Table 3.

Fat

Macronutrient	Source and quality	Summary
Fats	Animal and plant Sources of animal fat include fish, poultry, meat and dairy (including butter, cream and cheese). Eggs are not listed here due to their low fat content. The fatty acid profile can be affected by what the animal has been fed. Grass fed beef tends to have a lower total fat content than grain-fed beef. Fatty fish (mackerel, salmon, sardines, herring and trout contain the n3 polyunsaturated fats eicosapentaenoic acid and docosahexaenoic acid). Meat can also vary substantially regarding total and saturated fat content. Sources of plant fat include nuts and seeds, and vegetables (including oils). The fatty acid profile of oils varies hugely. Oils high in n6 polyunsaturated fats include soybean, sunflower, safflower and walnut. Oils that contain more n3 polyunsaturated fats include flaxseed, walnut and rapeseed. Olive oil contains predominantly n9 monounsaturated fats. Coconut oil (a plant-based oil) contains predominantly saturated fat.	Acknowledgement of the source is vital, especially considering saturated and polyunsaturated fats. The effect of reducing saturated fat on cardiovascular outcomes is greater when baseline saturated fat is high and the intervention diet leads to a greater decrease in saturated fat and TC.20 Reducing saturated fat and replacement with unsaturated fats appears to convey the greatest cardiovascular benefit.20 Industrial trans fats (found in pastries, cakes and deep fried foods) should be avoided as they are associated with increased total mortality.21 Increasing consumption of n6 fatty acids appears to reduce the risk of MI and lower TC but has no significant effect on other cardiovascular outcomes such as CVD events, CHD events or stroke.22 Reducing saturated fat and increasing marine polyunsaturated fats (specifically the n3 eicosapentaenoic acid and docosahexaenoic acid) is associated with decreased total and all-cause mortality.21 Practical advice around this is to encourage individuals to increase consumption of oily fish (fresh or tinned). There appears no benefit from consuming n3 supplements for the prevention of fatal CVD, largely due to the dose of eicosapentaenoic acid and docosahexaenoic acid not being high enough for any substantial benefit on reducing CVD or fatal CHD.23 Higher, purified doses of eicosapentaenoic acid do result in reductions in cardiovascular death[24] and the effect is likely due to a pleiotropic action of eicosapentaenoic acid (lipid lowering, anti-inflammatory, antiplatelet and antithrombotic actions). Based on meta-analyses, replacement of saturated fat with unsaturated fat appears to convey to greatest benefit for cardiovascular health. However, similar to protein and carbohydrate, manipulation of dietary fat and its constituents (saturated, monounsaturated and polyunsaturated) must acknowledge the source of these nutrients when focusing on cardiovascular health.

CHD, coronary heart disease ; CVD, cardiovascular disease; MI, myocardial infarction; TC, total cholesterol.