Table 1.
The effect of replacing saturated fat with other macronutrients on Lp(a) and low-density lipoprotein cholesterol (LDL-C).
| Study | Design | Study Duration | Participants | N | Test Diets | Macronutrient Profiles of the Test Diets 1 | Lp(a) mg/dL (Mean ± SEM) | LDL-C (Measured) mg/Dl (Mean ± SEM) |
SFA Replacement Effect Summary | |||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CHO | PRO | Total Fat | SFA | MUFA | PUFA | |||||||||
| Ginsberg et al. 1998 (USA) DELTA 1 [80] | 4-site multicenter, randomized, 3 period crossover, controlled feeding trial | 8-week diet periods (4–6 washout) | Normolipidemic, aged 22–65 years; 55% women (30% black; 32% postmenopausal) and 45% men (20% black) | 103 | AAD | 48 | 15 | 34.3 | 15.0 | 12.8 | 6.5 | 15.5 ± 1.8 a | 131.4 ± 2.7 2,a | SFA→CHO: ↑ Lp(a) ↓LDL-C |
| Step 1 | 55 | 15 | 28.6 | 9 | 12.9 | 6.7 | 17.0 ± 1.8 b | 122.2 ± 2.6 2,b | ||||||
| Low-SFA | 59 | 15 | 25.3 | 6.1 | 12.4 | 6.7 | 18.2 ± 1.9 c | 116.9 ± 2.6 2,c | ||||||
| Berglund et al. 2007 (USA) DELTA 2 [81] | 4-site multicenter, randomized, 3 period crossover, controlled feeding trial | 7-week diet periods (4–6 washout) | Low HDL-C, moderately elevated triglycerides and insulin;aged 21–65 years; 39% women (18% black) and 61% men (8% black) | 85 | AAD | 49 | 15.3 | 35.8 | 15.6 | 14.4 | 5.8 | 9.9 ± 1.4 a | 128 ± 3.1 a | SFA→CHO: ↑ Lp(a) ↓LDL-C SFA→MUFA: ↑ Lp(a) ↓LDL-C |
| MUFA | 48.8 | 15.5 | 35.7 | 8.7 | 20.8 | 6.2 | 11.0 ± 1.5 b | 120 ± 3.1 b | ||||||
| Step 1 | 54.9 | 16.1 | 29 | 8 | 15.5 | 5.5 | 11.9 ± 1.6 b | 119 ± 3.1 b | ||||||
| Clevidence et al. 1997 (USA) [82] | Randomized, 4 period, crossover, controlled feeding trial | 6-week diet periods (no washout) | 80–120% of desirable BMI; aged 25–65 years; total cholesterol 50th–75th percentile; HDL-C > 35 mg/dl (men) or >40 mg/dL (women) | 58 | SFA | 45 | 15 | 40 | 19.3 4 | 10.9 5 | 6.1 6 | 21.9 ± 0.4 a | 141 ± 9.3 2,a | SFA→MUFA: ↑ Lp(a) ↓LDL-C |
| Oleic | 46 | 15 | 39 | 13.4 4 | 16.7 5 | 6.1 6 | 23.8 ± 0.4 b | 129 ± 9.3 2,b | ||||||
| Moderate trans fat 7 | 46 | 15 | 39 | 13.0 4 | 14.1 5 | 6.0 6 | 23.8 ± 0.4 b | 137 ± 9.3 2,c | ||||||
| High trans fat 8 | 46 | 15 | 39 | 12.7 4 | 11.4 5 | 6.2 6 | 24.7 ± 0.4 b | 139 ± 9.3 2,a,c | ||||||
| Mensink et al. 1992 (The Netherlands) Experiment 1 [85] | 2 group parallel, controlled feeding trial | 17 days–control run-in diet 36 days–MUFA or PUFA |
Young, normolipidemic (mean total cholesterol 193 ± 31 mg/dL), non-obese (mean BMI 21.6 ± 2.0 kg/m2) students | 58 | High SFA (control) | 48–49 | 13 | 36.7 | 19.3 | 11.5 | 4.6 | Pre MUFA: 8.4 (0–34.0) 9 Pre PUFA: 3.7 (0–23.5) 9 |
Pre MUFA: 128 ± 29 2,3 Pre PUFA: 129 ± 26 2,3 |
SFA→MUFA: ←→ Lp(a) ↓LDL-C SFA→PUFA: ←→ Lp(a) ↓LDL-C |
| 29 | MUFA | 48–49 | 13 | 37.4 | 12.9 | 15.1 | 7.9 | 9.1 (0–33.6) 9 | 104 ± 26 2,3,a | |||||
| 29 | PUFA | 48–49 | 13 | 37.6 | 12.6 | 10.8 | 12.7 | 4.0 (0–24.0) 9 | 111 ± 23 2,3,b | |||||
| Mensink et al. 1992 (The Netherlands) Experiment 2 [85] |
Randomized, 3 period, crossover, controlled feeding trial | 3-week diet periods (washout not reported) | Mean total cholesterol 184 ± 31 mg/dL; Mean BMI 21.5 ± 2.1 kg/m2 | 59 | SFA | 46 | 13–14 | 38.8 | 19.4 | 14.7 | 3.4 | 2.6 (0–44.7) 9,a | 121 ± 22 2,3,a | SFA→MUFA: ↑ Lp(a) ↓LDL-C |
| Oleic acid 10 | 46 | 13–14 | 39.6 | 9.5 | 24.1 | 4.6 | 3.2 (0–48.4) 9,b | 103 ± 21 2,3,b | ||||||
| Trans fat | 46 | 13–14 | 40.2 | 10.0 | 13.3 | 4.6 | 4.5 (0–51.0) 9,c | 118 ± 24 2,3c | ||||||
| Mensink et al. 1992 (The Netherlands) Experiment 3 [85] |
Randomized, 3 period, crossover, controlled feeding trial | 3-week diet periods (washout not reported) | Mean total cholesterol 195 ± 25 mg/dL; Mean BMI 22.0 ± 2.3 kg/m2 | 56 | Stearate | 44–47 | 12–13 | 43.5 | 20.1 (11.8 stearic acid) | 16.3 | 4.3 | 6.9 (0–74.9) 9,a | 116 ± 27 2,3,a | SFA→PUFA: ←→ Lp(a) ↓LDL-C |
| Linoleate | 44–47 | 12–13 | 41.1 | 11.0 (2.8 stearic acid) | 15.7 | 12.5 | 6.9 (0–78.2) 9,a | 109 ± 24 2,3,b | ||||||
| Trans fat 11 | 44–47 | 12–13 | 39.7 | 10.3 (3.0 stearic acid) | 15.6 | 3.8 | 8.5 (0–89.1) 9,b | 119 ± 25 2,3,a | ||||||
| Muller et al. 2003 (Norway) [83,84] | Randomized, 3 period, crossover, controlled feeding trial | 3-week diet periods (1-week washout) | Female students, aged 31 ± 10, BMI 24.5 ± 3.2 kg/m2 | 25 | High saturated fat | 46.7 | 14.9 | 38.4 | 22.7 12 | 5.5 | 3.9 | 31.6 ± 48.7 3,a | 124 ± 30 2,3,a | SFA 12→MUFA/PUFA: ↑ Lp(a) ↓LDL-C SFA 12→CHO: ←→ Lp(a) ←→ LDL-C |
| Low saturated fat | 63.8 | 16.5 | 19.7 | 10.5 12 | 3.5 | 2.3 | 34.0 ± 49.3 3,a,b | 121 ± 26 2,3,a | ||||||
| High MUFA/PUFA | 46.8 | 15 | 38.2 | 2.4 12 | 14.1 | 15.6 | 35.8 ± 51.5 3,b | 97 ± 25 2,3,b | ||||||
1. Percentage of total kcal, unless otherwise stated, 2. Calculated LDL-C (Friedewald equation) or method not reported, 3. Standard deviation, 4. Lauric + myristic + palmitic + stearic acids only, 5. Oleic acid only, 6. Linoleic acid only, 7. Contains 3.8% kcal from trans fat, 8. Contains 6.6% kcal from trans fat, 9. Median (range), 10. Trans oleic acid 10.9% kcal, 11. Trans oleic acid 7.7% kcal, 12. Only C12:0, C14:0, C16:0 (from coconut oil), *Different vs. baseline (or run-in), LDLreal is LDL-C minus Lp(a) and IDL, For a study, values with differing superscript letters for an outcome are statistically different (p < 0.05). Abbreviations: AAD Average American Diet; BMI body mass index; CHO carbohydrate; HDL-C high density lipoprotein cholesterol; Lp(a) lipoprotein(a); LDL-C low-density lipoprotein cholesterol; MUFA monounsaturated fatty acids; PRO protein; PUFA polyunsaturated fatty acids; SFA saturated fatty acids