Table 1.

Authoritative recommendations for saturated fat and evidence ratings

Recommendation			Evidence rating
2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk	NHLBI grade	NHLBI evidence statements	ACC/AHA COR	ACC/AHA COR
Aim for a dietary pattern that achieves 5%–6% of calories from SFA	A (strong)*	Evidence statement 11 – strength of evidence: high†	I‡	A§
Reduce per cent of calories from SFA	A (strong)*	Evidence statement 11 – strength of evidence: high†	I‡	A§

2015 National Lipid Association recommendations for patient-centred management of dyslipidaemia: part 2	Grade	Strength of recommendation
Dietary SFA may be partially replaced with unsaturated fats (MUFA and PUFA), as well as proteins, to reach a goal of <7% of energy from SFA.	A*	Moderate¶

Scientific report of the 2015 Dietary Guidelines Advisory Committee	DGAC grade
Strong and consistent evidence from RCTs and statistical modelling in prospective cohort studies shows that replacing SFA with PUFA reduces the risk of CVD events and coronary mortality.	Strong**

2016 ESC/EAS guidelines for the management of dyslipidaemias	Magnitude of the effect	Level of evidence
For SFA, consumption should be <10% of the total caloric intake and should be further reduced (<7% of energy) in the presence of hypercholesterolaemia.	+++††	A‡‡

Strength of recommendation – strong: there is high certainty, based on evidence, that the net benefit is substantial.

Evidence Statement 11: when food was supplied to adults in a dietary pattern that achieved a macronutrient composition of 5%–6% saturated fat, 26%–27% total fat, 15%–18% protein and 55%–59% carbohydrate compared with the control diet (14%–15% saturated fat, 34%–38% total fat, 13%–15% protein and 48%–51% carbohydrate), LDL-C was lowered 11–13 mg/dL in two studies and 11% in another study. Strength of evidence: high.

Classification of recommendation (COR): class I: benefit >>> risk; procedure/treatment should be performed/administered.

Level of evidence: level A: multiple populations evaluated; data derived from multiple randomised clinical trials or meta-analyses.

RCTs with minor limitations affecting confidence in, or applicability of, the results. Well-designed, well-executed non-randomised controlled studies and well-designed, well-executed observational studies. Well-conducted meta-analyses of such studies. Moderately certain about the estimate of effect; further research may have an impact on our confidence in the estimate of effect and may change the estimate.

+++ – Marked effects.

Level of evidence – A: data derived from multiple randomised clinical trials or meta-analyses.

ACC, American College of Cardiology; AHA, American Heart Association; COR, Classification of recommendation; CVD, cardiovascular disease; DGAC, Dietary Guidelines Advisory Committee; EAS, European Atherosclerosis Society; ESC, European Society of Cardiology; LDL-C, low-density lipoprotein-cholesterol; MUFA, monounsaturated fatty acid; NHLBI, National Heart, Lung, and Blood Institute; PUFA, polyunsaturated fatty acid; RCT, randomised controlled trial; SFA, Saturated fatty acid.