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Systematic Review

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Clinical Outcomes of Dietary Replacement of Saturated Fatty Acids with Unsaturated Fat Sources in Adults with Overweight and Obesity: A Systematic Review and Meta-Analysis of Randomized Control Trials

Hannon B.A.a · Thompson S.V.a · An R.a · Teran-Garcia M.a, b

Author affiliations

aDivision of Nutritional Sciences, and bHispanic Health Programs, Department of Human Development and Family Studies, Division of Nutritional Sciences, Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, USA

Corresponding Author

Margarita Teran-Garcia, MD, PhD

University of Illinois at Urbana-Champaign

904 W. Nevada

2005 Christopher Hall, Urbana, IL 61801 (USA)

E-Mail teranmd@illinois.edu

Related Articles for ""

Ann Nutr Metab 2017;71:107-117

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Background: Obesity and dyslipidemia are frequently treated with dietary interventions before pharmacotherapy is given. Diets high in unsaturated fat have proven advantageous to disease treatment. Aims: The purpose of this systematic review and meta-analysis was to assess the evidence of the effect of saturated fatty acids (SFA) replacement with unsaturated fatty acids (UFA) in metabolically healthy adults with overweight and obesity on markers of dyslipidemia and body composition. Methods: Keyword search was performed in PubMed, CINAHL, and Cochrane Library for randomized controlled trials (RCTs) evaluating the effects of fatty acid substitution in adults with overweight and obesity. Meta-analysis was performed on interventions assessing lipoprotein levels and body composition. Publication bias was assessed by funnel plot inspection, Begg's, and Egger's test. Results: Eight RCTs enrolling 663 participants were included in the review, with intervention durations between 4 and 28 weeks. Although nonsignificant (p = 0.06), meta-analysis found UFA replacement to reduce total cholesterol concentrations by 10.68 mg/dL (95%CI -21.90 to 0.53). Reductions in low-density lipoprotein cholesterol and triglycerides were statistically nonsignificant. Conclusions: Due to null results and a small number of studies included, there is no strong evidence that replacement of SFA with UFA may benefit lipid profiles in this population.

© 2017 S. Karger AG, Basel


  1. Flegal KM, Carroll MD, Kit BK, Ogden CL: Prevalence of obesity and trends in the distribution of body mass index among us adults, 1999-2010. JAMA 2012;307:491-497.
  2. Fierabracci P, Tamberi A, Santini F: Obesity-Related Comorbidities; Minimally Invasive Bariatric and Metabolic Surgery. 2015, pp 25-34.
  3. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, de Ferranti S, Després JP, Fullerton HJ, Howard VJ, Huffman MD, Judd SE, Kissela BM, Lackland DT, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Matchar DB, McGuire DK, Mohler ER, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Willey JZ, Woo D, Yeh RW, Turner MB: Heart Disease and Stroke Statistics-2015 Update. A Report From the American Heart Association, 2014.
  4. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults: Executive summary of the third report of the national Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA 2001;285:2486-2497.
  5. Vernarelli JA, Mitchell DC, Rolls BJ, Hartman TJ: Dietary energy density is associated with obesity and other biomarkers of chronic disease in US adults. Eur J Nutr 2015;54:59-65.
  6. Schelbert KB: Comorbidities of obesity. Primary Care 2009;36:271-285.
  7. DeSalvo KB, Olson R, Casavale KO: Dietary guidelines for Americans. JAMA 2016;315:457-458.
    External Resources
  8. Jakicic JM, Lee IM, Smith Jr SC, Lichtenstein AH, Svetkey LP, Millen BE, Yanovski SZ: American Heart Association/American College of Cardiology Guideline on Lifestyle Management to Reduce Cardiovascular Risk, 2013.
  9. Eckel RH, Jakicic JM, Ard JD, de Jesus JM, Houston Miller N, Hubbard VS, Lee IM, Lichtenstein AH, Loria CM, Millen BE, Nonas CA, Sacks FM, Smith SC Jr, Svetkey LP, Wadden TA, Yanovski SZ: 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014;63:2960-2984.
  10. Sofi F, Abbate R, Gensini GF, Casini A: Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis. Am J Clin Nutr 2010;92:1189-1196.
  11. Salehi-Abargouei A, Maghsoudi Z, Shirani F, Azadbakht L: Effects of dietary approaches to stop hypertension (DASH)-style diet on fatal or nonfatal cardiovascular diseases-Incidence: a systematic review and meta-analysis on observational prospective studies. Nutrition 2013;29:611-618.
  12. Sofi F, Macchi C, Abbate R, Gensini GF, Casini A: Mediterranean diet and health status: An updated meta-analysis and a proposal for a literature-based adherence score. Public Health Nutr 2014;17:2769-2782.
  13. Peou S, Milliard-Hasting B, Shah SA: Impact of avocado-enriched diets on plasma lipoproteins: a meta-analysis. J Clin Lipidol 2016;10:161-171.
  14. Muller H, Lindman AS, Brantsaeter AL, Pedersen JI: The serum LDL/HDL cholesterol ratio is influenced more favorably by exchanging saturated with unsaturated fat than by reducing saturated fat in the diet of women. J Nutr 2003;133:78-83.
    External Resources
  15. Hooper L, Martin N, Abdelhamid A, Davey Smith G: Reduction in saturated fat intake for cardiovascular disease. Cochrane Database Syst Rev 2015;10:6:CD011737.
  16. Smart NA, Marshall BJ, Daley M, Boulos E, Windus J, Baker N, Kwok N: Low-fat diets for acquired hypercholesterolaemia. Cochrane Database Syst Rev 2011;2:CD007957.
  17. Rey-Lopez JP, de Rezende LF, de Sa TH, Stamatakis E: Is the metabolically healthy obesity phenotype an irrelevant artifact for public health? Am J Epidemiol 2015;182:737-741.
  18. Ferrer R, Pardina E, Rossell J, Oller L, Vinas A, Baena-Fustegueras JA, Lecube A, Vargas V, Balibrea JM, Caubet E, Gonzalez O, Vilallonga R, Fort JM, Peinado-Onsurbe J: Morbidly “healthy” obese are not metabolically healthy but less metabolically imbalanced than those with type 2 diabetes or dyslipidemia. Obes Surg 2015;25:1380-1391.
  19. Obesity: Preventing and Managing the Global Epidemic. World Health Organization, 2000.
  20. Makris A, Foster GD: Dietary approaches to the treatment of obesity. Psychiatr Clin North Am 2011;34:813-827.
  21. Bjermo H, Iggman D, Kuliberg J, Dahlman I, Johansson L, Persson L, Berglund J, Pulkki K, Basu S, Uusitupa M, Rudling M, Arner P, Cederholm T, Ahlstwm H, Risãrus U: Effects of n-6 PUFAs compared with SFAs on liver fat, lipoproteins, and inflammation in abdominal obesity: a randomized controlled trial. Am J Clin Nutr 2012;95:1003-1012.
  22. Uusitupa M, Schwab U, Mäkimattila S, Karhapää P, Sarkkinen E, Maliranta H, Agren J, Penttilä I: Effects of two high-fat diets with different fatty acid compositions on glucose and lipid metabolism in healthy young women. Am J Clin Nutr 1994;59:1310-1316.
    External Resources
  23. Rasmussen LG, Larsen TM, Mortensen PK, Due A, Astrup A: Effect on 24-h energy expenditure of a moderate-fat diet high in monounsaturated fatty acids compared with that of a low-fat, carbohydrate-rich diet: a 6-mo controlled dietary intervention trial. Am J Clin Nutr 2007;85:1014-1022.
    External Resources
  24. Roche HM, Zampelas A, Jackson KG, Williams CM, Gibney MJ: The effect of test meal monounsaturated fatty acid: saturated fatty acid ratio on postprandial lipid metabolism. Br J Nutr 1998;79:419-424.
  25. Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group: Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009;6:e1000097.
  26. Ogden CL, Carroll MD, Kit BK, Flegal KM: Prevalence of obesity and trends in body mass index among US children and adolescents, 1999-2010. JAMA 2012;307:483-490.
  27. Waist Circumference and Waist-Hip Ratio. Report of a WHO Expert Consultation. Geneva, World Health Organization, 2008, pp 8-11.
  28. Littell JH: Lessons from a systematic review of effects of multisystemic therapy. Child Youth Serv Rev 2005;27:445-463.
    External Resources
  29. Rugge B, Balshem H, Sehgal R, Relevo R, Gorman P, Helfand M: Screening and Treatment of Subclinical Hypothyroidism or Hyperthyroidism. Agency for Healthcare Research and Quality (US), 2011.
    External Resources
  30. Kriketos AD, Robertson RM Sharp TA, Drougas H, Reed GW, Storlien LH, Hill JO: Role of weight loss and polyunsaturated fatty acids in improving metabolic fitness in moderately obese, moderately hypertensive subjects. J Hypertens 2001;19:1745-1754.
  31. Moreira Alves RD, Boroni Moreira AP, Macedo VS, Bressan J, de Cassia Goncalves Alfenas R, Mattes R, Brunoro Costa NM: High-oleic peanuts: new perspective to attenuate glucose homeostasis disruption and inflammation related obesity. Obesity (Silver Spring) 2014;22:1981-1988.
  32. Higgins JP, Green S: Cochrane Handbook for Systematic Reviews of Interventions. Wiley Online Library, 2008.
  33. Wu S, Cohen D, Shi Y, Pearson M, Sturm R: Economic analysis of physical activity interventions. Am J Prev Med 2011;40:149-158.
  34. Krauss RM, Blanche PJ, Rawlings RS, Fernstrom HS, Williams PT: Separate effects of reduced carbohydrate intake and weight loss on atherogenic dyslipidemia. Am J Clin Nutr 2006;83:1025-1031.
    External Resources
  35. Piers LS, Walker KZ, Stoney RM, Soares MJ, O'Dea K: Substitution of saturated with monounsaturated fat in a 4-week diet affects body weight and composition of overweight and obese men. Br J Nutr 2003;90:717-727.
  36. Noakes M, Clifton PM: Changes in plasma lipids and other cardiovascular risk factors during 3 energy-restricted diets differing in total fat and fatty acid composition. Am J Clin Nutr 2000;71:706-712.
    External Resources
  37. Bos MB, de Vries JH, Feskens EJ, van Dijk SJ, Hoelen DW, Siebelink E, Heijligenberg R, de Groot LC: Effect of a high monounsaturated fatty acids diet and a Mediterranean diet on serum lipids and insulin sensitivity in adults with mild abdominal obesity. Nutr Metab Cardiovas 2010;20:591-598.
  38. Hartwich J, Mm M, Partyka L, Pérez-Martinez P, Marin C, López-Miranda J, Ac T, McMonagle J, Hm R, Defoort C, Wolkow P, Dembinska-Kiec A: The effect of the plasma n-3/n-6 polyunsaturated fatty acid ratio on the dietary LDL phenotype transformation - insights from the LIPGENE study. Clin Nutr 2009;28:510-515.
  39. Kriketos AD, Robertson RM, Sharp TA, Drougas H, Reed GW, Storlien LH, Hill JO: Role of weight loss and polyunsaturated fatty acids in improving metabolic fitness in moderately obese, moderately hypertensive subjects. J Hypertens 2001;19:1745-1754.
  40. van Dijk SJ, Feskens EJ, Bos MB, Hoelen DW, Heijligenberg R, Bromhaar MG, de Groot LC, de Vries JH, Muller M, Afman LA: A saturated fatty acid-rich diet induces an obesity-linked proinflammatory gene expression profile in adipose tissue of subjects at risk of metabolic syndrome. Am J Clin Nutr 2009;90:1656-1664.
  41. Kris-Etherton PM, Yu S: Individual fatty acid effects on plasma lipids and lipoproteins: Human studies. Am J Clin Nutr 1997;65:1628s-1644s.
    External Resources
  42. Hooper L, Martin N, Abdelhamid A, Davey Smith G: Reduction in saturated fat intake for cardiovascular disease. Cochrane Database Syst Rev 2015;10:6:CD011737.
  43. Schwingshackl L, Strasser B, Hoffmann G: Effects of monounsaturated fatty acids on cardiovascular risk factors: a systematic review and meta-analysis. Ann Nutr Metab 2011;59:176-186.
  44. Davis C, Bryan J, Hodgson J, Murphy K: Definition of the mediterranean diet; a literature review. Nutrients 2015;7:9139-9153.
  45. Kastorini CM, Milionis HJ, Esposito K, Giugliano D, Goudevenos JA, Panagiotakos DB: The effect of mediterranean diet on metabolic syndrome and its components: a meta-analysis of 50 studies and 534,906 individuals. J Am Coll Cardiol 2011;57:1299-1313.
  46. Fernandez ML, West KL: Mechanisms by which dietary fatty acids modulate plasma lipids. J Nutr 2005;135:2075-2078.
    External Resources
  47. Teran-Garcia M, Rufo C, Nakamura MT, Osborne TF, Clarke SD: NF-Y involvement in the polyunsaturated fat inhibition of fatty acid synthase gene transcription. Biochem Biophys Res Commun 2002;290:1295-1299.
  48. Brousseau ME, Ordovas JM, Osada J, Fasulo J, Robins SJ, Nicolosi RJ, Schaefer EJ: Dietary monounsaturated and polyunsaturated fatty acids are comparable in their effects on hepatic apolipoprotein mRNA abundance and liver lipid concentrations when substituted for saturated fatty acids in cynomolgus monkeys. J Nutr 1995;125:425-436.
    External Resources
  49. Wadden TA, Webb VL, Moran CH, Bailer BA: Lifestyle modification for obesity: New developments in diet, physical activity, and behavior therapy. Circulation 2012;125:1157-1170.
  50. Trumbo P, Schlicker S, Yates AA, Poos M: Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein and amino acids. J Am Diet Assoc 2002;102:1621-1630.
    External Resources
  51. Dombrowski SU, Knittle K, Avenell A, Araújo-Soares V, Sniehotta FF: Long term maintenance of weight loss with non-surgical interventions in obese adults: systematic review and meta-analyses of randomised controlled trials. BMJ 2014;348:g2646.
  52. Naude CE, Schoonees A, Senekal M, Young T, Garner P, Volmink J: Low carbohydrate versus isoenergetic balanced diets for reducing weight and cardiovascular risk: a systematic review and meta-analysis. PLoS One 2014;9:e100652.
  53. Ioannidis JP: We need more randomized trials in nutrition-preferably large, long-term, and with negative results. Am J Clin Nutr 2016;103:1385-1386.

Article / Publication Details

First-Page Preview
Abstract of Systematic Review

Received: August 15, 2016
Accepted: May 02, 2017
Published online: July 29, 2017
Issue release date: September 2017

Number of Print Pages: 11
Number of Figures: 3
Number of Tables: 4

ISSN: 0250-6807 (Print)
eISSN: 1421-9697 (Online)

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