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Dietary fat guidelines have no evidence base: where next for public health nutritional advice?
  1. Zoë Harcombe
  1. Correspondence to Dr Zoë Harcombe, Institute of Clinical Exercise and Health Science, University of the West of Scotland, Almada Street, Hamilton ML3 0JB, UK; zoe{at}theobesityepidemic.org

Abstract

Introduction National dietary guidelines were introduced in 1977 and 1983, by the US and UK governments, with the aim of reducing coronary heart disease (CHD) mortality. The 2 specific dietary fat recommendations were to reduce total fat and saturated fat consumption to 30% and 10% of total energy intake, respectively.

Methods 4 systematic reviews (3 with meta-analysis) were undertaken to examine the evidence for these dietary fat guidelines: (1) randomised controlled trial (RCT) and (2) prospective cohort (PC) evidence at the time the guidelines were introduced; and (3) RCT and (4) PC evidence currently available. This narrative review examines all evidence collated.

Results The RCT and PC evidence available to the dietary committees did not support the introduction of the dietary fat guidelines. The RCT and PC evidence currently available does not support the extant recommendations. Furthermore, the quality of the evidence is so poor that it could not be relied on had it provided support.

Conclusions Dietary fat guidelines have prevailed for almost 40 years. The evidence base at the time of their introduction has been examined for the first time and found lacking. Evidence currently available provides no additional support. Public health opinion differed when the guidelines were introduced. Opposition to the guidelines is becoming more strident. Substantial increases in diet-related illness over the past four decades, particularly obesity and type 2 diabetes, indicate that a review of dietary advice is warranted.

  • Epidemiology
  • Dietary
  • Public health
  • Heart disease
  • Randomised controlled trial

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Footnotes

  • Twitter Follow Zoe Harcombe at @zoeharcombe

  • Competing interests ZH receives income from writing and from two small self-employment businesses: The Harcombe Diet Co and Columbus Publishing.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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