Summary
This meta-analysis of 60 controlled trials quantified the differential effects of individual fatty acids and carbohydrates on the total:HDL cholesterol ratio and serum lipid profiles, a more specific cardiovascular risk marker than LDL cholesterol alone. The findings revealed that replacing saturated and trans fatty acids with cis unsaturated fatty acids improved the ratio, whilst carbohydrate substitution for saturated fat did not change the ratio but increased fasting triacylglycerols. Individual saturated fatty acids showed markedly different effects on the ratio, with lauric acid improving it despite raising total cholesterol, whilst myristic and palmitic acids had minimal impact.
Regional applicability
The findings from this international meta-analysis are applicable to United Kingdom dietary guidance and cardiovascular disease prevention strategy, particularly for refined understanding of how fat composition (rather than total fat amount) influences cholesterol biomarkers. The work directly informed evidence-based recommendations on replacing trans and saturated fats with cis unsaturated fats, which remain current in UK nutrition policy.
Key measures
Total:HDL cholesterol ratio, total cholesterol, HDL cholesterol, LDL cholesterol, fasting triacylglycerol concentrations, effects of saturated, monounsaturated, polyunsaturated, trans, and individual fatty acids (lauric, myristic, palmitic, stearic)
Outcomes reported
The meta-analysis evaluated how individual fatty acids and carbohydrates affect the ratio of total to HDL cholesterol and serum lipoprotein profiles across 60 controlled trials. Specific lipid outcomes included total cholesterol, HDL cholesterol, LDL cholesterol, and fasting triacylglycerol concentrations.
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