WHO draft guidelines on dietary saturated and trans fatty acids: time for a new approach?

The 2018 WHO draft guidance on fatty acids fails to consider the importance of the food matrix, argue Arne Astrup and colleagues.

Key messages

• The 2018 WHO draft guidelines on dietary saturated fatty acids and trans fatty acids recommend reducing total intake of saturated fat and replacing it with polyunsaturated and monounsaturated fatty acids
• The recommendations fail to take into account considerable evidence that the health effects of saturated fat varies depending on the specific fatty acid and on the specific food source
• Maintaining general advice to reduce total saturated fatty acids will work against the intentions of the guidelines and weaken their effect on chronic disease incidence and mortality
• A food based translation of the recommendations for saturated fat intake would avoid unnecessary reduction or exclusion of foods that are key sources of important nutrients

Non-communicable diseases are the world’s leading cause of death, responsible for 72% of the 54.7 million deaths in 2016.1 Cardiovascular diseases are responsible for approximately 45% of all deaths from non-communicable diseases, with modifiable risk factors such as diet, physical activity, smoking, and alcohol intake being major causes of disease.

Among dietary factors, the World Health Organization considers saturated fatty acids and trans fatty acids to be important. Consensus exists on the health benefits of eliminating industrially produced trans fatty acids—that it will reduce incidence of cardiovascular disease and mortality.2 Foods containing more than 2% total fat as trans fat were banned in Denmark in 2004, and similar legislation is soon to be implemented throughout the European Union. In the United States the Food and Drug Administration no longer considers industrial trans fats to be “generally regarded as safe.”

Many governments consider WHO dietary guidelines to be state of the art scientific evidence, translating them into regional and national dietary recommendations. These guidelines have potential health implications for billions of people, so the consistency of the science behind such recommendations and the validity of the conclusions are crucial. Here, we look at the evidence linking saturated fat intake and cardiovascular risk and find that the WHO draft guidelines have excluded some important aspects and studies.

doi: https://doi.org/10.1136/bmj.l4137 (Published 03 July 2019)  BMJ 2019;366:l4137