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In March 2014, an article appeared in the Annals of Internal Medicine that sent the food-obsessed public into gastronomic raptures. The Annals article, and the subsequent news coverage, set off a national conversation about dietary fat. Keys had made a name for himself during World War II by developing the K ration, and after the war turned his attention to the relationship between diet and health, particularly heart disease. Keys also conducted controlled feeding studies, in parallel with the HSPH Department of Nutrition’s Mark Hegsted, which showed that polyunsaturated fats (the kind found just in plants) reduced blood cholesterol levels. In 1997, HSPH’s Frank Hu—at the time a postdoctoral fellow at HSPH, now professor of nutrition and epidemiology— published a landmark epidemiological study in the New England Journal of Medicine. It was against this backdrop that the 2014 Annals of Internal Medicine study created such a stir. As Willett and Hu saw it, the glaring problem in the article was one of the findings: that replacing saturated fat with polyunsaturated fat does not necessarily reduce your risk for heart disease.
Researchers say we should focus on healthy dietary patterns, rather than glorify or demonize specific nutrients. Complicated questions about diet and health require evidence from many different types of studies over many years before the weight of evidence shifts toward consensus.
The 2014 Annals of Internal Medicine study on saturated fat raised questions about the growing use of meta-analyses in scientific research.
Compounding the problem is the fact that dietary advice, even from august bodies like the National Institutes of Health (NIH), can lag the scientific evidence.
Though saddled with a drab title—“Association of Dietary, Circulating and Supplement Fatty Acids with Coronary Risk”—the article reported a seemingly stunning result: eating less saturated fat, the dietary demon that makes buttery croissants so irresistible, doesn’t actually lower a person’s risk for heart disease.

Indeed, there is debate within the scientific community itself over how important it is to focus on certain types of dietary fat—and that debate existed long before the Annals article appeared.
The fact is, not all fats are bad, and concentrating too much on eliminating “fat” from our diets has, in many cases, led us to replace even healthy fats with sugars and other simple carbohydrate foods that may actually be worse for our health. Instead, doctors and scientists running the National Heart, Lung and Blood Institute’s National Cholesterol Education Program in the mid-1980s decided to simplify it, explains Lilian Cheung, director of health promotion and communication in the HSPH Department of Nutrition. What we eat should be whole, minimally processed, nutritious food—food that is in many cases as close to its natural form as possible. The article discussed the results of a “meta-analysis,” a type of statistical analysis that gathers data from many different studies and crunches them together.
He requested a data supplement from the journal and noticed that the authors had pulled incorrect numbers from some of the original studies, including the long-running Nurses’ Health Study, which Willett helps direct. He believes that the evidence indicates that, compared to the average diet consumed by Americans, polyunsaturated fat is more beneficial to heart health than any other major macronutrient. They replace it with something else, says Walter Willett, chair of the HSPH Department of Nutrition.
A healthy pattern includes heaps of fresh fruits and vegetables, whole grains, nuts, legumes, poultry, and fish. Willett says the analysis did not properly account for factors like the tendency of frail elderly people to lose weight (not healthy), smokers to be skinny (also not healthy), and people with serious diseases to lose weight before they die. The debate exists even among professional colleagues—and friends—within Harvard School of Public Health’s Department of Nutrition. In the early 1990s, Walter Willett, now chair of the HSPH Department of Nutrition, and others determined that trans fats—liquid vegetable oils transformed into shelf-stable solids (think Crisco)—were associated with greater risk of heart disease and are a double metabolic whammy, raising “bad” LDL and decreasing “good” HDL.

His data, collected from 80,082 women enrolled in the long-running Nurses’ Health Study—a collaboration by HSPH, Harvard Medical School, and Brigham and Women’s Hospital— suggested that replacing a mere 5 percent of saturated fat calories with unsaturated fat would reduce one’s risk of heart disease by a whopping 42 percent.
Saturated fat, on the other hand, turns out to be neutral from a heart health perspective when compared to the average diet—so that campaigns which prioritize reducing saturated fat consumption, rather than focusing on foods and overall diet quality, are a misplaced and misleading public health strategy.
The NIH’s Healthy Cooking and Snacking website suggests snacks to children and families like fat-free cheese on crackers and fat-free chocolate milk.
Scientists around the world simultaneously showed that saturated fat—the kind in butter and lard—increases both “bad” LDL cholesterol and “good” HDL cholesterol, making it similar to carbohydrates overall but not as beneficial to health as polyunsaturated fats from nuts and vegetables. The journal posted their letter online several days after publication and, subsequently, a version of the article in which some of the specific errors were corrected. Finally, omega-3 and omega-6 fatty acids are essential for many biological processes—from building healthy cells to maintaining brain and nerve function—and we should eat a variety of healthy foods, such as fish, nuts, seeds, and vegetable oils, to obtain adequate amounts of both fatty acids. Epidemiologists established large investigations like the Framingham Heart Study, monitoring people’s health for years. We’re not going to artificially create healthy diets by manufacturing low-fat, low-saturated-fat packaged foods.

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