Recommended Foods and Fats to Decrease Cardiovascular Disease Risk

Current dietary guidance recommends a healthy dietary pattern that meets food-based recommendations and targets for saturated fat (SFA, < 10% energy), sodium (< 2300 mg/day), and added sugars (< 10% energy).  There are many different healthy dietary patterns that meet these criteria and effectively lower risk of cardiometabolic diseases.  Over the years, dietary recommendations have evolved from specific nutrient targets to replacement messages (i.e., replace SFA with unsaturated fatty acids, mainly polyunsaturated fatty acids - PUFA).  Evidence demonstrates benefits of replacing SFA with PUFA, plant-based monounsaturated fat, carbohydrate from whole grains and plant-based proteins.  Current dietary recommendations focus on replacement messages for specific foods to achieve nutrient density and targets for nutrients of concern.  This new message is based on evidence showing increased risk of cardiometabolic diseases with increased consumption of red meats and decreased risk associated with seafood, nuts, fiber-rich whole grains, legumes, and plant-based protein foods.  Specific to SFA, the overarching message is to consume the leanest fat versions of foods containing SFA such as animal-based foods (i.e., meats and dairy products).  Replacement foods are sources of unsaturated fats (including seafood and nuts), fiber-rich whole grains and legumes and/or plant-based protein foods such as soy protein and nuts.   Dairy products and specifically full-fat versions are high in SFA; however, emerging evidence suggests that the food matrix of dairy products (i.e., cheese and yogurt) has either a neutral or possibly beneficial association with cardiometabolic diseases.  However, importantly, the replacement food seems to account for disease-related associations for dairy products.  Specifically, replacing dairy foods with plant-based foods (and specifically nuts) is associated with better cardiometabolic health and reduced risk of all-cause mortality.  Thus, replacing the major food sources of SFA with plant-based foods confers the greatest cardiometabolic benefits.