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Dietary Fat Quality for Optimal Health and Well-Being: Overview of Recommendations

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Dietary Fat Quality for Optimal Health and Well-Being: Overview of Recommendations

Abstract and Figures

A century ago, dietary fat was mainly seen as a source of energy. In 1929, George and Mildred Burr introduced the concept of essential fats: certain fats, i.e. linoleic acid and alpha-linolenic acid, need to be provided by the diet to prevent deficiencies. Although essential fats were initially considered of marginal nutritional importance for humans, clinical deficiency symptoms were recorded for the first time in the 1960s. Beyond the fact that essential fats can prevent deficiencies, research over the past decades has shown that they also play a major role in preventing chronic conditions such as cardiovascular diseases. This has resulted in an increased interest in the quality of the dietary lipid supply as a major determinant of long-term health and well-being, which is also reflected in recent diet guidelines. This paper will give an overview of key aspects of present recommendations on dietary fats.
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Basel
Freiburg
Paris
London
New York
Bangalore
Bangkok
Shanghai
Singapore
Tokyo
Sydney
Health Significance of
Fat Quality of the Diet
Expert Meeting
Barcelona, February 1–2, 2009
Guest Editors
R. Uauy, Santiago de Chile
P. Puska, Helsinki
14 figures, 2 in color, and 8 tables, 2009
ANM_2009_054_S01_tivo.indd 1ANM_2009_054_S01_tivo.indd 1 01.07.2009 14:41:5801.07.2009 14:41:58
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This International Expert Meeting on Health Significance of Fat
Quality of the Diet was held under the auspices of the International
Union of Nutrition Sciences and World Heart Federation. Both these
organisations have a partnership with Unilever. Copies of the mem-
oranda of understanding are available on request. The meeting was
sponsored by an unrestricted grant from Unilever.
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Vol. 54, Suppl. 1, 2009
Contents
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© 2009 S. Karger AG, Basel
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1 Preface
2 Dietary Fat Quality for Optimal Health and Well-Being: Overview of
Recommendations
Uauy, R. (London)
8 Dietary Fat Intake – A Global Perspective
Elmadfa, I.; Kornsteiner, M. (Vienna)
15 Foods with a High Fat Quality Are Essential for Healthy Diets
Zevenbergen, H.; de Bree, A.; Zeelenberg, M.; Laitinen, K.; van Duijn, G.; Flöter, E.
(Vlaardingen)
25 Consumer Perception and Insights on Fats and Fatty Acids:
Knowledge on the Quality of Diet Fat
Diekman, C. (St. Louis, Mo.); Malcolm, K. (Warwick)
33 Fat and Heart Disease: Yes We Can Make a Change – The Case of North
Karelia (Finland)
Puska, P. (Helsinki)
39 Summary Statement of the International Expert Meeting: Health
Significance of Fat Quality of the Diet. Barcelona, Spain, February 1–2, 2009
Diekman, C.; Elmadfa, I.; Koletzko, B.; Puska, P.; Uauy, R.; Zevenbergen, H.
41 List of Participants
42 Author Index/Subject Index
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Ann Nutr Metab 2009;54(suppl 1):1
DOI: 10.1159/000220820
Preface
This supplement of Annals of Nutrition and Metabolism contains the Pro-
ceedings of the International Expert Meeting (IEM) on Health Significance
of Fat Quality of the Diet, held on February 1–2, 2009, in Barcelona, Spain.
The year 2009 has started in a situation with global economic crisis, caus-
ing many changes in the societal landscape. For us in the health field, it is
critical to consider how to maintain and streng then good public healt h work.
Health is, indeed, of growing value to people and of increasing interest to so-
cieties, also for economic reasons.
Diet plays a critical role in obtaining and maintaining good health and it
is quite obvious that the quality of dietary fats is a crucial element in this. The
aim of the Barcelona IEM was to review:
(1) existing recommendations and guidelines on fats in order to update the
knowledge on health implications of the fat quality of the diet;
(2) the role of high-quality fat sources in contributing to achieving an optimal
fat quality of the diet;
(3) consumer perception and insights on fats and fatty acids in order to ana-
lyze what consumers actually know about fats and health, and
(4) current dietary fat intakes and evaluate whether they are in line with the
(inter)national recommendations for fats and fatty acids.
Furthermore, the goal was to agree on a statement, in which the experts
with input from other stakeholders such as health and communication pro-
fessionals and the food industry, call for concerted actions at all levels to guide
consumers in making healthier choices with respect to the fat quality of the
diet.
The IEM was organized under the auspices of the International Union of
Nutrition Sciences and the World Heart Federation and funded through an
unrestricted educational grant from Unilever.
We believe that the papers presented during the IEM and the summary
statement provide a global viewpoint on health significance of the fat quality
of the diet and hope that it will stimulate the discourse on fat in expert and
consumer forums from ‘eating less fat’ to ‘eating the right type of fat’.
M a r c h , 2 0 0 9
Ricardo Uauy , Pekka Puska
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Ann Nutr Metab 2009;54(suppl 1):2–7
DOI: 10.1159/000220821
Dietary Fat Quality for Optimal Health
and Well-Being:
Overview of Recommendations
Ricardo Uauy
Department of Public Health Nutrition, London School of Hygiene and Tropical Medicine, London , UK;
Instituto de Nutrición y Tecnología de los Alimentos, Universidad de Chile, Santiago , Chile
Introduction
Fats were traditionally considered part of dietary en-
ergy needs until George and Mildred Burr in 1929 intro-
duced the concept that fat might be necessary for the
proper growth and development of animals and possibly
humans. They proposed that linoleic acid (LA; 18:
2 n–6),
arachidonic acid (20:
4 n–6) and -LA (ALA; 18: 3 n–3) be
considered essential fatty acids (EFAs)
[1] . These were
considered of marginal nutritional importance for hu-
mans until the 1960s, when signs of clinical n–6 (omega–
6) EFA deficiency were first identified in infants given
skimmed milk with added coconut oil, providing limited
or absent EFAs, and later recorded in children and adults
given fat-free parenteral nutrition
[2, 3] . More subtle
symptoms appear in n–3 (omega–3) EFA deficiency in-
cluding skin changes unresponsive to LA supplementa-
tion, abnormal visual function and peripheral neuropa-
thy in subjects receiving high n–6, low n–3 fat sources in
their intravenous nutrition supply
[4] .
Over the past decades, the focus of lipid nutrition re-
search has shifted beyond the study of their role as essen-
tial nutrients for growth and skin health to encompass
the role of specific fatty acids (FAs) on cholesterol, lipo-
protein and glucose metabolism
[5, 6] . It is now well
Key Words
Cardiovascular diseases Dietary recommendations
Fat quality Health Lipids
Abstract
A century ago, dietary fat was mainly seen as a source of
energy. In 1929, George and Mildred Burr introduced the
concept of essential fats: certain fats, i.e. linoleic acid and -
linolenic acid, need to be provided by the diet to prevent
deficiencies. Although essential fats were initially consid-
ered of marginal nutritional importance for humans, clinical
deficiency symptoms were recorded for the first time in the
1960s. Beyond the fact that essential fats can prevent defi-
ciencies, research over the past decades has shown that they
also play a major role in preventing chronic conditions such
as cardiovascular diseases. This has resulted in an increased
interest in the quality of the dietary lipid supply as a major
determinant of long-term health and well-being, which is
also reflected in recent diet guidelines. This paper will give
an overview of key aspects of present recommendations on
dietary fats. Copyright © 200 9 S. Karger AG, Basel
Published online: $ $ $
Prof. Rica rdo Uauy, MD, PhD
INTA, Universidad de Chile
Casilla 138-11
Santiago (Chile)
Fax +56 2 221 4030, E -Mail uauy@inta.cl
© 2009 S. Ka rger AG, Basel
0250–6807/09/0545–0002$26.00/0
Accessible online at:
www.karger.com/anm
ANM157.indd 2ANM157.indd 2 01.07.2009 14:44:2601.07.2009 14:44:26
Fat Quality for Optimal Health Ann Nutr Metab 2009;54(suppl 1):2–7
3
established that the plasma concentration of low-densi-
ty-lipoprotein (LDL), very-low-density-lipoprotein and
high-density-lipoprotein (HDL) cholesterol and triglyc-
eride levels are related to the type and amount of FA in-
take
[7, 8] . More recently, evidence on the effect of FAs on
insulin sensitivity and glucose metabolism has emerged
[9] . The recognition that n–6 and n–3 EFA are precursors
to the formation of prostanoids, thromboxanes, leukotri-
enes and neuroprotectins, which in turn regulate key
physiologic functions (blood pressure, vessel stiffness/re-
laxation, thrombocyte aggregation, fibrinolytic activity,
inflammatory responses and leukocyte migration) has
added a further dimension to the potential consequences
of FAs for human health. Inflammation, vasoconstric-
tion, vasodilatation, blood pressure, bronchial constric-
tion, uterine contractil ity and reperfusion oxidative da m-
age have been demonstrated to be affected and poten-
tially regulated by n–3 and n–6 EFA or their endogenous
metabolic products
[10 –12] .
Interest in the quality of dietary lipid supply as a major
determinant of long-term health and well-being is pres-
ently growing. We clearly have to go beyond the tradi-
tional saturated and polyunsaturated classification that
yielded the polyunsaturated/saturated ratio or vegetable
versus animal fat division suggesting that animal fat was
bad and vegetable fats were good. The role of specific fats
which define fat quality and impact health must pres-
ently be considered by examining the effects of individu-
al FAs. The key descriptors for fat quality presently in-
clude: saturated FAs (SFAs: lauric, myristic, palmitic and
stearic acids); monounsaturated FAs (oleic); polyunsatu-
rated FAs [(PUFAs) of the n–6 (LA and arachidonic acid)
and n–3 (ALA, eicosapentaenoic acid, EPA, and docosa-
hexaenoic acid, DHA) series] and trans FAs (TFAs, elaid-
ic and conjugated trans LA). Thus recent national/inter-
national dietary fat and FA recommendations consider
the need to satisfy EFA needs, promote neurodevelop-
ment and cardiovascular health and prevent degenerative
diseases at all stages of the life course. The World Health
Organization (WHO) and the Food and Agriculture Or-
ganization of the United Nations (FAO) have provided
international recommendations for fats in human health
in 1978 and 1994
[13, 14] ; additionally, the WHO/FAO
expert group that met in 2002 to address nutrition and
the prevention of chronic diseases considered fat quality
as an important aspect of the preventive strategies (Tech-
nical Report Series 916)
[15, 16] . The WHO recently pro-
duced an update on TFAs in human nutrition
[17] , and a
new report on fat and FAs in human nutrition based on
expert consultation conducted late in 2008 is being edited
and will be published in the near future. The Barcelona
International Expert Meeting used existing national and
international recommendations for its deliberations.
Overview of the Present Knowledge and
Recommendations
Essential Fatty Acids
Present knowledge establishes a clear need for essen-
tial fats; these are the essential PUFAs, LAs and ALAs.
These should be considered essential and indispensable
since they cannot be synthesized by humans and must be
provided by the diet. Since DHA (22:
6 n–3) and arachi-
donic acid (20:
4 n–6) can be synthesized from ALA and
LA, respectively, they should be considered dispensable,
although a dietary supply may be necessary for long-term
health
[11, 18] . Given the limited and highly variable for-
mation of DHA from ALA (1–5%) and because of its crit-
ical role in normal retinal and brain development in the
human, DHA (as provided by human milk) should be
considered conditionally essential during early develop-
ment
[19 –22] . Similarly, DHA might be considered nec-
essary for life-long health considering intakes required
for the prevention of cardiovascular (CVDs) and other
chronic diseases
[10, 11] . Moreover, considering new
knowledge on the role of genetic polymorphisms
[(rs174575) FADS2 gene responsible for 6 desaturase ac-
tivity] – that might explain the variability in the capacity
to form DHA f rom dietary ALA by humans it is recom-
mended that preformed long-chain n–3 PUFAs (EPA +
DHA) be provided for optimal health at all stages of the
life course
[23, 24] . Infants and children from conception
to birth and throughout the life course need sufficient es-
sential fats of the n–6 and n–3 series in their diet to meet
their needs
[11, 25] . Breast milk as consumed normally
provides adequate amounts of these essential fats and ad-
equate amounts of DHA for normal development. After
breast feeding is completed, all chi ldren and adults should
secure an adequate intake of EFAs not only to meet needs
for normal growth and development but also sufficient to
promote optimal health and well-being. There is limited
and inconclusive evidence of the effect of fish oil (a good
source of EPA and DHA) on learning ability and behavior
among school-age children; studies are mostly limited to
children with neurodevelopmental disorders. Research is
needed to determine potential age-specific effects of n–3
PUFAs on depression, aggressiveness, mood swings, at-
tentiveness and learning of school children. The potential
impact on learning/behavior in school is of great social,
ANM157.indd 3ANM157.indd 3 01.07.2009 14:44:2901.07.2009 14:44:29
Uauy
Ann Nutr Metab 2009;54(suppl 1):2–7
4
public health and economic interest [Koletzko et al., pers.
commun.].
Fat Intake and Weight Maintenance
Ecological studies, including the recent publication by
Marantz et al.
[26] , show that emphasis on low-fat diets
has not resulted in a decreased trend of obesity. The effect
of the total fat content of the diet on health is mediated
by the quality of fat consumed rather than by the quan-
tity of fat consumed. Consumption of excess energy be-
yond energy needed for maintenance, growth and physi-
cal activity is responsible for excess body fat accumula-
tion independent of whether the energy is derived from
fat or carbohydrates. In addition, the fat and water con-
tents of foods are the main determinants of the energy
density of the diet. A lower consumption of energy-dense
(i.e. high-fat, high-sugars and high-starch) foods and en-
ergy-dense (i.e. high free sugars) drinks contributes to a
reduction in total energy intake. Conversely, a high in-
take of energy-dilute foods (i.e. vegetables and fruits) and
foods high in non-starch polysaccharide, e.g. wholegrain
cereals, contributes to a reduction in total energy intake.
It should be noted, t hat ver y active groups who have diets
high in veget ables, legumes, f ruits and wholegra in cereals
may sustain a total fat intake of up to 35–40% without the
risk of unhealthy weight gain. Despite the role of fat in
increasing energy density of diets, the long-term effect of
energy density in defining unhealthy weight gain is not
well established. Women’s Healthy Eating & Living Trial
and Women’s Health Initiative, two very large and long-
term randomized, double-blind, placebo-controlled tri-
als (RCTs) of low fat, both showed minimal effects on
weight
[27, 28] . Multiple well-controlled RCTs of equal
intensity interventions show greater weight loss on high-
fat diets
[29, 30] . However, recent data [31] suggest that
weight loss is attained mainly by achieving a sustained
reduction in energy intake independent of the fat, protein
or carbohydrate composition of the diet. The recommen-
dations for total fat are usually formulated to include
countries where the usual fat intake is typically above
30% as well as those where the usual intake may be very
low, for example ! 15%. Total fat energy of at least 20% is
consistent with good health
[15 , 32] . Highly active groups
with diets rich in vegetables, legumes, fruits and who-
legrain cereals may, however, sustain a total fat intake of
up to 35% without the risk of unhealthy weight gain. For
women of reproductive age at least 20% has been recom-
mended by the Joint FAO/WHO Expert Consultation on
Fats and Oils in Human Nutrition
[13] and confirmed in
the WHO Technical Report Series 916 on Diet, Nutrition
and the Prevention of Chronic Diseases
[15] . The concern
for low-fat diets in women from developing countries re-
lates to the high prevalence of young women with low
body mass index, especially in the Indian subcontinent,
since this condition is associated with low birth weight
and a high prevalence of stunted children
[32] .
Fats, Fatty Acids and Cholesterol, and Risk of
Cardiovascular Diseases
The study of the relationship between dietary fats and
CVDs, especially coronary heart disease (CHD), with ev-
idence accrued from animal experiments, observational
studies, clinical trials and metabolic studies conducted in
diverse human populations, reveals strong and consistent
associations between diet and CHD
[5, 6, 33, 34] . The po-
tential mechanisms have also been well studied focusing
mainly on the ef fect of d iet on plasma lipoprotein choles-
terol fractions. SFAs raise total and LDL cholesterol, but
individual FAs within this group have different effects.
Myristic and palmitic acids have the greatest LDL raising
effect and are abundant in diets rich in dairy products
and meat
[7, 8] . Stearic acid has not been reported to el-
evate blood cholesterol and has been shown to be rapidly
converted to oleic acid in vivo, thus it is considered neu-
tral in terms of the plasma cholesterol effect
[35, 36] ; less
is known on other potential adverse effects of stearic acid
on the CVD risk
[37, 3 8] . TFAs are similar to SFAs in their
effect on LDL, but additionally they lower the protective
HDL cholesterol and increase lipoprotein(a), which fur-
ther increases the CHD risk. TFAs are the geometrical
isomers of cis-unsaturated FAs produced in the rumen of
ruminant animals or by partial hydrogenation; this pro-
cess creates TFAs and also removes the critical unsatu-
rated bonds present in EFAs and essentia l for their action.
Metabolic studies have demonstrated that TFAs of natu-
ral or as products of partial hydrogenation render the
plasma lipid profile even more atherogenic than SFAs,
not only by elevating LDL cholesterol to similar levels but
also by decreasing HDL cholesterol
[7, 39 41] . Several
large cohort studies have found that intake of TFAs in-
creases the risk of CHD
[4244] . The most effective re-
placement for SFAs and TFAs in terms of reducing CHD
as an outcome are PUFAs; oils with both LA and ALA
predominantly present have been shown to be effective in
decreasing LDL cholesterol, CHD events and deaths. This
is now supported by the results of several large random-
ized clinical trials, in which replacement of SFAs and
TFAs by vegetable oils rich in essential PUFAs lowered
the CHD risk. A recent pooled analysis of 11 large pro-
spective cohort RCTs confirms this statement
[45] . TFAs
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Fat Quality for Optimal Health Ann Nutr Metab 2009;54(suppl 1):2–7
5
are presently being reduced or eliminated from retail fats
and margarines and spreads in many parts of the world,
however deep-fried fast foods and baked goods remain a
major source of T FAs [17, 44] . The very-long-chain PUFA
of the n–3 series, EPA and DHA, powerfully lower serum
triglycerides, but do not modify or may even raise serum
LDL cholesterol
[4549] . Most of the epidemiological ev-
idence related to the protective effects of n–3 PUFAs is
derived from studies of fish consumption in populations
or interventions involving fish oils administered in clin-
ical trials
[5054] .
Cholesterol in the blood and tissues is derived from
two sources: diet and endogenous synthesis, the former
commonly contributes 20–30% to the total body choles-
terol pool, thus the regulation of endogenous synthesis
plays a key role in the control of plasma levels
[55] . Al-
though dietary cholesterol mildly raises plasma choles-
terol levels when intake is very high ( 1 400 mg/day), an
increase in intake of 100 mg/day would be expected to
increase serum cholesterol by approximately 4 mg/dl
[56] ; epidemiological evidence for an association of di-
etary cholesterol intake with CVD is contradictory
[56
58] .
C o n c l u s i o n s
CHD rates can be significantly reduced by dietary
changes, which is achieved by replacing saturated fat and
trans fats with cis-unsaturated FAs. Advice about dietary
fat should focus on the replacement of SFAs and TFAs
with PUFA-rich vegetable oils, including sources of n–3
FAs. Replacement of SFAs by carbohydrates provides no
benefit in terms of the CHD risk
[45] . The food industry
should take advantage of the costs and effort of reformu-
lation to make healthier products, avoiding replacing
tra ns a nd sat urated anima l fats wit h vegetable oils r ich in
palmitic acid (palm oil) and lauric acid (coconut oil). Em-
phasis should be placed on the need to reduce overall en-
er gy intake and increase p hys ica l ac ti vit y rat her tha n re c-
ommendations to lower percent energy from fat and re-
duce fat or ‘fatty foods’ as a way to lose weight.
The following recommendations on the quality of fat
in the diet are made for optimal health across the life
course worldwide, from an age of about 2 years on-
wards:
fat may provide up to 30–35% of the daily energy in-
take;
saturated fat should provide no more than 10% of the
daily energy intake;
• essential PUFA (n–6 and n–3) should contribute 6–
10% of the daily energy intake;
trans fats should be less than 1% of the daily energy
intake, and
the remaining of the energy from fat can be provided
by monounsaturated fats (based on Technical Report
Series 916)
[15] .
Disclosure Statement
Ricardo Uauy is President of the IU NS, the IUNS has a private
public partnership (PPP) agreement with UNILEVER that has as
an objective the dissemination of up-to-date scientific informa-
tion on diet and nutrition, including dietary fat quality. The PPP
is i n the public domain a nd is available at www.iuns.org. R.U. has
no personal financial gain linked to this PPP or to his participa-
tion in this International Expert Meeting.
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Fax +41 61 306 12 34
E-Mail karger@karger.ch
www.karger.com
Ann Nutr Metab 2009;54(suppl 1):8–14
DOI: 10.1159/000220822
Dietary Fat Intake – A Global Perspective
I. Elmadfa M. Kornsteiner
Institute of Nutritional Sciences, University of Vienna, Vienna , Austria
be given worldwide. Due to different dietary patterns, only
regionally specific recommendations can be made about
what would be necessary to modify and improve fat quan-
tity and quality of the diet. Copyright © 200 9 S. Karger AG, Basel
Introduction
Coronary heart disease (CHD) is a major contributor
to morbidity and mortality worldwide. Risk factors are
sedentary lifestyle, overweight/obesity, smoking, high
blood pressure, raised total cholesterol, low-density-lipo-
protein (LDL) cholesterol and triglycerides, as well as
type 2 d iabetes [1] . In b r ie f, h ig h i nt a k e o f s a t ur a te d (S FA s)
and trans fatty acids (TFAs) as a percentage of total en-
ergy intake (%E) is known to correlate with CHD due to
raised LDL cholesterol levels
[2] . A recent pooled analysis
of 11 cohort studies has suggested that replacing fatty ac-
ids (FAs) with polyunsaturated fatty acids (PUFAs) in-
stead of monounsaturated fatty acids (MUFAs) or carbo-
hydrates prevents coronary heart diseases
[3] . However,
the type of carbohydrate was not identified in this study
[3] . In addition, it is also recognized that commercial
foods labeled as ‘low-fat/fat-free’, which are high in re-
fined carbohydrates and sugars, do not prevent the in-
creasing trend towards obesity and type 2 diabetes
[2] .
Moreover, low-fat, high-carbohydrate diets are known to
reduce the ‘good’ high-density lipoprotein (HDL) choles-
terol and raise triglycerides. Both are associated with an
Key Words
Docosahexaenoic acid Eicosapentaenoic acid Fat intake
Fatty acids Linoleic acid
Abstract
Background/Aim: The obje ct ive of t his rev ie w wa s to col lec t
data on the dietary intake of total fat and saturated (SFA),
monounsaturated (MUFA) and polyunsaturated fatty acids
(PUFA), especially linoleic (LA), -linolenic (ALA), eicosapen-
taenoic and docosahexaenoic fatty acids, in adults from var-
ious countries and to compare them with current recom-
mendations for fat intake. Methods: Weighted mean intake
data were collected from national dietary surveys, large
cross-sectional studies and/or studies with focus on health
and nutrition. Thereof, only studies with diet recalls, weigh-
ing records or food frequency questionnaires were consid-
ered. Results: Data from 28 countries were included, repre-
senti ng Afric a (3), Americ a (4), Asia (5), Aus tralia/ New Zeala nd
(2) and Europe (14). Total fat intake ranged from 11.1 (China,
Guangxi Bai Ku Yao and Han populations) to 50.7 (rural dwell-
ers in Nigeria) percentages of total energy (%E). SFA intake
varied from 3.1 (China, Guangxi Bai Ku Yao and Han popula-
tions) to 25.4%E (rural dwellers in Nigeria). Mean MUFA and
PUFA intake ranged from 3.5 (China, Guangxi Bai Ku Yao and
Han populations) to 22.3 (Greece), and 3.3 (India) to 11.3%E
(Taiwan), respectively. The mean intake of LA and ALA was
between 2.7 (India) and 7.2 (Austria), and 0.4 (France) and
1.0%E (Finland). Conclusion: With regard to recommenda-
tions for fat intake, no general advice for improvements can
Published online: $ $ $
Ibrahim Elmadfa
Institut e of Nutritional Sciences , University of Vienna
Altha nstrasse 14/2F
AT–1090 Vienna (Austr ia)
Tel. +43 1 4277 54901, Fax +43 1 427 7 9549, E-Mail ibra him.elmadfa@un ivie.ac.at
© 2009 S. Ka rger AG, Basel
0250–6807/09/0545–0008$26.00/0
Accessible online at:
www.karger.com/anm
ANM163.indd 8ANM163.indd 8 01.07.2009 14:46:4801.07.2009 14:46:48
Dietary Fat Intake – A Global Perspective Ann Nutr Metab 2009;54(suppl 1):8–14
9
increased CHD risk [4] . The results from the Nurses’
Health Study demonstrated that replacing SFAs with un-
saturated FAs was inversely related to the risk of CHD
due to beneficial effects on blood lipids [4] , whereas total
fat intake was not significantly associated with the risk of
CHD [4] . High consumption of linoleic acid (LA, 5–10%E)
is regarded to reduce the risk of CHD, which is based on
a lowered total/HDL cholesterol ratio
[5] . This ratio is
considered to be a more specific marker for CHD than
LDL cholesterol levels
[5] . A number of studies suggested
that ALA seems to be similar to LA in decreasing LDL
cholesterol levels
[6] . In addition, there is also a low bio-
synthesis of eicosapentaenoic (EPA) and docosahexaeno-
ic acid (DHA) from the parent essential ALA. Especially
the intake of both EPA and DHA is inversely related to
the risk of fatal (and possibly nonfatal) CHD. The protec-
tive tissue levels are reached by an intake of preformed
EPA and DHA between 250 and 500 mg/day
[7] .
Due to different effects on health, the following rec-
ommendations for fat intake have been established. In-
takes of total fat are recommended from 15 to 35%E,
SFAs ! 10%E, TFAs ! 1%E and PUFAs from 6 to 10%E
[8–10] .
M e t h o d s
The objective of this review was to gather fat intake data for as
many countries as possible to provide a global perspective. The
intake data on fat quantity (total fat) and quality (SFAs, MUFAs
and PUFAs) in adults were included. In this review, the fat intake
data are based on estimates of food purchases and availability.
The food balance sheets of the Food and Agricultural Organiza-
tion of the United Nations (FAO) were excluded. They demon-
strate only national trends and facilitate international compari-
sons. However, they are not suited to consider requirements and
intakes with regard to age, sex and ethnic groups. Only individu-
al dietary intake data calculated from 24-hour recalls, weighing
records and food frequency questionnaires were included. There-
fore, the collec ted data can only give a rou gh overview of fat inta ke
in various countries, but are limited to direct comparisons due to
the usage of different methods.
Only publications from the past 15 years were considered.
Data were collected via internet and the electronic database
PubMed between July 2008 and Februar y 2009. The following key
words were used: intake or diet of total fat, saturated fatty acids,
polyunsatur ated fatty acids, linoleic acid , -linolenic acid, eicosa-
pentaenoic acid, docosahexaenoic acid, essential fatt y acids, ome-
ga–6 and omega–3 fatty acids, long-chain polyunsaturated fatty
acids, and the name of the country included in title and abstract.
The search strategy was limited to the English and German lan-
guages.
In most publications included in this review, results were pre-
sented as means. Some data had to be recalculated because they
were given in absolute amounts; they were then related to and ex-
pressed as the percentage of fat energy i n total energy intake (%E).
When only the results of subgroups were presented, a weighted
me a n w as us ed to gi ve an ov er v ie w f or t h is co un tr y. Th is wa s d on e
by weighting the mean fat intake of each subgroup by the number
of individuals in the subgroup.
R e s u l t s
Intake Data
Intake data were found for 28 countries. Three coun-
tries were from Africa, four from America, five from
Asia, 14 from Europe and one each from Australia and
New Zealand. All reports/publications provided data on
total fat intake, SFAs, MUFAs and PUFAs, with the ex-
ception of Nigeria (only total fat and SFAs). An overview
of the characteristics of the surveys found for each of the
countries is presented in table 1 . The data of 10 countries
were obtained from the European Nutrition and Health
Report 2004
[11] , which included intake data on total fat,
SFAs, MUFAs and PUFAs from mainly national dietary
surveys. Fourteen countries provided additional specific
data on LA and ALA, and for 12 countries intake data on
EPA and DHA were available.
Fat Intake – A Global Perspective
Mean daily intake of total fat expressed as percentage
of energy ranged from 11.1 to 50.7%E ( table 1 ). The high-
est variation in total fat intake was observed in Africa
(13.1–50.7%E). However, America (25.7–37.2%E), Asia
(11.1–35.6%E) and Europe (28.5–46.2%E) also demon-
strated great differences in regional fat intakes ( table 2 ).
Total fat intake of 15 countries (Canada, Costa Rica,
Mexico, US, China, India, Japan, South Korea, Australia,
Finland, Italy, Norway, Portugal, Sweden and the UK) was
between 20 and 35%E. Nine countries, the USA (Alaska),
Taiwan, New Zealand, Austria, Denmark, France, Ger-
many, Hungary and Spain, demonstrated high fat intakes
(
6
35% E). I n add itio n, v ery hig h fat intakes ( 1 40%E) were
observed in Cameroon, Belgium, Nigeria and Greece,
while total fat intake in China (Guangxi Bai Ku Yao and
Han populations) and Tanzania is ^ 15%E.
Eight countries had a lower SFA intake than 10%E,
ranging from 3.1%E (China: Guangxi Bai Ku Yao and
Han populations) to 9.5%E (Portugal). The remaining
countries had a higher SFA intake (10.0–25.4%E) than
the recommended ! 10%E [8, 10] . The highest SFA intake
(25.4%E) was observed in rural dwellers in Northern Ni-
geria, whereas urban dwellers ate only 5.7%E of SFAs. The
region comparison demonstrated that SFA intake was
ANM163.indd 9ANM163.indd 9 01.07.2009 14:46:5101.07.2009 14:46:51
Elmadfa/Kornsteiner
Ann Nutr Metab 2009;54(suppl 1):8–14
10
Tab le 1. Overview of mean intakes (%E) of total fat, SFAs, MUFAs and PUFAs and characteristics of the surveys from various coun-
tries
Country and
reference
Abbr. Year
of publ.
Data source Sample
size
Dietary method Age
group
Total
fat, %E
SFA
%E
MUFA
%E
PUFA
%E
Africa
Cameroon [15] CM 2000 habitual diet study of rural and
urban subjects in Cameroon
1,785 24-hour recall and FFQ 24–74 42.8 14.1 16.4 5.9
Nigeria [16] NG 2004 study of urban and 135 4!24-hour recalls and FFQ
and 7 day dietary record
20–75 37.9 5.7
rural dwellers in northern Nigeria 115 50.7 25.4
Tanzania [17] TZ 1997 food consumption in rural and
urban Tanzania
105 24-hour recall 35–44 13.1 4.1 4.7 4.0
America
Canada [18] CA 2004 nutrition survey, Canada excluding
territories
18,820 24-hour recall 19+ 31.4 10.2 12.5 5.6
Costa Rica [19] CR 2002 comparison of dietary intakes in rural,
suburban and urban populations
503 FFQ 57 32.1 11.2 12.0 5.5
Mexico [20] MX in
prep.
MHNS (Mexican Health an Nutrition
Survey) 2006
15,951 FFQ (data are expressed
as medians)
19–69 25.7 7.4 7.2 4.4
US [21] (a) US (a) 2008 (NHANES) nutrition survey 4,423 2!24-hour recall 20+ 33.7 11.3 12.4 7.1
US Alaska [22] (b) US (b) 2005 GOCADAN (Genetics of Coronary
Artery Disease in Alaska Natives) Study
734 FFQ (data are expressed
as medians)
17–60 37.2 12.2 14.3 6.7
Asia
China [23] (a) CH (a) 2007 INTERMAP (International Study of
Macro- and Mironutrients and Blood
Pressure) Study
839 24-hour recall 49 20.0 5.0 8.1 5.8
China [24] (b) CH (b) 2007 dietary intake of Guangxi Bai Ku Yao
and Han populations
2,343 24-hour recall 15–89 11.1 3.1 3.5 4.3
India [25] IN 2005 survey, only women 200 3!24-hour recall 26.7 10.6 6.0 3.3
Japan [23] JP (b) 2007 INTERMAP (International Study
of Macro- and Miro- nutrients and
Blood Pressure) Study
1,145 24-hour recall 49 24.9 6.6 9.0 6.4
South Korea [26] KR 2004 contribution of specific foods to fat
and fatty acids
224 FFQ and 3-day dietary
record
30–85 21.1 6.0 7.7 5.1
Taiwan [27] TW 1994 government employees 423 24-hour recall 40–59 35.6 8.8 12.6 11.3
Australia
Australia [28] AU 1998 National Nutrition Survey 10,851 24-hour recall and FFQ 19+ 32.5 12.7 11.8 5.0
New Zealand [29] NZ 1999 National Nutrition Survey 4,636 24-hour recall and FFQ 15+ 35.0 15.0 12.0 5.0
Europe
Austria [30] AT 2009 Austrian Nutrition Survey 2008 2,123 24-hour recall 19–64 37.3 14.6 12.6 8.0
Belgium [11] BE 20051Survey 1979–1984 6,870 24-hour recall 25–75 41.5 16.5 15.0 8.5
Belgium [31] BE 2006 Epidemiological Survey, only women 641 48-hour recall 18–39 34.3 13.7 13.1 6.0
Denmark [11] DK 20051Survey 1995 1,352 7-day record 19–64 36.3 15.2 11.0 5.0
Finland [11] FI 20051Survey 2002 2,007 48-hour recall 25–64 33.7 13.9 11.2 5.0
France [11] FR 20051Survey 1994–2002 8,202 24-hour recall 35–60 38.2 15.6 14.0 5.0
Germany [32] DE 2003 EPIC Cohort 4,021 24-hour recall 35–40 37.6 15.7 12.8 6.5
Greece [11] (a) GR (a) 20051EPIC Cohort 20,942 FFQ 25–64 46.2 13.1 22.3 6.6
Greece [33]
(Cretan) (b)
GR (b) 1999 food and nutrient intake of
Cretan adults
470 validated 24-hour recall 18–64 40.3 11.8 19.8 5.1
Hungary [11] HU 20051Survey 1992–1994 2,349 3!24-hour recall 18–54 37.9 14.0 15.0 4.0
Italy [11] IT 20051Survey 1994–1996 7-day record 18–64 34.0 10.0 13.0 5.0
Norway [34] NO 1998 Norwegian national nutrition
surveys 1997
3,144 FFQ 19–79 31.0 12.2 10.9 5.5
Portugal [11] (a) PT (a) 20051Surveys 1995–1998, 2001 972 FFQ >18 30.1 9.5 12.9 5.3
Portugal [42] (b) PT (b) 1999 assessment of food nutrient intakes 489 FFQ >40 28.5 8.9 12.4 4.9
Spain [11] (a) ES (a) 20051Survey 1990–1998 10,208 24-hour recalls, 3 day
record FFQ
25–60 38.1 12.0 16.0 5.5
Spain [35] (Catalan) (b) ES (b) 1999 Catalan Nutrition Survey 1,600 2!24-hour recall and FFQ 18–60 38.0 12.8 17.2 4.6
Sweden [11] SE 20051National Food Survey 1997–1998 1,215 7-day record 18–74 34.0 14.5 12.5 5.0
UK [36] UK 2003 National Diet and Nutrition Survey
adults 19–64 years
1,724 7-day dietary record 19–64 33.5 12.6 11.1 6.0
TZ: SFA, MUFA and PUFA estimated and calculated from graphs. FFQ = Food frequency questionnaire.
1 Data from the European Nutrition and Health Report 2004.
ANM163.indd 10ANM163.indd 10 01.07.2009 14:46:5101.07.2009 14:46:51
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11
highest in European countries (11.8–16.5%E), with the
exception of Portugal and Italy ( ^ 10%E; table 1 ).
The average proportion of MUFAs was between 3.5
and 22.3%E. The mean daily intake of PUFAs in popula-
tions ranged from 3.3 (India) to 11.3%E (Taiwan). Twen-
ty countries demonstrated mean intakes of PUFAs ! 6%E.
The ratio of SFAs to the sum of MUFAs and PUFAs
[SFAs/(MUFAs + PUFAs)] ranged from 0.36 (China) to
1.14 (India). A ratio 1 0.5 demonstrates that the propor-
tion of SFAs is unfavorable, which could be observed in
21 countries ( fig. 1 ).
Data on LA and ALA intake were limited to 14 coun-
tries (USA, Costa Rica, India, Japan, China, South Korea,
Australia, Austria, Belgium, Finland, France, Germany,
Sweden and the UK). Mean LA intake was between 2.7
(India) and 7.2%E (Austria). All countries demonstrated
higher intakes than the 2.5%E of LA that are necessary to
prevent deficiency symptoms
[10] , whereas 9/14 countries
did not meet the WHO/FAO-recommended intake for n-6
(mainly LA) (5–8%E)
[8] ( fig. 2 ). Nine of 14 countries had
mean ALA intakes of 6 0.5–1%E and five countries dem-
Tab le 2 . Range s of intake (%E) of t otal fat , SFA, M UFA and PUFA
from different continents
Continents Total fat SFA MUFA PUFA
Africa 13.1–50.7 4.1–25.4 4.7–16.4 4.0–5.9
America 25.7–37.2 7.4–12.2 7.2–14.3 4.4–7.1
Asia 11.1–35.6 3.1–10.6 3.5–12.6 3.3–11.3
Australia 32.5–35.0 12.7–15.0 11.8–12.0 5.0
Europe 28.5–46.2 8.9–16.5 10.9–22.3 4.0–8.5
Africa (total fat and SFA: CM, NG and TZ; MUFA and PUFA:
CM and TZ).
America (total fat, SFA, MUFA and PUFA: CA, CR, MX
and US).
Asia (CH, IN, JP, KR and TW).
Australia (AU and NZ).
Europe (AT, BE, DK, FI, FR, DE, GR, HU, IT, NO, PT, ES, SE
and UK).
The full country names and references are shown in table 1.
America Asia Australia EuropeAfrica
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
1.1
1.2
Ratio of SFAs/(MUFAs + PUFAs)
CM TZ CA CR MX US
(a)
US
(b)
CH
(a)
CH
(b)
IN JP KR TW AU NZ AT BE
(a)
BE
(b)
DK FI FR DE GR
(a)
GR
(b)
HU IT NO PT
(a)
PT
(b)
ES
(a)
ES
(b)
SE UK
Fig. 1. Ratio of SFAs/(MUFAs + PUFAs) in the diet in different regions. For full country names and references, see table 1.
ANM163.indd 11ANM163.indd 11 01.07.2009 14:46:5101.07.2009 14:46:51
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Ann Nutr Metab 2009;54(suppl 1):8–14
12
onstrated very low intakes of ALA ( ! 0.5%E), which is bor-
derline when it comes to the prevention of deficiency
symptoms
[10] . The mean intake of EPA and DHA varied
between 0.03 (China) and 1.05 g/day (Japan; fig. 3 ).
Discussion
Tremendous differences in total fat and FA intakes
were observed between countries from different regions.
For instance, 13 countries (Cameroon, Nigeria, US Alas-
ka, Taiwan, Austria, Belgium, Denmark, France, Germa-
ny, Greece, Hungary, Spain and New Zealand ) had total
fat intakes 6 35%E, which is higher than recommended
[8, 10] . Total fat intake of six countries was in agreement
with the WHO/FAO nutrient intake goals (20–30%E)
[8] ,
including Mexico, China, India, Japan, South Korea and
Portugal, while about nine countries were borderline (to-
tal fat intake between 30 and 35%E). It has to be empha-
sized that there is no uniform recommendation for this
higher range of total fat intake between 30 and 35%E, es-
pecially in populations with a sedentary lifestyle
[8–10,
America Asia Australia Europe
0
1
2
3
4
5
6
7
8
%E
LA ALA
US CR IN JP CH KR AU AT BE FI FR DE NO UK
Fig. 2. Mean daily intake of LA and ALA
among adults in various count ries. For full
country names, see table 1; US
[37] ; CR
[19] ; IN [25] ; JP [23] ; CH [23] ; KR [26] ; AU
[38] ; AT [30] ; BE [31] ; FI [39] ; FR [40] ; DE
[32] ; NO [34] ; UK [41] .
0
0.2
0.4
0.6
0.8
1.0
1.2
Fatty acid intake (g/day)
EPA DHA EPA + DHA
America Asia Australia Europe
US CR JP CH KR AU AT BE FR DE NO UK
Fig. 3. Mean daily intake of EPA and DHA
among adults in various count ries. For full
country names, see table 1; US
[37] ; CR
[19] ; JP [23] ; CH [23] ; KR [26] ; AU [38] ; AT
[30] ; BE [31] ; FR [40] ; DE [32] ; NO [3 4] ; UK
[41] .
ANM163.indd 12ANM163.indd 12 01.07.2009 14:46:5201.07.2009 14:46:52
Dietary Fat Intake – A Global Perspective Ann Nutr Metab 2009;54(suppl 1):8–14
13
12] . Total fat intake was even below the recommendation
( ^ 15%E) [8] in China (Guangx i Bai Ku Yao and Han pop-
ulations) and Tanzania.
The proportion of SFAs in total fat intake was higher
than that of ot her FA g roup s in mo st co unt ri es in Eu rope ,
America (Mexico), Africa (Cameroon and Nigeria; rural
dwellers), Asia (India), Australia and New Zealand. The
highest intakes ( 6 14%E) of SFAs were reported in Cam-
eroon, Nigeria, New Zealand, Austria, Belgium, Den-
mark, France, Germany, Hungary and Sweden. Only
eight of 28 countries (Nigeria-urban, Tanzania, Mexico,
China, Japan, South Korea, Taiwan and Portugal) had an
SFA intake ! 10%E. SFAs, namely lauric, myristic and
palmitic acids, are known to increase LDL cholesterol,
which is a major risk factor for CHD
[13] . Therefore, the
upper level for SFA intake is set at 10%E
[8] .
The average percentage of MUFAs was between 3.5
and 22.3%E. The recommendation for MUFAs is cal-
culated as total fat – (SFAs + PUFAs + TFAs)
[11] . The
replacement of SFAs and TFAs with cis-MUFAs and
-PUFAs is negatively associated with CHD
[4] . On the
one hand, MUFAs are regarded as important FAs to im-
prove the FA pattern by reducing SFAs and TFAs, but on
the other hand this is not enough to change the quality of
the fat intake when the total fat intake is very high
( 1 35%E). For instance, Greece demonstrated a very high
intake of MUFAs (22.3%E) and total fat intake (46.2%E;
table 1 ), and although direct relationships between fat in-
ta ke a nd body m as s inde x have to be v ie wed w it h c aut ion,
a look at the data shows that the mean body mass index
in Greek adults ranges from 25.4 (women, age group 25–
34) to 30.3 (women, age group 55–64)
[11] .
All countries demonstrated higher intakes than 2.5%E
of LA, which is sufficient to prevent deficiency symp-
toms. The majority (20) of the countries failed to reach
the WHO/FAO population nutrient intake goals for
PUFA intake (6–10%E)
[11] , which are important for the
prevention of chronic diseases ( table 1 ), especially in pop-
ulations with borderline or even higher total fat intake
(30–35%E). Mainly European countries, but also Austra-
lia and New Zealand, fit into this dietary pattern. Twenty
countries demonstrated mean intakes of PUFAs ! 6%E.
Due to the predominance of SFAs compared to unsatu-
rated FAs, the calculated ratio of SFAs/(MUFAs + PUFAs)
was unfavorable ( 1 0. 5) in 21 of the 28 c ount rie s. The bor-
derline was set according to the general recommenda-
tions for fat and FAs ( ! 10%E SFAs, 6–10%E PUFAs and
the remaining from MUFAs 10–15%E)
[8, 10] . Asia dem-
onstrates a ratio ! 0.5 with the exception of India. Data
from India are limited to women and are not representa-
tive for the whole population. Intake data for India are
rare, but in 1998, Ghafoorunissa
[14] reported that the fat
intake in India varied considerably, which can be ob-
served by widespread chronic energy deficiency related
to low fat intake up to an increased risk of CHD in the
urban middle- and high-income groups.
All countries demonstrated higher intakes than 2.5%E
of LA. This level of intake is necessary to prevent defi-
ciency symptoms
[10] . In five countries, ALA intakes
were well below ! 0.5%E, an intake level which is at the
borderline to the prevention of deficiency symptoms
[
10] , especially when the diet is lacking in n–3 long-chain
PUFAs. Data on the mean intake of EPA and DHA were
only available from 12 countries. The sum of both FAs var-
ied between 0.03 (China) and 1.05 g/day (Japan; fig. 3 ).
Conclusion
Except for the fact that more accurate intake data are
required to assess present global fat intake, available data
indicate a very heterogeneous picture regarding current
quantity and quality. Africa reveals a very high diversity
in total fat, ranging from 13.1 to 50.1%E. In addition,
these variations are not only found between countries in
Africa, they are also found within a state (e.g. urban and
rural dwellers in Northern Nigeria). Similar observations
can be made for Asia, due to the fact that quantity and
quality can differ hugely. All considered European coun-
tries mostly have high fat intakes ( 1 35%E). Especially the
intake of SFAs is high ( 1 10%E). Therefore, the reduction
in saturated fat (from animal products) would reduce
both total fat and SFA intake, while the ratio of SFA to
unsaturated FAs would be improved. Only Japan, South
Korea and Norway demonstrate higher intakes of long-
chain n–3 fatty acids ( 1 0.4 g/day), which are recognized
to have health benefits.
Disclosure Statement
The data presented here was partially supported by the Uni-
versity of Vienna, the Austrian MOH (Austrian Nutrition Report
2008) and t he European Commis sion, Hea lth and Consumer Pro-
tection Directorate General (European Nutrition and Health re-
port, Grant Agreement No. SPC.2002356).
ANM163.indd 13ANM163.indd 13 01.07.2009 14:46:5201.07.2009 14:46:52
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14
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Fax +41 61 306 12 34
E-Mail karger@karger.ch
www.karger.com
Ann Nutr Metab 2009;54(suppl 1):15–24
DOI: 10.1159/000220823
Foods with a High Fat Quality Are
Essential for Healthy Diets
H. Zevenbergen A. de Bree M. Zeelenberg K. Laitinen G. van Duijn E. Flöter
Unilever Research and Development, Vlaardingen , The Netherlands
the essential PUFAs -linolenic acid (vegetable omega–3) or
lino lei c aci d (om ega –6), m arga rin es an d dres sing s with both
essential fatty acids present in significant quantities can be
realized. In addition, full hydrogenation and fat rearrange-
ment have enabled the production of cost-effective marga-
rines virtually devoid of TFA and low in SFA. Dietary surveys
indicate that vegetable oils, soft margarines and dressings
are indeed often important sources of essential fatty acids in
people’s diets, whilst providing negligible amounts of TFA
and contributing modestly to SFA intakes. Based on empiri-
cal and epidemiological data, the public health benefit of
switching from products with a low fat quality to products
with a high fat quality can be predic ted. For example, switch-
ing from butter or palm oil to a soft margarine shows a sub-
stantial improvement in the nutritional quality of the diet.
These simple, practical dietary adaptations can be expected
to contribute to the healthy growth and development of
children and to reduce the burden of cardiovascular dis-
ease. Copyright © 200 9 S. Karger AG, Basel
Introduction
Fat is an important part of the diet in most societies.
However, the public has generally little knowledge about
fats and the products containing fats. Fat is often per-
ceived as fattening and hence has a bad perception. Con-
sequently, the fat quality of the diet of many people is
Key Words
Cardiovascular health Essential fatty acids Fat modification
Growth and development Hydrogenation Interesterification
Margarine Polyunsaturated fats Saturated fat
Abstract
Fat is generally a highly valued element of the diet to provide
energy, palatability to dry foods or to serve as a cooking me-
dium. However, some foods rich in fat have a low fat quality
with respect to nutrition, i.e., a relative high content of satu-
rated (SFA) as compared to unsaturated fatty acids, whereas
others have a more desirable fat quality, i.e., a relative high
content of unsaturated fatty acids as compared to SFA. High-
fat dairy products and fatty meats are examples of foods
with low fat quality, whereas vegetable oils (tropical oils
such as palm and coconut oil excluded) are products with a
generally high fat quality. The aim of this paper is to explore
the nutritional impact of products made of vegetable oils,
e.g. margarines and dressings, and how they can be de-
signed to contribute to good health. Since their first indus-
trial production, the food industry has endeavored to im-
prove products like margarines, including their nutritional
characteristics. With evolving nutrition science, margarines
and cooking products, and to a lesser extent dressings, have
been adapted to contain less trans fatty acids (TFA), less SFA
and more essential (polyunsaturated, PUFA) fatty acids. This
has been possible by using careful fat and oil selection and
modification processes. By blending vegetable oils rich in
Published online: $ $ $
H. Zevenbergen
Unilever Res earch and Development, PO Box 114
NL–3130 AC Vlaardingen (The Netherl ands)
Tel. +31 10 460 6 506, Fax +31 10 4605 726, E-Mail ha ns.zevenbergen@unilever.com
© 2009 S. Ka rger AG, Basel
0250–6807/09/0545–0015$26.00/0
Accessible online at:
www.karger.com/anm
ANM162.indd 15ANM162.indd 15 01.07.2009 14:45:5001.07.2009 14:45:50
Zevenbergen/de Bree/Zeelenberg/
Laitinen/van Duijn/Flöter
Ann Nutr Metab 2009;54(suppl 1):15–24
16
deviati ng significantly f rom what is recommended, which
may have a negative impact on health.
The aim of this paper was to outline what the main
sources of fat in our diets are, how products rich in fat are
produced and what the nutritional characteristics of the
main fat-rich products are. Finally, we provide examples
of the positive impact that foods with a high fat quality
can make on our health.
Main Dietary Sources of Fat
The main fats commonly consumed are vegetable oils
and fats, dairy fat and fats derived from animals, e.g. lard,
tallow and fish oil. Many food products in the world are
prepared with these fats and oils. In this paper, we focus
on those products that contain a significant amount of
fat. Major examples are listed in the following.
Margarines and Reduced Fat Spreads. Originally, the
term margarine was reserved for butter-like products
with 80% fat. In this paper, we will use this term for all
spreadable fat products made predominantly from vege-
table oils and fats at levels ranging from 20 to 80%.
Butter and Ghee. By definition, butter is made with
80% milk fat in most countries. Ghee is clarified butter
(butterfat), used in South-Asia/Middle East. Mélanges
are mixtures of vegetable fats and oils with butterfat.
Vanas p ati. Vanaspati is a cooking fat usually made
from partially hydrogenated vegetable oils used in South-
Asia and Africa.
Cooking Fats/White Fats/Shortenings, either from Ani-
mal or Vegetable Origin. These are products made to re-
main stable at high temperatures as in cooking and bak-
ing.
Mayonnaise . Similar to margarine, originally with
80% vegetable oil, mayonnaise now represents products
with fat levels ranging from 20–80%.
These products are often named by consumers as
products high in fat: they form the majority of the so-
called visible fats, as opposed to invisible fats: fats hidden
in products that may not be perceived as fatty, such as
cheese, milk, meats and baked goods.
As dietary recommendations often advice to reduce
the saturated fat (SFA) intake and maintain or increase
the intake of polyunsaturated fats (PUFA)
[1] , a rough
indication of the foods that contribute most to the intakes
of these types of fat is useful. Wide differences in com-
mon usage of foods exist all over the world: this makes it
impossible and irrelevant to define a ‘global average’.
However, in looking at the products that are the major
sources of SFA or PUFA in countries or regions around
the world, often the same t ypes of products appear. There-
fore, a few general comments on foods often providing a
significant contribution to the SFA intake can be made
[1–5] :
In many countries, dairy fat, either via cheese, butter
or milk, is the most important source of SFA. This is
particularly true for the Western World.
– Meat is again, particularly in the Western World, an
important source of SFA.
In many developing countries, baked and fried foods,
high in SFA, are very common. Fatty snacks in gen-
eral often provide a significant amount of this fat.
Finally, cooking fats and oils like vanaspati and tropi-
cal oils are often significant sources of SFA.
Ma jo r c ont r ibuto rs to the PU FA in ta ke are le ss di ve rs e:
these are for most populations either vegetable oils or
products made thereof, like margarines and mayonnaise.
Chicken or pork can also be significant contributors but
both, pork in particular, also contribute significantly to
the SFA intake.
Of course, the contribution to the SFA and PUFA in-
take is determined by the amount of food consumed and
the level of these fats in those foods. For some of the most
common high-fat products, the fraction of trans fatty
acid (TFA), SFA, monounsaturated fatty acid (MUFA)
and PUFA of the total fat is depicted in figure 1 .
0
10
20
30
40
50
60
70
80
90
100
%PUFA MUFA SFA TFA
Vanaspati
Butter
Palm oil
Hard wrapper margarine
Soft premium margarine
High PUFA margarine
Mayonnaise
Canola oil
Fig. 1. Fatty acid composition of common fat-rich products.
Color versi on available onlin e
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Foods with a High Fat Quality Are
Essential for Healthy Diets
Ann Nutr Metab 2009;54(suppl 1):15–24
17
A differentiation often used in the communication to
consumers is that of ‘good fat’ and ‘bad fat’, the latter be-
ing SFA and TFA and the former being the unsaturated
fats, i.e., PUFA and MUFA. Vanaspati and butter are very
rich in ‘bad fats, predominantly SFA; however, whereas
butter usually contains a few percent of TFA (3–5%), va-
naspati can contain much more than 20%. Both provide
very little PUFA. One of the most important edible oils is
palm oil. This oil is about 50/50 in ‘bad’ and ‘good’ fats.
Of the various types of margarine, stick margarines or
wrappers usually contain 1 40% SFA on fat. These prod-
ucts are hard and often can stand higher temperatures.
Soft premium margarines, sold in the chilled cabinet, are
better in composition with 30% SFA on fat and a rea-
sonable level of PUFA, usually 1 30%. The best marga-
rines from a health perspective are high-quality soft mar-
garines rich in PUFA: they are predominantly made of
vegetable oils rich in PUFA and hence relatively low in
SFA (some contain ! 20% on fat). It should be realized
that nowadays the majority of margarines globally are
almost free of TFA (‘virtually trans fat free’) and contain
less TFA than for example butter. Mayonnaise is made
from vegetable oil, such as soybean oil. This oil is low in
SFA and contains 1 50% PUFA. Finally, the common oil
lowest in SFA is rapeseed (or canola) oil.
The total global oil and fat market is a huge economic
factor with a total turnover of more than 120 billion Euro,
making it one of the bigger markets in the food-agricul-
tural segment
[6, 7] . With the rise of af fluence in develop-
ing countries, this market is increasing and can be ex-
pected to increase further.
More important for public health is the actual con-
su mption of oils a nd fat s and produc ts mad e thereof. Un-
fortunately, due to the complex nature of the worldwide
oil and fat usage, clear data on consumption do not exist.
On the basis of various production data on butter, mar-
garine, spreads and some other sources, e.g. the vegetable
fat and oil production data reported by the Food and Ag-
riculture Organization of the United Nations, a rough es-
timate of the total consumption split out over various
types of oils and fats can be attempted. It is important to
stress that these data are only an indication of the con-
sumption, providing useful insights but no hard facts.
Oil and Fat Consumption
The total fat and oil disappearance, including wastage
(although this is estimated to be minor for the majority
of the world population), but excluding the use as animal
feed and for the chemical industry, was around 120 mil-
lion tons in 2005. With a world population of 6.5 billion
people in 2005, the average intake of oils and fats would
be almost 20 kg per person per year. Of course there is a
wide variability: intake in the Western World is estimat-
ed at around 50 kg/person/year whilst in sub-Saharan
Africa this is no more than 10 kg.
Table 1 captures the estimated split over the various
types of oils and fats and some of their products. It is ev-
ident that margarine and vanaspati are made from vege-
table oils, which are included in tropical and seed oils, but
nevertheless this representation gives a rough indication
of the sizes of these segments.
The table shows that vegetable oils and fats are by far
the most important for human consumption and consti-
tute about two thirds of all fat sources. Of vegetable oils,
seed and bean oils, which have generally a healthy fatty
acid composition, are about half, and tropical oils with
palm as its main representative the other half. But the in-
take of animal fat, while on the decline worldwide, is still
considerable: butter, ghee, tallow and lard make up about
23% of the fat consumption. This is important for public
health as these fats are generally high in SFA and low in
PUFA and are thus not contributing to a healthy fat in-
take. Olive oil is relative small in volume and localized in
Europe and the Americas. Its share of the total oil and fat
market is no more than 3%.
Of the products made of vegetable oils and fats, mar-
garine is the biggest in volume and most widespread. The
margarine segment is about as big as the butter segment.
Vanaspati, a replacement product for butter, is a common
product in India and the surrounding countries. In India
alone, the production of vanaspati is approximately 1 bil-
lion kg/year
[8] .
Tab le 1. Share of fats and oils to total consumption (i.e., 120 mil-
lion tons) globally in 2005
Type of fat/oil Share
Seed and bean oils
(e.g. soybean, sunflower seed, rapeseed) 33%
Tropical oils and fats
(e.g. palm, coconut, palm kernel) 30%
Olive oil 3%
Margarine and spreads 6%
Butter 6%
Edible tallow 7%
Ghee 3%
Industrial lard 7%
Vanaspati 5%
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Zevenbergen/de Bree/Zeelenberg/
Laitinen/van Duijn/Flöter
Ann Nutr Metab 2009;54(suppl 1):15–24
18
Differences in the habits of people regarding fat and
oil usage are quite marked. In the Northern hemisphere,
butter and margarine is widely used, with oils for cooking
or cold use. Around the Mediterranean, olive oil is the
main oil used. In the US, cooking with lard and shorten-
ing is fairly common. The Southern hemisphere is char-
acterized by oil as the predominant source of visible fat.
A large part of that is used as cooking medium. China is