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American Journal of Clinical Nutrition, Vol. 77, No. 5, 1146-1155, May 2003
© 2003 American Society for Clinical Nutrition


Original Research Communication

Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials1,2,3

Ronald P Mensink, Peter L Zock, Arnold DM Kester and Martijn B Katan

1 From the Departments of Human Biology (RPM) and Methodology and Statistics (ADMK), Maastricht University, Maastricht, Netherlands, and the Wageningen Centre for Food Sciences and Division of Human Nutrition and Epidemiology, Wageningen University, Wageningen, Netherlands (PLZ and MBK).

Background: The effects of dietary fats on the risk of coronary artery disease (CAD) have traditionally been estimated from their effects on LDL cholesterol. Fats, however, also affect HDL cholesterol, and the ratio of total to HDL cholesterol is a more specific marker of CAD than is LDL cholesterol.

Objective: The objective was to evaluate the effects of individual fatty acids on the ratis of total to HDL cholesterol and on serum lipoproteins.

Design: We performed a meta-analysis of 60 selected trials and calculated the effects of the amount and type of fat on total:HDL cholesterol and on other lipids.

Results: The ratio did not change if carbohydrates replaced saturated fatty acids, but it decreased if cis unsaturated fatty acids replaced saturated fatty acids. The effect on total:HDL cholesterol of replacing trans fatty acids with a mix of carbohydrates and cis unsaturated fatty acids was almost twice as large as that of replacing saturated fatty acids. Lauric acid greatly increased total cholesterol, but much of its effect was on HDL cholesterol. Consequently, oils rich in lauric acid decreased the ratio of total to HDL cholesterol. Myristic and palmitic acids had little effect on the ratio, and stearic acid reduced the ratio slightly. Replacing fats with carbohydrates increased fasting triacylglycerol concentrations.

Conclusions: The effects of dietary fats on total:HDL cholesterol may differ markedly from their effects on LDL. The effects of fats on these risk markers should not in themselves be considered to reflect changes in risk but should be confirmed by prospective observational studies or clinical trials. By that standard, risk is reduced most effectively when trans fatty acids and saturated fatty acids are replaced with cis unsaturated fatty acids. The effects of carbohydrates and of lauric acid–rich fats on CAD risk remain uncertain.

Key Words: Diet • fatty acids • carbohydrates • serum lipoproteins • coronary artery disease risk




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J. Nutr.Home page
J. Kraft, L. Hanske, P. Mockel, S. Zimmermann, A. Hartl, J. K. G. Kramer, and G. Jahreis
The Conversion Efficiency of trans-11 and trans-12 18:1 by {Delta}9-Desaturation Differs in Rats
J. Nutr., May 1, 2006; 136(5): 1209 - 1214.
[Abstract] [Full Text] [PDF]


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J. Nutr.Home page
W.-H. Wu, Y.-P. Kang, N.-H. Wang, H.-J. Jou, and T.-A. Wang
Sesame Ingestion Affects Sex Hormones, Antioxidant Status, and Blood Lipids in Postmenopausal Women
J. Nutr., May 1, 2006; 136(5): 1270 - 1275.
[Abstract] [Full Text] [PDF]


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NEJMHome page
D. Mozaffarian, M. B. Katan, A. Ascherio, M. J. Stampfer, and W. C. Willett
Trans Fatty Acids and Cardiovascular Disease
N. Engl. J. Med., April 13, 2006; 354(15): 1601 - 1613.
[Full Text] [PDF]


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Am. J. Clin. Nutr.Home page
S. Tricon, G. C Burdge, E. L Jones, J. J Russell, S. El-Khazen, E. Moretti, W. L Hall, A. B Gerry, D. S Leake, R. F Grimble, et al.
Effects of dairy products naturally enriched with cis-9,trans-11 conjugated linoleic acid on the blood lipid profile in healthy middle-aged men.
Am. J. Clinical Nutrition, April 1, 2006; 83(4): 744 - 753.
[Abstract] [Full Text] [PDF]


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Am. J. Clin. Nutr.Home page
F. L Crowe, C M. Skeaff, T. J Green, and A. R Gray
Serum fatty acids as biomarkers of fat intake predict serum cholesterol concentrations in a population-based survey of New Zealand adolescents and adults.
Am. J. Clinical Nutrition, April 1, 2006; 83(4): 887 - 894.
[Abstract] [Full Text] [PDF]


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Am. J. Clin. Nutr.Home page
M. Lefevre and C. Champagne
Reply to D Giugliano and K Esposito
Am. J. Clinical Nutrition, April 1, 2006; 83(4): 921 - 922.
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Am. J. Clin. Nutr.Home page
T. Tholstrup, M. Raff, S. Basu, P. Nonboe, K. Sejrsen, and E. M Straarup
Effects of butter high in ruminant trans and monounsaturated fatty acids on lipoproteins, incorporation of fatty acids into lipid classes, plasma C-reactive protein, oxidative stress, hemostatic variables, and insulin in healthy young men
Am. J. Clinical Nutrition, February 1, 2006; 83(2): 237 - 243.
[Abstract] [Full Text] [PDF]


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Endocr. Rev.Home page
A. D. Mooradian, M. J. Haas, and N. C. W. Wong
The Effect of Select Nutrients on Serum High-Density Lipoprotein Cholesterol and Apolipoprotein A-I Levels
Endocr. Rev., February 1, 2006; 27(1): 2 - 16.
[Abstract] [Full Text] [PDF]


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NEJMHome page
M. S. Itskowitz, J. L. Pollock, M. B. Katan, Y. Xie, N. O. Davidson, D. Ashen, and R. S. Blumenthal
Low HDL cholesterol levels.
N. Engl. J. Med., January 26, 2006; 354(4): 417 - 419.
[Full Text] [PDF]


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J. Nutr.Home page
P. L. L. Goyens and R. P. Mensink
The Dietary {alpha}-Linolenic Acid to Linoleic Acid Ratio Does Not Affect the Serum Lipoprotein Profile in Humans
J. Nutr., December 1, 2005; 135(12): 2799 - 2804.
[Abstract] [Full Text] [PDF]


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JAMAHome page
L. J. Appel, F. M. Sacks, V. J. Carey, E. Obarzanek, J. F. Swain, E. R. Miller III, P. R. Conlin, T. P. Erlinger, B. A. Rosner, N. M. Laranjo, et al.
Effects of Protein, Monounsaturated Fat, and Carbohydrate Intake on Blood Pressure and Serum Lipids: Results of the OmniHeart Randomized Trial
JAMA, November 16, 2005; 294(19): 2455 - 2464.
[Abstract] [Full Text] [PDF]


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CirculationHome page
B. Fletcher, K. Berra, P. Ades, L. T. Braun, L. E. Burke, J. L. Durstine, J. M. Fair, G. F. Fletcher, D. Goff, L. L. Hayman, et al.
Managing Abnormal Blood Lipids: A Collaborative Approach
Circulation, November 15, 2005; 112(20): 3184 - 3209.
[Abstract] [Full Text] [PDF]


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Am. J. Physiol. Regul. Integr. Comp. Physiol.Home page
T. J. Little, K. L. Feltrin, M. Horowitz, A. J. P. M. Smout, T. Rades, J. H. Meyer, A. N. Pilichiewicz, J. Wishart, and C. Feinle-Bisset
Dose-related effects of lauric acid on antropyloroduodenal motility, gastrointestinal hormone release, appetite, and energy intake in healthy men
Am J Physiol Regulatory Integrative Comp Physiol, October 1, 2005; 289(4): R1090 - R1098.
[Abstract] [Full Text] [PDF]


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Am. J. Clin. Nutr.Home page
M. A Thijssen and R. P Mensink
Small differences in the effects of stearic acid, oleic acid, and linoleic acid on the serum lipoprotein profile of humans
Am. J. Clinical Nutrition, September 1, 2005; 82(3): 510 - 516.
[Abstract] [Full Text] [PDF]


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Am. J. Clin. Nutr.Home page
P. Verhoef, T. van Vliet, M. R Olthof, and M. B Katan
A high-protein diet increases postprandial but not fasting plasma total homocysteine concentrations: a dietary controlled, crossover trial in healthy volunteers
Am. J. Clinical Nutrition, September 1, 2005; 82(3): 553 - 558.
[Abstract] [Full Text] [PDF]


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J. Nutr.Home page
M. L. Fernandez and K. L. West
Mechanisms by which Dietary Fatty Acids Modulate Plasma Lipids1
J. Nutr., September 1, 2005; 135(9): 2075 - 2078.
[Abstract] [Full Text] [PDF]


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J. Nutr.Home page
A. L. Lock, C. A. M. Horne, D. E. Bauman, and A. M. Salter
Butter Naturally Enriched in Conjugated Linoleic Acid and Vaccenic Acid Alters Tissue Fatty Acids and Improves the Plasma Lipoprotein Profile in Cholesterol-Fed Hamsters
J. Nutr., August 1, 2005; 135(8): 1934 - 1939.
[Abstract] [Full Text] [PDF]


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Am. J. Clin. Nutr.Home page
P. T Williams, P. J Blanche, R. Rawlings, and R. M Krauss
Concordant lipoprotein and weight responses to dietary fat change in identical twins with divergent exercise levels 1
Am. J. Clinical Nutrition, July 1, 2005; 82(1): 181 - 187.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
J. B. Keogh, J. A. Grieger, M. Noakes, and P. M. Clifton
Flow-Mediated Dilatation Is Impaired by a High-Saturated Fat Diet but Not by a High-Carbohydrate Diet
Arterioscler Thromb Vasc Biol, June 1, 2005; 25(6): 1274 - 1279.
[Abstract] [Full Text] [PDF]


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Am. J. Clin. Nutr.Home page
G. Bos, J. M Dekker, E. J. Feskens, M. C Ocke, G. Nijpels, C. D. Stehouwer, L. M Bouter, R. J Heine, and H. Jansen
Interactions of dietary fat intake and the hepatic lipase -480C->T polymorphism in determining hepatic lipase activity: the Hoorn Study
Am. J. Clinical Nutrition, April 1, 2005; 81(4): 911 - 915.
[Abstract] [Full Text] [PDF]


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Am J EpidemiolHome page
K. Oh, F. B. Hu, J. E. Manson, M. J. Stampfer, and W. C. Willett
Dietary Fat Intake and Risk of Coronary Heart Disease in Women: 20 Years of Follow-up of the Nurses' Health Study
Am. J. Epidemiol., April 1, 2005; 161(7): 672 - 679.
[Abstract] [Full Text] [PDF]


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Am. J. Clin. Nutr.Home page
C. Bellido, J. Lopez-Miranda, L. M. Blanco-Colio, P. Perez-Martinez, F. J. Muriana, J. L. Martin-Ventura, C. Marin, P. Gomez, F. Fuentes, J. Egido, et al.
Butter and walnuts, but not olive oil, elicit postprandial activation of nuclear transcription factor {kappa}B in peripheral blood mononuclear cells from healthy men
Am. J. Clinical Nutrition, December 1, 2004; 80(6): 1487 - 1491.
[Abstract] [Full Text] [PDF]


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J. Lipid Res.Home page
S. Desroches, M.-E. Paradis, M. Perusse, W. R. Archer, J. Bergeron, P. Couture, N. Bergeron, and B. Lamarche
Apolipoprotein A-I, A-II, and VLDL-B-100 metabolism in men: comparison of a low-fat diet and a high-monounsaturated fatty acid diet
J. Lipid Res., December 1, 2004; 45(12): 2331 - 2338.
[Abstract] [Full Text] [PDF]


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Diabetes CareHome page
L. C. Tapsell, L. J. Gillen, C. S. Patch, M. Batterham, A. Owen, M. Bare, and M. Kennedy
Including Walnuts in a Low-Fat/Modified-Fat Diet Improves HDL Cholesterol-to-Total Cholesterol Ratios in Patients With Type 2 Diabetes
Diabetes Care, December 1, 2004; 27(12): 2777 - 2783.
[Abstract] [Full Text] [PDF]


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Am. J. Clin. Nutr.Home page
J B. German and C. J Dillard
Saturated fats: what dietary intake?
Am. J. Clinical Nutrition, September 1, 2004; 80(3): 550 - 559.
[Abstract] [Full Text] [PDF]


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Diabetes CareHome page
M.-P. St-Onge, I. Janssen, and S. B. Heymsfield
Metabolic Syndrome in Normal-Weight Americans: New definition of the metabolically obese, normal-weight individual
Diabetes Care, September 1, 2004; 27(9): 2222 - 2228.
[Abstract] [Full Text] [PDF]


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Am J EpidemiolHome page
M. U. Jakobsen, K. Overvad, J. Dyerberg, M. Schroll, and B. L. Heitmann
Dietary Fat and Risk of Coronary Heart Disease: Possible Effect Modification by Gender and Age
Am. J. Epidemiol., July 15, 2004; 160(2): 141 - 149.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
N. R. Matthan, F. K. Welty, P. H. R. Barrett, C. Harausz, G. G. Dolnikowski, J. S. Parks, R. H. Eckel, E. J. Schaefer, and A. H. Lichtenstein
Dietary Hydrogenated Fat Increases High-Density Lipoprotein apoA-I Catabolism and Decreases Low-Density Lipoprotein apoB-100 Catabolism in Hypercholesterolemic Women
Arterioscler Thromb Vasc Biol, June 1, 2004; 24(6): 1092 - 1097.
[Abstract] [Full Text]


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J. Am. Coll. Nutr.Home page
K. Meksawan, D. R. Pendergast, J. J. Leddy, M. Mason, P. J. Horvath, and A. B. Awad
Effect of Low and High Fat Diets on Nutrient Intakes and Selected Cardiovascular Risk Factors in Sedentary Men and Women
J. Am. Coll. Nutr., April 1, 2004; 23(2): 131 - 140.
[Abstract] [Full Text] [PDF]


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Health Aff (Millwood)Home page
M. M. Mello, E. B. Rimm, and D. M. Studdert
The McLawsuit: The Fast-Food Industry And Legal Accountability For Obesity
Health Aff., November 1, 2003; 22(6): 207 - 216.
[Abstract] [Full Text] [PDF]




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