Dietary recommendations for fat intake

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Dietary recommendation

• Not sufficient data to define a Lower Threshold Intake or Tolerable Upper Intake Level for total fat.
• Only a Reference Intake range can be established: 20 – 35 E% for all age groups, except for infants aged 6-12 months (40 E%) and children aged 12-36 months (35- 40 E%.)

• Limit fat intake to 30% of total energy intake or less to reduce the risk of unhealthy weight gain. 

• Minimum total fat intake for adults set at 15 E%, to ensure adequate total energy, essential FA and fat-soluble vitamins. For women of reproductive age as well as adults with BMI <18.5, especially in developing countries, minimum is 20 E%.
• Maximum intake of 30-35 E%.
• For populations with insufficient energy intake, dietary fats are important macronutrients that can 'contribute to increase energy intake to more appropriate levels'.

• Guiding value for adults: 30 E%. Individuals with higher physical activity levels might require higher fat intakes. 

• 'The total fat recommendation is 25–40 E% and is based on the recommended ranges for different fatty acid categories'.

• 'For most individuals, a wide range of total fat intakes is acceptable, and will depend upon individual preferences and characteristics'.
• 'However, fat intakes >35-40% of calories are generally associated with increased intakes of both saturated fat and calories'.
• 'Conversely, a low intake of fats and oils increases the risk of inadequate intakes of vitamin E and of essential fatty acids, and may contribute to unfavourable changes in HDL'.

• Total lipid intake of 35-45 E% is recommended in adults.

• Population average intake at 35 E% maximum to reduce risk of cardiovascular disease and reduce energy density of diets.

• 'In low-fat diets, fats are often replaced with refined carbohydrates and this is of particular concern because such diets are generally associated with dyslipidemia (hypertriglyceridemia and low HDL cholesterol concentrations)'.
• 'dietary advice should put the emphasis on optimizing types of dietary fat and not reducing total fat'.

• 'dietary fat for the healthy adult population should provide 20% to 35% of energy'.

• Acceptable Macronutrient Distribution Range (AMDR) at 20-35 E% for ages >4 yrs., and 30-40% for ages 1-3 yrs.
• 'Active people can probably consume relatively high-fat diets while maintaining their body weight.'

• Most countries recommend limiting total amount of fat consumed. Where quantitative recommendations are made they refer to a maximum of 30% E daily intake from total fat.

• Food based dietary guidelines from several of the WHO European Region countries recommend less than 30 E% daily intake from total fat.

• 'SFA are synthesised by the body and are not required in the diet'.
• 'SFA intake should be as low as is possible within the context of a nutritionally adequate diet.
• 'Limiting the intake of saturated fatty acids should be considered when establishing nutrient goals and recommendations'.

• Reduce saturated fatty acid intake to 10% of total energy intake. 
• Further reducing saturated fatty acid intake to less than 10% of total energy intake might have additional benefits. 
• Replace saturated fatty acids in the diet with polyunsaturated fatty acids (strong recommendation), monounsaturated fatty acids from plant sources or carbohydrates from foods containing naturally occurring dietary fibre, such as whole grains, vegetables, fruits and pulses. 

• Replace SFA with PUFA (omega-3 and omega-6) in the diet; total SFA intake no more than 10 E%.

• Consuming fewer saturated fatty acids (mostly from animal products) and more unsaturated fatty acids has a positive effect on cardiovascular health.

• Intake of saturated fatty acids should be limited to less than 10 E%.

• To improve plasma lipids, SFA intake should be lower than 10 E% and should be further reduced to <7% of total intake in the presence of hypercholesterolaemia.

• 'it is advisable to distinguish the subgroup of ‘lauric, myristic, and palmitic acid, which is atherogenic in the event of excess'- Maximum recommended intake of 8 E%.
• 'Other saturated FAs, particularly the short and medium chains, have no known harmful effect and some of them even have rather beneficial effects. However, at present, it is not possible to establish recommendations for them'
•  Maintain total SFA intake <12 E%.

• Population average contribution of saturated fatty acids to total dietary energy be reduced to no more than 10%.  
• Saturated fats should be substituted with unsaturated fats.

• Recommendations to retain 10 E% as upper limit for SFA intake.
• Replace saturated fat-containing foods with plant sources rich in MUFA, PUFA, and fibre, rather than other animal sources of saturated fat, for reduction in CVD risk.
• Reducing foods high in saturated fat such as butter, processed and unprocessed red meat, and dairy, and substituting or replacing these with a wide range of plant-based food sources, including plant-based protein foods (e.g., beans, peas, and lentils), whole grains, vegetables, or monounsaturated fatty acid (MUFA)- and PUFA-rich vegetable oils and spreads, is associated with cardiovascular disease risk reduction.

• Support for reducing SFA intake for reduced risk of CVD and CVD events.
• Does not recommend specific percentage of SFA reduction or intake.  

• Replacement of saturated fat with dietary monounsaturated and polyunsaturated fats can be beneficial to reduce risk of cardiovascular disease.

• 'It is neither possible nor advisable to achieve zero percent of energy from saturated fatty acids […] in typical diets, since this would require extraordinary dietary changes that may lead to inadequate protein and micronutrient intake, as well as other undesirable effects.
• Recommendation to keep SFA consumption 'as low as possible while consuming a nutritionally adequate diet'.

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Dietary recommendation

• No Dietary Reference Value (DRV) set - MUFA are synthesised in the body, have no known role in preventing or promoting diet-related diseases, and are not indispensable diet constituents

• After accounting for the recommended intakes of saturated and trans fats, the remaining fat intake should come from monounsaturated fatty acids sourced from plant sources. 

• No specific recommendation - WHO notes that determination of MUFA intake (in E%) is unique since it is calculated by difference of TF and SFA & PUFA intake (i.e. MUFA = TF-SFA-PUFA) and 'therefore, the MUFA intake resulting may cover a wide range depending on the total fat intake and dietary fatty acid pattern'.

• MUFA and PUFA 'should constitute at least two thirds of the total fatty acids in the diet.'

• 'Fat intake should predominantly come from sources of monounsaturated fatty acids, including both n-6 and n-3 PUFAs'.

• Range of 15-20 E% for oleic acid.

• Population average intake at 13 E%.

• Limit foods and beverages high in saturated fat by replacing them with unsaturated fats, particularly polyunsaturated fats (PUFA). The replacement with monounsaturated (MUFA) and polyunsaturated fats (PUFA) should prioritise plant-based sources.

• Generally, EU countries recommend using vegetable oils high in MUFA and PUFA instead of animal fats.

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Dietary recommendation

• Adequate Intake for linoleic and α-linolenic acid at 4 and 0.5 E% respectively (based on lowest estimated mean intakes in European populations where deficiency symptoms are absent).
• Adequate Intake for linoleic acid at 4 E% (based on lowest estimated mean intakes in European populations where deficiency symptoms are absent).
• For EPA + DHA, adequate intake of 250 mg daily for adults, based on cardiovascular considerations. Insufficient evidence to set adequate intake levels for children 2-18 yrs., however adult recommendations apply. During pregnancy and lactation, for adequate intake, 100 - 200 mg of DHA should be added to the general recommendation. For older infants (> 6 months and < 24 months) adequate intake of DHA set at 100 mg.

• 6–10% of total energy should come from polyunsaturated fats including linoleic acid, α-linolenic acid and long chain polyunsaturated fatty acids.

• For the purpose of lowering LDL and total cholesterol concentration, increasing HDL and decreasing the risk of CHD, recommended total PUFA consumption should be 6 -11 E%.
• To prevent deficiency, minimum intake should be 2.5 E% and 0.5 E% for linoleic and α-linolenic acid respectively, and range between 2.5 – 3.5 E% for total PUFA
• No specific recommendations for an omega-6 to omega-3 ratio, or linoleic to α-linolenic acid ratio, if intakes are within the above recommendations.
• For adults, 250 mg of EPA +DHA is recommended. For pregnant and lactating women, minimum should be 300 mg, of which at least 200 mg DHA.

• The sum of n-6 and n-3 fatty acids should be 3-4.5 E% depending on age.

• 'The intake of n-6 and n-3 PUFA in total should give 5–10 E%, of which n-3 fatty acids should account for at least 1 E%'.
• 'The recommendation for essential fatty acids is 3 E%, of which at least 0.5 E% should be ALA'.
• MUFA and PUFA 'should make up at least two thirds of the total fatty acids in the diet'.
• 'Linoleic and α-linolenic acids are essential fatty acids and should contribute at least 3 E%, including at least 0.5 E% as a-linolenic acid. For pregnant and lactating women, the essential fatty acids should contribute at least 5 E%, including 1 E% from omega-3 fatty acids of which 200 mg/d should be DHA'. 

• Fat intake should come from sources of MUFAs and both omega-3 and omega-6 PUFAs.
• 'not enough data are available to make a recommendation regarding the optimal n-3/n-6 fatty acid ratio'.

• For linoleic acid and α-linolenic, minimum intakes at 2 E% and 0.8 E% , respectively, while population reference intake set at 4 E% and 1 E% respectively, in adult populations.
• For DHA and EPA, population reference intake at 250 mg/day each, in adults populations.

• Population average intake at 6.5 E%.

• Limit foods and beverages high in saturated fat by replacing them with unsaturated fats, particularly polyunsaturated fats (PUFA). The replacement with monounsaturated (MUFA) and polyunsaturated fats (PUFA) should prioritise plant-based sources.

• Recommends 'increased consumption for n-3 PUFA'.

• Acceptable macronutrient distribution range for omega-6 and omega-3 PUFA set at 5-10 E% and 0.6-1.2 E% respectively for all age groups.

• Generally, EU countries recommend using high-quality vegetable oils high in MUFA and PUFA instead of animal fats.

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Dietary recommendation

• 'Trans fatty acids are not synthesised by the human body and are not required in the diet'.
• 'Dietary TFA are provided by several fats and oils that are also important sources of essential fatty acids and other nutrients. Thus, there is a limit to which the intake of TFA can be lowered without compromising adequacy of intake of essential nutrients'.
• Recommendation for an intake that is 'as low as is possible within the context of a nutritionally adequate diet. Limiting the intake of trans fatty acids should be considered when establishing nutrient goals and recommendations'.

• Limit trans-fatty acid intake to at most 1% of total energy, with additional benefits observed when reduced to below 1% of total energy.
• Replace trans-fatty acids in the diet with polyunsaturated fatty acids or monounsaturated fatty acids primarily from plant sources.

• 'Intake of trans-fatty acids should be kept as low as possible'.

• 'Avoid dietary trans fats'.

• Population average intake at 2 E% maximum.

• Since June 2015 FDA no longer considers iTFAs as 'Generally Recognised As Safe' (GRAS) for human nutrition. 

• 'Intake of trans-fatty acids should be kept low.'

• Recommends limited intake of trans fats

• 'Trans fatty acids confer no known health benefits'.
• 'It is neither possible nor advisable to achieve zero percent of energy from […] TFA in typical diets, since this would require extraordinary dietary changes that may lead to inadequate protein and micronutrient intake, as well as other undesirable effects.
• Recommendation to keep TFA consumption 'as low as possible while consuming a nutritionally adequate diet'.

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Dietary recommendation

• 'Cholesterol is synthesised by the body and is not required in the diet'.
• 'Most dietary cholesterol is obtained from foods which are also significant sources of dietary saturated fatty acids, e.g. dairy and meat products.
• Dietary reference values specifically for dietary cholesterol are not set (besides from recommendations on SFA intake).

• 'The cholesterol intake in the diet should be reduced to (<300 mg/day, particularly in people with high plasma cholesterol levels'.

• 'it seems prudent to recommend lower intake of foods high in dietary cholesterol'.

• No evidence for biological requirement of dietary cholesterol'.
• 'Because cholesterol is unavoidable in ordinary non-vegan diets, eliminating cholesterol in the diet would require significant dietary changes. These changes require careful planning to ensure adequate intakes of proteins and certain micronutrients. Still, it is possible to eat a low cholesterol, yet nutritionally adequate, diet'.
• 'Recommended that people maintain their dietary cholesterol intake as low as possible, while consuming a diet that is nutritionally adequate in all required nutrients'