**4. Cholesterol**

SFA on diabetic control, and the ADA nutrition position paper recommends people with diabetes follow the guidelines for the general population, which is 10% according to USDA [109]. Despite insufficient data about effects of SFA on glycemic control, the evidence in many review manuscripts or meta-analyses so far accumulated has indicated that a Mediterranean diet helps prevent type 2 diabetes and causes HbA1c reduction in persons with established diabetes [111–115]. Therefore, food habits to restrict intake of SFA as in the Mediterranean diet is a very

Three Japanese cohort studies have shown that the incidence of brain hemorrhage is inversely related to intake of SFA [116–118], and this moved the JAS to define the lower limit (4.5%) of intake of SFA [35]. This relation has not been demonstrated in meta-analysis of subjects in the US and Europe. There have been no data showing high incidence of stroke in vegetarians who consume very little SFA. Therefore, none of the guidelines in the rest of the world have incorporated the lower limit of intake of SFA. One has to be cautious that limiting SFA in the diet

Intake of 7% of calories as SFA is equivalent to about 15 g of SFA in a person who needs 2000 cal/day. Average intake of SFA is 15.2 and 13.8 g/day for Japanese men and women at the age of 30–49 years old [119], and 31.4 and 20.3 g/day for American men and women at the age of 31–50 years old [120]. It is reasonable that refraining from red meat, processed meat, butter, or SFA-loaded snacks is a simple way to cut SFA in daily food habits. In the US, only approximately 5% of the population consumes less than 7% of their calories from saturated fat [120].

Beneficial effects of PUFA and MUFA seem to be fully recognized in guidelines

Literature has emerged that the biological effects of olive oil differ from those of plant-based MUFA or PUFA. Incorporating data from the PREDIMED study [6], the 2016 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia [121] concretely recommend olive oil (>60 ml/day) and nuts (>30 g/ day) rather than using general terms for MUFA. An authoritative review of dietaries and policies for cardiovascular diseases in 2016 [122] has also listed its daily recommended doses of MUFA and PUFA, such as 10–30 ml/day of soybean oil (MUFA: 22%, PUFA: 56%, and SFA: 15%), extra virgin olive oil (MUFA: 74%, PUFA: 7%, and SFA: 13%), and canola oil (MUFA: 64%, PUFA: 28%, and SFA: 7%). These guidelines provide data of effects on plasma LDL cholesterol and CV events

The differences in guideline recommendations of the fat intake appear to reflect

the differences in food habits and in recognition of the benefits of healthy fats between countries. In 2010, nonoptimal intake of n-6 PUFA, SFA, and trans fat resulted in 710,000, 251,000, and 537,000 deaths from CHD per year worldwide [123]. In 80% of nations, including Japan, China, and other many Asian nations, CHD burdens attributable to n-6 PUFA were 2-fold higher than the SFAattributable burdens. These data indicate that it is more important to focus on increasing healthful n-6 rich vegetable oils in the diet than to focus on replacement

**3.10 Guideline recommendations for dietary intake of PUFA and MUFA**

in the US and Europe (**Table 1**). Guidelines from ADA, ACC/AHA, NLA, and USDA strongly recommend the Mediterranean and DASH diets. Regarding efficacy of decreasing blood glucose, the ADA provides the same recommendation for both PUFA and MUFA [36]. The 2013 AHA/ACC Guideline on Lifestyle Management [38] states that PUFA or MUFA should be used for reducing LDL cholesterol instead

tends to decrease intake of good fat, as PUFA, fish oil, or olive oil.

reasonable strategy in diabetic subjects.

*New Insights into Metabolic Syndrome*

of SFA at the same recommendation level.

by substitution of SFA with PUFA and MUFA.

of SFA and carbohydrates for public health benefits.

**84**
