What is the question?

• The question is: What is the relationship between food sources of saturated fat consumed and risk of cardiovascular disease? The population of interest included children and adolescents, and adults and older adults.

Why was this question asked?

• This systematic review was conducted by the 2025 Dietary Guidelines Advisory Committee as part of the process to develop the Dietary Guidelines for Americans, 2025-2030.

How was this question answered?

• The Committee conducted a new systematic review to answer this question with support from the USDA Nutrition Evidence Systematic Review team.  

What is the answer to the question?

Children and adolescents

• A conclusion statement cannot be drawn about dairy sources of saturated fat and different comparators consumed by children and adolescents and the relationship with blood lipids or blood pressure because there is not enough evidence available. Comparators considered included similar food sources with different amounts of total fat; food sources of unsaturated fat, carbohydrate, or protein; or a different food source of saturated fat.
• A conclusion statement cannot be drawn about meat sources of saturated fat (including red meat, processed meat, and white meat) and different comparators consumed by children and adolescents and the relationship with blood lipids or blood pressure because there is no evidence available. Comparators considered included similar food sources with different amounts of total fat; food sources of unsaturated fat, carbohydrate, or protein; or a different food source of saturated fat.
• A conclusion statement cannot be drawn about plant sources higher in saturated fat (such as palm oil, coconut oil, or cocoa butter) and different comparators consumed by children and adolescents and the relationship with blood lipids or blood pressure because there is no evidence available. Comparators considered included similar food sources with different amounts of total fat; food sources of unsaturated fat, carbohydrate, or protein; or a different food source of saturated fat.

Adults and older adults

Dairy sources of saturated fat

• Substituting higher-fat dairy with lower-fat dairy by adults and older adults is not associated with a difference in risk of cardiovascular disease morbidity. This conclusion statement is based on evidence graded as limited.
• A conclusion statement cannot be drawn about the relationship between higher-fat dairy consumption, compared to their lower-fat versions, by adults and older adults and blood lipids, blood pressure and cardiovascular disease mortality because there is not enough evidence available.
• Substituting dairy with food sources of unsaturated fatty acids by adults and older adults may be associated with a lower risk of cardiovascular disease. This conclusion statement is based on evidence graded as limited.
• Replacing butter with plant-based oils and spreads, with predominantly unsaturated fatty acids, by adults and older adults decreases LDL-C levels but does not affect HDL-C or triglyceride levels. This conclusion statement is based on evidence graded as strong.
• Substituting butter with plant-based oils and spreads, with predominantly unsaturated fatty acids, by adults and older adults may be associated with a decreased risk of cardiovascular disease morbidity and mortality. This conclusion statement is based on evidence graded as limited.
• Substituting or replacing one form of dairy (including milk, yogurt, cheese, butter and buttermilk) with another form of dairy by adults and older adults is not associated with a difference in risk of cardiovascular disease. This conclusion statement is based on evidence graded as moderate.
• A conclusion statement cannot be drawn about the relationship between consumption of dairy compared to food sources of carbohydrates and protein by adults and older adults and risk of cardiovascular disease because of substantial concerns with consistency in the body of evidence.

Dairy sources of saturated fat compared to meat sources of saturated fat

• Substituting processed meat and red meat with dairy by adults and older adults is associated with a lower risk of cardiovascular disease morbidity. This conclusion statement is based on evidence graded as moderate.
• A conclusion statement cannot be drawn about the relationship between replacing dairy with meat consumption by adults and older adults and blood lipids, blood pressure, and cardiovascular disease mortality because there is not enough evidence available.  

Meat sources of saturated fat

• Substituting processed or unprocessed red meat with plant sources of protein (such as beans, peas, lentils, nuts, seeds, or soy) by adults and older adults is associated with lower risk of cardiovascular disease morbidity. This conclusion statement is based on evidence graded as moderate.
• Substituting processed or unprocessed red meat with whole grains by adults and older adults is associated with lower risk of cardiovascular disease morbidity. This conclusion statement is based on evidence graded as moderate.
• Substituting processed or unprocessed red meat with vegetables by adults and older adults is associated with lower risk of cardiovascular disease morbidity. This conclusion statement is based on evidence graded as moderate.
• Substituting processed or unprocessed red meat with fish or seafood by adults and older adults may not be associated with risk of cardiovascular disease morbidity. This conclusion statement is based on evidence graded as limited.
• Substituting processed or unprocessed red meat with white meat by adults and older adults is not associated with risk of cardiovascular disease morbidity. This conclusion statement is based on evidence graded as moderate.
• Replacing consumption of lean, unprocessed red meat with lean, unprocessed white meat by adults and older adults may not affect blood lipids or blood pressure. This conclusion statement is based on evidence graded as limited.
• Substituting processed or unprocessed red meat with eggs by adults and older adults is not associated with risk of cardiovascular disease morbidity. This conclusion statement is based on evidence graded as moderate.
• Substituting white meat with plant-based foods by adults and older adults is not associated with risk of cardiovascular disease morbidity. This conclusion statement is based on evidence graded as moderate.
• Substituting white meat with fish or seafood by adults and older adults is not associated with risk of cardiovascular disease morbidity. This conclusion statement is based on evidence graded as moderate.
• A conclusion statement cannot be drawn about the effects of unprocessed meat consumption compared to plant-based foods on blood lipids or blood pressure in adults and older adults because of substantial concerns with consistency of the comparator, directness, risk of bias, and precision in the body of evidence.
• A conclusion statement cannot be drawn about the relationship between consumption of red meat with different amounts of saturated fat by adults and older adults and risk of cardiovascular disease because there is not enough evidence available.
• A conclusion statement cannot be drawn about the relationship between consumption of white meat with different amounts of saturated fat by adults and older adults and risk of cardiovascular disease because there is no evidence available.
• A conclusion statement cannot be drawn about the relationship between consumption of processed red meat compared to unprocessed red meat by adults and older adults and risk of cardiovascular disease because there is not enough evidence available.
• A conclusion statement cannot be drawn about the relationship between consumption of processed white meat compared to unprocessed white meat by adults and older adults and risk of cardiovascular disease because there is no evidence available.  

Meat sources of saturated fat compared to plant sources of saturated fat

• A conclusion statement cannot be drawn about the relationship between consumption of meat sources of saturated fat compared to plant sources of saturated fat by adults and older adults and risk of cardiovascular disease because there is no evidence available.

Plant sources of saturated fat

• Replacing plant sources higher in saturated fat, including coconut oil, cocoa butter, and palm oil, with vegetable oils higher in unsaturated fat, by adults and older adults decreases LDL-C and has no effect on blood pressure. This conclusion statement is based on evidence graded as moderate. 
• Replacing palm olein with vegetable oils higher in unsaturated fat by adults and older adults may not affect blood lipids. This conclusion statement is based on evidence graded as limited.
• A conclusion statement cannot be drawn about the relationship between consumption of plant sources higher in saturated fat, compared to food sources of carbohydrate or protein, by adults and older adults and risk of cardiovascular disease because there is not enough evidence available.
• A conclusion statement cannot be drawn about the relationship between consumption of plant sources higher in saturated fat, compared to a different food source of saturated fat (including dairy, meat, or another plant source of saturated fat), by adults and older adults and risk of cardiovascular disease because there is not enough evidence available.

How up-to-date is this systematic review?

• Conclusion statements from this review are based on articles published between January 1990 and January 2024.

Background

• This systematic review was conducted by the 2025 Dietary Guidelines Advisory Committee as part of the process to develop the Dietary Guidelines for Americans, 2025-2030. The U.S. Departments of Health and Human Services (HHS) and Agriculture (USDA) appointed the 2025 Dietary Guidelines Advisory Committee (Committee) in January 2023 to review evidence on high priority scientific questions related to diet and health. Their review forms the basis of their independent, science-based advice and recommendations to HHS and USDA, which is considered as the Departments develop the next edition of the Dietary Guidelines. As part of that process, the Committee conducted a systematic review with support from the USDA Nutrition Evidence Systematic Review (NESR) team to answer the following question: What is the relationship between food sources of saturated fat consumed and risk of cardiovascular disease?

Methods

• The Committee conducted a systematic review using the methodology of the USDA NESR team. The Committee first developed a protocol. The intervention/exposure of interest is the consumption of food sources of saturated fatty acids (SFA) from: animal sources of saturated fat, such as dairy products (e.g., milk, cheese, yogurt, ice cream); meat (e.g., white meat, red meat, processed meat); solid fats (e.g., butter, ghee, tallow, lard); plant sources of saturated fat, such as tropical food sources/oils (e.g., palm oil, coconut oil, cocoa butter, coconut); and mixed/other food sources (e.g., shortening, baked goods) in children and adolescents (ages 2 up to 19 years), and adults and older adults (19 years and older). The comparators are consumption of similar food sources with different amounts of SFA (e.g., low fat dairy vs full-fat dairy), consumption of a food source of monounsaturated fatty acids (MUFA), or polyunsaturated fatty acids (PUFA) (e.g., oils, nuts, fish), consumption of a food source of carbohydrate and/or protein, and consumption of different food sources of SFA. In children, adolescents, adults and older adults, the outcomes include LDL-C, HDL-C, triglycerides, hyperlipidemia, blood pressure (systolic and diastolic), and hypertension; and in adults and older adults, the outcomes also include cardiovascular disease (CVD) morbidity (e.g., myocardial infarction, coronary heart disease, coronary artery disease, congestive heart failure, peripheral artery disease (PAD), stroke), or composite CVD morbidity and CVD mortality, and CVD-related mortality. Additional criteria were established to include: a) randomized or non-randomized controlled trial, prospective or retrospective cohort, or nested case-control designs, or modeling studies b) published in English in peer-reviewed journals, c) studies in countries classified as high or very high on the Human Development Index, and d) participants with a range of health statuses. The review excluded studies that exclusively enrolled participants who were being treated for a disease. The epidemiologic evidence from food substitution analyses was included in this body of evidence because defining the comparator food of interest among the participants who consume less of the exposure food improves the interpretation of observational analyses and facilitates the appropriate synthesis of evidence across a large diverse body of evidence.
• NESR librarians performed the literature search in PubMed, Embase, and Cochrane to identify articles published between January 1990 and January 2024. Two NESR analysts independently screened all electronic results and the reference lists of included articles based on the pre-determined criteria.
• NESR analysts extracted data, from each included article, with a second analyst verifying accuracy of the extraction. Two NESR analysts independently conducted a formal risk of bias assessment, by study design, for each included article, then reconciled any differences in the assessment. The Committee qualitatively synthesized the evidence, according to the synthesis plan, with attention given to the overarching themes or key concepts from the findings, similarities and differences between studies, and factors that may have affected the results. The Committee developed conclusion statements and graded the strength of the evidence based on its consistency, precision, risk of bias, directness and generalizability.

Results

Children and adolescents

Conclusion statement and grade

• A conclusion statement cannot be drawn about dairy sources of saturated fat and different comparators consumed by children and adolescents and the relationship with blood lipids or blood pressure because there is not enough evidence available. Comparators considered included similar food sources with different amounts of total fat; food sources of unsaturated fat, carbohydrate, or protein; or a different food source of saturated fat. (Grade: Grade Not Assignable)

Summary of the evidence

• Five articles examined dairy sources of saturated fat and different comparators by children and adolescents and blood lipids and blood pressure. Four were randomized controlled trials and 1 was a prospective cohort study.
• The 2025 Committee was not able to draw a conclusion due to critical limitations in the body of evidence. 

Conclusion statement and grade

• A conclusion statement cannot be drawn about meat sources of saturated fat (including red meat, processed meat, and white meat) and different comparators consumed by children and adolescents and the relationship with blood lipids or blood pressure because there is no evidence available. Comparators considered included similar food sources with different amounts of total fat; food sources of unsaturated fat, carbohydrate, or protein; or a different food source of saturated fat. (Grade: Grade Not Assignable)

Summary of the evidence

• No articles examined meat sources of saturated fat consumed by children and adolescents.  

Conclusion statement and grade

• A conclusion statement cannot be drawn about plant sources higher in saturated fat (such as palm oil, coconut oil, or cocoa butter) and different comparators consumed by children and adolescents and the relationship with blood lipids or blood pressure because there is no evidence available. Comparators considered included similar food sources with different amounts of total fat; food sources of unsaturated fat, carbohydrate, or protein; or a different food source of saturated fat. (Grade: Grade Not Assignable)

Summary of the evidence

• No articles examined plant sources higher in saturated fat consumed by children and adolescents.

Adults and older adults

Conclusion statement and grade

• Substituting higher-fat dairy with lower-fat dairy by adults and older adults is not associated with a difference in risk of cardiovascular disease morbidity. This conclusion statement is based on evidence graded as limited. (Grade: Limited)

Summary of the evidence

• Nine articles (15 comparisons) examined the substitution of higher-fat dairy with lower-fat dairy by adults and older adults and risk of cardiovascular disease morbidity. All were prospective cohort studies.
• The direction and effect size of results were similar across studies. 
• The sizes of study groups were adequate or large and variation around the effect estimates were narrow across studies. 
• Few studies were designed and conducted well.
• The populations and outcome measures examined directly represented those of interest in the review. 
• The evidence may not be entirely applicable to the U.S. population, since majority of the studies were not conducted in the U.S.

Conclusion statement and grade

• A conclusion statement cannot be drawn about the relationship between higher-fat dairy consumption, compared to their lower-fat versions, by adults and older adults and blood lipids, blood pressure and cardiovascular disease mortality because there is not enough evidence available. (Grade: Grade Not Assignable)

Summary of the evidence

• Six articles compared higher-fat dairy with lower-fat dairy by adults and older adults and blood lipids, blood pressure and cardiovascular disease mortality. Three were randomized controlled trials and 3 were prospective cohort studies.
• The 2025 Committee was not able to draw a conclusion due to critical limitations in the body of evidence.

Conclusion statement and grade

• Substituting dairy with food sources of unsaturated fatty acids by adults and older adults may be associated with a lower risk of cardiovascular disease. This conclusion statement is based on evidence graded as limited. (Grade: Limited)

Summary of the evidence

• Seven articles (11 comparisons) examined the substitution of dairy with food sources of unsaturated fatty acids by adults and older adults and risk of cardiovascular disease. Two were randomized controlled trials and 5 were prospective cohort studies. 
• The direction and effect size of results were similar across studies.  
• The size of samples was small in some studies. 
• Many studies were designed and conducted well, although there were concerns due to confounding, exposure measurement, potential for selective reporting of results and missing data in a few studies.
• The interventions/exposures and comparators examined may not fully represent those of interest in this review, as some studies used substitution analyses.
• The evidence may not be entirely applicable to the U.S. population, since participants had limited diversity.

Conclusion statement and grade

• Replacing butter with plant-based oils and spreads, with predominantly unsaturated fatty acids, by adults and older adults decreases LDL-C levels but does not affect HDL-C or triglyceride levels. This conclusion statement is based on evidence graded as strong. (Grade: Strong)

Summary of the evidence

• Twelve articles (21 comparisons) examined replacing butter with plant-based oils and spreads by adults and older adults and LDL-C, HDL-C and triglyceride levels. All were randomized controlled trials. 
• The direction and effect size of results were similar across studies.  
• The sizes of study groups were adequate or large and variation around the effect estimates was narrow across studies.  
• Most studies were designed and conducted well, although there was lack of information about randomizations and potential for selective reporting of results in a few studies.
• The populations, intervention and outcome measures examined directly represented those of interest in the review. 
• The evidence may not be entirely applicable to the U.S. population, since the majority of the trials were not conducted in the U.S.

Conclusion statement and grade

• Substituting butter with plant-based oils and spreads, with predominantly unsaturated fatty acids, by adults and older adults may be associated with a decreased risk of cardiovascular disease morbidity and mortality. This conclusion statement is based on evidence graded as limited. (Grade: Limited)

Summary of the evidence

• Six articles (12 comparisons) examined the substitution of butter with plant-based oils and spreads with predominantly unsaturated fatty acids, by adults and older adults and risk of cardiovascular disease morbidity and mortality. All were prospective cohort studies.
• The direction of results and effects sizes were different across studies.
• The sizes of study groups were adequate or large and variation around effect estimates was narrow across studies.
• Studies were designed and conducted well, although there were some concerns with selection of reported results and missing data in a few articles. 
• The interventions/exposures and comparators examined may not fully represent those of interest in this review, as studies primarily used substitution analyses.
• The evidence may not be entirely applicable to the U.S. population, since participants had limited diversity.

Conclusion statement and grade

• Substituting or replacing one form of dairy (including milk, yogurt, cheese, butter and buttermilk) with another form of dairy by adults and older adults is not associated with a difference in risk of cardiovascular disease. This conclusion statement is based on evidence graded as moderate. (Grade: Moderate)

Summary of the evidence

• Ten articles (66 comparisons) examined the substitution or replacement of one form of dairy with another form of dairy by adults and older adults and risk of cardiovascular disease. Six were randomized controlled trials and 4 were prospective cohort studies. 
• The direction and effect size of results were similar across studies.  
• The sizes of study groups were adequate or large and variation around effect estimates was narrow across studies.
• Most studies were designed and conducted well, although there were some concerns with exposure assessment in some studies. 
• The interventions/exposures and comparators examined may not fully represent those of interest in this review, as some studies used substitution analyses.
• The evidence may not be entirely applicable to the U.S. population, since the majority of the studies were not conducted in the U.S.

Conclusion statement and grade

• A conclusion statement cannot be drawn about the relationship between consumption of dairy compared to food sources of carbohydrates and protein by adults and older adults and risk of cardiovascular disease because of substantial concerns with consistency in the body of evidence. (Grade: Grade Not Assignable)

Summary of the evidence

• Twelve articles examined the consumption of dairy compared to food sources of carbohydrates and protein by adults and older adults and risk of cardiovascular disease. Ten were randomized controlled trials and 2 were prospective cohort studies.
• The 2025 Committee was not able to draw a conclusion due to critical limitations in the body of evidence.

Conclusion statement and grade

• Substituting processed meat and red meat with dairy by adults and older adults is associated with a lower risk of cardiovascular disease morbidity. This conclusion statement is based on evidence graded as moderate. (Grade: Moderate)

Summary of the evidence

• Six articles (18 comparisons) examined the substitution of processed meat and red meat with dairy by adults and older adults and risk of cardiovascular disease morbidity. All were prospective cohort studies.
• The direction and effect size of results were similar across studies. 
• The size of study groups was large and variation around effect estimates was narrow across studies.  
• Few studies were designed and conducted well.
• The interventions/exposures and comparators examined may not fully represent those of interest in this review, as studies primarily used substitution analyses.
• The evidence may not be entirely applicable to the U.S. population, since participants had limited diversity.  

Conclusion statement and grade

• A conclusion statement cannot be drawn about the relationship between replacing dairy with meat consumption by adults and older adults and blood lipids, blood pressure, and cardiovascular disease mortality because there is not enough evidence available. (Grade: Grade Not Assignable)

Summary of the evidence

• One article compared replacing dairy with meat consumption by adults and older adults with outcomes including blood lipids, blood pressure and cardiovascular disease mortality. One article was a nested case-control study. 
• The 2025 Committee was not able to draw a conclusion since there is not enough evidence available to answer this question.

Conclusion statement and grade

• Substituting processed or unprocessed red meat with plant sources of protein (such as beans, peas, lentils, nuts, seeds, or soy) by adults and older adults is associated with lower risk of cardiovascular disease morbidity. This conclusion statement is based on evidence graded as moderate. (Grade: Moderate)

Summary of the evidence

• Eight articles (33 comparisons) examined the substitution of processed or unprocessed red meat with plant sources of protein (such as beans, peas, lentils, nuts, seeds, or soy) by adults and older adults and risk of cardiovascular morbidity. All were prospective cohort studies.
• The direction and effect size of results were similar across studies. 
• Sample sizes were large, and variation around the effect estimates was narrow across studies. 
• Some studies were designed and conducted well.
• The interventions/exposures and comparators examined may not fully represent those of interest in this review, as studies primarily used substitution analyses.
• The evidence may not apply to the U.S. population.

Conclusion statement and grade

• Substituting processed or unprocessed red meat with vegetables by adults and older adults is associated with lower risk of cardiovascular disease morbidity. This conclusion statement is based on evidence graded as moderate. (Grade: Moderate)

Summary of the evidence

• Four articles (12 comparisons) examined the substitution of processed or unprocessed red meat with vegetables by adults and older adults and risk of cardiovascular disease morbidity. All were prospective cohort studies.
• The direction and effect size of results were similar across studies. 
• The number of studies was small, but sample sizes were large, and variation around the effect estimates was narrow across studies.
• Some studies were designed and conducted well.
• The interventions/exposures and comparators examined may not fully represent those of interest in this review, as studies primarily used substitution analyses.
• The evidence may not apply to the U.S. population. 

Conclusion statement and grade

• Substituting processed or unprocessed red meat with whole grains by adults and older adults is associated with lower risk of cardiovascular disease morbidity. This conclusion statement is based on evidence graded as moderate. (Grade: Moderate)

Summary of the evidence

• Four articles (9 comparisons) examined the substitution of processed or unprocessed red meat with whole grains by adults and older adults and risk of cardiovascular disease morbidity. All were prospective cohort studies.
• The direction and effect size of results was similar across studies. 
• The number of studies was small, but sample sizes were large, and variation around the effect estimates was narrow across studies.
• Few studies were designed and conducted well.
• The interventions/exposures and comparators examined may not fully represent those of interest in this review, as studies primarily used substitution analyses.
• The evidence may apply across socioeconomic positions in the U.S. but has uncertain generalizability across race and/or ethnicity due to limited representation.

Conclusion statement and grade

• Substituting processed or unprocessed red meat with white meat by adults and older adults is not associated with risk of cardiovascular disease morbidity. This conclusion statement is based on evidence graded as moderate. (Grade: Moderate)

Summary of the evidence

• Eight articles (16 comparisons) examined the substitution of processed or unprocessed red meat with white meat by adults and older adults and risk of cardiovascular disease morbidity. All were prospective cohort studies.
• The direction and effect size of results were similar across studies. 
• Sample sizes were large, and variation around the effect estimates was narrow across studies. 
• Few studies were designed and conducted well.
• The interventions/exposures and comparators examined may not fully represent those of interest in this review, as studies primarily used substitution analyses.
• The evidence may apply across socioeconomic positions in the U.S. but has uncertain generalizability across race and/or ethnicity due to limited representation.

Conclusion statement and grade

• Replacing consumption of lean, unprocessed red meat with lean, unprocessed white meat by adults and older adults may not affect blood lipids or blood pressure. This conclusion statement is based on evidence graded as limited. (Grade: Limited)

Summary of the evidence

• Six articles (6 comparisons) examined replacing consumption of lean, unprocessed red meat with lean, unprocessed white meat by adults and older adults and blood lipids or blood pressure. All were randomized controlled trials.
• Results tended to show no relationship but had some inconsistency. 
• Sample sizes were small.
• Few studies were designed and conducted well.
• The outcomes directly represent those of interest in this review, but the interventions and comparators do not.
• The evidence may not apply to the U.S. population.

Conclusion statement and grade

• Substituting processed or unprocessed red meat with fish or seafood by adults and older adults may not be associated with risk of cardiovascular disease morbidity. This conclusion statement is based on evidence graded as limited. (Grade: Limited)

Summary of the evidence

• Nine articles (25 comparisons) examined the substitution of processed or unprocessed red meat with fish or seafood by adults and older adults and risk of cardiovascular disease morbidity. All were prospective cohort studies.
• Results tended to show no relationship but had some inconsistency.
• Sample sizes were large, and variation around the effect estimates was narrow across studies. 
• Some studies were designed and conducted well.
• The interventions/exposures and comparators examined may not fully represent those of interest in this review, as studies primarily used substitution analyses.
• The evidence may not apply to the U.S. population.

Conclusion statement and grade

• Substituting processed or unprocessed red meat with eggs by adults and older adults is not associated with risk of cardiovascular disease morbidity. This conclusion statement is based on evidence graded as moderate. (Grade: Moderate)

Summary of the evidence

• Seven articles (12 comparisons) examined the substitution of processed or unprocessed red meat with eggs by adults and older adults and risk of cardiovascular disease morbidity. All were prospective cohort studies.
• Results tended to show no relationship but had some inconsistency.
• Sample sizes were large, and variation around the effect estimates was narrow across studies. 
• Few studies were designed and conducted well.
• The interventions/exposures and comparators examined may not fully represent those of interest in this review, as studies primarily used substitution analyses.
• The evidence may not apply to the U.S. population.

Conclusion statement and grade

• Substituting white meat with plant-based foods by adults and older adults is not associated with risk of cardiovascular disease morbidity. This conclusion statement is based on evidence graded as moderate. (Grade: Moderate)

Summary of the evidence

• Six articles (11 comparisons) examined the substitution of white meat with plant-based foods by adults and older adults and risk of cardiovascular disease morbidity. All were prospective cohort studies.
• Results tended to show no relationship but had some inconsistency.
• Sample sizes were large, and variation around the effect estimates was narrow across studies. 
• Some studies were designed and conducted well.
• The interventions/exposures and comparators examined may not fully represent those of interest in this review, as studies primarily used substitution analyses.
• Although most studies were conducted in the U.S., not all populations were diverse in race and/or ethnicity or socioeconomic position.

Conclusion statement and grade

• Substituting white meat with fish or seafood by adults and older adults is not associated with risk of cardiovascular disease morbidity. This conclusion statement is based on evidence graded as moderate. (Grade: Moderate)

Summary of the evidence

• Six articles (10 comparisons) examined the substitution of white meat with fish or seafood by adults and older adults and risk of cardiovascular disease morbidity. All were prospective cohort studies.
• The direction and effect size of results were similar across studies. 
• The number of studies was small, but sample sizes were large, and variation around the effect estimates was narrow across studies.
• Some studies were designed and conducted well.
• The interventions/exposures and comparators examined may not fully represent those of interest in this review, as studies primarily used substitution analyses.
• The evidence may not apply to the U.S. population. 

Conclusion statement and grade

• A conclusion statement cannot be drawn about the effects of unprocessed meat consumption compared to plant foods on blood lipids or blood pressure in adults and older adults because of substantial concerns with consistency of the comparator, directness, risk of bias, and precision in the body of evidence. (Grade: Grade Not Assignable)

Summary of the evidence

• Five articles examined the effects of unprocessed meat consumption compared to plant-based foods in adults and older adults and blood lipids or blood pressure. All were randomized controlled trials. 
• Substantial concerns about study design and inconsistency in study foods and findings prevented synthesis.

Conclusion statement and grade

• A conclusion statement cannot be drawn about the relationship between consumption of red meat with different amounts of saturated fat by adults and older adults and risk of cardiovascular disease because there is not enough evidence available. (Grade: Grade Not Assignable)

Summary of the evidence

• Three articles examined consumption of red meat with different amounts of saturated fat by adults and older adults. Two were randomized controlled trials and 1 was a prospective cohort study. 
• Substantial variability in food sources examined prevented synthesis.

Conclusion statement and grade

• A conclusion statement cannot be drawn about the relationship between consumption of white meat with different amounts of saturated fat by adults and older adults and risk of cardiovascular disease because there is no evidence available. (Grade: Grade Not Assignable)

Summary of the evidence

• No articles examined consumption of white meat with different amounts of saturated fat by adults and older adults.

Conclusion statement and grade

• A conclusion statement cannot be drawn about the relationship between consumption of processed red meat compared to unprocessed red meat by adults and older adults and risk of cardiovascular disease because there is not enough evidence available. (Grade: Grade Not Assignable)

Summary of the evidence

• Six articles compared processed red meat to unprocessed red meat by adults and older adults. One was a randomized controlled trial and 5 were prospective cohort studies. 
• There was not enough evidence for any outcome to allow synthesis.

Conclusion statement and grade

• A conclusion statement cannot be drawn about the relationship between consumption of processed white meat compared to unprocessed white meat by adults and older adults and risk of cardiovascular disease because there is no evidence available. (Grade: Grade Not Assignable)

Summary of the evidence

• No articles compared processed white meat to unprocessed white meat by adults and older adults.

Conclusion statement and grade

• A conclusion statement cannot be drawn about the relationship between consumption of meat sources of saturated fat compared to plant sources of saturated fat by adults and older adults and risk of cardiovascular disease because there is no evidence available. (Grade: Grade Not Assignable)

Summary of the evidence

• No articles compared meat sources of saturated fat to plant sources of saturated fat by adults and older adults.

Conclusion statement and grade

• Replacing plant sources higher in saturated fat, including coconut oil, cocoa butter, and palm oil, with vegetable oils higher in unsaturated fat, by adults and older adults decreases LDL-C and has no effect on blood pressure. This conclusion statement is based on evidence graded as moderate. (Grade: Moderate)

Summary of the evidence

• Nine articles (11 comparisons) examined replacing plant sources higher in saturated fat, including coconut oil, cocoa butter, and palm oil, with vegetable oils higher in unsaturated fat, by adults and older adults and LDL cholesterol and blood pressure. All were randomized controlled trials.
• The direction of results was similar across studies. 
• Sample sizes were small and nearly half of the studies were sufficiently powered.
• Most studies were designed and conducted well, although many did not provide adequate information about the randomization process and most did not have a pre-specified analysis plan. 
• Most of the studies were controlled feeding trials designed to directly address the research question of interest. 
• The evidence may not be entirely applicable to the U.S. population, since few studies were conducted in the U.S. Few studies reported socioeconomic position and race and/or ethnicity. 

Conclusion statement and grade

• Replacing palm olein with vegetable oils higher in unsaturated fat by adults and older adults may not affect blood lipids. This conclusion statement is based on evidence graded as limited. (Grade: Limited)

Summary of the evidence

• Six articles (6 comparisons) examined replacing plant sources higher in saturated fat with vegetable oils higher in unsaturated fat by adults and older adults and blood lipids. All were randomized controlled trials.
• The direction of results was similar across studies. 
• Most of the studies had small sample sizes, with one study being sufficiently powered. 
• Most studies were not designed and conducted well. Some studies had risk of bias primarily due to randomization process, missing outcome data, and selection of reported results. 
• Most of the studies were controlled feeding trials designed to directly address the research question of interest.
• The evidence may not apply to the U.S. population. Few studies reported data on socioeconomic position and race and/or ethnicity. None of the studies were conducted in the United States.

Conclusion statement and grade

• A conclusion statement cannot be drawn about the relationship between consumption of plant sources higher in saturated fat, compared to food sources of carbohydrate or protein, by adults and older adults and risk of cardiovascular disease because there is not enough evidence available. (Grade: Grade Not Assignable)

Summary of the evidence

• Two articles examined consumption of plant sources higher in saturated fat, compared to food sources of carbohydrate or protein, by adults and older adults and risk of cardiovascular disease. Both were randomized controlled trials.
• The 2025 Committee was not able to draw a conclusion since there is not enough evidence available to answer this question.

Conclusion statement and grade

• A conclusion statement cannot be drawn about the relationship between consumption of plant sources higher in saturated fat, compared to a different food source of saturated fat (including dairy, meat, or another plant source of saturated fat), by adults and older adults and risk of cardiovascular disease because there is not enough evidence available. (Grade: Grade Not Assignable)

Summary of the evidence

• Six articles examined consumption of plant sources higher in saturated fat, compared to a different food source of saturated fat by adults and older adults and risk of cardiovascular disease. All were randomized controlled trials.
• The 2025 Committee was not able to draw a conclusion since there is not enough evidence available to answer this question.

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Suggested citation: Gardner C, Hoelscher DM, Tobias D, Anderson CAM, Taylor C, Booth S, Deierlein A, Fung T, Giovannucci E, Raynor H, Stanford FC, Talegawkar S, Raghavan R, Kingshipp BJ, Kim JH, Cole NC, Higgins M, Huang S, Reigh N, Butera G, Terry N, Obbagy J. Food Sources of Saturated Fat and Risk of Cardiovascular Disease: A Systematic Review. November 2024. U.S. Department of Agriculture, Food and Nutrition Service, Center for Nutrition Policy and Promotion, Nutrition Evidence Systematic Review. Available at: https://doi.org/10.52570/NESR.DGAC2025.SR24