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Because unsaturated fats themselves have beneficial effects on blood lipids, fat war the benefits of eliminating trans or saturated fats would be less if they were replaced by carbohydrate. The second approach calculates risk fat war directly from the strength of the association between trans fat and CHD as observed in epidemiological studies. A pooled estimate of the results reported in the prospective studies (ATBC, HPFS, and NHS) gives a relative risk of 1.31 (1.15, 1.49) for an increase in trans consumption of 2% of energy. Assuming that this relation is causal, the fat war attributable risk would be 24%, or over 100,000 coronary deaths per year. Moreover, according to the results of the HPFS and NHS, it would require a 10% of energy reduction in saturated fat intake to obtain a benefit comparable to that of eliminating trans fat from the U.S. diet. No benefit of reducing saturated fat intake would be predicted by the results of the ATBC. Our first approach, using data from metabolic studies obtained above, assumes that the adverse effects of trans are entirely mediated by their effects on blood levels of LDL and HDL; whereas, the second approach, using results of epidemiological studies, suggests that the increase in risk of CHD caused by trans fat is higher than predicted by effects on blood lipids alone.
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