Macro partitioning
In normotensive postmenopausal women with high baseline fat intake, replacing total fat with increased carbohydrate and plant-based protein significantly reduces coronary heart disease risk, whereas replacing fat with carbohydrate alone does not.
If you are a normotensive woman with high baseline fat intake, simply lowering fat is not enough to maximize heart health benefits. You must actively replace the calories from fat with plant-based proteins (like beans and legumes) and fiber. Simply replacing fat with refined carbohydrates (like sugar) does not reduce coronary heart disease risk and may even negate the benefits of the low-fat diet.
Intervention group total fat reduction replaced with increased carbohydrate and some protein, especially plant-based protein, was related to lower CHD risk in normotensive women without CVD who reported high baseline total fat intake.
Why this rating
Large randomized clinical trial (WHI) with long-term follow-up and specific subgroup analysis, though self-reported dietary data introduces measurement noise.
Source
Eating Pattern Response to a Low-Fat Diet Intervention and Cardiovascular Outcomes in Normotensive Women: The Women’s Health Initiative
Linda Van Horn et al. · Current Developments in Nutrition · 2020
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