nutrients Article Dietary Saturated Fats and Health: Are the U.S. Guidelines Evidence-Based? Arne Astrup 1, * , Nina Teicholz 2 , Faidon Magkos 3 , Dennis M. Bier 4 , J. Thomas Brenna 5,6,7 , Janet C. King 8 , Andrew Mente 9,10 , José M. Ordovas 11,12 , Jeff S. Volek 13 , Salim Yusuf 9,14 and Ronald M. Krauss 15,16   Citation: Astrup, A.; Teicholz, N.; Magkos, F.; Bier, D.M.; Brenna, J.T.; King, J.C.; Mente, A.; Ordovas, J.M.; Volek, J.S.; Yusuf, S.; et al. Dietary Saturated Fats and Health: Are the U.S. Guidelines Evidence-Based? Nutrients 2021, 13, 3305. https://doi.org/10.3390/ nu13103305 Academic Editors: Susanna Iossa and Deanna L. Gibson Received: 9 August 2021 Accepted: 16 September 2021 Published: 22 September 2021 Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affil- iations. Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). 1 Healthy Weight Center, Novo Nordisk Foundation, Tuborg Havnevej 19, 2900 Hellerup, Denmark 2 The Nutrition Coalition, New York, NY 10011, USA; nina@nutritioncoalition.us 3 Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark; fma@nexs.ku.dk 4 Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; dbier@bcm.edu 5 Department of Pediatrics, Dell Pediatric Research Institute, University of Texas at Austin, Austin, TX 78723, USA; tbrenna@utexas.edu 6 Department of Chemistry, Dell Pediatric Research Institute, University of Texas at Austin, Austin, TX 78723, USA 7 Department of Nutrition, Dell Pediatric Research Institute, University of Texas at Austin, Austin, TX 78723, USA 8 Departmentof Nutritional Sciences and Toxicology, University of California-Berkeley, Berkeley, CA 94720, USA; jking829@berkeley.edu 9 Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON L8L 2X2, Canada; Andrew.Mente@phri.ca (A.M.); Salim.Yusuf@phri.ca (S.Y.) 10 Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada 11 Nutrition and Genomics Laboratory, Human Nutrition Research Center of Aging, Tufts University, Boston, MA 02111, USA; Jose.Ordovas@tufts.edu 12 IMDEA Food Institute, 28049 Madrid, Spain 13 Department of Human Sciences, Ohio State University, Columbus, OH 43210, USA; volek.1@osu.edu 14 Department of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada 15 Department of Pediatrics, University of California-San Francisco, San Francisco, CA 94609, USA; ronald.krauss@ucsf.edu 16 Department of Medicine, University of California-San Francisco, San Francisco, CA 94609, USA * Correspondence: ARA@novo.dk Abstract: The last decade has seen nearly 20 papers reviewing the totality of the data on saturated fats and cardiovascular outcomes, which, altogether, have demonstrated a lack of rigorous evidence to support continued recommendations either to limit the consumption of saturated fatty acids or to replace them with polyunsaturated fatty acids. These papers were unfortunately not considered by the process leading to the most recent U.S. Dietary Guidelines for Americans, the country’s national nutrition policy, which recently reconfirmed its recommendation to limit saturated fats to 10% or less of total energy intake, based on insufficient and inconsistent evidence. Continuation of a cap on saturated fat intake also fails to consider the important effects of the food matrix and the overall dietary pattern in which saturated fatty acids are consumed. Keywords: saturated fats; polyunsaturated fats; dietary guidelines; Dietary Guidelines for Americans; nutrition guidelines; cardiovascular disease; heart disease; evidence-based 1. Introduction Since the introduction of the U.S. Dietary Guidelines for Americans (DGA) in 1980, national nutrition policy has consistently advised limiting saturated fat consumption as a central strategy for reducing risk for atherosclerotic cardiovascular disease (CVD). Saturated fatty acids are defined as those molecules that are “saturated” by hydrogen, Nutrients 2021, 13, 3305. https://doi.org/10.3390/nu13103305 https://www.mdpi.com/journal/nutrients