Dear Ministry of Health,

Your dietary guidelines state:

[1] Recommendations for children state: In general, saturated fat and trans fatty acids increase total and LDL cholesterol (increasing the risk of cardiovascular disease), monounsaturated fatty acids are neutral, and polyunsaturated fatty acids decrease total and LDL cholesterol.

Food and Nutrition Guidelines for Healthy Children and Young People (Aged 2 –18 years)
A background paper
https://www.health.govt.nz/system/files/...

[2] Recommendations for adults state: Choose and/or prepare food and drinks: with unsaturated fats instead of saturated
Reasons for the recommendation: The types of fat people consume affect their risk of cardiovascular disease.
• Reducing saturated fat intake and partially replacing it with unsaturated fats, in
particular polyunsaturated fats, is linked with a decreased risk of cardiovascular
disease (Hooper at al 2015).
• The evidence base underpinning these Guidelines Statements supports eating
patterns that include plant- and marine-based fats, but that are low in saturated fat.
• The recommended intake for saturated fat and trans-fats together is no more than
10 percent of total energy (NHMRC 2006; Nordic Council of Ministers 2014).
https://www.tewhatuora.govt.nz/assets/Fo...

The Cochrane Review (Hooper et al, May 2020) was released in 2020 - the same year dietary guidelines were released. It states:
'We found little or no effect of reducing saturated fat on all-cause mortality (RR 0.96; 95% CI 0.90 to 1.03; 11 trials, 55,858 participants) or cardiovascular mortality (RR 0.95; 95% CI 0.80 to 1.12, 10 trials, 53,421 participants), both with GRADE moderate-quality evidence.

There was little or no effect of reducing saturated fats on non-fatal myocardial infarction (RR 0.97, 95% CI 0.87 to 1.07) or CHD mortality (RR 0.97, 95% CI 0.82 to 1.16, both low-quality evidence), but effects on total (fatal or non-fatal) myocardial infarction, stroke and CHD events (fatal or non-fatal) were all unclear as the evidence was of very low quality. There was little or no effect on cancer mortality, cancer diagnoses, diabetes diagnosis, HDL cholesterol, serum triglycerides or blood pressure, and small reductions in weight, serum total cholesterol, LDL cholesterol and BMI. There was no evidence of harmful effects of reducing saturated fat intakes.'

The Cochrane review did not consider saturated fats and risk in children age 2-18.

OIA REQUEST:

[a] In which month were the 2020 Ministry of Health guidelines published?

[b] Did the Ministry of Health guideline authors (who cited the Hooper 2015 review) consider the May 2020 Cochrane review led by Lee Hooper, and discuss the findings that there was no effect from saturated fat intake across a wide spectrum of health conditions?

[c] Please provide all citations based on your recommendation for ages 2-18 - used to justify the claim that 'saturated fat and trans fatty acids increase total and LDL cholesterol (increasing the risk of cardiovascular disease)' which underpin the recommendation that children aged 2-18 years should lower saturated fat intake.

[d] (a) Has the Ministry of Health ever reviewed the evidence that partial substitution of carbohydrate with either protein and fats can lower blood pressure, improve lipid levels, reduce estimated cardiovascular risk and reduce pre-diabetes and diabetes incidence?

[d] (b) Does the Ministry of Health plan to review this evidence?

(see for example: Appel LJ, Sacks FM, Carey VJ, et al. Effects of Protein, Monounsaturated Fat, and Carbohydrate Intake on Blood Pressure and Serum Lipids: Results of the OmniHeart Randomized Trial. JAMA. 2005;294(19):2455–2464. doi:10.1001/jama.294.19.2455
Unwin D, Delon C, Unwin J, Tobin S, Taylor R. What predicts drug-free type 2 diabetes remission? Insights from an 8-year general practice service evaluation of a lower carbohydrate diet with weight loss. BMJ Nutr Prev Health. 2023 Jan 2;6(1):46-55. doi: 10.1136/bmjnph-2022-000544. PMID: 37559961; PMCID: PMC10407412.)

[e] Has the Ministry of Health reviewed evidence that current dietary guidelines relating to current recommended levels of breads and cereals in the diet may have potential to increase serum lipids and contribute to the development of pre-diabetes and diabetes?
- Preschoolers: at least 4 servings
- Children: at least 5 servings
- Young people: at least 6 servings

Thank you

Yours faithfully,

J Bruning