Reply to PM Kris-Etherton et al

Department of Medicine, L-465, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR 97201-3098

Dear Sir:

There is no doubt that saturated fats are important dietary constituents in causing coronary heart disease (1). This being the case, it is important that the total saturated fat content of the diet be reduced to 6–8% of total energy, which is a >50% reduction from present intakes. The saturated fat content of the diet is derived from individual foods, of which chocolate is one, as indicated in Table 1 of the editorial (2). Kris-Etherton et al are correct in that, for many people, chocolate may not be a large component of the diet. Yet chocolate is a highly saturated fat containing some 59% of total fatty acids as saturated fat, including palmitic and stearic acids. The total saturated fat content of a typical chocolate bar is 8.1 g. Thus, the consumption of even one chocolate bar per day would use up one-third to one-half of the day's saturated fat allowance. For a 11715-kJ (2800 kcal) diet, this would be 22 g saturated fat; for an 8368-kJ (2000 kcal) diet, the saturated fat allowance would be 16 g.

Also, as is recognized by nutritionists and dietitians, there is a group of people in our society who are particularly fond of chocolate and who consume several chocolate bars or the equivalent each day. For these people, chocolate is an even greater contributor to the day's total intake of saturated fat. Because all saturated fat is potentially pathogenic for coronary heart disease and down-regulates the LDL receptor in the liver for the removal of LDL cholesterol from the blood, it is apparent that all food sources of saturated fat in the diet need to be considered in the prevention of coronary heart disease. Cocoa butter, the parent source of chocolate, was shown in many metabolic experiments to intensely elevate plasma cholesterol concentrations (3, 4).

The other point I tried to make was that the wonderful and even mystical qualities of chocolate should be enjoyed sparingly, perhaps at the time of a celebration or a feast day, and not consumed regularly, because of the high saturated fat content of chocolate.

REFERENCES

1. Hu FB, Stampfer MJ, Manson JE, et al. Dietary saturated fats and their food sources in relation to the risk of coronary heart disease in women. Am J Clin Nutr 1999;70:1001–8.
2. Connor WE. Harbingers of coronary heart disease: dietary saturated fatty acids and cholesterol. Is chocolate benign because of its stearic acid content? Am J Clin Nutr 1999;70:951–2.
3. Ahrens EH, Hirsch J, Insull W, Tsaltas TT, Blomstrand R, Peterson ML. The influence of dietary fats on serum-lipid levels in man. Lancet 1957;1:943.
4. Connor WE, Witiak DT, Stone DB, Armstrong ML. The cholesterol balance and fecal neutral steroid and bile acid excretion in normal men fed dietary fats of different fatty acid composition. J Clin Invest 1969;48:1363–75.