Reply to OH Holmqvist

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Abstract
As shown in Table 1 of our article (1), protein intake, especially animal protein, is positively associated with saturated fat because major sources of protein such as red meat also contain high amounts of saturated fat. Therefore, our multivariate analyses controlled for saturated fat intake. We previously published results on saturated fat intake and risk of coronary heart disease in the Nurses' Health Study (2). In this study, 5% of energy from saturated fat, compared with an equivalent amount of energy from carbohydrates, was associated with a nonsignificant 17% greater risk of coronary disease (relative risk: 1.17; 95% CI: 0.97, 1.41; P = 0.10). In metabolic studies, replacing carbohydrates with saturated fat increases not only plasma LDL cholesterol, but also HDL cholesterol (3). The weak effect observed in prospective studies is consistent with the possibility that the proportional increase in plasma HDL-cholesterol concentrations produced by saturated fatty acids largely compensates for the adverse effects of these fatty acids on LDL concentrations.

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