The letter by the authors of the study reiterates their article's conclusions without ever defending the lack of any reliable data in the article about monounsaturated fatty acids replacing saturated fatty acids. Nor is there a specific defense of the statistical approach they used to generate this "data". See below.
We agree with Dr Roehm that the results of our study do not provide evidence against a protective role of the Mediterranean diet, which was not directly investigated in this study. Our objective was to investigate whether energy intake from unsaturated fatty acids or carbohydrates should replace energy intake from saturated fatty acids to prevent coronary heart disease (1). Our results suggest that replacing saturated fatty acids with polyunsaturated fatty acids rather than monounsaturated fatty acids or carbohydrates prevents coronary heart disease (1). As emphasized by Roehm and stated in our discussion, the main source of monounsaturated fatty acids in the included populations is animal fat. Therefore, our results should not be interpreted in the context of a Mediterranean diet, in which olive oil contributes a large proportion of monounsaturated fat intake.
The author did not declare any conflict of interest.
U Jakobsen on behalf of the coauthors
1. Jakobsen MU, O’Reilly EJ, Heitmann BL, et al. Major types of dietary fat and risk of coronary heart disease: a pooled analysis of 11 cohort studies. Am J Clin Nutr 2009;89:1425–32