Authors’ reply

We would like to thank the authors of the letter for their interest in our review on the impact of polyunsaturated fatty acids (PUFAs) on cardiovascular diseases and the controversies in the results of recent studies.1

In fact, we agree that the majority of patients without regular dietetic consultations lack knowledge on where they are in cardiovascular prevention in terms of dietary habits. It was demonstrated that patients’ knowledge was associated with their behavior and adherence to the lifestyle changes, which should be recognized in preventive programs.2 Of course, the guideline-based recommendations should be communicated to all cardiovascular patients, including suggestions concerning the optimal intake of saturated and unsaturated fatty acids. A simple tool that would help patients establish the levels of fatty acid, as well as other nutrients, is needed and would definitely be beneficial. We agree that most currently available dietary apps were not clinically validated and sometimes could overestimate the energy intake, as Bzikowska-Jura et al3 showed in their paper.

We believe that such a tool might be particularly important in specific populations of patients at very high cardiovascular risk, especially those with concomitant type 2 diabetes. The cardiovascular risk of patients with type 2 diabetes is more than 2-fold higher when compared with nondiabetic individuals.4 This group of patients should pay special attention to diet, especially the intake of simple carbohydrates and the glycemic index of consumed meals. However, as we have shown before, the specific PUFAs concentrations, n–3 to n–6 PUFA ratio, or the amount of saturated and unsaturated fatty acids in this high cardiovascular risk group are of vital importance. Moreover, recent large clinical trials focused our attention to the dose of PUFAs used in the treatment of such populations, especially in the secondary prevention of cardiovascular diseases. Certainly, this type of information taken from this nutrition assessment tool for both patients and physicians would be of great clinical importance.

We are looking forward to seeing the work on fatty acid intake. However, the authors will probably face some limitations. It could be challenging to establish an accurate level of specific subtypes of PUFAs, so essential for cardiovascular protection, for example, eicosapentaenoic (EPA) or docosahexaenoic acids. As we described previously,5 the levels of total saturated or unsaturated fatty acids may impact the secondary prevention of cardiovascular diseases, but recent large randomized clinical trials focused on specific molecules, especially the EPA.