Effects on Coronary Heart Disease of Increasing Polyunsaturated Fat in Place of Saturated Fat: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Background:
Reduced saturated fat (SFA) consumption is recommended to reduce coronary heart disease (CHD), but there is an absence of strong supporting evidence from randomized controlled trials (RCTs) of clinical CHD events and few guidelines focus on any specific replacement nutrient. Additionally, some public health groups recommend lowering or limiting polyunsaturated fat (PUFA) consumption, a major potential replacement for SFA.
Methods and Findings:
We systematically investigated and quantified the effects of increased PUFA consumption, as a replacement for SFA, on CHD endpoints in RCTs. RCTs were identified by systematic searches of multiple online databases through June 2009, grey literature sources, hand-searching related articles and citations, and direct contacts with experts to identify potentially unpublished trials. Studies were included if they randomized participants to increased PUFA for at least 1 year without major concomitant interventions, had an appropriate control group, and reported incidence of CHD (myocardial infarction and/or cardiac death). Inclusions/exclusions were adjudicated and data were extracted independently and in duplicate by two investigators and included population characteristics, control and intervention diets, follow-up duration, types of events, risk ratios, and SEs. Pooled effects were calculated using inverse-variance-weighted random effects meta-analysis. From 346 identified abstracts, eight trials met inclusion criteria, totaling 13,614 participants with 1,042 CHD events. Average weighted PUFA consumption was 14.9% energy (range 8.0%–20.7%) in intervention groups versus 5.0% energy (range 4.0%–6.4%) in controls. The overall pooled risk reduction was 19% (RR = 0.81, 95% confidence interval [CI] 0.70–0.95, p = 0.008), corresponding to 10% reduced CHD risk (RR = 0.90, 95% CI = 0.83–0.97) for each 5% energy of increased PUFA, without evidence for statistical heterogeneity (Q-statistic p = 0.13; I2 = 37%). Meta-regression identified study duration as an independent determinant of risk reduction (p = 0.017), with studies of longer duration showing greater benefits.
Conclusions:
These findings provide evidence that consuming PUFA in place of SFA reduces CHD events in RCTs. This suggests that rather than trying to lower PUFA consumption, a shift toward greater population PUFA consumption in place of SFA would significantly reduce rates of CHD.
: Please see later in the article for the Editors' Summary
Vyšlo v časopise:
Effects on Coronary Heart Disease of Increasing Polyunsaturated Fat in Place of Saturated Fat: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. PLoS Med 7(3): e32767. doi:10.1371/journal.pmed.1000252
Kategorie:
Research Article
prolekare.web.journal.doi_sk:
https://doi.org/10.1371/journal.pmed.1000252
Souhrn
Background:
Reduced saturated fat (SFA) consumption is recommended to reduce coronary heart disease (CHD), but there is an absence of strong supporting evidence from randomized controlled trials (RCTs) of clinical CHD events and few guidelines focus on any specific replacement nutrient. Additionally, some public health groups recommend lowering or limiting polyunsaturated fat (PUFA) consumption, a major potential replacement for SFA.
Methods and Findings:
We systematically investigated and quantified the effects of increased PUFA consumption, as a replacement for SFA, on CHD endpoints in RCTs. RCTs were identified by systematic searches of multiple online databases through June 2009, grey literature sources, hand-searching related articles and citations, and direct contacts with experts to identify potentially unpublished trials. Studies were included if they randomized participants to increased PUFA for at least 1 year without major concomitant interventions, had an appropriate control group, and reported incidence of CHD (myocardial infarction and/or cardiac death). Inclusions/exclusions were adjudicated and data were extracted independently and in duplicate by two investigators and included population characteristics, control and intervention diets, follow-up duration, types of events, risk ratios, and SEs. Pooled effects were calculated using inverse-variance-weighted random effects meta-analysis. From 346 identified abstracts, eight trials met inclusion criteria, totaling 13,614 participants with 1,042 CHD events. Average weighted PUFA consumption was 14.9% energy (range 8.0%–20.7%) in intervention groups versus 5.0% energy (range 4.0%–6.4%) in controls. The overall pooled risk reduction was 19% (RR = 0.81, 95% confidence interval [CI] 0.70–0.95, p = 0.008), corresponding to 10% reduced CHD risk (RR = 0.90, 95% CI = 0.83–0.97) for each 5% energy of increased PUFA, without evidence for statistical heterogeneity (Q-statistic p = 0.13; I2 = 37%). Meta-regression identified study duration as an independent determinant of risk reduction (p = 0.017), with studies of longer duration showing greater benefits.
Conclusions:
These findings provide evidence that consuming PUFA in place of SFA reduces CHD events in RCTs. This suggests that rather than trying to lower PUFA consumption, a shift toward greater population PUFA consumption in place of SFA would significantly reduce rates of CHD.
: Please see later in the article for the Editors' Summary
Zdroje
1. DaytonS
PearceML
GoldmanH
HarnishA
PlotkinD
1968 Controlled trial of a diet high in unsaturated fat for prevention of atherosclerotic complications. Lancet 2 1060 1062
2. Medical Research Council 1968 Controlled trial of soya-bean oil in myocardial infarction. Lancet 2 693 699
3. LerenP
1970 The Oslo diet-heart study. Eleven-year report. Circulation 42 935 942
4. TurpeinenO
KarvonenMJ
PekkarinenM
MiettinenM
ElosuoR
1979 Dietary prevention of coronary heart disease: the Finnish Mental Hospital Study. Int J Epidemiol 8 99 118
5. MiettinenM
TurpeinenO
KarvonenMJ
PekkarinenM
PaavilainenE
1983 Dietary prevention of coronary heart disease in women: the Finnish mental hospital study. Int J Epidemiol 12 17 25
6. FrantzIDJr
DawsonEA
AshmanPL
GatewoodLC
BartschGE
1989 Test of effect of lipid lowering by diet on cardiovascular risk. The Minnesota Coronary Survey. Arteriosclerosis 9 129 135
7. BurrML
FehilyAM
GilbertJF
RogersS
HollidayRM
1989 Effects of changes in fat, fish, and fibre intakes on death and myocardial reinfarction: diet and reinfarction trial (DART). Lancet 2 757 761
8. WattsGF
LewisB
BruntJN
LewisES
ColtartDJ
1992 Effects on coronary artery disease of lipid-lowering diet, or diet plus cholestyramine, in the St Thomas' Atherosclerosis Regression Study (STARS). Lancet 339 563 569
9. Siri-TarinoPW
SunQ
HuFB
KraussRM
2010 Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. Am J Clin Nutr [Epub ahead of print, January 13]
10. HooperL
SummerbellCD
HigginsJP
ThompsonRL
CappsNE
2001 Dietary fat intake and prevention of cardiovascular disease: systematic review. Bmj 322 757 763
11. MensinkRP
ZockPL
KesterAD
KatanMB
2003 Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials. Am J Clin Nutr 77 1146 1155
12. U.S. Department of Health and Human Services. U.S. Department of Agriculture 2005 Dietary Guidelines For Americans 2005
13. Dietary Guidelines Advisory Committee 2005 2005 Dietary Guidelines Advisory Committee Report. U.S. Department of Health and Human Services. U.S. Department of Agriculture
14. World Health Organization, FAO 2003 Diet, nutrition and the prevention of chronic diseases: report of a joint WHO/FAO expert consultation (Report 916) Geneva World Health Organization
15. LewingtonS
WhitlockG
ClarkeR
SherlikerP
EmbersonJ
2007 Blood cholesterol and vascular mortality by age, sex, and blood pressure: a meta-analysis of individual data from 61 prospective studies with 55,000 vascular deaths. Lancet 370 1829 1839
16. SummersLK
FieldingBA
BradshawHA
IlicV
BeysenC
2002 Substituting dietary saturated fat with polyunsaturated fat changes abdominal fat distribution and improves insulin sensitivity. Diabetologia 45 369 377
17. SalmeronJ
HuFB
MansonJE
StampferMJ
ColditzGA
2001 Dietary fat intake and risk of type 2 diabetes in women. Am J Clin Nutr 73 1019 1026
18. PischonT
HankinsonSE
HotamisligilGS
RifaiN
WillettWC
2003 Habitual dietary intake of n-3 and n-6 fatty acids in relation to inflammatory markers among US men and women. Circulation 108 155 160
19. De CaterinaR
LiaoJK
LibbyP
2000 Fatty acid modulation of endothelial activation. Am J Clin Nutr 71 213S 223S
20. FerrucciL
CherubiniA
BandinelliS
BartaliB
CorsiA
2006 Relationship of plasma polyunsaturated fatty acids to circulating inflammatory markers. J Clin Endocrinol Metab 91 439 446
21. HamazakiT
OkuyamaH
2003 The Japan Society for Lipid Nutrition recommends to reduce the intake of linoleic acid. A review and critique of the scientific evidence. World Rev Nutr Diet 92 109 132
22. SearsB
2003 The Omega Rx Zone: The Miracle of the New High-Dose Fish Oil New York, NY HarperCollins
23. SimopoulosAP
2008 The importance of the omega-6/omega-3 fatty acid ratio in cardiovascular disease and other chronic diseases. Exp Biol Med (Maywood) 233 674 688
24. Institute of Medicine 2002 Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (Macronutrients) Washington, D.C The National Academies Press
25. MoherD
CookDJ
EastwoodS
OlkinI
RennieD
1999 Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Quality of Reporting of Meta-analyses. Lancet 354 1896 1900
26. MoherD
JadadAR
TugwellP
1996 Assessing the quality of randomized controlled trials. Current issues and future directions. Int J Technol Assess Health Care 12 195 208
27. MoherD
PhamB
JonesA
CookDJ
JadadAR
1998 Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses? Lancet 352 609 613
28. DerSimonianR
LairdN
1986 Meta-analysis in clinical trials. Control Clin Trials 7 177 188
29. TakkoucheB
Cadarso-SuarezC
SpiegelmanD
1999 Evaluation of old and new tests of heterogeneity in epidemiologic meta-analysis. Am J Epidemiol 150 206 215
30. EggerM
Davey SmithG
SchneiderM
MinderC
1997 Bias in meta-analysis detected by a simple, graphical test. BMJ 315 629 634
31. BeggCB
MazumdarM
1994 Operating characteristics of a rank correlation test for publication bias. Biometrics 50 1088 1101
32. RoseGA
ThomsonWB
WilliamsRT
1965 Corn Oil in Treatment of Ischaemic Heart Disease. Br Med J 1 1531 1533
33. DaytonS
PearceML
1969 Diet high in unsaturated fat. A controlled clinical trial. Minn Med 52 1237 1242
34. MiettinenM
TurpeinenO
KarvonenMJ
ElosuoR
PaavilainenE
1972 Effect of cholesterol-lowering diet on mortality from coronary heart-disease and other causes. A twelve-year clinical trial in men and women. Lancet 2 835 838
35. Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto miocardico 1999 Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial. Lancet 354 447 455
36. YokoyamaM
OrigasaH
MatsuzakiM
MatsuzawaY
SaitoY
2007 Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis. Lancet 369 1090 1098
37. GISSI-Heart Failure Investigators 2008 Effect of n-3 polyunsaturated fatty acids in patients with chronic heart failure (the GISSI-HF trial): a randomised, double-blind, placebo-controlled trial. Lancet Aug 29. [Epub ahead of print]
38. JakobsenMU
O'ReillyEJ
HeitmannBL
PereiraMA
BalterK
2009 Major types of dietary fat and risk of coronary heart disease: a pooled analysis of 11 cohort studies. Am J Clin Nutr 89 1425 1432
39. HowardBV
Van HornL
HsiaJ
MansonJE
StefanickML
2006 Low-fat dietary pattern and risk of cardiovascular disease: the Women's Health Initiative Randomized Controlled Dietary Modification Trial. JAMA 295 655 666
40. ZatonskiW
CamposH
WillettW
2008 Rapid declines in coronary heart disease mortality in Eastern Europe are associated with increased consumption of oils rich in alpha-linolenic acid. Eur J Epidemiol 23 3 10
41. MozaffarianD
2005 Does alpha-linolenic acid intake reduce the risk of coronary heart disease? A review of the evidence. Altern Ther Health Med 11 24 30; quiz 31, 79
42. OhK
HuFB
MansonJE
StampferMJ
WillettWC
2005 Dietary fat intake and risk of coronary heart disease in women: 20 years of follow-up of the nurses' health study. Am J Epidemiol 161 672 679
43. MozaffarianD
ClarkeR
2009 Quantitative effects on cardiovascular risk factors and coronary heart disease risk of replacing partially hydrogenated vegetable oils with other fats and oils. Eur J Clin Nutr 63 Suppl 2 S22 33
44. DanaeiG
DingEL
MozaffarianD
TaylorB
RehmJ
2009 The preventable causes of death in the United States: comparative risk assessment of dietary, lifestyle, and metabolic risk factors. PLoS Med 6 Epub 2009 Apr 2028
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