Association of dietary, circulating, and supplement fatty acids with coronary risk: a systematic review and meta-analysis
R Chowdhury, S Warnakula, S Kunutsor… - Annals of internal …, 2014 - acpjournals.org
Annals of internal medicine, 2014•acpjournals.org
Background: Guidelines advocate changes in fatty acid consumption to promote
cardiovascular health. Purpose: To summarize evidence about associations between fatty
acids and coronary disease. Data Sources: MEDLINE, Science Citation Index, and
Cochrane Central Register of Controlled Trials through July 2013. Study Selection:
Prospective, observational studies and randomized, controlled trials. Data Extraction:
Investigators extracted data about study characteristics and assessed study biases. Data …
cardiovascular health. Purpose: To summarize evidence about associations between fatty
acids and coronary disease. Data Sources: MEDLINE, Science Citation Index, and
Cochrane Central Register of Controlled Trials through July 2013. Study Selection:
Prospective, observational studies and randomized, controlled trials. Data Extraction:
Investigators extracted data about study characteristics and assessed study biases. Data …
Background
Guidelines advocate changes in fatty acid consumption to promote cardiovascular health.
Purpose
To summarize evidence about associations between fatty acids and coronary disease.
Data Sources
MEDLINE, Science Citation Index, and Cochrane Central Register of Controlled Trials through July 2013.
Study Selection
Prospective, observational studies and randomized, controlled trials.
Data Extraction
Investigators extracted data about study characteristics and assessed study biases.
Data Synthesis
There were 32 observational studies (512 420 participants) of fatty acids from dietary intake; 17 observational studies (25 721 participants) of fatty acid biomarkers; and 27 randomized, controlled trials (105 085 participants) of fatty acid supplementation. In observational studies, relative risks for coronary disease were 1.03 (95% CI, 0.98 to 1.07) for saturated, 1.00 (CI, 0.91 to 1.10) for monounsaturated, 0.87 (CI, 0.78 to 0.97) for long-chain ω-3 polyunsaturated, 0.98 (CI, 0.90 to 1.06) for ω-6 polyunsaturated, and 1.16 (CI, 1.06 to 1.27) for trans fatty acids when the top and bottom thirds of baseline dietary fatty acid intake were compared. Corresponding estimates for circulating fatty acids were 1.06 (CI, 0.86 to 1.30), 1.06 (CI, 0.97 to 1.17), 0.84 (CI, 0.63 to 1.11), 0.94 (CI, 0.84 to 1.06), and 1.05 (CI, 0.76 to 1.44), respectively. There was heterogeneity of the associations among individual circulating fatty acids and coronary disease. In randomized, controlled trials, relative risks for coronary disease were 0.97 (CI, 0.69 to 1.36) for α-linolenic, 0.94 (CI, 0.86 to 1.03) for long-chain ω-3 polyunsaturated, and 0.86 (CI, 0.69 to 1.07) for ω-6 polyunsaturated fatty acid supplementations.
Limitation
Potential biases from preferential publication and selective reporting.
Conclusion
Current evidence does not clearly support cardiovascular guidelines that encourage high consumption of polyunsaturated fatty acids and low consumption of total saturated fats.
Primary Funding Source
British Heart Foundation, Medical Research Council, Cambridge National Institute for Health Research Biomedical Research Centre, and Gates Cambridge.
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