Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk: A Systematic Review and Meta-analysis
Publication: Annals of Internal Medicine
Volume 160, Number 6
Abstract
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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Supplemental Material
Supplement 1. Tables and Figures
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Information & Authors
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Published In
Annals of Internal Medicine
Volume 160 • Number 6 • 18 March 2014
Pages: 398 - 406
History
Published online: 18 March 2014
Published in issue: 18 March 2014
Keywords
Copyright
© 2014 American College of Physicians.
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Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk: A Systematic Review and Meta-analysis. Ann Intern Med.2014;160:398-406. [Epub 18 March 2014]. doi:10.7326/M13-1788
Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk: A Systematic Review and Meta-analysis. Ann Intern Med.2014;160:398-406. [Epub 18 March 2014]. doi:10.7326/M13-1788
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