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Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies.
BMJ 2015; 351:h3978BMJ

Abstract

OBJECTIVE

To systematically review associations between intake of saturated fat and trans unsaturated fat and all cause mortality, cardiovascular disease (CVD) and associated mortality, coronary heart disease (CHD) and associated mortality, ischemic stroke, and type 2 diabetes.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Medline, Embase, Cochrane Central Registry of Controlled Trials, Evidence-Based Medicine Reviews, and CINAHL from inception to 1 May 2015, supplemented by bibliographies of retrieved articles and previous reviews.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Observational studies reporting associations of saturated fat and/or trans unsaturated fat (total, industrially manufactured, or from ruminant animals) with all cause mortality, CHD/CVD mortality, total CHD, ischemic stroke, or type 2 diabetes.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently extracted data and assessed study risks of bias. Multivariable relative risks were pooled. Heterogeneity was assessed and quantified. Potential publication bias was assessed and subgroup analyses were undertaken. The GRADE approach was used to evaluate quality of evidence and certainty of conclusions.

RESULTS

For saturated fat, three to 12 prospective cohort studies for each association were pooled (five to 17 comparisons with 90,501-339,090 participants). Saturated fat intake was not associated with all cause mortality (relative risk 0.99, 95% confidence interval 0.91 to 1.09), CVD mortality (0.97, 0.84 to 1.12), total CHD (1.06, 0.95 to 1.17), ischemic stroke (1.02, 0.90 to 1.15), or type 2 diabetes (0.95, 0.88 to 1.03). There was no convincing lack of association between saturated fat and CHD mortality (1.15, 0.97 to 1.36; P=0.10). For trans fats, one to six prospective cohort studies for each association were pooled (two to seven comparisons with 12,942-230,135 participants). Total trans fat intake was associated with all cause mortality (1.34, 1.16 to 1.56), CHD mortality (1.28, 1.09 to 1.50), and total CHD (1.21, 1.10 to 1.33) but not ischemic stroke (1.07, 0.88 to 1.28) or type 2 diabetes (1.10, 0.95 to 1.27). Industrial, but not ruminant, trans fats were associated with CHD mortality (1.18 (1.04 to 1.33) v 1.01 (0.71 to 1.43)) and CHD (1.42 (1.05 to 1.92) v 0.93 (0.73 to 1.18)). Ruminant trans-palmitoleic acid was inversely associated with type 2 diabetes (0.58, 0.46 to 0.74). The certainty of associations between saturated fat and all outcomes was "very low." The certainty of associations of trans fat with CHD outcomes was "moderate" and "very low" to "low" for other associations.

CONCLUSIONS

Saturated fats are not associated with all cause mortality, CVD, CHD, ischemic stroke, or type 2 diabetes, but the evidence is heterogeneous with methodological limitations. Trans fats are associated with all cause mortality, total CHD, and CHD mortality, probably because of higher levels of intake of industrial trans fats than ruminant trans fats. Dietary guidelines must carefully consider the health effects of recommendations for alternative macronutrients to replace trans fats and saturated fats.

Authors+Show Affiliations

Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada Chanchlani Research Centre, McMaster University, Hamilton, ON, Canada Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada Clinical Nutrition and Risk Factor Modification Center, St Michael's Hospital, Toronto, ON, Canada.Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada Chanchlani Research Centre, McMaster University, Hamilton, ON, Canada Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada.Chanchlani Research Centre, McMaster University, Hamilton, ON, Canada.Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada Clinical Nutrition and Risk Factor Modification Center, St Michael's Hospital, Toronto, ON, Canada.Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada Clinical Nutrition and Risk Factor Modification Center, St Michael's Hospital, Toronto, ON, Canada anands@mcmaster.ca.Scotiabank Health Sciences Library, St Michael's Hospital, Toronto, ON, Canada.Hospital Library and Archives, Hospital for Sick Children, Toronto, ON, Canada.Clinical Nutrition and Risk Factor Modification Center, St Michael's Hospital, Toronto, ON, Canada.Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada Department of Medicine, McMaster University, Hamilton, ON, Canada.Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada Chanchlani Research Centre, McMaster University, Hamilton, ON, Canada.Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada Chanchlani Research Centre, McMaster University, Hamilton, ON, Canada Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada Department of Medicine, McMaster University, Hamilton, ON, Canada anands@mcmaster.ca.

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

Language

eng

PubMed ID

26268692

Citation

de Souza, Russell J., et al. "Intake of Saturated and Trans Unsaturated Fatty Acids and Risk of All Cause Mortality, Cardiovascular Disease, and Type 2 Diabetes: Systematic Review and Meta-analysis of Observational Studies." BMJ (Clinical Research Ed.), vol. 351, 2015, pp. h3978.
de Souza RJ, Mente A, Maroleanu A, et al. Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies. BMJ. 2015;351:h3978.
de Souza, R. J., Mente, A., Maroleanu, A., Cozma, A. I., Ha, V., Kishibe, T., ... Anand, S. S. (2015). Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies. BMJ (Clinical Research Ed.), 351, pp. h3978. doi:10.1136/bmj.h3978.
de Souza RJ, et al. Intake of Saturated and Trans Unsaturated Fatty Acids and Risk of All Cause Mortality, Cardiovascular Disease, and Type 2 Diabetes: Systematic Review and Meta-analysis of Observational Studies. BMJ. 2015 Aug 11;351:h3978. PubMed PMID: 26268692.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies. AU - de Souza,Russell J, AU - Mente,Andrew, AU - Maroleanu,Adriana, AU - Cozma,Adrian I, AU - Ha,Vanessa, AU - Kishibe,Teruko, AU - Uleryk,Elizabeth, AU - Budylowski,Patrick, AU - Schünemann,Holger, AU - Beyene,Joseph, AU - Anand,Sonia S, Y1 - 2015/08/11/ PY - 2015/8/14/entrez PY - 2015/8/14/pubmed PY - 2015/10/27/medline SP - h3978 EP - h3978 JF - BMJ (Clinical research ed.) JO - BMJ VL - 351 N2 - OBJECTIVE: To systematically review associations between intake of saturated fat and trans unsaturated fat and all cause mortality, cardiovascular disease (CVD) and associated mortality, coronary heart disease (CHD) and associated mortality, ischemic stroke, and type 2 diabetes. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Medline, Embase, Cochrane Central Registry of Controlled Trials, Evidence-Based Medicine Reviews, and CINAHL from inception to 1 May 2015, supplemented by bibliographies of retrieved articles and previous reviews. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Observational studies reporting associations of saturated fat and/or trans unsaturated fat (total, industrially manufactured, or from ruminant animals) with all cause mortality, CHD/CVD mortality, total CHD, ischemic stroke, or type 2 diabetes. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently extracted data and assessed study risks of bias. Multivariable relative risks were pooled. Heterogeneity was assessed and quantified. Potential publication bias was assessed and subgroup analyses were undertaken. The GRADE approach was used to evaluate quality of evidence and certainty of conclusions. RESULTS: For saturated fat, three to 12 prospective cohort studies for each association were pooled (five to 17 comparisons with 90,501-339,090 participants). Saturated fat intake was not associated with all cause mortality (relative risk 0.99, 95% confidence interval 0.91 to 1.09), CVD mortality (0.97, 0.84 to 1.12), total CHD (1.06, 0.95 to 1.17), ischemic stroke (1.02, 0.90 to 1.15), or type 2 diabetes (0.95, 0.88 to 1.03). There was no convincing lack of association between saturated fat and CHD mortality (1.15, 0.97 to 1.36; P=0.10). For trans fats, one to six prospective cohort studies for each association were pooled (two to seven comparisons with 12,942-230,135 participants). Total trans fat intake was associated with all cause mortality (1.34, 1.16 to 1.56), CHD mortality (1.28, 1.09 to 1.50), and total CHD (1.21, 1.10 to 1.33) but not ischemic stroke (1.07, 0.88 to 1.28) or type 2 diabetes (1.10, 0.95 to 1.27). Industrial, but not ruminant, trans fats were associated with CHD mortality (1.18 (1.04 to 1.33) v 1.01 (0.71 to 1.43)) and CHD (1.42 (1.05 to 1.92) v 0.93 (0.73 to 1.18)). Ruminant trans-palmitoleic acid was inversely associated with type 2 diabetes (0.58, 0.46 to 0.74). The certainty of associations between saturated fat and all outcomes was "very low." The certainty of associations of trans fat with CHD outcomes was "moderate" and "very low" to "low" for other associations. CONCLUSIONS: Saturated fats are not associated with all cause mortality, CVD, CHD, ischemic stroke, or type 2 diabetes, but the evidence is heterogeneous with methodological limitations. Trans fats are associated with all cause mortality, total CHD, and CHD mortality, probably because of higher levels of intake of industrial trans fats than ruminant trans fats. Dietary guidelines must carefully consider the health effects of recommendations for alternative macronutrients to replace trans fats and saturated fats. SN - 1756-1833 UR - https://www.unboundmedicine.com/medline/citation/26268692/Intake_of_saturated_and_trans_unsaturated_fatty_acids_and_risk_of_all_cause_mortality_cardiovascular_disease_and_type_2_diabetes:_systematic_review_and_meta_analysis_of_observational_studies_ L2 - http://www.bmj.com/cgi/pmidlookup?view=long&pmid=26268692 DB - PRIME DP - Unbound Medicine ER -