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Reduction in saturated fat intake for cardiovascular disease

Published on Jun 10, 2015in Cochrane Database of Systematic Reviews 6.75
· DOI :10.1002/14651858.CD011737
Lee Hooper51
Estimated H-index: 51
(University of East Anglia),
Nicole Martin7
Estimated H-index: 7
(University of London)
+ 1 AuthorsGeorge Davey-Smith177
Estimated H-index: 177
(University of Bristol)
Background Reducing saturated fat reduces serum cholesterol, but effects on other intermediate outcomes may be less clear. Additionally it is unclear whether the energy from saturated fats that are lost in the diet are more helpfully replaced by polyunsaturated fats, monounsaturated fats, carbohydrate or protein. This review is part of a series split from and updating an overarching review. Objectives To assess the effect of reducing saturated fat intake and replacing it with carbohydrate (CHO), polyunsaturated (PUFA) or monounsaturated fat (MUFA) and/or protein on mortality and cardiovascular morbidity, using all available randomised clinical trials. Search methods We updated our searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid) and EMBASE (Ovid) on 5 March 2014. We also checked references of included studies and reviews. Selection criteria Trials fulfilled the following criteria: 1) randomised with appropriate control group; 2) intention to reduce saturated fat intake OR intention to alter dietary fats and achieving a reduction in saturated fat; 3) not multifactorial; 4) adult humans with or without cardiovascular disease (but not acutely ill, pregnant or breastfeeding); 5) intervention at least 24 months; 6) mortality or cardiovascular morbidity data available. Data collection and analysis Two review authors working independently extracted participant numbers experiencing health outcomes in each arm, and we performed random-effects meta-analyses, meta-regression, subgrouping, sensitivity analyses and funnel plots. Main results We include 15 randomised controlled trials (RCTs) (17 comparisons, ˜59,000 participants), which used a variety of interventions from providing all food to advice on how to reduce saturated fat. The included long-term trials suggested that reducing dietary saturated fat reduced the risk of cardiovascular events by 17% (risk ratio (RR) 0.83; 95% confidence interval (CI) 0.72 to 0.96, 13 comparisons, 53,300 participants of whom 8% had a cardiovascular event, I² 65%, GRADE moderate quality of evidence), but effects on all-cause mortality (RR 0.97; 95% CI 0.90 to 1.05; 12 trials, 55,858 participants) and cardiovascular mortality (RR 0.95; 95% CI 0.80 to 1.12, 12 trials, 53,421 participants) were less clear (both GRADE moderate quality of evidence). There was some evidence that reducing saturated fats reduced the risk of myocardial infarction (fatal and non-fatal, RR 0.90; 95% CI 0.80 to 1.01; 11 trials, 53,167 participants), but evidence for non-fatal myocardial infarction (RR 0.95; 95% CI 0.80 to 1.13; 9 trials, 52,834 participants) was unclear and there were no clear effects on stroke (any stroke, RR 1.00; 95% CI 0.89 to 1.12; 8 trials, 50,952 participants). These relationships did not alter with sensitivity analysis. Subgrouping suggested that the reduction in cardiovascular events was seen in studies that primarily replaced saturated fat calories with polyunsaturated fat, and no effects were seen in studies replacing saturated fat with carbohydrate or protein, but effects in studies replacing with monounsaturated fats were unclear (as we located only one small trial). Subgrouping and meta-regression suggested that the degree of reduction in cardiovascular events was related to the degree of reduction of serum total cholesterol, and there were suggestions of greater protection with greater saturated fat reduction or greater increase in polyunsaturated and monounsaturated fats. There was no evidence of harmful effects of reducing saturated fat intakes on cancer mortality, cancer diagnoses or blood pressure, while there was some evidence of improvements in weight and BMI. Authors' conclusions The findings of this updated review are suggestive of a small but potentially important reduction in cardiovascular risk on reduction of saturated fat intake. Replacing the energy from saturated fat with polyunsaturated fat appears to be a useful strategy, and replacement with carbohydrate appears less useful, but effects of replacement with monounsaturated fat were unclear due to inclusion of only one small trial. This effect did not appear to alter by study duration, sex or baseline level of cardiovascular risk. Lifestyle advice to all those at risk of cardiovascular disease and to lower risk population groups should continue to include permanent reduction of dietary saturated fat and partial replacement by unsaturated fats. The ideal type of unsaturated fat is unclear.
  • References (681)
  • Citations (138)
Published on Jan 1, 2015
Zoë Harcombe7
Estimated H-index: 7
(University of the West of Scotland),
Julien S. Baker21
Estimated H-index: 21
(University of the West of Scotland)
+ 4 AuthorsFergal M. Grace17
Estimated H-index: 17
(University of the West of Scotland)
Objectives: National dietary guidelines were introduced in 1977 and 1983, by the US and UK governments, respectively, with the ambition of reducing coronary heart disease (CHD) by reducing fat intake. To date, no analysis of the evidence base for these recommendations has been undertaken. The present study examines the evidence from randomised controlled trials (RCTs) available to the US and UK regulatory committees at their respective points of implementation. Methods: A systematic review and m...
75 Citations Source Cite
Published on Dec 1, 2014in Systematic Reviews
Elizabeth Stovold7
Estimated H-index: 7
(St George's, University of London),
Deirdre Beecher10
Estimated H-index: 10
(University of London)
+ 1 AuthorsAnna Noel-Storr19
Estimated H-index: 19
(John Radcliffe Hospital)
Cochrane systematic reviews are conducted and reported according to rigorous standards. A study flow diagram must be included in a new review, and there is clear guidance from the PRISMA statement on how to do this. However, for a review update, there is currently no guidance on how study flow diagrams should be presented. To address this, a working group was formed to find a solution and produce guidance on how to use these diagrams in review updates.
47 Citations Source Cite
Published on Jun 24, 2014in Circulation 18.88
Robert H. Eckel96
Estimated H-index: 96
John M. Jakicic66
Estimated H-index: 66
+ 13 AuthorsSidney C. Smith Mdfacc157
Estimated H-index: 157
Preamble and Transition to ACC/AHA Guidelines to The goals of the American College of Cardiology (ACC) and the American Heart Association (AHA) are to prevent cardiovascular diseases (CVDs); improve the management …
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Published on Jun 24, 2014in Circulation 18.88
Neil J. Stone40
Estimated H-index: 40
Jennifer G. Robinson57
Estimated H-index: 57
+ 13 AuthorsDonald M. Lloyd-Jones83
Estimated H-index: 83
Preamble and Transition to ACC/AHA Guidelines to Reduce Cardiovascular Risk S2 The goals of the …
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Published on Jun 10, 2014in Cochrane Database of Systematic Reviews 6.75
Anita Malhotra3
Estimated H-index: 3
(Government Medical College, Thiruvananthapuram),
Nusrat Shafiq17
Estimated H-index: 17
+ 3 AuthorsSamir Malhotra23
Estimated H-index: 23
Background A cholesterol-lowering diet and several other dietary interventions have been suggested as a management approach either independently or as an adjuvant to drug therapy in children and adults with familial hypercholesterolaemia (FH). However, a consensus has yet to be reached on the most appropriate dietary treatment. Plant sterols are commonly used in FH although patients may know them by other names like phytosterols or stanols. Objectives To examine whether a cholesterol-lowering di...
21 Citations Source Cite
Published on Apr 1, 2014in Heart 5.42
Jbs Board1
Estimated H-index: 1
(British Heart Foundation)
In 1961, the publication of the findings of the Framingham study provided the National Institutes of Health (NIH), the USA, and the world at large with a huge return on the initial investment. Identification of the common risk factors fuelling the epidemic of cardiovascular disease (CVD) stimulated a ‘call to arms’ and the initiation of programmes to attack these targets on a national scale. This has led to stunning declines in CVD mortality over the last 40–50 years in North America, Western Eu...
267 Citations Source Cite
Published on Mar 1, 2014in Thrombosis Research 2.78
Else-Marie Bladbjerg17
Estimated H-index: 17
(University of Southern Denmark),
Thomas Meinert Larsen32
Estimated H-index: 32
(University of Copenhagen)
+ 3 AuthorsA. Astrup92
Estimated H-index: 92
(University of Copenhagen)
Abstract Diet is important in the prevention of cardiovascular disease, and it has been suggested that a high-MUFA diet is more cardioprotective than a low-fat diet. We hypothesised that the postprandial thrombotic risk profile is improved most favourably by a high-MUFA diet compared with a low-fat diet. This was tested in a parallel intervention trial on overweight individuals (aged 28.4 (SD 4.7) years) randomly assigned to a MUFA-diet (35-45% of energy as fat; > 20% as MUFA, n = 21) or a low-f...
5 Citations Source Cite
Published on Feb 1, 2014in The American Journal of Clinical Nutrition 6.55
Khadijeh Mirzaei11
Estimated H-index: 11
(Harvard University),
Min Xu30
Estimated H-index: 30
(Harvard University)
+ 4 AuthorsLu Qi72
Estimated H-index: 72
(Harvard University)
Background: Circadian rhythm has been shown to be related to glucose metabolism and risk of diabetes, probably through effects on energy balance. Recent genome-wide association studies identified variants in circadian rhythm‐related genes (CRY2 and MTNR1B )a ssociated with glucose homeostasis. Objective: We tested whether CRY2 and MTNR1B genotypes affected changes in measures of energy expenditure in response to a weight-loss diet intervention in a 2-y randomized clinical trial, the POUNDS (Prev...
26 Citations Source Cite
Aleix Sala-Vila21
Estimated H-index: 21
Edwin-Saúl Romero-Mamani2
Estimated H-index: 2
+ 10 AuthorsJavier Rekondo7
Estimated H-index: 7
Objective— The Prevencion con Dieta Mediterranea (PREDIMED) trial showed that a Mediterranean diet (MedDiet) supplemented with either extra virgin olive oil or 30 g/d of mixed nuts reduced incident cardiovascular events compared with a control (low fat) diet. The mechanisms of cardiovascular protection afforded by MedDiets remain to be uncovered. We assessed the effect of both supplemented MedDiets on internal carotid intima-media thickness (ICA-IMT) and plaque height, the ultrasound features th...
33 Citations Source Cite
Published on Jan 22, 2014in JAMA 47.66
Miguel Ruiz-Canela26
Estimated H-index: 26
(University of Navarra),
Ramón Estruch73
Estimated H-index: 73
+ 2 AuthorsMiguel A. Martínez-González85
Estimated H-index: 85
(University of Navarra)
The role of nutrition in preventing peripheral artery disease (PAD) remains elusive.1 Mediterranean diets reduce the risk of myocardial infarction and stroke.2,3 They also may reduce the risk of PAD, but this hypothesis has never been tested in a randomized trial. We assessed the association of Mediterranean diets with the occurrence of symptomatic PAD in an exploratory, nonprespecified analysis of a randomized trial.
79 Citations Source Cite
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Published on Mar 4, 2019in BMC Obesity
Marewa Glover17
Estimated H-index: 17
(Massey University),
Marrit Nolte (Wageningen University and Research Centre)+ 6 AuthorsMathu Shanthakumar1
Estimated H-index: 1
(Massey University)
Background New Zealand Pacific and Māori populations measure disproportionately high on the international body mass index (BMI). Information is needed on what behavioural weight loss goals to recommend and how to attract and retain them in interventions. Our team weight loss competition trial for participants with a BMI ≥30 used cash prizes to incentivise completion of nine daily behaviour goals. This paper evaluates the theoretical merit of and adherence to these goals.
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Published on Apr 6, 2019in Lipids in Health and Disease 2.66
Yongjian Zhu (Zhengzhou University), Yacong Bo (Zhengzhou University), Yanhua Liu (Zhengzhou University)
Background Several epidemiological studies have investigated the association between dietary fat intake and cardiovascular disease. However, dietary recommendations based on systematic review and meta-analysis might be more credible.
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Published on Jun 1, 2019in Journal of Functional Foods 3.47
Xiaofeng Wang (University of Alberta), Jianping Wu32
Estimated H-index: 32
(University of Alberta)
Abstract Skin aging is a degenerative process with a tremendous impact on appearance and quality of life, which is believed to be an emerging health issue in accordance with the growing aging population. Lipids play a vital role in skin as a barrier and as building blocks for cell membrane and a variety of bioactive molecules. The latest evidence has indicated that the supplementation of certain types of fatty acids and sterols may modulate skin cell function differentially. This review summariz...
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Published on May 21, 2019in JAMA 47.66
Amanda M. Perak2
Estimated H-index: 2
(Northwestern University),
Hongyan Ning27
Estimated H-index: 27
(Northwestern University)
+ 4 AuthorsDonald M. Lloyd-Jones83
Estimated H-index: 83
(Northwestern University)
Importance Favorable trends occurred in the lipid levels of US youths through 2010, but these trends may be altered by ongoing changes in the food supply, obesity prevalence, and other factors. Objective To analyze trends in levels of lipids and apolipoprotein B in US youths during 18 years from 1999 through 2016. Design, Setting, and Participants Serial cross-sectional analysis of US population–weighted data for youths aged 6 to 19 years from the National Health and Nutrition Examination Survey...
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Published on May 16, 2019in Nature Reviews Cardiology 15.16
Jason H.Y. Wu33
Estimated H-index: 33
(The George Institute for Global Health),
Renata Micha37
Estimated H-index: 37
(Tufts University),
Dariush Mozaffarian113
Estimated H-index: 113
(Tufts University)
The effect of dietary fats on cardiometabolic diseases, including cardiovascular diseases and type 2 diabetes mellitus, has generated tremendous interest. Many earlier investigations focused on total fat and conventional fat classes (such as saturated and unsaturated fats) and their influence on a limited number of risk factors. However, dietary fats comprise heterogeneous molecules with diverse structures, and growing research in the past two decades supports correspondingly complex health effe...
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Published on May 1, 2019in Food Research International 3.52
Cristian Del Bo12
Estimated H-index: 12
(University of Milan),
Valeria Deon3
Estimated H-index: 3
(University of Milan)
+ 4 AuthorsO. Guardamagna19
Estimated H-index: 19
Abstract Children affected by primary hyperlipidemia have a high risk of developing cardiovascular diseases (CVDs) during adulthood. Several studies have reported a positive association between the intake of polyunsaturated fatty acids (PUFAs) and improvements in lipid markers and CVD risk. Dietary supplements may represent a potential strategy in the management of hyperlipidemia. In this context, the effectiveness of hempseed oil (HSO) rich in PUFAs (particularly linoleic acid (LA) and α-linole...
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Published on May 1, 2019in Diabetes Care 13.40
Alison B. Evert4
Estimated H-index: 4
(University of Washington),
Michelle Dennison1
Estimated H-index: 1
+ 11 AuthorsShamera Robinson1
Estimated H-index: 1
(American Diabetes Association)
This Consensus Report is intended to provide clinical professionals with evidence-based guidance about individualizing nutrition therapy for adults with diabetes or prediabetes. Strong evidence supports the efficacy and cost-effectiveness of nutrition therapy as a component of quality diabetes care, including its integration into the medical management of diabetes; therefore, it is important that all members of the health care team know and champion the benefits of nutrition therapy and key nutr...
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Published on May 1, 2019in Clinical Nutrition 5.50
Kati Mokkala6
Estimated H-index: 6
Noora Houttu3
Estimated H-index: 3
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Estimated H-index: 27
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Published on Apr 15, 2019in Nutrients 4.20
Biljana Pokimica1
Estimated H-index: 1
María Teresa García-Conesa1
Estimated H-index: 1
+ 6 AuthorsMaria Glibetic11
Estimated H-index: 11
Chokeberry polyphenols have been suggested to reduce cholesterol and blood pressure and thus protect against cardiovascular diseases (CVD), but the evidence in humans is limited and inconsistent. This randomized double-blinded three-parallel groups trial investigated the changes in various anthropometric and clinical biomarkers, and in plasma phospholipids fatty acids (PPFA) in volunteers at cardiovascular risk after a four-week intervention with 100 mL/day of (1) chokeberry juice with a high-do...
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