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

Published on Aug 11, 2015in BMJ27.60
· DOI :10.1136/bmj.h3978
Russell J. de Souza35
Estimated H-index: 35
Andrew Mente30
Estimated H-index: 30
(McMaster University)
+ 8 AuthorsSonia S. Anand74
Estimated H-index: 74
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.
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  • Citations (336)
Published on Dec 1, 2015in Journal of Human Nutrition and Dietetics3.09
Valérie Turcot6
Estimated H-index: 6
(UdeM: Université de Montréal),
J. Brunet1
Estimated H-index: 1
(MHI: Montreal Heart Institute)
+ 3 AuthorsGuillaume Lettre50
Estimated H-index: 50
(UdeM: Université de Montréal)
Background To improve the prevention, treatment and risk prediction of cardiovascular diseases, genetic markers and gene–diet interactions are currently being investigated. The Montreal Heart Institute (MHI) Biobank is suitable for such studies because of its large sample size (currently, n = 17 000), the availability of biospecimens, and the collection of data on dietary intakes of saturated (SFAs) and n-3 and n-6 polyunsaturated (PUFAs) fatty acids estimated from a 14-item food frequency quest...
Published on Jun 10, 2015in Cochrane Database of Systematic Reviews7.75
Lee Hooper51
Estimated H-index: 51
(UEA: University of East Anglia),
Nicole Martin7
Estimated H-index: 7
(Lond: University of London)
+ 1 AuthorsGeorge Davey-Smith177
Estimated H-index: 177
(UoB: 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),...
Published on Jun 1, 2015in Diabetes Care15.27
Qianyi Wang4
Estimated H-index: 4
(Harvard University),
Fumiaki Imamura27
Estimated H-index: 27
(Medical Research Council)
+ 10 AuthorsKenneth J. Mukamal60
Estimated H-index: 60
(BIDMC: Beth Israel Deaconess Medical Center)
OBJECTIVE To investigate the effects of trans fatty acids (TFAs) on type 2 diabetes mellitus (DM) by specific TFA subtype or method of assessment. RESEARCH DESIGN AND METHODS In the Cardiovascular Health Study, plasma phospholipid trans ( t )-16:1n9, t -18:1, and cis ( c ) /t - , t/c - , and t/t -18:2 were measured in blood drawn from 2,919 adults aged 74 ± 5 years and free of prevalent DM in 1992. Dietary TFA was estimated among 4,207 adults free of prevalent DM when dietary questionnaires were...
Published on Mar 10, 2015in Circulation23.05
Janette de Goede12
Estimated H-index: 12
(WUR: Wageningen University and Research Centre),
Sabita S. Soedamah-Muthu25
Estimated H-index: 25
(WUR: Wageningen University and Research Centre)
+ 2 AuthorsDaan Kromhout105
Estimated H-index: 105
(WUR: Wageningen University and Research Centre)
Introduction: Associations of saturated fatty acids (SFA) with coronary heart disease (CHD) may depend on their food source. We examined the association of SFA intake from different food sources, with 15-year incidence of coronary heart disease (CHD) in elderly men in the Netherlands. Methods: Data were collected from 686 elderly men from the Zutphen Elderly Study, aged 65-85 years with no CHD or diabetes mellitus. At baseline (1985), habitual diet was assessed with a cross-check dietary history...
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...
Published on Dec 1, 2014in British Journal of Nutrition3.32
Constance Gayet-Boyer1
Estimated H-index: 1
Fanny Tenenhaus-Aziza1
Estimated H-index: 1
+ 4 AuthorsJean-Michel Chardigny29
Estimated H-index: 29
The effects of ruminant (R) trans-fatty acids (TFA) on the risk of CVD are still under debate. It could be argued that the lack of the effect of R-TFA may be the result of the small amount of their intake. Taking into consideration the growing available data from intervention studies, we carried out a systematic review and meta-regression to assess the impact of R-TFA intake levels on changes in the total cholesterol: HDL-cholesterol (TC:HDL-C) ratio. A systematic review of the literature was co...
Published on Dec 1, 2014in Arteriosclerosis, Thrombosis, and Vascular Biology6.62
Jyrki K. Virtanen28
Estimated H-index: 28
(University of Eastern Finland),
Jaakko Mursu31
Estimated H-index: 31
(University of Eastern Finland)
+ 1 AuthorsSari Voutilainen40
Estimated H-index: 40
(University of Eastern Finland)
Objective— The epidemiological evidence of the role of dietary saturated fatty acids (SFA) in the development of coronary heart disease (CHD) is inconsistent. We investigated the associations of dietary fatty acids with the risk of CHD and carotid atherosclerosis in men with high SFA intake and high rates of CHD. Approach and Results— In total, 1981 men from the population-based Kuopio Ischemic Heart Disease Risk Factor Study (KIHD), aged 42 to 60 years and free of CHD at baseline in 1984 to 198...
Published on Dec 1, 2014in The American Journal of Clinical Nutrition6.57
Ingrid D Santaren2
Estimated H-index: 2
(U of T: University of Toronto),
Steven M. Watkins35
Estimated H-index: 35
+ 5 AuthorsAnthony J. Hanley60
Estimated H-index: 60
(U of T: University of Toronto)
Background: Growing evidence suggests that dairy consumption is associated with lower type 2 diabetes risk. However, observational studies have reported inconsistent results, and few have examined dairy's association with the underlying disorders of insulin resistance and β-cell dysfunction. Objective: We investigated the association of the dairy fatty acid biomarkers pentadecanoic acid (15:0) and trans-palmitoleic acid (trans 16:1n−7) with type 2 diabetes traits by evaluating 1) prospective ass...
Published on Oct 28, 2014in Circulation23.05
Maryam Sadat Farvid1
Estimated H-index: 1
(Shahid Beheshti University of Medical Sciences and Health Services),
Ming Ding10
Estimated H-index: 10
(Harvard University)
+ 5 AuthorsFrank B. Hu202
Estimated H-index: 202
(Harvard University)
Background—Previous studies on intake of linoleic acid (LA), the predominant n-6 fatty acid, and coronary heart disease (CHD) risk have generated inconsistent results. We performed a systematic review and meta-analysis of prospective cohort studies to summarize the evidence regarding the relation of dietary LA intake and CHD risk. Methods and Results—We searched MEDLINE and EMBASE databases through June 2013 for prospective cohort studies that reported the association between dietary LA and CHD ...
Cited By336
Published on Dec 1, 2019in Globalization and Health2.55
Andrea Parziale (Sant'Anna School of Advanced Studies), Gorik Ooms21
Estimated H-index: 21
(Lond: University of London)
Non-communicable diseases in general and cardiovascular diseases in particular are a leading cause of death globally. Trans-fat consumption is a significant risk factor for cardiovascular diseases. The World Health Organization’s ‘REPLACE’ action package of 2018 aims to eliminate it completely in the global food supply by 2023. Legislative and other regulatory actions (i.e., banning trans-fat) are considered as effective means to achieve such a goal. Both wealthier and poorer countries are takin...
Published on Apr 6, 2019in Lipids in Health and Disease2.65
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.
Published on Dec 1, 2019in Scientific Reports4.01
Tilakavati Karupaiah9
Estimated H-index: 9
(Taylors University),
Khun-Aik Chuah1
Estimated H-index: 1
(UKM: National University of Malaysia)
+ 4 AuthorsKalyana Sundram22
Estimated H-index: 22
We conducted this cross-sectional population study with a healthy multi-ethnic urban population (n = 577) in Malaysia, combining nutritional assessments with cardiometabolic biomarkers defined by lipid, atherogenic lipoproteins, inflammation and insulin resistance. We found diametrically opposing associations of carbohydrate (246·6 ± 57·7 g, 54·3 ± 6·5%-TEI) and fat (total = 64·5 ± 19·8 g, 31·6 ± 5·5%-TEI; saturated fat = 14·1 ± 2·7%-TEI) intakes as regards waist circumference, HDL-C, blood pres...
Published on Feb 28, 2019in BMC Public Health2.57
Shooka Mohammadi1
Estimated H-index: 1
(UM: University of Malaya),
Muhammad Yazid Jalaludin9
Estimated H-index: 9
(UM: University of Malaya)
+ 3 AuthorsHazreen Abdul Majid13
Estimated H-index: 13
(UM: University of Malaya)
A sedentary lifestyle and an unhealthy diet are major factors in the increasing prevalence of obesity among Malaysian adolescents. The purpose of this systematic review is to compile the evidence from observational and intervention studies among Malaysian adolescents to evaluate the associations between diet and physical activity (PA) as determinants of cardio-metabolic risk factors. A systematic search of Medline via the PubMed, Science Direct, Cochrane Review and Web of Science databases was c...
Published on 2019in Food Research International3.58
Camila A. Palla5
Estimated H-index: 5
(UNS: Universidad Nacional del Sur),
Juan de Vicente17
Estimated H-index: 17
(UGR: University of Granada)
+ 1 AuthorsMaría José Gálvez ruiz (UGR: University of Granada)
Abstract The oleogelation process has become in a great interest area for the food sector. The aim of this study was to understand the effect of cooling temperature profiles (CTP) applied during oleogelation on microstructure and some macroscopic properties of monoglycerides (MG) oleogels. To this purpose, oleogels from MG and high oleic sunflower oil were produced using programed CTP corresponding to the actual temperature evolution of the samples when they are left at rest to progress in a spe...
Published on May 16, 2019in Nature Reviews Cardiology17.42
Jason H.Y. Wu33
Estimated H-index: 33
(The George Institute for Global Health),
Renata Micha38
Estimated H-index: 38
(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...
Published on Sep 1, 2019in Journal of Functional Foods3.20
Xiaofeng Wang2
Estimated H-index: 2
(U of A: University of Alberta),
Alexandra England (U of A: University of Alberta)+ 2 AuthorsCatherine B. Chan32
Estimated H-index: 32
(U of A: University of Alberta)
Abstract It is largely unknown whether and how trans -11 vaccenic acid (VA), a ruminant trans -fatty acid with health benefits, influences glucose homeostasis in type 2 diabetes (T2D). VA was provided in diet to rats and in vitro to human/rat islets with diabetogenic challenges. Compared to rats with T2D induced by high-fat diet/streptozotocin, T2D + VA animals had improved ambient and fasting blood glucose, β-cell area, in vivo insulin secretion, and ex vivo glucose-stimulated insulin secretion...
Published on Sep 1, 2019in Advances in Nutrition7.24
A. Astrup92
Estimated H-index: 92
(UCPH: University of Copenhagen),
Nina Rica Wium Geiker10
Estimated H-index: 10
(UCPH: University of Copenhagen),
Faidon Magkos43
Estimated H-index: 43
(UCPH: University of Copenhagen)
Published on May 30, 2019in Neurogastroenterology and Motility3.80
Paula Mosińska7
Estimated H-index: 7
(Medical University of Łódź),
Marta Martín-Ruiz1
Estimated H-index: 1
(UAM: Autonomous University of Madrid)
+ 8 AuthorsJakub Fichna26
Estimated H-index: 26
(Medical University of Łódź)
View next paperReduction in saturated fat intake for cardiovascular disease