Objective: To determine whether dietary supplementation with a linolenic acid (ALA) can modify established and emerging cardiovascular risk markers. Design: Systematic review and meta-analysis of randomised controlled trials identified by a search of Medline, Embase, Cochrane Controlled Trials Register (CENTRAL), and the metaRegister of Controlled Trials (mRCT). Patients: All human studies were reviewed. Main outcome measures: Changes in concentrations of total cholesterol, low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol, very low density lipoprotein (VLDL) cholesterol, triglyceride, fibrinogen, and fasting plasma glucose, and changes in body mass index, weight, and systolic and diastolic blood pressure.Results: 14 studies with minimum treatment duration of four weeks were reviewed. ALA had a significant effect on three of the 32 outcomes examined in these studies. Concentrations of fibrinogen (0.17 mmol/l, 95% confidence interval (CI) 20.30 to 20.04, p = 0.01) and fasting plasma glucose (0.20 mmol/l, 95% CI 20.30 to 20.10, p , 0.01) were reduced. There was a small but clinically unimportant decrease in HDL (0.01 mmol/l, 95% CI 20.02 to 0.00, p , 0.01). Treatment with ALA did not significantly modify total cholesterol, triglycerides, weight, body mass index, LDL, diastolic blood pressure, systolic blood pressure, VLDL, and apolipoprotein B. Conclusions: Although ALA supplementation may cause small decreases in fibrinogen concentrations and fasting plasma glucose, most cardiovascular risk markers do not appear to be affected. Further trials are needed, but dietary supplementation with ALA to reduce cardiovascular disease cannot be recommended.T he cardiovascular benefits of fish oil are now well established, 1 , but it is unclear whether a linolenic acid (ALA) confers similar benefits. ALA is a plant v-3 fatty acid, precursor of docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), the two main v-3 polyunsaturated fatty acids found in fish oils.2 However, unlike fish oils, ALA is inexpensive to produce and is more palatable than cod liver oil.Clinical trials of dietary supplementation such as the Lyon diet heart study, in which ALA was a component, suggest that ALA may confer cardiovascular benefits.3 This has led to calls for trials specifically evaluating the effect of substituting oils containing ALA.We therefore systematically reviewed randomised controlled trials to investigate the impact of ALA on cardiovascular risk markers.
METHODSWe searched Medline, Embase, and the Cochrane Controlled Trials Register (CENTRAL) databases for published studies and the metaRegister of Controlled Trials (mRCT) for unpublished studies by using the search terms linolenic acid, plant oils, flax, linseed, canola, rapeseed, perilla, juglans, pumpkin, and purslane with a standard search filter to identify randomised controlled trials. We identified additional studies by searching references cited in identified primary studies. We restricted our search to studies of humans and included a...