Major types of dietary fat and risk of coronary heart disease: a pooled analysis of 11 cohort studies

Jakobsen, Marianne Uhre; O’Reilly, Éilis J.; Heitmann, Berit Lilienthal; Pereira, Mark A.; Bälter, Katarina; Fraser, Gary E.; Goldbourt, Uri; Hallmans, Göran; Knekt, Paul; Liu, Simin; Pietinen, Pirjo; Spiegelman, Donna; Stevens, June; Virtamo, Jarmo; Willett, Walter C.; Ascherio, Alberto

doi:10.3945/ajcn.2008.27124

Cited by 843 publications

(715 citation statements)

References 32 publications

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“…They estimated a 10% reduction in CHD risk for each 5% of energy of increased PUFA. Thus, in line with the findings of Jakobsen et al (2009) they concluded that replacing saturated fat with PUFA would significantly reduce rates of CHD.…”

Section: Diet-heart Hypothesissupporting

confidence: 67%

“…Details of some of these, together with their general conclusions, are listed in Table 2. Jakobsen et al (2009) used data from 11 European and American cohort studies to try to clarify whether energy from unsaturated fatty acids or carbohydrates should replace that from SFA to prevent CHD. Combined data from 344 696 people followed-up for 4 to 10 years yielded 5249 coronary events and 2155 coronary deaths.…”

Section: Diet-heart Hypothesismentioning

confidence: 99%

“…The latter has found particular favor as it represents a major component of the Mediterranean diet consumed by many countries exhibiting low levels of CVD. Although there are a number of potential components of the Mediterranean diet that may be associated with protection from CVD, the meta-analysis described have produced somewhat conflicting results over the relative efficacy of MUFA, with Jakobsen et al (2009) suggesting no significant effects and Hooper et al (2011) failing to distinguish between MUFA and PUFA.…”

Section: Diet-heart Hypothesismentioning

confidence: 99%

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Dietary fatty acids and cardiovascular disease

Salter

2013

Animal

118

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In 1991, the Committee on Medical Aspects of Food Policy produced a report on the dietary reference values for food energy and nutrients for groups of people in the United Kingdom. The resulting recommendations, which included specific limits for intakes of total, saturated, trans-and cis-polyunsaturated fatty acids (PUFA) have remained a cornerstone of public health policy ever since, and similar recommendations have been adopted by the World Health Organization. These recommendations were made largely on the basis of specific effects of these fatty acids on the risk of developing atherosclerotic cardiovascular disease (CVD). The intervening years have seen a plethora of human epidemiological and intervention trials to further elucidate the specific relationship between dietary fatty acid intake, plasma lipids and lipoproteins and cardiovascular morbidity and mortality. A number of recent meta-analyses and systematic reviews have revisited the role of specific dietary fatty acid classes and CVD risk. In general, these continue to support a link between saturated fatty acids (SFA) and CVD morbidity/mortality. They also highlight the potent adverse effects of trans fatty acids derived from partially hydrogenated vegetable oil. The most recent data suggest that replacing SFA with cis-PUFA (primarily linoleic acid) has the greatest impact on reducing CVD risk. Evidence of specific beneficial effects of n-3 PUFA is generally stronger for secondary, rather than primary, CVD risk, and it is restricted to very long chain fatty acids of marine origin as opposed to alpha-linolenic acid. Taken together, these data suggest that recent focus on dietary n-6-to-n-3 PUFA ratios may have been misguided, and that future strategies should focus on replacing dietary SFA with total PUFA, rather than concentrating on n-6 : n-3 PUFA ratio.

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Section: Diet-heart Hypothesissupporting

confidence: 67%

Section: Diet-heart Hypothesismentioning

confidence: 99%

Section: Diet-heart Hypothesismentioning

confidence: 99%

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Dietary fatty acids and cardiovascular disease

Salter

2013

Animal

118

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“…Assuming that each 1·33 unit changes in the total cholesterol to HDL-cholesterol ratio are associated with a 33 % lower risk of fatal CHD (10) , this difference would translate into no more than a 4 % change in risk if the effects of PUFA were entirely explained by the effects on serum lipids. Jakobsen et al (11) conducted a meta-analysis of the pooled data from cohort studies and estimated that replacement of 5 % SFA with PUFA lowered CHD mortality by closer to 12 %. The analysis of LA intake in the Nurses Health Study suggested a linear reduction in risk of CHD with increasing intakes of up to about 8 % energy intake with no suggestion of adverse effects on CHD mortality (12) .…”

Section: Evidence Using Clinical Endpoints From Prospective Cohort Stmentioning

confidence: 99%

Protective effects of dietary PUFA against chronic disease: evidence from epidemiological studies and intervention trials

Sanders

2013

Proc. Nutr. Soc.

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This review considers evidence for a protective effect of PUFA on chronic disease. Estimates of PUFA intakes in prospective cohort studies are usually based on FFQ or biomarkers of intake. Cohort studies suggest that both linoleic and linolenic acid intake are associated with a lower risk of CHD. The intake of fish, the major source of long-chain n-3 PUFA is associated with a lower risk of both stroke and CHD, particularly sudden cardiac death. No relationship with common sites of cancer (breast and colon) and PUFA has been found. However, some recent studies suggest an association of high intakes of n-3 PUFA with risk of prostate cancer. An updated Cochrane review of dietary fat modification (replacing SFA with PUFA) randomised controlled trials to prevent CHD found a 14 % lower incidence and a non-significant 7 % lower mortality from CHD. The effects of an increased intake of n-3 PUFA on CHD incidence mortality have been tested in patients with pre-existing CHD in randomised controlled trials. Meta-analysis of these trials showed no overall benefit on total mortality or CVD incidence but a trend for lower risk of cardiac death was 0·91 (95 % CI 0·85, 0·98). At present, there is little evidence from other trials demonstrating the clear benefits or harm from increased intakes of PUFA. In conclusion, present evidence intakes benefit from partial replacement of SFA with a balanced mixture of n-6 and n-3 PUFA which may contribute to CVD prevention.

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“…Dietary aspects have been associated with cardiovascular diseases 1 and type 2 diabetes Mellitus 2 . The role of diet as main risk factor, confounding variable, or effect modifier between other factors and these diseases has been analyzed by the main cohort studies in the world.…”

Section: Introductionmentioning

confidence: 99%

Diet assessment in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): Development of a food frequency questionnaire

et al. 2013

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Major types of dietary fat and risk of coronary heart disease: a pooled analysis of 11 cohort studies

Abstract: The associations suggest that replacing SFAs with PUFAs rather than MUFAs or carbohydrates prevents CHD over a wide range of intakes.

Cited by 843 publications

References 32 publications

Dietary fatty acids and cardiovascular disease

Dietary fatty acids and cardiovascular disease

Protective effects of dietary PUFA against chronic disease: evidence from epidemiological studies and intervention trials

Diet assessment in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): Development of a food frequency questionnaire

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