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Dietary fat intake and prevention of cardiovascular disease: systematic review

Dietary fat intake and prevention of cardiovascular disease: systematic review
Dietary fat intake and prevention of cardiovascular disease: systematic review
Objective: To assess the effect of reduction or modification of dietary fat intake on total and cardiovascular mortality and cardiovascular morbidity.
Design: Systematic review.
Data sources: Cochrane Library, Medline, Embase, CAB abstracts, SIGLE, CVRCT registry, and biographies were searched; trials known to experts were included.
Included studies: Randomised controlled trials stating intention to reduce or modify fat or cholesterol intake in healthy adult participants over at least six months. Inclusion decisions, validity, and data extraction were duplicated. Meta-analysis (random effects methodology), meta-regression, and funnel plots were performed.
Results: 27 studies (30 902 person years of observation) were included. Alteration of dietary fat intake had small effects on total mortality (rate ratio 0.98; 95% confidence interval 0.86 to 1.12). Cardiovascular mortality was reduced by 9% (0.91; 0.77 to 1.07) and cardiovascular events by 16% (0.84; 0.72 to 0.99), which was attenuated (0.86; 0.72 to 1.03) in a sensitivity analysis that excluded a trial using oily fish. Trials with at least two years' follow up provided stronger evidence of protection from cardiovascular events (0.76; 0.65 to 0.90).
Conclusions: There is a small but potentially important reduction in cardiovascular risk with reduction or modification of dietary fat intake, seen particularly in trials of longer duration.
What is already known on this topic: The epidemiological relation between dietary fat intake and cardiovascular disease is central in strategies aimed at risk reduction in populations and individuals. Systematic review of randomised controlled trials supports manipulation of dietary fat to control serum lipid concentrations, though evidence of effect on one risk factor does not rule out an opposite or reinforced effect on another unstudied risk factor. Randomised controlled trials of dietary fat reduction or modification have shown varying results on cardiovascular morbidity and mortality
What this study adds: Systematic review of trials of modified fat intake shows that reduction or modification of dietary fat intake results in reductions in cardiovascular events, but only in trials of at least two years' duration. There is little effect on total mortality. Despite decades of effort and many thousands of people randomised, there is still only limited and inconclusive evidence of the effects of modification of total, saturated, monounsaturated, or polyunsaturated fats on cardiovascular morbidity and mortality
0959-8138
757-763
Hooper, Lee
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Summerbell, Carolyn D.
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Higgins, Julian P.T.
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Thompson, Rachel L.
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Capps, Nigel E.
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Smith, George Davey
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Riemersma, Rudolph A.
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Ebrahim, Shah
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Hooper, Lee
180e83a3-39cf-4160-9c34-6ca37632040d
Summerbell, Carolyn D.
7f84df86-5dac-458e-9b49-d939879bc69f
Higgins, Julian P.T.
540c0ce1-7844-42e9-ac58-b748609a85a1
Thompson, Rachel L.
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Capps, Nigel E.
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Smith, George Davey
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Riemersma, Rudolph A.
cd2ac5cd-b7e0-4626-9632-910643b8b3b7
Ebrahim, Shah
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Hooper, Lee, Summerbell, Carolyn D., Higgins, Julian P.T., Thompson, Rachel L., Capps, Nigel E., Smith, George Davey, Riemersma, Rudolph A. and Ebrahim, Shah (2001) Dietary fat intake and prevention of cardiovascular disease: systematic review. BMJ, 322 (7289), 757-763.

Record type: Article

Abstract

Objective: To assess the effect of reduction or modification of dietary fat intake on total and cardiovascular mortality and cardiovascular morbidity.
Design: Systematic review.
Data sources: Cochrane Library, Medline, Embase, CAB abstracts, SIGLE, CVRCT registry, and biographies were searched; trials known to experts were included.
Included studies: Randomised controlled trials stating intention to reduce or modify fat or cholesterol intake in healthy adult participants over at least six months. Inclusion decisions, validity, and data extraction were duplicated. Meta-analysis (random effects methodology), meta-regression, and funnel plots were performed.
Results: 27 studies (30 902 person years of observation) were included. Alteration of dietary fat intake had small effects on total mortality (rate ratio 0.98; 95% confidence interval 0.86 to 1.12). Cardiovascular mortality was reduced by 9% (0.91; 0.77 to 1.07) and cardiovascular events by 16% (0.84; 0.72 to 0.99), which was attenuated (0.86; 0.72 to 1.03) in a sensitivity analysis that excluded a trial using oily fish. Trials with at least two years' follow up provided stronger evidence of protection from cardiovascular events (0.76; 0.65 to 0.90).
Conclusions: There is a small but potentially important reduction in cardiovascular risk with reduction or modification of dietary fat intake, seen particularly in trials of longer duration.
What is already known on this topic: The epidemiological relation between dietary fat intake and cardiovascular disease is central in strategies aimed at risk reduction in populations and individuals. Systematic review of randomised controlled trials supports manipulation of dietary fat to control serum lipid concentrations, though evidence of effect on one risk factor does not rule out an opposite or reinforced effect on another unstudied risk factor. Randomised controlled trials of dietary fat reduction or modification have shown varying results on cardiovascular morbidity and mortality
What this study adds: Systematic review of trials of modified fat intake shows that reduction or modification of dietary fat intake results in reductions in cardiovascular events, but only in trials of at least two years' duration. There is little effect on total mortality. Despite decades of effort and many thousands of people randomised, there is still only limited and inconclusive evidence of the effects of modification of total, saturated, monounsaturated, or polyunsaturated fats on cardiovascular morbidity and mortality

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Published date: 2001

Identifiers

Local EPrints ID: 25640
URI: https://eprints.soton.ac.uk/id/eprint/25640
ISSN: 0959-8138
PURE UUID: c841392b-ef01-412e-98d4-b22849918b3f

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Date deposited: 11 Apr 2006
Last modified: 17 Jul 2017 16:09

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Contributors

Author: Lee Hooper
Author: Carolyn D. Summerbell
Author: Julian P.T. Higgins
Author: Rachel L. Thompson
Author: Nigel E. Capps
Author: George Davey Smith
Author: Rudolph A. Riemersma
Author: Shah Ebrahim

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