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Meta-Analysis
. 2011 Jul 6:(7):CD002137.
doi: 10.1002/14651858.CD002137.pub2.

Reduced or modified dietary fat for preventing cardiovascular disease

Lee Hooper  1 , Carolyn D Summerbell, Rachel Thompson, Deirdre Sills, Felicia G Roberts, Helen Moore, George Davey Smith
Affiliations
Meta-Analysis

Reduced or modified dietary fat for preventing cardiovascular disease

Lee Hooper et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Reduction and modification of dietary fats have differing effects on cardiovascular risk factors (such as serum cholesterol), but their effects on important health outcomes are less clear.

Objectives: To assess the effect of reduction and/or modification of dietary fats on mortality, cardiovascular mortality, cardiovascular morbidity and individual outcomes including myocardial infarction, stroke and cancer diagnoses in randomised clinical trials of at least 6 months duration.

Search strategy: For this review update, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE, were searched through to June 2010. References of Included studies and reviews were also checked.

Selection criteria: Trials fulfilled the following criteria: 1) randomised with appropriate control group, 2) intention to reduce or modify fat or cholesterol intake (excluding exclusively omega-3 fat interventions), 3) not multi factorial, 4) adult humans with or without cardiovascular disease, 5) intervention at least six months, 6) mortality or cardiovascular morbidity data available.

Data collection and analysis: Participant numbers experiencing health outcomes in each arm were extracted independently in duplicate and random effects meta-analyses, meta-regression, sub-grouping, sensitivity analyses and funnel plots were performed.

Main results: This updated review suggested that reducing saturated fat by reducing and/or modifying dietary fat reduced the risk of cardiovascular events by 14% (RR 0.86, 95% CI 0.77 to 0.96, 24 comparisons, 65,508 participants of whom 7% had a cardiovascular event, I(2) 50%). Subgrouping suggested that this reduction in cardiovascular events was seen in studies of fat modification (not reduction - which related directly to the degree of effect on serum total and LDL cholesterol and triglycerides), of at least two years duration and in studies of men (not of women). There were no clear effects of dietary fat changes on total mortality (RR 0.98, 95% CI 0.93 to 1.04, 71,790 participants) or cardiovascular mortality (RR 0.94, 95% CI 0.85 to 1.04, 65,978 participants). This did not alter with sub-grouping or sensitivity analysis.Few studies compared reduced with modified fat diets, so direct comparison was not possible.

Authors' conclusions: The findings are suggestive of a small but potentially important reduction in cardiovascular risk on modification of dietary fat, but not reduction of total fat, in longer trials. 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 unsaturates. The ideal type of unsaturated fat is unclear.

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Figures

Figure 1
Figure 1. Methodological quality summary: review authors’ judgements about each methodological quality item for each included study
Figure 2
Figure 2. Methodological quality graph: review authors’ judgements about each methodological quality item presented as percentages across all included studies
Figure 3
Figure 3. Funnel plot of comparison: fat modification or reduction vs usual diet - total mortality
Figure 4
Figure 4. Funnel plot of comparison: fat modification or reduction vs usual diet - combined cardiovascular events
Figure 5
Figure 5. Summary of findings, for reduced or modified fat diets vs usual diet (primary outcomes)
Figure 6
Figure 6. Summary of findings, reduced fat vs modified fat diets, cardiovascular events
Figure 7
Figure 7. Summary of findings, reduced or modified dietary fat vs usual diet, important secondary outcomes (myocardial infarction, stroke, cancer diagnosis)
See this image and copyright information in PMC

Update of

Comment in

References

References to studies included in this review

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Additional references

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References to other published versions of this review

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    1. *

    2. Hooper L, Summerbell CD, Higgins JPT, Thompson RL, Capps N, Davey Smith G, et al. Dietary fat intake and prevention of cardiovascular disease: systematic review. BMJ. 2001;322:757–63. - PMC - PubMed

    1. * Indicates the major publication for the study

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