Table 2

Meta-analyses examining the relationship of dietary fat to mortality and/or cardiovascular events

AuthorNo. of  StudiesSelection criteriaMortality benefit?CVE benefit?Comments
Jakobsen, 200911Cohort studies replacing SFA with MUFA, PUFA or CHO Yes HR 0.74 (95% CI 0.61 to 0.89) for PUFA
Increased mortality with CHO
Yes HR 0.87 (95% CI 0.77 to 0.97) for PUFAMortality=coronary death
CVE=coronary event
Skeaff, 200928Cohort and RCTs examining dietary fat and CHDNo for total fat, SFA, MUFA and PUFA
Increased mortality for TFA
Yes for ω-3 LCPUFA RR 0.82 (95% CI 0.71 to 0.94)
No for total fat, SFA, MUFA, PUFA, ω-3 LCPUFA
Increased CVE for TFA
Mortality=CHD death
CVE=CHD event
Mozaffarian, 20108RCTs that replace SFA with PUFANot reported Yes RR 0.81 (95% CI 0.70 to 0.95)CVE=CHD death or MI
Siri-Tarino, 201021Prospective epidemiological studies of risk of CVD/CHD with SFANot reportedNo RR 1.00 (95% CI 0.89 to 1.11)No association of SFA with increased risk of CVD or CHD
Ramsden, 2013
Sydney Diet Heart
8RCTs that replace SFA with PUFANo RR 0.99 (95% CI 0.82 to 1.19)Not reportedMortality=CV death
Chowdhury, 201432Prospective cohort studies of dietary fatty acid intakeNot reported Yes only for ω-3 LCPUFA RR 0.87 (95% CI 0.78 to 0.97)CVE=coronary outcome
No benefit for SFA, MUFA, LA or ω-6 PUFA
Increased CVE with TFA
Chowdhury, 201419Prospective cohort studies of fatty acid biomarkersNot reportedNoCVE=coronary outcome
No benefit for SFA, MUFA, ω-3 PUFA, ω-6 PUFA, trans FA
Chowdhury, 201427RCTs of fatty acid supplementationNot reportedNoCVE=coronary outcome
No benefit for LA, LC ω-3 PUFA, ω-6 PUFA
Farvid, 201413Prospective cohort studies of dietary LA & CHD events Yes RR 0.79 (95% CI 0.71 to 0.89) Yes RR 0.85 (95% CI 0.78 to 0.92)Mortality=CHD death
CVE=CHD event
Includes unpublished data
Schwingshackl and Hoffman14 201412RCTs that replace SFA with PUFA in secondary preventionNo 0.92 (I2=59%)No 0.85 (I2=75%)
Harcombe, 2016 (updated from 2015)10RCTs examining relationship between dietary fat and  cholesterol with CHDNo RR 0.99 (95% CI 0.94 to 1.05)Not reported
Ramsden, 2016
Minnesota Coronary Experiment
5RCTs that replace SFA with vegetable oil rich in linoleic acidNo RR 1.07 (95% CI 0.90 to 1.27)Not reported
Hooper et al, 7 2015
Cochrane review
15RCTs that reduce/modify fat or cholesterol intake to reduce SFANo RR 0.97 (95% CI 0.90 to 1.05) Yes RR 0.83 (95% CI 0.72 to 0.96)Benefit seen mainly in subgroup of men with fat modification, not fat reduction, and RCTs>2 years duration
Hooper, 2018
Cochrane review
19RCTs that assess ω-6 PUFA on CV outcomesNo RR 1.00 (95% CI 0.88 to 1.12)No RR 0.97 (95% CI 0.81 to 1.15)
Abdelhamid, 2018
Cochrane review
49RCTs that assess PUFA on CV outcomesNo RR 0.98 (95% CI 0.89 to 1.07)No RR 0.89 (95% CI 0.79 to 1.01)
Abdelhamid, 2018
Cochrane review
79RCTs that assess ω-3 PUFA on CV outcomesNo RR 0.98 (95% CI 0.90 to 1.03)No RR 0.99 (95% CI 0.94 to 1.04)
AHA, 20184RCTs that replace SFA with PUFANot reported Yes RR 0.71 (95% CI 0.62 to 0.81)CVE=CHD event
  • AHA, American Heart Association; CHD, coronary  heart   disease; CHO, carbohydrate; CV, cardiovascular; CVD, cardiovascular disease; CVE, cardiovascular event; LA, linolenic acid; LC, long chain; LCPUFA, long-chain polyunsaturated fatty acid; MI, myocardial infarction; MUFA, monounsaturated fatty acid; PUFA, polyunsaturated fatty acid; RCT, randomised controlled trial; RR, risk ratio; SFA, saturated fatty acid; TFA, trans fatty acid; ω-6, omega-6.