Meta-analyses examining the relationship of dietary fat to mortality and/or cardiovascular events
| Author | No. of Studies | Selection criteria | Mortality benefit? | CVE benefit? | Comments |
| Jakobsen, 2009 | 11 | Cohort 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 PUFA | Mortality=coronary death CVE=coronary event |
| Skeaff, 2009 | 28 | Cohort and RCTs examining dietary fat and CHD | No 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, 2010 | 8 | RCTs that replace SFA with PUFA | Not reported | Yes RR 0.81 (95% CI 0.70 to 0.95) | CVE=CHD death or MI |
| Siri-Tarino, 2010 | 21 | Prospective epidemiological studies of risk of CVD/CHD with SFA | Not reported | No 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 | 8 | RCTs that replace SFA with PUFA | No RR 0.99 (95% CI 0.82 to 1.19) | Not reported | Mortality=CV death |
| Chowdhury, 2014 | 32 | Prospective cohort studies of dietary fatty acid intake | Not 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, 2014 | 19 | Prospective cohort studies of fatty acid biomarkers | Not reported | No | CVE=coronary outcome No benefit for SFA, MUFA, ω-3 PUFA, ω-6 PUFA, trans FA |
| Chowdhury, 2014 | 27 | RCTs of fatty acid supplementation | Not reported | No | CVE=coronary outcome No benefit for LA, LC ω-3 PUFA, ω-6 PUFA |
| Farvid, 2014 | 13 | Prospective 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| Yes RR 0.79 (95% CI 0.71 to 0.89) | Yes RR 0.85 (95% CI 0.78 to 0.92) | Mortality=CHD death CVE=CHD event Includes unpublished data |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 2014 | 12 | RCTs that replace SFA with PUFA in secondary prevention | No 0.92 (I2=59%) | No 0.85 (I2=75%) | |
| Harcombe, 2016 (updated from 2015) | 10 | RCTs examining relationship between dietary fat and cholesterol with CHD | No RR 0.99 (95% CI 0.94 to 1.05) | Not reported | |
| Ramsden, 2016 Minnesota Coronary Experiment | 5 | RCTs that replace SFA with vegetable oil rich in linoleic acid | No RR 1.07 (95% CI 0.90 to 1.27) | Not reported | |
| Hooper et al,
7 2015 Cochrane review | 15 | RCTs that reduce/modify fat or cholesterol intake to reduce SFA | No 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 | 19 | RCTs that assess ω-6 PUFA on CV outcomes | No 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 | 49 | RCTs that assess PUFA on CV outcomes | No 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 | 79 | RCTs that assess ω-3 PUFA on CV outcomes | No RR 0.98 (95% CI 0.90 to 1.03) | No RR 0.99 (95% CI 0.94 to 1.04) | |
| AHA, 2018 | 4 | RCTs that replace SFA with PUFA | Not 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.