Dietary intake, biomarkers and supplementation of fatty acids and risk of coronary events: a systematic review and dose-response meta-analysis of randomized controlled trials and prospective observational studies

Abstract

We aimed to review the association of dietary fats and risk of coronary events in adults. We searched PubMed, Embase, CENTRAL, Scopus, and Web of Sciences to April 2022 for prospective cohorts and randomized trials investigating the association of dietary intake and biomarkers of fats and fatty acid interventions and the risk of coronary events. We performed random-effects meta-analyses to estimate relative risk (RR) for the top versus bottom tertiles of exposures. One-hundered sixty-five prospective cohorts and randomized trials were included. Dietary intake and biomarkers of total fat and saturated, monounsaturated, and polyunsaturated fatty acids were not associated with the risk of coronary events. Dietary intake of trans fatty acids, palmitic acid, stearic acid, and saturated fatty acids from meat and unprocessed meat was modestly associated with a higher risk and, in contrast, intake of alpha-linolenic acid, long-chain omega-3 fatty acids, and linoleic acid was modestly associated with a lower risk. Supplementation with long-chain omega-3 fatty acids and increasing the consumption of alpha-linolenic and linoleic acids in place of saturated fats reduced the risk of coronary events. Existing evidence, in its totality, provides a modest support in favor of current recommendations suggesting replacement of saturated fats with polyunsaturated fats.

Keywords:

• Cardiovascular disease
• coronary heart disease
• dietary fats
• meta-analysis
• monounsaturated fatty acids
• polyunsaturated fatty acids
• randomized trials
• saturated fatty acids

Authors’ contributions

AJ and SS-B conceived and designed the study. AJ and AE conducted systematic search, screened articles and read the full texts for eligibility. AJ and SS extracted data from original studies. AJ and SS-B performed risk of bias assessments. AJ performed the analyses. AJ, SS, and AE contributed to the interpretation of the results and wrote the first draft of the manuscript. SS-B and KG contributed to the interpretation of the results and critically revised the manuscript. All authors acknowledge full responsibility for the analyses and interpretation of the report. All authors have read and approved the final manuscript. SS-B is the guarantor. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

Disclosure statement

The authors report no conflict of interest.

Patient and public involvement

Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

Provenance and peer review

Not commissioned; externally peer reviewed.

Data availability statement

Data and analytical codes used for the present study will be available upon reasonable request.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.