The effect of replacing saturated fat with mostly n-6 polyunsaturated fat on coronary heart disease: a meta-analysis of randomised controlled trials

Table 1 Results from earlier meta-analyses

Meta-analysis	Search criteria	CHD events	CHD mortality	Total mortality
Skeaff and Miller [14]	Altered PUFA/SFA ratio	0.83 (0.69-1.00)	0.84 (0.62-1.12)	0.88 (0.76-1.02)
Skeaff and Miller [14]	Altered PUFA/SFA ratio	P = 0.050	P = 0.867	P = 0.083
Mozaffarian et al. [19]	Increase in total or n-6 PUFA	0.81 (0.70-0.95)	0.80 (0.65-0.98)	0.98 (0.89-1.08)
Mozaffarian et al. [19]	Increase in total or n-6 PUFA	P = 0.008	P < 0.05
Hooper et al.^a,b [17]	Modified dietary fat	0.82 (0.66-1.02)	0.92 (0.73-1.15)	1.02 (0.88-1.18)
	Modified dietary fat	P = 0.073	P = 0.46	P = 0.81
	Reduced and modified fat	0.77 (0.57-1.03)	0.98 (0.76-1.27)	0.97 (0.76-1.23)
	Reduced and modified fat	P = 0.077	P = 0.88	P = 0.78
Chowdhury et al.^c [3]	n-6 fatty acid supplementation	0.86 (0.69-1.07)	-	-
Schwingshackl and Hoffman^b [20]	PUFA vs. SFA in secondary prevention trials	0.93 (0.72-1.19)	1.05 (0.76-1.44)	0.99 (0.75-1.29)
Schwingshackl and Hoffman^b [20]	PUFA vs. SFA in secondary prevention trials	P = 0.54	P = 0.77	P = 0.91
Harcombe et al.^d [4]	Reduced or modified fat and published by 1983 or earlier	-	0.99 (0.78-1.25)	1.00 (0.87-1.15)
Hooper et al.^b [18]	Reduced SFA	0.83 (0.72-0.96)	0.95 (0.80-1.12)	0.97 (0.90-1.05)
Hooper et al.^b [18]	Reduced SFA	P = 0.013	P = 0.51	P = 0.47
Ramsden et al.^e [5]	Main analysis: replaced SFA with mainly n-6 PUFA	1.07 (0.80-1.41)	1.13 (0.83-1.54)	1.07 (0.90-1.27)
Ramsden et al.^e [5]	Also includes dietary advice only or increased long chain n-3	-	1.00 (0.81-1.24)	1.00 (0.87-1.15)

Data are in relative risk (95% confidence interval). ^aHooper et al. (2012) categorised trials as replacing modified fat or modified and reduced fat, and performed a separate analysis for each category. ^bHooper et al. (2012), Schwingshackl & Hoffmann (2014), and Hooper et al. (2015) analysed CVD events and CVD mortality rather than CHD events and CHD mortality. ^cChowdhury et al. (2014) did not conduct an analysis for CHD mortality or total mortality. ^dHarcombe et al. (2015) did not conduct an analysis for CHD events. ^eRamsden et al. (2016) included trials that replaced SFA with mainly n-6 PUFA in their main analysis and conducted a sensitivity analysis that included a further 3 trials that also increased intake of long chain n-3 PUFA in addition to replacing SFA with mainly n-6 PUFA or where participants were only provided with dietary advice

ISSN: 1475-2891