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Era of fat modification trials
1. Replacing saturated fat with
polyunsaturated fat in randomized
trials with coronary heart disease
(CHD) endpoints, ie. “fat
modication trials”
Results from 6 meta-analyses published
2009-2014 including trials performed mainly
1960-1970
Updated and modified May 20141
2. Core principle in most fat
modification studies*
2
substitution
*) Simplification. In reality, some other parts of the experimental diets
have changed at the same time such as oily fish intake, trans fat
intake, etc.
3. 1960 1970 1990 2009-2014
Era of the pivotal fat modification trials *
Oslo Diet
Heart 1958-
1964
Finnish Mental
Hospital 1959-1971
Lyon Heart
1988-1992
MRC Soy 1968
STARS 1992
Minnesota
Coronary Survey
1968-1973
LA Veterans
1969
DART 1989
Rose Corn Oil
1965
40 years later
Still new insights
from these old
studies:
Skeaff & Milelr
2009, Mente 2009,
Mozaffarian et al
2010
Ramsden et
al.2010
Hooper et al 2011
Chowdhury et al.
2014.
*) if the exact years not given, the publication date. Many of the studies are
not pure fat mofication trials even if often called categori as such
Sydney Diet Heart
1966-1973
4. The key results regarding
coronary heart disease
Meta-analyses published 2009-2014
4
5. Mente et al. 2009 –No effect (CHD event)
5
Mente A et al. Arch Intern Med. 2009 Apr 13;169(7):659-69.
6. Skeaff & Miller 2009 –Borderline
beneficial effect (CHD event and CHD
death)
6
Skeaff CM & Miller J. Ann Nutr Metab 2009;55:173–201
7. Mozaffarian et al. 2010 –Beneficial
effect (any CHD event)
Mozaffarian et al. PLoS Medicine.2010; 7(3): e1000252. doi:10.1371/journal.pmed.1000252
7
8. Ramsden et al. 2010 –Beneficial effect
(heart attack and CHD death)
8
Ramsden et al. Br J Nutr 2010; 104: 1586-1600
9. Hooper et al. 2011 –No effect (CVD
combined). Beneficial effect only if fat
modification and reduction lumped (-14%)
9
Hooper L et al. Cochrane Reviews, 2011, Issue 7. Article No. CD002137. DOI:
10.1002/14651858.CD002137.pub2.
10. Hooper et al. 2010 –No effect (heart
attacks)
10
Hooper L et al. Cochrane Reviews, 2011, Issue 7. Article No. CD002137. DOI:
10.1002/14651858.CD002137.pub2.
11. Ramsden et al. 2013 –Beneficial effect
with mixed omega-3/-6 trials only
Ramsden CE, Zamora D, Leelarthaepin B, Majchrzak-Hong SF, Faurot KR, Suchindran CM, et al. Use of dietary
linoleic acid for secondary prevention of coronary heart disease and death: evaluation of recovered data from the
Sydney Diet Heart Study and updated meta-analysis. BMJ 2013;346:e8707.
12. Chowdhury et al. 2014 –No effect
12
Chowdhury et al. Ann Intern Med 2014; 160;398-406
13. Coronary heart disease outcomes
are either neutral or favouring
polyunsaturated fat in the meta-
analyses
None of the meta-analyses suggest that
saturated fat would be beneficial
13
14. Conclusion
• Results of meta-analyses are dependent on
– which studies are included in the meta-analyses
– what fatty acids are used in compensating saturated fatty acids.
Mixed omega-3 and omega-6 trials show beneficial effects
– which endpoints are calculated (CHD events only or combination of
CHD and other CVD endpoints)
– Other issues, such as trans fat content of substituting margarines in
1960-1970
• 4 studies seem to be “tipping point” studies.
Exclusion/inclusion of these seem to determine which
direction the CHD outcome bends in a meta-analysis:
– Finnish Mental Hospital Study
– Oslo Diet Heart Study
– Sydney Diet Heart Study
– Rose Corn Oil Study
14
15. Interested in knowing more?
• Check out my other Slideshare decks:
– Is butter healthier than butter?
– Fats and inflammation
– Oslo Diet Heart Study
– Finnish Mental Hospital Study
– Lyon Diet Heart Study
– Predimed Study
– Sydney Diet Heart Study
– And more
