Observational studies are compatible with an association between saturated and trans fats and cardiovascular disease
Notice bibliographique
Résumé
Context: What is the relationship between saturated or trans fats in our food and cardiovascular risk? To find out we must examine the totality of interventional and observational evidence, and all appropriate outcomes. The World Health Organization Nutrition Guidance Advisory Group (WHO NUGAG) recently commissioned systematic reviews of randomised controlled trials (RCTs) which examined effects of modifying saturated or trans fat intakes on mortality or cardiovascular health1, 2 and controlled trials on lipid outcomes (updates of these published reviews are due to be published3, 4) as well as this systematic review of observational data (reported by de Souza et al). Methods: De Souza’s systematic review included observational studies reporting associations between saturated or trans fat intakes and all-cause mortality, CHD or cardiovascular disease (CVD) mortality, total CHD, ischaemic stroke or type 2 diabetes. The review clearly stated the questions addressed, searched widely, one reviewer assessed titles and abstracts and a second reviewer checked potentially relevant studies. Risk of bias was assessed using the Newcastle-Ottawa scale plus risk of misclassification of exposure to trans fats, and used GRADE to assess confidence in the findings. Primary meta-analyses (reported here) presented most-adjusted results of high vs low intake in prospective cohorts. Findings: Saturated fats: meta-analysis suggested no association between higher saturated fat intake and all-cause mortality (RR=0.99, 95%CI 0.91-1.09, 5 studies, 14090 deaths, I233%), CVD mortality, total CHD, ischaemic stroke or type 2 diabetes (all very low GRADE evidence), but suggested non-significantly increased CHD mortality (RR=1.15, 95%CI 0.97-1.36, 11 studies, 2970 deaths, I270%). Trans fats: meta-analysis suggested increased risk of CHD mortality (RR=1.28, 95%CI 1.09-1.50, 5 studies, 1234 deaths, I20%) and total CHD (RR=1.21, 95%CI 1.10-1.33, 6 studies, 4579 events, I20%) with higher total trans fat intake (moderate GRADE evidence), with similar effects for industrial, but not ruminant, trans fats. There were no consistent associations for all-cause mortality or ischaemic stroke (low to very low GRADE evidence), but the suggestion of lower diabetes risk with higher ruminant trans fat intake (RR=0.58, 95%CI 0.46-0.74, 5 studies, I230%, very low GRADE evidence). Commentary: The observational evidence needs to be seen in the context of RCTs of effects on mortality, health outcomes and lipids. Saturated fats: meta-analyses of RCTs found that reduced saturated fat reduced risk of CVD events by 17% (RR=0.83, 95%CI 0.72-0.96, 4377 people with events, I²65%, moderate GRADE evidence), but had no clear effects on all-cause mortality, CVD mortality, CHD deaths or events (moderate GRADE evidence). Replacement of saturated fats with polyunsaturated fats was associated with a statistically significant 27% reduction in CVD events, while replacement with carbohydrate, protein or monounsaturated fats showed no significant effects1. Meta-analyses of controlled trials found that replacing 1% of dietary energy isoenergetically with saturated fats increased LDL cholesterol by 0.032mmol/L (95%CI 0.025-0.039, 43 studies) and the most favourable total cholesterol:HDL ratio was achieved when saturated fats were replaced by polyunsaturated fats3. The interventional and observational systematic reviews together suggest that reducing saturated fats reduces cardiovascular events, and may have a more striking effect on cardiovascular events when replacement is by polyunsaturated fats. Trans fats: systematic review found no RCTs assessing effects of reduction of trans fat intake on mortality, CVD or CHD2. Combining trials in linear regression suggested that each 1% of energy from total trans fats replacing monounsaturated fats increased LDL cholesterol by 0.048mmol/L (95%CI 0.037-0.058), with similar effects of industrial trans fats4. Each 1% of energy from industrial trans fats replacing monounsaturated fats increased LDL:HDL ratio by 0.055mmol/L (95%CI 0.044-0.066), and ruminant trans fats increased LDL:HDL ratio by 0.038mmol/L (95%CI 0.012-0.074)4. The balance of available evidence suggests that reducing total and industrial trans fats will reduce CHD mortality and events. Implications for practice The complete set of evidence suggests that reducing saturated and industrial trans fats, and replacing them with polyunsaturated fats, will reduce risks of CVD and CHD.
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Comment cette classification a été obtenuedéplier
Étiquettes directes de modèles (non validées)
Étiquettes de catégorie et de devis d'étude par modèle, issues des rondes d'étiquetage. C'est une sortie machine, non validée, et le désaccord entre modèles est livré comme donnée. Aucun devis ici n'est encore validé contre MEDLINE.
| Bras | Catégories | Devis d'étude | Confiance |
|---|---|---|---|
| gemma | aucune catégorie Domaine: non disponible · Genre: Empirique Porte sur le système de recherche canadien: non · Porte sur un sujet canadien: non | Observationnel | low |
| gpt | aucune catégorie Domaine: non disponible · Genre: Commentaire Porte sur le système de recherche canadien: non · Porte sur un sujet canadien: non | Sans objet | high |
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéeÉtiqueté directement par 2 modèles lisant le dossier complet.
Les modèles divergent sur des parties de cette classification; chaque voix est préservée dans la section en fin de page.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».