Era of fat modification trials


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Era of fat modification trials

  1. 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. 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. 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. 4. The key results regarding coronary heart disease Meta-analyses published 2009-2014 4
  5. 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. 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. 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. 8. Ramsden et al. 2010 –Beneficial effect (heart attack and CHD death) 8 Ramsden et al. Br J Nutr 2010; 104: 1586-1600
  9. 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. 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. 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. 12. Chowdhury et al. 2014 –No effect 12 Chowdhury et al. Ann Intern Med 2014; 160;398-406
  13. 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. 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. 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
  16. 16. Welcome aboard 16 Reijo Laatikainen, authorized nutritionist, MBA, dietitian