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Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk A Systematic Review and Meta-analysis. Chowdhury et al, 2014, Ann Int Med. (Quick) paper summary. Aim: Associations between fatty acids and coronary disease Method: Meta-analysis of prospective trials

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Association of Dietary, Circulating, and Supplement Fatty Acids WithCoronary RiskA Systematic Review and Meta-analysis

Chowdhury et al, 2014, Ann Int Med

quick paper summary
(Quick) paper summary
  • Aim: Associations between fatty acids and coronary disease
  • Method: Meta-analysis of prospective trials
    • Dietary FA intake
    • Biomarkers of plasma FAs
    • Intervention (supplementation) trials
  • Results (later)
  • Conclusions: ”Evidence does not clearly support CV guidelines that encourage high consumption of polyunsaturated FAs, and low consumption of total SFAs”
scientist backlash
Scientist backlash?
  • Complaints
  • Controversy
  • Calls (for retraction):

Not universal…..

proposed resolution
Proposed resolution
  • Consider the history of the paper
  • Read the results
  • Consider the methodology
    • What was done
    • What was not done
  • Consider the original studies
  • Consider other research
2 read the results
2. Read the results
  • (now there is a novelty).
2 read the results3
2. Read the results
  • Plasma PUFAs (ω-3)

(remember – EVERYTHING we knew about diet was wrong).

2 read the results4
2. Read the results
  • Plasma PUFAs (ω-6)
2 read the results5
2. Read the results
  • Intervention (supplementation) trials
2 read the results6
2. Read the results
  • Self-reported habitual intake of total SFA not associated with cardiac events
  • Self-reported habitual intake of total MUFA not associated with cardiac events
  • Self-reported habitual intake of α-linolenic not associated with cardiac events
  • Self-reported habitual intake of LC ω-3 protective
  • Self-reported habitual intake of Total ω -6 not associated with cardiac events
  • Total trans fat associated
2 read the results7
2. Read the results
  • Plasma SFAs: only 17:0 protective. 14:0; 15:0, 16:0, 15:0, 18:0 not associated
  • Total MUFA not associated
  • All LC ω-3 strongly protective individually
  • No evidence that total LC ω -3 associated
  • Protective effect of ARA, no association with other ω-6
2 read the results8
2. Read the results
  • Intervention trials showed no effect of supplementation for α-linolenic, total LC ω-6, or ω-6
my first conclusions
My first conclusions
  • Different FAs have different associations with outcomes
  • Those most associated with a protective effect have not been measured in the diet, nor studied in interventions
  • But, no evidence that total saturated fat (intake / plasma) associated with events
  • Convincing evidence that some ω-3 protective, although this has not been studied in an intervention trial.
in defense of the authors
In defense of the authors:
  • … do not clearly support .. guidelines that promote high consumption of ω-6 PUFA and … reduced consumption of SFA
  • LC ω -3 PUFAs in primary prevention
  • odd-chain SFAs (…milk or dairy consumption) may have less deleterious effects
3 consider the methodology1
3. Consider the methodology
  • Nutrient density substitution models convey information on dietary substitution; associations do not.
4 consider the original samples
4. Consider the original samples
  • Timeframe
  • Participants & baseline characteristics
  • Event rate was up to 42%
acknowledgements
Acknowledgements
  • DariushMozaffarian*
  • Brian Steffen*
  • American Heart Association*

*The views expressed in this presentation are not necessarily the views of the organizations / individuals

further discussion
Further discussion
  • Is this an irresponsible paper?
  • If so – who was irresponsible?
  • Should we reconsider guidelines on saturated fat?
  • Do YOU know what the guidelines are?
  • What about other outcomes?
  • The role of carbohydrates