Siri-Tarino - See corresponding editorial on page 497....

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See corresponding editorial on page 497. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease 1–5 Patty W Siri-Tarino, Qi Sun, Frank B Hu, and Ronald M Krauss ABSTRACT Background: A reduction in dietary saturated fat has generally been thought to improve cardiovascular health. Objective: The objective of this meta-analysis was to summarize the evidence related to the association of dietary saturated fat with risk of coronary heart disease (CHD), stroke, and cardiovascular disease (CVD; CHD inclusive of stroke) in prospective epidemio- logic studies. Design: Twenty-one studies identified by searching MEDLINE and EMBASE databases and secondary referencing qualified for inclu- sion in this study. A random-effects model was used to derive composite relative risk estimates for CHD, stroke, and CVD. Results: During 5–23 y of follow-up of 347,747 subjects, 11,006 developed CHD or stroke. Intake of saturated fat was not associated with an increased risk of CHD, stroke, or CVD. The pooled relative risk estimates that compared extreme quantiles of saturated fat in- take were 1.07 (95% CI: 0.96, 1.19; P = 0.22) for CHD, 0.81 (95% CI: 0.62, 1.05; P = 0.11) for stroke, and 1.00 (95% CI: 0.89, 1.11; P = 0.95) for CVD. Consideration of age, sex, and study quality did not change the results. Conclusions: A meta-analysis of prospective epidemiologic studies showed that there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD. More data are needed to elucidate whether CVD risks are likely to be influenced by the specific nutrients used to replace saturated fat. Am J Clin Nutr 2010;91:535–46. INTRODUCTION Early animal studies showed that high dietary saturated fat and cholesterol intakes led to increased plasma cholesterol concen- trations as well as atherosclerotic lesions (1). These findings were supported by associations in humans in which dietary saturated fat correlated with coronary heart disease (CHD) risk (2, 3). More recent epidemiologic studies have shown positive (4–10), inverse (11, 12), or no (4, 13–18) associations of dietary saturated fat with CVD morbidity and/or mortality. A limited number of randomized clinical interventions have been conducted that have evaluated the effects of saturated fat on risk of CVD. Whereas some studies have shown beneficial effects of reduced dietary saturated fat (19–21), others have shown no effects of such diets on CVD risk (22, 23). The studies that showed beneficial effects of diets reduced in saturated fat replaced saturated fat with polyunsaturated fat, with the impli- cation that the CVD benefit observed could have been due to an increase in polyunsaturated fat or in the ratio of polyunsaturated fat to saturated fat (P:S), a hypothesis supported by a recent pooling analysis conducted by Jakobsen et al (24).
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Siri-Tarino - See corresponding editorial on page 497....

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