Ann Intern Med. 2014 Mar 18;160(6):398-406. doi: 10.7326/M13-1788.
Guidelines advocate changes in fatty acid consumption to promote cardiovascular health.
To summarize evidence about associations between fatty acids and coronary disease.
MEDLINE, Science Citation Index, and Cochrane Central Register of Controlled Trials through July 2013.
Prospective, observational studies and randomized, controlled trials.
Investigators extracted data about study characteristics and assessed study biases.
There were 32 observational studies (530,525 participants) of fatty acids from dietary intake; 17 observational studies (25,721 participants) of fatty acid biomarkers; and 27 randomized, controlled trials (103,052 participants) of fatty acid supplementation. In observational studies, relative risks for coronary disease were 1.02 (95% CI, 0.97 to 1.07) for saturated, 0.99 (CI, 0.89 to 1.09) for monounsaturated, 0.93 (CI, 0.84 to 1.02) for long-chain ω-3 polyunsaturated, 1.01 (CI, 0.96 to 1.07) for ω-6 polyunsaturated, and 1.16 (CI, 1.06 to 1.27) for trans fatty acids when the top and bottom thirds of baseline dietary fatty acid intake were compared. Corresponding estimates for circulating fatty acids were 1.06 (CI, 0.86 to 1.30), 1.06 (CI, 0.97 to 1.17), 0.84 (CI, 0.63 to 1.11), 0.94 (CI, 0.84 to 1.06), and 1.05 (CI, 0.76 to 1.44), respectively. There was heterogeneity of the associations among individual circulating fatty acids and coronary disease. In randomized, controlled trials, relative risks for coronary disease were 0.97 (CI, 0.69 to 1.36) for α-linolenic, 0.94 (CI, 0.86 to 1.03) for long-chain ω-3 polyunsaturated, and 0.89 (CI, 0.71 to 1.12) for ω-6 polyunsaturated fatty acid supplementations.
Potential biases from preferential publication and selective reporting.
Current evidence does not clearly support cardiovascular guidelines that encourage high consumption of polyunsaturated fatty acids and low consumption of total saturated fats.
British Heart Foundation, Medical Research Council, Cambridge National Institute for Health Research Biomedical Research Centre, and Gates Cambridge.
指南提倡改变脂肪酸的摄入量以促进心血管健康。
总结脂肪酸与冠心病之间关联的证据。
通过 2013 年 7 月的 MEDLINE、科学引文索引和 Cochrane 对照试验中心注册库进行检索。
前瞻性观察性研究和随机、对照试验。
研究人员提取了有关研究特征和评估研究偏倚的数据。
有 32 项关于饮食中脂肪酸的观察性研究（530525 名参与者）；17 项关于脂肪酸生物标志物的观察性研究（25721 名参与者）；27 项关于脂肪酸补充的随机、对照试验（103052 名参与者）。在观察性研究中，与冠心病相关的相对风险为：饱和脂肪酸为 1.02（95%CI，0.97 至 1.07）；单不饱和脂肪酸为 0.99（CI，0.89 至 1.09）；长链 ω-3 多不饱和脂肪酸为 0.93（CI，0.84 至 1.02）；ω-6 多不饱和脂肪酸为 1.01（CI，0.96 至 1.07）；反式脂肪酸为 1.16（CI，1.06 至 1.27），当比较基线饮食脂肪酸摄入的上 3 分位和下 3 分位时。相应的循环脂肪酸估计值分别为 1.06（CI，0.86 至 1.30）、1.06（CI，0.97 至 1.17）、0.84（CI，0.63 至 1.11）、0.94（CI，0.84 至 1.06）和 1.05（CI，0.76 至 1.44）。个体循环脂肪酸与冠心病之间的关联存在异质性。在随机、对照试验中，与冠心病相关的相对风险为 α-亚麻酸为 0.97（CI，0.69 至 1.36）；长链 ω-3 多不饱和脂肪酸为 0.94（CI，0.86 至 1.03）；ω-6 多不饱和脂肪酸为 0.89（CI，0.71 至 1.12）。
可能存在选择性发表和报告偏倚的潜在偏倚。
目前的证据并不明确支持鼓励摄入高多不饱和脂肪酸和低饱和脂肪总摄入量的心血管指南。
英国心脏基金会、医学研究理事会、剑桥国家卫生研究院健康研究所生物医学研究中心和盖茨剑桥。
