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Chowdhury et al, 2014, Ann Int Med

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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Chowdhury et al, 2014, Ann Int Med

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  1. Association of Dietary, Circulating, and Supplement Fatty Acids WithCoronary RiskA Systematic Review and Meta-analysis Chowdhury et al, 2014, Ann Int Med

  2. (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”

  3. Media interpretation of the paper

  4. Media dramatization of the paper

  5. Scientist backlash? • Complaints • Controversy • Calls (for retraction): Not universal…..

  6. Resolution to the 3-way

  7. 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

  8. 1. History of the paper

  9. 2. Read the results • (now there is a novelty).

  10. 2. Read the results • Plasma SFAs

  11. 2. Read the results • Plasma MUFAs

  12. 2. Read the results • Plasma PUFAs (ω-3) (remember – EVERYTHING we knew about diet was wrong).

  13. 2. Read the results • Plasma PUFAs (ω-6)

  14. 2. Read the results • Intervention (supplementation) trials

  15. 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

  16. 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

  17. 2. Read the results • Intervention trials showed no effect of supplementation for α-linolenic, total LC ω-6, or ω-6

  18. 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.

  19. 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

  20. 3. Consider the methodology

  21. The development of cardiac events

  22. The development of cardiac events

  23. 3. Consider the methodlogy

  24. 3. Consider the methodology • Nutrient density substitution models convey information on dietary substitution; associations do not.

  25. 4. Consider the original samples • Timeframe • Participants & baseline characteristics • Event rate was up to 42%

  26. Acknowledgements • DariushMozaffarian* • Brian Steffen* • American Heart Association* *The views expressed in this presentation are not necessarily the views of the organizations / individuals

  27. 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

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