Association of dietary, circulating, and supplement fatty acids with coronary risk: a systematic review and meta-analysis

Rajiv Chowdhury, Samantha Warnakula, Setor Kunutsor, Francesca Crowe, Heather A Ward, Laura Johnson, Oscar H Franco, Adam S Butterworth, Nita G Forouhi, Simon G Thompson, Kay-Tee Khaw, Dariush Mozaffarian, John Danesh, Emanuele Di Angelantonio

Research output: Contribution to journalArticle (Academic Journal)peer-review

965 Citations (Scopus)


BACKGROUND: Guidelines advocate changes in fatty acid consumption to promote cardiovascular health.

PURPOSE: To summarize evidence about associations between fatty acids and coronary disease.

DATA SOURCES: MEDLINE, Science Citation Index, and Cochrane Central Register of Controlled Trials through July 2013.

STUDY SELECTION: Prospective, observational studies and randomized, controlled trials.

DATA EXTRACTION: Investigators extracted data about study characteristics and assessed study biases.

DATA SYNTHESIS: 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.

LIMITATION: Potential biases from preferential publication and selective reporting.

CONCLUSION: Current evidence does not clearly support cardiovascular guidelines that encourage high consumption of polyunsaturated fatty acids and low consumption of total saturated fats.

PRIMARY FUNDING SOURCE: British Heart Foundation, Medical Research Council, Cambridge National Institute for Health Research Biomedical Research Centre, and Gates Cambridge.

Original languageEnglish
Pages (from-to)398-406
Number of pages9
JournalAnnals of Internal Medicine
Issue number6
Publication statusPublished - 18 Mar 2014


  • Biological Markers
  • Coronary Disease
  • Diet, Fat-Restricted
  • Dietary Fats
  • Dietary Supplements
  • Fatty Acids
  • Fatty Acids, Unsaturated
  • Humans
  • Risk Factors


Dive into the research topics of 'Association of dietary, circulating, and supplement fatty acids with coronary risk: a systematic review and meta-analysis'. Together they form a unique fingerprint.

Cite this