Saturated fat, the estimated absolute risk and certainty of risk for mortality and major cancer and cardiometabolic outcomes: an overview of systematic reviews
Abstract Objective To assess the impact of reducing saturated fat or fatty foods, or replacing saturated fat with unsaturated fat, carbohydrate or protein, on the risk of mortality and major cancer and cardiometabolic outcomes in adults. Methods We searched MEDLINE, EMBASE, CINAHL, and references of...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-09-01
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| Series: | Systematic Reviews |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13643-023-02312-3 |
| _version_ | 1827724323623796736 |
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| author | Jhalok Ronjan Talukdar Jeremy P. Steen Joshua Z. Goldenberg Qian Zhang Robin W. M. Vernooij Long Ge Dena Zeraatkar Małgorzata M. Bała Geoff D. C. Ball Lehana Thabane Bradley C. Johnston |
| author_facet | Jhalok Ronjan Talukdar Jeremy P. Steen Joshua Z. Goldenberg Qian Zhang Robin W. M. Vernooij Long Ge Dena Zeraatkar Małgorzata M. Bała Geoff D. C. Ball Lehana Thabane Bradley C. Johnston |
| author_sort | Jhalok Ronjan Talukdar |
| collection | DOAJ |
| description | Abstract Objective To assess the impact of reducing saturated fat or fatty foods, or replacing saturated fat with unsaturated fat, carbohydrate or protein, on the risk of mortality and major cancer and cardiometabolic outcomes in adults. Methods We searched MEDLINE, EMBASE, CINAHL, and references of included studies for systematic reviews and meta-analyses (SRMAs) of randomized controlled trials (RCTs) and observational studies in adults published in the past 10 years. Eligible reviews investigated reducing saturated fat or fatty foods or replacing saturated fat with unsaturated fat, carbohydrate or protein, on the risk of cancer and cardiometabolic outcomes and assessed the certainty of evidence for each outcome using, for example, the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) approach. We assessed the quality of SRMAs using a modified version of AMSTAR-2. Results were summarized as absolute estimates of effect together with the certainty of effects using a narrative synthesis approach. Results We included 17 SRMAs (13 reviews of observational studies with follow-up 1 to 34 years; 4 reviews of RCTs with follow-up 1 to 17 years). The quality of two-thirds of the SRMAs was critically low to moderate; the main limitations included deficient reporting of study selection, absolute effect estimates, sources of funding, and a priori subgroups to explore heterogeneity. Our included reviews reported > 100 estimates of effect across 11 critically important cancer and cardiometabolic outcomes. High quality SRMAs consistently and predominantly reported low to very low certainty evidence that reducing or replacing saturated fat was associated with a very small risk reduction in cancer and cardiometabolic endpoints. The risk reductions where approximately divided, some being statistically significant and some being not statistically significant. However, based on 2 moderate to high quality reviews, we found moderate certainty evidence for a small but important effect that was statistically significant for two outcomes (total mortality events [20 fewer events per 1000 followed] and combined cardiovascular events [16 fewer per 1000 followed]). Conversely, 4 moderate to high quality reviews showed very small effects on total mortality, with 3 of these reviews showing non-statistically significant mortality effects. Conclusion Systematic reviews investigating the impact of SFA on mortality and major cancer and cardiometabolic outcomes almost universally suggest very small absolute changes in risk, and the data is based primarily on low and very low certainty evidence. Systematic review registration PROSPERO CRD42020172141 |
| first_indexed | 2024-03-10T22:14:09Z |
| format | Article |
| id | doaj.art-44db5702c3704af883a59635d313e769 |
| institution | Directory Open Access Journal |
| issn | 2046-4053 |
| language | English |
| last_indexed | 2024-03-10T22:14:09Z |
| publishDate | 2023-09-01 |
| publisher | BMC |
| record_format | Article |
| series | Systematic Reviews |
| spelling | doaj.art-44db5702c3704af883a59635d313e7692023-11-19T12:30:57ZengBMCSystematic Reviews2046-40532023-09-0112111310.1186/s13643-023-02312-3Saturated fat, the estimated absolute risk and certainty of risk for mortality and major cancer and cardiometabolic outcomes: an overview of systematic reviewsJhalok Ronjan Talukdar0Jeremy P. Steen1Joshua Z. Goldenberg2Qian Zhang3Robin W. M. Vernooij4Long Ge5Dena Zeraatkar6Małgorzata M. Bała7Geoff D. C. Ball8Lehana Thabane9Bradley C. Johnston10Department of Health Research Methods, Evidence, and Impact, McMaster UniversityFaculty of Health Sciences, McMaster UniversityDepartment of Nutrition, College of Agriculture and Life Sciences, Texas A&M UniversitySchool of Nursing, Faculty of Health Sciences, University of OttawaDepartment of Nephrology and Hypertension, University Medical Center UtrechtDepartment of Health Research Methods, Evidence, and Impact, McMaster UniversityDepartment of Health Research Methods, Evidence, and Impact, McMaster UniversityDepartment of Hygiene and Dietetics, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical CollegeDepartment of Pediatrics, Faculty of Medicine & Dentistry, College of Health Sciences, University of AlbertaDepartment of Health Research Methods, Evidence, and Impact, McMaster UniversityDepartment of Nutrition, College of Agriculture and Life Sciences, Texas A&M UniversityAbstract Objective To assess the impact of reducing saturated fat or fatty foods, or replacing saturated fat with unsaturated fat, carbohydrate or protein, on the risk of mortality and major cancer and cardiometabolic outcomes in adults. Methods We searched MEDLINE, EMBASE, CINAHL, and references of included studies for systematic reviews and meta-analyses (SRMAs) of randomized controlled trials (RCTs) and observational studies in adults published in the past 10 years. Eligible reviews investigated reducing saturated fat or fatty foods or replacing saturated fat with unsaturated fat, carbohydrate or protein, on the risk of cancer and cardiometabolic outcomes and assessed the certainty of evidence for each outcome using, for example, the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) approach. We assessed the quality of SRMAs using a modified version of AMSTAR-2. Results were summarized as absolute estimates of effect together with the certainty of effects using a narrative synthesis approach. Results We included 17 SRMAs (13 reviews of observational studies with follow-up 1 to 34 years; 4 reviews of RCTs with follow-up 1 to 17 years). The quality of two-thirds of the SRMAs was critically low to moderate; the main limitations included deficient reporting of study selection, absolute effect estimates, sources of funding, and a priori subgroups to explore heterogeneity. Our included reviews reported > 100 estimates of effect across 11 critically important cancer and cardiometabolic outcomes. High quality SRMAs consistently and predominantly reported low to very low certainty evidence that reducing or replacing saturated fat was associated with a very small risk reduction in cancer and cardiometabolic endpoints. The risk reductions where approximately divided, some being statistically significant and some being not statistically significant. However, based on 2 moderate to high quality reviews, we found moderate certainty evidence for a small but important effect that was statistically significant for two outcomes (total mortality events [20 fewer events per 1000 followed] and combined cardiovascular events [16 fewer per 1000 followed]). Conversely, 4 moderate to high quality reviews showed very small effects on total mortality, with 3 of these reviews showing non-statistically significant mortality effects. Conclusion Systematic reviews investigating the impact of SFA on mortality and major cancer and cardiometabolic outcomes almost universally suggest very small absolute changes in risk, and the data is based primarily on low and very low certainty evidence. Systematic review registration PROSPERO CRD42020172141https://doi.org/10.1186/s13643-023-02312-3NutritionSaturated fatty acidsCardiovascular diseaseCancerSystematic review |
| spellingShingle | Jhalok Ronjan Talukdar Jeremy P. Steen Joshua Z. Goldenberg Qian Zhang Robin W. M. Vernooij Long Ge Dena Zeraatkar Małgorzata M. Bała Geoff D. C. Ball Lehana Thabane Bradley C. Johnston Saturated fat, the estimated absolute risk and certainty of risk for mortality and major cancer and cardiometabolic outcomes: an overview of systematic reviews Systematic Reviews Nutrition Saturated fatty acids Cardiovascular disease Cancer Systematic review |
| title | Saturated fat, the estimated absolute risk and certainty of risk for mortality and major cancer and cardiometabolic outcomes: an overview of systematic reviews |
| title_full | Saturated fat, the estimated absolute risk and certainty of risk for mortality and major cancer and cardiometabolic outcomes: an overview of systematic reviews |
| title_fullStr | Saturated fat, the estimated absolute risk and certainty of risk for mortality and major cancer and cardiometabolic outcomes: an overview of systematic reviews |
| title_full_unstemmed | Saturated fat, the estimated absolute risk and certainty of risk for mortality and major cancer and cardiometabolic outcomes: an overview of systematic reviews |
| title_short | Saturated fat, the estimated absolute risk and certainty of risk for mortality and major cancer and cardiometabolic outcomes: an overview of systematic reviews |
| title_sort | saturated fat the estimated absolute risk and certainty of risk for mortality and major cancer and cardiometabolic outcomes an overview of systematic reviews |
| topic | Nutrition Saturated fatty acids Cardiovascular disease Cancer Systematic review |
| url | https://doi.org/10.1186/s13643-023-02312-3 |
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