Reduced or modified

dietary fat for preventing

cardiovascular disease: a
Cochrane review
Clinical

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Public Health questions

What are the effects of modifying or reducing
dietary fat on mortality and cardiovascular
events?
How long do people need to adhere to a modified
or reduced fat diet to achieve any benefits?
Are any effects similar in men and women?

Source:

Hooper L, Summerbell CD, Thompson R, Sills D, Roberts FG, Moore H, Davey Smith G.
Reduced or modified dietary fat for preventing cardiovascular disease. Cochrane Database of Systematic
Reviews 2011 , Issue 7. Art. No.: CD002137. DOI: 10.1002/14651858.CD002137.pub2

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Context
The modification and reduction of dietary
fat have been considered an important
tenet of public health policy in industrialized
countries for over 50 years.
The focus of whether to modify dietary fat
(replacing saturated fats with mono- or
poly-unsaturated fats) or reduce fat intake
(replacing saturated fats with starchy or
high protein foods) has fluctuated over the
years.
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Methods
Searches were carried out in the Cochrane Central
Register of Controlled Trials, MEDLINE and EMBASE.
More than 22,000 titles and abstracts were assessed.
The inclusion of potentially eligible studies and the
extraction of data were done independently by two
authors.
The number of participants randomised and the
numbers of events in each study group for the time
point with longest follow-up were extracted, and used
in Mantel-Haenszel random effects meta-analyses.

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PICO(S) to assess eligible

studies
Participants: Adults in any risk category for
cardiovascular disease.
Intervention: Modified fat intake (30% of energy from
total fats, with saturated fats partly replaced by mono- or
poly-unsaturated fats) or reduced total fat intake (to <30%
of energy from fat) or both. Participants could be given
dietary advice, or provided with the complete diet or with
supplements.
Comparison: Usual diet, placebo or a control diet.
Outcomes (primary): Mortality, cardiovascular mortality,
cardiovascular events and quality of life.
Studies: Randomized trials, lasting at least 6 months.
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Description of eligible
studies
48 studies were included, with a total of 60 randomised

comparisons. 16 comparisons were in men alone and 14

were in women alone; 10 included people at high risk of
cardiovascular disease, 17 at moderate risk, and 33 at
low risk.
Studies were published between 1965-2009, with most
comparisons from North America (30), followed by Europe
(26), Australia and New Zealand (3) and the Middle East
(1).
Data on deaths or cardiovascular events were not
available for some trials, because the studies had been
designed to measure other outcomes (such as breast
cancer).
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Effects of modified fat diet

A meta-analysis of death was possible for 8 randomised
trials (11,441 people) that compared a modified fat diet
with usual or control diet, with 1120 deaths in total
Risk of death was not shown to be lower with modified
fat
RR 1.02 (95% CI 0.88 to 1.18)
A meta-analysis of cardiovascular events was possible for
9 randomised trials (11,660 people) that compared a
modified fat diet with usual or control diet, with 855
events in total
Cardiovascular events might be lower with modified
fat
RR 0.82 (95% CI 0.66 to 1.02, p=0.07)
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Effects of reduced fat diet

A meta-analysis of death was possible for 10 randomised
trials (58,130 people) that compared a reduced fat diet
with usual or control diet, with 2936 deaths in total
Risk of death was not shown to be lower with reduced
fat
RR 0.97 (95% CI 0.90 to 1.04)
A meta-analysis of cardiovascular events was possible for
7 randomised trials (50,655 people) that compared a
reduced fat diet with usual or control diet, with 3632
events in total
Cardiovascular events were not shown to be lower with
reduced fat
RR 0.97 (95% CI 0.87 to 1.08)
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Effects of modified and reduced

fat
diet
A meta-analysis of death was possible for 3 randomised
trials (2219 people) that compared a modified and
reduced fat diet with usual or control diet, with 236
deaths in total
Risk of death was not shown to be lower with this diet
RR 0.97 (95% CI 0.76 to 1.23)
A meta-analysis of cardiovascular events was possible for
6 randomised trials (3193 people) that compared a
modified and reduced fat diet with usual or control diet,
with 400 events in total
Cardiovascular events might be lower with this diet
RR 0.77 (95% CI 0.57 to 1.03, p=0.08)
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Summary of findings
Event

Usual diet risk

Modified or
reduced fat
diet (95%
confidence
interval)
67 per 1000
(63 to 71)
42 per 1000
(38 to 47)
131 per 1000
(117 to 146)
126 per 1000
(102 to 155)

Relative Risk
(95%
confidence
interval)

Participants
And trials

Quality of
evidence

0.98 (0.93
1.04)
0.94 (0.84
1.04)
0.86 (0.77
0.96)
0.83 (0.67
1.02)

71,790
trials)
65,978
trials)
65,609
trials)
11,761
trials)

High

High

Moderate

Low

152 per 1000

147 per 1000

(132 to 164)

0.97 (0.87 to
1.08)

50,655 (8 trials)

High

152 per 1000

117 per 1000

(87 to 157)

0.77 (0.57 to
1.03)

3193 (6 trials)

Low

Total mortality 68 per 1000

Cardiovascula
r mortality
Cardiovascula
r events
Cardiovascula
r events
(modified fat)
Cardiovascula
r events
(reduced fat)
Cardiovascula
r events
(modified and
reduced fat)

45 per 1000
152 per 1000
152 per 1000

to
to
to
to

(21
(16
(24
(10

Modified fat or reduced diet versus usual diet: This table shows the effect of the diets in
relative and absolute terms. Results are presented for a medium risk population, with
evidence quality assessed using GRADE.
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Duration of diet
Trials were grouped into those with a duration of
less than 2 years, and those that were longer
In shorter duration trials, no effect of modified
or reduced fat was found on the risk of
cardiovascular events
RR 0.95 (95% CI 0.84 to 1.09)
In trials that lasted 2 years or longer, a modified
or reduced fat diet reduced the risk of
cardiovascular events by 22%
RR 0.78 (95% CI 0.67 to 0.92)
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Men and women

Results were available separately for men and
women from some trials. There was good
evidence of benefits for men, but not for
women; but these trials also differed in other
ways (e.g. duration and intervention)
10,600 men (13 trials)
1162 cardiovascular events
RR 0.82 (95% CI 0.74 to 0.90)
53,600 women (4 trials)
3566 cardiovascular events
RR 1.04 (95% CI 0.89 to 1.21)
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Conclusions: current
findings

There is no evidence that modifying or reducing

dietary fat reduces the risk of death.
Modifying dietary fat (with or without fat
reduction) reduces the risk of cardiovascular
events, if the diet is followed for at least 2 years.
Reducing dietary fat alone does not appear to
reduce the risk of cardiovascular events.
There is good data on the benefits of long term
modified fat diets in men, but not for women.

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13

Useful links
Cochrane Journal Club discussion
points
Reduced or modified dietary fat for
preventing cardiovascular disease

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