Monounsaturated Fatty Acids and Risk of Cardiovascular Disease: Synopsis of the Evidence Available from Systematic Reviews and Meta-Analyses
Abstract
:1. Monounsaturated Fatty Acids
C-Atoms: Double Bonds | Scientific Name of Acid | Molecular Formula | Chemical Name |
---|---|---|---|
11:1 | Undecylenic | C10H19COOH | cis-10-undecenoic acid |
14:1 | Myristoleic | C13H25COOH | cis-9-tetradecenoic acid |
16:1 | Palmitoleic | C15H29COOH | cis-9-hexadecenoic acid |
16:1 | Palmitelaidic | C15H29COOH | trans-9-hexadecenoic acid |
16:1 | / | C15H29COOH | cis-7-hexadecenoic |
18:1 | Petroselinic | C17H33COOH | cis-6-octadecenoic acid |
18:1 | Oleic | C17H33COOH | cis-9-octadecenoic acid |
18:1 | Elaidic | C17H33COOH | trans-9-octadecenoic acid |
18:1 | Vaccenic | C17H33COOH | cis-11-octadecenoic acid |
20:1 | Gondoleic | C19H37COOH | cis-9-eicosenoic acid |
20:1 | Gondolic | C19H37COOH | cis-11-eicosenoic acid |
22:1 | Cetoleic | C21H41COOH | cis-11-docosenoic acid |
22:1 | Erucic | C21H41COOH | cis-13-docosenoic acid |
24:1 | Nervonic | C23H45COOH | cis-15-tetracosaenoic acid |
Oils | MUFA, % | PUFA, % | SFA, % |
---|---|---|---|
Olive oil | 73 | 10.5 | 14 |
Coconut oil | 6 | 2 | 86 |
Soybean oil | 23 | 58 | 16 |
Peanut oil | 46 | 32 | 17 |
Sesame oil | 40 | 42 | 14 |
Sunflower oil (linoleic acid <60%) | 45 | 40 | 10 |
High-oleic safflower oil | 72 | 13 | 7.5 |
Sunflower oils (linoleic acid >70%) | 14 | 75 | 6 |
Walnut oil | 23 | 63 | 9 |
Almond oil | 70 | 17 | 8 |
Hazelnut oil | 78 | 10 | 7 |
Avocado oil | 71 | 13 | 12 |
Canola oil | 63 | 28 | 7 |
Mustard oil | 59 | 21 | 12 |
High oleic sunflower | 84 | 4 | 10 |
Hering oil | 57 | 16 | 21 |
Fish oil, cold liver | 47 | 23 | 23 |
Flaxseed oil, cold press | 18 | 68 | 9 |
Corn and canola oil | 58 | 29 | 8 |
High oleic sunflower | 84 | 4 | 10 |
Hazelnut oil | 78 | 10 | 7 |
Olive oil | 73 | 10.5 | 14 |
High-oleic safflower oil | 72 | 13 | 7.5 |
Avocado oil | 71 | 13 | 12 |
Almond oil | 70 | 17 | 8 |
Canola oil | 63 | 28 | 7 |
Mustard oil | 59 | 21 | 12 |
Corn and canola oil | 58 | 29 | 8 |
Hering oil | 57 | 16 | 21 |
Fish oil, cold liver | 47 | 23 | 23 |
Peanut Oil | 46 | 32 | 17 |
Sunflower Oil (linoleic acid <60%) | 45 | 40 | 10 |
Sesame Oil | 40 | 42 | 14 |
Soybean oil | 23 | 58 | 16 |
Walnut oil | 23 | 63 | 9 |
Flaxseed oil, cold press | 18 | 68 | 9 |
Sunflower oils (linoleic acid >70%) | 14 | 75 | 6 |
Coconut oil | 6 | 2 | 86 |
Nuts and Seeds | MUFA, % | PUFA, % | SFA, % |
Macademia | 59 | 12 | 2 |
Hazelnut | 46 | 8 | 4 |
Pecanut | 41 | 22 | 6 |
Almonds | 31 | 11 | 4 |
cashew nuts, dry roasted | 27 | 7 | 9 |
Pistacchio nuts | 24 | 14 | 5 |
Sunflower seed kernels, dried | 19 | 23 | 4 |
Sesame, whole, roasted and toasted | 18 | 21 | 7 |
Walnuts | 15 | 35 | 3 |
Flaxseed | 8 | 29 | 4 |
Safflower kernels, dried | 5 | 28 | 4 |
Products of Animal Origin | MUFA, % | PUFA, % | SFA, % |
Butter, salted | 21 | 3 | 51 |
Cheese, cheddar | 9 | 1 | 21 |
Pork, ham | 8.3 | 2 | 6.5 |
Mackerl | 5.4 | 3.3 | 3.2 |
Beef, steak | 4.5 | 0.4 | 4.3 |
Egg | 3.6 | 2 | 3 |
Salmon | 2.1 | 2.5 | 0.9 |
Milk, 3.7% fat | 1 | 0.1 | 2.2 |
Chicken | 0.9 | 0.75 | 0.8 |
2. Guidelines
2.1. General Nutrition Guidelines
Authority/Society | MUFA (% of TEC) | Target Group/Remarks | References |
---|---|---|---|
American Heart Association | <20 | Healthy adults | [5] |
Academy of Nutrition and Dietetics/Canadian Dietetic Association | <25 | Healthy adults | [6] |
Dutch Dietary Guidelines | 8–38 | Healthy adults Upper limit for obese: 25% of TEC | [7] |
European Food Safety Authority | No specific recommendations | Healthy adults | [8] |
Italian Society of Human Nutrition | No specific recommendations | Healthy adults | [9] |
Joint Committees of Germany, Austria, and Switzerland | 10 | Healthy adults | [10] |
National Cholesterol Educational Program III | <20 | Healthy adults | [11] |
National Institute of Medicine | No specific recommendations | Healthy adults | [12] |
Nordic Nutrition Dietary Guidelines | 10–15 | Healthy adults | [13] |
Nutritional Recommendations for the French Population | 20 | Healthy adults Including pregnant and lactating women | [14] |
UK COMA Committee | 12 | Healthy adults | [15] |
US Department of Agriculture | No specific recommendations | Healthy adults | [16] |
World Health Organization/Food Agriculture Organization | 15–20 | Healthy adults Adjusted to total fat intake | [3] |
American Association of Clinical Endocrinologists | No specific recommendations | Diabetic patients | [17] |
American Diabetes Association | No specific recommendations | Diabetic patients Initial recommendation: 10%–20% of TEC | [18,19] |
British Diabetes Association | 10–15 | Diabetic patients | [20] |
Canadian Diabetes Association | No specific recommendations | Diabetic patients Replacement of SFA by MUFA | [21] |
European Association for the Study of Diabetes | 10–20 | Diabetic patients Limitation of total fat to 35% of TEC | [22] |
International College of Nutrition of India | 7 | Diabetic patients | [23] |
2.2. Specific Guidelines for the Prevention and Treatment of Diabetes
3. Risk Factors for Diabetes and Cardiovascular Disease
4. Methods
4.1. Data Sources and Search Strategy
4.2. Inclusion Criteria
4.3. Study Quality Assessment
Reference | Aim | Methods (Inclusion/Exclusion criteria) | Heterogeneity | Period | Quality Assessment |
---|---|---|---|---|---|
Hegsted et al. 1993 [45] | Overall evaluation of the rather extensive literature on the effects of dietary fatty acid composition and cholesterol on serum lipid concentration | Design: metabolic studies (appear to have been done under rather careful control in which food was prepared and fed to the subjects); field trials (diet was modified by instructions or by a combination of instructions and provision of some foods) | not analyzed | until 1991 | 8 |
Mensink et al. 1992 [46] | Combining results to derive equations that relate changes in the dietary fatty acid intake to changes in serum HDL-C, LDL-C, TC and TG | Design: parallel design, crossover or Latin-square; “before and after” designs that lacked a control group were excluded. Diets enriched with very-long-chain ( n-3) PUFA were also excluded | not analyzed | 1970–1991 | 10 |
Gardner et al. 1995 [47] | The purpose of this investigation was to address the controversy regarding a differential effect of MUFA vs. PUFA on serum lipids | Design: randomized trials comparing a high-mono and high-poly fat diet; similar in all respects (isoenergetic, total fat content, SFA) except for levels of monounsaturated and polyunsaturated fat intake; minimum 10 subjects on each diet arm | analyzed | 1966–1994 | 12 |
Yu et al. 1995 [48] | Conducted to more comprehensively examine the effects of steraic acid, MUFAs, and other fatty acids on total and lipoprotein cholesterol concentrations in both men and women | Studies reported the quantity of individual SFA or steraic acid, sum of lauric, myristic and palmitic acids, and sum of MUFA and PUFA of the experimental diets. | not analyzed | 1970–1993 | 8 |
Exclusion. Liquid formula diets; diets that were specifically enriched with in trans isomers; diets enriched with very-long-chain PUFA; subject with familiar hypercholesterolemia | |||||
Clarke et al. 1997 [49] | The aim of this meta-analysis of metabolic ward studies is to provide reliable quantitative estimates of the relevance of dietary intake of fatty acids and dietary cholesterol to blood concentrations of total cholesterol and cholesterol fraction | Design: dietary intervention studies conducted under controlled conditions that ensured compliance | not analyzed | / | 9 |
Garg 1998 [50] | Examining the effects of high carbohydrate low fat diets vs. high MUFA diets on metabolic indexes in T2D subjects | Design: randomized, crossover trials using isoenergetic, weight maintaining diets | not analyzed | / | 9 |
Mensink et al. 2003 [30] | Combining results to derive equations that relate changes in the dietary fatty acid intake to changes in serum HDL-C, LDL-C, TC and TG, Apo-B and Apo A-I, TC:HDL-C | Design: parallel design, crossover or Latin-square; “before and after” designs that lacked a control group were excluded. Diets enriched with very-long-chain ( n-3) PUFA were also excluded | not analyzed | 1970–1998 | 13 |
Shah et al. 2007 [46] | Comparing high carbohydrate and high- cis-MUFA interventions trials conducted to increase understanding of the effect of carbohydrate and cis-MUFA on blood pressure | Design: randomized and non-randomized intervention studies comparing the effects of high-carbohydrate diets with those of high- cis-MUFA diets on blood pressure (crossover or parallel design), comparison of diets isoenergetic, body weight had to remain stable | analyzed | until 2006 | 12 |
Cao et al. 2009 [51] | Objective was to quantify the magnitude of the changes in lipids and lipoproteins in response to a MF blood cholesterol-lowering diet rich in unsaturated fat vs. LF in subjects with and without diabetes | Design: controlled feeding with a crossover or parallel design comparing MF vs. LF diets; designed to lower blood lipids; comparisons were isoenergetic; participants maintained constant weight during study; dietary protein and cholesterol were kept constant between diets | not analyzed | 1987–2007 | 14 |
Jakobsen et al. 2009 [52] | Associations between energy intake from MUFA, PUFA, and carbohydrates and risk of CHD while assessing the potential effect-modifying role of sex and age | Design: cohort studies; published follow-up study with ≥150 incident coronary events; availability of usual dietary intake; a validation or repeatability study of the diet-assessment method used | analyzed | / | 10 |
Kodama et al. 2009 [53] | To elucidate the effect of replacing dietary fat with carbohydrate on glucose and lipid parameters | Design: randomized controlled trials (crossover and parallel-group design); isoenergetic; only T2D | analyzed | 1966–2007 | 16 |
Exclusion: T1D, diets with change in in the content or quality of carbohydrates; heterogeneity analyzed | |||||
Mente et al. 2009 [54] | Examining the association between nutrient intake, dietary components, and dietary patterns and CHD and its related clinical outcomes | Design: cohort studies; dietary pattern: higher intake level is compared with lowest intake level; p-values for trend, where available, were used to evaluate dose-response relationship. FFQ, food records, 24 h recalls; Bradford Hill criteria | analyzed | 1950–2007 | 15 |
Mozaffarianand Clarke2009 [55] | Examining the effects on CHD risk of replacing partially hydrogenated formulations on other specific fats on the basis of the content of TFA, SFA, MUFA and PUFA | Design: randomized controlled trials (consumption of fatty acids on risk factors), cohort studies (association of habitual intake of fatty acids with incidence of CHD events); isocaloric replacement | not analyzed | until 2008 | 10 |
Skeaffand Miller2009 [56] | The purpose of this article was to summarize the evidence from cohort studies and randomized controlled trials of the relation between dietary fat and risk of CHD | Design: cohort studies; quintiles intake of PUFA, MUFA, SFA, TFA; The dietary assessment methods used in the cohort studies included single 24 h recall, diet records, diet histories and food frequency questionnaires; For MUFA only studies included in which exposure was determined by dietary assessment because blood fatty acids are not good biomarkers of MUFA intake | analyzed | / | 10 |
Schwingshackl et al. 2011 [57] | Comparing high MUFA (>12% of TEC) vs. low MUFA (≤12% MUFA of TEC) on cardiovascular risk factors | Design: randomized controlled trials, ≥6 months, isocaloric and hypocaloric diets; subgroup analysis MUFA vs. LF, PUFA, LGI, HGI, Controls | analyzed | 1966–2011 | 13 |
Schwingshackl et al. 2011 [58] | Comparing high MUFA (>12% of TEC) vs. low MUFA (≤12% MUFA of TEC) on glycemic control in subjects with abnormal glucose metabolism | Design: randomized controlled trials, ≥6 months, isocaloric and hypocaloric diets, subgroup analysis MUFA vs. LF, PUFA, LGI, HGI, Controls | analyzed | 1966–2011 | 13 |
5. Evidence from Meta-Analyses
5.1. Healthy Subjects
Reference | No. Studies | Statistical Method | Min. Duration | Participants | Effects of MUFA |
---|---|---|---|---|---|
Hegsted et al. 1993 [45] | n = 77 | Multiple regression | n.d. | n.d. | ↔ TC, LDL-C, HDL-C |
Mensink et al. 1992 [61] | n = 28 | meta-regression | 14 days | 682 | ↓ TG, HDL-C:LDL-C |
↑ HDL-C | |||||
↔ TC, LDL | |||||
Gardner et al. 1995 ** [47] | n = 14 | Standardized effect size | 3 weeks | 439 | ↑ TG * |
↔ LDL-C, HDL-C | |||||
Yu et al. 1995 [48] | n = 18 | Meta-regression analysis | n.d. | 804 | ↓ TC, LDL-C |
↑ HDL-C | |||||
Clarke et al. 1997 [49] | n = 91 | Multilevel regression analysis | 2 weeks | 5910 | ↑ HDL-C |
↔ TC, LDL-C | |||||
Garg 1998 [50] | n = 9 | meta-analysis | 2 weeks | 133 | ↓ TG, TC, VLDL-C, FG |
↑ HDL-C, Apo A-1 | |||||
↔LDL-C, Apo B, FI, HbA1c | |||||
Mensink et al. 2003 [30] | n = 60 | meta-regression | 13 days | 1672 | ↓ TG, LDL-C, Apo B, TC:HDL-C |
↑ HDL-C, Apo A-1 | |||||
↔ TC | |||||
Shah et al. 2007 [46] | n = 10 | Random effect modell | 3 weeks | 400 | ↓ SBP, DBP * |
Cao et al. 2009 [51] | n = 30 | Random effect modell | 2 weeks | 1213 | ↓ TG |
↑ HDL-C, Apo A 1 | |||||
↔ LDL-C | |||||
Jakobsen et al. 2009 [52] | n = 11 | Random effect meta-analysis | 4 years | 344,696 | ↑ risk of CHD events |
↔ risk of CHD death | |||||
Kodama et al. 2009 [53] | n = 11 | Fixed effect modell | 10 days | 329 | ↓TG |
↔ FG, FI, TC, HDL-C, LDL-C | |||||
Mente et al. 2009 [54] | n = 146 | Random effect meta-analysis | n.d. | 101,521 | ↓ CHD events |
Mozaffarian and Clarke 2009 [55] | n = 13 | Multilevel regression analysis | 2 weeks | 554 | ↓ TC, TG, LDL-C, Apo B, TC:HDL-C |
↑ HDL-C, Apo A-1 | |||||
Skeaff et al. 2009 [56] | n = 28 | Random effect meta-analysis | 4 years | 280,000 | ↔ risk of CHD death/events |
Schwingshackl et al. 2011 [57] | n = 12 | Random effect meta-analysis | 6 months | 1990 | ↓ FM, SBP, DBP |
↔W, WC, TC, LDL-C, HDL-C, TG, CRP | |||||
Schwingshackl et al. 2011 [58] | n = 9 | Random effect meta-analysis | 6 months | 1547 | ↓ HbA1c, FG |
↔ FI, HOMA-IR |
1++ High quality meta-analyses, systematic reviews of RCTs, or RCTs with a very low risk of bias | |
1+ Well conducted meta-analyses, systematic reviews, or RCTs with a low risk of bias | |
1− Meta-analyses, systematic reviews, or RCTs with a high risk of bias | |
2++ High quality systematic reviews of case control or cohort studies | |
High quality case control or cohort studies with a very low risk of confounding or bias and a high probability that the relationship is causal | |
2+ Well conducted case control or cohort studies with a low risk of confounding or bias and a moderate probability that the relationship is causal | |
2− Case control or cohort studies with a high risk of confounding or bias and a significant risk that the relationship is not causal | |
3 Non-analytic studies, e.g., case reports, case series | |
4 Expert opinion | |
A | At least one meta-analysis, systematic review, or RCT rated as 1++, and directly applicable to the target population; or |
A body of evidence consisting principally of studies rated as 1+, directly applicable to the target population, and demonstrating overall consistency of results | |
B | A body of evidence including studies rated as 2++, directly applicable to the target population, and demonstrating overall consistency of results; or |
Extrapolated evidence from studies rated as 1++ or 1+ | |
C | A body of evidence including studies rated as 2+, directly applicable to the target population and demonstrating overall consistency of results; or |
Extrapolated evidence from studies rated as 2++ | |
D | Evidence level 3 or 4; or Extrapolated evidence from studies rated as 2+ |
5.2. Patients with Abnormal Glucose Metabolism/Diabetes Mellitus
5.3. Patients with CVD
6. Conclusions
Conflict of Interest
Supplementary Files
Supplementary File 1References
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Schwingshackl, L.; Hoffmann, G. Monounsaturated Fatty Acids and Risk of Cardiovascular Disease: Synopsis of the Evidence Available from Systematic Reviews and Meta-Analyses. Nutrients 2012, 4, 1989-2007. https://doi.org/10.3390/nu4121989
Schwingshackl L, Hoffmann G. Monounsaturated Fatty Acids and Risk of Cardiovascular Disease: Synopsis of the Evidence Available from Systematic Reviews and Meta-Analyses. Nutrients. 2012; 4(12):1989-2007. https://doi.org/10.3390/nu4121989
Chicago/Turabian StyleSchwingshackl, Lukas, and Georg Hoffmann. 2012. "Monounsaturated Fatty Acids and Risk of Cardiovascular Disease: Synopsis of the Evidence Available from Systematic Reviews and Meta-Analyses" Nutrients 4, no. 12: 1989-2007. https://doi.org/10.3390/nu4121989