Scolaris Content Display Scolaris Content Display

Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
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Figure 1

Methodological quality summary: review authors' judgements about each methodological quality item for each included study.

Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
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Figure 2

Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.

Funnel plot of comparison: fat modification or reduction vs usual diet ‐ total mortality.
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Figure 3

Funnel plot of comparison: fat modification or reduction vs usual diet ‐ total mortality.

Funnel plot of comparison: fat modification or reduction vs usual diet ‐ combined cardiovascular events.
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Figure 4

Funnel plot of comparison: fat modification or reduction vs usual diet ‐ combined cardiovascular events.

Summary of findings, for reduced or modified fat diets vs usual diet (primary outcomes).
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Figure 5

Summary of findings, for reduced or modified fat diets vs usual diet (primary outcomes).

Summary of findings, reduced fat vs modified fat diets, cardiovascular events.
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Figure 6

Summary of findings, reduced fat vs modified fat diets, cardiovascular events.

Summary of findings, reduced or modified dietary fat vs usual diet, important secondary outcomes (myocardial infarction, stroke, cancer diagnosis)
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Figure 7

Summary of findings, reduced or modified dietary fat vs usual diet, important secondary outcomes (myocardial infarction, stroke, cancer diagnosis)

Comparison 1 fat modification or reduction vs usual diet ‐ primary outcomes, Outcome 1 Total mortality.
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Analysis 1.1

Comparison 1 fat modification or reduction vs usual diet ‐ primary outcomes, Outcome 1 Total mortality.

Comparison 1 fat modification or reduction vs usual diet ‐ primary outcomes, Outcome 2 Cardiovascular mortality.
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Analysis 1.2

Comparison 1 fat modification or reduction vs usual diet ‐ primary outcomes, Outcome 2 Cardiovascular mortality.

Comparison 1 fat modification or reduction vs usual diet ‐ primary outcomes, Outcome 3 Combined cardiovascular events.
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Analysis 1.3

Comparison 1 fat modification or reduction vs usual diet ‐ primary outcomes, Outcome 3 Combined cardiovascular events.

Comparison 2 fat modification or reduction vs usual diet ‐ secondary outcomes, Outcome 1 Myocardial infarctions.
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Analysis 2.1

Comparison 2 fat modification or reduction vs usual diet ‐ secondary outcomes, Outcome 1 Myocardial infarctions.

Comparison 2 fat modification or reduction vs usual diet ‐ secondary outcomes, Outcome 2 Stroke.
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Analysis 2.2

Comparison 2 fat modification or reduction vs usual diet ‐ secondary outcomes, Outcome 2 Stroke.

Comparison 2 fat modification or reduction vs usual diet ‐ secondary outcomes, Outcome 3 Cancer deaths.
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Analysis 2.3

Comparison 2 fat modification or reduction vs usual diet ‐ secondary outcomes, Outcome 3 Cancer deaths.

Comparison 2 fat modification or reduction vs usual diet ‐ secondary outcomes, Outcome 4 Cancer diagnoses.
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Analysis 2.4

Comparison 2 fat modification or reduction vs usual diet ‐ secondary outcomes, Outcome 4 Cancer diagnoses.

Comparison 2 fat modification or reduction vs usual diet ‐ secondary outcomes, Outcome 5 Diabetes diagnoses.
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Analysis 2.5

Comparison 2 fat modification or reduction vs usual diet ‐ secondary outcomes, Outcome 5 Diabetes diagnoses.

Comparison 2 fat modification or reduction vs usual diet ‐ secondary outcomes, Outcome 6 Non‐fatal MI.
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Analysis 2.6

Comparison 2 fat modification or reduction vs usual diet ‐ secondary outcomes, Outcome 6 Non‐fatal MI.

Comparison 3 fat modification or reduction vs usual diet ‐ tertiary outcomes, Outcome 1 Weight, kg.
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Analysis 3.1

Comparison 3 fat modification or reduction vs usual diet ‐ tertiary outcomes, Outcome 1 Weight, kg.

Comparison 3 fat modification or reduction vs usual diet ‐ tertiary outcomes, Outcome 2 BMI, kg/m2.
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Analysis 3.2

Comparison 3 fat modification or reduction vs usual diet ‐ tertiary outcomes, Outcome 2 BMI, kg/m2.

Comparison 3 fat modification or reduction vs usual diet ‐ tertiary outcomes, Outcome 3 LDL cholesterol, mmol/L.
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Analysis 3.3

Comparison 3 fat modification or reduction vs usual diet ‐ tertiary outcomes, Outcome 3 LDL cholesterol, mmol/L.

Comparison 3 fat modification or reduction vs usual diet ‐ tertiary outcomes, Outcome 4 HDL cholesterol, mmol/Lkg.
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Analysis 3.4

Comparison 3 fat modification or reduction vs usual diet ‐ tertiary outcomes, Outcome 4 HDL cholesterol, mmol/Lkg.

Comparison 3 fat modification or reduction vs usual diet ‐ tertiary outcomes, Outcome 5 Total cholesterol, mmol/L.
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Analysis 3.5

Comparison 3 fat modification or reduction vs usual diet ‐ tertiary outcomes, Outcome 5 Total cholesterol, mmol/L.

Comparison 3 fat modification or reduction vs usual diet ‐ tertiary outcomes, Outcome 6 Triglycerides, mmol/L.
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Analysis 3.6

Comparison 3 fat modification or reduction vs usual diet ‐ tertiary outcomes, Outcome 6 Triglycerides, mmol/L.

Comparison 3 fat modification or reduction vs usual diet ‐ tertiary outcomes, Outcome 7 Systolic Blood Pressure, mmHg.
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Analysis 3.7

Comparison 3 fat modification or reduction vs usual diet ‐ tertiary outcomes, Outcome 7 Systolic Blood Pressure, mmHg.

Comparison 3 fat modification or reduction vs usual diet ‐ tertiary outcomes, Outcome 8 Diastolic Blood Pressure, mmHg.
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Analysis 3.8

Comparison 3 fat modification or reduction vs usual diet ‐ tertiary outcomes, Outcome 8 Diastolic Blood Pressure, mmHg.

Comparison 4 fat reduction vs fat modification ‐ primary outcomes, Outcome 3 Combined cardiovascular events.
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Analysis 4.3

Comparison 4 fat reduction vs fat modification ‐ primary outcomes, Outcome 3 Combined cardiovascular events.

Comparison 5 fat reduction vs fat modification ‐ secondary outcomes, Outcome 1 Myocardial infarction.
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Analysis 5.1

Comparison 5 fat reduction vs fat modification ‐ secondary outcomes, Outcome 1 Myocardial infarction.

Comparison 5 fat reduction vs fat modification ‐ secondary outcomes, Outcome 2 Stroke.
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Analysis 5.2

Comparison 5 fat reduction vs fat modification ‐ secondary outcomes, Outcome 2 Stroke.

Comparison 5 fat reduction vs fat modification ‐ secondary outcomes, Outcome 4 Cancer diagnoses.
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Analysis 5.4

Comparison 5 fat reduction vs fat modification ‐ secondary outcomes, Outcome 4 Cancer diagnoses.

Comparison 5 fat reduction vs fat modification ‐ secondary outcomes, Outcome 6 Non‐fatal MI.
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Analysis 5.6

Comparison 5 fat reduction vs fat modification ‐ secondary outcomes, Outcome 6 Non‐fatal MI.

Comparison 6 fat reduction vs fat modification ‐ tertiary outcomes, Outcome 1 Weight, kg.
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Analysis 6.1

Comparison 6 fat reduction vs fat modification ‐ tertiary outcomes, Outcome 1 Weight, kg.

Comparison 6 fat reduction vs fat modification ‐ tertiary outcomes, Outcome 2 BMI, kg/m2.
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Analysis 6.2

Comparison 6 fat reduction vs fat modification ‐ tertiary outcomes, Outcome 2 BMI, kg/m2.

Comparison 6 fat reduction vs fat modification ‐ tertiary outcomes, Outcome 3 LDL cholesterol, mmol/L.
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Analysis 6.3

Comparison 6 fat reduction vs fat modification ‐ tertiary outcomes, Outcome 3 LDL cholesterol, mmol/L.

Comparison 6 fat reduction vs fat modification ‐ tertiary outcomes, Outcome 4 HDL cholesterol, mmol/Lkg.
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Analysis 6.4

Comparison 6 fat reduction vs fat modification ‐ tertiary outcomes, Outcome 4 HDL cholesterol, mmol/Lkg.

Comparison 6 fat reduction vs fat modification ‐ tertiary outcomes, Outcome 5 Total cholesterol, mmol/L.
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Analysis 6.5

Comparison 6 fat reduction vs fat modification ‐ tertiary outcomes, Outcome 5 Total cholesterol, mmol/L.

Comparison 6 fat reduction vs fat modification ‐ tertiary outcomes, Outcome 6 Triglycerides, mmol/L.
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Analysis 6.6

Comparison 6 fat reduction vs fat modification ‐ tertiary outcomes, Outcome 6 Triglycerides, mmol/L.

Comparison 6 fat reduction vs fat modification ‐ tertiary outcomes, Outcome 7 Systolic Blood Pressure, mmHg.
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Analysis 6.7

Comparison 6 fat reduction vs fat modification ‐ tertiary outcomes, Outcome 7 Systolic Blood Pressure, mmHg.

Comparison 6 fat reduction vs fat modification ‐ tertiary outcomes, Outcome 8 Diastolic Blood Pressure, mmHg.
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Analysis 6.8

Comparison 6 fat reduction vs fat modification ‐ tertiary outcomes, Outcome 8 Diastolic Blood Pressure, mmHg.

Comparison 6 fat reduction vs fat modification ‐ tertiary outcomes, Outcome 9 Dropouts.
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Analysis 6.9

Comparison 6 fat reduction vs fat modification ‐ tertiary outcomes, Outcome 9 Dropouts.

Table 1. Sensitivity analyses of primary outcomes

Outcome

Sensitivity Analysis

Subgroup

Risk ratio (95% CI)

Number of studies / participants/ events

I2

Total mortality

Mantel‐Haenszel, Fixed effects

Overall analysis

0.98 (0.93 to 1.04)

21/ 71795 / 4292

0%

Total mortality

Mantel‐Haenszel, Fixed effects

Modified fat intake

1.03 (0.92 to 1.14)

8/ 11441/ 1120

34%

Total mortality

Mantel‐Haenszel, Fixed effects

Reduced fat intake

0.97 (0.90 to 1.04)

10/ 58130/ 2936

0%

Total mortality

Mantel‐Haenszel, Fixed effects

Reduced & modified fat intake

0.96 (0.76 to 1.22)

2/ 2224/ 236

0%

Total mortality

Peto Odds Ratio (fixed effects)

Overall analysis

OR 0.98 (0.92 to 1.05)

21/ 71795 / 4292

0%

Total mortality

Peto Odds Ratio (fixed effects)

Modified fat intake

OR 1.03 (0.91 to 1.18)

8/ 11441/ 1120

39%

Total mortality

Peto Odds Ratio (fixed effects)

Reduced fat intake

OR 0.97 (0.90 to 1.04)

10/ 58130/ 2936

0%

Total mortality

Peto Odds Ratio (fixed effects)

Reduced and modified fat intake

OR 0.96 (0.73 to 1.25)

2/ 2224/ 236

0%

Total mortality

Excluding WHI

Overall analysis

0.98 (0.91 to 1.07)

20/ 22960/ 1888

0%

Total mortality

Excluding WHI

Reduced fat intake

0.94 (0.80 to 1.10)

9/ 9295/ 532

0%

Total mortality

Excluding studies with systematic difference in care

Overall analysis

1.03 (0.92 to 1.16)

6/ 10715/ 882

0%

Total mortality

Excluding studies with systematic difference in care

Modified fat intake

1.03 (0.92 to 1.16)

5/ 10178/ 881

0%

Total mortality

Excluding studies with systematic difference in care

Reduced fat intake

0.33 (0.01 to 8.12)

1/ 537/ 1

NR

Total mortality

Excluding studies with systematic difference in care

Reduced & modified fat intake

NR

0/ 0/ 0

NR

Total mortality

Excluding studies with systematic differences in diet other than fat

Overall analysis

1.03 (0.93 to 1.13)

12/ 16060/ 1320

0%

Total mortality

Excluding studies with systematic differences in diet other than fat

Modified fat intake

1.05 (0.93 to 1.18)

7/ 11029/ 1005

7%

Total mortality

Excluding studies with systematic differences in diet other than fat

Reduced fat intake

0.90 (0.60 to 1.34)

4/ 2998/ 89

0%

Total mortality

Excluding studies with systematic differences in diet other than fat

Reduced & modified fat intake

0.98 (0.76 to 1.25)

1/ 2033/ 224

NR

Cardiovascular mortality

Mantel‐Haenszel, Fixed effects

Overall analysis

0.95 (0.85 to 1.05)

16/ 65983/ 1407

0%

Cardiovascular mortality

Mantel‐Haenszel, Fixed effects

Modified fat intake

0.92 (0.79 to 1.08)

6/ 10788/ 593

45%

Cardiovascular mortality

Mantel‐Haenszel, Fixed effects

Reduced fat intake

0.96 (0.82 to 1.12)

7/ 52971/ 602

0%

Cardiovascular mortality

Mantel‐Haenszel, Fixed effects

Reduced & modified fat intake

0.98 (0.76 to 1.26)

3/ 2224/ 212

0%

Cardiovascular mortality

Peto Odds Ratio (fixed effects)

Overall analysis

OR 0.94 (0.84 to 1.05)

16/ 65983/ 1407

11%

Cardiovascular mortality

Peto Odds Ratio (fixed effects)

Modified fat intake

OR 0.91 (0.77 to 1.08)

6/ 10788/ 593

51%

Cardiovascular mortality

Peto Odds Ratio (fixed effects)

Reduced fat intake

OR 0.96 (0.81 to 1.13)

7/ 52971/ 602

0%

Cardiovascular mortality

Peto Odds Ratio (fixed effects)

Reduced & Modified fat intake

OR 0.97 (0.73 to 1.29)

3/ 2224/ 212

0%

Cardiovascular mortality

Excluding WHI

5Overall analysis

0.91 (0.79 to 1.04)

14/ 17148/ 874

7%

Cardiovascular mortality

Excluding WHI

Reduced fat intake

0.74 (0.47 to 1.17)

5/ 4136/ 69

0%

Cardiovascular mortality

Excluding studies with systematic difference in care

Overall analysis

0.97 (0.70 to 1.33)

4/ 9983/ 451

59%

Cardiovascular mortality

Excluding studies with systematic difference in care

Modified fat intake

0.97 (0.70 to 1.33)

4/ 9983/ 451

59%

Cardiovascular mortality

Excluding studies with systematic difference in care

Reduced fat intake

NR

0/ 0/ 0

NR

Cardiovascular mortality

Excluding studies with systematic difference in care

Reduced & modified fat intake

NR

0/ 0/ 0

NR

Cardiovascular mortality

Excluding studies with systematic differences in diet other than fat

Overall analysis

0.95 (0.80 to 1.13)

9/ 12970/ 748

22%

Cardiovascular mortality

Excluding studies with systematic differences in diet other than fat

Modified fat intake

0.97 (0.75 to 1.26)

5/ 10376/ 503

47%

Cardiovascular mortality

Excluding studies with systematic differences in diet other than fat

Reduced fat intake

0.75 (0.40 to 1.42)

3/ 561/ 44

3%

Cardiovascular mortality

Excluding studies with systematic differences in diet other than fat

Reduced & modified fat intake

1.01 (0.77 to 1.31)

1/ 2033/ 201

NR

Combined cardiovascular events

Mantel‐Haenszel, Fixed effects

Overall analysis

0.93 (0.88 to 0.98)

23/ 65508/ 4887

50%

Combined cardiovascular events

Mantel‐Haenszel, Fixed effects

Modified fat intake

0.83 (0.73 to 0.93)

9/ 11660/ 855

61%

Combined cardiovascular events

Mantel‐Haenszel, Fixed effects

Reduced fat intake

0.96 (0.91 to 1.03)

8/ 50655/ 3632

17%

Combined cardiovascular events

Mantel‐Haenszel, Fixed effects

Reduced & modified fat intake

0.84 (0.71 to 1.00)

6/ 3193/ 400

40%

Combined cardiovascular events

Peto Odds Ratio (fixed effects)

Overall analysis

OR 0.92 (0.86 to 0.97)

23/ 65508/ 4887

61%

Combined cardiovascular events

Peto Odds Ratio (fixed effects)

Modified fat intake

OR 0.78 (0.67 to 0.91)

9/ 11660/ 855

70%

Combined cardiovascular events

Peto Odds Ratio (fixed effects)

Reduced fat intake

OR 0.96 (0.90 to 1.03)

8/ 50655/ 3632

30%

Combined cardiovascular events

Peto Odds Ratio (fixed effects)

Reduced & modified fat intake

OR 0.79 (0.63 to 1.00)

6/ 3193/ 400

60%

Combined cardiovascular events

Excluding WHI

Overall analysis

0.81 (0.70 to 0.93)

21/ 16673/ 1442

39%

Combined cardiovascular events

Excluding WHI

Reduced fat intake

0.82 (0.63 to 1.05)

6/ 1820/ 187

0%

Combined cardiovascular events

Excluding studies with systematic difference in care

Overall analysis

0.93 (0.77 to 1.12)

9/ 12158/ 533

12%

Combined cardiovascular events

Excluding studies with systematic difference in care

Modified fat intake

0.95 (0.77 to 1.17)

6/ 10753/ 527

24%

Combined cardiovascular events

Excluding studies with systematic difference in care

Reduced fat intake

0.20 (0.01 to 4.13)

1/ 537/ 2

NR

Combined cardiovascular events

Excluding studies with systematic difference in care

Reduced & modified fat intake

0.28 (0.04 to 2.15)

2/ 868/ 4

0%

Combined cardiovascular events

Excluding studies with systematic differences in diet other than fat

Overall analysis

0.85 (0.72 to 1.01)

14/ 14710/ 1097

42%

Combined cardiovascular events

Excluding studies with systematic differences in diet other than fat

Modified fat intake

0.84 (0.65 to 1.09)

8/ 11248/ 701

63%

Combined cardiovascular events

Excluding studies with systematic differences in diet other than fat

Reduced fat intake

0.87 (0.63 to 1.20)

3/ 561/ 109

0%

Combined cardiovascular events

Excluding studies with systematic differences in diet other than fat

Reduced & modified fat intake

0.91 (0.73 to 1.13)

3/ 2901/ 287

0%

Figuras y tablas -
Table 1. Sensitivity analyses of primary outcomes
Table 2. Subgrouping data for primary outcomes

Analysis described

Total mortality: Number of studies, participants, events

Total mortality:

Relative Risk (95% CI), Heterogeneity ‐ I2, %

CVD mortality: Number of studies, participants, events

CVD mortality:

Relative Risk (95% CI), Heterogeneity ‐ I2, %

CVD events:

Number of studies, participants, events

CVD events:

Relative Risk (95% CI), Heterogeneity ‐ I2, %

Main meta‐analysis

21, 71790, 4292

0.98 (0.93 to 1.04), 0

16, 65978, 1407

0.94 (0.85 to 1.04), 0

23, 65508, 4887

0.86 (0.77 to 0.96), 50

Sub‐group 'mean follow‐up ≤2 years'

9, 12272, 767

1.05 (0.91 to 1.20), 0

6, 11434, 523

1.04 (0.88 to 1.23), 0

12, 13844, 689

0.95 (0.84 to 1.09), 0

Sub‐group 'mean follow‐up >2 years'

12, 59518, 3525

0.97 (0.91 to 1.03), 0

10, 54544, 884

0.89 (0.78 to 1.01), 0

11, 51664, 4198

0.78 (0.67 to 0.92), 72

Sub‐group 'low CVD risk'

10, 66776, 3717

0.99 (0.93 to 1.05), 0

6, 59682, 879

0.93 (0.77 to 1.13), 35

10, 58338, 3408

0.93 (0.82 to 1.05), 13

Sub‐group 'moderate CVD risk'

3, 1200, 47

0.69 (0.39 to 1.21), 0

2, 663, 23

0.66 (0.28 to 1.53), 0

5, 1537, 143

0.57 (0.33 to 0.99), 53

Sub‐group 'high CVD risk'

8, 3814, 528

0.95 (0.78 to 1.17), 24

8, 5633, 505

0.95 (0.80 to 1.12), 0

8, 5633, 1336

0.88 (0.75 to 1.02), 58

Sub‐group 'Dietary advice'

13, 60320, 3201

0.98 (0.92 to 1.05), 0

9, 54703, 796

0.97 (0.85 to 1.12), 0

12, 52595, 3998

0.85 (0.72 to 1.00), 62

Sub‐group 'dietary advice plus supplementation'

4, 1372, 219

0.80 (0.63 to 1.02), 0

4, 1372, 169

0.87 (0.62 to 1.21), 15

4, 1372, 395

0.78 (0.66 to 0.92), 0

Sub‐group 'diet provided'

4, 10098, 872

1.03 (0.92 to 1.15), 0

3, 9903, 442

0.93 (0.69 to 1.26), 63

7, 11541, 494

0.91 (0.73 to 1.14), 19

Sub‐group 'total fat in control <30%E'

4, 3592, 81

0.93 (0.61 to 1.43), 0

2, 618, 25

0.76 (0.35 to 1.64), 0

3, 1155, 152

0.82 (0.65 to 1.03), 1

Sub‐group 'total fat in control 30‐34.9%E'

4, 3450, 333

0.91 (0.46 to 1.81), 23

3, 3344, 21

0.72 (0.15 to 3.53), 51

5, 1429, 74

0.93 (0.62 to 1.39), 0

Sub‐group 'total fat in control 35‐39.9%E'

8, 62820, 3311

1.00 (0.94 to 1.07), 0

6, 60088, 1054

1.00 (0.88 to 1.12), 0

10, 60919, 4034

0.96 (0.84 to 1.10), 44

Sub‐group 'total fat in control 40+%E'

3, 1491, 454

0.96 (0.83 to 1.11), 0

3, 1491, 227

0.80 (0.63 to 1.02), 0

3, 1491, 435

0.83 (0.71 to 0.97), 0

Sub‐group 'saturated fat in control <10%E'

2, 3625, 316

0.97 (0.79 to 1.20), 0

1, 3088, 7

0.40 (0.08 to 2.08), ‐

1, 537, 2

0.20 (0.01 to 4.13), ‐

Sub‐group 'saturated fat in control 10‐14.9%E'

5, 50089, 2520

1.01 (0.77 to 1.32), 32

5, 49631, 558

0.98 (0.83 to 1.16), 0

11, 51610, 3565

0.97 (0.87 to 1.07), 10

Sub‐group 'saturated fat in control 15‐19.9%E'

6, 14598, 1134

1.02 (0.92 to 1.13), 0

4, 11966, 657

0.90 (0.74 to 1.11), 37

5, 11991, 793

0.86 (0.68 to 1.09), 64

Sub‐group 'saturated fat in control 20+%E'

0, 0, 0

0, 0, 0

0, 0, 0

Sub‐group 'studies of men'

11, 9604, 1224

0.97 (0.87 to 1.08), 7

9, 8951, 735

0.89 (0.77 to 1.02), 0

13, 10589, 1162

0.82 (0.74 to 0.90), 0

Sub‐group 'studies of women'

5, 59130, 2960

0.99 (0.92 to 1.07), 0

4, 56587, 658

1.03 (0.88 to 1.20), 0

4, 53605, 3566

1.04 (0.89 to 1.21), 53

Sub‐group 'studies of men and women'

5, 3056, 108

0.84 (0.58 to 1.22), 0

3, 440, 14

0.45 (0.15 to 1.37), 0

6, 1314, 159

0.60 (0.32 to 1.13), 66

Sub‐group 'community setting'

17, 61692, 3420

0.97 (0.91 to 1.03), 0

13, 56077, 965

0.95 (0.84 to 1.07), 0

20, 55605, 4405

0.84 (0.73 to 0.95), 51

Sub‐group 'residential setting'

4, 10098, 872

1.03 (0.92 to 1.15), 0

3, 9903, 442

0.93 (0.69 to 1.26), 63

3, 9903, 482

0.94 (0.71 to 1.24), 63

Sub‐group 'published in 1960s'

6, 2178, 580

0.92 (0.80 to 1.06), 2

5, 1983, 326

0.80, 0.64 to 1.00), 11

9, 3621, 638

0.81 (0.71 to 0.92), 0

Sub‐group 'published in 1970s'

3, 9515, 584

1.13 (0.95 to 1.33), 9

2, 9057, 304

1.06 (0.85 to 1.33), 0

3, 9159, 301

0.71 (0.35 to 1.43), 88

Sub‐group 'published in 1980s'

1, 2033, 224

0.98 (0.76 to 1.25), ‐

1, 2033, 201

1.01 (0.77 to 1.31), ‐

1, 2033, 283

0.92 (0.74 to 1.15), ‐

Sub‐group 'published in 1990s'

5, 4880, 137

0.90 (0.65 to 1.26), 0

3, 364, 11

0.27 (0.07 to 1.08), 0

3, 364, 57

0.51 (0.32 to 0.81), 0

Sub‐group 'published since 2000'

6, 53184, 2767

0.98 (0.91 to 1.05), 0

5, 52541, 565

0.98 (0.83 to 1.15), 0

7, 50331, 3608

0.96 (0.85 to 1.08), 29

Figuras y tablas -
Table 2. Subgrouping data for primary outcomes
Table 3. Meta‐regression, exploring effects of dietary changes on the primary outcomes

Outcome / Variable

Total mortality, coefficient (95% CI), number of studies, I2

Cardiovascular mortality, coefficient (95% CI), number of studies, I2

Cardiovascular events, coefficient (95% CI), number of studies, I2

CVD events (co‐regression with duration) coefficient (95% CI), number of studies, I2,  

Difference in total fat intake, %E

‐0.010 (‐0.030 to  0.010), 20, 0%*

‐0.023 (‐0.074  to 0.029), 14, 4%

‐0.012 (‐0.037 to 0.012), 21, 25%

‐0.016 (‐0.045 to 0.013), 21, 23%

Difference in SFA intake, %E

0.005 (‐0.016 to 0.026), 18, 0%

‐0.006 (‐0.050 to 0.037), 14, 3%

‐.013 (‐0.043 to 0.017), 21, 19%

‐0.008 (‐0.048 to 0.032), 21, 22%

Difference in MUFA intake, %E

‐0.036 (‐0.112 to 0.040), 15, 0%

‐0.073 (‐0.203 to 0.056), 13, 3%

‐0.023 (‐0.067 to 0.021), 14, 41%

‐0.024 (‐0.071 to 0.022), 14, 36%

Difference in PUFA intake, %E

‐0.004 (‐0.016 to 0.008), 17, 0%

‐0.000 (‐0.027 to 0.026), 14, 4%

‐0.002 (‐0.022 to 0.019), 19, 24%

‐0.006 (‐0.032 to 0.021), 19, 27%

Difference in trans fat intake, %E

Insufficient data, 2 studies

Insufficient data, 2 studies

Insufficient data, 2 studies

Insufficient data, 2 studies

Difference in weight, kg

‐0.035 (‐0.138 to 0.068), 14, 0%

‐0.067 (‐0.240 to 0.106), 9, 17%

‐0.038 (‐0.154 to 0.078), 14, 47%

‐0.033 (‐0.118 to 0.052), 14, 15%**

Difference in LDL cholesterol, mmol/L

‐0.948 (‐5.752 to 3.856), 6, 0%

‐2.909 (‐10.529 to     4.710), 6, 0%

‐1.600 (‐3.815 to 0.616), 7, 28%

‐1.465 (‐4.094 to 1.164), 7, 25%

Difference in serum total cholesterol, mmol/L

0.024 (‐0.168 to 0.217), 18, 0%

‐0.187 (‐0.505 to 0.131), 15, 0%

‐0.155 (‐0.554 to 0.244), 17, 49%

‐0.155 (‐0.635 to 0.325), 17, 53%

Study duration, years

‐0.004 (‐0.024 to 0.016), 22, 0%

‐0.014 (‐0.072 to 0.044), 16, 4%

‐0.037  (‐0.106 to 0.032), 24, 45%

 

Figuras y tablas -
Table 3. Meta‐regression, exploring effects of dietary changes on the primary outcomes
Comparison 1. fat modification or reduction vs usual diet ‐ primary outcomes

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Total mortality Show forest plot

21

71790

Risk Ratio (M‐H, Random, 95% CI)

0.98 [0.93, 1.04]

1.1 Modified fat intake

8

11441

Risk Ratio (M‐H, Random, 95% CI)

1.02 [0.88, 1.18]

1.2 Reduced fat intake

10

58130

Risk Ratio (M‐H, Random, 95% CI)

0.97 [0.90, 1.04]

1.3 Reduced and modified fat intake

3

2219

Risk Ratio (M‐H, Random, 95% CI)

0.97 [0.76, 1.23]

2 Cardiovascular mortality Show forest plot

16

65978

Risk Ratio (M‐H, Random, 95% CI)

0.94 [0.85, 1.04]

2.1 Modified fat intake

6

10788

Risk Ratio (M‐H, Random, 95% CI)

0.92 [0.73, 1.15]

2.2 Reduced fat intake

7

52971

Risk Ratio (M‐H, Random, 95% CI)

0.96 [0.82, 1.13]

2.3 Reduced and modified fat intake

3

2219

Risk Ratio (M‐H, Random, 95% CI)

0.98 [0.76, 1.27]

3 Combined cardiovascular events Show forest plot

23

65508

Risk Ratio (M‐H, Random, 95% CI)

0.86 [0.77, 0.96]

3.1 Modified fat intake

9

11660

Risk Ratio (M‐H, Random, 95% CI)

0.82 [0.66, 1.02]

3.2 Reduced fat intake

8

50655

Risk Ratio (M‐H, Random, 95% CI)

0.97 [0.87, 1.08]

3.3 Reduced and modified fat intake

6

3193

Risk Ratio (M‐H, Random, 95% CI)

0.77 [0.57, 1.03]

Figuras y tablas -
Comparison 1. fat modification or reduction vs usual diet ‐ primary outcomes
Comparison 2. fat modification or reduction vs usual diet ‐ secondary outcomes

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Myocardial infarctions Show forest plot

19

64891

Risk Ratio (M‐H, Random, 95% CI)

0.93 [0.84, 1.02]

1.1 Modified fat intake

9

11831

Risk Ratio (M‐H, Random, 95% CI)

0.91 [0.72, 1.16]

1.2 Reduced fat intake

6

50522

Risk Ratio (M‐H, Random, 95% CI)

0.97 [0.86, 1.08]

1.3 Reduced and modified fat intake

4

2538

Risk Ratio (M‐H, Random, 95% CI)

0.90 [0.72, 1.11]

2 Stroke Show forest plot

11

59853

Risk Ratio (M‐H, Random, 95% CI)

0.99 [0.89, 1.11]

2.1 Modified fat intake

4

10315

Risk Ratio (M‐H, Random, 95% CI)

0.70 [0.36, 1.34]

2.2 Reduced fat intake

4

49246

Risk Ratio (M‐H, Random, 95% CI)

1.01 [0.90, 1.13]

2.3 Reduced and modified fat intake

3

292

Risk Ratio (M‐H, Random, 95% CI)

0.40 [0.08, 2.04]

3 Cancer deaths Show forest plot

10

64759

Risk Ratio (M‐H, Random, 95% CI)

0.98 [0.91, 1.06]

3.1 Modified fat intake

3

9903

Risk Ratio (M‐H, Random, 95% CI)

1.46 [0.96, 2.21]

3.2 Reduced fat intake

5

52692

Risk Ratio (M‐H, Random, 95% CI)

0.97 [0.90, 1.05]

3.3 Reduced and modified fat intake

2

2164

Risk Ratio (M‐H, Random, 95% CI)

0.81 [0.25, 2.61]

4 Cancer diagnoses Show forest plot

12

58847

Risk Ratio (M‐H, Random, 95% CI)

0.96 [0.91, 1.01]

4.1 Modified fat intake

2

1535

Risk Ratio (M‐H, Random, 95% CI)

1.17 [0.85, 1.60]

4.2 Reduced fat intake

8

57075

Risk Ratio (M‐H, Random, 95% CI)

0.95 [0.88, 1.02]

4.3 Reduced and modified intake

2

237

Risk Ratio (M‐H, Random, 95% CI)

0.73 [0.06, 9.03]

5 Diabetes diagnoses Show forest plot

3

49859

Risk Ratio (M‐H, Random, 95% CI)

0.96 [0.90, 1.02]

5.1 Modified fat intake

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

5.2 Reduced fat intake

3

49859

Risk Ratio (M‐H, Random, 95% CI)

0.96 [0.90, 1.02]

5.3 Reduced and modified intake

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

6 Non‐fatal MI Show forest plot

13

54883

Risk Ratio (M‐H, Random, 95% CI)

0.95 [0.81, 1.12]

6.1 Modified fat intake

6

2672

Risk Ratio (M‐H, Random, 95% CI)

0.86 [0.64, 1.16]

6.2 Reduced fat intake

5

49859

Risk Ratio (M‐H, Random, 95% CI)

1.06 [0.80, 1.40]

6.3 Reduced and modified intake

2

2352

Risk Ratio (M‐H, Random, 95% CI)

0.72 [0.47, 1.10]

Figuras y tablas -
Comparison 2. fat modification or reduction vs usual diet ‐ secondary outcomes
Comparison 3. fat modification or reduction vs usual diet ‐ tertiary outcomes

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Weight, kg Show forest plot

18

Mean Difference (IV, Random, 95% CI)

Subtotals only

1.1 Modified fat intake

2

99

Mean Difference (IV, Random, 95% CI)

‐1.10 [‐3.14, 0.93]

1.2 Reduced fat intake

16

11058

Mean Difference (IV, Random, 95% CI)

‐0.83 [‐1.37, ‐0.30]

1.3 Reduced and modified fat intake

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

2 BMI, kg/m2 Show forest plot

14

Mean Difference (IV, Random, 95% CI)

Subtotals only

2.1 Modified fat intake

2

116

Mean Difference (IV, Random, 95% CI)

‐0.34 [‐0.99, 0.31]

2.2 Reduced fat intake

10

5972

Mean Difference (IV, Random, 95% CI)

‐0.47 [‐0.72, ‐0.23]

2.3 Reduced and modified fat intake

2

111

Mean Difference (IV, Random, 95% CI)

‐0.20 [‐1.30, 0.91]

3 LDL cholesterol, mmol/L Show forest plot

20

Mean Difference (IV, Random, 95% CI)

Subtotals only

3.1 Modified fat intake

2

116

Mean Difference (IV, Random, 95% CI)

‐0.20 [‐0.47, 0.07]

3.2 Reduced fat intake

14

6971

Mean Difference (IV, Random, 95% CI)

‐0.10 [‐0.14, ‐0.05]

3.3 Reduced and modified fat intake

4

627

Mean Difference (IV, Random, 95% CI)

‐0.21 [‐0.35, ‐0.08]

4 HDL cholesterol, mmol/Lkg Show forest plot

22

Mean Difference (IV, Random, 95% CI)

Subtotals only

4.1 Modified fat intake

3

152

Mean Difference (IV, Random, 95% CI)

‐0.04 [‐0.18, 0.09]

4.2 Reduced fat intake

15

7082

Mean Difference (IV, Random, 95% CI)

‐0.01 [‐0.02, 0.01]

4.3 Reduced and modified fat intake

4

2073

Mean Difference (IV, Random, 95% CI)

‐0.01 [‐0.04, 0.01]

5 Total cholesterol, mmol/L Show forest plot

28

Mean Difference (IV, Random, 95% CI)

Subtotals only

5.1 Modified fat intake

8

2280

Mean Difference (IV, Random, 95% CI)

‐0.44 [‐0.60, ‐0.28]

5.2 Reduced fat intake

15

7602

Mean Difference (IV, Random, 95% CI)

‐0.10 [‐0.14, ‐0.05]

5.3 Reduced and modified fat intake

5

2131

Mean Difference (IV, Random, 95% CI)

‐0.26 [‐0.47, ‐0.04]

6 Triglycerides, mmol/L Show forest plot

21

Mean Difference (IV, Random, 95% CI)

Subtotals only

6.1 Modified fat intake

5

706

Mean Difference (IV, Random, 95% CI)

‐0.11 [‐0.22, ‐0.00]

6.2 Reduced fat intake

13

6875

Mean Difference (IV, Random, 95% CI)

‐0.00 [‐0.00, 0.00]

6.3 Reduced and modified fat intake

3

218

Mean Difference (IV, Random, 95% CI)

‐0.27 [‐0.53, ‐0.00]

7 Systolic Blood Pressure, mmHg Show forest plot

7

4059

Mean Difference (IV, Random, 95% CI)

‐0.67 [‐1.61, 0.28]

7.1 Modified fat intake

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

7.2 Reduced fat intake

6

3981

Mean Difference (IV, Random, 95% CI)

‐0.56 [‐1.52, 0.40]

7.3 Reduced and modified fat intake

1

78

Mean Difference (IV, Random, 95% CI)

‐5.08 [‐11.22, 1.06]

8 Diastolic Blood Pressure, mmHg Show forest plot

7

3621

Mean Difference (IV, Random, 95% CI)

‐0.40 [1.00, 0.20]

8.1 Modified fat intake

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

8.2 Reduced fat intake

6

3543

Mean Difference (IV, Random, 95% CI)

‐0.35 [‐0.96, 0.26]

8.3 Reduced and modified fat intake

1

78

Mean Difference (IV, Random, 95% CI)

‐2.31 [‐6.20, 1.58]

Figuras y tablas -
Comparison 3. fat modification or reduction vs usual diet ‐ tertiary outcomes
Comparison 4. fat reduction vs fat modification ‐ primary outcomes

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Total mortality

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2 Cardiovascular mortality

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3 Combined cardiovascular events Show forest plot

3

912

Risk Ratio (M‐H, Random, 95% CI)

1.13 [0.41, 3.06]

Figuras y tablas -
Comparison 4. fat reduction vs fat modification ‐ primary outcomes
Comparison 5. fat reduction vs fat modification ‐ secondary outcomes

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Myocardial infarction Show forest plot

1

101

Risk Ratio (M‐H, Random, 95% CI)

3.06 [0.33, 28.44]

2 Stroke Show forest plot

1

101

Risk Ratio (M‐H, Random, 95% CI)

0.34 [0.04, 3.16]

3 Cancer deaths

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4 Cancer diagnoses Show forest plot

2

811

Risk Ratio (M‐H, Random, 95% CI)

2.07 [0.27, 15.98]

5 Diabetes diagnoses

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

6 Non‐fatal MI Show forest plot

1

101

Risk Ratio (M‐H, Random, 95% CI)

3.06 [0.33, 28.44]

Figuras y tablas -
Comparison 5. fat reduction vs fat modification ‐ secondary outcomes
Comparison 6. fat reduction vs fat modification ‐ tertiary outcomes

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Weight, kg Show forest plot

6

1057

Mean Difference (IV, Random, 95% CI)

‐0.25 [‐1.88, 1.39]

2 BMI, kg/m2 Show forest plot

5

345

Mean Difference (IV, Random, 95% CI)

0.06 [‐0.79, 0.92]

3 LDL cholesterol, mmol/L Show forest plot

9

1275

Mean Difference (IV, Random, 95% CI)

‐0.01 [‐0.13, 0.12]

4 HDL cholesterol, mmol/Lkg Show forest plot

9

1275

Mean Difference (IV, Random, 95% CI)

‐0.02 [‐0.06, 0.02]

5 Total cholesterol, mmol/L Show forest plot

7

1130

Mean Difference (IV, Random, 95% CI)

‐0.04 [‐0.18, 0.09]

6 Triglycerides, mmol/L Show forest plot

9

1275

Mean Difference (IV, Random, 95% CI)

0.05 [‐0.02, 0.12]

7 Systolic Blood Pressure, mmHg Show forest plot

6

1068

Mean Difference (IV, Random, 95% CI)

‐0.13 [‐2.16, 1.90]

8 Diastolic Blood Pressure, mmHg Show forest plot

6

1068

Mean Difference (IV, Random, 95% CI)

‐0.23 [‐1.90, 1.43]

9 Dropouts Show forest plot

9

1353

Risk Ratio (M‐H, Random, 95% CI)

0.84 [0.58, 1.22]

Figuras y tablas -
Comparison 6. fat reduction vs fat modification ‐ tertiary outcomes