n-6 fatty acid-specific and mixed polyunsaturate dietary interventions have different effects on CHD risk: a meta-analysis of randomised controlled trials.
n-6 fatty acid-specific and mixed polyunsaturate dietary interventions have different effects on CHD risk: a meta-analysis of randomised controlled trials.
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DOI：
10.1017/s0007114510004010
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发表时间：
2010-12
影响因子：
3.6
通讯作者：
Davis, John M.
中科院分区：
文献类型：
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作者：
Ramsden, Christopher E.;Hibbeln, Joseph R.;Majchrzak, Sharon F.;Davis, John M.
混合n-6和n-3 PUFA饮食的随机对照试验（RCT）及其CHD结局的荟萃分析被认为是明确建议消费“至少5- 10%的能量作为n-6 PUFA”的决定性证据。在此，我们（1）进行了广泛的文献检索，并提取了详细的饮食和结果数据，以便对所有增加PUFA并报告相关CHD结果的RCT进行严格检查;（2）确定饮食干预是否特异性增加n-6 PUFA，或增加n-3和n-6 PUFA（即混合n-3/n-6 PUFA饮食）;（3）在荟萃分析中比较混合n-3/n-6 PUFA与n-6特定PUFA饮食对相关CHD结局的影响;（4）评价反式脂肪酸（TFA）的潜在混杂作用。8个数据集中有4个数据集n-3 PUFA摄入量显著增加，4个数据集中n-6 PUFA亚油酸特异性升高。在所有八个数据集中，n-3和n-6 PUFA取代了TFA和SFA的组合。对于非致死性心肌梗死（MI）+ CHD死亡，混合n-3/n-6 PUFA饮食的合并风险降低22%（风险比（RR）0.78; 95% CI 0.65，0.93），而n-6特定PUFA饮食的风险增加13%（RR 1.13; 95% CI 0.84，1.53）。与混合n-3/n-6 PUFA饮食相比，n-6特定PUFA饮食中的非致死性MI + CHD死亡风险显著更高（P= 0.02）。用n-6 PUFA替代TFA和SFA而不同时增加n-3 PUFA的RCT导致死亡风险增加，接近统计学显著性（RR 1.16; 95% CI 0.95，1.42）。根据混合n-3/n-6 RCT数据，专门增加n-6 PUFA摄入量的建议不太可能提供预期的益处，实际上可能增加CHD和死亡的风险。
Randomised controlled trials (RCT) of mixed n-6 and n-3 PUFA diets, and meta-analyses of their CHD outcomes, have been considered decisive evidence in specifically advising consumption of ‘at least 5–10 % of energy as n-6 PUFA’. Here we (1) performed an extensive literature search and extracted detailed dietary and outcome data enabling a critical examination of all RCT that increased PUFA and reported relevant CHD outcomes; (2) determined if dietary interventions increased n-6 PUFA with specificity, or increased both n-3 and n-6 PUFA (i.e. mixed n-3/n-6 PUFA diets); (3) compared mixed n-3/n-6 PUFA to n-6 specific PUFA diets on relevant CHD outcomes in meta-analyses; (4) evaluated the potential confounding role of trans-fatty acids (TFA). n-3 PUFA intakes were increased substantially in four of eight datasets, and the n-6 PUFA linoleic acid was raised with specificity in four datasets. n-3 and n-6 PUFA replaced a combination of TFA and SFA in all eight datasets. For non-fatal myocardial infarction (MI) + CHD death, the pooled risk reduction for mixed n-3/n-6 PUFA diets was 22 % (risk ratio (RR) 0·78; 95 % CI 0·65, 0·93) compared to an increased risk of 13 % for n-6 specific PUFA diets (RR 1·13; 95 % CI 0·84, 1·53). Risk of non-fatal MI + CHD death was significantly higher in n-6 specific PUFA diets compared to mixed n-3/n-6 PUFA diets (P=0·02). RCT that substituted n-6 PUFA for TFA and SFA without simultaneously increasing n-3 PUFA produced an increase in risk of death that approached statistical significance (RR 1·16; 95 % CI 0·95, 1·42). Advice to specifically increase n-6 PUFA intake, based on mixed n-3/n-6 RCT data, is unlikely to provide the intended benefits, and may actually increase the risks of CHD and death.