Table 1.
General study characteristics of the included cohort studies
| Author, year | Cohort name country | Outcomes | Population | Follow-up (years) | Age at entry (years) | Sex | MUFA source | Adjustment | Multivariate adjusted | Study quality |
|---|---|---|---|---|---|---|---|---|---|---|
| (Newcastle-Ottawa scale) | ||||||||||
| Atkins et al. 2014 [34] | British Regional Heart Study GBR | All-cause mortality CVD mortality CVD events CHD events | 3,328 | 11.3 | 60-79 | M | Olive oil | Age, energy intake, smoking, alcohol, PA, social class, BMI, and a modified version of the HDI/EDI score not containing the individual component of interest | Fourth vs. first quartile | 8 |
| Barzi et al. 2003 [50] | Studio della Sopravvivenza nell’Infarto Miocardico ITA | All-cause mortality | 11,323 with myocardial infarction | 6.5 | 59 | M/F | Olive oil | Age, sex, hypertension, HDL-cholesterol, diabetes, smoking, claudication, electrical instability, left ventricular dysfunction, residual myocardial ischaemia, dietary supplementation, pharmacological therapies | Third vs. first tertile | 7 |
| Bendinelli et al. 2011 [49] | European Prospective Into Cancer and Nutrition ITA | CHD | 29,689 | 7.85 | 35-74 | F | MUFA MUFA:SFA | Energy intake, educational level, smoking status, alcohol consumption, body height, body weight, waist circumference daily non-alcohol caloric intake, hypertension, menopausal status, PA, total meat consumption | Fourth vs. first quartile | 8 |
| Buckland et al. 2012 [11] | European Prospective Into Cancer and Nutrition SPA | All-cause mortality CVD mortality Cancer mortality | 41,078 | 10.4 | 29-69 | M/F | Olive oil | Centre, sex, age, energy intake, BMI, waist circumference, educational status, smoking status, PA, and alcohol intake, intake of fruit, vegetables, meat, and dairy | Fourth vs. first quartile | 8 |
| Buckland et al. 2012 [56] | European Prospective Into Cancer and Nutrition SPA | CHD | 40,142 | 10.4 | 29-69 | M/F | Olive oil | Educational level, BMI, waist circumference, PA, smoking status, alcohol consumption, energy intake excluding alcohol, hyperlipidaemia, hypertension and diabetes, Mediterranean diet score (excluding olive oil and alcohol) | Fourth vs. first quartile | 8 |
| Chiuve et al. 2012 [32] | Nurses’ Health Study USA | Sudden death | 91,981 | 30 | 34-59 | F | MUFA | Total calories, smoking, BMI, family history of myocardial infarction, menopausal status, hormone therapy, exercise, aspirin use, use of multivitamins, use of vitamin E supplements, alcohol use, and history of diabetes, hypertension, hypercholesterolemia, coronary heart disease, and cancer at baseline, percentage of energy from total fat | Fifth vs. first quintile | 8 |
| Dilis et al. 2012 [19] | European Prospective Into Cancer and Nutrition GRE | CHD mortality CHD incidence | 23,929 | 10 | 20-86 | M/F | MUFA Olive Oil MUFA:SFA | Age, BMI, height, PA, years of schooling and energy intake entered, alcohol consumption, smoking status and arterial blood pressure | 1 SD increment | 9 |
| Esrey et al. 1996 [42] | Lipid Research Clinics Prevalence Study USA | CVD mortality | 4,546 | 12.4 | ≥30 | M/F | MUFA | Age, sex, energy intake, serum lipids, systolic blood pressure, cigarette smoking, BMI, glucose intolerance | 1 unit increase | 9 |
| Gardener et al. 2011 [43] | Northern Manhattan Study USA | Ischemic stroke Myocardial infarction Vascular death | 2,568 | 9 | >40 | M/F | MUFA:SFA | Age, sex, race ethnicity, completion of high school education, moderate-to-heavy PA, energy intake, and cigarette smoking | ≥ median vs. < median | 7 |
| Gillman et al. 1997 [40] | Framingham Heart Study USA | Stroke | 832 | 20 | 45-65 | M | MUFA | Age, energy, systolic blood pressure, cigarette smoking, glucose intolerance, BMI, PA, left ventricular hypertrophy, alcohol, fruit and vegetables | 1% increase MUFA | 9 |
| Goldbourt et al. 1993 [18] | Israeli Ischemic Heart Disease Study ISR | CHD All-cause mortality | 10,059 | 23 | >40 | M | MUFA:SFA | Age | Fifth vs. first quintile | 7 |
| Guasch-Ferre et al. 2014 [54] | PREvención con DIeta MEDiterránea SPA | All-cause mortality CVD mortality CVD events | 7216 | 4.8 | 55-80 | M/W | Olive oil | Age, sex, BMI, smoking status, alcohol intake, education level, PA, prevalence of diabetes, prevalence of hypertension, prevalence of hypercholesterolemia, use of antihypertensive, use of statins, Mediterranean diet adherence | Third vs. first tertile | 8 |
| He et al. 2003 [47] | Health professional study USA | Stroke | 43,732 | 14 | 40-75 | M | MUFA | BMI, PA, history of hypertension, smoking status, aspirin use, multivitamin use, and consumption of alcohol, potassium, fibre, and vitamin E, total servings of fruit and vegetables, total energy intake, and hypercholesterolemia at baseline | Fifth vs. first quintile | 7 |
| Houston et al. 2011 [38] | Health ABC study USA | CVD events | 1,941 | 9 | 70-79 | M/F | MUFA | Age, gender, race, education, field centre, smoking, alcohol use, PA, BMI, total energy intake, protein intake, fibre intake, multivitamin use, supplemental vitamin E use, statin use, aspirin use, oral estrogen use, and prevalent diabetes or hypertension, fat, PUFA, trans fat, and cholesterol | Third vs. first tertile | 8 |
| Iso et al. 2001 [37] | Nurses’ Health Study USA | Stroke | 85,764 | 14 | 30-59 | F | MUFA | Age, smoking status, time interval, BMI, alcohol intake, menopausal status and postmenopausal hormone use, vigorous exercise, usual aspirin use, multivitamin use, vitamin E use, n-3 fatty acid intake, calcium intake, and histories of hypertension, diabetes, high cholesterol levels, and total energy intake | Fifth vs. first quintile | 7 |
| Iso et al. 2003 [36] | JAP | Stroke | 4,775 | 14 | 40-69 | M/F | MUFA | Age, sex, quartiles of total energy intake and BMI, hypertension category, diabetes, serum total cholesterol, smoking status, ethanol intake, and menopausal status | Fourth vs. first quartile | 8 |
| Jakobsen et al. 2004 [4] | Multinational MONItoring of trends and determinants in CArdiovascular disease I, II EU | CHD | 3,686 | 16 | 30-71 | M/F | MUFA | Total energy intake, energy from protein, energy from fat, energy from carbohydrates, non-dietary and dietary coronary heart disease risk factors | 5% increase | 8 |
| Kouris-Blazos et al. 1999 [55] | AUS | All-cause mortality | 330 | 4-6 | >70 | M/F | MUFA:SFA | Age, sex and smoking status but not ethnic origin | MUFA:SFA (1 unit) | 6 |
| Larsson et al. 2012 [48] | Swedish Mammography Cohort SWE | Stroke | 34,670 | 10.4 | 49-83 | F | MUFA | Age, smoking status and pack-years of smoking, education, BMI, PA, history of hypertension, history of diabetes, aspirin use, family history of myocardial infarction, intakes of alcohol, protein, and dietary fibre, cholesterol | Fifth vs. first quintile | 8 |
| Lasheras et al. 2000 [26] | SPA | All-cause mortality | 161 | 9 | 65-95 | M/F | MUFA:SFA | Age, sex, BMI, albumin concentration, PA, self-assessment of health, and dieting for chronic conditions | MUFA:SFA (1 unit) | 6 |
| Leosdottir et al. 2007 [28], Wallström et al. 2012 [29] | Malmö Diet and cancer Study SWE | CVD events Stroke CHD | 28,098 | 13.5 | 44-73 | M/F | MUFA MUFA:SFA | Age, smoking habits, alcohol consumption, socioeconomic status, marital status, PA, BMI, fibre intake, and blood pressure, total fat intake for the ratio between unsaturated and saturated fats | Fifth vs. first quintile Fourth vs. first quartile | 9 |
| Levitan et al. 2013 [57] | Women’s Health Initiative trial and observational study USA | Heart Failure | 68,132 (WHI) 93,676 (WHI-OS) | 4.6 | 50-79 | F | MUFA:SFA | Age at heart failure hospitalization, total energy intake, race/ethnicity, education, income, married, current smoking, total exercise, physical function, use of off-study postmenopausal hormone therapy, Women’s Health Initiative (WHI) study arm, systolic blood pressure, diastolic blood pressure, use of diuretics, β-blockers, and angiotensin converting enzyme inhibitors or angiotensin receptor blockers, BMI, and history of high cholesterol, high blood pressure, diabetes mellitus, myocardial infarction, coronary revascularization, and atrial fibrillation | Fourth vs. first quartile | 8 |
| Martinez-Gonzalez et al. 2011 [45] | Seguimiento University of Navarra SPA | All-cause mortality | 15,535 | 6.8 | University graduates (mean: 38) | M/F | MUFA:SFA | Age, years of university of education, BMI, smoking, PA, hours per day spent watching television, history of depression, baseline hypertension, baseline hypercholesterolemia, total energy intake, egg consumption, potato consumption, and adoption of special diets | ≥ median vs. < median | 8 |
| Martinez-Gonzalez et al. 2009 | Seguimiento University of Navarra SPA | CVD CHD | 13,609 | 4.9 | University graduates (mean: 38) | M/F | MUFA:SFA | Age, sex, family history of coronary heart disease, total energy intake, PA, smoking, BMI, diabetes at baseline, use of aspirin, history of hypertension and history of hypercholesterolemia | ≥ median (W: ≥1.24, M: ≥1.19) vs. < median | 8 |
| Misirli et al. 2012 [52] | European Prospective Into Cancer and Nutrition GRE | Stroke Incidence Stroke Mortality | 23,601 | 10.6 | 20-87 | M/F | MUFA Olive Oil | Age, sex, education, smoking status, BMI, PA, hypertension, diabetes, and total energy intake. | Olive oil (23 g/d) MUFA (18 g/d) | 9 |
| Nagata et al. 2012 [31] | Takayama study JAP | All-cause mortality CVD mortality Cancer mortality | 28,356 | 16 | ≥35 | M/F | MUFA | Age, non-alcohol energy, and protein expressed as percentage of non-alcohol energy and was additionally adjusted for fat subtypes expressed as percentage of non-alcohol energy as appropriate, height, BMI, PA, smoking status, alcohol intake, education, marital status, menopausal status, histories of diabetes and hypertension, and intakes of fruits, vegetables, and dietary fibre | Fifth vs. first quintile | 8 |
| Oh et al. 2005 [33] | Nurses’ Health Study USA | CHD | 78,778 | 20 | 30-55 | F | MUFA | Age, BMI, smoking, alcohol intake, parental history of myocardial infarction, history of hypertension, menopausal status and hormone use, aspirin use, multivitamin use, vitamin E supplement use, PA, energy, protein, cholesterol intake, saturated, polyunsaturated, and trans-fat; a-linolenic acid; marine n-3 fatty acids; cereal fiber; and fruits and vegetables | Fifth vs. first quintile | 7 |
| Pietinen et al. 1997 [53] | Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study USA | CVD events CVD mortality | 21,930 | 6.1 | 50-69 | M | MUFA Oleic acid | Age, smoking, BMI, blood pressure, energy intake, alcohol, education, PA | Fifth vs. first quintile | 7 |
| Posner et al. 1991 [46] | Framingham Study USA | CHD | 813 | 16 | 45-65 | M | MUFA | Energy, serum cholesterol levels, PA, systolic blood pressure, left ventricular hypertrophy, cigarette smoking, glucose intolerance, and metropolitan relative weight | For recommended vs. actual intake | 9 |
| Sauvaget et al. 2004 [35] | JAP | Stroke | 3,731 | 14 | 35-89 | M/F | MUFA | Age, sex, adjusted for radiation dose, city, BMI, smoking status, alcohol habits, and medical history of hypertension and diabetes | Third vs. first tertile | 8 |
| Samieri et al. 2011 [10] | Three city study FRA | Stroke | 7,625 | 5.25 | ≥65 | M/F | Olive oil | Age, sex, education, smoking status, BMI, PA, hypertension, diabetes, and total energy intake | Third vs. first tertile | 8 |
| Solfrizzi et al. 2005 [51] | Italian Longitudinal Study on Aging ITA | All-cause mortality | 278 | 8.5 | 65-84 | F | MUFA MUFA:SFA | Age, sex, waist-hip ratio, smoking status, Charlson co-morbidity index, and total energy intake | Fourth vs. first quartile | 7 |
| Tognon et al. 2011 [24] | DEN | All-cause mortality | 1,037 | 8.5 | 70 | M/F | MUFA:SFA | Gender, BMI, waist circumference, PA, smoking status, marital status and education | ≥ median vs. < median | 7 |
| Trichopoulou et al. 2005 [23] | European Prospective Into Cancer and Nutrition Elderly EU | All-cause mortality | 74,607 | 7.4 | >60 | M/F | MUFA MUFA:SFA | Age, sex, diabetes mellitus at baseline, waist to hip ratio, BMI, educational achievement, smoking status, PA at occupation, PA score at leisure, alcohol intake, and total energy intake | MUFA (12 g) MUFA:SFA (0.4) | 8 |
| Trichopoulou et al. 2009 [20] | European Prospective Into Cancer and Nutrition GRE | All-cause mortality | 23,349 | 8.5 | 20-86 | M/F | MUFA:SFA | Age, sex, education, smoking status, waist-to-hip ratio, BMI, MET score, and total energy intake | ≥ median vs. < median | 9 |
| Trichopoulou et al. 1995 [22] | GRE | All-cause mortality | 182 | 4-5 | >70 | M/F | MUFA:SFA | Age, sex, and smoking status | MUFA:SFA (1 unit) | 7 |
| Trichopoulou et al. 2003 [21] | European Prospective Into Cancer and Nutrition GRE | All-cause mortality | 22,043 | 3.7 | 20-86 | M/F | MUFA Olive oil MUFA:SFA | Age, sex, waist-to-hip ratio, energy-expenditure score, years of education, smoking status, BMI, and total energy intake | MUFA (15 g/d) Increment olive oil (20 g) MUFA:SFA (0.5) | 9 |
| Van den Brandt et al. 2011 [27] | Netherlands cohort study NED | All-cause mortality | 120,852 | 10 | 55-69 | M/F | MUFA:SFA | Age, cigarette smoking status, number of cigarettes smoked per day, years of smoking, BMI, non-occupational PA, history of hypertension, highest level of education, and energy intake | Fourth vs. first quartile | 9 |
| Yaemsiri et al. 2012 [39] | Women’s Health initiative observational study USA | Stroke | 87,025 | 7.6 | 50-79 | F | MUFA | Age, race, education, family income, total metabolic equivalent task hours per week, alcohol intake, history of CHD, history of atrial fibrillation, history of diabetes, aspirin use, use of antihypertensive medication, use of cholesterol-lowering medication, BMI, systolic blood pressure, and total energy intake, dietary vitamin E, fruits and vegetable intake, fibre | Fifth vs. first quintile | 8 |
| Xu et al. 2006 [41] | Strong Heart Study USA | CHD CHD mortality | 2,938 | 7.2 | 47-79 | M/F | MUFA | Age, sex, energy, study centre, diabetes status, BMI, HDL, LDL, triacylglycerol, smoking, alcohol consumption, hypertension, percentage of energy from protein, and total energy intake | Fourth vs. first quartile | 9 |
| Wakai et al. 2014 [30] | Japan Collaborative Cohort Study JAP | All-cause mortality CVD mortality | 58,672 | 19.3 | 40-79 | M/F | MUFA | Age, area, education, smoking, alcohol consumption, BMI, sleep duration, walking, consumption of vegetables and fruit, and total energy intake | Fifth vs. first quintile | 8 |
BMI Body Mass Index, CHD coronary heart disease, CVD cardiovascular disease, DEN Denmark, EDI Elderly Diet Index, EU European Union, FRA France, GBR Great Britain, HDI Healthy Diet Index, ISR Israel, ITA Italy, JAP Japan, MET metabolic equivalent of task, MUFA monounsaturated fatty acids, NED The Netherlands, PA physical activity, SFA saturated fatty acids, SPA Spain, SWE Sweden, WHI Women’s Health Initiative, USA United States of America.