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. 2020 Aug 21;2020(8):CD011737. doi: 10.1002/14651858.CD011737.pub3

Comparison 1. SFA reduction vs usual diet ‐ primary outcomes.

Outcome or subgroup title No. of studies No. of participants Statistical method Effect size
1.1 ALL‐CAUSE MORTALITY 12 55858 Risk Ratio (M‐H, Random, 95% CI) 0.96 [0.90, 1.03]
1.2 All‐cause mortality, SA low summary risk of bias 7 53219 Risk Ratio (M‐H, Random, 95% CI) 0.95 [0.84, 1.08]
1.3 All‐cause mortality, SA aim to reduce SFA 9 53112 Risk Ratio (M‐H, Random, 95% CI) 0.97 [0.89, 1.06]
1.4 All‐cause mortality, SA statistically significant SFA reduction 8 54973 Risk Ratio (M‐H, Random, 95% CI) 0.98 [0.92, 1.04]
1.5 All‐cause mortality, SA TC reduction 8 53073 Risk Ratio (M‐H, Random, 95% CI) 0.97 [0.88, 1.07]
1.6 All‐cause mortality, SA excluding WHI 11 7023 Risk Ratio (M‐H, Random, 95% CI) 0.95 [0.83, 1.07]
1.7 All‐cause mortality, SA Mantel‐Haenszel fixed‐effect 12 55858 Risk Ratio (M‐H, Fixed, 95% CI) 0.97 [0.91, 1.03]
1.8 All‐cause mortality, SA Peto fixed‐effect 12 55858 Peto Odds Ratio (Peto, Fixed, 95% CI) 0.96 [0.90, 1.04]
1.9 All‐cause mortality, subgroup by any substitution 12   Risk Ratio (M‐H, Random, 95% CI) Subtotals only
1.9.1 replaced by PUFA 7 4238 Risk Ratio (M‐H, Random, 95% CI) 0.96 [0.82, 1.13]
1.9.2 replaced by MUFA 1 52 Risk Ratio (M‐H, Random, 95% CI) 3.00 [0.33, 26.99]
1.9.3 replaced by CHO 6 53669 Risk Ratio (M‐H, Random, 95% CI) 0.97 [0.90, 1.04]
1.9.4 replaced by protein 5 53614 Risk Ratio (M‐H, Random, 95% CI) 0.97 [0.90, 1.04]
1.9.5 replacement unclear 0 0 Risk Ratio (M‐H, Random, 95% CI) Not estimable
1.10 All‐cause mortality, subgroup by main substitution 12   Risk Ratio (M‐H, Random, 95% CI) Subtotals only
1.10.1 replaced by PUFA 6 4183 Risk Ratio (M‐H, Random, 95% CI) 0.97 [0.82, 1.14]
1.10.2 replaced by MUFA 1 52 Risk Ratio (M‐H, Random, 95% CI) 3.00 [0.33, 26.99]
1.10.3 replaced by CHO 5 51636 Risk Ratio (M‐H, Random, 95% CI) 0.97 [0.90, 1.04]
1.10.4 replaced by protein 0 0 Risk Ratio (M‐H, Random, 95% CI) Not estimable
1.10.5 replacement unclear 0 0 Risk Ratio (M‐H, Random, 95% CI) Not estimable
1.11 All‐cause mortality, subgroup by duration 12 55858 Risk Ratio (M‐H, Random, 95% CI) 0.96 [0.90, 1.03]
1.11.1 up to 24mo 4 2246 Risk Ratio (M‐H, Random, 95% CI) 0.99 [0.78, 1.26]
1.11.2 >24 to 48mo 3 1294 Risk Ratio (M‐H, Random, 95% CI) 0.96 [0.83, 1.12]
1.11.3 >48mo 4 52142 Risk Ratio (M‐H, Random, 95% CI) 0.96 [0.79, 1.16]
1.11.4 unclear duration 1 176 Risk Ratio (M‐H, Random, 95% CI) 0.33 [0.07, 1.61]
1.12 All‐cause mortality, subgroup by baseline SFA 12 55858 Risk Ratio (M‐H, Random, 95% CI) 0.96 [0.90, 1.03]
1.12.1 up to 12%E SFA baseline 1 2437 Risk Ratio (M‐H, Random, 95% CI) 0.90 [0.67, 1.21]
1.12.2 >12 to 15%E SFA baseline 5 51635 Risk Ratio (M‐H, Random, 95% CI) 1.01 [0.86, 1.19]
1.12.3 >15 to 18%E SFA baseline 1 55 Risk Ratio (M‐H, Random, 95% CI) 0.35 [0.04, 3.12]
1.12.4 >18%E SFA baseline 1 846 Risk Ratio (M‐H, Random, 95% CI) 0.98 [0.83, 1.15]
1.12.5 unclear 4 885 Risk Ratio (M‐H, Random, 95% CI) 0.80 [0.62, 1.04]
1.13 All‐cause mortality, subgroup by SFA change 12 55858 Risk Ratio (M‐H, Random, 95% CI) 0.96 [0.90, 1.03]
1.13.1 up to 4%E difference 5 53939 Risk Ratio (M‐H, Random, 95% CI) 0.99 [0.86, 1.13]
1.13.2 >4 to 8%E difference 2 188 Risk Ratio (M‐H, Random, 95% CI) 0.41 [0.08, 2.07]
1.13.3 >8%E difference 1 846 Risk Ratio (M‐H, Random, 95% CI) 0.98 [0.83, 1.15]
1.13.4 unclear 4 885 Risk Ratio (M‐H, Random, 95% CI) 0.80 [0.62, 1.04]
1.14 All‐cause mortality, subgroup by sex 12 55858 Risk Ratio (M‐H, Random, 95% CI) 0.96 [0.90, 1.03]
1.14.1 Men 9 4410 Risk Ratio (M‐H, Random, 95% CI) 0.96 [0.83, 1.11]
1.14.2 Women 2 51272 Risk Ratio (M‐H, Random, 95% CI) 0.97 [0.90, 1.05]
1.14.3 Mixed, men and women 1 176 Risk Ratio (M‐H, Random, 95% CI) 0.33 [0.07, 1.61]
1.15 All‐cause mortality, subgroup by CVD risk 12 55858 Risk Ratio (M‐H, Random, 95% CI) 0.96 [0.90, 1.03]
1.15.1 Low CVD risk 4 52251 Risk Ratio (M‐H, Random, 95% CI) 0.97 [0.91, 1.04]
1.15.2 Moderate CVD risk 1 176 Risk Ratio (M‐H, Random, 95% CI) 0.33 [0.07, 1.61]
1.15.3 Existing CVD disease 7 3431 Risk Ratio (M‐H, Random, 95% CI) 0.97 [0.76, 1.24]
1.16 All‐cause mortality, subgroup by TC reduction 12   Risk Ratio (M‐H, Random, 95% CI) Subtotals only
1.16.1 serum chol reduced by at least 0.2mmol/L 7 4238 Risk Ratio (M‐H, Random, 95% CI) 0.96 [0.81, 1.14]
1.16.2 serum chol reduced by <0.2mmol/L 4 51487 Risk Ratio (M‐H, Random, 95% CI) 0.97 [0.90, 1.04]
1.16.3 serum chol reduction unclear 1 133 Risk Ratio (M‐H, Random, 95% CI) 0.51 [0.05, 5.46]
1.17 All‐cause mortality, subgroup decade of publication 12 55858 Risk Ratio (M‐H, Random, 95% CI) 0.96 [0.90, 1.03]
1.17.1 1960s 5 1731 Risk Ratio (M‐H, Random, 95% CI) 0.92 [0.80, 1.07]
1.17.2 1970s 1 458 Risk Ratio (M‐H, Random, 95% CI) 1.49 [0.95, 2.34]
1.17.3 1980s 1 2033 Risk Ratio (M‐H, Random, 95% CI) 0.98 [0.76, 1.25]
1.17.4 1990s 2 188 Risk Ratio (M‐H, Random, 95% CI) 0.41 [0.08, 2.07]
1.17.5 2000s 3 51448 Risk Ratio (M‐H, Random, 95% CI) 0.97 [0.88, 1.05]
1.18 CARDIOVASCULAR MORTALITY 11 53421 Risk Ratio (M‐H, Random, 95% CI) 0.94 [0.78, 1.13]
1.19 CVD mortality, SA low summary risk of bias 4 50315 Risk Ratio (M‐H, Random, 95% CI) 0.96 [0.67, 1.38]
1.20 CVD mortality, SA aim to reduce SFA 9 53112 Risk Ratio (M‐H, Random, 95% CI) 0.95 [0.79, 1.14]
1.21 CVD mortality, SA statistically significant SFA reduction 7 52536 Risk Ratio (M‐H, Random, 95% CI) 0.95 [0.75, 1.21]
1.22 CVD mortality, SA TC reduction 8 53073 Risk Ratio (M‐H, Random, 95% CI) 0.95 [0.78, 1.15]
1.23 CVD mortality, SA excluding WHI 10 4586 Risk Ratio (M‐H, Random, 95% CI) 0.92 [0.72, 1.18]
1.24 CVD mortality, SA Mantel‐Haenszel fixed‐effect 11 53421 Risk Ratio (M‐H, Fixed, 95% CI) 0.95 [0.85, 1.07]
1.25 CVD mortality, SA Peto fixed‐effect 11 53421 Peto Odds Ratio (Peto, Fixed, 95% CI) 0.95 [0.84, 1.08]
1.26 CVD mortality, subgroup by any substitution 11   Risk Ratio (M‐H, Random, 95% CI) Subtotals only
1.26.1 replaced by PUFA 7 4251 Risk Ratio (M‐H, Random, 95% CI) 0.95 [0.73, 1.25]
1.26.2 replaced by MUFA 1 52 Risk Ratio (M‐H, Random, 95% CI) 3.00 [0.33, 26.99]
1.26.3 replace by CHO 5 51232 Risk Ratio (M‐H, Random, 95% CI) 0.99 [0.85, 1.14]
1.26.4 replaced by protein 4 51177 Risk Ratio (M‐H, Random, 95% CI) 0.99 [0.86, 1.14]
1.26.5 replacement unclear 0 0 Risk Ratio (M‐H, Random, 95% CI) Not estimable
1.27 CVD mortality, subgroup by main substitution 11   Risk Ratio (M‐H, Random, 95% CI) Subtotals only
1.27.1 replaced by PUFA 6 4196 Risk Ratio (M‐H, Random, 95% CI) 0.97 [0.73, 1.28]
1.27.2 replaced by MUFA 1 52 Risk Ratio (M‐H, Random, 95% CI) 3.00 [0.33, 26.99]
1.27.3 replace by CHO 4 49199 Risk Ratio (M‐H, Random, 95% CI) 0.78 [0.42, 1.46]
1.27.4 replaced by protein 0 0 Risk Ratio (M‐H, Random, 95% CI) Not estimable
1.27.5 replacement unclear 0 0 Risk Ratio (M‐H, Random, 95% CI) Not estimable
1.28 CVD mortality, subgroup by duration 11 53447 Risk Ratio (M‐H, Random, 95% CI) 0.95 [0.78, 1.16]
1.28.1 up to 24mo 4 2272 Risk Ratio (M‐H, Random, 95% CI) 1.26 [0.54, 2.94]
1.28.2 >24 to 48mo 3 1294 Risk Ratio (M‐H, Random, 95% CI) 0.79 [0.57, 1.08]
1.28.3 >48 mo 3 49705 Risk Ratio (M‐H, Random, 95% CI) 1.02 [0.73, 1.43]
1.28.4 unclear duration 1 176 Risk Ratio (M‐H, Random, 95% CI) 0.25 [0.03, 2.19]
1.29 CVD mortality, subgroup by baseline SFA 11 53447 Risk Ratio (M‐H, Random, 95% CI) 0.95 [0.78, 1.16]
1.29.1 up to 12%E SFA baseline 0 0 Risk Ratio (M‐H, Random, 95% CI) Not estimable
1.29.2 >12 to 15%E SFA baseline 5 51635 Risk Ratio (M‐H, Random, 95% CI) 1.06 [0.84, 1.32]
1.29.3 >15 to 18%E SFA baseline 1 55 Risk Ratio (M‐H, Random, 95% CI) 0.35 [0.04, 3.12]
1.29.4 >18%E SFA baseline 1 846 Risk Ratio (M‐H, Random, 95% CI) 0.70 [0.51, 0.96]
1.29.5 unclear 4 911 Risk Ratio (M‐H, Random, 95% CI) 1.00 [0.61, 1.66]
1.30 CVD mortality, subgroup by SFA change 11 53447 Risk Ratio (M‐H, Random, 95% CI) 0.95 [0.78, 1.16]
1.30.1 up to 4%E difference 4 51502 Risk Ratio (M‐H, Random, 95% CI) 1.07 [0.85, 1.33]
1.30.2 >4 to 8%E difference 2 188 Risk Ratio (M‐H, Random, 95% CI) 0.29 [0.05, 1.70]
1.30.3 >8%E difference 1 846 Risk Ratio (M‐H, Random, 95% CI) 0.70 [0.51, 0.96]
1.30.4 unclear 4 911 Risk Ratio (M‐H, Random, 95% CI) 1.00 [0.61, 1.66]
1.31 CVD mortality, subgroup by sex 11 53447 Risk Ratio (M‐H, Random, 95% CI) 0.95 [0.78, 1.16]
1.31.1 Men 9 4436 Risk Ratio (M‐H, Random, 95% CI) 0.96 [0.73, 1.25]
1.31.2 Women 1 48835 Risk Ratio (M‐H, Random, 95% CI) 1.00 [0.84, 1.19]
1.31.3 Mixed, men and women 1 176 Risk Ratio (M‐H, Random, 95% CI) 0.25 [0.03, 2.19]
1.32 CVD mortality, subgroup by CVD risk 11 53447 Risk Ratio (M‐H, Random, 95% CI) 0.96 [0.80, 1.14]
1.32.1 Low CVD risk 3 47537 Risk Ratio (M‐H, Random, 95% CI) 0.84 [0.60, 1.16]
1.32.2 Moderate CVD risk 1 176 Risk Ratio (M‐H, Random, 95% CI) 0.25 [0.03, 2.19]
1.32.3 Existing CVD disease 8 5734 Risk Ratio (M‐H, Random, 95% CI) 1.04 [0.83, 1.31]
1.33 CVD mortality, subgroup by TC reduction 11   Risk Ratio (M‐H, Random, 95% CI) Subtotals only
1.33.1 serum chol reduced by at least 0.2mmol/L 7 4251 Risk Ratio (M‐H, Random, 95% CI) 0.95 [0.73, 1.25]
1.33.2 serum chol reduced by <0.2mmol/L 3 49063 Risk Ratio (M‐H, Random, 95% CI) 0.97 [0.47, 2.01]
1.33.3 serum chol reduction unclear 1 133 Risk Ratio (M‐H, Random, 95% CI) 0.20 [0.01, 4.15]
1.34 CVD mortality, subgroup decade of publication 11 53421 Risk Ratio (M‐H, Random, 95% CI) 0.94 [0.78, 1.13]
1.34.1 1960s 5 1731 Risk Ratio (M‐H, Random, 95% CI) 0.78 [0.63, 0.97]
1.34.2 1970s 1 458 Risk Ratio (M‐H, Random, 95% CI) 1.59 [0.99, 2.55]
1.34.3 1980s 1 2033 Risk Ratio (M‐H, Random, 95% CI) 1.01 [0.77, 1.31]
1.34.4 1990s 2 188 Risk Ratio (M‐H, Random, 95% CI) 0.29 [0.05, 1.70]
1.34.5 2000s 2 49011 Risk Ratio (M‐H, Random, 95% CI) 0.78 [0.27, 2.21]
1.35 COMBINED CARDIOVASCULAR EVENTS 13 53758 Risk Ratio (M‐H, Random, 95% CI) 0.83 [0.70, 0.98]
1.36 CVD events, SA low summary risk of bias 4 50315 Risk Ratio (M‐H, Random, 95% CI) 0.96 [0.76, 1.20]
1.37 CVD events, SA aim to reduce SFA 11 53449 Risk Ratio (M‐H, Random, 95% CI) 0.84 [0.70, 1.00]
1.38 CVD events, SA statistically significant SFA reduction 8 52771 Risk Ratio (M‐H, Random, 95% CI) 0.90 [0.74, 1.08]
1.39 CVD events, SA TC reduction 10 53410 Risk Ratio (M‐H, Random, 95% CI) 0.83 [0.69, 1.00]
1.40 CVD events, SA excluding WHI 12 4923 Risk Ratio (M‐H, Random, 95% CI) 0.79 [0.64, 0.98]
1.41 CVD events, SA Mantel‐Haenszel fixed‐effect 13 53758 Risk Ratio (M‐H, Fixed, 95% CI) 0.94 [0.89, 0.99]
1.42 CVD events, SA Peto fixed‐effect 13 53758 Peto Odds Ratio (Peto, Fixed, 95% CI) 0.93 [0.88, 0.99]
1.43 CVD events, SA excluding trials with additional interventions 10 4456 Risk Ratio (M‐H, Random, 95% CI) 0.86 [0.67, 1.09]
1.44 CVD events, subgroup by any substitution 13   Risk Ratio (M‐H, Random, 95% CI) Subtotals only
1.44.1 replaced by PUFA 8 4353 Risk Ratio (M‐H, Random, 95% CI) 0.79 [0.62, 1.00]
1.44.2 replaced by MUFA 1 52 Risk Ratio (M‐H, Random, 95% CI) 1.00 [0.53, 1.89]
1.44.3 replace by CHO 5 51232 Risk Ratio (M‐H, Random, 95% CI) 0.84 [0.67, 1.06]
1.44.4 replaced by protein 4 51177 Risk Ratio (M‐H, Random, 95% CI) 0.97 [0.91, 1.03]
1.44.5 replacement unclear 1 235 Risk Ratio (M‐H, Random, 95% CI) 1.68 [0.41, 6.87]
1.45 CVD events, subgroup by main substitution 13   Risk Ratio (M‐H, Random, 95% CI) Subtotals only
1.45.1 replaced by PUFA 7 4298 Risk Ratio (M‐H, Random, 95% CI) 0.84 [0.66, 1.06]
1.45.2 replaced by MUFA 1 52 Risk Ratio (M‐H, Random, 95% CI) 1.00 [0.53, 1.89]
1.45.3 replace by CHO 4 49199 Risk Ratio (M‐H, Random, 95% CI) 0.67 [0.39, 1.16]
1.45.4 replaced by protein 0 0 Risk Ratio (M‐H, Random, 95% CI) Not estimable
1.45.5 replacement unclear 1 235 Risk Ratio (M‐H, Random, 95% CI) 1.68 [0.41, 6.87]
1.46 CVD events, subgroup by duration 13 53758 Risk Ratio (M‐H, Random, 95% CI) 0.83 [0.70, 0.98]
1.46.1 up to 24mo 5 2481 Risk Ratio (M‐H, Random, 95% CI) 0.96 [0.78, 1.16]
1.46.2 >24 to 48mo 3 1294 Risk Ratio (M‐H, Random, 95% CI) 0.73 [0.56, 0.95]
1.46.3 >48mo 3 49705 Risk Ratio (M‐H, Random, 95% CI) 0.97 [0.72, 1.33]
1.46.4 unclear duration 2 278 Risk Ratio (M‐H, Random, 95% CI) 0.43 [0.17, 1.08]
1.47 CVD events, subgroup by baseline SFA 13 53758 Risk Ratio (M‐H, Random, 95% CI) 0.83 [0.70, 0.98]
1.47.1 up to 12%E SFA baseline 0 0 Risk Ratio (M‐H, Random, 95% CI) Not estimable
1.47.2 >12 to 15%E SFA baseline 6 51870 Risk Ratio (M‐H, Random, 95% CI) 0.99 [0.85, 1.15]
1.47.3 >15 to 18%E SFA baseline 1 55 Risk Ratio (M‐H, Random, 95% CI) 0.41 [0.22, 0.78]
1.47.4 >18%E SFA baseline 1 846 Risk Ratio (M‐H, Random, 95% CI) 0.79 [0.63, 1.00]
1.47.5 unclear 5 987 Risk Ratio (M‐H, Random, 95% CI) 0.72 [0.51, 1.03]
1.48 CVD events, subgroup by SFA change 13 53758 Risk Ratio (M‐H, Random, 95% CI) 0.83 [0.70, 0.98]
1.48.1 up to 4%E difference 5 51737 Risk Ratio (M‐H, Random, 95% CI) 1.00 [0.86, 1.16]
1.48.2 >4 to 8%E difference 2 188 Risk Ratio (M‐H, Random, 95% CI) 0.40 [0.22, 0.74]
1.48.3 >8%E difference 1 846 Risk Ratio (M‐H, Random, 95% CI) 0.79 [0.63, 1.00]
1.48.4 unclear 5 987 Risk Ratio (M‐H, Random, 95% CI) 0.72 [0.51, 1.03]
1.49 CVD events, subgroup by sex 13 53758 Risk Ratio (M‐H, Random, 95% CI) 0.83 [0.70, 0.98]
1.49.1 Men 9 4410 Risk Ratio (M‐H, Random, 95% CI) 0.85 [0.71, 1.03]
1.49.2 Women 1 48835 Risk Ratio (M‐H, Random, 95% CI) 0.98 [0.92, 1.04]
1.49.3 Mixed, men and women 3 513 Risk Ratio (M‐H, Random, 95% CI) 0.59 [0.23, 1.49]
1.50 CVD events, subgroup by CVD risk 13 53758 Risk Ratio (M‐H, Random, 95% CI) 0.86 [0.74, 1.00]
1.50.1 Low CVD risk 3 47537 Risk Ratio (M‐H, Random, 95% CI) 0.89 [0.75, 1.06]
1.50.2 Moderate CVD risk 3 513 Risk Ratio (M‐H, Random, 95% CI) 0.59 [0.23, 1.49]
1.50.3 Existing CVD disease 8 5708 Risk Ratio (M‐H, Random, 95% CI) 0.91 [0.75, 1.12]
1.51 CVD events, subgroup by TC reduction 13   Risk Ratio (M‐H, Random, 95% CI) Subtotals only
1.51.1 serum chol reduced by at least 0.2mmol/L 9 4575 Risk Ratio (M‐H, Random, 95% CI) 0.79 [0.63, 1.00]
1.51.2 serum chol reduced by <0.2mmol/L 3 49050 Risk Ratio (M‐H, Random, 95% CI) 0.98 [0.91, 1.04]
1.51.3 serum chol reduction unclear 1 133 Risk Ratio (M‐H, Random, 95% CI) 0.20 [0.01, 4.15]
1.52 CVD events, subgroup decade of publication 13 53758 Risk Ratio (M‐H, Random, 95% CI) 0.83 [0.70, 0.98]
1.52.1 1960s 5 1731 Risk Ratio (M‐H, Random, 95% CI) 0.79 [0.69, 0.91]
1.52.2 1970s 2 560 Risk Ratio (M‐H, Random, 95% CI) 0.66 [0.12, 3.80]
1.52.3 1980s 1 2033 Risk Ratio (M‐H, Random, 95% CI) 0.92 [0.74, 1.15]
1.52.4 1990s 2 188 Risk Ratio (M‐H, Random, 95% CI) 0.40 [0.22, 0.74]
1.52.5 2000s 3 49246 Risk Ratio (M‐H, Random, 95% CI) 0.98 [0.91, 1.04]