Home > General Cardiology, Journal Club > Journal Club 18 February 2015

Journal Club 18 February 2015

Paper

Evidence from randomised controlled trials did not support the introduction
of dietary fat guidelines in 1977 and 1983: a systematic review and meta-analysis

Presenter

MD

Summary

Objectives

National dietary guidelines were
introduced in 1977 and 1983, by the US and UK
governments, respectively, with the ambition of
reducing coronary heart disease (CHD) by reducing fat
intake. To date, no analysis of the evidence base for
these recommendations has been undertaken. The
present study examines the evidence from randomised
controlled trials (RCTs) available to the US and UK
regulatory committees at their respective points of
implementation.

Methods

A systematic review and meta-analysis were
undertaken of RCTs, published prior to 1983, which
examined the relationship between dietary fat, serum
cholesterol and the development of CHD.

Results

2467 males participated in six dietary trials:
five secondary prevention studies and one including
healthy participants. There were 370 deaths from allcause
mortality in the intervention and control groups.
The risk ratio (RR) from meta-analysis was 0.996
(95% CI 0.865 to 1.147). There were 207 and 216
deaths from CHD in the intervention and control
groups, respectively. The RR was 0.989 (95% CI 0.784
to 1.247). There were no differences in all-cause
mortality and non-significant differences in CHD
mortality, resulting from the dietary interventions.
The reductions in mean serum cholesterol levels were
significantly higher in the intervention groups; this did
not result in significant differences in CHD or all-cause
mortality. Government dietary fat recommendations
were untested in any trial prior to being introduced.

Conclusions

Dietary recommendations were
introduced for 220 million US and 56 million UK
citizens by 1983, in the absence of supporting
evidence from RCTs.

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