title: Dietary linoleic acid and risk of coronary heart disease: a systematic review and meta-analysis of prospective cohort studies.
abstract: BACKGROUND
  Previous studies on intake of linoleic acid (LA), the predominant n-6 fatty acid, and coronary heart disease (CHD) risk have generated inconsistent results. We performed a systematic review and meta-analysis of prospective cohort studies to summarize the evidence regarding the relation of dietary LA intake and CHD risk.
  
  
  RESULTS
  We searched MEDLINE and EMBASE databases through June 2013 for prospective cohort studies that reported the association between dietary LA and CHD events. In addition, we used unpublished data from cohort studies in a previous pooling project. We pooled the multivariate-adjusted relative risk (RR) to compare the highest with the lowest categories of LA intake using fixed-effect meta-analysis. We identified 13 published and unpublished cohort studies with a total of 310 602 individuals and 12 479 total CHD events, including 5882 CHD deaths. When the highest category was compared with the lowest category, dietary LA was associated with a 15% lower risk of CHD events (pooled RR, 0.85; 95% confidence intervals, 0.78-0.92; I(2)=35.5%) and a 21% lower risk of CHD deaths (pooled RR, 0.79; 95% confidence intervals, 0.71-0.89; I(2)=0.0%). A 5% of energy increment in LA intake replacing energy from saturated fat intake was associated with a 9% lower risk of CHD events (RR, 0.91; 95% confidence intervals, 0.87-0.96) and a 13% lower risk of CHD deaths (RR, 0.87; 95% confidence intervals, 0.82-0.94).
  
  
  CONCLUSIONS
  In prospective observational studies, dietary LA intake is inversely associated with CHD risk in a dose-response manner. These data provide support for current recommendations to replace saturated fat with polyunsaturated fat for primary prevention of CHD.
authors.affiliation: From the Departments of Nutrition (M.S.F., M.D., Q.S., S.E.C., W.C.W., F.B.H.) and Epidemiology (W.C.W., F.B.H.), Harvard School of Public Health, Boston, MA; Department of Community Nutrition (M.S.F.), Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Saw Swee Hock School of Public Health and Yong Loo Lin School of Medicine (A.P.), National University of Singapore and National University Health System, Republic of Singapore; Channing Division of Network Medicine, Department of Medicine (Q.S., W.C.W., F.B.H.) and Division of Preventive Medicine, Department of Medicine (S.E.C.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Division of Epidemiology and Community Health (L.M.S.), University of Minnesota School of Public Health, Minnesota, MN.
authors.forename: Maryam S
authors.initials: MS
authors.lastname: Farvid
authors.affiliation: From the Departments of Nutrition (M.S.F., M.D., Q.S., S.E.C., W.C.W., F.B.H.) and Epidemiology (W.C.W., F.B.H.), Harvard School of Public Health, Boston, MA; Department of Community Nutrition (M.S.F.), Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Saw Swee Hock School of Public Health and Yong Loo Lin School of Medicine (A.P.), National University of Singapore and National University Health System, Republic of Singapore; Channing Division of Network Medicine, Department of Medicine (Q.S., W.C.W., F.B.H.) and Division of Preventive Medicine, Department of Medicine (S.E.C.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Division of Epidemiology and Community Health (L.M.S.), University of Minnesota School of Public Health, Minnesota, MN.
authors.forename: Ming
authors.initials: M
authors.lastname: Ding
authors.affiliation: From the Departments of Nutrition (M.S.F., M.D., Q.S., S.E.C., W.C.W., F.B.H.) and Epidemiology (W.C.W., F.B.H.), Harvard School of Public Health, Boston, MA; Department of Community Nutrition (M.S.F.), Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Saw Swee Hock School of Public Health and Yong Loo Lin School of Medicine (A.P.), National University of Singapore and National University Health System, Republic of Singapore; Channing Division of Network Medicine, Department of Medicine (Q.S., W.C.W., F.B.H.) and Division of Preventive Medicine, Department of Medicine (S.E.C.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Division of Epidemiology and Community Health (L.M.S.), University of Minnesota School of Public Health, Minnesota, MN.
authors.forename: An
authors.initials: A
authors.lastname: Pan
authors.affiliation: From the Departments of Nutrition (M.S.F., M.D., Q.S., S.E.C., W.C.W., F.B.H.) and Epidemiology (W.C.W., F.B.H.), Harvard School of Public Health, Boston, MA; Department of Community Nutrition (M.S.F.), Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Saw Swee Hock School of Public Health and Yong Loo Lin School of Medicine (A.P.), National University of Singapore and National University Health System, Republic of Singapore; Channing Division of Network Medicine, Department of Medicine (Q.S., W.C.W., F.B.H.) and Division of Preventive Medicine, Department of Medicine (S.E.C.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Division of Epidemiology and Community Health (L.M.S.), University of Minnesota School of Public Health, Minnesota, MN.
authors.forename: Qi
authors.initials: Q
authors.lastname: Sun
authors.affiliation: From the Departments of Nutrition (M.S.F., M.D., Q.S., S.E.C., W.C.W., F.B.H.) and Epidemiology (W.C.W., F.B.H.), Harvard School of Public Health, Boston, MA; Department of Community Nutrition (M.S.F.), Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Saw Swee Hock School of Public Health and Yong Loo Lin School of Medicine (A.P.), National University of Singapore and National University Health System, Republic of Singapore; Channing Division of Network Medicine, Department of Medicine (Q.S., W.C.W., F.B.H.) and Division of Preventive Medicine, Department of Medicine (S.E.C.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Division of Epidemiology and Community Health (L.M.S.), University of Minnesota School of Public Health, Minnesota, MN.
authors.forename: Stephanie E
authors.initials: SE
authors.lastname: Chiuve
authors.affiliation: From the Departments of Nutrition (M.S.F., M.D., Q.S., S.E.C., W.C.W., F.B.H.) and Epidemiology (W.C.W., F.B.H.), Harvard School of Public Health, Boston, MA; Department of Community Nutrition (M.S.F.), Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Saw Swee Hock School of Public Health and Yong Loo Lin School of Medicine (A.P.), National University of Singapore and National University Health System, Republic of Singapore; Channing Division of Network Medicine, Department of Medicine (Q.S., W.C.W., F.B.H.) and Division of Preventive Medicine, Department of Medicine (S.E.C.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Division of Epidemiology and Community Health (L.M.S.), University of Minnesota School of Public Health, Minnesota, MN.
authors.forename: Lyn M
authors.initials: LM
authors.lastname: Steffen
authors.affiliation: From the Departments of Nutrition (M.S.F., M.D., Q.S., S.E.C., W.C.W., F.B.H.) and Epidemiology (W.C.W., F.B.H.), Harvard School of Public Health, Boston, MA; Department of Community Nutrition (M.S.F.), Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Saw Swee Hock School of Public Health and Yong Loo Lin School of Medicine (A.P.), National University of Singapore and National University Health System, Republic of Singapore; Channing Division of Network Medicine, Department of Medicine (Q.S., W.C.W., F.B.H.) and Division of Preventive Medicine, Department of Medicine (S.E.C.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Division of Epidemiology and Community Health (L.M.S.), University of Minnesota School of Public Health, Minnesota, MN.
authors.forename: Walter C
authors.initials: WC
authors.lastname: Willett
authors.affiliation: From the Departments of Nutrition (M.S.F., M.D., Q.S., S.E.C., W.C.W., F.B.H.) and Epidemiology (W.C.W., F.B.H.), Harvard School of Public Health, Boston, MA; Department of Community Nutrition (M.S.F.), Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Saw Swee Hock School of Public Health and Yong Loo Lin School of Medicine (A.P.), National University of Singapore and National University Health System, Republic of Singapore; Channing Division of Network Medicine, Department of Medicine (Q.S., W.C.W., F.B.H.) and Division of Preventive Medicine, Department of Medicine (S.E.C.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Division of Epidemiology and Community Health (L.M.S.), University of Minnesota School of Public Health, Minnesota, MN. nhbfh@channing.harvard.edu.
authors.forename: Frank B
authors.initials: FB
authors.lastname: Hu
mesh_terms: D003327:Coronary Disease / Q000178:diet therapy* / Q000453:epidemiology*; D004041:Dietary Fats / Q000008:administration & dosage*; D006801:Humans; D019787:Linoleic Acid / Q000008:administration & dosage*; D064887:Observational Studies as Topic; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D004041:Dietary Fats; D019787:Linoleic Acid
keywords: cardiovascular disease; coronary disease; diet; linoleic acid; meta-analysis; polyunsaturated fatty acids; saturated fatty acids