Systematic review of palm oil consumption and the risk of cardiovascular disease.2018
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Систематический обзор потребления пальмового масла и риска сердечно-сосудистых заболеваний, 2018 г.
Сгенерированная сводка:
Сообщалось, что общее потребление НЖК не оказывает существенного влияния на риск ИМ. Различное потребление жареной пищи, наибольший вклад в общее количество НЖК, при этом 36% домохозяйств используют пальмовое масло для жарки, не выявили значимой связи с риском ИМ. Вероятность развития первого несмертельного острого ИМ была выше в пальмовом масле по сравнению с соевым маслом с 5% жира, чем с пальмовым маслом, по сравнению с соевым маслом с 22% жира.
Типичные симптомы инфаркта миокарда и повышение уровней сердечных ферментов или диагностические изменения на электрокардиограмме, Оценка риска пятого квинтиля диетического потребления по сравнению с самым низким квинтилем диетического потребления, Другими маслами были подсолнечное масло, кукурузное масло, оливковое масло, масло канолы , и реже масла и жиры.
Процент использования в случаях и контроле составлял 10% и 11% для соевого масла с 22% транс-жиров, 39% и 41% для соевого масла с 5% транс-жиров и 21% и 25% для других масел соответственно. диета характеризовалась увеличением потребления пальмового масла, бобовых, очищенных зерен, свежих приправ, кофе, красного мяса, добавленного сахара и субпродуктов, а также снижением потребления других масел, фруктовых соков, заправок, хлопьев для холодного завтрака, пиццы, без кожи и нежирная курица и нежирные молочные продукты.
В верхнем квинтиле потребления жареной пищи пальмовое и соевое масло были основными маслами, используемыми для жарки.
Вероятность развития первого несмертельного острого ИМ была выше в пальмовом масле по сравнению с соевым маслом с 5% жира, чем с пальмовым маслом, по сравнению с соевым маслом с 22% жира.
Abstract:
Conclusion
In view of the abundance of palm oil in the market, quantifying its true association with CVD outcomes is challenging. The present review could not establish strong evidence for or against palm oil consumption relating to cardiovascular disease risk and cardiovascular disease-specific mortality. Further studies are needed to establish the association of palm oil with CVD. A healthy overall diet should still be prioritised for good cardiometabolic health.,The present review could not establish strong evidence for or against palm oil consumption with risk and mortality of cardiovascular disease outcomes. The abundance of the availability of palm oil not only as cooking oil, but also in numerous food items makes it challenging to quantify its true association with cardiovascular outcomes. A healthy overall diet should still be prioritised for good cardiometabolic health.
Result
Our search retrieved 2,738 citations for stroke with one included study and 1,777 citations for coronary heart disease (CHD) with four included studies. Palmitic acid was reported to be associated with risk of myocardial infarction (MI) (OR 2.76; 95%CI = 1.39–5.47). Total SFA intake was reported to be not significant for risk of MI. Varying intake of fried foods, highest contributor to total SFA with 36% of households using palm oil for frying, showed no significant associations to risk of MI. Odds of developing first non-fatal acute MI was higher in palm oil compared to soybean oil with 5% ,-fat (OR = 1.33; 95%CI = 1.09–1.62) than palm oil compared to soybean oil with 22% ,-fat (OR = 1.16; 95%CI = 0.86–1.56). Nevertheless, these risk estimates were non-significant and imprecise. The trend amongst those taking staple pattern diet (characterised by higher palm oil, red meat and added sugar consumption) was inconsistent across the factor score quintiles. During the years of 1980 and 1997, for every additional kilogram of palm oil consumed per-capita annually, CHD mortality risk was 68 deaths per 100,000 (95% CI = 21–115) in developing countries and 17 deaths per 100,000 (95%CI = 5.3–29) in high-income countries, whereas stroke was associated with 19 deaths per 100,000 (95%CI = -12–49) and 5.1 deaths per 100,000 (95% CI: -1.2–11) respectively.,The evidence for the outcomes of this review were all graded as very low. The findings of this review should be interpreted with some caution, owing to the lack of a pooled effect estimate of the association, significant bias in selection criteria and confounding factors, inclusion of other food items together with palm oil, and the possible out-dated trend in the ecological study.,We retrieved 1,777 unique citations through our electronic databases search to evaluate the CHD outcomes. Prior to titles and abstracts screening, 122 duplicate articles were removed. A total of 1,655 titles and abstracts were screened based on the eligibility criteria of which 1,640 were excluded based on irrelevant studied population, intervention characteristics or outcomes. Fifteen full text articles were then screened for eligibility of which 11 articles were excluded for the following reasons: 1 for irrelevant intervention, 2 for other vegetable oils used as intervention, 3 for unclear origin of saturated fatty acids, 4 for irrelevant outcomes and 1 for a retracted publication. Subsequently 4 articles remained to be included in the review of which three were for risk of myocardial infarction and one for risk of coronary heart diseases-related mortality. Our search PRISMA flowchart is presented in ,.,SFA: Saturated fatty acids.,Our search for stroke outcomes resulted in 2,738 potentially relevant citations. Following that, 146 duplicates were removed. We screened 2,592 titles and abstracts of which 2,171 articles were removed based on irrelevant studied population, intervention characteristics or outcomes. We then screened for eligibility in 21 full text articles. Twenty full text articles were excluded due to irrelevant intervention (11 articles) and irrelevant outcomes (9 articles). Only one article met the full eligibility criteria for this review. No articles were retrieved for risk of stroke, however one article was included for stroke-related mortality. Our search flowchart and reasons for exclusion for stroke are presented in ,.,There were three case-control studies that evaluated the effects of palm oil consumption with CHD risk. Our included studies evaluated palm oil consumption in terms of contribution to daily intake of saturated fatty acids [,], type of vegetable oil used for cooking [,], and pattern of diet of the studied population [,]. The summary of characteristics of included studies is presented in ,. All three studies were conducted in Costa Rica and part of the same study. The mean age of participants were 58 years (SD 10.9) for cases and 58 years (SD 11.20) for controls. There were no significant differences in age between the two groups of the studies. In all three studies, the controls were matched for age, gender and area of residence therefore there were no significant differences for these factors between controls and cases. Number of women recruited was between 26% and 27% of all the participants in these studies.,CI: Confidence interval, CHD: Coronary heart disease, MI: Myocardial infarction, MUFA: Mono-unsaturated fatty acid, OR: Odds ratio, PO: Palm oil, PUFA: Polyunsaturated fatty acid, SFA: Saturated fatty acids, SES: Socioeconomic status, SO: Soybean oil, WHO: World Health Organisation., Typical symptoms of myocardial infarction and elevations in cardiac enzyme levels or diagnostic changes in electrocardiogram, Risk estimates of the fifth quintile of dietary intake as compared to the lowest quintile of dietary intake, Other oils were sunflower oil, corn oil, olive oil, canola oil, and less common oils and fats. Percentage of usage in cases and controls were 10% and 11% for soybean oil with 22% trans fat, 39% and 41% for soybean oil with 5% trans fat, and 21% and 25% for other oils, respectively, Staple pattern diet was characterised by increasing intake of palm oil, legumes, refined grains, fresh condiments, coffee, red meat, added sugar, and organ meat, and decreasing intake of other oils, fruit juices, dressings, cold breakfast cereals, pizza, skinless and lean chicken, and low-fat dairy products. Vegetable pattern diet was characterised by higher intake of all vegetables, fruits, skinless and lean chicken, and saccharin, and lower intake of added sugar, chicken and coffee., Risk estimates of the fifth quintile of factor scores as compared to the lowest quintile of factor scores based on the principal components factor analysis of food groups,The cases had significantly higher number of current smokers and individuals with hypertension or diabetes, higher waist-to-hip ratio, lower physical activity and lower household income than the controls. Total daily energy intake, daily intake of saturated and polyunsaturated fat, cholesterol and alcohol consumption were also reported to be significantly higher in cases than in controls.,Kabagambe et al. [,] studied the effects of lauric acid, myristic acid, palmitic acid, stearic acid and total saturated acids for risk of nonfatal acute MI for every 1% increase in energy intake. This association was not significantly different between the two study groups in all fatty acids studied, except for lauric acid. Total saturated fat intake was reported to be associated with risk of MI (OR for the 5, vs 1, quintile of dietary intake = 3.00; 95%CI = 1.54–5.84). Palmitic acid, the highest saturated fat found in palm oil, was also reported to be associated with risk of MI (OR for the 5, vs 1, quintile of dietary intake = 2.76; 95%CI = 1.39–5.47). The trend across the quintiles was however inconsistent. Fried foods contributed to 30% of the total saturated fat intake. Fried foods (40%) and red meat (18%) were the highest contributors of palmitic acid in the study. In the top quintile for intake of fried foods, palm oil (50%) and soybean oil (40%) were the major oils used for frying. Alternatively, in the lowest quintile, soybean oil (43%) was used more than palm oil (27%). This however did not show any significant impact to the risk of MI. There were no significant differences throughout the different quintiles of intake of fried foods to the risk of MI. The highest consumption of beef and pork also did not show any association with risk of MI.,Kabagambe et al. [,] evaluated the different types of cooking oil used in the Costa Rican population. The average ,-fat in soybean oil before 1998 was 22% following which changes in the edible oil industry in Costa Rica resulted in mean ,-fat of 5% in the oil. Odds of developing first non-fatal acute MI was higher in palm oil compared to soybean oil with 5% ,-fat (OR = 1.33; 95%CI = 1.09–1.62) than palm oil compared to soybean oil with 22% ,-fat (OR = 1.16; 95%CI = 0.86–1.56). Nevertheless, these risk estimates were non-significant and imprecise. Palm oil was used for cooking in the homes of 30% of the cases and 23% of controls. We graded this evidence as very low (,).,*, (and its 95% confidence interval) is based on the assumed risk in the comparison group and the , of the intervention (and its 95% CI)., Confidence interval, We are very confident that the true effect lies close to that of the estimate of the effect , We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different , Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect , We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect, Downgraded one level due to limitation in imprecision of effects (wide and non-significant confidence interval),Martinez-Ortíz et al. [,] looked into the two commonest food patterns in Costa Rica: vegetable pattern and staple pattern diet. Amongst those with a vegetable pattern diet, there was not a significant linear trend in the association with risk of MI and increasing quintiles of factor scores. The factor scores were generated as a result from the principal component analysis of the food groups. The risks of MI amongst those with vegetable pattern diet were also not significant all quintiles (OR for the 5, vs 1, quintile of factor score = 0.92; 95%CI = 0.57–1.50). The vegetable pattern diet reported approximately 3 times lower odds of nonfatal MI as compared to staple pattern diet, across the similar quintiles. The trend amongst those taking staple pattern diet was however inconsistent across the quintiles, with the odds of the third quintile being the highest (OR = 3.55; 95%CI = 2.05–6.15). Confidence intervals in the point estimates of staple pattern diet were larger than those for the vegetable pattern diet, showing significant variability in the staple pattern diet estimates.,Both CHD- and stroke-related mortality outcomes were described by the same study [,]. Chen et al.[,] performed a retrospective ecological study between the years 1980 and 1997, including 234 annual observations from Historically High-Income Countries (HIC) and Developing Countries (DC) to evaluate CVD-related mortality with country-level annual total domestic consumption of palm oil for food use. Characteristics of the included study are found in ,. Throughout the study period, the mortality rates from ischaemic heart disease (IHD) and stroke were declining in HIC but were increasing steadily in DC. There were no significant differences in per-capita palm oil consumption and per-capita coconut oil consumption between HIC and DC at baseline. However, there were significant differences between the two study groups for other major sources of saturated fatty acids (beef, milk, butter, cheese, pork and chicken).,CI: Confidence interval, CVD: Cardiovascular disease, DC: Developing countries, HIC: Historically high-income countries, ICD: International Coding of Disease, IHD: Ischaemic heart disease, USA: United States of America, USDA: U.S. Department of Agriculture, WDI: World Bank World Development Indicator, Mortality rate is reported as number of deaths per 100,000 for every additional kilogram of palm oil consumed per-capita annually,Historically high-income countries included Australia, Canada, Finland, France, Hong Kong, Italy, New Zealand, Netherlands, Norway, Singapore, Spain, Sweden and United States. Developing countries included Brazil, Colombia, Ecuador, Egypt, Greece, Mexico, Peru, Russia, Thailand, and Venezuela.,Chen et al.[,] reported that in developing countries, for every additional kilogram of palm oil consumed per-capita annually, IHD mortality rates increased by 68 deaths per 100,000 (95% CI: 21–115). In HIC, the IHD mortality rates increased by 17 deaths per 100,000 (95% CI: 5.3–29) for every additional kilogram of palm oil consumed per-capita annually. Sensitivity analyses were performed for consumption of other major sources of saturated fat, individual country, and other major courses of saturated fat that included beef, pork, chicken, coconut oil, milk, cheese and butter. Nevertheless, there was loss of sample size in the inclusion of other major sources of saturated fat. The sensitivity analysis revealed that despite the increased consumption of other saturated fats the association between palm oil consumption and IHD mortality remained significant. This effect was not seen with consumption of butter and cheese.,In terms of stroke mortality, for every additional kilogram of palm oil consumed per-capita annually, stroke mortality rates increased by 19 deaths per 100,000 (95% CI: -12–49) in DC. While in HIC, for every additional kilogram of palm oil consumed per-capita annually, stroke mortality rates increased by 5.1 deaths per 100,000 (95% CI: -1.2–11). In view of the insignificant association found, the authors reported that sensitivity analyses was not performed for consumption of other major sources of saturated fat and individual country effect. Sensitivity analysis was not reported for stroke mortality.,We graded the quality of evidence for the association of palm oil consumption and CVD-related mortality as very low quality (,). The evidences were downgraded three levels due to the limitations in the trial design and imprecision of the effects.,*, (and its 95% confidence interval) is based on the assumed risk in the comparison group and the , of the intervention (and its 95% CI)., Confidence interval, Downgraded one level due to imprecision of effects (wide confidence interval),The three case control studies were judged to be at low risk of bias in all domains assessed in this review [,–,]. While the ecological study had two domains with high risk of bias [,]. Detailed risk of bias assessments for each included study is described in ,.,In the study by Chen et al. [,], we rated the selection bias as high risk of bias because the imbalanced number of observations in the two study groups and that the exclusion of the main exporters and consumers of palm oil, Indonesia and Malaysia. This exclusion could have under or overestimated the true differences between the two study groups. The judgement for high risk of bias for confounding factors to Chen et al. [,] was given because of exclusion of important prognostic factors such as diabetes mellitus and hypertension.