Skip to main content Accessibility help
×
Home

The association and dose–response relationship between dietary intake of α-linolenic acid and risk of CHD: a systematic review and meta-analysis of cohort studies

  • Jingkai Wei (a1), Ruixue Hou (a2), Yuzhi Xi (a1), Alysse Kowalski (a3), Tiansheng Wang (a1), Zhi Yu (a4), Yirui Hu (a5), Eeshwar K. Chandrasekar (a6), Hao Sun (a7) and Mohammed K. Ali (a6) (a8)...

Abstract

Previous studies show inconsistent associations between α-linolenic acid (ALA) and risk of CHD. We aimed to examine an aggregate association between ALA intake and risk of CHD, and assess for any dose–response relationship. We searched the PubMed, EMBASE and Web of Science databases for prospective cohort studies examining associations between ALA intake and CHD, including composite CHD and fatal CHD. Data were pooled using random-effects meta-analysis models, comparing the highest category of ALA intake with the lowest across studies. Subgroup analysis was conducted based on study design, geographic region, age and sex. For dose–response analyses, we used two-stage random-effects dose–response models. In all, fourteen studies of thirteen cohorts were identified and included in the meta-analysis. The pooled results showed that higher ALA intake was associated with modest reduced risk of composite CHD (risk ratios (RR)=0·91; 95 % CI 0·85, 0·97) and fatal CHD (RR=0·85; 95 % CI 0·75, 0·96). The analysis showed a J-shaped relationship between ALA intake and relative risk of composite CHD (χ 2=21·95, P<0·001). Compared with people without ALA intake, only people with ALA intake <1·4 g/d showed reduced risk of composite CHD. ALA intake was linearly associated with fatal CHD – every 1 g/d increase in ALA intake was associated with a 12 % decrease in fatal CHD risk (95 % CI −0·21, −0·04). Though a higher dietary ALA intake was associated with reduced risk of composite and fatal CHD, the excess composite CHD risk at higher ALA intakes warrants further investigation, especially through randomised controlled trials.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      The association and dose–response relationship between dietary intake of α-linolenic acid and risk of CHD: a systematic review and meta-analysis of cohort studies
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      The association and dose–response relationship between dietary intake of α-linolenic acid and risk of CHD: a systematic review and meta-analysis of cohort studies
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      The association and dose–response relationship between dietary intake of α-linolenic acid and risk of CHD: a systematic review and meta-analysis of cohort studies
      Available formats
      ×

Copyright

Corresponding author

* Corresponding author: J. Wei, email jingkai@live.unc.edu

References

Hide All
1. Mathers, CD, Fat, DM, Inoue, M, et al. (2005) Counting the dead and what they died from: an assessment of the global status of cause of death data. Bull World Health Organ 83, 171177.
2. Al-Mawali, A (2015) Non-communicable diseases: shining a light on cardiovascular disease, Oman’s biggest killer. Oman Med J 30, 227228.
3. Sala-Vila, A, Estruch, R & Ros, E (2015) New insights into the role of nutrition in CVD prevention. Curr Cardiol Rep 17, 26.
4. Kris-Etherton, PM, Harris, WS, Appel, LJ, et al. (2002) Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease. Circulation 106, 27472757.
5. Mozaffarian, D & Wu, JHY (2011) Omega-3 fatty acids and cardiovascular disease: effects on risk factors, molecular pathways, and clinical events. J Am Coll Cardiol 58, 20472067.
6. Mozaffarian, D, Appel, LJ & Van Horn, L (2011) Components of a cardioprotective diet: new insights. Circulation 123, 28702891.
7. Rajaram, S (2014) Health benefits of plant-derived alpha-linolenic acid. Am J Clin Nutr 100, Suppl. 1, 443s448s.
8. Mozaffarian, D (2005) Does alpha-linolenic acid intake reduce the risk of coronary heart disease? A review of the evidence. Altern Ther Health Med 11, 2430; quiz 31, 79.
9. Pan, A, Chen, M, Chowdhury, R, et al. (2012) Alpha-linolenic acid intake and biomarker in relation to risk of cardiovascular disease: a meta-analysis and systematic review. Am J Clin Nutr 96, 12621273.
10. Otto, MCD, Wu, JHY, Baylin, A, et al. (2013) Circulating and dietary omega-3 and omega-6 polyunsaturated fatty acids and incidence of CVD in the Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc 2, e000506.
11. Fretts, AM, Mozaffarian, D, Siscovick, DS, et al. (2014) Plasma phospholipid and dietary alpha-linolenic acid, mortality, CHD and stroke: the Cardiovascular Health Study. Br J Nutr 112, 12061213.
12. Koh, AS, Pan, A, Wang, R, et al. (2015) The association between dietary omega-3 fatty acids and cardiovascular death: the Singapore Chinese Health Study. Eur J Prev Cardiol 22, 364372.
13. Sala-Vila, A, Guasch-Ferre, M, Hu, FB, et al. (2016) Dietary alpha-linolenic acid, marine omega-3 fatty acids, and mortality in a population with high fish consumption: findings from the PREvencion con DIeta MEDiterranea (PREDIMED) Study. J Am Heart Assoc 5, e002543.
14. Bork, CS, Jakobsen, MU, Lundbye-Christensen, S, et al. (2016) Dietary intake and adipose tissue content of alpha-linolenic acid and risk of myocardial infarction: a Danish cohort study. Am J Clin Nutr 104, 4148.
15. Wells, GA, Shea, B, O’Connell, D, et al. (2000) The Newcastle–Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp (accessed November 2017).
16. Vedtofte, MS, Jakobsen, MU, Lauritzen, L, et al. (2011) Dietary alpha-linolenic acid, linoleic acid, and n-3 long-chain PUFA and risk of ischemic heart disease. Am J Clin Nutr 94, 10971103.
17. Ascherio, A, Rimm, EB, Giovannucci, EL, et al. (1996) Dietary fat and risk of coronary heart disease in men: cohort follow up study in the United States. BMJ 313, 8490.
18. Pietinen, P, Ascherio, A, Korhonen, P, et al. (1997) Intake of fatty acids and risk of coronary heart disease in a cohort of Finnish men. The Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study. Am J Epidemiol 145, 876887.
19. Oomen, CM, Ocke, MC, Feskens, EJ, et al. (2001) alpha-Linolenic acid intake is not beneficially associated with 10-y risk of coronary artery disease incidence: the Zutphen Elderly Study. Am J Clin Nutr 74, 457463.
20. de Goede, J, Verschuren, WM, Boer, JM, et al. (2011) Alpha-linolenic acid intake and 10-year incidence of coronary heart disease and stroke in 20,000 middle-aged men and women in the Netherlands. PLoS ONE 6, e17967.
21. Albert, CM, Oh, K, Whang, W, et al. (2005) Dietary alpha-linolenic acid intake and risk of sudden cardiac death and coronary heart disease. Circulation 112, 32323238.
22. Rhee, JJ, Kim, E, Buring, JE, et al. (2017) Fish consumption, omega-3 fatty acids, and risk of cardiovascular disease. Am J Prev Med 52, 1019.
23. Dolecek, TA (1992) Epidemiological evidence of relationships between dietary polyunsaturated fatty acids and mortality in the multiple risk factor intervention trial. Proc Soc Exp Biol Med 200, 177182.
24. Hu, FB, Stampfer, MJ, Manson, JE, et al. (1999) Dietary intake of alpha-linolenic acid and risk of fatal ischemic heart disease among women. Am J Clin Nutr 69, 890897.
25. Vedtofte, MS, Jakobsen, MU, Lauritzen, L, et al. (2014) Association between the intake of alpha-linolenic acid and the risk of CHD. Br J Nutr 112, 735743.
26. Zatonski, W, Campos, H & Willett, W (2008) Rapid declines in coronary heart disease mortality in Eastern Europe are associated with increased consumption of oils rich in alpha-linolenic acid. Eur J Epidemiol 23, 310.
27. Pedersen, JI, Ringstad, J, Almendingen, K, et al. (2000) Adipose tissue fatty acids and risk of myocardial infarction – a case-control study. Eur J Clin Nutr 54, 618625.
28. Barcelo-Coblijn, G & Murphy, EJ (2009) Alpha-linolenic acid and its conversion to longer chain n-3 fatty acids: benefits for human health and a role in maintaining tissue n-3 fatty acid levels. Prog Lipid Res 48, 355374.
29. Lemaitre, RN, King, IB, Sotoodehnia, N, et al. (2009) Red blood cell membrane alpha-linolenic acid and the risk of sudden cardiac arrest. Metabolism 58, 534540.
30. Yu, Z, Malik, VS, Keum, N, et al. (2016) Associations between nut consumption and inflammatory biomarkers. Am J Clin Nutr 104, 722728.
31. Sanchez-Villegas, A, Martinez, JA, De Irala, J, et al. (2002) Determinants of the adherence to an ‘a priori’ defined Mediterranean dietary pattern. Eur J Nutr 41, 249257.
32. Sacks, FM, Obarzanek, E, Windhauser, MM, et al. (1995) Rationale and design of the Dietary Approaches to Stop Hypertension trial (DASH). A multicenter controlled-feeding study of dietary patterns to lower blood pressure. Ann Epidemiol 5, 108118.
33. de Lorgeril, M, Renaud, S, Mamelle, N, et al. (1994) Mediterranean alpha-linolenic acid-rich diet in secondary prevention of coronary heart disease. Lancet 343, 14541459.
34. Kromhout, D, Giltay, EJ & Geleijnse, JM (2010) n-3 fatty acids and cardiovascular events after myocardial infarction. N Engl J Med 363, 20152026.

Keywords

Type Description Title
WORD
Supplementary materials

Wei et al. supplementary material
Wei et al. supplementary material 1

 Word (2.5 MB)
2.5 MB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed