Dietary intake and biomarkers of alpha linolenic acid and risk of all cause, cardiovascular, and cancer mortality: systematic review and dose-response meta-analysis of cohort studies

• Published in: BMJ (Online) Vol. 375; p. n2213
• Main Authors: Naghshi, Sina, Aune, Dagfinn, Beyene, Joseph, Mobarak, Sara, Asadi, Masoomeh, Sadeghi, Omid
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 13.10.2021; BMJ Publishing Group LTD; BMJ Publishing Group Ltd
• Subjects: alpha-Linolenic Acid - blood; alpha-Linolenic Acid - metabolism; Bias; Biomarkers; Blood levels; Cancer; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - metabolism; Cardiovascular Diseases - mortality; Chronic illnesses; Cohort analysis; Confidence intervals; Coronary artery disease; Dietary intake; Eating - physiology; Estimates; Fatty acids; Heart diseases; Humans; Linolenic acid; Medicin och hälsovetenskap; Meta-analysis; Mortality; Neoplasms - metabolism; Neoplasms - mortality; Protective Factors; Reviews; Risk Assessment; Statistical analysis; Systematic review; Variables
• ISSN: 1756-1833; 0959-8138; 1756-1833
• DOI: 10.1136/bmj.n2213

AbstractObjectiveTo examine the associations between dietary intake and tissue biomarkers of alpha linolenic acid (ALA) and risk of mortality from all causes, cardiovascular disease (CVD), and cancer.DesignSystematic review and meta-analysis of prospective cohort studies.Data sourcesPubMed, Scopus, ISI Web of Science, and Google Scholar to 30 April 2021.Study selectionProspective cohort studies that reported the risk estimates for death from all causes, CVD, and cancer.Data synthesisSummary relative risks and 95% confidence intervals were calculated for the highest versus lowest categories of ALA intake using random effects and fixed effects models. Linear and non-linear dose-response analyses were conducted to assess the dose-response associations between ALA intake and mortality.Results41 articles from prospective cohort studies were included in this systematic review and meta-analysis, totalling 1 197 564 participants. During follow-up ranging from two to 32 years, 198 113 deaths from all causes, 62 773 from CVD, and 65 954 from cancer were recorded. High intake of ALA compared with low intake was significantly associated with a lower risk of deaths from all causes (pooled relative risk 0.90, 95% confidence interval 0.83 to 0.97, I2=77.8%, 15 studies), CVD (0.92, 0.86 to 0.99, I2=48.2%, n=16), and coronary heart disease (CHD) (0.89, 0.81 to 0.97, I2=5.6%, n=9), and a slightly higher risk of cancer mortality (1.06, 1.02 to 1.11, I2=3.8%, n=10). In the dose-response analysis, a 1 g/day increase in ALA intake (equivalent to one tablespoon of canola oil or 0.5 ounces of walnut) was associated with a 5% lower risk of all cause (0.95, 0.91 to 0.99, I2=76.2%, n=12) and CVD mortality (0.95, 0.91 to 0.98, I2=30.7%, n=14). The pooled relative risks for the highest compared with lowest tissue levels of ALA indicated a significant inverse association with all cause mortality (0.95, 0.90 to 0.99, I2=8.2%, n=26). Also, based on the dose-response analysis, each 1 standard deviation increment in blood concentrations of ALA was associated with a lower risk of CHD mortality (0.92, 0.86 to 0.98, I2=37.1%, n=14).ConclusionsThe findings show that dietary ALA intake is associated with a reduced risk of mortality from all causes, CVD, and CHD, and a slightly higher risk of cancer mortality, whereas higher blood levels of ALA are associated with a reduced risk of all cause and CHD mortality only.Systematic review registrationPROSPERO CRD42021229487.