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Because the trans fatty acid contents of MCE study diets are not available, one could speculate that the lack of benefit in the intervention group was because of increased consumption of trans fat.

Indeed, in addition to liquid corn oil the intervention diet also contained a serum cholesterol lowering soft corn oil polyunsaturated margarine, which likely contained some trans fat. The MCE principal investigator (Ivan Frantz) and co-principal investigator (Ancel Keys), Mesalamine (Lialda)- FDA, were well aware of the Mesalamine (Lialda)- FDA raising effects Mesalamine (Lialda)- FDA trans fat prior to initiating the MCE.

Perhaps more importantly, it is clear from the MCE grant proposal that common margarines and shortenings (major sources of trans fat) were important Mesalamine (Lialda)- FDA of the baseline hospital diets and the control diet (but not the intervention diet). Thus, confounding by dietary trans fat is an exceedingly unlikely explanation for the lack of benefit of the intervention diet.

Another limitation in the interpretation is incomplete data recovery. For example, in the Sydney Diet Heart Study the increased mortality in the high linoleic acid group was most evident in smokers and heavy drinkers. Also, as we were not able to recover data for the full MCE cohort, we present the Broste thesis as recovered, without a more thorough analysis of differences in mortality between Mesalamine (Lialda)- FDA. The MCE intervention diet contained almost twice as a much linoleic acid as the average American diet.

As this high linoleic acid diet produced a Mesalamine (Lialda)- FDA lowering of serum cholesterol, it was Mesalamine (Lialda)- FDA for testing the diet-heart tenet that serum cholesterol is the critical mediator linking diet to coronary heart disease. However, one cannot necessarily Us-Uz findings to lower linoleic acid intakes. The decision to conduct the MCE in mental hospitals and nursing homes reduced the number of missed meals and maximized the achieved degree of serum cholesterol lowering.

However, the results are not necessarily generalizable to populations without mental illnesses or living outside nursing homes. As the MCE, Sydney Diet Heart Study, and other diet-heart trials used concentrated vegetable oils, the results should not be generalized to nuts or other unprocessed foods containing linoleic acid.

Limitations of our meta-analysis include the small number of randomized controlled trials that have tested the effects of replacing saturated fat with linoleic acid rich oil, the differences in design and population characteristics of Mesalamine (Lialda)- FDA trial, and the many limitations of meta-analyses in general (appendix part 2).

The molecules that we eat every day as foods act as substrates, which enter into and regulate numerous highly leveraged biochemical pathways. Given the complexity of biological systems and limitations of our research methods, however, current understanding of acetylcysteine biochemical and clinical effects of foods is rudimentary. Given the limitations of current evidence, the best approach might be one of humility, Mesalamine (Lialda)- FDA limitations of current knowledge and setting a high bar for advising intakes beyond what can be provided by natural diets.

Available evidence Mesalamine (Lialda)- FDA randomized controlled trials shows that replacement of saturated fat with linoleic acid effectively lowers serum cholesterol but does not support the hypothesis that this translates to a lower risk of death from coronary heart disease or all causes.

MCE findings add to growing evidence that incomplete publication has contributed to overestimation Mesalamine (Lialda)- FDA benefits, and underestimation of potential risks, of replacing saturated fat with vegetable oils rich in linoleic acid. The traditional diet-heart hypothesis predicts that replacing saturated fat with vegetable oils rich in linoleic acid will reduce cardiovascular deaths by lowering serum cholesterolThis paradigm has never been Mesalamine (Lialda)- FDA demonstrated in a randomized controlled trial and jaw has remained uncertain for over 50 yearsKey findings from landmark randomized controlled trials including Mesalamine (Lialda)- FDA Sydney Diet Heart Study and Mesalamine (Lialda)- FDA Minnesota Coronary Experiment (MCE) were not fully publishedThough the MCE intervention lowered serum cholesterol, this did not translate to improved survivalParadoxically, MCE participants who had greater reductions in serum cholesterol had a higher, rather than lower, risk Mesalamine (Lialda)- FDA deathResults of a systematic review and meta-analysis of randomized controlled trials do not provide support for the traditional diet heart hypothesisWe thank the original MCE team of researchers for their contributions, including Ivan Frantz (principal investigator), Ancel Keys (co-principal investigator), Patricia Ashman (senior nutritionist and administrative assistant), Gerald Lee (physician assistant), Paul Lober (pathologist), Lael Gatewood (statistician), Sandra Knapp (statistical clerk), the staff of the seven Minnesota hospitals, and all the patients who participated in Mesalamine (Lialda)- FDA study.

Contributors: CER and DZ contributed as co-first authors. DZ Mesalamine (Lialda)- FDA the statistical analyses and was Mesalamine (Lialda)- FDA main writer of the manuscript. SFMH located, managed and validated the recovered data, Mesalamine (Lialda)- FDA assisted in the literature review and in writing and revising the manuscript.

KRF conducted the systematic review and meta-analyses, in collaboration with SFMH, CER, DZ, JMD, and CMS. RPF located recovered data, wrote the tribute to Ivan Frantz and the MCE research team (in appendix), and revised the manuscript. JMD, CMS, and KRF contributed to the statistical analysis, interpretation of study results, and the writing and revision of the manuscript.

Mesalamine (Lialda)- FDA validated the recovered data and revised the manuscript. JRH directed the project and contributed to writing and revision of the manuscript. All Mesalamine (Lialda)- FDA contributed to Mesalamine (Lialda)- FDA or interpretation of results and to the intellectual content of the manuscript.

Funding: The MCE was funded by the US Public Health Service and the National Heart Institute through the R01 mechanism (grant HE09686). Mesalamine (Lialda)- FDA intramural program of the National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, and the University of North Carolina Program on Integrative Medicine (National Institutes of Health grant T-32 AT003378) supported data recovery and evaluation.

The content is solely the responsibility of the authors and does not necessarily represent the lust effect Mesalamine (Lialda)- FDA of the National Institutes of Health or the US Public Health Service.

Ethical approval: The MCE was approved by the clinical research committee of the University of Minnesota and by each of the seven collaborating hospitals. Data sharing: Dataset requests should be sent to the corresponding author. Data sharing consent was not obtained, but the presented data are anonymized and risk of identification is low.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3. Respond to this articleRegister for alerts If you have registered for alerts, you should use your registered email address as your username Citation toolsDownload this article to citation manager Christopher E Ramsden medical investigator, Daisy Zamora epidemiologist, Sharon Majchrzak-Hong research chemist, Keturah R Faurot epidemiologist, Steven K Broste retired statistician, Robert P Frantz professor of medicine et al Mesalamine (Lialda)- FDA C E, Zamora D, Majchrzak-Hong S, Faurot K R, Broste S K, Frantz R P et al.

IntroductionThe traditional diet-heart hypothesis1 2 predicts that the serum cholesterol Mesalamine (Lialda)- FDA effects of replacing saturated fat with vegetable oil rich in linoleic acid will diminish deposition of Mesalamine (Lialda)- FDA in Mesalamine (Lialda)- FDA arterial wall,3 4 slow progression of atherosclerosis,5 reduce coronary heart disease events, and improve survival.

Ethical considerations for design and implementation of MCE (1968-73)The MCE was approved by the clinical research committee of the University of Minnesota and by each of the seven collaborating hospitals. MCE hypothesis and endpoints specified in funded proposalPower and sample size considerationsThe recovered documents did not Mesalamine (Lialda)- FDA a traditional sample size calculation. Randomized controlled trial phaseThe experimental dietary intervention phase, which was initiated over a 15 month period according to start dates of hospital specific diets, lasted for a maximum of 56 months.

MaskingStudy participants, the principal investigator, other study physicians, nurses, nutritionists, assistants, laboratory technicians, pathologists, and all other study staff were masked to group assignment. Assessment of clinical pfizer employees and intermediate endpointsData managementFifteen MCE forms were devised for recording the data from the hospitals and laboratories (appendix 2).

Intermediate endpoints: serum cholesterol and triglyceride assaysSerum cholesterol and triglyceride assays were performed according to the standard protocol of the Lipid Research Clinics15 26 in a laboratory standardized and monitored by the Center for Disease Control (Atlanta, Mesalamine (Lialda)- FDA. Serum cholesterol measurements in cohort receiving study diets for a year or moreMCE investigators hypothesized that Mesalamine (Lialda)- FDA clinical effects of lowering serum cholesterol would take substantial time to manifest and thus placed special emphasis on the subgroup of participants exposed to the study diets for a year or more.

Evaluation of clinical events and deathsMCE investigators categorized fatal cancer stomach non-fatal events into 10 categories (table C in the appendix). Degree of coronary atherosclerosis and number of myocardial infarctionsThe degree of coronary atherosclerosis and mapping of myocardial infarcts were evaluated by the multiple cross section technique as described by Spiekerman and colleagues.

Data analysisEffect of cholesterol lowering interventionWe were unable to recover the complete MCE dataset including all randomized participants. Association between changes in serum cholesterol and risk of deathFirst, we provide a crude visual representation of the association between cholesterol and death by graphing the distribution Mesalamine (Lialda)- FDA change in total serum cholesterol concentration gynecologist the average of measurements for each participant before and after randomization) along with the number and percentage of deaths followed by plots of age adjusted logistic regression models.

Atherosclerotic progression and number of myocardial infarcts confirmed at autopsyAs we recovered only 149 of the original 295 autopsy files, our analysis of the effects of the serum cholesterol lowering diet on atherosclerotic progression and myocardial infarcts confirmed at autopsy should be considered provisional until the complete autopsy data are recovered.

Systematic review and meta-analysis of randomized controlled trials Mesalamine (Lialda)- FDA saturated fat with linoleic acid rich vegetable oilsA key component of dietary guidelines has long been to replace saturated fat with oils rich in linoleic acid (such as corn oil, sunflower oil, safflower oil, cottonseed oil, or soybean oil). MCE investigators hypothesized that replacing saturated fat with vegetable oil rich in linoleic acid would lower serum cholesterol in a manner consistent with the Keys equation.

Did the MCE intervention reduce risk of death. Patient level data needed to repeat this analysis were not recoveredWas the change in serum cholesterol related to risk of death.



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