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A study was rated as at low risk of misclassification if it accomplished all three; moderate risk of misclassification) if it accomplished two of three; high risk of misclassification if it accomplished one of three; or at very high risk of misclassification if it did not accomplish any. For assessment of ruminant trans fats, the most common approach was to use the known nutrient composition from food tables for dairy and meat products to estimate ruminant trans fats and possibly supplemented by direct measurement with gas chromatography (see eTable 1 in appendix 2).Study risk of biasWe used the Newcastle Ottawa scale30 to assess the risk of bias of the included studies on the basis of selection of study groups, comparability of groups, and ascertainment of exposure(s) or outcome(s).Grading of recommendations assessment https://www.charmspandora-canada.com/, development, and evaluation (GRADE)The GRADE approach was used to assess the confidence in the effect estimates derived from the body of evidence (quality of evidence) by outcome and produce evidence profiles.20 21 22 We limited the presentations of results in the main text to the synthesis of prospective cohort studies as these are considered the highest level of evidence for observational studies and thus were used for the GRADE assessments of confidence. Appendix 3 provides full details of designs that did not directly inform GRADE (that is, retrospective case control studies and other studies not amenable to quantitative synthesis).

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