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Major types of dietary fat and risk of coronary heart disease: a pooled analysis of 11 cohort studies1,2,3
1 From the Research Unit for Dietary Studies at the Institute of Preventive Medicine, Copenhagen University Hospital, Centre for Health and Society, Copenhagen, Denmark (MUJ and BLH); the Research Centre for Prevention and Health, Glostrup University Hospital, Glostrup, Denmark (MUJ); the Department of Clinical Epidemiology, Aarhus University Hospital, Aalborg, Denmark (MUJ); the Center for Cardiovascular Research, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark (MUJ); the Departments of Nutrition (EJO, WCW, and AA), Epidemiology (EJO, SL, DS, WCW, and AA), and Biostatistics (DS), Harvard School of Public Health, Boston, MA; the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN (MAP); the Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden (KB); the Department of Epidemiology and Biostatistics, Loma Linda University, Loma Linda, CA (GEF); the Section of Epidemiology and Biostatistics, Henry N Neufeld Cardiac Research Institute, Department of Epidemiology and Preventive Medicine, Tel Aviv University, Tel Aviv, Israel (UG); the Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, Sweden (GH); the National Public Health Institute, Helsinki, Finland (PK, PP, and JV); the Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (SL); the Departments of Nutrition and Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, NC (JS); the Harvard Center for Cancer Prevention, Boston, MA (WCW); and the Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (WCW).
2 Supported by the National Heart, Lung, and Blood Institute, National Institutes of Health (grant R01 HL58904) and the Danish Heart Foundation (grants 02-1-9F-7-22961 and 02-2-9-8-22010). The establishment of the Research Unit for Dietary Studies was financed by the Female Researchers in Joint Action program from the Danish Medical Research Council. 3 Reprints not available. Address correspondence to MU Jakobsen, Department of Clinical Epidemiology, Aarhus University Hospital, Sdr Skovvej 15, DK-9000 Aalborg, Denmark. E-mail: muj{at}dce.au.dk.
ABSTRACT
Background: Saturated fatty acid (SFA) intake increases plasma LDL-cholesterol concentrations; therefore, intake should be reduced to prevent coronary heart disease (CHD). Lower habitual intakes of SFAs, however, requires substitution of other macronutrients to maintain energy balance.
Objective: We investigated associations between energy intake from monounsaturated fatty acids (MUFAs), polyunsaturated fatty acids (PUFAs), and carbohydrates and risk of CHD while assessing the potential effect-modifying role of sex and age. Using substitution models, our aim was to clarify whether energy from unsaturated fatty acids or carbohydrates should replace energy from SFAs to prevent CHD.
Design: This was a follow-up study in which data from 11 American and European cohort studies were pooled. The outcome measure was incident CHD.
Results: During 4–10 y of follow-up, 5249 coronary events and 2155 coronary deaths occurred among 344,696 persons. For a 5% lower energy intake from SFAs and a concomitant higher energy intake from PUFAs, there was a significant inverse association between PUFAs and risk of coronary events (hazard ratio: 0.87; 95% CI: 0.77, 0.97); the hazard ratio for coronary deaths was 0.74 (95% CI: 0.61, 0.89). For a 5% lower energy intake from SFAs and a concomitant higher energy intake from carbohydrates, there was a modest significant direct association between carbohydrates and coronary events (hazard ratio: 1.07; 95% CI: 1.01, 1.14); the hazard ratio for coronary deaths was 0.96 (95% CI: 0.82, 1.13). MUFA intake was not associated with CHD. No effect modification by sex or age was found.
Conclusion: The associations suggest that replacing SFAs with PUFAs rather than MUFAs or carbohydrates prevents CHD over a wide range of intakes.
Received for publication October 17, 2008. Accepted for publication January 7, 2009.
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