Consumption of individual saturated fatty acids and the risk of myocardial infarction in a UK and a Danish cohort (original) (raw)
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Saturated fatty acids and coronary heart disease risk: the debate goes on
Current opinion in clinical nutrition and metabolic care, 2015
Recently published meta-analyses of cohort studies and randomized controlled trials (RCTs) have challenged the link between saturated fatty acid (SFA) intake and coronary heart disease (CHD) risk. This review considers the outcome of these studies in the context of other evidence. Recent meta-analyses of cohort studies suggest that reducing SFA intakes has little impact on CHD risk when replaced by carbohydrates. The evidence for benefits on CHD risk of replacing SFA with unsaturated fatty acids in cohort studies is stronger and is also supported by data from a recent Cochrane analysis of RCTs of dietary SFA reduction and CHD risk. This review highlights the challenges of cohort studies involving diet because of the changing patterns of dietary behaviour and other multifactorial risk factors. The studies included are normally conducted over many years and are often dependent on a single measurement of dietary intake. The link between SFA intake, plasma cholesterol, and CHD risk is b...
Saturated and trans fatty acids and coronary heart disease
Current Atherosclerosis Reports, 2008
Dietary intake of both saturated and trans fatty acids has been associated with an increase in the risk of coronary heart disease (CHD). Evidence comes mainly from controlled dietary experiments with intermediate end points, such as blood lipoproteins, and from observational studies. A few small, randomized controlled trials with clinical end points have been carried out in which saturated fat was replaced with polyunsaturated fat, leading to a reduction in low-density lipoprotein cholesterol and a reduction in CHD risk. However, no such studies exist for trans fatty acids. More high-quality, randomized controlled trials on fatty acids and CHD are required, but public health recommendations to reduce intake of both saturated and trans fatty acids are appropriate based on the current evidence.
Dietary fatty acids and cardiovascular disease: An epidemiological approach
Progress in Lipid Research, 2008
The quality of dietary fat in relation to cardiovascular disease forms the basis of the diet-heart hypothesis. Current recommendations on dietary fat now emphasise quality rather than quantity. The focus of this review is to summarise the results from prospective cohort studies on dietary fat and cardiovascular disease outcomes. Relatively few prospective cohort studies have found an association between dietary fat quality and cardiovascular disease, partly because of limitations in estimating dietary intake. Saturated and trans fatty acids have increased cardiovascular risk in several studies. Both nÀ6 and nÀ3 polyunsaturated fatty acids have been associated with lower cardiovascular risk. Within the nÀ6 series, linoleic acid seems to decrease cardiovascular risk. Within the nÀ3 series the long-chain fatty acids (eicosapentaenoic and docosahexaenoic acids) are associated with decreased risk for especially fatal coronary outcomes, whereas the role of a-linolenic acid is less clear. Dietary fat quality also influences the activity of enzymes involved in the desaturation of fatty acids in the body. Serum desaturase indices have been consistently associated with adverse cardiovascular outcomes. Data from metabolic and clinical studies reinforce findings from observational studies supporting recommendations to replace saturated and trans fat with unsaturated fat in the prevention of cardiovascular disease.
The Questionable Role of Saturated and Polyunsaturated Fatty Acids in Cardiovascular Disease
Journal of Clinical Epidemiology, 1998
A fat diet, rich in saturated fatty acids (SFA) and low in polyunsaturated fatty acids (PUFA), is said to be an important cause of atherosclerosis and cardiovascular diseases (CVD). The evidence for this hypothesis was sought by reviewing studies of the direct link between dietary fats and atherosclerotic vascular disease in human beings. The review included ecological, dynamic population, cross-sectional, cohort, and casecontrol studies, as well as controlled, randomized trials of the effect of fat reduction alone. The positive ecological correlations between national intakes of total fat (TF) and SFA and cardiovascular mortality found in earlier studies were absent or negative in the larger, more recent studies. Secular trends of national fat consumption and mortality from coronary heart disease (CHD) in 18-35 countries (four studies) during different time periods diverged from each other as often as they coincided. In cross-sectional studies of CHD and atherosclerosis, one group of studies (Bantu people vs. Caucasians) were supportive; six groups of studies (West Indians vs. Americans, Japanese, and Japanese migrants vs. Americans, Yemenite Jews vs. Yemenite migrants; Seminole and Pima Indians vs. Americans, Seven Countries) gave partly supportive, partly contradictive results; in seven groups of studies (Navajo Indians vs. Americans; pure vegetarians vs. lacto-ovo-vegetarians and non-vegetarians, Masai people vs. Americans, Asiatic Indians vs. non-Indians, north vs. south Indians, Indian migrants vs. British residents, Geographic Study of Atherosclerosis) the findings were contradictory. Among 21 cohort studies of CHD including 28 cohorts, CHD patients had eaten significantly more SFA in three cohorts and significantly less in one cohort than had CHD-free individuals; in 22 cohorts no significant difference was noted. In three cohorts, CHD patients had eaten significantly more PUFA, in 24 cohorts no significant difference was noted. In three of four cohort studies of atherosclerosis, the vascular changes were unassociated with SFA or PUFA; in one study they were inversely related to TF. No significant differences in fat intake were noted in six case-control studies of CVD patients and CVD-free controls; and neither total or CHD mortality were lowered in a metaanalysis of nine controlled, randomized dietary trials with substantial reductions of dietary fats, in six trials combined with addition of PUFA. The harmful effect of dietary SFA and the protective effect of dietary PUFA on atherosclerosis and CVD are questioned.
Journal of The American Dietetic Association, 2007
Objective To evaluate the relation between intake and adipose tissue composition of fatty acids and acute myocardial infarction in Portuguese men. Design Case-control study. Diet was assessed using a semiquantitative food frequency questionnaire. In 49 case and 49 control subjects, adipose tissue composition was assessed by gas-liquid chromatography. Subjects/setting Population-based; subjects were 297 consecutively admitted cases of first acute myocardial infarction in a tertiary care hospital who were aged Ն40 years. Three hundred ten community controls were selected by random-digit dialing. Main outcome measure Odds ratio (OR). Statistical analysis performed Logistic regression, adjusting for age, education, family history of acute myocardial infarction, smoking, physical activity, body mass index, and energy intake. Results Total fat intake (OR 0.45, fourth quartile, Pϭ0.02), lauric acid (OR 0.44, fourth quartile, Pϭ0.02), palmitic acid (OR 0.58, fourth quartile, Pϭ0.03), and oleic acid (OR 0.42, fourth quartile, Pϭ0.03) were inversely associated with acute myocardial infarction. No significant ef-fects were found for the remaining fatty acids. In the adipose tissue composition data, the adjusted risk estimates of acute myocardial infarction for the highest vs the lowest tertile were 0.16, 0.14, and 0.04 for lauric, oleic, and trans-fatty acids, respectively. A significant direct association was found for palmitic and linoleic acids (adjusted ORs for the highest tertile were 9.02 and 3.63, respectively). Conclusions Low intake of total fat and lauric acid from dairy products was associated with acute myocardial infarction. The association of polyunsaturated fatty acids with risk of acute myocardial infarction was nonsignificant after adjustment for energy intake and confounders.
Dietary fats and cardiovascular health: a summary of the scientific evidence and current debate
International journal of food sciences and nutrition, 2018
This narrative review summarises the main studies of the role of the different fatty acids in coronary heart disease (CHD) and cardiovascular disease (CVD) risk and the current scientific debate on dietary recommendations. Reduction and substitution of the saturated fatty acids (SFAs) with the polyunsaturated fatty acids (PUFAs) are still the main dietary recommendation to prevent CHD and CVD. In the last few years, however, the strength of the scientific evidence underlying this dietary advice has been questioned. Recent investigations reappraise the previously declared deleterious role of the SFAs and reduce the positive role of PUFAs, mainly the omega-6, whereas the role of monounsaturated fatty acids (MUFAs) remains unclear. In contrast, the negative effects of trans fatty acids (TFAs) seem stronger than previously thought. Finally, criticisms have emerged from a dietary recommendation approach focussed on individual components rather than on wide food items and eating habits.
American Journal of Clinical Nutrition, 2009
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, require 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.
Dietary saturated fats and their food sources in relation to risk of coronary heart disease in women
American Journal of Clinical Nutrition, 1999
Background: Metabolic studies suggest that saturated fatty acids differ in their effects on blood lipids. Objective: The objective was to examine the associations between intakes of individual saturated fatty acids and their food sources in relation to the risk of coronary heart disease (CHD). Design: This was a prospective cohort study of 80 082 women in the Nurses' Health Study aged 34-59 y. Subjects had no known cardiovascular disease, cancer, hypercholesterolemia, or diabetes, and completed validated food-frequency questionnaires in 1980. Results: During 14 y of follow-up, we documented 939 incident cases of major CHD events. In multivariate analyses in which age, smoking, and other covariates were controlled for, intakes of short-to medium-chain saturated fatty acids (4:0-10:0) were not significantly associated with the risk of CHD. In contrast, intakes of longer-chain saturated fatty acids (12:0-18:0) were each separately associated with a small increase in risk. The multivariate RR for a 1% energy increase from stearic acid was 1.19 (95% CI: 1.02, 1.37). The ratio of polyunsaturated to saturated fat was strongly and inversely associated with CHD risk (multivariate RR for a comparison of the highest with the lowest deciles: 0.58; 95% CI: 0.41, 0.83; P for trend < 0.0001). Conversely, higher ratios of red meat to poultry and fish consumption and of high-fat to low-fat dairy consumption were associated with significantly greater risk. Conclusion: A distinction between stearic acid and other saturated fats does not appear to be important in dietary advice to reduce CHD risk, in part because of the high correlation between stearic acid and other saturated fatty acids in typical diets. Am J Clin Nutr 1999;70:1001-8.
2018
BACKGROUND: Coronary heart disease (CHD) is a leading cause of death worldwide. Saturated fats were known as a risk factor for CHD and dietary guidelines restrict the daily consumption of SFs. However, the association between SFs and higher risk of CHD is not clear. This systematic review includes 14 high-quality prospective cohort studies which reported the association between CHD and SFs. OBJECTIVE: This systematic review aims to examine the association between SFs intake and higher risk of CHD among prospective cohort studies. DESIGN: A systematic review was conducted for published literaure in Scopus and ProQuest during the period 2000 to 2017. Studies included if they have a prospective cohort design with follow-up more than 4 years, published in English, and provide information about the association of interest. Data were extracted and summarised into three tables. RESULTS: A total number of 14 prospective cohort studies were included in this review in which all from develop...