期刊
LANCET
卷 390, 期 10107, 页码 2050-2062出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/S0140-6736(17)32252-3
关键词
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资金
- Heart and Stroke Foundation/Marion W Burke Chair in Cardiovascular Disease
- Population Health Research Institute
- Canadian Institutes of Health Research (CIHR)
- Heart and Stroke Foundation of Ontario from CIHR's Strategy for Patient Oriented Research, through the Ontario SPOR Support Unit
- Ontario Ministry of Health and Long-Term Care
- AstraZeneca [Canada]
- Sanofi-Aventis [France]
- Sanofi-Aventis [Canada]
- Boehringer Ingelheim [Germany]
- Boehringer Ingelheim [Canada]
- Servier
- GlaxoSmithKline
- Novartis
- King Pharma
- Argentina: Fundacion ECLA
- Bangladesh: Independent University
- Bangladesh and Mitra and Associates
- Brazil: Unilever Health Institute, Brazil
- Canada: Public Health Agency of Canada and Champlain Cardiovascular Disease Prevention Network
- Chile: Universidad de la Frontera
- China: National Center for Cardiovascular Diseases
- Colombia: Colciencias [6566-04-18062]
- India: Indian Council of Medical Research
- Malaysia: Ministry of Science, Technology and Innovation of Malaysia [100-IRDC/BIOTEK 16/6/21[13/2007], 07-05-IFN-BPH 010]
- Malaysia: Ministry of Higher Education of Malaysia [600-RMI/LRGS/5/3[2/2011]]
- Malaysia: Universiti Teknologi MARA
- Malaysia: Universiti Kebangsaan Malaysia [UKM-Hejim-Komuniti-15-2010]
- occupied Palestinian territory: the UN Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), International Development Research Centre, Canada
- Poland: Polish Ministry of Science and Higher Education [290/W-PURE/2008/0]
- Poland: Wroclaw Medical University
- South Africa: The North-West University
- South Africa: SANPAD (SA and Netherlands Programme for Alternative Development)
- South Africa: National Research Foundation
- South Africa: Medical Research Council of South Africa
- South Africa: South Africa Sugar Association
- South Africa: Faculty of Community and Health Sciences
- Sweden: Swedish State
- Sweden: Swedish Heart and Lung Foundation
- Sweden: Swedish Research Council
- Sweden: Swedish Council for Health, Working Life and Welfare
- Sweden: King Gustaf V's and Queen Victoria Freemasons Foundation
- Sweden: AFA Insurance
- Sweden: Swedish Council for Working Life and Social Research
- Sweden: Swedish Research Council for Environment, Agricultural Sciences and Spatial Planning
- Sweden: Vastra Gotaland Region
- Turkey: Metabolic Syndrome Society
- Turkey: AstraZeneca, Turkey
- Turkey: Sanofi Aventis, Turkey
- United Arab Emirates: Sheikh Hamdan Bin Rashid Al Maktoum Award for Medical Sciences, Dubai Health Authority, Dubai
- Swedish State
Background The relationship between macronutrients and cardiovascular disease and mortality is controversial. Most available data are from European and North American populations where nutrition excess is more likely, so their applicability to other populations is unclear. Methods The Prospective Urban Rural Epidemiology (PURE) study is a large, epidemiological cohort study of individuals aged 35-70 years (enrolled between Jan 1, 2003, and March 31, 2013) in 18 countries with a median followup of 7.4 years (IQR 5.3-9.3). Dietary intake of 135 335 individuals was recorded using validated food frequency questionnaires. The primary outcomes were total mortality and major cardiovascular events (fatal cardiovascular disease, non-fatal myocardial infarction, stroke, and heart failure). Secondary outcomes were all myocardial infarctions, stroke, cardiovascular disease mortality, and non-cardiovascular disease mortality. Participants were categorised into quintiles of nutrient intake (carbohydrate, fats, and protein) based on percentage of energy provided by nutrients. We assessed the associations between consumption of carbohydrate, total fat, and each type of fat with cardiovascular disease and total mortality. We calculated hazard ratios (HRs) using a multivariable Cox frailty model with random intercepts to account for centre clustering. Findings During follow-up, we documented 5796 deaths and 4784 major cardiovascular disease events. Higher carbohydrate intake was associated with an increased risk of total mortality (highest [quintile 5] vs lowest quintile [quintile 1] category, HR 1.28 [95% CI 1.12-1.46], p(trend) = 0.0001) but not with the risk of cardiovascular disease or cardiovascular disease mortality. Intake of total fat and each type of fat was associated with lower risk of total mortality (quintile 5 vs quintile 1, total fat: HR 0.77 [95% CI 0.67-0.87], p(trend) < 0.0001; saturated fat, HR 0.86 [0.76-0.99], p(trend) = 0.0088; monounsaturated fat: HR 0.81 [0.71-0.92], p(trend) < 0.0001; and polyunsaturated fat: HR 0.80 [0.71-0.89], p(trend) < 0.0001). Higher saturated fat intake was associated with lower risk of stroke (quintile 5 vs quintile 1, HR 0.79 [95% CI 0.64-0.98], p(trend) = 0.0498). Total fat and saturated and unsaturated fats were not significantly associated with risk of myocardial infarction or cardiovascular disease mortality. Interpretation High carbohydrate intake was associated with higher risk of total mortality, whereas total fat and individual types of fat were related to lower total mortality. Total fat and types of fat were not associated with cardiovascular disease, myocardial infarction, or cardiovascular disease mortality, whereas saturated fat had an inverse association with stroke. Global dietary guidelines should be reconsidered in light of these findings.
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