期刊
AMERICAN JOURNAL OF CLINICAL NUTRITION
卷 102, 期 6, 页码 1563-1573出版社
OXFORD UNIV PRESS
DOI: 10.3945/ajcn.115.116046
关键词
dietary fat; fat subtypes; saturated fat; cardiovascular disease; all-cause death; PREDIMED study
资金
- Spanish Ministry of Health [Instituto de Salud Carlos III (ISCIII)] [PI1001407, G03/140, RD06/0045]
- FEDER (FondoEuropeo de Desarrollo Regional)
- Centre Catala de la Nutricio de l'Institut d'Estudis Catalans
- Spanish government, Instituto de Salud Carlos III (ISCIII) [RTIC G03/140, RTIC RD 06/0045]
- Spanish government, Instituto de Salud Carlos III (ISCIII) (through Centro de Investigacion Biomedica en Red de Fisiopatologia de la Obesidad y Nutricion (CIBEROBN))
- Centro Nacional de Investigaciones Cardiovasculares [CNIC 06/2007]
- Fondo de Investigacion Sanitaria-Fondo Europeo de Desarrollo Regional [PI04-2239, PI 05/2584, CP06/00100, PI07/0240, PI07/1138, PI07/0954, PI 07/0473, PI10/01407, PI10/02658, PI11/01647, P11/02505, PI13/00462]
- Ministerio de Ciencia e Innovacion [AGL-2009-13906-C02, AGL2010-22319-C03]
- Fundacion Mapfre
- Consejeria de Salud de la Junta de Andalucia [PI0105/2007]
- Public Health Division of the Department of Health of the Autonomous Government of Catalonia, Generalitat Valenciana [ACOMP06109, GVA-COMP2010-181, GVA-COMP2011-151, CS2010-AP-111, CS2011-AP-042]
- Regional Government of Navarra [P27/2011]
Background: Dietary fat quality and fat replacement are more important for cardiovascular disease (CVD) prevention than is total dietary fat intake. Objective: The aim was to evaluate the association between total fat intake and fat subtypes with the risk of CVD (myocardial infarction, stroke, or death from cardiovascular causes) and cardiovascular and all-cause death. We also examined the hypothetical effect of the isocaloric substitution of one macronutrient for another. Design: We prospectively studied 7038 participants at high CVD risk from the PREvencion con DIeta MEDiterranea (PREDIMED) study. The trial was conducted from 2003 to 2010, but the present analysis was based on an expanded follow-up until 2012. At baseline and yearly thereafter, total and specific fat subtypes were repeatedly measured by using validated food-frequency questionnaires. Time-dependent Cox proportional hazards models were used. Results: After 6 y of follow-up, we documented 336 CVD cases and 414 total deaths. HRs (95% CIs) for CVD for those in the highest quintile of total fat, monounsaturated fatty acid (MUFA), and polyunsaturated fatty acid (PUFA) intake compared with those in the lowest quintile were 0.58 (0.39, 0.86), 0.50 (0.31, 0.81), and 0.68 (0.48, 0.96), respectively. In the comparison between extreme quintiles, higher saturated fatty acid (SFA) and trans-fat intakes were associated with 81% (HR: 1.81; 95% CI: 1.05, 3.13) and 67% (HR: 1.67; 95% CI: 1.09, 2.57) higher risk of CVD. Inverse associations with all-cause death were also observed for PUFA and MUFA intakes. Isocaloric replacements of SFAs with MUFAs and PUFAs or trans fat with MUFAs were associated with a lower risk of CVD. SFAs from pastries and processed foods were associated with a higher risk of CVD. Conclusions: Intakes of MUFAs and PUFAs were associated with a lower risk of CVD and death, whereas SFA and trans-fat intakes were associated with a higher risk of CVD. The replacement of SFAs with MUFAs and PUFAs or of trans fat with MUFAs was inversely associated with CVD.
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