Dietary Fatty Acids, Macronutrient Substitutions, Food Sources and Incidence of Coronary Heart Disease: Findings From the EPIC‐CVD Case‐Cohort Study Across Nine European Countries
Year: 2021
Type: article
Study design: Observational Study
Abstract: Background There is controversy about associations between total dietary fatty acids, their classes (saturated fatty acids [SFAs], monounsaturated fatty acids, and polyunsaturated fatty acids), and risk of coronary heart disease (CHD). Specifically, the relevance of food sources of SFAs to CHD associations is uncertain. Methods and Results We conducted a case-cohort study involving 10 529 incident CHD cases and a random subcohort of 16 730 adults selected from a cohort of 385 747 participants in 9 countries of the EPIC (European Prospective Investigation into Cancer and Nutrition) study. We estimated multivariable adjusted country-specific hazard ratios (HRs) and 95% CIs per 5% of energy intake from dietary fatty acids, with and without isocaloric macronutrient substitutions, using Prentice-weighted Cox regression models and pooled results using random-effects meta-analysis. We found no evidence for associations of the consumption of total or fatty acid classes with CHD, regardless of macronutrient substitutions. In analyses considering food sources, CHD incidence was lower per 1% higher energy intake of SFAs from yogurt (HR, 0.93 [95% CI, 0.88-0.99]), cheese (HR, 0.98 [95% CI, 0.96-1.00]), and fish (HR, 0.87 [95% CI, 0.75-1.00]), but higher for SFAs from red meat (HR, 1.07 [95% CI, 1.02-1.12]) and butter (HR, 1.02 [95% CI, 1.00-1.04]). Conclusions This observational study found no strong associations of total fatty acids, SFAs, monounsaturated fatty acids, and polyunsaturated fatty acids, with incident CHD. By contrast, we found associations of SFAs with CHD in opposite directions dependent on the food source. These findings should be further confirmed, but support public health recommendations to consider food sources alongside the macronutrients they contain, and suggest the importance of the overall food matrix.
Authors: Marinka Steur, Laura Johnson, Stephen J. Sharp, Fumiaki Imamura, Ivonne Sluijs, Timothy J. Key, Angela Wood, Rajiv Chowdhury, Marcela Guevara, Marianne U. Jakobsen, Ingegerd Johansson, Albert Koulman, Kim Overvad, Maria‐José Sánchez, Yvonne T. van der Schouw, Antonia Trichopoulou, Elisabete Weiderpass, Maria Wennberg, Ju‐Sheng Zheng, Heiner Boeing, Jolanda M. A. Boer, Marie‐Christine Boutron‐Ruault, Ulrika Ericson, Alicia K. Heath, Inge Huybrechts, Liher Imaz, Rudolf Kaaks, Vittorio Krogh, Tilman Kühn, Cecilie Kyrø, Giovanna Masala, Olle Melander, Conchi Moreno‐Iribas, Salvatore Panico, José R. Quirós, Miguel Rodríguez‐Barranco, Carlotta Sacerdote, Carmen Santiuste, Guri Skeie, Anne Tjønneland, Rosario Tumino, W. M. Monique Verschuren, Raul Zamora‐Ros, Christina C. Dahm, Aurora Perez‐Cornago, Matthias B. Schulze, Tammy Y. N. Tong, Elio Riboli, Nicholas J. Wareham, John Danesh, Adam S. Butterworth, Nita G. Forouhi
Institutions: University of Cambridge, MRC Epidemiology Unit, University of Bristol, Utrecht University, University Medical Center Utrecht, University of Oxford, Instituto de Salud Pública de Navarra, Navarre Institute of Health Research, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Technical University of Denmark, Umeå University, National Institute for Health and Care Research, NIHR Cambridge Biomedical Research Centre, Aarhus University, Aalborg University Hospital, Universidad de Granada, Instituto de Investigación Biosanitaria de Granada, Andalusian School of Public Health, Hellenic Health Foundation, Centre international de recherche sur le cancer, Westlake University, German Institute of Human Nutrition, National Institute for Public Health and the Environment, Centre de recherche en Epidémiologie et Santé des Populations, Lund University, Imperial College London, Basque Government, Biogipuzkoa Health Research Institute, German Cancer Research Center, Fondazione IRCCS Istituto Nazionale dei Tumori, Danish Cancer Society, Red de Investigación en Servicios de Salud en Enfermedades Crónicas, Federico II University Hospital, University of Naples Federico II, Azienda Ospedaliera Citta' della Salute e della Scienza di Torino, Piedmont Reference Center for Epidemiology and Cancer Prevention, University of Turin, Instituto Murciano de Investigación Biosanitaria, UiT The Arctic University of Norway, University of Copenhagen, Associazione Iblea per la Ricerca Epidemiologica E.T.S., Institut d'Investigació Biomédica de Bellvitge, Institut Català d'Oncologia, University of Potsdam, Wellcome Sanger Institute
Language: English
Subfield: Nutrition and Dietetics
Field: Nursing
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,025
Funders: World Health Organization, Aarhus Universitet, Deutsches Krebsforschungszentrum, European Association of Social Psychology, Westlake University, Cancer Research UK, National Institute for Health and Care Research, British Heart Foundation, Imperial College London, European Commission, Institut National de la Santé et de la Recherche Médicale, Bundesministerium für Bildung und Forschung, Aalborg Universitet, Cancerfonden, Cambridge University Hospitals, Eusko Jaurlaritza, Lunds Universitet, Ligue Contre le Cancer, Vetenskapsrådet, Umeå Universitet, Associazione Italiana per la Ricerca sul Cancro, Deutsche Krebshilfe, Aalborg Universitetshospital, Universidad de Granada, Université Paris-Saclay, Institut Gustave-Roussy, Hellenic Health Foundation, Université de Versailles Saint-Quentin-en-Yvelines, Medical Research Council, World Cancer Research Fund, Instituto de Salud Carlos III, Akademi Sains Malaysia, NIHR Imperial Biomedical Research Centre, School of Public Health, Imperial College London, NIHR Cambridge Biomedical Research Centre
Awards: NIHR Senior Investigator Award, Large-scale integrative genomic studies of high-dimensional traits in cardiovascular diseases (renewal), G299057155, G3328679326, G370598735, NIHR Senior Investigator Award, Health of vegetarians, G4584873075, The EPIC-Norfolk prospective population study: biological and behavioural determinants of health and disease in an ageing population, G5897142711, Genetic, lipid and other risk factors in early-onset acute myocardial infarction in Malaysia., NIHR Senior Investigator Award, Large-scale integrative studies of risk factors in coronary heart disease: from discovery to application (renewal). (Joint funding with MRC), G8585681489, Large-scale integrative studies of risk factors in coronary heart disease: from discovery to application
OpenAlex ID: W3184283970