TY - JOUR

T1 - Dietary fatty acids, macronutrient substitutions, food sources and incidence of coronary heart disease

T2 - Findings from the EPIC-CVD case-cohort study across nine european countries

AU - Steur, Marinka

AU - Johnson, Laura

AU - Sharp, Stephen J.

AU - Imamura, Fumiaki

AU - Sluijs, Ivonne

AU - Key, Timothy J.

AU - Wood, Angela

AU - Chowdhury, Rajiv

AU - Guevara, Marcela

AU - Jakobsen, Marianne U.

AU - Johansson, Ingegerd

AU - Koulman, Albert

AU - Overvad, Kim

AU - Sánchez, Maria José

AU - van der Schouw, Yvonne T.

AU - Trichopoulou, Antonia

AU - Weiderpass, Elisabete

AU - Wennberg, Maria

AU - Zheng, Ju Sheng

AU - Boeing, Heiner

AU - Boer, Jolanda M.A.

AU - Boutron-Ruault, Marie Christine

AU - Ericson, Ulrika

AU - Heath, Alicia K.

AU - Huybrechts, Inge

AU - Imaz, Liher

AU - Kaaks, Rudolf

AU - Krogh, Vittorio

AU - Kühn, Tilman

AU - Kyrø, Cecilie

AU - Masala, Giovanna

AU - Melander, Olle

AU - Moreno-Iribas, Conchi

AU - Panico, Salvatore

AU - Quirós, José R.

AU - Rodríguez-Barranco, Miguel

AU - Sacerdote, Carlotta

AU - Santiuste, Carmen

AU - Skeie, Guri

AU - Tjønneland, Anne

AU - Tumino, Rosario

AU - Monique Verschuren, W. M.

AU - Zamora-Ros, Raul

AU - Dahm, Christina C.

AU - Perez-Cornago, Aurora

AU - Schulze, Matthias B.

AU - Tong, Tammy Y.N.

AU - Riboli, Elio

AU - Wareham, Nicholas J.

AU - Danesh, John

AU - Butterworth, Adam S.

AU - Forouhi, Nita G.

N1 - Publisher Copyright: © 2021 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

PY - 2021

Y1 - 2021

N2 - 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 direc-tions 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.

AB - 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 direc-tions 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.

KW - Coronary heart disease

KW - Dietary guidelines

KW - Nutritional epidemiology

KW - Primary prevention

KW - Saturated fat

U2 - 10.1161/JAHA.120.019814

DO - 10.1161/JAHA.120.019814

M3 - Journal article

C2 - 34796724

AN - SCOPUS:85121028397

VL - 10

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

IS - 23

M1 - e019814

ER -