scholarly journals n-6/n-3 Ratio of Dietary Fatty Acids Rather Than Hypercholesterolemia As the Major Risk Factor for Atherosclerosis and Coronary Heart Disease.

2000 ◽  
Vol 46 (3) ◽  
pp. 157-177 ◽  
Author(s):  
Harumi Okuyama ◽  
Yoichi Fujii ◽  
Atsushi Ikemoto
Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Marinka Steur ◽  

Introduction: The associations of dietary total fatty acids and the classes saturated, monounsaturated, and polyunsaturated fatty acids (SFAs, MUFAs, and PUFAs) with coronary heart disease (CHD) remain contentious. Moreover, the role of isocaloric macronutrient substitutions and specific food sources of SFAs, particularly in European context, is unclear. Hypothesis: We evaluated the hypothesis that associations of dietary fatty acids vary depending on specific macronutrient substitutions and food sources of SFAs. Methods: We conducted case-cohort analyses including 10,529 incident CHD cases and a random subcohort of 16,730 men and women selected from 385,747 eligible participants in nine countries of the European Prospective Investigation into Cancer and Nutrition Study. Habitual diet was assessed using country-specific dietary questionnaires, and macronutrient intakes were estimated using standardised nutrient databases. Country-specific HRs (95% CIs) per 5% energy intake from dietary total fatty acids, SFAs, MUFAs, and PUFAs were estimated using Prentice-weighted Cox regression models and pooled using random-effects meta-analyses, with and without considering isocaloric macronutrient substitutions. The associations of dietary SFAs from different food sources, including specific macronutrient substitutions, with CHD were also investigated. Results: There was no evidence of associations of dietary total fatty acids, SFAs, MUFAs, or PUFAs with incident CHD, regardless of the substitution macronutrient. Each 1% higher energy intake of SFAs from yoghurt, cheese, and fish were associated with a 7% (95% CI 1-12%), 2% (0-4%) and 13% (0-25%) lower CHD incidence, while SFAs from red meat and butter were associated with a 7% (2-12%) and 2% (0-4%) higher CHD incidence, respectively. Conclusions: There was no evidence of associations of dietary total fatty acids, SFAs, MUFAs, and PUFAs, with CHD incidence, regardless of the substitution nutrients, within the range of intakes in this European population. The opposite direction of associations of SFAs from different food sources such as red meat versus fermented dairy products suggests that public health recommendations should consider foods and overall diets, alongside the macronutrients they contain.


Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Famke J Mölenberg ◽  
Janette de Goede ◽  
Anne J Wanders ◽  
Peter L Zock ◽  
Daan Kromhout ◽  
...  

Background: Replacement of saturated fatty acids (SFA) with polyunsaturated fatty acids (PUFA) is associated with a lower risk of coronary heart disease (CHD) in the general population. Whether this is also the case for CHD patients is not yet clear. In this observational study of Dutch CHD patients, we examined the risk of CHD mortality for the exchange of SFA with total unsaturated fatty acids (UFA), PUFA and cis -monounsaturated fatty acids (MUFA). Methods: We included 4146 post-myocardial infarction patients aged 60-80 (78% male; Alpha Omega Cohort) in whom diet was assessed at baseline (2002-2006) by a validated 203-item food-frequency questionnaire. Cause-specific mortality was monitored until January 2013. Iso-caloric replacement of SFA with (subgroups of) UFA in relation to CHD mortality was studied in quintiles and continuously per 5 energy percent (en%), using Cox regression models. Hazard ratios (HR, 95%-CI) were obtained after adjustment for age, sex, BMI, smoking, education, physical activity, cardiovascular drugs (anticoagulants, antihypertensives, statins), diabetes, and dietary factors, i.e. total energy, protein (en%), carbohydrates (en%), trans fatty acids (en%), dietary fiber (g/d) and dietary cholesterol (mg/d). The model for PUFA also included MUFA as a covariate, and vice versa . Results: During a median follow-up of 7.3 years, there were 888 deaths including 249 CHD deaths. SFA replacement was inversely associated with CHD mortality when comparing extreme quintiles of intake, which was statistically significant for total UFA (HR: 0.44; 95% CI: 0.21-0.92; P = 0.03) and non-significant for PUFA (0.58, 0.31-1.09) and MUFA (0.81, 0.45-1.49). When expressed per 5 en% (Figure), replacing SFA with either UFA, PUFA or MUFA was associated with a more than 30% lower risk of CHD mortality. Findings were similar when confined to statin users. Conclusion: In well-treated CHD patients, replacement of SFA by UFA is associated with a lower CHD mortality risk.


Author(s):  
Marinka Steur ◽  
Laura Johnson ◽  
Stephen J. Sharp ◽  
Fumiaki Imamura ◽  
Ivonne Sluijs ◽  
...  

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.


Lipids ◽  
1999 ◽  
Vol 34 (S1) ◽  
pp. S19-S22 ◽  
Author(s):  
Arne Nordøy

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