Dietary fat intake and risk of cardiovascular disease and all-cause mortality in a population at high risk of cardiovascular disease

医学 多不饱和脂肪 多不饱和脂肪酸 心肌梗塞 饱和脂肪 死因 内科学 饱和脂肪酸 冲程(发动机) 人口 低风险 疾病 危险系数 脂肪酸 生理学 置信区间 胆固醇 环境卫生 生物 机械工程 工程类 生物化学
作者
Marta Guasch‐Ferré,Nancy Babió,Miguel Ángel Martínez‐González,Dolores Corella,Emilio Ros,Sandra Martín‐Peláez,Ramón Estruch,Fernando Arós,Enrique Gómez‐Gracia,Miquel Fiol,José Manuel Santos‐Lozano,Lluís Serra-Majem,Mònica Bulló,Estefanía Toledo,Rocío Barragán,Montserrat Fitó,Alfredo Gea,Jordi Salas‐Salvadó
出处
期刊:The American Journal of Clinical Nutrition [Oxford University Press]
卷期号:102 (6): 1563-1573 被引量:210
标识
DOI:10.3945/ajcn.115.116046
摘要

Dietary fat quality and fat replacement are more important for cardiovascular disease (CVD) prevention than is total dietary fat intake.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.We prospectively studied 7038 participants at high CVD risk from the PREvención con DIeta MEDiterránea (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.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.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. This trial was registered at www.controlled-trials.com as ISRCTN 35739639.
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