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

  • Marinka Steur
    MRC Epidemiology Unit University of Cambridge School of Clinical Medicine Cambridge UK
  • Laura Johnson
    Centre for Exercise, Nutrition and Health Sciences School for Policy Studies University of Bristol Bristol UK
  • Stephen J. Sharp
    MRC Epidemiology Unit University of Cambridge School of Clinical Medicine Cambridge UK
  • Fumiaki Imamura
    MRC Epidemiology Unit University of Cambridge School of Clinical Medicine Cambridge UK
  • Ivonne Sluijs
    Julius Center for Health Sciences and Primary Care University Medical Center UtrechtUtrecht University Utrecht The Netherlands
  • Timothy J. Key
    Cancer Epidemiology Unit Nuffield Department of Population Health University of Oxford Oxford UK
  • Angela Wood
    BHF Cardiovascular Epidemiology Unit Department of Public Health and Primary Care University of Cambridge Cambridge UK
  • Rajiv Chowdhury
    BHF Cardiovascular Epidemiology Unit Department of Public Health and Primary Care University of Cambridge Cambridge UK
  • Marcela Guevara
    Navarra Public Health Institute Pamplona Spain
  • Marianne U. Jakobsen
    National Food Institute Division for Diet Disease Prevention and Toxicology Technical University of Denmark Kongens Lyngby Denmark
  • Ingegerd Johansson
    Department of Odontology Umeå University Umeå Sweden
  • Albert Koulman
    MRC Epidemiology Unit University of Cambridge School of Clinical Medicine Cambridge UK
  • Kim Overvad
    Department of Public Health Aarhus University Aarhus Denmark
  • Maria‐José Sánchez
    CIBER of Epidemiology and Public Health (CIBERESP) Madrid Spain
  • Yvonne T. van der Schouw
    Julius Center for Health Sciences and Primary Care University Medical Center UtrechtUtrecht University Utrecht The Netherlands
  • Antonia Trichopoulou
    Hellenic Health Foundation Athens Greece
  • Elisabete Weiderpass
    International Agency for Research on CancerWorld Health Organization Lyon France
  • Maria Wennberg
    Section of Sustainable Health Department of Public Health and Clinical Medicine Umeå University Umeå Sweden
  • Ju‐Sheng Zheng
    MRC Epidemiology Unit University of Cambridge School of Clinical Medicine Cambridge UK
  • Heiner Boeing
    Department of Epidemiology German Institute of Human Nutrition (DIfE), Potsdam‐Rehbrücke Nuthetal Germany
  • Jolanda M. A. Boer
    National Institute for Public Health and the Environment Bilthoven The Netherlands
  • Marie‐Christine Boutron‐Ruault
    Le Centre de recherche en Epidémiologie et Santé des Populations (CESP) Faculté de médecine ‐ Univ. Paris‐SudFaculté de Médecine–UVSQINSERMUniversité Paris‐Saclay Villejuif France
  • Ulrika Ericson
    Diabetes and Cardiovascular disease Genetic Epidemiology Department of Clinical Sciences in Malmö Lund University Malmö Sweden
  • Alicia K. Heath
    Department of Epidemiology and Biostatistics School of Public Health Imperial College London London UK
  • Inge Huybrechts
    International Agency for Research on CancerWorld Health Organization Lyon France
  • Liher Imaz
    Ministry of Health of the Basque GovernmentPublic Health Division of Gipuzkoa Donostia‐San Sebastian Spain
  • Rudolf Kaaks
    Division of Cancer EpidemiologyGerman Cancer Research Center (DKFZ) Heidelberg Germany
  • Vittorio Krogh
    Nutritional Epidemiology Unit Fondazione IRCCS Istituto Nazionale dei Tumori Milan Italy
  • Tilman Kühn
    Division of Cancer EpidemiologyGerman Cancer Research Center (DKFZ) Heidelberg Germany
  • Cecilie Kyrø
    Danish Cancer Society Research Center Copenhagen Denmark
  • Giovanna Masala
    Cancer Risk Factors and Life‐Style Epidemiology UnitInstitute for Cancer Research, Prevention and Clinical Network ‐ ISPRO Florence Italy
  • Olle Melander
    Department of Clinical Sciences Lund University Malmö Sweden
  • Conchi Moreno‐Iribas
    Navarra Public Health Institute Pamplona Spain
  • Salvatore Panico
    Dipartmento Di Medicina Clinica E Chiorurgia Federcio II University Naples Italy
  • José R. Quirós
    Public Health Directorate Asturias Spain
  • Miguel Rodríguez‐Barranco
    CIBER of Epidemiology and Public Health (CIBERESP) Madrid Spain
  • Carlotta Sacerdote
    Unit of Cancer Epidemiology Citta' della Salute e della Scienza Hospital‐University of Turin Turin Italy
  • Carmen Santiuste
    CIBER of Epidemiology and Public Health (CIBERESP) Madrid Spain
  • Guri Skeie
    Department of Community Medicine University of TromsøThe Arctic University of Norway Tromsø Norway
  • Anne Tjønneland
    Danish Cancer Society Research Center Copenhagen Denmark
  • Rosario Tumino
    Cancer Registry and Histopathology Department Azienda Sanitaria Provinciale (ASP) Ragusa Italy
  • W. M. Monique Verschuren
    Julius Center for Health Sciences and Primary Care University Medical Center UtrechtUtrecht University Utrecht The Netherlands
  • Raul Zamora‐Ros
    Unit of Nutrition and Cancer Cancer Epidemiology Research Program Catalan Institute of Oncology (ICO)Bellvitge Biomedical Research Institute (IDIBELL) Barcelona Spain
  • Christina C. Dahm
    Department of Public Health Aarhus University Aarhus Denmark
  • Aurora Perez‐Cornago
    Cancer Epidemiology Unit Nuffield Department of Population Health University of Oxford Oxford UK
  • Matthias B. Schulze
    Department of Molecular Epidemiology German Institute of Human Nutrition, Potsdam‐Rehbruecke Nuthetal Germany
  • Tammy Y. N. Tong
    Cancer Epidemiology Unit Nuffield Department of Population Health University of Oxford Oxford UK
  • Elio Riboli
    Department of Epidemiology and Biostatistics School of Public Health Imperial College London London UK
  • Nicholas J. Wareham
    MRC Epidemiology Unit University of Cambridge School of Clinical Medicine Cambridge UK
  • John Danesh
    BHF Cardiovascular Epidemiology Unit Department of Public Health and Primary Care University of Cambridge Cambridge UK
  • Adam S. Butterworth
    BHF Cardiovascular Epidemiology Unit Department of Public Health and Primary Care University of Cambridge Cambridge UK
  • Nita G. Forouhi
    MRC Epidemiology Unit University of Cambridge School of Clinical Medicine Cambridge UK

抄録

<jats:sec xml:lang="en"> <jats:title>Background</jats:title> <jats:p xml:lang="en">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.</jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Methods and Results</jats:title> <jats:p xml:lang="en">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]).</jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Conclusions</jats:title> <jats:p xml:lang="en">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.</jats:p> </jats:sec>

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