Dietary fats and mortality among patients with type 2 diabetes: analysis in two population based cohort studies

Abstract

ObjectiveTo assess the association of dietary fatty acids with cardiovascular disease mortality and total mortality among patients with type 2 diabetes.DesignProspective, longitudinal cohort study.SettingHealth professionals in the United States.Participants11 264 participants with type 2 diabetes in the Nurses’ Health Study (1980-2014) and Health Professionals Follow-Up Study (1986-2014).ExposuresDietary fat intake assessed using validated food frequency questionnaires and updated every two to four years.Main outcome measureTotal and cardiovascular disease mortality during follow-up.ResultsDuring follow-up, 2502 deaths including 646 deaths due to cardiovascular disease were documented. After multivariate adjustment, intake of polyunsaturated fatty acids (PUFAs) was associated with a lower cardiovascular disease mortality, compared with total carbohydrates: hazard ratios comparing the highest with the lowest quarter were 0.76 (95% confidence interval 0.58 to 0.99; P for trend=0.03) for total PUFAs, 0.69 (0.52 to 0.90; P=0.007) for marine n-3 PUFAs, 1.13 (0.85 to 1.51) for α-linolenic acid, and 0.75 (0.56 to 1.01) for linoleic acid. Inverse associations with total mortality were also observed for intakes of total PUFAs, n-3 PUFAs, and linoleic acid, whereas monounsaturated fatty acids of animal, but not plant, origin were associated with a higher total mortality. In models that examined the theoretical effects of substituting PUFAs for other fats, isocalorically replacing 2% of energy from saturated fatty acids with total PUFAs or linoleic acid was associated with 13% (hazard ratio 0.87, 0.77 to 0.99) or 15% (0.85, 0.73 to 0.99) lower cardiovascular disease mortality, respectively. A 2% replacement of energy from saturated fatty acids with total PUFAs was associated with 12% (hazard ratio 0.88, 0.83 to 0.94) lower total mortality.ConclusionsIn patients with type 2 diabetes, higher intake of PUFAs, in comparison with carbohydrates or saturated fatty acids, is associated with lower total mortality and cardiovascular disease mortality. These findings highlight the important role of quality of dietary fat in the prevention of cardiovascular disease and total mortality among adults with type 2 diabetes.

The Jiangnan diet, a healthy diet pattern for Chinese

“…Similarly, rapeseed has grown in the Jiangnan region for thousands of years, and the Southeast Chinese are habituated to use squeezed rapeseed oils, which have a high polyunsaturated/saturated fat ratio (rich in Omega-6) with a similar protective effect to that of monounsaturated oil in reducing total mortality. [34][35][36] Additionally, they also consume relatively high Omega-3 unsaturated fatty acids from fish. However, Northern Chinese maintain higher consumption of wheat flour, starch, tubers, and other cereals, and lower consumption of vegetables and fruits, and more animal foods, with lower CVD benefit 13 ; meanwhile, they like to cook with boiling oil, which usually ruins the good monoand polyunsaturated fat and turns it into saturated or trans fat.…”

“…Thus, olives from the Mediterranean region have high monounsaturated/saturated fat ratio and CVD benefit. Similarly, rapeseed has grown in the Jiangnan region for thousands of years, and the Southeast Chinese are habituated to use squeezed rapeseed oils, which have a high polyunsaturated/saturated fat ratio (rich in Omega‐6) with a similar protective effect to that of monounsaturated oil in reducing total mortality . Additionally, they also consume relatively high Omega‐3 unsaturated fatty acids from fish.…”

Factors associated with subsequent diabetes‐related self‐care activities: The role of social support and optimism

“…One explanation may be that in diabetes self‐management, people often meet obstacles and are more likely to implement DRSCA if they receive actual support in advance. For example, it was recently indicated that the intake of polyunsaturated fatty acids (PUFAs) was more beneficial for the long‐term health of people with T2DM compared with total carbohydrates (Jiao et al, ). Having family providing a healthy diet is thus helpful for people with T2DM for implementing diabetic diet therapy.…”

The Effects of Linoleic Acid Consumption on Lipid Risk Markers for Cardiovascular Disease in Healthy Individuals: A Review of Human Intervention Trials

“…In a prospective cohort study, replacing 5% of energy from saturated fats with PUFAs, was associated with a 25% decreased risk of CHD [20]. In one population-based cohort study, there was an inverse association between total dietary PUFAs, including LA and omega-3 PUFAs, and CVD mortality [21]. Furthermore, according to meta-analyses of prospective cohort studies, a low consumption of n-6 PUFAs and higher intakes of saturated and trans-fatty acids increased CHD mortality [22].…”