The association between dietary saturated fatty acids and ischemic heart disease depends on the type and source of fatty acid in the European Prospective Investigation into Cancer and Nutrition–Netherlands cohort

Abstract

Background: The association between saturated fatty acid (SFA) intake and ischemic heart disease (IHD) risk is debated. Objective: We sought to investigate whether dietary SFAs were associated with IHD risk and whether associations depended on 1) the substituting macronutrient, 2) the carbon chain length of SFAs, and 3) the SFA food source. Design: Baseline (1993-1997) SFA intake was measured with a foodfrequency questionnaire among 35,597 participants from the European Prospective Investigation into Cancer and Nutrition-Netherlands cohort. IHD risks were estimated with multivariable Cox regression for the substitution of SFAs with other macronutrients and for higher intakes of total SFAs, individual SFAs, and SFAs from different food sources. Results: During 12 y of follow-up, 1807 IHD events occurred. Total SFA intake was associated with a lower IHD risk (HR per 5% of energy: 0.83; 95% CI: 0.74, 0.93). Substituting SFAs with animal protein, cis monounsaturated fatty acids, polyunsaturated fatty acids (PUFAs), or carbohydrates was significantly associated with higher IHD risks (HR per 5% of energy: 1.27-1.37). Slightly lower IHD risks were observed for higher intakes of the sum of butyric (4: Conclusions:In this Dutch population, higher SFA intake was not associated with higher IHD risks. The lower IHD risk observed did not depend on the substituting macronutrient but appeared to be driven mainly by the sums of butyric through capric acid, the sum of pentadecylic and margaric acid, myristic acid, and SFAs from dairy sources. Residual confounding by cholesterol-lowering therapy and trans fat or limited variation in SFA and PUFA intake may explain our findings. Analyses need to be repeated in populations with larger differences in SFA intake and different SFA food sources.Am J Clin Nutr 2016;103:356-65.

Saturated Fatty Acids and Cardiovascular Disease: Replacements for Saturated Fat to Reduce Cardiovascular Risk

“…A systematic review and meta-analysis of randomized controlled trials showed that replacement of SFA with cis-PUFA reduced total cholesterol, LDL-and HDL-cholesterol, and triglycerides [4]. Mozaffarian et al reported that for every 5% of energy from SFA exchanged for PUFA in short-term feeding trials, LDL cholesterol was reduced by 10 mg/dl, and the ratio of total cholesterol: HDL cholesterol decreased 0.16 [61].…”

Misvisende om kosthold i ny nasjonal retningslinje for forebygging av hjerte- og karsykdommer

“…Praagman og medarbeidere 217 fant på den annen side ikke at utskifting av mettet fett med umettet fett var forbundet med lavere risiko for koronar hjertesykdom i den nederlandske EPIC-kohorten hvor 97 % spiste mer enn 10 E% mettet fett og hvor meieriprodukter var en stor kilde til mettet fett.…”

“…I den ovennevnte studien av Praagman og medarbeidere -som ikke fant en sammenheng mellom mettet fett og koronar hjertesykdom -var det eksempelvis -ifølge forfatterne -sannsynlig at økende bruk av kolesterolsenkende medisiner i studieperioden kan ha svekket denne sammenhengen 217 . Samtidig var margarin den viktigste kilden til flerumettet fett blant deltakerne, men også en viktig kilde til transfettsyrer da inntaket ble målt på 1990-tallet.…”

Saturated fat –a never ending story?

“…Replacing SFA with linoleic acid increased CVD risk in one trial [2]. Additionally, a recent large prospective cohort study reported lower CVD risk with increased intake of energy from SFA [3], and recent meta-analyses of cohort studies found that SFA did not increase the risk of CVD [4,5]. Such evidence supports and excites scientists and others who strongly argue for increasing the fat content of food, including SFA.…”

“…For example, in a recent cohort study reporting possible benefits of SFA [3], the diet was assessed at study baseline in the mid-1990s and the participants were followed up to 25 years later, suggesting that assessment of the diet at one time-point can predict disease many years later, a very common study design. However, in another study with different results [9] the diet was measured eight times during a 25 years period.…”