Saturated Fats Compared With Unsaturated Fats and Sources of Carbohydrates in Relation to Risk of Coronary Heart Disease: A Prospective Cohort Study

Published on Oct 1, 2015in Journal of the American College of Cardiology 16.83
· DOI :10.1016/j.jacc.2015.07.055
Yanping Li42
Estimated H-index: 42
(Harvard University),
Adela Hruby18
Estimated H-index: 18
(Harvard University)
+ 8 AuthorsFrank B. Hu199
Estimated H-index: 199
(Harvard University)
Abstract
Abstract Background The associations between dietary saturated fats and the risk of coronary heart disease (CHD) remain controversial, but few studies have compared saturated with unsaturated fats and sources of carbohydrates in relation to CHD risk. Objectives This study sought to investigate associations of saturated fats compared with unsaturated fats and different sources of carbohydrates in relation to CHD risk. Methods We followed 84,628 women (Nurses’ Health Study, 1980 to 2010), and 42,908 men (Health Professionals Follow-up Study, 1986 to 2010) who were free of diabetes, cardiovascular disease, and cancer at baseline. Diet was assessed by a semiquantitative food frequency questionnaire every 4 years. Results During 24 to 30 years of follow-up, we documented 7,667 incident cases of CHD. Higher intakes of polyunsaturated fatty acids (PUFAs) and carbohydrates from whole grains were significantly associated with a lower risk of CHD comparing the highest with lowest quintile for PUFAs (hazard ratio [HR]: 0.80, 95% confidence interval [CI]: 0.73 to 0.88; p trend  0.10). Conclusions Our findings indicate that unsaturated fats, especially PUFAs, and/or high-quality carbohydrates can be used to replace saturated fats to reduce CHD risk.
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  • Citations (132)
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References22
Published on Jan 1, 2001in Journal of Nutrition Health & Aging 2.87
Frank B. Hu199
Estimated H-index: 199
,
Barry M. Popkin317
Estimated H-index: 317
In the last decade, our understanding of the nutrients and foods most likely to promote cardiac health has improved substantially, owing in part to the data from several large and carefully conducted prospective cohort studies, including the Nurses' Health Study (NHS) and Health Professionals' Follow-up Study (HPFS). Using more refined dietary assessment tools and multiple measurements, the NHS and HPFS have provided a wealth of information not only on major types of fat and different classes of...
48 Citations
Published on Dec 1, 2007in The Lancet 53.25
Sarah Lewington41
Estimated H-index: 41
,
Gary Whitlock26
Estimated H-index: 26
+ 6 AuthorsRory Collins128
Estimated H-index: 128
Background Age, sex, and blood pressure could modify the associations of total cholesterol (and its main two fractions, HDL and LDL cholesterol) with vascular mortality. This meta-analysis combined prospective studies of vascular mortality that recorded both blood pressure and total cholesterol at baseline, to determine the joint relevance of these two risk factors. Methods Information was obtained from 61 prospective observational studies, mostly in western Europe or North America, consisting o...
1,418 Citations Source Cite
Published on Aug 1, 1991in The American Journal of Clinical Nutrition 6.55
Stephanie J. London77
Estimated H-index: 77
,
Frank M. Sacks110
Estimated H-index: 110
+ 3 AuthorsBarry M. Popkin317
Estimated H-index: 317
The distributions of fatty acids in subcutaneous-adipose-tissue aspirates and their relation to intake as assessed by a semiquantitative food-frequency questionnaire were investigated in 1 15 postmenopausal US women free from cancer. Percentages of fatty acids in adipose tissue were significantly correlated with the percentage of total fat intake for polyunsaturated fatty acids (Spearman correlation = 0.37), n-3 fatty acids of marine origin (Spearman correlation = 0.48), and trans fatty acids (S...
181 Citations Source Cite
Published on Jun 1, 2000in The American Journal of Clinical Nutrition 6.55
Simin Liu100
Estimated H-index: 100
,
Barry M. Popkin317
Estimated H-index: 317
+ 5 AuthorsJoAnn E. Manson230
Estimated H-index: 230
Background: Little is known about the effects of the amount and type of carbohydrates on risk of coronary heart disease (CHD). Objective: The objective of this study was to prospectively evaluate the relations of the amount and type of carbohydrates with risk of CHD. Design: A cohort of 75 521 women aged 38-63 y with no previous diagnosis of diabetes mellitus, myocardial infarction, angina, stroke, or other cardiovascular diseases in 1984 was followed for 10 y. Each participant's dietary glycemi...
910 Citations Source Cite
Published on Nov 9, 2006in The New England Journal of Medicine 79.26
Thomas L. Halton4
Estimated H-index: 4
,
Barry M. Popkin317
Estimated H-index: 317
+ 4 AuthorsFrank B. Hu199
Estimated H-index: 199
(Harvard University)
Background Low-carbohydrate diets have been advocated for weight loss and to prevent obesity, but the long-term safety of these diets has not been determined. Methods We evaluated data on 82,802 women in the Nurses’ Health Study who had completed a validated food-frequency questionnaire. Data from the questionnaire were used to calculate a low-carbohydrate-diet score, which was based on the percentage of energy as carbohydrate, fat, and protein (a higher score reflects a higher intake of fat and...
316 Citations Source Cite
Published on Oct 1, 2014in JAMA Internal Medicine 19.99
Dong D. Wang18
Estimated H-index: 18
(Harvard University),
Cindy W. Leung17
Estimated H-index: 17
(University of California, San Francisco)
+ 4 AuthorsBarry M. Popkin317
Estimated H-index: 317
(Harvard University)
Importance Many changes in the economy, policies related to nutrition, and food processing have occurred within the United States since 2000, and the net effect on dietary quality is not clear. These changes may have affected various socioeconomic groups differentially. Objective To investigate trends in dietary quality from 1999 to 2010 in the US adult population and within socioeconomic subgroups. Design, Setting, and Participants Nationally representative sample of 29 124 adults aged 20 to 85...
140 Citations Source Cite
Published on May 1, 2011in American Journal of Preventive Medicine 4.13
Stephanie E. Chiuve43
Estimated H-index: 43
(Harvard University),
Laura Sampson34
Estimated H-index: 34
(Harvard University),
Barry M. Popkin317
Estimated H-index: 317
(Harvard University)
Background The Overall Nutritional Quality Index (ONQI) algorithm is a nutrient profiling scheme that incorporates more than 30 dietary components, and it aims to rank foods by relative healthfulness. Purpose To assess whether diets with a higher ONQI score predict lower risk of major chronic disease risk. Methods A total of 62,284 healthy women from the Nurses' Health Study and 42,382 healthy men from Health Professionals Follow-Up Study were followed from 1986 to 2006. Dietary data were collec...
100 Citations Source Cite
Published on Jul 1, 2014in The American Journal of Clinical Nutrition 6.55
Shilpa N Bhupathiraju22
Estimated H-index: 22
,
Deirdre K. Tobias22
Estimated H-index: 22
+ 5 AuthorsFrank B. Hu199
Estimated H-index: 199
Background: Epidemiologic evidence for the relation between carbohydrate quality and risk of type 2 diabetes (T2D) has been mixed. Objective: We prospectively examined the association of dietary glycemic index (GI) and glycemic load (GL) with T2D risk. Design: We prospectively followed 74,248 women from the Nurses’ Health Study (1984–2008), 90,411 women from the Nurses’ Health Study II (1991–2009), and 40,498 men from the Health Professionals FollowUp Study (1986–2008) who were free of diabetes,...
145 Citations Source Cite
Published on Mar 23, 2010in PLOS Medicine 11.68
Dariush Mozaffarian111
Estimated H-index: 111
(Harvard University),
Renata Micha35
Estimated H-index: 35
(Harvard University),
Sarah K. Wallace3
Estimated H-index: 3
(Harvard University)
Background: Reduced saturated fat (SFA) consumption is recommended to reduce coronary heart disease (CHD), but there is an absence of strong supporting evidence from randomized controlled trials (RCTs) of clinical CHD events and few guidelines focus on any specific replacement nutrient. Additionally, some public health groups recommend lowering or limiting polyunsaturated fat (PUFA) consumption, a major potential replacement for SFA. Methods and Findings: We systematically investigated and quant...
640 Citations Source Cite
Published on Mar 1, 1981in The American Journal of Clinical Nutrition 6.55
David J.A. Jenkins89
Estimated H-index: 89
(University of Toronto),
Thomas M. S. Wolever76
Estimated H-index: 76
+ 7 AuthorsDavidV Goff6
Estimated H-index: 6
To determine the effect of different foods on the blood glucose, 62 commonly eaten foods and sugars were fed individually to groups of 5 to 10 healthy fasting volunteers. Blood glucose levels were measured over 2 h. and expressed as a percentage of the area under the glucose response curve when the same amount of carbohydrate was taken as glucose. The largest rises were seen with vegetables (70 ± 5%). followed by breakfast cereals (65 ± 5%), cereals and biscuits (60 ± 3%), fruit (50 ± 5%), dairy...
2,408 Citations Source Cite
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  • Citations (132)
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Cited By132
Published on Mar 1, 2016in Progress in Cardiovascular Diseases 6.75
James J. DiNicolantonio19
Estimated H-index: 19
,
Sean C. Lucan17
Estimated H-index: 17
,
James H. O'Keefe49
Estimated H-index: 49
Dietary guidelines continue to recommend restricting intake of saturated fats. This recommendation follows largely from the observation that saturated fats can raise levels of total serum cholesterol (TC), thereby putatively increasing the risk of atherosclerotic coronary heart disease (CHD). However, TC is only modestly associated with CHD, and more important than the total level of cholesterol in the blood may be the number and size of low-density lipoprotein (LDL) particles that contain it. A...
56 Citations Source Cite
Published on Dec 1, 2015in The American Journal of Clinical Nutrition 6.55
Marta Guasch-Ferré19
Estimated H-index: 19
(Rovira i Virgili University),
Nancy Babio25
Estimated H-index: 25
(Rovira i Virgili University)
+ 15 AuthorsMiquel Fiol37
Estimated H-index: 37
(Instituto de Salud Carlos III)
Abstract 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 partic...
71 Citations Source Cite
Published on Oct 1, 2015in Journal of the American College of Cardiology 16.83
Robert A. Vogel46
Estimated H-index: 46
Evaluating drugs is easy; assessing the healthfulness of food is not. For drugs, we have a proscribed process: determine the dose; screen for toxicity; and then randomly give the drug or its placebo to enough subjects for a sufficient length of time to acquire statistically meaningful endpoints.
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Published on Feb 1, 2016in The American Journal of Clinical Nutrition 6.55
Jaike Praagman2
Estimated H-index: 2
(Utrecht University),
Joline W.J. Beulens46
Estimated H-index: 46
(Utrecht University)
+ 4 AuthorsY. T. van der Schouw84
Estimated H-index: 84
(Utrecht University)
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...
59 Citations Source Cite
Published on Feb 1, 2016in Journal of the American College of Cardiology 16.83
Valentin Fuster MDPhD159
Estimated H-index: 159
Each week, I record audio summaries for every article in JACC, as well as an issue summary. While this process has been time-consuming, I have become very familiar with every paper that we publish. Thus, I have personally selected the papers (both original investigations and review articles) from 13 distinct specialties for your review. In addition to my personal choices, I have included manuscripts that have been the most accessed or downloaded on our websites, as well as those selected by the ...
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Published on Aug 1, 2016in Journal of Internal Medicine 6.75
Ingar Holme37
Estimated H-index: 37
(Oslo University Hospital),
Kjetil Retterstøl19
Estimated H-index: 19
(University of Oslo)
+ 1 AuthorsIngvar Hjermann1
Estimated H-index: 1
(Oslo University Hospital)
Background The effects of saturated fat on atherosclerotic vascular disease are currently debated. Objectives In the Oslo cardiovascular study initiated in 1972/1973, a 5-year randomized intervention was conducted in healthy middle-aged men at high risk of coronary heart disease to compare the effects on coronary heart disease incidence of diet and antismoking advice versus control (no intervention). A significant reduction (47%) in first myocardial infarction incidence was observed. We have fol...
8 Citations Source Cite
Published on Jan 1, 2016in Lipid Technology
Adela Hruby18
Estimated H-index: 18
(Harvard University),
Frank B. Hu199
Estimated H-index: 199
(Harvard University)
In recent years, many nutrition news headlines exclaimed that saturated fat was not linked to heart disease, leaving the public confused about whether to limit intake, as has been the dietary recommendation for several decades. However, a more nuanced look at the evidence indicates that high saturated fat diets are in fact not benign with respect to heart disease risk. Dietary recommendations should emphasize replacing saturated fats typical in red and processed meats, and certain tropical oils ...
3 Citations Source Cite
Published on Apr 1, 2016in Gynakologe
Eine adaquate Ernahrung und ein gesunder Lebensstil konnen das Risiko fur Krebs und kardiovaskulare Erkrankungen wirksam beeinflussen. Epidemiologischen Daten zufolge bestehen bei Frauen mit der geringsten Adharenz im Hinblick auf Ernahrungs- und Lebensstilempfehlungen eine 3‑fach erhohte Krebsmortalitat und ein 4‑fach erhohtes Risiko fur kardiovaskularen Tod. Erwiesenermasen geht die Wirkung von Ernahrung und Lebensstil weit uber die Beeinflussung klassischer Risikofaktoren hinaus, beispielswei...
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Published on Jul 1, 2016in Canadian Journal of Cardiology 4.52
C. Johnson4
Estimated H-index: 4
(University of Ottawa),
Margot K. Davis6
Estimated H-index: 6
(University of British Columbia)
+ 1 AuthorsJeffrey Sulpher5
Estimated H-index: 5
(University of Ottawa)
Abstract The cardiovascular toxicity of cancer therapy has raised awareness of the importance of heart disease in cancer care among oncologists and cardiologists, leading to the new interdisciplinary field of cardio-oncology. Evidence is accumulating to suggest that risk factors associated with cardiovascular disease are also related to an increased incidence of cancer and excess cancer mortality. We review the epidemiologic evidence that smoking, obesity, poor diet, and inactivity can cause bot...
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Published on Aug 1, 2016in Current Opinion in Lipidology 3.85
Patty W. Siri-Tarino7
Estimated H-index: 7
,
Ronald M. Krauss107
Estimated H-index: 107
Modulation of diet is the primary lifestyle approach for reducing cardiovascular disease (CVD) risk, with a major focus of current guidelines being to lower LDL cholesterol by reducing intake of saturated fatty acids. However, dietary effects on lipid-related CVD risk factors extend beyond LDL cholesterol, with growing emphasis on the prevention and management of atherogenic dyslipidemia, which includes elevated triglyceride, small dense LDL, and reduced HDL cholesterol, and which is associated ...
10 Citations Source Cite