Match!

Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study

Published on Nov 1, 2017in The Lancet59.10
· DOI :10.1016/S0140-6736(17)32252-3
Mahshid Dehghan24
Estimated H-index: 24
(Population Health Research Institute),
Andrew Mente32
Estimated H-index: 32
(McMaster University)
+ 352 AuthorsR Mapanga4
Estimated H-index: 4
View in Source
Abstract
Summary Background The relationship between macronutrients and cardiovascular disease and mortality is controversial. Most available data are from European and North American populations where nutrition excess is more likely, so their applicability to other populations is unclear. Methods The Prospective Urban Rural Epidemiology (PURE) study is a large, epidemiological cohort study of individuals aged 35–70 years (enrolled between Jan 1, 2003, and March 31, 2013) in 18 countries with a median follow-up of 7·4 years (IQR 5·3–9·3). Dietary intake of 135 335 individuals was recorded using validated food frequency questionnaires. The primary outcomes were total mortality and major cardiovascular events (fatal cardiovascular disease, non-fatal myocardial infarction, stroke, and heart failure). Secondary outcomes were all myocardial infarctions, stroke, cardiovascular disease mortality, and non-cardiovascular disease mortality. Participants were categorised into quintiles of nutrient intake (carbohydrate, fats, and protein) based on percentage of energy provided by nutrients. We assessed the associations between consumption of carbohydrate, total fat, and each type of fat with cardiovascular disease and total mortality. We calculated hazard ratios (HRs) using a multivariable Cox frailty model with random intercepts to account for centre clustering. Findings During follow-up, we documented 5796 deaths and 4784 major cardiovascular disease events. Higher carbohydrate intake was associated with an increased risk of total mortality (highest [quintile 5] vs lowest quintile [quintile 1] category, HR 1·28 [95% CI 1·12–1·46], p trend =0·0001) but not with the risk of cardiovascular disease or cardiovascular disease mortality. Intake of total fat and each type of fat was associated with lower risk of total mortality (quintile 5 vs quintile 1, total fat: HR 0·77 [95% CI 0·67–0·87], p trend trend =0·0088; monounsaturated fat: HR 0·81 [0·71–0·92], p trend trend vs quintile 1, HR 0·79 [95% CI 0·64–0·98], p trend =0·0498). Total fat and saturated and unsaturated fats were not significantly associated with risk of myocardial infarction or cardiovascular disease mortality. Interpretation High carbohydrate intake was associated with higher risk of total mortality, whereas total fat and individual types of fat were related to lower total mortality. Total fat and types of fat were not associated with cardiovascular disease, myocardial infarction, or cardiovascular disease mortality, whereas saturated fat had an inverse association with stroke. Global dietary guidelines should be reconsidered in light of these findings. Funding Full funding sources listed at the end of the paper (see Acknowledgments).
  • References (55)
  • Citations (224)
References55
Newest
#1Steven Hamley (Deakin University)H-Index: 6
28 CitationsSource
#1Victoria Miller (Population Health Research Institute)H-Index: 2
#2Andrew Mente (Population Health Research Institute)H-Index: 32
Last.R MapangaH-Index: 4
view all 355 authors...
73 CitationsSource
#1Andrew Mente (McMaster University)H-Index: 32
#2Mahshid Dehghan (Population Health Research Institute)H-Index: 24
Last.R MapangaH-Index: 4
view all 423 authors...
53 CitationsSource
#1Edward YuH-Index: 9
#2Eric B. RimmH-Index: 169
Last.JoAnn E. MansonH-Index: 235
view all 9 authors...
25 CitationsSource
16 CitationsSource
#1Dong D. Wang (Harvard University)H-Index: 21
#2Yanping Li (Harvard University)H-Index: 48
Last.Frank B. Hu (Harvard University)H-Index: 205
view all 8 authors...
133 CitationsSource
#1Martin O'Donnell (National University of Ireland, Galway)H-Index: 54
#2Siu Lim Chin (Population Health Research Institute)H-Index: 3
Last.Salim Yusuf Mb Bs DPhil Frcpc (Population Health Research Institute)H-Index: 214
view all 46 authors...
336 CitationsSource
#1Christopher E. Ramsden (UNC: University of North Carolina at Chapel Hill)H-Index: 12
#2Daisy Zamora (UNC: University of North Carolina at Chapel Hill)H-Index: 12
Last.Joseph R. Hibbeln (NIH: National Institutes of Health)H-Index: 51
view all 10 authors...
130 CitationsSource
#1Indu Mani (St. John's Medical College)H-Index: 1
#2Anura V. Kurpad (St. John's Medical College)H-Index: 41
4 CitationsSource
#1Jaike Praagman (UU: Utrecht University)H-Index: 4
#2Joline W.J. Beulens (UU: Utrecht University)H-Index: 50
Last.Y. T. van der Schouw (UU: Utrecht University)H-Index: 88
view all 7 authors...
65 CitationsSource
Cited By224
Newest
#1Gidon Eshel (Bard College)H-Index: 8
#2Paul Stainier (Harvard University)
Last.Akshay Swaminathan (Harvard University)H-Index: 1
view all 4 authors...
Source
#1Yongjian Zhu (Zhengzhou University)H-Index: 1
#2Yacong Bo (Zhengzhou University)H-Index: 1
Last.Yanhua Liu (Zhengzhou University)H-Index: 1
view all 3 authors...
1 CitationsSource
#1Alessandra da Silva (UFV: Universidade Federal de Viçosa)H-Index: 3
#2Ana Paula Silva Caldas (UFV: Universidade Federal de Viçosa)H-Index: 4
Last.Josefina Bressan (UFV: Universidade Federal de Viçosa)H-Index: 26
view all 7 authors...
Source
#1Tilakavati Karupaiah (Taylors University)H-Index: 9
#2Khun-Aik Chuah (UKM: National University of Malaysia)H-Index: 1
Last.Kalyana SundramH-Index: 22
view all 7 authors...
Source
#1Donatella Verbanac (University of Zagreb)H-Index: 13
#2Zeljan Males (University of Zagreb)H-Index: 14
Last.Karmela Barišić (University of Zagreb)H-Index: 12
view all 3 authors...
Source
#1Fereidoun Azizi (Shahid Beheshti University of Medical Sciences and Health Services)H-Index: 66
#2Farzad Hadaegh (Shahid Beheshti University of Medical Sciences and Health Services)H-Index: 30
Last.Davood Khalili (Shahid Beheshti University of Medical Sciences and Health Services)H-Index: 21
view all 12 authors...
Source
#1Massimiliano Caprio (OU: Open University)H-Index: 25
#2Marco Infante (University of Rome Tor Vergata)H-Index: 2
Last.Andrea Lenzi (Sapienza University of Rome)H-Index: 57
view all 36 authors...
2 CitationsSource
#1Nadine WellingtonH-Index: 1
Last.Philip Britz-McKibbinH-Index: 26
view all 11 authors...
1 CitationsSource
Source
#1Frank Qian (Harvard University)H-Index: 8
#2Gang Liu (Harvard University)H-Index: 18
Last.Qi Sun (Harvard University)H-Index: 62
view all 5 authors...
1 CitationsSource