Association of dietary nutrients with blood lipids and blood pressure in 18 countries: a cross-sectional analysis from the PURE study

Published on Oct 1, 2017in The Lancet Diabetes & Endocrinology24.54
· DOI :10.1016/S2213-8587(17)30283-8
Andrew Mente30
Estimated H-index: 30
(McMaster University),
Mahshid Dehghan22
Estimated H-index: 22
(Population Health Research Institute)
+ 420 AuthorsR Mapanga4
Estimated H-index: 4
Summary Background The relation between dietary nutrients and cardiovascular disease risk markers in many regions worldwide is unknown. In this study, we investigated the effect of dietary nutrients on blood lipids and blood pressure, two of the most important risk factors for cardiovascular disease, in low-income, middle-income, and high-income countries. Methods We studied 125 287 participants from 18 countries in North America, South America, Europe, Africa, and Asia in the Prospective Urban Rural Epidemiology (PURE) study. Habitual food intake was measured with validated food frequency questionnaires. We assessed the associations between nutrients (total fats, saturated fatty acids, monounsaturated fatty acids, polyunsaturated fatty acids, carbohydrates, protein, and dietary cholesterol) and cardiovascular disease risk markers using multilevel modelling. The effect of isocaloric replacement of saturated fatty acids with other fats and carbohydrates was determined overall and by levels of intakes by use of nutrient density models. We did simulation modelling in which we assumed that the effects of saturated fatty acids on cardiovascular disease events was solely related to their association through an individual risk marker, and then compared these simulated risk marker-based estimates with directly observed associations of saturated fatty acids with cardiovascular disease events. Findings Participants were enrolled into the study from Jan 1, 2003, to March 31, 2013. Intake of total fat and each type of fat was associated with higher concentrations of total cholesterol and LDL cholesterol, but also with higher HDL cholesterol and apolipoprotein A1 (ApoA1), and lower triglycerides, ratio of total cholesterol to HDL cholesterol, ratio of triglycerides to HDL cholesterol, and ratio of apolipoprotein B (ApoB) to ApoA1 (all p trend trend trend =0·0014]). Higher intakes of total fat, saturated fatty acids, and carbohydrates were associated with higher blood pressure, whereas higher protein intake was associated with lower blood pressure. Replacement of saturated fatty acids with carbohydrates was associated with the most adverse effects on lipids, whereas replacement of saturated fatty acids with unsaturated fats improved some risk markers (LDL cholesterol and blood pressure), but seemed to worsen others (HDL cholesterol and triglycerides). The observed associations between saturated fatty acids and cardiovascular disease events were approximated by the simulated associations mediated through the effects on the ApoB-to-ApoA1 ratio, but not with other lipid markers including LDL cholesterol. Interpretation Our data are at odds with current recommendations to reduce total fat and saturated fats. Reducing saturated fatty acid intake and replacing it with carbohydrate has an adverse effect on blood lipids. Substituting saturated fatty acids with unsaturated fats might improve some risk markers, but might worsen others. Simulations suggest that ApoB-to-ApoA1 ratio probably provides the best overall indication of the effect of saturated fatty acids on cardiovascular disease risk among the markers tested. Focusing on a single lipid marker such as LDL cholesterol alone does not capture the net clinical effects of nutrients on cardiovascular risk. Funding Full funding sources listed at the end of the paper (see Acknowledgments).
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Published on Nov 1, 2017in The Lancet59.10
Mahshid Dehghan22
Estimated H-index: 22
(Population Health Research Institute),
Andrew Mente30
Estimated H-index: 30
(McMaster University)
+ 352 AuthorsAnders H. Rosengren84
Estimated H-index: 84
(University of Gothenburg)
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 fo...
Published on Aug 1, 2016in The Lancet59.10
Martin O'Donnell50
Estimated H-index: 50
(National University of Ireland, Galway),
Siu Lim Chin3
Estimated H-index: 3
(Population Health Research Institute)
+ 43 AuthorsSteven Agapay1
Estimated H-index: 1
(Population Health Research Institute)
Summary Background Stroke is a leading cause of death and disability, especially in low-income and middle-income countries. We sought to quantify the importance of potentially modifiable risk factors for stroke in different regions of the world, and in key populations and primary pathological subtypes of stroke. Methods We completed a standardised international case-control study in 32 countries in Asia, America, Europe, Australia, the Middle East, and Africa. Cases were patients with acute firs...
Published on Apr 12, 2016in BMJ27.60
Christopher E. Ramsden16
Estimated H-index: 16
(UNC: University of North Carolina at Chapel Hill),
Daisy Zamora11
Estimated H-index: 11
(UNC: University of North Carolina at Chapel Hill)
+ 7 AuthorsJoseph R. Hibbeln46
Estimated H-index: 46
(NIH: National Institutes of Health)
Objective To examine the traditional diet-heart hypothesis through recovery and analysis of previously unpublished data from the Minnesota Coronary Experiment (MCE) and to put findings in the context of existing diet-heart randomized controlled trials through a systematic review and meta-analysis. Design The MCE (1968-73) is a double blind randomized controlled trial designed to test whether replacement of saturated fat with vegetable oil rich in linoleic acid reduces coronary heart disease and ...
Published on Oct 20, 2015in PLOS ONE2.78
Jonathan Sackner-Bernstein19
Estimated H-index: 19
(Hastings Entertainment),
David Kanter1
Estimated H-index: 1
(Georgetown University Law Center),
Sanjay Kaul59
Estimated H-index: 59
(Cedars-Sinai Medical Center)
Background Reduced calorie, low fat diet is currently recommended diet for overweight and obese adults. Prior data suggest that low carbohydrate diets may also be a viable option for those who are overweight and obese. Purpose Compare the effects of low carbohydrate versus low fats diet on weight and atherosclerotic cardiovascular disease risk in overweight and obese patients. Data Sources Systematic literature review via PubMed (1966–2014). Study Selection Randomized controlled trials with ≥8 w...
Published on Aug 28, 2014in The New England Journal of Medicine70.67
Abstr Act85
Estimated H-index: 85
(Population Health Research Institute),
Salim Yusuf Mb Bs DPhil Frcpc209
Estimated H-index: 209
(Population Health Research Institute)
+ 37 AuthorsF. Lu1
Estimated H-index: 1
The mean INTERHEART Risk Score was highest in high-income countries, intermediate in middle-income countries, and lowest in low-income countries (P<0.001). However, the rates of major cardiovascular events (death from cardiovascular causes, myocardial infarction, stroke, or heart failure) were lower in high-income countries than in middle- and low-income countries (3.99 events per 1000 personyears vs. 5.38 and 6.43 events per 1000 person-years, respectively; P<0.001). Case fatality rates were al...
Published on Aug 14, 2014in The New England Journal of Medicine70.67
Andrew Mente30
Estimated H-index: 30
Sumathy Rangarajan34
Estimated H-index: 34
+ 25 AuthorsPrem Mony14
Estimated H-index: 14
Methods We studied 102,216 adults from 18 countries. Estimates of 24-hour sodium and potassium excretion were made from a single fasting morning urine specimen and were used as surrogates for intake. We assessed the relationship between electrolyte excretion and blood pressure, as measured with an automated device. Results Regression analyses showed increments of 2.11 mm Hg in systolic blood pressure and 0.78 mm Hg in diastolic blood pressure for each 1-g increment in estimated sodium excretion....
Published on Jun 24, 2014in Circulation23.05
Robert H. Eckel96
Estimated H-index: 96
John M. Jakicic66
Estimated H-index: 66
+ 13 AuthorsSidney C. Smith Mdfacc157
Estimated H-index: 157
Preamble and Transition to ACC/AHA Guidelines to The goals of the American College of Cardiology (ACC) and the American Heart Association (AHA) are to prevent cardiovascular diseases (CVDs); improve the management …
Published on May 1, 2014in American Journal of Cardiology2.84
Aaqib H. Malik1
Estimated H-index: 1
(Yale University),
Yasir Akram2
Estimated H-index: 2
+ 2 AuthorsValentine Yanchou Njike24
Estimated H-index: 24
(Yale University)
The impact of sugar-sweetened beverages (SSBs) on blood pressure (BP) has been debated, with some evidence suggesting that their increased intake is related to higher risk of developing hypertension. We conducted a systematic review exploring the relation between consumption of SSB and BP. A comprehensive search in 5 electronic databases along with a bibliography search was performed. The keywords "sugar sweetened beverages," "sugary drinks," "added sugars," "blood pressure," and "hypertension" ...
Published on Dec 1, 2013in Journal of the Academy of Nutrition and Dietetics4.14
Lukas Schwingshackl30
Estimated H-index: 30
Georg F. Hoffmann63
Estimated H-index: 63
Abstract Dietary fat plays an important role in the primary prevention of cardiovascular disease, but long-term (≥12 months) effects of different percentages of fat in the diet on blood lipid levels remain to be established. Our systematic review and meta-analysis focused on randomized controlled trials assessing the long-term effects of low-fat diets compared with diets with high amounts of fat on blood lipid levels. Relevant randomized controlled trials were identified searching MEDLINE, EMBAS...
Cited By35
Published on May 29, 2019in Current Nutrition Reports
Stephanie Byun (Columbia University), Zara Mayat (Columbia University)+ 2 AuthorsNour Makarem6
Estimated H-index: 6
(Columbia University)
Purpose of Review This review discusses recent evidence on the association of dietary carbohydrates (quantity, quality, and timing of intake) with hypertension (HTN) risk and out-of-clinic blood pressure (BP) measures.
Published on Jul 23, 2018in European Journal of Nutrition4.45
Georgios Georgiopoulos13
Estimated H-index: 13
(UoA: National and Kapodistrian University of Athens),
Kalliopi Karatzi16
Estimated H-index: 16
(HUA: Harokopio University)
+ 8 AuthorsChristos Papamichael44
Estimated H-index: 44
(UoA: National and Kapodistrian University of Athens)
Purpose There is limited and inconsistent evidence regarding longitudinal effects of macronutrients on blood pressure (BP) haemodynamics and arterial aging in populations without cardiovascular disease (CVD). We aimed to prospectively investigate potential association of dietary macronutrients with long-term changes in peripheral and central haemodynamics and arterial stiffness.
Published in Frontiers in Physiology3.20
Christelle Le Foll13
Estimated H-index: 13
(UZH: University of Zurich)
The obesity and type-2 diabetes epidemic is escalating and represents one of the costliest biomedical challenges confronting modern society. Moreover, the increasing consumption of high fat food is often correlated with an increase in body mass index. In people predisposed to be obese or already obese, the impaired ability of the brain to monitor and respond to alterations in fatty acid (FA) metabolism is increasingly recognized as playing a role in the pathophysiological development of these di...
Published in Nutrients4.17
Keiko Mizobuchi , Kentaro Jujo11
Estimated H-index: 11
+ -3 AuthorsNobuhisa Hagiwara31
Estimated H-index: 31
Introduction: Peripheral artery disease (PAD) occurs at an advanced stage of atherosclerosis and its comorbidities are associated with poor prognoses. Malnutrition is related to the severity of atherosclerosis in patients with cardiovascular disease and it predicts mortality. The Controlling Nutritional Status (CONUT) score is calculated from serum albumin concentration, peripheral lymphocyte count and total cholesterol concentration, and it robustly represents the nutritional status of hospital...
Published on Jul 3, 2019in BMJ27.60
A. Astrup92
Estimated H-index: 92
(UCPH: University of Copenhagen),
Hanne Cs Bertram (AU: Aarhus University)+ 15 AuthorsRonald M. Krauss108
Estimated H-index: 108
(Children's Hospital Oakland Research Institute)
The 2018 WHO draft guidance on fatty acids fails to consider the importance of the food matrix, argue Arne Astrup and colleagues
Published on Jun 21, 2019in European Journal of Clinical Nutrition3.11
Welma Stonehouse16
Estimated H-index: 16
Bianca Benassi-Evans + 1 AuthorsMahinda Y. Abeywardena33
Estimated H-index: 33
Hypercholesterolaemic effects of saturated fatty acids (SFA) may be influenced not only by the chain length, but also by their specific location within the triacylglycerol (TAG) molecule. We examined the hypothesis that dietary fats rich in SFA, but containing mostly unsaturated fatty acids in the sn-2 position with most SFA in sn-1 and -3 (palm olein [PO] and cocoa butter [CB]) will have similar serum lipid outcomes to unsaturated olive oil (OO). Thirty-eight participants (20–40 yr, 18.5– ≤ 27....
Published on Jun 4, 2019in Journal of Clinical Medicine
Ki Heon Nam5
Estimated H-index: 5
Seong Yeong An5
Estimated H-index: 5
+ 7 AuthorsJung Tak Park24
Estimated H-index: 24
Despite the potential relationship with metabolic derangements, the association between dietary carbohydrate intake and renal function remains unknown. The present study investigated the impact of dietary carbohydrate intake on the development of incident chronic kidney disease (CKD) in a large-scale prospective cohort with normal renal function. A total of 6746 and 1058 subjects without and with diabetes mellitus (DM) were analyzed, respectively. Carbohydrate intake was assessed by a 24-h dieta...
Published on Jun 1, 2019in International Journal of Cardiology3.47
Paul A. Camacho11
Estimated H-index: 11
(UNAB: Autonomous University of Bucaramanga),
Johanna Otero2
Estimated H-index: 2
+ 16 AuthorsCarlos Cure2
Estimated H-index: 2
(Universidad del Norte, Colombia)
Abstract Background Dyslipidemia is a major risk factor for cardiovascular diseases (CVD). Worldwide, a third of ischemic heart disease is due to abnormal cholesterol levels and it is the most common cause of cardiovascular deaths in Colombia. In Colombia, no representative, large-scale study has assessed the prevalence of dyslipidemia. The aim of the present analysis was to identify the magnitude of the problem in Colombia, a middle-income-country with large regional, geographic, and socio-econ...
Published on May 3, 2019in Journal of Periodontology2.77
Dayana Dias Mendonça , Mariana Vargas Furtado8
Estimated H-index: 8
(UFRGS: Universidade Federal do Rio Grande do Sul)
+ 6 AuthorsAlex Nogueira Haas17
Estimated H-index: 17