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Major types of dietary fat and risk of coronary heart disease: a pooled analysis of 11 cohort studies
Aarhus Univ Hosp, Dept Clin Epidemiol, DK-9000 Aalborg, Denmark.;Copenhagen Univ Hosp, Ctr Hlth & Soc, Res Unit Dietary Studies, Inst Prevent Med, Copenhagen, Denmark.;Glostrup Univ Hosp, Res Ctr Prevent & Hlth, Glostrup, Denmark.;Aarhus Univ Hosp, Cardiovasc Res Ctr, Aalborg Hosp, DK-9000 Aalborg, Denmark..
Harvard Univ, Sch Publ Hlth, Dept Nutr, Boston, MA 02115 USA.;Harvard Univ, Sch Publ Hlth, Dept Epidemiol, Boston, MA 02115 USA..
Copenhagen Univ Hosp, Ctr Hlth & Soc, Res Unit Dietary Studies, Inst Prevent Med, Copenhagen, Denmark..
Univ Minnesota, Sch Publ Hlth, Div Epidemiol & Community Hlth, Minneapolis, MN USA..
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2009 (English)In: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 89, no 5, p. 1425-1432Article in journal (Refereed) Published
Abstract [en]

Background: Saturated fatty acid (SFA) intake increases plasma LDL-cholesterol concentrations; therefore, intake should be reduced to prevent coronary heart disease (CHD). Lower habitual intakes of SFAs, however, require substitution of other macronutrients to maintain energy balance. Objective: We investigated associations between energy intake from monounsaturated fatty acids (MUFAs), polyunsaturated fatty acids (PUFAs), and carbohydrates and risk of CHD while assessing the potential effect-modifying role of sex and age. Using substitution models, our aim was to clarify whether energy from unsaturated fatty acids or carbohydrates should replace energy from SFAs to prevent CHD. Design: This was a follow-up study in which data from 11 American and European cohort studies were pooled. The outcome measure was incident CHD. Results: During 4-10 y of follow-up, 5249 coronary events and 2155 coronary deaths occurred among 344,696 persons. For a 5% lower energy intake from SFAs and a concomitant higher energy intake from PUFAs, there was a significant inverse association between PUFAs and risk of coronary events (hazard ratio: 0.87; 95% CI: 0.77, 0.97); the hazard ratio for coronary deaths was 0.74 (95% CI: 0.61, 0.89). For a 5% lower energy intake from SFAs and a concomitant higher energy intake from carbohydrates, there was a modest significant direct association between carbohydrates and coronary events (hazard ratio: 1.07; 95% CI: 1.01, 1.14); the hazard ratio for coronary deaths was 0.96 (95% CI: 0.82, 1.13). MUFA intake was not associated with CHD. No effect modification by sex or age was found. Conclusion: The associations suggest that replacing SFAs with PUFAs rather than MUFAs or carbohydrates prevents CHD over a wide range of intakes. Am J Clin Nutr 2009;89:1425-32.

Place, publisher, year, edition, pages
AMER SOC CLINICAL NUTRITION , 2009. Vol. 89, no 5, p. 1425-1432
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URN: urn:nbn:se:mdh:diva-40702DOI: 10.3945/ajcn.2008.27124ISI: 000265394300021PubMedID: 19211817OAI: oai:DiVA.org:mdh-40702DiVA, id: diva2:1246089
Available from: 2018-09-06 Created: 2018-09-06 Last updated: 2018-09-06Bibliographically approved

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