Dietary Fatty Acids, Macronutrient Substitutions, Food Sources and Incidence of Coronary Heart Disease: Findings From the EPIC-CVD Case-Cohort Study Across Nine European Countries
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Coronary heart diseaseDietary guidelinesNutritional epidemiologyPrimary preventionSaturated fat
Steur, M... [et al.] (2021). Dietary Fatty Acids, Macronutrient Substitutions, Food Sources and Incidence of Coronary Heart Disease: Findings From the EPIC‐CVD Case‐Cohort Study Across Nine European Countries. Journal of the American Heart Association, 10(23), e019814. DOI: [10.1161/JAHA.120.019814]
SponsorshipEuropean Commission Framework Programme 7 HEALTH-F2-2012-279233; European Research Council (ERC); European Commission 268834; UK Research & Innovation (UKRI); Medical Research Council UK (MRC) G0800270 MR/L003120/1; British Heart Foundation SP/09/002 RG13/13/30194 RG/18/13/33946; National Institute for Health Research (NIHR) BRC-1215-20014; European Commission LSHM_CT_ 2006_037197; UK Research & Innovation (UKRI); Medical Research Council UK (MRC) MC_UU_ 00006/1 MC_UU_00006/3; International Agency for Research on Cancer; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London; Danish Cancer Society; Ligue Contre le Cancer, Institut Gustave Roussy, Mutuelle Generale de l'Education Nationale, Institut National de la Sante et de la Recherche Medicale (France); German Cancer Aid, German Cancer Research Center, German Institute of Human Nutrition Potsdam-; Rehbruecke, Federal Ministry of Education and Research (Germany); Fondazione AIRC per la ricerca sul cancro; Compagnia di San Paolo; Dutch Ministry of Public Health, Welfare and Sports; Netherlands Cancer Registry; LK Research Funds; Dutch Prevention Funds; Zorg Onderzoek Nederland; World Cancer Research Fund International (WCRF); Netherlands Government; Instituto de Salud Carlos III; Junta de Andalucia; Regional Government of Asturias; Basque Government; Regional Government of Murcia; Regional Government of Navarra; Catalan Institute of Oncology (Spain); Swedish Cancer Society; County Council of Skane (Sweden); County Council of Vasterbotten (Sweden); Cancer Research UK 14136 C8221/A29017; UK Research & Innovation (UKRI); Medical Research Council UK (MRC) 1000143 MR/M012190/1; Hellenic Health Foundation (Greece); NIHR* Cambridge BRC: Nutrition, Diet, and Lifestyle Research Theme IS-BRC-1215-20014; British Heart Foundation; Institute of Health Carlos III (European Social Fund-European Social Fund Investing in Your Future) CP15/00100; BHF-Turing Cardiovascular Data Science Award; European Commission-Innovative Medicines Initiative (BigData@Heart); MRC-Newton project grant MR/P013880/1; United Kingdom Research and Innovation-Global Challenges Research Fund; NIHR Senior Investigator Award
BACKGROUND: There is controversy about associations between total dietary fatty acids, their classes (saturated fatty acids [SFAs], monounsaturated fatty acids, and polyunsaturated fatty acids), and risk of coronary heart disease (CHD). Specifically, the relevance of food sources of SFAs to CHD associations is uncertain. METHODS AND RESULTS: We conducted a case-cohort study involving 10 529 incident CHD cases and a random subcohort of 16 730 adults selected from a cohort of 385 747 participants in 9 countries of the EPIC (European Prospective Investigation into Cancer and Nutrition) study. We estimated multivariable adjusted country-specific hazard ratios (HRs) and 95% CIs per 5% of energy intake from dietary fatty acids, with and without isocaloric macronutrient substitutions, using Prentice-weighted Cox regression models and pooled results using random-effects meta-analysis. We found no evidence for associations of the consumption of total or fatty acid classes with CHD, regardless of macronutrient substitutions. In analyses considering food sources, CHD incidence was lower per 1% higher energy intake of SFAs from yogurt (HR, 0.93 [95% CI, 0.88–0.99]), cheese (HR, 0.98 [95% CI, 0.96–1.00]), and fish (HR, 0.87 [95% CI, 0.75–1.00]), but higher for SFAs from red meat (HR, 1.07 [95% CI, 1.02–1.12]) and butter (HR, 1.02 [95% CI, 1.00–1.04]). CONCLUSIONS: This observational study found no strong associations of total fatty acids, SFAs, monounsaturated fatty acids, and polyunsaturated fatty acids, with incident CHD. By contrast, we found associations of SFAs with CHD in opposite directions dependent on the food source. These findings should be further confirmed, but support public health recommendations to consider food sources alongside the macronutrients they contain, and suggest the importance of the overall food matrix.