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Cited by 439Nutritional Studies and DietFatty Acid Research and HealthNuts composition and effects

Association of Specific Dietary Fats With Total and Cause-Specific Mortality

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Wang, Dong D., Li, Yanping, Chiuve, Stephanie E., Stampfer, Meir J., Manson, JoAnn E., Rimm, Eric B., Willett, Walter C., Hu, Frank B.·2016·JAMA Internal Medicine
DOI 10.1001/jamainternmed.2016.2417PMC PMC5123772
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Abstract

IMPORTANCE: Previous studies have shown distinct associations between specific dietary fat and cardiovascular disease. However, evidence on specific dietary fat and mortality remains limited and inconsistent. OBJECTIVE: To examine the associations of specific dietary fats with total and cause-specific mortality in 2 large ongoing cohort studies. DESIGN, SETTING, AND PARTICIPANTS: This cohort study investigated 83 349 women from the Nurses' Health Study (July 1, 1980, to June 30, 2012) and 42 884 men from the Health Professionals Follow-up Study (February 1, 1986, to January 31, 2012) who were free of cardiovascular disease, cancer, and types 1 and 2 diabetes at baseline. Dietary fat intake was assessed at baseline and updated every 2 to 4 years. Information on mortality was obtained from systematic searches of the vital records of states and the National Death Index, supplemented by reports from family members or postal authorities. Data were analyzed from September 18, 2014, to March 27, 2016. MAIN OUTCOMES AND MEASURES: Total and cause-specific mortality. RESULTS: During 3 439 954 person-years of follow-up, 33 304 deaths were documented. After adjustment for known and suspected risk factors, dietary total fat compared with total carbohydrates was inversely associated with total mortality (hazard ratio [HR] comparing extreme quintiles, 0.84; 95% CI, 0.81-0.88; P < .001 for trend). The HRs of total mortality comparing extreme quintiles of specific dietary fats were 1.08 (95% CI, 1.03-1.14) for saturated fat, 0.81 (95% CI, 0.78-0.84) for polyunsaturated fatty acid (PUFA), 0.89 (95% CI, 0.84-0.94) for monounsaturated fatty acid (MUFA), and 1.13 (95% CI, 1.07-1.18) for trans-fat (P < .001 for trend for all). Replacing 5% of energy from saturated fats with equivalent energy from PUFA and MUFA was associated with estimated reductions in total mortality of 27% (HR, 0.73; 95% CI, 0.70-0.77) and 13% (HR, 0.87; 95% CI, 0.82-0.93), respectively. The HR for total mortality comparing extreme quintiles of ω-6 PUFA intake was 0.85 (95% CI, 0.81-0.89; P < .001 for trend). Intake of ω-6 PUFA, especially linoleic acid, was inversely associated with mortality owing to most major causes, whereas marine ω-3 PUFA intake was associated with a modestly lower total mortality (HR comparing extreme quintiles, 0.96; 95% CI, 0.93-1.00; P = .002 for trend). CONCLUSIONS AND RELEVANCE: Different types of dietary fats have divergent associations with total and cause-specific mortality. These findings support current dietary recommendations to replace saturated fat and trans-fat with unsaturated fats.

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  • The recommendation to limit dietary saturated fat intake is primarily drawn from observational studies rather than randomized controlled trials of cardiovascular disease prevention.

    “The recommendation to limit dietary saturated fat intake is primarily drawn from observational studies rather than randomized controlled trials of cardiovascular disease prevention.”

    From Saturated Fat Restriction for Cardiovascular Disease Prevention: A Systematic Review and Meta-analysis of Randomized Controlled Trials (2025) · cites this paper as [5]

    The Introduction says replacing saturated fat with unsaturated fat is widely recommended, and the Discussion identifies this study as observational. Neither passage says the recommendation is drawn primarily from observational studies rather than randomized cardiovascular-prevention trials; the Discussion also notes consistency with randomized trials on diet and CVD-related outcomes. (LLM, conf=0.84)

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  • One observational study showed a positive correlation between SFA intake and all-cause mortality.

    “One study showed a positive correlation between SFA intake and all-cause mortality (5), but the other did not reveal such an association (6).”

    From Saturated Fat Restriction for Cardiovascular Disease Prevention: A Systematic Review and Meta-analysis of Randomized Controlled Trials (2025) · cites this paper as [5]

  • The American College of Cardiology/American Heart Association guideline recommended SFA restriction on the basis of 2 observational studies.

    “On the basis of 2 observational studies (5), (6), the American College of Cardiology/American Heart Association (AHA) guideline (7) recommended SFA restriction.”

    From Saturated Fat Restriction for Cardiovascular Disease Prevention: A Systematic Review and Meta-analysis of Randomized Controlled Trials (2025) · cites this paper as [5]

    The Discussion supports replacing saturated fats with unsaturated fats as a dietary recommendation, but it does not discuss the American College of Cardiology/American Heart Association guideline or what evidence that guideline relied on. Searches for the guideline and for a basis of two observational studies found no passage addressing the claim. (LLM, conf=0.74)

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Authors
Wang, D. D., Li, Y., Chiuve, S. E., Stampfer, M. J., Manson, J. E., Rimm, E. B., Willett, W. C., & Hu, F. B.
Affiliations
  • Harvard University (US)
  • Brigham and Women's Hospital (US)
Corresponding author
Hu, Frank B.
ORCID
Venue
JAMA Internal Medicine
Publisher
American Medical Association (AMA)
Published
2016-08-01
Volume
176
Issue
8
Pages
1134
ISSN
2168-6106 (ISSN-L)
DOI
10.1001/jamainternmed.2016.2417
PMC
PMC5123772
OpenAlex
W2470745271
Cited by
439
References
57
Citations by year
2026: 19 · 2025: 30 · 2024: 33 · 2023: 34 · 2022: 39 · 2021: 54 · 2020: 46 · 2019: 53 · 2018: 69 · 2017: 38 · 2016: 21
FWCI
59.83
Type
journal article
Language
en
Open access
Locations
  • JAMA Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
Funders
  • California Walnut Commission
  • National Institutes of Health (DK46200, UM1-CA167552, CA-167552, CA186107, CA 87969)
  • National Heart, Lung, and Blood Institute (R01HL060712, R01HL035464, R01HL034594, R01HL088521)
  • National Cancer Institute (P01CA087969, UM1CA186107, UM1CA167552)
  • National Institute of Diabetes and Digestive and Kidney Diseases (P30DK046200)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
  • Health Sciences › Nursing › Nutrition and Dietetics › Fatty Acid Research and Health
  • Health Sciences › Nursing › Nutrition and Dietetics › Nuts composition and effects
Keywords
dietary fat, all-cause mortality, cause-specific mortality, saturated fat, polyunsaturated fatty acids, monounsaturated fatty acids, trans fatty acids, fat replacement, cardiovascular disease, cancer mortality, cardiovascular mortality, Nurses' Health Study, Health Professionals Follow-up Study, dietary assessment, men, cohort studies, mortality risk factors
MeSH terms
Adult, Aged, Cardiovascular Diseases, Cause of Death, Dietary Fats, Dietary Fats, Unsaturated, Female, Follow-Up Studies, Food Preferences, Humans, Male, Middle Aged, Myocardial Infarction, Cohort Studies, Fast Foods, Food, Preserved

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