Dietary saturated fats and their food sources in relation to the risk of coronary heart disease in women
Open accessAbstract
Background Metabolic studies suggest that saturated fatty acids differ in their effects on blood lipids.Objective The objective was to examine the associations between intakes of individual saturated fatty acids and their food sources in relation to the risk of coronary heart disease (CHD).Design This was a prospective cohort study of 80082 women in the Nurses' Health Study aged 34-59 y. Subjects had no known cardiovascular disease, cancer, hypercholesterolemia, or diabetes, and completed validated food-frequency questionnaires in 1980.Results During 14 y of follow-up, we documented 939 incident cases of major CHD events. In multivariate analyses in which age, smoking, and other covariates were controlled for, intakes of short- to medium-chain saturated fatty acids (4:0-10:0) were not significantly associated with the risk of CHD. In contrast, intakes of longer-chain saturated fatty acids (12:0-18:0) were each separately associated with a small increase in risk. The multivariate RR for a 1% energy increase from stearic acid was 1.19 (95% CI: 1.02, 1.37). The ratio of polyunsaturated to saturated fat was strongly and inversely associated with CHD risk (multivariate RR for a comparison of the highest with the lowest deciles: 0.58; 95% CI: 0.41, 0.83; P for trend < 0.0001). Conversely, higher ratios of red meat to poultry and fish consumption and of high-fat to low-fat dairy consumption were associated with significantly greater risk.Conclusion A distinction between stearic acid and other saturated fats does not appear to be important in dietary advice to reduce CHD risk, in part because of the high correlation between stearic acid and other saturated fatty acids in typical diets.
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The effect of a saturated fat on CHD may depend on the type of fatty acid and the specific food source (dairy vs meat).
“Emerging evidence suggests that the effect of a saturated fat on CHD may depend on the type of fatty acid and the specific food source (i.e., dairy vs. meat) (160,161).”
From Food Consumption and its Impact on Cardiovascular Disease: Importance of Solutions Focused on the Globalized Food System (2015) · cites this paper as [161]
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“Fat is made up of different types of fatty acids: saturated fatty acids (SFAs), monounsaturated fatty acids (MUFAs) and polyunsaturated fatty acids (PUFAs).”
BackgroundInfluentialSoda consumption and the risk of stroke in men and women
Bernstein, A. M., de Koning, L., Flint, A. J., Rexrode, K. M., & Willett, W. C. (2012) · The American Journal of Clinical Nutrition · doi:10.3945/ajcn.111.030205 · Cited by 189 · see citing works
Self-citationTorres‐Moreno, M., Torrescasana, E., Salas‐Salvadó, J., & Blanch, C. (2014) · Food Chemistry · doi:10.1016/j.foodchem.2014.05.141 · Cited by 188 · see citing works
“…data have shown that fatty acids profile in food has a direct impact on 87 human health (Hu, Stampfer, Manson, Ascherio, Colditz, Speizer, Hennekens and 88 Willett, 1999; López-Huertas, 2009; Solfrizzi, D’Introno, Colaccio, Capurso, Palasciano, 89 Capurso, Torres, Capurso and Panza, 2005).”
BackgroundPoudyal, H., Panchal, S. K., Waanders, J., Ward, L. C., & Brown, L. (2011) · The Journal of Nutritional Biochemistry · doi:10.1016/j.jnutbio.2010.11.011 · Cited by 187 · see citing works
“The cardiovascular health study [16]; The Nurses' Health study [17,18]; the National Heart, Lung, and Blood Institute Family Heart Study [19] and the Health Professionals Study [20] concluded that higher ALA intake was associated with a reduced risk of coronary heart disease and related mortalities.”
BackgroundDairy fat and risk of cardiovascular disease in 3 cohorts of US adults
Chen, M., Li, Y., Sun, Q., Pan, A., Manson, J. E., Rexrode, K. M., Willett, W. C., Rimm, E. B., & Hu, F. B. (2016) · The American Journal of Clinical Nutrition · doi:10.3945/ajcn.116.134460 · Cited by 182 · see citing works
Variation in Fatty Acid Contents of Milk and Milk Fat Within and Across Breeds
Soyeurt, H., Dardenne, P., Gillon, A., Croquet, C., Vanderick, S., Mayeres, P., Bertozzi, C., & Gengler, N. (2006) · Journal of Dairy Science · doi:10.3168/jds.s0022-0302(06)72534-6 · Cited by 185 · see citing works
“In the case of SAT, although myristic acid is known for its negative effect on cardiovascular diseases, stearic acid does not seem to have this effect (Hu et al., 1999).”
BackgroundDietary Fats and Health: Dietary Recommendations in the Context of Scientific Evidence
Lawrence, G. D. (2013) · Advances in Nutrition · doi:10.3945/an.113.003657 · Cited by 174 · see citing works
“Although prospective cohort studies often find a significant reduction in the incidence of CAD with a larger ratio of PUFAs to SFAs in the diet (114), there are often many other factors related to overall health that correlate with the unsaturated to SFA ratio, such as exercise, a healthier lifestyle, and more fiber a…”
BackgroundGoldbohm, R. A., Chorus, A. M. J., Garre, F. G., Schouten, L. J., & van den Brandt, P. A. (2011) · American Journal of Clinical Nutrition · doi:10.3945/ajcn.110.000430 · Cited by 173 · see citing works
Plasma and erythrocyte biomarkers of dairy fat intake and risk of ischemic heart disease
Sun, Q., Ma, J., Campos, H., & Hu, F. B. (2007) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/86.4.929 · Cited by 171 · see citing works
Praagman, J., Beulens, J. W. J., Alssema, M., Zock, P. L., Wanders, A. J., Sluijs, I., & van der Schouw, Y. T. (2016) · American Journal of Clinical Nutrition · doi:10.3945/ajcn.115.122671 · Cited by 166 · see citing works
“The NHS (Nurses’ Health Study) is the only prospective cohort study to our knowledge that has specifically addressed the relation be-tween dietary SFAs differing in carbon chain length and IHD (14).”
Qin, L., Xu, J., Han, S.-F., Zhang, Z., Zhao, Y., & Szeto, I. M. Y. (2015) · PubMed · doi:10.6133/apjcn.2015.24.1.09 · Cited by 167 · see citing works
“The NHS study also found that the ratio of high- to low-fat dairy food consumption was positively associated with an increased CHD risk.(32) A most recent meta-analysis further confirmed the beneficial effects of the Dietary Approaches to Stop Hypertension (DASH) diet, which is rich in low-fat dairy products, on CVD,…”
Benatar, J. R., Sidhu, K., & Stewart, R. (2013) · PLoS ONE · doi:10.1371/journal.pone.0076480 · Cited by 165 · see citing works
“A modest inverse association between dairy consumption and cardiovascular disease has also been reported[18-20].”
Dietary fats and cardiometabolic disease: mechanisms and effects on risk factors and outcomes
Wu, J. H. Y., Micha, R., & Mozaffarian, D. (2019) · Nature Reviews Cardiology · doi:10.1038/s41569-019-0206-1 · Cited by 167 · see citing works
Fats and fatty acid requirements for adults
Elmadfa, I., & Kornsteiner, M. (2009) · Annals of Nutrition and Metabolism · doi:10.1159/000228996 · Cited by 161 · see citing works
Changes in dietary fat and declining coronary heart disease in Poland: population based study
Zatoński, W. A., & Willett, W. C. (2005) · BMJ · doi:10.1136/bmj.331.7510.187 · Cited by 157 · see citing works
Croissant, A. E., Washburn, S. P., Dean, L. L., & Drake, M. A. (2007) · Journal of Dairy Science · doi:10.3168/jds.2007-0456 · Cited by 158 · see citing works
“Saturated fatty acids have been associated with an increased risk of coronary heart disease (Hu et al., 1999), making the lower ratio of saturated:unsaturated fatty acids in PB milk more beneficial for health.”
BackgroundGanesan, K., Sukalingam, K., & Xu, B. (2017) · Trends in Food Science & Technology · doi:10.1016/j.tifs.2017.11.003 · Cited by 160 · see citing works
Yoo, S., Nicklas, T. A., Baranowski, T., Zakeri, I., Yang, S.-J., Srinivasan, S. R., & Berenson, G. S. (2004) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/80.4.841 · Cited by 156 · see citing works
“However, red meat or processed meat consumption, both associated with a higher risk of diabetes (44) and coronary heart disease (45) in previous studies, was not related to metabolic syndrome in this study (data not shown).”
BackgroundEstimation of Heritability and Genetic Correlations for the Major Fatty Acids in Bovine Milk
Soyeurt, H., Gillon, A., Vanderick, S., Mayeres, P., Bertozzi, C., & Gengler, N. (2007) · Journal of Dairy Science · doi:10.3168/jds.2007-0054 · Cited by 152 · see citing works
“Many previous studies have intensively examined the effect of FA on human health (Noakes et al., 1996; Hu et al., 1999; Parodi, 1999; Simo-poulos, 2003).”
BackgroundBacker, G. D., Ambrosio, G., Borch‐Johnsen, K., Brotons, C., Cífková, R., Dallongeville, J., Ebrahim, S. B. J., Færgeman, O., Graham, I. D., Mancia, G., et al. (2003) · PubMed · doi:10.1097/01.hjr.0000087913.96265.e2 · Cited by 151 · see citing works
Dietary phosphorus in bone health and quality of life
Takeda, E., Yamamoto, H., Yamanaka‐Okumura, H., & Taketani, Y. (2012) · Nutrition Reviews · doi:10.1111/j.1753-4887.2012.00473.x · Cited by 148 · see citing works
Oral sensitivity to oleic acid is associated with fat intake and body mass index
Stewart, J. E., Newman, L. P., & Keast, R. (2011) · Clinical Nutrition · doi:10.1016/j.clnu.2011.06.007 · Cited by 146 · see citing works
Dairy constituents and neurocognitive health in ageing
Camfield, D., Owen, L., Scholey, A. B., Pipingas, A., & Stough, C. K. K. (2011) · British Journal Of Nutrition · doi:10.1017/s0007114511000158 · Cited by 147 · see citing works
“The epidemiological evidence suggests that it is the ratio of high-fat:low-fat dairy products that is associated with a greater risk of CHD, not dairy consumption per se (61) .”
Soedamah‐Muthu, S. S., Masset, G., Verberne, L. D. M., Geleijnse, J. M., & Brunner, E. J. (2012) · British Journal Of Nutrition · doi:10.1017/s0007114512001845 · Cited by 145 · see citing works
“In another meta-analysis of nine prospective studies, an inverse association between milk (and dairy food) and CHD has been reported (HR 0·92, 95 % CI 0·80, 0·99 for the highest relative to lowest intake)((9)), but the results were attenuated when types of milk were taken into account for one large study contributing…”
ResultConsumption of meat and dairy products in China: a review
He, Y., Yang, X., Xia, J., Zhao, L., & Yang, Y. (2016) · Proceedings of The Nutrition Society · doi:10.1017/s0029665116000641 · Cited by 145 · see citing works
“Therefore, meat consumption had been identified as a dietary risk factor for CHD(5,6), obesity(7), diabetes(8), colorectal cancer(9) and stroke(10).”
Indicators of milk and beef quality
Cassandro, M., GALLO, L., Carnier, P., Bittante, G., Povinelli, M., Marcomin, D., R, D. Z., & Valorz, C. (2005) · Wageningen Academic Publishers eBooks · doi:10.3920/978-90-8686-537-6 · Cited by 144 · see citing works
“In the epidemiological study on the nurses (Nurses’ Health Study), the results obtained from the food consumption surveys showed that dairy products (cheeses, skimmed milk, butter and unskimmed milk) contributed to 42% of myristic acid consumption, the more atherogenic fatty acid (Hu et al., 1999).”
BackgroundThe role of dietary n-6 fatty acids in the prevention of cardiovascular disease
Willett, W. (2007) · Journal of Cardiovascular Medicine · doi:10.2459/01.jcm.0000289275.72556.13 · Cited by 155 · see citing works
Warensjö, E., Jansson, J., Cederholm, T., Boman, K., Eliasson, M., Hallmans, G., Johansson, I., & Sjögren, P. (2010) · American Journal of Clinical Nutrition · doi:10.3945/ajcn.2009.29054 · Cited by 141 · see citing works
“In the Nurses’ Health Study, a higher ratio of high- to low-fat dairy product consumption was significantly associated with heart disease over 14 y of follow-up (32).”
BackgroundYakoob, M. Y., Shi, P., Willett, W. C., Rexrode, K. M., Campos, H., Orav, E. J., Hu, F. B., & Mozaffarian, D. (2016) · Circulation · doi:10.1161/circulationaha.115.018410 · Cited by 140 · see citing works
Saturated Fatty Acid Chain Length and Risk of Cardiovascular Disease: A Systematic Review
Perna, M., & Hewlings, S. J. (2022) · Nutrients · doi:10.3390/nu15010030 · Cited by 143 · see citing works
Relation of food cost to healthfulness of diet among US women
Bernstein, A. M., Bloom, D. E., ROSNER, B. A., FRANZ, M. M., & Willett, W. C. (2010) · American Journal of Clinical Nutrition · doi:10.3945/ajcn.2010.29854 · Cited by 134 · see citing works
Hoffmann, K., Zyriax, B., Boeing, H., & Windler, E. E. T. (2004) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/80.3.633 · Cited by 133 · see citing works
Protein, body weight, and cardiovascular health
Hu, F. B. (2005) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/82.1.242s · Cited by 130 · see citing works
“In the Nurses’ Health Study (50), after adjustment for age, consumption of red meat and high-fat dairy products was associated with increased risk of CHD, whereas consumption of poultry/fish and low-fat dairy products was associated with a lower risk.”
BackgroundInfluentialThe scope for manipulating the polyunsaturated fatty acid content of beef: a review
Vahmani, P., Mapiye, C., Prieto, N., Rolland, D. C., McAllister, T. A., Aalhus, J. L., & Dugan, M. E. R. (2015) · Journal of Animal Science and Biotechnology/Journal of animal science and biotechnology · doi:10.1186/s40104-015-0026-z · Cited by 129 · see citing works
“Fatty acids singled out in the Nurses’ Health Study as being problematic for CHD are SFA with chain lengths from 14:0 to 18:0, and a stronger association was found when the polyunsaturated fatty acid (PUFA) to SFA ratio was reduced [5].”
BackgroundYi, B., Kim, M., Lee, S. Y., & Lee, J. (2017) · Food Science and Biotechnology · doi:10.1007/s10068-017-0011-8 · Cited by 129 · see citing works
“, coronary heart disease) (5,7-9); therefore, avoiding foods that are rich in these fats is strongly recommended (7,10).”
BackgroundZong, G., Li, Y., Sampson, L., Dougherty, L., Willett, W. C., Wanders, A. J., Alssema, M., Zock, P. L., Hu, F. B., & Sun, Q. (2018) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/nqx004 · Cited by 129 · see citing works
“8) reflect their overlapping food sources (21), such as red meats and dairy products (37).”
BackgroundMethodNeuenschwander, M., Stadelmaier, J., Eble, J., Grummich, K., Szczerba, E., Kiesswetter, E., Schlesinger, S., & Schwingshackl, L. (2023) · BMC Medicine · doi:10.1186/s12916-023-03093-1 · Cited by 132 · see citing works
Hoffman, R. M., & Gerber, M. (2013) · Nutrition Reviews · doi:10.1111/nure.12040 · Cited by 128 · see citing works
Li, D., Siriamornpun, S., Wahlqvist, M. L., Mann, N. J., & Sinclair, A. J. (2005) · PubMed · Cited by 125 · see citing works
de Goede, J., Geleijnse, J. M., Ding, E. L., & Soedamah‐Muthu, S. S. (2015) · Nutrition Reviews · doi:10.1093/nutrit/nuu060 · Cited by 125 · see citing works
Attia, Y. A., Al‐Harthi, M. A., Korish, M. A., & Shiboob, M. M. (2015) · Lipids in Health and Disease · doi:10.1186/s12944-015-0133-z · Cited by 123 · see citing works
Biong, A. S., Müller, H., Seljeflot, I., Veierød, M. B., & Pedersen, J. I. (2004) · British Journal Of Nutrition · doi:10.1079/bjn20041257 · Cited by 123 · see citing works
“Certain varieties of cheese are rich sources of saturated fat, which may be positively associated with an increased risk of heart disease (Hu et al. 1999), but some are also rich sources of Ca. Ca has been associated with a plasma lipid profile predictive of a lower risk of CHD (Jacqmain et al.…”
BackgroundAttia, Y. A., Al‐Harthi, M. A., Korish, M. A., & Shiboob, M. M. (2017) · Lipids in Health and Disease · doi:10.1186/s12944-017-0423-8 · Cited by 122 · see citing works
“A very large observational study carried out in the United States on a female population reported an inverse relationship between the intakes of poultry and the risk of developing coronary artery disease [10].”
BackgroundNogoy, K. M. C., Sun, B., Shin, S., Lee, Y., Li, X. Z., Choi, S. H., & Park, S. (2022) · Food Science of Animal Resources · doi:10.5851/kosfa.2021.e73 · Cited by 128 · see citing works
- Authors
- Hu, F. B., Stampfer, M. J., Manson, J. E., Ascherio, A., Colditz, G. A., Speizer, F. E., Hennekens, C. H., & Willett, W. C.
- Affiliations
- Brigham and Women's Hospital (US)
- Corresponding author
- Hu, Frank B
- ORCID
- Venue
- The American Journal of Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 1999-12
- Volume
- 70
- Issue
- 6
- Pages
- 1001-1008
- ISSN
- 0002-9165 (ISSN-L)
- OpenAlex
- W2150396523
- Cited by
- 661
- References
- 25
- Citations by year
- 2026: 3 · 2025: 10 · 2024: 19 · 2023: 17 · 2022: 17 · 2021: 23 · 2020: 23 · 2019: 24 · 2018: 28 · 2017: 38 · 2016: 38 · 2015: 37 · 2014: 39 · 2013: 39 · 2012: 29
- FWCI
- 9.79
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- American Journal of Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Heart, Lung, and Blood Institute (HL24074, HL34594, R01HL034594)
- National Cancer Institute (CA-40356)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Fatty Acid Research and Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Keywords
- saturated fatty acids, coronary artery disease, women, stearic acid, long-chain saturated fatty acids, polyunsaturated to saturated fat ratio, dietary fat intake, food sources, red meat consumption, milk fat, Nurses' Health Study
- MeSH terms
- Adult, Coronary Disease, Dairy Products, Dietary Fats, Fatty Acids, Female, Follow-Up Studies, Humans, Meat, Middle Aged, Prospective Studies, Surveys and Questionnaires, Risk Factors, United States, Cohort Studies, Multivariate Analysis, Women's Health
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