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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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“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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“Nevertheless, in our previous analysis of the Nurses’ Health Study (52), overall red meat consumption was associated with a modest increase in CHD risk, whereas white meat consumption was associated with a lower risk.”
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Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women
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BackgroundRed meat consumption: An overview of the risks and benefits
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InfluentialMajor Dietary Protein Sources and Risk of Coronary Heart Disease in Women
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“Additionally, moderate consumption of protein is associated with a reduced risk of CAD (163), whereas substitution of red meat with poultry and fish also decreases risk (161).”
BackgroundSaturated Fats and Health: A Reassessment and Proposal for Food-Based Recommendations
Astrup, A. V., Magkos, F., Bier, D. M., Brenna, J. T., Otto, M. C. D. O., Hill, J. O., King, J. C., Mente, A., Ordovás, J. M., Volek, J. S., et al. (2020) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2020.05.077 · Cited by 581
“For example, the major food sources of short-chain SFAs are dairy fats, while medium- and long-chain SFAs are predominantly found in red meat, dairy fats, and plant oils (9,10).”
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“Meanwhile, high-fat dairy product consumption has been shown to be positively related to CHD (22, 23), whereas low-fat dairy product consumption has been shown to be inversely associated with CHD (22) or stroke (15).”
BackgroundTrends in the Incidence of Coronary Heart Disease and Changes in Diet and Lifestyle in Women
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“The general associations of higher SF consumption with a less-healthful lifestyle and diets overall, as evidenced by our data and the data of others (35, 36), indicate that SF and dairy consumption are likely to be confounded toward harm by other dietary habits, in particular the consumption of fiber, fruit and vegeta…”
ResultDietary cholesterol and cardiovascular disease: a systematic review and meta-analysis
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“Risk of CVD has been reported to be related to increased consumption of saturated fatty acids and percentage of calories from fat (27, 62, 63), which are positively associated with cholesterol intake.”
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Dietary fats and coronary heart disease
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“Likewise, the association between whole-milk intake and CHD risk should be further studied because a positive association was shown in women in 1 study (22), whereas no association was observed in both men and women in another study (15).”
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Ley, S. H., Sun, Q., Willett, W. C., Eliassen, A. H., Wu, K., Pan, A., Grodstein, F., & Hu, F. B. (2014) · The American Journal of Clinical Nutrition · doi:10.3945/ajcn.113.075663 · Cited by 248
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“This recommendation is based on data from the Nurse’s Health Study, in which the high-fat to low-fat dairy consumption ratio was associated with significantly greater risk [49].”
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“Although ecologic studies have implicated high intake of saturated fat as a risk factor for coronary heart disease (35), most large prospective cohort studies have not found significant positive associations between intakes of saturated fat (36–38) or high-fat dairy foods (39) and the risk of coronary heart disease.”
BackgroundA Review of Issues of Dietary Protein Intake in Humans
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A prescription for lifestyle change in patients with hyperuricemia and gout
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Wang, D. D., & Hu, F. B. (2017) · Annual Review of Nutrition · doi:10.1146/annurev-nutr-071816-064614 · Cited by 229
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“During a 14-year follow-up of 80,082 US women, a higher ratio of red meat to poultry and fish consumption was associated with a significantly increased risk of incident cases of major CHD events independent of major risk factors (33).”
BackgroundValidation of the Healthy Eating Index with use of plasma biomarkers in a clinical sample of women
Hann, C. S., Rock, C. L., King, I. B., & Drewnowski, A. (2001) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/74.4.479 · Cited by 212
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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
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“…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).”
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“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
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“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 178
“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
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
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“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 176
“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,…”
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“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 172
Fats and fatty acid requirements for adults
Elmadfa, I., & Kornsteiner, M. (2009) · Annals of Nutrition and Metabolism · doi:10.1159/000228996 · Cited by 161
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
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
“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
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
“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
“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 153
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 153
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
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 151
“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 144
“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 147
“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 147
“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. C. (2007) · Journal of Cardiovascular Medicine · doi:10.2459/01.jcm.0000289275.72556.13 · Cited by 142
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
“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 146
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 147
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 138
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 136
Protein, body weight, and cardiovascular health
Hu, F. B. (2005) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/82.1.242s · Cited by 132
“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 138
“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
“, 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 133
“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 136
Hoffman, R. M., & Gerber, M. (2013) · Nutrition Reviews · doi:10.1111/nure.12040 · Cited by 131
Li, D., Siriamornpun, S., Wahlqvist, M. L., Mann, N. J., & Sinclair, A. J. (2005) · PubMed · Cited by 125
de Goede, J., Geleijnse, J. M., Ding, E. L., & Soedamah‐Muthu, S. S. (2015) · Nutrition Reviews · doi:10.1093/nutrit/nuu060 · Cited by 128
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
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
“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
“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
Metadata
- 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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