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Dietary fat intake and risk of cardiovascular disease and all-cause mortality in a population at high risk of cardiovascular disease
Open accessAbstract
Background Dietary fat quality and fat replacement are more important for cardiovascular disease (CVD) prevention than is total dietary fat intake.Objective The aim was to evaluate the association between total fat intake and fat subtypes with the risk of CVD (myocardial infarction, stroke, or death from cardiovascular causes) and cardiovascular and all-cause death. We also examined the hypothetical effect of the isocaloric substitution of one macronutrient for another.Design We prospectively studied 7038 participants at high CVD risk from the PREvención con DIeta MEDiterránea (PREDIMED) study. The trial was conducted from 2003 to 2010, but the present analysis was based on an expanded follow-up until 2012. At baseline and yearly thereafter, total and specific fat subtypes were repeatedly measured by using validated food-frequency questionnaires. Time-dependent Cox proportional hazards models were used.Results After 6 y of follow-up, we documented 336 CVD cases and 414 total deaths. HRs (95% CIs) for CVD for those in the highest quintile of total fat, monounsaturated fatty acid (MUFA), and polyunsaturated fatty acid (PUFA) intake compared with those in the lowest quintile were 0.58 (0.39, 0.86), 0.50 (0.31, 0.81), and 0.68 (0.48, 0.96), respectively. In the comparison between extreme quintiles, higher saturated fatty acid (SFA) and trans-fat intakes were associated with 81% (HR: 1.81; 95% CI: 1.05, 3.13) and 67% (HR: 1.67; 95% CI: 1.09, 2.57) higher risk of CVD. Inverse associations with all-cause death were also observed for PUFA and MUFA intakes. Isocaloric replacements of SFAs with MUFAs and PUFAs or trans fat with MUFAs were associated with a lower risk of CVD. SFAs from pastries and processed foods were associated with a higher risk of CVD.Conclusions Intakes of MUFAs and PUFAs were associated with a lower risk of CVD and death, whereas SFA and trans-fat intakes were associated with a higher risk of CVD. The replacement of SFAs with MUFAs and PUFAs or of trans fat with MUFAs was inversely associated with CVD. This trial was registered at www.controlled-trials.com as ISRCTN 35739639.
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Metadata
- Authors
- Guasch-Ferré, M., Babio, N., Martínez-González, M. A., Corella, D., Ros, E., Martín-Peláez, S., Estruch, R., Arós, F., Gómez-Gracia, E., Fiol, M., Santos-Lozano, J. M., Serra-Majem, L., Bulló, M., Toledo, E., Barragán, R., Fitó, M., Gea, A., & Salas-Salvadó, J.
- Affiliations
- Universitat de València (ES)
- Instituto de Salud Carlos III (ES)
- ORCID
- Venue
- The American Journal of Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2015-12
- Volume
- 102
- Issue
- 6
- Pages
- 1563-1573
- ISSN
- 0002-9165 (ISSN-L)
- OpenAlex
- W2176413553
- Cited by
- 313
- References
- 31
- Citations by year
- 2026: 14 · 2025: 34 · 2024: 35 · 2023: 27 · 2022: 22 · 2021: 35 · 2020: 39 · 2019: 28 · 2018: 33 · 2017: 28 · 2016: 17
- FWCI
- 27.58
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- American Journal of Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Repository of Digital Objects for Teaching Research and Culture (University of Valencia) (submittedVersion, other-oa)
- Funders
- Spanish Ministry of Health (PI1001407)
- Thematic Network (G03/140, RD06/0045)
- Centre Català de la Nutrició de l’Institut d’Estudis Catalans
- Spanish government, Instituto de Salud Carlos III
- Centro Nacional de Investigaciones Cardiovasculares (CNIC 06/2007)
- Fondo de Investigación Sanitaria–Fondo Europeo de Desarrollo Regional (PI04-2239, PI 05/2584, CP06/00100, PI07/0240, PI07/1138, PI07/0954, PI 07/0473, PI10/01407, PI10/02658, PI11/01647, P11/02505, PI13/00462)
- Ministerio de Ciencia e Innovación (AGL-2009-13906-C02, AGL2010-22319-C03)
- Fundación Mapfre 2010
- Consejería de Salud de la Junta de Andalucía (PI0105/2007)
- Public Health Division of the Department of Health of the Autonomous Government (ACOMP06109, GVA-COMP2010-181, GVACOMP2011-151, CS2010-AP-111, CS2011-AP-042)
- Regional Government of Navarra (P27/2011)
- Fundación Patrimonio Comunal Olivarero
- Hojiblanca SA
- California Walnut Commission
- Borges SA
- Morella Nuts SA
- 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 › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Keywords
- dietary fat intake, cardiovascular disease, all-cause mortality, saturated fatty acids, trans fatty acids, monounsaturated fatty acids, polyunsaturated fatty acids, PREDIMED study, myocardial infarction, stroke, processed foods, pastry, Mediterranean diet, cardiovascular disease prevention, food frequency questionnaire
- MeSH terms
- Aged, Aged, 80 and over, Cardiovascular Diseases, Dietary Fats, Dietary Fats, Unsaturated, Fatty Acids, Unsaturated, Female, Follow-Up Studies, Humans, Male, Mortality, Prospective Studies, Risk Factors, Spain, Cohort Studies, Incidence, Proportional Hazards Models, Diet, Mediterranean, Trans Fatty Acids, Fast Foods, Food, Preserved, Elder Nutritional Physiological Phenomena
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