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Cited by 1,026Fatty Acid Research and HealthNutritional Studies and DietNuts composition and effects

Major types of dietary fat and risk of coronary heart disease: a pooled analysis of 11 cohort studies

Open access
Jakobsen, Marianne U, O’Reilly, Eilis J, Heitmann, Berit L, Pereira, Mark A, Bälter, Katarina, Fraser, Gary E, Goldbourt, Uri, Hallmans, Göran +8 more·2009·The American Journal of Clinical Nutrition
DOI 10.3945/ajcn.2008.27124PMC PMC2676998
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Abstract

Background Saturated fatty acid (SFA) intake increases plasma LDL-cholesterol concentrations; therefore, intake should be reduced to prevent coronary heart disease (CHD). Lower habitual intakes of SFAs, however, require substitution of other macronutrients to maintain energy balance.Objective We investigated associations between energy intake from monounsaturated fatty acids (MUFAs), polyunsaturated fatty acids (PUFAs), and carbohydrates and risk of CHD while assessing the potential effect-modifying role of sex and age. Using substitution models, our aim was to clarify whether energy from unsaturated fatty acids or carbohydrates should replace energy from SFAs to prevent CHD.Design This was a follow-up study in which data from 11 American and European cohort studies were pooled. The outcome measure was incident CHD.Results During 4-10 y of follow-up, 5249 coronary events and 2155 coronary deaths occurred among 344,696 persons. For a 5% lower energy intake from SFAs and a concomitant higher energy intake from PUFAs, there was a significant inverse association between PUFAs and risk of coronary events (hazard ratio: 0.87; 95% CI: 0.77, 0.97); the hazard ratio for coronary deaths was 0.74 (95% CI: 0.61, 0.89). For a 5% lower energy intake from SFAs and a concomitant higher energy intake from carbohydrates, there was a modest significant direct association between carbohydrates and coronary events (hazard ratio: 1.07; 95% CI: 1.01, 1.14); the hazard ratio for coronary deaths was 0.96 (95% CI: 0.82, 1.13). MUFA intake was not associated with CHD. No effect modification by sex or age was found.Conclusion The associations suggest that replacing SFAs with PUFAs rather than MUFAs or carbohydrates prevents CHD over a wide range of intakes.

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  • Observational studies indicate there might be no benefits if saturated fat reduction is associated with an increase in carbohydrates, supported by the absence of benefits from a low fat diet in the Women's Health Initiative.

    “However, observational studies indicate that there might be no benefits if saturated fat reduction is associated with an increase in carbohydrates,91 which is also supported by the absence of benefits from a low fat diet in the Women’s Health Initiative.192”

    From A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010 (2012) · cites this paper as [91]

  • Saturated fat intake showed associations with coronary heart disease risk that were relatively similar to those of total carbohydrate, the most common background macronutrient.

    “However, SFA consumption, traditionally considered highly atherogenic, had relatively similar associations with CHD risk as total carbohydrate, the most common (calorically predominant) background macronutrient.142”

    From Components of a Cardioprotective Diet: New Insights (2011) · cites this paper as [142]

  • In prospective cohort studies, polyunsaturated fatty acid intake is linked to fewer cardiovascular disease events.

    “PUFA consumption improves levels of blood lipids and lipoproteins, is associated with lower CVD event rates in prospective cohort studies, and reduces clinical events as a replacement for SFA in RCTs.139,142,143”

    From Components of a Cardioprotective Diet: New Insights (2011) · cites this paper as [142]

  • Eating polyunsaturated fatty acids improves levels of blood lipids and lipoproteins.

    “PUFA consumption improves levels of blood lipids and lipoproteins, is associated with lower CVD event rates in prospective cohort studies, and reduces clinical events as a replacement for SFA in RCTs.139,142,143”

    From Components of a Cardioprotective Diet: New Insights (2011) · cites this paper as [142]

  • In randomized controlled trials, replacing saturated fat with polyunsaturated fat reduces clinical events.

    “PUFA consumption improves levels of blood lipids and lipoproteins, is associated with lower CVD event rates in prospective cohort studies, and reduces clinical events as a replacement for SFA in RCTs.139,142,143”

    From Components of a Cardioprotective Diet: New Insights (2011) · cites this paper as [142]

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Authors
Jakobsen, M. U., O’Reilly, E. J., Heitmann, B. L., Pereira, M. A., Bälter, K., Fraser, G. E., Goldbourt, U., Hallmans, G., Knekt, P., Liu, S., Pietinen, P., Spiegelman, D., Stevens, J., Virtamo, J., Willett, W. C., & Ascherio, A.
Affiliations
University of Minnesota (US)
Corresponding author
Jakobsen, Marianne U
ORCID
Venue
The American Journal of Clinical Nutrition
Publisher
Elsevier BV
Published
2009-05
Volume
89
Issue
5
Pages
1425-1432
ISSN
0002-9165 (ISSN-L)
DOI
10.3945/ajcn.2008.27124
PMC
PMC2676998
OpenAlex
W2156924995
Cited by
1,026
References
34
Citations by year
2026: 19 · 2025: 20 · 2024: 28 · 2023: 42 · 2022: 45 · 2021: 60 · 2020: 46 · 2019: 62 · 2018: 78 · 2017: 75 · 2016: 81 · 2015: 94 · 2014: 89 · 2013: 82 · 2012: 75
FWCI
64.38
Type
journal article
Language
en
Open access
Licence
Locations
  • American Journal of Clinical Nutrition (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Research at the University of Copenhagen (University of Copenhagen) (publishedVersion)
  • Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
Funders
  • National Heart, Lung, and Blood Institute (R01HL058904)
  • National Institute of Diabetes and Digestive and Kidney Diseases (P30DK040561)
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 › Nursing › Nutrition and Dietetics › Nuts composition and effects
Keywords
coronary artery disease, saturated fatty acids, polyunsaturated fatty acids, monounsaturated fatty acids, dietary fat, carbohydrate intake, LDL cholesterol, macronutrient substitution, coronary events, coronary heart disease mortality
MeSH terms
Adult, Aged, Coronary Disease, Dietary Carbohydrates, Dietary Fats, Europe, Fatty Acids, Fatty Acids, Monounsaturated, Humans, Cholesterol, LDL, Middle Aged, Surveys and Questionnaires, United States, Cohort Studies, Proportional Hazards Models

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