Kiage James N, Merrill Peter D, Judd Suzanne E, He Ka, Lipworth Loren, Cushman Mary, Howard Virginia J, Kabagambe Edmond K
Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (JNK, LL, and EKK); the Departments of Epidemiology (VJH) and Biostatistics (PDM and SEJ), School of Public Health, University of Alabama at Birmingham, Birmingham, AL; the Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN (KH); and the Departments of Medicine and Pathology, College of Medicine, University of Vermont, Burlington, VT (MC).
Am J Clin Nutr. 2014 May;99(5):1071-6. doi: 10.3945/ajcn.113.075713. Epub 2014 Feb 12.
Whether elevated intakes of trans fatty acids (TFAs) increase the risk of stroke remains unclear. Except for the Women's Health Initiative-Observational Study, most studies that directly assessed the association between TFA intake and stroke yielded null results.
The aim of this study was to investigate the association between TFA intake and stroke incidence.
We prospectively investigated the association between TFA intake and stroke incidence in black and white men and women (n = 17,107) from the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort. Participants were recruited between 2003 and 2007 from the continental United States and followed for incident stroke. Diet was assessed by using the Block 1998 food-frequency questionnaire. Cox regression was used to test whether energy-adjusted TFA intake in 1-SD increments was associated with incident stroke.
During a median follow-up of 7 y, 479 strokes were identified, including 401 ischemic strokes. Sex modified the association between TFA intake and stroke (P-interaction = 0.06), and thus the results were stratified by sex. In fully adjusted models, a 1-SD (2-g/d) increase in TFA intake was associated with an increased risk of any stroke in men (HR: 1.14; 95% CI: 1.02, 1.28) but not in women (HR: 0.93; 95% CI: 0.79, 1.11). Similarly, our results showed an increased risk of ischemic stroke in men (HR: 1.13; 95% CI: 1.00, 1.28) but not in women (HR: 0.93; 95% CI: 0.77, 1.12).
We show that sex modifies the association between TFA intake and stroke; for every 2-g/d increase in TFA intake, there was a 14% increase in the risk of stroke in men but not in women. Our findings provide further evidence to support the concerted effort to minimize TFAs in the diet.
反式脂肪酸（TFA）摄入量升高是否会增加中风风险仍不明确。除了女性健康倡议观察性研究外，大多数直接评估TFA摄入量与中风之间关联的研究均未得出显著结果。
本研究旨在调查TFA摄入量与中风发病率之间的关联。
我们前瞻性地研究了来自中风地理和种族差异原因（REGARDS）队列的黑人和白人男性及女性（n = 17107）中TFA摄入量与中风发病率之间的关联。参与者于2003年至2007年期间从美国大陆招募，并对中风发病情况进行随访。饮食通过使用1998年Block食物频率问卷进行评估。采用Cox回归检验能量调整后的TFA摄入量每增加1个标准差是否与中风发病相关。
在中位随访7年期间，共确诊479例中风，其中包括401例缺血性中风。性别对TFA摄入量与中风之间的关联有影响（P交互作用 = 0.06），因此按性别对结果进行分层。在完全调整模型中，TFA摄入量每增加1个标准差（2克/天），男性发生任何中风的风险增加（风险比：1.14；95%置信区间：1.02, 1.28），而女性则未增加（风险比：0.93；95%置信区间：0.79, 1.11）。同样，我们的结果显示男性缺血性中风风险增加（风险比：1.13；95%置信区间：1.00, 1.28），而女性则未增加（风险比：0.93；95%置信区间：0.77, 1.12）。
我们发现性别对TFA摄入量与中风之间的关联有影响；TFA摄入量每增加2克/天，男性中风风险增加14%，而女性则未增加。我们的研究结果为支持在饮食中尽量减少TFA的协同努力提供了进一步证据。
