膳食脂肪摄入与心血管疾病风险和高心血管疾病风险人群的全因死亡率。
Dietary fat intake and risk of cardiovascular disease and all-cause mortality in a population at high risk of cardiovascular disease.
机构信息
Human Nutrition Unit, University Hospital of Sant Joan de Reus, Department of Biochemistry and Biotechnology, Faculty of Medicine and Health Sciences, IISPV, Rovira i Virgili University, Reus, Spain; Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain;
Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain; Department of Preventive Medicine and Public Health, University of Navarra IDISNA (Instituto de Investigación Sanitaria de Navarra), Pamplona, Spain;
出版信息
Am J Clin Nutr. 2015 Dec;102(6):1563-73. doi: 10.3945/ajcn.115.116046. Epub 2015 Nov 11.
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.
背景
对于心血管疾病（CVD）的预防而言，膳食脂肪的质量和脂肪替代比总膳食脂肪摄入量更为重要。
目的
本研究旨在评估总脂肪摄入量和不同脂肪类型与 CVD（心肌梗死、中风或心血管原因导致的死亡）以及心血管和全因死亡风险之间的相关性。我们还研究了用一种宏量营养素替代另一种宏量营养素的假设效果。
设计
我们前瞻性地研究了来自 PREvención con DIeta MEDiterránea（PREDIMED）研究的 7038 名处于高 CVD 风险的参与者。该试验于 2003 年至 2010 年进行，但目前的分析基于 2012 年之前的扩展随访。在基线和之后的每年，我们通过使用经过验证的食物频率问卷反复测量总脂肪和特定脂肪类型。使用时间依赖性 Cox 比例风险模型。
结果
经过 6 年的随访，我们记录了 336 例 CVD 病例和 414 例总死亡病例。与最低五分位数相比，总脂肪、单不饱和脂肪酸（MUFA）和多不饱和脂肪酸（PUFA）摄入量最高五分位数的 CVD 风险比（95%CI）分别为 0.58（0.39，0.86）、0.50（0.31，0.81）和 0.68（0.48，0.96）。在极值五分位数之间的比较中，较高的饱和脂肪酸（SFA）和反式脂肪摄入量与 CVD 风险增加 81%（HR：1.81；95%CI：1.05，3.13）和 67%（HR：1.67；95%CI：1.09，2.57）相关。也观察到多不饱和脂肪酸和单不饱和脂肪酸摄入与全因死亡呈负相关。用 MUFA 和 PUFA 替代 SFA，或用 MUFA 替代反式脂肪与 CVD 风险降低相关。来自糕点和加工食品的 SFA 与 CVD 风险升高相关。
结论
MUFA 和 PUFA 的摄入量与 CVD 和死亡风险降低相关，而 SFA 和反式脂肪摄入量与 CVD 风险增加相关。用 MUFA 和 PUFA 替代 SFA，或用 MUFA 替代反式脂肪与 CVD 呈负相关。该试验在 www.controlled-trials.com 上注册为 ISRCTN 35739639。
Zotero 插件