Arnesen Erik Kristoffer, Laake Ida, Veierød Marit B, Retterstøl Kjetil
Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo0317, Norway.
Norwegian Institute of Public Health, Oslo, Norway.
Br J Nutr. 2024 Sep 16;132(4):1-13. doi: 10.1017/S0007114524001351.
The contribution of dietary saturated fatty acids (SFA) to cardiovascular disease (CVD) and mortality remains debated after decades of research. Few previous studies had repeated dietary assessments and power to assess mortality. Evidence for individual SFA is limited. In this large population-based cohort study, we investigated associations between intake of total and individual SFA and risk of total and CVD mortality. Adult residents (mean 41·1 years at baseline) in three Norwegian counties were invited to repeated health screenings between 1974 and 1988 (> 80 % attendance). We calculated cumulative average intakes of macronutrients from semi-quantitative FFQ. Median (interquartile range) intake of SFA was 14·6 % (12·8-16·6 %) of total energy (E%). Hazard ratios (HR) and 95 % CI were estimated using multivariable Cox regression models to assess total, CVD, ischaemic heart disease (IHD) and acute myocardial infarction (AMI) mortality. Among 78 725 participants, 28 555 deaths occurred during a median follow-up of 33·5 years, with 9318 deaths due to CVD. Higher intake of SFA (replacing carbohydrates) was positively associated with all mortality endpoints, including total (HR per 5 E% increment, 1·18; 95 % CI 1·13, 1·23) and CVD mortality (1·16; 95 % CI 1·07, 1·25). Theoretical isoenergetic substitution of SFA with carbohydrates or MUFA was associated with lower risk. Of individual SFA, myristic (14:0) and palmitic acid (16:0) were positively associated with mortality. In summary, dietary SFA intake was strongly associated with higher total and CVD mortality in this long-term cohort study. This supports policies implemented to reduce SFA consumption in favour of carbohydrates and unsaturated fats.
经过数十年的研究，膳食饱和脂肪酸（SFA）对心血管疾病（CVD）和死亡率的影响仍存在争议。以前很少有研究进行重复的膳食评估并有能力评估死亡率。关于个别饱和脂肪酸的证据有限。在这项基于人群的大型队列研究中，我们调查了总饱和脂肪酸和个别饱和脂肪酸的摄入量与总死亡率和心血管疾病死亡率风险之间的关联。邀请了挪威三个县的成年居民（基线时平均年龄41.1岁）在1974年至1988年期间进行重复健康筛查（参与率>80%）。我们通过半定量食物频率问卷计算了常量营养素的累积平均摄入量。饱和脂肪酸的摄入量中位数（四分位间距）为总能量（E%）的14.6%（12.8 - 16.6%）。使用多变量Cox回归模型估计风险比（HR）和95%置信区间，以评估总死亡率、心血管疾病死亡率、缺血性心脏病（IHD）和急性心肌梗死（AMI）死亡率。在78725名参与者中，在中位随访33.5年期间发生了28555例死亡，其中9318例死于心血管疾病。较高的饱和脂肪酸摄入量（替代碳水化合物）与所有死亡率终点呈正相关，包括总死亡率（每增加5 E%的HR为1.18；95%置信区间1.13，1.23）和心血管疾病死亡率（1.16；95%置信区间1.07，1.25）。用碳水化合物或单不饱和脂肪酸对饱和脂肪酸进行理论等能量替代与较低风险相关。在个别饱和脂肪酸中，肉豆蔻酸（14:0）和棕榈酸（16:0）与死亡率呈正相关。总之，在这项长期队列研究中，膳食饱和脂肪酸摄入量与较高的总死亡率和心血管疾病死亡率密切相关。这支持了为减少饱和脂肪酸消费以利于碳水化合物和不饱和脂肪而实施的政策。
