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Title: Dietary fat intake and risk of cardiovascular disease and all-cause mortality in a population at high risk of cardiovascular disease
Authors: Guasch-Ferré, Marta
Babio, Nancy
Martínez-González, Miguel A.
Corella, Dolores
Ros, Emilio
Martín-Peláez, Sandra
Estruch, Ramon
Arós, Fernando
Gómez-Gracia, Enrique
Fiol, Miquel
Santos-Lozano, José M.
Serra-Majem, Lluís 
Bulló, Monica
Toledo, Estefanía
Barragán, Rocío
Fitó, Montserrat
Gea, Alfredo
Salas-Salvadó, Jordi
Keywords: Coronary-Heart-Disease
Saturated Fat
Prospective Cohort
Unsaturated Fats
Acids, et al
Issue Date: 2015
Publisher: 0002-9165
Journal: The American journal of clinical nutrition 
Abstract: 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 PREvencion con DIeta MEDiterranea (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.
ISSN: 0002-9165
DOI: 10.3945/ajcn.115.116046
Source: American Journal of Clinical Nutrition[ISSN 0002-9165],v. 102, p. 1563-1573
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