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Association of Specific Dietary Fats With Total and Cause-Specific Mortality.
JAMA Intern Med 2016; 176(8):1134-45JIM

Abstract

IMPORTANCE

Previous studies have shown distinct associations between specific dietary fat and cardiovascular disease. However, evidence on specific dietary fat and mortality remains limited and inconsistent.

OBJECTIVE

To examine the associations of specific dietary fats with total and cause-specific mortality in 2 large ongoing cohort studies.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study investigated 83 349 women from the Nurses' Health Study (July 1, 1980, to June 30, 2012) and 42 884 men from the Health Professionals Follow-up Study (February 1, 1986, to January 31, 2012) who were free of cardiovascular disease, cancer, and types 1 and 2 diabetes at baseline. Dietary fat intake was assessed at baseline and updated every 2 to 4 years. Information on mortality was obtained from systematic searches of the vital records of states and the National Death Index, supplemented by reports from family members or postal authorities. Data were analyzed from September 18, 2014, to March 27, 2016.

MAIN OUTCOMES AND MEASURES

Total and cause-specific mortality.

RESULTS

During 3 439 954 person-years of follow-up, 33 304 deaths were documented. After adjustment for known and suspected risk factors, dietary total fat compared with total carbohydrates was inversely associated with total mortality (hazard ratio [HR] comparing extreme quintiles, 0.84; 95% CI, 0.81-0.88; P < .001 for trend). The HRs of total mortality comparing extreme quintiles of specific dietary fats were 1.08 (95% CI, 1.03-1.14) for saturated fat, 0.81 (95% CI, 0.78-0.84) for polyunsaturated fatty acid (PUFA), 0.89 (95% CI, 0.84-0.94) for monounsaturated fatty acid (MUFA), and 1.13 (95% CI, 1.07-1.18) for trans-fat (P < .001 for trend for all). Replacing 5% of energy from saturated fats with equivalent energy from PUFA and MUFA was associated with estimated reductions in total mortality of 27% (HR, 0.73; 95% CI, 0.70-0.77) and 13% (HR, 0.87; 95% CI, 0.82-0.93), respectively. The HR for total mortality comparing extreme quintiles of ω-6 PUFA intake was 0.85 (95% CI, 0.81-0.89; P < .001 for trend). Intake of ω-6 PUFA, especially linoleic acid, was inversely associated with mortality owing to most major causes, whereas marine ω-3 PUFA intake was associated with a modestly lower total mortality (HR comparing extreme quintiles, 0.96; 95% CI, 0.93-1.00; P = .002 for trend).

CONCLUSIONS AND RELEVANCE

Different types of dietary fats have divergent associations with total and cause-specific mortality. These findings support current dietary recommendations to replace saturated fat and trans-fat with unsaturated fats.

Authors+Show Affiliations

Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts3Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts2Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts2Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts3Department of Epidemiology.Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts3Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts4Channing Division for Net.Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts3Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts4Channing Division for Network Medicine, Brigham and Women's Hospital a.Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts3Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts4Channing Division for Network Medicine, Brigham and Women's Hospital a.Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts3Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts4Channing Division for Network Medicine, Brigham and Women's Hospital a.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

27379574

Citation

Wang, Dong D., et al. "Association of Specific Dietary Fats With Total and Cause-Specific Mortality." JAMA Internal Medicine, vol. 176, no. 8, 2016, pp. 1134-45.
Wang DD, Li Y, Chiuve SE, et al. Association of Specific Dietary Fats With Total and Cause-Specific Mortality. JAMA Intern Med. 2016;176(8):1134-45.
Wang, D. D., Li, Y., Chiuve, S. E., Stampfer, M. J., Manson, J. E., Rimm, E. B., ... Hu, F. B. (2016). Association of Specific Dietary Fats With Total and Cause-Specific Mortality. JAMA Internal Medicine, 176(8), pp. 1134-45. doi:10.1001/jamainternmed.2016.2417.
Wang DD, et al. Association of Specific Dietary Fats With Total and Cause-Specific Mortality. JAMA Intern Med. 2016 08 1;176(8):1134-45. PubMed PMID: 27379574.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of Specific Dietary Fats With Total and Cause-Specific Mortality. AU - Wang,Dong D, AU - Li,Yanping, AU - Chiuve,Stephanie E, AU - Stampfer,Meir J, AU - Manson,JoAnn E, AU - Rimm,Eric B, AU - Willett,Walter C, AU - Hu,Frank B, PY - 2016/7/6/entrez PY - 2016/7/6/pubmed PY - 2017/6/18/medline SP - 1134 EP - 45 JF - JAMA internal medicine JO - JAMA Intern Med VL - 176 IS - 8 N2 - IMPORTANCE: Previous studies have shown distinct associations between specific dietary fat and cardiovascular disease. However, evidence on specific dietary fat and mortality remains limited and inconsistent. OBJECTIVE: To examine the associations of specific dietary fats with total and cause-specific mortality in 2 large ongoing cohort studies. DESIGN, SETTING, AND PARTICIPANTS: This cohort study investigated 83 349 women from the Nurses' Health Study (July 1, 1980, to June 30, 2012) and 42 884 men from the Health Professionals Follow-up Study (February 1, 1986, to January 31, 2012) who were free of cardiovascular disease, cancer, and types 1 and 2 diabetes at baseline. Dietary fat intake was assessed at baseline and updated every 2 to 4 years. Information on mortality was obtained from systematic searches of the vital records of states and the National Death Index, supplemented by reports from family members or postal authorities. Data were analyzed from September 18, 2014, to March 27, 2016. MAIN OUTCOMES AND MEASURES: Total and cause-specific mortality. RESULTS: During 3 439 954 person-years of follow-up, 33 304 deaths were documented. After adjustment for known and suspected risk factors, dietary total fat compared with total carbohydrates was inversely associated with total mortality (hazard ratio [HR] comparing extreme quintiles, 0.84; 95% CI, 0.81-0.88; P < .001 for trend). The HRs of total mortality comparing extreme quintiles of specific dietary fats were 1.08 (95% CI, 1.03-1.14) for saturated fat, 0.81 (95% CI, 0.78-0.84) for polyunsaturated fatty acid (PUFA), 0.89 (95% CI, 0.84-0.94) for monounsaturated fatty acid (MUFA), and 1.13 (95% CI, 1.07-1.18) for trans-fat (P < .001 for trend for all). Replacing 5% of energy from saturated fats with equivalent energy from PUFA and MUFA was associated with estimated reductions in total mortality of 27% (HR, 0.73; 95% CI, 0.70-0.77) and 13% (HR, 0.87; 95% CI, 0.82-0.93), respectively. The HR for total mortality comparing extreme quintiles of ω-6 PUFA intake was 0.85 (95% CI, 0.81-0.89; P < .001 for trend). Intake of ω-6 PUFA, especially linoleic acid, was inversely associated with mortality owing to most major causes, whereas marine ω-3 PUFA intake was associated with a modestly lower total mortality (HR comparing extreme quintiles, 0.96; 95% CI, 0.93-1.00; P = .002 for trend). CONCLUSIONS AND RELEVANCE: Different types of dietary fats have divergent associations with total and cause-specific mortality. These findings support current dietary recommendations to replace saturated fat and trans-fat with unsaturated fats. SN - 2168-6114 UR - https://www.unboundmedicine.com/medline/citation/27379574/Association_of_Specific_Dietary_Fats_With_Total_and_Cause_Specific_Mortality_ L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/jamainternmed.2016.2417 DB - PRIME DP - Unbound Medicine ER -