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Dietary fatty acid intake after myocardial infarction: a theoretical substitution analysis of the Alpha Omega Cohort.
Am J Clin Nutr 2017; 106(3):895-901AJ

Abstract

Background

Replacement of saturated fatty acids (SFAs) with unsaturated fatty acids (UFAs), especially polyunsaturated fatty acids (PUFAs), has been associated with a lower risk of ischemic heart disease (IHD). Whether this replacement is beneficial for drug-treated patients with cardiac disease is not yet clear.

Objective

In a prospective study of Dutch patients with cardiac disease (Alpha Omega Cohort), we examined the risk of cardiovascular disease (CVD) and IHD mortality when the sum of SFAs and trans fatty acids (TFAs) was theoretically replaced by total UFAs, PUFAs, or cis monounsaturated fatty acids (MUFAs).

Design

We included 4146 state-of-the-art drug-treated patients aged 60-80 y with a history of myocardial infarction (79% male patients) and reliable dietary data at baseline (2002-2006). Cause-specific mortality was monitored until 1 January 2013. HRs for CVD mortality and IHD mortality for theoretical, isocaloric replacement of dietary fatty acids (FAs) in quintiles (1-5) and continuously (per 5% of energy) were obtained from Cox regression models, adjusting for demographic factors, medication use, and lifestyle and dietary factors.

Results

Patients consumed, on average, 17.5% of energy of total UFAs, 13.0% of energy of SFAs, and <1% of energy of TFAs. During ∼7 y of follow-up, 372 CVD deaths and 249 IHD deaths occurred. Substitution modeling yielded significantly lower risks of CVD mortality when replacing SFAs plus TFAs with total UFAs [HR in quintile 5 compared with quintile 1: 0.45 (95% CI: 0.28, 0.72)] or PUFAs [HR: 0.66 (95% CI: 0.44, 0.98)], whereas HRs in cis MUFA quintiles were nonsignificant. HRs were similar for IHD mortality. In continuous analyses, replacement of SFAs plus TFAs with total UFAs, PUFAs, or cis MUFAs (per 5% of energy) was associated with significantly lower risks of CVD mortality (HRs between 0.68 and 0.75) and IHD mortality (HRs between 0.55 and 0.70).

Conclusion

Shifting the FA composition of the diet toward a higher proportion of UFAs may lower CVD mortality risk in drug-treated patients with cardiac disease. This study was registered at clinicaltrials.gov as NCT03192410.

Authors+Show Affiliations

Division of Human Nutrition, Wageningen University, Wageningen, Netherlands.Division of Human Nutrition, Wageningen University, Wageningen, Netherlands.Unilever Research and Development, Vlaardingen, Netherlands.Unilever Research and Development, Vlaardingen, Netherlands.Division of Human Nutrition, Wageningen University, Wageningen, Netherlands. Department of Epidemiology, University Medical Center Groningen, Groningen, Netherlands.Division of Human Nutrition, Wageningen University, Wageningen, Netherlands.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28793994

Citation

Mölenberg, Famke J M., et al. "Dietary Fatty Acid Intake After Myocardial Infarction: a Theoretical Substitution Analysis of the Alpha Omega Cohort." The American Journal of Clinical Nutrition, vol. 106, no. 3, 2017, pp. 895-901.
Mölenberg FJM, de Goede J, Wanders AJ, et al. Dietary fatty acid intake after myocardial infarction: a theoretical substitution analysis of the Alpha Omega Cohort. Am J Clin Nutr. 2017;106(3):895-901.
Mölenberg, F. J. M., de Goede, J., Wanders, A. J., Zock, P. L., Kromhout, D., & Geleijnse, J. M. (2017). Dietary fatty acid intake after myocardial infarction: a theoretical substitution analysis of the Alpha Omega Cohort. The American Journal of Clinical Nutrition, 106(3), pp. 895-901. doi:10.3945/ajcn.117.157826.
Mölenberg FJM, et al. Dietary Fatty Acid Intake After Myocardial Infarction: a Theoretical Substitution Analysis of the Alpha Omega Cohort. Am J Clin Nutr. 2017 Sep 1;106(3):895-901. PubMed PMID: 28793994.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dietary fatty acid intake after myocardial infarction: a theoretical substitution analysis of the Alpha Omega Cohort. AU - Mölenberg,Famke J M, AU - de Goede,Janette, AU - Wanders,Anne J, AU - Zock,Peter L, AU - Kromhout,Daan, AU - Geleijnse,Johanna M, PY - 2017/03/29/received PY - 2017/06/29/accepted PY - 2017/8/11/pubmed PY - 2019/5/14/medline PY - 2017/8/11/entrez KW - cardiac patients KW - cardiovascular disease KW - coronary heart disease KW - dietary fatty acids KW - prospective cohort study KW - substitution analysis SP - 895 EP - 901 JF - The American journal of clinical nutrition JO - Am. J. Clin. Nutr. VL - 106 IS - 3 N2 - Background: Replacement of saturated fatty acids (SFAs) with unsaturated fatty acids (UFAs), especially polyunsaturated fatty acids (PUFAs), has been associated with a lower risk of ischemic heart disease (IHD). Whether this replacement is beneficial for drug-treated patients with cardiac disease is not yet clear. Objective: In a prospective study of Dutch patients with cardiac disease (Alpha Omega Cohort), we examined the risk of cardiovascular disease (CVD) and IHD mortality when the sum of SFAs and trans fatty acids (TFAs) was theoretically replaced by total UFAs, PUFAs, or cis monounsaturated fatty acids (MUFAs). Design: We included 4146 state-of-the-art drug-treated patients aged 60-80 y with a history of myocardial infarction (79% male patients) and reliable dietary data at baseline (2002-2006). Cause-specific mortality was monitored until 1 January 2013. HRs for CVD mortality and IHD mortality for theoretical, isocaloric replacement of dietary fatty acids (FAs) in quintiles (1-5) and continuously (per 5% of energy) were obtained from Cox regression models, adjusting for demographic factors, medication use, and lifestyle and dietary factors. Results: Patients consumed, on average, 17.5% of energy of total UFAs, 13.0% of energy of SFAs, and <1% of energy of TFAs. During ∼7 y of follow-up, 372 CVD deaths and 249 IHD deaths occurred. Substitution modeling yielded significantly lower risks of CVD mortality when replacing SFAs plus TFAs with total UFAs [HR in quintile 5 compared with quintile 1: 0.45 (95% CI: 0.28, 0.72)] or PUFAs [HR: 0.66 (95% CI: 0.44, 0.98)], whereas HRs in cis MUFA quintiles were nonsignificant. HRs were similar for IHD mortality. In continuous analyses, replacement of SFAs plus TFAs with total UFAs, PUFAs, or cis MUFAs (per 5% of energy) was associated with significantly lower risks of CVD mortality (HRs between 0.68 and 0.75) and IHD mortality (HRs between 0.55 and 0.70). Conclusion: Shifting the FA composition of the diet toward a higher proportion of UFAs may lower CVD mortality risk in drug-treated patients with cardiac disease. This study was registered at clinicaltrials.gov as NCT03192410. SN - 1938-3207 UR - https://www.unboundmedicine.com/medline/citation/28793994/Dietary_fatty_acid_intake_after_myocardial_infarction:_a_theoretical_substitution_analysis_of_the_Alpha_Omega_Cohort_ L2 - https://academic.oup.com/ajcn/article-lookup/doi/10.3945/ajcn.117.157826 DB - PRIME DP - Unbound Medicine ER -