Abstract

Introduction: While saturated fat (SFA) intake has long been considered as an important risk factor for cardiovascular disease (CVD), some evidence in recent years has called these findings into question. There is limited evidence examining the separate effects of SFAs from different food sources on cardiovascular risk. Objective: The goal of this study was to determine whether higher (vs. lower) intakes of SFA from dairy and non-dairy sources were associated with risk of incident cardiovascular disease. Methods: Data from 1991 adults, ages 30 and older, who were free of CVD at the time of baseline dietary assessment in the prospective Framingham Offspring Study were included in these analyses. Dairy and non-dairy SFA was assessed using 3-day diet records at exams 3 and 5; intakes were adjusted for body weight using the residual method. Subjects were followed from exam 5 to exam 9 for CVD events (median follow-up 16.9 years). Cox proportional hazards models were used to adjust for confounding by sex, age, BMI, physical activity, smoking (pack-years), non-dairy SFA (in dairy SFA models, and vice versa for non-dairy models), and time dependent occurrence of hypertension or use of lipid-lowering medications. Results: Subjects were classified into 3 categories of sex-specific intake of dairy SFA (<9, 9-<13, and ≥13 g/day for men; <6, 6-<9, ≥9 g/day for women) and non-dairy SFA (<15, 15-<18 and ≥18 g/day for men; <12, 12-<15, and ≥15 g/day for women). Women with moderate (vs. low) and high (vs. low) dairy SFA intakes had 56% (95% CI: 0.27-0.71) and 20% (95% CI: 0.56-1.14) lower CVD risks, respectively, while women consuming high (vs. low) non-dairy SFA had 22% (CI: 0.52-1.16) lower risks. Neither dairy-based SFA nor non-dairy SFA intake was associated with CVD occurrence in men. To determine whether the combined effects of SFA from dairy and non-dairy sources were associated with CVD risk, we cross-classified SFA intakes from the two sources (i.e., high/low dairy SFA intake: <9 vs. ≥9 g/day for men, <6 vs ≥6 g/day for women; high/low non-dairy SFA intake: <15 vs. ≥15 g/day for both men & women). Overall, subjects with higher intakes of dairy SFA combined with lower intakes of non-dairy SFA had the lowest risks of CVD (HR:0.73; 95% CI: 0.54-0.98). These effects were stronger in women (HR:0.60; 95% CI: 0.41-0.88), and non-statistically significant in men (HR: 0.88; 95% CI: 0.54-1.43). Women with higher combined intakes of SFA from both dairy and non-dairy sources still had 44% lower risks of CVD. However, higher intakes of SFA from non-dairy sources alone was not associated with CVD risk in either men or women. Conclusions: Saturated fats derived from dairy sources were associated with a reduced risk of incident CVD in women. For both men and women, those who had higher intakes of dairy-derived SFA combined with lower intakes of non-dairy SFA tended to have lower risks of CVD than those with lower intakes of SFA from both sources.

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