Abstract
PurposeThe relationship of total, saturated, mono-unsaturated and poly-unsaturated fatty acids (SFA, MUFA, PUFA) with coronary heart disease (CHD) is debated. We hypothesized that the association of dairy-derived FA with CHD may be different than the association of meat-derived FA with CHD. We therefore aimed to directly compare association of FA intakes from dairy and meat with risk of CHD using substitution models.MethodsBaseline (1993–1997) FA intake was measured using a validated food frequency questionnaire among 35,767 participants from the European Prospective Investigation into Cancer and Nutrition-Netherlands cohort (EPIC-NL). Incident CHD events (n = 2374) were obtained through linkage with national registries during a mean follow-up of 15 years. Association of FA from dairy substituted with FA from meat with CHD risk was estimated through multivariable Cox regression.ResultsParticipants consumed 81.9 (SD 28.7) grams of FA per day, of which 17.9 (SD 5.2) was from dairy and 15.3 (SD 9.5) from meat. Substituting 1 en% of dairy-derived SFA with meat-derived SFA was associated with higher CHD risk (HR 1.06, 95% CI 1.02–1.10), but substituting dairy-derived MUFA or PUFA did not (HRMUFA 1.03, 95% CI 0.97–1.09; HRPUFA 1.17, 95% CI 0.90–1.53).ConclusionsOur modelling suggests that substituting dairy SFA with meat SFA is associated with a higher risk of CHD, but substituting dairy MUFA or PUFA with meat FA is not. These results need to be replicated in other cohorts with different fat intakes, preferably with larger variation in the intake of MUFA and PUFA from dairy and meat.
Highlights
Dietary guidelines recommend to keep intake of saturated fatty acids (SFA) below 10% of total energy intake, and to replace SFA by mono-unsaturated fatty acids (MUFA) or polyunsaturated fatty acids (PUFA) [37]
Data are expressed as percentage of total SFA intake from food source. In this prospective cohort study among 35,767 men and women, we observed that substituting 1en% SFA from dairy with SFA from meat was associated with a 6% higher risk of coronary heart disease
In the models where substitution was not specified, consuming more FA from meat was associated with a higher risk of coronary heart disease (CHD), whereas a higher FA intake from dairy was generally not associated with incident CHD risk
Summary
Dietary guidelines recommend to keep intake of saturated fatty acids (SFA) below 10% of total energy intake, and to replace SFA by mono-unsaturated fatty acids (MUFA) or polyunsaturated fatty acids (PUFA) [37]. Observational studies and RCTs suggest that replacement of SFA by PUFA decreases CHD risk [13, 20], some observational cohort studies did not confirm this [25, 26]. It remains unclear why the substitution of SFA with unsaturated FA does not improve cardiovascular health in all populations. In a Dutch population, SFA from dairy has been related with a lower CHD risk, whereas SFA from meat or fats was not related to CHD [25]
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