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JOURNAL ARTICLE

Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study

Mahshid Dehghan, Andrew Mente, Xiaohe Zhang, Sumathi Swaminathan, Wei Li, Viswanathan Mohan, Romaina Iqbal, Rajesh Kumar, Edelweiss Wentzel-Viljoen, Annika Rosengren, Leela Itty Amma, Alvaro Avezum, Jephat Chifamba, Rafael Diaz, Rasha Khatib, Scott Lear, Patricio Lopez-Jaramillo, Xiaoyun Liu, Rajeev Gupta, Noushin Mohammadifard, Nan Gao, Aytekin Oguz, Anis Safura Ramli, Pamela Seron, Yi Sun, Andrzej Szuba, Lungiswa Tsolekile, Andreas Wielgosz, Rita Yusuf, Afzal Hussein Yusufali, Koon K Teo, Sumathy Rangarajan, Gilles Dagenais, Shrikant I Bangdiwala, Shofiqul Islam, Sonia S Anand, Salim Yusuf
Lancet 2017 November 4, 390 (10107): 2050-2062
28864332

BACKGROUND: The relationship between macronutrients and cardiovascular disease and mortality is controversial. Most available data are from European and North American populations where nutrition excess is more likely, so their applicability to other populations is unclear.

METHODS: The Prospective Urban Rural Epidemiology (PURE) study is a large, epidemiological cohort study of individuals aged 35-70 years (enrolled between Jan 1, 2003, and March 31, 2013) in 18 countries with a median follow-up of 7·4 years (IQR 5·3-9·3). Dietary intake of 135 335 individuals was recorded using validated food frequency questionnaires. The primary outcomes were total mortality and major cardiovascular events (fatal cardiovascular disease, non-fatal myocardial infarction, stroke, and heart failure). Secondary outcomes were all myocardial infarctions, stroke, cardiovascular disease mortality, and non-cardiovascular disease mortality. Participants were categorised into quintiles of nutrient intake (carbohydrate, fats, and protein) based on percentage of energy provided by nutrients. We assessed the associations between consumption of carbohydrate, total fat, and each type of fat with cardiovascular disease and total mortality. We calculated hazard ratios (HRs) using a multivariable Cox frailty model with random intercepts to account for centre clustering.

FINDINGS: During follow-up, we documented 5796 deaths and 4784 major cardiovascular disease events. Higher carbohydrate intake was associated with an increased risk of total mortality (highest [quintile 5] vs lowest quintile [quintile 1] category, HR 1·28 [95% CI 1·12-1·46], ptrend=0·0001) but not with the risk of cardiovascular disease or cardiovascular disease mortality. Intake of total fat and each type of fat was associated with lower risk of total mortality (quintile 5 vs quintile 1, total fat: HR 0·77 [95% CI 0·67-0·87], ptrend<0·0001; saturated fat, HR 0·86 [0·76-0·99], ptrend=0·0088; monounsaturated fat: HR 0·81 [0·71-0·92], ptrend<0·0001; and polyunsaturated fat: HR 0·80 [0·71-0·89], ptrend<0·0001). Higher saturated fat intake was associated with lower risk of stroke (quintile 5 vs quintile 1, HR 0·79 [95% CI 0·64-0·98], ptrend=0·0498). Total fat and saturated and unsaturated fats were not significantly associated with risk of myocardial infarction or cardiovascular disease mortality.

INTERPRETATION: High carbohydrate intake was associated with higher risk of total mortality, whereas total fat and individual types of fat were related to lower total mortality. Total fat and types of fat were not associated with cardiovascular disease, myocardial infarction, or cardiovascular disease mortality, whereas saturated fat had an inverse association with stroke. Global dietary guidelines should be reconsidered in light of these findings.

FUNDING: Full funding sources listed at the end of the paper (see Acknowledgments).

Comments

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Terren Trott wrote:

19

Please also see JAMA's 2017 editorial on 'big sugar' and influence of the last 50 years of research. Reputable source contradicting most of what's known about 'proper diet'.

Matthias Friedrich wrote:

10

It's obvious that, now globally, sugar, which makes lives shorter

Leandro Franco wrote:

5

Methodolgical bias...lower overall mortality, but not lower mortality related to cardiovascular disease.
What does it means? Poorer population have a diet with higher carbohidrate intake, and have also worse public health assistence. The increased overall mortality could be explained by this fact.

Dietrich Zschaeck wrote:

2

These results are not unexpected if you follow good science papers. The dreafull 9 country study published by Ansel Keys vilified fats in the diet, which resulted in a US policy of reducing fat intake from 40% of total calories as Fats to 30%, with the result of increased cardiovascular mortality, incidence of Type2 DM and obesity. BAD SCIENCE WITH VERY BAD CONSEQUENCES.
This is a very challenging study. Where is it published? D. Zschaeck MD. Venezuela

Jerry Yoo wrote:

2

further support for the ketogenic diet.

Mariwan Saka wrote:

1

Hi everyone for those interested in this article please send your mail so I can forwarded to you
Regards

Angela Martin wrote:

0

Pelease send me a copy

Tarik Saab wrote:

0

Can You please send me a copyright

Ali Alavi wrote:

0

Its interesting and may be change our vision to this

Mona Mansour wrote:

0

Send a copy for the recommendation of this article
Thank you

Marlou Funtanar wrote:

0

Can you please send me a copy? Thanks

joao fernandes wrote:

0

Pl ase sendo me a copa. Thank you!

Shelia Catlett wrote:

0

Please send me a copy of this paper

Talat Rakhmanov wrote:

0

Thanks! Very interesting !Please send me a copy!

Mia Boloix wrote:

0

Where can I get a copy of this paper?

Michael Heneghan wrote:

0

How do I get a copy of the paper

Dennis Hines Jr MD wrote:

0

Is then correlation of saturated fat and cerebral atrophy ?

cesar rojas wrote:

0

interesanting

Juan Chero wrote:

0

Njj

Ricardo Correa wrote:

0

Unbelievable!!

Abdulfattah Elforgani wrote:

0

It implies to us here in Libya?

Dennis Hines Jr MD wrote:

-1

Please send a copy to my email of the study. Thanks

Javier Amor wrote:

-1

Please send me a copy
Javier Amor

Jose Orozco wrote:

-1

Please send me a copy

salvador dell wrote:

-1

Please send me a copy
Thank you.

Mohamed Hussein wrote:

-1

Can you send me the paper

Uun Ratriantari wrote:

-2

Your article is very interesting, can you send me your paper please? Thank you

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