Changes in fatty acid intake and subsequent risk of all-cause and cause-specific mortality in males and females: a prospective cohort study.

IF 6.5 1区医学 Q1 NUTRITION & DIETETICS American Journal of Clinical Nutrition Pub Date : 2024-11-15 DOI:10.1016/j.ajcnut.2024.11.012

Yuxi Liu, Xiao Gu, Yanping Li, Eric B Rimm, Walter C Willett, Meir J Stampfer, Frank B Hu, Dong D Wang

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Abstract

Background: The associations between changes in fatty acid intake over time and subsequent mortality are unclear.

Objective: To prospectively examine associations between changes in fatty acid intake (as percentage of total energy) and mortality.

Methods: Among 65,179 adults from the Nurses' Health Study and Health Professionals Follow-up Study, free from cardiovascular disease, cancer, and diabetes at baseline in 1994, we documented 20,571 deaths through 2020 (1,334,603 person-years). Diets were assessed every four years using validated questionnaires. Hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality risk were estimated from Cox proportional hazards models.

Results: A 5% of energy increment in total fat intake was associated with 5% lower all-cause mortality (HR =0.95; 95% CI: 0.93, 0.96; isocaloric comparison was total carbohydrate). The HRs of all-cause mortality (95% CI) were 0.83 (0.78, 0.89) and 0.91 (0.87, 0.94) for 5% increment in energy intake from polyunsaturated fatty acid (PUFA) and monounsaturated fatty acid (MUFA), respectively, and was 1.10 (1.04, 1.17) for a 1% increase in energy intake from trans fatty acid (TFA; all P_trend ≤0.001). Changes in saturated fatty acid (SFA) were not associated with all-cause mortality. Increases in intakes of linoleic acid, marine n-3 PUFA, and MUFA from plant sources were each significantly associated with lower all-cause mortality. In substitution analyses, replacing 5% energy from SFA with PUFA was associated with 19% lower all-cause mortality (HR =0.81; 95% CI: 0.75, 0.87), while replacing 0.3% of energy from SFA with marine n-3 PUFA was associated with 11% lower all-cause mortality (HR =0.89; 95% CI: 0.84, 0.93). Isocaloric substitution of SFA by PUFA, particularly marine n-3 PUFA, was associated with lower mortality due to cardiovascular, neurodegenerative and respiratory diseases.

Conclusions: These findings support replacing SFA with unsaturated fatty acids (especially from plant sources) and eliminating dietary TFA to reduce premature death.

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男性和女性脂肪酸摄入量的变化与随后的全因和特定原因死亡风险：一项前瞻性队列研究。

背景：脂肪酸摄入量随时间的变化与随后死亡率之间的关系尚不清楚：脂肪酸摄入量随时间的变化与随后死亡率之间的关系尚不清楚：前瞻性研究脂肪酸摄入量（占总能量的百分比）的变化与死亡率之间的关系：我们记录了截至 2020 年的 20,571 例死亡病例（1,334,603 人-年），其中 65,179 名成年人来自 "护士健康研究"（Nurses' Health Study）和 "健康专业人员随访研究"（Health Professionals Follow-up Study），他们在 1994 年基线时未患有心血管疾病、癌症和糖尿病。每四年使用有效问卷对饮食进行一次评估。根据 Cox 比例危险模型估算了死亡风险的危险比 (HR) 和 95% 置信区间 (CI)：结果：总脂肪摄入量每增加 5%，全因死亡率就会降低 5%（HR =0.95；95% CI：0.93，0.96；等热量比较为总碳水化合物）。多不饱和脂肪酸（PUFA）和单不饱和脂肪酸（MUFA）的能量摄入量增加5%，全因死亡率的HRs（95% CI）分别为0.83（0.78，0.89）和0.91（0.87，0.94）；反式脂肪酸（TFA）的能量摄入量增加1%，全因死亡率的HRs为1.10（1.04，1.17）；所有Ptrend均≤0.001）。饱和脂肪酸（SFA）的变化与全因死亡率无关。亚油酸、海洋 n-3 PUFA 和植物来源的 MUFA 摄入量的增加均与全因死亡率的降低显著相关。在替代分析中，用 PUFA 取代 5% 的 SFA 能量可使全因死亡率降低 19%（HR =0.81；95% CI：0.75, 0.87），而用海洋 n-3 PUFA 取代 0.3% 的 SFA 能量可使全因死亡率降低 11%（HR =0.89；95% CI：0.84, 0.93）。用 PUFA（尤其是海洋 n-3 PUFA）等热量替代 SFA 与心血管疾病、神经退行性疾病和呼吸系统疾病导致的死亡率降低有关：这些研究结果支持用不饱和脂肪酸（尤其是来自植物的不饱和脂肪酸）替代 SFA，并消除膳食中的反式脂肪酸，以减少过早死亡。

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来源期刊

American Journal of Clinical Nutrition 医学-营养学

CiteScore

12.40

自引率

4.20%

发文量

332

审稿时长

38 days

期刊介绍： American Journal of Clinical Nutrition is recognized as the most highly rated peer-reviewed, primary research journal in nutrition and dietetics.It focuses on publishing the latest research on various topics in nutrition, including but not limited to obesity, vitamins and minerals, nutrition and disease, and energy metabolism. Purpose: The purpose of AJCN is to: Publish original research studies relevant to human and clinical nutrition. Consider well-controlled clinical studies describing scientific mechanisms, efficacy, and safety of dietary interventions in the context of disease prevention or health benefits. Encourage public health and epidemiologic studies relevant to human nutrition. Promote innovative investigations of nutritional questions employing epigenetic, genomic, proteomic, and metabolomic approaches. Include solicited editorials, book reviews, solicited or unsolicited review articles, invited controversy position papers, and letters to the Editor related to prior AJCN articles. Peer Review Process: All submitted material with scientific content undergoes peer review by the Editors or their designees before acceptance for publication.