Association of dietary nutrients with blood lipids and blood pressure in 18 countries: a cross-sectional analysis from the PURE study

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Fourie, J and Muzigaba, M and Xapa, S and Gobile, N and Ndayi, K and Jwili, B and Ndibaza, K and Egbujie, B and Rosengren, A and Bengtsson Boström, K and Gustavsson, A and Andreasson, M and Snällman, M and Wirdemann, L and Yeates, K and Sleeth, J and Kilonzo, K and Oguz, A and Imeryuz, N and Altuntas, Y and Gulec, S and Temizhan, A and Karsidag, K and Calik, KBT and Akalin, AAK and Caklili, OT and Keskinler, MV and Erbakan, AN and Yusufali, AM and Almahmeed, W and Swidan, H and Darwish, EA and Hashemi, ARA and Al-Khaja, N and Muscat-Baron, JM and Ahmed, SH and Mamdouh, TM and Darwish, WM and Abdelmotagali, MHS and Awed, SA Omer and Movahedi, GA and Hussain, F and Al Shaibani, H and Gharabou, RIM and Youssef, DF and Nawati, AZS and Salah, ZAR Abu and Abdalla, RFE and Al Shuwaihi, SM and Al Omairi, MA and Cadigal, OD and Alejandrino, R.S. and Chifamba, J and Gwaunza, L and Terera, G and Mahachi, C and Murambiwa, P and Machiweni, T and Mapanga, R (2017) Association of dietary nutrients with blood lipids and blood pressure in 18 countries: a cross-sectional analysis from the PURE study. The Lancet Diabetes & Endocrinology, 5 (10). p. 774. ISSN 22138587

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BACKGROUND: The relation between dietary nutrients and cardiovascular disease risk markers in many regions worldwide is unknown. In this study, we investigated the effect of dietary nutrients on blood lipids and blood pressure, two of the most important risk factors for cardiovascular disease, in low-income, middle-income, and high-income countries. METHODS: We studied 125 287 participants from 18 countries in North America, South America, Europe, Africa, and Asia in the Prospective Urban Rural Epidemiology (PURE) study. Habitual food intake was measured with validated food frequency questionnaires. We assessed the associations between nutrients (total fats, saturated fatty acids, monounsaturated fatty acids, polyunsaturated fatty acids, carbohydrates, protein, and dietary cholesterol) and cardiovascular disease risk markers using multilevel modelling. The effect of isocaloric replacement of saturated fatty acids with other fats and carbohydrates was determined overall and by levels of intakes by use of nutrient density models. We did simulation modelling in which we assumed that the effects of saturated fatty acids on cardiovascular disease events was solely related to their association through an individual risk marker, and then compared these simulated risk marker-based estimates with directly observed associations of saturated fatty acids with cardiovascular disease events. FINDINGS: Participants were enrolled into the study from Jan 1, 2003, to March 31, 2013. Intake of total fat and each type of fat was associated with higher concentrations of total cholesterol and LDL cholesterol, but also with higher HDL cholesterol and apolipoprotein A1 (ApoA1), and lower triglycerides, ratio of total cholesterol to HDL cholesterol, ratio of triglycerides to HDL cholesterol, and ratio of apolipoprotein B (ApoB) to ApoA1 (all ptrend<0·0001). Higher carbohydrate intake was associated with lower total cholesterol, LDL cholesterol, and ApoB, but also with lower HDL cholesterol and ApoA1, and higher triglycerides, ratio of total cholesterol to HDL cholesterol, ratio of triglycerides to HDL cholesterol, and ApoB-to-ApoA1 ratio (all ptrend<0·0001, apart from ApoB [ptrend=0·0014]). Higher intakes of total fat, saturated fatty acids, and carbohydrates were associated with higher blood pressure, whereas higher protein intake was associated with lower blood pressure. Replacement of saturated fatty acids with carbohydrates was associated with the most adverse effects on lipids, whereas replacement of saturated fatty acids with unsaturated fats improved some risk markers (LDL cholesterol and blood pressure), but seemed to worsen others (HDL cholesterol and triglycerides). The observed associations between saturated fatty acids and cardiovascular disease events were approximated by the simulated associations mediated through the effects on the ApoB-to-ApoA1 ratio, but not with other lipid markers including LDL cholesterol. INTERPRETATION: Our data are at odds with current recommendations to reduce total fat and saturated fats. Reducing saturated fatty acid intake and replacing it with carbohydrate has an adverse effect on blood lipids. Substituting saturated fatty acids with unsaturated fats might improve some risk markers, but might worsen others. Simulations suggest that ApoB-to-ApoA1 ratio probably provides the best overall indication of the effect of saturated fatty acids on cardiovascular disease risk among the markers tested. Focusing on a single lipid marker such as LDL cholesterol alone does not capture the net clinical effects of nutrients on cardiovascular risk.

Item Type:Article
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Uncontrolled Keywords:PURE; Diet; Nutrition
Subjects:Nutrition and Diabetes
Divisions:Department of Epidemiology
Department of Diabetology
ID Code:1068
Deposited By:surendar radha
Deposited On:26 Oct 2017 12:38
Last Modified:26 Oct 2017 12:38

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