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

Dehghan, M and Mente, A and Zhang, X and Swaminathan, S and Li, Wei and Kumar, Rajesh and Mohan, V and Deepa, M and Parthiban, K and Anitha, M and Hemavathy, S and Rahulashankiruthiyayan, T and Anitha, D and Sridevi, K and Gupta, R and Panwar, RB and Renjini, AR and Deepu, A and Sandhya, B and Asha, S and Soumya, HS and Kelishadi, R and Bahonar, A and Mohammadifard, N and Heidari, H and Yusoff, K and Ismail, TST and Ng, KK and Devi, A and Yasin, MM and Nasir, NM and Miskan, M and Rahman, EA and Arsad, MKM and Ariffin, F and Razak, SA and Majid, FA and Bakar, NA and Yacob, MY and Zainon, N and Salleh, R and Ramli, MKA and Halim, NA and Norlizan, SR and Ghazali, NM and Arshad, MN and Razali, R and Ali, S and Othman, HR and Hafar, CWJCW and Pit, A and Danuri, N and Basir, F and Zahari, SNA and Abdullah, H and Arippin, MA and Zakaria, NA and Noorhassim, I and Hasni, MJ and Azmi, MT and Zaleha, MI and Hazdi, KY and Rizam, AR and Sazman, W and Azman, A and Khatib, R and Khammash, U and Khatib, A and Giacaman, R and Iqbal, R and Afridi, A and Khawaja, R and Raza, A and Kazmi, K and Zatonski, W and Szuba, A and Zatonska, K and Ilow, R and Ferus, M and Regulska-Ilow, B and Rózanska, D and Wolyniec, M and Alkamel, and Ali, M and Kruger, M A and Voster, H H and Schutte, A E and Wentzel-Viljoen, E and Eloff, FC and de Ridder, H and Moss, H and Potgieter, J and Roux, AA and Watson, M and de Wet, G and Olckers, A and Jerling, JC and Pieters, M and Hoekstra, T and Puoane, T and Igumbor, E and Tsolekile, L and Sanders, D and Naidoo, P and Steyn, N and Peer, N and Mayosi, B and Rayner, B and Lambert, V and Levitt, N and Kolbe-Alexander, T and Ntyintyane, L and Hughes, G and Swart, R and 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 Boström, K Bengtsson and Gustavsson, A and Andreasson, M and Snällman, M and Wirdemann, L 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 , GA (2017) Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study. The Lancet, 390 (10107). p. 2050. ISSN 01406736



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.

Item Type:Article
Official URL/DOI:
Uncontrolled Keywords:PURE; Carbohydrate intake; cardiovascular
Subjects:Diabetology > Cardiovascular Diabetology
Divisions:Department of Epidemiology
Department of Diabetology
ID Code:1071
Deposited By:surendar radha
Deposited On:10 Nov 2017 16:11
Last Modified:10 Nov 2017 16:11

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