title: The association between dietary saturated fatty acids and ischemic heart disease depends on the type and source of fatty acid in the European Prospective Investigation into Cancer and Nutrition-Netherlands cohort.
abstract: BACKGROUND
  The association between saturated fatty acid (SFA) intake and ischemic heart disease (IHD) risk is debated.
  
  
  OBJECTIVE
  We sought to investigate whether dietary SFAs were associated with IHD risk and whether associations depended on 1) the substituting macronutrient, 2) the carbon chain length of SFAs, and 3) the SFA food source.
  
  
  METHODS
  Baseline (1993-1997) SFA intake was measured with a food-frequency questionnaire among 35,597 participants from the European Prospective Investigation into Cancer and Nutrition-Netherlands cohort. IHD risks were estimated with multivariable Cox regression for the substitution of SFAs with other macronutrients and for higher intakes of total SFAs, individual SFAs, and SFAs from different food sources.
  
  
  RESULTS
  During 12 y of follow-up, 1807 IHD events occurred. Total SFA intake was associated with a lower IHD risk (HR per 5% of energy: 0.83; 95% CI: 0.74, 0.93). Substituting SFAs with animal protein, cis monounsaturated fatty acids, polyunsaturated fatty acids (PUFAs), or carbohydrates was significantly associated with higher IHD risks (HR per 5% of energy: 1.27-1.37). Slightly lower IHD risks were observed for higher intakes of the sum of butyric (4:0) through capric (10:0) acid (HRSD: 0.93; 95% CI: 0.89, 0.99), myristic acid (14:0) (HRSD: 0.90; 95% CI: 0.83, 0.97), the sum of pentadecylic (15:0) and margaric (17:0) acid (HRSD: 0.91: 95% CI: 0.83, 0.99), and for SFAs from dairy sources, including butter (HRSD: 0.94; 95% CI: 0.90, 0.99), cheese (HRSD: 0.91; 95% CI: 0.86, 0.97), and milk and milk products (HRSD: 0.92; 95% CI: 0.86, 0.97).
  
  
  CONCLUSIONS
  In this Dutch population, higher SFA intake was not associated with higher IHD risks. The lower IHD risk observed did not depend on the substituting macronutrient but appeared to be driven mainly by the sums of butyric through capric acid, the sum of pentadecylic and margaric acid, myristic acid, and SFAs from dairy sources. Residual confounding by cholesterol-lowering therapy and trans fat or limited variation in SFA and PUFA intake may explain our findings. Analyses need to be repeated in populations with larger differences in SFA intake and different SFA food sources.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands;
authors.forename: Jaike
authors.initials: J
authors.lastname: Praagman
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands; Department of Epidemiology and Biostatistics.
authors.forename: Joline Wj
authors.initials: JW
authors.lastname: Beulens
authors.affiliation: EMGO+ Institute for Health and Care Research, Vrije University Medical Center, Amsterdam, Netherlands; and Unilever Research and Development, Vlaardingen, Netherlands.
authors.forename: Marjan
authors.initials: M
authors.lastname: Alssema
authors.affiliation: Unilever Research and Development, Vlaardingen, Netherlands.
authors.forename: Peter L
authors.initials: PL
authors.lastname: Zock
authors.affiliation: Unilever Research and Development, Vlaardingen, Netherlands.
authors.forename: Anne J
authors.initials: AJ
authors.lastname: Wanders
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands;
authors.forename: Ivonne
authors.initials: I
authors.lastname: Sluijs
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands; y.t.vanderschouw@umcutrecht.nl.
authors.forename: Yvonne T
authors.identifier: http://orcid.org/0000-0002-4605-435X
authors.initials: YT
authors.lastname: van der Schouw
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003611:Dairy Products / Q000009:adverse effects / Q000032:analysis; D004032:Diet / Q000009:adverse effects / Q000208:ethnology; D004034:Diet Surveys; D018752:Diet, Fat-Restricted / Q000009:adverse effects; D004041:Dietary Fats / Q000009:adverse effects / Q000032:analysis / Q000627:therapeutic use*; D005232:Fatty Acids, Volatile / Q000009:adverse effects / Q000032:analysis / Q000737:chemistry / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008460:Meat / Q000009:adverse effects / Q000032:analysis; D008875:Middle Aged; D008970:Molecular Weight; D017202:Myocardial Ischemia / Q000453:epidemiology / Q000208:ethnology / Q000209:etiology / Q000517:prevention & control*; D009426:Netherlands / Q000453:epidemiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors
chemical_list: D004041:Dietary Fats; D005232:Fatty Acids, Volatile
keywords: epidemiology; follow-up studies; ischemic heart disease; nutrition; saturated fatty acids