title: Dietary Cholesterol Increases the Risk whereas PUFAs Reduce the Risk of Active Tuberculosis in Singapore Chinese.
abstract: Experimental studies suggest that cholesterol enhances the intracellular survival of Mycobacterium tuberculosis, whereas marine ω-3 (n-3) and ω-6 (n-6) fatty acids (FAs) may modulate responses to M. tuberculosis in macrophage and animal models. However, there are no epidemiologic data from prospective studies of the relation between dietary cholesterol and FAs and the risk of developing active tuberculosis.
  
  
  
  We aimed to investigate the relation between dietary intake of cholesterol and FAs and the risk of active tuberculosis in a prospective cohort in Singapore.
  
  
  
  We analyzed data from the Singapore Chinese Health Study, a cohort of 63,257 Chinese men and women aged 45-74 y recruited between 1993 and 1998. Dietary intake of cholesterol and FAs was determined with the use of a validated food-frequency questionnaire. Incident cases of active tuberculosis were identified via linkage with the nationwide tuberculosis registry. Analysis was performed with the use of Cox proportional hazards models.
  
  
  
  As of 31 December 2013, 1136 incident cases of active tuberculosis were identified. Dietary cholesterol was positively associated with an increased risk of active tuberculosis in a dose-dependent manner. Compared with the lowest intake quartile, the HR was 1.22 (95% CI: 1.00, 1.47) for the highest quartile (P-trend = 0.04). Conversely, dietary marine n-3 and n-6 FAs were associated with a reduced risk of active tuberculosis in a dose-dependent manner. Compared with the lowest quartile, the HR for the highest intake quartile was 0.77 (95% CI: 0.62, 0.95) for marine n-3 FAs (P-trend = 0.01) and 0.82 (95% CI: 0.68, 0.98) for n-6 FAs (P-trend = 0.03). There was no association with saturated, monounsaturated, or plant-based n-3 FA intake.
  
  
  
  Dietary intake of cholesterol may increase the risk of active tuberculosis, whereas marine n-3 and n-6 FAs may reduce the risk of active tuberculosis in the Chinese population.
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, Singapore;
authors.forename: Avril Z
authors.initials: AZ
authors.lastname: Soh
authors.affiliation: Singapore Tuberculosis Control Unit, Tan Tock Seng Hospital, Singapore;
authors.forename: Cynthia Be
authors.initials: CB
authors.lastname: Chee
authors.affiliation: Singapore Tuberculosis Control Unit, Tan Tock Seng Hospital, Singapore;
authors.forename: Yee-Tang
authors.initials: YT
authors.lastname: Wang
authors.affiliation: Division of Cancer Control and Population Sciences, University of Pittsburgh Cancer Institute, and Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA; and.
authors.forename: Jian-Min
authors.initials: JM
authors.lastname: Yuan
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Duke-NUS Graduate Medical School Singapore, Singapore woonpuay.koh@duke-nus.edu.sg.
authors.forename: Woon-Puay
authors.initials: WP
authors.lastname: Koh
mesh_terms: D000368:Aged; D044466:Asian People; D002681:China / Q000208:ethnology; D002791:Cholesterol, Dietary / Q000009:adverse effects*; D004032:Diet; D004034:Diet Surveys; D004305:Dose-Response Relationship, Drug; D002149:Energy Intake; D015525:Fatty Acids, Omega-3 / Q000494:pharmacology*; D043371:Fatty Acids, Omega-6 / Q000494:pharmacology*; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000254:growth & development; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012846:Singapore; D014376:Tuberculosis / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology / Q000517:prevention & control
chemical_list: D002791:Cholesterol, Dietary; D015525:Fatty Acids, Omega-3; D043371:Fatty Acids, Omega-6
keywords: PUFA; cholesterol; diet; epidemiology; fatty acids; tuberculosis