title: Intake of individual saturated fatty acids and risk of coronary heart disease in US men and women: two prospective longitudinal cohort studies.
abstract: OBJECTIVE
  To investigate the association between long term intake of individual saturated fatty acids (SFAs) and the risk of coronary heart disease, in two large cohort studies.
  
  
  METHODS
  Prospective, longitudinal cohort study.
  
  
  METHODS
  Health professionals in the United States.
  
  
  METHODS
  73 147 women in the Nurses' Health Study (1984-2012) and 42 635 men in the Health Professionals Follow-up Study (1986-2010), who were free of major chronic diseases at baseline.
  
  
  METHODS
  Incidence of coronary heart disease (n=7035) was self-reported, and related deaths were identified by searching National Death Index or through report of next of kin or postal authority. Cases were confirmed by medical records review.
  
  
  RESULTS
  Mean intake of SFAs accounted for 9.0-11.3% energy intake over time, and was mainly composed of lauric acid (12:0), myristic acid (14:0), palmitic acid (16:0), and stearic acid (18:0; 8.8-10.7% energy). Intake of 12:0, 14:0, 16:0 and 18:0 were highly correlated, with Spearman correlation coefficients between 0.38 and 0.93 (all P<0.001). Comparing the highest to the lowest groups of individual SFA intakes, hazard ratios of coronary heart disease were 1.07 (95% confidence interval 0.99 to 1.15; Ptrend=0.05) for 12:0, 1.13 (1.05 to 1.22; Ptrend<0.001) for 14:0, 1.18 (1.09 to 1.27; Ptrend<0.001) for 16:0, 1.18 (1.09 to 1.28; Ptrend<0.001) for 18:0, and 1.18 (1.09 to 1.28; Ptrend<0.001) for all four SFAs combined (12:0-18:0), after multivariate adjustment of lifestyle factors and total energy intake. Hazard ratios of coronary heart disease for isocaloric replacement of 1% energy from 12:0-18:0 were 0.92 (95% confidence interval 0.89 to 0.96; P<0.001) for polyunsaturated fat, 0.95 (0.90 to 1.01; P=0.08) for monounsaturated fat, 0.94 (0.91 to 0.97; P<0.001) for whole grain carbohydrates, and 0.93 (0.89 to 0.97; P=0.001) for plant proteins. For individual SFAs, the lowest risk of coronary heart disease was observed when the most abundant SFA, 16:0, was replaced. Hazard ratios of coronary heart disease for replacing 1% energy from 16:0 were 0.88 (95% confidence interval 0.81 to 0.96; P=0.002) for polyunsaturated fat, 0.92 (0.83 to 1.02; P=0.10) for monounsaturated fat, 0.90 (0.83 to 0.97; P=0.01) for whole grain carbohydrates, and 0.89 (0.82 to 0.97; P=0.01) for plant proteins.
  
  
  CONCLUSIONS
  Higher dietary intakes of major SFAs are associated with an increased risk of coronary heart disease. Owing to similar associations and high correlations among individual SFAs, dietary recommendations for the prevention of coronary heart disease should continue to focus on replacing total saturated fat with more healthy sources of energy.
authors.affiliation: Department of Nutrition, Harvard T H Chan School of Public Health, Boston, MA, USA.
authors.forename: Geng
authors.initials: G
authors.lastname: Zong
authors.affiliation: Department of Nutrition, Harvard T H Chan School of Public Health, Boston, MA, USA.
authors.forename: Yanping
authors.initials: Y
authors.lastname: Li
authors.affiliation: Unilever Research and Development, 3133AT, Vlaardingen, Netherlands.
authors.forename: Anne J
authors.initials: AJ
authors.lastname: Wanders
authors.affiliation: Unilever Research and Development, 3133AT, Vlaardingen, Netherlands.
authors.forename: Marjan
authors.initials: M
authors.lastname: Alssema
authors.affiliation: Unilever Research and Development, 3133AT, Vlaardingen, Netherlands.
authors.forename: Peter L
authors.initials: PL
authors.lastname: Zock
authors.affiliation: Departments of Nutrition and Epidemiology, Harvard T H Chan School of Public Health, Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Walter C
authors.initials: WC
authors.lastname: Willett
authors.affiliation: Departments of Nutrition and Epidemiology, Harvard T H Chan School of Public Health, Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Frank B
authors.initials: FB
authors.lastname: Hu
authors.affiliation: Department of Nutrition, Harvard T H Chan School of Public Health, Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 665 Huntington Avenue, Boston, MA 02115, USA qisun@hsph.harvard.edu.
authors.forename: Qi
authors.initials: Q
authors.lastname: Sun
mesh_terms: D000328:Adult; D000368:Aged; D003327:Coronary Disease / Q000453:epidemiology*; D002149:Energy Intake; D005227:Fatty Acids / Q000008:administration & dosage* / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006282:Health Personnel; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology
chemical_list: D005227:Fatty Acids