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Higher intake of unsaturated fats, carbohydrates from whole grains may reduce CHD risk
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Healthy adults who reported greater consumption of polyunsaturated fatty acids and carbohydrates from whole grains had a reduced risk for CHD, researchers reported in a recent study.
Replacing 5% of the energy derived from saturated fats with polyunsaturated or monounsaturated fats and high-quality carbohydrates would have a significant effect on CHD risk, the researchers wrote.
The study included data collected from 84,628 women enrolled in the Nurses’ Health Study and 42,908 men enrolled in the Health Professionals Follow-up Study. All participants were free of diabetes, CVD and cancer at baseline.
Responses to a semiquantitative food-frequency questionnaire administered every 4 years were used to determine consumption of saturated and unsaturated fats, as well as carbohydrate sources. Follow-up was 24 years in the Health Professionals Follow-up Study and 30 years in the Nurses’ Health Study.
During follow-up, 7,667 patients developed incident CHD, including 4,931 nonfatal MIs and 2,736 CHD-related deaths. Researchers observed significant associations between reduced risk for CHD and increased polyunsaturated fatty acid intake (HR = 0.8; 95% CI, 0.73-0.88 for highest vs. lowest quintile) and consumption of carbohydrates from whole grains (HR = 0.9; 95% CI, 0.83-0.98). CHD risk significantly increased with greater consumption of carbohydrates obtained from refined starches and/or added sugars (HR = 1.1; 95% CI, 1-1.21), as well as consumption of trans fats (HR = 1.2; 95% CI, 1.09-1.32).
The risk for CHD would be reduced significantly if 5% of energy obtained from saturated fat was replaced with energy obtained from consumption of polyunsaturated fatty acids (HR = 0.75; 95% CI, 0.67-0.84), monounsaturated fatty acids (HR = 0.85; 95% CI, 0.74-0.97) or carbohydrates from whole grains (HR = 0.91; 95% CI, 0.85-0.98), the researchers wrote. No significant difference in CHD risk was observed from replacing energy from saturated fats with that obtained from refined starches or added sugars, according to the findings.
“Our observations, together with evidence from previous studies, indicate that evidence-based, population-level and individual-level recommendations to reduce saturated fatty acid consumption should specify replacing saturated fatty acids with unsaturated fats and/or high-quality carbohydrates,” the researchers concluded.
In a related editorial, Robert A. Vogel, MD, from the cardiology section, Department of Veterans Affairs Medical Center, Denver, wrote, “It is time to set aside the low-fat vs. low-carbohydrate diet debate. Healthfulness clearly lies in the quality or type of both fat and carbohydrate.”
Vogel acknowledged the limitations of the study, including that not all saturated fatty acids are similarly associated with CHD; the study was observational and potentially confounded by unmeasured factors; the exclusion of fruits, vegetables, legumes and alcohol from analysis; and the potential inaccuracy of self-reported dietary behavior.
“What we are left with is a slightly clearer message about food as heart medicine,” he wrote. “We in health care need to be better informed about nutrition and nutritional research and have a clearer public health message. The challenge will be to convince an increasingly wary public that we know what we are talking about.” – by Adam Taliercio
Disclosure: One researcher reports receiving honoraria from the Hass Avocado Board for participating in an academic symposium, and grant support from Metagenics and the California Walnut Commission. Vogel reports consulting for the Pritkin Longevity Institute.
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