To evaluate the relation between intake and adipose tissue composition of fatty acids and acute myocardial infarction in Portuguese men.
Design
Case-control study. Diet was assessed using a semiquantitative food frequency questionnaire. In 49 case and 49 control subjects, adipose tissue composition was assessed by gas-liquid chromatography.
Subjects/Setting
Population-based; subjects were 297 consecutively admitted cases of first acute myocardial infarction in a tertiary care hospital who were aged ≥40 years. Three hundred ten community controls were selected by random-digit dialing.
Main Outcome Measure
Odds ratio (OR).
Statistical Analysis Performed
Logistic regression, adjusting for age, education, family history of acute myocardial infarction, smoking, physical activity, body mass index, and energy intake.
Results
Total fat intake (OR 0.45, fourth quartile, P=0.02), lauric acid (OR 0.44, fourth quartile, P=0.02), palmitic acid (OR 0.58, fourth quartile, P=0.03), and oleic acid (OR 0.42, fourth quartile, P=0.03) were inversely associated with acute myocardial infarction. No significant effects were found for the remaining fatty acids. In the adipose tissue composition data, the adjusted risk estimates of acute myocardial infarction for the highest vs the lowest tertile were 0.16, 0.14, and 0.04 for lauric, oleic, and trans-fatty acids, respectively. A significant direct association was found for palmitic and linoleic acids (adjusted ORs for the highest tertile were 9.02 and 3.63, respectively).
Conclusions
Low intake of total fat and lauric acid from dairy products was associated with acute myocardial infarction. The association of polyunsaturated fatty acids with risk of acute myocardial infarction was nonsignificant after adjustment for energy intake and confounders. Recommendations on fatty acid intake should aim for both an upper and lower limit.
Section snippets
Subjects
Case subjects were derived from patients aged 40 years or older, consecutively admitted to the Department of Cardiology of Hospital de S João in Porto, in northern Portugal, with a diagnosis of first acute myocardial infarction, who survived at least four days after the acute event (n=377). The diagnosis of acute myocardial infarction was based on fulfilling two out of three criteria: clinical, electrocardiographic, and serum enzyme pattern. We excluded patients unable to answer the
Results
The characteristics of participants, considering previously known general risk factors for myocardial infarction and intake of macronutrients and ethanol, are shown in Table 1. In both groups, the prevalence of smoking was considerably higher in case subjects than control subjects, case subjects were less educated and had significantly lower total fat and carbohydrates intake and higher ethanol intake and level of total physical activity. There were no significant differences between case
Discussion
In this study, total fat intake as measured by FFQ was inversely associated with the occurrence of acute myocardial infarction. The risk of acute myocardial infarction was significantly reduced by higher intake of lauric, palmitic, and oleic acids, after adjusting for energy intake and confounders. The same tendency was observed for myristic, linoleic, and α-linolenic acids, although statistical significance was not reached. No such effect was found for stearic, eicosapentaenoic,
Conclusions
In this population-based case-control study performed in an area with low average intake of saturated fatty acids and moderate intake of total fat, the role of the intake of total fat and individual fatty acids was somewhat different from that reported in populations with high intakes of total fat and saturated fatty acids. Lower intakes of total fat and the saturated lauric acid and the content in trans-fatty acids of adipose tissue were associated with an increased risk of acute myocardial
C. Lopes is an assistant professor of Epidemiology, A. Azevedo is an assistant professor of Epidemiology and a resident in Internal Medicine, E. Ramos is a researcher, and H. Barros is a professor of Epidemiology and head of the department, Department of Epidemiology, University of Porto Medical School, Porto, Portugal.
Dietary guidelines for healthy American adults: A statement for health professionals from the Nutrition Committee, American Heart Association
Circulation
(1996)
F. Hu et al.
Types of dietary fat and risk of coronary heart disease: A critical review
J Am Coll Nutr
(2001)
A. Ascherio
Epidemiologic studies on dietary fats and coronary heart disease
Am J Med
(2002)
L.H. Kushi et al.
Diet and 20-year mortality from coronary heart disease: The Ireland-Boston Diet-Heart study
N Engl J Med
(1985)
D. McGee et al.
Ten-year incidence of coronary heart disease in the Honolulu Heart Program: Relationship to nutrient intake
Am J Epidemiol
(1984)
T. Gordon et al.
Diet and its relation to coronary heart disease and death in three populations
Circulation
(1981)
R.B. Shekelle et al.
Diet, serum cholesterol, and death from coronary heart disease: The Western Electric study
N Engl J Med
(1981)
P. Pietinen et al.
Intake of fatty acids and risk of coronary heart disease in a cohort of Finnish menThe Alpha-Tocopherol, Beta-Carotene Cancer Prevention study
Am J Epidemiol
(1997)
A. Ascherio et al.
Dietary fat and risk of coronary heart disease in men: Cohort follow up study in the United States
BMJ
(1996)
D. Kromhout et al.
Prevalence and 10-year mortality from coronary heart disease in 871 middle-aged men
Am J Epidemiol
(1984)
Cited by (0)
C. Lopes is an assistant professor of Epidemiology, A. Azevedo is an assistant professor of Epidemiology and a resident in Internal Medicine, E. Ramos is a researcher, and H. Barros is a professor of Epidemiology and head of the department, Department of Epidemiology, University of Porto Medical School, Porto, Portugal.
A. Aro is a professor of Epidemiology and a researcher, Department of Health and Functional Capacity, KTL, National Public Health Institute, Helsinki, Finland.
