OBJECTIVE To investigate the association of macronutrient intake with all cause mortality and cardiovascular disease (CVD), and the implications for dietary advice. DESIGN Prospective population based study. SETTING UK Biobank. PARTICIPANTS 195 658 of the 502 536 participants in UK Biobank completed at least one dietary questionnaire and were included in the analyses. Diet was assessed using Oxford WebQ, a web based 24 hour recall questionnaire, and nutrient intakes were estimated using standard methodology. Cox proportional models with penalised cubic splines were used to study non-linear associations. MAIN OUTCOME MEASURES All cause mortality and incidence of CVD. RESULTS 4780 (2.4%) participants died over a mean 10.6 (range 9.4-13.9) years of follow-up, and 948 (0.5%) and 9776 (5.0%) experienced fatal and non-fatal CVD events, respectively, over a mean 9.7 (range 8.5-13.0) years of follow-up. Non-linear associations were found for many macronutrients. Carbohydrate intake showed a non-linear association with mortality; no association at 20-50% of total energy intake but a positive association at 50-70% of energy intake (3.14 v 2.75 per 1000 person years, average hazard ratio 1.14, 95% confidence interval 1.03 to 1.28 (60-70% v 50% of energy)). A similar pattern was observed for sugar but not for starch or fibre. A higher intake of monounsaturated fat (2.94 v 3.50 per 1000 person years, average hazard ratio 0.58, 0.51 to 0.66 (20-25% v 5% of energy)) and lower intake of polyunsaturated fat (2.66 v 3.04 per 1000 person years, 0.78, 0.75 to 0.81 (5-7% v 12% of energy)) and saturated fat (2.66 v 3.59 per 1000 person years, 0.67, 0.62 to 0.73 (5-10% v 20% of energy)) were associated with a lower risk of mortality. A dietary risk matrix was developed to illustrate how dietary advice can be given based on current intake. CONCLUSION Many associations between macronutrient intake and health outcomes are non-linear. Thus dietary advice could be tailored to current intake. Dietary guidelines on macronutrients (eg, carbohydrate) should also take account of differential associations of its components (eg, sugar and starch).

中文翻译：

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脂肪和碳水化合物摄入与心血管疾病和死亡率的关联：对英国生物库参与者的前瞻性队列研究。

目的研究大量营养素摄入与所有原因死亡率和心血管疾病（CVD）的关系，以及对饮食建议的影响。设计基于人群的前瞻性研究。设置英国生物库。参与者UK Biobank的502 536名参与者中的195 658名至少填写了一份饮食调查表，并包括在分析中。使用牛津WebQ（基于网络的24小时召回问卷）评估饮食，并使用标准方法估算营养摄入量。使用带有罚分三次样条的Cox比例模型来研究非线性关联。主要观察指标均引起CVD的死亡和发病。结果4780名（2.4％）参与者在平均10.6年（范围9.4-13.9）的随访期内死亡，分别有948名（0.5％）和9776名（5.0％）经历了致命和非致命性CVD事件，平均随访9.7年（范围8.5-13.0）。发现许多常量营养素之间存在非线性关联。碳水化合物的摄入与死亡率呈非线性关系。在总能量摄入量的20-50％时没有关联，但在能量摄入量的50-70％时为正关联（每千人年3.14 v 2.75，平均危险比1.14，95％置信区间1.03至1.28（60-70％v 50％的能量））。对于糖观察到相似的模式，但对于淀粉或纤维观察不到。较高的单不饱和脂肪摄入量（每1000人年2.94 v 3.50，平均危险比0.58、0.51至0.66（20-25％v能量的5％））和较低的多不饱和脂肪摄入量（每1000人年2.66 v 3.04， 0.78，0.75至0.81（5-7％v 12％的能量））和饱和脂肪（2.66 v 3.59每1000人年，0.67，0.62至0。73（5-10％v 20％的能量）与较低的死亡风险相关。制定了饮食风险矩阵，以说明如何根据当前摄入量给出饮食建议。结论大量营养素摄入与健康结果之间的关系是非线性的。因此，饮食建议可以根据当前摄入量进行调整。关于大量营养素（例如碳水化合物）的饮食指南也应考虑其成分（例如糖和淀粉）的不同关联。