BackgroundThere is controversy about associations between total dietary fatty acids, their classes (saturated fatty acids [SFAs], monounsaturated fatty acids, and polyunsaturated fatty acids), and risk of coronary heart disease (CHD). Specifically, the relevance of food sources of SFAs to CHD associations is uncertain.Methods and ResultsWe conducted a case‐cohort study involving 10 529 incident CHD cases and a random subcohort of 16 730 adults selected from a cohort of 385 747 participants in 9 countries of the EPIC (European Prospective Investigation into Cancer and Nutrition) study. We estimated multivariable adjusted country‐specific hazard ratios (HRs) and 95% CIs per 5% of energy intake from dietary fatty acids, with and without isocaloric macronutrient substitutions, using Prentice‐weighted Cox regression models and pooled results using random‐effects meta‐analysis. We found no evidence for associations of the consumption of total or fatty acid classes with CHD, regardless of macronutrient substitutions. In analyses considering food sources, CHD incidence was lower per 1% higher energy intake of SFAs from yogurt (HR, 0.93 [95% CI, 0.88–0.99]), cheese (HR, 0.98 [95% CI, 0.96–1.00]), and fish (HR, 0.87 [95% CI, 0.75–1.00]), but higher for SFAs from red meat (HR, 1.07 [95% CI, 1.02–1.12]) and butter (HR, 1.02 [95% CI, 1.00–1.04]).ConclusionsThis observational study found no strong associations of total fatty acids, SFAs, monounsaturated fatty acids, and polyunsaturated fatty acids, with incident CHD. By contrast, we found associations of SFAs with CHD in opposite directions dependent on the food source. These findings should be further confirmed, but support public health recommendations to consider food sources alongside the macronutrients they contain, and suggest the importance of the overall food matrix.

中文翻译：

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膳食脂肪酸、常量营养素替代、食物来源和冠心病发病率：来自欧洲九个国家的 EPIC-CVD 病例队列研究的结果

背景关于总膳食脂肪酸、其类别（饱和脂肪酸 [SFA]、单不饱和脂肪酸和多不饱和脂肪酸）与冠心病 (CHD) 风险之间的关联存在争议。具体而言，SFA 的食物来源与 CHD 关联的相关性尚不确定。 方法和结果 我们进行了一项病例队列研究，涉及 10 529 例 CHD 病例和随机亚组 16 730 名成年人，该组从 9 个国家的 385 747 名参与者中选出。 EPIC（欧洲癌症和营养前瞻性调查）研究。我们估计了多变量调整后的国家特定风险比 (HRs) 和每 5% 的膳食脂肪酸能量摄入的 95% CI，有和没有等热量常量营养素替代，使用 Prentice 加权 Cox 回归模型和使用随机效应荟萃分析的汇总结果。无论常量营养素替代如何，我们都没有发现总脂肪酸或脂肪酸类别的消耗与冠心病相关的证据。在考虑食物来源的分析中，来自酸奶（HR，0.93 [95% CI，0.88-0.99]）、奶酪（HR，0.98 [95% CI，0.96-1.00]）的 SFA 能量摄入每增加 1%，CHD 发病率就会降低, 和鱼 (HR, 0.87 [95% CI, 0.75–1.00])，但来自红肉 (HR, 1.07 [95% CI, 1.02–1.12]) 和黄油 (HR, 1.02 [95% CI, 1.00–1.04])。结论这项观察性研究发现，总脂肪酸、SFAs、单不饱和脂肪酸和多不饱和脂肪酸与冠心病事件没有密切关联。相比之下，我们发现 SFA 与 CHD 在相反方向上的关联取决于食物来源。