Dehghan M, et al. - A prospective cohort study was done to investigate the relationship of fats and carbohydrate consumption with cardiovascular disease and mortality in 18 countries from five continents (PURE). High carbohydrate consumption was related to higher risk of total mortality, whereas total fat and individual types of fat were identified with lower total mortality. Total fat and types of fat were not related to cardiovascular disease, myocardial infarction, or cardiovascular disease mortality, whereas saturated fat had an inverse relationship with stroke. Global dietary guidelines ought to be reconsidered in light of these findings.

Methods

• For this study, they conducted a Prospective Urban Rural Epidemiology (PURE) study.
• This study is a large, epidemiological cohort study of individuals aged 35-70 years (enrolled between Jan 1, 2003, and March 31, 2013) in 18 countries with a median follow-up of 7·4 years (IQR 5·3-9·3).
• Dietary intake of 135335 individuals was recorded utilizing validated food frequency questionnaires.
• The primary outcomes were total mortality and major cardiovascular events (fatal cardiovascular disease, non-fatal myocardial infarction, stroke, and heart failure).
• Secondary outcomes were all myocardial infarctions, stroke, cardiovascular disease mortality, and non-cardiovascular disease mortality.
• Participants were categorised into quintiles of nutrient consumption (carbohydrate, fats, and protein) based on percentage of energy provided by nutrients.
• They evaluated the relationship between intake of carbohydrate, total fat, and each type of fat with cardiovascular disease and total mortality.
• By utilizing a multivariable Cox frailty model with random intercepts to account for center clustering, they ascertained hazard ratios (HRs).

Results

• In this study, they reported 5796 deaths and 4784 major cardiovascular disease events amid the follow-up.
• Higher carbohydrate consumption was related to an increased risk of total mortality (highest [quintile 5] vslowest quintile [quintile 1] category, HR 1·28 [95% CI 1·12-1·46], ptrend=0·0001) but not with the risk of cardiovascular disease or cardiovascular disease mortality.
• Consumption of total fat and each type of fat was related to lower risk of total mortality (quintile 5 vs quintile 1, total fat: HR 0·77 [95% CI 0·67-0·87], ptrend<0·0001; saturated fat, HR 0·86 [0·76-0·99], ptrend=0·0088; monounsaturated fat: HR 0·81 [0·71-0·92], ptrend<0·0001; and polyunsaturated fat: HR 0·80 [0·71-0·89], ptrend<0·0001).
• Higher saturated fat consumption was related to lower risk of stroke (quintile 5 vs quintile 1, HR 0·79 [95% CI 0·64-0·98], ptrend=0·0498).
• Total fat and saturated and unsaturated fats were not significantly related to risk of myocardial infarction or cardiovascular disease mortality.