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. 2016 Jan 20;5(1):e002891.
doi: 10.1161/JAHA.115.002891.

Impact of Nonoptimal Intakes of Saturated, Polyunsaturated, and Trans Fat on Global Burdens of Coronary Heart Disease

Qianyi Wang  1 , Ashkan Afshin  2 , Mohammad Yawar Yakoob  1 , Gitanjali M Singh  2 , Colin D Rehm  2 , Shahab Khatibzadeh  1 , Renata Micha  2 , Peilin Shi  2 , Dariush Mozaffarian  2 ; Global Burden of Diseases Nutrition and Chronic Diseases Expert Group (NutriCoDE)
Collaborators, Affiliations

Impact of Nonoptimal Intakes of Saturated, Polyunsaturated, and Trans Fat on Global Burdens of Coronary Heart Disease

Qianyi Wang et al. J Am Heart Assoc. .

Erratum in

Abstract

Background: Saturated fat (SFA), ω-6 (n-6) polyunsaturated fat (PUFA), and trans fat (TFA) influence risk of coronary heart disease (CHD), but attributable CHD mortalities by country, age, sex, and time are unclear.

Methods and results: National intakes of SFA, n-6 PUFA, and TFA were estimated using a Bayesian hierarchical model based on country-specific dietary surveys; food availability data; and, for TFA, industry reports on fats/oils and packaged foods. Etiologic effects of dietary fats on CHD mortality were derived from meta-analyses of prospective cohorts and CHD mortality rates from the 2010 Global Burden of Diseases study. Absolute and proportional attributable CHD mortality were computed using a comparative risk assessment framework. In 2010, nonoptimal intakes of n-6 PUFA, SFA, and TFA were estimated to result in 711 800 (95% uncertainty interval [UI] 680 700-745 000), 250 900 (95% UI 236 900-265 800), and 537 200 (95% UI 517 600-557 000) CHD deaths per year worldwide, accounting for 10.3% (95% UI 9.9%-10.6%), 3.6%, (95% UI 3.5%-3.6%) and 7.7% (95% UI 7.6%-7.9%) of global CHD mortality. Tropical oil-consuming countries were estimated to have the highest proportional n-6 PUFA- and SFA-attributable CHD mortality, whereas Egypt, Pakistan, and Canada were estimated to have the highest proportional TFA-attributable CHD mortality. From 1990 to 2010 globally, the estimated proportional CHD mortality decreased by 9% for insufficient n-6 PUFA and by 21% for higher SFA, whereas it increased by 4% for higher TFA, with the latter driven by increases in low- and middle-income countries.

Conclusions: Nonoptimal intakes of n-6 PUFA, TFA, and SFA each contribute to significant estimated CHD mortality, with important heterogeneity across countries that informs nation-specific clinical, public health, and policy priorities.

Keywords: cardiovascular disease; coronary heart disease; dietary fat; saturated fat; trans fat; ω‐6 polyunsaturated fat.

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Figures

Figure 1
Figure 1
Regional CHD mortality attributable to insufficient n‐6 PUFA intake in 1990 and 2010. The y‐axis represents the CHD deaths per 1 million adults (on the left) or the proportion of CHD deaths (on the right) attributable to insufficient n‐6 PUFA intake. The x‐axis includes the world estimates and estimates for the 21 regions. Red triangles indicate estimates in 1990, whereas blue circles indicate estimates in 2010. The error bars represent the 95% uncertainty level of each estimate. CHD indicates coronary heart disease; n‐6 PUFA, ω‐6 polyunsaturated fat.
Figure 2
Figure 2
Regional CHD mortality attributable to higher TFA intake in 1990 and 2010. The y‐axis represents the CHD deaths per 1 million adults (on the left) or the proportion of CHD deaths (on the right) attributable to higher TFA consumption. The x‐axis includes the world estimates and the estimates for the 21 regions. Red triangles indicate estimates in 1990, whereas blue circles indicate estimates in 2010. The error bars represent the 95% uncertainty level of each estimate. CHD indicates coronary heart disease; TFA, trans fat.
Figure 3
Figure 3
Global absolute CHD mortality attributable to SFA, n‐6PUFA, and TFA in 2010. World Health Organization income levels are as follows: high, ≥$12 616 per capita; upper‐middle, $4086 to $12 615 per capita; lower‐middle, $1036 to $4085 per capita; low, ≤$1035 per capita. Attributable CHD mortality was estimated for (A) higher SFA intake (red triangles), modeled as decreasing consumption to 10%E when isocalorically replaced with PUFA up to 12%E; (B) insufficient n‐6 PUFA (blue diamonds), modeled as increasing consumption to 12%E when isocalorically replaced with either carbohydrates or SFA; and (C) higher TFA (green circles), modeled as decreasing consumption to 0.5%E when isocalorically replacing with other fats. *In Egypt, TFA‐attributable CHD mortality per 1 million adults was 1120, beyond the x‐axis scale. %E indicates percentage of total energy intake; ARE, United Arab Emirates; ATG, Antigua and Barbuda; BIH, Bosnia and Herzegovina; CAF, Central African Republic; CHD, coronary heart disease; COD, Democratic Republic of the Congo; DOM, Dominican Republic; FSM, Federated States of Micronesia; GNQ, Equatorial Guinea; n‐6 PUFA, ω‐6 polyunsaturated fat; PNG, Papua New Guinea; SFA, saturated fat; STP, Sao Tome and Principe; TFA, trans fat; TTO, Trinidad and Tobago; VCT, Saint Vincent and the Grenadines.
Figure 4
Figure 4
Global proportional CHD mortality attributable to SFA and n‐6 PUFA in 2010. The proportion of CHD mortality attributable to different dietary fats was calculated by dividing the number of attributable CHD deaths by the total number of CHD deaths within each country. The color scale of each map indicates the proportional CHD mortality in 186 countries attributable to the given dietary fat. The optimal level is 10±1%E for SFA and 12±1.2%E for n‐6 PUFA. %E indicates percentage of total energy intake; CHD, coronary heart disease; n‐6 PUFA, ω‐6 polyunsaturated fat; SFA, saturated fat.
Figure 5
Figure 5
Annual CHD mortality attributable to SFA, n‐6PUFA, and TFA in the world's 20 most populous nations in 1990 and 2010. The x‐axis represents CHD deaths per 1 million adults attributable to different dietary fats, calculated by dividing the number of attributable CHD deaths by the adult population (defined as people aged ≥25 years) of the specific country and then multiplying by 1 million. The y‐axis (from the top to the bottom) shows the 20 most populous countries in 2010. The error bars represent the 95% uncertainty level. The optimal level is 10±1%E for SFA, 12±1.2%E for n‐6 PUFA, and 0.5±0.05%E for TFA. %E indicates percentage of total energy intake; CHD, coronary heart disease; n‐6 PUFA, ω‐6 poly‐unsaturated fat; SFA, saturated fat; TFA, trans fat.
Figure 6
Figure 6
Global proportional CHD mortality attributable to higher TFA intake in 2010. The proportion of CHD mortality attributable to TFA was calculated by dividing the number of attributable CHD deaths by the total number of CHD deaths within each country. The color scale of each map indicates the proportional CHD mortality in 186 countries attributable to TFA. The optimal level is 0.5±0.05%E (percentage of total energy intake). CHD indicates coronary heart disease; TFA, trans fat.
Figure 7
Figure 7
Regional CHD mortality attributable to higher SFA intake in 1990 and 2010. The y‐axis represents the CHD deaths per 1 million adults (on the left) or the proportion of CHD deaths (on the right) attributable to higher SFA intake. The x‐axis includes the world estimates as well as the estimates of the 21 regions. Red triangles indicate estimates in 1990, whereas blue circles indicate estimates in 2010. The error bars represent the 95% uncertainty level of each estimate. CHD indicates coronary heart disease; SFA, saturated fat.
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