Plant and Animal Fat Intake and Overall and Cardiovascular Disease Mortality

Abstract

Importance: The impact of dietary fat intake on long-term human health has attracted substantial research interest, and the health effects of diverse dietary fats depend on available food sources. Yet there is a paucity of data elucidating the links between dietary fats from specific food sources and health.

Objective: To study associations of dietary plant and animal fat intake with overall mortality and cardiovascular disease (CVD) mortality.

Design, setting, and participants: This large prospective cohort study took place in the US from 1995 to 2019. The analysis of men and women was conducted in the National Institutes of Health-AARP Diet and Health Study. Data were analyzed from February 2021 to May 2024.

Exposures: Specific food sources of dietary fats and other dietary information were collected at baseline, using a validated food frequency questionnaire.

Main outcomes and measures: Hazard ratios (HRs) and 24-year adjusted absolute risk differences (ARDs) were estimated using multivariable-adjusted Cox proportional hazards regression.

Results: The analysis included 407 531 men and women (231 881 [56.9%] male; the mean [SD] age of the cohort was 61.2 [5.4] years). During 8 107 711 person-years of follow-up, 185 111 deaths were ascertained, including 58 526 CVD deaths. After multivariable adjustment (including adjustment for the relevant food sources), a greater intake of plant fat (HRs, 0.91 and 0.86; adjusted ARDs, -1.10% and -0.73%; P for trend < .001), particularly fat from grains (HRs, 0.92 and 0.86; adjusted ARDs, -0.98% and -0.71%; P for trend < .001) and vegetable oils (HRs, 0.88 and 0.85; adjusted ARDs, -1.40% and -0.71%; P for trend < .001), was associated with a lower risk for overall and CVD mortality, respectively, comparing the highest to the lowest quintile. In contrast, a higher intake of total animal fat (HRs, 1.16 and 1.14; adjusted ARDs, 0.78% and 0.32%; P for trend < .001), dairy fat (HRs, 1.09 and 1.07; adjusted ARDs, 0.86% and 0.24%; P for trend < .001), or egg fat (HRs, 1.13 and 1.16; adjusted ARDs, 1.40% and 0.82%; P for trend < .001) was associated with an increased risk for mortality for overall and CVD mortality, respectively, comparing the highest to the lowest quintile. Replacement of 5% energy from animal fat with 5% energy from plant fat, particularly fat from grains or vegetable oils, was associated with a lower risk for mortality: 4% to 24% reduction in overall mortality, and 5% to 30% reduction in CVD mortality.

Conclusions and relevance: The findings from this prospective cohort study demonstrated consistent but small inverse associations between a higher intake of plant fat, particularly fat from grains and vegetable oils, and a lower risk for both overall and CVD mortality. A diet with a high intake of animal-based fat, including fat from dairy foods and eggs, was also shown to be associated with an elevated risk for both overall and CVD mortality.

Figure.. Risk for Overall Mortality With Plant Fat and Animal Fat Intake According to Subgroups

Hazard ratios and 95% CIs for overall mortality were calculated by comparing the highest vs the lowest quintile of intake of plant fat and animal fat. The analyses were adjusted for age at baseline, sex, body mass index (BMI; <18.5, 18.5 to <25, 25 to <30, 30 to <35, or ≥35; calculated as weight in kilograms divided by height in meters squared), race or ethnicity (non-Hispanic Black, non-Hispanic White, or other race or ethnicity [ie, Hispanic, Asian, Pacific Islander, American Indian, and Alaska Native]), smoking status (never, former, or current), physical activity (never/rarely, 1-3 times/mo, 1-2 times/wk, 3-4 times/wk, or ≥5 times/wk), education (less than high school, high school graduate, post–high school training or some college, or college graduate or higher), married/unmarried, diabetes (yes/no), health status (poor to fair, good, or very good to excellent), vitamin supplement use (yes/no), intake of total protein (continuous variable), carbohydrates (continuous variable), fiber (quintiles), trans fatty acids (quintiles) and cholesterol (quintiles), and alcohol consumption (none to ≤1, >1 to 3, or >3 drinks per day). Fats from different sources were mutually adjusted for one another (eg, for plant fat, models were further adjusted for red meat fat, white meat fat, dairy fat, egg fat, and fish fat; for animal fat, models were further adjusted for fat from grains, fat from nuts, fat from beans and legumes, and vegetable oils). All analyses were additionally adjusted for relevant food sources. For example, for plant fat, model was further adjusted for daily consumption of bread, cereals and pasta, nuts, beans and legumes, fruits, and vegetables. For animal fat, model was further adjusted for daily consumption of all meat, dairy, egg, and total fish. HEI-2015 indicates Healthy Eating Index 2015.