Material and Methods
Title: Fat Consumption in Relation to Risk for Cardiovascular Diseases Review
Nutritionists and health professionals have always recommended a reduction in the intake of diet rich in fats. Besides, the fats quality is acknowledged for being of great importance compared to the total fat for the prevention of coronary diseases as well as death. Moreover, the consumption of trans fat from hydrogenated oils has been linked with adverse health problems and its intake directed to be lowered to the minimum. Studies show that heart diseases can be reduced by replacing saturated fats (SF) with monounsaturated fats (MUF) and polyunsaturated fats (PUF). Findings also show that Med diets (diets rich in MUF and PUF) are useful in the prevention of risks of CVD relative to the low-fat diet. Due to the controversy in a number of findings, recent researchers have questioned whether there is any association between SF and coronary diseases, and if there is, is the connection positive? Besides, findings on the relationship between the consumption of other subtype fats, heart diseases, and death remain unclear. As of late, researchers have concentrated on the subtypes of SFs, their dietary patterns, food source plus the foods they replace. Ideally, food sources have varying levels of SF (e.g. lauric and myristic) which have varying effects on inflammation and plasma lipids hence on the risk for coronary diseases (Appel et al., 2005).
In a present study, it has been hypothesized that PUFs and MUFs are connected with lower risks of heart diseases plus death contrary to the SFs. Besides, examinations have been done between the consumption of SF, PUF, and MUF and the risks of cardiovascular deaths.
- Study demography
The data used in this analysis is the observational prospective cohort study. The study was an extensive, population for the death rate from degenerative cardiovascular diseases. The participants were males from Japan, Italy, England and Wales, Australia, and the USA taken from 1948 to 1949 and aged between 45 to 49 years (Yerushalmy and Hilleboe, 1957). Although the findings were completed in 1949, the end point of a current analysis was based on the extensive outcome with the use of similar techniques like those used previously in the trial to get the current data on cardiovascular clinical events as well as death. ‘Exclusion criteria’ was the main thing in the adverse chronic sickness, alcohol, and drug /substance abuse, the ‘body mass index’ (BMI) of greater than or equal to 40 kg plus the allergy/intolerance to either nuts or non-hydrogenated olive oils. The number of deaths per 1000 people was recorded against the percentage consumption of fat. All the participants presented a written and informed consent with respect to the protocol recommended by an organization review board (Rosito et al., 2008).
- Dietary plus covariate examination
In the ‘baseline’ as well as annually in the follow-up, professional nutritionists filled a ‘food frequency questionnaire’ (FFQ) in a confrontation ‘interview with the participants.’ The questionnaire is validated in the demography in high coronary heart diseases risk in America (Yerushalmy and Hilleboe, 1957). Besides, the questionnaire wasn’t compared alongside the ‘objective measurements.’ Both ‘validity’ plus reproducibility of a food frequency questionnaire for the whole ‘dietary fat,’ SFs, PUFs plus MUFs estimated via the Pearson correlation was 0.62, 0.68, 0.58, and 0.64 respectively. Besides, the interclass correlation coefficient for validity plus reproducibility was 0.64 and 0.78 for the total fat, 0.80 and 0.67 for the SFs, 0.73 and 0.66 for MUFs as well as 0.76 and 0.59 for PUFs. The food frequency questionnaire comprised of 135 food items plus rates of consumption of the items was reported to have an increment of nine levels. The American food consumption table was used to estimate both energy and nutrient consumption (Mahabadet al., 2009). At the baseline as well as annually in the follow-up, the questionnaire on the history of ailment, lifestyle changes, medication use and educational achievement was used. Mahabadet al. (2009) postulates that the physical activity was examined using an American version “leisure time physical activity questionnaire.” Professionals obtained the blood pressure plus anthropometric measurements. Calibrated scales were employed plus the Wall Mounted Stadiometer to examine height and weight with the participants having no shoes and wearing light clothes. Moreover, waist measurement was also taken between the low cribs up to ‘the iliac crest’ with a tape. Also, validated oscillator was employed for measuring hypersensitivity, in three copies with a 5-minute interval in every measurement. Lastly, means of the values were recorded (Kratz et al., 2013).
- Ascertainment of CVD plus death
Results
For the current analysis, three different endpoints were reemployed, and they included a key parameter which is the composite of CVD events, the coronary death, plus all-cause of mortality. A committee of people, who were blinded to treatment allocation, gave an updated data on the endpoints on a yearly basis (Howard et al., 2006) . The board used diverse sources of information which included annual questionnaires plus examination for every participant, a detailed annual review of medical records of every member, family doctors as well as annual consultation of the NDI or ‘national death index.’ According to Houston et al., (2011) the ‘medical records’ of the dead were recorded plus ‘an endpoint adjudication committee’ investigated the leading cause of mortality. Through this, it was easier to access the death rate irrespective of attrition. Above all the rates were not influenced by any of the dropout rates.
- ‘Statistical analyses’
Males were having ‘total energy intake’(TEI) that was few or more compared to the pre-defined limit of 800 & 4000 kilocalories per day plus those having missed information on a food frequency questionnaire were extracted from ‘the current analysis.’ However, to take advantage of the continuous measurements of food, annual and present measures of the ‘total fats’ plus subtype of fat consumption using information from the baseline up to the last food frequency questionnaire prior to the start of the coronary diseases or death. However, participants were put into five groups in respect to the quintiles of the energy derived from the ‘total fat’ plus the MUFs, SFs, PUFs plus the trans fat (Yerushalmy and Hilleboe, 1957). Baseline properties are given in respect to extreme quintiles of the whole fat plus the subtype of other fats as mentioned above as (± Standard deviations SDs) for the quantitative characteristics as well as n (%) to represent the ‘categorical variables.’ A follow-up time was found to a range involving the death of coronary diseases, death, or even the end of follow-up whichever preceded the other as well as ‘the date of random assessment.’ A ‘time-dependent Cox regression model’ was employed to check a connection involving annual ‘updated measures of the whole fat plus the subtypes of fat consumption, coronary diseases plus a death in the follow-up process (Yerushalmy and Hilleboe, 1957).
The first ‘multi-variable model’ for an impedance analysis was then arranged via ‘recruitment center’ as well as modified for the ‘randomized controlled trials, updated T.E /quintiles of protein, dietary cholesterol, and alcohol intake. The model of particular subtypes of fats was also put as ‘covariates of the other subtypes.’ Another model was also modified especially for the non-dietary confounders as well as the coronary risk factors. They comprise of the ‘body mass index’ (BMI), educational level, smoking status and family history of CVD to mention just a few (Yerushalmy and Hilleboe, 1957).The estimated high risks can be interpreted to be the estimate difference in danger for low consumption from CHOs plus concomitant greater energy consumption from either the subtypes of fat or the total fat
According to Astrup et al.., (2011) the association of the ‘isocaloric substitutions’ of the CHOs, MUFs, PUFs, and SFs were estimated including the continuous variable in a similar multivariable model that contained similar covariates like in the first model. The difference between ‘regression coefficients were used plus the covariance and variance to calculate the hazard ratios of CVD at the 95% confidence interval. The analysis was then concluded for all the causes of death and coronary disease as the outcome.
Discussion
Besides, it was also evaluated that the connection between SFs consumption from varying food sources plus coronary heart diseases as well as every cause of death using a similar statistical model like in the earlier analysis (Chowdhury et al., 2014). However, the estimated hazard ratios of deaths from the models is therefore seen as the ‘estimated difference’ in the risks of little energy consumption from a given SF source as well as concomitant greater energy consumption from other food sources since SF use wasn’t included to be the covariate
Out of the 7036 male participants, 336 CVD events were documented, 102 coronary deaths recorded and a total of 441 deaths. People were classified to quintiles of annually updated measures of the whole fat as well as distinct subtypes of fat consumption (Yerushalmy and Hilleboe, 1957). The average age of the participants in the baseline was 46 years while average consumption of the whole fat in the lowest quintile was 30% relative to the 48.5 % in the higher quintile of the total fat consumption. The participants having a higher intake of SFs and total fat were less active and had higher risks of death due to the CVD. Besides, they consume higher cholesterol plus few ‘dietary fiber’ and CHOs. On the other hand, the dropout rate was 4.1%. The rates in respect to varying quintiles of the whole fat were 8.6% for the first one, 4.2 % for the second, 3.4% for the third 2.7% for the fourth and 2.9% (Yerushalmy and Hilleboe, 1957). Ideally, a dropout distribution for the quintiles of certain fat subtype was the same as to that of ‘total fat.’
The hazard ratios also represented energy replacement from the total CHOs having an equal percentage of energy from the ‘total fat’ as well as from every subtype. Most importantly, whole fat consumption was connected with lower risks of cardiovascular diseases. However, in a complete adjusted model relative to the ‘lowest quintile,’ the greater quintile of whole fat consumption was connected with 441% lower coronary heart disease risk. For the MUFs and PUFs, they were also correlated with lower risks of cardiovascular diseases hence death.
Després (2012) holds that the higher consumption of SFs as well as trans fat was associated with greater risks of developing coronary diseases following the adjustment of the model to potential confounders. Whole fat intake was connected with fewer risks of total death. However, in the complete adjusted model, the risks of the causes of death were 46 % lower in a top quintile relative to the bottom quintile. The different connections between the MUFs and PUFs consumption and the number of deaths were found. ‘trans fat’ was highly connected with 39% a higher risk of all the causes of mortality in the multivariable model (Després, 2012). However, the connection was weakened in a ‘fully adjusted model.’ SF was connected with all the causes of death.
Both PUF and MUF consumption did not lead to CVD deaths. The hazard ratio was 0.36 for males in a higher quintile of PUF consumption relative to those in the ‘lowest quintile.’ For the MUFs, the corresponding hazard ratio was 0.79. Above all, SF use was connected with greater risks CVD deaths in the age modified as well as the ‘first multivariable model’ (Hooper et al., 2001). In a completely modified model, the connection was insignificant and the hazard ratio for the ‘trans fat’ for males in the ‘highest quintile’ was found to be 1.52.
Conclusion
In the study presented, the males who were at higher risks of cardiovascular diseases and death are those consume a high level of SF and trans fat. On the other hand, those who consume greater levels of MUFs and PUFs are at lesser risks of developing coronary diseases which can lead to death. However, the isocaloric substitution of SFs with PUFs or MUFs was connected with less risk of heart diseases and death (Yerushalmy and Hilleboe, 1957). Moreover, it was found that higher consumption of SFs from pastries as well as processed food was highly connected with greater risks of developing cardiovascular diseases hence death. New findings to present were the SFs from vegetables plus fish were connected with fewer risks of cardiovascular diseases. As a result, this finding need to be taken with caution since the levels of SFs from fish taken in the demography was minimal.
An observed advantage of cardiovascular diseases plus deaths of substituting SFs with MUFs and PUFs found in the population was consistent with the pooled analysis of eleven cohorts as well as a meta-analysis of > 20 RCTs or ‘randomized control trials’ (Rosito et al., 2008). PUF in substitute of SF was found to be connected with less risk of heart diseases as well as deaths in the pooled analysis of eleven cohort studies. Besides, another current pooled analysis of eight randomized control trials concluded that 8% lowers the CVD risks in every 4% consumption of energy from SFs being replaced by PUFs. Despite the fact that use of MUFs has been associated with added benefits on health there’s still no concordant reason for the MUFs recommendation. According to the research conducted there is an inverse connection between MUFs intake, cardiovascular diseases, and the cause of death as well as the CVD death. Notably, the demography had a high consumption of nuts and vegetable oils which are considered to be rich in MUFs. Rosito et al., (2008) holds that the possible decline in the in the risks of coronary diseases as well as death was also found in the replacement of SFs with MUFs. This data is in concordance with the results that were found that replacing the SFs with MUFs would lower the risks of coronary diseases hence coronary death. Fats are an integral part in the dietary intervention performed in the trial. Hence it should be understood that it’s hard to disentangle if the connection found is driven by particular consumption of PUFs or MMUFs or by the substitute food provided.
Besides, the analysis for intervention group to manage the result of intervention was adjusted. In another analysis when trying to stratify the sample via the intervention groups, it was found that the same findings on the three ‘intervention groups’ suggested that the results were free from intervention. Despite the fact that our diet plus analysis of food choices usually tells us more about the lifestyles compared to single items, it’s of great importance to look at the specific nutrients they exert in our body or the adverse effects on the disease risk such as the discussed CVD (Kratz et al., 2013).
A larger consumption of total fat in the population presented was however connected with lower risks of cardiovascular diseases plus deaths. Notably, a significant proportion of the total fat taken in the population came from PPUFs and MUFs which have shown good signs on the health of the people. On the other hand and in concordance with the findings of the ‘Nurses health research’ plus a recent study in 58000 Asians (Japanese) people total fat consumption was not connected with the CVD deaths in the present studies (Yerushalmy and Hilleboe, 1957). In concordance with other studies Tran fat consumption was linked with higher risks of coronary diseases, and the benefits of their substitution were also presented.
Other evidence from Meta-analyses shows that the results of taking SFs on coronary risks vary in regard to the substituted nutrients. However, the majority of these analyses did not show that the association between the consumption of SFs and danger of coronary diseases or even death. Besides, they could not consider the effects of substituting nutrients as well as effects of other foods sources of the SFs. According to the hypothesis presented in this study, it is evident that increased intake of SFs is associated with higher risks of heart diseases (Appel et al., 2005). However, no connection between CVD and total deaths was found. SF consumption wasn’t associated with the total deaths as well as coronary deaths in the new Meta-analysis of six prospective cohort studies. Opposite of the study presented here, the substitution of trans fat or SFs with other nutrients was not done. It was found that a continuous decline in the risks of developing coronary diseases and death occurred when SFs was substituted with other components such as the PUFs and MUFs (German. Et al.,, 2009). However, no significant connection was found for the replacement of the SFs with total CHOs such as refined sugars, legumes, and whole grains to mention just a few.
In summary, it can be concluded that both PUFs and MUFs are opposite connected with the coronary diseases as well as death whereas trans fat &SFs were linked with greater risks of cardiovascular diseases in people at high coronary risk. Also total dietary was connected with fewer risks of heart diseases and death. According to Despres (2012) the replacement of either trans fats or SFs with PUFs or MUFs was highly connected with lower risks of cardiovascular diseases. Finally, the Intake of SFs from processed food as well as pastries was connected with higher risks in high-risk people.
References
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