Macro partitioning
High intake of trans-fatty acids is positively associated with an increased risk of coronary death in middle-aged male smokers, independent of saturated fat and cholesterol intake.
For middle-aged male smokers, avoiding trans-fatty acids is critical for reducing coronary death risk. This study suggests that trans-fat intake is a more significant predictor of heart disease mortality than saturated fat or cholesterol intake. Prioritize eliminating trans fats (often found in partially hydrogenated oils) from the diet, as high intake (median 6.2 g/day in the top quintile) was linked to a 39% higher risk of coronary death compared to low intake.
After controlling for age, supplement group, several coronary risk factors, total energy, and fiber intake, the authors observed a significant positive association between the intake of trans-fatty acids and the risk of coronary death. For men in the top quintile of trans-fatty acid intake (median = 6.2 g/day), the multivariate relative risk of coronary death was 1.39 (95% confidence interval (CI) 1.09-1.78) (p for trend = 0.004) as compared with men in the lowest quintile of intake (median = 1.3 g/day).
Why this rating
Large prospective cohort (n=21,930), long follow-up (6.1 years), rigorous dietary assessment, and adjustment for multiple confounders, though observational design limits causal inference.
Source
Intake of Fatty Acids and Risk of Coronary Heart Disease in a Cohort of Finnish Men: The Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study
P Pietinen et al. · American Journal of Epidemiology · 1997
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