Observational studyJournal of the American Heart Association2021
Dietary Fatty Acids, Macronutrient Substitutions, Food Sources and Incidence of Coronary Heart Disease: Findings From the EPIC-CVD Case-Cohort Study Across Nine European Countries.
Observational study in Journal of the American Heart Association, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
31 citing papers in PubMed, 3 syntheses or guidelines pooled it, 50 citations in OpenAlex.
- Association of circulating fatty acids with cardiovascular disease risk: analysis of individual-level data in three large prospective cohorts and updated meta-analysis.European journal of preventive cardiology · 2025Pooled it
- Substitution of animal-based with plant-based foods on cardiometabolic health and all-cause mortality: a systematic review and meta-analysis of prospective studies.BMC medicine · 2023Pooled it
- Cheese consumption and multiple health outcomes: an umbrella review and updated meta-analysis of prospective studies.Advances in nutrition (Bethesda, Md.) · 2023Pooled it
- Effect of high-fat diet and morning or evening exercise on lipoprotein subfraction profiles: secondary analysis of a randomised trial.Scientific reports · 2023Trial
- Biomarker-calibrated dietary macronutrient densities and their comparative associations with chronic disease risk in a cohort of postmenopausal females.The American journal of clinical nutrition · 2026Article
- Dietary pattern and epigenetic aging: a longitudinal twin study.GeroScience · 2026Article
- Dietary diversity in Mediterranean countries is characterized by amino acid and fatty acid profiles.European journal of nutrition · 2026Article
- Macronutrient intake in infancy and cardiometabolic health in preschool children from the EDEN mother-child cohort.European journal of nutrition · 2026Article
- Fatty Acids and Their Roles in Cardiac Physiology and Pathology: Mechanistic and Interventional Studies.Nutrients · 2026Review
- The Effect of Astaxanthin on Quality of the Common Cuttlefish (Food science & nutrition · 2026Article
- Low-fat and whole milk consumption in relation to cardiovascular disease-related and all-cause mortality: a prospective cohort study in 3 Norwegian counties.The American journal of clinical nutrition · 2025Article
- Review
- Regular-fat and low-fat dairy foods and cardiovascular diseases: perspectives for future dietary recommendations.The American journal of clinical nutrition · 2025Review
- The energy model of insulin resistance: A unifying theory linking seed oils to metabolic disease and cancer.Frontiers in nutrition · 2025Article
- Replacement of Saturated Fatty Acids from Meat by Dairy Sources in Relation to Incident Cardiovascular Disease: The European Prospective Investigation into Cancer and Nutrition (EPIC)-Norfolk Study.The American journal of clinical nutrition · 2024Article
- Substitution of Dairy Products and Risk of Death and Cardiometabolic Diseases: A Systematic Review and Meta-Analysis of Prospective Studies.Current developments in nutrition · 2024Review
- Associations between dietary fatty acids intake and abdominal aortic calcification: a national population-based study.Lipids in health and disease · 2024Article
- Substitution analyses of foods with varying fat quality and the associations with all-cause mortality and impact of the FADS-1 genotype in elderly men.European journal of nutrition · 2024Article
- Dietary amino acids and risk of stroke subtypes: a prospective analysis of 356,000 participants in seven European countries.European journal of nutrition · 2024Article
- Article
Corrections and comments
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Authors and funding
52 authors at 20 institutions in 11 countries.
Funding
Abstract
Background There is controversy about associations between total dietary fatty acids, their classes (saturated fatty acids [SFAs], monounsaturated fatty acids, and polyunsaturated fatty acids), and risk of coronary heart disease (CHD). Specifically, the relevance of food sources of SFAs to CHD associations is uncertain. Methods and Results We conducted a case-cohort study involving 10 529 incident CHD cases and a random subcohort of 16 730 adults selected from a cohort of 385 747 participants in 9 countries of the EPIC (European Prospective Investigation into Cancer and Nutrition) study. We estimated multivariable adjusted country-specific hazard ratios (HRs) and 95% CIs per 5% of energy intake from dietary fatty acids, with and without isocaloric macronutrient substitutions, using Prentice-weighted Cox regression models and pooled results using random-effects meta-analysis. We found no evidence for associations of the consumption of total or fatty acid classes with CHD, regardless of macronutrient substitutions. In analyses considering food sources, CHD incidence was lower per 1% higher energy intake of SFAs from yogurt (HR, 0.93 [95% CI, 0.88-0.99]), cheese (HR, 0.98 [95% CI, 0.96-1.00]), and fish (HR, 0.87 [95% CI, 0.75-1.00]), but higher for SFAs from red meat (HR, 1.07 [95% CI, 1.02-1.12]) and butter (HR, 1.02 [95% CI, 1.00-1.04]). Conclusions This observational study found no strong associations of total fatty acids, SFAs, monounsaturated fatty acids, and polyunsaturated fatty acids, with incident CHD. By contrast, we found associations of SFAs with CHD in opposite directions dependent on the food source. These findings should be further confirmed, but support public health recommendations to consider food sources alongside the macronutrients they contain, and suggest the importance of the overall food matrix.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.