1. Intake and Adipose Tissue Composition of Fatty Acids and Risk of Myocardial Infarction in a Male Portuguese Community Sample.
Carla Lopes1, Antti Aro2, Ana Azevedo1, Elisabete Ramos1, Henrique Barros1.
1Department of Epidemiology, University of Porto Medical School, Portugal;
2Department of Nutrition, National Institute Public Health, Helsinki, Finland.
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION
Lopes C, et al. J Am Diet Assoc. 107(2), Feb. 2007

2. Fatty Acids and Risk of Myocardial Infarction
Objective
To evaluate the relation between intake and adipose tissue composition of fatty acids and acute myocardial infarction in Portuguese men.
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION
Lopes C, et al. J Am Diet Assoc. 107(2), Feb. 2007

3. Study design: Population based case - control study (EPIcardis study)
Fatty Acids and Risk of Myocardial Infarction
Study design: Population based case - control study (EPIcardis study)
Cases: first acute non-fatal myocardial infarction
Community participants Controls
Selected by random digit dialling (participation proportion - 70%)
No previous MI (Rose questionnaire or electrocardiography)
All Participants
Portuguese Caucasian men
Age  40 years old
Residence in Porto
No dietary changes in the previous year
"Mini-mental state examination" > 23
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION
Lopes C, et al. J Am Diet Assoc. 107(2), Feb. 2007

4. Characteristics of participants
Fatty Acids and Risk of Myocardial Infarction
Characteristics of participants
All cases
n=297
All controls
n= 310
Cases with
AT* sample
n=49
Controls with AT* sample
mean (sd)
Age ( years)
56.6 (10.5)
57.3 (11.3)
54.8 (9.2)
61.2 (10.5)
Education ( years)
6.3 (4.1)
8.7 (4.7)
6.2 (3.7)
8.8 (4.6)
Physical activity (MET*h/day)
38.9 (10.5)
36.8 (6.7)
38.4 (9.0)
35.7 (6.6)
Body Mass Index (kg/m2)
26.3 (12.8)
26.4 (11.8)
26.3 (2.7)
26.1 (3.4)
Total energy intake ( Kcal)
2613 (689)
2661 (669)
2526 (549)
2593 (679)
Total fat intake (% Kcal)
27.2 (4.5)
28.1 (4.9)
25.4 (4.2)
28.4 (5.4)
n (%)
Family history of MI
92 (31.0)
61 (19.7)
12 (24.5)
14 (28.6)
Current Smoking
166 (55.9)
105 (33.9)
27 (55.1)
10 (20.4)
*AT – adipose tissue
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION
Lopes C, et al. J Am Diet Assoc. 107(2), Feb. 2007

5. Semi-quantitative food frequency questionnaire
Fatty Acids and Risk of Myocardial Infarction
Semi-quantitative food frequency questionnaire
82 food items
9 frequency categories
Food conversion data base: Food Processor Plus 7.0
Unit of Nutritional Epidemiology
Department of Hygiene and Epidemiology
University of Porto Medical School
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION
Lopes C, et al. J Am Diet Assoc. 107(2), Feb. 2007

6. Fatty acid sampling and analysis
Fatty Acids and Risk of Myocardial Infarction
Fatty acid sampling and analysis
A sample from buttock using vacuum needle aspiration
Fatty acids methyl esters analyzed by gas-liquid chromatography (50m CP-Sil 88 capillary column)
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION
Lopes C, et al. J Am Diet Assoc. 107(2), Feb. 2007

7. Total fat intake and acute myocardial infarction in men
Fatty Acids and Risk of Myocardial Infarction
Total fat intake and acute myocardial infarction in men
Adjusted OR (95% CI)
OR*
1stQ†
2ndQ
3thQ
4thQ
63.4
73.2
86.0
98.3
Median intake (g/day)
*OR adjusted for age, education, family history of myocardial infarction, physical activity, energy intake and body mass index.
†Q - Quartile
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION
Lopes C, et al. J Am Diet Assoc. 107(2), Feb. 2007

8. Lauric acid intake and acute myocardial infarction in men
Fatty Acids and Risk of Myocardial Infarction
Lauric acid intake and acute myocardial infarction in men
Adjusted OR (95% CI)
OR*
0.18
0.32
0.40
0.67
FFQ
Adipose Tissue
0.09
0.14
0.27
Median intake (g)
Median intake (% Fat)
*OR adjusted for age, education, family history of myocardial infarction, physical activity, energy intake and body mass index.
†Q – Quartile; ‡T – Tertile.
1stQ†
2ndQ
3thQ
4thQ
1stT‡
2ndT
3thT
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION
Lopes C, et al. J Am Diet Assoc. 107(2), Feb. 2007

9. Palmitic acid intake and acute myocardial infarction in men
Fatty Acids and Risk of Myocardial Infarction
Palmitic acid intake and acute myocardial infarction in men
Adjusted OR (95% CI)
OR*
9.8
12.0
14.2
17.8
FFQ
Adipose Tissue
17.3
18.7
21.8
Median intake (g)
Median intake (% Fat)
*OR adjusted for age, education, family history of myocardial infarction, physical activity, energy intake and body mass index.
†Q – Quartile; ‡T – Tertile.
1stQ†
2ndQ
3thQ
4thQ
1stT‡
2ndT
3thT
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION
Lopes C, et al. J Am Diet Assoc. 107(2), Feb. 2007

10. Oleic acid intake and acute myocardial infarction in men
Fatty Acids and Risk of Myocardial Infarction
Oleic acid intake and acute myocardial infarction in men
Adjusted OR (and 95% CI)
OR*
21.2
28.1
31.8
37.4
FFQ
Adipose Tissue
45.6
49.4
54.2
Median intake (g)
Median intake (% Fat)
*OR adjusted for age, education, family history of myocardial infarction, physical activity, energy intake and body mass index.
†Q – Quartile; ‡T – Tertile.
1stQ†
2ndQ
3thQ
4thQ
1stT‡
2ndT
3thT
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION
Lopes C, et al. J Am Diet Assoc. 107(2), Feb. 2007

11. Discussion: Comparison of intake – Porto vs. Finish Study*
Fatty Acids and Risk of Myocardial Infarction
Discussion: Comparison of intake – Porto vs. Finish Study* 1 2 3 4 5
Saturated FA (g/day)
Current study
Finnish Study
18.4
34.7
22.4
43.3
28.2
50.3
33.2
57.4
67.5
Mono FA (g/day)
26.9
26.0
33.7
29.5
37.2
31.8
45.3
34.1
37.8
Poli FA (g/day)
11.0
6.6
13.0
8.0
15.2
9.6
18.1
12.5
20.7
Trans FA (g/day)
0.34
1.3
0.63
1.7
1.21
2.0
1.74
2.7
5.6
N-3 FA (g/day)
1.13
0.2
1.38
0.3
1.57
0.4
1.97
0.5
0.8
*Pietinen P, et al. Am J Epidemiol. 145(10), May. 1997
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION
Lopes C, et al. J Am Diet Assoc. 107(2), Feb. 2007

12. Fatty Acids and Risk of Myocardial Infarction
Discussion:
Daily fatty acids and ethanol consumption in Porto and in USA
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION
Lopes C, et al. J Am Diet Assoc. 107(2), Feb. 2007

13. Saturated fat intake and acute myocardial infarction in women
Fatty Acids and Risk of Myocardial Infarction
Saturated fat intake and acute myocardial infarction in women
Risk
10.7
12.8
14.3
16.0
18.8
Median Intake (% Kcal)
6.8
8.5
9.8
12.3
EPIcardis Study
Nurses’ HS. USA*
* Hu FB, et al. New Engl J Med; 337(21), Nov. 1997
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION
Lopes C, et al. J Am Diet Assoc. 107(2), Feb. 2007

14. Discussion: Fatty Acids and Risk of Myocardial Infarction
Adams J, White M Int J Epidemiol. 34(1), Feb. 2005
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION
Lopes C, et al. J Am Diet Assoc. 107(2), Feb. 2007

15. Discussion: Fatty Acids and Risk of Myocardial Infarction
Only a few epidemiologic studies evaluated the relation between individual fatty acids intake and the risk of AMI, particularly in men.
Generally these studies came from populations with high intakes of fatty acids and narrower range of variation of dietary exposures than the Portuguese population.
In populations with adequate mean intakes of fatty acids the recommendation of decreasing the consumption may be injurious.
Recommendations on fatty acids should aim for both an upper and lower limit.
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION
Lopes C, et al. J Am Diet Assoc. 107(2), Feb. 2007

16. Conclusion: Fatty Acids and Risk of Myocardial Infarction
In this study performed in an area with low average intake of saturated fatty acids and moderate intake of total fat:
Lower intakes of total fat and the saturated lauric acid and the content in trans fatty acids of adipose tissue were associated with an increased risk of AMI
No association was found between polyunsaturated fatty acids and risk of AMI
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION
Lopes C, et al. J Am Diet Assoc. 107(2), Feb. 2007