Issue 212 Item 15 Replacement of Saturated by Unsaturated Fat Recommended in Wom

Cardiovascular disease risk increases significantly with higher saturated fat and cholesterol intake in women with type II diabetes. "A lower risk of fatal cardiovascular events was associated with a higher proportion of polyunsaturated to saturated fat," write Michaela Tanasescu and colleagues, Departments of Nutrition and Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States.

The authors studied 5674 women who reported a physician’s diagnosis of diabetes mellitus at age 30 years or younger between 1976 and 1996. All women were participants in the Nurses’ Health Study (NHS) on potential cardiovascular disease (CVD) risk factors established in 1976.

The primary end point of the present analysis was total CVD, including fatal coronary heart disease, nonfatal myocardial infarction (MI), and stroke, as reported by the participants on sent questionnaires.

During the 57 195 person-years of follow up, 619 CVD events were documented: 268 nonfatal MI, 183 fatal MI, and 168 strokes.

In age-adjusted analyses, animal fat intake, saturated fat and cholesterol were each associated with an increased risk of cardiovascular disease. Vegetable fat was associated with a reduced risk of CVD. A higher polyunsaturated to saturated fat ratio (P:S) was associated with a decreased risk of CVD. Monounsaturated fat tended to be associated with an increase in CVD.

Further analyses showed that each increase of 200 mg cholesterol/1000 kcal was associated with a 37% increase in CVD risk. The relation between trans fat and CVD risk was positive but not significant.

The authors estimated that replacing 5% energy from saturated fat with equivalent energy from carbohydrates would be associated with a 22% lower risk of CVD (95% CI: 2%, 39%; P = .04). The same replacement with monounsaturated fat would be associated with a 37% decrease in the risk of CVD (95% CI: 0%, 60%; P = .048).

"Women with higher intake of saturated fat and women with a higher intake of polyunsaturated fat were found to exercise less, to drink less water and to be less likely to use multivitamin and vitamin E supplements," added the researchers.

"In this cohort of diabetic women, a diet characterized by higher cholesterol and saturated fat and a lower P:S fat was associated with increased CVD risk," the authors concluded. Am J Clin Nutr 2004 Jun;79:6:999-1005