Impact of Nonoptimal Intakes of Saturated, Polyunsaturated, and Trans Fat on Global Burdens of Coronary Heart Disease
Authors: Wang Qianyi , Afshin Ashkan , Yakoob Mohammad Yawar , Singh Gitanjali M. , Rehm Colin D. , Khatibzadeh Shahab , Micha Renata , Shi Peilin , Mozaffarian Dariush ,   the Global Burden of Diseases Nutrition and Chronic Diseases Expert Group (NutriCoDE), Mozaffarian Dariush , Micha Renata , Shi Peilin , Ezzati Majid , Fahimi Saman , Khatibzadeh Shahab , Powles John , Elmadfa Ibrahim , Rao Mayuree , Wirojratana Pattra , Lim Stephen S. , Engell Rebecca E. , Andrews Kathryn G. , Abbott Pamela A. , Abdollahi Morteza , Abeyá Gilardon Enrique O. , Ahsan Habibul , Al Nsour Mohannad Abed Alfattah , Al‐Hooti Suad N. , Arambepola Carukshi , Barennes Hubert , Barquera Simon , Baylin Ana , Becker Wulf , Bjerregaard Peter , Bourne Lesley T. , Calleja Neville , Castetbon Katia , Chang Hsing‐Yi , Cowan Melanie J. , De Henauw Stefaan , Ding Eric L. , Duante Charmaine A. , Duran Pablo , Elmadfa Ibrahim , Barbieri Heléne Enghardt , Farzadfar Farshad , Fernando Dulitha N. , Hadziomeragic Aida Filipovic , Fisberg Regina M. , Forsyth Simon , Garriguet Didier , Gaspoz Jean‐Michel , Gauci Dorothy , Ginnela Brahmam N. V. , Guessous Idris , Hadden Wilbur , Hoffman Daniel J. , Houshiar‐Rad Anahita , Huybrechts Inge , Hwalla Nahla C. , Ibrahim Hajah Masni , Inoue Manami , Jackson Maria D. , Johansson Lars , Keinan‐Boker Lital , Kim Cho‐il , Koksal Eda , Lee Hae‐Jeung , Li Yanping , Lipoeto Nur Indrawaty , Ma Guansheng , Mangialavori Guadalupe L. , Matsumura Yasuhiro , Mensink Gert B.M. , McGarvey Stephen T. , Fen Chan Mei , Monge‐Rojas Rafael A. , Musaiger Abdulrahman Obaid , Nagalla Balakrishna , Naska Androniki , Ocke Marga C. , Oltarzewski Maciej , Orfanos Philippos , Ovaskainen Marja‐Leena , Pan Wen‐Harn , Panagiotakos Demosthenes B. , Pekcan Gulden Ayla , Petrova Stefka , Piaseu Noppawan , Pitsavos Christos , Posada Luz Gladys , Riley Leanne M. , Sánchez‐Romero Luz Maria , Selamat Rusidah B. T. , Sharma Sangita , Sibai Abla Mehio , Sichieri Rosely , Simmala Chansimaly , Steingrimsdottir Laufey , Swan Gillian , Sygnowska Elżbieta Halina , Szponar Lucjan , Tapanainen Heli , Templeton Robert , Thanopoulou Anastasia , Thorgeirsdóttir Holmfridur , Thorsdottir Inga , Trichopoulou Antonia , Tsugane Shoichiro , Turrini Aida , Vaask Sirje , van Oosterhout Coline , Veerman J Lennert , Verena Nowak , Waskiewicz Anna , Zaghloul Sahar , Zajkás Gábor 
Published: January 2016

Background

Saturated fat (
SFA
), ω‐6 (n‐6) polyunsaturated fat (
PUFA
), and trans fat (
TFA
) influence risk of coronary heart disease (
CHD
), but attributable
CHD
mortalities by country, age, sex, and time are unclear.

Methods and Results

National intakes of
SFA
, n‐6
PUFA
, and
TFA
were estimated using a Bayesian hierarchical model based on country‐specific dietary surveys; food availability data; and, for
TFA
, industry reports on fats/oils and packaged foods. Etiologic effects of dietary fats on
CHD
mortality were derived from meta‐analyses of prospective cohorts and
CHD
mortality rates from the 2010 Global Burden of Diseases study. Absolute and proportional attributable
CHD
mortality were computed using a comparative risk assessment framework. In 2010, nonoptimal intakes of n‐6
PUFA
,
SFA
, and
TFA
were estimated to result in 711 800 (95% uncertainty interval [UI] 680 700–745 000), 250 900 (95%
UI
236 900–265 800), and 537 200 (95%
UI
517 600–557 000)
CHD
deaths per year worldwide, accounting for 10.3% (95%
UI
9.9%–10.6%), 3.6%, (95%
UI
3.5%–3.6%) and 7.7% (95%
UI
7.6%–7.9%) of global
CHD
mortality. Tropical oil–consuming countries were estimated to have the highest proportional n‐6
PUFA
– and
SFA
‐attributable
CHD
mortality, whereas Egypt, Pakistan, and Canada were estimated to have the highest proportional
TFA
‐attributable
CHD
mortality. From 1990 to 2010 globally, the estimated proportional CHD mortality decreased by 9% for insufficient n‐6 PUFA and by 21% for higher SFA, whereas it increased by 4% for higher
TFA
, with the latter driven by increases in low‐ and middle‐income countries.

Conclusions

Nonoptimal intakes of n‐6
PUFA
,
TFA
, and
SFA
each contribute to significant estimated
CHD
mortality, with important heterogeneity across countries that informs nation‐specific clinical, public health, and policy priorities.