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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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