Inverse association of dietary fat with development of ischemic stroke in men
M. W. Gillman, L. A. Cupples, B. E. Millen, R. C. Ellison and P. A. Wolf
Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, MA 02215, USA.
CONTEXT: A few ecological and cohort studies in Asian populations suggest
an inverse association of the intake of both fat and saturated fat with
risk of stroke. However, data among western populations are scant.
OBJECTIVE: To examine the association of stroke incidence with intake of
fat and type of fat among middle-aged US men during 20 years of follow-up.
DESIGN AND SETTING: The Framingham Heart Study, a population-based cohort
study. PARTICIPANTS: A total of 832 men, aged 45 through 65 years, who were
free of cardiovascular disease at baseline (1966-1969). MEASUREMENTS AND
DATA ANALYSIS: The diet of each subject was assessed at baseline by a
single 24-hour dietary recall, from which intakes of energy and
macronutrients were estimated. In Kaplan-Meier analyses, we calculated
age-adjusted cumulative incidence rates of stroke. Using Cox regression, we
estimated stroke incidence relative risks during 20 years of follow-up.
MAIN OUTCOME MEASURE: Incidence of ischemic stroke, which occurred in 61
subjects during the follow-up period. RESULTS: Mean intakes were 10975 kJ
for energy; 114 g (39% of energy) for total fat; 44 g (15%) for saturated
fat; 46 g (16%) for monounsaturated fat; and 16 g (5%) for polyunsaturated
fat. Risk of ischemic stroke declined across the increasing quintile of
total fat (log-rank trend P=.008), saturated fat (P=.002), and
monounsaturated fat (P=.008) but not polyunsaturated fat (P=.33). The age-
and energy-adjusted relative risk for each increment of 3% of energy from
total fat was 0.85 (95% confidence interval [CI], 0.78-0.94); for an
increment of 1% from saturated fat, 0.91 (95% CI, 0.85-0.98); and for 1%
from monounsaturated fat, 0.89 (95% CI, 0.83-0.96). Adjustment for
cigarette smoking, glucose intolerance, body mass index, blood pressure,
blood cholesterol level, physical activity, and intake of vegetables and
fruits and alcohol did not materially change the results. Too few cases of
hemorrhagic stroke (n=14) occurred to draw inferences. CONCLUSION: Intakes
of fat, saturated fat, and monounsaturated fat were associated with reduced
risk of ischemic stroke in men.
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