Fatty acids from dairy and meat and risk of coronary heart disease

In this study, we will examine the association with CHD of replacing total, saturated, mono-unsaturated and poly-unsaturated fatty acids from dairy with the corresponding fatty acids from meat. We will do this by modelling isocaloric substitution of these fatty acids in a multivariable cox regression among participants of the European Prospective Investigation into Cancer and Nutrition-Nederlands (EPIC-NL) cohort, with 2,374 incident CHD events during 15 years of follow-up.

We hypothesise that the relations of total fat and fatty acid (FA) subtypes (SFA, MUFA, or PUFA) with CHD are modified by their food source. We aim to directly compare relations of FA subtype intake from dairy and meat with risk of CHD by using substitution models.

Participants of the EPIC-NL study were followed for incidence of CHD by linkage to mortality and hospital discharge registers. Data on morbidity were provided by the National Medical Registry, using the Dutch Hospital Discharge Diagnosis Database. Vital status was obtained through linkage with the municipal population registries. Mortality data was obtained from Statistics Netherlands, which provided primary and secondary causes of death.

In the Dutch Hospital Discharge Diagnosis Database, CHD was defined through International Classification of Diseases (ICD)-9 codes: 410-414, 427.5, 798.1, 798.2, 798.9. Causes of death were coded according to ICD-10: I-20-I25, I46, R96

We will use Cox proportional regression analysis to estimate Hazard Ratios (HRs) and 95%- confidence intervals (CIs) for the association between substituting FA from dairy by FA from meat, and risk of CHD. Adjustments are made for sex, age, smoking, physical activity, educational level, alcohol intake (in categories) and energy adjusted intake of cholesterol and fibre, BMI, hyperlipidaemia, diabetes and hypertension