@article{3101383,
    title = "Impact of nonoptimal intakes of saturated, polyunsaturated, and trans fat on global burdens of coronary heart disease",
    author = "Wang, Q. and Afshin, A. and Yakoob, M.Y. and Singh, G.M. and Rehm, C.D. and Khatibzadeh, S. and Micha, R. and Shi, P. and Mozaffarian, D. and Ezzati, M. and Fahimi, S. and Wirojratana, P. and Powles, J. and Elmadfa, I. and Rao, M. and Alpert, W. and Lim, S.S. and Engell, R.E. and Andrews, K.G. and Abbott, P.A. and Abdollahi, M. and Abeyá Gilardon, E.O. and Ahsan, H. and Al Nsour, M.A.A. and Al-Hooti, S.N. and Arambepola, C. and Fernando, D.N. and Barennes, H. and Barquera, S. and Baylin, A. and Becker, W. and Bjerregaard, P. and Bourne, L.T. and Capanzana, M.V. and Castetbon, K. and Chang, H.-Y. and Chen, Y. and Cowan, M.J. and Riley, L.M. and De Henauw, S. and Ding, E.L. and Duante, C.A. and Duran, P. and Barbieri, H.E. and Farzadfar, F. and Hadziomeragic, A.F. and Fisberg, R.M. and Forsyth, S. and Garriguet, D. and Gaspoz, J.-M. and Gauci, D. and Calleja, N. and Ginnela, B.N.V. and Guessous, I. and Gulliford, M.C. and Hadden, W. and Haerpfer, C. and Hoffman, D.J. and Houshiar-Rad, A. and Huybrechts, I. and Hwalla, N.C. and Ibrahim, H.M. and Inoue, M. and Jackson, M.D. and Johansson, L. and Keinan-Boker, L. and Kim, C.-I. and Koksal, E. and Lee, H.-J. and Li, Y. and Lipoeto, N.I. and Ma, G. and Mangialavori, G.L. and Matsumura, Y. and McGarvey, S.T. and Fen, C.M. and Monge-Rojas, R.A. and Musaiger, A.O. and Nagalla, B. and Naska, A. and Ocke, M.C. and Oltarzewski, M. and Szponar, L. and Orfanos, P. and Ovaskainen, M.-L. and Tapanainen, H. and Pan, W.-H. and Panagiotakos, D.B. and Pekcan, G.A. and Petrova, S. and Piaseu, N. and Pitsavos, C. and Posada, L.G. and Sánchez-Romero, L.M. and Selamat, R.B.T. and Sharma, S. and Sibai, A.M. and Sichieri, R. and Simmala, C. and Steingrimsdottir, L. and Swan, G. and Sygnowska, E.H. and Templeton, R. and Thanopoulou, A. and Thorgeirsdóttir, H. and Thorsdottir, I. and Trichopoulou, A. and Tsugane, S. and Turrini, A. and Vaask, S. and van Oosterhout, C. and Veerman, J.L. and Verena, N. and Waskiewicz, A. and Zaghloul, S. and Zajkás, G.",
    journal = "Journal of the American Heart Association",
    year = "2016",
    volume = "5",
    number = "1",
    publisher = "John Wiley and Sons Inc",
    issn = "2047-9980",
    doi = "10.1161/JAHA.115.002891",
    keywords = "polyunsaturated fatty acid;  saturated fatty acid;  trans fatty acid;  fat intake;  omega 6 fatty acid;  trans fatty acid, Article;  Bayes theorem;  Canada;  carbohydrate intake;  cause of death;  cerebrovascular accident;  dietary intake;  Egypt;  fat intake;  food availability;  human;  ICD-10;  ischemic heart disease;  low income country;  middle income country;  mortality rate;  Pakistan;  priority journal;  risk assessment;  risk factor;  sensitivity analysis;  trend study;  administration and dosage;  adverse effects;  age distribution;  Coronary Disease;  diet;  dietary reference intake;  fat intake;  female;  male;  Markov chain;  Monte Carlo method;  mortality;  protection;  sex ratio;  time factor, Age Distribution;  Bayes Theorem;  Coronary Disease;  Diet Surveys;  Dietary Fats;  Fatty Acids, Omega-6;  Female;  Humans;  Male;  Markov Chains;  Monte Carlo Method;  Protective Factors;  Recommended Dietary Allowances;  Risk Assessment;  Risk Factors;  Sex Distribution;  Time Factors;  Trans Fatty Acids",
    abstract = "Background: Saturated fat (SFA), x-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 SFAattributable 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. © 2016 The Authors."
}