Intake of carbohydrates compared with intake of saturated fatty acids and risk of myocardial infarction: importance of the glycemic index

• Published in: The American journal of clinical nutrition 2010-06, Vol.91 (6), p.1764-1768
• Main Authors: Jakobsen, Marianne U, Dethlefsen, Claus, Joensen, Albert M, Stegger, Jakob, Tjønneland, Anne, Schmidt, Erik B, Overvad, Kim
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; carbohydrate intake; Carbohydrates; Cohort Studies; Denmark - epidemiology; dietary carbohydrate; Dietary Carbohydrates - administration & dosage; dietary fat; Dietary Fats - administration & dosage; Energy Intake - physiology; fat intake; Fatty acids; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Glycemic index; Glycemic Index - physiology; Heart attacks; Humans; longitudinal studies; Male; men; Middle Aged; myocardial infarction; Myocardial Infarction - epidemiology; Nutrition; Nutrition research; Proportional Hazards Models; Prospective Studies; risk assessment; saturated fatty acids; Sex Factors; Socioeconomic Factors; Surveys and Questionnaires; Vertebrates: anatomy and physiology, studies on body, several organs or systems; women
• ISSN: 0002-9165; 1938-3207
• DOI: 10.3945/ajcn.2009.29099

BACKGROUND: Studies have suggested that replacing saturated fatty acids (SFAs) with carbohydrates is modestly associated with a higher risk of ischemic heart disease, whereas replacing SFAs with polyunsaturated fatty acids is associated with a lower risk of ischemic heart disease. The effect of carbohydrates, however, may depend on the type consumed. OBJECTIVES: By using substitution models, we aimed to investigate the risk of myocardial infarction (MI) associated with a higher energy intake from carbohydrates and a concomitant lower energy intake from SFAs. Carbohydrates with different glycemic index (GI) values were also investigated. DESIGN: Our prospective cohort study included 53,644 women and men free of MI at baseline. RESULTS: During a median of 12 y of follow-up, 1943 incident MI cases occurred. There was a nonsignificant inverse association between substitution of carbohydrates with low-GI values for SFAs and risk of MI [hazard ratio (HR) for MI per 5% increment of energy intake from carbohydrates: 0.88; 95% CI: 0.72, 1.07). In contrast, there was a statistically significant positive association between substitution of carbohydrates with high-GI values for SFAs and risk of MI (HR: 1.33; 95% CI: 1.08, 1.64). There was no association for carbohydrates with medium-GI values (HR: 0.98; 95% CI: 0.80, 1.21). No effect modification by sex was observed. CONCLUSION: This study suggests that replacing SFAs with carbohydrates with low-GI values is associated with a lower risk of MI, whereas replacing SFAs with carbohydrates with high-GI values is associated with a higher risk of MI.