Abstract
Background: The effect of dietary fat intake on the metabolic syndrome (MetS) and in turn on cardiovascular disease (CVD) remains unclear in individuals at high CVD risk. Objective: To assess the association between fat intake and MetS components in an adult Mediterranean population at high CVD risk. Design: Baseline assessment of nutritional adequacy in participants (n = 6560, men and women, 55-75 years old, with overweight/obesity and MetS) in the PREvención con DIeta MEDiterránea (PREDIMED)-Plus randomized trial. Methods: Assessment of fat intake (total fat, monounsatured fatty acids: MUFA, polyunsaturated fatty acids: PUFA, saturated fatty acids: SFA, trans-fatty acids: trans-FA, linoleic acid, α-linolenic acid, and ω-3 FA) using a validated food frequency questionnaire, and diet quality using 17-item Mediterranean dietary questionnaire and fat quality index (FQI). Results: Participants in the highest quintile of total dietary fat intake showed lower intake of energy, carbohydrates, protein and fiber, but higher intake of PUFA, MUFA, SFA, TFA, LA, ALA and ω-3 FA. Differences in MetS components were found according to fat intake. Odds (5th vs. 1st quintile): hyperglycemia: 1.3-1.6 times higher for total fat, MUFA, SFA and ω-3 FA intake; low high-density lipoprotein cholesterol (HDL-c): 1.2 higher for LA; hypertriglyceridemia: 0.7 lower for SFA and ω-3 FA intake. Conclusions: Dietary fats played different role on MetS components of high CVD risk patients. Dietary fat intake was associated with higher risk of hyperglycemia.
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Key Points
Obesity and the ensuing metabolic syndrome (MetS) are becoming an epidemic. In an effort to tackle the problem of obesity, and in turn cardiovascular risk, nutritional guidelines recommended a global limit on total fat intake, inevitably resulting in an increased intake of simple carbohydrates and decreased intake of healthy unsaturated fatty acids (UFA). The Mediterranean diet (MedDiet) is characterized by high intakes of plant foods (fruits, vegetables, legumes, nuts, and whole grains) and olive oil as the principal source of dietary lipids. This dietary pattern seems to ameliorate metabolic risk factors defining the MetS and reduce the incidence of cardiovascular events, breast cancer, and T2DM compared with any other diet.
The PREvención con DIeta MEDiterránea (PREDIMED)-Plus study provides a unique opportunity to assess the association between fat intake and MetS components in an adult Mediterranean population at high CVD risk. In this cross-sectional study, the association of total dietary fat and specific subtypes of dietary fat intake with the components of MetS in a Mediterranean population at high cardiovascular risk was evaluated. The most important finding of the present study is a significant increase in the risk of hyperglycemia among participants in the upper quintiles of total dietary fat, SFA, MUFA, and ω-3 FA intake, a significant increase in the risk of low HDL-c levels among participants in the upper quintile of LA, and a significant decrease in the risk of hypertriglyceridemia among participants in the upper quintiles of SFA and ω-3 FA intakes.
High SFA intake and hyperglycemia were positively associated in this study. The results showed a significant increase in the prevalence of hyperglycemia with increasing MUFA and ω-3 FA intake. The OR for hypertriglyceridemia was lower in the upper quintiles of SFA intake (Q3–Q5). Contrarily to our results, a positive association of SFA intake with serum TG has been found in the literature. The present study showed a significant increase in risk of hypertriglyceridemia in the upper quintile of ω-3 FA intake.
The results may help to highlight the fact that dietary recommendations should focus not on lowering the total fat content of the diet but rather on specific types of fats and carbohydrates and, more importantly, on specific foods and overall dietary patterns for individuals at high CVD risk. These data suggest a potential different role of types of dietary fat on the MetS components of individuals at high cardiovascular risk. The main findings suggest that the intake of dietary fat was associated with a higher risk of hyperglycemia. It is likely that the effects of dietary fat intake on cardiometabolic syndrome will be influenced by the combination of nutrients of the food consumed. Therefore, the type of dietary fat should be considered for future dietary recommendations to decrease risk of MetS at a population level.