Intake of carbohydrates and SFA and risk of CHD in middle-age adults: the Hordaland Health Study (HUSK)

OBJECTIVE: Limiting SFA intake may minimise the risk of CHD. However, such reduction often leads to increased intake of carbohydrates. We aimed to evaluate associations and the interplay of carbohydrate and SFA intake on CHD risk. DESIGN: Prospective cohort study. SETTING: We followed participants in the Hordaland Health Study, Norway from 1997–1999 through 2009. Information on carbohydrate and SFA intake was obtained from a FFQ and analysed as continuous and categorical (quartiles) variables. Multivariable Cox regression estimated hazard ratios (HR) and 95 % CI. Theoretical substitution analyses modelled the substitution of carbohydrates with other nutrients. CHD was defined as fatal or non-fatal CHD (ICD9 codes 410–414 and ICD10 codes I20–I25). PARTICIPANTS: 2995 men and women, aged 46–49 years. RESULTS: Adjusting for age, sex, energy intake, physical activity and smoking, SFA was associated with lower risk (HR(Q4 v. Q1) 0·44, 95 % CI 0·26, 0·76, P (trend) = 0·002). For carbohydrates, the opposite pattern was observed (HR(Q4 v. Q1) 2·10, 95 % CI 1·22, 3·63, P (trend) = 0·003). SFA from cheese was associated with lower CHD risk (HR(Q4 v. Q1) 0·44, 95 % CI 0·24, 0·83, P (trend) = 0·006), while there were no associations between SFA from other food items and CHD. A 5 E% substitution of carbohydrates with total fat, but not SFA, was associated with lower CHD risk (HR 0·75, 95 % CI 0·62, 0·90). CONCLUSIONS: Higher intake of predominantly high glycaemic carbohydrates and lower intake of SFA, specifically lower intake from cheese, were associated with higher CHD risk. Substituting carbohydrates with total fat, but not SFA, was associated with significantly lower risk of CHD.