Individual omega-9 monounsaturated fatty acids and mortality-The Ludwigshafen Risk and Cardiovascular Health Study

J Clin Lipidol. Jan-Feb 2017;11(1):126-135.e5. doi: 10.1016/j.jacl.2016.10.015. Epub 2016 Nov 10.


Background: The association of polyunsaturated omega-3 and omega-6 fatty acids with mortality has been extensively studied. Far less is known about the association of omega-9 monounsaturated fatty acids (omega-9 MUFA) with mortality.

Objective: We aimed to study the association of individual omega-MUFA with all-cause and cardiovascular mortality.

Methods: Omega-9 MUFA concentrations were measured in erythrocytes in 3259 patients participating in the Ludwigshafen Risk and Cardiovascular Health Study using the HS-Omega-3 index method. Associations with mortality were analyzed by Cox proportional hazards regression with adjustment for conventional risk factors separately for men and women.

Results: During a median follow-up of 10.0 years, 975 patients (29.9%) died. Partial correlation analysis adjusted for age and gender showed inverse correlations of oleic acid (OA), gondoic acid (GA), and nervonic acid (NA) with LDL-C, HDL-C, and eGFR but direct correlations with markers of inflammation and endothelial activation as well as heart failure. A 1-SD increase in OA, GA, and NA was associated with increased risk of all-cause mortality with HRs (95% CI) of 1.08 (1.01-1.16), 1.07 (1.01-1.13), and 1.12 (1.05-1.20), respectively. NA was the only omega-9 MUFA being associated with increased risk in men, whereas in women also GA was associated with risk. The association between OA and mortality seems to be U-shaped with a nadir at a concentration of approx 14%.

Conclusions: All three omega-9 MUFA showed direct associations with mortality. Further studies are warranted to explore biologic and prognostic properties of omega-9 fatty acids, with a focus on nervonic acid.

Keywords: Monounsaturated fatty acids; Mortality; Nervonic acid; Nutrition; Oleic acid.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cardiovascular Diseases / blood*
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / mortality*
  • Erythrocytes / metabolism
  • Fatty Acids, Monounsaturated / blood*
  • Fatty Acids, Unsaturated / blood
  • Female
  • Humans
  • Male
  • Middle Aged
  • Proportional Hazards Models
  • Risk Assessment
  • Risk Factors


  • Fatty Acids, Monounsaturated
  • Fatty Acids, Unsaturated