Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study

doi:10.1016/S0140-6736(17)32252-3

Comparative Study

. 2017 Nov 4;390(10107):2050-2062.

doi: 10.1016/S0140-6736(17)32252-3. Epub 2017 Aug 29.

Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study

Mahshid Dehghan¹, Andrew Mente², Xiaohe Zhang³, Sumathi Swaminathan⁴, Wei Li⁵, Viswanathan Mohan⁶, Romaina Iqbal⁷, Rajesh Kumar⁸, Edelweiss Wentzel-Viljoen⁹, Annika Rosengren¹⁰, Leela Itty Amma¹¹, Alvaro Avezum¹², Jephat Chifamba¹³, Rafael Diaz¹⁴, Rasha Khatib¹⁵, Scott Lear¹⁶, Patricio Lopez-Jaramillo¹⁷, Xiaoyun Liu⁵, Rajeev Gupta¹⁸, Noushin Mohammadifard¹⁹, Nan Gao⁵, Aytekin Oguz²⁰, Anis Safura Ramli²¹, Pamela Seron²², Yi Sun⁵, Andrzej Szuba²³, Lungiswa Tsolekile²⁴, Andreas Wielgosz²⁵, Rita Yusuf²⁶, Afzal Hussein Yusufali²⁷, Koon K Teo³, Sumathy Rangarajan³, Gilles Dagenais²⁸, Shrikant I Bangdiwala³, Shofiqul Islam³, Sonia S Anand²⁹, Salim Yusuf³, Prospective Urban Rural Epidemiology (PURE) study investigators

Collaborators, Affiliations

Collaborators

Prospective Urban Rural Epidemiology (PURE) study investigators:
R Diaz, A Orlandini, B Linetsky, S Toscanelli, G Casaccia, Jm Maini Cuneo, O Rahman, R Yusuf, A K Azad, K A Rabbani, H M Cherry, A Mannan, I Hassan, A T Talukdar, R B Tooheen, M U Khan, M Sintaha, T Choudhury, R Haque, S Parvin, A Avezum, G B Oliveira, C S Marcilio, A C Mattos, K Teo, S Yusuf, J Dejesus, D Agapay, T Tongana, R Solano, I Kay, S Trottier, J Rimac, W Elsheikh, L Heldman, E Ramezani, G Dagenais, P Poirier, G Turbide, D Auger, A LeBlanc De Bluts, M C Proulx, M Cayer, N Bonneville, S Lear, D Gasevic, E Corber, V de Jong, I Vukmirovich, A Wielgosz, G Fodor, A Pipe, A Shane, F Lanas, P Seron, S Martinez, A Valdebenito, M Oliveros, Li Wei, Liu Lisheng, Chen Chunming, Wang Xingyu, Zhao Wenhua, Zhang Hongye, Jia Xuan, Hu Bo, Sun Yi, Bo Jian, Zhao Xiuwen, Chang Xiaohong, Chen Tao, Chen Hui, Chang Xiaohong, Deng Qing, Cheng Xiaoru, Deng Qing, He Xinye, Hu Bo, Jia Xuan, Li Jian, Li Juan, Liu Xu, Ren Bing, Sun Yi, Wang Wei, Wang Yang, Yang Jun, Zhai Yi, Zhang Hongye, Zhao Xiuwen, Zhu Manlu, Lu Fanghong, Wu Jianfang, Li Yindong, Hou Yan, Zhang Liangqing, Guo Baoxia, Liao Xiaoyang, Zhang Shiying, Bian Rongwen, Tian Xiuzhen, Li Dong, Chen Di, Wu Jianguo, Xiao Yize, Liu Tianlu, Zhang Peng, Dong Changlin, Li Ning, Ma Xiaolan, Yang Yuqing, Lei Rensheng, Fu Minfan, He Jing, Liu Yu, Xing Xiaojie, Zhou Qiang, P Lopez-Jaramillo, Pa Camacho Lopez, R Garcia, Lja Jurado, D Gómez-Arbeláez, J F Arguello, R Dueñas, S Silva, L P Pradilla, F Ramirez, D I Molina, C Cure-Cure, M Perez, E Hernandez, E Arcos, S Fernandez, C Narvaez, J Paez, A Sotomayor, H Garcia, G Sanchez, T David, A Rico, P Mony, M Vaz, A V Bharathi, S Swaminathan, K Shankar Av Kurpad, K G Jayachitra, N Kumar, Hal Hospital, V Mohan, M Deepa, K Parthiban, M Anitha, S Hemavathy, T Rahulashankiruthiyayan, D Anitha, K Sridevi, R Gupta, R B Panwar, I Mohan, P Rastogi, S Rastogi, R Bhargava, R Kumar, J S Thakur, B Patro, Pvm Lakshmi, R Mahajan, P Chaudary, V Raman Kutty, K Vijayakumar, K Ajayan, G Rajasree, A R Renjini, A Deepu, B Sandhya, S Asha, H S Soumya, R Kelishadi, A Bahonar, N Mohammadifard, H Heidari, K Yusoff, Tst Ismail, K K Ng, A Devi, N M Nasir, M M Yasin, M Miskan, E A Rahman, Mkm Arsad, F Ariffin, S A Razak, F A Majid, N A Bakar, M Y Yacob, N Zainon, R Salleh, Mka Ramli, N A Halim, S R Norlizan, N M Ghazali, M N Arshad, R Razali, S Ali, H R Othman, Cwjcw Hafar, A Pit, N Danuri, F Basir, Sna Zahari, H Abdullah, M A Arippin, N A Zakaria, I Noorhassim, M J Hasni, M T Azmi, M I Zaleha, K Y Hazdi, A R Rizam, W Sazman, A Azman, R Khatib, U Khammash, A Khatib, R Giacaman, R Iqbal, A Afridi, R Khawaja, A Raza, K Kazmi, W Zatonski, A Szuba, K Zatonska, R Ilow, M Ferus, B Regulska-Ilow, D Rózanska, M Wolyniec, Alkamel, M Ali, M A Kruger, H H Voster, A E Schutte, E Wentzel-Viljoen, F C Eloff, H de Ridder, H Moss, J Potgieter, A A Roux, M Watson, G de Wet, A Olckers, J C Jerling, M Pieters, T Hoekstra, T Puoane, E Igumbor, L Tsolekile, D Sanders, P Naidoo, N Steyn, N Peer, B Mayosi, B Rayner, V Lambert, N Levitt, T Kolbe-Alexander, L Ntyintyane, G Hughes, R Swart, J Fourie, M Muzigaba, S Xapa, N Gobile, K Ndayi, B Jwili, K Ndibaza, B Egbujie, A Rosengren, K Bengtsson Boström, A Gustavsson, M Andreasson, M Snällman, L Wirdemann, A Oguz, N Imeryuz, Y Altuntas, S Gulec, A Temizhan, K Karsidag, Kbt Calik, Aak Akalin, O T Caklili, M V Keskinler, A N Erbakan, A M Yusufali, W Almahmeed, H Swidan, E A Darwish, Ara Hashemi, N Al-Khaja, J M Muscat-Baron, S H Ahmed, T M Mamdouh, W M Darwish, Mhs Abdelmotagali, Sa Omer Awed, G A Movahedi, F Hussain, H Al Shaibani, Rim Gharabou, D F Youssef, Azs Nawati, Zar Abu Salah, Rfe Abdalla, S M Al Shuwaihi, M A Al Omairi, O D Cadigal, R S Alejandrino, J Chifamba, L Gwaunza, G Terera, C Mahachi, P Murambiwa, T Machiweni, R Mapanga

Affiliations

¹ Population Health Research Institute, McMaster University, Hamilton, ON, Canada. Electronic address: mahshid.dehghan@phri.ca.
² Population Health Research Institute, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
³ Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
⁴ St John's Research Institute, St John's National Academy of Health Sciences, Sarjapur Road, Koramangala, Bangalore, Karnataka, India.
⁵ State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China.
⁶ Madras Diabetes Research Foundation, Chennai, India.
⁷ Departments of Community Health Sciences and Medicine, Aga Khan University, Karachi, Pakistan.
⁸ PGIMER School of Public Health, Chandigarh, India.
⁹ Centre of Excellence for Nutrition, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa.
¹⁰ Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.
¹¹ Health Action by People TC 1/1706, Medical College PO, Trivandrum, India.
¹² Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil.
¹³ University of Zimbabwe, College of Health Sciences, Department of Physiology, Harare, Zimbabwe.
¹⁴ Estudios Clínicos Latinoamérica, ECLA, Rosario, Argentina.
¹⁵ Institute of Community and Public Health, Birzeit University, Birzeit, occupied Palestinian territory.
¹⁶ Faculty of Health Sciences, Department of Biomedical Physiology & Kinesiology, Simon Fraser University, Burnaby, BC, Canada.
¹⁷ Fundacion Oftalmologica de Santander-FOSCAL, Floridablanca-Santander, Colombia.
¹⁸ Eternal Heart Care Centre and Research Institute, Jaipur, India.
¹⁹ Isfahan Cardiovascular Research Centre, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
²⁰ Istanbul Medeniyet University, Faculty of Medicine, Department of Internal Medicine, Goztepe, Istanbul, Turkey.
²¹ Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia.
²² Universidad de La Frontera, Temuco, Araucanía, Chile.
²³ Division of Angiology, Wroclaw Medical University, Wroclaw, Poland.
²⁴ University of the Western Cape, Bellville, Western Province, Cape Town, South Africa.
²⁵ University of Ottawa Department of Medicine, Ottawa, ON, Canada.
²⁶ Independent University, Bangladesh, Dhaka, Bangladesh.
²⁷ Dubai Medical University, Hatta Hospital, Dubai Health Authority, Dubai, United Arab Emirates.
²⁸ Université Laval, Institut Universitaire de Cardiologie, Ville de Québec, QC, Canada.
²⁹ Department of Medicine, McMaster University, Hamilton, ON, Canada.

PMID: 28864332
DOI: 10.1016/S0140-6736(17)32252-3

Comparative Study

Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study

Mahshid Dehghan et al. Lancet. 2017.

. 2017 Nov 4;390(10107):2050-2062.

doi: 10.1016/S0140-6736(17)32252-3. Epub 2017 Aug 29.

Authors

Collaborators

Prospective Urban Rural Epidemiology (PURE) study investigators:
R Diaz, A Orlandini, B Linetsky, S Toscanelli, G Casaccia, Jm Maini Cuneo, O Rahman, R Yusuf, A K Azad, K A Rabbani, H M Cherry, A Mannan, I Hassan, A T Talukdar, R B Tooheen, M U Khan, M Sintaha, T Choudhury, R Haque, S Parvin, A Avezum, G B Oliveira, C S Marcilio, A C Mattos, K Teo, S Yusuf, J Dejesus, D Agapay, T Tongana, R Solano, I Kay, S Trottier, J Rimac, W Elsheikh, L Heldman, E Ramezani, G Dagenais, P Poirier, G Turbide, D Auger, A LeBlanc De Bluts, M C Proulx, M Cayer, N Bonneville, S Lear, D Gasevic, E Corber, V de Jong, I Vukmirovich, A Wielgosz, G Fodor, A Pipe, A Shane, F Lanas, P Seron, S Martinez, A Valdebenito, M Oliveros, Li Wei, Liu Lisheng, Chen Chunming, Wang Xingyu, Zhao Wenhua, Zhang Hongye, Jia Xuan, Hu Bo, Sun Yi, Bo Jian, Zhao Xiuwen, Chang Xiaohong, Chen Tao, Chen Hui, Chang Xiaohong, Deng Qing, Cheng Xiaoru, Deng Qing, He Xinye, Hu Bo, Jia Xuan, Li Jian, Li Juan, Liu Xu, Ren Bing, Sun Yi, Wang Wei, Wang Yang, Yang Jun, Zhai Yi, Zhang Hongye, Zhao Xiuwen, Zhu Manlu, Lu Fanghong, Wu Jianfang, Li Yindong, Hou Yan, Zhang Liangqing, Guo Baoxia, Liao Xiaoyang, Zhang Shiying, Bian Rongwen, Tian Xiuzhen, Li Dong, Chen Di, Wu Jianguo, Xiao Yize, Liu Tianlu, Zhang Peng, Dong Changlin, Li Ning, Ma Xiaolan, Yang Yuqing, Lei Rensheng, Fu Minfan, He Jing, Liu Yu, Xing Xiaojie, Zhou Qiang, P Lopez-Jaramillo, Pa Camacho Lopez, R Garcia, Lja Jurado, D Gómez-Arbeláez, J F Arguello, R Dueñas, S Silva, L P Pradilla, F Ramirez, D I Molina, C Cure-Cure, M Perez, E Hernandez, E Arcos, S Fernandez, C Narvaez, J Paez, A Sotomayor, H Garcia, G Sanchez, T David, A Rico, P Mony, M Vaz, A V Bharathi, S Swaminathan, K Shankar Av Kurpad, K G Jayachitra, N Kumar, Hal Hospital, V Mohan, M Deepa, K Parthiban, M Anitha, S Hemavathy, T Rahulashankiruthiyayan, D Anitha, K Sridevi, R Gupta, R B Panwar, I Mohan, P Rastogi, S Rastogi, R Bhargava, R Kumar, J S Thakur, B Patro, Pvm Lakshmi, R Mahajan, P Chaudary, V Raman Kutty, K Vijayakumar, K Ajayan, G Rajasree, A R Renjini, A Deepu, B Sandhya, S Asha, H S Soumya, R Kelishadi, A Bahonar, N Mohammadifard, H Heidari, K Yusoff, Tst Ismail, K K Ng, A Devi, N M Nasir, M M Yasin, M Miskan, E A Rahman, Mkm Arsad, F Ariffin, S A Razak, F A Majid, N A Bakar, M Y Yacob, N Zainon, R Salleh, Mka Ramli, N A Halim, S R Norlizan, N M Ghazali, M N Arshad, R Razali, S Ali, H R Othman, Cwjcw Hafar, A Pit, N Danuri, F Basir, Sna Zahari, H Abdullah, M A Arippin, N A Zakaria, I Noorhassim, M J Hasni, M T Azmi, M I Zaleha, K Y Hazdi, A R Rizam, W Sazman, A Azman, R Khatib, U Khammash, A Khatib, R Giacaman, R Iqbal, A Afridi, R Khawaja, A Raza, K Kazmi, W Zatonski, A Szuba, K Zatonska, R Ilow, M Ferus, B Regulska-Ilow, D Rózanska, M Wolyniec, Alkamel, M Ali, M A Kruger, H H Voster, A E Schutte, E Wentzel-Viljoen, F C Eloff, H de Ridder, H Moss, J Potgieter, A A Roux, M Watson, G de Wet, A Olckers, J C Jerling, M Pieters, T Hoekstra, T Puoane, E Igumbor, L Tsolekile, D Sanders, P Naidoo, N Steyn, N Peer, B Mayosi, B Rayner, V Lambert, N Levitt, T Kolbe-Alexander, L Ntyintyane, G Hughes, R Swart, J Fourie, M Muzigaba, S Xapa, N Gobile, K Ndayi, B Jwili, K Ndibaza, B Egbujie, A Rosengren, K Bengtsson Boström, A Gustavsson, M Andreasson, M Snällman, L Wirdemann, A Oguz, N Imeryuz, Y Altuntas, S Gulec, A Temizhan, K Karsidag, Kbt Calik, Aak Akalin, O T Caklili, M V Keskinler, A N Erbakan, A M Yusufali, W Almahmeed, H Swidan, E A Darwish, Ara Hashemi, N Al-Khaja, J M Muscat-Baron, S H Ahmed, T M Mamdouh, W M Darwish, Mhs Abdelmotagali, Sa Omer Awed, G A Movahedi, F Hussain, H Al Shaibani, Rim Gharabou, D F Youssef, Azs Nawati, Zar Abu Salah, Rfe Abdalla, S M Al Shuwaihi, M A Al Omairi, O D Cadigal, R S Alejandrino, J Chifamba, L Gwaunza, G Terera, C Mahachi, P Murambiwa, T Machiweni, R Mapanga

Affiliations

¹ Population Health Research Institute, McMaster University, Hamilton, ON, Canada. Electronic address: mahshid.dehghan@phri.ca.
² Population Health Research Institute, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
³ Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
⁴ St John's Research Institute, St John's National Academy of Health Sciences, Sarjapur Road, Koramangala, Bangalore, Karnataka, India.
⁵ State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China.
⁶ Madras Diabetes Research Foundation, Chennai, India.
⁷ Departments of Community Health Sciences and Medicine, Aga Khan University, Karachi, Pakistan.
⁸ PGIMER School of Public Health, Chandigarh, India.
⁹ Centre of Excellence for Nutrition, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa.
¹⁰ Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.
¹¹ Health Action by People TC 1/1706, Medical College PO, Trivandrum, India.
¹² Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil.
¹³ University of Zimbabwe, College of Health Sciences, Department of Physiology, Harare, Zimbabwe.
¹⁴ Estudios Clínicos Latinoamérica, ECLA, Rosario, Argentina.
¹⁵ Institute of Community and Public Health, Birzeit University, Birzeit, occupied Palestinian territory.
¹⁶ Faculty of Health Sciences, Department of Biomedical Physiology & Kinesiology, Simon Fraser University, Burnaby, BC, Canada.
¹⁷ Fundacion Oftalmologica de Santander-FOSCAL, Floridablanca-Santander, Colombia.
¹⁸ Eternal Heart Care Centre and Research Institute, Jaipur, India.
¹⁹ Isfahan Cardiovascular Research Centre, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
²⁰ Istanbul Medeniyet University, Faculty of Medicine, Department of Internal Medicine, Goztepe, Istanbul, Turkey.
²¹ Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia.
²² Universidad de La Frontera, Temuco, Araucanía, Chile.
²³ Division of Angiology, Wroclaw Medical University, Wroclaw, Poland.
²⁴ University of the Western Cape, Bellville, Western Province, Cape Town, South Africa.
²⁵ University of Ottawa Department of Medicine, Ottawa, ON, Canada.
²⁶ Independent University, Bangladesh, Dhaka, Bangladesh.
²⁷ Dubai Medical University, Hatta Hospital, Dubai Health Authority, Dubai, United Arab Emirates.
²⁸ Université Laval, Institut Universitaire de Cardiologie, Ville de Québec, QC, Canada.
²⁹ Department of Medicine, McMaster University, Hamilton, ON, Canada.

PMID: 28864332
DOI: 10.1016/S0140-6736(17)32252-3

Favorites

Abstract

Background: The relationship between macronutrients and cardiovascular disease and mortality is controversial. Most available data are from European and North American populations where nutrition excess is more likely, so their applicability to other populations is unclear.

Methods: The Prospective Urban Rural Epidemiology (PURE) study is a large, epidemiological cohort study of individuals aged 35-70 years (enrolled between Jan 1, 2003, and March 31, 2013) in 18 countries with a median follow-up of 7·4 years (IQR 5·3-9·3). Dietary intake of 135 335 individuals was recorded using validated food frequency questionnaires. The primary outcomes were total mortality and major cardiovascular events (fatal cardiovascular disease, non-fatal myocardial infarction, stroke, and heart failure). Secondary outcomes were all myocardial infarctions, stroke, cardiovascular disease mortality, and non-cardiovascular disease mortality. Participants were categorised into quintiles of nutrient intake (carbohydrate, fats, and protein) based on percentage of energy provided by nutrients. We assessed the associations between consumption of carbohydrate, total fat, and each type of fat with cardiovascular disease and total mortality. We calculated hazard ratios (HRs) using a multivariable Cox frailty model with random intercepts to account for centre clustering.

Findings: During follow-up, we documented 5796 deaths and 4784 major cardiovascular disease events. Higher carbohydrate intake was associated with an increased risk of total mortality (highest [quintile 5] vs lowest quintile [quintile 1] category, HR 1·28 [95% CI 1·12-1·46], p_trend=0·0001) but not with the risk of cardiovascular disease or cardiovascular disease mortality. Intake of total fat and each type of fat was associated with lower risk of total mortality (quintile 5 vs quintile 1, total fat: HR 0·77 [95% CI 0·67-0·87], p_trend<0·0001; saturated fat, HR 0·86 [0·76-0·99], p_trend=0·0088; monounsaturated fat: HR 0·81 [0·71-0·92], p_trend<0·0001; and polyunsaturated fat: HR 0·80 [0·71-0·89], p_trend<0·0001). Higher saturated fat intake was associated with lower risk of stroke (quintile 5 vs quintile 1, HR 0·79 [95% CI 0·64-0·98], p_trend=0·0498). Total fat and saturated and unsaturated fats were not significantly associated with risk of myocardial infarction or cardiovascular disease mortality.

Interpretation: High carbohydrate intake was associated with higher risk of total mortality, whereas total fat and individual types of fat were related to lower total mortality. Total fat and types of fat were not associated with cardiovascular disease, myocardial infarction, or cardiovascular disease mortality, whereas saturated fat had an inverse association with stroke. Global dietary guidelines should be reconsidered in light of these findings.

Funding: Full funding sources listed at the end of the paper (see Acknowledgments).

Comment in

PURE study challenges the definition of a healthy diet: but key questions remain.
Ramsden CE, Domenichiello AF. Ramsden CE, et al. Lancet. 2017 Nov 4;390(10107):2018-2019. doi: 10.1016/S0140-6736(17)32241-9. Epub 2017 Aug 29. Lancet. 2017. PMID: 28864330 No abstract available.
The triumph of HIV treatment: another new antiretroviral.
Boffito M, Venter F. Boffito M, et al. Lancet. 2017 Nov 4;390(10107):2019-2021. doi: 10.1016/S0140-6736(17)32297-3. Epub 2017 Aug 31. Lancet. 2017. PMID: 28867498 No abstract available.
Prevention: The healthy diet - fruits, vegetables, legumes, and fats.
Fernández-Ruiz I. Fernández-Ruiz I. Nat Rev Cardiol. 2017 Nov;14(11):631. doi: 10.1038/nrcardio.2017.151. Epub 2017 Sep 14. Nat Rev Cardiol. 2017. PMID: 28905865 No abstract available.
Is it really good for you to eat fat as much as you could?
Li D. Li D. Sci China Life Sci. 2018 Mar;61(3):363-364. doi: 10.1007/s11427-017-9194-3. Epub 2017 Oct 27. Sci China Life Sci. 2018. PMID: 29143278 No abstract available.
Choose right carbohydrates and right fats (RCRF) - keys to optimal health.
Bengmark S. Bengmark S. Hepatobiliary Surg Nutr. 2017 Dec;6(6):429-433. doi: 10.21037/hbsn.2017.12.03. Hepatobiliary Surg Nutr. 2017. PMID: 29312983 Free PMC article. No abstract available.
Associations of fats and carbohydrates with cardiovascular disease and mortality-PURE and simple?
Kahleova H, Crosby L, Levin S, Barnard ND. Kahleova H, et al. Lancet. 2018 Apr 28;391(10131):1676-1677. doi: 10.1016/S0140-6736(18)30805-5. Epub 2018 Apr 26. Lancet. 2018. PMID: 29726332 No abstract available.
Associations of fats and carbohydrates with cardiovascular disease and mortality-PURE and simple?
Reynolds AN. Reynolds AN. Lancet. 2018 Apr 28;391(10131):1676. doi: 10.1016/S0140-6736(18)30845-6. Epub 2018 Apr 26. Lancet. 2018. PMID: 29726333 No abstract available.
Associations of fats and carbohydrates with cardiovascular disease and mortality-PURE and simple?
Mann J, Meerpohl J, Nishida C, McLean R, Te Morenga L. Mann J, et al. Lancet. 2018 Apr 28;391(10131):1676. doi: 10.1016/S0140-6736(18)30804-3. Epub 2018 Apr 26. Lancet. 2018. PMID: 29726334 No abstract available.
Associations of fats and carbohydrates with cardiovascular disease and mortality-PURE and simple?
Bhopal RS, Misra A. Bhopal RS, et al. Lancet. 2018 Apr 28;391(10131):1677-1678. doi: 10.1016/S0140-6736(18)30787-6. Epub 2018 Apr 26. Lancet. 2018. PMID: 29726335 No abstract available.
Associations of fats and carbohydrates with cardiovascular disease and mortality-PURE and simple?
Rossouw JE, Prentice RL. Rossouw JE, et al. Lancet. 2018 Apr 28;391(10131):1677. doi: 10.1016/S0140-6736(18)30753-0. Epub 2018 Apr 26. Lancet. 2018. PMID: 29726336 No abstract available.
Associations of fats and carbohydrates with cardiovascular disease and mortality-PURE and simple?
Lorkowski S, Richter M, Linseisen J, Watzl B; German Nutrition Society. Lorkowski S, et al. Lancet. 2018 Apr 28;391(10131):1678-1679. doi: 10.1016/S0140-6736(18)30800-6. Epub 2018 Apr 26. Lancet. 2018. PMID: 29726337 No abstract available.
Associations of fats and carbohydrates with cardiovascular disease and mortality-PURE and simple?
Carbone S, Billingsley H, Abbate A. Carbone S, et al. Lancet. 2018 Apr 28;391(10131):1679. doi: 10.1016/S0140-6736(18)30799-2. Epub 2018 Apr 26. Lancet. 2018. PMID: 29726338 No abstract available.
Associations of fats and carbohydrates with cardiovascular disease and mortality-PURE and simple?
Cao XP, Tan CC, Yu JT. Cao XP, et al. Lancet. 2018 Apr 28;391(10131):1679-1680. doi: 10.1016/S0140-6736(18)30793-1. Epub 2018 Apr 26. Lancet. 2018. PMID: 29726339 No abstract available.
Associations of fats and carbohydrates with cardiovascular disease and mortality-PURE and simple?
Kleber ME, Delgado GE, Dawczynski C, Lorkowski S, März W. Kleber ME, et al. Lancet. 2018 Apr 28;391(10131):1680-1681. doi: 10.1016/S0140-6736(18)30798-0. Epub 2018 Apr 26. Lancet. 2018. PMID: 29726340 No abstract available.
Associations of fats and carbohydrates with cardiovascular disease and mortality-PURE and simple?
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Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study

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Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study

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Abstract

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Cited by 157 articles

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Medical