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 ...