Adequacy of Fatty Acids Consumption Among Individuals in Secondary Cardiovascular Prevention

Marcadenti, Aline; Machado, Rachel H. Vieira; Santos, Renato Hideo Nakagawa; Kasai, Caio Cesar dos Santos; Kovacs, Cristiane; Bello, Annie; de Matos, Cristina H.; Bertacco, Renata Torres Abib; Souza, Gabriela C.; Schirmann, Gabriela da S.; Nagano, Francisca Eugenia Zaina; Poloni, Soraia; Kik, Raquel Milani El; Feres, Naoel Hassan; Rodrigues, Isa G.; Sousa, Antônio Carlos Sobral; Pinheiro, Josilene M. F.; Vasconcelos, Sandra Mary Lima; Carlos, Daniele Maria de Oliveira; Souza, Viviane Sahade; Gomes, Adriana Barros; Figueiredo Neto, José Albuquerque de; Moriguchi, Emilio Hideyuki; Izar, Maria Cristina; Pinto, Sônia Lopes; Bressan, Josefina; de Souza, Simone Raimondi; Kumbier, Magali C.; de Araújo, Celme Barroncas Passos; Torreglosa, Camila R.; Weber, Bernardete; Bersch-Ferreira, Ângela Cristine

doi:10.36660/abc.20230487i

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Original Article • Arq. Bras. Cardiol. 121 (3) • 2024 • https://doi.org/10.36660/abc.20230487i copy

Adequacy of Fatty Acids Consumption Among Individuals in Secondary Cardiovascular Prevention

Authorship SCIMAGO INSTITUTIONS RANKINGS

Background:

Adhering to a diet adequate in macronutrients is crucial for the secondary prevention of cardiovascular diseases.

Objective:

To assess the prevalence of adherence to recommendations for the consumption of dietary fatty acids for the prevention and treatment of cardiovascular diseases and to estimate whether the presence of certain cardiovascular risk factors would be associated with adherence.

Methods:

Cross-sectional study using baseline data from 2,358 participants included in the "Brazilian Cardioprotective Nutritional Program Trial". Dietary intake and cardiovascular risk factors were assessed. Adequate intake of polyunsaturated fatty acids (PUFA) was considered as ≥10% of total daily energy intake; for monounsaturated fatty acids (MUFA), 20%; and for saturated fatty acids (SFA), <7% according to the Brazilian Society of Cardiology. A significance level of 5% was considered in the statistical analysis.

Results:

No participant adhered to all recommendations simultaneously, and more than half (1,482 [62.9%]) did not adhere to any recommendation. Adherence exclusively to the SFA recommendation was the most prevalent, fulfilled by 659 (28%) participants, followed by adherence exclusively to the PUFA (178 [7.6%]) and MUFA (5 [0.2%]) recommendations. There was no association between the number of comorbidities and adherence to nutritional recommendations (p = 0.269). Participants from the Brazilian Northeast region showed a higher proportion of adherence to SFA consumption recommendations (38.42%) and lower adherence to PUFA intake (3.52%) (p <0.001) compared to other regions.

Conclusions:

Among the evaluated sample, there was low adherence to nutritional recommendations for dietary fatty acid consumption.

Keywords:
Fatty Acids; Diet; Cardiovascular Disease; Secondary Prevention

Features		Do not adhere to any recommendation (n=1482)	Adheres to at least 1 recommendation (n=876)	Total (n=2358)	p
Demographic data
Age (years) - mean ± SD		63.3 ± 9.1	62.9 ± 8.7 (n=876)	63.2 ± 9	0.259
Female sex		606/1482 (40.9%)	374/876 (42.7%)	980/2358 (41.6%)	0.411
Social class
	D/E	175/1375 (12.7%)	128/787 (16.3%)	303/2162 (14%)	0.014
	C	778/1375 (56.6%)	455/787 (57.8%)	1233/2162 (57%)
	A/B	422/1375 (30.7%)	204/787 (25.9%)	626/2162 (29%)
Education
	Elementary School	803/1375 (58.4%)	515/791 (65.1%)	1318/2166 (60.8%)	0.004
	High School	451/1375 (32.8%)	228/791 (28.8%)	679/2166 (31.3%)
	Higher Education	121/1375 (8.8%)	48/791 (6.1%)	169/2166 (7.8%)
Clinical data
Physical Activity Level
	Sedentary	964/1470 (65.6%)	581/867 (67%)	1545/2337 (66.1%)	0.334
	Low	419/1470 (28.5%)	246/867 (28.4%)	665/2337 (28.5%)
	Moderate	79/1470 (5.4%)	39/867 (4.5%)	118/2337 (5%)
	Vigorous	8/1470 (0.5%)	1/867 (0.1%)	9/2337 (0.4%)
Current Smoking		109/1481 (7.4%)	73/873 (8.4%)	182/2354 (7.7%)	0.381
BMI (kg/m²) - mean ± SD		29.2 ± 4.9 (n=1478)	28.9 ± 5 (n=873)	29.1 ± 5 (n=2351)	0.117
Number of Comorbidities
	0	59/1482 (4%)	26/876 (3%)	85/2358 (3.6%)	0.257
	1	239/1482 (16.1%)	148/876 (16.9%)	387/2358 (16.4%)
	2	670/1482 (45.2%)	372/876 (42.5%)	1042/2358 (44.2%)
	3	514/1482 (34.7%)	330/876 (37.7%)	844/2358 (35.8%)
Comorbidities
	Hypertension	1330/1482 (89.7%)	796/876 (90.9%)	2126/2358 (90.2%)	0.391
	Type 2 Diabetes Mellitus	642/1482 (43.3%)	401/876 (45.8%)	1043/2358 (44.2%)	0.247
	Dyslipidemia	1149/1482 (77.5%)	685/876 (78.2%)	1834/2358 (77.8%)	0.72

	Does not adhere to the recommendation for SFA (n=1668)	adhere to the recommendation for SFA (n=690)	Total (n=2358)	p
Energy (kcal)	1408.3 [1115.5 - 1787.7]	1225.5 [979.2 - 1532.3]	1359.7 [1067.5 - 1714.6]	<0.001
Carbohydrate (%)	50.6 [44.7 - 55.6]	60.5 [55.1 - 65.7]	53.2 [47 - 59.2]	<0.001
Protein (%)	19.2 [16 - 23.1]	18.9 [15.1 - 23.2]	19.1 [15.7 - 23.1]	0.107
Total fats (%)	29.4 [25.6 - 33.6]	19.8 [17.1 - 22.7]	26.9 [21.9 - 31.8]	<0.001
SFA (%)	9.9 [8.4 - 11.7]	5.7 [4.8 - 6.4]	8.7 [6.6 - 10.7]	<0.001
MUFA (%)	8.7 [7.4 - 10.5]	5.4 [4.5 - 6.4]	7.8 [6.1 - 9.7]	<0.001
PUFA (%)	6.6 [5.2 - 8.3]	5.7 [4.5 - 7.1]	6.3 [4.9 - 8]	<0.001
Sodium (mg)	2634 [1947.5 - 3500.7]	2304 [1731.9 - 3040.1]	2545.5 [1880.3 - 3340.4]	<0.001
Dietary Cholesterol (mg)	193.6 [128 - 290.5]	111.2 [67.2 - 187.6]	168.9 [106 - 262.2]	<0.001
Dietary Fiber (g)	16.7 [11.5 - 23.9]	18.8 [13.8 - 26.4]	17.3 [12.2 - 24.5]	<0.001

	Does not adhere to the recommendation for PUFA (n=2147)	adhere to the recommendation for PUFA (n=211)	Total (n=2358)	p
Energy (kcal)	1354 [1060.1 - 1715.4]	1391.4 [1091.2 - 1713.4]	1359.7 [1067.5 - 1714.6]	0.376
Carbohydrate (%)	53.7 [47.7 - 59.7]	46.7 [40 - 53.1]	53.2 [47 - 59.2]	<0.001
Protein (%)	19.2 [15.8 - 23.1]	18.8 [15.6 - 22.2]	19.1 [15.7 - 23.1]	0.293
Total fats (%)	26.2 [21.4 - 31]	33.4 [29.5 - 38.7]	26.9 [21.9 - 31.8]	<0.001
SFA (%)	8.5 [6.5 - 10.7]	9.6 [8.1 - 11.6]	8.7 [6.6 - 10.7]	<0.001
MUFA (%)	7.6 [5.9 - 9.5]	10 [8.3 - 12.3]	7.8 [6.1 - 9.7]	<0.001
PUFA (%)	6.1 [4.8 - 7.5]	11.5 [10.6 - 12.7]	6.3 [4.9 - 8]	<0.001
Sodium (mg)	2498.6 [1857.5 - 3297.6]	2832.9 [2230.6 - 3726]	2545.5 [1880.3 - 3340.4]	<0.001
Dietary Cholesterol (mg)	164.9 [104.2 - 253.9]	228.5 [145.7 - 352.5]	168.9 [106 - 262.2]	<0.001
Dietary Fiber (g)	17.2 [12.2 - 24.4]	18 [12.5 - 26.9]	17.3 [12.2 - 24.5]	0.2

	Does not adhere to the recommendation for MUFA (n=2349)	adhere to the recommendation for MUFA (n=9)	Total (n=2358)	p
Energy (kcal)	1360.4 [1067.3 - 1714.9]	1324.4 [1077.3 - 1590.1]	1359.7 [1067.5 - 1714.6]	0.742
Carbohydrate (%)	53.2 [47 - 59.2]	29.2 [21.9 - 50.3]	53.2 [47 - 59.2]	0.001
Protein (%)	19.1 [15.8 - 23.1]	21.1 [14.8 - 26.2]	19.1 [15.7 - 23.1]	0.694
Total fats (%)	26.8 [21.9 - 31.7]	46.4 [39.6 - 50.3]	26.9 [21.9 - 31.8]	<0.001
SFA (%)	8.7 [6.6 - 10.7]	17.1 [13.2 - 20.9]	8.7 [6.6 - 10.7]	<0.001
MUFA (%)	7.8 [6.1 - 9.7]	22 [21.8 - 24.7]	7.8 [6.1 - 9.7]	<0.001
PUFA (%)	6.3 [4.9 - 8]	8 [7.6 - 10.8]	6.3 [4.9 - 8]	0.004
Sodium (mg)	2545.2 [1881.6 - 3340.8]	2743 [1583.2 - 3291.8]	2545.5 [1880.3 - 3340.4]	0.881
Dietary Cholesterol (mg)	168.8 [106 - 261.2]	500.6 [230.5 - 634]	168.9 [106 - 262.2]	0.024
Dietary Fiber (g)	17.3 [12.3 - 24.5]	10.2 [7.2 - 20.9]	17.3 [12.2 - 24.5]	0.073

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