The associations of circulating common and uncommon polyunsaturated fatty acids and modification effects on dietary quality with all-cause and disease-specific mortality in NHANES 2003–2004 and 2011–2012

Figures & data

Table 1. Baseline characteristics of the 4132 people from the NHANES in 2003–2004 and 2011 2012^a.

	All	Male	Female
	(n = 4132)	(n = 2037)	(n = 2095)
Age, y	46.85 (45.87–47.84)	46.23 (45.18–47.28)	47.47 (46.29–48.64)*
BMI, kg/m^2	28.55 (28.17–28.93)	28.49 (28.16–28.83)	28.60 (28.08–29.13)
Non-Hispanic white, %	72.8 (67.0–77.9)	70.9 (65.5–75.8)	71.8 (66.5–76.7)
Current smoking, %	25.2 (22.5–28.0)	32.7 (28.8–36.9)	17.8 (15.4–20.5)*
Current drinking, %	72.5 (69.6–75.3)	82.6 (79.7–85.2)	72.5 (69.6–75.3)*
College graduate or above, %	27.9 (23.9–32.2)	27.1 (23.4–31.2)	28.6 (24.1–33.6)
>$100,000 annual household income, %	11.9 (8.3–16.8)	13.5 (9.0–19.7)	10.3 (1.7–14.3)
Regular exercise, %	44.6 (41.1–48.1)	44.2 (39.8–48.8)	45.0 (40.9–49.1)
Dietary supplement use, %	53.7 (51.3–56.1)	47.4 (44.6–50.1)	59.9 (56.5–63.2)*
Prevalent diabetes, %	11.0 (9.5–12.7)	11.8 (9.9–14.1)	10.1 (8.5–12.0)
Ever controlled diabetes, %	3.9 (3.2–4.8)	4.1 (3.1–5.5)	3.7 (2.9–4.6)
Prevalent high cholesterol level, %	38.9 (36.3–41.5)	41.0 (37.3–44.7)	36.9 (33.9–40.1)
Ever controlled cholesterol, %	22.1 (20.2–24.2)	22.8 (20.2–25.7)	21.5 (18.8–24.4)
Prevalent hypertension, %	37.0 (33.9–40.2)	38.7 (35.0–42.6)	35.3 (31.6–39.1)
Ever controlled hypertension, %	25.2 (22.4–28.3)	25.0 (21.5–28.8)	25.4 (22.4–28.7)
Prevalent cancer or malignancy, %	8.7 (7.5–10.2)	7.5 (6.1–9.2)	9.9 (7.8–12.5)*
Triglycerides, mmol/L	1.55 (1.48–1.62)	1.68 (1.61–1.75)	1.43 (1.34–1.51)*
HDL cholesterol, mmol/L	1.39 (1.36–1.42)	1.25 (1.23–1.28)	1.53 (1.49–1.56)*
LDL cholesterol, mmol/L	3.01 (2.97–3.06)	3.00 (2.95–3.05)	3.03 (2.97–3.09)
Total Cholesterol, mmol/L	5.10 (5.05–5.15)	5.00 (4.93–5.06)	5.21 (5.14–5.27)*
C-reactive protein, mg/dL	0.46 (0.40–0.51)	0.38 (0.29–0.46)	0.54 (0.45–0.62)*
LA, % in total serum fatty acids	31.38 (31.16–31.60)	31.01 (30.67–31.36)	31.74 (31.47–32.01)*
GLA, % in total serum fatty acids	0.48 (0.47–0.49)	0.49 (0.48–0.51)	0.47 (0.46–0.49)*
DGLA, % in total serum fatty acids	1.37 (1.35–1.39)	1.33 (1.30–1.35)	1.41 (1.39–1.43)*
AA, % in total serum fatty acids	7.22 (7.15–7.30)	7.13 (7.02–7.24)	7.32 (7.21–7.42)*
ALA, % in total serum fatty acids	0.68 (0.65–0.70)	0.68 (0.66–0.70)	0.67 (0.65–0.69)
SDA, % in total serum fatty acids	0.032 (0.031–0.034)	0.032 (0.030–0.035)	0.032 (0.030–0.034)
EPA, % in total serum fatty acids	0.51 (0.48–0.54)	0.51 (0.47–0.54)	0.52 (0.48–0.55)
DPAn3, % in total serum fatty acids	0.41 (0.40–0.42)	0.42 (0.41–0.43)	0.40 (0.39–0.41)*
DHA, % in total serum fatty acids	1.27 (1.21–1.33)	1.19 (1.14–1.25)	1.34 (1.27–1.41)*
Total n-6 fatty acids, % in total serum fatty acids	41.05 (40.83–41.28)	40.55 (40.22–40.89)	41.54 (41.27–41.81)*
Total n-3 fatty acids, % in total serum fatty acids	2.88 (2.79–2.98)	2.82 (2.73–2.91)	2.95 (2.84–3.05)*
Total serum n-6 / Total serum n-3	15.66 (15.18–16.13)	15.79 (15.29–16.29)	15.53 (15.02–16.03)
Dietary intakes
Energy, kcal/d	2182.47 (2147.39–2217.56)	2549.56 (2496.42–2603.29)	1823.98 (1786.98–1860.99)*
Carbohydrate, g/d	263.73 (259.14–268.32)	302.52 (297.24–307.80)	225.88 (220.05–231.70)*
Protein, g/d	84.73 (83.00–86.45)	99.68 (97.09–102.28)	70.13 (68.46–71.80)*
Total fat, g/d	83.04 (81.04–85.04)	96.41 (93.46–99.37)	69.99 (67.89–72.09)*
Total sugars, g/d	118.83 (115.52–122.15)	134.71 (130.72.138.70)	103.34 (99.51–107.18)*
SFAs, % of energy	10.62 (10.39–10.86)	10.60 (10.38–10.83)	10.64 (10.32–10.97)
MUFAs, % of energy	12.17 (11.90–12.45)	12.24 (11.94–12.54)	12.11 (11.79–12.43)
PUFAs, % of energy	7.53 (7.39–7.67)	7.36 (7.21–7.51)	7.70 (7.49–7.90)*
Fibre, g/d	17.09 (16.46–17.72)	18.84 (18.09–19.58)	15.38 (14.76–16.01)*
AHEI-2010	55.15 (54.37–55.94)	59.71 (58.77–60.65)	50.70 (49.88–51.52)*

^aValues are weighted means (95%CI) or weighted percentages (95%CI).

*p < .05. p was assessed with General linear models adjusting for age (continuous variables) or χ2 test (bivariate relationships).

All data analyses conducted in the current study were based on estimates with sample weights provided by NHANES.

LA: linoleic acid; GLA: gamma-linolenic acid; DGLA: dihomo-gamma-linolenic acid; AA: arachidonic acid; ALA: α-Linolenic acid; SDA: stearidonic acid; EPA: eicosapentaenoic acid; DPAn3: n-3 Docosapentaenoic acid; DHA: docosahexaenoic acid; SFA: saturated fatty acids; MUFA: monounsaturated fatty acids; PUFA: polyunsaturated fatty acids.

Figure 1. Adjusted HRs for associations between different n-6 PUFAs and all-cause, CVD and cancer mortality. The models were adjusted for age (years), sex (male/female), BMI (kg/m²), current smoking (yes/no), current drinking (yes/no), education level, family annual income (dollars), leisure-time physical activity (yes/no), prevalent diabetes or cardiovascular disease or cancer (yes/no), ever controlled blood pressure, blood cholesterol or blood glucose (yes/no), serum triglycerides (mmol/L), serum total cholesterol (mmol/L) and intakes of SFAs (percentage of energy), USFAs (percentage of energy), fibre (g/d), total energy (kcal/day), carbohydrate (g/d),protein (g/d) and AHEI-2010. Serum LA, AA, ALA and LCn3 were mutually adjusted; %, ratio of each serum fatty acid to the total serum fatty acid; Q, quintile. X-axis tick marks was showed in logarithmic scale.

Figure 2. Adjusted HRs for associations between different n-3 PUFAs and all-cause, CVD and cancer mortality. The models were adjusted for age (years), sex (male/female), BMI (kg/m²), current smoking (yes/no), current drinking (yes/no), education level, family annual income (dollars), leisure-time physical activity (yes/no), prevalent diabetes or cardiovascular disease or cancer (yes/no), ever controlled blood pressure, blood cholesterol or blood glucose (yes/no), serum triglycerides (mmol/L), serum total cholesterol (mmol/L) and intakes of SFAs (percentage of energy), USFAs (percentage of energy), fibre (g/d), total energy (kcal/day), carbohydrate (g/d), protein (g/d) and AHEI-2010; %, ratio of each serum fatty acid to the total serum fatty acid. Serum LA, AA, ALA and LCn3 were mutually adjusted; Q, quintile. X-axis tick marks was showed in logarithmic scale.

Figure 3. Associations between serum LA, ALA, EPA, DPAn3 and DHA with all-cause mortality. Assessed by multivariable-adjusted HRs using of Cox proportional hazard models and restricted cubic splines. The solid lines represent the central estimates and the dashed lines area the 95% confidence intervals. The models were adjusted for The models were adjusted for age (years), sex (male/female), BMI (kg/m²), current smoking (yes/no), current drinking (yes/no), education level, family annual income (dollars), leisure-time physical activity (yes/no), prevalent diabetes or cardiovascular disease or cancer (yes/no), ever controlled blood pressure, blood cholesterol or blood glucose (yes/no), serum triglycerides (mmol/L), serum total cholesterol (mmol/L) and intakes of SFAs (percentage of energy), USFAs (percentage of energy), fibre (g/d), total energy (kcal/day), carbohydrate (g/d), protein (g/d) and AHEI-2010. Serum LA, AA, ALA and LCn3 were mutually adjusted. LA: linoleic acid; ALA: α-Linolenic acid; EPA: eicosapentaenoic acid; DPAn3: n-3 Docosapentaenoic acid; DHA: docosahexaenoic acid.

Figure 4. Associations between serum EPA and ALA with CVD and cancer mortality (left figure: association between EPA and CVD mortality; right figure: association between ALA and cancer mortality). Assessed by multivariable-adjusted HRs using of Cox proportional hazard models and restricted cubic splines. The solid lines represent the central estimates and the dashed lines area the 95% confidence intervals. The models were adjusted for The models were adjusted for age (years), sex (male/female), BMI (kg/m²), current smoking (yes/no), current drinking (yes/no), education level, family annual income (dollars), leisure-time physical activity (yes/no), prevalent diabetes or cardiovascular disease or cancer (yes/no), ever controlled blood pressure, blood cholesterol or blood glucose (yes/no), serum triglycerides (mmol/L), serum total cholesterol (mmol/L) and intakes of SFAs (percentage of energy), USFAs (percentage of energy), fibre (g/d), total energy (kcal/day), carbohydrate (g/d), protein (g/d) and AHEI-2010. Serum LA, AA, ALA and LCn3 were mutually adjusted. ALA: α-Linolenic acid; EPA: eicosapentaenoic acid.

Data availability statement

All data are available within the Article and Supplementary Files, or available from the authors upon request.