Fried food intake and risk of acute myocardial infarct (Heart Attack)

 

Fried food intake and risk of nonfatal acute myocardial infarction in the Costa Rica Heart Stuy

 Introduction 

Historically, food preparation and consumption in low- and middle-income countries has been restricted to the home. Costa Rican families prepare meals by various means, including frying, a method in which food is submerged in hot oil More recently, economic development in low- and middle-income countries has resulted in changes to food preparation and consumption, including higher intake of refined grains, sodium, and red meat. These foods are characteristic of being highly processed and packaged for “on the go” eating or eating outside of the home. In fact, the entire food system, lifestyles, cooking methods, and eating practices are changing rapidly [1,2]. For example, in China, the energy contributions from snacks, foods eaten outside of home, and foods prepared outside of home have increased over time. In Latin America, retail food sales increased from 15% in 1990 to 60% by 2000 in Latin American supermarkets While frying is not a new technique in Costa Rica, people are currently eating more fried foods and foods outside the home compared to 30 years ago . Higher consumption of fried food outside the home, resulting from modernization, economic development and urbanization, could be associated with increased risk of cardiovascular disease CVD.

Although frying improves taste and aroma, fried foods may have detrimental cardiovascular effects . A cross-sectional study in Spain found that food fried with re-used oils was associated with a higher prevalence of arterial hypertension [8]. Fried food intake was also associated with higher body weight and risk of obesity [9,10] and type 2 diabetes among US men [11] and women [11,12]. Italian adults with a higher intake of fried food had lower high density lipoprotein cholesterol levels and larger waist circumferences [13]. A positive association between fried foods and risk of myocardial infarction (MI) was observed in INTERHEART, a case-control study of 52 countries [14]. In contrast, the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC) study found no association between fried food and risk of coronary heart disease [15]. The authors concluded that the type of frying oil was the main reason for the differences between studies: olive and sunflower oils are the most commonly used fats for frying in Spain and are less prone to oxidation than other edible oils or fats [16].

Interestingly, results from two large, prospective cohorts that evaluated consumption of fried foods inside versus outside the home showed that fried food intake was significantly associated with risk of incident type 2 diabetes and coronary artery disease, primarily when the fried foods were eaten outside of the home [11]. These studies suggest that unique characteristics of foods fried away from home such as the type and amount of oil used, portion size, and the carbohydrate quality of the food being fried may be responsible for their potential adverse effects [17]. Our previous study in Costa Rica found no association between consumption of fried foods and risk of nonfatal acute MI, but we did not distinguish between eating fried foods inside and outside of the home [1]. Since fried foods eaten away from home may have a unique impact on risk of MI [11], the purpose of the present study was to examine whether intake of fried foods inside and outside the home is associated with the risk of MI in the Costa Rica Heart Study

 Discussion 

In this case control study conducted in the Central Valley of Costa Rica, higher intake of total fried foods was associated with increased risk of MI. This association was mostly attributed to intake of fried foods outside the home. Daily intake of fried foods outside the home was associated with a 55% higher risk of MI, whereas no association was observed with daily intake of fried food inside the home after adjusting for smoking, physical activity, alcohol intake, education, occupation, income, waist circumference, fiber, saturated fat, energy intake, and history of diabetes or hypertension.

Frying is a commonly used cooking technique in Costa Rican homes. In fact, over 85% of the studied population reported intake of fried foods inside the home at least once per week. The most commonly fried foods in Costa Rican homes include plantains, potatoes, cassava, maize turnovers, and rice. Interestingly, we did not find an association between intake of fried foods inside the home and risk of MI despite of the potential detrimental health effects of fried foods [26]. This null association could be explained in part by lower oxidation products in fried foods inside the home. Frying increases the amount of cholesterol and other lipid oxidation products mostly when cooking meat, fish, and vegetables, as opposed to carbohydrate rich foods [27,28]. Frying foods inside the home involves shorter frying times, lower temperatures, and pan-frying (versus deep frying). These characteristics of frying foods inside the home could have contributed to the observed result [29,30]. In contrast, commercially prepared fried foods are often more likely to re-use oil several times and deep-fry at higher temperatures.

In sum, we found that frequent consumption of fried foods outside of the home is associated with a higher risk of MI. This finding suggests that the trend towards higher consumption of commercially available foods outside the home could have detrimental effects on the risk of cardiovascular disease in middle-income countries..

Ref 

PLoS One. 2018 Feb 15;13(2):e0192960. doi: 10.1371/journal.pone.0192960

Fried food intake and risk of nonfatal acute myocardial infarction in the Costa Rica Heart Studt

Editor: Manuel Portero-Otin4