Importance

The relationship between butter and plant-based oil intakes and mortality remains unclear, with conflicting results from previous studies. Long-term dietary assessments are needed to clarify these associations.

Objective

To investigate associations of butter and plant-based oil intakes with risk of total and cause-specific mortality among US adults.

Design, Setting, and Participants

This prospective population-based cohort study used data from 3 large cohorts: the Nurses’ Health Study (1990-2023), the Nurses’ Health Study II (1991-2023), and the Health Professionals Follow-up Study (1990-2023). Women and men who were free of cancer, cardiovascular disease (CVD), diabetes, or neurodegenerative disease at baseline were included.

Exposures

Primary exposures included intakes of butter (butter added at the table and from cooking) and plant-based oil (safflower, soybean, corn, canola, and olive oil). Diet was assessed by validated semiquantitative food frequency questionnaires every 4 years.

Main Outcomes and Measures

Total mortality was the primary outcome, and mortality due to cancer and CVD were secondary outcomes. Deaths were identified through the National Death Index and other sources. A physician classified the cause of death based on death certificates and medical records.

Results

During up to 33 years of follow-up among 221 054 adults (mean [SD] age at baseline: 56.1 [7.1] years for Nurses’ Health Study, 36.1 [4.7] years for Nurses’ Health Study II, and 56.3 [9.3] years for Health Professionals Follow-up Study), 50 932 deaths were documented, with 12 241 due to cancer and 11 240 due to CVD. Participants were categorized into quartiles based on their butter or plant-based oil intake. After adjusting for potential confounders, the highest butter intake was associated with a 15% higher risk of total mortality compared to the lowest intake (hazard ratio [HR], 1.15; 95% CI, 1.08-1.22; P for trend < .001). In contrast, the highest intake of total plant-based oils compared to the lowest intake was associated with a 16% lower total mortality (HR, 0.84; 95% CI, 0.79-0.90; P for trend < .001). There was a statistically significant association between higher intakes of canola, soybean, and olive oils and lower total mortality, with HRs per 5-g/d increment of 0.85 (95% CI, 0.78-0.92), 0.94 (95% CI, 0.91-0.96), and 0.92 (95% CI, 0.91-0.94), respectively (all P for trend < .001). Every 10-g/d increment in plant-based oils intake was associated with an 11% lower risk of cancer mortality (HR, 0.89; 95% CI, 0.85-0.94; P for trend < .001) and a 6% lower risk of CVD mortality (HR, 0.94; 95% CI, 0.89-0.99; P for trend = .03), whereas a higher intake of butter was associated with higher cancer mortality (HR, 1.12; 95% CI, 1.04-1.20; P for trend < .001). Substituting 10-g/d intake of total butter with an equivalent amount of total plant-based oils was associated with an estimated 17% reduction in total mortality (HR, 0.83; 95% CI, 0.79-0.86; P < .001) and a 17% reduction in cancer mortality (HR, 0.83; 95% CI, 0.76-0.90; P < .001).

Conclusions and Relevance

In this cohort study, higher intake of butter was associated with increased mortality, while higher plant-based oils intake was associated with lower mortality. Substituting butter with plant-based oils may confer substantial benefits for preventing premature deaths.

Background

Decades of steady improvements in life expectancy in Europe slowed down from around 2011, well before the COVID-19 pandemic, for reasons which remain disputed. We aimed to assess how changes in risk factors and cause-specific death rates in different European countries related to changes in life expectancy in those countries before and during the COVID-19 pandemic.

Methods

We used data and methods from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 to compare changes in life expectancy at birth, causes of death, and population exposure to risk factors in 16 European Economic Area countries (Austria, Belgium, Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Italy, Luxembourg, the Netherlands, Norway, Portugal, Spain, and Sweden) and the four UK nations (England, Northern Ireland, Scotland, and Wales) for three time periods: 1990–2011, 2011–19, and 2019–21. Changes in life expectancy and causes of death were estimated with an established life expectancy cause-specific decomposition method, and compared with summary exposure values of risk factors for the major causes of death influencing life expectancy.

Findings

All countries showed mean annual improvements in life expectancy in both 1990–2011 (overall mean 0·23 years [95% uncertainty interval [UI] 0·23 to 0·24]) and 2011–19 (overall mean 0·15 years [0·13 to 0·16]). The rate of improvement was lower in 2011–19 than in 1990–2011 in all countries except for Norway, where the mean annual increase in life expectancy rose from 0·21 years (95% UI 0·20 to 0·22) in 1990–2011 to 0·23 years (0·21 to 0·26) in 2011–19 (difference of 0·03 years). In other countries, the difference in mean annual improvement between these periods ranged from –0·01 years in Iceland (0·19 years [95% UI 0·16 to 0·21] vs 0·18 years [0·09 to 0·26]), to –0·18 years in England (0·25 years [0·24 to 0·25] vs 0·07 years [0·06 to 0·08]). In 2019–21, there was an overall decrease in mean annual life expectancy across all countries (overall mean –0·18 years [95% UI –0·22 to –0·13]), with all countries having an absolute fall in life expectancy except for Ireland, Iceland, Sweden, Norway, and Denmark, which showed marginal improvement in life expectancy, and Belgium, which showed no change in life expectancy. Across countries, the causes of death responsible for the largest improvements in life expectancy from 1990 to 2011 were cardiovascular diseases and neoplasms. Deaths from cardiovascular diseases were the primary driver of reductions in life expectancy improvements during 2011–19, and deaths from respiratory infections and other COVID-19 pandemic-related outcomes were responsible for the decreases in life expectancy during 2019–21. Deaths from cardiovascular diseases and neoplasms in 2019 were attributable to high systolic blood pressure, dietary risks, tobacco smoke, high LDL cholesterol, high BMI, occupational risks, high alcohol use, and other risks including low physical activity. Exposure to these major risk factors differed by country, with trends of increasing exposure to high BMI and decreasing exposure to tobacco smoke observed in all countries during 1990–2021.

Interpretation

The countries that best maintained improvements in life expectancy after 2011 (Norway, Iceland, Belgium, Denmark, and Sweden) did so through better maintenance of reductions in mortality from cardiovascular diseases and neoplasms, underpinned by decreased exposures to major risks, possibly mitigated by government policies. The continued improvements in life expectancy in five countries during 2019–21 indicate that these countries were better prepared to withstand the COVID-19 pandemic. By contrast, countries with the greatest slowdown in life expectancy improvements after 2011 went on to have some of the largest decreases in life expectancy in 2019–21. These findings suggest that government policies that improve population health also build resilience to future shocks. Such policies include reducing population exposure to major upstream risks for cardiovascular diseases and neoplasms, such as harmful diets and low physical activity, tackling the commercial determinants of poor health, and ensuring access to affordable health services.

Funding

Gates Foundation.

Objective

Low body fat and high physical activity levels are key lifestyle factors in cancer prevention, but the interplay of abdominal obesity and physical activity on cancer risk remains unknown. We explored individual and joint associations of waist circumference and physical activity with cancer risk.

Methods

Using UK Biobank data (n=315 457), we categorised individuals according to WHO guideline thresholds for waist circumference and self-reported physical activity levels. Multivariable-adjusted Cox regression was used to estimate HRs and 95% CIs of total cancer. The reference group comprised individuals with recommended levels of waist circumference (<88 cm for women and <102 cm for men) and physical activity (>10 metabolic equivalent of task hours/week). Furthermore, we estimated the proportion of cancers attributable to abdominal obesity and insufficient physical activity.

Results

During a median follow-up period of 11 years (3 321 486 person-years), 29 710 participants developed any type of cancer. Participants not meeting the WHO guideline on waist circumference had increased cancer risk, even when sufficiently physically active according to the WHO (HR 1.11, 95% CI 1.08 to 1.15). Similarly, individuals not achieving the WHO guideline for physical activity showed an elevated risk, even if they were abdominally lean (HR 1.04, 95% CI 1.01 to 1.07). Not adhering to either guideline yielded the strongest increase in risk (HR 1.15, 95% CI 1.11 to 1.19). We estimated that abdominal obesity coupled with insufficient physical activity could account for 2.0% of UK Biobank cancer cases.

Conclusion

Adherence to both WHO guidelines for waist circumference and physical activity is essential for cancer prevention; meeting just one of these guidelines is insufficient.

ABSTRACT

Background

Vigorous intermittent lifestyle physical activity (VILPA) refers to brief bouts of intense physical activity embedded into daily life.

Objective

To examine sex differences in the dose–response association of VILPA with major adverse cardiovascular events (MACE) and its subtypes.

Methods

Using multivariable-adjusted cubic splines, we examined the associations of daily VILPA duration with overall MACE and its subtypes (incident myocardial infarction, heart failure and stroke) among non-exercisers (individuals self-reporting no leisure-time exercise and no more than one recreational walk per week) in the UK Biobank. We also undertook analogous analyses for vigorous physical activity among exercisers (individuals self-reporting participation in leisure-time exercise and/or recreational walking more than once a week).

Results

Among 13 018 women and 9350 men, there were 331 and 488 all MACE, respectively, over a 7.9-year follow-up. In women, daily VILPA duration exhibited a near-linear dose–response association with all MACE, myocardial infarction and heart failure. In men, dose-reponse curves were less clear with less evidence of statistical signifigance. Compared with women with no VILPA, women’s median daily VILPA duration of 3.4 min was associated with hazard ratios (HRs; 95% confidence intervals) of 0.55 (0.41 to 0.75) for all MACE and 0.33 (0.18 to 0.59) for heart failure. Women’s minimum doses of 1.2–1.6 min of VILPA per day were associated with HRs of 0.70 (0.58 to 0.86) for all MACE, 0.67 (0.50 to 0.91) for myocardial infarction, and 0.60 (0.45 to 0.81) for heart failure. The equivalent analyses in UK Biobank’s accelerometry sub-study exercisers suggested no appreciable sex differences in dose–response.

Conclusions

Among non-exercising women, small amounts of VILPA were associated with a substantially lower risk of all MACE, myocardial infarction and heart failure. VILPA may be a promising physical activity target for cardiovascular disease prevention, particularly in women unable or not willing to engage in formal exercise.