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Association of fried food consumption with all cause, cardiovascular, and cancer mortality: prospective cohort study

BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.k5420 (Published 23 January 2019) Cite this as: BMJ 2019;364:k5420

Re: Association of fried food consumption with all cause, cardiovascular, and cancer mortality: prospective cohort study

Sun and colleagues1 presented a comprehensive description of the association between frequent consumption of fried foods with risk of a higher risk of all cause and cardiovascular mortality in women in the US. However, in this study, impact of some risk factors on all-cause and cardiovascular diseases mortality was not fully characterized.
First, the National Health and Nutrition Examination Survey (NHANES) 2003 to 2006 data indicate that the prevalence of diabetes is approximately 12% with 27% of cases remain undiagnosed, and 35% of US adults aged>20 years have prediabetes. Similar to diagnosed diabetes, prediabetes was also associated with a higher risk of future stroke, one of the most important cardiovascular diseases.2 Therefore, we suggest that undiagnosed diabetes or prediabetes should be considered in subgroup analyzes as well. Second, Perak AM et al.3 concluded that familial hypercholesterolemia was likely to increase the long-term cardiovascular diseases burden in the general US population. In fact, familial hypercholesterolemia affects up to 1.5 million individuals in the US, and the prevalence is about 1 in 250 to 1 in 200. Consequently, FH deserves more attention in this study.
In sum, we concerned that assessing the association of total and individual fried food consumption with incident cardiovascular diseases and all-cause mortality in women without a detailed analysis of undiagnosed diabetes or prediabetes, familial hypercholesterolemia represents a big confounding issue. In our view, due to this shortcoming, the conclusion of this study should be treated with caution although this is an important finding at the population level.

Reference
1. Sun Y, Liu B, Snetselaar LG, et al. Association of fried food consumption with all cause, cardiovascular, and cancer mortality: prospective cohort study. BMJ. 2019;364:k5420.
2. Lee M, Saver JL, Hong KS, Song S, Chang KH, Ovbiagele B. Effect of pre-diabetes on future risk of stroke: meta-analysis. BMJ. 2012;344:e3564.
3. Perak AM, Ning H, de Ferranti SD, Gooding HC, Wilkins JT, Lloyd-Jones DM. Long-Term Risk of Atherosclerotic Cardiovascular Disease in US Adults With the Familial Hypercholesterolemia Phenotype. Circulation. 2016;134(1):9-19.

Competing interests: No competing interests

05 May 2019
Hua-Guo Xu
Associate professor
Jing zhou BS, Hemant Goyal MD
The First Affiliated Hospital of Nanjing Medical University
Hua-Guo Xu, Department of Laboratory Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China e-mail: huaguoxu@njmu.edu.cn; Phone:+862568303494