Plant-sourced and animal-sourced monounsaturated fatty acid intakes in relation to mortality: a prospective nationwide cohort study

  • Lei Mao
  • Yu Zhang
  • Wenqiao Wang
  • Pan Zhuang
  • Fei Wu
  • Jingjing JiaoEmail author
Original Contribution



Monounsaturated fatty acids (MUFAs) are typical components of various plant-sourced and animal-sourced foods. However, the associations of MUFA consumption from different sources with mortality remain unclear. This study aimed to investigate the relationships between MUFA intakes from plant and animal sources and mortality.


A total of 14,305 participants from China Health and Nutrition Survey were prospectively followed up for 14 years. Dietary intake of MUFAs was assessed by 3-day 24-h dietary records in each round. Cox proportional hazards regression models were used to compute hazard ratios (HRs) and 95% confidence intervals (CIs).


A total of 1006 deaths occurred during 199,091 person-years of follow-up. Intake of total MUFAs was not associated with mortality (P-trend = 0.17). The plant-sourced MUFA intake was strongly associated with lower mortality [HRQ4vsQ1 (95% CI) 0.72 (0.58–0.89); P-trend = 0.008], whereas animal-sourced MUFA intake showed no significant association. Likewise, oleic acid (OA) and palmitoleic acid (PA) intakes from plant sources were also inversely associated with mortality [HRQ4vsQ1 (95% CI) 0.66 (0.52–0.84) for OA and 0.73 (0.59–0.91) for PA], while animal-sourced OA and PA were not related to mortality. Theoretically replacing saturated fatty acids (SFAs) (5% of total energy) with isocaloric plant-sourced MUFAs was associated with 15% (95% CI 5–25%) lower mortality. In addition, 18% (95% CI 10–26%) lower mortality was observed when theoretically replacing the sum of SFAs and animal-sourced MUFAs with isocaloric plant-sourced MUFAs.


Intakes of MUFAs, including OA and PA, from plant but not animal sources were associated with lower total mortality. These findings suggested the importance of consuming MUFAs from plant-based foods for overall health.


Monounsaturated fatty acids Plant sources Animal sources Mortality China Health and Nutrition Survey 



Alternative healthy eating index


China Health and Nutrition Survey


Coronary heart disease


Confidence interval


Cardiovascular disease


High density lipoprotein


Hazard ratio


Low density lipoprotein


Monounsaturated fatty acids


Oleic acid


Palmitoleic acid


Polyunsaturated fatty acids


Relative risk


Saturated fatty acids



We thank the National Institute of Nutrition and Food Safety, China Center for Disease Control and Prevention, Carolina Population Center (5 R24 HD050924), the University of North Carolina at Chapel Hill, the NIH (R01-HD30880, DK056350, R24 HD050924, and R01-HD38700) and the Fogarty International Center, NIH for the CHNS data collection and analysis files from 1989 to 2011 and future surveys.

Author contributions

JJ conceived and designed the study. LM, YZ, WW, PZ, and FW acquired and collected the data. LM and PZ performed statistical analysis. LM drafted the manuscript. All authors contributed to the interpretation of the results and critical revision of the manuscript for important intellectual content and approved the final version of the manuscript. JJ is the guarantor and takes responsibility for the integrity of the data and the accuracy of the data analysis.


This research was funded by Grants from the Zhejiang Provincial Natural Science Foundation of China (Grant no. LR18C200001), National Natural Science Foundation of China (Grant no. 81773419) and China National Program for Support of Top-notch Young Professionals.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

394_2019_2048_MOESM1_ESM.docx (84 kb)
Supplementary material 1 (DOCX 83 kb)


  1. 1.
    Estruch R, Ros E, Salas-Salvado J, Covas MI, Corella D, Aros F, Gomez-Gracia E, Ruiz-Gutierrez V, Fiol M, Lapetra J, Lamuela-Raventos RM, Serra-Majem L, Pinto X, Basora J, Munoz MA, Sorli JV, Martinez JA, Martinez-Gonzalez MA, Investigators PS (2013) Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med 368(14):1279–1290. CrossRefGoogle Scholar
  2. 2.
    Salas-Salvadó J, Bulló M, Estruch R et al (2014) Prevention of diabetes with mediterranean diets: a subgroup analysis of a randomized trial. Ann Intern Med 160(1):1–10. CrossRefGoogle Scholar
  3. 3.
    Linseisen J, Welch AA, Ocke M, Amiano P, Agnoli C, Ferrari P, Sonestedt E, Chajes V, Bueno-de-Mesquita HB, Kaaks R, Weikert C, Dorronsoro M, Rodriguez L, Ermini I, Mattiello A, van der Schouw YT, Manjer J, Nilsson S, Jenab M, Lund E, Brustad M, Halkjaer J, Jakobsen MU, Khaw KT, Crowe F, Georgila C, Misirli G, Niravong M, Touvier M, Bingham S, Riboli E, Slimani N (2009) Dietary fat intake in the European Prospective Investigation into Cancer and Nutrition: results from the 24-h dietary recalls. Eur J Clin Nutr 63(Suppl 4):S61–S80. CrossRefGoogle Scholar
  4. 4.
    Zhai FY, Du SF, Wang ZH, Zhang JG, Du WW, Popkin BM (2014) Dynamics of the Chinese diet and the role of urbanicity, 1991–2011. Obes Rev 15(Suppl 1):16–26. CrossRefGoogle Scholar
  5. 5.
    Lichtenstein AH, Appel LJ, Brands M, Carnethon M, Daniels S, Franch HA, Franklin B, Kris-Etherton P, Harris WS, Howard B, Karanja N, Lefevre M, Rudel L, Sacks F, Van Horn L, Winston M, Wylie-Rosett J (2006) Summary of American Heart Association diet and lifestyle recommendations revision 2006. Arterioscler Thromb Vasc Biol 26(10):2186–2191. CrossRefGoogle Scholar
  6. 6.
    Institute of Medicine of the National Academies (2005) Dietary fats: total fat and fatty acids. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein and amino acids (macronutrients). The National Academy Press, Washington, DC, pp 422–541Google Scholar
  7. 7.
    EFSA (2010) Scientific opinion on dietary reference values for fats, including saturated fatty acids, polyunsaturated fatty acids, monounsaturated fatty acids, trans fatty acids, and cholesterol. EFSA J 8(3):1461Google Scholar
  8. 8.
    Wang SS, Lay S, Yu HN, Shen SR (2016) Dietary guidelines for Chinese Residents (2016): comments and comparisons. J Zhejiang Univ Sci B 17(9):649–656. CrossRefGoogle Scholar
  9. 9.
    Wang DD, Li Y, Chiuve SE, Stampfer MJ, Manson JE, Rimm EB, Willett WC, Hu FB (2016) Association of specific dietary fats with total and cause-specific mortality. JAMA Intern Med 176(8):1134–1145. CrossRefGoogle Scholar
  10. 10.
    Buckland G, Mayen AL, Agudo A, Travier N, Navarro C, Huerta JM, Chirlaque MD, Barricarte A, Ardanaz E, Moreno-Iribas C, Marin P, Quiros JR, Redondo ML, Amiano P, Dorronsoro M, Arriola L, Molina E, Sanchez MJ, Gonzalez CA (2012) Olive oil intake and mortality within the Spanish population (EPIC-Spain). Am J Clin Nutr 96(1):142–149. CrossRefGoogle Scholar
  11. 11.
    Guasch-Ferre M, Hu FB, Martinez-Gonzalez MA, Fito M, Bullo M, Estruch R, Ros E, Corella D, Recondo J, Gomez-Gracia E, Fiol M, Lapetra J, Serra-Majem L, Munoz MA, Pinto X, Lamuela-Raventos RM, Basora J, Buil-Cosiales P, Sorli JV, Ruiz-Gutierrez V, Martinez JA, Salas-Salvado J (2014) Olive oil intake and risk of cardiovascular disease and mortality in the PREDIMED Study. BMC Med 12:78. CrossRefGoogle Scholar
  12. 12.
    Trichopoulou A, Costacou T, Bamia C, Trichopoulos D (2003) Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med 348(26):2599–2608. CrossRefGoogle Scholar
  13. 13.
    Solfrizzi V, D’Introno A, Colacicco AM, Capurso C, Palasciano R, Capurso S, Torres F, Capurso A, Panza F (2005) Unsaturated fatty acids intake and all-causes mortality: a 8.5-year follow-up of the Italian longitudinal study on aging. Exp Gerontol 40(4):335–343. CrossRefGoogle Scholar
  14. 14.
    Trichopoulou A, Orfanos P, Norat T, Bueno-de-Mesquita B, Ocke MC, Peeters PH, van der Schouw YT, Boeing H, Hoffmann K, Boffetta P, Nagel G, Masala G, Krogh V, Panico S, Tumino R, Vineis P, Bamia C, Naska A, Benetou V, Ferrari P, Slimani N, Pera G, Martinez-Garcia C, Navarro C, Rodriguez-Barranco M, Dorronsoro M, Spencer EA, Key TJ, Bingham S, Khaw KT, Kesse E, Clavel-Chapelon F, Boutron-Ruault MC, Berglund G, Wirfalt E, Hallmans G, Johansson I, Tjonneland A, Olsen A, Overvad K, Hundborg HH, Riboli E, Trichopoulos D (2005) Modified Mediterranean diet and survival: EPIC-elderly prospective cohort study. BMJ 330(7498):991. CrossRefGoogle Scholar
  15. 15.
    Nagata C, Nakamura K, Wada K, Oba S, Tsuji M, Tamai Y, Kawachi T (2012) Total fat intake is associated with decreased mortality in Japanese men but not in women. J Nutr 142(9):1713–1719. CrossRefGoogle Scholar
  16. 16.
    Wakai K, Naito M, Date C, Iso H, Tamakoshi A, Group JS (2014) Dietary intakes of fat and total mortality among Japanese populations with a low fat intake: the Japan Collaborative Cohort (JACC) study. Nutr Metab (Lond) 11(1):12. CrossRefGoogle Scholar
  17. 17.
    Delgado GE, Kramer BK, Lorkowski S, Marz W, von Schacky C, Kleber ME (2017) Individual omega-9 monounsaturated fatty acids and mortality—the Ludwigshafen risk and cardiovascular health study. J Clin Lipidol 11(1):126–135. CrossRefGoogle Scholar
  18. 18.
    Chowdhury R, Warnakula S, Kunutsor S et al (2014) Association of dietary, circulating, and supplement fatty acids with coronary risk: a systematic review and meta-analysis. Ann Intern Med 160(6):398–406. CrossRefGoogle Scholar
  19. 19.
    Jakobsen MU, O’Reilly EJ, Heitmann BL, Pereira MA, Balter K, Fraser GE, Goldbourt U, Hallmans G, Knekt P, Liu S, Pietinen P, Spiegelman D, Stevens J, Virtamo J, Willett WC, Ascherio A (2009) Major types of dietary fat and risk of coronary heart disease: a pooled analysis of 11 cohort studies. Am J Clin Nutr 89(5):1425–1432. CrossRefGoogle Scholar
  20. 20.
    Schwingshackl L, Hoffmann G (2014) Dietary fatty acids in the secondary prevention of coronary heart disease: a systematic review, meta-analysis and meta-regression. BMJ Open 4(4):e004487CrossRefGoogle Scholar
  21. 21.
    Hooper L, Martin N, Abdelhamid A, Davey Smith G (2015) Reduction in saturated fat intake for cardiovascular disease. Cochrane Database Syst Rev 6:CD011737. Google Scholar
  22. 22.
    Li Z, Zhang Y, Su D, Lv X, Wang M, Ding D, Ma J, Xia M, Wang D, Yang Y, Qiu J, Hu G, Ling W (2014) The opposite associations of long-chain versus very long-chain monounsaturated fatty acids with mortality among patients with coronary artery disease. Heart 100(20):1597–1605. CrossRefGoogle Scholar
  23. 23.
    Shi Z, Riley M, Taylor AW, Page A (2017) Chilli consumption and the incidence of overweight and obesity in a Chinese adult population. Int J Obes 41:1074.
  24. 24.
    Popkin BM, Lu B, Zhai F (2002) Understanding the nutrition transition: measuring rapid dietary changes in transitional countries. Public Health Nutr 5(6a):947–953. CrossRefGoogle Scholar
  25. 25.
    Tee ES (2011) Development and promotion of Malaysian Dietary Guidelines. Asia Pac J Clin Nutr 20(3):455–461Google Scholar
  26. 26.
    Batis C, Sotres-Alvarez D, Gordon-Larsen P, Mendez MA, Adair L, Popkin B (2014) Longitudinal analysis of dietary patterns in Chinese adults from 1991 to 2009. Br J Nutr 111(8):1441–1451. CrossRefGoogle Scholar
  27. 27.
    Zhuang P, Wang W, Wang J, Zhang Y, Jiao J (2018) Polyunsaturated fatty acids intake, omega-6/omega-3 ratio and mortality: findings from two independent nationwide cohorts. Clin Nutr. Google Scholar
  28. 28.
    Ng SW, Howard AG, Wang HJ, Su C, Zhang B (2014) The physical activity transition among adults in China: 1991–2011. Obes Rev 15(Suppl 1):27–36. CrossRefGoogle Scholar
  29. 29.
    Wang Z, Adair LS, Cai J, Gordon-Larsen P, Siega-Riz AM, Zhang B, Popkin BM (2017) Diet quality is linked to insulin resistance among adults in China. J Nutr 147(11):2102–2108. Google Scholar
  30. 30.
    Campmans-Kuijpers MJ, Sluijs I, Nothlings U, Freisling H, Overvad K, Boeing H, Masala G, Panico S, Tumino R, Sieri S, Johansson I, Winkvist A, Katzke VA, Kuehn T, Nilsson PM, Halkjaer J, Tjonneland A, Spijkerman AM, Arriola L, Sacerdote C, Barricarte A, May AM, Beulens JW (2016) The association of substituting carbohydrates with total fat and different types of fatty acids with mortality and weight change among diabetes patients. Clin Nutr 35(5):1096–1102. CrossRefGoogle Scholar
  31. 31.
    Lasheras C, Fernandez S, Patterson AM (2000) Mediterranean diet and age with respect to overall survival in institutionalized, nonsmoking elderly people. Am J Clin Nutr 71(4):987–992. CrossRefGoogle Scholar
  32. 32.
    Mente A, de Koning L, Shannon HS, Anand SS (2009) A systematic review of the evidence supporting a causal link between dietary factors and coronary heart disease. Arch Intern Med 169(7):659–669. CrossRefGoogle Scholar
  33. 33.
    Schwingshackl L, Hoffmann G (2014) Monounsaturated fatty acids, olive oil and health status: a systematic review and meta-analysis of cohort studies. Lipids Health Dis 13(1):154. CrossRefGoogle Scholar
  34. 34.
    Chien KL, Lin HJ, Hsu HC, Chen PC, Su TC, Chen MF, Lee YT (2013) Comparison of predictive performance of various fatty acids for the risk of cardiovascular disease events and all-cause deaths in a community-based cohort. Atherosclerosis 230(1):140–147. CrossRefGoogle Scholar
  35. 35.
    Zong G, Li Y, Sampson L, Dougherty LW, Willett WC, Wanders AJ, Alssema M, Zock PL, Hu FB, Sun Q (2018) Monounsaturated fats from plant and animal sources in relation to risk of coronary heart disease among US men and women. Am J Clin Nutr 107(3):445–453. CrossRefGoogle Scholar
  36. 36.
    Sun Q (2012) Red meat consumption and mortality. Arch Intern Med. Google Scholar
  37. 37.
    Vafeiadou K, Weech M, Altowaijri H, Todd S, Yaqoob P, Jackson KG, Lovegrove JA (2015) Replacement of saturated with unsaturated fats had no impact on vascular function but beneficial effects on lipid biomarkers, E-selectin, and blood pressure: results from the randomized, controlled Dietary Intervention and Vascular function (DIVAS) study. Am J Clin Nutr 102(1):40–48. CrossRefGoogle Scholar
  38. 38.
    Goncalves-de-Albuquerque CF, Medeiros-de-Moraes IM, Oliveira FM, Burth P, Bozza PT, Castro Faria MV, Silva AR, Castro-Faria-Neto HC (2016) Omega-9 oleic acid induces fatty acid oxidation and decreases organ dysfunction and mortality in experimental sepsis. PLoS One 11(4):e0153607. CrossRefGoogle Scholar
  39. 39.
    Pestka JJ, Vines LL, Bates MA, He K, Langohr I (2014) Comparative effects of n-3, n-6 and n-9 unsaturated fatty acid-rich diet consumption on lupus nephritis, autoantibody production and CD4 + T cell-related gene responses in the autoimmune NZBWF1 mouse. PLoS One 9(6):e100255. CrossRefGoogle Scholar
  40. 40.
    Emken E (2013) Human studies using isotope labeled fatty acids: answered and unanswered questions. J Oleo Sci 62(5):245–255CrossRefGoogle Scholar
  41. 41.
    de Souza CO, Teixeira AAS, Biondo LA, Lima Junior EA, Batatinha HAP, Rosa Neto JC (2017) Palmitoleic acid improves metabolic functions in fatty liver by PPAR alpha-dependent AMPK activation. J Cell Physiol 232(8):2168–2177. CrossRefGoogle Scholar
  42. 42.
    Yang ZH, Miyahara H, Hatanaka A (2011) Chronic administration of palmitoleic acid reduces insulin resistance and hepatic lipid accumulation in KK-Ay Mice with genetic type 2 diabetes. Lipids Health Dis 10:120. CrossRefGoogle Scholar
  43. 43.
    Bolsoni-Lopes A, Festuccia WT, Chimin P, Farias TS, Torres-Leal FL, Cruz MM, Andrade PB, Hirabara SM, Lima FB, Alonso-Vale MI (2014) Palmitoleic acid (n-7) increases white adipocytes GLUT4 content and glucose uptake in association with AMPK activation. Lipids Health Dis 13:199. CrossRefGoogle Scholar
  44. 44.
    Bernstein AM, Roizen MF, Martinez L (2014) Purified palmitoleic acid for the reduction of high-sensitivity C-reactive protein and serum lipids: a double-blinded, randomized, placebo controlled study. J Clin Lipidol 8(6):612–617. CrossRefGoogle Scholar
  45. 45.
    Zong G, Ye X, Sun L, Li H, Yu Z, Hu FB, Sun Q, Lin X (2012) Associations of erythrocyte palmitoleic acid with adipokines, inflammatory markers, and the metabolic syndrome in middle-aged and older Chinese. Am J Clin Nutr 96(5):970–976. CrossRefGoogle Scholar
  46. 46.
    Yin G, Wang Y, Cen XM, Yang Y, Yang M, Xie QB (2017) Identification of palmitoleic acid controlled by mTOR signaling as a biomarker of polymyositis. J Immunol Res 2017:3262384. Google Scholar
  47. 47.
    Yu DX, Sun Q, Ye XW, Pan A, Zong G, Zhou YH, Li HX, Hu FB, Lin X (2012) Erythrocyte trans-fatty acids, type 2 diabetes and cardiovascular risk factors in middle-aged and older Chinese individuals. Diabetologia 55(11):2954–2962CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Nutrition, School of Public HealthZhejiang University School of MedicineHangzhouChina
  2. 2.National Engineering Laboratory of Intelligent Food Technology and Equipment, Zhejiang Key Laboratory for Agro-Food Processing, College of Biosystems Engineering and Food ScienceZhejiang UniversityHangzhouChina

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