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Dietary Guidelines Lowers CVD Risk

According to the NHS, adhering to the Dietary Guidelines for Americans lowered CVD risk by 14% in women. It did not reduce their risk of cancer or other chronic diseases. Healthy eating pattern was associated with low CHD risk in Health Professionals Follow-up Study.

http://www.enc-online.org/ncu1704.htm

Volume 17 - Number 4 Winter 2000 TABLE OF CONTENTS

  • Dietary Guidelines Lowers CVD Risk
  • Plasma and Tissue Lutein and Zeaxanthin Increases with High Carotenoid Intake
  • Whole Grain Lowers Both Ischemic Stroke and Type 2 Diabetes
  • CHD Associated to Lipoprotein-Associated Phospholipase A2 Enzyme
  • Impaired Fat Oxidation Leads to Increased Obesity in Undernourished Children

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Low-saturated Fat and Cholesterol Diets are Safe and Effective for Preschool Kids

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Orange Juice Improves Plasma HDL Cholesterol Levels

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Editorial: A New Approach for a New Millennium

COMMON ABBREVIATIONS BMI: body mass index (kg/m2) CAD: coronary artery disease CHD: coronary heart disease CHO: carbohydrate CI: confidence interval CVD: cardiovascular disease ene: energy HDL: high density lipoprotein LDL: low density lipoprotein Lp(a): lipoprotein (a) MI: myocardial infarction MUFA: monounsaturated fatty acids NCEP: National Cholesterol Education Program P:S: dietary polyunsaturated:saturated fat ratio PUFA: polyunsaturated fatty acids RR: relative risk SFA: saturated fatty acids TAG: triacylglycerol VLDL: very low density lipoprotein

Dietary Guidelines Lowers CVD Risk

We all know that a healthful diet plays an important role in protecting us against major chronic diseases. And in an effort to assist Americans to eat more healthfully, the USDA and Health and Human Services developed the Dietary Guidelines for Americans, which is a compilation of healthy eating patterns. This tool, which was first developed in 1980 has undergone regular evaluation to insure that the recommendation is inline with current research data. However, the efficacy of this guideline has been untested until recently. Hu et al. tested the relationship between adherence to the Dietary Guidelines for Americans and risk of major chronic disease in men, than using the Nurses’ Health Study (NHS) data, McCullogh and colleagues assessed the same relationship in women. However, these 2 studies arrived at 2 very different results regarding the efficacy of adherence to the Dietary Guidelines for Americans in protecting against major chronic diseases.

Using the food frequency questionnaires 67, 272 healthy women enrolled in the NHS, the researchers calculated the Healthy Eating Index (HEI) scores ranging from 0 (worst) to 100 (best). The criteria for the HEI score was based on the frequency of eating from all 5 food groups and restricting negative nutrients such as fats and sodium. The mean HEI score was 64.4 in the study cohort. This was the same HEI scores as in the CSFII subpopulation, who were matched for age and degree of education with the NHS cohorts. However, compared to the subjects in the NHS, the CSFII cohort ate less vegetables, fruits, and meats. High HEI scores were associated with overall healthier lifestyle behaviors in both cohorts. During the 12-year follow-up, 365 cases of CVD, 5216 cases of cancer, and 496 cases of traumatic deaths were reported. The researchers divided individuals into quintiles based on their HEI scores. The median HEI scores were 48, 50, 65, 75, and 80 for quintiles 1 through 5, respectively. Intakes of milk, fruits, vegetables, grains were directly associated with higher HEI scores, while fat and sodium were inversely related.

In relation to HEI scores, age-adjusted RR for the highest quintile to the lowest quintile for major chronic diseases was 0.81, 0.59 for CVD, and 0.92 for cancers. However, when other CVD risk factors were included in the analysis, it diminished the net beneficial effects of a higher HEI score. The multivariate adjusted RR for major chronic diseases, CVD, and cancer were 0.97, 0.86, and 1.02, respectively, in the highest HEI score group. The data suggest that following a healthy diet as prescribed by the Dietary Guidelines for Americans lowered CVD risk by 14% but made no difference in either cancer or mortality rates from major chronic diseases.

The researchers postulated that the weak association between following the Dietary Guidelines for Americans and less than resounding protection against cancer, and other major chronic diseases might have been the result of several limitations in the design of the study. For example, HEI scores were developed to assess nutritional quality of a 24-hour food recall rather than for long-term dietary habits as in the case with food frequency questionnaires used in the NHS. Also, since HEI scores were based on the frequency of all 5 food groups, rather than specific foods, HEI scores would be high for people eating high qualities of red meats and refined bread products as well as someone eating lots of whole grains, fruits and vegetables. Even though this is not a perfect study, as a result of this study, it is possible to conclude that the HEI score does not necessarily measure the optimal diet to prevent major chronic diseases. And in order to help Americans eat more healthily, HEI, the Dietary Guidelines for Americans, and Food Guide Pyramid, “should be continue to be evaluated for their efficacy in reducing the incidence of disease of major public health concern.”

Contrary to the NHS findings, the data from the Health Professionals Follow-Up Study (n=44,875 males) suggested that following a healthy dietary pattern does lower CHD risk, independent of other CHD risk factors. For example, of the 1089 cases of both fatal and nonfatal CHD reported during the 8 year follow-up period, it occurred more in the subjects who followed the Western pattern diet, which is higher in fat content and highly processed foods, versus the prudent pattern which is high in fruits, vegetables, fish, and poultry.

The subjects were stratified into the prudent pattern and Western pattern based on the 131-item food frequency questionnaires. And based on the analysis, the multivariate adjusted RR across increasing quintiles of prudent pattern score were 1.0, 0.87, .079, 0.75, and 0.70 (95%CI: 0.56, 0.86; p for trend=0.0009). On the other hand, the RR across increasing quintiles of the Western pattern were 1.0, 1.21, 1.36, 1.40, and 1.64 (95% CI: 1.24, 2.17, p for trend <0.00013). Separate analysis of the direct relationship between Western pattern and fatal and nonfatal CHD showed that it was much stronger for fatal CHD events. Based on this result, Hu et al. concluded that the 2 dietary patterns shown by the food frequency questionnaire is a good predictor of CHD risk. And by replacing diets high in fat and processed foods with more fruits, vegetables, fish, and poultry, consumers should be able to lower their risk of CHD.

McCullough ML, Feskanich D, Stampfer MJ, et al. Adherence to the Dietary Guidelines for Americans and risk of major chronic disease in women. Am J Clin Nutr. 2000;72:1214-1222.

Hu FB, Rimm EB, Stampfer MJ et al. Prospective study of major dietary patterns and risk of coronary heart disease in men. Am. J. Clin Nutr. 2000;72:912-921.

Key Messages

  • According to the NHS, adhering to the Dietary Guidelines for Americans lowered CVD risk by 14% in women. It did not reduce their risk of cancer or other chronic diseases. Multivariate RR for CVD, cancer, and nontraumatic deaths were 0.86, 1.02, and 0.97 for women in the highest HEI group HEI need to be refined to better determine optimal diet. Healthy eating pattern was associated with low CHD risk in Health Professionals Follow-up Study. The prudent pattern, diets high in fruits, vegetables, fish, and poultry was inversely associated with CHD risk, while the Western pattern, diets high in fat, red meats, processed meats, refined grains, and French-fries were directly associated with CHD risk.

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Coronary heart disease (CHD)

  1. Hu FB, Manson JE, Stampfer MJ, et al. Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med 2001; 345:790-7. 2. Tuomilehto J, Lindstrom J, Eriksson JG, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001; 344:1343-50. 3. Shiue H, Sather C, Layman D. Reduced carbohydrate/protein ratio enhances metabolic changes associated with weight loss diet (abst), Federation of American Societies for Experimental Biology, Orlando, FL, April 1, 2001. 4. McCullough ML, Feskanich D, Rimm EB, et al. Adherence to the dietary guidelines for Americans and risk of major chronic disease in men. Am J Clin Nutr 2000; 72:1223-31. 5. McCullough ML, Feskanich D, Stampfer MJ, et al. Adherence to the dietary guidelines for americans and risk of major chronic disease in women. Am J Clin Nutr 2000; 72:1214-22. 6. Liu S, Willett WC, Stampfer MJ, et al. A prospective study of dietary glycemic load, carbohydrate intake, and risk of coronary heart disease in US women. Am J Clin Nutr 2000; 71:1455-61. 7. Salmeron J, Hu FB, Manson JE, et al. Dietary fat intake and risk of type 2 diabetes in women. Am J Clin Nutr 2001; 73:1019-26. 8. Salmeron JA, Alberto; Rimm, Eric; Colditz, Graham; Jenkins, David; Stampfer, Meir; Wing, Alvin; Willett, Walter. Dietary Fiber, Glycemic Load, and Risk of NIDDM in Men. Diabetes Care 1997; 20:545-549. 9. Hu FB, Manson JE, Willett WC. Types of dietary fat and risk of coronary heart disease: a critical review. J Am Coll Nutr 2001; 20:5-19. 10. Hu F, Stampfer M, Manson J, et al. Dietary fat intake and the risk of coronary heart disease in women. New Engl J Med 1997; 337:1491-9. 11. Brown AA, Hu FB. Dietary modulation of endothelial function: implications for cardiovascular disease. Am J Clin Nutr 2001; 73:673-86.
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