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Eating patterns and the risk of coronary heart disease

 

There is a substantial amount of research on the effects of individual nutrients or foods on the risk of coronary heart disease. Nutrients and foods, however, are eaten in combination. This study examines the overall diet to quantify the association between eating patterns and the risk of coronary heart disease.

Bottom line

A diet high in fruit, vegetables, whole grains, legumes, poultry and fish reduces the risk of coronary heart disease by 24%. A diet high in red and processed meats, refined grains, chips, desserts and sweets increases the risk of coronary heart disease by 46%.


Reference

TT Fung et al. Dietary patterns and the risk of coronary heart disease in women. Archives of Internal Medicine 2001 161: 1857-1862.

Study

Participants were 69,017 women, aged 38 to 63 years, from the US Nurses’ Health Study. Excluded were women with a history of myocardial infarction, angina, coronary artery bypass surgery, hypercholesterolemia, diabetes and stroke. Questionnaires assessed lifestyle and medical history (updated every two years). Dietary intake was assessed with food frequency questionnaires administered in 1984, 1986, 1990 and 1994. Dietary patterns were identified with factor analysis and divided into quintiles. Cases of coronary heart disease were confirmed by various means, including medical records, autopsy reports and death certificates.

The women were followed for 12 years. A total of 821 cases of coronary heart disease were confirmed.

Results

Two eating patterns were identified. The first was characterised by higher intakes of fruit, vegetables, whole grains, legumes, poultry and fish (labelled ‘prudent’). The second was characterised by higher intakes of red and processed meats, refined grains, chips, desserts and sweets (labelled ‘Western’).

Women with high prudent scores were less likely to smoke, use more vitamin supplements and consume more folate, fibre and protein. Women with high Western scores were more likely to smoke, use fewer vitamin supplements and consume less folate and fibre.

  • A higher prudent score was associated with a lower risk of total coronary heart disease. Compared with women in the lowest quintile of the prudent diet, those in the highest quintile had a 24% reduced risk of coronary heart disease (relative risk 0.76, 95% confidence interval 0.60 to 0.98).
  • A higher Western score was associated with a higher risk of total coronary heart disease. Compared with women in the lowest quintile of the Western diet, those in the highest quintile had a 46% increased risk of coronary heart disease (relative risk 1.46, 95% confidence interval 1.07 to 1.99).
  • The lowest risk was among women who were in the highest quintile of the prudent diet and the lowest quintile of the Western diet, with a reduced risk of 36%, compared with those with the opposite pattern profile (relative risk 0.64, 95% confidence interval 0.44 to 0.92).

These results were adjusted for age, smoking, energy intake, body mass index, multivitamin and vitamin E supplement use, physical activity, hormone replacement therapy, parental history of myocardial infarction and history of hypertension.

Comment

Investigating overall eating patterns is much more true to life than looking at intake of individual foods or nutrients. Although this study looked at women, the same two eating patterns have been found to predict the risk of coronary heart disease in men.