Abstract

Background and Objective: Coronary artery calcium (CAC) score is an early indicator of CVD. Diet is an established primary prevention strategy for CVD, but limited research has systematically evaluated the relationship between diet and CAC. The current study sought to review longitudinal studies evaluating the association between dietary intake and CAC score. Methods: Five databases were searched from inception to October 2022. We included prospective studies that included terms to capture food, diet, and nutrient intake in disease-free adults with CAC score measured by computed tomography. Two authors developed the search strategies and screened articles for inclusion. Results: Of 58 articles on dietary intake and CAC score, nine assessed the relationship between dietary intake at baseline and CAC score at follow up. Sample size was moderate to large across the nine studies, ranging from 861 to 15,368 participants. Seven studies used a food frequency questionnaire, one used a semi-quantitative interview, and one used a single-item question to assess diet intake. One study was conducted in Germany, while eight were conducted in the US. Three studies derived data from the CARDIA study, a cohort of young adults aged 18-30 at baseline. Two studies used the MESA study, a prospective study of adults aged 45-84 at baseline. Four studies found an association between dietary pattern intake and CAC score, with studies finding that higher fruit and vegetable intake and Mediterranean-like diet associated with lower risk of CAC progression, and low carbohydrate diet and starchy vegetable, meat and alcohol intake associated with increased risk of CAC presence. Conclusions: Studies suggested that there is a relationship between diet intake and CAC presence and progression, with research reflecting positive effects associated with patterns rich in fruits and vegetables alongside deleterious effects associated with high saturated fat and low dietary fiber intake. Finding reflect the strong influence of diet on clinical indicators of CVD.

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