Dietary nutrients of relative importance associated with coronary artery disease: Public health implication from random forest analysis.

Til Bahadur Basnet,Rajesh Basnet,Srijana G C,Bidusha Neupane,Samson Gebremedhin

doi:10.1371/journal.pone.0243063

Til Bahadur Basnet, Rajesh Basnet + Show 3 more

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https://doi.org/10.1371/journal.pone.0243063

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Abstract

Dietary nutrients have significant effects on the risk of cardiovascular diseases. However, the results were not uniform across different countries. The study aims to determine the relative importance of dietary nutrients associated with coronary artery disease (CAD) among the Nepalese population. A hospital-based matched case-control study was carried out at Shahid Gangalal National Heart Center in Nepal. In the present study, patients with more than seventy percent stenosis in any main coronary artery branch in angiography were defined as cases, while those presenting normal coronary angiography or negative for stressed exercise test were considered controls. Dietary intakes of 612 respondents over the past 12 months were evaluated using a semi-quantitative customized food frequency questionnaire. In conditional regression model, the daily average dietary intake of β-carotene (OR: 0.54; 95%CI: 0.34, 0.87), and vitamin C (OR: 0.96; 95%CI: 0.93, 0.99) were inversely, whereas dietary carbohydrate (OR: 1.16; 95%CI: 1.1, 1.24), total fat/oil (OR: 1.47; 95%CI: 1.27, 1.69), saturated fatty acid (SFA) (OR: 1.2; 95%CI: 1.11, 1.3), cholesterol (OR: 1.01; 95%CI: 1.001, 1.014), and iron intakes (OR: 1.11; 95%CI: 1.03, 1.19) were positively linked with CAD. Moreover, in random forest analysis, the daily average dietary intakes of SFA, vitamin A, total fat/oil, β-carotene, and cholesterol were among the top five nutrients (out of 12 nutrients variables) of relative importance associated with CAD. The nutrients of relative importance imply a reasonable preventive measure in public health nutrients specific intervention to prevent CAD in a resource-poor country like Nepal. The findings are at best suggestive of a possible relationship between these nutrients and the development of CAD, but prospective cohort studies and randomized control trials will need to be performed in the Nepalese population.

Highlights

Coronary artery disease (CAD) is a significant cause of disability and premature death throughout the world
As CAD incidence is lower in the female population, fewer female CAD cases were admitted to the hospital, resulting in the ratio of male-to-female cases of 3:1
Random forest analysis revealed that dietary intake of saturated fatty acid (SFA), vitamin A, total fat and oil, β-carotene, and cholesterol were the topmost important nutrients associated with CAD

Summary

Introduction

Coronary artery disease (CAD) is a significant cause of disability and premature death throughout the world. An estimated 7.4 million people died from CAD in 2015, representing 13% of all global deaths [2]. A global strategy based on knowledge of the importance of risk factors for cardiovascular disease (CVDs) in different geographic regions and various ethnic groups is needed to prevent diseases effectively [4]. Western people mostly rely on high energy-dense food, substantially not reducing the incidence of obesity and CVDs [5] despite improved medical care and an increase in the cessation of smoking [6]. In low and middle-income countries, fast food, energy-dense food, and diet in high fat are related to an abrupt rise in CAD even in a younger population of high socioeconomic status of an urban area [7]

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