Simple Nutrient-Based Rules vs. a Nutritionally Rich Plant-Centered Diet in Prediction of Future Coronary Heart Disease and Stroke: Prospective Observational Study in the US.

Yuni Choi,Jamal S Rana,Katie A Meyer,David R Jacobs,Karianne Svendsen,Lyn M Steffen,Daniel A Duprez,Pamela J Schreiner,James M Shikany,Daniel D Gallaher

doi:10.3390/nu14030469

Abstract

To better understand nutrition paradigm shift from nutrients to foods and dietary patterns, we compared associations of a nutrient-based blood cholesterol-lowering diet vs. a food-based plant-centered diet with risk of coronary heart disease (CHD) and stroke. Participants were 4701 adults aged 18–30 years and free of cardiovascular disease at baseline, followed for clinical events from 1985 and 86 to 2018. A plant-centered diet was represented by higher A Priori Diet Quality Score (APDQS). A blood cholesterol-lowering diet was represented by lower Keys Score. Proportional hazards regression was used to calculate hazard ratios (HR). Higher APDQS showed a nutrient-dense composition that is low in saturated fat but high in fiber, vitamins and minerals. Keys Score and APDQS changes were each inversely associated with concurrent plasma low-density lipoprotein cholesterol (LDL-C) change. Over follow-up, 116 CHD and 80 stroke events occurred. LDL-C predicted CHD, but not stroke. APDQS, but not Keys Score, predicted lower risk of CHD and of stroke. Adjusted HRs (95% CIs) for each 1-SD higher APDQS were 0.73 (0.55–0.96) for CHD and 0.70 (0.50–0.99) for stroke. Neither low dietary fat nor low dietary carbohydrate predicted these events. Our findings support the ongoing shift in diet messages for cardiovascular prevention.

Highlights

Over recent decades, there has been a shift in focus from nutrient-based messages to recommendations about food groups and diet patterns [1]
Results from randomized controlled trials (RCTs) and prospective studies generally suggested that replacing saturated fats with PUFAs, MUFAs derived from plant foods, or whole grains may reduce the risk of coronary heart disease (CHD) [24,26,27,28,29]
Our data support the a priori hypothesis that low-density lipoprotein cholesterol (LDL-C) is causally related to CHD, but the LDL-C association with stroke is not as strong as with CHD [30,31]

Summary

Introduction

There has been a shift in focus from nutrient-based messages to recommendations about food groups and diet patterns [1]. Low fat promulgated in the 1980 Dietary Guidelines for Americans (DGA) was adopted, which was influenced by the diet-heart hypothesis (Keys) [2,3]. Especially saturated fat, contribute to elevated blood cholesterol, which thereby increases coronary heart disease (CHD) risk. The simplification in this recommendation was the assertion that reducing total fat would reduce saturated fat and, in general, lead to a more healthful serum lipid profile [4]. DGA maintain low saturated fat advice [5,6] Over these years, a contrasting message has been to eat a diet low in carbohydrates. While never endorsed in the DGA, this idea has been widely noted [7,8]

Methods

Results

Discussion

Conclusion