Cardioprotective Diet Research Articles

Nut Consumption and Weight Gain in a Mediterranean Cohort: The SUN Study

To assess the association, in a Mediterranean population, between nut consumption and risk of weight gain (at least 5 kg) or the risk of becoming overweight/obese. The Seguimiento Universidad de Navarra project is a prospective cohort of 8865 adult men and women who completed a follow-up questionnaire after a median of 28 months. Dietary habits were assessed with a previously validated semiquantitative food-frequency questionnaire. Nine hundred thirty-seven participants reported a weight gain of > or =5 kg at follow-up. After adjusting for age, sex, smoking, leisure time physical activity, and other known risk factors for obesity, participants who ate nuts two or more times per week had a significantly lower risk of weight gain (odds ratio: 0.69; 95% confidence interval: 0.53 to 0.90, p for trend = 0.006) than those who never or almost never ate nuts. Participants with little nut consumption (never/almost never) gained an average of 424 grams (95% confidence interval: 102 to 746) more than frequent nut eaters. Nut consumption was not significantly associated with incident overweight/obesity in the cohort. Frequent nut consumption was associated with a reduced risk of weight gain (5 kg or more). These results support the recommendation of nut consumption as an important component of a cardioprotective diet and also allay fears of possible weight gain.

Eierkonsum und kardiovaskuläres Risiko

Egg yolk has the highest content of cholesterol observed in different types of food. Intake of one egg per day increases the serum concentration of LDL cholesterol by 0.10 mmol/l. In healthy people eating a Western diet, egg consumption does not correlate with cardiovascular risk. However, a significant increase of the risk was observed in diabetic subjects starting from an intake of 5-7 eggs per week. However, dietary pattern rather than a single component of nutrition influences cardiovascular risk. The egg - rich in proteins, unsaturated fatty acids, vitamins and minerals - should be part of our nutrition, and it is not justified to recommend a general limitation of egg intake. However, we do not advice unbalanced high egg consumption. A cardioprotective diet is characterized by high variability and contains plenty of fruits, vegetables, and complex carbohydrates.

Development of a short dietary intake questionnaire for the quantitative estimation of adherence to a cardioprotective Mediterranean diet.

Our objective was to develop a short questionnaire that can be easily used to estimate quantitatively the level of adherence to cardioprotective Mediterranean diets. The short questionnaire assessed the consumption of cardioprotective elements included in the Mediterranean diet (olive oil, wine, fruits, vegetables, fish, legumes and whole-grain intake). A low consumption of meat or meat-products was also included in the composite score. The relative risk of myocardial infarction for each category of the composite score obtained (range 0-9) was computed using data from a case-control study that included 171 cases of first myocardial infarction and 171 matched controls. We found an adjusted odds ratio=0.18 (95% confidence interval (CI): 0.03-0.97; P=0.04) for those scoring 7-9 points when comparing them with those scoring 1-2 points. An increment of one point in the score was associated with an 18% reduction in the relative risk of myocardial infarction (P=0.05).

Understanding the Mediterranean diet

PREVIEWMost physicians recommend the American Heart Association (AHA) Step I or Step II diet to patients at risk for heart disease and stroke, but recent studies suggest there might be a better approach. The Mediterranean diet, which has been around for thousands of years, offers a practical, effective, and enjoyable strategy that is relatively easy to adopt and more likely to be successful over the long term than most other heart-healthy diets. In this article, Drs Curtis and O'Keefe review the current understanding and scientific evidence related to cardioprotective diets and present practical ideas for implementation.

Diet and coronary heart disease: advice on a cardioprotective diet.

Coronary heart disease is a major disease leading to early morbidity and mortality in the UK. The causes are multifactorial, a combination of modifiable and non-modifiable risk factors. Although recent statistics show a reduction in the coronary heart disease mortality rate, the disease continues to be a major focus in health care, with strategies being developed to improve prevention and treatment. Dietary modification has a role to play in both primary and secondary prevention.

Dietary fats in the prevention of coronary heart disease: the need for more clinical trials

On the basis of various lines of evidence, including clinical trials, diet appears to have the potential to lessen the risk of CHD events, independent of effects on serum lipid values, at least as great as the most effective medical and interventional treatments available today. Given the diversity of these cardioprotective diets, as well as their salutary components, one of the priorities in research should be to undertake more comparative trials, trials which determine patient acceptability, effects on surrogate markers of risk, and which ultimately impact on morbidity and mortality. The Carolina Diet Heart Trial is a clinical outcome trial comparing two ‘proven’ cardioprotective diets, the AHA endorsed Step II diet versus an American-Mediterranean diet, and having the amount and type of unsaturated fat as the main dependent variable. This study is a protective, randomized, multi-centre, secondary prevention trial with the ultimate intention of reducing the incidence of subsequent cardiovascular events through dietary modification in patients who have survived a previous acute coronary syndrome. The study intervention is also designed to give these patients the necessary knowledge, motivation and practical ability to modify their current diets and maintain long-term adherence to a more cardioprotective diet. The initial pilot phase will assess compliance with the two study diets, as well as assess the impact of each diet on a marker of CHD risk.

Role of the cardioprotective diet in preventing coronary heart disease.

Diet is a significant feature in the prevention of primary and secondary coronary heart disease (CHD). Obesity management is crucial because of its direct influence on many CHD risk factors, angina symptoms and capacity to exercise. Much evidence is available on the best dietary and nutritional intake for maximum cardiac protection. The dietary habits enjoyed by the Mediterranean countries appear to confer the best health benefits. These involve eating plenty of fruit, vegetables, pulses, nuts, cereal products, olive oil and fish and only small amounts of meat and dairy foods. The Mediterranean diet does not contain the amounts of animal fats, margarines, cakes, sweets, biscuits and manufactured foods that are characteristic of the British diet. Nurses, in their professional capacity, can motivate and support patients to change their eating habits.

Family Hospitality and Ethnic Tradition Among South Asian, Italian and General Population Women in the West of Scotland

South Asians have a high risk of heart disease in Britain and Italians low, and there are corresponding differences in total energy and total fat intake. The present paper explores how far obligatory patterns of food intake exist in either group and are reflected in conventions of hospitality. Both groups are from peasant‐based economies, where, despite the common pattern of low fat intake, food occupies a high proportion of family income, and is correspondingly important as a part of gift exchange in marriage, and as a bearer of collective meanings.Open‐ended questions on meals suitable for family hospitality were asked of South Asian women (63 born abroad, 56 in Britain), and Italian women (39 abroad, 51 in Britain) together with 50 women from the general population, all aged 20–40 and resident in the West of Scotland urban area. The traditional family meal of the Glasgow general population corresponds to the cooked dinner described in South Wales, and suggests a pan‐British cultural symbol. However traditional family hospitality meals play a more important part in the life of migrant South Asians and Italians than they do in the majority culture, and British‐born South Asians maintain this pattern more than British‐born Italians. This pattern of hospitality, in an economy where energy‐dense foods are readily available, may result in high energy intake and increased coronary risk. However realisation of these implications, and increased weight consciousness, can lead to restoration of the traditional cardioprotective diet.

Randomised Controlled Trial of Cardioprotective Diet in Patients with Acute Myocardial Infarction: Results of One Year Follow up

Randomised Controlled Trial of Cardioprotective Diet in Patients with Acute Myocardial Infarction: Results of One Year Follow up

The 'diet heart' hypothesis in secondary prevention of coronary heart disease.

From this detailed analysis of the main dietary trials conducted over the last 30 years in the secondary prevention of coronary heart disease, it can be said that the older trials were conducted on low risk patients and used high fat diets (about 40% of energy as lipids), comprising low saturated fat and cholesterol intake but very high (15 to 20% of energy) polyunsaturated fat intake, particularly from the omega-6 fatty acid family. These experimental diets were designed to reduce blood cholesterol and failed to improve prognosis. By contrast, recent trials were not primarily designed to reduce cholesterol, were conducted in medium- and high-risk patients and used low fat diets supplemented by omega-3 fatty acids from various sources. In two of these trials, the consumption of natural antioxidants, oligoelements and vegetable proteins was increased. Recurrence rate was reduced in the range of 30 to 70%. One conclusion from these well-conducted recent experiments on more than 3000 patients is that new and more specific dietary recommendations are clearly warranted in secondary prevention of coronary heart disease. They should be more specific and more clearly defined and therefore different from those generally provided in the U.S.A. and Europe at present. In a recent Consensus Panel statement, authors wrote less than one line to describe a cardioprotective diet in patients with coronary heart disease, summarized as < or = 30% fat, < 7% saturated fat, < 200 mg.day-1 cholesterol. This is both too much (too restrictive to hope that white European and American patients will adhere in the long-term) and insufficient because dietary counselling cannot be restricted to three factors. Ulbricht and Southgate recently emphasized that the relationship between diet and coronary heart disease is more complex than the current cholesterol hypothesis. They identified at least seven major dietary factors, including fibres, although the evidence of an effect on coronary heart disease is weak. However, they did not mention vegetable and fish proteins which are rich in arginine and L-glutamine, major regulators of cardiovascular function. Thus, new dietary advice should include: reduce intake of total (not more than 30% of energy) and saturated (less than 10%) fats maintain intake at least minimally, of the essential omega-6 fatty acids augment consumption of oleic acid and moderately increase consumption of omega-3 fatty acids augment intake of natural antioxidants and oligo-elements maintain sufficient intake of vegetable proteins As conceptualized in the 'Mediterranean' and 'Asian-vegetarian' types of diet, it is very important that a healthy diet should be thought of as a whole rather than as a recitation of good and bad components. Although these protective dietary modifications should probably all be used in each patient to obtain maximal efficacy, these scientifically quantitated principles should be adapted to the culture, ethnic origin and 'image of the world' of each patient in order to create an environment favourable to the perception of positive associations between various foods and healthy habits.

Fish Oil Supplementation Versus Gemfibrozil Treatment in Hyperlipidemic NIDDM

To compare the impact of dietary fish oil supplementation (FO, 22 ml daily, containing 4.6 g of n-3 (omega-3) fatty acids, equalling 14.4 mmol) on carbohydrate and lipid metabolism with that of conventional lipostatic therapy (Gemfibrozil (G), 900 mg daily, equalling 3.6 mmol) on hyperlipidemic non-insulin dependent diabetes mellitus (NIDDM), 10 patients were selected for a randomized, short-time, cross-over study. Each patient was treated for a duration of 2 weeks, with an individual washout period of 8 weeks. Metabolic variables and intravenous glucose tolerances (1.2 mmol/kg body weight, t = 30 min) were determined on days 1 and 15 of each treatment period. Plasma lipid concentrations were identical at baseline, but were reduced more markedly following G as against FO exposure (% change vs. baseline: total cholesterol (chol), - 13**/-6* (G vs FO: p = 0.05); total triglycerides (TG), -39**/-18** (p < 0.05); APO B, -17**/- 10* (N.S.); LDL-chol, -15**/0 (p < 0.02); VLDL-chol, -50***/- 34*** (N.S.); VLDL-TG, -44***/-27** (N.S.); (p vs. baseline: * < 0.05, ** < 0.01, *** < 0.001). Total-HDL, HDL2, HDL3 and APO A were not influenced by either FO or G. Neither FO nor G induced a change in intravenous glucose tolerances or associated basal and incremental concentrations of insulin and C-peptide. We concluded, based on short-time applications, that (a) neither treatment affected the carbohydrate metabolism in patients with NIDDM, and (b) a greater hypolipidemic efficacy had to be assigned to Gemfibrozil than to fish oil. It would therefore appear that Gemfibrozil acts as a useful lipostatic pharmacologic compound, whilst fish oil could serve as a potential ingredient of a prudent cardio-protective diet which favours the low plasma triglyceride concentrations found in NIDDM patients.

Randomized, controlled trial of antioxidant vitamins and cardioprotective diet on hyperlipidemia, oxidative stress, and development of experimental atherosclerosis: the diet and antioxidant trial on atherosclerosis (DATA).

The effects of administration of guava and papaya fruit (100 g/day), vegetables, and mustard oil (5 g/day) (group A); antioxidant vitamins C (50 mg/day) and E (30 mg/day), plus betacarotene (10 mg/day) (group B); a high-fat (5-10 g/day) (group C); or a low-fat (4-5 g/day) diet (group D) were compared over 24 diet weeks in a randomized fashion, while all groups of rabbits (five in each of four groups) received a hydrogenated fat diet (5-10 g/day) for a period of 36 weeks. After 12 weeks on the high-fat diet, each group of rabbits had an increase in blood lipoproteins. The fruit and vegetable-enriched prudent diet (group A) caused a significant decline in blood lipids at 24 and 36 weeks, whereas the lipid levels increased significantly in groups C and D. Group A also had a significant rise in vitamin E (2.1 Umol/l), C (10.5 Umol/l), A (0.66 Umol/l), and carotene (0.08 Umol/l) and a decrease in lipid peroxides (0.34 nmol/ml at 36 weeks, whereas the levels were unchanged in groups C and D. Group B rabbits had a significant and greater increase than group A in plasma vitamins E, C, A, and carotene; a rise in HDL cholesterol; and a greater decrease in lipid peroxides after 24 and 36 weeks of treatment. After stimulation of lipid peroxidation in all rabbits, 3 of 5 group C and 2 of 5 group D rabbits died due to coronary thrombosis, whereas in groups A and B there were no deaths, indicating that antioxidant therapy can provide protection against lipid peroxidation and free radical generation. Aortic lipids and sudanophilia, indicating atherosclerosis, were significantly higher in groups C and D than in groups A and B. Fatty streaks and atheromatous and fibrous plaques were noted in all the rabbits in groups C and D. Intimal fibrosis and medial degeneration were also present in the group C rabbits. While group A (36.4 +/- 4.4 microns) and group B (37.1 +/- 4.2 microns) rabbits had minimal coronary artery plaque sizes, group C (75.4 +/- 10.6 microns) and group D rabbits (69.5 +/- 6.2 microns) had significantly greater plaque sizes. Aortic plaque sizes were also greater in groups C and D than in groups A and B. It is possible that combined therapy with antioxidant vitamins C, E, and carotene, and a diet rich in antioxidants, could independently inhibit free radical generation and the development of atherosclerosis.

Varying content of polyphenols in olive and other edible oils: a neglected aspect of nutrition and cardioprotective diets

Varying content of polyphenols in olive and other edible oils: a neglected aspect of nutrition and cardioprotective diets

Cardioprotective diet reduced mortality and complications after recent myocardial infarction

Source Citation Singh RB, Rastogi SS, Verma R, et al. Randomised controlled trial of cardioprotective diet in patients with recent acute myocardial infarction: results of one year follow up. BMJ. 1...

Cardioprotective Indian diet beneficial after MI

Cardioprotective Indian diet beneficial after MI

Cardiovascular Disease

Cardioprotective diet, Familial hypercholesterolaemia, Heart failure, Stroke, including dysphagia, Hypertension, Peripheral arterial disease

Antibodies in malignant disease.

Nutrition has a central role in both primary and secondary prevention of cardiovascular disease yet only relatively recently has food been regarded as a treatment, rather than as an adjunct to established medical and pharmacotherapy. As a field of research, nutrition science is constantly evolving making it difficult for patients and practitioners to ascertain best practice. This is compounded further by the inherent difficulties in performing double-blind randomised controlled trials. This paper covers dietary patterns that are associated with improved cardiovascular outcomes, including the Mediterranean Diet but also low-carbohydrate diets and the potential issues encountered with their implementation. We suggest there must be a refocus away from macronutrients and consideration of whole foods when advising individuals. This approach is fundamental to practice, as clinical guidelines have focused on macronutrients without necessarily considering their source, and ultimately people consume foods containing multiple nutrients. The inclusion of food-based recommendations aids the practitioner to help the patient make genuine and meaningful changes in their diet. We advocate that the cardioprotective diet constructed around the traditional Mediterranean eating pattern (based around vegetables and fruits, nuts, legumes, and unrefined cereals, with modest amounts of fish and shellfish, and fermented dairy products) is still important. However, there are other approaches that can be tried, including low-carbohydrate diets. We encourage practitioners to adopt a flexible dietary approach, being mindful of patient preferences and other comorbidities that may necessitate deviations away from established advice, and advocate for more dietitians in this field to guide the multi-professional team.