Dietetic guidelines: diet in secondary prevention of cardiovascular disease (first update, June 2003)

AIM: To update dietetic guidelines summarizing the systematic review evidence on dietary advice to prevent further events in people with existing cardiovascular disease (CVD) (secondary prevention). METHODS: The Cochrane Library, MEDLINE and EMBASE were comprehensively searched to November 2002 for systematic reviews on aspects of diet and heart health. Reviews were included if they searched systematically for randomised controlled trials relating to diet and secondary prevention of CVD. Two members of the UK Heart Health and Thoracic Dietitians Group critically appraised each review. The quality and results of each review were discussed and summarized in a meeting of the whole group. RESULTS: Providing evidence-based dietary information (including increasing omega-3 fat intake) to all people who have had a myocardial infarction will save more lives than concentrating dietary advice on just those in need of weight loss or lipid lowering. The practice of prioritizing dietetic time in secondary prevention to those with raised lipids is out of date since the advent of statin therapy. However, effective dietary advice for those with angina, stroke, peripheral vascular disease or heart failure is less clear. CONCLUSION: There is good systematic review evidence that dietary advice to those with coronary heart disease can reduce mortality and morbidity as well as modify some risk factors. Dietary advice that does this most effectively should be prioritized.     

A reappraisal of the impact of dairy foods and milk fat on cardiovascular disease risk

Background  This review provides a reappraisal of the potential effects of dairy foods, including dairy fats, on cardiovascular disease (CVD)/coronary heart disease (CHD) risk. Commodities and foods containing saturated fats are of particular focus as current public dietary recommendations are directed toward reducing the intake of saturated fats as a means to improve the overall health of the population. A conference of scientists from different perspectives of dietary fat and health was convened in order to consider the scientific basis for these recommendations. Aims  This review and summary of the conference focus on four key areas related to the biology of dairy foods and fats and their potential impact on human health: (a) the effect of dairy foods on CVD in prospective cohort studies; (b) the impact of dairy fat on plasma lipid risk factors for CVD; (c) the effects of dairy fat on non-lipid risk factors for CVD; and (d) the role of dairy products as essential contributors of micronutrients in reference food patterns for the elderly. Conclusions  Despite the contribution of dairy products to the saturated fatty acid composition of the diet, and given the diversity of dairy foods of widely differing composition, there is no clear evidence that dairy food consumption is consistently associated with a higher risk of CVD. Thus, recommendations to reduce dairy food consumption irrespective of the nature of the dairy product should be made with caution.     

Review of the evidence for the potential impact and feasibility of substituting saturated fat in the New Zealand diet

Objective: To estimate the potential impact on cardiovascular health of modifying dietary intake of saturated fat across the New Zealand population, and whether this would be appropriate and feasible. Methods: First, a literature review of meta‐analyses was conducted to estimate the magnitude of reduction in risk for cardiovascular events in response to a reduction in dietary saturated fat intake (with or without substitution with other macronutrients). Second, data from the New Zealand Adult Nutrition Survey 2008/09 were used to determine whether a change to the population's dietary fat intake would be warranted and feasible. Results: Five relevant meta‐analyses were identified. No significant association between saturated fat intake alone and cardiovascular disease was found. However, the incidence of cardiovascular disease events was less when dietary saturated fats were replaced with polyunsaturated fats, reducing the risk of cardiovascular events by about 10%. Compared with nutritional guidelines, New Zealanders’ current saturated fat intake is excessive while polyunsaturated fat intake is inadequate; both would be corrected by a substitution of 5% of daily energy intake. Conclusions: Replacing 5% of daily energy consumed as saturated fat with polyunsaturated fats would be expected to reduce cardiovascular events by about 10%. Implications: In order to achieve the population‐wide dietary fat modifications needed to improve cardiovascular health for New Zealanders, a public health strategy (e.g. fiscal, regulatory and/or educational interventions) must be implemented. Further work is needed to establish the cost‐effectiveness of the various strategies.     

Grasas de la dieta y salud cardiovascular

Although dietary fat and its role in cardiovascular prevention has been one of the most extensively studied nutritional topics, it continues to be an ever-expanding research area. Particularly thanks to studies on Mediterranean diet, we now know that fat quality is more relevant than the amount of fat we eat in the diet. Thus, saturated and trans fats have been found to increase the risk of atherogenic disease. This is why it is recommended to substitute complex carbohydrates or unsaturated fat for unsaturated and trans fats with the aim of reducing saturated and trans fat intake to <10% and <1%, respectively, of the total calorie intake. Recent population studies, particularly that conducted in Kuopio, Finland, and those on Mediterranean diet, stress the important role of monounsaturated and polyunsaturated fats as key nutrients in preventing cardiovascular disease in modern societies. Furthermore, a special type of polyunsaturated fatty acids, i.e. those of the omega-3 (n-3) series, is increasingly becoming essential nutrients for a healthy diet, especially in the case of children. Therefore, there is a rationale for four the Scientific Societies that are strongly committed to disseminate the benefits of a healthy diet in preventing cardiovascular disease, and to prepare a joint statement with the purpose of spreading improved knowledge on the importance of changing to a healthy diet with a well-balanced fat intake for industrialized populations. Accordingly, a multidisciplinary panel of experts from the following institutions has developed the present joint statement targeted at both adults and children of different ages: Spanish Society of Arteriosclerosis, Spanish Society of Family and Community Medicine, Spanish Association of Paediatrics, Spanish Society of Gastroenterology, Hepatology and Paediatric Nutrition and Dietetics, and Spanish Society for Food Sciences.     

Assessing the Physiological Effects of Traditional Regional Diets Targeting the Prevention of Cardiovascular Disease: A Systematic Review of Randomized Controlled Trials Implementing Mediterranean,New Nordic,Japanese, Atlantic,Persian and Mexican Dietary Interventions

Traditional regional diets are considered as sustainable dietary patterns, while many have been examined with regard to their health benefits. The aim of the present systematic review was to aggerate all evidence on the physiological effects of regional diets among adults at high risk for cardiovascular disease (CVD). Three databases were searched for randomized controlled trials (RCTs) implementing any regional diet (Mediterranean (MedD), Persian, Southern European Atlantic, Japanese, Chinese, new Nordic, or other) while examining cardiovascular risk factors among adults at increased risk. Primary outcomes included anthropometric indices and secondary outcomes involved blood lipid concentrations, glucose metabolism, inflammation and other markers of CVD progression. Twenty RCTs fulfilled the study’s criteria and were included in the qualitative synthesis, with the majority implementing a MedD. Adherence to most of the regional diets induced a reduction in the BW and anthropometric indices of the participants. The majority of RCTs with blood pressure endpoints failed to note a significant reduction in the intervention compared to the comparator arm, with the exception of some new Nordic and MedD ones. Despite the interventions, inflammation markers remained unchanged except for CRP, which was reduced in the intervention groups of one new Nordic, the older Japanese, and the Atlantic diet RCTs. With regard to blood lipids, regional diet interventions either failed to induce significant differences or improved selective blood lipid markers of the participants adhering to the experimental regional diet arms. Finally, in the majority of RCTs glucose metabolism failed to improve. The body of evidence examining the effect of regional dietary patterns on CVD risk among high-risk populations, while employing an RCT design, appears to be limited, with the exception of the MedD. More research is required to advocate for the efficacy of most regional diets with regard to CVD.     

Food Sources of Saturated Fat and the Association With Mortality: A Meta-Analysis

We summarized the data related to foods high in saturated fat and risk of mortality. We searched Cochrane Library, MEDLINE, EMBASE, and ProQuest for studies from January 1952 to May 2012. We identified 26 publications with individual dietary data and all-cause, total cancer, or cardiovascular mortality as endpoints.Pooled relative risk estimates demonstrated that high intakes of milk, cheese, yogurt, and butter were not associated with a significantly increased risk of mortality compared with low intakes. High intakes of meat and processed meat were significantly associated with an increased risk of mortality but were associated with a decreased risk in a subanalysis of Asian studies. The overall quality of studies was variable.Associations varied by food group and population. This may be because of factors outside saturated fat content of individual foods. There is an ongoing need for improvement in assessment tools and methods that investigate food sources of saturated fat and mortality to inform dietary guidelines.National dietary guidelines typically promote foods low in saturated fat.1–3 These guidelines have arisen from early epidemiological studies showing that increased serum cholesterol was associated with increased risk of cardiovascular disease (CVD) and feeding studies showing that some, but not all, saturated fats increased serum cholesterol in comparison with unsaturated fats.4,5 However, the effects of diet on CVD can be mediated through pathways other than total serum cholesterol or low-density lipoprotein cholesterol,6 and the use of intermediate measures such as cholesterol as outcomes could be misleading. Restriction of saturated fat is now being questioned,7 with a recent meta-analysis showing that intake of saturated fats was not significantly associated with an increased risk of CVD.8As awareness of the relationship between diet, nutrition, and health increases in the general public, it is imperative that the dietary advice of health professionals be evidence based and reflect current scientific understanding. The recent debate regarding intake of saturated fats and risk of disease highlights 2 important questions for research.9 First, should dietary nutrients be considered in isolation? People consume foods, not individual nutrients. Thus, the effect of saturated fat needs to be considered in the context of its food sources. Individual saturated fatty acids may have different effects on mortality risk; for example, the type of saturated fat found in dairy products may be protective for chronic disease.10–13 Second, are individual biological markers sufficient measures of risk compared with clinical endpoints such as mortality, which give a more definitive outcome? We conducted a meta-analysis of cohort studies reporting the relationship between key food groups typically high in saturated fatty acids and mortality in initially healthy adults. We tested the null hypothesis that there would be no significant association of saturated fat sources with all-cause, CVD, or cancer mortality.     

Plasma and Dietary Antioxidant Status as Cardiovascular Disease Risk Factors: A Review of Human Studies

Extensive evidence has demonstrated that many antioxidants such as vitamin C, vitamin E, carotenoids and polyphenols have protective effects in preventing cardiovascular disease (CVD), a chronic disease that is mediated by oxidative stress and inflammation. This review focuses on evidence from prospective cohort studies and clinical trials in regard to the associations between plasma/dietary antioxidants and cardiovascular events. Long-term, large-scale, population-based cohort studies have found that higher levels of serum albumin, bilirubin, glutathione, vitamin E, vitamin C, and carotenoids were associated with a lower risk of CVD. Evidence from the cohort studies in regard to dietary antioxidants also supported the protective effects of dietary vitamin E, vitamin C, carotenoids, and polyphenols on CVD risk. However, results from large randomized controlled trials did not support long-term use of single antioxidant supplements for CVD prevention due to their null or even adverse effects on major cardiovascular events or cancer. Diet quality indexes that consider overall diet quality rather than single nutrients have been drawing increasing attention. Cohort studies and intervention studies that focused on diet patterns such as high total antioxidant capacity have documented protective effects on CVD risk. This review provides a perspective for future studies that investigate antioxidant intake and risk of CVD.     

Molecular Immune-Inflammatory Connections between Dietary Fats and Atherosclerotic Cardiovascular Disease: Which Translation into Clinics?

Current guidelines recommend reducing the daily intake of dietary fats for the prevention of ischemic cardiovascular diseases (CVDs). Avoiding saturated fats while increasing the intake of mono- or polyunsaturated fatty acids has been for long time the cornerstone of dietary approaches in cardiovascular prevention, mainly due to the metabolic effects of these molecules. However, recently, this approach has been critically revised. The experimental evidence, in fact, supports the concept that the pro- or anti-inflammatory potential of different dietary fats contributes to atherogenic or anti-atherogenic cellular and molecular processes beyond (or in addition to) their metabolic effects. All these aspects are hardly translatable into clinics when trying to find connections between the pro-/anti-inflammatory potential of dietary lipids and their effects on CVD outcomes. Interventional trials, although providing stronger potential for causal inference, are typically small sample-sized, and they have short follow-up, noncompliance, and high attrition rates. Besides, observational studies are confounded by a number of variables and the quantification of dietary intakes is far from optimal. A better understanding of the anatomic and physiological barriers for the absorption and the players involved in the metabolism of dietary lipids (e.g., gut microbiota) might be an alternative strategy in the attempt to provide a first step towards a personalized dietary approach in CVD prevention.     

Dietary intakes vary with age among Eskimo adults of Northwest Alaska in the GOCADAN study, 2000-2003

Dietary factors influence the development of cardiovascular disease (CVD). The diet of Alaskan Eskimos differs from that of other populations. We surveyed Eskimo adults in Northwest Alaska to document their usual dietary intakes, differences based on gender and age, and sources of selected nutrients, and to generate appropriate dietary advice to reduce CVD. Interviewers surveyed 850 men and women 17-92 y old, using a quantitative food-frequency instrument. We observed many significant (chi(2) analysis P < 0.05) differences in nutrient intakes among 3 age-groups. Energy intake from carbohydrate was negatively related to participant age-group (P < or = 0.01). Energy intake from all fats (P < 0.001) and polyunsaturated fat (P < or = 0.01) was positively related to age-group among both men and women in contrast to other studies in which age differences were either not observed or decreased with age. Native foods were major sources of monounsaturated and polyunsaturated fats, including 56% of (n-3) fatty acids primarily from seal oil and salmon. However, Native foods contributed significantly less to the diets of young adults than to those of elders, especially among women. Store-bought foods were the main sources of energy, carbohydrate, fat, saturated fat, and fiber for all adults. Based on their nutrient density and potential to inhibit CVD, continued consumption of traditional foods is recommended. Variations in intake by age may portend changing eating patterns that will influence CVD as participants age. These data will contribute to understanding dietary risk factors for cardiovascular disease in this population.     

Scientific Evidence of Interventions Using the Mediterranean Diet: A Systematic Review

The Mediterranean Diet has been associated with greater longevity and quality of life in epidemiological studies, the majority being observational. The application of evidence-based medicine to the area of public health nutrition involves the necessity of developing clinical trials and systematic reviews to develop sound recommendations. The purpose of this study was to analyze and review the experimental studies on Mediterranean diet and disease prevention. A systematic review was made and a total of 43 articles corresponding to 35 different experimental studies were selected. Results were analyzed for the effects of the Mediterranean diet on lipoproteins, endothelial resistance, diabetes and antioxidative capacity, cardiovascular diseases, arthritis, cancer, body composition, and psychological function. The Mediterranean diet showed favorable effects on lipoprotein levels, endothelium vasodilatation, insulin resistance, metabolic syndrome, antioxidant capacity, myocardial and cardiovascular mortality, and cancer incidence in obese patients and in those with previous myocardial infarction. Results disclose the mechanisms of the Mediterranean diet in disease prevention, particularly in cardiovascular disease secondary prevention, but also emphasize the need to undertake experimental research and systematic reviews in the areas of primary prevention of cardiovascular disease, hypertension, diabetes, obesity, infectious diseases, age-related cognitive impairment, and cancer, among others. Interventions should use food scores or patterns to ascertain adherence to the Mediterranean diet. Further experimental research is needed to corroborate the benefits of the Mediterranean diet and the underlying mechanisms, and in this sense the methodology of the ongoing PREDIMED study is explained.     

Fat Quality Index and Risk of Cardiovascular Disease in the Sun Project

Objectives

To examine the association between a dietary fat quality index (FQI), and the risk of incident cardiovascular events or deaths in the Seguimiento Universidad de Navarra (SUN) cohort.

Design

Longitudinal analysis during 10.1 years of median follow-up. Cox models were used to estimate adjusted hazard ratios (HR) of incident cardiovascular diseases (CVD) according to tertiles of FQI and of different fat subtypes.

Setting

University of Navarra, Spain.

Participants

19,341 middle-aged adults.

Measurements

Fat intake was measured with a validated food-frequency questionnaire. The FQI was calculated according to the ratio: (monounsaturated+polyunsaturated) / (saturated+trans fatty acids).

Results

We observed 140 incident cases of CVD. No association was found for FQI (HR=0.94, 95 %CI 0.61–1.47 for the highest vs the lowest tertile, p for trend=0.884). No significant associations were found for different dietary fat subtypes on CVD risk. The results suggest no clear association between a higher FQI and a higher amount of energy from fat and incidence of CVD (p for interaction: 0.259 and p for trend only among participants with a percentage of energy from fat ≥35% of total energy: 0.272).

Conclusion

In this Mediterranean cohort, the FQI was not associated with cardiovascular events. A “heart-healthy diet” should focus its attention on dietary fat sources and should use an overall dietary pattern approach, rather than limiting the focus on fat subtypes. More research is needed to validate dietary advice on specific fatty acids intake or saturated fatty acids replacements for reducing CVD risk.

     

Alternatives for macronutrient intake and chronic disease: a comparison of the OmniHeart diets with popular diets and with dietary recommendations

BACKGROUND: Enhancements to current dietary advice to prevent chronic disease are of great clinical and public health importance. The OmniHeart Trial compared 3 diets designed to reduce cardiovascular disease (CVD) risk-one high in carbohydrate and 2 that replaced carbohydrate with either unsaturated fat or protein. The lower carbohydrate diets improved the CVD risk factors. Several popular diets claiming health benefits emphasize carbohydrate, fat, or protein or various combined approaches. OBJECTIVE: The objective of this study was to compare the macronutrient contents of the OmniHeart trial diets to those of several popular diets and to evaluate each diet for consistency with national health guidelines. DESIGN: The macronutrient contents of 7-d menu plans from the OmniHeart Study, Dietary Approaches to Stop Hypertension (DASH), Zone, Atkins, Mediterranean, South Beach, and Ornish diets were evaluated for consistency with the US Food and Nutrition Board's Acceptable Macronutrient Distribution Ranges (AMDRs) and with the dietary recommendations of several health organizations. RESULTS: The OmniHeart diets fulfilled the major AMDRs, but, of the popular diets, only the Zone diet did. The OmniHeart diets were generally consistent with national guidelines to prevent cancer, diabetes, and heart disease, whereas most popular diets had limitations for fulfilling one or more guidelines. CONCLUSIONS: Although the OmniHeart protein and unsaturated fat diets were superior to the carbohydrate diet in improving CVD risk, all 3 study diets were consistent with national guidelines to reduce chronic disease risk, which suggests that the guidelines might now be fine-tuned to optimize disease prevention. Popular diets vary in their nutritional adequacy and consistency with guidelines for risk reduction.     

Dietary fat and cholesterol and the risk of cardiovascular disease among women with type 2 diabetes

BACKGROUND: Nutritional therapy is a cornerstone of diabetes management, but no epidemiologic studies have investigated the relation between specific dietary fatty acids and cholesterol and cardiovascular disease (CVD) risk among diabetic patients. OBJECTIVE: This study assessed the relation between specific dietary fatty acids and cholesterol and CVD risk among women with type 2 diabetes. DESIGN: Among 5672 women with type 2 diabetes from the Nurses' Health Study, diet was assessed prospectively and updated periodically. Relative risks of CVD were estimated from Cox proportional hazards analysis after adjustment for potential confounders. RESULTS: Between 1980 and 1998, we identified 619 new cases of CVD (nonfatal myocardial infarction, fatal coronary heart disease, and stroke). The relative risk (RR) of CVD for an increase of 200 mg cholesterol/1000 kcal was 1.37 (95% CI: 1.12, 1.68; P = 0.003). Each 5% of energy intake from saturated fat, as compared with equivalent energy from carbohydrates, was associated with a 29% greater risk of CVD (RR: 1.29; 95% CI: 1.02, 1.63; P = 0.04). The ratio of polyunsaturated to saturated fat (P:S) was inversely associated with the risk of fatal CVD. We estimated that replacement of 5% of energy from saturated fat with equivalent energy from carbohydrates or monounsaturated fat was associated with a 22% or 37% lower risk of CVD, respectively. CONCLUSIONS: A higher intake of cholesterol and saturated fat and a low P:S were related to increased CVD risk among women with type 2 diabetes. Among diabetic persons, replacement of saturated fat with monounsaturated fat may be more effective in lowering CVD risk than is replacement with carbohydrates.     

Modern fat technology: what is the potential for heart health?

Saturated and trans-fatty acids raise total cholesterol and LDL-cholesterol and are known to increase the risk of CHD, while dietary unsaturated fatty acids play important roles in maintaining cardiovascular health. Replacing saturated fats with unsaturated fats in the diet often involves many complex dietary changes. Modifying the composition of foods high in saturated fat, particularly those foods that are consumed daily, can help individuals to meet the nutritional targets for reducing the risk of CHD. In the 1960s the Dutch medical community approached Unilever about the technical feasibility of producing margarine with a high-PUFA and low-saturated fatty acid composition. Margarine is an emulsion of water in liquid oil that is stabilised by a network of fat crystals. In-depth expertise of fat crystallisation processes allowed Unilever scientists to use a minimum of solid fat (saturated fatty acids) to structure a maximum level of PUFA-rich liquid oil, thus developing the first blood-cholesterol-lowering product, Becel. Over the years the composition of this spread has been modified to reflect new scientific findings and recommendations. The present paper will briefly review the developments in fat technology that have made these improvements possible. Unilever produces spreads that are low in total fat and saturated fat, virtually free of trans-fatty acids and with levels of n-3 and n-6 PUFA that are in line with the latest dietary recommendations for the prevention of CHD. Individuals with the metabolic syndrome have a 2-4-fold increased risk of developing CHD; therefore, these spreads could make a contribution to CHD prevention in this group. In addition, for individuals with the metabolic syndrome the spreads could be further modified to address their unique dyslipidaemia, i.e. elevated blood triacylglycerols and low HDL-cholesterol. Research conducted in the LIPGENE study and other dietary intervention studies will deliver the scientific evidence to justify further modifications in the composition of spreads that are healthy for the heart disease risk factors associated with the metabolic syndrome.     

Effect of moderate changes in dietary fatty acid profile on postprandial lipaemia, haemostatic and related CVD risk factors in healthy men

OBJECTIVE: To investigate the effect of moderate changes in dietary fatty acid profile on postprandial risk factors for cardiovascular disease (CVD). DESIGN: Double-blind, randomised, crossover, intervention trial. SETTING:: University of Auckland Human Nutrition Unit, New Zealand. SUBJECTS: A total of 18 lean healthy men. INTERVENTION: A dairy butter fat modified to reduce the saturated:unsaturated fatty acid ratio and a conventional high saturated butter fat were given on two separate occasions as a high-fat test meal (59+/-4 g fat; 71 en% fat) at breakfast. A fat exclusion lunch, dinner and snacks were also given. Blood samples were collected at 0 (baseline), 1, 3, 6, 10 and 24 h. RESULTS: Maximum peak in total triacylglycerol (TAG) occurred 3 h postprandially and was highest on modified treatment (diet, P<0.05) due predominantly to increased TAG within the chylomicron-rich fraction. Transient peaks in total-, LDL- and HDL-cholesterol occurred postprandially, but did not differ between dietary treatments (P>0.05). There were no differential effects of diet on postprandial free fatty acids, apo A, apo B, glucose, insulin, amylin or haemostatic clotting factors (P>0.05). CONCLUSIONS: In a group of healthy young men, replacement of 16% of total saturated fatty acids by mono- and polyunsaturated fats within a dairy lipid did not induce postprandial changes in CVD risk that may be considered beneficial for health. SPONSORSHIP: Fonterra, Wellington; New Zealand.     

Incorporating macadamia oil and butter to reduce dietary omega‐6 polyunsaturated fatty acid intake

Aim: Claims have been made that the level of omega‐6 fats in the diet is too high and that this cannot be reduced without increasing the saturated fat intake. The aim of this study was to design a diet within the framework of the Australian Guide to Healthy Eating (AGHE) which would supply <2% energy (% E) from the omega‐6 polyunsaturated fatty acid (PUFA), linoleic acid, compared with the 4–5% E in the current Australian diet. Methods: Separate seven‐day diet plans were designed using FoodWorks (version 2009) for males (10 000 kJ)/day) and females (8000 kJ/day). The reduction in dietary omega‐6 PUFA content was achieved by replacing standard plant‐based oils and spreads used in cooking and baking (canola and sunflower oils) with macadamia oil and butter, and restricting the intake of some processed foods. All diets complied with the AGHE. Results: We successfully designed diets which complied with the AGHE and which had a linoleic acid (LA) content of 1.80% E and 1.75% E in females and males, respectively. In both cases, the omega‐6 : omega‐3 ratio was reduced to 5.1:1, compared with ～12:1 in the typical Australian diet, and the saturated fat content was <10% E. Conclusion: These results suggest that reducing the LA content of the diet can be readily achieved within the boundaries set by the AGHE, without an increase in saturated fat intake.     

Longitudinal changes in diet from childhood into adulthood with respect to risk of cardiovascular diseases: The Cardiovascular Risk in Young Finns Study

OBJECTIVE: To assess nutrient intakes relevant in the prevention of cardiovascular diseases (CVD) among young adults in Finland and to find past and present determinants of quality of diet. DESIGN: Prospective study, 21 years of follow-up. SETTING: The Cardiovascular Risk in Young Finns Study, Finland. SUBJECTS: At baseline in 1980: 3569 children aged 3-18 y participated (83% of those invited), and every second of them (1780) were selected to the dietary study. At follow-ups in 1986 and 2001: 1200 and 1037 of the original sample, respectively, participated. METHODS: Food consumption was assessed using 48-h dietary recall. Intakes in 2001 were compared with those obtained in 1980 and 1986. Nutrients selected for further examination were those implicated in the risk of CVD: saturated, monounsaturated, polyunsaturated and n-3 fatty acids, fibre and salt. An index describing the quality of adulthood diet was constructed. Multivariate logistic regression was used to identify independent childhood and adulthood determinants of the quality index. RESULTS: The average intakes showed substantial changes since 1980. Intakes of fat and saturated fat had decreased, while the consumption of vegetables and fruit had increased. However, a great disparity was present between the recommended levels and actual intakes for many of the nutrients, particularly salt, saturated fat and fibre. Intake of fat and consumption of vegetables in childhood and physical activity in adulthood were important health behavioural determinants of the cardiovascular quality of the adult diet. Socio-demographic factors, including education of the subject and their parents, had no significant associations with diet. CONCLUSIONS: While intakes of energy and nutrients have changed favourably in Finnish young adults between 1980 and 2001 with regard to the risk of CVD, they are still far from recommended levels. Childhood diet is a significant determinant of adult diet even after 21 y. SPONSORSHIP: This study was supported by the Academy of Finland (grant 77841) and Juho Vainio Foundation.     

The high-fat Greek diet: a recipe for all?

OBJECTIVE: To examine critically the published results of dietary surveys on the fat content of the Greek diet, and to assess its evolution and its relationship to the health of the Greeks. To consider the implications of these findings for current views on the nature and health implications of the traditional Mediterranean diet and how best to define it for use in modern policy making. DESIGN: A systematic review of the literature on food consumption in Greece. SETTING: Greece. RESULTS: The first fully published data on the fat content of the Greek diet-the Seven Countries Survey-relates only to a small number of adult males in Crete and Corfu; the legitimacy of extrapolating these results to the rest of Greece is questioned. Earlier studies and chemical validation of intakes point to a lower fat content of the traditional diet than that inferred for Crete. Nearly all later surveys relate only to urban groups in Athens (mostly case-control hospital-based samples) and a variety of non-representative Cretan groups. Only two studies are larger and more representative, but one uses FAO food balance-sheets to reflect the national diet, and the other surveyed school-age children in three out of the 52 Greek counties. Unfortunately recent dietary studies have proved unreliable, given the continuing lack of national food composition tables with survey methods which proved inaccurate for dietary fat content. A progressive upward trend in total and saturated fat intake appears to have occurred with all health indicators in relation to fat indicating remarkable increases in adult and childhood obesity with attendant progressive deterioration in cardiovascular mortality and its risk factors, ie hypertension and diabetes. These data emphasise the need to alter current nutritional advice in Greece, particularly when it focuses on the promotion of olive oil and a high-fat diet. CONCLUSIONS: The findings reaffirm low-moderate fat policies for optimum health, within which olive oil can be an important component of the diet.     

Proceedings: Nutrition forum: Progress in developing the prudent diet. Summary of symposium and recommendations for food industry action

Diet and nutrition are important factors in the prevention and treatment of the commonest types of cardiovascular disease—coronary heart disease and stroke—both in the primary and secondary prevention.The most important aspect of diet and cardiovascular disease is that one can manipulate the diet with some ease. Many of the principles of nutrition that have preventive values relative to heart disease can actually be built into manufactured foods, and most of our foods today, and more in the future, will be manufactured foods. This, I think, is not only a challenge to the food industry but a responsibility. It is a challenge in which they should be helped by our regulatory agencies rather than hindered. No doubt those in the food industry who continue to make advances in this area will continue to be attacked by far out consumer activists who get such ego satisfaction by creating confusion and distrust in a gullible public that all is not well with the nation's food supply.Here are a few specifics for the food industry: design of foods with fewer calories, generally that means foods with less fat and more water; design of foods with less saturated fat, replacing part of the saturated fat with either mono- or polyunsaturated fat; the production of meat low in saturated fats and meat products (e.g., sausages, hot dogs, and cold cuts) low in saturated fats yet with an acceptable total fat, by the addition of polyunsaturated fats; the development of strains of animals that convert higher proportions of feed to protein rather than fat; a shift to range feeding with earlier slaughter of cattle to yield leaner animals; modernization of laws and regulations relating to the definition of meat products; further development and use of high-quality vegetable protein products; development of an intensive education program concerning the cooking of lean meats to assure their optimal palatability and acceptability without the use of added saturated fats; reduction in saturated fat and cholesterol content of dairy products; reduction of saturated fat, cholesterol, and calorie content of baked goods; reduction of use of egg yolk in foods. Lastly, it should be emphasized that diet is only one of the risk factors in our commonest type of ill health and death—cardiovascular disease—but it is a risk factor readily modified.