What should we eat? Evidence from observational studies.Abstract: Observational studies observational studies, n.pl an investigational method involving description of the associations be-tween interventions and outcomes. Outcomes research and practice audits are examples of this investigational method. provide a wealth of important correlations between diet and disease. There is a clear pattern of dietary habits that is associated with reduced rates of a multitude of common illnesses, including heart attack, cancer, stroke, diabetes, and hypertension. In some cases, interventional studies have proven the benefits of dietary change; in others, there is insufficient evidence insufficient evidence n. a finding (decision) by a trial judge or an appeals court that the prosecution in a criminal case or a plaintiff in a lawsuit has not proved the case because the attorney did not present enough convincing evidence. to prove causation. Based on the existing evidence, the optimal diet should emphasize fruits and vegetables, nuts, unsaturated oils, whole grains, and fish, while minimizing saturated fats (especially trans fats), sodium, and red meats. Its overall calorie content should be low enough to maintain a healthy weight. Key Words: dietary habits. lifestyle, risk reduction, food, healthy diet ********** There is extensive epidemiologic evidence linking dietary content with a wide variety of illness. Large differences in the rates of heart disease, stroke, diabetes, and cancer have all been linked to food choices. Unfortunately, most of the data is observational, and in many cases there is little direct evidence of benefit from dietary interventions because of the lack of sufficiently powered clinical trials. Dietary intervention trials that measure surrogate endpoints are much more common than those that show direct changes in morbidity and mortality Morbidity and Mortality can refer to:
Diet and Heart Disease Diet may play an important role in causing or preventing heart disease. Doctors and nutritionists have studied numerous diets and dietary components in an effort to minimise the risk of heart diseases. The relationship between diet and coronary artery disease coronary artery disease, condition that results when the coronary arteries are narrowed or occluded, most commonly by atherosclerotic deposits of fibrous and fatty tissue. is probably the most frequent dietary topic that physicians face. There are a number of common misconceptions that find their way into the advice physicians give their patients. The most striking example is the universal recommendation to "cut back on fat," without making distinctions between types of fat. In contrast, epidemiologic studies show that total fat intake does not correlate with coronary artery disease risk, and those that consume more unhydrogenated polyunsaturated polyunsaturated /poly·un·sat·u·rat·ed/ (-un-sach´er-at-ed) denoting a chemical compound, particularly a fatty acid, having two or more double or triple bonds in its hydrocarbon chain. and monounsaturated fats such as olive oil have lower rates of heart disease. (1) Thus it seems evident that the type of fat is much more important than the amount of fat consumed. (2) The Nurse's Health Study showed no correlation between total fat consumption and coronary disease in women, but considerable differences between types of fat. Based on this study, it was estimated that replacement of 5% of the energy derived from saturated fats with unsaturated fats would reduce the risk of coronary disease by 42%. Replacing a mere 2% of calories derived from trans fat with unsaturated, unhydrogenated fats results in an estimated risk reduction of 53%. (3) In contrast, the Health Professional Follow-up Study failed to find statistically significant relationships between saturated fat consumption and myocardial infarction myocardial infarction: see under infarction. in men. The same study showed a strongly positive association between linoleic acid linoleic acid /lin·o·le·ic ac·id/ (lin?o-le´ik) a polyunsaturated fatty acid, occurring as a major constituent of many vegetable oils; it is used in the biosynthesis of prostaglandins and cell membranes. (an omega-3 fatty acid omega-3 fatty acid n. Any of various polyunsaturated fatty acids that are found primarily in fish, fish oils, vegetable oils, and leafy green vegetables, and that seem to reduce the risk of stroke and heart attack. found in various plant oils) and decreased heart disease (relative risk 0.41 for 1% increase in energy consumption) after controlling for non-dietary risk factors and adjusting for total fat intake. (4) The Lyon Diet Heart Study, which compared a low-fat diet low-fat diet A diet low in fats, especially saturated fats, which has a positive effect on arthritis, CA, ASHD, DM, HTN, obesity, and strokes. See Diet, Low-fat snack; Cf Animal fat, High-fat diet. to a "Mediterranean diet Mediterranean diet Nutrition A diet that differs by country, characterized by ↑ consumption of olive oil, complex carbohydrates, vegetables, ↓ red meat. See Diet, Mediterranean diet pyramid. Cf Affluent diet. " that emphasized fruits, vegetables, cereals, and unsaturated fats lends further credence to this idea. The adjusted risk ratio for primary and secondary endpoints was 0.53 after 4 years, and the all-cause mortality rate was 56% lower in the Mediterranean diet group. (5) It must be noted, however, that there have been criticisms of the study's methodology. (6) The Indian Heart Study tested a diet that emphasized fruits, vegetables, nuts, and grains versus standard advice for a low-fat diet. The intervention group had 40% fewer cardiac events and lower mortality after one year. (7) The Nurse's Health Study found a coronary heart disease coronary heart disease: see coronary artery disease. coronary heart disease or ischemic heart disease Progressive reduction of blood supply to the heart muscle due to narrowing or blocking of a coronary artery (see atherosclerosis). relative risk of 0.76 for women who ate a diet rich in fruits, vegetables, whole grains, legumes Legumes A family of plants that bear edible seeds in pods, including beans and peas. Mentioned in: Cholesterol, High legumes (l , poultry, and fish and low in refined grains, potatoes, and red or processed meats. The risk ratio comparing the 20% of subjects with the best diet against the 20% with the worst diet was 0.64. (8) Fish consumption has been shown to be associated with a lower risk of heart disease in multiple studies. A recent meta-analysis showed an overall 20% risk reduction for fatal myocardial infarction in those who consume fish versus those who consume little or no fish. (9) Patients who eat tuna or baked or broiled broil 1 v. broiled, broil·ing, broils v.tr. 1. To cook by direct radiant heat, as over a grill or under an electric element. 2. To expose to great heat. v. fish have up to a 32% lower rate of congestive heart failure congestive heart failure, inability of the heart to expel sufficient blood to keep pace with the metabolic demands of the body. In the healthy individual the heart can tolerate large increases of workload for a considerable length of time. . Eating fried fish does not appear to be protective. (10) Since 2000, the American Heart Association's dietary guidelines dietary guidelines Cardiology A series of dietary recommendations from the Nutrition Committee of the Am Heart Assn, that promote cardiovascular health. See Caloric restriction, food pyramid, French paradox. have recommended that healthy adults eat at least two servings of fish per week, particularly fatty fish such as mackerel mackerel, common name for members of the family Scombridae, 60 species of open-sea fishes, including the albacore, bonito, and tuna. They are characterized by deeply forked tails that narrow greatly where they join the body; small finlets behind both the dorsal and , lake trout lake trout or Mackinaw trout or Great Lakes trout or salmon trout Large, voracious char (Salvelinus namaycush) found widely from northern Canada and Alaska to New England and the Great Lakes, usually in deep, cool lakes. , herring, sardines, albacore albacore: see tuna. albacore Large oceanic tuna (Thunnus alalunga) that is noted for its fine flesh. The streamlined bodies of these voracious predators are adapted to fast and continuous swimming. tuna and salmon. (11) The beneficial health effects of fish consumption are widely believed to be due to the omega-3 fats they contain. A Cochrane Database analysis could not find proof of a link between omega-3 intake and improved cardiovascular health, (12) but a more recent meta-analysis of omega-3 studies found evidence of decreased mortality, nonfatal myocardial infarction, and sudden cardiac death Sudden Cardiac Death Definition Sudden cardiac death (SCD) is an unexpected death due to heart problems, which occurs within one hour from the start of any cardiac-related symptoms. SCD is sometimes called cardiac arrest. . (13) The largest omega-3 trial (GISSI) enrolled over 11,000 patients and showed a statistically significant decrease in mortality within 3 months of therapy, with a relative risk of 0.59; the relative risk of sudden death at 4 months was 0.47. (14) A diet high in whole grain has been linked with a lower risk of heart disease. In the Nurses' Health Study Nurses' Health Study Cardiology A large cohort study that evaluated the effect of exogenous HRT on the risk of cardiovascular disease. See Estrogen replacement therapy, Osteoporosis. , after 10 years of follow-up, the 20% of patients who ate the most whole grain products had a relative risk of coronary heart disease of 0.67 compared with 20% with the lowest intake. (15) The Iowa Women's Health Women's Health Definition Women's health is the effect of gender on disease and health that encompasses a broad range of biological and psychosocial issues. Study had nearly identical results, with a relative risk of 0.7 between the highest and lowest quintiles Quintiles Transnational Corp. is a contract research organization which serves the pharmaceutical, biotechnology and healthcare industries. History Quintiles was founded in 1982 by Dennis Gillings and as of 2007 it has 18,000 employees. of whole grain consumption. (16) The Health Professional Follow-up Study showed after 14 years similar evidence of benefit with a relative risk of 0.82 between the extreme quintiles of whole grain intake. Those in the highest quintile quin·tile n. 1. The astrological aspect of planets distant from each other by 72° or one fifth of the zodiac. 2. Statistics The portion of a frequency distribution containing one fifth of the total sample. of added bran intake had a relative risk of coronary heart disease of 0.70, relative to those with no intake of added bran. Added germ showed no benefit. (17) The consumption of fruits and vegetables is associated with a lower risk of heart disease. A 13-year study of men in Finland demonstrated that after adjustment for other risk factors, there was a relative risk of cardiovascular-related death of 0.59 for the highest quintile of fruit, berry, and vegetable intake compared with the lowest quintile. (18) Analysis of the results of the Nurses' Health Study and the Health Professionals Follow-up Study showed that consumption of fruits and vegetables, particularly vitamin C-rich fruits and vegetables, appears to have a protective effect against coronary heart disease. (19) Eating nuts is associated with reduced heart disease. In the Adventist Health Study, those who ate nuts 1 to 4 times per week had 22% fewer myocardial infarctions, and those who ate nuts 5 or more times per week had 51% fewer infarctions. The effect seemed to be independent of vegetarian or nonvegetarian status. (20) Vegetarians have a dramatically lower risk of heart disease. Analysis of observational studies show for men an age-standardized rate ratio of first event fatal coronary heart disease of 0.59. For women the ratio is 0.49. The ratios for first event myocardial infarction are 0.60 and 0.46 for men and women, respectively. (21) Diet and Stroke Observational studies have shown links between diet and risk of stroke that are similar to those seen with heart disease. The Nurses' Health Study showed that after risk factor adjustment, women who ate fish once a week had a relative risk of stroke of 0.78 relative to those who ate fish less than once a month. The relative risk for those who ate fish 5 or more times per week was 0.48. (22) The Health Professional Follow-up Study reported similar findings in males, with a 0.57 relative risk for those who ate fish 1 to 3 times per month compared with those who ate fish less than once a month. (23) A meta-analysis of 9 independent cohorts showed similar relationships. The authors concluded that fish consumption as infrequently as 1 to 3 times per month may protect against ischemic stroke. (24) The way in which fish is prepared may be important. A study of 4,775 adults 65 years or older showed after 12 years a 27% reduction in ischemic stroke for those who ate tuna or baked/broiled fish one to four times per week. There was a statistically significant increase in stroke for those who ate fried fish and/or fish sandwiches, and a 44% increased risk of hemorrhagic stroke hemorrhagic stroke Neurology An ischemic stroke in which blood enters necrotic brain tissue, which may not be accompanied by a worsening clinical status Risks for HS Hemophilia, thrombocytopenia, sickle cell anemia, DIC, anticoagulants, HTN. See Stroke. in that same group. (25) The Danish Diet, Cancer, and Health Study followed 54,506 men and women for four years and found an inverse relationship between fruit and vegetable intake and ischemic stroke. The relative risk for the highest quintile of consumption relative to the lowest was 0.60. (26) In a large Japanese study that spanned almost 2 decades, daily fruit intake was associated with a 35% reduction of stroke in men and a 25% reduction in women. Daily intake of green-yellow vegetables was associated with a 26% reduction in stroke death in both genders compared with those who ate one serving or less per week. (27) The Nurses' Health Study showed a strong association between eating whole grains and decreased ischemic stroke risk. The relative risk between the highest and lowest quintiles was 0.49. The ratio was 0.69 after controlling for tobacco and coronary vascular disease risk factors. (28) Further analysis of the same study found an increased relative risk (1.58) of stroke between the highest and lowest quintiles of those consuming a "Western pattern" diet (red and processed meats, refined grains, sweets, and desserts) versus a "prudent" diet (fruits, vegetables, legumes, fish, and whole grains). (29) Higher levels of cereal fiber intake is associated with a lower ischemic Ischemic An inadequate supply of blood to a part of the body, caused by partial or total blockage of an artery. Mentioned in: Antiangiogenic Therapy, Subarachnoid Hemorrhage, Ventricular Fibrillation ischemic and hemorrhagic stroke risk in women (relative risks = 0.66 and 0.51, respectively). In contrast, the Health Professional Follow-up Study showed no statistically significant association between stroke and cholesterol, red meat, dairy products, nuts, eggs, or specific types of fats consumed in men. (30) A high intake of refined carbohydrates may increase the risk of hemorrhagic stroke in women, particularly among those who are obese. (31) Diet and Cancer There is a real need for additional large studies to clarify the relationship between diet and cancer. Multiple case control studies have shown a relationship between diet quality and cancer risk. In 1997, the World Cancer Research Fund Report stated that based on the data available at the time, the consumption of fruits and vegetables was probably or convincingly associated with a lower risk of cancers of the mouth, esophagus, lung, stomach, large intestine large intestine End section of the intestine. It is about 5 ft (1.5 m) long, is wider than the small intestine, and has a smooth inner wall. In the first half, enzymes from the small intestine complete digestion, and bacteria produce many B vitamins and vitamin K. , larynx, pancreas, breast, and bladder. Subsequently, analysis of the Harvard Nurses Health and Health Professionals Follow-up Studies found no association between fruit and vegetable consumption and cancer risk. The study populations as a whole consumed much more fruits and vegetables than the US average. It has been suggested that the failure to show benefit could be due to a "plateau effect" in the relationship between diet and disease. (32) A more recent report did show statistically significant associations between recommended food score (RFS (Remote File System) A distributed file system for Unix computers introduced by AT&T in 1986 with Unix System V Release 3.0. It is similar to Sun's NFS, but only for Unix systems. : a measure of overall diet quality) and cancer. In a cohort of 42,254 American women with a median follow-up of 9.5 years, RFS was inversely related to cancer risk and death; the relative risk ratio was 0.8 for total mortality, 0.74 for cancer mortality, 0.75 for breast cancer, 0.49 for colon/rectal cancer, and 0.62 for lung cancer lung cancer, cancer that originates in the tissues of the lungs. Lung cancer is the leading cause of cancer death in the United States in both men and women. Like other cancers, lung cancer occurs after repeated insults to the genetic material of the cell. . (33) In contrast, a pooled analysis of two prospective studies in Japan, which included 88,658 men and women, showed no association between colorectal cancer colorectal cancer Malignant tumour of the large intestine (colon) or rectum. Risk factors include age (after age 50), family history of colorectal cancer, chronic inflammatory bowel diseases, benign polyps, physical inactivity, and a diet high in fat. and fruit or vegetable intake. (34) Red meat and meat cooked at high temperatures is associated with an increased risk of adenomas of the colon. (35) A large prospective European study (478,040 patients) showed a link between colorectal cancer risk and the intake of red and processed meat (corrected hazard ratio 1.55/100 g increase in consumption) and a decreased risk with increasing levels of fish consumption (corrected hazard ratio 0.46 per 100 g increase in consumption). (36) High levels of red meat consumption are associated with a 68% increase in pancreatic cancer pancreatic cancer Malignant tumour of the pancreas. Risk factors include smoking, a diet high in fat, exposure to certain industrial products, and diseases such as diabetes and chronic pancreatitis. Pancreatic cancer is more common in men. also. (37) There is some evidence that diet may contribute to improved outcomes in patients with cancer. A study of 1,551 women with a history of breast cancer found those with the highest levels of plasma carotenoids Carotenoids Carotenoids are yellow to deep-red pigments. Mentioned in: Vitamin A Deficiency carotenoids (k (a marker of vegetable intake) had a much lower risk of a new breast cancer event (hazard ratio = 0.57). (38) An Australian study showed improved survival in ovarian cancer ovarian cancer Malignant tumour of the ovaries. Risk factors include early age of first menstruation (before age 12), late onset of menopause (after age 52), absence of pregnancy, presence of specific genetic mutations, use of fertility drugs, and personal history of breast with increasing levels of vegetable consumption (hazard ratio = 0.75). (39) An Italian case-control study case-control study, n an investigation employing an epidemiologic approach in which previously existing incidents of a medical condition are used in lieu of gathering new information from a randomized population. of ovarian cancer likewise showed increased risk with red meat (odds ratio [OR] = 1.53) and decreased risk with fish (OR = 0.51), raw (OR = 0.47) and cooked (OR = 0.65) vegetables. (40) Diabetes and Diet The relationship between obesity and diabetes is one of the strongest risk factor-disease associations. Adults with a body mass index (BMI BMI body mass index. BMI abbr. body mass index Body mass index (BMI) A measurement that has replaced weight as the preferred determinant of obesity. ) over 35 have a 20 times higher risk of type 2 diabetes type 2 diabetes n. See diabetes mellitus. than those with a normal BMI. (41) Obviously diet and obesity are tightly linked. There are also dietary factors that predict an increased risk of type 2 diabetes independent of BMI. The Nurses' Health Study revealed that a pattern of diet that was high in sugar-sweetened soft drinks, refined grains, diet soft drinks, and processed meat but low in wine, coffee, and cruciferous cru·ci·fer n. 1. One who bears a cross in a religious procession. 2. Botany Any of various plants in the mustard family (Cruciferae or Brassicaceae), which includes the alyssum, candytuft, cabbage, radish, broccoli, and and yellow vegetables was associated with increased risk. After adjusting for BMI and lifestyle, the odds ratio was 2.56 comparing extreme quintiles in the Nurses' Health Study and 2.93 in the Nurses' Health Study II. (42) After controlling for other risk factors, there also appears to be a modest increased risk of type 2 diabetes mellitus Type 2 diabetes mellitus One of the two major types of diabetes mellitus, characterized by late age of onset (30 years or older), insulin resistance, high levels of blood sugar, and little or no need for supple-mental insulin. and high levels of red meat consumption (relative risk = 1.28). (43) Higher consumption of saturated fat is associated with higher rates of impaired glucose tolerance Impaired Glucose Tolerance (IGT) is a pre-diabetic state of dysglycemia, that is associated with insulin resistance and increased risk of cardiovascular pathology. IGT may precede type 2 diabetes mellitus by many years. IGT is also a risk factor for mortality. and diabetes, while unsaturated fats are inversely associated with risk. (41) Hypertension and Diet The most famous study linking diet and hypertension is the Dietary Approach to Stop Hypertension (DASH) study. After eight weeks of a diet rich in fruits and vegetables, an 11.4 mm Hg drop in systolic blood pressure Systolic blood pressure Blood pressure when the heart contracts (beats). Mentioned in: Hypertension and 5.5 mm Hg drop in diastolic blood pressure Diastolic blood pressure Blood pressure when the heart is resting between beats. Mentioned in: Hypertension was seen in those with hypertension compared with the control group. (44) The Trials of Hypertension Prevention II showed a reduced risk of hypertension through weight loss and exercise, with a relative risk of 0.81 at 36 months. The relative risk of hypertension after 3 years was 0.35 for those who lost at least 4.5 kg and maintained the loss. (45) The same study suggests that a decrease in blood pressure of 4.4/2.8 mm Hg can be obtained by a decreased sodium intake of 100 mmoL/d. (46) The Intersalt study showed a significant association between salt consumption and hypertension across 52 international centers. It also showed an association between the ratio of sodium to potassium in the diet and rates of hypertension. (47) Diets low in calcium and magnesium are also associated with elevations in blood pressure. (48) The CARDIA study followed young people (18 to 30 years old) for 15 years and revealed significant associations between dietary content and hypertension. It found plant food intake to be protective (relative risk between extreme quintiles 0.64), while red and processed meat consumption was associated with increased risk. (49) The Optimal Macronutrient macronutrient /mac·ro·nu·tri·ent/ (-noo´tre-ent) an essential nutrient required in relatively large amounts, such as carbohydrates, fats, proteins, or water; sometimes certain minerals are included, such as calcium, chloride, or sodium. Intake Trial to Prevent Heart Disease (OmniHeart) evaluated the following three healthful health·ful adj. 1. Conducive to good health; salutary. 2. Healthy. health  ful·ness n. diets in a
randomized ran·dom·ize tr.v. ran·dom·ized, ran·dom·iz·ing, ran·dom·iz·es To make random in arrangement, especially in order to control the variables in an experiment. , crossover design over a six-week period. The comparators were 1) a carbohydrate-rich diet, similar to the DASH diet, 2) a protein-rich diet, with approximately half of the protein derived from plant sources (such as grains, legumes, nuts, and seeds), and 3) a monounsaturated monounsaturated /mono·un·sat·u·rat·ed/ (mon?o-un-sach´er-at?ed) of a chemical compound, containing one double or triple bond. mon·o·un·sat·u·rat·ed adj. fat-rich diet (principally olive, canola, and safflower oils). All three diets lowered BP and lipids from baseline, with the best results being obtained with the protein-rich and unsaturated fat-rich diets. The investigators write, "Partial substitution of carbohydrate with either protein or monounsaturated fat can further lower blood pressure, improve lipid levels, and reduce estimated cardiovascular risk." They further conclude that in addition to salt, potassium, weight, alcohol, and the DASH diet, macronutrients This is a list of macronutrients. Minerals
Amino Acids
Conclusion There is sufficient evidence to argue that diet contributes directly or indirectly to the rates of seven of the top ten causes of death in the United States. The four causes from that list that were discussed above (heart disease, cancer, stroke, and diabetes) together account for 61% of all deaths in the US. (51) The dietary habits that result in reduced rates of a multitude of different diseases are remarkably similar for each disease. These habits are accurately reflected in the revised USDA USDA, n.pr See United States Department of Agriculture. Dietary Guidelines for Americans 2005, available at http://www.health.gov/dietaryguidelines/dga2005/document/default.htm. Okinawans, who have an exceptional longevity, have been studied at home in Japan and abroad in Hawaii and Brazil utilizing biomarkers for fish and soy intake as well as interventional studies. Results indicate that fish and soy, along with seaweed and green vegetables, are candidates for chronic disease prevention as well as overall promotion of longevity. (52) There is more than enough evidence to confidently make dietary recommendations for populations. In some illnesses, further study is needed to clarify the magnitude of benefit an individual patient might expect to see with dietary modification. Data from the Adventists Health Studies suggests that the overall benefits from multiple positive lifestyle factors could account for up to a 10-year difference in life expectancy Life Expectancy 1. The age until which a person is expected to live. 2. The remaining number of years an individual is expected to live, based on IRS issued life expectancy tables. . (53) References 1. Yancy Jr WS, Westman EC, French PA, et al. Diets and clinical coronary events: the truth is out there. Circulation 2003;107:10-16. 2. Hu FB, Willett WC. Optimal diets for prevention of coronary heart disease. JAMA JAMA abbr. Journal of the American Medical Association 2002;288:2569-2578. 3. Hu FB, Stampfer MJ, Manson JE, et al. Dietary fat intake and the risk of coronary heart disease in women. N Engl J Med 1997;337:1491-1499. 4. Ascherio A, Rimm EB, Giovannucci EL. et al. Dietary fat and risk of coronary heart disease in men: cohort follow up study in the United States. BMJ BMJ n abbr (= British Medical Journal) → vom BMA herausgegebene Zeitschrift 1996;313:84-90. 5. de Lorgeril M, Salen P, Martin JL, et al. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation 1999;99:779-785. 6. Kris-Etherton P, Eckel RH, Howard BV, et al. Nutrition Committee Population Science Committee and Clinical Science Committee of the American Heart Association American Heart Association (AHA), n.pr a national voluntary health agency that has the goal of increasing public and medical awareness of cardiovascular diseases and stroke, and thereby reducing the number of associated deaths and disabilities. . AHA Science Advisory: Lyon Diet Heart Study: Benefits of a Mediterranean-style, National Cholesterol Education Program/American Heart Association Step I Dietary Pattern on Cardiovascular Disease Cardiovascular disease Disease that affects the heart and blood vessels. Mentioned in: Lipoproteins Test cardiovascular disease . Circulation 2001;103:1823-1825. 7. Singh RB, Rastogi SS, Verma R, et al. Randomised Adj. 1. randomised - set up or distributed in a deliberately random way randomized irregular - contrary to rule or accepted order or general practice; "irregular hiring practices" controlled trial controlled trial Clinical research A clinical study in which one group of participants receives an experimental drug while the other receives either a placebo or an approved–'gold standard' therapy. See Blinding, Double-blinded. of cardioprotective diet in patients with recent acute myocardial infarction acute myocardial infarction (  ·kyōōtˑ mī·ō·karˑ·dē· : results of one year follow up. BMJ 1992;304:1015-1019.
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Diet and risk of coronary heart disease and type 2 diabetes. Lancet 2002;360:783-789. 42. Schulze MB, Hoffmann K, Manson JE, et al. Dietary pattern, inflammation, and incidence of type 2 diabetes in women. Am J Clin Nutr 2005;82:675-684. 43. Song Y. Manson JE, Buring JE, et al. A prospective study of red meat consumption and type 2 diabetes in middle-aged and elderly women: the women's health study. Diabetes Care 2004;27:2108-2115. 44. Appel LJ, Moore TJ, Obarzanek E, et al. A clinical trial of the effects of dietary patterns on blood pressure: DASH Collaborative Research Group. N Engl J Med 1997;336:1117-1124. 45. Stevens VJ, Obarzanek E, Cook NR, et al. Long-term weight loss and changes in blood pressure: results of the Trials of Hypertension Prevention, phase II. Ann Intern Med 2001;134:1-11. 46. Cook NR, Kumanyika SK, Cutler JA. Effect of change in sodium excretion on change in blood pressure corrected for measurement error: the Trials of Hypertension Prevention, Phase I. Am J Epidemiol 1998;148:431-444. 47. INTERSALT: an international study of electrolyte excretion and blood pressure: results for 24 hour urinary sodium and potassium excretion: Intersalt Cooperative Research Group. BMJ 1988;297:319-328. 48. Khan NA, McAlister FA, Lewanczuk RZ, et al, Canadian Hypertension Education Program. The 2005 Canadian Hypertension Education Program recommendations for the management of hypertension: part II, therapy. Can J Cardiol 2005;21:657-672. 49. Steffen LM, Kroenke CH, Yu X, et al. Associations of plant food, dairy product, and meat intakes with 15-y incidence of elevated blood pressure in young black and white adults: the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Am J Clin Nutr 2005;82:1169-1177. 50. Appel LJ, Sacks FM, Carey VJ, et al, OmniHeart Collaborative Research Group. Effects of protein, monounsaturated fat, and carbohydrate intake on blood pressure and serum lipids: results of the OmniHeart randomized trial. JAMA 2005;294:2455-2464. 51. Anderson RN, Smith BL. Deaths: Leading Causes for 2002. National Vital Statistics Reports. March 7. 2005;53:17. 52. Yamori Y, Miura A, Taira K. Implications from and for food cultures for cardiovascular diseases: Japanese food, particularly Okinawan diets. Asia Pac J Clin Nutr 2001;10:144-145. 53. Willett W. Lessons from dietary studies in Adventists and questions for the future. Am J Clin Nutr 2003;78 (Suppl 3):539S-543S. Stephen M. Adams, MD, and John B. Standridge, MD From the Department of Family Medicine, University of Tennessee Health Science Center The University of Tennessee Health Science Center (UTHSC) in Memphis includes the Colleges of Allied Health Sciences, Dentistry, Graduate Health Sciences, Medicine, Nursing and Pharmacy. Its pediatric residency program is affiliated with Le Bonheur Children's Medical Center. College of Medicine, Chattanooga Unit; Chattanooga. TN. Reprint requests to Stephen M. Adams, MD, 1100 E. 3rd Street, Chattanooga, Tennessee, 37403. Email: Stephen.Adams@erlanger.org Accepted March 2, 2006. RELATED ARTICLE: Key Points * Diet contributes directly or indirectly to the rates of seven of the top ten causes of death in the United States. * The same healthy dietary habits are associated with reduced rates of a multitude of different diseases. * The overall benefits from positive lifestyle factors could account for up to a 10 year difference in life expectancy. |
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