A review of previously published studies suggests that vegetable and nut intake and a Mediterranean dietary pattern appear to be associated with a lower risk for heart disease, according to a report published in the April 13 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. However, intake of trans-fatty acids and foods with a high glycemic index may be harmful to heart health.
"The relationship between dietary factors and coronary heart disease has been a major focus of health research for almost half a century," the authors write as background information in the article. Although "a wealth of literature" has been published on the topic, "the strength of the evidence supporting valid associations has not been evaluated systematically in a single investigation."
Andrew Mente, Ph.D., of the Population Health Research Institute, and colleagues conducted a systematic search for articles investigating dietary factors in relation to heart disease published between 1950 and June 2007. A total of 146 prospective cohort studies (looking back on the habits of a particular group of individuals) and 43 randomized controlled trials (where participants are randomly assigned to a dietary intervention or a control group) were identified and included in the systematic review.
When the researchers pooled the study results and applied a predefined algorithm, "we identified strong evidence of a causal relationship for protective factors, including intake of vegetables, nuts and monounsaturated fatty acids and Mediterranean, prudent and high-quality dietary patterns, and harmful factors, including intake of trans–fatty acids and foods with a high glycemic index or load and a western dietary pattern," they write. "Among these dietary exposures, however, only a Mediterranean dietary pattern has been studied in randomized controlled trials and significantly associated with coronary heart disease."
In addition, modest relationships were found supporting a causal relationship between intake of several other foods and vitamins and heart disease risk, including fish, omega-3 fatty acids from marine sources, folate, whole grains, alcohol, fruits, fiber and dietary vitamins E and C and beta carotene. Weak evidence also supported causal relationships between vitamin E and ascorbic acid supplements, saturated and polyunsaturated fatty acids and total fats, alpha-linoleic acid, meat, eggs and milk.
"The modest or weak evidence of these dietary exposures is mostly consistent with the findings of randomized controlled trials, although randomized controlled trials have yet to be conducted for several factors," the authors write. "Taken together, these findings support a causal relationship between only a few dietary exposures and coronary heart disease, whereas the evidence for most individual nutrients or foods is too modest to be conclusive."
"Although investigations of dietary components may help to shed light on mechanisms behind the benefits of dietary patterns, it is unlikely that modifying the intake of a few nutrients or foods would substantially influence coronary outcomes," they conclude. "Our findings support the strategy of investigating dietary patterns in cohort studies and randomized controlled trials for common and complex chronic diseases such as coronary heart disease."
(Arch Intern Med. 2009;169:659-669. Available pre-embargo to the media at www.jamamedia.org.)
Editor's Note: This study was supported by a Heart and Stroke Foundation of Canada Postdoctoral Research Fellowship, the Canadian Institutes of Health Research Clinician-Scientist Phase 2 Award and a Heart and Stroke Foundation of Ontario Michael E. DeGroote Research Chair in Population Health Research. Co-author Mr. de Koning is a recipient of a Canadian Institutes of Health Research Canada Graduate Scholarship Doctoral Award. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.