Diet and Plasma Cholesterol in 99 Bank Men

Dietary fatty acids and mortality risk from heart disease in US adults: an analysis based on NHANES

We investigated the association of dietary intake of major types of fatty acids with heart disease mortality in a general adult cohort with or without a prior diagnosis of myocardial infarction (MI). This cohort study included US adults who attended the National Health and Nutrition Examination Surveys from 1988 to 2014. Heart disease mortality was ascertained by linkage to the National Death Index records through 31 December 2015. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of fatty acid intake for heart disease mortality. This cohort included 45,820 adults among which 1,541 had a prior diagnosis of MI. Participants were followed up for 532,722 person-years (mean follow-up, 11.6 years), with 2,313 deaths recorded from heart disease being recorded. Intake of saturated (SFAs) and monounsaturated fatty acids (MUFAs) was associated with heart disease mortality after adjustment for all the tested confounders. In contrast, a 5% higher calorie intake from polyunsaturated fatty acids (PUFAs) was associated with a 9% (HR, 0.91; 95% CI 0.83-1.00; P = 0.048) lower multivariate-adjusted risk of heart disease mortality. Sub-analyses showed that this inverse association was present in those without a prior diagnosis of MI (HR,0.89; 95% CI 0.80-0.99) but not in those with the condition (HR, 0.94; 95% CI 0.75-1.16). The lack of association in the MI group could be due to a small sample size or severity and procedural complications (e.g., stenting and medication adherence) of the disease. Higher PUFA intake was associated with a favourable lipid profile. However, further adjustment for plasma lipids did not materially change the inverse association between PUFAs and heart disease mortality. Higher intake of PUFAs, but not SFAs and MUFAs, was associated with a lower adjusted risk of heart disease mortality in a large population of US adults supporting the need to increase dietary PUFA intake in the general public.

Trends in individual fat consumption in the UK 1900-1985

Mortality from coronary heart disease is decreasing in a number of Western countries, although the pattern of the decrease differs from country to country. In the UK the mortality rate from coronary heart disease has declined since 1979, whereas in the USA mortality from this disease began to fall in 1968 and has continued since that time. Of many factors suggested as reasons for the decline, diet has been implicated, particularly dietary fat intake. However, food balance information suggests little change in fat intake. A recent examination of all published studies from the USA where individual fat intake has been reported indicated that fat intake in that country has fallen steadily since the mid 1960s. The present study describes a similar compilation of all published studies from the UK giving individual fat intakes. Ninety-seven studies, representing information for 24,045 individuals, were used. Studies ranged in size from two to 3581 individuals and were drawn from all regions of the UK. Most studies used 7 d weighed intakes as the method of dietary assessment. Quadratic regression equations were applied to the fat intakes from all studies over time, with each study weighted by the number of individuals surveyed. Data were also divided into 10-year periods and weighted fat intakes for each decade were calculated. Data were expressed for all studies, then subdivided into males, females, children and the elderly. Comparisons between Scotland and the South-East of England were made. Results indicate that fat represented 30% or less of dietary energy in the UK until the 1930s, when it began to rise. This rise was curtailed by rationing during and after the Second World War, after which the rise continued, reaching a plateau of about 40% energy in the late 1950s, with little change until the late 1970s. Trends were similar in all age-groups, but less change has occurred recently in Scotland compared with South-East England. These results differ from the pattern in the USA and suggest that if greater changes in mortality from coronary heart disease are to be seen in the UK a greater reduction in dietary fat intake will have to occur.

Dietary predictors of serum cholesterol in men: the Framingham cohort population

This study examines the cross-sectional relationships between diet and serum cholesterol in a sample of 413 Framingham cohort males, ages 37-70. Regression analyses controlling for age, calories, and coronary heart disease risk factors showed that the direct predictors of serum cholesterol included: fat (g) (p less than 0.05), cholesterol (mg/1000 calories) (p less than 0.05), protein (g and calorie density) (p less than 0.05 and p less than 0.001, respectively), Metropolitan relative weight (p less than 0.05), and systolic blood pressure (p less than 0.001). Fat (calorie density) and cholesterol (mg) were marginally significant direct positive predictors (0.05 less than or equal to p less than or equal to 0.10). Inverse correlates of serum cholesterol were total carbohydrate (g and calorie density) and simple carbohydrate (calorie density) (p less than 0.001). A marginally inverse correlate of serum cholesterol was complex carbohydrate (calorie density) (0.05 less than or equal to p less than or equal to 0.10). These cross-sectional results show that dietary variables predict serum cholesterol levels in men independent of other coronary heart disease risk factors.

Validation of a self-administered diet history questionnaire using multiple diet records

The validity of a self-administered diet history questionnaire has been estimated using as the reference data the mean of three 4-day diet records collected over the year prior to the administration of the questionnaire, in 1985-1986. Subjects were women ages 45-70 years, participants in the Women's Health Trial Feasibility Study, a multi-center clinical trial in which some women were randomized to be taught to adopt and maintain a low-fat diet, while others maintained their usual diet. The questionnaire produced group mean nutrient estimates closely approximating the values obtained by three 4-day records, e.g. in the usual-diet group, 37.7% of calories from fat by both food records and by questionnaire, and in the low-fat group, 21.3% of calories from fat by food records and 23.7% of calories from fat by questionnaire. Correlations between questionnaire and diet records for per cent of calories from fat were 0.67 and 0.65 respectively in the two groups; most correlations were in the 0.5-0.6 range, and were similar to those achievable by a single 4-day food record.

[Nutritional risk factors for ischemic cardiopathy]

The purpose of this review is to analyze original and review papers dealing with associations between diet and its influence on the incidence of Coronary Heart Diseases, so as its implications on the preventive measures at regional levels. It has been analyzed relationships between serum cholesterol levels and Coronary Heart Disease, diet and serum cholesterol and diet and Coronary Heart Disease. It is concluded that there have been shown strong relations in comparisons between communities. However, there are not consistent relations when subjects from the same community are compared. This could be due to variations in variable measurements, such as the limitations of the tools used (food survey, food composition tables, individual intake variations, etc.). All these would difficult to extrapolate the results from one region to another. To develop more effective preventive measures there is the need of cohort studies at regional level bearing in mine all that considerations above mentioned.

Fat consumption and factor VII coagulant activity in middle-aged men. An association between a dietary and thrombogenic coronary risk factor

Diet was measured by 5-day weighed inventory to search for an association between fat intake in the general population and factor VII coagulant activity (VIIc), a strong predictor of coronary heart disease. Of 275 men aged 40-59 years registered with a medical practice, 203 (74%) participated and 170 (62%) provided a satisfactory record. After allowance for the increase in fat intake with body size, a statistically significant and positive association was found between dietary fat and VIIc (r = 0.18; P less than 0.05). The correlation coefficient was increased to 0.24 when adjusted for the effect of day-to-day variability in individual fat intake, thereby providing an improved estimate of the true strength of association. The mean difference in VIIc of 12% of standard between men in the highest and lowest quarters of the distribution of fat intake was similar to that reported between men experiencing coronary heart disease and those remaining free. The results support previous experimental fat-feeding studies and suggest that a high fat diet has adverse consequences for blood coagulability and coronary thrombosis.

Is low energy intake a risk factor for ischaemic heart disease?

The relation between total energy intake and the development of ischaemic heart disease was investigated from a review of all available data including the results of 26 years of follow up from a longitudinal study of diet and ischaemic heart disease. A consistent inverse relation was found, whose strength and consistency are similar to those of other established risk factors. It is concluded that there may be a minimum energy intake below which the risk of ischaemic heart disease is increased.

Copper and ischemic heart disease

Absolute or relative deficiency of copper is hypothesized to be of prime importance in the etiology of ischemic heart disease. According to recent estimates, only 25% of the diets in the United States contain the 2 mg of copper thought to be required daily by adults. Some of these diets have ratios of zinc to copper greater than those that have produced hypercholesteremia in animals. There are many epidemiologic associations between the ratio of zinc to copper and dietary characteristics, organ analyses, clinical status, and environmental features that relate the metabolism of these elements to the anatomy, chemistry, pathology, pharmacology, and physiology of ischemic heart disease. Animals deficient in copper or exposed to a high dietary ratio of zinc to copper, which can produce a relative copper deficiency, are hypercholesteremic and hyperuricemic, and have glucose intolerance and abnormalities of the electrocardiogram. Their hearts and arteries have abnormal connective tissue, lipid deposits, and inflammatory changes; they die suddenly, often with ruptured hearts. Hypercholesteremia and glucose intolerance have been found in men depleted of copper and in children with Menkes' disease, an inability to absorb copper.

Diet, serum cholesterol, and death from coronary heart disease. The Western Electric study

Over twenty years ago, we evaluated diet, serum cholesterol, and other variables in 1900 middle-aged men and repeated the evaluation one year later. No therapeutic suggestions were made. Vital status was determined at the 20th anniversary of the initial examination. Scores summarizing each participant's dietary intake of cholesterol, saturated fatty acids, and polyunsaturated fatty acids were calculated according to the formulas of Keys and Hegsted and their co-workers. The two scores were highly correlated, and results were similar for both: there was a positive association between diet score and serum cholesterol concentration at the initial examination, a positive association between change in diet score and change in serum cholesterol concentration from the initial to the second examination, and a positive association prospectively between mean base-line diet score and the 19-year risk of death from coronary heart disease. These associations persisted after adjustment for potentially confounding factors. The results support the conclusion that lipid composition of the diet affects serum cholesterol concentration and risk of coronary death in middle-aged American men.

The relationship of diet to serum cholesterol levels in young men in Antarctica

1. Regular estimations of dietary intake, body-weight, skinfold thickness, blood pressure and pulse rate, and serum lipids were made in twenty-four members of an Antarctic expedition over 1 year.

2. The mean levels of serum total cholesterol, phospholipids, and triglycerides were 198.5 ±4.85 mg/100 ml, 221.4±5.73 mg/100 ml and 120.9±13.53 mg/100 ml respectively.

3. A positive correlation was found between the total intake of fat expressed as calories and the following serum lipid levels: total cholesterol, β-cholesterol, and the cholesterol:phospholipid ratio. Significant positive correlation was also found between the latter serum levels and fat when expressed as a percentage of the total food intake.

4. This correlation has not been found in small groups before, and is due to the fact that each estimation was the result of several assessments made over 1 year.

5. The survey suggests that the personal serum cholesterol level may be dependent upon the habitual total intake of dietary fat and the percentage of the total calories supplied by fat.

Dietary factors and coronary heart disease

Mortality data from arteriosclerotic and degenerative heart disease (AHD) and per capita consumption of total fat, saturated fat, sucrose, simple sugars, complex carbohydrates, and protein, and calorie intake for 37 countries were statistically evaluated to investigate possible relationships between dietary factors and incidence of AHD. On a geographical basis, consumption of total and saturated fats is strongly and positively correlated with the death rates, while consumption of complex carbohydrates is negatively correlated. No correlations were found with temporal changes in death rates or with differences within one country. These findings are discussed in the light of the works of many other investigators. It is concluded that the relation of diet to AHD is still controversial, and that the development and severity of the disease cannot be confidently attributed to any single dietary factor nor to blood cholesterol. The contributing effects of other factors, such as physical activity, mental stress, and affluence, are also discussed.

Food intake in Antarctica

1. Body-weight, skinfold thickness and food intake were measured at regular intervals in twenty-five young men while on an Antarctic expedition.

2. The mean calorie intake over the year was 3600 kcal/man per day; 12.1% of these calories were supplied by protein, 39.8% by fat, and 48.1% by carbohydrate.

3. The calorie intake was equivalent to that which would be expected in a moderately active worker living in a temperate climate. The chemical composition of the diets did not differ from average values for young men in the United Kingdom.

4. There was a significant fall in food intake during the winter months, when the outside temperatures were greatly reduced and there was polar night. During this period the men were largely confined to the limits of the base hut and the levels of physical activity showed a marked fall.

5. During the year there was a gain in body-weight of 2.7 kg. Of this gain 2.5 kg occurred in the first 2 months.

6. Skinfold thickness followed the trend of the body-weights except for the April-May increment which was unaccompanied by a weight change. This dissociation could not be explained.