Nutrition and heart_disease2012 http://www.thaiheart.org/images/column_1332988782/Nutrition_and_heart_disease2012.pdf

1. Heart Health Diet
Somkiat Sangwatanaroj M.D.
Division of Cardiovascular Medicine,
Department of Medicine, Faculty of Medicine,
Chulalongkorn University
Somkiat.s@chula.ac.th

2. Diets cause Coronary Heart Disease ?

3. Causal link diet & CHD: systematic review
Mente A. Arch Intern Med 2009;169:659-69

4. Causal link diet & CHD: Cohorts
Mente A. Arch Intern Med 2009;169:659-69
g
Bradford Hill score is 4 when restricting analyses to cohort studies of
high methodologic quality (low risk of bias).

8. Mediterranean diet & mortality
Meta-analysis. Sofi F. BMJ 2008;337:a1344
doi:10.1136/bmj.a1344
Studies analysed prospectively association
between adherence to Mediterranean diet,
mortality & incidence of diseases; 12 studies,
with 1,574,299 subjects followed for 3-18 yrs
8 cohorts (514,816 subjects & 33,576 deaths):
two point increase in the adherence score was
significantly associated with a reduced risk of
total mortality (9%),CV mortality (9%),cancer
mortality(6
13%)

10. Mediterranean diet & mortality
Meta-analysis. Sofi F. BMJ 2008;337:a1344
doi:10.1136/bmj.a1344

13. Mediterranean diet & Parkinson &
Meta-analysis.Sofi F. BMJ 2008;337:a1344. doi:10.1136/bmj.a1344

16. P for trend <0.0001).
B, Multivariate
P for trend <0.0001).

19. Mediterranean dietary pattern.
Trichopoulou A. Pub Health Nutr 2004;7:943-7

21. Brown rice, whole grains
DM risk
Sun Qi. Arch Intern Med 2010;170:961-9.
White & brown rice consumption relation to
T2DM risk in Health Professionals Follow-up
Prospectively ascertained & updated diet,
lifestyle practices & disease status among 39
765 men & 157 463 women.
Multivariate adjustment for age, lifestyle &
dietary risk factors, higher intake of white rice
(5 servings/wk vs. 1/ month) risk

24. Systematic review. n=352,384, FU 4-22 y.Hu EA.BMJ 2012;344:e1454

25. Fruit, vegetable & heart disease

26. Fruit & vegetable 5 servings/d & CHD
Meta-analysis. He FJ. J Human Hypertens 2007;21:717-28.

34. Nuts, Peanuts prevent CHD
Kris-Etherton PM. J Nutr 2008;138:1746S-51S.
Pooled analysis of epidemiologic studies on nut consumption and CHD risk.

35. Nut & peanut butter lower CVD in T2DM women
2009;139:1333-8
Cohort of 6,309 T2DM women,
Food Frequency
Questionnaires q 2-4 yrs (1980-2002)
Incident MI, revascularization & stroke
54,656 person-yr FU, 452 (MI &
revascularization) & 182 stroke cases

38. ?

41. Salt intake increase stroke & CVD risk
Systematic review/meta-a. Strazzullo P. BMJ 2009;339:b4567 doi:10.1136/bmj.b4567
Medline (1966-2008),Embase (1988-),AMED
(1985-), CINAHL (1982-), Psychinfo (1985-) &
Cochrane Library.
Relative risks & 95% CI and random effect model,
weighting for inverse of variance. Heterogeneity,
publication bias, subgroup, & meta-regression
analyses.
19 independent cohort samples from 13 studies,
with 177,025 participants (follow-up 3.5-19 yrs) &
> 11,000 vascular events

42. Higher salt intake increase stroke risk (23%)
Systematic review/meta-a. Strazzullo P. BMJ 2009;339:b4567 doi:10.1136/bmj.b4567

44. dietary salt reduction
/

49. vs.

55. RR of CHD/50 g/d processed meat
Systematic review. Circulation 2010;121:2271-83.
Case-control
RR of CHD/100 g/d total meat

60. -cause death
Pan A. Arch Intern Med 2012; doi:10.1001/archinternmed.2011.2287
Pooled hazard ratio
(95% CI) of total
mortality for a 1serving/day increase
was 1.13 (1.07-1.20) for
unprocessed red meat
and 1.20 (1.15-1.24) for
processed red meat.

61. Pan A. Arch Intern Med 2012; doi:10.1001/archinternmed.2011.2287

62. Pan A. Arch Intern Med 2012; doi:10.1001/archinternmed.2011.2287

67. Fat: bad, better or best

73. Angell SY. Ann Intern Med 2009;151:129-134.

77. Glycemic index (GI), Glycemic load (GL)
GI = ability of food to provoke postprandial
glycemic response in man compared with
reference food:
Glucose or bread (GI = 100)
Glucose : Bread GI = 100 : 70
GL = product of amount of available CHO in
specified serving size & GI / 100
GL = CHO x GI / 100
Atkinson FS. Diabetes Care ; 31: 2281- 83
2008

79. Rate ratio(95%CI) highest vs. lowest GI & GL in 27
cohorts.Systematic review Barclay AW. Am J Clin Nutr 2008;87:627-37
1
Final fully adjusted models only.

84. Dietary supplements ?
?

86. Antioxidant supplements 1ry & 2ry prevention
Bjelakovic G. JAMA. 2007;297:842-857
Electronic databases & bibliographies published by Oct 2005.
Randomized trials, adults, beta carotene, vitamin A, vitamin C
(ascorbic acid), vitamin E & selenium either singly or
combined vs placebo or vs no intervention.
Randomization, blinding, and follow-up: markers of bias.
The effect of antioxidant supplements on all-cause mortality:
random-effects meta-analyses as RR with 95% CIs. Metaregression to assess the effect of covariates across the trials.
68 Randomized trials ( n = 232,606 from 385 publications).

88. %
Bjelakovic G. JAMA. 2007;297:842-857

91. Diet & lifestyle recommendation 2006.
American Heart Association. Circulation 2006;114:82-96
Although antioxidant supplements vitamin E,
beta-carotene, selenium etc) are not
recommended, food sources of antioxidant
nutrients, principally from a variety of plantderived foods such as fruits, vegetables, whole
grains, and vegetable oils are recommended.

96. Vit E/C & MI,Stroke,CV death in PHSII
RCT. Sesso HD. JAMA 2008;300:2123-33.

97. Vit E/C & MI,Stroke,CV death in PHSII
RCT. Sesso HD. JAMA 2008;300:2123-33.

98. Vit E/C & MI,Stroke,CV death in PHSII
RCT. Sesso HD. JAMA 2008;300:2123-33.

99. Vitamin B in DM nephropathy

100. Diabetic Intervention with Vitamins to Improve
Nephropathy.RCT (DB, PC). House AA. JAMA 2010;303:1603-09.
5 university medical centers Canada, May
2001-July 2007, 238 type 1 or 2 DM and
clinical diagnosis of diabetic nephropathy.
1 tablet of B vitamins: folic acid (2.5 mg/d),
vitamin B6 (25 mg/d), vitamin B12 (1 mg/d),
or matching placebo.
Change in radionuclide GFR at 36 months.
Dialysis and composite of MI, stroke,
revascularization, and all-cause mortality.

101. Vit B+folic decrease GFR in DM nephropathy.
DIVINE: RCT (DB, PC). House AA. JAMA 2010;303:1603-09.

102. Vit B+folic increase CV events in DM nephropathy.
DIVINE: RCT (DB, PC). House AA. JAMA 2010;303:1603-09.

103. Take home message:
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