Optimal diets for prevention of coronary heart disease.
BACKGROUND
Coronary heart disease (CHD) remains the leading cause of mortality in industrialized countries and is rapidly becoming a primary cause of death worldwide. Thus, identification of the dietary changes that most effectively prevent CHD is critical.


OBJECTIVE
To review metabolic, epidemiologic, and clinical trial evidence regarding diet and CHD prevention.


METHODS
We searched MEDLINE through May 2002 for epidemiologic and clinical investigations of major dietary factors (fat, cholesterol, omega-3 fatty acids, trans-fatty acids, carbohydrates, glycemic index, fiber, folate, specific foods, and dietary patterns) and CHD. We selected 147 original investigations and reviews of metabolic studies, epidemiologic studies, and dietary intervention trials of diet and CHD.


METHODS
Data were examined for relevance and quality and extracted by 1 of the authors.


RESULTS
Compelling evidence from metabolic studies, prospective cohort studies, and clinical trials in the past several decades indicates that at least 3 dietary strategies are effective in preventing CHD: substitute nonhydrogenated unsaturated fats for saturated and trans-fats; increase consumption of omega-3 fatty acids from fish, fish oil supplements, or plant sources; and consume a diet high in fruits, vegetables, nuts, and whole grains and low in refined grain products. However, simply lowering the percentage of energy from total fat in the diet is unlikely to improve lipid profile or reduce CHD incidence. Many issues remain unsettled, including the optimal amounts of monounsaturated and polyunsaturated fats, the optimal balance between omega-3 and omega-6 polyunsaturated fats, the amount and sources of protein, and the effects of individual phytochemicals, antioxidant vitamins, and minerals.


CONCLUSIONS
Substantial evidence indicates that diets using nonhydrogenated unsaturated fats as the predominant form of dietary fat, whole grains as the main form of carbohydrates, an abundance of fruits and vegetables, and adequate omega-3 fatty acids can offer significant protection against CHD. Such diets, together with regular physical activity, avoidance of smoking, and maintenance of a healthy body weight, may prevent the majority of cardiovascular disease in Western populations.
Hu
Frank B
FB
Department of Nutrition, Harvard School of Public Health, 665 Huntington Ave, Boston, MA 02115, USA. frank.hu@channing.harvard.edu
Willett
Walter C
WC
D003324:Coronary Artery Disease / Q000178:diet therapy / Q000453:epidemiology / Q000517:prevention & control*; D004032:Diet; D004040:Dietary Carbohydrates; D004041:Dietary Fats; D004043:Dietary Fiber; D005492:Folic Acid; D006801:Humans; D008019:Life Style; D008074:Lipoproteins / Q000097:blood
D004040:Dietary Carbohydrates; D004041:Dietary Fats; D004043:Dietary Fiber; D008074:Lipoproteins; D005492:Folic Acid