Diets lower in folic acid and carotenoids are associated with the coronary disease epidemic in Central and Eastern Europe.
OBJECTIVE
To test our hypothesis that lower intakes of previously identified cardioprotective nutrients would be associated with the coronary epidemic in Central and Eastern Europe.


METHODS
We conducted a survey of coronary mortality in 16 countries and diet in 19 countries.


METHODS
Countries were placed in four groups with different cultural patterns (Central and Eastern Europe, including Russia; Western Europe and the United States; Mediterranean; and Asian).


METHODS
Independent predictors of coronary mortality.


METHODS
Means and standard deviations were calculated, and analysis of variance with Bonferroni post hoc tests and backward elimination regression analysis was conducted.


RESULTS
Coronary mortality was highest in Central and Eastern Europe followed by Western Europe and the United States, the Mediterranean countries, and Asia (Japan). The model with folate, fiber, and n-6/n-3 fatty acids explained the majority of variation in coronary mortality (men 86%, women 90%). Most of the variation was explained by folate (men 61%, women 62%). The picture is complicated by the fact that folate, lutein/zeaxanthin, and beta-carotene were highly intercorrelated ( r =0.87 to 0.99).


CONCLUSIONS
A diet low in foods containing folate and carotenoids (beta-carotene and lutein/zeaxanthin) may be a major contributing factor to increased coronary risk observed in the countries of Central and Eastern Europe.
Connor
Sonja L
SL
Department of Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA. connors@ohsu.edu
Ojeda
Lila S
LS
Sexton
Gary
G
Weidner
Gerdi
G
Connor
William E
WE
D000704:Analysis of Variance; D000975:Antioxidants / Q000008:administration & dosage*; D001208:Asia / Q000453:epidemiology; D002338:Carotenoids / Q000008:administration & dosage*; D003327:Coronary Disease / Q000453:epidemiology / Q000401:mortality* / Q000517:prevention & control; D004032:Diet; D004043:Dietary Fiber / Q000008:administration & dosage; D005060:Europe / Q000453:epidemiology; D005061:Europe, Eastern / Q000453:epidemiology; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage; D043371:Fatty Acids, Omega-6 / Q000008:administration & dosage; D005231:Fatty Acids, Unsaturated / Q000008:administration & dosage; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage*; D006306:Health Surveys; D006801:Humans; D008297:Male; D012737:Sex Factors; D014481:United States / Q000453:epidemiology
D000975:Antioxidants; D004043:Dietary Fiber; D015525:Fatty Acids, Omega-3; D043371:Fatty Acids, Omega-6; D005231:Fatty Acids, Unsaturated; D002338:Carotenoids; D005492:Folic Acid