Adherence to 2005 Dietary Guidelines for Americans is associated with a reduced progression of coronary artery atherosclerosis in women with established coronary artery disease.
BACKGROUND
A premise of the 2005 Dietary Guidelines for Americans (DGA) is chronic disease prevention.


OBJECTIVE
The goal was to determine whether a diet meeting the DGA is associated with less atherosclerotic lesion progression.


METHODS
We used the data from 224 postmenopausal women with established coronary artery disease enrolled in the Estrogen Replacement and Atherosclerosis Study. Atherosclerosis progression was defined by repeated measures of quantitative angiography over a 3-y period. Adherence to the key DGA recommendations was measured by using the DGA Adherence Index (DGAI; possible range: 0-20), with each component weighted equally, and the modified DGAI score (wDGAI; possible range: -0.19-0.51), with each component weighted based on its relation to atherosclerosis progression. Mixed-model regression analyses were performed to assess the association between diet and atherosclerosis progression.


RESULTS
No women consumed a diet meeting all of the DGA recommendations. The mean (range) of the DGAI score was 14.1 (8.0-19.0). DGAI was not associated with atherosclerosis progression (P = 0.44), whereas wDGAI was inversely associated; a 1-SD difference in wDGAI was related to 0.049-mm less narrowing of the coronary arteries (SE = 0.017, P = 0.004).


CONCLUSIONS
In postmenopausal women with established heart disease, under the assumption that all DGA recommendations are similarly effective, overall adherence was not associated with atherosclerosis progression. However, assigning differential weights to the DGA recommendations, the adherence was significantly associated with slower atherosclerosis progression. Assuming equity of associations between all dietary recommendations and disease outcomes is a limitation in accurately examining the effectiveness of the DGA.
Jean Meyer US Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA.
Fumiaki
F
Imamura
Paul F
PF
Jacques
David M
DM
Herrington
Gerard E
GE
Dallal
Alice H
AH
Lichtenstein
D000368:Aged; D050197:Atherosclerosis / Q000503:physiopathology / Q000517:prevention & control*; D018849:Controlled Clinical Trials as Topic; D003327:Coronary Disease / Q000453:epidemiology* / Q000503:physiopathology / Q000517:prevention & control*; D004032:Diet; D018450:Disease Progression; D004311:Double-Blind Method; D015914:Estrogen Replacement Therapy; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006801:Humans; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D017698:Postmenopause