Food and vessels: the importance of a healthy diet to prevent cardiovascular disease.
OBJECTIVE
We attempted to quantify the burden of cardiovascular disease that can be prevented by broader adherence to recommendations on dietary intake of key nutrients.


METHODS
A computer model capturing the epidemiology of chronic disease and risk factors in the Dutch population was used to simulate differences in the occurrence of cardiovascular disease under various scenarios defined by levels of intake of saturated and trans fatty acids, fruit, vegetables and fish. The following scenarios were compared with the current situation: (i) the whole population adhering to recommendations (optimum scenario); (ii) a moderate improvement and (iii) increased intake of fruit as has been achieved in an actual intervention ('fruit at work'). Other outcome measures assessed were (differences in) life expectancy and healthy life expectancy for a 40-year-old individual.


RESULTS
In the optimum scenario, cumulative incidence prevented over a period of 20 years was 240,000 cases for acute myocardial infarction, or 30% of the expected number of cases, 328,000 (16%) for other coronary heart disease and 215,000 (21%) for stroke. For the moderate improvement scenario, the corresponding figures were 119,000 (14%), 163 000 (8%) and 105,000 (10%), respectively. The individual contributions of each of the separate dietary factors were greatest for fish, followed in decreasing order by fruit, vegetables, saturated and trans fatty acids. Only fish and fruit contributed to a decrease in strokes. In the optimum scenario, 1 year was added to the life expectancy of a 40-year-old individual and half a year in the moderate improvement scenario.


CONCLUSIONS
Broader adherence to recommendations for daily intake of fruit, vegetables, fish and fatty acid composition may take away as much as 20-30% of the burden of cardiovascular disease and result in approximately 1 extra life year for a 40-year-old individual. Promotion of a healthy diet should be given more emphasis in the prevention of cardiovascular disease.
Engelfriet
Peter
P
Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment, BA Bilthoven, The Netherlands.
Hoekstra
Jeljer
J
Hoogenveen
Rudolf
R
Büchner
Frederike
F
van Rossum
Caroline
C
Verschuren
Monique
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D003198:Computer Simulation; D004032:Diet / Q000009:adverse effects*; D018752:Diet, Fat-Restricted; D004041:Dietary Fats / Q000009:adverse effects; D005638:Fruit; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion; D006801:Humans; D015994:Incidence; D008017:Life Expectancy; D008875:Middle Aged; D008954:Models, Biological; D009426:Netherlands / Q000453:epidemiology; D018673:Nutrition Policy; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D017747:Seafood; D014675:Vegetables; D055815:Young Adult
D004041:Dietary Fats