Cardiovascular disease

Coronary Artery Bypass Surgery

J Nutr. 2005 Mar;135(3):556-61.
The combination of high fruit and vegetable and low saturated fat intakes is more protective against mortality in aging men than is either alone: the Baltimore Longitudinal Study of Aging.
Tucker KL, Hallfrisch J, Qiao N, Muller D, Andres R, Fleg JL; Baltimore Longitudinal Study of Aging.
Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA. katharine.tucker@tufts.edu

  Saturated fat (SF) intake contributes to the risk of coronary heart disease (CHD) mortality. Recently, the protective effects of fruit and vegetable (FV) intake on both CHD and all-cause mortality were documented. However, individuals consuming more FV may be displacing higher-fat foods. Therefore, we investigated the individual and combined effects of FV and SF consumption on total and CHD mortality among 501 initially healthy men in the Baltimore Longitudinal Study of Aging (BLSA). Over a mean 18 y of follow-up, 7-d diet records were taken at 1-7 visits. Cause of death was ascertained from death certificates, hospital records, and autopsy data. After adjustment for age, total energy intake, BMI, smoking, alcohol use, dietary supplements, and physical activity score, FV and SF intakes were individually associated with lower all-cause and CHD mortality (P < 0.05). When both FV and SF were included in the same model, associations of each were attenuated with CHD mortality, and no longer significant for all-cause mortality. Men consuming the combination of > or =5 servings of FV/d and < or =12% energy from SF were 31% less likely to die of any cause (P < 0.05), and 76% less likely to die from CHD (P < 0.001), relative to those consuming < 5 FV and >12% SF. Men consuming either low SF or high FV, but not both, did not have a significantly lower risk of total mortality; but did have 64-67% lower risk of CHD mortality (P < 0.05) relative to those doing neither. These results confirm the protective effects of low SF and high FV intake against CHD mortality. In addition, they extend these findings by demonstrating that the combination of both behaviors is more protective than either alone, suggesting that their beneficial effects are mediated by different mechanisms.

PMID: 15735093


Am J Clin Nutr. 2004 Feb;79(2):213-7.
Fruit and vegetable consumption and LDL cholesterol: the National Heart, Lung, and Blood Institute Family Heart Study.
Djousse L, Arnett DK, Coon H, Province MA, Moore LL, Ellison RC.
Section of Preventive Medicine and Epidemiology, Evans Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA. ldjousse@bu.edu

  BACKGROUND: An elevated LDL-cholesterol concentration is associated with an increased risk of cardiovascular disease. The association between fruit and vegetable consumption and LDL has been inconsistent.
  OBJECTIVE: The objective was to determine whether a high intake of fruit and vegetables is inversely associated with LDL concentrations.
  DESIGN: We used data collected from 4466 subjects in the National Heart, Lung, and Blood Institute Family Heart Study to study the association between fruit and vegetable consumption and serum LDL. We used a food-frequency questionnaire to assess fruit and vegetable intakes and regression models to estimate adjusted mean LDL according to fruit and vegetable consumption.
  RESULTS: The mean (+/-SD) age of the men (n = 2047) was 51.5 +/- 14.0 y and that of the women (n = 2419) was 52.2 +/- 13.7 y. The average daily serving of fruit and vegetables was 3.2 +/- 1.7 for men and was 3.5 +/- 1.8 for women. Fruit and vegetable consumption was inversely related to LDL: in the categories 0-1.9, 2.0-2.9, 3.0-3.9, and > or = 4 servings/d, multivariate-adjusted mean (95% CI) LDL concentrations were 3.36 (3.28, 3.44), 3.35 (3.27, 3.43), 3.26 (3.17, 3.35), and 3.17 (3.09, 3.25) mmol/L, respectively, for men (P for trend < 0.0001) and 3.35 (3.26, 3.44), 3.22 (3.14, 3.30), 3.21 (3.13, 3.29), and 3.11 (3.04, 3.18), respectively, for women (P for trend < 0.0001). This association was observed across categories of age, education, smoking status, physical activity, and tertiles of Keys score. Exclusion of subjects with prevalent diabetes mellitus or coronary artery disease did not alter these results significantly.
  CONCLUSION: Consumption of fruit and vegetables is inversely related to LDL in men and women.

PMID: 14749225


Asia Pac J Clin Nutr. 2003;12 Suppl:S20.
Plasma coagulation factor VII activity and its correlates in healthy men.
Li D, Sinclair AJ.
Department of Food Science, Hangzhou University of Commerce, Hangzhou,China, 310035.

  Background - Previous studies have provided evidence showing that increased coagulation factors and impaired fibrinolysis system are important predictors of cardiovascular disease. Elevated plasma coagulation factor VII activity (VII) have been claimed to be an important independent risk factor for occlusive vascular disease.
  Objective - To investigate the relationship between plasma VII and individual fatty acid concentration in plasma phospholipid (PL). Design - Cross-sectional study, consisting of 139 aged 20-55 years healthy men were recruited from Melbourne, each volunteer completed semi-FFQ and gave a blood sample. According to their habitual dietary intake, they were divided into four groups: vegan (n=18), ovolacto vegetarians (n=43), moderate-meat-eaters (n=60) and high-meat-eaters (n=18).
  Outcomes: Both vegans and ovolacto vegetarians had lower plasma VII than omnivores. In the stepwise regression, plasma VII was used as a dependent variable, and 20 factors that were significantly correlated with plasma VII in age-adjusted bivariate analysis (P< 0.01) were used as independent variables. The two most important variables of plasma VII were selected in the model with R(2)=0.465 and P<0.0001; these were prothrombin time and plasma PL 18:0 concentration, standard coefficient were -0.603 and +0.191, respectively.
  Conclusions - The present results indicate that both ovolacto vegetarians and vegans have a lower plasma VII compared with omnivores. Despite the correlation between plasma PL 18:0 concentration and VII is not a causal relation, previous studies have implicated diet total fat intake is a contributor to rased plasma VII.

PMID: 15023616


Eur J Clin Nutr. 2003 Aug;57(8):904-8.
The relation between dietary flavonol intake and coronary heart disease mortality: a meta-analysis of prospective cohort studies.
Huxley RR, Neil HA. 1Institute for International Health, University of Sydney, Australia.

  OBJECTIVE:: To assess the association of dietary flavonol intake with the subsequent risk of coronary heart disease (CHD) mortality.
  DESIGN:: Meta-analysis of prospective cohort studies published before September 2001. Studies were identified by MEDLINE and EMBASE searches and by scanning relevant reference lists. The following information was extracted from published reports: size of cohort, mean age, mean duration of follow-up, number of fatal CHD events, mean flavonol intake, main sources of flavonol intake, degree of adjustment for potential confounders, and the relation of CHD mortality to dietary flavonol intake measured at baseline.
  RESULTS:: Seven prospective cohorts of men and women were identified including a total of 2087 fatal CHD events. Comparison of individuals in the top third with those in the bottom third of dietary flavonol intake yielded a combined risk ratio of 0.80 (95% CI 0.69-0.93) after adjustment for known CHD risk factors and other dietary components.
  CONCLUSION:: This overview of prospective cohort studies indicates that high dietary intake of flavonols from a small number of fruits and vegetables, tea and red wine may be associated with a reduced risk from CHD mortality in free-living populations.
  SPONSORSHIP:: Institute for International Health, University of Sydney.

PMID: 12879084


Can J Diet Pract Res. 2003 Summer;64(2):62-81.
Position of the American Dietetic Association and Dietitians of Canada: vegetarian diets.
American Dietetic Association; Dietitians of Canada.

  It is the position of the American Dietetic Association and Dietitians of Canada that appropriately planned vegetarian diets are healthful, nutritionally adequate, and provide health benefits in the prevention and treatment of certain diseases. Approximately 2.5% of adults in the United States and 4% of adults in Canada follow vegetarian diets. A vegetarian diet is defined as one that does not include meat, fish, or fowl. Interest in vegetarianism appears to be increasing, with many restaurants and college foodservices offering vegetarian meals routinely. Substantial growth in sales of foods attractive to vegetarians has occurred and these foods appear in many supermarkets. This position paper reviews the current scientific data related to key nutrients for vegetarians including protein, iron, zinc, calcium, vitamin D, riboflavin, vitamin B-12, vitamin A, n-3 fatty acids, and iodine. A vegetarian, including vegan, diet can meet current recommendations for all of these nutrients. In some cases, use of fortified foods or supplements can be helpful in meeting recommendations for individual nutrients. Well-planned vegan and other types of vegetarian diets are appropriate for all stages of the life-cycle including during pregnancy, lactation, infancy, childhood, and adolescence. Vegetarian diets offer a number of nutritional benefits including lower levels of saturated fat, cholesterol, and animal protein as well as higher levels of carbohydrates, fibre, magnesium, potassium, folate, antioxidants such as vitamins C and E, and phytochemicals. Vegetarians have been reported to have lower body mass indices than non-vegetarians, as well as lower rates of death from ischemic heart disease, lower blood cholesterol levels, lower blood pressure, and lower rates of hypertension, type 2 diabetes, and prostate and colon cancer. While a number of federally funded and institutional feeding programs can accommodate vegetarians, few have foods suitable for vegans at this time. Because of the variability of dietary practices among vegetarians, individual assessment of dietary intakes of vegetarians is required. Dietetics professionals have a responsibility to support and encourage those who express an interest in consuming a vegetarian diet. They can play key roles in educating vegetarian clients about food sources of specific nutrients, food purchase and preparation, and any dietary modifications that may be necessary to meet individual needs. Menu planning for vegetarians can be simplified by use of a food guide that specifies food groups and serving sizes.

PMID: 12826028


Am J Clin Nutr 2003 Jun;77(6):1379-84
Serum lipid response to the graduated enrichment of a Step I diet with almonds: a randomized feeding trial.
Sabate J, Haddad E, Tanzman JS, Jambazian P, Rajaram S Department of Nutrition, School of Public Health, Loma Linda University, Loma Linda, CA.

  BACKGROUND: Frequent consumption of nuts may lower the risk of cardiovascular disease by favorably altering serum lipid and lipoprotein concentrations.
  OBJECTIVE: We compared the effects of 2 amounts of almond intake with those of a National Cholesterol Education Program Step I diet on serum lipids, lipoproteins, apolipoproteins, and glucose in healthy and mildly hypercholesterolemic adults.
  DESIGN: In a randomized crossover design, 25 healthy subjects (14 men, 11 women) with a mean (+/- SD) age of 41 +/- 13 y were fed 3 isoenergetic diets for 4 wk each after being fed a 2-wk run-in diet (containing 34% of energy from fat). The experimental diets included a Step I diet, a low-almond diet, and a high-almond diet, in which almonds contributed 0%, 10%, and 20% of total energy, respectively.
  RESULTS: Inverse relations were observed between the percentage of energy in the diet from almonds and the subject's total cholesterol (P value for trend < 0.001), LDL-cholesterol (P < 0.001), and apolipoprotein B (P < 0.001) concentrations and the ratios of LDL to HDL cholesterol (P < 0.001) and of apolipoprotein B to apolipoprotein A (P < 0.001). Compared with the Step I diet, the high-almond diet reduced total cholesterol (0.24 mmol/L or 4.4%; P = 0.001), LDL cholesterol (0.26 mmol/L or 7.0%; P < 0.001), and apolipoprotein B (6.6 mg/dL or 6.6%; P < 0.001); increased HDL cholesterol (0.02 mmol/L or 1.7%; P = 0.08); and decreased the ratio of LDL to HDL cholesterol (8.8%; P < 0.001).
  CONCLUSIONS: Isoenergetic incorporation of approximately 68 g of almonds (20% of energy) into an 8368-kJ (2000-kcal) Step I diet markedly improved the serum lipid profile of healthy and mildly hypercholesterolemic adults. Total and LDL-cholesterol concentrations declined with progressively higher intakes of almonds, which suggests a dose-response relation.

PMID: 12791613


Am J Clin Nutr 2003 Jun;77(6):1390-9
Dietary carotenoids and risk of coronary artery disease in women.
Osganian SK, Stampfer MJ, Rimm E, Spiegelman D, Manson JE, Willett WC Children's Hospital, Department of Medicine, Boston (SKO).

  BACKGROUND: Numerous studies have shown that higher intakes or higher blood concentrations of carotenes are associated with a lower risk of coronary artery disease (CAD). Given the null results in trials of beta-carotene supplementation, considerable attention has focused on the potential role of other dietary carotenoids in the prevention of CAD.
  OBJECTIVE: Our objective was to prospectively examine the relation between dietary intakes of specific carotenoids and risk of CAD in women.
  DESIGN: In 1984, 73,286 female nurses completed a semiquantitative food-frequency questionnaire that assessed their consumption of carotenoids and various other nutrients. The women were followed for 12 y for the development of incident CAD (nonfatal myocardial infarction and fatal CAD), and dietary information was updated in 1986, 1990, and 1994.
  RESULTS: During 12 y of follow-up (803,590 person-years), we identified 998 incident cases of CAD. After adjustment for age, smoking, and other CAD risk factors, we observed modest but significant inverse associations between the highest quintiles of intake of beta-carotene and alpha-carotene and risk of CAD but no significant relation with intakes of lutein/zeaxanthin, lycopene, or beta-cryptoxanthin. For women in the highest compared with the respective lowest quintile of intake, the relative risks for beta-carotene and alpha-carotene were 0.74 (95% CI: 0.59, 0.93) and 0.80 (95% CI: 0.65, 0.99), respectively. The association between the specific carotenoids and CAD risk did not vary significantly by current smoking status.
  CONCLUSION: Higher intakes of foods rich in alpha-carotene or beta-carotene are associated with a reduction in risk of CAD.

PMID: 12791615


Am J Clin Nutr 2003 Jun;77(6):1466-73
Dietary flavanols and procyanidin oligomers from cocoa (Theobroma cacao) inhibit platelet function.
Murphy KJ, Chronopoulos AK, Singh I, Francis MA, Moriarty H, Pike MJ, Turner AH, Mann NJ, Sinclair AJ Department of Food Science (KJM, AKC, NJM, and AJS) and the School of Medical Sciences (IS, MAF, MJP, and AHT), RMIT University, Melbourne, Australia, and the School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, Australia (IS and HM).

  BACKGROUND: Flavonoids may be partly responsible for some health benefits, including antiinflammatory action and a decreased tendency for the blood to clot. An acute dose of flavanols and oligomeric procyanidins from cocoa powder inhibits platelet activation and function over 6 h in humans.
  OBJECTIVE: This study sought to evaluate whether 28 d of supplementation with cocoa flavanols and related procyanidin oligomers would modulate human platelet reactivity and primary hemostasis and reduce oxidative markers in vivo.
  DESIGN: Thirty-two healthy subjects were assigned to consume active (234 mg cocoa flavanols and procyanidins/d) or placebo (   RESULTS: Plasma concentrations of epicatechin and catechin in the active group increased by 81% and 28%, respectively, during the intervention period. The active group had significantly lower P selectin expression and significantly lower ADP-induced aggregation and collagen-induced aggregation than did the placebo group. Plasma ascorbic acid concentrations were significantly higher in the active than in the placebo group (P < 0.05), whereas plasma oxidation markers and antioxidant status did not change in either group.
  CONCLUSIONS: Cocoa flavanol and procyanidin supplementation for 28 d significantly increased plasma epicatechin and catechin concentrations and significantly decreased platelet function. These data support the results of acute studies that used higher doses of cocoa flavanols and procyanidins.

PMID: 12791625


Am J Clin Nutr 2003 Jun;77(6):1489-97
Infant nutrition and blood pressure in early adulthood: the Barry Caerphilly Growth study.
Martin RM, McCarthy A, Smith GD, Davies DP, Ben-Shlomo Y Department of Social Medicine, University of Bristol, Bristol, United Kingdom (RMM, AM, GDS, and YB-S), and the Department of Child Health, University of Wales College of Medicine, Cardiff, United Kingdom (DPD).

  BACKGROUND: Evidence suggests that environmental factors acting early in life may affect blood pressure in adulthood.
  OBJECTIVE: The objective was to test the hypothesis that dried formula milk (derived from cow milk) intake in infancy is positively associated with blood pressure in early adulthood.
  DESIGN: We conducted a long-term follow-up (1997-1999) of the Barry Caerphilly Growth study cohort (1972-1974) into which mothers and their offspring had originally been randomly assigned to receive a milk supplement or usual care. Participants were the offspring, who were aged 23-27 y at follow-up. The main outcome measures were systolic and diastolic blood pressure.
  RESULTS: The social and demographic characteristics of the subjects who were (n = 679) and were not (n = 272) followed up were similar. For each increase in quartile of dried milk consumption (in oz) at 3 mo of age, there was a 1.28-mm Hg (95% CI: 0.46, 2.10 mm Hg) increase in systolic and a 0.63-mm Hg (95% CI: 0.04, 1.22 mm Hg) increase in diastolic blood pressure after adjustment for sex, intervention group, birth weight z scores, social class in childhood, age at follow-up, alcohol consumption, and pack-years of smoking. These coefficients were attenuated when adult body mass index and height were included in the models, but the association of dried milk consumption at 3 mo of age with systolic pressure remained significant (1.07 mm Hg; 95% CI: 0.27, 1.87 mm Hg).
  CONCLUSIONS: Our findings are consistent with the hypothesis that high blood pressure in later life is influenced by early postnatal nutrition. Thus, interventions to optimize infant nutrition may have important long-term health benefits.

PMID: 12791629


Med Hypotheses 2003 May;60(5):624-33
A preliminary fast may potentiate response to a subsequent low-salt, low-fat vegan diet in the management of hypertension - fasting as a strategy for breaking metabolic vicious cycles.
McCarty MF. Pantox Laboratories, San Diego, California, USA

  Although a salted diet appears to be a sine qua non for the development of essential hypertension, low-salt diets often have a modest or even negligible impact on the blood pressure of hypertensives; this suggests that salt, perhaps often acting in concert with other aspects of a modern, rich diet, may set in place certain metabolic vicious cycles that sustain blood pressure elevation even when dietary salt is eliminated. Therapeutic fasting is known to lower elevated blood pressure - presumably in large part because it minimizes insulin secretion - and may have the potential to break some of these vicious cycles. Goldhamer has recently reported that a regimen comprised of a water-only fast of moderate duration, followed by a transition to a low-fat, low-salt, whole-food vegan diet, achieves dramatic reductions in the blood pressure of hypertensives, such that the large majority of patients can be restored to normotensive status, in the absence of any drug therapy. Although long-term follow-up of these subjects has been sporadic, the available data suggest that these large reductions is blood pressure can be conserved in patients who remain compliant with the follow-up diet - in other words, a 'cure' for hypertension may be feasible. If a protein-sparing modified fast can be shown to be virtually as effective as a total fast for achieving these benefits, it may be possible to implement this regimen safely on an outpatient basis. The ability of therapeutic fasts to break metabolic vicious cycles may also contribute to the efficacy of fasting in the treatment of type 2 diabetes and autoimmune disorders. As a general principle, if a metabolic disorder is susceptible to prevention - but not reversal - by a specific diet, and therapeutic fasting has a temporary favorable impact on this disorder, then a more definitive therapy may consist of a therapeutic fast, followed up by the protective diet as a maintenance regimen.

PMID: 12710893


Eur J Clin Nutr 2003 Mar;57(3):439-46
Mediterranean diet, but not red wine, is associated with beneficial changes in primary haemostasis.
Mezzano D, Leighton F, Strobel P, Martinez C, Marshall G, Cuevas A, Castillo O, Panes O, Munoz B, Rozowski J, Pereira J Department of Haematology-Oncology, Faculty of Biological Sciences, Pontificia Universidad Catolica de Chile, Santiago, Chile.

  OBJECTIVE:: (1) To compare the effect of an alcohol-free Mediterranean-type diet (MD) and a high-fat diet (HFD) on variables of primary haemostasis (bleeding time, plasma von Willebrand factor and platelet aggregation/secretion). (2) To test whether red wine supplementation modified these variables, independently of the diet.
  DESIGN, SUBJECTS AND INTERVENTION:: Controlled prospective intervention study. Two groups, each consisting of 21 healthy male university students (22+/-3.4 y), received either MD or HFD during 90 days. Between days 30 and 60, both diets were supplemented with 240 ml/day of red wine. Baseline (T0) and T30, T60 and T90-day samples were drawn. Bleeding time was measured before (day 30) and after (day 60) wine supplementation. No drop out from the study was experienced.
  SETTING:: University campus and outpatient nutrition clinic.
  RESULTS:: All baseline (day 0) variables did not differ significantly between study groups. On day 30, individuals on MD had significantly higher levels of plasma beta-carotene, folate, ascorbate, and eicosapentaenoic acid in plasma lipid fractions, than those on HFD. Total plasma cholesterol, HDL and LDL did not change significantly in either study group at any time point. After 30 days on each diet, individuals on MD had longer bleeding time (BT) than those on HFD (7.6+/-2.8 vs 5.8+/-1.7 min; P=0.017). BT did not change significantly after I month of wine supplementation (7.1+/-2.0 vs 5.5+/-2.0 min, respectively). Plasma von Willebrand factor (vWF : Ag) on day 0 was 89+/-40 and 111+/-70% in MD and HFD groups, respectively (P=0.21). These values did not change significantly at 30, 60 or 90 days. MD intake was associated with an increase in platelet serotonin secretion (P=0.02) and a marginal increase in platelet aggregation after stimulation with epinephrine (P=0.07). Wine intake resulted in a marginal decrease in platelet (14)C-5-HT secretion with 4 micro M ADP (P=0.07). However, both platelet aggregation and secretion were consistently increased when using collagen as agonist (1 and 2 micro g/ml, P=0.01).
  CONCLUSION:: The longer BT in individuals on MD, obtained independently of red wine, denotes less interaction of platelets with the vascular wall, which could be beneficial from the point of view of cardiovascular (CV) risk. This effect is not explained by changes in the measured haemostatic determinants of BT (plasma vWF, ex vivo platelet function), and might be attributed to other as yet unknown vascular factors. Moderate consumption of red wine results in a significant increase in ex vivo platelet aggregation and secretion after stimulation with collagen. This observation contradicts previous reports, although further studies are required to elucidate the influence of this finding on CV risk.
  SPONSORSHIP:: P. Catholic University of Chile.European Journal of Clinical Nutrition (2003) 57, 439-446. doi:10.1038/sj.ejcn.16001558

PMID: 12627181


Vopr Pitan 2002;71(4):17-9
[Estimation of action of lactoovovegetarian and vegan diets on blood level of atherogenic lipoproteins in healthy people] [Article in Russian]
Medkova IL, Mosiakina LI, Biriukova LS.

  The biochemical status of 72 vegetarians (aged 40-60) was studied; 35 persons kept to a lactoovovegetarian diet and 37 persons followed a vegan diet (vegetable food only). As the results of the investigation showed, almost all of the biochemical parameters of blood tests in the both groups were kept to the physiological norm. A pronounced hypolipidemic effect of both the diets was observed (the total cholesterol level was 5.24 +/- 0.28 mmol/l in the vegetarian group and 3.26 +/- 0.17 mmol/l in the vegan group), some parameters of lipid metabolism in the group of vegan being lower then in the vegetarian group. Thus, the total cholesterol level in the vegan group was lower by 38.7%, the atherogenic coefficient--by 13.8%, the low density cholesterol--by 34.3%, triglicerides--by 28.3%. Although the above mentioned parameters of the vegan group seem to be more satisfactory than those of the vegetarian group, we could not recommend the vegan diet for long periods of time because of deficiency of some nutrients in it.

PMID: 12462949


J Altern Complement Med 2002 Oct;8(5):643-50
  Comment in: J Altern Complement Med. 2002 Dec;8(6):696-7.
Medically supervised water-only fasting in the treatment of borderline hypertension.
Goldhamer AC, Lisle DJ, Sultana P, Anderson SV, Parpia B, Hughes B, Campbell TC. TrueNorth Health Center, Rohnert Park, CA 94928, USA. dracg@att.net

  BACKGROUND: Hypertension-related diseases are the leading causes of morbidity and mortality in industrially developed societies. Surprisingly, 68% of all mortality attributed to high blood pressure (BP) occurs with systolic BP between 120 and 140 mm Hg and diastolic BP below 90 mm Hg. Dietary and lifestyle modifications are effective in the treatment of borderline hypertension. One such lifestyle intervention is the use of medically supervised water-only fasting as a safe and effective means of normalizing BP and initiating health-promoting behavioral changes.
  METHODS: Sixty-eight (68) consecutive patients with borderline hypertension with systolic BP in excess of 119 mm Hg and diastolic BP less than 91 mm Hg were treated in an inpatient setting under medical supervision. The treatment program consisted of a short prefasting period (approximately 1-2 days on average) during which food consumption was limited to fruits and vegetables followed by medically supervised water-only fasting (approximately 13.6 days on average). Fasting was followed by a refeeding period (approximately 6.0 days on average). The refeeding program consisted of a low-fat, low-sodium, plant-based, vegan diet.
  RESULTS: Approximately 82% of the subjects achieved BP at or below 120/80 mm Hg by the end of the treatment program. The mean BP reduction was 20/7 mm Hg, with the greatest decrease being observed for subjects with the highest baseline BP. A linear regression of BP decrease against baseline BP showed that the estimated BP below which no further decrease would be expected was 96.0/67.0 mm Hg at the end of the fast and 99.2/67.3 mm Hg at the end of refeeding. These levels are in agreement with other estimates of the BP below which stroke events are eliminated, thus suggesting that these levels could be regarded as the "ideal" BP values.
  CONCLUSION: Medically supervised water-only fasting appears to be a safe and effective means of normalizing BP and may assist in motivating health-promoting diet and lifestyle changes.

PMID: 12470446


Med Hypotheses 2002 Sep;59(3):268-79
Policosanol safely down-regulates HMG-CoA reductase - potential as a component of the Esselstyn regimen.
McCarty MF. Pantox Laboratories, San Diego 92109, USA.

  Many of the wide-ranging health benefits conferred by statin therapy are mediated, not by reductions in LDL cholesterol, but rather by inhibition of isoprenylation reactions essential to the activation of Rho family GTPases; this may be the mechanism primarily responsible for the favorable impact of statins on risk for ischemic stroke, senile dementia, and fractures, as well as the anti-hypertensive and platelet-stabilizing actions of these drugs. Indeed, the extent of these benefits is such as to suggest that most adults would be wise to take statins; however, owing to the significant expense of statin therapy, as well as to the potential for dangerous side effects that mandates regular physician follow-up, this strategy appears impractical. However, policosanol, a mixture of long-chain aliphatic alcohols extractable from sugar cane wax, has shown cholesterol-lowering potency comparable to that of statins, and yet appears to be devoid of toxic risk. Recent evidence indicates that policosanol down-regulates cellular expression of HMG-CoA reductase, and thus has the potential to suppress isoprenylation reactions much like statins do. Consistent with this possibility, the results of certain clinical and animal studies demonstrate that policosanol has many effects analogous to those of statins that are not likely explained by reductions of LDL cholesterol. However, unlike statins, policosanol does not directly inhibit HMG-CoA reductase, and even in high concentrations it fails to down-regulate this enzyme by more than 50% - thus likely accounting for the safety of this nutraceutical. In light of the fact that policosanol is quite inexpensive and is becoming available as a non-prescription dietary supplement, it may represent a practical resource that could enable the general public to enjoy health benefits comparable to those conferred by statins. In a long-term clinical study enrolling patients with significant symptomatic coronary disease, Esselstyn has demonstrated that a low-fat, whole-food vegan diet, coupled with sufficient statin therapy to maintain serum cholesterol below 150 mg/dL, can stop the progression of coronary disease and virtually eliminate further risk for heart attack. A comparable regimen, in which policosanol is used in place of statins, may represent a practical strategy whereby nearly everyone willing to commit to health-protective eating can either prevent coronary disease, or prevent pre-existing coronary disease from progressing to a life-threatening event.

PMID: 12208152


Vopr Pitan 2002;71(3):11-4 [Vegetarian diet in treating elderly patients with ischemic heart disease (clinico-hemodynamic, biochemical, and hemorheological effects)] [Article in Russian]
Ivanov AN, Medkova IL, Mosiagina LI.

  The inclusion of balanced antiatherogenis of vegetarian diet in a complex of therapeutical means of the patients of ischemic heart disease in elderly age (average age 72.3 years) promotes normalization of clinical and biochemical parameters, correction of lipid metabolism and parameters plasma hemostasis. Vegetarian antiatherogenis the diet is perspective means in treatment of the patients ischemic heart disease of elderly age.

PMID: 12227010


Public Health Nutr 2002 Oct;5(5):645-54
Hypertension and blood pressure among meat eaters, fish eaters, vegetarians and vegans in EPIC-Oxford.
Appleby PN, Davey GK, Key TJ. Cancer Research UK, Epidemiology Unit, University of Oxford, Gibson Building, The Radcliffe Infirmary, UK. Paul.Appleby@cancer.org.uk

  OBJECTIVE: To compare the prevalence of self-reported hypertension and mean systolic and diastolic blood pressures in four diet groups (meat eaters, fish eaters, vegetarians and vegans) and to investigate dietary and other lifestyle factors that might account for any differences observed between the groups.
  DESIGN: Analysis of cross-sectional data from participants in the Oxford cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Oxford). SETTING: United Kingdom.
  SUBJECTS: Eleven thousand and four British men and women aged 20-78 years at blood pressure measurement.
  RESULTS: The age-adjusted prevalence of self-reported hypertension was significantly different between the four diet groups, ranging from 15.0% in male meat eaters to 5.8% in male vegans, and from 12.1% in female meat eaters to 7.7% in female vegans, with fish eaters and vegetarians having similar and intermediate prevalences. Mean systolic and diastolic blood pressures were significantly different between the four diet groups, with meat eaters having the highest values and vegans the lowest values. The differences in age-adjusted mean blood pressure between meat eaters and vegans among participants with no self-reported hypertension were 4.2 and 2.6 mmHg systolic and 2.8 and 1.7 mmHg diastolic for men and women, respectively. Much of the variation was attributable to differences in body mass index between the diet groups.
  CONCLUSIONS: Non-meat eaters, especially vegans, have a lower prevalence of hypertension and lower systolic and diastolic blood pressures than meat eaters, largely because of differences in body mass index.

PMID: 12372158


Am J Clin Nutr 2002 Jul;76(1):93-9
Fruit and vegetable intake and risk of cardiovascular disease in US adults: the first National Health and Nutrition Examination Survey Epidemiologic Follow-up Study.
Bazzano LA, He J, Ogden LG, Loria CM, Vupputuri S, Myers L, Whelton PK Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA.

  BACKGROUND: Epidemiologic studies report inconsistent findings on the association of fruit and vegetable intake with the risk of cardiovascular disease.
  OBJECTIVE: The objective was to examine the relation between fruit and vegetable intake and the risk of cardiovascular disease.
  DESIGN: We studied 9608 adults aged 25-74 y participating in the first National Health and Nutrition Examination Survey Epidemiologic Follow-up Study and free of cardiovascular disease at the time of their baseline examination between 1971 and 1975. Fruit and vegetable intake at baseline was measured with a food-frequency questionnaire. The incidence of and mortality from cardiovascular disease were obtained from medical records and death certificates.
  RESULTS: Over an average of 19 y, 888 strokes (218 fatal), 1786 ischemic heart disease events (639 fatal), 1145 cardiovascular disease deaths, and 2530 all-cause deaths were documented. Consuming fruit and vegetables > or = 3 times/d compared with <1 time/d was associated with a 27% lower stroke incidence [relative risk (RR): 0.73; 95% CI: 0.57, 0.95; P for trend = 0.01), a 42% lower stroke mortality (0.58; 0.33, 1.02; P for trend = 0.05), a 24% lower ischemic heart disease mortality (0.76; 0.56, 1.03; P for trend = 0.07), a 27% lower cardiovascular disease mortality (0.73; 0.58, 0.92; P for trend = 0.008), and a 15% lower all-cause mortality (0.85; 0.72, 1.00; P for trend = 0.02) after adjustment for established cardiovascular disease risk factors.
  CONCLUSION: We showed an inverse association of fruit and vegetable intake with the risk of cardiovascular disease and all-cause mortality in the general US population.

PMID: 12081821


Am J Clin Nutr 2002 May;75(5):880-6
Inverse association of tea and flavonoid intakes with incident myocardial infarction: the Rotterdam Study.
Geleijnse JM, Launer LJ, Van der Kuip DA, Hofman A, Witteman JC Department of Epidemiology & Biostatistics, Erasmus Medical Center, Rotterdam, Netherlands.

  BACKGROUND: Dietary flavonoids may protect against cardiovascular disease, but evidence is still conflicting. Tea is the major source of flavonoids in Western populations.
  OBJECTIVE: The association of tea and flavonoid intake with incident myocardial infarction was examined in the general Dutch population.
  DESIGN: A longitudinal analysis was performed with the use of data from the Rotterdam Study-a population-based study of men and women aged >or=55 y. Diet was assessed at baseline (1990-1993) with a validated semiquantitative food-frequency questionnaire. The analysis included 4807 subjects with no history of myocardial infarction, who were followed until 31 December 1997. Data were analyzed in a Cox regression model, with adjustment for age, sex, body mass index, smoking status, pack-years of cigarette smoking, education level, and daily intakes of alcohol, coffee, polyunsaturated fat, saturated fat, fiber, vitamin E, and total energy. RESULTS: During 5.6 y of follow-up, a total of 146 first myocardial infarctions occurred, 30 of which were fatal. The relative risk (RR) of incident myocardial infarction was lower in tea drinkers with a daily intake >375 mL (RR: 0.57; 95% CI: 0.33, 0.98) than in nontea drinkers. The inverse association with tea drinking was stronger for fatal events (0.30; 0.09, 0.94) than for nonfatal events (0.68; 0.37, 1.26). The intake of dietary flavonoids (quercetin + kaempferol + myricetin) was significantly inversely associated only with fatal myocardial infarction (0.35; 0.13, 0.98) in upper compared with lower tertiles of intake.
  CONCLUSIONS: An increased intake of tea and flavonoids may contribute to the primary prevention of ischemic heart disease.

PMID: 11976162


Am J Clin Nutr 2002 Feb;75(2):191-212
Lipoproteins, nutrition, and heart disease.
Schaefer EJ. Lipid Metabolism Laboratory, Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, and the Lipid and Heart Disease Prevention Program, New England Medical Center, Boston.

  This article reviews the current status of our knowledge of lipoproteins, nutrition, and coronary heart disease (CHD). Special emphasis is placed on CHD risk assessment, dietary intervention studies, diet-gene interactions, and current dietary guidelines and the contributions of my laboratory to these areas. CHD remains a major cause of death and disability, and risk factors include age, sex, hypertension, smoking, diabetes, elevated serum LDL cholesterol, and low HDL cholesterol. Emerging independent risk factors include elevated serum concentrations of lipoprotein(a), remnant lipoproteins, and homocysteine. The cornerstone of CHD prevention is lifestyle modification. Dietary intervention studies support the concepts that restricting saturated fat and cholesterol and increasing the intake of essential fatty acids, especially n - 3 fatty acids, reduces CHD risk. The variability in LDL-cholesterol response to diet is large, related in part to APOE and APOA4 genotype. The use of antioxidants in intervention studies has not been shown to reduce CHD risk. Compliance with dietary recommendations remains a major problem, and directly altering the food supply may be the most effective way to ensure compliance. The available data indicate that the recommendation to use fats, oils, and sugars sparingly for CHD prevention should be modified to a recommendation to use animal, dairy, and hydrogenated fats; tropical oils; egg yolks; and sugars sparingly and to increase the use of vegetables, fruit, and whole grains.

PMID: 11815309


Integrative Cardiac Revitalization: Bypass Surgery, Angioplasty, and Chelation. Benefits, Risks, and Limitations
Sb Lek. 2001;102(4):519-25.
[Effect of a 10-day animal fat-free diet on cholesterol and glucose serum levels, blood pressure and body weight in 50-year-old volunteers] [Article in Czech]
Slavicek J, Kittnar O, Dohnalova A, Trojan S, Novak V, Tichy JA, Trefny ZM. Fyziologicky ustav 1, lekarske fakulty Univerzity Karlovy, Albertov 5, 128 00 Praha 2, Czech Republic.

  The morbidity and mortality of cardiovascular diseases is high in developed countries including Czech Republic. The lifestyle decreases it in 50%. The aim of this work was to ascertain if the short lasting stay without stress and with vegetarian diet (without eggs) and physical activity is able to decrease the main risk factors of cardiovascular diseases. In 106 volunteers, mean age 49.1 (+/- 14.1) years, 83 women and 23 men, the body weight, blood pressure, serum cholesterol and blood glucose (Accutrend GC, Boehringer, Mannheim, BRD) have been measured before and after the stay at the same conditions. Eighty persons were healthy, seven persons with essential hypertension, eight persons with ischemic heart disease, four persons with diabetes mellitus and seven persons with other than cardiovascular diseases. In some persons the lipid spectrum was measured. Cholesterol decreased in blood serum from 4.9 to 4.3 mmol/l (11%--p < 0.01), blood glucose decreased from 4.2 to 3.3 mmol/l (p < 0.05), blood pressure systolic from 121.5 to 117.4 mm Hg (p < 0.01) and diastolic from 76.5 to 73.8 mm Hg (p < 0.05), body weight was not significantly changed. Our results showed, that 10-days lasting stay containing vegetarian diet and physical activity decreased the risk factors of cardiovascular diseases in 50 years-old volunteers.

PMID: 12448204


Z Gerontol Geriatr 2001 Dec;34(6):476-9
[Soluble leukocyte adhesion molecules in vegetarians of various ages] [Article in German]
Purschwitz K, Rassoul F, Reuter W, Purschwitz R, Jahn N, Kellert D, Richter V. Institut fur Laboratoriumsmedizin Klinische Chemie und Molekulare Diagnostik Universitatsklinikum Leipzig Liebigstrasse 27 04103 Leipzig, Germany.

  OBJECTIVES: Upregulation of leukocyte adhesion molecules under atherogenic conditions is accompanied by the release of soluble forms of adhesion molecules into the bloodstream. Vegetarians have a favorable cardiovascular risk profile. The aim of the present study was to assess the levels of circulating E-selectin (cE-selectin), circulating intercellular adhesion molecule-1 (cICAM-1), and circulating vascular adhesion molecule-1 (cVCAM-1) in both vegetarians and subjects of the average population and furthermore to evaluate the age dependence of cell adhesion molecules.
  METHODS: 24 male and 59 female vegetarians (mainly members of the German Society of Vegetarians) and 124 male and 179 female control subjects (volunteers, of the ILSE study Leipzig = Interdisciplinary Long Time Study of Health Adult Age and the Lipid-Study Leipzig), 18-89 years old were included in the study. The serum levels of circulating cell adhesion molecules were determined using monoclonal antibody-based ELISA assays (R & D Systems, Abingdon, Europe Ltd.).
  RESULTS: Vegetarians were characterized by a favorable lipid profile and a low prevalence of common risk factors for atherosclerosis. This group showed a tendency towards lower cICAM-1 levels in comparison with control subjects. Furthermore, significantly lower cE-selectin levels were found in the group of vegetarians. An age-dependent increase of cVCAM-1 and cICAM-1 levels was found both in the group of vegetarians and control subjects. No significant differences were noted regarding the gender of the subjects included in the study.
  CONCLUSION: Low cE-selectin levels of vegetarians may reflect the favorable cardiovascular risk profile of this group. Furthermore, the present data indicate that cVCAM-1 and cICAM-1 are age-dependent parameters independent of risk for atherosclerosis.

PMID: 11828888


P N G Med J 2001 Sep-Dec;44(3-4):135-50
Superiority of traditional village diet and lifestyle in minimizing cardiovascular disease risk in Papua New Guineans.
Kende M., Department of Pathology, Port Moresby General Hospital, Boroko, Papua New Guinea.

  In the traditional society of Papua New Guinea (PNG) atherosclerotic cardiovascular diseases (CVD) are rare. However, among the urban population reports of cases of atheroma-related CVD are increasing. The purpose of this study was therefore to compare the CVD risk factors in a homogeneous population of the Southern Highlands Province living in both rural and urban areas differing only in their diet and lifestyle. A total of 221 Samberigi people over the age of 25 years were selected for the survey. These included 123 individuals from remote villages of Samberigi and 98 of their relatives who had lived in Port Moresby city continuously for a minimum of 5 years. The anthropometric measurements, blood lipid, blood glucose and glycosylated haemoglobin (HbA1c) levels were measured and compared. The rural diets were mainly of vegetarian type, limited in variety and low in fat and protein content. In the urban subjects, the typical meal comprised refined foods with high fat and protein content. The urban men and women had significantly (p < 0.05) greater body weight, body mass index (BMI), and waist and hip circumferences than their rural counterparts. In Port Moresby, 57% of the men and 67% of the women were overweight or obese compared to 28% of their rural counterparts. Similarly, the mean plasma total cholesterol, low-density lipoprotein cholesterol (LDLC), high-density lipoprotein cholesterol (HDLC), fasting blood glucose and HbA1c were significantly higher in the urban group. However, no significant differences were demonstrated for waist to hip ratio, LDLC/HDLC ratio and lipoprotein (a) levels between the two groups. The total cholesterol, LDLC and HbA1c were positively associated with age and BMI in both rural and urban locations. In conclusion, there were significant increases in CVD risk factors in the urban population compared to the rural residents. This was predominantly due to the adoption of a western lifestyle and diet as people moved from rural villages to the city of Port Moresby.

PMID: 12422985


Prev Cardiol. 2001 Autumn;4(4):171-177.
Resolving the Coronary Artery Disease Epidemic Through Plant-Based Nutrition.
Esselstyn CB Jr. Cleveland Clinic Foundation, Cleveland, OH 44195.

  The world's advanced countries have easy access to plentiful high-fat food; ironically, it is this rich diet that produces atherosclerosis. In the world's poorer nations, many people subsist on a primarily plant-based diet, which is far healthier, especially in terms of heart disease. To treat coronary heart disease, a century of scientific investigation has produced a device-driven, risk factor-oriented strategy. Nevertheless, many patients treated with this approach experience progressive disability and death. This strategy is a rear-guard defensive one. In contrast, compelling data from nutritional studies, population surveys, and interventional studies support the effectiveness of a plant-based diet and aggressive lipid lowering to arrest, prevent, and selectively reverse heart disease. In essence, this is an offensive strategy. The single biggest step toward adopting this strategy would be to have United States dietary guidelines support a plant-based diet. An expert committee purged of industrial and political influence is required to assure that science is the basis for dietary recommendations. (c)2001 CHF, Inc.

PMID: 11832674


J Am Coll Cardiol 2001 Jun 1;37(7):1929-35
Post-prandial remnant lipids impair arterial compliance.
Nestel PJ, Shige H, Pomeroy S, Cehun M, Chin-Dusting J. Baker Medical Research Institute, Melbourne, Australia. paul.nestel@baker.edu.au

  OBJECTIVES: We sought to examine the effects of plasma lipids, especially in remnants after a fat meal, on systemic arterial compliance (SAC), a newly recognized cardiovascular risk factor.
  BACKGROUND: Post-prandial remnants correlate with coronary heart disease events through mechanisms that may include vascular dysfunction, although the effect on SAC has not been studied.
  METHODS: Systemic arterial compliance was measured non-invasively over 6 h after a fat meal in 16 subjects with varying plasma triglyceride levels. Changes were related to rises in plasma lipids and remnant lipids. Systemic arterial compliance was measured in 20 subjects after a control low-fat meal.
  RESULTS: The fat meal induced increments in plasma triglyceride and remnant cholesterol and triglyceride (respectively +54%, 50% and 290% at 3 h, analysis of variance <0.001). Systemic arterial compliance fell at 3 h and 6 h by 25% and 27% (analysis of variance <0.001). Baseline SAC correlated significantly with all lipid concentrations at 0, 3 h and 6 h, but only with triglyceride on stepwise regression analysis. The SAC response to the low-fat meal was very small and not significant.
  CONCLUSIONS: This is the first demonstration of SAC becoming impaired after a fat meal. Remnant lipids and plasma total triglyceride appeared to contribute to the fall in SAC.

PMID: 1140113


Metabolism 2001 Apr;50(4):494-503
Effect of a very-high-fiber vegetable, fruit, and nut diet on serum lipids and colonic function. Jenkins DJ, Kendall CW, Popovich DG, Vidgen E, Mehling CC, Vuksan V, Ransom TP, Rao AV, Rosenberg-Zand R, Tariq N, Corey P, Jones PJ, Raeini M, Story JA, Furumoto EJ, Illingworth DR, Pappu AS, Connelly PW. Clinical Nutrition and Risk Factor Modification Center, Department of Medicine, Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Quebec, Canada.

  We tested the effects of feeding a diet very high in fiber from fruit and vegetables. The levels fed were those, which had originally inspired the dietary fiber hypothesis related to colon cancer and heart disease prevention and also may have been eaten early in human evolution. Ten healthy volunteers each took 3 metabolic diets of 2 weeks duration. The diets were: high-vegetable, fruit, and nut (very-high-fiber, 55 g/1,000 kcal); starch-based containing cereals and legumes (early agricultural diet); or low-fat (contemporary therapeutic diet). All diets were intended to be weight-maintaining (mean intake, 2,577 kcal/d). Compared with the starch-based and low-fat diets, the high-fiber vegetable diet resulted in the largest reduction in low-density lipoprotein (LDL) cholesterol (33% +/- 4%, P <.001) and the greatest fecal bile acid output (1.13 +/- 0.30 g/d, P =.002), fecal bulk (906 +/- 130 g/d, P <.001), and fecal short-chain fatty acid outputs (78 +/- 13 mmol/d, P <.001). Nevertheless, due to the increase in fecal bulk, the actual concentrations of fecal bile acids were lowest on the vegetable diet (1.2 mg/g wet weight, P =.002). Maximum lipid reductions occurred within 1 week. Urinary mevalonic acid excretion increased (P =.036) on the high-vegetable diet reflecting large fecal steroid losses. We conclude that very high-vegetable fiber intakes reduce risk factors for cardiovascular disease and possibly colon cancer. Vegetable and fruit fibers therefore warrant further detailed investigation.

PMID: 11288049


Prev Med 2000 Mar;30(3):225-33
Vegan diet-based lifestyle program rapidly lowers homocysteine levels.
DeRose DJ, Charles-Marcel ZL, Jamison JM, Muscat JE, Braman MA, McLane GD, Keith Mullen J. Lifestyle Center of America in Sulphur, Oklahoma 73086, USA. drderose@brightok.net

  BACKGROUND: Plasma homocysteine levels have been directly associated with cardiac disease risk. Current research raises concerns as to whether comprehensive lifestyle approaches including a plant-based diet may interact with other known modulators of homocysteine levels.
  METHODS: We report our observations of homocysteine levels in 40 self-selected subjects who participated in a vegan diet-based lifestyle program. Each subject attended a residential lifestyle change program at the Lifestyle Center of America in Sulphur, Oklahoma and had fasting plasma total homocysteine measured on enrollment and then after 1 week of lifestyle intervention. The intervention included a vegan diet, moderate physical exercise, stress management and spirituality enhancement sessions, group support, and exclusion of tobacco, alcohol, and caffeine. B vitamin supplements known to reduce blood homocysteine levels were not provided. RESULTS: Subjects' mean homocysteine levels fell 13%: from 8.66 micromol/L (SD 2.7 micromol/L) to 7.53 micromol/L (SD 2.12 micromol/L; P < 0.0001). Subgroup analysis showed that homocysteine decreased across a range of demographic and diagnostic categories.
  Conclusions. Our results suggest that broad-based lifestyle interventions favorably impact homocysteine levels. Furthermore, analysis of Lifestyle Center of America program components suggests that other factors in addition to B vitamin intake may be involved in the observed homocysteine lowering.

PMID: 10684746


Klin Med (Mosk) 2000;78(1):21-4
[Blood lipids and intensity of free radical oxidant processes in elderly patients with ischemic heart disease on antiatherogenic vegetarian diet.] [Article in Russian]
Medkova IL, Ivanov AN, Mosiakina LI, Goncharov LF.

  The authors studied the effects of balanced antiatherogenic vegetarian diet enriched with soya bean products on blood lipids and intensity of free radical oxidant processes in elderly patients with ischemic heart disease. 45 patients with dyslipoproteinemia type IIA or IIB were examined for hemodynamic parameters, lipid spectrum and intensity of free radical oxidation. The diet promoted a trend to normalization of central hemodynamics, significantly reduced the level of atherogenic lipids in blood, improved free radical lipid peroxidation and activity of nonenzymatic antioxidant defence

PMID: 10697368


Am J Cardiol 2000 Apr 15;85(8):969-72
Effectiveness of a low-fat vegetarian diet in altering serum lipids in healthy premenopausal women.
Barnard ND, Scialli AR, Bertron P, Hurlock D, Edmonds K, Talev L. Physicians Committee for Responsible Medicine, Washington DC, USA. nbarnard@pcrm.org

  Few controlled trials have studied cholesterol-lowering diets in premenopausal women. None has examined the cholesterol-lowering effect of a low-fat vegetarian diet, which, in other population groups, leads to marked reductions in serum cholesterol concentrations and, in combination with other life-style changes, a regression of atherosclerosis. We tested the hypothesis that a low-fat, vegetarian diet significantly reduces serum total and low-density lipoprotein (LDL) cholesterol concentrations in premenopausal women. In a crossover design, 35 women, aged 22 to 48, followed a low-fat vegetarian diet deriving approximately 10% of energy from fat for 2 menstrual cycles. For 2 additional cycles, they followed their customary diet while also taking a "supplement" (placebo) pill. Serum lipid concentrations were assessed at baseline and during each intervention phase. Mean serum LDL, high-density lipoprotein (HDL), and total cholesterol concentrations decreased 16. 9%, 16.5%, and 13.2%, respectively, from baseline to the intervention diet phase (p<0.001), whereas mean serum triacylglycerol concentration increased 18.7% (p<0.01). LDL/HDL ratio remained unchanged. Thus, in healthy premenopausal women, a low-fat vegetarian diet led to rapid and sizable reductions in serum total, LDL, and HDL cholesterol concentrations.

PMID: 10760336


J Nutr 2000 Jun;130(6):1591-6
LDL of Taiwanese vegetarians are less oxidizable than those of omnivores.
Lu SC, Wu WH, Lee CA, Chou HF, Lee HR, Huang PC. Department of Biochemistry, College of Medicine, National Taiwan University, Taipei, Taiwan.

  The vegetarians in Taiwan consume diets high in polyunsaturated fatty acids. To investigate whether this dietary pattern results in high susceptibility of LDL to oxidation, 109 long-term (8 +/- 5 y) male and female vegans and lactovegetarians (ages 31-45 y) from Taipei and females from Hualien and matched omnivores were recruited to have 24-h-recall dietary assessments and blood lipid analysis. Body mass index and blood pressure were significantly lower in all vegetarian groups than in the matched omnivore groups (P < 0.05). Vegetarians consumed less energy except in the males and less protein, fat and cholesterol (P < 0.05). The mean polyunsaturated/saturated fatty acid (P/S) ratio of 2.4 in vegetarian diet was about two times that in omnivore diet (P < 0. 001). The concentrations of plasma total- and LDL-cholesterol (LDL-C) but not HDL-cholesterol (HDL-C) were significantly lower (P < 0.001) and resulting HDL-C/LDL-C ratio was 38, 46 and 30% higher (P < 0.01) in Taipei female, male and Hualien female vegetarians, respectively, than in the matched omnivores. Plasma triglyceride concentration was significantly lower only in the Hualien women vegetarians (31%, P < 0.001) than in the matched omnivores. The lag time of conjugated diene formation in LDL oxidized in vitro induced by copper was longer in Taipei female (62%, P < 0.001), male (29%, P < 0.05) and Hualien female (38%, P < 0.01), and the production of thiobarbituric acid reactive substances (TBARS) in LDL after 2-4 h of oxidation was 22-32% less (P < 0.005) in Taipei male and Hualien female vegetarians than the matched omnivores. Lag time of LDL oxidation was negatively related to LDL arachidonic (r = -0.55, P = 0.0003) and eicosapentaenoic (r = -0.47, P = 0.003) acid contents. LDL-TBARS production was negatively related to LDL linoleic acid content (r = -0.36, P = 0.023), but positively related to LDL arachidonic (r = 0.56, P = 0.0002) and eicosapentaenoic (r = 0.45, P = 0.004) acids. No significant differences were found in dietary vitamins C and E intakes and plasma LDL alpha-tocopherol concentrations between vegetarians and omnivores. Our results suggest that vegetarian diets decrease the susceptibility of LDL to oxidation despite their higher dietary P/S ratio.

PMID: 10827215


Clin Sci (Colch) 2001 Jan;100(1):25-32
Relationship between the concentrations of plasma phospholipid stearic acid and plasma lipoprotein lipids in healthy men.
Li D. Department of Food Science, RMIT University, Melbourne, Victoria 3000, Australia. d.li@rmit.edu.au

  This study investigated the correlation between the plasma phospholipid (PL) saturated fatty acid (SFA) concentration (as a surrogate marker of SFA intake) and plasma lipid and lipoprotein lipid concentrations in 139 healthy Australian men aged 20-55 years old with widely varying intakes of saturated fat (vegans, n=18; ovolacto vegetarians, n=43; moderate meat eaters, n=60; high meat eaters, n=18). Both the ovolacto vegetarian and vegan groups demonstrated significant decreases in plasma total cholesterol (TC), low-density-lipoprotein cholesterol (LDL-C) and triacylglycerol concentrations compared with both the high-meat-eater and moderate-meat-eater groups. Total SFA and individual SFA [palmitic acid (16:0), stearic acid (18:0) and arachidic acid (20:0)] in the plasma PL were significantly lower in both the ovolacto vegetarian and vegan groups than in both the high- and moderate-meat-eater groups, while myristic acid (14:0) was significantly lower in the vegans than in the high-meat-eaters. Bivariate analysis of the results showed that the plasma PL stearic acid concentration was strongly positively correlated with plasma TC (P<0.0001), LDL-C (P<0.0001) and triacylglycerol (P<0.0001), with r(2) values of 0.655, 0.518 and 0.43 respectively. In multiple linear regression, after controlling for potential confounding factors (such as exercise, dietary group, age, body mass index, plasma PL myristic acid, palmitic acid and arachidic acid, and dietary total fat, saturated fat, cholesterol, carbohydrate and fibre intake), the plasma PL stearic acid concentration was still strongly positively correlated with plasma TC (P<0.0001) and LDL-C (P=0.006) concentrations. Based on the present data, it would seem appropriate for the population to reduce their dietary total SFA intake rather than to replace other SFA with stearic acid.

PMID: 11115414


J Manipulative Physiol Ther 2001 Jun;24(5):335-9
Medically supervised water-only fasting in the treatment of hypertension.
Goldhamer A, Lisle D, Parpia B, Anderson SV, Campbell TC. Center for Conservative Therapy, Penngrove, Calif, USA. dracg@att.net

  BACKGROUND: Hypertension-related diseases are the leading cause of morbidity and mortality in industrially developed societies. Although antihypertensive drugs are extensively used, dietary and lifestyle modifications also are effective in the treatment of patients with hypertension. One such lifestyle intervention is the use of medically supervised, water-only fasting as a safe and effective means of normalizing blood pressure and initiating health-promoting behavioral changes.
  METHODS: One hundred seventy-four consecutive hypertensive patients with blood pressure in excess of 140 mm Hg systolic, 90 mm Hg diastolic (140/90 mm Hg), or both were treated in an inpatient setting under medical supervision. The treatment program consisted of a short prefasting period (approximately 2 to 3 days on average) during which food consumption was limited to fruits and vegetables, followed by medically supervised water-only fasting (approximately 10 to 11 days on average) and a refeeding period (approximately 6 to 7 days on average) introducing a low-fat, low-sodium, vegan diet.
  RESULTS: Almost 90% of the subjects achieved blood pressure less than 140/90 mm Hg by the end of the treatment program. The average reduction in blood pressure was 37/13 mm Hg, with the greatest decrease being observed for subjects with the most severe hypertension. Patients with stage 3 hypertension (those with systolic blood pressure greater than 180 mg Hg, diastolic blood pressure greater than 110 mg Hg, or both) had an average reduction of 60/17 mm Hg at the conclusion of treatment. All of the subjects who were taking antihypertensive medication at entry (6.3% of the total sample) successfully discontinued the use of medication.
  CONCLUSION: Medically supervised water-only fasting appears to be a safe and effective means of normalizing blood pressure and may assist in motivating health-promoting diet and lifestyle changes.

PMID: 11416824


Prostaglandins Leukot Essent Fatty Acids 2001 Jun;64(6):323-30
Plant sterols regulate rat vascular smooth muscle cell growth and prostacyclin release in culture.
Awad AB, Smith AJ, Fink CS. Department of Physical Therapy, Exercise and Nutrition Sciences, State University of NY, Buffalo, USA

  Cardiovascular disease (CVD) is the leading cause of death in the USA and other industrialized countries. A large number of epidemiological studies have established a direct correlation between diet and the development and progression of atherosclerosis. Several studies have shown the incidence of CVD to be lower in populations consuming a predominantly plant-based diet, as compared to meat-based diets. Besides being low in fat and cholesterol, vegetarian and Asian diets contain a large variety of phytochemicals, which may function in the body. For example, phytosterols (PS) are plant sterols that interfere with the absorption of cholesterol from the intestine when present in adequate amounts. Although PS may also function at a cellular level in the body, there are few studies examining the action of PS on cells involved in atherosclerosis. The purpose of this study was to examine the effect of dietary PS on vascular smooth muscle cell (VSMC) growth and function, since VSMC play a central role in the development of atherosclerosis. VSMC were treated with 16 &mgr;M cholesterol, 25-hydroxycholesterol, campesterol and beta -sitosterol (SIT) using an ethanol as a vehicle. Cell growth was determined by cell counting and cell proliferation by DNA synthesis, which was measured by [(3)H]-thymidine incorporation. Cholesterol supplementation had no effect on cell growth and proliferation. 25-Hydroxycholesterol decreased cell growth by 68% and DNA synthesis by 99%. SIT was found to inhibit VSMC growth more effectively than campesterol. Of the two PS, campesterol decreased cell growth by 16% and SIT decreased cell growth by 30%. DNA synthesis was decreased 25% by SIT supplementation but was not influenced by campesterol or cholesterol supplementation. Cholesterol, campesterol and SIT were not cytotoxic to VSMC and did not significantly alter cell viability. 25-Hydroxycholesterol, however, was cytotoxic and decreased cell viability by 45% as determined by lactate dehydrogenase release and a trypan blue dye exclusion test. De novo cholesterol synthesis was decreased 28% by campesterol, 49% by SIT and 23% by cholesterol. beta -Sitosterol exhibited a greater effect on cholesterol synthesis than campesterol or cholesterol supplementation. Measurement of cell sterol content demonstrated incorporation of PS into VSMC at the expense of cholesterol. Campesterol decreased VSMC cholesterol content by 36%, representing 40% of the total sterol content following treatment. beta -Sitosterol decreased VSMC cholesterol by 41% following supplementation and represented 49% of the total sterol amount. Cholesterol treatment did not alter the cholesterol content of the cells. Prostacyclin production was significantly altered by PS treatment. Basal prostacyclin release was increased 43% by campesterol and 81% by SIT. A23187 stimulated prostacyclin release was increased 25% by campesterol and 54% by SIT. SIT supplementation induced a greater effect on prostacyclin release from VSMC than cholesterol or campesterol supplementation. The in vitro results presented here suggest that dietary PS, especially SIT, may offer protection from the VSMC hyperproliferation found in atherosclerosis. Further in vivo research is needed to support these observations. Copyright 2001 Harcourt Publishers Ltd.

PMID: 11427042


Atherosclerosis 2001 Sep;158(1):247-51
Vascular dilatory functions of ovo-lactovegetarians compared with omnivores.
Lin CL, Fang TC, Gueng MK. Division of Cardiology, Department of Internal Medicine, Buddhist Tzu Chi General Hospital, 2 Min-Sheng Road, Dalin, Chia-Yi, Taiwan, ROC. cllinmd@hcc.tcu.edu.tw

  Vegetarians have lower blood pressure and lower cardiovascular mortality. Vegetarian diets may have lower cardiovascular risks through positive influence on endothelium-dependent relaxation and related functions. The objectives of this study were to assess the differences of vascular dilatory functions between middle-aged vegetarians and sex and age-matched omnivores before they develop any clinical manifestations of atherosclerosis. Twenty healthy vegetarians over the age of 50 and 20 healthy omnivores over the age of 50 were recruited for this study. Subjects with known risk factors for atherosclerosis such as hypertension, diabetes, obesity, hypercholesteremia, cigarette smoking, family history of vascular diseases, or taking any regular medication were excluded. Medical history, body weight, height, and duration of vegetarian diet were recorded. Baseline CBC, urinalysis and biochemical data such as fasting blood glucose, thyroid function, blood urea nitrogen, creatinine, serum electrolytes (sodium, potassium, chloride, calcium and magnesium), lipid profiles [total cholesterol, triglycerides, high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol] were obtained after a 14 h fast. Blood pressures and heart rate were recorded in supine position. Vascular dilatory functions, both flow-mediated (endothelium-dependent) and nitroglycerin-induced (endothelium-independent), were evaluated by using a non-invasive ultrasonographic method. The results show that there were no significant differences in the baseline characteristic between the vegetarians and the omnivores. There were also no significant differences in serum glucose, lipid profiles and thyroid function between these two groups. However, vasodilatation responses (both flow-mediated and nitroglycerin-induced) were significantly better in the vegetarian group and the degree of vasodilatation appeared to be correlated with years on vegetarian diets. Our findings suggest that vegetarian diets, by themselves, have a direct beneficial effect on vascular endothelial and smooth muscle function and may help to account for the lower incidence of atherosclerosis and cardiovascular mortality.

PMID: 11500198


Annals of Internal Medicine June 19, 2001 (Volume 134, Number 12)
The Effect of Fruit and Vegetable Intake on Risk for Coronary Heart Disease
Joshipura KJ, Hu FB, Manson JE, et al Ann Intern Med. 2001;134:1106-1114

  Clear associations have been demonstrated between dietary intake and the development of coronary heart disease (CHD). Joshipura and colleagues[1] recently published data showing that patients with a high intake of fruits and vegetables had a decreased risk of developing ischemic stroke.
   In this study, the authors evaluate the potential association between the intake of fruits and vegetables to the incidence of coronary heart disease. The population of this study was culled from 2 studies that have been well covered in the literature. The Nurses' Health Study[2] began in 1976 when 121,700 female nurses aged 30-55 years were enrolled. The Health Professionals' Follow-up Study[3] began in 1986, enrolling 51,529 male health professionals aged 40-75 years. Patients for the current study were excluded if they had incomplete dietary assessments, previously diagnosed cancer, diabetes, or cardiovascular disease. The eligible patient population consisted of 84,251 women (followed for 14 years) and 42,138 men (followed for 8 years).
  The primary end points analyzed were nonfatal myocardial infarction and fatal coronary disease between 1980 and 1994 for women and between 1986 and 1994 for men. Diet was assessed for the women using a 61-item questionnaire regarding dietary intake of 6 fruit items, 11 vegetable items, and 3 potato items, which was expanded in 1984 to 126 questions that expanded the number of food items (15 fruit items and 28 vegetable items plus potatoes). The men's survey was similar although it included 131 dietary questions. The data recorded by the patient was converted into average daily intake for data analysis.
  There were 1127 cases of CHD among the women surveyed, compared with 1063 cases among the men. Because of sex-related differences and different surveys were administered to each group, data analyses were performed separately. At baseline, participants with a higher intake of fruits and vegetables had healthier lifestyles. These individuals were less likely to smoke and more likely to use multivitamin and vitamin E supplements. For women, the median fruit and vegetable intake was 5.8 servings/day compared with 5.1 servings/day for men. Each 1 serving/day increase in intake, adjusted for age, caloric intake, and time period yielded a relative risk of 0.87 (95% confidence interval [CI], 0.84 to 0.91) and 0.94 (95% CI, 0.02 to 0.97) among women and men, respectively.
   Smoking adjustment increased the relative risk for both groups, although barely maintaining statistical significance. Multiple adjustments of the data were performed for dietary and nondietary factors that showed trends (sometimes significant) for increased intake of fruits and vegetables leading to decreased risk of coronary heart disease. In terms of dietary intake, consumption of more than 8 servings/day was associated with a statistically significant decrease in relative risk for CHD (P = .01) in patients (intake > 4-8 servings/day was associated with a slight but nonsignificant decrease in risk).
  Greater consumption of leafy green and cruciferous vegetables, and vitamin C-rich fruits and vegetables was associated with the lowest risk.
  This study represents the gold standard for prospective cohort evaluation in terms of design. However the conversion by way of self-reported surveys to quantify average daily intake is somewhat crude and may provide inaccurate data. Given the results of the authors' previous work involving ischemic stroke[1] and the apparent trend in decreased CHD presented, there appears to be a benefit to fruit and vegetable intake for thrombotic or atherosclerotic disease.

  References:
[1]  Joshipura KJ, Ascherio A, Manson JE, et al. Fruit and vegetable intake in relation to risk of ischemic stroke. JAMA. 1999;282:1233-1239.

[2]  Hu FB, Stampfer MJ, Manson JE, et al. Dietary fat intake and the risk of coronary heart disease in women. N Engl J Med. 1997;337:1491-1499.

[3]  Rimm EB, Stampfer MJ, Ascherio A, Giovannucci E, Colditz GA, Willett WC. Vitamin E consumption and the risk of coronary heart disease in men. N Engl J Med. 1993;328:1450-1456.


J Am Coll Nutr 2000 Oct;19(5):622-7
Vegetarianism and ischemic heart disease in older Chinese women.
Kwok TK, Woo J, Ho S, Sham A. Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong. TKWOK@UHK.EDU.HK

  OBJECTIVE: This study compared the risk of ischemic heart disease among older vegetarian Chinese women with that of older non-vegetarian women.
  METHODS: 90 vegetarian Chinese women over 70 years old in Hong Kong were screened for ischemic heart disease by electrocardiogram (ECG) and cardiovascular questionnaire. They were compared with 90 non-vegetarian women of similar age examined in a previous local survey. The effects of confounding factors were adjusted by stepwise logistic regression analysis.
  RESULTS: The percentages of subjects with ischemic heart disease defined by symptoms and ECG or by ECG alone were significantly lower in vegetarian women (p <0.005 and p<0.05 respectively). Vegetarians had lower serum cholesterol levels: more were old age home residents and were less likely to perform regular exercise. On stepwise logistic regression, using probable ischemic heart disease defined by questionnaire and ECG as outcome measure, vegetarianism was the only significant predictor (OR 0.3, 95%CI 0.1-0.6, p<0.005).
  CONCLUSIONS: Vegetarian older Chinese women had lower risk of ischemic heart disease when compared with non-vegetarians. Apart from lower serum cholesterol levels, vegetarianism may have other protective factors against ischemic heart disease.

PMID: 11022876


J Nutr 2000 Jun;130(6):1591-6
LDL of Taiwanese vegetarians are less oxidizable than those of omnivores.
Lu SC, Wu WH, Lee CA, Chou HF, Lee HR, Huang PC. Department of Biochemistry, College of Medicine, National Taiwan University, Taipei, Taiwan.

  The vegetarians in Taiwan consume diets high in polyunsaturated fatty acids. To investigate whether this dietary pattern results in high susceptibility of LDL to oxidation, 109 long-term (8 +/- 5 y) male and female vegans and lactovegetarians (ages 31-45 y) from Taipei and females from Hualien and matched omnivores were recruited to have 24-h-recall dietary assessments and blood lipid analysis. Body mass index and blood pressure were significantly lower in all vegetarian groups than in the matched omnivore groups (P < 0.05). Vegetarians consumed less energy except in the males and less protein, fat and cholesterol (P < 0.05). The mean polyunsaturated/saturated fatty acid (P/S) ratio of 2.4 in vegetarian diet was about two times that in omnivore diet (P < 0. 001). The concentrations of plasma total- and LDL-cholesterol (LDL-C) but not HDL-cholesterol (HDL-C) were significantly lower (P < 0.001) and resulting HDL-C/LDL-C ratio was 38, 46 and 30% higher (P < 0.01) in Taipei female, male and Hualien female vegetarians, respectively, than in the matched omnivores. Plasma triglyceride concentration was significantly lower only in the Hualien women vegetarians (31%, P < 0.001) than in the matched omnivores. The lag time of conjugated diene formation in LDL oxidized in vitro induced by copper was longer in Taipei female (62%, P < 0.001), male (29%, P < 0.05) and Hualien female (38%, P < 0.01), and the production of thiobarbituric acid reactive substances (TBARS) in LDL after 2-4 h of oxidation was 22-32% less (P < 0.005) in Taipei male and Hualien female vegetarians than the matched omnivores. Lag time of LDL oxidation was negatively related to LDL arachidonic (r = -0.55, P = 0.0003) and eicosapentaenoic (r = -0.47, P = 0.003) acid contents. LDL-TBARS production was negatively related to LDL linoleic acid content (r = -0.36, P = 0.023), but positively related to LDL arachidonic (r = 0.56, P = 0.0002) and eicosapentaenoic (r = 0.45, P = 0.004) acids. No significant differences were found in dietary vitamins C and E intakes and plasma LDL alpha-tocopherol concentrations between vegetarians and omnivores. Our results suggest that vegetarian diets decrease the susceptibility of LDL to oxidation despite their higher dietary P/S ratio.

PMID: 10827215


QJM. 1999 Sep;92(9):531-44.
Comment in: QJM. 2000 Jun;93(6):387.
Vegetarian diet: panacea for modern lifestyle diseases?
Segasothy M, Phillips PA. Department of Medicine, Northern Territory Clinical School of Medicine of Flinders University, Alice Springs, Australia. m.segasothy@nt.gov.au

  We review the beneficial and adverse effects of vegetarian diets in various medical conditions. Soybean-protein diet, legumes, nuts and soluble fibre significantly decrease total cholesterol, low-density lipoprotein cholesterol and triglycerides. Diets rich in fibre and complex carbohydrate, and restricted in fat, improve control of blood glucose concentration, lower insulin requirement and aid in weight control in diabetic patients. An inverse association has been reported between nut, fruit, vegetable and fibre consumption, and the risk of coronary heart disease. Patients eating a vegetarian diet, with comprehensive lifestyle changes, have had reduced frequency, duration and severity of angina as well as regression of coronary atherosclerosis and improved coronary perfusion. An inverse association between fruit and vegetable consumption and stroke has been suggested. Consumption of fruits and vegetables, especially spinach and collard green, was associated with a lower risk of age-related ocular macular degeneration. There is an inverse association between dietary fibre intake and incidence of colon and breast cancer as well as prevalence of colonic diverticula and gallstones. A decreased breast cancer risk has been associated with high intake of soy bean products. The beneficial effects could be due to the diet (monounsaturated and polyunsaturated fatty acids, minerals, fibre, complex carbohydrate, antioxidant vitamins, flavanoids, folic acid and phytoestrogens) as well as the associated healthy lifestyle in vegetarians. There are few adverse effects, mainly increased intestinal gas production and a small risk of vitamin B12 deficiency.

PMID: 10627874


Br J Nutr 1999 Sep;82(3):193-201
Blood cholesterol and apolipoprotein B levels in relation to intakes of animal and plant proteins in US adults.
Smit E, Nieto FJ, Crespo CJ. Department of Epidemiology, Johns Hopkins University, Baltimore, MD 21205, USA. esmit@jhsph.edu

  Few studies have examined the association between specific sources of protein and blood lipids in a national sample of adults. We examined this relationship in a sample of adults 20 years and older who participated in phase 1 (1988-91) of the Third National Health and Nutrition Examination Survey, a representative sample of the United States non-institutionalized population. After excluding those participants who reported having been told they had high blood cholesterol concentrations, the final sample size was 6228. Mean intakes of different sources of proteins, as a percentage of total protein, were compared in quartiles of blood lipids. Intakes were adjusted for age, sex and race. Additional adjustments were made for other dietary variables, recall day, BMI, smoking, and income. We observed a lower percentage meat, fish and poultry (MFP) protein intake, including a lower percentage of beef and pork protein, among persons in the lowest quartile of serum total cholesterol and apolipoprotein B (ApoB) concentrations than among persons in the higher quartiles. The percentage of plant protein intake was higher in the lowest quartile than in the highest quartile of serum cholesterol. We also observed a higher percentage of fruit protein intake with lower serum cholesterol and ApoB concentrations. We conclude that in this cross-sectional sample, consumption of MFP proteins was consistently higher among persons with higher cholesterol concentrations while consumption of plant proteins was consistently higher among persons with lower cholesterol concentrations. Our findings support the importance of assessing intake of specific protein sources, especially in studies that address dietary intake in relation to blood lipids.

PMID: 10655966


J Am Diet Assoc 1999 Aug;99(8 Suppl):S12-8
Dietary Approaches to Stop Hypertension: rationale, design, and methods.
DASH Collaborative Research Group. Vogt TM, Appel LJ, Obarzanek E, Moore TJ, Vollmer WM, Svetkey LP, Sacks FM, Bray GA, Cutler JA, Windhauser MM, Lin PH, Karanja NM. Kaiser Permanente Center for Health Research, Honolulu, Hawaii 96813, USA.

  Epidemiologic studies across societies have shown consistent differences in blood pressure that appear to be related to diet. Vegetarian diets are consistently associated with reduced blood pressure in observational and interventional studies, but clinical trials of individual nutrient supplements have had an inconsistent pattern of results. Dietary Approaches to Stop Hypertension (DASH) was a multicenter, randomized feeding study, designed to compare the impact on blood pressure of 3 dietary patterns. DASH was designed as a test of eating patterns rather than of individual nutrients in an effort to identify practical, palatable dietary approaches that might have a meaningful impact on reducing morbidity and mortality related to blood pressure in the general population. The objectives of this article are to present the scientific rationale for this trial, review the methods used, and discuss important design considerations and implications.

PMID: 10450289


Am J Clin Nutr 1999 Sep;70(3 Suppl):516S-524S
Mortality in vegetarians and nonvegetarians: detailed findings from a collaborative analysis of 5 prospective studies.
Key TJ, Fraser GE, Thorogood M, Appleby PN, Beral V, Reeves G, Burr ML, Chang-Claude J, Frentzel-Beyme R, Kuzma JW, Mann J, McPherson K. Imperial Cancer Research Fund, Cancer Epidemiology Unit, Oxford, United Kingdom. key@icrf.icnet.uk

  We combined data from 5 prospective studies to compare the death rates from common diseases of vegetarians with those of nonvegetarians with similar lifestyles. A summary of these results was reported previously; we report here more details of the findings. Data for 76172 men and women were available. Vegetarians were those who did not eat any meat or fish (n = 27808). Death rate ratios at ages 16-89 y were calculated by Poisson regression and all results were adjusted for age, sex, and smoking status. A random-effects model was used to calculate pooled estimates of effect for all studies combined. There were 8330 deaths after a mean of 10.6 y of follow-up. Mortality from ischemic heart disease was 24% lower in vegetarians than in nonvegetarians (death rate ratio: 0.76; 95% CI: 0.62, 0.94; P<0.01). The lower mortality from ischemic heart disease among vegetarians was greater at younger ages and was restricted to those who had followed their current diet for >5 y. Further categorization of diets showed that, in comparison with regular meat eaters, mortality from ischemic heart disease was 20% lower in occasional meat eaters, 34% lower in people who ate fish but not meat, 34% lower in lactoovovegetarians, and 26% lower in vegans. There were no significant differences between vegetarians and nonvegetarians in mortality from cerebrovascular disease, stomach cancer, colorectal cancer, lung cancer, breast cancer, prostate cancer, or all other causes combined.

PMID: 10479225


Proc Nutr Soc 1999 May;58(2):271-5
Health benefits of a vegetarian diet.
Key TJ, Davey GK, Appleby PN. Imperial Cancer Research Fund, Cancer Epidemiology Unit, University of Oxford, Radcliffe Infirmary, UK. key@icrf.icnet.uk

  Compared with non-vegetarians, Western vegetarians have a lower mean BMI (by about 1 kg/m2), a lower mean plasma total cholesterol concentration (by about 0.5 mmol/l), and a lower mortality from IHD (by about 25%). They may also have a lower risk for some other diseases such as constipation, diverticular disease, gallstones and appendicitis. No differences in mortality from common cancers have been established. There is no evidence of adverse effects on mortality. Much more information is needed, particularly on other causes of death, other morbidity including osteoporosis, and long-term health in vegans. The evidence available suggests that widespread adoption of a vegetarian diet could prevent approximately 40,000 deaths from IHD in Britain each year.

PMID: 10466166


Am J Clin Nutr 1999 Sep;70(3 Suppl):532S-538S
Associations between diet and cancer, ischemic heart disease, and all-cause mortality in non-Hispanic white California Seventh-day Adventists.
Fraser GE. Center for Health Research and the Department of Epidemiology and Biostatistics, Loma Linda University, CA 92350, USA. gfraser@sph.llu.edu

  Results associating diet with chronic disease in a cohort of 34192 California Seventh-day Adventists are summarized. Most Seventh-day Adventists do not smoke cigarettes or drink alcohol, and there is a wide range of dietary exposures within the population. About 50% of those studied ate meat products <1 time/wk or not at all, and vegetarians consumed more tomatoes, legumes, nuts, and fruit, but less coffee, doughnuts, and eggs than did nonvegetarians. Multivariate analyses showed significant associations between beef consumption and fatal ischemic heart disease (IHD) in men [relative risk (RR) = 2.31 for subjects who ate beef > or =3 times/wk compared with vegetarians], significant protective associations between nut consumption and fatal and nonfatal IHD in both sexes (RR approximately 0.5 for subjects who ate nuts > or =5 times/wk compared with those who ate nuts <1 time/wk), and reduced risk of IHD in subjects preferring whole-grain to white bread. The lifetime risk of IHD was reduced by approximately 31% in those who consumed nuts frequently and by 37% in male vegetarians compared with nonvegetarians. Cancers of the colon and prostate were significantly more likely in nonvegetarians (RR of 1.88 and 1.54, respectively), and frequent beef consumers also had higher risk of bladder cancer. Intake of legumes was negatively associated with risk of colon cancer in nonvegetarians and risk of pancreatic cancer. Higher consumption of all fruit or dried fruit was associated with lower risks of lung, prostate, and pancreatic cancers. Cross-sectional data suggest vegetarian Seventh-day Adventists have lower risks of diabetes mellitus, hypertension, and arthritis than nonvegetarians. Thus, among Seventh-day Adventists, vegetarians are healthier than nonvegetarians but this cannot be ascribed only to the absence of meat.

PMID: 10479227


Public Health Nutr 1998 Mar;1(1):33-41
Mortality in vegetarians and non-vegetarians: a collaborative analysis of 8300 deaths among 76,000 men and women in five prospective studies.
Key TJ, Fraser GE, Thorogood M, Appleby PN, Beral V, Reeves G, Burr ML, Chang-Claude J, Frentzel-Beyme R, Kuzma JW, Mann J, McPherson K Imperial Cancer Research Fund, Cancer Epidemiology Unit, Oxford, UK. key@icrf.icnet.uk

  OBJECTIVE: To compare the mortality rates of vegetarians and non-vegetarians. DESIGN: Collaborative analysis using original data from five prospective studies. Death rate ratios for vegetarians compared to non-vegetarians were calculated for ischaemic heart disease, cerebrovascular disease, cancers of the stomach, large bowel, lung, breast and prostate, and for all causes of death. All results were adjusted for age, sex and smoking. A random effects model was used to calculate pooled estimates of effect for all studies combined. SETTING: USA, UK and Germany. SUBJECTS: 76,172 men and women aged 16-89 years at recruitment. Vegetarians were those who did not eat any meat or fish (n = 27,808). Non-vegetarians were from a similar background to the vegetarians within each study. RESULTS: After a mean of 10.6 years of follow-up there were 8330 deaths before the age of 90 years, including 2264 deaths from ischaemic heart disease. In comparison with non-vegetarians, vegetarians had a 24% reduction in mortality from ischaemic heart disease (death rate ratio 0.76, 95% CI 0.62-0.94). The reduction in mortality among vegetarians varied significantly with age at death: rate ratios for vegetarians compared to non-vegetarians were 0.55 (95% CI 0.35-0.85), 0.69 (95% CI 0.53-0.90) and 0.92 (95% CI 0.73-1.16) for deaths from ischaemic heart disease at ages <65, 65-79 and 80-89 years, respectively. When the non-vegetarians were divided into regular meat eaters (who ate meat at least once a week) and semi-vegetarians (who ate fish only or ate meat less than once a week), the ischaemic heart disease death rate ratios compared to regular meat eaters were 0.78 (95% CI 0.68-0.89) in semi-vegetarians and 0.66 (95% CI 0.53-0.83) in vegetarians (test for trend P< 0.001). There were no significant differences between vegetarians and non-vegetarians in mortality from the other causes of death examined. CONCLUSION: Vegetarians have a lower risk of dying from ischaemic heart disease than non-vegetarians.

PMID: 10555529


JAMA 1998 Dec 16;280(23):2001-7 Erratum in: JAMA 1999 Apr 21;281(15):1380 Comment in: JAMA. 1999 Jul 14;282(2):130; discussion 131-2 JAMA. 1999 Jul 14;282(2):131-2
Intensive lifestyle changes for reversal of coronary heart disease.
Ornish D, Scherwitz LW, Billings JH, Brown SE, Gould KL, Merritt TA, Sparler S, Armstrong WT, Ports TA, Kirkeeide RL, Hogeboom C, Brand RJ. Department of Medicine, California Pacific Medical Center, San Francisco, USA. DeanOrnish@aol.com

  CONTEXT: The Lifestyle Heart Trial demonstrated that intensive lifestyle changes may lead to regression of coronary atherosclerosis after 1 year.
  OBJECTIVES: To determine the feasibility of patients to sustain intensive lifestyle changes for a total of 5 years and the effects of these lifestyle changes (without lipid-lowering drugs) on coronary heart disease.
  DESIGN: Randomized controlled trial conducted from 1986 to 1992 using a randomized invitational design.
  PATIENTS: Forty-eight patients with moderate to severe coronary heart disease were randomized to an intensive lifestyle change group or to a usual-care control group, and 35 completed the 5-year follow-up quantitative coronary arteriography.
  SETTING: Two tertiary care university medical centers.
  INTERVENTION: Intensive lifestyle changes (10% fat whole foods vegetarian diet, aerobic exercise, stress management training, smoking cessation, group psychosocial support) for 5 years.
  MAIN OUTCOME MEASURES: Adherence to intensive lifestyle changes, changes in coronary artery percent diameter stenosis, and cardiac events.
  RESULTS: Experimental group patients (20 [71%] of 28 patients completed 5-year follow-up) made and maintained comprehensive lifestyle changes for 5 years, whereas control group patients (15 [75%] of 20 patients completed 5-year follow-up) made more moderate changes. In the experimental group, the average percent diameter stenosis at baseline decreased 1.75 absolute percentage points after 1 year (a 4.5% relative improvement) and by 3.1 absolute percentage points after 5 years (a 7.9% relative improvement). In contrast, the average percent diameter stenosis in the control group increased by 2.3 percentage points after 1 year (a 5.4% relative worsening) and by 11.8 percentage points after 5 years (a 27.7% relative worsening) (P=.001 between groups. Twenty-five cardiac events occurred in 28 experimental group patients vs 45 events in 20 control group patients during the 5-year follow-up (risk ratio for any event for the control group, 2.47 [95% confidence interval, 1.48-4.20]).
  CONCLUSIONS: More regression of coronary atherosclerosis occurred after 5 years than after 1 year in the experimental group. In contrast, in the control group, coronary atherosclerosis continued to progress and more than twice as many cardiac events occurred.

PMID: 9863851


Clinical Biochemistry, 1998, 31:7:545-549
Blood pressure and blood lipid levels among vegetarian, semi-vegetarian, and non-vegetarian native Africans
Ademola Adekunle Famodu, Odutola Osilesi, Yetunde Olawumi Makinde and Olusoga Adewale Osonuga

  Abstract Background: Several epidemiological studies have implicated hypercholesterolemia and hypertriglyceridaemia as a dietary risk factor in the etiology of vascular desease. To date, there are virtually no blood lipid data available for Negroid Black African Seventh-Day Adventist vegetarians. This study was undertaken to gain a preliminary and better understanding of the relationships between BP, blood lipids, and diets in adults at the Seventh-Day Adventist Seminary of West Africa, Ilisan-Remo, Nigeria. Methods: Three randomly selected groups of the Nigerian populace with different dietary habits were investigated. The Seventh-Day Adventist Seminary of West Africa was the study area. Anthropometric measurements, blood pressure, serum cholesterol, triglycerides, and serum glucose were estimated using standard methods. Findings: The vegetarians (VEGs) had significantly lower body weight 75.0 1.9 kg than the semi-vegetarians (SEMI-VEGs) 77.3 1.8 kg (p < 0.05). There was no significant difference between the blood pressure (BP) of the three groups studied, although the VEGs exhibited lower systolic BP. The VEGs had significantly lower serum total cholesterol and triglycerides (p < 0.05), than non-vegetarians (NON-VEGs). The SEMI-VEGs had blood triglycerides values inbetween NON-VEGs and VEGs levels but these were not significant. There were no differences in blood glucose in the three groups. Conclusions: The vegetarian diet as well as the African natural diet are associated with lower levels of important cardiovascular disease risk factors. The significantly lower cardiovascular disease risk factors in vegetarian African Adventists could be a protective measure against the development of premature IHD and CVD incidence.


Public Health Nutr 1998 Mar;1(1):33-41
Mortality in vegetarians and non-vegetarians: a collaborative analysis of 8300 deaths among 76,000 men and women in five prospective studies.
Key TJ, Fraser GE, Thorogood M, Appleby PN, Beral V, Reeves G, Burr ML, Chang-Claude J, Frentzel-Beyme R, Kuzma JW, Mann J, McPherson K. Imperial Cancer Research Fund, Cancer Epidemiology Unit, Oxford, UK. key@icrf.icnet.uk

  OBJECTIVE: To compare the mortality rates of vegetarians and non-vegetarians.
  DESIGN: Collaborative analysis using original data from five prospective studies. Death rate ratios for vegetarians compared to non-vegetarians were calculated for ischaemic heart disease, cerebrovascular disease, cancers of the stomach, large bowel, lung, breast and prostate, and for all causes of death. All results were adjusted for age, sex and smoking. A random effects model was used to calculate pooled estimates of effect for all studies combined.
  SETTING: USA, UK and Germany.
  SUBJECTS: 76,172 men and women aged 16-89 years at recruitment. Vegetarians were those who did not eat any meat or fish (n = 27,808). Non-vegetarians were from a similar background to the vegetarians within each study.
  RESULTS: After a mean of 10.6 years of follow-up there were 8330 deaths before the age of 90 years, including 2264 deaths from ischaemic heart disease. In comparison with non-vegetarians, vegetarians had a 24% reduction in mortality from ischaemic heart disease (death rate ratio 0.76, 95% CI 0.62-0.94). The reduction in mortality among vegetarians varied significantly with age at death: rate ratios for vegetarians compared to non-vegetarians were 0.55 (95% CI 0.35-0.85), 0.69 (95% CI 0.53-0.90) and 0.92 (95% CI 0.73-1.16) for deaths from ischaemic heart disease at ages <65, 65-79 and 80-89 years, respectively. When the non-vegetarians were divided into regular meat eaters (who ate meat at least once a week) and semi-vegetarians (who ate fish only or ate meat less than once a week), the ischaemic heart disease death rate ratios compared to regular meat eaters were 0.78 (95% CI 0.68-0.89) in semi-vegetarians and 0.66 (95% CI 0.53-0.83) in vegetarians (test for trend P< 0.001). There were no significant differences between vegetarians and non-vegetarians in mortality from the other causes of death examined.
  CONCLUSION: Vegetarians have a lower risk of dying from ischaemic heart disease than non-vegetarians
.

PMID: 10555529


Heart 1997 Nov;78(5):450-5
Dietary determinants of ischaemic heart disease in health conscious individuals.
Mann JI, Appleby PN, Key TJ, Thorogood M. Department of Human Nutrition, University of Otago, Dunedin, New Zealand.

  OBJECTIVE: To investigate dietary determinants of ischaemic heart disease (IHD) in health conscious individuals to explain the reduced risk in vegetarians, and to examine the relation between IHD and body mass index (BMI) within the normal range.
  DESIGN: Prospective observation of vegetarians, semi-vegetarians, and meat eaters for whom baseline dietary data, reported weight and height information, social class, and smoking habits were recorded.
  SUBJECTS: 10,802 men and women in the UK aged between 16 and 79, mean duration of follow up 13.3 years.
  MAIN OUTCOME MEASURES: Death rate rations for IHD and total mortality in relation to dietary and other characteristics recorded at recruitment (reference category death rate = 100).
  RESULTS: IHD mortality was less than half that expected from the experience reported for all of England and Wales. An increase in mortality for IHD was observed with increasing intakes of total and saturated animal fat and dietary cholesterol-death rate ratios in the third tertile compared with the first tertile: 329, 95% confidence interval (CI) 150 to 721; 277, 95% CI 125 to 613; 353, 95% CI 157 to 796, respectively. No protective effects were observed for dietary fibre, fish or alcohol. Within the study, death rate ratios were increased among those in the upper half of the normal BMI range (22.5 to < 25) and those who were overweight (BMI > or = 25) compared with those with BMI 20 to < 22.5.
  CONCLUSIONS: In these relatively health conscious individuals the deleterious effects of saturated animal fat and dietary cholesterol appear to be more important in the aetiology of IHD than the protective effect of dietary fibre. Reduced intakes of saturated animal fat and cholesterol may explain the lower rates of IHD among vegetarians compared with meat eaters. Increasing BMI within the normal range is associated with increased risk of IHD. The results have important public health implications.

PMID: 9415002


Metabolism 1997 May;46(5):530-7
Effect of a diet high in vegetables, fruit, and nuts on serum lipids.
Jenkins DJ, Popovich DG, Kendall CW, Vidgen E, Tariq N, Ransom TP, Wolever TM, Vuksan V, Mehling CC, Boctor DL, Bolognesi C, Huang J, Patten R.
Clinical Nutrition and Risk Factor Modification Center, Division of Endocrinology, St. Michael's Hospital, Toronto, Ontario, Canada.

  We assessed the effect of a diet high in leafy and green vegetables, fruit, and nuts on serum lipid risk factors for cardiovascular disease. Ten healthy volunteers (seven men and three women aged 33 +/- 4 years [mean +/- SEM]; body mass index, 23 +/- 1 kg/m2) consumed their habitual diet (control diet, 29% +/- 2% fat calories) and a diet consisting largely of leafy and other low-calorie vegetables, fruit, and nuts (vegetable diet, 25% +/- 3% fat calories) for two 2-week periods in a randomized crossover design. After 2 weeks on the vegetable diet, lipid risk factors for cardiovascular disease were significantly reduced by comparison with the control diet (low-density lipoprotein [LDL] cholesterol, 33% +/- 4%, P < .001; ratio of total to high-density lipoprotein [HDL] cholesterol, 21% +/- 4%, P X .001; apolipoprotein [apo] B:A-I, 23% +/- 2%, P < .001; and lipoprotein (a) [Lp(a)], 24% +/- 9%, P = .031). The reduction in apo B was related to increased intakes of soluble fiber (r = .84, P = .003) and vegetable protein (r = -.65, P = .041). On the vegetable compared with the control diet, the reduction in total serum cholesterol was 34% to 49% greater than would be predicted by differences in dietary fat and cholesterol. A diet consisting largely of low-calorie vegetables and fruit and nuts markedly reduced lipid risk factors for cardiovascular disease. Several aspects of such diets, which may have been consumed early in human evolution, have implications for cardiovascular disease prevention.

PMID: 9160820


BMJ 1996 Sep 28;313(7060):775-9
Comment in: BMJ. 1996 Sep 28;313(7060):765-6
                    BMJ. 1997 Jan 11;314(7074):148; discussion 148-9
Dietary habits and mortality in 11,000 vegetarians and health conscious people: results of a 17 year follow up.
Key TJ, Thorogood M, Appleby PN, Burr ML. Cancer Epidemiology Unit, Radcliffe Infirmary, Oxford.

  OBJECTIVE: To investigate the association of dietary habits with mortality in a cohort of vegetarians and other health conscious people.
  DESIGN: Observational study.  
  SETTING: United Kingdom.
  SUBJECTS: 4336 men and 6435 women recruited through health food shops, vegetarian societies, and magazines.
  MAIN OUTCOME MEASURES: Mortality ratios for vegetarianism and for daily versus less than daily consumption of wholemeal bread, bran cereals, nuts or dried fruit, fresh fruit, and raw salad in relation to all cause mortality and mortality from ischaemic heart disease, cerebrovascular disease, all malignant neoplasms, lung cancer, colorectal cancer, and breast cancer.
  RESULTS: 2064 (19%) subjects smoked, 4627 (43%) were vegetarian, 6699 (62%) ate wholemeal bread daily, 2948 (27%) ate bran cereals daily, 4091 (38%) ate nuts or dried fruit daily, 8304 (77%) ate fresh fruit daily, and 4105 (38%) ate raw salad daily. After a mean of 16.8 years follow up there were 1343 deaths before age 80. Overall the cohort had a mortality about half that of the general population. Within the cohort, daily consumption of fresh fruit was associated with significantly reduced mortality from ischaemic heart disease (rate ratio adjusted for smoking 0.76 (95% confidence interval 0.60 to 0.97)), cerebrovascular disease (0.68 (0.47 to 0.98)), and for all causes combined (0.79 (0.70 to 0.90)).
  CONCLUSIONS: In this cohort of health conscious individuals, daily consumption of fresh fruit is associated with a reduced mortality from ischaemic heart disease, cerebrovascular disease, and all causes combined.

PMID: 8842068


Prev Med. 1995 Nov;24(6):646-55. Comment in: Prev Med. 1995 Nov;24(6):565-7.
The medical costs attributable to meat consumption.
Barnard ND, Nicholson A, Howard JL.
Physicians Committee for Responsible Medicine, Washington, DC 20016, USA.

  OBJECTIVE. To estimate the medical costs that are attributable to the health effects of meat consumption.
  METHODS. The prevalence of hypertension, heart disease, cancer, diabetes, gallstones, obesity, and foodborne illness among omnivores and vegetarians are compared in studies that have controlled for other lifestyle factors, and the corresponding attributable medical costs are calculated in 1992 dollars.
  RESULTS. Direct health care costs attributable to meat consumption are estimated to be +2.8-8.5 billion for hypertension, +9.5 billion for heart disease, +0-16.5 billion for cancer, +14.0-17.1 billion for diabetes, +0.2-2.4 billion for gallbladder disease, +1.9 billion for obesity-related musculoskeletal disorders, and +0.2-5.5 billion for foodborne illness. The total direct medical costs attributable to meat consumption for 1992 are estimated at +28.6-61.4 billion.
  CONCLUSION. Health care costs attributable to meat consumption are quantifiable and substantial.

PMID: 8610089


Ann Nutr Metab 1995;39(6):334-9
Selected vitamins and trace elements in blood of vegetarians.
Krajcovicova-Kudlackova M, Simoncic R, Babinska K, Bederova A, Brtkova A, Magalova T, Grancicova E. Research Institute of Nutrition, Bratislava, Slovakia.

  Selected vitamin (A, C, E, beta-carotene) and trace element (selenium, zinc, copper) levels were estimated in the blood of 67 vegetarian nonsmokers aged 34-60 years. The average period of lacto- or lacto-ovovegetarianism was 6.2 years. The results were compared with those of 75 nonvegetarians of the same age and living in the same region. Vegetarians had significantly higher plasma levels of essential antioxidants: vitamin C, beta-carotene, and vitamin A. A significantly higher molar ratio vitamin E/cholesterol indicates a more effective protection especially of low-density lipoproteins against peroxidation. Oxidation of low-density lipoproteins represents one of the key factors in the pathogenesis of atherosclerosis. The molar ratio vitamin E/total lipids was significantly higher in plasma of vegetarians, demonstrating a more effective protection of polyunsaturated fatty acids against peroxidation. Vegetarians had significantly higher plasma levels of selenium and similar levels of zinc and copper when compared to nonvegetarians. These trace elements are important for the activity of antioxidant enzymes. The results document a beneficial effect of vegetarian nutritional habits on antioxidative parameters and thus on the reduction of cardiovascular diseases and cancer risk. Reactive products of oxygen metabolism and subsequent toxic products of lipid peroxidation play an important role in the etiology of these diseases.

PMID: 8678468


Dig Dis 1994 May-Jun;12(3):177-85
Vegetarianism, dietary fibre and gastro-intestinal disease.
Nair P, Mayberry JF. Gastrointestinal Research Unit, Leicester General Hospital, UK.

  PURPOSE: To review the association between vegetarianism, dietary fibre and gastro-intestinal disease.
  DATA: There is an increasing trend towards vegetarianism in the United Kingdom. Studies have shown a lower than expected death rate in vegetarians with a significant association between meat eating and mortality from all causes in men. Vegetarians were found to have a lower incidence of gastro-intestinal cancer, gallstones, diverticular disease and constipation. Patients treated with vegetarian/high-fibre diets have not experienced significant benefits when diets are used in gastro-intestinal cancer, peptic ulcer disease or inflammatory bowel disease.
  CONCLUSION: The benefits of a vegetarian life-style may be conferred to non-vegetarians by eating a carefully planned non-vegetarian diet consisting of increased fruit, vegetables and fibre.

PMID: 7988064


Med J Aust 1992 May 4;156 Suppl:S9-16
Diet and coronary heart disease.
The National Heart Foundation of Australia.
Shrapnel WS, Calvert GD, Nestel PJ, Truswell AS. National Heart Foundation, Deakin, ACT.

  Over the last four decades there has been extensive research into the links between diet and coronary heart disease. The most recent literature is reviewed in this position statement. The clinical and public health aspects of the National Heart Foundation's nutrition policy are based on this review. The key points are as follows: 1. Saturated fatty acids A high intake of saturated fatty acids is strongly associated with elevated serum cholesterol and LDL-cholesterol levels and increased risk of coronary heart disease. 2. The n-6 polyunsaturated fatty acids The n-6 polyunsaturated fatty acids (principally linoleic acid) lower serum cholesterol levels when substituted for saturated fats and probably have an independent cholesterol-lowering effect. 3. The n-3 polyunsaturated fatty acids (fish oils) The n-3 polyunsaturated fatty acids reduce serum triglyceride levels, decrease the tendency to thrombosis and may further reduce coronary risk through other mechanisms. 4. Monounsaturated fatty acids Monounsaturated fatty acids reduce serum cholesterol levels when substituted for saturated fatty acids. It is not clear whether this is an independent effect or simply the result of displacement of saturates. 5. Trans fatty acids Trans fatty acids may increase serum cholesterol levels and can be reckoned to be equivalent to saturated fatty acids. 6. Total fat Total fat intake, independent of fatty acid type, is not strongly associated with coronary heart disease but may contribute to obesity. Associations between total fat intake and coronary heart disease are primarily mediated through the saturated fatty acid component. 7. Dietary cholesterol Dietary cholesterol increases serum cholesterol levels in some people and may increase risk of coronary heart disease. 8. Alcohol A high intake of alcohol increases blood pressure and serum triglyceride levels and increases mortality from cardiovascular disease. Light alcohol consumption reduces the risk of coronary heart disease. 9. Sugar The consumption of sugar is not associated with coronary heart disease. 10. Sodium and potassium High salt intake is related to hypertension especially in the subset of "salt-sensitive" people. Potassium intake may be inversely related to hypertension. 11. Overweight and obesity Abdominal obesity increases the risk of coronary heart disease probably by adversely influencing conventional risk factors. 12. Vegetarianism A high intake of plant foods reduces the risk of coronary heart disease through several mechanisms, including lowering serum cholesterol and blood pressure levels.

PMID: 1630369


Int J Cardiol 1991 Nov;33(2):191-8 Comment in: Int J Cardiol. 1992 Feb;34(2):227-8 Int J Cardiol. 1992 May;35(2):281-3
Is calcium excess in western diet a major cause of arterial disease?
Seely S.

  The daily requirement of a young adult for calcium is 300-400 mg, the quantity consumed in many third-world countries. The dietary intake can be doubled or trebled by consumption of milk, thus half a litre of milk, consumed by many individuals daily in prosperous countries, adds 600 mg. The need for calcium is greatly reduced in old age, so that the excess from a given intake becomes more pronounced. The potential hazard of a high intake is that a small fraction finds its way into soft tissues. The aorta is notably prone to calcification, resulting in loss of elasticity. The aorta and its large branches constitute an elastic reservoir, distended during systole and contracting in diastole. This contraction provides the energy for the maintenance of diastolic pressure, which decreases with the deterioration of elasticity and needs a continually increasing systolic pressure to restore its normal value. The heart is disadvantaged in two ways. Its work is increased by having to eject the systolic volume into a stiffer reservoir, and the diastolic filling of the coronary arteries is reduced. This is the main cause of hypertension in old age--there is no increase in blood pressure with age in undeveloped countries where intake of calcium is low. The best cure would be prevention: the reduction of intake of calcium in prosperous countries. Failing that, phytic acid is suggested as the best calcium antagonist. Phytic acid, a natural product present in grains, converts dietary calcium into insoluble phosphates which pass unabsorbed through the digestive tract. The presently used calcium antagonists are not so satisfactory.

PMID: 1743778


Clin Exp Pharmacol Physiol 1988 Mar;15(3):215-23
Non-pharmacological control of blood pressure.
Beilin LJ. Department of Medicine, University of Western Australia, Royal Perth Hospital.

  1. Essential hypertension is a disorder caused by environmental factors operating against a background of genetic susceptibility. 2. Weight control, sodium restriction, increased potassium intake and reduced alcohol consumption can all cause a fall in blood pressure in hypertensive people. 3. A vegetarian diet causes a fall in blood pressure but it is not clear which dietary components are responsible for these effects. 4. The role of calcium, magnesium, dietary fish and fish oils in lowering blood pressure is uncertain. 5. Physical activity lowers blood pressure. 6. Psychological techniques appear to lower blood pressure but their role in management of hypertensive patients is not clear. 7. Most non-pharmacological measures have not been evaluated over a long time period. 8. Recent studies suggest that hypertensives who have been controlled with drugs may then be able to be controlled by non-pharmacological measures

PMID: 3078276


Am J Clin Nutr 1988 Sep;48(3 Suppl):830-2
Heart disease in British vegetarians.
Burr ML, Butland BK. MRC Epidemiology Unit, Cardiff, United Kingdom.

  A prospective study was conducted among customers of health food shops and members of societies interested in health foods. A total of 10,896 persons were followed for 10-12 y, including 4671 vegetarians and 6225 nonvegetarians. Mortality from ischemic heart disease (IHD) was significantly lower in the vegetarians than in the nonvegetarians; the difference was especially marked among the men. In a subset of 300 subjects, serum cholesterol and body mass index were lower in the vegetarians than in the nonvegetarians but there were no consistent differences in blood pressure between the two groups. Vegetarianism seems to confer some protection against IHD but it is not clear whether this is due to abstinence from meat or to a high consumption of vegetables.

PMID: 3414590


Am J Epidemiol 1987 Dec;126(6):1093-102
Dietary fiber and reduced ischemic heart disease mortality rates in men and women: a 12-year prospective study.
Khaw KT, Barrett-Connor E. Department of Community and Family Medicine, School of Medicine, University of California San Diego, La Jolla 92093.

  The authors examined the relation between 24-hour dietary fiber intake at baseline survey in 1972-1974 and subsequent 12-year ischemic heart disease mortality in a southern Californian population-based cohort of 859 men and women aged 50-79 years. Relative risks of ischemic heart disease mortality in those with dietary fiber intake of 16 gm/24 hours or more compared with those with intake less than 16 gm/24 hours were 0.33 in men and 0.37 in women. A 6 gm increment in daily fiber intake was associated with a 25% reduction in ischemic heart disease mortality (p less than 0.01). This effect was independent of other dietary variables, including calories, fat, cholesterol, protein, carbohydrate, alcohol, calcium, and potassium. Some, but not all, of this effect appears to be mediated through the known cardiovascular risk factors: after multivariate adjustment for age, sex, blood pressure, plasma cholesterol, obesity, fasting plasma glucose, and cigarette smoking habit, the magnitude of the protective effect of fiber was reduced but still significant in both sexes combined. These findings support the hypothesis that high dietary fiber intake is protective for ischemic heart disease mortality.

PMID: 2825519


Am J Clin Nutr 1984 Nov;40(5):1027-37
Changing the Mediterranean diet: effects on blood lipids.
Ferro-Luzzi A, Strazzullo P, Scaccini C, Siani A, Sette S, Mariani MA, Mastranzo P, Dougherty RM, Iacono JM, Mancini M.

  A study was carried out on 48 healthy middle-age men and women habitually subsisting on a "Mediterranean type" diet in a rural area of southern Italy. Their freely chosen natural diet was modified for a period of 42 days by partially substituting animal fats for olive oil. Currently available foods were used, and the subjects maintained their habitual lifestyle. Dietary fat content changed from 33 to 37% of total energy and the polyunsaturated to saturated fatty acid ratio changed from 0.48 to 0.22. The base-line serum total cholesterol of men increased during the dietary intervention period from 214 +/- 30 mg/dl (mean and SD) to 245 +/- 33 mg (+15%). Low-density lipoprotein cholesterol increased 19%, while high-density lipoprotein cholesterol remained unmodified. Women, while exhibiting a similar trend in serum total cholesterol (+16%), showed also a 19% increase in their high-density lipoprotein cholesterol (p less than 0.001). Apoprotein B increased in parallel with low-density lipoprotein cholesterol in both sexes. The results of the study confirm the impact of the dietary factor on blood lipids. They also provide additional evidence on the response of high-density lipoprotein cholesterol to diet in free-living populations.

PMID: 6496382


Atherosclerosis 1984 Aug;52(2):219-31
The effect of dietary casein and soy protein on cholesterol and very low density lipoprotein metabolism in the rat.
Cohn JS, Kimpton WG, Nestel PJ.

  Rats fed a high-cholesterol semipurified diet containing casein [milk protein/LF] developed higher levels of serum cholesterol than soy-fed animals. The hypercholesterolaemia of casein-fed rats was due to accumulation of very low density lipoproteins (VLDL), as measured by increased concentrations of serum VLDL cholesterol, protein and apoprotein B. High density lipoprotein (HDL) cholesterol was similar for the two dietary groups. Cholesterol absorption, as measured by the dual isotope ratio method and by direct measurement of cholesterol secretion into thoracic duct lymph, did not differ between the two groups. Cholesterol kinetics were derived from plasma cholesterol specific radioactivity curves and the casein-fed rats had a similar rate of plasma cholesterol production, but a significantly lower plasma cholesterol fractional catabolic rate (FCR) compared with the soy-fed rats. Kinetics of plasma VLDL apoprotein B, derived from analysis of reinjected 125I-labelled VLDL protein, also showed a lower fractional catabolic rate with casein feeding. This suggests that the accumulation of VLDL in the plasma of rats fed dietary casein is not due to excess VLDL production but to deficient VLDL removal. The hypercholesterolaemia appears to be a consequence of diminished VLDL catabolism.

PMID: 6541048


Prev Med 1984 Sep;13(5):490-500
Meat consumption and fatal ischemic heart disease.
Snowdon DA, Phillips RL, Fraser GE.

  In 1960 the meat-consumption habits of 25,153 California Seventh-Day Adventists were assessed by questionnaire. Between 1960 and 1980 ischemic heart disease deaths were identified. Meat consumption was positively associated with fatal ischemic heart disease in both men and women. This association was apparently not due to confounding by eggs, dairy products, obesity, marital status, or cigarette smoking. The positive association between meat consumption and fatal ischemic heart disease was stronger in men than in women and, overall, strongest in young men. For 45- to 64-year-old men, there was approximately a threefold difference in risk between men who ate meat daily and those who did not eat meat. This is the first study to clearly show a dose-response relationship between meat consumption and ischemic heart disease risk.

PMID: 6527990


Am J Clin Nutr 1982 Nov;36(5):873-7
Vegetarianism, dietary fiber, and mortality.
Burr ML, Sweetnam PM.

  A prospective study was set up to test the hypotheses that the risk of death from various diseases is reduced by a high intake of dietary fiber or by vegetarianism. A simple screening questionnaire was distributed among persons with a special interest in health foods, and 10,943 subjects were recruited and followed-up. Their mortality was ascertained by flagging their National Health Service records, and analyzed after 7 yr. A significant negative association was found between vegetarianism and mortality from ischemic heart disease which was especially marked among the men and did not seem to be due to a confounding effect of smoking. No significant associations were found with fiber, although persons who habitually ate wholemeal bread had a lower mortality from cerebrovascular disease. These findings confirm other evidence of a lower mortality from heart disease among vegetarians.

PMID: 6291372


Med Hypotheses 1982 Apr;8(4):349-54
The possible connection between phytoestrogens, milk and coronary heart disease.
Seely S

  Phytoestrogens are estrogen mimics produced mainly by leguminous plants, like clover, lucerne and soya beans, but also by some grasses and other plants. They are isoflavones and other plant phenols, bearing no resemblance to natural estrogens, but somewhat similar to non-steroidal synthetic estrogens, like diethylstilbestrol. Normally they have little ill effect on herbivores, but in large doses they can result in prolonged periods of estrus. It is suggested that when consumed by lactating cows, the estrogenic substance appears in their milk and transferred to the human consumer, on whom the effect could be similar to that of diethylstilbestrol - a substance with well substantiated atherogenic properties. This could be the explanation of the strong positive correlation between the consumption of milk and mortality from coronary disease reported in previous papers of the writer and other authors, and also of the differences between male and female mortality from coronary disease. When phytoestrogens are consumed directly in plants like soya beans, they appear to be correlated with cerebrovascular disease.

PMID: 7099059


Am J Clin Nutr 1979 Aug;32(8):1645-58
Clinical experience with the soybean protein diet in the treatment of hypercholesterolemia.
Sirtori CR, Gatti E, Mantero O, Conti F, Agradi E, Tremoli E, Sirtori M, Fraterrigo L, Tavazzi L, Kritchevsky D.

  The efficacy of the total substitution of animal proteins with a textured soybean protein in hypercholesterolemic individuals was assayed in 42 in-patients and 18 out-patients. The in-patients studied followed one of three different crossover protocols: in protocol A, the soybean diet was compared with a standard low lipid diet; protocol B compared two soybean diets, one with added cholesterol, one without; and protocol C compared a soybean diet containing a high P/S fatty acid ratio to one with a low P/S ratio. In all three protocols, the soybean regimen provided valid and reproducible hypocholesterolemic effects that were not modified by the addition of cholesterol. P/S variations appeared, however, to modify the final effect: soybean definitely had a decreased effectiveness with a low P/S (0.1) regimen. The overall plasma cholesterol changes in the 42 in-patients after 3 weeks on the different soybean diet protocols was -20%. Patients with type IIA and IIB hypercholesterolemia provided almost equivalent results, whereas patients with mixed phenotypes (IIB-III) appeared somewhat more sensitive to the dietary effect. Cholesterol decreased mostly in the low density lipoprotein fraction, but some very low density lipoprotein changes were also noted upon variation of the P/S ratio. The out-patients studied provided less satisfactory results. possibly due to the difficulty of adequately complying with the diet. These studies indicate that treatment with the soybean diet is an effective regimen for inducing a significant cholesterol reduction in type II patients refractory to standard low lipid regimens.

PMID: 38031


Circulation 1979 Jan;59(1):1-7
Effect of cholesterol-lowering diet on mortality from coronary heart disease and other causes. Turpeinen O.

  International statistics indicate that there is a close correlation between the consumption of saturated fats (dairy fats and meat fats) and the mortality from coronary heart disease (CHD), and this conception has been confirmed by many epidemiological studies. Such studies alone, however, cannot prove the existence of a cause-and-effect relationship between these two variables; dietary intervention trials are needed. The Finnish Mental Hospital Study was such a trial, conducted in two hospitals near Helsinki in 1959--1971. Practically total replacement of dairy fats by vegetable oils in the diets of these hospitals was followed by a substantial reduction in the mortality of men from CHD. Total mortality also appeared to be reduced. As to the causes of death other than CHD, none was significantly influenced by dietary change. This was also true for malignant neoplasms. To alleviate the burden of CHD on public health, many investigators have recommended important changes in the quantity and quality of dietary fats.

PMID: 758101

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