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March 26, 2003

Optimal Diets to Prevent Heart DiseaseOptimal Diets to Prevent Heart Disease

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;289(12):1509-1511. doi:10.1001/jama.289.12.1509-a

To the Editor: We agree with Drs Hu and Willett1 that the risk of CHD can be reduced by decreasing saturated fat intake; increasing omega-3 fatty acid intake; avoiding refined carbohydrate sources; increasing folate, B6, and B12 intake; and increasing fruit, vegetable, whole grain, and fiber intake. However, evidence from several trials2,3 conflicts with their claim that "triglyceride levels increase when dietary fatty acids are replaced by carbohydrates." We agree that studies in which fat was replaced isoenergetically with low-fiber "refined" carbohydrate sources have shown an increase in fasting triglyceride levels.4 This is not the case, however, in unrestricted high-fiber carbohydrate diets.4,5 Barnard3 reported that replacing total fat intake with mostly "unrefined" carbohydrate sources can decrease triglyceride levels by 33%. This was a high-fiber diet with about 10% of calories from fat, 15% to 20% of calories from protein, and 65% to 75% of calories from largely high-fiber carbohydrate sources, combined with daily exercise.

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