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Hu FB, Willett WC. Optimal Diets for Prevention of Coronary Heart Disease. JAMA. 2002;288(20):2569–2578. doi:10.1001/jama.288.20.2569
Author Affiliations: Departments of Nutrition and Epidemiology, Harvard School of Public Health, and Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass.
Clinical Cardiology Section Editor: Michael
S. Lauer, MD, Contributing Editor.
Context Coronary heart disease (CHD) remains the leading cause of mortality
in industrialized countries and is rapidly becoming a primary cause of death
worldwide. Thus, identification of the dietary changes that most effectively
prevent CHD is critical.
Objective To review metabolic, epidemiologic, and clinical trial evidence regarding
diet and CHD prevention.
Data Sources and Study Selection We searched MEDLINE through May 2002 for epidemiologic and clinical
investigations of major dietary factors (fat, cholesterol, omega-3 fatty acids, trans-fatty acids, carbohydrates, glycemic index, fiber,
folate, specific foods, and dietary patterns) and CHD. We selected 147 original
investigations and reviews of metabolic studies, epidemiologic studies, and
dietary intervention trials of diet and CHD.
Data Extraction Data were examined for relevance and quality and extracted by 1 of the
Data Synthesis Compelling evidence from metabolic studies, prospective cohort studies,
and clinical trials in the past several decades indicates that at least 3
dietary strategies are effective in preventing CHD: substitute nonhydrogenated
unsaturated fats for saturated and trans-fats; increase
consumption of omega-3 fatty acids from fish, fish oil supplements, or plant
sources; and consume a diet high in fruits, vegetables, nuts, and whole grains
and low in refined grain products. However, simply lowering the percentage
of energy from total fat in the diet is unlikely to improve lipid profile
or reduce CHD incidence. Many issues remain unsettled, including the optimal
amounts of monounsaturated and polyunsaturated fats, the optimal balance between
omega-3 and omega-6 polyunsaturated fats, the amount and sources of protein,
and the effects of individual phytochemicals, antioxidant vitamins, and minerals.
Conclusions Substantial evidence indicates that diets using nonhydrogenated unsaturated
fats as the predominant form of dietary fat, whole grains as the main form
of carbohydrates, an abundance of fruits and vegetables, and adequate omega-3
fatty acids can offer significant protection against CHD. Such diets, together
with regular physical activity, avoidance of smoking, and maintenance of a
healthy body weight, may prevent the majority of cardiovascular disease in
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