Strong adherence to healthy eating patterns yields CV benefit
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People with greater adherence to healthy eating patterns had a lower risk for CVD, according to a study published in JAMA Internal Medicine.
“We found that following a variety of healthy eating patterns such as the Mediterranean diet or plant-based diet significantly lowered the risk of cardiovascular disease in both men and women and in different racial and ethnic groups,” Frank B. Hu, MD, PhD, professor and chair of the department of nutrition at Harvard T.H. Chan School of Public Health, told Healio. “Although these patterns vary in specific constituents, they share common components such as increased consumption of fruits, vegetables, whole grains, legumes and nuts, and lower consumption of red and processed meats and added sugar.”
Food frequency data
Zhilei Shan, MD, PhD, postdoctoral fellow in the department of nutrition at Harvard T.H. Chan School of Public Health, and colleagues analyzed data from 74,930 women (mean age, 50 years) from the Nurses’ Health Study, 90,864 women from the Nurses’ Health Study II (mean age, 36 years) and 43,339 men from the Health Professionals Follow-Up Study (mean age, 53 years).
All participants completed a validated semiquantitative food frequency questionnaire at baseline and were asked about their dietary habits every 2 to 4 years. This information was used to calculate adherence to different dietary patterns with the healthy eating index-2015, the healthful plant-based diet index, the alternate Mediterranean diet score and the alternate healthy eating index.
Researchers assessed incident cases of CVD, defined as fatal and nonfatal stroke, and fatal and nonfatal CHD, which included CABG and nonfatal MI.
There were 23,366 cases of incident CVD during 5,257,190 person-years of follow-up. Of these events, 5,687 were stroke and 18,092 were CHD, and some patients had both stroke and CHD.
Researchers compared the highest quintiles with the lowest quintiles for the scores that were calculated. The pooled multivariable-adjusted HR for CVD was 0.83 for the alternate Mediterranean diet score (95% CI, 0.79-0.86), 0.83 for the healthy eating index-2015 (95% CI, 0.79-0.86), 0.79 for the alternate healthy eating index (95% CI, 0.75-0.82) and 0.86 for the healthful plant-based diet index (95% CI, 0.82-0.89; P for trend for all < .001).
The risk for CVD decreased by 10% to 20% with a 25-percentile higher dietary score according to the alternate Mediterranean diet score (HR = 0.9; 95% CI, 0.87-0.92), the healthy eating index-2015 (HR = 0.8; 95% CI, 0.77-0.83), for the alternate healthy eating index (HR = 0.81; 95% CI, 0.78-0.84) and for the healthful plant-based diet index (HR = 0.86; 95% CI, 0.82-0.89).
Source: Harvard T.H. Chan School of Public Health
The four dietary scores were significantly linked to a lower risk for both stroke and CHD. The inverse association between the scores and the risk for CVD were consistent in most subgroups when analyses were stratified by race/ethnicity and other CVD risk factors.
Healthy eating patterns
“A common misconception is that there is a magic bullet diet to health and longevity, but no such magic diet solution exists,” Hu said in an interview. “To improve health, there is no one-size-fits-all diet that is best for everyone. One can combine a wide range of healthy foods in a variety of flexible ways to achieve healthily and balanced eating patterns according to individuals’ health needs, food preferences and cultural traditions.”
For more information:
Frank B. Hu, MD, PhD, can be reached at fhu@hsph.harvard.edu.
Perspective
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Monica Aggarwal, MD, FACC
There are few studies that look at the role of adherence to diet and the effect of that adherence on health outcomes. This study tried to understand the importance of adherence.
This study reminds us that sticking with a healthy dietary pattern such as the healthy Mediterranean and healthy plant-based diets leads to lower CVD risk. In terms of clinical practice, we know this intuitively, but such studies become launching points for clinical discussion. They remind us to bring the nutrition conversation into the clinical visit, which happens infrequently and takes up less than 3 minutes of a standard cardiology visit. The conversation should focus on shifting away from a standard American diet, which is often high in animal products, saturated fats, and refined and processed foods and low in fiber, fruits and vegetables, and shift toward a foundation of plants, unrefined and whole foods.
We should be reminding our patients that this will improve their overall CV health. In our clinics, it is important to focus on methods to improve nutritional adherence such as through frequent patient-doctor discussion, nutrition educational materials and support groups.
Nutrition studies are always challenging because they come with multiple confounding factors. For instance, because the environment is not controlled, confounders such as exercise and social stress contributions are not always considered. Further, studies based on food frequency questionnaires are always tricky and leave room for misclassification of foods and, therefore, can skew the data. The authors appropriately acknowledge this and, unfortunately, this is a continued flaw in self-reporting of dietary composition.
More prospective data are needed where individual nutrient composition can be evaluated with laboratory testing to assess compliance. Alternatively, running nutrition studies in a controlled environment where adherence can be closely monitored is another way to remove such confounders.
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