Heart 1997;78:450-455 ( November )

Dietary determinants of ischaemic heart disease in health conscious individuals

Jim I Mann,^a Paul N Appleby,^b Timothy J Key,^b Margaret Thorogood^c

^a Department of Human Nutrition, University of Otago, PO Box 56, Dunedin, New Zealand, ^b Imperial Cancer Research Fund, Cancer Epidemiology Unit, University of Oxford, Oxford, UK, ^c London School of Hygiene and Tropical Medicine, University of London, London, UK

Correspondence to: Professor Mann.

Accepted for publication 22 July 1997

ObjectiveTo 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.
DesignProspective 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.
Subjects10 802 men and women in the UK aged between 16 and 79, mean duration of follow up 13.3 years.
Main outcome measuresDeath rate ratios for IHD and total mortality in relation to dietary and other characteristics recorded at recruitment (reference category death rate = 100).
ResultsIHD 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 cholesteroldeath 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  25) compared with those with BMI 20 to < 22.5.
ConclusionsIn 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.

Keywords: ischaemic heart disease;  diet;  risk factors

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© 1997 by Heart
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