American Journal of Clinical Nutrition, doi:10.3945/ajcn.2009.27576
Vol. 90, No. 1, 193-201, July 2009
American Society for Clinical Nutrition
ORIGINAL RESEARCH COMMUNICATION |
Adherence to 2005 Dietary Guidelines for Americans is associated with a reduced progression of coronary artery atherosclerosis in women with established coronary artery disease1,2,3,4
1 From the Jean Meyer US Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, MA (FI, AHL, GED, and PFJ), and the Department of Internal Medicine/Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (DMH).
2 Any opinions, findings, conclusions or recommendations expressed in this publication are those of the authors, and do not necessarily reflect the view of the US Department of Agriculture. 3 Supported by the National Heart, Lung, and Blood Institute (U01 HL 45488 and NIH HL 54727), National Center for Research Resources General Clinical Research Center (Mo1 rr07122), and US Department of Agriculture (Agreement no. 58 1950 9 001). 4 Address correspondence to AH Lichtenstein Jean Meyer USDA Human Nutrition Research Center on Aging, 711 Washington Street, Boston, MA 02111. E-mail: alice.lichtenstein{at}tufts.edu.
Background: A premise of the 2005 Dietary Guidelines for Americans (DGA) is chronic disease prevention.
Objective: The goal was to determine whether a diet meeting the DGA is associated with less atherosclerotic lesion progression.
Design: We used the data from 224 postmenopausal women with established coronary artery disease enrolled in the Estrogen Replacement and Atherosclerosis Study. Atherosclerosis progression was defined by repeated measures of quantitative angiography over a 3-y period. Adherence to the key DGA recommendations was measured by using the DGA Adherence Index (DGAI; possible range: 0–20), with each component weighted equally, and the modified DGAI score (wDGAI; possible range: –0.19–0.51), with each component weighted based on its relation to atherosclerosis progression. Mixed-model regression analyses were performed to assess the association between diet and atherosclerosis progression.
Results: No women consumed a diet meeting all of the DGA recommendations. The mean (range) of the DGAI score was 14.1 (8.0–19.0). DGAI was not associated with atherosclerosis progression (P = 0.44), whereas wDGAI was inversely associated; a 1-SD difference in wDGAI was related to 0.049-mm less narrowing of the coronary arteries (SE = 0.017, P = 0.004).
Conclusions: In postmenopausal women with established heart disease, under the assumption that all DGA recommendations are similarly effective, overall adherence was not associated with atherosclerosis progression. However, assigning differential weights to the DGA recommendations, the adherence was significantly associated with slower atherosclerosis progression. Assuming equity of associations between all dietary recommendations and disease outcomes is a limitation in accurately examining the effectiveness of the DGA.
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- Adherence to dietary guidelines: benefits on atherosclerosis progression
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