Coronary heart disease : dietary links and pathogenesis.
Serge Renaud*1, Dominique Lanzmann-Petithory2
INSERM, Unité 330, University Bordeaux 2, 146, rue Léo Saignat, 33076 Bordeaux Cedex, France
Department of Internal Medicine, Nutrition and lipid metabolism. Henri Mondor Hospital, 51. Avenue, Marechal de Lattre deTassigny, 94010 Creteil Cedex - France
Short Title: Diet and coronary heart disease
coronary heart disease, diet, saturated fatty acids, linoleic acid, alphalinolenic acid, trans fatty acids , antioxidants, fibers, calcium, alcohol.
For decades it has been postulated that the
main environmental factor for coronary heart disease (CHD) was the intake of
saturated fatty acids (SFA). Nevertheless, confirmation of the role of SFA in
CHD through intervention trials has been disappointing. It was only when the
diet was enriched in n-3 fatty acids that CHD was significantly prevented,
especially cardiac death.
In addition to n-3 fatty acids, many other foodstuffs or nutrients such as fibers, antioxidants, folic acid, calcium and even alcohol contribute to prevent CHD. Thus the relationship between diet and CHD morbidity and mortality appears to be much more complex than formerly suspected considering as key factors only SFA, linoleic acid, cholesterol and atherosclerosis. Some of the mechanisms are briefly described, but many additional nutrients (or non nutrients) may also play an important role in the pathogenesis of CHD.
Finally, as a result of the most recent epidemiologic studies the ideal diet may comprise : 8% energy from SFA, 5% from polyunsaturated fatty acids with a ratio 5/1 of linoleic/alpha-linolenic acid + longer chains n-3, oleic acid as desired, large intake of cereals, vegetables, legumes and fruits, fish twice a week, cheese and yoghurt as dairy products, rape-seed and olive oils as edible fat. Without side effects, such a diet can be highly palatable, easily enjoyed by many populations and may prevent effectively and rapidly (within a few weeks or months) CHD.
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