Diet and incident ischaemic heart disease: the Caerphilly Study

Abstract

The Caerphilly Prospective Ischaemic Heart Disease (IHD) Study is based on a sample of 2512 men aged 45-59 years when first seen. Nutrient intakes, estimated using a self-administered semi-quantitative food frequency questionnaire, are available for 2423 men (96 %). Amongst these, 148 major IHD events occurred during the first 5 years of follow-up. Associations were examined between these events and baseline diet. Incident IHD (new events) was negatively associated with total energy intake: men who went on to experience an IHD event had consumed 560 kJ (134 kcal)/d (6%) less at baseline than men who experienced no event (P = 0.01). The relative odds of an IHD event was 1.5 among men in the lowest fifth of energy intake, compared with 1.3,1.2,0.9 and 1.0 respectively for the other four fifths (P < 0.05).The difference in energy intake was reflected in lower intakes of every nutrient examined. When expressed as a percentage of total energy, mean intakes of men who experienced an IHD event were virtually identical to those of men who did not. There was some evidence suggesting a positive association between total fat intake and IHD risk, but the trend was not consistent and not statistically significant. There was no association for animal fat. Alcohol consumption was negatively associated with subsequent IHD, but only in men who already had evidence of IHD at baseline (P < 0.05). Dietary fibre, particularly from fruit and vegetables, was 7% lower in men who had an incident IHD event (P < 0.05), but the difference was not independent of total energy. There was a trend of increasing IHD risk with decreasing vitamin C intake, the relative odds of an IHD event being 1.6 among men in the lowest one-fifth of the vitamin C distribution, but this was not statistically significant.Energy intake: Fat intake: Dietary fibre: Ischaemic heart disease: Vitamin C The Caerphilly Ischaemic Heart Disease (IHD) Study is a longitudinal study of a representative population sample of middle-aged men in a typical town in South Wales (Caerphilly and Speedwell Collaborative Group, 1984). The aims include the assessment of possible risk factors measured at recruitment (haemostatic, lipid, hormone, psycho-social and dietary factors) in relation to incidence of major IHD events (new events).

Fiber intake and risk of nonfatal acute myocardial infarction

“…This study confirms in a Southern European population the inverse association found in studies from Northern Europe and the USA (Bolton-Smith et al, 1992; Burr & Sweetnam, 1982;Fehily et al, 1993;Humble et al, 1993;Khaw & BarrettConnor, 1987;Kromhout et al, 1982;Kushi et al, 1985;Morris et al, 1977;Pietinen et al, 1996;Rimm et al, 1996;Wolk et al, 1999). Only a few studies, however, adjusted for energy intake and presented data separately for different types and sources of fiber.…”

“…Several, mostly prospective, epidemiological studies, (Bolton-Smith et al, 1992;Burr & Sweetnam, 1982;Fehily et al, 1993;Humble et al, 1993;Khaw & Barrett-Connor, 1987;Kromhout et al, 1982;Kushi et al, 1985;Morris et al, 1977;Pietinen et al, 1996;Rimm et al, 1996;Wolk et al, 1999) have investigated the relation between fiber intake and risk of acute myocardial infarction (AMI) or cardiovascular disease in general. Most have found significant inverse associations, although only a few have presented estimates adjusted for energy intake and separately for different types and sources of fiber (Kushi et al, 1999).…”

“…Most have found significant inverse associations, although only a few have presented estimates adjusted for energy intake and separately for different types and sources of fiber (Kushi et al, 1999). These studies were conducted in the USA (Humble et al, 1993;Khaw & BarrettConnor, 1987;Kushi et al, 1985;Rimm et al, 1996;Wolk et al, 1999), the UK (Bolton-Smith et al, 1992;Burr & Sweetnam, 1982;Fehily et al, 1993;Kushi et al, 1985;Morris et al, 1977) or Northern Europe (Kromhout et al, 1982;Pietinen et al, 1996), and no data are available, to our knowledge, from Mediterranean countries, where the composition of the diet is qualitatively different, and smoking patterns and other relevant lifestyle habits and environmental exposures also differ.…”

Milk drinking, ischaemic heart disease and ischaemic stroke I. Evidence from the Caerphilly cohort

“…The questionnaire from each subject was carefully reviewed with a dietitian and further questions asked as necessary to ensure that the answers were complete and unambiguous. A 30% sample of the men were also asked to keep a 7-day weighed dietary intake record and data from these were used both to derive average portion sizes for use in the analysis of the questionnaires and to test the validity of the questionnaires (Fehily et al, 1987;Fehily & Hopkinson, 1993).…”

“…First, the estimates of milk intake used in the analyses were derived from a semiquantitative food frequency questionnaire. In the interpretation of this, however, portion sizes were derived from 7-day weighed intake records kept in the cohort (Fehily et al, 1987;Fehily & Hopkinson, 1993). Moreover, the correlation between milk consumption as recorded in the 7-day weighed intake records provided by a subsample of 665 of the men, and as stated by those men in their questionnaires at baseline, was high (0.61; Po0.001).…”