Association between the Adherence to AHA Step 1 Nutrition Criteria and the Cardiometabolic Outcome in the General Population a Two Year Follow-Up Study

Laura Redaelli, Katia Garlaschelli, Liliana Grigore, Giuseppe Danilo Norata, Alberico Luigi Catapano

Center for the Study of Atherosclerosis, SISA Sez Reg Lomb, Bassini Hospital, Cinisello Balsamo, Italy.
Center for the Study of Atherosclerosis, SISA Sez Reg Lomb, Bassini Hospital, Cinisello Balsamo, Italy; 2Department of Phar- macological Sciences, Università degli Studi di Milano, Milan, Italy.
Department of Phar- macological Sciences, Università degli Studi di Milano, Milan, Italy; I.R.C.C.S. Multimedica, Milan, Italy.
Department of Phar- macological Sciences, Università degli Studi di Milano, Milan, Italy; I.R.C.C.S. Multimedica, Milan, Italy..

DOI: 10.4236/fns.2012.32040                

Abstract

Introduction: The National Cholesterol Education Program and the American Heart Association considered a dietary therapy as a primary approach to prevent and treat hyperlipemia and hypertension. Mediterranean diet has been promoted as a model of healthy eating and widely recognized for favorable effects on lipid profile. Objective: We investigated whether the adherence to dietary recommendations have any significant benefit on cardiovascular risk factors. A cohort of 2141 of subjects attending our center was recruited by collaborating General Practitioners who participate in the PLIC Study. Methods: Participants completed a week quantitative food questionnaire, which was analized on a subgroup of 338 subjects at enrolment (V1) and after two years of follow up (V2). Daily energy intake in Kcal, lipid, protein, carbohydrates in percentage of total energy, monounsatured (MUFA), saturated (SFA), polyunsaturated fatty acids (PUFA) in g/die, cholesterol in mg/die was calculated from the food questionnaires. Cardiovascular risk (CVR) was estimated according Framingham algorithm. Results: Subjects which adhered to AHA step 1 diet showed a significantly lower total cholesterol, 213.88 ± 43.00 vs 220.19 ± 39.3 mg/dL, LDL-cholesterol, 139.80 ± 76.36 vs 142.75 ± 35.60 mg/dL (p < 0.01 for both) as compared to subjects with an impaired dietary pattern while no differences were observed for HDL cholesterol. Conclusions: Changes in dietary profiles are associated with an improved lipid profile and therefore remain one of the more favorable nutritional models in the primary prevention of cardiovascular disease.

Keywords

AHA Step 1; MUFA; PUFA; Cholesterol

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	A. Keys, “Coronary Heart Disease in Seven Countries,” Circulation, Vol. 41, 1974, pp. 1-211.
[2]	F. Sofi, S. Vecchio, G. Giuliani, F. Martinelli, R. Marcucci, A. M. Gori, S. Fedi, A. Casini, C. Surrenti, R. Abbate and G. F. Gensini, “Dietary Habits, Lifestyle and Cardiovascular Risk Factors in a Clinically Healthy Italian Population: The ‘Florence’ Diet Is Not Mediterranean,” European Journal of Clinical Nutrition, Vol. 4, No. 59, 2005, pp. 584-591. doi:10.1038/sj.ejcn.1602112
[3]	Expert Panel on Detection, Evaluation and Treatment of high blood cholesterol in adults, et al., “Executive Summery of the Third Report of the National Cholesterol Educational Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III),” Journal American Medical Association, Vol. 285, No. 19, 2001, pp. 24862497.
[4]	V. Ganji, M. R. Kafai, Third National Health and Nutrition Examination Survey, “Demographic, Health, Lifestyle, and Blood Vitamin Determinants of Serum Total Homocysteine Concentrations in the Third National Health and Nutrition Examination Survey, 1988-1994,” American Journal Clinical Nutrition, Vol. 4, No. 77, 2003, pp. 826-833.
[5]	A. Ascherio, E. B. Rimm and E. L. Giovannucci, “A Prospective Study of Nutritional Factors and Hypertension among US Men,” Circulation, Vol. 5, No. 86, 1992, pp. 1475-1484.
[6]	L. Appel, T. Moore, E. Obarzanek, W. Vollmer, L. Svetkey and F. Sacks, “A Clinical Trial of the Effect of Dietary Patterns on Blood Pressure,” New England Journal Medicine, Vol. 336, No. 16, 1997, pp. 1117-1124. doi:10.1056/NEJM199704173361601
[7]	J. F. Price and F. G. R. Fowkes, “Antioxidant Vitamins in the Prevention of Cardiovascular Disease,” European Heart Journal, Vol. 18, No. 5, 1997, pp. 719-727.
[8]	L. B. Bunyard, K. E. Dennis and B. J. Nicklas, “Dietary Intake and Changes in Lipoprotein Lipids in Obese, Postmenopausal Women Placed on an American Heart Association Step 1 Diet,” Journal American Diet Association, Vol. 1, 2002, pp. 2-7.
[9]	A. Keys, A. Menotti, M. J. Karvonen, C. Aravanis, H. Blackburn, R. Buzina, B. S. Djordevic, A. S. Dontas, F. Fidanza, M. H. Keys, D. Kromhout, S. Nedeljkovic, S. Punsar, F. Seccareccia and H. Toshima, “The Diet and 15-Year Death Rate in the Seven Countries Study,” American Journal of Epidemiology, Vol. 124, No. 6, 1986, pp. 903-915.
[10]	G. D. Norata, I. Baragetti, S. Raselli, A. Stuc chi, K. Garlaschelli, S. Vettoretti, G. Piloni, G. Buccianti and A. L. Catapano, “Plasma Adiponectin Levels in Chronic Kidney Disease Patients: Relation with Molecular Inflammatory Profile and Metabolic Status,” Nutrition Metabolism Cardiovascular Disease, Vol. 20, No. 1, 2010, pp. 56-63.
[11]	G. D. Norata, S. Raselli, L. Grigore, K. Garlaschelli, E. Dozio, P. Magni and A. L. Catapano, “Leptin: Adiponectin Ratio Is an Independent Predictor of Intima Media Thickness of the Common Carotid Artery,” Stroke, Vol. 38, No. 10, 2007, pp. 2844-2846. doi:10.1161/STROKEAHA.107.485540
[12]	G. D. Norata, M. Ongari, K. Garlaschelli, S. Raselli, L. Grigore and A. L. Catapano, “Plasma Resistin Levels Correlate with Determinants of the Metabolic Syndrome,” European Journal Endocrinology, Vol. 156, No. 2, 2007, pp. 279-284. doi:10.1530/eje.1.02338
[13]	E. Carnevale and F. Miuccio, “Tabelle di Composizione Degli Alimenti,” Istituto Nazionale della Nutrizione, Via Ardeatina, 1989.
[14]	A. W. Caggiula and V. A. Mustad, “Effects of Dietary Fats and Fatty Acids on Coronary Artery Disease Risk and Total and Lipoprotein Cholesterol Concentration: Epidemiological Studies,” American Journal Clinical Nutrition, Vol. 65, No. 5, 1997, pp. 1597S-1610S.
[15]	B. Karamanos, A. Thanopoulou, F. Angelico, S. AssaadKhalil, A. Barbato, M. Del Ben, V. Dimitrijevic-Sreckovic, P. Djordjevic, C. Gallotti, N. Katsilsambros, I. Migdalis, M. Mrabet, M. Petkova, D. Roussi and M. T. Tenconi, “Nutritional Habits in the Mediterranean Basin. The Macronutrient Composition of Diet and Its Relation with the Traditional Mediterranean Diet. Multi-Centre Study of the Mediterranean Group for the Study of Diabetes (MGSD),” European Journal Clinical Nutrition, Vol. 56, No. 10, 2002, pp. 9