Whole Diet Approaches to CHD Risk Reduction
A number of studies have moved beyond food components and have investigated whether whole foods are protective against CHD. Some studies have explored the efficacy of a whole diet approach for CHD prevention and therapy [21].
Fruit, Vegetables, and Whole Grain Cereals
Fruits and vegetables are complex foods and contain many bioactive components, including folate, potassium, magnesium, hundreds of phytochemicals, and dietary fiber, while also having a negligible amount of fat. Epidemiological studies and RCTs have repeatedly shown that consumption of fruit and vegetables has a strong protective association with risk of CHD [12]. This is not surprising when we consider the various healthful effects of these foods. By virtue of their high content of fiber and low energy density (i.e., a low calorie content per 100 g), a generous intake of fruit and vegetables helps counter the development of obesity. These foods have also been used as part of the DASH diet, a dietary strategy to lower blood pressure (Chap. 12). Potatoes, especially French fries, are generally excluded from recommendations to eat more vegetables.
Epidemiological studies have also generated strong evidence that intake of whole grains is strongly and negatively associated with risk of CHD [22]. These foods are likely to be protective against CHD for much the same reasons as fruit and vegetables. Their content of fiber may be especially important.
The Mediterranean Diet
The Mediterranean diet is a dietary pattern characterized by a high intake of plant foods (i.e., fruit, vegetables, cereals, legumes, nuts, and seeds) and olive oil consumption; moderate intake of fish, poultry, low-fat dairy products, and wine; and a low intake of red and processed meat. This diet is associated with a higher antioxidant intake and is high in PUFA and MUFA. Meta-analyses have consistently reported significant inverse associations between adherence to the Mediterranean diet and CHD risk [23, 24]. Furthermore, a large RCT (PREDIMED), involving 7447 adults, reported a significant reduction in coronary events in those consuming a Mediterranean diet supplemented with either olive oil or nuts, compared to those consuming a low-fat control diet [25]. PREDIMED demonstrates that changes in diet quality consistent with a Mediterranean diet and independent of weight loss can prevent CHD.
