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NUTRITION AND CVD IN 2018

Nutrient supplementation no substitute for healthy diets

Nature Reviews Cardiology volume 16, pages 77–79 (2019)Cite this article

Subjects

The VITAL trial showed that neither vitamin D nor fish oil supplementation significantly reduced the incidence of cardiovascular disease (CVD). Conversely, current evidence supports the benefits of multiple dietary patterns, especially the Mediterranean diet, in primary prevention of CVD. Health effects of low-carbohydrate diets depend on the food sources of macronutrients.

Key advances

  • The VITAL trial demonstrated that fish oil or vitamin D3 supplements are unlikely to have a significant benefit on primary prevention of cardiovascular disease (CVD) or cancer1,2.

  • The re-analysis of the PREDIMED trial reaffirmed the benefits of the Mediterranean diet in primary prevention of CVD3.

  • A meta-analysis of observational cohort studies suggests that both low carbohydrate consumption (<40% of calories) and high carbohydrate consumption (>70% of calories) are associated with increased mortality compared with moderate carbohydrate consumption9.

  • The debate on the efficacy and effectiveness of low-fat or low-carbohydrate diets in cardiovascular disease prevention is largely moot unless the food sources of fats or carbohydrates are clearly defined8,9.

The long-awaited results from the VITAL trial1,2 were presented at the AHA Scientific Sessions in November 2018 and published simultaneously in NEJM. The VITAL trial was a randomized, placebo-controlled study, with a 2 × 2 factorial design, of vitamin D3 (cholecalciferol) at a dose of 2,000 IU per day and marine omega-3 fatty acids (fish oil) at a dose of 1 g per day for the prevention of cardiovascular disease (CVD) and cancer among 25,871 men (aged ≥50 years) and women (aged ≥55 years) in the USA. After a median follow-up of 5.3 years, neither vitamin D3 nor fish oil supplementation significantly reduced the incidence of major cardiovascular events (a composite of myocardial infarction, stroke or death from cardiovascular causes) or invasive cancer compared with placebo1,2. However, fish oil supplementation significantly reduced the incidence of total myocardial infarction (HR 0.72, 95% CI 0.59–0.90), one of the prespecified secondary end points1. This risk reduction was particularly strong among African-American individuals (HR 0.23, 95% CI 0.11–0.47), who accounted for 20% of the study sample. The reduction in the risk of myocardial infarction was also found to be stronger among participants with lower amounts of fish intake at baseline (<1.5 servings per week; HR 0.60) than those with higher amounts of fish intake (≥1.5 servings per week; HR 0.94). Although these findings are intriguing, they should be interpreted with caution because the subgroup differences could be due to chance. Overall, supplementation with vitamin D3 had no significant effect on the incidence of CVD or cancer. However, in an exploratory analysis that excluded the first 2 years of follow-up, cancer mortality was reduced (HR 0.75, 95% CI 0.59–0.96)2.

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References

  1. Manson, J. E. et al. Marine n-3 fatty acids and prevention of cardiovascular disease and cancer. N. Engl. J. Med. https://doi.org/10.1056/NEJMoa1811403 (2018).

    Article  PubMed  Google Scholar 

  2. Manson, J. E. et al. Vitamin D supplements and prevention of cancer and cardiovascular disease. N. Engl. J. Med. https://doi.org/10.1056/NEJMoa1809944 (2018).

    Article  PubMed  Google Scholar 

  3. Estruch, R. et al. Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts. N. Engl. J. Med. 378, e34 (2018).

    Article  CAS  Google Scholar 

  4. Rosato, V. et al. Mediterranean diet and cardiovascular disease: a systematic review and meta-analysis of observational studies. Eur. J. Nutr. https://doi.org/10.1007/s00394-017-1582-0 (2017).

    Article  PubMed  Google Scholar 

  5. US Department of Health and Human Services & US Department of Agriculture. 2015–2020 dietary guideline for Americans, 8th edition. USHHS https://health.gov/dietaryguidelines/2015/resources/2015-2020_Dietary_Guidelines.pdf (2015).

  6. Dehghan, M. et al. Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study. Lancet 390, 2050–2062 (2017).

    Article  CAS  Google Scholar 

  7. Dehghan, M. et al. Association of dairy intake with cardiovascular disease and mortality in 21 countries from five continents (PURE): a prospective cohort study. Lancet 392, P2288–P2297 (2018).

    Article  Google Scholar 

  8. Pan, A. et al. Diet and cardiovascular disease: advances and challenges in population-based studies. Cell Metab. 27, 489–496 (2018).

    Article  CAS  Google Scholar 

  9. Seidelmann, S. B. et al. Dietary carbohydrate intake and mortality: a prospective cohort study and meta-analysis. Lancet Public Health 3, e419–e428 (2018).

    Article  Google Scholar 

  10. Ludwig, D. S. et al. Dietary fat: from foe to friend? Science 362, 764–770 (2018).

    Article  CAS  Google Scholar 

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Acknowledgements

F.B.H. is supported by grants HL60712, HL118264 and DK112940 from the NIH.

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Authors and Affiliations

  1. Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Frank B. Hu

  2. Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Frank B. Hu

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Correspondence to Frank B. Hu.

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Competing interests

F.B.H. declares receiving research support from the California Walnut Commission and honoraria for lectures from Metagenics and Standard Process and honoraria from Diet Quality Photo Navigation, unrelated to this article.

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Hu, F.B. Nutrient supplementation no substitute for healthy diets. Nat Rev Cardiol 16, 77–79 (2019). https://doi.org/10.1038/s41569-018-0143-4

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