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Nutrient supplementation no substitute for healthy diets

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.

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  1. Manson, J. E. et al. Marine n-3 fatty acids and prevention of cardiovascular disease and cancer. N. Engl. J. Med. (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. (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. (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 (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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F.B.H. is supported by grants HL60712, HL118264 and DK112940 from the NIH.

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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).

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