The Chinese total diet study in 1990. Part II. Nutrients

This paper reports the intakes of 72 nutrients and their dietary sources obtained from the Chinese total diet study in 1990. Most of the nutrient intakes are close or equal to their corresponding recommended daily allowances (RDAs). Both the total energy intake (2203 kcal) and the proportions contributed by protein, fat, and carbohydrate meet the current Chinese RDAs and the World Health Organization (WHO) nutrient goals. The average protein intake was 64 g/day. The intake of essential amino acids all exceeded the Chinese RDA, and their proportions were generally consistent with the WHO recommended pattern. The average fat intake was 51.2 g/day (21.2% of the total energy intake). However, the dietary fat intake has been increasing significantly in the Chinese diet and the proportion of animal fat has reached 53% of the total fat intake. The total saturated:total monounsaturated: total polyunsaturated fatty acid ratio was 1.0:1.5:1.0. Although the average cholesterol intake was only 179 mg/day, it was 248 mg/day in the South 1 region. The intakes of thiamine and riboflavin were below the RDA. Retinol intakes in all the 4 regions were low. Most (80%) of the retinol (equivalent) intakes were from carotenoids. The average intake of total tocopherol was 89% of the RDA, and among the 4 regions, only the South 2 region has relatively low intake. The intakes of iron, copper, manganese, sodium, and phosphorus were adequate. The intakes of calcium, zinc, and potassium were insufficient, and intakes of selenium and magnesium were a little low. High sodium and low potassium intake is a traditional problem in the Chinese diet.     

Dietary fat intake and the risk of coronary heart disease in women

BACKGROUND: The relation between dietary intake of specific types of fat, particularly trans unsaturated fat and the risk of coronary disease remains unclear. We therefore studied this relation in women enrolled in the Nurses' Health Study. METHODS: We prospectively studied 80,082 women who were 34 to 59 years of age and had no known coronary disease, stroke, cancer, hypercholesterolemia, or diabetes in 1980. Information on diet was obtained at base line and updated during follow-up by means of validated questionnaires. During 14 years of follow-up, we documented 939 cases of nonfatal myocardial infarction or death from coronary heart disease. Mutivariate analyses included age, smoking status, total energy intake, dietary cholesterol intake, percentages of energy obtained from protein and specific types of fat, and other risk factors. RESULTS: Each increase of 5 percent of energy intake from saturated fat, as compared with equivalent energy intake from carbohydrates, was associated with a 17 percent increase in the risk of coronary disease (relative risk, 1.17; 95 percent confidence interval, 0.97 to 1.41; P=0.10). As compared with equivalent energy from carbohydrates, the relative risk for a 2 percent increment in energy intake from trans unsaturated fat was 1.93 (95 percent confidence interval, 1.43 to 2.61; P<0.001); that for a 5 percent increment in energy from monounsaturated fat was 0.81 (95 percent confidence interval, 0.65 to 1.00; P=0.05); and that for a 5 percent increment in energy from polyunsaturated fat was 0.62 (95 percent confidence interval, 0.46 to 0.85; P= 0.003). Total fat intake was not signficantly related to the risk of coronary disease (for a 5 percent increase in energy from fat, the relative risk was 1.02; 95 percent confidence interval, 0.97 to 1.07; P=0.55). We estimated that the replacement of 5 percent of energy from saturated fat with energy from unsaturated fats would reduce risk by 42 percent (95 percent confidence interval, 23 to 56; P<0.001) and that the replacement of 2 percent of energy from trans fat with energy from unhydrogenated, unsaturated fats would reduce risk by 53 percent (95 percent confidence interval, 34 to 67; P<.001). CONCLUSIONS: Our findings suggest that replacing saturated and trans unsaturated fats with unhydrogenated monounsaturated and polyunsaturated fats is more effective in preventing coronary heart disease in women than reducing overall fat intake.     

Estimates of food and macronutrient intake in a random sample of Northern Ireland adolescents

Estimates of food consumption and macronutrient intake were obtained from a randomly selected population sample (2%) of 1015 adolescents aged 12 and 15 years in Northern Ireland during the 1990/1991 school year. Dietary intake was assessed by diet history with photographic album to estimate portion size. Reported median energy intakes were 11.0 and 13.1 MJ/d for boys aged 12 and 15 years respectively and 9.2 and 9.1 MJ/d for girls of these ages. Protein, carbohydrate and total sugars intakes as a percentage of total energy varied little between the age and sex groups and were approximately 11, 49 and 20% respectively of daily total energy intakes. Median dietary fibre intakes were approximately 20 and 24 g/d for boys aged 12 and 15 years respectively and 18 and 19 g/d for girls of these ages. Major food sources of energy (as a percentage of total energy intakes) were bread and cereals (15-18%), cakes and biscuits (12-14%), chips and crisps (13-14%), dairy products (9-11%), meat and meat products (9-11%) and confectionery (9%). Fruit and vegetable intakes were low at about 2.5% and 1.5% respectively of total energy intakes. Median fat intakes were high at 39% of total daily energy intakes. Major food sources of fat as a percentage of total fat intakes were from the food groupings: chips and crisps (16-19%), meat and meat products (14-17%), fats and oils (14-16%), cakes and biscuits (13-16%) and dairy products (12-15%). Median intakes of saturated fatty acids were also high at approximately 15% of daily total energy intake while intakes of monounsaturated fatty acids averaged 12% of daily total energy intake. Median polyunsaturated fatty acid (PUFA) intakes were low, comprising 5.2 and 5.5% of daily total energy intake for boys aged 12 and 15 years respectively and were lower than the PUFA intakes (5.9 and 6.3% of daily total energy intake) for girls of these ages. About 1.3% for boys and 1.4% for girls of daily total energy intake was in the form of n-3 PUFA. Ca and Mg intakes were adequate for both sexes. Based on these results, some concern about the dietary habits and related health consequences in Northern Ireland adolescents appears justified.     

Partial replacement of saturated fatty acids with almonds or walnuts lowers total plasma cholesterol and low-density-lipoprotein cholesterol

Sixteen normolipidemic male volunteers aged 41 +/- 9 y (mean +/- SD) consumed a diet providing 36% of energy as fat (92 g fat/d) for 9 wk. A daily supplement of nuts (providing half of the total fat intake) was provided against a common background diet. In the first 3-wk period the background diet was supplemented with raw peanuts (50 g/d), coconut cubes (40 g/d), and a coconut confectionary bar (50 g/d), designed to provide 47 g fat with a ratio of polyunsaturated to monounsaturated to saturated fatty acids (P:M:S) to match the Australian diet (reference diet). During the following 3 wk the background diet was supplemented with monounsaturated fatty acid-rich raw almonds (84 g/d), equivalent to 46 g fat, and during the final 3-wk period the background diet was supplemented with polyunsaturated fatty acid-rich walnuts (68 g/d), equivalent to 46 g fat. Compared with the reference diet there were significant reductions in total and LDL cholesterol, 7% and 10%, respectively, after supplementation with almonds, and 5% and 9%, respectively, after supplementation with walnuts.     

Dietary assessment in Whitehall II: the influence of reporting bias on apparent socioeconomic variation in nutrient intakes

OBJECTIVE: To assess socio-economic differences in nutrient intake, giving particular consideration to the influence of reporting bias. DESIGN: Cross-sectional study. Three methods of data analysis (inclusion of all subjects, exclusion of low energy reporters, and regression-based energy adjustment) were evaluated against biomarkers of fatty acid and antioxidant intakes. SETTING: London-based Civil Servants. SUBJECTS: Age and employment grade stratified random sub-sample of 459 men and 406 women aged 39-61 y who completed 7 d diet diaries at Phase 3 follow-up (1991-93) of the Whitehall II Study. DIETARY MEASURES: Mean daily intakes by employment grade (6 levels) of dietary energy, total fat, saturated fatty acids, polyunsaturated fatty acids (PUFA), linoleic acid, carbohydrate excluding fibre, dietary fibre, protein, alcohol, vitamin C, vitamin E, carotenes, potassium and calcium. Biomarkers: serum cholesterol ester fatty acids (CEFA), total cholesterol, plasma alpha-tocopherol and beta-carotene. RESULTS: Low energy reporting (LER), defined as a reported energy intake below 1.2 times calculated basal metabolic rate, was strongly associated with employment grade (top grade: men 17.3%, women 19.3%, bottom grade: men 45.7%, women 49.2% trend P < 0.0001 both sexes). This association is only to a small extent accounted for by the relative weight distribution across grades. The direct associations with grade--high status, high intakes--of total fat, saturated and polyunsaturated fatty acids seen in the results overall were greatly reduced or abolished when LER were excluded or when energy adjustment was used. Direct associations between grade and intakes of vitamin C and potassium in both sexes were evident regardless of data presentation method. Spearman correlations between biomarkers and reported intakes, for example CEFA and dietary linoleate (men 0.46, women 0.61), plasma beta-carotene/cholesterol ratio and dietary carotenes (men 0.16, women 0.21) together with theoretical considerations indicate that energy adjustment may be the preferred method for reducing the influence of reporting bias. CONCLUSIONS: Low energy reporting is a major source of bias in dietary surveys and its prevalence shows a marked inverse association with socio-economic status. The energy adjustment method provides an approach which reduces this bias without exclusion of low energy reporters. Intakes of micronutrients including vitamin C, rather than fatty acids, showed associations with socio-economic status consistent with a dietary explanation for social inequalities in cardiovascular disease.     

Pulmonary veins: magnetic resonance angiography anatomy

OBJECTIVES: This study was undertaken to investigate the relation between dietary fat composition and adiposity in adult men. SUBJECTS: A sample of 128 male subjects who participated in Phase 2 of the Québec Family Study. DESIGN: The association between adiposity and total dietary fat intake (TFI), saturated fat intake (SFA), monounsaturated fat intake (MUFA) and polyunsaturated fat intake (PUFA) was analyzed in the overall sample. A comparison of body fatness was also performed between consumers of high (4th quartile) and low amounts (1st quartile) of TFI, SFA, MUFA and PUFA. RESULTS: Significant positive correlations were found between the percentage of dietary energy as total fat and body fatness. Men in the upper quartile of TFI displayed significantly more adiposity than those in the lower quartile. Significant differences were also observed when quartiles were established using SFA and MUFA. However, higher intakes of PUFA had no statistical effects on adiposity. CONCLUSION: These results confirm the notion that high fat diets might lead over time to excess body fat deposition. SFA and MUFA intake also seem to be predictors of actual adiposity markers while high PUFA intake seems to exert no effect on these markers.     

Cocaine and cocaethylene binding to human milk

The relationship between frequency of intake of different types of fat and breast cancer was investigated in a case-control study conducted in Montevideo, Uruguay, during the time period 1994-1996. Our study comprised 365 cases and 397 controls. A moderate and non-significant increase in risk of breast cancer, associated with total fat intake, was found. Saturated and monounsaturated fat intake were not associated to an increased risk of this malignancy, whereas polyunsaturated fat and linoleic acid were associated with a significantly reduced risk (OR 0.26, 95% CI 0.13-0.53). On the contrary, both alpha-linolenic acid and cholesterol intakes were associated with an increased risk of breast cancer (OR for the upper quartile of intake of alpha-linolenic acid 3.79, 95% CI 1.53-9.40). When alpha-linolenic was examined at different levels of intake, the OR's were significantly higher at low levels of linoleic acid intake (OR 7.5, 95% CI 1.9-28.8).     

Gabapentin does not alter single-dose lithium pharmacokinetics

We considered the role of monounsaturated and other types of fats on breast carcinogenesis, using data from a case-control study of 2,569 incident, histologically confirmed cases of breast cancer and 2,588 controls from six Italian areas. The multivariate odds ratios, adjusted for age, education, parity, menopausal status plus various sources of energy and types of fats, were 1.10 (95% confidence interval 0.99-1.23) for an increase of 10 g/day of saturated fat intake, 0.99 (0.94-1.04) for an increase of 10 g/day of monounsaturated fats, and 0.91 (0.87-0.96) for an increase of 5 g/day of polyunsaturated fats. The present data confirm that saturated, but not mono- or polyunsaturated fats, are directly, though moderately, related to breast cancer risk.     

Intake of potassium, magnesium, calcium, and fiber and risk of stroke among US men

BACKGROUND: Animal experiments and epidemiological studies have suggested that high potassium intake may reduce the risk of stroke, but the evidence is inconclusive, and the role of other nutrients in potassium-rich foods remains unknown. METHODS AND RESULTS: We examined the association of potassium and related nutrients with risk of stroke among 43 738 US men, 40 to 75 years old, without diagnosed cardiovascular diseases or diabetes, who completed a semiquantitative food frequency questionnaire in 1986. During 8 years of follow-up, 328 strokes (210 ischemic, 70 hemorrhagic, 48 unspecified) were documented. The multivariate relative risk of stroke of any type for men in the top fifth of potassium intake (median intake, 4.3 g/d) versus those in the bottom (median, 2.4 g/d) was 0.62 (95% CI, 0.43, 0.88; P for trend=0.007). Results for ischemic stroke alone were similar. Intakes of cereal fiber and magnesium, but not of calcium, were also inversely associated with risk of total stroke. These inverse associations were all stronger in hypertensive than normotensive men and were not materially altered by adjustment for blood pressure levels. Use of potassium supplements was also inversely related to risk of stroke, particularly among men taking diuretics (relative risk, 0.36; 95% CI, 0.18, 0.72). CONCLUSIONS: Although these data do not prove a causal relationship, they are consistent with the hypothesis that diets rich in potassium, magnesium, and cereal fiber reduce the risk of stroke, particularly among hypertensive men. Potassium supplements may also be beneficial, but because of potential risks, use should be carefully monitored and restricted to men taking potassium-losing diuretics.     

Intake of fatty acids and risk of coronary heart disease in a cohort of Finnish men. The Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study

The relation of intakes of specific fatty acids and the risk of coronary heart disease was examined in a cohort of 21,930 smoking men aged 50-69 years who were initially free of diagnosed cardiovascular disease. All men participated in the Finnish Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study and completed a detailed and validated dietary questionnaire at baseline. After 6.1 years of follow-up from 1985-1988, the authors documented 1,399 major coronary events and 635 coronary deaths. After controlling for age, supplement group, several coronary risk factors, total energy, and fiber intake, the authors observed a significant positive association between the intake of trans-fatty acids and the risk of coronary death. For men in the top quintile of trans-fatty acid intake (median = 6.2 g/day), the multivariate relative risk of coronary death was 1.39 (95% confidence interval (CI) 1.09-1.78) (p for trend = 0.004) as compared with men in the lowest quintile of intake (median = 1.3 g/day). The intake of omega-3 fatty acids from fish was also directly related to the risk of coronary death in the multivariate model adjusting also for trans-saturated and cis-monounsaturated fatty acids (relative risk (RR) = 1.30, 95% CI 1.01-1.67) (p for trend = 0.06 for men in the highest quintile of intake compared with the lowest). There was no association between intakes of saturated or cis-monounsaturated fatty acids, linoleic or linolenic acid, or dietary cholesterol and the risk of coronary deaths. All the associations were similar but somewhat weaker for all major coronary events.     

Mycobacterium kansasii and human immunodeficiency virus co-infection in London

In a sample of 627 healthy German children and adolescents between the age of 1 and 18 years the intake of macronutrients (protein, fat, carbohydrates) and their specific subgroups (animal protein, saturated (SFA), monounsaturated (MUFA) and polyunsaturated fatty acids (PUFA), cholesterol, added sugars, dietary fiber) were assessed from 3d weighed diet records. The medians of the nutrient intake (% of energy) were 13% protein (2/3 animal), 38% fat, 49% carbohydrates, 17% SFA, 16% MUFA, 5% PUFA, 12% added sugars and (per MJ) 34 mg cholesterol, 1.9 g dietary fiber. The macronutrient patterns were almost uniform across the age and sex groups with the exception of lower fat, PUFA, and sugar intakes in the 1 year olds. The findings were almost in accordance with former and current dietary surveys in Germany and neighboring countries. Several findings, particularly the high SFA and low fiber intake, differed considerably from the diet for the prevention of the chronic diseases related to nutrition in western societies which is recommended for this age range. Based on the findings of this study, a preventive dietary concept for German children and adolescents was proposed.     

Dietary fat intake and risk of lung cancer: a prospective study of 51,452 Norwegian men and women

The relationship between incidence of lung cancer and intake of dietary fats, high-fat foods, fish, and fish products was studied in 25,956 men and 25,496 women aged 16-56 years attending Norwegian health screening between 1977 and 1983. Linkage to the Cancer Registry of Norway and the Central Bureau of Statistics of Norway ensured a complete follow-up until 31 December 1991. Diet was recorded on a semiquantitative food-frequency questionnaire, and 153 cases of lung cancer were identified during follow-up. Mean age at diagnosis was 56 years. After adjusting for smoking status, gender, age at screening, and attained age, significant lower risks were found for cod liver oil supplement (incidence rate ratio (IRR) = 0.5, 95% CI = 0.3-1.0) and for skim milk compared to whole milk (IRR = 0.5, 95% CI = 0.3-0.9)). No association was found with dietary cholesterol and saturated fat. A threshold of increased risk starting at the second quartile was seen for mono- and polyunsaturated fat. The potential protective effect of cod liver oil, a supplement rich in preformed vitamin A, omega-3 fatty acids, and monounsaturated fat, has to our knowledge, not been reported before. Confounding from lifestyle is possible, but the result deserves further investigation.     

Relationships between dietary fat, body fat, and serum lipid profile in prepubertal children

OBJECTIVE: The purpose of the study was to test the hypothesis that dietary fat components were associated with the serum lipid profile independent of ethnicity, body fat, and fat distribution in prepubertal children. RESEARCH METHODS AND PROCEDURES: Sixty-six children (45 African American and 21 Caucasian), aged from 4 to 10 years, were recruited into the study. Dietary total fat, saturated fat, monounsaturated fat, and polyunsaturated fat were estimated by averaging two 24-hour diet recalls. Fasting serum triacylglycerol, total cholesterol, and high-density lipoprotein cholesterol were analyzed, and low-density lipoprotein cholesterol (LDL-C) was calculated by the method of Friedewald. Body composition and fat distribution were measured by dual energy X-ray absorptiometry and computed tomography. RESULTS: Children in both ethnic groups tended to overreport their dietary intake relative to total energy expenditure by 18%. African American children consumed more energy from total fat (35.3% vs. 31.5%, p<0.05), saturated fat (13.7% vs 12.2%, p<0.05), protein (16.4% vs. 13.2%, p=0.02), and less from carbohydrate (48% vs. 57.1%, p<0.01) than Caucasian children. There was no significant correlation between dietary fat and either serum lipids or body fat indices after adjusting for nonfat energy intake and total lean tissue mass. Total body fat (r=0.32), subcutaneous abdominal adipose tissue (r=0.39), and intra-abdominal adipose tissue (r=0.42) were positively related to serum triacylglycerol; these associations remained significant in a multiple linear regression model in which body fat indices were adjusted for ethnicity, total lean tissue, dietary total fat, and nonfat intake. DISCUSSION: Our results do not support a link between dietary fat and serum lipids; instead, our data suggest that body fat may play a more important role than dietary fat in the course of cardiovascular disease development in prepubertal children.     

Study of prediagnostic selenium level in toenails and the risk of advanced prostate cancer

BACKGROUND: In a recent randomized intervention trial, the risk of prostate cancer for men receiving a daily supplement of 200 microg selenium was one third of that for men receiving placebo. By use of a nested case-control design within a prospective study, i.e., the Health Professionals Follow-Up Study, we investigated the association between risk of prostate cancer and prediagnostic level of selenium in toenails, a measure of long-term selenium intake. METHODS: In 1986, 51,529 male health professionals aged 40-75 years responded to a mailed questionnaire to form the prospective study. In 1987, 33,737 cohort members provided toenail clippings. In 1988, 1990, 1992, and 1994, follow-up questionnaires were mailed. From 1989 through 1994, 181 new cases of advanced prostate cancer were reported. Case and control subjects were matched by age, smoking status, and month of toenail return. Selenium levels were determined by neutron activation. All P values are two-sided. RESULTS: The selenium level in toenails varied substantially among men, with quintile medians ranging from 0.66 to 1.14 microg/g for control subjects. When matched case-control data were analyzed, higher selenium levels were associated with a reduced risk of advanced prostate cancer (odds ratio [OR] for comparison of highest to lowest quintile = 0.49; 95% confidence interval [CI] = 0.25-0.96; P for trend = .11). After additionally controlling for family history of prostate cancer, body mass index, calcium intake, lycopene intake, saturated fat intake, vasectomy, and geographical region, the OR was 0.35 (95% CI = 0.16-0.78; P for trend = .03). CONCLUSIONS: Our results support earlier findings that higher selenium intakes may reduce the risk of prostate cancer. Further prospective studies and randomized trials of this relationship should be conducted.     

Nutrient intake and blood pressure in the Dietary Intervention Study in Children

Delineating the role that diet plays in blood pressure levels in children is important for guiding dietary recommendations for the prevention of hypertension. The purpose of this study was to investigate relationships between dietary nutrients and blood pressure in children. Data were analyzed from 662 participants in the Dietary Intervention Study in Children who had elevated low-density lipoprotein cholesterol and were aged 8 to 11 years at baseline. Three 24-hour dietary recalls, systolic pressure, diastolic pressure, height, and weight were obtained at baseline, 1 year, and 3 years. Nutrients analyzed were the micronutrients calcium, magnesium, and potassium; the macronutrients protein, carbohydrates, total fat, saturated fat, polyunsaturated fat, and monounsaturated fat; dietary cholesterol; and total dietary fiber. Baseline and 3-year longitudinal relationships were examined through multivariate models on diastolic and systolic pressures separately, controlling for height, weight, sex, and total caloric intake. The following associations were found in longitudinal analyses: analyzing each nutrient separately, for systolic pressure, inverse associations with calcium (P < .05); magnesium, potassium, and protein (all P < .01); and fiber (P < .05), and direct associations with total fat and monounsaturated fat (both P < .05); for diastolic pressure, inverse associations with calcium (P < .01); magnesium and potassium (both P < .05), protein (P < .01); and carbohydrates and fiber (both P < .05), and direct associations with polyunsaturated fat (P < .01) and monounsaturated fat (P < .05). Analyzing all nutrients simultaneously, for systolic pressure, direct association with total fat (P < .01); for diastolic pressure, inverse associations with calcium (P < .01) and fiber (P < .05), and direct association with total and monounsaturated fats (both P < .05). Results from this sample of children with elevated low-density lipoprotein cholesterol indicate that dietary calcium, fiber, and fat may be important determinants of blood pressure level in children.     

Effects of carbontetrachloride and chenodeoxycholic acid on hepatic monooxygenase system, lipid peroxidation and some immunologic parameters in rats

BACKGROUND: Nutritional characteristics of the mediterranean diet, with a high intake of complex carbohydrates, fibre, monounsatured fatty acids and vegetables, are related to a lower prevalence of some nutritional associated diseases. The aim of our study was to perform a longitudinal analysis of the evolution of food intake in a mediterranean population in order to observe its influence on the energy and nutritional intake and their balance. The latter could have some effects on health status. METHODS: Dietary intake was evaluated using the 24 hours recall method in a representative sample (n = 941, age range = 10-69) of a Reus population. This longitudinal study consisted of 70% of the samples studied in 1983 using identical methodology. RESULTS: During this decade (1983-1993), energy intake decreased significantly 180 kcal/day for men and 158 kcal/day for women, carbohydrates being the main cause for this drop (132 and 84 kcal/day less for men and women, respectively). Protein intake decreased significantly in both sexes, 5.6% for men and 8.0% for women. However, the evolution of fat intake was different for men (no changes) and for women (a significant decrease of 5.7%). Saturated and monounsatured fatty acids did not show significant changes in this decade. Cholesterol intake decreased significantly in both sexes. Energy percents obtained from lipids, saturated and monounsaturated fatty acids significantly increased. However, in absolute values very little changes in fat intake in both sexes were observed. CONCLUSIONS: The dietary pattern evolved to a lower energy intake with an increment of the percentage of dietary lipids, but this feature was did not reflect a greater fat intake in absolute values. Moreover, the main characteristics of the typical mediterranean diet (which is basically different to the usual diet of other non mediterranean european countries mainly due to its richness in monounsaturated fatty acids) did not change in the period analyzed.     

Cigarette smoking is associated with unhealthy patterns of nutrient intake: a meta-analysis

The aim of this investigation was to assess the relationship between smoking status and nutrient intakes using a meta-analysis. Publications in English were sought through a Medline search using the following key words: food habits, eating, feeding behavior, diet, food, nutrition, nutritional status or assessment, tobacco use disorder, tobacco, nicotine and smoking. Scanning relevant reference lists of articles and hand searching completed the data collection. No attempt was made to search for unpublished results. Paper selection was based on nutritional surveys including comparisons of smokers with nonsmokers. Fifty-one published nutritional surveys from 15 different countries with 47,250 nonsmokers and 35,870 smokers were used in the analysis. The estimates of size effects were calculated with the mean and variance values of each nutrient intake and the size of the sample. Smokers declared significantly (all P < 10(-5)) higher intakes of energy (+4.9%), total fat (+3.5%), saturated fat (+8.9%), cholesterol (+10.8%) and alcohol (+77.5%) and lower intakes of polyunsaturated fat (-6.5%), fiber (-12.4%), vitamin C (-16.5%), vitamin E (-10.8%) and beta-carotene (-11.8%) than nonsmokers. Protein and carbohydrate intakes did not differ between smokers and nonsmokers. There was no evidence of heterogeneity among studies. In conclusion, the nutrient intakes of smokers differ substantially from those of nonsmokers. Some of these differences may exacerbate the deleterious effects of smoke components on cancer and coronary heart disease risk.     

Intake of trans fatty acids and risk of coronary heart disease among women

Trans isomers of fatty acids, formed by the partial hydrogenation of vegetable oils to produce margarine and vegetable shortening, increase the ratio of plasma low-density-lipoprotein to high-density-lipoprotein cholesterol, so it is possible that they adversely influence risk of coronary heart disease (CHD). To investigate this possibility, we studied dietary data from participants in the Nurses' Health Study. We calculated intake of trans fatty acids from dietary questionnaires completed by 85,095 women without diagnosed CHD, stroke, diabetes, or hypercholesterolaemia in 1980. During 8 years of follow-up, there were 431 cases of new CHD (non-fatal myocardial infarction or death from CHD). After adjustment for age and total energy intake, intake of trans isomers was directly related to risk of CHD (relative risk for highest vs lowest quintile 1.50 [95% Cl 1.12-2.00], p for trend = 0.001). Additional control for established CHD risk factors, multivitamin use, and intakes of saturated fat, monounsaturated fat, and linoleic acid, dietary cholesterol, vitamins E or C, carotene, or fibre did not change the relative risk substantially. The association was stronger for the 69,181 women whose margarine consumption over the previous 10 years had been stable (1.67 [1.05-2.66], p for trend = 0.002). Intakes of foods that are major sources of trans isomers (margarine, cookies [biscuits], cake, and white bread) were each significantly associated with higher risks of CHD. These findings support the hypothesis that consumption of partially hydrogenated vegetable oils may contribute to occurrence of CHD.     

Dietary cholesterol affects serum lipids, lipoproteins and LDL metabolism in cynomolgus monkeys in a dose-dependent manner

To examine the mechanism(s) underlying the cholesterolemic response to dietary cholesterol and saturated fatty acids, low density lipoprotein (LDL) metabolism was studied in two groups of cynomolgus monkeys fed diets containing 30 or 36% of total energy as fat. At each dietary fat level, the same group of monkeys was sequentially fed three dietary cholesterol concentrations as egg yolk in the following sequence: low (0.01 mg/kJ), medium (0.03 mg/kJ) and high (0.05 mg/kJ) for 30, 32 and 24 wk, respectively. Dietary polyunsaturated and monounsaturated fatty acids were the same in the two groups; the 6% difference in fat was due to the saturated fatty acids, 12:0 and 14:0. Serum total cholesterol, LDL cholesterol and LDL apolipoprotein B concentrations increased (P < 0.05) with dietary cholesterol in a dose-dependent manner in both fat groups. These elevations were the result of generally increasing LDL apolipoprotein B production rates, concomitant with reduced LDL apolipoprotein B fractional clearance at the high cholesterol intake. Serum HDL cholesterol and HDL apolipoprotein A-I concentrations were not affected in a consistent manner. These results demonstrate that cynomolgus monkeys are hyperresponsive to dietary cholesterol compared with humans, suggesting that this model may be useful in identifying metabolic and genetic predictors for hyperresponsiveness to dietary cholesterol in humans as well as assessing the metabolic heterogeneity of responses to dietary cholesterol.     

Low fat intake and coronary artery disease in a population with higher prevalence of coronary artery disease: the Indian paradox

OBJECTIVE: To determine the association between saturated fat intake and prevalence of coronary artery disease (CAD) and coronary risk factors. DESIGN AND SETTING: Total community cross sectional survey of 20 urban streets out of 196 streets, in the city of Moradabad in north India. SUBJECTS AND METHODS: Adult population between 25 to 64 years inclusive comprised of 1806 subjects (904 men, 902 women) were divided into three groups according to level of saturated fat intake as assessed by 7-day dietary intake records (very low < 7%, low 7 to 10%, high > 10% energy (en) per day). RESULTS: We examined the relationship between CAD risk and levels of % en from fat intake. Low (7 to 10% en/day) and high (> 10% en/day) saturated fat were positively and significantly associated with higher prevalence of CAD. The prevalence of coronary risk factors (hypertension, hypercholesterolemia, obesity and sedentary lifestyle) were significantly higher among subjects with low and high saturated fat intake compared to subjects with very low (< 7%) saturated fat intake. Logistic regression analysis with adjustment for age showed that hypercholesterolemia (OR: men 0.89, women 0.68), hypertension (men 0.92, women 0.56), physical activity (men 0.80, women 0.36), obesity (men 0.82, women 0.88) and smoking (0.70 men) were significant risk factors of CAD. Low and high saturated fat intake were associated with more prestigious occupations, higher and middle income status and better educational levels compared to very low saturated fat intake. CONCLUSIONS: The prevalence of CAD and coronary risk factors was higher in urban Indians with low and high saturated fat intake than those with lower saturated fat intake. These findings suggest that the saturated fat intake should be < 7% en/day for prevention of CAD in Indians.