Wrong diet may worsen CVD risk even in normal weight individuals, AJPC study.

Diet quality is a significant contributor to cardiovascular disease (CVD) development given its substantial influence on important downstream CVD mediators such as weight. But if an individual has normal body weight, is he/she safe from the impact of unhealthy diet?

A recent study published in American Journal of Preventive Cardiology explored the impact of diet across various BMI (body mass index) categories and has found that higher diet quality is significantly associated with lower risk of incident CVD among individuals with normal weight. Infact the inverse relationship between diet quality and CVD risk is not maintained for individuals belonging to obese category, probably since a healthy diet alone cannot mitigate the magnitude of CVD risk present in these individuals.

For this study, prospective cohort data from the Lifetime Risk Pooling Project was analyzed. Diet data from 6 US cohorts were harmonized. The alternative Healthy Eating Index-2010 (aHEI-2010) score was calculated for each participant.

Within each cohort, participants were divided into aHEI-2010 quintiles. The primary outcome of interest was composite incident CVD event including coronary heart disease, stroke, heart failure, and CVD death. A total of 30,219 participants were included. During a median follow-up of 16.2 years, there were a total of 7,021 CVD events.

An inverse association between aHEI-2010 score and incident CVD was identified among participants who were normal weight and among participants with overweight. Interestingly, aHEI-2010 score was not associated with CVD among participants with obesity suggesting lesser significance of diet on this overall "very high" CVD risk category.

The fact that obesity is a strong, known risk factor for CVD suggests a causal relationship in the observed mitigation of diet quality on risk of CVD in participants with obesity.

Another interesting article published in the same issue of the journal explores the role of dietary components in day-to day diet. Studies have shown that "southern diet" that is rich in fats, fried food, eggs, processed meats and sugar sweetened beverages, was associated with a 56% increase in acute coronary heart disease events and a 30% increase in stroke.

Replacement of saturated fats with mono and polyunsaturated varieties and an altogether avoidance of trans fat source like cakes, cookies, crackers, etc should be done. Adoption of Mediterranean diet (based on the results of PREDIMED study) can lower the risk of CVD by upto 30% even when compared to a low fat diet.

On a societal level, improving diet quality is a safe intervention with profound public health implications for the entire population. From a clinical perspective, counseling of a healthy diet should be initiated early in life and sustained regardless of weight category.

Source:

American Journal of Preventive Cardiology:

1. https://doi.org/10.1016/j.ajpc.2021.100298

2. https://doi.org/10.1016/j.ajpc.2021.100287