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The Rationale and Potential Efficacy of Preventive Nutrition in Heart Disease: The Framingham Offspring-Spouse Study

Barbara Millen Posner, DrPH, RD; L. Adrienne Cupples, PhD; David Gagnon, MD, MPH; Peter W. F. Wilson, MD; Kim Chetwynd, MPH; Deborah Felix, MPH

Arch Intern Med. 1993;153(13):1549-1556.

Abstract
Background
To examine the rationale for preventive nutrition intervention and the potential efficacy of nutrition-related risk factor modification on heart disease incidence, the cardiovascular disease risk and dietary profiles of Framingham (Mass) men and women, 30 to 79 years old (n=1798 and 1845, respectively), were compared with the Healthy People 2000: National Health Promotion and Disease Prevention Objectives for the Nation and used to project the 10-year incidence of coronary heart disease with and without lowering serum cholesterol levels.

Methods
Data for this report are derived from the 1984 to 1988 cycle III examinations of the Framingham offspring-spouse cohort. Estimates of the reduction in coronary heart disease risk associated with modifications in serum cholesterol levels and other cardiovascular disease risk factors are projected using Framingham models.

Results
About 40% met guidelines for desirable total cholesterol levels (<5.17 mmol/L [<200 mg/dL]); 20% were hypertensive; one quarter smoked; and 10% of women and 20% of men were obese. Twenty-four-hour dietary data, adjusted for estimates of usual intake, indicated that about 50% to 80% met dietary cholesterol (<300 mg) and 55% to 94% met sodium (<3 g/d) objectives. In contrast, mean total fat intakes were high (38% of total energy), and only 6% to 9% of subjects met total fat, 9% to 14% met saturated fat, and fewer than 3% met dietary fiber guidelines. Ten-year cumulative incidence for coronary heart disease was projected to be up to 25% lower with reduction in serum cholesterol level.

Conclusion
Risk factor lowering, emphasizing preventive nutrition measures, is an important element of health care reform, particularly strategies to reduce cardiovascular disease rates and to promote population health.

(Arch Intern Med. 1993;153:1549-1556)

Author Affiliations
From the Office of the Director (Dr Posner) and the Departments of Social and Behavioral Sciences (Dr Posner and Mss Chetwynd and Felix) and Epidemiology and Biostatistics (Drs Cupples and Gagnon), Boston (Mass) University School of Public Health, School of Medicine, and the Framingham (Mass) Heart Study (Dr Wilson).

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