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Abstract
The diet-heart hypothesis proposes that elevated intakes of total fat, saturated fat,
and dietary cholesterol raise serum cholesterol, which in turn increases the risk
of developing coronary heart disease (CHD). To examine the relationship between dietary
intake and 12-year CHD mortality we used data from the Lipid Research Clinics Prevalence
Follow-Up Study. Dietary intake was measured at study entry using the 24-hour recall
technique among 4546 North American men and women who were at least 30 years old and
initially free of CHD. Proportional hazards analyses controlling for total energy
intake indicated that increasing percentages of energy intake as total fat (RR 1.04,
95% CI = 1.01-1.08), saturated fat (RR 1.11, CI = 1.04-1.18), and monounsaturated
fat (RR 1.08, CI = 1.01-1.16) were significant risk factors for CHD mortality among
30 to 59 year olds. The increasing percentage of energy intake from carbohydrate had
a significant protective effect (RR 0.96, CI = 0.94-0.99). The strength of these associations
was not diminished after adjustment for specific serum lipids, suggesting that serum
lipids did not mediate the effect of diet on CHD mortality. None of the dietary components
were significantly associated with CHD mortality among those aged 60-79 years. We
conclude that future research must be directed toward better understanding the pathway
between dietary intake and coronary disease as the current diet-lipid-heart hypothesis
may be overly simplistic.