Oslo Diet Heart Study
-
Upload
reijo-laatikainen -
Category
Health & Medicine
-
view
3.763 -
download
1
description
Transcript of Oslo Diet Heart Study
Oslo Diet Heart Study
Leren et al. The effect of plasma cholesterol lowering diet in male survivors of myocardial infarction. Bull N Y Acad Med. 1968
August; 44(8): 1012–1020.
(does NOT contain detailed diet instrcutions)
Published also as doctoral thesis in
Acta Med Scand. 1966; Suppl 466; 1-9
(comprehensive version containing the detailed dietary instructions )
[Updated February 2015]
Page 1
Important note:
Detailed dietary instructions can only be found in the long and
original paper version from 1966, not in the electronically available
version from 1968
2
Pronutritionist’s background
• In meta-analyses, saturated fat intake is not independently linked to coronary heart disease (CHD) incidence (Siri-Tarino et al. 2010, Skeaff & Miller J. 2009 and Mente et al. 2009)
• Another meta-analysis based on the randomized outcome trials, demonstrated a lower incidence of CHD if saturated fat was replaced by polyunsaturated fat (Mozaffarian et al. 2010)
• The results of Mozaffarian’s meta-analysis were heavily driven by two studies: a) Finnish Mental Hospital Study (FMHS) and b) Oslo Diet Heart Study
• Oslo Diet Heart Study is often perceived as a fat modification trial but this has been questioned by Ramsden et al. 2010
• Oslo Diet Heart Study is still a landmark trial, but how does it stand the test of time?
Leren et al. . Bull N Y Acad Med. 1968 August; 44(8): 1012–1020
Page 3
Methods (patients)• Parallel randomized trial • Secondary prevention of CHD among myocardial infarction (MI)
survivors• Primary outcomes: Reinfarctions and serum total cholesterol• N=412, males, age 30-64 years• Active treatment was started 1-2 years after MI • Total cholesterol levels at baseline in both groups 7,6 mmol/L (296
mg/dl)• Subjects were free living• Length: 5 years per arm• Era: 1956 → (60 months follow up)
• “Dieters” = active treatment group”
Leren et al. . Bull N Y Acad Med. 1968 August; 44(8): 1012–1020
Page 4
Methods (schematic)
Leren et al. . Bull N Y Acad Med. 1968 August; 44(8): 1012–1020
Page 5
Randomization of patients (MI survivors, n = 412)
Comprehensive “cholesterol lowering diet” (“Dieters”) (see details next page) n=206
Dairy fat diet = control (normal Norwegian diet) n=206
5 yearsy. 1956→
Methods, diet (1/3)
Cholesterol lowering diet• Soybean oil was provided for free
(from “15-30 g /day as medicine” OR 0,5 L/week for cooking)
• Sardines canned in cod liver oil “which proved to be a popular as a bread spread”. Provided for free.
• Fish and shell fish recommended instead of all types of meat
• All consumed meat to be lean (visible fat should be removed)
• Use of “brown bread” encouraged instead of “whole milk loaf”
• Increased vegetable, nuts, beans, peas & fruit consumption encouraged
• Margarine use was “entirely restricted”• Only 1 egg yolk per week• Multivitamin provided
Normal diet (control)• No restrictions• No free foods were provided for
controls • Multivitamin provided
Leren et al. . Acta Med Scand. 1966; Suppl 466; 1-9
Page 6
Note! This data on diets is only available in Acta Med Scan publication (original paper
version)
Methods, diet (2/3)
Leren et al. . Acta Med Scand. 1966; Suppl 466; 1-9 (only in the paper version of the study)
Page 7
Note! This data on diets is only available in Acta Med Scan publication (original paper
version)
Methods, diet (3/3)
Leren et al. . Acta Med Scand. 1966; Suppl 466; 1-9 (only in the paper version of the study)
Page 8
Results (myocardial infarctions)
Leren et al. . Bull N Y Acad Med. 1968 August; 44(8): 1012–1020
Page 9
Absolute number of outcomes P=0.022
Δ - 33 %
P=0.029
Δ - 56 %
Difference in MI’s was driven by younger patients
Results (total cholesterol)
Leren et al. . Bull N Y Acad Med. 1968 August; 44(8): 1012–1020
Page 10
Total cholesterol change from baseline (%)
Multifactorial cholesterol
lowering diet
Baseline in both groups 7,6 mmol/L (296 mg/dl)
Results (diet)
Multifactorial diet Normal diet
Total fat 104 g (39 E %) N/A
Soy bean oil 72 % of total fat N/A
Fish fat 11,6 % of total fat N/A
Animal fat 8.8 % of total fat N/A
Cereal fat 5.0 % of total fat N/A
Other fat sources 2.6 % of total fat N/A
Cholesterol 264 mg N/A
Carbohydrates 269 g N/A
Protein 92 g N/A
Leren et al. . Bull N Y Acad Med. 1968 August; 44(8): 1012–1020
Page 11
Dietary intakes (based on a sub-group representing 4 % of all subjects)
Pronutritionist’s discussion (1/3) • Oslo Diet-Heart delivered robust results in secondary prevention of
coronary heart disease (CHD -33 % & fatal MI -54 %)
• Oslo Diet Heart Study is not a sheer SFA/PUFA modification trial but a dietary pattern studysuch as Lyon Diet Heart or Predimed studies
• Oslo Diet Heart dietary intakes were poorly reported. Only 4 % of participants provided any dietary data. In controls none provided dietary data.
• “Dieters” possibly received 5 grams of marine omega-3 fatty acids, 15 mcg vitamin D extra, and controls received 7 grams more of TFA due to different dietary patterns (Ramsden et al. 2010)
Leren et al. . Bull N Y Acad Med. 1968 August; 44(8): 1012–1020
Page 12
Pronutritionist’s discussion (2/3)Pursued dietary changes in Oslo Diet-Heart
Means Method of support
Increase in omega-6 fatty acids (linoleic acid)
Soybean Oil for cooking or “as medicine”Nuts
Free soybean oil
Encouraged
Increase in omega-3 fatty acids
Canned sardines in cod liver oil Nuts
Free canned sardine delivery twice during the studyEncouraged
Increase in Vitamin D Canned sardines in cod liver oil
Free canned sardine delivery twice during the study
Decrease in SFA intake Skim milk ↑, butter/margarine and meat restricted
Encouraged/banned
Decrease in trans fat intake
Margarine restricted Banned
Increase fiber and indigestible carbs
Increase in brown bread & vegetable, fruit, beans intake
Encouraged
http://www.facebook.com/pronutritionist
Leren et al. . Bull N Y Acad Med. 1968 August; 44(8): 1012–1020
Page 13
Pronutritionist’s discussion (3/3)
• Oslo Diet Heart Study produced very similar results to Lyon Diet Heart Study in which TFA-low margarine was the vehicle of n-3 and n-6 fatty acids in the context of Mediterranean dietary pattern
• Dietary pattern used in Oslo Diet Heart Study is very similar to what is recommended in many official dietary guidelines globally
– Higher than usual intake of both n-6 and n-3 FAs– High fiber intake – Low refined carbohydrate intake– Low intake of saturated fat and cholesterol– High consumption of vegetables, fruits, berries, whole grains, nuts and beans – More fish and seafood and possibly poultry instead of of red and processed meat– More vegetable oils or margarines low in TFA instead of butter and old-fashioned
margarines high in TFA
Page 14
Read also about Finnish Mental Hospital Study
Click for slides here
15
Welcome aboard!
11/04/2316
http://twitter.com/pronutritionisthttp://www.facebook.com/pronutritionisthttp://www.pronutritionist.net (Finnish)
http://www.pronutritionistblog.com (English)
Reijo Laatikainen, Authorized Nutritionist, MBA