Oslo Diet Heart Study

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This study is the first one to show the effect of dietary intervention in the secondary prevention of CHD. It is meal pattern study even if very often labelled as sole fat modification study

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Oslo Diet Heart Study

  1. 1. 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
  2. 2. 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
  3. 3. 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
  4. 4. 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
  5. 5. 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→
  6. 6. 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)
  7. 7. 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)
  8. 8. 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
  9. 9. 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
  10. 10. 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)
  11. 11. 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)
  12. 12. 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
  13. 13. 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 study Encouraged 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/pron utritionist Leren et al. . Bull N Y Acad Med. 1968 August; 44(8): 1012–1020 Page 13
  14. 14. 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
  15. 15. Read also about Finnish Mental Hospital Study Click for slides here 15
  16. 16. Welcome aboard! 14/02/1516 http://twitter.com/pronutritionist http://www.facebook.com/pronutritionist http://www.pronutritionist.net (Finnish) http://www.pronutritionistblog.com (English) Reijo Laatikainen, Authorized Nutritionist, MBA

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