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Effect of an Indo-Mediterranean diet on progression of coronary artery disease in high risk patients (Indo-Mediterranean Diet Heart Study): a randomised single-blind trial
Abstract
Background The rapid emergence of coronary artery disease (CAD) in south Asian people is not explained by conventional risk factors. In view of cardioprotective effects of a Mediterranean style diet rich in alpha-linolenic acid, we assessed the benefits of this diet for patients at high risk of CAD.Methods We did a randomised, single-blind trial in 1000 patients with angina pectoris, myocardial infarction, or surrogate risk factors for CAD. 499 patients were allocated to a diet rich in whole grains, fruits, vegetables, walnuts, and almonds. 501 controls consumed a local diet similar to the step I National Cholesterol Education Program (NCEP) prudent diet.Findings The intervention group consumed more fruits, vegetables, legumes, walnuts, and almonds than did controls (573 g [SD 127] vs 231 g [19] per day p<0.001). The intervention group had an increased intake of whole grains and mustard or soy bean oil. The mean intake of alpha-linolenic acid was two-fold greater in the intervention group (1.8 g [SD 0.4] vs 0.8 g [0.2] per day, p<0.001). Total cardiac end points were significantly fewer in the intervention group than the controls (39 vs 76 events, p<0.001). Sudden cardiac deaths were also reduced (6 vs 16, p=0.015), as were non-fatal myocardial infarctions (21 vs 43, p<0.001). We noted a significant reduction in serum cholesterol concentration and other risk factors in both groups, but especially in the intervention diet group. In the treatment group, patients with pre-existing CAD had significantly greater benefits compared with such patients in the control group.Interpretation An Indo-Mediterranean diet that is rich in alpha-linolenic acid might be more effective in primary and secondary prevention of CAD than the conventional step I NCEP prudent diet.
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“In another randomized clinical trial, Singh and colleagues tested a “Indo-Mediterranean diet,” rich in whole grains, fruits, vegetables, walnuts, almonds, mustard, or soybean oil, in 1,000 Indian patients at high risk or with existing coronary heart disease, and found a significant reduction in total cardiac end points.”
From Health Benefits of the Mediterranean Diet: Metabolic and Molecular Mechanisms (2018) · cites this paper as [23]
In the citing paper
“Compared with patients randomized to a step I National Cholesterol Education Program prudent diet, those following the Indo-Mediterranean diet rich in α-linolenic acid experienced an approximate 50% reduction in the rate of nonfatal myocardial infarction and an approximate 60% reduction in the rate of sudden cardiac death (23).”
From Health Benefits of the Mediterranean Diet: Metabolic and Molecular Mechanisms (2018) · cites this paper as [23]
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Olive oil and haemostasis: a review on its healthy effects
Pérez‐Jiménez, F., Delgado‐Lista, J., Pérez‐Martínez, P., Lopez‐Segura, F., Fuentes, F. J., Rodríguez, B. C., Lozano, A., & López‐Miranda, J. (2006) · Public Health Nutrition · doi:10.1017/s1368980007668566 · Cited by 27
Siger, A., Michalak, M., & Rudzińska, M. (2015) · European Journal of Lipid Science and Technology · doi:10.1002/ejlt.201500314 · Cited by 27
The Mediterranean Diet and Your Health
Brill, J. B. (2008) · American Journal of Lifestyle Medicine · doi:10.1177/1559827608325476 · Cited by 27
The Tsim Tsoum Approaches for Prevention of Cardiovascular Disease
Singh, R. B., DeMeester, F., & Wilczynska, A. (2010) · Cardiology Research and Practice · doi:10.4061/2010/824938 · Cited by 26
“[109] tested an “Indo-Mediterranean diet” in 1000 patients in India, with existing coronary disease or at high risk for coronary disease.”
MethodTreatment of Risk Factors to Prevent Stroke
Aoki, J., & Uchino, K. (2011) · Neurotherapeutics · doi:10.1007/s13311-011-0054-0 · Cited by 25
“It also seems to have beneficial effects in reducing myocardial infarction, but the effects on stroke is less clear [ 83 , 84].”
BackgroundThe effect of social class on the amount of salt intake in patients with hypertension
Mahmoodabad, S. S. M., Tehrani, H., Gholian‐Aval, M., Gholami, H., & Nematy, M. (2016) · Blood Pressure · doi:10.1080/08037051.2016.1179508 · Cited by 26
“The diets of people belonging to the low socioeconomic class include salty, fatty, high-calorie, low-quality and cheap foods.[17] On the other hand, since the low-class staple is bread, which is normally of low quality in such districts,[18] the salt hidden in bread was the most important source of high salt intake in…”
BackgroundLinoleic Acid to Alpha-Linolenic Acid Ratio
Zampelas, A., Paschos, G. K., Rallidis, L. S., & Yiannakouris, N. (2003) · KARGER eBooks · doi:10.1159/000073795 · Cited by 26
Nutritional assessment and counseling for prevention and treatment of cardiovascular disease.
Olendzki, B. C., Speed, C., & Domino, F. J. (2006) · PubMed · Cited by 26
Singh, R. B., Fedačko, J., Pella, D., Pella, D., Fatima, G., Gushchina, Y. S., Magomedova, A. G., Elkilany, G., Moshiri, M., Hristova, K., et al. (2022) · Antioxidants · doi:10.3390/antiox11081464 · Cited by 26
Effects of dietary interventions on cardiovascular outcomes: a network meta-analysis
Doundoulakis, I., Farmakis, I. T., Theodoridis, X., Konstantelos, A., Christoglou, M., Kotzakioulafi, E., Chrysoula, L., Siargkas, A., Karligkiotis, A., Kyprianou, G., et al. (2023) · Nutrition Reviews · doi:10.1093/nutrit/nuad080 · Cited by 30
“49– 41,45 and 2”
BackgroundMethodBioactive Foods and Nutraceutical Supplementation Criteria in Cardiovascular Protection
Sharma, R., & Singh, R. B. (2010) · The Open Nutraceuticals Journal · doi:10.2174/18763960010030300141 · Cited by 25
“In further randomized, controlled intervention trials, Singh et al. 2002, 2008 administered 400 g/day of fruits, vegetables and nuts(almonds and walnuts) and another 400g/day of whole grains including legumes in conjunction with 25- 50g/day of mustard oils (ALA 2.9 g/day) in patients with high risk…”
BackgroundInfluentialSingh, R. B., Fedačko, J., Mojto, V., Isaza, A., Dewi, M., Watanabe, S., Chauhan, A. K., Fatima, G., Kartikey, K., & Sulaeman, A. (2020) · MOJ Public Health · doi:10.15406/mojph.2020.09.00318 · Cited by 25
Michalsen, A., Knoblauch, N. T. M., Lehmann, N., Grossman, P., Kerkhoff, G., Wilhelm, F. H., Moebus, S., Konstantinides, S., Binder, L., Heusch, G., et al. (2006) · American Heart Journal · doi:10.1016/j.ahj.2005.06.025 · Cited by 25
“35 (95% CI 20-61) in LG and 41 (13-66) in AG, representing moderate relative increases of 14.”
BackgroundDietary n-6:n-3 Fatty Acid Ratio and Health
Gebauer, S. K., Harris, W. S., Kris-Etherton, M., & Etherton, T. D. (2019) · AOCS Publishing eBooks · doi:10.1201/9780429104497-11 · Cited by 25
Prevention of coronary artery disease: the south Asian paradox
Pella, D., Thomas, G. N., Tomlinson, B., & Singh, R. B. (2003) · The Lancet · doi:10.1016/s0140-6736(03)12139-3 · Cited by 25
Mediterranean Diet and cardiovascular health: an historical perspective
Delarue, J. (2021) · British Journal Of Nutrition · doi:10.1017/s0007114521002105 · Cited by 27
Is Cardiovascular Disease in Women Inevitable?
Johannes, J., & Merz, C. N. B. (2011) · Cardiology in Review · doi:10.1097/crd.0b013e318209a711 · Cited by 23
Mediterranean diet and spirituality/religion: eating with meaning
Dominguez, L. J., Veronese, N., Ragusa, F. S., Petralia, V., Ciriminna, S., Bella, G. D., Schirò, P., Sabico, S., Al‐Daghri, N. M., & Barbagallo, M. (2024) · Aging Clinical and Experimental Research · doi:10.1007/s40520-024-02873-w · Cited by 26
Modified Cretan Mediterranean Diet in the Prevention of Coronary Heart Disease and Cancer: An Update
de Lorgeril, M., & Salen, P. (2006) · KARGER eBooks · doi:10.1159/000097870 · Cited by 23
Slyper, A. H. (2013) · Journal of Pediatric Endocrinology and Metabolism · doi:10.1515/jpem-2012-0419 · Cited by 23
Metadata
- Authors
- Singh, R. B., Dubnov, G., Niaz, M. A., Ghosh, S., Singh, R., Rastogi, S. S., Manor, O., Pella, D., & Berry, E. M.
- Affiliations
- Teerthanker Mahaveer Medical College & Research Centre (IN)
- Hebrew University of Jerusalem (IL)
- Corresponding author
- Berry, Elliot M
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2002-11
- Volume
- 360
- Issue
- 9344
- Pages
- 1455-1461
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2093983853
- Cited by
- 663
- References
- 39
- Citations by year
- 2026: 8 · 2025: 12 · 2024: 11 · 2023: 14 · 2022: 12 · 2021: 25 · 2020: 11 · 2019: 19 · 2018: 25 · 2017: 18 · 2016: 19 · 2015: 25 · 2014: 25 · 2013: 21 · 2012: 37
- FWCI
- 57.17
- Type
- journal article
- Language
- en
- Update notices
- expression_of_concern (2005-07-30)
- Open access
- closed
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Nursing › Nutrition and Dietetics › Fatty Acid Research and Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Keywords
- coronary artery disease, alpha-linolenic acid, dietary intervention, angina pectoris, myocardial infarction, sudden cardiac death, whole grains, nuts, fruits and vegetables, serum cholesterol, secondary prevention, South Asian populations
- MeSH terms
- Angina Pectoris, Coronary Artery Disease, Female, Humans, Male, Middle Aged, Myocardial Infarction, Risk Factors, Proportional Hazards Models, Survival Analysis, Single-Blind Method, Disease Progression, Diet, Mediterranean
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