Diet and the Risk of
Coronary Heart Disease
Adventist men, and at least younger and middle-aged Adventist women, experience fewer fatal and nonfatal heart attacks than non-Adventists at a given age (see Chapter 2). This observation demands explanation, so in this chapter dietary associations with coronary heart disease (CHD) that may partially explain the lower risk among Adventists are sought. Detailed information on diet and other health habits was collected in the Adventist Health Study. Since no non-Adventists were included as a comparison group, the contrasts were between the CHD experience of different groups of Adventists defined by their dietary habits. One benefit of looking only within the Adventist group is that there is less risk that differences in other lifestyle, psychological, educational, or even genetic factors may interfere with the interpretation of comparisons.
This chapter is the first of three dealing with the possibility that individual foods or food groups can influence the risk of chronic disease. It is confusing to the public and to health professionals that well-designed dietary epidemiologic studies often seem to produce conflicting results when specific dietary factors are evaluated. Few foods or nutrients have not been claimed, on the basis of some study, to be either hazardous or beneficial in regard to cardiovascular disease or cancer. As this book focuses on diet and health and uses epidemiologic data as its main basis, an attempt at clarification is in order.
An important problem that potentially interferes with the interpretation of all studies in dietary epidemiology is that of measurement errors. These occur when we do not measure exactly what we wish to measure. In dietary research this happens when subjects cannot remember accurately what they usually eat, or become tired with answering so many questions and less careful with their answers. The problem is that measurement er-