By David Douglas

NEW YORK (Reuters Health) - A diet rich in fish, fruit, and vegetables may reduce endothelial dysfunction and low-grade inflammation and hence lead to less cardiovascular disease (CVD), according to Dutch researchers.

"Our study shows for the very first time that a healthy diet influences beneficially an important process that leads to heart disease. Such an effect might be even stronger in those with diabetes and (or) cardiovascular disease already," Dr. Ronald M. A. Henry, of the Cardiovascular Research Institute Maastricht in the Netherlands, told Reuters Health by email.

"Endothelial dysfunction and low-grade inflammation play important roles in the development of CVD," the investigators wrote in their December 31 online paper in The Journal of Nutrition. "Dietary modification of these phenomena may constitute a mechanism through which CVD may be prevented."

Dr. Henry and colleagues note that such a diet, moderate in alcohol and low in dairy products and meat, apparently has cardiovascular benefits but the underlying mechanisms are unclear.

To investigate further, the team conducted a longitudinal cohort study of 557 subjects with a mean age of almost 60 years at baseline who had an increased cardiovascular disease risk.

The team used a validated food frequency questionnaire to determine consumption of fish, vegetables, fruit, alcohol-containing beverages, dairy products, and meat.

They also measured an extensive array of biomarkers of both endothelial dysfunction (such as von Willebrand factor) and low-grade inflammation (including C-reactive protein and serum amyloid A).

They repeated the process seven years later. They found that a higher consumption of fish, but not total consumption of the other five dietary components, was associated with a lower overall endothelial dysfunction score. They found no associations with the overall low-grade inflammation score.

Further analyses indicated that consumption of more lean fish and raw vegetables and fewer high-fat dairy products was associated with less endothelial dysfunction.

They also found that consumption of more fresh fruit, wine, and poultry and fewer high-fat dairy products was associated with less low-grade inflammation.

Given these findings, say the researchers, such dietary factors "may modify processes that are important in atherothrombosis and thereby favorably influence the development of cardiovascular disease."

Thus, concluded Dr. Henry, "It seems that our mother's plea at the table to eat healthily" by including vegetables and the other things we dreaded over most as children, "made more than sense. Especially if one takes into account that diet is such a lifelong 'risk' factor."

The authors report to external funding or disclosures.


J Clin Nutr 2014.