Regularly eating a Southern-style diet may increase the risk of sudden cardiac death, while regularly eating a Mediterranean diet may reduce that risk, according to new research published today. Journal of the American Heart AssociationAn open access journal of the American Heart Association.
The Southern diet is characterized by added fat, fried foods, eggs, organ meats (such as liver or giblets), processed meats (such as deli meats, bacon, and hotdogs), and sugar-sweetened beverages. The Mediterranean diet is high in fruits, vegetables, fish, whole grains and legumes and low in meat and dairy.
“Although this study was observational in nature, the results suggest that diet may be a modifiable risk factor for sudden cardiac death, and therefore, diet is a risk factor over which we have some control,” said James M. Shikani, MD. PH, FAHA, is the study’s lead author and professor of medicine and associate director for research in the Division of Preventive Medicine at the University of Alabama at Birmingham.
“Improving one’s diet — by eating foods rich in fruits, vegetables, whole grains, and fish such as the Mediterranean diet and less fried foods, organ meats, and processed meats, characteristic of a Southern-style dietary pattern, can reduce one’s risk. Sudden cardiac To die for,” he said.
The study examined data from more than 21,000 people age 45 and older who were enrolled in an ongoing national research project called Reasons for Geographic and Racial Differences in Stroke (REGARDS), examining geographic and racial differences in stroke. Participants were recruited between 2003 and 2007. 56% of the participants in this analysis were female; 33% were black adults; And 56% lived in the southeastern United States, an area known as the stroke belt, notable for its high stroke death rate. The stroke belt states included in this study are North Carolina, South Carolina, Georgia, Tennessee, Alabama, Mississippi, Arkansas, and Louisiana.
The study is the latest to explore the relationship between cardiovascular disease and diet — which foods have positive versus negative effects on cardiovascular disease risk. This may be the only study to examine the relationship between dietary patterns and the risk of sudden cardiac death, which is the sudden loss of heart function that leads to death within an hour of the onset of symptoms. Sudden cardiac death is a common cause of death and accounted for 1 in 7.5 deaths in the United States in 2016, or about 367,000 deaths, according to 2019 American Heart Association statistics.
The researchers included participants with and without a history of coronary heart disease at the start of the study and assessed diet through a food frequency questionnaire completed at the start of the study. Participants were asked how often and in what amounts they had eaten 110 different food items in the previous year.
The researchers calculated a Mediterranean diet score based on specific food groups considered beneficial or harmful to health. They also identified five dietary patterns. Along with the Southern-style eating pattern, the analysis included a “sweet” dietary pattern, which features foods with added sugars such as desserts, chocolate, candy, and sweet breakfast foods; a “convenience” eating pattern that relies on easy-to-prepare meals such as mixed meals, pasta dishes, or items that can be ordered as take-out such as pizza, Mexican food, and Chinese food; A “plant-based” dietary pattern was classified as high in vegetables, fruit, fruit juice, cereals, beans, fish, poultry, and yogurt; and an “alcohol and salad” dietary pattern, which relied heavily on beer, wine, liquor with greens, tomatoes, and salad dressings.
Shikani points out that the patterns are not mutually exclusive. “All participants had some level of adherence to each pattern, but generally adhered more to some patterns and less to others,” he explained. “For example, it would not be unusual for someone who adheres to a very southern pattern to also adhere to a plant-based pattern, but to a much lesser degree.”
After an average of nearly 10 years of follow-up every six months to examine cardiovascular disease events, more than 400 sudden cardiac deaths occurred among 21,000 study participants.
The study found:
Overall, participants who regularly ate a Southern-style diet had a 46% higher risk of sudden cardiac death than those who least adhered to this dietary pattern. In addition, participants who followed the traditional Mediterranean diet most closely had a 26% lower risk of sudden cardiac death than those who adhered least to this eating style. The American Heart Association’s diet and lifestyle recommendations emphasize eating vegetables, fruits, whole grains, lean protein, fish, beans, legumes, nuts, and non-tropical vegetable cooking oils such as olive and canola oil. Limiting saturated fat, sodium, added sugar and processed meats is recommended. Sugary drinks are the number one source of added sugar in the US diet, according to the Centers for Disease Control and Prevention, and the American Heart Association supports a sugary drink tax to reduce consumption of these products.
“These findings support the idea that a healthy diet will prevent serious cardiovascular disease, and we should all be encouraged to adopt a healthy diet as part of our lifestyle,” said American Heart member Stephen Jurasek, MD, PhD. Nutrition Committee of the Association of Lifestyle and Cardiometabolic Health Councils. According to the American Heart Association recommendations, “As much as they can, people should evaluate the number of fruits and vegetables they eat each day and try to get at least 5-6 servings per day. 8-9 servings per day is optimal.”
“This research also raises important issues about health equity, food security and the social determinants of health,” he continued. “The authors describe the “Southern diet” based on the US geography associated with this dietary pattern, yet it would be a mistake to assume that it is a diet of our choice. I think American society needs to look more broadly at why this dietary pattern is more common in the South and some ethnicities. , clusters within racial or socioeconomic groups to develop interventions that can improve diet quality. The food gap between the underprivileged and the healthy in the United States continues to grow, and there is an incredible need to understand the complex social factors that have led to and continue this disparity. .”
This current study extends previous research on participants from a similar national stroke project, Wishes. In a 2018 analysis, Shikani and colleagues reported that adults aged 45 and older with heart disease who were fond of Southern cuisine had a higher risk of death from any cause, whereas greater adherence to the Mediterranean diet was associated with a lower risk. Death from any cause. And in a 2015 study, a Southern diet was associated with a greater risk of coronary heart disease in the same population.
The large population sample and regional diversity, including a significant number of black participants, are considered strengths of the REGARDS research project. However, potential limitations of this study include that dietary intake was based on a one-time, self-reported questionnaire, thus, it relied on participants’ recollection. Self-reported diet may include inaccuracies that lead to biases that may reduce the strength of observed associations.
A common association that remains unexplained is that among people with a history of heart disease, those who followed the most sugary eating pattern had a 51% lower risk of sudden cardiac death than those who followed that pattern. The researchers note that they “found no viable explanation for the inverse association of sweetened dietary patterns with a history of coronary heart disease with risk of sudden cardiac death.”