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Cardiovascular disease

Evidence

This section contains a brief overview of the research carried out in this area. The evidence is divided into the settings listed here.

View overview

Cardiovascular disease (CVD) is the UK’s biggest killer and is responsible for approximately 35% of deaths in the UK each year. One in five men and one in six women die from coronary heart disease, which is the main form of CVD. 1

There is a strong evidence base for the relationship between an unhealthy diet and CVD. The recent WHO World Health Report estimates that over 60% of CHD and 40% of ischaemic stroke in developed countries is caused by a diet high in saturated fat which leads to raised blood cholesterol. 2 The INTERHEART study estimated that 45% of heart attacks in Western Europe are due to raised blood cholesterol, and individuals with blood cholesterol levels over 5.2mmol/l are at more than three times the risk of a heart attack compared those with normal blood cholesterol levels. 3

The key dietary changes which would help to reduce rates of CHD in the UK population are: a reduction in saturated fat intake (and replacement with polyunsaturates); a reduction in salt intake; and an increase in fruit and vegetables and carbohydrate intake.

Today’s children represent the next generation of CVD victims. Research into the health and wellbeing of children shows that their daily diet raises major concerns about their current and future health. 4 The mean intake levels for saturated fat among young children aged 2 to 6 are over 50% higher than recommended. Similarly, intake levels for sugar and salt are approximately twofold higher than the maximum limits. 5 Furthermore, children on average eat only around two of the recommended five portions of fruit and vegetables a day. 6

The evidence base for interventions that help people to eat a more healthy diet to reduce their incidence of CVD is vast and complex, and includes the general population, minority ethnic groups, elderly people, and the workplace.

References

  1. British Heart Foundation Statistics website. External Link (accessed 13 Feb 2007)
  2. World Health Organisation (WHO). The world health report 2002: reducing risks, promoting healthy life. Geneva: WHO, 2002. External Link (accessed 11 Apr 2007)
  3. Yusuf S, Hawken S, Ounpuu S, et al. INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 2004;364:937–952. External Link
  4. Caballero B. Early nutrition and risk of disease in the adult. Public Health Nutr 2001;4:1335-1336. External Link
  5. Ministry of Agriculture, Fisheries and Food, Department of Health. National Diet and nutrition survey. London: HMSO, 1995. External Link
  6. Gregory J, Lowe S et al. National diet and nutrition survey: young people aged 4 to 18 years. Volume 1: Report of the diet and nutrition survey. London: The Stationery Office, 2000.

Interventions to reduce intake of dietary saturated fat in children

View Methodology

Topics searched

We searched for studies on interventions to reduce intake of dietary saturated fat in children and adolescents (aged between 1 and 17 years).

Any intervention targeted at the general population was included (for example, a policy to reduce the amount of saturated fat in baked goods sold in supermarkets in the United Kingdom, school classes to teach children about healthy and unhealthy dietary fat). Interventions targeted solely at children with conditions such as obesity were excluded.

Studies that had only self reported outcomes that were unvalidated by another person were excluded from the review by critical appraisal.

We excluded studies with fewer than 100 participants.

Randomised controlled trials that did not have a follow-up of 3 months or more were excluded.

We excluded studies conducted in low income and lower-middle income countries, according to the World Bank list, because their results may not be generalisable to the UK setting.

Dates and study types searched

We searched for systematic reviews and randomised controlled trials published from 1990 until November 2006. We also searched for cohort studies and policy analyses (for “whole population” or policy and taxation interventions) published from 2001 to November 2006.

Databases searched

We searched Medline, Embase, HMIC, and the Cochrane Library for relevant studies. We also searched DARE, NHS EED, Trip database, Health-evidence.ca, and the WHO Health Evidence Network (HEN).

Search strategies

These are searches that have been conducted on Ovid Medline (http://gateway.ovid.com/). The other searches have been adapted from this one to accommodate the search engine of each specific database.

Randomised controlled trials and systematic reviews

  1. exp child/
  2. (child$ or infant$ or baby or babies or toddler?).ti,ab.
  3. (adolescen$ or teen? or teenage$).ti,ab.
  4. Infant/
  5. Dietary Fats/
  6. Butter/
  7. Cholesterol, Dietary/
  8. Margarine/
  9. (diet$ adj3 fat$).ti,ab.
  10. (butter? or lard? or margarine?).ti,ab.
  11. ((animal$ or saturat$ or trans or hydrogenat$) adj2 (fat? or oil?)).ti,ab.
  12. pc.fs.
  13. prevent$.ti,ab.
  14. reduc$.ti,ab.
  15. control$.ti,ab.
  16. cut?.ti,ab.
  17. diminish.ti,ab.
  18. lessen.ti,ab.
  19. decreas$.ti,ab.
  20. (intervention$ or program$ or campaign$).ti,ab.
  21. or/1-4
  22. or/5-11
  23. or/12-20
  24. 21 and 22 and 23

Cohort studies and policy analyses

  1. exp child/
  2. (child$ or infant$ or baby or babies or toddler?).ti,ab.
  3. (adolescen$ or teen? or teenage$).ti,ab.
  4. Infant/
  5. adult/
  6. adult?.ti,ab.
  7. Dietary Fats/
  8. Butter/
  9. Cholesterol, Dietary/
  10. Margarine/
  11. (diet$ adj3 fat$).ti,ab.
  12. (butter? or lard? or margarine?).ti,ab.
  13. ((animal$ or saturat$ or trans or hydrogenat$) adj2 (fat? or oil?)).ti,ab.
  14. pc.fs.
  15. prevent$.ti,ab.
  16. reduc$.ti,ab.
  17. control$.ti,ab.
  18. cut?.ti,ab.
  19. diminish.ti,ab.
  20. lessen.ti,ab.
  21. decreas$.ti,ab.
  22. (intervention$ or program$ or campaign$).ti,ab.
  23. (tax$ or pric$ or tariff?).ti,ab.
  24. (laws or law or legal or legislat$).ti,ab.
  25. (policy$ or policies).ti,ab.
  26. Public Policy/
  27. Legislation, Food/
  28. Legislation/
  29. Taxes/
  30. Nutrition Policy/
  31. Food Labeling/
  32. Government Regulation/
  33. or/1-6
  34. or/7-13
  35. or/14-22
  36. or/23-32
  37. 33 and 34 and 35 and 36

Filter

The following filter was used to include randomised controlled trials or systematic reviews for the first search strategy above:

  1. ("review" or "review academic" or "review tutorial").pt.
  2. (medline or medlars or embase).tw,sh
  3. (scisearch or psychinfo or psycinfo).tw,sh.
  4. (psychlit or psyclit).tw,sh.
  5. cinahl.tw,sh.
  6. ((hand adj2 search$) or (manual$ adj2 search$)).tw,sh.
  7. (electronic database$ or bibliographic database$ or computeri?ed database$ or online database$).tw,sh
  8. (pooling or pooled or mantel haenszel).tw,sh.
  9. (peto or dersimonian or der simonian or fixed effect).tw,sh.
  10. or/2-9 47239
  11. 1 and 10
  12. meta-analysis.pt.
  13. meta-analysis.sh.
  14. (meta-analys$ or meta analys$ or metaanalys$).tw,sh.
  15. (systematic$ adj5 review$).tw,sh.
  16. (systematic$ adj5 overview$).tw,sh.
  17. (quantitativ$ adj5 review$).tw,sh.
  18. (quantitativ$ adj5 overview$).tw,sh.
  19. (quantitativ$ adj5 synthesis$).tw,sh
  20. (methodologic$ adj5 review$).tw,sh.
  21. (methodologic$ adj5 overview$).tw,sh.
  22. (integrative research review$ or research integration).tw.
  23. or/12-22
  24. 11 or 23
  25. exp Randomized controlled trials/
  26. "randomized controlled trial".pt.
  27. "controlled clinical trial".pt.
  28. (random$ or placebo$).ti,ab,sh.
  29. ((singl$ or double$ or triple$ or treble$) and (blind$ or mask$)).tw,sh.
  30. or/25-29
  31. (animals not humans).sh.
  32. 30 not 31