Diets lower in folic acid and carotenoids are associated with the coronary disease epidemic in Central and Eastern Europe

Objective To test. our hypothesis that lower intakes of previously identified cardioprotective nutrients would be associated with the coronary epidemic in Central and Eastern Europe. Design We conducted a survey of coronary mortality in 16 countries and diet in 19 countries. Subjects/Setting Countries were placed in four groups with different cultural patterns (Central and Eastern Europe, including Russia; Western Europe and the United States; Mediterranean; and Asian). Main Outcome Measures Independent predictors of coronary mortality. Statistical Analyses Performed Means and standard deviations were calculated, and analysis of variance with Bon-ferroni post hoc tests and backward elimination regression analysis was conducted. Results Coronary mortality was highest in Central and Eastern Europe followed by Western Europe and the United States, the Mediterranean countries, and Asia (Japan). The model with folate, fiber, and n-6/n-3 fatty acids explained the majority of variation in coronary mortality (men 86%, women 90%). Most of the variation was explained by folate (men 61%, women 62%). The picture is complicated by the fact that folate, lutein/zeaxanthin, and beta-carotene were highly intercorrelated (r=0.87 to 0.99). Conclusions A diet low in foods containing folate and carotenoids (beta-carotene and lutein/zeaxanthin) may be a major contributing factor to increased coronary risk observed in the countries of Central and Eastern Europe.