Southern Diet May Raise Risk of Coronary Artery Disease

James M. Shikany, DrPH Professor of Medicine Division of Preventive Medicine University of Alabama at Birmingham Birmingham, AL Interview with:
James M. Shikany, DrPH
Professor of Medicine
Division of Preventive Medicine
University of Alabama at Birmingham
Birmingham, AL


Medical Research: What is the background for this study? What are the main findings?

Dr. Shikany: There is a growing interest in the field of nutritional epidemiology in relating overall dietary practices to various disease endpoints. For example, the assessment of dietary patterns in a population may be more meaningful than concentrating on isolated nutrients or foods because they more closely reflect how people eat in the real world. Previously, we looked at how the degree to which one adhered to 5 dietary patterns identified in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study was associated with the risk of stroke. In the current study, we investigated how the degree to which one adhered to these dietary patterns was related to the risk of incident acute coronary heart disease.

The main finding was that a Southern dietary pattern (characterized by added fats, fried foods, eggs and egg dishes, organ meats, processed meats, and sugar-sweetened beverages) was associated with a significantly greater hazard of incident acute coronary heart disease in REGARDS participants. The association persisted following adjustment for sociodemographics, lifestyle factors, and energy intake. Specifically, following multivariable adjustment, participants in the highest quartile of consumption of the Southern pattern experienced a 56% greater hazard of incident coronary heart disease compared with those in the lowest quartile of consumption of this pattern. Another pattern we observed – the Plant-based pattern – characterized by vegetables, fruits, beans, yogurt, poultry, and fish was not associated with an increased risk of coronary heart disease.

Medical Research: What should clinicians and patients take away from your report?

Dr. Shikany: It should be acknowledged that this was an observational study, not a clinical trial. However, it was a large study in a well-characterized cohort using rigorous methods. It also included regional and sociodemographic diversity (including a large proportion of African American participants). The major take-away message is that a person’s overall pattern of eating may be related to the risk of coronary heart disease. Specifically, based on our results, it would be prudent to advise those who report usually consuming a Southern-type dietary pattern to move away from this pattern by recommending such things as eating fewer fried foods and processed and organ meats and drinking fewer sugar-sweetened beverages. Guiding patients to consume more of the Plant-based dietary pattern may be advisable because of its lack of an association with risk of coronary heart disease in this study. There are no known risks associated with these recommendations, and they may favorably influence the risk of incident coronary heart disease.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Shikany: As with most research, these findings need to be replicated in different populations.


Southern Dietary Pattern is Associated with Hazard of Acute Coronary Heart Disease in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) StudyJames M. Shikany, Monika M. Safford, P.K. Newby, Raegan W. Durant, Todd M. Brown, and Suzanne E. Judd

Circulation. 2015;CIRCULATIONAHA.114.014421published online before print August 10 2015, doi:10.1161/CIRCULATIONAHA.114.014421 is not a forum for the exchange of personal medical information, advice or the promotion of self-destructive behavior (e.g., eating disorders, suicide). While you may freely discuss your troubles, you should not look to the Website for information or advice on such topics. Instead, we recommend that you talk in person with a trusted medical professional.

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