Van Gool & Bridges
Despite the existence of the unexplained portion of the relationship between diabetes
and CHD3 there exists neither sufficient evidence nor a biomedical model from which
we could conclude that diabetes is an independent risk factor for CHD. Even though it
is possible that diabetes has independent explanatory power, it is equally likely that the
relationship can be explained through an, as yet, unidentified mechanism. Hence, this
analysis has not included diabetes as a modifiable risk factor for CHD.
Nutrition - Fibre
For a number of years there has been general consensus that increased intakes of dietary
fibre has a protective effect against CHD (Morria et al 1977, & Khaw and Barret-
Conner, 1983). The mechanism for this effect is still unclear16.
Dietary fibre is a non-starch polysaccharide. Vegetables and fruits are good sources of
dietary fibre, but the best source is from cereals. Rimm et al (1996) found that there is a
strong link between the consumption of dietary fibre and reduced rates of CHD.
There is some evidence to suggest that the reduced risks due to dietary fibre come from
reduced serum cholesterol. These studies show that increased dietary fibre is associated
with a reduction of LDL-C while HDL-C and triglyceride levels are not effected (Zhang
et al, 1992).
Even though there is not a clear consensus on the mechanism for the reduced risks of
CHD due to increased dietary fibre, there is some evidence to suggest that it operates
through other risk factors. It is not clear whether the consιπnption of fibre should be
included as an outcome measure.
Nutrition - Antioxidants
Recently there has been much interest in the protective effect of antioxidants on CHD
(Silagy and Mant, 1996)17. Antioxidants may be intracellular enzymes such as catalas
and glutothione or may lie outside the cell, such as vitamins. Of the second type there
are two categories, naturally existing and synthetic. The former includes vitamins such
as E and C and beta-carotene. These three are the most important dietary supplied
antioxidants in humans.
16 See www.heartfoundation.com.au/docs/pp4 htm as at 24/02/98.
'7 Also refer to www.heatfoundation.com.au/docs/pp9.htm as at 24/02/98.
61
Chere Project Report 11- November 1999