Association between nutrients intake and coronary heart disease among adults in Saudi Arabia: a case-control study

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Najlaa Aljefree
Israa Shatwan
Noha Almoraie


: coronary heart disease, dietary intake, nutrients, fatty acids, omega 3, Saudi Arabia.


Background and Objective: Coronary heart disease (CHD) is a leading cause of mortality worldwide. Increasing evidence links CHD to the dietary intake among different populations. This paper aims to examine the association between nutrients intake and CHD in Saudi Arabia. Methods and Study Design: A case-control study was conducted in western Saudi Arabia. An interview-administered questionnaire was performed to collect data on socio-demographic characteristics and family histories of the disease. All participants completed three consecutive daily food records. Fasting blood samples were collected to measure glucose and total cholesterol. Body weight, height, and blood pressure measurements were also recorded. Results: A total of 85 patients were included in this study. Case participants had significantly higher intakes of monounsaturated fatty acids and polyunsaturated fatty acids but lower intakes of total energy, saturated fatty acids, and trans fatty acids than did controls. In addition, case participants consumed significantly fewer carbohydrates and less calcium, sodium, and zinc than did controls. The excess intake of total energy, trans fatty acid, and sodium associated with an increased risk of CHD. Also, deficient intake of polyunsaturated fatty acids, protein, zinc, vitamin A, vitamin C, and alpha-linolenic acid associated with an increased risk of CHD among participants. Conclusions: The current study’s findings provide appropriate nutritional solutions to prevent and control the incidence of CHD in Saudi Arabia. Further studies with larger sample size are essential to confirm these findings.


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1.World Health Organization. Global Health Observatory: Cardiovascular Diseases-Country Statistics. Retrieved on April 04, 2020 from:
2. Saad A, Al-Husayni F, Lama B et al. The perception of Coronary Artery Disease and Cardiac Catheterization in Saudi Arabia:“what the public know”. Cureus. 2020;12(1).
3. World Health Organization: World Health Statistics. Retrieved on April 10, 2020 from:
4. Aljefree N, Ahmed F. Prevalence of cardiovascular disease and associated risk factors among adult population in the Gulf region: a systematic review. Advances in Public Health. 2015;2015.
5. Al-Nozha MM, Arafah MR, Al-Mazrou YY et al. Coronary artery disease in Saudi Arabia. Saudi Med J. 2004;25(9):1165-71.
6. Kumosani TA, Alama MN, Iyer A. Cardiovascular diseases in Saudi Arabia. Prime Res Med. 2011;1(10):1-6.
7. Health Statistical Yearbook. Kingdom of Saudi Arabia, Ministry of Health, Statistics Directorate; 2018. Retrieved on March 15, 2020 from:
8. Yusuf S, Hawken S, Ounpuu S. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): Case-control study. Lancet 2004;364: 937-52.
9. Hu FB, Willett WC. Optimal diets for prevention of coronary heart disease. JAMA 2002; 288:2569-78.
10. Hu F. Optimal diet and lifestyle for prevention of coronary heart disease. Atheroscler. Suppl. 2003; 2(4):6.
11. Waskiewicz A, Szczesniewska D, Szostak-Wegierek D et al. Are dietary habits of the Polish population consistent with the recommendations for prevention of cardiovascular disease? WOBASZ II project. Kardiol Pol. 2016;74:969-77.
12. Liu AG, Ford NA, Hu FB, Zelman KM, Mozaffarian D, Kris-Etherton PM. A healthy approach to dietary fats: understanding the science and taking action to reduce consumer confusion. Nutr J. 2017;16(1):53.
13. Mahmood D, Jahan K, Habibullah K. Primary prevention with statins in cardiovascular diseases: A Saudi Arabian perspective. J Saudi Heart Assoc. 2015;27:179-91.
14. Aljefree N, Ahmed F. Association between dietary pattern and risk of cardiovascular disease among adults in the Middle East and North Africa region: A systematic review. Food Nutr Res. 2015;59:27486.
15. Conrad Z, Raatz S, Jahns L. Greater vegetable variety and amount are associated with lower prevalence of coronary heart disease: National Health and Nutrition Examination Survey, 1999–2014. Nutr J. 2018;17:67.
16. DiNicolantonio JJ, Lucan SC, O’Keefe JH. The evidence for saturated fat and for sugar related to coronary heart disease. Prog Cardiovasc Dis. 2016;58(5):464-72.
17. Panagiotakos DB, Pitsavos C, Stefanadis C. Dietary patterns: A Mediterranean diet score and its relation to clinical and biological markers of cardiovascular disease risk. Nutr Metab Cardiovasc Dis. 2006; 16:559-68.
18. Kromhout D. Omega-3 fatty acids and coronary heart disease. The final verdict?. Curr Opin Lipidol. 2012;23(6):554-9.
19. Woodside J, Young IS, McKinley MC. Fruit and vegetable intake and risk of cardiovascular disease. Proc Nutr Soc. 2013;72:399-406.
20. Abdelhamid AS, Brown TJ, Brainard JS et al. Omega‐3 fatty acids for the primary and secondary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2020(3).
21. Alissa EM, Alama NA. Nutritional intake and cardiovascular risk factors in Saudi subjects with different degrees of atherosclerosis: a case control study. J Nutri Med Diet Care. 2015;1(008).
22. Alissa EM, Bahjri SM, Al-Ama N, Ahmed WH, Starkey B, Ferns GA. Dietary vitamin A may be a cardiovascular risk factor in a Saudi population. Asia Pac J Clin Nutr. 2005;14: 137-44.
23. Alhabib KF, Batais MA, Almigbal TH et al. Demographic, behavioral, and cardiovascular disease risk factors in the Saudi population: results from the Prospective Urban Rural Epidemiology study (PURE-Saudi). BMC Public Health. 2020;20(1):1-4.
24. Aljefree NM, Lee P, Alsaqqaf JM, Ahmed F. Association between vitamin D status and coronary heart disease among adults in Saudi Arabia: a case-control study. Healthcare. 2016; 4:77.
25. Nelson M, Atkinson M, Meyer J, Britain G. A photographic atlas of food portion sizes: London, Ministry of Agriculture, Fisheries and Food publication, 1997.
26. McCance, R. and Widdowson, E. The composition of food, seventh edition. The Royal Society of Chemistry, London. 2002.
27. Department of Health (DoH). Dietary reference values for food energy and nutrients for the United Kingdom. London: Her Majesty's Stationery Office (HMSO); 1991.
28. Institute of Medicine, Food and Nutrition Board. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids (macronutrients). Washington, DC: National Academy Press; 2005.
29. Balakumar P, Maung-U K, Jagadeesh G. Prevalence and prevention of cardiovascular disease and diabetes mellitus. Pharmacol Res Commun. 2016;113:600-9.
30. Siri-Tarino PW, Sun Q, Hu FB, Krauss RM. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. AM J Clin Nutr. 2010;91(3):535-46.
31. Fattore E, Bosetti C, Brighenti F, Agostoni C, Fattore G. Palm oil and blood lipid–related markers of cardiovascular disease: a systematic review and meta-analysis of dietary intervention trials. AM J Clin Nutr. 2014;99(6):1331-50.
32. Jakobsen MU, Overvad K, Dyerberg J, Schroll M, Heitmann BL. Dietary fat and risk of coronary heart disease: possible effect modification by gender and age. AM J Epidemiol. 2004;160(2):141-9.
33. Sun Q, Ma J, Campos H et al. A prospective study of trans fatty acids in erythrocytes and risk of coronary heart disease. Circulation. 2007.
34. Skeaff CM, Miller J. Dietary fat and coronary heart disease: summary of evidence from prospective cohort and randomised controlled trials. Ann Nutr Metab. 2009;55:173-201.
35. Hammad S, Pu S, Jones PJ. Current evidence supporting the link between dietary fatty acids and cardiovascular disease. Lipids. 2016;51(5):507-17.
36. Nestel P, Noakes M, Belling B et al. Plasma lipoprotein lipid and Lp [a] changes with substitution of elaidic acid for oleic acid in the diet. J Lipid Res. 1992;33(7):1029-36.
37. Katan MB, Zock PL, Mensink RP. Trans fatty acids and their effects on lipoproteins in humans. Annu Rev Nutr. 1995;15(1):473-93.
38. Mozaffarian D, Katan MB, Ascherio A, Stampfer MJ, Willett WC. Trans fatty acids and cardiovascular disease. N Engl J Med. 2006;354(15):1601-13.
39. Russo GL. Dietary n− 6 and n− 3 polyunsaturated fatty acids: from biochemistry to clinical implications in cardiovascular prevention. Biochem Pharmacol. 2009;77(6):937-46.
40. He K, Liu K, Daviglus ML et al. Intakes of long-chain n–3 polyunsaturated fatty acids and fish in relation to measurements of subclinical atherosclerosis. Am J Clin Nutr. 2008;88(4):1111-8.
41. Mozaffarian D: Does alpha-linolenic acid intake reduce the risk of coronary heart disease? A review of the evidence. Altern Ther Health Med 2005;11:24-30.
42. Poudel-Tandukar K, Nanri A, Matsushita Y et al. Dietary intakes of alpha-linolenic and linoleic acids are inversely associated with serum C-reactive protein levels among Japanese men. Nutr Res 2009;29:363-70.
43. Miller M, Stone NJ, Ballantyne C et al. Triglycerides and cardiovascular disease: a scientific statement from the American Heart Association. Circulation 2011;123:2292-333.
44. Campos H, Baylin A, Willett WC. Alpha-linolenic acid and risk of nonfatal acute myocardial infarction. Circulation 2008;118:339-45.
45. de Goede J, Verschuren WM, Boer JM, Kromhout D, Geleijnse JM. Alpha-linolenic acid intake and 10-year incidence of coronary heart disease and stroke in 20,000 middle-aged men and women in the Netherlands. PLoS ONE 2011;6:e17967.
46. Lavie CJ, Milani RV, Mehra MR, Ventura HO. Omega-3 polyunsaturated fatty acids and cardiovascular diseases. J Am Coll Cardiol. 2009;54(7):585-94.
47. Ekpenyong CE. Micronutrient Vitamin Deficiencies and Cardiovascular Disease Risk: Advancing Current Understanding. Eur J Prev Med. 2017;5(1):1-8.
48. Khamis RY, Ammari T, Mikhail GW. Gender differences in coronary heart disease. Heart. 2016;102(14):1142-9.
49. Bostick RM, Kushi LH, Wu Y, Meyer KA, Sellers TA, Folsom AR. Relation of calcium, vitamin D, and dairy food intake to ischemic heart disease mortality among postmenopausal women. Am J Epidemiol. 1999;149(2):151-61.
50. Khan B, Nowson CA, Daly RM et al. Higher dietary calcium intakes are associated with reduced risks of fractures, cardiovascular events, and mortality: a prospective cohort study of older men and women. J Bone Miner Res. 2015;30(10):1758-66.
51. Michaëlsson K, Melhus H, Lemming EW, Wolk A, Byberg L. Long term calcium intake and rates of all cause and cardiovascular mortality: community based prospective longitudinal cohort study. Bmj. 2013;346.
52. Musaiger AO. Diet and prevention of coronary heart disease in the Arab Middle East countries. Medical principles and practice. 2002;11(Suppl. 2):9-16.
53. Lichtenstein AH, Appel LJ, Brands M et al. Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee. Circulation. 2006;114(1):82-96.
54. Altun B, Arici M. Salt and blood pressure: time to challenge. Cardiology. 2006;105(1):9-16.
55. Little PJ, Bhattacharya R, Moreyra AE, Korichneva IL. Zinc and cardiovascular disease. Nutr. 2010;26(11-12):1050-7.
56. Chu A, Foster M, Samman S. Zinc Status and risk of cardiovascular diseases and type 2 diabetes mellitus—a systematic review of prospective cohort studies. Nutrients. 2016;8(11):707.
57. Hosseini B, Saedisomeolia A, Skilton MR. Association between micronutrients intake/status and carotid intima media thickness: a systematic review. J Acad Nutr Diet. 2017;117(1):69-82.
58. Milton AH, Vashum KP, McEvoy M et al. Prospective study of dietary zinc intake and risk of cardiovascular disease in women. Nutrients. 2018; 10(1):38.
59. Han J, Zhao C, Cai J, Liang Y. Comparative efficacy of vitamin supplements on prevention of major cardiovascular disease: Systematic review with network meta-analysis. Complementary Therapies in Clinical Practice. 2020;14:101142.
60. Salvayre R., Negre-Salvayre A., Camaré C. Oxidative theory of atherosclerosis and antioxidants. Biochimie. 2016;125:281–296.
61. Kerver JM, Yang EJ, Bianchi L, Song WO. Dietary patterns associated with risk factors for cardiovascular disease in healthy US adults. AM J Clin Nutr. 2003;78(6):1103-10.
62. Anderson AS, Lean ME. Healthy changes? Observations on a decade of dietary change in a sample of Glaswegian South Asian migrant women. J Hum Nutr Diet. 1995;8(2):129-36.