Influence of baseline inflammatory status on dietary effects of nutrition counseling in women with and without coronary artery disease

Abstract

INTRODUCTION: Inflammatory status influences the biochemical response to diet, suggesting an additional mechanism increasing coronary artery disease (CAD) risk. Aims: To determine the effect of baseline inflammatory status on biochemical response to nutrition counseling to reduce CAD risk. METHODS: A 2x2 factorial experiment having an intervention was conducted among 40-60 year old women with (n=101) and without CAD (n=109). Intervention comprised nutrition counseling. Baseline and post-intervention data on diet, serum high sensitivity CRP (hsCRP), soluble ICAM-1 (sICAM-1), ferritin, folate, plasma total homocysteine (tHcy) concentrations and traditional CAD risk factors were assessed. RESULTS: At baseline tHcy, sICAM-1 and hsCRP concentrations were significantly higher (p<0.05) among women with CAD than in women without CAD. Baseline sICAM-1 [OR=3.19 (95"% CI, 1.65-6.17)] and tHcy concentrations [OR=1.33 (95% CI 1.1-1.61)] were independently associated with CAD after adjusting for other risk factors. Nutrition counseling significantly decreased serum total and LDL cholesterol and increased serum folate (p<0.05) in women without CAD, but not in women with CAD. Among women without CAD, nutrition counseling decreased serum total and LDL cholesterol, and increased serum folate (p<0.05) in the "low" hsCRP group (below median of controls) but not in the "high" hsCRP group (above median). CONCLUSIONS: Nutrition counseling was effective in reducing serum total and LDL cholesterol and increasing serum folate in women without CAD having a "low" baseline inflammatory status. The hindering effect of underlying inflammation, on the biochemical response to dietary modification should be considered in dietary interventions in CAD risk reduction.