Adult height has directionally opposing relationships with risk of death from several different major causes of chronic diseases.

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A study of base-line nutrient intakes of 8218 urban and rural Puerto Rican man aged 45 to 64 years was undertaken in relation to subsequent six year coronary heart disease (CHD) incidence. Urban dietary intakes were significantly higher in total fat and lower in carbohydrate, particularly starch. Average cholesterol intakes were 83 mg/day higher in urban than rural men. Urban serum cholesterol values were significantly higher than rural values. Urban men who developed myocardial infarction or CHD death had significantly lower calorie and carbohydrate intakes i.e., chiefly those derived from rice and legumes. The same association was found in the rural group but failed to reach statistical significance. A very low intake of alcohol was noted in the 73 rural CHD cases. Dietary sucrose intake showed no relationship to CHD incidence. Multivariate analysis, taking relative weight, hematocrit, blood pressure, serum cholesterol, alcohol intake, cigarette smoking, area, and age into account, demonstrated an independent inverse relation of carbohydrate intake from legumes to CHD incidence. The apparent protective effect of complex carbohydrate merits further investigation.

SUMMARY Baseline 24-hour dietary recalls from 16,349 men ages 45-64 years who had no evidence of coronary heart disease (CHD) were obtained in three prospective studies: the Framingham Study (859 men), the Honolulu Heart Study (7272 men) and the Puerto Rico Heart Health Program (8218 men). These men were followed for up to 6 years for the first appearance of CHD or death. Men who had a greater caloric intake or a greater caloric intake per kilogram of body weight were less likely to develop CHD manifest as myocardial infarction (MI) or CHD death, even though men of greater weight were more likely to develop CHD. This may reflect the benefit of greater physical activity. Men who consumed more alcohol were less likely to develop CHD, but more likely to die of causes other than CHD, particularly in the Honolulu study. In the Honolulu and Puerto Rico studies, but not in the Framingham study, men who consumed more starch were less likely to develop MI or CHD death. There was an inverse relation between starch intake and serum cholesterol, but it was too weak to explain fully the inverse starch-CHD association. There was also no evidence that the inverse relation between starch intake and incidence of CHD in the Honolulu and Puerto Rico studies was an indirect result of differences in fat intake. While the findings suggest additional areas for research, none of them would lead to an alteration of currently recommended preventive diets that emphasize lowering fat intake, because in isocaloric diets the logical way to balance a decreased fat intake is to increase the consumption of foods containing starch.TWO MECHANISMS by which diet may impinge on coronary heart disease (CHD) are frequently postulated -obesity and serum cholesterol. Dietary alterations can alter both body weight and serum cholesterol levels. Therefore, it is reasonable to suggest reducing the risk of CHD by means of a diet that reduces obesity and elevated serum cholesterol. This still leaves moot the importance of dietary factors, either through the specified mechanisms or through others, in accounting for the different levels of CHD risk actually observed between or within populations. MethodsIn 1965, a 24-hour dietary recall was incorporated in the standardized examinations given men in three different prospective cardiovascular studies supported by the National Heart, Lung, and Blood Institute: the Framingham Study, the Honolulu Heart Study and the Puerto Rico Heart Health Program.The population studied in the Puerto Rico Heart Health Program' consisted of men born between 1900 and 1919 who lived in three urban and four rural districts in and around San Juan. In the 45-64-year age group, 8218 men were free of CHD and had complete 24-hour dietary recall interviews at the time of their initial examination, which took place in [1965][1966][1967][1968]

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