Diets lower in folic acid and carotenoids are associated with the coronary disease epidemic in Central and Eastern Europe.

OBJECTIVE: To test our hypothesis that lower intakes of previously identified cardioprotective nutrients would be associated with the coronary epidemic in Central and Eastern Europe.
DESIGN: We conducted a survey of coronary mortality in 16 countries and diet in 19 countries. SUBJECTS/
SETTING: Countries were placed in four groups with different cultural patterns (Central and Eastern Europe, including Russia; Western Europe and the United States; Mediterranean; and Asian). MAIN OUTCOME MEASURES: Independent predictors of coronary mortality. STATISTICAL ANALYSES PERFORMED: Means and standard deviations were calculated, and analysis of variance with Bonferroni post hoc tests and backward elimination regression analysis was conducted.
RESULTS: Coronary mortality was highest in Central and Eastern Europe followed by Western Europe and the United States, the Mediterranean countries, and Asia (Japan). The model with folate, fiber, and n-6/n-3 fatty acids explained the majority of variation in coronary mortality (men 86%, women 90%). Most of the variation was explained by folate (men 61%, women 62%). The picture is complicated by the fact that folate, lutein/zeaxanthin, and beta-carotene were highly intercorrelated ( r =0.87 to 0.99).
CONCLUSIONS: A diet low in foods containing folate and carotenoids (beta-carotene and lutein/zeaxanthin) may be a major contributing factor to increased coronary risk observed in the countries of Central and Eastern Europe.