Skip to main content Accessibility help

Patients undergoing elective coronary artery bypass grafting exhibit poor pre-operative intakes of fruit, vegetables, dietary fibre, fish and vitamin D

  • B. Ruiz-Núñez (a1), G. H. A. M. van den Hurk (a1), J. H. M. de Vries (a2), M. A. Mariani (a3), M. J. L. de Jongste (a3), D. A. J. Dijck-Brouwer (a1) and F. A. J. Muskiet (a1)...


CHD may ensue from chronic systemic low-grade inflammation. Diet is a modifiable risk factor for both, and its optimisation may reduce post-operative mortality, atrial fibrillation and cognitive decline. In the present study, we investigated the usual dietary intakes of patients undergoing elective coronary artery bypass grafting (CABG), emphasising on food groups and nutrients with putative roles in the inflammatory/anti-inflammatory balance. From November 2012 to April 2013, we approached ninety-three consecutive patients (80 % men) undergoing elective CABG. Of these, fifty-five were finally included (84 % men, median age 69 years; range 46–84 years). The median BMI was 27 (range 18–36) kg/m2. The dietary intake items were fruits (median 181 g/d; range 0–433 g/d), vegetables (median 115 g/d; range 0–303 g/d), dietary fibre (median 22 g/d; range 9–45 g/d), EPA+DHA (median 0·14 g/d; range 0·01–1·06 g/d), vitamin D (median 4·9 μg/d; range 1·9–11·2 μg/d), saturated fat (median 13·1 % of energy (E%); range 9–23 E%) and linoleic acid (LA; median 6·3 E%; range 1·9–11·3 E%). The percentages of patients with dietary intakes below recommendations were 62 % (fruits; recommendation 200 g/d), 87 % (vegetables; recommendation 150–200 g/d), 73 % (dietary fibre; recommendation 30–45 g/d), 91 % (EPA+DHA; recommendation 0·45 g/d), 98 % (vitamin D; recommendation 10–20 μg/d) and 13 % (LA; recommendation 5–10 E%). The percentages of patients with dietary intakes above recommendations were 95 % (saturated fat; recommendation < 10 E%) and 7 % (LA). The dietary intakes of patients proved comparable with the average nutritional intake of the age- and sex-matched healthy Dutch population. These unbalanced pre-operative diets may put them at risk of unfavourable surgical outcomes, since they promote a pro-inflammatory state. We conclude that there is an urgent need for intervention trials aiming at rapid improvement of their diets to reduce peri-operative risks.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Patients undergoing elective coronary artery bypass grafting exhibit poor pre-operative intakes of fruit, vegetables, dietary fibre, fish and vitamin D
      Available formats

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Patients undergoing elective coronary artery bypass grafting exhibit poor pre-operative intakes of fruit, vegetables, dietary fibre, fish and vitamin D
      Available formats

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Patients undergoing elective coronary artery bypass grafting exhibit poor pre-operative intakes of fruit, vegetables, dietary fibre, fish and vitamin D
      Available formats


Corresponding author

* Corresponding author: B. Ruiz-Núñez, fax +31 50 361 2290, email


Hide All
1 Libby, P (2012) Inflammation in atherosclerosis. Arterioscler Thromb Vasc Biol 32, 20452051.
2 Black, HR (1992) Cardiovascular risk factors. In The Yale University School of Medicine Heart Book, pp. 2335. New York, NY: Hearst Books.
3 Serruys, PW, Morice, M, Kappetein, AP, et al. (2009) Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med 360, 961972.
4 Selnes, OA, Gottesman, RF, Grega, MA, et al. (2012) Cognitive and neurologic outcomes after coronary-artery bypass surgery. N Engl J Med 366, 250257.
5 Evered, L, Scott, DA, Silbert, B, et al. (2011) Postoperative cognitive dysfunction is independent of type of surgery and anesthetic. Anesth Analg 112, 11791185.
6 Eisenächer, K & Krug, A (2012) Regulation of RLR-mediated innate immune signaling – it is all about keeping the balance. Eur J Cell Biol 91, 3647.
7 Bone, RC, Balk, RA, Cerra, FB, et al. (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest J 101, 16441655.
8 Rogers, J (2008) The inflammatory response in Alzheimer's disease. J Periodontol 79, 15351543.
9 Bone, RC (1996) Sir Isaac Newton, sepsis, SIRS, and CARS. Crit Care Med 24, 11251128.
10 Cormack, F, Shipolini, A, Awad, WI, et al. (2012) A meta-analysis of cognitive outcome following coronary artery bypass graft surgery. Neurosci Biobehav Rev 36, 21182129.
11 Straub, RH (2011) Concepts of evolutionary medicine and energy regulation contribute to the etiology of systemic chronic inflammatory diseases. Brain Behav Immun 25, 15.
12 Ruiz-Núñez, B, Pruimboom, L, Dijck-Brouwer, DAJ, et al. (2013) Lifestyle and nutritional imbalances associated with Western diseases: causes and consequences of chronic systemic low grade inflammation in an evolutionary context. J Nutr Biochem 24, 11831201.
13 National Institute for Public Health and the Environment, The Netherlands (RIVM) (2006) Our Food, Our Health. Healthy Diet and Safe Food in The Netherlands no. 270555009 . Bilthoven: National Institute for Public Health and the Environment.
14 He, K, Song, Y, Daviglus, ML, et al. (2004) Accumulated evidence on fish consumption and coronary heart disease mortality. Circulation 109, 27052711.
15 Feunekes, GI, Van Staveren, WA, De Vries, JH, et al. (1993) Relative and biomarker-based validity of a food-frequency questionnaire estimating intake of fats and cholesterol. Am J Clin Nutr 58, 489496.
16 van Rossum, C, Fransen, HP, Verkaik-Kloosterman, J, et al. (2011) Dutch National Food Consumption Survey 2007–2010. Diet of Children and Adults Aged 7 to 69 Years. RIVM Report 350050006. Bilthoven: RIVM.
17 RIVM (2010) NEVO-online Version 2010/2.0. Bilthoven: RIVM. (accessed accessed February 2014).
18 Streppel, MT, de Vries, JH, Meijboom, S, et al. (2013) Relative validity of the food frequency questionnaire used to assess dietary intake in the Leiden Longevity Study. Nutr J 12, 75.
19 Siebelink, E, Geelen, A & de Vries, JHM (2011) Self-reported energy intake by FFQ compared with actual energy intake to maintain body weight in 516 adults. Br J Nutr 106, 274281.
20 Molag, M (2010) Towards Transparent Development of Food Frequency Questionnaires. PhD Thesis. Wageningen: University of Wageningen.
21 Health Council of The Netherlands (2006) Guidelines for a Healthy Diet 2006. Publication no. 2006/21E. The Hague: Health Council of the Netherlands.
22 Health Council of The Netherlands (2001) Dietary Reference Intakes: Energy, Proteins, Fats and Digestible Carbohydrates. The Hague: Health Council of the Netherlands. (Publication no. 2001/19, ISBN 90-5549-384-8).
23 US Department of Agriculture and US Department of Health and Human Services (2010) Dietary Guidelines for Americans, 2010, 7th ed. Washington, DC: US Government Printing Office.
24 American Heart Association (2010) Fats and Oils: AHA Recommendation. (accessed May 2014)..
25 Kris-Etherton, PM, Harris, WS, Appel, LJ, et al. (2003) Omega-3 fatty acids and cardiovascular disease: new recommendations from the American Heart Association. Arterioscler Thromb Vasc Biol 23, 151152.
26 Health Council of the Netherlands (2012) Evaluation of the Dietary Reference Values for Vitamin D. The Hague: Health Council of the Netherlands (no. 2012/15).
27 Amirkalali, B, Najafi, M, Ataie-Jafari, A, et al. (2008) Under- and overreporting of energy in a group of candidates for CABG surgery and its association with some anthropometric and sociodemographic factors, Tehran, Iran. Vasc Health Risk Manag 4, 11151120.
28 Najafi, M & Sheikhvatan, M (2013) Gender differences in coronary artery disease: correlational study on dietary pattern and known cardiovascular risk factors. Int Cardiovasc Res J 7, 124129.
29 Giugliano, D, Ceriello, A & Esposito, K (2006) The effects of diet on inflammation: emphasis on the metabolic syndrome. J Am Coll Cardiol 48, 677685.
30 Borges, MC, Martini, LA & Rogero, MM (2011) Current perspectives on vitamin D, immune system, and chronic diseases. Nutrition 27, 399404.
31 Serhan, CN & Chiang, N (2008) Endogenous pro-resolving and anti-inflammatory lipid mediators: a new pharmacologic genus. Br J Pharmacol 153, Suppl. 1, 200215.
32 Marchioli, R, Barzi, F, Bomba, E, et al. (2002) Early protection against sudden death by n-3 polyunsaturated fatty acids after myocardial infarction: time-course analysis of the results of the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico (GISSI)-Prevenzione. Circulation 105, 18971903.
33 Yokoyama, M & Origasa, H (2003) Effects of eicosapentaenoic acid on cardiovascular events in Japanese patients with hypercholesterolemia: rationale, design, and baseline characteristics of the Japan EPA Lipid Intervention Study (JELIS). Am Heart J 146, 613620.
34 Mariani, J, Doval, HC, Nul, D, et al. (2013) n-3 Polyunsaturated fatty acids to prevent atrial fibrillation: updated systematic review and meta-analysis of randomized controlled trials. J Am Heart Assoc 2, e005033.
35 Andreasen, J & Schmidt, E (2012) Therapeutic potential of marine n-3 fatty acids in CABG patients. Curr Opin Pharmacol 12, 142146.
36 Kromhout, D, Giltay, EJ & Geleijnse, JM (2010) n-3 Fatty acids and cardiovascular events after myocardial infarction. N Engl J Med 363, 20152026.
37 Sublette, ME, Ellis, S, Geant, A, et al. (2011) Meta-analysis of the effects of eicosapentaenoic acid (EPA) in clinical trials in depression. J Clin Psychiatry 72, 15771584.
38 Raison, CL, Capuron, L & Miller, AH (2006) Cytokines sing the blues: inflammation and the pathogenesis of depression. Trends Immunol 27, 2431.
39 Dinan, TG, Stanton, C & Cryan, JF (2013) Psychobiotics: a novel class of psychotropic. Biol Psychiatry 74, 720726.
40 DeMar, JC Jr, Ma, K, Bell, JM, et al. (2006) One generation of n-3 polyunsaturated fatty acid deprivation increases depression and aggression test scores in rats. J Lipid Res 47, 172180.
41 Chowdhury, R, Warnakula, S, Kunutsor, S, et al. (2014) Association of dietary, circulating, and supplement fatty acids with coronary risk. A systematic review and meta-analysis. Ann Intern Med 160, 398406.
42 Ramsden, C, Zamora, D, Leelarthaepin, B, et al. (2013) Use of dietary linoleic acid for secondary prevention of coronary heart disease and death: evaluation of recovered data from the Sydney Diet Heart Study and updated meta-analysis. BMJ 346, e8707.
43 Oh, K, Hu, F, Manson, J, et al. (2005) Dietary fat intake and risk of coronary heart disease in women: 20 years of follow-up of the nurses' health study. Am J Epidemiol 161, 672679.
44 German, JB, Gibson, R, Krauss, R, et al. (2009) A reappraisal of the impact of dairy foods and milk fat on cardiovascular disease risk. Eur J Nutr 48, 191203.
45 Micha, R, Wallace, S & Mozaffarian, D (2010) Red and processed meat consumption and risk of incident coronary heart disease, stroke, and diabetes mellitus: a systematic review and meta-analysis. Circulation 121, 22712283.
46 Ruiz-Núñez, B, Kuipers, R, Luxwolda, M, et al. (2014) Saturated fatty acid (SFA)-status and SFA-intake exhibit different relations with serum total cholesterol and lipoprotein-cholesterol: a mechanistic explanation centered around lifestyle-induced low grade inflammation. J Nutr Biochem 25, 304312.
47 Donnelly, KL, Smith, CI, Schwarzenberg, SJ, et al. (2005) Sources of fatty acids stored in liver and secreted via lipoproteins in patients with nonalcoholic fatty liver disease. J Clin Invest 115, 13431351.
48 Schwarz, J, Linfoot, P, Dare, D, et al. (2003) Hepatic de novo lipogenesis in normoinsulinemic and hyperinsulinemic subjects consuming high-fat, low-carbohydrate and low-fat, high-carbohydrate isoenergetic diets. Am J Clin Nutr 77, 4350.
49 Reaven, G (2012) Insulin resistance and coronary heart disease in nondiabetic individuals. Arterioscler Thromb Vasc Biol 32, 17541759.
50 De Filippo, C, Cavalieri, D, Di Paola, M, et al. (2010) Impact of diet in shaping gut microbiota revealed by a comparative study in children from Europe and rural Africa. Proc Natl Acad Sci U S A 107, 1469114696.
51 Maslowski, KM, Vieira, AT, Ng, A, et al. (2009) Regulation of inflammatory responses by gut microbiota and chemoattractant receptor GPR43. Nature 461, 12821286.
52 Macia, L, Thorburn, A, Binge, L, et al. (2012) Microbial influences on epithelial integrity and immune function as a basis for inflammatory diseases. Immunol Rev 245, 164176.
53 Buyken, AE, Goletzke, J, Joslowski, G, et al. (2014) Association between carbohydrate quality and inflammatory markers: systematic review of observational and interventional studies. Am J Clin Nutr 99, 813833.
54 Boeing, H, Bechthold, A, Bub, A, et al. (2012) Critical review: vegetables and fruit in the prevention of chronic diseases. Eur J Nutr 51, 637663.
55 He, FJ, Nowson, CA, Lucas, M, et al. (2007) Increased consumption of fruit and vegetables is related to a reduced risk of coronary heart disease: meta-analysis of cohort studies. J Hum Hypertens 21, 717728.
56 Oyebode, O, Gordon-Dseagu, V, Walker, A, et al. (2014) Fruit and vegetable consumption and all-cause, cancer and CVD mortality: analysis of Health Survey for England data. J Epidemiol Community Health 68, 856862.
57 Drewnowski, A & Fulgoni, VL 3rd (2014) Nutrient density: principles and evaluation tools. Am J Clin Nutr 99, 1223S1228S.
58 Hertog, MG, Feskens, EJ, Hollman, PC, et al. (1993) Dietary antioxidant flavonoids and risk of coronary heart disease: the Zutphen Elderly Study. Lancet 342, 10071011.
59 Kennedy, DO & Wightman, EL (2011) Herbal extracts and phytochemicals: plant secondary metabolites and the enhancement of human brain function. Adv Nutr 2, 3250.
60 Wink, M (2010) Annual Plant Reviews Volume 39. Functions and Biotechnology of Plants Secondary Metabolites, 2nd ed. Oxford, UK: Blackwell Publishing Ltd.
61 Su, Z, Shu, L, Khor, T, et al. (2013) A perspective on dietary phytochemicals and cancer chemoprevention: oxidative stress, nrf2, and epigenomics. Top Curr Chem 329, 133162.
62 Itoh, K, Chiba, T, Takahashi, S, et al. (1997) An Nrf2/small Maf heterodimer mediates the induction of phase II detoxifying enzyme genes through antioxidant response elements. Biochem Biophys Res Commun 236, 313322.
63 Hayes, JD & Dinkova-Kostova, AT (2014) The Nrf2 regulatory network provides an interface between redox and intermediary metabolism. Trends Biochem Sci 39, 199218.
64 Gounder, SS, Kannan, S, Devadoss, D, et al. (2012) Impaired transcriptional activity of Nrf2 in age-related myocardial oxidative stress is reversible by moderate exercise training. PLOS ONE 7, e45697.
65 Li, J, Ichikawa, T, Villacorta, L, et al. (2009) Nrf2 protects against maladaptive cardiac responses to hemodynamic stress. Arterioscler Thromb Vasc Biol 29, 18431850.
66 Sandberg, M, Patil, J, D'Angelo, B, et al. (2014) NRF2-regulation in brain health and disease: implication of cerebral inflammation. Neuropharmacology 79, 298306.
67 Nagpal, S, Na, S & Rathnachalam, R (2005) Noncalcemic actions of vitamin D receptor ligands. Endocr Rev 26, 662687.
68 Baeke, F, Takiishi, T, Korf, H, et al. (2010) Vitamin D: modulator of the immune system. Curr Opin Pharmacol 10, 482496.
69 Baz-Hecht, M & Goldfine, AB (2010) The impact of vitamin D deficiency on diabetes and cardiovascular risk. Curr Opin Endocrinol Diabetes Obes 17, 113119.
70 Zittermann, A, Kuhn, J, Dreier, J, et al. (2013) Vitamin D status and the risk of major adverse cardiac and cerebrovascular events in cardiac surgery. Eur Heart J 34, 13581364.
71 Wang, L, Song, Y, Manson, JE, et al. (2012) Circulating 25-hydroxy-vitamin D and risk of cardiovascular disease: a meta-analysis of prospective studies. Circ Cardiovasc Qual Outcomes 5, 819829.
72 Eyles, DW, Burne, THJ & McGrath, JJ (2013) Vitamin D, effects on brain development, adult brain function and the links between low levels of vitamin D and neuropsychiatric disease. Front Neuroendocrinol 34, 4764.
73 Hu, F & Willett, W (2002) Optimal diets for prevention of coronary heart disease. JAMA 288, 25692578.
74 Berg, CM, Lappas, G, Strandhagen, E, et al. (2008) Food patterns and cardiovascular disease risk factors: the Swedish INTERGENE research program. Am J Clin Nutr 88, 289297.
75 Mozaffarian, D (2007) JELIS, fish oil, and cardiac events. Lancet 369, 10621063.
76 Umhau, JC, Zhou, W, Carson, RE, et al. (2009) Imaging incorporation of circulating docosahexaenoic acid into the human brain using positron emission tomography. J Lipid Res 50, 12591268.
77 Freund Levi, Y, Vedin, I, Cederholm, T, et al. (2013) Transfer of omega-3 fatty acids across the blood–brain barrier after dietary supplementation with a docosahexaenoic acid-rich omega-3 fatty acid preparation in patients with Alzheimer's disease: the OmegAD study. J Intern Med 275, 428436.
78 Grimm, MO, Zimmer, VC, Lehmann, J, et al. (2013) The impact of cholesterol, DHA, and sphingolipids on Alzheimer's disease. Biomed Res Int, article ID 814390.
79 Yeon, J, Kim, H & Sung, M (2012) Diets rich in fruits and vegetables suppress blood biomarkers of metabolic stress in overweight women. Prev Med 54, S109S115.
80 Frassetto, LA, Schloetter, M, Mietus-Synder, M, et al. (2009) Metabolic and physiologic improvements from consuming a Paleolithic, hunter-gatherer type diet. Eur J Clin Nutr 63, 947955.
81 Boers, I, Muskiet, FA, Berkelaar, E, et al. (2014) Favourable effects of consuming a Palaeolithic-type diet on characteristics of the metabolic syndrome: a randomized controlled pilot-study. Lipids Health Dis 13, 113.
82 Kipnis, V, Midthune, D, Freedman, L, et al. (2002) Bias in dietary-report instruments and its implications for nutritional epidemiology. Public Health Nutr 5, 915923.
83 Mendis, S, Puska, P & Norrving, B (2011) Global Atlas on Cardiovascular Disease Prevention and Control. World Health Organization in Collaboration with World Heart Federation, World Stroke Organization. Geneva: World Health Organization.
84 Lachner, C, Steinle, NI & Regenold, WT (2012) The neuropsychiatry of vitamin B12 deficiency in elderly patients. J Neuropsychiatry Clin Neurosci 24, 515.
85 Kuipers, RS, Luxwolda, MF, Dijck-Brouwer, DA, et al. (2010) Estimated macronutrient and fatty acid intakes from an East African Paleolithic diet. Br J Nutr 104, 16661687.
86 Eckel, RH, Jakicic, JM, Ard, JD, et al. (2013) 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 63, 29602984.
87 Institute of Medicine (US) Panel on Micronutrients (2005) Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein and Amino Acids. Panel on Macronutrients Panel on the Definition of Dietary Fiber, Subcommittee on Upper Reference Levels of Nutrients, Subcommittee on Interpretation and Uses of Dietary Reference Intakes, and the Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, Food and Nutrition Board. Washington, DC: National Academies Press.


Patients undergoing elective coronary artery bypass grafting exhibit poor pre-operative intakes of fruit, vegetables, dietary fibre, fish and vitamin D

  • B. Ruiz-Núñez (a1), G. H. A. M. van den Hurk (a1), J. H. M. de Vries (a2), M. A. Mariani (a3), M. J. L. de Jongste (a3), D. A. J. Dijck-Brouwer (a1) and F. A. J. Muskiet (a1)...


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed