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Appendix 1. Description of food groups in the food group frequency questionnaire

a) Meat/poultry: Includes beef, pork, lamb, mutton, goat, veal, rabbit, chicken, turkey, duck, pheasant; their curries; Mexican meat soups/stews (menudo), liver, kidney, brain, spleen, heart and sausages.

b) Fish: Includes fresh-water and sea-water fish; preserved fish such as salted fish, canned fish, dried fish; shellfish and crustaceans (clams, squid, prawns, mollusks); caviar.

c) Eggs: Includes preserved eggs, duck eggs, thousand year old eggs.

d) Grains: Includes whole wheat flour; whole wheat chappati, cracked wheat; brown/wild rice; corn/hominy/masa harina/corn flour/maize, oats - old fashioned & Scotch/cracked oats; couscous; pot barley, brown rusk; whole wheat pasta, semolina.

e) Refined/milled grains: Includes white flour; white flour chapati; white/polished/instant/ parboiled rice; jook or rice congee; pasta; noodles/ramen/somen; bulgur; pearl barley, sago; plain rusk; sheermal; taftan.

f) Dairy products: Includes milk, yogurt, cheese, curd, raita, lassi, custard, khoya, firni, kheer, milk puddings, and ice cream.

g) Deep fried foods: Includes french fries, potato chips, onion rings, samosas, papad, pakoras; sev; fried won ton, egg roll.

h) Soy and other sauces: Includes fish sauce, oyster sauce, tamari; fermented bean pastes (hoi sin); other salty sauces.

i) Salty snacks: Includes salt added in cooking and to food at the table and salty snacks such as chips, crackers etc.

j) Pickled vegetables : Includes pickled in brine such as dill pickles, relishes; olives; salted

(brine) cabbage or leafy greens (mui choi); mango pickle, lemon pickle; salted root vegetables (choi po); pickled eggs, pickled meat.

k) Desserts/sweet snacks: Includes the use of jam; cakes; pies; chocolate; candy; burfi/ladoo; rasgulla/gulab jamun; halwa; shameia, mohalabeia, Chinese sweet buns; nor mei; sweet bean desserts, Coke and other soft drinks.

l) Sugar/sweetener: Includes the use of white sugar, brown sugar, corn syrup, honey, molasses, maple syrup, treacle.

m) Tofu/soybean curd: Includes textured vegetable protein, soy milk.

n) Legumes: Includes dried beans, lentils, peas, daals; soups (split pea).

o) Nuts/seeds: Includes peanuts, almonds, sunflower seeds, cashews, walnuts.

p) Fruit/juice: Includes all fruits and their juices.

q) Leafy greens: Includes all fresh leafy green vegetables: spinach, bok choi; choi sum, collards, mustard or turnip greens; asparagus.

r) Other raw vegetables: Includes any raw vegetables not included in the preceding categories.

s) Other cooked Includes any cooked vegetables not included in the preceding

vegetables : categories.

Appendix 2: Odds ratio of AMI for dietary patterns stratified by region*





Western Dietary Pattern

Prudent Dietary Pattern


Region

Q2 vs. 1

Q3 vs. 1

Q4 vs. 1

P for trend

Q2 vs. 1

Q3 vs. 1

Q4 vs. 1

P for trend

N. America, W. Europe & Australia

0.75 (0.51-1.12)

0.75 (0.49-1.15)

1.04 (0.67-1.62)

0.28

0.51 (0.21-1.23)

0.30 (0.13-0.67)

0.33 (0.14-0.74)

0.0093

Central Europe

1.07 (0.71-1.61)

1.83 (1.23-2.73)

1.68 (1.11-2.55)

0.0045

0.96 (0.62-1.48)

0.77 (0.50-1.17)

0.76 (0.50-1.16)

0.37

Middle East

0.83 (0.62-1.13)

0.99 (0.73-1.35)

1.17 (0.87-1.59)

0.21

1.03 (0.75-1.43)

0.99 (0.71-1.37)

1.08 (0.76-1.52)

0.95

Africa

0.83 (0.37-1.89)

0.92 (0.42-2.02)

0.78 (0.36-1.71)

0.90

0.74 (0.39-1.42)

0.80 (0.41-1.56)

0.73 (0.37-1.46)

0.80

South Asia

0.78 (0.58-1.06)

0.84 (0.62-1.14)

0.82 (0.57-1.17)

0.43

0.72 (0.52-0.98)

0.64 (0.47-0.87)

0.90 (0.64-1.27)

0.0184

China

0.83 (0.66-1.05)

1.11 (0.87-1.41)

1.42 (1.12-1.80)

<0.0001

0.70 (0.57-0.85)

0.63 (0.51-0.79)

0.55 (0.40-0.76)

<0.0001

Southeast Asia

0.98 (0.50-1.93)

0.99 (0.53-1.87)

2.22 (1.25-3.96)

0.0006

1.16 (0.72-1.85)

0.68 (0.41-1.14)

0.54 (0.31-0.94)

0.0214

S. America

0.59 (0.38-0.91)

0.86 (0.55-1.32)

1.07 (0.70-1.63)

0.0395

0.55 (0.35-0.87)

0.42 (0.27-0.66)

0.59 (0.38-0.92)

0.0020

* Adjusted for all INTERHEART risk factors: age, sex, region, education, household income, physical activity status, smoking, BMI, psychosocial factors, apoB/apoA1 tertiles

Appendix 3: Odds ratio of AMI for dietary risk score stratified by region







Dietary Risk Score


Region

Q2 vs. 1

Q3 vs. 1

Q4 vs. 1

P for trend

N. America, W. Europe & Australia

0.99(0.68-1.44)

0.85(0.54-1.36)


1.42(0.91-2.20)

0.27

Central Europe

1.19(0.79-1.80)

1.80(1.20-2.70)

1.49(1.01-2.19)

0.0296

Middle East

1.12(0.82-1.51)

1.20(0.88-1.64)

1.37(0.99-1.90)

0.27

Africa

0.81(0.39-1.67)

0.95(0.49-1.83)

1.22(0.66-2.23)

0.62

South Asia

1.28(0.94-1.74)

1.27(0.92-1.75)

0.79(0.54-1.16)

0.02

China

1.11(0.85-1.46)

1.31(1.00-1.73)

2.02(1.55-2.64)

<0.0001

Southeast Asia

1.58(0.93-2.66)

1.95(1.15-3.31)

2.96(1.78-4.94)

0.0005

S. America

0.64(0.42-0.98)

0.85(0.54-1.31)

1.27(0.85-1.90)

0.0125

Adjusted for all INTERHEART risk factors: age, sex, region, education, household income, physical activity status, smoking, BMI, psychosocial factors, apoB/apoA1 tertiles
Appendix 4: INTERHEART Project Office Staff, National Coordinators and Investigators
Project office staff (Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Canada): Coordination and Data Management: S Yusuf (Principal Investigator); S Ounpuu (Project Officer); P Montague, J Keys, S Rangarajan (Study Coordinators); S Hawken, A Negassa (Statisticians); C Wright, R Mayhew, L Westfall, P Mackie, C Cuvay, D Cunningham, K Picken, S Anand, H Gerstein. Core Laboratories: M McQueen, K Hall, J Keys (Hamilton), X Wang (Beijing, China)
Argentina: R Diaz*; E Paolasso*, M Ciruzzi*, R Nordaby, CH Sosa, HL Luciardi, EM Marzetti, JA Piasentin, M Amuchastegui, C Cuneo, G Zapata, JO Bono, EM Marxetti, A Caccavo, RAA Guerrero, R Nordaby, C Dizeo; AUSTRALIA/NEW ZEALAND: D Hunt*, J Varigos*, M Sallaberger, G Aroney, P Hicks, D Campbell, J Amerena, W Walsh, G Nelson, D Careless, J Durech, K Gunawardane, A Thomson, D Owensby, A Buncle, B Watson, H Ikram, M Audeau, M Hills, D Rosen, J Rankin, A Tunesi, J Sampson, K Roberts, A Hamer, L Roberts, B Singh, C Singh, R Hendriks, G Tulloch, A Hill, D Rees, C Hall; Bahrain: MA Halim*, MI Amin; Bangladesh: S Haque*, G M Faruque, M Hossain; BENIN REPUBLIC: H Agboton* ; Botswana: C Onen* ; Brazil: A Avezum*, L Piegas*, G Reis, JP Esteves, LC Bodanese, AR Junior, JAM Neto, RF Ramos, ES Silva, A Labrunie, ACC Carvalho, IP Filho, DCD Albuquerque, JAM Abrantes, OCE Gebara, PE Leaes, SS Xavier, RL Marino, O Dutra; Cameroon: W Muna*, KN Blackett*; Canada: K Teo*, S Yusuf*, S, Ounpuu, YK Chan; C Joyner, AD Kitching, A Morris, A Panju, H Lee, I Bata, B May, JG Hiscock, PV Greenwood, W Tymchak, M Natarajan; CHILE: F Lanas*; D Standen, A Lanas, C Santibanez, P Soto, S Potthoff, R Soto, E Mercadal; CHINA: LS Liu*, LX Jiang*, Q Chen, N Sun, J Wang, L Zhang, X Li, H Chen, Z Li, Y Shi, J Meng, D Wang, Z Liu, J Yan, W Zhang, Z Wan, Y Xu, X Li, L Wang, Q Fu, K Zhu, Y Wang, X Wang, F Wang, R Liu, R Zhao, K Sun, S Yue, Y Zhang, X Zhao, L Zhao, C Zhou, X Meng, A Liu, X Li, R Wu, R Xiao, X Zhang, G Wan, X Chen, Z Ge, T Zhou, Y Li, X Zhou, F Zhang ; Colombia: LE Bautista*, JP Casas, CA Morillo, E Ardilla, IA Arenas,M Lindarte, D Aristizabal; Croatia: Z Rumboldt*, M Rumboldt, V Carevic ; Czech Republic: P Widimsky*, M Branny, P Gregor; Egypt: M S Khedr*; MG Abdel-Aziz, S Abdel-Kader, MA Abdel-Moneim, F El-Demerdash, A El-Saiid, S Gharib, M Hassanin, F Abdel-Hamid Maklady, I Sadek, Germany: H J Rupprecht*, T Wittlinger*, P Schuster, A Schmidt, HR Ochs; GREECE: N Karatzas*, A Pipilis*, D Symeonides, K Karidis, TH Tsaknakis, K Kyfnidis; Guatemala: M Luna*, AM Arroyo, G Sotomora, MA Rodas, L Velasquez, A Ovando; Hong Kong: J Sanderson*, WY Ma, S Chan; Hungary: M Keltai*, F Szaboki, P Karpati, K Toth, S Timar, E Kalo, A Janosi, M Rusznak, D Lehoczky, J Tarjan, E Kiss, E Sitkei, P Valyi, I Edes ; India: P Pais*, KS Reddy*, PP Joshi, D Prabhakaran, D Xavier, A Roy, L Ramakrishnan; Iran: MRM Hasani*, S H Mirkhani*; ISRAEL: D Halon*, B Lewis* ; ITaly: MG Franzosi*, G Tognoni*, M Villella, M Mennuni, F Saiu, G Pettinati, S Ciricugno, S Antonaci, L Carrieri, E Balli, D Bicego, MG DelleDonne, A Ottaviano, L Moretti, C Melloni, G Melandri, E Carbonieri, A Vetrano; Japan: M Hori*, H Sato, K Fujii; KENYA: EN Ogola*, P Wangai; Kuwait: M Zubaid*, W Rashed; Malaysia: CC Lang*, WAW Ahmad, A Kadirvelu, R Zambahari ; MEXICO: MA Ramos-Corrales* ; MOZAMBIQUE: A Damasceno* ; Nepal: MR Pandey*, G Baniya, A Sayami, M Kiratee, B Rawat, M Pandey, J Gurung ; Netherlands: R Peters*, DCG Basart, PNA Bronzwaer, JA Heijmeriks, HR Michels, GMA Pop; NIGERIA: KK Akinroye* ; Pakistan: K Kazmi*, NA Memon, SK Memon, S Nishtar, A Badar, MA Mattu, M Yakub, K Soomra, J Khatri, AMA Faruqui, SI Rasool, A Samad; Philippines: AL Dans*, FQ Punzalan, MVC Villarruz, BT Mendoza, CS Recto III, BR Tamesis, V Mendoza, DJ Torres, DD Morales, I Ongtengco; Poland: A Budaj*, L Ceremuzynski*, S Stec, J Gorny, K Prochniewska, TK Urbanek, P Wojewoda, M Pawlowski, K Religa, R Klabisz, H Latocha, M Szpajer, K Cymerman, M Laniec, H Danielewicz, M Ogorek, D Kopcik, A Baranowska, A Kozlowski, M Blachowicz, A Jedrzejowski, T Waszyrowski, Z Zielinski, K Janik, M Tomzynski, M Mytnik, A Maziarz, G Rembelska, M Piepiorka, K Debkowska, T Krynski, BS Szczeklik, W Krasowski, M Rozwodowska, P Miekus, J Surwilo, S Malinowski, J Hybel, M Michalak, P Achremczyk, J Majchrzak, WS Korombel, M Dobrowolski, J Gessek ; PORTUGAL: J Morais*; Qatar: AA Gehani*, HA Hajar*; MM Almowla; AA Omer; Russia: EG Volkova*, SU Levashov, OM Filatova, UI Evchenko, GS Malkiman, NN Karaulovskaya ; SEYCHELLES: J Panovsky*; Singapore: BA Johan*; A Cheng; KS Ng, YL Lim, K H Neoh, K S Tan, LN Lum, Y Cheah; South Africa: P Commerford*, K Steyn*, B Brown, F Martiz, P Raubenheimer, A Aboo, JD Marx, E Batiste, K Sliwa, P Sareli, C Zambiakides; Spain: V Valentin*, J Ferriz, A Rovira, A Rodriguez-Llorian, E Cereijo, T Monzo, N Alonso, E Gomez-Martinez, A Lopez-Perez, B. Novella, R. Gabriel-Sanchez; Sri Lanka: S Mendis*, T Jayalath; Sultanate of Oman: ATA Hinai*, MO Hassan;

Sweden: A Rosengren*; Thailand: C Sitthi-Amorn*, S Chaithiraphan, K Bhuripanyo, S Srimahachota, M Anukulwutipong, P Loothavorn, P Sritara, S Tanomsup, J Tantitham, P Tatsanavivat, T Yipinsoi, W Jintapakorn, W Puavilai, B Koanantakul, P Kasemsuwan, C Supanantareauk, C Peamsomboon, B Saejueng, K Jeamsomboon, A Sukontasup; UNITED ARAB EMIRATES: W Almahmeed*, LO Abdelwareth, A Bokhari, NS Rao, S Bakir, AM Yusufali, E Hatou, Q Zaidi; United Kingdom: K Fox*, M Flather*; United states.: J Probstfield*; R Freeman, J Mathew, M Schweiger, W Johnson, E Ofili; Zimbabwe: J Chifamba*.

*National Coordinator


Funding Sources:


The INTERHEART study was funded by the Canadian Institutes of Health Research, the Heart and Stroke Foundation of Ontario, the International Clinical Epidemiology Network (INCLEN), and through unrestricted grants from several pharmaceutical companies [with major contributions from Astra Zeneca, Novartis, Hoechst Marion Roussel (now Aventis), Knoll Pharmaceuticals (now Abbott), Bristol-Myers Squibb and Sanofi-Sythelabo], and additionally by various national bodies in different countries: Chile: Universidad de la Frontera, Sociedad Chilena de Cardiologia Filial Sur; Colombia: Colciencias, Ministerio de Salud; Croatia: Croatian Ministry of Science & Technology; Guatemala: Liga Guatemalteca del Corazon; Hungary: Astra Hassle, National Health Science Council, George Gabor Foundation; Iran: Iran Ministry of Health; Italy: Boehringer-Ingelheim; Japan: Sankyo Pharmaceutical Co., Banyu Pharmaceutical Co., Astra Japan; Kuwait: Endowment Fund for Health Development in Kuwait; Pakistan: ATCO Laboratories; Philippines: Philippine Council for Health Research & Dev., INCLEN, Pfizer Philippines Foundation, Inc., Astra Pharmacetuicals, Inc. & the Astra Fund for Clinical Research & Continuing Medical Education, Pharmacia & Upjohn Inc.; Poland: Foundation PROCLINICA, State Committee for Scientific Research; Singapore: Singapore National Heart Association; South Africa: MRC South Africa, Warner-Parke-Davis Pharmaceuticals, Aventis; Sweden: Grant from the Swedish State under LUA Agreement, Swedish Heart and Lung Foundation; Thailand: The Heart Association of Thailand, Thailand Research Fund; USA: King Pharma

Web Table 1. Distribution of dietary patterns by region




Oriental Dietary Pattern

Western Dietary Pattern

Prudent Dietary Pattern

Regions n (%)

Q1

Q2

Q3

Q4

Q1

Q2

Q3

Q4

Q1

Q2

Q3

Q4

N. America, W. Europe & Australia (n=1898)

599 (31.6)

663 (34.9)

548 (28.9)

88 (4.6)

570 (30.0)

490 (25.8)

438 (23.1)

400 (21.1)

90 (4.7)

221 (11.6)

473 (24.9)

1114 (58.7)

Central Europe

(n= 1875)

573 (30.6)

671 (35.8)

557 (29.7)

74 (4.0)

479 (25.6)

422 (22.5)

506 (27.0)

468 (25.0)

227 (12.1)

420 (22.4)

587 (31.3)

641 (34.2)

Middle East (n=2233)

690 (30.9)

687 (30.8)

733 (32.8)

123 (5.5)

659 (29.5)

542 (24.3)

510 (22.8)

522 (23.4)

464 (20.8)

608 (27.2)

588 (26.3)

573 (25.7)

Africa

(n= 815)

353 (43.3)

211 (25.9)

211 (25.9)

40 (4.9)

115 (14.1)

175 (21.5)

258 (31.7)

267 (32.8)

161 (19.8)

241 (29.6)

223 (27.4)

190 (23.3)

South Asia (n=2702)

936 (34.6)

856 (31.7)

702 (26.0)

208 (7.7)

736 (27.2)

717 (26.5)

746 (27.6)

503 (18.6)

1175 (43.5)

576 (21.3)

545 (20.2)

406 (15.0)

China (n= 3669)

16 (0.4)

280 (7.6)

651 (17.7)

2722 (74.2)

777 (21.2)

1031 (28.1)

895 (24.4)

966 (26.3)

1232 (33.6)

1285 (35.0)

837 (22.8)

315 (8.6)

South East Asia (n=1279)

71 (5.5)

151 (11.8)

330 (25.8)

727 (56.8)

239 (18.7)

240 (18.8)

317 (24.8)

483 (37.8)

360 (28.2)

326 (25.5)

296 (23.1)

297 (23.2)

South America (n=1622)

785 (48.4)

504 (31.1)

292 (18.0)

41 (2.5)

448 (27.6)

406 (25.0)

354 (21.8)

414 (25.5)

314 (19.4)

346 (21.3)

475 (29.3)

487 (30.0)







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