Editorial See corresponding article on page XXX.

Adherence to dietary guidelines: benefits on atherosclerosis progression1,2 Penny M Kris-Etherton Throughout the annals of history, good nutritional practices have maintained a time-honored position for attaining optimal health and preventing disease. Early documentation of the im-portance of good nutrition dates back to the time of Hippocrates (460–377 BC), who is quoted as saying, ‘‘Let thy food be thy med-icine and thy medicine be thy food.’ ’ Today, diet is the cornerstone of healthy lifestyle recommendations issued by many federal agen-cies and health organizations. The foundation for healthy lifestyle recommendations is a robust evidence base that has evolved over time. We currently have evidence from major clinical trials that show efficacy of nutrition practices in ‘‘curing’ ’ diseases, slowing disease progression, and markedly decreasing risk of chronic dis-eases to a similar extent as pharmacologic therapy. With respect to diabetes, recommended lifestyle behaviors surpass the benefits of drug therapy. In the Diabetes Prevention Program, intensive lifestyle intervention (with a 7 % weight loss) lowered the inci-dence of diabetes in subjects with elevated fasting and postload plasma glucose concentrations from 11.0 (placebo) to 4.8 cases per 100 person-years (1). The metformin treatment group was beneficial (7.8 cases per 100 person-years) compared with pla-cebo but clearly not as effective as intensive lifestyle interven-tion. Several earlier controlled clinical trials that decreased total cholesterol by 15 % in response to a diet high in polyunsatu-rated fatty acids (and low in saturated fatty acids) significantly reduced coronary heart disease mortality (reviewed in reference 2). Remarkable cardioprotective benefits of fish and fish oil have been shown in the Diet and Reinfarction Trial (DART) (3) and the Gruppo Italiano per lo Studio della Sopravvivenza nell’In-farto Micocardio (GISSI)–Prevenzione Study (4). In the DART Study, subjects who had survived a myocardial infarction and who were advised to eat fatty fish (200–400 g/wk) had a 29% reduction in 2-y all-cause mortality compared with the non-intervention group (3). In the GISSI Study, 850 mg eicosapen-taenoic acid plus docosahexaenoic acid/d decreased sudden death by 47 % in patients surviving a myocardial infarction. I