The best evidence that ALA can protect the heart comes from the Lyon Diet Heart Study, a randomized clinical trial in Europe. It tested the effects of an ALA-enriched Mediterranean diet in 605 patients with coronary artery disease. Over a four-year period, the high-ALA diet produced a 72% reduction in heart attacks and cardiac deaths and a 56% lower risk of dying from any cause (including cancer). The Mediterranean diet differed from the standard Western diet in many respects, but because it contained a special canola oil margarine, the greatest difference was in its ALA content, which was nearly eight times higher in the protective diet.
Nutrition-sensitive approaches are difficult to link to women's nutritional status (5, 102). This is due to limited measurement of benefits to program beneficiaries, families, households, and communities, limited timeframes to evaluate long-term impact, logistical and political realities that make implementation difficult, and different priorities of different stakeholders in multisectoral programs (102). Many nutrition-sensitive approaches, as will be described, thus focus on more distal measures of impact (e.g., coverage, knowledge) and not more proximal measures of women's nutritional status (e.g., BMI, anemia status, etc.).