Posner B M (Department of Social and Behavioral Sciences, Boston University School of Public Health, 80 East Concord Street, Boston, MA 02118, USA). Cupples L A, Franz M M and Gagnon D R. Diet and heart disease risk factors in adult American men and women: The Framingham Offspring-Spouse nutrition studies. International Journal of Epidemiology 1993; 22: 1014–1025. The 1984–1988 dietary and cardiovascular disease risk factor profiles of the Framingham Offspring-Spouse population (n = 3787 Framingham males and females, 22–79 years) were compared to earlier estimates from the 1976–1980 NHANES II and 1977–1978 USDA Nationwide Food Consumption surveys. The goals were to assess whether differences exist among population estimates, to determine whether national population-based nutrition recommendations for cardiovascular disease risk reduction are appropriately targeted, and to identify focus areas for future preventive nutrition interventions. Overall, population mean levels of cardiovascular disease risk factors were high but mean total cholesterol and blood pressure levels and rates of dyslipidaemie were lower in Framingham men and women and hypertension appeared higher in Framingham compared with NHANES II. Severe overweight appeared more prevalent in Framingham men but similar in Framingham women in comparison with NHANES. Population estimates of total fat (36–41% of calories) and saturated fat (12.5–13.7% of calories) intakes were higher and carbohydrate intakes were lower (40–46% of calories) than current recommended levels. Dietary cholesterol and sodium intakes in Framingham women appeared to have reached recommended levels but were high in men. While the goals of current nutrition recommendations remain appropriate, future population-based preventive nutrition interventions to lower cardiovascular disease risk need to emphasize weight reduction, lowering intakes of foods rich in animal and plant fats, increases in dietary sources of complex carbohydrates, fibre and micronutrients, and lower sodium intakes, particularly in adult men