New Dietary Guidance to Improve Cardiovascular Health: Meeting People Where They Are
By Seema Gupta, MD, MSPH
Clinical Assistant Professor, Department of Family and Community Health, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV
SYNOPSIS: The American Heart Association emphasizes the importance of an overall lifetime heart-healthy diet and the vital role of nutrition early in life.
SOURCE: Lichtenstein AH, Appel LJ, Vadiveloo M, et al. 2021 dietary guidance to improve cardiovascular health: A scientific statement from the American Heart Association. Circulation 2021;144:e472-e487.
Poor diet is considered one of the leading causes of negative health outcomes, including diet-related cancers, cardiovascular disease, diabetes, and obesity.1 In the United States, researchers estimate dietary factors account for more than 650,000 deaths annually and 14% of all disability-adjusted life-years lost.2 Therefore, it is critical to focus on the aspects of diet that improve cardiovascular health.
To enhance cardiovascular health, Lichtenstein et al analyzed the available evidence to provide guidance in their scientific statement to reduce the rates of cardiovascular morbidity and mortality. The stated purpose of the guidance included emphasizing the importance of dietary patterns, not just individual foods or nutrients; the significance of initiating heart-healthy dietary habits early in life; and discussing dietary patterns that not only promote cardiometabolic health but also benefits beyond cardiovascular health. For the first time, the authors included information about food-related sustainability and structural challenges that may impede the adoption of heart-healthy diets. The guidance includes 10 central points:
- To maintain a healthy weight, patients should adjust energy intake and expenditure. Portion control and engaging in at least 150 minutes of moderate physical activity each week are essential.
- Diets should include a high volume of a variety of vegetables and fruits (excluding white potatoes).
- Cull refined grains and replace them with more whole grains.
- Regularly consuming plant-based food, fish, and low-fat or fat-free dairy products can boost cardiovascular health. Avoid processed meats; choose lean cuts.
- Avoid tropical oils, (e.g., coconut and palm), animal fats, and partially hydrogenated fats; replace with liquid plant oils. Monounsaturated and polyunsaturated fats can benefit cardiovascular health.
- Avoid ultra-processed foods, which are tied to several negative health outcomes.
- Minimize added sugars, especially sugar-sweetened beverages.
- Use little or no salt when preparing food. Avoiding excess sodium intake helps blood pressure stay at a normal level.
- Patients should not start drinking alcohol if they have never consumed any. Patients who already drink alcohol should limit their intake. Alcohol intake at any level to improve cardiovascular health is no longer recommended.
- Policies should encourage making the healthier choice the easy choice.
The highest-quality diet scores may be associated with a lower risk of all-cause mortality, cardiovascular disease incidence or mortality, cancer incidence/mortality, type 2 diabetes, and neurogenerative diseases. However, the statement recognizes significant challenges to adherence to heart-healthy dietary patterns. This includes socioeconomic factors, food insecurity, structural racism, and targeted marketing of unhealthy foods and beverages. Overall, the guidance calls for creating an environment that promotes rather than hinders the adherence to heart-healthy dietary patterns among all individuals.
COMMENTARY
Even with advances in healthcare, the cardiovascular disease mortality rate has leveled off in recent years and may appear to be trending upward.3 Although dietary modification is a cornerstone of cardiovascular health, implementation often can be complicated to practice, time-consuming, expensive, or sometimes just unappealing to patients. The American Heart Association’s latest dietary guidance to improving cardiovascular health aims to emphasize the importance of healthy eating throughout one’s life. Based on most current research, it is designed to accommodate today’s diverse eating habits and food choices. There are a few noteworthy aspects that make these guidelines unique or at least cognizant of the reality we face. This includes focusing on the value of an overall heart-healthy diet throughout one’s lifetime, rather than thinking in terms of “good” or “bad” foods, as well as the critical role of initiating heart-healthy dietary habits early in life. The guidelines also underline additional benefits of heart-healthy dietary patterns beyond cardiovascular health. Finally, the authors highlighted structural challenges that impede the adoption of heart-healthy dietary patterns.
Most importantly, these guidelines aim to meet people where they are. Whether someone predominantly eats at restaurants or is a truck driver who lives on a tight budget, everyone can benefit from a heart-healthy dietary pattern. The guidelines emphasize that a one-size-fits-all approach may no longer be needed. A heart-healthy dietary pattern can be for everyone and be consistent with personal preferences, lifestyles, and religious and cultural customs.
REFERENCES
- Rehm CD, Peñalvo JL, Afshin A, Mozaffarian D. Dietary intake among US adults, 1999-2012. JAMA 2016;315:2542-2553.
- Murray CJ, Atkinson C, Bhalla K, et al. The state of US health, 1990-2010: Burden of diseases, injuries, and risk factors. JAMA 2013;310:591-608.
- Pallazola VA, Davis DM, Whelton SP, et al. A clinician’s guide to healthy eating for cardiovascular disease prevention. Mayo Clin Proc Innov Qual Outcomes 2019;3:251-267.
The American Heart Association emphasizes the importance of an overall lifetime heart-healthy diet and the vital role of nutrition early in life.
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