Recent data show that about 55% of children in the United States and 41% of adults have poor dietary patterns. In addition, it is estimated that more than two-thirds of U.S. adults and about one-third of U.S. children are overweight or obese. The intake of foods prepared with refined grains, added sugars, solid fats, and sodium laden-ingredients has contributed to both the obesity epidemic and also increased risks for cardiovascular disease issues, such as like hypertension, dyslipidemia, and insulin resistance.
The American Heart Association (AHA) and American College of Cardiology (ACC) recently published guidelines on lifestyle management to reduce cardiovascular risk. These guidelines provide details for adopting evidence-based diet and lifestyle behaviors to achieve those goals. In addition, the 2015-2020 Dietary Guidelines for Americans were recently updated and confirm and further address these diet-disease associations.
Building upon the strong evidence base relevant to reducing cardiovascular risk, the AHA recently published a scientific statement in Circulation on the recommended dietary pattern to empower healthcare providers to guide their patients toward adoption of the AHA/ACC guidelines. “This document offers translational guidance for healthcare providers to successfully apply the AHA/ACC guidelines clinically,” explains Linda Van Horn, PhD, RD, FAHA, who chaired the writing group that developed the scientific statement.
According to Dr. Van Horn, the initial AHA/ACC guidelines are strongly evidence-based and provide saturated fat, trans-fat, and other nutrient-based recommendations. “Many physicians appreciate further tips and tools that can be practically initiated in the office setting,” she says. “Subsequent referral to registered dietitians can help patients achieve and maintain therapeutic goals, especially if they have multiple cardiovascular risk factors. However, physicians and healthcare providers on the frontlines have the opportunity to use the new statement to launch diet change efforts the first time when they see a patient.”
The goal of the AHA scientific statement is to help providers develop healthy lifestyle recommendations for their patients by tailoring nutrient-dense choices within individual calorie limits. The document also outlines implementation strategies to assess adherence, address limitations, and encourage energy balance with physical activity (Table). “A key emphasis is on reducing saturated and trans-fatty acids while increasing unsaturated fatty acid intake,” Dr. Van Horn says. “These are top priorities in managing dyslipidemia, despite what the popular press may lead average consumers to believe.”
In order to achieve these goals, several dietary patterns are described and show the foods that can improve cardiometabolic risk factors. The dietary pattern has several common features with those established in the DASH (Dietary Approaches to Stop Hypertension) diet, the Mediterranean diet, and by the U.S. Department of Agriculture by emphasizing the consumption of fruits, vegetables, whole grains, nuts, fish, and other healthful foods. Fad diets should be avoided because they do not achieve long term weight loss or benefit cardiovascular health.
According to the AHA statement, self-monitoring of diet and physical activity levels are linked to successful behavior changes. Patients should choose to participate in regular physical activity as a complementary component of a heart-healthy lifestyle. Most adults should engage in at least 150 minutes of moderate physical activity of their choosing or 75 minutes of vigorous physical activity each week. For adults who would benefit from lowering LDL cholesterol or blood pressure, three to four sessions of 40 minutes of moderate-to-vigorous physical activity are recommended each week.
“Patients need direction and encouragement to develop a healthy lifestyle,” says Dr. Van Horn. “Even when patients are referred to a registered dietitian nutritionist, it’s valuable for them to hear their physicians endorse and personalize the messages emphasized in the AHA scientific statement. Motivation to change behaviors—especially if patients are apprehensive—becomes a major factor in successful adoption. Unfortunately, few physicians in practice today received any formal nutrition training or education in medical school or during residency. The hope is that this new document will compensate for those shortcomings.”
More to Come
Although a heart-healthy dietary pattern has been well-defined, additional research is needed to develop evidence-based strategies to sustain dietary changes long term and help replace problem foods with preferred choices and eating behaviors that reduce heart disease risks. This includes individual choices made at the institutional level, such as schools, childcare facilities, hospitals, restaurants, prisons, workplace cafeterias, and other public food service locations. “Plans are underway to conduct studies that evaluate the entire eating pattern rather than just nutrient-specific results,” Dr. Van Horn adds.
Likewise, efforts to examine the accessibility, utility, and accuracy of objective biomarkers of dietary intake are also high priorities, according to the scientific statement authors. Additionally, innovative approaches to monitor food intake and validate self-reported dietary data are key to evaluating the accuracy and relevancy of diet assessment. A focus on scientific research that addresses health disparities is critical to identifying effective dietary interventions for different patient populations.
Van Horn L, Carson JS, Appel LJ, et al. Recommended dietary pattern to achieve adherence to the American Heart Association/American College of Cardiology (AHA/ACC) guidelines: a scientific statement from the American Heart Association. Circulation. 2016 Oct 27 [Epub ahead of print]. Available at: http://circ.ahajournals.org/content/early/2016/10/27/CIR.0000000000000462.
US Department of Health and Human Services and US Department of Agriculture. 2015-2020 Dietary Guidelines for Americans. 8th ed. December 2015. Available at http://health.gov/dietaryguidelines/2015/guidelines/.
Lloyd-Jones DM, Hong Y, Labarthe D, et al. American Heart Association Strategic Planning Task Force and Statistics Committee. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association’s strategic Impact Goal through 2020 and beyond. Circulation. 2010;121:586-613.
Mozaffarian D. Dietary and policy priorities for cardiovascular disease, diabetes, and obesity: a comprehensive review. Circulation. 2016;133:187-225.