2021 Dietary Guidance to Improve Cardiovascular Health, a scientific statement by AHA.

Poor diet quality is strongly associated with elevated risk of cardiovascular disease morbidity and mortality. A new scientific statement by American Heart Association provides Dietary Guidance to Improve Cardiovascular Health and was released yesterday in Circulation Journal.

This scientific statement emphasizes the importance of dietary patterns beyond individual foods or nutrients, underscores the critical role of nutrition early in life, presents elements of heart-healthy dietary patterns, and highlights structural challenges that impede adherence to heart-healthy dietary patterns.

The following sections summarize the rationale and evidence for each of the 10 features that have been highlighted by these guidelines:

Feature 1: Adjust Energy Intake and Expenditure to Achieve and Maintain a Healthy Body Weight

During adulthood, energy needs decrease by ≈70 to 100 calories with each decade. Also, large portion sizes, even for healthy foods, can contribute to positive energy balance and weight gain. A public health and clinical focus on promoting adoption of a healthy dietary pattern concurrent with portion control and energy balance, is essential for reducing excess body weight gain and CVD risk.

Feature 2: Eat Plenty of Fruits and Vegetables, Choose a Wide Variety

Deeply colored fruits and vegetables (eg, leafy greens, peaches) tend to be more nutrient dense than lighter colored and white fruits and vegetables.

Whole fruits and vegetables provide more dietary fiber and satiety than their respective juices; hence, the majority of fruits and vegetables should be consumed whole rather than as juice.

Frozen fruits and vegetables have a longer shelf-life than fresh forms, are ready-to-use, have similar or higher nutrient content, and at times are lower priced. Types with added salt and sugar should be limited.

Feature 3: Choose Foods Made Mostly With Whole Grains Rather Than Refined Grains

Whole grains contain intact starchy endosperm, germ, and bran, and are a rich source of fiber.

Feature 4: Choose Healthy Sources of Protein

Soybeans (including edamame and tofu), other beans, lentils, chickpeas, and split peas are common types of legumes are not only rich in protein, but they are also good sources of fiber.

The rapid emergence of plant-based meat alternatives requires some caution, because, at this time, many are ultra-processed and contain added sugar, saturated fat, salt, stabilizers, and preservatives.

Dietary patterns containing fish and seafood are consistently associated with lower CVD risk. The preparation of fish and seafood matters; fried forms are not associated with the benefits. Current data support dietary patterns that contain at least 2 fish meals per week.

Replacing full-fat dairy products with non-fat and low-fat dairy products and other sources of unsaturated fat shifts the composition of dietary patterns toward higher unsaturated to saturated fat ratios that are associated with better cardiovascular health.

If meat or poultry are desired, choose lean cuts and avoid processed forms.

Feature 5: Use Liquid Plant Oils Rather Than Tropical Oils (Coconut, Palm, and Palm Kernel), Animal Fats (Butter and Lard), and Partially Hydrogenated Fats

The cardioprotective effects of unsaturated fat, including reducing low-density lipoprotein (LDL) cholesterol concentrations and CVD risk, are somewhat stronger for polyunsaturated than for monounsaturated fats. Major sources of polyunsaturated fat include plant oils such as soybean, corn, safflower and sunflower oils, walnuts, and flax seeds.

Feature 6: Choose Minimally Processed Foods Instead of Ultra-Processed Foods

Feature 7: Minimize Intake of Beverages and Foods With Added Sugars

Using low-energy sweeteners to replace added sugars in beverages has been proposed as a means to reduce intake of added sugars and energy. Low-abundance mono- and disaccharides, which are metabolized differently than traditional sugars, have recently emerged as potentially preferable, lower-energy substitutes.

Feature 8: Choose and Prepare Foods With Little or No Salt.

The combination of the DASH diet and reduced sodium is greater than either approach alone. A promising alternative is replacement of regular salt with potassium-enriched salts, especially in settings in which the addition of salt during food preparation is the most common source.

Feature 9: If You Do Not Drink Alcohol, Do Not Start; If You Choose to Drink Alcohol, Limit Intake.

For certain outcomes, the relation is direct, that is, as alcohol intake increases, so does the risk of hemorrhagic stroke and atrial fibrillation. For CHD and ischemic stroke, there is a J- or U-shaped relationship, with the lowest risk at low alcohol intake, ≈1 to 2 drinks per day, and higher risks at no intake and higher intake. The AHA does not support initiation of alcohol intake at any level to improve CVD health, given the uncertainty about net health effects, especially in light of the deleterious effects of alcohol on numerous other outcomes.

Feature 10: Adhere to This Guidance Regardless of Wherever Food Is Prepared or Consumed.

Challenges to adhering to heart-healthy dietary patterns include targeted marketing of unhealthy foods and beverages, structural racism, neighborhood segregation, and food and nutrition insecurity.

"Creating an environment that facilitates, rather than impedes, adherence to heart-healthy dietary patterns among all individuals is a public health imperative", conclude authors.

Circulation Journal:https://doi.org/10.1161/CIR.0000000000001031