Beyond ‘Low Salt, Low Fat’: Experts Push for Precise Dietary Prescriptions at Cardiac Discharge, AJPC Study, December 2025

A recent commentary concluded that redefining dietary advice at the point of discharge is not merely aspirational but a practical, evidence-based strategy to improve patient outcomes, and reduce long-term healthcare burden. Achieving this requires structured discharge processes, alignment with evidence-based nutrition guidance, physician competence and accountability, and supportive institutional policies. The authors advocate that by strengthening the quality and clarity of discharge advice, we can transform this critical transition point into a powerful opportunity for sustained cardiovascular risk reduction.

These findings were published in December 2025 in the American Journal of Preventive Cardiology.

Discharge Summaries - The Critical Window to Drive Behavioral Change

The immediate period following hospitalization for a cardiac event, such as post-myocardial infarction or heart failure, is recognized as a critical window for optimal recovery. During this time, patients tend to be psychologically receptive, more inclined to reflect on their health, and ready to adopt healthier behavior. Discharge summaries are vital documents providing the post-discharge care plan. American Heart Association (AHA) and American College of Cardiology Foundation (ACCF) guidelines clearly state the need for including non-pharmacological therapies in the care plan for patients with chronic cardiac conditions. However, the nutritional components of many discharge summaries are often vague, restricted to generic terms like ‘low salt, low fat diet’. This oversimplification not only fails to empower patients but also overlooks a powerful tool for secondary prevention.

A Case for Prescriptive Nutrition

This commentary advocates for a paradigm shift in post-discharge dietary counseling, positioning it as a critical, evidence-based tool. The authors synthesize evidence from global and interventional studies to discuss the urgent need for prescriptive nutritional advice. The rationale for moving beyond simple restriction is clear: the global burden of disease (GBD) study highlights that the leading dietary risk factors for cardiovascular disease (CVD) are not just high sodium intake, but primarily the low intake of protective foods, including whole grains, fruits, vegetables, nuts and seeds, and omega-3 fatty acids.

Evidence Supports Plant-Predominant Prescriptions

The synthesis confirms that while reducing sodium and saturated fat is important, a transformative dietary pattern requires the inclusion of nutrient-rich, plant-predominant whole foods. Dietary factors contribute to 56% of Disability Adjusted Life Years (DALYs), making them the most important modifiable risk factors. Plant-predominant diets, such as the Mediterranean diet and the Dietary Approach to Stop Hypertension (DASH), are highly effective, evidence-based dietary interventions. According to the AHA/ACC clinical practice guidelines, there is a strong (Class I) recommendation for including vegetables, fruits, legumes, nuts, whole grains, and lean protein to reduce the risk of CVD events. Crucially, when physicians actively engage and take ownership of delivering these key dietary messages, they enhance patient trust and motivation, thereby significantly improving adherence and long-term health outcomes.

Institutionalizing Change for Sustainable Adherence

Translating this evidence into consistent practice requires a multi-level strategy focused on accountability and competence. Clinicians need to achieve core competencies in nutrition, necessitating its integration into medical education and training. Immersive learning strategies, such as culinary medicine training, are proposed as effective experiential methods to build physician competence and empathy for patient challenges in making dietary changes.

For institutional support, the commentary proposes embedding structured and actionable dietary prescriptions into electronic health records (EHR). This includes customized, validated diet prescriptions using structured models like TAF (type, amount, frequency) or FITT (frequency, intensity, type, time), allowing clinicians to provide specific, actionable advice with the same rigor as pharmacological prescriptions. Furthermore, institutional policies must ensure consistent discharge summary quality through periodic audits and standardized checklists. By strengthening the quality and clarity of advice, health systems can transform discharge into a powerful opportunity for sustained cardiovascular risk reduction and improve health system sustainability.

Reference: Kannappan S, Gopalan R. Beyond 'low salt, low fat': Reimagining nutrition advice in the cardiac discharge summary. Am J Prev Cardiol. 2025 Oct 4;24:101321. doi: 10.1016/j.ajpc.2025.101321. PMID: 41141605; PMCID: PMC12547284.

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