The American Heart Association has released a new scientific statement that emphasizes the importance of overall dietary pattern rather than individual foods or nutrients and underscores the critical role of nutrition in all stages of life.
The statement, “2021 Dietary Guidance to Improve Cardiovascular Health”, outlines 10 key features of a heart-healthy eating pattern.
The new statement reflects the latest scientific evidence on the benefits of heart-healthy eating throughout life and that poor diet quality is strongly associated with an increased risk of cardiovascular disease and death.
It emphasizes the importance of looking at one’s total dietary pattern rather than “good” or “bad” individual foods or nutrients. A dietary pattern refers to the balance, variety, amounts and combination of foods and beverages that are regularly eaten.
The statement also highlights the critical role of nutrition education, starting healthy eating early in life and maintaining throughout the lifespan, as well as societal and other challenges that may make it harder to adopt or maintain a heart-healthy diet pattern.
Because food is often eaten in places besides the home, the statement emphasizes that it is possible to follow a heart-healthy dietary pattern regardless of whether food is prepared at home, ordered in a restaurant or online, or purchased as a prepared meal. It might take a little planning, however, but after the first few times it can become routine.
10 features of a dietary pattern to promote heart health
- Balance food and calorie intake with physical activity to maintain a healthy weight.
- Choose a wide variety and eat plenty of fruits and vegetables to get a full range of nutrients from food rather than supplements;
- Choose whole grains and other foods made up mostly of whole grains;
- Include healthy sources of lean and/or high-fiber protein such as plant proteins (nuts and legumes), fish or seafood, low fat or non-fat dairy, lean cuts of meat and limit red and processed meats;
- Use liquid non-tropical plant oils such as olive or sunflower oils;
- Choose minimally processed foods rather than ultra-processed foods as much as possible;
- Minimize intake of beverages and foods with added sugars;
- Choose or prepare foods with little or no salt;
- Limit alcohol consumption; if you don’t drink, do not start; and
- Apply this guidance no matter where food is prepared or consumed.
What are “processed” foods?
Processed foods include meats that are preserved by smoking, curing or adding chemical preservatives, and plant-based foods that have added salt, sugar or fats. Many processed meats are high in salt, saturated fat and cholesterol.
Research shows that replacing processed meat with other protein sources is associated with lower death rates.
Ultra-processed foods are those that go beyond added salt, sweeteners or fat to also include artificial colors, flavours and preservatives that promote shelf stability, preserve texture and increase palatability.
A heart-healthy diet is good for a lifetime
Nutrition plays a critical role in heart health throughout life, according to the statement. A heart-healthy diet and healthy lifestyle behaviors – such as regular physical activity and avoiding exposure to tobacco products – are key from childhood throughout adulthood to lower the risk of developing elevated “bad” LDL cholesterol, high blood pressure, obesity, type 2 diabetes and metabolic syndrome, each of which can increase heart disease risk.
Before and during pregnancy, women who eat a heart-healthy diet can reduce heart disease risk factors, which may help to prevent unhealthy weight gain in their children. Evidence shows that the prevention of childhood obesity is key to preserving and prolonging heart health through the life span.
Later in life, people who eat a heart-healthy diet have slower age-related declines in thinking abilities and memory.
The statement also emphasized the importance of educating children at all ages so as they transition into adulthood, they will be able to make informed decisions about what they eat and serve as positive role models for generations to come.
A heart-healthy diet helps the environment
For the first time, the issue of sustainability is included in the Association’s dietary guidance. Commonly consumed animal products, particularly red meat (beef, lamb, pork, veal, venison or goat), have the largest environmental impact in terms of water and land usage, and contribute significantly to greenhouse gas emissions. Hence, shifting reliance from meat to plant proteins can help to improve individual health and the environment.
The statement does note, however, that not all sustainable diets are heart healthy. For example, if a plant-based diet includes lots of refined carbohydrates and added sugars, the risk of type 2 diabetes and heart disease increases.
Societal challenges needed
The 2021 dietary guidance discusses several challenges that can make it harder to adopt or maintain a heart-healthy diet. These include:
- Widespread dietary misinformation from the Internet;
- A lack of nutrition education in grade schools and medical schools;
- Food and nutrition insecurity – According to references cited in the statement, an estimated 37 million Americans had limited or unstable access to safe and nutritious foods in 2020;
- Structural racism and neighborhood segregation, whereby many communities with a higher proportion of racial and ethnic diversity have few grocery stores but many fast-food outlets; and
- Targeted marketing of unhealthy foods and beverages to people from diverse racial and ethnic backgrounds through tailored advertising efforts and sponsorship of events and organizations in those communities.
Public health action and policy changes are required to address these challenges and barriers, according to the statement.
“Creating an environment that promotes and supports adherence to heart-healthy dietary patterns among all individuals is a public health imperative,” the statement concludes.
Source: Circulation, November 2, 2021.
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