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General dietary guidelines and recommendations

Find the most important recent research and guidelines that support cardiovascular health.

2021 Dietary Guidance to Improve Cardiovascular Health: A Scientific Statement From the American Heart Association

Poor diet quality is strongly associated with elevated risk of cardiovascular disease morbidity and mortality. 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. Evidence-based dietary pattern guidance to promote cardiometabolic health includes; (1) adjust energy intake and expenditure to achieve and maintain a healthy body weight; (2) eat plenty and a variety of fruits and vegetables; (3) choose whole grain foods and products; (4) choose healthy sources of protein (mostly plants; regular intake of fish and seafood; low-fat or fat-free dairy products; and if meat or poultry is desired, choose lean cuts and unprocessed forms); (5) use liquid plant oils rather than tropical oils and partially hydrogenated fats; (6) choose minimally processed foods instead of ultra-processed foods; (7) minimize the intake of beverages and foods with added sugars; (8) choose and prepare foods with little or no salt; (9) if you do not drink alcohol, do not start; if you choose to drink alcohol, limit intake; and (10) adhere to this guidance regardless of where food is prepared or consumed.

Dietary Cholesterol and Cardiovascular Risk: A Science Advisory From the American Heart Association

A Science Advisory from the American Heart Association recently  reviewed the evidence examining the relationship between dietary cholesterol and blood lipids, lipoproteins and cardiovascular disease risk. Meta-analyses of intervention studies generally find associations between cholesterol intakes that exceed current average levels with elevated total and LDL-C. However, the available evidence suggests that, within the context of healthy eating patterns, replacing SFA with UFA is expected to produce greater reductions in LDL-C than reducing dietary cholesterol alone.  Rather than provide a specific dietary cholesterol target, it is recommended to promote healthy eating patterns which emphasise fruit and vegetables, whole grains, low fat dairy foods, lean protein sources, nuts, seeds and liquid vegetable oils. These eating patterns are inherently  low in cholesterol.

2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk: The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS)

These recently published guidelines for lipid management include dietary and lifestyle recommendations based on the totality of evidence to date.

NICE Guidance; Cardiovascular disease: risk assessment and reduction, including lipid modification

This guideline covers the assessment and care of adults who are at risk of or who have Cardiovascular Disease, such as heart disease and stroke. Cardioprotective dietary recommendations are provided in the guidance. 

2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

Guidelines published by the American Heart Association and American College of Cardiology include diet and lifestyle advice. Emphasis is placed on fruits, vegetables, legumes, nuts, whole grains and lean vegetable or animal protein (preferably fish). Plant-based and Mediterranean diets, which embrace this type of pattern, are singled out in the guidelines. 

How effective are current dietary guidelines for cardiovascular disease prevention in healthy middle-aged and older men and women? A randomized controlled trial.

This parallel-designed, randomized controlled trial, involving 165 healthy nonsmoking men and women (aged 40-70 y), compared the effects of following the UK dietary guidelines with a traditional British diet (control) on vascular and lipid CVD risk factors. Selecting a diet consistent with current dietary guidelines lowered blood pressure and lipids, which would be expected to reduce the risk of CVD by one-third in healthy middle-aged and older men and women. 

Peter M. Clifton (2019) Diet, exercise and weight loss and dyslipidaemia. Pathology; 51(2): 222 - 226

This review of recent evidence highlights the association between diet and serum lipids and confirms a diet-heart disease link. 

Toh DWK, Koh ES, Kim JE (2019) Incorporating healthy dietary changes in addition to an increase in fruit and vegetable intake further improves the status of cardiovascular disease risk factors: a systematic review, meta-regression, and meta-analysis of randomized controlled trials. Nutr Rev. 2019 Dec 31. pii: nuz104. doi: 10.1093/nutrit/nuz104. [Epub ahead of print]

This systematic review and meta-analysis of randomized controlled trials found that increasing fruit and vegetable intake to > 3 servings daily improves CVD risk factors, most distinctly triglyceride, especially when complemented with other healthy dietary changes.

Zhilei Shan, Yanjun Guo, Frank B. Hu, et al (2020) Association of Low-Carbohydrate and Low-Fat Diets With Mortality Among US Adults. JAMA Intern Med. doi:10.1001/jamainternmed.2019.6980

This prospective cohort study, using data from 37 233 adults included in the US National Health and Nutrition Examination Survey from 1999 to 2014, investigated the associations of low-carbohydrate and low-fat diets with total and cause-specific mortality. Overall low-carbohydrate-diet and low-fat-diet scores were not associated with total mortality. BUT unhealthy low-carbohydrate-diet and unhealthy low-fat-diet scores were associated with higher total mortality, and healthy low-carbohydrate-diet and healthy low-fat-diet scores were associated with lower total mortality. These findings suggest that the associations of low-carbohydrate and low-fat diets with mortality may depend on the quality and food sources of macronutrients.

Sigma Nutrition Statement (Part 1): Cholesterol, Lipoproteins & Lipids: Understanding CVD Risk 

The first in a series of statements examining the relationship between diet and cardiovascular disease and specifically coronary heart disease. Part 1 focuses on the roles of lipids, cholesterol and lipoproteins in atherosclerosis & CVD development.

Sigma Nutrition Statement (Part 2): The Impact of Diet on Blood Lipids

The second statement in this series focuses on the influence of diet on blood lipids in the context of the conclusions from the first statement.

Sigma Nutrition Statement (Part 3): How Diet Influences Heart Disease Risk

The final statement in this series, brings together the evidence from the previous two statements and examines the role of diet in influencing risk of CVD/ CHD.