The American Heart Association (AHA) released 2021 dietary guidelines, published in Circulation, aimed at improving cardiovascular health.
The scientific statement supersedes the AHA’s 2006 guidelines about diet and lifestyle. The updated recommendation emphasizes the importance of dietary patterns, which should be initiated early in life; highlights which patterns promote cardiometabolic health; discusses how these healthy habits may improve other aspects of health; and highlights structural challenges impeding individuals from adopting heart-healthy habits.
Per the guidelines, individuals should maintain a healthy body weight by balancing energy intake and expenditure. Over the last 3 decades, increased energy intake coupled with the prominence of sedentary lifestyles has shifted the population toward accumulation of excess body weight.
The AHA recommends, in general, for individuals to engage in over 150 minutes of moderate physical activity every week to optimize energy balance. Energy requirements differ on the basis of age, gender, size, and activity level. During adulthood, energy needs decrease by approximately 70-100 calories with each decade of life.
A healthy diet comprises a wide variety of fruits and vegetables, proteins from healthier sources, regular intake of fish and seafood, whole grains rather than refined grains, and low-fat or fat-free dairy products.
For oils, the AHA says, liquid plant oils should be prioritized over tropical oils, animal fats, and partially hydrogenated fats. There is robust evidence that the consumption of unsaturated fats reduces low-density lipoprotein cholesterol.
The AHA also advises against consumption of ultra-processed foods. Sales of processed foods have been and continue to increase. Consuming these foods can have adverse outcomes, such as obesity, cardiometabolic disorder, type 2 diabetes, and all-cause mortality.
Similarly, beverages and foods with sugars added to the product during preparation or processing should be avoided. Sugars commonly added include glucose, dextrose, sucrose, corn syrup, honey, maple syrup, and concentrated fruit juice. Increased consumption of added sugar products has been associated with excess body weight, risk for type 2 diabetes, and coronary heart disease.
Foods should be prepared with little to no salt. Increased intake of sodium chloride is positively related with blood pressure (BP). Lowering salt intake has been shown to decrease BP among both populations with and without hypertension.
However, despite widespread knowledge about what components make up a heart-healthy diet, there remains little progress in the United States for the general population to adopt healthy habits.
One important factor in the lack of healthy diet uptake is dietary disparities, which are associated with income, race and ethnicity, education, and use of food assistance programs. In 2018, 37 million Americans, particularly Black and Hispanic individuals, were affected by food and nutrition insecurity. More action is needed to ensure Americans relying on food assistance programs have improved access to healthy foods.
Additional study is needed to determine the efficacy and impact of precision nutrition, which would include components of when and how to eat throughout the course of life by using genetics, bioinformatics, artificial intelligence, and behavioral science to better design heart-healthy diets.
Disclosure: An author declared affiliations with industry. Please refer to the original article for a full list of disclosures.
Lichtenstein AH, Appel LJ, Vadiveloo M, et al. 2021 Dietary guidance to improve cardiovascular health: a scientific statement from the American Heart Association. Circ. Published online November 2, 2021. doi:10.1161/CIR.0000000000001031