The American Heart Association issued a scientific statement in 2021 to describe the fundamental principles of dietary patterns that can improve cardiovascular health.
In an article published in the journal Circulation, scientists have discussed various clinical and cultural factors that can potentially affect long-term adherence to healthy dietary patterns aligned with the recently published American Heart Association criteria. They have also proposed strategies to promote the consumption of heart-healthy diets.
Popular Dietary Patterns: Alignment With American Heart Association 2021 Dietary Guidance: A Scientific Statement From the American Heart Association. Image Credit: SewCreamStudio / Shutterstock
Dietary patterns to improve cardiovascular health
The 2021 dietary guideline by the American Heart Association to promote cardiovascular health includes ten primary features. According to this guideline, a balance between energy intake and expenditure should be maintained to avoid body weight gain. A wide variety of vegetables and fruits should be consumed in high quantities.
Consumption of proteins from healthy sources, including plants, fish, and seafood, is vital for cardiovascular fitness. Minimal or no consumption of red meat is recommended. Lean cuts of poultry are better than processed forms. Similarly, low-fat or fat-free dairy products are better than full-fat products.
For cooking and seasoning, plant-derived oils (olive oil, sunflower, corn) are recommended over animal fats (butter) and tropical oils (coconut, palm, kernel). Processed or ultra-processed foods, high-sugar beverages, and high-salt foods should be avoided.
Alcohol or alcohol-based beverages should be avoided or minimally consumed. However, the most important recommendation is strictly adhering to this entire guideline regardless of where food is prepared or consumed.
Popular dietary patterns followed in the United States
The scientists evaluated popular dietary patterns frequently consumed in the United States and aligned them with the 2021 dietary guideline issued by the American Heart Association. With the aim of increasing interpretation and implementation, they divided these popular dietary patterns into ten categories based on the degree of similarity in the macronutrient profile, food groups, or both that were emphasized or restricted.
The selected dietary patterns were DASH (Dietary Approaches to Stop Hypertension)-style, Mediterranean-style, pescetarian, ovo/lacto-vegetarian, vegan, low-fat, very low-fat, low-carbohydrate, Paleolithic, and very low-carbohydrate/ketogenic dietary patterns.
The primary focus of the DASH diet is to increase the consumption of micronutrients from plants, lean meat, fish, and dairy products and restrict the consumption of saturated fats, added sugars, and salt.
The primary focus of the Mediterranean diet is to increase the consumption of plant-based foods, whole grains, legumes, nuts and seeds, poultry, fish and seafood, and polyunsaturated fats (olive oil). The diet also recommends consuming a moderate amount of red wine with each meal. The consumption of processed foods, red meat, dairy products, and high-sugar foods and beverages is restricted in this diet.
Vegetarian dietary patterns mostly exclude the consumption of animal products. However, certain vegetarian diets, including pescetarian and ovo/lacto-vegetarian diets, allow some degree of animal product intake. In contrast, a vegan diet strictly restricts the consumption of all forms of animal products.
Low-fat dietary patterns allow energy intake of 20 – 30% from fat-based food sources. On the other hand, very low-fat dietary patterns allow less than 10% of energy intake from fats. Low-carbohydrate dietary patterns allow 20 – 40% of energy intake from carbohydrates. Very low-carbohydrate dietary patterns, on the other hand, allow 5 – 10% of energy intake from carbohydrates.
The primary focus of the Paleo diet is to increase the consumption of vegetables, fruits, nuts, meat, poultry, fish, and eggs and avoid consuming added sugars, whole and refined grains, legumes, oils, dairy, alcohol, and sodium.
The scientific state made in the study
The scientists identified the highest alignment of the DASH, Mediterranean, pescetarian, and vegetarian diets with the 2021 dietary guidelines of the American Heart Association. Because of lower intake of animal-based foods, these diets support planetary health and, thus, have a lower environmental impact.
Vegan and low-fat diets showed good alignment with the recommended guideline. Although these diets are associated with optimal cardiovascular outcomes, the scientists advised ensuring the inclusion of healthy plant-based protein sources in the vegan diet. For low-fat diets, they advised to include unsaturated fats as replacing unsaturated fats with refined carbohydrates and added sugars could have a negative cardiovascular impact.
No optimal alignment of a very low-fat diet and low-carbohydrate diet with the guideline was observed in the study. Particularly, the avoidance of nuts and plant-based oils in very low-fat diets did not align with the guideline that recommends the inclusion of healthy fats in diets. In a low-carbohydrate diet, restricted intake of healthy whole grains, legumes, and some whole fruits was identified as the main problematic feature that showed no alignment with the guideline.
The Paleo and very low-carbohydrate diets had the lowest alignment with the guideline. The most problematic features of these diets include the restricted intake of healthy whole grains and legumes and the inclusion of high-saturated fats. These kinds of dietary arrangements could significantly negatively impact cardiovascular health.
Strategies for the adoption of healthy dietary patterns
The scientists recommend that healthcare professionals should follow up on how patients or consumers implement a given dietary pattern. This would help identify potential misunderstandings and provide opportunities to improve adherence to the features of the American Heart Association guideline.
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