Primary prevention of cardiovascular disease—how to promote healthy eating habits in populations?

Abstract

The obesity epidemic brings with it an increase in related diseases, like diabetes mellitus, and subsequently cardiovascular disease. Traditional dietary guidelines have focused on food composition rather than energy balance. To identify promising approaches towards promoting healthy eating and lifestyle patterns. Implementation strategies were also sought. A review of the pertinent literature based on MEDLINE searches. Weight loss subsequent to gastric surgery reduces mortality and morbidity in obese persons. Other approaches seem promising. Studies in children and adolescents demonstrate the feasibility of maintaining a healthy lifestyle pattern taught in school. In epidemiological studies, a healthy lifestyle is associated with lower mortality and morbidity; intervention studies with surrogate and intermediate, but not with clinical, endpoints support this concept in primary prevention. Secondary prevention studies with clinical endpoints, however, lend support to the Mediterranean diet and to increasing intake of marine omega-3 fatty acids. Primary prevention guidelines largely reflect the current data. Implementing a healthy lifestyle is possible, with the magnitude of effect reflecting the intensity of the intervention. Cost-effectiveness partly remains to be demonstrated. Primary prevention of cardiovascular disease by promoting a healthy eating and lifestyle pattern seems feasible. The best strategies, their cost-effectiveness and other practical problems remain to be clarified.