Abstract
The American Heart Association (AHA) dietary guidelines recommend 30–35% of energy intake (%E) be from total fat, <7%E from saturated fatty acids (SFA), and <1%E from trans fatty acid (TFA). This study evaluates the effect of AHA dietary counselling on fat intake. Between 2009 and 2014, 119 obese adults with metabolic syndrome (MetS), (71% women, average 52.5 years of age, and 34.9 kg/m2 of body mass index), received individual and group counselling on the AHA diet, over a one-year study period. Each participant attended 2 individual sessions (months 1 and 12) and 12 group sessions, at one-month intervals. At baseline and one-year, we collected three random 24-h diet recalls (two weekdays and one weekend day). Fat intake patterns over time were analyzed using paired-t test and linear mixed-effect models. There was significant variation on SFA and TFA intake per meal, being highest at dinner, in restaurants, and on weekends. Over the one-year study period, daily intake of total fat, SFA, and TFA decreased by 27%, 37% and 41%, respectively (p-value < 0.01, each). Correspondingly, the percentage of participants complying with AHA’s recommendations, increased from 25.2% to 40.2% for total fat (p-value = 0.02); from 2.5% to 20.7% for SFA (p-value < 0.01); and from 45.4% to 62% for TFA (p-value = 0.02). Additionally, SFA intake for all meal types at home decreased significantly (p-value < 0.05, each). AHA dietary counselling significantly increased the compliance with AHA dietary guidelines, with an eightfold increase in compliance in SFA intake. Nonetheless, ~80% of our participants still exceeded the recommended SFA intake. Substantial efforts are needed to encourage low-SFA and low-TFA food preparation at home, with strong public health policies to decrease SFA and TFA in restaurants and prepared foods.
Highlights
Cardiovascular disease (CVD) is the leading cause of death in the United States, and the risk is often exacerbated by a poor diet [1]
We investigated the effect of American Heart Association (AHA)-based dietary counselling on saturated fatty acids (SFA) and trans fatty acid (TFA) intake among individuals with metabolic syndrome (MetS)
The present study indicates that the proportion of participants complying with the AHA dietary guidelines for intake of total fat, SFA, and TFA significantly increased after the one-year AHA
Summary
Cardiovascular disease (CVD) is the leading cause of death in the United States, and the risk is often exacerbated by a poor diet [1]. Saturated fatty acids (SFA) and trans fatty acids (TFA) have been widely understood to have a negative effect on serum cholesterol profiles, thereby increasing the risk of CVD [2,3,4,5]. Numerous randomized controlled trials [6,7,8] and prospective observational studies [9,10,11,12] have provided strong and consistent evidence that a decrease in dietary SFA reduces the risk of CVD events and all-cause mortality. Association and American College of Cardiology (AHA/ACC) guidelines suggest a decrease in SFA intake to 5–6% of an individual’s total daily energy intake (%E) for those with elevated low-density lipoprotein cholesterol (LDL-C) concentration [13].
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