American Heart Association Dietary Guidelines Research Articles

Dietary Models and Cardiovascular Risk Prevention in Pediatric Patients.

Nutritional intervention is worldwide recognized as a first step treatment for subjects with increased cardiovascular risk and it is of utmost importance especially for children and adolescents. Currently scientific evidence supports the role of dietary patterns instead of simple single nutrients or foods in cardiovascular risk prevention. Indeed, the American Heart Association dietary guidelines have expanded beyond nutrients to dietary pattern, that comprise not only single food items but also behavioral or cultural habits of specific populations. The aim of our narrative review is to analyze the most frequently adopted dietary patterns in children and adolescents and to evaluate their effect on cardiovascular risk factors and in cardiovascular risk prevention. Literature review showed that children cannot be considered as little adults: nutritional intervention must always grant adequate growth and neurodevelopment before reaching the proposed goals, therefore dietary patterns considered heart-healthy for adult subjects might not be suitable for pediatric patients. Mediterranean diet, DASH diet, Nordic diet and some plant-based diets seem to be the most promising dietary patterns in terms of cardiovascular health in the developmental age, even if further studies are needed to better standardize and analyze their effect on growing up individuals.

ODP152 Impact of Dietary Cholesterol on LDL: Lessons in Absorption and Overconsumption

Abstract Background The impact of dietary cholesterol on lipid profiles have remained controversial, highlighted by alterations in the 2015-2020 American Heart Association dietary guidelines abolishing the prior dietary cholesterol limit of 300mg/day. Eggs often are the example cited in this debate as they are a rich source of dietary cholesterol without comparative high levels of saturated fat, 1 of which the effects on LDL cholesterol are well established. To date, evidence has been mixed although most studies show only modest increases in LDL with dietary cholesterol. 1 However, recent research supports significant variation in these findings among predisposed individuals. 2 Heterogeneity in dietary cholesterol absorption can potentially account for these variations and has important clinical implications. Clinical Case A 58 year old woman with PMH ulcerative colitis, hyperlipidemia, and radiological evidence of CAD without prior CVD, presented for management of hyperlipidemia. At baseline, her lipid panel in 2015 noted an LDL-C of 125 mg/dL. In 2017, LDL-C was 255 mg/dL, prompting treatment with Atorvastatin. Following initiation of Atorvastatin, LDL-C improved to 137 mg/dL. However, on Atorvastatin, she experienced dermatitis and underwent Dermatology evaluation/biopsy. Medication reaction was favored as the etiology and Atorvastatin was discontinued. In Jan. 2019, off of Atorvastatin, LDL-C was 162 mg/dL. From around 2015-2018, the patient consumed a vegan diet. In 2019, she incorporated nine eggs per day (1600mg dietary cholesterol) into her diet. She denied additional changes to diet or consumption of other animal products. In Aug. 2019, LDL-C was 378 mg/dL. In Aug. 2020, LDL-C was 420 mg/dL. In Aug. 2020, she was advised that her goal LDL was 100 mg/dL or less. She was advised to limit her egg yolk consumption to four per week (∼100 mg/day of cholesterol). She continued to avoid all other animal products. In Oct. 2020, without addition of medication or other notable lifestyle changes her LDL-C decreased to 204 mg/dL. In Jan. 2021, her LDL-C was 130 mg/dL. From 2015-2021, her weight ranged 93-103lbs (BMI ∼16). In Aug. 2021, her LDL-C was 142 mg/dL. Ezetimibe 10mg daily was then added with reduction in LDL-C to a near-target of 103 mg/dL (27% reduction) within four months. Conclusion For the average American, current guidelines do not recommend egg restriction as an effective tool for LDL-C lowering. However, as shown in this case, certain individuals may be more prone to high LDL-C when consuming high cholesterol diets. Further study on how to better identify these susceptible individuals could help personalize nutritional and medication treatment plans for patients with dyslipidemia.

Abstract 52: Plasma Metabolomic Signatures of the American Heart Association Diet Score: Findings From the Boston Puerto Rican Health Study

Introduction: Puerto Rican adults living on the US mainland tend to have poor quality diets and adverse cardiometabolic risk. Plasma metabolomic signatures reflect dietary intakes and variability in metabolic response to diet. Hypothesis: A plasma metabolomic signature reflecting adherence to the American Heart Association (AHA) dietary guidelines will be associated with cardiometabolic risk. Methods: We used LC/MS to measure plasma metabolites (>700) among Boston Puerto Rican Health Study participants, aged 45-75 years, without (n=252) and with (n=254) type 2 diabetes (T2D). We calculated a modified version of a previously validated AHA diet score (AHA-DS), which included variety and amounts of fruits/vegetables, whole grains, fish, saturated fat, trans fat, sodium, and added sugars. We used elastic net regression to identify a metabolomic signature that associated with higher adherence to the AHA-DS among those without T2D (training set) and replicated the associations among those with T2D (testing set). A metabolomic score was calculated as the weighted sum of the diet associated metabolites. We used general linear models to determine the cross-sectional associations between the AHA-DS, metabolomic score, and cardiometabolic risk factors. Results: A diet-associated metabolomic signature with 58 metabolites, primarily lipids and amino acids, was identified. This metabolomic score correlated moderately with the AHA-DS among those with and without T2D (r=0.42-0.46, P <5.7x10 -12 ). In all participants (n=506), the metabolomic score, but not the AHA-DS, was significantly associated with higher HDL-C and LDL-C concentrations, and lower waist circumference ( P <0.004; Table 1). No associations were observed for triglyceride concentrations, glycemia measures, or blood pressure. Conclusions: In individuals of Puerto Rican descent, we identified a metabolomic signature that reflected adherence and metabolic response to the AHA dietary guidelines and that associated with cardiometabolic risk factors.

Adherence to Pre-pregnancy DASH Dietary Pattern and Diet Recommendations from the American Heart Association and the Risk of Preeclampsia (OR35-06-19)

Abstract Objectives Because the relationship between diet and hypertensive disorders of pregnancy (HDPs), including preeclampsia, remains unclear we aim to evaluate the association between pre-pregnancy adherence to the American Heart Association (AHA) diet recommendations and the Dietary Approaches to Stop Hypertension (DASH) dietary pattern with risk of developing preeclampsia (PE). Methods Our prospective cohort study included 20,024 pregnancies from 13,645 women enrolled in the Nurses’ Health Study II (NHS2) (1991 to 2007). Pre-pregnancy diet was measured in 1991 by a semi-quantitative food frequency questionnaire and updated every four years. Pregnancy outcomes were self-reported every 2 years during follow-up. We derived the DASH scores based on the intake of 8 food groups (fruits and fruit juices, vegetables, whole-grain, red and processed meats, nuts and legumes, sugar sweetened beverages, and sodium). The AHA score was derived from 5 food groups (fruits and vegetables, whole grain, fish, SSBs and sodium) consistent with AHA dietary guidelines to reduce hypertension in the general population. We estimated the RR and 95% CIs of PE by log-Poisson regression employing generalized estimating equations and adjusting for total energy intake, age at pregnancy, BMI, physical activity, parity, smoking status, infertility, marital status, multivitamin use, and gestational diabetes. Results HDPs were reported in 1,089 (5.4%) pregnancies, of which 505 (2.5%) were PE. The DASH score (max points = 40) ranged from 16 to 32 points and the AHA score (max score = 50) ranged from 18 to 41 points in our population. Compared to women in the lowest quintile of adherence to the AHA, the RR (95%CI) of PE in quintiles 2, 3, 4, and 5 were 0.88 (0.68, 1.14), 0.87 (0.66, 1.15), 0.83 (0.64, 1.09), and 0.79 (0.60, 1.06), respectively (p-trend = 0.09). Similarly, the RR (95%CI) of PE among women in increasing quintiles of adherence to the DASH score was 0.88 (0.68, 1.13), 0.72 (0.55, 0.94), 0.80 (0.61, 1.05), and 0.62 (0.45, 0.84) compared to women in the lowest quintile (p-trend = 0.002). Conclusions Stronger pre-pregnancy adherence to the DASH dietary pattern was inversely associated to developing PE among participants of the NHS2. Funding Sources Supported by National Institutes of Health grants UM1-CA176726, P30-DK046200, U54-CA155626, and T32-DK007703-16.

Substantial Increase in Compliance with Saturated Fatty Acid Intake Recommendations after One Year Following the American Heart Association Diet.

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.

Dietary Quality and Adherence to Dietary Recommendations in Patients Undergoing Hemodialysis

The multiple dietary restrictions recommended to hemodialysis patients may be difficult to achieve and, at the same time, may result in nutritional deficiencies rendering a poor dietary quality. We here assess the dietary quality and adherence to renal-specific guideline recommendations among hemodialysis patients from a single center in Canary Islands, Spain. Cross-sectional study, including 91 patients undergoing maintenance hemodialysis. Clinical data and 3-day dietary records were collected. We compared patient's reported nutrients intake with guideline recommendations. We also evaluated their alignment with current American Heart Association dietary guidelines for cardiovascular prevention. Seventy-seven percent and 50% of patients consumed less than the recommended daily energy and protein, respectively. Although half of the patients met the recommendations for dietary fat intake, this was accounted by an excess of saturated fat in 92% of them. Only 22% consumed sufficient fiber. A very small proportion of patients (less than 50%) met the requirements for vitamins and other micronutrients. Insufficient dietary intake was observed in most patients for all vitamins except for cobalamin. Similarly, inadequate dietary intake was observed for many minerals, by both excess (phosphorus, calcium, sodium, and potassium) and defect (magnesium). Most patients met the recommendations for iron and zinc in their diets. A large proportion of hemodialysis patients at our center did not meet current renal-specific dietary recommendations. The quality of the diet was considered poor and proatherogenic according to American Heart Association guidelines.

Trends in Diet Quality for Coronary Heart Disease Prevention between 1980-1982 and 2000-2002: The Minnesota Heart Survey

Objective Describe secular trends in overall diet quality for coronary heart disease (CHD) prevention during the past two decades (1980-1982 through 2000-2002). Design Dietary data were drawn from the Minnesota Heart Survey, a repeated population-based survey designed to examine trends in mortality, morbidity, and risk factors for CHD within geographically defined independent probability samples. Subjects/setting Adults residing in the Minneapolis/St Paul, MN, metropolitan area. Main Outcomes Measures Dietary intake was assessed by an interviewer administered 24-hour dietary recall from a subsample of survey participants. A Heart Disease Prevention Eating Index was developed to measure overall diet quality by compliance with the current American Heart Association Dietary Guidelines. Statistical Analyses A generalized linear mixed model was used to examine trends in Heart Disease Prevention Eating Index scores and trends in each element of the index. Results Age-adjusted mean Heart Disease Prevention Eating Index scores increased in both sexes during the past 2 decades, particularly driven by improvements in total grain, whole grain, total fat, saturated fatty acids, trans-fatty acids, and cholesterol intake. Energy balance, sodium intake, and fish intake were observed to change unfavorably or stay at a low compliance level. Conclusions Of concern is that improvements in mean Heart Disease Prevention Eating Index appear to have plateaued in 1995-1997, with the mean Heart Disease Prevention Eating Index scores similar between the 1995-1997 and 2000-2002 survey periods. Public health programs for CHD prevention may benefit by applying findings from this study in designing interventions to promote further improvements in the diets of American adults.

Adherence to the American Heart Association Dietary Guidelines by Individuals Living with HIV Infection

Adherence to the American Heart Association Dietary Guidelines by Individuals Living with HIV Infection

Rigid adherence to the dietary intake recommendations of selected food guideline emblems would not lead to simultaneous compliance with the tenets of the revised 2000 American Heart Association Dietary Guidelines

A total of 13 national and 25 variant dietary guideline emblems, among 58 examined, were found to provide quantitative behavioral recommendations regarding the consumption of foods or food groups. Of the 12 specific recommendations of the 2000 Revised Dietary Guidelines of the American Heart Association (AHA), seven were related to specific dietary practices that occur in one or another emblem. To determine how well a strict adherence to the tenets of a quantitative emblem would simultaneously advance the AHA behavioral agenda, an exercise for the classification rating of the selected emblems was conducted. The number of AHA specific recommendations incorporated into the emblems ranged from 1/7 to 6/7, with a median of 2/7. The two AHA recommendations that were most often embodied in emblems were compliance with variety of fruits/vegetables (95%) and variety of grain products (87%). Clear guidance for five of the AHA Dietary Guidelines cannot be found in the emblems. Although dietary guideline emblems make some contribution for maximal cardiovascular prevention in populations, individuals must be educated to go well beyond sketchy and incomplete guidance given by the emblems.

Antioxidant vitamin supplements and cardiovascular disease.

Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticlePDF/EPUB

Validation of the MEDFICTS dietary questionnaire: a clinical tool to assess adherence to American Heart Association dietary fat intake guidelines.

BackgroundDietary assessment tools are often too long, difficult to quantify, expensive to process, and largely used for research purposes. A rapid and accurate assessment of dietary fat intake is critically important in clinical decision-making regarding dietary advice for coronary risk reduction. We assessed the validity of the MEDFICTS (MF) questionnaire, a brief instrument developed to assess fat intake according to the American Heart Association (AHA) dietary "steps".MethodsWe surveyed 164 active-duty US Army personnel without known coronary artery disease at their intake interview for a primary prevention cardiac intervention trial using the Block food frequency (FFQ) and MF questionnaires. Both surveys were completed on the same intake visit and independently scored. Correlations between each tools' assessment of fat intake, the agreement in AHA step categorization of dietary quality with each tool, and the test characteristics of the MF using the FFQ as the gold standard were assessed.ResultsSubjects consumed a mean of 36.0 ± 13.0% of their total calories as fat, which included saturated fat consumption of 13.0 ± 0.4%. The majority of subjects (125/164; 76.2%) had a high fat (worse than AHA Step 1) diet. There were significant correlations between the MF and the FFQ for the intake of total fat (r = 0.52, P < 0.0001) and saturated fat (r = 0.52, P < 0.0001). Despite these modest correlations, the currently recommended MF cutpoints correctly identified only 29 of 125 (23.3%) high fat (worse than AHA Step 1) diets. Overall agreement for the AHA diet step between the FFQ and MF (using the previously proposed MF score cutoffs of 0–39 [AHA Step 2], 40–70 [Step 1], and >70 [high fat diet]) was negligible (kappa statistic = 0.036). The MF was accurate at the extremes of fat intake, but could not reliably identify the 3 AHA dietary classifications. Alternative MF cutpoints of <30 (Step 2), 30–50 (Step 1), and >50 (high fat diet) were highly sensitive (96%), but had low specificity (46%) for a high fat diet. ROC curve analysis identified that a MF score cutoff of 38 provided optimal sensitivity 75% and specificity 72%, and had modest agreement (kappa = 0.39, P < 0.001) with the FFQ for the identification of subjects with a high fat diet.ConclusionsThe MEDFICTS questionnaire is most suitable as a tool to identify high fat diets, rather than discriminate AHA Step 1 and Step 2 diets. Currently recommended MEDFICTS cutpoints are too high, leading to overestimation of dietary quality. A cutpoint of 38 appears to be providing optimal identification of patients who do not meet AHA dietary guidelines for fat intake.

So Many Nutrition Recommendations—Contradictory or Compatible?

Recently, the Food and Nutrition Board of the National Academies, Institute of Medicine, released acceptable ranges of intake of energy sources—fat, carbohydrate, and protein. Previously, the American Heart Association (AHA), National Cholesterol Education Program (NCEP), and the American Diabetes Association (ADA) had also issued nutrition guidelines. The Food and Nutrition report, titled Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids , focuses on macronutrients, as well as energy and physical activity recommendations.1 Acceptable ranges are based on evidence that, when consumed above or below these ranges, either nutrient inadequacy or increased risk of developing chronic diseases, including coronary heart disease, obesity, type 2 diabetes, and/or cancer, may develop. To meet the body’s daily nutritional needs while minimizing risk for chronic disease, it is recommended that adults consume 45–65% of their total energy from carbohydrate 20–35% from fat, and 10–35% from protein. The expressed hope is that these ranges may be more useful and flexible for food and nutrition planning than the single maximum values recommended in the past.1 The AHA report, AHA Dietary Guidelines , was published in November 2000.2 This was followed by the NCEP guidelines for the evaluation and treatment of high blood cholesterol in adults (Adult Treatment Panel III) in May 20013 and the ADA nutrition principles and recommendations technical review and position statement in January 2002.4,5 Although recommendations from these organizations are similar, there are differences in their approaches, ratings of evidence, and ease of translation to the general public. Table 1 is a summary comparison of the three sets of nutrition guidelines.6 How do the guidelines from the various health organizations differ from the dietary reference intake (DRIs)? The DRIs are an expanded system for determining the recommended dietary allowances …

AHA Science Advisory: Lyon Diet Heart Study. Benefits of a Mediterranean-style, National Cholesterol Education Program/American Heart Association Step I Dietary Pattern on Cardiovascular Disease.

Diet is a cornerstone of cardiovascular disease (CVD) prevention and treatment efforts. Step I and Step II diets are widely recommended as the first line of CVD intervention.1 At the core of this dietary guidance are the recommendations to decrease saturated fat and cholesterol and to consume more fruits, vegetables, and whole grain products. Information from an extensive database, especially regarding saturated fat, indicates that these diets significantly lower blood cholesterol levels, a major risk factor for CVD. Consequently, it is beyond debate that these diets reduce CVD risk. Since the advent of Step I and Step II diets, nutritionists have sought to develop effective implementation strategies, including identifying dietary patterns that augment the beneficial effects of these diets. Recent findings indicate that we are making impressive progress in attaining these goals. There is provocative evidence from the Lyon Diet Heart Study2 suggesting that a Mediterranean-style, Step I diet (emphasizing more bread, more root vegetables and green vegetables, more fish, less beef, lamb and pork replaced with poultry, no day without fruit, and butter and cream replaced with margarine high in α-linolenic acid) has effects that may be superior to those observed for the usual Step I diet. These findings raise the interesting, but not yet corroborated, question of whether a modified Step I diet (ie, a Mediterranean-style Step I diet) that features a dietary pattern consistent with the new American Heart Association (AHA) Dietary Guidelines may augment the Step I or Step II diets that are presently implemented in clinical practice. Defining a Mediterranean-style diet is challenging given the broad geographical region, including at least 16 countries, that borders the Mediterranean Sea. As would be expected, there are cultural, ethnic, religious, economic, and agricultural production differences that result in different dietary practices in these areas and that …

AHA Science Advisory. Monounsaturated fatty acids and risk of cardiovascular disease. American Heart Association. Nutrition Committee.

This report summarizes our current understanding of how monounsaturated fatty acids (MUFAs) affect risk for cardiovascular disease (CVD). This is a topic that has attracted considerable scientific interest,1 2 3 in large part because of uncertainty regarding whether MUFA or carbohydrate should be substituted for saturated fatty acids (SFAs) and the desirable quantity of MUFA to include in the diet. MUFAs are distinguished from the other fatty acid classes on the basis of having only 1 double bond. In contrast, polyunsaturated fatty acids (PUFAs) have 2 or more double bonds, and SFAs have none. The position of the hydrogen atoms around the double bond determines the geometric configuration of the MUFA and hence whether it is a cis or trans isomer. In a cis MUFA, the hydrogen atoms are present on the same side of the double bond, whereas in the trans configuration, they are on opposite sides. The American Heart Association Nutrition Committee recently published a scientific statement regarding the relationship of trans MUFA to CVD risk,4 and the present statement, therefore, will be limited to a discussion of dietary cis MUFAs, of which oleic acid ( cis C18:1) comprises ≈92% of cis MUFAs. In the United States, average total MUFA intake is 13% to 14% of total energy intake, an amount that is comparable to (or slightly greater than) SFA intake. In contrast, PUFAs contribute less (ie, 7% of energy). The major emphasis of current dietary guidelines involves replacing SFAs with complex carbohydrates to achieve a total fat intake of ≤30% of calories. There is evidence suggesting that the substitution of MUFA instead of carbohydrate for SFA calories may favorably affect CVD risk.5 6 7 The American Heart Association dietary guidelines for healthy American adults recommend a diet that provides <10% of calories from SFA, up …

Correlates of adherence to behavioral contracts for cholesterol reduction

There is considerable evidence that total serum cholesterol is related to coronary heart disease (CHD) (1-3). The Lipid Research Clinics Coronary Prevention Trial and the Multiple Risk Factor Intervention Trial (MRFIT) have both reported substantial reductions in CHD risk from lowering serum cholesterol (4-5). The American Heart Association (AHA) advocates reducing elevated serum cholesterol by follOWing a diet low in total fat, saturated fat and dietary cholesterol (6-8). However, dietary interventions for cholesterol reduction have had varying degrees of success (9-14), and the majority of studies which have employed long term follow-up measures of dietary change and serum cholesterol have not been encouraging (12, 15). Behavioral contracting is an intervention technique in which a client signs an agreement to make certain behavior changes within a specified time frame, in return for a desired reinforcement or reward. Contracting has been successfully employed to increase programmatic adherence in a variety of health behavior change programs (16, 17), but has not been widely used in cholesterol reduction interventions (18). This paper presents follow-up results from 52 individuals who signed behavioral contracts to adhere to the AHA dietary guidelines for cholesterol reduction. Data are presented to address the following questions: a) How do demographic variables and baseline body weight and serum cholesterol relate to initial contract signing and level of contract adherence? b) Do those individuals who successfully achieve their contract goals to adopt the AHA diet also experience a reduction in serum cholesterol? c) How well

Cholesterol Reduction among Volunteers in a Health Promotion Project

Behavioral contracting was used with moderate success as a primary intervention strategy in an urban clinic-based health promotion program designed to reduce serum cholesterol. Of the 223 adults screened, 144 had high serum cholesterol. One hundred and eighteen attended an interpretation/education session, and 51 participants agreed to sign a behavioral contract. Among those who signed contracts, adherence to American Heart Association dietary guidelines was significantly related to serum cholesterol changes. Eleven of the 46 adults who returned for the six-month clinical assessment reduced their cholesterol levels to recommended levels.