Food-based Dietary Recommendations Research Articles

Replacement of Milk and Dairy Products with Soy-Based Alternatives–How to Avoid Nutrient Deficiencies in a Milk-Free Diet?

BackgroundIn Germany, milk and dairy products are increasingly replaced by their plant-based alternatives. Although they can be used as substitutes, they differ significantly in their nutrient composition; thus, substitution could lead to nutrient deficiencies. So far, there are no food-based dietary recommendations that show which foods can replace milk and dairy products in a healthy way when switching to a plant-based substitute. ObjectivesAgainst this background, the question arises as to how to ensure adequate intake of critical nutrients when plant-based alternatives are consumed instead of milk and dairy products. To answer this question, this study aims to analyze what dietary changes would be required to avoid possible nutrient deficiencies and what types of foods can be consumed instead. MethodsTo answer the research question, 3 different models are compared using the linear programming method: healthy diets with 1) milk and dairy products, 2) nonfortified plant-based alternatives, and 3) fortified plant-based alternatives. The models are applied to omnivorous, pescatarian, and vegetarian diet types. ResultsThe results show that when consuming nonfortified soy alternatives, an adequate supply of calcium and, in the case of a vegetarian diet, vitamin B12 can only be achieved if significant dietary changes are made compared to the average diet. This includes a significantly higher consumption of fruit and vegetables, whereby within the groups, calcium-rich varieties should be chosen (e.g., green leafy vegetables). When consuming fortified soy-based alternatives instead, the absence of milk and dairy products can be well compensated by the nutrients currently added to commercially available products. ConclusionsGiven the trend to consume less milk and dairy products or to abstain from them altogether, public health measures should point out possible nutrient deficiencies as well as necessary dietary changes, especially because in Germany, many plant-based alternatives are not fortified.

Developing food-based dietary recommendations in the UK.

The present paper provides an overview of the approach to developing food-based dietary recommendations in the UK. UK dietary recommendations are based on independent advice from the Scientific Advisory Committee on Nutrition (SACN). SACN's remit includes specific reference to the nutrient content of individual foods and advice on diet as a whole, including the definition of a balanced diet. SACN's approach is set out in its Framework for Evaluating Evidence and its assessments are supported by the data provided by the National Diet and Nutrition Survey. SACN's risk assessments have primarily focused on energy requirements, macro and micronutrients and/or the needs of specific population groups. However, dietary patterns or individual foods and health outcomes have been considered where sufficient evidence is available. An example of this is SACN's risk assessment on carbohydrates and health, which included consideration of evidence on sugar-sweetened beverages and the resulting dietary recommendations on free sugars and sugar-sweetened beverages led to a range of policies to reduce sugar intake in the UK, including the soft drinks industry levy. SACN has also recently published a position statement on processed foods and health. Government dietary advice is encapsulated in the UK's national food model, the Eatwell Guide. The Eatwell Guide shows the proportions in which different food groups should be consumed to have a well-balanced, healthier, more sustainable diet, to help meet nutrient requirements and reduce the risk of chronic disease. Any substantive change to government dietary advice is likely to lead to a review of the national food model.

Higher adherence to the EAT-Lancet reference diet is associated with higher nutrient adequacy in the NutriNet-Santé cohort: a cross-sectional study

BackgroundIn 2019, the EAT-Lancet Commission proposed a planetary and healthy reference diet; however, its nutritional quality has been rarely evaluated. ObjectiveAcross different adherence levels to the EAT-Lancet reference diet, the following were our objectives:1) describe the food and nutritional intakes of the French population, 2) evaluate the nutrient quality, and 3) investigate the consistency between the French national recommendations and the EAT-Lancet reference diet. MethodsThis cross-sectional study was conducted among participants of the NutriNet-Santé cohort, and the sample was weighted on the characteristics of the general French population. Adherence to the EAT-Lancet reference diet was estimated using the EAT-Lancet Diet Index (ELD-I). Usual nutrient intakes were obtained using the variance reduction method. We used the estimated average requirements cut-point method to estimate the proportion of participants who meet their respective nutritional requirements. Furthermore, the adequacy of the French food-based dietary recommendations [Programme National Nutrition Santé (PNNS)] according to adherence to the EAT-Lancet reference diet was studied. ResultsThe weighted sample was composed of 98,465 participants. Except for bioavailable zinc and vitamin B12, we observed a decrease in the nutrient inadequacy prevalence when the adherence to the EAT-Lancet reference diet increased, particularly for vitamin B9 (Q1 = 37.8% compared with Q5 = 5.5%, P < 0.0001) and vitamin C (Q1 = 59.0% compared with Q5 = 10.8 %, P < 0.0001). However, inadequacy prevalence remained high in all ELD-I quintiles, particularly for fiber (95.9%), vitamin B1 (70.8%), iodine (48.4%), and magnesium (76.8%). Higher ELD-I score was associated with higher adherence for most components of the PNNS, except for food groups that are not specifically included in the EAT-Lancet reference diet and are typical of the French diet, including alcohol, processed meat, and salt. ConclusionIn the French context, although issues with the intake of certain nutrients may occur, a diet that remains within the planetary limits as the EAT-Lancet reference diet allows a favorable nutritional quality.This trial was registered at clinicaltrials.gov as NCT03335644.

Nutritional Quality of Kids' Fast-Food Meals

Despite the increasing consumption of fast foods, the nutrient quality of such meals has not been systematically evaluated I Turkey. Our study aimed to investigate and compare the nutritional value of the kids' menus of 4 popular fast-food chains and traditional Turkish menus created by specialist dietitians. The nutritional values of the kids' menus were assessed using the recommended daily allowance, dietary guidelines for Turkey, and national food-based dietary recommendations of the Turkish Ministry of Health. All meals were compared in terms of energy, macro food items, and sodium content. The kids' menus from the following 4 most preferred fast-food companies in Turkey were included in the study: McDonald's, Burger King, Popeyes, and Arby's. The menus with the highest energy and fat content were offered by Burger King, those with the highest protein content were offered by Popeyes, and those with the highest sodium content were offered by Arby's. The contribution of fat to the energy content was found to be low in traditional Turkish menus (P &lt; .05), whereas the contribution of protein to the energy content was significantly higher in the Popeyes menus (P &lt; .05). Improving the nutritional quality of kids' fast-food menus may be effective in controlling childhood obesity.

The potential contribution of house crickets to the dietary zinc content and nutrient adequacy in young Kenyan children: a linear programming analysis using Optifood.

Zn deficiency arising from inadequate dietary intake of bioavailable Zn is common in children in developing countries. Because house crickets are a rich source of Zn, their consumption could be an effective public health measure to combat Zn deficiency. This study used Optifood, a tool based on linear programming analysis, to develop food-based dietary recommendations (FBR) and predict whether dietary house crickets can improve both Zn and overall nutrient adequacy of children's diets. Two quantitative, multi-pass 24-h recalls from forty-seven children aged 2 and 3 years residing in rural Kenya were collected and used to derive model parameters, including a list of commonly consumed foods, median serving sizes and frequency of consumption. Two scenarios were modelled: (i) FBR based on local available foods and (ii) FBR based on local available foods with house crickets. Results revealed that Zn would cease to be a problem nutrient when including house crickets to children's diets (population reference intake coverage for Zn increased from 89 % to 121 % in the best-case scenario). FBR based on both scenarios could ensure nutrient adequacy for all nutrients except for fat, but energy percentage (E%) for fat was higher when house crickets were included in the diet (23 E% v. 19 E%). This manoeuvre, combined with realistic changes in dietary practices, could therefore improve dietary Zn content and ensure adequacy for twelve nutrients for Kenyan children. Further research is needed to render these theoretical recommendations, practical.

Feasibility of a Culturally Adapted Dietary Weight-Loss Intervention among Ghanaian Migrants in Berlin, Germany: The ADAPT Study.

Background: Dietary weight-loss interventions often fail among migrant populations. We investigated the practicability and acceptability of a culturally adapted dietary weight-loss intervention among Ghanaian migrants in Berlin. Methods: The national guidelines for the treatment of adiposity were adapted to the cultural characteristics of the target population, aiming at weight-loss of ≥2.5 kg in 3 months using food-based dietary recommendations. We invited 93 individuals of Ghanaian descent with overweight or obesity to participate in a 12-weeks intervention. The culturally adapted intervention included a Ghanaian dietician and research team, one session of dietary counselling, three home-based cooking sessions with focus on traditional Ghanaian foods, weekly smart-phone reminders, and monthly monitoring of diet and physical activity. We applied a 7-domains acceptability questionnaire and determined changes in anthropometric measures during clinic-based examinations at baseline and after the intervention. Results: Of the 93 invitees, five participants and four family volunteers completed the study. Reasons for non-participation were changed residence (13%), lack of time to attend examinations (10%), and no interest (9%); 64% did not want to give any reason. The intervention was highly accepted among the participants (mean range: 5.3–6.0 of a 6-points Likert scale). Over the 12 weeks, median weight-loss reached −0.6 kg (range: +0.5, −3.6 kg); the diet was rich in meats but low in convenience foods. The median contribution of fat to daily energy intake was 24% (range: 16–40%). Conclusions: Acceptance of our invitation to the intervention was poor but, once initiated, compliance was good. Assessment centers in the participants’ vicinity and early stakeholder involvement might facilitate improved acceptance of the invitation. A randomized controlled trial is required to determine the actual effects of the intervention.

Defining healthy and sustainable diets for infants, children and adolescents

This paper provides an overview of nutrition recommendations for dietary intakes necessary to support normal growth and development of children from birth to 18 years and to promote long-term health and quality of life. Key nutrients and food-based dietary recommendations have been examined from international evidence-based child dietary and feeding guidelines from the World Health Organization and a convenience sample of countries. The paper also reviews key issues relating to the environmental impacts of child diets. Fundamental gaps are identified in defining optimal intakes for children at specific ages and for those living in different geographical regions and food environments.

Nutrition and behavioral health disorders: depression and anxiety.

Suboptimal nutrition has been implicated in the underlying pathology of behavioral health disorders and may impede treatment and recovery. Thus, optimizing nutritional status should be a treatment for these disorders and is likely important for prevention. The purpose of this narrative review is to describe the global burden and features of depression and anxiety, and summarize recent evidence regarding the role of diet and nutrition in the prevention and management of depression and anxiety. Current evidence suggests that healthy eating patterns that meet food-based dietary recommendations and nutrient requirements may assist in the prevention and treatment of depression and anxiety. Randomized controlled trials are needed to better understand how diet and nutrition-related biological mechanisms affect behavioral health disorders, to assist with the development of effective evidence-based nutrition interventions, to reduce the impact of these disorders, and promote well-being for affected individuals.

Identifying Dietary Strategies to Improve Nutrient Adequacy among Ethiopian Infants and Young Children Using Linear Modelling.

Nutrient adequacy of young children’s diet and best possible strategies to improve nutrient adequacy were assessed. Data from the Ethiopian National Food Consumption Survey were analysed using Optifood (software for linear programming) to identify nutrient gaps in diets for children (6–8, 9–11 and 12–23 months), and to formulate feasible Food-Based Dietary Recommendations (FBDRs) in four regions which differ in culture and food practices. Alternative interventions including a local complementary food, micronutrient powders (MNPs), Small quantity Lipid-based Nutrient Supplement (Sq-LNS) and combinations of these were modelled in combination with the formulated FBDRs to compare their relative contributions. Risk of inadequate and excess nutrient intakes was simulated using the Estimated Average Requirement cut-point method and the full probability approach. Optimized local diets did not provide adequate zinc in all regions and age groups, iron for infants <12 months of age in all regions, and calcium, niacin, thiamine, folate, vitamin B12 and B6 in some regions and age-groups. The set of regional FBDRs, considerably different for four regions, increased nutrient adequacy but some nutrients remained sub-optimal. Combination of regional FBDRs with daily MNP supplementation for 6–12 months of age and every other day for 12–23 months of age, closed the identified nutrient gaps without leading to a substantial increase in the risk of excess intakes.

New Chinese dietary guidelines: healthy eating patterns and food-based dietary recommendations.

The Chinese Dietary Guidelines (CDGs) were first released to the public in 1989 by the Chinese Nutrition Society (CNS). In 2016, the Ministry of Health commissioned the CNS to revise and publish new CDGs. The CNS convened an expert committee of leaders in the fields of nutrition, epidemiology, public health, preventive medicine, and food science. The CDGs were revised according to the World Health Organization Handbook for Guideline Development procedures. The expert committee recommended key inclusions for the CDGs on the basis of the current status of public health and priority health challenges affecting the Chinese population, as well as the quality of scientific evidence. The CDGs (2016) provide six key dietary recommendations for the general Chinese population aged 2 years and above. In addition to a newly revised Chinese Food Guide Pagoda, both the Chinese Food Guide Plate and Chinese Food Guide Abacus are newly created pictorial models in the CDGs (2016); the Chinese Food Guide Abacus is specifically designed for children. Seven additional dietary guidelines targeting specific populations are included; these guidelines emphasize the different physiological and nutritional requirements of particular populations, including dietary guidelines for vegetarians for the first time. The CDGs (2016) is an official document published by the National Health Commission of China. Its content highlights the current status of public health and offers advice to address health concerns faced by the Chinese population. The CDGs (2016) have been widely disseminated and accepted in the Chinese population; the National Nutrition Week is a major national event in which the CDG are used as its core to increase public awareness towards a healthy diet and lifestyle.

Combining food-based dietary recommendations using Optifood with zinc-fortified water potentially improves nutrient adequacy among 4- to 6-year-old children in Kisumu West district, Kenya.

Children in developing countries often face multiple micronutrient deficiencies. Introduction of zinc-fortified water can increase zinc intake, but additional recommendations are required to address overall diet nutrient adequacy. We developed and tested food-based recommendations (FBRs) that included zinc-fortified water for children aged between 4 and 6years from rural Kenya to achieve the best possible nutrient adequacy. Dietary intakes of 60 children aged 4-6years, from Kisumu West district, Kenya, were assessed using a quantitative multipass 24-hr recall. Linear programming model parameters were derived, including a list of foods consumed, median serving sizes, and distribution of frequency of consumption. By using the Optifood linear programming tool, we developed FBRs for diets including zinc-fortified water. FBRs with nutrient levels achieving ≥70% recommended nutrient intake (RNI) of the World Health Organization/Food and Agriculture Organization of the United Nations RNI for most of the 12 considered nutrients were selected as the final recommendations for the children. With no FBRs and no zinc-fortified water, percent RNI coverage range was between 40% and 76% for zinc, improving to 66-101% after introduction of zinc-fortified water. The final set of FBRs achieved nutrient adequacy for all nutrients except for vitamin A (25% RNI) and folate (68% RNI). Introduction of zinc-fortified water combined with FBRs will likely improve the nutrient adequacy of diets consumed by children in Kenya but needs to be complemented with alternative interventions to ensure dietary adequacy.

Association of flavonoid-rich foods and flavonoids with risk of all-cause mortality.

Flavonoids are bioactive compounds found in foods such as tea, red wine, fruits and vegetables. Higher intakes of specific flavonoids, and flavonoid-rich foods, have been linked to reduced mortality from specific vascular diseases and cancers. However, the importance of flavonoid-rich foods, and flavonoids, in preventing all-cause mortality remains uncertain. As such, we examined the association of intake of flavonoid-rich foods and flavonoids with subsequent mortality among 93 145 young and middle-aged women in the Nurses' Health Study II. During 1 838 946 person-years of follow-up, 1808 participants died. When compared with non-consumers, frequent consumers of red wine, tea, peppers, blueberries and strawberries were at reduced risk of all-cause mortality (P<0·05), with the strongest associations observed for red wine and tea; multivariable-adjusted hazard ratios 0·60 (95 % CI 0·49, 0·74) and 0·73 (95 % CI 0·65, 0·83), respectively. Conversely, frequent grapefruit consumers were at increased risk of all-cause mortality, compared with their non-grapefruit consuming counterparts (P<0·05). When compared with those in the lowest consumption quintile, participants in the highest quintile of total-flavonoid intake were at reduced risk of all-cause mortality in the age-adjusted model; 0·81 (95 % CI 0·71, 0·93). However, this association was attenuated following multivariable adjustment; 0·92 (95 % CI 0·80, 1·06). Similar results were observed for consumption of flavan-3-ols, proanthocyanidins and anthocyanins. Flavonols, flavanones and flavones were not associated with all-cause mortality in any model. Despite null associations at the compound level and select foods, higher consumption of red wine, tea, peppers, blueberries and strawberries, was associated with reduced risk of total and cause-specific mortality. These findings support the rationale for making food-based dietary recommendations.

The Impact of Dietary Factors on Indices of Chronic Disease in Older People: A Systematic Review.

There has been little evaluation of the evidence relating dietary factors to functional capacity in older adults. The aims were to i) conduct a systematic review of studies assessing dietary factors in relation to six key functional indicators which impact on quality of life in adults ≥65 yrs: non-fatal cardiovascular events, cognition, mental health, falls and fractures, physical health (muscle mass, strength) and frailty; and ii) assess if there was sufficient evidence to devise food-based dietary recommendations. Systematic review. Cross-sectional and prospective cohort studies were included together with intervention studies that evaluated food/drink interventions (excluding supplements). Evidence base statements were determined according to the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) levels of evidence criteria (Grades (A-excellent; B-good; C-satisfactory; D-poor). There was good evidence that the Mediterranean type diet (MD) reduced the risk of non-fatal cardiovascular events (Grade B) and reduced cognitive decline (Grade B). There was some evidence indicating that a MD decreases the likelihood of frailty (Grade C), consistent but weaker evidence that ≥3 servings/d of vegetables is associated with reduced cognitive decline (Grade D), a modest increase in protein may be associated with improved cognition (Grade C) and decreased frailty (Grade C), and that protein plus resistance exercise training in frail elderly may enhance physical strength (Grade C). It is recommended that older adults adopt the characteristics of a Mediterranean type diet such as including olive oil and eating ≥3 servings/d of vegetables to reduce their risk of chronic disease, impaired cognition and frailty. Consumption of dietary protein above the current dietary requirements would be recommended to reduce risk of frailty and impaired cognition. A modest increase in dietary protein when combined with resistance exercise would be recommended to help maintain muscle mass and strength and to enhance functional capacity.

Discretionary Foods Have a High Contribution and Fruit, Vegetables, and Legumes Have a Low Contribution to the Total Energy Intake of the Mexican Population

Background: Overweight and obesity prevalences in Mexico are among the highest in the world, with dietary factors being the third-leading category of risk contributing to the burden of disease. Consequently, studying the compliance of the Mexican population to food-based dietary recommendations is essential for informing nutritional policies.Objectives: We described the energy contribution of food groups to total dietary energy intake of the Mexican population and by sociodemographic subgroups and compared these results with Mexican dietary recommendations.Methods: Twenty-four-hour dietary recalls for participants aged ≥5 y (n = 7983) from the 2012 Mexican National Health and Nutrition Survey were used. Foods and beverages were classified into 8 groups (the first 6 were called “basic foods” and the last 2 “discretionary foods”), as follows: 1) cereals, 2) legumes, 3) milk and dairy, 4) meat and animal products, 5) fruit and vegetables, 6) fats and oils, 7) sugar-sweetened beverages (SSBs), and 8) products high in saturated fat and/or added sugar (HSFAS). Recommendations were based on the Mexican Dietary Guidelines (MDG). Energy contributions from the food groups by age, sex, region, residence (rural or urban), and socioeconomic status (SES) were estimated.Results: The highest contribution to total energy intake came from cereals (33%) followed by HSFAS (16%), meat and animal products (14%), and SSBs (9.8%). Fruit and vegetables (5.7%) and legumes (3.8%) had the lowest contribution. Energy contribution of several food groups differed significantly between population subgroups. Overall, discretionary foods contributed more than one-quarter of total energy intake (26%) and were 13 percentage points above the maximum allowed by the recommendations, whereas the intakes of legumes and fruit and vegetables were much lower than recommended.Conclusions: Our results show the need to generate a food environment conducive to a healthier diet in the Mexican population.

Whole-grain foods and chronic disease: evidence from epidemiological and intervention studies.

Cereal-based foods are key components of the diet and they dominate most food-based dietary recommendations in order to achieve targets for intake of carbohydrate, protein and dietary fibre. Processing (milling) of grains to produce refined grain products removes key nutrients and phytochemicals from the flour and although in some countries nutrients may be replaced with mandatory fortification, overall this refinement reduces their potential nutritional quality. There is increasing evidence from both observational and intervention studies that increased intake of less-refined, whole-grain (WG) foods has positive health benefits. The highest WG consumers are consistently shown to have lower risk of developing CVD, type 2 diabetes and some cancers. WG consumers may also have better digestive health and are likely to have lower BMI and gain less weight over time. The bulk of the evidence for the benefits of WG comes from observational studies, but evidence of benefit in intervention studies and potential mechanisms of action is increasing. Overall this evidence supports the promotion of WG foods over refined grain foods in the diet, but this would require adoption of standard definitions of 'whole grain' and 'whole-grain foods' which will enable innovation by food manufacturers, provide clarity for the consumer and encourage the implementation of food-based dietary recommendations and public health strategies.

Development of Food Based Dietary Guidelines for Kenyan Women Using Linear Programming

Objectives: Women in Kenya are at high risk of multiple micronutrient deficiencies due to low intake through monotonous diets. Country-specific food based dietary recommendations (FBRs) facilitate dietary improvement. Main objective was to develop and evaluate FBRs based on the existing diet using linear programming for women of reproductive age from Mbooni division, Eastern Kenyan. Methods: A consumption study was conducted among 205 woman (19-50 yrs.) using three nonconsecutive 24-hour recalls. Excel, Access and SPSS were used to prepare required model parameters (foods consumed by >10% of women, including median portion size, weekly frequency consumption, food composition values, food group patterns (median and range), staple/snacks. Linear programming (‘Optifood') was used to develop and evaluate FBRs. Results: Out of 62 foods, 30 foods were consumed by more than 10% of the surveyed women. Fat, iron, folate and vitamin-B12 requirements could not be met both in worst (≥70%RNI) and best case (≥100% RNI) scenario diets, covering 43.6%, 48.4%, 30.0% & 18.8% of RNI. Calcium, vitamin A, riboflavin, niacin, B6 and zinc intake was inadequate, but requirements could be met by inclusion of kale, pumpkin leaves, red beans, cow's milk and cooking fat. Conclusions: Realistic food based dietary guidelines based on locally available foods for Kenyan women were successfully developed using linear programming. These guidelines will ensure at least 70% RNI of energy, protein, calcium, vitamin A, C, B1, B2, B5, B6, and zinc. To obtain adequate amounts of fat, folate, iron and vitamin-B12 in the women's diet, alternative strategies are required. © 2015 Ngala et al.; This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Conference Abstract

Do Norwegians with diabetes have a healthier diet than the general population?

Objective: Review current knowledge about dietary habits among people with diabetes in Norway compared with the general population and nutrient- and food-based dietary recommendations. Method: Baseline dietary data from four intervention studies in subjects with type 2 diabetes, were merged (n=92) and compared with data extracted from a nationwide dietary survey, NORKOST, where participants with diabetes (n=115) were compared with a gender and age matched control group (n=575). A validated food frequency questionnaire was used for dietary assessment. An overview of previously published data from two studies among young people with type 1 diabetes was included for comparison. Results: Subjects with diabetes had an intake of carbohydrates in the lower recommended range and lower than the controls, which was reflected in a lower intake of added sugar, sweets, potatoes, sugar-sweetened beverages, and fruit juices. Subjects with diabetes had a fiber intake which was similar or higher than controls, but below the recommended intake. They reported a higher proportion of energy from protein and fat than controls, reflecting the higher intake of meat, fish, edible fats, and high-fat meat products. There was a higher intake of vegetables, fruits and whole grain among subjects with diabetes compared with controls, but also a higher intake of red meat. Conclusion: Compared with the recommendations, people with diabetes had a low intake of carbohydrates and a high intake of protein and fat, but they made more healthy choices regarding intake of selected food groups compared with the control groups.

Recent discoveries in inclusive food-based approaches and dietary patterns for reduction in risk for cardiovascular disease.

To discuss new evidence-based dietary recommendations founded on an inclusive food strategy and to address the challenges that are posed by integrating a growing list of heart healthy foods into the diet without increasing energy intake beyond that required to achieve a healthy body weight. New food-based dietary recommendations issued by the American Heart Association with the objective of reducing risk for cardiovascular disease (CVD) promote an inclusionary approach. The American Heart Association recommends a variety of foods to target four major goals: achieve a healthy overall diet, achieve a healthy weight, promote desirable lipid levels, and promote desirable blood pressure. Specific foods recommended include fruits and vegetables, grain products (including whole grains), fish, lean meat and poultry, fat-free or low-fat dairy products, and legumes. In addition, the new National Cholesterol Education Program Adult Treatment Panel III recommends reductions in saturated fat and cholesterol and therapeutic dietary options for enhancing LDL-cholesterol lowering, with inclusion of plant stanols/sterols (2 g/day) and increased viscous (soluble) fiber (10-25 g/day). In parallel with the evolution of new dietary recommendations is the expanding list of specific foods that have cardioprotective effects. Additional foods on this list are nuts, soy, legumes, alcohol, tea, and garlic. It will be challenging to include all foods that reduce CVD risk in the diet and still maintain energy control. Strategies are needed that facilitate developing heart healthy dietary patterns that maximally reduce CVD risk.