2021 Dietary Guidance to Improve Cardiovascular Health: A Scientific Statement From the American Heart Association

Authors: LICHTENSTEIN, ALICE - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; APPEL, LAWRENCE - Johns Hopkins University; VADIVELOO, MAYA - University Of Rhode Island; HU, FRANK - Harvard University; KRIS-ETHERTON, PENNY - Pennsylvania State University; REBHOLZ, CASEY - Johns Hopkins University; SACKS, FRANK - Harvard School Of Public Health; THORNDIKE, ANNE - Massachusetts General Hospital; VAN HORN, LINDA - Northwestern University; WYLIE-ROSETT, JUDITH - Albert Einstein College Of Medicine

Submitted to: Circulation
Publication Type: Review Article
Publication Acceptance Date: 11/2/2021
Publication Date: 11/2/2021
Citation: Lichtenstein, A.H., Appel, L.J., Vadiveloo, M., Hu, F.B., Kris-Etherton, P.M., Rebholz, C.M., Sacks, F.M., Thorndike, A.M., Van Horn, L., Wylie-Rosett, J. 2021. 2021 Dietary guidance to improve cardiovascular health: A scientific statement from the American Heart Association. Circulation. 144(23):e472-e487. https://doi.org/10.1161/CIR.0000000000001031.
DOI: https://doi.org/10.1161/CIR.0000000000001031

Interpretive Summary: Poor diet quality is strongly associated with elevated risk of cardiovascular disease morbidity and mortality. This is a scientific statement from the American Heart Association. Emphasized is the importance of dietary patterns beyond individual foods or nutrients. It underscores the critical role of nutrition early in life, presents elements of heart-healthy dietary patterns, and highlights structural challenges that impede adoption of heart-healthy dietary patterns. In summary, evidence-based dietary pattern guidance to promote cardiometabolic health includes the following: (1) adjust energy intake and expenditure to achieve and maintain a healthy body weight; (2) eat plenty and a variety of fruits and vegetables; (3) choose whole grain foods and products; (4) choose healthy sources of protein (mostly plants; regular fish and seafood intake; low-fat or fat-free dairy products; and if meat or poultry are desired, choose lean cuts and unprocessed forms) (5) use liquid plant oils rather than tropical oils and partially-hydrogenated fats; (6) choose minimally processed foods instead of ultra-processed foods; (7) minimize intake of beverages and foods with added sugars; (8) choose and prepare foods with little or no salt; (9) if you don't drink alcohol, don't start; if you choose to drink alcohol, limit intake; and (10) adhere to this guidance regardless of where food is prepared or consumed. Challenges to eating a heart-healthy dietary pattern that are highlighted include structural racism, neighborhood segregation, food insecurity, and targeted marketing of unhealthy foods. The statement advocates creating an environment that facilitates, rather than impedes, adherence to heart-healthy dietary patterns among all individuals is a public health imperative.

Technical Abstract: Poor diet quality is strongly associated with elevated risk of cardiovascular disease morbidity and mortality. This scientific statement emphasizes the importance of dietary patterns beyond individual foods or nutrients, underscores the critical role of nutrition early in life, presents elements of heart-healthy dietary patterns, and highlights structural challenges that impede adherence to heart-healthy dietary patterns. Evidence-based dietary pattern guidance to promote cardiometabolic health includes the following: (1) adjust energy intake and expenditure to achieve and maintain a healthy body weight; (2) eat plenty and a variety of fruits and vegetables; (3) choose whole grain foods and products; (4) choose healthy sources of protein (mostly plants; regular intake of fish and seafood; low-fat or fat-free dairy products; and if meat or poultry is desired, choose lean cuts and unprocessed forms); (5) use liquid plant oils rather than tropical oils and partially hydrogenated fats; (6) choose minimally processed foods instead of ultra-processed foods; (7) minimize the intake of beverages and foods with added sugars; (8) choose and prepare foods with little or no salt; (9) if you do not drink alcohol, do not start; if you choose to drink alcohol, limit intake; and (10) adhere to this guidance regardless of where food is prepared or consumed. Challenges that impede adherence to heart-healthy dietary patterns include targeted marketing of unhealthy foods, neighborhood segregation, food and nutrition insecurity, and structural racism. Creating an environment that facilitates, rather than impedes, adherence to heart-healthy dietary patterns among all individuals is a public health imperative.