New Look at Nutrition Research Identifies 10 Features of a Heart-Healthy Eating Pattern

The American Heart Association has outlined 10 key features of a heart-healthy eating pattern in a new scientific statement that emphasizes the importance of overall dietary pattern rather than individual foods or nutrients and underscores the critical role of nutrition in all stages of life. These features can be adapted to accommodate individual food likes and dislikes, cultural traditions and whether most meals are consumed at home, or on-the-go, according to the statement: 2021 Dietary Guidance to Improve Cardiovascular Health, published in the Association’s flagship journal Circulation.

The new statement reflects the latest scientific evidence on the benefits of heart-healthy eating throughout life and that poor diet quality is strongly associated with an increased risk of cardiovascular disease and death. The statement emphasises the importance of looking at the total dietary pattern rather than ‘good’ or ‘bad’ individual foods or nutrients.

A dietary pattern refers to the balance, variety, amounts and combination of foods and beverages regularly eaten. The statement also highlights the critical role of nutrition education, starting healthy eating early in life and maintaining throughout the lifespan, as well as societal and other challenges that may make it harder to adopt or maintain a heart-healthy diet pattern.

“We can all benefit from a heart-healthy dietary pattern regardless of stage of life, and it is possible to design one that is consistent with personal preferences, lifestyles and cultural customs. It does not need to be complicated, time consuming, expensive or unappealing,” said Chair of the scientific statement writing group Alice H. Lichtenstein, D.Sc., FAHA, senior scientist and director of the Cardiovascular Nutrition Team at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University in Boston.

Because food is often eaten in places outside the home, the statement also emphasises following a heart-healthy dietary pattern regardless of whether food is prepared: at home, in a restaurant, ordered online, or purchased as a ready-meal.

“You can absolutely adapt a heart-healthy diet to different lifestyles,” said Lichtenstein, who is also the Stanley N. Gershoff Professor of Nutrition Science and Policy at the Friedman School of Nutrition Science and Policy, “including one that incorporates eating out at restaurants. It might take a little planning, however, after the first few times it can become routine.”

The statement details 10 features of a dietary protein to promote heart health:

• Balance food and calorie intake with physical activity to maintain a healthy weight.
• Choose a wide variety and eat plenty of fruits and vegetables to get a full range of nutrients from food rather than supplements.
• Choose whole grains and other foods made up mostly of whole grains.
• Include healthy sources of lean and/or high-fibre protein such as plant proteins (nuts and legumes), fish or seafood, low fat or non-fat dairy, lean cuts of meat and limit red and processed meats.
• Use liquid non-tropical plant oils such as olive or sunflower oils.
• Choose minimally processed foods rather than ultra-processed foods as much as possible.
• Minimize intake of beverages and foods with added sugars.
• Choose or prepare foods with little or no salt.
• Limit alcohol consumption; if you do not drink, do not start.
• And apply this guidance no matter where food is prepared or consumed.

A heart-healthy diet can also help the environment

For the first time, the issue of sustainability is included in the Association’s dietary guidance. Commonly consumed animal products, particularly red meat (beef, lamb, pork, veal, venison or goat), have the largest environmental impacts in terms of water and land usage, and contribute significantly to greenhouse gas emissions. Hence, shifting reliance from meat protein to plant protein can also help to reduce overall environmental impact.

“It is important to recognize that the guidance is consistent not only with heart health but also sustainability – it is a win-win for individuals and our environment,” said Lichtenstein.

And, for the first time, the 2021 dietary guidance discusses several challenges that can make it harder to adopt or maintain a heart-healthy diet. These include:

• Widespread dietary misinformation from the internet.
• A lack of nutrition education in grade schools and medical schools.
• Food and nutrition insecurity – According to references cited in the statement, an estimated 37 million Americans had limited or unstable access to safe and nutritious foods in 2020.
• Structural racism and neighbourhood segregation, whereby many communities with a higher proportion of racial and ethnic diversity have few grocery stores but many fast-food outlets.
• Targeted marketing of unhealthy foods and beverages to people from diverse racial and ethnic backgrounds through tailored advertising efforts and sponsorship of events and organizations in those communities.

Public health action and policy changes are required to address these challenges and barriers, according to the statement.

“Creating an environment that promotes and supports adherence to heart-healthy dietary patterns among all individuals is a public health imperative,” the statement concludes.

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