Top Things to Know: Popular Dietary Patterns: Alignment with AHA 2021 Dietary Guidance
Published: April 27, 2023
Prepared by Radhika Rajgopal Singh, Ph.D; SVP Science and Medicine
- Proliferation of nutrition misinformation regarding wise food choices and the challenges of many popular dietary patterns limits population-wide adherence to consuming a heart-healthy dietary pattern.
- The objective of this scientific statement is to assess the alignment of commonly practiced U.S. dietary patterns with the criteria listed in the American Heart Association’s (AHA) 2021 Dietary Guidance, determine clinical and cultural factors that affect long-term adherence, and propose approaches for adoption of healthy dietary patterns.
- The statement also clarifies the intended implementation of prevailing dietary patterns, and summarizes strengths, facilitators, challenges, opportunities, and priorities for future dietary pattern research that incorporates historically underrepresented cultural patterns. As many clinicians cite insufficient time and inadequate nutrition training as barriers to providing nutrition advice or counseling, the statement highlights the strengths or favorable attributes of the 10 identified dietary patterns, discusses facilitators to adopting the best practices of each pattern, identifies challenges to be addressed by health care professionals, and provides actionable opportunities to improve adherence or enhance the health promoting aspects of the pattern.
- A detailed review of randomized controlled trials and descriptions from U.S. federal agencies or health organizations, including large prospective cohort studies, where available, was conducted to identify popular dietary patterns practiced in the U.S.
- To enhance interpretation and implementation, the identified dietary patterns were grouped into 10 categories based on how similarly each pattern emphasized, included, limited and/or avoided food groups in the 2021 AHA Dietary Guidance.
- The statement evaluates how closely each of the 10 dietary pattern categories aligns with the criteria identified in the 2021 AHA Dietary Guidance. The dietary patterns included were: (1) DASH-Style (2) Mediterranean-style, (3) Pescetarian, (4) Ovo/Lacto Vegetarian (5) Vegan, (6) Low Fat, (7) Very Low-Fat, (8) Low-Carbohydrate, (9) Paleo, and (10) Very Low-Carbohydrate/Ketogenic.
- While many dietary patterns are or can be aligned with the 2021 AHA Dietary Guidance, some of the more restrictive and extreme low-carbohydrates diets, such as Paleo and Ketogenic, remain substantially out of alignment with AHA when implemented as intended.
- To promote equity in cardiovascular health outcomes, interventions that are research based and foster structural changes in food systems are needed. The statement includes examples of strategies anchored in the socioecological model, and addresses factors that operate at the individual, relationship, community, and societal/policy levels.
- There is robust evidence supporting a diverse set of dietary patterns that promote cardiometabolic health and that can be designed to reflect personal and cultural preferences and budgetary constraints.
- For all dietary patterns identified in this statement, there are healthier and less healthy ways to follow them, and optimal cardiovascular health is best supported by developing a food environment that supports adherence to the optimal and key features of these patterns wherever food is prepared or consumed.
Citation
Gardner CD, Vadiveloo MK, Petersen KS, Anderson CAM, Springfield S, Van Horn L, Khera A, Lamendola C, Mayo SM, Joseph JJ; on behalf of the American Heart Association Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular and Stroke Nursing; Council on Hypertension; and Council on Peripheral Vascular Disease. Popular dietary patterns: alignment with AHA 2021 dietary guidance: a scientific statement from the American Heart Association [published online ahead of print April 27, 2023]. Circulation. doi: 10.1161/CIR.0000000000001146