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Improvements needed in healthy food access, education to prevent CVD
Positive changes in diet can be critical in preventing CVD, although various factors can hinder patients from accessing healthy foods, according to a review published in the Journal of the American College of Cardiology.
“Eating habits are forged over a lifetime and are influenced by a multitude of factors from all levels of society, including biological, economic, physical, social and psychological determinants,” Frank B. Hu, MD, PhD, chair of the department of nutrition at Harvard T.H. Chan School of Public Health, said in a press release. “The assumption that most people would replace unhealthy dietary components in light of new research is overly optimistic.”
CVD prevention
Dietary composition consistently affects primordial, primary and secondary prevention of CVD, Edward Yu, ScD, research assistant at Harvard T.H. Chan School of Public Health, and colleagues wrote. Calorie restriction contributes to a cardiometabolic benefit by improving blood glucose, insulin sensitivity and inflammation. Evidence has shown that Mediterranean and low-carbohydrate diets help patients maintain weight loss compared with low-fat diets.
Although benefits within subgroups have been less studied, total fruit and vegetable intake has been inversely associated with CVD risk. Whole grains may also reduce the risk for CVD; however, refined grains may increase the risk, although it is nonsignificant.
Long-chain omega-3 fatty acids from marine fish can reduce thrombosis, arrhythmias and BP, in addition to modifying the lipid profile. Legumes and nuts are also beneficial because they contain high levels of fiber, unsaturated fat, phytochemicals and micronutrients. Dairy products have a weak inverse association with CVD.
The risk for CVD may rise with an increased intake of processed and unprocessed meats, but replacing those with other sources of protein such as poultry, fish and nuts decreased the incidence of CHD, the authors wrote.
Alcohol increases CVD risk in those who abstain from drinking and those who drink heavily compared with those who are moderate drinkers. Sugar-sweetened beverages also increase the risk for CVD. The risk decreased in patients who regularly consumed coffee and tea.
The quality and quantity of carbohydrate consumption is important in healthy eating patterns, the authors wrote. The risk for CHD increases with diets that are high in glycemic load and glycemic index, and low glycemic index or load is inversely associated with CHD. Another group that increases the risk for CVD are added sugars such as high-fructose corn syrup and sucrose. Dietary fiber can reduce the risk for CVD and improve CV risk factors, as shown in observational and dietary intervention studies. Trans fatty acids have been linked to adverse CV outcomes, which led to their ban in the United States.
Reluctance to eat healthy
Research helps clinicians understand what makes up a healthy diet, but it is still not well-understood why people do not eat a healthy diet. Some suggestions include a lack of knowledge, lack of availability of healthy foods, price, time scarcity and palatability.
“Given the magnitude of the CVD burden in the United States and globally, and the complexity of dietary risk factor modification, simultaneous prevention strategies and policies across multiple societal levels are needed to make a measurable impact on reducing prevalence rates,” Yu and colleagues wrote.
Some tools that may help include nutrition and agricultural policies, taxes on select foods and beverages, agricultural subsidies, government regulation of school lunch programs and labeling regulations, according to the authors.
School-based programs and worksite-based interventions can educate patients on the benefits of choosing a healthy lifestyle and how to overcome barriers to access.
“Additional improvements in diet quality can be achieved from a combination of policy strategies across multiple levels, including excise taxes on [sugar-sweetened beverages], economic incentives for the production of healthy foods, regulation of food marketing, healthy school and work environments, and education campaigns,” Yu and colleagues wrote. “Health professionals and community leaders have a great responsibility to promote cardiovascular health and disease prevention but require a basic nutrition knowledge base. A concerted effort from all levels of society will be needed to fundamentally change the current food environment and the global food system.” – by Darlene Dobkowski
Disclosures: The authors report no relevant financial disclosures.