Review Examines How Policy Changes Can Lead to Healthier Diets

Diet modification can be a vital step to prevent cardiovascular disease. While various biological, economical, physical, social and psychological factors influence food choices, interventions targeting these factors can lead to meaningful improvements in long-term eating habits, according to a review paper published Aug. 13 in the Journal of the American College of Cardiology.

Edward Yu, ScD, et al., explain that research has consistently shown that a healthy diet – particularly one high in fruits, vegetables, whole grains, fish, nuts and legumes and low in processed meats, refined grains, sodium and sugary beverages – is associated with the prevention of heart disease. However, many people face roadblocks in achieving an ideal diet. Higher prices, lack of nutritional knowledge and a limited availability of healthy food – or "food deserts" – can all contribute to a poor diet in low income and minority populations. According to the researchers, large amounts of sugar and sodium are added to processed food products to help make them more palatable. Social determinants such as culture, community, friends, family and social media can also have an influence over food choices.

To help improve diets, the authors recommend policy strategies across multiple levels, including nutrition labeling, taxing sugar sweetened beverages, providing economic incentives for the production of healthy foods, regulating food marketing, promoting healthy school and work environments, and funding educational campaigns.

"Given the magnitude of the cardiovascular disease burden in the U.S. 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," said senior author said Frank B. Hu, MD, PhD. "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 global food system."

This paper is the first in an eight-part cardiovascular health promotion JACC focus seminar, where each paper will focus on a different behavioral consideration that impacts cardiovascular health: nutrition and diet; healthy weight; exercise and physical activity; tobacco-free lifestyle; blood pressure; cholesterol; blood sugar; and psychological health.

In an introduction to the series, Valentin Fuster, MD, PhD, MACC, et al., explain that JACC is moving towards an increased concentration on cardiovascular health promotion in the primordial, primary and secondary prevention stages. "Editors of medical journals have a responsibility to inform cardiovascular clinicians on the safest and most effective means of preventing disease as well as treating cardiovascular disease," they explain.

Keywords: Vegetables, Food Labeling, Tobacco, Fruit, Blood Glucose, Nuts, Sweetening Agents, Fabaceae, Risk Factors, Motivation, Sodium, Secondary Prevention, Blood Pressure, Prevalence, Diet, Food Preferences, Feeding Behavior, Body Weight, Health Promotion, Exercise, Cardiovascular Diseases, Heart Diseases, Knowledge Bases, Cholesterol

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