As the ACC commemorates its 75-year history with a pledge to integrate health equity into cardiovascular (CV) care, education and innovation, a cadre of members have recognized that a greater focus on nutrition security, i.e., diet quality, is essential to realize this goal.

Despite abundant evidence from cohorts, randomized trials and mechanistic studies that healthy eating patterns are associated with reductions in cardiovascular disease risk factors, morbidity and all-cause mortality, this has not been well translated by health systems.

As reported in JACC¹ and elsewhere, poor diet has become the #1 killer in the U.S. and globally, contributing to an estimated 45% of cardiovascular deaths, and is a leading driver of chronic disease, disability and health care costs.²

Large disparities exist. Diet scores are persistently lower in most ethnic minorities.³ Food insecurity, another marker of poor diet quality, is higher in Blacks and Hispanics in general, and in Whites with vs. without cardiovascular disease.⁴

None of this is surprising given the aggressive marketing of fast and ultraprocessed foods in poorer communities. Compounding the problem, a low rate of medical nutrition education during cardiology training, documented by an ACC survey,⁵ along with restricted coverage for registered dietitian nutrition services, have left cardiovascular teams and health systems unable to systematically address dietary behaviors or to model healthy eating.

To address these gaps, the Nutrition and Lifestyle Work Group (NLWG) was established in 2015 and it has since grown to 50+ members, published numerous articles, contributed to conference programming, developed a podcast, fielded the ACC survey, published guidance for improving hospital food on ACC.org, and is increasingly engaged in nutrition advocacy.

Through work with the ACC Cross-Sectional Advocacy Work Group, the NLWG worked with ACC's Health Affairs Committee to secure College support of the Biden administration's request for $121 million for the National Institutes of Health's Office of Nutrition Research to expand funding, including for research by health systems, and helped pass a partner resolution with the American Medical Association (AMA) through ACC-AMA Delegates Kim Allan Williams, MD, MACC, and Neal D. Barnard, MD, FACC.

NLWG members also added public comments to the 2024 Farm Bill, 2025 Dietary Guidelines Advisory Committee, and an American College of Graduation Medical Education task force for expanding nutrition education.

In line with ACC strategies, the NLWG has embraced Food Is Medicine (FIM),⁶ a novel intervention spearheaded by Tufts University and NLWG member Dariush Mozaffarian, MD, FACC, that will leverage digital tools for universal diet screening, private partnerships for healthy food access, and physician-led team care to identify those in need. An FIM Task Force to raise awareness has been established under the Board of Governors (BOG), with the help of past BOG chair Nicole Lohr, MD, PhD, FACC, and NLWG members.

In under a decade, vision, passion, hard work and team spirit have helped move the NLWG and the College towards a goal of reducing diet-driven cardiovascular disease and disparities. Much work remains, but we're up to the challenge.

References

1. Mensah GA, et al. Global burden of cardiovascular diseases and risks, 1990-2022. J Am Coll Cardiol 2023;82:2350-2473.
2. The Rockefeller Foundation. True Cost of Food: Measuring What Matters to Transform the U.S. Food System. Avalable here.
3. Liu J, Mozaffarian D. Trends in diet quality among U.S. adults from 1999 to 2020 by race, ethnicity, and socioeconomic disadvantage. Ann Intern Med 2024;177: 841-50.
4. Brandt EJ, Chang T, Leung C, et al. Food insecurity among individuals with cardiovascular disease and cardiometabolic risk factors across race and ethnicity in 1999-2018. JAMA Cardiol 2022; 7:1218-26.
5. Devries S, Agatston A, Aggarwal M, et al. A deficiency of nutrition education and practice in cardiology. Am J Med 2017;130:1298-1305.
6. Mozaffarian D, Aspry KE, Garfield K, et al., "Food Is Medicine" strategies for nutrition security and cardiometabolic health equity: JACC State-of-the-Art Review. J Am Coll Cardiol 2024;83:843-64.

Clinical Topics: Prevention, Diet

Keywords: Cardiology Magazine, ACC Publications, Health Equity, Diet, Nutrition Policy, Food Insecurity, Health Care Costs, Risk Factors