Cardiovascular Nutrition Controversies

Freeman AM, Morris PB, Barnard N, et al.
Trending Cardiovascular Nutrition Controversies. J Am Coll Cardiol 2017;69:1172-1187.

The following are key points to remember from this review about some of the more popular foods and dietary patterns that are promoted for cardiovascular health:

  1. A healthy dietary pattern high in fruits, vegetables, whole grains, legumes, and nuts in moderation, with limited quantities of lean meat, fish, low-fat and nonfat dairy products, and liquid vegetable oils is recommended to reduce risk for atherosclerotic cardiovascular disease (ASCVD) and related risk factors. A dietary pattern should also be low in saturated, trans, and solid fats; sodium; added sugars; and refined grains.
  2. A diet low in dietary cholesterol is recommended. Dietary cholesterol is often from eggs. Shellfish is a source of dietary cholesterol, which is also low in saturated fatty acids (SFAs) and thus may be a better choice than foods high in SFAs, but should be limited to reduce dietary intake of cholesterol.
  3. Solid fats (at room temperature) are not recommended for reduction of ASCVD risk. This includes coconut and palm oils. Current claims of documented health benefits of the tropical oils are unsubstantiated, and use of these oils should be discouraged. In contrast, liquid vegetable oils have beneficial effects on lipids including decreasing low-density lipoprotein cholesterol. The evidence base for olive oil is the most comprehensive, with clear evidence for a benefit in ASCVD risk reduction.
  4. Current evidence supports the consumption of fruits and vegetables as sources of antioxidants for ASCVD risk reduction. In contrast, there is no evidence of benefit related to antioxidant dietary supplements. A diet high in green leafy vegetables has significant benefits for reducing ASCVD risk. Careful guidance should be provided to patients on warfarin to establish a stable, consistent intake to avoid variations in the efficacy of anticoagulation.
  5. Nuts are part of a healthy dietary pattern for the reduction of ASCVD risk. However, portion control is important to reduce excess caloric intake.
  6. Whole food consumption is preferred over juicing. Guidance should be provided to maintain optimal overall caloric intake and to avoid the addition of sugars (e.g., honey) to minimize caloric overconsumption.
  7. A plant-based diet is associated with reduction in ASCVD risk factors and heart disease. Therefore, a whole-food, plant-based dietary pattern plays an important role in ASCVD risk reduction.
  8. For patients with gluten-related disorders, a gluten-free diet that is rich in fruits and vegetables, legumes and dried beans, lean protein sources, nuts and seeds, low-fat dairy or nondairy alternatives rich in calcium and vitamin D, and healthy fats, including omega-3 fatty acids, plays an important role in management of symptoms. However, in patients without gluten-related disorders, many of the claims for health benefits are unsubstantiated.

Clinical Topics: Anticoagulation Management, Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Lipid Metabolism, Nonstatins, Diet

Keywords: Anticoagulants, Antioxidants, Atherosclerosis, Calcium, Cholesterol, Cholesterol, Dietary, Cholesterol, LDL, Dairy Products, Diet, Gluten-Free, Dietary Supplements, Energy Intake, Fatty Acids, Fatty Acids, Omega-3, Fruit, Glutens, Honey, Nutritional Sciences, Nuts, Primary Prevention, Risk Factors, Risk Reduction Behavior, Shellfish, Sodium, Vegetables, Vitamin D, Warfarin

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