Medscape Cardiology 2006. © 2006 Medscape

"... the 2006 AHA Diet and Lifestyle Recommendations are [but] one component of a comprehensive plan to achieve specific goals for cardiovascular risk reduction..."

Americans can substantially reduce their risk of developing cardiovascular disease if they follow the latest recommendations in a scientific statement from the American Heart Association (AHA), the authors of the statement believe. Based on a review of more than 90 scientific publications by a panel of nutrition and cardiovascular disease experts, the new diet and lifestyle recommendations have been published in Circulation.^[1]

The guidelines are intended for healthy Americans adults and children aged 2 years and older and replace guidelines issued in 2000. The new recommendations are "intentionally flexible to meet the unique needs for growth, development, and aging," and they can be applied to the clinical management of patients with or at risk for cardiovascular disease, although for certain patients at higher risk the recommendations may need to be intensified, the authors stress.

The 2006 recommendations have been reformatted so that they can be more easily understood. Besides the goals and recommendations, the statement has new sections with practical information for consumers about how they can identify their caloric needs, food preparation tips, and some examples of dietary patterns consistent with the new recommendations.

The new guidelines recognize that diet is part of an overall healthy lifestyle. "The previous recommendations stressed a healthy dietary pattern; the new ones broaden that concept to include the importance of a healthy lifestyle pattern. The two go together -- they should be inseparable," said lead author Alice Lichtenstein, DSc, Gershoff Professor of Nutrition Science and Policy at the Friedman School of Nutrition Science and Policy, at Tufts University in Boston, Massachusetts, and Chair of the AHA's Nutrition Committee.

The goals of the new guidelines are to promote:

• Consumption of an overall healthy diet;
  
  
• A healthy body weight (body mass index 18.5 -24.9 kg/m²);
  
  
• Recommended lipid levels:
  
  
  • low-density lipoprotein cholesterol < 100 mg/dL;
    
    
  • high-density lipoprotein cholesterol > 50 mg/dL in women, > 40 mg/dL in men;
    
    
  • triglycerides < 150 mg/dL;
    
    
• Normal blood pressure (systolic blood pressure < 120 mm Hg, diastolic blood pressure < 80 mm Hg);
  
  
• Normal blood glucose level (fasting blood glucose ≤ 100 mg/dL);
  
  
• Being physically active; and
  
  
• Avoiding use of and exposure to tobacco products.

The guidelines are aimed at balancing calorie intake and physical activity. The AHA diet recommendations are to:

• Eat a diet rich in fruit and vegetables;
  
  
• Choose whole-grain, high-fiber foods;
  
  
• Eat fish, especially oily fish, at least 2 times a week;
  
  
• Minimize intake of food and drinks with added sugar;
  
  
• Choose and prepare foods with little or no salt;
  
  
• Consume alcohol only in moderation; and
  
  
• Limit saturated fat intake to < 7% of energy, trans fat to < 1% of energy, and cholesterol to < 300 mg/day.

The goals for saturated fat and trans fat represent major changes in the dietary recommendations. To achieve these goals, the guidelines suggest reducing intake of animal fats by decreasing consumption of meat and dairy products and by cutting back on commercially baked and fried foods, such as crackers, french fries, cakes, pies, bread, and cookies.

As in the past, the recommendations also address special groups such as children > 2 years of age, older adults, individuals with metabolic syndrome or chronic kidney disease, and certain socioeconomic groups at high risk for cardiovascular disease. (Dietary guidelines specifically addressing the special needs of growing children have been published separately.^[2])

Environmental Issues

A section raising awareness about environmental influences on cardiovascular disease health behaviors is another new feature of the guidelines. Changes in environment are a major driving force behind the obesity epidemic, they acknowledge. Although no single factor is to blame, increased food portion sizes, high-calorie foods, and easy access to plentiful, inexpensive food are contributors to excess calorie intake, according to the guidelines. They also blame environmental factors that discourage physical activity. These include an environment that encourages driving rather than walking and in which a great deal of time is spent on sedentary activities such as watching television, using computers, and playing video games.

The guidelines authors call for "substantial changes to the environment" and target healthcare practitioners, restaurants, the food industry, schools, and local government, with specific recommendations about future policies that could be initiated by these groups. Examples include displaying caloric content prominently on menus, reducing portion size, limiting trans fatty acids, and using low-saturated-fatty-acid oils in food preparation.

Consistent with the strategic plan of the AHA, the 2006 AHA Diet and Lifestyle Recommendations are one component of a comprehensive plan to achieve specific goals for cardiovascular risk reduction, the authors emphasize. "The key message of the recommendations is to focus on long-term, permanent changes in how we eat and live. The best way to lower cardiovascular risk is to combine physical activity with heart-healthy eating habits, coupled with weight control and avoiding tobacco products," Dr. Lichtenstein said.

References

1. Lichtenstein AH, Appel LJ, Brands M, et al. Diet and Lifestyle Recommendations Revision 2006. A Scientific Statement From the American Heart Association Nutrition Committee. Circulation. 2006;114:82-96.
2. Gidding SS, Dennison BA, Birch LL, et al; American Heart Association; American Academy of Pediatrics. Dietary recommendations for children and adolescents: a guide for practitioners: consensus statement from the American Heart Association. Circulation. 2005;112:2061-2075.