The following are key points for clinicians to remember regarding the trend in cardiovascular (CV) nutrition controversies:

1. Evidence supports the use of a diet rich in fruits, vegetables, whole grains, and legumes. Nuts in moderation have also been associated with a lower risk of cardiovascular disease. Some healthy dietary patterns also include moderate amounts of lean meats (including poultry and fish), low-fat dairy products, liquid vegetable oils, and alcoholic beverages. However, some foods remain controversial in terms of CV health or food-related harm.
2. Evidence for or against dairy products is limited by study design, potential biases from industry-sponsored trials, and the heterogeneity of the dairy products included in the studies. That being said, full-fat dairy products are a significant source of saturated fat and sodium in the American diet and therefore should be limited. Low-fat dairy products include essential vitamins and minerals as well as high-quality protein.
3. Evidence demonstrates the CV risk associated with added sugars, including atherogenesis. Clinicians should recommend eating a whole foods diet with a low intake of processed foods, careful selection of foods with little or no added sugars in any form, and the elimination of sugary drinks.
4. Limited evidence supports the elimination of energy drinks, due to current evidence of an increased risk of arrhythmias, coronary spasms, and potential death.
5. Legumes are a potential source of protein and fiber, accessible to most populations. Pulses are associated with a reduction in CV events and an improvement in blood glucose.
6. Current data suggest that coffee intake is correlated with a dose-dependent protective benefit including all-cause mortality and mortality from CV disease. It is recommended to avoid coffee drinks with a high content of added sugars.
7. Tea consumption is associated with arterial health and can reverse blood vessel dysfunction. As with coffee drinks, it is recommended to avoid added sugars and high-fat milk or cream. Alcohol consumption is observed to have vasodilatory, antiplatelet, and anti-inflammatory effects. These potential benefits must be balanced against the potential harm related to certain cancers, liver disease, and the risk of falls.
8. Mushroom consumption has been associated with better QOL outcomes, through anti-inflammatory and antioxidant effects. However, high-quality data is lacking. High-quality data on fermented foods and seaweeds are also lacking. That said, they do suggest potential benefits in reducing the risk of CV disease outcomes and dyslipidemia.
9. There are two distinct classes of omega-3 fatty acids (OM3): long-chain n-3 polyunsaturated fatty acids from marine sources and alpha-linolenic acid from plant sources. Both have CV benefits, with evidence favoring the daily incorporation of OM3 from plant or marine sources into a heart-healthy diet, as whole foods rather than supplement forms.
10. Multiple large-scale studies do not support the supplemental use of vitamin B12 to prevent CVD. Only among those who are deficient in vitamin B12, supplemental use is recommended since this is an essential nutrient.

Editor’s Note: Part I of the CV nutrition controversies was published last year (J Am Coll Cardiol 2017;69:1172-87).

Extracted from: A Clinician’s Guide for Trending Cardiovascular Nutrition Controversies: Part II. J Am Coll Cardiol 2018;72:553-568 ( http://www.onlinejacc.org/content/72/5/553?_ga=2.181300388.2060141420.1534262837-2129274551.1534262837 )

The following are key points for clinicians to remember regarding the trend in cardiovascular (CV) nutrition controversies:

1. Evidence supports the use of a diet rich in fruits, vegetables, whole grains, and legumes. Nuts in moderation have also been associated with a lower risk of cardiovascular disease. Some healthy dietary patterns also include moderate amounts of lean meats (including poultry and fish), low-fat dairy products, liquid vegetable oils, and alcoholic beverages. However, some foods remain controversial in terms of CV health or food-related harm.
2. Evidence for or against dairy products is limited by study design, potential biases from industry-sponsored trials, and the heterogeneity of the dairy products included in the studies. That being said, full-fat dairy products are a significant source of saturated fat and sodium in the American diet and therefore should be limited. Low-fat dairy products include essential vitamins and minerals as well as high-quality protein.
3. Evidence demonstrates the CV risk associated with added sugars, including atherogenesis. Clinicians should recommend eating a whole foods diet with a low intake of processed foods, careful selection of foods with little or no added sugars in any form, and the elimination of sugary drinks.
4. Limited evidence supports the elimination of energy drinks, due to current evidence of an increased risk of arrhythmias, coronary spasms, and potential death.
5. Legumes are a potential source of protein and fiber, accessible to most populations. Pulses are associated with a reduction in CV events and an improvement in blood glucose.
6. Current data suggest that coffee intake is correlated with a dose-dependent protective benefit including all-cause mortality and mortality from CV disease. It is recommended to avoid coffee drinks with a high content of added sugars.
7. Tea consumption is associated with arterial health and can reverse blood vessel dysfunction. As with coffee drinks, it is recommended to avoid added sugars and high-fat milk or cream. Alcohol consumption is observed to have vasodilatory, antiplatelet, and anti-inflammatory effects. These potential benefits must be balanced against the potential harm related to certain cancers, liver disease, and the risk of falls.
8. Mushroom consumption has been associated with better QOL outcomes, through anti-inflammatory and antioxidant effects. However, high-quality data is lacking. High-quality data on fermented foods and seaweeds are also lacking. That said, they do suggest potential benefits in reducing the risk of CV disease outcomes and dyslipidemia.
9. There are two distinct classes of omega-3 fatty acids (OM3): long-chain n-3 polyunsaturated fatty acids from marine sources and alpha-linolenic acid from plant sources. Both have CV benefits, with evidence favoring the daily incorporation of OM3 from plant or marine sources into a heart-healthy diet, as whole foods rather than supplement forms.
10. Multiple large-scale studies do not support the supplemental use of vitamin B12 to prevent CVD. Only among those who are deficient in vitamin B12, supplemental use is recommended since this is an essential nutrient.

Editor’s Note: Part I of the CV nutrition controversies was published last year (J Am Coll Cardiol 2017;69:1172-87).

Extracted from: A Clinician’s Guide for Trending Cardiovascular Nutrition Controversies: Part II. J Am Coll Cardiol 2018;72:553-568 ( http://www.onlinejacc.org/content/72/5/553?_ga=2.181300388.2060141420.1534262837-2129274551.1534262837 )

Diet

The role of diet is crucial in the development and prevention of cardiovascular diseases (CVD). Diet is a key modifiable risk factor for CVD.

Change in eating habits

The average weight of humans is increasing. In the second half of the 20th century there were major changes in daily diets, from plant-based diets to high-fat animal-based diets.

The obesity epidemic is spreading to low- and middle-income countries as a result of new eating habits and sedentary lifestyles, which fuel chronic disease and premature mortality.

Components of a healthy diet

A healthy diet should be low in saturated fat, salt, and carbohydrates, and high in fruits and vegetables. Also, eating whole grains, at least two servings of fish a week, and nuts can reduce the risk of cardiovascular disease.

The World Health Organization (WHO) recommends that individuals:

Limit fat intake and shift fat intake from saturated fat to unsaturated fat and toward eliminating trans fat.

Increase consumption of fruits and vegetables, and whole grains and nuts. Adults should consume at least 500g of fresh fruits and vegetables per day.
Limit intake of free sugars and intake of salt (sodium) from all sources. A recent guideline recommends eating less than 1,500 mg of sodium a day

Overweight and obesity

Overweight and obesity are classified according to the individual’s body mass index (BMI). The BMI is measured by dividing a person’s weight by their height squared in meters. In adults, overweight is defined as a BMI of 25.0 to 29.9 kg/m2; obesity is defined as a BMI of 30.0 kg/m2 or higher.

Impact of Obesity on Heart Health

Obesity is an independent risk factor for cardiovascular disease. An overweight person can develop hypertension, type 2 diabetes, and musculoskeletal disorders.

Increased body weight leads to an increased risk of developing type 2 diabetes and the incidence of hypertension increases. Statistics show that 58% of diabetes mellitus worldwide and 21% of chronic heart disease are attributable to a BMI greater than 21%.

Excess fat can also affect a person’s blood pressure and blood lipid levels, interfering with their ability to use insulin effectively.