Age Management Medicine News Letter - 07.20.06

The American Heart Association (AHA) revised dietary and lifestyle recommendations - a step in the right direction.

June 19, 2006 — The American Heart Association (AHA) revised their dietary and lifestyle recommendations aimed at preventing cardiovascular disease and published them in the June 19 Rapid Access issue of Circulation.

"The previous recommendations stressed a healthy dietary pattern; the new ones broaden that concept to include the importance of a healthy lifestyle pattern, lead author and chair of the AHA's Nutrition Committee Alice Lichtenstein, DSc, from Tufts University in Boston, Mass, said in a news release. "The two go together — they should be inseparable."

The revised guidelines update those issued in 2000, and they are directed at healthy Americans age 2 years and older. New recommendations are further reducing dietary saturated and trans fatty acids; minimizing consumption of food and beverages with added sugars; emphasizing physical activity and weight control; eating a diet rich in vegetables, fruits, and whole-grain foods; avoiding use of and exposure to tobacco products; and achieving and maintaining healthy cholesterol, blood pressure, and blood glucose levels.

"The key message of the recommendations is to focus on long-term, permanent changes in how we eat and live," Dr. Lichtenstein says. "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."

Although the AHA panel continues to emphasize achieving and maintaining a healthy body weight, there is now more emphasis on balancing the number of calories consumed with the number of calories burned. In addition, the revised guidelines emphasize food preparation methods that avoid adding saturated fat, sugar, or salt and portion size control.

Before revising the 2000 guidelines, the AHA panel of nutrition and cardiovascular disease experts reviewed more than 90 scientific publications. The revised statement contains goals, recommendations, and new sections with practical information for consumers, including caloric requirements, food preparation tips, and some examples of dietary patterns consistent with the new recommendations. The guidelines also highlight the needs of special groups, including children, older adults, individuals with metabolic syndrome or chronic kidney disease, and certain socioeconomic groups at high risk for cardiovascular disease.

The revised guidelines place a new emphasis on maintaining a healthy dietary pattern while eating outside the home. Because environmental factors strongly affect dietary and exercise patterns, the 2006 guidelines feature a list of suggestions for practitioners, restaurants, the food industry, schools, and local governments to help the general public adopt these recommendations. These include displaying caloric content prominently on menus, reducing portion size, limiting trans fatty acids, and using low-saturated fatty-acid oils in food preparation.

The updated dietary recommendations set a lower goal for saturated fat (less than 7% vs less than 10% in the 2000 guidelines) and a goal for trans fatty acids of less than 1% of total calories. Saturated fatty acids occur naturally in meat, dairy products, and tropical oils, including coconut and palm oil. Trans fatty acids, which are now required to be shown on the Nutrition Facts label of packaged foods, occur in commercially baked and fried foods, including crackers, French fries, cakes, pies, bread, and cookies. The AHA recommends that the food industry gradually reduce the salt and sugar content of processed foods and increase the proportion of whole grains vs white flour in baked goods.

"The point is not to calculate the amount of saturated and trans fatty acids in the diet, but to choose foods that minimize your intake," Dr. Lichtenstein says. "For example, you can choose leaner cuts of meat and lower-fat dairy products, smaller serving sizes, avoid foods made with hydrogenated fat and include more fruits, vegetables, vegetarian options and fish in the diet."

The 2006 recommendations are as follows:

  • Consume an overall healthy diet.
  • To maintain a healthy body weight, balance calories consumed with calories burned.
  • Increase awareness of calorie content of foods for portions typically consumed and of daily caloric requirements.
  • Set a goal of at least 30 minutes of physical activity daily.
  • Consume a diet rich in a wide variety of fruits and vegetables (not fruit juices), especially those that are deeply colored (spinach, carrots, peaches, and berries).
  • Prepare fruits and vegetables with little added saturated or trans fat, salt, and sugar.
  • Choose whole-grain, high-fiber foods.
  • Consume 2 servings of fish, especially those relatively high in omega-3 fatty-acids (eg, salmon, trout, and herring) at least twice weekly.
  • Children and pregnant women should follow Food and Drug Administration (FDA) guidelines for avoiding mercury-contaminated fish (eg, shark, swordfish, king mackerel, and tilefish).
  • Limit intake of saturated fat, trans fat, and cholesterol by choosing lean meats, vegetable alternatives, and fat-free (skim) and low-fat (1% fat) dairy products and minimize intake of partially hydrogenated fats.
  • Minimize intake of beverages and foods with added sugars.
  • To consume no more than 2300 mg of sodium daily, choose and prepare foods with little or no salt. Middle-aged and older adults, African Americans, and those with hypertension should consume no more than 1500 mg of sodium daily.
  • Limit alcohol intake to not more than 1 drink per day for women and 2 drinks per day for men (1 drink = 12 oz of beer, 4 oz of wine, 1.5 oz of 80-proof distilled spirits, or 1 oz of 100-proof spirits).
  • When eating out, be aware of portion size; select vegetables and fruits; and avoid foods prepared with added saturated or trans fat, salt, and sugar.

"A good first step to improve your diet and lifestyle — start paying attention to portion size and liquid calories, such as those in soft drinks, fruit drinks, fruit juices and alcoholic beverages," Dr. Lichtenstein says. "The next step is to try to get at least 30 minutes of physical activity every day. It does not have to be done all at once — accumulating 30 minutes throughout the day is fine — and, of course, more is better."

Dietary factors with unproven or uncertain effects on cardiovascular disease include the use of dietary supplements. Vitamin E and other antioxidant supplements have not been shown to lower the risk for coronary heart disease (CHD) nor have folate and B vitamin supplements. However, dietary antioxidant nutrients should be obtained from fruits, vegetables, and vegetable oils rich in antioxidants.

Soy protein should be used to replace animal protein products high in saturated fatty acids, but studies have not confirmed the direct benefit of consuming soy on plasma cholesterol levels.

Patients with documented CHD should consume 1 g of EPA plus DHA per day, preferably from oily fish. EPA plus DHA supplements could be considered if recommended by a clinician. Individuals with hypertriglyceridemia should consume 2 to 4 g of eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA) daily, under a clinician's supervision.

Daily consumption of plant stanols and sterols, which are available in a wide variety of foods, drinks and soft gel capsules, may be helpful for those with elevated low-density lipoprotein cholesterol. Maximal effects have been observed at intakes of 2 g/day.

"Almost anyone can make changes in how they eat and move their bodies to bring themselves closer to the recommended goals," Dr. Lichtenstein says. "The changes can be small but need to be maintained. In no way are we saying people will have to give up all the things they enjoy; they just may have to make a few modifications in their current habits."

Circulation. Posted online June 19, 2006

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