Newsfeed display by CaRP A healthy diet and lifestyle are key weapons in the fight to prevent cardiovascular disease-- the nation’s No. 1 killer--according to new American Heart Association diet and lifestyle recommendations published in Circulation: Journal of the American Heart Association.

Intended for healthy Americans age 2 and older, the recommendations, which replace guidelines issued in 2000, now recommend:
1. Further reducing saturated and trans fatty acids in the diet.
2. Minimizing the intake of food and beverages with added sugars.
3. Emphasizing physical activity and weight control.
4. Eating a diet rich in vegetables, fruits and whole-grain foods.
5. Avoiding use of and exposure to tobacco products.
6. Achieving and maintaining healthy cholesterol, blood pressure and blood glucose levels.

"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 Alice Lichtenstein, D.Sc., chair of the American Heart Association’s Nutrition Committee and Gershoff professor of nutrition science and policy at the Friedman School of Nutrition Science and Policy, at Tufts University in Boston.

"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," Lichtenstein said.

The association continues to emphasize achieving and maintaining a healthy body weight, but is putting more emphasis on balancing the number of calories consumed with the number of calories burned. More emphasis is put on food preparation methods that avoid adding saturated fat, sugar or salt and portion size control.

A panel of nutrition and cardiovascular disease experts for the new American Heart Association recommendations reviewed more than 90 scientific publications. Besides the goals and recommendations, the statement has new sections with practical information for consumers such as knowing your caloric needs, food preparation tips and some examples of dietary patterns consistent with the new recommendations.

As in the past, the recommendations also address special groups such as children, older adults, individuals with metabolic syndrome or chronic kidney disease and certain socioeconomic groups at high risk for cardiovascular disease (CVD).
Most importantly, these new recommendations address a key challenge faced by increasing numbers of Americans: maintaining a healthy dietary pattern while eating more foods prepared outside the home.

Environmental factors strongly influence how Americans eat and exercise. Accordingly, a new feature of the 2006 American Heart Association Diet and Lifestyle Recommendations is a list of ways that practitioners, restaurants, the food industry, schools and local governments can help the general public adopt these recommendations. 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.

Another major change in the dietary recommendations is a lower goal for saturated fat--from less than 10 percent to less than 7 percent--and establishing a goal for trans fatty acids of less than 1 percent of total calories.

"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. 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," Lichtenstein said.
Saturated fatty acids occur naturally in foods from animals, such as meat and dairy products, and tropical oils such as coconut and palm oil.
Trans-fatty acids--which are now required to be shown on the Nutrition Facts panel of packaged foods--are commonly found in commercially baked and fried foods, such as crackers, French fries, cakes, pies, bread and cookies.

"Almost anyone can make changes in how they eat and move their bodies to bring themselves closer to the recommended goals. 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," Lichtenstein said.
"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. The next step is to try to get at least 30 minutes of physical activity every day," Lichtenstein said. "It does not have to be done all at once--accumulating 30 minutes throughout the day is fine--and, of course, more is better. No one is too old or too out of shape to make small changes to increase physical activity."

The association urges industry to gradually reduce the salt and sugar content of processed foods and to increase the proportion of whole grains compared to white flour in baked goods, among other recommendations.

Recommendations-At-A-Glance.

Consume an overall healthy diet:

Balance calories consumed with calories burned to maintain a healthy body weight
1. Increase awareness of calorie content of foods for the portion sizes you normally eat.
2. Know how many calories you need a day.
3. Aim for at least 30 minutes of physical activity daily.

Consume a diet rich in fruits and vegetables:
1. Include a wide variety of fruits and vegetables in your diet daily.
2. Emphasize vegetables and fruits--not fruit juices--that are deeply colored (spinach, carrots, peaches and berries).
3. Prepare fruits and vegetables with little added saturated or trans fat, salt and sugar.

Choose whole-grain, high-fiber foods:
1. Consume 2 servings of fish, especially oily fish, at least twice a week.
2. Examples of fish relatively high in omega-3 fatty acids include salmon, trout and herring.
3. Children and pregnant women should follow FDA guidelines for avoiding mercury-contaminated fish. Fish with potential for the highest mercury contamination are shark, swordfish, king mackerel and tilefish.

Limit intake of saturated fat, trans fat and cholesterol:
1. Choose lean meats and vegetable alternatives.
2. Select fat-free (skim) and 1 percent fat dairy products.
3. Minimize intake of partially hydrogenated fats.

Minimize the intake of beverages and foods with added sugars:
1. Choose and prepare foods with little or no salt.
2. Consume no more than 2300 mg of sodium per day.
3. Middle-aged and older adults, African-Americans and those with high blood pressure should consume for no more than 1500 mg.

Consume alcohol in moderation:
1. Limit alcohol intake to one drink per day for women and two drinks per day for men.
2. One drink is equal to 12 ounces of beer, 4 ounces of wine, 1.5 ounces of 80-proof distilled spirits or 1 ounce of 100-proof spirits.

When eating out:
1. Be aware of portion size.
2. Select options that include vegetables and fruits.
3. Select foods prepared with little added saturated or trans fat, salt and sugar.
Dietary factors with unproven or uncertain effects on cardiovascular disease risk.

Antioxidant vitamin supplements:
1. Vitamin E and other antioxidant supplementation studies to lower coronary heart disease have not demonstrated a benefit.
2. Dietary antioxidant nutrients should be obtained from foods high in these compounds such as fruits, vegetables and vegetable oils.

Folate and B vitamin supplements:
1. Folate and B vitamin supplementation studies to lower coronary heart disease have not demonstrated a benefit.

Soy Protein:
1. Use soy protein to replace animal protein products high in saturated fatty acids.
2. Recent studies cannot confirm direct benefit of consuming soy on plasma cholesterol levels; however, there may be an indirect benefit if soy replaces foods high in saturated fats.

Other recommendations.

Fish and fish oil supplements:
1. Eat two servings of fish, preferably oily fish, twice a week.
2. Patients with documented coronary heart disease should consume 1 gram of EPA + DHA per day, preferably from oily fish.
3. EPA + DHA supplements could be considered in consultation with a physician.
4. For individuals with hypertriglyceridemia, 2-4 grams of EPA + DHA, provided under a physician’s care, are recommended.

Plant stanols/sterols:
1. These may be helpful for people with elevated low-density lipoprotein (LDL) cholesterol.
2. Maximal effects have been observed at intakes of 2 grams per day.
3. To sustain LDL reductions, individuals need to consume them daily.
4. Plant stanols/sterols are available in a wide variety of foods, drinks and soft gel capsules.