Removing Roadblocks to Dietary Change for CVD Prevention

Debra L Beck

August 13, 2018

Governments, professional societies, and clinicians all need to do more to affect diet quality as a vital step in the primordial, primary, and secondary prevention of cardiovascular disease (CVD), a new review concludes.

The review, the first of a series of articles focusing on diet for cardiovascular disease prevention, is published online August 13 in the Journal of the American College of Cardiology (JACC).

Many biological, economical, physical, social, and psychological factors influence food choices, offering a rich variety of targets for intervention that might lead to meaningful improvements in long-term eating habits, senior author Frank B. Hu, MD, PhD, from the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, and colleagues write.

"In the present review, we first summarize the current state of knowledge regarding various food groups and nutrients," the authors write. "Subsequent sections explore factors driving individual food choice, where preventive action can be implemented, and what potential roadblocks may hinder progress."

Studies of human diet and health are logistically and methodologically complicated to conduct, but the research that has been done has consistently shown that a healthy diet — particularly one high in fruits, vegetables, whole grains, fish, nuts, and legumes and low in processed meats, refined grains, sodium, and sugary beverages — is associated with the prevention of heart disease, the authors point out.

However, many people face multiple hurdles in achieving an ideal diet that go beyond behavioral control to include myriad social and cultural influences, economic concerns, and time scarcity, they note.

"The assumption that most people would replace unhealthy dietary components in light of new research is overly optimistic," Hu and colleagues write.

Specifically, economic concerns, lack of nutritional knowledge, and a limited availability of healthy food can all contribute to a poor diet, especially in low-income and minority populations. Policies targeted toward low-income women and children and better meal offerings in school are among the solutions suggested.

On the manufacturing side, the addition of excessive amounts of sugar and sodium to processed food products to make them more palatable is another concern.

The researchers suggest that policy-level and preventive strategies are needed "across multiple societal levels" to make a meaningful impact on reducing food-related morbidity.

Their suggestions include nutrition labeling, educational campaigns to raise nutrition literacy, the taxing of sugar-sweetened beverages, and economic incentives designed to encourage good food manufacturing and consumption.

"A concerted effort from all levels of society will be needed to fundamentally change the current food environment and global food system," Hu and colleagues conclude.

JACC Pivots to Health Promotion

This paper is the first in an eight-part health promotion series in which each installment will focus on a different risk factor for cardiovascular disease. The goal of the series is to supplement the treatment-focused content in JACC with comprehensive and practical information on cardiovascular health promotion.

"Editors of medical journals have a responsibility to inform cardiovascular clinicians on the safest and most effective means of preventing disease as well as treating CVD," Valentin Fuster, MD, PhD, editor-in-chief of JACC, and colleagues write in an editorial announcing the series.

The eight topics chosen for the series are nutrition and diet, healthy weight, exercise and physical activity, tobacco-free lifestyle, blood pressure, cholesterol, blood sugar, and psychological health.

The reviews will address the detrimental pathophysiological effects of each behavior or risk factor; the personal and social mechanistic or triggering factors that lead to the risk behavior; and the role of preventive action through personal, educational, and communal efforts, along with possible societal or authoritative intervention.

The last part of each paper will "provide guidance for caregivers of health promotion, including competencies for training for health promotion, as well as variables that could affect standardizing health promotion care pathways," the editorial notes.

The research was supported by National Institutes of Health grants and an F31 grant awarded to Yu.  The authors have disclosed no relevant financial relationships.

J Am Coll Cardiol. 2018;72:914-26, 908-13. Abstract, Editorial

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