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The American Heart Association has updated its recommendations about heart-healthy eating. Sergio Marcos/Stocksy
  • Following its 2006 scientific statement, the American Heart Association (AHA) has updated its nutritional recommendations for 2021.
  • The wide-ranging recommendations aim to provide guidance regardless of what we eat or who we are.
  • The paper emphasizes the importance of healthy eating throughout one’s life.

The AHA’s “2021 Dietary Guidance to Improve Cardiovascular Health” has fresh recommendations informed by the latest research and designed to accommodate today’s diverse tastes and eating habits.

The new scientific statement focuses on the value of an overall heart-healthy diet throughout one’s lifetime, rather than thinking in terms of “good” or “bad” foods.

Cardiology dietitian and owner of Michelle Routhenstein explained to Medical News Today, “If someone hyper-focuses on everything they need to eliminate, they can become nutrient-deficient, which negatively impacts heart health.”

Dr. Alice H. Lichtenstein, chair of the group responsible for writing the document, explained the goals in an email to MNT:

“The purpose of the statement is to:

  • Emphasize the importance of dietary patterns beyond individual foods or nutrients.
  • Underscore the critical role of initiating heart-healthy dietary habits early in life.
  • Present common features of dietary patterns that promote cardiometabolic health.
  • Discuss additional benefits of heart-healthy dietary patterns beyond cardiovascular health.
  • Highlight structural challenges that impede the adoption of heart-healthy dietary patterns.”

The AHA’s new scientific statement is published in the journal Circulation.

Dr. Lichtenstein explains:

“We can all benefit from a heart-healthy dietary pattern, regardless of stage of life, and it is possible to design one that is consistent with personal preferences, lifestyles, and cultural customs. It does not need to be complicated, time-consuming, expensive, or unappealing.”

She adds, “You can absolutely adapt a heart-healthy diet to different lifestyles, including one that incorporates eating out at restaurants.”

The recommendations in the statement aim to help people achieve healthy dietary patterns:

“Food-based dietary pattern guidance is designed to achieve nutrient adequacy, support heart health and general well-being, and encompass personal preferences, ethnic and religious practices, and life stages.”

Routhenstein, who was not involved in developing the AHA statement, pointed out:

“These guidelines are general guidelines that can be preliminarily helpful in guiding [people] to heart health. However, they don’t necessarily address underlying issues and root causes that are essential components to heart disease risk reduction. For instance, someone with insulin resistance, excess inflammation and/or oxidative stress needs to address these issues for optimal risk reduction and will likely benefit from a more personalized approach to obtain results.”

Central to the AHA’s guidance are these requirements for a heart-healthy dietary pattern:

  1. Adjust energy intake and expenditure to achieve and maintain a healthy body weight.
  2. Eat plenty and a variety of fruits and vegetables.
  3. Choose whole grain foods and products.
  4. Choose healthy sources of protein: mostly plants, a regular intake of fish and seafood, and low-fat or fat-free dairy products. If meat or poultry is desired, choose lean cuts and unprocessed forms.
  5. Use liquid plant oils rather than tropical oils, such as coconut and palm, and partially hydrogenated fats.
  6. Choose minimally processed foods instead of ultra-processed foods.
  7. Minimize the intake of beverages and foods with added sugars.
  8. Choose and prepare foods with little or no salt.
  9. If you do not drink alcohol, do not start; if you choose to drink alcohol, limit the intake.
  10. Adhere to this guidance regardless of where food is prepared or consumed.

The AHA statement emphasizes the role of lifelong healthy eating in warding off potentially dangerous heart-related conditions, including high LDL cholesterol levels, hypertension, obesity, type 2 diabetes, and metabolic syndrome.

The authors write that from early childhood onward, there is “well-documented evidence that the prevention of pediatric obesity is key to preserving and prolonging ideal cardiovascular health.”

According to the Centers for Disease Control and Prevention (CDC), childhood obesity affected some 14.4 million children and adolescents in the United States in 2017–2018.

In addition, says Dr. Lichtenstein, “It is important to educate children at all ages so as they transition into adulthood, they will be able to make informed decisions about what they eat and serve as positive role models for generations to come.”

The AHA also recognizes that maintaining a healthy diet is particularly challenging for minoritized communities that are affected by structural racism.

According to the statement, many communities of underrepresented ethnicities and races lack access to healthy foods in local supermarkets. Such neighborhoods are served mostly by fast-food eateries and dollar store markets.

The authors write:

“Reaching population-level dietary goals will not occur without addressing structural factors responsible for neighborhood segregation, low educational attainment, and low income.”

For the first time, the AHA cites food-related sustainability and environmental issues:

“There are increasing concerns about the environmental impact of current dietary patterns and food systems that favor animal-based food production and consumption, which contribute substantially to human-generated, greenhouse gas emissions and water and land usage.”

“Commonly consumed animal products, particularly red meat, have the largest environmental impact,” says the AHA.

Concluding its scientific statement, the association looks ahead to the rapidly expanding study of precision nutrition, noting, however, that the field is still in its infancy.

For now, the authors write, “Creating an environment that facilitates, rather than impedes, adherence to heart-healthy dietary patterns among all individuals is a public health imperative.”