Summary of American Heart Association Diet and Lifestyle Recommendations Revision 2006
2006; Lippincott Williams & Wilkins; Volume: 26; Issue: 10 Linguagem: Inglês
10.1161/01.atv.0000238352.25222.5e
ISSN1524-4636
AutoresAlice H. Lichtenstein, Lawrence J. Appel, Michael W. Brands, Mercedes R. Carnethon, Stephen R. Daniels, Harold A. Franch, Barry A. Franklin, Penny M. Kris‐Etherton, William S. Harris, Barbara V. Howard, Njeri Karanja, Michael Lefevre, Lawrence L. Rudel, Frank M. Sacks, Linda Van Horn, Mary Winston, Judith Wylie‐Rosett,
Tópico(s)Folate and B Vitamins Research
ResumoHomeArteriosclerosis, Thrombosis, and Vascular BiologyVol. 26, No. 10Summary of American Heart Association Diet and Lifestyle Recommendations Revision 2006 Free AccessEditorialPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessEditorialPDF/EPUBSummary of American Heart Association Diet and Lifestyle Recommendations Revision 2006 Alice H. Lichtenstein, Lawrence J. Appel, Michael Brands, Mercedes Carnethon, Stephen Daniels, Harold A. Franch, Barry Franklin, Penny Kris-Etherton, William S. Harris, Barbara Howard, Njeri Karanja, Michael Lefevre, Lawrence Rudel, Frank Sacks, Linda Van Horn, Mary Winston and Judith Wylie-Rosett Alice H. LichtensteinAlice H. Lichtenstein From the Tufts University (A.H.L.), Boston, Mass; John Hopkins University (L.J.A.), Baltimore, Md; Medical College of Georgia (M.B.), August, Ga; Northwestern University (M.C., L.V.H.), Chicago, Ill; University of Colorado (S.D.), Boulder, Colo; Emory University (H.A.F.), Atlanta, Ga; Wayne State University (B.F.), Detroit, Mich; Pennsylvania State University (P.K.-E.), University Park, Penn; St. Luke's Hospital (W.S.H.), Kansas City, Mo; MedStar Research Institute (B.H.), Washington, DC; Center for Health Research (N.K.), Berkeley, Calif; Pennington Biomedical Research Center (M.L.), Baton Rouge, La; Wake Forest University School of Medicine (L.R.), Winston-Salem, NC; Harvard School of Public Medicine (F.S.), Boston, Mass; and Albert Einstein College of Medicine (J.W.-R.), New York, NY. M.W. is an AHA consultant. , Lawrence J. AppelLawrence J. Appel From the Tufts University (A.H.L.), Boston, Mass; John Hopkins University (L.J.A.), Baltimore, Md; Medical College of Georgia (M.B.), August, Ga; Northwestern University (M.C., L.V.H.), Chicago, Ill; University of Colorado (S.D.), Boulder, Colo; Emory University (H.A.F.), Atlanta, Ga; Wayne State University (B.F.), Detroit, Mich; Pennsylvania State University (P.K.-E.), University Park, Penn; St. Luke's Hospital (W.S.H.), Kansas City, Mo; MedStar Research Institute (B.H.), Washington, DC; Center for Health Research (N.K.), Berkeley, Calif; Pennington Biomedical Research Center (M.L.), Baton Rouge, La; Wake Forest University School of Medicine (L.R.), Winston-Salem, NC; Harvard School of Public Medicine (F.S.), Boston, Mass; and Albert Einstein College of Medicine (J.W.-R.), New York, NY. M.W. is an AHA consultant. , Michael BrandsMichael Brands From the Tufts University (A.H.L.), Boston, Mass; John Hopkins University (L.J.A.), Baltimore, Md; Medical College of Georgia (M.B.), August, Ga; Northwestern University (M.C., L.V.H.), Chicago, Ill; University of Colorado (S.D.), Boulder, Colo; Emory University (H.A.F.), Atlanta, Ga; Wayne State University (B.F.), Detroit, Mich; Pennsylvania State University (P.K.-E.), University Park, Penn; St. Luke's Hospital (W.S.H.), Kansas City, Mo; MedStar Research Institute (B.H.), Washington, DC; Center for Health Research (N.K.), Berkeley, Calif; Pennington Biomedical Research Center (M.L.), Baton Rouge, La; Wake Forest University School of Medicine (L.R.), Winston-Salem, NC; Harvard School of Public Medicine (F.S.), Boston, Mass; and Albert Einstein College of Medicine (J.W.-R.), New York, NY. M.W. is an AHA consultant. , Mercedes CarnethonMercedes Carnethon From the Tufts University (A.H.L.), Boston, Mass; John Hopkins University (L.J.A.), Baltimore, Md; Medical College of Georgia (M.B.), August, Ga; Northwestern University (M.C., L.V.H.), Chicago, Ill; University of Colorado (S.D.), Boulder, Colo; Emory University (H.A.F.), Atlanta, Ga; Wayne State University (B.F.), Detroit, Mich; Pennsylvania State University (P.K.-E.), University Park, Penn; St. Luke's Hospital (W.S.H.), Kansas City, Mo; MedStar Research Institute (B.H.), Washington, DC; Center for Health Research (N.K.), Berkeley, Calif; Pennington Biomedical Research Center (M.L.), Baton Rouge, La; Wake Forest University School of Medicine (L.R.), Winston-Salem, NC; Harvard School of Public Medicine (F.S.), Boston, Mass; and Albert Einstein College of Medicine (J.W.-R.), New York, NY. M.W. is an AHA consultant. , Stephen DanielsStephen Daniels From the Tufts University (A.H.L.), Boston, Mass; John Hopkins University (L.J.A.), Baltimore, Md; Medical College of Georgia (M.B.), August, Ga; Northwestern University (M.C., L.V.H.), Chicago, Ill; University of Colorado (S.D.), Boulder, Colo; Emory University (H.A.F.), Atlanta, Ga; Wayne State University (B.F.), Detroit, Mich; Pennsylvania State University (P.K.-E.), University Park, Penn; St. Luke's Hospital (W.S.H.), Kansas City, Mo; MedStar Research Institute (B.H.), Washington, DC; Center for Health Research (N.K.), Berkeley, Calif; Pennington Biomedical Research Center (M.L.), Baton Rouge, La; Wake Forest University School of Medicine (L.R.), Winston-Salem, NC; Harvard School of Public Medicine (F.S.), Boston, Mass; and Albert Einstein College of Medicine (J.W.-R.), New York, NY. M.W. is an AHA consultant. , Harold A. FranchHarold A. Franch From the Tufts University (A.H.L.), Boston, Mass; John Hopkins University (L.J.A.), Baltimore, Md; Medical College of Georgia (M.B.), August, Ga; Northwestern University (M.C., L.V.H.), Chicago, Ill; University of Colorado (S.D.), Boulder, Colo; Emory University (H.A.F.), Atlanta, Ga; Wayne State University (B.F.), Detroit, Mich; Pennsylvania State University (P.K.-E.), University Park, Penn; St. Luke's Hospital (W.S.H.), Kansas City, Mo; MedStar Research Institute (B.H.), Washington, DC; Center for Health Research (N.K.), Berkeley, Calif; Pennington Biomedical Research Center (M.L.), Baton Rouge, La; Wake Forest University School of Medicine (L.R.), Winston-Salem, NC; Harvard School of Public Medicine (F.S.), Boston, Mass; and Albert Einstein College of Medicine (J.W.-R.), New York, NY. M.W. is an AHA consultant. , Barry FranklinBarry Franklin From the Tufts University (A.H.L.), Boston, Mass; John Hopkins University (L.J.A.), Baltimore, Md; Medical College of Georgia (M.B.), August, Ga; Northwestern University (M.C., L.V.H.), Chicago, Ill; University of Colorado (S.D.), Boulder, Colo; Emory University (H.A.F.), Atlanta, Ga; Wayne State University (B.F.), Detroit, Mich; Pennsylvania State University (P.K.-E.), University Park, Penn; St. Luke's Hospital (W.S.H.), Kansas City, Mo; MedStar Research Institute (B.H.), Washington, DC; Center for Health Research (N.K.), Berkeley, Calif; Pennington Biomedical Research Center (M.L.), Baton Rouge, La; Wake Forest University School of Medicine (L.R.), Winston-Salem, NC; Harvard School of Public Medicine (F.S.), Boston, Mass; and Albert Einstein College of Medicine (J.W.-R.), New York, NY. M.W. is an AHA consultant. , Penny Kris-EthertonPenny Kris-Etherton From the Tufts University (A.H.L.), Boston, Mass; John Hopkins University (L.J.A.), Baltimore, Md; Medical College of Georgia (M.B.), August, Ga; Northwestern University (M.C., L.V.H.), Chicago, Ill; University of Colorado (S.D.), Boulder, Colo; Emory University (H.A.F.), Atlanta, Ga; Wayne State University (B.F.), Detroit, Mich; Pennsylvania State University (P.K.-E.), University Park, Penn; St. Luke's Hospital (W.S.H.), Kansas City, Mo; MedStar Research Institute (B.H.), Washington, DC; Center for Health Research (N.K.), Berkeley, Calif; Pennington Biomedical Research Center (M.L.), Baton Rouge, La; Wake Forest University School of Medicine (L.R.), Winston-Salem, NC; Harvard School of Public Medicine (F.S.), Boston, Mass; and Albert Einstein College of Medicine (J.W.-R.), New York, NY. M.W. is an AHA consultant. , William S. HarrisWilliam S. Harris From the Tufts University (A.H.L.), Boston, Mass; John Hopkins University (L.J.A.), Baltimore, Md; Medical College of Georgia (M.B.), August, Ga; Northwestern University (M.C., L.V.H.), Chicago, Ill; University of Colorado (S.D.), Boulder, Colo; Emory University (H.A.F.), Atlanta, Ga; Wayne State University (B.F.), Detroit, Mich; Pennsylvania State University (P.K.-E.), University Park, Penn; St. Luke's Hospital (W.S.H.), Kansas City, Mo; MedStar Research Institute (B.H.), Washington, DC; Center for Health Research (N.K.), Berkeley, Calif; Pennington Biomedical Research Center (M.L.), Baton Rouge, La; Wake Forest University School of Medicine (L.R.), Winston-Salem, NC; Harvard School of Public Medicine (F.S.), Boston, Mass; and Albert Einstein College of Medicine (J.W.-R.), New York, NY. M.W. is an AHA consultant. , Barbara HowardBarbara Howard From the Tufts University (A.H.L.), Boston, Mass; John Hopkins University (L.J.A.), Baltimore, Md; Medical College of Georgia (M.B.), August, Ga; Northwestern University (M.C., L.V.H.), Chicago, Ill; University of Colorado (S.D.), Boulder, Colo; Emory University (H.A.F.), Atlanta, Ga; Wayne State University (B.F.), Detroit, Mich; Pennsylvania State University (P.K.-E.), University Park, Penn; St. Luke's Hospital (W.S.H.), Kansas City, Mo; MedStar Research Institute (B.H.), Washington, DC; Center for Health Research (N.K.), Berkeley, Calif; Pennington Biomedical Research Center (M.L.), Baton Rouge, La; Wake Forest University School of Medicine (L.R.), Winston-Salem, NC; Harvard School of Public Medicine (F.S.), Boston, Mass; and Albert Einstein College of Medicine (J.W.-R.), New York, NY. M.W. is an AHA consultant. , Njeri KaranjaNjeri Karanja From the Tufts University (A.H.L.), Boston, Mass; John Hopkins University (L.J.A.), Baltimore, Md; Medical College of Georgia (M.B.), August, Ga; Northwestern University (M.C., L.V.H.), Chicago, Ill; University of Colorado (S.D.), Boulder, Colo; Emory University (H.A.F.), Atlanta, Ga; Wayne State University (B.F.), Detroit, Mich; Pennsylvania State University (P.K.-E.), University Park, Penn; St. Luke's Hospital (W.S.H.), Kansas City, Mo; MedStar Research Institute (B.H.), Washington, DC; Center for Health Research (N.K.), Berkeley, Calif; Pennington Biomedical Research Center (M.L.), Baton Rouge, La; Wake Forest University School of Medicine (L.R.), Winston-Salem, NC; Harvard School of Public Medicine (F.S.), Boston, Mass; and Albert Einstein College of Medicine (J.W.-R.), New York, NY. M.W. is an AHA consultant. , Michael LefevreMichael Lefevre From the Tufts University (A.H.L.), Boston, Mass; John Hopkins University (L.J.A.), Baltimore, Md; Medical College of Georgia (M.B.), August, Ga; Northwestern University (M.C., L.V.H.), Chicago, Ill; University of Colorado (S.D.), Boulder, Colo; Emory University (H.A.F.), Atlanta, Ga; Wayne State University (B.F.), Detroit, Mich; Pennsylvania State University (P.K.-E.), University Park, Penn; St. Luke's Hospital (W.S.H.), Kansas City, Mo; MedStar Research Institute (B.H.), Washington, DC; Center for Health Research (N.K.), Berkeley, Calif; Pennington Biomedical Research Center (M.L.), Baton Rouge, La; Wake Forest University School of Medicine (L.R.), Winston-Salem, NC; Harvard School of Public Medicine (F.S.), Boston, Mass; and Albert Einstein College of Medicine (J.W.-R.), New York, NY. M.W. is an AHA consultant. , Lawrence RudelLawrence Rudel From the Tufts University (A.H.L.), Boston, Mass; John Hopkins University (L.J.A.), Baltimore, Md; Medical College of Georgia (M.B.), August, Ga; Northwestern University (M.C., L.V.H.), Chicago, Ill; University of Colorado (S.D.), Boulder, Colo; Emory University (H.A.F.), Atlanta, Ga; Wayne State University (B.F.), Detroit, Mich; Pennsylvania State University (P.K.-E.), University Park, Penn; St. Luke's Hospital (W.S.H.), Kansas City, Mo; MedStar Research Institute (B.H.), Washington, DC; Center for Health Research (N.K.), Berkeley, Calif; Pennington Biomedical Research Center (M.L.), Baton Rouge, La; Wake Forest University School of Medicine (L.R.), Winston-Salem, NC; Harvard School of Public Medicine (F.S.), Boston, Mass; and Albert Einstein College of Medicine (J.W.-R.), New York, NY. M.W. is an AHA consultant. , Frank SacksFrank Sacks From the Tufts University (A.H.L.), Boston, Mass; John Hopkins University (L.J.A.), Baltimore, Md; Medical College of Georgia (M.B.), August, Ga; Northwestern University (M.C., L.V.H.), Chicago, Ill; University of Colorado (S.D.), Boulder, Colo; Emory University (H.A.F.), Atlanta, Ga; Wayne State University (B.F.), Detroit, Mich; Pennsylvania State University (P.K.-E.), University Park, Penn; St. Luke's Hospital (W.S.H.), Kansas City, Mo; MedStar Research Institute (B.H.), Washington, DC; Center for Health Research (N.K.), Berkeley, Calif; Pennington Biomedical Research Center (M.L.), Baton Rouge, La; Wake Forest University School of Medicine (L.R.), Winston-Salem, NC; Harvard School of Public Medicine (F.S.), Boston, Mass; and Albert Einstein College of Medicine (J.W.-R.), New York, NY. M.W. is an AHA consultant. , Linda Van HornLinda Van Horn From the Tufts University (A.H.L.), Boston, Mass; John Hopkins University (L.J.A.), Baltimore, Md; Medical College of Georgia (M.B.), August, Ga; Northwestern University (M.C., L.V.H.), Chicago, Ill; University of Colorado (S.D.), Boulder, Colo; Emory University (H.A.F.), Atlanta, Ga; Wayne State University (B.F.), Detroit, Mich; Pennsylvania State University (P.K.-E.), University Park, Penn; St. Luke's Hospital (W.S.H.), Kansas City, Mo; MedStar Research Institute (B.H.), Washington, DC; Center for Health Research (N.K.), Berkeley, Calif; Pennington Biomedical Research Center (M.L.), Baton Rouge, La; Wake Forest University School of Medicine (L.R.), Winston-Salem, NC; Harvard School of Public Medicine (F.S.), Boston, Mass; and Albert Einstein College of Medicine (J.W.-R.), New York, NY. M.W. is an AHA consultant. , Mary WinstonMary Winston From the Tufts University (A.H.L.), Boston, Mass; John Hopkins University (L.J.A.), Baltimore, Md; Medical College of Georgia (M.B.), August, Ga; Northwestern University (M.C., L.V.H.), Chicago, Ill; University of Colorado (S.D.), Boulder, Colo; Emory University (H.A.F.), Atlanta, Ga; Wayne State University (B.F.), Detroit, Mich; Pennsylvania State University (P.K.-E.), University Park, Penn; St. Luke's Hospital (W.S.H.), Kansas City, Mo; MedStar Research Institute (B.H.), Washington, DC; Center for Health Research (N.K.), Berkeley, Calif; Pennington Biomedical Research Center (M.L.), Baton Rouge, La; Wake Forest University School of Medicine (L.R.), Winston-Salem, NC; Harvard School of Public Medicine (F.S.), Boston, Mass; and Albert Einstein College of Medicine (J.W.-R.), New York, NY. M.W. is an AHA consultant. and Judith Wylie-RosettJudith Wylie-Rosett From the Tufts University (A.H.L.), Boston, Mass; John Hopkins University (L.J.A.), Baltimore, Md; Medical College of Georgia (M.B.), August, Ga; Northwestern University (M.C., L.V.H.), Chicago, Ill; University of Colorado (S.D.), Boulder, Colo; Emory University (H.A.F.), Atlanta, Ga; Wayne State University (B.F.), Detroit, Mich; Pennsylvania State University (P.K.-E.), University Park, Penn; St. Luke's Hospital (W.S.H.), Kansas City, Mo; MedStar Research Institute (B.H.), Washington, DC; Center for Health Research (N.K.), Berkeley, Calif; Pennington Biomedical Research Center (M.L.), Baton Rouge, La; Wake Forest University School of Medicine (L.R.), Winston-Salem, NC; Harvard School of Public Medicine (F.S.), Boston, Mass; and Albert Einstein College of Medicine (J.W.-R.), New York, NY. M.W. is an AHA consultant. Originally published1 Oct 2006https://doi.org/10.1161/01.ATV.0000238352.25222.5eArteriosclerosis, Thrombosis, and Vascular Biology. 2006;26:2186–2191This article summarizes the recent American Heart Association (AHA) Science Statement, Diet and Lifestyle Recommendations, published in Circulation in the July 4, 2006 issue.1 Improving diet and lifestyle recommendations is a critical component of the AHA's strategy for cardiovascular disease risk reduction in the general population. Specific goals are to consume an overall healthy diet; aim for a healthy body weight; aim for recommended levels of low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides; aim for normal blood pressure; aim for a normal blood glucose level; be physically active; and avoid use of and exposure to tobacco products. The recommendations are to balance caloric intake and physical activity to achieve and maintain a healthy body weight; consume a diet rich in vegetables and fruits; choose whole-grain, high-fiber foods; consume fish, especially oily fish, at least twice a week; limit intake of saturated fat to <7% of energy, trans fat to <1% of energy, and cholesterol to <300 mg/d by choosing lean meats and vegetable alternatives, fat-free (skim) or low-fat (1% fat) dairy products and minimize intake of partially hydrogenated fats; minimize intake of beverages and foods with added sugars; choose and prepare foods with little or no salt; if you consume alcohol, do so in moderation; and when you eat food prepared outside of the home, follow these Diet and Lifestyle Recommendations. By adhering to these diet and lifestyle recommendations, the risk of developing cardiovascular disease can be substantially reduced, which remains the leading cause of morbidity and mortality in the United States.Improving diet and lifestyle is a critical component of the AHA strategy to prevent cardiovascular disease (CVD). The 2006 AHA Diet and Lifestyle Recommendations1 were designed to meet this objective and are one component of a comprehensive plan for cardiovascular risk reduction. The recommendations are appropriate for the general public, including adults and children over 2 years of age. Separate AHA dietary recommendations specifically addressing the special needs of growing children have recently been published.2Public Health and Clinical Application of AHA Diet and Lifestyle RecommendationsPublic Health RecommendationsMaintaining a healthy diet and lifestyle offers the greatest potential of all known approaches to reduce CVD risk in the general public. This is still true in spite of major advances in clinical medicine. The recommendations contained in the document provide a foundation for a public health approach to CVD risk reduction through healthy eating habits and other lifestyle factors.Clinical RecommendationsThe recommendations can be applied to the clinical management of patients with or at risk for CVD. For certain patients at higher risk, the recommendations may have to be intensified. Although great advances have been made in prevention and treatment of CVD through drug therapies and procedures, diet and lifestyle therapies remain the foundation of clinical intervention for prevention. Unfortunately, the latter are commonly neglected, to the detriment of patients.GoalsThe AHA Diet and Lifestyle Goals are intended to reduce CVD risk (Table 1). They provide guidance for adults and children over the age of 2 years. TABLE 1. AHA 2006 Diet and Lifestyle Goals for Cardiovascular Disease Risk ReductionConsume an overall healthy diet.Aim for a healthy body weight.Aim for recommended levels of low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides.Aim for a normal blood pressure.Aim for a normal blood glucose level.Be physically active.Avoid use of and exposure to tobacco products.Consume an Overall Healthy DietHealthy dietary patterns are associated with a substantially reduced risk of CVD, CVD risk factors, and noncardiovascular diseases.3–6 An emphasis on the whole diet is appropriate to ensure nutrient adequacy and energy balance.7 The AHA recommends that individuals consume a variety of fruits, vegetables, and grain products, especially whole grains; choose fat-free and low-fat dairy products, legumes, poultry, and lean meats; and eat fish, preferably oily fish, at least twice a week.Aim for a Healthy Body WeightObesity is an independent risk factor for CVD.8 Excess body weight adversely affects CVD risk factors (eg, increasing low-density lipoprotein [LDL] cholesterol levels, triglyceride levels, blood pressure [BP], and blood glucose levels, and reducing high-density lipoprotein [HDL] cholesterol levels) and increases the risk of developing coronary heart disease (CHD), heart failure, stroke, and cardiac arrhythmias. It is important to intensify efforts in the general population to help individuals avoid inappropriate weight gain during childhood and subsequent weight gain during adult years.Aim for a Desirable Lipid ProfileLDL is the major cholesterol-carrying lipoprotein particle in plasma. Its concentrations are most closely associated with risk of developing CVD.9 The strongest dietary determinants of elevated LDL cholesterol concentrations are dietary saturated fatty acid and trans fatty acid intakes.9 To a lesser extent, dietary cholesterol and excess body weight are positively related to levels of LDL cholesterol.9 The concentration of HDL cholesterol is inversely associated with CVD risk.9 This association is thought to be mediated by a constellation of events collectively referred to as reverse cholesterol transport. Determinants of high triglycerides are mainly the same as those of low HDL cholesterol.10 The major dietary factors adversely affecting HDL cholesterol levels include very low-fat diets (<15% energy as fat) and excess body weight.10Aim for a Normal Blood PressureA normal BP is a systolic BP <120 mm Hg and a diastolic BP <80 mm Hg. BP is a strong, consistent, continuous, independent, and etiologically relevant risk factor for cardiovascular-renal disease. Dietary factors known to lower BP are reduced salt intake, caloric deficit to induce weight loss, moderation of excess alcohol consumption, increased potassium intake, and consumption of an overall healthy diet consistent with the recommendations in this document.4Aim for a Normal Blood Glucose LevelA normal fasting glucose level is ≤100 mg/dL, whereas diabetes is defined by a fasting glucose level ≥126 mg/dL. Hyperglycemia and the often-associated insulin resistance are related to numerous cardiovascular complications, including CHD, stroke, peripheral vascular disease, cardiomyopathy, and heart failure. Reducing caloric intake and increasing physical activity to achieve even a modest weight loss can delay the onset of insulin resistance and improve glucose control once it is established.11,12Be Physically ActiveRegular physical activity is essential for maintaining physical and cardiovascular fitness, maintaining healthy weight, and sustaining weight loss once achieved.13 Physical activity improves cardiovascular risk factors and lowers the risk of developing other chronic diseases.14Avoid Use of and Exposure to Tobacco ProductsOn the basis of the overwhelming evidence for the adverse effects of tobacco products and secondary exposure to tobacco smoke on CVD, as well as cancer and other serious illness, the AHA strongly and unequivocally endorses efforts to eliminate the use of tobacco products and minimize exposure to second-hand smoke.15–17 Concern about weight gain should not be a reason for continued use of tobacco products.18AHA Diet and Lifestyle RecommendationsThese recommendations are intentionally presented in a manner that allows maximal flexibility in their implementation (Table 2).1 They are not presented as a "diet plan," per se, but rather a lifestyle prescription to promote cardiovascular health. Practical approaches for implementing these recommendations are presented in Table 3. TABLE 2. AHA 2006 Diet and Lifestyle Recommendations for Cardiovascular Disease Risk ReductionBalance calorie intake and physical activity to achieve or maintain a healthy body weight.Consume a diet rich in vegetables and fruits.Choose whole-grain, high-fiber foods.Consume fish, especially oily fish, at least twice a week.Limit your intake of saturated fat to <7% of energy, trans fat to <1% of energy, and cholesterol to <300 mg per day by: choosing lean meats and vegetable alternatives; selecting fat-free (skim), 1%-fat, and low-fat dairy products; and minimizing intake of partially hydrogenated fats.Minimize your intake of beverages and foods with added sugars.Choose and prepare foods with little or no salt.If you consume alcohol, do so in moderation.When you eat food that is prepared outside of the home, follow the AHA Diet and Lifestyle Recommendations.TABLE 3. Practical Tips to Implement AHA 2006 Diet and Lifestyle RecommendationsLifestyle• Know your caloric needs to achieve and maintain a healthy weight.• Know the calorie content of the foods and beverages you consume.• Track your weight, physical activity, and calorie intake.• Prepare and eat smaller portions.• Track and, when possible, decrease screen time (eg, watching television, surfing the Web, playing computer games).• Incorporate physical movement into habitual activities.• Do not smoke or use tobacco products.• If you consume alcohol, do so in moderation (equivalent of no more than 1 drink in women or 2 drinks in men per day).Food choices and preparation• Use the nutrition facts panel and ingredients list when choosing foods to buy.• Eat fresh, frozen, and canned vegetables and fruits without high-calorie sauces and added salt and sugars.• Replace high-calorie foods with fruits and vegetables.• Increase fiber intake by eating beans (legumes), whole-grain products, fruits, and vegetables.• Use liquid vegetable oils in place of solid fats.• Limit beverages and foods high in added sugars. Common forms of added sugars are sucrose, glucose, fructose, maltose, dextrose, corn syrups, concentrated fruit juice, and honey.• Choose foods made with whole grains. Common forms of whole grains are whole wheat, oats/oatmeal, rye, barley, corn, popcorn, brown rice, wild rice, buckwheat, triticale, bulgur (cracked wheat), millet, quinoa, and sorghum.• Cut back on pastries and high-calorie bakery products (eg, muffins, doughnuts).• Select milk and dairy products that are either fat free or low fat.• Reduce salt intake by: comparing the sodium content of similar products (eg, different brands of tomato sauce) and choosing products with less salt; choosing versions of processed foods, including cereals and baked goods, that are reduced in salt; and limiting condiments (eg, soy sauce, ketchup).• Use lean cuts of meat and remove skin from poultry before eating.• Limit processed meats that are high in saturated fat and sodium.• Grill, bake, or broil fish, meat, and poultry.• Incorporate vegetable-based meat substitutes into favorite recipes.• Encourage the consumption of whole vegetables and fruits in place of juices.Balance Calorie Intake and Physical Activity to Achieve or Maintain a Healthy Body WeightTo avoid weight gain after childhood, individuals must control calorie intake so that energy balance is achieved—that is, energy intake matches energy expenditure. To control calorie intake, individuals should increase their awareness of the calorie content of foods and beverages per portion consumed.19 Regular daily physical activity has been shown to be particularly effective in maintaining weight loss once achieved.20 The AHA recommends that all adults accumulate ≥30 minutes of physical activity most days of the week.Consume a Diet Rich in Vegetables and FruitsIn longitudinal observation studies, persons who regularly consume rich in vegetable and fruit diets are at a lower risk of developing cardiovascular disease, particularly stroke.21,22 Most vegetables and fruits are rich in nutrients, low in calories, and high in fiber. Vegetables and fruits that are deeply colored throughout (eg, spinach, carrots, peaches, berries) should be emphasized. Techniques that preserve nutrient and fiber content without adding unnecessary calories, saturated or trans fat, sugar, and salt are recommended (Table 3). Fruit juice is not equivalent to the whole fruit in fiber content and perhaps satiety value and should not be emphasized.Choose Whole-Grain, High-Fiber FoodsDietary patterns that are high in whole-grain products and fiber have been associated with increased diet quality.23 Fiber modestly reduces LDL cholesterol levels, has been associated with decreased CVD risk and slower progression of CVD, and may promote satiety.24–27 The AHA recommends that at least half of grain intake come from whole grains.Consume Fish, Especially Oily Fish, at Least Twice a WeekFish, especially oily fish, is rich in very long-chain omega-3 polyunsaturated fatty acids: eicosapentaenoic acid, C20:5n-3 (EPA) and docosahexaenoic acid, C22:6n-3 (DHA). The consumption of 2 servings (≈8 ounces) per week of fish is associated with a reduced risk of both sudden death and death from coronary artery disease in adults.28,29 Methods used to prepare fish should minimize the addition of saturated and trans fatty acids, as occurs with the use of cream sauces or hydrogenated fat during frying.Limit Your Intake of Saturated and Trans Fat and CholesterolAs a set of goals, the AHA recommends intakes of <7% of energy as saturated fat, <1% of energy as trans fat, and <300 mg cholesterol per day. These goals can be achieved by choosing lean meats and vegetable alternatives; selecting fat-free (skim), and low-fat (1%-fat), dairy products; and minimizing intake of partially hydrogenated fats. The AHA supports the recommendations of the Institute of Medicine and the National Cholesterol Education Program of 25% to 35% of total energy as fat.30,31Minimize Your Intake of Beverages and Foods With Added SugarsOver the past few decades, the consumption of beverages and foods with added sugars has risen markedly.32,33 The primary reasons for reducing the intake of beverages and foods with added sugars are to lower total calorie intake and promote nutrient adequacy.34 Some evidence suggests that calories consumed as liquid are not as satiating as calories consumed as solid food.35Choose and Prepare Foods With Little or No SaltA reduced sodium intake can prevent hypertension in nonhyperte
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