Healthful Diets Are Crucial, But Population-Level Follow-Through Remains a Challenge

The average American can likely recall that fruits and vegetables form the foundation of a healthy diet. Medical societies are in broad agreement as well: American Heart Association, the American College of Cardiology, the American Society for Preventive Cardiology, the Canadian Cardiovascular Society, and the European Society of Cardiology are all broadly aligned on this point. The challenge, said Robert Ostfeld, MD, ScM, is that these recommendations don’t trickle down well—at least not in the United States.

Ostfeld is the director of preventive cardiology at the Montefiore Health System and a professor of medicine at Albert Einstein College of Medicine in the Bronx, New York. He spoke with Drug Topics ahead of the American Society for Preventive Cardiology Congress on CVD Prevention, held August 2 through August 4 in Salt Lake City, Utah.

“There’s a huge gap between where we are and where we could be,” Ostfeld said. A 2021 study using the National Health and Nutrition Examination Survey database evaluated data from just over 11,000 individuals and found that only 0.7% of people in the US have an “ideal” dietary pattern, consuming at least 4 and a half servings of fruits and vegetables and 3 servings of whole grains per day, 2 servings of fatty fish each week, and low sugar, sweetened beverage, and salt consumption. Investigators went on to model what would happen if everyone adopted an ideal dietary pattern—incorporating 4 or 5 of those 5 elements—for just 1 year. “It was estimated that cardiovascular event rates would fall by about 42%,” Ostfeld said. “The gap matters.”

Other research has shown that a healthful dietary pattern—one that’s more plant-based and more closely aligned with American College of Cardiology and American Heart Association recommendations—can be helpful for managing conditions such as high blood pressure, high cholesterol, and diabetes. But, Ostfeld noted, “it’s not really that there’s 1 diet [for each of those conditions]. They’re broadly aligned that consuming more healthful, plant-based foods—fruits, vegetables, whole grains, beans, lentils—and less ultra-processed food and…red and processed meats is helpful” for both cardiovascular and cardiometabolic health.

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