In the JournalsPerspective

New lifestyle guideline emphasizes heart-healthy diet, physical activity

A new clinical practice guideline on lifestyle modification outlines an optimal heart-healthy diet and makes recommendations for physical activity.

The 2013 Guideline on the Assessment of Cardiovascular Risk, issued by the American College of Cardiology and the American Heart Association, stresses that lifestyle modification be part of a CVD prevention strategy for all people, even those taking medications to manage BP and cholesterol.

The guideline writing group examined evidence that “dietary patterns, nutrient intake and levels and types of physical activity can play a major role in CVD prevention and treatment through effects on modifiable CVD risk factors, specifically related to lipids and BP,” Robert Eckel, MD, co-chair of the writing committee, said at a press conference. “The concept here is that diet and physical activity are both important in CVD risk reduction.”

Heart-healthy diet recommendations

The work group’s outline for a heart-healthy eating pattern based on a 2,000 calorie per day diet is as follows:

  • Four or five servings of fruits per day.
  • Four or five servings of vegetables per day.
  • Six to eight servings of whole grains, preferably high fiber, per day.
  • Two or three servings of fat-free or low-fat milk and milk products per day.
  • Six or fewer ounces of lean meats, poultry and fish per day.
  • Four or five servings of nuts, legumes and seeds per week.
  • Two or three servings of healthy oils per day, with limitations on trans fat and saturated fat.
  • Limitations on sweets and added sugars.

“These guidelines are increasingly emphasizing the importance of dietary patterns,” Eckel said. “We’re talking about diets that are enriched in fruits and vegetables, whole grains, fish and lean poultry, and limited in saturated fat intake and trans fat intake. In addition, [we recommend] diets that have nuts and are otherwise consistent with that of the Mediterranean diet or the DASH [Dietary Approaches to Stop Hypertension] dietary pattern. These were the two diets that got the most attention, because they were most represented in the more recent literature which we surveyed.”

“There is strong evidence to support that reductions in saturated fats lower LDL,” Eckel said, noting that reducing intake of trans fats and sodium is also important. The guideline recommends sodium intake of no more than 2,400 mg/day, with a preference for 1,500 mg/day. The current average in US adults is 3,600 mg/day.

Physical activity recommendations

The guideline’s recommendations for physical activity are largely based on a 2008 report from the Department of Health and Human Services indicating that 30 to 40 minutes of moderate to vigorous physical activity at least three or four days per week is beneficial for reducing LDL, non-HDL and BP, Eckel said.

The guideline does not address weight loss issues, which are covered in a separate guideline.

For more information:

Eckel R. Circulation. 2013;doi:10.1161/01.cir.0000437740.48606.d1.

Eckel R. J Am Coll Cardiol. 2013;doi:10.1016/j.jacc.2013.11.003.

Disclosure: See the full guideline for a list of the work group members’ relevant financial disclosures.

A new clinical practice guideline on lifestyle modification outlines an optimal heart-healthy diet and makes recommendations for physical activity.

The 2013 Guideline on the Assessment of Cardiovascular Risk, issued by the American College of Cardiology and the American Heart Association, stresses that lifestyle modification be part of a CVD prevention strategy for all people, even those taking medications to manage BP and cholesterol.

The guideline writing group examined evidence that “dietary patterns, nutrient intake and levels and types of physical activity can play a major role in CVD prevention and treatment through effects on modifiable CVD risk factors, specifically related to lipids and BP,” Robert Eckel, MD, co-chair of the writing committee, said at a press conference. “The concept here is that diet and physical activity are both important in CVD risk reduction.”

Heart-healthy diet recommendations

The work group’s outline for a heart-healthy eating pattern based on a 2,000 calorie per day diet is as follows:

  • Four or five servings of fruits per day.
  • Four or five servings of vegetables per day.
  • Six to eight servings of whole grains, preferably high fiber, per day.
  • Two or three servings of fat-free or low-fat milk and milk products per day.
  • Six or fewer ounces of lean meats, poultry and fish per day.
  • Four or five servings of nuts, legumes and seeds per week.
  • Two or three servings of healthy oils per day, with limitations on trans fat and saturated fat.
  • Limitations on sweets and added sugars.

“These guidelines are increasingly emphasizing the importance of dietary patterns,” Eckel said. “We’re talking about diets that are enriched in fruits and vegetables, whole grains, fish and lean poultry, and limited in saturated fat intake and trans fat intake. In addition, [we recommend] diets that have nuts and are otherwise consistent with that of the Mediterranean diet or the DASH [Dietary Approaches to Stop Hypertension] dietary pattern. These were the two diets that got the most attention, because they were most represented in the more recent literature which we surveyed.”

“There is strong evidence to support that reductions in saturated fats lower LDL,” Eckel said, noting that reducing intake of trans fats and sodium is also important. The guideline recommends sodium intake of no more than 2,400 mg/day, with a preference for 1,500 mg/day. The current average in US adults is 3,600 mg/day.

Physical activity recommendations

The guideline’s recommendations for physical activity are largely based on a 2008 report from the Department of Health and Human Services indicating that 30 to 40 minutes of moderate to vigorous physical activity at least three or four days per week is beneficial for reducing LDL, non-HDL and BP, Eckel said.

The guideline does not address weight loss issues, which are covered in a separate guideline.

For more information:

Eckel R. Circulation. 2013;doi:10.1161/01.cir.0000437740.48606.d1.

Eckel R. J Am Coll Cardiol. 2013;doi:10.1016/j.jacc.2013.11.003.

Disclosure: See the full guideline for a list of the work group members’ relevant financial disclosures.

    Perspective
    Nanette K. Wenger

    Nanette K. Wenger

    We must emphasize that these guidelines are based on data through October 2011, when the NHLBI closed its literature database. Two years of data are not incorporated. This means that the guidelines will require a rapid update. That may change some recommendations because of new information from recent years. I commend the authors for noting that, with a few exceptions, these are data though October 2011 and updates will be needed rapidly.

    In terms of lifestyle recommendations, what would be most appealing if I were a patient or a primary care physician is that the basic diet for LDL lowering and BP lowering is the same, just with the addition of sodium restriction for BP lowering.

    Also, the basic exercise recommendations are comparable, both for BP lowering and for LDL lowering. That makes it simple. There’s also a nice explanation why these differ a bit from the US general recommendations for physical activity. There is little difference between 30 minutes five times a week or 40 minutes three or four times a week. The important aspects are exercise intensity and exercise duration. I would hope some professional organization will translate this into steps. Patients are accustomed to the 10,000 steps daily and most patients use a pedometer.  Multiple organizations have signed off on the guidelines and the organizations with the particular skills now have the challenge to translate information for patients.

    • Nanette K. Wenger, MD
    • Cardiology Today Editorial Board member

    Disclosures: Wenger reports financial ties with Arbor Pharmaceuticals.