Table 2.
Dietary Priorities for Cardiometabolic Health.*
| Goal* | One Serving Equals... | Examples | ||
|---|---|---|---|---|
| Consume More | Fruits | 3 servings per day | 1 medium-sized fruit; ½ cup of fresh, frozen, or unsweetened canned fruit; ½+ cup of dried fruit; ½ cup of 100% juice | Blueberries, strawberries, apple, orange, banana, grapes, grapefruit, avocado, mango. Whole fruits are preferable to 100% juice, which should be limited to no more than 1 serving/day. |
| Nuts, seeds | 4 servings per week | 1 ounce | Almonds, walnuts, peanuts, hazelnuts, cashews, pecans, Brazil nuts, sunflower seeds, sesame seeds. | |
| Vegetables, including legumes (excluding russet or white potatoes) | 3 servings per day | 1 cup of raw leafy vegetables; ½ cup of cut-up raw vegetables, cooked vegetables, or 100% vegetable juice | Spinach, kale, and other green leafy plants; broccoli, carrots, onions, peppers. Minimize starchy vegetables, especially russet or white potatoes. | |
| Whole grains† | 3 servings per day, in place of refined grains | 1 slice of whole-grain bread; 1 cup of high-fiber, whole-grain cereal; ½ cup of cooked whole-grain rice, pasta, or cereal | Oats, bulgur, whole-wheat couscous, barley, whole-grain breads and cereals, brown rice. | |
| Fish, shellfish | 2 or more servings per week | 3.5 ounces (100 g) | The best choices are oily fish such as salmon, tuna, mackerel, trout, herring, and sardines. | |
| Dairy products, especially yogurt and cheese ‡ | 2-3 servings per day | 1 cup of milk or yogurt; 1 ounce of cheese | Whole-fat or low-fat yogurt, cheese, milk. | |
| Vegetable oils | 2 to 6 servings per day | 1 teaspoon oil, 1 tablespoon vegetable spread | Best evidence for phenolic- and unsaturated-fat-rich oils such as soybean, canola, and extra-virgin olive oil; also consider safflower oil, peanut oil, and soft margarine spreads made with these oils. | |
| Consume Less | Refined grains, starches, added sugars† | No more than 1-2 servings per day | 1 slice of bread, ½ cup of rice or cereal, 1 sweet or dessert | White bread, white rice, most breakfast cereals, crackers, granola bars, sweets, bakery desserts, added sugars. |
| Processed meats | No more than 1 servings per week | 1.75 ounces (50 g) | Preserved (sodium, nitrates) meats such as bacon, sausage, hot dogs, pepperoni, salami, low-fat deli meats (e.g., chicken, turkey, ham, beef). | |
| Unprocessed red meats | No more than 2-3 servings per week | 3.5 ounces (100 g) | Fresh/frozen beef, pork, lamb. | |
| Industrial trans fat § | Don't eat | Any food containing or made with partially hydrogenated vegetable oil | Certain stick margarines, commercially prepared baked foods (cookies, pies, donuts, etc.), snack foods, deep-fried foods. | |
| Sugar-sweetened beverages | Don't drink | 8 ounces of beverage; 1 small sweet, pastry, or dessert | Sugar-sweetened soda, fruit drinks, sports drinks, energy drinks, iced teas. | |
| Sodium | No more than 2000 mg/d | n/a | Sodium is commonly high in foods as a preservative or to mask unpleasant flavors when previously cooked. Common sources include bread, chicken (often injected to increase succulence), cheese, processed meats, soups, canned foods. | |
Based on a 2000 kcal/day diet. Servings should be adjusted accordingly for higher or lower energy consumption.
As a practical rule-of-thumb for selecting healthful whole grains and avoiding carbohydrate-rich products high in starches and added sugars, the ratio of total carbohydrate to dietary fiber (g/serving of each) appears useful.168, 169 Foods with ratios <10:1 are preferable; i.e., food containing at least 1 g of fiber for every 10 g of total carbohydrate. In addition, minimally processed whole grains (e.g., steel-cut oats, stone ground bread) are generally preferable to finely milled whole grains (e.g., many commercial whole grain breads and breakfast cereals) due to larger glycemic responses of the latter.
Current evidence does not permit clear differentiation of whether low-fat or whole-fat products are superior for cardiometabolic health. Other characteristics, such as probiotic content or fermentation, may be far more relevant than fat content.
The US Food and Drug Administration recently ruled that use of partially hydrogenated vegetable oils is no longer “generally regarded as safe”,384 which should effectively eliminate the majority of industrial trans fats from the US food supply. Several countries including Denmark, Argentina, Austria, Iceland, and Switzerland have effectively eliminated use of partially hydrogenated vegetable oils through direct legislation on amounts of allowable trans fats in foods. Small amounts of certain trans fatty acids may be formed through other industrial processes, including oil deodorization and high temperature cooking; health effects of these trace industrial trans fats require careful investigation.