Table 1.
Food-Based Components of Dietary Patterns That Improve Cardiometabolic Health*
| Goal† | Serving Sizes | Nutrient Benefits | |
|---|---|---|---|
| Consume more: | |||
| Fruits | 4 to 5 servings per day | 1 medium-sized fruit;½ cup of fresh, frozen, or unsweetened canned fruit; ¼ cup of dried fruit; ½ cup of 100% juice. Many guidelines recommended no more than 4 oz of juice per day for children. | Whole fruits maximize access to vitamins, minerals, fiber, and phytochemicals and enhance satiety. Five servings of fruit contribute ~400–600 kcal. |
| Vegetables | 4 to 5 servings per day | 1 cup of raw leafy vegetable; ½ cup of cut-up raw vegetables, cooked vegetables, or 100% juice. Limit starchy vegetables such as potatoes to ½ cup or less per day. | Raw, cooked, and minimally processed nonstarchy vegetables contribute potassium, magnesium, fiber, antioxidant vitamins, and other micronutrients. Five servings of vegetables (including 1 starchy) contribute ~300–500 kcal. |
| 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. | Whole grains contribute B vitamins, vitamin E, fiber, folate, and other nutrients; enhance satiety; and displace consumption of refined carbohydrates. Three servings of whole grains contribute ~210–450 kcal. |
| Fish and shellfish | 2+ servings per week, preferably oily (see text) | 100 g (3.5 oz). Goals should not be met with commercially prepared deep fried or breaded fish. | Provide omega-3 fatty acids, proteins, selenium, magnesium, vitamin D, and other nutrients. One serving contributes ~75–150 kcal. |
| Nuts | 4 to 5 servings per week | 50 g (1.75 oz). Unsalted nuts are preferable to minimize sodium intake. | Provide fatty acids, vegetable protein, phosphorus, magnesium, and phytochemicals. One serving contributes ~160 kcal. |
| Dairy products | 2 to 3 servings per day | 1 cup of milk or yogurt; 1 oz of cheese. Most dietary guidelines recommend low-fat or nonfat dairy products. | Provide calcium, vitamin D, fatty acids, magnesium, and protein. Two servings contribute ~180–300 kcal. |
| Vegetable oils | 2 to 6 servings per day | 1 teaspoon oil, eg, in cooking or salad dressing; 1 tablespoon vegetable spread. Goals should not be met with coconut, palm kernel, or other tropical oils low in unsaturated fats. | Contribute polyunsaturated and monounsaturated fatty acids and other active compounds. Flaxseed, canola, and soybean oil provide alpha-linolenic acid, the plant-derived omega-3. One teaspoon of oil provides ~40 kcal; 1 tablespoon of spread provides ~70 kcal. |
| Consume less: | |||
| Fats, oils, or foods containing or made with partially hydrogenated vegetable oils | Avoid intake | Reduced consumption of industrially produced trans fatty acids. | |
| Processed meats (eg, bacon, sausage, hot dogs, processed deli meats) | Modest intake, eg, up to 2 servings per week | 50 g (1.75 oz) | Reduced consumption of salt, other preservatives, heme iron, saturated fat, and dietary cholesterol. |
| Sugar-sweetened beverages, sweets, and grain-based desserts and bakery foods | Modest intake, eg, up to 5 servings per week | 8 oz of soda; 1 small candy, cookie, doughnut, or muffin; 1 slice of cake or pie | Reduced consumption of liquid sugars, refined carbohydrates; improved satiety from consumption of other foods. |
| Alcohol§ | For those who consume alcohol, up to 2 daily for men, 1 daily for women | 5 oz wine; 12 oz beer; 1.5 oz spirits | Moderate alcohol use raises HDL cholesterol, improves insulin sensitivity, and reduces systemic inflammation. |
| Energy balance | Reduce portion sizes, increase physical activity (minimum 150 min/wk moderate or 75 min/wk vigorous activity)∥, limit TV watching, and ensure adequate sleep. | For an average 73-kg adult, 1 hour of brisk walking burns ~277 kcal; hiking, 438 kcal; swimming, 511 kcal; and jogging, tennis, or basketball, 584 kcal.18 |
On the basis of the evidence described in this review, and generally consistent with US Department of Agriculture and American Heart Association guidelines and the American Heart Association 2020 Impact Goals. Food-based recommendations can facilitate communication and translation to both individual patients and populations. Some specific individual nutrients, such as sodium and industrially produced trans fats, are also highly relevant and can be successfully targeted by policy measures to reduce their consumption.
Based on a 2000-kcal/d diet. Servings should be adjusted accordingly for higher or lower energy consumption.
Or potentially, whole legumes (beans), although evidence for equivalent effects is limited. Characterization of whole grain content in packaged foods is challenging; pragmatically, sufficient whole grain content was defined by the American Heart Association 2020 Impact Goals7 as the fiber content of whole wheat, ie, at least 1.1 g of naturally occurring dietary fiber per 10 g of carbohydrate in the grain product.
Because of alcohol-related accidents, homicides, and suicides, especially among younger adults, alcohol use has an overall net adverse effect on population mortality.2 Thus, alcohol use is not advisable as a population-based strategy to reduce cardiovascular risk. For adults who already drink alcohol, no more than moderate use should be encouraged.
Higher levels of physical activity may be needed to promote prolonged negative energy balance, ie, sustained weight loss.