-
1.
Medical nutrition therapy is most effective in reducing CVD when the dietary interventions are evidence-based, promote healthful quantitative and qualitative dietary intake, and when conducive to long-term patient adherence [3]
-
2.
Saturated fat intake may promote atherogenesis via increased low-density lipoprotein cholesterol levels, increased apolipoprotein B levels, increased low density lipoprotein particle number, increase inflammation, and endothelial dysfunction [14,15]. Dairy products contain micro and macronutrients (e.g., proteins, calcium, magnesium, potassium, vitamins) that may reduce inflammation and reduce CVD risk [16]. Dairy products also contain short, medium, and long-chain saturated fatty acids, with differences in fatty acid size having different potential effects in promoting CVD risk [17]. The balanced nutrients within “whole food” dairy consumption may help explain why dairy intake is often reported to have a neutral or favorable effect on CVD risk [18,19], and why dairy consumption within the Mediterranean Diet does not increase, and may reduce CVD risk.
-
3.
Ultra-processed carbohydrates increase the risk of post-prandial hyperglycemia, hyperinsulinemia, hypertriglyceridemia, inflammation, endothelial dysfunction, sympathetic hyperactivity, and hypercoagulability [20], all CVD risk factors. The nutrient comparator component in some clinical trials is a confounder in claims regarding the effects of saturated fats and ultra-processed carbohydrates on CVD risk. CVD risk is not reduced with isocaloric substitution of saturated fats with unhealthful ultra-processed carbohydrates. CVD risk is not reduced with the isocaloric substitution of refined carbohydrates with saturated fats. CVD risk is reduced when saturated fats are replaced by unsaturated fats and when ultra-processed carbohydrates are replaced by fiber-rich complex carbohydrates found in healthful whole foods [21].
-
4.
The “Dietary Approaches to Stop Hypertension” (DASH) diet has among the best evidence for prevention of CVD [2]. DASH diet meal planning includes vegetables, fruits, whole grains, fat-free or low-fat dairy products, fish, poultry, lean meats, nuts, seeds, legumes, fiber and the minerals calcium, potassium, and magnesium. Sodium is limited 1500–2300 mg per day, total fat is limited to ~27% of total daily calories, saturated fat is <6% of total daily calories, and cholesterol is limited to ≤150 mg per day for a 2100-Calorie eating plan. Among foods discouraged are red and processed meats, sugar-sweetened beverages, and foods with added sugars [22].
-
5.
The Mediterranean Diet has among the best evidence for prevention of CVD [2]. Monounsaturated olive oil is a main source of fat, with other food components including vegetables, fruits, legumes, whole grains, nuts, and seeds, moderate intake of red wine, moderate consumption of seafood, fermented dairy products (cheese and yogurt), poultry, and eggs. Among foods discouraged are red meat, meat products, ultra-processed carbohydrates, and saturated fats (although lard and butter for cooking is found in some Mediterranean cuisine) [23].
-
6
The Vegetarian Diet has among the best evidence for CVD prevention [2]. A vegetarian diet meal plan includes foods that come mostly from plants such as vegetables, fruits whole grains, legumes, seeds, nuts, and may include eggs and milk. Animal meats are discouraged [24]. While healthful plant-based foods (whole grains, fruits, vegetables, nuts, legumes, oils, tea, and coffee) may reduce CVD risk, unhealthful plant-based intake (juices, sweetened beverages, ultra-refined grains, potatoes/fries, and sweets) may increase CVD risk [25], This (in addition to genetics and other factors) helps account for a relatively high rate of CVD among many vegetarians from India [26].
-
7.
The Ketogenic Diet is a carbohydrate-restricted intervention that typically discourages unhealthful ultra-processed and refined foods, foods high in glycemic index/load, and foods rich in trans fatty acids. No long-term prospective clinical trial evidence supports the ketogenic diet as reducing CVD. Ketosis may reduce appetite and is often utilized for weight and CVD risk factor reduction in patients with overweight or obesity. In addition to reducing body weight, the ketogenic diet may lower postprandial glucose/insulin levels, lower blood pressure, lower triglyceride, and raise high density lipoprotein cholesterol levels. The ketogenic diet may increase low density lipoprotein cholesterol, which is an effect that may be somewhat mitigated by consumption of monounsaturated and/or polyunsaturated fats versus saturated fats [3,[27], [28], [29]].
-
8.
The Therapeutic Lifestyle Change (TLC) diet is a relatively low-fat meal-plan originally recommended by the National Cholesterol Education Program, Adult Treatment Panel. While not as commonly used in clinical practice, the TLC diet continues to be a “diet” often used in lipid clinical trials. Total fat is 25–35%; polyunsaturated fats ≤10%; monounsaturated fat ≤20% of total daily calories. Carbohydrates are 50%–60% of total calories. Soluble fiber is increased to at least 5–10 g a day, preferably 10–25 g a day, as well as adding up to 2 g per day of plant stanols or sterols through foods or dietary supplements. Saturated fats are <7% daily calories; cholesterol is < 200 mg a day [30].
-
9.
The Ornish Diet is illustrative of a fat-restricted nutritional intervention wherein macro and micronutrients are best eaten in their natural food form. The Ornish Diet includes vegetables, fruits, whole grains, legumes, and soy with limited amounts of green tea. Other recommendations are fish oil 3–4 g each day and small meals eaten frequently throughout the day. Dietary fat is limited to <10% of total daily calories and dietary cholesterol to ≤10 mg per day. Other nutrients limited or best avoided include sugar, sodium, alcohol, animal products (red meat, poultry, and fish), caffeine (except green tea), refined carbohydrates and oils [31,32].
-
10.
Intermittent fasting may reduce overall caloric intake, reduce body weight, and improve metabolic parameters (e.g. improve insulin sensitivity, blood pressure, lipids, and inflammatory markers, even among patients with metabolic syndrome treated with statins and anti-hypertensive agents) often with preservation in resting metabolic rate and lean body mass [3,33].
|
