Popular Dietary Patterns: Alignment With American Heart Association 2021 Dietary Guidance

Key points

• The statement scored 10 popular dietary pattern categories on 9 features of the 2021 AHA Dietary Guidance, with scores normalised to 100.
• Tier 1 (scores above 85, strongly aligned): DASH-style 100, pescetarian 92, Mediterranean 89 and ovo/lacto-vegetarian 86.
• Tier 2 (scores 75-85, mostly aligned): vegan 78 and low-fat 78.
• Tier 3 (scores about 55-74, low to moderate alignment): very low-fat 72 and low-carbohydrate 64.
• Tier 4 (scores below 55, least aligned): Paleo 53 and very low-carbohydrate/ketogenic 31, which restrict legumes and whole grains and allow high saturated fat sources.

Overview

This AHA scientific statement assesses how commonly followed US dietary patterns align with the 2021 AHA Dietary Guidance, which calls for plenty of vegetables and fruits, whole grains, healthy protein sources, liquid plant oils, minimally processed foods, and limited added sugar, salt and alcohol. Each pattern was scored as intended; energy balance was discussed separately. Diets for non-cardiometabolic conditions, diets followed for less than 12 weeks, commercial programmes and practices such as intermittent fasting were excluded.

Tier 1 and 2 patterns in practice

Mediterranean, DASH, pescetarian and vegetarian patterns are flexible and can be adapted to culture, preference and budget. Challenges include focusing only on olive oil or eating fried fish or refined plant foods, and meeting sodium targets: in the PREMIER trial only 28% of participants met the sodium target of less than 1500 mg/d at 6 months. Frozen or low-sodium canned produce, legumes and lower-cost fatty fish can reduce costs. People following vegan diets should consider a vitamin B12 supplement or fortified foods, and people on low-fat diets should replace saturated fat with unsaturated fats rather than refined carbohydrates.

Tier 3 and 4 patterns in practice

Very low-fat diets restrict nuts and plant oils and need monitoring for vitamin B12, essential fatty acid and protein deficiencies; low-carbohydrate diets tend to overemphasise animal foods. Very low-carbohydrate/ketogenic diets improved risk factors in studies up to 6 months, but in a 2019 review most improvements were no longer significant after 12 months; they raise LDL cholesterol, and many people experience keto flu. People on these diets should eat more vegetables, fruits and nuts, choose plant-based fats, and consider a multivitamin with potassium and magnesium.

FAQ

Which popular diets best match AHA heart-healthy guidance?

DASH-style, pescetarian, Mediterranean and ovo/lacto-vegetarian patterns, which form tier 1.

Is a ketogenic diet heart-healthy?

It aligns least with AHA guidance (score 31), because it restricts fruits, legumes and whole grains and is high in saturated fat.

What should people following a vegan diet watch for?

Vitamin B12 deficiency; a supplement or fortified foods are advised, and highly processed vegan products should be limited.

Source

Gardner CD, Vadiveloo MK, Petersen KS, et al. Popular Dietary Patterns: Alignment With American Heart Association 2021 Dietary Guidance: A Scientific Statement From the American Heart Association. Circulation 2023;147:1715-1730. DOI: 10.1161/CIR.0000000000001146. © 2023 American Heart Association, Inc. Summary prepared by Medpresso from the original publication; it is not a substitute for the full text or for medical advice.