Cited by 507Nutritional Studies and DietCardiovascular Health and Risk FactorsAgriculture Sustainability and Environmental Impact

The DOI matches its Crossref record; 299 of the 325 references it cites were found in a registry or an index; none of the 363 sources its claims cite is checked for support yet.

Food Consumption and its Impact on Cardiovascular Disease: Importance of Solutions Focused on the Globalized Food System

Open access

Abstract

Major scholars in the field, on the basis of a 3-day consensus, created an in-depth review of current knowledge on the role of diet in cardiovascular disease (CVD), the changing global food system and global dietary patterns, and potential policy solutions. Evidence from different countries and age/race/ethnicity/socioeconomic groups suggesting the health effects studies of foods, macronutrients, and dietary patterns on CVD appear to be far more consistent though regional knowledge gaps is highlighted. Large gaps in knowledge about the association of macronutrients to CVD in low- and middle-income countries particularly linked with dietary patterns are reviewed. Our understanding of foods and macronutrients in relationship to CVD is broadly clear; however, major gaps exist both in dietary pattern research and ways to change diets and food systems. On the basis of the current evidence, the traditional Mediterranean-type diet, including plant foods and emphasis on plant protein sources provides a well-tested healthy dietary pattern to reduce CVD.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This consensus review summarizes evidence linking foods, macronutrients, and dietary patterns to cardiovascular disease (CVD) and argues that the globalized food system shapes unhealthy diets. It concludes that a Mediterranean-type pattern emphasizing whole grains, fruits/vegetables, legumes, nuts, fish, poultry, moderate dairy, and heart-healthy oils, while limiting refined grains, added sugars, trans fats, sugar-sweetened beverages (SSBs), and red/processed meats, is optimal and likely reduces CVD risk by about one third.

Key findings

  • The optimal dietary pattern to reduce CVD emphasizes whole grains, fruits and vegetables, legumes, nuts, fish, poultry, moderate dairy, and heart-healthy vegetable oils; it should be low in refined grains, added sugars, trans-fats, SSBs, and red and processed meats, and likely reduces CVD risk by about a third. The traditional Mediterranean-type diet is described as a well-tested prototype.
  • In meta-analyses, a 1-serving/day increase in SSB consumption was associated with RR 1.17 (95% CI 1.10–1.24) for CHD and RR 1.08 (95% CI 1.04–1.12) for incident hypertension, with no clear effect for total stroke; 1–2 SSB servings/day was associated with a 26% increased T2DM risk versus non-consumers, and ≥7 SSB servings/week was associated with a 29% increased CVD mortality risk versus <1 serving/week.
  • A Cochrane Review of 23 epidemiological studies (n=274,683) found the lowest risk of CVD events and deaths at sodium intake between 2.7 and 5.0 g/day; PURE found both high (>6 g/day) and low (<3 g/day) sodium excretion associated with higher mortality and CVD events compared with average (4.00–5.99 g/day).
  • In INTERSTROKE, 1 serving of fruit/day was protective against stroke (OR 0.61, 95% CI 0.50–0.73); a meta-analysis of 20 prospective cohort studies found highest versus lowest fruit and vegetable consumption associated with decreased stroke risk (RR 0.79, 95% CI 0.75–0.84); and PREDIMED found a Mediterranean diet with 50 g/day extra virgin olive oil reduced CVD events by 30% over five years. Replacing saturated fat with high-GI carbohydrate increased MI risk by 33%.

Methods

  • Design: consensus review based on a 3-day World Heart Federation international workshop; the authors state it is not based on new systematic reviews or meta-analyses but represents a careful review of published meta-analyses, seminal primary studies, and recent research by participating scholars.
  • Data/sample: evidence from different countries and age/race/ethnicity/socioeconomic groups, with major gaps noted for low- and middle-income countries (LMIC); cited global studies include PURE (138,926 individuals in 628 communities, 17 countries), INTERSTROKE, and INTERHEART, alongside meta-analyses and randomized trials.
  • Analysis: narrative synthesis of macronutrients, foods, dietary patterns, global food-system changes, environmental impacts, and policy solutions; no formal quantitative pooling is reported.

Limitations

  • Stated: major gaps exist in dietary pattern research and in ways to change diets and food systems; large gaps remain in LMIC macronutrient–CVD evidence; few RCTs have CVD outcomes; sodium studies have methodological issues, and large RCTs are needed for definitive evidence.
  • Stated: data relating diet to CVD have predominantly come from high-income countries, although over 80% of CVD deaths occur in LMIC; regional heterogeneity and limited LMIC data are noted for SSBs, meat, dairy, and other foods.
  • Evident: as a consensus/narrative review, it lacks a systematic search and formal quality appraisal, and it relies in places on unpublished data from PURE, ONTARGET, and INTERHEART; findings are not based on new meta-analyses.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.jacc.2015.07.050

Cites

299 of 299 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

0 of 363 cited sources checked · 0 supported · 0 flagged

Show all 181 claims

  • It may state two separate claims as one. 109
  • Probably not a substantial claim. 32
  • The quote only partly states this claim. 2
135 of 135
  • The paper relies on this without support.

    Changes to the global food system can address current diet-related public health problems and simultaneously have beneficial impacts on climate change.

    “an outline of how changes to the global food system can address current diet-related public health problems, and simultaneously have beneficial impacts on climate change.”
  • The paper relies on this without support.

    The consensus of scholars participating in the workshop adequately represents current knowledge on diet and CVD.

    “Major scholars in the field, based on a 3-day consensus, created an in-depth review of current knowledge on the role of diet in CVD, the changing global food system and global dietary patterns, and potential policy solutions.”
  • The paper relies on this without support.

    Current red meat consumption in Asian countries does not reflect long-term patterns.

    “current consumption does not likely reflect long-term patterns.”
  • The paper relies on this without support.

    Low-input, biodiverse farming systems are more sustainable than high-input monocultures and tend to be more productive per land area.

    “Low-input, biodiverse farming systems are more sustainable than high-input monocultures and tend to be more productive per land area, making greater use of ecological space.”
  • The paper relies on this without support.

    Dietary patterns differ in various regions of the world and the context in which foods are accessed differs markedly.

    “However, similar data are needed from LMIC as dietary patterns differ in various regions of the world and the context in which foods are accessed differs markedly.”
  • The paper relies on this without support.

    We now understand the components of the healthy dietary pattern sufficiently to translate it to other regions.

    “Given that we now understand the components of this diet sufficiently, it may be possible to translate this pattern to other regions, with appropriate similar food replacements based on food availability and preferences (see attached Table S1).”
  • The paper relies on this without support.

    Policy actions and interventions that improve food supplies and dietary patterns have social, cultural and environmental benefits.

    “Policy actions and interventions that improve food supplies and dietary patterns have social, cultural and environmental benefits.”
  • The paper relies on this without support.

    There are many opportunities to increase access to healthy food that are also likely to have significant environmental benefits.

    “There are many opportunities to increase access to healthy food that are also likely to have significant environmental benefits.”
8 of 8

Citations

Cites

2 retracted

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Show all 325 references

26 of the 325 references couldn’t be matched to a known paper.

Research works printed but not linked: 6

  1. Wang, 2008, Dynamic shifts in Chinese eating behaviors, Asia Pac J Clin Nutr, 17, 123
  2. Monteiro C. The big issue is ultra-processing. Journal of the World Public Health Nutrition Association 2010. Available at: http://www.wphna.org/wn_commentary_ultraprocessing_nov2010.asp. Accessed August 7, 2015.
  3. Aldersey C. Consumer trends and usage of fats and oils. Paper presented at: 14th Biennial Sunflower Conference; June 24-26, 2003; Australia.
  4. Micha, 2014, Global, regional, and national consumption levels of dietary fats and oils in 1990 and 2010: a systematic analysis including 266 country-specific nutrition surveys, Br Med J, 348, g2272, 10.1136/bmj.g2272 · DOI · Paper page
  5. Hall, 2009, The progressive increase of food waste in America and its environmental impact, PLoS One, 4, e7940, 10.1371/journal.pone.0007940 · DOI · Paper page
  6. Godfray, 2010, The future of the global food system, Phil Trans R Soc B: Bio Sci, 365, 2769, 10.1098/rstb.2010.0180 · DOI

Cited by

Metadata

Authors
Anand, S. S., Hawkes, C., de Souza, R. J., Mente, A., Dehghan, M., Nugent, R., Zulyniak, M. A., Weis, T., Bernstein, A. M., Krauss, R. M., Kromhout, D., Jenkins, D. J. A., Malik, V., Martinez-Gonzalez, M. A., Mozaffarian, D., Yusuf, S., Willett, W. C., & Popkin, B. M.
Affiliations
  • Population Health Research Institute (CA)
  • City, University of London (GB)
  • University of Washington (US)
  • McMaster University (CA)
  • Western University (CA)
  • Cleveland Clinic (US)
  • Wageningen University & Research (NL)
  • St. Michael's Hospital (CA)
  • Harvard University (US)
  • Tufts University (US)
  • Universidad de Navarra (ES)
  • University of North Carolina at Chapel Hill (US)
Corresponding author
Popkin, Barry M.
Venue
Journal of the American College of Cardiology
Publisher
Elsevier BV
Published
2015-10
Volume
66
Issue
14
Pages
1590-1614
ISSN
0735-1097 (ISSN-L)
OpenAlex
W1778213696
Cited by
507
References
325
Citations by year
2026: 22 · 2025: 38 · 2024: 68 · 2023: 44 · 2022: 68 · 2021: 74 · 2020: 50 · 2019: 40 · 2018: 35 · 2017: 37 · 2016: 27 · 2015: 3
FWCI
4.90
Type
journal article
Language
en
Update notices
erratum (2015-10-27)
Open access
Locations
  • Journal of the American College of Cardiology (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • Socio-Environmental Systems Modeling (acceptedVersion)
  • City Research Online (City University London) (acceptedVersion)
  • Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
  • UNC Libraries
Funders
  • World Health Organization
  • California Strawberry Commission
  • Danone
  • Almond Board of California
  • Hamilton Health Sciences
  • McMaster University
  • Amarin Corporation
  • Australian Government
  • Government of Canada
  • Alpro Foundation
  • World Heart Federation
  • National Institutes of Health (2r24hd050924-06)
  • National Institute of Diabetes and Digestive and Kidney Diseases (R01DK098072, P30DK098722)
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (R24 HD-050924, P2CHD050924)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
  • Physical Sciences › Environmental Science › Ecology › Agriculture Sustainability and Environmental Impact
Keywords
cardiovascular disease, diet, global food system, dietary habits, macronutrients, Mediterranean diet, plant-based foods, plant proteins, low- and middle-income countries, food globalization, health disparities
MeSH terms
Cardiovascular Diseases, Diet, Feeding Behavior, Food Supply, Humans, Risk Factors, Global Health, Climate Change

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