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Cited by 172Nutritional Studies and DietCardiovascular Health and Risk FactorsNutrition, Health, and Society Studies

Popular dietary patterns: alignment with American Heart Association 2021 dietary guidance: a scientific statement from the American Heart Association.

Open access
Gardner, Christopher D., Vadiveloo, Maya K., Petersen, Kristina S., Anderson, Cheryl A.M., Springfield, Sparkle, Van Horn, Linda, Khera, Amit, Lamendola, Cindy +3 more·2023·Circulation
DOI 10.1161/cir.0000000000001146
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Abstract

The evolution of dietary guidelines from isolated nutrients to broader dietary pattern recommendations results from growing knowledge of the synergy between nutrients and their food sources as they influence health. Macronutrient and micronutrient needs can be met by consuming various dietary patterns, but guidance is often required to facilitate population-wide adherence to wise food choices to achieve a healthy dietary pattern. This is particularly true in this era with the proliferation of nutrition misinformation and misplaced emphasis. In 2021, the American Heart Association issued a scientific statement outlining key principles of a heart-healthy dietary pattern that could be operationalized in various ways. The objective of this scientific statement is to assess alignment of commonly practiced US dietary patterns with the recently published American Heart Association criteria, to determine clinical and cultural factors that affect long-term adherence, and to propose approaches for adoption of healthy dietary patterns. This scientific statement is intended to serve as a tool for clinicians and consumers to evaluate whether these popular dietary pattern(s) promote cardiometabolic health and suggests factors to consider when adopting any pattern to improve alignment with the 2021 American Heart Association Dietary Guidance. Numerous patterns strongly aligned with 2021 American Heart Association Dietary Guidance (ie, Mediterranean, DASH [Dietary Approaches to Stop Hypertension], pescetarian, vegetarian) can be adapted to reflect personal and cultural preferences and budgetary constraints. Thus, optimal cardiovascular health would be best supported by developing a food environment that supports adherence to these patterns wherever food is prepared or consumed.

AI snapshot

Written from the paper’s full text.

TL;DR

This AHA scientific statement evaluates 10 popular US dietary patterns against the 2021 AHA Dietary Guidance and tiers them by alignment. Mediterranean, DASH-style, pescetarian, and ovo/lacto-vegetarian patterns align best, while Paleo and very-low-carbohydrate/ketogenic patterns align least.

Key findings

  • The writing group identified 10 dietary pattern categories: DASH-style, Mediterranean-style, pescetarian, ovo/lacto-vegetarian, vegan, low-fat, very low-fat, low-carbohydrate, Paleo, and very low-carbohydrate/ketogenic.
  • Scoring 9 of the 10 AHA guidance features yielded 4 tiers: tier 1, scores >85 (Mediterranean, DASH, pescetarian, ovo/lacto-vegetarian); tier 2, scores 75–85 (vegan, low-fat); tier 3, scores ≈55–74 (low-carbohydrate, very low-fat); and tier 4, scores <55 (Paleo, VLCD/ketogenic).
  • Tier 1 patterns are flexible and can be adapted to cultural preferences and budget; tier 4 patterns restrict food groups such as legumes and whole grains and allow high-saturated-fat sources.
  • In the PREMIER trial, only 28% of participants met sodium targets (eg, <1500 mg/d) at 6 months, although meeting <2300 mg/d was relatively feasible by avoiding processed foods.

Methods

  • A review identified popular US dietary patterns using publicly available diet-trend information; the writing group prioritized randomized controlled trials when available and also used descriptions from US federal agencies, health organizations, or large prospective cohort studies.
  • Excluded were diets for noncardiometabolic conditions, diets designed for <12 weeks, commercial programs, diets with unclear definitions, and dietary practices such as intermittent fasting or time-restricted eating.
  • Three writing group members reviewed evidence to define each pattern, grouped patterns into 10 categories, and scored alignment with 9 of the 10 2021 AHA features using 1, 0.75, 0.5, or 0 points for fully, mostly, partially, or not meeting each recommendation; consensus was reached with the other 7 experts.

Limitations

  • The paper states that some subjectivity was required in scoring, that achieving energy balance was addressed separately rather than included in the primary pattern scoring, and that patterns were evaluated “as intended” rather than as actually practiced.
  • The paper states that it excluded diets aimed at managing noncardiometabolic conditions, diets followed for <12 weeks, commercial programs, diets with unclear definitions, and dietary practices such as intermittent fasting; modifications for underlying diseases, allergies, or intolerances were out of scope.
  • Evident from the text: this is a consensus-based scientific statement, not a formal systematic review or meta-analysis, and the tier scores are subjective alignment ratings rather than direct comparisons of clinical outcomes.

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

Integrity signals

Registry

Crossref · 10.1161/cir.0000000000001146

Cites

115 of 115 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 120 cited sources checked · 0 supported · 0 flagged

  • Findingreasoning

    Guidance on sodium varies across Mediterranean diet sources, including implicit and explicit recommendations.

    “Guidance on sodium varies across different sources and includes both implicit and explicit recommendations (ie, many Mediterranean patterns implicitly limit sodium by restricting the consumption of commercial food, which is a primary contributor of sodium).”
    Quote in the paperNot a substantial claim
  • Findingcitation

    Mediterranean-style diets tend to be relatively high in unsaturated fat, particularly from extra-virgin olive oil.

    “They tend to be relatively high in unsaturated fat, particularly from extravirgin olive oil.”
    Quote in the paperNot a substantial claim0 of 6 sources checked
    • cites [19] source

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    • cites [23] source

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    • cites [24] source

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  • Findingreasoning

    DASH-style patterns are well aligned with AHA criteria.

    “DASH-style patterns are well aligned with AHA criteria.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The pattern component definitions are treated as intended as much as possible, consistent with ideal implementation of the diet.
  • Findingcitation

    The Paleo diet avoids many foods featured in the 2021 AHA Dietary Guidance, including whole grains, legumes, oils, and dairy regardless of fat content.

    “Foods to avoid include many that are featured in the 2021 AHA Dietary Guidance such as whole grains, legumes, oils, and dairy (regardless of the fat content of the dairy foods).”
    Quote in the paperSubstantial claim
  • Findingreasoning

    In VLCD, the only dairy permitted is the highest-fat versions such as heavy cream, to avoid lactose.

    “To avoid the lactose contribution of most dairy products, the only dairy permitted is the highest-fat versions such as heavy cream.”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. 57
  • May combine two claims. 47
  • The quote only partly states this claim. 2

  • Classified as probably not a substantial claim.

    Findingown data

    The writing group identified 10 overarching categories of popular dietary patterns based on similarity in macronutrient profile, food groups, or both.

    “The identified dietary patterns were grouped into 10 overarching categories based on the degree of similarity in the macronutrient profile, food groups, or both that were emphasized or limited/restricted.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    The Mediterranean dietary pattern is unique in its inclusion of alcohol, specifically qualified as alcohol in moderation.

    “This dietary pattern is unique in its inclusion of alcohol, although this is specifically qualified as alcohol in moderation.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    Several popularized dietary patterns fall outside the Acceptable Macronutrient Distribution Range, including very low-fat (lower fat, higher carbohydrate), Mediterranean (higher fat, especially extra-virgin olive oil), and ketogenic (lower carbohydrate).

    “Several of the popularized dietary patterns are outside of the Acceptable Macronutrient Distribution Range ranges (eg, very low-fat diet is lower in fat and higher in carbohydrates; Mediterranean diet is higher in fat specifically from extra-virgin olive oil; ketogenic diet is lower in carbohydrates).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    Dairy foods are a source of variability across Mediterranean diet sources, with some recommendations to limit and some to include yogurt and cheese, and limited focus on differentiating low-fat from whole-fat food.

    “Dairy foods are another source of variability across different sources, with some recommendations to limit and some to include both yogurt and cheese and limited focus on differentiating low-fat from whole-fat food.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Findingreasoning

    The 10 dietary pattern categories are DASH-style, Mediterranean-style, pescetarian, ovo/lacto-vegetarian, vegan, low-fat, very low-fat, low-carbohydrate, Paleolithic, and very low-carbohydrate/ketogenic.

    “Dietary patterns identified and summarized in Table 2 include (1) DASH (Dietary Approaches to Stop Hypertension)-style, (2) Mediterranean-style, (3) pescetarian, (4) ovo/lacto-vegetarian, (5) vegan, (6) low-fat, (7) very low-fat, (8) low-carbohydrate, (9) Paleolithic (Paleo), and (10) very low-carbohydrate/ketogenic patterns.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingreasoning

    Very low-fat patterns differ from vegan patterns by strictly limiting nontropical plant sources of fat.

    “Very low-fat patterns differ from vegan patterns by strictly limiting nontropical plant sources of fat.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Findingreasoning

    The most defining feature of very low-fat patterns is severe restriction of dietary fat, limiting or avoiding high-fat plant foods such as nuts, seeds, avocados, and liquid plant oils.

    “Therefore, the most defining feature of this pattern is its severe restriction of dietary fat, that is, limiting or avoiding high-fat plant foods such as nuts, seeds, avocados, and liquid plant oils, which are currently viewed as important characteristics to consider when evaluating overall nutrient adequacy and alignment with features of the 2021 AHA Dietary Guidance.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based). The quote only partly states this claim.

    Findingnone given

    A distinguishing characteristic of low-carbohydrate patterns is the restriction of whole grains, legumes, and, in some cases, total and whole fruit.

    “A distinguishing characteristic of low-kilocalories patterns is the restriction of whole grains, legumes, and, in some cases, total and whole fruit.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    Low-fat patterns generally align with 2021 AHA Dietary Guidance for vegetables, fruits, whole grains, low-fat dairy, and lean protein but are less likely to meet recommendations for nuts and healthy oils.

    “Low-fat patterns generally align with 2021 AHA Dietary Guidance for vegetables, fruits, whole grains, low-fat dairy, and lean protein but are less likely to meet recommendations for nuts and healthy oils.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The pattern component definitions are treated as intended as much as possible, consistent with ideal implementation of the diet.

  • May combine two claims.

    Findingreasoning

    The Paleo diet emphasizes meat, poultry, and fish (and tends to be high in saturated fat as a result), as well as vegetables, fruits, and nuts.

    “The Paleo diet emphasizes meat, poultry, and fish (and tends to be high in saturated fat as a result), as well as vegetables, fruits, and nuts.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingnone given

    DASH patterns are differentiated by greater focus on limiting sodium intake and emphasizing low-fat dairy.

    “DASH patterns are differentiated by their greater focus on limiting sodium intake and emphasizing low-fat dairy.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingreasoning

    Low-fat diets, widely popularized in the 1970s, continue to have proponents because of their familiarity, plentiful low-fat options in prepared food products, and relative simplicity of recommendations.

    “Lowfat diets, widely popularized in the 1970s, continue to have proponents because of their familiarity, plentiful low-fat options in prepared food products, and relative simplicity of recommendations.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    The four tier 1 dietary patterns are flexible, providing a broad array of healthy foods from which to choose.

    “These 4 dietary patterns are flexible, providing a broad array of healthy foods from which to choose.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    Pescetarian and ovo/lacto-vegetarian patterns are differentiated by the degree to which they restrict animal-sourced foods.

    “Pescetarian and ovo/lacto-vegetarian patterns remain differentiated by the degree to which they restrict animal-sourced foods.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    Both very low-fat and low-carbohydrate patterns restrict some food groups emphasized for inclusion in the AHA Dietary Guidance.

    “Both patterns restrict some food groups emphasized for inclusion in the AHA Dietary Guidance.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    Nuts and plant oils are restricted in very low-fat diets, and some legumes, grains, and fruits are restricted in low-carbohydrate diets.

    “Nuts and plant oils are restricted in very low-fat diets, and some legumes, grains, and fruits are restricted in low-carbohydrate diets.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    Paleo and VLCD/ketogenic patterns have strengths including emphasis on nonstarchy vegetables, nuts, and fish and minimal intake of added sugar, with limited alcohol consumption.

    “Strengths for these patterns include an emphasis on nonstarchy vegetables, nuts, and fish and minimal intake of foods and beverages with added sugar, with limited alcohol consumption.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Findingnone given

    Both very low-fat and low-carbohydrate patterns often have lower sodium consumption.

    “and often lower sodium consumption.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    Both very low-fat and low-carbohydrate patterns include minimal intake of foods and beverages with added sugar and limited alcohol consumption.

    “minimal intake of foods and beverages with added sugar; limited alcohol consumption;”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Findingown data

    The writing group's scoring yielded 4 tiers of alignment.

    “This yielded 4 tiers of alignment.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    Tier 2 (scores 75-85) includes vegan and low-fat diets.

    “The next tier (scores 75-85) includes vegan and low-fat diets.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Tier 1 patterns (scores >85) are well aligned with the 2021 AHA Dietary Guidance and include DASH, Mediterranean, pescetarian, and vegetarian (ovo, lacto, ovo/lacto).

    “The tier 1 patterns (scores of >85) are well aligned with the 2021 AHA Dietary Guidance and included DASH, Mediterranean, pescetarian, and vegetarian (ovo, lacto, ovo/ lacto).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingreasoning

    These bottom-tier patterns, even when followed optimally, promote restriction of food groups that are considered essential features of a heart-healthy diet (legumes, whole grains) and allow high-saturated-fat sources that are strongly discouraged (from meats for both Paleo and VLCD and dairy for VLCD).

    “These bottom-tier patterns, even when followed optimally, promote restriction of food groups that are considered essential features of a heart-healthy diet (legumes, whole grains) and allow highsaturated-fat sources that are strongly discouraged (from meats for both Paleo and VLCD and dairy for VLCD).”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims. The quote only partly states this claim.

    Study design and conductreasoning

    Consensus was reached among writing group members for the set of overall diets, the 10 overarching categories, and the assignment of points.

    “Consensus was reached in this manner for all points.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    Of the 10 initial AHA Dietary Guidance criteria, 9 were included in the scoring system and 1 (achieving energy balance) was addressed separately.

    “Of the 10 initial criteria, 9 have been included in the score with 1 criterion (ie, achieving energy balance) discussed separately.”
    • Also stated in: § METHODS: SELECTION OF DIETARY PATTERNS AND DEFINITIONS · plain
      “For the first feature, “achieving energy balance, ” we determined that this could not be clearly or meaningfully used to differentiate dietary patterns, so this is addressed separately from the primary pattern scoring.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    The theoretical range of the subjective alignment score is 0 to 9 points, with higher scores reflecting greater alignment with the 2021 AHA Dietary Guidance criteria.

    “Therefore, the theoretical range of the subjective score is between 0 and 9 points (also presented as a percentage of criteria met), with higher scores reflecting greater alignment with the criteria in the 2021 AHA Dietary Guidance.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    The 2021 AHA Dietary Guidance provides a set of criteria for heart-healthy diets that promote cardiometabolic health and includes 10 features pertaining to food group guidance.

    “The most recent 2021 AHA Dietary Guidance provides a set of criteria for heart-healthy diets that promote cardiometabolic health and includes 10 features that pertain to food group guidance 4 (Table 1).”
    • Also stated in: § METHODS: SELECTION OF DIETARY PATTERNS AND DEFINITIONS · plain
      “The original 2021 AHA Dietary Guidance includes 10 primary features (Table 1).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Lichtenstein et al. 4

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    A healthy vegetarian dietary pattern is recommended in the Dietary Guidelines for Americans.

    “A healthy vegetarian dietary pattern is recommended in the Dietary Guidelines for Americans, and most of the features of this pattern align with 2021 AHA Dietary Guidance.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Dietary Guidelines for Americans

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    A saturation approach was used to select examples of published studies for each diet category, such that identifying additional references was not expected to change the defining features.

    “As for the number of examples selected, a saturation approach was used such that identifying additional references was not expected to change the defining features (summarized in Table 2).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The DASH pattern focuses on increasing intake of plant and lean meat/fish/dairy micronutrients associated with lowering blood pressure (potassium, calcium, magnesium) and limiting macronutrients and micronutrients associated with increased blood pressure (saturated fat, added sugars, sodium).

    “The DASH pattern is focused on increasing the intake of plant and lean meat/fish/dairy micronutrients associated with lowering blood pressure (potassium, calcium, and magnesium) and limiting macronutrients and micronutrients associated with increased blood pressure (saturated fat, added sugars, and sodium).12-18”
    Quote in the paperSubstantial claim0 of 7 sources checked
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  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    The scoring system allocated 1 point for fully meeting a recommendation, 0.75 for mostly, 0.5 for partially, and 0 for not meeting it.

    “We allocated 1 point for a specific component of a dietary pattern if it matched the 2021 statement guidance for that feature.If the com ponent somewhat met the recommendation, we allocated 2 different levels: 0.75 points for mostly and 0.5 for partially.If the component was contrary to 2021 AHA Dietary Guidance, we allocated 0 points for that criterion.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The 2020-2025 Dietary Guidelines for Americans state that for adults choosing to drink alcohol, intake should be limited to ≤2 drinks/d for men and ≤1 drink/d for women.

    “The 2020 to 2025 Dietary Guidelines for Americans state that for adults choosing to drink alcohol, intake should be limited to ≤2 drinks/d for men and ≤1 drink/d for women.8”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [8]

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  • Classified as probably not a substantial claim.

    Study design and conductown data

    The writing group developed a scoring system to evaluate how closely each dietary pattern addressed 9 of the features in the 2021 AHA Dietary Guidance.

    “For ease of interpretation, we developed a scoring system to evaluate how closely each dietary pattern addressed 9 of the features described in the 2021 AHA Dietary Guidance.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Low-energy-dense foods such as vegetables and fruits are associated with greater satiety, and some evidence suggests that higher intakes of fiber and protein promote satiety.

    “Low-energy-dense foods such as vegetables and fruits are associated with greater satiety, and some evidence suggests that higher intakes of fiber and protein promote satiety.62,63”
    Quote in the paperNot a substantial claim0 of 2 sources checked
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  • May combine two claims.

    Interpretationreasoning

    Because of its restrictions, the VLCD is high in animal-sourced foods and saturated fat and raises concerns about nutrient adequacy.

    “Because of these restrictions and recommendations, the VLCD is high in animal-sourced foods and saturated fat and therefore raises concerns about nutrient adequacy.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Very low-fat patterns are characterized predominantly by having ≤10% energy from fat.

    “Very low-fat patterns are characterized predominantly by having ≤10% energy from fat. 37,[39][40][41]57,58”
    Quote in the paperNot a substantial claim0 of 6 sources checked
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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Low-carbohydrate patterns generally refer to patterns with total carbohydrate targets between 20% and 40% of kilocalories.

    “Low-carbohydrate patterns generally refer to patterns with total carbohydrate targets between 20% and 40% of kilocalaroies.20,[29][30][31][32][33][34][35][36]”
    Quote in the paperNot a substantial claim0 of 9 sources checked
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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Very low-carbohydrate diet patterns restrict total carbohydrates to 5% to 10% of kilocalories.

    “Very low-carbohydrate diet (VLCD) patterns restrict total carbohydrates to 5% to 10% of kilocalories.29,[49][50][51][52][53]”
    Quote in the paperNot a substantial claim0 of 6 sources checked
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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    For patients preferring some animal-sourced protein, Mediterranean, pescetarian, and DASH-style patterns may be easier to adopt because protein from both plant and animal sources is included.

    “For patients preferring some animal-sourced protein, the Mediterranean, pescetarian, and DASH-style patterns may be easier to adopt because protein from both plant and animal sources is included such as low-fat dairy, eggs, and fish (specifically fatty fish for Mediterranean and including lean meat and poultry in the DASH-style pattern).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Highly restrictive diets can support short-term energy restriction and weight loss but have been associated with higher food cravings and attrition over time, although that may be modulated by individual characteristics.

    “Energy balance may also be influenced by dietary restraint: Highly restrictive diets can support short-term energy restriction and weight loss but have been associated with higher food cravings and attrition over time, although that may be modulated by individual characteristics.64”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [64] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    With the Mediterranean pattern, some patients may focus solely on olive oil consumption, increasing total calorie intake and missing out on other important features of the diet.

    “With the Mediterranean pattern, some patients may focus solely on olive oil consumption, increasing total calorie intake and missing out on many of the other important features of the diet.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Clinicians and other members of the health care team are trusted sources of dietary advice and play an important role in providing evidence-based dietary advice for primary prevention.

    “Clinicians and other members of the health care team are trusted sources of dietary advice and thus play an important role in providing evidence-based dietary advice for primary prevention.[67][68][69]”
    Quote in the paperNot a substantial claim0 of 3 sources checked
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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The most recent US Dietary Guidelines advise consuming ≥2 servings of seafood or fish per week, with preference for higher omega-3 sources that have low mercury levels, following federal and local fish and seafood advisories.

    “The most recent US Dietary Guidelines continue to advise consuming ≥2 servings of seafood or fish per week, with preference given to higher omega-3 sources that have low mercury levels, following federal and local fish and seafood advisories.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites US Dietary Guidelines

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  • May combine two claims.

    Premisecitation

    In the PREMIER trial, only 28% of participants met sodium targets (eg, <1500 mg/d) at 6 months, although it was relatively feasible to meet the target of <2300 mg/d by avoiding processed foods.

    “Notably, in the PREMIER trial (PREMIER: Lifestyle Interventions for Blood Pressure Control), only 28% of participants met sodium targets (eg, <1500 mg/d) at 6 months, although it was relatively feasible to meet the target of <2300 mg/d by avoiding processed foods.14,70”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [14] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    The budgetary savings and environmental benefits of ovo/lacto-vegetarian diets relative to animal flesh-containing diets may be a desirable feature for some patients.

    “The budgetary savings and environmental benefits of ovo/lacto-vegetarian diets relative to animal flesh-containing diets may be a desirable feature for some patients.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    Many patients are interested in vegan dietary patterns for animal welfare reasons or environmental concerns alongside documented health benefits, which may be a useful impetus to promote behavioral change.

    “Many patients are interested in vegan dietary patterns for animal welfare reasons or because of environmental concerns alongside documented health benefits, which may be a useful impetus to promote behavioral change.25,77,78”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [25] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationnone given

    The first tier patterns can be adapted to respect cultural practices, food preferences, and budget to promote long-term adherence.

    “The first tier of 4 patterns (ie, Mediterranean, DASH style, pescetarian, and ovo-lacto-vegetarian), if implemented as intended, align best with the recent 2021 AHA Dietary Guidance 4 and can be adapted to respect cultural practices, food preferences, and budget to promote long-term adherence.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationnone given

    Higher intake of low-fat dairy products advised in the DASH pattern can be challenging for individuals with lactose intolerance.

    “Last, higher intake of low-fat dairy products advised in the DASH pattern can be challenging for individuals with lactose intolerance.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationnone given

    With all patterns, there is potential for oversimplification and misinterpretation of the defining features.

    “With all patterns, there is the potential for oversimplification and misinterpretation of the defining features.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    Reduced red meat, refined grains, and sweets and reduced health care costs due to a healthier diet can make these patterns more cost-effective.

    “However, reduced red meat, refined grains, and sweets and reduced health care costs due to a healthier diet can make these patterns more cost-effective.72”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [72] source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    The energy balance feature was difficult to include meaningfully in the scoring process and is described generally instead.

    “Given the variability of influences from these different dietary features on energy balance and the variability of the selected 10 dietary pattern categories, it was determined that this feature was difficult to include meaningfully in the scoring process; alternatively, it is described here in general as it applies to all the dietary pattern categories.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationcitation

    It is easier to achieve sodium targets when preparing foods from scratch, so providing access to DASH-style recipes that use herbs to flavor food can promote adherence.

    “It is easier to achieve sodium targets when preparing foods from scratch, so providing access to DASH-style recipes that use herbs to flavor food can promote adherence.75”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [75]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The evaluated patterns are organized into 4 tiers, roughly quartiles, for presentation and discussion.

    “The evaluated patterns are organized into 4 tiers, roughly quartiles, for the practical purpose of organizational efficiency in presentation and discussion.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    Low-fat diets are often implemented by increasing intake of less healthful sources of carbohydrate, which tend to raise triglycerides and lower HDL cholesterol.

    “Low-fat diets are often implemented by increasing intake of less healthful sources of carbohydrate, which tend to raise triglycerides and lower high-density lipoprotein cholesterol.81”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [81] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    These symptoms improve over time with continuation on the diet.

    “These symptoms improve over time with continuation on the diet.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    VLCD/ketogenic diets are high in fat without limiting saturated fat, leading to increases in low-density lipoprotein cholesterol.

    “In addition, VCLD/ketogenic diets are high in fat without limiting saturated fat, leading to increases in low-density lipoprotein cholesterol.[89][90][91][92]”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [89] source

      Not checked in the free run.

    • cites [90] source

      Not checked in the free run.

    • cites [91] source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Some liberalization around restricted food groups such as fruits, whole grains, legumes, and nuts and seeds may promote long-term adherence and align more closely with the 2021 AHA Dietary Guidance.

    “thus, some liberalization around restricted food groups such fruits, whole grains, legumes, and nuts and seeds (depending on the pattern) may promote long-term adherence and align more closely with the 2021 AHA Dietary Guidance.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    Using VLCD/ketogenic diets may limit hunger while leading to weight loss.

    “using VLCD/ketogenic diets may limit hunger while leading to weight loss.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    These restrictions may lead to nutritional deficiencies and loss of beneficial phytochemicals found in plant-based foods consistently associated with reduced morbidity and mortality.

    “and may lead to nutritional deficiencies and loss of beneficial phytochemicals found in plant-based foods consistently associated with reduced morbidity and mortality.49,89”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [49] source

      Not checked in the free run.

    • cites [89] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    For those following low-carbohydrate diets, meats and animal-sourced foods tend to be overemphasized, leading to inappropriate restriction of fiber and increased saturated fat intake.

    “For those following lowcarbohydrate diets, meats and animal-sourced foods tend to be overemphasized, leading to inappropriate restriction of fiber and increased saturated fat intake.29,35,36,42,43”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [29] source

      Not checked in the free run.

    • cites [35] source

      Not checked in the free run.

    • cites [36] source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisenone given

    Potassium and magnesium may be limited in the VLCD/ketogenic diet.

    “which may be limited in the VLCD/ketogenic diet.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Some subjectivity was required in scoring.

    “Some subjectivity was required in scoring.”
    • Also stated in: § Reviewer Disclosures Continued · plain
      “Some subjectivity was required in scoring.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Disparities in cardiovascular health metrics and cardiovascular disease have been persistent, and the burden of mortality is particularly high for non-Hispanic Black individuals.

    “Disparities in cardiovascular health (CVH) metrics and cardiovascular disease have been persistent, and the burden of mortality is particularly high for non-Hispanic Black individuals.[94][95][96]”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [94]

      Not checked in the free run.

    • cites [95] source

      Not checked in the free run.

    • cites [96] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationcitation

    Otherwise, diet disparities may continue to widen.

    “Otherwise, diet disparities may continue to widen.130,131”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [130] source

      Not checked in the free run.

    • cites [131] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisenone given

    Excess sodium intake is a potent cardiovascular risk factor, and choosing and preparing foods with little or no salt is a key recommendation in the 2021 AHA Dietary Guidance.

    “Excess sodium intake is a potent cardiovascular risk factor, and choosing and preparing foods with little or no salt is a key recommendation in the 2021 AHA Dietary Guidance.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisenone given

    There is robust evidence supporting diverse dietary patterns (ie, DASH, Mediterranean, pescetarian, vegetarian) that promote cardiometabolic health and that can be designed to reflect personal and cultural preferences and budgetary constraints.

    “There is robust evidence supporting diverse dietary patterns (ie, DASH, Mediterranean, pescetarian, vegetarian) that promote cardiometabolic health and that can be designed to reflect personal and cultural preferences and budgetary constraints.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    According to Churchwell et al, racist policies established the notion that anyone who is not White is inferior and can be devalued and dehumanized.

    “According to Churchwell et al, 96 racist policies (eg, the Black code, the Indian Removal Act of 1830, the anti-Hispanic/Latino immigration policy, the Chinese Exclusion Act of 1882, and the 1924 Immigration Act)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Churchwell et al, 96

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisenone given

    The 2021 AHA Dietary Guidance builds on past AHA reports, takes into consideration the latest research findings, and provides a set of dietary features that are best supported by scientific evidence for promoting cardiovascular health.

    “The 2021 AHA Dietary Guidance builds on past AHA reports, takes into consideration the latest research findings, and provides a set of dietary features that are best supported by scientific evidence for promoting CVH.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisereasoning

    Policies and laws that are initiated at the local, national, and global levels provide broad support for healthful eating.

    “Policies and laws that are initiated at the local, national, and global levels provide broad support for healthful eating.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationcitation

    Health equity through dietary pattern research will require profound cultural humility from the majority of health researchers and professionals, including the redressing of perceived power imbalances, lifelong learning, and constant self-reflection, if progress is to be achieved.

    “Health equity through dietary pattern research will require profound cultural humility from the majority of health researchers and professionals, including the redressing of perceived power imbalances, lifelong learning, and constant self-reflection, if progress is to be achieved.129,130”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [129]

      Not checked in the free run.

    • cites [130] source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationnone given

    For all identified dietary patterns, there are healthier and less healthy ways to follow them, and nutrition misinformation, misplaced emphasis, or oversimplification may lead to adoption of patterns not as intended.

    “For all identified dietary patterns, there are healthier and less healthy ways to follow them, and nutrition misinformation, misplaced emphasis, or oversimplification may lead to adoption of patterns not as intended.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationcitation

    This approach may help to restore a healthy food culture in populations negatively affected by historical injustices and forced acculturation.

    “This approach may help to restore a healthy food culture in populations negatively affected by historical injustices and forced acculturation.119,120”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [119] source

      Not checked in the free run.

    • cites [120] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    These dietary patterns have healthful aspects and are characterized by fiber-rich plant-based foods, lean meat and fish, and herbs, some of which are derived from ancient medicinal practices.

    “These dietary patterns have healthful aspects and are characterized by fiber-rich plant-based foods, lean meat and fish, and herbs, some of which are derived from ancient medicinal practices.[114][115][116]”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [114] source

      Not checked in the free run.

    • cites [115] source

      Not checked in the free run.

    • cites [116] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisenone given

    Reasons that might explain disparities in dietary patterns by race and ethnicity include racism, social determinants of health such as healthy food access, and related aspects such as cost, convenience, and the built food environment.

    “These include racism, social determinants of health such as healthy food access, and related aspects such as cost, convenience, and the built food environment.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    Evidence-based interventions to improve dietary patterns that are effectively executed with cultural humility could lower sodium, added sugar, and saturated fat intake and improve cardiovascular health across racial and ethnic groups who bear the burden of cardiovascular disease and its risk factors.

    “More specifically, evidencebased interventions to improve dietary patterns that are effectively executed with cultural humility 107,108 could lower sodium, added sugar, and saturated fat intake and improve CVH across racial and ethnic groups who bear the burden of cardiovascular disease and its risk factors.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [107]

      Not checked in the free run.

    • cites [108] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    Families, friends, and traditions are key determinants of dietary intake and health behaviors.

    “Families, friends, and traditions are key determinants of dietary intake and health behaviors.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Premisecitation

    The behavioral research field is not immune to this historical context.

    “The behavioral research field is not immune to this historical context 127”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [127] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    They affect large numbers of people, can be long term, incentivize many sectors of society toward positive change, and can shape more equitable and healthy societies.

    “They affect large numbers of people, can be long term, incentivize many sectors of society toward positive change, and can shape more equitable and healthy societies.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    High-scoring tiers (tiers 1 and 2), reflective of alignment with the 2021 Dietary Guidance, also have lower environmental impact and are more supportive of planetary health because of reduced meat intake.

    “It is notable that high-scoring tiers (tiers 1 and 2), reflective of alignment with the 2021 Dietary Guidance, also have lower environmental impact and are more supportive of planetary health because of reduced meat intake.4”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [4] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationreasoning

    Anchoring strategies that address the challenges of individuals in the socioecological model allows the incorporation of reasons that might explain disparities in dietary patterns by race and ethnicity.

    “Anchoring strategies that address the challenges of individuals in the socioecological model allows the incorporation of reasons that might explain disparities in dietary patterns by race and ethnicity.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisenone given

    Choosing liquid vegetable oils rather than tropical oils and solid fats was emphasized in heart-healthy dietary patterns.

    “Choosing liquid vegetable oils rather than tropical oils and solid fats was emphasized in heart-healthy dietary patterns.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationcitation

    Leveraging the family structure as a means of social support could positively augment health promotion and prevention efforts.

    “Leveraging the family structure as a means of social support could positively augment health promotion and prevention efforts.118”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [118] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Adherence to guidelines regardless of where foods are prepared or consumed reflects the evolution of eating behavior in the United States and acknowledges that many people consume more than one-third of calories outside the home.

    “Adherence to guidelines regardless of where foods are prepared or consumed reflects the evolution of eating behavior in the United States and acknowledges that many people consume more than one-third of calories outside the home.61”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [61]

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisenone given

    The foods emphasized include vegetables, fruits, whole grains, legumes, nuts, seafood and fish, and vegetable oils, with low-fat dairy and lean meat consumption allowed as desired.

    “The foods emphasized include vegetables, fruits, whole grains, legumes, nuts, seafood and fish, and vegetable oils, with low-fat dairy and lean meat consumption allowed as desired.”
    Quote in the paperSubstantial claim
84 of 84

  • The authors state this as an assumption.

    The pattern component definitions are treated as intended as much as possible, consistent with ideal implementation of the diet.

    “An important underlying assumption for this step was to treat the pattern component definitions “as intended” as much as possible (ie, in a manner consistent with ideal implementation of the diet).”

  • The authors state this as an assumption.

    For the evaluation, optimal versions of animal-restricted dietary patterns are considered, meaning patterns that otherwise align with the US Dietary Guidelines.

    “Although it is possible to adhere to any animalrestricted dietary pattern and consume unhealthy foods (eg, refined grains, foods high in added sugars, solid fats), for the purposes of this evaluation, here we consider optimal versions of these patterns (ie, patterns that otherwise align with the US Dietary Guidelines).”

  • The paper relies on this without support.

    Many clinicians cite insufficient time and inadequate nutrition training as barriers to providing nutrition advice or counseling.

    “Yet, many clinicians cite insufficient time and inadequate nutrition training as barriers to providing nutrition advice or counseling.”

  • The paper relies on this without support.

    Highly processed low-fat or vegan foods that are sources of refined grains, added sugars, and sodium often lead to implementation of the pattern not as intended through higher consumption of unhealthy convenience foods.

    “For both patterns, the proliferation of highly processed foods that are low fat or vegan but sources of refined grains, added sugars, and sodium can often lead to implementation of the pattern not as intended but rather through higher consumption of unhealthy convenience foods.”

  • The paper relies on this without support.

    Dietary fats are often replaced by sugar and refined grain.

    “because dietary fats are often replaced by sugar and refined grain”

  • The paper relies on this without support.

    Vitamin B12 may be limited in the vegan diet.

    “which may be limited in the vegan diet.”

  • The paper relies on this without support.

    Overconsuming fatty meats and sodium may be detrimental to health.

    “overconsuming fatty meats and sodium may be detrimental to health.”

  • The paper relies on this without support.

    Overall diet quality among US adults is poor.

    “Given the poor overall diet quality among US adults”

  • The paper relies on this without support.

    Racism, social determinants of health such as healthy food access, and related aspects such as cost, convenience, and the built food environment are reasons that might explain disparities in dietary patterns by race and ethnicity.

    “These include racism, social determinants of health such as healthy food access, and related aspects such as cost, convenience, and the built food environment.”

  • The paper relies on this without support.

    Families, friends, and traditions are key determinants of dietary intake and health behaviors.

    “Families, friends, and traditions are key determinants of dietary intake and health behaviors.”

  • The paper relies on this without support.

    Policies and laws that are initiated at the local, national, and global levels provide broad support for healthful eating.

    “Policies and laws that are initiated at the local, national, and global levels provide broad support for healthful eating.”

  • The paper relies on this without support.

    They affect large numbers of people, can be long term, incentivize many sectors of society toward positive change, and can shape more equitable and healthy societies.

    “They affect large numbers of people, can be long term, incentivize many sectors of society toward positive change, and can shape more equitable and healthy societies.”

  • The paper relies on this without support.

    The 2021 AHA Dietary Guidance builds on past AHA reports, takes into consideration the latest research findings, and provides a set of dietary features that are best supported by scientific evidence for promoting cardiovascular health.

    “The 2021 AHA Dietary Guidance builds on past AHA reports, takes into consideration the latest research findings, and provides a set of dietary features that are best supported by scientific evidence for promoting CVH.”

  • The paper relies on this without support.

    Cardiometabolic risks are associated with replacing unsaturated fats with refined carbohydrates and added sugars.

    “particularly because of the cardiometabolic risks associated with replacing unsaturated fats with refined carbohydrates and added sugars.”

  • The paper relies on this without support.

    There is robust evidence supporting diverse dietary patterns (ie, DASH, Mediterranean, pescetarian, vegetarian) that promote cardiometabolic health and that can be designed to reflect personal and cultural preferences and budgetary constraints.

    “There is robust evidence supporting diverse dietary patterns (ie, DASH, Mediterranean, pescetarian, vegetarian) that promote cardiometabolic health and that can be designed to reflect personal and cultural preferences and budgetary constraints.”

  • The paper relies on this without support.

    Excess sodium intake is a potent cardiovascular risk factor.

    “Excess sodium intake is a potent cardiovascular risk factor”

  • The paper relies on this without support.

    Choosing liquid vegetable oils rather than tropical oils and solid fats was emphasized in heart-healthy dietary patterns.

    “Choosing liquid vegetable oils rather than tropical oils and solid fats was emphasized in heart-healthy dietary patterns.”
17 of 17

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Abundant evidence from observational and intervention studies indicates that vegan diets are associated with improved cardiovascular health and decreased risk of cardiovascular disease.

    “Abundant evidence from observational and intervention studies7,8,9,10,11,12,13 indicates that vegan diets are associated with improved cardiovascular health and decreased risk of cardiovascular disease, likely because of the higher daily consumption of vegetables and fruits, legumes, whole grains and nuts, and seeds compared with other different types of dietary patterns.14”

    From Cardiometabolic Effects of Omnivorous vs Vegan Diets in Identical Twins: A Randomized Clinical Trial (2023) · cites this paper as [11]

    The Conclusions say vegan diets can support optimal cardiovascular health, and Facilitators cites observational studies and smaller randomized trials suggesting stabilization or potential reversal of atherosclerotic cardiovascular disease with very-low-fat diets that are often vegan. Those narrower findings do not establish the claimed abundant evidence that vegan diets generally are associated with decreased cardiovascular disease risk. Page numbers are unavailable in our copy. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Previous trials have reported similar metabolic and weight loss benefits of vegan diets yet tended to focus on very low-fat vegan diets, study populations with diabetes or overweight, and comparison diets with limited attention to equipoise.

    “Sixth, previous trials11,13,31,50,54,55 have reported similar metabolic and weight loss benefits of vegan diets yet tended to focus on very low–fat vegan diets, study populations with diabetes or overweight, and comparison diets with limited attention to equipoise.”

    From Cardiometabolic Effects of Omnivorous vs Vegan Diets in Identical Twins: A Randomized Clinical Trial (2023) · cites this paper as [11]

    Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

    Experimental — accuracy not yet measured

  • American Heart Association clinical practice guidelines recommend that practitioners encourage patients to choose healthy sources of protein, mostly from plants, to promote cardiovascular health.

    “Clinical practice guidelines from the American Heart Association recommend that practitioners encourage patients to choose healthy sources of protein, mostly from plants, to promote cardiovascular health.11,48”

    From Cardiometabolic Effects of Omnivorous vs Vegan Diets in Identical Twins: A Randomized Clinical Trial (2023) · cites this paper as [11]

Cites

Flagged first, then by citations

Research works printed but not linked: 3

  1. Volek, J, Phinney, SD, Kossoff, E, Eberstein, JA, Moore, J. The Art and Science of Low Carbohydrate Living: An Expert Guide to Making the Life-saving Benefits of Carbohydrate Restriction Sustainable and Enjoyable. Beyond Obesity; 2011.
  2. Where did you hear that? American Dietetic Association Survey reveals popular and credible sources of nutrition information. In: Nutrition and You: Trends 2008. American Dietetic Association; 2008.
  3. Xu, JQ, Murphy, SL, Kochanek, KD, Arias, E. Mortality in the United States, 2018. NCHS Data Brief, No. 355. National Center for Health Statistics; 2020.

Cited by

Sorted by citations

Related

Authors
Gardner, C. D., Vadiveloo, M. K., Petersen, K. S., Anderson, C. A. M., Springfield, S., Van Horn, L., Khera, A., Lamendola, C., Mayo, S. M., Joseph, J. J., & on behalf of the American Heart Association Council on Lifestyle and Cardiometabolic Health
ORCID
Venue
Circulation
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2023-05-30
Volume
147
Issue
22
Pages
1715-1730
ISSN
  • 0009-7322 (ISSN-L)
  • 1524-4539
DOI
10.1161/cir.0000000000001146
OpenAlex
W4367322250
Semantic Scholar
fddd4374a4d70f363fb3b47dca1b3335381360c0
Cited by
172
References
114
Citations by year
2026: 56 · 2025: 48 · 2024: 49 · 2023: 19
FWCI
8.49
Type
journal article
Language
en
Open access
Locations
  • Circulation (publishedVersion)
  • PubMed (publishedVersion)
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
  • Life Sciences › Agricultural and Biological Sciences › Food Science › Nutrition, Health, and Society Studies
Keywords
dietary habits, heart-healthy diet, Mediterranean diet, DASH diet, vegetarian diet, dietary adherence, cardiometabolic health, nutrition misinformation, cultural food preferences, food environment, cardiovascular health
MeSH terms
American Heart Association, Diet, Humans, Hypertension, United States, Nutrition Policy, Nutrition Therapy

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

Statistics and arithmetic are recomputed, not judged.

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