Diet and Lifestyle Recommendations Revision 2006: A Scientific Statement From the American Heart Association Nutrition Committee

In the paper

“Individuals who consume large amounts of beverages with added sugars tend to consume more calories and gain weight.[55][56][57]”

What the sources say

• Not checked yetcites [55][56][57]

In the paper

“Some trials, in fact, have documented potential harm, including an increased risk of lung cancer from beta-carotene supplements in smokers and an increased risk of heart failure 70 and the possibility of increased total mortality 71 from high-dose vitamin E supplements.”

What the sources say

• ?Not matched

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  cites [70] 70. Kris-Etherton PM, Lichtenstein AH, Howard BV, Steinberg D, Witztum JL; Nutrition Committee of the American Heart Association Council on Nutrition, Physical Activity, and Metabolism. Antioxidant vitamin sup- plements and cardiovascular disease. Circulation. 2004;110:637-641.
• Not checked yetcites [71] 71. Lee IM, Cook NR, Gaziano JM, Gordon D, Ridker PM, Manson JE, Hennekens CH, Buring JE. Vitamin E in the primary prevention of cardiovascular disease and cancer: the Women's Health Study: a ran- domized controlled trial. JAMA. 2005;294:56 -65. source

In the paper

“There is a positive association between frequency of meal consumption at quick-serve restaurants and total energy intake, weight gain, and insulin resistance.67”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [67] 67. Guthrie JF, Lin BH, Frazao E. Role of food prepared away from home in the American diet, 1977-78 versus 1994 -96: changes and consequences. J Nutr Educ Behav. 2002;34:140 -150.

In the paper

“Overweight and obesity are a particular concern for children as the prevalence of overweight is now Ϸ16% for children and adolescents.”

In the paper

“Data indicate that body weight at 18 years tracks with subsequent risk of developing CVD and diabetes, as does weight gain after 18 years of age.12”

What the sources say

• Not checked yetcites [12] 12. Freedman DS, Khan LK, Serdula MK, Galuska DA, Dietz WH. Trends and correlates of class 3 obesity in the United States from 1990 through 2000. JAMA. 2002;288:1758 -1761.

In the paper

“Trans fatty acids tend to increase LDL cholesterol levels slightly less than saturated fatty acids, whereas saturated fatty acids increase HDL cholesterol concentrations but trans fatty acids do not.16”

What the sources say

• Not checked yetcites [16] 16. Wing RR, Phelan S. Long-term weight loss maintenance. Am J Clin Nutri. 2005;82:222S-225S. source

In the paper

“These data have documented that healthy dietary patterns are associated with a substantially reduced risk of CVD, 4 CVD risk factors, 5,6 and noncardiovascular diseases.7”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [4] 4. US Department of Health and Human Services; US Department of Agri- culture. Dietary Guidelines for Americans, 2005. 6th ed. Washington, DC: US Government Printing Office; 2005.
• Not checked yetcites [5] 5. Gidding SS, Dennison BA, Birch LL, Daniels SR, Gilman MW, Lich- tenstein AH, Rattay KT, Steinberger J, Stettler N, Van Horn L; American Heart Association; American Academy of Pediatrics. Dietary recommen- dations for children and adolescents: a guide for practitioners: consensus statement from the American Heart Association. Circulation. 2005;112: 2061-2075. source
• Not checked yetcites [6] 6. Knoops KT, de Groot LC, Kromhout D, Perrin AE, Moreiras-Varela O, Menotti A, van Staveren WA. Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE proj- ect. JAMA. 2004;292:1433-1439. source
• Not checked yetcites [7] 7. Appel LJ, Moore TJ, Obarzanek E, Vollmer WM, Svetkey LP, Sacks FM, Bray GA, Vogt TM, Cutler JA, Windhauser MM, Lin PH, Karanja JA clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. N Engl J Med. 1997;336:1117-1124. source

In the paper

“Excess body weight adversely affects CVD risk factors (eg, increasing low-density lipoprotein [LDL] cholesterol levels, triglyceride levels, blood pressure [BP], and blood glucose levels, and reducing high-density lipoprotein [HDL] cholesterol levels) and increases the risk of developing coronary heart disease (CHD), heart failure, stroke, and cardiac arrhythmias.”

What the sources say

• ?Not matched

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  cites [11] 11. American Heart Association. Heart Disease and Stroke Statistics-2005 Update. Dallas, Tex: American Heart Association; 2005. Available at http://www.americanheart.org/presenter.jhtml!identifierϭ1928. Accessed May 31, 2006.

In the paper

“In nondiabetic individuals, weight loss and increased physical activity can delay the onset of and possibly prevent diabetes.22,23”

What the sources say

• Not checked yetcites [22] 22. Wang Y, Wang QJ. The prevalence of prehypertension and hypertension among US adults according to the new joint national committee guide- lines: new challenges of the old problem. Arch Intern Med. 2004;164: 2126 -2134. source
• Not checked yetcites [23] 23. Appel LJ, Brands MW, Daniels SR, Karanja N, Elmer PJ, Sacks FM; American Heart Association. Dietary approaches to prevent and treat hypertension. A scientific statement from the American Heart Asso- ciation. Hypertension. 2006;47:296. source

In the paper

“This number should only be considered a crude estimate because it is likely current intakes are shifting, in part prompted by the new trans fatty acid labeling requirement.”

In the paper

“A reduced sodium intake can prevent hypertension in nonhypertensive individuals, can lower BP in the setting of antihypertensive medication, and can facilitate hypertension control.”

In the paper

“Nearly 23% of US adults smoke, with the highest rates in American Indian/ Alaskan Native women (37%) and the lowest rates in Asian women (7%).9”

What the sources say

• Not checked yetcites [9] 9. van Dam RM, Rimm EB, Willett WC, Stampfer MJ, Hu FB. Dietary patterns and risk for type 2 diabetes mellitus in U.S. men. Ann Intern Med. 2002;136:201-209.

In the paper

“Additional benefits will likely be derived if activity levels exceed this minimum recommendation.”

In the paper

“Notably, no evidence of a BP threshold exists-that is, the risk of CVD increases progressively throughout the range of BP, including the prehypertensive range (a systolic BP of 120 to 139 mm Hg or diastolic BP of 80 to 89 mm Hg).19”

What the sources say

• ?Not matched

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  cites [19] 19. Wilson PW, Grundy SM. The metabolic syndrome: a practical guide to origins and treatment: part II. Circulation. 2003;108:1537-1540.

In the paper

“A reduced sodium intake is associated with a blunted age-related rise in systolic BP and a reduced risk of atherosclerotic cardiovascular events and congestive heart failure.”

In the paper

“Individuals who choose to consume alcoholic beverages should also be aware that alcohol has a higher caloric density than protein and carbohydrate and is a source of additional “empty” calories.”

In the paper

“To avoid weight gain after childhood, individuals must control calorie intake so that energy balance is achievedthat is, energy intake matches energy expenditure.”

In the paper

“In general, a moderate inverse relationship exists between triglyceride and HDL cholesterol concentrations, and determinants of high triglycerides are mainly the same as those of low HDL cholesterol.17”

What the sources say

• Not checked yetcites [17] 17. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA. 2001;285:2486 -2497. source

In the paper

“Diets rich in potassium lower BP and also blunt the BP-raising effects of an increased sodium intake.59”

What the sources say

• Not checked yetcites [59] 59. Ariza AJ, Chen EH, Binns HJ, Christoffel KK. Risk factors for over- weight in five-to six-year-old Hispanic-American children: a pilot study. J Urban Health. 2004;81:150 -161. source

In the paper

“Large portion sizes and high energy density are common features of away food.66”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [66] 66. Pearson TA. Alcohol and heart disease. Circulation. 1996;94:3023-3025.

In the paper

“In addition to providing EPA and DHA, regular fish consumption may facilitate the displacement of other foods higher in saturated and trans fatty acids from the diet, such as fatty meats and full-fat dairy products.”

In the paper

“Dietary patterns that are high in whole-grain products and fiber have been associated with increased diet quality and decreased risk of CVD.34”

What the sources say

• Not checked yetcites [34] 34. Bazzano LA, Serdula MK, Liu S. Dietary intake of fruits and vegetables and risk of cardiovascular disease. Curr Atheroscler Rep. 2003;5: 492-499. source

In the paper

“Although observational studies have suggested that high intakes of antioxidant vitamins from food and supplements are associated with a lower risk of CVD, clinical trials of antioxidant vitamin supplements have not confirmed benefit.”

In the paper

“Soluble fiber may increase short-chain fatty acid synthesis, thereby reducing endogenous cholesterol production.41”

What the sources say

• Not checked yetcites [41] 41. Erkkilä AT, Herrington DM, Mozaffarian D, Lichtenstein AH. Cereal fiber and whole-grain intake are associated with reduced progression of coronary-artery atherosclerosis in postmenopausal women with coronary artery disease. Am Heart J. 2005;150:94 -101. source

In the paper

“Although earlier research has suggested that soy protein has clinically important favorable effects on LDL cholesterol levels and other CVD risk factors, studies reported during the past 5 years have not confirmed those results.72”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [72] 72. Lonn E, Bosch J, Yusuf S, Sheridan P, Pogue J, Arnold JM, Ross C, Arnold A, Sleight P, Probstfield J, Dagenais GR; HOPE and HOPE-TOO Trial Investigators. Effects of long-term vitamin E supplementation on cardiovascular events and cancer: a randomized controlled trial. JAMA. 2005;293:1338 -1347.

In the paper

“Regular physical activity improves cardiovascular risk factors (BP, lipid profiles, and blood sugar) and lowers the risk of developing other chronic diseases, including type 2 diabetes, osteoporosis, obesity, depression, and cancer of the breast and colon.25”

What the sources say

• Not checked yetcites [25] 25. Lindstrom J, Louheranta A, Mannelin M, Rastas M, Salminen V, Eriksson J, Uusitupa M, Tuomilehto J; Finnish Diabetes Prevention Study Group. The Finnish Diabetes Prevention Study (DPS): lifestyle inter- vention and 3-year results on diet and physical activity. Diabetes Care. 2003;26:3230 -3236. source

In the paper

“Regardless, diets rich in vegetables and fruits have been shown to lower BP and improve other CVD risk factors in short-term randomized trials.5,6,31”

What the sources say

• Not checked yetcites [5] 5. Gidding SS, Dennison BA, Birch LL, Daniels SR, Gilman MW, Lich- tenstein AH, Rattay KT, Steinberger J, Stettler N, Van Horn L; American Heart Association; American Academy of Pediatrics. Dietary recommen- dations for children and adolescents: a guide for practitioners: consensus statement from the American Heart Association. Circulation. 2005;112: 2061-2075. source
• Not checked yetcites [6] 6. Knoops KT, de Groot LC, Kromhout D, Perrin AE, Moreiras-Varela O, Menotti A, van Staveren WA. Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE proj- ect. JAMA. 2004;292:1433-1439. source
• ?Not matched

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  cites [31] 31. Filozof C, Fernandez Pinilla MC, Fernandez-Cruz A. Smoking cessation and weight gain. Obes Rev. 2004;5:95-103.

In the paper

“Because of the progressive dose-response relationship between sodium intake and BP, it is difficult to set a recommended upper level of sodium intake, which could be as low as 1.5 g/d (65 mmol/d).”

In the paper

“According to the most recent National Health and Nutrition Examination Survey (NHANES) (1999 -2000), 27% of adult Americans have hypertension (systolic BP Ն140 mm Hg, diastolic BP Ն90 mm Hg, or use of antihypertensive medication), and another 31% have prehypertension.20”

What the sources say

• Not checked yetcites [20] 20. Howard BV, Ruotolo G, Robbins DC. Obesity and dyslipidemia. Endo- crinol Metab Clin North Am. 2003;32:855-867. source

In the paper

“Subgroups within the population are likely to have higher or lower intakes based on their habitual dietary practices.”

In the paper

“In the current US diet, the major sources of saturated fatty acids are animal fats (meat and dairy), and the primary sources of trans fatty acids are partially hydrogenated fats used to prepare commercially fried and baked products.”

In the paper

“Dietary modifications that lower BP are reduced salt intake, caloric deficit to induce weight loss, moderation of alcohol consumption (among those who drink), increased potassium intake, and consumption of an overall healthy diet, based on the DASH (Dietary Approaches to Stop Hypertension) diet.5”

What the sources say

• Not checked yetcites [5] 5. Gidding SS, Dennison BA, Birch LL, Daniels SR, Gilman MW, Lich- tenstein AH, Rattay KT, Steinberger J, Stettler N, Van Horn L; American Heart Association; American Academy of Pediatrics. Dietary recommen- dations for children and adolescents: a guide for practitioners: consensus statement from the American Heart Association. Circulation. 2005;112: 2061-2075. source

In the paper

“To a lesser extent, dietary cholesterol and excess body weight are positively related to levels of LDL cholesterol.15”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [15] 15. Hill JO, Thompson H, Wyatt H. Weight maintenance: what's missing? J Am Diet Assoc. 2005;105(suppl 1):S63-S66.

In the paper

“Regular physical activity is essential for maintaining physical and cardiovascular fitness, maintaining healthy weight, and sustaining weight loss once achieved.24”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [24] 24. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM; Diabetes Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or met- formin. N Engl J Med. 2002;346:393-403.

In the paper

“Insoluble fiber has been associated with decreased CVD risk 36 -38 and slower progression of CVD in high-risk individuals.39”

What the sources say

• Not checked yetcites [36] 36. Hu FB, Willett WC. Optimal diets for prevention of coronary heart disease. JAMA. 2002;288:2569 -2578. source
• Not checked yetcites [37] 37. Brown L, Rosner B, Willett WW, Sacks FM. Cholesterol-lowering effects of dietary fiber: a meta-analysis. Am J Clin Nutr. 1999;69:30 -42. source
• Not checked yetcites [38] 38. Pereira MA, O'Reilly E, Augustsson K, Fraser GE, Goldbourt U, Heitmann BL, Hallmans G, Knekt P, Liu S, Pietinen P, Spiegelman D, Stevens J, Virtamo J, Willett WC, Ascherio A. Dietary fiber and risk of coronary heart disease: a pooled analysis of cohort studies. Arch Intern Med. 2004;164:370 -376. source
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  cites [39] 39. Liu S, Stampfer MJ, Hu FB, Giovannucci E, Rimm E, Manson JE, Hennekens CH, Willett WC. Whole-grain consumption and risk of coronary heart disease: results from the Nurses' Health Study. Am J Clin Nutr. 1999;70:412-419.

In the paper

“This association is not only found with wine but also with other alcoholic beverages.61,62”

What the sources say

• Not checked yetcites [61] 61. Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, Obarzanek E, Conlin PR, Miller ER 3rd, Simons-Morton DG, Karanja N, Lin PH; DASH-Sodium Collaborative Research Group. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. N Engl J Med. 2001;344:3-10. source
• Not checked yetcites [62] 62. Johnson AG, Nguyen TV, Davis D. Blood pressure is linked to salt intake and modulated by the angiotensinogen gene in normotensive and hyper- tensive elderly subjects. J Hypertens. 2001;19:1053-1060. source

In the paper

“Alcohol can be addictive, and high intake can be associated with serious adverse health and social consequences, including hypertriglyceridemia, hypertension, liver damage, physical abuse, vehicular and work accidents, and increased risk of breast cancer.2”

What the sources say

• Not checked yetcites [2] 2. Ten-Year Risk Assessment Tool: http://hin.nhlbi.nih.gov/atpiii/ riskcalc.htm BMI Calculator: http://hin.nhlbi.nih.gov/bmi_palm.htm Obesity Education Initiative Guidelines Implementation Tool: http://hin.nhlbi.nih.gov/obgdpalm.htm Dietary Guidelines for Americans 2005 (In addition to the guide- lines, link contains several other links to tools and other resources on diet and physical activity.): http://www.healthierus.gov/ dietaryguidelines USDA National Nutrient Database (nutrient content of individual foods): http://www.nal.usda.gov/fnic/foodcomp/Data What You Need to Know About Mercury in

In the paper

“Evidence of a direct cardiovascular health benefit from consuming soy protein products instead of dairy or other proteins or of isoflavone supplements is minimal.71,72”

What the sources say

• Not checked yetcites [71] 71. Lee IM, Cook NR, Gaziano JM, Gordon D, Ridker PM, Manson JE, Hennekens CH, Buring JE. Vitamin E in the primary prevention of cardiovascular disease and cancer: the Women's Health Study: a ran- domized controlled trial. JAMA. 2005;294:56 -65. source
• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [72] 72. Lonn E, Bosch J, Yusuf S, Sheridan P, Pogue J, Arnold JM, Ross C, Arnold A, Sleight P, Probstfield J, Dagenais GR; HOPE and HOPE-TOO Trial Investigators. Effects of long-term vitamin E supplementation on cardiovascular events and cancer: a randomized controlled trial. JAMA. 2005;293:1338 -1347.

In the paper

“Atherosclerosis is a chronic process beginning in youth.”

In the paper

“A very large amount of soy protein, comprising more than half of daily protein intake, may lower LDL cholesterol levels by a few percentage points when it replaces dairy protein or a mixture of animal proteins, but data are mainly from hypercholesterolemic individuals.”

In the paper

“In brief, it is well recognized that the current environment encourages overconsumption of calories and discourages expenditure of energy.”

In the paper

“To sustain LDL cholesterol reductions from these products, individuals need to consume them daily, just as they would use lipid-lowering medication.”

In the paper

“Such findings reinforce the belief that multiple factors are responsible for the obesity epidemic and that the optimal strategy to arrest the epidemic will be multifactorial.”

In the paper

“Within these categories are multiple possible compounds, most of which are not well characterized and whose modes of action are not established.83”

What the sources say

• Not checked yetcites [83] 83. Lonn E, Yusuf S, Arnold MJ, Sheridan P, Pogue J, Micks M, McQueen MJ, Probstfield J, Fodor G, Held C, Genest J Jr; Heart Outcomes Pre- vention Evaluation (HOPE) 2 Investigators. Homocysteine lowering with folic acid and B vitamins in vascular disease. N Engl J Med. 2006;354: 1567-1577.

In the paper

“Environmental factors that contribute to excess calorie intake are increased portion sizes, high-calorie foods, and easy access to plentiful inexpensive food.”

In the paper

“Environmental factors that discourage physical activity include an environment that encourages automobile use rather than walking and that has few cues to promote activity and numerous cues that discourage activity (eg, poor pedestrian infrastructure, lack of sidewalks and other safety features, and poor street aesthetics).”

In the paper

“CKD is associated with a high prevalence of diabetes, dyslipidemia (especially hypertriglyceridemia), and hypertension.”

In the paper

“Children can eat a diet consistent with the AHA 2006 Diet and Lifestyle Recommendations and maintain appropriate growth while lowering risk for future CVD.”

In the paper

“Available evidence is inadequate to recommend folate and other B vitamin supplements as a means to reduce CVD risk at this time.”

In the paper

“Because they have decreased energy needs while their vitamin and mineral requirements remain constant or increase, however, older individuals should be counseled to select nutrient-dense choices within each food group.90”

What the sources say

• Not checked yetcites [90] 90. Mozaffarian D, Longstreth WT Jr, Lemaitre RN, Manolio TA, Kuller LH, Burke GL, Siscovick DS. Fish consumption and stroke risk in elderly individuals: the cardiovascular health study. Arch Intern Med. 2005;165: 200 -206. source

In the paper

“CKD, which precedes end-stage kidney disease, substantially increases the risk of CVD, at least in part through diet-related CVD risk factors.93”

What the sources say

• Not checked yetcites [93] 93. Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, Gordon DJ, Krauss RM, Savage PJ, Smith SC Jr, Spertus JA, Costa F; American Heart Association; National Heart, Lung, and Blood Institute. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005;112:2735-2752. source

In the paper

“Importantly, lifestyle modifications can effectively control CVD risk factors and lower CVD risk.”

In the paper

“Still, the environment has a powerful influence on whether people consume excess calories, follow a healthy diet, and are physically active.”

In the paper

“A substantial and expanding body of evidence has implicated several aspects of diet in the pathogenesis of CVD and its risk factors.”

In the paper

“Accomplishing these objectives will require individuals to change their behavior and society to make substantial environmental changes.”

In the paper

“Because many of these factors are beyond the control of individuals (eg, size of portions served in restaurants, lack of information on calorie content at point of purchase, presence of sidewalks, adequate streetlights after dark), substantial changes to the environment will be required.”

In the paper

“Also, ample evidence from clinical trials indicates that older-aged persons can make and sustain lifestyle changes, perhaps more so than younger adults.86,87”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [86] 86. Balk EM, Lichtenstein AH, Chung M, Kupelnick B, Chew P, Lau J. Effects of omega-3 fatty acids on serum markers of cardiovascular disease risk: a systematic review. Atherosclerosis. 2006;184:237-246.
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  cites [87] 87. Grundy SM. Stanol esters as a component of maximal dietary therapy in the National Cholesterol Education Program Adult Treatment Panel III report. Am J Cardiol. 2005;96:47D-50D.

In the paper

“Furthermore, because diet in youth is associated with the occurrence of CVD outcomes later in life and because lifestyle habits in youth track into adulthood, adoption of a healthy diet and lifestyle at early ages is recommended.”

In the paper

“Furthermore, the obesity epidemic highlights the importance of primary prevention efforts in children so that adverse diet and lifestyle behaviors do not become habits.”

In the paper

“Flavonoids and sulfur-containing compounds are classes of compounds found in fruits and vegetables that may be important in reducing the risk of atherosclerosis.”