CoChat
Sign Up
Cited by 571Nutritional Studies and DietCardiovascular Health and Risk FactorsFatty Acid Research and Health

Components of a Cardioprotective Diet: New Insights

Open access
Mozaffarian, Dariush, Appel, Lawrence J., Van Horn, Linda·2011·Circulation
DOI 10.1161/circulationaha.110.968735PMC PMC6261290
Open this paper in CoChat — free account

Abstract

The global burdens of cardiovascular diseases (CVD), type 2 diabetes mellitus (DM), and obesity are rising, producing enormous losses of life and disability-adjusted life-years in both developed and developing nations.1 Most of these burdens are preventable and are occurring at unnecessarily younger ages, largely owing to suboptimal lifestyle, which includes poor diet quality, excess caloric intake, physical inactivity, and smoking.2,–,5 Worldwide, striking differences in dietary habits and rates of chronic diseases exist. The identification and targeting of dietary factors with the greatest potential for reducing CVD, DM, and obesity are of major scientific and public health importance. The science of diet and chronic disease is relatively young, spanning perhaps only half a century.6 New advances offer substantial evidence from complementary research paradigms on cardiometabolic effects of specific dietary factors. Several recent evidence-based reviews conducted in conjunction with national and international policy-making efforts provide the context for the present report. The need to prioritize selected foods and overall dietary patterns rather than only individual nutrients, the relevance of carbohydrate and fat quality as well as quantity, the effects and policy implications of sodium consumption, the importance of energy balance, and the role of dietary supplements represent several key findings of interest. Evidence-based insights into successful individual and public health strategies for behavior change are also addressed. Overall, the present report is intended to provide a useful framework for health practitioners and policy makers to understand contemporary issues related to the effects of diet on CVD. Evidence for effects of dietary factors on cardiometabolic health was reviewed, often derived from recent comprehensive reviews performed for policy-making or similar activities, including those of the American Heart Association (AHA) 2020 Impact Goals Committee (D.M., L.J.A.),7 the AHA Nutrition Committee (D.M., L.J.A., L.V.H.),8,9 the …

Integrity signals

Registry

Crossref · 10.1161/circulationaha.110.968735

Cites

229 of 229 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 280 cited sources checked · 0 supported · 0 flagged

  • Findingcitation

    Greater fruit consumption is associated with lower incidence of stroke.

    “and greater fruit consumption is associated with lower incidence of stroke (Figure 1).27,28”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [27] Dauchet L, Amouyel P, Hercberg S, Dallongeville J. Fruit and vegetable consumption and risk of coronary heart disease: a meta-analysis of cohort studies. J Nutr. 2006; 136: 2588– 2593. 16988131 source

      Not checked in the free run.

    • cites [28] Dauchet L, Amouyel P, Dallongeville J. Fruit and vegetable consumption and risk of stroke: a meta-analysis of cohort studies. Neurology. 2005; 65: 1193– 1197. 16247045 source

      Not checked in the free run.

  • Findingreasoning

    The type and extent of processing modify the health effects of grain and carbohydrate consumption.

    “The type and extent of processing appear to modify the health effects of grain and carbohydrate consumption (Figure 2).”
    Quote in the paperSubstantial claim
  • Findingcitation

    Removal of bran and germ reduces dietary fiber that has important benefits, including lowering blood pressure and cholesterol.

    “removal of bran and germ reduces dietary fiber that has important benefits, including lowering of BP and cholesterol levels31,32;”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [31] Anderson JW, Randles KM, Kendall CW, Jenkins DJ. Carbohydrate and fiber recommendations for individuals with diabetes: a quantitative assessment and meta-analysis of the evidence. J Am Coll Nutr. 2004; 23: 5– 17. 14963049 source

      Not checked in the free run.

    • cites [32] Whelton SP, Hyre AD, Pedersen B, Yi Y, Whelton PK, He J. Effect of dietary fiber intake on blood pressure: a meta-analysis of randomized, controlled clinical trials. J Hypertens. 2005; 23: 475– 481. 15716684 source

      Not checked in the free run.

  • Findingcitation

    The benefits of fruit and vegetable consumption are not dependent on dietary macronutrient composition.

    “nor are they dependent on dietary macronutrient (fat, protein, or carbohydrate) composition.22”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [22] Miller ER 3rd, Erlinger TP, Appel LJ. The effects of macronutrients on blood pressure and lipids: an overview of the DASH and OmniHeart trials. Curr Atheroscler Rep. 2006; 8: 460– 465. 17045071 source

      Not checked in the free run.

  • Findingcitation

    The benefits of fruit and vegetable consumption are not reproducible with equivalent amounts of representative mineral and fiber supplements.

    “Benefits do not appear reproducible with equivalent amounts of representative mineral and fiber supplements,26”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [26] Al-Solaiman Y, Jesri A, Mountford WK, Lackland DT, Zhao Y, Egan BM. DASH lowers blood pressure in obese hypertensives beyond potassium, magnesium and fibre. J Hum Hypertens 2009; 24: 237– 246. 19626043 PMC2841705 source

      Not checked in the free run.

  • May combine two claims. 47
  • Classified as probably not a substantial claim. 12

  • May combine two claims.

    Findingreasoning

    Dietary patterns based on particular foods/components have established cardiometabolic benefits and are higher in dietary fiber, healthy fatty acids, vitamins, antioxidants, potassium, other minerals, and phytochemicals and lower in refined carbohydrates, sugars, salt, saturated fat, cholesterol, and trans fat.

    “Dietary patterns based on particular foods/components (Table 1) have established cardiometabolic benefits and are higher in dietary fiber, healthy fatty acids, vitamins, antioxidants, potassium, other minerals, and phyto-chemicals and lower in refined carbohydrates, sugars, salt, saturated fatty acid (SFA), dietary cholesterol, and trans fat.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    Greater fruit and vegetable consumption are each associated with lower incidence of coronary heart disease.

    “In long-term observational studies, greater fruit and vegetable consumption are each associated with lower incidence of coronary heart disease (CHD),”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [27] Dauchet L, Amouyel P, Hercberg S, Dallongeville J. Fruit and vegetable consumption and risk of coronary heart disease: a meta-analysis of cohort studies. J Nutr. 2006; 136: 2588– 2593. 16988131 source

      Not checked in the free run.

    • cites [28] Dauchet L, Amouyel P, Dallongeville J. Fruit and vegetable consumption and risk of stroke: a meta-analysis of cohort studies. Neurology. 2005; 65: 1193– 1197. 16247045 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In RCTs, diets emphasizing fruits and vegetables produce substantial improvements in blood pressure, lipid levels, insulin resistance, inflammatory biomarkers, endothelial function, and weight control.

    “In RCTs, diets that emphasize consumption of fruits and vegetables produce substantial improvements in several risk factors, including blood pressure (BP), lipid levels, insulin resistance, inflammatory biomarker levels, endothelial function, and weight control.19–25”
    Quote in the paperSubstantial claim0 of 7 sources checked
    • cites [19] Esposito K, Marfella R, Ciotola M, Di Palo C, Giugliano F, Giugliano G, D’Armiento M, D’Andrea F, Giugliano D. Effect of a Mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial. JAMA. 2004; 292: 1440– 1446. 15383514 source

      Not checked in the free run.

    • cites [20] Ard JD, Grambow SC, Liu D, Slentz CA, Kraus WE, Svetkey LP. The effect of the PREMIER interventions on insulin sensitivity. Diabetes Care. 2004; 27: 340– 347. 14747211 source

      Not checked in the free run.

    • cites [21] Elmer PJ, Obarzanek E, Vollmer WM, Simons-Morton D, Stevens VJ, Young DR, Lin PH, Champagne C, Harsha DW, Svetkey LP, Ard J, Brantley PJ, Proschan MA, Erlinger TP, Appel LJ. Effects of comprehensive lifestyle modification on diet, weight, physical fitness, and blood pressure control: 18-month results of a randomized trial. Ann Intern Med. 2006; 144: 485– 495. 16585662 source

      Not checked in the free run.

    • cites [22] Miller ER 3rd, Erlinger TP, Appel LJ. The effects of macronutrients on blood pressure and lipids: an overview of the DASH and OmniHeart trials. Curr Atheroscler Rep. 2006; 8: 460– 465. 17045071 source

      Not checked in the free run.

    • cites [23] Svendsen M, Blomhoff R, Holme I, Tonstad S. The effect of an increased intake of vegetables and fruit on weight loss, blood pressure and antioxidant defense in subjects with sleep related breathing disorders. Eur J Clin Nutr. 2007; 61: 1301– 1311. 17268408 source

      Not checked in the free run.

    • cites [24] McCall DO, McGartland CP, McKinley MC, Patterson CC, Sharpe P, McCance DR, Young IS, Woodside JV. Dietary intake of fruits and vegetables improves microvascular function in hypertensive subjects in a dose-dependent manner. Circulation. 2009; 119: 2153– 2160. 19364976 source

      Not checked in the free run.

    • cites [25] Jenkins DJ, Wong JM, Kendall CW, Esfahani A, Ng VW, Leong TC, Faulkner DA, Vidgen E, Greaves KA, Paul G, Singer W. The effect of a plant-based low-carbohydrate (“Eco-Atkins”) diet on body weight and blood lipid concentrations in hyperlipidemic subjects. Arch Intern Med. 2009; 169: 1046– 1054. 19506174 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In a meta-analysis of RCTs, consumption of soy-containing foods produced trends toward lowering systolic and diastolic blood pressure, but effects did not achieve statistical significance.

    “In a meta-analysis of RCTs, consumption of soy-containing foods produced trends toward lowering of systolic (−5.8 mm Hg) and diastolic (−4.0 mm Hg) BP, but effects did not achieve statistical significance.63”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [63] Hooper L, Kroon PA, Rimm EB, Cohn JS, Harvey I, Le Cornu KA, Ryder JJ, Hall WL, Cassidy A. Flavonoids, flavonoid-rich foods, and cardiovascular risk: a meta-analysis of randomized controlled trials. Am J Clin Nutr. 2008; 88: 38– 50. 18614722 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In RCTs, nut consumption reduces total cholesterol, LDL cholesterol, postprandial hyperglycemia from high-carbohydrate meals, and variably oxidative, inflammatory, and endothelial biomarkers.

    “In RCTs, nut consumption reduces total cholesterol, LDL cholesterol, postprandial hyperglycemia from high-carbohydrate meals, and (variably) oxidative, inflammatory, and endothelial biomarkers.55,57–59”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [55] Kris-Etherton PM, Hu FB, Ros E, Sabate J. The role of tree nuts and peanuts in the prevention of coronary heart disease: multiple potential mechanisms. J Nutr. 2008; 138: 1746S– 1751S. 18716180 source

      Not checked in the free run.

    • cites [57] Ros E Nuts and novel biomarkers of cardiovascular disease. Am J Clin Nutr. 2009; 89: 1649S– 1656S. 19321561 source

      Not checked in the free run.

    • cites [58] Banel DK, Hu FB. Effects of walnut consumption on blood lipids and other cardiovascular risk factors: a meta-analysis and systematic review. Am J Clin Nutr. 2009; 90: 56– 63. 19458020 PMC2696995 source

      Not checked in the free run.

    • cites [59] Kendall CW, Josse AR, Esfahani A, Jenkins DJ. Nuts, metabolic syndrome and diabetes. Br J Nutr. 2010; 104: 465– 473. 20441672 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In RCTs, whole grain consumption improves glucose-insulin homeostasis and endothelial function and possibly reduces inflammation and improves weight loss.

    “In RCTs, consumption of whole grains improves glucose-insulin homeostasis and endothelial function and possibly reduces inflammation and improves weight loss.34–36”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [34] de Munter JS, Hu FB, Spiegelman D, Franz M, van Dam RM. Whole grain, bran, and germ intake and risk of type 2 diabetes: a prospective cohort study and systematic review. PLoS Med. 2007; 4: e261. 17760498 PMC1952203 source

      Not checked in the free run.

    • cites [35] Mellen PB, Walsh TF, Herrington DM. Whole grain intake and cardiovascular disease: a meta-analysis. Nutr Metab Cardiovasc Dis. 2008; 18: 283– 290. 17449231 source

      Not checked in the free run.

    • cites [36] Katcher HI, Legro RS, Kunselman AR, Gillies PJ, Demers LM, Bagshaw DM, Kris-Etherton PM. The effects of a whole grain-enriched hypocaloric diet on cardiovascular disease risk factors in men and women with metabolic syndrome. Am J Clin Nutr. 2008; 87: 79– 90. 18175740 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Whole grain oats reduce LDL cholesterol without reducing HDL cholesterol or raising triglycerides.

    “Consumption of whole grain oats reduces low-density lipoprotein (LDL) cholesterol without reducing high-density lipoprotein cholesterol or raising triglycerides.37”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [37] Kelly SA, Summerbell CD, Brynes A, Whittaker V, Frost G. Wholegrain cereals for coronary heart disease. Cochrane Database Syst Rev. 2007;(2): CD005051. 17443567

      Not checked in the free run.

  • May combine two claims.

    Findingreasoning

    Greater whole grain consumption is associated with lower incidence of coronary heart disease, diabetes mellitus, and possibly stroke.

    “Consistent with physiological benefits, greater whole grain consumption is associated with lower incidence of CHD, DM, and possibly stroke (Figure 1).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    In human trials, fish oil lowers triglyceride levels, systolic and diastolic blood pressure, and resting heart rate.

    “In human trials, fish oil lowers triglyceride levels,43 systolic and diastolic BP,44 and resting heart rate.45”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [43] Eslick GD, Howe PR, Smith C, Priest R, Bensoussan A. Benefits of fish oil supplementation in hyperlipidemia: a systematic review and meta-analysis. Int J Cardiol. 2009; 136: 4– 16. 18774613 source

      Not checked in the free run.

    • cites [44] Geleijnse JM, Giltay EJ, Grobbee DE, Donders AR, Kok FJ. Blood pressure response to fish oil supplementation: metaregression analysis of randomized trials. J Hypertens. 2002; 20: 1493– 1499. 12172309 source

      Not checked in the free run.

    • cites [45] Mozaffarian D, Geelen A, Brouwer IA, Geleijnse JM, Zock PL, Katan MB. Effect of fish oil on heart rate in humans: a meta-analysis of randomized controlled trials. Circulation. 2005; 112: 1945– 1952. 16172267 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In RCTs, increased dietary fiber reduces serum triglycerides, LDL cholesterol, blood glucose, and blood pressure.

    “In RCTs, increased dietary fiber reduces serum triglycerides, LDL cholesterol, blood glucose, and BP.31,32”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [31] Anderson JW, Randles KM, Kendall CW, Jenkins DJ. Carbohydrate and fiber recommendations for individuals with diabetes: a quantitative assessment and meta-analysis of the evidence. J Am Coll Nutr. 2004; 23: 5– 17. 14963049 source

      Not checked in the free run.

    • cites [32] Whelton SP, Hyre AD, Pedersen B, Yi Y, Whelton PK, He J. Effect of dietary fiber intake on blood pressure: a meta-analysis of randomized, controlled clinical trials. J Hypertens. 2005; 23: 475– 481. 15716684 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Observational and RCT evidence suggests fish or fish oil consumption may reduce inflammation, improve endothelial function, normalize heart rate variability, improve myocardial relaxation and efficiency, and at high doses limit platelet aggregation.

    “Observational and RCT evidence suggests that fish or fish oil consumption may also reduce inflammation, improve endothelial function, normalize heart rate variability, improve myocardial relaxation and efficiency, and, at high doses, limit platelet aggregation.46”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [46] Mozaffarian D, Wu JHY. Omega-3 fatty acids and cardiovascular disease–effects on risk factors, molecular pathways, and clinical events. J Am Coll Cardiol. In press. 22051327

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Removal of bran and germ increases bioavailability and rapidity of digestion of remaining endosperm, which increases glycemic responses.

    “increases bioavailability and rapidity of digestion of remaining endosperm, which increases glycemic responses33;”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [33] Ludwig DS. The glycemic index: physiological mechanisms relating to obesity, diabetes, and cardiovascular disease. JAMA. 2002; 287: 2414– 2423. 11988062 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Most of this increase was from sugar-sweetened beverages (60%), followed by alcohol (31%) and 100% fruit juices (9%); calories from other beverages did not increase.

    “Most of this increase was from sugar-sweetened beverages (60%), such as sodas/colas, sweetened fruit drinks, and sports drinks, followed by alcohol (31%) and 100% fruit juices (9%); calories from other beverages (eg, milk) did not increase.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [89] Duffey KJ, Popkin BM. Shifts in patterns and consumption of beverages between 1965 and 2002. Obesity (Silver Spring). 2007; 15: 2739– 2747. 18070765

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Habitual heavy alcohol intake is cardiotoxic, causing a large portion of nonischemic dilated cardiomyopathies in many nations.

    “Habitual heavy alcohol intake is cardiotoxic, causing a large portion of nonischemic dilated cardiomyopathies in many nations.98”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [98] Laonigro I, Correale M, Di Biase M, Altomare E. Alcohol abuse and heart failure. Eur J Heart Fail. 2009; 11: 453– 462. 19336433 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    The ventricular dysfunction from heavy alcohol intake is often irreversible even when alcohol consumption is stopped; continued drinking in such patients is associated with high mortality.

    “The ensuing ventricular dysfunction is often irreversible, even when alcohol consumption is stopped; continued drinking in such patients is associated with high mortality.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [98] Laonigro I, Correale M, Di Biase M, Altomare E. Alcohol abuse and heart failure. Eur J Heart Fail. 2009; 11: 453– 462. 19336433 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Multicomponent dietary interventions that included daily intake of low-fat dairy foods significantly lowered blood pressure, lipid levels, and insulin resistance and improved endothelial function, independent of changes in weight.

    “Multicomponent dietary interventions that included daily intake of low-fat dairy foods significantly lowered BP, lipid levels, and insulin resistance and improved endothelial function, independent of changes in weight.20–22,26”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [20] Ard JD, Grambow SC, Liu D, Slentz CA, Kraus WE, Svetkey LP. The effect of the PREMIER interventions on insulin sensitivity. Diabetes Care. 2004; 27: 340– 347. 14747211 source

      Not checked in the free run.

    • cites [21] Elmer PJ, Obarzanek E, Vollmer WM, Simons-Morton D, Stevens VJ, Young DR, Lin PH, Champagne C, Harsha DW, Svetkey LP, Ard J, Brantley PJ, Proschan MA, Erlinger TP, Appel LJ. Effects of comprehensive lifestyle modification on diet, weight, physical fitness, and blood pressure control: 18-month results of a randomized trial. Ann Intern Med. 2006; 144: 485– 495. 16585662 source

      Not checked in the free run.

    • cites [22] Miller ER 3rd, Erlinger TP, Appel LJ. The effects of macronutrients on blood pressure and lipids: an overview of the DASH and OmniHeart trials. Curr Atheroscler Rep. 2006; 8: 460– 465. 17045071 source

      Not checked in the free run.

    • cites [26] Al-Solaiman Y, Jesri A, Mountford WK, Lackland DT, Zhao Y, Egan BM. DASH lowers blood pressure in obese hypertensives beyond potassium, magnesium and fibre. J Hum Hypertens 2009; 24: 237– 246. 19626043 PMC2841705 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Higher dairy consumption was associated with lower risk of both stroke and DM in long-term observational cohorts.

    “Nonetheless, consistent with physiological benefits, higher dairy consumption was associated with lower risk of both stroke and DM in long-term observational cohorts (Figure 1).69–71”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [69] Elwood PC, Givens DI, Beswick AD, Fehily AM, Pickering JE, Gallacher J. The survival advantage of milk and dairy consumption: an overview of evidence from cohort studies of vascular diseases, diabetes and cancer. J Am Coll Nutr. 2008; 27: 723S– 734S. 19155432 source

      Not checked in the free run.

    • cites [70] Tremblay A, Gilbert JA. Milk products, insulin resistance syndrome and type 2 diabetes. J Am Coll Nutr. 2009; 28(suppl 1): 91S– 102S. 19571167 source

      Not checked in the free run.

    • cites [71] Soedamah-Muthu SS, Ding EL, Al-Delaimy WK, Hu FB, Engberink MF, Willett WC, Geleijnse JM. Milk and dairy consumption and incidence of cardiovascular diseases and all-cause mortality: dose-response meta-analysis of prospective cohort studies. Am J Clin Nutr. 2010; 93: 158– 171. 21068345 PMC3361013 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    RCTs have demonstrated very small benefits or even adverse cardiometabolic effects of conjugated linoleic acid and calcium.

    “Conjugated linoleic acid and calcium were proposed as potential mediators, but RCTs have demonstrated very small benefits or even adverse cardiometabolic effects of these factors.78–84”
    Quote in the paperSubstantial claim0 of 7 sources checked
    • cites [78] Chardigny J-M, Destaillats F, Malpuech-Brugère C, Moulin J, Bauman DE, Lock AL, Barbano DM, Mensink RP, Bezelgues JB, Chaumont P, Combe N, Cristiani I, Joffre F, German JB, Dionisi F, Boirie Y, Sébédio JL. Do industrially-produced and natural trans fatty acid sources have the same impact on cardiovascular diseases risk factors in healthy subjects? Results of the TRANSFACT Study. Am J Clin Nutr. 2008; 87: 515– 516. 18326592 source

      Not checked in the free run.

    • cites [79] Motard-Belanger A, Charest A, Grenier G, Paquin P, Chouinard Y, Lemieux S, Couture P, Lamarche B. Study of the effect of trans fatty acids from ruminants on blood lipids and other risk factors for cardiovascular disease. Am J Clin Nutr. 2008; 87: 593– 599. 18326596 source

      Not checked in the free run.

    • cites [80] Riserus U, Smedman A, Basu S, Vessby B. Metabolic effects of conjugated linoleic acid in humans: the Swedish experience. Am J Clin Nutr. 2004; 79: 1146S– 1148S. 15159248 source

      Not checked in the free run.

    • cites [81] Moloney F, Yeow TP, Mullen A, Nolan JJ, Roche HM. Conjugated linoleic acid supplementation, insulin sensitivity, and lipoprotein metabolism in patients with type 2 diabetes mellitus. Am J Clin Nutr. 2004; 80: 887– 895. 15447895 source

      Not checked in the free run.

    • cites [82] Zemel MB, Thompson W, Milstead A, Morris K, Campbell P. Calcium and dairy acceleration of weight and fat loss during energy restriction in obese adults. Obes Res. 2004; 12: 582– 590. 15090625 source

      Not checked in the free run.

    • cites [83] Harvey-Berino J, Gold BC, Lauber R, Starinski A. The impact of calcium and dairy product consumption on weight loss. Obes Res. 2005; 13: 1720– 1726. 16286519 source

      Not checked in the free run.

    • cites [84] Bolland MJ, Avenell A, Baron JA, Grey A, MacLennan GS, Gamble GD, Reid IR. Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. BMJ. 2010; 341: c3691. 20671013 PMC2912459 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    The average American teenage boy drinks about 24 oz/d (300 kcal) of sugar-sweetened beverages; the average American teenage girl about 16 oz/d (200 kcal).

    “The average American teenage boy drinks ~24 oz/d (300 kcal) of sugar-sweetened beverages; the average American teenage girl, ~16 oz/d (200 kcal).90”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [90] Lloyd-Jones D, Adams R, Carnethon M, De Simone G, Ferguson TB, Flegal K, Ford E, Furie K, Go A, Greenlund K, Haase N, Hailpern S, Ho M, Howard V, Kissela B, Kittner S, Lackland D, Lisabeth L, Marelli A, McDermott M, Meigs J, Mozaffarian D, Nichol G, O’Donnell C, Roger V, Rosamond W, Sacco R, Sorlie P, Stafford R, Steinberger J, Thom T, Wasserthiel-Smoller S, Wong N, Wylie-Rosett J, Hong Y. Heart disease and stroke statistics–2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2009; 119: e21– e181. 19075105

      Not checked in the free run.

  • May combine two claims.

    Findingnone given

    Several additional characteristics of carbohydrates are relevant in determining cardiometabolic effects, including dietary fiber content, bran and germ content, food structure, and potentially glycemic responses or induction of hepatic de novo lipogenesis.

    “These include dietary fiber content; bran and germ content; food structure (eg, intact, minimally processed, refined, or liquid); and potentially glycemic responses or induction of hepatic de novo lipogenesis following ingestion (Figure 2).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Findingnone given

    Among the most important new insights related to diet and cardiometabolic health is the growing evidence characterizing the importance of carbohydrate quality.

    “Among the most important new insights related to diet and cardiometabolic health is the growing evidence characterizing the importance of carbohydrate quality.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    An average serving of alcohol contributes about 120 to 200 kcal that may be less satiating than calories from solid foods.

    “Avoidance of weight gain should also be reinforced, because an average serving of alcohol contributes ~120 to 200 kcal that, as discussed previously, may be less satiating than calories from solid foods.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    In controlled feeding trials, DASH diets significantly lowered blood pressure and improved blood lipids compared with usual Western diets.

    “In controlled feeding trials, each of these DASH diets significantly lowered BP and improved blood lipids compared with usual Western diets (Figure 3),22,112”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [22] Miller ER 3rd, Erlinger TP, Appel LJ. The effects of macronutrients on blood pressure and lipids: an overview of the DASH and OmniHeart trials. Curr Atheroscler Rep. 2006; 8: 460– 465. 17045071 source

      Not checked in the free run.

    • cites [112] Appel LJ, Sacks FM, Carey VJ, Obarzanek E, Swain JF, Miller ER 3rd, Conlin PR, Erlinger TP, Rosner BA, Laranjo NM, Charleston J, McCarron P, Bishop LM. Effects of protein, monounsaturated fat, and carbohydrate intake on blood pressure and serum lipids: results of the OmniHeart randomized trial. JAMA. 2005; 294: 2455– 2464. 16287956 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Emerging and compelling evidence suggests that foods with higher glycemic responses can adversely affect blood glucose control and triglycerides and perhaps LDL cholesterol levels, inflammation, endothelial function, and fibrinolysis.

    “Emerging and compelling evidence suggests that foods with higher glycemic responses can adversely affect blood glucose control and triglycerides and perhaps LDL cholesterol levels, inflammation, endothelial function, and fibrinolysis.33,129–132”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [33] Ludwig DS. The glycemic index: physiological mechanisms relating to obesity, diabetes, and cardiovascular disease. JAMA. 2002; 287: 2414– 2423. 11988062 source

      Not checked in the free run.

    • cites [129] Livesey G, Taylor R, Hulshof T, Howlett J. Glycemic response and health: a systematic review and meta-analysis: relations between dietary glycemic properties and health outcomes. Am J Clin Nutr. 2008; 87: 258S– 268S. 18175766 source

      Not checked in the free run.

    • cites [130] Riccardi G, Rivellese AA, Giacco R. Role of glycemic index and glycemic load in the healthy state, in prediabetes, and in diabetes. Am J Clin Nutr. 2008; 87: 269S– 274S. 18175767 source

      Not checked in the free run.

    • cites [131] Thomas D, Elliott EJ. Low glycaemic index, or low glycaemic load, diets for diabetes mellitus. Cochrane Database Syst Rev. 2009;(1): CD006296. PMC6486008 19160276 source

      Not checked in the free run.

    • cites [132] O’Keefe JH, Gheewala NM, O’Keefe JO. Dietary strategies for improving post-prandial glucose, lipids, inflammation, and cardiovascular health. J Am Coll Cardiol. 2008; 51: 249– 255. 18206731 132a. Tappy L, Le KA. Metabolic effects of fructose and the worldwide increase in obesity. Physiol Rev. 2010; 90: 23– 46. 20086073 source

      Not checked in the free run.

  • May combine two claims.

    Findingreasoning

    Several healthful dietary patterns share key characteristics, including an emphasis on fruits, vegetables, other plant foods such as beans and nuts, and in many patterns whole grains and fish; with limited or occasional dairy products; and often with limited red meats or processed meats and fewer refined carbohydrates and other processed foods.

    “Several healthful dietary patterns have been identified, often derived by different research approaches but sharing several key characteristics, including an emphasis on fruits, vegetables, other plant foods such as beans and nuts, and (in many patterns) whole grains and fish; with limited or occasional dairy products; and often with limited red meats or processed meats and fewer refined Carbohydr”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    In controlled trials and in the absence of weight gain, modest alcohol use raises high-density lipoprotein cholesterol, reduces systemic inflammation, and improves insulin resistance.

    “Conversely, in controlled trials and in the absence of weight gain, modest alcohol use raises high-density lipoprotein cholesterol, reduces systemic inflammation, and improves insulin resistance.100–102”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [100] Rimm EB, Williams P, Fosher K, Criqui M, Stampfer MJ. Moderate alcohol intake and lower risk of coronary heart disease: meta-analysis of effects on lipids and haemostatic factors. BMJ. 1999; 319: 1523– 1528. 10591709 PMC28294 source

      Not checked in the free run.

    • cites [101] Shai I, Wainstein J, Harman-Boehm I, Raz I, Fraser D, Rudich A, Stampfer MJ. Glycemic effects of moderate alcohol intake among patients with type 2 diabetes: a multicenter, randomized, clinical intervention trial. Diabetes Care. 2007; 30: 3011– 3016. 17848609 source

      Not checked in the free run.

    • cites [102] Joosten MM, Beulens JW, Kersten S, Hendriks HF. Moderate alcohol consumption increases insulin sensitivity and ADIPOQ expression in postmenopausal women: a randomised, crossover trial. Diabetologia. 2008; 51: 1375– 1381. 18504547 PMC2491412 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In Crete, diets now contain less fruit and olive oil and more meats than diets of earlier generations, with associated increases in serum cholesterol and adiposity among modern residents.

    “In Crete, a Mediterranean island with historically low rates of CHD, diets now contain less fruit and olive oil and more meats than diets of earlier generations, with associated increases in serum cholesterol and adiposity among these modern residents.114”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [114] Vardavas CI, Linardakis MK, Hatzis CM, Saris WH, Kafatos AG. Cardiovascular disease risk factors and dietary habits of farmers from Crete 45 years after the first description of the Mediterranean diet. Eur J Cardiovasc Prev Rehabil. 2010; 17: 440– 446. 20531009 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    An impressive and expanding body of evidence demonstrates that overall dietary patterns can improve health and prevent CVD.

    “An impressive and expanding body of evidence demonstrates that overall dietary patterns can improve health and prevent CVD (Table 2).108”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [108] Appel LJ. Dietary patterns and longevity: expanding the blue zones. Circulation. 2008; 118: 214– 215. 18625902 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Both acute binges and higher habitual intake of alcohol have been associated with higher risk of atrial fibrillation.

    “Both acute binges and higher habitual intake of alcohol have also been associated with higher risk of atrial fibrillation.99”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [99] Conen D, Tedrow UB, Cook NR, Moorthy MV, Buring JE, Albert CM. Alcohol consumption and risk of incident atrial fibrillation in women. JAMA. 2008; 300: 2489– 2496. 19050192 PMC2630715 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    The effects of dietary fiber are best established, including lowering of serum triglycerides, LDL cholesterol, blood glucose, and blood pressure.

    “The effects of dietary fiber are best established, including lowering of serum triglycerides, LDL cholesterol, blood glucose, and BP.31,32”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [31] Anderson JW, Randles KM, Kendall CW, Jenkins DJ. Carbohydrate and fiber recommendations for individuals with diabetes: a quantitative assessment and meta-analysis of the evidence. J Am Coll Nutr. 2004; 23: 5– 17. 14963049 source

      Not checked in the free run.

    • cites [32] Whelton SP, Hyre AD, Pedersen B, Yi Y, Whelton PK, He J. Effect of dietary fiber intake on blood pressure: a meta-analysis of randomized, controlled clinical trials. J Hypertens. 2005; 23: 475– 481. 15716684 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Emerging evidence suggests that the effects of carbohydrate quality may be most relevant in the immediate postprandial period and among individuals more predisposed to insulin resistance.

    “Emerging evidence suggests that the effects of carbohydrate quality may be most relevant in the immediate postprandial period and among individuals more predisposed to insulin resistance.129–132”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [129] Livesey G, Taylor R, Hulshof T, Howlett J. Glycemic response and health: a systematic review and meta-analysis: relations between dietary glycemic properties and health outcomes. Am J Clin Nutr. 2008; 87: 258S– 268S. 18175766 source

      Not checked in the free run.

    • cites [130] Riccardi G, Rivellese AA, Giacco R. Role of glycemic index and glycemic load in the healthy state, in prediabetes, and in diabetes. Am J Clin Nutr. 2008; 87: 269S– 274S. 18175767 source

      Not checked in the free run.

    • cites [131] Thomas D, Elliott EJ. Low glycaemic index, or low glycaemic load, diets for diabetes mellitus. Cochrane Database Syst Rev. 2009;(1): CD006296. PMC6486008 19160276 source

      Not checked in the free run.

    • cites [132] O’Keefe JH, Gheewala NM, O’Keefe JO. Dietary strategies for improving post-prandial glucose, lipids, inflammation, and cardiovascular health. J Am Coll Cardiol. 2008; 51: 249– 255. 18206731 132a. Tappy L, Le KA. Metabolic effects of fructose and the worldwide increase in obesity. Physiol Rev. 2010; 90: 23– 46. 20086073 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Some evidence supports cardiovascular benefits of plant-derived omega-3 fats, but compared with seafood omega-3, the potency of plant-based omega-3 appears weaker, and mixed findings preclude strong conclusions.

    “Some evidence supports cardiovascular benefits of plant-derived omega-3 fats, but compared with naturally occurring omega-3 from seafood, the potency of plant-based omega-3 appears weaker, and mixed findings preclude strong conclusions.137,138”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [137] Mozaffarian D Does alpha-linolenic acid intake reduce the risk of coronary heart disease? A review of the evidence. Altern Ther Health Med. 2005; 11: 24– 30. 15945135

      Not checked in the free run.

    • cites [138] Kromhout D, Giltay EJ, Geleijnse JM; Alpha Omega Trial Group. n-3 Fatty acids and cardiovascular events after myocardial infarction. N Engl J Med. 2010; 363: 2015– 2026. 20929341 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § Components of a Cardioprotective Diet New Insights

    Most of these disease burdens are preventable and occur at unnecessarily younger ages, largely because of suboptimal lifestyle factors including poor diet, excess calories, inactivity, and smoking.

    “Most of these burdens are preventable and are occurring at unnecessarily younger ages, largely owing to suboptimal lifestyle, which includes poor diet quality, excess caloric intake, physical inactivity, and smoking.2–5”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [2] Danaei G, Ding EL, Mozaffarian D, Taylor B, Rehm J, Murray CJ, Ezzati M. The preventable causes of death in the United States: comparative risk assessment of dietary, lifestyle, and metabolic risk factors. PLoS Med. 2009; 6: e1000058. 19399161 PMC2667673 source

      Not checked in the free run.

    • cites [3] Popkin BM. Global nutrition dynamics: the world is shifting rapidly toward a diet linked with noncommunicable diseases. Am J Clin Nutr. 2006; 84: 289– 298. 16895874 source

      Not checked in the free run.

    • cites [4] Stampfer MJ, Hu FB, Manson JE, Rimm EB, Willett WC. Primary prevention of coronary heart disease in women through diet and lifestyle. N Engl J Med. 2000; 343: 16– 22. 10882764 source

      Not checked in the free run.

    • cites [5] Mozaffarian D, Kamineni A, Carnethon M, Djoussé L, Mukamal KJ, Siscovick DS. Lifestyle risk factors and new-onset diabetes mellitus in older adults: the Cardiovascular Health Study. Arch Intern Med. 2009; 169: 798– 807. 19398692 PMC2828342 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The benefits of fruits and vegetables might derive from a more complex set of micronutrients, phytochemicals, and fiber, enhanced bioavailability in natural state, and/or replacement of less healthful foods.

    “This evidence suggests that benefits might be derived from (1) a more complex set of micronutrients, phytochemicals, and fiber found in fruits and vegetables; (2) potentially enhanced bioavailability of these nutrients in their natural state; and/or (3) replacement of less healthful foods in the diet.”
    Quote in the paperSubstantial claim

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

    Premisecitation
    § Components of a Cardioprotective Diet New Insights

    The global burdens of cardiovascular disease, type 2 diabetes, and obesity are increasing and cause large losses of life and disability-adjusted life-years in both developed and developing countries.

    “The global burdens of cardiovascular diseases (CVD), type 2 diabetes mellitus (DM), and obesity are rising, producing enormous losses of life and disability-adjusted life-years in both developed and developing nations.1”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med. 2006; 3: e442. 17132052 PMC1664601 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    These findings are concordant with long-term observational studies of habitual fish intake and with physiological benefits of fish or fish oil in intervention studies.

    “Overall, these findings are concordant with long-term observational studies of habitual fish intake in generally healthy populations and with physiological benefits of fish or fish oil in intervention studies (Table 2).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationnone given

    Several constituents of red meats could increase cardiometabolic risk, including saturated fat, cholesterol, heme iron, and in processed meats, high levels of salt and other preservatives.

    “Several constituents of red meats could increase cardiometabolic risk, including SFA, cholesterol, heme iron, and in processed meats, high levels of salt and other preservatives.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Cardiovascular benefits of modest nut consumption are supported by effects on risk factors in short-term trials and by the magnitude and consistency of reduced CVD risk in prospective cohort studies.

    “Overall, cardiovascular benefits of modest nut consumption are supported by effects on risk factors in short-term trials and by the magnitude and consistency of reduced CVD risk observed in prospective cohort studies (Table 2).”
    Quote in the paperSubstantial claim

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

    Interpretationreasoning

    Legumes provide an overall package of micronutrients, phytochemicals, and fiber that could plausibly reduce cardiometabolic risk.

    “Legumes provide an overall package of micronutrients, phytochemicals, and fiber that could plausibly reduce cardiometabolic risk.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Health effects of whole grains may result from synergistic effects of multiple constituents and from dietary substitution for more refined carbohydrates and starches.

    “Thus, similar to fruits and vegetables, health effects of whole grains may result from synergistic effects of multiple constituents that are unlikely to be matched by supplemental fiber alone, added bran, or isolated micronutrients, as well as from dietary substitution for more highly refined/processed carbohydrates and starches that may themselves induce adverse cardiometabolic effects”
    Quote in the paperSubstantial claim

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

    Premisecitation

    Most dietary guidelines and scientific organizations recommend low-fat or nonfat dairy consumption based on lower content of calories, saturated fat, and cholesterol and no established nutritional advantage of whole-fat dairy.

    “On the basis of lower content of calories, SFA, and cholesterol, together with no established nutritional advantage of whole-fat dairy, most dietary guidelines and scientific organizations recommend low-fat or nonfat dairy consumption.10”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Dietary Guidelines Advisory Committee. 2010 Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans. US Department of Agriculture, Agricultural Research Service. http://www.cnpp.usda.gov/DGAs2010-DGACReport.htm. Accessed September 26, 2010.

      Not checked in the free run.

  • May combine two claims.

    Interpretationnone given

    Japanese diets often contain high sodium from soy sauce and added salt at home, likely contributing to the relatively high incidence of stroke and some cancers.

    “Conversely, Japanese diets often contain high sodium from soy sauce and added salt at home, likely contributing to the relatively high incidence of stroke and some cancers.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Appropriate energy balance and little age-related weight gain are important features of the Okinawan diet pattern.

    “Appropriate energy balance and little age-related weight gain are also important features of the Okinawan diet pattern.111”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [111] Willcox BJ, Willcox DC, Todoriki H, Fujiyoshi A, Yano K, He Q, Curb JD, Suzuki M. Caloric restriction, the traditional Okinawan diet, and healthy aging: the diet of the world’s longest-lived people and its potential impact on morbidity and life span. Ann N Y Acad Sci. 2007; 1114: 434– 455. 17986602 111a. Willcox DC, Willcox BJ, Todoriki H, Suzuki M The Okinawan diet: health implications of a low-calorie, nutrient-dense, antioxidant-rich dietary pattern low in glycemic load. J Am Coll Nutr. 2009; 28(suppl): 500S– 516S. 20234038 source

      Not checked in the free run.

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

    Premisenone given

    Diverse agricultural patterns, cultures, and countries bordering the Mediterranean Sea preclude defining any single Mediterranean dietary pattern or simple criteria.

    “Diverse agricultural patterns, cultures, and countries bordering the Mediterranean Sea preclude defining any single Mediterranean dietary pattern or simple criteria.”
    Quote in the paperNot a substantial claim

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

    Interpretationreasoning

    Because vegetarians are often generally more health conscious, other lifestyle characteristics, in addition to diet, could contribute to observed lower rates of CVD.

    “Because vegetarians are often generally more health conscious, other lifestyle characteristics, in addition to diet, could contribute to observed lower rates of CVD.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Japanese dietary patterns appear promising for CHD prevention, but the reasons for relatively high rates of stroke and some cancers require further investigation, and epidemiological and clinical trial evidence for benefits remains more limited than evidence supporting the DASH and Mediterranean diets.

    “Japanese dietary patterns appear promising for CHD prevention, but the reasons for relatively high rates of stroke and some cancers require further investigation, and epidemiological and clinical trial evidence for benefits remains more limited than evidence supporting the DASH and Mediterranean diets.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    Several characteristics of vegetarian diets could account for these relationships, including greater inclusion of plant-based foods and fewer meats, processed meats, and other processed and fast foods.

    “Several characteristics of vegetarian diets could account for these relationships, including greater inclusion of plant-based foods and fewer meats, processed meats, and other processed and fast foods.110c”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites 110c

      Not checked in the free run.

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

    Premisecitation

    A recent World Health Organization Expert Consultation recommended that all adults consume at least 250 mg/d EPA plus DHA from seafood.

    “and a recent World Health Organization Expert Consultation recommended that all adults consume at least 250 mg/d EPA plus DHA from seafood.11”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [11] Joint FAO/WHO expert consultation on fats and fatty acids in human nutrition: interim summary. Food and Agriculture Organization of the United Nations, World Health Organization. http://www.who.int/nutrition/topics/FFA_summary_rec_conclusion.pdf. Accessed September 22, 2010.

      Not checked in the free run.

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

    Premisecitation

    Nearly two thirds of strokes and half of coronary heart disease events are estimated to be attributable to elevated blood pressure.

    “Elevated BP is estimated to account for nearly two thirds of strokes and half of all CHD events.153”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [153] World Health Organization. World Health Report 2002: Reducing Risks, Promoting Healthy Life. Geneva, Switzerland: World Health Organization; 2002.

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

  • May combine two claims.

    Premisecitation

    If US salt intake were cut by 3 g/d nationally, an estimated 60,000-120,000 coronary heart disease events and 32,000-66,000 strokes could be prevented each year, with savings of 194,000-392,000 quality-adjusted life-years and $10-$24 billion in healthcare costs.

    “A national effort that reduced US salt intake by 3 g/d (~1.2 g/d less sodium) could annually prevent between 60 000 and 120 000 CHD events and 32 000 to 66 000 strokes, saving 194 000 to 392 000 quality-adjusted life-years and $10 to $24 billion in healthcare costs.160”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [160] Bibbins-Domingo K, Chertow GM, Coxson PG, Moran A, Lightwood JM, Pletcher MJ, Goldman L. Projected effect of dietary salt reductions on future cardiovascular disease. N Engl J Med. 2010; 362: 590– 599. 20089957 PMC3066566

      Not checked in the free run.

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

    Interpretationreasoning

    Some individuals can eat many calories yet maintain neutral or negative energy balance due to high expenditure, while others eat few calories but have positive energy balance because they expend little.

    “Some people may consume relatively high calories but have neutral or negative energy balance because of high expenditure, whereas others may consume relatively few calories but have positive energy balance because of low expenditure.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Overall, the evidence supports aggressive policy measures to reduce sodium intake as a way to prevent cardiovascular disease caused by high blood pressure.

    “Overall, the totality of evidence supports aggressive policy-level approaches to lower sodium intake as a means to prevent the CVD consequences of elevated BP.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Television watching, lower average sleep duration, socioeconomic status, race/ethnicity, local environments, advertising, social norms, and work and home dynamics are linked to energy imbalance.

    “These include television watching and lower average sleep duration, especially among children/adolescents; socioeconomic status and race/ethnicity; local environments, such as the presence of fast food restaurants, grocery stores, crime safety, parks or open spaces, and walking or biking paths; and influences of advertising, social norms, and work and home dynamics.”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites 87a

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

    • cites [182] Wansink B Mindless Eating: Why We Eat More Than We Think. New York, NY: Bantam Dell; 2006.

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

    • cites [183] Singh GK, Kogan MD, Van Dyck PC, Siahpush M. Racial/ethnic, socioeconomic, and behavioral determinants of childhood and adolescent obesity in the United States: analyzing independent and joint associations. Ann Epidemiol. 2008; 18: 682– 695. 18794009 source

      Not checked in the free run.

    • cites [184] Li F, Harmer P, Cardinal BJ, Bosworth M, Johnson-Shelton D, Moore JM, Acock A, Vongjaturapat N. Built environment and 1-year change in weight and waist circumference in middle-aged and older adults: Portland Neighborhood Environment and Health Study. Am J Epidemiol. 2009; 169: 401– 408. 19153214 PMC2726645 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given

    Appropriate energy balance is essential.

    “Appropriate energy balance is also essential, which will require sustained approaches that target dietary quality (types of foods/beverages consumed), portion sizes, television watching, physical activity, and local environments.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationnone given

    A large body of knowledge guides dietary priorities and behavior-change strategies for improving cardiometabolic health.

    “Although gaps in knowledge remain, a substantial knowledge base informs relevant dietary priorities and behavior-change strategies for improving cardiometabolic health.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In some developing nations, the recent obesity pandemic seems temporally linked to both higher consumption and lower expenditure.

    “Although the quality of available time-trend data is suboptimal, the recent obesity pandemic appears temporally related to increased energy consumption in developed nations90 and to both increased consumption and decreased expenditure in some developing nations.3”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] Popkin BM. Global nutrition dynamics: the world is shifting rapidly toward a diet linked with noncommunicable diseases. Am J Clin Nutr. 2006; 84: 289– 298. 16895874 source

      Not checked in the free run.

56 of 56

  • The paper relies on this without support.

    The populations and methods of the cited studies are sufficiently comparable to be synthesized into the review's conclusions.

    “Evidence for effects of dietary factors on cardiometabolic health was reviewed, often derived from recent comprehensive reviews performed for policy-making or similar activities, including those of the American Heart Association (AHA) 2020 Impact Goals Committee (D.M., L.J.A.),7 the AHA Nutrition Committee (D.M., L.J.A.,L.V.H.),8,9 the US Dietary Guidelines Advisory Committee (L.J.A.,L.V.H.),10”

  • The authors state this as an assumption.

    The Bradford Hill and similar criteria are appropriate for evaluating evidence on dietary habits and chronic diseases.

    “Several relevant criteria currently used to evaluate evidence for effects of dietary habits on chronic diseases were adopted, including those of Bradford Hill,14 the World Health Organization,15 and similar criteria.”

  • The paper relies on this without support.

    Monounsaturated fat comes from both animal and vegetable sources.

    “Also, because monounsaturated fat is derived from both animal (eg, meats and dairy) and vegetable (eg, olive oil, and canola) sources, health effects may plausibly vary depending on the types of foods consumed.”

  • The paper relies on this without support.

    The main determinant of weight gain and adiposity is energy balance.

    “Energy balance (calories consumed versus expended) is the principal determinant of weight gain and adiposity.”

  • The paper relies on this without support.

    Physical activity, body size, muscle mass, age, and sex determine basal and activity-related energy expenditure.

    “Basal and activity-related energy expenditure are determined by physical activity, body size, muscle mass, age, and sex.”

  • The paper relies on this without support.

    Diet-related prevention strategies are likely to be highly cost-effective for society in many cases.

    “Although many diet-related prevention strategies are likely to be highly cost-effective for society, most policy makers and medical systems remain focused on downstream treatments that use drugs, devices, and surgeries.”

  • The paper relies on this without support.

    Policy makers and medical systems mostly continue to focus on downstream treatments involving drugs, devices, and surgery.

    “Although many diet-related prevention strategies are likely to be highly cost-effective for society, most policy makers and medical systems remain focused on downstream treatments that use drugs, devices, and surgeries.”
7 of 7

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?

  • Two separate cost-effectiveness analyses estimated that population reductions in dietary salt would be cost-effective and cost-saving.

    “Two separate cost-effectiveness analyses estimated that population reductions in dietary salt would not only be cost-effective but actually cost-saving.118,119”

    From Heart Disease and Stroke Statistics—2013 Update: A Report From the American Heart Association (2013) · cites this paper as [118]

  • Specific foods and overall diet patterns, rather than single isolated nutrients, are important for cardiometabolic risk.

    “A second key lesson is the importance of specific foods and overall diet patterns, rather than single isolated nutrients, for cardiometabolic risk.8, 9”

    From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [19]

  • Evidence-informed beneficial diet patterns share several key characteristics: more minimally processed foods (fruits, nuts/seeds, vegetables excluding russet or white potatoes, legumes, whole grains, seafood, yogurt, vegetable oils) and fewer red meats, processed meats, refined grains, starches, and added sugars.

    “These include more minimally processed foods such as fruits, nuts/seeds, vegetables (excluding russet or white potatoes), legumes, whole grains, seafood, yogurt, and vegetable oils; and fewer red meats, processed (sodium-preserved) meats, refined grains, starches, and added sugars.”

    From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [19]

  • Both Mediterranean and DASH diet patterns improve a range of risk factors, reduce long-term weight gain, and are consistently associated with lower risk of clinical events.

    “Both Mediterranean and DASH diet patterns improve a range of risk factors, reduce long-term weight gain, and are consistently associated with lower risk of clinical events.19, 21, 27-29”

    From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [19]

  • Independent of calories and body weight, one's dietary pattern strongly influences metabolic dysfunction including risk of diabetes.

    “In addition, independent of calories and body weight, one's dietary pattern strongly influences metabolic dysfunction including risk of diabetes.19, 21”

    From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [19]

Cites

Flagged first, then by citations

7 of the 236 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. 10.1301/nr.2007.oct.439–450 · DOI
  2. World Health Organization. Interventions on Diet and Physical Activity: What Works. Geneva, Switzerland: WHO Press; 2009.

Cited by

Sorted by citations

Related

Authors
Mozaffarian, D., Appel, L. J., & Van Horn, L.
Affiliations
  • Northwestern University (US)
  • From the Division of Cardiovascular Medicine and Channing Laboratory, Brigham and Women's Hospital and Harvard Medical School, and Departments of Epidemiology and Nutrition, Harvard School of Public Health; Boston, MA (D.M.); Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD (L.J.A.); and Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (L.V.H.).
ORCID
Venue
Circulation
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2011-06-21
Volume
123
Issue
24
Pages
2870-2891
ISSN
  • 0009-7322 (ISSN-L)
  • 1524-4539
DOI
10.1161/circulationaha.110.968735
PMC
PMC6261290
OpenAlex
W2113495166
Semantic Scholar
607dd844822d67c850cb94cc9d621ebfae71bc14
Cited by
571
References
236
Citations by year
2026: 21 · 2025: 16 · 2024: 21 · 2023: 26 · 2022: 30 · 2021: 28 · 2020: 23 · 2019: 32 · 2018: 54 · 2017: 55 · 2016: 42 · 2015: 62 · 2014: 67 · 2013: 52 · 2012: 25
FWCI
49.07
Type
journal article
Language
en
Open access
Locations
  • Circulation (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • World Health Organization
  • Harvard University
  • National Heart, Lung, and Blood Institute (R01HL085710)
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
  • Health Sciences › Nursing › Nutrition and Dietetics › Fatty Acid Research and Health
Keywords
cardioprotective diet, food components, heart disease prevention, nutrition
MeSH terms
Cardiovascular Diseases, Feeding Behavior, Food, Health Promotion, Humans, Life Style, Risk Factors, Dietary Supplements

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 2026-10-07.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-07.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review