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C HAP TE R 36 / Lipid Management and Cardiovascular Disease 833

times each week is a safe and prudent alternative. Plants sterols and Dietary Recommendations
stanols at doses of 2 g/day or greater can lower LDL cholesterol by
9% to 14%. Studies on other additives, such as soy protein, soluble The goal of diet therapy is to reduce LDL cholesterol to desirable
fiber, antioxidants, and garlic, have been inconsistent and at best levels predicated by the person’s CVD risk status while maintain-
have shown very modest LDL (3% or less) reductions. 80 ing a nutritionally sound eating pattern. The most recent dietary
The marked increase in obesity of the U.S. population has recommendations from the American Heart Association include
89
been attributed to increased consumption of carbohydrates as re- both dietary and healthy lifestyle recommendations. The over-
placement for dietary fat and has further added to the diet con- arching recommendations call for (1) balancing calorie intake and
troversy. In an effort to reduce dietary fat, Americans frequently physical activity to achieve desirable weight, (2) consuming a diet
select low-fat manufactured products containing sugar rather than rich in fruits and vegetables, (3) using whole grain and high-fiber
choosing plant-based carbohydrate foods. This is evident in that foods, (4) consuming fish two or more times per week, (5) re-
s
s
the consumption of refined sugar has increased from 120 lb per stricting saturated fat to less than 7% of total calories, trans-fats to
person in 1970 to 150 lb per person in 1995, and fiber intake re- less than 1% of calories, and cholesterol intake to less than 300 mg/
mains low. 86 Even those researchers who advocated diets high in day, (6) use little or no salt, (7) restrict intake of sweetened bever-
monounsaturated fats are recommending lower consumption of ages and foods with added sugar, and (8) use alcohol only in mod-
refined carbohydrates and increased consumption of fruits and eration. The major change in these goals recognizes the impor-
vegetables similar to the Mediterranean dietary pattern and the tance of a balanced diet and contrary to the previous National
Dietary Approaches to Stop Hypertension (DASH) diet advo- Cholesterol Education Program (NCEP) (NCEP III) diet plan,
cated for persons with hypertension. 80,87,88 Taken together, the total fat intake is not restricted rather the quality of the fat is em-
2
above studies confirmed the effects of diet on blood lipids and phasized. These dietary recommendations are consistent with the
have influenced the current dietary guidelines. DASH and Mediterranean diets (see Table 36-9).

Table 36-9 ■ HEART HEALTHY DIETARY PLANS*
AHA Healthy Lifestyle † Mediterranean Diet ‡ DASH Diet §

Fats and oils Two to three servings a day Olive oil with each meal Two to three servings a day
Use vegetable or liquid oils. Examples: Used as the principal source of fat
1 tsp of soft margarine or vegetable oil. 25%–35% of total calories
2 tbsp mayonnaise.
Saturated fat: Less than 7% of daily calories Saturated fat: Less than 7% of daily Saturated fat: Less than 6% of daily
calories calories
s
s
Trans-fat Less than 1% of daily calories. Minimize use of Very low—likely due to the absence of Not specified
partially hydrogenated fats. hydrogenated foods
Lean meat, Less than 6 oz a day. Examples: grill or broil Meat: four to five servings a month 2 Servings a day
poultry, or fish meats, trim fat.
Fish intake 8 oz a week, particularly of oily fish. Poultry: one to three servings a week Includes eggs
Do not fry or serve with cream sauces. Fish: four to five servings a week
Whole grains Six to eight servings a day. Examples: 1 slice of Nonrefined whole grains—eight Seven to eight servings a day
1 1
⁄
⁄
bread, 1 oz dry cereal, ⁄2 cup cooked rice or servings a day Include at least three servings of
pasta. At least half of the grains should be whole grains a day
whole grains.
Nuts, seed, legumes Four to five servings a week. Examples: 2 tbsp Greater than four servings a week Four to five a week
1 1
1 1
⁄
peanut butter, or ⁄2 oz of seeds, ⁄2 cup of
⁄
⁄
⁄
dried peas or beans.
Vegetables Four to five servings a day. Examples: 1 cup of Two to three servings a day. Four to five servings a day
1 1
⁄
⁄
leafy greens, ⁄2 cup of raw or cooked vegetables Potatoes four to five servings a week
Fruits Four to five servings a day. Examples: 1 medium Four to six servings a day. Four to five a day
1 1
1 1
⁄
⁄
fruit, ⁄4 cup dried fruit, ⁄2 cup fruit juice
⁄
⁄
Fat-free or low-fat Two to three servings a day: Use only low or non- One to two servings a day Two to three servings a day: Use
dairy products fat products. Examples: 1 cup of milk, 1 cup White cheese and yogurt intake more only low or non-fat products.
1 1
⁄
⁄
of yogurt, 1 ⁄2 oz of hard cheese. common than milk.
Sweets and sugars Five or less servings a week. Limit beverages with One to three servings a week Limited
1 1
⁄
⁄
added sugar. Examples: ⁄2 cup of sorbets or
ices, 1 tbsp of jam, 1 tbsp sugar.
Alcohol If consumed, use in moderation: 1 drink for One to two wine servings a day— 1 oz a day men,
women, 2 for men. Examples: 4 oz wine, accompanying meals
1 1
1 1
⁄
⁄
12 oz beer , 1 ⁄2 oz spirits ⁄2 oz women
⁄
⁄
Dietary cholesterol 300 mg a day. Not specified 150 mg a day
*Serving size examples are based on a 2000 daily caloric intake and require adjustment for other calorie intakes.
†
American Heart Association Nutrition Committee, Lichtenstein, A. H., Appel, L. J., Brands, M., et al. (2006). Diet and Lifestyle Recommendations revision 2006: A scientific state-
ment from the American Heart Association Nutrition Committee. Circulation, 114, 82–96.
4
4
‡
Willett, W. C., Sacks, F., Trichopoulou, A., et al. (1995). Mediterranean diet pyramid: A cultural model for healthy eating. American Journal of Clinical Nutrition, 61, 1402S–1406S.
§
Dietary Approaches to Stop Hypertension Diet available at: http://www.nhlbi.nih.gov/health/bublic/heart/hbp/dash/new_dash.pdf