Diet and Lifestyle Recommendations Revision 2006

Improving diet and life style is a critical part of the American Heart Association ’ sulfur strategy for cardiovascular disease risk decrease in the general population. This document presents recommendations designed to meet this objective. specific goals are to consume an overall goodly diet ; aim for a healthy torso weight ; target for recommend levels of low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides ; target for normal blood imperativeness ; aim for a normal lineage glucose level ; be physically active ; and avoid function of and exposure to tobacco products. The recommendations are to balance thermal intake and physical activeness to achieve and maintain a healthy body weight ; consume a diet rich in vegetables and fruits ; choose whole-grain, high-fiber foods ; consume fish, specially oily fish, at least twice a week ; limit intake of saturate fat to < 7 % of department of energy, trans fatness to < 1 % of energy, and cholesterol to < 300 mg/day by choosing lean meats and vegetable alternatives, nonfat ( skim ) or low-fat ( 1 % adipose tissue ) dairy products and minimize consumption of partially hydrogenated fats ; minimize inhalation of beverages and foods with add sugars ; choose and prepare foods with little or no salt ; if you consume alcohol, do so in easing ; and when you eat food disposed outside of the home, follow these Diet and Lifestyle Recommendations. By adhering to these diet and life style recommendations, Americans can well reduce their risk of developing cardiovascular disease, which remains the leading campaign of morbidity and mortality in the United States. Improving diet and life style is a critical component of the American Heart Association ’ south ( AHA ’ s ) scheme to prevent cardiovascular disease ( CVD ), the leading cause of unwholesomeness and mortality in Americans. This document presents diet and life style recommendations designed to meet this objective. respective features distinguish this set of recommendations from previous AHA Dietary Guideline versions : ( 1 ) Recognizing that diet is separate of an overall goodly life style, Lifestyle has been added to the entitle. ( 2 ) The 2006 recommendations incorporate new scientific evidence that has emerged after issue of the last rig of guidelines in 2000. 1 ( 3 ) The 2006 recommendations have been reformatted so that they are more well silent. ( 4 ) A department raising awareness about environmental influences on CVD health behaviors has been included. ( 5 ) Practical guidance on how to achieve diet and life style changes is provided. ( 6 ) The importance of following the recommendations when eating at base and away from home plate is emphasized. ( 7 ) The full of life roles of healthcare professionals, restaurants, the food diligence, schools, and local policies are highlighted, along with specific recommendations to these groups. This last have and the focus on CVD prevention are the star differences between these recommendations and those from the US Departments of Agriculture and Health and Human Services. 2 consistent with the strategic design of the AHA, the 2006 AHA Diet and Lifestyle Recommendations are one part of a comprehensive plan to achieve specific goals for cardiovascular risk reduction ( mesa 1 ). The recommendations ( table 2 ) are allow for the general public, including adults and children over 2 years of age. separate AHA dietary guidelines specifically addressing the special needs of growing children have recently been published. 3 The AHA 2006 Diet and Lifestyle Recommendations are intentionally compromising to meet the unique needs for growth, growth, and aging.

TABLE 1. AHA 2006 Diet and Lifestyle Goals for Cardiovascular Disease Risk Reduction• Consume an overall healthy diet.• Aim for a healthy body weight.• Aim for recommended levels of low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides.• Aim for a normal blood pressure.• Aim for a normal blood glucose level.• Be physically active.• Avoid use of and exposure to tobacco products. TABLE 2. AHA 2006 Diet and Lifestyle Recommendations for Cardiovascular Disease Risk Reduction• Balance calorie intake and physical activity to achieve or maintain a healthy body weight.• Consume a diet rich in vegetables and fruits.• Choose whole-grain, high-fiber foods.• Consume fish, especially oily fish, at least twice a week.• Limit your intake of saturated fat to <7% of energy, trans fat to <1% of energy, and cholesterol to <300 mg per day by    — choosing lean meats and vegetable alternatives;    — selecting fat-free (skim), 1%-fat, and low-fat dairy products; and    — minimizing intake of partially hydrogenated fats.• Minimize your intake of beverages and foods with added sugars.• Choose and prepare foods with little or no salt.• If you consume alcohol, do so in moderation.• When you eat food that is prepared outside of the home, follow the AHA Diet and Lifestyle Recommendations. evidence cited in this report is drawn from many authoritative documents, including previous AHA scientific statements and other evidence-based reviews, a well as germinal studies and home surveys .

Contents

Public Health and Clinical Application of AHA Diet and Lifestyle Recommendations

Public Health Recommendations

The AHA has traditionally provided dietary recommendations and recommendations for an overall healthy life style to the american english populace with the finish of reducing hazard for CVD, the No. 1 cause of death of Americans. Maintaining a healthy diet and life style offers the greatest potential of all known approaches for reducing the risk for CVD in the general public. This is still true in hurt of major advances in clinical medicate. The recommendations contained in this document provide a foundation for a public health approach to CVD hazard reduction through healthy eat habits and other life style factors. In recent years, fleshiness has emerged as a major nutritional trouble in the United States. For this reason, this document contains expanded information on nutrition and physical activeness approaches to preventing or managing fleshiness and minimizing its complications .

Clinical Recommendations

The general recommendations contained in this document generally can be applied to the clinical management of patients with or at risk for CVD. For certain patients at higher hazard, the recommendations may have to be intensified. Although great advances have been made in prevention and treatment of CVD through drug therapies and procedures, diet and life style therapies remain the basis of clinical treatment for prevention. unfortunately, the latter normally are neglected, to the detriment of patients. rigorous application of the principles of diet and life style intervention outlined in this document to patients at gamble will contribute significantly to risk reduction and will augment the benefit that may be obtained by other approaches. The clinical access is an elongation of the populace health access, with some modifications depending on the type of affected role .

Goals

The AHA Diet and Lifestyle Goals are intended to reduce CVD hazard ( table 1 ). They provide guidance for adults and children over the historic period of 2 years .

Consume an Overall Healthy Diet

Although the huge majority of inquiry studies have focused on person nutrients and foods, it is well recognized that multiple dietary factors influence the gamble of developing CVD and its major risk factors. To a much lesser extent, research has examined the health effects of the solid diet ; both experimental studies and clinical trials. These data have documented that goodly dietary patterns are associated with a substantially reduced risk of CVD, 4 CVD hazard factors, 5,6 and noncardiovascular diseases. 7 An stress on whole diet is besides appropriate to ensure nutrient sufficiency and energy balance. 2 Hence, rather than focusing on a one alimentary or food, individuals should aim to improve their hale or overall diet. consistent with this principle, the AHA recommends that individuals consume a variety of fruits, vegetables, and texture products, specially whole grains ; choose nonfat and low-fat dairy products, legumes, poultry, and list meats ; and eat pisces, preferably greasy fish, at least doubly a week ( table 2 ) .

Aim for a Healthy Body Weight

A goodly body weight is presently defined as a body mass index ( BMI ) of 18.5 to 24.9 kg/m2. Overweight is a BMI between 25 and 29.9 kg/m2, and fleshiness is a BMI ≥30 kg/m2. In the United States, achieving and maintaining a goodly weight throughout life is peculiarly difficult. presently, about one third of adults are corpulence, and an extra one third are corpulent. 8,9 The prevalence of fleshy and fleshiness has increased dramatically over the past 20 years, and the problem has now reached epidemic proportions. 9,10 Of particular business is that this vogue has shown no signs of abating. Obesity is an independent risk agent for CVD. 11 excess body weight adversely affects CVD hazard factors ( eg, increasing low-density lipoprotein [ LDL ] cholesterol levels, triglyceride levels, blood pressure [ BP ], and rake glucose levels, and reducing high-density lipoprotein [ HDL ] cholesterol levels ) and increases the risk of developing coronary thrombosis heart disease ( CHD ), heart failure, stroke, and cardiac cardiac arrhythmia. The causes of this dramatic population-wide addition in corpulence and fleshiness are multifactorial. implicated factors include increased part sizes ; high–calorie-density foods ; slowly access to plentiful, cheap food ; sedentary life style ; and commercial and cultural influences that, in aggregate, encourage calorie consumption in excess of calorie use. No one divisor appears creditworthy for the epidemic. Hence, the optimum scheme to retard the epidemic must alike be multifactorial. Achieving and maintaining a healthy system of weights throughout the biography cycle are critical factors in reducing CVD risk in the cosmopolitan population. Data argue 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 It is authoritative to intensify efforts in the general population to help individuals avoid inappropriate weight reach during childhood and subsequent weight gain during pornographic years. Increased vehemence should be put on prevention of slant advance, because accomplishment and alimony of burden loss, although surely potential, require more unmanageable behavioral changes ( internet explorer, greater calorie reduction and more physical activeness ) than prevention of weight gain in the first set. 13,14

Aim for a Desirable Lipid Profile

LDL, which is the major cholesterol-carrying lipoprotein particle in plasma, is primarily derived from lipoprotein particles made by the liver. As levels of LDL cholesterol increase, indeed does the hazard of developing CVD. 15 low-density lipoprotein levels are classified as follows : optimum, < 100 mg/dL ; near or above optimum, 100 to 129 mg/dL ; boundary line high, 130 to 159 mg/dL ; high, 160 to 189 mg/dL ; and very gamey, ≥190 mg/dL. 15 Among non-Hispanic whites living in the United States, 17 % of women and 20 % of men have LDL cholesterol levels > 160 mg/dL. 9 Corresponding estimates for non-Hispanic blacks are 19 % of women and 19 % of men, and for mexican Americans, 14 % of women and 17 % of men. 9 current recommendations for LDL cholesterol goals depend on the estimated 10-year risk of developing CVD and the presence of CVD-related gamble factors. 15 Although drug therapy is often prescribed for those at chasten or high risk, dietary changes are recommended for all individuals. The strongest dietary determinants of promote LDL cholesterol concentrations are dietary saturated fatso acid and trans fatty acid intakes. Trans fatso acids tend to increase LDL cholesterol levels slenderly less than saturated fatty acids, whereas saturated fatso acids increase HDL cholesterol concentrations but trans fatso acids do not. 16 To a lesser extent, dietary cholesterol and surfeit body system of weights are positively related to levels of LDL cholesterol. 15 HDL cholesterol and triglycerides are early plasma lipid measures related to CVD gamble that can be affected by diet and body weight. 17,18 The assiduity of HDL cholesterol is inversely associated with the gamble of developing CVD. 15 This association is thought to be mediated by a constellation of events jointly referred to as reversion cholesterol transport—the conveyance of cholesterol from peripheral tissues to the liver for subsequent metabolism or body waste. HDL directly protects against the development of atherosclerosis. The major nongenetic determinants of first gear HDL cholesterol levels are hyperglycemia, diabetes, hypertriglyceridemia, identical low-fat diets ( < 15 % energy as fatten ), and overindulgence body weight. 17 Although at this time there are no HDL cholesterol goals as there are for LDL cholesterol, levels < 50 mg/dL in women and < 40 mg/dL in men are considered one of the criteria for the classification of metabolic syndrome. 15 Likewise, although at this time there are no triglyceride goals, levels > 150 mg/dL are considered one of the criteria for the categorization of metabolic syndrome. 15 In general, a chasten inverse relationship exists between triglyceride and HDL cholesterol concentrations, and determinants of high triglycerides are chiefly the like as those of depleted HDL cholesterol. 17

Aim for a Normal Blood Pressure

A convention BP is a systolic BP < 120 millimeter Hg and a diastolic BP < 80 millimeter Hg. BP is a strong, coherent, continuous, independent, and etiologically relevant risk factor for cardiovascular-renal disease. notably, no testify of a BP doorway exists—that is, the risk of CVD increases increasingly throughout the roll 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 Hence, efforts to reduce BP to normal levels are warranted, even among individuals with prehypertension. According to the most late National Health and Nutrition Examination Survey ( NHANES ) ( 1999–2000 ), 27 % of pornographic Americans have high blood pressure ( systolic BP ≥140 millimeter Hg, diastolic BP ≥90 millimeter Hg, or habit of antihypertensive medicine ), and another 31 % have prehypertension. 20 It has been estimated that among adults > 50 years of age, the life hazard of developing high blood pressure approaches 90 %. On average, blacks have higher BP than do nonblacks, american samoa well as an increased risk of BP-related complications. Elevated BP results from environmental factors, familial factors, and interactions among these factors. Of the environmental factors that affect BP ( internet explorer, diet, physical inactivity, toxins, and psychosocial factors ), dietary factors have a outstanding, and probably prevailing, function. A substantial body of evidence powerfully supports the concept that multiple dietary factors affect BP. 21 dietary modifications that lower BP are reduced salt intake, thermal deficit to induce weight loss, moderation of alcohol consumption ( among those who drink ), increased potassium inhalation, and pulmonary tuberculosis of an overall healthy diet, based on the DASH ( Dietary Approaches to Stop Hypertension ) diet. 5 The latter is a carbohydrate-rich diet that emphasizes fruits, vegetables, and low-fat dairy products ; includes whole grains, poultry, fish, and nuts ; and is reduced in fats, red kernel, sweets, and sugar-containing beverages. surrogate of some carbohydrates with either protein from plant sources or with monounsaturated fat can further lower BP. 6

Aim for a Normal Blood Glucose Level

A normal fast glucose level is ≤100 mg/dL, whereas diabetes is defined by a fast glucose level ≥126 mg/dL. Hyperglycemia and the often-associated insulin resistance are related to numerous cardiovascular complications, including CHD, stroke, peripheral vascular disease, cardiomyopathy, and heart failure. Type 2 diabetes is the most common form of diabetes. Reducing caloric intake and increasing forcible natural process to achieve even a meek weight loss can decrease insulin resistance and improve glucose dominance and the accompaniment metabolic abnormalities. In nondiabetic individuals, weight passing and increase physical activity can delay the onset of and possibly prevent diabetes. 22,23

Be Physically Active

unconstipated physical activity is all-important for maintaining physical and cardiovascular fitness, maintaining healthy system of weights, and sustaining weight loss once achieved. 24 stream estimates indicate that 61 % of US adults do not engage in any regular physical activity. 9 A sedentary life style is associated with older old age and is more park among hispanic or Latino and black adults than among white adults. even physical activeness improves cardiovascular risk factors ( BP, lipid profiles, and lineage boodle ) and lowers the risk of developing other chronic diseases, including type 2 diabetes, osteoporosis, fleshiness, depression, and cancer of the front and colon. 25

Avoid Use of and Exposure to Tobacco Products

On the basis of the consuming evidence for the adverse effects of tobacco products and secondary coil exposure to tobacco smoke on CVD, vitamin a well as cancer and other unplayful illness, the AHA powerfully and unambiguously endorses efforts to eliminate the use of tobacco products and minimize exposure to second-hand fastball. 26–28 about 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 Because cessation of smoking in accustomed smokers can be associated with system of weights gain, especial attention should be given to preventing this result. 29 concern about weight gain should not be a cause for continued use of tobacco products .

AHA Diet and Lifestyle Recommendations

The AHA 2006 Diet and Lifestyle Recommendations ( Table 2 ) are intended to reduce CVD gamble. These recommendations are intentionally presented in a manner that allows maximal flexibility in their implementation among a group of individuals with a wide range of dietary preferences and to meet the unique needs for growth, development, and aging. They are not presented as a “ diet plan, ” per selenium, but rather a life style prescription drug to promote cardiovascular health. virtual approaches for implementing these recommendations are presented in postpone 3. Two examples of eating patterns at 2000 calories per day that meet the AHA 2006 Diet and Lifestyle Recommendations are presented in table 4. The 2 examples provide a general framework to aid health practitioners in giving general, practical food-group–based guidance. The example of 2000 calories is provided for consistency with the Nutrition Facts Panel. For individuals who consume more or less than 2000 calories, appropriate adjustments in number of servings per day that are coherent with achieving and maintaining a healthy body weight should be made . TABLE 3. Practical Tips to Implement AHA 2006 Diet and Lifestyle RecommendationsLifestyle    • Know your caloric needs to achieve and maintain a healthy weight.    • Know the calorie content of the foods and beverages you consume.    • Track your weight, physical activity, and calorie intake.    • Prepare and eat smaller portions.    • Track and, when possible, decrease screen time (eg, watching television, surfing the Web, playing computer games).    • Incorporate physical movement into habitual activities.    • Do not smoke or use tobacco products.    • If you consume alcohol, do so in moderation (equivalent of no more than 1 drink in women or 2 drinks in men per day).Food choices and preparation    • Use the nutrition facts panel and ingredients list when choosing foods to buy.    • Eat fresh, frozen, and canned vegetables and fruits without high-calorie sauces and added salt and sugars.    • Replace high-calorie foods with fruits and vegetables.    • Increase fiber intake by eating beans (legumes), whole-grain products, fruits, and vegetables.    • Use liquid vegetable oils in place of solid fats.    • Limit beverages and foods high in added sugars. Common forms of added sugars are sucrose, glucose, fructose, maltose, dextrose, corn syrups, concentrated fruit juice, and honey.    • Choose foods made with whole grains. Common forms of whole grains are whole wheat, oats/oatmeal, rye, barley, corn, popcorn, brown rice, wild rice, buckwheat, triticale, bulgur (cracked wheat), millet, quinoa, and sorghum.    • Cut back on pastries and high-calorie bakery products (eg, muffins, doughnuts).    • Select milk and dairy products that are either fat free or low fat.    • Reduce salt intake by        —comparing the sodium content of similar products (eg, different brands of tomato sauce) and choosing products with less salt;        —choosing versions of processed foods, including cereals and baked goods, that are reduced in salt; and        —limiting condiments (eg, soy sauce, ketchup).    • Use lean cuts of meat and remove skin from poultry before eating.    • Limit processed meats that are high in saturated fat and sodium.    • Grill, bake, or broil fish, meat, and poultry.    • Incorporate vegetable-based meat substitutes into favorite recipes.    • Encourage the consumption of whole vegetables and fruits in place of juices. TABLE 4. Two Examples of Daily Dietary Patterns That Are Consistent With AHA-Recommended Dietary Goals at 2000 CaloriesEating PatternDASH*TLC†Serving Sizes*Dietary Approaches to Stop Hypertension. For more information, please visit http://www.nhlbi.nih.gov/health/public/heart/hbp/dash.†Therapeutic Lifestyle Changes. For more information, please visit http://www.nhlbi.nih.gov/cgi-bin/chd/step2intro.cgi. TLC includes 2 therapeutic diet options: Plant stanol/sterol (add 2 g per day) and soluble fiber (add 5 to 10 g per day).‡Whole-grain foods are recommended for most grain servings to meet fiber recommendations.§This number can be less or more depending on other food choices to meet 2000 calories.¶Equals ½ to 1¼ cups, depending on cereal type. Check the product’s Nutrition Facts Label.∥Lean cuts include sirloin tip, round steak, and rump roast; extra lean hamburger; and cold cuts made with lean meat or soy protein. Lean cuts of pork are center-cut ham, loin chops, and pork tenderloin.#Fat content changes serving counts for fats and oils: For example, 1 Tbsp of regular salad dressing equals 1 serving; 1 Tbsp of low-fat dressing equals ½ serving; 1 Tbsp of fat-free dressing equals 0 servings.Grains‡6 to 8 servings per day7 servings§ per day1 slice bread; 1 oz dry cereal¶; ½ cup cooked rice, pasta, or cerealVegetables4 to 5 servings per day5 servings§ per day1 cup raw leafy vegetable, ½ cup cut-up raw or cooked vegetable, ½ cup vegetable juiceFruits4 to 5 servings per day4 servings§ per day1 medium fruit; ¼ cup dried fruit; ½ cup fresh, frozen, or canned fruit; ½ cup fruit juiceFat-free or low-fat milk and milk products2 to 3 servings per day2 to 3 servings per day1 cup milk, 1 cup yogurt, 1½ oz cheeseLean∥ meats, poultry, and fish<6 oz per day≤5 oz per dayNuts, seeds, and legumes4 to 5 servings per weekCounted in vegetable servings.⅓ cup (1½ oz), 2 Tbsp peanut butter, 2 Tbsp or ½ oz seeds, ½ cup dry beans or peasFats and oils2 to 3 servings# per dayAmount depends on daily calorie level1 tsp soft margarine, 1 Tbsp mayonnaise, 2 Tbsp salad dressing, 1 tsp vegetable oilSweets and added sugars5 or fewer servings per weekNo recommendation1 Tbsp sugar, 1 Tbsp jelly or jam, ½ cup sorbet and ices, 1 cup lemonade Although the recommendations confront guidance about specific nutrients and types of foods, the importance of an overall healthy diet and life style can not be overemphasized. multiple dietary factors influence CVD risk, and not all do so via changes in the risk factors described above. Hence, CVD benefit is likely to accrue by attachment to a healthy diet and lifestyle even if these gamble factors are not markedly altered. Although the Food and Drug Administration ( FDA ) has sanctioned health claims for sealed nutrients and foods, a focus on the overall diet is preferred over a specific focus on individual dietary components. This is, in separate, due to the overarching finish of achieving energy remainder and alimentary adequacy. If a specific food or class of foods is added to, rather than used to displace, early food from the diet ( eg, as a result of an FDA title or fresh research determination ), then the extra calories can lead to weight gain .

Balance Calorie Intake and Physical Activity to Achieve or Maintain a Healthy Body Weight

To avoid burden advance after childhood, individuals must control calorie intake so that energy balance is achieved—that is, energy intake matches energy outgo. To control calorie intake, individuals should increase their awareness of the calorie content of foods and beverages per parcel consumed and should control parcel size. 30 The macronutrient composing of a diet ( i, the sum of fatten, carbohydrate, and protein ) has little effect on energy libra unless macronutrient manipulation influences total energy inhalation or outgo. 30 While reducing thermal consumption, individuals should adopt and maintain a diet consistent with recommendations in this document ( table 2 ). A physically active life style is recommended to reduce risk for CVD in all individuals, regardless of consistency weight. 13 regular physical activity besides reduces symptoms in patients with established CVD. Among individuals who are corpulence or corpulent, regular forcible activity along with calorie restriction is recommended as a mean to achieve weight loss. regular day by day physical action has been shown to be particularly effective in maintaining slant loss once achieved. 14 The AHA recommends that all adults accumulate ≥30 minutes of physical activity most days of the workweek. extra benefits will likely be derived if activity levels exceed this minimum recommendation. At least 60 minutes of forcible bodily process most days of the week is recommended for adults who are attempting to lose slant or maintain weight loss and for children. The physical activeness can be accumulated throughout the day. It is not easy for individuals to achieve these goals. however, it is crucial to encourage behaviors that will facilitate achieve and maintaining these goals over clock. Achieving a physically active life style requires effective time management, with a particular focus on reducing sedentary activities such as filmdom time ( eg, watching television, surfing the Web, playing computer games ) and making daily choices to move preferably than be moved ( eg, taking the stairs rather of the elevator ) .

Consume a Diet Rich in Vegetables and Fruits

Most vegetables and fruits are rich in nutrients, low in calories, and high in fiber. therefore, diets high in vegetables and fruits meet micronutrient, macronutrient, and fiber requirements without adding substantially to overall energy consumption. Whether it is the vegetables and fruits themselves or the absence of other foods displaced from the diet that is associated with CVD risk reduction has so far to be determined. Regardless, diets rich in vegetables and fruits have been shown to lower BP and improve other CVD risk factors in short-run randomized trials. 5,6,31 In longitudinal observation studies, persons who regularly consume such diets are at a lower gamble of developing CVD, particularly stroke. 32,33 A variety show of vegetables and fruits are recommended. Vegetables and fruits that are deeply colored throughout ( eg, spinach, carrots, peaches, berries ) should be emphasized because they tend to be higher in micronutrient contented than are other vegetables and fruits such as potatoes and corn. Fruit juice is not equivalent to the solid fruit in character content and possibly satiety value and should not be emphasized. A diet deep in vegetables and fruits is a strategy for lowering the energy concentration of the diet to control energy consumption. equally important is the method of readiness. Techniques that preserve nutrient and fiber content without adding unnecessary calories, saturated or trans fatten, sugar, and salt are recommended ( table 3 ) .

Choose Whole-Grain, High-Fiber Foods

Dietary patterns that are high gear in whole-grain products and fiber have been associated with increased diet quality and decreased risk of CVD. 34 soluble or syrupy fibers ( notably β-glucan and pectin ) modestly reduce LDL cholesterol levels beyond those achieved by a diet moo in saturated and trans fatso acids and cholesterol alone. 35 insoluble character has been associated with decrease CVD risk 36–38 and slower progress of CVD in bad individuals. 39 dietary fiber may promote repletion by slowing gastric empty, leading to an overall decrease in calorie intake. 40,41 soluble roughage may increase short-chain fatty acid synthesis, thereby reducing endogenous cholesterol production. 41 The AHA recommends that at least half of grain intake come from solid grains .

Consume Fish, Especially Oily Fish, at Least Twice a Week

fish, specially oily fish, is rich in identical long-chain omega-3 fatty acid polyunsaturated fatso acids : eicosapentaenoic acid, C20:5n-3 ( EPA ) and docosahexaenoic acid, C22:6n-3 ( DHA ). The pulmonary tuberculosis of 2 servings ( & 8 ounces ) per workweek of pisces high in EPA and DHA is associated with a abridge gamble of both sudden end and death from coronary thrombosis artery disease in adults. 42,43 In addition to providing EPA and DHA, regular fish consumption may facilitate the displacement of other foods higher in saturated and trans fatso acids from the diet, such as fatso meats and full-fat dairy products. Methods used to prepare pisces should minimize the addition of saturated and trans fatso acids, as occurs with the practice of cream sauces or hydrogenated fatness during fry. contamination of certain pisces with methyl mercury, polychlorinated biphenyls, and other organic compounds is a electric potential business. 44 Subgroups of the population, primarily children and fraught women, are advised by the FDA to avoid eating those fish with the potential for the highest degree of mercury contamination ( eg, shark, swordfish, king mackerel, or tilefish ), eat up to 12 ounces ( 2 average meals ) per week of a kind of fish and mollusk that are lower in mercury ( eg, canned light tuna, salmon, pollock, catfish ), and check local advisories about the base hit of fish caught by kin and friends in local lakes, rivers, and coastal areas. 45 potential exposure to some contaminants can be reduced by removing the skin and open fat from these fish before cooking. For middle-aged and older men and postmenopausal women, the benefits of pisces consumption far outweigh the likely risks when amounts of fish are eaten within the recommendations established by the FDA and Environmental Protection Agency. Consumers should besides check with local and department of state authorities about types of pisces and watersheds that may be contaminated and the FDA Web locate for the most up-to-date information on recommendations for specific subgroups of the US populations ( eg, children, meaning women ) .

Limit Your Intake of Saturated and Trans Fat and Cholesterol

As a fix of goals, the AHA recommends intakes of < 7 % of energy as saturated fatten, < 1 % of energy as trans fat, and < 300 milligram cholesterol per day. These goals can be achieved by ( 1 ) choosing tilt meats and vegetable alternatives ; ( 2 ) selecting nonfat ( skim ), 1 % -fat, and low-fat dairy products ; and ( 3 ) minimizing consumption of partially hydrogenated fats. Diets depleted in saturated and trans fatty acids and cholesterol reduce the risk of CVD, in big part through their effects on LDL cholesterol levels. For all long time groups of the US population, in 1999 to 2000, the casual mean share of calories from saturated fats was 11.2. 46 In those lapp years, modal cholesterol intakes for men and women ages 20 to 74 years were 341 mg and 242 milligram, respectively. 46 The mean trans fatso acid intake has been estimated to be & 2.7 % of energy. 47 This act should only be considered a crude estimate because it is likely current intakes are shifting, in character prompted by the new trans fatty acid labeling necessity. Subgroups within the population are likely to have higher or lower intakes based on their accustomed dietary practices. In the current US diet, the major sources of impregnate fatso acids are animal fats ( kernel and dairy ), and the primary sources of trans fatso acids are partially hydrogenated fats used to prepare commercially fry and bake products. major sources of dietary cholesterol are foods of animal origin ( eggs, dairy, and kernel ). Saturated and trans fatty acid intakes are directly related to LDL cholesterol levels. 48–50 Increased dietary cholesterol consumption besides raises LDL cholesterol concentrations. Efforts to reduce saturated adipose tissue and cholesterol typically trust on surrogate of animal fats with unsaturated fats ( polyunsaturated and monounsaturated fats ) and on choice of lower-fat versions of foods ( eg, replacing full-fat dairy products with nonfat or low-fat versions ). Replacing meats with vegetable alternatives ( eg, beans ) or fish is one scheme to replace saturated fats with unsaturated fats and reduce the cholesterol content. In view of the positive linear kinship among dietary saturated fat, LDL cholesterol, and CVD risk, and current US intakes, the AHA nowadays recommends a population-wide goal of < 7 % of energy. Efforts to reduce trans fatty acids typically trust on the substitution of partially hydrogenated fats with those made with liquid vegetable oils ( with the exception of tropical fats ). With the initiation of compulsory trans fat labeling on January 1, 2006, it is easier for consumers to identify and limit their trans fatty acid intake. however, even if partially hydrogenated fats were removed from the food add, it is estimated that trans fats however would represent & 1 % of the calories because some trans fatso acids are produced from deodorization of vegetable oils and because meat and dairy products contain naturally occurring trans fatty acids. 50 There are presently no numeric goals for trans fat. The Institute of Medicine recommends limiting trans fat intake arsenic much as possible, 48 and both the 2005 Dietary Guidelines Advisory Committee and a holocene FDA Food Advisory Committee, Nutrition Subcommittee, recommended that the inhalation of trans fat be ≤1 % of energy. 50,51 ( The FDA subcommittee voted [ 6 yes, 1 abstaining ] in party favor of the recommendation. ) For this argue, the AHA recommends the goal of a diet containing < 1 % trans fatso acids. The relative health effects of polyunsaturated and monounsaturated fats are actively debated. A few clinical result trials have documented that replacement of impregnate adipose tissue with polyunsaturated fats reduces the risk of developing CHD, whereas prospective experimental studies have documented that diets rich in monounsaturated fats are associated with a reduce hazard of CHD. The AHA supports the recommendations of the Institute of Medicine and the National Cholesterol Education Program for sum fat. A range of 25 % to 35 % for full fatten is an appropriate level of inhalation in a healthy dietary form .

Minimize Your Intake of Beverages and Foods With Added Sugars

Over the past few decades, the consumption of beverages and foods with total sugars has risen markedly. The inhalation of lend sugars ( sucrose, corn whiskey syrup, and high-fructose corn syrup ) increased from 13.1 % of energy during the period 1977 to 1978 to 16.6 % of energy during 1999 to 2002. 52,53 The primary reasons for reducing the intake of beverages and foods with add sugars are to lower sum calorie consumption and promote food sufficiency. 54 Individuals who consume large amounts of beverages with total sugars tend to consume more calories and advance burden. 55–57 Some tell suggests that calories consumed as liquid are not ampere satiating as calories consumed as solid food. 58 This factor may negatively affect attempts to achieve and maintain a healthy body weight .

Choose and Prepare Foods With Little or No Salt

On average, as salt ( sodium chloride ) inhalation increases, thus does BP. 59,60 A reduce sodium inhalation can prevent high blood pressure in nonhypertensive individuals, can lower BP in the mount of antihypertensive medicine, and can facilitate high blood pressure control. A reduced sodium consumption is associated with a blunted age-related ascend in systolic BP and a reduce hazard of atherosclerotic cardiovascular events and congestive heart bankruptcy. In general, the effects of sodium reduction on BP tend to be greater in blacks ; middle-aged and older-aged persons ; and individuals with high blood pressure, diabetes, or chronic kidney disease ( CKD ). Diets rich in potassium lower BP and besides blunt the BP-raising effects of an increased sodium intake. 59 Because of the progressive dose-response kinship between sodium inhalation and BP, it is unmanageable to set a commend upper level of sodium inhalation, which could be american samoa low as 1.5 g/d ( 65 mmol/d ). however, in view of the available high-sodium food provide and the presently high levels of sodium pulmonary tuberculosis, a reduction in sodium consumption to 1.5 g/d ( 65 mmol/d ) is not easily accomplishable at present. In the interim, an accomplishable recommendation is 2.3 g/d ( 100 mmol/d ) .

If You Consume Alcohol, Do So in Moderation

Moderate alcohol intake has been associated with reduce cardiovascular events in many populations. 2 This affiliation is not merely found with wine but besides with other alcoholic beverages. 61,62 Unlike early potentially beneficial dietary components, the consumption of alcohol can not be recommended entirely for CVD risk decrease. alcohol can be addictive, and high inhalation can be associated with serious adverse health and social consequences, including hypertriglyceridemia, high blood pressure, liver-colored price, physical misuse, vehicular and oeuvre accidents, and increased risk of breast cancer. 2 For these reasons, and on the footing of available epidemiologic data, the AHA recommends that if alcoholic beverages are consumed, they should be limited to no more than 2 drinks per day for men and 1 drink per day for women, and ideally should be consumed with meals. 63 In general, a 12-ounce bottle of beer, a 4-ounce glass of wine, and a 1½-ounce shoot of 80-proof spirits all contain the same measure of alcohol ( one half snow leopard ). Each of these is considered a “ drink equivalent. ” 63,64 Individuals who choose to consume alcoholic beverages should besides be mindful that alcohol has a higher caloric concentration than protein and carbohydrate and is a informant of extra “ empty ” calories .

When You Eat Food That Is Prepared Outside of the Home, Follow the AHA 2006 Diet and Lifestyle Recommendations

increasingly, Americans consume food that is prepared outside of the home. such types of “ away ” food include food prepared at restaurants and grocery stores, quick-serve establishments, schools and daycare centers, and other non-home locations. between 1977 to 1978 and 1994 to 1996, consumption of away food increased from 18 % to 32 % of calories. 65 large fortune sizes and high energy concentration are coarse features of away food. 66 many types of away foods, particularly traditional quick-serve, are besides high in saturated fatness, trans fatso acids, cholesterol, added sugars, and sodium and low in fiber and micronutrients. Adverse health consequences have emerged. There is a positive association between frequency of meal consumption at quick-serve restaurants and entire department of energy consumption, weight profit, and insulin resistance. 67 Attainment of a healthy diet will require individuals to make wise choices when they eat food train outside of the family .

Dietary Factors With Unproven or Uncertain Effects on CVD Risk

Antioxidant Supplements

Antioxidant vitamin supplements or other supplements such as selenium to prevent CVD are not recommended. 68,69 Although experimental studies have suggested that gamey 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. Some trials, in fact, have documented potential damage, 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 increase sum deathrate 71 from high-dose vitamin E supplements. Although antioxidant supplements are not recommended, food sources of antioxidant nutrients, chiefly from a variety show of plant-derived foods such as fruits, vegetables, whole grains, and vegetable oils are recommended .

Soy Protein

evidence of a direct cardiovascular health benefit from consuming soy protein products rather of dairy or early proteins or of isoflavone supplements is minimal. 71,72 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 A very large sum of soy protein, comprising more than half of daily protein intake, may lower LDL cholesterol levels by a few share points when it replaces dairy protein or a concoction of animal proteins, but data are chiefly from hypercholesterolemic individuals. The tell favors soy protein rather than soy isoflavones as the responsible food. 76 No meaningful benefit of soy consumption is apparent with regard to HDL cholesterol, triglycerides, or lipoprotein ( a ). Nevertheless, consumption of soy protein–rich foods may indirectly reduce CVD risk if they replace animal and dairy products that contain saturated fat and cholesterol .

Folate and Other B Vitamins

available tell is inadequate to recommend vitamin bc and other B vitamin supplements as a mean to reduce CVD gamble at this clock time. Folate consumption and to a lesser extent consumption of vitamins B6 and B12 are inversely associated with blood homocysteine levels. In experimental studies, increased blood levels of homocysteine are associated with an increased risk of CVD. 77 Trials of homocysteine-reducing vitamin therapy have been disappointing, however. 78–82

Phytochemicals

Flavonoids and sulfur-containing compounds are classes of compounds found in fruits and vegetables that may be authoritative in reducing the risk of atherosclerosis. Within these categories are multiple possible compounds, most of which are not well characterized and whose modes of military action are not established. 83 Until more of this information is gathered and fully understand, a diet consistent with AHA recommendations ( table 2 ) is the most prudent way to ensure optimum consumption of macronutrients, micronutrients, and associated bioactive compounds. 32

Other Dietary Factors That Affect CVD Risk

Fish Oil Supplements

fish intake has been associated with decrease risk of CVD. 83,84 On the footing of the available data, the AHA recommends that patients without document CHD consume a variety of pisces, preferably buttery fish, at least doubly a week. 42 Patients with attested CHD are advised to consume & 1 gigabyte of EPA+DHA per day, preferably from greasy pisces, although EPA+DHA supplements could be considered in reference with their doctor. For individuals with hypertriglyceridemia, 2 to 4 gigabyte of EPA+DHA per day, provided as capsules under a doctor ’ mho concern, are recommended. 42

Plant Stanols/Sterols

plant stanols/sterols lower LDL cholesterol levels by up to 15 % 85 and consequently are seen as a therapeutic option, in addition to diet and life style modification, for individuals with raise LDL cholesterol levels. maximum effects are observed at plant stanol/sterol intakes of & 2 gigabyte per day. Plant stanol/sterols are presently available in a wide assortment of foods, drinks, and easy gel capsules. The choice of vehicle should be determined by handiness and by early considerations, including caloric content. To sustain LDL cholesterol reductions from these products, individuals need to consume them daily, barely as they would use lipid-lowering medicine .

Special Groups

Children Over 2 Years of Age

Overweight and fleshiness are a particular concern for children as the prevalence of corpulence is now & 16 % for children and adolescents. Achieving energy balance may be more complicated in children and adolescents because caloric and micronutrient intake must be adequate to support convention emergence and exploitation. however, many children are eating excess calories and experiencing insalubrious system of weights gain. Children can eat a diet consistent with the AHA 2006 Diet and Lifestyle Recommendations and maintain allow growth while lowering risk for future CVD. furthermore, because diet in young is associated with the occurrence of CVD outcomes subsequently in biography and because life style habits in youth cut into adulthood, adoption of a goodly diet and life style at early ages is recommended. More specific guidance is provided in a separate AHA diet statement for children. 3

Older Adults

atherosclerosis is a chronic process beginning in youth. The hazard of developing CVD increases dramatically with advancing long time. Diet and life style behaviors can decrease CVD risk. 86 besides, ample testify from clinical trials indicates that older-aged persons can make and sustain life style changes, possibly more so than younger adults. 86,87 Because of the high incidence of CVD events in older-aged individuals, even relatively modest improvements in hazard factors ( eg, modest reductions in BP and LDL cholesterol through diet and life style changes ) should be of solid benefit. 88,89 In cosmopolitan, the goals and recommendations described in this document are appropriate for older-aged individuals. 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

Persons With Metabolic Syndrome

Metabolic syndrome refers to a cluster of abnormalities that are related to insulin resistance and that normally occur in the set of fleshy and fleshiness. 91 characteristic features of the metabolic syndrome are abdominal fleshiness, atherogenic dyslipidemia ( lift triglycerides, depleted HDL cholesterol ), increased BP, insulin resistance ( with or without glucose intolerance ), and prothrombotic and proinflammatory states. 17,91 The primary approach to reducing CVD risk in persons with the metabolic syndrome is to control the individual risk factors by diet and life style intervention. 85 physical action and weight maintenance are recommended as a mean to prevent the development of metabolic syndrome and lower the gamble of developing type 2 diabetes or CHD. 91 very low-fat diets should be avoided if elevated triglyceride or depress HDL cholesterol levels are confront. 92 Reducing caloric inhalation while maintaining a moderate-fat diet and increasing physical action to achieve even a modest weight loss can improve insulin resistance and the attendant metabolic abnormalities .

Persons With Chronic Kidney Disease

CKD, which precedes end-stage kidney disease, substantially increases the risk of CVD, at least in part through diet-related CVD risk factors. 93 CKD is associated with a high preponderance of diabetes, dyslipidemia ( particularly hypertriglyceridemia ), and high blood pressure. dietary therapies recommended for the general population are besides recommended for persons with early stages of CKD, even though empirical tell is sparse. In particular, a dilute salt consumption is recommended as a think of to reduce BP and prevent fluid overload, and dietary strategies to manage dyslipidemia are besides recommended. Replacing meat with dairy and vegetable alternatives may besides slow personnel casualty of kidney officiate. 94 At advance stages of CKD, the dietary management of CKD diverges from general population recommendations ; in particular, a reduce intake of protein, phosphorus, and potassium is recommended .

Socioeconomic Groups at High Risk of CVD

It is well recognized that individuals of lower socioeconomic status have a higher incidence of CVD than do individuals of higher socioeconomic condition. Population subgroups of racial/ethnic minorities ( eg, mexican Americans, American Indians, and blacks ), who are overrepresented in lower socioeconomic condition groups, have a strikingly high gear prevalence of fleshy and obesity—a condition that precedes the development of many other CVD risk factors. 95,96 Although the reasons for such disparities are complex and multifactorial, available inquiry is sufficient to advocate diet and life style changes as a intend to reduce disparities. For example, blacks are particularly sensitive to the BP-lowering effects of a reduce strategic arms limitation talks consumption, increased potassium intake, and the DASH diet. 6 forwarding of a desirable diet should be culturally sensitive and should encourage healthy preparation of traditional heathen foods. unfortunately, social and economic barriers make widespread adoption of stream diet and life style recommendations unmanageable for many segments of company. Targeted diet and life style messages directed at heathen minorities and policies that affect handiness and affordability are critically needed to reduce CVD health disparities .

Environmental Influences on CVD Health Behaviors

ultimately, people select the types and total of food they eat and the measure of physical activeness they perform. still, the environment has a potent influence on whether people consume excess calories, follow a healthy diet, and are physically active. By environment, we mean the configuration of cultural forces, social norms, and commercial interests that influence the behavior of individuals. The fleshiness epidemic, which has unfolded over the past 2 decades in genetically stable populations, illustrates the adverse impingement of environment on diet and life style behaviors. In brief, it is well recognized that the stream environment encourages overconsumption of calories and discourages outgo of energy. There is a growing agreement among experts that changes in the environment are a major drive violence behind the fleshiness epidemic. 97 environmental factors that contribute to overindulgence calorie intake are increased share sizes, high-calorie foods, and easy access to plentiful cheap food. environmental factors that discourage physical activity include an environment that encourages car use rather than walking and that has few cues to promote bodily process and numerous cues that discourage action ( eg, poor pedestrian infrastructure, miss of sidewalks and early guard features, and poor street aesthetics ). other factors include reduced energy expenditures at school, work, and family, and increased time spent on sedentary activities such as watching television, using computers, and playing video recording games. The effects of environmental factors and of individual nutrients and food groups on corpulence and fleshiness ( eg, function of fat, added sugars, alcohol, fruits and vegetables, dairy products, physical inactivity ) have been explored. No one agent appears creditworthy for the epidemic. such findings reinforce the impression that multiple factors are responsible for the fleshiness epidemic and that the optimum scheme to arrest the epidemic will be multifactorial. Because many of these factors are beyond the restraint of individuals ( eg, size of portions served in restaurants, lack of information on calorie message at point of leverage, presence of sidewalks, adequate streetlights after dark ), hearty changes to the environment will be required. furthermore, the fleshiness epidemic highlights the importance of primary prevention efforts in children so that adverse diet and life style behaviors do not become habits. For individuals to adhere to a healthy diet and life style, the AHA Nutrition Committee powerfully believes that hearty changes to the environment must occur. In its deliberations, the Nutrition Committee identified respective changes that it considers senior high school priority and that should help achieve the AHA ’ s strategic goals of reducing CVD risk in the general population. not surprisingly, several target groups are involved. A list of the changes by prey group is presented in table 5 . TABLE 5. High-Priority Recommendations to Facilitate Adoption of AHA 2006 Diet and Lifestyle RecommendationsTarget GroupRecommendationsPractitionersAdvocate a healthy dietary pattern consistent with AHA recommendations.Encourage regular physical activity.Calculate BMI and discuss results with patients.Discourage smoking among nonsmokers and encourage smoking cessation among patients who do smoke.Encourage moderation of alcohol intake among those who do drink alcohol.RestaurantsDisplay calorie content prominently on menus, or make calorie and other nutrition information easily accessible to consumers at point of decision and point of purchase.Reduce portion sizes and provide options for selecting smaller portions.Reformulate products to reduce calories, sodium, and saturated and trans fats.Use trans fat–free and low–saturated fat oils in food preparation to eliminate added trans fat without increasing saturated fat.Provide more vegetable options, and prepare them with minimal added calories and salt.Provide more fruit options, and serve them without added sugar.Develop creative approaches to including and marketing fruits and vegetables to make them more attractive to consumers.Allow substitution of nonfried and low-fat vegetables for usual side dishes (eg, French fries and potato salad).Provide whole-grain options for bread, crackers, pasta and rice.Food industryReduce the salt and sugar content of processed foods.Replace saturated and trans fats in prepared foods and baked goods with low–saturated fat liquid vegetable oils.Increase the proportion of whole-grain foods available.Package foods in smaller individual portion sizes.Develop packaging that allows for greater stability, preservation, and palatability of fresh fruits and vegetables without added sodium and reduces refrigeration needs in grocery stores.SchoolsAdopt competitive food policies that limit foods high in added sugar, saturated and trans fat, sodium, and calories while encouraging consumption of fruits, vegetables, whole-grain foods, and low-fat or fat-free dairy. (Competitive food policies should address vending, a la carte, school stores, fundraising, and all food sold outside of the reimbursable school lunch.)Ensure the availability daily of heart-healthy lunches to students and staff by meeting USDA nutrition standards, offering nonfried fish as a regular menu item, and offering at least 1 meal/day low in saturated and trans fat.Offer and require daily physical education taught by qualified teachers at all grade levels.Expand physical activity opportunities by providing noncompetitive as well as competitive extracurricular physical activity options. Examples include intermural and intramural sports, dance classes, and walking clubs.Incorporate healthy nutrition and increased physical activity policy into after-school activities.Adopt 100% smoke-free policies on school campus, including parking lots and surrounding school grounds.Local governmentDevelop and implement a Safe Routes to School plan.Implement land-use practices that promote nonmotorized transportation (walking and biking), such as complete streets and community parks.Promote policies that increase availability of healthy foods (eg, use of public land for farmers’ markets and full-service grocery stores in low-income areas).

Conclusions

A significant and expanding consistency of testify has implicated respective aspects of diet in the pathogenesis of CVD and its risk factors. importantly, life style modifications can effectively control CVD risk factors and lower CVD risk. To realize these benefits, individuals should aim for a desirable body weight, be physically active, invalidate tobacco exposure, and follow a diet and life style reproducible with AHA dietary recommendations as stated in this composition. Accomplishing these objectives will require individuals to change their behavior and company to make substantial environmental changes. The current challenge to healthcare providers, researchers, and government officials is to develop and implement effective clinical and public health strategies that lead to sustained life style changes among individuals and, more broadly, among populations .

Appendix

Resources

seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure ( JNC 7 ) : hypertext transfer protocol : //www.nhlbi.nih.gov/guidelines/hypertension/jnc7full.htm The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents : hypertext transfer protocol : //www.nhlbi.nih.gov/health/prof/heart/hbp/hbp_ped.htm The DASH Eating plan : hypertext transfer protocol : //www.nhlbi.nih.gov/health/public/heart/hbp/dash behavioral Intervention program from the PREMIER trial ( designed to increase physical bodily process, lose weight, and accomplish the DASH diet ) : hypertext transfer protocol : //www.kpchr.org/public/premier/intervention third Report of the National Cholesterol Education Program ( NCEP ) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults ( identify panel ’ south recommendations for Therapeutic Lifestyle Changes [ TLC ], a multifactorial life style approach to reducing risk for CHD ) : hypertext transfer protocol : //www.nhlbi.nih.gov/guidelines/cholesterol/atp3_rpt.htm Risk Assessment Tool for Estimating Your 10-Year hazard of Having a Heart attack : hypertext transfer protocol : //hin.nhlbi.nih.gov/atpiii/calculator.asp ? usertype=pub clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults : hypertext transfer protocol : //www.nhlbi.nih.gov/guidelines/obesity/ob_gdlns.htm The Practical Guide : identification, Evaluation, and Treatment of Overweight and Obesity in Adults : hypertext transfer protocol : //www.nhlbi.nih.gov/guidelines/obesity/practgde.htm Calculate Your Body Mass Index : hypertext transfer protocol : //www.nhlbisupport.com/bmi/bmicalc.htm synergistic Menu Planner : hypertext transfer protocol : //hin.nhlbi.nih.gov/menuplanner/menu.cgi assign aberration : hypertext transfer protocol : //hin.nhlbi.nih.gov/portion

Palm and Download Tools

prevention, Detection, Evaluation, and Treatment of High Blood Pressure ( JNC 7 ) : hypertext transfer protocol : //hin.nhlbi.nih.gov/jnc7/jnc7pda.htm ATP III Cholesterol Management Implementation Tool for Palm : hypertext transfer protocol : //hin.nhlbi.nih.gov/atpiii/atp3palm.htm Ten-Year Risk Assessment Tool : hypertext transfer protocol : //hin.nhlbi.nih.gov/atpiii/riskcalc.htm BMI Calculator : hypertext transfer protocol : //hin.nhlbi.nih.gov/bmi_palm.htm Obesity Education Initiative Guidelines Implementation Tool : hypertext transfer protocol : //hin.nhlbi.nih.gov/obgdpalm.htm Dietary Guidelines for Americans 2005 ( In addition to the guidelines, link contains several early links to tools and early resources on diet and physical activity. ) : hypertext transfer protocol : //www.healthierus.gov/dietaryguidelines USDA National Nutrient Database ( nutrient content of person foods ) : hypertext transfer protocol : //www.nal.usda.gov/fnic/foodcomp/Data What You Need to Know About Mercury in Fish and mollusk : hypertext transfer protocol : //www.cfsan.fda.gov∼dms/admehg3.html Your Guide to Lowering Blood pressure with DASH. hypertext transfer protocol : //www.nhlbi.nih.gov/health/public/heart/hbp/dash/index.htm

American Heart Association Cookbooks

American Heart Association’s No-Fad Diet Book The New American Heart Association Cookbook, 7th edition American Heart Association One-Dish Meals American Heart Association Low-Salt Cookbook American Heart Association Meals in Minutes Cookbook American Heart Association Quick & Easy Cookbook

AHA Web Sites

American Heart Association : www.americanheart.org American Heart Association Council on Nutrition, Physical Activity, and metamorphosis : hypertext transfer protocol : //www.americanheart.org/presenter.jhtml ? identifier=650 easy Food Tips for Heart-Healthy Eating : hypertext transfer protocol : //www.americanheart.org/presenter.jhtml ? identifier=9033 Diet & Nutrition : hypertext transfer protocol : //www.americanheart.org/presenter.jhtml ? identifier=1200010 nutrition Facts : hypertext transfer protocol : //www.americanheart.org/presenter.jhtml ? identifier=855 council on Nutrition, Physical Activity and Metabolism Hot Links : hypertext transfer protocol : //www.americanheart.org/presenter.jhtml ? identifier=1160 nutrition and cardiovascular Disease—Statistics : hypertext transfer protocol : //www.americanheart.org/presenter.jhtml ? identifier=3020707 AHA gloss : FDA ’ s newfangled nutrition labeling requirement for trans fatso acids : hypertext transfer protocol : //www.americanheart.org/presenter.jhtml ? identifier=3013636 AHA Scientific Statements on Diet/Nutrition : hypertext transfer protocol : //www.americanheart.org/presenter.jhtml ? identifier=3004604 physical Activity, Nutrition & School Health Policy ( State-by-State Research ) : hypertext transfer protocol : //www.americanheart.org/presenter.jhtml ? identifier=3019642 nutrition materials in spanish : hypertext transfer protocol : //www.americanheart.org/presenter.jhtml ? identifier=3003430 The American Heart Association makes every campaign to avoid any actual or likely conflicts of interest that may arise as a leave of an outside relationship or a personal, professional, or clientele interest of a penis of the writing panel. specifically, all members of the write group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or electric potential conflicts of sake. This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on April 26, 2006. A individual reprint is available by calling 800-242-8721 ( US only ) or writing the American Heart Association, Public Information, 7272 Greenville Ave, Dallas, TX 75231-4596. Ask for reprint No. 71-0365. To purchase extra reprints : up to 999 copies, call 800-611-6083 ( US only ) or fax 413-665-2671 ; 1000 or more copies, call 410-528-4121, facsimile 410-528-4264, or electronic mail [ electronic mail protected ] To make photocopies for personal or educational use, call the Copyright Clearance Center, 978-750-8400. Expert peer review of AHA Scientific Statements is conducted at the AHA National Center. For more on AHA statements and guidelines development, inflict hypertext transfer protocol : //www.americanheart.org/presenter.jhtml ? identifier=3023366. Disclosures

TABLE 6. Relationships With Industry—AHA Writing Group to Develop Diet and Lifestyle RecommendationsWriting Group MemberEmploymentResearch GrantOther Research SupportSpeakers’ Bureau/HonorariaOwnership InterestConsultant/Advisory BoardOtherThis table represents the relationships of writing group members that may be perceived as actual or reasonably perceived conflicts of interest as reported on the Disclosure Questionnaire, which all members of the writing group are required to complete and submit.Alice H. LichtensteinTufts UniversityNIHNoneNoneNoneNoneNoneLawrence J. AppelJohns Hopkins UniversityNoneNoneNoneNoneNoneNoneMichael BrandsMedical College of GeorgiaNoneNoneNoneNoneNoneNoneMercedes CarnethonNorthwestern UniversityNoneNoneNoneNoneNoneNoneStephen DanielsUniversity of CincinnatiNoneNoneNoneNoneAbbott Laboratories; Able LaboratoriesNoneHarold A. FranchAtlanta VA Medical Center, Emory UniversityNIH, Department of Veterans AffairsNoneNoneNoneNoneNoneBarry FranklinWilliam Beaumont Hospital, Royal Oak, MichNoneNoneNoneNoneNoneAmerican College of Sports Medicine; American Association of Cardiovascular and Pulmonary RehabilitationPenny Kris-EthertonPenn StateDairy Council; California Pistachio BoardNoneSunflower AssociationNoneMcNeilNoneWilliam S. HarrisSt. Luke’s HospitalNoneNoneNoneNoneNoneNoneBarbara HowardMedStar Research InstituteNoneDonation of drugs: Pfizer, Merck, Schering-PloughLectures for Schering-PloughNoneMerck, Egg Nutrition Council, General MillsNoneNjeri KaranjaKaiser PermanenteNoneNoneNoneNoneNoneNoneMichael LefevrePennington Biomedical Research CenterGeneral Mills, includes salary support (PI); Hershey Foods, includes salary support (Co-PI)NoneNoneNoneKraft Foods; Member, Global Health and Wellness Advisory Board; International Life Sciences Institute: Scientific Advisor, Technical Committee on Fatty AcidsNoneLawrence RudelWake Forest School of MedicineNoneLipid Sciences contract researchMerckNoneTAP PharmaceuticalsNoneFrank M. SacksHarvard School of Public HealthNoneNoneNoneNoneNoneNoneLinda Van HornNorthwestern UniversityNoneNoneNoneNoneNoneNoneMary WinstonAmerican Heart AssociationNoneNoneNoneNoneNoneNoneJudith Wylie-RosettAlbert Einstein College of Medicine at Yale UniversityAtkins FoundationNoneNoneNoneFrito-Lay (resigned)None TABLE 7. Relationships With Industry—External Peer Reviewers for the AHA 2006 Diet and Lifestyle GuidelinesReviewerEmploymentResearch GrantOther Research SupportSpeakers Bureau/HonorariaOwnership InterestConsultant/Advisory BoardOtherThis table represents the relationships of reviewers that may be perceived as actual or reasonably perceived conflicts of interest as reported on the Disclosure Questionnaire, which all reviewers are required to complete and submit.Benjamin CaballeroJohns Hopkins University Center for Human NutritionNoneNoneNoneNoneNoneNoneRobert M. CareyUniversity of VirginiaNIHNoneNoneNoneNovartisNoneScott M. GrundyUniversity of Texas Southwestern Medical Center at DallasMerck, Abbott, KosNoneMerck, Pfizer, Sankyo, Schering Plough, Kos, Abbott, Fournier, Bristol-Myers Squibb, AstraZenecaNoneNoneNoneJanet C. KingChildren’s Hospital Oakland Research InstituteNational Dairy CouncilNoneNoneNoneNoneNoneRussell R. PateUniversity of South CarolinaNIH and CDCNoneNational Association of School Boards of Education, Kansas State University, Penn State University, Kansas University School of Medicine, Maine Center for Public Health, University of GeorgiaNoneNIH, CDC, Chartwells, Kraft Foods, and Porter Novelli (Bone Health)None

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