Diets for Health: Goals and Guidelines

 

Am Fam Physician. 2018 Jun 1;97(11):721-728.

  Patient information: See related handout on nutrition written by the authors of this article.

Author disclosure: No relevant financial affiliations.

Diet is the single most significant risk factor for disability and premature death. Patients and physicians often have difficulty staying abreast of diet trends, many of which focus primarily on weight loss rather than nutrition and health. Recommending an eating style can help patients make positive change. Dietary patterns that support health include the Mediterranean diet, the Dietary Approaches to Stop Hypertension diet, the 2015 Dietary Guidelines for Americans, and the Healthy Eating Plate. These approaches have benefits that include prevention of cardiovascular disease, cancer, type 2 diabetes mellitus, and obesity. These dietary patterns are supported by strong evidence that promotes a primary focus on unprocessed foods, fruits and vegetables, plant-based fats and proteins, legumes, whole grains, and nuts. Added sugars should be limited to less than 5% to 10% of daily caloric intake. Vegetables (not including potatoes) and fruits should make up one-half of each meal. Carbohydrate sources should primarily include beans/legumes, whole grains, fruits, and vegetables. An emphasis on monounsaturated fats, such as olive oil, avocados, and nuts, and omega-3 fatty acids, such as flax, cold-water fish, and nuts, helps prevent cardiovascular disease, type 2 diabetes, and cognitive decline. A focus on foods rather than macronutrients can assist patients in understanding a healthy diet. Addressing barriers to following a healthy diet and utilizing the entire health care team can assist patients in following these guidelines.

Although diet is the single most significant risk factor for disability and premature death,1 most Americans do not adhere to U.S. dietary recommendations,2 and nutrition is minimally addressed in health care.1 When nutrition is discussed with patients, much of what is presented is inconsistent with existing evidence.3 Patients and clinicians are often overwhelmed with information on diet and the nutritional value of foods. Although weight loss is a common focus, no diet has been proven superior to others. However, when health is considered, specific dietary patterns—including particular macronutrients and foods—have good evidence for primary and secondary prevention of several chronic diseases. Patients are more likely to understand information about foods rather than nutrients, so focusing on food categories may be useful. Diets for the treatment of specific medical conditions are beyond the scope of this article.

WHAT IS NEW ON THIS TOPIC: DIETS FOR HEALTH

Large, prospective cohort studies show that vegetarian diets reduce the risk of coronary heart disease and type 2 diabetes mellitus, and that vegan diets offer additional benefits for obesity, hypertension, type 2 diabetes, and cardiovascular mortality.

Eating nuts, including peanuts, is associated with decreased cardiovascular disease and mortality, lower body weight, and lower diabetes risk.

In a prospective cohort study, consumption of artificially sweetened beverages increased the risk of type 2 diabetes about one-half as much as sugar-sweetened beverages.

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

A dietary pattern that emphasizes vegetables, fruits, legumes, and whole grains and minimizes free sugars and red meats lowers blood pressure and cholesterol levels.

C

20

One-half of each meal should consist of fruits and vegetables.

C

11

Plant-based foods should be emphasized over animal-based foods in the diet.

B

49

Free sugars should be limited to less than 10% of daily calories.

C

60

Water should be the primary beverage consumed.

C

65

Intensive lifestyle modification should be recommended to patients at high risk of cardiovascular disease to assist in health behavior change.

B

17


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

A dietary pattern that emphasizes vegetables, fruits, legumes, and whole grains and minimizes free sugars and red meats lowers blood pressure and cholesterol levels.

C

20

One-half of each meal should consist of fruits and vegetables.

C

11

Plant-based foods should be emphasized over animal-based foods in the diet.

B

49

Free sugars should be limited to less than 10% of daily calories.

C

60

Water should be the primary beverage consumed.

C

65

Intensive lifestyle modification should be recommended to patients at high risk of cardiovascular disease to assist in health behavior change.

B

17


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion,

The Authors

show all author info

AMY LOCKE, MD, is an associate professor in the Department of Family and Preventive Medicine at the University of Utah Health, Salt Lake City, and adjunct assistant professor at the University of Michigan Medical School, Ann Arbor....

JILL SCHNEIDERHAN, MD, is clinical faculty in the Department of Family Medicine at the University of Michigan Medical School.

SUZANNA M. ZICK, ND, MPH, is a research associate professor in the Department of Nutritional Sciences at the University of Michigan School of Public Health.

Address correspondence to Amy Locke, MD, University of Utah Hospital, 555 Foothill Dr., Salt Lake City, UT 84109 (e-mail: amy.locke@hsc.utah.edu). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

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show all references

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