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Dietary patterns to promote cardiometabolic health

Nature Reviews Cardiology (2024)Cite this article

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Abstract

Multiple professional societies recommend the Mediterranean and/or Dietary Approaches to Stop Hypertension dietary patterns in their cardiovascular disease prevention guidelines because these diets can improve cardiometabolic health and reduce the risk of cardiovascular events. Furthermore, low sodium intake can be particularly beneficial for patients with hypertension. Carbohydrate restriction, with an emphasis on including high-quality carbohydrates and limiting refined starches and foods and beverages with added sugars, can promote weight loss and cardiometabolic benefits in the short term, compared with higher carbohydrate intake. Evidence is lacking for sustained, long-term effects of low carbohydrate and very low carbohydrate intake on cardiometabolic risk and cardiovascular outcomes. Time-restricted eating, in the context of an overall healthy dietary pattern, can promote cardiometabolic health by aligning food intake with the circadian rhythm, although its effect on hard clinical outcomes remains to be proven. Although there is no one dietary pattern that is appropriate for all patients, engaging in shared decision-making with patients, utilizing behaviour-change principles and engaging members of the health-care team, such as registered dietitian nutritionists, can lead to substantial improvement in the lifestyle and overall health trajectory of a patient. Emphasizing the similarities, rather than differences, of recommended dietary patterns, which include an emphasis on vegetables, fruits, legumes, nuts, whole grains and minimally processed protein foods, such as fatty fish or plant-based proteins, can simplify the process for both patients and clinicians alike.

Key points

  • The Mediterranean and Dietary Approaches to Stop Hypertension dietary patterns have high-quality evidence to support improvement in cardiometabolic health.

  • A low intake of sodium, in addition to a healthy dietary pattern, can be particularly beneficial for individuals with hypertension.

  • If patients choose to follow a carbohydrate-restricted diet, high-quality carbohydrates (fruits, vegetables, whole grains and legumes) should be emphasized, whereas refined carbohydrates (refined starches, and foods and beverages with added sugars) should be limited.

  • Carbohydrate restriction, versus higher carbohydrate intake, results in a significant reduction in body weight in the short term; evidence is lacking for long-term benefit on body weight, other cardiometabolic risk factors and clinical outcomes.

  • Time-restricted eating might improve cardiometabolic health parameters, but its effect on long-term, hard clinical outcomes remains to be proven.

  • Emphasizing the similarities between recommended dietary patterns (maximizing the consumption of vegetables, fruits, legumes, nuts, whole grains and minimally processed proteins) might enable clinicians to provide clear and concise guidance for patients.

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Fig. 1: Dietary patterns to promote cardiometabolic health.

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Authors and Affiliations

  1. Division of Cardiology, Duke University School of Medicine, Duke Clinical Research Institute, Durham, NC, USA

    Neha J. Pagidipati

  2. Division of Cardiovascular Medicine, University of California San Diego School of Medicine, La Jolla, CA, USA

    Pam R. Taub

  3. Division of Cardiology, Montefiore Health System, Bronx, NY, USA

    Robert J. Ostfeld

  4. Midwest Biomedical Research, Addison, IL, USA

    Carol F. Kirkpatrick

  5. Kasiska Division of Health Sciences, Idaho State University, Pocatello, ID, USA

    Carol F. Kirkpatrick

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Correspondence to Neha J. Pagidipati.

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Competing interests

N.J.P. declares research support from Alnylam, Amgen, Bayer, Boehringer Ingelheim, Eggland’s Best, Eli Lilly, Novartis, Novo Nordisk and Merck; consultation/advisory panels for AstraZeneca, Bayer, Boehringer Ingelheim, CRISPR Therapeutics, Eli Lilly, Esperion, Merck, Novartis and Novo Nordisk; executive committee member for trials sponsored by Amgen and Novo Nordisk; data safety and monitoring board for trials sponsored by Johnson & Johnson and Novartis; and medical advisory board for Miga Health. P.R.T. is a consultant to Amgen, Bayer, Boehringer Ingelheim, Edwards, Esperion, Lilly, Medtronic, Merck, Novartis, Novo Nordisk and Sanofi; and is a founder and shareholder of Epirium Bio. R.J.O. declares research grants from Greenbaum Foundation and Purjes Foundation; research agreement with Beyond Meat; scientific advisory board of Mesuron, with stock option. C.F.K. declares no competing interests.

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Nature Reviews Cardiology thanks Demosthenes Panagiotakos, who co-reviewed with Evangelia Sigala; and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Related links

DASH Eating Plan: https://www.nhlbi.nih.gov/education/dash-eating-plan

National Lipid Association infographic: https://www.lipid.org/sites/default/files/files/NLA_Infographic_EffectsLowVeryLowCarbDiets.pdf

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Pagidipati, N.J., Taub, P.R., Ostfeld, R.J. et al. Dietary patterns to promote cardiometabolic health. Nat Rev Cardiol (2024). https://doi.org/10.1038/s41569-024-01061-7

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