Rebecca M. Mullis

AHA Dietary Guidelines Revision 2000: A Statement for Healthcare Professionals From the Nutrition Committee of the American Heart Association

This document presents guidelines for reducing the risk of cardiovascular disease by dietary and other lifestyle practices. Since the previous publication of these guidelines by the American Heart Association,1 the overall approach has been modified to emphasize their relation to specific goals that the AHA considers of greatest importance for lowering the risk of heart disease and stroke. The revised guidelines place increased emphasis on foods and an overall eating pattern and the need for all Americans to achieve and maintain a healthy body weight (Table⇓). View this table: Table 1. Summary of Dietary Guidelines The major guidelines are designed for the general population and collectively replace the “Step 1” designation used for earlier AHA population-wide dietary recommendations. More individualized approaches involving medical nutrition therapy for specific subgroups (for example, those with lipid disorders, diabetes, and preexisting cardiovascular disease) replace the previous “Step 2” diet for higher-risk individuals. The major emphasis for weight management should be on avoidance of excess total energy intake and a regular pattern of physical activity. Fat intake of ≤30% of total energy is recommended to assist in limiting consumption of total energy as well as saturated fat. The guidelines continue to advocate a population-wide limitation of dietary saturated fat to <10% of energy and cholesterol to <300 mg/d. Specific intakes for individuals should be based on cholesterol and lipoprotein levels and the presence of existing heart disease, diabetes, and other risk factors. Because of increased evidence for the cardiovascular benefits of fish (particularly fatty fish), consumption of at least 2 fish servings per week is now recommended. Finally, recent studies support a major benefit on blood pressure of consuming vegetables, fruits, and low-fat dairy products, as well as limiting salt intake (<6 grams per day) and alcohol (no more than 2 drinks per day for men and …

Community-wide prevention of cardiovascular disease: Education strategies of the Minnesota Heart Health Program

The Minnesota Heart Health Program (MHHP) is a research and demonstration project of population-wide primary prevention of cardiovascular disease. Study goals are to achieve reductions in cardiovascular disease risk factors and morbidity and mortality in three education communities compared with three reference communities. The program in the first of the three intervention communities, Mankato, has been operating for 3 of the planned 5 years. Early objectives of the program have been achieved based on data obtained from population-based random samples surveyed in education and comparison communities. After 2 years of participation, Mankato was significantly more exposed to activities promoting cardiovascular disease prevention. In this town of 38,000 inhabitants, 190 community leaders were directly involved as program volunteers, 14,103 residents (over 60% of adults) attended a screening education center, 2,094 attended MHHP health education classes, 42 of 65 physicians and 728 other health professionals participated in continuing education programs offered by MHHP, and distribution of printed media averaged 12.2 pieces per household. These combined educational strategies have resulted in widespread awareness of MHHP and participation by the majority of the Mankato adult population in its education activities.

Environmental Interventions to Promote Healthy Eating: A Review of Models, Programs, and Evidence

Environmental interventions are an important part of efforts to improve health in populations. With respect to strategies to encourage positive nutrition behavior, envi ronmental approaches help create opportunities for action by removing barriers to following a healthy diet. This article reviews the rationale, conceptual models, program examples, and recent empirical evidence regarding the extent and effects of environ mental interventions to promote healthy eating. The state of the art is described for five types of interventions: (1) changes in the food supply; (2) point of choice nutri tion information; (3) collaboration with private sector food vendors; (4) worksite nutrition policies and incentives; and (5) changes in the structure of health and medi cal care related to nutrition. Environmental approaches to dietary behavior change can reach large segments of the population through increased availability of nutritious foods, provision of quality nutrition services in workplace and health care settings, and accessible information about healthful food choices. Nutrition intervention can also serve as a model for other types of health promotion initiatives using multidimensional environmental and educational technologies.

Prevention Conference VII Obesity, a Worldwide Epidemic Related to Heart Disease and Stroke: Executive Summary

On April 27 and 28, 2002, the American Heart Association (AHA) sponsored a scientific conference, “Obesity, a Worldwide Epidemic Related to Heart Disease and Stroke,” in Honolulu, Hawaii. The purpose of the conference was to develop a plan to reduce cardiovascular diseases (CVDs) associated with overweight and obesity. This report discusses the activities of the 4 working groups held before the conference, presentations at the conference, and extensive discussions among working group members after the conference. The primary objectives of this meeting were to The major findings of each working group are presented in this Executive Summary of the conference proceedings. The complete conference report with references is available online at http://www.circulationaha.org in the November 2, 2004, issue of Circulation . The prevalence of obesity is increasing in virtually all populations and age groups worldwide. Although this increase is most evident in the United States, it is not limited to the more developed, affluent nations of the world. The escalation in obesity rates reflects the upward shift in body weights of individual populations in response to environmental changes. BMI, or weight in kilograms per square meter of height (kg/m2), generally is accepted as a convenient measurement that provides a crude indication of body fat. The classifications of normal weight (BMI 18.5 to 24.9), overweight (BMI 25.0 to 29.9), and obesity (BMI >30.0) are somewhat arbitrary but are based on international analyses of the health impact of different BMIs. By using approaches similar to those used for birth cohort trends in cholesterol …

Increasing fruit and vegetable consumption among 4th and 5th grade students: results from focus groups using reciprocal determinism

Abstract The Year 2000 Goals for the U.S. identify a goal of five servings per day of fruits and vegetables (F&V), which is roughly double what children are currently eating. Focus group discussions (based on the reciprocal determinism concept in social learning theory) were conducted with 4th and 5th grade students, their parents, teachers, and school food service workers, in preparation for the design of a school nutrition education program to increase consumption of F&V. A social learning theory perspective was taken because it has been demonstrated to be useful in the design of effective school nutrition education programs. A theory-based protocol delineating the sequence of questions to be asked in each focus group was designed before each group met. Discussions were conducted with ten groups of students, two groups each of teachers and of parents, and one of school food service employees. Three general factors appeared to be most likely to increase F&V consumption in these children: increasing availability of F&V in the home, enhancing liking for vegetables, and providing skills in increasing F&V availability and in preparing F&V.

Environmental and Policy Approaches to Cardiovascular Disease Prevention Through Nutrition: Opportunities for State and Local Action

This article reviews environmental and policy intervention approaches to cardiovascular disease prevention through nutrition and recommends opportunities for state and local health departments to initiate and participate in environmental and nutrition policy initiatives. By addressing these complementary aims, the authors hope to stimulate further efforts to achieve progress in nutrition promotion among state and local health-related organizations. Key categories of opportunity to develop new or expanded nutrition policies and environmental strategies include economic incentives, food assistance and feeding programs, regulations for institutional food service operations, and nutrition services in health care. Environmental strategies to reduce barriers to following dietary guidelines, such as point-of-choice programs and school nutrition programs, should be tailored for local communities and widely disseminated. In addition, current federal policy efforts, notably nutrition labeling rules, will provide a valuable focal point for state and local advocacy, education, and monitoring.

The eating pattern assessment tool: A simple instrument for assessing dietary fat and cholesterol intake☆

OBJECTIVE This study describes the development of the self-administered Eating Pattern Assessment Tool (EPAT), which is designed to assess dietary fat and cholesterol intake and aid patients and health professionals in achieving control of blood cholesterol levels. DESIGN Test-retest reliability of the instrument over five visits and concurrent validity testing compared with 4-day food records. SETTING AND SAMPLE The instrument was tested at multiple sites of a large manufacturing corporation using 436 adult volunteers with approximately equal proportions of men and women from three socioeconomic levels. MAIN OUTCOME MEASURE Development of the EPAT centered on creating an instrument that was simple and easy to use in a primary-care setting, that would provide a reliable assessment of intake of dietary fat and cholesterol among adults, and that would measure frequency of consumption of foods from high-fat and low-fat categories. ANALYSES Test-retest reliability for repeated use was estimated by between-visit Pearson product-moment correlations of EPAT section scores. Concurrent validity was assessed by using product-moment correlation between EPAT section scores and mean daily B-scores obtained from 4-day food records. RESULTS Test-retest reliability estimates were 0.91 between all adjacent pairs of visits and 0.83 between visits 1 and 5 (4 months). Validity was 0.56. APPLICATIONS/CONCLUSIONS The EPAT is a simple, quick, self-administered tool using an easy scoring method for accurately assessing fat and cholesterol intake. It is a reliable and valid substitute for more time-consuming food records. EPAT also provides an efficient way to monitor eating patterns of patients over time and is arranged to provide an educational message that reinforces the consumption of recommended types and numbers of servings of low-fat foods.

Parent education in youth-directed nutrition interventions.

Since parents play a pivotal role in helping their children to implement eating pattern changes, interest in parent education in youth-directed nutrition interventions is likely to increase along with heightened interest in primary prevention. Previous experience indicates, however, that it may be difficult to recruit and sustain parent involvement. This article describes an evaluation of the effect on parents of two youth-directed interventions with a parent component, a classroom curriculum called Hearty Heart and Friends and a mailed-home, parent-taught approach called Hearty Heart Home Team. Using incentives, a participation rate of 85.6% was achieved in Hearty Heart Home Team. This parent-taught intervention had significantly greater impact on parent than did the school-only curriculum in the following areas: knowledge about diet and heart disease; attitudes of efficacy, intention, outcome expectation and modeling; and parent-child communication and child involvement in food or nutrition-related issues in the home. In addition, the parent-taught approach influenced foods present in the home as evidenced by Home Team groups having significantly more encouraged foods and more positive choices in six scores on a shelf inventory measure conducted by in-home interviewers.

AHA Dietary Guidelines

This document presents guidelines for reducing the risk of cardiovascular disease by dietary and other lifestyle practices. Since the previous publication of these guidelines by the American Heart Association,1 the overall approach has been modified to emphasize their relation to specific goals that the AHA considers of greatest importance for lowering the risk of heart disease and stroke. The revised guidelines place increased emphasis on foods and an overall eating pattern and the need for all Americans to achieve and maintain a healthy body weight (Table⇓). View this table: Table 1. Summary of Dietary Guidelines The major guidelines are designed for the general population and collectively replace the “Step 1” designation used for earlier AHA population-wide dietary recommendations. More individualized approaches involving medical nutrition therapy for specific subgroups (for example, those with lipid disorders, diabetes, and preexisting cardiovascular disease) replace the previous “Step 2” diet for higher-risk individuals. The major emphasis for weight management should be on avoidance of excess total energy intake and a regular pattern of physical activity. Fat intake of ≤30% of total energy is recommended to assist in limiting consumption of total energy as well as saturated fat. The guidelines continue to advocate a population-wide limitation of dietary saturated fat to <10% of energy and cholesterol to <300 mg/d. Specific intakes for individuals should be based on cholesterol and lipoprotein levels and the presence of existing heart disease, diabetes, and other risk factors. Because of increased evidence for the cardiovascular benefits of fish (particularly fatty fish), consumption of at least 2 fish servings per week is now recommended. Finally, recent studies support a major benefit on blood pressure of consuming vegetables, fruits, and low-fat dairy products, as well as limiting salt intake (<6 grams per day) and alcohol (no more than 2 drinks per day for men and …

Cholesterol reduction through low-intensity interventions: Results from the Minnesota heart health program☆

The National Cholesterol Education Program has underscored the need for health professionals to work together to promote dietary changes and reduce blood cholesterol levels across the population. This article reports the results of an evaluation of several low-intensity intervention programs designed for the general public that could be offered on a larger scale, either through traditional outlets for short courses or on an outpatient basis after physician referral. The interventions were designed as classes, required approximately 8 hr of contact time with the participants, cost approximately