Written by:

Dr Jonathan Pearson-Stuttard

BMBCh, MSc, MA (Oxon), MFPH

Dr Pearson-Stuttard is a specialist in public health and epidemiology. Jonny currently works at Imperial College London and has a wide range of research interests including identifying the role of nutrition in cardiovascular disease, diabetes and cancer as well as modelling population dietary policies. He is also researching interventions to reduce smoking in pregnancy.

Your diet and your cardiometabolic health

In this article:

  • What we know
  • Starchy Vegetables and Carbohydrates
  • Meat
  • Oils, Butters and Spreads
  • Sugary drinks
  • Fruits and vegetables
  • Fish
  • Salt
  • Main Points

Your diet and your cardiometabolic health
After giving birth, maintaining a healthy weight and healthy lifestyle can be more difficult than in the years before motherhood. Diet is a leading cause of unhealthy weight, and diseases associated with sub-optimal weight such as heart disease, stroke and diabetes, while poor diet is the leading risk factor for all death and ill-health and, specifically, heart disease and stroke1.

What we know

Initial guidelines for a healthy diet focused on individual nutrients, such as reducing ‘total fat’ intake. However, we now know that all fats do not have the same health effects but instead are consumed as part of complex food patterns. Focusing on healthy dietary patterns can be more effective and this has been confirmed in clinical trials2.The Dietary Approach to Stop Hypertension (DASH) diet and the traditional Mediterranean diet consistently lower the risk of heart disease and stroke3,4.An evidence-based healthy diet means substantial consumption of minimally processed foods such as fruits, vegetables, nuts, seeds, whole grains, seafood, legumes, yoghurt and vegetable oils, while minimising consumption of salt, red and processed meats, refined carbohydrates and added sugars.

Starchy Vegetables and Carbohydrates

Carbohydrate rich foods currently account for approximately half of all calories in the western diet. This mixed food group was initially classified as simple (sugar) and complex (starch); but this has little relevance in predicting health outcomes. Recently, more meaningful classifications of carbohydrate quality have been proposed. These would see greater weight given to the role of beneficial characteristics including dietary fiber content, glycemic index, minimal processing and whole grain content5.Conversely, consumption of refined grains (white bread), starch (potatoes) and added sugars increase the risk of heart disease and stroke6,7.

Meat

The evidence of the harmful effect of processed meats, such as bacon, sausage and salami, is strong and plausible8,9; for example, salt content can be 400% higher than in unprocessed meats. The effect of the consumption of unprocessed red meat upon heart disease and stroke is less clear10.

Oils, Butters and Spreads

The evidence of the protective effects of extra virgin olive oil for heart disease and stroke is strong. The PREDIMED trial found the intervention group who consumed extra virgin olive oil alongside a Mediterranean diet experienced a 30% lower risk of stroke or heart attack compared to the control (non-intervention) group11.For butter, only a few studies exist assessing health effects of butter itself, however the evidence to date suggests a relatively small, or even neutral effect of consumption upon heart disease and stroke12.

Sugary drinks

Sugar-sweetened beverage (SSB) consumption increases the risk of heart disease, but mainly through being overweight13. Artificial sweetened beverages appear less harmful, but are still apparently associated with increased obesity, diabetes and heart disease risk compared to drinking water.

Fruits and vegetables

Fruits and vegetables have consistently been associated with protective effects in relation to heart disease and stroke14,15,16,17. Fruits and vegetables are a good source of dietary fibre, with low salt and added sugar content forming an important part of a balanced diet. They are a rich source of nutrients such as potassium, magnesium and vitamins A, C and E. Despite this, fruits and vegetables are under-consumed across the developed and developing world in all age groups.

Fish

Moderate consumption (2 or more servings per week) of fish substantially lowers the risk of heart disease and also modestly reduces the risk of stroke18.

Salt

75% of salt consumption in developed countries is from packaged foods and restaurants, the remainder coming from cooking or table salt19. Salt increases the risk of heart disease and stroke20 by increasing blood pressure, the leading risk factor for stroke and heart disease.


References

  1. Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2224-60.
  2. Satija A, Yu E, Willett WC, Hu FB. Understanding Nutritional Epidemiology and Its Role in Policy. Advances in Nutrition: An International Review Journal. 2015;6(1):5-18.
  3. Gadgil MD, Appel LJ, Yeung E, Anderson CAM, Sacks FM, Miller ER. The Effects of Carbohydrate, Unsaturated Fat, and Protein Intake on Measures of Insulin Sensitivity. Results from the OmniHeart Trial. 2013;36(5):1132-7.
  4. Haring B, Wyler von Ballmoos MC, Appel LJ, Sacks FM. Healthy Dietary Interventions and Lipoprotein (a) Plasma Levels: Results from the Omni Heart Trial. PLoS ONE. 2014;9(12):e114859.
  5. Mozaffarian D, Appel LJ, Van Horn L. Components of a Cardioprotective Diet. New Insights. 2011;123(24):2870-91.
  6. Mirrahimi A, de Souza RJ, Chiavaroli L, Sievenpiper JL, Beyene J, Hanley AJ, et al. Associations of Glycemic Index and Load With Coronary Heart Disease Events: A Systematic Review and Meta-Analysis of Prospective Cohorts. Journal of the American Heart Association. 2012;1(5).
  7. Fan J, Song Y, Wang Y, Hui R, Zhang W. Dietary Glycemic Index, Glycemic Load, and Risk of Coronary Heart Disease, Stroke, and Stroke Mortality: A Systematic Review with Meta-Analysis. PLoS ONE. 2012;7(12):e52182.
  8. Abete I, Romaguera D, Vieira AR, Lopez de Munain A, Norat T. Association between total, processed, red and white meat consumption and all-cause, CVD and IHD mortality: a meta-analysis of cohort studies. Br J Nutr. 2014;112(5):762-75.
  9. Chen GC, Lv DB, Pang Z, Liu QF. Red and processed meat consumption and risk of stroke: a meta-analysis of prospective cohort studies. Eur J Clin Nutr. 2013;67(1):91-5.
  10. Mozaffarian D. Meat Intake and Mortality: Evidence for Harm, No Effect, or Benefit? Arch Intern Med. 2009;169(16):1537-8.
  11. Estruch R, Ros E, Salas-Salvadó J, Covas M-I, Corella D, Arós F, et al. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet. New England Journal of Medicine. 2013;368(14):1279-90.
  12. Pimpin L, Wu JH, Haskelberg H, Del Gobbo L, Mozaffarian D. Is Butter Back? A Systematic Review and Meta-Analysis of Butter Consumption and Risk of Cardiovascular Disease, Diabetes, and Total Mortality. PLoS One. 2016;11(6):e0158118.
  13. Xi B, Huang Y, Reilly KH, Li S, Zheng R, Barrio-Lopez MT, et al. Sugar-sweetened beverages and risk of hypertension and CVD: a dose–response meta-analysis. British Journal of Nutrition. 2015;113(05):709-17.
  14. Gan Y, Tong X, Li L, Cao S, Yin X, Gao C, et al. Consumption of fruit and vegetable and risk of coronary heart disease: a meta-analysis of prospective cohort studies. Int J Cardiol. 2015;183:129-37.
  15. Hu D, Huang J, Wang Y, Zhang D, Qu Y. Fruits and vegetables consumption and risk of stroke: a meta-analysis of prospective cohort studies. Stroke. 2014;45(6):1613-9.
  16. Li M, Fan Y, Zhang X, Hou W, Tang Z. Fruit and vegetable intake and risk of type 2 diabetes mellitus: meta-analysis of prospective cohort studies. BMJ Open. 2014;4(11).
  17. Afshin A, Micha R, Khatibzadeh S, Mozaffarian D. Consumption of nuts and legumes and risk of incident ischemic heart disease, stroke, and diabetes: a systematic review and meta-analysis. The American Journal of Clinical Nutrition. 2014;100(1):278-88.
  18. Mozaffarian D, Wu JHY. Omega-3 Fatty Acids and Cardiovascular Disease: Effects on Risk Factors, Molecular Pathways, and Clinical Events. Journal of the American College of Cardiology. 2011;58(20):2047-67.
  19. Brown IJ, Tzoulaki I, Candeias V, Elliott P. Salt intakes around the world: implications for public health. International Journal of Epidemiology. 2009;38(3):791-813.
  20. Aburto NJ, Ziolkovska A, Hooper L, Elliott P, Cappuccio FP, Meerpohl JJ. Effect of lower sodium intake on health: systematic review and meta-analyses. BMJ. 2013;346.

 

Main Points

  • After giving birth, maintaining a healthy weight and healthy lifestyle can be more difficult than in the years before motherhood.
  • The Dietary Approach to Stop Hypertension (DASH) diet and the traditional Mediterranean diet consistently lower the risk of heart disease and stroke.
  • An evidence-based healthy diet means substantial consumption of minimally processed foods such as fruits, vegetables, nuts, seeds, whole grains, seafood, legumes, yoghurt and vegetable oils, while minimising consumption of salt, red and processed meats, refined carbohydrates and added sugars.
  • The evidence of the protective effects of extra virgin olive oil for heart disease and stroke is strong.
  • The evidence of the harmful effect of processed meats, such as bacon, sausage and salami, is strong and plausible.
  • Sugar-sweetened beverage (SSB) consumption increases the risk of heart disease.
  • Fruits and vegetables are under-consumed across the developed and developing world in all age groups.