Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review

Circulation. 2016 Jan 12;133(2):187-225. doi: 10.1161/CIRCULATIONAHA.115.018585.


Suboptimal nutrition is a leading cause of poor health. Nutrition and policy science have advanced rapidly, creating confusion yet also providing powerful opportunities to reduce the adverse health and economic impacts of poor diets. This review considers the history, new evidence, controversies, and corresponding lessons for modern dietary and policy priorities for cardiovascular diseases, obesity, and diabetes mellitus. Major identified themes include the importance of evaluating the full diversity of diet-related risk pathways, not only blood lipids or obesity; focusing on foods and overall diet patterns, rather than single isolated nutrients; recognizing the complex influences of different foods on long-term weight regulation, rather than simply counting calories; and characterizing and implementing evidence-based strategies, including policy approaches, for lifestyle change. Evidence-informed dietary priorities include increased fruits, nonstarchy vegetables, nuts, legumes, fish, vegetable oils, yogurt, and minimally processed whole grains; and fewer red meats, processed (eg, sodium-preserved) meats, and foods rich in refined grains, starch, added sugars, salt, and trans fat. More investigation is needed on the cardiometabolic effects of phenolics, dairy fat, probiotics, fermentation, coffee, tea, cocoa, eggs, specific vegetable and tropical oils, vitamin D, individual fatty acids, and diet-microbiome interactions. Little evidence to date supports the cardiometabolic relevance of other popular priorities: eg, local, organic, grass-fed, farmed/wild, or non-genetically modified. Evidence-based personalized nutrition appears to depend more on nongenetic characteristics (eg, physical activity, abdominal adiposity, gender, socioeconomic status, culture) than genetic factors. Food choices must be strongly supported by clinical behavior change efforts, health systems reforms, novel technologies, and robust policy strategies targeting economic incentives, schools and workplaces, neighborhood environments, and the food system. Scientific advances provide crucial new insights on optimal targets and best practices to reduce the burdens of diet-related cardiometabolic diseases.

Keywords: cardiovascular diseases; delivery of health care; diabetes mellitus; diet; nutrition; obesity; policy; prevention and control; review.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / prevention & control*
  • Diabetes Mellitus / diet therapy
  • Diabetes Mellitus / epidemiology
  • Diabetes Mellitus / prevention & control*
  • Diet Fads
  • Diet* / adverse effects
  • Diet* / standards
  • Dietary Supplements
  • Energy Metabolism
  • Feeding Behavior
  • Food Preferences
  • Food* / adverse effects
  • Food, Genetically Modified
  • Forecasting
  • Genetic Predisposition to Disease
  • Health Policy*
  • Health Priorities*
  • Health Promotion
  • Humans
  • Nutrition Policy
  • Nutritional Sciences / trends
  • Nutritive Value
  • Obesity / diet therapy
  • Obesity / epidemiology
  • Obesity / prevention & control*
  • Precision Medicine / trends
  • Recommended Dietary Allowances
  • Risk Factors
  • United States / epidemiology
  • Weight Gain