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AHA Diet Focuses On Fats, Exercise.

Trans-fatty acids are out, omega-3 fatty acids are in.

And that's just part of the skinny on the American Heart Association's recently revised dietary guidelines, which also stress for the first time the importance of preventing obesity.

The AHA's evidence-based guidelines, last revised in 1996, are more definitive recommendations than their predecessors and include targeted advice regarding fat intake, exercise, and diets.

The revised guidelines essentially replace the AHA's Step 1 and Step 2 diets, which were geared primarily toward individuals with risk factors for cardiovascular disease and existing cardiovascular disease.

Dr. Ronald M. Krauss, who chaired the dietary guidelines committee, said that the Step 1 diet is no longer seen as a treatment but, rather, as a diet that the whole population should be following. The Step 2 diet has been replaced by specific modifications to the general recommendations as they relate to an individual's medical condition.

The committee recognized that there are medical conditions other than cardiovascular disease, such as diabetes and kidney disease, that require more careful attention to diet and that the guidelines needed to include individualized diet recommendations for those conditions, Dr. Krauss said in an interview.

In general, the guidelines continue to recommend a saturated fat intake of less than 10% of total calories, but they go further to recommend that less than 3% of total calories be in the form of trans-fatty acids, which have been shown to increase LDL cholesterol and to reduce HDL cholesterol (Circulation 102[18]:2284-99, 2000).

The guidelines also suggest substituting saturated fats and trans-fatty acids with grains and unsaturated fatty acids from fish, vegetables, legumes, and nuts. The guidelines include a new recommendation of at least 2 weekly servings of fish, which are rich in cardioprotective omega-3 fatty acids.

Other sources of omega-3 fatty acids include flaxseed and flaxseed oil, canola oil, soybean oil, and nuts.

The AHA has always recommended physical activity, but the revised guidelines place a higher priority on exercise, said Dr. Krauss, who is head of molecular and nuclear medicine at the Lawrence Berkeley National Laboratory at the University of California, Berkeley The guidelines advise at least 30 minutes of physical activity daily or on most days of the week.

The guidelines also address specific diets that have become popular among Americans. The guidelines said that a diet high in unsaturated fats and low in saturated fats, which most people know as the "Mediterranean diet," can be an alternative to a diet that is low in total fat, particularly in individuals with insulin resistance syndrome.

The guidelines advised strongly against very-low-fat diets, which may result in nutritional inadequacies for essential fatty acids and are often associated with processed low-fat foods that are calorie dense.

The guidelines also advised against high-protein diets. There is no existing scientific evidence to support the concepts that high-protein diets result in sustained weight loss, significant changes in metabolism, or improved health, the guidelines said.

Dr. Krauss said that the revised guidelines stress overall eating patterns rather than a percentage of dietary fat or other nutrients, making them easier to use. However, the recommended percentages of each food component remain the same.

When counseling patients on diet, consider their overall risk profile, cholesterol levels, blood pressure, body weight, and overall dietary pattern. These are things that people focus on, both in making food choices and in interacting with health care providers concerning specific dietary practices that would be necessary for their situation.
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Publication:Family Practice News
Article Type:Brief Article
Date:Nov 15, 2000
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