Dietary patterns to promote cardiometabolic health

• Published in: Nature reviews cardiology 2025, Vol.22 (1), p.38-46
• Main Authors: Pagidipati, Neha J., Taub, Pam R., Ostfeld, Robert J., Kirkpatrick, Carol F.
• Format: Article
• Language: English
• Subjects: 692/699/75; 692/700/2817; 692/700/459/284; Carbohydrates; Cardiac Imaging; Cardiac Surgery; Cardiology; Cardiometabolic Risk Factors; Cardiovascular Diseases - prevention & control; Diet, Healthy; Diet, Mediterranean; Dietary Approaches To Stop Hypertension; Dietary Patterns; Feeding Behavior; Humans; Hypertension; Medicine; Medicine & Public Health; Review Article; Risk Reduction Behavior
• ISSN: 1759-5002; 1759-5010; 1759-5010
• DOI: 10.1038/s41569-024-01061-7

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. Various dietary patterns have been proposed to improve cardiometabolic health. In this Review, Pagidipati et al. emphasize the commonalities between recommendations on what to eat (Mediterranean, Dietary Approaches to Stop Hypertension and low-carbohydrate or ketogenic diets) and the possible benefits of time-restricted eating and intermittent fasting. 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