Diet modification can be a vital step to prevent cardiovascular disease. While various biological, economical, physical, social and psychological factors influence food choices, interventions targeting these factors can lead to meaningful improvements in long-term eating habits, according to a review paper published today in the Journal of the American College of Cardiology.

Research has consistently shown that a healthy diet -- particularly one high in fruits, vegetables, whole grains, fish, nuts and legumes and low in processed meats, refined grains, sodium and sugary beverages -- is associated with the prevention of heart disease. However, many people face roadblocks in achieving an ideal diet.

"Eating habits are forged over a lifetime and are influenced by a multitude of factors from all levels of society including biological, economic, physical, social and psychological determinants," said Frank B. Hu, MD, PhD, chair of the department of nutrition at the Harvard T.H. Chan School of Public Health and the senior author of the paper. "The assumption that most people would replace unhealthy dietary components in light of new research is overly optimistic."

Higher prices, lack of nutritional knowledge and a limited availability of healthy food -- or "food deserts" -- can all contribute to a poor diet in low income and minority populations. According to the researchers, large amounts of sugar and sodium are added to processed food products to help make them more palatable. Social determinants such as culture, community, friends, family and social media can also have an influence over food choices.

"Given the magnitude of the cardiovascular disease burden in the U.S. and globally and the complexity of dietary risk factor modification, simultaneous prevention strategies and policies across multiple societal levels are needed to make a measureable impact on reducing prevalence rates," Hu said.

To help improve diets, the authors recommend policy strategies across multiple levels, including nutrition labeling, taxing sugar sweetened beverages, providing economic incentives for the production of healthy foods, regulating food marketing, promoting healthy school and work environments, and funding educational campaigns.

"Health professionals and community leaders have a great responsibility to promote cardiovascular health and disease prevention but require a basic nutrition knowledge base," Hu said. "A concerted effort from all levels of society will be needed to fundamentally change the current food environment and global food system."

This paper is the first in an eight-part health promotion series where each paper will focus on a different risk factor for cardiovascular disease.

"The editors and I are quite excited about this series, as we feel it could have tremendous impact in informing clinicians about the prevention of cardiovascular disease," said Valentin Fuster, MD, PhD, editor-in-chief of the Journal of the American College of Cardiology.