Cardiometabolic diseases, including cardiovascular diseases (CVDs), diabetes mellitus, and Metabolic Syndrome (MetS), are leading causes of morbidity and mortality worldwide. These conditions pose a significant public health burden, underscoring the need for effective prevention and treatment strategies. The cardio metabolic diet emerges as an integrative approach that considers various factors, including biological, dietary, behavioral, and environmental characteristics, to improve cardiometabolic health.
Understanding Cardiometabolic Health
Cardiometabolic health refers to an individual's overall metabolic and cardiovascular well-being. While there is no universally accepted definition, it is generally understood to be inversely related to the risk of overweight/obesity, insulin resistance, type 2 diabetes mellitus, hypertriglyceridemia, elevated blood pressure, increased C-reactive protein concentrations, and cardiovascular disease.
The prevalence of CVD in the United States was approximately 36.6% among adults aged 20 and older between 2011 and 2014. Non-Hispanic African American individuals exhibited a significantly higher prevalence, with 46.0% of males and 47.7% of females affected. The dynamic connection between CVD and MetS is evident, with epidemiological studies demonstrating overlapping risks, comorbidities, and outcomes for both conditions. MetS, characterized by a cluster of clinical risk factors such as abdominal adiposity, hypertension, dyslipidemia, and insulin resistance, affects approximately 1 in 4 adults. The increasing prevalence of these conditions highlights the need for effective prevention strategies.
Risk Factors and the Nutrition Transition
Common risk factors for cardiometabolic disorders include genetic predisposition, race, age, gender, socioeconomic status, dietary intake, physical activity, and environmental factors. Dietary risk is both the most modifiable and least modifiable, as it is influenced by other modifiable and non-modifiable characteristics.
During the nutrition transition, the "Westernization" of food production led to increased availability of processed foods and excessive intakes of calories, sugar, sodium, and fat, resulting in decreased diet quality. This transition also led to a shift in omega-6 fatty acids intake and an elevation in the dietary omega-6/omega-3 fatty acid ratio. These dietary and lifestyle changes have contributed to nutritional deficiencies/toxicities, physiological imbalances, chronic inflammation, and the pathogenesis of chronic, diet-related diseases such as CVD, diabetes, obesity, and certain cancers.
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Dietary Strategies for Cardiometabolic Health
Given the cardiometabolic threats introduced during the nutrition transition, there is an opportunity to improve diet quality by emphasizing whole foods and balanced macronutrient ratios.
High-Quality Diet
The benefits of consuming a high-quality diet are consistently valued, and the role of diet in safeguarding cardiometabolic health cannot be underestimated. Diets rich in whole grains, non-starchy vegetables, and fruits, moderate in processed foods and refined grains, and consequently lower omega-6 to omega-3 fatty acid ratios appear to offer the greatest potential benefit.
The Mediterranean Diet
The Mediterranean Diet, characterized by a high intake of plant-based foods and a lower omega-6/omega-3 fatty acid ratio, has demonstrated positive nutritional genomic effects on cardiometabolic health. Non-nutritive bioactive compounds commonly found in plants may favorably influence nutrigenomics and shift the balance in the direction of health promotion and disease prevention by selectively amending specific metabolic pathways and attenuating inflammatory mechanisms implicated in disease pathogenesis.
Importance of Macronutrient Content
Although caloric restriction has been endorsed to benefit metabolic health, it has been suggested that the macronutrient content of the diet, rather than total caloric intake, guides cardiometabolic health. The influence of macronutrient intake on body fat, blood pressure, and blood lipids appears to vary among males and females.
Omega-3 and Omega-6 Fatty Acids
The essential omega-3 and omega-6 polyunsaturated fatty acids have an array of physiological functions in cellular integrity and viability, immune function, inflammation, and disease risk. Omega-3 fatty acids may exert beneficial actions in reducing the risks associated with MetS by influencing oxidative status, glucose homeostasis, lipid metabolism, and adiposity.
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It has been proposed that reducing omega-6 fatty acid intake (below the current recommended levels of 5% to 10% of total energy) may potentially increase risk for CVD. Individuals should consume "optimal" intakes of omega-3 and omega-6 polyunsaturated fatty acids to prevent essential fatty acid deficiency and decrease chronic disease risk. The balance in omega-3 and omega-6 fatty acids intake affects the production of eicosanoid metabolites that facilitate inflammatory and other homeostatic responses and is central in the pathogenesis of diseases with an inflammatory epicenter, such as cardiovascular diseases, diabetes, degenerative diseases, and mental disorders.
Dietary Patterns for Improving Cardiometabolic Health
Numerous studies have demonstrated that healthy dietary patterns with emphasis on food‐based recommendations are the gold standard for extending lifespan and reducing the risks of CMD and mortality. Healthy dietary patterns include various permutations of energy restriction, macronutrients, and food intake patterns such as calorie restriction, intermittent fasting, Mediterranean diet, plant‐based diets, etc.
Restrictive Dietary Patterns
Dietary restriction is a common therapeutic dietary pattern to achieve therapeutic goals for disease by limiting metabolic unfavorable factors.
Calorie Restriction (CR)
CR without malnutrition is the most effective non‐pharmacological intervention for extending healthy lifespan, slowing aging, and combating CMD. A 2-year CR intervention (average energy intake reduced by 11.9%) improved abnormal cardiometabolic risk factors and maintained the positive effects on cardiometabolic profile during the weight stabilization period after weight loss.
Intermittent Fasting (IF)
Compared with CR, which must strictly control the types of food intake and monitor energy intake, fasting can be achieved by simply ensuring that no food intake is consumed for a period (>12 h). Alternate-day fasting (ADF) has consistently demonstrated significant improvements in body weight, the fat/muscle ratio, glycolipid metabolism, and BP compared with control diets, especially in terms of outstanding weight loss. Time-restricted eating (TRE) combined with CR resulted in better weight loss than CR alone and significantly improved several cardiometabolic parameters, such as fat mass, fasting blood glucose, and lipid levels in patients with obesity.
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Macronutrient Ratio Diets
The ratio of dietary nutrients also influences metabolic health. Maintaining a low protein intake can ensure efficient weight loss outcomes and glycemic management among patients with obesity. Restriction of carbohydrate intake is important for improving cardiometabolic health. Low-carbohydrate diets (LCDs) show more potential metabolic benefits, including reduced body fat mass, improved pre‐meal insulin sensitivity, and optimized lipid profiles. A meta-analysis of LCD in T2DM patients revealed that, when compared to control diets at 6 months, the LCD produced greater rates of T2DM remission, and showed improvements in weight loss, fasting insulin sensitivity, HbA1c, and TG.
Low-fat diets (LFD) may significantly improve body fat and lipid levels in overweight/obese patients, including reductions in body weight, BMI, WC, body fat percentage, TC, and LDL‐c levels.
Regional Dietary Patterns
Healthy diets have a very similar dietary structure. Hence, we have described in detail the dietary patterns of these regions to fully understand their cardiometabolic potential and to try to explore the possibility of developing dietary patterns for different regional populations that better match local dietary habits.
The Mediterranean Diet
Subsequent data from several large cohort studies and RCTs have provided additional and stronger evidence of the health effects of the Mediterranean diet. These favorable effects on known risk factors may partially explain the benefits of the Mediterranean diet on the morbidity, recurrence, and mortality of CVD. Adherence to this plant‐based dietary pattern may significantly decrease the risk of symptoms and death in patients with CMD, especially in those with CVD.
The Nordic Diet
The Nordic diet is a dietary pattern that combines the Nordic nutrition recommendations, which are issued by five Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden) with traditional Nordic foods. These findings contribute to the plausible explanations of cardiometabolic benefits, other than weight loss, induced by the Nordic diet.
The Jiangnan and Japanese Diets
The traditional Jiangnan diet comes from the lower Yangtze River in China. The traditional Japanese diet, “washoku,” consists of one bowl of rice, one bowl of soup, and one main and two side dishes. Several studies have demonstrated the cardiometabolic potential of the Japanese diet. The key dietary feature that gives it cardiometabolic potential is not any particular regional cuisine but a flexible and healthy dietary structure, including rich plant foods, whole grains, nuts, moderate amounts of dairy products, fish, and small amounts of refined processed foods and red meat.
Practical Considerations for the Cardio Metabolic Diet
Sweeteners
As much as possible, refrain from eating any added sweeteners due to the damaging effects that sugar can have on blood vessels and other body organs. Choose from the low to moderate-GI fruits listed on the Cardiometabolic Food Plan when craving something sweet. Stevia may be used in limited amounts for food preparation.
Drinks
Drink water throughout the day. A good goal is to drink about half one’s body weight in ounces (e.g., a 160-pound person would drink 80 ounces, or 10 cups), with a limit of 100 ounces daily. Unsweetened herbal teas, such as mint, chamomile, or hibiscus, are also good choices as they provide flavor and medicinal compounds. Green tea helps with blood sugar control. Typical recommendations for herbal or green tea are 1-3 cups per day.
Eggs
People with CVD may eat eggs on a daily basis.
Condiments
Many condiments, such as teriyaki sauce, ketchup, barbecue sauce, and glazes, have sugar added. It would be best to avoid them entirely and to make homemade versions that are healthier.
Alcohol
A health practitioner who knows the individual patient’s health history can make a determination as to whether moderate or occasional use of alcohol would be appropriate and consistent with health goals. For a generally healthy man, 1 to 2 glasses (5 ounces or ⅔ cup) of red wine, depending on body weight may be perfectly acceptable at meals.
Caffeinated Coffee or Tea
Every particular situation must be evaluated and discussed with a health practitioner. Patients should be advised not to add cow’s milk and sugar. Rather, they should use dairy alternatives such as almond, flaxseed, coconut, and soy milks. Green tea may be a better drink for most people. It contains caffeine, but not as much as a typical cup of coffee, and it can be purchased in non-caffeinated varieties. Green tea contains phytonutrients that are anti-inflammatory and antioxidant, helping to assist with blood sugar balance, blood lipids, and the expansion of the blood vessels. Drinking both green and black teas has been associated with reduction in the risk of heart disease and stroke by 10% to 20%.
Coconut Oil
Extra-virgin olive oil should be the staple oil for salad dressings and cooking, but small amounts of coconut oil can also be used.