Abstract / Description: 

In the United States, cardiovascular disease (CVD) is the leading cause of death and disability. Suboptimal diet quality is responsible for a greater percentage of CVD?related morbidity and mortality than any other modifiable risk factor. Further troubling are the stark racial/ethnic and socioeconomic disparities in diet quality. This represents a major public health concern that urgently requires a coordinated effort to better characterize the barriers to healthy dietary practices in population groups disproportionally affected by CVD and poor diet quality to inform multifaceted approaches at the government (policy), community environment, sociocultural, and individual levels. This paper reviews the barriers, opportunities, and challenges involved in shifting population behaviors, especially in underserved populations, toward healthy dietary practices. It is imperative that public health policies address the social determinants of nutrition more intensively than previously in order to significantly decrease CVD on a population?wide basis.

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the United States.1 Despite significant progress in the past 40 years,2 reductions in the CVD mortality rate have slowed after 4 decades of decline; between 2010 and 2015, CVD deaths increased, although the age?adjusted death rate declined by 1.8% between 2015 and 2016.3 Arnett et al4 attributed the deceleration in CVD mortality decline to increasing obesity prevalence, which is a direct result of suboptimal dietary habits. In the United States, approximately half of all CVD?related disability and death is attributed to poor diet quality, making it the leading cause of CVD.1 Disparities in diet quality exist by race, ethnicity, and socioeconomic status (SES).3, 5, 6 Diet?related disparities mirror the disproportionate burden of CVD in underserved populations.3 The purpose of this article is to summarize the disparities in diet quality that exist in the United States as it relates to CVD, and discuss barriers and strategies to improve overall diet quality with a focus on the social determinants of CVD and poor diet quality.

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General CV
Penny M. Kris?Etherton , PhD, RDN, Kristina S. Petersen , PhD, APD, Gladys Velarde, MD, Neal D. Barnard, MD, Michael Miller, MD, Emilio Ros, MD, PhD, James H. O'Keefe, MD, Kim WilliamsSr., MD, MACC, Linda Van Horn, PhD, RDN, Muzi Na, PhD, MHS, Christina Shay, PhD, Paul Douglass, MD, David L. Katz, and MD, MPH, and Andrew M. Freeman MD