Substantial data generated from clinical and population-based studies support the critically important role of dietary quality in promoting cardiovascular health and reducing risk for cardiovascular disease (CVD) across the life span. The recently issued Dietary Guidelines for Americans, 2020-2025 is grounded in science and provides recommendations by life stage, from birth through older adulthood.1 Designed for health and nutrition professionals to help individuals and families consume a healthy, nutritionally adequate diet, the information is also used to develop, implement, and evaluate federal food, nutrition, and health policies and programs. The guidelines also form the basis for federal nutrition education materials designed for the public as well as the nutrition education components of the US Department of Agriculture and US Department of Health and Human Services nutrition programs.1

Developed with a public health orientation and emphasis, a major aim of the Dietary Guidelines is to promote health and prevent diseases. More specifically, the body of scientific evidence on diet and health reviewed to inform the Dietary Guidelines is representative of the US population including individuals who are healthy as well as individuals at risk for diet-related chronic conditions including obesity, type 2 diabetes, and CVD and individuals living with one or more of these diet-related chronic conditions. An important and fundamental premise of the 2020-2025 Dietary Guidelines is that most Americans, regardless of health status, can benefit from shifting food and beverage choices to better support healthy dietary patterns. Many recommendations have remained relatively consistent over time; however, recognizing that diet-related chronic conditions including obesity and CVD are increasingly prevalent among Americans, more emphasis is placed on promoting healthy dietary patterns in individuals with or at risk for these conditions. Building upon scientific evidence, the 2020-2025 Dietary Guidelines emphasize patterns of dietary intake, the combination of foods and beverages that constitute an individual's dietary intake over time with an emphasis on nutrient-dense foods and beverages. Of note, the guidelines include a life span approach highlighting the importance of encouraging healthy dietary patterns at every life stage from infancy through older adulthood.

Consistent with American Academy of Pediatrics guidelines,2 exclusive breastfeeding is recommended for the first 6 months of life and, through the first year if possible, introducing nutrient-dense complementary foods at 6 months is also recommended. If human milk is unavailable, iron-fortified infant formula is recommended. Supplemental vitamin D beginning soon after birth is recommended for all infants, and foods rich in iron and zinc as complementary foods from major food groups are introduced beginning at 6 months. From 12 months through older adulthood, a healthy dietary pattern designed to meet nutrient needs, achieve and maintain a healthy body weight, and reduce the risk of chronic conditions is recommended.

Recommendations for health promotion highlight customizing and enjoying nutrient-dense foods ("making every bite count" approach) and beverage choices to reflect personal preferences, cultural traditions, and budgetary considerations. Limiting foods and beverages high in added sugars (less than 10% of calories per day starting at the age of 2 years and avoidance before the age of 2 years), saturated fat (less than 10% of calories staring at the age of 2 years), and sodium (less than 2300 mg/d) as well as alcoholic beverages (2 or less per day for men and 1 or less per day for women) is also recommended.1

The recommendation of customizing the guidelines for individuals and underserved populations requires careful consideration of the social determinants of health including but not limited to financial resources. A recent review by Kris-Etherton and colleagues3 highlighted the disparities in diet quality by race/ethnicity, education level, income, and use of food assistance programs in the United States. Of note, these dietary disparities mirror those observed and documented in the burden of CVD. Evidence indicates that unfavorable nutrition environments disproportionally affect some racial/ethnic groups as well as those of low socioeconomic status. Clearly, the availability, price, and quality of healthy foods available in a neighborhood directly impact diet quality. Food deserts, areas that lack access to affordable fruits, vegetables, whole grains, and other foods that comprise a healthy diet, are more prevalent in neighborhoods where individuals and families of low-income status, low educational attainment, and racial/ethnic minorities reside. Relatedly, low-income communities with a high proportion of racial/ethnic minorities have a greater density of fast food outlets and convenience stores with few healthy options, aptly referred to as food swamps. Food insecurity or limited access to adequate food has been attributed to economic factors including food pricing and income level as well as food availability and access.3 In 2017, approximately 12% of households in the United States were food insecure at some point in the year.4 Of note, households with any children (15%), with children younger than 6 years (16.4%), headed by single women (30.3%) or men (19.7%), headed by non-Hispanic Blacks (21.8%) or Hispanics (18%), or with income less than 185% of the poverty threshold (30.9%) were disproportionately affected by food insecurity.4

In addressing these disparities in diet quality, Kris-Etherton and colleagues3 suggest a "call to action" with multifaceted approaches that strategically target the social determinants of diet quality and CVD, including confronting multilevel barriers to a healthy diet in underserved populations. Revisions to public policy to increase the affordability of healthy foods have the potential to benefit low-income groups most significantly. Nutrition safety-net programs and food assistance programs are particularly important for underserved, marginalized groups. Thus, continuation of these programs is recommended as one strategy to promote diet quality across the life span of individuals from diverse and marginalized populations.

Cardiovascular nurses are well prepared and positioned in clinical and community-based settings to help individuals and families adapt and adhere to the Dietary Guidelines as part of self-care for cardiovascular health promotion and risk reduction. From a public health perspective, empowering consumers on how to use the guidelines and resources available to optimize patterns of dietary intake is an important part of nursing practice. Equally as important, advocating for the multilevel policies and programs focused on promoting healthy patterns of dietary intake for all and with the goal of promoting cardiovascular health and reducing CVD is an essential component of evidence-based nursing practice in 2021 and beyond.

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