Contemporary dietary guidance recommends healthy dietary patterns with emphasis on food-based recommendations because the totality of the diet (i.e., the combinations and quantities of foods and nutrients consumed) is an important determinant of health. In many guidelines, recommendations are still made for saturated fat, added sugar, sodium, and dietary cholesterol because these are over-consumed by many people and are related to chronic disease development. Epidemiological research illustrates the importance of considering the total diet and the interrelatedness of nutrients in a dietary pattern. Traditionally, epidemiological research focused on individual nutrients in isolation, which can result in erroneous conclusions. An example of this, which has led to substantial controversy, is the evidence from studies evaluating the association between saturated fat and CVD without considering the replacement nutrient. Another controversial topic is the relationship between dietary cholesterol and CVD, which is confounded by saturated fat intake. Finally, the totality of evidence shows that high sodium intake is associated with greater CVD risk; however, some epidemiological research has suggested that a low-sodium intake is detrimental, which has caused some controversy. Overall, this reductionist approach has led to a debate about recommendations for saturated fat, cholesterol, and sodium. However, if approaches that accounted for the interrelatedness of nutrients had been taken, it is likely that there would be less controversy about these nutrients. To encourage dietary pattern-based approaches and consideration of total intake, dietary guidelines should emphasize food-based recommendations that meet nutrient targets. Thus, nutrient targets should underpin food-based dietary guidelines, and recommended dietary patterns should comply with nutrient-based targets. The evidence reviewed shows that it is imperative to consider total dietary patterns for CVD prevention. Dietary guidance should be aligned with nutrient targets and recommendations should be food and dietary pattern based.

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Background: Legumes are an inexpensive, healthy source of protein, fiber, and micronutrients, have low greenhouse gas and water footprints, and enrich soil through nitrogen fixation. Although higher legume consumption is recommended under US dietary guidelines, legumes currently comprise only a minor part of the US diet.Objectives: To characterize the types of legumes most commonly purchased by US consumers and patterns of legume purchases by state and region, seasonality of legume purchases, and to characterize adults that have a higher intake of legumes.Methods: We examined grocery market, chain supermarket, big box and club stores, Walmart, military commissary, and dollar store retail scanner data from Nielsen collected 2017–2019 and dietary intake from the National Health and Nutrition Examination Survey (NHANES), 2017–2018.Results: The five leading types of legumes purchased in the US were pinto bean, black bean, kidney bean, lima bean, and chickpea. The mean annual per capita expenditure on legumes based on grocery purchases was $4.76 during 2017–2019. The annual per capita expenditure on legumes varied greatly by state with highest expenditure in Louisiana, South Carolina, Florida, Alabama, Mississippi, and lowest expenditure in Washington, New York, and Wisconsin. There were large regional differences in the most commonly purchased legumes. Of 4,741 adults who participated in the 24-h dietary recall in NHANES, 2017–2018, 20.5% reported eating any legumes in the previous 24 h. Those who consumed legumes were more likely to be Hispanic, with a higher education level, with a larger household size (all P < 0.05), but were not different by age, gender, or income level compared to those who did not consume legumes.Conclusion: Although legumes are inexpensive, healthy, and a sustainable source of protein, per capita legume intake remains low in the US and below US dietary guidelines. Further insight is needed into barriers to legume consumption in the US.

Fruit intake is associated with lower risk of cardiometabolic diseases. However, effects of dried fruits on cardiometabolic health are not well researched. We investigated the effect of daily dried fruit consumption compared with a carbohydrate-rich snack on cardiometabolic disease risk factors in adults with increased cardiometabolic risk. A two-period randomised crossover trial was conducted in adults (n 55) with elevated BMI and at least one additional risk factor for cardiometabolic disease to compare the effects of consuming 3/4 cup/d mixed dried fruits (plums, figs, dates and raisins) or an energy- and carbohydrate-matched control snack for 4 weeks. The primary outcome was LDL-cholesterol; secondary outcomes included other lipids and lipoproteins, glucose and insulin, C-reactive protein, blood pressure and vascular stiffness. Linear mixed models were used for data analysis. Lipid and lipoprotein concentrations did not differ between conditions; however, dried fruit increased LDL-cholesterol (0·10 mmol/l, 95 % CI 0·01, 0·20) compared with baseline. Compared with the control, dried fruit increased mean fasting glucose (0·08 mmol/l, 95 % CI 0·005, 0·16; P = 0·038). Vascular outcomes, fasting insulin and C-reactive protein did not differ between conditions. Mean weight changes did not differ (P = 0·55) but tended to increase after both conditions (dried fruit 0·3 kg, 95 % CI –0·09, 0·65; control 0·4 kg, 95 % CI 0·01, 0·75). Thus, short-term daily consumption of a large portion of mixed dried plums, figs, dates and raisins, without structured dietary guidance, did not improve cardiometabolic risk factors, compared with carbohydrate-rich snacks, in adults with increased baseline cardiometabolic risk.