Barriers, Opportunities, and Challenges in Addressing Disparities in Diet‐Related Cardiovascular Disease in the United States

Abstract

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.

Barriers and facilitators to participant adherence of dietary recommendations within comprehensive cardiac rehabilitation programmes: a systematic review

“…Data from availability of CR programs around the world were extracted from study published by Turk-Adawi et al (53) and n-3 supplement intake and transitioning to vegetarianrich diets, as patients reported difficulty in finding healthy food options close to their homes (34,(40)(41)(42)(43) . Previous studies have identified an association between availability of healthy food and race/ethnicity, financial situation, and access to grocery stores and supermarkets (57)(58)(59) . In the American city of Baltimore, Morland et al (57) suggested that high availability of healthy foods was present in only 19 % of predominately black neighbourhoods compared with 68 % of white neighbourhoods.…”

“…In the American city of Baltimore, Morland et al (57) suggested that high availability of healthy foods was present in only 19 % of predominately black neighbourhoods compared with 68 % of white neighbourhoods. People living in areas with long distances to supermarkets, low access to fresh foods and with an abundance of unhealthy processed fast food outlets were less likely to adhere to dietary recommendations (57)(58)(59) . Patients' income also has an important impact on their adherence to dietary recommendations (60) .…”

Improving Healthy Food Choices in Low-Income Settings in the United States Using Behavioral Economic-Based Adaptations to Choice Architecture

“…Low diet quality represents a significant public health problem in the United States (US). Estimates state that 82% of US adults aged 20-49 years and 73% of adults over 50 years score poorly on measures of diet (1). Low-income populations are disproportionately impacted by low dietary quality, as evidence suggests that compared to high-income households, low-income households purchase less healthful foods and have significantly lower dietary quality (2,3).…”

Are recommended dietary patterns equitable?

“…Adherence to dietary recommendations remains a challenge for the majority of Americans for a number of reasons including taste preferences, limitations in nutrition education or food preparation knowledge, or most importantly, the systemic barriers leading to inequitable access to healthy food. It is well established that racial/ethnic minorities and those at lower income levels in the U.S. have poorer diet quality compared to whites and individuals at higher income levels (1,2) . One dimension that has been less explored is the potential limitation of existing dietary recommendations in considering diverse cultural values around food that may consequently compromise nutritional intake.…”