The American Heart Association (AHA) has released updated nutrition guidance for cardiovascular health, recommending a heart-healthy eating pattern centered on vegetables, fruits, whole grains, and minimally processed foods, while encouraging a shift toward plant-based protein sources and noting ongoing uncertainty in specific areas including dietary fat sources and alcohol-related risk.
Published in Circulation, the AHA scientific statement updates its 2021 guidance and emphasizes dietary patterns rather than single foods or nutrients. The statement applies to the general population across the cardiovascular disease (CVD) risk spectrum, including patients with established disease, and cites an updated review of cardiovascular nutrition literature, with supplemental evidence tables and a review protocol available through the journal site.
The 2026 AHA guidance lists nine features of a heart-healthy dietary pattern — with a previous 10th step on applying guidance across food settings removed from the essential features list but retained in the body of the statement: maintain healthy body weight; eat a wide variety of vegetables and fruits; choose whole grains over refined grains; choose healthy protein sources; replace saturated fat with unsaturated fat; choose minimally processed foods over ultraprocessed foods; minimize added sugars; reduce sodium; and avoid starting alcohol or limit intake if alcohol is consumed.
Several recommendations align with the 2025 to 2030 Dietary Guidelines for Americans, including emphasis on vegetables, fruits, whole grains, lower sodium, limited added sugars, reduced intake of highly processed foods, and less alcohol. However, differences emerge in protein and fat guidance. The federal guidelines highlight protein within overall dietary patterns, incorporate both animal and plant protein sources, recommend full-fat dairy without added sugars, and list butter and beef tallow among examples of cooking fats, while continuing to advise that saturated fat intake remain below 10% of daily calories.
“A number of people have tried to model this now with 3 servings a day of whole dairy and red meat and cooking with butter and beef tallow and can’t do it — they can’t get less than 10% saturated fat,” said Christopher Gardner, PhD, of Stanford University School of Medicine.
Protein: A Key Point of Divergence
The AHA guidance recommends shifting from meat toward plant-based protein sources such as legumes and nuts. Dietary patterns with greater legume intake and less red and processed meat are linked to lower CVD and coronary heart disease risk, while higher nut intake is associated with lower cardiovascular and all-cause mortality risk. If red meat is consumed, the guidance recommends choosing lean cuts, avoiding processed products, and limiting portion size.
The AHA statement also notes that the relationship between protein quantity and cardiovascular health remains uncertain, so its guidance centers on protein sources — particularly fatty acid profile and fiber content. Fish and seafood remain recommended, but the statement notes that fish oil supplementation alone has not been shown to lower CVD risk in otherwise healthy adults and may be associated with increased atrial fibrillation risk in some patients.
“We appreciate that the majority of Americans eat a fair amount of meat, and so we have to be cognizant of that,” said Amit Khera, MD, vice chair of the statement’s writing committee and director of preventive cardiology at the University of Texas Southwestern Medical Center. “But if people even shifted somewhat more towards plant-based sources or healthier sources of protein, we think that could go a long way for cardiovascular health.”
Dairy Fat: An Evidence Gap
Dairy guidance remains a nuanced area. The AHA notes that the benefits of low-fat or fat-free dairy compared with full-fat dairy remain debated, and one systematic review found limited evidence that substituting higher-fat dairy with lower-fat dairy results in similar CVD risk. Still, the AHA concluded it would be prudent to continue prior guidance to replace major sources of saturated fat, including dairy fat, with unsaturated fat sources and choose nonfat or low-fat dairy.
“It’s probably beneficial if you’re consuming a decent amount of milk to focus on low-fat or fat-free in this evidence void,” Dr. Khera said, “but we do acknowledge that there’s an evidence void.”
Added Sugars, Sodium, and Alcohol
The statement highlights several effect sizes relevant to clinical counseling. Obesity currently affects 21% of pediatric and adolescent patients and 40% of adults in the US. Adults should engage in at least 150 minutes per week of moderate to vigorous physical activity. For added sugars, the AHA cites an estimate that adults consuming 25% or more of energy from added sugars have a nearly 3-fold higher risk of CVD mortality compared with those consuming less than 10% of energy from added sugars.
The AHA reports that observational studies have linked low or moderate alcohol intake with lower coronary heart disease risk, although these findings may reflect residual confounding, and notes that Mendelian randomization analyses have challenged this association. Alcohol intake is also associated with progressively higher blood pressure across intake levels. The guidance does not recommend initiating alcohol consumption to improve cardiovascular health.
Starting Early Across the Life Course
A key message of the updated statement is that heart-healthy dietary patterns should be established early — beginning at 1 year of age — and maintained across the life course.
“If we really want to prevent disease, it has to start early in life,” Dr. Khera said. “This is a critical message that we want to reinforce.”
Areas of Ongoing Uncertainty
The AHA indicates that the biological pathways linking ultraprocessed foods to adverse health outcomes are not well established. It also notes ongoing debate regarding the health effects of dairy fat and highlights uncertainty about potassium-enriched salt substitutes, including their applicability in populations where most sodium intake comes from commercially prepared foods and the potential risk of hyperkalemia in patients with impaired urinary potassium excretion.
Context: The Federal Guidelines
In a separate JAMA article, experts described the Dietary Guidelines Advisory Committee report as the product of a 2-year process involving scientific reviews, food pattern modeling, data analysis, and opportunities for public comment. However, the final 2025 to 2030 guidelines were issued alongside a separate Scientific Foundation document produced without a public comment period. The American Society for Nutrition said it supported the overall eating pattern but raised concerns about lack of transparency and oversimplification that introduce contradictory messaging.
“In general, the findings that have been emerging for the past few decades actually still are solid and have been validated,” said Alice Lichtenstein, DSc, of Tufts University, who chaired the statement’s writing committee. “There’s so much opportunity for customizing and still staying within the concept of a healthy dietary pattern that hopefully in the long run, that’s really going to facilitate implementation.”
Disclosures
Alice H. Lichtenstein, DSc, reported receiving research funding from the US Department of Agriculture and the National Institutes of Health. Lawrence J. Appel, MD, reported UpToDate chapter work. Dana DeSilva, PhD, RD, reported involvement with the Agriculture, Food, and Nutrition Evidence Center. Kristina S. Petersen, PhD, reported significant research funding from the National Cattlemen’s Beef Association, American Pecan Council, Egg Nutrition Center, Alliance for Potato Research & Education, American Pecan Promotion Board, Cotton Incorporated, and McCormick Science Institute, and advisory roles with Potatoes USA, McCormick Science Institute, and The Peanut Institute. All other writing group members reported no relevant disclosures.
In a related JAMA article, Penny M. Kris-Etherton, PhD, reported serving as a member of the Seafood Nutrition Advisory Committee. Lichtenstein reported receiving funding and grants from the US National Institutes of Health and the US Department of Agriculture. Donald M. Lloyd-Jones, MD, reported prior unpaid leadership roles with the AHA. David S. Ludwig, MD, PhD, reported authoring books for the public that recommend reduced-carbohydrate diets. Barbara Schneeman, PhD, reported chairing the 2020 Dietary Guidelines Advisory Committee and participating in advisory, scientific, and nonprofit organizations related to nutrition and food science. No other disclosures were reported.
Sources: Shift From Meat to Plants, Heart Group Says in Updated Dietary Guidance, What Nutrition Experts Say About the New Dietary Guidelines for Americans, 2026 Dietary Guidance to Improve Cardiovascular Health: A Scientific Statement From the American Heart Association, 2021 Dietary Guidance to Improve Cardiovascular Health: A Scientific Statement From the American Heart Association, Fact Sheet: Trump Administration Resets U.S. Nutrition Policy, Puts Real Food Back at the Center of Health, Dietary Guidelines For Americans
