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.

Keywords: cardiovascular disease prevention; cardiovascular disease risk factors; diet; disparities; nutrition; social determinants.

Figure 1

Prevalence of poor, intermediate, and ideal scores for the dietary component of the American Heart Association's Ideal Cardiovascular Health Definition in US adults aged ≥20 years (age standardized) and selected age groups by race/ethnicity. Source: National Center for Health Statistics, National Health and Nutrition Examination Survey, 2015 to 2016. Hisp indicates Hispanic; Ideal, 4 to 5 ideal components; Intermediate, 2 to 3 ideal components; NHA, non‐Hispanic Asian; NHB, non‐Hispanic black; NHW, non‐Hispanic white; and Poor, 0 to 1 ideal components.

Figure 2

Determinants of food choice and diet quality.