Nutrition and cardiovascular disease: Putting a pathogenic framework into focus

In the last two decades it has become clear that dietary recommendations are a key element in the management of cardiovascular disease (CVD). An expanding body of evidence indicates that certain dietary patterns can influence cardiovascular health and primary prevention of CVD by modifying risk factors such as obesity, dyslipidemia, and hypertension as well as factors involved in systemic inflammation, insulin sensitivity, oxidative stress, endothelial function, thrombosis, and cardiac rhythm [1–3]. In the last century dietary and exercise habits have changed, with greater abundance of refined foods and a more sedentary lifestyle, resulting in the rising prevalence of obesity in Western countries [4,5].In the present Spotlight Issue, we present a series of review articles and original papers with the aim of investigating the various dietary profiles and pathogenic mechanisms that have emerged in the literature and the major studies that investigated their effectiveness in modifying cardiovascular risk. However, we need to keep in mind that long-term adherence can become a problem with some dietary advice that uses severe restriction of certain food groups. Indeed, in trials that investigated the effectiveness of low-carbohydrate diets in inducing weight loss, the attrition rates ranged between 24% and 39%. In most of these trials, comparable attrition rates were observed in subjects assigned to a low-fat diet [6–8]. More important, when a major change in the proportion of one macronutrient is imposed, compensatory changes in the proportions of other macronutrients will naturally occur. In the case of low-carbohydrate diets, there is a concern that excessive dietary protein intake without appropriate quantity of water and beverages can occur and potentially increase long-term risks for nephrolithiasis [9]. Furthermore, when dietary fat intake is severely restricted, biochemical evidence of essential fatty acid deficiency can result. Some clinical consequences have been reported, including episodic … *Corresponding author. Tel./fax: +39 081 293399. Email address: claunap{at}tin.it