Danielle Belardo

Does the New Dietary Guideline for Americans Follow the Dietary Evidence? A Narrative Review

The Dietary Guidelines for Americans (DGA) shape federal nutrition programs, clinical counseling, and food industry practice for an estimated 330 million people. The 2025-2030 edition, released in January 2026, departs substantially from prior editions. This narrative review appraises the new DGA from a preventive cardiology standpoint, mapping its major recommendations onto current cardiometabolic evidence and consensus statements of major cardiovascular and nutrition societies. The 2025-2030 edition aligns with current cardiometabolic evidence in limiting added sugars, emphasizing fruits, vegetables, and whole grains, and retaining the cap on saturated fat at less than 10% of daily energy. It diverges, however, on several issues, such as dropping the longstanding recommendation to replace saturated fat with unsaturated fat, framing well-planned vegetarian and vegan patterns as excessively at risk of nutritional deficiencies, and endorsing full-fat dairy and animal cooking fats. Furthermore, it raises protein targets, removes the quantitative alcohol limits carried out since 1990 despite evidence of dose-dependent harm, reintroduces a food pyramid that was not consumer-tested and omits sustainability and equity. This review is organized by dietary component, distinguishing recommendations that contradict evidence from those that either extrapolate beyond the current evidence or that lack practical operationalization. We examine governance and conflict-of-interest concerns, including industry ties among authors of the supporting Scientific Foundation, and we examine affordability. We close with proposals for the next revision cycle that separates population guidance from targets clinicians can apply to high-risk patients, and outline a research agenda to address current evidence gaps.

iCARDIO Alliance Global Implementation Guidelines for the Management of Obesity 2025

Global guidelines address obesity management, suggesting novel therapies to optimize care worldwide.

iCARDIO Alliance Global Implementation Guidelines for the Management of Obesity: Focus on Prevention and Treatment of Cardiometabolic Disease

iCARDIO Alliance Global Implementation Guidelines for the Management of Obesity 2025

Global guidelines provide a unified strategy for managing obesity, highlighting novel therapies and local challenges.

iCARDIO Alliance global implementation guidelines for the management of obesity 2025 focus on prevention and treatment of cardiometabolic disease

There are a number of guidelines on how to manage obesity, but inconsistencies in healthcare access, varying infrastructure, resource constraints and diverse local practices restrict their global applicability. This underscores the need for universal recommendations that address the unique challenges faced by patients and healthcare providers worldwide. Our Global Guidelines emphasize the incorporation of novel therapies, while integrating standards of care with the most up-to-date evidence to enable clinicians to optimize obesity management. Context-specific recommendations tailored to individual patient needs are highlighted, providing a thorough evaluation of the risks, benefits, and overall value of each therapy, aiming to establish a standard of care that improves patient outcomes and reduces the burden of hospitalization in this susceptible population. These Global Guidelines provide evidence-based recommendations that represent a group consensus considering the many other published guidelines that have reviewed many of the issues discussed here, but they also make new recommendations where new evidence has recently emerged, and - most importantly - also provide recommendations on several issues where resource limitations may put constraints on the care provided to patients living with obesity. Such "economic adjustment" recommendations aim to guide situations when "Resources are somewhat limited" or when "Resources are severely limited". Hence, this document presents a comprehensive update to obesity management guidelines, thereby aiming to provide a unified strategy for the pharmacological, non-pharmacological, and invasive management of this significant global health challenge that is applicable to the needs of healthcare around the globe.

Intravenous Diuresis in Severe Precapillary Pulmonary-Hypertension-Related Right Heart Failure: Effects on Renal Function and Blood Pressure

In patients with right heart failure (RHF) and pulmonary hypertension (PH), classical teaching often advises cautious diuresis in the setting of ‘preload dependence’ to avoid renal injury and hemodynamic compromise. However, while this physiology may hold true in some clinical settings, such as acute ischemia with right ventricular infarction, it cannot necessarily be extended to PH-related RHF. Rather, in patients with precapillary PH and decompensated RHF, diuresis aimed to decongest the right heart and systemic venous system may be directly beneficial. This study aimed to evaluate the effects of diuresis on renal function and blood pressure in patients with severe precapillary PH. A retrospective chart review was conducted on 62 patients with severe precapillary PH admitted for decompensated RHF. The hemodynamic phenotype of these patients was characterized by invasive hemodynamics and echocardiographic data. Laboratory and hemodynamic data were collected at both admission and discharge. After large-volume diuresis in this patient population, there was an improvement in both glomerular filtration rate and creatinine. While there was a decline in blood pressure after diuresis, this was not clinically significant, given the blood pressure remained in a normal range with improvement in renal function. In conclusion, this study demonstrated that despite concern for preload dependence, significant diuresis in patients with acute decompensated RHF from precapillary PH is not only safe but beneficial.

MAR 2022BelardoAmerican Journal of Preventive Cardiology

Practical, Evidence-Based Approaches to Nutritional Modifications to Reduce Atherosclerotic Cardiovascular Disease: An American Society For Preventive Cardiology Clinical Practice Statement

Clinical practice statement emphasizes dietary interventions for preventing atherosclerotic cardiovascular disease.

A Look Back, A Path Forward

[Figure: see text]

A Look Back, A Path Forward: Moving Toward Diversity and Inclusion in Cardiovascular Society Presidents

Despite the number of female cardiologists increasing over time, women comprise only <15% of practicing cardiologists worldwide. Women cardiologists are less likely to be full professors, receive research funding, or have a registered clinical trial. Although there has been an increase in women authors of cardiovascular scientific publications over the past 40 years, women are still less likely to be first or senior authors, and they are underrepresented on cardiovascular journal editorial boards. It is well known that women hold few departmental leadership positions in medicine—they are less often cardiology division chiefs or fellowship program directors, and this holds true even in specialties that are female dominated. Additionally, there is a dearth of women and men from diverse backgrounds. Black people comprise 13% of the U.S. population but represent only 2% of cardiologists. Black cardiologists are underrepresented in leadership roles, as well as at the level of full professor. Similarly, only 2% of practicing cardiologists are Hispanic or Latino, and Indigenous people are underrepresented in both medicine and cardiology.

Agricultural policy and societal factors influence patients’ ability to follow a healthy diet

•Cardiovascular and cardiometabolic diseases are largely preventable, and are propagated by a poor diet.•Poor diet may be due to a lack of supply and access to healthy foods, agricultural subsidies, and marketing.•Improving national dietary intake starts with enhancing dietary guidelines, enacting legislative changes to optimize agricultural subsidies and food advertising, and incentivizing a plant-forward diet.

Public Awareness of a Plant-Based Diet Following the Release of “Game Changers” and “What The Health” Documentaries

Background: Poor diet is a leading cause of premature death and thus diet and lifestyle changes are needed; yet, no consensus exists regarding diets that provide the greatest benefit. One of these diets gaining popularity around the world is a plant-based, vegan diet. Recently, Netflix documentaries What the Health (2017) and The Game Changers (2019) have attempted to improve public awareness of veganism and plant-based diets. Methods: We used Google Trends to obtain data for keywords specific to plant-based diets, veganism, and documentary-specific terms over a time period before and after the release of the Netflix documentaries. We then created a forecasted model for trended search terms using autoregressive integrated moving algorithms and compared the actual trends to the forecast model to determine the effect of the documentaries on each selected term. Results: Search interest for the term “plant-based diet” increased significantly—2.8 times the mean forecasted value for What the Health ( t = 12.892, df = 30.012, P < .001) and 2 times the forecasted mean for The Game Changers ( t = 19.826, df = 30.118, P < .001). Additionally, following the release of The Game Changers, mean search interest for “plant-based athlete” was 2.8 times higher than the forecasted values. Conclusion: The documentaries What the Health (2017) and The Game Changers (2019) are associated with an increased interest in plant-based diets based on Google search trends, highlighting the need for continued research regarding plant-based diets and their health benefits related to chronic disease.

The Precision of Cardiovascular Disease Prevention Begins With a Zip Code

Emphasizes that effective primary and secondary ASCVD prevention requires clinicians to actively screen for and address social determinants of health alongside traditional risk factors, aligning with 2019 ACC/AHA Class I recommendations.