Frequently consuming foods typical of a Southern-style diet may increase a person’s risk of a heart attack or heart-related death, a new study suggests.

James M. Shikany, DrPH, a nutritional epidemiologist at the University of Alabama, and his research team analyzed food frequency questionnaires from 17,418 Caucasian and African American participants (other ethnic groups excluded) in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study.  The investigators identified and characterized five dietary patterns based on participants’ usual intake of 110 food items: Southern, Plant-based, Sweets, Convenience, and Alcohol-Salad.

The “Southern” diet included a high proportion of fried foods, added fats, eggs, organ and processed meats, and sugar-sweetened beverages (and a low intake of fruits, vegetables, and fiber-rich foods). Men and women with the highest intake of these foods had a 56% greater risk of non-fatal myocardial infarction or death due to coronary heart disease (CHD) over 5.8 years, compared with people with the lowest consumption, according to results published in Circulation. The participants, aged 45 and older, had no history of CHD at the start.

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The other dietary patterns showed neither positive nor negative associations with acute CHD, including, interestingly enough, the Plant-based diet consisting of produce, fruit juices, cereals, beans, fish, poultry, and yogurt, foods. The Sweets eating pattern was loaded with added sugars, desserts, chocolate, candy, and sweetened breakfast foods. The Convenience diet featured pasta, pizza, Mexican and Chinese foods, as well as mixed dishes. The Alcohol-Salad eating pattern included predominantly beer, wine, liquor, green leafy vegetables, tomatoes, and salad dressing.

The investigators suggest atherosclerosis may link a Southern-style diet with CHD. Previous research on processed meat consumption pointed to its high sodium and nitrate content, as well as its byproducts, which may promote atherosclerosis and vascular dysfunction. Sugar-sweetened beverages likewise may spur atherosclerosis by increasing body mass index (BMI) and glycemic load, which in turn promotes insulin resistance, beta cell dysfunction, and inflammation.

“Regardless of your gender, race, or where you live, if you frequently eat a Southern-style diet you should be aware of your risk of heart disease and try to make some gradual changes to your diet,” Shikany advised, according to a release. “Try cutting down the number of times you eat fried foods or processed meats from every day to three days a week as a start, and try substituting baked or grilled chicken or vegetable-based foods.”

Consumers of the Southern diet tended to be male, African American, smokers, residents of the stroke belt, and low income earners. They also were more likely to have a higher BMI, greater waist circumference, hypertension, dyslipidemia, and diabetes. When the researchers accounted for BMI and the above medical conditions, it reduced the risk of acute CHD only somewhat to 37%.


  1. Shikany, JM; Safford, MM; Newby, PK, et al. Circulation; doi: 10.1161/CirculationAHA.114.014421.
  2. American Heart Association News Release, Aug 10, 2015.