If your dinner plate often includes fried chicken, gravy-smothered liver, buttered rolls and sweet tea — your heart may not find it so tasty. Eating a Southern-style diet is associated with an increased risk of heart disease, according to research published in Circulation, an American Heart Association (AHA) journal.

In a large-scale study that explored the relationship between dietary patterns and heart disease risk, researchers found that people who regularly ate traditional Southern fare — which they characterized as fried foods, fatty foods, eggs, processed meats, such as bacon and ham, organ meats like liver, and sugary drinks — were at a higher risk for suffering a heart attack or heart-related death during the next 5.8 years. Previous research also links the Southern diet with increased stroke risk.

The study is one of the first to include a regionally and socioeconomically diverse population. Researchers compared the dietary habits of more than 17,000 white and African-American adults in different regions of the United States. After adjusting for a combination of demographic and lifestyle factors, along with energy intake, they found:

• People who most often ate foods conforming to the Southern dietary pattern had a 56 percent higher risk of heart disease compared to those who ate it less frequently.
• The highest consumers of the Southern diet tended to be male, African-American, those who had not graduated from high school or were residents of southern states (North Carolina, South Carolina, Georgia, Tennessee, Alabama, Mississippi, Arkansas and Louisiana.)
• No other dietary pattern was associated with the risk of heart disease.

Gradual changes

“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,” said James M. Shikany, Dr.P.H. lead researcher and a nutritional epidemiologist at the University of Alabama at Birmingham’s Division of Preventive Medicine. “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.”

Researchers used data from participants in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study of white and African-American men and women aged 45 or older enrolled from 2003 to 2007. Participants were screened by telephone and then given an in-home physical exam and food frequency questionnaire that asked how often and how much, on average, they consumed the foods during the previous year.

Fats, fried food & organ meat

Researchers grouped the types of foods the participants regularly ate into five dietary patterns: the “convenience” pattern was comprised mostly of pasta dishes, Mexican food, Chinese food, mixed dishes and pizza; the “plant-based” pattern which was mostly vegetables, fruits, cereal, beans, yogurt, poultry and fish; the “sweets” pattern which consisted of added sugars, desserts, chocolate, candy and sweetened breakfast foods; the “alcohol/salads” was characterized by beer, wine, liquor, green leafy vegetables, tomatoes and salad dressings, and the “Southern” pattern, which was an eating pattern that the researchers observed to a greater extent in the Southeastern United States, included added fats, fried food, eggs and egg dishes, organ meats, processed meats and sugar-sweetened beverages.

Every six months, the participants were interviewed via telephone about their general health status and hospitalizations for nearly six years. For this study, the researchers only included participants who had no known heart disease at the beginning of the study.

Co-authors are Monika M. Safford, M.D.; P. K. Newby, Sc.D., M.P.H., MS; Raegan W. Durant, M.D.; Todd M. Brown, M.D.; and Suzanne E. Judd, Ph.D. Author disclosures are on the manuscript. The National Institute of Neurological Disorders and Stroke; the National Heart, Lung, and Blood Institute; and the General Mills Bell Institute of Health and Nutrition funded the study.