What diet is recommended for patients with Abdominal Aortic Aneurysm (AAA)?

Dietary Recommendations for Patients with Abdominal Aortic Aneurysm

Patients with AAA should follow a Mediterranean-style diet rich in legumes, dietary fiber, nuts, fruits, and vegetables, with high flavonoid intake, as this dietary pattern is specifically recommended by the 2024 ESC Guidelines for cardiovascular disease prevention in peripheral arterial and aortic diseases and has been shown to reduce AAA risk. 1

Core Dietary Pattern

The Mediterranean diet forms the foundation of nutritional management for AAA patients, with specific evidence demonstrating protective effects:

• Consume at least 2 servings of fruit daily to reduce AAA risk by approximately 31% for non-ruptured AAA and 39% for ruptured AAA compared to no fruit consumption 2
• Emphasize whole grains, legumes, nuts, and vegetables as these components collectively reduce cholesterol and blood pressure while providing protective benefits against AAA development 1
• Include at least 2 servings of fish per week, particularly fatty fish, for cardiovascular benefits 1
• Incorporate low-fat or fat-free dairy products as part of the overall dietary pattern 1, 3

Specific Macronutrient Targets

Limit saturated fat to less than 7% of total calories and dietary cholesterol to less than 200 mg per day to achieve optimal lipid control, as AAA patients require aggressive LDL-C reduction to <55 mg/dL 1, 4

• Substitute unsaturated fats from vegetables, fish, legumes, and nuts for saturated fats 1
• Total fat intake should remain below 30% of total energy to assist in limiting total energy consumption 1
• Include lean meats and poultry when consuming animal proteins 1

Sodium and Blood Pressure Management

Restrict sodium intake to less than 6 grams per day as blood pressure control is critical in AAA management, with target systolic blood pressure of 120-129 mmHg 1

• This sodium restriction works synergistically with the Mediterranean dietary pattern to achieve optimal blood pressure control 1
• The combination of dietary sodium restriction and the DASH-style eating pattern has demonstrated effectiveness in AAA risk reduction 3

Alcohol Consumption

Limit alcohol to no more than 1 drink per day for women and 2 drinks per day for men, and avoid excessive alcohol intake entirely 1

Weight Management

Maintain BMI between 20-25 kg/m² with waist circumference less than 94 cm in men and less than 80 cm in women 1

• Match total energy intake to energy needs, limiting high-calorie density foods with low nutritional quality 1
• Balance energy intake with regular physical activity (low to moderate intensity aerobic exercise) 1

Evidence-Based Rationale

The recommendation for Mediterranean diet specifically stems from a large cohort study with 17.5 years of follow-up demonstrating that adherence to this dietary pattern was associated with reduced AAA risk in current and former smokers 1. Additionally, the ARIC study showed that individuals with the highest adherence to a DASH-style dietary pattern (similar to Mediterranean diet) had a 40% lower risk of AAA hospitalization compared to those with lowest adherence 3.

Higher consumption of fruits showed more pronounced protective effects than vegetables alone, with those consuming more than 2 servings of fruit daily having a 25% lower risk of AAA overall and 43% lower risk of ruptured AAA 2. This fruit-specific benefit appears particularly important for AAA prevention.

Critical Pitfalls to Avoid

• Do not recommend high-fat diets as experimental evidence demonstrates that high-fat diets containing cholesterol can induce aortic aneurysm formation through inflammatory mechanisms 5
• Avoid recommending vitamin and mineral supplements as substitutes for a balanced diet emphasizing whole foods 6
• Do not focus solely on cholesterol reduction without addressing the overall dietary pattern, as the synergistic effects of multiple dietary components provide the greatest benefit 1, 3

Integration with Medical Management

Dietary therapy must be implemented alongside comprehensive medical management including:

• High-intensity statin therapy targeting LDL-C <55 mg/dL 1
• Antihypertensive therapy with beta-blockers as preferred agents 7
• Complete smoking cessation (mandatory and non-negotiable) 1
• Regular physical activity (low to moderate intensity aerobic exercise) 1

Nutritional support may be particularly important for patients undergoing invasive procedures, as malnutrition and metabolic disorders can complicate post-procedural recovery 1