Lead researcher James Shikany, a professor of nutritional epidemiology at the University of Alabama in Birmingham, said that regularly eating Southern-style dishes was linked to a 56 percent increased risk for heart attack during the almost six years of the study.
However, it's important to note that the study wasn't designed to prove a cause-and-effect relationship between these foods and heart disease, only an association.
Still, Shikany said, "there are many possible mechanisms that increase risk." These include excess saturated fats and nitrates in processed meats and sugar, which increase cholesterol, insulin resistance and body weight, all of which are linked to an increased risk for heart disease, he added.
For the study, Shikany's team collected diet data on more than 17,000 people from around the United States who took part in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study of white and black men and women aged 45 or older enrolled from 2003 to 2007.
The researchers compared the Southern diet with other diet patterns. Patterns included the "convenience" pattern made up of pasta dishes, Mexican food, Chinese food and pizza; the "plant-based" pattern included mostly vegetables, fruits, cereal, beans, yogurt, poultry and fish; the "sweets" pattern consisting of added sugars, desserts, chocolate, candy and sweetened breakfast foods; and the "alcohol/salads" pattern, which included beer, wine, liquor, green leafy vegetables, tomatoes and salad dressings.
Those who regularly ate a typical Southern diet tended to be men, blacks and people who had not graduated from high school, the study found. The researchers also found -- unsurprisingly -- that people who regularly consumed Southern fare tended to live in the so-called "Stroke belt." This includes North Carolina, South Carolina, Georgia, Tennessee, Alabama, Mississippi, Arkansas and Louisiana, the researchers said.
No other dietary pattern the researchers looked at was associated with the risk for heart disease. The "Southern" pattern included added fats, fried food, eggs and egg dishes, organ meats, processed meats and sugar-sweetened drinks, the researchers said.
The report was published online Aug. 10 in the journal Circulation.
Samantha Heller, a senior clinical nutritionist at NYU Langone Medical Center in New York City, said, "It would seem that just about everyone knows that eating fried pork chops and gravy, butter-drenched, lard-laden biscuits and bacon-infused everything is not a healthy diet."
However, what people choose to eat is based on cultural, emotional, social, economic, psychological, physiological and environmental influences, she said.
"This is clear in the findings of this study as the South is known for heavily meat- and dairy-based dishes, fried foods and rich sauces," Heller said. "The deep South is often referred to as the Stroke Belt and the Diabetes Belt because of the high prevalence of dietary-related stroke, type 2 diabetes, obesity and heart disease," she added.
Trying to shift the culture around a certain style of eating, in this case shifting the Southern style to a healthier, more plant-based approach, can be daunting, Heller explained.
"As much as I try to convince patients that collards can still taste great without a pound of smoked ham hocks, butter and tons of salt, it's a tough sell," she said. "Still, it is necessary for nutrition education and support to be brought to the communities and populations most at risk."
One way may be to approach the shift from a slightly different angle, Heller said. "Instead of making substitute dishes such as 'healthy fried chicken' -- since it will not taste anything like its deep-fried namesake -- alternate dishes may be a better approach. Thus, one might encourage Southern food eaters to opt for oven-fried nut-crusted chicken. Or New York-style collard greens simmered with extra virgin olive oil, tomatoes, garlic and organic vegetable stock," she said.
Shikany doesn't think people have to completely eliminate these foods from their diet. "I tend to be a moderation person," he said. "I don't like to tell people 'don't eat this, don't eat that,' because it doesn't work. People get frustrated."
He would rather encourage people to modify their diet. For example, he suggests not having bacon or ham every day for breakfast, but limiting it to a couple of times a week. "It's probably best to cut it out, but I tend to be realistic, so I try to get people to cut down," he said.