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New Dietary Guidelines set limit on added sugars, promote lifetime healthy eating patterns

The 8th edition of the Dietary Guidelines for Americans was released in January by the HHS and the U.S. Department of Agriculture.

The guidelines have a strong focus on healthy eating patterns across the lifespan, limited calories from added sugars and saturated fats, and reduced sodium intake, in an effort to help Americans better manage their weight and decrease their risk for CVD, hypertension, type 2 diabetes and other diet-related chronic diseases. It is also the first edition of the guidelines to set measurable limits on how much added sugar Americans should consume.

“Protecting the health of the American public includes empowering them with the tools they need to make healthy choices in their daily lives. By focusing on small shifts in what we eat and drink, eating healthy becomes more manageable. The Dietary Guidelines provide science-based recommendations on food and nutrition so people can make decisions that may help keep their weight under control and prevent chronic conditions like type 2 diabetes, hypertension and heart disease,” HHS Secretary Sylvia M. Burwell said in a press release.

2015-2020 guidelines

The new document provides five overarching guidelines that encourage healthy eating patterns:

  • Follow a healthy eating pattern across the lifespan to help achieve and maintain a healthy body weight, support nutrition adequacy and reduce risk for chronic diseases.
  • Focus on variety, nutrient density and amount.
  • Limit calories from added sugars and saturated fats and decrease sodium intake by cutting back on foods and beverages high in these components to amounts that fit within healthy eating patterns.
  • Opt for healthier food and beverage choices.
  • Support healthy eating patterns for everyone, in multiple settings — from home to school to work to communities.

Key recommendations in the Dietary Guidelines include consuming a variety of nutrient-dense foods such as dark green, red and orange vegetables; legumes; starchy vegetables; whole fruits; grains, at least half of which are whole grains; and low- or fat-free milk, yogurt, cheese and fortified soy drinks. Protein-rich foods such as seafood, lean meats and poultry, eggs, soy, nuts and seeds, as well as plant-based oils, are also considered healthy choices. The Dietary Guidelines specifically limit consumption of saturated and trans fats, citing research that indicates replacing saturated fats with polyunsaturated fats is associated with reduced risk for CVD events and death.

Measurable limits were also set for added sugar, sodium, fats and alcohol:

  • Limit added sugars to less than 10% of daily caloric intake.
  • Limit sodium to less than 2,300 mg of daily caloric intake, and even less for children and adolescents aged younger than 14 years.
  • Limit saturated and trans fat to less than 10% of daily caloric intake.
  • Limit alcohol to up to one drink per day for women and up to two drinks per day for men of legal drinking age.

For adults with prehypertension and hypertension, further sodium reduction to 1,500 mg per day is recommended for an even greater reduction in BP. The effects of the DASH diet on BP and cholesterol have been cited in the DASH-Sodium Trial and the OmniHeart Trial.

One of the key recommendations from the 2010 Dietary Guidelines to limit consumption of dietary cholesterol to 300 mg per day was omitted in the new update due to a lack of evidence on the dose-response relationship between dietary cholesterol and blood cholesterol, according to the statement. The guidelines emphasize, however, that this change is not meant to suggest that dietary cholesterol is not important. As recommended by the Institute of Medicine, Americans should keep their dietary cholesterol intake to a minimum because the body makes enough cholesterol to support the body’s functions, according to the statement.

Strategies are also offered to businesses, industries, community organizations and individuals to support healthy eating for all Americans. In a related editorial published in JAMA upon release of the Dietary Guidelines, Karen B. DeSalvo, MD, MPH, MSc, from the office of the assistant secretary for health at HHS, and colleagues noted that health care professionals, communities, businesses and industries, organizations, governments and other segments of society play a vital part in supporting health eating patterns and physical activity goals.

However, reactions to the 2015-2020 recommendations have been mixed.

“Obesity rates and related health problems have risen dramatically in recent decades. Very recently there have been indications from the CDC that the growth in obesity is leveling off, but there is still a lot of work to be done to help Americans return to healthier body weight to reduce heart disease and other related health issues. Following the recommendations in the 2015 Guideline to lower intake of cholesterol, fat and sugar, will help improve the health of the American population,” Kim Allan Williams, MD, FACC, president of the American College of Cardiology, said in a press release.

Kim Allan Williams, MD, FACC
Kim Allan Williams

Mark A. Creager, MD, FAHA, FACC, president of the American Heart Association, encouraged all Americans to use the Dietary Guidelines as a tool for achieving healthier eating patterns.

“The new federal dietary guidelines give Americans more flexibility in their diets without sacrificing their health. By providing a valuable source of nutrition information, the standards are part of a roadmap to help build a ‘culture of health’ in America. This healthier culture will help reduce our risk for heart disease and stroke — the two leading causes of death in the world,” Creager said in a release.

Although the American Heart Association and the American College of Cardiology announced support in favor of the updates, the HHS and USDA have drawn fire by others in the medical community for a lack of quality research and unclear messages on red meat consumption and dietary cholesterol.

In a discussion published in The Mayo Clinic Proceedings, Edward Archer, PhD, MS, and Gregory Pavela, PhD, both from the University of Alabama at Birmingham, and Carl J. Lavie, MD, FACC, FACP, FCCP, from John Ochsner Heart and Vascular Institute, Queensland University, New Orleans, wrote, “In the 2015 [Dietary Guidelines Advisory Committee] report, the distinction between correlation and causation is either ignored or dismissed. For example, the words ‘association,’ ‘associated’ and ‘relationship’ are used more than 900 times in the 571-page [Dietary Guidelines Advisory Committee] text, whereas the words ‘causal’ and ‘causality’ are used fewer than 30 times and not once to describe an actual causal diet-health relationship.”

In an editorial published in the Annals of Internal Medicine,Cardiology Today Editorial Board member Steven E. Nissen, MD, pointed out that the report “repeatedly makes recommendations based on observational studies and surrogate endpoints, failing to distinguish between recommendations based on expert consensus, rather than high-quality [randomized controlled clinical trials].”

Steven E. Nissen, MD
Steven E. Nissen

According to Nissen, knowledge is lacking on the effect of low-fat diets and limited saturated fats on risk factors for coronary disease. The most promising data come from the PREDIMED study, published in 2013, which compared adherence to a Mediterranean diet vs. the AHA low-fat diet in participants at risk for CHD. Compared with the low-fat diet, the adjusted HRs for CHD were 0.7 for the group assigned an extra-virgin olive oil-enriched diet and 0.72 for the group assigned a diet enriched with nuts.

“It is time for careful [randomized controlled clinical trials] testing various dietary interventions — studies unlikely to be industry-funded,” he wrote.

Nissen told Cardiology Today that “cardiologists should inform their patients that the best way to protect themselves from CVD is to follow the Mediterranean diet, rich in oils and nuts.” – by Tracey Romero

Disclosures: Archer reports receiving honoraria from the International Life Sciences Institute and the Coca-Cola Company. DeSalvo and Nissen report no relevant financial disclosures. See full commentary for all authors’ relevant financial disclosures.

The 8th edition of the Dietary Guidelines for Americans was released in January by the HHS and the U.S. Department of Agriculture.

The guidelines have a strong focus on healthy eating patterns across the lifespan, limited calories from added sugars and saturated fats, and reduced sodium intake, in an effort to help Americans better manage their weight and decrease their risk for CVD, hypertension, type 2 diabetes and other diet-related chronic diseases. It is also the first edition of the guidelines to set measurable limits on how much added sugar Americans should consume.

“Protecting the health of the American public includes empowering them with the tools they need to make healthy choices in their daily lives. By focusing on small shifts in what we eat and drink, eating healthy becomes more manageable. The Dietary Guidelines provide science-based recommendations on food and nutrition so people can make decisions that may help keep their weight under control and prevent chronic conditions like type 2 diabetes, hypertension and heart disease,” HHS Secretary Sylvia M. Burwell said in a press release.

2015-2020 guidelines

The new document provides five overarching guidelines that encourage healthy eating patterns:

  • Follow a healthy eating pattern across the lifespan to help achieve and maintain a healthy body weight, support nutrition adequacy and reduce risk for chronic diseases.
  • Focus on variety, nutrient density and amount.
  • Limit calories from added sugars and saturated fats and decrease sodium intake by cutting back on foods and beverages high in these components to amounts that fit within healthy eating patterns.
  • Opt for healthier food and beverage choices.
  • Support healthy eating patterns for everyone, in multiple settings — from home to school to work to communities.

Key recommendations in the Dietary Guidelines include consuming a variety of nutrient-dense foods such as dark green, red and orange vegetables; legumes; starchy vegetables; whole fruits; grains, at least half of which are whole grains; and low- or fat-free milk, yogurt, cheese and fortified soy drinks. Protein-rich foods such as seafood, lean meats and poultry, eggs, soy, nuts and seeds, as well as plant-based oils, are also considered healthy choices. The Dietary Guidelines specifically limit consumption of saturated and trans fats, citing research that indicates replacing saturated fats with polyunsaturated fats is associated with reduced risk for CVD events and death.

Measurable limits were also set for added sugar, sodium, fats and alcohol:

  • Limit added sugars to less than 10% of daily caloric intake.
  • Limit sodium to less than 2,300 mg of daily caloric intake, and even less for children and adolescents aged younger than 14 years.
  • Limit saturated and trans fat to less than 10% of daily caloric intake.
  • Limit alcohol to up to one drink per day for women and up to two drinks per day for men of legal drinking age.

For adults with prehypertension and hypertension, further sodium reduction to 1,500 mg per day is recommended for an even greater reduction in BP. The effects of the DASH diet on BP and cholesterol have been cited in the DASH-Sodium Trial and the OmniHeart Trial.

One of the key recommendations from the 2010 Dietary Guidelines to limit consumption of dietary cholesterol to 300 mg per day was omitted in the new update due to a lack of evidence on the dose-response relationship between dietary cholesterol and blood cholesterol, according to the statement. The guidelines emphasize, however, that this change is not meant to suggest that dietary cholesterol is not important. As recommended by the Institute of Medicine, Americans should keep their dietary cholesterol intake to a minimum because the body makes enough cholesterol to support the body’s functions, according to the statement.

Strategies are also offered to businesses, industries, community organizations and individuals to support healthy eating for all Americans. In a related editorial published in JAMA upon release of the Dietary Guidelines, Karen B. DeSalvo, MD, MPH, MSc, from the office of the assistant secretary for health at HHS, and colleagues noted that health care professionals, communities, businesses and industries, organizations, governments and other segments of society play a vital part in supporting health eating patterns and physical activity goals.

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However, reactions to the 2015-2020 recommendations have been mixed.

“Obesity rates and related health problems have risen dramatically in recent decades. Very recently there have been indications from the CDC that the growth in obesity is leveling off, but there is still a lot of work to be done to help Americans return to healthier body weight to reduce heart disease and other related health issues. Following the recommendations in the 2015 Guideline to lower intake of cholesterol, fat and sugar, will help improve the health of the American population,” Kim Allan Williams, MD, FACC, president of the American College of Cardiology, said in a press release.

Kim Allan Williams, MD, FACC
Kim Allan Williams

Mark A. Creager, MD, FAHA, FACC, president of the American Heart Association, encouraged all Americans to use the Dietary Guidelines as a tool for achieving healthier eating patterns.

“The new federal dietary guidelines give Americans more flexibility in their diets without sacrificing their health. By providing a valuable source of nutrition information, the standards are part of a roadmap to help build a ‘culture of health’ in America. This healthier culture will help reduce our risk for heart disease and stroke — the two leading causes of death in the world,” Creager said in a release.

Although the American Heart Association and the American College of Cardiology announced support in favor of the updates, the HHS and USDA have drawn fire by others in the medical community for a lack of quality research and unclear messages on red meat consumption and dietary cholesterol.

In a discussion published in The Mayo Clinic Proceedings, Edward Archer, PhD, MS, and Gregory Pavela, PhD, both from the University of Alabama at Birmingham, and Carl J. Lavie, MD, FACC, FACP, FCCP, from John Ochsner Heart and Vascular Institute, Queensland University, New Orleans, wrote, “In the 2015 [Dietary Guidelines Advisory Committee] report, the distinction between correlation and causation is either ignored or dismissed. For example, the words ‘association,’ ‘associated’ and ‘relationship’ are used more than 900 times in the 571-page [Dietary Guidelines Advisory Committee] text, whereas the words ‘causal’ and ‘causality’ are used fewer than 30 times and not once to describe an actual causal diet-health relationship.”

In an editorial published in the Annals of Internal Medicine,Cardiology Today Editorial Board member Steven E. Nissen, MD, pointed out that the report “repeatedly makes recommendations based on observational studies and surrogate endpoints, failing to distinguish between recommendations based on expert consensus, rather than high-quality [randomized controlled clinical trials].”

Steven E. Nissen, MD
Steven E. Nissen

According to Nissen, knowledge is lacking on the effect of low-fat diets and limited saturated fats on risk factors for coronary disease. The most promising data come from the PREDIMED study, published in 2013, which compared adherence to a Mediterranean diet vs. the AHA low-fat diet in participants at risk for CHD. Compared with the low-fat diet, the adjusted HRs for CHD were 0.7 for the group assigned an extra-virgin olive oil-enriched diet and 0.72 for the group assigned a diet enriched with nuts.

“It is time for careful [randomized controlled clinical trials] testing various dietary interventions — studies unlikely to be industry-funded,” he wrote.

Nissen told Cardiology Today that “cardiologists should inform their patients that the best way to protect themselves from CVD is to follow the Mediterranean diet, rich in oils and nuts.” – by Tracey Romero

Disclosures: Archer reports receiving honoraria from the International Life Sciences Institute and the Coca-Cola Company. DeSalvo and Nissen report no relevant financial disclosures. See full commentary for all authors’ relevant financial disclosures.