Dietary Guidelines for Americans

The US Departments of Health and Human Services (DHHS) and Agriculture (USDA) have released the eighth edition (2015-2020) of the Dietary Guidelines for Americans.¹ The Dietary Guidelines are an important part of a complex and multifaceted solution to promoting health and preventing diet-related chronic diseases including cardiovascular disease, type 2 diabetes, some cancers, and obesity. The Dietary Guidelines are required under the National Nutrition Monitoring and Related Research Act of 1990 and inform the development of federal food, nutrition, and health policies and programs. They serve as the evidence-based foundation for federal government nutrition education materials and are used to inform programs like Older Americans Act Nutrition Services Programs and the Supplemental Nutrition Assistance Program (SNAP) that affect millions of people each day. The Dietary Guidelines can also be adapted by health care professionals to describe and recommend healthy eating to patients. Recent studies have shown that diets that align closely with the Dietary Guidelines are associated with a significant reduction in the onset of and deaths due to diet-related chronic diseases.^2,3

To update the Dietary Guidelines, as required by law, the Secretaries of the DHHS and the USDA formed an external Dietary Guidelines Advisory Committee made up of prestigious researchers and scientists in the fields of nutrition, health, and medicine. The 2015 advisory committee was charged with reviewing the 2010Dietary Guidelines to determine topics for which new scientific evidence is likely available and to review that evidence to inform the development of the 2015-2020 edition. The committee used 4 approaches to review the available evidence: original systematic reviews; existing systematic reviews, meta-analyses, and reports by federal agencies or leading scientific organizations; data analyses; and food pattern modeling analyses. The work of the committee was submitted to the DHHS and USDA in the scientific report of the 2015 Dietary Guidelines Advisory Committee and made available for public comment. In addition to the committee report, the DHHS and USDA obtained input from federal nutrition and medical experts and comments from the public to develop the 2015-2020 Dietary Guidelines.

Although many of the recommendations have remained relatively consistent over time, the Dietary Guidelines have evolved with scientific knowledge. For example, recent research has examined the relationship between overall eating patterns and health. Consequently, eating patterns are a main focus of the 2015-2020 Dietary Guidelines. For most individuals, achieving a healthy eating pattern may require adjustments in food and beverage choices because at the population level, Americans are not following healthy eating patterns. The current guidelines focus on shifts in eating patterns to align current dietary intake with their recommendations and highlight multiple strategies across all segments of society to promote healthy eating and physical activity behaviors.

The 2015-2020 Dietary Guidelines contain 5 overarching goals and 13 key recommendations (Box).

Below is a brief summary of guidance for calories from added sugars and saturated fats, dietary cholesterol, and sodium. Additional information can be found at http://www.health.gov/DietaryGuidelines.¹

When sugars are added to foods and beverages, they add calories without contributing essential nutrients. The recommendation to limit added sugars to less than 10% of calories per day is a target to help the public achieve a healthy eating pattern—meeting nutrient and food group needs through nutrient-dense food and beverage choices while staying within calorie limits. This target is also informed by national data indicating that added sugars currently account for more than 13% of total calories consumed by the US population.⁵

Intake of saturated fats should be limited to less than 10% of calories per day. Strong and consistent evidence shows that replacing saturated fats with polyunsaturated fats is associated with a reduced risk of cardiovascular disease events and deaths. The key recommendation from the 2010 Dietary Guidelines to limit consumption of dietary cholesterol to 300 mg/d is not included in the 2015 edition because adequate evidence is not available for a quantitative limit specific to the Dietary Guidelines. However, this change does not suggest that dietary cholesterol is no longer important to consider. In general, foods that are higher in dietary cholesterol, such as butter and sausage, also tend to be higher in saturated fats. Examples of healthy eating patterns in the Dietary Guidelines limit dietary cholesterol to a range of 100 to 300 mg/d.

The scientific consensus from expert bodies, such as the Institute of Medicine,⁶ the American Heart Association, and Dietary Guidelines Advisory Committees, is that the average sodium intake among Americans aged 1 year or older, currently 3440 mg/d, is too high and should be reduced. Healthy eating patterns limit sodium to less than 2300 mg/d for adults and children aged 14 years or older and to the age- and sex-appropriate Tolerable Upper Intake Levels⁷ of sodium for children younger than 14 years. This recommendation is based on evidence showing a linear dose-response relationship between increased sodium intake and increased blood pressure in adults. Direct evidence for the association between sodium intake and risk of cardiovascular disease in adults is not as consistent as the evidence for blood pressure.

Everyone has a role in supporting healthy eating patterns. Concerted efforts among health care professionals, communities, businesses and industries, organizations, governments, and other segments of society are important to support individuals and families in making dietary and physical activity choices that align with the Dietary Guidelines and work for them. Health care professionals can help individuals identify how they can modify and improve their dietary patterns and intake to align with the Dietary Guidelines. Educational materials for both professionals and consumers will be available in 2016.

 read more at JAMA