New Dietary Guidelines Receive Support, but Also Spark Controversy

The recently published 2015–2020 Dietary Guidelines for Americans¹ have received general support from a number of professional organizations, including the American Medical Association,² American Diabetes Association,³ and American Academy of Pediatrics.⁴ However, certain recommendations and omissions have been met with surprise and disagreement by several experts in a range of specialties.

The US Department of Health and Human Services and the US Department of Agriculture (USDA) release a new set of dietary guidelines every 5 years to reflect current scientific evidence. These guidelines are reviewed by a 15-member Dietary Guidelines Advisory Committee (DGAC) and are intended to inform the decisions and practices of policymakers and health care providers.

One favorably viewed aspect of the new guidelines is the new big-picture approach, rather than the compartmentalized approach of previous guidelines.

“The guidelines shift every 5 years to highlight and eliminate certain elements,” said Caroline M. Apovian, MD, professor of medicine and pediatrics at Boston University School of Medicine and director of the Nutrition and Weight Management Center at Boston Medical Center in Massachusetts. “The shift in the new guidelines is toward talking about patterns, which include variety and nutrient-dense foods,” Dr Apovian told Endocrinology Advisor on behalf of the Endocrine Society.

While previous versions of the guidelines have focused on specific nutrients and food groups, the updated version acknowledges that in reality, people do not consume these foods in isolation but as part of an overall dietary pattern.

“The components of the eating pattern can have interactive and potentially cumulative effects on health,” the guideline authors wrote.¹ “These patterns can be tailored to an individual’s personal preferences, enabling Americans to choose the diet that is right for them.”

Specific Updates

Whereas the preceding set of guidelines⁵ encouraged weight management via control of caloric intake (and increased physical activity, which is still recommended), the updated version emphasizes an overall healthy eating pattern that includes a variety of vegetables, fruits, grains — of which half should be whole vs refined — fat-free or low-fat dairy, various sources of protein, and oils. The guidelines recommend that added sugars and saturated fat each comprise no more than 10% of an individual’s daily calories and that daily sodium intake be less than 2300 mg. Additionally, it is suggested that women drink no more than 1 alcoholic drink per day and that men limit their intake to 2 drinks daily.

Other changes include encouragement to replace foods high in saturated fats with those high in unsaturated fats, including nuts and avocados, and the removal of the recommendation to limit dietary cholesterol intake. The guidelines still recommend that people “eat as little dietary cholesterol as possible while consuming a healthy eating pattern,” though they now allow for foods that are high in dietary cholesterol, such as eggs and shellfish.

Areas of Concern

Dariush Mozaffarian, MD, DrPH, a cardiologist and epidemiologist and dean of the Tufts University Friedman School of Nutrition Science & Policy, considers the new emphasis on overall patterns rather than isolated nutrient targets to be a positive change. However, he is critical of several aspects of the guidelines.

“A glaring and shameful omission is the lack of emphasis on reducing refined grains, starchy vegetables, or red meats, especially processed meats,” though suggested limits on these foods were clearly highlighted in the advisory committee’s report, Dr Mozaffarian told Endocrinology Advisor. There is “little focus anywhere on actually reducing unhealthy foods, just on ‘greater access to healthy choices,’” he said.