HHS, USDA Release Final 2015-2020 Dietary Guidelines

AAFP Questions Evidence Supporting Sodium Intake Recommendation

January 13, 2016 01:26 pm Chris Crawford

On Jan. 7, HHS Secretary Sylvia Burwell and U.S. Department of Agriculture (USDA) Secretary Tom Vilsack released the agencies' joint 2015-2020 Dietary Guidelines for Americans,(health.gov) which are intended to help improve eating habits and, in turn, reduce obesity and prevent chronic diseases such as Type 2 diabetes, hypertension and heart disease.

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"The Dietary Guidelines for Americans is one of many important tools that help to support a healthier next generation of Americans," Vilsack said in a news release.(www.hhs.gov) "The latest edition of the Dietary Guidelines provides individuals with the flexibility to make healthy food choices that are right for them and their families and take advantage of the diversity of products available, thanks to America's farmers and ranchers."

Guidelines Specifics

This eighth edition of the guidelines includes recommendations categorized into five areas:

  • follow a healthy eating pattern across the lifespan;
  • focus on variety, nutrient-dense foods and amount;
  •  limit calories from added sugars and saturated fats and reduce sodium intake;
  •  shift to healthier food and beverage choices; and
  •  support healthy eating patterns for all.
Story highlights
  • HHS and the U.S. Department of Agriculture recently released the agencies' joint 2015-2020 Dietary Guidelines for Americans.
  • This is the first edition of the guidelines to recommend a quantitative limit on caloric intake from added sugars.
  • As for the guidelines' recommendation to reduce sodium intake to less than 2,300 mg per day, the Academy found evidence was lacking to support the recommendation.

The guidelines recommend that Americans consume a variety of vegetables (i.e., dark green, red and orange vegetables; legumes; and starchy and other vegetables); fruits; grains (at least half being whole grains); fat-free or low-fat dairy products; a variety of proteins, including seafood, lean meats and poultry; and oils, including those from plants and nuts.

In addition, the guidelines recommend that Americans consume

  • less than 10 percent of their daily calories as added sugars,
  • less than 10 percent of daily calories as saturated fats and
  • less than 2,300 mg of sodium per day (for people older than 14 years).

This is the first edition of the guidelines to recommend a quantitative limit on caloric intake from added sugars.

The guidelines were informed by recommendations from the 2015 Dietary Guidelines Advisory Committee, which was composed of researchers in the fields of nutrition, health and medicine, and by consideration of public and federal agency comments.

Salty Advice

As for the committee's recommendation to reduce sodium intake to less 2,300 mg per day among people 14 years and older, the Academy found evidence was lacking to support the recommendation.

Jennifer Frost, M.D., medical director for the AAFP Health of the Public and Science Division, told AAFP News there is no argument that most Americans consume too much sodium and that high sodium intake increases the risk of cardiovascular disease. But the cutoff of 2,300 mg per day is not evidence-based.

"It's not that we think it's too low," she said. "We just don't know what the right amount is."

Frost said the Institute of Medicine did a comprehensive review of the evidence on sodium and concluded "... studies on health outcomes are inconsistent in quality and insufficient in quantity to determine that sodium intakes below 2,300 mg/day either increase or decrease the risk of heart disease, stroke or all-cause mortality in the general U.S. population."

"There also is emerging evidence that salt intake that is too low may cause harm," she said. "The AAFP agrees that the average American should decrease their sodium intake; we just don't agree on 'less than 2,300 mg/day.'"

Additional Notes

Back in May, AAFP News wrote about these guidelines when HHS and the USDA requested comments on them.

In an April 28 letter(2 page PDF) to HHS Deputy Assistant Secretary for Health Don Wright, M.D., M.P.H.; Angela Tagtow, M.S., R.D., L.D., executive director of the Center for Nutrition Policy and Promotion at USDA; and Steven Shafer, Ph.D., associate administrator of USDA's Agricultural Research Service, (then) AAFP Board Chair Reid Blackwelder, M.D., of Kingsport, Tenn., applauded the report's thoroughness, particularly its focus on population health, health equity, health interventions and behavior change.

"We support the inclusion of psychosocial factors discussed concerning food deserts," Blackwelder said in the letter. "We acknowledge and appreciate the considerations given to food insecurity and its overall effect on health.

"The fact that low-income communities frequently do not have access to healthy and affordable food choices has serious detrimental effects on our population's health, and the AAFP encourages further action to reduce these food deserts."

Blackwelder also asked the Dietary Guidelines Advisory Committee to further examine early exercise interventions to combat childhood obesity going forward because such efforts "provide sustained benefits into adulthood."

Finally, the letter acknowledged the committee's efforts to be "consumer-oriented," but noted that it lacked layperson representation in the group.

"Since it is recommended that patients participate in clinical practice guidelines to ensure that patient preference is being considered, the AAFP urges inclusion of patients since their perspective could be valuable in the development of dietary guidelines," Blackwelder said.

Related AAFP News Coverage
Proposed Dietary Guidance Draws Scrutiny
Cholesterol Recommendations, Focus on Sustainability No Surprise, Says AAFP


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