1. Dwyer, Johanna DSc, RD

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We are in the home stretch for the 2010 Dietary Guidelines, with the Dietary Guidelines Advisory Committee report now available to be viewed in its entirety at The 2010 Dietary Guidelines Advisory Committee members, listed in Table 1, deserve thanks not only from the nutrition community but also from the people of the United States for volunteering for this difficult task and then working without pay for months and months to produce this comprehensive report. There is plenty to read, to think about, discuss, praise, and dispute. The old adage was that for a bridal shower, the gifts should include something old, something new, something borrowed, and something blue (the cover is blue!), and the gift we have received from the committee has followed this advice.

Table 1 - Click to enlarge in new windowTable 1. The 21010 Dietary Guidelines Advisory Committee

Some Things Old

Like its 21st century parents, the year 2000 and 2005 Dietary Guidelines, the 2010 Guidelines stress both a balanced nutrient dense diet and plenty of physical activity. The other general messages summarized in Table 2 Americans have heard, if not heeded, before.

Table 2 - Click to enlarge in new windowTable 2. Recommendations of the Dietary Guidelines Advisory Committee

Just as the guidelines committee was forming, we applauded the use of more systematic, evidence-based processes for generating the 2010 Guidelines.1 This committee has made greater strides than any prior committee was able to in this regard. When existing systematic reviews were not available, the evidence collected from the literature was systematically reviewed, graded by trained individuals, and synthesized to answer questions the committee posed. The resulting report incorporates them and the quality of the evidence presented, generally in a succinct and understandable manner. Food pattern modeling was also put to good use to answer questions concerning the impact of proposed changes in guidance on intakes.

Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.

Both nutrients and food patterns were also discussed at length by the 2010 committee. Many of the issues are familiar to readers of Nutrition Today because they were discussed in our Dietary Guidelines series over the past few years.2-8


Some Things New

The scientific committee's attention to individual differences and needs did not extend to nutrigenomic prescriptions because the science simply is not there yet to make such recommendations. However, the committee did emphasize how the guidelines could be tailored to be in line with many different healthful food patterns. These include the US Department of Agriculture's (USDA's) MyPyramid, the Dietary Approaches to Stop Hypertension-style dietary pattern, and certain Mediterranean style dietary patterns.


Some other additions to the 2010 Guidelines that are welcome are a much expanded excellent chapter on food safety and extensive appendices with the results of modeling various dietary patterns. A special bonus that should not be overlooked is the set of short papers at the very end of the document called "Resources." They include useful material on food allergens, conventional and organic foods, child overweight, and other issues.


Some Things Borrowed

Physical activity needs a more prominent place in the thinking of all nutritionists and consumers.9 Therefore, it is good to see that the Physical Activity Guidelines for Americans were borrowed from extensively in the 2010 document. Those Physical Activity Guidelines cover energy output with as much rigor as the Dietary Guidelines do for food and eating and also deserve reading in their entirety.


Many Things True

The Dietary Guidelines committee members deserve great credit for all their hard work and for the well-crafted document they have produced. The remarkably thorough and advice-filled and practical information-loaded text runs several hundred pages.


Some Things Missing?

The public comment period on the report closed in early July, and now the 2 cabinet level departments that sponsor the guidelines will further review and refine the recommendations and package them for consumers and policy makers.


The 1980 Dietary Guidelines were much shorter and sweeter (no pun intended) than the 2010 set, but they were consumer directed rather than heavily referenced scientific reviews. In fact, the 1980 Guidelines fit on the cover of a small USDA pamphlet with accompanying text of about 8 pages and an accompanying supplement to the American Journal of Clinical Nutrition that examined the evidence for each guideline. In the 2010 scientific document, it is difficult to discern what the 2010 Dietary Guidelines really are because the many actionable messages are embedded in the text. Americans may have gotten fatter over past 30 years, but their attention spans have certainly not increased. What are missing are some positive, actionable guidelines that people can easily remember and put to work in their daily lives. The committee clearly communication as a priority, as did the authors of several recent articles in Nutrition Today.9,10 We hope that now that the science has been reviewed, that actionable messages in everyday language will be crafted by communications experts as the document and its progeny are further refined in the next few months by USDA and US Department of Health and Human Services.




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Is Higher Consumption of Sugars Linked to Unfavorable Lipid Levels?


Consuming a higher amount of added sugars in processed or prepared foods is associated with lower levels of high-density lipoprotein cholesterol (HDL-C, the "good cholesterol") and higher levels of triglycerides, which are important risk factors for cardiovascular disease according to an analysis of national survey data. The researchers assessed the association between consumption of added sugars and blood lipid levels in 6113 adults who were respondents in the National Health and Nutrition Examination Survey 1999-2006. They were grouped by intake of "added sugars" using limits of less than 5% of total calories (reference group), 5% to less than 10%, 10% to less than 17.5%, 17.5% to less than 25%, and 25% or more of total calories. Various measures calculated in the study included average HDL-C, average triglycerides, and average low-density lipoprotein cholesterol (LDL-C) levels and adjusted odds ratios for dyslipidemia (abnormal amounts of lipids and lipoproteins in the blood), including low HDL-C levels (<40 mg/dL for men, <50 mg/dL for women), high triglyceride levels (>=150 mg/dL), high LDL-C levels (>=130 mg/dL), or high ratio of triglycerides to HDL-C (>3.8). Results were weighted to be representative of the US population. In the population studied, daily consumption of added sugars averaged 3.2 oz (about 21 tsp or 359 calories), which represents 15.8% of total daily caloric intake.


Adjusted average HDL-C levels were lower among respondents consuming higher amounts of added sugars: about 59 mg/dL among those consuming less than 5% energy from added sugars, 58 mg/dL among those consuming 5% to less than 10%, 54 mg/dL among those consuming 10% to 17.4%, 51 mg/dL among those consuming 17.5% to less than 24.0%, and 48 mg/dL among those consuming 25% or greater. Among higher consumers (>=10% added sugars), the odds of low HDL-C levels were 50% to more than 300% greater compared with the reference group (<5% added sugars). The researchers also found that higher consumption of added sugars was associated with higher triglyceride levels and higher ratios of triglycerides to HDL-C. It is not clear if other factors that might have influenced some of these blood values were controlled, such as total sugars and total carbohydrates, physical activity, and body weight. Long-term trials to study the effect of reducing added sugars and other carbohydrates on lipid profiles are needed.


Source: Welsh JA, Sharma A, Abramson JL, Vaccarino V, Gillespie C, Vos MB. Caloric sweetener consumption and dyslipidemia among US adults. JAMA. 2010;303(15):1490-1497.


DOI: 10.1097/NT.0b013e3181f2fa5d