Update: The Newest Preliminary Dietary Guidelines for Americans

July 20, 2020

The next set of Dietary Guidelines for Americans are officially in the works and there are some pretty interesting changes in the pipeline.

You see, the Dietary Guidelines Advisory Committee (established by the Department of Health and Human Services) has been tasked with "examining the evidence on specific nutrition and public health topics and providing independent, science- based advice to the Federal government as the Departments develop the next edition of the Dietary Guidelines for Americans."

So that's what they've done.

Today we have their preliminary report, which you can read in its entirety here. This report is now open for public comment, and there will be an online meeting on August 11 to discuss thoughts on the initial report before it goes into the next phase of development into the official Dietary Guidelines for Americans.

Remember, this report is not an officially-approved version of the Dietary Guidelines... yet. However, it's still important to follow these findings because they review five years of research and most of the findings usually do end up in the guidelines.

Now, because I love ya, my team and I are working around the clock to get you summaries, in-depth exploration, and analysis of these preliminary guidelines. Today we begin with a look at the executive summary.

The procedures governing the committee and its methods have changed a bit for this edition, outlining topics to address before the committees were formed instead of after. We will dig deeper into their evidence review process in our next edition, but if you just can't wait, take a look at Part C right here.

The committees highlighted the following elements that are looming large in the health and nutrition scene in the United States right now...

"More than 70 percent of Americans have overweight or obesity, and the prevalence of severe obesity has increased over the past 2 decades."
Obesity has been linked to chronic health issues including type 2 diabetes, heart disease, and certain cancers. 60% of Americans have some kind of chronic health condition.
Access to affordable healthy food and food insecurity are very real problems that affect more than 37 million people.

The committees address these elements in two ways...

Expanding the ages and stages of people's health journeys. "The Committee reviewed the period from birth to age 24 months and also conducted a review of diet and health issues in pregnancy and lactation." This is new, they haven't done this officially before.
The guidelines focus on dietary patterns as a whole, rather than discrete topics and food groups. This is a continuation of a change they began in the last edition of the Dietary Guidelines for Americans.

So now let's take a deeper dive into each topic in the summary. Here's an overview of our next section...

Current Dietary Intakes Through the Life Course
Pregnancy and Lactation
Diet and Health: Birth to 24 Months
Diet and Health from Age 2 and Older
- Dietary Patterns
- Dietary Fats and Seafood
- Beverages
- Alcoholic Beverages
- Added Sugars
- Frequency of Eating
- USDA Food Patterns for Age 2 and Older
Integrating the Evidence

It looks like a lot, but I promise we'll move quickly...

Current Dietary Intakes through the Life Course: "Diet is a modifiable factor that is critically relevant to the primary and secondary prevention of most non-communicable diseases and the leading causes of disability and death affecting Americans." Many Americans have at least one of these diseases and tend to over-consume total calories, added sugars, saturated fats, and sodium, while often under-consuming vegetables, whole grains, and fruits. This pattern is of grave public health concern. The risk of chronic disease begins very early and can be compounded as habits form. "Within each life stage, opportunities exist to provide specific advice to individuals about food components that provide key nutrients at that life stage and for ways they can make healthy food choices."

Pregnancy and Lactation: These are particular stages in a woman's lifespan with distinct nutritional needs, but since her health going into either stage has an impact on how those stages go, " they can, in turn, influence [that woman] and her child’s future health trajectory. These cross-cutting influences highlight the potential for long-term benefits to be gained from improving nutrition during pregnancy and lactation."

Sticking to healthy dietary patterns during pregnancy can reduce the risk of gestational diabetes, preterm birth, and certain hypertensive disorders. Most of these dietary patterns are quite similar to the ones that people can use to reduce their risk of chronic disease. Further, according to the preliminary guidelines, "women who are pregnant should consume at least 8 and up to 12 ounces of a variety of seafood per week from choices that are lower in methlymercury and higher in omega-3 fatty acids" in order to reduce the "risk of hypertensive disorders and preterm birth and [improve the chances of] better cognitive development and language and communication development in children."

The benefits of consumption of healthful seafood choices continue into the lactation period, and thus the new recommendations include continuing with eating between 8 and 12 ounces of a variety of healthful seafood choices per week during this time. The committee also calls for additional research about nutrition and health outcomes during this period.

Diet and Health: Birth to 24 Months: This is another brand-new section of the preliminary dietary guidelines. This period of life includes breastmilk or formula feeding, the introduction of complimentary foods and beverages, and a gradual transition to what the rest of the family is eating.

"The Committee examined how various exposures to human milk and/or infant formula are linked to selected outcomes in offspring. The strongest evidence found was that ever being breastfed may reduce the risk of overweight or obesity, type 1 diabetes, and asthma, compared to never being breastfed. Evidence also suggested that a longer duration of any breastfeeding is associated with lower risk of type 1 diabetes and asthma, although the optimal duration of breastfeeding with respect to these outcomes is not well understood." Once again, the committee found a significant need for additional research about breast milk, formula, and infant health.

Once the children begin to transition into the introduction of complimentary foods and beverages (at about 6 months), their caretakers should ensure that the initial foods have iron and zinc and polyunsaturated fatty acids. The researchers also found that introducing egg and peanuts (in a form safe for babies to eat) may reduce the risk of the child developing allergies to those foods later. And, for a variety of health reasons, sugar-sweetened beverages should not be introduced until after age 2.

In terms of healthy food patterns for children younger than 24 months, the committee had a bit of a struggle, despite the fact that they could conclude, "Establishing healthy dietary patterns in early childhood is crucial to support immediate needs for growth and development and to promote lifelong health." They found a few (as yet undisclosed) scenarios for infants up to 6 months, but weren't able to bring together a pattern to recommend for age 6 months to 12 months, though they were able to develop recommendations for introducing complimentary foods that came close to meeting their requirements. They did come up with several patterns for ages 12 months to 24 months. The first, for children who aren't getting breast milk or formula, allows for various fruits, vegetables, grains, nuts, seeds, poultry, meat, eggs, seafood, and dairy. The committee notes, "Key aspects to emphasize include choosing potassium-rich fruits and vegetables, prioritizing seafood, making whole grains the predominant type of grains offered, and choosing oils over solid fats." They also developed a second pattern for who don't get formula or breastmilk but eat a lacto-ovo vegetarian diet, but that pattern was not detailed in this version.

The patterns emphasize foods that are particularly rich in nutrients. At the same time, they do not necessarily dictate specific foods or preparations within each subgroup, in order to allow for flexibility in meeting these guidelines.

Now we're moving into the realms that are much more familiar from past guidelines, Diet and Health from Age 2 and Older. This is where the core of the guidelines is, and where much of the focus has been in past editions. So let's dive right in...

Dietary Patterns: The committees define dietary patterns as "The quantities, proportions, variety or combination of different foods, drinks, and nutrients in diets and the frequency with which they are habitually consumed." Dietary patterns that are consistently linked with positive health outcomes make sure to include the following elements...

High intake of whole grains, fruits, vegetables, lean meat and poultry, seafood, nuts, low-fat or nonfat dairy, and unsaturated vegetable oils.
Lower intake of refined grains, added sugars, and red and processed meats.

The committees found that several different patterns that highlighted these common themes were all associated with better health, which in turn indicates that "a healthy diet that promotes optimum growth and development while minimizing risk factors for chronic diseases can be created and tailored to suit cost considerations and a wide variety of personal and cultural preferences."

Dietary Fats and Seafood: Did you know that dietary fats make up roughly 30% of all calories consumed after infancy? Just as in previous guidelines, the type of fat consumed has a big impact on health. Replacing saturated fats with unsaturated fats reduces the incidence of cardiovascular disease in adults and reduces serum cholesterol and LDL cholesterol in all adults and some children. This is most effective as part of an overall healthful dietary pattern. In this edition of the guidelines, the committees call for further study about seafood consumption during childhood and adolescence and its impact on heart health and neurocognitive disorder risk.

Beverages: "Sweetened beverages, not including coffee and tea with added sugar, account for approximately one-third of total beverage consumption and contribute approximately 30 percent, 50 percent, and 60 percent of added sugars to the diet of young children, adolescents, and adults, respectively." The committee continues, "Because of their low nutrient to energy content ratio and the high prevalence of overweight and obesity in the population, it is important to continue encouraging only limited intake of [sugar-sweetened beverages]." Also of note, the committee found that limited evidence links low/no-calorie sweetened drinks to "reduced adiposity" in adults, but call for more research when it comes to children.

Alcoholic Beverages: Here be changes! Before, the Dietary Guidelines for Americans have called for limiting alcoholic drinks to 1 drink per day for women and 2 drinks per day for men. Now, however, these new proposed guidelines instead assert that both men and women should have no more than 1 drink per day. As in past editions of the guidelines, the committee maintains "those who do not drink should not begin to drink because they believe alcohol would make them healthier. Although alcohol can be consumed at low levels with relatively low risk, for those who choose to consume alcohol, evidence points to a general rule that drinking less is better for health than drinking more. Therefore, the focus should remain on reducing consumption among those who drink, particularly among those who drink in ways that increase the risk of harms."

Added Sugars: There's another significant change in this section! Before, the Dietary Guidelines for Americans recommended that people get no more than 10% of their total calories from added sugars. Now, the committees propose limiting added sugars to no more than 6% of total calories. As of now, most Americans over the age of one get at least 13% of their total daily calories from added sugars. These sugars typically come from 5 main sources...

Sweetened beverages (except for coffee and tea)
Sweetened coffee and tea
Candy and sugar
Desserts and sweet snacks
Breakfast bars and cereals

Frequency of Eating: "A person’s daily nutrient intake, and overall nutritional status, are determined by a complex interplay of 3 factors surrounding food choice: type, amount, and frequency." The committees explored a variety of factors surrounding eating frequency and "growth, body size and composition, overweight and obesity, CVD, type 2 diabetes, and all-cause mortality" but were unable to directly address the link between eating frequency and health. They were however, able to reveal some patterns that were affected by socioeconomic and demographic elements. Once again the preliminary guidelines call for further research.

USDA Food Patterns for Age 2 and Older: These don't appear to be changing much from where they were in the last edition of the guidelines. The three put forward in the 2015-2020 version were...

The Healthy U.S.-Style Pattern
The Healthy Vegetarian Pattern
The Healthy Mediterranean-Style Pattern

These three patterns are still the ones the next edition wants to pursue. The preliminary guidelines for that edition assert, "The Committee noted that the types of foods that individuals should eat are remarkably consistent and that these Patterns can be applied across life stages, even taking into account specific nutrient needs at particular life stages."

Integrating the Evidence: Stay with me here, we're almost done! In this section, the committee highlights its new "lifespan" approach and reaffirms its commitment to using dietary patterns to promote healthful choices.

They maintain, "Integrating the evidence reviewed for the topics addressed in this report, the 2020 Committee concludes that every life stage provides an opportunity to make food choices that promote health and well- being, achieve and maintain appropriate weight status, and reduce risk of diet-related chronic disease." Using dietary patterns "enables multiple adaptations to fit cultural, personal, and individual needs and preferences in food choices."

And that's it for this update! Remember, this edition is "advisory only" and is not yet an official version of the guidelines.

Next week we'll take a deeper dive into parts B and C, "Setting the Stage and Integrating the Evidence" and "Methodology." And the dietitians on our team will be letting you know what they think about these proposed new guidelines.

Remember, you can read the whole thing here and submit public comments here.