Special Issue "Towards Better Dietary Guidelines: New Approaches Based on Recent Science"

A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Nutritional Policies and Education for Health Promotion".

Deadline for manuscript submissions: closed (31 July 2021).

Special Issue Editors

Prof. Dr. Arne Astrup
E-Mail Website
Guest Editor
1. Healthy Weight Initiative, the Novo Nordisk Foundation & Department of Nutrition, Exercise and Sports (NEXS), 2200 Copenhagen, Denmark
2. Faculty of Science, University of Copenhagen, 2200 Copenhagen, Denmark
Interests: nutrients; food; obesity, type 2 diabetes; cardiovascular disease
Prof. Dr. Ronald M. Krauss
E-Mail Website
Co-Guest Editor
1. Department of Pediatrics, University of California-San Francisco, San Francisco, California 94143, USA
2. Department of Medicine, University of California-San Francisco, San Francisco, California 94143, USA
Interests: lipoprotein metabolism; coronary artery disease; pediatrics; individual variability to statin treatment

Special Issue Information

Dear Colleagues,

The U.S. Dietary Guidelines for Americans (DGA) is the country’s top nutrition policy, launched in 1980 and updated every five years by the Departments of Agriculture and Health and Human Services. This broadly influential policy is considered a global gold standard. The DGA has been unable, however, to stem the still-rising epidemics of obesity, diabetes, and other metabolic diseases. Among the reasons for this problem is one identified by National Academies of Sciences, Engineering and Medicine, namely, the need to update the DGA scientific review methodology in order to assure reliable results. Two topics where a more comprehensive evaluation of the current science could result in updated results are saturated fats and salt. The DGA policy could also expand its focus from disease prevention to include treatment of these diseases. This could involve a consideration of diets lower in carbohydrates than those recommended in the current DGA.

Prof. Dr. Arne Astrup
Prof. Dr. Ronald M. Krauss
Guest Editors

Manuscript Submission Information

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Keywords

  • Dietary Guidelines
  • Policy
  • Evidence-based
  • Salt
  • Saturated fats
  • Low carbohydrate

Published Papers (4 papers)

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Research

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Article
Dietary Saturated Fats and Health: Are the U.S. Guidelines Evidence-Based?
Nutrients 2021, 13(10), 3305; https://doi.org/10.3390/nu13103305 - 22 Sep 2021
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Abstract
The last decade has seen nearly 20 papers reviewing the totality of the data on saturated fats and cardiovascular outcomes, which, altogether, have demonstrated a lack of rigorous evidence to support continued recommendations either to limit the consumption of saturated fatty acids or [...] Read more.
The last decade has seen nearly 20 papers reviewing the totality of the data on saturated fats and cardiovascular outcomes, which, altogether, have demonstrated a lack of rigorous evidence to support continued recommendations either to limit the consumption of saturated fatty acids or to replace them with polyunsaturated fatty acids. These papers were unfortunately not considered by the process leading to the most recent U.S. Dietary Guidelines for Americans, the country’s national nutrition policy, which recently reconfirmed its recommendation to limit saturated fats to 10% or less of total energy intake, based on insufficient and inconsistent evidence. Continuation of a cap on saturated fat intake also fails to consider the important effects of the food matrix and the overall dietary pattern in which saturated fatty acids are consumed. Full article

Review

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Review
Processed Meat Consumption and the Risk of Cancer: A Critical Evaluation of the Constraints of Current Evidence from Epidemiological Studies
Nutrients 2021, 13(10), 3601; https://doi.org/10.3390/nu13103601 - 14 Oct 2021
Viewed by 1006
Abstract
Based on a large volume of observational scientific studies and many summary papers, a high consumption of meat and processed meat products has been suggested to have a harmful effect on human health. These results have led guideline panels worldwide to recommend to [...] Read more.
Based on a large volume of observational scientific studies and many summary papers, a high consumption of meat and processed meat products has been suggested to have a harmful effect on human health. These results have led guideline panels worldwide to recommend to the general population a reduced consumption of processed meat and meat products, with the overarching aim of lowering disease risk, especially of cancer. We revisited and updated the evidence base, evaluating the methodological quality and the certainty of estimates in the published systematic reviews and meta-analyses that examined the association between processed meat consumption and the risk of cancer at different sites across the body, as well as the overall risk of cancer mortality. We further explored if discrepancies in study designs and risks of bias could explain the heterogeneity observed in meta-analyses. In summary, there are severe methodological limitations to the majority of the previously published systematic reviews and meta-analyses that examined the consumption of processed meat and the risk of cancer. Many lacked the proper assessment of the methodological quality of the primary studies they included, or the literature searches did not fulfill the methodological standards needed in order to be systematic and transparent. The primary studies included in the reviews had a potential risk for the misclassification of exposure, a serious risk of bias due to confounding, a moderate to serious risk of bias due to missing data, and/or a moderate to serious risk of selection of the reported results. All these factors may have potentially led to the overestimation of the risk related to processed meat intake across all cancer outcomes. Thus, with the aim of lowering the risk of cancer, the recommendation to reduce the consumption of processed meat and meat products in the general population seems to be based on evidence that is not methodologically strong. Full article
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Review
Alternative Dietary Patterns for Americans: Low-Carbohydrate Diets
Nutrients 2021, 13(10), 3299; https://doi.org/10.3390/nu13103299 - 22 Sep 2021
Viewed by 10608
Abstract
The decades-long dietary experiment embodied in the Dietary Guidelines for Americans (DGA) focused on limiting fat, especially saturated fat, and higher carbohydrate intake has coincided with rapidly escalating epidemics of obesity and type 2 diabetes (T2D) that are contributing to the progression of [...] Read more.
The decades-long dietary experiment embodied in the Dietary Guidelines for Americans (DGA) focused on limiting fat, especially saturated fat, and higher carbohydrate intake has coincided with rapidly escalating epidemics of obesity and type 2 diabetes (T2D) that are contributing to the progression of cardiovascular disease (CVD) and other diet-related chronic diseases. Moreover, the lack of flexibility in the DGA as it pertains to low carbohydrate approaches does not align with the contemporary trend toward precision nutrition. We argue that personalizing the level of dietary carbohydrate should be a high priority based on evidence that Americans have a wide spectrum of metabolic variability in their tolerance to high carbohydrate loads. Obesity, metabolic syndrome, and T2D are conditions strongly associated with insulin resistance, a condition exacerbated by increased dietary carbohydrate and improved by restricting carbohydrate. Low-carbohydrate diets are grounded across the time-span of human evolution, have well-established biochemical principles, and are now supported by multiple clinical trials in humans that demonstrate consistent improvements in multiple established risk factors associated with insulin resistance and cardiovascular disease. The American Diabetes Association (ADA) recently recognized a low carbohydrate eating pattern as an effective approach for patients with diabetes. Despite this evidence base, low-carbohydrate diets are not reflected in the DGA. As the DGA Dietary Patterns have not been demonstrated to be universally effective in addressing the needs of many Americans and recognizing the lack of widely available treatments for obesity, metabolic syndrome, and T2D that are safe, effective, and sustainable, the argument for an alternative, low-carbohydrate Dietary Pattern is all the more compelling. Full article
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Review
Sodium Intake and Health: What Should We Recommend Based on the Current Evidence?
Nutrients 2021, 13(9), 3232; https://doi.org/10.3390/nu13093232 - 16 Sep 2021
Viewed by 10658
Abstract
Several health organizations recommend low sodium intake (below 2.3 g/day, 5.8 g/day of salt) for entire populations, on the premise that lowering of sodium intake, irrespective of its level of intake, will lower blood pressure and, in turn, will result in a lower [...] Read more.
Several health organizations recommend low sodium intake (below 2.3 g/day, 5.8 g/day of salt) for entire populations, on the premise that lowering of sodium intake, irrespective of its level of intake, will lower blood pressure and, in turn, will result in a lower incidence of cardiovascular disease. These guidelines were developed without effective interventions to achieve long term sodium intakes at low levels in free-living individuals and without high-quality evidence that low sodium intake reduces cardiovascular events (compared with average levels of intake). In this review, we examine whether advice to consume low amounts of sodium is supported by robust evidence. We contend that current evidence indicates that most people around the world consume a moderate range of dietary sodium (3 to 5 g/day), that this level of intake is associated with the lowest risk of cardiovascular disease and mortality, and that the risk of adverse health outcomes increases when sodium intakes exceeds 5 g/day or is below 3 g/day. While the current evidence has limitations, it is reasonable, based upon prospective cohort studies, to suggest a mean target of below 5 g/day in populations, while awaiting the results of large randomized controlled trials of sodium reduction on cardiovascular disease and death. Full article
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