Dietary Panel Releases Report; Cholesterol Removed From List of Nutrients to Avoid

Dietary cholesterol may no longer be verboten for most Americans, if the US Secretaries of Agriculture and Health and Human Services (HHS) accept a recommendation from the 2015 Dietary Guidelines Advisory Committee (DGAC).The panel has spent more than a year reviewing the latest evidence on how what we eat—and where we eat—affects our overall health.

DGAC released its report late yesterday, which included the recommendation to remove cholesterol from the list of “nutrients of concern for overconsumption.” The Washington Post first reported that the 2015 panel would make this change.

The change on cholesterol is based on a 2013 review by the American Heart Association and the American College of Cardiology; the dietary panel said current evidence “shows no appreciable relationship between consumption of dietary cholesterol and serum cholesterol.”

The updated cholesterol recommendation has drawn mixed reviews; some say there is no reason for healthy adults to avoid naturally occurring cholesterol in foods like eggs or seafood. Others worry that Americans will take the change as a license to continue to add saturated fats to their diets, which DGAC notes elsewhere is a significant problem. And the change may not apply to persons with diabetes, which will create challenges for these patients and those who treat them.

Yesterday’s report concludes the work of the advisory committee, which is convened every 5 years by law to advise the 2 secretaries, who will have the final word on the 2015 Dietary Guidelines for Americans. The guidelines are the nation’s official nutrition policy and affect everything from military meals to nutrition programs for poor mothers and children, to school lunches. The 2010 guidelines informed the law that overhauled the National School Lunch Program, triggering backlash from school cafeteria officials and students.

While the secretaries can change the recommendations, historically DGAC’s outline is left intact. (The report is subject to a 45-day comment period and a public hearing.) A discussion of national nutrition policy and the 2015 guidelines featuring Frank Hu, MD, MPH, a DGAC member from the Harvard School of Public Health, will be part of the agenda at Patient-Centered Diabetes Care, to be held in Boston April 16-17, 2015. The meeting is jointly hosted by The American Journal of Managed Care and Joslin Diabetes Center.

While the cholesterol change will capture the public’s attention, the 2015 report contains plenty of sobering news for public health officials. Starting in the late childhood years, Americans fall far short of recommended levels of fruit and vegetable consumption, and this pattern continues into early adulthood. As adults age, there is some recovery of vegetable consumption, and those ages 51-70 report the highest vegetable intake. However, most Americans continue to consume less than recommended levels of dark green or other colored vegetables.

The report notes that potatoes (white potatoes) are “the most commonly consumed single vegetable,” and account for 25 percent of all vegetable consumption. While DGAC cites potatoes as “a good source of both potassium and fiber,” the report also breaks down the methods of preparation, some of which are less than healthy: 31% being boiled (including mashed and in dishes such as potato salad, soups, and stews), 22% as chips, sticks, or puffs, 19% as French fries, 17% as baked, and 12% as home fries or hash browns.

As promised, DGAC’s scientific report bursts with information about changing patterns of American food consumption, and the implications for what Americans consume and overall health. In fact, parts of the report lend credence to some of the complaints about the changes to the school lunch program; as one superintendent told TIME, it wasn’t that he didn’t agree with the nutrition standards, but schools should not be left alone to force students to eat fruits and vegetables while nothing is done about unhealthy options at McDonald’s or gas stations.

With these challenges in mind, the report finds that “action is needed across all sectors of food production, distribution, and consumption at and individual behavioral and population levels. … Individuals, families, schools, worksites, healthcare and public health settings, restaurants, and other food establishments must work together” to implement the following recommendations:

· Increased intake of underconsumed food groups—such as fruits and vegetables—and nutrient-dense foods, “while maintaining energy balance, and without increasing saturated fat, sodium, and added sugars.” In other words, Americans must eat more vegetables without layering on added butter, cheese or salt.

· Adding more low-fat/fat-free fluid milk and yogurt to diets while decreasing cheese would result in higher intakes of magnesium, potassium, vitamin A, and vitamin D while reducing the intake of sodium and saturated fat.

· Replacing soft drinks and other sugar-sweetened beverages (including sports drinks) with non-fat fluid milk would substantially reduce added sugars and empty calories and increase the intake of shortfall nutrients, including calcium, vitamin D, and magnesium.

Beyond the cholesterol recommendation, DGAC’s report listed several “nutrients of concern for underconsumption,” which were vitamin D, calcium, potassium, fiber, and, for pregnant women especially, iron. Nutrients of concern for overconsumption were sodium and saturated fat. The panel also said that Americans “underconsume” vitamin A, vitamin E, folate, vitamin C, and magnesium.

DGAC’s recommendations on dairy are also likely to draw criticism in some circles. As reported in Evidence-Based Diabetes Management last year, a parade of witnesses testified at the panel’s public hearing that there are other ways to get calcium into diets without relying on dairy, and that the promotion of dairy is harmful to some populations. The Harvard School of Public Health even created an alternative to the government's "MyPlate" logo that downplayed the importance of dairy consumption.