So Many Nutrition Recommendations—Contradictory or Compatible?

Abstract

Recently, the Food and Nutrition Board of the National Academies, Institute of Medicine, released acceptable ranges of intake of energy sources—fat, carbohydrate, and protein. Previously, the American Heart Association (AHA), National Cholesterol Education Program (NCEP), and the American Diabetes Association (ADA) had also issued nutrition guidelines. The Food and Nutrition report, titled Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids , focuses on macronutrients, as well as energy and physical activity recommendations.1 Acceptable ranges are based on evidence that, when consumed above or below these ranges, either nutrient inadequacy or increased risk of developing chronic diseases, including coronary heart disease, obesity, type 2 diabetes, and/or cancer, may develop. To meet the body’s daily nutritional needs while minimizing risk for chronic disease, it is recommended that adults consume 45–65% of their total energy from carbohydrate 20–35% from fat, and 10–35% from protein. The expressed hope is that these ranges may be more useful and flexible for food and nutrition planning than the single maximum values recommended in the past.1 The AHA report, AHA Dietary Guidelines , was published in November 2000.2 This was followed by the NCEP guidelines for the evaluation and treatment of high blood cholesterol in adults (Adult Treatment Panel III) in May 20013 and the ADA nutrition principles and recommendations technical review and position statement in January 2002.4,5 Although recommendations from these organizations are similar, there are differences in their approaches, ratings of evidence, and ease of translation to the general public. Table 1 is a summary comparison of the three sets of nutrition guidelines.6 How do the guidelines from the various health organizations differ from the dietary reference intake (DRIs)? The DRIs are an expanded system for determining the recommended dietary allowances …