Official Dietary Guidelines Research Articles

Reassessing the Effects of Dietary Fat on Cardiovascular Disease in China: A Review of the Last Three Decades.

Cardiovascular disease (CVD) is a leading cause of global mortality, and is considered one of diseases with the most rapid growth rate in China. Numerous studies have indicated a closed relationship between an increased incidence of CVD and dietary factors. Dietary fat is one of the three primary nutrients of consumption; however, high fat dietary in causing CVD has been neglected in some official dietary guidelines. Our present review has analyzed the relationship between dietary fat consumption and CVD in China over the past 30 years (from 1990 to 2019). There is a significant correlation between CVD incidence and mortality for consumption of both vegetable oils and animal fats, per capita consumption, and the relative weight of dietary fat exceeding that of other food ingredients (e.g., salt, fruit, and marine food). For fatty acid species, the proportion of ω6 fatty acid consumption increased, causing a significant increase in the ratios of ω6/ω3 fatty acids, whereas the proportion of monounsaturated fatty acid consumption decreased. Such changes have been considered a characteristic of dietary fat consumption in Chinese residents over the past 30 years, and are closely related to the incidence of CVD. Therefore, we suggest that the government should spread awareness regarding the consumption of dietary fat intake to prevent CVD and related health disorders. The public should be educated to avoid high fat diet and increase the intake of monounsaturated fatty acids and ω3 fatty acids.

The Bidirectional Link between Nutritional Factors and Inflammatory Bowel Diseases: Dietary Deficits, Habits, and Recommended Interventions-A Narrative Review.

Inflammatory bowel diseases comprise Crohn's disease and ulcerative colitis, two chronic inflammatory disorders of the digestive tract that develop in adolescence and early adulthood and show a rising pattern in industrialized societies, as well as in developing countries, being strongly influenced by environmental pressures such as nutrition, pollution and lifestyle behaviors. Here, we provide a narrative review of the bidirectional link between nutritional factors and IBD, of dietary deficits observed in IBD patients due to both the disease itself and dietary habits, and of the suggested nutritional interventions. Research of the literature was conducted. Clinical and basic research studies consistently demonstrate that diet could alter the risk of developing IBD in predisposed individuals. On the other hand, dietary interventions represent a valid tool in support of conventional therapies to control IBD symptoms, rebalance states of malnutrition, promote/maintain clinical remission and improve patients' quality of life. Although there are no official dietary guidelines for patients with IBD, they should receive nutritional advice and undergo oral, enteral, or parenteral nutritional supplementation if needed. However, the dietary management of malnutrition in IBD patients is complex; future clinical studies are required to standardize its management.

Does the concept of “ultra-processed foods” help inform dietary guidelines, beyond conventional classification systems? YES

The recommendation to prefer unprocessed/minimally processed foods and freshly made meals instead of ultra-processed foods (following the Nova food classification system) is being increasingly adopted in new official dietary guidelines issued by national governments and international health associations. This recommendation is supported by systematic reviews and meta-analyses of nationally representative dietary surveys and long-term cohort studies. These data show that increased intake of ultra-processed foods is associated with poor-quality diets and with increased morbidity and mortality from several chronic diseases. Various attributes of ultra-processed foods acting through known, plausible, or suggested physiologic and behavioral mechanisms relate them to ill health, and it is likely that different combinations of attributes and mechanisms affect different health outcomes. Although more research should be done to identify these mechanisms, existing evidence is sufficient to recommend the avoidance of ultra-processed foods to optimize health and policies to support and make feasible this recommendation.

Consumer interest in hummus made from different pulses: Effects of information about origin and variety seeking tendency

Official dietary guidelines emphasize the importance of consuming pulses due to the advantageous nutritional composition and based on aspects of public health and sustainable production. Along with a global trend of increased focus on sustainability, launching locally produced plant-based food products have thus gained commercial interest. The purpose of this study is to investigate various pulses and how information about their origin affects the willingness to try and willingness to pay for hummus made from these pulses. In addition, variation seeking tendencies and attitude towards the environment were measured. The research design is a quantitative study including data obtained via online surveys. Respondents, (N = 363 Danish speaking and resident consumers) were presented with images of one traditional chickpea and four experimental versions of pulse-based hummus. Participants were presented with representative photos of the hummus samples and respective pulses and randomly selected to be given information regarding origin of the pulses (n = 164) or presented blind (n = 199). To investigate modulation of variation seeking tendency and individual attitude towards the environment, the VARSEEK scale and EAI-24 scale were applied respectively. Results suggest that providing information regarding origin has a positive effect on willingness to try and willingness to pay. Increase in variety seeking tendency significantly increased both willingness to try, willingness to pay, and ratings for appetizing appearance. Increased attitude towards the environment showed only a slightly significant increase on appetizing appearance. Furthermore, providing information about the pulses to respondents, particularly the segment with low variation seeking tendency had a significantly positive effect on willingness to try and ratings of appetizing appearance.

Experiences of dietary advice and nutrition-related information: a qualitative analysis of primigravid women in England during the COVID-19 pandemic

BackgroundThere is limited research in England on the impact and experiences of dietary advice and nutrition-related information for pregnant women. However, overseas research has shown that such information can cause women to feel anxious and confused. This study aimed to analyse the impact and experience amongst primigravids in England.MethodologyThis was a qualitative study. Twelve semi-structured individual interviews were carried out (videoconference and telephone). Interviews were audio recorded and transcribed verbatim. Inductive thematic analysis was used for data analysis. Data quality measures were adhered to throughout the research process.ResultsFive major themes were identified: ‘physiological changes and taste preferences’, ‘the health and safety of the baby comes first’, ‘scarcity of nutrition information given’, ‘seeking nutrition information for control’ and ‘every pregnant woman is unique’. Participants put the health and safety of their baby first, and this was amplified due to the COVID-19 pandemic. There was a lack of information given to participants from health care professionals. Information was broadly sought out as a way of exerting control; either to feel informed, or to restrict contact with new information in order to avoid feeling overwhelmed. In both cases, participants expressed that information was abundant. Official dietary guidelines were seen as trustworthy but too generic and not applicable to them. Some participants used multiple pregnancy apps with inaccurate information.ConclusionsAs nutrition in pregnancy is important for the woman and the growing foetus, midwives are in a critical position to advise primigravids in England. Further research is needed to understand their barriers for doing so. More is needed from the National Health Service to signpost women to using evidenced-based pregnancy apps and to enable a healthy nutrition environment post-pregnancy.

The role of cereals in nutrition and health for a sustainable diet

Over the last years, the impact of food systems on human and planetary health has been appointed. The transition towards more sustainable and healthier diets is postulated as an urgent measure to address the increasing environmental and health concerns related to the current food production and consumption systems. This work reviews recent developments to integrate sustainability into dietary recommendations and food-based dietary guidelines, recognising the role of cereals as the basis for healthy sustainable dietary patterns. It is worth noting that a change in current eating patterns, to achieve greater adherence to existing official dietary guidelines, is proposed as a more realistic and feasible goal to improve the environmental and health impact of food systems. In this context, cereals play a key role as fundamental pillar of healthy and sustainable dietary patterns, due to their energy and nutrient contribution to human diet worldwide, and the different health benefits associated with an adequate intake of grain fibre and wholegrains.

Policy communication for health and sustainability: comparison of food-based dietary guidelines

Abstract Background Food-based dietary guidelines (FBDGs) provide advice on what constitutes a healthy diet, influencing both decision-making at the policy level, and educational programs addressed to consumers. There is a growing body of literature that allows to estimate the health and environmental impacts of the wide adoption of FBDG at the country and global levels. This unlocks the possibility of evaluating the most sustainable dietary guidelines from a communication perspective. This study aims at answering what are the key converging messages and main differences in the communication of FBDG that have a high environmental potential, and what of those FBDG do communicate a sustainability purpose in an explicit way. Methods A mixed-method comparative review of FBDGs with a two-stage sampling process was developed. Building on Springmann et al (2020) we identified the countries where the wide population adoption of dietary guidelines would have the highest potential of reducing food-related greenhouse gas emissions (GHGe) while delivering positive health outcomes. In a second stage, a purposeful sample of FBDGs was designed to cover countries from different WHO regions, income levels, and languages. Results This study is in progress and results are preliminary. Out of the initial sample of identified FBDG with a GHGe reduction potential of more than 25 percent, a few of them, Germany, Brazil, Sweden, Netherlands, and France had been previously identified in the literature as having sustainability-based recommendations. Other guidelines with similar GHGe reduction potential, such as those of Switzerland and Italy also address sustainability in an explicit way. Conclusions FBDGs have been traditionally focused on health and nutrition messages. Several countries have updated recommendations considering the environmental impacts of food consumption. Not all the FBDG with a high environmental potential explicitly communicate sustainability concerns. Key messages Several countries can improve their health and climate change outcomes by promoting a wider adoption of their official dietary guidelines. Communication is a key aspect of this process.

Fatty acids: facts vs. fiction.

During the last 100 years official dietary guidelines have recommended an increased consumption of fats derived from seeds while decreasing the consumption of traditional fats, especially saturated fats. These recommendations are being challenged by recent studies. Furthermore, the increased use of refining processes in fat production had deleterious health effects. Today, the number of high-quality studies on fatty acids is large enough to make useful recommendations on clinical application and everyday practice. Saturated fats have many beneficial functions and palmitic acid appears to be problematic only when it is synthesized due to excess fructose consumption. Trans fatty acids were shown to be harmful when they are manmade but beneficial when of natural origin. Conjugated linoleic acid has many benefits but the isomer mix that is available in supplement form differs from its natural origin and may better be avoided. The ω3 fatty acid linolenic acid has rather limited use as an anti-inflammatory agent - a fact that is frequently overlooked. On the other hand, the targeted use of long chain ω3 fatty acids based on blood analysis has great potential to supplement or even be an alternative to various pharmacological therapies. At the same time ω6 fatty acids like linoleic acid and arachidonic acid have important physiological functions and should not be avoided but their consumption needs to be balanced with long chain ω3 fatty acids. The quality and quantity of these fats together with appropriate antioxidative protection are critical for their positive health effects.

Technology offers sustainable nutrition solutions

Technology offers sustainable nutrition solutions

Effects of substitution dietary guidelines targeted at prevention of IHD on dietary intake and risk factors in middle-aged Danish adults: the Diet and Prevention of Ischemic Heart Disease: a Translational Approach (DIPI) randomised controlled trial.

The objective was to investigate the effects of substitution (SUB) dietary guidelines (DG) targeted at the prevention of IHD on dietary intake and IHD risk factors in Danish adults with minimum one self-assessed IHD risk factor. A 6-month single-blinded parallel randomised controlled trial with a follow-up at month 12 included 219 subjects (median age 51 years, 59 % female, 73 % overweight or obese) randomised into an SUB DG, an official (OFF) DG or a control group following their habitual diet (HAB). Participants in the DG intervention groups received bi-weekly reminders of their DG and recipes for dishes and the HAB group received a greeting. Dietary intake and fasting blood, anthropometric and blood pressure measurements were obtained at baseline, month 6 and month 12. Linear regression analyses were applied. At month 6, when compared with the HAB, the SUB had a greater impact on the extent of dietary changes with increased intake of whole grains, dietary fibre and low fibre vegetables compared with the OFF DG, and both DG groups had similar decreased percentage of energy (E%) intake from SFA. The extent of dietary changes was similar at month 12. No overall significant changes from baseline were found in blood pressure, anthropometrics and IHD risk markers. In conclusion, both SUB and OFF DG resulted in cardioprotective dietary changes. However, neither the SUB nor the OFF DG resulted in any overall effects on the selected intermediate risk factors for IHD.

'A holistic approach': incorporating sustainability into biopedagogies of healthy eating in Sweden's dietary guidelines.

Dietary guidelines can be considered a pedagogical tool, designed to promote healthy eating at the population level. In this study, we critically examine the biopedagogies implicated in Sweden’s official dietary guidelines. Published in 2015, these guidelines take a potentially innovative ‘holistic approach’ to food and eating, addressing the challenge of formulating dietary advice that considers both human health and environmental concerns. Applying Bacchi´s ‘What’s the problem represented to be?’ approach, we interrogate how the guidelines frame the interplay of public health concerns and environmental concerns in making food choices. We find that the biopedagogies of sustainable eating, as presented in these guidelines, implicate the subject position of the ideal eater. The ideal eater values sustainability, has high cultural capital, and draws on both taste and nutritional knowledge to make good food choices. However, while the ideal eater is expected to be aware of environmental issues, these are incorporated into the ideal eater’s choices only in addition to the primary concern of health. Thus, although the guidelines frame a ‘holistic approach’ as the solution to both health and environmental concerns, in cases where health and environmental priorities conflict, the guidelines’ biopedagogies of sustainable eating align with earlier biopedagogies of healthy eating.

Associations between dietary patterns at age 71 and the prevalence of sarcopenia 16 years later

The growing recognition of the significance of sarcopenia has highlighted the need to understand etiologic factors, where food intake likely plays a role. The aim was to investigate the association between dietary patterns at mean age 71 and the prevalence of sarcopenia at mean age 87 in a Swedish cohort of community dwelling men. Dietary habits were assessed using a 7-day food record. Adherences to official dietary guidelines, defined by the World Health Organization (WHO) by using the Healthy Diet Indicator, and Mediterranean-like dietary habits by using the Mediterranean Diet Score, were calculated. Sarcopenia was determined using the definition from the European Working Group on Sarcopenia in Older People (EWGSOP) and associations to each dietary pattern were analyzed using logistic regression, adjusted for potential confounders. Our study population included 254 men, mean age 71at baseline, and 53 (21%) were defined as sarcopenic 16 years later. There was no linear relationship between increased adherence to WHO dietary guidelines and future prevalence of sarcopenia, although those with medium adherence seemed to be protected (crude OR=0.41, 95% CI 0.19-0.92). On the other hand, an inverse relationship to sarcopenia was found for each SD increment in the Mediterranean diet score (crude OR=0.68, 95% CI 0.46-0.99), which remained after adjusting for potential confounders. Sensitivity analysis indicated relationships to be independent of changes in physical activity and dietary misreporting. In this prospective study of elderly men, using a single measure of diet at age 71 as a reflection of habitual dietary habits, healthy dietary patterns tended to protect against the development of sarcopenia over 16 years. In particular, we found indications that increased adherence to a Mediterranean dietary pattern might be advantageous.

Digesting Data: Tracing the Chromosomal Imprint of Scientific Evidence Through the Development and Use of Canadian Dietary Guidelines

The Eating Well With Canada’s Food Guide (CFG), which represents Canada’s official dietary guidelines, is designed to address high rates of obesity and diet-related chronic disease in Canada. This article presents a qualitative study of the social and ideological actions that the CFG performs. The study draws on the concepts of antecedent genres and uptake from rhetorical genre studies, applying them in a multimodal analysis of the CFG and interviews with the CFG’s producers and registered dietitians (RDs) who work with vulnerable populations. Findings reveal that scientific representations play a profound role in the social and ideological actions that the CFG performs. The author demonstrates how representations of scientific evidence from nutrition science, as exemplified in the concept of the Food Guide Serving, are taken up by the CFG and, in turn, how these scientific representations influence RDs’ use of the CFG and dominate, rather than facilitate, discussions about healthy eating. The study suggests that the CFG, instead of being an enabling resource, is a limiting document: It limits who can make healthier food choices and how such choices can be made.

Consumer accounts of favourable dietary behaviour change and comparison with official dietary guidelines.

The current study aimed to assess Uruguayan consumers' accounts of their own need to change their dietary patterns, their intended changes and the barriers related to doing so, and to compare the intentions and barriers with the recommendations of the national dietary guidelines. An online survey with 2381 Uruguayan employed adults, aged between 18 and 65 years, 65 % females, was conducted. Participants had to answer two open-ended questions related to changes they could make in the foods they eat and/or the way in which they eat to improve the quality of their diet and the reasons why they had not implemented those changes yet. Content analysis using inductive coding by two researchers was used to analyse the responses. Consumers mainly intended to change consumption of types of foods, particularly eating more fruits, vegetables and legumes and consuming less flour, but also intended to alter their eating patterns. Lack of time and the fact that healthy foods are perceived as being more expensive than unhealthy foods were major barriers to behaviour change. Some of the recommendations of the dietary guidelines, particularly those related to enjoying cooking and meals and engaging in it as a social activity, were not represented in consumer accounts. Accompanying policies to the dietary guidelines need to underline the importance of changes in dietary patterns, including greater enjoyment and sharing food preparation and meals in the company with others, address misconceptions about flour, and provide concrete, consumer-derived recommendations on how to enact the guidelines.

Is adherence to the Chinese Dietary Guidelines associated with better self-reported health? The Chinese Dietary Guidelines Adherence Score.

Poor adherence to dietary guidelines is related to physical and mental disorders, as reflected in self-reported health statuses. This study evaluates the association between diet quality and selfreported health within the Shanghai Diet and Health Study. We used Chinese Dietary Guidelines Adherence scores to assess diet quality in a cross-sectional study of 4487 subjects above 15 years of age, who completed three-day 24h diet recalls and responded to self-reported health questionnaires. A composite health score was calculated based on Item Response Theory, using the Rasch model. Multiple linearregression models were evaluated to assess the relationship between self-reported health status and diet quality. Based on the various adherence scores, we divided our sample into fifths. Based on these divisions and with the exception of a single instance, our results show a significant trend: self-reported health declines with declining adherence to official dietary guidelines. This trend was even significant when controlling for a large number of potential confounders. This study shows that consumption of a healthy and balanced diet, as reflected in adherence to the Chinese Dietary Guidelines, is related to increased levels of overall health among Shanghai residents.

Stakeholder responses to governmental dietary guidelines

PurposeThe purpose of this paper is to explore how stakeholders in the food and nutrition field construct and conceptualise “appropriate” national dietary advice.Design/methodology/approachIn total, 40 voluntarily written stakeholder responses to updated official dietary guidelines in Sweden were analysed thematically. The analysis explored the logics and arguments employed by authorities, interest organisations, industry and private stakeholders in attempting to influence the formulation of dietary guidelines.FindingsTwo main themes were identified: the centrality of anchoring advice scientifically and modes of getting the message across to the public. Stakeholders expressed a view of effective health communication as that which is nutritionally and quantitatively oriented and which optimises individuals’ capacities to take action for their own health. Their responses did not offer alternative framings of how healthy eating could be practiced but rather conveyed an understanding of dietary guidelines as documents that provide simplified answers to complex questions.Practical implicationsPolicymakers should be aware of industrial actors’ potential vested interests and actively seek out other stakeholders representing communities and citizen interests. The next step should be to question the extent to which it is ethical to publish dietary advice that represents a simplified way of conceptualising behavioural change, and thereby places responsibility for health on the individual.Originality/valueThis research provides a stakeholder perspective on the concept of dietary advice and is among the first to investigate referral responses to dietary guidelines.

Food consumption and the actual statistics of cardiovascular diseases: an epidemiological comparison of 42 European countries

BackgroundThe aim of this ecological study was to identify the main nutritional factors related to the prevalence of cardiovascular diseases (CVDs) in Europe, based on a comparison of international statistics.DesignThe mean consumption of 62 food items from the FAOSTAT database (1993–2008) was compared with the actual statistics of five CVD indicators in 42 European countries. Several other exogenous factors (health expenditure, smoking, body mass index) and the historical stability of results were also examined.ResultsWe found exceptionally strong relationships between some of the examined factors, the highest being a correlation between raised cholesterol in men and the combined consumption of animal fat and animal protein (r=0.92, p<0.001). The most significant dietary correlate of low CVD risk was high total fat and animal protein consumption. Additional statistical analyses further highlighted citrus fruits, high-fat dairy (cheese) and tree nuts. Among other non-dietary factors, health expenditure showed by far the highest correlation coefficients. The major correlate of high CVD risk was the proportion of energy from carbohydrates and alcohol, or from potato and cereal carbohydrates. Similar patterns were observed between food consumption and CVD statistics from the period 1980–2000, which shows that these relationships are stable over time. However, we found striking discrepancies in men's CVD statistics from 1980 and 1990, which can probably explain the origin of the ‘saturated fat hypothesis’ that influenced public health policies in the following decades.ConclusionOur results do not support the association between CVDs and saturated fat, which is still contained in official dietary guidelines. Instead, they agree with data accumulated from recent studies that link CVD risk with the high glycaemic index/load of carbohydrate-based diets. In the absence of any scientific evidence connecting saturated fat with CVDs, these findings show that current dietary recommendations regarding CVDs should be seriously reconsidered.

Underestimated sources of flavonoids, limonoids and dietary fibre: Availability in lemon's by-products

The distribution of bioactive molecules has been determined in all by-products (seeds, exhausted peels and pulps, waste waters) generated by the industrial processing of lemon fruits. These are usually sent for disposal, despite being rich sources of bioactive molecules, in particular flavones, flavanones, flavanols, phenolic acids, limonoids, carotenoids, coumarins, furocoumarins, polymethoxyflavones, and dietary fibre, among others. All samples were treated with solvents (methanol, ethanol, ethyl acetate, petroleum ether) to extract flavonoids, carotenoids, limonoids and oxygen heterocyclic compounds. Analyses were performed by HPLC/PDA/MS. The major classes of compounds determined were flavanones, flavones and phenolic acids. Carotenoids were not detected due to probable chemical degradation. The peel and pulp contained dietary fibre (soluble and insoluble) with an optimal percentage of the soluble fraction of about 35% as recommended by official dietary guidelines. The information here reported may stimulate operators to re-evaluate their by-products, with the possibility to recover significant amounts of nutraceuticals and produce functional foods.

A healthy diet with and without cereal grains and dairy products in patients with type 2 diabetes: study protocol for a random-order cross-over pilot study - Alimentation and Diabetes in Lanzarote -ADILAN

BackgroundResearch on the role of nutrition in type 2 diabetes has largely focused on macro/micronutrient composition and dietary fiber intake, while fewer studies have tested the effects of differing food choice. Some observational studies and short-term intervention studies suggest that a food pattern mimicking the diet with which humans evolved positively influences glucose control and associated endocrine systems. Such a food pattern mainly differs from other common healthy food patterns in its absence of cereal grains and dairy products. The primary aim of this pilot study is to determine the effect of two healthy diets with or without cereal grains and dairy products on glucose control, while keeping participants’ weight stable and other food parameters, such as macro/micronutrient composition, dietary fiber and glycemic load, the same in both diets.Methods/DesignWe intend to include 15 adult patients with a medical diagnosis of type 2 diabetes mellitus with or without medication and with an increased waist circumference (≥ 80 cm for women and ≥ 94 cm for men) in a random-order cross-over diet intervention study during two periods of four-weeks separated by a six-week washout period. Patients will be instructed to eat two healthy diets according to official dietary guidelines with respect to macro/micronutrient composition and fiber content, but differing in the type of food included, with one diet being without cereal grains and dairy products. Lunch will be served in a hospital kitchen for control of nutrient intake, while the rest of the meals will be eaten at home according to specific directions. The energy content of the diets will be individually adjusted to maintain a stable body weight during the two four-week intervention periods. Primary outcomes will be change in fasting plasma glucagon and fructosamine, while secondary outcomes include change in fasting glucose and glycated hemoglobin, glucose and glucagon response during oral glucose tolerance test, blood lipids, blood pressure, C-reactive protein, body composition, quality of life, subjective experience with the two diets, satiety scores and changes in medication.DiscussionUsing these results, we will assess the need to conduct larger and longer studies with similar design.Trial registrationThis trial was registered at clinicaltrials.gov as NCT01891955 and Spanish Agency of Medication and Sanitary Products (AEMPS) registration code: MFV-ADI-2013-01.

The art of translating nutritional science into dietary guidance: history and evolution of the Dietary Guidelines for Americans

The United States government has published official Dietary Guidelines for Americans (DGA) since 1980 and has recently released the 2010 version. Serving as a foundational cornerstone for federal nutrition policy, the DGA embrace current nutritional science and translate it into practical guidance to enhance the overall health of Americans. This article reviews the history and process for developing the DGA, including the incorporation of sophisticated and systematic techniques for reviewing emerging evidence. It also explores issues related to implementation of the guidelines through federal policy, the food supply, and consumer knowledge and behavior.