Nutrition guidelines crack down on added sugar

Reflecting a message common among pediatric nutritionists, the recently released federal Dietary Guidelines for 2015-2020 are targeting the reduction of added sugar, particularly from sugar-sweetened beverages, and are for the first time ever putting a hard cap on sugar intake.

“With children currently consuming as much as 17% of calories from added sugars, small changes like replacing sugar-sweetened beverages with beverages with no added sugars and swapping snacks with added sugars for fresh fruit will help parents and children make healthy choices that reduce the amount of added sugars in their diets,” says Frances Bevington, MA, strategic communication and public affairs advisor for the US Department of Health and Human Services’ (HHS) Office of Disease Prevention and Health Promotion.

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Bevington says, in line with the new guidelines, pediatricians should urge parents to limit their children’s added sugar intake to no more than 10% of their daily calories.

While the federal guidelines are intended for Americans over age 2 years, Bevington says the recommendations provide useful evidence-based information that pediatricians can use in counseling parents and clients on the importance of food choices for preventing chronic disease.

While the guidelines do not restrict fat and meat consumption, as was expected based on earlier draft recommendations, the new plan emphasizes lifelong healthy eating patterns that focus on the intake of essential nutrients while maintaining a caloric intake that supports a healthy body weight.

Overall, the guidelines promote the consumption of a variety of fruits and vegetables, whole grains, fat-free or low-fat dairy foods, and lean meats and protein products including beans and nuts.

Ninety percent of Americans consume less than the daily recommended amount of vegetables, and 50% more sodium, according to HHS, which urges Americans to pay attention to hidden dangers on food labels and change their diets through small food replacements such as substituting refined grains like white breads for whole grain products. Other suggestions include replacing high-calorie snacks like chips and dip for nutrient dense versions such as vegetables with dip.

While federal guidelines have long promoted heavy consumption of fruits and vegetables, the new guidelines actually break down what types of fruits and vegetables should be consumed and in what amounts. For example, the guidelines show the actual versus recommended consumption of dark green vegetables, red and orange vegetables, legumes, and starchy vegetables-and consumption of each one is under the recommended amount in nearly every gender and age group.

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One source of contention in the new guidelines, however, is the omission of a draft recommendation from a 2015 advisory report from the Dietary Guidelines Advisory Committee (DGAC) that environmental sustainability be addressed in the new federal guidelines.

This suggestion was a first for the federal guidelines, and suggested that part of a healthy diet includes consideration of where those foods come from and whether consumption of certain food types impacts future supply and global environmental health

“An important reason for addressing sustainable diets, a new area for the DGAC, is to have alignment and consistency in dietary guidance that promotes both health and sustainability,” the report states. “This also recognizes the significant impact of food and beverages on environmental outcomes, from farm to plate to waste disposal, and, therefore, the need for dietary guidance to include the wider issue of sustainability. Addressing this complex challenge is essential to ensure a healthy food supply will be available for future generations.”

The concept of ensuring sustainability meant that the DGAC was leaning toward advocating a more plant-based diet and a decrease in meat consumption-similar to the World Health Organization’s October 2015 statement about the dangers of consuming too much red and processed meats-an aspect of the report that immediately drew criticism from meat producers.

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In a statement following the release of the DGAC report, the American Meat Institute requested additional time for comments on the report, suggesting that nutrition experts have no place in making environmental recommendations and the federal guidelines should be limited to nutritional advice.

In the end, lobbying and criticism of the guidelines garnered the attention of Congress, which passed a bill in December 2015 limiting the scope of the federal nutrition guidelines and threatening to cut off funding for guidelines that included recommendations about environmental sustainability.

What did remain in the final guidelines, however, was the suggestion that men and boys consume less protein, although the guidelines don’t offer any specific recommendations to accomplish this reduction.

While a decrease in meat consumption was dropped from the final recommendations, the guidelines still urge Americans to limit saturated fat consumption to less than 10% of daily calories and to cut sodium by a third-recommendations that could translate to a decrease in the consumption of meats and processed foods.

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Despite criticisms of the new guidelines, medical associations are focusing on the positive aspects of the recommendations and applaud HHS’ stance on sugar consumption.

“For the first time, the guidelines recommend limiting the consumption of added sugars to less than 10% of calories per day, and continue to recommend more vegetables, fruits, whole grains, and lean proteins, and less sodium and saturated fat, all of which support a healthy eating pattern for families,” the American Academy of Pediatricians (AAP) wrote in a statement about the new guidelines. “Pediatricians routinely look to the dietary guidelines to provide advice to our patients, and we do so with confidence that the best scientific evidence available was used to inform the recommendations.”

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The guidelines are used to manage key aspects of federal nutrition programs, says AAP, and the new guidelines could have a huge impact on providing adequate nutrition for needy children.

“The dietary guidelines underpin key federal nutrition programs like Women, Infants, and Children and the school meals program. At a time when our children are facing nutritional crises resulting from a 21% poverty rate among children; 15 million children who are living in homes where food is scarce; and nearly 1 in 3 children suffering from overweight or obesity, the guidelines play a pivotal role in influencing the foods children eat in school and the choices families make at home,” AAP says. “The Dietary Guidelines for Americans are an important source of information for children ages 2 years and up, and the critical work of the federal government to establish guidelines for children under age 2 years must continue moving forward so that we can provide a foundation of strong health from the earliest days of life.”

The American Medical Association (AMA) also applauds the new guidelines, noting that it is the first set of guidelines to focus on lifespan nutrition rather than piecemeal changes.

“The AMA applauds the Committee for recommending that our nation's children and adults should focus on achieving a healthy overall diet rather than focus on consuming only specific nutrients,” AMA says in a statement about the guidelines.

The American Academy of Family Physicians (AAFP) also released a statement applauding some aspects of the new guidelines, while criticizing others-including the omission of the earlier sustainability recommendations.

"There is no doubt that a diet that is higher in plant-based foods is healthier, and it is also associated with less of an impact on the environment," says Jennifer Frost, MD, medical director for the AAFP Health of the Public and Science Division. "The Advisory Committee is being criticized for including sustainability in their recommendations, but access to sufficient and nutritious food has an important impact on health.”

The AAFP also criticized the lack of guidance on cholesterol and questioned the lack of evidence to back the guidelines’ 2300 mg per day cap on sodium.

"It's not that we think it's too low," Frost says. "We just don't know what the right amount is."

The AAFP notes that the guidelines did a good job with the inclusion of psychosocial and economic factors into the report, and urges federal authorities to continue working to find ways to help low-income children secure access to nutritious foods. The AAFP says it also hopes the DGAC will continue to work on identifying early exercise interventions and the impact they can have on childhood obesity rather than focusing on nutrition alone.

The 2015-2020 federal nutrition guidelines going forward will have an impact not only on consumers, but also federal programs and nutrition labels.