Dietary Guidelines 2015-2020 summary

 

Guidelines (Abbreviated)

  • Follow a healthy eating pattern across the life span.
  • Focus on variety, nutrient density, and amount.
  • Limit calories from added sugars and saturated fats and reduce sodium intake.
  • Shift to healthier food and beverage choices.
  • Support healthy eating patterns for all.

 

Key Recommendations
Follow a healthy eating pattern that accounts for all foods and beverages within an appropriate calorie level.       A healthy eating pattern includes

A variety of vegetables from all of the subgroups—dark green, red and orange, legumes (beans and peas), starchy, and other

Fruits, especially whole fruits

Grains, at least half of which are whole grains

Fat-free or low-fat dairy, including milk, yogurt, cheese, and fortified soy beverages

A variety of protein foods, including seafood, lean meats and poultry, eggs, legumes (beans and peas), and nuts, seeds, and soy products

Oils

A healthy eating pattern limits saturated fats and trans fats, added sugars, and sodium.

 

Key recommendations that are quantitative are provided for several components of the diet of particular public health concern that should be limited.

Consume less than 10% of calories per day from added sugars.

Consume less than 10% of calories per day from saturated fats.

Consume less than 2300 mg/d of sodium.

If alcohol is consumed, it should be consumed in moderation—up to 1 drink per day for women and up to 2 drinks per day for men—and only by adults of legal drinking age.

 

The Dietary Guidelines also include a key recommendation to meet the Physical Activity Guidelines for Americans.

 

 

 

 

This Viewpoint summarizes the updated recommendations of the US Department of Health and Human Services’ recently released 2015-2020 Dietary Guidelines for Americans.

Source: JAMA Network | JAMA | Dietary Guidelines for Americans

should we trust and follow evidence based guidelines?

Guidelines authored by Medical bodies like American Heart Association are strongly followed in our cardiology practise in India as there is lack of trial data conducted in India. I as a practising cardiologist strongly advocate Guideline based therapy. 

However, lately I have been surprised by the recommendations of the new guidelines on various topics. This is because of the change in recommendations which are totally contrary to the previous version of the guidelines. 

Let me cite some examples:

  1. The ATP-3 guidelines strongly advocated Goal based therapy for LDL-cholesterol management. They suggested that LDL cholesterol should be maintained below 100 mg/dl in patients with diabetes  or coronary artery disease. These recommendations were followed by Cardiologists all over the world for the last 12-13 years. However, the new guidelines on Lipid management released by the ACC 2014 mentions that there is no trial to suggest that the target-based therapy of LDL cholesterol works. Instead they advocate high dose statin to be given in patients with high risks and to bring down the LDL cholesterol levels by 50%. This is a drastic change which then calls into question the data on which the earlier ATP guidelines were based.

2.  Beta-blockers were advocated in earlier version of guidelines for treatment of Vasovagal syncope. Even, in my personal experience I have number of patients who felt better with beta-blockers and had remission in their symptoms. However, the new guidelines mentions beta-blockers as Class III (harmful).

3. Amiodarone was advocated earlier for acute treatment of  recurrent ventricular tachycardia (VT). However the new European guidelines on Arrhythmias in ACS mentions that it should be avoided and instead Cardioversion should be preferred.

 

The drastic change in the new recommendations/ guidelines  for treatment of the various disorders (as mentioned above in examples) is unexpected and surprising. The reasons for these may be availability of new trial data or not a thorough evaluation of the trials by earlier committees.

Whatever the reasons, for us as practising Clinicians, patient safety is paramount. Thus, Strict adherence to the new guidelines is advisable and to be followed (till the time we have data available from trials conducted in India on Indian patients). However the therapy should be discussed with and individualised for each patient.

 

 

Guidelines for Treating Overweight and Obesity.

The recently released “2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults” was created to reflect the latest research to outline best practices when it comes to treating obesity—a condition that affects more than one-third of American adults.

These guidelines help address questions like “What’s the best way to lose weight?” and “When is bariatric surgery appropriate?”.

Here is what every patient should know about the treatment of overweight and obesity:

Definition of obesity:

Obesity is a medical condition in which excess body fat has accumulated to the extent that it can have an adverse effect on one’s health. Obesity can be diagnosed using body mass index (BMI), a measurement of height and weight, as well as waist circumference. Obesity is categorized as having a BMI of 30 or greater. Abdominal obesity is defined as having a waist circumference greater than 40 inches for a man or 35 inches for a woman.

Benefits of weight loss:

Obesity increases risk for serious conditions such as heart disease, diabetes and death, but losing just a little bit of weight can result in significant health benefits. For an adult who is obese, losing just 3–5% of body weight can improve blood pressure and cholesterol levels and reduce risk for heart disease and diabetes. Ideally, doctors recommend 5–10% weight loss for obese adults, which can produce even greater health benefits.

Weight loss strategies:

There is no single diet or weight loss program that works best for all patients. In general, reduced caloric intake and a comprehensive lifestyle intervention involving physical activity and behavior modification tailored according to a patient’s preferences and health status is most successful for sustained weight loss. Further, weight loss interventions should include frequent visits with health care providers and last more than one year for sustained weight loss.

Bariatric Surgery:

Bariatric surgery may be a good option for severely obese patients to reduce their risk of health complications and improve overall health. However, bariatric surgery should be reserved for only the highest risk patients until more evidence is available on this issue. Present guidelines advise that weight loss surgery is only recommended for patients with extreme obesity (BMI>40) or in patients that have a BMI>35, in addition to a chronic health condition.

 

via Guidelines for Treating Overweight and Obesity.