This month I'd like to focus on what will no doubt be a popular topic in the media over the coming months, the updated USDA Dietary Guidelines. On June 15, the Dietary Guidelines Advisory Committee published a draft of its updated recommendations. A period of public comment followed through mid-July, and the final guidelines document will be published later this year.

Pearls for Discussion

An overview of the main points in the guidelines provides nutrition pearls to discuss with your patients, who may ask about the report as it is covered in the media. The guidelines document is long and includes five sections and numerous subsections. The most important points for your patients are summarized here and can be found in the Part E Appendix (E-1), under the heading Major Conclusions. The key recommendations are as follows:

• the reduction of overall caloric intake accompanied by increased physical activity (encouraging patients to meet the 2008 Physical Activity Guidelines for Americans)
• shifting food intake patterns to emphasize more nutrient-dense foods (e.g., vegetables, fruits, whole grains, nuts and seeds, seafood, fat-free and low-fat dairy)
• shifting food intake patterns to emphasize moderate consumption of lean meats, poultry and eggs
• reduced intake of foods containing sugars and solid fats (SoFAS), because these dietary components definitively contribute to excess calories and provide few necessary nutrients
• reduced intake of sodium and refined grains, especially refined grains coupled with added sugar, solid fat and sodium.

Specifically, the report emphasizes a plant-based diet and reducing saturated fat intake to 7% of calories. 

Obesity Call to Arms

The 2010 USDA recommendations focus on the health risks associated with obesity, with an emphasis on achieving healthy weight in children in particular. Recommendations within the draft advise reduction of nutrient-poor foods and drinks and increased consumption of nutrient-rich foods and drinks. The draft makes strong recommendations about food environment and the relationship of fast food to the obesity epidemic. It recommends limiting children's media time and increasing the availability of nutrition information at the point of purchase.

The draft discusses high sugary drink intake by children and adolescents and suggests working toward reduction or even avoidance. The draft also states that among adolescents aged 14 to 18, the top calorie source is energy, sports and soda drinks.

In addition, the draft recommends smaller amounts of fruit juice for children overall. The draft does not suggest a link between sugar-sweetened beverages and higher body mass index or overweight in adults, yet it does note that there is stronger evidence to link an increase in sugar-sweetened beverages with increased levels of obesity among children. With adults, the draft notes a "moderate" body of evidence indicative of associations between the intake of sugar-sweetened beverages and an overall higher daily caloric intake.

Sugar Information

The draft does not recommend an upper limit on added sugar in foods, although setting a limit is recommended by the American Dietetic Association (and was discussed in a previous column). The draft guidelines do suggest an overall reduction in SoFAS, which can make up an average of 35% of daily calories in the American diet. The report recommends SoFAS reductions that replace the 2005 Dietary Guidelines recommendations for decreasing discretionary calories in general. The latter has been a difficult concept for Americans to grasp and implement.

In its draft guidelines, the committee does not distinguish between various forms of sugars. The members view all caloric sweeteners similarly, for example, high fructose corn syrup (HFCS) is no different from table sugar. Thus, although there are recommendations to decrease daily calories from sugar-sweetened beverages, extra calories from sugar-sweetened beverages are no different from those in other beverage or food sources. The panel acknowledges the potential benefits of zero-calorie sweeteners and states that these can have a role in decreasing overall calorie intake when substituted for foods and beverages higher in calories.

To view the guidelines draft, visit http://www.cnpp.usda.gov/DGAs2010-DGACReport.htm.

Robyn Kievit is a family nurse practitioner and registered dietitian in the Boston area. E-mail your nutrition and weight loss questions to robyn@robynkievit.com or visit her website at www.robynkievit.com. On Facebook and Twitter, search for nutritionmentor.