If the Dietary Guidelines Advisory Committee drops cholesterol from the list of "nutrients of concern," it will be consistent with a 2013 task force finding as well as the panel's focus on dietary patterns, or the mix of foods that Americans eat and their effect on population health.
The panel charged with making recommendations that affect everything from school lunches to military meals appears poised to eliminate cholesterol from its list of “nutrients of concern,” a change that will send waves through nutrition policy circles and could create confusion for persons with diabetes and those who treat them.
The Dietary Guidelines Advisory Committee (DGAC) has spent more than a year discussing its 2015 recommendations to the secretaries of Health and Human Services and Agriculture, a process that occurs every 5 years. According to The Washington Post, DGAC’s report, which will be published soon, will change the recommendation on cholesterol, a move that was hinted at during the panel’s final public meeting in December.
While the 2 secretaries will have the final word on the 2015 Dietary Guidelines for Americans, the DGAC recommendations are typically left intact. A discussion of national nutrition policy and the forthcoming 2015 guidelines will be part of the agenda at Patient-Centered Diabetes Care, to be held in Boston April 16-17, 2015. The meeting is jointly hosted by The American Journal of Managed Care and Joslin Diabetes Center.
As the Post reported, updating the finding on cholesterol reflects a change in thinking about what to recommend for diets for healthy adults, who likely have no need to automatically avoid foods such as eggs or seafood.
Indeed, as reported last year in Evidence-Based Diabetes Management, the cholesterol recommendation should be viewed within the broader context of DGAC’s focus on “dietary patterns,” which sought to shift the focus to the mix of foods that Americans eat, which panel members viewed as more relevant to population health.
The healthcare challenge will come not from certain foods that are naturally high in cholesterol but offer other benefits, but if Americans interpret the cholesterol recommendation as a license to consume foods heavy in saturated fats, such as fatty meats, or add large amounts of butter to foods in preparation. The DGAC recommendation is not expected to change advisories on low-density lipoprotein (LDL) or “bad” cholesterol, which has been linked to heart disease.
Cholesterol measurements are unlikely to vanish anytime soon. Population-level measures of LDL cholesterol are among the 5 diabetes-related measures considered in determining Medicare reimbursement for accountable care organizations (ACOs) that take part in the Medicare Shared Savings Program.
For healthy adults, however, the tide against dietary cholesterol has been shifting. A 2013 task force of the American College of Cardiology and the American Heart Association that examined current studies found “insufficient evidence” to make a recommendation. Since the 2015 DGAC panel announced at the outset its intention to consider updated scientific evidence in its deliberations, the cholesterol finding, if it appears in the final report, will not be complete surprise.
Current guidelines, upheld by the 2010 members of DGAC, call for restricting cholesterol intake to 300 milligrams daily. American adult men on average ingest about 340 milligrams of cholesterol a day, according to figures reported to the federal government.
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