As noted by the Robert Woods Johnson Foundation (RWJF), the dietary guidelines for Americans (last issued in 2015), have tremendous influence upon public policy and how Americans eat, as well as public healthcare. The Dietary Guidelines for Americans issued by the Department of Health and Human Services (HHS) and the Department of Agriculture (USDA) are used in setting the standards for the National School Lunch Program, on which many children are dependent for their main source of nutritional calories for the day at low or reduced cost. Physicians are influenced by its guidelines, and ordinary Americans are influenced by the guidelines when they make decisions in the grocery store.
As noted by the RWJF, a number of significant modifications were made in the most recent 2015 guidelines, including limiting the sugar added to the individual’s diet to no more than 10% of daily calories (Goldman, 2015). It should be noted that this does not apply to fruit and other foods with natural sugars. The guidelines also removed the previous recommendation to limit cholesterol to 300 mg per day, in line with current evidence-based research and revised the recommendations. Regarding fat, the guidelines now state that instead of limiting fat to a specific percentage of one’s diet, no more than 10% of the individual’s total dietary calories should come from saturated fat (Goldman, 2015).
Of course, these dietary recommendations have been quite controversial over the years. Depending on what particular diet people prefer or recommend (paleo and low-carbohydrate advocates tend to support a more fat-heavy and animal protein-heavy diet, versus vegetarians who are more apt to eschew recommendations to allow for more animal cholesterol in the diet), they are more or less likely to support these new revisions. There are also concerns that business-related lobbying groups, or agricultural producers will influence the dietary recommendations based upon their economic needs and political clout in Washington, versus the genuine physical health requirements of Americans.
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With this in mind, it can be useful for advanced practice nurses (APNs) to review the literature that supports or does not support the current guidelines and recommendations. APNs must be aware of the guidelines’ influence upon how school lunches are prepared and even how the labels on foods appear, given that the dietary recommendations are often posted upon prepared and processed foods.
Perhaps the least controversial recommendation of…
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…guidelines clear to the patient, pinpoint the patient’s personal genetic and lifestyle risk factors, and work to assess the best dietary interventions to ensure optimum health, also taking into consideration the patient’s lifestyle choices and psychology in regards to diet.
Just as not all cholesterol is bad cholesterol, yet another confusing yet relevant insight of the new dietary recommendations is that not all fat is created equal. The new dietary recommendations specifically target saturated fat as a problem, versus all fat in general. Fat is a necessary part of the human diet, and has a beneficial role in promoting satiety, as well as is needed to metabolize other macronutrients effectively. Eschewing fat entirely is counterproductive to good nutrition and to weight maintenance. In fact, according to Nettleton (et al., 2017), even saturated fat has been unfairly demonized over the years, and a review of current studies found: “Higher intakes of SAFA were not associated with higher risks of CHD or stroke,” although emphasizing unsaturated fats my still be wise given the other nutritional benefits of foods high in unsaturated fats such as nuts, almonds, etcetera (par.1). Once again, the APN has an important role in helping patients contextualize….....
Blesso, C. N., & Fernandez, M. L. (2018). Dietary cholesterol, serum lipids, and heart disease: Are eggs working for or against you? Nutrients, 10(4), 426. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5946211/
Goldman, T.R. (2015). Dietary guidelines for Americans. Robert Woods Johnson Foundation. (RWJF). Retrieved from: https://www.rwjf.org/en/library/research/2015/12/dietary- guidelines-for-americans.html
Fessler M. B. (2015). Revisiting “good” and “bad” cholesterol. American Journal of Respiratory
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Nettleton, J. A., Brouwer, I. A., Geleijnse, J. M., & Hornstra, G. (2017). Saturated fat consumption and risk of coronary heart disease and ischemic stroke: A science update. Annals of Nutrition & Metabolism, 70(1), 26-33. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5475232/
Vreman, R. A., Goodell, A. J., Rodriguez, L. A., Porco, T. C., Lustig, R. H., & Kahn, J. G. (2017). Health and economic benefits of reducing sugar intake in the USA, including effects via non-alcoholic fatty liver disease: a microsimulation model. BMJ, 7(8), e013543. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5577881/