Abstract
Dietary guidelines, especially those designed to prevent the diseases of dietary excess,
are a relatively new phenomenon in the United States. National dietary guidelines
have been promulgated based on scientific reasoning and indirect evidence. In general,
weak evidentiary support has been accepted as adequate justification for these guidelines.
This low standard of evidence is based on several misconceptions, most importantly
the belief that such guidelines could not cause harm. Using guidelines against dietary
fat as a case in point, an analysis is provided that suggests that harm indeed may
have been caused by the widespread dissemination of and adherence to these guidelines,
through their contribution to the current epidemic of obesity and overweight in the
U.S. An explanation is provided of what may have gone wrong in the development of
dietary guidelines, and an alternative and more rigorous standard is proposed for
evidentiary support, including the recommendation that when adequate evidence is not
available, the best option may be to issue no guideline.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of Preventive MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Evidence-based public health.Oxford University Press, New York2003
- America’s eating habits: changes and consequences.in: Frazao E. America’s eating habits: changes and consequences. U.S. Department of Agriculture/Economic Research Service, Washington DC1999: 33
- Dietary recommendations for Americans, 1990.
- Dietary fat intake does affect obesity!.Am J Clin Nutr. 1998; 68: 1157-1173
- Dietary guidelines for Americans, 1980.
- Dietary guidelines for Americans, 1985.
- Dietary guidelines for Americans, 1995.USDA, USDHHS, Washington DC1995
- Report of the Dietary Guidelines Advisory Committee on the dietary guidelines for Americans, 2000: to the Secretary of Health and Human Services and the Secretary of Agriculture.The Committee, National Technical Information Service, Washington DC, Springfield VA2000
- Achievements in public health, 1900–1999: Decline in deaths from heart disease and stroke—United States, 1900–1999.MMWR. 1999; 48: 649-656
- Dietary fat intake and prevention of cardiovascular disease: systematic review.BMJ. 2001; 322: 757-763
- Health United States, 2005, with chartbook on trends in the Health of Americans.National Center for Health Statistics, Hyattsville, MD2005
- CDC data and trends, national diabetes surveillance system.
- The soft science of dietary fat.Science. 2001; 291: 2536-2545
- Hypothalamic sensing of fatty acids.Nat Neurosci. 2005; 8: 579-584
- The strategy of preventive medicine.Oxford University Press, Oxford1993
- Increasing burden of cardiovascular disease: current knowledge and future directions for research on risk factors.Circulation. 1998; 97: 1095-1102
- Sick individuals and sick populations.Int J Epidemiol. 1985; 14: 32-38
- Evidence relating dietary sodium to cardiovascular disease.J Am Coll Nutr. 2006; 25: 256S-261S
- Preventive cardiology: what lies ahead?.Prev Med. 1990; 19: 97-104
- Sodium intake and mortality in the NHANES follow-up study.Am J Med. 2006; 119 (e7–14): 275
- Effects of sodium restriction on blood pressure, renin, aldosterone, catecholamines, cholesterols, and triglycerides: a meta-analysis.JAMA. 1998; 279: 1383-1391
- Long term effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of the trials of hypertension prevention (TOHP).BMJ. 2007; 334: 885
- Report of the Dietary Guidelines Advisory Committee on the dietary guidelines for Americans, to the Secretary of Health and Human Services and the Secretary of Agriculture.The Committee; National Technical Information Service, Washington DC, Springfield VA1995
- Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomized trials of statins.Lancet. 2005; 366: 1267-1278
- WHO cooperative trial on primary prevention of ischaemic heart disease with clofibrate to lower serum cholesterol: final mortality follow-up.Lancet. 1984; 2: 600-604
- United States Life Tables, 2003.National Vital Statistics Reports. 2006; 54: 1-40
- Weighing the evidence to formulate dietary guidelines.J Am Coll Nutr. 2006; 25: 277S-284S
- Current methods of the U.S. Preventive Services Task Force: a review of the process.Am J Prev Med. 2001; 20: 21-35
- Trans fatty acids and cardiovascular disease.N Engl J Med. 2006; 354: 1601-1613
- Katz’s deli made the transfat switch years ago.
- Intake of trans fatty acids and risk of coronary heart disease among women.Lancet. 1993; 341: 581-585
- Margarine intake and subsequent coronary heart disease in men.Epidemiology. 1997; 8: 144-149
- 21 CFR Part 101, Food Labeling; Trans Fatty Acids in Nutrition Labeling; Consumer Research to Consider Nutrient Content and Health Claims and Possible Footnote or Disclosure Statements; Final Rule and Proposed Rule.Federal Register. 2003; 68: 41469-41470
- New York to trans fats: you’re out!.N Engl J Med. 2007; 356: 2017-2021
- Dietary guidelines for Americans, 2000.
- Dietary fat and risk of coronary heart disease: possible effect modification by gender and age.Am J Epidemiol. 2004; 160: 141-149
- The effect of a low-fat, high-carbohydrate diet on serum high density lipoprotein cholesterol and triglyceride.Eur J Clin Nutr. 1998; 52: 728-732
Article Info
Identification
Copyright
© 2008 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.