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A Call for Higher Standards of Evidence for Dietary Guidelines

  • Paul R. Marantz
    Correspondence
    Address correspondence and reprint requests to: Paul Marantz, MD, MPH, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx NY 10461.
    Affiliations
    Department of Epidemiology and Population Health, Albert Einstein College of Medicine, and the Institute for Public Health Sciences of Yeshiva University, Bronx, New York
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  • Elizabeth D. Bird
    Affiliations
    Department of Epidemiology and Population Health, Albert Einstein College of Medicine, and the Institute for Public Health Sciences of Yeshiva University, Bronx, New York
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  • Michael H. Alderman
    Affiliations
    Department of Epidemiology and Population Health, Albert Einstein College of Medicine, and the Institute for Public Health Sciences of Yeshiva University, Bronx, New York
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      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.
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