In Reply Dr Graudal and Dr Stafford question certain recommendations in the 2015-2020 Dietary Guidelines for Americans. Graudal is concerned with the recommendation that the average sodium intake of Americans (currently 3440 mg/d) should be reduced. Graudal cites publications arguing that the current sodium intake levels are healthy and reduction harmful. We disagree, as there are serious methodological issues with the studies in question.1 In addition, most scientific bodies agree with the recommended reduction—the World Health Organization, for example, recommends 2000 mg/d, whereas the American Heart Association recommends 1500 mg/d for most people. We also disagree with Gradual’s assessment of the 2013 IOM committee’s recommendations. The 2015 Dietary Guidelines Advisory Committee, which provided scientific recommendations for the Dietary Guidelines, had 2 members who also served on the 2013 IOM committee; their understanding of the IOM’s work, combined with a systematic literature review, led the advisory committee to concur with the IOM report that higher levels of sodium intake are associated with higher risk of cardiovascular disease and that the current sodium intake in the United States is too high and should be reduced. The advisory committee’s recommendations were incorporated into the Dietary Guidelines. We disagree with Graudal’s statement that “‘a linear dose-response relationship between increased sodium intake and increased blood pressure in adults’ is only valid for individuals with prehypertension and hypertension.” The recommended limit for sodium intake for adults and children aged 14 years or older is the upper limit set by the IOM based on the evidence of a dose-response relationship among adults both with and without prehypertension and hypertension.2 The 2015 advisory committee supported this evidence3 and the 2010 advisory committee’s scientific report also describes the evidence supporting this relationship.3 Stafford takes exception to the Dietary Guidelines’ focus on a healthy eating pattern that includes lean meat and poultry. The Dietary Guidelines actually provide 3 examples of healthy eating patterns. The healthy vegetarian-style eating pattern is for people who choose not to consume meat or other animal products, while both the healthy US-style and Mediterranean-style eating patterns recommend lower amounts of meat and poultry intake than the typical US diet. The emphasis on healthy eating patterns is simple: eating patterns may be more predictive of overall health status and disease risk than individual foods or nutrients. Some evidence has identified lean meats and lean poultry in healthy eating patterns; they can contribute important nutrients in the diet. The 2015 advisory committee’s report reviews the evidence on dietary patterns and health outcomes, and some healthy dietary patterns, such as some Mediterranean-style patterns, have included lean meats, lean poultry, or both.4 The recommendations of the Dietary Guidelines recognize that a meat- and animal product–free diet can be consumed in a healthy way, but they are also practical and evidence-based, so the evidence that a healthy diet can include lean meat and lean poultry cannot be ignored. However, the average intake of the protein subgroup of meat, poultry, and eggs is higher than recommended for older adolescent boys and adult men and should be reduced. Section Editor: Jody W. Zylke, MD, Deputy Editor. Back to top Article Information Corresponding Author: Karen B. DeSalvo, MD, MPH, MSc, Office of the Assistant Secretary for Health, US Department of Health and Human Services, 200 Independence Ave SW, Washington, DC 20201 (firstname.lastname@example.org). Conflict of Interest Disclosures: The author has completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported. References 1. Whelton PK, Appel LJ. Sodium and cardiovascular disease. Am J Hypertens. 2014;27(9):1143-1145.PubMedGoogle ScholarCrossref 2. Institute of Medicine. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Washington, DC: National Academies Press; 2005. 3. US Department of Agriculture. Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 2010. http://origin.www.cnpp.usda.gov/DGAs2010-DGACReport.htm. Accessed March 24, 2016. 4. Office of Disease Prevention and Health Promotion, Department of Health and Human Services. 2015-2020 Dietary Guidelines for Americans. 8th ed. http://health.gov/dietaryguidelines/2015-scientific-report/. Accessed March 24, 2016.
JAMA – American Medical Association
Published: Jul 12, 2016