US guideline may drop cholesterol limits but keep link between dietary saturated fats and trans fats and heart disease

BMJ 2015; 350 doi: http://dx.doi.org/10.1136/bmj.h835 (Published 18 February 2015) Cite this as: BMJ 2015;350:h835

A draft version of a document due out later this year may no longer warn consumers to limit their consumption of dietary cholesterol. The 2015 version of the Dietary Guidelines for Americans, which are revised every five years, have urged US consumers to limit cholesterol in their diet since the 1980s.

The decision to drop the cholesterol limits, reported first by the Washington Post, was discussed at a 15 December meeting of the Dietary Guidelines Advisory Committee. The expert panel evaluates the current scientific evidence and submits its findings to the US Department of Health and Human Services and the Department of Agriculture, which draw up the final guidance. In the discussion of its findings the panel concluded that, although Americans were consuming too much sodium and saturated fats, cholesterol was “not considered a concern for overconsumption.”

Although it is not bound to follow the committee’s advice, the government usually accepts its recommendations. The current guidelines, issued in 2010, recommend less than 300 mg a day of cholesterol to reduce the risk of cardiovascular disease. (1) One large egg contains about 186 mg of cholesterol. The guidance applies only to dietary cholesterol and not to elevated serum cholesterol, which experts agree increases cardiovascular risk.

The guidelines provide the basis for public health education efforts, shape nutritional policies of government agencies, such as food assistance programs, and even influence product development and marketing by the food industry.

Robert H Eckel of the University of Colorado in Denver, who is not on the advisory committee, said that the proposed change would bring the US guidelines in line with current evidence, which indicates that it is the overall amount of saturated fats and trans fats in the diet that increases the risk of cardiovascular disease. Eckel was co-chair of the working group that drew up the 2013 lifestyle guidelines of the American College of Cardiology and the American Heart Association. Those guidelines concluded that there was “insufficient evidence” to make a recommendation concerning dietary cholesterol and its role in cardiovascular risk.(2)

A high serum cholesterol concentration was clearly a risk factor for cardiovascular disease, Eckel said, but evidence implicating dietary cholesterol came from older studies that were conducted when our understanding of cholesterol and its effects were relatively unsophisticated. Guidelines were supposed to be based on evidence, he noted, and the current evidence did not support singling out dietary cholesterol as a risk factor. That didn’t mean that cholesterol was harmless, Eckel added, but new, better designed studies were needed to assess the risk, if any, posed by cholesterol.

 

References

1. US Department of Agriculture, Department of Health and Human Services. Dietary guidelines for Americans, 2010. www.cnpp.usda.gov/dietary-guidelines-2010. 
2. Eckel RH, Jakicic JM, Ard JD, de Jesus JM, Houston Miller N, Hubbard VS, et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol2014;63(25 pt B):2960-84. doi:10.1016/j.jacc.2013.11.003.