2020 Dietary Guidelines Released: New Recs for Infants, No Changes to Sugar Intake

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Washington, D.C.—The 2020-2025 Dietary Guidelines for Americans is out, with recommendations for babies and an unaltered recommendation regarding sugar intake.

The report is published by the U.S. Departments of Agriculture (USDA) and Health and Human Services (HHS), and is required to be based on the preponderance of current scientific and medical knowledge. It is based on the 2015 edition, and revised with input from the Scientific Report of the 2020 Dietary Guidelines Advisory Committee and public comments.

The latest edition encourages Americans to “Make Every Bite Count” by following a healthy dietary pattern and focusing on nutrient-dense foods and beverages.

The Executive Summary of the report notes three ways the current Dietary Guidelines edition differs from previous editions:

  • The recognition that diet-related chronic diseases, such as CVD, type 2 diabetes, obesity, and some types of cancer are prevalent among Americans, with more than half of adults having one or more diet-related chronic diseases. A fundamental premise of this edition is that “just about everyone” can benefit from shifting to healthier food and beverage choices.
  • It focuses on dietary patterns, and the understanding that nutrients and foods are not consumed in isolation. The 2020-2025 edition carries forward the 2015-2020 edition’s focus on a healthy dietary pattern as a whole, rather than on individual nutrients, foods, or food groups in isolation.
  • The 2020-2025 edition also focuses on a lifespan approach—for the first time since the 1985 edition, the Dietary Guidelines includes recommendations for healthy dietary patterns for infants and toddlers.

The recommendations for infants and toddlers are:

  • For about the first six months of life, feed infants human milk exclusively. They should be fed iron-fortified infant formula during the first year of life when human milk is unavailable. Infants should also take supplemental vitamin D beginning soon after birth.
  • At six months, begin introducing infants to nutrient-dense foods, while continuing to feed them human milk. Infants and toddlers should be introduced to potentially allergenic foods, and should try a variety of foods from all food groups, particularly those rich in iron and zinc.
  • At 12 months, toddlers can be weaned off human milk, although the guidelines note that toddlers can be fed human milk for longer if desired. Toddlers should begin following a healthy dietary pattern at this stage, to continue across the lifespan.

The Scientific Committee’s recommendations were largely included, with two notable exceptions: changes to the amount of added sugar allowed by the guidelines, and changes to the recommended upper limit of alcohol men should drink.

Related: USDA Posts Dietary Guidelines Advisory Committee’s Final Report
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Regarding sugars, the 2015-2020 guidelines recommended that no more than 10% of energy come from daily sugars; the Committee recommended that that number drop to 6%. Regarding alcohol, after noting that “drinking less is generally better for drinking more,” the Committee stated that there is evidence that rather than recommending an upper limit of two drinks per day for men, that number should be dropped to one drink per day, matching the upper limit for women.

In an FAQ on the Dietary Guidelines website, USDA and HHS state that “Any revisions to previous editions of the Dietary Guidelines must have sufficient scientific justification, and by law, must be based on the preponderance of scientific and medical knowledge current at the time and not on individual studies or opinion…However, there was not a preponderance of evidence in the Committee’s review of studies since the 2015-2020 edition to substantiate changes to the quantitative limits for either added sugars or alcohol. Thus, the 2020-2025 edition underscores the importance of limiting added sugars and alcohol intake, and carries forward the quantitative limits from the 2015-2020 edition.” USDA and HHS encouraged further research on these topics.

Industry Reactions (Updated 12/30)

Industry groups have spoken out about the new guidelines–largely in support, although the Physicians Committee notes a major issue in need of overhaul.

FMI has released a statement commending the guidelines for promoting connections between food and health. Krystal Register, MS, RDN, LDN, FMI Director of Health and Well-being, commented: “With growing consumer interest in the connection between food and health, there is opportunity to help shoppers make small changes to embrace these science-based recommendations while shopping, cooking and eating. We also commend the agency’s effort to incorporate food safety messaging in the guidelines. The food industry works diligently to deliver a consumer marketplace full of healthy, accessible, nutrient-dense food and beverage choices. Along with education and encouragement by registered dietitians and community health professionals, this can lead to small changes and the gradual adoption of healthy eating habits more closely aligned with the DGAs to ultimately improve overall public health.”

The Natural Products Association (NPA) has released a statement noting that these guidelines are further proof that Congress needs to work harder to make sure that people have access to dietary supplements. “This reinforces what we already know: that access to proper nutrition, especially for children and pregnant mothers, is critical to long-term health,” said Daniel Fabricant, Ph.D., President and CEO of NPA. “The next Congress and Administration can do more to ensure Americans have access to products that support their health, and expanding health savings accounts and programs like WIC to include nutritional supplements is the best way to make that happen. This report provides a real world look at how supplements are an integral part of the American diet at all stages of development.”

NPA supports legislation that would expand the SNAP and WIC programs to cover dietary supplements, and supports expanding HSA and FSA to cover money spent on dietary supplements.

The Council for Responsible Nutrition applauded the guidelines in a press release, also pointing to the support they provide for dietary supplements. The document incorporates several of CRN’s recommendations: CRN recommended vitamin D supplementation for breastfed infants, recommended that pregnant and lactating women be advised to seek guidance from a health care provider on appropriate use of dietary supplements, and the guidelines acknowledge that nutrient needs during lactation are different from those during pregnancy, another one of CRN’s recommendations.

“Underconsumption of key nutrients is a public health concern,” said Haiuyen Nguyen, Senior Director of Scientific and Regulatory Affairs at CRN. “We’re pleased to see USDA and HHS recognize certain U.S. population groups do not achieve recommended nutrient levels from dietary intake alone. The Guidelines reflect how dietary supplements can support the health of all Americans.”

The Physicians Committee for Responsible Medicine, however, requested that the Dietary Guidelines be retracted and rewritten, as it is likely to maintain high cancer rates in Americans, and particularly in Black Americans.

“Secretary of Agriculture Sonny Perdue released the Guidelines too hastily. They need to be pulled back and redrafted,” said Susan Levin, MS, RD, CSSD, Director of Nutrition Education for the Physicians Committee for Responsible Medicine, in a press release. “The Guidelines maintain a racially tinged promotion of dairy products, which are far less healthful than other calcium sources and have been shown to increase the risk of prostate and breast cancer, both of which are particularly deadly in the Black community, as well as an inappropriate emphasis on meat, rather than healthier foods.”

Breast cancer death rates are 40% higher among Black women, compared with white women; Black men are more likely to get prostate cancer than other men, and are twice as likely to die from prostate cancer than other men. Research funded by the National Cancer Institute, the National Institutes of Health, and the World Cancer Research Fund found that women who consumed 1 cup of cow’s milk per day had a 50% increased chance for breast cancer. A 2015 meta-analysis found that high intakes of dairy products increase the risk for prostate cancer, and another study found that those who consumed three or more servings of dairy products per day–the current recommendation made by the Dietary Guidelines–had a 141% higher risk of death due to prostate cancer compared to those who consumed less than one serving.

Additionally, the American Medical Association passed a resolution recognizing that lactose intolerance is common among many Americans, especially Black Americans, Asian Americans, and Native Americans, and recommending that the Guidelines indicate that “meat and dairy products are optional.”

Nor is this the first time the Physicians Committee has brought this issue to the attention of the USDA and HHS: The Committee submitted a letter in August 2020 signed by nearly 500 health care professionals making this argument.

The Physicians Committee is calling on the USDA to rework the guidelines, focusing on these three recommendations:

  1. Delete dairy promotions, since dairy products increase cancer risk, while nondairy calcium sources help prevent cancer.
  2. Avoid equating “protein” with meat, as there are abundant sources of protein without meat’s fat and cholesterol.
  3. Increase emphasis on plant-based foods, which are associated with reduced risk of obesity, cancer, and cardiovascular disease.

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