Exclusion of Dietary Cholesterol from The Specific Food Restrictions: A Review in Indonesia

Hypercholesterolemia, the presence of high levels of cholesterol in the blood, is one of the major risk factor for cardiovascular disease (CVD). One of the key recommendation in the Dietary Guidelines for Americans 2010, is to consume less than 300 mg of dietary cholesterol per day. The same amount is also adopted in Indonesia (BPOM, 2016) until today. However, in the latest Dietary Guidelines for Americans 2015-2020, dietary cholesterol is no longer included in the list of specific foods that should be limited. The added sugars, sodium, saturated fats and trans fats remain on the list of food components that should be reduced. Generally, foods that are higher in dietary cholesterol are also higher in saturated fats. But there are also some foods that are higher in cholesterol but not in saturated fats. According to the latest recommendation, this kind of foods can be consumed without any specific restriction. In this review, some of clinical studies related to the association between dietary cholesterol and blood cholesterol levels are selected. The findings from those studies will be summarized to consider whether the same recommendation should be implemented in other countries, especially in Indonesia.

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Eggs: good or bad?

Proceedings of The Nutrition Society ◽

10.1017/s0029665116000215 ◽

2016 ◽

Vol 75 (3) ◽

pp. 259-264 ◽

Cited By ~ 11

Author(s):

Bruce A. Griffin

Keyword(s):

Ldl Cholesterol ◽

Dietary Cholesterol ◽

Burden Of Proof ◽

Dietary Guidelines ◽

Blood Cholesterol ◽

Sufficient Evidence ◽

Cvd Risk ◽

Nutrient Density ◽

The Difference ◽

Density Ratios

Eggs have one of the lowest energy to nutrient density ratios of any food, and contain a quality of protein that is superior to beef steak and similar to dairy. From a nutritional perspective, this must qualify eggs as ‘good’. The greater burden of proof has been to establish that eggs are not ‘bad’, by increasing awareness of the difference between dietary and blood cholesterol, and accumulating sufficient evidence to exonerate eggs from their associations with CVD and diabetes. After 60 years of research, a general consensus has now been reached that dietary cholesterol, chiefly from eggs, exerts a relatively small effect on serum LDL-cholesterol and CVD risk, in comparison with other diet and lifestyle factors. While dietary guidelines have been revised worldwide to reflect this view, associations between egg intake and the incidence of diabetes, and increased CVD risk in diabetes, prevail. These associations may be explained, in part, by residual confounding produced by other dietary components. The strength of evidence that links egg intake to increased CVD risk in diabetes is also complicated by variation in the response of serum LDL-cholesterol to eggs and dietary cholesterol in types 1 and 2 diabetes. On balance, the answer to the question as to whether eggs are ‘bad’, is probably ‘no’, but we do need to gain a better understanding of the effects of dietary cholesterol and its association with CVD risk in diabetes.

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Dietary Cholesterol Intake and Sources among U.S Adults: Results from National Health and Nutrition Examination Surveys (NHANES), 2001–2014

10.20944/preprints201805.0301.v1 ◽

2018 ◽

Author(s):

Zhe Xu ◽

Scott T. McClure ◽

Lawrence J. Appel

Keyword(s):

Dietary Cholesterol ◽

Dietary Guidelines ◽

Food Sources ◽

Dietary Recommendations ◽

Total Consumption ◽

Dietary Recall ◽

Recall Data ◽

Cholesterol Intake ◽

Dietary Guidelines For Americans ◽

Nationally Representative

The 2015 Dietary Guidelines for Americans recommends that individuals should eat as little dietary cholesterol as possible. However, current dietary cholesterol intake and its food sources have not been well-characterized. We examined dietary cholesterol intake by age, sex, race, and food sources using 24-hour dietary recall data from a nationally representative sample of 5047 adults aged 20 years or older who participated in NHANES (2013–2014 survey cycle). We also reported trends in cholesterol intake across the past 7 NHANES surveys. Mean dietary cholesterol intake was 293 mg/day (348 mg/day for males and 242 mg/day for females) in the 2013–2014 survey cycle; 39% of adults had dietary cholesterol intake above 300 mg/day (46% for males and 28% for females). Meat, eggs, grain products, and milk were the highest four food sources of cholesterol, contributing to 96% of the total consumption. Both average cholesterol intake and food source varied by age, sex, and race (each p < 0.05). Mean cholesterol intake of the overall population had been relatively constant at ~290 mg/day from 2001–2002 to 2013–2014 (p-trend = 0.98). These results should inform public health efforts in implementing dietary guidelines and tailoring dietary recommendations.

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Dietary quality among children from 6 months to 4 years, NHANES 2011–2016

American Journal of Clinical Nutrition ◽

10.1093/ajcn/nqz261 ◽

2019 ◽

Author(s):

Heather C Hamner ◽

Latetia V Moore

Keyword(s):

Dietary Guidelines ◽

Dietary Quality ◽

Dietary Recommendations ◽

Added Sugars ◽

Sweetened Beverages ◽

The Us ◽

Age Appropriate ◽

Dietary Guidelines For Americans ◽

Modified Diet

ABSTRACT Background The US Dietary Guidelines for Americans provide dietary recommendations for individuals aged ≥2 y and metrics exist to assess alignment. Nonfederal feeding recommendations exist for children <2 y, but limited metrics and assessment of dietary quality are available. Objective We aimed to assess dietary quality of children aged 6 mo–4 y using a modified Diet Quality Index Score (DQIS). Methods NHANES 2011–2016 dietary data were used to estimate the dietary quality of children 6 mo–4 y old using a modified DQIS. Differences in mean modified DQIS by demographics were assessed using linear regression. Results Mean modified DQIS ± SE was 22.4 ± 0.23 out of 45 possible points (50%) for children 6 mo–4 y of age on a given day. Modified DQIS scores on a given day decreased with age (27.7 ± 0.27 for 6- to 11-mo-olds, 23.9 ± 0.31 for 1-y-olds, 21.4 ± 0.26 for 2- to 3-y-olds, and 20.6 ± 0.49 for 4-y-olds; P < 0.0001 for trend). Children 6–11 mo old had 16% higher overall modified DQIS scores than 1-y-olds (P < 0.0001) and higher modified DQIS subcomponent scores for refined grains and protein, indicating higher age-appropriate intakes (P < 0.05). Similarly, children 6–11 mo old also had higher modified DQIS subcomponent scores, indicating no or limited intake, for 100% fruit juice, sugar-sweetened beverages, other added sugars, and salty snacks (P < 0.02). Conclusions Dietary quality declines with age and may begin as early as 1 y. The modified DQIS tool could help assess the dietary quality of young children. This may be important when identifying programmatic and policy efforts aimed at establishing and maintaining healthy dietary patterns beginning at an early age.

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Review of the scientific evidence used for establishing US policies on added sugars

Nutrition Reviews ◽

10.1093/nutrit/nuz014 ◽

2019 ◽

Vol 77 (9) ◽

pp. 646-661 ◽

Cited By ~ 2

Author(s):

Paula R Trumbo

Keyword(s):

World Health Organization ◽

Drug Administration ◽

Scientific Evidence ◽

Dietary Guidelines ◽

World Health ◽

Added Sugars ◽

The Us ◽

The World ◽

Dietary Guidelines For Americans ◽

Health Organization

AbstractThe 2015 Dietary Guidelines for Americans Advisory Committee has set recommendations to limit added sugars. This action was based on the association between dietary pattern quality scores and chronic disease risk, the results of meta-analyses conducted for the World Health Organization, and data from modeling of dietary patterns for establishing the US Department of Agriculture’s Healthy US-Style Eating Patterns. Recommendations provided by the 2015–2020 Dietary Guidelines for Americans were used by the US Food and Drug Administration to establish, for the first time, the mandatory declaration of added sugars and a Daily Value of added sugars for the Nutrition Facts label. This review provides an overview of the scientific evidence considered by the World Health Organization, the 2015–2020 Dietary Guidelines for Americans, and the US Food and Drug Administration for setting recent polices and regulations on added sugars and highlights important issues and inconsistencies in the evaluations and interpretations of the evidence.

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Energy and Nutrient Intake of Americans according to Meeting Current Dairy Recommendations

Nutrients ◽

10.3390/nu12103006 ◽

2020 ◽

Vol 12 (10) ◽

pp. 3006 ◽

Cited By ~ 1

Author(s):

Julie M. Hess ◽

Christopher J. Cifelli ◽

Victor L. Fulgoni III

Keyword(s):

Nutrient Intake ◽

Saturated Fat ◽

Dietary Guidelines ◽

Adequate Intake ◽

Dairy Food ◽

Added Sugars ◽

Dairy Foods ◽

Dietary Guidelines For Americans ◽

Calcium Magnesium ◽

Using Data

Most Americans do not meet dairy food recommendations from the 2015 Dietary Guidelines for Americans (DGA). This study assesses differences in nutrient intake between Americans who meet recommendations for dairy intake and those who do not, using data from the National Health and Nutrition Examination Survey from 2013–2014 and 2015–2016 (n = 5670 children ages 2–18 years and n = 10,112 adults ages 19+). Among children and adults, those meeting dairy food recommendations were significantly more likely to have adequate intake (% above Estimated Average Requirement (EAR)) of calcium, magnesium, phosphorus, riboflavin, vitamin A, vitamin B12, and zinc and consume above the Adequate Intake (AI) for potassium and choline than Americans not meeting dairy recommendations, regardless of age, sex, or race/ethnicity. Americans meeting dairy recommendations were also more likely to exceed recommendations for sodium and saturated fat but consume less added sugars. Nearly 60% of Americans 2 years and older not meeting dairy recommendations consumed calcium and magnesium below the EAR. Only about 20% of Americans who did not meet dairy recommendations consumed above the AI for potassium. Dairy foods make important and unique contributions to dietary patterns, and it can be difficult to meet nutrient needs without consuming recommended amounts of dairy foods.

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Dietary Saturated Fats and Health: Are the U.S. Guidelines Evidence-Based?

Nutrients ◽

10.3390/nu13103305 ◽

2021 ◽

Vol 13 (10) ◽

pp. 3305

Author(s):

Arne Astrup ◽

Nina Teicholz ◽

Faidon Magkos ◽

Dennis M. Bier ◽

J. Thomas Brenna ◽

...

Keyword(s):

Fatty Acids ◽

Saturated Fatty Acids ◽

Saturated Fat ◽

Dietary Guidelines ◽

Evidence Based ◽

Fat Intake ◽

Food Matrix ◽

Saturated Fats ◽

Dietary Guidelines For Americans ◽

Saturated Fat Intake

The last decade has seen nearly 20 papers reviewing the totality of the data on saturated fats and cardiovascular outcomes, which, altogether, have demonstrated a lack of rigorous evidence to support continued recommendations either to limit the consumption of saturated fatty acids or to replace them with polyunsaturated fatty acids. These papers were unfortunately not considered by the process leading to the most recent U.S. Dietary Guidelines for Americans, the country’s national nutrition policy, which recently reconfirmed its recommendation to limit saturated fats to 10% or less of total energy intake, based on insufficient and inconsistent evidence. Continuation of a cap on saturated fat intake also fails to consider the important effects of the food matrix and the overall dietary pattern in which saturated fatty acids are consumed.

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Perspective: The Public Health Case for Modernizing the Definition of Protein Quality

Advances in Nutrition ◽

10.1093/advances/nmz023 ◽

2019 ◽

Vol 10 (5) ◽

pp. 755-764 ◽

Cited By ~ 14

Author(s):

David L Katz ◽

Kimberly N Doughty ◽

Kate Geagan ◽

David A Jenkins ◽

Christopher D Gardner

Keyword(s):

Protein Quality ◽

Relevant Literature ◽

Dietary Guidelines ◽

Food Sources ◽

The Public ◽

Plant Protein Sources ◽

Dietary Guidelines For Americans ◽

Definition Of ◽

Specific Food

ABSTRACT Prevailing definitions of protein quality are predicated on considerations of biochemistry and metabolism rather than the net effects on human health or the environment of specific food sources of protein. In the vernacular, higher “quality” equates to desirability. This implication is compounded by sequential, societal trends in which first dietary fat and then dietary carbohydrate were vilified during recent decades, leaving dietary protein under an implied halo. The popular concept that protein is “good” and that the more the better, coupled with a protein quality definition that favors meat, fosters the impression that eating more meat, as well as eggs and dairy, is desirable and preferable. This message, however, is directly opposed to current Dietary Guidelines for Americans, which encourage consumption of more plant foods and less meat, and at odds with the literature on the environmental impacts of foods, from carbon emissions to water utilization, which decisively favor plant protein sources. Thus, the message conveyed by the current definitions of protein quality is at odds with imperatives of public and planetary health alike. We review the relevant literature in this context and make the case that the definition of protein quality is both misleading and antiquated. We propose a modernized definition that incorporates the quality of health and environmental outcomes associated with specific food sources of protein. We demonstrate how such an approach can be adapted into a metric and applied to the food supply.

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Procedure to Estimate Added and Free Sugars in Food Items from the Swedish Food Composition Database Used in the National Dietary Survey Riksmaten Adolescents 2016–17

Nutrients ◽

10.3390/nu11061342 ◽

2019 ◽

Vol 11 (6) ◽

pp. 1342 ◽

Cited By ~ 2

Author(s):

Julia Wanselius ◽

Cecilia Axelsson ◽

Lotta Moraeus ◽

Christina Berg ◽

Irene Mattisson ◽

...

Keyword(s):

National Sample ◽

Food Composition ◽

Dietary Guidelines ◽

Food Sources ◽

Dietary Survey ◽

Free Sugars ◽

Added Sugars ◽

Food Items ◽

School Year ◽

Specific Food

A high intake of added and free sugars is associated with poor diet quality, caries, and potentially has a role in non-communicable diseases. As a result, dietary guidelines advice limitation. However, there is no standardized method for estimation of added and free sugars in food items and consequently intake is difficult to measure. This study aimed to refine a procedure for sugars estimation and apply it to a Swedish dietary survey on adolescents (Riksmaten Adolescents 2016–17). A national sample of 3099 adolescents in school year 5, 8 and 11 participated (55% girls). Individual dietary intake data from two non-consecutive days was collected retrospectively and used for analysis. A ten-step systematic procedure for estimation of sugars in a Swedish context has been developed by combining two earlier methods, one for estimation of added sugars and one for free sugars. Sugars estimates were made for all food items comprising the survey database. Mainly objective decisions were necessary to make the estimates (92% and 93% for the sugars respectively); meaning that the procedure was largely transparent. In relation to Nordic Nutrition Recommendations, 45% of the participants had an intake that adhered to the guidelines. However, the majority of intakes was close to the recommendation. Further research on how specific food sources contribute to added and free sugars is necessary to facilitate further guidance on sugars and how to reach recommended target levels in Sweden.

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CHILDHOOD DIET AND CORONARY HEART DISEASE

PEDIATRICS ◽

10.1542/peds.49.2.305 ◽

1972 ◽

Vol 49 (2) ◽

pp. 305-307

Author(s):

L. J. Filler ◽

Lewis A. Barness ◽

Richard B. Goldbloom ◽

James C. Haworth ◽

Malcolm A. Holliday ◽

...

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Dietary Intervention ◽

Dietary Habits ◽

Dietary Cholesterol ◽

Later Life ◽

Blood Cholesterol ◽

Cholesterol Levels ◽

Childhood Diet ◽

Special Circumstances

A subcommittee of the Inter-Society Commission for Heart Disease Resources recently recommended an immediate, nationwide change in dietary habits to reduce the risk of coronary heart disease in later life.1 Specifically, the Commission urges that people eat less than 300 mg of cholesterol each day, that the total calories from fat be less than 35% of the diet, and that the fat calories essentially be divided equally among saturated, monounsaturated, and polyunsaturated sources. (A commentary on these recommendations appears in this issue of Pediatrics.2) The Committee on Nutrition, realizing that pediatricians will increasingly be asked about diets for children to reduce the risk of heart disease in later life, has evaluated the Commission's report for its application to pediatric practice. The Committee stresses that such dietary intervention is, at present, experimental and recommends against dietary changes for all children. Dietary intervention may be warranted in special circumstances, but not before 1 year of age. Reasons for these recommendations will be given in this report. The evidence relating dietary cholesterol to coronary heart disease is summarized as follows: 1. Some inborn or acquired diseases with hypercholesterolemia are associated with premature atherosclerosis. 2. Serum cholesterol levels are higher than usual in persons with coronary heart disease. 3. Persons with high cholesterol levels in prospective studies developed coronary heart disease more often than those with normal levels. 4. The mortality rate from coronary heart disease in different countries varies in relation to the average blood cholesterol values (or dietary fat intake). 5. Experimentally induced hypercholesterolemia in animals is associated with atherosclerotic deposits.

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IV. The Individualized Approach: Treatment

PEDIATRICS ◽

10.1542/peds.89.3.555 ◽

1992 ◽

Vol 89 (3) ◽

pp. 555-584

Keyword(s):

Children And Adolescents ◽

Total Cholesterol ◽

Ldl Cholesterol ◽

Saturated Fatty Acids ◽

Dietary Cholesterol ◽

Diet Therapy ◽

Blood Cholesterol ◽

Healthy Children ◽

Eating Pattern ◽

Cholesterol Levels

DIET THERAPY The general aim of diet therapy is to reduce elevated blood cholesterol levels while maintaining a nutritionally adequate eating pattern. The primary emphasis is on decreasing the level of saturated fatty acids (SFA), total fat, and cholesterol and on consuming only enough calories to achieve or maintain desirable body weight. Diet therapy is presented in two steps, the Step-One and Step-Two Diets, which are designed to reduce progressively intakes of SFA and dietary cholesterol. Definition of Total and Low-Density Lipoprotein (LDL) Cholesterol Initiation Levels for Diet Therapy The panel's recommended initiation levels (cutpoints) for dietary intervention in children and adolescents with a family history of cardiovascular disease (CVD) or parental hypercholesterolemia are shown in Table 4-1. Children and adolescents with total cholesterol levels <170 mg/dL or LDL cholesterol levels <110 mg/dL have acceptable levels. These young people should receive education on the recommended population eating pattern (see Section II, "The Population Approach: Nutrition Recommendations for Healthy Children and Adolescents") and risk factor reduction. Therapeutic dietary instruction is indicated in all children and adolescents with a total cholesterol level ≥l70 mg/dL or an LDL cholesterol ≥ll0 mg/dL. Those with borderline total blood cholesterol levels 170 to 199 mg/dL or borderline LDL cholesterol levels 110 to 129 mg/dL (about the 75th to 95th percentile) require advice that consists of instruction on the Step-One Diet and other risk factors by a physician, registered dietitian or other qualified nutrition professional, or other appropriately trained health professional, with reevaluation in 1 year (Fig 4-1).

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