Recommendations for the 2015 Dietary Guidelines for Americans

June 1, 2015

Photo of person holding apple for the Recommendations for the 2015 Dietary Guidelines for AmericansThe U.S. Dietary Guidelines for Americans are federal food and physical activity recommendations for promoting good health for persons ages two and over. The guidelines also serve as the foundation of all federal nutrition policy and program initiatives. Every five years, the U.S. Departments of Health and Human Services (HHS) and Agriculture (USDA) are required to review and update the guidelines. As part of the update process, the departments are informed by recommendations from the Dietary Guidelines Advisory Committee (DGAC), a federal advisory committee of independent experts in the fields of nutrition and health. The comment period for the DGAC report1 closed in May 2015, and the federal government is now in the process of developing the 2015 Dietary Guidelines.

The Nutrition, Physical Activity, and Cancer Link

The American Cancer Society estimates that up to one third of the approximately 1.7 million new cancer cases
expected to be diagnosed in the US in 2015 are related to poor diet, overweight and obesity, and physical inactivity.2
For the majority of Americans who do not use tobacco products, eating a healthy diet, being physically active, and
managing weight are the best things they can do to reduce their long-term cancer risk. Among its key
recommendations, the American Cancer Society’s Nutrition and Physical Activity Guidelines for Cancer Prevention3
recommend eating a healthy diet with an emphasis on plant-based foods. More specifically, the guidelines
recommend:

• Eating foods and beverages in appropriate amounts to achieve and maintain a healthy weight;
• Limiting consumption of processed meats and red meats;
• Eating at least 2.5 cups of vegetables and fruits each day;
• Choosing whole grains instead of refined grains; and
• Limiting consumption of alcoholic beverages to no more than one drink per day for women or two for men.

The American Cancer Society Cancer Action Network (ACS CAN), the nonprofit, nonpartisan advocacy affiliate of the
American Cancer Society, advocates for policy and legislative changes that eliminate cancer as a major health problem.
ACS CAN supports providing tools, resources, and environments that support and facilitate healthy diet and lifestyle
choices.

The 2015 Dietary Guidelines Advisory Committee Report

The 2015 DGAC reviewed the research on the relationships among diet, weight, and various health outcomes. ACS CAN
is pleased that the committee examined the relationship between diet, obesity, and several of the most common types
of cancers. Consistent with other reports,4 5 the DGAC concluded that there is a link between a healthy dietary pattern
and a lower risk of colorectal and post-menopausal breast cancer.

The DGAC also reviewed the research and made recommendations for an overall healthy dietary pattern. According to
the DGAC, the U.S. population should be encouraged to eat a dietary pattern that is:

  • high in vegetables, fruit, whole grains, seafood, legumes, and nuts;
  • moderate in low- and non-fat dairy products and alcohol (among adults);
  • lower in red and processed meat; and
  • low in sugar-sweetened foods and beverages and refined grains.

One recommendation of particular importance is to limit consumption of red meats and processed meats. While the current Dietary Guidelines recommends eating lean meat, the 2015 DGAC recommends that Americans should lower consumption of all red and processed meats, including lean meats, because of the link between these types of meats and colorectal cancer. While variations in the definitions of types of meats complicated the DGAC’s analyses, the DGAC was able to conclude that higher intake of red and processed meats was identified as detrimental compared to lower intake. Many potential biological mechanisms have been identified as influencing the relationship, including heme iron, nitrates, and nitrites in the meat, high temperatures typically used in cooking, and gut bacteria produced by an unbalanced diet that leads to DNA damage, abnormal cell growth, or inflammation in the gut that ultimately leads to colorectal cancer.

Also of note, the DGAC examined and made recommendations regarding a broad range of factors that influence people’s food and physical activity choices, recognizing the need to support individuals and families in making food and physical activity choices that are consistent with the current science. The DGAC found that policy and environmental changes in places such as schools, communities, and worksites are particularly important because it is easier for people to make healthy choices when they are affordable, readily available, and encouraged.

The DGAC’s recommendations are largely consistent with the ACS guidelines, despite the fact that the ACS guidelines are specific to cancer risk and the Dietary Guidelines are intended to provide guidance relevant for overall health.

ACS CAN’s Recommendations

ACS CAN strongly supports the science-based process to update the Dietary Guidelines. We urge HHS and USDA to
include the majority of the DGAC’s sensible and science-based recommendations in the 2015 Dietary Guidelines.
Specifically, we urge HHS and USDA to:

  • Recommend a Healthy Dietary Pattern - Recognize that there are a variety of healthy dietary patterns that can help to lower risk of cancer and other chronic diseases, and the dietary patterns share many of the same characteristics. Common characteristics of healthy diets include higher intakes of fruits, vegetables, and whole grains and lower intakes of added sugars, saturated fat, sodium, and red and processed meats. Dietary patterns can be adapted for individuals’ social, cultural, and biological needs and preferences.
  • Limit Red and Processed Meats - Include a recommendation to reduce consumption of processed meats and red meats, which when eaten regularly, increase the risk for colorectal cancer. If meats are eaten, they should be lean, but it is important for the 2015 Dietary Guidelines to clearly state that regular consumption of even lean red meat or lower-sodium processed meats increase cancer risk.
  • Reduce Added Sugars - Include a recommendation to reduce consumption of added sugars, which are added during packaging or processing, and sugar-sweetened beverages. Unlike sugars that naturally occur in foods such as fruits and dairy products, added sugars provide additional calories without any health benefits.
  • Limit Alcohol – Recommend that women have no more than one drink per day and men no more than two per day, consistent with the recommendations in the current Dietary Guidelines. These amounts should be framed as daily limits, rather than averages, as the DGAC report proposed. Given that consumption of less than one alcoholic beverage per day is associated with an increased breast cancer risk, women must balance their risk of cardiovascular disease and of breast cancer in deciding whether or not to drink alcohol.
  • Encourage Fruits and Vegetables and Whole Grains – Recommend that individuals increase fruits and vegetables as part of an overall healthy dietary pattern and choose whole grain products over refined grains. Whole grains provide fiber and promote satiety, which reduces the risk of colorectal cancer and of obesity. Overweight and obesity increase the risk of several types of cancer.
  • Be Physically Active – Emphasize the importance of physical activity in managing weight, as well as independently reducing the risk of several types of cancers. The Dietary Guidelines should recommend that adults get at least 150 minutes of moderate or 75 minutes of vigorous activity per week, and youth should get at least an hour of moderate-vigorous physical activity per week, as recommended by the Physical Activity Guidelines for Americans. The Guidelines should also recommend avoiding inactivity.
  • Focus on Policy Approaches - Emphasize the broad range of factors, including policy and environmental approaches, that influence people’s dietary and weight-related behaviors. Improvements to the food environment and changes to public policies are needed to support and facilitate Americans’ abilities to make healthier food and beverage choices across the lifespan.

In order to translate the scientific recommendations into real-life changes in individuals’ diets and related behaviors, it is important that the 2015 Dietary Guidelines include clear, actionable guidance at multiple levels. Guidance is particularly needed in three key areas:

1) Advice to consumers on how to meet the updated guidelines across the lifespan;
2) Sensible, science-based recommendations for changes to the food environment; and
3) Public policies that will support Americans making healthier food and beverage choices.

ACS CAN looks forward to working with the federal government and other key stakeholders to encourage and promote a healthy diet and an overall healthy lifestyle to reduce the long-term risk of cancer and other chronic diseases.

References

1 U.S. Department of Agriculture and U.S. Department of Health and Human Services. Scientific Report of the 2015 Dietary
Guidelines Advisory Committee: Advisory Report to the Secretary of Health and Human Services and the Secretary of Agriculture.
February 2015.
2 American Cancer Society. Cancer Facts & Figures, 2015. Atlanta, GA: American Cancer Society, 2015.
3 Kushi LH, Doyle C, McCullough M, et al. American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer
Prevention: Reducing the Risk of Cancer with Healthy Food Choices and Physical Activity. Ca Cancer J Clin 2012; 62: 30-67.
4 World Cancer Research Fund (WCRF) and American Institute for Cancer Research (AICR). Continuous Update Project.
Colorectal Cancer 2011 Report: Food, Nutrition, Physical Activity, and the Prevention of Colorectal Cancer. Updated December
2014. Available at http://www.aicr.org/continuous-update-project/reports/Colorectal-Cancer-2011-Report.pdf.
5 WCRF and AICR. Continuous Update Project. Breast Cancer 2010 Report: Food, Nutrition, Physical Activity, and the Prevention
of Breast Cancer. Updated December 2014. Available at http://www.aicr.org/continuous-update-project/breast-cancer.html.