2020-2025 Dietary Guidelines for Americans 'miss the mark' on added sugar, suggest “shifts” in protein consumption to “add variety"

By Elaine Watson contact

- Last updated on GMT

"Dietary patterns characterized by higher intake of red and processed meats, sugar-sweetened foods and beverages, and refined grains are… associated with detrimental health outcomes."
"Dietary patterns characterized by higher intake of red and processed meats, sugar-sweetened foods and beverages, and refined grains are… associated with detrimental health outcomes."

Related tags: Dietary Guidelines for Americans, Dietary guidelines

The 2020-2025 Dietary Guidelines advise Americans to watch their sugar and alcohol consumption but fall short of recommending the drastic cuts recently suggested by the Dietary Guidelines Advisory Committee (DGAC).

In its advisory report published in July​, the DGAC recommended that Americans should more than halve their consumption of added sugars, from 13% of daily energy intake to just 6% (30g for someone on a 2,000 calorie-a-day diet); and advised Americans to limit alcohol intakes to one drink per day.

The final dietary guidelines​ – ​released by USDA and HHS Tuesday Dec 29 - instead advise Americans to cut down somewhat, from an average of 13% to 10% of calories from added sugar. They also retain what the American Institute for Cancer Research claims is “outdated advice​” that men may consume up to two alcoholic drinks per day.

In a press release accompanying the guidelines, USDA's food and nutrition service noted that it would not be adhering to the "quantitative recommendations​" on added sugar and alcohol made by the DGAC "as there was not a preponderance of evidence​ in the material the committee reviewed to support specific changes."

What's not​ in the report?

As for other bones of contention, the 2015 Dietary Guidelines prompted a heated debate over the influence of industry lobby groups and the extent to which environmental factors should impact dietary advice, with some stakeholders insisting that sustainability has nothing to do with nutrition, and others arguing that healthy eating advice cannot ignore the health of the planet.

The 2020-25 guidelines do not address sustainability or food insecurity, and do not explicitly promote a shift to more plant-based eating patterns.

However, they acknowledge that “dietary patterns characterized by higher intake of red and processed meats, sugar-sweetened foods and beverages, and refined grains are… associated with detrimental health outcomes.”

‘Replacing processed or high-fat meats with beans, peas, and lentils…’

They also suggest some “shifts” ​in protein consumption to “add variety​.”

For example, say the guidelines, “Replacing processed or high-fat meats (e.g., hot dogs, sausages, bacon) with seafood could help lower intake of saturated fat and sodium, nutrients that are often consumed in excess of recommended limits.

“Replacing processed or high-fat meats with beans, peas, and lentils would have similar benefits, as well as increasing dietary fiber, a dietary component of public health concern.”

Plant-based ‘dairy’ focuses on fortified soy

Plant-based meat, dairy and egg alternatives - an area of significant focus​ and investment for many food companies - are not really referenced in the guidelines, although they note that a “Healthy Vegetarian Dietary Pattern is higher in soy products (particularly tofu and other processed soy products); beans, peas, and lentils; nuts and seeds; and whole grains.”

There are a couple of segments on plant-based milks: “For individuals who choose dairy alternatives, fortified soy beverages (commonly known as ‘soy milk’) and soy yogurt—which are fortified with calcium, vitamin A, and vitamin D—are included as part of the dairy group because they are similar to milk and yogurt based on nutrient composition and in their use in meals.

“Other products sold as ‘milks’ but made from plants (e.g., almond, rice, coconut, oat, and hemp ‘milks’) may contain calcium and be consumed as a source of calcium, but they are not included as part of the dairy group because their overall nutritional content is not similar to dairy milk and fortified soy beverages.”

The health of the nation

A high percentage of American adults are dealing with diet and lifestyle related diseases, which reflect poor nutrition, lack of physical activity, and excessive alcohol use, say the 2020-25 Dietary Guidelines for Americans​:

  • About 74% of adults and 40% of children and young adults are overweight or have obesity.
  • About 45% of adults have hypertension.
  • Almost 11% of Americans have type 1 or type 2 diabetes, and almost 35% of American adults have prediabetes.
  • Large numbers of Americans don't get enough calcium, potassium, dietary fiber, and vitamin D.

Noting that “more than half of adults have one or more diet-related chronic diseases​,” as in previous years, the advice broadly is to:

  • Consume a healthy dietary pattern, including​: Vegetables, fruits, legumes, whole grains, nuts and seeds, with some vegetable oils, low-fat dairy or fortified soy beverages and yogurt, lean meat and poultry, and seafood.
  • Limit: ​Alcoholic beverages, and foods and beverages higher in added sugars, saturated fat, and sodium.

The guidelines - which for the first time include dietary recommendations for infants from birth through 24 months - may not be something to which the average consumer pays much attention, but they are watched closely by industry and health experts as they set the parameters for government nutrition programs and inform nutrition advice in multiple settings.*

You can read the report in full HERE​, but here are some highlights: 

Infants aged 0-24 months should avoid foods and beverages with added sugar

  • For about the first six months, exclusively feed infants human milk. Continue through at least the first year of life...
  • Feed infants iron-fortified infant formula during the first year of life when human milk is unavailable. Provide infants with supplemental vitamin D beginning soon after birth.
  • At about six months, introduce infants to nutrient-dense complementary foods.
  • Introduce infants to potentially allergenic foods along with other complementary foods. “There is no evidence that delaying introduction of allergenic foods, beyond when other complementary foods are introduced, helps to prevent food allergy.”
  • If an infant has severe eczema, egg allergy, or both (conditions that increase the risk of peanut allergy), age-appropriate, peanut-containing foods should be introduced into the diet as early as age 4 to 6 months.
  • Low- and no-calorie sweeteners are not recommended for children younger than age two.
  • Encourage infants and toddlers to consume a variety of foods from all food groups. Include foods rich in iron and zinc, particularly for infants fed human milk.
  • Avoid foods and beverages with added sugars.
  • Limit foods and beverages higher in sodium.  
  • Infants should not consume cow milk or fortified soy beverages before age 12 months to replace human milk or infant formula.
  • There are no clear needs for toddler milks or drinks.

"The difference between recommended food group amounts and current intakes is greater for adolescents ages 14 through 18 than for any other age group across the lifespan..."

Children and adolescents: ‘Beverages that contain no added sugars should be the primary choice’

Sugary drinks: “Beverages that contain no added sugars should be the primary choice for children and adolescents… As a percent of total daily energy intake, average intake of added sugars is 11% among young children and peaks at 15% during adolescence​.” Sugar sweetened beverages account for 32% of added sugar consumption among adolescents.

Adolescent girls need more iron, folate, B6, B12, protein: ​“Adolescent females have low dietary intakes of iron, folate, vitamin B6 , and vitamin B12. Adolescent females also consume less meat, poultry, and eggs than do adolescent males, and in combination with lowconsumption of seafood and other protein subgroups, including beans, peas, and lentils, this results in the under-consumption of total protein.”

Teen nutrient deficiencies:​ “The difference between recommended food group amounts and current intakes is greater for adolescents ages 14 through 18 than for any other age group across the lifespan. As a result, adolescents are at greater risk of dietary inadequacy than are other age groups.

“Low intakes of nutrient-dense foods and beverages within the grains, dairy and alternatives, fruits, and vegetables food groups lead to low intakes of phosphorus, magnesium, and choline.”

High intensity sweeteners​: “Replacing added sugars with low- and no-calorie sweeteners may reduce calorie intake in the short-term and aid in weight management, yet questions remain about their effectiveness as a long-term weight management strategy.”

Reaction: ‘Advice misses the mark on added sugars’

We’ll get more reaction in the coming days, but here are some early reactions from stakeholders:

American Heart Association: “We are disappointed that USDA and HHS did not accept all of the DGAC’s science-based recommendations in the final guidelines for 2020, including the recommendation to lower added sugars consumption to less than 6% of calories. Many adults and children have little room in their diet for empty calories and need to go lower than 10% to have a healthy dietary pattern and meet their essential nutrient needs.”

American Institute for Cancer Research​: “The dietary guidelines have retained the outdated advice that men may consume up to two alcoholic drinks per day…

“The recommendations do not fully reflect the research on the health benefits of reducing intake of processed meats and further reducing intake of added sugars... AICR’s research has found strong evidence that diets high in red and processed meat increase the risk of colorectal cancer.”

Marion Nestle, PhD., Paulette Goddard Professor of Nutrition, Food Studies, and Public Health, New York University​: “The big news: They paid no attention​ to the recommendations of the Dietary Guidelines Advisory Committee... USDA and HHS overrode the scientific decisions of the DGAC.  So much for 'science-based' dietary guidelines."

Dr. Erin Quann, RD, head of medical affairs at Gerber/Nestlé Nutrition: " We are thrilled to see this science-based approach to baby's nutrition take a more prominent place within the Dietary Guidelines for Americans.”

Lee Sanders, senior vice president, government relations and public affairs, American Bakers Association: “We strongly agree on the goodness of six grain servings, half enriched grains and half whole grains, on Americans’ daily plates.”

North American Millers' Association president Jane DeMarchi​: “We are delighted that the nutritional value of both whole and enriched grains in the diet, which is supported by vast scientific research, is acknowledged by the updated Dietary Guidelines.  

Jessi Silverman, policy associate, Center for Science in the Public Interest:  “Instead of heeding the 2020 Dietary Guidelines Advisory Committee’s recommendation that individuals over 2 years of age should consume less than 6% of total calories from added sugars, the new Dietary Guidelines retain the advice from the previous edition to limit added sugars to less than 10 percent of total calories.  

While it is disappointing that this edition of the Dietary Guidelines misses the mark on added sugars, people in the U.S. ultimately need much more than advice: CSPI urges the incoming administration to remove barriers to healthy eating in our stores, restaurants, and institutions, and to implement policies that actually help Americans eat according to the Guidelines.”

Lisa Young, PhD., RDN, adjunct professor, New York University​“I commend the agencies for offering guidance for each stage of the lifecycle, including infants and toddlers. This is most welcome for families and new moms. I like the focus on ‘Make every bite count,’ addressing the importance of portion control and staying within calorie limits as well as taking into account budgetary and cultural considerations. 

“I was disappointed, however, that the guidelines didn’t include the committee recommendations on added sugar and alcohol—namely, to reduce added sugar to 6% of total  calories and to limit alcohol to one drink a day for men. There are no benefits to consuming foods high in added sugar so less is best. And as for alcohol, less is probably best as well. After all, no one got heart disease from a deficiency of alcohol. Despite the DGAC report, these guidelines remained virtually unchanged.”

The Council for Responsible Nutrition: "The 2020–2025 Dietary Guidelines underscore that under-consumption of vitamin D, iron, calcium, dietary fiber, and potassium among Americans is linked to health concerns. The Guidelines highlight that recommendations for vitamin D in particular may be more difficult for individuals to achieve through natural sources and diet alone, noting that vitamin D supplementation may be appropriate."

Lisa Gable, CEO, Food Allergy Research and Education (FARE): FARE is thrilled to see the inclusion of more comprehensive dietary guidance around the early introduction of egg and peanut for infants and toddlers.”

Jim Mulhern, president and CEO, The National Milk Producers Federation: “USDA and HHS deserve praise for once again recognizing just how vital dairy is to the nation’s health and well-being. We encourage them to affirm that role even more clearly in the next iteration of the Dietary Guidelines, to reflect the positive contribution of dairy fats in diets that’s increasingly recognized in a growing body of evidence.”

Linda Cornish, president, Seafood Nutrition Partnership​: “Americans are still falling short of consuming the recommended amounts of seafood and we are hopeful that the launch of the DGA 2020-2025 will bring a renewed sense of urgency for Americans to include more seafood into their diets for its great taste and important nutrients.”

Mickey Rubin, PhD, executive director, American Egg Board’s Egg Nutrition Center:​ “Choline is a nutrient under-consumed by all Americans, and the guidelines recommend eggs as a notable source of choline to support brain health and development during pregnancy. Additionally, establishing healthy eating patterns from the start ensures children’s growing bodies and brains get the nutrition they need. Eggs are a fundamental food in these early years because they provide a unique nutrient package.”

*​ For example, the National School Lunch Program and the Older Americans Act Nutrition Program incorporate the dietary guidelines in menu planning; the Special Supplemental Nutrition Program for Women, Infants, and Children applies the dietary guidelines in its program and educational materials; and the Healthy People objectives for the Nation include objectives based on the dietary guidelines. The dietary guidelines also provides a structure for state and local public health promotion and disease prevention initiatives.  

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