June 11, 2020
In preparation for its final meeting, the Dietary Guidelines Advisory Committee has posted its draft scientific conclusions, including several on dietary cholesterol. For the most part, the statements are consistent with the previous scientific report in 2015, which led to the elimination of the longstanding recommendation to limit dietary cholesterol to 300 milligrams per day. However, a new conclusion statement about dietary patterns in children could create confusion about cholesterol in the diet.
Selected statements are below. The "grade" after each statement reflects the DGAC's judgment about the strength of the scientific evidence backing up the statement.
Dietary Cholesterol and Blood Cholesterol in Children: "Strong evidence demonstrates that diets lower in saturated fatty acids and cholesterol during childhood result in lower levels of total blood and low-density lipoprotein cholesterol throughout childhood, particularly in boys. Grade: Strong"
Dietary Cholesterol and Blood Cholesterol in Adults: "Limited evidence suggests that lower intake of dietary cholesterol in adults may reduce total and low-density lipoprotein cholesterol. Grade: Limited"
Dietary Fats and Cardiovascular Disease in Children: "Insufficient evidence is available to determine the relationship between intake of types of dietary fat during childhood and cardiovascular health outcomes during adulthood. Grade: Grade Not Assignable"
Dietary Cholesterol and Cardiovascular Disease in Adults: "Insufficient evidence is available from randomized controlled trials to quantify an independent relationship between dietary cholesterol intake in adults and the overall risk of cardiovascular disease. Grade: Grade Not Assignable"
Normally, conclusions where the grade is "limited" or "not assignable" would not be considered strong enough to include as recommendations in the final policy document. These findings suggest no definitive relationship between dietary cholesterol and CVD in either children or adults. The evidence of a link between cholesterol intake and blood cholesterol levels is "limited" in adults, which would make it unlikely that the DGAC would return to a specific quantitative recommendation like 300 mg.
What remains to be seen is how the committee will handle the "strong" evidence of a link of diets lower in saturated fatty acids and cholesterol during childhood with lower total and LDL blood cholesterol in children. Notice that the link is not solely to dietary cholesterol but also to saturated fats, which are known to impact LDL cholesterol levels. While elevated serum LDL cholesterol has been identified as a major coronary heart disease risk factor, the connection between dietary cholesterol and blood cholesterol is not straightforward. More important, the vast majority of scientific evidence demonstrates egg consumption is not associated with cardiovascular disease.
The committee's position on dietary cholesterol won't be clear until its report is issued in July. From the statements released so far, however, the committee seems headed for somewhere near the final 2015 Dietary Guidelines for Americans. That document removed the 300-milligram recommendation but also encouraged consumers to keep dietary cholesterol low, while making positive statements about some foods that contain cholesterol, such as eggs and shrimp, confusing some readers.
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