Dietary Guidelines 2010

The US Department of Agriculture (USDA) has released the Dietary Guidelines for Americans, 2010 which are intended for Americans ages 2 years and older, including those at increased risk of chronic disease.

 The main concepts of the guidelines are to maintain calorie balance over time to achieve and sustain a healthy weight and to focus on consuming nutrient-dense foods and beverages.

The key recommendations are:

1.     Balancing calories and manage weight

•                 Prevent and/or reduce overweight and obesity through improved eating and physical activity behaviors.

•                 Control total calorie intake to manage body weight. For people who are overweight or obese, this will mean consuming fewer calories from foods and beverages.

•                 Increase physical activity and reduce time spent in sedentary behaviors.

•                 Maintain appropriate calorie balance during each stage of life—childhood, adolescence, adulthood, pregnancy and breastfeeding, and older age.

2.     Foods and food components to reduce

•                 Reduce daily sodium intake to less than 2,300 milligrams (mg) and further reduce intake to 1,500 mg among persons who are 51 and older and those of any age who are African American or have hypertension, diabetes, or chronic kidney disease. The 1,500 mg recommendation applies to about half of the U.S. population, including children, and the majority of adults.

•                 Consume less than 10 percent of calories from saturated fatty acids by replacing them with monounsaturated and polyunsaturated fatty acids.

•                 Consume less than 300 mg per day of dietary cholesterol.

•                 Keep trans fatty acid consumption as low as possible by limiting foods that contain synthetic sources of trans fats, such as partially hydrogenated oils, and by limiting other solid fats.

•                 Reduce the intake of calories from solid fats and added sugars.

•                 Limit the consumption of foods that contain refined grains, especially refined grain foods that contain solid fats, added sugars, and sodium.

If alcohol is consumed, it should be consumed in moderation—up to one drink per day for women and two drinks per day for men—and only by adults of legal drinking age.
For detalied guidelines refer to http://www.cnpp.usda.gov/Publications/DietaryGuidelines/2010/PolicyDoc/ExecSumm.pdf
http://www.cnpp.usda.gov/DGAs2010-PolicyDocument.htm

HPS trial post hoc analysis

The results of Heart Protection Study  post-hoc analysis have been publishedd in the latest issue of Lancet.(1) The HPS tested the hypothesis that the effects of statin therapy differ according to baseline concentrations of CRP and LDL cholesterol.

Patients were categorised into six baseline CRP groups (<1·25, 1·25—1·99, 2·00—2·99, 3·00—4·99, 5·00—7·99, and ≥8·00 mg/L), each including about 3000 patients.

Results showing the effect of Simvastatin on LDL_C levels have been published earlier. Results of this post-hoc analysis:

·        Allocation to simvastatin produced a significant 24% (95% CI 19—28) proportional reduction in the incidence of first major vascular event after randomisation.

·        There was no significant trend in the proportional risk reduction with increasing baseline CRP, with significant reductions in each of the baseline CRP groups, including in participants with CRP concentration less than 1·25 mg/L (29% risk reduction, 99% CI 12—43; p<0·0001).

·        Indeed, even in those with baseline CRP concentration less than 1 mg/L, there was a significant 27% (99% CI 5—44) reduction in risk (166 [13·7%] allocated to simvastatin vs 218 [18·3%] allocated to placebo; p=0·0022).

·        Allocation to simvastatin reduced the incidence of first major coronary event by 27% (95% CI 21—33), of first stroke by 25% (15—34), and of first revascularisation by 24% (17—30), with no significant trend in the proportional risk reduction with increasing baseline CRP concentration for any of these outcomes.

·        There was also no significant trend in the proportional reduction in vascular death with increasing baseline CRP.

·        The proportional risk reduction in participants with low LDL cholesterol and low CRP (27%, 99% CI 11—40; p<0·0001) was statistically similar to that in participants with high LDL cholesterol and high CRP (23%, 10—35; p<0·0001). The authors have mentioned that even when the threshold used to define low LDL cholesterol was reduced to 2·8 mmol/L (which was the median baseline concentration in the JUPITER trial), the proportional reduction in major vascular events in participants with low LDL cholesterol and low CRP (92 [13·6%] vs 128 [18·2%]; risk reduction 0·73, 99% CI 0·52—1·04; p=0·0213) was still similar to the reduction recorded overall.

According to the authors the results of this post-hoc analysis does not lend support to the hypothesis that baseline CRP concentration modifies the vascular benefits of statin therapy materially.

The discussion on the hypothesis has been done on http://www.theheart.org/article/1177999.do

(1) http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)62174-5/fulltext?_eventId=login#bib2