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Tag: Guidelines

  • Fewer Children are Having Peanut Allergies in Recent Years Following a Change in Guidelines, Study Shows

    Fewer Children are Having Peanut Allergies in Recent Years Following a Change in Guidelines, Study Shows

    Fewer children are being found with peanut allergies in the last few years, a study shows, which is believed to be due to a change in policy regarding early exposure.

    This began when experts recommended that parents should avoid having their infants exposed to common allergens as a means to curb rising food allergy rates. However, a 2015 landmark trial found that feeding peanuts to babies could actually decrease their chances of developing an allergy by more than 80 percent.

    Peanut Allergies in Children

    In 2017, the National Institute of Allergy and Infectious Diseases formally recommended that parents use the early-introduction approach and issued national guidelines. A new study that was published on Monday found that food allergy rates in kids under three have fallen following those changes.

    The data showed that the numbers dropped to 0.93 percent between 2017 and 2020, from 1.46 percent between 2012 and 2015. Comparing these statistics shows a 36 percent reduction in all food allergies, which is largely driven by a 43 percent drop in peanut allergies, according to the New York Times.

    Additionally, the study found that eggs overtook peanuts as the No. 1 food allergen in young children. However, the researchers did not examine what infants ate, which means the study does not show that the guidelines directly caused the decline.

    A pediatrician at Columbia University Irving Medical Center in New York, Dr. Edith Bracho-Sanchez, said that the data is still promising as it relates to the prevention of a potentially deadly and life-changing diagnosis.

    One of the researchers of the latest study, co-author Sanislaw Gabryszewski, MD, PhD, said that their observations provide real-world evidence that public health efforts that promote early allergen introduction in infancy are making an impact, AJMC reported.

    A Change in National Guidelines

    The finding comes as roughly four percent of kids are affected by a food allergy that is mediated by IgE, which includes food like eggs, nuts, milk, wheat, and peanuts. These can then cause immediate reactions that can threaten the children’s lives, including difficulty breathing and swelling.

    Another researcher involved in the new study, Dr. David Hill, said that their findings were “remarkable.” He and his colleagues analyzed electronic health records from dozens of pediatric practices so they could track diagnoses of food allergies in young kids before, during, and after the guidelines were issued.

    Despite this, the effort has not yet resulted in a reduction in the overall increase in food allergies in the United States in the past few years, as per LMT Online.



    Originally published on parentherald.com

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  • Study opens door to a rethink of colonoscopy guidelines — Harvard Gazette

    Study opens door to a rethink of colonoscopy guidelines — Harvard Gazette


    A new analysis of nearly 200,000 adults shows that those with a clean result on their first colonoscopy may not need another for longer — perhaps significantly longer — than the current recommendation of 10 years.

    The result is a bit of good news about a cancer whose increasing rates in younger patients has worried experts, including the Harvard Chan School’s Mingyang Song, for several years. Colorectal cancer is the nation’s second-deadliest after lung cancer, killing an estimated 52,550 in 2023. While rates among older patients have been declining, younger patients — those 40 to 49 — have seen cases rise 15 percent between 2000 and 2026. Experts aren’t sure of the cause, but in 2021, the U.S. Preventive Services Task Force lowered the recommended age of first screening to 45 from 50. They also recommend that those with average risk get screened 10 years afterward.

    Song, an associate professor of clinical epidemiology and nutrition at the Chan School, said that the increase in screenings has also increased appointment wait times.

    “Especially with the lowered age, the clinic is overwhelmed,” said Song, also an associate professor at Harvard Medical School. “It was overwhelmed before, now it’s even worse.”

    In the work, published last month in JAMA Oncology, Song and colleagues examined colorectal cancer screening results and colorectal cancer incidence among 195,453 participants in three long-running studies: the Nurses’ Health Study, Nurses’ Health Study II, and the Health Professionals Followup Study. They compared incidence between two groups: those who received negative results in their initial colorectal cancer screening — meaning no polyps or cancer — and those who had not yet been screened.

    They found that the risk of developing colorectal cancer was significantly lower among those who had received a negative cancer screening than those who had not yet been screened. The research team, led by first author Markus Knudsen, a postdoctoral fellow in Song’s lab, then divided the negative screening result group according to lifestyle risk factors for colorectal cancer. The work was supported in part by the National Institutes of Health.

    The results showed that it took 16 years for those with a negative screening result and an intermediate-risk lifestyle to have the same colorectal cancer incidence of the unscreened group at 10 years. Those with negative screening and a low-risk lifestyle — including a healthy diet and exercise — didn’t reach the 10-year cancer incidence of the unscreened group until 25 years from their negative screening.

    The results, Song said, show that cancer screening should be individualized and discussed between patient and physician. While it is likely that additional evidence will be needed before national screening guidelines are changed, those with a negative screening result may be able to safely extend the screening interval beyond the recommended 10 years and, for those also living a low-risk lifestyle, perhaps as long as 20 years.

    What this more tailored approach would do, Song said, is spare those who might get little benefit from a colonoscopy while focusing increasingly scarce resources where they’re most needed: on people who’ve never been screened — only about 70 percent of eligible U.S. adults have been screened — on disadvantaged groups with historically lower screen rates, and on those whose lifestyle or family history puts them at increased risk.  

    “What we have seen generally is that the more advantaged groups of individuals are more likely to receive colonoscopy, whereas those who are disadvantaged and who actually have a higher risk of developing colon cancer are less likely to receive colonoscopy,” Song said. “We’ve tried to correct this mismatch and improve colonoscopy delivery at the population scale.”


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  • Dietary Guidelines for Americans 2020 released – The Nutrition Source

    The 9th edition of the Dietary Guidelines for Americans 2020-2025 is out, with the tagline to Make Every Bite Count. Intended for policy makers, healthcare providers, nutrition educators, and Federal nutrition program operators, the new edition has expanded to almost 150 pages, providing nutrition guidelines for even more age groups throughout the life cycle. As in the previous edition, the Dietary Guidelines emphasize dietary patterns rather than promoting specific nutrients or foods. This allows for greater flexibility in food choices, as health benefits are achieved by consuming a wide variety of nutrient-dense foods across different food categories, rather than a few “superfoods.” In addition, the Dietary Guidelines again emphasize how nutrition educators need to be aware that food choices are strongly impacted by age, race, cultural traditions, environment, food access, budget, and personal beliefs and preferences. [1]

    Highlights from the Guidelines

    What’s new:

    • Recommended dietary patterns for infants and toddlers (birth to 23 months).
    • Food allergy prevention in infants; for example, the guidelines recommend introducing peanut-containing foods as early as 4-6 months in infants at high risk for peanut allergy, to lower the risk of developing a peanut allergy.
    • An expanded comprehensive section on healthy dietary patterns and food safety during pregnancy and lactation, and recommendations for breast feeding.
    • New sections on overweight and obesity in children and pregnant women.
    • Addressing health problems stemming from obesity-related stigma and discrimination.
    • More user-friendly graphics, such as how to modify meals to be higher in nutrients while controlling calories, sugar, and sodium; sample menus; and interpreting the Nutrition Facts label.

    The key players in the “Healthy U.S.-Style Dietary Pattern” remain unchanged from the previous edition of the Guidelines:

    • Vegetables of all types—dark green; red and orange; beans, peas, and lentils; starchy; and other vegetables
    • Fruits, especially whole fruit
    • Grains, at least half of which are whole grain
    • Dairy, including fat-free or low-fat milk, yogurt, and cheese, and/or lactose-free versions and fortified soy beverages and yogurt as alternatives
    • Protein foods, including lean meats, poultry, and eggs; seafood; beans, peas, and lentils; and nuts, seeds, and soy products
    • Oils, including vegetable oils and oils in food, such as seafood and nuts

    Dietary components to limit:

    The guidelines carry over the same limits for saturated fat, added sugars, and sodium, but this time include a specific age range:

    • For added sugars, the limit is 10% or less of total calories starting at age 2. For context, drinking even one 20-ounce bottle of soda would exceed this recommended 10% limit. A new advisory suggests that infants and toddlers younger than 2 years avoid all foods and beverages containing added sugars.
    • For saturated fat, the limit is less than 10% of total calories starting at age 2.
    • For sodium, the limit is less than 2,300 milligrams daily for older teenagers and adults, and less for children younger than age 14 (1,200 mg/day for ages 1-3; 1,500 mg/day for ages 4-8; and 1,800 mg/day for ages 9-13).
    • Although the recommended amounts for alcohol have not changed, the messaging is subtly different, placing an emphasis on limiting drinks rather than drinking in moderation. The prior edition suggested up to two drinks daily for men and one drink for women. The new guidelines emphasize a limit of two drinks or less for men and 1 drink or less for women, followed by a statement that drinking less is better for health than drinking more.

    Where the Guidelines fall short

    While the Guidelines include dietary patterns that remain examples of healthy diets (“Healthy Mediterranean-Style Pattern,” and “Healthy Vegetarian Pattern”), the dietary targets for the “Healthy U.S.-Style Pattern” emphasize a diet relatively high in meat, eggs, and dairy foods. Dr. Walter Willett, Professor of Epidemiology and Nutrition in the Department of Nutrition at Harvard T.H. Chan School of Public Health said this about the new Guidelines:

    In general, there was minimal change from the last edition of the Guidelines, which did include many positive suggestions. However, guidance that considers scientific evidence on specific protein sources and health, and also the environmental consequences of dietary patterns, is needed to provide Americans with advice and policies for healthy and sustainable diets. The current Dietary Guidelines fail to do this.

    Like the previous edition, the Guidelines are silent on the environmental impacts of their dietary targets, which other analyses show would have serious impacts on climate change and other environmental footprints because of the relatively large amounts of meat and dairy foods recommended. [2] Along with varying impacts on human health, different foods also have differing impacts on the environment. The production of animal-based foods tends to have higher greenhouse gas emissions than plant-based foods—and red meat (especially beef) and dairy stand out for their disproportionate impact.

    Willett points out that the Guidelines’ continued dairy recommendation of 3 servings per day has never been justified by evidence for health outcomes, and the guidance for low-fat and fat-free dairy products doesn’t detail a plan for disposal of the fat naturally present in milk:

    Because the disposal of dairy fat would be hugely wasteful, it would almost certainly remain in the food supply, which makes this recommendation somewhat of a fantasy. The report does appropriately mention that soy milk is an alternative to cow milk, but to avoid the large greenhouse gas emissions associated with dairy food consumption at three servings per day, the majority of milk and dairy foods would need to be plant-based.

    Similarly, the Guidelines also recommend lean meats, but don’t discuss the fate of cuts of meat that are not lean. Willett says that realistically, they would almost certainly be consumed, “probably as cheap cuts and processed meats, especially by low-income groups who already experience excess rates of obesity and diabetes.”

    It’s notable that the overall protein recommendation leads with “lean meats,” which could be interpreted by consumers as including “lean” or “low-fat” cuts of bacon or other processed meats. Although further guidance clarifies that “most intake of meats and poultry should be from fresh, frozen, or canned, and in lean forms (e.g., chicken breast or ground turkey) versus processed meats (e.g., hot dogs, sausages, ham, luncheon meats),” [1] this statement is buried within the chapters of the guidelines, rather than emphasized within the summarized protein recommendation. This is a particularly important distinction, since consuming healthy protein sources like beans, nuts, fish, or poultry in place of red meat and processed meat can lower the risk of several diseases and premature death.

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  • Unpacking WHO guidelines on non-sugar sweeteners – The Nutrition Source

    The World Health Organization (WHO) released a new guideline on non-sugar sweeteners (NSS)—often referred to as artificial or low-calorie sweeteners—that advises against use of NSS to control body weight or reduce the risk of noncommunicable diseases. After conducting a research review, they concluded that replacing sugar sweeteners with NSS did not promote weight loss in the long term in adults and children. However, clinical trial data showed that higher intakes of NSS resulted in lower calorie intake when they replaced sugar and sugar-sweetened foods/beverages. There was no significant effect of NSS on hunger or satiety levels. Some trials showed less hunger with use of NSS, but others showed a stronger appetite in participants with higher intakes of NSS-containing beverages.

    When looking at observational cohort studies, long-term use of NSS-containing beverages was associated with an increased risk of cardiovascular disease and early death in adults. A higher intake of NSS, either in beverages or added to foods, was also associated with increased risk of developing type 2 diabetes. The WHO noted that “reverse causation” may have contributed to the positive association: participants with the highest intakes of NSS tended to have a higher body mass index and obesity or metabolic risk factors, and therefore may have already been predisposed to chronic disease (for which they were choosing NSS as a health measure). No association was found with intakes of NSS-containing beverages and cancer or cancer deaths.

    Based on these findings, WHO advised that people work to lower the overall sweetness in the diet starting early in life, as NSS do not provide nutritional value. Examples of NSS include acesulfame K, aspartame, saccharin, sucralose, and stevia. Their analysis did not study sugar alcohols (polyols) such as maltitol, xylitol, and sorbitol that are added to many foods and beverages.

    Harvard Chan School experts agreed with the WHO recommendation to tame our sweet tooths, but had some criticisms that the meta-analysis excluded certain large studies. [1-3] The omitted cohort studies—which included more than 100,000 people—found that increasing consumption of artificially sweetened beverages at the expense of sugar-sweetened beverages was associated with less weight gain over time, consistent with findings from small, short-term randomized controlled trials. Based on statistical modeling, it was estimated that replacing one serving of sugar-sweetened beverage with an artificially sweetened beverage was associated with a 4% lower risk of total mortality, 5% lower risk of cardiovascular disease-related mortality, and 4% lower risk of cancer-related mortality.

    Of course, when it comes to optimal beverages for long-term health, we should look to other options. Frank Hu, Chair of the Department of Nutrition at the Harvard T.H. Chan School of Public Health, explains that “for habitual consumers of sugar-sweetened beverages, artificially sweetened beverages can be used as a temporary replacement, although the best choices would be water and unsweetened coffee or tea.”

    Related

    The International Agency for Research on Cancer, the World Health Organization, and the Joint Expert Committee on Food Additives recently released a risk assessment of aspartame and cancer. It classified aspartame as a Group 2B carcinogen having “limited evidence” for cancer in humans, specifically liver cancer. Their prior recommendation of an acceptable daily intake of aspartame of 40 mg/kg of body weight did not change, as they acknowledged that their research review did not provide differing evidence to alter this guideline, and affirmed that an intake within this range is safe. For a 150-pound (68 kg) woman, this would mean a limit of 2,727 mg of aspartame daily, equivalent to about eleven 12-ounce cans of diet soda (one can contains about 250 mg). They stated that the evidence on cancer risk in humans based on animal and human studies was not convincing, and that more research, specifically longer-term studies with follow-up and randomized controlled trials, were needed.

    Learn more about aspartame and other sweeteners

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  • WHO releases updated guidelines on defining healthy diets – The Nutrition Source

    Harvard experts say most recommendations are well-supported, but guidance on total fat intake omits decades of evidence

    The World Health Organization (WHO) has released updated guidelines for defining healthy diets, with particular attention to carbohydrates, total fat, and specific types of fat such as saturated and trans fats. The guidelines are an addition to their previous recommendations on added sugars, sodium, and non-sugar sweeteners. With the exception of total fat intake, the recommendations below are geared toward everyone ages 2 and older:

    • A healthy dietary pattern—a combination of foods that is influenced by availability, affordability, preferences, culture, traditions, and other factors—is encouraged with the core tenets of adequacy, diversity, balance, and moderation.
    • A variety of food groups and a variety of foods within each food group are encouraged to reduce the risk of vitamin and mineral deficiencies, and to provide health-promoting components found in a diverse diet.
    • Carbohydrate intake should comprise 40-70% of total calorie intake and come mainly from minimally processed whole grains, vegetables, fruits, and legumes, with research finding that these foods are associated with a reduced risk of deaths from any cause and diet-related non-communicable diseases (e.g., diabetes, cardiovascular disease, cancer). They advised 400 grams of fruits and vegetables daily (equivalent to about 2 servings each), and 25 grams fiber daily.
    • Saturated fatty acid intake should be reduced to 10% or less of total calorie intake, and trans fat intake to 1% of total calorie intake, which is associated with reduced risk of deaths from any cause, reduced cardiovascular disease, and lower LDL levels. They advise replacing saturated fatty acids with polyunsaturated fatty acids.
    • Total fat intake for adults ages 20 and older should comprise 30% or less of total calorie intake for the prevention of unhealthy weight gain, and the type of fat consumed should be mostly unsaturated fatty acids. This amount was associated with reduced body weight, body mass index, waist circumference, and body fat percentage. They cited evidence that suggested a dose response, in that the more fat intake was reduced, the greater the reduction in body weight. A reduced-fat intake was associated with a lower calorie intake, leading to decreased weight. The guidelines also cited that individuals who can maintain their weight may be able to consume higher levels of fat greater than 30%; for example, one may consume 40% of calories from fat but intakes of carbohydrate and protein would decrease in order to maintain energy balance by consuming the same calorie level. [1]

    Experts in the Department of Nutrition at the Harvard T.H. Chan School of Public Health disagreed with the WHO guidelines to limit total fat intake to 30% or less of total calorie intake, citing evidence from dozens of long-term cohort studies and randomized trials that showed a lack of benefit of low-fat diets for lowering risk of chronic conditions including cancer, diabetes, cardiovascular disease, and weight loss. For example, the PREDIMED trials—which randomly assigned people to a Mediterranean diet with a higher fat intake of 39-42% of total calories (mostly from unsaturated fats) or a low-fat diet—found a lower risk of cardiovascular disease and type 2 diabetes on the higher fat diet. [2,3] The Harvard researchers also expressed concern that lowering total fat intake could mean increasing carbohydrate intake, especially refined carbohydrates and sugars, which has been shown to increase blood pressure and triglycerides.

    “The new WHO recommendation that intake of total fat be limited to 30% of calories is narrowly based on one deeply flawed meta-analysis of weight gain,” said Dr. Walter Willett, Professor of Epidemiology and Nutrition. “This ignores the last several decades of research on dietary fat and excludes the traditional Mediterranean diet, which has been widely recognized as a healthy model for eating, based on a massive body of evidence. Although other aspects of the WHO dietary recommendations are well-supported, the limit on total fat is best ignored.”

    In the meta-analyses supporting the WHO guidelines, Willett and colleagues noted that the WHO report did not include a comprehensive assembly of randomized controlled trials but rather selective studies in which weight change was not the primary outcome, and many participants had chronic conditions like cancer, diabetes, and cardiovascular disease, and therefore were not considered healthy.

    They also noted that the meta-analyses excluded studies that were carefully designed to look at dietary fat and weight changes, and that many of the included studies provided an unequal intervention. For example, in many studies, the low-fat diet group received intensive guidance and monitoring of fat reduction, whereas the control group received no advice or monitoring. This is meaningful as close dietary guidance and monitoring itself results in small reductions in weight.

    “Even if the result of the meta-analysis were to be believed, the difference between the low- and high-total fat groups was only about two pounds (0.9 kg after accounting for sample size), hardly sufficient to be setting global dietary recommendations,” Willett added. “On the other hand, the type of dietary fat has major implications for long term health and wellbeing, and the recommendation to emphasize unsaturated sources of fat from plants over those high in saturated and trans fat is well-founded.”

    Last updated July 18.

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