Commonalities Among Dietary Guidelines for Chronic Disease Prevention and Health Promotion: A Meta-Epidemiological Study From the American College of Lifestyle Medicine

OBJECTIVES: Lifestyle recommendations, specifically diet, are foundational components of many clinical practice guidelines from major medical professional and other stakeholder associations. To support clinicians in appropriate treatment pathways, this study aims to identify commonalities among dietary recommendations of current practice guidelines. METHODS: Using a systematic review approach, this meta-epidemiological study (no clinical outcomes; guidelines as unit of analysis) assessed practice guidelines containing dietary pattern, food group, or food item recommendations for adults from general populations or with major chronic diseases. Search strategies were implemented in 5 databases for publications from January 2010 to 2022 and were augmented by hand searches in point-of-care resource databases and relevant stakeholder websites. Two investigators independently screened guidelines and extracted or checked data. Disagreements were resolved by consensus. RESULTS: Of 2,435 screened records, 88 guidelines were included; preliminary results from 82 guidelines published by Nov. 2020 are presented. Most (95%) targeted adults with chronic diseases, and 45% focused on prevention or treatment of heart disease. Mediterranean-style diets, Dietary Approaches to Stop Hypertension (DASH) or low-sodium diets, and a “healthy diet” (various definitions) were each recommended by about 30% of guidelines. Food groups most commonly recommended for daily intake were vegetables (74%), fruit (71%), whole grains (59%), and legumes (46%). Those most commonly recommended to limit/exclude/decrease were red (34%) and processed meats (30%). Fish/seafood was recommended by 51% of guidelines with many suggesting 1–2 servings a week. Food components most commonly recommended to limit/exclude/decrease were alcohol (65%), salt (50%), sugar sweetened beverages or added sugars (43%), and refined grains or "processed” foods (30%). CONCLUSIONS: Guidelines aimed at preventing or treating major chronic diseases are closely aligned in their dietary recommendations for daily intakes of unrefined plant foods with limited alcohol and salt. Based on current evidence, clinicians should feel confident making these recommendations in accordance with their respective clinical practice guidelines. FUNDING SOURCES: Supported by the American College of Lifestyle Medicine.