Intended for healthcare professionals


Where the latest US dietary guidelines are heading

BMJ 2015; 351 doi: (Published 24 July 2015) Cite this as: BMJ 2015;351:h4034
  1. Daan Kromhout, emeritus professor
  1. 1Wageningen University, 6700 EV Wageningen, Netherlands
  1. daan.kromhout{at}

So farewell dietary cholesterol and total fat as risk factors worth worrying about

Recently, the US Dietary Guidelines Advisory Committee released its recommendations for the next edition of Dietary Guidelines for Americans.1 Two notable conclusions of the committee have attracted particular attention2 3: the elimination of dietary cholesterol as a “nutrient of concern” and the absence of a limit on total fat consumption. The committee’s pronouncements will reverse nutrition policy because the low cholesterol, low fat diet has been the cornerstone of public health nutrition since 1980. In this editorial I will review the evidence for this change in policy from a historical perspective.

Fat is bad

The low cholesterol, low fat diet for preventing heart attacks was popularised in the first part of the 20th century. Classic animal experiments showed that feeding rabbits excessive cholesterol induced lipid containing lesions in the aorta. Anitschkow hypothesized that a high plasma cholesterol concentration caused atherosclerosis and its complications.4 Observant medical doctors from the Netherlands noticed extraordinarily low numbers of patients with myocardial infarction in the East Dutch Indies (Cornelis de Langen) and China (Isodore Snapper).5 The diets of these …

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