Complementary Alternative Cardiovascular Medicine

74 Alternative Cardiovascular Medicine
makes new recommendations for energy, carbohydrates, fiber, fat, fatty
acids, cholesterol, protein, and amino acids. The DRI Report embraces
the philosophy of making dietary recommendations that assure a nutritionally
adequate diet, promote good health, prevent chronic disease,
and avoid overconsumption. Recommendations suggest that adults
should consume a diet that provides 45% to 65% of their calories from
carbohydrates, 10% to 35% from protein, and 20% to 35% from fat. The
report advises that saturated fat, trans fat, and cholesterol be as low as
possible. Because polyunsaturated fatty acids (PUFAs) are essential
nutrients, the DRI Report recommends 17 g/d for men and 12 g/d for
women of linoleic acid (C18:2), an omega-6 PUFA. For α-linolenic acid
(ALA), an omega-3 fatty acid, 1.6 and 1.1 g/d should be consumed by
men and women, respectively. The recommendations for PUFA are
based on average intakes in the United States. For simplicity, the report
recommends that 5% to 10% of calories come from PUFA and 0.6% to
1.2% come from ALA. Importantly, approx 10% of omega-3 fatty acid
intake can come from long-chain, highly unsaturated fatty acids,
eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Because
of the total fat recommendation and the guidance provided about
saturated fat, trans fat, and PUFA intake, the balance will be derived
from monounsaturated fatty acids (MUFAs). The range of total fat from
20% to 35% of calories recognizes that healthy diets can be planned over
a reasonably broad range of fat intake, as long as saturated fat, trans fat,
and cholesterol are kept as low as possible. This range in total fat reflects
the health benefits of unsaturated fat in the context of a nutritionally
adequate diet that promotes a healthy weight. The range of all macronutrients
acknowledges that there are many healthy diets with respect to
macronutrient profiles, as long as each diet meets the specific recommendations
made in the DRI Report for saturated fat, trans fat, cholesterol,
total fiber (38 g/d for men and 25 g/d for women), and added sugar (a
maximum of 25% or fewer calories from added sugars).
Although the DRI Report for macronutrients is made for healthy populations,
it is consistent with the latest guidelines from the National Cholesterol
Education Program Adult Treatment Panel (ATP) III (2) for
primary and secondary prevention of coronary heart disease (CHD).
These treatment guidelines target low-density lipoprotein (LDL) cholesterol,
as well as other major risk factors for CHD. ATP III recommends
a diet that provides fewer than 7% of calories from saturated fat
and fewer than 200 mg of cholesterol per day. In addition, up to 10% of
calories from PUFA and up to 20% of calories from MUFA are allowed.
A total fat recommendation of 25% to 35% of calories is also made in
ATP III. Collectively, both ATP III and the DRI Report have made