Dietary Guidelines for Americans
Intro
- U.S. Department of Agriculture (USDA) has been issuing dietary recommendations for over 100 years
- In 1980, USDA and the Dept. of Health and Human Services issued first joint dietary guidelines for Americans.
- Since that document, the DG have been a coordinated, evidence and science-based set of recommendations from the federal government
- DG target the healthy public over the age of two; promote health and aim to reduce the risk of chronic disease, including obesity, cardiovascular disease, diabetes, and some cancers
- DG reviewed & reissued every 5 years by DHHS & USDA, based on recommendations of DG Advisory Committee (DGAC); new DGAC report released Sept 2015; DGA2015 released in early 2016
- Scientific recommendations then translated into consumer messages and guidance
Implementation Challenges
- Combining the best scientific knowledge about nutrition in health with practical and achievable messages
- Debate over whether recommendations should be food based or nutrient based (if you eat the right foods in the right amounts, nutrients should take care of themselves)
- 2/3 of adult Americans are overweight & at risk for chronic diseases; thus need to target messages for healthy persons and those with overweight/obesity & other health issues
- evidence based process still has weaknesses and controversy over recommendations
- critics claim that many strong conclusions of the DG document result from weak evidence; proponents argue that some of the research questions were difficult to address because relevant data did not exist, research was limited, or the findings were inconclusive
- DGAC 2015: suggested consideration of sustainability; criticized for over-stepping charge
Influence of the DG on consumer understanding
a. Despite extensive efforts to improve consumer understanding of nutrition and healthful eating patterns (DG, food label regulations and mandates), consumer misunderstanding prevails
b. < 25% of parents and their children correctly identified grains as the group from which the most servings should be consumed daily
c. Consumer knowledge of calorie needs is lacking; International Food Information Council 2010 survey found: 12% consumers ~ correctly estimate calorie needs; 51% overestimated
d. Even though 71% of Americans had heard of the DG in 2010, about 50% said they only knew a little about them
Impact of the DG on the American Diet
- Overweight/obesity an overarching focus of the 2010 guidelines
- In 2009 26.7% of the U.S. population was obese; rate of weight gain is has leveled off for the population as a whole
- Socioeconomic, ethnic, and racial disparities with regard to obesity continue to increase as do weight issues in children
- Even in the absence of overweight, poor diet and physical inactivity are associated with significant morbidity and mortality
- Americans consume too few green vegetables, orange vegetables, legumes, and whole grains, fruits, low fat dairy, and seafood; only 6% & 8% achieve their recommended target intakes for vegetables & fruits, respectively in average day
- 18.8% of Americans consume < 2300 mg sodium per day
- Excess intakes of solid fats, added sugars (SoFAS), refined grains, and sodium; caloric intake exceeds energy expended
Three big nutrition issues for Americans
a. Americans consume too few green vegetables, orange vegetables, legumes, and whole grains, fruits, low fat dairy, and seafood; only 6% & 8% achieve their recommended target intakes for vegetables & fruits, respectively in average day
b. 18.8% of Americans consume < 2300 mg sodium per day
c. Excess intakes of solid fats, added sugars (SoFAS), refined grains, and sodium; caloric intake exceeds energy expended
Why do Americans continue to struggle with healthful eating and lifestyles?
- Genetic and adaptive taste preferences that are slow to change
- Realities of daily life have changed such that free time, time for meal preparation and enjoyment are scarce
- Eating patterns established in childhood track into later life
- Inexpensive nutrient poor food choices are plentiful
- Food is deeply personal; things that motivate individuals to eat in a particular way are complicated and rarely based on health alone
- Availability and food access for healthful foods remain issues in economically disadvantaged neighborhoods
DG 2010: ADOPTION OF NEW VISUAL ICON
A. Replaced visual image of MyPyramid with the new MyPlate; MyPyramid was criticized for simultaneously being too complicated and too simplistic
• Plate icon adopted – conveys message about importance of family mealtime with visual reminders about choosing more whole grains, vegetables, and fruits and low fat dairy.
• Criticisms of Plate icon – applies more to dinner than other meals, addresses proportionality of foods between groups but doesn’t address portion sizes, difficult to adapt to combination foods, and doesn’t represent a total day or total diet; (see also alternative icons)
B. Choosemyplate.gov website promotes healthy eating with simple messages and offers a variety of interactive tools to individualize the approach
• Need internet access and some computer savvy to navigate the site
• Extensive consumer friendly information available
DG 2015-2020 MAIN MESSAGES – FIVE MAJOR THEMES:
1) Follow a Healthy Eating Pattern Across the Lifespan;
• “Eating pattern” – combination of all foods & beverages a person eats/drinks over time
3 Examples: a) Healthy US Style,
b) Healthy Mediterranean-style,
c) Healthy Vegetarian
• Food & beverage choices add up over a lifetime
• Eating patterns have significant impact on health; diet = one of most powerful tools to reduce onset of chronic diseases (ob, T2DM, hypertension, CVD) that 50% of US adults have.
2) Focus on Variety, Nutrient Density, & Amount
• Clear recommendations for health eating patterns to:
• Stay w/in appropriate caloric intake for age, sex, activity level (ie, energy balance!)
• Meet nutritional needs
• Be achievable & maintainable in long-term
• Emphasis on “nutrient density” – F/V, whole grains, variety of protein foods, oils from plants (canola, olive, peanut, etc) & foods (nuts, seeds, seafood, olives, avocados)
3) Limit Calories from Added Sugars & Saturated Fats, & Reduce Sodium Intake
• Added sugars: limit to < 10% of total daily calories
• Consume < 10% calories from saturated fatty acids and limit trans fats to as low as possible
• Reduce sodium intake to less than 2300 mg/d
• Alcohol: limit to ≤ 1 drink per day for women and 2 drinks per day for men
4) Shift to Healthier Food & Beverage Choices
• “Shifts:” term for healthy substitutions – replacing typical food choices with nutrient dense alternatives. Healthy shifts can be w/in food groups or between them: (white bread—>/whole grain; whole milk–> low/non-fat dairy; chips–>nuts; soft drinks—> water);
- Don’t forget physical activity; make it a regular part of your lifestyle
- See Physical Activity Guidelines:
- Vary activities between aerobic, muscle strengthening, bone strengthening (esp. important for children and teens), and balance and stretching
- Bursts of activity (brisk walk, etc.) of at least 10 minutes provide health benefits
- Moderate to vigorous activity associated with most health benefits; even light activity is a place to start for those who are sedentary
5) Support Healthy Eating Patterns for All
• “Vast majority” of Americans aren’t following the recommendations in the DG; professionals can work together – w/ help from public – to put the DG into action around the nation.
• Home, schools, workplace, community
History of Dietary Guidance in U.S.
a. USDA – diet rec’s x > 100 yr
b. 1980: USDA + DHHS joint rec’s
c. Progression:
Consistency of recommendations
Increased specificity of guidance
Implementation challenges
Increasing emphasis on evidence based review process
Moving toward healthy dietary pattern (2015)
Fun history of different dietary guidelines
1940’s: Basic 7
1956-70’s
Basic 4
Foundational diet→ nutrient adequacy
1979: “Hassle Free Daily Food Guide”
BFFG + limit fats, sugar, alcohol
1984: “Food Wheel”
5 food groups, 3 calorie levels
’92-’05: Food Guide Pyramid
Total diet approach: goals for nutrient adequacy and moderation; 3 kcal levels
’05-’11: My Pyramid
Variety, moderation, proportion
1st physical activity
12 calorie levels; 41 rec’s
Public Health Promotion through Dietary Recommendations
a. What: science-based advice to promote health and reduce risk for major chronic diseases through diet and physical activity…for general public.
b. Applications: Guide Federal policy: USDA & DHHS
i. Basis of Federal food, nutrition education, and information programs
ii. By law must be promoted by all Federal agencies
1980 - 2005
“Eat a variety of foods” → “Let the Pyramid guide your food choices” (2000)
1980: “Maintain ideal body weight”
1985: “Maintain desirable weight”
1990: “Maintain healthy weight”
1995: “Maintain or improve your weight”(1st time to mention physical activity & E balance)
2000: “Aim for a healthy weight”
2005: “Eat fewer calories, be more active”
Do DGA have an impact on consumers?
a. Federal policy – “food stamps”, WIC, school lunch, etc
b. < 25% parents indicate [whole] grains should be primary food group
c. ~ 50% people overestimate caloric needs
d. 71% Americans have heard of DGA-10, 50% knew little about them
DGA 2015: Major Aspects
a. ~ ½ of US adults (~117 M) have ≥ 1 preventable, chronic diseases & 2/3 (155 M) overweight/obese
i. Conditions highly prevalent x > 2 decades
ii. Poor diet patterns, excess calories & physical inactivity contribute
b. Lifestyle behaviors (diet & physical activity) influenced by personal, social, organizational, environmental contexts
5 Major Themes of DGA 2015
- Follow healthy eating pattern
i. Healthy US Style
ii. Healthy Mediterranean style
iii. Healthy Vegetarian - Focus on variety, nutrient density, & amount
- Limit calories from added sugars & saturated fats, & reduce sodium intake
- Shift to healthier food & beverage choices
- Support healthy eating patterns for all
Healthy US Style
Part of DGA (important)
a. Variety of vegetables
i. All of the subgroups—dark green, red and orange, legumes (beans and peas), starchy, and other
b. Fruits, especially whole fruits
c. Grains, ≥ half whole grains
d. Fat-free or low-fat dairy
i. Milk, yogurt, cheese, and/or fortified soy beverages
e. Variety of protein foods:
i. Seafood, lean meats and poultry, eggs, legumes (beans and peas), and nuts, seeds, and soy products
f. Oils –
i. From plants: olive, canola, corn, peanut, etc + “naturally present in foods” (nuts, avocados, seeds, olives, seafood)
Know these general nutrition rules for DGA
- Variety of vegetables
i. All of the subgroups—dark green, red and orange, legumes (beans and peas), starchy, and other - Fruits, especially whole fruits
- Grains, ≥ half whole grains
- Fat-free or low-fat dairy
i. Milk, yogurt, cheese, and/or fortified soy beverages - Variety of protein foods:
i. Seafood, lean meats and poultry, eggs, legumes (beans and peas), and nuts, seeds, and soy products
Healthy Mediterranean style
a. More fruits and seafood, less dairy compared to Healthy U.S.-Style
i. Critical to see more fruit and seafood
b. Example of Mediterranean: Breads & cereals (unrefined) Fruits & vegetables Nuts Olive oil Fish Limited: sat. fat, meats, full fat dairy
Healthy Vegetarian
a. More (cf US Healthy Style):
- legumes (beans and peas)
- soy products
- nuts and seeds
- whole grains
b. No meats, poultry, or seafood
- Follow a Healthy Eating Pattern Across the Lifespan
Eating pattern: combination of all the foods and beverages a person eats and drinks over time
i. Significant impact on health(prevent/reduce chronic diseases)
ii. Adaptable (preferences, traditions, culture, budget)
- Focus on Variety, Nutrient Density, & Amount
a. Appropriate caloric intake for age, sex, activity level (ie, energy balance!)
b. Meet nutritional needs (ie, RDA’s)
c. Be achievable & maintainable
d. Nutrient-dense foods: right balance
i. Plenty of key nutrients
ii. Naturally lean or low in solid fats
iii. Little or no added solid fats, sugars, refined starches, or sodium
iv. Nutrient-dense foods are the foundation of a healthy eating pattern
Nutrient-dense foods: right balance
Nutrient-dense foods: right balance
a. Plenty of key nutrients
b. Naturally lean or low in solid fats
c. Little or no added solid fats, sugars, refined starches, or sodium
d. Nutrient-dense foods are the foundation of a healthy eating pattern
Nutrient Density Implies:
Variety of vegetables Fruits, especially whole fruits Grains, esp whole grains Fat-free or low-fat dairy Variety of protein foods, Oils, including those from plants
- Limit Calories from Added Sugars & Saturated Fats, & Reduce Sodium
a. Added sugars: limit < 10% total calories
b. Saturated fats:
i. Consume < 10% calories SFA
ii. Limit trans fats: as low as possible
c. Reduce sodium intake to < 2300 mg/d(~ 1 tsp salt/day)
d. Alcohol: limit to ≤ 1 drink per day for women and 2 drinks per day for men
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Protein Biochem and Metabolism56
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Protein Biochemistry56
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Purine and Pyrimidine Metabolism42
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Inborn Errors: Amino Acid and Urea Cycle41
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Inborn Errors: Glycolipid Disorders37
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Hospital Based Nutrition49
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Nutrition Intro41
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Dietary Guidelines41
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Eating Disorders19
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Fat Soluble Vitamins43
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Water Soluble Vitamins41
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Micronutrients: Trace Elements56
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Malnutrition23
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International Nutrition42
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Adult Obesity and Metabolic Syndrome60
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Obesity Treatment: Diet and Activity70
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Regulation of Energy Intake & Body Weight Regulation38
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Pediatric Obesity: Health Implications36
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Obesity Treatment: Drugs, Surgical Options and Popular Diets36
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Nutritional Counseling for Behavior Change20
