11.4: A Proper Diet
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\(\newcommand{\avec}{\mathbf a}\) \(\newcommand{\bvec}{\mathbf b}\) \(\newcommand{\cvec}{\mathbf c}\) \(\newcommand{\dvec}{\mathbf d}\) \(\newcommand{\dtil}{\widetilde{\mathbf d}}\) \(\newcommand{\evec}{\mathbf e}\) \(\newcommand{\fvec}{\mathbf f}\) \(\newcommand{\nvec}{\mathbf n}\) \(\newcommand{\pvec}{\mathbf p}\) \(\newcommand{\qvec}{\mathbf q}\) \(\newcommand{\svec}{\mathbf s}\) \(\newcommand{\tvec}{\mathbf t}\) \(\newcommand{\uvec}{\mathbf u}\) \(\newcommand{\vvec}{\mathbf v}\) \(\newcommand{\wvec}{\mathbf w}\) \(\newcommand{\xvec}{\mathbf x}\) \(\newcommand{\yvec}{\mathbf y}\) \(\newcommand{\zvec}{\mathbf z}\) \(\newcommand{\rvec}{\mathbf r}\) \(\newcommand{\mvec}{\mathbf m}\) \(\newcommand{\zerovec}{\mathbf 0}\) \(\newcommand{\onevec}{\mathbf 1}\) \(\newcommand{\real}{\mathbb R}\) \(\newcommand{\twovec}[2]{\left[\begin{array}{r}#1 \\ #2 \end{array}\right]}\) \(\newcommand{\ctwovec}[2]{\left[\begin{array}{c}#1 \\ #2 \end{array}\right]}\) \(\newcommand{\threevec}[3]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \end{array}\right]}\) \(\newcommand{\cthreevec}[3]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \end{array}\right]}\) \(\newcommand{\fourvec}[4]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \\ #4 \end{array}\right]}\) \(\newcommand{\cfourvec}[4]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \\ #4 \end{array}\right]}\) \(\newcommand{\fivevec}[5]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \\ #4 \\ #5 \\ \end{array}\right]}\) \(\newcommand{\cfivevec}[5]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \\ #4 \\ #5 \\ \end{array}\right]}\) \(\newcommand{\mattwo}[4]{\left[\begin{array}{rr}#1 \amp #2 \\ #3 \amp #4 \\ \end{array}\right]}\) \(\newcommand{\laspan}[1]{\text{Span}\{#1\}}\) \(\newcommand{\bcal}{\cal B}\) \(\newcommand{\ccal}{\cal C}\) \(\newcommand{\scal}{\cal S}\) \(\newcommand{\wcal}{\cal W}\) \(\newcommand{\ecal}{\cal E}\) \(\newcommand{\coords}[2]{\left\{#1\right\}_{#2}}\) \(\newcommand{\gray}[1]{\color{gray}{#1}}\) \(\newcommand{\lgray}[1]{\color{lightgray}{#1}}\) \(\newcommand{\rank}{\operatorname{rank}}\) \(\newcommand{\row}{\text{Row}}\) \(\newcommand{\col}{\text{Col}}\) \(\renewcommand{\row}{\text{Row}}\) \(\newcommand{\nul}{\text{Nul}}\) \(\newcommand{\var}{\text{Var}}\) \(\newcommand{\corr}{\text{corr}}\) \(\newcommand{\len}[1]{\left|#1\right|}\) \(\newcommand{\bbar}{\overline{\bvec}}\) \(\newcommand{\bhat}{\widehat{\bvec}}\) \(\newcommand{\bperp}{\bvec^\perp}\) \(\newcommand{\xhat}{\widehat{\xvec}}\) \(\newcommand{\vhat}{\widehat{\vvec}}\) \(\newcommand{\uhat}{\widehat{\uvec}}\) \(\newcommand{\what}{\widehat{\wvec}}\) \(\newcommand{\Sighat}{\widehat{\Sigma}}\) \(\newcommand{\lt}{<}\) \(\newcommand{\gt}{>}\) \(\newcommand{\amp}{&}\) \(\definecolor{fillinmathshade}{gray}{0.9}\)A Word of Caution
Since proper nutrition depends on consuming a proper diet, we will now explore such a diet for healthy adults. One must realize that the following recommendations may be improper for individuals who are in unusual situations or have abnormal or disease conditions. Examples include athletes undergoing intense physical training, people living in extremely hot or cold environments, individuals who are bedridden, and people with diabetes mellitus or kidney failure. Such individuals need to implement significant modifications to the recommendations to achieve nutritional homeostasis or avoid additional problems from their peculiar circumstances or diseases. This concept is especially important in regard to the elderly because people become more heterogeneous with age. Therefore, while the following recommendations can serve as guidelines in evaluating and planning diets for groups of healthy elderly people, they should be applied to individuals with caution.
Diet Based on Food Selection
Describing a diet in terms of commonly eaten foods is the most practical way to select a diet that will provide nutritional homeostasis for most healthy adults. The U.S. Department of Agriculture (USDA) has developed such a diet, My Plate. Though this plan consists of food groups, items high in fats, oils, and sweets provide energy but few other necessary nutrients. Foods from this group should be minimized except for individuals who are active and need to obtain more energy. (Suggestion 236.01.02) (Suggestion 136.01.03)
To see old Food Guide Pyramids and the new MyPlate updates and applications, go to http://www.choosemyplate.gov/ . (Suggestion 237.01.Figure 11.1)
To see information about a specialized MyPlate for elders, go to
https://now.tufts.edu/news-releases/tufts-university-nutrition-scientists-provide-updated-myplate-older-adults or https://www.nutritionletter.tufts.edu/healthy-eating/myplate-for-older-adults-eat-right-for-your-age .
To download and use the MyPlate icon and related graphics, go to https://www.choosemyplate.gov/resources/myplate-graphic-resources and https://www.choosemyplate.gov/ .
The U.S. RDAs have been replaced by the Reference Daily Intake (RDI). The list includes only values for protein, vitamins, and minerals for use in nutrition labeling. The values for the U.S. RDAs were essentially the same as those in the RDIs except for protein. Food labeling information on Reference Daily Intakes (RDIs), Daily Reference Values (DRVs), Daily Values (DVs),, and % DVs is at "Food Labeling & Nutrition" (https://www.fda.gov/food/food-labeling-nutrition) and "Dietary Reference Intakes" (https://www.nal.usda.gov/fnic/dietary-reference-intakes).
Information from the FDA called " Changes to the Nutrition Facts Label” is at https://www.fda.gov/food/food-labeling-nutrition/changes-nutrition-facts-label
Information for elders from the FDA called " Understanding and Using the Nutrition Facts Label” is at https://www.fda.gov/files/food/published/Understanding-and-Using-the-Nutrition-Facts-Label---Companion-Patient-Materials.pdf .
Selecting recommended servings each day from the other five food groups and varying the selections within each group will provide an adult who engages in a fairly low amount of physical activity with adequate amounts of almost all essential nutrients. Individuals who are more active should increase serving sizes or, better still, increase the number and variety of servings. Individuals who are inactive should increase their physical activity so that they can select enough servings with enough variety to achieve nutritional homeostasis without gaining weight. Trying to avoid weight gain by eliminating food groups or servings from the diet can lead to a deficiency in one or more essential nutrients.
The Food Guide Pyramid, and perhaps My Plate, can be improved by including foods with vitamin C (e.g., citrus fruits) from the fruit group; choosing items with minimum fat content from the milk and meat groups; and selecting items made with whole grains from the bread group.
Although following the Food Guide Pyramid, My Plate, and these three suggestions will provide adequate dietary nutrients, this alone may not solve other problems associated with an improper diet. These problems include atherosclerosis, diabetes mellitus, tooth decay, high blood pressure, constipation, cancer, cirrhosis, and accidents. Therefore, the USDA and the Department of Health and Human Services have added several recommendations, such as (1) avoiding fat, saturated fat, cholesterol, sugar, and sodium, (2) consuming enough starch and fiber, and (3) not drinking more than a moderate amount of alcoholic beverages.
The Food Guide Pyramids are outdated. They were replaced with My Plate, which seems to lack information specific for elders. Go to https://www.choosemyplate.gov/ or put https://www.choosemyplate.gov/ into the place of the URL in your browser. Use the links or the Search feature on the home page for https://www.choosemyplate.gov/ to find information on topics of interest (e.g., history of MyPlate, graphics, and a specialized MyPlate for elders).
For a “A Brief History of USDA Food Guides” including Food Guide Pyramids, see https://myplate-prod.azureedge.net/sites/default/files/2020-12/ABriefHistoryOfUSDAFoodGuides.pdf
See also “Healthy Eating Plate” at https://www.health.harvard.edu/plate/healthy-eating-plate.
For a “A Brief History of USDA Food Guides” including Food Guide Pyramids, see https://myplate-prod.azureedge.net/sites/default/files/2020-12/ABriefHistoryOfUSDAFoodGuides.pdf
To download and use the MyPlate icon and related graphics, go to http://www.choosemyplate.gov/print-materials-ordering/graphic-resources.html and http://www.choosemyplate.gov/food-groups/downloads/MyPlate/MyPlateGraphicsStandards.pdf.
For information about a specialized MyPlate for elders, go to http://www.nutrition.tufts.edu/research/myplate-older-adults .
Diet Based on Chemical Composition
Recommended Dietary Allowances
The recommendations for a proper diet based on food selection were developed primarily to ensure that individuals could regularly obtain adequate amounts of each nutrient. These amounts have been established by the Food and Nutrition Board of the National Academy of Science and are referred to as the Recommended Dietary Allowances (RDAs) of nutrients whose requirements have been well studied. The RDAs provide enough of each nutrient to maintain good health and are higher than the amounts needed just to survive. The RDAs and the dietary recommendations mentioned next can be found in tables in most textbooks on nutrition. (Suggestion 236.02.04)
Several features of the RDAs warrant special attention. First, the recommendations are for individuals of certain weights and heights and should be adjusted for the individual. Second, except for infants and children, men and women have different RDAs. Third, the RDAs group individuals into categories based on age. Fourth, there are only two age categories for those over age 24. These categories are ages 25 to 50 and age 51 and over. This lumps all elderly individuals together even though it is thought that age changes after age 51 affect nutritional needs. Though little information is available about adjusting the RDAs to compensate for these age changes, a few recommendations are included in the second part of this chapter.
Besides the RDAs for specific nutrients, a table of recommended energy intake has been developed. In this table, the estimated energy requirements, indicated as kcals, are for persons who perform light to moderate physical activity. A kcal, or kilocalorie, also called a Calorie (note the uppercase C), is the unit most often used to measure the energy content in food or the energy consumed. A kilocalorie is 1,000 calories (note the lowercase c).
Persons with body dimensions that differ greatly from those listed in the table and individuals whose activity levels are very low (e.g., the bedridden) or very high (e.g., athletes) may have energy requirements as much as 1,000 kcal below or above those listed. Individuals recovering from a serious illness or accident also often need an increased energy intake to provide the energy necessary for healing. For any particular individual, the best way to estimate energy requirements is to determine the energy intake needed to maintain a desirable body weight as discussed later in this chapter.
The energy table shows that the energy requirements for people age 51 and over are lower than those for younger adults. The decline in recommended energy intake at higher ages is based on the average age-related decline in muscle mass and amount of physical activity.
Calculations using the RDAs for protein intake for people age 51 and over result in a value of approximately 0.8 gram per kilogram (0.36 gram per pound) of body weight. Other authorities suggest that the elderly can benefit from a protein intake of 1.0 gram per kilogram (0.45 gram per pound) of body weight while reducing energy intake from carbohydrates and fat. This modification can assure an adequate protein intake while preventing weight gain since elderly people tend to have lower energy requirements.
U.S. Recommended Daily Allowances
Though the RDAs are listed as daily allowances, a person need not consume each nutrient in the recommended amount each day because the body can store excess nutrients and release the stored nutrients when lesser quantities are eaten. A person need only consume enough of each nutrient over a few days or a week so that the average amounts consumed each day correspond to the RDAs.
To assist consumers and those evaluating and planning diets, the Food and Drug Administration used the values in the RDAs to develop the U.S. Recommended Daily Allowance (U.S. RDA) for many nutrients. The age categories for U.S. RDAs are even broader than those for RDAs, placing all individuals above age 3 into one category.
The labels on many packaged foods list the percentages of the U.S. RDA for many nutrients. This information is useful in determining the nutrient quality of foods and the contribution each food item can make to a person's daily nutrient intake.
Estimated Safe and Adequate Daily Dietary Intakes
The lists of RDAs do not include all required nutrients. Estimates of requirements for other nutrients have been made by the Food and Nutrition Board and are listed as Estimated Safe and Adequate Daily Dietary Intakes (ESADDIs). This list places all adults into one category regardless of age. (Suggestion 238.01.05)
The ESADDIs are published in Recommended Dietary Allowances: 10th Edition, Food and Nutrition Board, Commission on Life Sciences, National Research Council (1989). A free on-line version can be seen and downloaded by going to http://www.nap.edu/catalog/1349.html . Some ESADDIs are in the Summary Table on page 284 and at http://www.nap.edu/openbook.php?record_id=1349&page=284 .
Dietary Reference Intakes
The Dietary Reference Intakes (DRIs) make up a new comprehensive method for establishing and evaluating recommended dietary intake recommendations. This new system is under development, and some DRIs for specific nutrients have been established. The DRIs will supplant other systems on which it is based. (Suggestion 238.01.07)
An on-line version of the reference book Dietary Reference Intakes: Applications in Dietary Planning (2003) from the Food and Nutrition Board and the Institute of Medicine is at http://www.nap.edu/books/0309088534/html/ .
The tables of Dietary Reference Intakes are at http://www.nap.edu/download.php?record_id=10872#, .and more information about DRIs from the National Academy of Sciences is at http://nationalacademies.org/hmd/Activities/Nutrition/SummaryDRIs/DRI-Tables.aspx .
The DRIs are based on a combination of Recommended Dietary Allowances (RDAs), Estimated Average Requirements (EARs), Adequate Intakes (AIs), and Tolerable Upper Intake Levels (ULs). These four systems have different goals. The RDAs provide adequate intake to give 97 percent of a population adequate intake. The EARs provide adequate intake to give 50 percent of a population adequate nutrient. The AIs list the average intake for a population that will give a desired predetermined outcome (e.g., risk of a disease) based on outcomes from actual diets in that population. The ULs list maximum intakes in an actual population that provide 97 percent to 98 percent of the population with no adverse risks or effects from the high levels of intake.
Because the DRIs are based on systems with diverse standards and goals, different portions of the DRIs should be used in different circumstances so the desired outcomes are most likely to be achieved. Different portions of the DRIs satisfy different percentages of a population. Also, different levels of the DRIs are being set for different types of populations (e.g., age groups, body size, percent body fat, gender, health status, cultures, etc.). The DRIs will use 12 life stages (i.e., 0-6 months, 6-12 months, 1-3 years, 4-8 years, 9-13 years, 14-18 years, 19-30 years, 30-50 years, 51-70 years, 71+ years, and pregnant and lactating women). Different aspects of the DRIs can be used for planning diets, for assessing diets, or for assessing outcomes from programs affecting diets (e.g., institutional meal plans, school meal plans). (Suggestion 238.02.02)
To see all the Recommended Dietary Allowances (RDAs) and the Dietary Reference Intakes (DRIs), go to https://www.nal.usda.gov/fnic/dietary-reference-intakes
and search for "dietary reference intakes". Then search for specific dietary components (e.g., vitamins, minerals, water, macronutrients, electrolytes, etc.).
To calculate DRIs for an individual, go to https://www.nal.usda.gov/fnic/dri-calculator/index.php.
Comparing Proper Diets for Younger and Older Adults
A comparison of proper diets for healthy younger adults and healthy older adults reveals that with very few exceptions, these diets are basically the same. The exceptions include slight increases for the elderly in fiber, protein, and calcium intakes, while total energy and vitamin A intakes should be somewhat lower. If the diets of healthy, active younger and older adults were compared, the recommended differences in protein and total energy intakes would be eliminated, making the diets even more similar. The reason for this similarity is that the types and total amounts of cellular activities and therefore the nutritional needs of healthy active adults remain essentially the same regardless of age. However, increasing age is often accompanied by a decrease in physical activity, unusual situations, abnormal changes, and diseases, all of which may require individualized dietary adjustments.
For nutrition information, exercise, and recommendations for the elderly, go to http://nutritionandaging.fiu.edu/ . It is developed by the National Resource Center on Nutrition, Physical Activity & Aging. Also go to a list of web pages at Web Sites/Nutrition at https://www.biologyofhumanaging.com/websites.htm#Nutrition .