1.11: Understanding the Bigger Picture of Dietary Guidelines

Skills to Develop

• Describe the major themes of the 2020-2025 US Dietary Guidelines for Americans.

The first US dietary recommendations were set by the National Academy of Sciences in 1941. The recommended dietary allowances (RDA) were first established out of concern that America’s overseas World War II troops were not consuming enough daily nutrients to maintain good health. The first Food and Nutrition Board was created in 1941, and in the same year set recommendations for the adequate intake of caloric energy and eight essential nutrients. These were disseminated to officials responsible for food relief for armed forces and civilians supporting the war effort. Since 1980, the dietary guidelines have been reevaluated and updated every five years by the advisory committees of the US Department of Agriculture (USDA) and the US Department of Health and Human Services (USDHHS). The guidelines are continually revised to keep up with new scientific evidence-based conclusions on the importance of nutritional adequacy and physical activity to overall health. While dietary recommendations set prior to 1980 focused only on preventing nutrient inadequacy, the current dietary guidelines have the additional goals of promoting health, reducing chronic disease, and decreasing the prevalence of overweight and obesity. The guidelines are also used to provide a scientific basis for the USDA school food lunch program and the Food Stamp program.

Figure \(\PageIndex{}\): .1: Dietary guidelines help people to stay on a healthful track by drawing attention to the overall scope of their diet and lifestyle. © Dreamstime

Why Are Guidelines Needed?

Instituting nationwide standard policies provides consistency across organizations and allows healthcare workers, nutrition educators, school boards, and elder-care facilities to improve nutrition and, subsequently, the health of their respective populations. At the same time, the goal of the 2020-2025 Dietary Guidelines (https://www.dietaryguidelines.gov/) is to provide informative guidelines that will help any interested person in obtaining optimal nutritional balance and health. The ninth edition of the Dietary Guidelines was released in 2020 and focuses on making every bite count. This edition marks the first time the guidelines have provided recommendations by life stage, from birth through older adulthood. The Dietary Guidelines are formulated by the Food and Nutrition Board of the Institute of Medicine (IOM) from the review of thousands of scientific journal articles by a consensus panel consisting of many nutrition experts with the overall mission of improving the nation’s health.

Figure \(\PageIndex{}\): .2: The major theme of the 2015 Dietary Guidelines for Americans is a healthy eating pattern combined with regular physical activity.

Major Themes of the 2020-2025 Dietary Guidelines

The 2020-2025 Dietary Guidelines consist of four guidelines to help the American public improve their eating habits. Each guideline has specific recommendations. Here are the four guidelines:

1. Follow a healthy dietary pattern at every life stage.
2. Customize and enjoy nutrient-dense food and beverage choices to reflect personal preferences, cultural traditions, and budgetary considerations
3. Focus on meeting food group needs with nutrient-dense foods and beverages, and stay within calorie limits.
4. Limit foods and beverages higher in added sugars, saturated fat, and sodium, and limit alcoholic beverages.

Here is more detailed guidance from the Dietary Guidelines for Americans on how to make every bite count:

1. Follow a healthy dietary pattern at every life stage. At every life stage—infancy, toddlerhood, childhood, adolescence, adulthood, pregnancy, lactation, and older adulthood—it is never too early or too late to eat healthfully.
   • For about the first 6 months of life, exclusively feed infants human milk. Continue to feed infants human milk through at least the first year of life, and longer if desired. Feed infants iron-fortified infant formula during the first year of life when human milk is unavailable. Provide infants with supplemental vitamin D beginning soon after birth.
   • At about 6 months, introduce infants to nutrient-dense complementary foods. Introduce infants to potentially allergenic foods along with other complementary foods. Encourage infants and toddlers to consume a variety of foods from all food groups. Include foods rich in iron and zinc, particularly for infants fed human milk.
   • From 12 months through older adulthood, follow a healthy dietary pattern across the lifespan to meet nutrient needs, help achieve a healthy body weight, and reduce the risk of chronic disease.
2. Customize and enjoy nutrient-dense food and beverage choices to reflect personal preferences, cultural traditions, and budgetary considerations. A healthy dietary pattern can benefit all individuals regardless of age, race, or ethnicity, or current health status. The Dietary Guidelines provide a framework intended to be customized to individual needs and preferences, as well as the foodways of the diverse cultures in the United States.
3. Focus on meeting food group needs with nutrient-dense foods and beverages, and stay within calorie limits. An underlying premise of the Dietary Guidelines is that nutritional needs should be met primarily from foods and beverages—specifically, nutrient-dense foods and beverages. Nutrient-dense foods provide vitamins, minerals, and other health-promoting components and have no or little added sugars, saturated fat, and sodium. A healthy dietary pattern consists of nutrient-dense forms of foods and beverages across all food groups, in recommended amounts, and within calorie limits.

   1. The core elements that make up a healthy dietary pattern include:

      •      Vegetables of all types—dark green; red and orange; beans, peas, and lentils; starchy; and other vegetables

      •      Fruits, especially whole fruit

      •      Grains, at least half of which are whole grain

      •      Dairy, including fat-free or low-fat milk, yogurt, and cheese, and/or lactose-free versions and fortified soy beverages and yogurt as alternatives

      •      Protein foods, including lean meats, poultry, and eggs; seafood; beans, peas, and lentils; and nuts, seeds, and soy products

      •      Oils, including vegetable oils and oils in food, such as seafood and nuts

4. Limit foods and beverages higher in added sugars, saturated fat, and sodium, and limit alcoholic beverages. At every life stage, meeting food group recommendations—even with nutrient-dense choices—requires most of a person’s daily calorie needs and sodium limits. A healthy dietary pattern doesn’t have much room for extra added sugars, saturated fat, or sodium—or for alcoholic beverages. A small amount of added sugars, saturated fat, or sodium can be added to nutrient-dense foods and beverages to help meet food group recommendations, but foods and beverages high in these components should be limited. Limits are:

• Added sugars—Less than 10 percent of calories per day starting at age 2. Avoid foods and beverages with added sugars for those younger than age 2.
• Saturated fat—Less than 10 percent of calories per day starting at age 2.
• Sodium—Less than 2,300 milligrams per day—and even less for children younger than age 14.
• Alcoholic beverages—Adults of legal drinking age can choose not to drink, or to drink in moderation by limiting intake to 2 drinks or less in a day for men and 1 drink or less in a day for women, when alcohol is consumed. Drinking less is better for health than drinking more. There are some adults who should not drink alcohol, such as women who are pregnant.

 

Finally, all Americans, regardless of age, should meet the Physical Activity Guidelines for Americans (https://health.gov/our-work/nutrition-physical-activity/physical-activity-guidelines/current-guidelines/scientific-report).

Foods and Food Components to Reduce

High consumption of certain foods, such as those high in saturated and trans fat, sodium, and added sugars may contribute to the increased incidence of chronic disease. Additionally, excessive consumption of these foods replaces the intake of more nutrient-dense foods.

Table 1.11.1: A Little Less of These, Please

Dietary Constituent	Health Implications	Recommendations
Excess sodium	High blood pressure	Limit intake to 2,300 mg daily
SoFAS (solid fats and added sugars)	Obesity, Type 2 diabetes, CVD, cancer	Avoid if possible
Too much alcohol	Impaired liver function, impaired motor function	No more than one drink per day for women; No more than two drinks per day for men
Too much saturated fat	Cardiovascular disease	Limit intake to < 10 percent of total calories
Trans fats	Cardiovascular disease	Minimal, if any consumption
Cholesterol	Cardiovascular disease	Minimal, if any consumption
Caffeine		Drink in moderation (no more than three to five 8 oz cups/day)

 

The average person consumes 3,400 milligrams of sodium per day, mainly in the form of table salt. The 2020 Dietary Guidelines recommend that Americans reduce their daily sodium intake to less than 2,300 milligrams. If you are over the age of fifty-one, are African American, or have cardiovascular risk factors, such as high blood pressure or diabetes, sodium intake should be reduced even further to 1,500 milligrams. The Dietary Guidelines also recommend that less than 10 percent of calories come from saturated fat, and those fat calories should be obtained by eating foods high in unsaturated fatty acids. Cholesterol and trans fatty acid intake should be as low as possible without compromising the diet’s nutrition adequacy. The Dietary Guidelines stress the importance of limiting the consumption of foods with refined grains and added sugars. Added sugars should make up less than 10% of one’s total daily caloric intake. If alcohol is consumed, it should be consumed in moderation, which is not more than one drink per day for women and not more than two drinks per day for men. The macronutrients protein, carbohydrates, and fats contribute considerably to total caloric intake. The IOM has made recommendations for different age groups on the percentage of total calories that should be obtained from each macronutrient class (Table 1.11.2).

Table 1.11.2: Recommendations for Macronutrient Intake As Percentage of Total Calories

Age Group	Protein (%)	Carbohydrates (%)	Fat (%)
Children (1–3)	5–20	45–65	30–40
Children and Adolescents (4–18)	10–30	45–65	25–35
Adults (>19)	10–35	45–65	20–35

Source: 2020 Dietary Guidelines.