2.1: Understanding the Bigger Picture of Dietary Guidelines

Learning Objectives

• Describe the major themes of the 2020-2025 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 intakes 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 (HHS). 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.

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 nation-wide 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 Dietary Guidelines is to provide informative guidelines that will help any interested person in obtaining optimal nutritional balance and health. The seventh edition of the Dietary Guidelines was released in 2010 and focused mainly on combating the obesity epidemic. USDA Secretary Tom Vilsack said, “The bottom line is that most Americans need to trim their waistlines to reduce the risk of developing diet-related chronic disease. Improving our eating habits is not only good for every individual and family, but also for our country.” The 2015 Dietary Guidelines focus on eating patterns, which may be predictive of overall health status and disease risk. The Dietary Guidelines were formulated by the Food and Nutrition Board of the Institute of Medicine (IOM), which has recently changed its name to the National Academy of Medicine (NAM). The 2020–2025 Dietary Guidelines are designed to help Americans eat a healthier diet. Intended for policymakers and health professionals, the 2020 edition of the Dietary Guidelines outlines how people can improve their overall eating patterns — the complete combination of foods and drinks in their diet. The free 2020 edition offers overarching themes about what constitutes a healthy diet, how to shift behaviors to make it possible to follow a healthful diet and a number of Key Recommendations with specific nutritional targets and dietary limits. These guidelines are from the review of thousands of scientific journal articles by a consensus panel consisting of more than two thousand nutrition experts with the overall mission of improving the health of the nation.

Figure \(\PageIndex{2}\): The major theme of the 2020-2025 Dietary Guidelines for Americans is to make every bite count. © Dreamstime

Major Themes of the 2020-2025 Dietary Guidelines

The 2020 Dietary Guidelines consists of four major action steps for the American public to improve their eating habits. It also includes several key recommendations. These four steps are as follows:

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.

Below are the highlights for each guideline; however, if you are interested in reading more, visit the USDA website, https://health.gov/dietaryguidelines/2015/guidelines/.

Make every bite count with the Dietary Guidelines for Americans. Here’s how:

1. Follow a healthy diet 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. 1 2 Follow a healthy dietary pattern at every life stage.

1. 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 provides a framework intended to be customized to individual needs and preferences, as well as the foodways of the diverse cultures in the United States.

1. 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. 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

1. 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.

How should you develop a healthy eating plan to best achieve your goals of losing weight, gaining weight, or maintaining weight? We will start with some basics and move on to healthy eating patterns. To provide further guidance, several key recommendations are provided. These should be applied in their entirety because of their interconnectedness.

Consume a healthy eating pattern that accounts for all foods and beverages within an appropriate calorie level.

A health heating pattern includes:

• A variety of vegetables from all of the subgroups - dark green, red and orange, legumes (beans and peas), starchy, and other
• Fruits, especially whole fruits
• Grains, at least half of which are whole grains
• Fat-free or low-fat dairy, including milk, yogurt, cheese, and/or fortified soy beverages
• A variety of protein foods, including seafood, lean meats and poultry, eggs, legumes (beans and peas), and nuts, seeds, and soy products
• Oils

The following components of the diet should be limited in order to achieve a healthy eating pattern:

• Consume less than 10 percent of calories per day from added sugars
• Consume less than 10 percent of calories per day from saturated fats
• Consume less than 2,300 milligrams (mg) per day of sodium
• If alcohol is consumed, it should be consumed in moderation - up to one drink per day for women and up to two drinks per day for men - and only by adults of legal drinking age.

Finally, all Americans regardless of age should meet the Physical Activity Guidelines for Americans.

Foods and Food Components to Reduce

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

Table \(\PageIndex{1}\): A Little Less of These, Please

Dietary Constituent	Health Implications	Recommendations
Excess sodium	High blood pressure	Limit intake to 2,300 mg daily
Too much saturated fat	Cardiovascular disease	Limit intake to < 10 percent of total calories
Trans fats	Cardiovascular disease	Minimal, if any consumption
Excess cholesterol	Atherosclerosis	Limit intake to below 300 mg daily
SoFAS (solid fats and added sugars)	Obesity, Type 2 diabetes	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

The average person consumes 3,400 milligrams of sodium per day, mostly 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 that fat calories should be obtained by eating foods high in unsaturated fatty acids. Cholesterol intake should be decreased to below 300 milligrams per day and trans fatty acid consumption kept to a bare minimum. The Dietary Guidelines stresses the importance of limiting the consumption of foods with refined grains and added sugars, and introduce the new term, SoFAS, which is an acronym for solid fats and added sugars, both of which are to be avoided in a healthy diet plan.Nelson, J. and K. Zeratsky. “Dietary Guidelines Connect SoFAS and Weight Gain.” Mayo Clinic, Nutrition-Wise (blog). August 25, 2010. www.mayoclinic.com/health/die...elines/MY01417. Moreover, if alcohol is consumed, it should be consumed only in moderation, which for women it is not more than one drink per day and for men is not more than two drinks per day. 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 \(\PageIndex{2}\)).

Table \(\PageIndex{2}\): 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: 2010 Dietary Guidelines.

Foods and Nutrients to Increase

The typical American diet lacks sufficient amounts of vegetables, fruits, whole grains, and high-calcium foods, causing concern for deficiencies in certain nutrients important for maintaining health. The 2010 Dietary Guidelines provide the following suggestions on food choices to achieve a healthier diet:

1. Eat a variety of vegetables, especially dark green, red, and orange vegetables.
2. Choose at least half of your grains consumed from whole-grain foods.
3. For dairy products, eat the low-fat versions.
4. Don’t get your protein only from red meats; choose instead seafood, poultry, eggs, beans, peas, nuts, seeds, and soy products.
5. Replace butter with oils.
6. Choose foods dense in the nutrients potassium, calcium, and vitamin D.
7. Increase intake of dietary fiber.

The typical American diet lacks sufficient amounts of vegetables, fruits, whole grains, and high-calcium foods, causing concern for deficiencies in certain nutrients important for maintaining health. The Dietary Guidelines provide the following suggestions on food choices to achieve a healthier diet:

Instead of…	Replace with…
Sweetened fruit yogurt	Plain fat-free yogurt with fresh fruit
Whole milk	Low-fat or fat-free milk
Cheese	Low-fat or reduced-fat cheese
Bacon or sausage	Canadian bacon or lean ham
Sweetened cereals	Minimally sweetened cereals with fresh fruit
Apple or berry pie	Fresh apple or berries
Deep-fried French fries	Oven-baked French fries or sweet potato baked fries
Fried vegetables	Steamed or roasted vegetables
Sugary sweetened soft drinks	Seltzer mixed with 100 percent fruit juice
Recipes that call for sugar	Experiment with reducing amount of sugar and adding spices (cinnamon, nutmeg, etc…)

Source: Food Groups. US Department of Agriculture. www.choosemyplate.gov/food-groups/. Updated April 19, 2017. Accessed November 22, 2017.

Building Healthy Eating Patterns

The 2020 Dietary Guidelines recommend that people make an effort to reduce their caloric consumption, reduce the intake of nutrient-poor foods, and increase the intake of nutrient-dense foods. To accomplish these tasks it is necessary to incorporate moderation and variety. The goal is not only choosing specific foods for your diet, but also the development of a healthy eating pattern. Several studies provide good evidence that certain dietary patterns increase overall health and decrease the risk of chronic disease. The Dietary Approaches to Stop Hypertension trial, or DASH, reports that men and women who consumed more than eight servings per day of fruits and vegetables had lower blood pressures than a control group that consumed under four servings per day of fruits and vegetables.Sacks, F.M, et al., “Effects on Blood Pressure of Reduced Dietary Sodium and the Dietary Approaches to Stop Hypertension (DASH) Diet.” N Engl J Med. 344, no. 1 (January 2001): 3–10. http://www.nejm.org/doi/full/10.1056/NEJM200101043440101. Other studies investigating the benefits of the DASH diet have also found it to be protective against cardiovascular disease and decrease overall mortality. Another well-known diet is the Mediterranean diet. In general, the Mediterranean diet is described as one that emphasizes fruits, vegetables, whole grains, and nuts, and olive oil as a replacement for butter. Few meats and high-fat dairy products are eaten. Observational studies have linked the Mediterranean diet to reduced cardiovascular disease and decreased mortality. Vegetarian diets, which emphasize many of the same foods as the DASH and Mediterranean diets have also been linked to a decrease in incidences of some chronic diseases.

Figure \(\PageIndex{3}\): Fresh vegetables and olive oil are examples of foods emphasized in the DASH and Mediterranean diets. © Thinkstock

Key Takeaways

• US dietary guidelines are based on evolving scientific evidence and are updated every five years. The goals of the 2015-2020 Dietary Guidelines are to prevent nutrient inadequacy, promote health, reduce chronic disease, and decrease the prevalence of overweight and obesity.
• To have a healthy eating pattern, reduce the intake of sodium, saturated and trans fats, cholesterol, added sugars, and refined grains. Increase the consumption of fruits, vegetables, low-fat dairy products, dietary fiber, and oils.
• Healthy eating patterns prevent chronic disease and provide nutrient adequacy.

Discussion Starter

1. Discuss with your classmates suggestions from the 2015-2020 Dietary Guidelines that you should incorporate into your diet. How can you align your personal dietary goals with these recommendations?