PART A: EXECUTIVE SUMMARY
Dietary Guidelines for Americans provide science-based
advice to promote health and to reduce risk for major chronic
diseases through diet and physical activity. By law (Public
Law 101-445, Section 301), the Secretaries of the Department
of Health and Human Services (HHS) and the Department of Agriculture
(USDA) issue a report at least every 5 years that "shall contain
nutritional and dietary information and guidelines for the
general public." Every 5 years, an expert Dietary Guidelines
Advisory Committee is appointed to make recommendations to
the Secretaries concerning revision of Dietary Guidelines
for Americans. The recommendations are to be targeted
to the general public age 2 years and older and based on the
preponderance of scientific and medical knowledge that is
current at the time of publication of the Committee's report.
Because of its focus on health promotion and risk reduction,
Dietary Guidelines form the basis of Federal food,
nutrition education, and information programs. By law, the
Dietary Guidelines is to be "promoted by each Federal
agency in carrying out any Federal food, nutrition, or health
program." This means that the Dietary Guidelines
must be applied in menu planning in programs such as the National
School Lunch Program; in educational materials used by the
Special Supplemental Nutrition Program for Women, Infants,
and Children (WIC) and by many other Federal programs; and
in setting the Healthy People objectives for the Nation. Using
Dietary Guidelines helps policymakers, educators,
clinicians, and others to speak with one voice on nutrition
and health.
This report presents the recommendations of the 2005 Dietary
Guidelines Advisory Committee to the Secretaries of HHS and
USDA. It represents a milestone in documenting the scientific
base used to develop the recommendations. The Committee used
a fresh approach rather than simply considering how the year
2000 Dietary Guidelines should be changed. Committee
members posed a large number of questions. Questions were
prioritized, and an extensive search of the scientific literature
was done. Available time, expertise, and resources precluded
an examination of all issues relating diet and physical activity
to health promotion and chronic disease prevention.
Working through subcommittees, the Committee critically reviewed
relevant scientific evidence, requested special analyses relating
to nutrients and dietary patterns, obtained useful information
and insights from invited experts and from public oral and
written testimony, and deliberated its findings. Since the
general public now comprises large numbers of individuals
with chronic health problems such as obesity, high blood pressure,
and abnormal blood lipid values, as well as a large elderly
population, the Committee addressed a few topics that may
go beyond the dietary concerns of persons who meet strict
definitions for good health. This report presents findings,
conclusions, and recommendations from the entire Committee.
Appendices and other materials posted at www.health.gov/dietaryguidelines
provide additional details about the evidence used by the
Committee.
The topics that the Committee addressed in depth included
meeting recommended nutrient intakes; physical activity; energy
balance; relationships of fats, carbohydrates, selected food
groups, and alcohol with health; and consumer aspects of food
safety. The Committee was especially interested in finding
strong scientific support for dietary and physical activity
measures that could reduce the Nation's major diet-related
health problems—overweight and obesity, hypertension, abnormal
blood lipids, diabetes, coronary heart disease (CHD), certain
types of cancer, and osteoporosis. They developed the concept
of discretionary calories in connection with calorie and weight
control; discretionary calories are those calories remaining
within a person's caloric allowance after all nutrient recommendations
are met. The Committee also focused on the potential health
benefits and serious health risks of alcohol intake. Because
food can promote health only if it is safe to eat and because
foodborne illness affects more than 76 million Americans each
year, food safety must undergird all dietary guidance.
Back to Top
KEY MESSAGES—TRANSLATING SCIENTIFIC FINDINGS INTO DIETARY
AND PHYSICAL ACTIVITY GUIDANCE
The Committee's extensive review of the evidence and deliberations
led to the development of a set of nine key messages. These
messages should be useful to nutrition-related program providers,
healthcare providers, and educators, as well as to those charged
with the responsibility to produce the publication Dietary
Guidelines for Americans, 2005 Edition. Part D of the
report provides the scientific basis for the nine key messages.
Part E provides specific recommendations for the content of
the main messages and supporting details without specifying
wording that would be suitable for consumers.
The Committee's findings support the development of Dietary
Guidelines that convey the following nine major messages:
-
Consume a variety of foods within and among the basic
food groups while staying within energy needs.
-
Control calorie intake to manage body weight.
-
Be physically active every day.
-
Increase daily intake of fruits and vegetables, whole
grains, and nonfat or low-fat milk and milk products.
-
Choose fats wisely for good health.
-
Choose carbohydrates wisely for good health.
-
Choose and prepare foods with little salt.
-
If you drink alcoholic beverages, do so in moderation.
-
Keep food safe to eat.
This list makes a major departure from previous editions
of Dietary Guidelines for Americans in that it does
not include a message specifically directed toward sugars.
This does not mean that the current Committee views the topic
of sugars to be unimportant. On the contrary, the Committee
provides a strong rationale for limiting one's intake of added
sugars (that is, sugars and syrups that are added to foods
during processing or preparation or at the table). The Committee's
intent is to make this point clearly under the new topic "Choose
Carbohydrates Wisely for Good Health" and also under the first
and second topics, which address energy needs and controlling
calorie intake, respectively.
A synopsis of the Committee's recommendations regarding content
to be included under each of the nine main messages follows.
Back to Top
Consume a Variety of Foods Within and Among the Basic Food
Groups, While Staying Within Energy Needs
Because the recommendations for nutrient intakes from the
Institute of Medicine now consider the prevention of chronic
disease as well as basic nutrient needs, meeting those recommendations
provides a firm foundation for current health and for reducing
chronic disease risk. Thus, meeting recommended nutrient intakes
while staying within energy needs is a basic premise of dietary
guidance. For most nutrients, intakes by Americans appear
adequate. However, efforts are warranted to promote increased
dietary intakes of vitamin E, calcium, magnesium, potassium,
and fiber by children and adults and to promote increased
dietary intakes of vitamins A and C by adults.
Choosing a variety of foods from within each of the basic
food groups helps achieve recommended nutrient intakes, but
attention to maintaining appropriate energy balance also is
important. This means limiting calorie intake, especially
from added sugars, solid fats, and alcoholic beverages—sources
of calories that are very poor sources of essential nutrients.
Use of the revised USDA food intake pattern included in the
report is one method to plan diets that meet recommended nutrient
intakes considering age, gender, and physical activity level.
This food pattern specifies recommended numbers of servings
from the five food groups and from food subgroups. The foods
in these groups are good sources of nutrients relative to
the calories that they provide. The pattern allows a wide
choice of foods within each food group and subgroup, and this
report suggests ways to make substitutions across some of
the food groups as well. Also included in this report are
food lists of the best sources of nutrients that tend to be
in short supply in the diets of Americans. These lists provide
a useful way for consumers to choose foods they like to boost
their intake of the nutrient; and they may be especially helpful
for meeting recommended intakes of vitamin E, potassium, and
fiber. Rather than simply adding nutrient-rich foods to one's
diet, substituting nutrient rich foods for nutrient poor foods
helps control calorie intake.
Special nutrient recommendations are warranted for a few
large subgroups of the population as follows:
-
Adolescent female and women of childbearing age need
extra iron and folic acid.
-
Persons over age 50 benefit from taking vitamin B12 in
its crystalline form from foods fortified with this vitamin
or from supplements that contain vitamin B12.
-
The elderly, persons with dark skin, and persons exposed
to little UVB radiation may need extra vitamin D from
vitamin D-fortified foods and/or supplements that contain
vitamin D.
Back to Top
Control Calorie Intake To Manage Body Weight
Calorie intake and physical activity go hand in hand in controlling
a person's weight. Caloric intake is emphasized under this
message, physical activity under the next one.
To stem the obesity epidemic, most Americans need to reduce
the amount of calories they consume. When it comes to weight
control, calories do count—not the proportions of
carbohydrate, fat, and protein in the diet. Energy expended
must equal energy consumed to stay at the same weight. A deficit
could be achieved by eating less, being more active physically,
or combining the two. Since many adults gain weight slowly
over time, even a small calorie deficit can help avoid weight
gain. For example, a calorie deficit of 50 to 100 calories
per day would enable many adults to maintain their weight
rather than continuing to gain weight each year. For children
who are gaining excess fat, a similar small decrease in energy
intake can reduce the rate at which they gain weight so as
they age they will grow into a healthy weight. Small changes
maintained over time can make a big difference in body weight.
Monitoring weight regularly helps people know if they need
to adjust their food intake or amount of physical activity
to maintain their weight. Limiting the portion sizes that
a person takes or serves to others often helps reduce calorie
intake, especially if the food is high in energy density.
On the other hand, consuming large portions of raw vegetables
or low-fat soups may help limit one's intake of other foods
that are more energy dense. The healthiest way to reduce calorie
intake is to reduce one's intake of added sugars, solid fats,
and alcohol—they all provide calories, but they do not provide
essential nutrients.
Back to Top
Be Physically Active Every Day
Making moderate physical activity a part of an adult's daily
routine for at least 30 minutes per day promotes fitness and
reduces the risk of chronic health conditions such as obesity,
hypertension, diabetes, and coronary artery disease. (Walking
at a brisk pace [3 to 4 miles per hour] is an example of a
moderate physical activity.) Moderate physical activity for
an hour each day can increase energy expenditure by about
150 to 200 calories, depending on body size. If not offset
by increased calorie intake, this increase in physical activity
could be helpful in preventing weight gain. Many adults need
to participate in up to 60 minutes of moderate to vigorous
physical activity on most days to prevent unhealthy weight
gain, while adults who have previously lost weight may need
60 to 90 minutes of moderate physical activity daily to help
avoid regain of weight. Children and adolescents need at least
60 minutes of moderate to vigorous physical activity on most
days for the maintenance of good health and fitness and for
healthy weight gain during growth. Compared with moderate
physical activity, vigorous physical activity provides greater
benefits for physical fitness and burns more calories per
unit time. Part D, Section 2, "Energy," addresses health benefits
of additional types of physical activity.
Back to Top
Choose Fats Wisely For Good Health
Keeping intake of saturated fat, trans fat and cholesterol
very low can help keep low-density lipoprotein (LDL) cholesterol
low and reduce the risk of CHD. The main goals are to keep
saturated fat intake below 10 percent of calories, trans
fat intake below about 1 percent of calories, and cholesterol
intake below 300 mg per day. Keeping saturated fat below 10
percent of calories should be the main focus, because this
is the predominant fat that adversely affects blood lipid
values. However, the lower the combined intake of saturated
and trans fat and the lower the dietary cholesterol
intake, the greater the cardiovascular benefit will be.
The major way to keep saturated fat low is to limit one's
intake of animal fats (such as those in cheese, milk, butter,
ice cream, and other full-fat dairy products; fatty meat;
bacon and sausage; and poultry skin and fat). The major way
to limit trans fat intake is to limit the intake
of foods made with partially hydrogenated vegetable oils.
To limit dietary intake of cholesterol, one needs to limit
the intake of eggs and organ meats especially, as well as
limit the intake of meat, shellfish, and poultry and dairy
products that contain fat.
A reduced risk of both sudden death and CHD death in adults
is associated with the consumption of two servings (approximately
eight ounces) per week of fish high in the n-3 fatty acids
called eicosapentaenoic acid (EPA) and docosahexaenoic acid
(DHA). To benefit from the potential cardioprotective effects
of EPA and DHA, the weekly consumption of two servings of
fish, particularly fish rich in EPA and DHA, is suggested.
However, it is advisable for pregnant women, lactating women,
and children to avoid eating fish with a high mercury content
and to limit their consumption of fish with a moderate mercury
content. Consulting current consumer advisories helps one
know which species of fish to limit or avoid in order to reduce
exposure to environmental contaminants.
Total fat intake of 20 to 35 percent of calories is recommended
for all Americans age 18 years or older. Intakes of fat outside
of this range are not recommended for most Americans because
of potential adverse effects on achieving recommended nutrient
intakes and on risk factors for chronic diseases. The lower limit of fat intake is higher for children: 30 percent of
calories from fat for children age 2 and 3 years, and 25 percent
of calories from fat for those age 4 to 18 years. Part D,
Section 4, includes conclusions relating to n-6 and n-3 polyunsaturated
fatty acids and monounsaturated fatty acids in addition to
the fats listed here.
Back to Top
Choose Carbohydrates Wisely For Good Health
Carbohydrates—the sugars, starches, and fibers found in fruits,
vegetables, grains, and milk products—are an important part
of a healthful diet and the major energy source in most diets.
Sugars and starches supply energy to the body in the form
of glucose, which is the only energy source for the red blood
cell and the preferred energy source for the brain, central
nervous system, placenta, and fetus, and for muscle cells
when they are operating anaerobically (without oxygen). Diets
rich in dietary fiber help promote healthy laxation and help
reduce the risk of type 2 diabetes and coronary heart disease.
When selecting foods from the fruit, vegetable, and grains
groups, it is beneficial to make fiber-rich choices often.
This means, for example, choosing whole fruits rather than
juices and whole grains rather than refined grains. Current
evidence suggests that there is no relationship between total
carbohydrate intake (minus fiber) and the incidence of either
type 1 or type 2 diabetes.
Following guidance to increase one's intake of fruits, vegetables,
whole grains, and nonfat or low-fat milk or milk products
is a healthful way to obtain the recommended amounts of carbohydrate.
Compared with individuals who consume small amounts of foods
and beverages that are high in added sugars, those who consume
large amounts tend to consume more calories but smaller amounts
of vitamins and minerals. Although more research is needed,
prospective studies suggest a positive association between
the consumption of sugar-sweetened beverages and weight gain.
A reduced intake of added sugars (especially sugar-sweetened
beverages) may be helpful in achieving the recommended intakes
of nutrients and in weight control.
Sugars and starches supply substrate for bacterial fermentation
in the mouth, and acids produced can cause tooth demineralization
resulting in dental caries. However, drinking fluoridated
water and/or using fluoride-containing dental hygiene products
helps reduce the risk of dental caries. A combined approach
is helpful for reducing caries incidence: reducing the frequency
of consuming sugars and starches (e.g., limiting snacking
on foods that contain these carbohydrates), limiting the length
of time the teeth are exposed to fermentable carbohydrates,
and optimizing oral hygiene practices.
Back to Top
Increase Daily Intakes of Fruits and Vegetables, Whole Grains,
and Reduced-Fat Milk and Milk Products
Fruits and Vegetables
Fruits contain glucose, fructose, sucrose, and fiber, and most
fruits are relatively low in calories. In addition, fruits are
important sources of at least eight additional nutrients, including
vitamin C, folate, and potassium (which may help control blood
pressure). Many vegetables provide only small amounts of sugars
and/or starch, some are high in starch, and all provide fiber.
Vegetables are important sources of 19 or more nutrients, including
potassium, folate, and vitamins A and E. Adults who
increase their fruit and vegetable consumption to meet recommended
nutrient intakes will also be consuming amounts of fruits
and vegetables that are associated with a decreased risk of
such chronic diseases as stroke, perhaps other cardiovascular
diseases, type 2 diabetes, and cancer in certain sites. Moreover,
increased consumption of fruits and vegetables may be a useful
component of programs designed to achieve and sustain weight
loss.
The suggested range of intake is 2½ to 6½ cups1
of fruits and vegetables daily, depending on calorie needs.
For persons needing 2,000 calories per day to maintain their
weight, the goal is 4½ cups (or the equivalent) of
fruits and vegetables per day. Consuming a variety of fruits
and vegetables daily is recommended—choosing among citrus
fruits, melons, and berries; other fruits; dark green leafy
vegetables; bright orange vegetables; legumes; starchy vegetables;
and other vegetables.
Back to Top
Whole Grains
Whole grains are high in starch, and they are important sources
of 14 nutrients including fiber. Diets rich in whole grains
can reduce the risk of CHD and type 2 diabetes and help with
weight control. Important sources of whole grains include
whole wheat, oatmeal, popcorn, bulgur, and brown rice. Whole
wheat bread is an example of a whole-grain food. The goal
is to eat at least three 1-ounce equivalents per day of whole-grain
foods, preferably in place of refined grains.
Back to Top
Nonfat and Low-Fat Milk and Milk Products
Milk and milk products are important sources of at least 12
nutrients including calcium, magnesium, potassium, and vitamin
D. Diets that provide 3 cups or the equivalent of milk and/or
milk products per day can improve bone mass. This amount of
milk product consumption may have additional health benefits
and is not associated with increased body weight. The
goal for persons with energy requirements greater than 1,600
calories per day is 3 cups or the equivalent of milk products
per day, preferably nonfat or low-fat products such as skim
milk and yogurt. Milk products that are consumed in their
nonfat or low-fat forms provide no or little solid fat and
are very nutrient dense. When considering alternatives to
milk, the most reliable way to derive the health benefits
associated with milk products is to choose alternatives within
the dairy food group such as lactose-free milk or yogurt.
Back to Top
Choose and Prepare Foods With Little Salt
Reducing salt (sodium chloride) intake is one of several
ways that people can lower their blood pressure. Reducing
blood pressure, ideally to the normal range, reduces the chance
of developing a stroke, heart disease, heart failure, and
kidney disease. The relationship between salt intake and blood
pressure is direct and progressive without an apparent threshold.
On average, the higher a person's salt intake, the higher
is his or her blood pressure. Thus, reducing salt intake as
much as possible is one way to lower blood pressure. Another
dietary measure to lower blood pressure is to consume a diet
rich in potassium. A potassium-rich diet also blunts the effects
of salt on blood pressure, may reduce the risk of developing
kidney stones, and possibly decrease bone loss with age.
The vast majority of the U.S. population consumes too much
salt, much of it from processed foods. The goal is to consume
less than 2,300 mg of sodium per day. The goal is expressed
in terms of sodium rather than salt because the Nutrition
Facts Labels on food products list sodium content. Many people—especially
persons with hypertension, blacks, and older adults—will benefit
from working toward a goal of an even lower sodium intake.
Reducing salt intake requires careful attention to food selection
when shopping or when eating outside the home, and also during
food preparation at home. The Nutrition Facts Label on food
packages can help consumers compare and identify prepared
foods that are lower in sodium.
Fruits, vegetables, and most milk products are widely available
in forms that contain no added salt, and most of them are
important sources of potassium. Increasing one's intake of
foods rich in potassium helps lower blood pressure. In addition,
many of these potassium-rich foods enhance the taste of other
foods that contain no added salt.
Back to Top
If You Drink Alcoholic Beverages, Do So in Moderation
Among middle-aged and older adults, the lowest all-cause
mortality occurs at the level of one to two drinks per day.
The mortality reduction is likely due to the protective effects
of moderate alcohol consumption on coronary heart disease,
primarily among males older than age 45 years and women older
than age 55 years. Among younger people, alcohol consumption
appears to provide little, if any, health benefit. Alcohol
use among young adults is associated with an increased risk
of traumatic injury and death. Heavy drinking is very hazardous,
contributing to automobile injuries and deaths, assault, liver
disease, and other health problems. Abstention is an important
option.
The goal for adults who choose to drink is to do so in moderation.
Moderation is defined as the consumption of up to one drink
per day for women and two drinks per day for men. One drink
is defined as 12 ounces of regular beer, 5 ounces of wine
(12 percent alcohol), or 1.5 ounces of 80-proof distilled
spirits.
Among the people who should not consume alcoholic beverages
are those who cannot restrict their drinking to moderate levels,
children and adolescents, and individuals taking medications
that can interact with alcohol or who have specific medical
conditions. Drinking alcoholic beverages should be avoided
by women who may become pregnant or who are pregnant, by breastfeeding
women, and by persons who plan to drive or take part in other
activities that require attention, skill, or coordination.
Back to Top
Keep Food Safe To Eat
Foodborne diseases cause approximately 76 million illnesses,
325,000 hospitalizations, and 5,000 deaths in the United States
each year. Three pathogens (Salmonella, Listeria,
and Toxoplasma) are responsible for more than 75
percent of these deaths. Actions by consumers can reduce the
occurrence of foodborne illness substantially. The behaviors
in the home that are most likely to prevent a problem with
foodborne illnesses are
-
Cleaning hands, contact surfaces, and fruits and vegetables
(This does not apply to meat and poultry, which should
not be washed.)
-
Separating raw, cooked, and ready-to-eat foods while
shopping, preparing, or storing
-
Cooking foods to a safe temperature
-
Chilling (refrigerating) perishable foods promptly
-
Avoiding higher-risk foods (e.g., deli meats and frankfurters
that have not been reheated to a safe temperature [may
contain Listeria]). This is especially important
for high-risk groups (the very young, pregnant women,
the elderly, and those who are immunocompromised).
Back to Top
HEEDING ALL THE MESSAGES
Making any one of the recommended changes in diet, decreasing
calorie intake, or increasing physical activity may improve
health and reduce one or more health risks. However, the greatest
benefits can be anticipated if one tries to heed all nine
of the major recommendations. It is well recognized that multiple
dietary factors and physical activity influence the risk of
chronic diseases and that no one factor accounts for any of
the chronic diseases.
The food pattern developed by the USDA and included in this
report integrates most of the recommendations made by the
Committee. This food pattern
-
Is high in fruits and vegetables, whole grains, and nonfat
or low-fat milk products
-
Provides amounts of nutrients (including potassium and
fiber) that are consistent with recommended nutrient intakes
and with reducing the risk of chronic disease
-
Is low in saturated fat, cholesterol, and added sugars
and can be low in trans fat2
and sodium3
A diet that is consistent with the diet-related recommendations
in this report—the Dietary Approaches to Stop Hypertension
(DASH diet)—has been demonstrated to have health benefits,
including reducing blood pressure and LDL cholesterol. The
DASH diet provides nutrients in recommended amounts and is
very close to the revised USDA food intake pattern in the
nutrients it provides. Thus, the finding that the DASH diet
provides health benefits lends support to the combination
of diet-related recommendations in this report.
Adding at least 30 minutes of moderate physical activity
into one's daily routine would increase the calorie requirement
by a small amount, allowing somewhat more leeway in the amount
of food that could be consumed without gaining weight. Increasing
physical activity would contribute to a lowering of chronic
disease risk as well. Moderation in alcohol consumption, if
used, also would reduce health risks. And taking measures
to keep food safe to eat would reduce the risk of foodborne
illness.
Back to Top
DEALING WITH HEALTH DISPARITIES AND CONTRIBUTIONS OF THE
ENVIRONMENT
Health disparities are substantial among racial and ethnic
minorities and among the economically disadvantaged. Available
evidence suggests that certain dietary changes are a means
to reduce these disparities. Social changes and educational
efforts are required to facilitate healthy diets and lifestyles
among these high-risk individuals.
In conducting the research on which this report is based,
the Committee was struck by the critical and likely predominant
role of the environment in determining whether or not individuals
consume excess calories, eat a healthful diet, and are physically
active. By environment we mean the constellation of cultural
forces, societal norms, family influences (e.g., mealtime
structure and parental feeding styles), changes in meal patterns,
and commercial advertising that potentially influence individual
behavior. Environmental influences tend to be beyond the control
of individuals. Examples include the large size of portions
served by many food establishments, lack of information on
calorie content at point of purchase, the high amount of sodium
in the food supply, the trans fatty acid content
of many ready-to-eat foods, the cost and availability of fruits
and vegetables, and opportunities for safe and enjoyable physical
activity. Thus, changes to the environment could make a substantial
difference in consumers' ability and willingness to follow
the guidance provided in this report.
1
2
3
Back to Top |
