PART E: TRANSLATING THE SCIENCE
INTO DIETARY GUIDANCE
The purpose of this part of the report is to identify content
needed to translate the Committee's findings into policy and
dietary guidance for consumers. This information should be
useful to nutrition-related program providers, healthcare
providers, and educators as well as to the groups charged
with the responsibility of producing policy statements and
the 2005 edition of Dietary Guidelines for Americans.
The Committee provides specific recommendations for the content
of main messages and supporting details, but we leave the
wording of consumer documents to communication experts.
Good nutrition is vital to good health—both in the present
and the distant future. Good nutrition is absolutely essential
for the healthy growth and development of children and adolescents.
A basic premise of the Committee is that nutrient needs should
be met primarily through consuming foods. Foods provide an
array of nutrients and of other compounds that may have beneficial
effects on health. In some cases, fortified foods may be useful
sources of one or more nutrients that otherwise might be consumed
in less than recommended amounts. Nutrient supplements cannot
replace a healthy diet. Supplements are useful when they fill
a specific identified nutrient gap that cannot or is not otherwise
being met by the individual's intake of food. Individuals
who are already consuming the recommended amount of a nutrient
will not achieve any recognized health benefit if they also
take the nutrient as a supplement. In fact, in some cases,
supplements and fortified foods may cause intakes to exceed
the Tolerable Upper Intake Level for nutrients.
In brief, the Committee's findings support 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 alcohol, do so in moderation.
-
Keep food safe to eat.
All these topics are important to promote day-to-day health
and to reduce the risk for major chronic diseases. The topics
are not listed in order of priority. In fact, they are closely
interrelated. Consuming a variety of foods from the basic food
groups and controlling calorie intake are two major themes—themes
that are intertwined. To achieve weight control, for example,
guidance to increase one's intake of certain food groups must
go hand in hand with guidance to decrease intake of added sugars
and solid fats. At the same time, being physically active increases
energy expenditure and makes it easier to meet recommended intakes
for nutrients and to control weight. The Committee believes
these messages should be conveyed in Nutrition and Your
Health: Dietary Guidelines for Americans, 2005. The
list of major messages includes a major departure from previous
editions of Dietary Guidelines for Americans in that
it does not include a message specifically directed toward
sugars. This omission does not mean that the current Committee
views the topic of sugars as unimportant. On the contrary,
the Committee provides a strong rationale for limiting one's
intake of added sugars. The Committee's intent is to make
this point clearly under the new topic "Choosing Carbohydrates
Wisely for Good Health" and under the first and second topics
that address energy needs and controlling calorie intake,
respectively.
Back to Top
CONSUME A VARIETY OF FOODS WITHIN AND AMONG THE BASIC FOOD
GROUPS WHILE STAYING WITHIN ENERGY NEEDS
Overview
Many Americans consume more calories than they need without
meeting recommended intakes for a number of nutrients. This
circumstance means that most people need to choose meals and
snacks that are high in nutrients but low to moderate in energy
content; that is, meeting nutrient recommendations must go
hand in hand with keeping calories under control. Doing both
offers important benefits—normal growth and development of
children, health promotion for people of all ages, and reduction
of risk for a number of chronic diseases that are major public
health problems.
Dietary data suggest that, in general,
-
Adults do not consume enough vitamins A, C, and E; calcium;
magnesium; potassium; and fiber.1
-
Children do not consume enough vitamin E, calcium, magnesium, potassium, and fiber.
At the same time, in general, Americans consume too many
calories and too much saturated and trans fat, cholesterol,
added sugars, and salt.
Back to Top
Key Messages
-
Eating a variety of food within and among the basic food
groups helps one achieve recommended nutrient intakes
while maintaining appropriate energy intake.
-
Adults who consume the amounts of fruits and vegetables,
whole grains, and nonfat or low-fat milk and milk products
that are recommended in the U.S. Department of Agriculture
(USDA) food intake pattern (see Table D1-13 and the Dietary
Approaches To Stop Hypertension (DASH) diet, Table D1-18)
will achieve the levels of intake of these foods that
are associated with a reduced risk of chronic disease.
-
Diets can be planned to meet recommended nutrient intakes
while considering the food preferences of different racial/ethnic
groups, vegetarians, and others.
-
A few special nutrient recommendations apply to the elderly,
women in the childbearing years, and groups susceptible
to vitamin D insufficiency.
-
Combining a physically active lifestyle with an eating
pattern that features foods high in nutrient density helps
to achieve recommended nutrient intake without excess
calorie intake.
Back to Top
Additional Important Information
Meeting Recommended Intakes Within Energy Needs
-
It is essential to convey the concept "a variety of foods
from within each of the basic food groups" accurately
to consumers. The food groups consist of fruits, vegetables,
grains, milk, and meat and beans. The term foods
refers to agricultural commodities such as wheat, corn,
green beans, oranges, beef, eggs, fish, poultry, milk,
and cheese. A meal that includes salmon, brown rice, spinach,
sliced tomatoes, and nonfat milk includes five different
food commodities. Bread, pasta, crackers, bulgar, and
wheat cereal represent only one food commodity (wheat).
Consuming different forms of the same commodity has not
been associated with improved nutrient intake.
-
The recommended nutrient intakes that are based on Dietary
Reference Intakes are listed in Table D1-1. The calorie
level that is generally appropriate for each age/gender
group at a specified physical activity level is shown
in Table D8-1.
-
The use of the revised USDA food intake pattern is one
method to plan to meet recommended nutrient intakes considering
age, gender, and physical activity level. The food intake
pattern in Table D1-13 includes suggested amounts to eat
from each of the basic food groups and subgroups. Oils
and trans fat free soft margarines also are included in
the food intake pattern to provide essential fatty acids
and vitamin E.
-
When using the food intake pattern to plan diets, one
must pay close attention to the forms of food described
in footnote 1 to Table D1-13 and to Table D1-14, which
provides additional information about discretionary calories.
The pattern assumes that the meats and poultry are in
their lowest fat form, the milk is nonfat, and the foods
from all of the food groups contain no added sugars or
fats. These are not the forms of food eaten by most Americans.
Discretionary calorie values listed in Table D1-13 and
D1-14 are the maximum amounts that can be accommodated
at each calorie level. Discretionary calories are available
to use for increasing variety, for example, having more
fruits or vegetables or having medium-fat meat or cheese
sometimes—or low-fat or whole milk, sweetened low-fat
yogurt, sweetened cereal, or cake. Most people will exceed
calorie recommendations if they consistently choose medium-fat
meat and full-fat milk products in the amounts specified
in the table—even if they do not have dessert, sweetened
beverages, or alcoholic beverages.
-
Eating the amounts of foods from each food group listed
in the food intake pattern table each day (or averaged
over a week in the case of vegetable subgroups) will enable
most people to meet their recommended nutrient intakes
at a calorie level that does not exceed their energy needs.
Eating in accordance with the food intake pattern also
will keep intakes of saturated fat, total fat, and cholesterol
within the limits recommended below under "Choosing Fats
Wisely for Good Health".
-
The food intake pattern that is designed to meet currently
recommended nutrient intakes differs in important ways
from commonly consumed food patterns. In general, they
include
-
More dark green vegetables, bright
orange vegetables, legumes, fruits, whole grains, and
milk
-
Less enriched grains, total fats (especially
solid fats), added sugars, and calories
-
Americans need to increase their consumption of vitamin
E- (α-tocopherol-) rich foods while decreasing their intake
of foods high in energy but low in nutrients. The USDA
food intake pattern does not provide for meeting the recommended
intake of vitamin E unless vitamin E-rich sources are
selected. Foods that can help increase vitamin E intake
are listed in Table D1-8a along with their calorie content.
Breakfast cereal that is fortified with vitamin E is an
option for individuals seeking to increase their vitamin
E intake while consuming a low-fat diet.
-
Most Americans of all ages also need to increase their
fiber intake. Diets rich in fiber help reduce the risk
of coronary heart disease (CHD) and promote healthy laxation.
Table D1-11a identifies foods that help increase fiber
intake. Substituting whole grains for refined grains is
a good way to increase fiber intake without increasing
energy intake.
-
Most Americans of all ages need to increase their potassium
intake. Diets rich in potassium can lower blood pressure,
lessen the adverse effects of salt on blood pressure,
may reduce the risk of developing kidney stones, and possibly
decrease bone loss. Blacks have a lower intake of potassium
than do whites and a higher prevalence of elevated blood
pressure and salt sensitivity. Thus, this subgroup of
the population especially would benefit from an increased
intake of potassium. Table D1-10a identifies foods that
can help increase potassium intake and provides information
about their calorie content.
-
Many Americans need to increase their intake of vitamins
A and C and/or magnesium. Tables D1-5a through D1-7a identify
foods that help increase the intake of each of these nutrients
along with their calorie content.
Back to Top
Flexibility
A number of approaches can be used to increase the flexibility
of the meal pattern while still meeting the recommended intake
values. Such flexibility is to be encouraged to accommodate
individual preferences, cultural preferences, cost, and availability.
-
Vegetarian Choices. Vegetarians
can achieve recommended nutrient intakes through careful
selection of foods, especially if they give special attention
to their intakes of protein, iron, vitamin B12,
and calcium and vitamin D (if they avoid milk products).
One way for
a lacto-ovo vegetarian who needs 2,200 kcal to make daily
selections from the meat and beans group would be to
eat
1 egg, 1.5 oz nuts, and 2/3 cup legumes instead of 6
ounces of meat, poultry, and/or fish (further information
is
available in Appendix G-2).
-
1 egg
-
1.5 oz of nuts
-
2/3 cup of legumes
-
Enriched Grain Substitutions.
Whole grains can be substituted for enriched grains on
an ounce-for-ounce basis. They are comparable in energy
content and will provide for meeting nutrient recommendations
nutrient adequacy in the food intake pattern. (Further
information is available in Appendix
G-2.)
-
Legume Substitutions. For
people who don't like legumes, several other food choices
can be substituted in the food intake pattern and still
provide for meeting nutrient recommendations. (See Appendix
G-2).
-
Substitutions for Milk and Milk Products.
Since milk and milk products provide more than 70 percent
of the calcium consumed by Americans, guidance on other
choices of dietary calcium is needed for those who choose
not to consume the recommended amount of milk products.
(Tables D1-9a and D1-19 include information on calcium
content and bioavailability from a variety of foods).
Those who avoid milk may need to choose rich sources of
the nutrients shown in Table D1-20 as well. Foods that
can help increase intake of some of the nutrients provided
by milk appear in Tables D1-5a, D1-7a, D1-9a, and D1-10a.
Those who avoid milk because of its lactose content may
obtain all the nutrients provided by the milk group by
using lactose-reduced or low-lactose milk products, taking
small servings of milk a number of times a day, taking
the enzyme lactase before consuming milk products, or
eating other calcium-rich foods such as calcium-fortified
orange juice, fortified soy milk, broccoli and oranges.
For additional information, see Tables D1-9a through D1-19
and http://digestive.niddk.nih.gov/ddiseases/pubs/
lactoseintolerance/index.htm.
Back to Top
Meeting Nutrient Needs of Special Groups
-
Women of childbearing age can reduce the risk of iron
deficiency by eating foods high in iron (preferably meat,
poultry, fish, shellfish) and/or consuming iron-rich plant
foods, such as iron-fortified breakfast cereals, with
a food rich in vitamin C (e.g., orange juice). Table D1-22a
lists foods that can help increase iron intake and gives
their calorie content.
-
To reduce the risk of a pregnancy being affected by a
neural tube defect, daily intake of 400 µg of synthetic
folic acid (from supplements or fortified food) is recommended
for women who are capable of becoming pregnant and those
in the first trimester of pregnancy.
-
Because many persons over age 50 have reduced ability
to absorb naturally occurring vitamin B12,
consuming vitamin B12 in its crystalline form is recommended
for this age group. The goal for those over age 50 is
to eat foods fortified with vitamin B12, such as fortified
breakfast cereals, or to take vitamin B12 supplements
to achieve a B12 intake of at least 2.4 mcg
per day. (This equals about 40 percent of the Daily Value
expressed on food labels.)
-
The elderly, persons with dark skin, and persons exposed
to insufficient ultraviolet band (UVB) radiation are at
risk of being unable to maintain vitamin D status. Persons
in these groups may need substantially more than the 1997
Adequate Intake (AI) for vitamin D from vitamin D-fortified
foods and/or vitamin D supplements. Three cups of vitamin
D-fortified milk (300 IU), one cup of vitamin D-fortified
orange juice (100 IU), and 600 IU of supplemental vitamin
D would provide 1,000 IU of vitamin D daily.
Back to Top
Nutrient Density
-
Nutrient-dense foods are those that provide substantial
amounts vitamins and minerals and relatively fewer calories.
Foods that are low in nutrient density are foods that
supply calories but relatively small amounts of micronutrients
(sometimes none at all).
-
The greater the consumption of foods or beverages that
are low in nutrient density, the more difficult it is
to consume enough nutrients without gaining weight, especially
for sedentary individuals.
-
The consumption of added sugars, solid fats, and alcohol
provides calories while providing little, if any, of the
essential nutrients.
Back to Top
CONTROL CALORIE INTAKE TO MANAGE BODY WEIGHT
Overview
The prevalence of obesity has doubled in the past two decades.
Nearly one-third of adults have a body mass index (BMI)
in
the obese range of 30 or greater. The prevalence of overweight
among both children and adolescents has increased substantially
as well. A high prevalence of overweight and obesity among
adults is of great public health concern because excess
body
fat leads to a much higher risk for premature death, diabetes
mellitus, hypertension, dyslipidemia, cardiovascular disease,
stroke, gall bladder disease, respiratory dysfunction, gout,
osteoarthritis, and certain kinds of cancers. Ideally, the
goal for adults is to achieve and maintain a BMI in the healthy
weight range. However, even modest weight loss (e.g., 10
pounds)
has health benefits, and the prevention of further weight
gain is very important. For overweight children and adolescents,
the goal is to slow the rate of weight gain to achieve healthy
growth. Maintaining a healthy weight throughout childhood
will reduce an individual's risk of becoming an overweight
or obese adult. Eating fewer calories is a key method of
controlling
body weight. Increasing physical activity also is very helpful
in weight control, but because physical activity has additional
beneficial effects on nutrition and health, it is covered
separately. (See below—"Be Physically Active Every Day.")
Back to Top
Key Messages
-
Persons who follow typical American eating and activity
patterns have used up all their discretionary calories
and are likely to be consuming diets well in excess of
their energy requirements for their age, gender, and physical
activity level. 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.
-
Since many adults gain weight slowly over time, even
small decreases in calorie intake can help avoid weight
gain. Decreasing intake or increasing expenditure by 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.
-
Focusing on the prevention of overweight is critical
because the behaviors required to lose weight are more
challenging than the behaviors required to prevent weight
gain. For most people, a reduction of 50 to 100 calories
per day will prevent weight gain, but a reduction of 500
calories or more per day is a common goal in weight loss
programs. Similarly, 30 to 60 minutes of moderate physical
activity per day is recommended to prevent weight gain,
but up to 60 to 90 minutes of physical activity per day
is recommended to sustain weight loss among persons who
have been overweight. (See below—"Being Physically Active
Every Day.")
-
Weight maintenance depends on balancing energy consumed
and energy expended. Weight loss requires taking in fewer
calories than expended. Small decreases in calorie intake
can lead to big benefits if sustained over time, especially
if accompanied by increased physical activity. (See "Essential
Elements for Weight Loss" in Table E-1.)
-
Calories come from fat, carbohydrate, protein, and alcohol.
The healthiest way to reduce calorie intake is to reduce
one's intake of added sugars, solid fat, and alcohol—they
all provide calories, but they do not provide essential
nutrients. Table E-2 gives some examples of how calories
can be decreased by choosing foods that are lower in saturated
fats. Table E-3 gives examples of how calories can be
decreased by decreasing alcoholic beverage intake.
-
When making changes to improve nutrient intake, one
needs to take care to make substitutions to avoid excessive
calorie intake. For example, foods such as fruits, vegetables,
and whole grains—all of which provide fiber—might be eaten
in place of more refined foods such as fruit drinks and
refined grain products.
-
Monitoring body weight regularly is a useful strategy
for identifying weight changes and the need to decrease
one's energy intake, increase physical activity, or both.
Such changes are fundamental to controlling one's weight.
-
Reduced calorie diets that provide fat, carbohydrate,
and protein within the recommended ranges can be safe
and efficacious for weight loss. Diets that provide very
low or very high amounts of protein, carbohydrate, or
fat are likely to provide low amounts of a number of nutrients
and are not advisable for long-term use.
Back to Top
Additional Important Information
-
Eating foods that are high in calories and low in volume
may make it hard to avoid excessive calorie intake. Eating
foods that are low in calories and high in volume (such
as many kinds of vegetables and fruits and some soups)
may be a useful strategy to reduce energy intake.
-
Controlling portion sizes helps limit calorie intake,
especially when eating energy-dense foods (foods that
are high in calories for a given amount). Table E-4 provides
information on how portion sizes have grown over the past
20 years.
-
Diets rich in whole grains, fruits, and vegetables may
help with weight maintenance.
-
It is unclear whether consuming milk products helps control
body weight, but consuming three servings of milk products
daily is not associated with increased body weight.
-
Table E-5 gives examples of some simple ways to cut calories
from your diet.
-
Use the BMI chart (Figure E-1) to determine your BMI
using your height and weight. If your BMI does not fall
into the "Healthy Weight" section, set your weight goal
as a weight corresponding to your height and "Healthy
Weight" on the BMI chart.
-
Table D3-1 will help you estimate your current energy
requirements on the basis of your gender, age, and physical
activity level so that you can know what your caloric
intake limit is to maintain a healthy weight.
Back to Top
BE PHYSICALLY ACTIVE EVERY DAY
Overview
Americans tend to be relatively inactive. In 2002, 38 percent
of adult Americans engaged in no leisure-time physical activity,
and in 1999, 43 percent of students in grades 9 through 12
viewed television nearly 3 hours per day. Regular physical
activity and physical fitness make a big contribution to one's
day-to-day health and sense of well-being. Lack of physical
activity puts many people at risk. In particular, a sedentary
lifestyle poses risks for coronary artery disease, hypertension,
type 2 diabetes, overweight and obesity, osteoporosis, certain
types of cancer, anxiety, depression, decreased health-related
quality of life, and decreased cardiorespiratory, metabolic,
and musculoskeletal fitness. All-cause mortality rates are
lower in physically active than in sedentary persons.
Back to Top
Key Messages
-
Thirty minutes of at least moderate physical activity
on most days provide important health benefits in adults
in part by reducing the risk of chronic disease. More
than 30 minutes of moderate to vigorous physical activity
on most days provide even more health benefits.
-
Participating in up to 60 minutes of moderate to vigorous
physical activity on most days is recommended to prevent
unhealthy weight gain among adults. After losing weight,
adults who obtain 60 to 90 minutes of moderate physical
activity daily are more successful at maintaining their
reduced weight than those who rely only on limiting calorie
intake.
-
The recommendation for children and adolescents is at
least 60 minutes of moderate to vigorous physical activity
on most days to maintain good health and fitness and for
healthy weight during growth. Increasing physical activity
can lower the BMI of overweight children.
-
Regular physical activity is essential to the maintenance
of a healthy weight for children and adults and a useful
component of weight control programs. Physical activity
increases total energy expenditure and thus the number
of calories needed in a day. Energy expenditure increases
with increases in both the duration and the intensity
of physical activity. Table E-6 provides examples of physical
activities and the calories expended by performing these
physical activities.
-
Physical fitness requires regular physical activity
that involves cardiovascular conditioning, stretching
exercises to enhance flexibility, and weight work or calisthenics
to develop strength and muscle endurance.
-
Vigorous-intensity physical activity (e.g., jogging or
other aerobic exercise) provides greater benefits for
physical fitness than moderate physical activity, and
it burns more calories per unit time.
-
During leisure time, it is advisable for all individuals
to limit sedentary behaviors, such as television watching
and video viewing, and replace them with activities that
require more movement. Engaging in physical activity will
increase a person's caloric requirement for weight maintenance.
Therefore, a person who engages in regular physical activity
may have more discretionary calories available to him
or her than a sedentary individual.
Back to Top
Additional Important Information
-
Activity counted toward the 30 minutes should not include
usual activities at work or at home.
-
The physical activity counted may include short bouts
(e.g., 10-minute bouts) of moderate activity. The accumulated
total is what is important—both for health and for burning
calories. Setting aside 30 to 60 consecutive minutes for
planned exercise is one way to obtain physical activity,
but it is not necessary. Physical activity can be accumulated
through three to six 10-minute bouts over the course of
a day. The accumulated total is what is important—both
for health and for burning calories
-
The body adapts to physical activity by building muscle
and by increasing the maximum amount of work than can
be done and the use of oxygen. Regular aerobic exercise
improves the cardiovascular system.
-
Two steps help avoid dehydration during prolonged physical
activity in conditions of heat stress, whether for work
or leisure: (1) consuming fluid regularly during the activity
and (2) drinking several glasses of water or other fluid
after the physical activity is completed.
-
Most persons can safely increase their physical activity
without consulting with a healthcare provider. However,
it is advisable for men over age 40, women over age 50,
and those with a personal history of chronic diseases
such as heart disease or diabetes to consult with a healthcare
provider before starting an exercise program.
-
Resistance exercise (such as weight training, using weight
machines and resistance band workouts) increases muscular
strength and endurance and maintains or increases lean
body weight. These benefits are seen in adolescents, adults,
and older adults who perform 8 to 10 resistance exercises
2 or more days per week.
-
Exercise that loads the skeleton has the potential to
reduce the risk of osteoporosis by increasing peak bone
mass during growth, maintaining peak bone mass during
adulthood, and reducing the rate of bone loss during aging.
Regular exercise can help prevent falls.
Back to Top
INCREASE DAILY INTAKE OF FRUITS AND VEGETABLES, WHOLE GRAINS,
AND NONFAT OR LOW-FAT MILK AND MILK PRODUCTS
Overview
Increased intakes of fruits, vegetables, whole grains, and
milk products are likely to have important health benefits
for Americans. Compared with the many persons who consume
only small amounts of fruits and vegetables, those who eat
more generous amounts are likely to have reduced risk of chronic
diseases, including stroke and perhaps other cardiovascular
diseases, type 2 diabetes, and cancers in certain sites (oral
cavity and pharynx, larynx, lung, esophagus, stomach, and
colon-rectum). Diets rich in dietary fiber and in whole grains
can reduce the risk of coronary heart disease. Diets rich
in milk and milk products can reduce the risk of low bone
mass throughout the life cycle, but many Americans have low
intakes of milk products. The consumption of milk products
is especially important for children and adolescents who are
building their peak bone mass and developing lifelong habits.
Back to Top
Key Messages
-
Fruits, vegetables, whole grains, and milk products are
all important to a healthy diet and are a good source
of the shortfall nutrients.
-
A range of 5 to 13 servings (2½ to 6½ cups) of fruits and vegetables each
day is recommended for daily energy intakes of 1,200 to 3,200 calories.2
For a 2,000-calorie daily energy intake, 9 servings (4½ cups) are recommended, with
increases or decreases depending on energy intake. Table E-7 provides the daily amounts
of fruits and vegetables by calorie level.
-
One goal is to consume a variety of fruits and vegetables
each day. Over a week, eating vegetables from all five
vegetable subgroups (dark green, bright yellow, legumes,
starchy vegetables, and other vegetables) is recommended.
For persons who require 2,000 calories daily to meet their
energy needs, the recommended combined intake is 4½
cups (or the equivalent) of fruits and vegetables each
day. Greater amounts are recommended for those with higher
calorie requirements, and somewhat smaller amounts are
recommended for those with lower calorie requirements.
Table E-8 provides a list of fruits and vegetables that
are the best sources of vitamins A and C, folate, and
potassium. Table E-9 provides recommendations for ways
to increase fruit and vegetable intake.
-
The goal for whole-grain intake is at least three servings
(approximately 3 ounces) per day, preferably by eating
whole grains in place of refined grains. Table E-10 lists
the whole grains that are widely available in the United
States.
-
For people who require 1,600 kcal per day or more, the
goal for milk and milk products is three servings (3 cups)
of nonfat or low-fat milk or milk products or the equivalent
per day. The goal is 2 cups per day for those with lower
calorie needs. Table E-11 provides recommendations for
ways to increase milk and milk product consumption.
Back to Top
Additional Important Information
-
When increasing intake of fruits, vegetables, whole grains,
and nonfat or low-fat milk and milk products, it is important
to decrease one's intake of other less-nutrient-dense
foods to control calorie intake.
-
As illustrated by the comparison of whole wheat and enriched
white flours in Table E-12, whole grains are richer in
many nutrients, but they are not richer in folate unless
they have been fortified with folic acid, which currently
is allowed for only a few types of whole grain products.
Enriched refined grains are required to be fortified with
folic acid. Label reading is important.
-
Young children and others with low energy needs are encouraged
to include three servings of whole grains daily, one of
which is a folic acid-fortified breakfast cereal.
-
One cannot identify whole grains by the color of the
food; label-reading skills are needed. Table E-10 identifies
names of whole grains that are widely available in the
United States. Table E-13 provides tips to consumers for
obtaining information about whole grains from food labels.
-
The strength of the evidence for the association between
increased intake of fruits and vegetables and reduced
risk of chronic diseases is variable and depends on the
specific disease, but a wide array of evidence points
to beneficial health effects.
-
Adults and children should not avoid nonfat or low-fat
milk and milk products because of concerns that these
foods are "fattening." Even the lowest calorie (1,000
calorie) USDA food pattern includes them.
-
When considering milk alternatives, the most reliable
and easiest way to derive the health benefits associated
with dairy consumption is to choose alternatives within
the dairy food group, such as lactose-free milk or yogurt.
-
Fruits, vegetables, whole grains, and milk products
contain sugars and/or starches. These sugars and starches
(like those provided by added sugars and refined cereals)
provide fermentable substrates for bacteria that, in turn,
can cause dental caries. However, good oral hygiene and
fluoridation protect against caries.
Back to Top
CHOOSE FATS WISELY FOR GOOD HEALTH
Overview
Fats and oils are a part of a healthy diet, but the type
of fat makes a difference to heart health, and the amount
of fat consumed also is important. High intakes of saturated
fats, trans fats, and cholesterol increase the risk
of unhealthy blood lipid levels, which, in turn, may increase
the risk of coronary heart disease. A high intake of fat (greater
than 35 percent of energy) generally increases saturated fat
intake and makes it more difficult to avoid consuming excess
calories. A low intake of fats and oils (less than 20 percent
of energy) increases the risk of inadequate intakes of vitamin
E and of essential fatty acids and may contribute to unfavorable
changes in high-density lipoprotein (HDL) cholesterol and
triglycerides. Fish contains oils that may have beneficial
effects on mortality from coronary artery disease.
Back to Top
Key Messages
-
To decrease their risk of an elevated low-density lipoprotein
(LDL) cholesterol, most Americans need to decrease their
intakes of saturated fat and trans fat, and many (especially
men because of their high cholesterol intake) need to
decrease their dietary intake of cholesterol.
-
Recommended goals are less than 10 percent of calories
from saturated fat and less than 300 mg of cholesterol
per day for adults with an LDL cholesterol less than 130
mg/dL. Even lower intakes (less than 7 percent of calories
from saturated fat and less than 200 mg of cholesterol)
are recommended for adults with an elevated LDL cholesterol
(greater than 130 mg/dL). Persons with an elevated LDL
cholesterol value should be under the care of a healthcare
provider.
-
Trans fatty acid consumption should be kept as low as
possible—about 1 percent of energy intake or less.
-
Decreasing one's intake of saturated fat and of trans fat is the recommended way to reduce fat intake so that
total fat intake does not exceed 35 percent of calories.
-
Consuming two servings of fish per week (approximately
8 ounces total) may reduce the risks from cardiovascular
disease, especially mortality from coronary heart disease.
The intake of salmon, trout, light tuna, mackerel, or
other fish that are high in eicosapentaenoic acid (EPA)
and docosahexanoic acid (DHA) may be especially beneficial.
Other sources of EPA and DHA may provide similar benefits;
however, more research is needed.
Back to Top
Additional Important Information
-
Recommended total fat intake is between 20 and 35 percent
of energy for adults. Few Americans consume less than
20 percent of calories from fat.
-
General information about fatty acids appears at the
beginning of Part D, Section 4, "Fats."
-
Because dietary intake of saturated fat is much higher
than that of trans fat and cholesterol, it is
most important to decrease one's intake of saturated fat.
However, intake of all three should be decreased. Table
E-14 shows, for selected calorie levels, the maximum amounts
of saturated fat to consume to keep saturated fat intake
below 10 percent of total calorie intake. This box may
be useful combined with label reading guidance. Table
E-2 gives a few practical examples of the differences
in the saturated fat content of different forms of commonly
consumed foods.
-
Table E-15 provides the dietary sources of saturated
fats in the U.S. diet, listed in decreasing order. Table
E-16 provides strategies for decreasing saturated fat
intake.
-
Since trans fatty acids are produced in the
hydrogenation of vegetable oils and account for more than
80 percent of total intake, the food industry has a large
role to play in helping consumers decrease their trans
fat intake. Table E-17 provides dietary sources of trans
fat, listed in decreasing order.
-
Table E-18 provides dietary sources of cholesterol.
-
Consumer advisories provide current information about
lowering exposure to environmental contaminants, such
as methylmercury, in fish. For more information on the
latest methylmercury advisory, see www.fda.gov/bbs/topics/
news/2004/NEW01038.html.
Back to Top
CHOOSE CARBOHYDRATES WISELY FOR GOOD HEALTH
Overview
Carbohydrates are part of a healthy diet. Sugars and starches
supply energy to the body in the form of glucose, which is
the only energy source for red blood cells and is the preferred
energy source for the brain, central nervous system, placenta,
and fetus. Dietary fiber has been shown to have a number of
beneficial effects including decreased risk of type 2 diabetes
and of coronary heart disease, and improvement in laxation.
Although the body's response to sugars does not depend on
whether they are naturally present in a food (such as the
fructose in fruit or the lactose in milk) or added to the
food, there is a concern that people should not consume excessive
amounts of foods that supply calories but few or no nutrients.
This is the case for many foods that contain added sugars.
Back to Top
Key Messages
-
As described above under "Increasing Daily Intake of
Fruits and Vegetables, Whole Grains, and Nonfat or Low-Fat
Milk and Milk Products," consuming foods from the basic
food groups that provide carbohydrates can promote health
and reduce chronic disease risk. Foods in these groups
are important sources of many nutrients.
-
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.
Table D1-8 lists some of the best sources of dietary fiber.
-
Reducing intake of added sugars (especially sugar-sweetened
beverages) may be helpful in achieving recommended nutrient
intakes and weight control.
-
A combined approach of reducing the frequency of consuming
sugars and starches (e.g., limiting snacking on foods
that contain these carbohydrates) and optimizing oral
hygiene practices is advised to reduce caries incidence.
Back to Top
Additional Important Information
-
The concern about added sugars is not the sugar itself
but rather with many of the foods in which added sugars
are found. Individuals who consume food or beverages high
in added sugars tend to consume more calories than those
who consume low amounts of added sugars, and also tend
to consume lower amounts of micronutrients.
-
The major sources of added sugars are listed in Table
E-19. Decreased intake of such foods is recommended.
-
Moderate amounts of sugars added to nutrient-dense foods
such as breakfast cereals and reduced-fat milk products
may increase a person's intake of such foods and thus
improve nutrient intake without contributing excessive
calories.
-
Table E-20 lists ingredients that are included in the
term added sugars. Nutritional
labels list the amount of total sugars, but not added
sugars. To find out whether a food contains added sugars,
one must examine the ingredient list (Table E-21).
Back to Top
CHOOSE AND PREPARE FOODS WITH LITTLE SALT
Overview
On average, the higher one's salt intake, the higher one's
blood pressure. Keeping blood pressure in the normal range
reduces one's risk of coronary heart disease, stroke, congestive
heart failure, and kidney disease. Nearly all American adults
will develop hypertension (high blood pressure) during their
lifetime. Lifestyle changes can prevent or delay the onset
of high blood pressure and can lower elevated blood pressure.
These lifestyle changes include reducing salt intake, increasing
potassium intake, losing excess body weight, increasing physical
activity, and eating an overall healthy diet (such as diets
based on the revised USDA food intake pattern or the DASH
diet described in this report).
Back to Top
Key Messages
-
Nearly all Americans consume substantially more salt
than they need. Decreasing salt (sodium chloride) intake
is advisable to reduce the risk of elevated blood pressure.
Expressed in terms of sodium, the general goal is for
adults to aim to consume less than 2,300 mg of sodium
per day.
-
Many persons will benefit from reducing their salt intake
even more. Such persons include hypertensive individuals,
blacks, and middle- and older-aged adults.
-
At the same time, individuals are encouraged to increase
their consumption of foods rich in potassium. Potassium
lowers blood pressure and blunts the effects of salt on
blood pressure.
-
Since sodium added during the processing of foods provides
more than three-fourths of total intake, the food industry
has a large role to play in helping consumers decrease
their sodium intake.
Back to Top
Additional Important Information
-
Salt is sodium chloride.
-
Food labels list sodium rather than salt content. Sources
of sodium in the food supply are provided in Figure E-2.
-
Many processed foods and foods served by food establishments
are high in sodium. See Table E-22 for examples of these
foods and Table E-23 for examples of strategies to decrease
sodium intake.
-
One's preference for salt is not fixed. After consuming
foods low in salt for a period of time, one's taste for
salt tends to decrease. Alternative flavorings may help.
Table E-24 provides examples of alternative flavorings
and foods to pair with seasonings.
Back to Top
IF YOU DRINK ALCOHOLIC BEVERAGES, DO SO IN MODERATION
Overview
The consumption of alcohol can have beneficial or harmful
effects depending on the amount consumed, the age and other
characteristics of the person consuming the alcohol, and specific
situations. The lowest all-cause mortality occurs at an intake
of one to two drinks per day. The lowest coronary heart disease
mortality also occurs at an intake of one to two drinks per
day. Morbidity and mortality are highest among those drinking
large amounts of alcohol.
Back to Top
Key Messages
-
Those who choose to drink alcoholic beverages should
do so sensibly, and in moderation.
-
Abstention is an important option; approximately one
in three American adults do not drink alcohol.
-
Moderation is defined as the consumption of up to one
drink per day for women and up to 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.
-
Drinking alcoholic beverages should be avoided before
or when driving, or whenever it puts anyone at risk.
Back to Top
Additional Important Information
The definition of moderation, including the size of one
drink, requires emphasis. (Some investigators and apparently
many individuals interpret "moderate drinking" to cover
higher levels of intake than shown in Table E-25. Many mixed
drinks actually provide several servings of alcohol per
drink. (See Table E-3.)
Studies suggest adverse effects even at moderate
alcohol consumption levels in specific individuals and situations.
Some people should not drink alcohol (e.g., individuals
who cannot restrict alcohol intake, children and adolescents,
individuals taking medications that can interact with alcohol,
and individuals with specific medical conditions).
In some situations, alcohol should be avoided (e.g., women
who may become or are pregnant; women who are breastfeeding;
and individuals who plan to drive, operate machinery, or
take part in other activities that require attention, skill,
or coordination).
Factors other than moderate alcohol consumption
that may reduce the risk of chronic disease include a healthy
diet (see above), physical activity, avoidance of smoking,
and maintenance of a healthy weight.
Compared with nondrinkers, women who consume one
drink per day appear to have a slightly higher risk of breast
cancer.
The consumption of one to two alcoholic beverages
per day is not associated with macronutrient or micronutrient
deficiencies or with overall dietary quality. Nonetheless,
the calorie content of alcoholic beverages should be considered.
(See Table E-3.)
Back to Top
KEEP FOOD SAFE TO EAT
Overview
Foodborne illness results from eating food contaminated with bacteria (or their toxins) or
other pathogens such as parasites or viruses. The signs and symptoms range from upset stomach
to diarrhea, fever, vomiting, abdominal cramps, and dehydration. It is estimated that every
year about 76 million people in the United States become ill from pathogens in food; of these,
about 5,000 die. The foodborne illness listeriosis, although rare, has very serious public health
consequences—it can be life threatening for vulnerable groups. Consumers can take simple measures
to reduce their risk of foodborne illness, especially in the home.
Back to Top
Key Messages
The most important food safety problem is microbial foodborne illness. 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 food from 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 unsafe foods also is an important protective measure, especially
for high-risk groups (the very young, pregnant women, elderly, and those who are immunocompromised).
Back to Top
Additional Important Information
-
For more information on cleaning, separating, cooking, chilling, and consumer messages,
see www.fightbac.org.).
-
Table D9-1 provides a protocol for washing hands.
-
Table D9-2 provides a protocol for washing fruits and vegetables.
-
Figure E-3 provides information for temperature rules for proper cooking.
-
Refrigerated leftovers may become unsafe within 3 to 4 days. Despite the appearance of
a food, it may not be safe to eat. Not all bacterial growth causes a food's surface to discolor
or smell bad. It may be unsafe to taste fresh or leftover food items when there is any doubt
about their safety. Safe disposal of the food is indicated if there is a question about
whether or not a food is safe to eat.
-
Those at risk of listeriosis (pregnant women, the elderly, and those who are immunocompromised)
should avoid high-risk foods, including deli meats and frankfurters that are not reheated
to a safe temperature. See Table E-26 for tips for those at increased risk of foodborne
illness.
-
Guidance is evolving on reducing dietary exposure to environmental contaminants, including
methylmercury in fish. Thus, referring to consumer advisories is recommended to obtain updates
on this topic. (For more information on the latest methylmercury advisory, see www.fda.gov/bbs/
topics/news/2004/NEW01038.html.)
-
Refrigerator surfaces can become contaminated from contact with high-risk foods such as
raw meats, poultry, fish, uncooked hotdogs, certain deli meats, or raw vegetables. If not
cleaned, affected refrigerator surfaces can, in turn, serve as a vehicle for contaminating
other foods.
-
Chilling should take place at any stage of food handling during which raw foods are not
being cleaned or cooked. For example, when shopping, it is advisable to buy perishable foods
last, take them straight home, and chill them. Until cooking takes place (e.g., while other
foods are being prepared), chilling is indicated after handling or preparing perishable
foods (especially raw meat, poultry, fish, shellfish, or eggs).
1
2
Back to Top |