1 DIETARY GUIDELINES FOR AMERICANS 2015-2020Gabriela Proaño, MS, RD Central Texas Veterans Health Care System December 2016
2 Outline Introduction on Dietary Guidelines- background on research and development behind dietary guidelines Discussion of Chapter 1: Key Elements in Healthy Eating Patterns Discussion of Chapter 2: Shifts Needed to Align With Healthy Eating Patterns Discussion of Chapter 3: Everyone Has a Role in Supporting Healthy Eating Patterns Review of past and current guidelines- what is new with guidelines and what has remained the same Application- how this can be applied in clinic and in the community for patients, students, and general population.
3 Introduction 1990 National Nutrition Monitoring and Related Research Act- “At least every five years the Secretaries shall publish a report entitled `Dietary Guidelines for Americans'. Each such report shall contain nutritional and dietary information and guidelines for the general public, and shall be promoted by each Federal agency in carrying out any Federal food, nutrition, or health program. BASIS OF GUIDELINES- The information and guidelines contained in each report required under paragraph (1) shall be based on the preponderance of the scientific and medical knowledge which is current at the time the report is prepared.” Document published every 5 years by U.S. Department of Health and Human Services (HHS) and of Agriculture (USDA) with information from the Scientific Report of the 2015 Dietary Guidelines Advisory Committee. -Committee made up of MDs, RDs, and experts in public health -Members were nominated (vetted for conflicts of interest) and used research primarily from Nutrition Evidence Library. Also review current reports from organizations such as American Heart Association, Institute of Medicine, World Health Organization. Use meta-analyses, systematic reviews, data analyses, and food pattern modeling analyses -Agencies have 60 days to review document before publishing to make sure it is accurate and presents current research. -Public free to listen in on advisory meetings and provide any input. -Also include peer-review step with non-federal experts that conduct independent review
4 Introduction Approximately 50% of American adults have one or more diet preventable chronic diseases (cardiovascular disease, type 2 diabetes, overweight/obesity). In , 65% of adult females and 73% of adult males were overweight/obese and one in three youths age 2-19 were overweight/obese. Guidelines are focused on PREVENTION and are used to formulate federal health and nutrition programs and educate the public -Incidence rates of all chronic diseases have increased and affect a large portion of the population. In 2010, 84 million men and women were affected by CVD, colorectal cancer and breast cancer is the second and third leading cause of cancer death in the United States, and in approximately 10 million adults age 50 and older had osteoporosis. -In medical costs associated with obesity were estimated to be $147 billion. -Used to help make programs such as the USDA National School Lunch and Breakfast program, WIC, and programs for older adults. Also used by nutrition professionals to educate through programs . General public is NOT the target audience
5 General Guidelines Follow a healthy eating pattern across the lifespan at an appropriate calorie level. Focus on variety, nutrient density, and amount of foods. Choose within all food groups Limit calories from added sugars and saturated fats and reduce sodium intake. Shift to healthier, more nutrient dense food and beverage choices Support healthy eating patterns for all (multiple settings- school, work, etc.)
6 Key recommendations Variety of vegetables from subgroups such as dark green, red and orange, legumes, starchy and other Whole fruits Whole grains Low fat or fat free dairy Protein foods such as seafood, lean meats, poultry, eggs, legumes, nuts/seeds, and soy Healthy diet includes oils Limit intake of saturated fat, trans fat, and added sugars to less than 10% of calories per day Consume less than 2300 mg sodium per day Alcohol consumption should be in moderation Physical activity guidelines for Americans -limited intake for saturated fat and added sugars not based on UL- based on research that replacing saturated fat with unsaturated fat reduces risk of heart disease and demonstrated public need to limit intake from added sugars. -moderate drinking: - one drink per day for women and two drinks per day for men -sodium- consensus statement from IOM and AHA is that average sodium intake is 3,440 mg per day is too high and should be reduced for reduced HTN and CVD -EtOH: 12 oz of beer, 5 oz of wine, and 1.5 oz of proof distilled spirits -PA guidelines: adults need at least 150 minutes of moderate PA in addition to muscle strengthening exercises at least 2 times per week. Youth age 6-17 yo need at least 60 minutes of PA per day including aerobic, muscle strengthening, and bone strengthening activities
7 Chapter 1: Key Elements in Healthy Eating PatternsHealthy eating pattern includes total foods and beverages consumed Nutrition needs should be met primarily through food Adapt healthy eating pattern based on cultural and personal preferences -focus on first three guidelines and key recommendations -include fresh, canned, dried etc. to allow them to fit into healthy eating pattern depending on population -choose nutrient dense foods to meet needs (fortified foods and supplements may be used if necessary) -Choose appropriate calorie level for age, sex, and activity. For adult women- consume calories and for adult men- consume calories daily dependent on age and calorie level -For weight loss- intake needs to be reduced by calories for 1 to 1.5 pound per week weight loss. That is approximately calories daily for most women and calories daily for most men. -Children are encouraged to maintain calorie balance to support normal growth and overweight/obese youth should change eating and physical activity to reduce rate of weight gain while linear growth occurs.
8 -Have Mediterranean style and vegetarian style eating pattern available in appendix 4 and 5.-The Healthy Mediterranean-Style Pattern contains more fruits and seafood and less dairy than does the Healthy U.S.-Style Pattern. -For vegetarian-style pattern, the Pattern is similar in meeting nutrient standards to the Healthy U.S.-Style Pattern, but somewhat higher in calcium and fiber and lower in vitamin D due to differences in the foods included.
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11 Vegetables Goal for 2,000 calorie diet is 2.5 cup equivalents.Include all 5 vegetable subgroups (dark green, red and orange, legumes (beans/peas), starchy and other. Important source of fiber, potassium, vitamin A, C, K, B6, folate, iron, magnesium, etc. Include wide variety of vegetables in nutrient dense form. Limit butter, salt, or creamy sauces. If canned or frozen, choose lower sodium versions.
12 Fruits Goal for 2,000 calorie diet is 2 cup-equivalentsInclude whole fruits (at least 50%) and 100% juice Fruit can be fresh, canned, frozen, and dried Important source of dietary fiber, potassium, vitamin C. etc. -Fruit juice only counts as 1 equivalent when 100%. If 25% juice, will have added sugars. These should be limited and accounted for in 10% of calories from added sugars.
13 Grains Goal for 2,000 calorie diet is 6 oz-equivalents-Enriched grains are refined grains that have added back iron and 4 B vitamins- thiamin, riboflavin, niacin, and folic aicd. -Limited refined grains high in sodium, added sugar, sodium etc. -best way to meet whole grain recommendation is to choose 100% whole grain foods at least 50% of the time. This will have 16 grams of whole grains. Whole grains should also be first or second ingredient after water. Goal for 2,000 calorie diet is 6 oz-equivalents Limit the intake of refined grains and include whole grains (make ½ whole). Include grains as single foods or ingredient. Whole grains sources of fiber, iron, zinc, manganese, folate, thiamin, riboflavin, etc.
14 Dairy Goal for 2,000 calorie diet is 3 cup equivalentsInclude fat-free and low-fat (1%) dairy- milk, yogurt, cheese, or fortified soy. Important source of calcium, phosphorus, vitamin A, vitamin B12, protein, etc. -Does not include other products sold as “milks” made from almond, rice, coconut, etc. as they may contain calcium but do not match the nutritional content of dairy.
15 Protein Goal for 2,000 calories is 5.5 ounce-equivalents per dayBroad group from both animal and plant sources. Subgroups include: seafood, meats, poultry, and eggs; and nuts, seeds, and soy products (also included in this group are legumes and dairy). Important source of B vitamins, selenium, phosphorus, copper, zinc, etc. -Nutrients differ by protein source- meats provide most zinc, chicken provides most niacin, MPF provide most heme iron, fish provides most B12 and polyunsaturated omega-3 fatty acids, eggs provide most choline, nuts/seeds provide most Vitamin E, and soy products provide the most copper and iron. -Recommendation for at least 8 oz-equivalents of seafood per week (provides an average of 250 mg per day of EPA and DHA. Can lead to reduced cardiac deaths and improved infant health outcomes.
16 -seafood choices higher in EPA and DHA but lower in methyl mercury are encouraged: salmon, anchovies, herring, shad, sardines, pacific oysters, trout, and Atlantic and pacific mackerel
17 Oils Goal for 2,000 calories is 27g (5 tsp) per day.Include fats high in monounsaturated and polyunsaturated fats. Important source in essential fatty acids and vitamin E. Include nuts, seeds, seafood, olives, avocados, as well as corn, canola, olive, peanut, safflower, soybean, and sunflower oil. -does not include fat from tropical plants such as coconut, palm kernel, palm oil
18 Figure 1-2: Fatty Acid Profiles of Common Fats & Oils-polyunsaturated found in greatest amounts in sunflower, corn, soybean, cottonseed oil, walnuts, pine nuts, sesame, pumpkin, sunflower, and flax seeds. Omega 3 fatty acids are a type of polyunsaturated fats found in seafood such as salmon, trout, herring, flax seeds and walnuts. -monounsaturated found in olive, canola, peanut, sunflower, safflower oils and avocados, peanut butter and most nuts. -saturated found in coconut and palm kernel oil, butter and animal fat. The body uses saturated fat for physiological and structural functions but makes more than enough to meet needs. Replacing saturated fats with unsaturated associated with reduced levels of TC and LDL and reduced risk of CVD events (not as strong evidence for monounsaturated as polyunsaturated. -trans fat are unsaturated found in partially hydrogenated oils and ruminant animal fats. Limit as much as possible from synthetic sources as they lead to increased risk of CVD due to LDL raising effects. -margarine vegetable oil spreads vary in composition. Read nutrition facts to find no trans fat and lower saturated fats Figure 1-2: Fatty Acid Profiles of Common Fats & Oils
19 Chapter 2: Shifts Needed to Align With Healthy Eating PatternsFocus on 4th dietary guideline 75% of population have eating patterns low in vegetables, fruits, dairy and oils. More than half of population exceeding total grain and protein recommendations but NOT for subgroups. Most Americans exceed the recommendation for added sugars, saturated fats, and sodium. -Shift to healthier, more nutrient dense food and beverage choices
20 Figure 2-1: Dietary Intakes Compared to RecommendationsFigure 2-1: Dietary Intakes Compared to Recommendations. Percent of the U.S. Population Ages 1 year & Older Who Are Below, At, or Above each Dietary Goal or Limit
21 Vegetable and Fruit IntakeVegetable consumption tends to be lowest among boys ages 9-13 yo and girls ages yo. Vegetables most often consumed as separate food items Shift by increasing vegetable content of mixed dishes and reducing portions of overconsumed food and choose green salad or vegetable as side dish Average intake of fruit is lowest among girls yo and adults ages yo. Fruits most often consumed alone Shift by increasing whole fruit as snacks, in salads, and side dishes -potatoes and tomatoes are the mot commonly consumed vegetables. -vegetables most often consumed as separate food items -shift by increasing vegetable content of mixed dishes and reducing portions of overconsumed food and choose green salad or vegetable s side dish -fruits most often consumed alone -shift by increasing whole fruit as snacks, in salads, and side dishes
22 Grains and Dairy IntakeTotal grains are closest to target amounts but do not meet whole grain recommendations 50% of intake of refined grains from mixed dishes Shift from white to whole grain or 100% whole wheat. Looking at ingredient list and reducing intake of refined desserts and sweet snacks Intake of dairy only met for children ages 1-3 but not for other age groups Dairy intake mostly from milk and cheese Shift to increasing low fat dairy and yogurt if low in added sugars and reducing cheese due to high saturated fat intake. Choose low fat milk with meals or yogurt as a snack.
23 Protein and Oils IntakeWhile protein intake is close to recommendations, vary for subgroups (low for seafood and legumes and high for nuts/seeds and meat, poultry, and eggs. Shift to increase seafood by adding to meals twice per week and using legumes instead of meat and poultry (choose lower sodium options) Oil intake is below recommendations for age groups Shift to use oils instead of solid fats -shift from saturated fats to polyunsaturated and monounsaturated -solid fats account for more than 16% of daily calories per day
24 Other Dietary ComponentsAdded sugars account for more than 13% of calories per day in U.S. population Shift to use beverages with no added sugars and reduce portion sizes for sugar sweetened beverages and desserts/sweet snacks -WHO guideline recommends adults and children reduce their daily intake of free sugars to less than 10% of their total energy intake. A further reduction to below 5% or roughly 25 grams (6 teaspoons) per day would provide additional health benefits. -High-intensity sweeteners can be used as a replacement for regular sugar sweeteners. Approved by the FDA but not enough research for long term effects on weight loss. Deemed safe for consumption as intended since expected daily intake not expected to exceed acceptable daily intake even for high consumers.
25 Chapter 3: Everyone Has a Role in Supporting Healthy Eating Patterns-Focus on 5th guideline Figure 3-1: A Social- Ecological Model for Food & Physical Activity Decision
26 Chapter 3: Everyone Has a Role in Supporting Healthy Eating PatternsSectors include systems (government, health care) and businesses/industries that may influence degree in which people have access to food or opportunities to be physically active. Setting affects what choices individuals make home and away from home. Setting = opportunities Social and cultural norms can be dictated by sectors an setting and difficult to change. Individual settings- adapt eating pattern to fit all requirements, budget, etc.
27 Strategies for Action Sectors to foster relationship with food producers, suppliers, and retailers Sectors to identify policies and programs that promote healthy eating/PA Expand access to healthy and affordable safe and affordable food choices Provide nutrition programs that meet tailored needs for community Help individuals become more aware of nutrition patterns and shift to align with dietary guidelines Teach skills such as gardening, cooking, meal planning and label reading
28 What is new? 2015 dietary guidelines builds off of 2010 guidelines.Focus is on dietary patterns as a whole instead to specific nutrients. Focus on shift to healthier, more nutrient dense food and beverage choices rather than increasing intake of certain foods Does not include dietary cholesterol for key recommendations- IOM still suggests to consume as little dietary cholesterol as possible within healthy eating patterns -Prevalence of overweight and obesity has remained high over past 25 years and adherence to dietary guidelines has remained low- that is why looking at more synergistic, whole view approach (data through Total Healthy Eating Index by NHANES) -Looking ahead- usually the dietary guidelines include recommendations for ages 2 and older. Due to important relationship with early nutrition and increased evidence- new dietary guidelines will include information for infants and toddlers from birth to age 2 as well as guidance on women that are pregnant for the edition -Recommendation for dietary cholesterol in 2010 guidelines was 300 mg per day.
29 Application Used to help make programs such as the USDA National School Lunch and Breakfast program, WIC, and programs for older adults. Used by nutrition professionals to educate through programs. General public is NOT the target audience Up to federal agencies how they wish to implement- use MyPlate, SuperTracker, and other federal government resources for education -Advocate for Healthy U.S. Eating Patterns as they have similarities with DASH diet- high in vegetables, fruits, low fat dairy, whole grains, poultry, fish, beans, and nuts and low in sweets, sugar sweetened beverages, and red meats. Low in saturated fat and rich in potassium, calcium, and magnesium as well as dietary fiber and protein and low sodium.
30 Questions? “Let food be thy medicine, and medicine be thy food.” ― Hippocrates, Greek Philosopher