Appendix D

Dietary Guidelines for Americans Guidelines and Key Recommendations

1980 DIETARY GUIDELINES FOR AMERICANS

The 1980 Dietary Guidelines for Americans presented seven guidelines (USDA/HHS, 1980):

• Eat a variety of foods.
• Maintain ideal weight.
• Avoid too much fat, saturated fat, and cholesterol.
• Eat foods with adequate starch and fiber.
• Avoid too much sugar.
• Avoid too much sodium.
• If you drink alcohol, do so in moderation.

1985 DIETARY GUIDELINES FOR AMERICANS

The 1985 Dietary Guidelines for Americans presented seven guidelines (USDA/HHS, 1985):

• Eat a variety of foods.
• Maintain desirable weight.
• Avoid too much fat, saturated fat, and cholesterol.
• Eat foods with adequate starch and fiber.
• Avoid too much sugar.
• Avoid too much sodium.
• If you drink alcoholic beverages, do so in moderation.

1990 DIETARY GUIDELINES FOR AMERICANS

The 1990 Dietary Guidelines for Americans presented seven guidelines (USDA/HHS, 1990):

• Eat a variety of foods.
• Maintain healthy weight.
• Choose a diet low in fat, saturated fat, and cholesterol.
• Choose a diet with plenty of vegetables, fruits, and grain products.
• Use sugars only in moderation.
• Use salt and sodium only in moderation.
• If you drink alcoholic beverages, do so in moderation.

1995 DIETARY GUIDELINES FOR AMERICANS

The 1995 Dietary Guidelines for Americans presented seven guidelines (USDA/HHS, 1995):

• Eat a variety of foods.
• Balance the food you eat with physical activity—maintain or improve your weight.
• Choose a diet with plenty of grain products, vegetables, and fruits.
• Choose a diet low in fat, saturated fat, and cholesterol.
• Choose a diet moderate in sugars.
• Choose a diet moderate in salt and sodium.
• If you drink alcoholic beverages, do so in moderation.

2000 DIETARY GUIDELINES FOR AMERICANS

The 2000 Dietary Guidelines for Americans contained 10 guidelines clustered into 3 messages (USDA/HHS, 2000):

10 Guidelines

• Aim for a healthy weight.
• Be physically active each day.
• Let the Pyramid guide your food choices.
• Choose a variety of grains daily, especially whole grains.
• Choose a variety of fruits and vegetables daily.
• Keep food safe to eat.
• Choose a diet that is low in saturated fat and cholesterol and moderate in total fat.
• Choose beverages and foods to moderate your intake of sugars.

• Choose and prepare foods with less salt.
• If you drink alcoholic beverages, do so in moderation.

3 Messages

• Aim for fitness.
• Build a healthy base.
• Choose sensibly.

2005 DIETARY GUIDELINES FOR AMERICANS

The 2005 Dietary Guidelines for Americans had 41 key recommendations, 23 of which were for the general population and 18 for specific population groups (HHS/USDA, 2005).

Adequate Nutrients Within Calorie Needs

Key Recommendations

• Consume a variety of nutrient-dense foods and beverages within and among the basic food groups while choosing foods that limit the intake of saturated and trans fats, cholesterol, added sugars, salt, and alcohol.
• Meet recommended intakes within energy needs by adopting a balanced eating pattern, such as the U.S. Department of Agriculture (USDA) Food Guide or the Dietary Approaches to Stop Hypertension (DASH) Eating Plan.

Key Recommendations for Specific Population Groups

• People over age 50. Consume vitamin B₁₂ in its crystalline form (i.e., fortified foods or supplements).
• Women of childbearing age who may become pregnant. Eat foods high in heme iron and/or consume iron-rich plant foods or iron-fortified foods with an enhancer of iron absorption, such as vitamin C–rich foods.
• Women of childbearing age who may become pregnant and those in the first trimester of pregnancy. Consume adequate synthetic folic acid daily (from fortified foods or supplements) in addition to food forms of folate from a varied diet.
• Older adults, people with dark skin, and people exposed to insufficient ultraviolet band radiation (i.e., sunlight). Consume extra vitamin D from vitamin D–fortified foods and/or supplements.

Weight Management

Key Recommendations

• To maintain body weight in a healthy range, balance calories from foods and beverages with calories expended.
• To prevent gradual weight gain over time, make small decreases in food and beverage calories and increase physical activity.

Key Recommendations for Specific Population Groups

• Those who need to lose weight. Aim for a slow, steady weight loss by decreasing calorie intake while maintaining an adequate nutrient intake and increasing physical activity.
• Overweight children. Reduce the rate of body weight gain while allowing growth and development. Consult a health care provider before placing a child on a weight-reduction diet.
• Pregnant women. Ensure appropriate weight gain as specified by a health care provider.
• Breastfeeding women. Moderate weight reduction is safe and does not compromise weight gain of the nursing infant.
• Overweight adults and overweight children with chronic diseases and/or on medication. Consult a health care provider about weight loss strategies prior to starting a weight-reduction program to ensure appropriate management of other health conditions.

Physical Activity

Key Recommendations

• Engage in regular physical activity and reduce sedentary activities to promote health, psychological well-being, and a healthy body weight.
  • To reduce the risk of chronic disease in adulthood: Engage in at least 30 minutes of moderate-intensity physical activity, above usual activity, at work or home on most days of the week.
  • For most people, greater health benefits can be obtained by engaging in physical activity of more vigorous intensity or longer duration.
  • To help manage body weight and prevent gradual, unhealthy body weight gain in adulthood: Engage in approximately 60 minutes of moderate- to vigorous-intensity activity on

• • most days of the week while not exceeding caloric intake requirements.

  • To sustain weight loss in adulthood: Participate in at least 60 to 90 minutes of daily moderate-intensity physical activity while not exceeding caloric intake requirements. Some people may need to consult with a health care provider before participating in this level of activity.
• Achieve physical fitness by including cardiovascular conditioning, stretching exercises for flexibility, and resistance exercises or calisthenics for muscle strength and endurance.

Key Recommendations for Specific Population Groups

• Children and adolescents. Engage in at least 60 minutes of physical activity on most, preferably all, days of the week.
• Pregnant women. In the absence of medical or obstetric complications, incorporate 30 minutes or more of moderate-intensity physical activity on most, if not all, days of the week. Avoid activities with a high risk of falling or abdominal trauma.
• Breastfeeding women. Be aware that neither acute nor regular exercise adversely affects the mother’s ability to successfully breastfeed.
• Older adults. Participate in regular physical activity to reduce functional declines associated with aging and to achieve the other benefits of physical activity identified for all adults.

Food Groups to Encourage

Key Recommendations

• Consume a sufficient amount of fruits and vegetables while staying within energy needs. Two cups of fruit and 2.5 cups of vegetables per day are recommended for a reference 2,000-calorie intake, with higher or lower amounts depending on the calorie level.
• Choose a variety of fruits and vegetables each day. In particular, select from all five vegetable subgroups (dark-green, orange, legumes, starchy vegetables, and other vegetables) several times a week.
• Consume 3 or more ounce-equivalents of whole-grain products per day, with the rest of the recommended grains coming from enriched or whole-grain products. In general, at least half the grains should come from whole grains.

• Consume 3 cups per day of fat-free or low-fat milk or equivalent milk products.

Key Recommendations for Specific Population Groups

• Children and adolescents. Consume whole-grain products often; at least half the grains should be whole grains. Children 2 to 8 years should consume 2 cups per day of fat-free or low-fat milk or equivalent milk products. Children 9 years of age and older should consume 3 cups per day of fat-free or low-fat milk or equivalent milk products.

Fats

Key Recommendations

• Consume less than 10 percent of calories from saturated fatty acids and less than 300 mg/day of cholesterol, and keep trans fatty acid consumption as low as possible.
• Keep total fat intake between 20 to 35 percent of calories, with most fats coming from sources of polyunsaturated and monounsaturated fatty acids, such as fish, nuts, and vegetable oils.
• When selecting and preparing meat, poultry, dry beans, and milk or milk products, make choices that are lean, low fat, or fat free.
• Limit intake of fats and oils high in saturated and/or trans fatty acids, and choose products low in such fats and oils.

Key Recommendations for Specific Population Groups

• Children and adolescents. Keep total fat intake between 30 to 35 percent of calories for children 2 to 3 years of age and between 25 to 35 percent of calories for children and adolescents 4 to 18 years of age, with most fats coming from sources of polyunsaturated and monounsaturated fatty acids, such as fish, nuts, and vegetable oils.

Carbohydrates

Key Recommendations

• Choose fiber-rich fruits, vegetables, and whole grains often.
• Choose and prepare foods and beverages with little added sugars or caloric sweeteners, such as amounts suggested by the USDA Food Guide and the DASH Eating Plan.

• Reduce the incidence of dental caries by practicing good oral hygiene and consuming sugar- and starch-containing foods and beverages less frequently.

Sodium and Potassium

Key Recommendations

• Consume less than 2,300 mg (approximately 1 teaspoon of salt) of sodium per day.
• Choose and prepare foods with little salt. At the same time, consume potassium-rich foods, such as fruits and vegetables.

Key Recommendations for Specific Population Groups

• Individuals with hypertension, blacks, and middle-aged and older adults. Aim to consume no more than 1,500 mg of sodium per day, and meet the potassium recommendation (4,700 mg/day) with food.

Alcoholic Beverages

Key Recommendations

• Those who choose to drink alcoholic beverages should do so sensibly and in moderation—defined as the consumption of up to one drink per day for women and up to two drinks per day for men.
• Alcoholic beverages should not be consumed by some individuals, including those who cannot restrict their alcohol intake, women of childbearing age who may become pregnant, pregnant and lactating women, children and adolescents, individuals taking medications that can interact with alcohol, and those with specific medical conditions.
• Alcoholic beverages should be avoided by individuals engaging in activities that require attention, skill, or coordination, such as driving or operating machinery.

Food Safety

Key Recommendations

• To avoid microbial food-borne illness:
  • Clean hands, food contact surfaces, and fruits and vegetables. Meat and poultry should not be washed or rinsed.

Key Recommendations for Specific Population Groups

• Infants and young children, pregnant women, older adults, and those who are immunocompromised. Do not eat or drink raw (unpasteurized) milk or any products made from unpasteurized milk, raw or partially cooked eggs or foods containing raw eggs, raw or undercooked meat and poultry, raw or undercooked fish or shellfish, unpasteurized juices, and raw sprouts.
• Pregnant women, older adults, and those who are immunocompromised. Only eat certain deli meats and frankfurters that have been reheated to steaming hot.

2010 DIETARY GUIDELINES FOR AMERICANS

The 2010 Dietary Guidelines for Americans had 29 key recommendations, 23 of which are for the general population and 6 for specific population groups (USDA/HHS, 2010).

Balancing Calories to Manage Weight

Key Recommendations

• Prevent and/or reduce overweight and obesity through improved eating and physical activity behaviors.
• Control total calorie intake to manage body weight. For people who are overweight or obese, this will mean consuming fewer calories from foods and beverages.
• Increase physical activity, and reduce time spent in sedentary behaviors.
• Maintain appropriate calorie balance during each stage of life—childhood, adolescence, adulthood, pregnancy and breastfeeding, and older age.

Foods and Food Components to Reduce

• Reduce daily sodium intake to less than 2,300 mg and further reduce intake to 1,500 mg among persons who are 51 and older and those of any age who are African American or have hypertension, diabetes, or chronic kidney disease. The 1,500 mg recommendation applies to about half of the U.S. population, including children, and the majority of adults.
• Consume less than 10 percent of calories from saturated fatty acids by replacing them with monounsaturated and polyunsaturated fatty acids.
• Consume less than 300 mg per day of dietary cholesterol.
• Keep trans fatty acid consumption as low as possible by limiting foods that contain synthetic sources of trans fats, such as partially hydrogenated oils, and by limiting other solid fats.
• Reduce the intake of calories from solid fats and added sugars.
• Limit the consumption of foods that contain refined grains, especially refined grain foods that contain solid fats, added sugars, and sodium.
• If alcohol is consumed, it should be consumed in moderation—up to one drink per day for women and two drinks per day for men—and only by adults of legal drinking age.

Foods and Nutrients to Increase

Individuals should meet the following recommendations as part of a healthy eating pattern while staying within their calorie needs.

Key Recommendations

• Increase vegetable and fruit intake.
• Eat a variety of vegetables, especially dark-green and red and orange vegetables and beans and peas.
• Consume at least half of all grains as whole grains. Increase whole-grain intake by replacing refined grains with whole grains.
• Increase intake of fat-free or low-fat milk and milk products, such as milk, yogurt, cheese, or fortified soy beverages.
• Choose a variety of protein foods, which include seafood, lean meat and poultry, eggs, beans and peas, soy products, and unsalted nuts and seeds.
• Increase the amount and variety of seafood consumed by choosing seafood in place of some meat and poultry.
• Replace protein foods that are higher in solid fats with choices that are lower in solid fats and calories and/or are sources of oils.

• Use oils to replace solid fats where possible.
• Choose foods that provide more potassium, dietary fiber, calcium, and vitamin D, which are nutrients of concern in American diets. These foods include vegetables, fruits, whole grains, and milk and milk products.

Key Recommendations for Specific Population Groups

• Women capable of becoming pregnant should choose foods that supply heme iron, which is more readily absorbed by the body, additional iron sources, and enhancers of iron absorption such as vitamin C–rich foods.
• Women capable of becoming pregnant should consume 400 micrograms (mcg) per day of synthetic folic acid (from fortified foods and/or supplements) in addition to food forms of folate from a varied diet.
• Women who are pregnant or breastfeeding should consume 8 to 12 ounces of seafood per week from a variety of seafood types.
• Women who are pregnant or breastfeeding should limit white albacore tuna to 6 ounces per week and do not eat the following four types of fish: tilefish, shark, swordfish, and king mackerel due to their high methyl mercury content.
• Women, if pregnant, should take an iron supplement, as recommended by an obstetrician or other health provider.
• Individuals ages 50 years and older should consume foods fortified with vitamin B₁₂, such as fortified cereals or dietary supplements.

Building Healthy Eating Patterns

• Select an eating pattern that meets nutrient needs over time at an appropriate calorie level.
• Account for all foods and beverages consumed, and assess how they fit within a total healthy eating pattern.
• Follow food safety recommendations when preparing and eating foods to reduce the risk of food-borne illnesses.

2015–2020 DIETARY GUIDELINES FOR AMERICANS

The 2015–2020 Dietary Guidelines for Americans had 5 overarching guidelines and 13 supporting key recommendations (HHS/USDA, 2015).

5 Overarching Guidelines

1. Follow a healthy eating pattern across the life span.
2. Focus on variety, nutrient density, and amount.
3. Limit calories from added sugars and saturated fats, and reduce sodium intake.
4. Shift to healthier food and beverage choices.
5. Support healthy eating patterns for all.

13 Key Recommendations

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

A healthy eating pattern includes

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

A healthy eating pattern limits:

• Saturated fats and trans fats, added sugars, and sodium

Key recommendations that are quantitative are provided for several components of the diet that should be limited. These components are of particular public health concern in the United States, and the specified limits can help individuals achieve healthful eating patterns within calorie limits:

• Consume less than 10 percent of calories per day from added sugars.
• Consume less than 10 percent of calories per day from saturated fats.
• Consume less than 2,300 milligrams (mg) per day of sodium.

• If alcohol is consumed, it should be consumed in moderation—up to one drink per day for women and up to two drinks per day for men—and only by adults of legal drinking age.

In tandem with the recommendations above, Americans of all ages—children, adolescents, adults, and older adults—should meet the Physical Activity Guidelines for Americans to help promote health and reduce the risk of chronic disease. Americans should aim to achieve and maintain a healthy body weight. The relationship between diet and physical activity contributes to caloric balance and managing body weight. As such, the Dietary Guidelines includes a key recommendation to:

• Meet the Physical Activity Guidelines for Americans.

REFERENCES