Report Of The Dietary - Dietary Guidelines

Policy OfficialsRajen S. Anand, DVM, PhDExecutive DirectorCenter for Nutrition Policy and PromotionU.S. Department of AgricultureRobert C. Post, PhD, MEd, MScDeputy DirectorCenter for Nutrition Policy and PromotionU.S. Department of AgriculturePenelope Slade-Sawyer, PT, MSW, RADM,USPHSDeputy Assistant Secretary for Health(Disease Prevention and Health Promotion)U.S. Department of Health and Human ServicesSarah R. Linde-Feucht, MD, CAPT, USPHSDeputy Director (through 3/10)Office of Disease Prevention and Health PromotionU.S. Department of Health and Human ServicesWendy E. Braund, MD, MPH, MSEdActing Deputy Director and Lead, Prevention Science TeamOffice of Disease Prevention and Health PromotionU.S. Department of Health and Human ServicesDietary Guidelines Management Team StaffJan Barrett Adams, MS, MBA, RDU.S. Department of AgriculturePatricia M. Guenther, PhD, RDU.S. Department of AgricultureShirley A. Blakely, PhD, RD, CAPT, USPHSU.S. Department of Health and Human ServicesRachel R. Hayes, MPH, RDU.S. Department of Health and Human ServicesPatricia Britten, MS, PhDU.S. Department of AgricultureHolly H. McPeak, MSU.S. Department of Health and Human ServicesEve V. Essery, PhDU.S. Department of Health and Human Services(until 8/09)U.S. Department of Agriculture (beginning 8/09)Kellie M. O’Connell, PhD, RDU.S. Department of Agriculture2010 Dietary Guidelines Advisory Committee ReportColette I. Rihane, MS, RDU.S. Department of Agriculturev

Dietary Guidelines Nutrition Evidence Library StaffJoanne M. Spahn, MS, RD, FADAU.S. Department of AgricultureDonna Blum-Kemelor, MS, RD, LDU.S. Department of AgricultureJoan M. G. Lyon, MS, RDU.S. Department of AgricultureEve V. Essery, PhDU.S. Department of AgricultureJean M. Altman, MSU.S. Department of AgricultureThomas V. Fungwe, PhDU.S. Department of AgriculturePatricia Carrera MacNeil, MS, LN, CNSU.S. Department of AgricultureJulie E. Obbagy, PhD, RDU.S. Department of AgricultureMary M. McGrane, PhDU.S. Department of AgricultureResearch LibrarianYat Ping Wong, MLS, MPHU.S. Department of AgricultureTechnical Writer/EditorAnne Brown RodgersFalls Church, Virginiavi2010 Dietary Guidelines Advisory Committee Report

Part A: Executive SummaryThe 2010 Dietary Guidelines Advisory Committee(DGAC) was established jointly by the Secretaries ofU.S. Department of Agriculture (USDA) and the U.S.Department of Health and Human Services (HHS). TheCommittee’s task was to advise the Secretaries ofUSDA and HHS on whether revisions to the 2005Dietary Guidelines were warranted, and if so, torecommend updates to the Guidelines. The DGACimmediately recognized that, on the basis of the vastamount of published research and emerging science onnumerous relevant topics, an updated report was indeedneeded.The 2010 DGAC Report is distinctly different fromprevious reports in several ways. First, it addresses anAmerican public of whom the majority are overweightor obese and yet under-nourished in several keynutrients. Second, the Committee used a newlydeveloped, state-of-the-art, web-based electronic systemand methodology, known as the Nutrition EvidenceLibrary (NEL), to answer the majority of the scientificquestions it posed. The remaining questions wereanswered by data analyses, food pattern modelinganalyses, and consideration of other evidence-basedreviews or existing reports, including the 2008 PhysicalActivity Guidelines for Americans. The 2005 DietaryGuidelines for Americans were the starting place formost reviews. If little or no scientific literature had beenpublished on a specific topic since the 2005 Report waspresented, the DGAC indicated this and established theconclusions accordingly.A third distinctive feature of this Report is theintroduction of two newly developed chapters. The firstof these chapters considers the total diet and how tointegrate all of the Report’s nutrient and energyrecommendations into practical terms that encouragepersonal choice but result in an eating pattern that isnutrient dense and calorie balanced. The second chaptercomplements this total diet approach by integrating andtranslating the scientific conclusions reached at theindividual level to encompass the broaderenvironmental and societal aspects that are crucial tofull adoption and successful implementation of theserecommendations.2010 Dietary Guidelines Advisory Committee ReportThe remainder of this Executive Summary providesbrief synopses of these and all of the other chapters,which review current evidence related to specific topicsand present the resulting highlights that comprise thefundamental essence of this report.Major Cross-cutting Findings andRecommendationsTotal Diet: Combining Nutrients, ConsumingFoodsThe 2010 DGAC Report concludes that good health andoptimal functionality across the lifespan are achievablegoals but require a lifestyle approach including a totaldiet that is energy balanced and nutrient dense. Now, asin the past, a disconnect exists between dietaryrecommendations and what Americans actuallyconsume. On average, Americans of all ages consumetoo few vegetables, fruits, high-fiber whole grains, lowfat milk and milk products, and seafood and they eat toomuch added sugars, solid fats, refined grains, andsodium. SoFAS (added sugars and solid fats) contributeapproximately 35 percent of calories to the Americandiet. This is true for children, adolescents, adults, andolder adults and for both males and females. Reducingthe intake of SoFAS can lead to a badly neededreduction in energy intake and inclusion of morehealthful foods into the total diet.The diet recommended in this Report is not a rigidprescription. Rather, it is a flexible approach thatincorporates a wide range of individual tastes and foodpreferences. Accumulating evidence documents thatcertain dietary patterns consumed around the world areassociated with beneficial health outcomes. Patterns ofeating that have been shown to be healthful include theDietary Approaches to Stop Hypertension (DASH)-styledietary patterns and certain Mediterranean-style dietarypatterns. Similarly, the USDA Food Patterns illustratethat both nutrient adequacy and moderation goals canbe met in a variety of ways. The daunting public healthchallenge is to accomplish population-wide adoption ofhealthful dietary patterns within the context of powerfulinfluences that currently promote unhealthy consumerchoices, behaviors, and lifestyles.1

Translating and Integrating the Evidence: ACall to ActionComplementing the Total Diet chapter, this chapterdescribes the four major findings that emerged from theDGAC’s review of the scientific evidence andarticulates steps that can be taken to help all Americansadopt health-promoting nutrition and physical activityguidelines: Reduce the incidence and prevalence of overweightand obesity of the U.S. population by reducingoverall calorie intake and increasing physicalactivity.Shift food intake patterns to a more plant-based dietthat emphasizes vegetables, cooked dry beans andpeas, fruits, whole grains, nuts, and seeds. Inaddition, increase the intake of seafood and fat-freeand low-fat milk and milk products and consumeonly moderate amounts of lean meats, poultry, andeggs.Significantly reduce intake of foods containingadded sugars and solid fats because these dietarycomponents contribute excess calories and few, ifany, nutrients. In addition, reduce sodium intakeand lower intake of refined grains, especiallyrefined grains that are coupled with added sugar,solid fat, and sodium.Meet the 2008 Physical Activity Guidelines forAmericans.The 2010 DGAC recognizes that substantial barriersmake it difficult for Americans to accomplish thesegoals. Ensuring that all Americans consume a healthpromoting dietary pattern and achieve and maintainenergy balance requires far more than individualbehavior change. A multi-sectoral strategy isimperative. For this reason, the 2010 DGAC stronglyrecommends that USDA and HHS convene appropriatecommittees, potentially through the Institute ofMedicine (IOM), to develop strategic plans focusing onthe actions needed to successfully implement key 2010DGAC recommendations. Separate committees may benecessary because the actions needed to implement keyrecommendations likely differ by goal.A coordinated strategic plan that includes all sectors ofsociety, including individuals, families, educators,communities, physicians and allied health professionals,public health advocates, policy makers, scientists, andsmall and large businesses (e.g., farmers, agriculturalproducers, food scientists, food manufacturers, and foodretailers of all kinds), should be engaged in the2development and ultimate implementation of a plan tohelp all Americans eat well, be physically active, andmaintain good health and function. It is important thatany strategic plan is evidence-informed, action-oriented,and focused on changes in systems in these sectors.Any and all systems-based strategies must include afocus on children. Primary prevention of obesity mustbegin in childhood. This is the single most powerfulpublic health approach to combating and reversingAmerica’s obesity epidemic over the long term.Strategies to help Americans change their dietary intakepatterns and be physically active also will go a long wayto ameliorating the disparities in health among racialand ethnic minorities and among differentsocioeconomic groups, which have been recognized as asignificant concern for decades. While the reasons forthese differences are complex and multifactorial, thisReport addresses research indicating that certain dietarychanges can provide a means to reduce healthdisparities.Change is needed in the overall food environment tosupport the efforts of all Americans to meet the keyrecommendations of the 2010 DGAC. To meet thesechallenges, the following sustainable changes mustoccur: Improve nutrition literacy and cooking skills,including safe food handling skills, and empowerand motivate the population, especially familieswith children, to prepare and consume healthyfoods at home.Increase comprehensive health, nutrition, andphysical education programs and curricula in U.S.schools and preschools, including food preparation,food safety, cooking, and physical education classesand improved quality of recess.For all Americans, especially those of low income,create greater financial incentives to purchase,prepare, and consume vegetables and fruit, wholegrains, seafood, fat-free and low-fat milk and milkproducts, lean meats, and other healthy foods.Improve the availability of affordable fresh producethrough greater access to grocery stores, producetrucks, and farmers’ markets.Increase environmentally sustainable production ofvegetables, fruits, and fiber-rich whole grains.Ensure household food security through measuresthat provide access to adequate amounts of foodsthat are nutritious and safe to eat.2010 Dietary Guidelines Advisory Committee Report

Develop safe, effective, and sustainable practices toexpand aquaculture and increase the availability ofseafood to all segments of the population. Enhanceaccess to publicly available, user-friendlybenefit/risk information that helps consumers makeinformed seafood choices.Encourage restaurants and the food industry to offerhealth-promoting foods that are low in sodium;limited in added sugars, refined grains, and solidfats; and served in smaller portions.Implement the U.S. National Physical Activity Plan,a private-public sector collaborative promoting local,state, and national programs and policies to increasephysical activity and reduce sedentary .htm).Through the Plan and other initiatives, developefforts across all sectors of society, including healthcare and public health; education; business andindustry; mass media; parks, recreation, fitness, andsports; transportation; land use; community design;and volunteer and non-profit. Reducing screen time,especially television, for all Americans also will beimportant.Topic-specific Findings and ConclusionsEnergy Balance and Weight ManagementThe prevalence of overweight and obesity in the U.S.has increased dramatically in the past three decades.This is true of children, adolescents, and adults and ismore severe in minority groups. The Americanenvironment is conducive to this epidemic, presentingtemptation to the populace in the form of tasty, energydense, micronutrient-poor foods and beverages. Themacronutrient distribution of a person’s diet is not thedriving force behind the current obesity epidemic.Rather, it is the over-consumption of total caloriescoupled with very low physical activity and too muchsedentary time. The energy density of foods eaten is animportant factor in overeating. Americans eat too manycalories from foods high in SoFAS that offer few or noother nutrients besides calories. This is true not only foradults but also for children, who consume energy-denseSoFAS, especially in the form of sugar-sweetenedbeverages, at levels substantially higher than required tomaintain themselves at a normal weight as they grow.With regard to special subgroups, maternal obesitybefore pregnancy and excessive weight gain duringpregnancy are deleterious for the mother and the fetus.2010 Dietary Guidelines Advisory Committee ReportOne-fifth of American women are obese when theybecome pregnant, often put on much more weight thanis healthy during pregnancy, and have trouble losing itafter delivery, placing their offspring at increased risk ofobesity and type 2 diabetes (T2D) later in life.Breastfeeding has no sustained impact on maternalweight gain or loss, but has numerous benefits formother and infant and should be encouraged.Older overweight or obese adults can derive as muchbenefit from losing weight and keeping it off as doyounger persons, with resulting improvements in qualityof life, including diminished disabilities and lower risksof chronic diseases.Selected behaviors that lead to a greater propensity togain weight include too much TV watching, too littlephysical activity, eating out frequently (especially atquick service restaurants [i.e., fast food restaurants]),snacking on energy-dense food and drinks, skippingbreakfast, and consuming large portions. Selfmonitoring, including knowing one’s own calorierequirement and the calorie content of foods, helpsmake individuals conscious of what, when, and howmuch they eat. Mindful, or conscious, eating is animportant lifestyle habit that can help to preventinappropriate weight gain, enhance weight loss in thosewho should lose weight, and assist others in maintaininga healthy weight.Nutrient AdequacyAmericans are encouraged to lower overall energyintakes to match their energy needs. Energy-denseforms of foods, especially foods high in SoFAS, shouldbe replaced with nutrient-dense forms of vegetables,fruits, whole grains, and fluid milk and milk products toincrease intakes of shortfall nutrients and nutrients ofconcern—vitamin D, calcium, potassium, and dietaryfiber. Women of reproductive capacity should consumefoods rich in folate and iron, and older individualsshould consume fortified foods rich in vitamin B12 orB12 supplements, if needs cannot be met through wholefoods. Nutritious breakfast consumption and in somecases nutrient-dense snacking may assist in meetingnutrient recommendations, especially in certainsubgroups.A daily multivitamin/mineral supplement does not offerhealth benefits to healthy Americans. Individualmineral/vitamin supplements can benefit somepopulation groups with known deficiencies, such ascalcium and vitamin D supplements to reduce risk of3

osteoporosis or iron supplements among those withdeficient iron intakes. However, in some settings,mineral/vitamin supplements have been associated withharmful effects and should be pursued cautiously.Fatty Acids and CholesterolIntakes of dietary fatty acids and cholesterol are majordeterminants of cardiovascular disease (CVD) and T2D,two major causes of morbidity and mortality inAmericans. Fats contribute 9 calories per gram. Thehealth impacts of dietary fats and cholesterol aremediated through levels of serum lipids, lipoproteins,and other intermediate markers. The U.S. consumptionof harmful types and amounts of fatty acids andcholesterol has not changed appreciably since 1990.In order to reduce the population’s burden from CVDand T2D and their risk factors, the preponderance of theevidence indicates beneficial health effects areassociated with several changes in consumption ofdietary fats and cholesterol. These include limitingsaturated fatty acid intake to less than 7 percent of totalcalories and substitutin

Dietary Guidelines Advisory Committee. 2010. Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 2010, to the Secretary of Agriculture and the Secretary of Health and Human Services. U.S. Department of Agriculture