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.
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.
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.
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.
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.
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.
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.
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.")
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.
Table E-2. Differences in Saturated Fat and Calorie Content of Commonly
Consumed Foods
A Comparison of Saturated Fat in
Some Foods |
Food Category |
Portion |
Saturated
Fat
Content in Grams |
Calories |
Cheese |
|
|
|
- Regular cheddar cheese
- Low-fat cheddar cheese
|
1 oz.
1 oz. |
6.0 1.2 |
114 49 |
Ground beef |
|
|
|
- Regular ground beef (25% fat)
- Extra lean ground beef (5% fat)
|
3 oz.
(cooked)
3 oz. (cooked) |
6.1 2.6 |
236 148 |
Milk |
|
|
|
- Whole milk
(3.24%)
- Low-fat (1%) milk
|
1 cup
1 cup |
4.6
1.5 |
146
102 |
Breads
|
|
|
|
- Croissant (med)
- Bagel, oat bran (4”)
|
1 medium
1 medium |
6.6
0.2 |
231
227 |
Frozen desserts |
|
|
|
- Regular ice cream
- Frozen yogurt
|
½ cup
½ cup |
4.9
2.0 |
145
110 |
Table spreads |
|
|
|
- Butter
- Trans-free soft margarine
|
1 tsp.
1 tsp. |
2.4
0.7 |
34
25 |
Chicken |
|
|
|
- Fried chicken (leg)
- Chicken breast
|
3 oz.
(cooked)
3 oz. (cooked) |
3.3
0.9 |
212
140 |
Fish |
|
|
|
|
3 oz.
3 oz. |
2.8
1.5 |
195
129 |
Source: ARS Nutrient Database for Standard Reference, Release 17
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.
Figure E-1. Adult BMI Chart
BMI |
19 |
20 |
21 |
22 |
23 |
24 |
25 |
26 |
27 |
28 |
29 |
30 |
31 |
32 |
33 |
34 |
35 |
|
Height |
Weight in Pounds |
|
Healthy Weight |
Overweight |
Obese |
4'10" |
91 |
96 |
100 |
105 |
110 |
115 |
119 |
124 |
129 |
134 |
138 |
143 |
148 |
153 |
158 |
162 |
167 |
4'11" |
94 |
99 |
104 |
109 |
114 |
119 |
124 |
128 |
133 |
138 |
143 |
148 |
153 |
158 |
163 |
168 |
173 |
5' |
97 |
102 |
107 |
112 |
118 |
123 |
128 |
133 |
138 |
143 |
148 |
153 |
158 |
163 |
158 |
174 |
179 |
5'1" |
100 |
106 |
111 |
116 |
122 |
127 |
132 |
137 |
143 |
148 |
153 |
158 |
164 |
169 |
174 |
180 |
185 |
5'2" |
104 |
109 |
115 |
120 |
126 |
131 |
136 |
142 |
147 |
153 |
158 |
164 |
169 |
175 |
180 |
186 |
191 |
5'3" |
107 |
113 |
118 |
124 |
130 |
135 |
141 |
146 |
152 |
158 |
163 |
169 |
175 |
180 |
186 |
191 |
197 |
5'4" |
110 |
116 |
122 |
128 |
134 |
140 |
145 |
151 |
157 |
163 |
169 |
174 |
180 |
186 |
192 |
197 |
204 |
5'5" |
114 |
120 |
126 |
132 |
138 |
144 |
150 |
156 |
162 |
168 |
174 |
180 |
186 |
192 |
198 |
204 |
210 |
5'6" |
118 |
124 |
130 |
136 |
142 |
148 |
155 |
161 |
167 |
173 |
179 |
186 |
192 |
198 |
204 |
210 |
216 |
5'7" |
121 |
127 |
134 |
140 |
146 |
153 |
159 |
166 |
172 |
178 |
185 |
191 |
198 |
204 |
211 |
217 |
223 |
5'8" |
125 |
131 |
138 |
144 |
151 |
158 |
164 |
171 |
177 |
184 |
190 |
197 |
203 |
210 |
216 |
223 |
230 |
5'9" |
128 |
135 |
142 |
149 |
155 |
162 |
169 |
176 |
182 |
189 |
196 |
203 |
209 |
216 |
223 |
230 |
236 |
5'10" |
132 |
139 |
146 |
153 |
160 |
167 |
174 |
181 |
188 |
195 |
202 |
209 |
216 |
222 |
229 |
236 |
243 |
5'11" |
136 |
143 |
150 |
157 |
165 |
172 |
179 |
186 |
193 |
200 |
208 |
215 |
222 |
229 |
236 |
243 |
250 |
6' |
140 |
147 |
154 |
162 |
169 |
177 |
184 |
191 |
199 |
206 |
213 |
221 |
228 |
235 |
242 |
250 |
258 |
6'1" |
144 |
151 |
159 |
166 |
174 |
182 |
189 |
197 |
204 |
212 |
219 |
227 |
235 |
242 |
250 |
257 |
265 |
6'2" |
148 |
155 |
163 |
171 |
179 |
186 |
194 |
202 |
210 |
218 |
225 |
233 |
241 |
249 |
256 |
264 |
272 |
6'3" |
152 |
160 |
168 |
176 |
184 |
192 |
200 |
208 |
216 |
224 |
232 |
240 |
248 |
256 |
264 |
272 |
279 |
Source: Evidence Report of Clinical Guidelines on the Identification,
Evaluation, and Treatment of Overweight and Obesity in Adults, 1998.
NIH/National Heart, Lung, and Blood Institute (NHLBI)
Table E-4. How Portion Sizes Have Changed
Food Item |
Calories per Portion 20 Years Ago |
Calories per Portion Today |
Bagel
|
140 calories (3
in. diameter) |
350 calories (6
in. diameter) |
Fast food cheeseburger
|
333 calories |
590 calories |
Spaghetti and meatballs
|
500 calories (1
cup of spaghetti with sauce and 3 small meatballs) |
1,025 calories (2
cups of spaghetti and 3 large meatballs) |
Bottle of soda
|
85 calories (6.5
oz.) |
250 calories (20
oz.) |
Fast food French fries
|
210 calories (2.4
oz) |
610 calories (6.9
oz) |
Turkey sandwich
|
320 calories |
820 calories (10
in. sub) |
Adapted from the Portion Distortion Quiz on the NHLBI Web site.
Table E-5. Strategies to Reduce Calories in Your Diet
- Instead of sugar-sweetened soft drinks, try a diet soda or water or at
least reduce the amount of regular soft drinks you consume by 8 ounces (1
cup).
- Have a toasted English muffin with 2 teaspoons of no-sugar-added
preserves instead of a croissant or sweet roll.
- Pick water-packed tuna instead of tuna packed in oil.
- Skip the cream-based or cheese sauce on your vegetables.
- Go for just a half cup of regular (10% fat) ice cream instead of rich
(16% fat) or premium (18%–20% fat) ice cream.
- Follow the low-fat directions when preparing brownie, cake, and cookie
mixes.
- Enjoy canned fruit packed in water or its natural juice instead of
heavy syrup
- Lighten up your favorite coffee drink by requesting nonfat milk and
using half the sugar or flavored syrup.
For more examples, visit
http://aom.americaonthemove.org |
Used with permission from America On the Move (www.americaonthemove.org).
Table E-1. Essential Elements of Weight Loss
- The energy you get from consuming food should be less than the energy
you expend.
- Caloric intake must be decreased to attain weight loss.
- Caloric reduction, regardless of macronutrient distribution, can
result in weight loss.
- A diet based on the basic food groups may be safer and easier to
follow on a long-term basis while providing adequate amounts of essential
nutrients and limiting saturated and trans fats and cholesterol.
- Increased physical activity will use up more energy, which can help in
weight reduction.
|
Adapted from ASCM Position Stand "Appropriate Intervention Strategies for
Weight Loss and Prevention of Weight Regain in Adults."
Table E-3. Estimated Caloric Content of Alcoholic Beverages*
Information on some typical drinks requested and consumed by Americans was
collected from several online sources. An Internet search identified a Web site
with consistent dietary information and recipes (www.drinksmixer.com).
Other potential resources (e.g., trade associations, consumer groups, company
web sites) yielded little or no information on the caloric content of mixed
drinks (made with liquor).
Alcoholic Beverage |
Beverage Serving Size |
Number of Alcohol Servings/
Beverage |
Calories |
Beer+ |
12
oz |
1 |
150 |
Light beer+ |
12 oz |
1 |
110 |
Dark beer+ |
12
oz |
1
|
168 |
Non-alcoholic beer+ |
12 oz. |
1 |
70 |
Distilled spirit |
1.5 oz. |
1 |
100 |
Dry dessert wine+++ |
5 oz. |
1 |
198 |
Sweet dessert
wine+++ |
5
oz. |
1 |
344 |
Red wine+++ |
5 oz. |
1 |
105 |
White wine+++ |
5
oz. |
1 |
100 |
Sparkling white wine+++ |
5 oz. |
1 |
106 |
Amaretto sour++
(Sweet and sour mix, almond amaretto liqueur, tequila, orange juice) |
6
oz. |
4 |
421 |
B-52++
(Kahlua coffee liqueur, amaretto almond liqueur, Bailey's Irish Cream) |
1.5 oz. |
1 |
91 |
Bloody Mary++
(vodka, tomato juice, lemon juice, Worcestershire sauce, Tabasco sauce,
lime) |
4.6 oz. |
1 |
120 |
Chocolate martini++
(Vodka, crème de cacao) |
2.5 oz. |
1.67 |
188 |
Cosmopolitan++
(vodka, triple sec, Rose's lime juice, cranberry juice) |
2.5 oz. |
1.67 |
131 |
Daiquiri++
(light rum, limes, powdered sugar) |
2.7 oz. |
1 |
137 |
Gin and tonic++
(gin, tonic water, lime) |
7
oz. |
1.33 |
189 |
Hurricane++
(dark rum, light rum, orange juice, pineapple juice, grenadine, 151
proof rum, cherries, pineapple, sugar) |
10.4 oz. |
3 |
384 |
Irish Coffee++
(Irish whiskey, coffee, sugar, whipped cream) |
10.2 oz. |
1 |
159 |
Kamikaze++
(vodka, triple sec, lime juice) |
3 oz. |
1 |
180 |
Mai Tai++
(dark rum, light rum, sweet and sour mix, grenadine, 151 proof rum, ice) |
4.9 oz. |
1.82 |
306 |
Manhattan++
(whisky, vermouth, bitters) |
2.1 oz. |
1.33 |
132 |
Margarita++
(coarse salt, lime, white tequila, triple sec, lime juice, crushed ice) |
6.3 oz. |
3 |
327 |
Martini++
(gin, dry vermouth) |
2 oz. |
1.33 |
119 |
Mudslide++
(Vodka, coffee liqueur, Irish cream, vanilla ice cream) |
12 oz. |
4 |
820 |
Pina colada++
(Malibu rum, pineapple juice, cream) |
8 oz. |
2.13 |
312 |
Rum and coke++++
(rum, cola) |
12 oz. |
2.67 |
361 |
Screwdriver++
(vodka, orange juice) |
7 oz. |
1.33 |
208 |
Whiskey sour++
(whiskey, lemon juice, powdered sugar, cherry, lemon slice) |
3
oz. |
1.33 |
125 |
|
Distilled spirit
*Caloric content will vary by recipe.
+Anheuser-Busch website. Available at
www.anheuser-busch.com. Accessed on
June 2, 2004.
++Drinkmixer Web site. Available at
www.drinksmixer.com. Accessed on June
2, 2004.
+++Calorie King. Available at:
www.calorieking.com. Accessed on June 2, 2004.
++++Recipe provided by
www.webtender.com as "typical rum and coke recipe." Serving size is based on
the recipe and calorie information was calculated with Coca-Cola calorie
information and rum.
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.
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.
Table E-6. Kcals/Hour Expended in Common Physical Activities
Moderate Physical Activity |
Kcals/hr for a 154 lb person1 |
Hiking
|
367 |
Light gardening/yard work
|
>331 |
Dancing
|
331 |
Golf (walking and carrying clubs)
|
331 |
Bicycling (<10 mph)
|
294 |
Walking (3.5 mph)
|
279 |
Weight lifting (general light workout)
|
220 |
Stretching
|
184 |
Vigorous Physical Activity |
Kcals/hr for a 154-lb person1 |
Running/jogging (5 mph)
|
588 |
Bicycling (>10 mph)
|
588 |
Swimming (slow freestyle laps)
|
514 |
Aerobics
|
478 |
Walking (4.5 mph)
|
464 |
Heavy yard work (chopping wood)
|
441 |
Weight lifting (vigorous effort)
|
441 |
Basketball (vigorous)
|
441 |
1For a 154-lb individual, calories burned per hour will be higher
for persons who weigh more than 154 lbs and lower for persons who weigh less.
NHANES 1999-2000
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.
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.
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.
Table E-7. Daily Amount of Fruits and Vegetables by Calorie Level
|
Daily Amount of Fruits and Vegetables/Legumes
(Also in Weekly Amounts) |
Calorie Level |
1000 |
1200 |
1400 |
1600 |
1800 |
2000 |
2200 |
2400 |
2600 |
2800 |
3000 |
3200 |
FRUITS
cups/day
|
1 |
1 |
1.5 |
1.5 |
1.5 |
2 |
2 |
2 |
2 |
2.5 |
2.5 |
2.5 |
VEGE-TABLES
cups/day
|
1 |
1.5 |
1.5 |
2 |
2.5 |
2.5 |
3 |
3 |
3.5 |
3.5 |
4 |
4 |
Dark
green
cups/wk
|
1 |
1.5 |
1.5 |
2 |
3 |
3 |
3 |
3 |
3 |
3 |
3 |
3 |
Orange
cups/wk
|
0.5 |
1 |
1 |
1.5 |
2 |
2 |
2 |
2 |
2.5 |
2.5 |
2.5 |
2.5 |
Starchy
cups/wk
|
1.5 |
2.5 |
2.5 |
2.5 |
3 |
3 |
6 |
6 |
7 |
7 |
9 |
9 |
Other
cups/wk
|
4 |
4.5 |
4.5 |
5.5 |
6.5 |
6.5 |
7 |
7 |
8.5 |
8.5 |
10 |
10 |
LEGUMES
cups/wk
|
1.5 |
1 |
1 |
2.5 |
3 |
3 |
3 |
3 |
3.5 |
3.5 |
3.5 |
3.5 |
Table E-8. Which Fruits and Vegetables Provide the Most Nutrients?
The lists below show which fruits and vegetables are the best sources of
vitamin A (carotenoids), vitamin C, folate, and potassium. Often, the brighter
the color, the higher the content of vitamins and minerals. Eat at least two
servings of fruits and at least three servings of vegetables each day.
Sources of vitamin A (carotenoids)
- Bright orange vegetables like carrots, sweet potatoes, and pumpkin
- Dark green leafy vegetables such as spinach, collards, and turnip greens
- Bright orange fruits like mango, cantaloupe, and apricots
Sources of vitamin C
- Citrus fruits and juices, kiwi fruit, strawberries, and cantaloupe
- Broccoli, peppers, tomatoes, cabbage, and potatoes
- Leafy greens such as romaine, turnip greens, and spinach
Sources of folate
- Cooked dried beans and peas
- Oranges and orange juice
- Deep green leaves like spinach and mustard greens
Sources of potassium
- Baked white or sweet potato, cooked greens (such as spinach), winter
(orange) squash
- Bananas, plantains, many dried fruits, and orange juice
Table E-9. Ways To Increase Consumption of Fruits and Vegetables
- Include one or more fruit or vegetable choice(s) at all meals and snacks.
- Toss fruit into your green salad for extra flavor, variety, color, and
crunch.
- Frozen fruits and vegetables and canned fruit (in 100% fruit juice) or
vegetables are perfect for busy lifestyles.
- Save time with pre-cut vegetables and salad mixes.
- Add apples, raisins, or pineapple chunks to deli salads like chicken,
tuna, or pasta.
- Add frozen mixed vegetables to canned or dried soups.
- Make a quick smoothie using frozen fruit.
- Keep an easy-to-grab pre-washed bowl of fruit on the counter.
- At work keep dried fruit and nuts in your desk drawer for quick and easy.
- Try fajitas with red bell peppers, summer squash, and garlic.
Adapted from Produce for Better Health.
www.5aday.com/html/consumers/easyway.php, and
www.5aday.com/html/consumers/faqs.php#getmore
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.
Table E-10. Whole Grains That Are Widely Available in the United States
- Brown rice
- Bulgur (cracked wheat)
- Graham flour (coarsely ground whole wheat flour)
- Oatmeal
- Pearl barley
- Popcorn
- Whole grain corn
- Whole oats
- Whole rye
- Whole wheat
Note: Wheat flour, enriched flour, and degerminated corn meal are not whole
grains.
Table E-11. Ways To Increase Consumption of Milk and Milk Products
- Include milk or milk products all meals and snacks.
- Add low-fat milk instead of water to oatmeal and hot cereals.
- Eat cereals with calcium added and with milk.
- Top bread with low-fat cheese and pop it under the broiler for a quick
toasted cheese sandwich.
- Add low-fat or nonfat milk instead of water to creamed soups, such as
tomato.
- Include milk and/or milk products in lunches for children.
- Serve hot chocolate made from low-fat milk and chocolate syrup.
- Cut up raw vegetables for dipping into a low-fat yogurt dip.
- Whip up fruit and yogurt smoothies in the blender.
- Try some pudding made with milk.
- Top salads, soups, and stews of fresh vegetables with low-fat shredded
cheese.
- Use flavored yogurts as topping for fruit for dessert.
- Top a baked potato with low-fat yogurt or low-fat or non fat sour cream.
Adapted from NIH.
http://www.nichd.nih.gov/milk/whycal/helpful_tips.cfm.
Table E-12. Comparison of 100 Grams of Whole-Grain Wheat Flour and Enriched, Bleached, White, All-Purpose Flour
|
100 Percent Whole Wheat Flour |
Enriched White Flour |
Calories, kcal
|
339.0
|
364.0
|
Dietary fiber, g
|
12.2
|
2.7
|
Calcium, mg
|
34.0
|
15.0
|
Magnesium, mg
|
138.0
|
22.0
|
Potassium, mg
|
405.0
|
107.0
|
Folate, DFE, mcg
|
44.0
|
291.0
|
Source: USDA Food Composition Database, SR-16
Table E-13. Tips for Finding Whole-Grain Information on Food Labels
- Read the ingredient list on the food label. For many whole-grain products,
the words whole or whole grain
will appear before the grain ingredient's name. The whole grain should be the
first ingredient listed.
- Wheat flour, enriched flour, and degerminated cornmeal are not
whole grains. A list of some common whole grains found in the U.S. food supply
are listed in Table E-10
- Look for the whole-grain health claim—"Diets rich in whole-grain foods and
other plant foods and low in total fat, saturated fat, and cholesterol may
help reduce the risk of heart disease and certain cancers"—on food product
labels. Foods that bear the whole-grain health claim must—
- Contain 51 percent or more whole grains by weight
- Be low in fat
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.
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.
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.
Table E-14. Maximum Daily Amounts of Saturated Fat To Consume To Keep
Saturated Fat Below 10 Percent of Total Calorie Intake
Total Calorie Intake |
Limit on Saturated Fat Intake |
1,600 |
18 g or less |
2,000* |
20 g or less |
2,200 |
24 g or less |
2,500* |
25 g or less |
2,800 |
31 g or less |
*Percent Daily Values on Nutrition Facts Labels are based on a
2,000-calorie diet. Values for 2,000 and 2,500 calories are rounded to the
nearest 5 grams to be consistent with the Nutrition Facts Label.
Table E-15. Dietary Sources of Saturated Fat Listed in Decreasing Order
|
Saturated Fat 1994–1996
(mean = 25.5 g) |
Food Group |
Ranking |
Percent Total |
Percent Cumulative |
Cheese
|
1 |
13.1 |
13.1 |
Beef
|
2 |
11.7 |
24.8 |
Milk
|
3 |
7.8 |
32.6 |
Oils
|
4 |
4.9 |
37.5 |
Ice cream/sherbet/
frozen yogurt
|
5 |
4.7 |
42.2 |
Cakes/cookies/
quick breads/
doughnuts
|
6 |
4.7 |
46.9 |
Butter
|
7 |
4.6 |
51.5 |
|
8 |
4.4 |
55.9 |
Salad dressings/
mayonnaise
|
9 |
3.7 |
59.6 |
Poultry
|
10 |
3.6 |
63.2 |
Margarine
|
11 |
3.2 |
66.4 |
Sausage
|
12 |
3.1 |
69.5 |
Potato chips/corn chips/popcorn
|
13 |
2.9 |
72.4 |
Yeast bread
|
14 |
2.6 |
75.0 |
Eggs
|
15 |
2.3 |
77.3 |
*Shortening and animal fats
Adapted from Cotton PA, Subar AF, Friday JE, Cook A. Dietary Sources of
Nutrients among U.S. Adults, 1994–1996. JADA 104:921-931; 2004.
Table E-16. Strategies for Decreasing Saturated Fat Intake
Fats and oils
- Choose vegetable oils or trans-free soft margarine rather than
solid fats (shortening, butter, and hard margarine).
Meat, poultry, fish, shellfish, eggs, beans, and nuts
- Choose very lean meats and trim the fat before eating.
- Remove the skin before eating chicken.
- Select lean ground beef.
- Limit intake of high-fat processed meats such as bacon, sausages, salami,
bologna, and cold cuts.
- Use eggs yolks and whole eggs in moderation; use eggs whites and egg
substitutes instead.
Dairy products
- Choose fat-free or low-fat milk, yogurt, and cheese
Table E-17. Dietary Sources of Trans
Fat Listed in Decreasing Order
|
Trans Fat 1994-1996
(mean = 5.84 g) |
Food Group |
Ranking |
Percent Total |
Percent Cumulative |
Cakes, cookies, crackers, pies,
bread, etc
|
1 |
40 |
40 |
Animal products
|
2 |
21 |
61 |
Margarine
|
3 |
17 |
78 |
Fried potatoes
|
4 |
8 |
86 |
Potato chips, corn chips, popcorn
|
5 |
5 |
91 |
Household shortening
|
6 |
4 |
95 |
|
7 |
5 |
|
*Includes breakfast cereal and candy. USDA analysis reported 0
grams of trans fat in salad dressing
Adapted from Federal Register notice. Food Labeling; Trans Fatty
Acids in Nutrition Labeling; Consumer Research To Consider Nutrient Content and
Health Claims and Possible Footnote or Disclosure Statements; Final Rule and
Proposed Rule. Vol. 68, No. 133, p. 41433-41506, July 11, 2003.
Table E-18. Dietary Sources of Cholesterol Listed in Decreasing Order
|
Cholesterol 1994–1996
(mean = 270 mg) |
Food Group |
Ranking |
Percent Total |
Percent Cumulative |
Eggs
|
1 |
29.3 |
29.3 |
Beef
|
2 |
16.1 |
45.4 |
Poultry
|
3 |
12.2 |
57.6 |
Cheese
|
4 |
5.8 |
63.4 |
Milk
|
5 |
5.0 |
68.4 |
|
6 |
3.7 |
72.1 |
Cakes/cookies/
quick breads/
doughnuts
|
7 |
3.3 |
75.4 |
Pork (fresh unprocessed)
|
8 |
2.8 |
78.2 |
Ice cream/
sherbet/
frozen yogurt
|
9 |
2.5 |
80.7 |
Sausage
|
10 |
2.0 |
82.7 |
*This category does not include canned tuna.
Adapted from Cotton PA, Subar AF, Friday JE, Cook A. Dietary Sources of
Nutrients among U.S. Adults, 1994–1996. JADA 104:921-931; 2004.
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.
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.
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).
Table E-19. Major Sources of Added Sweeteners in the American Diet
Each of the food categories listed below provide more than 5 percent
of the added sweeteners consumed in the United States.
Food Categories |
Percent Contribution to Added Sweeteners |
Soft drinks
|
33.0 |
Sugars and candy
|
16.1 |
Sweetened grains, such cakes, cookies, pies
|
12.9 |
Fruit drinks, such as fruitades and fruit punch
|
9.7 |
Dairy desserts and milk products, such as ice cream, sweetened yogurt and
sweetened milk
|
8.6 |
Other grains, such as cinnamon toast and honey-nut waffles
|
5.8 |
Source: Guthrie and Morton, Journal of the American Dietetic Association,
2000.
Table E-20. Sugars That Appear on Food Labels
Table E-21. Finding Added Sugars on Food Label Ingredient Lists
The ingredient list is usually located under the Nutrition Facts
panel or on the side of a food label. Ingredients are listed in order by weight.
The ingredient in the greatest amount by weight is listed first and the one in
the least amount is listed last. For example, in the ingredient list below, corn
syrup is the second ingredient listed and sugar is the third, which means that
combined, these two sugars are main ingredients in the apple pie.
Baked Apple Pie
Ingredient list: Apples, corn syrup, sugar, water, modified corn starch,
dextrose, brown sugar, sodium alginate, spices, citric acid, salt, dicalcium
phosphate. In a pastry consisting of enriched bleached wheat flour (niacin,
reduced iron, thiamine mononitrate, riboflavin, folic acid), vegetable
shortening (partially hydrogenated soybean and/or cottonseed oil), water, sugar,
less than 2 percent of salt, yeast, l-cysteine (dough conditioner), lecithin.
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).
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.
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.
Figure E-2. Sources of sodium in the diet
|
Percentage of Sodium in the Diet |
Food Processing |
77 |
Inherent
|
12 |
At the Table
|
>6 |
vAlign="top">
During Cooking
|
5 |
Source: Mattes and Donnelly, 1991
Table E-22. Range of Sodium Content for Selected Foods in Milligrams
Food Group |
Serving Size |
Range |
Breads
|
1 oz |
95 - 210 |
Frozen pizza
|
4 oz |
710 - 1200 |
Frozen vegetables
|
1 c |
95 - 300 |
Salad Dressing
|
2 Tbsp |
110 - 400 |
Salsa
|
2 Tbsp |
150 - 240 |
Soup (tomato)
|
8 oz |
700 - 1100 |
Tomato juice
|
8 oz |
480 - 800 |
Sources: Manufacturers. Foods were randomly selected on the grocery store
shelf. Serving sizes were comparable.
Note: None of the examples provided were low-sodium products.
Table E-23. Strategies for Reducing Sodium Intake
- At the store
- Choose fresh, plain frozen, or canned vegetables without added salt most
often; they are low in salt.
- Choose fresh or frozen fish, shellfish, poultry, and meat most often.
They are lower in salt than most canned and processed forms.
- Read the Nutrition Facts Label to compare the amount of sodium in
processed foods such as frozen dinners, packaged mixes, cereals, cheese,
breads, soups, salad dressings, and sauces. The amount in different types
and brands often varies widely.
- Look for labels that say low sodium. They
contain 140 mg (about 5% of the Daily Value) or less of sodium per serving.
- Ask your grocer or supermarket to offer more low-sodium foods.
- Cooking and eating at home
- If you salt foods in cooking or at the table, add small amounts. Learn
to use spices and herbs, rather than salt, to enhance the flavor of food.
- Go easy on condiments such as soy sauce, ketchup, mustard, pickles, and
olives; they can add a lot of salt to your food.
- Leave the salt shaker in a cupboard.
- Eating out
- Choose plain foods like grilled or roasted entrees, baked potatoes, and
salad with oil and vinegar. Batter-fried foods tend to be high in salt, as
do combination dishes like stews or pasta with sauce.
- Ask to have no salt added when the food is prepared.
- Any time
- Choose fruits and vegetables often.
- Drink water freely. It is usually very low in sodium. Check the label on
bottled water for sodium content.
Table E-24. Alternative Flavorings for Salt and Uses for These Flavorings
Food |
Alternative Flavoring |
Lean Meats |
Bay leaves,
caraway seeds, chives, mustard, lemon juice, garlic, curry powder, onion,
paprika, parsley, sage, thyme, allspice, turmeric |
Veal
|
Thyme, mace, curry
powder, nutmeg |
Lamb
|
Basil, curry
powder, dill, mace |
Lean pork
|
Thyme, savory,
rosemary, sage |
Poultry (chicken)
|
Rosemary, nutmeg,
mustard, lemon juice, ginger, dill, curry powder, bay leaves |
Lean ground meats
|
Allspice, basil,
mustard, savory |
Lean meat loaf
|
Rosemary, nutmeg |
Stews
|
Allspice, bay
leaves, onion, sage, caraway seeds, basil |
Soups
|
Thyme, savory, parsley, paprika, onion, basil, chives, curry powder, dill,
garlic, bay leaves |
Breads
|
Caraway seeds,
nutmeg (toast), sage (biscuits), rosemary (stuffing), cinnamon, mace |
Salads
|
Basil, dry
mustard, savory, caraway seeds, chives, cider vinegar, garlic, lemon
juice, dill, paprika, parsley, pimiento, onion, thyme |
Fruit
|
Almond extract,
ginger, cinnamon (especially apples), nutmeg, peppermint extract, mace,
allspice (especially in peaches, applesauce, and cranberry sauce) |
Vegetables
|
Lemon juice,
chives, dill, cider vinegar, pimiento, parsley, dry mustard, garlic, mace,
onion, paprika |
Tomatoes
|
Allspice, bay
leaves, curry powder, garlic, dill, thyme, savory, sage |
Potatoes
|
Nutmeg, mace,
garlic, dill, rosemary |
Onions
|
Thyme, sage |
Green beans, lima beans, or peaas
|
Savory, sage,
rosemary, thyme |
Pie crust
|
Nutmeg, cinnamon |
Puddings
|
Peppermint
extract, almond extract, nutmeg |
Mayonnaise
|
Curry powder, dry
mustard |
Sauces
|
Basil, turmeric,
rosemary, thyme, chives, cider vinegar, paprika, parsley, dry mustard |
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.
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.
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.)
Table E-25. Moderate Drinking Definition
What is drinking in moderation?
- Moderation is defined as no more than one drink per day for women and
no more than two drinks per day for men.
|
Count as one drink—
- 12 ounces of regular beer
- 5 ounces of wine (12% alcohol)
- 1.5 ounces of 80-proof distilled spirits
|
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.
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).
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).
Figure E-3. Temperature Rules for Safe Cooking
Foods |
Temperature |
Whole Poultry
|
180°F |
Poultry Breasts
|
170°F |
Stuffing, Ground Poultry, Reheat Leftovers
|
165°F |
vAlign="top">
Meats (medium), Egg Dishes, Pork and Ground Meats
|
160°F |
Beef Steaks, Roasts, Veal, Lamb (medium rare)
|
145°F |
Hold HOT Foods
|
140°F |
Refrigerator Temperatures
|
40°F |
Freezer Temperatures
|
0°F |
http://www.fsis.usda.gov/Frame/FrameRedirect.asp?main=
http://www.fsis.usda.gov/OA/pubs/cfg/cfg.htm
Table E-26. Tips for Those at High Risk of Foodborne Illness
Who is at high risk of foodborne illness?
What foods are high risk and support the growth of Listeria monocytogenes?
Tips for Those at High Risk of Foodborne Illness
Who is at high risk of foodborne illness?
- Pregnant women and their fetuses
- Young children
- Older persons
- People with weakened immune systems or certain chronic illnesses
- Individuals with pre-existing illness
Which foods are associated with listeriosis and pose a high risk to certain
high-risk and sensitive individuals?
- Some deli meats (excluding those that are very salty, such as some ham, or
low in water activity, such as salami) and frankfurters that have not been
reheated to steaming hot. Some ready-to-eat foods.
Besides following the guidance in this guideline, some of the extra
precautions those at high risk should take are—
- Do not eat or drink unpasteurized juices, raw sprouts, raw (unpasteurized)
milk, and products (such as cheese) made from unpasteurized milk.
- Do not eat raw or undercooked meat, poultry, eggs, fish, and shellfish
(clams, oysters, scallops, and mussels).
New information on food safety is constantly emerging. Recommendations and
precautions for people at high risk are updated as scientists learn more about
preventing foodborne illness. If you are among those at high risk, you need to
be aware of and follow the most current information on food safety.
For the latest information and precautions, call USDA’s Meat and Poultry
Hotline, 1-800-535-4555, or FDA’s Food Information Line, 1-888-SAFE
FOOD, or consult your healthcare provider. You can also get up-to-date
information by checking the Government’s food safety Web site at
http://www.foodsafety.gov.
1Folate also was identified as a shortfall
nutrient by the studies cited in Part D; however, the data used were for these
studies were collected prior to the mandatory fortification of enriched grains
with folate. See further discussion in Part D, Section 1, "Aiming To Meet
Recommended Intakes of Nutrients."
2See tables D1-13 and D1-16 for
information on 2-3 year olds