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Dietary Guidelines

DIETARY GUIDELINES

DIETARY GUIDELINES. The 1969 White House Conference on Food, Nutrition, and Health was instrumental in the development of the first set of U.S. dietary guidelines. Specific recommendations emerged out of this conference, which advocated that the government examine more closely the links between diet and chronic disease. The 1969 conference was followed in 1977 by the release of the U.S. Senate Dietary Goals, which summarized specific recommendations for the American diet.

The dietary guidelines are the cornerstone of the federal nutrition policy for the U.S. nutrition programs; thus programs such as food stamps, school lunch/school breakfast, and WIC use the dietary guidelines in developing program services. In addition, all nutrition education programs at the federal level must have messages that are consistent with the dietary guidelines. Thus the impact of the dietary guidelines is wide-ranging. It is estimated that one of every five Americans participates in at least one federal nutrition program.

History of the Dietary Guidelines for Americans

The Dietary Guidelines attempt to answer the question, "What should Americans eat to stay healthy?" Specifically, the dietary guidelines provide advice for healthy Americans aged two years and older about food choices that promote health and reduce the risk of disease.

The Dietary Guidelines were first developed in 1980 and have been updated every five years since then1985, 1990, 1995, and 2000. The National Nutrition Monitoring and Related Research Act of 1990 requires the Secretary of Agriculture and Secretary of Health and Human Services (HHS) to publish jointly every five years a report entitled Dietary Guidelines for Americans. The report must contain nutrition and dietary information and guidelines for the general public; be based on the preponderance of scientific and medical knowledge current at the time of publication; and be prompted by each federal agency in carrying out federal food, nutrition, or health programs. The 1995 Dietary Guidelines were the first to be statutorily mandated by the U.S. Congress.

Since 1985, USDA and the Department of Health and Human Services have used essentially the same process to prepare the dietary guidelines. An external Dietary Guidelines Advisory Committee (DGAC) has been appointed by the two secretaries to review and revise as necessary the guidelines. The members of the DGAC are widely recognized nutrition and medical experts. A series of public meetings are held to review and discuss the guidelines. Upon completion of the DGAC process, a technical report is sent to the two secretaries and reviewed within the two departments. In addition, in both 1995 and 2000, consumer research was conducted to test consumer reaction to specific design and content elements of the technical report. The consumer research is also used as one element in promoting the dietary guidelines.

Elements of the Dietary Guidelines

Between 1980 and 1995, the dietary guidelines were relatively stable (Table 1), maintaining seven guidelines. However, the 1995 guidelines reflected some exciting and important changes. More so than ever before, they put an emphasis on total diet; the wording in the 1995 guidelines moved away from individual foods in the direction of a total diet based on variety, moderation, and proportionality. The concept of total diet is reflected symbolically through the graphic of the 1995 Dietary Guidelines bulletin that links all seven guidelines together, anchored around the admonition to "Eat a variety of foods."

In the 1995 guideline on variety, the bulletin stresses a total diet rather than an individual food approach to healthy eating. The recommendation is to choose foods from each of the five major food groups in the Food Guide Pyramid. Also an emphasis is placed on foods from the base of the pyramid (grains) to form the center of the plate accompanied by food from other food groups.

For the first time, the dietary guidelines in 1995 recognized that with careful planning, a vegetarian diet can be consistent with the dietary guidelines and the Recommended Dietary Allowances. The guidelines also present a clear message that food sources of nutrients are preferred to supplements. This "food first" strategy is reinforced by a discussion of other healthful substances present in food, but not in dietary supplements. However, the 1995 guidelines do provide specific examples of situations where dietary supplements may be needed.

The 1995 guidelines also moved more forcefully in the direction of providing a discussion of the direct link between diet and health. Weight gain with age was discouraged for adults. Weight maintenance is encouraged as a first step to achieving a healthy weight. The benefits of physical activity are emphasized. And for the first time, a statement was included on the benefits of moderate alcohol in reducing the risk of heart disease. On this later point, both HHS and USDA were clear that the alcohol guideline was not intended to recommend that people start drinking.

In the 1995 guidelines there was also direct reference to the nutrition education tools that could be used to promote the dietary guidelines. The guidelines explain how consumers can use the three "crown jewels" to build a healthy diet: the Dietary Guidelines, the Food Guide Pyramid, and the Nutrition Facts Label.

The Dietary Guidelines 2000, released by President Bill Clinton in May 2000, break with the tradition of seven guidelines and now include ten separate guidelines. Not only do the Dietary Guidelines 2000 continue to emphasize a total diet approach, they also emphasize a healthy lifestyle. This is reflected clearly in three new concepts that are used as organizing principles for the 2000 Guidelines: "Aim for fitness," "Build a healthy base," "Choose sensibly."

Dietary guidelines for Americans, 1980 to 2000
1980 1985 1990 1995 2000
7 Guidelines 7 Guidelines 7 Guidelines 7 Guidelines 10 Guidelines
Eat a variety of foods Eat a variety of foods Eat a variety of foods Eat a variety of foods Let the Pyramid guide your food choices
Maintain ideal weight Maintain desirable weight Maintain healthy weight Balance the food you eat with physical activitymaintain or improve your weight Aim for a healthy weight
Avoid too much fat, saturated fat, and cholesterol Avoid too much fat, saturated fat, and cholesterol Choose a diet low in fat, saturated fat, and cholesterol Choose a diet low in fat, saturated fat, and cholesterol Choose a diet that is low in saturated fat and cholesterol and moderate in total fat
Eat foods with adequate starch and fiber and fruits and vegetables Eat foods with adequate starch and fiber and fruits and vegetables Choose a diet with plenty of grain, fruit, and vegetable products Choose a diet with plenty of grain, fruit, and vegetable products Eat a variety of grains daily, including whole grains
Eat a variety of fruits and vegetables daily
Avoid too much sugar Avoid too much sugar Use sugars only in moderation Choose a diet moderate in sugars Choose beverages and foods to moderate your intake of sugars
Avoid too much sodium Avoid too much sodium Use salt and sodium only in moderation Choose a diet moderate in salt and sodium Choose and prepare foods with less salt
If you drink alcohol, do so in moderation If you drink alcoholic beverages, do so in moderation If you drink alcoholic beverages, do so in moderation If you drink alcoholic beverages, do so in moderation If you drink alcoholic beverages, do so in moderation
Keep food safe to eat
Be physically active each day

There is now a separate guideline for physical activity that states, "Be physically active every day." In addition to helping to maintain a healthy weight, this guideline also discusses the other health benefits of physical activity. Specific quantitative recommendations are given for amount of physical activity for adults (30 minutes or more) and children (60 minutes or more) per day. For the first time ever there is now a guideline on food safety. Again, this reinforces components of a healthy diet and healthy lifesyle.

The consumer research that was conducted as part of the Dietary Guidelines 2000 process influenced the development of the guidelines. One clear message is that consumers preferred simple, action-oriented guidelines. Thus the guidelines themselves are much more direct and action-oriented as evidenced by: "Aim for a healthy weight!" or "Keep foods safe to eat."

The guidelines are more consumer-friendly and emphasize practical ways in which consumers can put the concepts into practice. To that end, sections entitled "Advice for Today" are included at the end of each individual guideline and include suggestions on key ways to operationalize the guidelines. The consumer research on the 2000 Dietary Guidelines indicated that consumers particularly liked the Advice for Today section.

Comparison with Other Dietary Guidelines

A large number of countriesboth industrialized and developing countrieshave authoritative sets of dietary guidelines. Despite the vastly different geographical and sociocultural contexts of the countries, there are six elements that are common to the sets of dietary guidelines that are in place. Those elements are: (1) Aim for a healthy weight; (2) Let the Food Pyramid guide your choices; (3) Eat a variety of grains daily, especially whole grains; (4) Choose a diet that is low in saturated fat and cholesterol and moderate in total fat; (5) Choose and prepare foods with less salt; (6) If you drink alcoholic beverages, do so in moderation.

A guideline on variety is common, and is often the core element used to reflect the concepts of dietary diversity. The variety ranges from general statements such as, "Eat a variety of foods," to a very specific quantification, as found in the Japanese guideline, which states that, to obtain well-balanced nutrition with a variety of foods, one should eat thirty foodstuffs a day.

Many of the country-specific dietary guidelines emphasize limiting or moderating total fat and saturated fat intake. Where there is a quantification of limits, this is most commonly a diet containing no more than 30 percent of total energy from fat and less than 10 percent of energy from saturated fat.

Countries typically also include a weight guideline, which emphasizes very clearly the maintenance or achievement of a healthy weight; in the French guideline, there is more specificity indicating individuals should weigh themselves monthly. Most of the dietary guidelines worldwide promote a plant-based diet as the building block of healthful eating. To that end, many countries emphasize grains as the basis of good diet. Reduction of salt and/or sodium is emphasized in a number of the sets of dietary guidelines.

Finally, the issue of alcohol consumption is addressed in many sets of dietary guidelines. There is always a level of caution related to the role of alcohol as part of a healthy diet. The 2000 dietary guidelines for Americans, as an example, indicate that benefits of alcohol in reducing the risk of heart disease can be achieved in other ways, such as maintaining a healthy weight, cessation of smoking, increasing physical activity, and reducing the level of fat and saturated fat in the diet. Indeed, countries like Venezuela go even further and specify: "Alcoholic beverages are not part of a healthy diet" (14).

Comparison with Disease-Specific Guidelines

A number of professional associations such as the American Heart Association (AHA) and American Cancer Society (ACA) have developed sets of dietary guidelines. Clearly the AHA and ACS have somewhat different objectives in developing their specific sets of guidelines; the American Heart Association guidelines put forward recommendations for a healthful diet, which if followed, reduces the risk of heart disease. Similarly, recommendations from the American Cancer Association are for dietary guidelines which, if followed, reduce the risk of cancer. Given the somewhat different objectives, there is a remarkable degree of similarity in the three sets of guidelines. Here again, the USDA/HHS, the AHA, and the ACA each recommend dietary guidelines related to weight, total saturated fat, salt, and alcohol in moderation as the basis of a healthful diet.

Guidelines for Children under Age Two

A limited number of countries have some parts of their food-based guidelines devoted to children less than two years of age. In most cases, the advice relates to a discussion of breast-feeding. Australia, for example, states: "Encourage and support breast-feeding." There is similar wording in guidelines from the Philippines and Singapore.

Most industrialized countries rely on national pediatric associations to guide the broad policy recommendations for infant feeding and/or feeding practices for the first two years of life. In almost all cases advice from pediatric associations stresses that human milk is the preferred form of infant feeding.

In devising food-based dietary guidelines for children under two, there is a clear need to segment this group of children by age groups: birth to 6 months, 6 to 12 months, and 13 to 24 months.

Future Directions

Worldwide major improvements in public health will be accomplished by an improvement in dietary patterns. Food-based dietary guidelines have been developed in a broad range of countries. A move toward consensus on food-based dietary guidelines is a practical way to develop core elements of global dietary guidelines that can be effectively promoted by individual countries as well as international health organizations.

See also Body Composition; Eating: Anatomy and Physiology of Eating; Food Stamps; Government Agencies, U.S.; Nutrients; Nutrition; Nutrition Transition: Worldwide Diet Change; School Meals; WIC (Women, Infants, and Children's Program).

BIBLIOGRAPHY

American Academy of Pediatrics. "Breastfeeding, and the Use of Human Milk." Pediatrics 100 (1997): 10351039.

American Cancer Society Advisory Committee on Diet, Nutrition, and Cancer Prevention. "Guidelines on Diet, Nutrition, and Cancer Prevention: Reducing the Risk of Cancer with Healthy Food Choices and Physical Activity." CA Cancer Journal for Clinicians 46 (1996): 325341.

Krauss M., et al. "Dietary Guidelines for Healthy American Adults: A Statement for Health Professionals from the Nutrition Committee, American Heart Association." Circulation 94 (1996): 17951800.

National Research Council, Academy of Sciences. Recommended Dietary Allowances. Washington, D.C.: National Academy Press, 1989.

Peng, M., and V. Molina. Food Dietary Guidelines and Health-Based Promotion in Latin America. Washington, D.C.: Pan American Health Organization, 1999.

Shils, Maurice E., et al., eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, Md.: Williams and Wilkins, 1999.

U.S. Department of Agriculture and U.S. Department of Health and Human Services. Nutrition and Your Health: Dietary Guidelines for Americans. Home and Garden Bulletin 232. Washington, D.C.: U.S. Government Printing Office, 1980.

U.S. Department of Agriculture and U.S. Department of Health and Human Services. Nutrition and Your Health: Dietary Guidelines for Americans. Home and Garden Bulletin 232. Washington, D.C.: U.S. Government Printing Office, 1985.

U.S. Department of Agriculture and U.S. Department of Health and Human Services. Nutrition and Your Health: Dietary Guidelines for Americans. Home and Garden Bulletin 232. Washington, D.C.: U.S. Government Printing Office, 1990.

U.S. Department of Agriculture and U.S. Department of Health and Human Services. Nutrition and Your Health: Dietary Guidelines for Americans. Home and Garden Bulletin 232. Washington, D.C.: U.S. Government Printing Office, 1995.

U.S. Department of Agriculture and U.S. Department of Health and Human Services. Nutrition and Your Health: Dietary Guidelines for Americans. Home and Garden Bulletin 232. Washington, D.C.: U.S. Government Printing Office, 2000.

U.S. Department of Agriculture. The Food Guide Pyramid. Home and Garden Bulletin 252. Washington, D.C.: U.S. Government Printing Office, 1992.

U.S. Senate Select Committee on Nutrition and Human Needs. Dietary Goals for the United States. 2d ed. Washington, D.C.: Government Printing Office, 1977.

Eileen Kennedy

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Dietary Guidelines

Dietary Guidelines

The Dietary Guidelines for Americans are the foundation of national nutrition policy for the United States. They are designed to help Americans make food choices that promote health and reduce the risk of disease. The guidelines are published jointly by the U.S. Department of Agriculture (USDA) and U.S. Department of Health and Human Services (HHS). The first set of guidelines was published as Nutrition and Your Health: Dietary Guidelines for Americans in 1980. Since then, an advisory committee has been appointed every five years to review and revise the guidelines based on the latest research in nutrition and health.

Early Dietary Advice in the United States

The first half of the twentieth century was a period of enormous growth in nutrition knowledge. The primary goal of nutrition advice at this time was to help people select foods to meet their energy (calorie ) needs and prevent nutritional deficiencies . During the Great Depression of the 1930s, food was rationed and people had little money to buy food. They needed to know how to select an adequate diet with few resources, and the USDA produced a set of meal plans that were affordable for families of various incomes. To this day, a food guide for low-income familiesthe Thrifty Food Planis issued regularly by the USDA and used to determine food stamp allotments. In addition to meal plans, the USDA developed food guidestools to help people select healthful diets. Over the years the food guides changed, based on the current information available.

Food Guides versus Dietary Guidelines

Food guides are practical tools that people can use to select a healthful diet. Food guide recommendations, such as how many servings of grains to eat, are based on dietary guidelines that are overall recommendations for healthful diets. For example, the Dietary Guidelines for Americans include the recommendation that Americans "choose a variety of grains daily, especially whole grains." To help people reach this goal, the USDA's Food Guide Pyramid is built on a base of grain foods and recommends six to eleven servings daily with several servings from whole grains. Thus, the Food Guide Pyramid supports the recommendations of the Dietary Guidelines.

Evolution of the Dietary Guidelines

During the 1970s, scientists began identifying links between people's usual eating habits and their risk for chronic diseases such as heart disease and cancer . They realized that a healthful diet was important not only to prevent nutrient deficiencies, but because it might play a role in decreasing the risk for chronic diseases. Since heart disease and cancer were, and still are, major causes of death and disability in the United States, there was a need to help Americans select health-promoting diets.

The first major step in federal dietary guidance was the 1977 publication of Dietary Goals for the United States by the Senate Select Committee on Nutrition and Human Needs, which recommended an increased intake of carbohydrates and a reduced intake of fat , saturated fat , cholesterol, salt, and sugar. There was heated debate among nutrition scientists when the Dietary Goals were published. Some nutritionists believed that not enough was known about effects of diet and health to make suggestions as specific as those given.

In 1980, the first edition of Dietary Guidelines for Americans was released by the USDA and HHS. The seven guidelines were: (1) Eat a variety of foods; (2) Maintain ideal weight; (3) Avoid too much fat, saturated fat, and cholesterol; (4) Eat foods with adequate starch and fiber ; (5) Avoid too much sugar; (6) Avoid too much sodium; and (7) If you drink alcohol, do so in moderation. The second edition, released in 1985, made a few changes, but kept most of the guidelines intact. Two exceptions were the weight guideline, which was changed to "Maintain desirable weight" and the last guideline, in which "alcohol" was changed to "alcoholic beverages."

Following publication of the second edition of the Dietary Guidelines, two influential reports concerning diet and health were issued. The Surgeon General's Report on Nutrition and Health was published in 1988, and the National Research Council's report Diet and HealthImplications for Reducing Chronic Disease Risk was published in 1989. These two reports supported the goal of the Dietary Guidelines to promote eating habits that can help people stay healthy. In 1990, the third edition of the guidelines took a more positive tone than previous editions, using phrases such as "Choose a diet..." or "Use ... only in moderation," rather than "Avoid too much..." This was seen as a positive step by many nutrition educators.

The fourth edition was the first to include the Food Guide Pyramid, which had been introduced in 1992. It also was the first edition to address vegetarian diets and the recently introduced "Nutrition Facts" panel for food labels. The fifth edition, issued in 2000, expanded the number of guidelines to ten and organized them into three messages: "Aim for Fitness, Build a Healthy Base, and Choose Sensibly" (ABC).

The 2000 Dietary Guidelines for Americans

Aim for Fitness

  • Aim for a healthy weight
  • Be physically active each day

Build a Healthy Base

  • 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 Sensibly

  • Choose a diet that is low in fat and cholesterol and moderate in fat
  • Choose beverages and foods to moderate your intake of sugar
  • Choose and prepare foods with less salt
  • If you drink alcoholic beverages, do so in moderation

The Dietary Guidelines for Americans have evolved since they were first published in 1980. Their recommendations represent the latest research in diet and health promotion, and, as new research emerges, the guidelines will continue to change to reflect new insights into diet and health. People can take steps toward healthier lifestyles by following the recommendations of the Dietary Guidelines and using tools like the Food Guide Pyramid to guide their food choices.

see also Dietary Trends, American; Food Guide Pyramid.

Linda Benjamin Bobroff

Bibliography

Cronin, Frances J., and Shaw, Anne M. (1988). "Summary of Dietary Recommendations for Healthy Americans." Nutrition Today 23:2634.

National Research Council (1989). Diet and Health: Implications for Reducing Chronic Disease Risk. Washington, DC: National Academy Press.

U.S. Department of Agriculture, and U.S. Department of Health and Human Services (1980). Nutrition and Your Health: Dietary Guidelines for Americans. (Home and Garden Bulletin 232.) Washington, DC: U.S. Government Printing Office.

U.S. Department of Agriculture, and U.S. Department of Health and Human Services (2000). Nutrition and Your Health: Dietary Guidelines for Americans, 5th ed. Washington, DC: Government Printing Office.

U.S. Department of Health and Human Services, Public Health Service (1988). The Surgeon General's Report on Nutrition and Health. (DHHS [PHS] Publication No. 88-50210.) Washington, DC: U.S. Government Printing Office.

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dietary guidelines

dietary guidelines Advice to the public on desirable eating behaviour and patterns of food intake, based on reference nutrient intakes or nutrient and food goals to achieve public health objectives. See also food pyramid.

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