Download Clearing Up Controversy (cont`d)

Guidelines for Healthy Eating
Chapter 8
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
How to Choose a Healthy Diet
• A healthy diet provides enough of all essential
nutrients to avoid deficiencies but not excessive
amounts that may increase the risk of nutrient
toxicities or chronic diseases
• Four of the 10 leading causes of death in the United
States are associated with dietary excesses:
– Heart disease
– Cancer
– Stroke
– Diabetes
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
How to Choose a Healthy Diet (cont’d)
• Many other health problems are related, at least
in part, to dietary excesses
– Obesity
– Hypertension
– Hypercholesterolemia
• A healthy diet has the potential to alleviate the
high economic and personal costs of morbidity
and mortality associated with these diseases
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Healthy People 2010
• Overall goals are to increase quality and years
of healthy life and eliminate health disparities
among Americans
• Specific, measurable objectives serve as the
basis for monitoring and measuring
improvements in the nation’s health over the
10-year period from 2000 to 2010
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Primarily Professional
• Historically, recommended dietary allowances
(RDAs) advocated a level of nutrients set to protect
people from nutrient deficiency diseases
• Old RDAs have been replaced with a new set of
standards, the dietary reference intakes (DRIs), that
incorporate an expanded focus of reducing the risk
of chronic diseases associated with dietary excesses
• Primarily for professional use because they deal with
quantities of nutrients as opposed to amounts of
food
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Dietary Reference Intakes
• Series of 8 in-depth reports featuring a new set of
references called dietary reference intakes (DRIs)
– Cover vitamins, minerals, the energy nutrients,
cholesterol, fiber, electrolytes, and water
– DRI is a group name that includes 4 separate
reference values that are based on the concepts
of probability and risk:
o Updated RDAs, estimated average
requirement (EAR), adequate intake (AI), and
the tolerable upper intake level (UL)
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Dietary Reference Intakes (cont’d)
• Each of these reference values has a specific
purpose and represents a different level of
intake
• Each reference value is viewed as an average
daily intake over time, at least 1 week for most
nutrients
– Additional reference values include
acceptable macronutrient distribution ranges
(AMDRs) and an estimated energy
requirement (EER)
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Dietary Reference Intakes (cont’d)
• Recommended dietary allowances
– Represent the average daily recommended
intake to meet the nutrient requirements of
97% to 98% of healthy individuals by life
stage and gender
– Based on specific criteria indicators
– Set high enough to account for daily
variations in intake
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
• The recommended daily allowances (RDAs) are said
to be primarily for professional use. Why is this?
a. Because they are based on a variety of
recommendations by professional people
b. Because it takes a professional to truly
understand them
c. Because only professional people are concerned
about what we eat
d. Because they deal with quantities of nutrients
rather than amounts of food
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
d. Because they deal with quantities of nutrients
rather than amounts of food
Rationale: Historically, the recommended dietary
allowances (RDAs) in the United States and the
recommended nutrient intakes in Canada
established levels of nutrients to protect people
from nutrient deficiency diseases. Therefore,
professionals had to interpret them in the diet.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Estimated Average Requirement
• Amount of a nutrient that is estimated to meet the
requirement of half of healthy people in a lifestyle
or gender group
• Not based solely on the prevention of nutrient
deficiencies
– Consideration for reducing the risk of chronic
disease
– Takes into account the bioavailability of the
nutrient
– EAR values are used to determine RDA values
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Adequate Intake
• Adequate intake (AI) is set when an RDA cannot
be determined due to lack of sufficient data on
requirements
• A recommended average daily intake level
thought to meet or exceed the needs of virtually
all members of a life stage/gender group based
on observed or experimentally determined
estimates of nutrient intake by groups of
healthy people
• Primary purpose of the AI is as a goal for the
nutrient intake of individuals
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Tolerable Upper Intake Level
• Highest level of average daily nutrient intake
that is likely to pose no risk of adverse health
effects to almost all individuals in the general
population
• Not intended to be a recommended level of
intake
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Acceptable Macronutrient
Distribution Ranges
• Broad ranges for each energy nutrient
• Expressed as a percentage of total calories
consumed
• Associated with reduced risk of chronic disease
while providing adequate intakes of essential
nutrients
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Estimated Energy Requirements
• Similar to the EAR
• Defined as the dietary energy intake predicted
to maintain energy balance in healthy, normalweight individuals of a defined age, gender,
weight, height, and level of physical activity
consistent with good health
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
How Are the DRIs Used?
• DRIs are used by:
– Scientists and nutritionists who work in research
or academic settings
– Dietitians who plan menus for specific
populations
– Used to assess the adequacy of an individual’s
intake by comparing estimated intake with
estimated requirements
– DRIs are not suited to teaching people how to
make healthy choices
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Conveying the Concept of a
Healthy Diet to Consumers
• Dietary Guidelines for Americans is most prominent
tool to assist Americans in making wise food choices
• Companion tool is MyPyramid
• Dietary recommendations also made by:
– American Heart Association
– American Cancer Society
– American Institute of Cancer Research
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Dietary Guidelines for Americans
• Serves as the federal policy on nutrition
• Evidence-based recommendations on diet and
physical activity to promote health and decrease
the risk of chronic diet-related diseases
• Covers 9 major messages
– 23 key recommendations
– 18 additional recommendations are made for
specific population groups
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Dietary Guidelines for Americans (cont’d)
• Intended to represent a pattern of eating for
Americans over the age of 2 years
• Should ideally be implemented as a whole
• Major themes:
– Eat fewer calories
– Be more physically active
– Make wiser food choices
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
• Is the following statement true or false?
The tolerable upper intake level is not intended
to be a recommended level of intake.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
True.
Rationale: The tolerable upper intake level (UL)
is the highest level of average daily nutrient
intake that is likely to pose no risk of adverse
health effects to almost all individuals in the
general population. It is not intended to be a
recommended level of intake.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
MyPyramid
• Newest generation of the food guide
• Vehicle by which the Dietary Guidelines for
Americans are translated into food and activity
choices for healthy individuals over the age of 2
• Philosophy is that nutrient needs should be met
through food, not supplements
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
MyPyramid (cont’d)
• Basic messages
– Eat more fruit, vegetables, and whole grains
– Eat less saturated fat, trans fat, and
cholesterol
– Limit sweets and salt
– Use alcohol in moderation, if at all
– Balance calorie intake with calorie
expenditure
– Be physically active most days of the week
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
MyPyramid (cont’d)
• Designed to convey the concepts of:
– Variety
– Moderation
– Proportionality
– Gradual improvement
– Personalization
– Physical activity
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Clearing Up Controversy
• Putting knowledge into practice is difficult
• Misunderstandings about servings and food
group placement are common
– Appropriate calorie level
o Actually an estimate of how many calories
a person of similar age and average height
and weight needs to maintain an
appropriate weight
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Clearing Up Controversy (cont’d)
• Discretionary calories
– Allow consumers to incorporate small
amounts of calorie-dense or “empty calorie”
foods into their eating plan and still meet
nutrient needs without exceeding total
calorie constraints
– Discretionary calories may be “eaten up” by
choosing foods within the existing plan that
are high in fat or added sugar
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Clearing Up Controversy (cont’d)
• Discretionary calories (cont’d)
– Recommendations for the amount of food to
consume are based on the “healthiest”
choices within each group
– Selecting the “healthiest” choices from each
food group is vital for achieving appropriate
calorie and nutrient recommendations
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Clearing Up Controversy (cont’d)
• Serving sizes
– Quality of foods chosen influences total
calorie intake, so does the quantity of foods
eaten
– Large serving sizes contribute to overeating
– Most effective way to downsize portion sizes
may be to change a person’s environment
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Clearing Up Controversy (cont’d)
• Variety
– Eating a varied diet helps ensure essential
nutrients are consumed in adequate
amounts
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Guidelines and Graphics in Other Countries
• Pyramid shape is not necessarily superior or
even appropriate for food guides in other
countries
• Core recommendations are consistently similar
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Recommendations From Health Agencies
• Recommendations are similar to each other and to
the Dietary Guidelines for Americans
– American Plate, a campaign by the American
Institute of Cancer Research to teach Americans
how to implement their diet guidelines, uses a
dinner plate as a visual aid
– Landmark report entitled Food Nutrition and the
Prevention of Cancer: A global perspective
– Additional recommendations regarding physical
activity and weight management are offered
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins