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Transcript
2015 Dietary Guidelines for Americans:
Focus on Child Nutrition
Keli Hawthorne, MS, RD, LD
Director of Clinical Research
Department of Pediatrics
Dell Medical School
The University of Texas at Austin
[email protected]
How are DGA used?
• To inform USDA and DHHS food programs
30 million
children
8 million
participants
1 billion
meals/day
USDA National School Lunch Program
& School Breakfast Program
USDA WIC Program
Older Americans Act Nutrition Services
Childhood Obesity Trends
Nearly 1/3 of US children are overweight or obese
2015 DGAC Report
5 main
messages from
the 2015
Dietary
Guidelines
Consume a healthy eating pattern that accounts for all
foods and beverages within an appropriate calorie level
Healthy US Eating Pattern
Healthy Mediterranean Pattern
Healthy Vegetarian Pattern
Healthy US Style Eating Pattern
•
Patterns at 1000, 1200, and 1400 kcal are
designed for 2-8 yr old children
• If a child 4-8 yrs old needs more kcal
(1600 kcal or more), recommended to
maintain 2.5 cups / day of dairy
•
Patterns at 1600 to 3200 kcal are designed
for children over 8 yrs old and adults
Healthy Mediterranean-Style Pattern
•
•
•
More fruits and seafood than US Healthy
Pattern
Less dairy than US Healthy Pattern
Based on patterns described in studies with
positive health outcomes rather than on
meeting specified nutrient standards
Healthy Mediterranean Pattern
• Changes in these amounts were limited to
patterns for adults, because children were not
part of the studies used in modifying the Pattern
Healthy Vegetarian Pattern
•
•
•
Replaces previous lacto-ovo vegetarian
adaptation of 2010 DGA
More legumes (beans and peas), soy
products, nuts/seeds, and whole grains than
US Healthy Pattern
No meats, poultry or seafood
• Can be vegan if all dairy choices are
fortified soy beverages (soymilk) or
other plant-based substitutes
Comparison of Eating Patterns (1,200 kcal)
Food
Group
Healthy US
Style
Mediterranean
Style
Vegetarian
Style
Vegetables
1½ cups / day
1½ cups / day
1½ cups / day
Fruits
1 cups / day
1 cups / day
1 cups / day
Grains
4 oz / day
4 oz / day
4 oz / day
2½ cups / day
2½ cups / day
2½ cups / day
Protein
3 oz / day
3 oz / day
1½ oz / day
Oils
17 g / day
17 g / day
17 g / day
100 kcal / day
(8%)
100 kcal / day
(8%)
170 kcal / day
(14%)
Dairy
Discretionary
Calories
•
Variety of vegetables from all subgroups: dark green, red and orange, legumes
(beans and peas), starchy, and other
•
Fruits, especially whole fruits
•
Grains, at least ½ of which are whole grains
•
Fat-free or low-fat dairy, including milk, yogurt, cheese, and/or fortified soy
beverages
•
Variety of protein foods: seafood, lean meats and poultry, eggs, legumes,
nuts, seeds, and soy products
•
Oils
• Consume <10% of calories per
day from added sugars
• Consume <10% of calories per
day from saturated fats
• Consume <2,300 mg per day of
sodium
Empower People to Make Healthy Shifts
Limit intake of solid fats and
added sugars (now called “empty
calories” by DGA 2015) to no
more than 5-15% of total calories
Limit calories from
added sugars
Consume less than 10%
of calories per day from
added sugars
Sugar: Old Topic, New Recommendation
•
•
Currently we get 13-17% of calories from added sugars
10% of total calories from added sugars
•
•
2,000 kcal diet: about 200 kcals = 50g = 12.5 tsp
1,600 kcal diet: about 160 kcals = 40 g = 10 tsp
Product
Amount
g Sugar
Teaspoons Sugar
Coke
12-oz can
39 g
10 tsp
Coke
16-oz bottle
52 g
13 tsp
Snickers
1 regular bar
28 g
7 tsp
Starbucks Cookie
1 cookie
27 g
7 tsp
Shipley Donut
1 glazed
16 g
4 tsp
Sugar: Review of the Evidence
•
Strong, consistent evidence shows that added sugars are
associated with excess body weight in children
•
Reduction of added sugars and sugar-sweetened
beverages reduces body mass index (BMI) in children
•
Moderate evidence indicates that dental caries are lower
when free sugar intake is <10% of energy
2015 DGAC Report
Calories from Added Sugars
in Comparison to USDA Food Pattern Limits
600
Improving,
but not enough
500
Calories
400
300
200
100
0
1-3 y
4-8 y
Males
Males
9-13 y
Females
14-18 y
Females
Added sugars intake has decreased for both males and females across
all age groups since 2001, but intakes still exceed the USDA limits
2015 DGAC Report
Dietary Sources of Added Sugars
39% of added
sugars come from
sugar-sweetened
beverages
2015 DGAC Report
FDA Proposal for
New Food Label
Currently it’s impossible for
consumers to find out what
amount of sugars are
added vs natural
DGAC Recommendations to
Reduce Added Sugars
•
•
•
•
•
Water is the preferred beverage choice
Nutrition labels should include added sugars (in g
and teaspoons) to assist consumers in making
good choices
Taxes on sugar-sweetened beverages should be
explored, using revenues to promote nutrition and
health
Limit marketing of foods/beverages high in added
sugars to children and adolescents
Public education campaigns
2015 DGAC Report
Sample Menu from DGA
This breakfast alone
contributes 8 tsp out of
12 allowed tsp of
added sugar for
2000 kcal/d pattern
2015 DGA
2015 DGA
Lunch and dinner sample menus were minimally
processed, allowing ability to remain within
recommendation of <10% of calories from added sugars
2015 DGA
Low-Calorie Sweeteners:
New Topic, Consistent Message
2010 DGA
2015 DGAC Report
only 1 reference to
low-calorie sweeteners
(aspartame)
115 references to
low-calorie sweeteners
(aspartame & others)
Both 2010 and 2015 DGA:
Replacing added sugars with non-caloric sweeteners may
reduce calorie intake in the short-term, yet questions remain
about their effectiveness as a weight management strategy
Consume <10% of calories
from saturated fats
NO CHANGE
DGAC Review of Empty Calories
• Sources of solid fats and added sugars
• Sugar in sugar-sweetened beverages (including
coffee and tea) and breakfast cereals
• Solid fats in burgers, sandwiches, and pizza
• Combo of both in cookies, cakes, ice cream, and
donuts
Nearly 100% of children 1-8 years old exceed the
recommended limit for solid fats & added sugars
2015 DGAC Report
Nearly 100% of children 1-8 years old exceed the
recommended limit for solid fats & added sugars
2015 DGAC Report
Current Intakes
of Saturated Fat
• 10.9% of total
calories for adults
• 11.1-12.6% of
total calories for
children
2015 DGA
DGAC Recommendations
• 93% of children with type 2
diabetes are 12-19 yrs old
• 90% of these children are
overweight or obese
• Obesity prevalence is
higher in African
Americans and Hispanics
compared to Caucasians
Nearly ¾ of these children have at least
1 cardiometabolic risk factor
2015 DGAC Report
Limit dietary cholesterol to
less than 300 mg/day
•
•
Recommendation to limit
cholesterol was removed
Adequate evidence is not
available for a quantitative
limit for dietary cholesterol
Current US averages are now 267 mg/d
Based on newer evidence that dietary cholesterol does not
play an active role in blood cholesterol
Keep trans fatty acid intake
as low as possible
Limit foods with solid fats and
synthetic sources of trans
fats, such as partially
hydrogenated oils
NO CHANGE
Reduce intake of calories from
solid fats & added sugars
Use oils to replace solid fats
where possible
No longer in
Key Recommendations
(Focus on saturated fats rather
than solid fats)
Oils should replace solid fats
rather than being added to the diet
Replace protein foods with
choices lower in solid fats,
calories, and/or are sources of oils
Key Recommendation changed to
a healthy eating pattern including a
variety of protein foods
Sources: Animal-based proteins (ie,
seafood, lean meats, poultry, eggs, milk,
and milk products) and plant-based proteins
(ie, legumes, nuts, seeds, and soy)
Consume whole grains for at
least HALF of total grain intake
Americans consume 6.3 oz
of refined grains/day
Major Sources: cereal, bread,
rice, cookies and cakes
No longer mentioned in Key
Recommendations (Included as
variety within eating patterns)
Limit to no more than HALF
of total grain intake
Children and adults should
consume foods naturally rich
in dietary fiber
No longer a Key Recommendation
Choose a dietary pattern that
supplies adequate fiber
(acknowledged as a nutrient of concern)
Sources: beans, peas,
vegetables, fruits, whole grains
Fruit Intake
Good News!
• Unlike the rest of the US population,
children ages 1 to 8 years old do actually
meet recommended intakes for total fruit
Not So Good News!
• Average intakes of fruits, including
juice, are lowest among girls ages 14
to 18 years
Reduce daily sodium intake to
<2,300 mg/d
Further reduce intake to 1,500
mg/d for older adults,
African Americans, or
individuals with diabetes,
chronic kidney disease, or
hypertension
Reduce daily sodium intake to
<2,300 mg/d
1,500 mg/d limit encouraged
for adults with prehypertension
No longer a recommendation
for older adults, African
Americans, or individuals with
diabetes or chronic kidney
disease
DGAC Report on Sodium & BP in Kids
•
Based on systematic
review from 15
intervention studies and 4
prospective cohort studies
•
Moderate evidence that as
sodium intake decreases,
BP in children birth to age
18 yrs also decreases
2015 DGAC Report
Not mentioned in
Key Recommendations
Moderate coffee consumption can
be part of healthy eating patterns
Three to five 8-oz cups/day
Or 400 mg/d of caffeine
Caffeinated beverages may include
calories from added sugars
Avoid caffeine when consuming
alcohol or when pregnant, trying to
become pregnant, or breastfeeding
DGAC Review of Caffeine in Children
•
Uncertainly about safe level of caffeine intake in children
and adolescents
•
Routine consumption patterns
currently do not indicate excessive
intakes in these groups
•
Median intakes <100 mg/d in 14-18 yr
olds
• Recommendation: Limited or no consumption of high
caffeine intake (>400 mg/d) is advised for children and
adolescents
2015 DGAC Report
Changing Physical Activity Patterns for
a Healthy Lifestyle
Only 30% of adolescent boys and
13% of adolescent girls report doing
regular physical activity
Children and adolescents ages 6 to 17 years need at least
60 minutes of physical activity per day, including aerobic,
muscle-strengthening, and bone-strengthening activities
Moderate & Vigorous-Intensity Activities
•
Most of a child’s 60-min of daily physical activity should be
moderate or vigorous to increase heart rate and work of
breathing
Muscle and Bone Strengthening Activities
•
Increases skeletal muscle strength,
power, endurance, & bone strength
Kids need muscle & bone
strengthening activities at least 3 days
per week as part of 60 min/day
Update on B-24 Project
•
Collaboration between USDA and DHHS to specifically include
infants and children from Birth to 24 months in future iterations
of the Dietary Guidelines for Americans
•
4 working groups were created: 0-6 months, 6-12 months, 12-24
months, and caregivers
•
Overall key research needs:
• Analysis of human milk composition and bioactive
component profile
• Updated nutrient specification for infant formula
• Factors affecting the gut microbiome
B-24 Project: Sample of Research Priorities
Work Group 1 (0-6 months)
•
•
•
•
Relationship between breast
milk composition and infant
health outcomes
Maternal diet and allergy risk
Regulation of infant appetite
Introduction of
complementary foods
Work Group 2 (6-12 months)
•
•
•
•
•
Impact of various protein
intakes
Role of beverages including
fruit juices
Taste preferences
Impact on WIC program
Micronutrients of concern: iron,
zinc, vit D, L-PUFA, fluoride, vit
B12
B-24 Project: Sample of Research Priorities
Work Group 3 (6-24 months)
•
Energy needs to promote
health and prevent disease
•
Optimal type and amount
of physical activity
•
Implications of sleep
patterns
•
Impact of media
•
Impact of various weaning
approaches
Work Group 4 (Caregivers)
•
Effects of dietary patterns
(vegan, paleo) on breast
milk composition
•
Impact of maternal feeding
style (control, pressure,
restriction, indulgent) and
responsiveness to satiety
and hunger cues on infant
growth and/or childhood
overweight/obesity
DGA 2015 Take Home Messages
•
•
•
•
•
•
DGA reaches >30 million children via School Lunch Programs
Shift towards healthy eating patterns with focus on variety, nutrient density, and
amounts
Fat: Limit saturated fat to 10% of calories
•
Eating less food with saturated fats may offer no benefit if it is replaced
by refined carbohydrates
Sugar: Limit added sugar to 10% of calories
•
1 sugar-sweetened beverage per day exceeds the limit for many people
•
DGAC proposed placing Added Sugars on food labels which the FDA is
working towards now
Children and adolescents need at least 60 minutes of physical activity per day,
including aerobic, muscle-strengthening, and bone-strengthening activities
B-24 to be included in 2020 DGA
Questions?
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