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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? Meet my adorable nephew Oliver and niece Greta!