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DIETARY GUIDELINES FOR AMERICANS 2015-2020 Gabriela Proaño, MS, RD Central Texas Veterans Health Care System December 2016 Outline Introduction on Dietary Guidelines- background on research and development behind dietary guidelines Discussion of Chapter 1: Key Elements in Healthy Eating Patterns Discussion of Chapter 2: Shifts Needed to Align With Healthy Eating Patterns Discussion of Chapter 3: Everyone Has a Role in Supporting Healthy Eating Patterns Review of past and current guidelines- what is new with 20152020 guidelines and what has remained the same Application- how this can be applied in clinic and in the community for patients, students, and general population. Introduction 1990 National Nutrition Monitoring and Related Research Act- “At least every five years the Secretaries shall publish a report entitled `Dietary Guidelines for Americans'. Each such report shall contain nutritional and dietary information and guidelines for the general public, and shall be promoted by each Federal agency in carrying out any Federal food, nutrition, or health program. BASIS OF GUIDELINES- The information and guidelines contained in each report required under paragraph (1) shall be based on the preponderance of the scientific and medical knowledge which is current at the time the report is prepared.” Document published every 5 years by U.S. Department of Health and Human Services (HHS) and of Agriculture (USDA) with information from the Scientific Report of the 2015 Dietary Guidelines Advisory Committee. Introduction Approximately 50% of American adults have one or more diet preventable chronic diseases (cardiovascular disease, type 2 diabetes, overweight/obesity). In 2009-2012, 65% of adult females and 73% of adult males were overweight/obese and one in three youths age 2-19 were overweight/obese. Guidelines are focused on PREVENTION and are used to formulate federal health and nutrition programs and educate the public General Guidelines 1. Follow a healthy eating pattern across the lifespan at an appropriate calorie level. 2. Focus on variety, nutrient density, and amount of foods. Choose within all food groups 3.Limit calories from added sugars and saturated fats and reduce sodium intake. 4.Shift to healthier, more nutrient dense food and beverage choices 5.Support healthy eating patterns for all (multiple settingsschool, work, etc.) Key recommendations Variety of vegetables from subgroups such as dark green, red and orange, legumes, starchy and other Whole fruits Whole grains Low fat or fat free dairy Protein foods such as seafood, lean meats, poultry, eggs, legumes, nuts/seeds, and soy Healthy diet includes oils Limit intake of saturated fat, trans fat, and added sugars to less than 10% of calories per day Consume less than 2300 mg sodium per day Alcohol consumption should be in moderation Physical activity guidelines for Americans Chapter 1: Key Elements in Healthy Eating Patterns Healthy eating pattern includes total foods and beverages consumed Nutrition needs should be met primarily through food Adapt healthy eating pattern based on cultural and personal preferences Vegetables Goal for 2,000 calorie diet is 2.5 cup equivalents. Include all 5 vegetable subgroups (dark green, red and orange, legumes (beans/peas), starchy and other. Important source of fiber, potassium, vitamin A, C, K, B6, folate, iron, magnesium, etc. Include wide variety of vegetables in nutrient dense form. Limit butter, salt, or creamy sauces. If canned or frozen, choose lower sodium versions. Fruits Goal for 2,000 calorie diet is 2 cup-equivalents Include whole fruits (at least 50%) and 100% juice Fruit can be fresh, canned, frozen, and dried Important source of dietary fiber, potassium, vitamin C. etc. Grains Goal for 2,000 calorie diet is 6 oz-equivalents Limit the intake of refined grains and include whole grains (make ½ whole). Include grains as single foods or ingredient. Whole grains sources of fiber, iron, zinc, manganese, folate, thiamin, riboflavin, etc. Dairy Goal for 2,000 calorie diet is 3 cup equivalents Include fat-free and low-fat (1%) dairy- milk, yogurt, cheese, or fortified soy. Important source of calcium, phosphorus, vitamin A, vitamin B12, protein, etc. Protein Goal for 2,000 calories is 5.5 ounce-equivalents per day Broad group from both animal and plant sources. Subgroups include: seafood, meats, poultry, and eggs; and nuts, seeds, and soy products (also included in this group are legumes and dairy). Important source of B vitamins, selenium, phosphorus, copper, zinc, etc. Oils Goal for 2,000 calories is 27g (5 tsp) per day. Include fats high in monounsaturated and polyunsaturated fats. Important source in essential fatty acids and vitamin E. Include nuts, seeds, seafood, olives, avocados, as well as corn, canola, olive, peanut, safflower, soybean, and sunflower oil. Figure 1-2: Fatty Acid Profiles of Common Fats & Oils Chapter 2: Shifts Needed to Align With Healthy Eating Patterns Focus on 4th dietary guideline 75% of population have eating patterns low in vegetables, fruits, dairy and oils. More than half of population exceeding total grain and protein recommendations but NOT for subgroups. Most Americans exceed the recommendation for added sugars, saturated fats, and sodium. Figure 2-1: Dietary Intakes Compared to Recommendations. Percent of the U.S. Population Ages 1 year & Older Who Are Below, At, or Above each Dietary Goal or Limit Vegetable and Fruit Intake Vegetable consumption tends to be lowest among boys ages 913 yo and girls ages 14-18 yo. Vegetables most often consumed as separate food items Shift by increasing vegetable content of mixed dishes and reducing portions of overconsumed food and choose green salad or vegetable as side dish Average intake of fruit is lowest among girls 14-18 yo and adults ages 19-50 yo. Fruits most often consumed alone Shift by increasing whole fruit as snacks, in salads, and side dishes Grains and Dairy Intake Total grains are closest to target amounts but do not meet whole grain recommendations 50% of intake of refined grains from mixed dishes Shift from white to whole grain or 100% whole wheat. Looking at ingredient list and reducing intake of refined desserts and sweet snacks Intake of dairy only met for children ages 1-3 but not for other age groups Dairy intake mostly from milk and cheese Shift to increasing low fat dairy and yogurt if low in added sugars and reducing cheese due to high saturated fat intake. Choose low fat milk with meals or yogurt as a snack. Protein and Oils Intake While protein intake is close to recommendations, vary for subgroups (low for seafood and legumes and high for nuts/seeds and meat, poultry, and eggs. Shift to increase seafood by adding to meals twice per week and using legumes instead of meat and poultry (choose lower sodium options) Oil intake is below recommendations for age groups Shift to use oils instead of solid fats Other Dietary Components Added sugars account for more than 13% of calories per day in U.S. population Shift to use beverages with no added sugars and reduce portion sizes for sugar sweetened beverages and desserts/sweet snacks Chapter 3: Everyone Has a Role in Supporting Healthy Eating Patterns Figure 3-1: A Social- Ecological Model for Food & Physical Activity Decision Chapter 3: Everyone Has a Role in Supporting Healthy Eating Patterns Sectors include systems (government, health care) and businesses/industries that may influence degree in which people have access to food or opportunities to be physically active. Setting affects what choices individuals make home and away from home. Setting = opportunities Social and cultural norms can be dictated by sectors an setting and difficult to change. Individual settings- adapt eating pattern to fit all requirements, budget, etc. Strategies for Action 1. Sectors to foster relationship with food producers, suppliers, and retailers 2. Sectors to identify policies and programs that promote healthy eating/PA 3.Expand access to healthy and affordable safe and affordable food choices 4.Provide nutrition programs that meet tailored needs for community 5.Help individuals become more aware of nutrition patterns and shift to align with dietary guidelines 6.Teach skills such as gardening, cooking, meal planning and label reading What is new? 2015 dietary guidelines builds off of 2010 guidelines. Focus is on dietary patterns as a whole instead to specific nutrients. Focus on shift to healthier, more nutrient dense food and beverage choices rather than increasing intake of certain foods Does not include dietary cholesterol for key recommendations- IOM still suggests to consume as little dietary cholesterol as possible within healthy eating patterns Application Used to help make programs such as the USDA National School Lunch and Breakfast program, WIC, and programs for older adults. Used by nutrition professionals to educate through programs. General public is NOT the target audience Up to federal agencies how they wish to implementuse MyPlate, SuperTracker, and other federal government resources for education Questions? “Let food be thy medicine, and medicine be thy food.” ― Hippocrates, Greek Philosopher