The 2015 – 2020 Dietary Guidelines for Americans provides guidance for choosing a healthy diet. There is a focus on preventing and alleviating the effects of diet-related chronic diseases. These include obesity, diabetes, cardiovascular disease, and stroke, among others. This article briefly reviews the primary guideline items that can be used to teach patients with respect to improving their diet. Clinical exercise physiologists who work with patients with chronic disease can use these guidelines for general discussions regarding a heart-healthy diet.
As early as 1917, the US Department of Agriculture and the US Food and Drug Administration joined forces and developed recommendations called Choose Your Food Wisely. This early government advice focused on preventing nutrient deficiencies. They also featured some interesting food groups like the sugar, syrup, jelly, and honey group, and the butter, drippings, and suet group. Now released every 5 years in the form of guidelines by the US Department of Health and Human Services and the US Department of Agriculture, the 2015 – 2020 Dietary Guidelines for Americans (Guidelines) encourage Americans, ages 2 and older, to adopt healthy eating habits to reduce obesity and prevent chronic diseases such as heart disease, high blood pressure, and type 2 diabetes (1).
As nutrition science evolved, so did the Guidelines. In 1980, the focus shifted to concerns about nutrient excesses, informing the public to avoid too much fat, saturated fat, and cholesterol, among other things. Today, the purpose of the Guidelines is to provide evidence-based recommendations about the components of a healthy diet, focusing on disease prevention rather than treatment.
DIETARY GUIDELINES SUMMARY
The current edition outlines 5 overarching guidelines.
Follow a healthy eating pattern across the lifespan. All food and beverage choices matter. Choose a healthy eating pattern at an appropriate calorie level to help achieve and maintain a healthy body weight, support nutrient adequacy, and reduce the risk of chronic disease.
Focus on variety, nutrient density, and amount. To meet nutrient needs within calorie limits, choose a variety of nutrient-dense foods across and within all food groups in recommended amounts.
Limit calories from added sugars and saturated fats, and reduce sodium intake. Consume an eating pattern low in added sugars, saturated fats, and sodium. Cut back on foods and beverages higher in these components to amounts that fit within healthy eating patterns.
Shift to healthier food and beverage choices. Choose nutrient-dense foods and beverages across and within all food groups in place of less healthy choices. Consider cultural and personal preferences to make these shifts easier to accomplish and maintain.
Support healthy eating patterns for all. Everyone has a role in helping to create and support healthy eating patterns in multiple settings nationwide, from home to school to work to communities.
At the core of the current Guidelines is an emphasis on healthy eating patterns that promote optimal health and prevent chronic disease. Rather than focusing solely on individual nutrients or foods in isolation, the eating pattern as a whole may be more predictive of overall health status and disease risk. A healthy eating pattern includes:
A variety of vegetables from all of the subgroups – dark green, red and orange, legumes (beans and peas), starchy, and other
Fruits, especially whole fruits, which include fresh, canned, dried, or frozen
Grains, at least half of which are whole grains
Fat-free or low-fat dairy, including milk, yogurt, cheese, and/or fortified soy beverages
A variety of protein foods, including seafood, lean meats and poultry, eggs, legumes, nuts, seeds, and soy products
Oils, such as canola, corn, olive, peanut, safflower, soybean, and sunflower
Additional recommendations set specific limits on nutrients that are of particular public health concern in the United States:
Consume less than 10 percent of calories per day from added sugars. These are the first Guidelines that place a limit on added sugar. For example, added sugar should be limited to 50 grams on a 2,000 calorie diet (about 12 teaspoons of sugar). Added sugars include brown sugar, corn sweetener, corn syrup, dextrose, fructose, glucose, high-fructose corn syrup, honey, invert sugar, malt syrup, molasses, raw sugar, and turbinado sugar. Naturally occurring sugars, such as those found in fruit or milk, are not added sugars.
Consume less than 10 percent of calories per day from saturated fats. Replacing saturated fats with unsaturated fats is associated with reduced risk of cardiovascular disease. Replacing saturated fats with carbohydrates is not associated with reduced risk of cardiovascular disease.
Limit intake of trans fats to as low as possible. Foods containing synthetic sources of trans fat, such as partially hydrogenated oils, should be limited. The 2013 American Heart Association/American College of Cardiology Lifestyle Management Guidelines advise adults who would benefit from LDL-cholesterol reduction to decrease the percentage of calories from trans fat (2). Previous AHA guidelines encouraged less than 1 percent of calories per day from trans fat (3). That recommendation would result in a daily trans fat intake of 2 grams or less when consuming 2,000 calories. Using 2003 to 2006 National Health and Nutrition Examination Survey data, intake of trans fat from partially hydrogenated oil was estimated to be only 1.3 grams/day to 1.6 grams/day among Americans 2 years of age and older (2).
Consume less than 2,300 milligrams per day of sodium. Set by the Institutes of Medicine, the Upper Tolerable Intake Level is 2,300 milligrams per day for individuals ages 14 and older (4). For adults with prehypertension and hypertension, a further reduction to 1,500 milligrams per day can result in even greater blood pressure reduction (1).
A major shift from previous Guidelines was the elimination of a daily dietary cholesterol recommendation. Previous Guidelines recommended an intake of no more than 300 milligrams cholesterol per day. This change does not suggest that dietary cholesterol is no longer an important consideration of a healthy eating pattern. However, adequate evidence for a quantitative dietary cholesterol limit is not currently available.
The Guidelines also provide specific statements regarding alcohol and coffee (caffeine) consumption. Moderate alcohol consumption can be a component of a healthy dietary pattern. If alcohol is consumed, it should be done in moderation (up to one drink a day for women and up to two drinks per day for men) and only by adults of legal drinking age. It is not recommended that individuals begin drinking or drink more frequently on the basis of potential health benefits. Of course, alcohol should not be consumed during pregnancy.
Moderate coffee consumption can be incorporated into a healthy dietary pattern. According to the Guidelines, coffee consumption within a moderate range (3 to 5 cups per day or up to 400 milligrams per day of caffeine) is not associated with increased health risks among healthy adults. Care should be taken to minimize additional calories from added sugars and high-fat dairy products.
In addition to consuming a healthy eating pattern, regular physical activity is key for health promotion and disease prevention. The Physical Activity Guidelines for Americans, released by the US Department of Health and Human Services, recommend amounts and types of physical activity for optimal health. Adults need at least 150 minutes of moderate-intensity physical activity and should perform muscle strengthening exercises on 2 or more days each week (5). Youth, ages 6 to 17 years, need at least 60 minutes of physical activity per day, including aerobic, muscle strengthening, and bone-strengthening activities.
Most clinical exercise professionals assist individuals with existing chronic disease(s). These patients are often searching for a better understanding of how they can improve their health. The Guidelines provide a common-sense approach to eating for better health. All clinical exercise professionals should become familiar with the Guidelines and comfortable discussing an overall general health eating plan.
1Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan
Conflicts of Interest and Source of Funding: None