S. Nutrition and Health Guidelines - Nationwide Priorities for Improvements in

Nationwide Priorities for Improvements in

U. S. Nutrition and Health Guidelines

In the United States, the national guidelines for diet and physical activity are called the “Dietary Guidelines for Americans” and the major educational tool for consumers

“MyPyramid” (Illustration 1.13).

Dietary Guidelines for Americans The Dietary Guidelines for Americans provide science-based recom-mendations to promote health and to reduce the risk for Although the United States spends more on health care

than any other country, statistics from the World Health Organization (WHO) indicate that it ranks twenty-sixth among developed countries of the world in life expectancy.

Today’s priorities for improvements in the public’s health and longevity center on reducing obesity, infant mortal-ity, smoking, excessive alcohol consumption, accidents, violence, and physical inactivity. Goals for dietary changes are a central part of the nation’s overall plan for health improvements. For the two out of three Americans who do not smoke or drink excessively, dietary intakes represent the major environmental influence on long-term health.⁷²

Goals for improving the nutritional health of the na-tion are summarized in the document “Healthy People

Table 1.22 2010 Nutrition Objectives for the Nation

Other Objectives Related to Nutrition

√ Reduce infant mortality from 7.6 to no more than 5 per 1000 live births.

√ Reduce the incidence of spina bifida and other neural tube defects from 7 to 3 per 10,000 live births.

√ Reduce the incidence of birth defects from 1.7 to 1.2 per 1000 live births.

√ Increase the proportion of women who receive preconceptional counseling.

√ Increase the proportion of pregnant women who begin prenatal care in the first trimester from 81 to 90% or more.

√ Reduce low birthweight (<2500 grams) from 7.3 to 5%.

√ Reduce preterm births (<37 weeks) from 9.1 to 7.6%.

√ Increase abstinence from alcohol use by pregnant women from 79 to 95%.

√ Reduce the incidence of fetal alcohol syndrome.

√ Increase the proportion of women who gain weight appropriately during pregnancy.

√ Increase from 60 to 75% the proportion of women who exclusively breastfeed after delivery.

√ Increase the proportion of adults who are at a healthy weight from 42 to 60%.

√ Reduce the proportion of adults who are obese from 23 to 15%.

√ Reduce the proportion of children and adolescents who are overweight or obese from 11 to 5%.

√ Reduce growth retardation among low-income children under age 5 years from 8 to 5%.

√ Increase the proportion of persons aged 2 years and older who:

Consume at least 2 daily servings of fruit from 28

• to 75%

Consume at least 3 daily servings of vegetables, with

•

at least one-third being dark-green or deep-yellow vegetables, from 3 to 50%

Consume at least 6 daily servings of grain products,

•

with at least three being whole grains, from 7 to 50%

Consume less than 10% of calories from saturated

•

fat from 36 to 75%

Consume no more than 30% of total calories from

•

fat from 33 to 75%

Consume 2400 mg or less of sodium daily from

•

21 to 65%

Meet dietary recommendations for calcium from

•

46 to 75%

√ Reduce iron deficiency among young children and females of childbearing age from 4–11% to 1–7%.

√ Reduce anemia among low-income pregnant females in their third trimester from 29 to 20%.

√ Increase the proportion of worksites that offer nutrition or weight-management classes or counseling from 55 to 85%.

√ Increase the proportion of physician office visits made by patients with the diagnosis of cardiovascular disease, diabetes, osteoporosis, or hyperlipidemia that include counseling or education related to diet and nutrition from 42 to 75%.

√ Increase food security among U.S. households, and in so, doing reduce hunger rates.

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Dietary Guidelines for Americans must be up-dated every five years.

The 2005 edition of the Dietary Guidelines stresses the importance of selecting nutrient-dense foods, balancing caloric intake with output, and increasing physical activity. This document includes the promise that the health of most in-dividuals will be enhanced if the recommenda-tions are followed. Each recommendation is part of an integrated whole—all the recommendations should be implemented for best results.

Focus Areas and Key Recommenda tions The Dietary Guidelines for 2005 include nine

“Focus Areas” and 23 “Key Recommendations.”

These are highlighted in Table 1.23. “Key Recommendations for Specific Population Groups” are also provided by the Dietary Guidelines. Special population groups addressed are infants and young children, pregnant women, older adults, and people with weakened immune systems. These and other recommendations included in the Dietary Guidelines are available online (see the resources section at the end of this chapter).

Implementation of the Dietary Guidelines The MyPyramid Food Guide is the major how-to tool intended to help the public implement the 2005 Dietary Illustration 1.13 The major nutritional and physical activity guides

in the United States.

Dietary Guidelines for Americans

www.healthierus.gov/dietaryguidelines

2005

www.mypyramid.gov

Table 1.23 The 2005 Dietary Guidelines for Americans: focus areas and examples of key recommendations Adequate Nutrients within Calorie Needs

Consume the variety of foods and beverages cited in MyPyramid food guide or the DASH eating plan. (Additional

•

information about the DASH eating plan is presented on page 46.) Weight Management

Achieve and maintain a healthy body weight.

•

Physical Activity

Engage in at least 30 minutes of moderate-intensity physical activity, above usual activity, at work or home on most

•

days of the week.

Food Groups to Encourage

Choose and consume colorful vegetables, fruits, whole-grain products, and low-fat dairy products.

•

Fats

Consume less than 10% of calories from saturated fatty acids, less than 300 mg/day of cholesterol, and keep

•

consumption of trans fatty acids as low as possible.

Carbohydrates

Choose fiber-rich fruits, vegetables, and whole grains often.

•

Sodium and Potassium

Consume less than 2300 mg of sodium (approximately 1 tsp of salt) per day.

•

Alcoholic Beverages

Alcoholic beverages, if chosen, should be consumed sensibly and in moderation.

•

Food Safety

Avoid food-borne illness by cleaning hands and food-preparation surfaces and cooking foods to safe temperatures.

•

major chronic diseases through diet and physical activity.

Due to its credibility and focus on health promotion and disease prevention for the public, the Dietary Guidelines form the basis of federal food and nutrition education programs and policies. Under legislative mandate, the

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food measure equivalents for common foods by food group shown in this section of Inside the Pyramid.

MyPyramid Tracker

● is a dietary and physical activ-ity assessment tool that provides information on your diet quality, physical activity status, and links to nutrient and physical activity information. Al-though the My Pyramid Food Guide is not designed for weight-loss diets, the My Pyramid Tracker tool can be used to assess and monitor caloric intake and physical activity levels.

MyPyramid Menu Planner

● can be used to develop

menus based on food preferences and calorie need.

After you answer questions about an individual’s age, sex, height, weight, and physical activity level, the planner calculates calorie need and food-group servings. Individuals can pick the foods that go into the menu and to see how well those choices stack up against the recommendations.

The DASH Diet Originally published as a diet that helps control mild and moderate high blood pressure in experimental studies, the DASH Eating Plan also reduces the risk of cancer, osteoporosis, and heart disease. Im-provements in blood pressure are generally seen within two weeks of starting this dietary pattern.⁷³

The DASH dietary pattern emphasizes fruits, vegeta-bles, low-fat dairy foods, whole-grain products, poultry, fish, and nuts. Only low amounts of fat, red meats, sweets, and sugar-containing beverages are included. This dietary pattern provides ample amounts of potassium, magne-sium, calcium, fiber, and protein and limited amounts of saturated and trans fats. Recommendations for types and amounts of food included in this eating plan for a 2000-calorie diet are shown in Table 1.22.

Although one calorie level is shown in the table, DASH Eating Plans for 12 calorie levels (1600 to 3200) are available at the website listed in Table 1.25.

The Mediterranean Diet Adherence to MyPyramid, DASH, and the Mediterranean dietary recommendations effectively lowers the risk of developing a range of dis-eases, from heart disease to diabetes.¹⁴ The Mediterranean diet was originally based on foods consumed by people in Greece, Crete, southern Italy, and other Mediterranean areas where rates of chronic disease were low and life expectancy long.¹⁶

The Mediterranean dietary pattern, shown in Illustra-tion 1.15, emphasizes daily consumpIllustra-tion of bread, pasta, fruits, vegetables, olive oil, legumes, cheese and yogurt, and meats such as fish, poultry, veal, and lamb. Daily physical activity, a traditional part of life in these areas, is included in the plan. Fish, poultry, eggs, and sweets are recommended weekly, and red meat monthly. Wine with meals is part of the Mediterranean diet.

Guidelines. In addition, the Dietary Guidelines report identified the Dietary Approaches to Stop Hypertension (DASH) Eating Plan as being consistent with the recommendations. MyPyramid covers both food selection and physical exercise, and the DASH Eating Plan addresses only dietary intake. Both are valuable tools that provide the framework for planning nutrient-dense, calorically appropriate diets that diminish the risk of chronic disease.

MyPyramid Food Guide Food group guides to the in-take of healthful diets have been available in the United States since 1916. Known by names such as “Basic Four Food Groups” and “Food Guide Pyramid,” the guides have been periodically updated. New releases of food-group guides reflect existing scientific knowledge about nutrition and health and are modified to address emerg-ing health problems.

The U.S. Department of Agriculture (USDA) released its newest version of the food guide in 2005. Called

“MyPyramid,” it is very different from previous guides.

It is Internet-based and resource-filled, and some of the educational resources offered are interactive. It is a popular website.

MyPyramid guidance stresses the importance of lower calorie intakes and increased physical activity levels.

Because low intakes increase the risk of certain chronic dis-eases, the new food guide emphasizes intake of whole-grain products, colourful vegetables, low-fat dairy products, and lean meats. MyPyramid uses cups and ounces as the primary measures of how much food to consume daily and it gives recommended number of cups or ounces for food within each group.

MyPyramid.gov: The Website A large assortment of educational and assessment tools are available at the MyPyramid website (www.mypyramid.gov). Here are a few examples of the types of resources you can find:

● The For Professionals link will connect you to detailed information about using MyPyramid educational materials and provides seven days of sample menus that correspond to MyPyramid recommendations for a 2000-calorie food pattern.

Four of the seven days included in the menus, and the nutrient analysis for the menus, are shown in Illustration 1.14. Menus offered as examples on MyPyramid may not correspond to individual food preferences and contain relatively few ethnic foods.

Inside the Pyramid

● explains each food group,

dis-cretionary calories, and physical activity recommen-dations. It provides information on which foods are within the various groups and food measure equivalents so you can convert food amounts into cups and ounces, and oils into teaspoons. Table 1.24 lists

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Illustration 1.14 My Pyramid sample menu (showing 4 of 7 days) and analysis for a 2000-calorie food pattern.

Food Group Daily Average

Over One Week

Total Grains (oz eq) 6.0 Whole Grains 3.4 Refined Grains 2.6

Total Veg* (cups) 2.6

Fruits (cups) 2.1

Milk (cups) 3.1

Meat/ Beans (oz eq) 5.6

Oils (tsp/grams) 7.2 tsp/32.4 g

Nutrient Daily Average Over One Week

Calories Protein, g Protein, % kcal Carbohydrate, g Carbohydrate, % kcal Total fat, g Total fat, % kcal Saturated fat, g Saturated fat, % kcal Monounsaturated fat, g Polyunsaturated fat, g Linoleic acid, g Alpha-linolenic acid, g Cholesterol, mg Total dietary fiber, g Potassium, mg Sodium, mg*

Calcium, mg Magnesium, mg Copper, mg Iron, mg Phosphorus, mg Zinc, mg Thiamin, mg Riboflavin, mg Niacin equivalents, mg Vitamin B6, mg Vitamin B12, mcg Vitamin C, mg Vitamin E, mg (AT) Vitamin A, mcg (RAE) Dietary folate equivalents, mcg

* Starred items are foods that are labeled as no-salt-added, low-sodium, or low-salt versions of the foods. They can also be prepared from scratch with little or no added salt. All other foods are regular commercial products that contain variable levels of sodium. Average sodium level of the seven day menu assumes no salt added in cooking or at the table.

1994 98 20 264 53 67 30 16 7.0 23 23 21 1.1 207 31 4715 1948 1389 432 1.9 21 1830 14 1.9 2.5 24 2.9 18.4 190 18.9 1430 558

*Vegetable subgroups (weekly totals) Dk-Green Veg (cups)

Orange Veg (cups) Beans/Peas (cups) Starchy Veg (cups) Other Veg (cups)

3.3 2.3 3.0 3.4 6.6

Day 1 Day 2 Day 3 Day 4

BREAKFAST

LUNCH

DINNER

SNACKS

1 whole wheat English muffin 2 tsp soft margarine 1 tbsp jam or preserves 1 medium grapefruit 1 hard-cooked egg 1 unsweetened beverage

White bean-vegetable soup 1 1/4 cup chunky vegetable soup 1/2 cup white beans* 2 ounce breadstick 8 baby carrots 1 cup fat-free milk

Rigatoni with meat sauce

1 cup rigatoni pasta (2 ounces dry) 1/2 cup tomato sauce tomato bits* 2 ounces extra lean cooked ground beef (sauteed in 2 tsp vegetable oil) 3 tbsp grated Parmesan cheese Spinach salad

1 cup baby spinach leaves 1/2 cup tangerine slices 1/2 ounce chopped walnuts 3 tsp sunflower oil and vinegar dressing

1 cup fat-free milk

1 cup low-fat fruited yogurt DINNER

SNACKS BREAKFAST

LUNCH Cold cereal 1 cup bran flakes 1 cup fat-free milk 1 small banana 1 slice whole wheat toast 1 tsp soft margarine 1 cup prune juice

Tuna fish sandwich 2 slices rye bread

3 ounces tuna (packed in water, drained)

2 tsp mayonnaise 1 tbsp diced celery

1/4 cup shredded romaine lettuce 2 slices tomato

1 medium pear 1 cup fat-free milk

Roasted chicked breast 3 ounces boneless skinless chicken breast* 1 large baked sweet potato 1/2 cup peas and onions 1 tsp soft magarine 1 ounce whole-wheat dinner roll 1 tsp soft magarine 1 cup leafy greens salad 3 tsp sunflower oil and vinegar dressing

1/4 cup dried apricots 1 cup low-fat fruited yogurt LUNCH

DINNER

SNACKS BREAKFAST Hot cereal

1/2 cup cooked oatmeal 2 tbsp raisins 1 tsp soft margarine 1/2 cup fat-free milk 1 cup orange juice

Taco salad

2 ounces tortilla chips 2 ounces ground turkey, sauteed in 2 tsp sunflower oil

1/2 cup black beans*

1/2 cup iceberg lettuce 2 slices tomato

1 ounce low-fat cheddar cheese 2 tbsp salsa

1/2 cup avocado 1 tsp time juice 1 unsweetened beverage

Spinach lasagna

1 cup lasagna noodles, cooked (2 oz dry)

2/3 cup cooked spinach 1/2 cup ricotta cheese 1/2 cup tomato sauce tomato bits*

1 ounce part-skim mozzarella cheese

1 ounce whole-wheat dinner roll 1 cup fat-free milk

1/2 ounce dry-roasted almonds*

1/4 cup pineapple 2 tbsp raisins BREAKFAST

LUNCH

DINNER

SNACKS Breakfast burrito 1 flour tortilla (7˝ diameter) 1 scrambled egg (in 1 tsp soft margarine)

1/3 cup black beans*

2 tbsp salsa 1 cup orange juice 1 cup fat-free milk

Roast beef sandwich 1 whole-grain sandwich bun 3 ounces lean roast beef 2 slices tomato

1/4 cup shredded romaine lettuce 1/8 cup sauteed mushrooms (in 1 tsp oil)

1 1/2 ounce part-skim mozzarella cheese

1 tsp yellow mustard 3/4 cup baked potato wedges*

1 tbsp ketchup 1 unsweetened beverage

Stuffed broiled salmon 5 ounce salmon filet 1 ounce bread stuffing mix 1 tbsp chopped onions 1 tbsp diced celery 2 tsp canola oil 1/2 cup saffron (white) rice 1 ounce slivered almonds 1/2 cup steamed broccoli 1 tsp soft margarine 1 cup fat-free milk

1 cup cantaloupe

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Table 1.24 MyPyramid food measure equivalents

1⁄2 cup ricotta 5 1 cup 2 cups cottage cheese 5 1 cup

Pudding 1 cup 5 1 cup

Frozen yogurt 1 cup 5 1 cup Ice cream 1¹⁄2 cup 5 1 cup

Fruits

Apple 1 small 5 1 cup

1⁄2 large 5 1 cup

Banana 1 large 5 1 cup

Cantaloupe ¹⁄8 5 1 cup

Grapes 32 5 1 cup

Grapefruit 1 5 1 cup

Orange 1 5 1 cup

Peach 1 5 1 cup

Pear 1 5 1 cup

Plums 3 5 1 cup

Strawberries 8 large 5 1 cup

Watermelon 1" wedge 5 1 cup Dried fruit ¹⁄2 cup 5 1 cup

Fruit juice 1 cup 5 1 cup Meat, Fish and Beans

Steak 1–3¹⁄2" 3 2¹⁄2" 3 ¹⁄2" 5 3 oz

Hamburger 1 small 5 2 oz

1 medium 5 4 oz

1 large 5 6 oz

Chicken ¹⁄2 breast 5 3 oz

1 thigh 5 2 oz

1 leg 5 3¹⁄2 oz

Pork chops 1 medium 5 3 oz

Fish 1 small can tuna 5 3¹⁄2 oz 1 small fish 5 3 oz 1 salmon steak 5 5 oz

Seafood 5 large srimp 5 1 oz

10 medium clams 5 3 oz

1⁄2 cup crab 5 2 oz

1⁄2 cup lobster 5 2¹⁄2 oz

Eggs 1 small 5 1 oz

1 large 5 2 oz

Grains

Bagel 1 mini bagel 5 1 oz

1 large bagel 5 4 oz

Biscuit 1–2" diameter 5 1 oz

1–3" diameter 5 2 oz

Bread 1 slice 5 1 oz

Cooked cereal ¹⁄2 cup 5 1 oz

Crackers 5 whole wheat 5 1 oz

7 square/round 5 1 oz

English muffin ¹⁄2 muffin 5 1 oz Muffin 1–2¹⁄2" diameter 5 1 oz 1–3¹⁄2" diameter 5 3 oz Pancake 1–4¹⁄2" diameter 5 1 oz

2–3" diameter 5 1 oz

Popcorn 3 cups 5 1 oz

Breakfast cereal 1 cup flakes 5 1 oz 1¹⁄4 cups 5 1 oz Rice ¹⁄2 cup 5 1 oz Pasta ¹⁄2 cup 5 1 oz

Tortilla 1–6" diameter 5 1 oz

1–12" diameter 5 4 oz

Vegetables

Cooked 1 cup 5 1 cup

Carrots 2 medium 5 1 cup

12 baby 5 1 cup

Celery 1 large stalk 5 1 cup Corn on the cob 1–6" long 5 ¹⁄2 cup

1–9" long 5 1 cup

Green/red peppers 1 large 5 1 cup

Potatoes 1 medium (3" diameter) 5 1 cup Raw, leafy greens 2 cups 5 1 cup

Tomato 1 large 5 1 cup

Milk

Milk 1 cup 5 1 cup

Yogurt 1 cup 5 1 cup

Cheese 1¹⁄2 oz hard 5 1 cup

1⁄3 cup shredded 5 1 cup 2 oz processed 5 1 cup

Table 1.25 The DASH Eating Plan for a 2000-calorie diet

Number of servings Number of servings

Lean meats, poultry, fish 2 or fewer Nuts, seeds, legumes 4–5/week

Fats and oils 2–3

Sweets 5/week Grains* 6–8

Vegetables 4–5 Fruits 4–5 Fat-free or low-fat milk and milk products 2–3

*whole-grain products primarily

source: Dietary Guidelines for Americans, Appendix A-1: The DASH Eating Plan at 1,600-, 2,000-, 2,600-, and 3,100- Caloric Levels (www.health.gov/

dietaryguidelines/dga2005/document/html/appendixA.htm).

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Illustration 1.15 The Mediterranean Diet Pyramid.

Dalam dokumen Through the Life Cycle (Halaman 72-77)