Appendix G. U.S. Nutrition Recommendations and Guidelines. Dietary Guidelines for Americans, Balancing Calories to Manage Weight

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1 Appendix G U.S. Nutrition Recommendations and Guidelines Dietary Guidelines for Americans, 2010 Balancing Calories to Manage Weight Prevent and/or reduce overweight and obesity through improved eating and physical activity behaviors. Control total calorie intake to manage body weight. For people who are overweight or obese, this will mean consuming fewer calories from foods and beverages. Increase physical activity and reduce time spent in sedentary behaviors. Maintain appropriate calorie balance during each stage of life-childhood, adolescence, adulthood, pregnancy and breastfeeding, and older age. Foods and Food Components to Reduce Reduce daily sodium intake to less than 2,300 milligrams (mg) and further reduce intake to 1,500 mg among persons who are 51 and older and those of any age who are African American or have hypertension, diabetes, or chronic kidney disease. The 1,500 mg recommendation applies to about half of the U.S. population, including children, and the majority of adults. Consume less than 10 percent of calories form saturated fatty acids by replacing them with monounsaturated and polyunsaturated fatty acids. Consume less than 300 mg per day of dietary cholesterol. Keep trans fatty acid consumption as low as possible by limiting foods that contain synthetic sources of trans fats, such as partially hydrogenated oils, and by limiting other solid fats. Reduce the intake of calories from solid fats and added sugars. Limit the consumption of foods that contain refined grains, especially refined grain foods that contain solid fats, added sugars, and sodium. If alcohol is consumed it should be consumed in moderation up to one drink per day for women and two drinks per day for men and only by adults of legal drinking age. 8

2 Foods and Nutrients to Increase Individuals should meet the following recommendations as part of a healthy eating pattern while staying within their calorie needs. Increase vegetable and fruit intake. Eat a variety of vegetables, especially dark-green and red and orange vegetables and beans and peas. Consume at least half of all grains as whole grains. Increase whole grain intake by replacing refined grains with whole grains. Increase intake of fat-free or low-fat milk and milk products, such as milk, yogurt, cheese, or fortified soy beverages. 1 Choose a variety of protein foods, which include seafood, lean meat and poultry, eggs, beans and peas, soy products and unsalted nuts and seeds. Increase the amount and variety of seafood consumed by choosing seafood in place of some meat and poultry. Replace protein foods that are higher in solid fats with choices that are lower in solid fats and calories and/or are sources of oils. Use oils to replace solid fats where possible Choose foods that provide more potassium, dietary fiber, calcium, and vitamin D, which are nutrients of concern in American diets. These foods include vegetables, fruits, whole grains, and milk and milk products. Recommendations for Specific Population Groups Women capable of becoming pregnant 2 Choose foods that supply heme iron, which is more readily absorbed by the body, additional iron sources, and enhancers of iron absorption such as vitamin C-rich foods. Consume 400 micrograms (mcg) per day of synthetic folic acid (from fortified foods and/or supplements) in addition to food forms of folate from a varied diet. 3 Women who are pregnant or breastfeeding 2 Consume 8 to 12 ounces of seafood per week form a variety of seafood types. Due to their high methyl mercury content, limit white (albacore) tuna to 6 ounces per week and do not eat the following four types of fish: tilefish, shark, swordfish, and king mackerel. If pregnant, take an iron supplement, as recommended by an obstetrician or other health care provider. Individuals ages 50 years and older Consume foods fortified with vitamin B 12, such as fortified cereals, or dietary supplements. Building Healthy Eating Patterns Select an eating pattern that meets nutrient needs over time at an appropriate calorie level. Account for all foods and beverages consumed and assess how they fit within a total healthy eating pattern. Follow food safety recommendations when preparing and eating foods to reduce the risk of foodborne illnesses. 1 Fortified soy beverages have been marketed as soymilk, a product name consumers could see in supermarkets and consumer materials. However, FDA S regulations do not contain provisions for the use of the term soymilk. Therefore, in this document, the term fortified soy beverage includes products that may be marketed as soymilk. 2 Includes adolescent girls. 3 Folic acid is the synthetic form of the nutrient, whereas, folate is the form found naturally in foods. Appendix G U.S. Nutrition Recommendations and Guidelines 9

3 American Institute for Cancer Research Recommendations for Cancer Prevention Ten recommendations for cancer prevention 1. Be as lean as possible without becoming underweight. 2. Be physically active for at least 30 minutes every day. 3. Avoid sugary drinks. Limit consumption of energy-dense foods. 4. Eat more of a variety of vegetables, fruits, whole grains and legumes such as beans. 5. Limit consumption of red meats (such as beef, pork and lamb) and avoid processed meats. 6. If consumed at all, limit alcoholic drinks to 2 for men and 1 for women a day. 7. Limit consumption of salty foods and foods processed with salt (sodium). 8. Don t use supplements to protect against cancer. 9. It is best for mothers to breastfeed exclusively for up to 6 months and then add other liquids and foods. 10. After treatment, cancer survivors should follow the recommendations for cancer prevention. And always remember do not smoke or chew tobacco. Source: American Institute of Cancer Research. Available online at Reprinted with permission from the American Institute for Cancer Research. Dietary Approaches to Stop Hypertension: DASH Diet Recommendations Daily servings for Daily servings for a Type of food Calorie diets 2000 Calorie diet Grains and grain products (include at least 3 whole grain foods each day) Fruits Vegetables Low fat or non fat dairy foods Lean meats, fish, poultry or less Nuts, seeds, and legumes 3 6 per week 4 5 per week Fats and sweets 2 4 limited Source: The DASH Diet Eating Plan. Available online at 10 Appendix G U.S. Nutrition Recommendations and Guidelines

4 Nutrition and Physical Fitness Recommendations from the American Cancer Society Maintain a healthy weight throughout life. Balance calorie intake with physical activity. Avoid excessive weight gain throughout life. Achieve and maintain a healthy weight if currently overweight or obese. Adopt a physically active lifestyle. Adults: Engage in at least 30 minutes of moderate to vigorous physical activity, above usual activities, on 5 or more days of the week; 45 to 60 minutes of intentional physical activity are preferable. Children and adolescents: Engage in at least 60 minutes per day of moderate to vigorous physical activity at least 5 days per week. Eat a healthy diet, with an emphasis on plant sources. Choose foods and drinks in amounts that help achieve and maintain a healthy weight. Eat 5 or more servings of a variety of vegetables and fruits every day. Choose whole grains over processed (refined) grains. Limit intake of processed and red meats. If you drink alcoholic beverages, limit your intake. Drink no more than 1 drink per day for women or 2 per day for men. Source: Some adapted from Complete Guide Nutrition and Physical Activity for Cancer Prevention. Available online at PED_3_2X_Diet_and_Activity_Factors_That_Affect_Risks.asp?sitearea PED. Reprinted by the permission of the American Cancer Society, Inc. All rights reserved. Appendix G U.S. Nutrition Recommendations and Guidelines 11

5 Healthy People 2020 Topics Indicators Objectives Access to care Healthy Behaviors Chronic Disease Environmental Determinants Social Determinants Injury Mental Health with access to healthcare services healthy behaviors Prevalence and mortality of chronic disease experiencing a healthy physical environment experiencing a healthy social environment that experiences injury experiencing positive mental health 1. Increase the proportion of persons with health insurance (AHS 1). 2. Increase proportion of persons with a usual primary care provider (AHS 3). 3. (Developmental) Increase the proportion of persons who receive appropriate evidence-based clinical preventive services (AHS 7). 4. Increase the proportion of adults who meet current federal physical activity guidelines for aerobic physical activity and for muscle- strengthing activity (PA 2). 5. Reduce the proportion of children and adolescents who are considered obese (NWS 10). 6. Reduce consumption of calories from solid fats and added sugars in the population aged 2 years and older (NWS 17). 7. Increase the proportion of adults who get sufficient sleep (SH 4). 8. Reduce coronary heart disease deaths (HDS 2). 9. Reduce the proportion of persons in the population with hypertension (HDS 5). 10. Reduce the overall cancer death rate (C 1). 11. Reduce the number of days the Air Quality Index (AQI) exceeds 100 (EH 1). 12. (Developmental) Improve the health literacy of the population (HC/HIT 1). 13. (Developmental) Increase the proportion of children who are ready for school in all five domains of healthy development: physical development, social-emotional development, approaches to learning, language, and cognitive development (EMC 1). 14. Increase educational achievement of adolescents and young adults (AH 5). 15. Reduce fatal and nonfatal injuries (IVP 1). 16. Reduce the proportion of persons who experience major depressive episodes (MDE) (MHMD 4). Maternal and Infant Health Proportion of healthy births 17. Reduce low birth weight (LBW) and very low birth weight (VLBW) (MICH 8). Responsible Sexual Behavior Substance Abuse Tobacco Quality of Care responsible sexual behavior substance abuse using tobacco receiving quality health care services 18. Reduce pregnancy rates among adolescent females (FP 8). 19. Increase the proportion of sexually active persons who use condoms (HIV 17). 20. Reduce past-month use of illicit substances (SA 13). 21. Reduce the proportion of persons engaging in binge drinking of alcoholic beverages (SA 14). 22. Reduce tobacco use by adults (TU 1). 23. Reduce the initiation of tobacco use among children, adolescents, and young adults (TU 3). 24. Reduce central line-associated blood stream infections (CLABSI) (HA 1). 12 Appendix G U.S. Nutrition Recommendations and Guidelines