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Chapter: Nutrition and Diet Therapy: Planning a Healthy Diet

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Dietary Guidelines

The Dietary Guidelines provide science-based advice to promote health and to reduce the risk for chronic diseases through diet and physical activity.

DIETARY GUIDELINES FOR AMERICANS

 

The Dietary Guidelines provide science-based advice to promote health and to reduce the risk for chronic diseases through diet and physical activity. The guidelines are targeted to the general public over 2 years of age in the United States. Below are the titles of the topics for each section; all of the following key recommendations are taken from www. health.gov/dietaryguidelines. The Dietary Guidelines themselves form an integrated set of key recommendations in each of the topic areas and will be discussed under the respective topics.

 

·   Adequate nutrients within calorie needs

·   Weight management

·   Physical activity

·   Food groups to encourage

·   Fats

·   Carbohydrates

·   Sodium and potassium

·   Alcoholic beverages

·   Food safety

 

Adequate Nutrients within Calorie Needs

 

A basic premise of the Dietary Guidelines is that recommended diets will provide all the nutrients needed for growth and health and that the nutrients consumed should come primarily from foods. Foods contain not only the vitamins and min-erals found in supplements, but also hundreds of naturally occurring substances, including carotenoids, flavonoids and isoflavones, and protease inhibitors that may protect against chronic health conditions.

 

Key Recommendations.

 

·  Consume a variety of nutrient-dense foods and beverages withinand among the basic food groups while choosing foods that limit the intake of saturated and trans fats, cholesterol, added sugars, salt, and alcohol.

 

·  Meet recommended intakes within energy needs by adopting abalanced eating pattern such as the USDA Food Guide or the Dietary Approaches to Stop Hypertension (DASH) Eating Plan (Appendix C-1).

 

Key Recommendations for Specific Population Groups.

 

·  People over age 50.Consume vitamin B12in its crystalline form(e.g., fortified foods or supplements).

 

·  Women of childbearing age who may become pregnant.Eat foodshigh in heme-iron and consume iron-rich plant foods or iron-fortified foods with an enhancer of iron absorption, such as vitamin C–rich foods.

 

·  Women of childbearing age who may become pregnant and those in thefirst trimester of pregnancy. Consume adequate synthetic folic aciddaily (from fortified foods or supplements) in addition to food forms of folate from a varied diet.

 

·  Older adults, people with dark skin, and people exposed to insufficientultraviolet band-radiation (i.e., sunlight). Consume extra vitamin Dfrom vitamin D–fortified foods and supplements. 

 

Weight Management

 

Over the last 20 years the prevalence of overweight in the general population, and especially among children and adolescents, has increased substantially; it is estimated that as many as 16% of children and adolescents are overweight. Overweight and obesity of both adults and children are of great public health concern because excess body fat leads to a higher risk of premature death, type 2 diabetes, hypertension, dyslipidemia, cardiovascular disease, stroke, gall-bladder disease, and other chronic diseases.

 

Key Recommendations.

 

·  To maintain body weight in a healthy range, balance calories fromfoods and beverages with calories expended.

 

·  To prevent gradual weight gain over time, make small decreases infood and beverage calories and increase physical activity.

 

Key Recommendations for Specific Population Groups.

 

·  Those who need to lose weight.Aim for a slow, steady weight loss bydecreasing calorie intake while maintaining an adequate nutrient intake and increasing physical activity.

 

·  Overweight children.Reduce the rate of body weight gain whileallowing growth and development. Consult a health care provider before placing a child on a weight reduction diet.

 

·  Pregnant women.Ensure appropriate weight gain as specified by ahealth care provider.

 

·  Breastfeeding women.Moderate weight reduction is safe and does notcompromise weight gain of the nursing infant.

 

·  Overweight adults and overweight children with chronic diseaseand/or on medication. Consult a health care provider about weightloss strategies before starting a weight reduction program to ensure appropriate management of other health conditions.

 

Physical Activity

 

Americans are relatively inactive. Regular physical activity and physical fitness make important contributions to one’s health, sense of well-being, and maintenance of a healthy body weight. Physical activity is defined as any bodily movement produced by skeletal muscles resulting in energy expenditure. Regular physical activity has been shown to reduce the risk of certain chronic diseases, including high blood pressure, stroke, coronary artery disease, type 2 diabetes, colon cancer, and osteoporosis. Therefore, it is recommended that adults engage in at least 30 minutes of moderate-intensity physical activity on most days of the week. Regular physical activity is also a key factor in achieving and maintaining a healthy body weight for adults and children (Tables 2-1, 2-2, and 2-3). It is recommended that males over age 40 and females over age 50 check with their health care provider before beginning aerobic activities. 



 

Key Recommendations.

 

·        Engage in regular physical activity and reduce sedentary activities topromote health, psychological well-being, and healthy body weight.


·         To reduce the risk of chronic disease in adulthood, engage in at least 30 minutes of moderate-intensity physical activity, above usual activity, at work or home on most days of the week. For most people, greater health benefits can be obtained by engaging in physical activity of more vigorous intensity or longer duration.


·        To help manage body weight and prevent gradual, unhealthybody weight gain in adulthood, engage in approximately 60 minutes of moderate- to vigorous-intensity activity on most days of the week while not exceeding caloric intake requirements.

 

·        To sustain weight loss in adulthood, participate in at least 60 to90 minutes of daily moderate-intensity physical activity while not exceeding caloric intake requirements. Some people may need to consult with a health care provider before participating in this level of activity.


·        Achieve physical fitness by including cardiovascular conditioning,stretching exercises for flexibility, and resistance exercises or calisthenics for muscle strength and endurance.

 

Key Recommendations for Specific Population Groups.

 

·        Children and adolescents.Engage in at least 60 minutes of physicalactivity on most, preferably all, days of the week.

 

·        Pregnant women.In the absence of medical or obstetriccomplications, incorporate 30 minutes or more of moderate-intensity physical activity on most, if not all, days of the week. Avoid activities with a high risk of falling or abdominal trauma.

 

·         Breastfeeding women.Be aware that neither acute nor regular exerciseadversely affects the mother’s ability to successfully breastfeed.

 

·         Older adults.Participate in regular physical activity to reducefunctional declines associated with aging and to achieve the other benefits of physical activity identified for all adults.

 

Food Groups to Encourage

 

Increased intakes of fruits, vegetables, whole grains, and fat-free or low-fat milk products will have important health benefits. Those who eat more generous amounts of fruits and vegetables as part of a healthful diet may reduce the risk of chronic diseases, including stroke and other cardiovascular diseases, type 2 diabetes, and cancers in certain sites (oral cavity and pharynx, larynx, lung, esophagus, stomach, and colon-rectum). In addition to fruits and vegetables, whole grains are an important source of fiber and other nutrients. Consuming at least three or more ounce-equivalents of whole grains per day can reduce the risk  of  several  chronic  diseases  and  may  help  with  weight  maintenance.

 

Table 2-4 can help one recognize the names of whole grains.


 

Key Recommendations.

 

·   Consume a sufficient amount of fruits and vegetables while stayingwithin energy needs. For a 2,000-calorie intake, 2 cups of fruit and

·  21⁄2 cups of vegetables per day are recommended, with higher or lower amounts depending on the calorie level.

·   Choose a variety of fruits and vegetables each day. In particular,select from all five vegetable subgroups (dark green vegetables, orange vegetables, legumes, starchy vegetables, and other vegetables) several times a week.

·   Consume three or more ounce-equivalents of whole-grain productsper day, with the rest of the recommended grains coming from enriched or whole-grain products. In general, at least half the grains should come from whole grains.

 

·   Consume 3 cups per day of fat-free or low-fat milk or equivalent milkproducts.

Key Recommendations for Specific Population Groups.

 

·        Children and adolescents.Consume whole-grain products often; at leasthalf the grains should be whole grains. Children 2 to 8 years should consume 2 cups per day of fat-free or low-fat milk or equivalent milk products. Children 9 years of age and older should consume 3 cups per day of fat-free or low-fat milk or equivalent milk products.

 

Fats

 

Fats and oils are part of a healthful diet, but the type of fat makes a difference to heart health, and the total amount of fat consumed is also important. High in-take of saturated fats, trans fats, and cholesterol increases the risk of coronary heart disease due to high blood lipid levels. Fats supply energy and essentialfatty acids and serve as a carrier for the absorption of the fat-soluble vitamins A, D, E, and K and carotenoids.

 

Key Recommendations.

 

·     Consume less than 10% of calories from saturated fatty acids andless than 300 mg/day of cholesterol and keep trans-fatty acid consumption as low as possible.

·         Keep total fat intake between 20 and 35% of calories, with mostfats coming from sources of polyunsaturated and monounsaturated fatty acids, such as fish, nuts, and vegetable oils.

·         When selecting and preparing meat, poultry, dry beans, and milk or milk products, make choices that are lean, low fat, or fat-free.

·         Limit intake of fats and oils high in saturated and trans-fatty acids,and choose products low in such fats and oils.

 

Key Recommendations for Specific Population Groups.

 

·        Children and adolescents.Keep total fat intake between 30 and 35% ofcalories for children 2 to 3 years of age and between 25 and 35% of calories for children and adolescents 4 to 18 years of age, with most fats coming from sources of polyunsaturated and monounsaturated fatty acids, such as fish, nuts, and vegetable oils.

 

Carbohydrates

 

Carbohydrates are part of a healthful diet. Foods in the basic food groups that provide carbohydrates—fruits, vegetables, grains, and milk—are important sources of many nutrients. Dietary fiber is composed of nondigestible carbohy-drates. Sugars and starches supply energy to the body in the form of glucose. Sugars can be naturally present in foods or added to the food. The greater the consumption of foods containing large amounts of added sugars, the more dif-ficult it is to consume enough nutrients without gaining weight. See Table 2-5 to help identify the names of added sugar on labels.


Key Recommendations.

 

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

 

•  Choose and prepare foods and beverages with little added sugarsor caloric sweeteners, such as the amounts suggested by the USDA MyPyramid and the DASH Eating Plan.

 

•  Reduce the incidence of dental caries by practicing good oralhygiene and consuming foods and beverages containing sugar and starch less frequently.

 

Key Recommendations for Specific Population Groups.

 

•  Older Adults.Dietary fiber is important for laxation (the eliminationof fecal waste through the anus). Since constipation may affect up to 20% of people over 65 years of age, older adults should choose to consume foods rich in dietary fiber.

 

•  Children.Carbohydrate intakes of children need specialconsiderations with regard to obtaining sufficient amounts of fiber, avoiding excessive amount of calories from added sugars, and prevention of dental caries.

 

Sodium and Potassium

 

On average, the higher one’s salt (sodium chloride) intake, the higher one’s blood pressure. Keeping blood pressure in the normal range reduces one’s risk of coronary heart disease, stroke, congestive heart failure, and kidney disease. When reading labels, look for the sodium content; foods that are low in sodium (less than 140 mg) are low in salt. Lifestyle changes includ-ing reducing salt intake, increasing potassium intake, losing excess body weight, increasing physical activity, and eating an overall healthful diet can prevent or delay the onset of high blood pressure and can lower elevated blood pressure.

 

Key Recommendations.

 

•  Consume less than 2,300 mg of sodium (approximately 1 teaspoonof salt) per day.

 

•  Choose and prepare foods with little salt. At the same time, consumepotassium-rich foods, such as fruits and vegetables.

 

Key Recommendations for Specific Population Groups.

 

•  Individuals with hypertension, blacks, and middle-aged and olderadults. Aim to consume no more than 1,500 mg of sodium perday and meet the potassium recommendation (4,700 mg/day) with food.

 

Alcoholic Beverages

 

Alcoholic beverages supply calories but few essential nutrients. As a result, ex-cessive alcohol consumption makes it difficult to eat sufficient nutrients within one’s daily calories and to maintain a healthy weight. Alcoholic beverages are harmful when consumed in excess.

 

Key Recommendations.

 

•  Those who choose to drink alcoholic beverages should do so sensiblyand in moderation—defined as the consumption of up to one drink per day for women and up to two drinks per day for men.

 

•  Alcoholic beverages should not be consumed by some individuals,including those who cannot restrict their alcohol intake, women of childbearing age who may become pregnant, pregnant and lactating women, children and adolescents, individuals taking medications that can interact with alcohol, and those with specific medical conditions.

•  Alcoholic beverages should be avoided by individuals engaging in activities that require attention, skill, or coordination, such as driving or operating machinery.

 

Food Safety

 

Avoiding foods that are contaminated with harmful bacteria, viruses, para-sites, toxins, and chemical and physical contaminants is vital for healthful eat-ing. It is estimated that every year about 76 million people in the United States become ill from pathogens in food.

 

Key Recommendations.

 

Clean hands, food contact surfaces, and fruits and vegetables.

Separate raw cooked and ready-to-eat foods while shopping, preparing, or storing foods.

Cook foods to a safe temperature to kill microorganisms.

Chill (refrigerate) perishable food promptly, and defrost foods properly.Avoid raw (unpasteurized) milk or any products made from unpasteurized milk, raw or partially cooked eggs or foods containing raw eggs, raw or undercooked meat and poultry, unpasteurized juices, and raw sprouts.

 

Key Recommendations for Specific Population Groups.

 

Infants and young children, pregnant women, older adults, andthose who are immunocompromised. Do not eat or drink raw(unpasteurized) milk or any products made from unpasteurized milk, raw or partially cooked eggs or foods containing raw eggs, raw or undercooked meat and poultry, and raw or undercooked fish or shellfish.

Pregnant women, older adults, and those who are immunocompromised.Only eat certain deli meats and frankfurters that have been reheated to steaming hot.


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