Chapter: Nutrition and Diet Therapy: Planning a Healthy Diet


MyPyramid is the former Food Guide Pyramid tipped on its side.


Dietary Guidelines for Americans, 2005, serve as the U.S. federal nutrition policy(USDHHS & USDA, 2005). These guidelines form the basis for the MyPyramid Food guidance system unveiled in April 2005. MyPyramid is applicable to Americans over age 2. By introducing all Americans to MyPyramid and its slo-gan, “Steps to a Healthier You,” the USDA hopes to help people make informed and healthier food choices. These choices can lead to a decrease in major nutrition-related chronic diseases, such as anemia, diabetes mellitus, coronary heart disease, hypertension, and alcoholic cirrhosis.

MyPyramid is the former Food Guide Pyramid tipped on its side. The color bands in MyPyramid represent the types of foods that should be con-sumed, and the width of the band denotes the approximate relative quantity of each food that should be consumed. In addition, MyPyramid incorporates the concept of physical activity into its design. A person climbing the stairs denotes the importance of physical activity in one’s daily life, just as the food groups denote daily food intake. Personalization of one’s diet is easier to accomplish by accessing the Web site, where age, gender, and physical activity can be keyed in and more specific nutrition guidelines are provided. Twelve different pyramids are available on the Web site using these parameters. The 12 pyramids range from daily intake levels of 1,000 to 3,200 calories. By following the appropriate pyramid, the individual should be able to maintain a healthy body weight and decrease the risk of nutrition-related chronic diseases. Quantities are stated in household measures such as cups and ounces instead of the servings that were used in the Food Guide Pyramid.

MyPyramid has the following features:

MyPyramid Plan.Provides a quick estimate of what and how muchfood you should eat from the different food groups by entering your age, gender, and activity level.


MyPyramid Tracker(www. My pyramid tracker .gov). Provides moredetailed information on your diet quality and physical activity status by comparing a day’s work of foods eaten with current nutrition guidance.


Inside MyPyramid.Provides in-depth information for every foodgroup, including recommended daily amounts in commonly used measures, like cups and ounces, with examples and everyday tips. Included in this section are recommendations for choosing healthy oils, discretionary calories, and physical activity.


Start Today.Offers tips and resources that include download able suggestions on all the food groups and physical activity and provides a downloadable worksheet to track what you are eating.

MyPyramid (Figure 2-1) has six color bands representing five food groups and oils. The bands are wider at the bottom, representing foods with little or no solid fats, added sugars, or caloric sweeteners, and become narrower at the top, in-dicating that the foods that contain fats and sugars should be limited. The five food groups represented along with oils have not changed. They are the following:


Grains—bread, cereal, rice, and pasta groupVegetable group


Fruit group


Milk, yogurt, and cheese group


Meat, poultry, fish, dry beans, eggs, and nuts groupFats, oils, and sweets group

The emphasis of MyPyramid, which takes its guidance from the DietaryGuidelines for Americans, 2005, is not on a percentage of intake but on dailyservings. Depending on the information one enters into MyPyramid, a calorie level will be individually determined. See Table 2-6 for intake patterns for various caloric levels.


Bread, Cereal, Rice, and Pasta Group


The largest section of MyPyramid is made up of the grains—the bread, cereal, rice, and pasta group (Table 2-7). As the table shows, the number of servings from grains is established with the recommendation that at least half of the servings should be whole grains. Whole grains provide dietary fiber, B vitamins, iron, and magnesium. Enriched products also contain B vitamins and iron, but if they are not made from whole grains, they contain little dietary fiber.

Vegetable Group


The food intake patterns have established the number of daily servings per calorie level of vegetable. All vegetables are included in the vegetable group: green and leafy, yellow, starchy, and legumes (Table 2-8). Vegetables provide carbohydrates; dietary fiber; vitamins A, B-complex, C, E, and K; and iron, calcium, phosphorus, potassium, magnesium, copper, manganese, and some-times, molybdenum.


This guideline, if followed, also guarantees that one will receive a vari-ety of nutrients, phytochemicals, and flavonoids. One-half cup of cooked or chopped raw vegetables or two cups of uncooked, leafy vegetables is considered one serving.


Fruit Group


All fruits are included in the fruit group. They provide vitamins A and C, potas-sium, magnesium, iron, and carbohydrates, including dietary fiber (Table 2-9).


It is recommended that one eat a variety of fruit daily, following the food intake patterns for quantity, and go easy on the fruit juice. The calories in fruit juice add up quickly, especially if one is thirsty and drinks large amounts of juice. One serving is three-quarters cup of fruit juice; a half of a grapefruit; one whole raw medium apple, orange, peach, pear, or banana; a half cup of canned or cooked fruit; and a quarter cup of dried fruit.


Milk, Yogurt, and Cheese Group


Milk, yogurt, and cheese are excellent sources of carbohydrate (lactose); cal-cium, phosphorus, and magnesium; proteins; riboflavin, vitamins A, B12, and, if the milk is fortified, vitamin D. Unfortunately, all contain sodium, and whole milk and whole-milk products also contain saturated fats and cholesterol. Fat-free milk has had the fats removed.


It is recommended that two to three servings of these foods be included in one’s daily diet. The serving size is one 8-ounce glass of milk or the equivalent in terms of calcium content.


Children                                  2 servings


Adolescents                             3 servings


Adults                                     3 servings


Pregnant or lactating women   3 servings


Pregnant or lactating teens      4 servings


The following dairy foods contain calcium equal to that found in one 8-ounce cup of milk. The best choices would be low fat.


11⁄2ounces cheddar cheese

2 cups cottage cheese

13⁄4cups of ice cream

1 cup yogurt

Milk used in making cream sauces, gravies, or baked products fulfills part of the calcium requirement. A cheese sandwich would fulfill one of the serv-ing requirements, and a serving of ice cream could fulfill half of one of the serving requirements. Obviously, drinking milk is not the only way to fulfill the calcium requirement.


Some clients suffer from lactose intolerance and cannot digest milk or milk products. If they eat or drink foods containing untreated lactose, they experience abdominal cramps and diarrhea. This condition is caused by a defi-ciency of lactase. In such cases, milk that has been treated with lactase can be used, or commercial lactase can be added to the milk or taken in tablet form before drinking milk or eating dairy products.


Meat and Beans Group


All meats, poultry, fish, eggs, soybeans, dry beans and peas, lentils, nuts, and seeds are included in this group (Table 2-10). These foods provide proteins, iron, copper, phosphorus, zinc, sodium, iodine, B vitamins, fats, and cholesterol.


Caution must be used so that the foods selected from this group are low in fat and cholesterol. Many meats contain large amounts of fats, and egg yolks and organ meats have very high cholesterol content.


Let the food intake patterns be the guide for the number of ounces one should eat daily. In general, 1 ounce of lean meat, poultry, or fish, 1 egg, 1 table-spoon of peanut butter, 1 ⁄4 cup of cooked dry beans, or 1 ⁄2 ounce of nuts or seeds can be considered as a 1 ounce-equivalent from the meat and beans group.




This group contains butter, margarine, cooking oils, mayonnaise and other salad dressings, sugar, syrup, honey, jam, jelly, and sodas. All of these foods have a low nutrient density, meaning they have few nutrients other than fats and carbo-hydrates and have a high calorie content. One’s limit for fat will be figured and listed as oils in accordance with the food intake patterns shown in Table 2-6. It is recommended that the fat sources be from fish, nuts, and vegetable oils.

The Mediterranean diet has received attention because of the American Heart Association’s recommendation to increase monounsaturated fats in the diet. The following guidelines are recommended:


·        Eat the majority of food from plant sources, such as potatoes, grains and breads, beans, fruits, vegetables, nuts, and seeds.


·        Eat minimally processed foods, with an emphasis on fresh, locally grown foods.


·        Replace other fats and oils with olive oil.


·        Keep total fat in a range of less than 20–35% of energy. Saturated fat should be no more than 7–8% of energy.


·        Eat low to moderate amounts of cheese and yogurt (low fat and fat-free preferable).


·        Eat low to moderate amounts of fish and poultry and from zero to four eggs per week (those used in cooking need to be counted).


·        Eat fruit for dessert; desserts that contain a significant amount of sugar and saturated fat should be eaten only a few times per week.


·        Eat red meat a few times per month, not to exceed 12–16 ounces per month.


·        Engage in regular exercise to promote fitness, a healthy weight, and a feeling of physical well-being.


·        Drink wine in moderation (wine is optional). Wine with meals—one to two glasses per day for men and one glass per day for women.


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