Transcript Dietary Guidelines for Americans 2005 Janalou Phelan MS, RD, LD Presbyterian Hospital of Dallas Outpatient Nutrition Clinic 4-1-5

Dietary Guidelines for
Americans 2005
Janalou Phelan MS, RD, LD
Presbyterian Hospital of
Dallas
Outpatient Nutrition Clinic
4-1-5
Purpose of Dietary Guidelines
 Updated every five years
 Provide science-based advice to promote health and
reduce risk for chronic diseases such as CVD, DM, HTN,
osteoporosis, some cancers
 Geared towards healthcare providers and nutrition
educators rather than the general public
 Provide recommendations for eating and activity to
improve health and lower disease risk
 Intended for Americans over two years of age
The 2005 Updated Guidelines
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Adequate Nutrients within
Calorie Needs
Weight Management
Physical Activity
Food Groups to Encourage
Fats
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Carbohydrates
Sodium and Potassium
Alcoholic Beverages
Food Safety
Adequate Nutrients within Calorie
Needs
 Consume a variety of nutrient-dense foods and
beverages among the basic food groups, limiting SFA,
trans fat, cholesterol, added sugar, salt, and alcohol.
 Nutrients consumed should come primarily from foods
which provide an array of nutrients
 Supplements may be useful when there is a nutrient gap
that cannot be met by food intake
 Meet energy needs by adopting a balanced eating
pattern via the Food Guide Pyramid or the DASH eating
plan
The Food Pyramid
Fats, Oils & Sweets
USE SPARINGLY
Milk, Yogurt &
Cheese Group
2-3 SERVINGS
Vegetable Group
3-5 SERVINGS
Meat, Poultry, Fish,
Dry Beans, Eggs &
Nuts Group
2-3 SERVINGS
Fruit Group
2-4 SERVINGS
Bread, Cereal,
Rice & Pasta
Group
6-11 SERVINGS
Suggestions for Getting Adequate
Nutrients within Calorie Needs
 Eat more dark green vegetables, orange vegetables,
legumes, fruits, whole grains, low-fat milk products
 Eat less refined grains, total fat (especially cholesterol,
SFA, and trans fat), added sugars, calories
 Emphasize lean meats, poultry, fish; moderate amounts
of nuts/seeds; non-meat protein (beans, soy)
 Specific nutrients of concern: calcium, potassium, fiber,
magnesium, vitamin A, C, E
Weight Management
 Approximately 2/3 of all Americans are overweight and
about one third of those are obese (BMI>=30)
 Up to 16% of children/adolescents are overweight
 Even small weight loss (five to 10% of BW) may improve
health
 Also need to prevent further weight gain
 Lifestyle change in diet and exercise is the best
approach for wt loss
Weight Management
 Fad diets are mostly ineffective long term weight
management
 Calories count more than the proportion of fat, carb,
and protein
 Moderate calorie reduction of about 500 calories/day
will promote one pound of wt loss per week, coupled
with regular activity
 Lifestyle change is essential for long term wt
management
Physical Activity
 About 25% of Americans
do not partake in any
physical activity
 Increased activity is
linked to lower risk of
chronic disease
 Sedentary lifestyle
increases risk for obesity,
CAD, HTN, DM,
osteoporosis, and some
cancers
So How Much Exercise is Enough?
 To reduce risk of chronic disease:
• 30 minutes of moderate-intensity activity on most
days of the week
 To help manage body weight and prevent gradual wt
gain:
• 60 minutes of moderate to vigorous activity on most
days of the week
 To sustain wt loss for previously obese/overweight
people:
• 60-90 minutes moderate intensity activity daily
Physical Activity
 Men > 40 years & women > 50
years who plan a vigorous
program, or have a chronic
disease or risk factors, should
consult their MD first
 Gradually build up to
recommended levels!
 Even getting someone to walk
5-10 minutes a day is
improvement!
 Cardiovascular, stretching,
and resistance exercise all
important
 Tell patients to “go out and
play”
What is Moderate Activity?
 Hiking
 Light gardening/yard
work
 Dancing
 Golf (walking,
carrying clubs)
 Cycling (<10 mph)
 Walking (3.5 mph)
 Weight lifting – light
 Stretching
What is Vigorous Activity?
 Running/jogging (5
mph)
 Cycling (>10 mph)
 Swimming (laps)
 Aerobics
 Walking (4.5 mph)
 Heavy yard work
(chopping wood)
 Weight lifting –
vigorous
 Basketball - vigorous
“But I Don’t Have Time to
Exercise!”
 Short bouts are ok (10 minute bouts of moderate
activity)
 Aim for three to six 10-minute bouts over the day
 Increase activity wherever you go – take the stairs, park
farther from the entrance
 Consider getting a pedometer and build up to 10,000
steps per day
Food Groups to Encourage
 Fruits and
Vegetables
 Whole Grains
 Low fat/fat free milk
or milk products
Fruits and Vegetables
 4.5 cups (nine
servings)
recommended daily
 2 cups of fruit
 2.5 cups vegetables
 Variety = nutritional
insurance
 Colors
 Whole fruits rather
than juice
Whole Grains
 Good source of fiber (along with
F&V); need 25-40 g fiber/day
 Three or more ounce-equivalent
servings of whole grains is
recommended per day (or at least
half of all grains consumed per
day)
 May help lower risk of chronic
disease and promote weight
maintenance
 Whole grains cannot be identified
by color – read labels!
 Whole grain should be first
ingredient listed on label
Whole Grains…Think Outside the
Bread Box
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Whole Oats
Barley
Brown rice
Quinoa
Whole grain pasta
Popcorn
Whole rye
Aramanth
Milk and Milk Products
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Recommended intake is 3
cups/day of fat free/low fat milk
or equivalent milk products
Supplies calcium Important for
bone health
Lactose intolerance – usually up to
one cup at a time of milk or milk
products is tolerated; yogurt and
low fat cheese lower in lactose
Lactaid milk or pills/drops
Non-dairy food sources of calcium
– soy milk, leafy greens, sardines,
canned salmon with bones, tofu
(vegetable sources usually less
bioavailable)
Fats
 High intake of saturated fats, trans fats, and
cholesterol may increase risk of unhealthy blood
lipid levels
 High fat intake (i.e. >35% of calories) may increase
SFA and calorie intake
 Low fat intake (i.e. < 20% of calories) may lower
HDL, raise TGs, and make it hard to get adequate
Vitamin E and essential fatty acids
Functions of Fat
 Supply essential fatty acids linoleic and
linolenic acids
 Help absorb fat soluble vitamins A, D, E, K,
and carotenoids
 Building blocks of cell membranes, help
make hormones, protects organs
 Energy source
Recommended Intakes of Fat
 20-35% of calories with most fat coming from
unsaturated sources (mono- and
polyunsaturated fats)
 Consume < 10% of calories from SFA and less
than 300 mg/day of cholesterol
 Keep trans fatty acids as low as possible
(more on this later on)
Saturated Fat Intake
Calories /day
1600
Limit on SFA Intake
<=18 g
2000
<= 20 g
2200
<= 24 g
2500
<= 25g
2800
<= 31g
Saturated Fat Comparison
Cheese (1oz)
Regular
Light
Ground beef (3 oz)
Regular (75% lean)
Extra lean (95% lean)
Milk (1 cup)
Whole
1%
Bread (one medium)
Croissant
Bagel
6g
1g
6.1 g
2.6 g
4.6 g
1.5 g
6.6 g
0.2 g
So What are the Best Sources of
Fat?
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Olive oil
Canola oil
Peanut oil
Nuts – especially walnuts
and almonds (unsalted)
Avocados
Flax meal
Sunflower seeds
(unsalted)
Peanut Butter
Reduced Fat margarines
Fatty fish – salmon, trout,
herring
Omega 3 Fats And Trans Fats
More to come on this later!
Carbohydrates
Bread
and Pasta Group
Theexamples
food groupofthat
getsand
the most
“press”
time!that
 List afew
bread
pasta
products
are plentiful in your area.
 Carbohydrates
are healthful
 Discuss
how many servings
a dayfoods…if
childrenyou
should eat
choose
wisely
and when they might have them.
 Together,
research
and discuss
benefits of
 Provide
main energy
sourcethe
for health
the body,
bread
and pasta.
especially
the brain, CNS, placenta, and fetus
 Encourage children to list foods that they like from this
foodgroup.
Also good source of vitamins, minerals, and fiber
 Choose healthful sources
 Should supply 45-60% of calories
What are the Best Sources of
Carbs?
 Whole grains – bread,
cereal, rice, pasta
 Fruits – mostly whole
fruit rather than juice
 Vegetables
 Low fat milk/yogurt
 Legumes – dry beans
and peas
What about Fiber?
 Insoluble – does not dissolve in water – helps with
constipation and may help lower risk for some cancers
 Soluble – dissolves in water – helps lower cholesterol and
regulate blood sugar
 Helps with weight management
 Aim for 25-40 grams/day from F&V, beans, whole grains
Is Sugar OK?
 Choose and prepare
foods and beverages
with little added
sugars and caloric
sweeteners
 Reduce the
incidence of dental
caries by practicing
good oral hygiene
and consuming sugar
and starch
containing foods and
beverages less
frequently
Sugar
 Empty calories
 Especially watch intake of sweetened beverages which
are high in calories – 10 tsp sugar in 12 oz. soda
 Rule of thumb – no more than 10% of total calories
 Example: 2000 calories/day – eat no more than 200
calories of sweets
Sodium and Potassium
 Most Americans consume more salt than they need
(only 500 mg/day)
 Excess sodium may increase BP
 Normal BP helps reduce risk for CHD, CVA, CHF, and
kidney dz
 Lifestyle change can help lower BP, including reducing
salt intake, increasing potassium intake, losing weight,
increasing exercise, and eating a healthful diet
What are the Recommendations
for Sodium and Potassium?
 Consume less than
2300 mg of sodium
per day (about 1
tsp salt)
 Choose and
prepare foods with
little salt; consume
potassium-rich
foods, such as fruits
and vegetables
Where’s the Sodium?
 About 10% of sodium is naturally occurring in foods
 About 5-10% from the salt shaker or added in cooking
 About 75% from food processing
 Typical fast food meal may contain 1400 mg sodium
before the fries are salted!
 Read food labels!
Salt Tips
 Buy low or reduced sodium foods
 140 mg or less is considered a “low” sodium food
 The taste of salt is a habit. After a couple months taste
buds will usually adjust to preferring less sodium in foods
 Other herbs and seasonings are great to use including
vinegar and lemon juice
 Be careful of salt substitutes – they contain potassium
but may be harmful for some medical conditions;
consult MD before using these
Potassium
 A diet rich in potassium may also lower BP
 Recommended intake is 4700 mg/day
 Should come from food sources – fruits and vegetables
Alcohol
 About 55% of Americans use alcohol
 May have beneficial effects when consumed in
moderation
 Lowest all cause mortality and CAD mortality
occurs at an intake of one to two drinks per day
 Heavy alcohol consumption may increase risk of
liver cirrhosis, HTN, cancer of the upper GI tract,
injury, violence, and death
 Morbidity and mortality are highest among those
who drink large amounts of alcohol
Recommendations for Alcohol
Intake
 Those who choose to
drink alcohol should do
so sensibly and in
moderation
 Up to one drink per day
for women and two
drinks per day for men;
one drink is
• 12 oz. regular beer
• 5 oz. wine
• 1.5 oz. 80-proof
distilled spirits
Recommendations for Alcohol
Intake
 Alcohol should not be consumed by those who cannot
restrict their 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
 Alcohol should be avoided by individuals engaging in
activities that require attention, skill, or coordination,
such as driving or operating machinery
More about Alcohol
 Supplies calories but few essential nutrients
 Heavy drinkers may be at risk of malnutrition if alcohol
substituted for food
 It is not recommended that anyone begin drinking or
drink more frequently on the basis of health
considerations
 Definition of moderation is NOT intended as an average
over several days but as the amount consumed on any
single day
 Compared with women who do not drink, women who
consume one drink per day appear to have a slightly
higher risk of breast cancer
Food Safety
 About 76 million people per year in the US become ill
from pathogens in food and about 5000 of these die
 Signs and symptoms of foodborne illness include upset
stomach, diarrhea, fever, vomiting, abdominal cramps,
dehydration, and even paralysis and meningitis
 The most important food safety problem is microbial
foodborne illness
Food Safety Recommendations
To avoid microbial
foodborne illness:
 Clean hands, food
contact surfaces, and
fruits and vegetables.
Meat and poultry should
not be washed or rinsed.
 Separate raw, cooked,
and ready-to-eat foods
while shopping,
preparing, or storing
foods.
 Cook foods to a safe
temperature to kill
microorganisms
Recommendations for Food
Safety
 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.
Hand Washing
 Primary way to prevent spread of foodborne
illness
 Wash hands often especially before and after
handling raw meat, poultry, eggs, or seafood
 Wet hands, apply soap, rub hands vigorously
together for 20 seconds, rinse hands thoroughly
under clean warm water, dry hands completely
using a clean disposable cloth towel
Food Safety - Produce
 Remove and discard outer leaves, wash produce
just before cooking or eating, wash under running
water, scrub with a clean brush or hands, dry
using a clean disposable cloth towel
 Ready-to-eat pre-washed bagged produce can
be used without further washing if kept
refrigerated and used by the “use-by” date; or it
can be washed again
Temperatures
 Bacteria grow most
rapidly in the range of
40-140oF
 Refrigerated leftovers
may become unsafe
within 3-4 days
 Despite the
appearance of food,
It may not be safe to
eat
 “If in doubt, throw it
out.”
Temperatures
 Beef steaks, roasts, veal and lamb - 145o (medium
rare)
 Eggs, pork, ground meats, and meats (medium) 160o
 Stuffing, ground poultry, and reheated leftovers 165o
 Poultry breasts - 170o
 Whole poultry - 180o
Food Safety and High Risk
Individuals
 Pregnant women, older adults, and those
immunocompromised are at risk of developing
listeriosis, a potentially life-threatening bacterial
infection
 Some deli meats, hot dogs, and ready-to-eat
foods should be reheated to steaming hot before
eating
 These individuals as well as infants and young
children should also not drink unpasteurized milk,
products made from unpasteurized milk (such as
some soft cheeses), raw or partially cooked eggs,
raw or undercooked meat/poultry, unpasteurized
juices, and raw sprouts
For More Information…
Go to:
www.healthierus.gov/dietaryguidelines