- Email: [email protected]
Translating the new dietary guidelines
CLINICAL PRACTICE
NUTRITION
Translating the new dietary guidelines Teresa A. Marshall, PhD, RD/LD
ral and systemic health are intertwined. Dietary choices, through nutrient intakes, can improve or adversely affect both oral and systemic health. The purpose of this article is to introduce dental practitioners to the latest federally sponsored dietary recommendations. The U.S. Department of Agriculture is charged with developing dietary recommendations to ensure adequate nutrient intakes and the prevention of chronic diseases. In cooperation with the Food and Nutrition Board (FNB) of the Institute of Medicine (IOM) and the U.S. Department of Health and Human Services, the Department of Agriculture undertakes this task in three areas: nutrient standards, dietary guidelines and food group plans. Nutrient standards (for example, the Dietary Reference Intakes [DRIs]) define nutrient intakes required to prevent deficiency- and toxicityassociated diseases. Dietary guidelines provide evidence-based targeted dietary messages to encourage adequate nutrient intakes and chronic disease prevention. Food group plans (for example, MyPyramid) present food patterns to achieve the recommended nutrient intakes while limiting chronic disease risk. Over the past 10 years, the Department of Agriculture revised the DRIs1 and released the new Dietary Guidelines for Americans2 and MyPyramid3 in 2005 in response to the revised DRIs.
O
DIETARY REFERENCE INTAKES
The FNB of the IOM, in collaboration with Health Canada, revised the format of the traditional Recommended Dietary Allowances (RDAs) on the publication of the 1258
JADA, Vol. 137
ABSTRACT Background. Diet- and nutrition-related diseases influence oral health. The U.S. government recently revisited the dietary guidelines for health promotion and chronic disease prevention. The purpose of this article is to review the new recommendations. Conclusions. The Dietary Reference Intakes are designed to identify nutrient intakes required to maintain health in people of a given age and sex. The Dietary Guidelines for Americans are designed to promote healthy dietary and activity habits. MyPyramid is designed to identify individual dietary patterns to ensure adequate nutrient intakes within energy needs. Clinical Implications. Familiarization with the new dietary guidelines will enable dental practitioners to develop diet-related oral health recommendations that are consistent with disease prevention. Key Words. Dietary guidelines; food; nutrition. JADA 2006;137(9):1258-60.
DRI series, which began in 1997.1 The FNB established the DRIs using evidence from peer-reviewed observational and experimental studies; support for the DRI values is outlined in nutrient-specific chapters of the series. The DRIs have four components: the RDAs, the Adequate Intakes (AIs), the Tolerable Upper Intake Levels (ULs) and the Estimated Average Requirements (EARs). The RDAs continue to be the average daily amounts of nutrients considered adequate to meet the known nutrient needs of practically all healthy people. The AIs are the average daily amounts of a nutrient that appear sufficient to maintain a specified nutritional criterion and are used as Dr. Marshall is an assistant professor, Department of Preventive and Community Dentistry, N335 DSB, University of Iowa, Iowa City, Iowa 52340, e-mail “[email protected]”. Address reprint requests to Dr. Marshall.
http://jada.ada.org September 2006 Copyright ©2006 American Dental Association. All rights reserved.
C L I N I C A L P R A C T I C E NUTRITION
guides when RDAs cannot be established. The ULs are the maximum daily amounts of a nutrient that appear safe for most healthy people, beyond which there is an increased risk of experiencing adverse health effects. The EARs are the daily amounts of a nutrient that will maintain a specific biochemical or physiological function in one-half the people of a given age and sex. DIETARY GUIDELINES FOR AMERICANS 2005
The Dietary Guidelines for Americans 2005 were designed to promote dietary and activity habits for optimal health and prevention of obesityrelated diseases, including cardiovascular disease, type 2 diabetes and some cancers. The Dietary Guidelines for Americans 2005 are evidence-based; to develop these guidelines, the Department of Agriculture used data on nutrients most likely to be deficient in people’s diets and nutrients whose high or disproportionate intakes contribute to obesity and related diseases.2 The Dietary Guidelines for Americans 2005 outline specific key messages within nine themes1: dselect nutrient-dense foods and beverages to achieve adequate nutrient intakes within energy requirements; dbalance energy intake with activity for weight management; dengage in physical activity to reduce chronic disease risk and to mange weight; dselect a sufficient amount and variety of fruits and vegetables, make one-half of grain selections whole grain and choose a sufficient amount of dairy products to ensure adequate nutrient and fiber intake; drestrict saturated fats, total fats and transfatty acids and select low-fat meat and dairy products to reduce the risk of developing obesity and obesity-related diseases; dselect high-fiber fruits, vegetables and whole grains while limiting added sugars to ensure adequate fiber intake and to reduce caries risk; dlimit sodium intake and consume potassiumrich foods to reduce hypertension; dconsume alcoholic beverages responsibly to prevent alcohol-related illnesses and accidents; dpractice safe food handling to reduce the risk of developing food-borne illnesses. MYPYRAMID
MyPyramid was designed to identify individual dietary patterns based on weight, age and sex to
Figure. The MyPyramid symbol incorporates recommendations from the Dietary Guidelines for Americans 2005, which was developed by the U.S. Department of Agriculture and U.S. Department of Health and Human Services. Orange stands for grains, green for vegetables, red for fruits, yellow for oils, blue for milk and purple for meat and beans.
ensure adequate nutrient intakes within energy allowances (Figure). The DRIs provided nutrient intake goals, and the Dietary Guidelines for Americans 2005 shape MyPyramid using the key messages to moderate intake of food groups and portion sizes to reduce the incidence of obesity and related diseases. MyPyramid is a how-to tool that can be used to help consumers implement the Dietary Guidelines for Americans 2005. It is presented in a why-to-do-it format to improve nutrition knowledge. MyPyramid expands the overall messages of the previous Food Guide Pyramid—moderation, proportionality, variety and activity—to include personalization of the dietary pattern and emphasize a gradual approach to achieving dietary change. MyPyramid retained the same food groups as the Food Guide Pyramid but in a vertical presentation as opposed to a hierarchical presentation. The only exception is that the “Oils” group replaced the “Other” group to emphasize the importance of essential fatty acids found in vegetable oils. New to MyPyramid is the concept of discretionary calories—extra calories to be consumed after accounting for calories from foods in the core food groups. The discretionary calories are few, typically between 100 and 300 kilocalories, and can be used to choose higher-fat core foods, added fats and sugars, or alcohol. Consumer-friendly measurement units have replaced serving sizes. The MyPyramid Web site3 is interactive; for
JADA, Vol. 137 http://jada.ada.org Copyright ©2006 American Dental Association. All rights reserved.
September 2006
1259
C L I N I C A L P R A C T I C E NUTRITION
example, the “My Pyramid Plan” section allows people to identify their meal patterns on the basis of their age, sex and activity level. The “Inside the Pyramid” section allows users to tour each food group and identify foods within the group, health benefits of each group, serving sizes of individual foods and tips for eating foods within the group. The “My Pyramid Tracker” section allows people to record their food intake and physical activity; the assessment tool, which is part of “My Pyramid Tracker,” provides feedback on diet quality and related nutritional information. Downloadable MyPyramid materials for patient distribution are available in the “For Professionals” section. CONCLUSIONS
Obesity and related diseases directly affect oral diseases, including periodontal disease. If dental practitioners are familiar with the Dietary Guide-
1260
JADA, Vol. 137
lines for Americans 2005 and MyPyramid, they can use these tools to support diet-related oral health recommendations and develop patient education materials for disease prevention. In addition, dental practitioners who help develop community or school policy recommendations (for example, making healthy choices, initiatives on the removal of carbonated beverages in schools) should support policies consistent with Dietary Guidelines for Americans 2005. ■ Nutrition is published in collaboration with the Nutrition Research Scientific Group of the International Association for Dental Research. 1. Food and Nutrition Board, Institute of Medicine, National Academy of Sciences. Dietary reference intakes. Available at: “www.iom.edu/project.asp?id=4574”. Accessed Nov. 28, 2005. 2. U.S. Department of Health and Human Services, U.S. Department of Agriculture. Dietary guidelines for Americans 2005. Available at: “www.healthierus.gov/dietaryguidelines/”. Accessed Nov. 28, 2005. 3. U.S. Department of Agriculture. Steps to a healthier you. Available at: “www.mypyramid.gov/index.html”. Accessed Nov. 28, 2005.
http://jada.ada.org September 2006 Copyright ©2006 American Dental Association. All rights reserved.
NUTRITION
Translating the new dietary guidelines Teresa A. Marshall, PhD, RD/LD
ral and systemic health are intertwined. Dietary choices, through nutrient intakes, can improve or adversely affect both oral and systemic health. The purpose of this article is to introduce dental practitioners to the latest federally sponsored dietary recommendations. The U.S. Department of Agriculture is charged with developing dietary recommendations to ensure adequate nutrient intakes and the prevention of chronic diseases. In cooperation with the Food and Nutrition Board (FNB) of the Institute of Medicine (IOM) and the U.S. Department of Health and Human Services, the Department of Agriculture undertakes this task in three areas: nutrient standards, dietary guidelines and food group plans. Nutrient standards (for example, the Dietary Reference Intakes [DRIs]) define nutrient intakes required to prevent deficiency- and toxicityassociated diseases. Dietary guidelines provide evidence-based targeted dietary messages to encourage adequate nutrient intakes and chronic disease prevention. Food group plans (for example, MyPyramid) present food patterns to achieve the recommended nutrient intakes while limiting chronic disease risk. Over the past 10 years, the Department of Agriculture revised the DRIs1 and released the new Dietary Guidelines for Americans2 and MyPyramid3 in 2005 in response to the revised DRIs.
O
DIETARY REFERENCE INTAKES
The FNB of the IOM, in collaboration with Health Canada, revised the format of the traditional Recommended Dietary Allowances (RDAs) on the publication of the 1258
JADA, Vol. 137
ABSTRACT Background. Diet- and nutrition-related diseases influence oral health. The U.S. government recently revisited the dietary guidelines for health promotion and chronic disease prevention. The purpose of this article is to review the new recommendations. Conclusions. The Dietary Reference Intakes are designed to identify nutrient intakes required to maintain health in people of a given age and sex. The Dietary Guidelines for Americans are designed to promote healthy dietary and activity habits. MyPyramid is designed to identify individual dietary patterns to ensure adequate nutrient intakes within energy needs. Clinical Implications. Familiarization with the new dietary guidelines will enable dental practitioners to develop diet-related oral health recommendations that are consistent with disease prevention. Key Words. Dietary guidelines; food; nutrition. JADA 2006;137(9):1258-60.
DRI series, which began in 1997.1 The FNB established the DRIs using evidence from peer-reviewed observational and experimental studies; support for the DRI values is outlined in nutrient-specific chapters of the series. The DRIs have four components: the RDAs, the Adequate Intakes (AIs), the Tolerable Upper Intake Levels (ULs) and the Estimated Average Requirements (EARs). The RDAs continue to be the average daily amounts of nutrients considered adequate to meet the known nutrient needs of practically all healthy people. The AIs are the average daily amounts of a nutrient that appear sufficient to maintain a specified nutritional criterion and are used as Dr. Marshall is an assistant professor, Department of Preventive and Community Dentistry, N335 DSB, University of Iowa, Iowa City, Iowa 52340, e-mail “[email protected]”. Address reprint requests to Dr. Marshall.
http://jada.ada.org September 2006 Copyright ©2006 American Dental Association. All rights reserved.
C L I N I C A L P R A C T I C E NUTRITION
guides when RDAs cannot be established. The ULs are the maximum daily amounts of a nutrient that appear safe for most healthy people, beyond which there is an increased risk of experiencing adverse health effects. The EARs are the daily amounts of a nutrient that will maintain a specific biochemical or physiological function in one-half the people of a given age and sex. DIETARY GUIDELINES FOR AMERICANS 2005
The Dietary Guidelines for Americans 2005 were designed to promote dietary and activity habits for optimal health and prevention of obesityrelated diseases, including cardiovascular disease, type 2 diabetes and some cancers. The Dietary Guidelines for Americans 2005 are evidence-based; to develop these guidelines, the Department of Agriculture used data on nutrients most likely to be deficient in people’s diets and nutrients whose high or disproportionate intakes contribute to obesity and related diseases.2 The Dietary Guidelines for Americans 2005 outline specific key messages within nine themes1: dselect nutrient-dense foods and beverages to achieve adequate nutrient intakes within energy requirements; dbalance energy intake with activity for weight management; dengage in physical activity to reduce chronic disease risk and to mange weight; dselect a sufficient amount and variety of fruits and vegetables, make one-half of grain selections whole grain and choose a sufficient amount of dairy products to ensure adequate nutrient and fiber intake; drestrict saturated fats, total fats and transfatty acids and select low-fat meat and dairy products to reduce the risk of developing obesity and obesity-related diseases; dselect high-fiber fruits, vegetables and whole grains while limiting added sugars to ensure adequate fiber intake and to reduce caries risk; dlimit sodium intake and consume potassiumrich foods to reduce hypertension; dconsume alcoholic beverages responsibly to prevent alcohol-related illnesses and accidents; dpractice safe food handling to reduce the risk of developing food-borne illnesses. MYPYRAMID
MyPyramid was designed to identify individual dietary patterns based on weight, age and sex to
Figure. The MyPyramid symbol incorporates recommendations from the Dietary Guidelines for Americans 2005, which was developed by the U.S. Department of Agriculture and U.S. Department of Health and Human Services. Orange stands for grains, green for vegetables, red for fruits, yellow for oils, blue for milk and purple for meat and beans.
ensure adequate nutrient intakes within energy allowances (Figure). The DRIs provided nutrient intake goals, and the Dietary Guidelines for Americans 2005 shape MyPyramid using the key messages to moderate intake of food groups and portion sizes to reduce the incidence of obesity and related diseases. MyPyramid is a how-to tool that can be used to help consumers implement the Dietary Guidelines for Americans 2005. It is presented in a why-to-do-it format to improve nutrition knowledge. MyPyramid expands the overall messages of the previous Food Guide Pyramid—moderation, proportionality, variety and activity—to include personalization of the dietary pattern and emphasize a gradual approach to achieving dietary change. MyPyramid retained the same food groups as the Food Guide Pyramid but in a vertical presentation as opposed to a hierarchical presentation. The only exception is that the “Oils” group replaced the “Other” group to emphasize the importance of essential fatty acids found in vegetable oils. New to MyPyramid is the concept of discretionary calories—extra calories to be consumed after accounting for calories from foods in the core food groups. The discretionary calories are few, typically between 100 and 300 kilocalories, and can be used to choose higher-fat core foods, added fats and sugars, or alcohol. Consumer-friendly measurement units have replaced serving sizes. The MyPyramid Web site3 is interactive; for
JADA, Vol. 137 http://jada.ada.org Copyright ©2006 American Dental Association. All rights reserved.
September 2006
1259
C L I N I C A L P R A C T I C E NUTRITION
example, the “My Pyramid Plan” section allows people to identify their meal patterns on the basis of their age, sex and activity level. The “Inside the Pyramid” section allows users to tour each food group and identify foods within the group, health benefits of each group, serving sizes of individual foods and tips for eating foods within the group. The “My Pyramid Tracker” section allows people to record their food intake and physical activity; the assessment tool, which is part of “My Pyramid Tracker,” provides feedback on diet quality and related nutritional information. Downloadable MyPyramid materials for patient distribution are available in the “For Professionals” section. CONCLUSIONS
Obesity and related diseases directly affect oral diseases, including periodontal disease. If dental practitioners are familiar with the Dietary Guide-
1260
JADA, Vol. 137
lines for Americans 2005 and MyPyramid, they can use these tools to support diet-related oral health recommendations and develop patient education materials for disease prevention. In addition, dental practitioners who help develop community or school policy recommendations (for example, making healthy choices, initiatives on the removal of carbonated beverages in schools) should support policies consistent with Dietary Guidelines for Americans 2005. ■ Nutrition is published in collaboration with the Nutrition Research Scientific Group of the International Association for Dental Research. 1. Food and Nutrition Board, Institute of Medicine, National Academy of Sciences. Dietary reference intakes. Available at: “www.iom.edu/project.asp?id=4574”. Accessed Nov. 28, 2005. 2. U.S. Department of Health and Human Services, U.S. Department of Agriculture. Dietary guidelines for Americans 2005. Available at: “www.healthierus.gov/dietaryguidelines/”. Accessed Nov. 28, 2005. 3. U.S. Department of Agriculture. Steps to a healthier you. Available at: “www.mypyramid.gov/index.html”. Accessed Nov. 28, 2005.
http://jada.ada.org September 2006 Copyright ©2006 American Dental Association. All rights reserved.