LearningObjectives

2

1 2 3Detail the process of

how the Dietary Guidelines for

Americans (DGAs) are created and updated.

Analyze and summarize the

changes and updates published in the 2020-2025 DGAs.

Formulate and deploy healthful eating

messages to clients based on the DGAs.

ANoteAboutReferences

All data and information within this presentation comes from the 2020-2025 Dietary Guidelines for Americans

Citation: U.S. Department of Agriculture and U.S. Department ofHealth and Human Services. Dietary Guidelines for Americans, 2020-2025.

9th Edition. December 2020. Available at DietaryGuidelines.gov.

Please refer to the previously sent reference list for additional recommended reading.

3

Part1:TheProcessofDevelopingtheDGAs

TheReality• 6 in 10 Americans live with at least one

chronic disease, like heart disease and stroke, cancer, or diabetes.

• 4 in 10 Americans have 2 or more chronic conditions.

• More than 70% of Americans are overweight or obese, and the prevalence of severe obesity has increased over the past 2 decades.

• The increasing prevalence of overweight and obesity at young ages is of particular concern:• Effects the current health of children • Risk of persistent overweight or obesity

into adulthood

5

TheReality• Food insecurity and lack of access to affordable

healthy food is a persistent problem: • In 2018, >37 million people, including 6 million

children, lived in households that were uncertain of having or unable to acquire enough food to meet their needs. • Certain populations are disproportionately

affected:• Low-income• Black, non-Hispanic and Hispanic households• Households with young children• Households headed by a single woman or man

6

PurposeoftheDietaryGuidelines• Since 1980, the DGAs have provided science-based advice on what to eat and drink in order to:

• Promote health• Reduce risk of chronic disease• Meet nutrient needs

• The DGAs are representative of the U.S. population that is:• Healthy• At risk for chronic conditions (i.e., CVD, T2D, obesity)• Living with one or more of these diet-related, chronic illnesses

• The DGAs build upon previous editions and evolve as scientific knowledge grows

7

AdherencetotheDGAs

2020-2025 DGAs, page 4.

9

AdherencetotheDGAsAcrossLifeStages

2020-2025 DGAs, page 6.

PurposeoftheDGAs• DGAs are designed for policymakers and

nutrition and health professionals to help all individuals and their families consume a healthy, nutritionally-adequate diet.

• Health professionals, communities, businesses and industries, organizations, governments, and other segments of society have a role to play to support individuals and families in:• Making choices that align with the

DGAs• Ensuring access to healthy and

affordable food

DGAsandtheLaw

H.R.1608 - National Nutrition Monitoring and Related Research Act of 1990. 101st Congress (1989-1990). https://www.congress.gov/bill/101st-congress/house-bill/1608

• Publication of the DGAs is required under the 1990 National Nutrition Monitoring and Related Research Act, which states the DGAs must be updated every 5 years.• The statute (Public Law 101-445, 7 US Code

5341 et seq) requires that the DGAs be based on the preponderance of current scientific and medical knowledge.

11

HowtheDGAsareDeveloped

12

1980The 1st DGAs released

1990Congress passed bill requiring DGAs be

updated every 5 years

20Experts serve on the 2020 Dietary

Guidelines Advisory Committee (DGAC)

• DGAs published jointly by the US Dept of Health & Human Services (HHS) and the USDA

• Intended for Americans of all ages (now including from 0-24 months)

• The Dietary Guidelines Advisory Committee (DGAC): • Nationally recognized health and nutrition

experts• Review, updated, and published every 5

years

• Scientific report of the 2015 DGAC:• Written as the basis for developing the DGA

policy• It is not a rough draft

HowtheDGAsareDeveloped

• Written comments open until May 8, 2015• HHS and USDA hosted a public oral

comments meeting from July 10-11, 2019 and again on January 23-24, 2020• Finally, the long-awaited release of the

2020-2025 DGAs

13

End June 2020DGAC report submitted to Federal Government. It

contains rationales & recommendations to consider as the official DGA are developed

Comment period(oral and written)

Dec 29, 2020HHS and USDA released 2020-2025

DGAs

DietaryGuidelineMilestones

14

1977, 1979 1980 1985 1990 1995 2000 2005 2010 2015 2020

1979: Surgeon General’s Report on Health Promotion

1985 DGAs (USDA/HHS)

1995 DGAs(USDA/HHS)

2005 DGAs(USDA/HHS)

2015 DGAs(USDA/HHS)

1977: McGovern Report-

Dietary Goals (6)

1980 DGAs (USDA/HHS)

2020 DGAs (USDA/HHS)

1990 DGAs (USDA/HHS)

2000 DGAs (USDA/HHS)

2010 DGAs (USDA/HHS)

HistoryofDietaryMessages

Oppenheimer GM, Benrubi ID. McGovern's Senate Select Committee on Nutrition and Human Needs versus the meat industry on the diet-heart question (1976-1977). Am J Public Health. 2014;104(1):59-69. doi:10.2105/AJPH.2013.301464

Goals:

• Energy balance to avoid overweight

• Increase consumption of complex CHO and “naturally-occurring sugars”

• Reduce consumption of refined and processed sugars, total fat, saturated fat, cholesterol, and sodium

• Increase consumption of fruits, vegetables, and whole grains

• Decrease consumption of:• Refined and processed sugars• Foods high in total fat and animal fat • Eggs, butterfat and high-cholesterol foods• Salt and foods high in salt• Choose low-fat and non-fat dairy

15

1977 McGovern

Report

Year Weight Sugar Fat

1980 Maintain ideal weight Avoid too much Avoid too much

1985 Maintain desirable weight Avoid too much Avoid too much

1990 Maintain healthy weight Use only in moderation Chose diet low in fat

1995 Improve your weight Choose diet moderate in sugars Choose diet low in fat

2000 Aim for a healthy weight Choose foods to moderate sugar intake

Choose diet low in fat

2005 Manage body weight No guidance Choose fats wisely

2010 Balanced calories to manage weight Reduce added sugars Consume <10% cals from sat fat

2015 Achieve and/or maintain a healthy body weight

Limit calories from added sugar Limit calories from saturated fats

2020 Achieve a healthy body weight Limit added sugars Limit food and beverages higher in saturated fat

RecommendationsOver40Years

WhyAretheDGAsImportant?• They are the foundation to federal food, nutrition,

and health policies and programs

• All federal dietary guidance for the public is required to be consistent with the DGs• National School Lunch Program• Older American Acts Nutrition Program• SNAP• WIC• Healthy People objectives based on DGAs

• Provides a critical structure for State and local public health promotion and disease prevention initiatives

• They influence the dietary guidelines other countries will have

17

PromoteHealthandReduceChronicDisease:EatHealthyAcrosstheLifespan

Age Benefits of Healthy Eating

Birth-23 months • Lower risk of overweight and obesity• Lower risk of type 1 diabetes• Adequate iron status and lower risk of iron deficiency• Lower risk of peanut allergy• Lower risk of asthma

Pregnant & lactating women

• Favorable cognitive development in the child• Favorable folate status in women during pregnancy and lactation

Children & adolescents

• Lower adiposity• Lower total and LDL cholesterol

Adults, including older adults

• Lower risk of all-cause mortality• Lower risk of CVD, type 2 diabetes, and cancers of the breast, colon and rectum• Lower risk of CVD mortality• Lower total and LDL cholesterol• Lower blood pressure• Lower risk of obesity• Lower BMI, waist circumference, and body fat• Favorable bone health, including lower risk of hip fracture

Part2:2020-2025DietaryGuidelinesforAmericans(DGAs)

2020-2025DGAs:MakeEveryBiteCountHere’s how to make every bite count with the DGAs:

1. Follow a healthy dietary pattern at every life stage.

2. Customize and enjoy nutrient-dense food and beverages choices to reflect personal preferences, cultural traditions, and budgetary considerations.

3. Focus on meeting food group needs with nutrient-dense foods and beverages and stay within calorie limits.

4. Limit food and beverages higher in added sugars, saturated fat, and sodium, and limit alcoholic beverages.

20

Roadmaptothe2020-2025DGAs• Chapter 1: Nutrition and Health Across the Lifespan: The Guidelines and Key

Recommendations• This chapter is the basis for the subsequent chapters

• Chapter 2: Infants and Toddlers (0-24 months)• Chapter 3: Children and Adolescents (2-18 years)

• Chapter 4: Adults (19-59 years)• Chapter 5: Women Who Are Pregnant or Lactating

• Select nutrition issues important to this stage of life• Chapter 6: Older Adults (60+ years)

• Appendices• Table with summarizing nutritional goals for age-sex groups• Estimated calorie needs for all ages and at 3 physical activity levels• USDA Dietary Pattern

21

Guideline1:FollowaHealthyDietaryPatternatEveryLifeStage

• 0-6 months: Exclusively breastfeed• Continue feeding human milk through at least 1 year of age, and longer if desired• If human milk is unavailable, use iron-fortified formula• Provide infants with supplemental vitamin D beginning soon after birth

• ~6 months: Introduce infants to nutrient-dense complementary foods• Introduce infants to potentially allergenic foods along with other complementary foods• Encourage a variety of foods from all food groups• Include foods rich in iron and zinc, especially for breastfed infants

• From 12 months through older adulthood• Follow a healthy dietary pattern across the lifespan to meet nutrient needs, help achieve a healthy body

weight, and reduce the risk of chronic disease

WhatisaDietaryPattern?• Represents the totality of what individuals

habitually eat and drink; all parts of the pattern act synergistically to affect health.

• Dietary patterns may better predict overall health status compared to individual foods or nutrients.

• If a healthy dietary pattern can be established early in life, and sustained, the impact on health could be significant.

• Framework for a healthy dietary pattern can be seen:• Healthy U.S.-style dietary pattern• Healthy Mediterranean-style dietary

pattern• Healthy vegetarian dietary pattern

23

2020-2025 DGAs, page 20

Nutrient-Densevs.

Non-Nutrient-DenseCalories

2020-2025 DGAs, page 21

Guideline2:Customizeandenjoynutrient-densefoodandbeveragechoicestoreflectpersonalpreferences,culturaltraditions,andbudgetaryconsiderations• A healthy dietary pattern can benefit all individuals

regardless of age, race, or ethnicity, or health status.

• The DGAs provide a framework intended to be customized to individual needs and preferences, and be inclusive of the diverse cultures in the U.S.

• Consider budgetary constraints and using the following strategies to help clients:• Advanced planning• Consider seasonal and regional food availability• Incorporating a variety of fresh, frozen, dried,

and canned options26

CustomizingtheDietaryFrameworkVegetable Group Foods IncludedDark-Green Vegetables • All fresh, frozen, and canned, cooked, or raw

• Examples: broccoli, collards, kale, turnip greens, taro leaves, watercress

Red and Orange Vegetables • All fresh, frozen, and canned or juice• Examples: 100% tomato juice, sweet potatoes, calabaza

Beans, Peas, Lentils • All cooked from dry or canned beans, peas, chickpeas, and lentils• Examples: black beans, black-eyed peas, mung beans

Starchy Vegetables • All fresh, frozen, and canned starchy vegetables• Examples: breadfruit, burdock root, cassava, plantains, white potatoes

Other Vegetables • All other fresh, frozen, and canned vegetables, cooked or raw• Examples: beets, bitter melon, Brussels sprouts, snow peas

27

CustomizingtheDietaryFrameworkFood Groups Foods IncludedFruits • Fresh, frozen, canned, and dried fruits, and 100% fruit juices

• Examples: blackberries, huckleberries, dates, figs, pineapple

Grains• Whole Grains

• Refined Grains

• All whole-grain products and whole grains used as ingredients• Examples: brown rice, whole-grain cornmeal, whole wheat bread

• All refined-grain products and refined grains used as ingredients• All refined products should be enriched• Examples: white bread, cream of wheat, masa, pasta, white rice

Dairy and Fortified Soy Alternatives

• All fluid, dry, or evaporated milk, including lactose-free and lactose-reduced products, and fortified soy beverages (soy milk), buttermilk, yogurt, kefir, frozen yogurt, dairy desserts, and cheeses

• Most choices should be fat-free or low-fat• Cream, sour cream, and cream cheese are not included due to low Ca+ content

28

CustomizingtheDietaryFrameworkProtein Foods Foods IncludedMeats, Poultry, Eggs • Meats include beef, goat, lamb, pork, and game (bison, elk, deer)

• Poultry includes chicken, Cornish hen, duck, game birds (ostrich, pheasant, quail), goose, turkey

• Organ meats include sweetbreads, liver, gizzards, giblets• Eggs include chicken eggs or other birds’ eggs• Meat and poultry should be lean or low-fat

Seafood • Seafood lower in methylmercury include anchovy, black sea bass, catfish, clams, cod, crab, crawfish, flounder, haddock, hake, herring, lobster, mullet, oyster, perch, pollock, salmon, sardine, scallop, shrimp, sole, squid, tilapia, freshwater trout, light tuna, whiting

Nuts, Seeds, Soy Products • Nuts and seeds include all nuts (tree nuts and peanuts), nut butters, seeds (i.e., chia, flax, pumpkin), and seed butters (i.e., sesame, tahini)

• Soy includes tofu, tempeh, and products made with soy flour, soy protein isolate, soy concentrate

• Nuts should be unsalted

Guideline3:Focusonmeetingfoodgroupneedswithnutrient-densefoodsandbeverages,andstaywithincalorielimits

• Nutritional needs should be met primarily with nutrient-dense foods• Provides vitamins, minerals, and other health-promoting

components• Have no or little added sugars, saturated fat, and sodium

• Core elements that make up a healthy dietary pattern include:• Vegetables of all types: dark green; red and orange; beans,

peas, and lentils; starchy and other vegetables• Fruits, especially whole fruit• Grains, at least half of which are whole grain• Dairy, including fat-free and low-fat milk, yogurt, and cheese,

and/or lactose-free versions and fortified soy beverages and yogurt as alternatives

• Protein foods, including lean meats, poultry, eggs,; seafood; beans, peas, and lentils; and nuts, seeds, and soy products

• Oils, including vegetable oils and oils in food (i.e., seafood and nuts)

30

2020-2025 DGAs, page 30

AboutBeans,Peas,andLentils

• “Beans, peas, and lentils” is the new name for the vegetable subgroup formally called “legumes (beans and peas).”

• Including beans, peas, and lentils, which are also known as “pulses,” including the dried edible seeds of legumes.

• Foods in this vegetable group have not changed, but the name more accurately reflects the category of foods included

• Note that edamame is counted in this subgroup even though it is eaten fresh, not dried

• This subgroup can be counted as either a vegetable or protein –not both!

• Green peas and green (string) beans are not counted in this subgroup because the nutrient contents are more similar tovegetables in other subgroups. • Green peas = starchy vegetable subgroup• Green beans = other vegetable subgroup

DairyandFortifiedSoyAlternatives

2020-2025 DGAs, page 33

• Dairy alternatives addressed:

• Other products sold as “milks” made from plants (i.e., almond, hemp, coconut, rice, oat) may contain Ca+ and be consumed as a source of calcium but aren’t included as part of the dairy group because their overall nutritional content is not similar to dairy milk and fortified soy beverages.

33

“For individuals who choose dairy alternatives, fortified soy beverage (commonly known as “soy milk”) and soy yogurt – which are fortified with Ca+, vit A, and vit D – are included as part of the dairy group because they are similar to milk and yogurt based on

nutrient composition and in their use in meals.”

ProteinFoods• Most intake of meats and poultry should be from fresh, frozen, or

canned, and in lean form (i.e., chicken breast or ground turkey) vs. processed meats (i.e., hot dogs, sausages, ham, luncheon meats).

• Healthy vegetarian meal pattern: Lacto-ovo vegetarian• Meats, poultry, and seafood are not included

• Seafood: fish and shellfish• Provides beneficial fatty acids (i.e., EPA, DHA)• Methylmercury is found in seafood in varying levels:

• FDA and EPA provide joint advice regarding seafood consumption to limit methylmercury exposure

• Specifically, women who might become pregnant or are lactating and young children to 8-12 oz./week.

• Lower methylmercury and higher EPA/DHA seafood includes:• Salmon, anchovies, sardines, pacific oysters, trout,

tilapia, shrimp, catfish, crab, flounder

34

ProteinFoods• Almost 90% do not meet recommendations for

seafood

• >50% do not meet recommendations for nuts, seeds, and soy products

• DGAs recommend a shift within the protein foods group to add variety to subgroup intakes:• Select from seafood subgroup• Select from beans, peas, and lentils

subgroup• Replace processed high fat meats with

seafood or beans, peas, lentils could help lower intake of saturated fat and sodium

Oils• Oils are part of a healthy dietary pattern because they

provide essential fatty acids.

• Commonly consumed oils: canola, corn, olive, peanut, soybean, sunflower

• Oils are naturally found in nuts, seeds, seafood, olives, avocados.

• The fat in tropical plants, coconut oil, palm oil, and palm kernel oil, are not included in the oil category because they contain a high percentage of saturated fat.

• Recommendations to shift intake to oils:• Cook with vegetable oils vs fats high in saturated fat

(i.e., butter, shortening, lard, coconut oil).• Be aware desserts that are prepared with oils are still

high in added sugars and are not considered a nutrient-dense food.

36

Beverages

2020-2025 DGAs, page 36

• When choosing beverages in a healthy dietary pattern, the calories and nutrients they provide are important considerations.

• Calorie-free beverages are the best choice = water

• Beverages that contribute beneficial nutrients, like fat-free or low-fat milk, and 100% juice, are best

• Coffee, tea, flavored waters are options but should contain little, if any, sweeteners or cream

37

Caffeine• Caffeine is a stimulant.• Most intake of caffeine in the U.S. comes

from coffee, tea, and soda.• Caffeine is generally recognized as safe

(GRAS) in cola-type beverages by the FDA.• Healthy adults: 400 mg/day of caffeine

per the FDA.

38

UnderconsumptionofNutrients:DietaryComponentsofPublicHealthConcern• Inadequate intake of nutrient-dense foods and beverages across food groups has resulted in

underconsumption of some nutrients and dietary components.• General U.S. population nutrients of concern are:

• Additional components under consumed during specific life stages will be highlighted.

39

○ Calcium ○ Potassium

○ Vitamin D ○ Dietary Fiber

Guideline4:Limitfoodsandbeverageshigherinaddedsugars,saturatedfat,andsodium,andlimitalcoholicbeverages• Every life stage, meeting food group recommendations, even with nutrient-dense

choices, requires most of a person’s daily calorie and sodium limits

Limited Nutrient RecommendationsAdded sugars • ≥2 years: <10% Kcal/day

• <2 years: Avoid food and beverages with added sugars

Saturated fat • ≥2 years: <10% Kcal/day

Sodium • ≥14 years: 2,300 mg/day• <14 years: Even less

Alcoholic Beverages • If you choose to drink, limit intake to 2 drinks/day or less for men and 1 drink/day or less for women

• Drinking less is better for health than drinking more• Women who are pregnant should not drink alcohol

PercentageofCalories:Nutrient-DenseChoicesvsOtherUses

2020-2025 DGAs, page 3741

• ~85% Kcals/day needed to meet food group recommendations healthfully.

• ~15% Kcals/day are calories available for other uses:• Added sugars• Saturated fat• Alcoholic beverages

• For most Americans, this ~250-350 kcals/day.

SlightChangestoIndividualPartsofMealCanMakeaBigDifference

2020-2025 DGA, page 3842

AddedSugars• Added sugars can help with:

• Preservation• Contribute to functional attributes (i.e., viscosity,

texture, body, color, browning capability, help improve palatability)

• The limit for added sugars is based on the following assumptions:• Most Kcal levels have <15% Kcals remaining after

meeting food group recommendations through nutrient-dense calories.

• ~50% of remaining Kcals are consumed as saturated fat and 50% consumed as added sugars.

• Total saturated fat intakes meet the recommendation for <10% of total Kcal intake.

• No alcoholic beverages are consumed.• Overcall Kcal intake does not exceed intake needed

to maintain or achieve a healthy weight.43

AddedSugars• An individual who needs 2,000 Kcal/day

has <7% Kcals available for added sugars.

• For 2,800 Kcal/day or less have <8% Kcal available for added sugars.

• For >3,000 Kcal/day may have 9-10% Kcal available for added sugars.

• The 10% added sugar limit allows for flexibility in food choices over time but also requires careful planning.

44

TopSourcesofAddedSugars:Ages1+Years

2020-2025 DGAs, page 43

Added Sugar Source Average Intake(% of calories/day)

Sugar-Sweetened Beverages--Soft Drinks --Fruit Drinks

--Sports & Energy Drinks--Other Sources

24%--16%--5%--2%--1%

Desserts & Sweet Snacks 19%

Other Sources 19%

Coffee & Tea 11%

Candy & Sugars 9%

Breakfast Cereals & Bars 7%

Sandwiches 7%

Higher Fat Milk & Yogurt 4%

45

Added SugarsAverage Intake:

266 Kcal/day

LowandNo-CalorieSweeteners• Replacing added sugars with

low- and no-calorie sweeteners may reduce Kcals short-term and aid in weight management.

• Effectiveness as a long-term weight management strategy is still in question.

SaturatedFat

2020-2025 DGAS, page 45

• Average intake of saturated fat = 11% of Kcals

• 23% of individuals consume <10% Kcals from saturated fat

Saturated FatSource

Average Intake (% Kcal/day)

Sandwiches 19%

Desserts & Sweet Snacks 11%

Rice, Pasta & Others Grain-Based Mixed Dishes

7%

Higher Fat Milk & Yogurt 6%

Pizza 5%

Cheese 4%

Chips, Crackers & Savory Snacks

4%

Vegetables, Excluding Starchy

4%

Meat, Poultry & Seafood Mixed Dishes

4%

Poultry, Excluding Deli & Mixed Dishes

4%

Saturated FatAverage Intake:

239 Kcal/day

Sodium(Na+)• Uses for Na+ include:

• Curing meat• Baking• Thickening agent• Flavor enhancer• Preservative• To retain moisture

• Average intake of Na+ is high across U.S. populations compared to the CDRRs

48

Age RecommendedNa+ Intake

1-3 years 1,200 mg/day

4-8 years 1,500 mg/day

9-13 years 1,800 mg/day

All other age groups

2,300 mg/day

*Chronic Disease Risk Reduction (CDRR) levels defined by the National Academies

Sodium(Na+)

2020-2025 DGAS, page 4749

Na+ Sources Average Intake (% Kcal/day)

Sandwiches 21%

Rice, Pasta & Other Grain-Based Mixed Dishes

8%

Vegetables, Excluding Starchy 7%

Meat, Poultry & Seafood Mixed Dishes

5%

Poultry, Excluding Deli & Mixed Dishes

5%

Pizza 5%

Soups 4%

Starchy Vegetables 4%

Chips, Crackers & Savory Snacks

4%

SodiumAverage Intake:3,393 mg/day

AlcoholicBeverages• Defining drink equivalents:

• 12 fluid ounces of regular beer (5% alcohol) = ~150 Kcals

• 5 fluid ounces of wine (12% alcohol) = ~120 Kcals

• 1.5 fluid ounces of 80 proof distilled spirits (40% alcohol) = ~100 Kcals

• The daily maximum is not intended as an average over several days, but rather the amount consumed on any single day.

• Binge drinking is defined as 5+ drinks for adult male, 4+ drinks for adult female in 2 hours

50

Part3:InfantsandToddlerRecommendations

51

KeyRecommendations• For about the first 6 months of life, feed infants

exclusively human milk. • Continue to feed infants human milk through the

1st year, and longer if desired. • Iron-fortified infant formula should be fed when

human milk is unavailable.• Provide infants with supplemental vitamin D

beginning soon after birth.

KeyRecommendations• At about 6 months, introduce infants to nutrient-dense

complimentary foods.• Introduce infants to potentially allergenic foods

along with other complementary foods.• Encourage infants and toddlers to consume a

variety of foods from all food groups• Foods high in iron and zinc, especially for

infants fed human milk.• Avoid foods and beverages with added sugars.• Limit foods and beverages higher in sodium.• As infants wean from human milk or infant

formula, transition to a healthy dietary pattern.

Infants: HumanMilkfortheFirst6Months,IfPossible• Human milk can support infant’s nutrient needs:

• Exception: vitamin D and possibly iron• Supplement 400IU vitamin D/day soon after birth

• Infant formulas:• Should be labeled “with iron”• Designed to meet nutrition needs of infants• Not needed beyond 12 months• Homemade infant formulas and those

improperly/illegally imported to the U.S. should not be used

• Toddler’s milks or formulas should not be fed to infants

54

Infants: HumanMilkfortheFirst6Months,IfPossible• Donor human milk:

• Obtain pasteurized donor human milk from a source (i.e., accredited human milk bank) that has screened donors and taken appropriate safety precautions.

• Donor milk obtained from the Internet or individuals has unlikely been screened for infectious diseases or collected/stored to reduce possible safety risks to the baby.

55

~6Months:IntroduceInfantstoNutrient-DenseComplementaryFoods

• Introduce complementary foods ~6 months:• Never before 4 months• Not after 6 months• Look for developmental signs of readiness

to eat solids

• Give infants age- and developmentally-appropriate foods to help prevent choking.

• Introduce potentially allergenic foods along with other complementary foods.

• For infants who are exclusively breastfed, complementary foods should be rich in iron and zinc.

56

IntroductionofSolids

Developmental Readiness for Beginning To Eat Solids

• Being able to control head and neck

• Sitting up alone without support

• Bringing objects to mouth

• Trying to grasp small objects, such as toys or food

• Swallowing food rather than pushing it back out onto the chin

57

Steps To Decrease Choking Risks

• Offering foods in the appropriate size, consistency, and shape that will allow an infant/young child to eat and swallow easily

• Making sure the infant/young child is sitting up in a high chair or other safe, supervised place

• Ensuring an adult is supervising feeding during mealtimes

• Not putting infant cereal or other solidfoods in infant’s bottle. This could increase risk of choking and will not make the infant sleep longer

Choking risk foods include:

v Hot dogsv Candyv Nuts and Seedsv Raw Carrotsv Grapesv Popcornv Chunks of peanut

butter

SupplementalVitaminB12• Human milk has sufficient Vitamin B12 to

meet infant needs, unless:• Mother’s B12 status is inadequate• Mother is strictly vegan• Other reasons

• Both mother and/or infant fed human milk may need vitamin B12 supplements

• Consult with healthcare provider to determine if a supplement is necessary

58

IntroductionofAllergenicFoodswithOtherComplementaryFoods

• Potentially allergenic foods should be introduced when other complementary foods are introduced in an infant’s diet.

• Introducing peanut-containing foods in the first year reduces the risk that infant will develop a food allergy to peanuts.

• Cow’s milk, as a beverage, should be introduced at 12 months or later.• There is no evidence that delaying introduction to allergenic foods helps prevent food allergy.

For infants at high risk of peanut allergy:• If infant has severe eczema, egg allergy, or both, age-appropriate peanut-containing foods

should be introduced as early as 4-6 months to help reduce the risk of developing a peanut allergy.

• Check with infant’s healthcare provider before feeding the infant peanut-containing foods; a blood test or skin prick test may be recommended first

59

EncourageInfants&ToddlersToConsumeaVarietyofComplementaryFoods&Beverages

• Nutrients of public health concern for infants:• Iron: 6-11 months who are exclusively breast fed

and consume inadequate iron from complementary foods

• Zinc and protein: Older infants who are fed primarily human milk

• Vitamin D, choline, and potassium: Under-consumed by all older infants

• Nutrients of public health concern for toddlers:• Vitamin D, calcium, dietary fiber, potassium• Overconsumption of added sugars and sodium

60

Iron-Rich Food Sources

üMeats

üSeafood

ü Iron-Fortified Infant Cereals

Zinc-Rich Food Sources

üMeat

üBeans

üZinc-Fortified Infant Cereals

EncourageAVarietyofFoodsFromAllFoodGroups~6Months• It may take 8-10 exposures for an infant to accept a new type of food

• Repeated offering of foods such as fruits & vegetables increases likelihood for an infant acceptance.

• Age 6 months-23 months: A nutrient-dense diverse diet recommended

Food Group Foods NutrientsProtein Foods • Meats, poultry, eggs, seafood, nuts, seeds, and soy

products• Seafood, nuts, seeds, and oils

• Iron, zinc, protein, choline, PUFA.• PUFA (omega-3 FA & omega-6 FA), some fish

vitamin D

Vegetables & Fruits • Fresh, frozen, canned• Don’t forget vegetable subgroup beans, peas, lentils

• Potassium, vitamin A, vitamin C• Protein, dietary fiber

Dairy • Yogurt and cheese, soy-based yogurt• Milk, yogurt, cheese, fortified soy beverage, soy

yogurt

• Before 12 months• After 12 months, calcium and vitamin D*

(fortified)

Grains • Iron-fortified infant cereal (iron, oat, barley, multigrain, rice)

• Iron• Offer whole grains more often than refined grains

to increase fiber and potassium

DietaryComponenttoLimit(0-23months)• NO Added sugars

• Can lead to preference for overly sweet foods.

• Avoid foods higher in sodium• Taste preference for salty foods may be

established early in life.• Avoid honey and unpasteurized foods and

beverages• No raw or cooked honey (Clostridium

Botulinum).• No unpasteurized foods or beverages:

• Unpasteurized juices, milk, yogurt, cheese, etc., due to potentially pathogenic bacteria

62

EstablishaHealthyBeveragePattern• Water:

• Supplemental water not typically needed up to 6 months.

• Small amount (4-8 fl. oz./day) plain, fluoridated drinking water can be given to infants with the introduction of complementary foods.

• Plain fluoridated drinking water can slowly be increased >1 year to meet hydration and fluoride needs.

• Cow’s Milk and Fortified Soy Beverage:• Do not consume <12 months.• Offered beginning ~12 months.• Flavored milks for children 12-23 months should be

avoided due to added sugars.

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EstablishaHealthyBeveragePattern• 100% Fruit Juice:

• <12 months: Avoid 100% fruit and vegetable juices• >12 months: Fruit juice not necessary. Fruit should come from whole fruit.

• If 100% fruit juice is provided, up to 4 fl oz/day• Avoid juices with added sugar

• Toddler Milk and Toddler Drinks:• No clear need• Tend to be drinks supplemented with nutrients, and typically

contain added sugars

• Sugar-Sweetened Beverages• Avoid Regular soda, juice drinks, sports drinks, flavored water

with sugar <2 years

• Caffeinated Beverages• ? Negative health effects of caffeine for young children• No safe limits of caffeine established for this age group• Beverages with caffeine should be avoided <2 years

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2020-2025 DGAs, page 64

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Part4:ChildrenandAdolescents

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OverweightandObeseChildren

2020-2025 DGAs, page 75

• In the U.S., 41% of children and adolescents are overweight or obese.• Prevalence is higher among Hispanic and

non-Hispanic black population.

• Puts youth at immediate health risks for high blood pressure, high cholesterol, and impaired glucose tolerance.

• Puts youth at increased risk for CVD and type 2 diabetes.

• Psychological (anxiety/depression) and social concerns (bullying, stigma) more likely.

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**Dietary patterns for 2-8 years, 9-13 years, and 14-18 years provided

SpecialConsiderations• Sugar-Sweetened Beverages:

• Not necessary in children’s or adolescent's diet.• Intake of added sugars increases throughout

childhood and adolescence with sugar-sweetened beverage being top contributor.

• 100% Fruit Juice:• Between 4-10 fl. oz./day, depending on Kcal level.

• Adolescent Nutrition• Low intake of grains, dairy and alternatives, fruits,

and vegetable food groups à low intakes of phosphorus, magnesium, and choline.

• Adolescent females: under-consumption of protein, iron, folate, vitamin B6, and B12.

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Part5:PregnantorLactatingWomen

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KcalandWeightGainRecommendations

2020-2025 DGAs, page 112-113

SpecialConsiderations• Meeting nutrient needs:

• Most healthcare providers recommend women who are pregnant or planning on becoming pregnant take a daily prenatal vitamin and mineral supplement.

• Lactating women’s use of prenatal vitamin/mineral may exceed folic acid and iron requirements.• Do not exceed Tolerable Upper Intake Level (UL) of

1,000 microgram folic acid/day and 45 mg iron/day

• Folate/Folic Acid:• Adequate folic acid is important prior to conception and

during first trimester.• Recommendation to women planning for or capable of

pregnancy: 400-800 mcg folic acid/day.

• Iron:• Iron needs increase during pregnancy.• Lactating women: iron needs fall and return to pre-

pregnancy levels once menstruation resumes.71

SpecialConsiderations• Iodine:

• Pregnancy: needs increase substantially.• Important for neurocognitive development of fetus.• Generally iron intake adequate, however if not regularly

consuming dairy products, eggs, seafood, or use iodized salt– may not consume enough iodine.

• Pregnant and lactating women should not start to use table salt if they do not do so already.

• If using table salt, encourage iodized salt.• May need a supplement to achieve adequate intake.

• Choline:• Needs increase during pregnancy and lactation.• Adequate intake needed to replenish maternal stores and support growth and development of child’s brain

and spinal cord.• Meeting needs through food intake is preferred but can speak to healthcare provider if supplement needed.• Most prenatal vitamins do not contain adequate choline to meet needs.

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SpecialConsiderations• Caffeine:

• Passes from mother to infant in small amounts through breast milk.• Usually does not affect infant when mother

consumes <300 mg/day (2-3 cups).

• Food Safety:• At high risk for foodborne illness.• Seafood, meats, poultry, eggs should be cooked to

minimum internal cooking temperatures.• Do not consume unpasteurized juice or milk, raw

sprouts, or some soft cheeses made from unpasteurized milk.

• Deli and luncheon meats and hot dogs should be reheated to 165°F to kill Listeria.

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Part6:OlderAdults

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SpecialConsiderations• Protein:

• Average intakes lower for 71+ years.• ~50% women and 30% men fall short.• Seafood, dairy and fortified soy alternatives, and beans, peas, and lentils are all

under-consumed.• Choose a wider variety of protein sources!

• Vitamin B12:• Ability to absorb vitamin B12 can decrease with age.• Use of certain medications can decrease absorption.• Some individuals may require vitamin B12 supplements.

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SpecialConsiderations• Beverages:

• Lack of fluids can lead to dehydration.• Sensation of thirst declines with age.• Concerns about bladder control issues may hinder

intake.• Water contained in foods (i.e., fruits, vegetables, soups)

contributes to hydration status.

• Dietary Supplements:• All sources of a nutrient or food component should be

considered when assessing an individual’s dietary pattern.• Including added sugars in supplemental drinks.

• Beverage supplements should not replace regular food intake unless instructed by a health professional.

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Part7:PuttingItAllTogether

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UsingMyPlate

ToSupportHealthyDietary

Patterns

Conclusion

2020-2025 DGAs, page 130.

• The DGAs are developed and written for a professional audience.

• Its translation into actionable consumer messages and resources is crucial to help individuals, families, and communities to achieve healthy dietary patterns.

• MyPlate is one example of consumer translation.• Can be used in various settings• Adaptable to meeting personal preferences, cultural foodways, traditions, and budgetary

needs

• Action is needed on many fronts to ensure that the healthy dietary choices available at home, school, work, and play are affordable and accessible to all.

• Everyone has a role to play in helping all Americans shift to a healthy dietary pattern and achieve better health!

• The bottom line: “For lifelong good health, make every bite count with the Dietary Guidelines for Americans.”

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Questions?

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www.tobyamidornutrition.com

Toby Amidor Nutrition

@tobyamidor

toby@namsko.com

TobyAmidor,MS,RD,CDN,FAND

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CREDIT CLAIMING INSTRUCTIONS: 1. Login to www.CE.TodaysDietitian.com.

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