Report of the Dietary Guidelines Advisory Committee - Center for

453 Pages·2011·4.61 MB·English

by  Ruth Coy

Prepared for the Report of the Dietary
Committee by the
Agricultural
Research Guidelines Advisory
Service
United States Committee on the Dietary
Department of
Agriculture
Guidelines for Americans,
United States
Department of
Health and 2010
Human Services
May 2010
To the Secretary of Agriculture and the
Secretary of Health and Human Services
Dietary Guidelines Advisory Committee. 2010. Report of the Dietary Guidelines Advisory Committee on
the Dietary Guidelines for Americans, 2010, to the Secretary of Agriculture and the Secretary of Health
and Human Services. U.S. Department of Agriculture, Agricultural Research Service, Washington, DC.

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May 2010
Contents

Letter to the Secretaries ................................................................................................................................ ii

Dietary Guidelines Advisory Committee Membership ................................................................................ iv

Part A: Executive Summary .......................................................................................................................... 1

Part B: Setting the Stage and Integrating the Evidence ................................................................................ 6
Section 1: Introduction ............................................................................................................................ 6
Section 2: The Total Diet: Combining Nutrients, Consuming Food...................................................... 11
Section 3: Translating and Integrating the Evidence: A Call to Action ................................................. 51

Part C: Methodology ................................................................................................................................... 57

Part D: The Science Base ............................................................................................................................ 67
Section 1: Energy Balance and Weight Management ............................................................................ 67
Section 2: Nutrient Adequacy .............................................................................................................. 125
Section 3: Fatty Acids and Cholesterol ................................................................................................ 210
Section 4: Protein ................................................................................................................................ 259
Section 5: Carbohydrates ..................................................................................................................... 286
Section 6: Sodium, Potassium, and Water ........................................................................................... 326
Section 7: Alcohol ................................................................................................................................ 354
Section 8: Food Safety and Technology .............................................................................................. 369

Part E: Appendices .................................................................................................................................... 404
Appendix E-1: Major Conclusions ...................................................................................................... 404
Appendix E-2: Glossary of Terms ....................................................................................................... 426
Appendix E-3: USDA Food Pattern Modeling Analyses .................................................................... 432
Appendix E-4: History of the Dietary Guidelines for Americans ........................................................ 433
Appendix E-5: Public Comments ........................................................................................................ 439
Appendix E-6: Biographical Sketches of the 2010 Dietary Guidelines Advisory
Committee Members ....................................................................................................................... 441
Appendix E-7: Dietary Guidelines Advisory Committee Report Acknowledgments ......................... 444

2010 Dietary Guidelines Advisory Committee Report i
DEPARTMENT OF DEPARTMENT OF HEALTH
AGRICULTURE AND HUMAN SERVICES

May 28, 2010

The Honorable Thomas J. Vilsack
Secretary of Agriculture
1400 Independence Avenue, SW
Whitten Bldg, Room 200A
Washington DC, 20250

The Honorable Kathleen Sebelius
Secretary of Health and Human Services
200 Independence Avenue, SW
Washington DC, 20201

Dear Secretaries Vilsack and Sebelius,

It is my privilege to present to you on behalf of the entire 2010 U.S. Dietary Guidelines Advisory
Committee the full Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for
Americans, 2010. In the initial charge to this panel, we were asked to “provide science-based advice for
Americans, in order to promote health and to reduce the risk for major chronic diseases through diet and
physical activity.” More specifically, this involved, among other tasks, that we base our Report upon “the
preponderance of the most current scientific and medical knowledge, and determine what issues for
change need to be addressed,” with a “primary focus on the review of scientific evidence published since
the last DGAC deliberations” and place “primary emphasis on the development of food-based
recommendations.” We attended to each of these objectives and much more during the past 20 months
and we are in consensus and committed to the content and recommendations delineated in the enclosed
Report.

It has been a remarkable journey, filled with extensive investigation and critical evidence-based
review, covering relevant aspects of diet and health. Just under 200 specific questions related to dietary
guidance were initially identified and most were addressed. With assistance from the USDA Nutrition
Evidence Library (NEL), and additional hand searches involving other extensive databases, the
Committee formulated answers to the questions that it believes reflect the most current scientific
evidence. In addition to the expertise represented by our members, we had the outstanding and able
assistance of Dietary Guidelines Management Team staff members from both USDA and HHS, without
whom this task would have been impossible. We also appreciate crucial input from the Federal staff from
both USDA and HHS who each deserve recognition for their invaluable contributions.

The single most sobering aspect of this Report is the recognition that we are addressing an
overweight and obese American population. Across all age, gender and ethnic groups, it is clear that
urgent and systems-wide efforts are needed to address America’s obesity epidemic as top priority.
Everything within this Report is presented through the filter of an obesegenic environment in critical need
of change. This is especially true in regard to American children whose incidence of obesity has tripled in

____________________________________________________________________________________
ii 2010 Dietary Guidelines Advisory Committee Report
the past five years. This desperately requires an all out effort to improve diet and physical activity
behaviors across the country. The Committee is united in its resolve to provide recommendations that halt
and reverse this rampant epidemic. This will require extensive collaboration and implementation of a
unified effort to help reduce calorie intake, increase physical activity output and enhance the overall
nutrient density of dietary intake. While the research evidence is now substantial and detailed in most
cases, there remain gaps in the science that required us to use clinical judgment to help reconcile some of
these missing pieces in order to provide reasonable recommendations on the basis of combined
knowledge and data. In these cases, the assistance of food pattern modeling, contributed specifically by
the highly capable team at the Center for Nutrition Policy and Promotion, provided those necessary
translational linkages when epidemiologic data were unavailable.

In this regard, we encourage you to do everything possible to increase funding for greatly needed
research studies on numerous, important and highly strategic nutrition issues raised throughout this
Report. Specifically, in ultimately drafting our conclusion statements, the DGAC was struck by the
number of questions that simply could not be addressed due to the absence of data or limitations due to
inconclusive findings. Likewise, we urge you to further emphasize the importance of keeping current with
the ongoing National Health and Nutrition Examination Survey (NHANES) data. The 2015 DGAC
should be provided with the opportunity to study the impact of the 2010 Report by having access to the
most current, accurate and detailed NHANES nutrient data available at that time. Steps should be taken to
update these data as quickly as possible in order to maintain an accurate and ongoing view of America’s
dietary intake. In addition, the time has come to consider including all Americans, from birth on, as part
of these results since research increasingly points to the importance of diet, even in utero, in shaping
future health. Subsequent reports should include a focus on pregnancy, breastfeeding behavior and early
diet from birth on.

In summary, every member of this Committee has worked diligently, collaboratively and
tirelessly to produce this landmark Report. When differences of interpretation were debated from time to
time, the mutual respect and admiration expressed for each and every member of this group has been
nothing short of inspirational. The Committee looks forward to seeing the final Report become available
online, as well as the subsequent documents, discussion and translational tools that will surely be
generated. Thank you for your steadfast support, enthusiasm and recognition. We remain encouraged and
hopeful that the American public will take these recommendations to heart and benefit extensively from
their implementation.

Sincerely,

Linda V. Van Horn, PhD, RD
Chair, 2010 Dietary Guidelines Advisory Committee
Professor, Department of Preventive Medicine
Northwestern University, Feinberg School of Medicine

____________________________________________________________________________________
2010 Dietary Guidelines Advisory Committee Report iii
2010 Dietary Guidelines Advisory Committee Membership

Chair Vice Chair

Linda V. Van Horn, PhD, RD, LD Naomi K. Fukagawa, MD, PhD
Northwestern University University of Vermont
Chicago, Illinois Burlington, Vermont

Members

Cheryl Achterberg, PhD Rafael Pérez-Escamilla, PhD
The Ohio State University Yale University
Columbus, Ohio New Haven, Connecticut

Lawrence J. Appel, MD, MPH F. Xavier Pi-Sunyer, MD, MPH
Johns Hopkins Medical Institutions Columbia University
Baltimore, Maryland New York, New York

Roger A. Clemens, DrPH Eric B. Rimm, ScD
University of Southern California Harvard University
Los Angeles, California Boston, Massachusetts

Miriam E. Nelson, PhD Joanne L. Slavin, PhD, RD
Tufts University University of Minnesota
Boston, Massachusetts St. Paul, Minnesota

Sharon (Shelly) M. Nickols-Richardson, PhD, RD Christine L. Williams, MD, MPH
The Pennsylvania State University Columbia University (Retired)
University Park, Pennsylvania Healthy Directions, Inc.
New York, New York
Thomas A. Pearson, MD, PhD, MPH
University of Rochester
Rochester, New York

Executive Secretaries

Carole A. Davis, MS Kathryn Y. McMurry, MS
U.S. Department of Agriculture U.S. Department of Health and Human Services
Washington, DC Washington, DC

Shanthy A. Bowman, PhD Holly H. McPeak, MS
U.S. Department of Agriculture U.S. Department of Health and Human Services
Washington, DC Washington, DC

iv 2010 Dietary Guidelines Advisory Committee Report
Policy Officials

Rajen S. Anand, DVM, PhD Penelope Slade-Sawyer, PT, MSW, RADM,
Executive Director USPHS
Center for Nutrition Policy and Promotion Deputy Assistant Secretary for Health
U.S. Department of Agriculture (Disease Prevention and Health Promotion)
U.S. Department of Health and Human Services
Robert C. Post, PhD, MEd, MSc
Deputy Director Sarah R. Linde-Feucht, MD, CAPT, USPHS
Center for Nutrition Policy and Promotion Deputy Director (through 3/10)
U.S. Department of Agriculture Office of Disease Prevention and Health Promotion
U.S. Department of Health and Human Services

Wendy E. Braund, MD, MPH, MSEd
Acting Deputy Director and Lead, Prevention Science Team
Office of Disease Prevention and Health Promotion
U.S. Department of Health and Human Services

Dietary Guidelines Management Team Staff

Jan Barrett Adams, MS, MBA, RD Patricia M. Guenther, PhD, RD
U.S. Department of Agriculture U.S. Department of Agriculture

Shirley A. Blakely, PhD, RD, CAPT, USPHS R a c h e l R . Hayes, MPH, RD
U.S. Department of Health and Human Services U.S. Department of Health and Human Services

Patricia Britten, MS, PhD Holly H. McPeak, MS
U.S. Department of Agriculture U.S. Department of Health and Human Services

Eve V. Essery, PhD Kellie M. O’Connell, PhD, RD
U.S. Department of Health and Human Services U.S. Department of Agriculture
(until 8/09)
U.S. Department of Agriculture (beginning 8/09) Colette I. Rihane, MS, RD
U.S. Department of Agriculture

2010 Dietary Guidelines Advisory Committee Report v
Dietary Guidelines Nutrition Evidence Library Staff

Joanne M. Spahn, MS, RD, FADA Donna Blum-Kemelor, MS, RD, LD
U.S. Department of Agriculture U.S. Department of Agriculture

Joan M. G. Lyon, MS, RD Eve V. Essery, PhD
U.S. Department of Agriculture U.S. Department of Agriculture

Jean M. Altman, MS Thomas V. Fungwe, PhD
U.S. Department of Agriculture U.S. Department of Agriculture

Patricia Carrera MacNeil, MS, LN, CNS Julie E. Obbagy, PhD, RD
U.S. Department of Agriculture U.S. Department of Agriculture

Mary M. McGrane, PhD
U.S. Department of Agriculture

Research Librarian

Yat Ping Wong, MLS, MPH
U.S. Department of Agriculture

Technical Writer/Editor

Anne Brown Rodgers
Falls Church, Virginia

vi 2010 Dietary Guidelines Advisory Committee Report
Part A: Executive Summary

The 2010 Dietary Guidelines Advisory Committee The remainder of this Executive Summary provides
(DGAC) was established jointly by the Secretaries of brief synopses of these and all of the other chapters,
U.S. Department of Agriculture (USDA) and the U.S. which review current evidence related to specific topics
Department of Health and Human Services (HHS). The and present the resulting highlights that comprise the
Committee’s task was to advise the Secretaries of fundamental essence of this report.
USDA and HHS on whether revisions to the 2005
Dietary Guidelines were warranted, and if so, to
recommend updates to the Guidelines. The DGAC Major Cross-cutting Findings and
immediately recognized that, on the basis of the vast Recommendations
amount of published research and emerging science on

numerous relevant topics, an updated report was indeed
Total Diet: Combining Nutrients, Consuming
needed.
Foods

The 2010 DGAC Report is distinctly different from
The 2010 DGAC Report concludes that good health and
previous reports in several ways. First, it addresses an
optimal functionality across the lifespan are achievable
American public of whom the majority are overweight
goals but require a lifestyle approach including a total
or obese and yet under-nourished in several key
diet that is energy balanced and nutrient dense. Now, as
nutrients. Second, the Committee used a newly
in the past, a disconnect exists between dietary
developed, state-of-the-art, web-based electronic system
recommendations and what Americans actually
and methodology, known as the Nutrition Evidence
consume. On average, Americans of all ages consume
Library (NEL), to answer the majority of the scientific
too few vegetables, fruits, high-fiber whole grains, low-
questions it posed. The remaining questions were
fat milk and milk products, and seafood and they eat too
answered by data analyses, food pattern modeling
much added sugars, solid fats, refined grains, and
analyses, and consideration of other evidence-based
sodium. SoFAS (added sugars and solid fats) contribute
reviews or existing reports, including the 2008 Physical
approximately 35 percent of calories to the American
Activity Guidelines for Americans. The 2005 Dietary
diet. This is true for children, adolescents, adults, and
Guidelines for Americans were the starting place for
older adults and for both males and females. Reducing
most reviews. If little or no scientific literature had been
the intake of SoFAS can lead to a badly needed
published on a specific topic since the 2005 Report was
reduction in energy intake and inclusion of more
presented, the DGAC indicated this and established the
healthful foods into the total diet.
conclusions accordingly.

The diet recommended in this Report is not a rigid
A third distinctive feature of this Report is the
prescription. Rather, it is a flexible approach that
introduction of two newly developed chapters. The first
incorporates a wide range of individual tastes and food
of these chapters considers the total diet and how to
preferences. Accumulating evidence documents that
integrate all of the Report’s nutrient and energy
certain dietary patterns consumed around the world are
recommendations into practical terms that encourage
associated with beneficial health outcomes. Patterns of
personal choice but result in an eating pattern that is
eating that have been shown to be healthful include the
nutrient dense and calorie balanced. The second chapter
Dietary Approaches to Stop Hypertension (DASH)-style
complements this total diet approach by integrating and
dietary patterns and certain Mediterranean-style dietary
translating the scientific conclusions reached at the
patterns. Similarly, the USDA Food Patterns illustrate
individual level to encompass the broader
that both nutrient adequacy and moderation goals can
environmental and societal aspects that are crucial to
be met in a variety of ways. The daunting public health
full adoption and successful implementation of these
challenge is to accomplish population-wide adoption of
recommendations.
healthful dietary patterns within the context of powerful

influences that currently promote unhealthy consumer
choices, behaviors, and lifestyles.
2010 Dietary Guidelines Advisory Committee Report 1
Translating and Integrating the Evidence: A development and ultimate implementation of a plan to
Call to Action help all Americans eat well, be physically active, and
maintain good health and function. It is important that
Complementing the Total Diet chapter, this chapter any strategic plan is evidence-informed, action-oriented,
describes the four major findings that emerged from the and focused on changes in systems in these sectors.
DGAC’s review of the scientific evidence and
articulates steps that can be taken to help all Americans Any and all systems-based strategies must include a
adopt health-promoting nutrition and physical activity focus on children. Primary prevention of obesity must
guidelines: begin in childhood. This is the single most powerful
public health approach to combating and reversing
• Reduce the incidence and prevalence of overweight America’s obesity epidemic over the long term.
and obesity of the U.S. population by reducing
overall calorie intake and increasing physical Strategies to help Americans change their dietary intake
activity. patterns and be physically active also will go a long way
• Shift food intake patterns to a more plant-based diet to ameliorating the disparities in health among racial
that emphasizes vegetables, cooked dry beans and and ethnic minorities and among different
peas, fruits, whole grains, nuts, and seeds. In socioeconomic groups, which have been recognized as a
addition, increase the intake of seafood and fat-free significant concern for decades. While the reasons for
and low-fat milk and milk products and consume these differences are complex and multifactorial, this
only moderate amounts of lean meats, poultry, and Report addresses research indicating that certain dietary
eggs. changes can provide a means to reduce health
• Significantly reduce intake of foods containing disparities.
added sugars and solid fats because these dietary
components contribute excess calories and few, if Change is needed in the overall food environment to
any, nutrients. In addition, reduce sodium intake support the efforts of all Americans to meet the key
and lower intake of refined grains, especially recommendations of the 2010 DGAC. To meet these
refined grains that are coupled with added sugar, challenges, the following sustainable changes must
solid fat, and sodium. occur:
• Meet the 2008 Physical Activity Guidelines for
Americans. • Improve nutrition literacy and cooking skills,
including safe food handling skills, and empower
The 2010 DGAC recognizes that substantial barriers and motivate the population, especially families
make it difficult for Americans to accomplish these with children, to prepare and consume healthy
goals. Ensuring that all Americans consume a health- foods at home.
promoting dietary pattern and achieve and maintain • Increase comprehensive health, nutrition, and
energy balance requires far more than individual physical education programs and curricula in U.S.
behavior change. A multi-sectoral strategy is schools and preschools, including food preparation,
imperative. For this reason, the 2010 DGAC strongly food safety, cooking, and physical education classes
recommends that USDA and HHS convene appropriate and improved quality of recess.
committees, potentially through the Institute of • For all Americans, especially those of low income,
Medicine (IOM), to develop strategic plans focusing on create greater financial incentives to purchase,
the actions needed to successfully implement key 2010 prepare, and consume vegetables and fruit, whole
DGAC recommendations. Separate committees may be grains, seafood, fat-free and low-fat milk and milk
necessary because the actions needed to implement key products, lean meats, and other healthy foods.
recommendations likely differ by goal. • Improve the availability of affordable fresh produce
through greater access to grocery stores, produce
A coordinated strategic plan that includes all sectors of trucks, and farmers’ markets.
society, including individuals, families, educators, • Increase environmentally sustainable production of
communities, physicians and allied health professionals, vegetables, fruits, and fiber-rich whole grains.
public health advocates, policy makers, scientists, and • Ensure household food security through measures
small and large businesses (e.g., farmers, agricultural that provide access to adequate amounts of foods
producers, food scientists, food manufacturers, and food that are nutritious and safe to eat.
retailers of all kinds), should be engaged in the
2 2010 Dietary Guidelines Advisory Committee Report