Chapter 2 Shifts Needed To Align With Healthy Eating Patterns

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As described in Chapter 1, most foods in healthy eating patterns should come from the food groups. As Figure 2-3 shows, across the U.S. population, average intakes of foods from the food groups are far from amounts recommended in the Healthy U.S.-Style Eating Pattern.

Figure 2-3. Average Daily Food Group Intakes by Age-Sex Groups, Compared to Ranges of Recommended Intake

Figure 2-3 - 5 charts, one for each food group - chart descriptions provided below

Data Sources: What We Eat in America, NHANES 2007-2010 for average intakes by age-sex group. Healthy U.S.-Style Food Patterns, which vary based on age, sex, and activity level, for recommended intake ranges.

Food Groups

The following sections describe total current intakes for each of the food groups and for oils, and the leading food categories contributing to this total. They also describe the shifts in food choices that are needed to meet recommendations and provide strategies that can help individuals make these shifts.

Vegetables

Current intakes: Figure 2-3 shows the low average intakes of vegetables across age-sex groups in comparison to recommended intake levels. Vegetable consumption relative to recommendations is lowest among boys ages 9 to 13 years and girls ages 14 to 18 years. Vegetable intakes relative to recommendations are slightly higher during the adult years, but intakes are still below recommendations. In addition, with few exceptions, the U.S. population does not meet intake recommendations for any of the vegetable subgroups (Figure 2-4).

Figure 2-4. Average Vegetable Subgroup Intakes in Cup-Equivalents per Week by Age-Sex Groups, Compared to Ranges of Recommended Intakes per Week

Figure 2-4 - 5 charts, one for each vegetable subgroup - chart descriptions provided below

Data Sources: What We Eat in America, NHANES 2007-2010 for average intakes by age-sex group. Healthy U.S.-Style Food Patterns, which vary based on age, sex, and activity level, for recommended intake ranges.

Potatoes and tomatoes are the most commonly consumed vegetables, accounting for 21 percent and 18 percent of all vegetable consumption, respectively. Lettuce and onions are the only other vegetables that make up more than 5 percent each of total vegetable group consumption. Table 2-1 lists additional examples of vegetables in each of the subgroups. About 60 percent of all vegetables are eaten as a separate food item, about 30 percent as part of a mixed dish, and the remaining 10 percent as part of snack foods, condiments, and gravies. Vegetables are part of many types of mixed dishes, from burgers, sandwiches, and tacos to pizza, meat stews, pasta dishes, grain-based casseroles, and soups.

Shift to consume more vegetables: For most individuals, following a healthy eating pattern would include an increase in total vegetable intake from all vegetable subgroups, in nutrient-dense forms, and an increase in the variety of different vegetables consumed over time (see Table 2-1). Strategies to increase vegetable intake include choosing more vegetables—from all subgroups—in place of foods high in calories, saturated fats, or sodium such as some meats, poultry, cheeses, and snack foods. One realistic option is to increase the vegetable content of mixed dishes while decreasing the amounts of other food components that are often overconsumed, such as refined grains or meats high in saturated fat and/or sodium. Other strategies include always choosing a green salad or a vegetable as a side dish and incorporating vegetables into most meals and snacks.

Table 2-1. Examples of Vegetables in Each Vegetable Subgroup

Fruits

Current intakes: As shown in Figure 2-3, average intake of fruits is below recommendations for almost all age-sex groups. Children ages 1 to 8 years differ from the rest of the population in that many do meet recommended intakes for total fruit. Average intakes of fruits, including juice, are lowest among girls ages 14 to 18 years and adults ages 19 to 50 years. Older women (ages 51 years and older) and young children consume fruits in amounts close to or meeting minimum recommended intakes (Figure 2-3).

About one-third of the intake of fruits in the U.S. population comes from fruit juice, and the remaining two-thirds from whole fruits (which includes cut up, cooked, canned, frozen, and dried fruits). The highest proportion of juice to whole fruits intake is among children ages 1 to 3 years, for whom about 47 percent of total fruit intake comes from fruit juice, and about 53 percent from whole fruits. Average juice intakes for young children are within the limits recommended by the American Academy of Pediatrics (see the Fruits section of Chapter 1).

Fruits and fruit juices are most likely to be consumed alone or in a mixture with other fruit, rather than as part of a mixed dish that includes foods from other food groups. Almost 90 percent of all fruit intake comes from single fruits, fruit salads, or fruit juices. The most commonly consumed fruits are apples, bananas, watermelon, grapes, strawberries, oranges, peaches, cantaloupe, pears, blueberries, raisins, and pineapple. Commonly consumed fruit juices are orange juice, apple juice, and grape juice.

Shift to consume more fruits: To help support healthy eating patterns, most individuals in the United States would benefit from increasing their intake of fruits, mostly whole fruits, in nutrient-dense forms. A wide variety of fruits are available in the U.S. marketplace, some year-round and others seasonally. Strategies to help achieve this shift include choosing more fruits as snacks, in salads, as side dishes, and as desserts in place of foods with added sugars, such as cakes, pies, cookies, doughnuts, ice cream, and candies.

Grains

Current intakes: Intakes of total grains are close to the target amounts (Figure 2-3) for all age-sex groups, but as shown in Figure 2-5, intakes do not meet the recommendations for whole grains and exceed limits for refined grains. Average intakes of whole grains are far below recommended levels across all age-sex groups, and average intakes of refined grains are well above recommended limits for most age-sex groups.

Figure 2-5. Average Whole and Refined Grain Intakes in Ounce-Equivalents per Day by Age-Sex Groups, Compared to Ranges of Recommended Daily Intake for Whole Grains and Limits for Refined Grains*

Figure 2-5 - chart descriptions provided below

*Note: Recommended daily intake of whole grains is to be at least half of total grain consumption, and the limit for refined grains is to be no more than half of total grain consumption. The blue vertical bars on this graph represent one half of the total grain recommendations for each age-sex group, and therefore indicate recommendations for the minimum amounts to consume of whole grains or maximum amounts of refined grains. To meet recommendations, whole grain intake should be within or above the blue bars and refined grain intake within or below the bars.

Data Sources: What We Eat in America, NHANES 2007-2010 for average intakes by age-sex group. Healthy U.S.-Style Food Patterns, which vary based on age, sex, and activity level, for recommended intake ranges.

Examples of commonly consumed whole-grain foods are whole-wheat breads, rolls, bagels, and crackers; oatmeal; whole-grain ready-to-eat cereals (e.g., shredded wheat, oat rings); popcorn; brown rice; and whole-grain pasta. Examples of refined grain foods are white bread, rolls, bagels, and crackers; pasta; pizza crust; grain-based desserts; refined grain ready-to-eat cereals (e.g., corn flakes, crispy rice cereal); corn and wheat tortillas; white rice; and cornbread. As noted in Chapter 1, most refined grain foods in the United States are made from enriched grains. Almost half of all refined grains intake is from mixed dishes, such as burgers, sandwiches, tacos, pizza, macaroni and cheese, and spaghetti with meatballs. About 20 percent of refined grain intake comes from snacks and sweets, including cakes, cookies, and other grain desserts. The remaining 30 percent of refined grain intake is eaten as a separate food item, such as cereals, breads, or rice. About 60 percent of whole-grain intake in the United States is from individual food items, mostly cereals, rather than mixed dishes.

Shift to make half of all grains consumed be whole grains: Shifting from refined to whole-grain versions of commonly consumed foods—such as from white to 100% whole-wheat breads, white to whole-grain pasta, and white to brown rice—would increase whole-grain intakes and lower refined grain intakes to help meet recommendations. Strategies to increase whole grains in place of refined grains include using the ingredient list on packaged foods to select foods that have whole grains listed as the first grain ingredient. Another strategy is to cut back on refined grain desserts and sweet snacks such as cakes, cookies, and pastries, which are high in added sugars, solid fats, or both, and are a common source of excess calories. Choosing both whole and refined grain foods in nutrient-dense forms, such as choosing plain popcorn instead of buttered, bread instead of croissants, and English muffins instead of biscuits also can help in meeting recommendations for a healthy eating pattern.

Dairy

Current intakes: As shown in Figure 2-3, average intakes of dairy for most age-sex groups are far below recommendations of the Healthy U.S.-Style Pattern. Average dairy intake for most young children ages 1 to 3 years meets recommended amounts, but all other age groups have average intakes that are below recommendations. An age-related decline in dairy intake begins in childhood, and intakes persist at low levels for adults of all ages.

Fluid milk (51%) and cheese (45%) comprise most of dairy consumption. Yogurt (2.6%) and fortified soy beverages (commonly known as “soymilk”) (1.5%) make up the rest of dairy intake. About three-fourths of all milk is consumed as a beverage or on cereal, but cheese is most commonly consumed as part of mixed dishes, such as burgers, sandwiches, tacos, pizza, and pasta dishes.

Shift to consume more dairy products in nutrient-dense forms: Most individuals in the United States would benefit by increasing dairy intake in fat-free or low-fat forms, whether from milk (including lactose-free milk), yogurt, and cheese or from fortified soy beverages (soymilk). Some sweetened milk and yogurt products may be included in a healthy eating pattern as long as the total amount of added sugars consumed does not exceed the limit for added sugars, and the eating pattern does not exceed calorie limits. Because most cheese contains more sodium and saturated fats, and less potassium, vitamin A, and vitamin D than milk or yogurt, increased intake of dairy products would be most beneficial if more fat-free or low-fat milk and yogurt were selected rather than cheese. Strategies to increase dairy intake include drinking fat-free or low-fat milk (or a fortified soy beverage) with meals, choosing yogurt as a snack, or using yogurt as an ingredient in prepared dishes such as salad dressings or spreads. Strategies for choosing dairy products in nutrient-dense forms include choosing lower fat versions of milk, yogurt, and cheese in place of whole milk products and regular cheese.

Protein Foods

Current Intakes: Overall, average intakes of protein foods are close to amounts recommended for all age-sex groups (Figure 2-3). However, Figure 2-6 shows that the average intakes of protein foods subgroups vary in comparison to the range of intake recommendations. Overall, average intakes of seafood are low for all age-sex groups; average intakes of nuts, seeds, and soy products are close to recommended levels; and average intakes of meats, poultry, and eggs are high for teen boys and adult men. Legumes (beans and peas), a vegetables subgroup, also may be considered as part of the protein foods group (see the About Legumes (Beans and Peas) call-out box in Chapter 1). As shown in Figure 2-4, intakes of legumes are below vegetable group recommendations.

Figure 2-6. Average Protein Foods Subgroup Intakes in Ounce-Equivalents per Week by Age-Sex Groups, Compared to Ranges of Recommended Intake

Figure 2-6 - 3 charts, one for each protein subgroup - chart description provided below

Data Sources: What We Eat in America, NHANES 2007-2010 for average intakes by age-sex group. Healthy U.S.-Style Food Patterns, which vary based on age, sex, and activity level, for recommended intake ranges.

Commonly consumed protein foods include beef (especially ground beef), chicken, pork, processed meats (e.g., hot dogs, sausages, ham, luncheon meats), and eggs. The most common seafood choices are shrimp, tuna, and salmon; and the most common nut choices are peanuts, peanut butter, almonds, and mixed nuts. Slightly less than half (49%) of all protein foods are consumed as a separate food item, such as a chicken breast, a steak, an egg, a fish filet, or peanuts. About the same proportion are consumed as part of a mixed dish (45%), with the largest amount from burgers, sandwiches, and tacos.

Shift to increase variety in protein foods choices and to make more nutrient-dense choices: Average intake of total protein foods is close to recommendations, while average seafood intake is below recommendations for all age-sex groups. Shifts are needed within the protein foods group to increase seafood intake, but the foods to be replaced depend on the individual’s current intake from the other protein subgroups. Strategies to increase the variety of protein foods include incorporating seafood as the protein foods choice in meals twice per week in place of meat, poultry, or eggs, and using legumes or nuts and seeds in mixed dishes instead of some meat or poultry. For example, choosing a salmon steak, a tuna sandwich, bean chili, or almonds on a main-dish salad could all increase protein variety.

Shifting to nutrient-dense options, including lean and lower sodium options, will improve the nutritional quality of protein food choices and support healthy eating patterns. Some individuals, especially teen boys and adult men, also need to reduce overall intake of protein foods (see Figure 2-3) by decreasing intakes of meats, poultry, and eggs and increasing amounts of vegetables or other underconsumed food groups.

Oils

Current Intakes: Average intakes of oils are below the recommendations for almost every age-sex group (Figure 2-7). However, intakes are not far from recommendations. In the United States, most oils are consumed in packaged foods, such as salad dressings, mayonnaise, prepared vegetables, snack chips (corn and potato), and as part of nuts and seeds. Oils also can be used in preparing foods such as stir-fries and sautés. The most commonly used oil in the United States is soybean oil. Other commonly used oils include canola, corn, olive, cottonseed, sunflower, and peanut oil. Oils also are found in nuts, avocados, and seafood. Coconut, palm, and palm kernel oils (tropical oils) are solid at room temperature because they have high amounts of saturated fatty acids and are therefore classified as a solid fat rather than as an oil. (See Chapter 1 for more information on tropical oils.)

Figure 2-7. Average Intakes of Oils and Solid Fats in Grams per Day by Age-Sex Group, in Comparison to Ranges of Recommended Intake for Oils

Figure 2-7 - chart description provided below

Data Sources: What We Eat in America, NHANES 2007-2010 for average intakes by age-sex group. Healthy U.S. Style Food Patterns, which vary based on age, sex, and activity level, for recommended intake ranges.

Shift from solid fats to oils: To move the intake of oils to recommended levels, individuals should use oils rather than solid fats in food preparation where possible. Strategies to shift intake include using vegetable oil in place of solid fats (butter, stick margarine, shortening, lard, coconut oil) when cooking, increasing the intake of foods that naturally contain oils, such as seafood and nuts, in place of some meat and poultry, and choosing other foods, such as salad dressings and spreads, made with oils instead of solid fats.

Figure 2-8. Typical Versus Nutrient-Dense Foods and Beverages

Achieving a healthy eating pattern means shifting typical food choices to more nutrient-dense options—that is, foods with important nutrients that aren’t packed with extra calories or sodium. Nutrient-dense foods and beverages are naturally lean or low in solid fats and have little or no added solid fats, sugars, refined starches, or sodium.

Pinto Beans
high sodium
low sodium
Chicken
fried
baked with herbs
Shredded Wheat
frosted
plain with fruit
Spinach
creamed
steamed
Peaches
in syrup
fresh or frozen without added sugars

Other Dietary Components

As described in Chapter 1, in addition to the food groups, other components also should be considered when building healthy eating patterns, including limiting the amounts of added sugars, saturated fats, and sodium consumed. Additionally, for adults who choose to drink alcohol, drinking should not exceed moderate intake, and the calories from alcoholic beverages should be considered within overall calorie limits.[3] The following sections describe total intakes compared to limits for these components, and the leading food categories contributing to this total.

Added Sugars

Current Intakes: Added sugars account on average for almost 270 calories, or more than 13 percent of calories per day in the U.S. population. As shown in Figure 2-9, intakes as a percent of calories are particularly high among children, adolescents, and young adults. The major source of added sugars in typical U.S. diets is beverages, which include soft drinks, fruit drinks, sweetened coffee and tea, energy drinks, alcoholic beverages, and flavored waters (Figure 2-10). Beverages account for almost half (47%) of all added sugars consumed by the U.S. population (Figure 2-10). The other major source of added sugars is snacks and sweets, which includes grain-based desserts such as cakes, pies, cookies, brownies, doughnuts, sweet rolls, and pastries; dairy desserts such as ice cream, other frozen desserts, and puddings; candies; sugars; jams; syrups; and sweet toppings. Together, these food categories make up more than 75 percent of intake of all added sugars.

Figure 2-9. Average Intakes of Added Sugars as a Percent of Calories per Day by Age-Sex Group, in Comparison to the Dietary Guidelines Maximum Limit of Less Than 10 Percent of Calories

Figure 2-9 - chart description provided below

Note: The maximum amount of added sugars allowable in a Healthy U.S.-Style Eating Pattern at the 1,200-to-1,800 calorie levels is less than the Dietary Guidelines limit of 10 percent of calories. Patterns at these calorie levels are appropriate for many children and older women who are not physically active.

Data Source: What We Eat in America, NHANES 2007-2010 for average intakes by age-sex group.

Figure 2-10. Food Category Sources of Added Sugars in the U.S. Population Ages 2 Years and Older

Figure 2-10 - pie chart - chart description provided below

Data Source: What We Eat in America (WWEIA) Food Category analyses for the 2015 Dietary Guidelines Advisory Committee. Estimates based on day 1 dietary recalls from WWEIA, NHANES 2009-2010.

Shift to reduce added sugars consumption to less than 10 percent of calories per day:[4] Individuals have many potential options for reducing the intake of added sugars. Strategies include choosing beverages with no added sugars, such as water, in place of sugar-sweetened beverages, reducing portions of sugar-sweetened beverages, drinking these beverages less often, and selecting beverages low in added sugars. Low-fat or fat-free milk or 100% fruit or vegetable juice also can be consumed within recommended amounts in place of sugar-sweetened beverages. Additional strategies include limiting or decreasing portion size of grain-based and dairy desserts and sweet snacks and choosing unsweetened or no-sugar-added versions of canned fruit, fruit sauces (e.g., applesauce), and yogurt. The use of high-intensity sweeteners as a replacement for added sugars is discussed in Chapter 1 in the Added Sugars section.

Saturated Fats

Current intakes: Current average intakes of saturated fats are 11 percent of calories. Only 29 percent of individuals in the United States consume amounts of saturated fats consistent with the limit of less than 10 percent of calories (see Figure 2-1). As shown in Figure 2-11, average intakes do not vary widely across age-sex groups. Average intakes for both adult men and adult women are at 10.9 percent, and the average intake for children ranges from 11.1 percent up to 12.6 percent of calories.

The mixed dishes food category is the major source of saturated fats in the United States (Figure 2-12), with 35 percent of all saturated fats coming from mixed dishes, especially those dishes containing cheese, meat, or both. These include burgers, sandwiches, and tacos; pizza; rice, pasta, and grain dishes; and meat, poultry, and seafood dishes. The other food categories that provide the most saturated fats in current diets are snacks and sweets, protein foods, and dairy products.

Figure 2-11. Average Intakes of Saturated Fats as a Percent of Calories per Day by Age-Sex Groups, Compared to Dietary Guidelines Maximum Limit of Less Than 10 Percent of Calories

Figure 2-11 - chart description provided below

Data Source: What We Eat in America, NHANES 2007-2010 for average intakes by age-sex group.

Figure 2-12. Food Category Sources of Saturated Fats in the U.S. Population Ages 2 Years and Older

Figure 2-12 - pie chart - chart description provided below

Data Source: What We Eat in America (WWEIA) Food Category analyses for the 2015 Dietary Guidelines Advisory Committee. Estimates based on day 1 dietary recalls from WWEIA, NHANES 2009-2010.

Shift to reduce saturated fats intake to less than 10 percent of calories per day: Individuals should aim to shift food choices from those high in saturated fats to those high in polyunsaturated and monounsaturated fats. Strategies to lower saturated fat intake include reading food labels to choose packaged foods lower in saturated fats and higher in polyunsaturated and monounsaturated fats, choosing lower fat forms of foods and beverages that contain solid fats (e.g., fat-free or low-fat milk instead of 2% or whole milk; low-fat cheese instead of regular cheese; lean rather than fatty cuts of meat), and consuming smaller portions of foods higher in saturated fats or consuming them less often. One realistic option is to change ingredients in mixed dishes to increase the amounts of vegetables, whole grains, lean meat, and low-fat or fat-free cheese, in place of some of the fatty meat and/or regular cheese in the dish. Additional strategies include preparing foods using oils that are high in polyunsaturated and monounsaturated fats, rather than solid fats, which are high in saturated fats (see Chapter 1, Figure 1-2), and using oil-based dressings and spreads on foods instead of those made from solid fats (e.g., butter, stick margarine, cream cheese) (see Solid Fats call-out box).

Sodium

Current intakes: As shown in Figure 2-13, average intakes of sodium are high across the U.S. population compared to the Tolerable Upper Intake Levels (ULs). Average intakes for those ages 1 year and older is 3,440 mg per day. Average intakes are generally higher for men than women. For all adult men, the average intake is 4,240 mg, and for adult women, the average is 2,980 mg per day. Only a small proportion of total sodium intake is from sodium inherent in foods or from salt added in home cooking or at the table. Most sodium consumed in the United States comes from salts added during commercial food processing and preparation.

Sodium is found in foods from almost all food categories (Figure 2-14). Mixed dishes—including burgers, sandwiches, and tacos; rice, pasta, and grain dishes; pizza; meat, poultry, and seafood dishes; and soups—account for almost half of the sodium consumed in the United States. The foods in many of these categories are often commercially processed or prepared.

Figure 2-13. Average Intake of Sodium in Milligrams per Day by Age-Sex Groups, Compared to Tolerable Upper Intake Levels (UL)

Figure 2-13 - line chart - chart description provided below

Data Sources: What We Eat in America, NHANES 2007-2010 for average intakes by age-sex group. Institute of Medicine Dietary Reference Intakes for Tolerable Upper Intake Levels (UL).

Figure 2-14. Food Category Sources of Sodium in the U.S. Population Ages 2 Years and Older

Figure 2-14 - pie chart - chart description provided below

Data Source: What We Eat in America (WWEIA) Food Category analyses for the 2015 Dietary Guidelines Advisory Committee. Estimates based on day 1 dietary recalls from WWEIA, NHANES 2009-2010.

Shift food choices to reduce sodium intake:[5] Because sodium is found in so many foods, careful choices are needed in all food groups to reduce intake. Strategies to lower sodium intake include using the Nutrition Facts label to compare sodium content of foods and choosing the product with less sodium and buying low-sodium, reduced sodium, or no-salt-added versions of products when available. Choose fresh, frozen (no sauce or seasoning), or no-salt-added canned vegetables, and fresh poultry, seafood, pork, and lean meat, rather than processed meat and poultry. Additional strategies include eating at home more often; cooking foods from scratch to control the sodium content of dishes; limiting sauces, mixes, and “instant” products, including flavored rice, instant noodles, and ready-made pasta; and flavoring foods with herbs and spices instead of salt.

Alcohol

In 2011, approximately 56 percent of U.S. adults 21 years of age and older were current drinkers, meaning that they had consumed alcohol in the past month; and 44 percent were not current drinkers. Current drinkers include 19 percent of all adults who consistently limited intake to moderate drinking, and 37 percent of all adults who did not. Drinking in greater amounts than moderation was more common among men, younger adults, and non-Hispanic whites. Two in three adult drinkers do not limit alcohol intake to moderate amounts one or more times per month.

The Dietary Guidelines does not recommend that individuals begin drinking or drink more for any reason. The amount of alcohol and calories in beverages varies and should be accounted for within the limits of healthy eating patterns. Alcohol should be consumed only by adults of legal drinking age. There are many circumstances in which individuals should not drink, such as during pregnancy. See Chapter 1 and Appendix 9. Alcohol for additional information.

Underconsumed Nutrients and Nutrients of Public Health Concern

In addition to helping reduce chronic disease risk, the shifts in eating patterns described in this chapter can help individuals meet nutrient needs. This is especially important for nutrients that are currently underconsumed. Although the majority of Americans consume sufficient amounts of most nutrients, some nutrients are consumed by many individuals in amounts below the Estimated Average Requirement or Adequate Intake levels. These include potassium, dietary fiber, choline, magnesium, calcium, and vitamins A, D, E, and C. Iron also is underconsumed by adolescent girls and women ages 19 to 50 years. Low intakes for most of these nutrients occur within the context of unhealthy overall eating patterns, due to low intakes of the food groups—vegetables, fruits, whole grains, and dairy—that contain these nutrients. Shifts to increase the intake of these food groups can move intakes of these underconsumed nutrients closer to recommendations.

Of the underconsumed nutrients, calcium, potassium, dietary fiber, and vitamin D are considered nutrients of public health concern because low intakes are associated with health concerns. For young children, women capable of becoming pregnant, and women who are pregnant, low intake of iron also is of public health concern.

Shift to eating more vegetables, fruits, whole grains, and dairy to increase intake of nutrients of public health concern. Low intakes of dietary fiber are due to low intakes of vegetables, fruits, and whole grains. Low intakes of potassium are due to low intakes of vegetables, fruits, and dairy. Low intakes of calcium are due to low intakes of dairy. If a healthy eating pattern, such as the Healthy U.S.-Style Eating Pattern, is consumed, amounts of calcium and dietary fiber will meet recommendations. Amounts of potassium will increase but depending on food choices may not meet the Adequate Intake recommendation. To increase potassium, focus on food choices with the most potassium, listed in Appendix 10. Food Sources of Potassium, such as white potatoes, beet greens, white beans, plain yogurt, and sweet potato.

Although amounts of vitamin D in the USDA Food Patterns are less than recommendations, vitamin D is unique in that sunlight on the skin enables the body to make vitamin D. Recommendations for vitamin D assume minimum sun exposure. Strategies to achieve higher levels of intake of dietary vitamin D include consuming seafood with higher amounts of vitamin D, such as salmon, herring, mackerel, and tuna, and more foods fortified with vitamin D, especially fluid milk, soy beverage (soymilk), yogurt, orange juice, and breakfast cereals. In some cases, taking a vitamin D supplement may be appropriate, especially when sunshine exposure is limited due to climate or the use of sunscreen.

The best food sources of potassium, calcium, vitamin D, and dietary fiber are found in Appendix 10, Appendix 11, Appendix 12, and Appendix 13, respectively.

Substantial numbers of women who are capable of becoming pregnant, including adolescent girls, are at risk of iron-deficiency anemia due to low intakes of iron. To improve iron status, women and adolescent girls should consume foods containing heme iron, such as lean meats, poultry, and seafood, which is more readily absorbed by the body. Additional iron sources include legumes (beans and peas) and dark-green vegetables, as well as foods enriched or fortified with iron, such as many breads and ready-to-eat cereals. Absorption of iron from non-heme sources is enhanced by consuming them along with vitamin C-rich foods. Women who are pregnant are advised to take an iron supplement when recommended by an obstetrician or other health care provider.

Beverages

Beverages are not always remembered or considered when individuals think about overall food intake. However, they are an important component of eating patterns. In addition to water, the beverages that are most commonly consumed include sugar-sweetened beverages, milk and flavored milk, alcoholic beverages, fruit and vegetable juices, and coffee and tea. Beverages vary in their nutrient and calorie content. Some, like water, do not contain any calories. Some, like soft drinks, contain calories but little nutritional value. Finally, some, like milk and fruit and vegetable juices, contain important nutrients such as calcium, potassium, and vitamin D, in addition to calories.

Beverages make a substantial contribution to total water needs as well as to nutrient and calorie intakes in most typical eating patterns. In fact, they account for almost 20 percent of total calorie intake. Within beverages, the largest source of calories is sweetened beverages, accounting for 35 percent of calories from beverages. Other major sources of calories from beverages are milk and milk drinks, alcoholic beverages, fruit and vegetable juices, and coffee and tea.

When choosing beverages, both the calories and nutrients they may provide are important considerations. Beverages that are calorie-free—especially water—or that contribute beneficial nutrients, such as fat-free and low-fat milk and 100% juice, should be the primary beverages consumed. Milk and 100% fruit juice should be consumed within recommended food group amounts and calorie limits. Sugar-sweetened beverages, such as soft drinks, sports drinks, and fruit drinks that are less than 100% juice, can contribute excess calories while providing few or no key nutrients. If they are consumed, amounts should be within overall calorie limits and limits for calories from added sugars (see Chapter 1). The use of high-intensity sweeteners, such as those used in “diet” beverages, as a replacement for added sugars is discussed in Chapter 1 in the Added Sugars section.

For adults who choose to drink alcohol, limits of only moderate intake (see Appendix 9) and overall calorie limits apply.[8] Coffee, tea, and flavored waters also can be selected, but calories from cream, added sugars, and other additions should be accounted for within the eating pattern.

Notes

[2] Britten P, Cleveland LE, Koegel KL, Kuczynski KJ, and Nickols-Richardson MS. Impact of typical rather than nutrient dense food choices in the US Department of Agriculture Food Patterns. J Acad Nutr Diet. 2012;112 (10):1560-1569.

[3] It is not recommended that individuals begin drinking or drink more for any reason. The amount of alcohol and calories in beverages varies and should be accounted for within the limits of healthy eating patterns. Alcohol should be consumed only by adults of legal drinking age. There are many circumstances in which individuals should not drink, such as during pregnancy. See Appendix 9. Alcohol for additional information.

[4] See Added Sugars section of Chapter 1 for more information and Appendix 3. USDA Food Patterns: Healthy U.S.-Style Eating Patterns for specific limits on calories that remain after meeting food group recommendation in nutrient-dense forms (“calorie limits for other uses”).

[5] The recommendation to limit intake of sodium to less than 2,300 mg per day is the UL for individuals ages 14 years and older set by the IOM. The recommendations for children younger than 14 years of age are the IOM age- and sex-appropriate ULs (see Appendix 7. Nutritional Goals for Age-Sex Groups, Based on Dietary Reference Intakes and Dietary Guidelines Recommendations).

[6] Caffeine is a substance that is generally recognized as safe (GRAS) in cola-type beverages by the Food and Drug Administration for use by adults and children. For more information, see: Code of Federal Regulation Title 21, subchapter B, Part 182, Subpart B. Caffeine. U.S. Government Printing Office. November 23, 2015. Available at: http://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=f8c3068e9ec0062a3b4078cfa6361cf6&ty=HTML&h=L&mc=true&r=SECTION&n=se21.3.182_11180. Accessed October 22, 2015.

[7] Dietary Folate Equivalents (DFE) adjust for the difference in bioavailability of food folate compared with synthetic folic acid. Food folate, measured as micrograms DFE, is less bioavailable than folic acid. 1 DFE = 1 mcg food folate = 0.6 mcg folic acid from supplements and fortified foods taken with meals.

[8] It is not recommended that individuals begin drinking or drink more for any reason. The amount of alcohol and calories in beverages varies and should be accounted for within the limits of healthy eating patterns. Alcohol should be consumed only by adults of legal drinking age. There are many circumstances in which individuals should not drink, such as during pregnancy. See Appendix 9 for additional information.