Dietary Guidelines for Americans 2020-2025 PDF

Dietary Guidelines for Americans 2020 - 2025 Make Every Bite Count With the Dietary Guidelines DietaryG...

Dietary Guidelines for Americans 2020 - 2025 Make Every Bite Count With the Dietary Guidelines DietaryGuidelines.gov This publication may be viewed and downloaded from the internet at DietaryGuidelines.gov. Suggested citation: U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2020-2025. 9th Edition. December 2020. Available at DietaryGuidelines.gov. 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December 2020  Dietary Guidelines for Americans 2020 - 2025 Make Every Bite Count With the Dietary Guidelines Ninth Edition DietaryGuidelines.gov Table of Contents Message From the Secretaries v Vegetables  31 Fruits 32 Acknowledgments vi Grains 32 Executive Summary vii Dairy and Fortified Soy Alternatives 33 Protein Foods 33 Introduction 1 Oils 35 Setting the Stage 3 Grounded in Science and Focused on Beverages 35 Public Health  3 Dietary Components of Public Health A Spotlight on Dietary Patterns 6 Concern for Underconsumption 36 Healthy Dietary Patterns at Every Life Stage 6 Guideline 4: Limit Foods and Beverages Higher in Added Sugars, Saturated Fat, and Dietary Guidelines for Americans: Sodium, and Limit Alcoholic Beverages 37 What It Is, What It Is Not 7 Added Sugars 41 Quantitative Guidance on Foods, Not Nutrient Requirements 7 Saturated Fat 44 Health Promotion, Not Disease Treatment 7 Sodium 46 Developing the Dietary Guidelines for Americans 7 Alcoholic Beverages 49 Stage 1: Identify Topics and Supporting Support Healthy Dietary Patterns Scientific Questions  8 for All Americans 50 Stage 2: Appoint a Dietary Guidelines Advisory Looking Toward the Life Stages 50 Committee To Review Current Scientific Evidence  8 Chapter 2: Infants and Toddlers 51 Stage 3: Develop the Dietary Guidelines 11 Introduction 53 Stage 4: Implement the Dietary Guidelines 12 Putting the Key Recommendations Into Action 54 A Roadmap to the Dietary Guidelines Feed Infants Human Milk for the First for Americans, 2020-2025 14 6 Months, If Possible 54 Provide Infants Supplemental Vitamin D Chapter 1: Nutrition and Health Across Beginning Soon After Birth 56 the Lifespan: The Guidelines and Key Introduce Infants to Nutrient-Dense Recommendations 15 Complementary Foods at About 6 Months Old 56 The Guidelines 17 Guideline 1: Follow a Healthy Dietary Pattern at Introduce Infants to Potentially Allergenic Foods Every Life Stage 19 Along With Other Complementary Foods 58 What Is a Dietary Pattern? 19 Encourage Infants and Toddlers To Consume a The Health Benefits of a Healthy Dietary Pattern 23 Variety of Complementary Foods and Beverages To Meet Energy and Nutrient Needs 59 A Healthy Dietary Pattern Supports Appropriate Calorie Levels 23 Establish a Healthy Beverage Pattern 61 Most Americans Do Not Follow a Healthy Dietary Pattern During a Healthy Dietary Pattern 26 Toddler's Second Year of Life 63 Current Intakes 65 Guideline 2: Customize and Enjoy Food and Supporting Healthy Eating 67 Beverage Choices To Reflect Accessing a Healthy Dietary Pattern 68 Personal Preferences, Cultural Traditions, and Budgetary Considerations 27 Looking Toward Chapter 3: Guideline 3: Focus on Meeting Food Group Needs Children and Adolescents 68 With Nutrient-Dense Foods and Beverages, and Stay Within Calorie Limits 30 Page i | Dietary Guidelines for Americans, 2020-2025 Chapter 3: Children and Adolescents 69 Chapter 6: Older Adults  121 Introduction 71 Introduction 123 Healthy Dietary Patterns 72 Healthy Dietary Patterns 124 Current Intakes 75 Current Intakes 126 Special Considerations 87 Special Considerations 128 Sugar-Sweetened Beverages  87 Protein 128 Dairy and Fortified Soy Alternatives 88 Vitamin B12 128 Adolescent Nutrition 88 Beverages 129 Supporting Healthy Eating 89 Supporting Healthy Eating 129 Accessing a Healthy Dietary Pattern 90 Healthy Eating Through the Lifespan 130 Looking Toward Chapter 4: Adults 90 Appendixes  131 Chapter 4: Adults 91 Appendix 1: Nutritional Goals for Age-Sex Groups 131 Introduction 93 Appendix 2: Estimated Calorie Needs 139 Healthy Dietary Patterns 95 Appendix 3: USDA Dietary Patterns 142 Current Intakes 97 Special Considerations 101 Dietary Fiber 101 Calcium and Vitamin D 101 Saturated Fat 102 Sodium 102 Added Sugars 103 Alcoholic Beverages 104 Supporting Healthy Eating 104 Accessing a Healthy Dietary Pattern 105 Looking Toward Chapter 5: Women Who Are Pregnant or Lactating and Chapter 6: Older Adults 106 Chapter 5: Women Who Are Pregnant or Lactating  107 Introduction 109 Healthy Dietary Patterns 110 Current Intakes 113 Special Considerations 115 Meeting Nutrient Needs 115 Folate/Folic Acid 115 Iron 115 Iodine 116 Choline 117 Seafood 117 Alcoholic Beverages 117 Caffeine 118 Supporting Healthy Eating 120 Dietary Guidelines for Americans, 2020-2025 — Page ii List of Tables Table I-1: Facts About Nutrition-Related Health Table A1-1: Daily Nutritional Goals, Conditions in the United States 5 Ages 6 Through 11 Months and 12 Through 23 Months 131 Table 1-1: Healthy U.S.-Style Dietary Pattern at the 2,000-Calorie Level, With Daily or Weekly Amounts Table A1-2: Daily Nutritional Goals, From Food Groups, Subgroups, and Components 20 Ages 2 and Older 133 Table 2-1: Healthy U.S.-Style Dietary Pattern for Table A1-3: Daily Nutritional Goals for Women Toddlers Ages 12 Through 23 Months Who Are No Who Are Pregnant, by Age Group and Trimester 135 Longer Receiving Human Milk or Infant Formula, Table A1-4: Daily Nutritional Goals for Women With Daily or Weekly Amounts From Food Groups, Who Are Lactating, by Age Group and Subgroups, and Components 64 Months Postpartum 137 Table 2-2: Signs a Child is Hungry or Full 67 Table A2-1: Estimated Calorie Needs per Day, Table 3-1: Healthy U.S.-Style Dietary Pattern for by Age and Sex, Ages 12 Through 23 Months 139 Children Ages 2 Through 8, With Daily or Table A2-2: Estimated Calorie Needs per Day, Weekly Amounts From Food Groups, Subgroups, by Age, Sex, and Physical Activity Level, and Components 74 Ages 2 and Older 141 Table 3-2: Healthy U.S.-Style Dietary Pattern for Table A2-3: Estimated Change in Calorie Needs Children and Adolescents Ages 9 Through 13, During Pregnancy and Lactation for Women With a With Daily or Weekly Amounts From Food Groups, Healthy Prepregnancy Weight 141 Subgroups, and Components 81 Table A3-1: Healthy U.S.-Style Dietary Pattern for Table 3-3: Healthy U.S.-Style Dietary Pattern for Toddlers Ages 12 Through 23 Months Who Are No Adolescents Ages 14 Through 18, Longer Receiving Human Milk or Infant Formula, With Daily or Weekly Amounts From Food Groups, With Daily or Weekly Amounts From Food Groups, Subgroups, and Components 84 Subgroups, and Components 143 Table 4-1: Healthy U.S.-Style Dietary Pattern for Adults Table A3-2: Healthy U.S.-Style Dietary Pattern for Ages 19 Through 59, With Daily or Weekly Amounts Ages 2 and Older, With Daily or Weekly Amounts From Food Groups, Subgroups, and Components 96 From Food Groups, Subgroups, and Components 144 Table 5-1: Healthy U.S.-Style Dietary Pattern for Table A3-3: Healthy Vegetarian Dietary Pattern for Women Who Are Pregnant or Lactating, Toddlers Ages 12 Through 23 Months Who Are With Daily or Weekly Amounts From Food Groups, No Longer Receiving Human Milk or Infant Formula, Subgroups, and Components 111 With Daily or Weekly Amounts From Food Groups, Table 5-2: Estimated Change in Calorie Needs Subgroups, and Components 147 During Pregnancy and Lactation for Women Table A3-4: Healthy Vegetarian Dietary Pattern for With a Healthy Prepregnancy Weight 112 Ages 2 and Older, With Daily or Weekly Amounts Table 5-3: Weight Gain Recommendations From Food Groups, Subgroups, and Components 148 for Pregnancy 112 Table A3-5: Healthy Mediterranean-Style Dietary Table 6-1: Healthy U.S.-Style Dietary Pattern for Adults Pattern for Ages 2 and Older, With Daily or Ages 60 and Older, With Daily or Weekly Amounts Weekly Amounts From Food Groups, Subgroups, From Food Groups, Subgroups, and Components 125 and Components 149 Page iii | Dietary Guidelines for Americans, 2020-2025 List of Figures Figure I-1: Adherence of the U.S. Population to the Figure 3-1: Healthy Eating Index Scores Across Dietary Guidelines Over Time, as Measured by the Childhood and Adolescence 75 Average Total Healthy Eating Index-2015 Scores 4 Figure 3-2: Current Intakes: Figure 1-1: Examples of Calories in Food Choices Ages 2 Through 4 77 That Are Not Nutrient Dense and Calories in Figure 3-3: Average Intakes of Subgroups Nutrient-Dense Forms of These Foods  21 Compared to Recommended Intake Ranges: Figure 1-2: Making Nutrient-Dense Choices: Ages 2 Through 4 78 One Food or Beverage At a Time 22 Figure 3-4: Current Intakes: Ages 5 Through 8 79 Figure 1-3: The Science Underlying the Dietary Figure 3-5: Average Intakes of Subgroups Guidelines Demonstrates That Healthy Eating Compared to Recommended Intake Ranges: Across the Lifespan Can Promote Health and Ages 5 Through 8 80 Reduce Risk of Chronic Disease 24 Figure 3-6: Current Intakes: Figure 1-4: Adherence of the U.S. Population to the Ages 9 Through 13 82 Dietary Guidelines Across Life Stages, as Measured by Average Total Healthy Eating Index-2015 Scores 26 Figure 3-7: Average Intakes of Subgroups Compared to Recommended Intake Ranges: Figure 1-5: Customizing the Dietary Guidelines Ages 9 Through 13 83 Framework 28 Figure 3-8: Current Intakes: Figure 1-6: Dietary Intakes Compared to Ages 14 Through 18 85 Recommendations: Percent of the U.S. Population Ages 1 and Older Who Are Below and At or Above Figure 3-9: Average Intakes of Subgroups Each Dietary Goal 30 Compared to Recommended Intake Ranges: Ages 14 Through 18 86 Figure 1-7: The 85-15 Guide: Percentage of Calories Needed To Meet Food Group Needs With Nutrient- Figure 4-1: Current Intakes: Dense Choices and Percentage Left for Other Uses 37 Ages 19 Through 30 97 Figure 1-8: Making Nutrient-Dense Choices: Figure 4-2: Average Intakes of Subgroups One Meal At a Time 38 Compared to Recommended Intake Ranges: Ages 19 Through 30 98 Figure 1-9: Making Healthy Choices: One Day At a Time 39 Figure 4-3: Current Intakes: Ages 31 Through 59 99 Figure 1-10: Top Sources and Average Intakes of Added Sugars: U.S. Population Ages 1 and Older 43 Figure 4-4: Average Intakes of Subgroups Compared to Recommended Intake Ranges: Figure 1-11: Top Sources and Average Intakes of Ages 31 Through 59 100 Saturated Fat: U.S. Population Ages 1 and Older 45 Figure 5-1: Current Intakes: Women Who Are Figure 1-12: Top Sources and Average Intakes of Pregnant or Lactating 113 Sodium: U.S. Population Ages 1 and Older 47 Figure 5-2: Average Intakes of Subgroups Figure 2-1: Make Healthy Shifts To Empower Compared to Recommended Intake Ranges: Toddlers To Eat Nutrient-Dense Foods in Women Who Are Pregnant or Lactating 114 Dietary Patterns 63 Figure 6-1: Current Intakes: Figure 2-2: Current Intakes: Ages 60 and Older 126 Ages 12 Through 23 Months 65 Figure 6-2: Average Intakes of Subgroups Figure 2-3: Average Intakes of Subgroups Compared to Recommended Intake Ranges: Compared to Recommended Intake Ranges: Ages 60 and Older 127 Ages 12 Through 23 Months 66 Dietary Guidelines for Americans, 2020-2025 — Page iv Message From the Secretaries We are pleased to present the Dietary Guidelines for Americans, 2020-2025. This edition marks the first time the Guidelines provide recommendations by life stage, from birth through older adulthood. Each stage of life is distinct and has unique needs that affect health and disease risk. Early food preferences influence food and beverage choices later. And the science has evolved to focus on the importance of a healthy dietary pattern over time. The science also shows it’s never too late to start and maintain a healthy dietary pattern, which can yield health benefits in the short term and cumulatively over years. This new edition of the Dietary Guidelines includes specific recommendations for all life stages, now including infants and toddlers, and pregnant and lactating women. We are excited this is the first edition to provide guidance for every life stage. This edition of the Dietary Guidelines is grounded in robust scientific reviews of the current body of evidence on key nutrition and health topics for each life stage. We thank the 20 distinguished scientists on the 2020 Dietary Guidelines Advisory Committee for their expertise and dedication in conducting an independent scientific review that was characterized by more transparency and public participation throughout the process than ever before. The Committee’s work culminated in a comprehensive scientific report on the current state of nutrition science and provided advice to the Departments for our development of this 9th edition of the Dietary Guidelines. The Committee also included important considerations for future research, such as a need to reconsider the Dietary Reference Intakes. The U.S. and Canadian Dietary Reference Intake Steering Committees are currently developing plans to re-examine energy, protein, fat, and carbohydrate–the timeline for these macronutrient reviews has not been established. USDA and HHS are looking forward to jointly funding the work to help guide our Departments’ research agendas in the coming years. With the science must come practice—that is, making food and beverage choices that align with the Dietary Guidelines. Using the new edition of the Dietary Guidelines, we hope Americans can find ways to “Start Simple” and incorporate modest changes each day that push Americans closer to meeting the recommendations. It’s more important than ever to make healthy eating a priority in the United States. With the release of the Dietary Guidelines for Americans, 2020-2025, we have an important call to action for you as health professionals and policymakers. We are asking you to help the public “make every bite count with the Dietary Guidelines for Americans.” Help people make food and beverage choices that are rich in nutrition—individual choices that can become a healthy routine over time, choices they can enjoy in good health for many years to come. Thank you for all you do to help Americans make strides toward aligning closer to the Dietary Guidelines as we all work together to help the public lead healthier lives. /Sonny Perdue/ /Alex M. Azar II/ Sonny Perdue Alex M. Azar II Secretary, Secretary, U.S. Department of Agriculture U.S. Department of Health and Human Services Page v | Dietary Guidelines for Americans, 2020-2025 Acknowledgments The U.S. Department of Agriculture and U.S. Department of Health and Human Services acknowledge the work of the 2020 Dietary Guidelines Advisory Committee whose recommendations informed the development of this edition of the Dietary Guidelines for Americans. Dietary Guidelines Advisory Committee Members Barbara Schneeman, PhD; Ronald Kleinman, MD; Jamy Ard, MD; Regan Bailey, PhD, MPH, RD; Lydia Bazzano, MD, PhD; Carol Boushey, PhD, MPH, RD; Teresa Davis, PhD; Kathryn Dewey, PhD; Sharon Donovan, PhD, RD; Steven Heymsfield, MD; Heather Leidy, PhD; Richard Mattes, PhD, MPH, RD; Elizabeth Mayer-Davis, PhD, RD; Timothy Naimi, MD, MPH; Rachel Novotny, PhD, RDN, LD; Joan Sabaté, MD, DrPH; Linda Snetselaar, PhD, RDN; Jamie Stang, PhD, MPH, RD; Elsie Taveras, MD, MPH; Linda Van Horn, PhD, RDN, LD. The Departments also acknowledge the work of the scientists, staff, and policy officials responsible for the production of this document. Policy Officials USDA: Secretary Sonny Perdue, DVM; Brandon Lipps; Pamilyn Miller; Jackie Haven, MS, RD. HHS: Secretary Alex M. Azar II, JD; Brett P. Giroir, MD; Paul Reed, MD; Don Wright, MD, MPH (through March 2020). Dietary Guidelines Writing Team USDA: Eve E. Stoody, PhD; Julie Obbagy, PhD, RD; TusaRebecca Pannucci, PhD, MPH, RD; Stephenie L. Fu; Elizabeth Rahavi, RD; Jean Altman, MS; Meghan Adler, MS, RDN; Clarissa (Claire) Brown, MS, MPH, RDN; Kelley S. Scanlon, PhD, RD. HHS: Janet de Jesus, MS, RD; Richard Olson, MD, MPH; Cria Perrine, PhD; Julia Quam, MSPH, RDN; Katrina Piercy, PhD, RD; Ashley Vargas, PhD, MPH, RDN; Jennifer Lerman, MPH, RD; Dana DeSilva, PhD, RD; Dennis Anderson-Villaluz, MBA, RD, LDN. Editorial Support: Anne Brown Rodgers; Jane Fleming. Reviewers The Departments acknowledge the contributions of numerous other internal departmental scientists and external peer reviewers who provided consultation and review during the production of this document. Finally, the Departments would like to acknowledge the important role of the Federal staff who supported the development of this edition of the Dietary Guidelines, and of those who provided public comments throughout the process. Dietary Guidelines for Americans, 2020-2025 — Page vi Executive Summary The foods and beverages that people consume have Research Act, which states that at least every 5 years, a profound impact on their health. The scientific the U.S. Departments of Agriculture (USDA) and of connection between food and health has been well Health and Human Services (HHS) must jointly publish documented for many decades, with substantial and a report containing nutritional and dietary information increasingly robust evidence showing that a healthy and guidelines for the general public. The statute lifestyle—including following a healthy dietary pattern— (Public Law 101-445, 7 United States Code 5341 et can help people achieve and maintain good health seq.) requires that the Dietary Guidelines be based on and reduce the risk of chronic diseases throughout the preponderance of current scientific and medical all stages of the lifespan: infancy and toddlerhood, knowledge. The 2020-2025 edition of the Dietary childhood and adolescence, adulthood, pregnancy and Guidelines builds from the 2015 edition, with revisions lactation, and older adulthood. The core elements of grounded in the Scientific Report of the 2020 Dietary a healthy dietary pattern are remarkably consistent Guidelines Advisory Committee and consideration of across the lifespan and across health outcomes. Federal agency and public comments. Since the first edition was published in 1980, the Dietary The Dietary Guidelines is designed for policymakers Guidelines for Americans have provided science-based and nutrition and health professionals to help all advice on what to eat and drink to promote health, individuals and their families consume a healthy, reduce risk of chronic disease, and meet nutrient needs. nutritionally adequate diet. The information in Publication of the Dietary Guidelines is required under the Dietary Guidelines is used to develop, implement, the 1990 National Nutrition Monitoring and Related and evaluate Federal food, nutrition, and health policies Page vii | Dietary Guidelines for Americans, 2020-2025 | Executive Summary and programs. It also is the basis for Federal nutrition chronic disease. A fundamental premise of the 2020- education materials designed for the public and for 2025 Dietary Guidelines is that just about everyone, the nutrition education components of USDA and no matter their health status, can benefit from shifting HHS nutrition programs. State and local governments, food and beverage choices to better support healthy schools, the food industry, other businesses, dietary patterns. community groups, and media also use Dietary Guidelines information to develop programs, policies, The second is its focus on dietary patterns. and communication for the general public. Researchers and public health experts, including registered dietitians, understand that nutrients and The aim of the Dietary Guidelines is to promote health foods are not consumed in isolation. Rather, people and prevent disease. Because of this public health consume them in various combinations over time—a orientation, the Dietary Guidelines is not intended dietary pattern—and these foods and beverages act to contain clinical guidelines for treating chronic synergistically to affect health. The Dietary Guidelines diseases. Chronic diseases result from a complex for Americans, 2015-2020 puts this understanding mix of genetic, biological, behavioral, socioeconomic, into action by focusing its recommendations on and environmental factors, and people with these consuming a healthy dietary pattern. The 2020-2025 conditions have unique health care requirements that Dietary Guidelines carries forward this emphasis on the require careful oversight by a health professional. The importance of a healthy dietary pattern as a whole— body of scientific evidence on diet and health reviewed rather than on individual nutrients, foods, or food to inform the Dietary Guidelines is representative of the groups in isolation. U.S. population—it includes people who are healthy, people at risk for diet-related chronic conditions and The third is its focus on a lifespan approach. This diseases, such as cardiovascular disease, type 2 edition of the Dietary Guidelines highlights the diabetes, and obesity, and some people who are living importance of encouraging healthy dietary patterns at with one or more of these diet-related chronic illnesses. every life stage from infancy through older adulthood. It At the same time, it is essential that Federal agencies, provides recommendations for healthy dietary patterns medical organizations, and health professionals adapt by life stage, identifying needs specific to each life stage the Dietary Guidelines to meet the specific needs of and considering healthy dietary pattern characteristics their patients as part of an individual, multifaceted that should be carried forward into the next stage of treatment plan for the specific chronic disease. life. For the first time since the 1985 edition, the 2020- 2025 Dietary Guidelines includes recommendations for healthy dietary patterns for infants and toddlers. Consistent and Evolving The Guidelines Although many recommendations have remained The 2020-2025 Dietary Guidelines provides four relatively consistent over time, the Dietary Guidelines overarching Guidelines that encourage healthy eating also has built upon previous editions and evolved as patterns at each stage of life and recognize that scientific knowledge has grown. The Dietary Guidelines individuals will need to make shifts in their food and for Americans, 2020-2025 reflects this in three beverage choices to achieve a healthy pattern. The important ways: Guidelines also explicitly emphasize that a healthy dietary pattern is not a rigid prescription. Rather, the The first is its recognition that diet-related chronic Guidelines are a customizable framework of core diseases, such as cardiovascular disease, type 2 elements within which individuals make tailored and diabetes, obesity, and some types of cancer, are very affordable choices that meet their personal, cultural, prevalent among Americans and pose a major public and traditional preferences. Several examples of health problem. Today, more than half of adults healthy dietary patterns that translate and integrate have one or more diet-related chronic diseases. As a the recommendations in overall healthy ways to eat result, recent editions of the Dietary Guidelines have are provided. The Guidelines are supported by Key focused on healthy individuals, as well as those with Recommendations that provide further guidance on overweight or obesity and those who are at risk of healthy eating across the lifespan. Dietary Guidelines for Americans, 2020-2025 | Executive Summary | Page viii  The Guidelines Make every bite count with the Dietary Guidelines for Americans. Here’s how: 1 Follow a healthy dietary pattern at every life stage. At every life stage—infancy, toddlerhood, childhood, adolescence, adulthood, pregnancy, lactation, and older adulthood—it is never too early or too late to eat healthfully. For about the first 6 months of life, exclusively feed infants human milk. Continue to feed infants human milk through at least the first year of life, and longer if desired. Feed infants iron-fortified infant formula during the first year of life when human milk is unavailable. Provide infants with supplemental vitamin D beginning soon after birth. At about 6 months, introduce infants to nutrient-dense complementary 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. Include foods rich in iron and zinc, particularly for infants fed human milk. 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. 2 Customize and enjoy nutrient-dense food and beverage choices to reflect personal preferences, cultural traditions, and budgetary considerations. A healthy dietary pattern can benefit all individuals regardless of age, race, or ethnicity, or current health status. The Dietary Guidelines provides a framework intended to be customized to individual needs and preferences, as well as the foodways of the diverse cultures in the United States. 3 Focus on meeting food group needs with nutrient-dense foods and beverages, and stay within calorie limits. An underlying premise of the Dietary Guidelines is that nutritional needs should be met primarily from foods and beverages—specifically, nutrient-dense foods and beverages. Nutrient-dense foods provide vitamins, minerals, and other health-promoting components and have no or little added sugars, saturated fat, and sodium. A healthy dietary pattern consists of nutrient-dense forms of foods and beverages across all food groups, in recommended amounts, and within calorie limits. The 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 or 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, and eggs; seafood; beans, peas, and lentils; and nuts, seeds, and soy products Oils, including vegetable oils and oils in food, such as seafood and nuts Page ix | Dietary Guidelines for Americans, 2020-2025 | Executive Summary  Limit foods and beverages higher in added sugars, saturated fat, and sodium, and 4 limit alcoholic beverages. At every life stage, meeting food group recommendations—even with nutrient-dense choices—requires most of a person’s daily calorie needs and sodium limits. A healthy dietary pattern doesn’t have much room for extra added sugars, saturated fat, or sodium—or for alcoholic beverages. A small amount of added sugars, saturated fat, or sodium can be added to nutrient-dense foods and beverages to help meet food group recommendations, but foods and beverages high in these components should be limited. Limits are: Added sugars—Less than 10 percent of calories per day starting at age 2. Avoid foods and beverages with added sugars for those younger than age 2. Saturated fat—Less than 10 percent of calories per day starting at age 2. Sodium—Less than 2,300 milligrams per day—and even less for children younger than age 14. Alcoholic beverages—Adults of legal drinking age can choose not to drink, or to drink in moderation by limiting intake to 2 drinks or less in a day for men and 1 drink or less in a day for women, when alcohol is consumed. Drinking less is better for health than drinking more. There are some adults who should not drink alcohol, such as women who are pregnant. For most individuals, no matter their age or health status, Terms to Know achieving a healthy dietary pattern will require changes in Several terms are used throughout food and beverage choices. Some of these changes can the Dietary Guidelines and are be accomplished by making simple substitutions, while essential to understanding the others will require greater effort to accomplish. This edition Guidelines and putting them into of the Dietary Guidelines presents overall guidance on action. These terms are defined here: choosing nutrient-dense foods and beverages in place of less healthy choices and also discusses special nutrition Dietary pattern: It is the combination of considerations for individuals at each life stage—infants foods and beverages that constitutes and toddlers, children and adolescents, adults, women who an individual’s complete dietary intake are pregnant or lactating, and older adults. over time. This may be a description of a customary way of eating or a description Although individuals ultimately decide what and how much of a combination of foods recommended to consume, their personal relationships; the settings in for consumption. which they live, learn, work, play, and gather; and other contextual factors—including their ability to consistently Nutrient dense: Nutrient-dense foods access healthy and affordable food—strongly influence and beverages provide vitamins, minerals, their choices. Health professionals, communities, and other health-promoting components businesses and industries, organizations, government, and have little added sugars, saturated and other segments of society all have a role to play in fat, and sodium. Vegetables, fruits, whole supporting individuals and families in making choices grains, seafood, eggs, beans, peas, and that align with the Dietary Guidelines and ensuring that lentils, unsalted nuts and seeds, fat-free all people have access to a healthy and affordable food and low-fat dairy products, and lean meats supply. Resources, including Federal programs that support and poultry—when prepared with no or little households, regardless of size and make-up, in choosing added sugars, saturated fat, and sodium— a healthy diet and improving access to healthy food, are are nutrient-dense foods. highlighted throughout this edition of the Dietary Guidelines for Americans. Dietary Guidelines for Americans, 2020-2025 | Executive Summary | Page x Page 1 Dietary Guidelines for Americans, 2020-2025 | Introduction  Introduction Dietary Guidelines for Americans, 2020-2025 | Introduction | Page 2 Setting the Stage T he foods and beverages that people consume have a profound impact on their health. The scientific connection between food and health has been well documented for many decades, with substantial evidence showing that healthy dietary patterns can help people achieve and maintain good health and reduce the risk of chronic diseases throughout all stages of the lifespan. Yet, Federal data show that from the first edition of the Dietary Guidelines for Americans in 1980 through today, Americans have fallen far short of meeting its recommendations, and diet-related chronic disease rates have risen to pervasive levels and continue to be a major public health concern. The Dietary Guidelines is an important part of a complex, multifaceted approach to promote health and reduce chronic disease risk. The Dietary Guidelines provides science-based advice on what to eat and drink to promote health, help reduce risk of chronic disease, and meet nutrient needs. The Dietary Guidelines is the foundation of Federal food, nutrition, and health policies and programs. An important audience is health professionals and nutrition program administrators who work with the general public to help them consume a healthy and nutritionally adequate diet and establish policies and services to support these efforts. Comprehensive, coordinated strategies built on the science-based foundation of the Dietary Guidelines—and a commitment to drive these strategies over time across sectors and settings—can help all Americans consume healthy dietary patterns, achieve and maintain good health, and reduce the risk of chronic diseases. Grounded in Science and Focused on Public Health The U.S. Departments of Agriculture (USDA) and of Health and Human Services (HHS) update the Dietary Guidelines at least every 5 years, based on the current science. A fundamental premise of the Dietary Guidelines is that everyone, no matter their age, race, or ethnicity, economic circumstances, or health status, can benefit from shifting food and beverage choices to better support healthy dietary patterns. Page 3 Dietary Guidelines for Americans, 2020-2025 | Introduction To make sure that the dietary advice provided in the 60 percent of adults have one or more diet-related chronic Dietary Guidelines is aimed at improving public health, diseases (Table I-1). Given its aim to prevent further the science used to inform the Guidelines has examined disease incidence by promoting health and reducing diet through a lens of health promotion and disease chronic disease risk, the Dietary Guidelines focuses on prevention and considered various segments of the the general public, including healthy individuals, as well United States population, including ethnic populations as those with overweight or obesity and those who are at who have disproportionately and/or historically been risk of chronic disease. The importance of following the affected by diet-related disparities. This means that Dietary Guidelines across all life stages has been brought priority has been placed on scientific studies that into focus even more with the emergence of COVID-19, examine the relationship between diet and health across as people living with diet-related chronic conditions and all life stages, in men, women, and children from diverse diseases are at an increased risk of severe illness from racial and ethnic backgrounds, who are healthy or at risk the novel coronavirus. of chronic disease. Grounded in the current body of scientific evidence Over time, eating patterns in the United States have on diet and health that is relevant to all Americans, remained far below Dietary Guidelines recommendations the Dietary Guidelines is a critically important tool for (Figure I-1). Concurrently, it has become increasingly health professionals, policymakers, and many other clear that diet-related chronic diseases, such as professionals. It is designed to help people make food cardiovascular disease, type 2 diabetes, obesity, liver and beverage choices all through life that are enjoyable disease, some types of cancer, and dental caries, pose and affordable and that also promote health and help a major public health problem for Americans. Today, prevent chronic disease. Figure I-1 Adherence of the U.S. Population to the Dietary Guidelines Over Time, as Measured by the Average Total Healthy Eating Index-2015 Scores 100 80 Maximum Total Score = 100 60 57 59 60 59 59 56 40 20 0 2005-2006 2007-2008 2009-2010 2011-2012 2013-2014 2015-2016 NOTE: HEI-2015 total scores are out of 100 possible points. A score of 100 indicates that recommendations on average were met or exceeded. A higher total score indicates a higher quality diet. Data Source: Analysis of What We Eat in America, National Health and Nutrition Examination Survey (NHANES) data from 2005-2006 through 2015-2016, ages 2 and older, day 1 dietary intake data, weighted. Dietary Guidelines for Americans, 2020-2025 | Introduction | Page 4 Table I-1 Facts About Nutrition-Related Health Conditions in the United States HEALTH CONDITIONS STATISTICS About 74% of adults are overweight or have obesity. Adults ages 40 to 59 have the highest rate of obesity (43%) of any age group with adults Overweight and Obesity 60 years and older having a 41% rate of obesity. About 40% of children and adolescents are overweight or have obesity; the rate of obesity increases throughout childhood and teen years. Heart disease is the leading cause of death. About 18.2 million adults have coronary artery disease, the most common type of heart disease. Stroke is the fifth leading cause of death. Cardiovascular Disease (CVD) and Risk Factors: Hypertension, high LDL cholesterol, and high total cholesterol are major risk factors in heart disease and stroke. Coronary artery disease Rates of hypertension and high total cholesterol are higher in adults with obesity than Hypertension those who are at a healthy weight. High LDL and total blood About 45% of adults have hypertension.a cholesterol More Black adults (54%) than White adults (46%) have hypertension. Stroke More adults ages 60 and older (75%) than adults ages 40 to 59 (55%) have hypertension. Nearly 4% of adolescents have hypertension.b More than 11% of adults have high total cholesterol, ≥240 mg/dL. More women (12%) than men (10%) have high total cholesterol, ≥240 mg/dL. 7% of children and adolescents have high total cholesterol, ≥200 mg/dL. Almost 11% of Americans have type 1 or type 2 diabetes. Almost 35% of American adults have prediabetes, and people 65 years and older have the highest rate (48%) compared to other age groups. Diabetes Almost 90% of adults with diabetes also are overweight or have obesity. About 210,000 children and adolescents have diabetes, including 187,000 with type 1 diabetes. About 6-9% of pregnant women develop gestational diabetes. Colorectal cancer in men and breast cancer in women are among the most common types of cancer. Cancer c About 250,520 women will be diagnosed with breast cancer this year. Breast Cancer Close to 5% of men and women will be diagnosed with colorectal cancer at some point during their lifetime. Colorectal Cancer More than 1.3 million people are living with colorectal cancer. The incidence and mortality rates are highest among those ages 65 and older for every cancer type. More women (17%) than men (5%) have osteoporosis. Bone Health and 20% of older adults have reduced muscle strength. Muscle Strength Adults over 80 years, non-Hispanic Asians, and women are at the highest risk for reduced bone mass and muscle strength. a For adults, hypertension is defined as systolic blood pressure (SBP) >130 mm Hg and/or a diastolic blood pressure (DBP) >90 mm Hg. b For children, hypertension was defined using the 2017 American Academy of Pediatrics (AAP) Clinical Practice Guideline. c The types of cancer included here are not a complete list of all diet- and physical activity-related cancers. Page 5 Dietary Guidelines for Americans, 2020-2025 | Introduction A Spotlight on Dietary Patterns Although many of its recommendations have remained relatively consistent over time, the Dietary Guidelines has evolved as scientific knowledge has grown. Early Dietary Guidelines editions used evidence that examined the relationships between individual nutrients, foods, and food groups and health outcomes. In recent years, researchers, public health experts, and registered dietitians have acknowledged that nutrients and foods are not consumed in isolation. Rather, people consume them in various combinations over time—a dietary pattern—and these foods and beverages act synergistically to affect health. The 2015-2020 Dietary Guidelines put this understanding into action by focusing its recommendations on consuming a healthy dietary pattern. The 2020-2025 Dietary Guidelines carries forward this emphasis on the importance of a healthy dietary pattern as a whole— rather than on individual nutrients or foods in isolation. Serving as a framework, the Guidelines’ dietary patterns approach enables policymakers, programs, and health professionals to help people personalize their food and beverage choices to accommodate their wants and needs, food preferences, cultural traditions and customs, and budgetary considerations. Healthy Dietary Patterns at Every Life Stage The 2020-2025 Dietary Guidelines takes the dietary patterns approach one step further by focusing on the importance of encouraging healthy dietary patterns at every stage of life, from birth to older adulthood. It provides recommendations for healthy dietary patterns by life stage, identifying needs specific to each life stage and considering healthy dietary pattern characteristics that should be carried forward into the next stage of life. And, for the first time since the 1985 edition, this edition of the Dietary Guidelines includes recommendations for infants and toddlers as well as continuing the emphasis on healthy dietary patterns during pregnancy and lactation. This approach recognizes that each life stage is distinct—nutrient needs vary over the lifespan and each life stage has unique implications for food and beverage choices and disease risk. At the same time, it recognizes an important continuity. Because early food preferences influence later food choices, establishing a healthy dietary pattern early in life may have a beneficial impact on health promotion and disease prevention over the course of decades. Dietary Guidelines for Americans, 2020-2025 | Introduction | Page 6 Dietary Guidelines for population, including healthy individuals and people at risk of diet-related chronic conditions and diseases, Americans: What It Is, such as cardiovascular disease, type 2 diabetes, or obesity, and some people who are living with a diet- What It Is Not related chronic illness. The Dietary Guidelines translates the current science Because of this public health orientation, the Dietary on diet and health into guidance to help people choose Guidelines is not intended to be a clinical guideline foods and beverages that comprise a healthy and for treating chronic diseases. However, the Dietary enjoyable dietary pattern—the “what” and “how much” Guidelines often has served as a reference for Federal, of foods and beverages to consume to achieve good medical, voluntary, and patient care organizations health, reduce risk of diet-related chronic diseases, and as they develop clinical nutrition guidance tailored meet nutrient needs. The Dietary Guidelines is just one for people living with a specific medical condition. piece of the nutrition guidance landscape, however. Chronic diseases result from a complex mix of Other guidance is designed to address requirements for genetic, biological, behavioral, socioeconomic, and the specific nutrients contained in foods and beverages environmental factors, and people with these conditions or to address treatments for individuals who have a have unique health care requirements that require chronic disease. The following section describes the careful oversight by a health professional. Health role of the Dietary Guidelines within this larger nutrition professionals can adapt the Dietary Guidelines to guidance landscape. meet the specific needs of their patients with chronic diseases, as part of a multi-faceted treatment plan. Quantitative Guidance on Foods, Not Nutrient Requirements Nutrient requirements are established and updated Developing the by the National Academies of Sciences, Engineering, and Medicine. At the request of the U.S. and Canadian Dietary Guidelines Federal Governments, the Academies set the quantitative requirements or limits—known as Dietary for Americans Reference Intakes (DRI)—on nutrients, which include The process to develop the Dietary Guidelines has macronutrients (i.e., protein, carbohydrates, and fats), evolved over time, in step with developments in nutrition vitamins and minerals (e.g., vitamin C, iron, and sodium), science, public health, and best practices in scientific and food components (e.g., dietary fiber). review and guidance development. USDA and HHS work together to determine the approach for each edition. Because foods provide an array of nutrients and other components that have benefits for health, nutritional As stipulated by law, USDA and HHS must update the needs should be met primarily through foods. Thus, Dietary Guidelines at least every 5 years. The Guidelines the Dietary Guidelines translates the Academies’ must be grounded in the body of scientific and medical nutrient requirements into food and beverage knowledge available at that time, not in individual recommendations. The Dietary Guidelines recognizes, studies or individual expert opinion. In establishing the though, that in some cases, fortified foods and process for the 2020-2025 Dietary Guidelines, USDA dietary supplements are useful when it is not possible and HHS considered and integrated recommendations otherwise to meet needs for one or more nutrients (e.g., from a comprehensive 2017 National Academies’ during specific life stages such as pregnancy). study, Review of the Process to Update the Dietary Guidelines. Greater transparency figured prominently Health Promotion, Not Disease Treatment in the Academies’ recommendations. As a result, in At its core, the Dietary Guidelines has a public health developing the 2020-2025 process, USDA and HHS mission—that is, health promotion and disease made significant changes to increase transparency and prevention. Medical and nutrition professionals may public participation while maintaining the core element use or adapt the Dietary Guidelines to encourage their of scientific integrity. patients or clients to follow a healthy dietary pattern. The body of current scientific evidence on diet and One of these changes was the addition of a new stage health reviewed to inform the Dietary Guidelines at the beginning of the process. Thus, the 2020-2025 included study participants who represent the U.S. process consisted of four stages: (1) identify the topics Page 7 Dietary Guidelines for Americans, 2020-2025 | Introduction  Stage 1: Stage 2: Stage 3: Stage 4: IDENTIFY Topics APPOINT a Dietary DEVELOP the IMPLEMENT the and Supporting Guidelines Advisory Dietary Guidelines Dietary Guidelines Scientific Questions Committee to Review Evidence and supporting scientific questions to be examined; and Federal agencies 30 days to view and provide (2) appoint a Dietary Guidelines Advisory Committee comments. Following review of the comments, USDA to review current scientific evidence; (3) develop the and HHS posted the final topics and questions, along new edition of the Dietary Guidelines; and (4) implement with the public call for nominations to the 2020 the Dietary Guidelines through Federal programs. Committee. Having topics and questions identified The following information provides an overview of upfront helped inform the public’s nominations by the 4-stage process. More details are available at defining which areas of nutrition expertise were needed DietaryGuidelines.gov. on the Committee. Stage 1: Identify Topics and Supporting Stage 2: Appoint a Dietary Guidelines Scientific Questions Advisory Committee To Review Current The Departments added a new step of identifying Scientific Evidence topics and scientific questions to begin the process In the second stage, the Secretaries of USDA and HHS of developing the next Dietary Guidelines. This was appointed the Committee with the single, time-limited done to promote a deliberate and transparent process, task of reviewing the 2015-2020 Dietary Guidelines, better define the expertise needed on the Committee, examining the evidence on the selected nutrition and ensure the scientific review conducted by the and public health topics and scientific questions, Committee would address Federal nutrition policy and and providing independent, science-based advice program needs and help manage resources. and recommendations to USDA and HHS. The 20 nationally recognized scientific experts appointed to In consultation with agencies across the Federal the Committee represented a mix of practitioners, Government, USDA and HHS identified potential epidemiologists, scientists, clinical trialists, and others topics and supporting scientific questions that were of from every region of the United States. greatest importance and relevance to Federal nutrition programs, policies, and consumer education priorities. The use of a Federal advisory committee is a commonly Compared to all previous Dietary Guidelines processes, used best practice to ensure the Federal Government the topic areas for 2020-2025 expanded due to the seeks sound, external scientific advice to inform added focus on infants and toddlers from birth through decisions. The Committee’s work concluded with its age 23 months, as well as women who are pregnant. scientific report submitted to the Secretaries of USDA The Agricultural Act of 2014 mandated that, beginning and HHS in June 2020.1 This report was not a draft of with the 2020-2025 edition, the Dietary Guidelines the Dietary Guidelines; it was a scientific document that should expand to include dietary guidance for these detailed the Committee’s evidence review and provided populations. Thus, the topics and questions—and areas advice to USDA and HHS. of expertise needed on the Committee—reflected this change. The Committee was divided into six subcommittees to conduct its work: Dietary Patterns, Pregnancy and The Departments posted the topics and questions Lactation, Birth to Age 24 Months, Beverages and publicly on DietaryGuidelines.gov, allowing the public Added Sugars, Dietary Fats and Seafood, and Frequency 1 Dietary Guidelines Advisory Committee. 2020. Scientific Report of the 2020 Dietary Guidelines Advisory Committee: Advisory Report to the Secretary of Agriculture and the Secretary of Health and Human Services. U.S. Department of Agriculture, Agricultural Research Service, Washington, DC. Dietary Guidelines for Americans, 2020-2025 | Introduction | Page 8 of Eating. The Committee also formed one cross-cutting working group—Data Analysis and Food Pattern Modeling— to support work across the subcommittees. The Committee’s work had three defining characteristics: the use of three approaches to examine the evidence, the creation of transparent protocols before the evidence review began, and the development of scientific review conclusion statements for the scientific reviews conducted. THREE APPROACHES TO EXAMINE THE EVIDENCE The 2020 Committee used three state-of-the-art approaches to conduct its robust and rigorous reviews: Data analysis: Using Federal, nationally representative data, this approach provided insights into current eating habits of the U.S. population and current diet-related chronic Food pattern modeling: This type of analysis disease rates in the United States. These data illustrates how changes to the amounts or helped make the Dietary Guidelines practical, types of foods and beverages in a dietary relevant, and achievable. pattern might affect meeting nutrient needs across the U.S. population. The Committee used data analysis to address scientific questions that looked at current dietary The Committee used this method to assess patterns and beverage consumption, current potential changes to the USDA Dietary intakes of food groups and nutrients, dietary Patterns, which help meet the DRIs set by components of public health concern, prevalence the National Academies, while taking into of nutrition-related chronic health conditions, and consideration current consumption in the relationships between eating habits and achieving United States and the conclusions from nutrient and food group recommendations. its systematic reviews. As with all food pattern modeling for the Dietary Guidelines, Nutrition Evidence Systematic Review (NESR): the results of the Committee’s food pattern Systematic reviews are research projects that modeling tests were interpreted in light of follow meticulously defined protocols (i.e., plans) two key assumptions. First, the modeling to answer clearly formulated scientific questions tests were based on nutrient profiles of by searching for, evaluating, and synthesizing nutrient-dense foods in the U.S. food supply all relevant, peer-reviewed studies. Systematic and U.S. population-based dietary data. reviews are considered a gold standard method to Population-based patterns articulate the inform development of evidence-based guidelines evidence on the relationships between diet by ensuring consideration of the strongest, most and health in ways that might be adopted by appropriate body of evidence available on a topic. the U.S. public as a whole. Second, modeling USDA’s Nutrition Evidence Systematic Review is a tests assumed population-wide compliance team of scientists who specializes in conducting with all food intake recommendations. systematic reviews focused on nutrition and As with other types of modeling, the food disease prevention and evaluating scientific pattern modeling is hypothetical and does evidence on nutrition topics relevant to Federal not predict the behaviors of individuals. policy and programs. NESR used its rigorous, protocol-driven methodology to support the Each of these approaches had its own rigorous, Committee in conducting its systematic reviews. protocol-driven methodology, and each had a New to the 2020 process, USDA and HHS added a unique, complementary role in examining the step for peer review of the systematic reviews by science. Additional detailed information is available Federal scientists. at DietaryGuidelines.gov and NESR.usda.gov. Page 9 Dietary Guidelines for Americans, 2020-2025 | Introduction TRANSPARENT PROTOCOLS FIRST, THEN REVIEW To answer each scientific question, the Committee Health Status of Participants in first created a protocol that described how the Studies Included in Nutrition Committee would apply one of the three approaches Evidence Systematic Reviews to examine the evidence related to that specific To ensure that the Dietary Guidelines promotes question. The Committee created each protocol the health of and reduce risk of disease among before examining any evidence, and, for the first time, all Americans, the evidence base that informs the protocols were posted online for the public as the Dietary Guidelines must comprise studies they were being developed. This enabled the public conducted with people who are representative of to understand how a specific scientific question the general public and must examine diet through would be answered and to have the opportunity to a health promotion and disease prevention lens. submit public comments before the Committee completed the protocols and conducted its reviews As outlined in the Committee’s systematic review of the scientific evidence. Detailed information on the protocols, the Committee’s reviews included Committee’s review is documented in its scientific studies with participants who were healthy and/ report, which is available on DietaryGuidelines.gov. or who were at risk of a chronic disease, including participants with obesity, as well as studies that enrolled some participants with a disease. Because the Dietary Guidelines is not intended to be a clinical guideline for treating chronic diseases, the Committee excluded studies that enrolled only patients with a disease with the intention to treat those individuals. In general, the majority of the reviews conducted to inform the Dietary Guidelines included trials that exclusively enrolled participants with overweight or obesity, or who were at high risk of cardiovascular disease or type 2 diabetes, and observational studies that enrolled participants from a wide range of health and weight status, including those with healthy weight, overweight, or obesity. The reviews included few studies that enrolled only healthy participants. Thus, the Dietary Guidelines are applicable to the overall U.S. population, including healthy individuals and people at risk of diet-related chronic conditions and diseases, such as cardiovascular disease, type 2 diabetes, and obesity. In addition, people living with a diet- related chronic illness can benefit from a healthy dietary pattern. The Dietary Guidelines can serve as a reference for Federal, medical, voluntary, and patient care organizations as they develop nutrition guidance tailored for people living with a specific medical condition. Health professionals can adapt the Dietary Guidelines to meet the specific needs of their patients with chronic diseases, as part of a multifaceted treatment plan. Dietary Guidelines for Americans, 2020-2025 | Introduction | Page 10 CONCLUSION STATEMENTS FOR THE SCIENTIFIC Grading the strength of the evidence applied only to REVIEWS CONDUCTED questions answered using NESR systematic reviews; it did not apply to questions answered using data For all topics and questions, regardless of the analysis or food pattern modeling. Therefore, data approach used to identify and evaluate the scientific analysis and food pattern modeling conclusion evidence, the Committee developed conclusion statements were not graded. statements. Each conclusion statement provided a succinct answer to the specific question posed. The As it completed its work, the Committee looked Committee took the strengths and limitations of the across all of the conclusion statements to develop evidence base into consideration when formulating overarching advice for USDA and HHS to consider as conclusion statements. the Departments developed the next edition of the Dietary Guidelines. For questions answered using NESR systematic reviews, the conclusion statements included a grade Using these three approaches, the Committee worked to indicate the strength of the evidence supporting collaboratively for 16 months and deliberated on the the conclusion statement. The grades were Strong, scientific reviews in six meetings, all of which were Moderate, Limited, or Grade Not Assignable. open to the public. Two of the six meetings included an opportunity for the public to provide oral comments to the Committee. An ongoing period for written public comments to the Committee spanned 15 months of its work. And, for the first time, a final public meeting was included for the Committee to discuss its draft scientific report 1 month before the final report was posted for public comment. In addition to documenting its rigorous review of the evidence to answer the scientific questions from USDA and HHS and providing advice for the Departments’ development of the next Dietary Guidelines edition, the Committee provided recommendations for future research. These research recommendations reflected an acknowledgment that science in nutrition, diet, and health associations continues to evolve, and that new findings build on and enhance existing evidence. Upon submitting its final scientific report to the USDA and HHS Secretaries, the Committee disbanded. The Departments then posted the scientific report and asked the public for comments. The Departments received written comments on the report over a 30-day period and also held an online meeting to hear oral comments. Stage 3: Develop the Dietary Guidelines Each edition of the Dietary Guidelines builds on the preceding edition, with the scientific justification for revisions informed by the Committee’s scientific report and consideration of public and Federal agency comments. As with previous editions, development of the 2020-2025 Dietary Guidelines involved a step-by- step process of writing, review, and revision conducted by a writing team of Federal staff from USDA and HHS. Page 11 Dietary Guidelines for Americans, 2020-2025 | Introduction The writing team included Federal nutrition scientists This process culminated with approval by the with expertise in the Dietary Guidelines and related Secretaries of USDA and HHS. After approval by the research and programs as well as specialists with Secretaries, the Departments released the Dietary expertise in communicating nutrition information. Guidelines to Federal agencies and the public for implementation across programs and through Key tenets of writing the Dietary Guidelines are that educational activities. it must: Stage 4: Implement the Dietary Guidelines Represent the totality of the evidence examined The U.S. Government uses the Dietary Guidelines as the basis of its food assistance and meal programs, Address the needs of Federal programs nutrition education efforts, and decisions about national health objectives. For example, the National School Reduce unintended consequences Lunch Program and the Older Americans Act Nutrition Program incorporate the Dietary Guidelines in menu Follow best practices for developing guidelines planning; the Special Supplemental Nutrition Program for Women, Infants, and Children applies the Dietary Use plain language Guidelines in its program and educational materials; and the Healthy People objectives for the Nation include The draft Dietary Guidelines went through internal and objectives based on the Dietary Guidelines. external review. Ultimately, the document was reviewed by all Agencies with nutrition policies and programs The Dietary Guidelines also provides a critical structure across USDA and HHS, such as USDA’s Food and for State and local public health promotion and Nutrition Service and its Food Safety and Inspection disease prevention initiatives. In addition, it provides Service, and HHS’ National Institutes of Health, Food and foundational, evidence-based nutrition guidance for Drug Administration, and Centers for Disease Control use by individuals and those who serve them in public and Prevention. The draft Dietary Guidelines also went and private settings, including health professionals, through an external expert peer review to ensure that it public health and social service agencies, health care accurately reflected the body of evidence documented in and educational institutions, researchers, agricultural the Committee’s scientific report. producers, food and beverage manufacturers, and more. Dietary Guidelines for Americans, 2020-2025 | Introduction | Page 12  Implementation of the Dietary Guidelines Through MyPlate Using MyPlate as a Guide To Support Healthy Dietary Patterns The Dietary Guidelines for Americans is developed and written for a professional audience. Therefore, its translation into actionable consumer messages and resources is crucial to help individuals, families, and communities achieve healthy dietary patterns. MyPlate is one example of consumer translation. Created to be used in various settings and adaptable to meeting personal preferences, cultural foodways, traditions, and budget needs, MyPlate is used by professionals across sectors to help people become more aware of and informed about making healthy food and beverage choices over time. More information is available at MyPlate.gov. Following a healthy dietary pattern from birth through older adulthood can have a profound impact on a person’s lifelong health. The Dietary Guidelines provides the framework for following such a pattern. However, broad and multisector collaboration is needed to help people achieve that goal. Action on many fronts is needed to ensure that healthy dietary choices at home, school, work, and play are the affordable, accessible norm. Everyone has a role to play in helping all Americans shift to a healthy dietary pattern and achieve better health. Try the MyPlate Plan A healthy eating routine is important at every stage of life and can have positive effects that add up over time. It’s important to eat a variety of fruits, vegetables, grains, dairy or fortified soy alternatives, and protein foods. When deciding what to eat or drink, choose options that are full of nutrients. Make every bite count. Think about how the following recommendations can come together over the course of your day or week to help you create a healthy eating routine: Make half your plate Move to low-fat or fruits & vegetables. fat-free dairy milk or yogurt (or lactose- free dairy or fortified Focus Make half soy versions). on whole your grains fruits. whole grains. To learn what the right amounts Vary your are for you, try Vary your protein the personalized veggies. routine. MyPlate Plan.2 Based on decades of solid science, MyPlate advice can help you day to day and over time. Choose foods and beverages with less added sugars, saturated fat, and sodium. The benefits of healthy eating add up over time, bite by bite. Small changes matter. Start Simple with MyPlate. with MyPlate 2 Available at: MyPlate.gov/myplate-plan Page 13 Dietary Guidelines for Americans, 2020-2025 | Introduction A Roadmap to the Dietary Guidelines 1 for Americans, 2020-2025 Reflecting the accumulating body of evidence Patterns for this age group, about the relationships between diet and health explains how current intakes outcomes, the 2020-2025 Dietary Guidelines presents compare to recommendations, its recommendations with a primary emphasis on and discusses special dietary 2 encouraging the consumption of a healthy overall guidance considerations for dietary pattern at every stage of life, from birth adults. The chapter concludes with through older adulthood. This edition of the Dietary suggestions for how to support healthy Guidelines consists of an Executive Summary, this dietary patterns among adults and a look Introduction, six chapters, and three appendixes. toward two important adult life stages—Women Who Are Pregnant or Lactating and Older Adults. Chapter 1: Nutrition and Health Across the Lifespan: The Guidelines and Key Chapter 5: Women Who Are Pregnant 3 Recommendations discusses the health or Lactating opens with a discussion of benefits of lifelong healthy dietary choices and selected nutrition issues important to this explains the four Guidelines and supporting Key stage of adult life. It then presents Recommendations. This chapter is the basis for the recommended Healthy Dietary all the succeeding chapters. Chapters 2 through 6 Patterns for this life stage, should be read in tandem with Chapter 1. explains how current intakes compare to recommendations, Chapter 2: Infants and Toddlers is the first of five and discusses special dietary 4 chapters that focus on healthy dietary patterns guidance considerations for for a specific life stage. This edition of the Dietary women who are pregnant Guidelines is the first since the 1985 edition to or lactating. The chapter provide guidance for infants and toddlers (birth concludes with suggestions through age 23 months). The chapter provides for how to support healthy specific key recommendations for this age dietary patterns among this group, along with guidance on how to put these population group. recommendations into action. The chapter closes 5 with a Healthy Dietary Pattern during the second Chapter 6: Older Adults opens with a year of life and a look toward the next life stage— discussion of selected nutrition issues that Children and Adolescents. are important for older adults, ages 60 and older. It then presents the recommended Chapter 3: Children and Adolescents first sets Healthy Dietary Patterns for this life the stage by describing nutrition issues specific stage, explains how current intakes to children and adolescents ages 2 through 18. It compare to recommendations, and then presents the recommended Healthy Dietary discusses special dietary guidance 6 Patterns for this age group, explains how current considerations for this age group. intakes compare to recommendations, and The chapter concludes with discusses special dietary guidance considerations suggestions for how to support for this life stage. The chapter concludes with healthy dietary patterns among a discussion of ways to support healthy dietary older adults. patterns among children and adolescents and a look toward the next life stage—Adults. Appendixes include a table summarizing nutritional goals for A Chapter 4: Adults opens with a discussion of age-sex groups, estimated calorie selected nutrition issues that characterize the needs for all ages and at three adult life stage (ages 19 through 59). It then physical activity levels, and the USDA presents the recommended Healthy Dietary Dietary Patterns.