Nutrition Guidelines and Assessment

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION o, you wantNOT to be FOR healthier—maybe SALE OR that’sDISTRIBUTION why you are taking this course! You probably already know that a well-planned diet is one important S element of being healthy. Although most of us know that the foods we choose to eat have a major impact on our health, we aren’t always certain about what choices to make. Choosing the right foods isn’t made any easier when © Jones & Bartlettwe are Learning, bombarded LLCby headlines and advertisements:© Jones Eat less & Bartlettfat! Get more Learning, LLC NOT FOR SALEfi berOR in DISTRIBUTION your diet! Moderation is the key! BuildNOT strong FOR bones SALE with calcium! OR DISTRIBUTION For many Americans, nutrition is simply a lot of hearsay, or maybe the latest slogan coined from last week’s news headlines. Conversations about nutrition start with “They say you should …” or “Now they think that …” Have you ever wondered who “they” are and why “they” are telling you what © Jones & Bartlett Learning,to eatLLC or what not to eat? © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION It’s no secret that a healthy NOTpopulation FOR is SALE a more OR productive DISTRIBUTION population, so many of our nutrition guidelines come from the federal government’s efforts to improve our overall health. Thus, the government is one “they.” Undernutri- tion and overnutrition are examples of two nutrition problems that government policy has helped to correct. © Jones & Bartlett Learning, LLC Many important© Jones elements & Bartlett of nutrition Learning, policy focus LLC on relieving under- NOT FOR SALE OR DISTRIBUTION nutrition in someNOT population FOR SALE groups. OR Let’s DISTRIBUTION look at some examples. To prevent widespread defi ciencies, the government requires food manufacturers to add nutrients to certain foods: iodine to salt, vitamin D to milk, and thiamin, ribofl avin, niacin, iron, and folic acid to enriched grains. Another example is the publication of dietary standards, such as the Dietary Reference Intakes, © Jones & Bartlettwhich Learning,make it easier LLC to defi ne adequate diets for© largeJones groups & Bartlett of people. Learning, LLC NOT FOR SALE OROvernutrition DISTRIBUTION has led to changes in public policyNOT as FOR well. Health SALE research- OR DISTRIBUTION ers have discovered links between diet and obesity, high blood pressure, cancer, and heart disease; as a result, nutritionists suggest that we make informed food choices by reducing our intake of excess calories, sodium, saturated fats, and trans fats, while being physically active. Another aspect of nutrition policy is © Jones & Bartlett Learning,shaped LLC by the public’s need to ©know Jones what & is Bartlettin the food Learning, they eat. This LLC need NOT FOR SALE OR DISTRIBUTIONhas led to increased nutrition informationNOT FOR on SALE food labels.OR DISTRIBUTION Public education efforts have resulted in the development of teaching tools such as MyPlate. New information about diet and health will continue to drive public policy. This chapter explores diet-planning tools, dietary guidelines, and current dietary standards and discusses how to evaluate nutritional health. How © Jones & Bartlett Learning, LLC does your diet ©compare Jones with & Bartlett these current Learning, guidelines LLC and standards? NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Quick Bite Linking Nutrients, Foods, and Health We all know that what we eat affects our health. Nutrition science has made Early “Laws” of Health many advances in identifying essential nutrients and the foods in which they Galen might be the best-known physician© who Jones & Bartlettare found. Learning, Eating foods LLC with all the essential nutrients© Jones prevents & Bartlett nutritional Learning, LLC ever lived. During the second century, Galen defi ciencies such as scurvy (vitamin C defi ciency) or pellagra (defi ciency of expounded his “laws of health”—eat properNOT foods, FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION drink the right beverages, exercise, breathe fresh air, get the B vitamin niacin). In the United States, few people suffer nutritional defi - enough sleep, have a daily bowel movement, and control ciencies as a result of dietary inadequacies. More often, Americans suffer from 1 your emotions. chronic diseases such as heart disease, cancer, hypertension, and diabetes—all linked to overconsumption and lifestyle choices. Your future health depends © Jones & Bartlett Learning,on LLC today’s lifestyle choices, including© Jones your & food Bartlett choices. Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Planning How You Will Eat Living in a high-tech world, we expect immediate solutions to long-term problems. It would be too easy if we could avoid the consequences of overeating by taking a pill, drinking a beverage, or getting a shot. But no magic food, © Jones & Bartlett Learning, LLC nutrient, or drug© exists.Jones Instead, & Bartlett we have Learning, to rely on healthful LLC foods, exercise, NOT FOR SALE OR DISTRIBUTION and lifestyle choicesNOT toFOR reduce SALE our risk OR of DISTRIBUTION chronic disease.

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALEMany ORtools DISTRIBUTION are available to help us select healthful NOTfoods toFOR eat. TheSALE U.S. OR DISTRIBUTION Department of Agriculture’s MyPlate food guidance system and the Exchange Lists are two common and comprehensive tools. Although different, these tools rely on the same core nutrition concepts: adequacy, balance, calorie (energy) control, nutrient density, moderation, and variety. Furthermore, these resources use a total© Jones diet approach & Bartlett to ensure Learning, nutritional LLC adequacy and © Jones & Bartlett Learning, LLC choices of healthful food.NOT1 FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Adequacy Having an adequate diet means that the foods you choose to eat provide all the essential nutrients, fi ber, and energy in amounts suffi cient to support growth and maintain© Jones health. & Bartlett 2 Many Learning,Americans consume LLC more calories than ©they Jones & Bartlett Learning, LLC need NOTwithout FOR getting SALE 100 percentOR DISTRIBUTION of the recommended intakes for a numberNOT FOR SALE OR DISTRIBUTION of nutrients. Take, for example, a meal of soda pop, two hard-shell beef tacos, and cinnamon breadsticks. Although this meal provides foods from different food groups, it is high in sugar and fat and low in many vitamins and minerals found in fruit and vegetables. Occasionally skipping fruits and vegetables © Jones &at aBartlett meal does Learning, not create LLCa vitamin or mineral defi ciency;© Jones however, & Bartlett dietary Learning, LLC NOT FORhabits SALE that OR skimp DISTRIBUTION on fruit and vegetables most of the timeNOT provide FOR an SALE overall OR DISTRIBUTION inadequate diet. Most people could improve the adequacy of their diet by choosing meals and snacks that are high in vitamins and minerals but low to moderate in energy (calorie) content. Doing so offers important benefi ts: normal growth and development of children, health promotion for people of all ages, and reduction© Jones of risk & for Bartlett a number Learning, of chronic diseasesLLC that are © Jones & Bartlett Learning, LLC major public health problems.NOT FOR 3 SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Balance A healthful diet requires a balance of food groups (grains, vegetables, fruits, oil, milk, and meat and beans), energy sources (carbohydrates, protein, and fat), and© Jones other nutrients & Bartlett (vitamins Learning, and minerals). LLC Your diet is balanced if© the Jones & Bartlett Learning, LLC amountNOT of energyFOR SALE(calories) OR you DISTRIBUTION eat equals the amount of energy you expendNOT FOR SALE OR DISTRIBUTION in daily activities and exercise. Also your diet can be balanced in a comple- mentary way when the foods you choose to eat provide you with adequate nutrients. The trick is to consume enough, but not too much, from all the Quick Bite different food groups. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, How Much Do LLC Doctors and Dentists Know About Nutrition? NOT FOR Calorie SALE Control OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION It can be a challenge to identify the amount of calories you need to maintain Nutrition training in medical schools and residency programs has been identifi ed as an essential component of or achieve a healthy weight. The key is to choosing an adequate diet that medical education by numerous organizations, including balances the calories you eat with the amount of calories your body uses to the American Society for Clinical Nutrition, the American sustain your metabolic and physical activities. The formula for weight main- Medical Student Association, the National Academy of tenance seems simple:© If Jones you eat &the Bartlett same amount Learning, of calories LLC that you use Sciences, ©and theJones U.S. Congress, & which Bartlett passed the National Learning, LLC Nutritional Monitoring and Related Research Act of 1990 each day, your weightNOT will stay FOR the SALEsame. If OR you DISTRIBUTIONeat more than you use, you mandatingNOT nutrition FORas a part of SALE the medical schoolOR curricu- DISTRIBUTION will gain weight, and if you eat less than you use, you will lose weight. This lum. Findings indicate, however, that signifi cant variation in chapter focuses on how to choose foods by learning how to get the most nutrition knowledge of U.S. medical students exists and that nutrients without wasting calories. This is a lesson on budgeting. the amount of time medical schools spend on nutrition education varies signifi cantly, ranging from a mandatory course Nutrient© Jones Density & Bartlett Learning, LLC © Jones in& nutrition Bartlett to nutrition Learning, education being a component LLC of another required course. The concernNOT FOR that Americans’SALE OR diets DISTRIBUTION are becoming increasingly energy richNOT but FORSources: SALE Data from OR National DISTRIBUTION Nutritional Monitoring and nutrient poor has focused attention on the nutrient content of individual Related Research Act of 1990. Public Law 1101-445/HR 1608, foods relative to the energy they provide. 4 The Dietary Guidelines Advisory section 302; Endevelt R, Shahar DR, Henkin Y. Development Committee report and the Dietary Guidelines for Americans confi rm that and implementation of a nutrition education program for 5 medical students: a new challenge. Education for Health. many Americans are overweight or obese, yet many are undernourished. 2006;19(3):321–330; and Schaeﬀ er J. Medical school checkup. © Jones &Understanding Bartlett Learning, nutrient density LLC can help you meet your nutrient© Jones needs & without Bartlett Learning,Today’s Dietitian. 2011;13(3):18.LLC NOT FORgetting SALE too OR many DISTRIBUTION calories. NOT FOR SALE OR DISTRIBUTION

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION Just as eachNOT of us FOR has a SALE monetary OR budget—a DISTRIBUTION limited amount of money to spend on things such as food, rent, books, and transportation—in a sense we all have a calorie budget as well. Once you determine how many calories your body uses each day and how to manipulate your calorie expenditure to reach certain health goals, you will be making food choices to match your © Jones & Bartlettcalorie Learning, needs. Every LLC time you eat, you are choosing© Jones to spend & Bartlettsome of your Learning, LLC NOT FOR SALEcalorie OR budgetDISTRIBUTION for that day. Those who spend theirNOT budget FOR wisely SALE tend OR to beDISTRIBUTION healthier than those who do not. nutrient density A description of the healthfulness The nutrient density of food provides a clue to how “healthy” a food of foods. Foods high in nutrient density are those that is. It is a ratio of nutrient content to energy content. Nutrient-dense foods provide substantial amounts of vitamins and minerals and provide substantial amounts of vitamins and minerals and relatively few calo- relatively few© calories; Jones foods low & in Bartlettnutrient density areLearning, LLC6 © Jones & Bartlett Learning, LLC those that supply calories but relatively small amounts of ries. Foods that are low in nutrient density supply calories but relatively small 7 vitamins andNOT minerals FOR(or none at SALE all). OR DISTRIBUTIONamounts of vitamins and minerals,NOT sometimes FOR SALE none OR at all. DISTRIBUTION A food high in calories but low in vitamins and minerals is less nutrient dense than one that has a high vitamin and mineral content compared with its overall calories. Let’s take a potato as an example. Potatoes are presented to us to eat in many different forms. We can eat baked potatoes, mashed potatoes with © Jones & Bartlett Learning, LLC butter or sauces,© Jonesor french & fries. Bartlett Depending Learning, on how LLC it is cooked and what NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Is the American Diet Contributing to a Warmer Planet? Our food choices, which include production, transport, processing, packaging, storage, and prepara- © Jonestion, might& Bartlett be a signifi Learning, cant contributor LLC to global warming. The© Jones“food sector” & Bartlett in the UnitedLearning, States accountsLLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION for 19 percent of total U.S. energy use each year. The average American diet creates 2.8 tons of carbon dioxide (CO 2) 1 emissions per person per year, which far surpasses the 2.2 tons of CO2 emissions generated by Americans driving. The highly processed foods that have become a big part of our diets often require barrels of oil to create and deliver to our dinner plates and are often low in nutrient value as well. Your food choices not only contribute to your state of health, both current and future, but also are a signifi cant part of your overall carbon footprint. The good news is that © Joneshealthy, & Bartlett fl avorful, Learning, and good-to-eat LLC foods are entirely possible© Joneswhile also & Bartletteasing the Learning,load of your LLCcarbon footprint. NOT FOR Here SALE are someOR DISTRIBUTION tips for lean and green eating: NOT FOR SALE OR DISTRIBUTION • Eat less red meat. The amount of beef in your diet is one of the biggest factors in your global impact. • Ban the bottled water. Liquids are one of the heaviest items to ship, and their plastic containers are fi lling landfi lls. • Snack sustainably. This is good for your waist as well as your waste. Ditch the processed snack foods and choose whole, real foods ©instead. Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC • Be an effi cient shopper.NOT Minimize FOR SALE shopping OR tripsDISTRIBUTION to different stores if possible, reuse bags,NOT and FOR shop SALE the bulk OR bins. DISTRIBUTION • Become a locavore. Eat locally (or regionally) and seasonally to the extent that you can. • Compost your food waste. Food scraps are about 12 percent of a family’s household waste and emit powerful warming gases in landfi lls. Regenerate them into healthy soil instead! • Cook in more, take out less. Dining out signifi cantly increases a food’s carbon footprint, especially if there is packaging.© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC • Practice NOT FOR “hara SALE hachi bu.” OR The DISTRIBUTION Okinawan phrase hara hachi bu translatesNOT as FOR“eat until SALE you are OR eight DISTRIBUTION parts full.” Slow down while you eat, and give your stomach time to tell your brain you are full. • Limit highly packaged, single-serving snacks, foods, and beverages. Hit the bulk aisle and bulk up instead. • Pack a PB&J for lunch. Make your own lunch and bring it with you. If it’s peanut butter and jelly or almond butter with local jam on whole-grain bread, it’s fast, easy, healthy, and greener, too.

© Jones 1 Eshel & G, Bartlett Martin PA. Diet, Learning, energy and global LLC warming. Earth Interactions. 2006;10(9):1–17.© Jones & Bartlett Learning, LLC NOT FOR Source: DataSALE from Geagan OR K. Go DISTRIBUTION Green, Get Lean: Trim Your Waistline with the Ultimate Low-Carbon FootprintNOT Diet FOR . Emmaus, PA: Rodale;SALE 2009. OR DISTRIBUTION

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORis SALEadded toOR it beforeDISTRIBUTION we eat it, the nutrient density of NOTthat potato FOR changes.SALE OR DISTRIBUTION The most nutrient-dense form of this potato would be a plain baked potato, which provides the most vitamins and minerals with relatively few calories. The least nutrient-dense version of this potato is french fries because frying a food adds a lot more calories without adding more vitamins and minerals, producing a product that© Jones has a relatively & Bartlett low amount Learning, of vitamins LLC and miner- © Jones & Bartlett Learning, LLC als compared to its overallNOT (higher) FOR SALE calorie ORcontent. DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Foods with little or no added sugar or fat are high-nutrient-dense food choices. For example, you might decide to eat a pear instead of a handful of caramel corn. Both provide about the same amount of calories. By choosing to eat the pear instead of the caramel corn, you are working toward meeting your ©daily Jones nutrient & Bartlettneeds on aLearning, lower energy LLC budget. These choices result© Jonesin & Bartlett Learning, LLC a dietNOT that isFOR healthier. SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Moderation Not too much or too little—that’s what moderation means. Moderation does not mean that you have to eliminate low-nutrient-dense foods from your diet, © Jones &but Bartlett rather that Learning, you can include LLC them occasionally. Moderation© Jones entails & Bartlett not Learning, LLC NOT FORtaking SALE anything OR DISTRIBUTION to extremes. You probably have heardNOT that FORvitamin SALE C has OR DISTRIBUTION 2 positive effects, but that doesn’t mean huge doses of this essential nutrient are appropriate for you. It’s also important to remember that substances that are healthful in small amounts can sometimes be dangerous in large quantities. For example, the body needs zinc for hundreds of chemical reactions, including those that support© normal Jones growth, & Bartlett development, Learning, and immune LLC function. © Jones & Bartlett Learning, LLC Too much zinc, however,NOT can FOR cause SALE defi ciency OR DISTRIBUTION of copper, another essential NOT FOR SALE OR DISTRIBUTION mineral, which can lead to impaired immune function. Being moderate in your diet means that you do not restrict or completely eliminate any one type of food, but rather that all types of food can fi t into a healthful diet. Food© Jones guides & and Bartlett their graphics Learning, convey LLC the message of © Jones & Bartlett Learning, LLC moderationNOT FOR by showing SALE suggested OR DISTRIBUTION amounts of different food NOT FOR SALE OR DISTRIBUTION groups. Appearing in diverse shapes, food guides from other countries refl ect their cultural contexts. Japan, for example, uses the shape of a spinning top (see Figure 2. 1 ).

© Jones & Variety Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORHow SALE many OR different DISTRIBUTION foods do you eat on a daily basis?NOT Ten? FOR SALE OR DISTRIBUTION Fifteen? Would it surprise you that one of Japan’s dietary guidelines suggests eating 30 different foods each day?8 Now that’s variety! Variety means including lots of different foods in the diet: not just different food groups such as fruits, vegetables, and grains but© alsoJones different & Bartlett foods from Learning, each group. LLC © Jones & Bartlett Learning, LLC 3 Eating two bananas andNOT three FOR carrots SALE each and OR every DISTRIBUTION day might NOT FOR SALE OR DISTRIBUTION give you the minimum number of recommended daily servings of fruits and vegetables, but it doesn’t add much variety. Variety is important for a number of reasons. Eating a variety of fruits, for example, provides a broader mix of vitamins, Dietary guidelines around the world. Global diﬀ erences in minerals,© Jones and phytochemicals & Bartlett Learning, than just including LLC one or two Figure© 2.1Jones & Bartlett Learning, LLC fruits.NOT Choosing FOR a SALE variety ofOR protein DISTRIBUTION sources gives you a differ- NOT FORenvironment, SALE culture, OR socioeconomics, DISTRIBUTION and behavior create signifi cant diﬀ erences in the foods that make up our diets. Despite this, dietary ent balance of fats and other nutrients. Variety can add interest guidelines from one country to the next show surprising similarities. Whether a country and excitement to your meals while preventing boredom with has only 3 guidelines or as many as 23, all share similar basic recommendations. For your diet. Perhaps most important, variety in your diet helps example, the Japanese dietary guidelines use a spinning top. The United States uses a ensure that you get all the nutrients you need. Studies have plate, and Canada uses a rainbow. Mexico and most European countries use a © Jones &shown Bartlett that peopleLearning, who have LLC varied diets are more likely© Jones to circular form. & Bartlett Learning, LLC NOT FORmeet SALE their OR overall DISTRIBUTION nutrient needs.9 NOT FOR Source: SALE Courtesy ofOR the Japanese DISTRIBUTION Ministry of Health, Labor and Welfare/USDA.

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION So remember,NOT there FOR are SALEno magic OR diets, DISTRIBUTION foods, or supplements. Instead, your overall, long-term food choices can bring you the benefi ts of a nutritious diet. A healthful diet is something you create over time, not the way you eat on any given day. Using the principles of adequacy, balance, calorie (energy) U.S. Department of Agriculture (USDA) The control, nutrient density, moderation, and variety can help you attain and government agency that monitors the production© Jones of eggs, & Bartlettachieve Learning, healthy eating LLC habits, which in turn will© contributeJones & to Bartlett your overall Learning, LLC poultry, and meat for adherence to standards of quality healthy lifestyle. Let’s take a look at some general guidance for making those and wholesomeness. The USDA also providesNOT public FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION nutrition education, performs nutrition research, and food choices. administers the WIC program. Key Concepts Food and nutrient intake play a major role in health and risk of disease. For most Americans, overnutri- U.S. Department of Health and Human Services tion is more of a problem than undernutrition. The diet-planning principles of adequacy, balance, calorie (energy) control, (DHHS) The principal federal agency responsible for nutrient density, moderation, and variety are important concepts in choosing a healthful diet. protecting the© health Jones of all Americans & Bartlett and providing Learning, LLC © Jones & Bartlett Learning, LLC essential humanNOT services. FOR The agency SALE is especially OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION concerned with those Americans who are least able to help Dietary Guidelines themselves. To help citizens improve their overall health, many countries have developed Dietary Guidelines for Americans, 2010 The Dietary Guidelines for Americans are the foundation of federal dietary guidelines—simple, easy-to-understand statements about food choices, nutrition policy and are developed by the U.S. Department food safety, and physical activity. This section examines dietary guidelines for © Jonesof Agriculture& Bartlett (USDA) and Learning, the Department of Health LLC and the United States© Jonesand Canada. & Bartlett Learning, LLC NOT FORHuman SALE Services (DHHS). OR These DISTRIBUTION science-based guidelines NOT FOR SALE OR DISTRIBUTION are intended to reduce the number of Americans who develop chronic diseases such as hypertension, diabetes, Dietary Guidelines for Americans cardiovascular disease, obesity, and alcoholism. In 1980, the U.S. Department of Agriculture (USDA) and the U.S. Department of Health and Human Services (DHHS) jointly released © Jones & Bartlettthe fi rstLearning, edition of theLLC Dietary Guidelines for Americans© Jones. Revised & Bartlett guidelines Learning, LLC NOT FOR SALEhave OR been DISTRIBUTION released every fi ve years as scientifiNOT c information FOR SALE about OR links DISTRIBUTION between diet and chronic disease is updated. The purpose of the Dietary Guidelines for Americans is to provide science-based advice to promote health and to reduce risk for chronic diseases through diet and physical activity.10 The food and physical activity choices you make every day affect © Jones & Bartlett Learning,your LLC health—how you feel today,© Jones tomorrow, & Bartlett and in the Learning, future. LLC NOT FOR SALE OR DISTRIBUTION The Dietary Guidelines NOTAmericans, FOR SALE2010 (see OR Figure DISTRIBUTION 2. 2 ) offers a road map intended to guide personal choices and help individuals make informed food and activity decisions. The result of a systematic, evidence- based review of the scientifi c literature, the Dietary Guidelines for Ameri- cans, 2010 is based on what experts have determined to be the best advice © Jones & Bartlett Learning, LLC for Americans ©to Jonesreduce the & Bartlettrisk for chronic Learning, diseases LLC and reduce the preva- NOT FOR SALE OR DISTRIBUTION lence of overweightNOT andFOR obesity SALE through OR DISTRIBUTION improved nutrition and physical activity. These guidelines are the cornerstone of federal nutrition policy and education. They are used to develop educational materials and to aid in the design and implementation of nutrition-related programs, such as the National School Lunch Program and Meals on Wheels. The Dietary Guide- © Jones & Bartlettlines for Learning, Americans LLCserves as the basis for nutrition© Jones messages & andBartlett consumer Learning, LLC NOT FOR SALEmaterials OR DISTRIBUTION developed by nutrition educators andNOT health FOR professionals SALE ORfor the DISTRIBUTION general public. 11 Lifestyle choices, including a poor diet and lack of physical activity, are the most important factors that contribute to the overweight and obesity epidemic that is currently affecting men, women, and children throughout the United © Jones & Bartlett Learning,States. LLC Even in individuals who© are Jones not overweight, & Bartlett a poor Learning, diet and physical LLC 2010 Dietary Guidelines for Figure 2.2NOT FOR SALE OR DISTRIBUTIONinactivity are well known to beNOT associated FOR with SALE the majorOR DISTRIBUTION causes of morbid- Americans . A revised Dietary Guidelines ity and mortality. Currently, the number of Americans who are overweight for Americans was released in 2010. or obese is at an all-time high; as a consequence, the risk for various chronic Source: Reproduced from US Department of Health and Human Services, US Department of Agriculture. Dietary Guidelines for diseases is also on the rise. In an effort to address this growing problem, Americans, 2010. 7th ed. Washington, DC: US Government Printing the Dietary Guidelines for Americans, 2010 focuses on the integration of © JonesO ﬃ c e ; 2& 0 1 0Bartlett . Learning, LLC government, agriculture,© Jones health& Bartlett care, business, Learning, educators, LLC and communities NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 12 NOT FORworking SALE together OR DISTRIBUTION to encourage individuals to make healthyNOT lifestyle FOR changes. SALE OR DISTRIBUTION The main objective of these guidelines is to encourage Americans to balance calorie intake with physical activity to manage weight. This means helping Americans make the choices they need to eat a healthier diet by promoting the consumption of more vegetables, fruits, whole grains, fat-free and low- fat dairy products, and© seafood; Jones the& Bartlettconsumption Learning, of foods withLLC less sodium, © Jones & Bartlett Learning, LLC saturated and trans fats,NOT added FOR sugars, SALE and ORrefi nedDISTRIBUTION grains; and an increase in NOTDietary FOR Guidelines SALE OR DISTRIBUTION daily physical activity. for Americans, 2010 Balancing Calories to Manage Weight: Key Recommendations from the Dietary Key Recommendations Guidelines© Jones for & Americans Bartlett Learning, LLC © Jones &• Bartlett Prevent and/or reduce Learning, overweight and obesityLLC The sixNOT chapters FOR of SALE the Dietary OR DISTRIBUTIONGuidelines for Americans, 2010 containNOT two FOR SALEthrough improved OR eatingDISTRIBUTION and physical activity overarching concepts and 23 key recommendations for the general popula- behaviors. • Control total calorie intake to manage body weight. tion, as well as 6 additional key recommendations for specifi c population For people who are overweight or obese, this will groups. The recommendations within the Dietary Guidelines for Americans, mean consuming fewer calories from foods and 2010 are intended for people age 2 years or older together with those who beverages. © Jones &are Bartlett at an increased Learning, risk of LLCchronic disease. © Jones & Bartlett Learning,• Increase physical LLC activity and reduce time spent in This section reviews the overarching concepts and key recommendations sedentary behaviors. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION• Maintain appropriate calorie balance during each from each chapter of the Dietary Guidelines for Americans, 2010. You can stage of life—childhood, adolescence, adulthood, access the full report at www.dietaryguidelines.gov . pregnancy and breastfeeding, and older age. Source: Reproduced from US Department of Agriculture Overarching Concepts and US Department of Health and Human Services. Dietary The two overarching concepts© Jones in the& Bartlett Dietary Guidelines Learning, for Americans,LLC 2010 Guidelines© for Jones Americans, 2010 &. 7th Bartlett ed. Washington, Learning, DC: US LLC Government Printing Oﬃ ce; December 2010. are as follows: NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION • Maintain calorie balance over time to achieve and sustain a healthy weight. To lower the number of overweight and obese children and adults, many Americans would benefi t from a decrease in calorie con- © sumptionJones & and Bartlett an increase Learning, in calorie LLC expenditure each day. © Jones & Bartlett Learning, LLC •NOT Focus FOR on consuming SALE OR nutrient-dense DISTRIBUTION foods and beverages . An eatingNOT pat- FOR SALE OR DISTRIBUTION tern that frequently includes foods that are low in nutrients and high in calories (unhealthy) will often take the place of more nutrient-dense (healthier) foods in one’s diet. In a healthy eating pattern, the majority of foods should be those foods and beverages that have a high nutrient © Jones & Bartlettcontent; Learning, foods with LLC a low nutrient density should© Jonesbe limited. & Bartlett Learning, LLC Calories In Calories Out NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTIONFood Body functions Balancing Calories to Manage Weight Beverages Physical activity Being successful at maintaining a healthy body weight requires a balance between the amount of calories you eat and the amount of calories you expend every day. Participating© Jones in & physical Bartlett activity Learning, on a regular LLC basis helps © Jones & Bartlett Learning, LLC make it easier for you NOTto maintain FOR a SALE healthy ORweight. DISTRIBUTION The 2008 Physical Activ- NOT FOR SALE OR DISTRIBUTION ity Guidelines for Americans suggests that adults should do the equivalent of 150 minutes of moderate-intensity aerobic activity each week—that’s an Relationship between energy balance and body fat storage. average of only 30 minutes a day, fi ve days a week. For children and ado- Source: Data from Centers for Disease Control and Prevention. lescents age 6 years or older, the recommendation is 60 minutes or more of Image: © Kraska/ShutterStock, Inc. physical© Jones activity &per Bartlett day.13 Learning, LLC © Jones & Bartlett Learning, LLC TheNOT environment FOR SALE in which OR DISTRIBUTION many Americans now live, work, learn,NOT and FOR SALE OR DISTRIBUTION play can be a roadblock for many people trying to achieve or maintain a healthy body weight. An obesogenic environment is a signifi cant contributor to America’s obesity epidemic because it affects both sides of the calorie balance equation. 14 In our modern lifestyle, the availability of high-calorie, © Jones &palatable, Bartlett inexpensive Learning, food LLC is coupled with many mechanized© Jones labor-saving & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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© Jones & Bartlett Learning, LLC Inc. © Ximagination/ShutterStock, (beer) © Photodisc; bread) (white Inc; Endeavor/ShutterStock, © Artistic (cookies) © Photodisc; shaker) (salt Photos: NOT FOR SALE OR DISTRIBUTION devices. The resultNOT is thatFOR we SALE live in an OR environment DISTRIBUTION that often promotes overeating while at the same time discouraging physical activity. Foods and Food Components to Reduce Several foods and food components that Americans typically consume in © Jones & Bartlettexcess Learning, are the focus LLCof the second chapter of the Dietary© Jones Guidelines & Bartlett for Ameri Learning,- LLC NOT FOR SALEcans, OR 2010 DISTRIBUTION. These foods and food componentsNOT include FOR sodium, SALE solid OR fats, DISTRIBUTION added sugars, and refined grains. Consistently eating too much of these foods and food components increases the risk of certain chronic diseases, such as cardiovascular disease, diabetes, and certain types of cancer. In addition, when these foods and food components are a regular part of a person’s diet, they © Jones & Bartlett Learning,tend LLC to replace more nutrient-dense© Jones foods &in Bartlettthe diet, makingLearning, it even LLC more NOT FOR SALE OR DISTRIBUTIONdifficult to meet recommendedNOT nutrient FOR and SALE calorie ORlevels. DISTRIBUTION Foods and Nutrients to Increase

e In the United States, intakes of vegetables, fruits, whole grains, low fat or fat free milk and milk products, and oils (to replace solid fats) are lower than rec- © Jones & Bartlett Learning, LLC ommended. As© a result,Jones dietary & Bartlett intakes of Learning, several nutrients, LLC such as potassium, oods to Reduc NOT FOR SALE OR DISTRIBUTIONF dietary fiber, calcium,NOT FOR and vitaminSALE D,OR are DISTRIBUTIONlow enough for both adults and children to be of public concern. Choosing healthful foods that provide these nutrients has been found to aid in preventing disease and to benefit overall well-being. Recommendations for a healthful eating pattern generally group foods based on commonalities in nutrients provided, their effects on health, and © Jones & Bartletthow the Learning, foods are viewedLLC and used by consumers.© Jones When adopting& Bartlett the Learning,fol- LLC NOT FOR SALElowing OR recommendationsDISTRIBUTION for a healthy eating pattern,NOT FOR also consider SALE ORrecom DISTRIBUTION- mendations from the previous section to help ensure that you are staying within your calorie needs. Examples of health benefits as well as tips for helping you to adopt the Dietary Guidelines’ key recommendations can be found in Table 2.1. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONRecommendations for Specific PopulationNOT FOR Groups SALE OR DISTRIBUTION These recommendations are designed to improve food choices and health outcomes of people who have specific nutritional needs, such as pregnant and lactating women and older adults.

© Jones & Bartlett Learning, LLC Building Healthy© Jones Eating &Patterns Bartlett Learning, LLC NOT FORThe Dietary SALE Guidelines OR for Americans, DISTRIBUTION 2010 recommends The Dietary GuidelinesNOT FOR for Americans, SALE OR 2010 DISTRIBUTION also shows you how recommen- reducing intake of sodium (salt), added sugars (e.g., cookies), dations and principles described in its previous chapters can be combined into and refined grains (e.g., white bread). Reducing alcohol intake a healthy overall eating pattern. Culture, ethnicity, tradition, personal prefer- (e.g., beer) is a strategy that adults can use to reduce calorie ences, food cost, and food availability are all factors people consider when consumption. creating the way they choose to eat. Americans have flexibility in the choices © Jones & Bartlettthey make Learning, when forming LLC their own healthy eating© Jonespatterns. & Americans Bartlett alsoLearning, LLC NOT FOR SALEhave OR access DISTRIBUTION to established eating plans, such as theNOT USDA FOR Food SALE Patterns OR and DISTRIBUTION DASH Eating Plan, to assist in such efforts. In addition, this chapter of the guidelines focuses on eating patterns that prevent foodborne illness and identifies how the four basic food safety principles—clean, separate, cook, and chill—work together to reduce the risk of © Jones & Bartlett Learning,foodborne LLC illnesses. © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONHelping Americans Make HealthyNOT ChoicesFOR SALE OR DISTRIBUTION This chapter focuses on two important factors for making healthy choices. The first is that people make choices every day about what to eat and how physically active they will be. Second, all elements of society—individuals © Jones & Bartlett Learning, LLC and families, communities,© Jones & business Bartlett and Learning, industry, and LLC various levels of gov- NOT FOR SALE OR DISTRIBUTION ernment—shouldNOT take FOR a positive SALE and OR productive DISTRIBUTION role in the efforts to make

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORAmerica SALE healthy. OR DISTRIBUTION The Dietary Guidelines for Americans,NOT 2010 FOR employs SALE the OR DISTRIBUTION social-ecological model (see Figure 2. 3 ) as a tool to illustrate how all elements of society combine to shape an individual’s food and physical activity choices. The Dietary Guidelines for Americans, 2010 Call to Action includes three Dietary Guidelines guiding principles: for Americans, 2010 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 1. Ensure that all Americans have access to nutritious foods and oppor- Foods and Nutrients to Increase: tunities for physicalNOT FORactivity. SALE OR DISTRIBUTION Key RecommendationsNOT FOR SALE OR DISTRIBUTION 2. Facilitate individual behavior change through environmental strategies. • Increase vegetable and fruit intake. 3. Set the stage for lifelong healthy eating, physical activity, and weight • Eat a variety of vegetables, especially dark-green and management behaviors. red and orange vegetables and beans and peas. • Consume at least half of all grains as whole grains. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Ways to Incorporate the Dietary Guidelines into Your Daily Life Increase whole-grain intake by replacing refi ned NOT FOR SALE OR DISTRIBUTION NOT FOR SALEgrains with ORwhole grains. DISTRIBUTION Think about your diet and consider your overall food intake to determine • Increase intake of fat-free or low-fat milk and milk whether it is consistent with the Dietary Guidelines for Americans, 2010 . products, such as milk, yogurt, cheese, or fortifi ed Choose more fruits, vegetables, and whole grains to make sure you are get- soy beverages. • Choose a variety of protein foods, which include sea- ting all the nutrients you need while lowering your intake of saturated fat, food, lean meat and poultry, eggs, beans and peas, © Jones &trans Bartlett fat, and Learning,cholesterol. EatLLC fewer high-fat toppings and© Jonesfried foods & Bartlettto help Learning,soy products, LLC and unsalted nuts and seeds. NOT FORyou SALE balance OR energy DISTRIBUTION intake and expenditure. Exercise regularly.NOT FOR Use theSALE extra OR DISTRIBUTION• Increase the amount and variety of seafood consumed things—sugar, salt, and alcohol—in moderation. Drink water more often than by choosing seafood in place of some meat and poultry. soft drinks, and if you choose to drink alcohol at all, use caution. • Replace protein foods that are higher in solid fat with choices that are lower in solid fats and calories and/or Using the Dietary Guidelines as your road map for fi nding a healthier way are sources of oils. of eating, you might fi nd it easier to meet your nutrition needs while also pro- • Use oils to replace solid fats where possible. tecting your health and© achievingJones & or Bartlett maintaining Learning, a healthy weightLLC along the • Choose© foodsJones that provide & moreBartlett potassium, dietary Learning, LLC way. Table 2. 1 suggestsNOT things FOR you might SALE be ableOR toDISTRIBUTION change in your own diet or fi ber,NOT calcium, FORand vitamin SALE D, which are OR nutrients DISTRIBUTION of lifestyle. Pick one or two suggestions or come up with some simple changes of concern in U.S. diets. These foods include vegetables, fruits, whole grains, and milk and milk products. your own to try that incorporate the Dietary Guidelines for Americans, 2010 Source: Reproduced from US Department of Agriculture into your daily life. Table 2. 2 summarizes daily limits or targets for a number and US Department of Health and Human Services. Dietary of nutrients addressed in the Dietary Guidelines . Guidelines for Americans, 2010. 7th ed. Washington, DC: US © Jones & Bartlett Learning, LLC © Jones &Government Bartlett Printing OﬃLearning, ce; December 2010. LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Belief Systems Heritage Religion Priorities Lifestyle © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning,Government LLC Body Image NOT FOR SALE OR DISTRIBUTIONHomes NOT FOR SALE OR DISTRIBUTIONPublic Health and Schools Health Care Systems Workplaces Agriculture Marketing/Media Recreational Facilities Social and Cultural Foodservice and Retail Norms and Values Community Design and Safety Establishments Foundations and Funders Sectors of Other©Community JonesSettings & Bartlett Learning, LLC ©Industry Jones & Bartlett Learning, LLC Inuence _ Food NOT FOR SALE OR DISTRIBUTION NOT_ Bevera FORge SALE OR DISTRIBUTION _ Environmental _ Physical Activity Demographic Factors Settings Entertainment (e.g., age, gender,socioeconomic status, race/ethnicity, disability status) © JonesPsyc &hosocial Bartlett Factors Learning, LLC Individual © Jones & Bartlett Learning, LLC NOT FORKnowledge SALE and Skills OR DISTRIBUTION Factors NOT FOR SALE OR DISTRIBUTION Gene-Environment Interactions Other Personal Factors Food and Physical Beverage Intake Activity © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC A social-ecological framework for nutrition and physical activity decisions. NOT FOR SALEFigure 2.3 OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Source: Reproduced from US Department of Health and Human Services, US Department of Agriculture. Dietary Guidelines for Americans, 2010 . 7th ed, p. 56. Washington, DC: US Government Printing Oﬃ ce; 2010.

49241_CH02_Printer.indd 35 22/02/13 3:54 PM NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning, LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC 49241_CH02_Printer.indd 36 36 Table 2.1 2010 Dietary Guidelines for Americans: Benefi ts, Behaviors, and Tips NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC Dietary Guideline Recommendation Goals or Behaviors That Could How-to Tips Benefi ts to Your Health Make You Healthier Control total • Helps you to achieve and sustain a healthy • Consume foods and drinks to meet, • Know your calorie needs. calorie intake to weight. not exceed, calorie needs. • Prepare and pack healthy snacks at home to be eaten at school or manage body • Benefi ts your physical health by improving • Plan ahead to make better food work. weight. blood pressure. choices. • Track and evaluate what you eat using a food journal or an online NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC • Benefi NOT FORSALEORDISTRIBUTION ts your© Jones&BartlettLearning,LLC physical health by improving • Track food and calorie intake. food planner. your blood cholesterol levels. • Reduce portion sizes, especially of • Pay attention to feelings of hunger. Eat only until you are satisfi ed, • Benefi ts your physical health by improving high-calorie foods. not full. your blood sugar levels. • Cook and eat more meals at home, • Limit eating while watching television, which often leads to

© Jones&Bartlett Learning,LLC.NOTFORSALEORDISTRIBUTION. • Improves your energy level. instead of eating out. overeating. • Improves your physical mobility. • Choose healthy options when • Choose smaller plates and smaller portions. • Improves your overall general mood and eating out. • To feel satisfi ed with fewer calories, replace large portions of high- self-confi dence. calorie foods with lower-calorie foods, like vegetables and fruits. • Cook and eat at home more often. • When eating out, choose a smaller size option or take home part of your meal. • Choose dishes that include vegetables, fruits, and/or whole grains, NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning, LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC and avoid choosing foods with the following words: creamy, fried, breaded, battered, or buttered. Increase • Helps to control your weight. • Limit screen time. • Limit the amount of time you spend watching television or using physical activity • Promotes psychological well-being. • Be more active daily. other media such as computers and video games. and reduce • Pick activities you like and that fi t into your life. time spent • Reduces feelings of pressure and anxiety. • Avoid couch time. Some physical in sedentary • Helps reduce your risk for chronic diseases activity is better than none. • Be active with family and friends. Having a support network can NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC behaviors. such as diabetes, metabolic syndrome, • Slowly build up the amount of help you stay active.NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC high blood pressure, and some cancers. physical activity you choose. • Keep track of your physical activity and gradually increase it • Helps build and maintain healthy bones, to meet the recommendations of the 2008 Physical Activity muscles, and joints. Guidelines for Americans. • Improves your ability to do daily activities. • Start by being active for longer each time you exercise, and then do more by exercising more often. • Helps older adults become stronger and • Adults should do the equivalent of 150 minutes of moderate- NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC better NOT FORSALEORDISTRIBUTION able© Jones&BartlettLearning,LLC to move about without falling. intensity aerobic activity each week. • Increases your chances of living longer. Increase • Eating vegetables and fruits as part of a • Eat fi ve or more servings of • Add dark-green, red, and orange vegetables to soups, stews, vegetable and reduced-calorie diet can be of benefi t to vegetables and fruit daily, made up casseroles, and stir-fries and other main and side dishes. fruit intake. your body weight. of a variety of choices. • Add beans or peas to salad, soups, and side dishes, or serve as a • Associated with a decreased risk for many main dish. chronic diseases such as cardiovascular • Have raw, cut-up vegetables and fruit handy for a quick side dish, disease and many cancers. snacks, salad, or desserts. • Contributes to healthy aging. • When eating out, choose a vegetable as a side dish. 22/02/13 3:54 PM NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning, LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC 49241_CH02_Printer.indd 37

Increase intake • Milk and milk products contribute many • Choose two to three servings of • Drink fat-free (skim) or low-fat (1%) milk. of fat-free or nutrients to the diet, including calcium low-fat dairy products every day. • When drinking beverages such as cappuccino or latte, request

low-fat milkNOT FORSALEORDISTRIBUTION and© Jones&BartlettLearning,LLC and vitamin D, which help to build and NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC • Replace higher-fat milk and milk fat-free or low-fat NOT FORSALEORDISTRIBUTION milk.© Jones&BartlettLearning,LLC milk products, maintain strong bones and teeth. products with lower-fat options. such as milk, • When recipes call for sour cream, substitute plain fat-free or low-fat • Adequate milk intake is associated with yogurt. yogurt, cheese, decreased chance of developing metabolic or fortifi ed soy syndrome and high blood pressure. beverages. Limit the • Eating foods that contain whole grains • Increase whole-grain intake. • Choose 100 percent whole-grain breads, crackers, rice, and pasta. NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC

consumption off ers a good source of antioxidants such NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC • Consume at least half of all grains • Use the Nutrition Facts label to choose whole grains that are a of foods that as vitamin E, magnesium, iron, and fi ber to as whole grains. good or excellent source of dietary fi ber. contain refi ned your diet. grains and added • Whenever possible, replace refi ned • Eat fewer refi ned grain products, such as cakes, cookies, other • Eating foods that contain fi ber helps lower grains with whole grains. desserts, and pizza. sugars. blood cholesterol levels, control blood © Jones&Bartlett Learning,LLC.NOTFORSALEORDISTRIBUTION. glucose levels for people with diabetes, • Choose foods and drinks with • Replace white bread, rolls, bagels, muffi ns, pasta, and rice with and causes a feeling of satiety. added sugars or caloric sweeteners whole-grain versions. (sugar-sweetened beverages) less • To increase fi ber in your diet, choose foods such as oat bran, barley, • A diet high in sugar is associated with frequently. being overweight/obese. kidney beans, fruits, vegetables, wheat bran, and whole grains. • Drink more water. • To increase insoluble fi ber in your diet, choose foods such as wheat bran, vegetables, and whole grains. • Drink few or no regular sodas, sports drinks, energy drinks, and fruit drinks. • Eat less cake, cookies, ice cream, other desserts, and candy. NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning, LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC • Choose water, fat-free milk, 100 percent fruit juice, or unsweetened tea or coff ee as drinks rather than sugar-sweetened drinks. Keep trans • Eating a diet that includes saturated fat, • Be aware of the most likely sources • When using spreads, choose soft margarines with zero trans fats fatty acid trans fat, and dietary cholesterol raises of trans fat in your diet, such as made from liquid vegetable oil, rather than stick margarine or consumption as low-density lipoprotein (LDL), or “bad” many pastry items and donuts, butter. low as possible. cholesterol, levels, which increases the risk deep-fried foods, many types of • Use vegetable oils such as olive, canola, corn, or sunfl ower oil rather NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC of coronary heart disease (CHD). snack chips, cookies, and crackers. than solid fats (butter,NOT FORSALEORDISTRIBUTION stick© Jones&BartlettLearning,LLC margarine, shortening, lard). • Check the Nutrition Facts label to choose foods with little or no saturated fat and no trans fat. • Limit foods that contain partially hydrogenated oils and other solid fats. If alcohol is • Excessive drinking has no benefi ts, and the • If you are of legal drinking age you • Limit alcohol to no more than one drink per day for women and NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC consumed, health NOT FORSALEORDISTRIBUTION and© Jones&BartlettLearning,LLC social hazards of heavy alcohol should drink alcoholic beverages in two drinks per day for men. it should be intake are numerous and well known. moderation. • Avoid excessive (heavy or binge) drinking. consumed in • Avoid alcohol in situations that can • Avoid alcohol if you are pregnant or may become pregnant. moderation. put you at risk. Follow food safety • Prevents foodborne illness. • Learn proper food handling • Clean: Wash hands, utensils, and cutting boards before and after recommendations techniques. contact with raw meat, poultry, seafood, and eggs. when preparing • When in doubt, throw it out. • Separate: Keep raw meat and poultry apart from foods that won’t and eating foods be cooked. to reduce the risk • Cook food to a safe temperature. of foodborne • Store food safely. • Cook: Use a food thermometer. illnesses. • Chill: Chill leftovers and takeout foods within 2 hours and keep the refrigerator at 40 degrees Fahrenheit or below. 22/02/13 3:54 PM 37 Source: Modifi ed from US Department of Health and Human Services, US Department of Agriculture. Dietary Guidelines for Americans, 2010. 7th ed, p. 63. Washington, DC: US Government Printing Oﬃ ce; 2010. 38 Chapter 2 NutritioN GuideliNes aNd assessmeNt

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION Table NOT2.2 FORDaily SALE Targets OR for DISTRIBUTION Nutrients as Addressed in the Dietary Guidelines Dietary Guidelines for Americans, 2010 for Americans, 2010 Key Recommendations for Specifi© Jones c & Bartlett Learning,Nutrient or LLCFood Group Target for Adults© JonesAges 19–50 & Bartlett Learning, LLC Population Groups NOT FOR SALE OR DISTRIBUTIONTotal fat (percent of calories) 20–35 NOT FOR SALE OR DISTRIBUTION Women capable of becoming pregnant: Saturated fat (percent of < 10 calories) • Choose foods that supply heme iron, which is more Cholesterol (mg) < 300 readily absorbed by the body, additional iron sources, and enhancers of iron absorption such as vitamin C– Calcium (mg) 1,000 rich foods.© Jones & Bartlett Learning, LLC Potassium (mg) © Jones4,700 & Bartlett Learning, LLC • Consume 400 micrograms (mcg) per day of synthetic NOT FOR SALE OR DISTRIBUTIONSodium (mg) NOT< 2,300 FOR SALE OR DISTRIBUTION folic acid (from fortifi ed foods and/or supplements) in addition to food forms of folate from a varied diet. Vitamin D (mcg)a 15 Women who are pregnant or breastfeeding: Fiber (g) 14 g per 1,000 calories (28–34 g/day) Vegetables and fruit At least 4–5 • Consume 8 to 12 ounces of seafood per week from a (cups per day) © Jones &variety Bartlett of seafood types. Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR• BecauseSALE of their OR methyl DISTRIBUTION mercury content, limit white Refi nedNOT grains FOR (oz per SALEday) OR > 3 DISTRIBUTION (albacore) tuna to 6 ounces per week and do not eat Physical activity 150 minutes of moderate-intensity the following four types of fi sh: tilefi sh, shark, sword- aerobic activity each week fi sh, and king mackerel. a 1 mcg of vitamin D is equivalent to 40 IU. • If pregnant, take an iron supplement as recom- Source: Data from US Department of Agriculture and US Department of Health and Human mended by an obstetrician or other health care Services. Dietary Guidelines for Americans, 2010. 7th ed. Washington, DC: US Government Printing provider. © Jones & Bartlett Learning,Oﬃ ce; December 2010.LLC © Jones & Bartlett Learning, LLC Individuals age 50 years or older: NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

• Consume foods fortifi ed with vitamin B12 , such as fortifi ed cereals, or take dietary supplements. Canada’s Guidelines for Healthy Eating Source: Reproduced from US Department of Agriculture Promoting healthy eating habits among Canadians has been a priority of and US Department© Jones of Health and& HumanBartlett Services. Dietary Learning, Health LLC Canada for many years.© HealthJones Canada & Bartlett is the Learning, federal department LLC Guidelines for Americans, 2010. 7th ed. Washington, DC: US responsible for helping the people of Canada maintain and improve their GovernmentNOT Printing OﬃFOR ce; December SALE 2010. OR DISTRIBUTIONhealth. In the 1980s, a high priorityNOT wasFOR given SALE to developing OR DISTRIBUTION a single set of dietary guidelines. The result of this effort was the 1990 Nutrition Recom- mendations for Canadians . This report updated the existing dietary standards and provided a scientifi c description of the characteristics of a healthy dietary pattern. Also published in 1990 was Canada’s Guidelines for © JonesNutrition & Bartlett Recommendations Learning, for Canadians LLC A set © Jones & Bartlett Learning, LLC of scientifi c statements that provide guidance to Canadians Healthy Eating, a set of fi ve positive, action-oriented messages for healthy NOT FORfor a dietarySALE pattern OR that will DISTRIBUTION supply recommended Canadians olderNOT than FOR age 2 SALE years. OR DISTRIBUTION amounts of all essential nutrients while reducing the risk The 2007 revision of Canada’s guidelines, Eating Well with Canada’s of chronic disease. Food Guide , recommends that Canadians do the following:15 Canada’s Guidelines for Healthy Eating Key messages that are based on the 1990 Nutrition • Eat at least one dark-green and one orange vegetable each day. Recommendations for Canadians and that© provide Jones positive, & Bartlett• Learning,Enjoy vegetables LLC and fruit prepared with ©little Jones or no &added Bartlett fat, sugar, Learning, LLC action-oriented, scientifi cally accurate NOTeating advice FOR to SALE ORor DISTRIBUTION salt. NOT FOR SALE OR DISTRIBUTION Canadians. • Have vegetables and fruits more often than juice. Eating Well with Canada’s Food Guide • Select whole grains for at least half of one’s grain products. Recommendations to help Canadians select foods to meet • Choose grain products that are low in fat, sugar, or salt. energy and nutrient needs while reducing the risk of chronic disease. The Food Guide is based on the Nutrition • Drink skim, 1 percent, or 2 percent milk each day. Recommendations© Jones for Canadians & and Bartlett Canada’s Guidelines Learning, LLC• Consume meat alternatives,© Jones such as & beans, Bartlett lentils, Learning, and tofu, often. LLC for HealthyNOT Eating and FOR is a key nutrition SALE education OR tool DISTRIBUTIONfor • Eat at least two Food GuideNOT servings FOR SALEof fi sh OReach DISTRIBUTIONweek. Canadians aged 4 years and older. • Select lean meat and alternatives prepared with little or no added fat or salt. • Include a small amount of unsaturated fat each day. • Satisfy thirst with water. © Jones & Bartlett Learning, LLC • Limit foods© Jones and beverages & Bartlett high inLearning, calories, fat, LLC sugar, or salt. NOT FOR SALE OR DISTRIBUTION • Be activeNOT every FOR day. SALE OR DISTRIBUTION

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Dietary Guidelines for Americans, 2010 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Building Healthy Eating Patterns: NOT FOR SALE OR DISTRIBUTION Key RecommendationsNOT FOR SALE OR DISTRIBUTION • Select an eating pattern that meets nutrient needs over time at an appropriate calorie level. • Account for all foods and beverages consumed and assess how they fi t within a total healthy eating © Jones & Bartlett Learning, LLC © Jones & Bartlettpattern. Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR• SALE Follow food OR safety recommendationsDISTRIBUTION when preparing and eating foods to reduce the risk of foodborne illnesses. Source: Reproduced from US Department of Agriculture and US Department of Health and Human Services. Dietary Guidelines for Americans, 2010. 7th ed. Washington, DC: US © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning,Government Printing LLC Oﬃ ce; December 2010. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

The companion document, Canada’s Physical Activity Guide, recommends Quick Bite 30 to 60 minutes of physical© Jones activity & Bartlett a day for Learning, children and LLC youth. How Well© Jones Do School & Cafeterias Bartlett Learning, LLC Dietary guidelinesNOT in the FORUnited SALE States and OR Canada DISTRIBUTION address similar issues: FollowNOT Nutrition FOR Guidelines? SALE OR DISTRIBUTION less fat; more fruits, vegetables, and grains; less salt; and achieving healthy About one in three kids and teenagers is obese, and weights. In addition, both countries have developed graphic depictions of a high-fat school lunches might be part of the problem. healthful diet by showing the balance of food groups to be consumed each Until recently, the USDA’s nutritional standards for school day. You can read about the USDA’s MyPlate and Canada’s Food Guide in meals had not been updated in more than 15 years. With the majority of school-age kids and teens getting 30 to the next© Jones section, & “From Bartlett Dietary Learning, Guidelines LLC to Planning.” © Jones 50& percent Bartlett of their total Learning, calories from cafeteria LLC meals each day, it’s important that these meals be as healthy as pos- Key ConceptsNOT FOR Dietary SALE guidelines areOR recommendations DISTRIBUTION based on current science that “guide” people towardNOT more FOR SALE OR DISTRIBUTION sible. The Healthy, Hunger-Free Kids Act is a plan that will healthful choices. The Dietary Guidelines for Americans, 2010 provides two overarching themes and 23 key recommenda- (1) boost the nutrition quality of school lunches by requiring tions for making food choices that promote good health and a healthy weight and help prevent disease. Six additional key fewer calories, less sodium, and more fresh fruits, vegeta- recommendations target specifi c population groups. Behavioral strategies and creating a healthy environment are important bles, and whole grains; (2) expand the number of students for adopting the recommendations in the Dietary Guidelines for Americans, 2010. Both the United States and Canada have enrolled in free- and reduced-cost meals; and (3) put into © Jones &guidelines Bartlett that embody Learning, the basic principles LLC of balance, variety, moderation, and calorie© control. Jones & Bartlett Learning,place a plan to eliminate LLC things like unhealthy vending NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTIONmachines from school cafeterias. From Dietary Guidelines to Planning: What You Will Eat By understanding the Dietary Guidelines for Americans , you will be able to identify characteristics© that Jones can make& Bartlett your diet Learning, and your LLClifestyle healthy. © Jones & Bartlett Learning, LLC The next step is to translateNOT yourFOR knowledge SALE OR into DISTRIBUTION healthful food choices. For NOT FOR SALE OR DISTRIBUTION many years, nutritionists and teachers have used food groups to illustrate food groups Categories of similar foods, such as fruits the proper combination of foods in a healthful diet. Even young children can or vegetables. sort food into groups and fi ll a plate with foods from each group. The foods within each group are similar because of their origins—fruits, for example, all come© from Jones the same & Bartlett part of different Learning, plants. LLC But from a nutritional perspec-© Jones & Bartlett Learning, LLC tive, NOTwhat fruitsFOR have SALE in common OR DISTRIBUTION is the balance of macronutrients andNOT the FOR SALE OR DISTRIBUTION similarities in micronutrient composition. Even so, the foods in one group can differ signifi cantly in their vitamin and mineral profi les. Some fruits (e.g., citrus, strawberries, and kiwi) are rich in vitamin C, and others (e.g., apples, bananas) have very little. Here again, we can see the importance of variety, © Jones &of Bartlettnot simply Learning, including different LLC food groups but also ©choosing Jones a &variety Bartlett of Learning, LLC NOT FORfoods SALE within OR each DISTRIBUTION group. NOT FOR SALE OR DISTRIBUTION

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION A Brief HistoryNOT of FOR Food SALE Group OR Plans DISTRIBUTION When the U.S. Department of Agriculture published its fi rst dietary rec- Academy of Nutrition ommendations in 1894, specifi c vitamins and minerals had not even and Dietetics been discovered. 16 The initial guide stressed the importance of consuming enough fat and sugar and energy-rich foods to support daily activity. Total Diet Approach to Communicating© Jones & BartlettBecause Learning, people performed LLC more manual labor© in Jonesthose days, & Bartlett many people Learning, LLC Food and Nutrition InformationNOT FOR SALEwere OR simply DISTRIBUTION not getting enough calories! Canada’sNOT FOR Offi cialSALE Food OR Rules DISTRIBUTION It is the position of the Academy of Nutrition and (1942) recommended a weekly serving of liver, heart, or kidney and regu- Dietetics that the total diet or overall pattern of food lar doses of fi sh liver oils—good sources of vitamins A and D. Later food eaten is the most important focus of a healthful eating group plans, including the Basic Four that was popular from the 1950s style. All foods can fi t within this pattern, if consumed through the 1970s, focused on fruits, vegetables, grains, dairy products, in moderation with appropriate portion size and com- © Jones & Bartlett Learning,and LLC meats and their substitutes.© TheJones Basic & Four Bartlett was usually Learning, illustrated LLC as bined withNOT regular physical FOR activity. SALE The Academy OR of DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Nutrition and Dietetics strives to communicate health- either a circle or a square, with each group having an equal share. The ful eating messages to the public that emphasize a implication was that people should consume equal amounts of food from balance of foods, rather than any one food or meal. each group. Nutrition science now tells us that those proportions give us Source: Reproduced from Position of the American a diet too high in fat and protein for our modern lifestyle, and not high enough in carbohydrates and fi ber. © JonesDietetic & Bartlett Association: total Learning, diet approach to communicating LLC © Jones & Bartlett Learning, LLC food and nutrition information. J Am Diet Assoc. 2007; After the development of the Dietary Guidelines for Americans in NOT FOR107:1224–1232. SALE Reprinted OR withDISTRIBUTION permission from the 1980, the USDANOT developed FOR SALE a new OR food DISTRIBUTION guide that would promote over- American Academy of Nutrition and Dietetics. all health and be consistent with the Dietary Guidelines. To bring this new food guide and its key messages to the attention of consumers, the colorful Food Guide Pyramid was developed. The Pyramid was designed Quick Bite to illustrate the Dietary Guidelines for American s in terms of food groups © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC and recommended numbers of daily servings. Updated again and renamed Pass Up the Salt NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION We require only a few hundred milligrams of in 2005, the USDA MyPyramid food guidance system was intended to sodium each day, but this would be unpalat- be a visual reminder for individuals to make healthy food choices and be able. Given our current high-salt food environment, it physically active every day. Based on the Dietary Guidelines for Americans would also be diﬃ cult to achieve. The guideline is to eat less and the Dietary Reference Intakes, the goal of MyPyramid was to trans- sodium, but not down to the level of actual requirements. © Jones & Bartlett Learning,late LLC dietary guidance into a total© Jones diet that & metBartlett nutrient Learning, needs from LLC food sources and aimed to limit dietary components often consumed in excess. NOT FOR SALE OR DISTRIBUTIONBy law, the Dietary GuidelinesNOT for Americans FOR SALE is reviewed, OR DISTRIBUTION updated if nec- MyPlate An educational tool that translates the essary, and published every five years. Along with the current version, the principles of the Dietary Guidelines for Americans and Dietary Guidelines for Americans, 2010, MyPlate and ChooseMyPlate. other nutritional standards to help consumers in making healthier food and physical activity choices. gov were created (see Figure 2. 4 ). © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION MyPlate NOT FOR SALE OR DISTRIBUTION MyPlate is the USDA’s current icon and primary food group symbol to accompany the Dietary Guidelines for Americans, 2010. As part of the government’s healthy eating initiative, MyPlate is designed to convey seven key messages from the Dietary Guidelines for Americans, 2010 : Enjoy food © Jones & Bartlettbut eat Learning, less; avoid oversizedLLC portions; make half© yourJones plate & fruitsBartlett and veg-Learning, LLC NOT FOR SALEetables; OR DISTRIBUTIONdrink water instead of sugary drinks; switchNOT to FOR fat-free SALE or low-fat OR (1DISTRIBUTION percent) milk; compare sodium in foods; and make at least half your grains whole grains. MyPlate is an easy-to-understand visual image intended to empower people with the information they need to make healthy food choices and © Jones & Bartlett Learning,create LLC eating habits consistent© with Jones the Dietary& Bartlett Guidelines Learning, for Americans, LLC NOT FOR SALE OR DISTRIBUTION2010. Because we eat from plates,NOT the FOR design SALE of the OR MyPlate DISTRIBUTION icon identifi es visually how much room on a plate each food group should occupy. It is the MyPlate. Released in 2011, MyPlate is Figure 2.4 an Internet-based educational tool that objective of this tool to remind people to think about, create, and make better, helps consumers implement the principles of the 2010 Dietary more balanced food choices. MyPlate uses the image of a dinner plate divided Guidelines for Americans and other nutritional standards. into four sections: fruits, vegetables, grains, and proteins, with a smaller © Jones Source: & Courtesy Bartlett of the USDA. Learning, LLC plate (or glass)© representing Jones & aBartlett serving of Learning, dairy. MyPlate LLC is accompanied by a NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR supporting SALE OR website: DISTRIBUTION www.ChooseMyPlate.gov . ChooseMyPlate.govNOT FOR providesSALE OR DISTRIBUTION tools, resources, and practical information on dietary assessment, nutrition education, and other user-friendly nutrition information. Quick Bite Unlike the USDA’s former food guide systems, MyPlate does not suggest SuperTracker: My Foods, particular foods or specifi c serving sizes and does not even mention desserts My Fitness, My Health or sweets. The purpose© behindJones these & Bartlett changes isLearning, clear—this foodLLC guide is dif- The MyPlate© websiteJones includes & an interactiveBartlett diet Learning, LLC ferent! It is not intended to tell people what to eat, but to empower them and physical activity tool called SuperTracker. Get your NOT FOR SALE OR DISTRIBUTION personalizedNOT nutrition FOR and physical SALE activity plan. OR Track DISTRIBUTION your to make their own healthy choices and to use this visual icon as a sensible foods and physical activities to see how they stack up to 17 guide. recommendations. Get tips and support to help you make healthier choices and plan ahead. Visit www.choosemyplate. gov/SuperTracker/default.aspx. Eating Well with Canada’s Food Guide © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC As scienceNOT advanced FOR SALE and nutritional OR DISTRIBUTION concerns changed, Canada’s Offi cial NOTFood FOR SALE OR DISTRIBUTION Rules evolved into Eating Well with Canada’s Food Guide (see Figure 2. 5 ). The amounts and types of foods recommended in the Canada’s Food Guide are based on the nutrient reference values of the Dietary Reference Intakes (DRIs). The foods pictured in the Canada’s Food Guide document essentially © Jones &incorporate Bartlett bothLearning, the recommended LLC eating pattern and© Jonesassociated & Bartlettdietary Learning, LLC NOT FORguidance. SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION The “rainbow” of Canada’s Food Guide places foods into four groups: Grain Products, Vegetables and Fruits, Milk Products, and Meat and Alter- natives. Canada’s Food Guide describes the kinds of foods to choose from

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Eating Well with Canada’s Food Guide . The rainbow Figure 2.5 portion of Canada’s Food Guide sorts food into groups The 10 Tips Series. from which people can make wise food choices. Source: Reproduced from U.S. Department of Agriculture and U.S. Department of Source: Eating Well with Canada’s Food Guide. Health Canada, 2011. Reproduced Health and Human Services. Dietary Guidelines Tip Sheet No. 10. Washington, DC: © Jones &with Bartlett the permission Learning, from the Minister of Health, LLC 2013. © Jones U.S. Government& Bartlett Printing Learning, Oﬃ ce; 2011. LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION MyPlate: Foods, Serving Sizes, and Tips © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC © JonesCommon & PortionsBartlett and Learning, Ounce LLC Grains NOT FOR SALE OR DISTRIBUTIONAmount Equal to 1 Ounce NOTEquivalents FOR SALE OR DISTRIBUTION Bagels 1 “mini” bagel 1 large bagel = 4 ounce equivalents Biscuits 1 small (2″ diameter) 1 large (3″) = 2 ounce equivalents Breads 1 regular slice 2 regular slices = 2 ounce equivalents Bulgur ½ cup cooked © JonesCornbread & Bartlett Learning, LLC 1 small piece (2½″ × 1¼©″ Jones × 1¼″) & Bartlett1 medium Learning, piece = 2 LLC ounce equivalents NOT FOREnglish SALE muffin OR DISTRIBUTION ½ muffin NOT FOR SALE OR1 muffin DISTRIBUTION = 2 ounce equivalents Muffins 1 small (2½″ diameter) 1 large (3½″ diameter) = 3 ounce equivalents Oatmeal ½ cup cooked Pancakes 1 pancake (4½″ diameter) 3 pancakes (4½″ diameter) = 3 ounce © Jones & Bartlett Learning, LLC equivalents © Jones & Bartlett Learning, LLC Popcorn 3 cups, popped 1 microwave bag, popped = 4 ounce NOT FOR SALE OR DISTRIBUTION equivalents NOT FOR SALE OR DISTRIBUTION Ready-to-eat cereals 1 cup flakes; 1¼ cups puffed Rice ½ cup cooked (1 ounce dry) 1 cup cooked = 2 ounce equivalents Pasta ½ cup cooked (1 ounce dry) 1 cup cooked = 2 ounce equivalents Tortillas © Jones & Bartlett Learning,1 small LLC (6″ diameter) © Jones1 large &(12 ″Bartlett diameter) = Learning, 4 ounce equivalents LLC Tips: MakeNOT at least FOR half SALE your grains OR whole DISTRIBUTION grains. Choose foods that name one of the followingNOT FOR first on SALE the label’s OR ingredient DISTRIBUTION list: brown rice, bulgur, graham flour, oatmeal, whole oats, whole rye, whole wheat, wild rice. Go easy on high-fat or sugary toppings.

Amount Equal to 1 Cup of Amount Equal to 1 Cup Vegetables Vegetables Vegetables of Vegetables © JonesDark-Green & Bartlett Vegetables Learning, LLC © Jones &Starchy Bartlett Vegetables Learning, LLC NOT FORSpinach, SALE romaine, OR collards, DISTRIBUTION 2 cups raw or 1 cup cookedNOT FORCorn SALE OR DISTRIBUTION1 cup or 1 large ear (8″ to mustard greens, kale, other leafy 9″ long) greens Green peas 1 cup Broccoli 1 cup chopped or florets White potatoes 1 cup diced or mashed 1 medium potato, boiled © Jones & Bartlett Learning, LLC © Jonesor baked & Bartlett Learning, LLC Orange Vegetables NOT FOR SALE OR DISTRIBUTIONOther Vegetables NOT FOR SALE OR DISTRIBUTION Carrots 1 cup, raw or cooked Bean sprouts 1 cup cooked 2 medium whole Green beans 1 cup cooked 1 cup baby carrots (about 12) Mushrooms 1 cup raw or cooked Pumpkin,© sweet Jones potato, & winter Bartlett Learning,1 cup, cooked LLC Tomatoes© Jones & Bartlett1 large Learning, raw whole (3 ″LLC) squash NOT FOR SALE OR DISTRIBUTION1 cup chopped, sliced, or cooked NOT FOR SALE OR DISTRIBUTION Dry Beans and Peas Black, garbanzo, kidney, pinto, 1 cup whole or mashed, cooked soybeans; black-eyed peas, split peas © JonesTofu & Bartlett Learning, LLC 1 cup of ½″ cubes © Jones & Bartlett Learning, LLC NOT FORTips: SALE Vary your OR veggies. DISTRIBUTION Make half your plate fruits and vegetables. EatNOT more FOR dark-green SALE vegetables, OR DISTRIBUTION more orange vegetables, and more dry beans. Buy fresh vegetables in season for best taste and lowest cost. Buy vegetables that are easy to prepare.

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Fruit Amount Equal to 1 Cup of Fruit Milk Amount Equal to 1 Cup of Milk Apple 1 small Milk 1 cup Applesauce 1 cup Yogurt 1 regular container (8 ounces) or 1 cup yogurt Banana © Jones1 large& Bartlett (8″ to 9″ long) Learning, LLC Cheese 1½© ounces Jones hard cheese& Bartlett Learning, LLC Melon NOT FOR1 cup SALE diced or OR melon DISTRIBUTION balls ¹∕³ cupNOT shredded FOR cheese SALE OR DISTRIBUTION Grapes 1 cup whole; 32 seedless grapes 2 ounces processed cheese Canned fruit or diced raw fruit 1 cup 2 cups cottage cheese Orange or peach 1 large Milk-based desserts 1 cup pudding made with milk Strawberries About 8 large berries 1 cup frozen yogurt © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 100% fruit juice 1 cup Soymilk 1 cup calcium-fortified soymilk NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Tips: Focus on fruit. Make half your plate fruits and vegetables. Eat a Tips: Get your calcium-rich foods. Switch to fat-free variety of fruit. Choose fresh, frozen, canned, or dried fruit. Go easy on or low-fat milk. If you don’t or can’t consume milk, get juices. When choosing a juice, look for “100% juice” on the label. your calcium-rich foods by choosing lactose-free or other calcium sources such as calcium-fortified juices, cereals, breads, soy beverages, or rice beverages. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Common Portions and Ounce Meat and Beans Amount Equal to 1 Ounce Equivalents Cooked lean beef, pork, ham 1 ounce 1 small steak = 3½ to 4 ounce equivalents Cooked chicken or turkey without skin 1 ounce 1 small lean hamburger = 2 to 3 ounce equivalents © Jones & Bartlett Learning, LLC 1 small chicken© Jones breast half & = Bartlett3 ounce Learning, LLC NOT FOR SALE OR DISTRIBUTION equivalentsNOT FOR SALE OR DISTRIBUTION Cooked fish or shellfish 1 ounce 1 can tuna, drained = 3 to 4 ounce equivalents 1 salmon steak = 4 to 6 ounce equivalents 1 small trout = 3 ounce equivalents Eggs © Jones & Bartlett Learning,1 egg LLC © Jones & Bartlett Learning, LLC Nuts andNOT seeds FOR SALE OR DISTRIBUTION½ ounce of nuts (12 almonds, 24 pistachios,NOT FOR SALE OR DISTRIBUTION 7 walnut halves) ½ ounce of seeds, roasted 1 tablespoon of peanut butter Dry beans and peas ¼ cup cooked beans or peas ¼ cup baked beans, refried beans © Jones & Bartlett Learning, LLC ¼ cup tofu © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION 1 ounce tempeh NOT FOR SALE OR DISTRIBUTION 2 tablespoons hummus Tips: Go lean with protein. Choose low-fat or lean meats and poultry. Bake it, broil it, or grill it. Vary your choices, with more fish, beans, peas, nuts, and seeds.

© Jones & Bartlett Learning,Oils LLC © Jones & Bartlett Learning, LLC Common oils: Vegetable oils (canola, corn, cottonseed, olive, safflower, soybean, sunflower) NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Foods naturally high in oils: Nuts Olives Some fish Avocados© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Tips: NOTKnow your FOR oils. SALE Oils are not OR a food DISTRIBUTION group, but they provide essential nutrients. MakeNOT most FOR of your SALE fat sources OR from DISTRIBUTION fish, nuts, and vegetable oils. Limit solid fats such as butter, stick margarine, shortening, and lard. Source: Modified from US Department of Agriculture Center for Nutrition Policy and Promotion. Food Groups, MyPlate. www.choosemyplate.gov/ food-groups. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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© Jones Stock © Digital & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION each group. ForNOT example, FOR in SALE the Vegetables OR DISTRIBUTION and Fruit group, Canada’s Food Guide suggests “Drink fortifi ed soy beverages if you do not drink milk.” Canada’s Food Guide illustrates that vegetables, fruits, and grains should be the major part of the diet, with milk products and meats consumed in smaller amounts. © Jones & Bartlett The Learning, “bar” side LLCof Canada’s Food Guide shows© Jones how many& Bartlett daily serv- Learning, LLC NOT FOR SALEings OR are DISTRIBUTION recommended from each group andNOT gives FORexamples SALE of servingOR DISTRIBUTION sizes. Canada’s Food Guide also provides specifi c advice for different ages and stages. Limiting foods and beverages high in calories, fat, sugar, or salt is recommended. Label reading is recommended, and a list of steps to healthy living is provided. The Health Canada website ( www.healthcanada 2–4 servings of© fruit Jones per day. & Bartlett Learning,.gc.ca/foodguide LLC ) includes a link© toJones My Food & Bartlett Guide, which Learning, is an interactive LLC NOT FOR SALE OR DISTRIBUTIONtool for personalizing the informationNOT FOR in Canada’s SALE Food Guide OR DISTRIBUTION . © Digital Stock © Digital Using MyPlate or Canada’s Food Guide in Diet Planning © Jones & Bartlett Learning, LLC The fi rst step in© usingJones MyPlate & Bartlett or Canada’s Learning, Food Guide LLC for diet planning is to NOT FOR SALE OR DISTRIBUTION determine the amountNOT FOR of calories SALE you OR should DISTRIBUTION eat each day. Table 2. 3 shows the recommended amounts of food for three calorie-intake levels. It also gives you an idea of how MyPlate varies with different energy needs. Next, become familiar with the types of food in each group, the number of recommended servings, and the appropriate serving sizes. For an intuitive guide to serving © Jones & Bartlettsizes, seeLearning, Table 2. 4 LLC , and plan your meals and© snacks Jones using & Bartlettthe suggested Learning, LLC NOT FOR SALEserving OR DISTRIBUTIONsizes for your appropriate calorie level. NOT FOR SALE OR DISTRIBUTION 6–11 servings of bread, rice, and cereal per day. Let’s start to plan a 2,000-calorie diet. Beginning with breakfast, you could plan to have the following: 1 cup (1 oz) of ready-to-eat cereal, ½ cup of skim milk, 1 slice of whole wheat toast with 1 teaspoon of butter, and 1 cup of orange juice. © Jones & Bartlett Learning, LLC Continue to plan your meals© Jonesand snacks & Bartlettfor the rest Learning, of the day with LLC the NOT FOR SALE OR DISTRIBUTIONamount of servings you have remainingNOT FOR for SALE each food OR group. DISTRIBUTION In this case,

Table 2.3 MyPlate Suggested Daily Amounts for Three Levels of Energy Intake © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT EnergyFOR SALEIntake Level OR DISTRIBUTION Food Group Low (1,400 kcal)a Moderate (2,000 kcal)b High (2,800 kcal)c Grains 5 oz eq 6 oz eq 10 oz eq Vegetables 1½ cups 2½ cups 3½ cups Fruits © Jones1½ cups & Bartlett Learning,2 cups LLC 2½ cups© Jones & Bartlett Learning, LLC Milk NOT2 FORcups SALE OR DISTRIBUTION3 cups 3 cupsNOT FOR SALE OR DISTRIBUTION Meat and beans 4 oz eq 5½ oz eq 7 oz eq Oils 4 teaspoons 6 teaspoons 8 teaspoons Empty calories allowedd 117 kilocalories 267 kilocalories 426 kilocalories a 1,400 kilocalories is about right for many young children. b 2,000 kilocalories© Jones is about right & for Bartlett teenaged girls, active Learning, women, and many LLC sedentary men. © Jones & Bartlett Learning, LLC c 2,800 kilocaloriesNOT is about FOR right forSALE teenaged boys OR and manyDISTRIBUTION active men. NOT FOR SALE OR DISTRIBUTION d Empty calorie allowance is the remaining amount of calories needed for all food groups, assuming that those choices are fat-free or low-fat and with no added sugars. Note: Your calorie needs may be higher or lower than those shown. Women may need more calories when they are pregnant or breastfeeding. Source: Modifi ed from Dietary Guidelines for Americans, 2010. 7th ed. US Government Printing Oﬃ ce; 2010. Courtesy of US Department of Agriculture and US Department of Health and Human Services.

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALETable 2.4 OR PlayingDISTRIBUTION with Portions NOT FOR SALE OR DISTRIBUTION Your favorite sports and games can help you visualize MyPlate portion sizes

GRAINS © Jones & Bartlett1 cup dryLearning, cereal LLC 2 ounce bagel © Jones½ cup & cooked Bartlett cereal, Learning, LLC rice, or pasta NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

1 baseball or 1 Rubik’s cube FRUITS 1 medium fruit (equivalent of 1 cup of fruit) © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

11 © Jones & Bartlett Learning, LLC 1 die ( ⁄16″ size) © Jones & Bartlett1 jacks ballLearning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 1 MILK 1½ ounces of hard cheese ⁄3 cup of shredded cheese

NOT FOR SALE OR11 DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 6 dice ( ⁄16″ size) 1 billiard ball or racquetball MEAT AND BEANS 3 ounces cooked meat 2 tablespoons hummus

1 deck of playing cards 1 ping pong ball

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION it would be as NOTshown FOR in Table SALE 2. 5 . ORKeep DISTRIBUTION in mind that what you consider a serving might differ from the sizes defi ned in MyPlate. Research shows that Americans’ serving sizes for common foods such as pasta, cookies, cereal, soft drinks, and french fries have increased signifi cantly. 18 Do large portions promote overeating and obesity? See the FYI feature “Portion Distortion” for © Jones & Bartletta scientifi Learning, c exploration LLC related to this question. © Jones & Bartlett Learning, LLC NOT FOR SALE ORSometimes DISTRIBUTION it’s diffi cult to fi gure out how NOTto account FOR forSALE foods OR that DISTRIBUTION are mixtures of different groups—lasagna, casseroles, or pizza, for example. Try separating such foods into their ingredients (e.g., pizza contains crust, tomato sauce, cheese, and toppings, which might be meats or vegetables) to estimate the amounts. You should be able to come up with a reasonable approxima- © Jones & Bartlett Learning,tion. LLC All in all, MyPlate and Canada’s© Jones Food & Guide Bartlett are easy-to-use Learning, guidelines LLC NOT FOR SALE OR DISTRIBUTIONthat can help you select a varietyNOT of foods. FOR SALE OR DISTRIBUTION Watch the empty calories, too. Note in Table 2. 5 that for a 2,000-calorie food plan, 267 calories are unused even when all the other food groups are accounted for. However, this accounting with leftover calories assumes that all food choices are fat-free or low-fat and do not have added sugars. What does © Jones & Bartlett Learning, LLC this mean? If you© Jones are already & Bartlett in the habit Learning, of choosing LLC low-fat and low-sugar NOT FOR SALE OR DISTRIBUTION options, you haveNOT a few FOR calories SALE to playOR withDISTRIBUTION each day. These calories can be used for a higher-fat choice or for some sugar in your iced tea. But watch out! Those calories get used up quickly. One regular 12-ounce soft drink would take up 150 discretionary calories; an extra tablespoon of dressing on your salad is 100 calories. © Jones & BartlettUsing Learning, the ChooseMyPlate.gov LLC website is easy© andJones informative. & Bartlett Getting Learning, a LLC NOT FOR SALEpersonalized OR DISTRIBUTION plan, learning healthy eating tips, NOTgetting FOR weight SALE loss informa- OR DISTRIBUTION tion, planning a healthy menu, and analyzing your diet are examples of what ChooseMyPlate.gov offers. The website is an excellent way to help guide you through the necessary steps of putting the Dietary Guidelines into practice, while at the same time teaching good nutrition and providing appropriate © Jones & Bartlett Learning,physical LLC activity information. © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Key Concepts MyPlate is a complete food guidance system based on the Dietary Guidelines for Americans and Dietary Reference Intakes to help Americans make healthy food choices and remind them to be active every day. The interactive tools on the ChooseMyPlate.gov website can help you monitor your food choices. Eating Well with Canada’s Food Guide illustrates the dietary guidelines for Canadians and the Dietary Reference Intakes. These graphic tools show the appropriate balance of food groups in a healthful diet: more whole grains, low-fat dairy, vegetables, and fruits and less meat, and added fats and sugars. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Table 2.5 Food Group Recommendations for a 2,000-Calorie Diet © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOTTotal FOR Recommended SALE OR for DISTRIBUTION Amount Used at AmountNOT Left FOR for SALE OR DISTRIBUTION Food Group 2,000-Calorie Diet Breakfast Remainder of the Day Grains 6 oz eq 2 oz eq 4 oz eq Vegetables 2½ cups 0 2½ cups Fruits © Jones & Bartlett2 cups Learning, LLC 1 cup © Jones &1 Bartlett cup Learning, LLC Dairy NOT FOR SALE OR3 cups DISTRIBUTION ½ cup NOT FOR SALE2½ cups OR DISTRIBUTION Protein 5½ oz eq 0 5½ oz Oils 6 tsp 1 tsp 5 tsp Empty calories allowed 267 calories 0 267 calories Source: Data from US Department of Agriculture and US Department of Health and Human Services. Dietary Guidelines for Americans, 2010. 7th ed. Washington, DC: US Government Printing © JonesOﬃ &ce; December Bartlett 2010. Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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© JonesPortion & Bartlett Distortion Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION The prevalence of obesity continues to be of great concern to both adults and children in the United States. A notable increase in obesity can be observed over the past 20 years. Thirty-six states had obesity rates greater than or equal to 25 percent; 12 of these states (Alabama, Arkansas, Kentucky, Louisville, Michigan, Mississippi, Missouri, Oklahoma, South Carolina, Tennessee, Texas, and West Virginia) had obesity rates greater than 30 percent (see Figure a ).1 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC

ManyNOT factors FOR contribute SALE to Americans’ OR DISTRIBUTION growing waistlines, NOT FOR SALE OR DISTRIBUTION but one observation in particular cannot be overlooked: The incidence of obesity has increased in parallel with increasing portion sizes.2 In almost every eating situation, we are now confronted by huge portions, which are perceived as “nor- © Jones &mal” Bartlett or “a great value.”Learning, This perception LLC that large portion sizes © Jones & Bartlett Learning, LLC NOT FORare SALE appropriate OR has DISTRIBUTION created an environment of portion dis- NOT FOR SALE OR DISTRIBUTION tortion. 3 We fi nd portion distortions in restaurants, where the jumbo-sized portions are consistently 250 percent larger than the regular portions. 4 We even fi nd portion distortions in our homes, where the sizes of our bowls and glasses have steadily increased and where the surface area of the average dinner plate has increased 36 percent© Jones since 1960. & 5Bartlett Research shows Learning, LLC © Jones & Bartlett Learning, LLC that people unintentionallyNOT consume FOR more caloriesSALE when OR faced DISTRIBUTION NOT FOR SALE OR DISTRIBUTION with larger portions. In addition, research also shows that portion distortion seems to aﬀ ect the portion sizes selected by young adults and children for some foods.6 Consuming larger portion sizes can contribute to positive energy balance, which, over time, leads to weight gain and ultimately can result in No Data < 10% 10%–14% 15%–19% 20%–24% 25%–29% ≥ 30% obesity.© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Figure A Prevalence of obesity. 45 kcals 350 kcals Source: Reproduced from Centers for Disease Control and Prevention. U.S. obesity trends: trends © iStockphoto/Thinkstock

© Jones & Bartlett Learning, LLC ©1 Centers Jones for Disease & BartlettControl and Prevention. Learning, Overweight LLCand obesity: adult obesity facts. www.cdc. NOT FOR SALE OR DISTRIBUTION NOTgov/obesity/data/trends.html FOR SALE . AccessedOR DISTRIBUTION 3/19/12. 2 Schwartz J, Byrd-Bredbenner C. Portion distortion: typical portion sizes selected by young adults. J Am Diet Assoc . 2006;106(9):1412–1418. 3 Wansink B, van Ittersum K. Portion size me: downsizing our consumption norms. J Am Diet Assoc . 8 oz with milk and sugar 16 oz mocha coff ee 2007;7(7):1103–1106. 4 Ibid. 5 Ibid. The phenomenon of portion distortion has the potential to © Jones & Bartlett Learning,6 Schwartz, LLC Byrd-Bredbenner. Op. cit.; and Lawhun SA,© Starkoff Jones B, Sundararajan & Bartlett S, et al. Infl uence Learning, of larger LLC hinder weight loss, weight NOTmaintenance, FOR and SALE health improve-OR DISTRIBUTIONportion sizes on the diet of overweight children andNOT adolescents. FOR J Am SALE Diet Assoc . 2008;108(9):A38.OR DISTRIBUTION ment eff orts. Food and nutrition professionals are working to 7 Schwartz, Byrd-Bredbenner. Op. cit. develop ways to “undistort” what people perceive to be typical portion sizes and help individuals recognize what is an appropriate amount to eat at a single eating occasion.7 To see whether you know how today’s portions compare to the© portions Jones available & Bartlett 20 years ago, Learning, take the interactive LLC por- © Jones & Bartlett Learning, LLC tion distortionNOT FOR quizzes SALE on the National OR DISTRIBUTION Heart Lung and Blood NOT FOR SALE OR DISTRIBUTION Institute’s Portion Distortion webpage ( http://hp2010.nhlbihin. net/portion). You can also learn about the amount of physical activity required to burn off the extra calories provided by today’s portions. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Key NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Exchange Lists Exchange Lists Lists of foods that in specifi ed Energy kilocalories Another tool for diet planning that uses food portions provide equivalent amounts of carbohydrate, Carbohydrate grams groups is called the Exchange Lists . Like fat, protein, and energy. Any food in an Exchange List can be substituted for any other without markedly aﬀ ecting Protein grams MyPlate, the Exchange Lists divide foods into macronutrient intake. Fat grams © Jones & Bartlett Learning, LLC groups. Diets can ©be Jonesplanned & by Bartlett choosing Learning, a LLC certain number of servings, or exchanges, from dietary standards Set of values for recommended Starch intake of nutrients. NOT FOR SALE OR DISTRIBUTIONeach group each day.NOT The FOR original SALE purpose OR DISTRIBUTIONof Dietary Reference Intakes (DRIs) A framework 80 15 3< 1 the Exchange Lists was to help people with of dietary standards that includes Estimated Average diabetes plan diets that would provide consis- Requirement (EAR), Recommended Dietary Allowance Fruits tent levels of energy and carbohydrates—both (RDA), Adequate Intake (AI), and Tolerable Upper Intake Level (UL). © Jones60 & Bartlett 15 00 Learning, LLC of which© Jones are essential & Bartlett for dietary Learning, management LLC C of diabetes. For this reason, foods are orga- A NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION R Fat-free and low-fat milk 1 cup fat-free or 1% milk nized into groups or lists not only by the type B = 2/3 cup plain fat-free yogurt of food (e.g., fruits or vegetables) but also by O 90 12 8 0–3 H the amount of macronutrients (carbohydrate, Y protein, and fat) in each portion. The por- D Reduced fat milk 1 cup 2% milk tions are defined so that each “exchange” has © Jones &R Bartlett Learning, LLC = 3/4 cup plain low-fat yogur©t Jones & Bartlett Learning, LLC A a similar composition. For example, 1 fruit NOT FORT SALE OR120 DISTRIBUTION12 8 5 NOT FOR exchangeSALE OR is ½DISTRIBUTION cup of orange juice or 17 small E S grapes or 1 medium apple or ½ cup of apple- Whole milk 1 cup whole milk sauce. All these exchanges have approximately & 60 kilocalories, 15 grams of carbohydrate, M 0 grams of protein, and 0 grams of fat. In I 150 12© Jones88 & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC L the Exchange Lists, starchy vegetables such K NOT FOR SALE OR DISTRIBUTIONas potatoes, corn, andNOT peas FOR are SALE grouped OR with DISTRIBUTION Other 3 small sugar-free cookies = 2 Tbsp light syrup breads and cereals instead of with other veg- Varies 15 Varies Varies = 1/2 cup gelatin etables because their balance of macronutrients is more like bread or pasta than carrots Vegetables 1 cup raw salad greens or tomatoes. © Jones & Bartlett Learning,= 1/2 cupLLC cooked carrots © Jones & Bartlett Learning, LLC 25 5 20= 1 large tomato Figure 2. 6 shows the amounts of carbohy- NOT FOR SALE OR DISTRIBUTION drate,NOT protein, FOR fat, SALE and kilocalories OR DISTRIBUTION in one exchange from each group, along with a sample serving size. Very lean 1 oz chicken = 1 oz canned (water packed) tuna = 1/2 cup cooked beans = 1/4 cup For a complete set of the Exchange Lists, go to go. 35 0 7 0–1 low-fat cottage cheese jblearning.com/nutrition. © JonesM &S BartlettLean Learning, LLC 1 oz beef tenderloin © Jones & Bartlett Learning, LLC E U = 1 oz salmon NOT FORA BSALE OR55 DISTRIBUTION0 73= 1 oz roast pork NOT FOR SALE OR DISTRIBUTION T S Using the Exchange Lists T & I Medium fat 1 oz ground beef in Diet Planning M T = 4 oz tofu E U 75 0 7 5 = 1 egg In addition to their use by people with diabetes, A T Exchange Lists are used in many weight-control T E © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC S High fat 1 oz sausage programs. Planning a diet using the Exchange NOT FOR SALE= 1 oz cheeseOR DISTRIBUTIONLists is done in muchNOT the same FOR manner SALE as OR using DISTRIBUTION 100 0 78? = 1 turkey hot dog MyPlate. The fi rst step is to become very familiar with the components of each group, the variations in fat content for dairy and meat lists, and ways F Fats 1 tsp butter = 8 large black olives = 1 slice that other foods may be included. Then, an indi- © Jones & Bartlett Learning,bacon LLC © Jones & Bartlett Learning, LLC A 45 00 5 T = 10 peanuts vidual diet plan can be used to select meals and NOT FOR SALE OR DISTRIBUTION snacksNOT throughout FOR SALE the day. OR An DISTRIBUTION exchange-based diet plan specifi es the number of exchanges to Figure 2.6 Exchange Lists. The Exchange Lists are a widely used system for meal planning for people with diabetes. They are also helpful for people interested in healthy be consumed from each group at each meal. For eating and weight control. example, a 1,500-kilocalorie weight reduction diet plan might have the following meal pattern: © Jones Source: & Data Bartlett from Exchange Learning,Lists for Meal Planning . LLC Alexandria, VA: Academy of Nutrition and Dietetics; 2003.© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION Exchange Lists NOT FOR SALE OR DISTRIBUTION Exchange Lists Lists of foods that in specifi ed Breakfast: 2 starch, 1 fruit, 1 milk, 1 fat Another tool for diet planning that uses food portions provide equivalent amounts of carbohydrate, groups is called the Exchange Lists . Like Lunch: 3 meat, 2 starch, 1 fruit, 1 vegetable, 1 fat fat, protein, and energy. Any food in an Exchange List can MyPlate, the Exchange Lists divide foods into Snack: 1 milk, 1 starch, 1 fat be substituted for any other without markedly aﬀ ecting macronutrient intake. groups. Diets can be planned by choosing a Dinner: 2 meat, 1 starch, 2 vegetable, 2 fat © Jones & Bartlett Learning, LLC dietary© standards Jones Set of& values Bartlett for recommended Learning, LLC certain number of servings, or exchanges, from Snack: 2 starch, 1 fruit intake of nutrients. each group each day. The original purpose of NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Dietary Reference Intakes (DRIs) A framework the Exchange Lists was to help people with of dietary standards that includes Estimated Average diabetes plan diets that would provide consis- Using this pattern and a complete set of the Exchange Lists, you could Requirement (EAR), Recommended Dietary Allowance tent levels of energy and carbohydrates—both (RDA), Adequate Intake (AI), and Tolerable Upper Intake then plan out a day or week of menus. Here’s one sample: Level (UL). of which are essential for dietary management © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC of diabetes. For this reason, foods are orga- nized into groups or lists not only by the type NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION of food (e.g., fruits or vegetables) but also by Breakfast: ½ cup orange juice, ¾ cup corn fl akes, 1 cup 2% milk, 1 slice the amount of macronutrients (carbohydrate, toast, 1 tsp margarine protein, and fat) in each portion. The por- Lunch: 3 oz cooked hamburger on bun, 1 tsp mayonnaise, ½ cup tions are defined so that each “exchange” has © Jones & Bartlett Learning,baby LLC carrots, 1 medium apple © Jones & Bartlett Learning, LLC a similar composition. For example, 1 fruit Snack: ¾ cup low-fat yogurt, ½ bagel with 1 tbsp cream cheese exchange is ½ cup of orange juice or 17 small NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Dinner: 2 oz cooked pork chop, ½ cup rice with 1 tsp margarine, grapes or 1 medium apple or ½ cup of apple- ½ cup yellow squash and ½ cup zucchini stir-fried in 1 tsp sauce. All these exchanges have approximately vegetable oil 60 kilocalories, 15 grams of carbohydrate, Snack: 1 toasted English muffi n, 1 medium pear 0 grams of protein, and 0 grams of fat. In © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC the Exchange Lists, starchy vegetables such as potatoes, corn, and peas are grouped with NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION breads and cereals instead of with other veg- Key Concepts The Exchange Lists are a diet-planning tool that use the idea of food groups, but define etables because their balance of macronutri- groups specifically in terms of macronutrient (carbohydrate, fat, and protein) content. Individual diet plans can be ents is more like bread or pasta than carrots developed for people who need to control energy or carbohydrate intake, such as for weight control or management of diabetes mellitus. or tomatoes. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Figure 2. 6 shows the amounts of carbohy- NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION drate, protein, fat, and kilocalories in one exchange Recommendations for Nutrient Intake: The DRIs from each group, along with a sample serving size. So far, the tools described ( Dietary Guidelines for Americans, Canada’s Guide- For a complete set of the Exchange Lists, go to go. lines for Healthy Eating, MyPlate, Eating Well with Canada’s Food Guide, and jblearning.com/nutrition. Exchange Lists) deal with whole foods and food groups rather than individual © Jones &nutrient Bartlett values; Learning, after all, foods LLC are what we think about© in Jonesplanning & our Bartlett daily Learning, LLC NOT FORmeals SALE and OR shopping DISTRIBUTION lists. Sometimes, though, we needNOT more FOR specifi SALE c infor- OR DISTRIBUTION Using the Exchange Lists mation about our nutritional needs—a healthful diet is healthful because of in Diet Planning the balance of nutrients it contains. Before we can choose foods that meet our needs for specifi c nutrients, we need to know how much of each nutrient In addition to their use by people with diabetes, we require daily. This is what dietary standards do—they defi ne healthful Exchange Lists are used in many weight-control diets in terms of specifi c amounts of the nutrients. programs. Planning a diet using the Exchange © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Lists is done in much the same manner as using NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION MyPlate. The fi rst step is to become very familiar Understanding Dietary Standards with the components of each group, the variations Dietary standards are sets of recommended intake values for nutrients. These in fat content for dairy and meat lists, and ways standards tell us how much of each nutrient we should have in our diets. In that other foods may be included. Then, an indi- the United States and Canada, the Dietary Reference Intakes (DRIs) are vidual diet plan can be used to select meals and the current© Jones dietary & Bartlettstandards. Learning, LLC © Jones & Bartlett Learning, LLC snacks throughout the day. An exchange-based Consider NOT FOR the followingSALE OR scenario. DISTRIBUTION You are running a research center locatedNOT FOR SALE OR DISTRIBUTION diet plan specifi es the number of exchanges to in Antarctica and staffed by 60 people. Because staff will not be able to leave be consumed from each group at each meal. For the site to get meals, you must provide all their food. You must keep the group example, a 1,500-kilocalorie weight reduction adequately nourished; you certainly don’t want anyone to become ill as a diet plan might have the following meal pattern: result of a nutrient defi ciency. How would you (or the nutritionist you hire) © Jones &start Bartlett planning? Learning, How can LLCyou be sure to provide adequate© Jones amounts & Bartlett of the Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION essential nutrients?NOT The FOR most SALE important OR DISTRIBUTIONtool would be a set of dietary standards! Essentially the same scenario faces those who plan and provide food for groups of people in more routine circumstances—the military, prisons, and even schools. To assess nutritional adequacy, diet planners can compare the nutrient composition of their food plans to recommended intake values. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE A BriefOR DISTRIBUTION History of Dietary Standards NOT FOR SALE OR DISTRIBUTION Beginning in 1938, Health Canada published dietary standards called Recommended Nutrient Intakes (RNIs) Canadian Recommended Nutrient Intakes (RNIs). In the United States, the dietary standards that have been replaced by Dietary Recommended Dietary Allowances (RDAs) were fi rst published in 1941. Reference Intakes. By the 1940s, nutrition scientists had been able to isolate and identify many Recommended© Jones Dietary Allowances & Bartlett (RDAs) TheLearning, of theLLC nutrients in food. They were© Jonesable to measure & Bartlett the amounts Learning, of these LLC nutri- nutrient intakeNOT levels thatFOR meet the SALE nutrient needs OR of DISTRIBUTIONents in foods and to recommendNOT daily FOR intake SALE levels. TheseOR DISTRIBUTION levels became the almost all (97 to 98 percent) individuals in a life-stage and gender group. fi rst RNI and RDA values. Committees of scientists regularly reviewed the standards and published revised editions; for example, the tenth (and fi nal) Food and Nutrition Board A board within the Institute of Medicine of the National Academy of Sciences. edition of RDAs was published in 1989. It is responsible for assembling the group of nutrition In the mid-1990s, the Food and Nutrition Board of the National Acad- © Jonesscientists & Bartlett who review available Learning, scientifi c data toLLC determine emy of Sciences © began Jones a partnership & Bartlett with Learning, Health Canada LLC to make fundamen- NOT FORappropriate SALE intake levelsOR of DISTRIBUTIONthe known essential nutrients. tal changes in NOTthe approach FOR SALE to setting OR dietary DISTRIBUTION standards and to replace the requirement The lowest continuing intake level of a RDAs and RNIs. In 1997, the fi rst set of DRIs was published. nutrient that prevents defi ciency in an individual. Estimated Average Requirement (EAR) The intake Dietary Reference Intakes value that meets the estimated nutrient needs of 50 Since the inception of the RDAs and RNIs, we have learned more about the percent of individuals in a specifi c life-stage© Jones and gender & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC group. relationships between diet and chronic disease, and nutrient-defi ciency diseases NOT FOR SALEhave OR become DISTRIBUTION rare in the United States and Canada.NOT The FOR new DRIsSALE refl OR ect DISTRIBUTIONnot just intake levels for dietary adequacy but also for optimal nutrition. The DRIs are reference values for nutrient intakes to be used in assessing and planning diets for healthy people (see Figure 2. 7 ). The DRIs include © Jones & Bartlett Learning,four LLC basic elements: Estimated ©Average Jones Requirement & Bartlett (EAR), Learning, Recommended LLC Dietary Allowance (RDA), Adequate Intake (AI), and Tolerable Upper Intake NOT FOR SALE OR DISTRIBUTIONLevel (UL). Underlying each ofNOT these FOR values SALE is the defiOR nitionDISTRIBUTION of a requirement as the “lowest continuing intake level of a nutrient that, for a specifi c indicator of adequacy, will maintain a defi ned level of nutriture in an individual.”19 In other words, a requirement is the smallest amount of a nutrient you should take in on a regular basis to remain healthy. In the DRI report © Jones & Bartlett Learning, LLC on macronutrients,© Jones two other& Bartlett concepts Learning, were introduced: LLC the Estimated NOT FOR SALE OR DISTRIBUTION Energy RequirementNOT FOR(EER) SALEand the OR Acceptable DISTRIBUTION Macronutrient Distribution Ranges (AMDRs). 20 Estimated Average Requirement The Estimated Average Requirement (EAR) refl ects the amount of a © Jones & Bartlettnutrient Learning, that would LLCmeet the needs of 50 percent© ofJones the people & Bartlett in a particu- Learning, LLC NOT FOR SALElar ORlife-stage DISTRIBUTION (age) and gender group. For each NOTnutrient, FOR this SALErequirement OR DISTRIBUTIONis defi ned using a specifi c indicator of dietary adequacy. This indicator could be the level of the nutrient or one of its breakdown products in the blood, or the amount of an enzyme associated with that nutrient.21 The EAR is used to set the RDA, and EAR values can also be used to assess dietary adequacy © Jones & Bartlett Learning,or LLCplan diets for groups of people.© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Recommended Dietary Allowance The Recommended Dietary Allowance (RDA) is the daily intake level that meets the needs of most people (97 to 98 percent) in a life-stage and gender group. The RDA is set at two standard deviations above the EAR. A nutrient © Jones & Bartlett Learning, LLC will not have an© RDAJones value & Bartlettif there are Learning, not enough LLCscientifi c data available NOT FOR SALE OR DISTRIBUTION to set an EAR NOTvalue. FOR SALE OR DISTRIBUTION

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONAll DRI values refer to intakes averaged over timeNOT FOR SALE OR DISTRIBUTION EAR RDA UL Photo: © Photodisc AI © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Number of people © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Nutrient intake

EAR RDA AI UL © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

RISK

The Estimated The© Recommended Jones & BartlettAdequate Intak Learning,e is based upon T olerableLLC Upper Intake Level © Jones & Bartlett Learning, LLC Average Requirement is the Dietary Allowance is the expert estimates of nutrient is the maximum level of daily nutrient intake level estimated to nutrientNOT intake FORlevel that is SALEintake byOR a dened DISTRIBUTION group of nutrient intake that poses little risk NOT FOR SALE OR DISTRIBUTION meet the needs of 50% of the sucient to meet the needs of healthy people. These estimates of adverse health eects to almost individuals in a life- stage and 97–98% of the individuals in a are used when there is all of the individuals in a dened gender group. life-stage and gender group. The insucient scientic evidence to group. In most cases, supplements RDA is calculated from the EAR. establish an EAR. AI is not must be consumed to reach a UL. © Jones & Bartlett Learning,equivalent LLC to RDA. © Jones & Bartlett Learning, LLC FigureNOT 2.7 FORDietary SALE Reference OR Intakes. DISTRIBUTION The Dietary Reference Intakes are a set of dietary standardsNOT that FOR SALE OR DISTRIBUTION include Estimated Average Requirement (EAR), Recommended Dietary Allowance (RDA), Adequate Intake (AI), and Tolerable Upper Intake Level (UL).

People can use the RDA value as a target or goal for dietary intake and © Jones &make Bartlett comparisons Learning, between LLC actual intake and RDA values.© Jones It is important& Bartlett Learning, LLC NOT FORto SALE remember, OR however,DISTRIBUTION that the RDAs do not defi ne anNOTindividual’s FOR SALE nutrient OR DISTRIBUTION requirements. Your actual nutrient needs might be much lower than average, and therefore the RDA would be more than you need. An analysis of your diet might show, for example, that you consume 45 percent of the RDA for a certain vitamin, but that might be adequate for your needs. Only specifi c laboratory or other tests© Jonescan determine & Bartlett a person’s Learning, true nutrient LLC requirements © Jones & Bartlett Learning, LLC and actual nutritional NOTstatus. FORAn intake SALE that ORis consistently DISTRIBUTION at or near the RDA NOT FOR SALE OR DISTRIBUTION level is likely to be meeting your needs. Adequate Intake If not enough scientifi c data are available to set an EAR level, a value called an Adequate © Jones Intake & Bartlett (AI) is determinedLearning, instead. LLC AI values are determined© Jonesin &Adequate Bartlett Intake (AI) Learning, The nutrient intake LLC that appears part byNOT observing FOR healthySALE groupsOR DISTRIBUTION of people and estimating their dietary intake.NOT FORto SALEsustain a defi ORned nutritional DISTRIBUTION state or some other All the current DRI values for infants are AI levels because there have been too indicator of health (e.g., growth rate or normal circulating nutrient values) in a specifi c population or subgroup. few scientifi c studies to determine specifi c requirements in infants. Instead, AI AI is used when there is insuﬃ cient scientifi c evidence to values for infants are usually based on nutrient levels in human milk, a complete establish an EAR. food for newborns and young infants. Values for older infants and children are © Jones &extrapolated Bartlett fromLearning, human milkLLC and from data on adults.© For nutrients Jones & withBartlett AI Learning, LLC NOT FORinstead SALE of ORRDA DISTRIBUTION values for all life-stage groups (e.g., calcium,NOT vitamin FOR D),SALE more OR DISTRIBUTION

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION scientifi c researchNOT is neededFOR SALEto better OR defi DISTRIBUTION ne the nutrient requirements of population groups. AI values can be considered target intake levels for individuals. Tolerable Upper Intake Level Tolerable Upper Intake Levels (ULs) The maximum Tolerable Upper Intake Levels (ULs) have been defi ned for many nutrients. levels of daily nutrient intakes that are unlikely© Jones to pose & BartlettConsumption Learning, of a LLCnutrient in amounts higher than© Jones the UL & could Bartlett be harm- Learning, LLC health risks to almost all of the individuals in the group for ful. The ULs have been developed partly in response to the growing interest whom they are designed. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION in dietary supplements that contain large amounts of essential nutrients. The Estimated Energy Requirement (EER) Dietary UL is not to be used as a target for intake but rather should be a cautionary energy intake that is predicted to maintain energy balance in a healthy adult of a defi ned age, gender, weight, height, level for people who regularly take nutrient supplements. and level of physical activity consistent with good health. Estimated Energy Requirement Acceptable© Macronutrient Jones & Distribution Bartlett Ranges Learning, LLC © Jones & Bartlett Learning, LLC (AMDRs) NOTRange of intakes FOR for a SALEparticular energy OR source DISTRIBUTION The Estimated Energy RequirementNOT FOR (EER) SALE is defi ORned DISTRIBUTIONas the energy intake that are associated with reduced risk of chronic disease that is estimated to maintain energy balance in healthy, normal-weight indi- while providing adequate intakes of essential nutrients. viduals. It is determined using an equation that considers weight, height, age, and physical activity. Different equations are used for males and females and for different age groups. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION Acceptable MacronutrientNOT FOR SALE Distribution OR DISTRIBUTION Ranges Acceptable Macronutrient Distribution Ranges (AMDRs) indicate the recommended balance of energy sources in a healthful diet. These values consider the amounts of macronutrients needed to provide adequate intake of essential nutrients while reducing the risk for chronic disease. The AMDRs © Jones & Bartlettare shown Learning, in Table LLC 2. 6 . © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Use of Dietary Standards The most appropriate use of DRIs is to plan and evaluate diets for large groups of people. Remember the South Pole scenario at the beginning of this section? © Jones & Bartlett Learning,If youLLC had planned menus and evaluated© Jones the & nutrient Bartlett composition Learning, of the LLC foods NOTAcceptable FOR SALE OR DISTRIBUTIONthat would be included and if theNOT average FOR nutrient SALE levels OR of DISTRIBUTION those daily menus Table 2.6 met or exceeded the RDA/AI levels, you could be confi dent that your group Macronutrient would be adequately nourished. If you had a very large group—thousands of Distribution Ranges for Adults soldiers, for instance—the EAR would be a more appropriate guide. Dietary standards are also used to make decisions about nutrition policy. © JonesFat & Bartlett Learning,20–35 LLC The Special Supplemental© Jones & Food Bartlett Program Learning, for Women, LLC Infants, and Children Carbohydrate 45–65 (WIC), for example, takes into account the DRIs as it provides food or vouch- NOT FOR SALE OR DISTRIBUTION ers for food. TheNOT goal FOR of this SALE federally OR funded DISTRIBUTION supplemental feeding program Protein 10–35 is to improve the nutrient intake of low-income pregnant and breastfeeding n-6 Polyunsaturated fatty 5–10 women, their infants, and young children. The guidelines for school lunch acids and breakfast programs are also based on DRI values. a-Linolenic acid 0.6–1.2 © Jones & BartlettOften, Learning, we use dietary LLC standards as comparison© valuesJones for & individual Bartlett diets, Learning, LLC Note: All values are percentage of energy intake. something you might be doing in class. It can be interesting to see how your Source: Reproduced from Institute of Medicine,NOT Food FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION and Nutrition Board. Dietary Reference Intakes for Energy, daily intake of a nutrient compares with the RDA or AI. However, an intake Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and that is less than the RDA/AI doesn’t necessarily mean defi ciency; your indi- Amino Acids. Copyright © 2005 by the National Academy vidual requirement for a nutrient can be less than the RDA/AI value. You can of Sciences, courtesy of the National Academies Press, use the RDA/AI values as targets for dietary intake, while avoiding nutrient Washington, DC. © Jones & Bartlett Learning,intake LLC that exceeds the UL. © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONKey Concepts Dietary standards are levelsNOT of nutrient FOR intake recommendedSALE OR for healthy DISTRIBUTION people. These standards help the government set nutrition policy and also can be used to guide the planning and evaluation of diets for groups and individuals. The Dietary Reference Intakes are the dietary standards for the United States and Canada. These standards focus on maintaining optimal health and lowering the risks of chronic disease, rather than simply on dietary adequacy.

© Jones & Bartlett Learning, LLC Food Labels© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Now that you understand diet-planning tools and dietary standards, let’s focus on your use of these tools—for example, when making decisions at

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORthe SALE grocery store. OR DISTRIBUTION One of the most useful tools in planningNOT aFOR healthful SALE diet OR DISTRIBUTION is the food label . food label Labels required by law on virtually all Specifi c federal regulations control what may and may not appear on a packaged foods and having fi ve requirements: (1) a food label and what must appear on it. The Food and Drug Administra- statement of identity; (2) the net contents (by weight, volume, or measure) of the package; (3) the name and tion (FDA) is responsible for ensuring that foods sold in the United States address of the manufacturer, packer, or distributor; (4) a list are safe, wholesome, ©and Jones properly & Bartlettlabeled. The Learning, Health Products LLC and Food of ingredients;© Jones and (5) nutrition & information.Bartlett Learning, LLC Branch of Health CanadaNOT hasFOR similar SALE responsibilities. OR DISTRIBUTION The FDA’s jurisdic- Food andNOT Drug Administration FOR SALE (FDA) ORThe federal DISTRIBUTION tion does not include meat, meat products, poultry, or poultry products; the agency responsible for ensuring that foods sold in USDA regulates these foods. the United States (except for eggs, poultry, and meat, As information about the role of diet in chronic disease grew during the which are monitored by the USDA) are safe, wholesome, 1970s and 1980s, so did the demand for nutrition labels on all food prod- and labeled properly. The FDA sets standards for the composition of some foods, inspects food plants, and ucts. As© Jonesa result, in& 1990Bartlett Congress Learning, passed the LLC Nutrition Labeling and Edu-© Jones monitors& Bartlett imported foods. Learning, The FDA is an agency LLC of the cationNOT Act (NLEA) FOR SALE . Once OR the DISTRIBUTION necessary regulations had been developed,NOT FORDepartment SALE of Health OR and DISTRIBUTION Human Services (DHHS). “Nutrition Facts” labels began appearing on foods in 1994. By 1997, 96.5 Nutrition Labeling and Education Act (NLEA) An percent of food products had nutrition labels.22 Voluntary nutrition labeling amendment to the Food, Drug, and Cosmetic Act of 1938. was introduced in Canada in 1988, and fi nal regulations to make nutrition The NLEA made major changes to the content and scope labeling mandatory were released in 2002. Canadian nutrition labels now of the nutrition label and to other elements of food labels. are similar in format to U.S. nutrition labels. Final regulations were published in 1993 and went into © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning,eﬀ ect in 1994. LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Ingredients and Other Basic Information The label on a food you buy today has been shaped by many sets of regulations. As Figure 2. 8 shows, food labels have fi ve mandatory components: 1. A statement of© identityJones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 2. The net contentsNOT of FORthe package SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 3. The name and address of the manufacturer, packer, or distributor 4. A list of ingredients 5. Nutrition information

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Figure 2.8 The fi ve mandatory requirements for food labels. Federal regulations determine what may and may not appear on food labels.

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC The statement of identity requirement means that the product must NOT FORstatement SALE of identity OR ADISTRIBUTION mandate that commercial NOT FOR SALE OR DISTRIBUTION food products prominently display the common or prominently display the common or usual name of the product or identify usual name of the product or identify the food with an the food with an “appropriately descriptive term.” For example, it would be “appropriately descriptive term.” misleading to label a fruit beverage containing only 10 percent fruit juice as Nutrition Facts A portion of the food label that states a “juice.” The statement of net package contents must accurately refl ect the the content of selected nutrients in a food© in Jones a standard & Bartlettquantity Learning, in terms of LLC weight, volume, measure, or© numericalJones & count. Bartlett Informa- Learning, LLC way prescribed by the Food and Drug Administration.NOT FOR By SALEtion OR about DISTRIBUTION the manufacturer, packer, or distributorNOT gives FOR consumers SALE a ORway DISTRIBUTIONto law, Nutrition Facts must appear on nearly all processed contact someone in case they have questions about the product. food products in the United States. Ingredients must be listed by common or usual name, in descending order by weight; thus, the fi rst ingredient listed is the primary ingredient in that food product. Let’s compare two cereals: © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Cereal A ingredients: Milled corn, sugar, salt, malt fl avoring, high- NOT FOR SALE OR DISTRIBUTIONfructose corn syrup NOT FOR SALE OR DISTRIBUTION Cereal B ingredients: Sugar, yellow corn fl our, rice fl our, wheat fl our, whole oat fl our, partially hydrogenated vegetable oil (contains one or more of the following oils: canola, soybean, cottonseed), salt, cocoa, © Jones & Bartlett Learning, LLC artifi cial© flJones avor, corn& Bartlett syrup Learning, LLC NOT FOR SALE OR DISTRIBUTION In Cereal B,NOT the fiFOR rst ingredient SALE OR listed DISTRIBUTION is sugar, which means this cereal contains more sugar by weight than any other ingredient. Cereal A’s primary ingredient is milled corn. That can make quite a difference in the amount (grams) of sugar a cereal contains! As you probably have noticed, when the ingredient list includes the artifi - © Jones & Bartlettcial sweetener Learning, aspartame, LLC it also displays a warning© Jones statement. & Also,Bartlett preserva- Learning, LLC NOT FOR SALEtives OR and DISTRIBUTION other additives in foods must be listed,NOT along FOR with SALEan explanation OR DISTRIBUTION of their function. Accurate and complete ingredient information is vital for people with food allergies who must avoid certain food components. As of January 2006, the labels of foods that contain any of the eight major food allergens (egg, wheat, peanuts, milk, tree nuts, soy, fi sh, and crustaceans) © Jones & Bartlett Learning,have LLC been required to include common© Jones names & Bartlett when listing Learning, these ingredients. LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Nutrition Facts Panel The Nutrition Facts panel contains the most important label information for the health-conscious consumer. Eighty-three percent of shoppers regularly © Jones & Bartlett Learning, LLC check the Nutrition© Jones Facts panel& Bartlett when buying Learning, a product LLC for the fi rst time, and NOT FOR SALE OR DISTRIBUTION 91 percent willNOT make aFOR purchasing SALE decision OR DISTRIBUTION based on nutrition information. 23 Although fat content is the most frequently sought piece of information, consumers are also looking for foods that are “low calorie,” “whole grain,” and “low salt/sodium.” The Nutrition Facts panel informs the consumer about the nutritional value of a food product, enabling an informed shopper to com- © Jones & Bartlettpare similar Learning, products. LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR Let’s DISTRIBUTION take a closer look at the elements ofNOT the Nutrition FOR SALE Facts ORpanel. DISTRIBUTION It was designed so that the nutrition information would be easy to fi nd on the label. The heading “Nutrition Facts” stands out clearly (see Figure 2. 9 ). Just under the heading is information about the serving size and number of servings per container. It is important to note the serving size because all the © Jones & Bartlett Learning,nutrient LLC information that follows© Jonesis based &on Bartlett that amount Learning, of food, andLLC the NOT FOR SALE OR DISTRIBUTIONlisted serving size might be differentNOT fromFOR what SALE you ORusually DISTRIBUTION eat. An 8-ounce bag of potato chips might be a small snack to a hungry college student, but according to the manufacturer, the bag really contains eight servings! Serving sizes are standardized according to reference amounts developed by the FDA. Similar products (cereals, for instance) have similar serving sizes (1 ounce). © Jones & Bartlett Learning, LLC This should make© Jones it easier & to Bartlett compare Learning,products because LLC the serving size on NOT FOR SALE OR DISTRIBUTION the food label NOTwill likely FOR be SALEthe same. OR DISTRIBUTION

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Serving Size: The serving size is a standardized Nutrition Facts Title reference amount, but check twice to see if this Serving Size: 1 slice (34g/1.2 oz) is the amount you usually eat. The numbers that Servings Per Container: 20 you will be looking at are based on this quantity. © Jones & Bartlett Learning,Amount Per Servin LLCg Calories© Jones Per Serving: & Having Bartlett the number ofLearning, calories LLC Calories 90 Calories from fat 10 and the number of calories from fat next to each other

NOT FOR SALE OR DISTRIBUTION% Daily Value* makesNOT it easy toFOR see if a food SALE is high in fat.OR DISTRIBUTION Total Fat 1g 2% Saturated Fat 0g 1% Trans Fat 0g Cholesterol0mg 0% % Daily Values: These percentages are based on the © Jones & Bartlett Learning, LLCSodium 160mg7©% Jones & Bartlettvalues given below Learning, in the footnote for aLLC 2,000-calorie List of Nutrients diet. Thus, if your caloric intake is di erent, you will Product-speci c Information NOT FOR SALE OR DISTRIBUTIONTotal Carbohydrate 15g 5%NOT FOR SALEneed to adjust OR these DISTRIBUTION values appropriately. Dietary Fiber 2g 8% Sugars 2g Protein 4g Vitamin A 0% •Vitamin C 0% © Jones & Bartlett Learning, LLC Calcium 0%© Jones•Iron & 4% Bartlett Learning, LLC *Percent Daily Values are based on a 2,000 Daily Values Footnote: Daily Values are shown for NOT FOR SALE OR DISTRIBUTION calorie diet. YoNOTur daily values FOR may be higher SALE or OR DISTRIBUTIONtwo caloric intake levels to emphasize the importance lower depending on your calorie needs: of evaluating your own diet in order to apply the Calories: 2,000 2,500 information on the label. Total FatLess Than 65g80g Sat FatLess Than 20g25g CholesterolLess Than 300mg300mg Sodium Less Than 2,400mg2,400mg Total Carbohydrate 300g 375g © Jones & Bartlett Learning,Dietary Fiber2 LLC5g 30g Caloric© ConversionJones Information: & Bartlett Handy reference Learning, LLC Consistent Information Calories per gram: values help you check the math on your own NOT FOR SALE ORFa DISTRIBUTIONt9•Carbohydrate4•Protein 4 calculations!NOT FOR SALE OR DISTRIBUTION

Figure 2.9 The Nutrition Facts panel. Consumers can use the Nutrition Facts panel to compare the nutritional values of diﬀ erent products.

The next part of the label shows the calories per serving and the calories that come from fat. This information reveals at a glance whether a food product is high or low in fat. If most calories in a product come from fat, it is © Jones &a high-fat Bartlett food. Learning, Following LLCthis is a list of the amounts ©of Jonestotal fat, & saturated Bartlett Learning, LLC NOT FORfat, SALE trans fat,OR cholesterol, DISTRIBUTION sodium, total carbohydrate, dietaryNOT fi FORber, sugars, SALE and OR DISTRIBUTIONenrich To add vitamins and minerals lost or diminished protein in one serving. This information is given both in quantity (grams or during food processing, particularly the addition of milligrams per serving) and as a percentage of the Daily Value—a comparison thiamin, ribofl avin, niacin, folic acid, and iron to grain standard specifi cally for food labels (this standard is described in the follow- products. ing section). Listed next are percentages of Daily Values for vitamins A and fortify Refers to the addition of vitamins or minerals that C, calcium, and iron, which© Jones are the & onlyBartlett micronutrients Learning, that LLC must appear on were not ©originally Jones present in& a food. Bartlett Learning, LLC all standard labels. ManufacturersNOT FOR canSALE choose OR to DISTRIBUTION include information about NOT FOR SALE OR DISTRIBUTION other nutrients, such as potassium, polyunsaturated fat, additional vitamins, or other minerals, in the Nutrition Facts panel. However, if they make a claim about an optional component (e.g., “good source of vitamin E”) or enrich or fortify the food, the manufacturers must include specifi c nutrition information for© Jones these added & Bartlett nutrients. Learning, This information LLC must be included even when© Jones & Bartlett Learning, LLC governmentNOT FOR regulations SALE require OR DISTRIBUTION enrichment or fortifi cation, such as theNOT forti- FOR SALE OR DISTRIBUTION fi cation of milk with vitamin D to prevent rickets (a bone disease in children that results from vitamin D defi ciency) and the fortifi cation of grain products with folic acid to reduce the risk of birth defects. Food products that come Nutrition Facts on small packages. Figure 2.10 in small packages (e.g., gum, candy, tuna) or that have little nutritional value When a product package has © Jones &(e.g., Bartlett diet soft Learning, drinks) can LLChave abbreviated versions of© theJones Nutrition & Bartlett Facts Learning,insuﬃ cient space to LLC display a full Nutrition Facts panel, NOT FORon SALE the label, OR as DISTRIBUTION Figure 2. 10 shows. NOT FOR SALE OR manufacturersDISTRIBUTION may use an abbreviated version.

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION Daily ValuesNOT FOR SALE OR DISTRIBUTION Daily Values (DVs) A single set of nutrient intake Let’s come back to the Daily Values part of the label. The Daily Values (DVs) standards developed by the Food and Drug Administration are a set of dietary standards used to compare the amount of a nutrient (or to represent the needs of the “typical” consumer; used as other component) in a serving of food to the amount recommended for standards for expressing nutrient content on food labels. daily consumption. Nutrients are listed as a percentage of the food’s Daily nutrient content claims These claims© describeJones the & BartlettValue Learning,on the Nutrition LLC Facts panel. This information© Jones lets consumers & Bartlett see Learning,at a LLC level of a nutrient or dietary substance NOTin the product, FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION using terms such as good source, high, or free. glance how a food fi ts into their diets. Let’s say you rely on your breakfast cereal as a major source of dietary fi ber intake. Comparing two packages, as in Figure 2. 11 , you fi nd that a serving of corn-fl akes cereal has 4 percent of the DV for dietary fi ber, but choosing bran-fl akes cereal gives you 20 percent. You don’t have to know anything about grams to see which has more! © Jones & Bartlett Learning,Keep LLC in mind that the Daily Values© Jones (which &were Bartlett established Learning, in 1993) LLC might NOT FOR SALE OR DISTRIBUTIONnot exactly match the more recentNOT DRI FOR values; SALE in most OR cases,DISTRIBUTION however, the differences are small.

Nutrient Content Claims © Jones & Bartlett Learning, LLC The NLEA and© the Jones associated & Bartlett FDA regulations Learning, allow LLC food manufacturers to NOT FOR SALE OR DISTRIBUTION make nutrient NOT content FOR claims SALE using OR a variety DISTRIBUTION of descriptive terms on labels,

© ServingJones Size: & Bartlett 1Learning, Cup (28g/1.0 oz.)LLC Serving Size: © Jones &3 /Bartlett4 Cup (30g) Learning, LLC NOTServings FOR Per Container:SALE OR DISTRIBUTIONAbout 18 Servings Per Container:NOT FOR SALEAbout OR15 DISTRIBUTION with with Amount 1/2 cup Amount 1/2 cup Per Serving Cereal Skim Milk Per Serving Cereal Skim Milk Calories 100140 Calories 100140 © Jones & BartlettFat Calories Learning,00 LLC © JonesCalories from & fatBartlett 55 Learning, LLC % Daily Value % Daily Value NOT FOR SALETo talOR Fa tDISTRIBUTION0g 0% 0% NOTTotal FOR Fat 0.5g SALE OR 1% DISTRIBUTION1% Saturated Fat 0g 0% 0% Saturated Fat 0g 0% 0% Trans Fat 0g Trans Fat 0g Cholesterol 0mg0%0% Cholesterol 0mg0%0% Sodium 300mg 13%15% Sodium 210mg9% 12% © Jones & Bartlett Learning,Po tassiuLLCm 25mg 1% ©7% Jones & BartlettPotassiu Learning,m 200mg LLC 6% 11% Total Total NOT FOR SALE OR DISTRIBUTIONCarbohydrate 24g8%1NOT0% FOR SALECarbohydrate OR DISTRIBUTION24g8%10% Dietar y Fiber 1g 4% 4% Dietar y Fiber 5g 20% 20% Sugars 2g Sugars 5g Other Carbohydrates 21g Other Carbohydrates 14g Protein 2g Protein 3g © VitaminJones A1 & Bartlett5% Learning,20% LLC Vitamin A1© Jones5% & Bartlett20% Learning, LLC NOTVitamin FOR C SALE25% OR DISTRIBUTION25% Vitamin C NOT0% FOR SALE2% OR DISTRIBUTION Calcium 0% 15% Calcium 0% 15% Iron 45% 45% Iron 45% 45% Vitamin D10% 25% Vitamin D10% 25% Thiamin 25% 30% Thiamin 25% 30% © Jones & BartlettRiboflavin Learning,25% LLC 35% © RiboflavinJones & Bartlett25% Learning,35% LLC NOT FOR SALENiacin OR DISTRIBUTION25% 25% NOTNiacin FOR SALE25% OR DISTRIBUTION25% Vitamin B6 25% 25% Vitamin B6 25% 25% Folate 25% 25% Folate 25% 25%

Vitamin B12 25% 35% Vitamin B12 25% 35%

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Comparing cereals. These cereal labels come from diﬀ erent types of breakfast cereal: corn-fl akes cereal (left) and bran-fl akes cereal (right). What might infl uence NOT FORFigure SALE 2.11 OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION your decision to buy one over the other?

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Definitions for Nutrient Content Claims on Food Labels © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Free: Food contains no amount (or trivial or Good Source: Food contains 10 to 19 percent product, such as a frozen entrée or dinner, “physiologically© Jones inconsequential” & Bartlett amounts).Learning, LLCof the Daily Value for a particular nutrient© Jones in & Bartlettmust provide Learning, 10 percent of two LLC or more of MayNOT be used FOR with one SALE or more OR of the DISTRIBUTION follow- one serving. NOT FOR SALEthese vitamins OR orDISTRIBUTION minerals, or protein or fiber, ing: fat, saturated fat, cholesterol, sodium, Reduced: Nutritionally altered product contain- in addition to meeting the other criteria. sugar, and calories. Synonyms include with- ing at least 25 percent less of a nutrient or of Additional regulations allow the term healthy out, no, and zero. calories than the regular or reference product. to be applied to raw, canned, or frozen fruits Fat-free: Less than 0.5 grams of fat per serving. Note: A “reduced” claim cannot be used if the and vegetables and enriched grains even if © Jones &Saturated Bartlett fat-free: Learning, Less than 0.5 LLC grams of satu- reference product© Jones already meets & Bartlett the require- Learning,the 10 percent LLC nutrient content rule is not rated fat per serving, and less than 0.5 grams ment for “low.” met. However, frozen or canned fruits or NOT FOR SALEof trans fattyOR acids DISTRIBUTION per serving. Less: Food, whetherNOT altered FOR or SALEnot, contains OR DISTRIBUTIONvegetables cannot contain ingredients that Cholesterol-free: Less than 2 milligrams of 25 percent less of a nutrient or of calories would change the nutrient profile. cholesterol and 2 grams or less of saturated than the reference food. Fewer is an accept- Fresh: Food is raw, has never been frozen or fat per serving. able synonym. heated, and contains no preservatives. Fresh Sodium-free: Less than 5 milligrams of sodium Light: This descriptor can have two meanings: frozen, frozen fresh, and freshly frozen can be per serving. used for foods that are quickly frozen while © Jones & Bartlett1. Learning, A nutritionally alteredLLC product contains © Jones & Bartlett Learning, LLC Sugar-free: Less than 0.5 grams of sugar per still fresh. Blanched foods also can be called one-third fewer calories or half the fat of serving. NOT FOR SALE OR DISTRIBUTION fresh.NOT FOR SALE OR DISTRIBUTION the reference food. If the reference food Calorie-free: Fewer than 5 calories per serving. Percent fat-free: Food must be a low-fat or a derives 50 percent or more of its calories Low: Food can be eaten frequently without fat-free product. In addition, the claim must from fat, the reduction must be 50 percent exceeding dietary guidelines for one or reflect accurately the amount of nonfat ingre- of the fat. more of these components: fat, saturated fat, dients in 100 grams of food. 2. The sodium content of a low-calorie, low- cholesterol, sodium, and calories. Synonyms Implied claims: These are prohibited when © Jones & Bartlett Learning, LLCfat food has been reduced by 50© percent. Jones & Bartlett Learning, LLC include little, few, and low source of. they wrongfully imply that a food contains Also, light in sodium may be used on a food Low-fat:NOT 3 grams FOR or lessSALE per serving. OR DISTRIBUTION NOT FOR SALEor does ORnot contain DISTRIBUTION a meaningful level of a in which the sodium content has been Low saturated-fat: 1 gram or less of saturated nutrient. For example, a product cannot claim reduced by at least 50 percent. fat per serving; no more than 15 percent of to be made with an ingredient known to be a Note: The term light can still be used to calories from saturated fat. source of fiber (such as “made with oat bran”) describe such properties as texture and Low-cholesterol: 20 milligrams or less and unless the product contains enough of that color as long as the label clearly explains 2 grams or less of saturated fat per serving. ingredient (e.g., oat bran) to meet the defi- © Jones & Bartlett Learning, LLC its meaning© (e.g.,Jones light brown & Bartlett sugar, light Learning, LLC Low-sodium: 140 milligrams or less per serving. nition for “good source” of fiber. As another and fluffy). NOT FOR VerySALE low sodium:OR DISTRIBUTION 35 milligrams or less per NOT FOR SALE OR DISTRIBUTIONexample, a claim that a product contains “no serving. More: A serving of food, whether altered or not, tropical oils” is allowed, but only on foods that Low-calorie: 40 calories or less per serving. contains more of a nutrient that is at least are “low” in saturated fat, because consumers Lean and extra lean: Describe the fat content 10 percent of the Daily Value more than the have come to equate tropical oils with high of meal and main dish products, seafood, and reference food. This also applies to fortified, levels of saturated fat. game meat products. © Jones & Bartlettenriched Learning,, and added LLCclaims, but in those cases, © Jones & Bartlett Learning, LLC Lean: Less than 10 grams NOTfat, 4.5 grams FOR or lessSALE ORthe foodDISTRIBUTION must be altered. Source:NOT Data from FoodFOR and Drug SALE Administration. OR Appendix DISTRIBUTION saturated fat, and less than 95 milligrams Healthy: A healthy food must be low in fat and A: Definitions of Nutrient Content Claims. October 2009. of cholesterol per serving and per 100 grams. saturated fat and contain limited amounts Guidance for Industry: A Food Labeling Guide. www.fda.gov/ Extra lean: Less than 5 grams fat, less of cholesterol (less than 60 milligrams) and Food/GuidanceComplianceRegulatoryInformation/ than 2 grams saturated fat, and less than sodium (less than 360 milligrams for indi- GuidanceDocuments/FoodLabelingNutrition/ FoodLabelingGuide/ucm064911.htm. Accessed 3/19/12. 95 milligrams of cholesterol per serving and vidual foods and less than 480 milligrams for per© 100 Jones grams. & Bartlett Learning, LLCmeal-type products). In addition,© a single-Jones & Bartlett Learning, LLC High:NOT Food FORcontains SALE 20 percent OR or moreDISTRIBUTION of item food must provide at least 10NOT percent FOR SALE OR DISTRIBUTION the Daily Value for a particular nutrient in a or more of one of the following: vitamin A or serving. C, iron, calcium, protein, or fiber. A meal-type

49241_CH02_Printer.indd 57 22/02/13 3:55 PM 22/02/13 3:55 PM © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett OR DISTRIBUTION NOT FOR SALE is a statement that links one or more is a statement that links one or more © Jones & Bartlett Learning, LLC © Jones & Bartlett OR DISTRIBUTION NOT FOR SALE © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION health claim . The FYI feature “Defi nitions for Nutrient Con- nitions for Nutrient “Defi FYI feature The . ber high fi © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC & Bartlett Learning, © Jones SALE OR DISTRIBUTION NOT FOR LLC © Jones & Bartlett Learning, NOT FOR SALE OR DISTRIBUTION

24 and and low fat Adequate calcium and vitamin D Adequate calcium and vitamin D and osteoporosis: Calcium, vitamin D, the risk of osteoporosis. reduce may exercise along with regular the risk for some reduce diets may Low-fat Dietary fat and cancer: types of cancer. and psyllium in whole oats, barley, as that found such ber, Dietary fi in fat and Diets low heart disease (CHD): seed husk, and coronary reduce the risk of heart disease. ber can help in these types of fi rich and dental caries sweeteners carbohydrate Dietary noncarcinogenic with sugar alcohols do not promote sweetened Foods (tooth decay): tooth decay. heart disease (CHD): and coronary fat and cholesterol Dietary saturated disease. heart for risk increase cholesterol and fat saturated in high Diets fat and heart disease: and trans fat, cholesterol, Dietary saturated Diets fat as possible in trans and as low cholesterol fat and in saturated low of heart disease. the risk reduce may fruits, and vegetables and cancer: products, grain Fiber-containing risk of the reduce may ber foods in high-fi and rich in fat low Diets certain cancers. water may uoridated Drinking fl Fluoridated water and dental caries: the risk of dental caries. reduce prior to and early intake Adequate folate defects: tube neural and Folate tube defects (a birth defect). the risk of neural reduce may in pregnancy in fruits and in fat and rich Diets low Fruits and vegetables and cancer: cancers. the risk of certain reduce may vegetables particularly ber, that contain fi products Fruits, vegetables, and grain in in fat and rich Diets low gums, and mucilages, and CHD: pectins, reduce the risk of heart disease. ber may these types of fi A health claim must be supported by scientifi cally valid evidence for it to cally scientifi A health claim must be supported by • • • • • • • • • • • dietary components to reduced risk of disease—such as a claim that calcium as risk of disease—such components to reduced dietary products passed, the NLEA was Before the risk of osteoporosis. helps reduce not foods. drugs, considered claims were making such - “signifi nding of a fi Regulations require for use on a food label. be approved authorize a new health claim. may the FDA before c agreement” cant scientifi a For example, for the use of claims. c criteria specifi are there In addition, So claim. for a health is also high in fat is not eligible ber food that high-fi health claims: the following has approved the FDA far, Health Claims Health Claims health to add allowed were also manufacturers NLEA, passage of the the With A claims to food labels. such as such The be used. that may a list of terms contains Labels” on Food tent Claims the regulations and terms meaningful, the make made an effort to has FDA It would statements. label misleading of potentially the number reduced have can of vegetable on a free” “cholesterol to print for example, be misleading, trans- and fat and high in saturated that is 100 percent shortening—a food this Although true, levels). blood cholesterol fat that raise fatty acids (types of with free” “cholesterol associate misleads consumers who type of statement choles- low about statements the NLEA regulations, Under “heart healthy.” fat saturated in low is also the product when only content can be used terol ned in defi to the content claims In addition per serving). (less than 2 grams of a new cation a notifi submit to the FDA companies may the regulations, an appropri- statement from “an authoritative claim based on nutrient content Academy or the National of the United States Government c body ate scientifi of Sciences.” © Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. NutritioN GuideliNes aNd assessmeNt assessmeNt aNd GuideliNes NutritioN © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett OR DISTRIBUTION NOT FOR SALE Any statement that associates a food a food associates that statement Any © Jones & Bartlett Learning, LLC © Jones & Bartlett OR DISTRIBUTION NOT FOR SALE © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION Chapter 2

health claim or a substance in a food with a disease or health-related with a disease or health-related in a food or a substance health claims. authorizes FDA The condition. 58

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE• Plant OR sterol/stanol DISTRIBUTION esters and CHD: Diets low in NOTsaturated FOR fat andSALE cho- OR DISTRIBUTION lesterol that contain signifi cant amounts of these additives may reduce the risk of heart disease. • Potassium and high blood pressure/stroke: Diets that contain good sources of potassium may reduce the risk of high blood pressure and stroke. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC • Sodium and hypertensionNOT FOR (high SALE blood OR pressure): DISTRIBUTION Low-sodium diets may NOT FOR SALE OR DISTRIBUTION help lower blood pressure. • Soy protein and CHD: Foods rich in soy protein as part of a low-fat diet may help reduce the risk of heart disease. • Substitution of saturated fat with unsaturated fat and heart disease: ©Replacing Jones & saturated Bartlett fat Learning, with similar LLCamounts of unsaturated fats ©may Jones & Bartlett Learning, LLC NOTreduce FOR the riskSALE of heart OR disease.DISTRIBUTION NOT FOR SALE OR DISTRIBUTION • Whole-grain foods and CHD or cancer: Diets high in whole-grain foods and other plant foods and low in total fat, saturated fat, VITAMIN 140 1g 410 mg 5g 1000 mg and cholesterol may help reduce the risk of heart disease and CALORIES SAT FAT SODIUM SUGARS POTASSIUM A certain cancers. 5% DV 17% DV 29% DV 20% DV © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC A new health claim may be proposed at any time, so this list Facts Up Front is a new voluntary food and beverage industry NOT FORmight expand SALE OR DISTRIBUTIONin the future. The most current informationNOT FOR on label SALE nutrient-based OR DISTRIBUTION labeling initiative that summarizes important nutrition statements and claims can be found on food tab of the FDA website at information on the front of food packages with the intention of helping www.fda.gov . 25 busy consumers make healthier food choices. Source: Courtesy of Grocery Manufacturers Association, available at http:// Qualifi ed Health Claims www.factsupfront.org. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Through an initiative NOTcalled FORConsumer SALE Health OR InformationDISTRIBUTION for Better Nutri- NOT FOR SALE OR DISTRIBUTION tion, the FDA hopes to facilitate the fl ow of information about sound dietary choices to consumers by allowing additional claims for foods and supplements. For many relationships between food components and the reduction of disease risk, the current scientifi c evidence is supportive but doesn’t rise to the level of “signifi© Jones cant scientifi & Bartlett c agreement” Learning, required LLC for health claims. Consequently,© Jones & Bartlett Learning, LLC the FDANOT does FOR now SALE allow manufacturers OR DISTRIBUTION to submit health claims for approvalNOT FOR SALE OR DISTRIBUTION for which the “weight of the evidence” supports the claimed relationship. 26 Such qualifi ed health claims also may be made for dietary supplements.27 When a qualifi ed health claim is approved, the allowed language and acceptable range of products are very specifi c. For example, the claim “Sci- © Jones &entifi Bartlett c evidence Learning, suggests LLCbut does not prove that eating© Jones1.5 ounces & Bartlettper day Learning, LLC of most nuts [such as almonds, hazelnuts, peanuts, and pecans] as part of a NOT FORdiet SALE low in OR saturated DISTRIBUTION fat and cholesterol may reduce theNOT risk of FOR heart disease.”SALE OR DISTRIBUTION Structure/Function Claims Food labels also may contain structure/function claims that describe poten- structure/function claims These statements may tial effects of a food, food© Jones component, & Bartlett or dietary Learning, supplement LLC component on claim a benefi© Jones t related to a &nutrient-defi Bartlett ciency disease Learning, LLC body structures or functions, such as bone health, muscle strength, and diges- (e.g., vitamin C prevents scurvy ) or describe the role of a NOT FOR SALE OR DISTRIBUTION nutrient orNOT dietary ingredientFOR intendedSALE to aﬀ ORect a structure DISTRIBUTION tion. As long as the label does not claim to diagnose, cure, mitigate, treat, or or function in humans (e.g., calcium helps build strong prevent a disease, a manufacturer can claim that a product “helps promote bones). immune health” or is an “energizer” if some evidence can be provided to support the claim. Currently, structure/function claims on foods must be related to the food’s© nutritiveJones value.& Bartlett Many scientists Learning, are concerned LLC about the lack of a© con- Jones & Bartlett Learning, LLC sistentNOT scientifi FOR c standard SALE forOR both DISTRIBUTION health claims and structure/function claims.NOT FOR SALE OR DISTRIBUTION Using Labels to Make Healthful Food Choices What’s the best way to start using information on food labels to make food choices? Let’s look at a couple examples. Perhaps one of your goals is to © Jones &add Bartlett more iron Learning, to your diet. LLC Compare the cereal labels in© FigureJones 2. 11 & .Bartlett Which Learning, LLC NOT FORcereal SALE contains OR DISTRIBUTION a higher percentage of the Daily Value forNOT iron? FOR How SALE do they OR DISTRIBUTION compare in terms of sugar content? What about vitamins and other minerals?

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Maybe it’s a frozen entrée you’re after. Look at the two examples in NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION undernutrition Poor health resulting from depletion of Nutrition Facts Figure 2. 12 . Which is the best choice nutritionally? Are you sure? Sometimes nutrients caused by inadequate nutrient intake over time. Ser ving Size: 1 Entree (240g) the answer is not clear-cut. Product A is higher in sodium, whereas Product It is now most often associated with poverty, alcoholism, Ser vings Per Container: 1 B has more saturated and trans fat. It would be important to know about the and some types of eating disorders. Amount Per Serving rest of your dietary intake before deciding. Do you already have quite a bit overnutrition The long-term consumption of an excess Calories 400 Calories from© Jonesfat 150 & Bartlettof sodium Learning, in your diet,LLC or are you likely to add ©salt Jones at the table? & Bartlett Maybe Learning,you LLC of nutrients. The most common type of overnutrition in the United States results from the regular consumption of NOT% Daily VaFORlue* SALEnever OR salt DISTRIBUTION your food, so a bit extra in your entréeNOT is okay. FOR If SALEyou know OR that DISTRIBUTION excess calories, fats, saturated fats, and cholesterol. Total Fat 16g 25% your saturated fat intake is already a bit high, however, Product A might be Saturated Fat 2.5g 13% a better choice. To make the best choice, you should know which substances ABCDs of nutrition assessment Nutrition assessment Trans Fat 1g are most important in terms of your own health risks. The label is there to components: anthropometric measurements, biochemical tests, clinical observations, and dietary intake. Cholesterol 10mg 3% help you make these types of food decisions. Sodium© Jones780mg & Bartlett33% Learning, LLC © Jones & Bartlett Learning, LLC TotalNOT Carbohydra FORte SALE56g 19% OR DISTRIBUTIONKey Concepts Making food choices at the groceryNOT store FOR is your opportunitySALE to OR implement DISTRIBUTION the Dietary Guidelines for Dietar y Fiber 2g 8% Americans and your MyPlate-planned diet. The Nutrition Facts panel on most packaged foods contains not only specifi c Sugars 2g amounts of nutrients shown in grams or milligrams, but also comparisons between amounts of nutrients in a food and Protein 8g recommended intake values. These comparisons are reported as %DV (Daily Values). The %DV information can be used to Vitamin A 2% •Vitamin C 4% compare two products or to see how individual foods contribute to the total diet. © Jones &Calcium Bartlett 6% Learning,•Iron 4% LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION Nutrition NOTAssessment: FOR SALE Determining OR DISTRIBUTION Product A Nutritional Health In a nutritional sense, what does it mean to be healthy? Nutritional health is quite simply obtaining all nutrients in amounts needed to support body Nutrition Facts © Jones & Bartlettprocesses. Learning, We can LLCmeasure nutritional health in© aJones number & of Bartlett ways. Taken Learning, LLC Ser ving Size: 1 package (269g) together, such measurements can give you insight into your current and long- Ser vings Per Container: 1NOT FOR SALEterm OR well-being. DISTRIBUTION The process of measuring nutritionalNOT health FOR is SALE usually ORtermed DISTRIBUTION Amount Per Serving nutrition assessment . Calories 400 Calories from fat 140 Nutrition assessment serves a variety of purposes. It can help evaluate % Daily Value* nutrition-related risks that can jeopardize a person’s current or future health. Total© FaJonest 16g & Bartlett24% Learning,Nutrition LLC assessment is a routine© Jonespart of the & nutritionalBartlett Learning, care of hospitalized LLC Saturated Fat 6g 30% patients. In this setting, nutrition assessment not only identifi es risks but also TransNOT Fat 2gFOR SALE OR DISTRIBUTIONmeasures the effectiveness of treatment.NOT FOR In SALEpublic health,OR DISTRIBUTION nutrition assess- Cholesterol 40mg 14% ment helps to identify people in need of nutrition-related interventions and to Sodium 690mg 29% monitor the effectiveness of intervention programs. Sometimes, assessments Total Carbohydrate 48g 16% determine the nutritional health of an entire population—identifying health Dietar y Fiber 2g 9% Sugars 5g risks common in a population group so that specifi c policy measures can be © Jones & Bartlett Learning, LLC developed to combat© Jones them. & Bartlett Learning, LLC NOT FOR SALEProtein 15g OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Vitamin A 10%• Vitamin C 8% Calcium 20% •Iron 15% The Continuum of Nutritional Status Your nutritional status can be seen as a point along a continuum, with undernutrition and overnutrition at the extremes. Chronic undernutrition results Product ©B Jones & Bartlettin the Learning,development LLC of nutritional defi ciency diseases,© Jones as &well Bartlett as conditions Learning, LLC Comparing productNOT labels. FOR Labels SALEof energyOR DISTRIBUTION and protein malnutrition, and can leadNOT to FORdeath. SALE Unlike ORstarva- DISTRIBUTION Figure 2.12 might looks similar, but appearances tion, undernutrition is a condition in which some food is being consumed, can be deceptive. Compare the amounts of saturated fat and but the intake is not nutritionally adequate. Although chronic undernutri- sodium in these two products. tion and associated defi ciency diseases were common in the United States in the 1800s and early 1900s, today they are rare. Undernutrition now is © Jones & Bartlett Learning,most LLC often associated with extreme© Jones poverty, & Bartlett alcoholism, Learning, illness, or LLC some NOT FOR SALE OR DISTRIBUTIONtypes of eating disorders. NOT FOR SALE OR DISTRIBUTION Overnutrition is the chronic consumption of more than is necessary for nutrition assessment Measurement of the nutritional good health. Specifi cally, overnutrition is the regular consumption of excess health of the body. It can include anthropometric calories, fats, saturated fats, or cholesterol—all of which increase risk for measurements, biochemical tests, clinical observations, chronic disease. Today, nutrition-related chronic diseases such as heart dis- and dietary intake, as well as medical histories and © Jonessocioeconomic & Bartlett factors. Learning, LLC ease, cancer, stroke,© Jones and diabetes & Bartlett are among Learning, the 10 LLCleading causes of death NOT FOR SALE OR DISTRIBUTION in the United States.NOT FORAll these SALE problems OR DISTRIBUTIONhave been linked to dietary excess.

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Maybe it’s a frozen entrée you’re after. Look at the two examples in NOT FOR(Remember SALE OR that DISTRIBUTION epidemiological [population] studies canNOT show FOR associations SALE OR DISTRIBUTION between various factors and diseases, but these correlations do not necessar- undernutrition Poor health resulting from depletion of Figure 2. 12 . Which is the best choice nutritionally? Are you sure? Sometimes nutrients caused by inadequate nutrient intake over time. the answer is not clear-cut. Product A is higher in sodium, whereas Product ily indicate cause and effect.) It is now most often associated with poverty, alcoholism, B has more saturated and trans fat. It would be important to know about the Between these two extremes lies a region of good health. Good food and and some types of eating disorders. rest of your dietary intake before deciding. Do you already have quite a bit lifestyle choices, a balanced diet, and regular exercise help to reduce the risk overnutrition The long-term consumption of an excess of sodium in your diet, or are you likely to add salt at the table? Maybe you of chronic disease and© delay Jones its onset, & Bartlett keeping Learning, us in a region LLC of good health of nutrients.© TheJones most common & typeBartlett of overnutrition Learning, in LLC never salt your food, so a bit extra in your entrée is okay. If you know that for more of our lifetime.NOT FOR SALE OR DISTRIBUTION the UnitedNOT States results FOR from theSALE regular consumption OR DISTRIBUTION of your saturated fat intake is already a bit high, however, Product A might be excess calories, fats, saturated fats, and cholesterol. a better choice. To make the best choice, you should know which substances ABCDs of nutrition assessment Nutrition assessment are most important in terms of your own health risks. The label is there to Nutrition Assessment of Individuals components: anthropometric measurements, biochemical tests, clinical observations, and dietary intake. help you make these types of food decisions. In health care settings, a registered dietitian or physician can do an individual nutrition© Jones assessment & Bartlett of a patient Learning, or client. DependingLLC on the purpose of© the Jones & Bartlett Learning, LLC Key Concepts Making food choices at the grocery store is your opportunity to implement the Dietary Guidelines for nutritionNOT assessment, FOR SALE the measures OR DISTRIBUTION can be very comprehensive and detailed.NOT FOR SALE OR DISTRIBUTION Americans and your MyPlate-planned diet. The Nutrition Facts panel on most packaged foods contains not only specifi c A dietitian can then use this information to plan individualized nutrition amounts of nutrients shown in grams or milligrams, but also comparisons between amounts of nutrients in a food and counseling. Nutrition assessment measures are often repeated to assess the recommended intake values. These comparisons are reported as %DV (Daily Values). The %DV information can be used to effectiveness of nutrition counseling. compare two products or to see how individual foods contribute to the total diet. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Nutrition Assessment: Determining NOT FOR Nutrition SALE OR Assessment DISTRIBUTION of Populations NOT FOR SALE OR DISTRIBUTION Nutritional Health Typically, nutrition assessment of populations is not as comprehensive as an assessment of an individual. One of the largest ongoing nationwide surveys of In a nutritional sense, what does it mean to be healthy? Nutritional health dietary intake and health status is the National Health and Nutrition Exami- is quite simply obtaining all nutrients in amounts needed to support body nation Survey (NHANES). The survey is unique in that it combines interviews processes. We can measure nutritional health in a number of ways. Taken and physical examinations.© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC together, such measurements can give you insight into your current and long- The NHANES program began in the early 1960s and has been conducted term well-being. The process of measuring nutritional health is usually termed NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION as a series of surveys focusing on different population groups or health topics. nutrition assessment . In 1999, the survey became a continuous program to meet emerging needs, Nutrition assessment serves a variety of purposes. It can help evaluate with a changing focus on a variety of health and nutrition measurements. nutrition-related risks that can jeopardize a person’s current or future health. Data from NHANES have told us a great deal about the nutritional status Nutrition assessment is a routine part of the nutritional care of hospitalized and dietary© Jones intake & of Bartlett our population. Learning, This information LLC is released periodically© Jones & Bartlett Learning, LLC patients. In this setting, nutrition assessment not only identifi es risks but also as the What We Eat in America report. measures the effectiveness of treatment. In public health, nutrition assess- NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ment helps to identify people in need of nutrition-related interventions and to monitor the effectiveness of intervention programs. Sometimes, assessments Nutrition Assessment Methods determine the nutritional health of an entire population—identifying health risks common in a population group so that specifi c policy measures can be Just as there is not only one measure of physical fi tness, there is not just one developed to combat them. © Jones &indicator Bartlett of nutritional Learning, health. LLC Nutrients play many roles© in Jones the body, & soBartlett mea- Learning, LLC NOT FORsures SALE of nutritional OR DISTRIBUTION status must look at many factors. OftenNOT these FOR factors SALE are OR DISTRIBUTION called the ABCDs of nutrition assessment: anthropometric measurements, The Continuum of Nutritional Status biochemical tests, clinical observations, and dietary intake. (See Table 2. 7 .) Your nutritional status can be seen as a point along a continuum, with undernutrition and overnutrition at the extremes. Chronic undernutrition results in the development of nutritional defi ciency diseases, as well as conditions © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Table 2.7 The ABCDs of Nutrition Assessment of energy and protein malnutrition, and can lead to death. Unlike starva- NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION tion, undernutrition is a condition in which some food is being consumed, but the intake is not nutritionally adequate. Although chronic undernutri- Assessment Method Why It’s Done tion and associated defi ciency diseases were common in the United States Anthropometric Measure growth in children; show changes in weight that in the 1800s and early 1900s, today they are rare. Undernutrition now is measures can refl ect diseases (e.g., cancer, thyroid problems); monitor most often associated with extreme poverty, alcoholism, illness, or some © Jones & Bartlettprogress Learning, in fat loss LLC © Jones & Bartlett Learning, LLC types of eating disorders. BiochemicalNOT FOR tests SALE Measure OR DISTRIBUTIONblood, urine, and feces for nutrients or NOT FOR SALE OR DISTRIBUTION Overnutrition is the chronic consumption of more than is necessary for metabolites that indicate infection or disease nutrition assessment Measurement of the nutritional good health. Specifi cally, overnutrition is the regular consumption of excess Clinical observations Assess change in skin color and health, hair texture, fi ngernail health of the body. It can include anthropometric calories, fats, saturated fats, or cholesterol—all of which increase risk for shape, etc. measurements, biochemical tests, clinical observations, chronic disease. Today, nutrition-related chronic diseases such as heart dis- Dietary intake Evaluate diet for nutrient (e.g., fat, calcium, protein) or food and dietary intake, as well as medical histories and (e.g., number of fruits and vegetables) intake socioeconomic factors. ease, cancer, stroke, and diabetes are among the 10 leading causes of death © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC in the United States. All these problems have been linked to dietary excess. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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© Jones© iStockphoto/Thinkstock & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION Anthropometric NOT FOR Measurements SALE OR DISTRIBUTION Anthropometric measurements are physical measurements of the body, such as height and weight, head circumference, girth measurement, or skinfold measurements. © Jones & BartlettHeight Learning, and Weight LLC © Jones & Bartlett Learning, LLC NOT FOR SALETo ORprovide DISTRIBUTION useful information, height and weight NOTmust be FOR accurately SALE measured. OR DISTRIBUTION For infants and very young children, measurement of height is really measurement of recumbent length (that is, length when they are lying down). Careful measurement of length at each checkup gives a clear indication of a child’s growth rate. Standard growth charts show how the child’s growth compares © Jones & Bartlett Learning,with LLC that of others of the same© age Jones and sex. & ForBartlett children Learning, 2 to 20 years LLC old, NOT FOR SALE OR DISTRIBUTIONcharts illustrating growth are basedNOT on FOR standing SALE height, OR or DISTRIBUTION stature. The standing height of older children and adults can be determined with a tape measure fi xed to a wall and a sliding right-angle headboard for reading the measurement. Aging adults lose some height as a result of bone loss and curvature, so it is important to measure height and not simply rely on © Jones & Bartlett Learning, LLC remembered values.© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION Weight is aNOT critical FOR measure SALE in nutritionOR DISTRIBUTION assessment. It is used to assess children’s growth, predict energy expenditure and protein needs, and deter- anthropometric measurements Measurements mine body mass index. Weight should be measured using a calibrated scale. of the physical characteristics of the body, such as For assessments that need a high degree of precision, subtract the weight of height, weight, head circumference, girth, and skinfold measurements. Anthropometric measurements© Jones are & Bartlettthe clothing. Learning, Because LLC many calculations and standards© Jones use &metric Bartlett measures Learning, LLC particularly useful in evaluating the growth of infants, of height and weight, it’s important to be familiar with standard conversion children, and adolescents and in determiningNOT body FOR SALEfactors. OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION composition. For the anthropometric assessment of infants and young children, a skinfold measurements A method to estimate body third measurement is common: head circumference. This is measured using fat by measuring with calipers the thickness of a fold of a fl exible tape measure placed snugly around the head. Head circumference skin and subcutaneous fat. © Jones & Bartlett Learning,measures LLC are compared with standard© Jones growth & Bartlett charts and Learning, are another LLC useful indicator of normal growth and development, especially during rapid growth NOT FOR SALE OR DISTRIBUTIONfrom birth to age 3 years. NOT FOR SALE OR DISTRIBUTION

To convert inches to centimeters, multiply the number Body Mass Index of inches by 2.54 Body mass index (BMI) is a useful tool to estimate weight status of an indi- inches × 2.54 = centimeters vidual. Assessed as the ratio of body weight for height, it is easy to calculate © Jones & Bartlett Learning, LLC and can be a reasonably© Jones accurate & Bartlett measure Learning, of the health LLC risks associated with NOT FOR SALE OR DISTRIBUTION body weight. BasedNOT on FOR standards SALE issued OR byDISTRIBUTION the National Institutes of Health and adopted by the Dietary Guidelines for Americans , body weight status is To convert pounds to kilograms, divide the number categorized as underweight, healthy weight, overweight, and obese to describe of pounds by 2.2 a weight for a given height. pounds ÷ 2.2 = kilograms © Jones & Bartlett Waist Learning,Circumference LLC © Jones & Bartlett Learning, LLC NOT FOR SALEOne OR of DISTRIBUTIONthe simplest means of determining bodyNOT fat distribution FOR SALE uses OR waist DISTRIBUTION circumference. Waist circumference is a good indicator of abdominal fat and risk for chronic diseases in adults.28 Skinfolds © Jones & Bartlett Learning,Skinfold LLC measurements serve© a Jones variety of& purposes.Bartlett BecauseLearning, a signifi LLC cant NOT FOR SALE OR DISTRIBUTIONamount of the body’s fat storesNOT is located FOR right SALE beneath OR the DISTRIBUTION skin (subcutaneous fat), skinfold measurements at various sites around the body can give a good indication of body fatness. This information can be used to evaluate the physical fi tness of an athlete or predict the risk of obesity-related disorders. Skinfold measurements also are useful in cases of illness; the maintenance © Jones & Bartlett Learning, LLC of fat stores in© a Jonespatient’s &body Bartlett is a valuable Learning, indicator LLC of dietary adequacy. NOT FOR SALE OR DISTRIBUTION Skinfold measurementsNOT FOR are SALE made withOR specialDISTRIBUTION calipers (see Figure 2. 13 ).

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Bone Skin Muscle © Jones & Bartlett Learning, LLC Fat © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Skinfold calipers

Figure 2.13 Skinfold measurements. A signifi cant amount of the body’s fat © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning,stores lies just beneath LLC the skin, so when done correctly, NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR skinfoldDISTRIBUTION measurements can provide an indication of body fatness. An inexperienced or careless measurer, however, can easily make large errors. Skinfold measurements usually work better for monitoring malnutrition than for identifying overweight and obesity. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC For reliable measurements,NOT training FOR SALE in the use OR of DISTRIBUTIONcalipers is essential. Skinfold NOT FOR SALE OR DISTRIBUTION measurements can be used to estimate the percentage of body fat or can be compared with percentile tables for specifi c sex and age categories.

Biochemical © Jones &Tests Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Because NOT of FORtheir relation SALE toOR growth DISTRIBUTION and body composition, anthropometricNOT FOR SALE OR DISTRIBUTION measurements give a broad picture of nutritional health—whether the diet contains enough calories and protein to maintain normal patterns of growth, normal body composition, and normal levels of lean body mass. However, anthropometric measures do not give specifi c information about nutrients . © Jones &For Bartlett that information, Learning, a variety LLC of biochemical tests is useful.© Jones & Bartlett Learning, LLC NOT FOR SALEBiochemical OR DISTRIBUTION assessment measures a nutrient or NOTmetabolite FOR (a SALE related OR DISTRIBUTIONbiochemical assessment Assessment by measuring compound) in one or more body fl uids, such as blood or urine, or in feces. a nutrient or its metabolite in one or more body fl uids, For example, the concentration of albumin (an important transport protein) such as blood and urine, or in feces. Also called laboratory assessment. in the blood can be an indicator of the body’s protein status. If little protein is eaten, the body produces smaller amounts of body proteins such as albumin. clinical observations Assessment by evaluating the characteristics of well-being that can be seen in a physical Biochemical assessments© Jones can include& Bartlett measurements Learning, of a nutrientLLC metabo- exam. Nonspecifi© Jones c, clinical observations& Bartlett can provide Learning, clues LLC lite, a storage or transportNOT compound, FOR SALE an enzyme OR DISTRIBUTION that depends on a vitamin to nutrientNOT defi ciency FOR or excess SALE that can be confiOR rmed DISTRIBUTION or or mineral, or another indicator of the body’s functioning in relation to a ruled out by biochemical testing. particular nutrient. These measures usually are a better indicator of nutritional status than directly measuring blood levels of nutrients such as vitamin A or calcium. The levels of nutrients excreted in the urine or feces also provide valuable© Jones information. & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Clinical Observations Clinical observations—the characteristics of health that can be seen during a physical exam—help to complete the picture of nutritional health. Although © Jones &often Bartlett nonspecifi Learning, c, clinical LLCsigns are clues to nutrient defi© ciencyJones or & excess Bartlett that Learning, LLC can be confi rmed or ruled out by further testing. In a clinical nutrition exam- NOT FORination, SALE a OR clinician DISTRIBUTION observes the hair, nails, skin, eyes,NOT lips, FORmouth, SALE bones, OR DISTRIBUTION

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORQuick SALE OR Bite DISTRIBUTION muscles, and joints.NOT SpecifiFOR SALEc fi ndings, OR suchDISTRIBUTION as cracking at the corners of the mouth (suggestive of ribofl avin, vitamin B6 , or niacin defi ciency) or petechiae Nutrition and Nails (small, pinpoint hemorrhages on the skin indicative of vitamin C defi ciency), Do your nails have white marks or ridges? need to be followed by other assessments. Clinical assessment should also Contrary to popular belief, that does not neces- include an evaluation of personal, social, environmental, and lifestyle factors sarily mean you have a vitamin defi ciency.© UsuallyJones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC a slight injury to the nail causes white marks or ridges. that could impact accesses to healthy food and nutritional well-being. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Dietary Intake A picture of nutritional health would not be complete without information about dietary intake. Dietary information can confi rm the lack or excess of © Jones & Bartlett Learning,a dietary LLC component suggested© by Jones anthropometric, & Bartlett biochemical, Learning, or clinicalLLC evaluations. NOT FOR SALE OR DISTRIBUTION There are a number of waysNOT to FORcollect SALE dietary OR intake DISTRIBUTION data. Each has strengths and weaknesses. It is important to match the method to the type and quantity of data needed. Remember, too, that the quality of information obtained about people’s diets often relies heavily on people’s memories, as © Jones & Bartlett Learning, LLC well as their honesty© Jones in sharing & Bartlett those recollections. Learning, How LLC well do you remember everything you ate yesterday? NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Diet History The most comprehensive form of dietary intake data collection is diet his- diet history Record of food intake and eating behaviors tory. In this method, a skilled interviewer fi nds out not only what the client that includes recent and long-term habits© of Jones food & Bartletthas been Learning, eating in LLCthe recent past but also the ©client’s Jones long-term & Bartlett food con-Learning, LLC consumption. Conducted by a skilled interviewer, the diet sumption habits. The interviewer’s questions also address other risk factors history is the most comprehensive formNOT of dietary FORintake SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION data collection. for nutrition-related problems, such as economic issues. food records Detailed information about day-to-day Food Record eating habits; typically includes all foods and beverages consumed for a defi ned period, usually three to seven Food records , or diaries, provide detailed information about day-to-day consecutive© days. Jones & Bartlett Learning,eating LLC habits. Typically, a person© recordsJones all & foodsBartlett and beveragesLearning, consumed LLC weighed foodNOT records FOR Detailed SALE food records OR obtained DISTRIBUTION during a defi ned period, usuallyNOT three FORto seven SALE consecutive OR DISTRIBUTION days. Because food by weighing foods before eating and then weighing records are recorded concurrently with intake, they are less prone to inac- leftovers to determine the exact amount consumed. curacy from lapses in memory. The data are completely self-reported, there- food frequency questionnaire (FFQ) fore, food records are not accurate if the person fails to record all items or A questionnaire for nutrition assessment that asks how changes their usual food intake while completing the record. To make food often the subject consumes specifi c foods or groups records more precise, the items in a meal can be weighed before consump- © Jonesof foods,& Bartlett rather than what Learning, specifi c foods the subject LLC © Jones & Bartlett Learning, LLC tion. Remaining portions are weighed at the end of the meal to determine NOT FORconsumes SALE daily. Also OR called DISTRIBUTIONfood frequency checklist. NOT FOR SALE OR DISTRIBUTION 24-hour dietary recall A form of dietary intake data exactly how much was eaten. Weighed food records are much more time collection. The interviewer takes the client through a consuming to complete. recent 24-hour period (usually midnight to midnight) to determine what foods and beverages the client consumed. Food Frequency Questionnaire © Jones & BartlettA food Learning, frequency LLCquestionnaire (FFQ) asks© how Jones often &the Bartlett subject con- Learning, LLC sumes specifi c foods or groups of foods, rather than what specifi c foods the NOT FOR SALEsubject OR consumesDISTRIBUTION daily. A food frequency questionnaireNOT FOR might SALE ask, for OR exam- DISTRIBUTION ple, “How often do you drink a cup of milk?” with the response options of daily, weekly, monthly, and so on. This information is used to estimate that person’s average daily intake. © Jones & Bartlett Learning, LLCAlthough food frequency questionnaires© Jones & Bartlettdo not require Learning, a trained LLC interviewer and can be relatively quick to complete, there are disadvantages to this NOT FOR SALE OR DISTRIBUTIONmethod of data collection. OneNOT problem FOR is that SALE it is often OR diffiDISTRIBUTION cult to translate people’s response to how often they drink milk, or how many cups of milk they drink per week, into specifi c nutrient values without more detailed information. More important, food frequency questionnaires require a person to © Jones & Bartlett Learning, LLC average, over a© long Jones period, & foodsBartlett consumed Learning, erratically LLC in portions that are sometimes large and sometimes small. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR24-Hour SALE DietaryOR DISTRIBUTION Recall NOT FOR SALE OR DISTRIBUTION The 24-hour dietary recall is the simplest form of dietary intake data collection. In a 24-hour recall, the interviewer takes the client through a recent 24-hour period (usually midnight to midnight) to determine what foods and beverages the client consumed. To get a complete, accurate picture of the subject’s diet, the interviewer© Jones must & askBartlett probing Learning, questions suchLLC as “Did you © Jones & Bartlett Learning, LLC put anything on your NOTtoast?” FOR but not SALE leading OR questions DISTRIBUTION such as “Did you put NOT FOR SALE OR DISTRIBUTION butter and jelly on your toast?” Comprehensive population surveys frequently use 24-hour recalls as the main method of data collection. Although a single 24-hour recall is not very useful for describing the nutrient content of an individual’s overall diet (there’s too much day-to-day variation), in large-scale studies© itJones gives a &reasonably Bartlett accurate Learning, picture LLC of the average nutrient intake© Jonesof & Bartlett Learning, LLC a population.NOT FOR Multiple SALE dietary OR recallsDISTRIBUTION also are useful for estimating the nutri-NOT FOR SALEDietary OR DISTRIBUTION Guidelines ent intake of individuals. for Americans, 2010 Methods of Evaluating Dietary Intake Data Foods and Food Components to Reduce: Once the data are collected, the next step is to determine the nutrient con- Key Recommendations © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC tent of the diet and evaluate that information in terms of dietary standards • Reduce daily sodium intake to less than 2,300 milli- NOT FORor SALE other reference OR DISTRIBUTION points. This is commonly done using NOTnutrient FOR analysis SALE soft- OR DISTRIBUTIONgrams (mg) (equals 1 teaspoon) and further reduce ware. Computer programs remove the tedium of looking up foods in tables intake to 1,500 milligrams among persons who are of nutrient composition; large databases allow for simple access to food com- 51 years or older and those of any age who are African position, and the computer does the math automatically. American or have hypertension, diabetes, or chronic kidney disease. The 1,500-milligram recommen- Comparison to Dietary Standards© Jones & Bartlett Learning, LLC dation© appliesJones to about & half Bartlettof the U.S. population, Learning, LLC including children, and the majority of adults. It is possible to compareNOT a person’s FOR SALE nutrient OR intake DISTRIBUTION to dietary standards such • ConsumeNOT less thanFOR 10 percent SALE of calories OR from satu- DISTRIBUTION as the RDA or AI values. Although this will give a quantitative idea of dietary rated fatty acids by replacing them with monounsat- adequacy, it cannot be considered a defi nitive evaluation of a person’s diet urated and polyunsaturated fatty acids. because we don’t know that individual’s specifi c nutrient requirements. The • Consume less than 300 milligrams per day of dietary cholesterol. bottom line is that comparisons of individual diets to RDA or AI values should • Keep trans fatty acid consumption as low as possible 29 be interpreted© Jones with & Bartlett caution. Learning, LLC © Jones & Bartlettby limiting foods Learning,that contain synthetic LLCsources of NOT FOR SALE OR DISTRIBUTION NOT FOR SALEtrans fats, suchOR as partially DISTRIBUTION hydrogenated oils, and by Comparison to MyPlate and the Dietary Guidelines for Americans limiting other solid fats. The MyPlate system has several online tools for assessment of dietary • Reduce the intake of calories from solid fats and intake. Individuals (or evaluators) can use the SuperTracker feature on the added sugars. • Limit the consumption of foods that contain refi ned Choos eMyPlate.com website to compare a typical day’s intake to the MyPlate grains, especially refi ned grain foods that contain © Jones &groups Bartlett and Dietary Learning, Guidelines LLC. Although these evaluations© Jones usually & areBartlett not Learning,solid fats, added LLC sugars, and sodium. NOT FORspecifi SALE c, theyOR DISTRIBUTIONgive a general idea of whether the subject’sNOT diet FOR is high SALE or low OR DISTRIBUTION• If alcohol is consumed, it should be consumed in in saturated fat, or whether the subject is eating enough fruits, vegetables, moderation—up to one drink per day for women and whole grains. and two drinks per day for men—and only by adults of legal drinking age. Outcomes of Nutrition Assessment Source: Reproduced from US Department of Agriculture When taken together, anthropometric measures, biochemical tests, clinical and US Department of Health and Human Services. Dietary © Jones & Bartlett Learning, LLC Guidelines© for Jones Americans, 2010 &. 7th Bartlett ed. Washington, Learning, DC: US LLC exams, and dietary evaluation,NOT FOR along SALE with OR the DISTRIBUTIONindividual’s family history, GovernmentNOT Printing FOR Oﬃ ce; December SALE 2010. OR DISTRIBUTION socioeconomic situation, and other factors, give a complete picture of nutritional health. A client’s assessment can lead to a recommendation for a diet change to reduce weight or blood cholesterol, the addition of a vitamin or mineral supplement to treat a defi ciency, the identifi cation of abnormal growth resulting© Jones from inadequate & Bartlett infant Learning, feeding, or LLCsimply the affi rmation that dietary© Jones & Bartlett Learning, LLC intakeNOT is adequate FOR SALE for current OR nutrition DISTRIBUTION needs. NOT FOR SALE OR DISTRIBUTION Key Concepts Nutrition assessment involves the collection of various types of data—anthropometric measurements, biochemical tests, clinical observations, and dietary intake—for a complete picture of one’s nutritional health. Such data are compared to established standards to diagnose nutritional defi ciencies, identify dietary inadequacies, or evaluate progress as a result of dietary changes. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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Ⅵ Servings for each food in the Exchange Lists are Key Terms grouped so that equal amounts of carbohydrate, fat, page© Jonesfood records & Bartlett Learning,64 LLCand protein are provided© by Jones each choice. & Bartlett Learning, LLC ABCDs of nutrition assessment NOT61 fortify FOR SALE OR DISTRIBUTION55 Ⅵ Dietary standards are valuesNOT for FOR individual SALE nutrients OR DISTRIBUTION Acceptable Macronutrient health claim 58 that reflect recommended intake levels. These values Distribution Ranges (AMDRs) 52 MyPlate 40 are used for planning and evaluating diets for groups Adequate Intake (AI) 51 nutrient content claims 56 and individuals. anthropometric measurements 62 nutrient density 30 Ⅵ The Dietary Reference Intakes are the current dietary biochemical© assessment Jones & Bartlett63 nutrition Learning, assessment LLC 60 © Jones & Bartlett Learning, LLC standards in the United States and Canada. The DRIs Canada’s GuidelinesNOT forFOR SALENutrition OR DISTRIBUTION Facts 54 NOT FOR SALE OR DISTRIBUTION consist of several types of values: EAR, RDA, AI, UL, Healthy Eating 38 Nutrition Labeling and EER, and AMDR. clinical observations 63 Education Act (NLEA) 53 Daily Values (DVs) 56 Nutrition Recommendations for Ⅵ Nutrition information on food labels can be used to diet history 64 Canadians 38 determine a more healthful diet. © JonesDietary & Guidelines Bartlett for Americans, Learning, overnutrition LLC 60 © JonesⅥ Label & Bartlettinformation Learning, not only LLCprovides the gram or NOT FOR2010 SALE OR DISTRIBUTION32 Recommended Dietary NOT FORmilligram SALE amounts OR DISTRIBUTION of the nutrients present, but also Dietary Reference Intakes (DRIs) 49 Allowances (RDAs) 50 gives a percentage of Daily Values so that the consum- dietary standards 49 Recommended Nutrient Intakes er can compare the amount in the food to the amount Eating Well with Canada’s Food (RNIs) 50 recommended for consumption each day. Guide 38 requirement 50 © Jones & Bartlett Learning, ⅥLLC Nutrition information, label© Jones statements, & Bartlett and health Learning, LLC enrich 55 skinfold measurements 62 claims are specifically defined by the regulations that Estimated Average Requirement NOTstatement FOR of SALE identity OR DISTRIBUTION54 were developed after passageNOT of FOR the Nutrition SALE OR Label DISTRIBUTION- (EAR) 50 structure/function claims 59 ing and Education Act of 1990. Estimated Energy Requirement Tolerable Upper Intake Levels Ⅵ Nutrition assessment is a process of determining the (EER) 52 (ULs) 52 overall health of a person as related to nutrition. Exchange Lists 48 24-hour dietary recall 65 Food and Drug© AdministrationJones & Bartlettundernutrition Learning, LLC 60 Ⅵ Nutrition© assessmentJones & Bartlettinvolves Learning,four major LLCevalua- (FDA) NOT FOR SALE53 U.S.OR Department DISTRIBUTION of Agriculture tions: anthropometricNOT FOR SALE measurements, OR DISTRIBUTION biochemical food frequency questionnaire (USDA) 32 tests, clinical observations, and dietary intake. (FFQ) 64 U.S. Department of Health and food groups 39 Human Services (DHHS) 32 Study Questions food label 53 weighed food records 64 © JonesFood and& Bartlett Nutrition Board Learning, 50 LLC © Jones1. Define & Bartlett undernutrition Learning, and overnutrition. LLC NOT FOR SALE OR DISTRIBUTION NOT2. FORWhat SALE is the ORpurpose DISTRIBUTION of the Dietary Guidelines for Americans? List the two overarching concepts of the Study Points 2010 Dietary Guidelines for Americans. 3. What are the recommended amounts for each food Ⅵ The diet-planning principles of adequacy, balance, group of MyPlate for a 2,000-calorie diet? calorie (energy) control,© Jones nutrient & Bartlettdensity, modera Learning,- LLC © Jones & Bartlett Learning, LLC tion, and variety are importantNOT FOR concepts SALE in OR choosing DISTRIBUTION 4. Describe how the exchangeNOT system FOR works SALE and OR why DISTRIBUTION a healthful diet. people with diabetes might use it. Ⅵ The Dietary Guidelines for Americans gives consum- 5. List and define four main Dietary Reference Intake ers advice regarding general components of the diet. categories. Ⅵ MyPlate© Jones is a graphic & Bartlett representation Learning, of a foodLLC guid- 6. List five© Jonesmandatory & componentsBartlett Learning, found on LLCall food labels. ance NOTsystem FOR that SALE supports OR theDISTRIBUTION principles of the NOT FOR SALE OR DISTRIBUTION Dietary Guidelines for Americans. 7. The standard Nutrition Facts panel shows informa- Ⅵ Each food group in MyPlate has a recommended dai- tion on which nutrients? ly amount based on calorie needs. A variety of foods 8. What is the purpose of the “% Daily Value” listed next from each group can supply all the nutrients. to most nutrients on food labels? © JonesⅥ &The Bartlett Exchange Learning, Lists are aLLC diet-planning tool most © Jones9. Define & Bartlett three types Learning, of claims LLCthat might be found on NOT FORoften SALE used OR for DISTRIBUTIONdiabetic or weight-control diets. NOT FORfood SALElabels. OR DISTRIBUTION

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Try This Sample one-day menu from Bobbie’s diet

Are You a MyPlate Pleaser? 7:45 A.M. Keep a detailed food diary for three days. Make sure to 1 raisin bagel, toasted 3 tablespoons light cream cheese include things you drink,© Jones along &with Bartlett the amounts Learning, (e.g., LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION10 fl uid ounces regular coffNOT ee FOR SALE OR DISTRIBUTION cups, ounces, tablespoons) of each food or beverage. How 2 packets of sugar well do you think your intake matches the Dietary Guide- 2 tablespoons of 2% milk lines and MyPlate recommendations? To fi nd out, go to ChooseMyPlate.gov and click on SuperTracker, and then 10:15 A.M. on Food Tracker. This feature allows you to do an online 1 banana © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC assessment of your food intake. Follow the directions to 12:15 P.M. registerNOT and FOR then enterSALE your OR Personal DISTRIBUTION Profi le. Then, click Turkey andNOT cheese FOR sandwich SALE OR DISTRIBUTION on Proceed to Food Intake and enter each food you ate 2 slices sourdough bread for one day. When you are done, you can click on Analyze 2 ounces sliced turkey lunch meat 2 teaspoons regular mayonnaise Your Food Intake and see the comparisons to the Dietary 2 teaspoons mustard Guidelines and MyPlate. © Jones & Bartlett Learning, LLC © Jones & 2 slicesBartlett tomato Learning, LLC How did you do? From which groups did you tend 2 slices dill pickle NOT FORto SALE eat more OR than DISTRIBUTION is recommended? Were there any groupsNOT FOR shreddedSALE lettuce OR DISTRIBUTION for which you did not meet the recommendations? Was Salad from cafeteria salad bar there a day-to-day variation in the number of servings you 2 cups shredded iceberg lettuce ate of each group? Use the results of this activity to plan 2 tablespoons each: shredded carrot ways you can improve your diet. You might want to visit © Jones & Bartlett Learning, LLC chopped egg © Jones & Bartlett Learning, LLC this site frequently to monitor changes you are making in croutons your food intake. NOT FOR SALE OR DISTRIBUTION kidney beans NOT FOR SALE OR DISTRIBUTION Italian salad dressing Grocery Store Scavenger Hunt 12 fl uid ounces diet soda On your next trip to the grocery store, fi nd a food item that 1 small chocolate chip cookie has any© Jones number & other Bartlett than aLearning, “0” listed for LLC the two vita- 3:30 P.M©. Jones & Bartlett Learning, LLC mins and minerals required to be listed on the food label 16 fl uid ounces water %DV.NOT It doesn’t FOR matter SALE whether OR DISTRIBUTIONyou choose a cereal, soup, 11⁄2 ouncesNOT regular FOR tortilla SALE chips OR DISTRIBUTION cracker, or snack item, as long as it has numbers other than 1⁄2 cup salsa “0” for all four items. Once you’re home, review the Daily 6:00 P.M. Values (inside the back cover) and calculate the number of Spaghetti with meatballs milligrams of calcium, iron, and vitamin C found in each 11⁄2 cups pasta © Jones &serving Bartlett of your Learning, food. Next, LLC take a look at vitamin A: How© Jones & 3 ouncesBartlett ground Learning, beef (meatballs) LLC NOT FORmany SALE International OR DISTRIBUTION Units (IUs) does each serving of yourNOT FOR 3SALE ounces spaghetti OR DISTRIBUTION sauce 2 tablespoons Parmesan cheese product have? If you can calculate these, you should have 1 piece garlic bread a better understanding of % Daily Values. 1⁄2 cup green beans 1 teaspoon butter What About Bobbie?© Jones & Bartlett Learning, LLC12 fl uid ounces diet soda © Jones & Bartlett Learning, LLC 10:15 P.M. Now that you have learnedNOT something FOR SALE about ORthe recommen- DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 1 slice cheese pizza dations for a healthful diet, how do you think Bobbie did? Review her one-day food record, listed in the right column. How closely does Bobbie’s intake fi t MyPlate? Do you think she met most of the Dietary Guidelines ? What about the RDA© Jones and AI & values? Bartlett Was Learning,her diet balanced LLC enough to the foods© in Jones Bobbie’s & diet Bartlett that contribute Learning, various LLC nutrients. meetNOT most ofFOR these SALE recommendations? OR DISTRIBUTION The following table Keep in NOTmind thatFOR this SALE is only OR a one-day DISTRIBUTION food record and summarizes the results of a computerized nutrient analysis might or might not represent her typical diet. of Bobbie’s diet. How do you think Bobbie’s food choices fi t with You might be completing a similar analysis of your the Dietary Guidelines for Americans and MyPlate? Can own diet as part of your course requirements. Later, you you classify all of Bobbie’s foods into one of the MyPlate © Jones &will Bartlett explore manyLearning, of these LLC nutrients further and look© at Jonesgroups? & Bartlett Some items, Learning, like the LLCcheese pizza, have elements NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 3 Ibid. Bobbie RDA/AI %RDA/AI 4 Ibid. Calories 2,300 2,290* 100% 5 Ibid. 6 Pennington J, Kandiah J, Nicklas T, et al. Practice paper of the American Carbohydrates 292 g 130 g 225% Dietetic Association: nutrient density: meeting nutrient goals within calorie Fiber 25 g© Jones 25 g & Bartlett 100% Learning, LLCneeds. J Am Diet Assoc. 2007;107(5):860–869.© Jones & Bartlett Learning, LLC 7 Ibid. Fat 86 gNOT 25 FOR g SALE — OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 8 Uauy R, Hertrampf E, Dangour AD. Food-based dietary guidelines for health- Cholesterol 261 mg — — ier populations: international considerations. In: Shils ME, Shike M, Ross AC, Protein 96 g 46 g 209% et al., eds. Modern Nutrition in Health and Disease . 10th ed. Baltimore, MD: Lippincott Williams & Wilkins; 2006. Vitamin A 493 mcg RAE 700 mcg RAE 70% 9 Foote JA, Murphy SP, Wilkens LR, et al. Dietary variety increases the prob- Vitamin D 0.5 mcg 5 mcg 10% ability of nutrient adequacy among adults. J Nutr. 2004;134:1779–1785. © Jones & Bartlett Learning, LLC 10 US Department© Jones of Agriculture & andBartlett US Department Learning, of Health and LLC Human Vitamin E 9 mg 15 mg 60% NOT FOR SALE OR DISTRIBUTION Services. DietaryNOT Guidelines FOR for SALE Americans, OR 2010 .DISTRIBUTION Thiamin 2.0 mg 1.1 mg 182% 11 Ibid. Ribofl avin 2.2 mg 1.1 mg 200% 12 Ibid. Niacin 27.5 mg 14 mg 196% 13 US Department of Health and Human Services. 2 008 Physical Activity Guide- lines for Americans. Washington, DC: US Department of Health and Human Vitamin B6 2.0 mg 1.3 mg 154% Services; 2008. Offi ce of Disease Prevention and Health Promotion publica- © JonesFolate & Bartlett Learning,650 mcg LLC 400 mcg 163% © Jonestion & U0035. Bartlett www.health.gov/paguidelines Learning, LLC. Accessed 3/19/12. NOT FOR SALE OR DISTRIBUTION NOT14 FORUS Department SALE of OR Agriculture DISTRIBUTION and US Department of Health and Human Vitamin B12 3.7 mcg 2.4 mcg 154% Services. Dietary Guidelines for Americans, 2010 . Vitamin C 42 mg 75 mg 56% 15 Health Canada. Eating Well with Canada’s Food Guide . www.hc-sc.gc.ca/ fn-an/food-guide-aliment/index-eng.php. Accessed 3/19/12. Pantothenic acid 3.7 mg 5 mg 74% 16 Davis C, Saltos E. Dietary Recommendations and How They Have Changed Sodium 4,820 mg 1,500 mg 321% Over Time. www.ers.usda.gov/media/91022/aib750b_1_.pdf . Accessed Potassium 2,890 mg© Jones 4,700 mg & Bartlett 61% Learning, LLC3/19/12. © Jones & Bartlett Learning, LLC 17 First Lady, Agriculture Secretary Vilsack and Surgeon General Benjamin Calcium 710 mgNOT 1,000 FOR mg SALE 71% OR DISTRIBUTIONlaunch MyPlate icon as a new reminderNOT to help FOR consumers SALE to make OR healthier DISTRIBUTION Phosphorus 1,230 mg 700 mg 176% food choices. US Department of Agriculture press release, June 2, 2011. www.usda.gov/wps/portal/usda/usdahome?contentid=2011/06/0225_ Magnesium 310 mg 310 mg 100% xml&contentidonly=true. Accessed 10/04/12. Iron 20 mg 18 mg 111% 18 Burger KS, Kern M, Coleman KJ. Characteristics of self-selected portion size in young adults. J Am Diet Assoc. 2007;3:611–618. Zinc 12 mg 8 mg 125% © Jones & Bartlett Learning, LLC 19 Institute of Medicine,© Jones Food and & NutritionBartlett Board. Learning, Dietary Reference IntakesLLC for CopperNOT FOR 1,560 SALE mcg OR 900 mcg DISTRIBUTION 173% Calcium, Phosphorus,NOT FOR Magnesium, SALE Vitamin ORD, and DISTRIBUTIONFluoride. Washington, DC: Manganese 2.8 mg 1.8 mg 156% National Academies Press; 1997; Institute of Medicine, Food and Nutrition Board. Dietary Reference Intakes for Thiamin, Ribofl avin, Niacin, Vitamin Selenium 152 mcg 55 mcg 276% B-6, Folate, Vitamin B-12, Pantothenic Acid, Biotin, and Choline . Washington, DC: National Academies Press; 1998; Institute of Medicine, Food and Nu- *EER for 19-year-old female, 155 pounds, 5′4″, low active. RAE, Retinol Activity Equivalents. trition Board. Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids . Washington, DC: National Academies Press; 2000; and © Jones & Bartlett Learning, LLC © JonesInstitute & Bartlettof Medicine, Food Learning, and Nutrition LLCBoard. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, NOT FOR SALE OR DISTRIBUTION NOT FORMolybdenum, SALE Nickel, OR Silicon, DISTRIBUTION Vanadium, and Zinc . Washington, DC: National of more than one group. Others, like the dill pickle, don’t Academies Press; 2001. seem to fi t anywhere. 20 Institute of Medicine, Food and Nutrition Board. Dietary Reference Intakes for When Bobbie entered her food intake into the MyPlate Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino diet analyzer, SuperTracker, she learned her diet was low in Acids . Washington, DC: National Academies Press; 2005. 21 American Dietetic Association. Practice paper of the American Dietetic milk, fruits, and meat and beans.© Jones She was & highBartlett in the Learning,Grains LLCAssociation: using the Dietary Reference© Jones Intakes. J Am & Diet Bartlett Assoc . 2011;111: Learning, LLC group, but without much NOTwhole FORgrain. SALEHer fat intakeOR DISTRIBUTION was 762–770. NOT FOR SALE OR DISTRIBUTION also a little high, as was sodium. It’s probably not fair to 22 Brecher SJ, Bender MM, Wilkening VL, et al. Status of nutrition labeling, health claims, and nutrient content claims for processed foods: 1997 food label and evaluate just this single day of eating, though. We would package survey. J Am Diet Assoc. 2000;100:1057–1062. need to know more about Bobbie’s usual diet and lifestyle 23 Food Marketing Institute. Shoppers demand healthier foods and more nutri- before making specifi c recommendations. tion information from nation’s supermarkets and manufacturers, according © Jones & Bartlett Learning, LLC to “2004 Shopping© Jones for Health.” & Bartlett FMI press release. Learning, November LLC22, 2004. www.fmi.org/news-room/news-archive/view/2004/11/22/shoppers- demand- ReferencesNOT FOR SALE OR DISTRIBUTION healthier-foods-and-more-nutrition-information-from-nation-s-supermarkets-NOT FOR SALE OR DISTRIBUTION and-manufacturers-according-to-2004-shopping-for-health-. Accessed 1 Nitzke S, Freeland-Graves J. Position of the American Dietetic Association: 3/19/12. total diet approach to communicating food and nutrition information. J Am 24 US Food and Drug Administration. Guidance for industry: notifi cation of a Diet Assoc. 2007;107(7):1224–1232. health claim or nutrient content claim based on an authoritative statement of 2 US Department of Agriculture and US Department of Health and Human a scientifi c body. June 11, 1998. www.fda.gov/Food/GuidanceCompliance © Jones &Services. Bartlett Dietary Guidelines Learning, for Americans, LLC 2010. 7th ed. Washington, DC: © JonesRegulatoryInformation/GuidanceDocuments/FoodLabelingNutrition/ & Bartlett Learning, LLC US Government Printing Offi ce; December 2010. ucm056975.htm. Accessed 3/16/12. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 25 US Food and Drug Administration. Food. Appendix C: Health claims. QualifiedHealthClaims/QualifiedHealthClaimsPetitions/ucm096010.htm. October 2009. www.fda.gov/Food/GuidanceComplianceRegulatoryInfor- Accessed 10/4/12. mation/GuidanceDocuments/FoodLabelingNutrition/FoodLabelingGuide/ 28 Nelms M, Habash D. Nutrition assessment: foundations of the nutrition care ucm064919.htm. Accessed 3/16/12. process. In: Nelms M, Sucher KP, Lacy K, Long Roth S, eds. Nutrition Therapy 26 Turner RE, Degnan FH, Archer DL. Label claims for foods and supplements: and Pathophysiology. 2nd ed. Belmont, CA: Wadsworth Cengage; 2011. a review of the regulations.© NutrJones Clin Pract &. 2005;20:21–32.Bartlett Learning, LLC29 Barr SI, Murphy SP, Poos MI.© Interpreting Jones and & using Bartlett the Dietary Learning, Reference LLC 27 US Food and Drug Administration. FDA’s consumer health information for Intakes in dietary assessment of individuals and groups. J Am Diet Assoc. better nutrition initiative. www.fda.gov/Food/LabelingNutrition/LabelClaims/NOT FOR SALE OR DISTRIBUTION2002;102:780–788. NOT FOR SALE OR DISTRIBUTION

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