Practice Guidelines

Dietary Guidelines for Americans 2020–2025: Recommendations from the U.S. Departments of Agriculture and Health and Human Services

 

Am Fam Physician. 2021 Nov ;104(5):533-536.

Related editorial: Translating the 2020-2025 U.S. Dietary Guidelines into Clinical Practice

Author disclosure: No relevant financial affiliations.

Key Points for Practice

• For people two years and older, vegetables and whole fruits represent one-half of a healthy diet.

• Potentially allergenic foods should be introduced to infants at about six months of age with solid foods to reduce food allergies.

• During pregnancy, there is no need to limit potentially allergenic foods without a known food allergy, although large fish, unpasteurized juices and dairy products, and alcohol should be avoided.

• In older adults, high-protein diets can limit natural decreases in lean muscle mass and vitamin B12 deficiency caused by decreased absorption.

From the AFP Editors

More than one-half of U.S. adults have at least one diet-related chronic disease such as type 2 diabetes mellitus, cardiovascular disease, and some cancers. About three-fourths are overweight or obese. Foods are consumed in patterns, and it is these dietary patterns that affect disease risk. Because surveys show minimal improvement in healthy eating over the past 10 years, simple guidance is needed in improving food and beverage choices. The U.S. Departments of Agriculture and Health and Human Services published updated guidelines for healthy eating across a person's lifespan.

Core Dietary Elements

For people two years and older, healthy dietary patterns involve choosing nutrient-dense foods and beverages. Nutrient-dense foods provide vitamins, minerals, and other essential nutrients, and are lower in added sugar, saturated fat, and sodium (Table 1). At least one-half of food eaten should be fruits and vegetables, especially whole fruits and vegetables of a variety of colors. The core elements of the other half of food that should be eaten include grains, dairy, protein, and oils with lower saturated fat. At least one-half of grain servings should be whole grains. Minimize alcohol use and consumption of foods with added sugar, saturated fat, and sodium. Serving sizes on labels can be used to determine appropriate single portions.

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TABLE 1.

Examples of Nutrient-Dense Foods and Less Healthy Forms

FoodNutrient-denseLess healthy

FormCaloriesFormCalories

Applesauce, 1 cup

Unsweetened

103

Sweetened

170

Cod, 4 oz

Baked

99

Breaded, fried

230

Ground beef, 3-oz patty

97% lean

122

80% lean

209

Milk, 1 cup

Fat free

83

Whole

146

Mocha, 12 oz

Fat-free milk

110

Full-fat milk and chocolate syrup

290

Popcorn, 2 cups

Air-popped

62

Buttered

184


Adapted from U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2020–2025. 9th ed. December 2020:21. Accessed September 16, 2021. https://dietaryguidelines.gov.

TABLE 1.

Examples of Nutrient-Dense Foods and Less Healthy Forms

FoodNutrient-denseLess healthy

FormCaloriesFormCalories

Applesauce, 1 cup

Unsweetened

103

Sweetened

170

Cod, 4 oz

Baked

99

Breaded, fried

230

Ground beef, 3-oz patty

97% lean

122

80% lean

209

Milk, 1 cup

Fat free

83

Whole

146

Mocha, 12 oz

Fat-free milk

110

Full-fat milk and chocolate syrup

290

Popcorn, 2 cups

Air-popped

62

Buttered

184


Adapted from U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2020–2025. 9th ed. December 2020:21. Accessed September 16, 2021. https://dietaryguidelines.gov.

These guidelines will be more difficult to follow for people with food insecurity, which is the limited or uncertain access to nutrient-dense foods that affects 10% of households. Most people, even those without limited access, exceed the recommended intake of refined grains, added sugars, sodium, and saturated fats.

Infants and Toddlers

During the first four months of life, breast milk is the optimal sole form of nutrition. Infants fed breast milk as part or all of their diet should get a 400-IU supplement of vitamin D each day. An iron-fortified commercial infant formula is recommended when breast milk is unavailable. Formula should be prepared per the manufacturer's instructions.

Between four and six months of age, infants can begin eating nutrient-dense foods prepared to reduce choking risk. Although dairy products such as yogurt and cheese can be introduced at this time, cow's milk is not a safe replacement for human milk or formula until 12 months of age. Foods high in added sugar or sodium should be limited. Honey and unpasteurized foods (e.g., juices, milk, yogurt, cheeses) are unsafe for infants to consume.

Potentially allergenic foods such as peanuts, tree nuts, egg, soy, and shellfish should be introduced with other complementary foods at six months of age to reduce risk of allergy. There is no evidence that delaying introduction of allergenic foods prevents food allergy, and introducing peanut-containing foods in the first year reduces the risk of developing an allergy.

Children and Adolescents

The same core nutrient-dense foods are recommended for children and adolescents as for adults, because childhood habits guide adult eating patterns. Modeling and supporting healthy dietary patterns

Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Michael J. Arnold, MD, contributing editor.

A collection of Practice Guidelines published in AFP is available at https://www.aafp.org/afp/practguide.

 

 

Copyright © 2021 by the American Academy of Family Physicians.
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