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Fact Sheet

Fact Sheet

Dietary recommendations for health:  Fact sheet

Compiled by: Prof M Senekal and colleagues, Division of Human Nutrition, Faculty of Health Sciences, University of Cape Town; Dr CE Naude, Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University

1.       Dietary recommendations for health have been published and are regularly updated by the World Health Organization, United States of America and Canada (Institute of Medicine, Food and Nutrition Board), Europe (the European Food Safety Authority), the Nordic countries (National Food Safety Agency) and Australia and New Zealand (Australian and New Zealand Ministries of Health) (see detail below in Table 1).  

 

2.       Within the context of energy balance for health and weight maintenance, these recommendations provide guidance on the macronutrienta composition of diets for the prevention of chronic diseasesb in healthy populations (groups of individuals), while also ensuring adequate intake of micronutrientsc and other beneficial compoundsd in foods. These guidelines may also apply to healthy individuals who have metabolic risk indicatorse for chronic diseases, but do not apply to individuals diagnosed with such diseases.

 

3.       Single “best values” for population level recommendations for healthy eating are seldom appropriate. It is for this reason that recommendations across countries specify “safe ranges” for macronutrient contributions to total energy intake. For carbohydrates the range varies between 45 to 75%, for protein between 10 to 35% and for fat between 20 to 40%. As both quantity (% contribution to total energy intake) and quality (type and nature) of macronutrients are of importance, guidance on the quality aspects of carbohydrates and fats are also included in most recommendations.

 

4.       Within the South African context these recommendations have been translated to the Food Based Dietary Guidelines published by the National Department of Health (see detail below in Table 2),f as is recommended and encouraged by the World Health Organization for all countries.

 

5.       Good quality carbohydrates provide energy, especially glucose for the brain, as well as vitamins, minerals, dietary fibre and other beneficial biologically active compounds. Food sources of good quality carbohydrates include unprocessed or minimally processed grains, legumes and fruits and vegetables.

 

6.       Good quality proteins provide essential amino acids for body protein synthesis, as well as vitamins and minerals. Food sources of good quality proteins include fish, chicken without skin, lean meats, reduced fat dairy products and eggs. Quality protein can also be obtained from soya and other plant sources if combined to ensure provision all essential amino acids e.g. samp and beans.

 

7.       Good quality fat in the diet is necessary to provide essential fatty acids, as well as for cell membrane integrity, hormone production, protection of organs, absorption of some vitamins and other functions.  Food sources of good quality fats include oily fish, plant oils, most nuts and seeds and avocado pears.

 

8.       Any diet that is promoted for health should be sustainable in the long-term, specifically in terms of ease of adherence to guidelines, availability and affordability of foods, as well as social and cultural acceptability. Sustainability of dietary recommendations should also consider the total life-cycle greenhouse gas (GHG) emissionsg of the production, transportation and distribution of foods.

 

If it is about Nutrition, ask your Dietitian www.adsa.org.za

 

 

a Macronutrients: carbohydrate, protein and fat

b Chronic diseases: diabetes, coronary heart disease, stroke, cancer...

c Micronutrients: vitamins and minerals

d Other beneficial compounds: fibre, biologically active compounds e.g. flavonoids, phytoestrogens...

e Metabolic risk indicators: poor glucose tolerance, high blood pressure, unhealthy blood lipid levels

f http://www.fao.org/ag/humannutrition/nutritioneducation/fbdg/49849/en/zaf/

g Shifting from red meat and dairy toward chicken/ fish/egg or vegetable based diets for 1 day a week reduces GHG emissions substantially1

Table 1: Macronutrient Recommendations from Selected Regions/Countries (Compiled by CE Naude)

 

Nordic countries2-3

United States of America and Canada4

Australia and New Zealand5

Europe6

World Health Organization7

Carbohydrate

% of TE

45 - 60

(population goal 55)

45 – 65

130 g minimum (RDA)

45 – 65

45 - 60

55-75

Fibre

grams per day

25 - 35

19-50 years: 38 (males); 25 (females)

>50 years: 30 (males); 21 (females)

30 (males)

25 (females)

25

25

Sugar

% of TE

< 10

(refined sugars)

< 25

(added sugar)

---

---

<10

(free sugars)

Total Fat

% of TE

25 – 40

(population goal 30)

20 – 35

20 - 35

20 - 35

20h-35i

Saturated fat

% of TE

< 10

As low as possible with

nutritionally adequate diet

< 8 - 10

As low as possible with

nutritionally adequate diet

< 10

Trans fat

% of TE

As little as possible

 

 

< 1

Monounsaturated fat

% of TE

10 – 20

---

---

---

By difference

Polyunsaturated fat

% of TE

5 – 10

---

---

---

6-10

Omega-3 Polyunsaturated fat (a-linolenic acid) % of TE

At least 0.5

 

0.6 – 1.2

0.4/0.5 - 1

0.5

(AI)

1-2

Omega-6 Polyunsaturated fat (linoleic acid) % of TE

3% when combined with omega-3 fat

5 - 10

4/5 - 10

4

(AI)

5-8

Protein

% of TE

10 – 20

 

10 - 35

15 - 25

---

10-15

Abbreviations: TE = Total Energy; RDA = Recommended Dietary Allowance; AI = Adequate Intake

hIntake of at least 20% is consistent with good health

iAcceptable for those who are highly active and consume diets rich in vegetables, legumes, fruits and whole grains, without the risk of unhealthy weight gain

 

Nordic Nutrition Recommendations, 2012 2-3: The Nordic Nutrition Recommendations (NNR) are primarily valid for groups of healthy individuals. They can be used as guidelines for planning diets for groups, as a basis for teaching and dietary information, as a basis for food and nutrition policy and as a basis for evaluation of dietary intake.

 

Dietary Reference Intakes, United States of America and Canada, 2002/2005 4: The Dietary Reference Intakes include Acceptable Macronutrient Distribution Ranges (AMDR), defined as the range of intake for a particular energy source that is associated with reduced risk of chronic disease while providing intakes of essential nutrients. Consumption in excess of the AMDR confers the potential of increasing the risk of chronic diseases and insufficient intakes of essential nutrients.  The AMDR is expressed as a percentage of total energy intake because its requirement, in a classical sense, is not independent of other energy fuel sources or of the total energy requirement of the individual. The Recommended Dietary Allowance for carbohydrate is set at 130 grams per day for adults and children based on the average minimum amount of glucose utilized by the brain.

 

Nutrient Reference Values for Australia and New Zealand, 2005 5: The Nutrient Reference Values include Acceptable Macronutrient Distribution Ranges (AMDRs) to reduce chronic disease risk whilst still ensuring adequate micronutrient intake. They are aimed at healthy people and may not meet the specific nutritional requirements of individuals with various diseases or conditions, pre-term infants, or people with specific genetic profiles. They are designed to assist nutrition and health professionals assess the dietary requirements of individuals and groups. They may also be used by public health nutritionists, food legislators and the food industry for dietary modelling and/or food labelling and food formulation.

 

Dietary Reference Values, European Food Safety Authority, 2010 6: The Dietary Reference Values apply to healthy populations and they are not intended as reference values for the treatment of patients with diseases or conditions like diabetes, obesity, or cardiovascular disease. However, they apply to healthy subjects with signs of metabolic disturbances like impaired glucose tolerance, elevated blood pressure, serum lipids, etc.

 

World Health Organization: Population nutrient intake goals for preventing diet-related chronic diseases, 20037: The WHO population nutrient intake goals represent the population average intake that is judged to be consistent with the maintenance of health in a population. Health, in this context, is marked by a low prevalence of diet-diseases in the population.

 

References

1. Weber CL, Matthews HS. Food-miles and the relative climate impacts of food choices in the United States. Environ Sci Technol. 2008 May 15;42(10):3508-13.

2. Becker W, Lyhne N, Pedersen AN, Aro A, Fogelholm M, Phorsdottir I, et al. Nordic Nutrition Recommendations 2004 - integrating nutrition and physical activity. Scandinavian Journal of Nutrition. 2004;48(4):178-87.

3. Nordic Council of Ministers. Nordic nutrition recommendations 2012. Integrating nutrition and physical activity. Arhus: Nordic Council of Ministers 20012.

4. Institute of Medicine Food and Nutrition Board. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (Macronutrients). Washington, DC: National Academies Press; 2002/2005.

5. Australian National Health and Medical Research Council and the New Zealand Ministry of Health. Nutrient Reference Values for Australia and New Zealand: Including Recommended Dietary Intakes. Canberra: Australian National Health and Medical Research Council and the New Zealand Ministry of Health2006.

6. EFSA Panel on Dietetic Products Nutrition and Allergies (NDA). Dietary Reference Values Parma: European Food Safety Authority (EFSA)2010.

7. World Health Organization/Food and Agricultural Organization. Diet, Nutrition and the Prevention of Chronic Disease. Report of a Joint WHO/FAO Expert Consultation. Chapter 5: Population nutrient intake goals for preventing chronic-diseases. Geneva: World Health Organization 2003.

Table 2: The South African Food Based Dietary Guidelines (FBDGs) for healthy adults and children 5 years and older

2012 FBDG Guideline

Key points

Evidence

General overview

FBDGs are science-based messages that aim to change the eating

behaviour of the general population towards more optimal diets that meet energy and nutrient requirements, while helping to protect against the development of non-communicable diseases such as diabetes, heart disease and cancer.

Vorster HH et al. An introduction to the revised food-based dietary guidelines for South Africa. SACJN. 2013; 3:S5-S12

Enjoy a variety of foods.

 

Healthy foods from all food groups should be consumed on a daily basis, preferably foods from at least 2 groups at each meal. It is important to remember that a single food cannot provide all the nutrients we need for optimal health. Elimination of food groups can lead to deficiencies and disease.

Steyn NP, Ochse R. “Enjoy a variety of foods”: as a food based dietary guideline for South Africa. SAJCN. 2013; 3:S13-S17

Make starchy foods part of most meals

Healthy choices include unprocessed or minimally processed grains such as whole-wheat bread, breakfast cereals, pasta, wraps, brown/wild rice. Starchy vegetables such as potatoes and sweet potatoes, preferably with the skins intact, are also healthy choices.

Vorster HH. “Make starchy foods part of most meals”: a food-based dietary guideline for South Africa. SAJCN. 2013; 3:S28-S35

Fish, chicken lean meat or eggs could be eaten daily

Healthy choices include oily fish such as pilchards and salmon, chicken without skin, lean meats such as steak with all excess fat trimmed, lean mince and ostrich. Intake of cheese and processed meat should be limited and healthy low-fat cooking methods such steaming, grilling and boiling should be used.

Schonfeldt HC, Pretorius B, Hall N. “Fish, chicken, lean meat and eggs can be eaten daily”: a food-based dietary guideline for South Africa. SAJCN. 2013; 3:S66-S76

Eat plenty of vegetables and fruit every day

At least 5 fruit and vegetables in total should be eaten each day. Dark green leafy vegetables and yellow or orange fleshed vegetables and fruit are specifically important for health. Some vegetables can be eaten raw; others need to be cooked to make them more digestible and palatable. Fruit should mostly be eaten fresh and raw, but can be eaten cooked or dried, preferably without added sugar.

Naude CE. “Eat plenty of vegetables and fruit every day”: a food-based dietary guideline for South Africa. SAJCN. 2013; 3:S46-S56

Eat dry beans, split peas, lentils and soya regularly

These foods should be eaten at least 2 to 3 times per week. They provide healthy and lower fat protein alternatives. Vegan vegetarians should combine different plant proteins to ensure that all essential amino acids are eaten e.g. combining samp with beans and a peanut butter sandwich.

Venter CS, Vorster HH, Ochse R, Swart R. “Eat dry beans, split peas, lentils and soya regularly”: a food-based dietary guideline. SAJCN. 2013; 3:S36-S45

Have milk, maas or yoghurt every day

Use low fat or skim milk or maas and preferably low fat yoghurt. Limit the use of milk products with added sugars.

Vorster HH et al.“Have milk, maas or yoghurt every day”:a food-based dietary guideline for South Africa. SAJCN. 2013; 3:S57-S65

Use salt and food high in salt sparingly.

 

Use salt in small amounts when cooking and avoid adding salt at the table. Reduce the intake of high salt containing foods e.g. salted snacks, stock cubes, commercial soups, salad dressings and processed meats.  Check food labels for salt content. Use herbs, garlic, spices and lemon juice to flavour foods instead of using salt.

Wentzel-Viljoen  E, Steyn K, Ketterer E, Charlton CE. “Use salt and foods high in salt sparingly”: a food-based dietary guideline for South Africa. SAJCN.  2013; 3:S105-S113

Eat fats sparingly, choose vegetable oils rather than hard fats.

Use a little fat at a time and choose plant fat or oils such as tub margarine or canola, sunflower or olive oil. Fatty fish, nuts, seeds and avocado pears also provide healthy fats.

Smuts CM, Wolmarans PW. The importance of the quality or type of fat in the diet: a food based dietary guideline for South Africa. SAJCN. 2013; 3:S87-S99

Use foods and drinks containing sugar sparingly, and not

between meals

Use foods moderate to high in sugar, especially those containing added sugar, sparingly. Consumption of sugar sweetened beverages should be limited.

Temple NJ, Steyn NP. Sugar and health: a food-based dietary guideline for South Africa. SAJCN. 2013; 3:S100-S104

Drink lots of clean, safe water

Children and adults need 6 to 8 glasses of water per day. Water needs may be higher for the elderly and for people who are involved in exercise or hard physical labour.

 

van Graan AE et al. “Drink lots of clean, safe water”: a food-based dietary guideline for South Africa. SAJCN. 2013; 3: S77-S86

Be active

Exercise at least 3 to 5 times a week for 20 to 50 minutes (min). This can be accumulated in smaller bouts of at least 10 min during the course of the day.  It is recommended that children/adolescents  and those seeking additional health benefits such as weight loss should do more exercise; up to 60 min most days of the week.

Botha CR, Wright HH, Moss SJ, Kolbe-Alexander TL. “Be active!” Revisiting the South African food-based dietary guideline for activity. SAJCN 3: S18-S27

 

To download the PDF version: http://http://www.health.uct.ac.za/sites/default/files/image_tool/images/116/diet-debate/2014%20Fact%20Sheet%20-%20Dietary%20Guidelines%20for%20Health%20Final.pdf