• Overview
  • Dietary Advice for General Health
  • Diet Evaluation Standards
  • Special Training and Licensure
  • Organizations and Agencies in Nutrition
• Disease States
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  • Type 2 Diabetes
  • HIV+
  • Hypertension
  • Weight Loss and Maintenance
• Interventions
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• Resources
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Dietary Advice for General Health

In order to answer the question, 'What is a healthy diet?," the National Institutes of Health (NIH) convened an "expert panel" of nutrition researchers that resulted in the US Dietary Guidelines and the US Department of Agriculture (USDA) convened a similar panel which developed the Food Guide Pyramid. Each was supposed to help the general public make better nutritional food choices. The impact of these two educational products has not, and probably could not be, clearly evaluated but using these standards is a good way to begin a personal evaluation of one's eating habits.

Tip Sheets:

• My Pyramid (PDF)
• Dietary Guidelines (PDF)

Dietary Evaluation

In all cases, dietary evaluation relies on an individual keeping a detailed food record of everything he/she eats and drinks. This record serves as the basis of the evaluation and three days of food intake gives a good approximation of one's usual intake. One could use the information on the food pyramid to put one's intake into the pyramid format and see if it meets the requirement of including all the food groups and a sufficient number of servings per food group. To obtain information on actual intake of grams or micrograms of nutrients one would need to use a software analysis program. Currently there are a number of purchased nutrient databases (references 1-3) to analyze this data but there are also some free sites on the web that make it possible to carry out a reasonable evaluation. See references 4-7. A not for profit site is more desirable. Most of the databases compare your intake of macro and micronutrients with the recommended Daily Reference Intakes (DRIs) or Dietary Guidelines.

What to Track

Macronutrients to track are calories, total fat, amount of saturated fat, polyunsaturated fat, dietary cholesterol and dietary fiber (non-nutrient polysaccharides). In addition, 15-20 vitamins and minerals will be tabulated for an average intake. In order to improve your diet, you would need to know which nutritional components are too high in your diet and which are too low. Then you need to identify those foods which are high or low in the appropriate macro or micronutrients to guide you in what changes to make. A number of consumer resources list foods high in specific micronutrients (references 8-10). Patient hand-outs on food sources for total and type of fats, omega 3-fatty acids, fiber and calcium, are included in the Resources for Clinicians section of this module.

In practical terms one can cite five general food-oriented suggestions to increase the healthfulness of one's diet. These suggestions are good both for the general public and for use by clinicians in medical practice. They are listed below together with sugestions for how to incorporate them into your eating habits.

Simple Nutrition Messages to Improve the Quality of One's Diet

1. Decrease intake of animal products by approximately 50% in order to decrease your intake of saturated fat. Saturated fat increases the risk of cardiovascular disease (CVD) and maybe of type 2 diabetes.
   
   How: Decrease portion size by half or decrease frequency of serving of animal products by half. Choose leaner meat options whenever possible, with all dairy products being reduced in fat. A portion size of meat is the size of a deck of cards.
   

2. At least double intake of fruits and vegetables in order to increase your intake of many micronutrients and minerals and also to increase fiber and decrease the glycemic load of your diet.
   
   How: Use fruits as a snack item and increase the portion size of your vegetables. Make sure you have a vegetable at lunch. You need at least two and a half cups of fruits and vegetables per day.
   

3. Increase intake of fiber by increasing consumption of fruits, vegetables, whole grains and legumes.
   
   How: Fnd a cereal and a bread that are high in fiber (more than 3g of fiber/serving). Find ways to add beans to soups and salads and eat more bean soup, e.g., lentil, split pea, minestrone, etc.
   

4. Decrease consumption of energy dense-nutrient poor foods (EDNP foods), e.g., white bread, white rice, pasta, crackers, cookies, rolls, bagels, candies, cookies, desserts, sodas. They do not provide many nutrients, are low in fiber and do not provide much satiety. They can also contribute to a high glycemic load diet.
   
   How: Use high fiber foods to supply satiety and have healthier snacks available (such as fruits, nuts, salads, etc.). Find dessert foods that contain fruits and nuts and not just high sugar content.
   

5. Increase your intake of fish (salmon, swordfish, bluefish, sardines, and other fatty fish) and foods that contain n-3 fatty acids, such as walnuts, walnut oil, canola oil, flaxseed oil. The protective role of n-3 fatty acids is still an active area of research but these fatty acids are believed to decrease risk of CVD.
   
   How: Use canola oil in cooking, use walnuts for snacks (with raisins) and find some fish dishes that you enjoy to have fish two times a week.

The above are some direct suggestions on how to eat a healthier diet. Also check out the Mediterranean diet which is high in fruits, vegetables, legumes and fish, as another approach to a new eating pattern. It has been estimated that it can take months and even years to make permanent changes in eating lifestyle, so be patient and persevere. Look for tasty recipes that are healthier, to add to your list of favorite meals and slowly decrease meals which are less healthful. After 1-2 years of a new eating pattern it is usually considered to be your "usual" eating pattern. Remember it is the "usual" eating pattern that is important and not the occasional splurges.

References

1. Nutrition Data System for Research (NDS-R), software version 4.06, developed by the Nutrition Coordinating Center, University of Minnesota, Minneapolis, MN, Food and Nutrition Database 34, released May 2003. (NCC contact is 612-626-9450.)

2. Nutrition Pro Version 2.1 2004 Nutrition Pro version 2.1, First Databank, Indianapolis, IN, (800-428-4495).

3. FoodWorks Nutrition Analysis Software, Version 6.0, copyright 2003, The Nutrition Company, Long Valley, NJ. (908-876-5580)

4. Fitday.com is a free website where an individual can track diet, exercise and weight: http://www.fitday.com/

5. National Institutes of Health Menu Planner allows the user to plan a menu based on a target number of calories. It is limited in food items and preparation options: http://hp2010.nhlbihin.net/menuplanner/menu.cgi

6. Nutrition Analysis Tool 2.0 is from the University of Illinois and is composed of the USDA Handbook #8 and has a limited number of brand-named items: http://www.nat.uiuc.edu

7. USDA Food Compositions Tables provides a single food look-up from a large database of foods. USDA and Agricultural Research Services: http://www.nal.usda.gov/fnic/

8. Trichopoulou A. Costacou T. Bamia C. Trichopoulos D. Adherence to a Mediterranean diet and survival in a Greek population.. New England Journal of Medicine. 348(26):2599-608, 2003 Jun 26.