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Chapter 3

Foods and Food


Components to Reduce

The Dietary Guidelines for Americans provides science- calorie intake. Many Americans are overweight or
based advice to promote health and reduce the risk obese, and are at higher risk of chronic diseases,
of major chronic diseases through diet and physical such as cardiovascular disease, diabetes, and certain
activity. Currently, very few Americans consume types of cancer. Even in the absence of overweight
diets that meet Dietary Guideline recommenda- or obesity, consuming too much sodium, solid fats,
tions. This chapter focuses on certain foods and saturated and trans fatty acids, cholesterol, added
food components that are consumed in excessive sugars, and alcohol increases the risk of some of
amounts and may increase the risk of certain chronic the most common chronic diseases in the United
diseases. These include sodium, solid fats (major States. Discussing solid fats in addition to saturated
sources of saturated and trans fatty acids), added and trans fatty acids is important because, apart
sugars, and refined grains. These food components from the effects of saturated and trans fatty acids on
are consumed in excess by children, adolescents, cardiovascular disease risk, solid fats are abundant
adults, and older adults. In addition, the diets of most in the diets of Americans and contribute signifi-
men exceed the recommendation for cholesterol. cantly to excess calorie intake. The recommenda-
Some people also consume too much alcohol. tions in this chapter are based on evidence that
eating less of these foods and food components can
This excessive intake replaces nutrient-dense forms help Americans meet their nutritional needs within
of foods in the diet, making it difficult for people to appropriate calorie levels, as well as help reduce
achieve recommended nutrient intake and control chronic disease risk.

DIETARY GUIDELINES FOR AMERICANS, 2010 | Chapter Three 20


Key Recommendations
� suPPorting the
recoMMendations
Reduce daily sodium intake to less than 2,300
milligrams (mg) and further reduce intake The following sections expand on the recommenda-
tions and review the evidence supporting the health
to 1,500 mg among persons who are 51 and
risks associated with greater intake of foods that are
older and those of any age who are African
high in sodium, solid fats, added sugars, and refined
American or have hypertension, diabetes,
grains, and excessive alcohol consumption. An
or chronic kidney disease. The 1,500 mg important underlying principle is the need to control
recommendation applies to about half of the calorie intake to manage body weight and limit the
U.S. population, including children, and the intake of food components that increase the risk of
majority of adults. certain chronic diseases. This goal can be achieved
by consuming fewer foods that are high in sodium,
Consume less than 10 percent of calories solid fats, added sugars, and refined grains and, for
from saturated fatty acids by replacing them those who drink, consuming alcohol in moderation.
with monounsaturated and polyunsaturated
fatty acids. sodium
Sodium is an essential nutrient and is needed by
Consume less than 300 mg per day of the body in relatively small quantities, provided that
dietary cholesterol. substantial sweating does not occur. On average,
the higher an individual’s sodium intake, the higher
Keep trans fatty acid consumption as low
the individual’s blood pressure. A strong body
as possible, especially by limiting foods
of evidence in adults documents that as sodium
that contain synthetic sources of trans fats, intake decreases, so does blood pressure. Moder-
such as partially hydrogenated oils, and by ate evidence in children also has documented that
limiting other solid fats. as sodium intake decreases, so does blood pressure.
Keeping blood pressure in the normal range reduces
Reduce the intake of calories from solid fats
an individual’s risk of cardiovascular disease, conges-
and added sugars. tive heart failure, and kidney disease. Therefore, adults
and children should limit their intake of sodium.
Limit the consumption of foods that
contain refined grains, especially refined
Virtually all Americans consume more sodium than
grain foods that contain solid fats, added
they need. The estimated average intake of sodium
sugars, and sodium. for all Americans ages 2 years and older is approxi-
mately 3,400 mg per day (Figure 3-1).
If alcohol is consumed, it should be
consumed in moderation—up to one drink
Sodium is primarily consumed as salt (sodium
per day for women and two drinks per day for
chloride). As a food ingredient, salt has multiple
men—and only by adults of legal drinking age. uses, such as in curing meat, baking, masking off-
flavors, retaining moisture, and enhancing flavor
(including the flavor of other ingredients). Salt added
how is an alcoholic at the table and in cooking provides only a small pro-
portion of the total sodium that Americans consume.
drink defined? Most sodium comes from salt added during food
processing. Many types of processed foods contrib-
One drink is defined as 12 fluid ounces of ute to the high intake of sodium (Figure 3-2).
regular beer (5% alcohol), 5 fluid ounces of
wine (12% alcohol), or 1.5 fluid ounces of 80 Some sodium-containing foods are high in sodium,
proof (40% alcohol) distilled spirits. One drink but the problem of excess sodium intake also is due
contains 0.6 fluid ounces of alcohol. to frequent consumption of foods that contain lower
amounts of sodium, such as yeast breads41 (which

41. Includes white bread or rolls, mixed-grain bread, flavored bread, whole-wheat bread or rolls, bagels, flat breads, croissants, and English muffins.

21 DIETARY GUIDELINES FOR AMERICANS, 2010 | Chapter Three


figure 3-1. estimated Mean daily sodium intake, by age–gender group,
nhanes 2005–2006

5,000

Males

Females
4,000
Milligrams per day

3,000

2,300 mga
2,000

­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ 1,500 mgb
1,000

0
2–5 6–11 12–19 20–29 30–39 40–49 50–59 60–69 >70
Age (years)

a. 2,300 mg/day is the Tolerable Upper Intake Level (UL) for sodium Source: U.S. Department of Agriculture, Agricultural Research Service
intake in adults set by the Institute of Medicine (IOM). For children and U.S. Department of Health and Human Services, Centers for Disease
younger than age 14 years, the UL is less than 2,300 mg/day. Control and Prevention. What We Eat In America, NHANES 2005–2006.
b. 1,500 mg/day is the Adequate Intake (AI) for individuals ages 9 years http://www.ars.usda.gov/Services/docs.htm?docid=13793. Accessed
and older. August 11, 2010.

figure 3-2. sources of sodium in the diets of the u.s. Population


ages 2 years and older, nhanes 2005–2006a
Yeast
breads
7.3%
Chicken and
chicken mixed
All other dishes
food categories 6.8%
31.9%
Pizza
6.3%

Pasta and 
pasta dishes
5.1%
Cold cuts
4.5%

Ready­to­eat Condiments
cereals 4.4%
2.0%
Salad dressing Tortillas,
2.4% Burgers burritos, tacosb
2.4% 4.1%
Eggs and  Sausage, franks,
egg mixed  Soups bacon, ribs
dishes  3.3% Regular  4.1%
2.6% Rice and  Grain­based cheese
rice  Beef and  desserts 3.5%
mixed  beef mixed 
3.4%
dishes dishes
2.6% 3.3%

a. Data are drawn from analyses of usual dietary intake conducted by the Source: National Cancer Institute. Sources of Sodium in the Diets of the
National Cancer Institute. Foods and beverages consumed were divided U.S. Population Ages 2 Years and Older, NHANES 2005–2006. Risk
into 97 categories and ranked according to sodium contribution to the Factor Monitoring and Methods, Cancer Control and Population Sciences.
diet. “All other food categories” represents food categories that each http://riskfactor.cancer.gov/diet/foodsources/sodium/table1a.html.
contributes less than 2% of the total intake of sodium from foods. Accessed August 11, 2010.
b. Also includes nachos, quesadillas, and other Mexican mixed dishes.

DIETARY GUIDELINES FOR AMERICANS, 2010 | Chapter Three 22


contribute 7% of the sodium in the U.S. diet). Other active individuals.45 It covers sodium sweat losses in
sources of sodium include chicken and chicken unacclimatized individuals who are exposed to high
mixed dishes42 (7% of sodium intake), pizza (6%), temperatures or who become physically active, and
and pasta and pasta dishes43 (5%). Some of the ensures that recommended intake levels for other
sources discussed here and in the following sec- nutrients can be met. The sodium AI for individu-
tions contain larger varieties of foods than others als ages 9 to 50 years is 1,500 mg per day. Lower
(e.g., chicken and chicken mixed dishes). Therefore, sodium AIs were established for children and older
some of these sources include foods that can be adults (ages 1 to 3 years: 1,000 mg/day; ages 4 to 8
purchased or prepared to be lower in sodium, as well years: 1,200 mg/day; ages 51 to 70 years: 1,300 mg/
as lower in other food components recommended to day; ages 71 years and older: 1,200 mg/day) because
be reduced. For example, chicken naturally contains their calorie requirements are lower.
little sodium. Chicken and chicken mixed dishes can
be prepared by purchasing chicken that has not had For adolescents and adults of all ages (14 years and
sodium added to it and by not adding salt or ingredi- older), the IOM set the Tolerable Upper Intake Level
ents containing sodium. (UL) at 2,300 mg per day. The UL is the highest
daily nutrient intake level that is likely to pose no
Americans can reduce their consumption of sodium risk of adverse health effects (e.g., for sodium,
in a variety of ways: increased blood pressure) to almost all individuals
in the general population. The IOM recognized that
• Read the Nutrition Facts label for information on
the association between sodium intake and blood
the sodium content of foods and purchase foods
pressure was continuous and without a threshold
that are low in sodium.
(i.e., a level below which the association no longer
• Consume more fresh foods and fewer processed exists). The UL was based on several trials, includ-
foods that are high in sodium. ing data from the Dietary Approaches to Stop
Hypertension (DASH)-Sodium trial. The IOM noted
• Eat more home-prepared foods, where you have more
that in the DASH-Sodium trial, blood pressure was
control over sodium, and use little or no salt or salt-
lowered when target sodium intake was reduced to
containing seasonings when cooking or eating foods.
2,300 mg per day, and lowered even further when
• When eating at restaurants, ask that salt not be sodium was targeted to the level of 1,200 mg per
added to your food or order lower sodium options, day.46 An intake level of 2,300 mg per day was
if available. commonly the next level above the AI of 1,500 mg
per day that was tested in the sodium trials evalu-
Sodium is found in a wide variety of foods, and ated by the IOM.
calorie intake is associated with sodium intake (i.e.,
the more foods and beverages people consume, the The DASH studies dem-
more sodium they tend to consume). Therefore, onstrated that the total for More inforMation
reducing calorie intake can help reduce sodium eating pattern, including See chapter 5 for more
intake, thereby contributing to the health benefits sodium and a number information about the
DASH research trials and
that occur with lowering sodium intake. of other nutrients and the DASH Eating Plan.
foods, affects blood
Because a Recommended Dietary Allowance for pressure. In the original
sodium could not be determined, the Institute of DASH trial, the DASH diet47 resulted in a significant
Medicine (IOM)44 set Adequate Intake (AI) levels for reduction in blood pressure compared to the control
this nutrient. The AI is the recommended daily aver- diet, which was typical of what many Americans
age intake level of a nutrient, and usual intakes at or consume. In the DASH-Sodium trial, blood pressure
above the AI have a low probability of inadequacy. levels declined with reduced sodium intake for those
The sodium AI is based on the amount that is needed who consumed either the DASH or control diet.
to meet the sodium needs of healthy and moderately However, blood pressure declined most for those

42. Includes fried or baked chicken parts and chicken strips/patties, chicken stir-fries, chicken casseroles, chicken sandwiches, chicken salads, stewed
chicken, and other chicken mixed dishes.
43. Includes macaroni and cheese, spaghetti and other pasta with or without sauces, filled pastas (e.g., lasagna and ravioli), and noodles.
44. Institute of Medicine. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Washington (DC): The National Academies Press; 2005.
45. Because of increased loss of sodium from sweat, the AI does not apply to highly active individuals and workers exposed to extreme heat stress.
46. The average achieved levels of sodium intake, as reflected by urinary sodium excretion, was 2,500 and 1,500 mg/day.
47. The DASH diet emphasized fruits, vegetables, and low-fat milk and milk products; included whole grains, poultry, fish, and nuts; and contained only
small amounts of red meat, sweets, sugar-containing beverages, and decreased amounts of total and saturated fat and cholesterol.

23 DIETARY GUIDELINES FOR AMERICANS, 2010 | Chapter Three


who both consumed the DASH diet and reduced they are structurally different from the predominant
their sodium intake. unsaturated fatty acids that occur naturally in plant
foods and have dissimilar health effects.
Americans should reduce their sodium intake to
less than 2,300 mg or 1,500 mg per day depend- The types of fatty acids consumed are more impor-
ing on age and other individual characteristics. tant in influencing the risk of cardiovascular disease
African Americans, individuals with hypertension, than is the total amount of fat in the diet. Animal
diabetes, or chronic kidney disease and individuals fats tend to have a higher proportion of saturated
ages 51 and older, comprise about half of the U.S. fatty acids (seafood being the major exception),
population ages 2 and older. While nearly everyone and plant foods tend to have a higher proportion of
benefits from reducing their sodium intake, the monounsaturated and/or polyunsaturated fatty acids
blood pressure of these individuals tends to be (coconut oil, palm kernel oil, and palm oil being the
even more responsive to the blood pressure-raising exceptions) (Figure 3-3).
effects of sodium than others; therefore, they
should reduce their intake to 1,500 mg per day. Most fats with a high percentage of saturated or
Additional dietary modifications may be needed trans fatty acids are solid at room temperature and
for people of all ages with hypertension, diabetes, are referred to as “solid fats,” while those with more
or chronic kidney disease, and they are advised unsaturated fatty acids are usually liquid at room
to consult a health care professional. Given the temperature and are referred to as “oils.” Solid fats
current U.S. marketplace and the resulting exces- are found in most animal foods but also can be made
sive high sodium intake, it is challenging to meet from vegetable oils through the process of hydroge-
even the less than 2,300 mg recommendation— nation, as described below.
fewer than 15 percent of Americans do so cur-
rently. An immediate, deliberate reduction in the Despite longstanding recommendations on total fat,
sodium content of foods saturated fatty acids, and cholesterol, intakes of these
in the marketplace fats have changed little from 1990 through 2005–
for More inforMation
See chapter 4 for a is necessary to allow 2006, the latest time period for which estimates are
discussion of the health consumers to reduce available. Total fat intake contributes an average of
benefits of foods that sodium intake to less 34 percent of calories. The following sections provide
contain potassium. than 2,300 mg or details on types of fat to limit in the diet.
1,500 mg per day now.
Saturated fatty acids
fats The body uses some saturated fatty acids for
Dietary fats are found in both plant and animal physiological and structural functions, but it makes
foods. Fats supply calories and essential fatty acids, more than enough to meet those needs. People
and help in the absorption of the fat-soluble vita- therefore have no dietary requirement for saturated
mins A, D, E, and K. The IOM established accept- fatty acids. A strong body of evidence indicates
able ranges for total fat intake for children and that higher intake of most dietary saturated fatty
adults (children ages 1 to 3 years: 30–40% of calo- acids is associated with higher levels of blood total
ries; children and adolescents ages 4 to 18 years: cholesterol and low-density lipoprotein (LDL)
25–35%; adults ages 19 years and older: 20–35%) cholesterol. Higher total and LDL cholesterol levels
(see Table 2-4). These ranges are associated with are risk factors for cardiovascular disease.
reduced risk of chronic diseases, such as cardiovas-
cular disease, while providing for adequate intake of Consuming less than 10 percent of calories from
essential nutrients. Total fat intake should fall within saturated fatty acids and replacing them with
these ranges. monounsaturated and/or polyunsaturated fatty
acids is associated with low blood cholesterol levels,
Fatty acids are categorized as being saturated, and therefore a lower risk of cardiovascular disease.
monounsaturated, or polyunsaturated. Fats contain Lowering the percentage of calories from dietary
a mixture of these different kinds of fatty acids. Trans saturated fatty acids even more, to 7 percent of
fatty acids are unsaturated fatty acids. However, calories, can further reduce the risk of cardiovascular

DIETARY GUIDELINES FOR AMERICANS, 2010 | Chapter Three 24


figure 3-3. fatty acid Profiles of common fats and oils

Saturated fat Monounsaturated fat Polyunsaturated fat

100

90

80
Fatty acid composition (% of total)

70

60

50

40

30

20

10

0
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il
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Solid fats Oils

a. Coconut oil, palm kernel oil, and palm oil are called oils because they d. The primary ingredient in soft margarine with no trans fats is liquid
come from plants. However, they are semi-solid at room temperature vegetable oil.
due to their high content of short-chain saturated fatty acids. They are
considered solid fats for nutritional purposes. Source: U.S. Department of Agriculture, Agricultural Research Service,
b. Partially hydrogenated vegetable oil shortening, which contains trans fats. Nutrient Data Laboratory. USDA National Nutrient Database for Standard
c. Most stick margarines contain partially hydrogenated vegetable oil, a Reference, Release 22, 2009. Available at http://www.ars.usda.gov/ba/
source of trans fats. bhnrc/ndl. Accessed July 19, 2010.

disease. Saturated fatty acids contribute an average of of the major food sources of saturated fatty acids can
11 percent of calories to the diet, which is higher than be purchased or prepared in ways that help reduce
recommended. Major sources of saturated fatty acids the consumption of saturated fatty acids (e.g.,
in the American diet include regular (full-fat) cheese purchasing fat-free or low-fat milk, trimming fat from
(9% of total saturated fat intake); pizza (6%); grain- meat). Oils that are rich in monounsaturated fatty
based desserts48 (6%); dairy-based desserts49 (6%); acids include canola, olive, and safflower oils. Oils
chicken and chicken mixed dishes (6%); and sausage, that are good sources of polyunsaturated fatty acids
franks, bacon, and ribs (5%) (Figure 3-4). include soybean, corn, and cottonseed oils.

To reduce the intake of saturated fatty acids, many Trans fatty acids
Americans should limit their consumption of the Trans fatty acids are found naturally in some foods and
major sources that are high in saturated fatty acids are formed during food processing; they are not essen-
and replace them with foods that are rich in mono- tial in the diet. A number of studies have observed an
unsaturated and polyunsaturated fatty acids. For association between increased trans fatty acid intake
example, when preparing foods at home, solid fats and increased risk of cardiovascular disease. This
(e.g., butter and lard) can be replaced with vegetable increased risk is due, in part, to its LDL cholesterol-
oils that are rich in monounsaturated and polyun- raising effect. Therefore, Americans should keep their
saturated fatty acids (Figure 3-3). In addition, many intake of trans fatty acids as low as possible.

48. Includes cakes, cookies, pies, cobblers, sweet rolls, pastries, and donuts.
49. Includes ice cream, frozen yogurt, sherbet, milk shakes, and pudding.

25 DIETARY GUIDELINES FOR AMERICANS, 2010 | Chapter Three


Some trans fatty acids that Americans consume are trans fatty acid levels in the U.S. food supply have
produced by a process referred to as hydrogenation. decreased dramatically since 2006 when the
Hydrogenation is used by food manufacturers to declaration of the amount of trans fatty acids on the
make products containing unsaturated fatty acids Nutrition Facts label became mandatory. Consuming
solid at room temperature (i.e., more saturated) fat-free or low-fat milk and milk products and lean
and therefore more resistant to becoming spoiled meats and poultry will reduce the intake of natural
or rancid. Partial hydrogenation means that some, trans fatty acids. Because natural trans fatty acids
but not all, unsaturated fatty acids are converted to are present in meat, milk, and milk products,50 their
saturated fatty acids; some of the unsaturated fatty elimination is not recommended because this could
acids are changed from a cis to trans configuration. have potential implications for nutrient adequacy.
Trans fatty acids produced this way are referred to as
“synthetic” or “industrial” trans fatty acids. Synthetic Cholesterol
trans fatty acids are found in the partially hydroge- The body uses cholesterol for physiological and
nated oils used in some margarines, snack foods, and structural functions, but it makes more than enough
prepared desserts as a replacement for saturated for these purposes. Therefore, people do not need
fatty acids. Trans fatty acids also are produced by to eat sources of dietary cholesterol. Cholesterol is
grazing animals, and small quantities are therefore found only in animal foods. The major sources of
found in meat and milk products.50 These are called cholesterol in the American diet include eggs and
“natural” or “ruminant” trans fatty acids. There is egg mixed dishes (25% of total cholesterol intake),51
limited evidence to conclude whether synthetic chicken and chicken mixed dishes (12%), beef and
and natural trans fatty acids differ in their metabolic beef mixed dishes (6%), and all types of beef burg-
effects and health outcomes. Overall, synthetic ers (5%).52 Cholesterol intake can be reduced by
50. Milk and milk products also can be referred to as dairy products.
51. Includes scrambled eggs, omelets, fried eggs, egg breakfast sandwiches/biscuits, boiled and poached eggs, egg salad, deviled eggs, quiche, and egg substitutes.
52. Beef and beef mixed dishes and all types of beef burgers would collectively contribute 11% of total cholesterol intake.

figure 3-4. sources of saturated fat in the diets of the u.s. Population
ages 2 years and older, nhanes 2005–2006a

Regular
cheese
8.5%

All other
food categories Pizza
24.5% 5.9%

Grain­based
Fried white desserts
potatoes 5.8%
2.0%
Dairy
Nuts and seeds, desserts
and nut and seed  5.6%
mixed dishes
2.1% Chicken and
Potato/corn/ chicken mixed
other chips dishes
2.4% 5.5%
Butter Sausage, franks,
2.9% bacon, ribs
Candy 4.9%
3.1% Burgers 
Eggs and 4.4%
egg mixed Whole Tortillas,
dishes   milk  Reduced­fat burritos, tacosb
3.2% 3.4% Pasta  milk Beef and 4.1%
and 3.9% beef mixed
pasta dishes dishes
3.7% 4.1%

a. Data are drawn from analyses of usual dietary intake conducted by the Source: National Cancer Institute. Sources of saturated fat in the diets of
National Cancer Institute. Foods and beverages consumed were divided the U.S. population ages 2 years and older, NHANES 2005–2006. Risk
into 97 categories and ranked according to the saturated fat contribution Factor Monitoring and Methods. Cancer Control and Population Sciences.
to the diet. “All other food categories” represents food categories that http://riskfactor.cancer.gov/diet/foodsources/sat_fat/sf.html. Accessed
each contributes less than 2% of the total saturated fat intake. August 11, 2010.
b. Also includes nachos, quesadillas, and other Mexican mixed dishes.

DIETARY GUIDELINES FOR AMERICANS, 2010 | Chapter Three 26


limiting the consumption of the specific foods that fats are abundant in the diets of Americans and
are high in cholesterol. Many of these major sources contribute significantly to excess calorie intake.
include foods that can be purchased or prepared in
ways that limit the intake of cholesterol (e.g., using Solid fats contribute an average of 19 percent of the
egg substitutes). Cholesterol intake by men averages total calories in American diets, but few essential
about 350 mg per day, which exceeds the recom- nutrients and no dietary fiber. Some major food sources
mended level of less than 300 mg per day. Average of solid fats in the American diet are grain-based des-
cholesterol intake by women is 240 mg per day. serts (11% of all solid fat intake); pizza (9%); regular
(full-fat) cheese (8%); sausage, franks, bacon, and ribs
Dietary cholesterol has been shown to raise blood LDL (7%); and fried white potatoes (5%) (Figure 3-5).
cholesterol levels in some individuals. However, this
effect is reduced when saturated fatty acid intake is In addition to being a major contributor of solid fats,
low, and the potential negative effects of dietary cho- moderate evidence suggests an association between
lesterol are relatively small compared to those of satu- the increased intake of processed meats (e.g., franks,
rated and trans fatty acids. Moderate evidence shows sausage, and bacon) and increased risk of colorectal
a relationship between higher intake of cholesterol cancer and cardiovascular disease.53 To reduce the
and higher risk of cardiovascular disease. Independent intake of solid fats, most Americans should limit their
of other dietary factors, evidence suggests that one intake of those sources that are high in solid fats and/
egg (i.e., egg yolk) per day does not result in increased or replace them with alternatives that are low in solid
blood cholesterol levels, nor does it increase the risk of fats (e.g., fat-free milk). Reducing these sources of
cardiovascular disease in healthy people. Consuming excess solid fats in the diet will result in reduced intake
less than 300 mg per day of cholesterol can help of saturated fatty acids, trans fatty acids, and calories.
maintain normal blood cholesterol levels. Consuming
less than 200 mg per day can further help individuals Added sugars
at high risk of cardiovascular disease. Sugars are found naturally in fruits (fructose) and
fluid milk and milk products (lactose). The majority
calories from solid fats and added sugars of sugars in typical American diets are sugars added
to foods during processing, preparation, or at the
Solid fats
table. These “added sugars” sweeten the flavor of
As noted previously, fats contain a mixture of
foods and beverages and improve their palatability.
different fatty acids, and much research has been
They also are added to foods for preservation pur-
conducted on the association between the intake
poses and to provide functional attributes, such as
of saturated and trans fatty acids and the risk of
viscosity, texture, body, and browning capacity.
chronic disease, especially cardiovascular disease.
Most fats with a high percentage of saturated and/
Although the body’s response to sugars does not
or trans fatty acids are solid at room temperature
depend on whether they are naturally present in food
and are referred to as “solid fats” (Figure 3-3).
or added to foods, sugars found naturally in foods
Common solid fats include butter, beef fat (tallow,
are part of the food’s total package of nutrients and
suet), chicken fat, pork fat (lard), stick margarine,
other healthful components. In contrast, many foods
and shortening. The fat in fluid milk also is consid-
that contain added sugars often supply calories, but
ered to be solid fat; milk fat (butter) is solid at room
few or no essential nutrients and no dietary fiber.
temperature but is suspended in fluid milk by the
Both naturally occurring sugars and added sugars
process of homogenization.
increase the risk of dental caries.
Although saturated and trans fatty acids are compo-
Added sugars contribute an average of 16 percent
nents of many foods, solid fats are foods themselves
of the total calories in American diets. Added
or ingredients (e.g., shortening in a cake or hydroge-
sugars include high fructose corn syrup, white
nated oils in fried foods). The purpose for discussing
sugar, brown sugar, corn syrup, corn syrup solids,
solid fats in addition to saturated and trans fatty
raw sugar, malt syrup, maple syrup, pancake syrup,
acids is that, apart from the effects of saturated and
fructose sweetener, liquid fructose, honey, molasses,
trans fatty acids on cardiovascular disease risk, solid
anhydrous dextrose, and crystal dextrose.

53. The DGAC did not evaluate the components of processed meats that are associated with increased risk of colorectal cancer and cardiovascular disease.

27 DIETARY GUIDELINES FOR AMERICANS, 2010 | Chapter Three


As a percent of calories from total added sugars, importantly to overall nutrient adequacy of the diet.
the major sources of added sugars in the diets of Moreover, they have implications for weight manage-
Americans are soda, energy drinks, and sports drinks ment. Foods containing solid fats and added sugars
(36% of added sugar intake), grain-based desserts are no more likely to contribute to weight gain than
(13%), sugar-sweetened fruit drinks54 (10%), dairy- any other source of calories in an eating pattern
based desserts (6%), and candy (6%) (Figure 3-6). that is within calorie limits. However, as the amount
of solid fats and/or added sugars increases in the
Reducing the consumption of these sources of added diet, it becomes more difficult to also eat foods with
sugars will lower the calorie content of the diet, with- sufficient dietary fiber and essential vitamins and
out compromising its nutrient adequacy. Sweetened minerals, and still stay within calorie limits. For most
foods and beverages can be replaced with those that people, no more than about 5 to 15 percent of calories
have no or are low in added sugars. For example, from solid fats and added sugars can be reasonably
sweetened beverages can be replaced with water accommodated in the
and unsweetened beverages. USDA Food Patterns,
for More inforMation
which are designed to See appendices 7, 8, and 9
Why calories from solid fats and added sugars are a meet nutrient needs for the USDA Food Patterns.
particular concern within calorie limits.
Solid fats and added sugars are consumed in excessive
amounts, and their intake should be limited. Together, Reducing the consumption of solid fats and added
they contribute a substantial portion of the calories sugars allows for increased intake of nutrient-dense
consumed by Americans—35 percent on average, or foods without exceeding overall calorie needs. Because
nearly 800 calories per day—without contributing solid fats and added sugars are added to foods and

54. Includes fruit-flavored drinks, fruit juice drinks, and fruit punch.

figure 3-5. sources of solid fats in the diets of the u.s. Population
ages 2 years and older, nhanes 2003–2004a

Grain­based
desserts
10.8%
All other
food categories
23.1%
Pizza
9.1%

Butter
2.4% Regular 
Beef and  cheese
beef mixed  7.6%
dishes
2.9%
Reduced­fat
milk Sausage, franks,
3.4% bacon, ribs
7.1%
Eggs and 
egg mixed  Fried white 
dishes  Burgers potatoes
3.7% 3.8% 4.8%

Dairy 
Whole millk Pasta and  desserts
3.9% pasta dishes
3.9% Chicken and Tortillas, 4.7%
burritos, tacosb
chicken mixed 4.6%
dishes
4.1%

a. Data are drawn from analyses of usual dietary intake conducted by the Source: National Cancer Institute. Sources of solid fats in the diets of U.S.
National Cancer Institute. Foods and beverages consumed were divided population ages 2 years and older, NHANES 2003-2004. Risk Factor
into 97 categories and ranked according to solid fat contribution to the Monitoring and Methods. Cancer Control and Population Sciences.
diet. “All other food categories” represents food categories that each http://riskfactor.cancer.gov/diet/foodsources/food_groups/table3.html.
contributes less than 2% of the total solid fat intake. Accessed August 11, 2010.
b. Also includes nachos, quesadillas, and other Mexican mixed dishes.

DIETARY GUIDELINES FOR AMERICANS, 2010 | Chapter Three 28


beverages by manufacturers and by consumers at home,
Americans can reduce their consumption of these food the food laBel: a useful tool
components in a variety of ways:
• Focus on eating the most nutrient-dense forms of
“Using the Food Label to Track Calories,
foods from all food groups.
Nutrients, and Ingredients” (Appendix 4)
• Limit the amount of solid fats and added sugars provides detailed guidance that can help
when cooking or eating (e.g., trimming fat from Americans make healthy food choices.
meat, using less butter and stick margarine, and
using less table sugar). The Nutrition Facts label provides information
on the amount of calories; beneficial nutrients,
• Consume fewer and smaller portions of foods and
such as dietary fiber and calcium; as well as the
beverages that contain
amount of certain food components that should
solid fats and/or added
for More inforMation be limited in the diet, including saturated fat,
See chapters 4 and 5 for sugars, such as grain-
trans fat, cholesterol, and sodium.
detailed discussion of all of based desserts, sodas,
these strategies. and other sugar-sweet-
The ingredients list can be used to find out
ened beverages.
whether a food or beverage contains solid fats,
added sugars, whole grains, and refined grains.
refined grains
The refining of whole grains involves a process that
results in the loss of vitamins, minerals, and dietary
fiber. Most refined grains are enriched with iron,
thiamin, riboflavin, niacin, and folic acid before being

figure 3-6. sources of added sugars in the diets of the u.s. Population
ages 2 years and older, nhanes 2005–2006a

All other
food categories
15.4%

Yeast
breads
2.1%
Soda, energy drinks,
Tea sports drinks
3.5% 35.7%
Sugars
and honey
3.5%
Ready­to­eat
cereals
3.8%

Candy
6.1%

Dairy
desserts
6.5% Grain­based
desserts
Fruit drinks 12.9%
10.5%

a. Data are drawn from analyses of usual dietary intake conducted by the Source: National Cancer Institute. Sources of added sugars in the diets
National Cancer Institute. Foods and beverages consumed were divided of the U.S. population ages 2 years and older, NHANES 2005–2006. Risk
into 97 categories and ranked according to added sugars contribution to Factor Monitoring and Methods. Cancer Control and Population Sciences.
the diet. “All other food categories” represents food categories that each http://riskfactor.cancer.gov/diet/foodsources/added_sugars/table5a.
contributes less than 2% of the total added sugar intake. html. Accessed August 11, 2010.

29 DIETARY GUIDELINES FOR AMERICANS, 2010 | Chapter Three


figure 3-7. sources of refined grains in the diets of the u.s. Population ages 2
years and older, nhanes 2003–2004a

All other
Pancakes,  food categories
waffles,  9.5%
French toast
2.2%
Pretzels
Ready­to­eat 2.3% Yeast
cereals breads
2.4% 25.9%
Crackers
2.8%
Burgers
2.9%
Quickbreads
3.4%
Potato/corn/
other chips
3.8%
Rice and  Pizza
rice mixed  11.4%
dishes 
4.4%
Chicken and Grain­based
chicken mixed desserts
dishes 9.9%
4.4% Pasta and 
pasta dishes Tortillas,
6.7% burritos, tacosb
8.0%

a. Data are drawn from analyses of usual dietary intake conducted by the Source: National Cancer Institute. Sources of refined grains in the diets
National Cancer Institute. Foods and beverages consumed were divided of the U.S. population ages 2 years and older, NHANES 2003–2004. Risk
into 97 categories and ranked according to refined grain contribution to Factor Monitoring and Methods. Cancer Control and Population Sciences.
the diet. “All other food categories” represents food categories that each http://riskfactor.cancer.gov/diet/foodsources/food_groups/table3.html.
contributes less than 2% of the total intake of refined grains. Accessed August 11, 2010.
b. Also includes nachos, quesadillas, and other Mexican mixed dishes.

further used as ingredients in foods. This returns level of the USDA Food Patterns, the recommended
some, but not all, of the vitamins and minerals that amount of refined grains is no more than 3 ounce-
were removed during the refining process.55 Dietary equivalents per day. Refined grains should be
fiber and some vitamins and minerals that are pres- replaced with whole grains, such that at least half
ent in whole grains are not routinely added back to of all grains eaten are whole grains. Consumption of
refined grains. Unlike solid fats and added sugars, refined grain products that also are high in solid fats
enriched refined grain products have a positive role and/or added sugars, such as cakes, cookies, donuts,
in providing some vitamins and minerals. However, and other desserts, should be reduced. Major
when consumed beyond recommended levels, sources of refined grains in the diets of Americans
they commonly provide excess calories, especially are yeast breads (26% of total refined grain intake);
because many refined pizza (11%); grain-based desserts (10%); and torti-
for More inforMation
grain products also are llas, burritos, and tacos (8%) (Figure 3-7).
See chapter 4 for additional high in solid fats and
discussion of whole grains. � added sugars (e.g., alcohol
cookies and cakes). In the United States, approximately 50 percent of
adults are current regular drinkers and 14 percent
On average, Americans consume 6.3 ounce-equiva- are current infrequent drinkers. An estimated
lents of refined grains per day.56 At the 2,000-calorie 9 percent of men consume an average of more

55. Folic acid is added to enriched refined grains to a level that doubles the amount lost during the refining process.
56. One ounce-equivalent of grain is 1 one-ounce slice bread; 1 ounce uncooked pasta or rice; ½ cup cooked rice, pasta, or cereal; 1 tortilla (6" diameter);
1 pancake (5" diameter); 1 ounce ready-to-eat cereal (about 1 cup cereal flakes).

DIETARY GUIDELINES FOR AMERICANS, 2010 | Chapter Three 30


than two drinks per day and 4 percent of women occasionally consuming an alcoholic drink does
consume an average of more than one drink per not warrant stopping breastfeeding. However,
day. Of those who drink, about 29 percent of U.S. breastfeeding women should be very cautious about
adult drinkers report binge drinking within the past drinking alcohol, if they choose to drink at all. If the
month, usually on multiple occasions. This results infant’s breastfeeding behavior is well established,
in about 1.5 billion episodes of binge drinking in the consistent, and predictable (no earlier than at 3
United States each year. months of age), a mother may consume a single
alcoholic drink if she then waits at least 4 hours
The consumption of alcohol can have beneficial or before breastfeeding. Alternatively, she may express
harmful effects, depending on the amount con- breast milk before consuming the drink and feed the
sumed, age, and other characteristics of the person expressed milk to her infant later.
consuming the alcohol. Alcohol consumption may
have beneficial effects when consumed in modera- Excessive (i.e., heavy, high-risk, or binge) drinking
tion. Strong evidence from observational studies has no benefits, and the hazards of heavy alcohol
has shown that moderate alcohol consumption intake are well known. Excessive drinking increases
is associated with a lower risk of cardiovascular the risk of cirrhosis of the liver, hypertension, stroke,
disease. Moderate alcohol consumption also is type 2 diabetes, cancer of the upper gastrointesti-
associated with reduced risk of all-cause mortality nal tract and colon, injury, and violence. Excessive
among middle-aged and older adults and may help drinking over time is associated with increased body
to keep cognitive function intact with age. However, weight and can impair short- and long-term cogni-
it is not recommended that anyone begin drinking tive function. For the growing percentage of the
or drink more frequently on the basis of potential population with elevated blood pressure, reducing
health benefits because moderate alcohol intake also alcohol intake can effectively lower blood pres-
is associated with increased risk of breast cancer, sure, although this is most effective when paired
violence, drowning, and injuries from falls and motor with changes in diet and physical activity patterns.
vehicle crashes. Excessive alcohol consumption is responsible for
an average of 79,000 deaths in the United States
Because of the substantial evidence clearly dem- each year. More than half of these deaths are due to
onstrating the health benefits of breastfeeding, binge drinking. Binge drinking also is associated with
a wide range of other health and social problems,
including sexually transmitted diseases, unintended
pregnancy, and violent crime.

key definitions for alcohol There are many circumstances in which people
should not drink alcohol:
• Individuals who cannot restrict their drinking to
what is moderate alcohol consumption?
moderate levels.
Moderate alcohol consumption is defined as up
to 1 drink per day for women and up to 2 drinks • Anyone younger than the legal drinking age.
per day for men. Besides being illegal, alcohol consumption
increases the risk of drowning, car accidents, and
what is heavy or high-risk drinking? Heavy or traumatic injury, which are common causes of
high-risk drinking is the consumption of more death in children and adolescents.
than 3 drinks on any day or more than 7 per
• Women who are pregnant or who may be preg-
week for women and more than 4 drinks on any
nant. Drinking during pregnancy, especially in the
day or more than 14 per week for men.
first few months of pregnancy, may result in nega-
tive behavioral or neurological consequences in
what is binge drinking? Binge drinking is the
the offspring. No safe level of alcohol consumption
consumption within 2 hours of 4 or more drinks
during pregnancy has been established.
for women and 5 or more drinks for men.

31 DIETARY GUIDELINES FOR AMERICANS, 2010 | Chapter Three


• Individuals taking prescription or over-the-counter Americans should follow the recommendations
medications that can interact with alcohol. provided in this chapter to help achieve a dietary
pattern that will meet their nutrient needs, control
• Individuals with certain specific medical condi-
calorie intake, and help reduce the risk of certain
tions (e.g., liver disease, hypertriglyceridemia,
chronic diseases. This goal can be achieved by
pancreatitis).
consuming fewer foods high in sodium, solid fats,
• Individuals who plan to drive, operate machinery, added sugars, and refined grains. For people who
or take part in other activities that require atten- drink, alcohol should be consumed in moderation.
tion, skill, or coordination or in situations where It is not recommended that anyone begin drink-
impaired judgment could cause injury or death ing alcohol or drink more frequently on the basis
(e.g., swimming). of potential health benefits. The dietary patterns
outlined in Chapter 5 can help Americans reduce
their consumption of these foods, thereby meeting
chaPter suMMary their nutrient needs within appropriate calorie lev-
els. Appendix 4 discusses how food labels can help
On average, American men, women, and children consumers evaluate and compare the nutritional
consume too much sodium, solid fats (the major content and/or ingredients of products, and assist
source of saturated and trans fatty acids), added them in purchasing foods that contain relatively
sugars, and refined grains. Men consume too much lower amounts of certain undesirable nutrients and
cholesterol, which also is found in some solid fats. In ingredients, such as sodium, saturated and trans
addition, some people consume too much alcohol. fats, and added sugars.

DIETARY GUIDELINES FOR AMERICANS, 2010 | Chapter Three 32