Past, present, and future of the Food Guide Pyramid

Awareness and use of nutrition information predict measured and self-rated diet quality of older adults in the USA

OBJECTIVES

To examine: (1) diet quality of older adults, using the Healthy Eating Index 2010 (HEI-2010) and self-rated diet quality, (2) characteristics associated with reported awareness and use of nutrition information and (3) factors associated with HEI score and self-rated diet quality.

DESIGN

Cross-sectional study. Based on Day 1 and/or Day 2 dietary recalls, the Per-Person method was used to estimate HEI-2010 component and total scores. T-tests and ANOVA were used to compare means. Logistic and linear regressions were used to test for associations with diet quality, controlling for potential confounders.

SETTING

National Health and Nutrition Examination Survey, 2009-2014.

PARTICIPANTS

Three thousand and fifty-six adults, aged 60 years and older, who completed at least one 24-h recall and answered questions on awareness and use of nutrition information.

RESULTS

Mean HEI score for men was significantly lower than for women (56·4 ± 0·6 v. 60·2 ± 0·6, P < 0·0001). Compared with men, more women were aware of (44·8 % v. 33·7 %, P < 0·05) and used (13·7 % v. 5·9 %, P < 0·05) nutrition information. In multivariable analyses, awareness and use of nutrition information were significant predictors of both HEI and self-rated diet quality for both women and men. Groups with lower nutrition awareness included men, non-Whites, participants in nutrition assistance programmes and those with lower education and socio-economic status.

CONCLUSIONS

Nutrition awareness and use of nutrition information are associated with diet quality in adults 60 years and older. Gaps in awareness of dietary guidelines in certain segments of the older adult population suggest that targeted education may improve diet quality for these groups.

Strategies for online personalised nutrition advice employed in the development of the eNutri web app

The internet has considerable potential to improve health-related food choice at low-cost. Online solutions in this field can be deployed quickly and at very low cost, especially if they are not dependent on bespoke devices or offline processes such as the provision and analysis of biological samples. One key challenge is the automated delivery of personalised dietary advice in a replicable, scalable and inexpensive way, using valid nutrition assessment methods and effective recommendations. We have developed a web-based personalised nutrition system (eNutri) which assesses dietary intake using a validated graphical FFQ and provides personalised food-based dietary advice automatically. Its effectiveness was evaluated during an online randomised controlled trial dietary intervention (EatWellUK study) in which personalised dietary advice was compared with general population recommendations (control) delivered online. The present paper presents a review of literature relevant to this work, and describes the strategies used during the development of the eNutri app. Its design and source code have been made publicly available under a permissive open source license, so that other researchers and organisations can benefit from this work. In a context where personalised diet advice has great potential for health promotion and disease prevention at-scale and yet is not currently being offered in the most popular mobile apps, the strategies and approaches described in the present paper can help to inform and advance the design and development of technologies for personalised nutrition.

Development of the SoFAS (solid fats and added sugars) concept: the 2010 Dietary Guidelines for Americans

The diets of most US children and adults are poor, as reflected by low diet quality scores, when compared with the recommendations of the Dietary Guidelines for Americans (DGAs). Contributing to these low scores is that most Americans overconsume solid fats, which may contain saturated fatty acids and added sugars; although alcohol consumption was generally modest, it provided few nutrients. Thus, the 2005 DGAs generated a new recommendation: to reduce intakes of solid fats, alcohol, and added sugars (SoFAAS). What precipitated the emergence of the new SoFAAS terminology was the concept of discretionary calories (a "calorie" is defined as the amount of energy needed to increase the temperature of 1 kg of water by 1°C), which were defined as calories consumed after an individual had met his or her recommended nutrient intakes while consuming fewer calories than the daily recommendation. A limitation with this concept was that additional amounts of nutrient-dense foods consumed beyond the recommended amount were also considered discretionary calories. The rationale for this was that if nutrient-dense foods were consumed beyond recommended amounts, after total energy intake was met then this constituted excess energy intake. In the 2010 DGAs, the terminology was changed to solid fats and added sugars (SoFAS); thus, alcohol was excluded because it made a minor contribution to overall intake and did not apply to children. The SoFAS terminology also negated nutrient-dense foods that were consumed in amounts above the recommendations for the specific food groups in the food patterns. The ambiguous SoFAS terminology was later changed to "empty calories" to reflect only those calories from solid fats and added sugars (and alcohol if consumed beyond moderate amounts). The purpose of this review is to provide an historical perspective on how the dietary recommendations went from SoFAAS to SoFAS and how discretionary calories went to empty calories between the 2005 and 2010 DGAs. This information will provide practitioners, as well as the public, with valuable information to better understand the evolution of SoFAS over time.

Communicating science-based recommendations with memorable and actionable guidelines

For many domains of basic and applied science, a key set of scientific facts is well established and there is a need for public action in light of those facts. However, individual citizens do not consistently follow science-based recommendations, even when they accept the veracity of the advice. To address this challenge, science communicators need to develop a guideline that individuals can commit to memory easily and act on straightforwardly at moments of decision. We draw on research from psychology to discuss several characteristics that will enhance a guideline's memorability and actionability and illustrate using a case study from the US Department of Agriculture's communications based on nutrition science. We conclude by discussing the importance of careful research to test whether any given guideline is memorable and actionable by the intended target audience.

Desenvolvimento de guias alimentares em diversos países

Os guias dietéticos baseados nos alimentos têm objetivo de favorecer a educação nutricional, utilizando termos que sejam compreensíveis, simples e claros para a maioria dos consumidores e indicando as modificações necessárias nos padrões alimentares. Este trabalho foi realizado com o objetivo de apresentar uma revisão da literatura sobre o desenvolvimento dos guias alimentares em vários países. Para tanto, foi realizado um levantamento bibliográfico no período de 1991 a 2006 nas bases de dados Medline e Lilacs, utilizando como palavras-chave "guia alimentar", "guia dietético" e "desenvolvimento de guia dietético" com o intuito de aprofundar os seguintes itens: elaboração, avaliação, implantação e problemas metodológicos relacionados ao desenvolvimento dos mesmos. Desde 1996, vêm sendo publicadas orientações pelo Comite de Alimentação e Nutrição/Organização Mundial de Saúde para elaboração dos guias alimentares e vários países os desenvolveram de acordo com essas recomendações, apesar dos diversos problemas metodológicos enfrentados. Após o desenvolvimento dos guias alimentares, os maiores desafios são a implantação e a avaliação. Dentre as estratégias para sua divulgação destaca-se a elaboração de ferramentas de educação nutricional, tais como: representação gráfica, folder, apostila e pôster. Com relação à avaliação dos guias alimentares, poucos países realizaram pesquisas abordando o conhecimento e o entendimento dos consumidores. Conclui-se que o processo de desenvolvimento dos guias alimentares é complexo e é necessário realizar um planejamento para sua implantação e avaliação, esta última devendo se voltar tanto ao entendimento como ao impacto sobre a saúde da população.

MyPyramid.gov: assessment of literacy, cultural and linguistic factors in the USDA food pyramid web site

MyPyramid.gov, a major national Web site about healthful eating and physical activity, was analyzed for literacy, cultural, and linguistic factors relevant to consumers. The assessment used 4 standardized readability tests, 1 navigational test, availability of non-English content, and new criteria for cultural factors. Readability scores averaged between grade levels 8.8 and 10.8, and half the navigation criteria were met. The Web site was available in Spanish, but it had little cultural tailoring for English speakers. It is recommended that MyPyramid's readability, navigation, and cultural tailoring be improved. References are provided to help educators learn more about assessing and using Internet communication with diverse audiences.

Development of food group composites and nutrient profiles for the MyPyramid Food Guidance System

OBJECTIVE

To identify food selections in each MyPyramid food group or subgroup reflective of typical consumption patterns by Americans, and the nutrient intake that can be expected from consuming a specified amount of these foods from each group, in a low-fat and no-added-sugars form.

DESIGN

An analytical process to identify food consumption choices within each food group and subgroup using national food consumption surveys, and to identify the expected nutrient content of each group using food composition databases.

VARIABLES MEASURED

Relative consumption of foods within each food group; nutrient content for each food group and subgroup (energy plus 27 nutrients).

ANALYSIS

Disaggregated foods from consumption surveys into component ingredients. Combined similar ingredients into "item clusters" and determined relative consumption of each. Calculated a consumption-weighted nutrient profile for each food group.

RESULTS

Consumption-weighted food intake selections and nutrient profiles were developed for all MyPyramid food groups and subgroups.

CONCLUSIONS AND IMPLICATIONS

This analytical process derived food group and subgroup composites which estimate typical food choices within each MyPyramid food group. These were used to assess the adequacy of the MyPyramid food intake patterns as they were being iteratively developed.

Developing the consumer interface for the MyPyramid Food Guidance System

OBJECTIVE

To assess consumer response to potential graphics, slogans, and messages for the consumer interface of the MyPyramid Food Guidance System.

DESIGN

Qualitative research conducted in two phases, composed of focus groups and Web-TV testing.

SETTING

Professional market research facilities in Baltimore, MD, and Chicago, IL, and Web-TV.

PARTICIPANTS

Phase 1,77 adults in 10 groups; Phase 2,407 adults via Web-TV.

PHENOMENON OF INTEREST

Consumer response to potential graphic images, slogans, and messages for the Food Guidance System.

ANALYSIS

A content analysis was used to summarize comments from focus groups and Web-TV tests into meaningful themes. Frequencies were calculated for responses.

RESULTS

Respondents preferred the familiarity of the pyramid shape and found graphics and slogans that were personal, active, and positive to be appealing.

CONCLUSIONS AND IMPLICATIONS

The consumer interface for the MyPyramid Food Guidance System was shaped by consumer feedback that identified appealing and useful elements and avoided elements that were potentially confusing or less meaningful. Consumers preferred images and messages that were perceived as new, personal, and active, but they desired some continuity with the original Pyramid shape.

Consumer research for development of educational messages for the MyPyramid Food Guidance System

OBJECTIVE

To assess consumer understanding and use of messages from the original Food Guide Pyramid and potential concepts for a revised Food Guidance System.

DESIGN

Focus groups conducted in two phases, in 2002 and 2004.

SETTING

Market research facilities in Baltimore, Chicago, and Houston.

PARTICIPANTS

Phase I, 178 participants in 18 groups: 6 of general adult consumers, 4 of adults over 60 years of age, 4 of food stamp recipients, and 4 of overweight adults. Phase II, 75 participants in 8 groups: 4 of younger adults and 4 of older adults.

PHENOMENON OF INTEREST

Understanding and use of original Pyramid symbol and messages and potential concepts for a revised food guidance system.

ANALYSIS

Focus group sessions were audiotaped and transcribed. Content analysis summarized comments into meaningful themes.

RESULTS

Key concepts of the original Pyramid were widely understood, but specific knowledge was limited and misunderstandings common, especially related to servings and food group placement. Detailed information about whole grains, types of fats, vegetable subgroups, and physical activity was lacking.

CONCLUSIONS AND IMPLICATIONS

While consumers are aware of general concepts about healthy eating, they lack specific knowledge to help them implement recommendations. Educators can help by providing consumers with concrete examples and specific information.

The diet and health knowledge survey: development of a short interview format

The primary aim of this study was to create a condensed short-form version of the structured interview named the Diet and Health Knowledge Survey (DHKS 1994-1996) via factor analysis. Data from 5765 participants of the 1994-1996 Diet and Health Knowledge Survey were used in the factor analysis. Appropriate sampling weights were used in the multivariate analyses (n=5233) that compared subgroups (i.e., ethnic group, sex, etc.) on the subscales of the DHKS. A 50-item, 12-factor condensed version of the 149-item original DHKS was derived from the analyses. Multivariate analyses, using age and education as covariates, indicated significant differences in dietary beliefs, practices, and behaviors for individuals of different ethnic groups, sex, dieting status, and BMI. Based on our analyses, the condensed short-form version of the Diet and Health Knowledge Survey appears to be a convenient and efficient tool, used in sections or in its entirety, for examining various dietary practices and beliefs of adults. The results from analysis of the short-form DHKS indicate that although a very large proportion of adults in the U.S. are overweight or obese, only a small proportion report current dieting. Examination of the DHKS indicates that although adults varied in their dietary beliefs and practices, dieters tended to report healthier dietary practices and attitudes than non-dieters. BMI level was positively related to self-reported amount of fat, cholesterol, and calories consumed.

Guias alimentares para crianças: aspectos históricos e evolução

Os guias alimentares possuem duas propostas: a primeira, ser um guia de saúde pública, e a segunda, uma ferramenta de educação nutricional. Este trabalho objetiva apresentar um histórico dos guias alimentares e suas características, bem como abordar os guias dietéticos desenvolvidos especificamente para crianças. Foi realizado um levantamento bibliográfico dos últimos dez anos, em base de dados Medline utilizando as palavras-chave guia alimentar, guia dietético infantil e pirâmide alimentar infantil. Desde 1916, os guias alimentares vêm sendo desenvolvidos a fim de traduzir as recomendações de uma dieta saudável para população, porém somente a partir de 1999 foi desenvolvido pelo United States Departament of Agriculture um guia alimentar para crianças. Observou-se que os guias alimentares infantis, de modo geral, foram elaborados recentemente. Poucos países os desenvolveram de acordo com o hábito alimentar das crianças, utilizando alimentos típicos da idade e tamanho das porções específicas para essa faixa etária, considerando a limitada capacidade gástrica das crianças. Conclui-se que é muito importante desenvolver, implementar e validar os guias alimentares infantis, pois são uma ferramenta de educação nutricional para a formação de hábitos saudáveis e para a prevenção de doenças crônicas.

Effect of a nutrition education program on nutrition-related knowledge of English-as-second-language elementary school students: a pilot study

Nutrition programs that target English-as-Second-Language (ESL) students can potentially improve their nutrition knowledge. This pilot study evaluated the effect of a Food Guide Pyramid (FGP) lesson on nutrition knowledge of ESL students (ages 9-12 years) in a refugee after-school program. A pre- and post-FGP lesson one group design was used. A 12-item knowledge questionnaire was administered to students (N = 15) and their opinions about the lesson were obtained. Overall FGP lesson mean knowledge scores did not increase significantly from pretest to posttest; however, scores that measured specific objectives on the ability to identify food groups and the number of servings for food groups increased, while scores on the ability to identify the importance of each food group for health decreased. Overall, students liked the nutrition lesson, described learning mainly about the FGP, and reported no confusing aspects. Findings suggest that nutrition education targeted to ESL students should emphasize foods versus nutrients and promote active learner involvement.

Concept of a nutritious food: toward a nutrient density score

The American diet is said to be increasingly energy-rich but nutrient-poor. To help improve the nutrient-to-energy ratio, the 2005 Dietary Guidelines for Americans recommend that consumers replace some foods in their diets with more nutrient-dense options. Such dietary guidance presupposes the existence of a nutrient density standard. However, a review of the literature shows that the concept of a nutritious food is not based on any consistent standards or criteria. In many cases, healthful foods are defined by the absence of problematic ingredients-fat, sugar, and sodium-rather than by the presence of any beneficial nutrients they might contain. Past attempts to quantify the nutrient density of foods have been based on a variety of calories-to-nutrient scores, nutrients-per-calorie indexes, and nutrient-to-nutrient ratios. The naturally nutrient rich (NNR) score, which is based on mean percentage daily values (DVs) for 14 nutrients in 2000 kcal food, can be used to assign nutrient density values to foods within and across food groups. Use of the NNR score allows consumers to identify and select nutrient-dense foods while permitting some flexibility where the discretionary calories are concerned. This approach has implications for food labeling, nutritional policy making, and consumer education. The Food and Drug Administration has considered approving nutrient claims based on the ratio of a beneficial nutrient to the food's energy content, as opposed to a specified minimum amount of a nutrient per serving size. Given the current dietary trends, the nutrient density approach can be a valuable tool for nutrition education and dietary guidance.

Programme and policy issues related to promoting positive early nutritional influences to prevent obesity, diabetes and cardiovascular disease in later life: a developing countries view

Public health policy differs from programme insofar as the former is the expression of goals at a higher decision-making level (international, regional, national or provincial) and the latter involves the execution of intervention measures at the community or individual level. It has recently become fashionable to speak of "evidence-based" policy. There is now ample evidence to suggest that early nutritional influences on chronic disease risk in later life are contributing to the acceleration of the overall worldwide epidemic of obesity and non-transmissible diseases. In developing countries, in which 80% of the world's population resides, the opportunities for preventive policy must be balanced against needs, cost and effectiveness considerations and the intrinsic limitations of policy execution. Not everyone in the population is at risk of suffering from any given negative condition of interest, nor will everyone at risk benefit from any given intervention. Hence, decisions must be made between universal or targeted policies, seeking maximal cost-efficiency, but without sowing the seeds of either discrimination or stigmatization with a non-universal application of benefits. Moreover, although large segments of the covered population may benefit from a public health measure, it may produce adverse and harmful effects on another segment. It is ethically incumbent on policy makers to minimize unintended consequences of public health measures. With respect to the particular case of mothers, fetuses and infants and long-term health, only a limited number of processes are amenable to intervention measures that could be codified in policy and executed as programmes.

Prenatal nutrition and birth outcomes

The complex relationship between maternal nutritional and birth outcomes emphasizes the need for consistent and thorough assessments of women's diet throughout pregnancy and individualized nutritional education to promote positive birth outcomes. The purpose of this article is to examine the influence of prenatal nutrition on birth outcomes, describe research on the effects of macro- and micronutrients on birth outcomes, and discuss strategies for monitoring diet and implementing nutrition education during pregnancy.

The obesity crisis: don't blame it on the pyramid

Since its release in 1992, the Food Guide Pyramid has become one of the most recognized nutrition education tools in US history. As such, it has been subject to criticism, particularly in several recent media reports that implicate it as the culprit in America's current obesity epidemic. What these reports often overlook, however, is that the diets of many Americans do not adhere to the dietary guidelines illustrated by the Pyramid, refuting the notion that the Pyramid is the cause of the nation's obesity problem. Data indicate that the more likely causes of escalating obesity rates are increased per capita caloric consumption and larger portion sizes, along with a lack of adequate physical activity. Although the Pyramid graphic was designed more than a decade ago, it still communicates three key concepts that continue to be the cornerstone of federal dietary guidance: variety, proportionality, and moderation. As such, it remains a viable and relevant nutrition education tool, especially when used by dietetics professionals as a component of individualized, comprehensive nutrition education and behavior modification interventions. As the United States Department of Agriculture begins to investigate whether the food intake patterns illustrated by the Pyramid are in need of updating, research is urgently needed to determine how nutrition education tools, including the Pyramid, can be most effectively implemented to help consumers adopt healthful eating behaviors and to improve the public health of America.

Composite index for aggregating nutrient density using food labels: ratio of recommended to restricted food components

This article describes a ratio of recommended to restricted food components (RRR) designed to provide consumers with a summary of food label information to guide healthful, single-item food selections. As a ratio, RRR is interpreted such that better foods score over 1.0. The potential usefulness of the ratio is illustrated comparing foods within categories of the Food Guide Pyramid (eg, skim milk and whole milk). The RRR is proposed for use at the point of purchase for single food items, summarizing the food label, or providing concise information where none is currently presented, such as in restaurants.

Adherence to the Food Guide Pyramid recommendations among Japanese Americans, Native Hawaiians, and whites: results from the Multiethnic Cohort Study

The Food Guide Pyramid is designed to help Americans make healthful food choices. Whereas national data have been collected to examine adherence to the pyramid recommendations in whites, African-Americans, and Latinos, there are virtually no data available for Japanese Americans or Native Hawaiians. Here we present data on intakes of the Food Guide Pyramid food groups (as servings per day) as well as of the components of the pyramid tip (discretionary fat, added sugar, and alcohol) in these ethnic groups and examine adherence to each of the food group recommendations. Degree of adherence to the fruit group recommendation was similar among the ethnic groups and energy-intake categories, but adherence to the other recommendations was greatest for those consuming more than 2,800 kilocalories per day. However, subjects in this energy-intake group also consumed more than three times as much discretionary fat, added sugar, and alcohol.