Dietary Guidelines for Americans 2020 – 2025 published

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The USDA has released their latest dietary guidelines document, with a new emphasis on the importance of considering different life stages when designing guidelines.

A new set of dietary guidelines are designed for the US population every five years, based on the recommendations of a scientific advisory committee who review the latest nutrition and health research, ensuring up-to-date advice.

In this document, specific dietary recommendations for infants and toddlers appear, where before this advice was absent. These recommendations cover breastfeeding and infant formula use, as well as complementary foods. Strong emphasis is placed on food variety for toddlers, as well as on the importance of iron and zinc intake.

The guidelines recommend that Americans should eat more whole fruits, vegetables, and whole grains, while limiting added sugars and saturated fat to less than 10% of daily calories each. While this largely chimes with the advisory committee’s scientific report, they had suggested that only 6% of daily calories be from added sugar, due to the negative health outcomes of high dietary sugar intake. The committee were also cautious on the contentious subject of saturated fat, not recommending any change to the current guidelines and mentioning that replacement of these fats with carbohydrates is not advised.

Nutrient density and dietary patterns were pulled out as important terms in the report. Nutrient dense foods are recommended throughout, and listed as vegetables, fruits, whole grains, seafood, eggs, beans, peas, lentils, unsalted nuts and seeds, fat-free and low-fat dairy products, and lean meats and poultry. However, the recommendations put emphasis on dietary patterns rather than on individual foods or food groups to enable adaptations that fit cultural, personal and individual needs and preferences. The three food patterns of the guidelines are the Healthy U.S-Style Pattern, the Healthy Vegetarian Pattern and the Healthy Mediterranean-Style Pattern. All three patterns provide most of their energy from plant-based sources, provide protein and fat from nutrient rich sources and limit intakes of added sugars, solid fats and sodium.

This is consistent with the results of the DELTA Model which illustrates that most of our energy should come from nutrient rich foods to ensure all nutrient requirements are met. Nutrient poor foods such as sugar should be minimised, and it is essential to consider the different needs of different demographic groups.

Interestingly, the guidelines make no mention of the environmental sustainability of different foods or diets. Several countries already make this inclusion, with this number likely to increase, but it will be at least 2025 before any such recommendations appear in the US dietary guidelines.

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Glossary

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WWF encourage planet-based diet

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The WWF report Bending the Curve: The Restorative Power of Planet-Based Diets joins other efforts to demonstrate the negative health and environmental consequences of our current way of producing and consuming food, while proposing ways to turn this around.

The report opens with the assertion that our food system must provide healthy, safe, affordable and nutritious diets for all, with reference to the UN Food Systems Summit later this year and the Sustainable Development Goals. This is completely in line with the principles of SNI: nutrition must come first when considering the global food system. The report then goes on to define planet-based diets as win-wins: healthy and with low environmental impacts and explores how these can be achieved.

A major recommendation of the report is that national dietary guidelines need to be more ambitious. This echoes a results of a previous WWF model. Currently, these guidelines largely reflect a healthier version of current consumption patterns and do not consider environmental impacts. The report argues that guidelines could be simultaneously healthier and more sustainable.

The main health recommendation of the report is to increase the plant-based proportion of the diet and decrease overconsumption. This is supported by the Global Burden of Disease study findings, indicating that low wholegrain and fruit intake, as well as high sodium intake, were the greatest dietary risk factors.

Beyond these overarching directions, recommendations for dietary and production change vary on a regional level. This is due to the difference in dietary, health and environmental factors seen in different parts of the world.

Countering biodiversity loss also requires a nuanced approach. For example, the report finds that most of the biodiversity loss associated with the Danish diet is due to imports of coffee, tea, cocoa and spices. Contrastingly, red meat holds this place for Latin American countries.

Similarly, the report states that we must feed our population on existing agricultural land and not further expand, but again the implications vary by region. Countries suffering from widespread undernutrition may need to expand their agricultural land to ensure healthy diets for their population, while more developed countries may need to contract.

The same regional variability is true for the planting of trees for carbon sequestration, conversion of grazing land to arable or optimising water use. The results of the report emphasise careful consideration of actions at a national level, as healthier diets can lead to increased environmental damage of one kind or another in vulnerable regions. A one-size-fits-all approach will not lead to a sustainable food system.

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Glossary

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GMO crops in the global food system

Genetically modified organisms (GMO) are already major contributors to the global food system since their commercial introduction in the 1990s. For example, over 90% of US corn and soy acreage is planted with GMO seeds. Despite this, the use of GMO is still controversial, with many individuals against their use and many authorities strictly regulating their production and consumption. Here, the arguments for and against GMO use in crop production are presented. 

GMO are defined as organisms, and products thereof, that are produced through techniques in which the genetic material has been altered in a way that does not occur naturally by mating and/or natural recombination. 

The process in which GMO are created differs depending on the degree of modification required but generally, a desirable trait is identified in one organism that could be of benefit in another. The trait is studied and, if possible, the gene(s) responsible for the trait are isolated. These genes are then introduced to the target organism, either via bacterial or viral infection, where the microorganism carries the target gene into the organism for uptake, or by bombarding the organism with particles coated in the target gene. 

The outcome of the process is a GMO that expresses the desired trait isolated from the original organism. 

Advantages of GMO  

The ability to transfer desirable traits between distantly related crops that cannot be interbred has obvious benefits. Examples of GMO use include the ability to increase photosynthetic rate, develop crops that are drought-tolerant with increased yields, and produce crops with disease resistance, such as blight-resistant potatoes

Moreover, crops can be developed that have greater nutritional value than conventional varieties. There exists a long list of such biofortified crops, including cassava with increased zinc, iron, protein and vitamin A content, high lysine maize, high provitamin A rice, and corn with increased provitamin A and folate. These crops are of particular value in global regions where nutrient deficiencies are a high priority public health issue. 

One widely used GMO is Bt-maize. This crop takes its name from Bacillus thuringiensis, the bacterium that donated to the maize plant the trait of producing an insecticidal toxin. Thus, Bt-maize is more resistant to pest insects than conventional maize, leading to higher yields and reduced pesticide use. As a result, 82% of the crop grown in the US in 2020 was the Bt variety. 

Disadvantages of GMO  

The arguments against GMO are largely based on health and environmental risks. The approval process for GMO is nationally administered, so differs between countries. Largely, these processes are more rigorous than for conventional foods and assess both the health and environmental risks of the GMO. 

The World Health Organisation states that no negative health consequences of approved GMO have been shown to date. However, concerns and risks do exist. One health concern raised is the possibility of allergenicity being unintentionally transferred between organisms. An example of this was when early GMO researchers, hoping to increase methionine content, found that the main allergen from Brazil nuts retained its allergenicity after transfer into a GMO soybean. As a result, the GMO soybean was never released commercially and allergenicity is now an important consideration when selecting donor crops. 

From an environmental perspective, there is the possibility that the GMO crop itself, or the introduced gene via cross-breeding or gene transfer, could escape the farmed environment and become a pest. The implications of this would depend entirely on the nature of the GMO crop; for example, transfer of a herbicide resistance gene to a non-target organism could lead to difficulties in controlling its growth. Alternatively, GMO crops could outcompete other plants due to the introduced trait, resulting in decreased biodiversity with unknown downstream implications. While the risk of these unintended consequences is low, they should be considered in the design and management of GMO. 

Finally, some express the opinion that GMO are morally wrong, as they involve too great an interference with living organisms. Such a decision can only be weighed by the individual but will likely mean that a proportion of the population will continue to avoid foods containing GMO products. 

This avoidance is challenging given the ubiquity of GMO products in many foods and by the difficulty for a consumer in identifying GMO foods. Different authorities take different stances on GMO labelling. For example, GMO are not specifically labelled in the US, rather foods that contain ‘bioengineered’ ingredients must be labelled as such. However, specific food labelling for certain types of GMO is on the horizon. The EU has stricter rules, with a requirement for GMO ingredients to be listed on food packaging. However, major food retailers have previously been forced to change their GMO policies due to the increasing “risk of finding GM material in non-GM food”. 

Conclusion 

GMO are widespread in the global food system, but not equally distributed.  

Moreover, regulation of GMO production varies and is not always clear and explicit. There are countries, like the US, where GMO crop production is widespread. Contrastingly, 19 member countries of the European Union have previously voted to either partially or fully ban the use of GMO. In New Zealand, no GMO crops are commercially grown. These variations in use and acceptance will certainly limit investment and development of future GMO. However, there is the opportunity for countries that have a GMO-free stance to use this status to market their products at a premium. 

GMO crops generally result in decreased pesticide use, coupled with increased yields and profitability. Moreover, there are those that believe that GMO will be necessary to adequately nourish a growing population and to adapt production to changing climates. The risks of GMO largely relate to unintended and uncertain consequences that must certainly be properly managed if GMO use and development is to increase. 

This Thought for Food was written by Cody Garton, a summer intern from Pūhoro STEM academy

Glossary

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Trends in undernourishment show promise

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A study of undernourishment in 76 countries found positive results, but not all global regions are progressing at the same rate.

Although overnutrition continues to grow globally, undernutrition rates are decreasing. Undernutrition currently affects more than 800 million people, either as protein-energy malnutrition or micronutrient deficiencies. 

The researchers used data from 1991-2013 from the FAO and the World Bank to analyse both undernutrition and related factors. The countries studied were mostly developing countries located in sub-Saharan Africa, Asia or Latin America. 

Undernourishment and child mortality showed decreasing trends overall. Urban populations, GDP, food production and agricultural land had all increased over the study period. However, when grouped into regions, the Eastern Mediterranean countries (Iran, Iraq, Jordan, Tunisia and Yemen) showed a late upwards trend in undernourishment, possibly due to political unrest in this region in the latter years of the study period. 

A problem noted by the authors is in equal distribution of food, both between countries and within national populations. This is a conclusion also reached by the DELTA Model, which shows that apart from a few micronutrients, the global food system in 2018 would have supplied sufficient nutrition for the world’s population, had it been equally distributed. The problems of unequal distribution are bound up in many other social, economic, political and environmental factors. 

While it is reassuring to see the decreases in undernourishment and infant mortality shown by this study, it also highlights areas that remain to be improved.

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Glossary

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Peas please

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Food Foundation in the UK are gaining traction with their ‘Peas Please: Making a pledge for more veg’ initiative, the results of which were recently described in Nutrition Bulletin. 

Despite a historically growing UK market for fruit, which has increased by around 50% since 1970, vegetable purchasing was seen to slowly decline over the same period. The common perceptions of vegetables as boring or not that tasty was likely not helped by minimal publicity, with only 1.2% of the UK food advertising spend used to market vegetables. On top of this, there are questions around the environmental impacts of the average UK shopping basket, and ample evidence that field-grown vegetables have small environmental footprints. 

Most of the UK public do not meet dietary guidelines for vegetables, particularly those with lower incomes. On top of low purchase rates, 40% of purchased vegetables in the UK are wasted at home. This matches the global trends of food waste shown by the DELTA Model, where most of the nutrient waste is from plant-sourced foods. Altogether, the nutritional and health implications of low vegetable intake due to consumer choice and waste needs to be tackled. 

The ‘Peas Please’ initiative aims to make eating vegetables more healthy, affordable, sustainable and pleasurable. Organisations, such as supermarkets and restaurants, pledge to follow these directives, in the hope of changing the way the country treats vegetables. Their website features ways in which individuals, communities and businesses can engage with the initiative and forge better relationships with vegetables. 

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Glossary

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Calcium comparisons between dairy, soy and almond beverages

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Research in the journal Current Developments in Nutrition has found that almond beverages were inferior to both milk and a calcium-fortified soy drink for bone health. 

The New Zealand researchers fed rats diets supplemented with either milk, or a soy-based or an almond-based drink. They analysed the amount of the liquid and feed consumed, as well as indicators of bone health and body composition. Fortified with calcium, the soy drink had the highest calcium (181 mg Ca/100 mL) and energy content (66 kcal/100 mL), while the almond drink had the lowest for both (105 mg Ca/100 mL; 29 kcal/100 mL). Milk lay in between for both energy and calcium (127 mg Ca/100 mL; 65 kcal/100 mL). 

The animals given the almond drink showed the least weight increase and the lowest body fat content. In terms of bone health, these animals showed the least bone growth, the lowest bone calcium content and the weakest bones. The fortified soy drink had results similar to those for milk, which is interesting given that the difference in calcium content between the almond drink and milk was far less than the difference between the fortified soy drink and milk. 

Many people, due to personal choice or health reasons, replace milk with plant-based beverages. The authors emphasised the need to consider more than just the energy or protein content of these replacements, which is particularly pertinent for elderly people prone to poor bone health. 

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Glossary

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Saturated facts

For nearly 50 years it has been believed that saturated fat is linked to heart disease. However, the scientific evidence does not universally support this assertion and recommendations are being made to change dietary guidelines and public knowledge around saturated fat. 

In response to increasing rates of heart disease in Western populations in the mid-20th century, the results of epidemiological studies comparing diets in different countries suggested that saturated fat intake could be a risk factor. Minimising the intake of saturated fat-containing foods such as red meat, dairy and chocolate was advised as a result. Currently, the NZ and UK dietary guidelines recommend reducing saturated fat intake, while the US and Australian Dietary Guidelines recommend the restriction of saturated fatty acids (SFAs) to less than 10% of total calorie intake in order to reduce the risk of cardiovascular disease (CVD). 

Saturated fatty acids (SFA), colloquially termed saturated fat, are molecules found in many common foods, especially animal fats and certain plant oils. Saturated refers to the molecular structure of the fatty acids, which have only single bonds between the carbon atoms, which cannot bond with any more hydrogen: thus, saturated with hydrogen. 

The claim that saturated fats were linked to negative health outcomes was accepted by public health institutes such as the World Health Organisation and the American Heart Association, and quickly caught on as a widespread belief. This has become so ingrained that, despite evidence to the contrary, it is proving difficult to change nutritional guidelines and the opinions of medical professionals, nutritionists, and consumers.  

A recent study, published in the Journal of the American College of Cardiology (JACC), performed a meta-analysis of randomized trials and observational studies on saturated fat. It was found that there were no beneficial effects of reducing SFA intake on cardiovascular disease and total mortality. While it was found that SFAs do increase cholesterol in most individuals, they increase concentrations of large particles of low-density lipoprotein (LDL) cholesterol, which is less correlated with CVD risk than the small, dense particles.  

An important finding of this study was that health effects could not be predicted from the SFA nutrient group alone; consideration of the overall macronutrient distribution and food matrix was necessary. Different SFAs have different physiological effects, which are further influenced by the foods they are found in and the carbohydrate content of the diet. Several foods relatively rich in SFAs but also rich in other nutrients, such as whole-fat dairy, dark chocolate, and unprocessed meat, were not associated with increased CVD or diabetes risk. 

There are calls to examine the overall risks of foods containing SFA, rather than SFA themselves. Likewise, the replacement of SFA-containing foods with those containing other fatty acids, often recommended in nutritional guidelines, was found unlikely to reduce CVD events or mortality. The authors of this last publication warned that current recommendations to replace SFA with alternative fatty acids may hinder efforts to get people to adopt more beneficial lifestyle changes, thinking that this single dietary change may be sufficient to reduce their CVD risk. 

One of the studies included in the JACC meta-analysis was the PURE (Prospective Urban Rural Epidemiological) study of 135,000 people from 18 countries on five continents. It found all types of fat (saturated, mono-unsaturated and polyunsaturated) were not associated with CVD, and saturated fat had an inverse association with stroke. Additionally, fat intake was associated with lower risk of total mortality. In contrast, a diet high in carbohydrates was associated with higher overall mortality risk.  

The claims around the negative consequences of fat intake may themselves have caused health problems. Reduction of saturated fat in the diet can lead to excessive consumption of carbohydrates as a replacement. Prevalence of obesity and type 2 diabetes has exploded in recent years, as seen in the chart below. Dr James Muecke, 2020 Australian of the Year, wrote in the Canberra Times“A flawed dietary guideline, which we have obediently and blindly followed for 40 years, is literally killing us. We’ve been encouraged to eat less fat and consume more carbs and yet we’ve never been fatter, our teeth never more rotten, and type 2 diabetes and its complications never more prevalent.” Dr Mueke makes clear the far greater need to prioritise reductions in excess carbohydrate consumption, rather than reductions in fat, to reduce the rate of non-communicable diseases in developed nations like Australia.

Rapidly increasing prevalence of obesity globally over the last 40 years. Source: World Health Organisation

In addition, advice to reduce consumption of nutrient-rich foods such as dairy and meat risks limiting the intake of nutrients such as calcium, iron, zinc, riboflavin and Vitamin B12. The Global Burden of Disease study shows that in the main, global health problems are caused more by what people do not eat – either through poor choice or through lack of choice – rather than an excess of certain foods. With the exception of excess sodium, the highest association of mortality and disability-adjusted life years globally was with insufficient intake of nutrient-rich foods. The study also showed the problems of consuming excess sugars. Consuming calorie-rich but nutrient-poor foods (e.g., sugary drinks) can displace nutrient-rich foods in the diet. The Global Burden of Disease study demonstrates that diets low in nutrient-rich foods are correlated with higher mortality. Importantly, saturated fat intake did not appear with any link to higher burden of disease. 

Number of deaths per 100 000 population attributable to individual dietary risks at the global level in 2017. Reproduced from the Global Burden of Disease study.

It is important for policy makers and health institutes to take all evidence into account when- designing nutritional guidelines. Arbitrary recommended intake levels for saturated fat will be less useful for the prevention of CVD or reduced mortality than targeting excess consumption, particularly of carbohydrates, and micronutrient deficiencies. Foods containing saturated fat, such as meat and dairy, can contribute to a nutritious balanced diet. They certainly should not be removed from the diet due to their saturated fat content, which has inconsistent links to modest impacts on CVD. Replacing these foods with carbohydrates will likely cause greater damage. 


Glossary

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Links found between maternal vegetarianism and infant stunting

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A study in the Journal of Nutrition has found that maternal and household diet were significantly correlated with the risk of child stunting, wasting and anaemia in India.

India has high rates of infant stunting (38%) and anaemia (58%). Around a quarter of Indian households are vegetarian. The study used the 2015-2016 National Family Health Survey (NFHS) and 2011-2012 National Sample Survey (NSS) to explore correlations between parental vegetarian and vegan status and child stunting. 

Children with vegan mothers were moderately but significantly more likely to be stunted, wasted or anaemic when compared with non-vegetarian households. Contrastingly, children of lacto-vegetarian mothers, who consume dairy more frequently, were less likely to be stunted compared with children of non-vegetarian mothers. 

Animal-sourced foods are rich in calories, high-quality protein, and a range of critical micronutrients. The authors state that exposure to a strictly vegetarian diet in early childhood or in utero could be a significant risk factor for malnutrition in India. More frequent dairy consumption in lacto-vegetarian households might help to explain the reduced risk of stunting in these households. Dairy has high concentrations of vitamins and minerals and has a rich amino acid profile including lysine, which is often limiting in traditional Indian diets.   

This study does have its limitations. For example, it does not provide in-depth exploration of associations between vegetarianism and religion or caste, geography or wealth. However, it does emphasise the importance of dairy and other animal-sourced foods, as well as dietary diversity, for healthy childhood development in India.

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Glossary

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FAO: The state of food security and nutrition in the world 2020

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FAO’s latest ‘The State of The World’ report assesses progress towards achieving sustainable development goals of ensuring access to safe, nutritious food for all people all year round, and eradicating all forms of malnutrition.

Current estimates are that nearly 690 million people are malnourished. This has been on the rise since 2014, increasing by nearly 60 million in 5 years. The world is not on track to achieve zero hunger by 2030. While there are significant challenges in just accessing food, accessing healthy diets is even harder. Based on FAO’s estimations, a healthy diet is five times more expensive than diets that only meet dietary energy needs and is unaffordable for more than three billion people globally.

In order to increase availability and affordability of healthy diets, cost of nutritious foods must come down, requiring large transformations in food supply chains globally. This must begin with prioritising agricultural production towards more nutrition-sensitive food. This is supported by the DELTA Model, which shows us that nutrient-dense foods must be prioritised to give the best chances of sufficient food production to meet global nutrient requirements. 

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Glossary

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World Food Day

Our Actions are our Future: Grow, Nourish, Sustain. Together.

Today – Friday 16th October – is World Food Day, the 75th anniversary of the founding of the Food and Agriculture Organisation of the United Nations with its goal to achieve food security for all and make sure that people have regular access to enough high-quality food to lead active, healthy lives. We congratulate the FAO on reaching this anniversary and all the good work the organisation does.

At the same time, it is a day for all of us to reflect on the challenges facing the global food system. Despite advances in agricultural production methods and yields, we fail to produce and distribute sufficient food to nourish an increasing global population. Many production systems are damaging the natural resources on which they or other food production systems rely, and many food producers receive subsistence income from their products. The 2030 Sustainable Development Goal (SDG) of Zero Hunger looks as far away today as it did when the SDGs were first developed. 

Sobering facts from the FAO’s World Food Day 2020 webpage:

  • Over 2 billion people do not have regular access to safe, nutritious and sufficient food whilst the global population is still growing and expected to reach almost 10 billion by 2050. 
  • Nearly 690 million people are hungry, up 10 million since 2019. The COVID-19 pandemic could add between 83-132 million people to this number. 
  • The impact of malnutrition in all its forms – undernutrition, micronutrient deficiencies, as well as overweight and obesity – on the global economy is estimated at USD 3.5 trillion per year. 
  • Today, only nine plant species account for 66% of total crop production, despite the fact that there are at least 30,000 edible plants. We need to grow a greater variety of foods to better nourish people and sustain the planet. 
  • Approximately 14% of food produced for human consumption is lost each year between the “farm” and the wholesale market. Even more food is wasted at the retail food and consumer stages. 

Our ability to effectively nourish an increasing global population is one of the key challenges facing the human race. The global food system is incredibly complex, the world’s largest economic sector, with multiple inputs and outputs. It is often politicised, is subject to various socio-cultural forces, and touches every human being on the planet. Charting a course for the food system of the future requires quality thinking and discussion built on strong evidence-based foundations.   

The Sustainable Nutrition Initiative was founded to meaningfully contribute to this discussion.  Some key thoughts as we consider the future of food:   

The DELTA Model has been developed to help people explore different futures for the food system for themselves. 

The goal remains to achieve food security for all and make sure that people have regular access to enough high-quality food to lead active, healthy lives. We can all help towards this through understanding the food system in all its complexity, strengths, and weaknesses, leading to better informed discussion on the future of food for all of us. 


Glossary

Image from FAO World Food Day 2020 website