Fundamentals of Human Nutrition/International Dietary Guidelines

International Dietary Guidelines

Section 2.3: International Dietary Guidelines

International Dietary Pyramids

International dietary guidelines and dietary pyramids serve to educate groups of people about health policies, nutritious eating habits, and healthy lifestyles based on one’s distinct culture or region in which they live (Food Based Dietary Guidelines, 2015). While the USDA dietary pyramid is well recognized in the United States for North American dietary guidelines, they don’t offer much information on international dietary guidelines. So, a nonprofit company named Oldways Preservation and Exchange Trust in conjunction with numerous research facilities conducted epidemiological studies and developed international dietary guidelines and pyramids for the Mediterranean, Asian, Latin, and African diets (Escobar, 1997). The multiple dietary pyramids were developed specifically in conjunction with the Harvard School of Public Health, The European Office of the World Health Organization, the Cornell-China-Oxford Project on Nutrition, and experts in African American and African Diasporan history (African Heritage Diet Pyramid, Asian Diet Pyramid, Latin American Diet Pyramid, Mediterranean Diet Pyramid, 2015).

The Mediterranean diet pyramid, first introduced in 1993, is now recognized as one of the best-rounded diets in terms of promoting a healthy lifestyle throughout one’s entire life. The dietary pyramid is based off of data from the dietary practices of people from Greece and Southern Italy circa 1960. The dietary traditions of the people in this region were first looked at because they had a very low incidence of chronic disease and high life expectancy within their population. Experts believe that the secret to this diet is its lack of modernization or refinement of food. The people in the Mediterranean region circa 1960 ate an abundant supply of fresh fruits and vegetables, nuts and legumes, and grains and seeds. The Mediterranean diet also focused on limitations of red meat, fats, added sugar, and processed foods. The pyramid further contains olive oil as the primary fat source, and focuses on fresh seafood for protein sources about two times a week instead of red meat. In addition to consuming fresh, local foods on a daily basis, the Mediterranean people also valued regular physical activity that helped to keep them fit and strong (Mediterranean Diet Pyramid, 2015).

The Asian dietary pyramid, like the Mediterranean pyramid, was first researched because of the population’s low incidence of chronic disease. The Asian dietary pyramid was developed in 1995 and covered populations from a broad range of countries in Asia including: China, India, Japan, and Thailand. One of the most prominent foods in the Asian diet is rice. Rice has an important status in many Asian countries because it has been so vital to their population’s survival during times of great famine. In addition to rice, the Asian diet also focuses on a plant based diet including vegetables, fruits, legumes, and vegetable oil. Certain coastal Asian countries such as Japan also include an abundance of fish and seafood in their diet (Asian Diet Pyramid, 2015).

The Latin American diet pyramid was developed in 1996 and was designed to guide people in consuming the traditional Latin American diet. These dietary guidelines can be dated back to representing the cultures of The Maya, Inca, and Aztec. The Latin American diet relies heavily on rich flavors and spices that are traditional to and representative of their culture. Some of the distinct foods that compose the Latin American diet are corn, potatoes, peanuts, and beans (Latin American Diet Pyramid, 2015).

The African Heritage diet pyramid is a compilation of dietary recommendations based on the dietary patterns of African people with roots in Africa, America, the Caribbean, and South America. Similar to the Latin American diet, the African diet relies heavily on rich flavor, spices, and tangy sauces to add pizzazz to simple and healthy plant based meals. The African diet focuses greatly on varieties of fresh fruits, leafy vegetables, beans, nuts, sweet potatoes, and whole grains. The African heritage pyramid also stresses the importance of consuming healthy oils, fish, poultry, and eggs. In addition to valuing healthy and nutritious foods, the African heritage lifestyle focuses on participation in uplifting activities that benefit one’s mind, body, and soul (African Heritage Diet Pyramid, 2015).

References

African Heritage Diet Pyramid. (2015). Retrieved December 1, 2015, from http://oldwayspt.org/programs/african-heritage-health/diet-pyramid (Links to an external site.) Asian Diet Pyramid. (2015). Retrieved December 1, 2015, from http://oldwayspt.org/resources/heritage-pyramids/asian-diet-pyramid/overview (Links to an external site.) Escobar, A. (1997, April 1). Are All Food Pyramids Created Equal? Retrieved December 1, 2015, from http://www.cnpp.usda.gov/sites/default/files/nutrition_insights_uploads/insight2.pdf (Links to an external site.) Food Based Dietary Guidelines. (2015). Retrieved December 1, 2015, from http://www.fao.org/nutrition/nutrition-education/food-dietary-guidelines/en/ (Links to an external site.) Latin American Diet Pyramid. (2015). Retrieved December 1, 2015, from http://oldwayspt.org/resources/heritage-pyramids/latino-diet-pyramid/overview (Links to an external site.) Mediterranean Diet Pyramid. (2015). Retrieved December 1, 2015, from http://oldwayspt.org/resources/heritage-pyramids/mediterranean-pyramid/overview (Links to an external site.)

Diets of the World

United Kingdom Dietary Guidelines The United Kingdom uses a resource called the eatwell plate. The eatwell plate is designed for “people, whether they’re a healthy weight or overweight, whether they eat meat or are vegetarian, and it applies to people of all ethnic origins” (The eatwell plate guide, 2013). The plate is designed to show different varieties of food people should eat and in what proportions they should eat them to maintain a healthy lifestyle. The plate is divided into five categories: fruits and vegetables, starchy foods, dairy foods, foods and drinks high in fat and sugar, and meat, fish, eggs, beans.

The eatwell plate includes a closer look at each food group as follows: Starchy Foods- Attempting to have at least one food that is starchy each day with your three big meals will ensure you meet your bodies carbohydrate needs. Wholegrain foods contain more fiber than white or starchy foods and thus are digested slower, keeping you full longer. Wholegrain foods include: wholegrain bread, pitta, and chapatti, whole-wheat pasta, brown rice, and whole oat breakfast cereals. Fruits and vegetables- Fruits and vegetables should take up about a third of the food eaten each day. The eatwell guide recommends eating at least five portions of different fruits and vegetables each day. A portion is 80g or any of the following: 1 apple, banana, pear, and orange, 3 heaped tablespoons of vegetables, a dessert bowl of salad, or a 150 ml of fruit juice. Milk and dairy foods- Dairy products are a good sources of protein and vitamins. While some dairy products have high levels of both fat and saturated fat, a well-balanced diet offers a wide range of other low fat choices. Lower-fat dairy options include: 1% or skimmed milk, reduced fat cheeses, or have smaller amounts of the high-fat varieties. Non-dairy sources of protein- To meet your protein needs in a lean way, it is recommended you eat more than two servings of fish each week, some of this fish should be oily fish containing omega-3. Some meats contain high levels of fat, so when purchasing them be aware of the meet cut. The way in which meat is cooked can also effect the amount of fat and saturated fat. The following are methods to lower your fat intake; purchase meats that are lean, remove the skin on chicken breast and cut the excess fat off red meats, make sure you are grilling meat and fish more often than you are frying it, and choose to make your egg in a healthy way such as poach or boiled. Another good altnernaive to meat is beans, peas, and lentils. These foods are high in fiber, protein and vitamins while remaining low in fat. (The eatwell guide, 2013) Foods and drinks high in fat and/or sugar- It is recommended that this is your smallest group. Some examples of foods that are high in fat are: cake, butter, cream, oil, and biscuits. Foods that contain high levels of sugar are: cake, biscuits, fizzy drinks, chocolate, and candy. Between meals, substitute fruit or whole wheat grains instead of fatty and sugary foods.

Food labels in the UK contain information about Guideline Daily Amount and/or traffic light color coding. The traffic light colors can easily be glanced at in the store and guide the consumer on the guidelines daily amount in the product. Red means high, amber means medium, and green means low in fat, saturated fats, sugars, and salt. (Food labels, 2015) The eatwell plate should provide all the necessary nutrients the body needs and thus added supplements should not be needed (Your guide to the eatwell plate, 2013). Supplements have not been proven to have the same benefits as a well-balanced diet. The eatwell plate guide includes the following 8 tips for eating well: 1. Choose a starch as the base for your meal 2. The majority of what you eat should be fruits and vegetables 3. Eat two portions of fish a week- one being and oily fish 4. Eat only a small amount of fats and sugars 5. Try to reduce salt intake 6. Exercise daily 7. Drink lots of water 8. Always eat a healthy breakfast

References

Food labels. (2015, July 13). Retrieved November 30, 2015, from http://www.nhs.uk/Livewell/Goodfood/Pages/food-labelling.aspx The eatwell plate. (n.d.). Retrieved November 30, 2015, from http://www.food.gov.uk/northern- ireland/nutritionni/niyoungpeople/survivorform/breadandbutterstuff/eatwellplate Your guide to the eatwell plate, (2013). Retrieved from http://www.fao.org/3/a-as838e.pdf

The Cuban Diet When thinking of the Caribbean, most people instinctively look to the largest of the Caribbean islands, Cuba, as a reference point. In areas such as Florida, where there is a high Cuban population, it is important to know what the dietary intake recommendations are for these large populations. The Global Hunger Index of Cuba is >5, indicating the country’s hunger status as low to moderately severe (WHO, 2015). The 2014 Global Nutrition Report for Cuba states that in 2008, 53% of the island’s adult population was overweight and 21% was obese (International Food Policy Research Institute, 2014, p. 1). According to the Fall 2009 MEDICC Review, the dietary guidelines for Cubans are as follows: Macronutrients Protein: According to the dietary guidelines, the total intake of protein as an energy source should constitute about 10% of the total energy intake in children less than a year old and no more than 12% for all other ages (Hernández-Triana, et al., 2009, p. 9). It is recommended that 70% of protein consumed should be of animal origin for children under one year and 50% in all other ages (Hernández-Triana, et al., 2009, p. 9). Fats: The minimum recommendation of fat intake is about 15% of the total energy intake for the Cuban diet (Hernández-Triana, et al., 2009, p. 9). However, as age increases, the percentage of fat intake as an energy source decreases. Infants are recommended to have a 40% intake, 35% for children aged 6 months to 2 years, for 2–5 years, pregnant or lactating women, and those who are very physically active they are recommended to intake about 25%, for ages 7–13 about 23% is recommended, and all other ages are recommended about 20% (Hernández-Triana, et al., 2009, p. 9). Also for infants, the proportion of fatty acids in baby formula should be equivalent to that of breast milk (Hernández-Triana, et al., 2009, p. 9). No more than 10% of the total energy intake should be from saturated fatty acids, 15% from monosaturated fatty acids, and 7% from polysaturated fatty acids (Hernández-Triana, et al., 2009, p. 9). The omega-6 to omega-3 ratio is recommended to be 5:1 (Hernández-Triana, et al., 2009, p. 9). The recommended limit to cholesterol consumption is 300 mg (Hernández-Triana, et al., 2009, p. 9). Carbohydrates: The dietary recommendations for Cubans advise that no fewer than 130 g of carbohydrates be consumed for all ages other than >1 year; this was based on the average glucose demand of the brain (Hernández-Triana, et al., 2009, p. 12). Of the carbohydrate intake, three quarters of that intake should be of complex carbohydrates and the remaining quarter should be simple carbohydrates. (Hernández-Triana, et al., 2009, p. 12). The sugar intake should be no more than 10% of the total energy intake (Hernández-Triana, et al., 2009, p. 12). Fiber: Until age 20, adequate intake of fiber is calculated as 5g a day plus the age of that person (Hernández-Triana, et al., 2009, p. 12). Adequate intake for adults (aged 19–50) is about 38g a day for men and 25g a day for women (Hernández-Triana, et al., 2009, p. 12). For those over 50 years, women are recommended to have 21g per day and men 30g per day (Hernández-Triana, et al., 2009, p. 12). 55g a day is the tolerable upper intake for adults; for children, the tolerable upper intake level is the sum of their age plus 10g/day (Hernández-Triana, et al., 2009, p. 12).

References

-Manuel Hernández-Triana, MD, PhD, Carmen Porrata, MD, PhD, Santa Jiménez, MD, PhD, Armando Rodríguez, PhD, Olimpia Carrillo, PhD, Álvaro García, PhD, Lourdes Valdés, PhD, & Mercedes Esquivel, MD, PhD (2009). Dietary Reference Intakes for the Cuban Population, 2008. Retrieved from: www.medicc.org/mediccreview/pdf.php?lang=&id=115. -World Health Organization (2015). Nutrition Landscape Information System Country Profile: Cuba. Retrieved from: http://apps.who.int/nutrition/landscape/report.aspx?iso=cub. -International Food Policy Research Institute (2014). 2014 Nutrition Country Profile: Cuba. Retrieved from: http://globalnutritionreport.org/files/2014/11/gnr14_cp_cuba.pdf.

The Asian diet. The Asian diet focuses primarily on plant foods and grains. The main sources of grains in most Asian countries are noodles, millet, and rice. A plethora of different vegetables are incorporated into the Asian diet as well. Some of the most prevalent vegetables are kelp, water chestnuts, straw mushrooms, sugar peas, bamboo, baby corn, amaranth, chayote, bok choy, and mung bean sprouts. Fruits, which are often found alongside Asian dishes, include mandarin orange, melons, persimmon, lychee, kumquat, carambola, and guava. Red meat is much more sparingly used in most Asian countries. Instead, most protein is derived from plant-based foods such as soybeans (tofu and soy milk). Seafood such as squid, fish, and shellfish is also preferable. Poultry, duck eggs, pork, peanuts, and cashews also have a presence on the Asian plate. Interestingly, milk and milk products are often totally excluded from Asian diets (Rolfes & Whitney, 2015).

Asian food pyramid. An example of an international dietary guideline is the Asian food pyramid published by the International Conference on the Diets of Asia in San Francisco in 1995. The diets of the populations of Vietnam, Thailand, Taiwan, Singapore, Philippines, South Korea, Nepal, Myanmar, Mongolia, Malaysia, Laos, Japan, Indonesia, India, China, Cambodia, and Bangladesh are included. The Asian diet has proven to produce less chronic diseases in its populations much like the diet of the Mediterranean. Asian diets closely coincide with religious practices and cultural traditions. Rice is one common and significant denominator of most Asian diets. There is a high consumption of plant foods such as vegetables, fruits, beans, legumes, nuts, and vegetable oils. Much less dairy is integrated, but some countries use some. India, for example, has paneer, ghee, and lassi as a source of dairy. Fish and other seafood are common in island nations such as Japan (“Asian Diet Pyramid,” 2015).

The Mediterranean diet. The grains of the Mediterranean include Italian bread, bulgur, focaccia, polenta, couscous, rice, pastas, and pita pocket bread. Often accompanying these grains are vegetables such as eggplant, peppers, cucumbers, tomatoes, and grape leaves. Fruits of the Mediterranean diet include the olive, figs, and grapes. Because most of the Mediterranean countries have access to the ocean, seafood is common. Gyros, lamb, pork, chicken, beef, sausage, lentils, and fava beans also make it to the plate in the Mediterranean. Diary is plentiful and diverse in this region’s diet. These include yogurt, goat cheese, ricotta, parmesan, mozzarella, ricotta, and feta (Rolfes & Whitney, 2015).

The Mexican diet. Taco shells, rice, and tortillas (corn and flour) are just a few of the grains often present in the Mexican diet. Chilies, tomatoes, cassava, cactus, yams, jicama, corn, chayote, and salsa are vegetables often seen in Mexican dishes. A multitude of fruits like oranges, avocadoes, papaya, mango, guava, plantain, and bananas are incorporated as well. Eggs, chorizo, beef, chicken, fish, and refried beans provide the necessary protein. Lastly, dairy includes various cheeses and custards (Rolfes & Whitney, 2015).

WHO Involvement in International Diets WHO has set a goal to lessen chronic diseases around the world by teaching to populations about the importance of healthy eating and leading an active lifestyle. WHO’s general recommendations to all countries includes many points regarding what makes a healthy diet. Firstly, people should achieve a healthy weight and energy balance. Energy intake from shift fats and total fats should be limited. Unsaturated fats should be more regularly consumed than saturated fats. Trans-fatty acids should be eliminated according to the World Health Organization. They recommend increasing intake of whole grains, nuts, legumes, vegetables, and fruits. WHO has stated that the intake of free sugars should also be limited. Additionally, salt (sodium) should be iodized (WHO, 2015).

References

Asian Diet Pyramid, (2015). Retrieved from http://oldwayspt.org/resources/heritage-pyramids/asian-diet-pyramid/overview

Rolfes and Whitney. (2015) Understanding Nutrition. Stamford, CT: Cengage Learning. (Rolfes & Whitney, 2015)

World Health Organization. Global Strategy on Diet, Physical Activity ad Health, (2015). Retrieved from http://www.who.int/dietphysicalactivity/diet/en/

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