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Chapter 5Building HealthyEating PatternsIndividuals and families can incorporate the recommendationspresented in each of the previouschapters into an overall healthy way to eat—ahealthy eating pattern. 71 A growing body of evidencefrom research on eating patterns supports theserecommendations. A healthy eating pattern is nota rigid prescription, but rather an array of optionsthat can accommodate cultural, ethnic, traditional,and personal preferences and food cost and availability.Americans have flexibility in making choicesto create a healthy eating pattern that meets nutrientneeds and stays within calorie limits. This chapterdescribes research findings from clinical trials ofeating patterns and from observational studies oftraditional eating patterns. The chapter also explainsthe principles for selecting a healthy eating pattern.Several templates—adaptable guides for healthy eating—havebeen developed that show how Americanscan put these principles into action: the USDA FoodPatterns, lacto-ovo vegetarian or vegan adaptationsof the USDA Food Patterns, and the DASH 72 EatingPlan. These templates translate and integrate dietaryrecommendations into an overall healthy way toeat. They identify average daily amounts of foods,in nutrient-dense forms, to eat from all food groupsand include limits for some dietary components.Consumers, professionals, and organizations canmake use of these templates to plan healthy eatingpatterns or assess food and beverage choices.Key RecommendationsSelect an eating pattern that meets nutrientneeds over time at an appropriate calorie level.Account for all foods and beveragesconsumed and assess how they fit within atotal healthy eating pattern.Follow food safety recommendations whenpreparing and eating foods to reduce therisk of foodborne illnesses.71. Dietary Guidelines for Americans, 2010 uses the term “eating pattern,” rather than the term “total diet” (the term used in the 2010 DGAC report), to referto the combination of foods and beverages that constitute an individual’s complete dietary intake over time. The term “diet” may be misconstrued as aneating pattern intended for weight loss.72. Dietary Approaches to Stop Hypertension.43DIETARY GUIDELINES FOR AMERICANS, 2010 | Chapter Five
esearch inforMs us aBouthealthy eating PatternsAround the world and within the United States, peoplemake strikingly different food choices and have differentdiet-related health outcomes. Although the studyof eating patterns is complex, evidence from internationalscientific research has identified various eatingpatterns that may provide short- and long-term healthbenefits, including a reduced risk of chronic disease.Many traditional eating patterns can provide healthbenefits, and their variety demonstrates that peoplecan eat healthfully in a number of ways.Several types of research studies have been conductedon these eating patterns, including clinicaltrials and prospective studies that measure specifichealth outcomes or health-related risk factors, andobservational studies of traditional eating patterns.Considerable research exists on health outcomesas well as information on nutrient and food groupcomposition of some eating patterns constructedfor clinical trials (e.g., DASH and its variations) andtraditional eating patterns (e.g., Mediterraneanstylepatterns). Some evidence for beneficial healthoutcomes for adults also exists for vegetarian eatingpatterns. In addition, investigators have studied traditionalJapanese and Okinawan dietary patterns andhave found associations with a low risk of coronaryheart disease. However, detailed information on thecomposition of these Asian diets, and evidence onhealth benefits similar to that available for the othertypes of diets, is very limited.research on dietary approaches to stophypertension (dash)The DASH eating pattern and its variations havebeen tested in clinical trials. In these studies, specificfoods are provided and health impacts monitoredover time. Prospective studies also have been conductedin groups of people who make their own foodchoices, to identify and evaluate eating patterns thatare similar to DASH.DASH emphasizes vegetables, fruits, and low-fat milkand milk products; 73 includes whole grains, poultry,seafood, and nuts; and is lower in sodium, red andprocessed meats, sweets, and sugar-containing beveragesthan typical intakes in the United States. One ofthe original DASH study diets also was lower in totalfat (27% of calories) than typical American intakes.However, modifications containing higher levels ofeither unsaturated fatty acids or protein have beentested. In research studies, each of these DASHstylepatterns lowered blood pressure, improvedblood lipids, and reduced cardiovascular disease riskcompared to diets that were designed to resemble atypical American diet. The DASH-Sodium study ofhypertensives and pre-hypertensives also reducedsodium, and resulted in lower blood pressure incomparison to the same eating pattern, but with ahigher sodium intake. Eating patterns that are similarto DASH also have been associated with a reducedrisk of cardiovascular disease and lowered mortality.research on Mediterranean-style eating patternsA large number of cultures and agricultural patternsexist in countries that border the MediterraneanSea, so the “Mediterranean diet” is not one eatingpattern. No single set of criteria exists for what constitutesa traditional Mediterranean eating pattern.However, in general terms, it can be described as aneating pattern that emphasizes vegetables, fruits andnuts, olive oil, and grains (often whole grains). Onlysmall amounts of meats and full-fat milk and milkproducts are usually included. It has a high monounsaturatedto saturated fatty acid intake ratio andoften includes wine with meals.Traditional eating patterns found throughout theMediterranean region, especially in Crete duringthe 1960s, are associated with a low risk of cardiovasculardisease. Over time, the diet of Crete haschanged remarkably and is now characterized byhigher intake of saturated fatty acids and cholesterol,and reduced intake of monounsaturated fatty acids,while total fat consumption has fallen. Over thissame period of time, the population of Crete hasexperienced a steady rise in risk of heart disease.A number of studies with varying designs haveexamined the effects of Mediterranean-style eatingpatterns on cardiovascular disease and total mortality.Most of these studies apply a score that comparesan individual’s food group or nutrient intaketo median intake of the study population: a higher“Mediterranean diet score” is above the medianintake for the study population in vegetables, fruits,nuts, legumes, whole grains/cereals, and fish; belowthe median intake for red and processed meats;moderate in alcohol intake; with a high monounsaturatedfatty acid to saturated fatty acid ratio; and in73. Milk and milk products also can be referred to as dairy products.DIETARY GUIDELINES FOR AMERICANS, 2010 | Chapter Five 44
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