Nutrition and Oral Medicine (Nutrition and Health)

Chapter 1 / General Health Status 11messages, was first published in 1980, followed by four intermittent revisions (34). Themost recent version, published in 2000, reflected recommendations based on currentscientific knowledge from the Departments of Health and Human Services (HHS) andAgriculture (USDA) on how dietary intake may reduce risk for major chronic diseasesand how a healthy diet may improve nutrition (34). Table 3 represents the recent versionsof the evolution of guidelines. Organizations focused on decreasing cancer or heartdisease risk have chosen to express guidelines in a comparable format. These conceptualstatements are designed to increase awareness and promote action related to associationsbetween lifestyle behaviors and chronic disease risk. In some instances, they may representsuggested choices that are not yet fully substantiated by significant causal data.4.1.2. FOOD PATTERN GUIDELINESThe clinician is encouraged to translate general guidelines to meet the needs of individuals.The Food Guide Pyramid for Americans (9) represents recommendations forselecting a variety of foods in amounts leading to successful implementation of the dietaryguidelines. It is primarily a nutrition education tool and food guidance system used toillustrate balance and variety within the realm of scientific nutrition evidence. Over time,it has been modified and adapted for special groups, like children and the elderly, basedon new knowledge and needs and will likely continue to change as new findings identifythe role of foods in health promotion (35). When similar pictorial representations ofvarious international dietary guidelines were compared, it was concluded that recommendationsfor individuals to consume larger amounts of fruits, vegetables, and grains andmoderate amounts of meats, milk, and dairy products were consistent. Major differencesin suggested dietary patterns were attributed to cultural differences (36). Table 1 describesthe components of the Food Guide Pyramid for Americans (9).Attempts to further assist the public in interpreting dietary behaviors research effortshave focused on the role of daily dietary patterns. In Table 1, recommendations formanaging hypertension were outlined according to findings from the Dietary Approachesto Stop Hypertension trial (15). The trial was designed to test eating patterns rather thanspecific nutrient intake related to hypertension because so many nutrients play an interdependentrole in maintenance of nutritional status (37).4.1.3. NUTRIENT INTAKE RECOMMENDATIONSDietary quality is further expressed in terms of nutrient composition. The evidence tosupport recommendations for both macronutrients and micronutrients represents a growingbody of knowledge specifically targeting a variety of diseases.The Institute of Medicine of the National Academy of Sciences (38) and the WorldHealth Organization (1) have published extensive documents in support of dietary recommendationsfor health promotion. A summary of guidelines for caloric distributionfrom energy nutrients and additional nutrients of major concern are listed in Table 4along with similar recommendations from other health-based agencies. Recommendationsfor protein, carbohydrate, and fat distribution in the daily diet are similar. Additionally,recommendations for specific nutrients like simple sugars and types of fat arenot specified by all agencies. The unequivocal scientific evidence to clearly define whatis optimum nutrition remains undefined. However, findings do support food guiderecommendations broader in scope. Essentially, diets need to provide adequate protein