Healthy eating patterns can accommodate nutrient-dense foods with small amounts of saturated fats, as long as calories from saturated fats do not exceed 10 percent per day, intake of total fats remains within the AMDR, and total calorie intake remains within limits. When possible, foods high in saturated fats should be replaced with foods high in unsaturated fats, and other choices to reduce solid fats should be made see Chapter 2.
Individuals should limit intake of trans fats to as low as possible by limiting foods that contain synthetic sources of trans fats, such as partially hydrogenated oils in margarines, and by limiting other solid fats. A number of studies have observed an association between increased intake of trans fats and increased risk of CVD. This increased risk is due, in part, to its LDL-cholesterol-raising effect. Trans fats occur naturally in some foods and also are produced in a process called hydrogenation.
Hydrogenation is used by food manufacturers to make products containing unsaturated fatty acids solid at room temperature i.
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Partial hydrogenation means that some, but not all, unsaturated fatty acids are converted to saturated fatty acids; some of the unsaturated fatty acids are changed from a cis to trans configuration. Artificial trans fatty acids are found in the partially hydrogenated oils  used in some margarines, snack foods, and prepared desserts as a replacement for saturated fatty acids.
Although food manufacturers and restaurants have reduced the amounts of artificial trans fats in many foods in recent years, these fats can still be found in some processed foods, such as some desserts, microwave popcorn, frozen pizza, margarines, and coffee creamers. Natural trans fats are present in small quantities in dairy products and meats, and consuming fat-free or low-fat dairy products and lean meats and poultry will reduce the intake of natural trans fats from these foods.
Because natural trans fats are present in dairy products and meats in only small quantities and these foods can be important sources of nutrients, these foods do not need to be eliminated from the diet. The body uses cholesterol for physiological and structural functions but makes more than enough for these purposes. Therefore, people do not need to obtain cholesterol through foods.
The Key Recommendation from the Dietary Guidelines to limit consumption of dietary cholesterol to mg per day is not included in the edition, but this change does not suggest that dietary cholesterol is no longer important to consider when building healthy eating patterns.
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As recommended by the IOM,  individuals should eat as little dietary cholesterol as possible while consuming a healthy eating pattern. In general, foods that are higher in dietary cholesterol, such as fatty meats and high-fat dairy products, are also higher in saturated fats. The USDA Food Patterns are limited in saturated fats, and because of the commonality of food sources of saturated fats and dietary cholesterol, the Patterns are also low in dietary cholesterol.
For example, the Healthy U. Current average intake of dietary cholesterol among those 1 year and older in the United States is approximately mg per day. Strong evidence from mostly prospective cohort studies but also randomized controlled trials has shown that eating patterns that include lower intake of dietary cholesterol are associated with reduced risk of CVD, and moderate evidence indicates that these eating patterns are associated with reduced risk of obesity. More research is needed regarding the dose-response relationship between dietary cholesterol and blood cholesterol levels.
Adequate evidence is not available for a quantitative limit for dietary cholesterol specific to the Dietary Guidelines. Dietary cholesterol is found only in animal foods such as egg yolk, dairy products, shellfish, meats, and poultry. A few foods, notably egg yolks and some shellfish, are higher in dietary cholesterol but not saturated fats. Eggs and shellfish can be consumed along with a variety of other choices within and across the subgroup recommendations of the protein foods group.
Healthy intake: The scientific consensus from expert bodies, such as the IOM, the American Heart Association, and Dietary Guidelines Advisory Committees, is that average sodium intake, which is currently 3, mg per day see Chapter 2 , is too high and should be reduced. Healthy eating patterns limit sodium to less than 2, mg per day for adults and children ages 14 years and older and to the age- and sex-appropriate Tolerable Upper Intake Levels UL of sodium for children younger than 14 years see Appendix 7.
Sodium is an essential nutrient and is needed by the body in relatively small quantities, provided that substantial sweating does not occur. The limits for sodium are the age- and sex-appropriate ULs. The UL is the highest daily nutrient intake level that is likely to pose no risk of adverse health effects to almost all individuals in the general population. The recommendation for adults and children ages 14 years and older to limit sodium intake to less than 2, mg per day is based on evidence showing a linear dose-response relationship between increased sodium intake and increased blood pressure in adults.
In addition, moderate evidence suggests an association between increased sodium intake and increased risk of CVD in adults. However, this evidence is not as consistent as the evidence on blood pressure, a surrogate indicator of CVD risk. Calorie intake is highly associated with sodium intake i. Because children have lower calorie needs than adults, the IOM established lower ULs for children younger than 14 years of age based on median intake of calories.
Similar to adults, moderate evidence also indicates that the linear dose-response relationship between sodium intake and blood pressure is found in children as well. Adults with prehypertension and hypertension would particularly benefit from blood pressure lowering. For these individuals, further reduction to 1, mg per day can result in even greater blood pressure reduction. Because of the linear dose-response relationship between sodium intake and blood pressure, every incremental decrease in sodium intake that moves toward recommended limits is encouraged.
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Even without reaching the limits for sodium intake, strong evidence indicates that reductions in sodium intake can lower blood pressure among people with prehypertension and hypertension. Further, strong evidence has demonstrated that adults who would benefit from blood pressure lowering should combine the Dietary Approaches to Stop Hypertension DASH dietary pattern with lower sodium intake see Dietary Approaches to Stop Hypertension call-out box.
Considerations: As a food ingredient, sodium has multiple uses, such as in curing meat, baking, thickening, enhancing flavor including the flavor of other ingredients , as a preservative, and in retaining moisture. For example, some fresh meats have sodium solutions added to help retain moisture in cooking. As discussed in Chapter 2 , sodium is found in foods across the food supply, including mixed dishes such as burgers, sandwiches, and tacos; rice, pasta, and grain dishes; pizza; meat, poultry, and seafood dishes; and soups.
Multiple strategies should be implemented to reduce sodium intake to the recommended limits see Chapter 3. The DASH dietary pattern is an example of a healthy eating pattern and has many of the same characteristics as the Healthy U. The DASH-Sodium trial confirmed the beneficial blood pressure and LDL-cholesterol effects of the DASH eating pattern at three levels of dietary sodium intake and also demonstrated a step-wise lowering of blood pressure as sodium intake was reduced.
The DASH Eating Plan is high in vegetables, fruits, low-fat dairy products, whole grains, poultry, fish, beans, and nuts and is low in sweets, sugar-sweetened beverages, and red meats. It is low in saturated fats and rich in potassium, calcium, and magnesium, as well as dietary fiber and protein. It also is lower in sodium than the typical American diet, and includes menus with two levels of sodium, 2, and 1, mg per day. The Dietary Guidelines does not recommend that individuals who do not drink alcohol start drinking for any reason. If alcohol is consumed, it should be in moderation—up to one drink per day for women and up to two drinks per day for men—and only by adults of legal drinking age.
For the purposes of evaluating amounts of alcohol that may be consumed, the Dietary Guidelines includes drink-equivalents. One alcoholic drink-equivalent is described as containing 14 g 0. See Appendix 9. Alcohol for additional information. Caffeine is not a nutrient; it is a dietary component that functions in the body as a stimulant. Caffeine occurs naturally in plants e.
It also is added to foods and beverages e. If caffeine is added to a food, it must be included in the listing of ingredients on the food label.
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Caffeinated beverages vary widely in their caffeine content. Much of the available evidence on caffeine focuses on coffee intake. This guidance on coffee is informed by strong and consistent evidence showing that, in healthy adults, moderate coffee consumption is not associated with an increased risk of major chronic diseases e.
However, individuals who do not consume caffeinated coffee or other caffeinated beverages are not encouraged to incorporate them into their eating pattern. Limited and mixed evidence is available from randomized controlled trials examining the relationship between those energy drinks which have high caffeine content and cardiovascular risk factors and other health outcomes. The same considerations apply to calories added to tea or other similar beverages.
Those who choose to drink alcohol should be cautious about mixing caffeine and alcohol together or consuming them at the same time; see Appendix 9. Alcohol for additional discussion. In addition, women who are capable of becoming pregnant or who are trying to, or who are pregnant, and those who are breastfeeding should consult their health care providers for advice concerning caffeine consumption. The amount of alcohol and calories in beverages varies and should be accounted for within the limits of healthy eating patterns.
Alcohol should be consumed only by adults of legal drinking age. There are many circumstances in which individuals should not drink, such as during pregnancy.
See Appendix 6. Weight gain during pregnancy: Reexamining the guidelines. J Am Coll Cardiol. PMID: Food and Drug Administration FDA health claim for whole grains have at least 51 percent of the total ingredients by weight as whole-grain ingredients; they also meet other criteria. The remaining 50 percent or less of grains, if any, must be enriched. Accessed October 22, Accessed November 25, Accessed September 26, Environmental Protection Agency EPA provide joint guidance regarding seafood consumption for women who are pregnant or breastfeeding and young children.
High-Intensity Sweeteners. May 19, Accessed October 19, Federal Register. June 17, ;80 Accessed October 20, Because of increased loss of sodium from sweat, the AI does not apply to highly active individuals and workers exposed to extreme heat stress, estimated to be less than 1 percent of the U. Institute of Medicine. Department of Agriculture, Beltsville, Maryland.