The Dietary Guidelines for Americans��Past, Present, Future

The Dietary Guidelines for Americans, and the process for their development are important to all people concerned about food, nutrition, and health policy and education. The information presented in the Dietary Guidelines consumer bulletin is the one voice with which the Federal Government speaks about what healthy Americans should eat to stay healthy and why. The Dietary Guidelines form the basis of Federal nutrition policy affecting food, nutrition education, and information programs. The use of the Dietary Guidelines assures that dietary advice coming from Federal sources is sound, up-to-date, and consistent.

Government nutritionists have been providing advice to Americans about what to eat for nearly a century. In looking at the contemporary Federal dietary recommendations from a historical perspective, it is apparent how far we have come in food guidance. Yet at the same time, it is surprising to see how much is, in fact, the same.

History of U.S. Department of Agriculture Food Guides

The use of the scientific process to develop dietary guidance began about 100 years ago at the U.S. Department of Agriculture (USDA) with W.O. Atwater, first director of the Office of Experiment Stations in USDA. He helped establish important data bases for the development of food guidance including dietary standards for protein, calories, and tables of food composition (4).

In a Farmers' Bulletin published in 1902, Atwater emphasized the importance of variety, proportionality, and moderation in healthful eating (5). He stated that, "for the great majority of people in good health, the ordinary food materials ... make a fitting diet, and the main question is how to use them in the kinds and proportions fitted to the actual needs of the body." Many of our dietary guidance efforts have focused on answering this question.

The first USDA food guide, "Food for Young Children" by Caroline Hunt, a USDA nutritionist, appeared in 1916 (9). It translated the emerging science of nutrition into national dietary recommendations for consumers. The food guide, which specified five food groups, translated nutrient recommendations into recommendations for food intake.

As more was learned about vitamin and mineral requirements and food consumption patterns of the population, food guides emerged such as the "Basic Seven" (1946) and the "Basic Four" (1958) (15,16). These guides focused on choosing enough of the kinds of foods to provide the nutrients needed for good health. These dietary recommendations outlined what was called a "foundation diet" or core of foods that would provide a major share of protein and the recommended vitamins and minerals known at the time these guides were developed. The "Basic Four"--milk, meat, vegetable and fruit, and bread and cereal--remained the centerpiece of nutrition education for the next two decades.

New Directions for Dietary Guidance

By the 1970's, there was a growing body of research relating overconsumption of certain dietary components--such as fat, saturated fat, cholesterol, and sodium--and the risk of some chronic diseases, such as heart disease and stroke.

A new direction for dietary guidance was set in 1977 with the release of the Dietary Goals for the United States by the U.S. Senate Select Committee on Nutrition and Human Needs, popularly known as the "McGovern Committee" (28). The Dietary Goals shifted the focus from obtaining adequate amounts of vitamins and minerals to avoiding excessive intakes of food components that had been linked to chronic diseases.

The Committee's report specified the amounts of protein, complex carbohydrates, sugars, fat, cholesterol, and salt that Americans should consume. It generated considerable discussion in the scientific community about the appropriateness and utility of the Dietary Goals. Because diets developed following these goals were so different from usual food patterns, USDA did not adopt the goals as the basis for its food plans and guides. However, they did draw attention to the need for guidance on diet and health.

In response to the Dietary Goals, the Department of Health and Human Services (HHS) asked the American Society for Clinical Nutrition (ASCN) to form a panel to study the relationships between dietary practices and health outcomes. The panel's findings were presented in a 1979 report entitled Healthy People: the Surgeon General's Report on Health Promotion and Disease Prevention (23). The report suggested that people reduce their consumption of excess calories, fat and cholesterol, salt, and sugar to lower disease rates.

Also in 1979, USDA released a colorful booklet entitled Food, which presented the "Hassle-Free Guide to a Better Diet" (18). This guide added a fifth food group to the "Basic Four"--the fats, sweets, and alcohol group. This food group separated foods that provided mainly calories with few other nutrients from the other four food groups. The guide highlighted the need to moderate the use of fat, sugars, and alcohol and gave special attention to cutting calories and getting adequate dietary fiber.

At about this same time, HHS and USDA began to develop a set of simple guidelines that would provide help for healthy people as they made daily food choices. Such guidelines, based in part on the 1979 Surgeon General's Report on Health Promotion and Disease Prevention, were published in 1980 as the first edition of Nutrition and Your Health: Dietary Guidelines for Americans (19).

The guidelines called for a diet of a variety of foods to provide essential nutrients and more starch and fiber while maintaining recommended body weight and moderating dietary constituents--fat, saturated fat, cholesterol, sugars, sodium, and alcohol--that might be risk factors in certain chronic diseases. These guidelines, even though they were directional rather than quantitative, were not totally acceptable to all nutrition scientists and health professionals and to certain consumer, commodity, and food industry groups. One concern was that use of the term "avoid" would be interpreted to mean "eliminate" foods that contained fat, saturated fat, and cholesterol from the diet.

Later in 1980, a Senate Committee on Appropriations directed that a committee be established to review scientific evidence and recommend revisions in the Dietary Guidelines (27). Such a review was considered desirable because of the continued intense interest in the information and because the state of knowledge in nutrition and dietary planning continued to advance. A Federal Advisory Committee of nine nutrition scientists selected from outside the Federal Government was convened in 1983 to review and make recommendations to USDA and HHS about the first edition of the Dietary Guidelines in anticipation of the next edition.

New Food Guide Developed

With the release of the first edition of the Dietary Guidelines, USDA began work on developing a new food guide that would help consumers put the guidelines into action in their daily food choices. The food guide focused on how to make food choices that met the objectives for nutrient adequacy and moderation of those components related to risk of chronic disease.

After development, the new food guide was first presented as a food wheel to consumers in 1984 as part of a nutrition course developed by USDA in cooperation with the American National Red Cross (3). The guide was also used in tabular form--"A Pattern for Daily Food Choices"--in several USDA publications released in the 1980's, including "Preparing Foods and Planning Menus Using the Dietary Guidelines" (Home and Garden Bulletin Number 8, 1989) and "Dietary Guidelines and Your Diet" (Home and Garden Bulletin Number 232-1, 1986).

Continued Revisions of the Dietary Guidelines

In 1985, HHS and USDA jointly issued a revised edition of the Dietary Guidelines (20). This second edition was nearly identical to the first. Some changes were made for clarity in wording; others added guidance about nutrition topics that became more prominent after 1980, such as following unsafe weight-loss diets, using large-dose supplements, and drinking of alcoholic beverages by pregnant women (6). These changes reflected advances in scientific knowledge of the associations between diet and a range of chronic diseases. The second edition received wide acceptance and was used as a framework for consumer education messages.

In 1987, a Conference Report of the House Committee on Appropriations indicated that USDA, in conjunction with HHS, "shall re-establish a Dietary Guidelines Advisory Group on a periodic basis" (26). In 1989, USDA and HHS established a second advisory committee that reviewed the 1985 Dietary Guidelines and made recommendations for revision in a report to the Secretaries of Agriculture and HHS (7).

The Surgeon General's Report on Nutrition and Health published in 1988 and the National Research Council's report, Diet and Health: Implications for Reducing Chronic Disease Risk published in 1989 were key resources used by the Dietary Guidelines Advisory Committee (10, 25). Other major resources were the 10th edition (1989) of the Recommended Dietary Allowances and the draft of a report by the Population Panel of the National Cholesterol Education Program (11, 24).

Another type of resource, research on the uses and usefulness of the second edition of the Dietary Guidelines, conducted at the University of Wisconsin and The Pennsylvania State University under USDA sponsorship, was also used by the Dietary Guidelines Advisory Committee (1, 2, 14). This type of research provided the Committee with input from professionals and consumers.

The 1988 Wisconsin study found widespread adoption and acceptance of the second edition of the Dietary Guidelines by Federal, State, and local professionals involved in the communication of food and nutrition information (14). The health professionals interviewed emphasized the importance of having health and nutrition experts speak with one voice in identifying important dietary practices. They also urged that the Dietary Guidelines be kept constantly before the public, in a variety of presentations.

In the Pennsylvania study, consumer evaluation of the second edition (1985) of the Dietary Guidelines bulletin, using focus groups and in-depth interviews, showed that consumers wanted more specific food-related guidance, definitions of technical terms, and practical tips for behavior change strategies (1, 2).

In 1990, USDA and HHS jointly released the third edition of the Dietary Guidelines (21). The basic tenets of the Dietary Guidelines were reaffirmed, with additional refinements reflecting an increased understanding of the science of nutrition and suggestions for communicating that science to consumers. The new Dietary Guidelines were more positive and more oriented toward the total diet. They also, for the first time, contained suggested numerical limits for total fat and saturated fat intake, and short action statements in an "Advice for Today" section (e.g., "check to see if you are at a healthy weight") along with each guideline. In response to consumer evaluation of the previous edition, more practical advice was given on how to implement the Dietary Guidelines in daily food choices by including the food guide--A Pattern for Daily Food Choices--developed by USDA in the early 1980's (3).

Also in 1990, The National Nutrition Monitoring and Related Research Act (7 U.S.C. 5341) was passed. This Act requires the Secretaries of Agriculture and Health and Human Services to publish jointly a report entitled Dietary Guidelines for Americans every 5 years. This legislation also requires review by the two Secretaries of all Federal publications containing dietary advice for the general public to assure that such guidance either is consistent with the Dietary Guidelines for Americans or is based on medical or new scientific knowledge, which is determined to be valid by the Secretaries.

The Food Guide Pyramid Released

In 1992, the Food Guide Pyramid, which was developed by USDA and supported by HHS, was released (17). This was a new graphic presentation of the original food guide developed by USDA in the mid-1980's. A separate publication explaining the food guide was prepared, involving consumer testing with adults and children during development. The Pyramid graphic conveys in a memorable way the key messages of the food guide--variety, proportionality, and moderation. The intent of the Food Guide Pyramid is to help consumers put the Dietary Guidelines into action.

The Food Guide Pyramid has been widely used by nutrition educators in a variety of materials, including posters, textbooks, school curricula, and computer software, and has also been used by industry on food labels. Such wide use has helped to communicate the Dietary Guidelines' message.

Process for Development of the 1995 Edition of the Dietary Guidelines

In 1994, USDA and HHS appointed an 11-member Dietary Guidelines Advisory Committee to review the 1990 edition of the Dietary Guidelines and determine if, on the basis of current scientific knowledge, revisions were warranted. The 1980, 1985, and 1990 editions of the Dietary Guidelines were issued voluntarily by USDA and HHS. The 1995 edition was the first report mandated by statute.

The Dietary Guidelines Advisory Committee held three public meetings from September 1994 through March 1995. All meetings were announced in the Federal Register and open to the public. Oral comments were received from the public during the second meeting. Additionally, written comments were solicited from the public. A search of Medline and AGRICOLA data bases for literature related to each guideline was performed and results were provided to the Committee by USDA and HHS staff. The Committee report was submitted to the Departments in June 1995 (8). Consumer reactions to specific design and content elements of the Dietary Guidelines were obtained by USDA-sponsored research done in collaboration with HHS (13).

Changes in the Dietary Guidelines Since 1980

Although the titles of some of the Dietary Guidelines have changed (see table), there have been few changes in the overall theme of the Dietary Guidelines over the past 15 years. There are seven guidelines for each edition. The target audience for the Dietary Guidelines has remained unchanged; they are directed to all healthy Americans 2 years of age and older.

Dietary Guidelines for Americans 1980-1995

            1980                         1985

Eat a variety of foods         Eat a variety of foods

Maintain ideal weight          Maintain desirable weight

Avoid too much fat,            Avoid too much fat,
saturated fat, and             saturated fat, and
cholesterol                    cholesterol

Eat foods with adequate        Eat foods with adequate
starch and fiber               starch and fiber

Avoid too much sugar           Avoid too much sugar

Avoid too much sodium          Avoid too much sodium

If you drink alcohol,          If you drink alcoholic
do so in moderation            beverages, do so in
                               moderation

            1990                         1995

Eat a variety of foods         Eat a variety of foods

Maintain healthy weight        Balance the food you eat with
                               physical activity--maintain or
                               improve your weight

Choose a diet low in fat,      Choose a diet with plenty of
saturated fat, and             grain products, vegetables,
cholesterol                    and fruits(*)

Choose a diet with plenty      Choose a diet low in fat,
of vegetables, fruits, and     saturated fat, and
grain products                 cholesterol(*)

Use sugars only in             Choose a diet moderate
moderation                     in sugars

Use salt and sodium only       Choose a diet moderate in
in moderation                  salt and sodium

If you drink alcoholic         If you drink alcoholic
beverages, do so in            beverages, do so in
moderation                     moderation

(*) In the 1995 edition, the order of the third and fourth guidelines has been reversed.

Eat a variety of foods. The title of this guideline has remained the same for all four editions. The fourth edition added boxes listing good food sources of iron and calcium. It also added information about the new Nutrition Facts Label, which by Federal law is required on most packaged retail food products. A discussion of vegetarian diets was also added to demonstrate the compatibility of such diets with the advice in the Dietary Guidelines (8).

Balance the food you eat with physical activity--maintain or improve your weight. The title of this guideline has seen several changes over the past 15 years. "Maintain ideal weight" was changed to "Maintain desirable weight" in 1985 because "ideal" seemed to imply an unduly precise understanding of what people should weigh (6). The title was changed again in 1990 to "Maintain healthy weight" because a procedure was introduced to help people assess their weight relative to health outcomes. The Dietary Guidelines brochure has always included a weight table to help adults assess their own weight status. The third edition added information about waist-hip ratio to help relate weight to risk for chronic diseases, such as heart disease, certain types of cancer, and adult-onset diabetes (7). In 1995, the title was changed to emphasize the importance of physical activity and energy balance. The weight table has been replaced with a chart that illustrates weight ranges for healthy weight, moderate overweight, and severe overweight. The suggested list of physical activities has also been updated based on recent research (12).

Choose a diet with plenty of grain products, vegetables, and fruits. The title of this guideline remained the same in 1980 and 1985. In 1990, the title was changed, in part due to research that indicated that consumers found the earlier title to be too difficult to follow (7). The new title placed more emphasis on foods rather than nutrients. In 1995, this guideline was moved up from fourth position to third to give it more prominence. The title was changed slightly to make it consistent with the placement of food groups within the Food Guide Pyramid (8). The text of the guideline has added information on food sources of folate and carotenoids, and the relationship of these nutrients to health outcomes is discussed.

Choose a diet low in fat, saturated fat, and cholesterol. The title of this guideline remained the same in 1980 and 1985. In 1990, the title was changed to make clear that the fat content of the total diet, not just individual foods, is of concern (7). The word "avoid" was removed to eliminate the possible misunderstanding that fats are to be completely eliminated from the diet. The 1995 edition concurs with the 1990 wording. The text of the 1995 edition adds more information about types and sources of fatty acids in the diet (including information about omega-3 polyunsaturated and trans fatty acids). It continues the 1990 recommendation for upper limits on total fat and saturated fat but recommends that children gradually adopt the guideline from age 2 to 5 years, so that by the time children are in elementary school, they should be consuming diets that follow the Dietary Guidelines (8).

Choose a diet moderate in sugars. The title of this guideline was the same in 1980 and 1985 but changed in 1990. The term "sugars" was used to more accurately define the foods of concern (table sugar as well as other caloric sweeteners, which were listed in the text) (7). The word "avoid" was removed to provide a more positive tone to the guideline. In 1995, the title of the guideline changed again to provide consistency with the other guidelines' focus on the total diet (8). The text of the 1995 edition placed more emphasis on sugars as a calorie source and less on the relationship of sugars' intake to dental health. The text also added the statement that the body cannot distinguish between naturally occurring and added sugars (8).

Choose a diet moderate in salt and sodium. The title of this guideline remained unchanged in 1980 and 1985. In 1990, the word "salt" was added because it is the source of most sodium in American diets and is better understood by consumers than "sodium" (7).

As with the fat and sugar guidelines, the term "avoid" was deleted to give the guideline a more positive tone. In 1995, the title changed again, to place an emphasis on the total diet. The term "use" was removed because it might be misunderstood by consumers to mean that only salt added by them in cooking or at the table is a problem, when in fact, most of the sodium in American diets is added as salt during processing (8).

Information was added about the relationship of nutrients other than sodium to blood pressure, and a list of good food sources of potassium was added. The guideline also refers to the level of sodium (2,400 mg) listed as the Daily Value on the Nutrition Facts Label.

If you drink alcoholic beverages, do so in moderation. In 1985, the title of the guideline changed slightly. The term "alcohol" was changed to "alcoholic beverages" to reflect the correct terminology (6). The title of the guideline has remained unchanged since that time. The 1995 edition retains the definition of moderate drinking, but it appears earlier in the text than in the previous edition. The list of those who should not drink has been reordered so that children and adolescents appear first. The text expands the statement in the 1990 guidelines to emphasize the food use of alcoholic beverages rather than the social drug use (8).

Brochure Presentation: Design and Format Changes

The "look" of the Dietary Guidelines brochure has changed over the years. The graphic on the front cover of the first edition included a number for each of the guidelines (see figure). The numbers were eliminated in subsequent editions because they led to misconceptions that certain guidelines were more important than others. The second and third editions used an interlocking chain and the fourth edition uses interlocking circles on the front cover to convey the concept that all of the guidelines are interrelated.

The Dietary Guidelines brochure has always included boxes with practical "how-to" information, such as tips for reducing fat and sodium intake (19, 20). The third edition added brief "Advice for Today" sections (21). The fourth edition added subtitles to improve readability of the brochure (22).

USDA's Food Guide made its first appearance in the third edition of the Dietary Guidelines. The graphic illustration of the Food Guide, the Food Guide Pyramid, appears in the fourth edition.

Future of the Dietary Guidelines

The Dietary Guidelines have provided a consensus as to what makes a healthy diet. They also form the basis of Federal nutrition policy affecting food, nutrition education, and information programs. They will continue to be reviewed every 5 years and revised as the science base evolves. However, as the Dietary Guidelines are revised in the future, it is likely that the underlying themes of variety, proportionality, and moderation initiated about 100 years ago will apply to choosing healthful diets for many years to come.

Since the initial release of the Dietary Guidelines for Americans in 1980, each edition has gained in acceptance and use by both professionals and consumers. USDA and HHS acknowledge the role that nutrition educators and health professionals have played in this greater acceptance and use and look forward to their continued support (14).

References

(1.) Achterberg, C.L., Getty, V.M., Pugh, M.A., Durrwachter, J.G., and Trenkner, L.L. 1989. Evaluation of "Nutrition and Your Health: Dietary Guidelines for Amerians;" Part I: A Women's Sample. Prepared for U.S. Department of Agriculture, Human Nutrition Information Service.

(2.) Achterberg, C.L., Ozgun, M.P., McCoy, J., and Getty, V.M. 1991. Evaluation of "Nutrition and Your Health: Dietary Guidelines for Americans;" Part II: A Men's Sample. Prepared for U.S. Department of Agriculture, Human Nutrition Information Service.

(3.) American Red Cross. 1984. Better Eating for Better Health: Instructor's Guide and Participants' Packet. American National Red Cross, Washington, DC.

(4.) Atwater, W.O. 1894. Foods: Nutritive Value and Cost. Farmers' Bulletin No. 23. U.S. Department of Agriculture.

(5.) Atwater, W.O. 1902. Principles of Nutrition and Nutritive Value of Food. Farmers' Bulletin No. 142. U.S. Department of Agriculture.

(6.) Dietary Guidelines Advisory Committee. 1985. Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans. U.S. Department of Agriculture, Human Nutrition Information Service.

(7.) Dietary Guidelines Advisory Committee. 1990. Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans. U.S. Department of Agriculture, Human Nutrition Information Service.

(8.) Dietary Guidelines Advisory Committee. 1995. Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 1995. U.S. Department of Agriculture, Agricultural Research Service.

(9.) Hunt, C.L. 1916. Food for Young Children. Farmers' Bulletin No. 717. U.S. Department of Agriculture.

(10.) National Academy of Sciences, National Research Council, Food and Nutrition Board. 1989. Diet and Health: Implications for Reducing Chronic Disease Risk. National Academy Press, Washington, DC.

(11.) National Academy of Sciences, National Research Council, Food and Nutrition Board. 1989. Recommended Dietary Allowances (10th ed.). National Academy Press, Washington, DC.

(12.) Pate, R.R., Pratt, M., Blair, S.N., et al. 1995. Physical activity and public health: A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. Journal of the American Medical Association 273(5):402407.

(13.) Prospect Associates. 1995. Dietary Guidelines Focus Group Report. Unpublished report prepared for U.S. Department of Agriculture, Center for Nutrition Policy and Promotion.

(14.) Steele, S.M. 1990. Cooperative Extension's Use of Dietary Guidelines and Your Diet and Suggestions About Revisions. Unpublished report prepared for U.S. Department of Agriculture, Human Nutrition Information Service.

(15.) U.S. Department of Agriculture. 1958. Food for Fitness--A Daily Food Guide. Leaflet No. 424.

(16.) U.S. Department of Agriculture, Bureau of Human Nutrition and Home Economics. 1946. National Food Guide. AIS-53, Rev. of NFC-4.

(17.) U.S. Department of Agriculture, Human Nutrition Information Service. 1992. The Food Guide Pyramid. Home and Garden Bulletin No. 252.

(18.) U.S. Department of Agriculture, Science and Education Administration. 1979. Food. Home and Garden Bulletin No. 228.

(19.) U.S. Department of Agriculture and U.S. Department of Health and Human Services. 1980. Nutrition and Your Health: Dietary Guidelines for Americans. U.S. Department of Agriculture. Home and Garden Bulletin No. 232.

(20.) U.S. Department of Agriculture and U.S. Department of Health and Human Services. 1985. Nutrition and Your Health: Dietary Guidelines for Americans (2d ed.). U.S. Department of Agriculture. Home and Garden Bulletin No. 232.

(21.) U.S. Department of Agriculture and U.S. Department of Health and Human Services. 1990. Nutrition and Your Health: Dietary Guidelines for Americans (3d ed.). U.S. Department of Agriculture. Home and Garden Bulletin No. 232.

(22.) U.S. Department of Agriculture and U.S. Department of Health and Human Services. 1995. Nutrition and Your Health: Dietary Guidelines for Americans (4th ed.). U.S. Department of Agriculture. Home and Garden Bulletin No. 232.

(23.) U.S. Department of Health, Education, and Welfare, Public Health Service. 1979. Healthy People: The Surgeon General's Report on Health Promotion and Disease Prevention. DHEW (PHS) Publication No. 79-55071.

(24.) U.S. Department of Health and Human Services, National Heart, Lung, and Blood Institute. 1990. National Cholesterol Education Program: Report of the Expert Panel on Population Strategies for Blood Cholesterol Reduction.

(25.) U.S. Department of Health and Human Services, Public Health Service. 1988. The Surgeon General's Report on Nutrition and Health.

(26.) U.S. House of Representatives Conference Committee, 100th Cong., 1st sess. 1987. H.R. 498.

(27.) U.S. Senate Agricultural Appropriations Committee. 1980. Senate Report No. 96-1030 Nov. 20.

(28.) U.S. Senate Select Committee on Nutrition and Human Needs. 1977. Dietary Goals for the United States (2d ed.).

Carole A. Davis

Chief Nutritionist Center for Nutrition Policy and Promotion

Etta A. Saltos

Nutritionist Center for Nutrition Policy and Promotion

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