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APPENDIX A Dietary Recommendations As described in Chapters 1 and 2, the term dietary recommendations is used throughout this report to refer as a group to the dietary ad- vice in (1) the Diet and Health report of the Food and Nutrition Board of the National Academy of Sciences, (2) The Surgeon General's Report on Nutrition and Health, and (3) the Dietary Guidelines for Americans report by the U.S. Departments of Agriculture and Health and Human Services. These three sets of dietary guidance are presented below. RECOMMENDATIONS FROM THE DIET AND HEALTH REPORT1 1. Reduce total fat intake to 30% or less of calories. Reduce satu- rated fatty acid intake to less than 10% of calories, and the intake of cholesterol to less than 300 mg daily. The intake of fat and choles- terol can be reduced by substituting fish, poultry without skin, lean meats, and low- or nonfat dairy products for fatty meats and whole- milk dairy products; by choosing more vegetables, fruits, cereals, and legumes; and by limiting oils, fats, egg yolks, and fried and other fatty foods. 2. Every day eat five or more servings of a combination of veg- etables and fruits, especially green and yellow vegetables and citrus fruits. Also, increase intake of starches and other complex carbohy- drates by eating six or more daily servings of a combination of breads, cereals, and legumes. 215

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216 APPENDIX A 3. Maintain protein intake at moderate levels. 4. Balance food intake and physical activity to maintain appropri- ate body weight. 5. The committee does not recommend alcohol consumption. For those who drink alcoholic beverages, the committee recommends limiting consumption to the equivalent of less than 1 ounce of pure alcohol in a single day. This is the equivalent of two cans of beer, two small glasses of wine, or two average cocktails. Pregnant women should avoid alcoholic beverages. 6. Limit total daily intake of salt (sodium chloride) to 6 g or less. Limit the use of salt in cooking and avoid adding it to food at the Salty, highly processed salty, salt-preserved, and salt-pickled table. ---, ---O-- ---, r - - ' ' foods should be consumed sparingly. 7. Maintain adequate calcium intake. 8. Avoid taking dietary supplements in excess of the RDA [Rec- ommended Dietary Allowances2] in any one day. 9 Maintain an optimal intake of fluoride, particularly during the years of primary and secondary tooth formation and growth. RECOMMENDATIONS OF THE SURGEON GENERAL OF THE UNITED STATES3 Issues for Most People 1. Fats and cholesterol: Reduce consumption of fat (especially satu- rated fat) and cholesterol. Choose foods relatively low in these sub- stances, such as vegetables, fruits, whole grain foods, fish, poultry, lean meats, and low-fat dairy products. Use food preparation meth- ods that add little or no fat. 2. Energy and weight control: Achieve and maintain a desirable body weight. To do so, choose a dietary pattern in which energy (caloric) ~ ' v, ~ ' - To reduce energy in- take, limit consumption of foods relatively high in calories, fats, and sugars, and minimize alcohol consumption. Increase energy expenditure through regular and sustained physical activity. 3. Complex carbohydrates And fiber: Increase consumption of whole grain foods and cereal products, vegetables (including dried beans and peas), and fruits. 4. Sodium: Reduce intake of sodium by choosing foods relatively low in sodium and limiting the amount of salt added in food prepa- ration and at the table. 5. Alcohol: To reduce the risk for chronic disease, take alcohol only in moderation (no more than two drinks a day), if at all. Avoid intake is consistent with energy expenditure.

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APPENDIX A 217 drinking any alcohol before or while driving, operating machinery, taking medications, or engaging in any other activity requiring judg- ment. Avoid drinking alcohol while pregnant. Other Issues for Some People 6. Fluoride: Community water systems should contain fluoride at optimal levels for prevention of tooth decay. If such water is not available, use other appropriate sources of fluoride. 7. Sugars: Those who are particularly vulnerable to dental caries (cavities), especially children, should limit their consumption and frequency of use of foods high in sugars. 8. Calcium: Adolescent girls and adult women should increase con- sumption of foods high in calcium, including low-fat dairy products. 9. Iron: Children, adolescents, and women of childbearing age should be sure to consume foods that are good sources of iron, such as lean meats, fish, certain beans, and iron-enriched cereals and whole grain products. This issue is of special concern for low-income families. DIETARY GUIDELINES FOR AMERICANS4 1. Eat a variety of foods. 2. Maintain healthy weight. 3. Choose a diet low in fat, saturated fat, and cholesterol. 4. Choose a diet with plenty of vegetables, fruits, and grain products. Use sugars only in moderation. Use salt and sodium only in moderation. If you drink alcoholic beverages, do so in moderation. NOTES 1. Source: National Research Council. 1989. Diet and Health: Implications for Reducing Chronic Disease Risk. Report of the Committee on Diet and Health, Food and Nutrition Board, Commission on Life Sciences. National Academy Press, Washington, D.C. 749 pp. 2. National Research Council. 1989. Recommended Dietary Allowances, 10th ed. Report of the Subcommittee on the Tenth Edition of the RDAs, Food and Nutrition Board, Commission on Life Sciences. National Academy Press, Washington, D.C. 284 PP 3. Source: U.S. Department of Health and Human Services. 1988. The Surgeon General's Report on Nutrition and Health. DHHS (PHS) Publ. No. 88-50210. Public Health Service, U.S. Department of Health and Human Services. U.S. Government Printing Office, Washington, D.C. 727 pp. 4. Source: U.S. Department of Agriculture/U.S. Department of Health and Human Services. 1990. Nutrition and Your Health: Dietary Guidelines for Americans, 3rd ed. Home & Garden Bulletin No. 232. U.S. Department of Agriculture and U.S. Depart- ment of Health and Human Services, Washington, D.C. 28 pp.