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## Complete Summary

#### GUIDELINE TITLE

Dietary guidelines for Americans, 2005.

#### BIBLIOGRAPHIC SOURCE(S)

U.S. Department of Health and Human Services, U.S. Department of
Agriculture. Dietary guidelines for Americans, 2005. Washington (DC):
U.S. Department of Health and Human Services, U.S. Department of
Agriculture; 2005. 71 p.

#### GUIDELINE STATUS

This is the current release of the guideline.

### COMPLETE SUMMARY CONTENT

 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 QUALIFYING STATEMENTS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

Chronic diseases and conditions linked to a poor diet or physical
inactivity including cardiovascular disease, hypertension, dyslipidemia,
type 2 diabetes, overweight and obesity, osteoporosis, constipation,
diverticular disease, iron deficiency anemia, oral diseases,
malnutrition, and some cancers

#### GUIDELINE CATEGORY

Prevention

#### CLINICAL SPECIALTY

Nutrition

#### INTENDED USERS

Dietitians\
Health Care Providers\
Public Health Departments

#### GUIDELINE OBJECTIVE(S)

-   To provide information and advice for choosing a nutritious diet,
    maintaining a healthy weight, achieving adequate exercise, and
    \"keeping foods safe\" to avoid foodborne illness

-   To promote health and to reduce risk for major chronic diseases
    through diet and physical activity

-   To summarize and synthesize knowledge regarding individual nutrients
    and food components into recommendations for a pattern of eating
    that can be adopted by the public

#### TARGET POPULATION

The general population over 2 years of age who are living in the United
States

#### INTERVENTIONS AND PRACTICES CONSIDERED

**Provision of Adequate Nutrients within Calorie Needs**

1.  Adopting a balanced eating pattern, such:

    -   Dietary Approaches to Stop Hypertension (DASH) eating plan

    -   U.S. Department of Agriculture (USDA) Food Guide

2.  Limiting intake of saturated and trans fats, cholesterol, added
    sugars, salt, and alcohol

3.  Consuming a variety of nutrient-dense foods and beverages within and
    among the basic food groups

4.  Promoting increased dietary intakes of potassium, fiber, and
    possibly vitamin E

5.  Considerations for special populations, such as people over 50,
    women of childbearing age who may become pregnant and those in the
    first trimester of pregnancy, and other special groups (i.e., older
    adults, people with dark skin, and people exposed to insufficient
    ultraviolet band radiation)

**Weight Management**

1.  Balancing calories from foods and beverages with calories expended

2.  Decreasing calorie intake and increasing physical activity

3.  Considerations for special populations, such as those who need to
    lose weight, overweight children, pregnant women, breastfeeding
    women, and overweight adults and overweight children with chronic
    diseases and/or on medication

**Physical Activity**

1.  Engaging in 30 to 90 minutes of moderate-vigorous exercise on most
    days of the week while not exceeding caloric intake

2.  Achieving physical fitness by including:

    -   Cardiovascular conditioning

    -   Stretching exercises for flexibility

    -   Resistance exercises or calisthenics for muscle strength and
        endurance

3.  Considerations for special populations, such as children and
    adolescents, pregnant women, breastfeeding women, and older adults

**Food Groups to Encourage**

1.  Consuming two cups of fruit per day\*

2.  Consuming two and a half cups of vegetables per day,\* with
    selections from all 5 vegetable subgroups several times per week

3.  Consuming three or more ounce-equivalents of whole-grain products
    per day

4.  Consuming three cups per day of fat-free or low-fat milk or
    equivalent milk products

5.  Considerations for special populations, such as children and
    adolescents

\*Based on a reference 2,000-calorie intake, with higher or lower
amounts depending on the calorie level.

**Fats**

1.  Consuming \<10% of calories from saturated fatty acids

2.  Consuming \<300 mg/day of cholesterol

3.  Decreasing intake of trans fats

4.  Considerations for special populations, such as children and
    adolescents

**Carbohydrates**

1.  Choosing fiber-rich fruits, vegetables, and whole grains

2.  Choosing foods and beverages with little added sugars or caloric
    sweeteners

3.  Practicing good oral hygiene

**Sodium and Potassium**

1.  Consuming \<2,300 mg (approximately 1 teaspoon of salt) of sodium
    per day

2.  Choosing and preparing foods with little salt

3.  Consuming potassium-rich foods

4.  Considerations for special populations, such as individuals with
    hypertension, blacks, and middle-aged and older adults

**Food Safety**

1.  Washing hands before and after handling food

2.  Washing fresh fruits and vegetables

3.  Separating raw, cooked, and ready-to-eat foods while shopping,
    preparing, or storing

4.  Cooking foods to safe temperature to kill microorganisms

5.  Refrigerating perishable foods promptly

6.  Defrosting foods properly

7.  Avoiding unpasteurized milk or any products made from unpasteurized
    milk, raw or partially cooked eggs or foods containing raw eggs, raw
    or undercooked meat and poultry, raw or undercooked fish or
    shellfish, unpasteurized juices, and raw sprouts

8.  Considerations for special populations such as pregnant women, older
    adults, and those who are immunocompromised

#### MAJOR OUTCOMES CONSIDERED

Clinically relevant outcomes such as clinical diseases (e.g., incident
cancer and myocardial infarction) and well-accepted risk factors (e.g.,
systolic blood pressure, low-density lipoprotein cholesterol, and
weight)

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Hand-searches of Published Literature (Primary Sources)\
Hand-searches of Published Literature (Secondary Sources)\
Searches of Electronic Databases\
Searches of Unpublished Data

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

**Research Questions**

Each subcommittee generated an initial list of research questions that
might be relevant to setting dietary guidelines. The subcommittee then
set priorities based on the perceived level of importance and
availability of literature. This process was iterative. Throughout the
deliberations, the wording and intent of the research questions evolved,
as did the need for additional questions. Available time, expertise, and
resources precluded an examination of all issues related to the effects
of diet on chronic disease.

**Systematic Review of the Scientific Evidence**

The Dietary Guidelines Advisory Committee (DGAC) relied on the published
literature and, in a few instances, preprints of articles that had been
accepted for publication and provided to the Committee by individual
members and invited experts. Major sources of evidence were the *Dietary
Reference Intake* reports prepared by expert committees convened by the
Institute of Medicine (IOM). Other sources were systematic
evidence-based reports such as the Agency for Healthcare Research and
Quality report on omega-3 fatty acids and the World Health Organization
International Agency for Research on Cancer (IARC) report on the
relation between fruit and vegetable intake and cancer. In addition to
these comprehensive documents, the subcommittees relied on literature
searches to identify pertinent articles on research questions not
addressed in any evidence-based report and to update previously
published evidence reports.

**Types of Evidence**

The Committee focused on studies conducted in humans. The primary types
of studies used were observational studies and clinical trials. Specific
types of observational studies were cross-sectional studies,
case-control studies, and cohort studies. The Committee placed greatest
emphasis on results from cohort studies and trials with well-accepted,
clinically relevant outcomes. Such outcomes included clinical diseases
(e.g., incident cancer and myocardial infarction) and well-accepted risk
factors (e.g., systolic blood pressure, low-density lipoprotein
cholesterol, and weight). Meta-analyses also were considered. The
majority of studies evaluated were based on adults; there were limited
studies on children.

**Literature Searches**

Staff developed the search strategy in consultation with each
subcommittee chair to meet the needs of that subcommittee. The search
strategy included search parameters, search terms, search databases, and
exclusion criteria (including years covered).

Typical exclusion criteria included the following: *in vitro* studies,
animal studies, articles before \"X\" date, and drug studies. The
specific exclusion criteria varied by question (e.g., questions
involving cancer as an endpoint may not exclude animal studies). In some
cases, additional references were identified by checking the reference
lists of review articles. The years covered were influenced by the
availability of evidence-based reviews that addressed the same topic.
For example, the literature search regarding fiber covered only 1999 and
later years because a prior IOM report covered the earlier years. Some
searches were expanded if results from the initial research were meager.

#### NUMBER OF SOURCE DOCUMENTS

Not stated

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Expert Consensus

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

Not applicable

#### METHODS USED TO ANALYZE THE EVIDENCE

Review of Published Meta-Analyses\
Systematic Review with Evidence Tables

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

**Summaries of Results**

The Science Review Subcommittee developed a prototype table to be used
for summarizing information obtained from relevant articles for priority
questions. Content included in the tables was to be concise, factual,
and descriptive and to provide a basis for formulating tentative
conclusions. Staff worked with the respective subcommittee chair to
examine the search results and eliminate articles that were not relevant
to the subcommittee\'s topic. They then extracted the key information
and, by using the prototype, produced a table to cover key information
about each question for which relevant articles were identified.

**Critical Review of Studies**

Subcommittee members read the tables and requested key articles. They
then critically assessed study quality and relevance to the overall
question being addressed. The subcommittee members, not the staff, made
the decisions on study quality and on the relative value of clinical
trials and observational studies. They considered these factors, along
with the data summarized in the tables, in reaching tentative
conclusions for consideration by the full Committee.

**Use of The United States Department of Agriculture (USDA) Food Intake
Pattern And Special Analyses**

The Committee had access to the food pattern proposed by the USDA
(*Federal Register* notice, vol. 68, no. 176, September 11, 2003, p.
535-36) and to technical support data related to the pattern. This
information included the following:

-   A proposed daily food intake pattern that lists the daily amounts of
    food from each food group and subgroup for 12 age/energy groups

-   Energy levels for the proposed food intake pattern

-   Nutritional goals for the daily food intake pattern covering
    vitamins, minerals, and macronutrients

-   Nutrient profiles of the basic food groups and their subgroups and
    for additional fats, oils, soft margarines, and added sugars. The
    food groups and subgroups are composites that reflect the types and
    amounts of foods commonly consumed by Americans.

-   Nutrients provided by the proposed food pattern

At the request of three subcommittees, USDA staff used its food modeling
system to conduct several types of analyses. Most of these analyses
involved the modeling of the food pattern intended to meet selected
specifications for nutrient intake. For example, the subcommittees
requested analyses to obtain information relevant to flexibility in the
choice of food to meet nutrient needs, the effects of different fat
intakes on the nutrients provided by the food pattern, and the
approximate number of calories needed to meet recommended nutrient
intakes.

The USDA food modeling process used in these analyses was developed
originally for deriving the Food Guide Pyramid. It was updated for these
analyses to include nutrient goals from the Institute of Medicine
*Dietary Reference Intakes* report that was released in 2004 (after the
*Federal Register* notice regarding the proposed food pattern) and the
most recent National Health and Nutrition Examination Survey (NHANES)
1999-2000 food consumption data.

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Expert Consensus

#### DESCRIPTION OF METHODS USED TO FORMULATE THE RECOMMENDATIONS

**Committee Appointment**

Beginning with the 1985 edition, the Department of Health and Human
Services (HHS) and the Department of Agriculture (USDA) have appointed a
Dietary Guidelines Advisory Committee (DGAC) of prominent experts in
nutrition and health to assist in the preparation of the *Dietary
Guidelines for Americans*. This Committee has been an effective
mechanism to obtain a competent review of the science, recommendations
from experts, and broad public acceptance of the *Dietary Guidelines*.
The 2005 DGAC was established for the single, time-limited task of
reviewing the 2000 edition of *Nutrition and Your Health: Dietary
Guidelines for Americans* and determining if, on the basis of current
scientific and medical knowledge, revision was warranted. The Committee
determined that a revision was warranted and developed nutrition and
health recommendations in this report to the Secretaries of HHS and
USDA. The Committee was dissolved upon delivery of this report.

**Charge to the 2005 DGAC**

The *Dietary Guidelines for Americans* provides science-based eating and
physical activity advice for healthy Americans over age 2 years. The
DGAC shall advise the Secretaries of HHS and USDA whether revisions to
the 2000 edition of *Nutrition and Your Health: Dietary Guidelines for
Americans* are warranted on the basis of the preponderance of the
scientific and medical knowledge currently available.

The Committee, whose duties are solely advisory and time-limited, will
perform the following functions:

-   If the Committee decides that no changes are necessary, it will so
    inform the Secretaries of the Departments. This action will
    terminate the DGAC.

-   If the Committee decides that changes are warranted on the basis of
    the preponderance of the scientific and medical knowledge, the
    Committee will determine what issues for change need to be
    addressed.

-   The focus of the Committee should be on the review of the new
    scientific evidence.

-   The Committee shall make and submit its technical recommendations
    and the rationale for these recommendations in a report to the
    Secretaries. The Committee\'s focus should be its recommendations
    and the supporting science rather than translating the
    recommendations into a communication document.

-   Upon the submittal of the Committee\'s recommendations, the DGAC
    will be terminated.

**The Committee Process**

The Committee served without pay and worked under the regulations of the
Federal Advisory Committee Act. It held public meetings, announced in
the *Federal Register*, in Washington, DC, in September 2003 and in
January, March, May, and August 2004. Meeting summaries are available at
[www.health.gov/dietaryguidelines](http://www.health.gov/dietaryguidelines).

To promote a fresh examination of the science base for dietary guidance,
the content areas to be addressed differed somewhat from the topics of
the 10 guidelines in the 2000 *Dietary Guidelines*. In particular, the
workload was divided and managed by subcommittees on nutrient adequacy,
carbohydrates, fats, fluid and electrolytes, energy, ethanol, and food
safety. Midway through the effort, a macronutrient subcommittee was
appointed to address some crosscutting topics, and a subcommittee was
formed to address fruits and vegetables, grains, milk, and milk
products. To aid in coordination and communication, a lead Committee
member was appointed for each subcommittee, but the conclusions reached
reflected the consensus of the entire group. One or more designated
staff members from HHS or USDA assisted each subcommittee.

The Science Review Subcommittee was formed to help maintain consistent
standards for the reviews across subcommittees. The Subcommittee also
addressed quality standards for the entire process, including
consideration of the format of the report to the Secretaries,
integration of the various subcommittees\' work into a cohesive
document, and meeting plans.

The subcommittees communicated by conference call, e-mail, and
face-to-face meetings. Each subcommittee was responsible for presenting
the basis for its conclusions and recommendations to the full Committee,
responding to questions, and making changes if indicated. To gain
perspectives for interpreting the science, some subcommittees invited
experts to respond to specific questions during conference calls. The
full Committee heard presentations from 12 invited experts, who
addressed questions posed by the Committee in advance and responded to
additional questions during the meeting. The conclusions in this report
reflect the consensus of the entire Committee.

**Preparation of Conclusive Statements**

For each research question, subcommittees prepared a brief document that
included a conclusion that specifically addressed the research question,
a list of key sources, and a summary of key studies and findings. The
subcommittee presented draft summary statements to the Dietary
Guidelines Advisory Committee (DGAC) for consideration. Members of the
Committee who were not members of the subcommittee were also assigned to
review the statements and provide in-depth critical review. For
especially controversial topics, the entire Committee examined the key
published evidence on which a conclusion was based. At the May and
August meetings, the whole Committee voted on the wording of each
conclusion.

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

Not applicable

#### COST ANALYSIS

A formal cost analysis was not performed and published cost analyses
were not reviewed.

#### METHOD OF GUIDELINE VALIDATION

External Peer Review

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

Written public comments were received throughout the Committee\'s
deliberations. Those received before August 10, 2004, were shared with
all Committee members. In response to a solicitation for oral comments,
31 organizations or individuals presented oral testimony during the
January 28-29, 2004, meeting of the Committee. These comments are
summarized in the January Public Meeting Summary
(<http://www.health.gov/dietaryguidelines>). Comments are available for
examination at the Office of Disease Prevention and Health Promotion,
1101 Wootton Parkway, Suite LL100, Rockville, MD, 20852.

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

**Adequate Nutrients within Calorie Needs: Key Recommendations**

-   Consume a variety of nutrient-dense foods and beverages within and
    among the basic food groups while choosing foods that limit the
    intake of saturated and trans-fats, cholesterol, added sugars, salt,
    and alcohol.

-   Meet recommended intakes within energy needs by adopting a balanced
    eating pattern, such as the U.S. Department of Agriculture (USDA)
    Food Guide or the Dietary Approaches to Stop Hypertension (DASH)
    Eating Plan.

**Key Recommendations for Specific Population Groups**

-   *People over age 50*. Consume vitamin B12 in its crystalline form
    (i.e., fortified foods or supplements).

-   *Women of childbearing age who may become pregnant*. Eat foods high
    in heme-iron and/or consume iron-rich plant foods or iron-fortified
    foods with an enhancer of iron absorption, such as vitamin C-rich
    foods.

-   *Women of childbearing age who may become pregnant and those in the
    first trimester of pregnancy*. Consume adequate synthetic folic acid
    daily (from fortified foods or supplements) in addition to food
    forms of folate from a varied diet.

-   *Older adults, people with dark skin, and people exposed to
    insufficient ultraviolet band radiation (i.e., sunlight)*. Consume
    extra vitamin D from vitamin D-fortified foods and/or supplements.

**Weight Management: Key Recommendations**

-   To maintain body weight in a healthy range, balance calories from
    foods and beverages with calories expended.

-   To prevent gradual weight gain over time, make small decreases in
    food and beverage calories and increase physical activity.

**Key Recommendations for Specific Population Groups**

-   *Those who need to lose weight*. Aim for a slow, steady weight loss
    by decreasing calorie intake while maintaining an adequate nutrient
    intake and increasing physical activity.

-   *Overweight children*. Reduce the rate of body weight gain while
    allowing growth and development. Consult a healthcare provider
    before placing a child on a weight-reduction diet.

-   *Pregnant women*. Ensure appropriate weight gain as specified by a
    healthcare provider.

-   *Breastfeeding women*. Moderate weight reduction is safe and does
    not compromise weight gain of the nursing infant.

-   *Overweight adults and overweight children with chronic diseases
    and/or on medication*. Consult a healthcare provider about weight
    loss strategies prior to starting a weight-reduction program to
    ensure appropriate management of other health conditions.

**Physical Activity: Key Recommendations**

-   Engage in regular physical activity and reduce sedentary activities
    to promote health, psychological well-being, and a healthy body
    weight.

    -   To reduce the risk of chronic disease in adulthood: Engage in at
        least 30 minutes of moderate-intensity physical activity, above
        usual activity, at work or home on most days of the week.

    -   For most people, greater health benefits can be obtained by
        engaging in physical activity of more vigorous intensity or
        longer duration.

    -   To help manage body weight and prevent gradual, unhealthy body
        weight gain in adulthood: Engage in approximately 60 minutes of
        moderate- to vigorous-intensity activity on most days of the
        week while not exceeding caloric intake requirements.

    -   To sustain weight loss in adulthood: Participate in at least 60
        to 90 minutes of daily moderate-intensity physical activity
        while not exceeding caloric intake requirements. Some people may
        need to consult with a healthcare provider before participating
        in this level of activity.

-   Achieve physical fitness by including cardiovascular conditioning,
    stretching exercises for flexibility, and resistance exercises or
    calisthenics for muscle strength and endurance.

**Key Recommendations for Specific Population Groups**

-   *Children and adolescents*. Engage in at least 60 minutes of
    physical activity on most, preferably all, days of the week.

-   *Pregnant women*. In the absence of medical or obstetric
    complications, incorporate 30 minutes or more of moderate-intensity
    physical activity on most, if not all, days of the week. Avoid
    activities with a high risk of falling or abdominal trauma.

-   *Breastfeeding women*. Be aware that neither acute nor regular
    exercise adversely affects the mother\'s ability to successfully
    breastfeed.

-   *Older adults*. Participate in regular physical activity to reduce
    functional declines associated with aging and to achieve the other
    benefits of physical activity identified for all adults.

**Food Groups to Encourage: Key Recommendations**

-   Consume a sufficient amount of fruits and vegetables while staying
    within energy needs. Two cups of fruit and 2 1/2 cups of vegetables
    per day are recommended for a reference 2,000-calorie intake, with
    higher or lower amounts depending on the calorie level.

-   Choose a variety of fruits and vegetables each day. In particular,
    select from all five vegetable subgroups (dark green, orange,
    legumes, starchy vegetables, and other vegetables) several times a
    week.

-   Consume 3 or more ounce-equivalents of whole-grain products per day,
    with the rest of the recommended grains coming from enriched or
    whole-grain products. In general, at least half the grains should
    come from whole grains.

-   Consume 3 cups per day of fat-free or low-fat milk or equivalent
    milk products.

**Key Recommendations for Specific Population Groups**

-   *Children and adolescents*. Consume whole-grain products often; at
    least half the grains should be whole grains. Children 2 to 8 years
    should consume 2 cups per day of fat-free or low-fat milk or
    equivalent milk products. Children 9 years of age and older should
    consume 3 cups per day of fat-free or low-fat milk or equivalent
    milk products.

**Fats: Key Recommendations**

-   Consume less than 10 percent of calories from saturated fatty acids
    and less than 300 mg/day of cholesterol, and keep trans-fatty acid
    consumption as low as possible.

-   Keep total fat intake between 20 to 35 percent of calories, with
    most fats coming from sources of polyunsaturated and monounsaturated
    fatty acids, such as fish, nuts, and vegetable oils.

-   When selecting and preparing meat, poultry, dry beans, and milk or
    milk products, make choices that are lean, low-fat, or fat-free.

-   Limit intake of fats and oils high in saturated and/or trans-fatty
    acids, and choose products low in such fats and oils.

**Key Recommendations for Specific Population Groups**

-   *Children and adolescents*. Keep total fat intake between 30 to 35
    percent of calories for children 2 to 3 years of age and between 25
    to 35 percent of calories for children and adolescents 4 to 18 years
    of age, with most fats coming from sources of polyunsaturated and
    monounsaturated fatty acids, such as fish, nuts, and vegetable oils.

**Carbohydrates: Key Recommendations**

-   Choose fiber-rich fruits, vegetables, and whole grains often.

-   Choose and prepare foods and beverages with little added sugars or
    caloric sweeteners, such as amounts suggested by the U.S. Department
    of Agriculture Food Guide and the Dietary Approaches to Stop
    Hypertension Eating Plan.

-   Reduce the incidence of dental caries by practicing good oral
    hygiene and consuming sugar- and starch-containing foods and
    beverages less frequently.

**Sodium and Potassium: Key Recommendations**

-   Consume less than 2,300 mg (approximately 1 tsp of salt) of sodium
    per day.

-   Choose and prepare foods with little salt. At the same time, consume
    potassium-rich foods, such as fruits and vegetables.

**Key Recommendations for Specific Population Groups**

-   *Individuals with hypertension, blacks, and middle-aged and older
    adults*. Aim to consume no more than 1,500 mg of sodium per day, and
    meet the potassium recommendation (4,700 mg/day) with food.

**Alcoholic Beverages: Key Recommendations**

-   Those who choose to drink alcoholic beverages should do so sensibly
    and in moderation-defined as the consumption of up to one drink per
    day for women and up to two drinks per day for men.

-   Alcoholic beverages should not be consumed by some individuals,
    including those who cannot restrict their alcohol intake, women of
    childbearing age who may become pregnant, pregnant and lactating
    women, children and adolescents, individuals taking medications that
    can interact with alcohol, and those with specific medical
    conditions.

-   Alcoholic beverages should be avoided by individuals engaging in
    activities that require attention, skill, or coordination, such as
    driving or operating machinery.

**Food Safety: Key Recommendations**

-   To avoid microbial foodborne illness:

    -   Clean hands, food contact surfaces, and fruits and vegetables.
        Meat and poultry should not be washed or rinsed.

    -   Separate raw, cooked, and ready-to-eat foods while shopping,
        preparing, or storing foods.

    -   Cook foods to a safe temperature to kill microorganisms.

    -   Chill (refrigerate) perishable food promptly and defrost foods
        properly.

    -   Avoid raw (unpasteurized) milk or any products made from
        unpasteurized milk, raw or partially cooked eggs or foods
        containing raw eggs, raw or undercooked meat and poultry,
        unpasteurized juices, and raw sprouts.

**Key Recommendations for Specific Population Groups**

-   *Infants and young children, pregnant women, older adults, and those
    who are immunocompromised*. Do not eat or drink raw (unpasteurized)
    milk or any products made from unpasteurized milk, raw or partially
    cooked eggs or foods containing raw eggs, raw or undercooked meat
    and poultry, raw or undercooked fish or shellfish, unpasteurized
    juices, and raw sprouts.

-   *Pregnant women, older adults, and those who are immunocompromised*:
    Only eat certain deli meats and frankfurters that have been reheated
    to steaming hot.

#### CLINICAL ALGORITHM(S)

None Provided

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of evidence supporting the recommendations is not specifically
stated.

The primary types of studies used were observational studies and
clinical trials. Specific types of observational studies were
cross-sectional studies, case-control studies, and cohort studies. The
Committee placed greatest emphasis on results from cohort studies and
trials with well-accepted, clinically relevant outcomes. Meta-analyses
also were considered. The majority of studies evaluated were based on
adults; there were limited studies on children.

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

-   There is a growing body of evidence which demonstrates that
    following a diet that complies with the Dietary Guidelines may
    reduce the risk of chronic disease.

-   Recently, it was reported that dietary patterns consisted with
    recommended dietary guidance were associated with a lower risk of
    mortality among individuals age 45 years and older in the United
    States.

-   Maintenance of good physical fitness enables one to meet the
    physical demands of work and leisure comfortably. People with higher
    levels of physical fitnesses are also at lower risk of developing
    chronic disease.

#### POTENTIAL HARMS

Not stated

### QUALIFYING STATEMENTS

#### QUALIFYING STATEMENTS

Because the recommendations are interrelated and mutually dependent, the
statements in this publication should be used together in the context of
an overall healthful diet. Likewise, because the Dietary Guidelines
contains discussions about emerging science, only statements included in
the Executive Summary and the highlighted boxes entitled \"Key
Recommendations,\" which reflect the preponderance of scientific
evidence, can be used for identification of authoritative statements.

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

**Development of Educational Materials and Communications**

The information in the *Dietary Guidelines* is useful for the
development of educational materials. For example, the federal dietary
guidance-related publications are required by law to be based on the
*Dietary Guidelines*. In addition, this publication will guide the
development of messages to communicate the *Dietary Guidelines* to the
public. Finally, the United States Department of Agriculture Food Guide,
the food label, and Nutrition Facts Panel provide information that is
useful for implementing the key recommendations in the *Dietary
Guidelines* and should be integrated into educational and communication
messages.

**Development of Nutrition-Related Programs**

The *Dietary Guidelines* aids policymakers in designing and implementing
nutrition-related programs. The Federal Government bases its nutrition
programs, such as the National Child Nutrition Programs or the Elderly
Nutrition Program, on the *Dietary Guidelines*.

**Development of Authoritative Statements**

The *Dietary Guidelines* has the potential to provide authoritative
statements as provided for in the Food and Drug Administration
Modernization Act (FDAMA). Because the recommendations are interrelated
and mutually dependent, the statements in this publication should be
used together in the context of an overall healthful diet. Likewise,
because the *Dietary Guidelines* contains discussions about emerging
science, only statements included in the Executive Summary and the
highlighted boxes entitled \"Key Recommendations,\" which reflect the
preponderance of scientific evidence, can be used for identification of
authoritative statements.

#### IMPLEMENTATION TOOLS

Foreign Language Translations\
Patient Resources\
Resources

For information about
[availability](#identifying-information-and-availability), see the
\"Availability of Companion Documents\" and \"Patient Resources\" fields
below.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Staying Healthy

#### IOM DOMAIN

Effectiveness\
Patient-centeredness

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

U.S. Department of Health and Human Services, U.S. Department of
Agriculture. Dietary guidelines for Americans, 2005. Washington (DC):
U.S. Department of Health and Human Services, U.S. Department of
Agriculture; 2005. 71 p.

#### ADAPTATION

Not applicable: The guideline was not adapted from another source.

#### DATE RELEASED

2005

#### GUIDELINE DEVELOPER(S)

Department of Agriculture (U.S.) - Federal Government Agency \[U.S.\]\
Department of Health and Human Services (U.S.) - Federal Government
Agency \[U.S.\]

#### SOURCE(S) OF FUNDING

United States Government

#### GUIDELINE COMMITTEE

Dietary Guidelines Advisory Committee

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

Janet C. King, PhD, RD (*chair*); Lawrence J. Appel, MD, MPH; Benjamin
Caballero, MD, PhD; Fergus M. Clydesdale, PhD; Penny M. Kris-Etherton,
PhD, RD; Theresa A. Nicklas, DrPH, MPH, LN; F. Xavier Pi-Sunyer, MD,
MPH; Yvonne L. Bronner, ScD, RD, LD; Carlos A. Camargo, MD, DrPH; Vay
Liang W. Go, MD; Joanne R. Lupton, PhD; Russell R. Pate, PhD; Connie M.
Weaver, PhD

*Scientific writer/editor*: Carol Suitor, ScD

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

The Committee served without pay and worked under the regulations of the
Federal Advisory Committee Act.

#### GUIDELINE STATUS

This is the current release of the guideline.

#### GUIDELINE AVAILABILITY

Electronic copies: Available from the [Healthier US Web
site](http://www.healthierus.gov/dietaryguidelines/).

#### AVAILABILITY OF COMPANION DOCUMENTS

The following are available:

-   Dietary guidelines for Americans, 2005. Executive summary.
    Washington (DC): U.S. Department of Health and Human Services, U.S.
    Department of Agriculture; 2005. 5 p. Available in English and
    Spanish in Portable Document Format from the [Healthier US Web
    site](http://www.healthierus.gov/dietaryguidelines/).

-   Adult energy needs and body mass index (BMI) calculator. U.S.
    Department of Agriculture/Agricultural Research Service. Available
    online from the [Healthier US Web
    site](http://www.healthierus.gov/dietaryguidelines/).

-   Facts about the DASH eating plan. Washington (DC): U.S. Department
    of Health and Human Services; 2003. 24 p. Available in Portable
    Document Format (PDF) from the [Healthier US Web
    site](http://www.healthierus.gov/dietaryguidelines/).

-   The food guide pyramid. Washington (DC): U.S. Department of
    Agriculture; 1996. 29 p. Available in English or Spanish in Portable
    Document Format (PDF) from the [Healthier US Web
    site](http://www.healthierus.gov/dietaryguidelines/). See the
    related QualityTool summary on the [Health Care Innovations Exchange
    Web site](http://innovations.ahrq.gov/content.aspx?id=1278).

-   General physical activity defined by level of intensity. Centers for
    Disease Control and Prevention. 5 p. Available in Portable Document
    Format (PDF) from the [Healthier US Web
    site](http://www.healthierus.gov/dietaryguidelines/).

-   2005 Dietary Guidelines Advisory Committee report. Electronic copies
    available from the [U.S. Department of Health and Human Services Web
    site](http://www.health.gov/dietaryguidelines/dga2005/report/). See
    the related QualityTool summary on the [Health Care Innovations
    Exchange Web
    site](http://innovations.ahrq.gov/content.aspx?id=1237).

#### PATIENT RESOURCES

The following is available:

-   Finding your way to a healthier you: based on the Dietary Guidelines
    for Americans. Washington (DC): U.S. Department of Health and Human
    Services, U.S. Department of Agriculture, 2005. 12 p.

Electronic copies available in Portable Document Format (PDF) from the
[Healthier US Web site](http://www.healthierus.gov/dietaryguidelines/).
See the related QualityTool summary on the [Health Care Innovations
Exchange Web site](http://innovations.ahrq.gov/content.aspx?id=671).

Please note: This patient information is intended to provide health
professionals with information to share with their patients to help them
better understand their health and their diagnosed disorders. By
providing access to this patient information, it is not the intention of
NGC to provide specific medical advice for particular patients. Rather
we urge patients and their representatives to review this material and
then to consult with a licensed health professional for evaluation of
treatment options suitable for them as well as for diagnosis and answers
to their personal medical questions. This patient information has been
derived and prepared from a guideline for health care professionals
included on NGC by the authors or publishers of that original guideline.
The patient information is not reviewed by NGC to establish whether or
not it accurately reflects the original guideline\'s content.

#### NGC STATUS

This NGC summary was completed by ECRI on February 11, 2005.

#### COPYRIGHT STATEMENT

No copyright restrictions apply.

### DISCLAIMER

#### NGC DISCLAIMER

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© 1998-2008 National Guideline Clearinghouse

Date Modified: 11/3/2008