Dietary
Guidelines
for Americans

2020 - 2025

Make Every
Bite Count With
the Dietary
Guidelines

DietaryGuidelines.gov

This publication may be viewed and downloaded from the internet at
DietaryGuidelines.gov.
Suggested citation: U.S. Department of Agriculture and U.S. Department of
Health and Human Services. Dietary Guidelines for Americans, 2020-2025.
9th Edition. December 2020. Available at DietaryGuidelines.gov.
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December 2020

Dietary
Guidelines
for Americans

2020 - 2025
Make Every Bite
Count With theDietary Guidelines
Ninth Edition • DietaryGuidelines.gov

Table of Contents
Message From the Secretaries����������������������������������������v
Acknowledgments�������������������������������������������������������������� vi
Executive Summary����������������������������������������������������������� vii
Introduction�������������������������������������������������������������������������������1
Setting the Stage������������������������������������������������������������������� 3
Grounded in Science and Focused on
Public Health �������������������������������������������������������������������� 3
A Spotlight on Dietary Patterns������������������������������������� 6
Healthy Dietary Patterns at Every Life Stage������������� 6
Dietary Guidelines for Americans:
What It Is, What It Is Not������������������������������������������������������ 7
Quantitative Guidance on Foods,
Not Nutrient Requirements�������������������������������������������� 7
Health Promotion, Not Disease Treatment���������������� 7
Developing the Dietary Guidelines for Americans����������� 7
Stage 1: Identify Topics and Supporting
Scientific Questions �������������������������������������������������������� 8
Stage 2: Appoint a Dietary Guidelines Advisory
Committee To Review Current Scientific Evidence � 8
Stage 3: Develop the Dietary Guidelines��������������������11
Stage 4: Implement the Dietary Guidelines���������������12
A Roadmap to the Dietary Guidelines
for Americans, 2020-2025��������������������������������������������������14
Chapter 1: Nutrition and Health Acrossthe Lifespan: The Guidelines and Key
Recommendations������������������������������������������������������������ 15
The Guidelines���������������������������������������������������������������������17
Guideline 1: Follow a Healthy Dietary Pattern at
Every Life Stage�������������������������������������������������������������������19
What Is a Dietary Pattern?��������������������������������������������19
The Health Benefits of a Healthy Dietary Pattern���23
A Healthy Dietary Pattern Supports
Appropriate Calorie Levels�������������������������������������������23
Most Americans Do Not Follow a
Healthy Dietary Pattern�������������������������������������������������26
Guideline 2: Customize and Enjoy Food andBeverage Choices To Reflect
Personal Preferences, Cultural Traditions,and Budgetary Considerations�����������������������������������������27
Guideline 3: Focus on Meeting Food Group Needs
With Nutrient-Dense Foods and Beverages,
and Stay Within Calorie Limits�����������������������������������������30
Page i | Dietary Guidelines for Americans, 2020-2025

Vegetables ����������������������������������������������������������������������31
Fruits���������������������������������������������������������������������������������32
Grains�������������������������������������������������������������������������������32
Dairy and Fortified Soy Alternatives���������������������������33
Protein Foods������������������������������������������������������������������33
Oils������������������������������������������������������������������������������������35
Beverages������������������������������������������������������������������������35
Dietary Components of Public Health
Concern for Underconsumption���������������������������������36
Guideline 4: Limit Foods and Beverages
Higher in Added Sugars, Saturated Fat, andSodium, and Limit Alcoholic Beverages������������������������37
Added Sugars�����������������������������������������������������������������41
Saturated Fat������������������������������������������������������������������44
Sodium�����������������������������������������������������������������������������46
Alcoholic Beverages������������������������������������������������������49
Support Healthy Dietary Patternsfor All Americans�����������������������������������������������������������������50
Looking Toward the Life Stages��������������������������������������50
Chapter 2: Infants and Toddlers��������������������������������� 51
Introduction��������������������������������������������������������������������������53
Putting the Key Recommendations Into Action�����������54
Feed Infants Human Milk for the First
6 Months, If Possible�����������������������������������������������������54
Provide Infants Supplemental Vitamin D
Beginning Soon After Birth�������������������������������������������56
Introduce Infants to Nutrient-Dense
Complementary Foods at About 6 Months Old������56
Introduce Infants to Potentially Allergenic Foods
Along With Other Complementary Foods�����������������58
Encourage Infants and Toddlers To Consume a
Variety of Complementary Foods andBeverages To Meet Energy and Nutrient Needs�����59
Establish a Healthy Beverage Pattern����������������������61
Healthy Dietary Pattern During a
Toddler's Second Year of Life�������������������������������������������63
Current Intakes��������������������������������������������������������������������65
Supporting Healthy Eating������������������������������������������������67
Accessing a Healthy Dietary Pattern�������������������������68
Looking Toward Chapter 3:
Children and Adolescents�������������������������������������������������68

Chapter 3: Children and Adolescents��������������������� 69
Introduction��������������������������������������������������������������������������71
Healthy Dietary Patterns���������������������������������������������������� 72
Current Intakes�������������������������������������������������������������������� 75
Special Considerations������������������������������������������������������ 87
Sugar-Sweetened Beverages ������������������������������������� 87

Chapter 6: Older Adults ������������������������������������������������� 121
Introduction������������������������������������������������������������������������123
Healthy Dietary Patterns��������������������������������������������������124
Current Intakes������������������������������������������������������������������126
Special Considerations����������������������������������������������������128
Protein����������������������������������������������������������������������������128

Dairy and Fortified Soy Alternatives��������������������������� 88

Vitamin B12���������������������������������������������������������������������128

Adolescent Nutrition������������������������������������������������������ 88

Beverages����������������������������������������������������������������������129

Supporting Healthy Eating������������������������������������������������ 89
Accessing a Healthy Dietary Pattern������������������������� 90

Supporting Healthy Eating����������������������������������������������129
Healthy Eating Through the Lifespan���������������������������130

Looking Toward Chapter 4: Adults���������������������������������� 90
Chapter 4: Adults����������������������������������������������������������������91
Introduction��������������������������������������������������������������������������93
Healthy Dietary Patterns���������������������������������������������������� 95
Current Intakes�������������������������������������������������������������������� 97
Special Considerations����������������������������������������������������101
Dietary Fiber������������������������������������������������������������������101

Appendixes �������������������������������������������������������������������������� 131
Appendix 1: Nutritional Goals for Age-Sex Groups����131
Appendix 2: Estimated Calorie Needs��������������������������139
Appendix 3: USDA Dietary Patterns�������������������������������142

Calcium and Vitamin D�����������������������������������������������101
Saturated Fat����������������������������������������������������������������102
Sodium���������������������������������������������������������������������������102
Added Sugars���������������������������������������������������������������103
Alcoholic Beverages����������������������������������������������������104
Supporting Healthy Eating����������������������������������������������104
Accessing a Healthy Dietary Pattern����������������������105
Looking Toward Chapter 5:
Women Who Are Pregnant or Lactating
and Chapter 6: Older Adults��������������������������������������������106
Chapter 5: Women Who Are Pregnant
or Lactating �������������������������������������������������������������������������107
Introduction������������������������������������������������������������������������109
Healthy Dietary Patterns��������������������������������������������������110
Current Intakes������������������������������������������������������������������113
Special Considerations����������������������������������������������������115
Meeting Nutrient Needs���������������������������������������������115
Folate/Folic Acid����������������������������������������������������������115
Iron����������������������������������������������������������������������������������115
Iodine������������������������������������������������������������������������������116
Choline����������������������������������������������������������������������������117
Seafood��������������������������������������������������������������������������117
Alcoholic Beverages����������������������������������������������������117
Caffeine��������������������������������������������������������������������������118
Supporting Healthy Eating����������������������������������������������120

Dietary Guidelines for Americans, 2020-2025 — Page ii

List of Tables
Table I-1: Facts About Nutrition-Related Health
Conditions in the United States������������������������������������������ 5
Table 1-1: Healthy U.S.-Style Dietary Pattern at the
2,000-Calorie Level, With Daily or Weekly Amounts
From Food Groups, Subgroups, and Components������� 20
Table 2-1: Healthy U.S.-Style Dietary Pattern for
Toddlers Ages 12 Through 23 Months Who Are No
Longer Receiving Human Milk or Infant Formula,With Daily or Weekly Amounts From Food Groups,
Subgroups, and Components������������������������������������������� 64
Table 2-2: Signs a Child is Hungry or Full���������������������� 67
Table 3-1: Healthy U.S.-Style Dietary Pattern forChildren Ages 2 Through 8, With Daily or
Weekly Amounts From Food Groups, Subgroups,
and Components����������������������������������������������������������������� 74
Table 3-2: Healthy U.S.-Style Dietary Pattern forChildren and Adolescents Ages 9 Through 13,
With Daily or Weekly Amounts From Food Groups,
Subgroups, and Components������������������������������������������� 81
Table 3-3: Healthy U.S.-Style Dietary Pattern for
Adolescents Ages 14 Through 18,
With Daily or Weekly Amounts From Food Groups,
Subgroups, and Components������������������������������������������� 84
Table 4-1: Healthy U.S.-Style Dietary Pattern for Adults
Ages 19 Through 59, With Daily or Weekly Amounts
From Food Groups, Subgroups, and Components������� 96
Table 5-1: Healthy U.S.-Style Dietary Pattern for
Women Who Are Pregnant or Lactating,With Daily or Weekly Amounts From Food Groups,
Subgroups, and Components�����������������������������������������111
Table 5-2: Estimated Change in Calorie Needs
During Pregnancy and Lactation for WomenWith a Healthy Prepregnancy Weight����������������������������112
Table 5-3: Weight Gain Recommendations
for Pregnancy���������������������������������������������������������������������112
Table 6-1: Healthy U.S.-Style Dietary Pattern for Adults
Ages 60 and Older, With Daily or Weekly Amounts
From Food Groups, Subgroups, and Components�����125

Page iii | Dietary Guidelines for Americans, 2020-2025

Table A1-1: Daily Nutritional Goals,
Ages 6 Through 11 Months and
12 Through 23 Months�����������������������������������������������������131
Table A1-2: Daily Nutritional Goals,
Ages 2 and Older���������������������������������������������������������������133
Table A1-3: Daily Nutritional Goals for Women
Who Are Pregnant, by Age Group and Trimester��������135
Table A1-4: Daily Nutritional Goals for Women
Who Are Lactating, by Age Group andMonths Postpartum����������������������������������������������������������137
Table A2-1: Estimated Calorie Needs per Day,by Age and Sex, Ages 12 Through 23 Months�������������139
Table A2-2: Estimated Calorie Needs per Day,by Age, Sex, and Physical Activity Level,
Ages 2 and Older���������������������������������������������������������������141
Table A2-3: Estimated Change in Calorie Needs
During Pregnancy and Lactation for Women With a
Healthy Prepregnancy Weight����������������������������������������141
Table A3-1: Healthy U.S.-Style Dietary Pattern for
Toddlers Ages 12 Through 23 Months Who Are No
Longer Receiving Human Milk or Infant Formula,With Daily or Weekly Amounts From Food Groups,
Subgroups, and Components�����������������������������������������143
Table A3-2: Healthy U.S.-Style Dietary Pattern forAges 2 and Older, With Daily or Weekly Amounts
From Food Groups, Subgroups, and Components�����144
Table A3-3: Healthy Vegetarian Dietary Pattern for
Toddlers Ages 12 Through 23 Months Who Are
No Longer Receiving Human Milk or Infant Formula,With Daily or Weekly Amounts From Food Groups,
Subgroups, and Components�����������������������������������������147
Table A3-4: Healthy Vegetarian Dietary Pattern forAges 2 and Older, With Daily or Weekly Amounts
From Food Groups, Subgroups, and Components�����148
Table A3-5: Healthy Mediterranean-Style Dietary
Pattern for Ages 2 and Older, With Daily or
Weekly Amounts From Food Groups, Subgroups,
and Components���������������������������������������������������������������149

List of Figures
Figure I-1: Adherence of the U.S. Population to theDietary Guidelines Over Time, as Measured by the
Average Total Healthy Eating Index-2015 Scores����������� 4
Figure 1-1: Examples of Calories in Food Choices
That Are Not Nutrient Dense and Calories in
Nutrient-Dense Forms of These Foods �������������������������� 21
Figure 1-2: Making Nutrient-Dense Choices:
One Food or Beverage At a Time�������������������������������������� 22
Figure 1-3: The Science Underlying the Dietary
Guidelines Demonstrates That Healthy Eating
Across the Lifespan Can Promote Health andReduce Risk of Chronic Disease��������������������������������������� 24
Figure 1-4: Adherence of the U.S. Population to theDietary Guidelines Across Life Stages, as Measured
by Average Total Healthy Eating Index-2015 Scores���� 26
Figure 1-5: Customizing the Dietary Guidelines
Framework���������������������������������������������������������������������������� 28
Figure 1-6: Dietary Intakes Compared to
Recommendations: Percent of the U.S. Population
Ages 1 and Older Who Are Below and At or Above
Each Dietary Goal���������������������������������������������������������������� 30
Figure 1-7: The 85-15 Guide: Percentage of Calories
Needed To Meet Food Group Needs With NutrientDense Choices and Percentage Left for Other Uses���� 37
Figure 1-8: Making Nutrient-Dense Choices:
One Meal At a Time������������������������������������������������������������� 38
Figure 1-9: Making Healthy Choices:
One Day At a Time��������������������������������������������������������������� 39
Figure 1-10: Top Sources and Average Intakes of
Added Sugars: U.S. Population Ages 1 and Older��������� 43
Figure 1-11: Top Sources and Average Intakes ofSaturated Fat: U.S. Population Ages 1 and Older���������� 45
Figure 1-12: Top Sources and Average Intakes of
Sodium: U.S. Population Ages 1 and Older�������������������� 47
Figure 2-1: Make Healthy Shifts To Empower
Toddlers To Eat Nutrient-Dense Foods in
Dietary Patterns������������������������������������������������������������������� 63
Figure 2-2: Current Intakes:
Ages 12 Through 23 Months��������������������������������������������� 65
Figure 2-3: Average Intakes of Subgroups
Compared to Recommended Intake Ranges:
Ages 12 Through 23 Months��������������������������������������������� 66

Figure 3-1: Healthy Eating Index Scores AcrossChildhood and Adolescence���������������������������������������������� 75
Figure 3-2: Current Intakes:
Ages 2 Through 4���������������������������������������������������������������� 77
Figure 3-3: Average Intakes of Subgroups
Compared to Recommended Intake Ranges:
Ages 2 Through 4���������������������������������������������������������������� 78
Figure 3-4: Current Intakes: Ages 5 Through 8������������� 79
Figure 3-5: Average Intakes of Subgroups
Compared to Recommended Intake Ranges:
Ages 5 Through 8���������������������������������������������������������������� 80
Figure 3-6: Current Intakes:
Ages 9 Through 13�������������������������������������������������������������� 82
Figure 3-7: Average Intakes of Subgroups
Compared to Recommended Intake Ranges:
Ages 9 Through 13�������������������������������������������������������������� 83
Figure 3-8: Current Intakes:
Ages 14 Through 18������������������������������������������������������������ 85
Figure 3-9: Average Intakes of Subgroups
Compared to Recommended Intake Ranges:
Ages 14 Through 18������������������������������������������������������������ 86
Figure 4-1: Current Intakes:
Ages 19 Through 30������������������������������������������������������������ 97
Figure 4-2: Average Intakes of Subgroups
Compared to Recommended Intake Ranges:
Ages 19 Through 30������������������������������������������������������������ 98
Figure 4-3: Current Intakes:
Ages 31 Through 59������������������������������������������������������������ 99
Figure 4-4: Average Intakes of Subgroups
Compared to Recommended Intake Ranges:
Ages 31 Through 59����������������������������������������������������������100
Figure 5-1: Current Intakes: Women Who Are
Pregnant or Lactating�������������������������������������������������������113
Figure 5-2: Average Intakes of Subgroups
Compared to Recommended Intake Ranges:
Women Who Are Pregnant or Lactating�����������������������114
Figure 6-1: Current Intakes:
Ages 60 and Older�������������������������������������������������������������126
Figure 6-2: Average Intakes of Subgroups
Compared to Recommended Intake Ranges:
Ages 60 and Older�������������������������������������������������������������127

Dietary Guidelines for Americans, 2020-2025 — Page iv

Message From theSecretaries
We are pleased to present the Dietary Guidelines for Americans, 2020-2025. This edition marks the first time the
Guidelines provide recommendations by life stage, from birth through older adulthood.
Each stage of life is distinct and has unique needs that affect health and disease risk. Early food preferences influence
food and beverage choices later. And the science has evolved to focus on the importance of a healthy dietary patternover time. The science also shows it’s never too late to start and maintain a healthy dietary pattern, which can yield
health benefits in the short term and cumulatively over years. This new edition of the Dietary Guidelines includes
specific recommendations for all life stages, now including infants and toddlers, and pregnant and lactating women.
We are excited this is the first edition to provide guidance for every life stage.
This edition of the Dietary Guidelines is grounded in robust scientific reviews of the current body of evidence on key
nutrition and health topics for each life stage. We thank the 20 distinguished scientists on the 2020 Dietary Guidelines
Advisory Committee for their expertise and dedication in conducting an independent scientific review that wascharacterized by more transparency and public participation throughout the process than ever before. The Committee’s
work culminated in a comprehensive scientific report on the current state of nutrition science and provided advice
to the Departments for our development of this 9th edition of the Dietary Guidelines. The Committee also included
important considerations for future research, such as a need to reconsider the Dietary Reference Intakes. The U.S. andCanadian Dietary Reference Intake Steering Committees are currently developing plans to re-examine energy, protein,fat, and carbohydrate–the timeline for these macronutrient reviews has not been established. USDA and HHS arelooking forward to jointly funding the work to help guide our Departments’ research agendas in the coming years.
With the science must come practice—that is, making food and beverage choices that align with the Dietary Guidelines.
Using the new edition of the Dietary Guidelines, we hope Americans can find ways to “Start Simple” and incorporate
modest changes each day that push Americans closer to meeting the recommendations. It’s more important thanever to make healthy eating a priority in the United States. With the release of the Dietary Guidelines for Americans,
2020-2025, we have an important call to action for you as health professionals and policymakers. We are asking you tohelp the public “make every bite count with the Dietary Guidelines for Americans.” Help people make food and beveragechoices that are rich in nutrition—individual choices that can become a healthy routine over time, choices they canenjoy in good health for many years to come.
Thank you for all you do to help Americans make strides toward aligning closer to the Dietary Guidelines as we all work
together to help the public lead healthier lives.
/Sonny Perdue/
Sonny Perdue
Secretary,
U.S. Department of Agriculture

Page v | Dietary Guidelines for Americans, 2020-2025/Alex M. Azar II/
Alex M. Azar II
Secretary,
U.S. Department of Health and Human Services

Acknowledgments
The U.S. Department of Agriculture and U.S. Department of Health and Human Services acknowledge the work of
the 2020 Dietary Guidelines Advisory Committee whose recommendations informed the development of this editionof the Dietary Guidelines for Americans.

Dietary Guidelines Advisory Committee Members

Barbara Schneeman, PhD; Ronald Kleinman, MD; Jamy Ard, MD; Regan Bailey, PhD, MPH, RD; Lydia Bazzano, MD,
PhD; Carol Boushey, PhD, MPH, RD; Teresa Davis, PhD; Kathryn Dewey, PhD; Sharon Donovan, PhD, RD;
Steven Heymsfield, MD; Heather Leidy, PhD; Richard Mattes, PhD, MPH, RD; Elizabeth Mayer-Davis, PhD, RD;
Timothy Naimi, MD, MPH; Rachel Novotny, PhD, RDN, LD; Joan Sabaté, MD, DrPH; Linda Snetselaar, PhD, RDN;
Jamie Stang, PhD, MPH, RD; Elsie Taveras, MD, MPH; Linda Van Horn, PhD, RDN, LD.
The Departments also acknowledge the work of the scientists, staff, and policy officials responsible for the
production of this document.

Policy Officials

USDA: Secretary Sonny Perdue, DVM; Brandon Lipps; Pamilyn Miller; Jackie Haven, MS, RD.
HHS: Secretary Alex M. Azar II, JD; Brett P. Giroir, MD; Paul Reed, MD; Don Wright, MD, MPH (through March 2020).

Dietary Guidelines Writing Team

USDA: Eve E. Stoody, PhD; Julie Obbagy, PhD, RD; TusaRebecca Pannucci, PhD, MPH, RD; Stephenie L. Fu;
Elizabeth Rahavi, RD; Jean Altman, MS; Meghan Adler, MS, RDN; Clarissa (Claire) Brown, MS, MPH, RDN;
Kelley S. Scanlon, PhD, RD.
HHS: Janet de Jesus, MS, RD; Richard Olson, MD, MPH; Cria Perrine, PhD; Julia Quam, MSPH, RDN;
Katrina Piercy, PhD, RD; Ashley Vargas, PhD, MPH, RDN; Jennifer Lerman, MPH, RD; Dana DeSilva, PhD, RD;
Dennis Anderson-Villaluz, MBA, RD, LDN.
Editorial Support: Anne Brown Rodgers; Jane Fleming.

Reviewers

The Departments acknowledge the contributions of numerous other internal departmental scientists and external
peer reviewers who provided consultation and review during the production of this document.
Finally, the Departments would like to acknowledge the important role of the Federal staff who supported thedevelopment of this edition of the Dietary Guidelines, and of those who provided public comments throughout
the process.

Dietary Guidelines for Americans, 2020-2025 — Page vi

Executive Summary
The foods and beverages that people consume havea profound impact on their health. The scientificconnection between food and health has been well
documented for many decades, with substantial andincreasingly robust evidence showing that a healthy
lifestyle—including following a healthy dietary pattern—
can help people achieve and maintain good healthand reduce the risk of chronic diseases throughout
all stages of the lifespan: infancy and toddlerhood,childhood and adolescence, adulthood, pregnancy andlactation, and older adulthood. The core elements ofa healthy dietary pattern are remarkably consistentacross the lifespan and across health outcomes.

Research Act, which states that at least every 5 years,
the U.S. Departments of Agriculture (USDA) and of
Health and Human Services (HHS) must jointly publish
a report containing nutritional and dietary informationand guidelines for the general public. The statute(Public Law 101-445, 7 United States Code 5341 etseq.) requires that the Dietary Guidelines be based on
the preponderance of current scientific and medical
knowledge. The 2020-2025 edition of the Dietary
Guidelines builds from the 2015 edition, with revisions
grounded in the Scientific Report of the 2020 Dietary
Guidelines Advisory Committee and consideration ofFederal agency and public comments.

Since the first edition was published in 1980, the Dietary
Guidelines for Americans have provided science-based
advice on what to eat and drink to promote health,reduce risk of chronic disease, and meet nutrient needs.
Publication of the Dietary Guidelines is required underthe 1990 National Nutrition Monitoring and Related

The Dietary Guidelines is designed for policymakers
and nutrition and health professionals to help all
individuals and their families consume a healthy,
nutritionally adequate diet. The information in
the Dietary Guidelines is used to develop, implement,
and evaluate Federal food, nutrition, and health policies

Page vii | Dietary Guidelines for Americans, 2020-2025 | Executive Summaryand programs. It also is the basis for Federal nutrition
education materials designed for the public and forthe nutrition education components of USDA andHHS nutrition programs. State and local governments,
schools, the food industry, other businesses,
community groups, and media also use Dietary
Guidelines information to develop programs, policies,and communication for the general public.
The aim of the Dietary Guidelines is to promote healthand prevent disease. Because of this public healthorientation, the Dietary Guidelines is not intended
to contain clinical guidelines for treating chronic
diseases. Chronic diseases result from a complex
mix of genetic, biological, behavioral, socioeconomic,
and environmental factors, and people with these
conditions have unique health care requirements that
require careful oversight by a health professional. The
body of scientific evidence on diet and health reviewed
to inform the Dietary Guidelines is representative of the
U.S. population—it includes people who are healthy,
people at risk for diet-related chronic conditions anddiseases, such as cardiovascular disease, type 2
diabetes, and obesity, and some people who are livingwith one or more of these diet-related chronic illnesses.
At the same time, it is essential that Federal agencies,
medical organizations, and health professionals adapt
the Dietary Guidelines to meet the specific needs oftheir patients as part of an individual, multifaceted
treatment plan for the specific chronic disease.

Consistentand Evolving

The second is its focus on dietary patterns.
Researchers and public health experts, including
registered dietitians, understand that nutrients andfoods are not consumed in isolation. Rather, people
consume them in various combinations over time—adietary pattern—and these foods and beverages act
synergistically to affect health. The Dietary Guidelines
for Americans, 2015-2020 puts this understanding
into action by focusing its recommendations on
consuming a healthy dietary pattern. The 2020-2025
Dietary Guidelines carries forward this emphasis on theimportance of a healthy dietary pattern as a whole—rather than on individual nutrients, foods, or foodgroups in isolation.
The third is its focus on a lifespan approach. This
edition of the Dietary Guidelines highlights theimportance of encouraging healthy dietary patterns at
every life stage from infancy through older adulthood. It
provides recommendations for healthy dietary patterns
by life stage, identifying needs specific to each life stage
and considering healthy dietary pattern characteristics
that should be carried forward into the next stage oflife. For the first time since the 1985 edition, the 20202025 Dietary Guidelines includes recommendations forhealthy dietary patterns for infants and toddlers.

The Guidelines

Although many recommendations have remained
relatively consistent over time, the Dietary Guidelines
also has built upon previous editions and evolved as
scientific knowledge has grown. The Dietary Guidelines
for Americans, 2020-2025 reflects this in threeimportant ways:
The first is its recognition that diet-related chronic
diseases, such as cardiovascular disease, type 2
diabetes, obesity, and some types of cancer, are very
prevalent among Americans and pose a major publichealth problem. Today, more than half of adults
have one or more diet-related chronic diseases. As aresult, recent editions of the Dietary Guidelines havefocused on healthy individuals, as well as those withoverweight or obesity and those who are at risk ofchronic disease. A fundamental premise of the 20202025 Dietary Guidelines is that just about everyone,
no matter their health status, can benefit from shifting
food and beverage choices to better support healthy
dietary patterns.

The 2020-2025 Dietary Guidelines provides four
overarching Guidelines that encourage healthy eating
patterns at each stage of life and recognize that
individuals will need to make shifts in their food andbeverage choices to achieve a healthy pattern. The
Guidelines also explicitly emphasize that a healthy
dietary pattern is not a rigid prescription. Rather, theGuidelines are a customizable framework of coreelements within which individuals make tailored andaffordable choices that meet their personal, cultural,and traditional preferences. Several examples ofhealthy dietary patterns that translate and integrate
the recommendations in overall healthy ways to eat
are provided. The Guidelines are supported by Key
Recommendations that provide further guidance on
healthy eating across the lifespan.

Dietary Guidelines for Americans, 2020-2025 | Executive Summary | Page viii

The Guidelines

Make every bite count with the Dietary Guidelines for Americans.
Here’s how:1

Follow a healthy dietary pattern at every life stage.

At every life stage—infancy, toddlerhood, childhood, adolescence, adulthood, pregnancy, lactation, andolder adulthood—it is never too early or too late to eat healthfully.
• For about the first 6 months of life, exclusively feed infants human milk. Continue to feed infants
human milk through at least the first year of life, and longer if desired. Feed infants iron-fortified infant
formula during the first year of life when human milk is unavailable. Provide infants with supplemental
vitamin D beginning soon after birth.
• At about 6 months, introduce infants to nutrient-dense complementary foods. Introduce infants topotentially allergenic foods along with other complementary foods. Encourage infants and toddlers
to consume a variety of foods from all food groups. Include foods rich in iron and zinc, particularly for
infants fed human milk.
• From 12 months through older adulthood, follow a healthy dietary pattern across the lifespan to meet
nutrient needs, help achieve a healthy body weight, and reduce the risk of chronic disease.

2

Customize and enjoy nutrient-dense food and beverage choices to reflect
personal preferences, cultural traditions, and budgetary considerations.

A healthy dietary pattern can benefit all individuals regardless of age, race, or ethnicity, or current healthstatus. The Dietary Guidelines provides a framework intended to be customized to individual needs andpreferences, as well as the foodways of the diverse cultures in the United States.

3

Focus on meeting food group needs with nutrient-dense foods and beverages,
and stay within calorie limits.

An underlying premise of the Dietary Guidelines is that nutritional needs should be met primarily fromfoods and beverages—specifically, nutrient-dense foods and beverages. Nutrient-dense foods provide
vitamins, minerals, and other health-promoting components and have no or little added sugars, saturated
fat, and sodium. A healthy dietary pattern consists of nutrient-dense forms of foods and beverages acrossall food groups, in recommended amounts, and within calorie limits.
The core elements that make up a healthy dietary pattern include:• Vegetables of all types—dark green; red and orange; beans, peas, and lentils; starchy; andother vegetables• Fruits, especially whole fruit• Grains, at least half of which are whole grain• Dairy, including fat-free or low-fat milk, yogurt, and cheese, and/or lactose-free versions and fortified
soy beverages and yogurt as alternatives• Protein foods, including lean meats, poultry, and eggs; seafood; beans, peas, and lentils; and nuts,
seeds, and soy products• Oils, including vegetable oils and oils in food, such as seafood and nuts

Page ix | Dietary Guidelines for Americans, 2020-2025 | Executive Summary

4

Limit foods and beverages higher in added sugars, saturated fat, and sodium, andlimit alcoholic beverages.

At every life stage, meeting food group recommendations—even with nutrient-dense choices—requires mostof a person’s daily calorie needs and sodium limits. A healthy dietary pattern doesn’t have much room forextra added sugars, saturated fat, or sodium—or for alcoholic beverages. A small amount of added sugars,
saturated fat, or sodium can be added to nutrient-dense foods and beverages to help meet food group
recommendations, but foods and beverages high in these components should be limited. Limits are:• Added sugars—Less than 10 percent of calories per day starting at age 2. Avoid foods and beverages withadded sugars for those younger than age 2.
• Saturated fat—Less than 10 percent of calories per day starting at age 2.
• Sodium—Less than 2,300 milligrams per day—and even less for children younger than age 14.
• Alcoholic beverages—Adults of legal drinking age can choose not to drink, or to drink in moderation bylimiting intake to 2 drinks or less in a day for men and 1 drink or less in a day for women, when alcohol isconsumed. Drinking less is better for health than drinking more. There are some adults who should not drink
alcohol, such as women who are pregnant.

Terms to Know

Several terms are used throughout
the Dietary Guidelines and areessential to understanding the
Guidelines and putting them into
action. These terms are defined here:• Dietary pattern: It is the combination offoods and beverages that constitutes
an individual’s complete dietary intake
over time. This may be a description of acustomary way of eating or a descriptionof a combination of foods recommended
for consumption.
• Nutrient dense: Nutrient-dense foods
and beverages provide vitamins, minerals,
and other health-promoting components
and have little added sugars, saturated
fat, and sodium. Vegetables, fruits, wholegrains, seafood, eggs, beans, peas, andlentils, unsalted nuts and seeds, fat-freeand low-fat dairy products, and lean meats
and poultry—when prepared with no or little
added sugars, saturated fat, and sodium—
are nutrient-dense foods.

For most individuals, no matter their age or health status,achieving a healthy dietary pattern will require changes infood and beverage choices. Some of these changes canbe accomplished by making simple substitutions, whileothers will require greater effort to accomplish. This editionof the Dietary Guidelines presents overall guidance onchoosing nutrient-dense foods and beverages in place ofless healthy choices and also discusses special nutrition
considerations for individuals at each life stage—infants
and toddlers, children and adolescents, adults, women who
are pregnant or lactating, and older adults.
Although individuals ultimately decide what and how muchto consume, their personal relationships; the settings inwhich they live, learn, work, play, and gather; and othercontextual factors—including their ability to consistently
access healthy and affordable food—strongly influence
their choices. Health professionals, communities,businesses and industries, organizations, government,
and other segments of society all have a role to play insupporting individuals and families in making choicesthat align with the Dietary Guidelines and ensuring thatall people have access to a healthy and affordable foodsupply. Resources, including Federal programs that support
households, regardless of size and make-up, in choosing
a healthy diet and improving access to healthy food, arehighlighted throughout this edition of the Dietary Guidelines
for Americans.
Dietary Guidelines for Americans, 2020-2025 | Executive Summary | Page x

Page 1 Dietary Guidelines for Americans, 2020-2025 | Introduction

Introduction

Dietary Guidelines for Americans, 2020-2025 | Introduction | Page 2

Setting the StageT

he foods and beverages that people consume have a profound
impact on their health. The scientific connection between foodand health has been well documented for many decades, with
substantial evidence showing that healthy dietary patterns can help
people achieve and maintain good health and reduce the risk ofchronic diseases throughout all stages of the lifespan. Yet, Federal
data show that from the first edition of the Dietary Guidelines for
Americans in 1980 through today, Americans have fallen far shortof meeting its recommendations, and diet-related chronic disease
rates have risen to pervasive levels and continue to be a major publichealth concern.
The Dietary Guidelines is an important part of a complex,
multifaceted approach to promote health and reducechronic disease risk. The Dietary Guidelines provides
science-based advice on what to eat and drink topromote health, help reduce risk of chronic disease,and meet nutrient needs. The Dietary Guidelines isthe foundation of Federal food, nutrition, and healthpolicies and programs. An important audience is healthprofessionals and nutrition program administrators
who work with the general public to help themconsume a healthy and nutritionally adequate diet andestablish policies and services to support these efforts.
Comprehensive, coordinated strategies built on thescience-based foundation of the Dietary Guidelines—anda commitment to drive these strategies over time acrosssectors and settings—can help all Americans consume
healthy dietary patterns, achieve and maintain good
health, and reduce the risk of chronic diseases.

Grounded in Science and Focused on
Public Health

The U.S. Departments of Agriculture (USDA) and of
Health and Human Services (HHS) update the Dietary
Guidelines at least every 5 years, based on the current
science. A fundamental premise of the Dietary Guidelines
is that everyone, no matter their age, race, or ethnicity,
economic circumstances, or health status, can benefit
from shifting food and beverage choices to bettersupport healthy dietary patterns.

Page 3 Dietary Guidelines for Americans, 2020-2025 | Introduction

To make sure that the dietary advice provided in the
Dietary Guidelines is aimed at improving public health,
the science used to inform the Guidelines has examined
diet through a lens of health promotion and disease
prevention and considered various segments of theUnited States population, including ethnic populations
who have disproportionately and/or historically been
affected by diet-related disparities. This means thatpriority has been placed on scientific studies thatexamine the relationship between diet and health acrossall life stages, in men, women, and children from diverse
racial and ethnic backgrounds, who are healthy or at riskof chronic disease.
Over time, eating patterns in the United States haveremained far below Dietary Guidelines recommendations(Figure I-1). Concurrently, it has become increasingly
clear that diet-related chronic diseases, such as
cardiovascular disease, type 2 diabetes, obesity, liverdisease, some types of cancer, and dental caries, posea major public health problem for Americans. Today,

60 percent of adults have one or more diet-related chronic
diseases (Table I-1). Given its aim to prevent further
disease incidence by promoting health and reducing
chronic disease risk, the Dietary Guidelines focuses on
the general public, including healthy individuals, as wellas those with overweight or obesity and those who are at
risk of chronic disease. The importance of following theDietary Guidelines across all life stages has been brought
into focus even more with the emergence of COVID-19,
as people living with diet-related chronic conditions anddiseases are at an increased risk of severe illness fromthe novel coronavirus.
Grounded in the current body of scientific evidence
on diet and health that is relevant to all Americans,the Dietary Guidelines is a critically important tool for
health professionals, policymakers, and many otherprofessionals. It is designed to help people make foodand beverage choices all through life that are enjoyable
and affordable and that also promote health and help
prevent chronic disease.

Figure I-1

Adherence of the U.S. Population to the Dietary
Guidelines Over Time, as Measured by the Average Total
Healthy Eating Index-2015 Scores

Maximum Total Score = 100

100
80

56

57

59

60

59

59

0
2005-2006

2007-20082009-20102011-20122013-20142015-2016

60
40
20

NOTE: HEI-2015 total scores are out of 100 possible points. A score of 100 indicates that recommendations on average were met or
exceeded. A higher total score indicates a higher quality diet.
Data Source: Analysis of What We Eat in America, National Health and Nutrition Examination Survey (NHANES) data from 2005-2006
through 2015-2016, ages 2 and older, day 1 dietary intake data, weighted.

Dietary Guidelines for Americans, 2020-2025 | Introduction | Page 4

Table I-1

Facts About Nutrition-Related Health Conditions in the
United States
HEALTH CONDITIONSSTATISTICS• About 74% of adults are overweight or have obesity.

Overweight and Obesity• Adults ages 40 to 59 have the highest rate of obesity (43%) of any age group with adults
60 years and older having a 41% rate of obesity.
• About 40% of children and adolescents are overweight or have obesity; the rate of obesity
increases throughout childhood and teen years.
• Heart disease is the leading cause of death.
• About 18.2 million adults have coronary artery disease, the most common type of heartdisease.

Cardiovascular Disease (CVD)
and Risk Factors:• Stroke is the fifth leading cause of death.

• Coronary artery disease• Rates of hypertension and high total cholesterol are higher in adults with obesity thanthose who are at a healthy weight.

• Hypertension• Hypertension, high LDL cholesterol, and high total cholesterol are major risk factors inheart disease and stroke.

• About 45% of adults have hypertension.a• High LDL and total blood
cholesterol• More Black adults (54%) than White adults (46%) have hypertension.

• Stroke• More adults ages 60 and older (75%) than adults ages 40 to 59 (55%) have hypertension.
• Nearly 4% of adolescents have hypertension.b• More than 11% of adults have high total cholesterol, ≥240 mg/dL.
• More women (12%) than men (10%) have high total cholesterol, ≥240 mg/dL.
• 7% of children and adolescents have high total cholesterol, ≥200 mg/dL.
• Almost 11% of Americans have type 1 or type 2 diabetes.
• Almost 35% of American adults have prediabetes, and people 65 years and older havethe highest rate (48%) compared to other age groups.

Diabetes• Almost 90% of adults with diabetes also are overweight or have obesity.
• About 210,000 children and adolescents have diabetes, including 187,000 with
type 1 diabetes.
• About 6-9% of pregnant women develop gestational diabetes.

Cancer c• Breast Cancer• Colorectal Cancer• Colorectal cancer in men and breast cancer in women are among the most common
types of cancer.
• About 250,520 women will be diagnosed with breast cancer this year.
• Close to 5% of men and women will be diagnosed with colorectal cancer at some point
during their lifetime.
• More than 1.3 million people are living with colorectal cancer.
• The incidence and mortality rates are highest among those ages 65 and older for every
cancer type.
• More women (17%) than men (5%) have osteoporosis.

Bone Health andMuscle Strength• 20% of older adults have reduced muscle strength.
• Adults over 80 years, non-Hispanic Asians, and women are at the highest risk for reducedbone mass and muscle strength.

a For adults, hypertension is defined as systolic blood pressure (SBP) >130 mm Hg and/or a diastolic blood pressure (DBP) >90 mm Hg.
b For children, hypertension was defined using the 2017 American Academy of Pediatrics (AAP) Clinical Practice Guideline.
c The types of cancer included here are not a complete list of all diet- and physical activity-related cancers.

Page 5 Dietary Guidelines for Americans, 2020-2025 | Introduction

A Spotlight on Dietary Patterns

Although many of its recommendations have remained
relatively consistent over time, the Dietary Guidelines
has evolved as scientific knowledge has grown. Early
Dietary Guidelines editions used evidence that examined
the relationships between individual nutrients, foods,
and food groups and health outcomes. In recent years,
researchers, public health experts, and registereddietitians have acknowledged that nutrients andfoods are not consumed in isolation. Rather, people
consume them in various combinations over time—adietary pattern—and these foods and beverages act
synergistically to affect health.
The 2015-2020 Dietary Guidelines put this understanding
into action by focusing its recommendations on
consuming a healthy dietary pattern. The 2020-2025
Dietary Guidelines carries forward this emphasis on theimportance of a healthy dietary pattern as a whole—rather than on individual nutrients or foods in isolation.
Serving as a framework, the Guidelines’ dietary patterns
approach enables policymakers, programs, and healthprofessionals to help people personalize their foodand beverage choices to accommodate their wants
and needs, food preferences, cultural traditions andcustoms, and budgetary considerations.

Healthy Dietary Patterns at Every
Life StageThe 2020-2025 Dietary Guidelines takes the dietary
patterns approach one step further by focusing on
the importance of encouraging healthy dietary patterns
at every stage of life, from birth to older adulthood.
It provides recommendations for healthy dietary
patterns by life stage, identifying needs specific toeach life stage and considering healthy dietary patterncharacteristics that should be carried forward into thenext stage of life. And, for the first time since the 1985
edition, this edition of the Dietary Guidelines includes
recommendations for infants and toddlers as well as
continuing the emphasis on healthy dietary patterns
during pregnancy and lactation.
This approach recognizes that each life stage isdistinct—nutrient needs vary over the lifespan andeach life stage has unique implications for food andbeverage choices and disease risk. At the same time, it
recognizes an important continuity. Because early foodpreferences influence later food choices, establishing ahealthy dietary pattern early in life may have a beneficial
impact on health promotion and disease prevention
over the course of decades.
Dietary Guidelines for Americans, 2020-2025 | Introduction | Page 6

Dietary Guidelines for
Americans: What It Is,
What It Is Not

population, including healthy individuals and people
at risk of diet-related chronic conditions and diseases,
such as cardiovascular disease, type 2 diabetes, orobesity, and some people who are living with a dietrelated chronic illness.

The Dietary Guidelines translates the current scienceon diet and health into guidance to help people choose
foods and beverages that comprise a healthy andenjoyable dietary pattern—the “what” and “how much”
of foods and beverages to consume to achieve good
health, reduce risk of diet-related chronic diseases, andmeet nutrient needs. The Dietary Guidelines is just one
piece of the nutrition guidance landscape, however.
Other guidance is designed to address requirements forthe specific nutrients contained in foods and beverages
or to address treatments for individuals who have achronic disease. The following section describes therole of the Dietary Guidelines within this larger nutrition
guidance landscape.

Because of this public health orientation, the Dietary
Guidelines is not intended to be a clinical guideline
for treating chronic diseases. However, the Dietary
Guidelines often has served as a reference for Federal,
medical, voluntary, and patient care organizations
as they develop clinical nutrition guidance tailoredfor people living with a specific medical condition.
Chronic diseases result from a complex mix ofgenetic, biological, behavioral, socioeconomic, andenvironmental factors, and people with these conditions
have unique health care requirements that require
careful oversight by a health professional. Healthprofessionals can adapt the Dietary Guidelines tomeet the specific needs of their patients with chronic
diseases, as part of a multi-faceted treatment plan.

Quantitative Guidance on Foods,
Not Nutrient Requirements

Nutrient requirements are established and updated
by the National Academies of Sciences, Engineering,and Medicine. At the request of the U.S. and CanadianFederal Governments, the Academies set thequantitative requirements or limits—known as Dietary
Reference Intakes (DRI)—on nutrients, which include
macronutrients (i.e., protein, carbohydrates, and fats),
vitamins and minerals (e.g., vitamin C, iron, and sodium),and food components (e.g., dietary fiber).
Because foods provide an array of nutrients and othercomponents that have benefits for health, nutritional
needs should be met primarily through foods. Thus,
the Dietary Guidelines translates the Academies’
nutrient requirements into food and beverage
recommendations. The Dietary Guidelines recognizes,
though, that in some cases, fortified foods anddietary supplements are useful when it is not possible
otherwise to meet needs for one or more nutrients (e.g.,during specific life stages such as pregnancy).

Health Promotion, Not Disease Treatment
At its core, the Dietary Guidelines has a public healthmission—that is, health promotion and disease
prevention. Medical and nutrition professionals may
use or adapt the Dietary Guidelines to encourage theirpatients or clients to follow a healthy dietary pattern.
The body of current scientific evidence on diet andhealth reviewed to inform the Dietary Guidelines
included study participants who represent the U.S.

Page 7 Dietary Guidelines for Americans, 2020-2025 | Introduction

Developing theDietary Guidelines
for Americans
The process to develop the Dietary Guidelines has
evolved over time, in step with developments in nutrition
science, public health, and best practices in scientificreview and guidance development. USDA and HHS work
together to determine the approach for each edition.
As stipulated by law, USDA and HHS must update theDietary Guidelines at least every 5 years. The Guidelines
must be grounded in the body of scientific and medical
knowledge available at that time, not in individual
studies or individual expert opinion. In establishing theprocess for the 2020-2025 Dietary Guidelines, USDA
and HHS considered and integrated recommendations
from a comprehensive 2017 National Academies’
study, Review of the Process to Update the Dietary
Guidelines. Greater transparency figured prominently
in the Academies’ recommendations. As a result, indeveloping the 2020-2025 process, USDA and HHS
made significant changes to increase transparency andpublic participation while maintaining the core elementof scientific integrity.
One of these changes was the addition of a new stage
at the beginning of the process. Thus, the 2020-2025
process consisted of four stages: (1) identify the topics

Stage 1:

Stage 2:

Stage 3:

Stage 4:IDENTIFY Topics
and Supporting
Scientific Questions

APPOINT a Dietary
Guidelines Advisory
Committee to
Review Evidence

DEVELOP the
Dietary Guidelines

IMPLEMENT the
Dietary Guidelines

and supporting scientific questions to be examined;(2) appoint a Dietary Guidelines Advisory Committee
to review current scientific evidence; (3) develop the
new edition of the Dietary Guidelines; and (4) implement
the Dietary Guidelines through Federal programs.
The following information provides an overview of
the 4-stage process. More details are available at
DietaryGuidelines.gov.

and Federal agencies 30 days to view and provide
comments. Following review of the comments, USDA
and HHS posted the final topics and questions, alongwith the public call for nominations to the 2020
Committee. Having topics and questions identified
upfront helped inform the public’s nominations bydefining which areas of nutrition expertise were neededon the Committee.

Stage 1: Identify Topics and Supporting
Scientific Questions

Stage 2: Appoint a Dietary Guidelines
Advisory Committee To Review Current
Scientific Evidence

The Departments added a new step of identifying
topics and scientific questions to begin the processof developing the next Dietary Guidelines. This wasdone to promote a deliberate and transparent process,better define the expertise needed on the Committee,
and ensure the scientific review conducted by theCommittee would address Federal nutrition policy andprogram needs and help manage resources.
In consultation with agencies across the Federal
Government, USDA and HHS identified potential
topics and supporting scientific questions that were ofgreatest importance and relevance to Federal nutrition
programs, policies, and consumer education priorities.
Compared to all previous Dietary Guidelines processes,
the topic areas for 2020-2025 expanded due to theadded focus on infants and toddlers from birth throughage 23 months, as well as women who are pregnant.
The Agricultural Act of 2014 mandated that, beginningwith the 2020-2025 edition, the Dietary Guidelines
should expand to include dietary guidance for these
populations. Thus, the topics and questions—and areasof expertise needed on the Committee—reflected
this change.
The Departments posted the topics and questions
publicly on DietaryGuidelines.gov, allowing the public

In the second stage, the Secretaries of USDA and HHS
appointed the Committee with the single, time-limited
task of reviewing the 2015-2020 Dietary Guidelines,
examining the evidence on the selected nutritionand public health topics and scientific questions,and providing independent, science-based advice
and recommendations to USDA and HHS. The 20
nationally recognized scientific experts appointed to
the Committee represented a mix of practitioners,
epidemiologists, scientists, clinical trialists, and othersfrom every region of the United States.
The use of a Federal advisory committee is a commonlyused best practice to ensure the Federal Government
seeks sound, external scientific advice to inform
decisions. The Committee’s work concluded with its
scientific report submitted to the Secretaries of USDA
and HHS in June 2020.1 This report was not a draft of
the Dietary Guidelines; it was a scientific document thatdetailed the Committee’s evidence review and provided
advice to USDA and HHS.
The Committee was divided into six subcommittees
to conduct its work: Dietary Patterns, Pregnancy andLactation, Birth to Age 24 Months, Beverages and
Added Sugars, Dietary Fats and Seafood, and Frequency

1 Dietary Guidelines Advisory Committee. 2020. Scientific Report of the 2020 Dietary Guidelines Advisory Committee: Advisory Report to
the Secretary of Agriculture and the Secretary of Health and Human Services. U.S. Department of Agriculture, Agricultural Research Service,
Washington, DC.

Dietary Guidelines for Americans, 2020-2025 | Introduction | Page 8

of Eating. The Committee also formed one cross-cutting
working group—Data Analysis and Food Pattern Modeling—
to support work across the subcommittees.
The Committee’s work had three defining characteristics:
the use of three approaches to examine the evidence,the creation of transparent protocols before the evidence
review began, and the development of scientific review
conclusion statements for the scientific reviews conducted.
THREE APPROACHES TO EXAMINE THE EVIDENCE
The 2020 Committee used three state-of-the-art approaches
to conduct its robust and rigorous reviews:
Data analysis: Using Federal, nationally
representative data, this approach provided
insights into current eating habits of the U.S.
population and current diet-related chronic
disease rates in the United States. These data
helped make the Dietary Guidelines practical,
relevant, and achievable.
The Committee used data analysis to addressscientific questions that looked at current dietary
patterns and beverage consumption, current
intakes of food groups and nutrients, dietarycomponents of public health concern, prevalenceof nutrition-related chronic health conditions, andrelationships between eating habits and achieving
nutrient and food group recommendations.
Nutrition Evidence Systematic Review (NESR):
Systematic reviews are research projects that
follow meticulously defined protocols (i.e., plans)
to answer clearly formulated scientific questions
by searching for, evaluating, and synthesizing
all relevant, peer-reviewed studies. Systematic
reviews are considered a gold standard method to
inform development of evidence-based guidelines
by ensuring consideration of the strongest, mostappropriate body of evidence available on a topic.
USDA’s Nutrition Evidence Systematic Review is ateam of scientists who specializes in conducting
systematic reviews focused on nutrition anddisease prevention and evaluating scientificevidence on nutrition topics relevant to Federal
policy and programs. NESR used its rigorous,
protocol-driven methodology to support theCommittee in conducting its systematic reviews.
New to the 2020 process, USDA and HHS added a
step for peer review of the systematic reviews byFederal scientists.
Page 9 Dietary Guidelines for Americans, 2020-2025 | Introduction

Food pattern modeling: This type of analysis
illustrates how changes to the amounts ortypes of foods and beverages in a dietary
pattern might affect meeting nutrient needs
across the U.S. population.
The Committee used this method to assess
potential changes to the USDA Dietary
Patterns, which help meet the DRIs set by
the National Academies, while taking into
consideration current consumption in the
United States and the conclusions fromits systematic reviews. As with all foodpattern modeling for the Dietary Guidelines,
the results of the Committee’s food patternmodeling tests were interpreted in light of
two key assumptions. First, the modelingtests were based on nutrient profiles ofnutrient-dense foods in the U.S. food supply
and U.S. population-based dietary data.
Population-based patterns articulate theevidence on the relationships between dietand health in ways that might be adopted by
the U.S. public as a whole. Second, modelingtests assumed population-wide compliancewith all food intake recommendations.
As with other types of modeling, the foodpattern modeling is hypothetical and does
not predict the behaviors of individuals.
Each of these approaches had its own rigorous,
protocol-driven methodology, and each had aunique, complementary role in examining thescience. Additional detailed information is available
at DietaryGuidelines.gov and NESR.usda.gov.

TRANSPARENT PROTOCOLS FIRST, THEN REVIEWTo answer each scientific question, the Committee
first created a protocol that described how theCommittee would apply one of the three approaches
to examine the evidence related to that specificquestion. The Committee created each protocol
before examining any evidence, and, for the first time,
the protocols were posted online for the public asthey were being developed. This enabled the public
to understand how a specific scientific question
would be answered and to have the opportunity tosubmit public comments before the Committee
completed the protocols and conducted its reviewsof the scientific evidence. Detailed information on theCommittee’s review is documented in its scientificreport, which is available on DietaryGuidelines.gov.

Health Status of Participants in
Studies Included in Nutrition
Evidence Systematic Reviews

To ensure that the Dietary Guidelines promotes
the health of and reduce risk of disease among
all Americans, the evidence base that informs
the Dietary Guidelines must comprise studies
conducted with people who are representative of
the general public and must examine diet througha health promotion and disease prevention lens.
As outlined in the Committee’s systematic review
protocols, the Committee’s reviews included
studies with participants who were healthy and/or who were at risk of a chronic disease, including
participants with obesity, as well as studies
that enrolled some participants with a disease.
Because the Dietary Guidelines is not intended to
be a clinical guideline for treating chronic diseases,
the Committee excluded studies that enrolled only
patients with a disease with the intention to treat
those individuals.
In general, the majority of the reviews conducted
to inform the Dietary Guidelines included trials that
exclusively enrolled participants with overweight orobesity, or who were at high risk of cardiovasculardisease or type 2 diabetes, and observational
studies that enrolled participants from a wide
range of health and weight status, including thosewith healthy weight, overweight, or obesity. The
reviews included few studies that enrolled only
healthy participants.
Thus, the Dietary Guidelines are applicable tothe overall U.S. population, including healthy
individuals and people at risk of diet-related
chronic conditions and diseases, such as
cardiovascular disease, type 2 diabetes, andobesity. In addition, people living with a dietrelated chronic illness can benefit from a healthy
dietary pattern. The Dietary Guidelines can serve
as a reference for Federal, medical, voluntary,and patient care organizations as they develop
nutrition guidance tailored for people living with a
specific medical condition. Health professionals
can adapt the Dietary Guidelines to meet the
specific needs of their patients with chronic
diseases, as part of a multifaceted treatment plan.

Dietary Guidelines for Americans, 2020-2025 | Introduction | Page 10

CONCLUSION STATEMENTS FOR THE SCIENTIFICREVIEWS CONDUCTED
For all topics and questions, regardless of theapproach used to identify and evaluate the scientificevidence, the Committee developed conclusion
statements. Each conclusion statement provided asuccinct answer to the specific question posed. The
Committee took the strengths and limitations of theevidence base into consideration when formulatingconclusion statements.
For questions answered using NESR systematic
reviews, the conclusion statements included a grade
to indicate the strength of the evidence supportingthe conclusion statement. The grades were Strong,
Moderate, Limited, or Grade Not Assignable.

Grading the strength of the evidence applied only toquestions answered using NESR systematic reviews;
it did not apply to questions answered using data
analysis or food pattern modeling. Therefore, data
analysis and food pattern modeling conclusion
statements were not graded.
As it completed its work, the Committee looked
across all of the conclusion statements to develop
overarching advice for USDA and HHS to consider as
the Departments developed the next edition of theDietary Guidelines.
Using these three approaches, the Committee worked
collaboratively for 16 months and deliberated on thescientific reviews in six meetings, all of which wereopen to the public. Two of the six meetings included
an opportunity for the public to provide oral comments
to the Committee. An ongoing period for written publiccomments to the Committee spanned 15 months of
its work. And, for the first time, a final public meeting
was included for the Committee to discuss its draft
scientific report 1 month before the final report wasposted for public comment.
In addition to documenting its rigorous review of theevidence to answer the scientific questions from USDA
and HHS and providing advice for the Departments’development of the next Dietary Guidelines edition,
the Committee provided recommendations for future
research. These research recommendations reflected
an acknowledgment that science in nutrition, diet, andhealth associations continues to evolve, and that new
findings build on and enhance existing evidence.
Upon submitting its final scientific report to the USDA
and HHS Secretaries, the Committee disbanded. The
Departments then posted the scientific report andasked the public for comments. The Departments
received written comments on the report over a
30-day period and also held an online meeting tohear oral comments.

Stage 3: Develop the Dietary Guidelines

Each edition of the Dietary Guidelines builds on thepreceding edition, with the scientific justification
for revisions informed by the Committee’s scientificreport and consideration of public and Federal agency
comments. As with previous editions, development of
the 2020-2025 Dietary Guidelines involved a step-bystep process of writing, review, and revision conductedby a writing team of Federal staff from USDA and HHS.

Page 11 Dietary Guidelines for Americans, 2020-2025 | Introduction

The writing team included Federal nutrition scientists
with expertise in the Dietary Guidelines and related
research and programs as well as specialists withexpertise in communicating nutrition information.
Key tenets of writing the Dietary Guidelines are thatit must:• Represent the totality of the evidence examined• Address the needs of Federal programs• Reduce unintended consequences• Follow best practices for developing guidelines• Use plain language
The draft Dietary Guidelines went through internal andexternal review. Ultimately, the document was reviewed
by all Agencies with nutrition policies and programs
across USDA and HHS, such as USDA’s Food andNutrition Service and its Food Safety and Inspection
Service, and HHS’ National Institutes of Health, Food andDrug Administration, and Centers for Disease Control
and Prevention. The draft Dietary Guidelines also went
through an external expert peer review to ensure that it
accurately reflected the body of evidence documented in
the Committee’s scientific report.

This process culminated with approval by the
Secretaries of USDA and HHS. After approval by the
Secretaries, the Departments released the Dietary
Guidelines to Federal agencies and the public for
implementation across programs and througheducational activities.

Stage 4: Implement the Dietary Guidelines

The U.S. Government uses the Dietary Guidelines as
the basis of its food assistance and meal programs,
nutrition education efforts, and decisions about national
health objectives. For example, the National School
Lunch Program and the Older Americans Act Nutrition
Program incorporate the Dietary Guidelines in menu
planning; the Special Supplemental Nutrition Program
for Women, Infants, and Children applies the Dietary
Guidelines in its program and educational materials;
and the Healthy People objectives for the Nation include
objectives based on the Dietary Guidelines.
The Dietary Guidelines also provides a critical structure
for State and local public health promotion anddisease prevention initiatives. In addition, it provides
foundational, evidence-based nutrition guidance foruse by individuals and those who serve them in public
and private settings, including health professionals,
public health and social service agencies, health careand educational institutions, researchers, agricultural
producers, food and beverage manufacturers, and more.

Dietary Guidelines for Americans, 2020-2025 | Introduction | Page 12

Implementation of the Dietary Guidelines Through MyPlate

Using MyPlate as a Guide To Support Healthy
Dietary Patterns
The Dietary Guidelines for Americans is developed and written for a professional audience. Therefore, its
translation into actionable consumer messages and resources is crucial to help individuals, families, andcommunities achieve healthy dietary patterns.
MyPlate is one example of consumer translation. Created to be used in various settings and adaptable
to meeting personal preferences, cultural foodways, traditions, and budget needs, MyPlate is used byprofessionals across sectors to help people become more aware of and informed about making healthy foodand beverage choices over time. More information is available at MyPlate.gov.
Following a healthy dietary pattern from birth through older adulthood can have a profound impact on a person’s
lifelong health. The Dietary Guidelines provides the framework for following such a pattern. However, broad andmultisector collaboration is needed to help people achieve that goal. Action on many fronts is needed to ensurethat healthy dietary choices at home, school, work, and play are the affordable, accessible norm. Everyone has arole to play in helping all Americans shift to a healthy dietary pattern and achieve better health.

Try the MyPlate Plan

A healthy eating routine is important at every stage of life and can have positive effects that add up
over time. It’s important to eat a variety of fruits, vegetables, grains, dairy or fortified soy alternatives,and protein foods. When deciding what to eat or drink, choose options that are full of nutrients.
Make every bite count.
Think about how the following recommendations can come together over the course of your day orweek to help you create a healthy eating routine:
Make half your plate
fruits & vegetables.

To learn what theright amounts
are for you, try
the personalized
MyPlate Plan.2

Focus
on whole
fruits.

Make halfyour grains
whole grains.

Vary yourveggies.

Vary yourproteinroutine.

Based on decadesof solid science,
MyPlate advice canhelp you day to day
and over time.

Move to low-fat or
fat-free dairy milk or
yogurt (or lactosefree dairy or fortified
soy versions).

Choose foods and beverages with lessadded sugars, saturated fat, and sodium.

The benefits of healthy eating add up over time, bite by bite.
Small changes matter. Start Simple with MyPlate.
2 Available at: MyPlate.gov/myplate-plan

Page 13 Dietary Guidelines for Americans, 2020-2025 | Introduction

with MyPlateA Roadmap to the Dietary Guidelines
for Americans, 2020-2025
Reflecting the accumulating body of evidence
about the relationships between diet and healthoutcomes, the 2020-2025 Dietary Guidelines presents
its recommendations with a primary emphasis on
encouraging the consumption of a healthy overall
dietary pattern at every stage of life, from birththrough older adulthood. This edition of the Dietary
Guidelines consists of an Executive Summary, thisIntroduction, six chapters, and three appendixes.
• Chapter 1: Nutrition and Health Acrossthe Lifespan: The Guidelines and Key
Recommendations discusses the healthbenefits of lifelong healthy dietary choices andexplains the four Guidelines and supporting Key
Recommendations. This chapter is the basis for
all the succeeding chapters. Chapters 2 through 6
should be read in tandem with Chapter 1.
• Chapter 2: Infants and Toddlers is the first of fivechapters that focus on healthy dietary patterns
for a specific life stage. This edition of the Dietary
Guidelines is the first since the 1985 edition toprovide guidance for infants and toddlers (birththrough age 23 months). The chapter provides
specific key recommendations for this age
group, along with guidance on how to put theserecommendations into action. The chapter closes
with a Healthy Dietary Pattern during the second
year of life and a look toward the next life stage—Children and Adolescents.
• Chapter 3: Children and Adolescents first sets
the stage by describing nutrition issues specificto children and adolescents ages 2 through 18. It
then presents the recommended Healthy Dietary
Patterns for this age group, explains how current
intakes compare to recommendations, anddiscusses special dietary guidance considerations
for this life stage. The chapter concludes witha discussion of ways to support healthy dietary
patterns among children and adolescents and alook toward the next life stage—Adults.
• Chapter 4: Adults opens with a discussion of
selected nutrition issues that characterize theadult life stage (ages 19 through 59). It thenpresents the recommended Healthy Dietary

1

Patterns for this age group,
explains how current intakes
compare to recommendations,and discusses special dietary2
guidance considerations for
adults. The chapter concludes withsuggestions for how to support healthy
dietary patterns among adults and a looktoward two important adult life stages—Women
Who Are Pregnant or Lactating and Older Adults.
• Chapter 5: Women Who Are Pregnant
or Lactating opens with a discussion of
selected nutrition issues important to thisstage of adult life. It then presents
the recommended Healthy Dietary
Patterns for this life stage,
explains how current intakes
compare to recommendations,and discusses special dietary
4
guidance considerations for
women who are pregnant
or lactating. The chapter
concludes with suggestions
for how to support healthy
dietary patterns among thispopulation group.

3

5• Chapter 6: Older Adults opens with a
discussion of selected nutrition issues thatare important for older adults, ages 60 andolder. It then presents the recommended
Healthy Dietary Patterns for this life
stage, explains how current intakes
compare to recommendations, anddiscusses special dietary guidanceconsiderations for this age group.
The chapter concludes withsuggestions for how to support
healthy dietary patterns amongolder adults.
• Appendixes include a tablesummarizing nutritional goals forage-sex groups, estimated calorie
needs for all ages and at threephysical activity levels, and the USDA
Dietary Patterns.

6

A

Dietary Guidelines for Americans, 2020-2025 | Introduction | Page 14

Page 15 | Dietary Guidelines for Americans, 2020-2025 | Chapter 1: Nutrition and Health Across the LifespanCHAPTER

1

Nutrition and
Health Acrossthe Lifespan:

The Guidelines and
Key Recommendations

Dietary Guidelines for Americans, 2020-2025 | Chapter 1: Nutrition and Health Across the Lifespan | Page 16

The Guidelines
Make every bite countwith the Dietary Guidelines for Americans. Here’s how:

Follow a healthy dietary
pattern at every life stage.

1
Limit foods
and beverages
higher in
added sugars,
saturated fat,and sodium,and limit
alcoholicbeverages.

4

2

Customize andenjoy nutrientdense foodand beveragechoices toreflect personal
preferences,
culturaltraditions, andbudgetaryconsiderations.

3
Focus on meeting food group needs withnutrient-dense foods and beverages,
and stay within calorie limits.

Page 17 | Dietary Guidelines for Americans, 2020-2025 | Chapter 1: Nutrition and Health Across the LifespanKey Recommendations
Guideline

Follow a healthy dietary pattern atevery life stage.

At every life stage—infancy, toddlerhood,childhood, adolescence, adulthood,pregnancy, lactation, and older
adulthood—it is never too early or too lateto eat healthfully.

1• For about the first 6 months of life, exclusively feed
infants human milk. Continue to feed infants humanmilk through at least the first year of life, and longer
if desired. Feed infants iron-fortified infant formuladuring the first year of life when human milk isunavailable. Provide infants with supplemental vitamin
D beginning soon after birth.
• At about 6 months, introduce infants to nutrient-dense
complementary foods. Introduce infants to potentiallyallergenic foods along with other complementary
foods. Encourage infants and toddlers to consume avariety of foods from all food groups. Include foods richin iron and zinc, particularly for infants fed human milk.
• From 12 months through older adulthood, follow ahealthy dietary pattern across the lifespan to meet
nutrient needs, help achieve a healthy body weight,
and reduce the risk of chronic disease.

Guideline

2

Customize and enjoy nutrientdense food and beverage choices
to reflect personal preferences,
cultural traditions, and budgetaryconsiderations.

A healthy dietary pattern can benefit
all individuals regardless of age, race, or
ethnicity, or current health status. The Dietary
Guidelines provides a framework intended to becustomized to individual needs and preferences, aswell as the foodways of the diverse cultures in the
United States.

Guideline

Focus on meeting food groupneeds with nutrient-dense foods
and beverages, and stay withincalorie limits.

An underlying premise of the Dietary
Guidelines is that nutritional needs
should be met primarily from foods andbeverages—specifically, nutrient-dense foods
and beverages. Nutrient-dense foods provide vitamins,
minerals, and other health-promoting components andhave no or little added sugars, saturated fat, and sodium.
A healthy dietary pattern consists of nutrient-dense
3

forms of foods and beverages across all food groups, inrecommended amounts, and within calorie limits.
The core elements that make up a healthy dietary
pattern include:• Vegetables of all types—dark green; red and orange;beans, peas, and lentils; starchy; and other vegetables• Fruits, especially whole fruit• Grains, at least half of which are whole grain• Dairy, including fat-free or low-fat milk, yogurt, andcheese, and/or lactose-free versions and fortified soy
beverages and yogurt as alternatives• Protein foods, including lean meats, poultry, and eggs;
seafood; beans, peas, and lentils; and nuts, seeds, andsoy products• Oils, including vegetable oils and oils in food, such as
seafood and nuts

Guideline

4

Limit foods and beverages higher
in added sugars, saturated fat,and sodium, and limit alcoholic
beverages.

At every life stage, meeting food group
recommendations—even with nutrientdense choices—requires most of a person’s
daily calorie needs and sodium limits. A healthy
dietary pattern doesn’t have much room for extra
added sugars, saturated fat, or sodium—or for alcoholic
beverages. A small amount of added sugars, saturated
fat, or sodium can be added to nutrient-dense foods andbeverages to help meet food group recommendations,but foods and beverages high in these components
should be limited. Limits are:• Added sugars—Less than 10 percent of calories per
day starting at age 2. Avoid foods and beverages withadded sugars for those younger than age 2.
• Saturated fat—Less than 10 percent of calories per
day starting at age 2.
• Sodium—Less than 2,300 milligrams per day—andeven less for children younger than age 14.
• Alcoholic beverages—Adults of legal drinking age canchoose not to drink or to drink in moderation by limiting
intake to 2 drinks or less in a day for men and 1 drinkor less in a day for women, when alcohol is consumed.
Drinking less is better for health than drinking more.
There are some adults who should not drink alcohol,such as women who are pregnant.

Dietary Guidelines for Americans, 2020-2025 | Chapter 1: Nutrition and Health Across the Lifespan | Page 18

Guideline

1

Guideline 1

Follow a Healthy Dietary Pattern at
Every Life StageA fundamental premise of the Dietary Guidelines isthat almost everyone, no matter an individual’s age,
race, or ethnicity, or health status, can benefit fromshifting food and beverage choices to better support
healthy dietary patterns.
Healthy eating starts at birth with the exclusive
consumption of human milk, if possible, for about thefirst 6 months. If human milk is unavailable, infants
should be fed an iron-fortified commercial infant
formula (i.e., labeled “with iron”) regulated by the
U.S. Food and Drug Administration (FDA), which are
based on standards that ensure nutrient content andsafety. Healthy eating continues with the introductionof complementary foods and beverages at about
6 months of age. By 12 months, infants should
maintain their healthy eating as they transition todevelopmentally appropriate foods and beverages.
Healthy eating continues in each life stage thereafter.
Even though nutrient needs vary across life stages, thefoods and beverages that individuals should eat overthe lifespan are remarkably consistent.
This chapter provides foundational guidance aboutmaintaining a healthy dietary pattern across each life
stage—infancy, toddlerhood, childhood, adolescence,
adulthood, pregnancy, lactation, and older adulthood.
Because the nutritional needs and transition of infants
and toddlers are unique, Chapter 2 provides a focused
discussion on this age group. Chapters 3, 4, 5, and 6
then provide tailored nutrition information specificto children and adolescents, adults, women who are
pregnant or lactating, and older adults, respectively.

What Is a Dietary Pattern?

Over the course of any given day, week, or year,
individuals consume foods and beverages1 in
combination—a dietary pattern. A dietary patternrepresents the totality of what individuals habitually
eat and drink, and the parts of the pattern act
synergistically to affect health. As a result, the dietary
pattern may better predict overall health status anddisease risk than individual foods or nutrients.
A healthy dietary pattern consists of nutrient-dense

forms of foods and beverages across all food groups,
in recommended amounts, and within calorie limits.
Achieving a healthy dietary pattern at each life stage
not only supports health at that point in time, but also
supports health in the next life stage and possibly for
future generations. If healthy dietary patterns can beestablished early in life and sustained thereafter, theimpact on health could be significant. Establishingand maintaining a healthy dietary pattern can help
minimize diet-related chronic disease risk. Conversely,
consuming foods and beverages that are not nutrientdense may lead to disease expression in later years.
High intakes of such foods (i.e., an unhealthy dietary
pattern) throughout the lifespan can increase the risk ofdeveloping chronic diseases.
The good news is that at any stage of life, individuals
can make efforts to adopt a healthy dietary pattern
and improve their health. The Healthy U.S.-Style Dietary
Pattern, USDA’s primary Dietary Pattern, provides aframework for healthy eating that all Americans canfollow. It is based on the types and proportions of foods
Americans of all ages, genders, races, and ethnicities
typically consume, but in nutrient-dense forms andappropriate amounts.
The Healthy U.S.-Style Dietary Pattern is carried forwardfrom the 2015-2020 Dietary Guidelines for Americans.
The 2,000-calorie level of the pattern is shown in
Table 1-1. The Healthy Mediterranean-Style Dietary
Pattern and the Healthy Vegetarian Dietary Pattern—also carried forward from the 2015-2020 Dietary
Guidelines for Americans—are variations of the Healthy
U.S.-Style Dietary Pattern that have the same coreelements. The USDA Dietary Patterns are described inAppendix 3. USDA Dietary Patterns and are meant tobe tailored to meet cultural and personal preferences
and used as guides to plan and serve meals forindividuals, households, and in a variety of institutions
and other settings. The Dietary Approaches to Stop
Hypertension (DASH) dietary pattern is an example ofa healthy dietary pattern and has many of the samecharacteristics as the Healthy U.S.-Style Dietary Pattern.
Additional details on DASH are available at nhlbi.nih.
gov/health-topics/dash-eating-plan.

1 If not specified explicitly, references to “foods” refer to “foods and beverages.”

Page 19 | Dietary Guidelines for Americans, 2020-2025 | Chapter 1: Nutrition and Health Across the LifespanGuideline

1

Table 1-1

Healthy U.S.-Style Dietary Pattern at the 2,000-Calorie
Level, With Daily or Weekly Amounts From Food Groups,
Subgroups, and Components
FOOD GROUP OR SUBGROUPa

Daily Amountb of Food From Each Group(Vegetable and protein foods subgroup amounts are per week.)

Vegetables (cup eq/day)

2½
Vegetable Subgroups in Weekly Amounts

Dark-Green Vegetables (cup eq/wk)

1½

Red and Orange Vegetables (cup eq/wk)

5½

Beans, Peas, Lentils (cup eq/wk)

1½

Starchy Vegetables (cup eq/wk)

5

Other Vegetables (cup eq/wk)

4

Fruits (cup eq/day)2

Grains (ounce eq/day)

6

Whole Grains (ounce eq/day)≥3

Refined Grains (ounce eq/day)<3

Dairy (cup eq/day)3

Protein Foods (ounce eq/day)

5½
Protein Foods Subgroups in Weekly Amounts

Meats, Poultry, Eggs (ounce eq/wk)

26

Seafood (ounce eq/wk)

8

Nuts, Seeds, Soy Products (ounce eq/wk)

5

Oils (grams/day)

27

Limit on Calories for Other Uses (kcal/day)c

240

Limit on Calories for Other Uses (%/day)

12%

a Definitions for each food group and subgroup are provided throughout the chapter and are compiled in Appendix 3.
b Food group amounts shown in cup or ounce equivalents (eq). Oils are shown in grams. Quantity equivalents for each food group are defined inAppendix 3. Amounts will vary for those who need <2,000 or >2,000 calories per day.

c Foods are assumed to be in nutrient-dense forms, lean or low-fat and prepared with minimal added sugars, refined starches, saturated fat, or

sodium. If all food choices to meet food group recommendations are in nutrient-dense forms, a small number of calories remain within the overall
limit of the pattern (i.e., limit on calories for other uses). The amount of calories depends on the total calorie level of the pattern and the amounts
of food from each food group required to meet nutritional goals. Calories up to the specified limit can be used for added sugars, saturated fat,and/or alcohol, or to eat more than the recommended amount of food in a food group.
NOTE: The total dietary pattern should not exceed Dietary Guidelines limits for added sugars, saturated fat, and alcohol; be within the Acceptable
Macronutrient Distribution Ranges for protein, carbohydrate, and total fats; and stay within calorie limits. Values are rounded. See Appendix 3 for
all calorie levels of the pattern.

Dietary Guidelines for Americans, 2020-2025 | Chapter 1: Nutrition and Health Across the Lifespan | Page 20

Guideline

1

Figure 1-1

Examples of Calories in Food Choices That Are
Not Nutrient Dense and Calories in Nutrient-Dense
Forms of These Foods
Calories in Nutrient-Dense Form of the Food

80% Lean
GroundBeef Patty,
3 ounces

97% Lean Beef

Beef Fat

122

87

Breading & Frying Oil

99

131

Fat-Free Milk

Milk Fat

83

63

Whole Milk,
1 cup

Air-Popped Popcorn

Butter62

122

Full-Fat
Mocha,
12 ounces

SweetenedApplesauce,
1 cup

0

209 Total

Baked Cod

Breaded, Fried
Cod, 4 ounces

Movie
Theater-Style
Popcorn
With Butter,2 cupsAdditional Calories in Food as Consumed

230 Total

146 Total

184 Total

Espresso & Fat-Free Milk

Milk Fat

Chocolate Syrup

110

79

101

Unsweetened Applesauce

Added Sugars

103

67

50

100

290 Total

170 Total

150

200

CALORIES

Data Source: U.S. Department of Agriculture, Agricultural Research Service. FoodData Central, 2019. fdc.nal.usda.gov.
Page 21 | Dietary Guidelines for Americans, 2020-2025 | Chapter 1: Nutrition and Health Across the Lifespan

250

300

Guideline

1

Figure 1-2

Making Nutrient-Dense Choices:
One Food or Beverage At a Time
Every food and beverage choice is an opportunity to move toward a healthy dietary pattern. Small changes in single
choices add up and can make a big difference. These are a few examples of realistic, small changes to nutrientdense choices that can help people adopt healthy dietary patterns.

Plain Shredded
Wheat

Plain, Low-Fat
Yogurt With Fruit

Low-Sodium
Black Beans

Vegetable Oil

Sparkling Water

FrostedShredded Wheat

Full-Fat Yogurt With
Added Sugars

Regular CannedBlack Beans

ButterSoda

NUTRIENTDENSE

TYPICAL

Dietary Guidelines for Americans, 2020-2025 | Chapter 1: Nutrition and Health Across the Lifespan | Page 22

Guideline

1

The Health Benefits of a Healthy
Dietary Pattern

Science is the foundation of the Dietary Guidelines
recommendations on what Americans should eat
and drink to promote health, reduce risk of chronic
disease, and meet nutrient needs. The science showsthat consuming a healthy dietary pattern, meeting foodgroup and nutrient needs with nutrient-dense foods andbeverages, and limiting intake of foods and beverages
that are not nutrient-dense is related to many healthbenefits. Science also supports the idea that every life
stage provides an opportunity to make food choicesthat promote health and well-being, achieve andmaintain appropriate weight status, and reduce risk of
diet-related chronic disease.
The science supporting the Dietary Guidelines is
extensively documented in the Scientific Report of the2020 Dietary Guidelines Advisory Committee, which
describes the state of the science on key topics related
to diet and health. Outcomes with Strong or Moderate
evidence are provided in Figure 1-3. The report isavailable at DietaryGuidelines.gov.
Evidence on the association between dietary
patterns and reduced risk of diet-related chronic
diseases has expanded in recent years and supports
the use of dietary patterns as a foundation for
the recommendations in the Dietary Guidelines
for Americans, 2020-2025. Consistent evidence
demonstrates that a healthy dietary pattern is
associated with beneficial outcomes for all-cause
mortality, cardiovascular disease, overweight andobesity, type 2 diabetes, bone health, and certain typesof cancer (breast and colorectal).
Common characteristics of dietary patterns associatedwith positive health outcomes include relatively higher
intake of vegetables, fruits, legumes, whole grains,

low- or non-fat dairy, lean meats and poultry,
seafood, nuts, and unsaturated vegetableoils, and relatively lower consumption of red
and processed meats, sugar-sweetened foods andbeverages, and refined grains. The evidence examined
showed broad representation across a number of
populations and demographic groups. This suggests a
consistent association no matter the region or culturalcontext in which a healthy dietary pattern is consumed.
In addition, dietary patterns characterized by higher
intake of red and processed meats, sugar-sweetened
foods and beverages, and refined grains are, in andof themselves, associated with detrimental healthoutcomes. These findings are consistent with—andbuild on—the evidence base that informed the 20152020 Dietary Guidelines.

A Healthy Dietary Pattern Supports
Appropriate Calorie Levels

The total number of calories a person needs each day
varies depending on a number of factors, namely the
person’s age, sex, height, weight, level of physical activity,and pregnancy or lactation status. Due to reductions
in basal metabolic rate that occur with aging, calorie
needs generally decrease for adults as they age. In
addition, a need to lose, maintain, or gain weight affects
how many calories should be consumed. Estimatedamounts of calories needed based on age, sex, andlevel of physical activity are provided in Appendix 2.
Estimated Calorie Needs, and estimated calorie needs
relevant for different ages are provided in each life stage
chapter. These estimates are based on the EstimatedEnergy Requirement (EER) equations established by
the National Academies of Sciences, Engineering, andMedicine (National Academies) using reference heights(average) and reference weights (healthy) for eachage-sex group. These amounts are estimates. The best
way to evaluate calorie intake, in comparison to calorie
needs, is by measuring body weight status.

Rather than focus on weight status at any one point in life, the Dietary Guidelines supports
healthy weight trajectories at each stage of life—appropriate weight gain during pregnancy
and postpartum weight loss, healthy growth and development from infancy throughadolescence, weight stability during mid-life, and healthy body composition late in life.
Meeting the Dietary Guidelines recommendations within calorie needs can help prevent
excess weight gain at every life stage and support overall good health.

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Figure 1-3

The Science Underlying the Dietary Guidelines
Demonstrates That Healthy Eating Across the Lifespan
Can Promote Health and Reduce Risk of Chronic Disease
Birth Through23 Months• Lower riskof overweight
and obesity• Lower risk oftype 1 diabetes• Adequate iron status
and lower risk ofiron deficiency• Lower risk of
peanut allergy• Lower riskof asthma

Children andAdolescents• Lower adiposity• Lower total andlow-density lipoprotein(LDL) cholesterol

Women Who
Are Pregnant or
Lactating• Favorable cognitive
development in
the child• Favorable folate
status in women
during pregnancy
and lactation

Adults, Including
Older Adults• Lower risk of
all-cause mortality• Lower risk ofcardiovascular disease• Lower risk of cardiovasculardisease mortality• Lower total and
LDL cholesterol• Lower blood pressure• Lower risk of obesity• Lower body mass index,
waist circumference, andbody fat• Lower risk of type 2 diabetes• Lower risk of cancers of thebreast, colon, and rectum• Favorable bone health,including lower risk of
hip fracture

NOTE: The 2020 Dietary Guidelines Advisory Committee examined the evidence on diet and health across the lifespan. Evidence is not available
for all combinations of exposures and outcomes for the population subgroups presented in this figure. The Committee rated the evidence on dietand health as Strong, Moderate, Limited, or Grade Not Assignable. Only outcomes with Strong or Moderate evidence are included in this table.
See the Committee’s Report for specific graded conclusion statements.

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Key Dietary Principles

To help people meet the Guidelines and Key Recommendations, thefollowing are important principles when making decisions about nutrientdense food and beverage choices to achieve a healthy dietary pattern.
MEET NUTRITIONAL NEEDS PRIMARILY FROM FOODSAND BEVERAGESThe Dietary Guidelines are designed to meet the Recommended Dietary
Allowances and Adequate Intakes for essential nutrients, as well as
Acceptable Macronutrient Distribution Ranges, all set by the National
Academies. An underlying premise of the Dietary Guidelines is thatnutritional needs should be met primarily from foods and beverages—
specifically, nutrient-dense foods and beverages. In some cases, when
meeting nutrient needs is not otherwise possible, fortified foods andnutrient-containing dietary supplements are useful. It is important to notethat the nutrient density and healthfulness of what people eat and drink
often is determined ultimately by how a food item, dish, or meal is prepared,
at home and away from home or produced by a manufacturer. Based on
the U.S. food supply and marketplace, the examples of healthy dietary
patterns in this edition are achievable through thoughtful, informed choices
one decision, one meal, one day at a time—and consistently over time.
CHOOSE A VARIETY OF OPTIONS FROM EACH FOOD GROUP
Enjoy different foods and beverages within each food group. This canhelp meet nutrient needs—and also allows for flexibility so that the Dietary
Guidelines can be tailored to meet cultural and personal preferences.
All forms of foods, including fresh, canned, dried, frozen, and 100% juices,in nutrient-dense forms, can be included in healthy dietary patterns.
PAY ATTENTION TO PORTION SIZE
Portion size is a term often used to describe the amount of a food orbeverage served or consumed in one eating occasion. It is important to
pay attention to portion size when making food and beverage choices,
particularly for foods and beverages that are not nutrient-dense. A conceptthat can help people choose appropriate portions is serving size. This term
is included on the Nutrition Facts label and refers to the amount of a foodor beverage that is customarily consumed—it is not a recommendationof how much to eat or drink. Consuming less than the stated serving
size results in consuming fewer calories and other nutrients or foodcomponents. Some products may have multiple servings per package.

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Most Americans Do Not Follow a Healthy Dietary Pattern

The typical dietary patterns currently consumed by many in the United States do not align with the Dietary
Guidelines (Figure 1-4). The Healthy Eating Index (HEI) is a measure of diet quality that can be used to assess
compliance with the Dietary Guidelines. For Americans ages 2 and older, HEI-2015 scores indicate that intakes are
not consistent with recommendations for a healthy dietary pattern. Average diet quality has slightly improved in
the past 10 years, but the average score of 59 (on a scale from 0 to 100) indicates that people have much room for
improvement. Differences in overall HEI scores are seen across age, sex, race-ethnic, and income subgroups andby pregnancy and lactation status, though poor diet quality is observed across all groups. With each step closer toa diet that aligns with the core elements of a healthy dietary pattern, HEI scores will increase and risk for chronic
disease will decrease.

Figure 1-4

Adherence of the U.S. Population to the Dietary Guidelines
Across Life Stages, as Measured by Average Total Healthy
Eating Index-2015 Scores

Maximum Total Score = 100

100

80

60

61

55

52

51

Ages 9-13

Ages 14-18

56

59

63

40

20

0

Ages 2-4

Ages 5-8

Ages 19-30

Ages 31-59

Ages 60+

NOTE: HEI-2015 total scores are out of 100 possible points. A score of 100 indicates that recommendations on average were met or exceeded.
A higher total score indicates a higher quality diet.
Data Source: Analysis of What We Eat in America, NHANES 2015-2016, ages 2 and older, day 1 dietary intake data, weighted.

In addition, the high percentage of the population with overweight or obesity suggests that many people in the UnitedStates consume foods and beverages that contribute to a calorie imbalance, a situation more likely to occur with low
physical activity. As shown in the Introduction, Table I-1, 74 percent of all adults and 40 percent of all children andyouth in the United States have either overweight or obesity.
Even from the youngest ages, almost all Americans should shift to healthier food and beverage choices andconsume smaller portions to achieve a healthy dietary pattern within an appropriate number of calories. It is never
too early or too late to improve intake and establish a healthy dietary pattern.

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Guideline 2

Customize and Enjoy Food and Beverage
Choices to Reflect Personal Preferences,
Cultural Traditions, and Budgetary
Considerations
Eating should be enjoyed, anda healthy dietary pattern can beenjoyable, from early life to older
adulthood. The science reviewed
to inform the Dietary Guidelines
represents the diversity ofAmericans, including all ages andlife stages, different racialand ethnic backgrounds, and arange of socioeconomic statuses.
A healthy dietary pattern canbenefit all individuals regardlessof age, race or ethnicity, or current
health status.
The Dietary Guidelines provides
a framework intended to becustomized to fit individual,
household, and Federal program
participants’ preferences, as wellas the foodways of the diverse
cultures in the United States. The
U.S. population is diverse in myriad
ways. The Dietary Guidelines
framework purposely provides
recommendations by food groups
and subgroups—not specificfoods and beverages—to avoid
being prescriptive. This framework
approach ensures that people can“make it their own” by selecting
healthy foods, beverages, meals,
and snacks specific to their needs
and preferences.
The food groups include a broad
variety of nutrient-dense food andbeverage choices. In every setting,across all cultures, and at any age
or budget, there are foods andbeverages that can fit within the
Dietary Guidelines framework.

Start with Personal Preferences

Exposure to different types of food is importantearly in life to better develop a child’s interest andwillingness to eat and enjoy a variety of foods.
Through each life stage that follows, a key starting
point for establishing and maintaining a healthy
dietary pattern is to ensure that individual and/or
family preferences—in nutrient-dense forms—arebuilt into day-to-day choices.

Incorporate Cultural Traditions

Cultural background can have significant influenceon food and beverage choices. Customizing theDietary Guidelines framework to reflect specificcultures and traditions is an important strategy
to help communities across the country eat andenjoy a healthy dietary pattern. Nutrient-dense
culturally relevant foods and beverages are partof all of the food groups. Spices and herbs canhelp flavor foods when reducing added sugars,
saturated fat, and sodium, and they also can add
to the enjoyment of nutrient-dense foods, dishes,and meals that reflect specific cultures. Relying on
the expertise of professionals in nutrition and inspecific cultural foodways can help people prepare
foods healthfully while retaining heritage.

Consider Budget

Despite a common perception that eating
healthfully is expensive, a healthy dietary pattern
can be affordable and fit within budgetary
constraints. There are a range of strategies thatcan be used to help individuals and families follow
a healthy dietary pattern including advancedplanning; considering regional and seasonal foodavailability; and incorporating a variety of fresh,frozen, dried, and canned options. The USDA
Food Plans—Thrifty, Low-Cost, Moderate-Cost,and Liberal-Cost food plans—each represent
a nutritious diet at a different cost level. These
plans are scheduled to be revised, with an updated
Thrifty Food Plan published by the end of 2022 toreflect this edition of the Dietary Guidelines andupdated food availability and food cost data.

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Figure 1-5

Customizing the Dietary Guidelines Framework
The Dietary Guidelines approach of providing a framework–not prescriptive details–ensures that its recommendations
can “meet people where they are,” from personal preferences to cultural foodways, and including budgetaryconsiderations. The examples below are a sample of the range of options in each food group—to be eaten in nutrientdense forms. Additional examples are listed under Table A3-2 in Appendix 3.

Vegetables• Dark-Green Vegetables: All fresh, frozen, and canned darkgreen leafy vegetables and broccoli, cooked or raw: forexample, amaranth leaves, bok choy, broccoli, chamnamul,chard, collards, kale, mustard greens, poke greens, romaine
lettuce, spinach, taro leaves, turnip greens, and watercress.
• Red and Orange Vegetables: All fresh, frozen, and canned red
and orange vegetables or juice, cooked or raw: for example,
calabaza, carrots, red or orange bell peppers, sweet potatoes,
tomatoes, 100% tomato juice, and winter squash.
• Beans, Peas, Lentils: All cooked from dry or canned beans,peas, chickpeas, and lentils: for example, black beans,black-eyed peas, bayo beans, chickpeas (garbanzo beans),
edamame, kidney beans, lentils, lima beans, mung beans,pigeon peas, pinto beans, and split peas. Does not include
green beans or green peas.
• Starchy Vegetables: All fresh, frozen, and canned starchy
vegetables: for example, breadfruit, burdock root, cassava,
corn, jicama, lotus root, lima beans, plantains, white potatoes,
salsify, taro root (dasheen or yautia), water chestnuts, yam,and yucca.
• Other Vegetables: All other fresh, frozen, and canned
vegetables, cooked or raw: for example, asparagus, avocado,bamboo shoots, beets, bitter melon, Brussels sprouts,
cabbage (green, red, napa, savoy), cactus pads (nopales),cauliflower, celery, chayote (mirliton), cucumber, eggplant,
green beans, kohlrabi, luffa, mushrooms, okra, onions, radish,rutabaga, seaweed, snow peas, summer squash, tomatillos,
and turnips.

Fruits• All fresh, frozen, canned, and dried fruits and 100% fruit
juices: for example, apples, Asian pears, bananas, berries(e.g., blackberries, blueberries, currants, huckleberries,
kiwifruit, mulberries, raspberries, and strawberries); citrus
fruit (e.g., calamondin, grapefruit, lemons, limes, oranges,
and pomelos); cherries, dates, figs, grapes, guava, jackfruit,
lychee, mangoes, melons (e.g., cantaloupe, casaba,
honeydew, and watermelon); nectarines, papaya, peaches,
pears, persimmons, pineapple, plums, pomegranates, raisins,
rhubarb, sapote, and soursop.
Dietary Guidelines for Americans, 2020-2025 | Chapter 1: Nutrition and Health Across the Lifespan | Page 28

Figure 1-5 Customizing the Dietary Guidelines Framework (continued)

Grains• Whole grains: All whole-grain products and whole grainsused as ingredients: for example, amaranth, barley (notpearled), brown rice, buckwheat, bulgur, millet, oats, popcorn,quinoa, dark rye, whole-grain cornmeal, whole-wheat bread,whole-wheat chapati, whole-grain cereals and crackers, andwild rice.
• Refined grains: All refined-grain products and refined grainsused as ingredients: for example, white breads, refined-graincereals and crackers, corn grits, cream of rice, cream ofwheat, barley (pearled), masa, pasta, and white rice. Refinedgrain choices should be enriched.

Dairy and Fortified Soy Alternatives• All fluid, dry, or evaporated milk, including lactose-free andlactose-reduced products and fortified soy beverages (soymilk), buttermilk, yogurt, kefir, frozen yogurt, dairy desserts,
and cheeses. Most choices should be fat-free or low-fat.
Cream, sour cream, and cream cheese are not included dueto their low calcium content.

Protein Foods• Meats, Poultry, Eggs: Meats include beef, goat, lamb,pork, and game meat (e.g., bison, moose, elk, deer). Poultry
includes chicken, Cornish hens, duck, game birds (e.g.,
ostrich, pheasant, and quail), goose, and turkey. Organ meats
include chitterlings, giblets, gizzard, liver, sweetbreads,
tongue, and tripe. Eggs include chicken eggs and other birds’
eggs. Meats and poultry should be lean or low-fat.
• Seafood: Seafood examples that are lower in methylmercury
include: anchovy, black sea bass, catfish, clams, cod, crab,
crawfish, flounder, haddock, hake, herring, lobster, mullet,
oyster, perch, pollock, salmon, sardine, scallop, shrimp, sole,
squid, tilapia, freshwater trout, light tuna, and whiting.
• Nuts, Seeds, Soy Products: Nuts and seeds include all nuts
(tree nuts and peanuts), nut butters, seeds (e.g., chia, flax,
pumpkin, sesame, and sunflower), and seed butters (e.g.,sesame or tahini and sunflower). Soy includes tofu, tempeh,
and products made from soy flour, soy protein isolate, andsoy concentrate. Nuts should be unsalted.

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Guideline 3

3

Focus on Meeting Food Group Needs With
Nutrient-Dense Foods and Beverages,
and Stay Within Calorie Limits
The Dietary Guidelines include recommendations for food groups—vegetables, fruits, grains, dairy, and protein foods—
eaten at an appropriate calorie level and in forms with limited amounts of added sugars, saturated fat, and sodium.
Science shows that these same core elements of a healthy dietary pattern are consistent across each life stage.
However, as shown in Figure 1-6, when compared to the Healthy U.S.-Style Dietary Pattern, most Americans havesubstantial room for improvement:• More than 80 percent have dietary patterns that are low in vegetables, fruits, and dairy.
• More than half of the population is meeting or exceeding total grain and total protein foods recommendations,but are not meeting the recommendations for the subgroups within each of these food groups.
Figure 1-6

Dietary Intakes Compared to Recommendations:
Percent of the U.S. Population Ages 1 and Older Who Are
Below and At or Above Each Dietary Goal
Intake At/Above Recommendation

Intake Below Recommendation

Percent of Population
At or Above Recommendation

100
90
80
70
60
50
The center (0)line is thegoal or limit.
For most, those
represented by
the dark blue
section of thebars canimprove theirdietary patternby shifting
toward thecenter line.

40
30
20
10

Percent of Population
Below Recommendation

0
10
20
30
40
50
60
70
80
90

ts

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y

Pr
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uc

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s

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s,

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ai
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100

*NOTE: Recommended daily intake of whole grains is to be at least half of total grain consumption, and the limit for refined grains is to be no
more than half of total grain consumption.
Data Source: Analysis of What We Eat in America, NHANES 2013-2016, ages 1 and older, 2 days dietary intake data, weighted. Recommended
Intake Ranges: Healthy U.S.-Style Dietary Patterns (see Appendix 3).
Dietary Guidelines for Americans, 2020-2025 | Chapter 1: Nutrition and Health Across the Lifespan | Page 30

Guideline

Learn More:

Table A3-2 in Appendix
3 provides the foodgroup-based Healthy
U.S.-Style Dietary
Pattern as a sample
framework. Information
on what counts as acup- or ounce-equivalentis also provided under
this table in footnote c.

About Beans, Peas, and Lentils“Beans, peas, and lentils” is a new name for thevegetable subgroup formerly called “legumes(beans and peas).” Beans, peas, and lentils, which
also are known as pulses, include the dried edible
seeds of legumes. The foods in this vegetable
subgroup have not changed. However, the newname of the subgroup more accurately reflects
the category of foods included. Beans include
varieties such as kidney beans, pinto beans, whitebeans, black beans, lima beans, and fava beans.
Also included are dried peas (e.g., chickpeas,
black-eyed peas, pigeon peas, and split peas) andlentils. Edamame, which is the soybean in the pod,is counted in the beans, peas, and lentils subgroupeven though it is eaten fresh and not dried.
Because beans, peas, and lentils have a similar
nutrient profile to foods in both the vegetablegroup and the protein foods group, they may bethought of as either a vegetable or a protein foodwhen aiming to meet recommended intakes.
Green peas and green (string) beans are
not counted in the beans, peas, and lentils
subgroup because the nutrient content of thesevegetables is more similar to vegetables in othersubgroups. Green peas, which are not dried before
consumption, are grouped with starchy vegetables
and green beans are in the other vegetables
subgroup, which includes onions, iceberg lettuce,
celery, and cabbage. Generally, foods made fromprocessed soybeans are a part of the nuts, seeds
and soy products protein foods subgroup.

3
The following sections use the Healthy U.S.-Style
Dietary Pattern to show how people can make shifts
in their choices to achieve a healthy dietary pattern.
Information on the amounts to consume—in cup and ounce
equivalents—for each life stage is discussed in the subsequent
life stage chapters and Appendix 3. USDA Dietary Patterns.

Eating an appropriate mix of foods from the food groups andsubgroups—within an appropriate calorie level—is importantto promote health at each life stage. Each of the food groups
and their subgroups provides an array of nutrients, and theamounts recommended reflect eating patterns that have been
associated with positive health outcomes. Foods from all of
the food groups should be eaten in nutrient-dense forms. The
following sections describe special considerations related toeach food group.

Vegetables

Healthy dietary patterns include a variety of vegetablesfrom all five vegetable subgroups—dark green; red and orange;beans, peas, and lentils; starchy; and other. These include
all fresh, frozen, canned, and dried options in cooked or raw
forms, including 100% vegetable juices. Vegetables in theirnutrient-dense forms have limited additions such as salt,butter, or creamy sauces. Examples of vegetables in each of
the subgroups are available in Appendix 3.
Almost 90 percent of the U.S. population does not meetthe recommendation for vegetables. In addition, withfew exceptions, the U.S. population does not meet intake
recommendations for any of the vegetable subgroups. About
45 percent of all vegetables are eaten as a separate food item;
about 40 percent as part of a mixed dish; and the remainder
are mostly consumed as snack foods and condiments.
Vegetables, when consumed on their own, are generally
consumed in forms with additional sodium either from salt
added in cooking or added sauces such as soy sauce orbottled stir-fry sauces. Many vegetables are consumed as partof mixed dishes like sandwiches, pasta with a tomato-basedsauce, or casseroles that may have other ingredients that aresources of saturated fat and/or sodium.
For most individuals, following a healthy eating pattern will
require an increase in total vegetable intake and from allvegetable subgroups, shifting to nutrient-dense forms, andan increase in the variety of different vegetables consumed
over time. Vegetables can be part of many types of mixed
dishes, from burgers, sandwiches, and tacos, to pizza, stews,
pasta dishes, grain-based casseroles, and soups. Strategies
to increase vegetable intake include increasing the vegetable
content of mixed dishes or eating less of a main dish toallow for more vegetables as side dishes—keeping thesenutrient dense.

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Fruits

The fruit food group includes whole fruits and 100% fruit
juice. Whole fruits include fresh, canned, frozen, anddried forms. Whole fruits can be eaten in various forms,
such as cut, sliced, diced, or cubed. At least half of therecommended amount of fruit should come from whole
fruit, rather than 100% juice. When juices are consumed,
they should be 100% juice and always pasteurized or
100% juice diluted with water (without added sugars).
Also, when selecting canned fruit, choose options
that are canned with 100% juice or options lowest in
added sugars.
About 80 percent of the U.S. population does not meet
fruit recommendations. Over 60 percent of all fruit
intake comes from whole forms—fresh, canned, frozen,
or dried—or 100% juice. Fruit is generally consumed innutrient-dense forms such as plain bananas, apples,oranges, or grapes. However, some fruit is consumed aspart of foods that may not be nutrient-dense, such as fruit
pie or similar desserts.
Most people would benefit from increasing their intakeof fruit, mostly as whole fruits in nutrient-dense forms. A
wide variety of fruits are available in the U.S. marketplace,some year-round and others seasonally. Strategies tohelp achieve this shift include choosing more whole fruits
as snacks and including them in meals.

GrainsHealthy dietary patterns include whole grains and limit
the intake of refined grains. At least half of total grains
should be whole grains. Individuals who eat refined grains
should choose enriched grains. Individuals who consume
all of their grains as whole grains should include somethat have been fortified with folic acid. Grain-based foodsin nutrient-dense forms limit the additions of addedsugars, saturated fat, and sodium.
A food is a 100% whole-grain food if the only grains
it contains are whole grains. A 1 ounce-equivalent of
100% whole grains has 16 grams of whole grains. The
recommendation to consume at least half of total grains
as whole grains can be met in a number of ways.
• Choose 100% whole-grain foods for at least half of all
grains consumed. The relative amount of whole grain in
the food can be inferred by the placement of the grainin the ingredient list. The whole grain should be the first
ingredient—or the second ingredient after water. For
foods with multiple whole-grain ingredients, they should
appear near the beginning of the ingredient list.

• Choose products with at least 50 percent of the total
weight as whole-grain ingredients. If a food has at least
8 grams of whole grains per ounce-equivalent then halfof the grains are whole-grain ingredients.
Most Americans meet recommendations for total grain
intakes, although 98 percent fall below recommendations
for whole grains and 74 percent exceed limits for refined
grains. Almost half of all intake of refined grains is frommixed dishes, such as sandwiches, burgers, tacos, pizza,
macaroni and cheese, and spaghetti with meatballs.
About 20 percent of intake of refined grains comes fromsnacks and sweets, including crackers, pretzels, cakes,
cookies, and other grain desserts. The remaining refined
grains are generally eaten as separate food items, suchas pancakes, cereals, breads, tortillas, pasta, or rice.
About 60 percent of whole-grain intake in the UnitedStates is from individual food items, mostly cereals andcrackers, rather than mixed dishes. Grains are generally
consumed in forms with higher amounts of sodium (e.g.,
breads, tortillas, crackers) and added sugars (e.g., grainbased desserts, many ready-to-eat breakfast cereals)
rather than the nutrient-dense forms. Further, grains areoften consumed as part of mixed dishes, such as pasta
dishes, casseroles, and sandwiches that may have otheringredients that are not in nutrient-dense forms.
Shifting from refined to whole-grain versions ofcommonly consumed foods—such as from white to100% whole-wheat breads, and white to brown ricewhere culturally appropriate—would increase whole-grain
intakes and lower refined grain intakes to help meet
recommendations. Additionally, shifting to more nutrientdense forms of grains, such as ready-to-eat breakfast
cereals with less sugar, will help meet healthy dietary
patterns. With careful planning, limited amounts of salt,butter, or sources of added sugars can be used to make

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Guideline

3

some grain-based foods more palatable while staying
within calorie and nutrient limits, but most grains shouldbe eaten in their most nutrient-dense forms. Reducing
intakes of cakes, cookies, and other grain desserts will
also support reducing refined grain intakes and staying
within calorie needs.

(including lactose-free milk), yogurt, and cheese, orfrom fortified soy beverages or soy yogurt. Strategies
to increase dairy intake include drinking fat-free or
low-fat milk or a fortified soy beverage with meals orincorporating unsweetened fat-free or low-fat yogurt into
breakfast or snacks.

Dairy and Fortified Soy Alternatives

Protein Foods

Healthy dietary patterns feature dairy, including fat-freeand low-fat (1%) milk, yogurt, and cheese. Individuals
who are lactose intolerant can choose low-lactose andlactose-free dairy products. For individuals who choose
dairy alternatives, fortified soy beverages (commonly
known as “soy milk”) and soy yogurt—which are fortified
with calcium, vitamin A, and vitamin D—are included aspart of the dairy group because they are similar to milk
and yogurt based on nutrient composition and in theiruse in meals.
Other products sold as “milks” but made from plants(e.g., almond, rice, coconut, oat, and hemp “milks”)
may contain calcium and be consumed as a sourceof calcium, but they are not included as part of thedairy group because their overall nutritional content is
not similar to dairy milk and fortified soy beverages.
Therefore, consuming these beverages does notcontribute to meeting the dairy group recommendation.
About 90 percent of the U.S. population does not meetdairy recommendations. The percent of Americans who
drink milk as a beverage on a given day is 65 percent
among young children, 34 percent in adolescents, andabout 20 percent for adults. Dairy is generally consumed
in forms with higher amounts of sodium (e.g., cheeses
as part of mixed dishes such as sandwiches, pizza, andpasta dishes) and saturated fat (e.g., higher fat milks andyogurts) and can be a source of added sugars such as
flavored milk, ice cream, and sweetened yogurts.
Most individuals would benefit by increasing intake ofdairy in fat-free or low-fat forms, whether from milk

Healthy dietary patterns include a variety of protein
foods in nutrient-dense forms. The protein foods group
comprises a broad group of foods from both animal andplant sources, and includes several subgroups: meats,
poultry, and eggs; seafood; and nuts, seeds, and soy
products. As noted previously, beans, peas, and lentils
may be considered a part of the protein foods groupas well as the vegetable group. Protein also is foundin some foods from other food groups, such as dairy.
Meats and poultry vary in fat content and include both
fresh and processed forms. Most intake of meats andpoultry should be from fresh, frozen, or canned, andin lean forms (e.g., chicken breast or ground turkey)
versus processed meats (e.g., hot dogs, sausages, ham,luncheon meats).
A healthy vegetarian dietary pattern can be achievedby incorporating protein foods from plants. Comparedwith the Healthy U.S.-Style Dietary Pattern, the Healthy
Vegetarian Dietary Pattern is higher in soy products(particularly tofu and other processed soy products);
beans, peas, and lentils; nuts and seeds; and wholegrains. Inclusion of dairy and eggs make this an
example of a lacto-ovo vegetarian pattern. Meats,
poultry, and seafood are not included.
Seafood, which includes fish and shellfish, is a protein
foods subgroup that provides beneficial fatty acids (e.g.,eicosapentaenoic acid [EPA] and docosahexaenoic
acid [DHA]). In addition, mercury, in the form of
methylmercury, is found in seafood in varying levels.
The U.S. Food and Drug Administration (FDA) and the
U.S. Environmental Protection Agency (EPA) provide

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joint advice regarding seafood consumption to limit
methylmercury exposure for women who might becomeor are pregnant or lactating and young children.2
Seafood choices higher in EPA and DHA and lower
in methylmercury are encouraged. Seafood varieties
commonly consumed in the United States that are higher
in EPA and DHA and lower in methylmercury include
salmon, anchovies, sardines, Pacific oysters, and trout.
Tilapia, shrimp, catfish, crab, and flounder are commonly
consumed varieties that also are lower in methylmercury.
Intakes of protein foods are close to the target amounts,
but many Americans do not meet recommendations
for specific protein subgroups. About three-quartersof Americans meet or exceed the recommendation formeats, poultry, and eggs. However, almost 90 percent
do not meet the recommendation for seafood and morethan half do not meet the recommendation for nuts,
seeds, and soy products. Slightly less than half (43%)
of all protein foods are consumed as a separate food
item, such as a chicken breast, a steak, an egg, a fish

filet, or peanuts. About the same proportion are
3
consumed as part of a mixed dish (48%), withthe largest amount from sandwiches including
burgers and tacos. Protein foods are generally consumed
in forms with higher amounts of saturated fat or sodium
and often part of mixed dishes (e.g., sandwiches,casseroles, pasta dishes) that include other ingredientsthat are not in nutrient-dense forms.
Shifts are needed within the protein foods group to
add variety to subgroup intakes. Selecting from theseafood subgroup or the beans, peas, and lentils
subgroup more often could help meet recommendations
while still ensuring adequate protein consumption.
Replacing processed or high-fat meats (e.g., hot dogs,
sausages, bacon) with seafood could help lower intake
of saturated fat and sodium, nutrients that are often
consumed in excess of recommended limits. Replacing
processed or high-fat meats with beans, peas, and lentils
would have similar benefits, as well as increasing dietaryfiber, a dietary component of public health concern.

2 Available at FDA.gov/fishadvice and EPA.gov/fishadvice.

Follow Food Safety Recommendations

An important part of healthy eating is keeping food safe. Individuals in their own homes can help keep
food safe by following safe food handling practices. Four basic food safety principles work together toreduce the risk of foodborne illness—Clean, Separate, Cook, and Chill.
1: Clean
Wash hands andsurfaces often.

2: Separate
Separate raw meatsfrom other foods.

3: Cook
Cook food to safeinternal temperatures.

4: Chill
Refrigerate foods
promptly.

Some eating behaviors, such as consuming raw, undercooked, or unpasteurized food products, increase the risk ofcontracting a foodborne illness. Populations at increased risk of foodborne illness, or those preparing food for them,should use extra caution. These include women who are pregnant, young children, and older adults. Specific guidance
for these life stages is discussed in subsequent chapters. Individuals with weakened immune systems are also at
increased risk for foodborne illness. More information about food safety is available at:• Your Gateway to Food Safety: foodsafety.gov• USDA Food Safety Education campaigns: fsis.usda.gov/wps/portal/fsis/topics/food-safety-education/teachothers/fsis-educational-campaigns• Fight BAC!®: fightbac.org and for Babies and Toddlers: fightbac.org/kids/• CDC 4 Steps to Food Safety: cdc.gov/foodsafety• FDA: Buy, Store & Serve Safe Food at fda.gov/food/consumers/buy-store-serve-safe-food

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Oils

Oils are important to consider as part of a healthy dietary pattern as they provide essential fatty acids. Commonly
consumed oils include canola, corn, olive, peanut, safflower, soybean, and sunflower oils. Oils also are naturally
present in nuts, seeds, seafood, olives, and avocados. The fat in some tropical plants, such as coconut oil, palm
kernel oil, and palm oil, are not included in the oils category because they contain a higher percentage of saturated
fat than do other oils.
Strategies to shift intake include cooking with vegetable oil in place of fats high in saturated fat, including butter,
shortening, lard, or coconut oil. However, some foods, such as desserts and sweet snacks, that are prepared withoils instead of fats high in saturated fat are still high in added sugars, and are thus not a nutrient-dense food choice.

Beverages

When choosing beverages in a healthy dietary pattern, both the calories and nutrients that they provide are importantconsiderations. Beverages that are calorie-free—especially water—or that contribute beneficial nutrients, such as
fat-free and low-fat milk and 100% juice, should be the primary beverages consumed. Coffee, tea, and flavoredwaters also are options, but the most nutrient-dense options for these beverages include little, if any, sweeteners or
cream. For discussion on sugar-sweetened beverages or alcohol, see “Added Sugars” and “Alcoholic Beverages,”
respectively.
CAFFEINE
Caffeine is a dietary component that functions in the body as a stimulant. Most intake of caffeine in the UnitedStates comes from coffee, tea, and soda. Caffeine is a substance that is Generally Recognized as Safe (GRAS) incola-type beverages by the Food and Drug Administration (FDA). For healthy adults, the FDA has cited 400 milligrams
per day of caffeine as an amount not generally associated with dangerous, negative effects. Additional information
related to caffeine is provided in subsequent life stage chapters.

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3

Beverages and Added Sugars

Examples of beverages that often have addedsugars are regular soda (i.e., not sugar-free), fruit
drinks, sports drinks, energy drinks, sweetenedwaters, and coffee and tea beverages with addedsugars. Coffee and tea beverages from restaurants
can contain many extra calories because of theaddition of cream or milk and sugar. See below
for examples of 12-ounce beverages showing theadded sugars and total calories.

Drink(12-ounce
serving)

Total
Calories

Added
Sugars(Grams)Added
Sugars(Teaspoons)

Plain Water

0

0

0

Unsweetened
Tea

0

0

0

Sports Drinks

97

20

5

Cafe Mocha

290

21

5

Chai Tea Latte

180

23

5½

Sweetened Tea

115

29

7

Regular Soda

156

37

9

Lemonade

171

43

10

Fruit Drinks

238

59

14

Data Source: U.S. Department of Agriculture, Agricultural
Research Service. 2020. USDA Food and Nutrient Database for
Dietary Studies and USDA Food Patterns Equivalents Database2017-2018. Food Surveys Research Group Home Page, ars.usda.
gov/nea/bhnrc/fsrg.

Dietary Components of Public Health
Concern for Underconsumption

Current inadequate intake of nutrient-dense foods
and beverages across food groups has resulted inunderconsumption of some nutrients and dietarycomponents. Calcium, potassium, dietary fiber, andvitamin D are considered dietary components ofpublic health concern for the general U.S. population
because low intakes are associated with healthconcerns. Additional dietary components that areunderconsumed during specific life stages arehighlighted in subsequent chapters.
If a healthy dietary pattern is consumed, amountsof calcium, potassium, and dietary fiber can meet
recommendations. Individuals should be encouraged
to make shifts to increase the intake of vegetables,
fruits, beans, whole grains, and dairy to move intakesof these underconsumed dietary components closer torecommendations. In some cases, fortified foods anddietary supplements may be useful in providing one
or more nutrients that otherwise may be consumed
in less than recommended amounts. Vitamin D
recommendations are harder to achieve throughnatural sources from diet alone and would requireconsuming foods and beverages fortified with vitamin
D. In many cases, taking a vitamin D supplement may
be appropriate especially when sunlight exposure islimited due to climate or the use of sunscreen. Listsof dietary sources of calcium, potassium, dietary fiber,and vitamin D are available at DietaryGuidelines.gov.

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Guideline 4

Limit Foods and Beverages Higher in
Added Sugars, Saturated Fat, and Sodium,and Limit Alcoholic Beverages
A healthy dietary pattern is designed to meet food group and nutrient recommendations while staying withincalorie needs. Additionally, a healthy dietary pattern is designed to not exceed the Tolerable Upper Intake Level(UL) or Chronic Disease Risk Reduction (CDRR) level for nutrients. To achieve these goals, the pattern is based on
consuming foods and beverages in their nutrient-dense forms—forms with the least amounts of added sugars,
saturated fat, and sodium.
Most of the calories a person needs to eat each day—around 85 percent—are needed to meet food group
recommendations healthfully, in nutrient-dense forms. The remaining calories—around 15 percent—are calories
available for other uses, including for added sugars or saturated fat beyond the small amounts found in nutrientdense forms of foods and beverages within the pattern, to consume more than the recommended amount of a foodgroup, or for alcoholic beverages. This equates to 250 to 350 remaining calories for calorie patterns appropriate formost Americans.

Figure 1-7

The 85-15 Guide: Percentage of Calories Needed To Meet FoodGroup Needs With Nutrient-Dense Choices and Percentage
Left for Other Uses
Total Calories Per Day

85%

of calories are needed per day to meetfood group recommendations healthfully,
in nutrient-dense forms

15%

of remaining
calories are available
for other uses(including addedsugars andsaturated fat)

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4

Figure 1-8

Making Nutrient-Dense Choices:
One Meal At a Time
Slight changes to individual parts of a meal can make a big difference. This meal shows examples of small shifts tomore nutrient-dense choices that significantly improve the nutritional profile of the meal overall while delivering on
taste and satisfaction.

Typical Burrito Bowl
Total Calories = 1,120

Nutrient-Dense Burrito Bowl
Total Calories = 715

White rice (1½ cups)

Brown rice (1 cup) + Romaine lettuce (½ cup)Black beans (⅓ cup)Black beans, reduced sodium (⅓ cup)

Chicken cooked with sauce (2 ounces)

Grilled chicken with spice rub (2 ounces)

No grilled vegetables

Added grilled vegetables (⅓ cup)

Guacamole (½ cup)

Sliced avocado (5 slices)

Jarred salsa (¼ cup)

Fresh salsa/pico de gallo (¼ cup)

Sour cream (¼ cup)

No sour creamCheese (⅓ cup)

Reduced-fat cheese (⅓ cup)

Jalapeño (5 slices)

Jalapeño (5 slices)

Iced tea with sugar (16 ounces)

Iced tea, no sugar (16 ounces)

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Figure 1-9

Making Healthy Choices: One Day At a Time
Small changes to more nutrient-dense, single food and beverage choices that, when combined, become a nutrientdense meal, can lead to a whole day made up of nutrient-dense meals and snacks. The following example, whichcomes in under 2,000 calories, shows how people can make thoughtful choices that meet their food group needs,
stay within limits, and, importantly, that they can enjoy.

BREAKFAST
Total calories: 375• Banana-Walnut Overnight Oats
(350 calories):» Oats (½ cup raw)
» Low-fat, plain Greek yogurt(¼ cup)» Fat-free milk (¼ cup)
» Banana (½ banana)» Walnuts (4 nuts)» Honey (1 tsp)
• Coffee (25 calories):» Coffee (1 cup)
» Fat-free milk (¼ cup)

LUNCH
Total calories: 715• Chicken Burrito Bowl
(710 calories)» Brown rice (1 cup)
» Romaine lettuce (½ cup)
» Black beans, low sodium(⅓ cup)» Grilled chicken with spice rub(2 ounces)» Grilled vegetables (⅓ cup)
» Sliced avocado (5 slices)» Fresh salsa/pico de gallo(¼ cup)» Reduced-fat cheese (⅓ cup)
» Jalapeño (5 slices)• Iced Tea, No Sugar(16 ounces) (5 calories)

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4

The nutrient density and healthfulness of what people eat and drink often is determined
ultimately by how a food item, dish or meal is prepared, at home and away from home, or
produced by a manufacturer. Based on the U.S. food supply and marketplace, the examples ofhealthy dietary patterns in this edition are achievable through thoughtful, informed choices one
decision, one meal, one day at a time—and consistently over time.

DINNER
Total calories: 585• Oven-Roasted Tilapia andVegetables With Pasta(510 calories)» Tilapia (4 ounces)» Broccoli (½ cup)
» Carrots (⅓ cup)
» Summer squash (⅓ cup)
» Pasta (¾ cup cooked)» Garlic-herb oil (1 Tbsp)• Orange (1 medium)(75 calories)• Sparkling Water(8 ounces) (0 calories)

SNACKS
Total calories: 300• Air-Popped Popcorn(2 cups) (60 calories)• Yogurt and Peaches(240 calories)» Plain, low-fat Greek yogurt(1 cup yogurt)» Canned peaches packed in
100% juice (½ cup)

TOTAL CALORIESFOR THE DAY:
2,000

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As such, a nutrient-dense diet, where most nutritional
needs are met by 85% of the calories consumed, offersa small amount of leeway to add minimal amountsof added sugars or saturated fat to the diet. For
example, one way to use remaining calories is to add
small amounts of added sugars or saturated fat tosome nutrient-dense foods to help make some foods
more palatable while working towards meeting foodgroup recommendations—for example, oatmeal with asmall amount of brown sugar or vegetables preparedwith small amounts of butter. However, to achieve ahealthy dietary pattern, all (or mostly all) food group
recommendations should be met with foods andbeverages that are in nutrient-dense forms.
A healthy dietary pattern has little room available forfoods and beverages high in added sugars, saturated
fat, and/or sodium. Intakes of foods and beverages
high in these components should be limited. Thesefoods and beverages should be occasional choices—
consumed in small portions.
While intakes of added sugars, saturated fat, andsodium should be limited, the guidance below isintended to allow programs and individuals to havesome flexibility to choose a healthy dietary pattern
within calorie limits that fits personal preferences andcultural traditions—and allows day-to-day flexibility

to support a healthy dietary pattern overtime. Additionally, if alcoholic beverages
are consumed, intakes should be within thelimits described in this chapter, and calories shouldbe accounted for to keep total calorie intake at an
appropriate level.

Added Sugars

A healthy dietary pattern limits added sugars to lessthan 10 percent of calories per day. Added sugars
can help with preservation; contribute to functional
attributes such as viscosity, texture, body, color, andbrowning capability, and/or help improve the palatabilityof some nutrient-dense foods. In fact, the nutrientdense choices included in the Healthy U.S.-Style Dietary
Pattern are based on availability in the U.S. food supply
and include 17-50 calories from added sugars, or
1.5-2 percent of total calories.
Foods and beverages high in calories from added sugars
should be limited to help achieve healthy dietary patterns
within calorie limits. When added sugars in foods andbeverages exceed 10 percent of calories, a healthy
dietary pattern within calories limits is very difficult toachieve. Most Americans have less than 8 percent ofcalories available for added sugars, including the addedsugars inherent to a healthy dietary pattern. The limit foradded sugars is based on the following assumptions:Page 41 | Dietary Guidelines for Americans, 2020-2025 | Chapter 1: Nutrition and Health Across the LifespanGuideline

4• Most calorie levels have less than 15 percent
of calories remaining after meeting food group
recommendations through nutrient-dense choices.

less than the allotted amount of calories for saturated
fat, 10 percent of added sugars may fit in a healthy
dietary pattern.

• Approximately half of remaining calories are
consumed as saturated fat and half consumed as
added sugars.

Added sugars account on average for almost 270
calories—or more than 13 percent of total calories—per
day in the U.S. population. As shown in Figure 1-10,
the major sources of added sugars in typical U.S. diets
are sugar-sweetened beverages, desserts and sweet
snacks, sweetened coffee and tea, and candy. Together,
these food categories make up more than half of theintake of all added sugars while contributing very little
to food group recommendations.

• Total saturated fat intakes meet the recommendation
for less than 10 percent of total calorie intake.
• No alcoholic beverages are consumed.
• Overall calorie intake does not exceed intake needs tomaintain or achieve a healthy weight.
Based on the assumptions above, an individual who
needs 2,000 calories per day (based on age, sex,
and physical activity level) has less than 7 percent
of calories available for added sugars. Individuals
who need 2,800 calories per day or less have lessthan 8 percent of calories available for added sugars.
Individuals who need more than 3,000 calories may
have a total of 9 to 10 percent of calories available foradded sugars. In this portion of the population that
requires high calorie intake, an upper limit of 10 percent
of calories from added sugars may be consumed whilestill meeting food group recommendations in nutrientdense forms. The 10 percent added sugar limit allows
for flexibility in food choices over time but also requires
careful planning. For example, if one chooses to eat

Individuals have many potential options for reducing theintake of added sugars, including reducing the intake
of major sources of added sugars. Strategies include
reducing portions, consuming these items less often,
and selecting options low in added sugars. For thosewith a weight loss goal, limiting intake of foods andbeverages high in added sugars is a strategy to help
reduce calorie intake.
It should be noted that replacing added sugars withlow- and no-calorie sweeteners may reduce calorie
intake in the short-term and aid in weight management,
yet questions remain about their effectiveness as along-term weight management strategy. For additional
information about high-intensity sweeteners permitted
for use in food in the United States, see fda.gov/food/
food-additives-petitions/high-intensity-sweeteners.

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Figure 1-10

Top Sources and Average Intakes of Added
Sugars: U.S. Population Ages 1 and Older
Breakfast
Cereals & Bars

Candy &
Sugars7%

Added Sugars
Average Intake:266 kcal/day

4

9%

Sugar-Sweetened
Beverages

24%

Higher Fat
Milk & Yogurt%

Desserts &Sweet Snacks

19%

Other Sources

19%

Coffee & Tea
Sandwiches

7

%

11%

Within Sugar-Sweetened
Beverages:
Other Sources

1%

Within Desserts &Sweet Snacks:
Other Sources

1%

3

%

Soft Drinks

Fruit Drinks

Cookies &&Cookies
Brownies
Brownies

%

%

%%

16

2

6

5

%

Doughnuts,
Sweet Rolls,& Pastries

IceCream
Cream&&
Ice
FrozenDairy
FrozenDesserts
Dairy Desserts
S

55

%%

Cakes && Pies
Pies
Cakes
Sport &
Energy Drinks

4%%

Data Source: Analysis of What We Eat in America, NHANES, 2013-2016, ages 1 and older, 2 days dietary intake data, weighted.
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4

Saturated Fat

For those 2 years and older, intake of saturated fat
should be limited to less than 10 percent of calories per
day by replacing them with unsaturated fats, particularly
polyunsaturated fats. Although some saturated fat isinherent in foods (e.g., high-fat meat), some sources areadded (e.g., butter on toast). Similar to added sugars,
some of the nutrient-dense choices included in the
Healthy U.S.-Style Dietary Pattern include saturated fat.
Approximately 5 percent of total calories inherent to thenutrient-dense foods in the Healthy U.S.-Style Dietary
Pattern are from saturated fat from sources such aslean meat, poultry, and eggs; nuts and seeds; grains;and saturated fatty acids in oils. As such, there is little
room to include additional saturated fat in a healthy
dietary pattern while staying within limits for saturated
fat and total calories.
Current average intakes of saturated fat are 11 percent
of calories. Only 23 percent of individuals consume
amounts of saturated fat consistent with the limit ofless than 10 percent of calories. The main sourcesof saturated fat in the U.S. diet include sandwiches,
including burgers, tacos, and burritos; desserts andsweet snacks; and rice, pasta, and other grain-based
mixed dishes (Figure 1-11). Saturated fat is commonly
found in higher amounts in high-fat meat, full-fat dairy
products (e.g., whole milk, ice cream, cheese), butter,coconut oil, and palm kernel and palm oil.

Strategies to lower saturated fat intake include reducing
intakes of dessert and sweet snacks by consuming
smaller portion sizes and eating these foods less often.
Additional strategies include reading food labels tochoose packaged foods lower in saturated fats andchoosing lower fat forms of foods and beverages(e.g., fat-free or low-fat milk instead of 2 percent orwhole milk; lean rather than fatty cuts of meat). Whencooking and purchasing meals, select lean meat andlower fat cheese in place of high-fat meats and regularcheese—or replace them with ingredients with oils,
such as nuts, seeds, or avocado. Cook and purchaseproducts made with oils higher in polyunsaturated andmonounsaturated fat (e.g., canola, corn, olive, peanut,
safflower, soybean, and sunflower) rather than butter,
shortening, or coconut or palm oils.
A note on trans fats and dietary cholesterol: The
National Academies recommends that trans fat
and dietary cholesterol consumption to be as low
as possible without compromising the nutritional
adequacy of the diet. The USDA Dietary Patterns arelimited in trans fats and low in dietary cholesterol.
Cholesterol and a small amount of trans fat occur
naturally in some animal source foods. As of June
2018, partially hydrogenated oils (PHOs), the major
source of artificial trans fat in the food supply, are nolonger Generally Recognized as Safe (GRAS). Therefore,
PHOs are no longer added to foods.

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Figure 1-11

Top Sources and Average Intakes ofSaturated Fat: U.S. Population Ages 1 and Older
Eggs

3

%

Pizza

5

%

Poultry,
Excluding Deli &Mixed Dishes

4

6

4

%

%

Saturated Fat
Average Intake:239 calories/day

Meat, Poultry &Seafood Mixed
DishesHigher Fat
Milk & Yogurt%

Spreads3%

Sandwiches

Desserts &Sweet Snacks

19%

11%

Meats,
Excluding Deli
& Mixed Dishes

3%

Rice, Pasta & Other
Grain-Based
Mixed Dishes

Cheese4

Vegetables,
ExcludingStarchy

%

4

7

%

%

Chips, Crackers& Savory
Snacks4%
Other Sources

20%

Starchy
Vegetables

3%

Breakfast
Sandwiches

WithinSandwiches:

Other
Sandwiches%

Burritos &
Tacos

6
4
1 3

%

Burgers

HotdogSandwiches

2

%

%

%

Cakes & Pies

Chicken & Turkey
Sandwiches

2 3%Within Desserts &Sweet Snacks:%

Ice Cream &Frozen Dairy
Desserts

4

Cookies &Brownies

3

%

%

2

%

Doughnuts,
Sweet Rolls& Pastries

Data Source: Analysis of What We Eat in America, NHANES, 2013-2016, ages 1 and older, 2 days dietary intake data, weighted.
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Sodium

Sodium is an essential nutrient primarily consumed as
salt (sodium chloride). Healthy eating patterns
limit sodium to the Chronic Disease Risk Reduction(CDRR) levels defined by the National Academies—
1,200 mg/day for ages 1 through 3; 1,500 mg/day forages 4 through 8; 1,800 mg/day for ages 9 through 13;
and 2,300 mg/day for all other age groups. The CDRR for
sodium was established using evidence of the benefit ofreducing sodium intake on cardiovascular risk andhypertension risk.
As a food ingredient, sodium is used in multiple ways,
including curing meat, baking, as a thickening agent, as aflavor enhancer, as a preservative, and to retain moisture.
The nutrient-dense choices in the Healthy U.S.-Style
Dietary Pattern provide approximately 60-100 percent of
the age-specific CDRR for sodium across calorie levels
with amounts ranging from about 1,000 to 2,200 mg.
For most calorie levels and at most ages, there is very
little room for food choices that are high in sodium.
Average intakes of sodium are high across the U.S.
population compared to the CDRRs. Average intakes
for those ages 1 and older is 3,393 milligrams per day,with a range of about 2,000 to 5,000 mg per day. Only asmall proportion of total sodium intake is from sodium
inherent in foods or from salt added in home cooking
or at the table. Most sodium consumed in the UnitedStates comes from salt added during commercial foodprocessing and preparation, including foods preparedat restaurants.
Sodium is found in foods from almost all food categories
across the food supply (Figure 1-12), including mixed
dishes such as sandwiches, burgers, and tacos; rice,
pasta, and grain dishes; pizza; meat, poultry, andseafood dishes; and soups. Calorie intake is highly
associated with sodium intake (i.e., the more foods andbeverages people consume, the more sodium they tend
to consume).
Because sodium is found in so many foods, multiple
strategies should be implemented to reduce sodium
intake to the recommended limits. Careful choices areneeded in all food groups to reduce intake. Strategies
to lower sodium intake include cooking at home more
often; using the Nutrition Facts label to choose productswith less sodium, reduced sodium, or no-salt-added, etc.;
and flavoring foods with herbs and spices instead of salt
based on personal and cultural foodways.

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Figure 1-12

Top Sources and Average Intakes of Sodium:
U.S. Population Ages 1 and Older
Yeast Breads& Tortillas

Starchy
Vegetables

Poultry,
Excluding Deli &Mixed Dishes

5

4

3

%

%

%

3

%

Chips, Crackers& Savory Snacks

Pizza

5

4

%

Eggs

3

SodiumAverage Intake:
3,393 mg/day

Deli & Cured
Products%

Sandwiches

%

21%

4

7%

Meat, Poultry& Seafood
Mixed Dishes

%

5

%

3

%

8%

Vegetables,
Excluding Starchy

Soups

Breakfast
Cereals & Bars

Rice, Pasta &Other Grain-Based
Mixed Dishes

Desserts &Sweet Snacks

4%
Other Sources

19%

Condiments& Gravies

3%

WithinSandwiches:
HotdogSandwiches

2 2Within Rice, Pasta &Other Grain-Based
Mixed Dishes:

Breakfast
Sandwiches%

Other Sources

%

Other
Sandwiches

7

4

%

%

1 3
%

PBJ
Sandwiches

Chicken & Turkey
Sandwiches%

Burritos &
Tacos

3%

3 1

%

%

Other Sources

2

Other
Mexican Dishes,
ExcludesTacos & Burritos

1

%

%

Rice Mixed
DishesPasta Mixed Dishes,
ExcludesMacaroni & Cheese

Data Source: Analysis of What We Eat in America, NHANES, 2013-2016, ages 1 and older, 2 days dietary intake data, weighted.
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4

Nutrition Facts Label

The Nutrition Facts label on packaged foods and beverages is a tool for making informed and healthy
food choices. For the first time in more than 20 years, the U.S. Food and Drug Administration (FDA) has
updated the Nutrition Facts label. There are a number of key changes to the label including:Along with the updated
design, the Nutrition Factslabel helps support healthy
dietary patterns by providing
Calories are displayed in larger, bolder font.
information on nutrients ofpublic health concern—dietary
Some Daily Values have been updated.
The percent Daily Value (%DV) shows
fiber, vitamin D, calcium,
how much a nutrient in a serving of foodiron, and potassium—andcontributes to a total daily diet. Fiveon dietary components topercent or less is low; 20 percent or more
limit, such as added sugars,
is high.
saturated fat, and sodium.
The serving size information is now inlarge, bold font and has been updated
to better reflect the amount that people
typically eat and drink.

Added sugars, vitamin D, andpotassium are now listed.

More information on the
Nutrition Facts label isavailable at: fda.gov/
NewNutritionFactsLabel.

Menu Nutrition Labeling

Americans eat and drink about one-third of theircalories from foods prepared away from home.
Usually, these foods provide more calories,
saturated fat, and sodium than meals preparedat home. To help individuals make informed andhealthy decisions, many food establishments
and chain restaurants list calories in foods
or beverages on menus or menu boards andadditional nutrition information is available
upon request. More information is available at
fda.gov/CaloriesOnTheMenu.

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Guideline

Alcoholic Beverages

The Dietary Guidelines does not recommend that
individuals who do not drink alcohol start drinking for any
reason. There are also some people who should not drink
at all, such as if they are pregnant or might be pregnant;under the legal age for drinking; if they have certain
medical conditions or are taking certain medications that
can interact with alcohol; and if they are recovering froman alcohol use disorder or if they are unable to control
the amount they drink. If adults age 21 years and older
choose to drink alcoholic beverages, drinking less isbetter for health than drinking more.
Evidence indicates that, among those who drink, higher
average alcohol consumption is associated with anincreased risk of death from all causes compared withlower average alcohol consumption. Alcohol misuseor consuming alcohol in excess of recommendations
increases risk of several other conditions such as liverdisease, cardiovascular disease, injuries, and alcohol
use disorders.
For the purposes of evaluating amounts of alcohol that
may be consumed, the Dietary Guidelines defines drink
equivalents. One alcoholic drink equivalent is defined as
containing 14 grams (0.6 fl oz) of pure alcohol.
The following count as one alcoholic drink equivalent:
12 fluid ounces of regular beer (5% alcohol), 5 fluid
ounces of wine (12% alcohol), or 1.5 fluid ounces of
80 proof distilled spirits (40% alcohol). To help Americans
move toward a healthy dietary pattern and minimizerisks associated with drinking, adults of legal drinking
age can choose not to drink or to drink in moderation
by limiting intakes to 2 drinks or less in a day for men
and 1 drink or less in a day for women, on days whenalcohol is consumed. This is not intended as an averageover several days, but rather the amount consumed on
any single day. Binge drinking,3 defined as 5 or more
drinks for the typical adult male or 4 or more drinks for4

the typical adult female in about 2 hours, should
be avoided. Emerging evidence suggests thateven drinking within the recommended limits
may increase the overall risk of death from various
causes, such as from several types of cancer and someforms of cardiovascular disease. Alcohol has beenfound to increase risk for cancer, and for some types ofcancer, the risk increases even at low levels of alcohol
consumption (less than 1 drink in a day). Caution,
therefore, is recommended.
Alcoholic beverages are not a component of the
USDA Dietary Patterns. The amount of alcohol andcalories in beverages varies and should be accounted
for within the limits of healthy dietary patterns, sothat calorie limits are not exceeded (see “Calories in
Alcoholic Beverages”).

Approximately 60 percent of adults report alcoholic
beverage consumption in the past month. Of those,
approximately 30 percent binge drink, sometimes
multiple times per month. During days when men andwomen consume alcohol, their consumption typicallyexceeds current guidance. Among adults, including
those who do not drink, alcoholic beverages contribute
approximately 5 percent of calorie intake (3 to 4% ofcalories for women and 5 to 7% for men); this translates
into approximately 9 percent of calories among those
who drink. As such, among those who drink, alcoholic
beverages, alone, account for most of the calories thatremain after meeting food group recommendations
in nutrient-dense forms—leaving very few calories foradded sugars or saturated fat.
Adults who choose to drink, and are not among theindividuals listed above who should not drink, areencouraged to limit daily intakes to align with the Dietary
Guidelines—and to consider calories from alcoholic
beverages so as not to exceed daily calorie limits.

3 More information is available at niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking.

Calories in Alcoholic Beverages

Alcoholic beverages supply calories but few nutrients,
and calories from alcoholic beverages should be
accounted for to keep total calorie intake at an
appropriate level. Alcoholic beverages may containcalories from both alcohol and other ingredients, suchas soda, juice, and added sugars. It is important toconsider ingredients and portion size. The range ofcalories in cocktails varies widely depending on serving
size and ingredients. Examples of calories contained inalcoholic beverages include:

12 fluid ounces of regularbeer (5% alcohol):about 150 calories

5 fluid ounces of wine
(12% alcohol):about 120 calories

1.5 fluid ounces of
80 proof distilled spirits(40% alcohol): about 100 calories

7 fluid ounces of arum (40% alcohol) andcola: about 190 calories

More information on calories in alcoholic beverages isavailable at rethinkingdrinking.niaaa.nih.gov/Tools/
Calculators/calorie-calculator.aspx.

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Support Healthy
Dietary Patterns for
All Americans
Everyone has a role to play to support access to healthy
foods and beverages in multiple settings nationwide
where people live, learn, work, play, and gather. Having
access to healthy, safe, and affordable food is crucial
for an individual to achieve a healthy dietary pattern.
Concerted efforts within communities, businesses
and industries, organizations, government, and othersegments of society are needed to support individuals
and families in making lifestyle choices that align with
the Dietary Guidelines.
Food manufacturers and retail establishments can
support Americans in achieving a healthy dietary
pattern by providing healthy options in all the places
where foods and beverages are purchased. During
the past few decades, food products and menus have
evolved substantially in response to consumer demandand public health concerns. Food reformulation andmenu and retail modification opportunities include
offering more vegetables, fruits, whole grains, low-fat
and fat-free dairy, and a greater variety of protein foods
that are nutrient dense, while also reducing sodium
and added sugars, reducing saturated fat and replacing
it with unsaturated fats, and reducing added refined
starches. Portion sizes also can be reduced to help
individuals make choices that better fit within theircalorie needs. Food manufacturers are encouraged toconsider the entire composition of the food or beverage,
and not just individual nutrients or ingredients whendeveloping or reformulating products.
Similarly, when developing or modifying menus,
establishments can consider the range of offerings
both within and across food groups and other dietarycomponents to determine whether the healthy options
offered reflect the proportions in healthy dietary
patterns. In taking these actions, care should be taken
to assess any potential unintended consequences sothat as changes are made to better align with the Dietary
Guidelines, undesirable changes are not introduced. For
example, a change made to reduce the amount of addedsugars in a product should not come at the expense ofincreasing the amount of saturated fat or sodium.
Food access is influenced by diverse factors, such as
proximity to food retail outlets (e.g., the number and4

types of stores in an area), ability to prepare
one’s own meals or eat independently, and theavailability of personal or public transportation.
The underlying socioeconomic characteristics of aneighborhood also may influence an individual’s ability
to access foods to support healthy eating patterns.

In 2019, 10.5 percent of households were food insecureat least some time during the year. Food insecurity
occurs when access to nutritionally adequate andsafe food is limited or uncertain. Food insecurity canbe temporary or persist over time, preventing
individuals and families from following a healthy
dietary pattern that aligns with the Dietary Guidelines.
The prevalence of food insecurity typically rises during
times of economic downturn as households experiencegreater hardship. Government and nongovernment
nutrition assistance programs help alleviate foodinsecurity and play an essential role by providing food,meals, and educational resources so that participants
can make healthy food choices within their budget.
Chapters 2, 3, 4, 5, and 6 highlight examples of theseresources at each life stage.
As discussed in subsequent chapters, everyone has
an important role in leading disease prevention efforts
within their organizations and communities to makehealthy eating an organizational and societal norm.
Changes at multiple levels of society are needed, andthese changes, in combination and over time, canhave a meaningful impact on the health of current andfuture generations.

Looking Toward
the Life Stages
This chapter has provided guidance about thefundamentals of a healthy dietary pattern. Thesefundamentals are remarkably consistent across life
stages, even though each stage also has its own
specific nutrition considerations. The following chaptersbuild on this chapter and take a closer look at each of
the life stages: Chapter 2 provides a focused discussionof the unique nutritional needs of infants and toddlers.
Chapters 3, 4, 5, and 6 present recommended dietary
patterns, describe current nutrition intakes, and provide
tailored nutrition information specific to children andadolescents, adults, women who are pregnant or
lactating, and older adults, respectively.

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B IRTH TH ROUGH 2 3 M O NT HS

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B I RT H T H R O U G H 23 M ONTHS

2

CHAPTER

Infants andToddlers

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B IRTH TH ROUGH 2 3 M O NT HS

Introduction

Key Recommendations

T• For about the first 6 monthsof life, exclusively feed infants
human milk. Continue to feed
infants human milk through at
least the first year of life, andlonger if desired. Feed infantsiron-fortified infant formula during
the first year of life when humanmilk is unavailable.

he time from birth until a child’s
second birthday is a criticallyimportant period for proper growthand development. It also is key forestablishing healthy dietary patterns
that may influence the trajectory ofeating behaviors and health throughout
the life course. During this period,
nutrients critical for brain development
and growth must be provided inadequate amounts. Children in thisage group consume small quantities
of foods, so it’s important to makeevery bite count!

• Provide infants with supplemental
vitamin D beginning soonafter birth.
• At about 6 months, introduce
infants to nutrient-dense
complementary foods.
• Introduce infants to potentiallyallergenic foods along with othercomplementary foods.
• Encourage infants and toddlers to
consume a variety of foods fromall food groups. Include foods richin iron and zinc, particularly for
infants fed human milk.
• Avoid foods and beverages withadded sugars.
• Limit foods and beverages higher
in sodium.
• As infants wean from human milk
or infant formula, transition to ahealthy dietary pattern.

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B I RT H T H R O U G H 23 M ONTHS

Human milk feeding alone is the ideal form of nutrition
from birth through about age 6 months. Human milk
provides necessary nutrients, protective factors against
disease, and other unique immunological benefits. If
human milk is unavailable, infants should be fed an ironfortified commercial infant formula. Once an infant isdevelopmentally ready, foods and beverages should be
introduced to complement human milk feeding. These
complementary foods and beverages are essential tomeet the nutrient requirements of infants starting at
about age 6 months and should be selected carefully
to help meet these needs. As an infant becomes a
toddler, and learns to eat a variety of foods, flavors, andtextures, the goal of complementary feeding becomes
establishing a healthy dietary pattern and transitioning toa healthy family diet by age 2.

Putting the Key
Recommendations
Into Action
Feed Infants Human Milk for the First
6 Months, If Possible

Exclusive human milk feeding is one of the best ways tostart an infant off on the path of lifelong healthy nutrition.
Exclusive human milk feeding, commonly referred to as
exclusive breastfeeding, refers to an infant consuming
only human milk, and not in combination with infant
formula and/or complementary foods or beverages(including water), except for medications or vitamin andmineral supplementation.
Human milk can support an infant’s nutrient needs forabout the first 6 months of life, with the exception ofvitamin D and potentially iron. In addition to nutrients,
human milk includes bioactive substances andimmunologic properties that support infant health andgrowth and development.
U.S. data show that about 84 percent of infants born in2017 were ever fed human milk, with only 25 percent fed
human milk exclusively through age 6 months, and 35
percent continuing to be fed any human milk at age 12months. Nearly one-quarter of infants were fed somehuman milk beyond age 12 months, with about 15 percent
of toddlers being fed human milk at age 18 months.
Families may have a number of reasons for not having
human milk for their infant. For example, a family may
choose not to breastfeed, a child may be adopted, or themother may be unable to produce a full milk supply or
may be unable to pump and store milk safely due to family
or workplace pressures. If human milk is unavailable,
infants should be fed an iron-fortified commercial infant
formula (i.e., labeled “with iron”) regulated by the U.S.
Food and Drug Administration (FDA), which is based onstandards that ensure nutrient content and safety. Infant
formulas are designed to meet the nutritional needs ofinfants and are not needed beyond age 12 months. It is
important to take precautions to ensure that expressed
human milk and prepared infant formula are handled
and stored safely (see “Proper Handling and Storage of
Human Milk and Infant Formula”).

Donor Human MilkIf families do not have sufficient human milk for their infant but want to feed their infant human
milk, they may look for alternative ways to obtain it. It is important for the family to obtain
pasteurized donor human milk from a source, such as an accredited human milk bank, that has
screened its donors and taken appropriate safety precautions. When human milk is obtained
directly from individuals or through the internet, the donor is unlikely to have been screened for
infectious diseases, and it is unknown whether the human milk has been collected or stored ina way to reduce possible safety risks to the baby. More information is available at fda.gov/science-research/
pediatrics/use-donor-human-milk.

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B IRTH TH ROUGH 2 3 M O NT HS

Proper Handling and Storage of Human Milk andInfant Formula• Wash hands thoroughly before expressing human milk or preparing to feed
human milk or infant formula.
• If expressing human milk, ensure pump parts are thoroughly cleaned
before use.
• If preparing powdered infant formula, use a safe water source and follow
instructions on the label.
• Refrigerate freshly expressed human milk within 4 hours for up to 4 days.
Previously frozen and thawed human milk should be used within 24 hours.
Thawed human milk should never be refrozen. Refrigerate prepared infant
formula for up to 24 hours.
• Do not use a microwave to warm human milk or infant formula. Warm safely
by placing the sealed container of human milk or infant formula in a bowl ofwarm water or under warm, running tap water.
• Once it has been offered to the infant, use or discard leftovers quickly (within
2 hours for human milk or 1 hour for infant formula).
• Thoroughly wash all infant feeding items, such as bottles and nipples.
Consider sanitizing feeding items for infants younger than 3 months of age,
infants born prematurely, or infants with a compromised immune system.
More information on storing and handling human milk is available at cdc.gov/
breastfeeding/recommendations/handling_breastmilk.htm. More information
on storing and preparing powdered infant formula is available at cdc.gov/
nutrition/downloads/prepare-store-powered-infant-formula-508.pdf.
Additional information on how to clean, sanitize, and store infant feeding items
is available at cdc.gov/healthywater/hygiene/healthychildcare/infantfeeding/cleansanitize.html.

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B I RT H T H R O U G H 23 M ONTHS

Homemade infant formulas and those that are improperly and illegallyimported into the United States without mandated FDA review andsupervision should not be used. Toddler milks or toddler formulas
should not be fed to infants, as they are not designed to meet thenutritional needs of infants.

Provide Infants Supplemental Vitamin D BeginningSoon After Birth

All infants who are fed human milk exclusively or who receive bothhuman milk and infant formula (mixed fed) will need a vitamin D
supplement of 400 IU per day beginning soon after birth. Infant formula
is fortified with vitamin D, thus, when an infant is receiving full feeds
of infant formula, vitamin D supplementation is not needed. Families
who do not wish to provide a supplement directly to their infant should
discuss with a healthcare provider the risks and benefits of maternalhigh dose supplementation options. Even when consuming a varieddiet, achieving adequate vitamin D from foods and beverages (natural
sources) alone is challenging, suggesting that young children may
need to continue taking a vitamin D supplement after age 12 months.
Parents, caregivers, and guardians should consult with a healthcare
provider to determine how long supplementation is necessary.

Introduce Infants To Nutrient-Dense Complementary
Foods at About 6 Months Old

Supplemental Vitamin B12

Human milk has sufficient vitamin
B12 to meet infant needs unlessthe mother’s vitamin B12 status
is inadequate. This can occur fordifferent reasons, including whenthe mother eats a strictly vegandiet without any animal source
foods. When the mother is at riskof vitamin B12 deficiency, humanmilk may not provide sufficientvitamin B12. In these cases, themother and/or infant fed humanmilk may require a vitamin B12
supplement. Parents, caregivers,
and guardians should consult witha healthcare provider to determine
whether supplementation isnecessary.

At about age 6 months, infants should be introduced to nutrient-dense,
developmentally appropriate foods to complement human milk or
infant formula feedings. Some infants may show developmental signsof readiness before age 6 months (see “Developmental Readiness for
Beginning to Eat Solid Foods”), but introducing complementary foods
before age 4 months is not recommended. Waiting until after age 6months to introduce foods also is not recommended. Starting aroundthat time, complementary foods are necessary to ensure adequate
nutrition and exposure to flavors, textures, and different types of foods.
Infants should be given age- and developmentally appropriate foods tohelp prevent choking. It is important to introduce potentially allergenic
foods along with other complementary foods. For infants fed human
milk, it is particularly important to include complementary foods thatare rich in iron and zinc when starting complementary foods (seeAppendix 1: Nutritional Goals for Age-Sex Groups).
About one-third (32%) of infants in the United States are introduced
to complementary foods and beverages before age 4 months,
highlighting the importance of providing guidance and support toparents, guardians, and caregivers on the timing of introduction tocomplementary foods. Early introduction of complementary foods andbeverages is higher among infants receiving infant formula (42%) or
a combination of infant formula and human milk (32%) than among
infants exclusively fed human milk (19%).

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B IRTH TH ROUGH 2 3 M O NT HS

Developmental Readiness for Beginning To
Eat Solid Foods

The age at which infants reach different developmental
stages will vary. Typically between age 4 and 6 months,
infants develop the gross motor, oral, and fine motor skills
necessary to begin to eat complementary foods. As an
infant’s oral skills develop, the thickness and texture offoods can gradually be varied. Signs that an infant is readyfor complementary foods include:• Being able to control head and neck.
• Sitting up alone or with support.
• Bringing objects to the mouth.
• Trying to grasp small objects, such as toys or food.
• Swallowing food rather than pushing it back out
onto the chin.
Infants and young children should be given age- anddevelopmentally appropriate foods to help prevent
choking. Foods such as hot dogs, candy, nuts andseeds, raw carrots, grapes, popcorn, and chunks ofpeanut butter are some of the foods that can be a choking
risk for young children. Parents, guardians, and caregivers
are encouraged to take steps to decrease choking
risks, including:• Offering foods in the appropriate size, consistency, andshape that will allow an infant or young child to eat andswallow easily.
• Making sure the infant or young child is sitting up
in a high chair or other safe, supervised place.
• Ensuring an adult is supervising feeding
during mealtimes.
• Not putting infant cereal or other solid foods in an
infant’s bottle. This could increase the risk of choking
and will not make the infant sleep longer.
More information on foods that can present choking
hazards is available from USDA at wicworks.fns.
usda.gov/resources/reducing-risk-choking-youngchildren-mealtimes.

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Introduce Infants to Potentially Allergenic Foods
Along With Other Complementary Foods

Potentially allergenic foods (e.g., peanuts, egg, cow milk products,
tree nuts, wheat, crustacean shellfish, fish, and soy) should be
introduced when other complementary foods are introduced to an
infant’s diet. Introducing peanut-containing foods in the first year
reduces the risk that an infant will develop a food allergy to peanuts.
Cow milk, as a beverage, should be introduced at age 12 months
or later (see “Establish a Healthy Beverage Pattern”). There is noevidence that delaying introduction of allergenic foods, beyond
when other complementary foods are introduced, helps to prevent
food allergy. For more information, see “For Infants at High Risk
of Peanut Allergy, Introduce Peanut-Containing Foods at Age
4 to 6 Months.”

For Infants at High Risk of
Peanut Allergy, Introduce
Peanut-Containing Foods
at Age 4 to 6 Months
If an infant has severe eczema,
egg allergy, or both (conditions
that increase the risk of peanut
allergy), age-appropriate, peanutcontaining foods should be
introduced into the diet as earlyas age 4 to 6 months. This will
reduce the risk of developing
peanut allergy.

Caregivers should check with
the infant’s healthcare provider
before feeding the infant peanutcontaining foods. A blood testor skin prick may berecommended to determine
whether peanut should be
introduced to the infant, and, if
so, the safest way to introduce it.
More information is available in
the Addendum Guidelines for thePrevention of Peanut Allergy in the
United States at niaid.nih.gov/
sites/default/files/addendumpeanut-allergy-preventionguidelines.pdf.

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B IRTH TH ROUGH 2 3 M O NT HS

Encourage Infants and Toddlers To
Consume a Variety of Complementary
Foods and Beverages To Meet Energy andNutrient Needs

Parents, caregivers, and guardians are encouraged
to introduce foods across all the food groups—asdescribed below and carrying forward the principles
in Chapter 1—including items that fit within afamily’s preferences, cultural traditions, and budget.
Complementary foods and beverages should be rich innutrients, meet calorie and nutrient requirements during
this critical period of growth and development, andstay within limits of dietary components such as addedsugars and sodium. Although the Dietary Guidelines does
not provide a recommended dietary pattern for infants
ages 6 through 11 months, infants should be on thepath to a healthy dietary pattern that is recommended
for those ages 12 through 23 months (see Appendix 3:
USDA Dietary Patterns).
In the United States, some dietary components areof public health concern for infants and toddlers. Ironis a dietary component of public health concern forunderconsumption among older infants ages 6 through11 months who are fed primarily human milk andconsume inadequate iron from complementary foods.
Older infants who are fed primarily human milk also
underconsume zinc and protein from complementary
foods, and vitamin D, choline, and potassium are notably
underconsumed by all older infants. During the second
year of life, the dietary components of public healthconcern for underconsumption are vitamin D, calcium,
dietary fiber, and potassium and for overconsumption
are added sugars and sodium. Lists of dietary sources ofiron, calcium, potassium, dietary fiber, and vitamin D are
available at DietaryGuidelines.gov.
INTRODUCE IRON-RICH FOODS TO INFANTS
STARTING AT ABOUT 6 MONTHS OLD
Iron-rich foods (e.g., meats and seafood rich in heme
iron and iron-fortified infant cereals) are importantcomponents of the infant’s diet from age 6 through11 months to maintain adequate iron status, which
supports neurologic development and immune function.
Infants are typically born with body stores of ironadequate for about the first 6 months of life, dependingon gestational age, maternal iron status, and timing ofumbilical cord clamping. By age 6 months, however,infants require an external source of iron apart fromhuman milk.
Caregivers of infants exclusively fed human milk should
talk with their pediatric care provider about whether
there may be a need for infants supplementation withiron before age 6 months. A complementary food sourceof iron beginning at about 6 months is particularly
important for infants fed human milk because the ironcontent of human milk is low and maternal iron intake
during lactation does not increase its content. In the
United States, an estimated 77 percent of infants fed
human milk have inadequate iron intake during thesecond half of infancy, highlighting the importance ofintroducing iron-rich foods starting at age 6 months.
Infants receiving most of their milk feeds as ironfortified infant formula are likely to need less iron fromcomplementary foods beginning at 6 months of age. After

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B I RT H T H R O U G H 23 M ONTHS

age 12 months, children have a lower iron requirement,
but good food sources of iron are still needed to maintainadequate iron status and prevent deficiency.
INTRODUCE ZINC-RICH FOODS TO INFANTS
STARTING AT ABOUT 6 MONTHS OLD
Zinc-rich complementary foods (e.g., meats, beans, zincfortified infant cereals) are important from age 6 months
onwards to support adequate zinc status, which supports
growth and immune function. Although the zinc content
of human milk is initially high and efficiently absorbed, theconcentration declines over the first 6 months of lactationand is not affected by maternal zinc intake. During thesecond half of infancy, approximately half (54%) of U.S.
infants fed human milk have inadequate zinc intake.
Prioritizing zinc-rich foods starting at 6 months of age tocomplement human milk feedings will help infants meettheir requirement for zinc.
ENCOURAGE A VARIETY OF FOODS FROM ALL
FOOD GROUPS TO INFANTS STARTING AT ABOUT
6 MONTHS OLD
To support nutrient adequacy, foster acceptance of
healthy foods, and set intakes on a path toward a healthy
pattern, it is important to encourage foods from all foodgroups. Because very young children are being exposed
to new textures and flavors for the first time, it may takeup to 8 to 10 exposures for an infant to accept a new typeof food. Repeated offering of foods such as fruits andvegetables increases the likelihood of an infant accepting
them. A nutrient-dense, diverse diet from age 6 through23 months of life includes a variety of food sources fromeach food group.
• Protein foods, including meats, poultry, eggs,
seafood, nuts, seeds, and soy products, are importantsources of iron, zinc, protein, choline, and long
chain polyunsaturated fatty acids. The long-chain
polyunsaturated fatty acids, specifically the essential
omega-3 and omega-6 fatty acids supplied throughseafood, nuts, seeds, and oils, influence the infant’s
fatty acid status and are among the key nutrientsneeded for the rapid brain development that occurs
through the infant’s first 2 years of life. Some types offish such as salmon and trout are also natural sourcesof vitamin D. To limit exposure to methylmercury fromseafood, the U.S. Food and Drug Administration andthe U.S. Environmental Protection Agency issued joint
guidance regarding the types of seafood to choose.1• Vegetables and fruits, especially those rich inpotassium, vitamin A, and vitamin C, should be offered
to infants and toddlers age 6 through 23 months. The
vegetable subgroup of beans, peas, and lentils also
provides a good source of protein and dietary fiber.
• For dairy, families can introduce yogurt and cheese,
including soy-based yogurt, before 12 months.
However, infants should not consume cow milk, asa beverage, or fortified soy beverage, before age 12months as a replacement for human milk or infant
formula (see “Cow Milk and Fortified Soy Beverages”).
In the second year of life, when calcium requirements
increase, dairy products, including milk, yogurt,
cheese, and fortified soy beverages and soy yogurt
provide a good source of calcium. Vitamin D-fortified
milk and soy beverages also provide a good source ofvitamin D. For those younger than the age of 2, offer
dairy products without added sugar (see “Avoid
Added Sugars”).
• Grains, including iron-fortified infant cereal, play animportant role in meeting nutrient needs during thislife stage. Infant cereals fortified with iron include oat,barley, multigrain, and rice cereals. Rice cereal fortified
with iron is a good source of nutrients for infants, but
rice cereal shouldn’t be the only type of cereal given
to infants. Offering young children whole grains more
often than refined grains will increase dietary fiber aswell as potassium intake during the second yearof life and help young children establish healthy
dietary practices.

1 U.S. Food and Drug Administration and U.S. Environmental Protection Agency. Advice About Eating Fish. Available at FDA.gov/fishadvice;
EPA.gov/fishadvice.

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B IRTH TH ROUGH 2 3 M O NT HSDIETARY COMPONENTS TO LIMIT
While encouraging intake from each food group, some dietarycomponents should be limited.
Avoid Added Sugars
Infants and young children have virtually no room in their diet foradded sugars. This is because the nutrient requirements for infants
and young children are quite high relative to their size, but the amountof complementary foods they consume is small. Complementary
foods need to be nutrient-dense and not contain additional calories
from added sugars. In addition, low- and no-calorie sweeteners, which
can also be called high-intensity sweeteners, are not recommended
for children younger than age 2. Taste preferences are being formed
during this time period, and infants and young children may develop
preferences for overly sweet foods if introduced to very sweet foods
during this timeframe. For more information on added sugars,
see Chapter 1.
Avoid Foods Higher in Sodium
Sodium is found in a number of foods, including some salty snacks,
commercial toddler foods, and processed meats. In addition tokeeping sodium intake within limits for toddlers (see Appendix 1),
another reason to avoid high-sodium foods is that taste preferences
for salty food may be established early in life. Choose fresh or
low-sodium frozen foods, when available, and low-sodium canned
foods to minimize sodium content. For more information on sodium,see Chapter 1.
Avoid Honey and Unpasteurized Foods and Beverages
Infants should not be given any foods containing raw or cooked
honey. Honey can contain the Clostridium botulinum organism that
could cause serious illness or death among infants. Infants andyoung children also should not be given any unpasteurized foods orbeverages, such as unpasteurized juices, milk, yogurt, or cheeses, as
they could contain harmful bacteria.

Establish a Healthy Beverage Pattern

An important part of establishing an overall healthy dietary pattern iscareful consideration of beverages. Guidance for different beveragecategories is provided below.
WATER
For healthy infants with adequate intake of human milk or infant
formula, supplemental water is typically not needed in the first
6 months. Small amounts (up to 4 to 8 ounces per day) of plain,
fluoridated drinking water can be given to infants with the introductionof complementary foods. Plain, fluoridated drinking water intake
can slowly be increased after age 1 to meet hydration andfluoride needs.

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COW MILK AND FORTIFIED SOY BEVERAGES
Infants should not consume cow milk or fortified soy
beverages before age 12 months to replace human milk
or infant formula. Cow milk does not have the correct
amount of nutrients for infants, and its higher protein
and mineral content are hard for an infant’s kidneys
and digestive system to process. Plain cow milk (wholemilk) or fortified unsweetened soy beverage can beoffered beginning around 12 months of age to help
meet calcium, potassium, vitamin D, and protein needs.
Flavored milks for children age 12 through 23 months
should be avoided because they contain added sugars.
PLANT-BASED MILK ALTERNATIVES
Plant-based milk alternatives, which are sometimes
referred to as milk alternatives, include beverages madefrom plants, such as soy, oat, rice, coconut, and almond.
These beverages should not be used in the first year oflife to replace human milk or infant formula. They may
come in different flavors and some forms have addedsugars. Unsweetened versions of these beverages may
be accommodated in small amounts in the diet during
the second year of life, but most have significantly
less protein than cow milk and are not always fortified
with calcium and vitamin D. Among plant-based milkalternatives, only fortified soy beverage is currently
considered a dairy equivalent. Thus, consuming otherplant-based beverages does not contribute to meeting
dairy recommendations.

SUGAR-SWEETENED BEVERAGES

Before age 12 months, 100% fruit or vegetable juices
should not be given to infants. In the second year oflife, fruit juice is not necessary, and most fruit intake
should come from eating whole fruit. If 100% fruit juice
is provided, up to 4 ounces per day can fit in a healthy
dietary pattern. Juices that contain added sugars should
be avoided.

Sugar-sweetened beverages (e.g., regular soda, juice
drinks [not 100% fruit juice], sports drinks, and flavoredwater with sugar) should not be given to children
younger than age 2. Drinks labeled as fruit drinks or
fruit-flavored drinks are not the same as 100% fruit juice
and contain added sugars. These beverages displace
nutrient-dense beverages and foods in the diet of young
children. Infants and toddlers do not have room in theirdiets for the additional calories from added sugars
found in these beverages. In addition, sugar-sweetened
beverage intake in infancy and early childhood may
predispose children to consume more of these
beverages later in life.

TODDLER MILK AND TODDLER DRINKSCAFFEINATED BEVERAGES

There are no clear needs for toddler milks or drinks.
Needed nutrients can be obtained from cow milkor fortified soy beverage and appropriate solid
foods. Toddler milks and toddler drinks are drinks
supplemented with nutrients, and typically contain addedsugars. A variety of nutrient-dense complementary
foods and beverages without added sugars should beemphasized for achieving nutrient recommendations.

Concerns exist about potential negative health effects ofcaffeine for young children, and no safe limits of caffeine
have been established for this age group. Caffeine
is a stimulant that can occur naturally in foods andbeverages or as an additive. Major sources of caffeine
for Americans include beverages such as soft drinks, tea,coffee, and sports drinks. Beverages containing caffeine
should be avoided for children younger than age 2.

100% FRUIT JUICE

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B IRTH TH ROUGH 2 3 M O NT HS

Healthy Dietary
Pattern During a
Toddler’s Second
Year of LifeIn the second year of life, toddlers consume lesshuman milk, and infant formula is not recommended.
Calories and nutrients should predominantly be met
from a healthy dietary pattern of age-appropriate foods
and beverages. The Healthy U.S.-Style Dietary Patternpresented here is intended for toddlers ages 12 through23 months who no longer consume human milk or
infant formula. The pattern represents the types andamounts of foods needed to meet energy and nutrition
requirements for this period (Table 2-1). For toddlers whoare still consuming human milk (approximately one-third
at 12 months and 15 percent at 18 months), a healthy
dietary pattern should include a similar combination ofnutrient-dense complementary foods and beverages.
Table 2-1 displays the Healthy U.S.-Style Dietary
Pattern to illustrate the specific amounts and limits
for food groups and other dietary components thatmake up healthy dietary patterns. The pattern isprovided at calorie levels ranging from 700 to 1,000
calories per day, which are appropriate for most
toddlers ages 12 through 23 months (see Appendix 2.
Estimated Calorie Needs). A healthy dietary

pattern includes a variety of nutrient-dense fruits,
vegetables, grains, protein foods (including leanmeats, poultry, eggs, seafood, nuts, and seeds), dairy(including milk, yogurt, and cheese), and oils. Based on
FDA and EPA’s joint “Advice About Eating Fish,” young
children should eat seafood lowest in methylmercury,and certain species of seafood should be avoided.2 Ifyoung children are lower in body weight, they should eat
less seafood than the amounts in the Healthy U.S.-Style
Dietary Pattern. More information is available on the FDA
or EPA websites at FDA.gov/fishadvice and EPA.gov/
fishadvice.
After food group and subgroup recommendations aremet, a small number of calories are allocated to oils.
The recommendation to limit saturated fat to less than
10 percent of calories per day does not apply to thoseyounger than age 2, and the inclusion of higher fat
versions of dairy is a notable difference in the pattern
for toddlers ages 12 through 23 months comparedto patterns for ages 2 and older. However, no calories
remain in the pattern for additional saturated fat orfor added sugars. To illustrate the concept of nutrient
density, Figure 2-1 shows examples of foods andbeverages appropriate for this life stage in forms
that are not in nutrient-dense forms compared to thosethat are in nutrient-dense forms. This dietary pattern
requires careful choices of foods and beverages but
does not require inclusion of fortified products
specifically formulated for infants or toddlers to meet
nutrient recommendations.

Figure 2-1
Make Healthy Shifts To Empower Toddlers To Eat Nutrient-Dense Foods in Dietary Patterns
Science shows that early food preferences influence later food choices. Make the first choice the healthiest choicesthat set the toddlers on a path of making nutrient-dense choices in the years to come. Examples of shifts in common
choices to healthier, more nutrient-dense food choices include:

Cereal with Added
Sugars

Cereal with Minimal
Added Sugars

Fruit Products with
Added Sugars

Fruit (e.g., canned in
100% juice)Fried Vegetables

Roasted Vegetables

High-sodium Snacks

Vegetables

High-sodium Meats

Ground Lean Meats

Beverages with Added
SugarsUnsweetened
Beverages

2 If consuming up to 2 ounces of seafood per week, children should only be fed cooked varieties from the “Best Choices” list in the FDA/EPA joint “Advice About
Eating Fish,” available at FDA.gov/fishadvice and EPA.gov/fishadvice. If consuming up to 3 ounces of seafood per week, children should only be fed cooked varieties
from the “Best Choices” list that contain even lower methylmercury: flatfish (e.g., flounder), salmon, tilapia, shrimp, catfish, crab, trout, haddock, oysters, sardines,
squid, pollock, anchovies, crawfish, mullet, scallops, whiting, clams, shad, and Atlantic mackerel. If consuming up to 3 ounces of seafood per week, many commonly
consumed varieties of seafood should be avoided because they cannot be consumed at 3 ounces per week by children without the potential of exceeding safe
methylmercury limits; examples that should not be consumed include: canned light tuna or white (albacore) tuna, cod, perch, black sea bass. For a complete list please
see: FDA.gov/fishadvice and EPA.gov/fishadvice.

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Table 2-1
Healthy U.S.-Style Dietary Pattern for Toddlers Ages 12 Through 23 Months Who Are No Longer
Receiving Human Milk or Infant Formula, With Daily or Weekly Amounts From Food Groups,
Subgroups, and Components
CALORIE LEVEL OF PATTERNa
FOOD GROUP OR SUBGROUPb,cVegetables (cup eq/day)

700

800

900

1,000

Daily Amount of Food From Each Groupd(Vegetable and protein foods subgroup amounts are per week.)
⅔

¾

1

1

Vegetable Subgroups in Weekly Amounts
Dark-Green Vegetables (cup eq/wk)

1

⅓

½

½

Red and Orange Vegetables (cup eq/wk)

1

1¾

2½

2½

Beans, Peas, Lentils (cup eq/wk)

¾

⅓

½

½

Starchy Vegetables (cup eq/wk)

1

1½

2

2

Other Vegetables (cup eq/wk)

¾

1¼

1½

1½

Fruits (cup eq/day)

½

¾

1

1

Grains (ounce eq/day)

1¾

2¼

2½

3

Whole Grains (ounce eq/day)

1½

2

2

2

Refined Grains (ounce eq/day)

¼

¼

½

1

Dairy (cup eq/day)

1⅔

1¾

2

2

Protein Foods (ounce eq/day)

2

2

2

2

Protein Foods Subgroups in Weekly Amounts
Meats, Poultry (ounce eq/wk)

8¾

7

7

7¾

Eggs (ounce eq/wk)

2

2¾

2½

2½

Seafood (ounce eq/wk)e

2-3

2-3

2-3

2-3

Nuts, Seeds, Soy Products (ounce eq/wk)

1

1

1¼

1¼

9

9

8

13

Oils (grams/day)a Calorie level ranges: Energy levels are calculated based on median length and body weight reference individuals. Calorie needs vary based on

many factors. The DRI Calculator for Healthcare Professionals, available at usda.gov/fnic/dri-calculator, can be used to estimate calorie needs
based on age, sex, and weight.

b Definitions for each food group and subgroup and quantity (i.e., cup or ounce equivalents) are provided in Chapter 1 and are compiled inAppendix 3.
c All foods are assumed to be in nutrient-dense forms and prepared with minimal added sugars, refined starches, or sodium. Foods are also leanor in low-fat forms with the exception of dairy, which includes whole-fat fluid milk, reduced-fat plain yogurts, and reduced-fat cheese. There are no
calories available for additional added sugars, saturated fat, or to eat more than the recommended amount of food in a food group.
d In some cases, food subgroup amounts are greatest at the lower calorie levels to help achieve nutrient adequacy when relatively small numberof calories are required.
e If consuming up to 2 ounces of seafood per week, children should only be fed cooked varieties from the “Best Choices” list in the FDA/EPA joint“Advice About Eating Fish,” available at FDA.gov/fishadvice and EPA.gov/fishadvice. If consuming up to 3 ounces of seafood per week, children
should only be fed cooked varieties from the “Best Choices” list that contain even lower methylmercury: flatfish (e.g., flounder), salmon, tilapia,
shrimp, catfish, crab, trout, haddock, oysters, sardines, squid, pollock, anchovies, crawfish, mullet, scallops, whiting, clams, shad, and Atlantic
mackerel. If consuming up to 3 ounces of seafood per week, many commonly consumed varieties of seafood should be avoided because theycannot be consumed at 3 ounces per week by children without the potential of exceeding safe methylmercury limits; examples that should not be
consumed include: canned light tuna or white (albacore) tuna, cod, perch, black sea bass. For a complete list please see: FDA.gov/fishadvice and
EPA.gov/fishadvice.

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B IRTH TH ROUGH 2 3 M O NT HS

Current Intakes
Figure 2-2 and 2-3 highlight the dietary intakes of toddlers during the second year of life. Average intakes of thefood groups are compared to the range of recommended intakes at the calorie levels most relevant to males andfemales in this age group (Figure 2-2). Additionally, the average intakes and range of intakes of added sugars,
saturated fat, and sodium are displayed. Average intakes compared to recommended intake ranges of the subgroups
for grains are represented in daily amounts; subgroups for vegetables and protein foods are represented in weekly
amounts (Figure 2-3).
Figure 2-2

Current Intakes: Ages 12 Through 23 Months
Average Daily Food Group Intakes Compared to
Recommended Intake Ranges
Recommended Intake Ranges

Average Intakes

Total
Vegetables
cup eq/day

Total
Grainsoz eq/day

3.5

CUP or OZ EQUIVALENT

3.0

2.5

2.0

1.5

1.0

0.5

0

Total
Fruitscup eq/day

Total
Dairy
cup eq/day

Total
Protein Foods
oz eq/day

FOOD GROUPS

Average Intakes of Added Sugars, Saturated Fat, and Sodium
Added Sugars

Saturated Fat

SodiumLimit: Avoid

Limit: N/A

Limit: 1,200 mg

Average Intakes

Average Intakes

Average Intakes

104 kcals

167 kcals

1,586 mg

Data Sources: Average Intakes: Analysis of What We Eat in America, NHANES 2007-2016, day 1 dietary intake data, weighted. Recommended
Intake Ranges: Healthy U.S.-Style Dietary Patterns (see Appendix 3).

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Ages 12-23 months

B I RT H T H R O U G H 23 M ONTHS

Figure 2-3
Average Intakes of Subgroups Compared to
Recommended Intake Ranges: Ages 12 Through23 Months
Recommended Intake Ranges
3.0

Average Intakes

Vegetables

CUP EQUIVALENT

2.5
2.0
1.5
1.0
0.5
0

3.5

DarkTotal
Vegetables Greencup eq/day

Red &OrangeBeans,
StarchyPeas,
Lentils
cup eq/week

Other

GrainsOZ EQUIVALENT

2.5
2.0
1.5
1.0
0.5
0

12

Total
GrainsWhole Grains

Refined Grainsoz eq/dayProtein Foods

10
8
6
4
2
0

Total grains, particularly refined grains, are consumed
in amounts that exceed recommendations. Conversely,
intakes of whole grains fall short of recommended
amounts for more than 95 percent of toddlers. A
majority of grains are consumed through breads, rolls,
tortillas, or other bread products or as part of a mixed
dish. Ten percent of grains come from sweet bakery
products and approximately 15 percent come fromcrackers and savory snacks. Many of these categories
are top sources of sodium or added sugars in thisage group.
Average intakes of dairy foods, most of which isconsumed as milk, generally exceed recommended
amounts in this age group. Intakes of yogurt and cheeseaccount for about 10 percent of dairy intakes. Plantbased beverages and flavored milks each make up
about 2 percent of dairy intakes among toddlers.

3.0

OZ EQUIVALENTApproximately 60 percent of toddlers meet or exceed
recommended intakes for fruit. A majority of fruit
is consumed as whole fruit (fresh, canned, puréed,frozen) or as 100% fruit juice. Average intake of total
vegetables is below the range of recommended
amounts, with nearly 90 percent of toddlers falling shortof recommendations. About one-half of vegetables are
consumed on their own, one-quarter are consumed aspart of a mixed dish, and nearly 5 percent are consumed
as savory snacks (e.g., potato chips).

Total
Protein Foods
oz eq/dayMeats,
Poultry

Eggs

Seafood Nuts, Seeds,
Soy Products
oz eq/week

Data Sources: Average Intakes: Analysis of What We Eat in
America, NHANES 2007-2016, day 1 dietary intake data, weighted.
Recommended Intake Ranges: Healthy U.S.-Style Dietary Patterns(see Appendix 3).

Protein foods intakes fall within recommended range,
on average. Intakes of meats, poultry, and eggs makeup a majority of protein foods intakes, however seafood
intakes in this age group is low. Children in this age
group can reduce sodium intake by eating less cured orprocessed meats including hot dogs, deli meats,and sausages.
Due to the relatively high nutrient needs of toddlers, a
healthy dietary pattern has virtually no room for addedsugars. Toddlers consume an average of more than 100
calories from added sugars each day, ranging from 40 to
250 calories a day (about 2.5 to 16 teaspoons). Sugarsweetened beverages, particularly fruit drinks, contribute
more than 25 percent of total added sugars intakes andsweet bakery products contribute about 15 percent.
Other food category sources contribute a smaller
proportion of total added sugars on their own, but thewide variety of sources, which include yogurts, ready-toeat cereals, candy, fruits, flavored milk, milk substitutes,
baby food products, and breads, points to the need tomake careful choices across all foods.

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B IRTH TH ROUGH 2 3 M O NT HS

Vegetarian Dietary Pattern During the Second Year of Life

A Healthy Vegetarian Dietary Pattern for young children ages 12 through 23 months who
are not fed human milk or infant formula is included in Appendix 3. This pattern describes
a lacto-ovo vegetarian diet that includes regular consumption of eggs, dairy products, soy
products, and nuts or seeds, in addition to vegetables including beans, peas, and lentils, fruits,
grains, and oils. Iron may be of particular concern because plant source foods contain only
non-heme iron, which is less bioavailable than is heme iron. Food source lists for both heme and non-heme
iron are available at DietaryGuidelines.gov. Vitamin B12 also may be of concern because it is present only inanimal source foods. When feeding infants and toddlers a lacto-ovo vegetarian diet, parents, caregivers, andguardians should consult with a healthcare provider to determine whether supplementation of iron, vitamin
B12, and/or other nutrients is necessary and if so, appropriate levels to meet their unique needs.

Supporting Healthy Eating
Parents, guardians, and caregivers play an important role in nutrition during this life stage because infants andtoddlers are fully reliant on them for their needs. In addition to “what” to feed children, “how” to feed young children
also is critical. As noted above, repeated exposure to foods can increase acceptance of new foods. Anotherimportant concept is responsive feeding, a feeding style that emphasizes recognizing and responding to the hunger
or fullness cues of an infant or young child (see “Responsive Feeding”).

Responsive Feeding

Responsive feeding is a term
used to describe a feeding stylethat emphasizes recognizing
and responding to the hunger orfullness cues of an infant or young
child. Responsive feeding helps
young children learn how to selfregulate their intake.
See Table 2-2 for some examplesof signs a child may show forhunger and fullness when he or
she is a newborn through age 5months, and signs a child may
start to show between age 6through 23 months.

Table 2-2
Signs a Child is Hungry or Full
Birth Through Age 5 Months
A child may be hungry if he or she:• Puts hands to mouth.
• Turns head toward breast or bottle.
• Puckers, smacks, or licks lips.
• Has clenched hands.

A child may be full if he or she:• Closes mouth.
• Turns head away from breast or bottle.
• Relaxes hands.

Age 6 Through 23 Months
A child may be hungry if he or she:
• Reaches for or points to food.
• Opens his or her mouth when offered aspoon or food.
• Gets excited when he or she sees food.
• Uses hand motions or makes sounds to
let you know he or she is still hungry.

A child may be full if he or she:• Pushes food away.
• Closes his or her mouth when food isoffered.
• Turns his or her head away from food.
• Uses hand motions or makes sounds to
let you know he or she is still full.

It is important to listen to thechild’s hunger and fullness cues
to build healthy eating habits during this critical age. If parents, guardians, or caregivers have questions or concerns, aconversation with a healthcare provider will be helpful.
For more information on signs a child is hungry or full, see: cdc.gov/nutritioninfantandtoddlernutrition/mealtime/
signs-your-child-is-hungry-or-full.html. More information on infant development skills, hunger and satiety cues, andtypical daily portion sizes is available at wicworks.fns.usda.gov/sites/default/files/media/document/Infant_Nutrition_
and_Feeding_Guide.pdf.

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Accessing a Healthy Dietary Pattern

Many resources exist to support healthy growth and development during
infancy and toddlerhood. These include the following Government programs
that aim to support a healthy dietary pattern for infants and toddlers living inhouseholds with limited incomes:• The Special Supplemental Nutrition Program for Women, Infants, andChildren (WIC) supports infant and early childhood nutrition throughsupplementing the diets of women who are pregnant or lactating and byproviding breastfeeding support and iron-fortified infant formula whenhuman milk is unavailable or fed only partially. WIC accommodates
the transition to solid foods by providing nutrient-dense foods in the
supplemental food packages offered to older infants and toddlers. Nutrition
education and counseling and referrals to healthcare and social services areother important resources offered to income-eligible WIC participants.
• The Child and Adult Care Food Program (CACFP) provides reimbursement
for nutrient-dense meals and snacks served to infants and toddlers inparticipating child care centers, including at Head Start programs, and day
care homes where infants and toddlers also have access to healthscreenings and families can be connected to health services to support theiroverall well-being.
• The Supplemental Nutrition Assistance Program (SNAP) is the largest
food assistance program in the United States. SNAP helps meet thenutritional needs of infants and toddlers living in low-income households byproviding temporary monthly benefits that can be used to access a healthy
dietary pattern.
These Government nutrition programs are especially important for the
14 percent3 of families with children who experience food insecurity and may
struggle to access the foods needed to support a healthy dietary pattern.
Professionals can use these, and additional Government and non-Government
resources that exist within communities, to support healthy eating during
infancy and toddlerhood.

Looking Toward Chapter 3:
Children and Adolescents
This chapter focused on nutrition issues important to infants and toddlers—
exclusive human milk feeding, if possible; introducing nutrient-dense
complementary foods at about age 6 months; and encouraging infants
and toddlers to sample and consume a variety of nutrient-dense foods andbeverages to meet their needs. As toddlers grow and their dietary patterns
become more integrated with the family’s food patterns, new issues arise.
These issues, and how to accommodate them within a lifelong healthy
dietary pattern, are discussed in the next chapter, which focuses on children
and adolescents.
3 More information on food insecurity is available at ers.usda.gov/data-products/ag-andfood-statistics-charting-the-essentials/food-security-and-nutrition-assistance.

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AGES 2-18

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AG ES 2 -18

3

CHAPTERChildren andAdolescents

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AGES 2-18

IntroductionChildren and adolescents include
individuals ages 2 through 18—
a life stage characterized by transitions
and the formation of dietary patterns.
Suboptimal current intake patterns amongchildren and adolescents and inadequate
physical activity contribute to overweight
and obesity in this life stage and risk ofchronic disease (e.g., type 2 diabetes,
cardiovascular disease) later in life.
Changing this trajectory is crucial because
dietary patterns established during this life
stage tend to continue into adult years.

Healthy eating throughout this life stage involves the child or adolescent,families and caregivers, and institutions and settings where food is provided
and consumed. Young children are fully reliant on others to provide theirmeals and snacks. As children transition to school-age and throughadolescence, they are exposed to new food choices and begin to havemore autonomy in the foods that are selected. New influences on eating
behavior also emerge, such as peer pressure, which can create opportunities
or challenges for establishing dietary patterns consistent with health andlongevity. Adolescents acquire ever-greater independence in their foodchoices as they mature, with more time spent on their own with peers
and more foods and beverages frequently consumed in social settings.
Other factors that influence eating behavior include social supports,
exposure to food marketing and promotion, and policies that determine
community design.
Youth have diverse calorie and nutrient needs based on age and patternsof growth, development, and physical activity. Current intake data ofyoung children show some components of a healthy dietary pattern that
continue from the infant and toddler life stages. Before these components
of a healthy dietary pattern are established, however, diet quality worsens
through childhood and into adolescence and intake patterns drift further
from recommendations in the Dietary Guidelines. Active community support
is needed to help youth meet food group and nutrient goals with nutrientdense foods and beverages.

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AG ES 2 -18

Childhood Overweight and Obesity

In the United States, 41 percent of children and adolescents are overweight or have obesity, and the prevalence
is higher among Hispanic and non-Hispanic Black children and adolescents as compared to non-Hispanic Asians
and Whites. Overweight and obesity put youth at high risk of serious health concerns. Youth with obesity are
more likely to have immediate health risks, including high blood pressure, high cholesterol, and impaired glucose
tolerance. They also are at increased risk of cardiovascular disease and type 2 diabetes beginning as soon as theteenage years and into adulthood. Psychological (e.g., anxiety, depression) and social concerns (e.g., bullying,stigma) also are more likely in children and adolescents with overweight or obesity.
The causes of childhood obesity are complex and interconnected. Behaviors (e.g., eating habits, level of physicalactivity, sedentary time) and the community in which a child or adolescent resides can influence risk of obesity.
Genetics and the fetal environment also play a role in the development of obesity. However, many opportunities
exist to help prevent or manage overweight and obesity as children transition through these life stages. The goalfor children and adolescents with overweight or obesity is to reduce the rate of weight gain while allowing normal
growth and development. This can primarily be done by emphasizing nutrient-dense food and beverage choices,minimizing calories from sources that do not contribute to a healthy dietary pattern, and encouraging regularphysical activity.

Healthy Dietary
Patterns
Children and adolescents are encouraged to follow therecommendations on the types of foods and beverages
that make up a healthy dietary pattern described in
Chapter 1. Nutrition and Health Across the Lifespan:
The Guidelines and Key Recommendations. Tables 3-1
to 3-3 display the Healthy U.S.-Style Dietary Pattern toillustrate the specific amounts and limits for food groups
and other dietary components that make up healthy
dietary patterns at the calorie levels appropriate for mostchildren and adolescents across four age ranges: onetable combining patterns relevant for ages 2 through4 and ages 5 through 8, and single tables for ages 9through 13 and for ages 14 through 18. Tables 3-1 to
3-3 also show the calories remaining for other uses—
about 10-15 percent of the total available—after meeting
food group and nutrient goals through the selection ofnutrient-dense foods and beverages.
Calorie needs generally increase throughout this life
stage to support growth and development. Child andadolescent females generally have lower calorie needs

than do males, with variations based on size and level ofphysical activity. During adolescence, the range of calorie
intakes widens to support diverse growth trajectories.
More information on the calorie estimates is provided inTables 3-1 to 3-3 (see footnote a) and in Appendix 2.
Estimated Calorie Needs.
The USDA Dietary Patterns, including the Healthy
U.S.-Style Dietary Pattern, provide a framework
to help children and adolescents follow a healthy
dietary pattern and meet the Guidelines and their
Key Recommendations. The USDA Foods Patterns
can be customized based on dietary needs, personal
preferences, and budgetary constraints. A variety ofnutrient-dense foods and beverages can be selectedacross the food group and subgroups as part of an
overall healthy dietary pattern. For more information
about the USDA Food Patterns, see Chapter 1 andAppendix 3. USDA Dietary Patterns. For this age group,
as for all the others, a figure comparing current intakes torecommendations is presented. See “Current Intakes” formore information.

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AGES 2-18

Children Ages 2 Through 8

In early childhood (ages 2 through 4), females require about 1,000 to 1,400 calories per day and males require
about 1,000 to 1,600 calories per day. With the transition to school-age (ages 5 through 8), females require
about 1,200 to 1,800 calories per day and males require about 1,200 to 2,000 calories per day.

Physical Activity

Childhood and adolescence is a critical period for developing movement
skills, learning healthy habits, and establishing a firm foundation for lifelong
health and well-being. For youth, regular physical activity can improve bonehealth, cardiorespiratory and muscular fitness, and cognition (including
academic achievement), and reduce the symptoms of depression.
Preschool-aged children should be active throughout the day to enhance
growth and development. Adults caring for children during this age
should encourage active play that includes a variety of activity types (light,
moderate, or vigorous intensity) and aim for at least 3 hours per day.
School-aged children and adolescents need at least 60 minutes of moderateto-vigorous activity daily to attain the most health benefits from physicalactivity. Most activity can be aerobic, like walking, running, or anything thatmakes their heart beat faster. They also need muscle-strengthening andbone-strengthening activities that make their muscles and bones strong, likeclimbing on playground equipment, playing basketball, and jumping rope.
The U.S. Department of Health and Human Service’s Physical Activity
Guidelines for Americans and related Move Your Way® resources have more
information about the benefits of physical activity and tips on how to getstarted. Available at health.gov/paguidelines.

Nutrient-Dense Foods
and Beverages

Nutrient-dense foods andbeverages provide vitamins,
minerals, and other healthpromoting components andhave little added sugars,
saturated fat, and sodium.
Vegetables, fruits, whole grains,seafood, eggs, beans, peas,and lentils, unsalted nuts andseeds, fat-free and low-fat dairy
products, and lean meats andpoultry—when prepared with noor little added sugars, saturated
fat, and sodium—are nutrientdense foods.

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AG ES 2 -18

Table 3-1
Healthy U.S.-Style Dietary Pattern for Children Ages 2 Through 8, With Daily or Weekly Amounts
From Food Groups, Subgroups, and Components
CALORIE LEVEL OF PATTERNa

1,000

1,400

1,600

1,800

2,000

Daily Amount of Food From Each Group(Vegetable and protein foods subgroup amounts are per week.)

FOOD GROUP OR SUBGROUPb
Vegetables (cup eq/day)

1,200

1

1½

1½

2

2½

2½

Vegetable Subgroups in Weekly Amounts
Dark-Green Vegetables (cup eq/wk)

½

1

1

1½

1½

1½

Red and Orange Vegetables (cup eq/wk)

2½

3

3

4

5½

5½

Beans, Peas, Lentils (cup eq/wk)

½

½

½

1

1½

1½

Starchy Vegetables (cup eq/wk)

2

3½

3½

4

5

5

Other Vegetables (cup eq/wk)

1½

2½

2½

3½

4

4

Fruits (cup eq/day)

1

1

1½

1½

1½

2

Grains (ounce eq/day)

3

4

5

5

6

6

Whole Grains (ounce eq/day)

1½

2

2½

3

3

3

Refined Grains (ounce eq/day)

1½

2

2½

2

3

3

Dairy (cup eq/day)

2

2½

2½

2½

2½

2½

Protein Foods (ounce eq/day)

2

3

4

5

5

5½

Protein Foods Subgroups in Weekly Amounts
Meats, Poultry, Eggs (ounce eq/wk)

10

14

19

23

23

26

Seafood (ounce eq/wk)c

2-3d

4

6

8

8

8

Nuts, Seeds, Soy Products (ounce eq/wk)

2

2

3

4

4

5

Oils (grams/day)

15

17

17

22

22

24

Limit on Calories for Other Uses (kcal/day)e

130

80

90

150

190

280

Limit on Calories for Other Uses (%/day)

13%

7%

6%

9%

10%

14%

a Calorie level ranges: Ages 2 through 4, Females: 1,000-1,400 calories;

Males: 1,000-1,600 calories. Ages 5 through 8, Females: 1,200-1,800
calories; Males: 1,200-2,000 calories. Energy levels are calculated
based on reference height (median) and reference weight (healthy)
corresponding with a healthy body mass index (BMI). Calorie needsvary based on many factors. The DRI Calculator for Healthcare
Professionals, available at nal.usda.gov/fnic/dri-calculator, can beused to estimate calorie needs based on age, sex, height, weight, andactivity level.

b Definitions for each food group and subgroup and quantity (i.e., cupor ounce equivalents) are provided in Chapter 1 and are compiled inAppendix 3.

c The U.S. Food and Drug Administration (FDA) and the U.S.
Environmental Protection Agency (EPA) provide joint advice regarding
seafood consumption to limit methylmercury exposure for children.
Depending on body weight, some children should choose seafood
lowest in methylmercury or eat less seafood than the amounts in the
Healthy US-Style Dietary Pattern. More information is available on the
FDA and EPA websites at FDA.gov/fishadvice and EPA.gov/fishadvice.
d If consuming up to 2 ounces of seafood per week, children should

only be fed cooked varieties from the “Best Choices” list in the FDA/EPA joint “Advice About Eating Fish,” available at FDA.gov/fishadvice
and EPA.gov/fishadvice. If consuming up to 3 ounces of seafood
per week, children should only be fed cooked varieties from the “Best

Choices” list that contain even lower methylmercury: flatfish (e.g.,
flounder), salmon, tilapia, shrimp, catfish, crab, trout, haddock, oysters,sardines, squid, pollock, anchovies, crawfish, mullet, scallops, whiting,clams, shad, and Atlantic mackerel. If consuming up to 3 ounces of
seafood per week, many commonly consumed varieties of seafood
should be avoided because they cannot be consumed at 3 ounces per
week by children without the potential of exceeding safe methylmercury
limits; examples that should not be consumed include: canned lighttuna or white (albacore) tuna, cod, perch, black sea bass. For acomplete list please see: FDA.gov/fishadvice and EPA.gov/fishadvice.
e Foods are assumed to be in nutrient-dense forms; lean or low-fat; andprepared with minimal added sugars, refined starches, saturated fat,or sodium. If all food choices to meet food group recommendations
are in nutrient-dense forms, a small number of calories remain within
the overall limit of the pattern (i.e., limit on calories for other uses). The
number of calories depends on the total calorie level of the pattern andthe amounts of food from each food group required to meet nutritional
goals. Calories up to the specified limit can be used for added sugars
and/or saturated fat, or to eat more than the recommended amount offood in a food group.

NOTE: The total dietary pattern should not exceed Dietary Guidelines
limits for added sugars and saturated fat; be within the Acceptable
Macronutrient Distribution Ranges for protein, carbohydrate, and total
fats; and stay within calorie limits. Values are rounded. See Appendix 3
for all calorie levels of the pattern.

Dietary Guidelines for Americans, 2020-2025 | Chapter 3: Children and Adolescents | Page 74

AGES 2-18

Current Intakes
Figures 3-2 to 3-9 highlight the dietary intakes ofchildren and adolescents, including the Healthy Eating
Index-2015 score, which is an overall measure of how
intakes align with the Dietary Guidelines, as well as
information on the components of a healthy diet—
specifically, the food groups. Figures 3-1, 3-3, 3-5,
and 3-7 display the average intakes of the food groups
compared to the range of recommended intakes at thecalorie levels most relevant to males and females inthese age groups. Additionally, the percent of children
and adolescents exceeding the recommended limits
for added sugars, saturated fat, and sodium are shown,along with average intakes of these components.
Average intakes compared to recommended intake
ranges of the subgroups for grains are represented indaily amounts; subgroups for vegetables and protein
foods are represented in weekly amounts (see Figures
3-2, 3-4, 3-6, and 3-8).
Current intakes show that from an early age, dietary
patterns are not aligned with the Dietary Guidelines.
The Healthy Eating Index score of 61 out of 100 for
children ages 2 through 4 indicates that overall dietquality is poor. Notably, HEI Scores decline throughout
childhood and adolescence, with scores for adolescents
approximately 10 points lower than those for young
children (Figure 3-1).
Among children ages 2 through 4, consumption of
total fruit is generally adequate for about 60 percent
of children. Compared to other age groups, a higher
percentage of young children also have intakes of
total vegetables at or above recommended levels.
The difference between recommended and actual
intakes of total fruit and total vegetables emerges andexpands as children age. By late adolescence, average
fruit and vegetable consumption is about half of therecommended range of intake. Throughout youth,
starchy vegetables (e.g., white potatoes, corn)—often informs that are fried or prepared with additions such asbutter and salt—are more frequently consumed than the
red and orange; dark green; or beans, peas, and lentils
vegetable subgroups. For fruit, about 70 percent of
intake comes from whole forms—fresh, canned, frozen,
or dried—and 100% juice, which are often nutrient-dense
forms. Some fruit is consumed through sources that are
not nutrient-dense; for example, fruit as part of a baked
dessert or juice drink.

Figure 3-1

Healthy Eating Index Scores Across Childhood and Adolescence100

Maximum Total Score = 100

80

60

61

55

52

51

Ages 9-13

Ages 14-18

40

20

0

Ages 2-4

Ages 5-8

Data Source: Analysis of What We Eat in America, NHANES 2015-2016, ages 2 through 18, day 1 dietary intake, weighted.
Page 75 | Dietary Guidelines for Americans, 2020-2025 | Chapter 3: Children and Adolescents

AG ES 2 -18

The amount of dairy foods consumed by children andadolescents is relatively stable across age groups.
Beginning at age 9 the amount of dairy foods in ahealthy dietary pattern increases from 2 ½ to 3 cup
equivalents per day to support an increase in calcium
intake that is needed during these life stages. As aresult, average intake of dairy foods is close to or atrecommended levels for children younger than age
9 while consumption among adolescents is typicallybelow recommended intake levels.
Although the gaps between recommended and current
intakes widen throughout these life stages for somedietary components, others, principally whole grains
and seafood, are infrequently consumed by any youth.
Whole grains are consumed below recommended levels
even by young children. As the difference between
recommended and current intakes widens across age
groups, the types of refined and whole-grain foods
consumed remains consistent. Mixed dishes, such as
pizza, pasta, sandwiches, burgers, and tacos, contributeabout 50 percent of total grains intake, and snacks andsweets, such as chips, crackers, and cookies, about 20
percent. Breakfast cereals and bars, including readyto-eat and cooked varieties, are the top contributor towhole-grains intake during these life stages. Despite
the underconsumption of whole grains, intakes of

total grains trend toward overconsumption due to thecontribution of refined grains.
Total protein intake generally meets targets except foradolescent females ages 14 through 18. Youth typicallymeet or exceed recommendations for meats, poultry,
and eggs. Seafood, a protein subgroup that can support
intakes of beneficial fatty acids, is consumed at levels
far below the lower end of the recommended intakes
range. When seafood is consumed, it is typicallyas part of a mixed dish rather than as an individual
food item.
Children and adolescents can improve intake patterns
by maintaining the components of a healthy diet thatare evident in early childhood, particularly total fruitand dairy foods, while increasing consumption of foodgroups that are underconsumed across all age groups,
specifically total vegetables and vegetable subgroups,
whole grains, and seafood. Reducing intakes of addedsugars, saturated fat, and sodium—components ofa dietary pattern that are often consumed above
recommended limits beginning at an early age—also
will support youth in achieving a healthy dietary pattern,particularly when considering the very limited amount ofcalories available outside of those needed for meeting
food group and nutrient goals.

Dietary Guidelines for Americans, 2020-2025 | Chapter 3: Children and Adolescents | Page 76

AGES 2-18

Current Intakes
Figure 3-2

Current Intakes: Ages 2 Through 4
Average Daily Food Group Intakes Compared to
Recommended Intake Ranges
Recommended Intake Ranges

Healthy Eating Index Score(on a scale of 0-100)

Average Intakes

6

61

CUP or OZ EQUIVALENT

5

4

3

2

1

0

M

F
Total
Vegetables
cup eq/day

M

F
Total
Fruitscup eq/day

M

F
Total
Grainsoz eq/day

M

F
Total
Dairy
cup eq/day

M

F
Total
Protein Foods
oz eq/day

FOOD GROUPS

Percent Exceeding Limits of Added Sugars,
Saturated Fat, and Sodium
Added Sugars

Limit: 10% of total energy

Males

61%

Females

57%

Average Intakes
Males
Females
173 kcal
158 kcalExceeding Limit

Saturated Fat

Limit: 10% of total energy

Males

87%

Females88%

Average Intakes
Males
Females
191 kcal
177 kcalWithin Recommended Limit

SodiumLimit: 1,200 mg*

Males

97%

Females95%

Average Intakes
Males
Females
2,274 mg
2,061 mg

*NOTE: Children ages 2 through 3 should reduce sodium intake if above 1,200 mg/d and those age 4 should reduce intake if above 1,500 mg/d.
Data Sources: Average Intakes and HEI-2015 Scores: Analysis of What We Eat in America, NHANES 2015-2016, day 1 dietary intake data,
weighted.
Recommended Intake Ranges: Healthy U.S.-Style Dietary Patterns (see Appendix 3). Percent Exceeding Limits: What We Eat in America,
Ages 2-4
NHANES 2013-2016, 2 days dietary intake data, weighted.

Page 77 | Dietary Guidelines for Americans, 2020-2025 | Chapter 3: Children and Adolescents

AG ES 2 -18

Figure 3-3
Average Intakes of Subgroups Compared to Recommended
Intake Ranges: Ages 2 Through 4
Recommended Intake Ranges
4.5

Average Intakes

Vegetables

CUP EQUIVALENT

4.0
3.5
3.0
2.5
2.0
1.5
1.0
0.5
0

6

M
F
M* F*
Total
DarkVegetables Greencup eq/day

M
F
Red &
OrangeM
F
M
F
Beans,
StarchyPeas,
Lentils
cup eq/week

M
F
Other

GrainsOZ EQUIVALENT

5
4
3
2
1
0

25

M

Total
GrainsF

M
F
Whole Grains

M
F
Refined Grainsoz eq/dayProtein Foods

OZ EQUIVALENT

20
15
10
5
0

M

F
M
F
Total
Meats, Poultry,
Protein Foods
Eggs
oz eq/dayM*
F*
Seafood
oz eq/weekM
F
Nuts, Seeds,
Soy Products*NOTE: Estimates may be less precise than others due to small sample size
and/or large relative standard error.
Data Sources: Average Intakes: Analysis of What We Eat in America, NHANES
2015-2016, day 1 dietary intake data, weighted. Recommended Intake Ranges:
Healthy U.S.-Style Dietary Patterns (see Appendix 3).
Dietary Guidelines for Americans, 2020-2025 | Chapter 3: Children and Adolescents | Page 78

AGES 2-18

Current Intakes
Figure 3-4

Current Intakes: Ages 5 Through 8
Average Daily Food Group Intakes Compared to
Recommended Intake Ranges
Recommended Intake Ranges

Healthy Eating Index Score(on a scale of 0-100)

Average Intakes

8

55

7

CUP or OZ EQUIVALENT

6
5
4
3
2
1
0

M

F
Total
Vegetables
cup eq/day

M

F
Total
Fruitscup eq/day

M

F
Total
Grainsoz eq/day

M

F
Total
Dairy
cup eq/day

M

F
Total
Protein Foods
oz eq/day

FOOD GROUPS

Percent Exceeding Limits of Added Sugars,
Saturated Fat, and Sodium
Added Sugars

80%

Within Recommended Limit

Saturated Fat

Limit: 10% of total energy

Males

Exceeding Limit

SodiumLimit: 10% of total energy

Females

77%

Average Intakes
Males
Females
266 kcal
238 kcal

Males

84

%

Limit: 1,500 mg

Females82%

Average Intakes
Males
Females
218 kcal
195 kcal

Males

97

%

Females

97%

Average Intakes
Males
Females
2,785 mg2,525 mg

Data Sources: Average Intakes and HEI-2015 Scores: Analysis of What We Eat in America, NHANES 2015-2016, day 1 dietary intake data,
weighted. Recommended Intake Ranges: Healthy U.S.-Style Dietary Patterns (see Appendix 3). Percent Exceeding Limits: What We Eat in
America, NHANES 2013-2016, 2 days dietary intake data, weighted.

Ages 5-8

Page 79 | Dietary Guidelines for Americans, 2020-2025 | Chapter 3: Children and Adolescents

AG ES 2 -18

Figure 3-5
Average Intakes of Subgroups Compared to
Recommended Intake Ranges: Ages 5 Through 8
Recommended Intake Ranges

CUP EQUIVALENT

6

Average Intakes

Vegetables

5
4
3
2
1
0

8

M
F*
M
F
DarkTotal
Vegetables Greencup eq/day

M
F
Red &
OrangeM
F
M
F
Beans,
StarchyPeas,
Lentils
cup eq/week

M
F
Other

GrainsOZ EQUIVALENT

7
6
5
4
3
2
1
0

30

M

Total
GrainsF

M
F
Whole Grains

M
F
Refined Grainsoz eq/dayProtein Foods

OZ EQUIVALENT

25
20
15
10
5
0

M

F
M
F
Total
Meats, Poultry,
Protein Foods
Eggs
oz eq/dayM*
F*
Seafood
oz eq/weekM
F
Nuts, Seeds,
Soy Products*NOTE: Estimates may be less precise than others due to small sample size
and/or large relative standard error.
Data Sources: Average Intake: Analysis of What We Eat in America, NHANES
2015-2016, day 1 dietary intake data, weighted. Recommended Intake Ranges:
Healthy U.S.-Style Dietary Patterns (see Appendix 3).
Dietary Guidelines for Americans, 2020-2025 | Chapter 3: Children and Adolescents | Page 80

AGES 2-18

Children and Adolescents Ages 9 Through 13

In the late childhood and early adolescence stage, females require about 1,400 to 2,200 calories per day and males
require about 1,600 to 2,600 calories per day.
Table 3-2
Healthy U.S.-Style Dietary Pattern for Children and Adolescents Ages 9 Through 13,
With Daily or Weekly Amounts From Food Groups, Subgroups, and Components
CALORIE LEVEL OF PATTERNa

1,400

1,800

2,000

2,200

2,400

2,600

Daily Amount of Food From Each Group(Vegetable and protein foods subgroup amounts are per week.)

FOOD GROUP OR SUBGROUPb
Vegetables (cup eq/day)

1,600

1½

2

2½

2½

3

3

3½

Vegetable Subgroups in Weekly Amounts
Dark-Green Vegetables (cup eq/wk)

1

1½

1½

1½

2

2

2½

Red & Orange Vegetables (cup eq/wk)

3

4

5½

5½

6

6

7

Beans, Peas, Lentils (cup eq/wk)

½

1

1½

1½

2

2

2½

Starchy Vegetables (cup eq/wk)

3½

4

5

5

6

6

7

Other Vegetables (cup eq/wk)

2½

3½

4

4

5

5

5½

Fruits (cup eq/day)

1½

1½

1½

2

2

2

2

Grains (ounce eq/day)

5

5

6

6

7

8

9

Whole Grains (ounce eq/day)

2½

3

3

3

3½

4

4½

Refined Grains (ounce eq/day)

2½

2

3

3

3½

4

4½

Dairy (cup eq/day)

3

3

3

3

3

3

3

Protein Foods (ounce eq/day)

4

5

5

5½

6

6½

6½

Protein Foods Subgroups in Weekly Amounts
Meats, Poultry, Eggs (ounce eq/wk)

19

23

23

26

28

31

31

Seafood (ounce eq/wk)c

6

8

8

8

9

10

10

Nuts, Seeds, Soy Products (ounce eq/wk)

3

4

4

5

5

5

5

Oils (grams/day)

17

22

24

27

29

31

34

Limit on Calories for Other Uses (kcal/day)d

50

100

140

240

250

320

350

Limit on Calories for Other Uses (%/day)

4%

6%

8%

12%

11%

13%

13%

a Calorie level ranges: Females: 1,400-2,200; Males: 1,600-2,600.

Energy levels are calculated based on reference height (median) andreference weight (healthy) corresponding with a healthy body massindex (BMI). Calorie needs vary based on many factors. The DRI
Calculator for Healthcare Professionals, available at nal.usda.gov/
fnic/dri-calculator, can be used to estimate calorie needs based onage, sex, height, weight, and activity level.

b Definitions for each food group and subgroup and quantity (i.e.,

cup or ounce equivalents) are provided in Chapter 1 and are compiledin Appendix 3.

c The U.S. Food and Drug Administration (FDA) and the U.S.
Environmental Protection Agency (EPA) provide joint advice regarding
seafood consumption to limit methylmercury exposure for children.
Depending on body weight, some children should choose seafood
lowest in methylmercury or eat less seafood than the amounts
in the Healthy US-Style Dietary Pattern. More information isavailable on the FDA and EPA websites at FDA.gov/fishadvice
and EPA.gov/fishadvice.

d All foods are assumed to be in nutrient-dense forms; lean or

low-fat; and prepared with minimal added sugars, saturated fat,refined starches, or sodium. If all food choices to meet food group
recommendations are in nutrient-dense forms, a small number ofcalories remain within the overall limit of the pattern (i.e., limit on
calories for other uses). The number of calories depends on the
total calorie level of the pattern and the amounts of food from eachfood group required to meet nutritional goals. Calories up to thespecified limit can be used for added sugars and/or saturated
fat, or to eat more than the recommended amount of food in afood group.
NOTE: The total dietary pattern should not exceed Dietary Guidelines
limits for added sugars and saturated fat; be within the Acceptable
Macronutrient Distribution Ranges for protein, carbohydrate, andtotal fats; and stay within calorie limits. Values are rounded. See
Appendix 3 for all calorie levels of the pattern.

Page 81 | Dietary Guidelines for Americans, 2020-2025 | Chapter 3: Children and Adolescents

AG ES 2 -18

Current Intakes
Figure 3-6

Current Intakes: Ages 9 Through 13
Average Daily Food Group Intakes Compared to
Recommended Intake Ranges
Recommended Intake Ranges

Average Intakes

Healthy Eating Index Score(on a scale of 0-100)

10
9

52

CUP or OZ EQUIVALENT

8
7
6
5
4
3
2
1
0

M

F
Total
Vegetables
cup eq/day

M

F
Total
Fruitscup eq/day

M

F
Total
Grainsoz eq/day

M

F
Total
Dairy
cup eq/day

M

F
Total
Protein Foods
oz eq/day

FOOD GROUPS

Percent Exceeding Limits of Added Sugars,
Saturated Fat, and Sodium
Added Sugars

Limit: 10% of total energy

Males

79%

Females

78%

Average Intakes
Males
Females
322 kcal
264 kcalExceeding Limit

Saturated Fat

Limit: 10% of total energy

Males

88%

Females86%

Average Intakes
Males
Females
259 kcal
229 kcalWithin Recommended Limit

SodiumLimit: 1,800 mg

Males

97%

Females

96%

Average Intakes
Males
Females
3,451 mg3,030 mg

Data Sources: Average Intake and HEI-2015 Scores: Analysis of What We Eat in America, NHANES 2015-2016, day 1 dietary intake data,
weighted. Recommended Intake Ranges: Healthy U.S.-Style Dietary Patterns (see Appendix 3). Percent Exceeding Limits: What We Eat in America,
NHANES 2013-2016, 2 days dietary intake data, weighted.

Ages 9-13

Dietary Guidelines for Americans, 2020-2025 | Chapter 3: Children and Adolescents | Page 82

AGES 2-18

Figure 3-7
Average Intakes of Subgroups Compared to
Recommended Intake Ranges: Ages 9 Through 13
Recommended Intake Ranges
8

Average Intakes

Vegetables

CUP EQUIVALENT

7
6
5
4
3
2
1
0

10

M
F
M
F
DarkTotal
Vegetables Greencup eq/day

M
F
Red &
OrangeM
F
M
F
Beans,
StarchyPeas,
Lentils
cup eq/week

M
F
Other

Grains9
OZ EQUIVALENT

8
7
6
5
4
3
2
1
0

35

M

Total
GrainsF

M
F
Whole Grains

M
F
Refined Grainsoz eq/dayProtein Foods

OZ EQUIVALENT

30
25
20
15
10
5
0

M

F
M
F
Total
Meats, Poultry,
Protein Foods
Eggs
oz eq/dayM*
F
Seafood
oz eq/weekM
F
Nuts, Seeds,
Soy Products*NOTE: Estimates may be less precise than others due to small sample size
and/or large relative standard error.
Data Sources: Average Intakes: Analysis of What We Eat in America, NHANES
2015-2016, day 1 dietary intake data, weighted. Recommended Intake Ranges:
Healthy U.S.-Style Dietary Patterns (see Appendix 3).
Page 83 | Dietary Guidelines for Americans, 2020-2025 | Chapter 3: Children and Adolescents

AG ES 2 -18

Adolescents Ages 14 Through 18

Adolescent females require about 1,800 to 2,400 calories per day and males require about 2,000 to 3,200
calories per day.
Table 3-3
Healthy U.S.-Style Dietary Pattern for Adolescents Ages 14 Through 18, With Daily or Weekly Amounts
From Food Groups, Subgroups, and Components
CALORIE LEVEL OF PATTERNa

1,800

2,000

2,400

2,600

2,800

3,000

3,200

Daily Amount of Food From Each Group(Vegetable and protein foods subgroup amounts are per week.)

FOOD GROUP OR SUBGROUPb
Vegetables (cup eq/day)

2,200

2½

2½

3

3

3½

3½

4

4

Vegetable Subgroups in Weekly Amounts
Dark-Green Vegetables (cup eq/wk)

1½

1½

2

2

2½

2½

2½

2½

Red and Orange Vegetables (cup eq/wk)

5½

5½

6

6

7

7

7½

7½

Beans, Peas, Lentils (cup eq/wk)

1½

1½

2

2

2½

2½

3

3

Starchy Vegetables (cup eq/wk)

5

5

6

6

7

7

8

8

Other Vegetables (cup eq/wk)

4

4

5

5

5½

5½

7

7

Fruits (cup eq/day)

1½

2

2

2

2

2½

2½

2½

Grains (ounce eq/day)

6

6

7

8

9

10

10

10

Whole Grains (ounce eq/day)

3

3

3½

4

4½

5

5

5

Refined Grains (ounce eq/day)

3

3

3½

4

4½

5

5

5

Dairy (cup eq/day)

3

3

3

3

3

3

3

3

Protein Foods (ounce eq/day)

5

5½

6

6½

6½

7

7

7

Protein Foods Subgroups in Weekly Amounts
Meats, Poultry, Eggs (ounce eq/wk)

23

26

28

31

31

33

33

33

Seafood (ounce eq/wk)

8

8

9

10

10

10

10

10

Nuts, Seeds, Soy Products (ounce eq/wk)

4

5

5

5

5

6

6

6

Oils (grams/day)

24

27

29

31

34

36

44

51

Limit on Calories for Other Uses (kcal/day)c

140

240

250

320

350

370

440

580

Limit on Calories for Other Uses (%/day)

8%

12%

11%

13%

13%

13%

15%

18%

a Calorie level ranges: Females: 1,800-2,400 calories; Males: 2,000-

3,200 calories. Energy levels are calculated based on reference height(median) and reference weight (healthy) corresponding with a healthy
body mass index (BMI). Calorie needs vary based on many factors. The
DRI Calculator for Healthcare Professionals, available at nal.usda.gov/
fnic/dri-calculator, can be used to estimate calorie needs based onage, sex, height, weight, activity level.

b Definitions for each food group and subgroup and quantity (i.e., cupor ounce equivalents) are provided in Chapter 1 and are compiled inAppendix 3.

c All foods are assumed to be in nutrient-dense forms; lean or
low-fat; and prepared with minimal added sugars, saturated fat,refined starches, or sodium. If all food choices to meet food group
recommendations are in nutrient-dense forms, a small number ofcalories remain within the overall limit of the pattern (i.e., limit on
calories for other uses). The number of calories depends on the total
calorie level of the pattern and the amounts of food from each foodgroup required to meet nutritional goals. Calories up to the specified
limit can be used for added sugars and/or saturated fat, or to eat morethan the recommended amount of food in a food group.
NOTE: The total dietary pattern should not exceed Dietary Guidelines
limits for added sugars and saturated fat; be within the Acceptable
Macronutrient Distribution Ranges for protein, carbohydrate, and total
fats; and stay within calorie limits. Values are rounded. See Appendix 3
for all calorie levels of the pattern.

Dietary Guidelines for Americans, 2020-2025 | Chapter 3: Children and Adolescents | Page 84

AGES 2-18

Current Intakes
Figure 3-8

Current Intakes: Ages 14 Through 18
Average Daily Food Group Intakes Compared to
Recommended Intake Ranges
Recommended Intake Ranges

Healthy Eating Index Score(on a scale of 0-100)

Average Intakes

12
11

51

10

CUP or OZ EQUIVALENT

9
8
7
6
5
4
3
2
1
0

M

F
Total
Vegetables
cup eq/day

M

F
Total
Fruitscup eq/day

M

F
Total
Grainsoz eq/day

M

F
Total
Dairy
cup eq/day

M

F
Total
Protein Foods
oz eq/day

FOOD GROUPS

Percent Exceeding Limits of Added Sugars,
Saturated Fat, and Sodium
Added Sugars

Limit: 10% of total energy

Males

72%

Females76%

Average Intakes
Males
Females
347 kcal
277 kcalExceeding Limit

Saturated Fat

Limit: 10% of total energy

Males

85%

Females

78%

Average Intakes
Males
Females
276 kcal
204 kcalWithin Recommended Limit

SodiumLimit: 2,300 mg

Males

97%

Females

77%

Average Intakes
Males
Females
3,888 mg2,875 mg

Data Sources: Average Intake and HEI-2015 Scores: Analysis of What We Eat in America, NHANES 2015-2016, day 1 dietary intake data,
weighted. Recommended Intake Ranges: Healthy U.S.-Style Dietary Patterns (see Appendix 3). Percent Exceeding Limits: What We Eat in America,
NHANES
2013-2016, 2 days dietary intake data, weighted.
Ages 14-18

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AG ES 2 -18

Figure 3-9
Average Intakes of Subgroups Compared to
Recommended Intake Ranges: Ages 14 Through 18
Recommended Intake Ranges
9

Average Intakes

Vegetables

CUP EQUIVALENT

8
7
6
5
4
3
2
1

OZ EQUIVALENT

0

12
11
10
9
8
7
6
5
4
3
2
1
0

M
F
M
F
DarkTotal
Vegetables Greencup eq/day

M
F
Red &
OrangeM
F
M
F
Beans,
StarchyPeas,
Lentils
cup eq/week

M
F
Other

GrainsM
F
Whole Grains

M
F
Total Grains

M
F
Refined Grainsoz eq/day
40

Protein Foods

OZ EQUIVALENT

35
30
25
20
15
10
5
0

M
F
Total Protein
Foods
oz eq/dayM
F
Meats, Poultry,
Eggs

M
F
Seafood
oz eq/weekM
F
Nuts, Seeds,
Soy Products

Data Sources: Average Intakes: Analysis of What We Eat in America, NHANES
2015-2016, day 1 dietary intake data, weighted. Recommended Intake Ranges:
Healthy U.S.-Style Dietary Patterns (see Appendix 3).
Dietary Guidelines for Americans, 2020-2025 | Chapter 3: Children and Adolescents | Page 86

AGES 2-18

SpecialConsiderations
The nutrition considerations for the general U.S.
population described in Chapter 1 apply to children
and adolescents. For example, due to low intakes offood groups as described above, the nutrients of publichealth concern—calcium, vitamin D, potassium, anddietary fiber—apply to these life stages as well. Although
the nutritional needs of youth are remarkably similar
to their parents, guardians, and caregivers, these agegroups do have some special nutrition considerations.
Specifically, increasing intakes of sugar-sweetened
beverages and decreasing intakes of dairy are dietarycomponents with notable and concerning shifts in
consumption throughout youth. Dietary intake patterns
for adolescents, particularly females, also are an area ofspecial consideration.
Accounting for the areas of dietary improvement thatare important for all children and adolescents, as wellas these special considerations, can improve diet quality
during a time when food preferences and intake patterns
are formed. When consistently followed, these healthy
dietary patterns can provide the foundation for healthy
dietary patterns in adulthood, promote health among
youth, and help prevent the onset of chronic disease
later in life.

Sugar-Sweetened Beverages

Sugar-sweetened beverages (e.g., soda, fruit drinks,
sports and energy drinks) are not necessary in thechild or adolescent diet nor are they a component of
the USDA Dietary Patterns. Intake of added sugars

increases throughout childhood and adolescence, andsugar-sweetened beverages are a top contributor. As
a percent of total daily energy intake, average intake ofadded sugars is 11 percent among young children andpeaks at 15 percent during adolescence. Coinciding withthis increase is the contribution of sugar-sweetened
beverages to total intake of added sugars. In childhood,sugar-sweetened beverages make up about 15 to 25
percent of total added sugars intake. By adolescence,
their contribution is 32 percent and even higher when
considering coffee and tea beverages with addedsugars (an additional 7 percent). Most sugar-sweetened
beverages (e.g., soda, sports drinks) do not contributeto meeting food group goals and often contain a highnumber of calories.
Decreasing consumption of sugar-sweetened beverages
to reduce added sugars intake will help youth achievea healthy dietary pattern. Beverages that contain no
added sugars should be the primary choice for children
and adolescents. These include water and unsweetened
fat-free or low-fat milk—including low-lactose or lactosefree options or fortified soy beverage—and 100% juice
within recommended amounts. Consuming beverages
with no added sugars is particularly important for young
children ages 2 through 8, when only a small number ofcalories remains for other uses after meeting food group
and nutrient needs with nutrient-dense choices (Table
3-1). The number of calories available for other uses
increases slightly as energy needs increase throughout
adolescence to support growth and development(Tables 3-2 and 3-3). However, most adolescents do notconsume foods and beverages in their nutrient-dense
forms, meaning they have few or no calories remaining
for added sugars.

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AG ES 2 -18

Juice

Many juice products, such as fruit drinks, contain minimal juice content and are consideredsugar-sweetened beverages because they are primarily composed of water with added sugars.
The percent of juice in a beverage may be found on the package label, such as “contains 25%
juice” or “100% fruit juice.” The Nutrition Facts label identifies the amount of sugars in juice
products that are not naturally occurring (i.e., added sugars). Although 100% fruit juice without added sugars canbe part of a healthy dietary pattern, it is lower in dietary fiber than whole fruit. Dietary fiber is a dietary componentof public health concern. With the recognition that fruit should mostly be consumed in whole forms, the amountof fruit juice in the USDA Food Patterns ranges from 4 fluid ounces at the lower calorie levels and no more than 10
fluid ounces at the highest calorie levels.

Dairy and Fortified Soy Alternatives

Throughout childhood and adolescence, the types of dairy foods
consumed and their contribution to a healthy dietary pattern change. Milk
consumption, particularly milk as a beverage, is lower and cheese intake,typically as part of mixed dishes such as sandwiches, pizza, or pasta, ishigher among adolescents when compared to younger children. These
differences in consumption occur alongside the widening gap between
current and recommended intakes of dairy foods that occurs throughout
youth. Nutrient-dense options within the dairy group are unsweetened
fat-free and low-fat (1%) milk, yogurt, cheese, fortified soy beverages
and yogurt, and low-lactose and lactose-free dairy products. Dairy andfortified soy alternatives provide protein and a variety of nutrients that areunderconsumed during these life stages. These include three nutrientsof public health concern discussed in Chapter 1: potassium, calcium,and vitamin D. The nutrient composition of dairy foods highlights theimportance of adequate consumption. This is especially relevant for
calcium and vitamin D, given that adolescents have an increased need for
consumption to support the accrual of bone mass.

Adolescent Nutrition

The difference between recommended food group amounts and current
intakes is greater for adolescents ages 14 through 18 than for any otherage group across the lifespan. As a result, adolescents are at greater riskof dietary inadequacy than are other age groups. For adolescent males
and females, low intakes of nutrient-dense foods and beverages within
the grains, dairy and alternatives, fruits, and vegetables food groups
lead to low intakes of phosphorus, magnesium, and choline. Adolescentfemales also consume less meat, poultry, and eggs than do adolescentmales, and in combination with low consumption of seafood and otherprotein subgroups, including beans, peas, and lentils, this results in theunderconsumption of total protein. In addition, adolescent females
have low dietary intakes of iron, folate, vitamin B6, and vitamin B12. The
potential for nutrient deficiencies existing alongside underconsumption ofnutrients of public health concern for all Americans creates a concerning
constellation of nutritional risks at a time of rapid growth and development
along with the onset of puberty, menarche, and hormonal changes.

Dietary Guidelines for Americans, 2020-2025 | Chapter 3: Children and Adolescents | Page 88

AGES 2-18

Supporting
Healthy Eating
The physical, mental, and emotional changes that occur
as children transition from pre-school to school-age
and into adolescence come with diverse and changing
opportunities to support a healthy dietary pattern.
Support and active engagement from the various
people and places involved in the lives of children andadolescents is necessary to help establish and maintainhealthy dietary patterns that support healthy weight andthe prevention of chronic disease.
In early childhood, parents, guardians, and caregivers
have a primary role in supporting healthy eating because
they control the foods and beverages purchased,
prepared, and served. Exposing young children to avariety of nutrient-dense foods within each food grouphelps build a healthy dietary pattern at an age whentaste preferences are acquired. Introducing children toa variety of nutrient-dense foods can be challenging.
As children grow, their search for a sense of autonomy
and desire for independence often manifest throughselective or “picky” eating, food neophobia, or food “jags”(eating only one or a few foods for periods of time).
Offering the same type of food to children multiple
times, in a variety of forms, or prepared in different ways
can increase acceptance and intake of healthy foods
within food groups. For example, children may show adislike for vegetables in the cooked form but accept
the raw version. Or, children may only accept fruit when
it is cut into small, bite-sized pieces. Even with thesestrategies, parents, guardians, and caregivers of young
children should know it may take up to 8 to 10 exposures
before a child will accept a new food.
Children’s dietary patterns often resemble those of
their household, highlighting the importance of theirenvironment in the establishment of a healthy dietary
pattern. Shared meals through shopping, cooking,and consumption provides parents, guardians, andcaregivers with an opportunity to model healthyeating behaviors and dietary practices. By making
nutrient-dense foods and beverages part of the normalhousehold routine, children can observe and learn
healthy behaviors that can extend throughout later
life stages.
Ideally, children continue to be exposed to a healthy
dietary pattern as they experience changes to their daily
routines, such as spending time in child care or school
settings. As at home, eating occasions in these settings
can be used as opportunities to support a healthy dietary
pattern. For example, snacks can be used as a way topromote intake of nutrient-dense fruits and vegetables,
like carrot sticks and hummus or apple slices, insteadof foods like chips or cookies. Using snacks as anopportunity to encourage nutrient-dense food groupchoices is especially relevant during early childhood
when the total volume of food consumed at regularmeals is lower and snacking is common.
When exposed to nutrient-dense foods and beverages
at an early age and supported in making healthy choices
across environments, a healthy dietary pattern canbe established and maintained as children transition
to the adolescence life stage. With this transition
comes increasing autonomy, increased influence ofpeers, and decreased influence of parents, guardians,
and caregivers on food choice. As a result, foods andbeverages are more commonly consumed outside of
the home, often with a preference for convenience foods
that often are not nutrient-dense. Parents, guardians,
and caregivers can continue to support healthy eating
during this life stage by providing convenient access tonutrient-dense foods; involving children and adolescentsin meal decisions, shopping, and cooking; and guiding
adolescents’ selection of food purchased and consumed
outside the home. In schools and community settings,
healthy eating can be encouraged by creating anenvironment that makes healthy choices the norm.

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AG ES 2 -18

Accessing a Healthy Dietary Pattern• Outside of the school year, the Summer Food
Service Program (SFSP) fills the gap by ensuringthat children continue to receive nutritious meals
when school is not in session. The SFSP operates
at sites in a community where children canreceive nutritious meals in a safe andsupervised environment.

• The Supplemental Nutrition Assistance Program(SNAP) provides temporary benefits to families withqualifying incomes for the purchase of foods andbeverages. About one-half of all SNAP participants
are children.1

Professionals working with youth and their families
can use these, and additional Government andnon-Government resources that exist at the community,
to support healthy eating during these life stages and toestablish the foundation for a healthy dietary pattern thatwill promote health and support disease prevention inlater years.

Many resources exist to support healthy growth anddevelopment during childhood and adolescence. The
following Government programs play an essential rolein providing access to healthy meals and educational
resources to support healthy dietary patterns for all
children and adolescents.

• Households with young children may be eligible for
the Special Supplemental Nutrition Program for
Women, Infants, and Children (WIC). WIC can help
families with limited resources meet their child’s
nutritional needs by providing nutritious foods tosupplement diets. WIC serves children up to the ageof 5 years who are at nutritional risk.
• In childcare and afterschool settings, the Childand Adult Care Food Program (CACFP) can
support the development of healthy dietary
patterns. CACFP is a nutrition program that provides
reimbursements for meals and snacks that alignwith the Dietary Guidelines to eligible children
enrolled at childcare centers, daycare homes,
and in afterschool programs.
• School-age children can benefit from the National
School Lunch Program and School Breakfast
Program. The school meal programs can provide
nearly two-thirds of daily calories, and therefore play
an influential role in the development of a healthy
dietary pattern.

Looking Toward
Chapter 4: Adults
This chapter focused on nutrition issues relevant tochildren and adolescents. These issues are particularly
important because this life stage encompasses
significant transitions, from young children who arestill dependent on parents, guardians, and caregivers
for all their food choices, to adolescents who arehighly independent in their food choices. Diet quality
tends to decrease as children mature into adolescence,with resulting concerns about underconsumptionof nutrients of public health concern. Establishingand maintaining healthy food and beverages choices
now can set a firm foundation for healthy dietary
patterns that reduce the risk of diet-related chronic
disease, an issue of increasing relevance to adults,
who are considered in the next chapter.

1Source: Characteristics of Supplemental Nutrition Assistance Program Households: Fiscal Year 2018. Available at: www.fns.usda.gov/snap/

characteristics-supplemental-nutrition-assistance-program-households-fiscal-year-2018.

Dietary Guidelines for Americans, 2020-2025 | Chapter 3: Children and Adolescents | Page 90

A D ULTS AGES 19-5 9Page 91 | Dietary Guidelines for Americans, 2020-2025 | Chapter 4: Adults

A D U LT S AG ES 19-59

CHAPTER

4

Adults

Dietary Guidelines for Americans, 2020-2025 | Chapter 4: Adults | Page 92

A D ULTS AGES 19-5 9IntroductionT

he adult life stage (ages 19 through59) is characterized by independence,
opportunity, and increased responsibility—from starting or completing educationand training, to managing work and/or
family, to planning for the transition toolder adulthood. Balancing work or school
responsibilities with personal, family,or other commitments can create realor perceived barriers to healthy eating.
Constraints on available time and financial
resources may make it challenging for
adults to adopt and maintain a healthy
dietary pattern. Support for healthy foodand beverage choices across the multiple
places where adults live, work, play,
and gather is needed to improve dietary
patterns among adults.

Page 93 | Dietary Guidelines for Americans, 2020-2025 | Chapter 4: Adults

Many individuals enter the adultlife stage with an unhealthy dietary
pattern already established fromthe childhood and adolescent years.
A concerted effort to change thistrajectory and support adults in
adopting a healthy dietary patternis needed for better health and topromote the well-being of family andfriends across life stages. Learned
food and beverage preferences, andnorms and values placed on diet,physical activity, and health, canpositively or negatively influence
health because they can determine
an individual’s willingness to change
and maintain behaviors. These norms
and values, including preferences
toward certain types of food, attitudes
about healthy eating, and beliefs
about the importance of physicalactivity, can extend beyond theindividual to larger social networks,
influencing the behaviors of friends
and older or younger family members.
Among adults caring for children,role modeling healthy dietary choices
is important because the foodcomponents of public health concern
observed in earlier life stages are
similar for adults.
Following a healthy dietary pattern,engaging in regular physicalactivity, and managing body weightare critical during this life stage.
More than one-half of adults areliving with one or more chronic
disease—diseases that are often
related to poor-quality diets andphysical inactivity. Improving dietary
patterns in adulthood can play abeneficial role in promoting healthand preventing the onset or rate ofprogression of chronic disease. For
adults with overweight or obesity,
making healthful changes to dietary
patterns and increasing physicalactivity will improve health andprevent additional weight gain and/or promote weight loss (see “TheImportance of Physical Activity” and“Overweight and Obesity”).

A D U LT S AG ES 19-59

The Importance of Physical Activity
Adults who are physically active are healthier, feel better, and are lesslikely to develop many chronic diseases than are adults who are inactive.
For adults, regular physical activity can provide both immediate benefits(e.g., boost mood, reduce stress, improve sleep) and long-term benefits(e.g., improved bone health and reduced risk of many diseases, such as
cardiovascular disease, type 2 diabetes, depression, dementia, and many
types of cancer).
Adults should move more and sit less throughout the day. Some physicalactivity is better than none. To attain the most health benefits fromphysical activity, adults need at least 150 to 300 minutes of moderateintensity aerobic activity, like brisk walking or fast dancing, each week.
Adults also need muscle-strengthening activity, like lifting weights ordoing push-ups, at least 2 days each week.
The U.S. Department of Health and Human Service’s Physical Activity
Guidelines for Americans and related Move Your Way® resources havemore information about the benefits of physical activity and tips on how
to get started. Available at health.gov/paguidelines.

Overweight and Obesity
In the United States, 74 percent of adults have overweight or obesity,
creating an increased risk for the development of other chronic healthconditions, including cardiovascular disease, type 2 diabetes, and certain
types of cancer.
Losing weight and maintaining weight loss is not a simple task. It
requires adults to reduce the number of calories they get from foods
and beverages and increase the amount expended through physicalactivity. Weight loss and maintenance are not likely achieved using
short-term solutions. They require a commitment to long-term lifestylechange and often need support from healthcare providers, family
members, and social networks. Intensive behavioral interventions thatuse one or more strategies—like group sessions and changes in both
diet and physical activity—can be effective for individuals trying to losea significant amount of weight. In addressing obesity, professionals
should be mindful of health problems stemming from obesity-related
stigma and discrimination.
The Centers for Disease Control and Prevention’s website provides
resources to support preventing weight gain (cdc.gov/healthyweight/
prevention/index.html) and losing weight (cdc.gov/healthyweight/
losing_weight/index.html).

Dietary Guidelines for Americans, 2020-2025 | Chapter 4: Adults | Page 94

A D ULTS AGES 19-5 9Healthy Dietary
Patterns
Adults are encouraged to follow therecommendations on the types of foods andbeverages that make up a healthy dietary patterndescribed in Chapter 1. Nutrition and HealthAcross the Lifespan: The Guidelines and Key
Recommendations. The USDA Dietary Patterns
provide a framework of nutrient-dense foods andbeverages that can be adapted to accommodate
budget, culture, and personal preferences to help
adults follow a healthy dietary pattern and meet
the Guidelines and their Key Recommendations.
Table 4-1 displays the Healthy U.S.-Style Dietary
Pattern at eight calorie levels that are appropriate
for most adults ages 19 through 59 years toillustrate the specific amounts and limits for foodgroups and other dietary components that makeup healthy dietary patterns. In general, calorie
needs are lower for females compared to males.
Calorie needs decline throughout adulthood due
to changes in metabolism that accompany aging.
Level of physical activity, body composition, andthe presence of chronic disease are additional
factors that affect calorie needs.
Females ages 19 through 30 require about
1,800 to 2,400 calories a day. Males in this age
group have higher calorie needs of about 2,400
to 3,000 a day. Calorie needs for adults ages 31
through 59 are generally lower; most females
require about 1,600 to 2,200 calories a day andmales require about 2,200 to 3,000 calories aday. Additional information on these estimates isprovided in Table 4-1 (footnote a) and in Appendix
2. Estimated Calorie Needs. The USDA Dietary
Patterns are discussed in greater detail in Chapter
1 and Appendix 3. USDA Dietary Patterns.

Nutrient-Dense Foods and Beverages

Nutrient-dense foods and beverages provide vitamins, minerals, and other health-promoting
components and have little added sugars, saturated fat, and sodium. Vegetables, fruits,
whole grains, seafood, eggs, beans, peas, and lentils, unsalted nuts and seeds, fat-free andlow-fat dairy products, and lean meats and poultry—when prepared with no or little addedsugars, saturated fat, and sodium—are nutrient-dense foods.

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A D U LT S AG ES 19-59

Table 4-1

Healthy U.S.-Style Dietary Pattern for Adults
Ages 19 Through 59, With Daily or Weekly Amounts
From Food Groups, Subgroups, and Components
CALORIE LEVEL OF PATTERNa

1,600

2,000

2,200

2,400

2,600

2,800

3,000

Daily Amount of Food From Each Group(Vegetable and protein foods subgroup amounts are per week.)

FOOD GROUP OR SUBGROUPb
Vegetables (cup eq/day)

1,800

2

2½

2½

3

3

3½

3½

4

Vegetable Subgroups in Weekly Amounts
Dark-Green Vegetables (cup eq/wk)

1½

1½

1½

2

2

2½

2½

2½

Red & Orange Vegetables (cup eq/wk)

4

5½

5½

6

6

7

7

7½

Beans, Peas, Lentils (cup eq/wk)

1

1½

1½

2

2

2½

2½

3

Starchy Vegetables (cup eq/wk)

4

5

5

6

6

7

7

8

Other Vegetables (cup eq/wk)

3½

4

4

5

5

5½

5½

7

Fruits (cup eq/day)

1½

1½

2

2

2

2

2½

2½

Grains (ounce eq/day)

5

6

6

7

8

9

10

10

Whole Grains (ounce eq/day)

3

3

3

3½

4

4½

5

5

Refined Grains (ounce eq/day)

2

3

3

3½

4

4½

5

5

Dairy (cup eq/day)

3

3

3

3

3

3

3

3

Protein Foods (ounce eq/day)

5

5

5½

6

6½

6½

7

7

Protein Foods Subgroups in Weekly Amounts
Meats, Poultry, Eggs (ounce eq/wk)

23

23

26

28

31

31

33

33

Seafood (ounce eq/wk)

8

8

8

9

10

10

10

10

Nuts, Seeds, Soy Products (ounce eq/wk)

4

4

5

5

5

5

6

6

Oils (grams/day)

22

24

27

29

31

34

36

44

Limit on Calories for Other Uses
(kcal/day)c

100

140

240

250

320

350

370

440

6%

8%

12%

11%

13%

13%

13%

15%

Limit on Calories for Other Uses (%/day)a Calorie level ranges: Ages 19 through 30, Females: 1,800-2,400 calories; Males: 2,400-3,000 calories. Ages 31 through 59, Females: 1,600-2,200

calories; Males 2,200-3,000 calories. Energy levels are calculated based on median height and body weight for healthy body mass index (BMI)
reference individuals. For adults, the reference man is 5 feet 10 inches tall and weighs 154 pounds. The reference woman is 5 feet 4 inches talland weighs 126 pounds. Calorie needs vary based on many factors. The DRI Calculator for Healthcare Professionals, available at nal.usda.gov/
fnic/dri-calculator, can be used to estimate calorie needs based on age, sex, height, weight, and activity level.

b Definitions for each food group and subgroup and quantity (i.e., cup or ounce equivalents) are provided in Chapter 1 and are compiled inAppendix 3.

c All foods are assumed to be in nutrient-dense forms; lean or low-fat; and prepared with minimal added sugars, refined starches, saturated fat, or

sodium. If all food choices to meet food group recommendations are in nutrient-dense forms, a small number of calories remain within the overall
limit of the pattern (i.e., limit on calories for other uses). The number of calories depends on the total calorie level of the pattern and the amounts
of food from each food group required to meet nutritional goals. Calories up to the specified limit can be used for added sugars, saturated fat, or
alcohol, or to eat more than the recommended amount of food in a food group.
NOTE: The total dietary pattern should not exceed Dietary Guidelines limits for added sugars, saturated fat, and alcohol; be within the Acceptable
Macronutrient Distribution Ranges for protein, carbohydrate, and total fats; and stay within calorie limits. Values are rounded. See Appendix 3 for
all calorie levels of the pattern.
Dietary Guidelines for Americans, 2020-2025 | Chapter 4: Adults | Page 96

A D ULTS AGES 19-5 9Current Intakes
Figure 4-1

Current Intakes: Ages 19 Through 30
Average Daily Food Group Intakes Compared to
Recommended Intake Ranges
Recommended Intake Ranges

Healthy Eating Index Score(on a scale of 0-100)

Average Intakes

56

12
11
10

CUP or OZ EQUIVALENT

9
8
7
6
5
4
3
2
1
0

M

F
Total
Vegetables
cup eq/day

M

F
Total
Fruitscup eq/day

M

F
Total
Grainsoz eq/day

M

F
Total
Dairy
cup eq/day

M

F
Total
Protein Foods
oz eq/day

FOOD GROUPS

Percent Exceeding Limits of Added Sugars,
Saturated Fat, and Sodium
Added Sugars

Limit: 10% of total energy

Males

62%

Females

66%

Average Intakes
Males
Females
313 kcal
271 kcalExceeding Limit

Saturated Fat

Limit: 10% of total energy

Males

76%

Females71%

Average Intakes
Males
Females
292 kcal
218 kcalWithin Recommended Limit

SodiumLimit: 2,300 mg

Males

97%

Females

84%

Average Intakes
Males
Females
4,274 mg
3,142 mg

Data Sources: Average Intakes and HEI-2015 Scores: Analysis of What We Eat in America, NHANES 2015-2016, day 1 dietary intake data,
weighted. Recommended Intake Ranges: Healthy U.S.-Style Dietary Patterns (see Appendix 3). Percent Exceeding Limits: What We Eat in America,
NHANES
2013-2016, 2 days dietary intake data, weighted.
Ages 19-30

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A D U LT S AG ES 19-59

Figure 4-2
Average Intakes of Subgroups Compared
to Recommended Intake Ranges:
Ages 19 Through 30
Recommended Intake Ranges
9

Average Intakes

Vegetables

CUP EQUIVALENT

8
7
6
5
4
3
2
1

OZ EQUIVALENT

0

12
11
10
9
8
7
6
5
4
3
2
1
0

50

M
F
M
F
DarkTotal
Vegetables Greencup eq/day

M
F
Red &
OrangeM
F
M
F
Beans,
StarchyPeas,
Lentils
cup eq/week

M
F
Other

The HEI scores in Figures 4-1 and 4-3 show that
adults across this life stage have diets that do notalign with the recommendations for food group andnutrient intake as described in Chapter 1. Althoughintake patterns are generally not consistent with theDietary Guidelines, adults ages 31 through 59 have aslightly higher HEI score (59 out of 100) comparedto adults ages 19 through 30 (56 out of 100).

GrainsM

Total
GrainsF

M
F
Whole Grains

Figures 4-1 to 4-4 highlight the dietary intake ofadults, including the Healthy Eating Index-2015(HEI) score, which is an overall measure of how
intakes align with the Dietary Guidelines, as wellas information on the components of a healthy
diet—specifically, the food groups. Figures 4-1 and4-3 display the average intakes of the food groups
compared to the range of recommended intakesat the calorie levels most relevant to males andfemales in both adult age groups. Additionally, thepercent of adults exceeding the limits for addedsugars, saturated fat, and sodium is shown, alongwith average intakes of these components. Averageintakes compared to recommended intake rangesof the subgroups for grains are represented in daily
amounts; subgroups for vegetables and protein
foods are represented in weekly amounts (seeFigures 4-2 and 4-4).

MF
Refined Grainsoz eq/dayProtein Foods

45

OZ EQUIVALENT

40
35
30
25
20
15
10
5
0

M

F
M
F
Total
Meats, Poultry,
Protein Foods
Eggs
oz eq/dayM*
F
Seafood
oz eq/weekM
F
Nuts, Seeds,
Soy Products*NOTE: Estimates may be less precise than others due to small sample size and/or large relative standard error.
Data Sources: Average Intakes: Analysis of What We Eat in America, NHANES 2015-2016, day 1 dietary intake data, weighted. Recommended
Intake Ranges: Healthy U.S.-Style Dietary Patterns (see Appendix 3).
Dietary Guidelines for Americans, 2020-2025 | Chapter 4: Adults | Page 98

A D ULTS AGES 19-5 9Figure 4-3

Current Intakes: Ages 31 Through 59
Healthy Eating Index Score(on a scale of 0-100)

Average Daily Food Group Intakes Compared to
Recommended Intake Ranges
Recommended Intake Ranges

Average Intakes

59

12
11
10

CUP or OZ EQUIVALENT

9
8
7
6
5
4
3
2
1
0

M

F
Total
Vegetables
cup eq/day

M

F
Total
Fruitscup eq/day

M

F
Total
Grainsoz eq/day

M

F
Total
Dairy
cup eq/day

M

F
Total
Protein Foods
oz eq/day

FOOD GROUPS

Percent Exceeding Limits of Added Sugars,
Saturated Fat, and Sodium
Added Sugars

59%

Within Recommended Limit

Saturated Fat

Limit: 10% of total energy

Males

Exceeding Limit

SodiumLimit: 10% of total energy

Females

63%

Average Intakes
Males
Females
348 kcal
233 kcal

Males

73

%

Limit: 2,300 mg

Females70%

Average Intakes
Males
Females
284 kcal
211 kcal

Males

97

%

Females82%

Average Intakes
Males
Females
4,172 mg
3,062 mg

Data Sources: Average Intakes and HEI-2015 Scores: Analysis of What We Eat in America, NHANES 2015-2016, day 1 dietary intake data,
weighted. Recommended Intake Ranges: Healthy U.S.-Style Dietary Patterns (see Appendix 3). Percent Exceeding Limits: What We Eat in America,
NHANES
2013-2016, 2 days dietary intake data, weighted.
Ages 31-59

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A D U LT S AG ES 19-59

Figure 4-4
Average Intakes of Subgroups
Compared to Recommended Intake Ranges:
Ages 31 Through 59
Recommended Intake Ranges
9

Average Intakes

Vegetables

CUP EQUIVALENT

8
7
6
5
4
3
2
1

OZ EQUIVALENT

0

12
11
10
9
8
7
6
5
4
3
2
1
0

50

M
F
M
F
DarkTotal
Vegetables Greencup eq/day

M
F
Red &
OrangeM
F
M
F
Beans,
StarchyPeas,
Lentils
cup eq/week

M
F
Other

GrainsM

Total
GrainsF

M
F
Whole Grains

M
F
Refined Grainsoz eq/dayProtein Foods

45

OZ EQUIVALENT

40
35
30
25
20
15
10
5
0

M

F
M
F
Total
Meats, Poultry,
Protein Foods
Eggs
oz eq/dayM
F
Seafood
oz eq/weekM
F
Nuts, Seeds,
Soy Products

Average intakes of fruits, vegetables, and dairy
fall below the range of recommended intakes for
all adults. Although average total grains intakes
meets recommendations, Figures 4-2 and 4-4
show that intake of whole grains is well below
recommendations, and intakes of refined grainsexceeds the upper end of the recommended
intake range for adults in both age groups. Intakesof protein foods generally meets or exceeds
recommended intake levels. Current patterns
generally include meats, poultry, eggs, and nuts,
seeds, and soy, while average intake of seafood
falls well below recommendations. Beans, peas,and lentils—a subgroup of both the vegetable andprotein foods groups—also are underconsumed bymost adults.
Figures 4-1 and 4-3 show that adults are exceeding
recommendations for added sugars, saturated
fat, and sodium. About 60 percent of men and
65 percent of women exceed the limit for intakesof added sugars. This is an average daily intake
of about 330 calories from added sugars formen and around 250 calories for women. Morethan 70 percent of adults are exceeding therecommendations for saturated fat. The average
daily intakes of saturated fat is about 290 calories
for men and 210 calories for women. The calorie
levels relevant to most adults (1,600-3,000 calories)
have about 100 to 400 calories remaining after foodgroup recommendations are met through nutrientdense choices. Combined, these average amountsof calories from added sugars and saturated fat
exceed the amount most adults have available—
and do not account for calories from alcoholic
beverages. For sodium, nearly all men and about
80 percent of women consume too much on a givenday. Men generally consume more than 4,000 mg of
sodium per day and women more than 3,000 mg.

Data Sources: Average Intakes: Analysis of What We Eat in America, NHANES
2015-2016, day 1 dietary intake data, weighted. Recommended Intake Ranges:
Healthy U.S.-Style Dietary Patterns (see Appendix 3).
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A D ULTS AGES 19-5 9SpecialConsiderations
The dietary considerations for the general U.S.
population, including adults, are described in Chapter 1.
The following sections of this chapter focus on several
special considerations to support a healthy dietary
pattern for adults that reflect adults’ current intake
patterns and the prevalence of overweight and obesityand diet-related chronic disease that become more
apparent in this life stage. These considerations include
a focus on dietary changes to increase intakes of dietaryfiber, calcium, and vitamin D and to decrease intakesof added sugars, saturated fat, and sodium. Special
considerations related to alcoholic beverages also
are discussed.

Dietary Fiber

Dietary patterns that do not meet recommended
intakes of fruits, vegetables, and whole grains
contribute to low intakes of dietary fiber. More than90 percent of women and 97 percent of men do notmeet recommended intakes for dietary fiber. Thisaligns with intake patterns where fruits, vegetables,
and whole grains are underconsumed by more than85 percent of adults. Appendix 1. Nutritional Goals for
Age-Sex Groups provides dietary fiber goals for men
and women based on the Dietary Reference Intakes.
These recommendations are based on levels observed
to reduce risk of coronary heart disease. Increasing
intakes of fruits, vegetables, and replacing refined
grains with whole grains to improve dietary fiber intakes
is especially important during this life stage, as theimpact of poor diet quality becomes apparent withthe onset and/or progression of diet-related chronic
diseases. Chapter 1 provides strategies on how toincrease intakes of these important food groups. A listof common food sources of dietary fiber is available at
DietaryGuidelines.gov.

Calcium and Vitamin D

Calcium and vitamin D are important at any age, andmost adults do not consume adequate amounts.
Close to 30 percent of men and 60 percent of womenolder than age 19 years do not consume enoughcalcium, and more than 90 percent do not consume
enough vitamin D. Dietary patterns that do not meet
recommended intake amounts for food groups andsubgroups, which include sources of calcium andvitamin D—such as dairy foods and fortified soy
alternatives and seafood—contribute to low intake ofthese nutrients. Particular attention should be given
to consuming adequate amounts of foods with thesenutrients during adult years to promote optimal bonehealth and prevent the onset of osteoporosis. Adequate
intake of calcium and vitamin D is particularly
important for adults during the time period when peakbone mass is still actively accruing (ages 19 throughabout 30) and, for women, in the post-menopausal
period when rapid bone remodeling occurs.
A healthy dietary pattern with nutrient-dense,
calcium-rich foods, such as low-fat milk and yogurt
and fortified soy alternatives and canned sardines
and salmon, can help adults better meet intake
recommendations. Vitamin D aids in the absorptionof calcium. Consuming the recommended amountof seafood and choosing foods that are fortified withvitamin D, including milk, fortified soy beverages, andfortified soy yogurt, and some whole-grain cereals,
can help adults meet their needs. In addition to dietary
sources, the body can make vitamin D from thePage 101 | Dietary Guidelines for Americans, 2020-2025 | Chapter 4: Adults

A D U LT S AG ES 19-59

About 70 to 75 percent of adults exceed the 10-percent
limit on saturated fat as a result of selecting foods andbeverages across food groups that are not in nutrientdense forms. The top sources of saturated fat for
adults are sandwiches (e.g., deli sandwiches, burgers,
tacos, burritos, grilled cheese, hot dogs) and othergrain-based mixed dishes (e.g. spaghetti and meatballs,
casseroles, quesadillas) that typically containingredients from several food groups that are not in
nutrient-dense forms, including grains, protein foods,
and dairy. Making changes to the type of ingredients aswell as amount and/or frequency of their consumption
will help adults lower saturated fat intake without aneed to eliminate these foods from the household diet.
Strategies include using lean meats and low-fat cheeseto prepare these foods or substituting beans in placeof meats as the protein source. Saturated fat also canbe reduced by substituting certain ingredients withsources of unsaturated fat (e.g., using avocado, nuts,
or seeds in a dish instead of cheese). Cooking with oils
higher in polyunsaturated and monounsaturated fat(e.g., canola, corn, olive, peanut, safflower, soybean, andsunflower) instead of butter also can reduce intakesof saturated fat.

Sodiumsun. However, some individuals may have difficulty
producing sufficient vitamin D from sunlight exposure
or consuming enough vitamin D from foods andbeverages, so a supplement may be recommended
by a health professional. Appendix 1 provides calcium
and vitamin D goals for men and women based on
the Dietary Reference Intakes. A list of common
food sources of calcium and vitamin D is available at
DietaryGuidelines.gov.

Saturated Fat

Chapter 1 explains the importance of limiting intakesof saturated fat to support healthy dietary patterns.
Staying within saturated fat limits and replacing
saturated fat with unsaturated fat is of particularimportance during the adult life stage. The prevalenceof coronary heart disease increases with age, and high
LDL cholesterol peaks between the ages of 50 to
59 in men and 60 to 69 in women.

The number of adults exceeding the Chronic Disease
Risk Reduction level for sodium (see Chapter 1 orAppendix 1) during this life stage is concerning giventhat 45 percent of adults ages 18 and older are livingwith hypertension. During adulthood, prevalence ofhypertension increases from about 22 percent of
adults ages 18 through 39 to about 55 percent of
adults ages 40 through 59.1 Changing this trend isimportant because hypertension is a preventable risk
factor for cardiovascular disease and stroke. Unlike
other factors that cannot be changed, such as genetics
and family history, reduced dietary intake of sodium
is a modifiable risk factor that can help improve bloodpressure control and reduce risk of hypertension.
Overconsumption of sodium occurs for several
reasons, as discussed in Chapter 1. Because sodium isfound in foods and beverages across all food groups,
with most coming from foods that have salt added
during commercial processing rather than salt added
to foods during or after preparation, reducing sodium
consumption will require a joint effort by individuals,
the food and beverage industry, and food service andretail establishments.

1 Ostchega Y, Fryar CD, Nwankwo T, Nguyen DT. Hypertension prevalence among adults aged 18 and over: United States, 2017–2018. NCHS Data

Brief, no 364. Hyattsville, MD: National Center for Health Statistics. 2020

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A D ULTS AGES 19-5 9Added Sugars

Most adults exceed recommended limits for addedsugars as a result of eating foods and drinking
beverages higher in added sugars and selecting
foods and beverages across food groups that are
not in nutrient-dense forms. Added sugars are ofparticular concern for adults because exceeding limits
contributes to excess calorie intake.
BEVERAGES AS A SOURCE OF ADDED SUGARSSugar-sweetened beverages (e.g., soda, sports drinks,
energy drinks, fruit drinks) and sweetened coffees
and teas (including ready-to-drink varieties) contributeover 40 percent of daily intake of added sugars. Morethan in earlier life stages, adults consume coffees andteas with additions, such as sugar and flavored syrup.
Frequent consumption of these and other beverages
containing added sugars can contribute to excess
calorie intake. Some sugar-sweetened beverages, suchas coffee and tea with milk, contribute to food groupintake (e.g., dairy) and can be made without addedsugars. Others, such as fruit drinks, can be replacedwith nutrient-dense options such as 100% juice to help
meet fruit group recommendations.
Most adults’ diets include choices across multiple
food groups that are not in nutrient-dense forms andtherefore cannot accommodate excess calories fromsweetened beverages. Intake of sugar-sweetened
beverages should be limited to small amounts andmost often replaced with beverage options that containno added sugars, such as water.
OTHER SOURCES OF ADDED SUGARS
A variety of foods and beverages contribute to theremaining added sugars consumed by adults. In
addition to the contribution of sugar-sweetened
beverages and sweetened coffees and teas, about
30 percent come from desserts and sweet snacks,
candies, and sweetened breakfast cereals. The
remaining 30 percent of added sugars is consumed inrelatively small amounts across many food categories,
as discussed in Chapter 1. Many of these foodcategories have seen market expansion in recent years.
For example, over the past decade, beverages, snacks,
and bakery foods have continuously topped the list
for the most new product introductions.2 As these andother food categories continue to change and expand,
it is vital for individuals to learn how to identify theamount of added sugars in a beverage or food productby reading the Nutrition Facts label (see Chapter 1).
Understanding which food choices contribute to intakesof added sugars without contributing to nutrient needs
can help individuals remove or replace these foods
with better choices that meet food group and nutrient
recommendations within calorie needs.

2 Additional information is available at ers.usda.gov/topics/food-markets-prices/processing-marketing/new-products.aspx.

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A D U LT S AG ES 19-59

Alcoholic Beverages

Alcoholic beverages are not a component of the USDA
Dietary Patterns and their calories are considereddiscretionary. Regular consumption of alcoholic
beverages can make it challenging for adults to meetfood group and nutrient needs while not consumingexcess calories. The ingredients in certain mixed drinks,
including soda, mixers, and heavy cream, also cancontribute to intake of added sugars and saturated fat.
The majority of U.S. adults consume alcoholic
beverages. About 66 percent of adults ages 21 through59 report alcoholic beverage consumption in thepast month, and of those, approximately half reportbinge drinking, sometimes multiple times per month.
Among adults who choose to drink, average intakesof calories from alcoholic beverages exceed theremaining calorie limit that is available after food group
recommendations are met.
There are some adults who should not drink alcoholic
beverages at all, such as if they are pregnant or might
be pregnant; younger than age 21; or recovering froman alcohol use disorder or if they are unable to control
the amount they drink. For those who choose to drink,intakes should be limited to 1 drink or less in a day
for women and 2 drinks or less in a day for men, ondays when alcohol is consumed. More information inavailable in Chapter 1 under Alcoholic Beverages.

Supporting
Healthy Eating
Individuals need support in making healthy choices
at home, work, and in the community to build healthy
dietary patterns.
Food retail outlets (e.g., grocery stores, convenience
stores, restaurants) provide adults with the option topurchase ingredients to prepare foods themselves or
to purchase foods prepared by others. National foodexpenditures suggest the purchase of prepared foods
is a regular habit for most adults, with expenditures
outpacing those of foods purchased for household
meal preparation.3 Estimates also suggest that the
younger generation of American adults are spending
an even larger proportion of their total food dollars on
prepared foods than are older generations.4

When adults prepare meals themselves, they have more
control over the types of food ingredients selected andcan focus on choosing nutrient-dense options that
contribute to food group goals with little or no addedsugars and saturated fat and less sodium. The same
is not always true when purchasing prepared foods,
despite changes and innovation in the marketplace,such as menu and product labeling or reformulation.
For some adults, preparing and consuming healthy
meals at home will mean adopting a new habit and/or
learning new skills, such as meal planning. For others, it
may entail small changes to current routines. Planningmeals and snacks in advance with food groups andnutrient-dense foods and beverages in mind cansupport healthy eating at home and improve dietary
patterns of individuals and families. Preparing meals
with family and friends also presents an opportunity
for greater connection and enjoyment around food.
For adults who are parents, guardians, or caregivers ofchildren or adolescents, preparing meals also provides
an opportunity to teach valuable cooking skills andmodel behaviors that support the adoption of healthy
dietary patterns across younger life stages.

3 Details are available at ers.usda.gov/webdocs/publications/96957/ap-083.pdf?v=5848.3.

4 Details are available at ers.usda.gov/amber-waves/2017/december/millennials-devote-larger-shares-of-their-grocery-spending-toprepared-foods-pasta-and-sugar-and-sweets-than-other-generations.

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A D ULTS AGES 19-5 9

It is not realistic or desirable to avoid the purchase andconsumption of foods prepared by others. Limits onavailable time and the desire for convenience makerestaurant and ready-to-eat meals a part of many
household routines. Many of these settings also
provide for social enjoyment of food with friends andfamily. However, foods prepared outside of the home
can contribute to the overconsumption of calories
as a result of large portion sizes and methods ofpreparation. Being mindful of the portion sizes andingredients of prepared foods can help adults achievea healthy dietary pattern while still enjoying foods
prepared by others. Health promotion activities that
center on increasing consumer knowledge and accessto healthy options in the places where Americans
purchase prepared foods are needed to provide
support for adults in these efforts.
Health professionals play an important role insupporting adults’ healthy eating behaviors. Helping
adults become more aware of the foods andbeverages that make up their typical dietary patterns
and identifying areas for improvement can empower
individuals to make changes to the types of foods theypurchase or prepare. Teaching skills like cooking andmeal planning and helping adults understand how toread labels or make healthy menu substitutions also
will support the adoption of a healthy dietary patternduring this life stage.
In settings where adults spend their time, changing
organizational practices, approaches, and/or policies
to support improved dietary patterns also is needed.
Strategies include offering healthy meals and snacks
in workplace cafeterias and vending machines, or
implementing educational programs tailored toworking adults. Or, communities can support farmers
markets, community gardens, and related educational
programming efforts.

Accessing a Healthy Dietary Pattern

A healthy dietary pattern can only be achieved whenadequate resources and supports exist in the places
where adults live, work, and gather. Food access is
crucial for adults to achieve a healthy dietary pattern
and is influenced by diverse factors, as discussed
in Chapter 1. Food insecurity, which occurs whenaccess to nutritionally adequate and safe food islimited or uncertain, is most prevalent in householdswith children and in single-parent households. Income
is one of the primary characteristics associated withfood insecurity. Government programs, such as the
Supplemental Nutrition Assistance Program (SNAP) or
the Food Distribution Program on Indian Reservations(FDPIR), serve as a resource for low-income adults
by supplementing food budgets to support healthy
lifestyles. Adults with children or those caring for older
family members also may benefit from resources
discussed in Chapters 2, 3, and 6.
Additional Government and non-Government
resources, such as food banks or community mealsites and programming offered through SNAP
Education (SNAP-Ed) and the Expanded Food andNutrition Education Program (EFNEP), play a role inproviding food and educational resources to support
adults in making healthy food choices within a limited
budget. Innovative approaches to support health, suchas incentive programs at farmers markets or healthy
corner-store initiatives, continue to expand. Continued
attention and creativity in approaches to expand
food access are needed to support a healthy dietary
pattern for adults and the larger social networks thatthey influence.

Learn More
The Federal Foodservice Guidelines is a
resource that food service providers can use
to help make healthy choices more available infood service establishments. The Guidelines areavailable at cdc.gov/nutrition/healthy-foodenvironments/food-serv-guide.html.

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A D U LT S AG ES 19-59

Looking Toward Chapter 5:
Women Who Are Pregnant or Lactating
and Chapter 6: Older Adults
This chapter has discussed the importance ofa healthy dietary pattern and related special
considerations during the adult life stage. The chapter
recognizes that dietary patterns are generally wellestablished by the time individuals reach adulthoodand encourages adults to take advantage of the many
opportunities available to make changes that supporta healthy dietary pattern. Making these changes
can have important benefits for achieving a healthy
weight status, reducing chronic disease risk, andpromoting overall health. These considerations areespecially important for the life stages discussed in
the next two chapters. Chapter 5 takes a closer lookat a special time in the life of many adults—pregnancy
and lactation. This chapter echoes the same guidance
for adults on following a healthy dietary pattern anddiscusses several special considerations that arise
during this life stage. Chapter 6 then makes thetransition from the Adults chapter to a focused look at
healthy eating for older adults.

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WOME N W H O AR E PR EGNANT O R L ACTAT ING

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WO M E N W H O A R E P R EG N A N T O R LACTATING

CHAPTER

5

Women Who
Are Pregnant
or Lactating

Dietary
DietaryGuidelines
Guidelinesfor
forAmericans,
Americans,2020-2025
2020-2025 || Chapter
Chapter5:
5:Women
WomenWho
WhoAreArePregnant
Pregnantor
orLactating
Lactating | Page 108

WOME N W H O AR E PR EGNANT O R L ACTAT ING

Introduction

P

regnancy and lactation are special stagesof life for women, and nutrition plays avital role before, during, and after these life
stages to support the health of the motherand her child. Following a healthy dietary
pattern is especially important for those whoare pregnant or lactating for several reasons.
Increased calorie and nutrient intakes
are necessary to support the growth anddevelopment of the baby and to maintainthe mother’s health. Consuming a healthy
dietary pattern before and during pregnancy
also may improve pregnancy outcomes. In
addition, following a healthy dietary pattern
before and during pregnancy and lactation
has the potential to affect health outcomesfor both the mother and child in subsequent
life stages.

This chapter addresses some
important nutritional considerations
for women before pregnancy andcontains nutrition guidance forwomen during pregnancy andlactation. A healthy dietary pattern,along with changing calorie andnutrient needs during pregnancy andlactation, are described throughout
the chapter. Special consideration is
given to the importance of achieving
and maintaining a healthy weight
before pregnancy, gaining weight
within gestational weight gain
guidelines, and returning to a healthy
weight during the postpartum
period. A healthy weight statusduring these life stages has shortand long-term health benefits for themother and her child. The chapter
also discusses other considerations
important to pregnancy andlactation, including those related
to intake of seafood, alcohol, andcaffeinated beverages. Finally,
during pregnancy, nausea, vomiting,food aversions, and food cravings
can make it difficult for some
women to achieve optimal dietaryintake. The chapter discusses how
these can be considered when
helping women who are pregnant
or lactating make healthy food andbeverage choices.

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WO M E N W H O A R E P R EG N A N T O R LACTATING

Healthy Dietary
Patterns
Women who are pregnant or lactating are encouraged
to follow the recommendations on the types offoods and beverages that make up a healthy dietary
pattern described in Chapter 1. Nutrition and HealthAcross the Lifespan: The Dietary Guidelines and Key
Recommendations. The core elements of a healthy dietfor women during these life stages are similar to therecommendations for women who are not pregnant.
Table 5-1 shows the Healthy U.S.-Style Dietary Pattern
to illustrate the specific amounts and limits for foodgroups and other dietary components that make uphealthy dietary patterns at the six calorie levels most
relevant to women who are pregnant or lactating.
Following a healthy dietary pattern during these life
stages can help women meet the Guidelines and its
Key Recommendations. The USDA Dietary Patterns are
discussed in greater detail in Chapter 1 and Appendix 3.
USDA Dietary Patterns.
Table 5-2 summarizes estimated daily calorie
needs during pregnancy and lactation compared
to prepregnancy needs for women with a healthy
prepregnancy weight. Additional information on
estimates of prepregnancy calorie needs is provided inTable 5-1 (footnote a) and in Appendix 2. EstimatedCalorie Needs. As shown in Table 5-2, calorie needs
generally increase as pregnancy progresses and remain
elevated during lactation. However, it is important tonote that women with a prepregnancy weight that is
considered overweight or obese have lower weightgain recommendations than do women with a healthy
prepregnancy weight (see “Weight Management”).
Women should follow their healthcare provider’sguidance regarding appropriate caloric intake during
pregnancy and lactation, as many factors, including
prepregnancy weight status, gestational weight gain,
and multiple pregnancies, may affect calorie needs.
In general, it is important for women who are pregnant
to be under the care of a healthcare provider who
can monitor their health status and the progress of
their pregnancy.

of pregnancy and throughout lactation. In short, womenshould meet their increased calorie and nutrient needs
with nutrient-dense foods instead of with foods high in
added sugars, saturated fat, and sodium.
The customizable components of the USDA Dietary
Patterns provide flexibility that allows women—or
professionals adapting these patterns—to choose from avariety of foods and beverages within each food group tosuit individual preference, lifestyle, traditions, culture, andbudget. This flexibility in being able to select among avariety of nutrient-dense options is particularly important
for women who experience pregnancy-induced nausea,
vomiting, or food aversions.
When making food and beverage choices, womenshould know that unless it’s medically indicated to
avoid for her own health, women do not need to restrict
their choices during pregnancy or lactation to prevent
food allergy from developing in their child. However,
women who are pregnant should pay attention to some
important food safety considerations (see “Food Safety
During Pregnancy”).

Nutrient-Dense Foods
and Beverages

Nutrient-dense foods andbeverages provide vitamins,
minerals, and other health-promoting
components and have little added sugars,
saturated fat, and sodium. Vegetables, fruits,
whole grains, seafood, eggs, beans, peas, andlentils, unsalted nuts
and seeds, fat-free andlow-fat dairy products,
and lean meats andpoultry—when preparedwith no or little addedsugars, saturated
fat, and sodium—are
nutrient-dense foods.

The increased calorie and nutrient needs for these life
stages should be met by consuming nutrient-dense foodchoices as part of a healthy dietary pattern. One way toachieve this is to follow the Healthy U.S.-Style Dietary
Pattern throughout pregnancy and lactation, but adjust
intake of food groups to reflect higher calorie patterns
recommended during the second and third trimesters
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WOME N W H O AR E PR EGNANT O R L ACTAT ING

Table 5-1

Healthy U.S.-Style Dietary Pattern for Women Who Are
Pregnant or Lactating, With Daily or Weekly Amounts From
Food Groups, Subgroups, and Components
CALORIE LEVEL OF PATTERNa

1,800

2,200

2,400

2,600

2,800

Daily Amount of Food From Each Group(Vegetable and protein foods subgroup amounts are per week.)

FOOD GROUP OR SUBGROUPb
Vegetables (cup eq/day)

2,000

2½

2½

3

3

3½

3½

Vegetable Subgroups in Weekly Amounts
Dark-Green Vegetables (cup eq/wk)

1½

1½

2

2

2½

2½

Red & Orange Vegetables (cup eq/wk)

5½

5½

6

6

7

7

Beans, Peas, Lentils (cup eq/wk)

1½

1½

2

2

2½

2½

Starchy Vegetables (cup eq/wk)

5

5

6

6

7

7

Other Vegetables (cup eq/wk)

4

4

5

5

5½

5½

Fruits (cup eq/day)

1½

2

2

2

2

2½

Grains (ounce eq/day)

6

6

7

8

9

10

Whole Grains (ounce eq/day)

3

3

3½

4

4½

5

Refined Grains (ounce eq/day)

3

3

3½

4

4½

5

Dairy (cup eq/day)

3

3

3

3

3

3

Protein Foods (ounce eq/day)

5

5½

6

6½

6½

7

Protein Foods Subgroups in Weekly Amounts
Meats, Poultry, Eggs (ounce eq/wk)

23

26

28

31

31

33

Seafood (ounce eq/wk)c

8

8

9

10

10

10

Nuts, Seeds, Soy Products (ounce eq/wk)

4

5

5

5

5

6

Oils (grams/day)

24

27

29

31

34

36

Limit on Calories for Other Uses (kcal/day)d

140

240

250

320

350

370

Limit on Calories for Other Uses (%/day)

8%

12%

11%

13%

13%

13%

a Calorie level ranges: Prepregnancy energy levels are calculated

based on median height and body weight for healthy body massindex (BMI) for a reference woman, who is 5 feet 4 inches tall andweighs 126 pounds. The calorie levels shown in this table include
estimates for women during the first trimester of pregnancy, whencalorie needs generally do not increase compared to prepregnancy
needs, plus the additional calories needed for the later trimesters
of pregnancy and during lactation. Calorie needs vary based on
many factors. Women with overweight or obesity have lower
recommended gestational weight gain during pregnancy, which
may affect calorie needs. The DRI Calculator for Healthcare
Professionals, available at nal.usda.gov/fnic/dri-calculator, can beused to estimate calorie needs based on age, sex, height, weight,
activity level, and pregnancy or lactation status.

b Definitions for each food group and subgroup and quantity (i.e., cupor ounce equivalents) are provided in Chapter 1 and are compiled inAppendix 3.

c The U.S. Food and Drug Administration (FDA) and the U.S.
Environmental Protection Agency (EPA) provide joint advice regarding
seafood consumption to limit methylmercury exposure for women
who might become or are pregnant or lactating. Depending on

body weight, some women should choose seafood lowest in
methylmercury or eat less seafood than the amounts in the Healthy
U.S.-Style Dietary Pattern. More information is available on the FDA
and EPA websites at FDA.gov/fishadvice and EPA.gov/fishadvice.
d All foods are assumed to be in nutrient-dense forms; lean or
low-fat; and prepared with minimal added sugars, refined starches,saturated fat, or sodium. If all food choices to meet food group
recommendations are in nutrient-dense forms, a small number ofcalories remain within the overall limit of the pattern (i.e., limit on
calories for other uses). The number of calories depends on the total
calorie level of the pattern and the amounts of food from each foodgroup required to meet nutritional goals. Calories up to the specified
limit can be used for added sugars and/or saturated fat, or to eat
more than the recommended amount of food in a food group.

NOTE: The total dietary pattern should not exceed Dietary Guidelines
limits for added sugars and saturated fat; be within the Acceptable
Macronutrient Distribution Ranges for protein, carbohydrate, and total
fats; and stay within calorie limits. Values are rounded. See Appendix
3 for all calorie levels of the pattern.

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WO M E N W H O A R E P R EG N A N T O R LACTATING

Table 5-2
Estimated Change in Calorie Needs During Pregnancy and Lactation for Women With a Healthya
Prepregnancy Weight
Estimated Change in Daily Calorie Needs
Compared to Prepregnancy Needs

Stage of Pregnancy or Lactation
Pregnancy: 1st trimester+ 0 calories

Pregnancy: 2nd trimester+ 340 calories

Pregnancy: 3rd trimester+ 452 calories

Lactation: 1st 6 months+ 330 caloriesb

Lactation: 2nd 6 months+ 400 caloriesc

a These estimates apply to women with a healthy prepregnancy

weight. Women with a prepregnancy weight that is consideredoverweight or obese should consult their healthcare provider for
guidance regarding appropriate caloric intake during pregnancy
and lactation.

b The EER for the first 6 months of lactation is calculated byadding 500 calories/day to prepregnancy needs to account for theenergy needed for milk production during this time period, thensubtracting 170 calories/day to account for weight loss in the first
6 months postpartum.

Weight Management

Weight management is complex, so women shouldseek advice from a healthcare provider on thebest way to achieve their goals. Women should
be encouraged to achieve and maintain a healthy
weight before becoming pregnant, as well as follow
the gestational weight gain guidelines developed by
the National Academies of Sciences, Engineering,and Medicine during pregnancy. These guidelines
are outlined in Table 5-3 and serve as a tool tohelp balance the benefits and risks associated withpregnancy weight change.

c The EER for the second 6 months of lactation is calculated byadding 400 calories/day to prepregnancy needs to account for theenergy needed for milk production during this time period. Weightstability is assumed after 6 months postpartum.

NOTE: Estimates are based on Estimated Energy Requirements (EER)
set by the Institute of Medicine. Source: Institute of Medicine. Dietary
Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids,
Cholesterol, Protein, and Amino Acids. Washington, DC: The National
Academies Press; 2005.

Table 5-3
Weight Gain Recommendations for Pregnancya
Prepregnancy
WeightCategory

Body
Mass
Index

Range of
Total
WeightGain (lb)

Rates of Weekly
Weight Gainb inthe 2nd and 3rd
Trimesters(mean [range],lbs)

UnderweightLess than
18.5

28-40

1 [1-1.3]

Healthy
Weight18.5-24.9

25-35

1 [0.8-1]

Overweight25-29.9

15-25

0.6 [0.5-0.7]

It is important to note that about half of women retain
10 pounds or more and nearly 1 in 4 women retain 20
30 andObese
11-20
0.5 [0.4-0.6]
greaterpounds or more at 12 months postpartum. Postpartum
weight retention results in about 1 in 7 womena Reference: Institute of Medicine and National Research Council. 2009.
moving from a healthy weight classification before
Weight Gain During Pregnancy: Reexamining the Guidelines. Washington,
DC: The National Academies Press. doi.org/10.17226/12584.
pregnancy to an overweight classification postpartum.
b Calculations assume a 1.1 to 4.4 lb weight gain in the first trimester.
Current estimates show that about half of womenof childbearing age have a weight classification of
overweight or obese. Women with overweight or obesity frequently exceed gestational weight gain recommendations
during pregnancy, which increases the likelihood of excess postpartum weight retention.
Weight gain is a natural part of pregnancy, which is why it is important to have a plan. Meeting weight management
goals may improve pregnancy outcomes, such as increasing the likelihood of delivering a healthy weight infant andimproving the long-term health of both mother and child. Women are encouraged to partner with their healthcare
provider and other medical professionals to achieve their goals and optimize health outcomes.

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WOME N W H O AR E PR EGNANT O R L ACTAT ING

Current Intakes
Figures 5-1 and 5-2 highlight the dietary intakes of women who are pregnant or lactating, including the Healthy
Eating Index-2015 score, which is an overall measure of how intakes align with the Dietary Guidelines, as well as
information on the components of a healthy diet—specifically, the food groups. Figure 5-1 displays the averageintakes of the food groups compared to the range of recommended intakes at the calorie levels most relevant tothese life stages.
Figure 5-1

Current Intakes: Women Who Are Pregnant or Lactating
Healthy Eating Index Score(on a scale of 0-100)

Average Daily Food Group Intakes Compared to
Recommended Intake Ranges
Recommended Intake Ranges

Average Intakes

63 62

12
11

54

10

CUP or OZ EQUIVALENT

9
8
7
6
5
4
3
2
1
0

P

L
Total
Vegetables
cup eq/day

P

L
Total
Fruitscup eq/day

P

L
Total
Grainsoz eq/day

P

L
Total
Dairy
cup eq/day

P

L
Total
Protein Foods
oz eq/day

Adult
Women

Women
Who ArePregnant

Women
Who AreLactating

FOOD GROUPS

Percent Exceeding Limits of Added Sugars,
Saturated Fat, and Sodium
Added Sugars

Exceeding Limit

Saturated Fat

Limit: 10% of total energy

SodiumLimit: 10% of total energy

Limit: 2,300 mg

Pregnant

LactatingPregnant

Lactating

%

%

%

%

70

Within Recommended Limit

51

Average Intakes
Pregnant
Lactating
288 kcal
248 kcal75

77

Average Intakes
Pregnant
Lactating
240 kcal
264 kcalPregnant

88%*

Lactating97%*

Average Intakes
Pregnant
Lactating
3,305 mg
3,880 mg

*NOTE: Estimates may be less precise than others due to small sample size and/or large relative standard error.
Data Sources: Average Intakes and HEI-2015 Scores: Analysis of What We Eat in America, NHANES 2013-2016, women ages 20-44, day 1
dietary intake data, weighted. Recommended Intake Ranges: Healthy U.S.-Style Dietary Patterns (see Appendix 3). Percent Exceeding Limits:
Pregnancy and Lactation
What We Eat in America, NHANES 2013-2016, 2 days dietary intake data, weighted.
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WO M E N W H O A R E P R EG N A N T O R LACTATING

Figure 5-2
Average Intakes of Subgroups Compared
to Recommended Intake Ranges: Women Who
Are Pregnant or Lactating
Recommended Intake Ranges
8

Average Intakes

Vegetables

CUP EQUIVALENT

7
6
5
4
3
2
1

OZ EQUIVALENT

0

12
11
10
9
8
7
6
5
4
3
2
1
0

45

P
L
P L*
DarkTotal
Vegetables Greencup eq/day

P
L
Red &
OrangePL
P L*
Beans,
StarchyPeas,
Lentils
cup eq/week

P
L
Other

GrainsAdditionally, the percent of women exceeding thelimits for added sugars, saturated fat, and sodium
are shown, along with average intakes of thesecomponents. Finally, average intakes compared
to recommended intake ranges of the subgroups
for grains in daily amounts and for vegetables andprotein foods in weekly amounts are also provided
in Figure 5-2.
P

Total
Grains

L

P
L
Whole Grains

P
L
Refined Grainsoz eq/dayProtein Foods

40

OZ EQUIVALENT

3530

The Healthy Eating Index score is 63 for women
who are pregnant and 62 for women who arelactating. Although diet quality is higher among
women during these life stages compared to peers
who are not pregnant or lactating (54), intakes
are still not optimal. Women who are pregnant or
lactating can benefit from making dietary changes
to better align with healthy dietary patterns.

25
20
15
10
5
0

P

L
P
L
Total
Meats, Poultry,
Protein Foods
Eggs
oz eq/dayP*
L*
Seafood
oz eq/weekP
L
Nuts, Seeds,
Soy Products

As described in Chapter 1, consistent with thegeneral U.S. population, women who are pregnant
or lactating are not meeting recommendations forfood group and nutrient intake. Figures 5-1 and 5-2
show average intakes are generally below or in thelower range of recommendations for food groups
and subgroups, while exceeding limits for addedsugars, saturated fat, and sodium.

*NOTE: Estimates may be less precise than others due to small sample size and/or large relative standard error.
Data Sources: Average Intakes: Analysis of What We Eat in America, NHANES 2013-2016, women ages 20-44, day 1 dietary intake data, weighted.
Recommended Intake Ranges: Healthy U.S.-Style Dietary Patterns (see Appendix 3).
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WOME N W H O AR E PR EGNANT O R L ACTAT ING

SpecialConsiderations
The nutrition considerations for the general U.S.
population described in Chapter 1 apply to women who
are pregnant or lactating. For example, the nutrients ofpublic health concern—calcium, vitamin D, potassium,and dietary fiber—apply to these life stages as well.
In addition, iron is a nutrient of public health concern
for women who are pregnant. These life stages also
have some special nutrient and dietary considerations
regarding folate, iodine, choline, seafood, alcoholic
beverages, and caffeinated beverages that are discussed
in the following sections of this chapter.

Meeting Nutrient Needs

As discussed in Chapter 1, nutritional needs should be
met primarily through foods and beverages. However,this may be difficult for some women, especiallythose who are pregnant. Most healthcare providers
recommend women who are pregnant or planning tobecome pregnant take a daily prenatal vitamin andmineral supplement in addition to consuming a healthy
dietary pattern. This may be especially important tomeet folate/folic acid, iron, iodine, and vitamin D needs
during pregnancy (see Appendix 1. Nutritional Goals for
Age-Sex Groups).
Nutrient needs for women who are lactating differ fromthose who are pregnant. Continued use of prenatal
supplements by women who are lactating may exceed
their needs for folic acid and iron. Women who arelactating should not exceed the Tolerable Upper Intake
Level (UL) of 1,000 micrograms of folic acid and 45
milligrams of iron. Women should seek guidance froma healthcare provider on appropriate use of prenatal orother dietary supplements during lactation.

Folate/Folic Acid

The RDA for folate is higher during pregnancy andlactation than all other life stages (see Appendix 1).
Adequate folic acid intake is particularly important prior
to conception and during the first trimester to help
prevent neural tube defects.
The United States Preventative Services Task Force(USPSTF) recommends that all women who are planningor capable of pregnancy take a daily supplement
containing 400 to 800 mcg of folic acid. The critical
period for supplementation starts at least 1 month
before conception and continues through the first 2 to 3

months of pregnancy. Dietary supplements may containeither folic acid or 5-methyltetrahydrofolate (5-MTHF),
but only folic acid has been shown to prevent neural tube
defects. Most prenatal supplements sold in the UnitedStates contain folic acid.
The recommendation for folic acid supplementation isin addition to the amounts of food folate contained ina healthy eating pattern. Folate is found inherently in
dark-green vegetables and beans, peas, and lentils. All
enriched grains (i.e., bread, pasta, rice, and cereal) andsome corn masa flours are fortified with folic acid.

Iron

Iron needs increase during pregnancy compared toprepregnancy. For women who are lactating, before
menstruation returns, iron needs fall and then returnto prepregnancy levels once menstruation resumes(see Appendix 1).
Iron is a key nutrient during pregnancy that supports
fetal development. Iron deficiency affects about 1 in
10 women who are pregnant and 1 in 4 women during
their third trimester. Heme iron, which is found in animal
source foods (e.g., lean meats, poultry, and someseafood) is more readily absorbed by the body than the
non-heme iron found in plant source foods (e.g., beans,peas, lentils, and dark-green vegetables). Additional ironsources include foods enriched or fortified withiron, such as many whole-wheat breads and ready-to-eat

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More than half of women continue to use prenatal
supplements during lactation. Most prenatal
supplements are designed to meet the higher iron needsof pregnancy. Depending on various factors—such as
when menstruation returns—prenatal supplements
may exceed the iron needs of women who are lactating.
Women should seek guidance from a healthcare
provider regarding the appropriate level of ironsupplementation during lactation based on theirunique needs.

IodineIodine needs increase substantially during pregnancy andlactation (see Appendix 1). Adequate iodine intake during
pregnancy is important for neurocognitive developmentof the fetus. Although women of reproductive age
generally have adequate iodine intake, some women,
particularly those who do not regularly consume dairy
products, eggs, seafood, or use iodized table salt, may
not consume enough iodine to meet increased needs
during pregnancy and lactation.
cereals. Absorption of iron from non-heme sources isenhanced by consuming them along with vitamin C-richfoods. Food source lists for both heme and non-heme
iron are available at DietaryGuidelines.gov. Women
who are pregnant or who are planning to become
pregnant are advised to take a supplement containing
iron when recommended by an obstetrician or other
healthcare provider.

Women who are pregnant or lactating should not be
encouraged to start using table salt if they do not do soalready. However, they should ensure that any table salt
used in cooking or added to food at the table is iodized.
Additionally, women who are pregnant or lactating mayneed a supplement containing iodine in order to achieveadequate intake. Many prenatal supplements do notcontain iodine. Thus, it is important to read the label.

Vegetarian or Vegan Dietary Patterns
During Pregnancy and Lactation

Women following a vegetarian or vegan dietary patternduring these life stages may need to take special careto ensure nutrient adequacy. Iron may be of particularconcern because plant source foods only containnon-heme iron, which is less bioavailable than heme
iron. Food source lists for both heme and non-heme
iron are available at DietaryGuidelines.gov. Vitamin
B12 also is of concern because it is present only inanimal source foods. Women following a vegetarian orvegan dietary pattern should consult with a healthcare
provider to determine whether supplementation of iron,vitamin B12, and/or other nutrients such as choline,
zinc, iodine , or EPA/DHA is necessary and if so, theappropriate levels to meet their unique needs.

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Choline

Choline needs also increase during pregnancy andlactation (see Appendix 1). Adequate intake of choline
during these life stages helps to both replenish maternal
stores and support the growth and development of thechild’s brain and spinal cord.
Most women do not meet recommended intakes ofcholine during pregnancy and lactation. Women areencouraged to consume a variety of choline-containing
foods during these life stages. Choline can be foundthroughout many food groups and subgroups. Meeting
recommended intakes for the dairy and protein
food groups—with eggs, meats, and some seafood
being notable sources—as well as the beans, peas,and lentils subgroup can help meet choline needs.
Meeting nutrient needs through foods and beverages
is preferred, but women who are concerned about
meeting recommendations should speak with theirhealthcare provider to determine whether choline
supplementation is appropriate. Many prenatal
supplements do not contain choline or only containsmall amounts inadequate to meet recommendations.

Seafood

Seafood intake during pregnancy is recommended, as
it is associated with favorable measures of cognitive
development in young children. Women who are
pregnant or lactating should consume at least 8 andup to 12 ounces of a variety of seafood per week, fromchoices lower in methylmercury. The U.S. Food andDrug Administration (FDA) and the U.S. Environmental
Protection Agency (EPA) provide joint advice regarding
seafood consumption to limit methylmercury exposure
for women who might become or who are pregnant
or lactating. Methylmercury can be harmful to thebrain and nervous system if a person is exposed totoo much of it over time; this is particularly importantduring pregnancy because eating too much of it canhave negative effects on the developing fetus. Basedon FDA and EPA’s advice, depending on body weight,
some women should choose seafood lowest in
methylmercury or eat less seafood than the amounts
in the Healthy U.S.-Style Dietary Pattern. Additionally,certain species of seafood (e.g., shark, swordfish, kingmackerel) should be avoided during pregnancy. Moreinformation is available on the FDA or EPA websites at
FDA.gov/fishadvice and EPA.gov/fishadvice.

Alcoholic Beverages

Women who are or who may be pregnant should not
drink alcohol. However, consumption of alcohol during
pregnancy continues to be of concern in the UnitedStates. Among women who are pregnant, about 1 in
10 reported consuming alcohol during the past month,with an average intake of 2 or more drink equivalents ondays alcohol is consumed.
It is not safe for women to drink any type or amount of
alcohol during pregnancy. Women who drink alcoholand become pregnant should stop drinking immediately
and women who are trying to become pregnant should

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WO M E N W H O A R E P R EG N A N T O R LACTATING

Food Safety During
Pregnancy

not drink at all. Alcohol can harm the baby at any time during pregnancy,
even during the first or second month when a woman may not know she
is pregnant.
Not drinking alcohol also is the safest option for women who are lactating.
Generally, moderate consumption of alcoholic beverages by a woman who
is lactating (up to 1 standard drink in a day) is not known to be harmful
to the infant, especially if the woman waits at least 2 hours after a single
drink before nursing or expressing breast milk. Additional informationon breastfeeding and alcohol can be found at: cdc.gov/breastfeeding/breastfeeding-special-circumstances/vaccinations-medications-drugs/
alcohol.html. Women considering consuming alcohol during lactation
should talk to their healthcare provider.

Caffeine

Many women consume caffeine during pregnancy or lactation. As discussed
in Chapter 1, most intake of caffeine in the United States comes from coffee,
tea, and soda. Caffeinated beverages vary widely in their caffeine content.
Caffeine passes from the mother to infant in small amounts through breast
milk, but usually does not adversely affect the infant when the motherconsumes low to moderate amounts (about 300 milligrams or less perday, which is about 2 to 3 cups of coffee). More information is available
at: cdc.gov/breastfeeding/breastfeeding-special-circumstances/dietand-micronutrients/maternal-diet.html. Women who could be or who are
pregnant should consult their healthcare providers for advice concerning
caffeine consumption.

Women who are pregnant andtheir unborn children are more
susceptible than are the general
population to the effects offoodborne illnesses, such as
listeriosis. They need to takespecial care to keep foods
safe and to not eat foods that
increase the risk of foodborne
illness. During pregnancy, womenshould only eat foods containing
seafood, meats, poultry, or
eggs that have been cooked torecommended safe minimum
internal temperatures. They also
should take special precautions
not to consume unpasteurized(raw) juice or milk, raw sprouts,
or some soft cheeses made from
unpasteurized milk. Deli andluncheon meats and hot dogs
should be reheated to steaming
hot or 165°F to kill Listeria, thebacteria that causes listeriosis.
Additional food safety resources
for pregnant women are available
at fda.gov/media/83740/
download and foodsafety.gov/
people-at-risk/pregnant-women,
and specific answers to foodsafety questions are available atfsis.usda.gov/wps/portal/fsis/
topics/food-safety-education/
get-answers.

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Physical Activity During Pregnancy and Postpartum
PREGNANCY
Physical activity during pregnancy can benefit both the mother and the baby. Physical activity increases ormaintains cardiorespiratory fitness and reduces the risk of excessive weight gain and gestational diabetes.
For many benefits, healthy women without contraindications should do a least 150 minutes of moderateintensity aerobic activity a week, as they are able. Women who habitually did vigorous-intensity activity ora lot of aerobic or muscle-strengthening physical activity before pregnancy can continue to do so during
pregnancy. Women can consult their healthcare provider about whether or how to adjust their physicalactivity during pregnancy.
POSTPARTUM
Physical activity following the birth of a child continues to benefit a woman’s overall health. Physical activity
during the postpartum period increases cardiorespiratory fitness, improves mood, and reduces the symptomsof postpartum depression. Additionally, physical activity can help achieve and maintain a healthy weight and,
when combined with caloric restriction, helps promote weight loss.
Women should start slow and build back up to more activity over time. Women should aim for at least 150
minutes of moderate-intensity aerobic activity a week.
The U.S. Department of Health and Human Service’s Physical Activity Guidelines for Americans and the MoveYour Way® communications campaign have information about the benefits of physical activity and tips to getstarted. Available at health.gov/paguidelines.

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WO M E N W H O A R E P R EG N A N T O R LACTATING

Supporting
Healthy Eating
Many women have increased interest in and motivation
to make healthy lifestyle changes during pregnancy
and lactation. Furthermore, the dietary choices madeduring these life stages can affect women’s healthand the health of their children. Supporting women in
adopting healthy dietary patterns during this importanttime of life and sustaining them thereafter also enables
them to serve as role models when their children begin
transitioning to complementary foods.
Women who are pregnant or lactating face many
real or perceived barriers when trying to meet therecommendations of the Dietary Guidelines. Constraints
on time and financial resources, limited access to highquality childcare and family leave policies, as well as
inadequate breastfeeding support at home or at work
are barriers women may face. These barriers should
be considered by all those who support women in theirefforts to follow a healthy dietary pattern.
Ensuring women have access to healthy, safe foodis vital due to the critical role nutrition plays in healthpromotion during these life stages. This is particularly
critical for families dealing with food insecurity, which
is most prevalent in households with children andin single-parent households. Participation in Federal
programs, such as the Special Supplemental Nutrition
Program for Women, Infants, and Children (WIC),
which serves low-income pregnant, breastfeeding, andnon-breastfeeding postpartum women, and infants andchildren up to age 5, can help alleviate these challenges
and improve dietary intake for many women andchildren facing economic hardship. The Supplemental
Nutrition Assistance Program (SNAP) and the FoodDistribution Program on Indian Reservations (FDPIR)

can also serve as resources for low-income womenand their families by both supplementing food budgets
to support health and by providing nutrition education
through the SNAP-Ed program. Additionally, USDA’s
Healthy Eating on A Budget1 can help women andfamilies plan and prepare healthy, inexpensive meals.
Other Government and non-Government resources,
such as food banks or community meal programs,
also provide food and educational resources that can
support women in making healthy food choices forthemselves and their families.
Support during lactation can help women meettheir breastfeeding goals, despite significant
demands on their time and energy during this life
stage. Worksite programs and policies that allow
women adequate time to pump breast milk whenaway from their child, as well as access to goodquality childcare, can allow women who return towork to achieve breastfeeding goals. Access tobreastfeeding peer counselors, such as those used
in WIC, or free breastfeeding support groups throughlocal hospitals also can support women during thislife stage. Additionally, health professionals canpromote the USDA’s WIC Breastfeeding Support2
and the U.S. Department of Health and Human
Services Office of Women’s Health (OWH) Your Guide
to Breastfeeding3 and their National Breastfeeding
Helpline4 (800-994-9662), which are freely accessible
to all women.
Health professionals, policymakers, worksite
administrators, community leaders, families,
and friends should consider these barriers andopportunities when seeking to support women andfamilies. Developing programs and resources that
reduce barriers and create opportunities can help
women meet their dietary needs and improve theiroverall health and the health of their children.

For more information on meeting theDietary Guidelines for children during theirfirst 2 years of life, see Chapter 2. Infants
and Toddlers
1 Available at: MyPlate.gov/budget
2 Available at: wicbreastfeeding.fns.usda.gov/
3 Available at: womenshealth.gov/files/your-guide-to-breastfeeding.pdf
4 Available at: womenshealth.gov/about-us/what-we-do/programs-and-activities/helpline

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A D ULTS AGES 6 0 AND O L DE R

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A D U LT S AG ES 6 0 A ND OLD ER

CHAPTER

6

Older Adults

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A D ULTS AGES 6 0 AND O L DE R

IntroductionOlder adults include individuals ages
60 and older—a life stage that
includes a broad range of ages and is
influenced by a number of health andsocial changes that affect this population’s
nutritional status. Compared to younger
adults, older adults are at greater risk ofchronic diseases, such as cardiovasculardisease and cancer, as well as healthconditions related to changes in bone andmuscle mass, such as osteoporosis andsarcopenia, respectively. An increasing
number of older adults start this life stage
with excess body weight. Preventing
additional weight gain and achieving ahealthy weight by following a healthy
dietary pattern and adopting an active
lifestyle can support healthy aging.

Selecting healthy food and beverage choices is important for people
throughout this life stage, regardless of their race or ethnicity or theircurrent health status. It is never too late to make improvements. Olderadults should follow a healthy dietary pattern because of the changing
dietary needs and the heightened risk of malnutrition that occurs withage. Older adults generally have lower calorie needs but similar or evenincreased nutrient needs compared to younger adults. The overall nutrient
density of dietary patterns is particularly important to this age group. Lower
calorie needs result from less physical activity, changes in metabolism,
and/or age-related loss in bone and muscle mass. Other factors may affectnutrient needs and absorption of nutrients in older adults, including chronic
disease and conditions, use of multiple medications, and changes in bodycomposition. The healthy dietary patterns described below take the uniqueneeds of older adults into account and are further supported by special
considerations and strategies for professionals to support healthy aging.
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Nutrient-Dense Foods
and Beverages

Nutrient-dense foods andbeverages provide vitamins,
minerals, and other healthpromoting components andhave little added sugars,
saturated fat, and sodium.
Vegetables, fruits, wholegrains, seafood, eggs, beans,peas, and lentils, unsalted nuts
and seeds, fat-free and low-fat
dairy products, and lean meats
and poultry—when preparedwith no or little added sugars,
saturated fat, and sodium—are
nutrient-dense foods.

A D U LT S AG ES 6 0 A ND OLD ER

Healthy Dietary
Patterns
Older adults are encouraged to follow therecommendations on the types of foods and beverages
that make up a healthy dietary pattern described in
Chapter 1. Nutrition and Health Across the Lifespan:
The Guidelines and Key Recommendations. Table
6-1 displays the Healthy U.S.-Style Dietary Pattern toillustrate the specific food group amounts and limits
for other dietary components that make up healthy
dietary patterns at the six calorie levels most relevant
to older adults.
Calorie needs are generally lower for females comparedto males, and for those who are older, smaller, and lessphysically active. Females ages 60 and older require
about 1,600 to 2,200 calories per day and males ages 60
and older require about 2,000 to 2,600 calories per day.
Additional information on these estimates is provided
in Table 6-1 (footnote a) and in Appendix 1. EstimatedCalorie Needs.
The USDA Food Patterns are discussed in greater detail in
Chapter 1. Nutrition and Health Across the Lifespan: The
Guidelines and Key Recommendations and Appendix
3. USDA Dietary Patterns. The USDA Dietary Patterns
provide a framework to help older adults follow a healthy
dietary pattern and meet the Guidelines and their Key
Recommendations. The Patterns provide a variety of foodand beverage choices that allow individuals to customize
their choices within each food group based on lifestyle,traditions, culture, and/or other individual needs.

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A D ULTS AGES 6 0 AND O L DE R

Table 6-1

Healthy U.S.-Style Dietary Pattern for Adults Ages 60 andOlder, With Daily or Weekly Amounts From Food Groups,
Subgroups, and Components
CALORIE LEVEL OF PATTERNa

1,600

2,000

2,200

2,400

2,600

Daily Amount of Food From Each Group(Vegetable and protein foods subgroup amounts are per week.)

FOOD GROUP OR SUBGROUPb
Vegetables (cup eq/day)

1,800

2

2½

2½

3

3

3½

Vegetable Subgroups in Weekly Amounts
Dark-Green Vegetables (cup eq/wk)

1½

1½

1½

2

2

2½

Red & Orange Vegetables (cup eq/wk)

4

5½

5½

6

6

7

Beans, Peas, Lentils (cup eq/wk)

1

1½

1½

2

2

2½

Starchy Vegetables (cup eq/wk)

4

5

5

6

6

7

Other Vegetables (cup eq/wk)

3½

4

4

5

5

5½

Fruits (cup eq/day)

1½

1½

2

2

2

2

Grains (ounce eq/day)

5

6

6

7

8

9

Whole Grains (ounce eq/day)

3

3

3

3½

4

4½

Refined Grains (ounce eq/day)

2

3

3

3½

4

4½

Dairy (cup eq/day)

3

3

3

3

3

3

Protein Foods (ounce eq/day)

5

5

5½

6

6½

6½

Protein Foods Subgroups in Weekly Amounts
Meats, Poultry, Eggs (ounce eq/wk)

23

23

26

28

31

31

Seafood (ounce eq/wk)

8

8

9

9

10

10

Nuts, Seeds, Soy Products (ounce eq/wk)

4

4

5

5

5

5

Oils (grams/day)

22

24

27

29

31

34

Limit on Calories for Other Uses (kcal/day)c

100

140

240

250

320

350

Limit on Calories for Other Uses (%/day)

7%

8%

12%

12%

13%

5

a Calorie level ranges: Females: 1,600-2,200 calories; Males: 2,000-2,600 calories. Energy levels are calculated based on median height and bodyweight for healthy body mass index (BMI) reference individuals. For adults, the reference man is 5 feet 10 inches tall and weighs 154 pounds. The
reference woman is 5 feet 4 inches tall and weighs 126 pounds. Calorie needs vary based on many factors. The DRI Calculator for Healthcare
Professionals, available at nal.usda.gov/fnic/dri-calculator, can be used to estimate calorie needs based on age, sex, height, weight, and physicalactivity level.
b Definitions for each food group and subgroup and quantity (e.g., cup or ounce equivalents) are provided in Chapter 1 and are compiled inAppendix 3.

c All foods are assumed to be in nutrient-dense forms; lean or low-fat and prepared with minimal added sugars; refined starches, saturated fat, or

sodium. If all food choices to meet food group recommendations are in nutrient-dense forms, a small number of calories remain within the overall
limit of the pattern (i.e., limit on calories for other uses). The number of calories depends on the total calorie level of the pattern and the amounts
of food from each food group required to meet nutritional goals. Calories up to the specified limit can be used for added sugars, saturated fat,and/or alcohol, or to eat more than the recommended amount of food in a food group.
*NOTE: The total dietary pattern should not exceed Dietary Guidelines limits for added sugars, saturated fat, and alcohol; be within the Acceptable
Macronutrient Distribution Ranges for protein, carbohydrate, and total fats; and stay within calorie limits. Values are rounded. See Appendix 3 for
all calorie levels of the pattern.
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A D U LT S AG ES 6 0 A ND OLD ER

Current Intakes
Figures 6-1 and 6-2 highlight the dietary intakes of older adults, including the Healthy Eating Index-2015 score,
which is an overall measure of how intakes align with the Dietary Guidelines, as well as information on thecomponents of a healthy diet—specifically, the food groups. Figure 6-1 displays the average intakes of the foodgroups compared to the range of recommended intakes at the calorie levels most relevant to males and females
in this age group. Additionally, the percent of older adults exceeding the recommended limits for added sugars,
saturated fat, and sodium are shown, along with average intakes of these components.
Figure 6-1

Current Intakes: Ages 60 and Older
Healthy Eating Index Score(on a scale of 0-100)

Average Daily Food Group Intakes Compared to
Recommended Intake Ranges
Recommended Intake Ranges

Average Intakes

10

63

9

CUP or OZ EQUIVALENT

8
7
6
5
4
3
2
1
0

M

F
Total
Vegetables
cup eq/day

M

F
Total
Fruitscup eq/day

M

F
Total
Grainsoz eq/day

M

F
Total
Dairy
cup eq/day

M

F
Total
Protein Foods
oz eq/day

FOOD GROUPS

Percent Exceeding Limits of Added Sugars,
Saturated Fat, and Sodium
Added Sugars

54%

Within Recommended Limit

Saturated Fat

Limit: 10% of total energy

Males

Exceeding Limit

SodiumLimit: 10% of total energy

Females

58%

Average Intakes
Males
Females
247 kcal
213 kcal

Males

80

%

Limit: 2,300 mg

Females

77%

Average Intakes
Males
Females
269 kcal203 kcal

Males

94

%

Females72%

Average Intakes
Males
Females
3,799 mg
2,802 mg

Data Sources: Average Intakes and HEI-2015 Scores: Analysis of What We Eat in America, NHANES 2015-2016, day 1 dietary intake data,
weighted. Recommended Intake Ranges: Healthy U.S.-Style Dietary Patterns (see Appendix 3). Percent Exceeding Limits: What We Eat in America,
NHANES 2013-2016, 2 days dietary intake data, weighted.

Ages 60+

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A D ULTS AGES 6 0 AND O L DE R

Average intakes compared to recommended intake
ranges of the subgroups for grains are represented
in daily amounts; subgroups for vegetables andprotein foods are represented in weekly amounts in
Figure 6-2.

Figure 6-2
Average Intakes of Subgroups
Compared to Recommended Intake Ranges:
Ages 60 and Older
Recommended Intake Ranges
8

Average Intakes

Vegetables

CUP EQUIVALENT

7
6
5
4
3
2
1
0

10

M
F
M
F
DarkTotal
Vegetables Greencup eq/day

M
F
Red &
OrangeM
F
M
F
Beans,
StarchyPeas,
Lentils
cup eq/week

M
F
Other

GrainsDiet quality is highest among older adults
compared to other ages. Consistent with thegeneral U.S. population, however, this age group is
not meeting the recommendations for food group
and nutrient intakes and has a Healthy Eating
Index score of 63 out of 100. Older adults canimprove dietary intake by increasing consumptionof fruit, vegetables, whole grains, and dairy, while
ensuring protein intake meets recommendations.
Reducing intakes of added sugars, saturated fat,and sodium also will help older adults achieve
recommendations and manage and avoid chronic
conditions (Figure 6-1). Older adults shouldchoose nutrient-dense options within each foodgroup and consume appropriate portion sizes
because calorie needs decline with age.

9

OZ EQUIVALENT

8
7
6
5
4
3
2
1
0

M

Total
GrainsF

M
F
Whole Grains

M
F
Refined Grainsoz eq/day
40

Protein Foods

35
OZ EQUIVALENT

30
25
20
15
10
5
0

M

F
M
F
Total
Meats, Poultry,
Protein Foods
Eggs
oz eq/dayM
F
Seafood
oz eq/weekM
F
Nuts, Seeds,
Soy Products

Data Sources: Average Intakes: Analysis of What We Eat in America, NHANES 2015-2016, day 1 dietary intake data, weighted. Recommended
Intake Ranges: Healthy U.S.-Style Dietary Patterns (see Appendix 3).
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A D U LT S AG ES 6 0 A ND OLD ER

SpecialConsiderations
The nutrition considerations for the general U.S.
population described in Chapter 1. apply to older
adults. For example, the nutrients of public concern—
calcium, vitamin D, potassium, and dietary fiber—apply
to this age group as well. However, this age group also
has some special nutrition considerations that are
discussed in the following sections of this chapter. For
example, several additional nutrients are more likely to
be underconsumed during this life stage. These include
dietary protein and vitamin B12. Beverage intake,particularly as it relates to hydration status, also is anarea of special consideration.

ProteinConsuming enough protein is important to prevent theloss of lean muscle mass that occurs naturally withage. Monitoring protein intake is especially importantas older adults transition through this life stage. Intake
patterns show average intakes of protein foods islower for individuals ages 71 and older compared toadults ages 60 through 70. About 50 percent of womenand 30 percent of men 71 and older fall short of protein
foods recommendations.
The majority of protein in the Healthy U.S.-Style Dietary
Pattern is accounted for in the protein foods subgroups:
seafood; meats, poultry and eggs; nuts, seeds, andsoy products; and the vegetable subgroup of beans,peas, and lentils, which also is considered a protein
foods subgroup. The dairy and fortified soy alternatives
food group is another source of dietary protein.
Most older adults are meeting or exceeding weekly
recommendations for meats, poultry, and eggs, making

this subgroup a common source of protein foods forolder adults (Table 6-1). However, seafood, dairy andfortified soy alternatives, and beans, peas, and lentils areunderconsumed, yet provide important nutrients that
support healthy dietary patterns. For example, the dairy
food group provides calcium, vitamin D, and vitamin
B12 and the beans, peas, and lentils subgroup provides
dietary fiber. Many choices within the seafood subgroupalso provide vitamins D and B12 and calcium (if eatenwith bones), and beneficial fatty acids. Food sourcesof calcium, vitamin D, and dietary fiber are available at
DietaryGuidelines.gov.
Many older adults can improve their dietary pattern
and better meet nutrient needs by choosing froma wider variety of protein sources. In some cases,
this may mean using seafood more often in placeof meats, poultry, or eggs or using beans, peas, andlentils in mixed dishes, such as soups, rice, or pasta
dishes. For others, it may mean maintaining current
intakes of protein and finding enjoyable ways to add
protein foods from underconsumed food groups andsubgroups in order to ensure that overall protein needs
are met.

Vitamin B12

Vitamin B12 is of concern for some older adults because
the ability to absorb this nutrient can decrease withage and use of certain medications can decrease
absorption. Older adults are encouraged to meet therecommendations for protein foods, a common sourceof vitamin B12, and include foods fortified with vitamin
B12, such as breakfast cereals. Some individuals
also may require vitamin B12 dietary supplements.
Individuals are encouraged to speak with theirhealthcare provider to determine what, if any,
supplementation is appropriate.

Dietary Supplements

Many adults in the United States take one or more dietary supplements either as a pillor drink. Popular supplements include some nutrients that are underconsumed amongolder adults, including calcium and vitamins D and B12. All sources of a nutrient or foodcomponent—whether from food or a dietary supplement—should be considered whenassessing an individual’s dietary pattern, including any added sugars that may come fromsupplement drinks. Older adults should track and discuss all dietary supplement use with
their healthcare provider. Beverage supplements should not replace regular food intake
unless instructed by a health professional. The National Institutes of Health, Office ofDietary Supplements provides the My Dietary Supplement and Medicine Record1, to help
individuals track supplement and medicine use.
1 Available at: ods.od.nih.gov/pubs/DietarySupplementandMedicineRecord.pdf

Dietary Guidelines for Americans, 2020-2025 | Chapter 6: Older Adults | Page 128

A D ULTS AGES 6 0 AND O L DE R

Beverages

Many older adults do not drink enough fluids to stay
hydrated. One reason for this is that the sensation ofthirst tends to decline with age. Concerns about bladdercontrol or issues with mobility also may hinder intake of
fluids among older adults. Mean intakes of beverages
show adults ages 60 and older consume significantly
fewer fluid ounces across all beverage types comparedto adults ages 59 and under—about 2 fewer cups perday, most of which is due to drinking less water.
It is important that older adults drink plenty of waterto prevent dehydration and aid in the digestion offood and absorption of nutrients. In addition to water,choosing unsweetened beverages such as 100%
fruit or vegetable juice and low-fat or fat-free milkor fortified soy beverage can support fluid intake toprevent dehydration while helping to achieve food group
recommendations. The water that is contained in foods,
such as fruits, vegetables, and soups, contributes tohydration status and is a contributor to total fluid intake.
ALCOHOLIC BEVERAGESThe Dietary Guidelines do not recommend initiating
alcohol consumption for any reason. To help older
adults move toward a healthy dietary pattern andminimize risks associated with drinking, older adults
can choose not to drink or drink in moderation—limiting
intakes to 2 drinks or less in a day for men and 1 drinkor less in a day for women, when alcohol is consumed.
Older adults who choose to drink may experience theeffects of alcohol more quickly than they did when they
were younger. This puts older adults at higher risk offalls, car crashes, and other injuries that may result fromdrinking. In addition, older adults tend to have a greaternumber of comorbid health conditions than younger
adults, and alcohol use or misuse may adversely affectthe condition or interfere with management of thedisease. Certain older adults should avoid drinking
alcohol completely, including those who:
• Plan to drive or operate machinery, or participate inactivities that require skill, coordination, and alertness.
• Take certain over-the-counter orprescription medications.
• Have certain medical conditions.
• Are recovering from alcohol use disorder or are
unable to control the amount they drink.
• More information on alcoholic beverages and theirrelationship to health is provided in Chapter 1.

Supporting
Healthy Eating
Similar to other life stages, older adults can besupported by professionals, family, and friends toachieve a healthy dietary pattern that accounts forfactors such as cost, preferences, traditions, andaccess. Additional factors to consider when supporting
healthy eating for older adults include:• Enjoyment of food: Sharing meals with friends andfamily can help increase food enjoyment and promoteadequacy of dietary intake for older adults.
• Ability to chew or swallow foods: Experimenting withthe preparation of foods from all food groups canhelp identify textures that are acceptable, appealing,and enjoyable for adults who have difficulties chewing
or swallowing. Good dental health is critical to overall
health, as well as the ability to chew foods properly.
• Food safety: Practicing safe food handlingprocedures is of particular importance for older
adults due to a decline in immune system functionthat accompanies age and that increases the risk of
foodborne illness. For more information: Foodsafety.
gov for older adults: foodsafety.gov/people-atrisk/older-adults or FDA: fda.gov/media/83744/
download.
Older adults have access to a variety of Government
resources to support a healthy dietary pattern as partof overall healthy aging. Professionals working witholder Americans can use these resources to bettersupport access to healthy, safe, and affordable
food choices.
• Congregate Nutrition Services: The Older Americans
Act authorizes meals and related services incongregate settings for any person age 60 and older
and their spouse of any age. Program sites offer
older individuals healthy meals and opportunities tosocialize. Congregate meals are typically provided
in senior centers, schools, churches, or othercommunity settings.
• Supplemental Nutrition Assistance Program(SNAP): Older adults with limited income may qualify
for SNAP, a Federal program that provides temporary
benefits to help individuals purchase foods andbeverages to support a healthy dietary pattern whenresources are constrained.

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A D U LT S AG ES 6 0 A ND OLD ER

Physical Activity and Older Adults

The benefits of regular physical activity occur throughout life and are essential for healthy
aging. It is never too late to start being physically active. For older adults, regular physicalactivity supports a number of additional health benefits including improved cognition,balance, and bone strength. These benefits make it easier to perform activities of daily living,
preserves function and mobility, and lowers the risk of falls and injuries from falls.
Adults should move more and sit less throughout the day. Some physical activity is better
than none. To attain the most health benefits from physical activity, older adults need at least
150 to 300 minutes of moderate-intensity aerobic activity per week. The talk test is a good way
to assess moderate intensity for older adults. A person doing moderate-intensity aerobic activity can talk, but not
sing. Older adults also need muscle-strengthening activity at least 2 days each week. Older adults should incorporate
multicomponent physical activity that includes balance training as well as aerobic and muscle-strengthening activities.
The U.S. Department of Health and Human Service’s Physical Activity Guidelines for Americans and the relatedMove Your Way® resources have information about the benefits of physical activity and tips to get started. Available
at health.gov/paguidelines.

• Commodity Supplemental Food Program (CSFP):The CSFP supplements the diets of low-income older
adults by providing nutritious USDA packaged foodto support a healthy dietary pattern. The CSFP isfederally funded, and private and nonprofit institutions
facilitate the distribution of monthly CSFP packages
to eligible older adults.
• Home-Delivered Nutrition Services: The Older
Americans Act authorizes meals and related services
in a person’s home for individuals ages 60 andolder and their spouse of any age. Older adults who
experience difficulty leaving the home due to frailty,
health concerns, or certain medical conditions may
benefit from home-delivered meals offered under theOlder Americans Act.
• Child and Adult Care Food Program (CACFP):The CACFP is a Federal program that provides
reimbursements for nutritious meals and snacks
to older adults enrolled in daycare facilities. Olderadults receiving care at nonresidential care centers
may receive meals and snacks that meet nutrition
standards of the CACFP.
Additional resources to support older adults exist at
the community level. For example, the Senior Farmers
Market Nutrition Program (SFMNP) provides many
low-income seniors with access to fruits and vegetables
grown in their local communities. SNAP Education(SNAP-Ed) programming may also be offered andteach older adults cooking and shopping skills.
Individuals working within these settings must ensure
the availability of nutrient-dense foods and assist older
adults in choosing a healthy dietary pattern that fits intheir cultural and food preferences.

Healthy Eating
Through the LifespanThis chapter has focused on the unique nutritional
considerations of the older adult life stage. It also has
reinforced the idea that the core elements of a healthy
dietary pattern are remarkably consistent across thelifespan and across health outcomes. More than that, a
healthy dietary pattern is flexible—people can customize
the Dietary Guidelines recommendations to suit theirpersonal preferences, cultural traditions, and budget
considerations.
Beginning at the earliest life stage—infancy andtoddlerhood—a healthy dietary pattern can help people
achieve and maintain good health and reduce the riskof chronic diseases. However, it is never too late to
make improvements. People at any stage of life canbenefit by changing to nutrient-dense forms of foods
and beverages across all food groups, in recommended
amounts, and within calorie limits. The bottom line:
For lifelong good health, make every bite count with
the Dietary Guidelines for Americans!

Dietary Guidelines for Americans, 2020-2025 | Chapter 6: Older Adults | Page 130

Appendix 1:
Nutritional Goals for Age-Sex GroupsaTable A1-1
Daily Nutritional Goals, Ages 6 Through 11 Months and 12 Through 23 Months
Nutrient

6 Through 11 Months

12 Through 23 Months

Goal

Source of Goalb

Goal

Source of Goalb

Protein (g)

11

RDA

13

RDA

Carbohydrate (g)

95

AI

130

RDA

Fiber, total dietary (g)

n/ad

n/ad

19

AI

Total lipid (% kcal)

n/ad

n/ad

30-40

AMDR

18:2 Linoleic acid (g)

4.6

AI

7

AI

18:3 Linolenic acid (g)

0.5

AI

0.7

AI

Calcium (mg)

260

AI

700

RDA

Iron (mg)

11

RDA

7

RDA

Magnesium (mg)

75

AI

80

RDA

Phosphorus (mg)

275

AI

460

RDA

Potassium (mg)

860

AI

2,000

AI

Sodium (mg)

370

AI

1,200

CDRR

Zinc (mg)

3

RDA

3

RDA

Vitamin A (mcg RAEc)

500

AI

300

RDA

Vitamin E (mg ATc)

5

AI

6

RDA

Vitamin D (IUc)

400

AI

600

RDA

Vitamin C (mg)

50

AI

15

RDA

Thiamin (mg)

0.3

AI

0.5

RDA

Riboflavin (mg)

0.4

AI

0.5

RDA

Niacin (mg)

4

AI

6

RDA

MacronutrientsMinerals

Vitamins

Page 131 | Dietary Guidelines for Americans, 2020-2025 | Appendix 1

Table A1-1 (continued)
Daily Nutritional Goals, Ages 6 Through 11 Months and 12 Through 23 Months
Nutrient

6 Through 11 Months

12 Through 23 Months

Goal

Source of Goalb

Goal

Source of Goalb

Vitamin B-6 (mg)

0.3

AI

0.5

RDA

Vitamin B-12 (mcg)

0.5

AI

0.9

RDA

Choline (mg)

150

AI

200

AI

Vitamin K (mcg)

2.5

AI

30

AI

Folate (mcg DFEc)

80

AI

150

RDA

a Goals reflect Dietary Reference Intakes developed for 7 to 12 months or 6 to 12 months applied to ages 6 to 12 months and DRIs for 1 to 3 years

applied to 12 to 24 months.

b AI = Adequate Intake, CDRR = Chronic Disease Risk Reduction Level, RDA = Recommended Dietary Allowance.
c AT = alpha-tocopherol, DFE = Dietary Folate Equivalent, IU = International Units, RAE = Retinol Activity Equivalents.
d n/a = not applicable to this age group.

Sources: Institute of Medicine. Dietary Reference Intakes: The Essential Guide to Nutrient Requirements. Washington, DC: The National Academies
Press; 2006. Institute of Medicine. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: The National Academies Press; 2011.
National Academies of Sciences, Engineering, and Medicine. Dietary Reference Intakes for Sodium and Potassium. Washington, DC: The National
Academies Press; 2019.

Dietary Guidelines for Americans, 2020-2025 | Appendix 1 | Page 132

Table A1-2
Daily Nutritional Goals, Ages 2 and Older
MACRONUTRIENTS,
MINERALS & VITAMINSAge-Sex Groups
M/F
2-3

F
4-8

F
9-13

F
14-18

F
19-30

F
31-50

F
51+

M
4-8

M
9-13

M
14-18

M
19-30

M
31-50

M
51+

Sourceof Goala

1,000

1,200

1,600

1,800

2,000

1,800

1,600

1,400

1,800

2,200

2,400

2,200

2,000

Protein(% kcal)

AMDR

5-20

10-30

10-30

10-30

10-35

10-35

10-35

10-30

10-30

10-30

10-35

10-35

10-35

Protein (g)

RDA

13

19

34

46

46

46

46

19

34

52

56

56

56

Carbohydrate(% kcal)

AMDR

45-65

45-65

45-65

45-65

45-65

45-65

45-65

45-65

45-65

45-65

45-65

45-65

45-65

Carbohydrate
(g)

RDA

130

130

130

130

130

130

130

130

130

130

130

130

130

Fiber (g)

14g/
1,000
kcal

14

17

22

25

28

25

22

20

25

31

34

31

28

Added Sugars(% kcal)

DGA

<10

<10

<10

<10

<10

<10

<10

<10

<10

<10

<10

<10

<10

Total lipid(% kcal)

AMDR

30-40

25-35

25-35

25-35

20-35

20-35

20-35

25-35

25-35

25-35

20-35

20-35

20-35

Saturated
Fatty Acids(% kcal)

DGA

<10

<10

<10

<10

<10

<10

<10

<10

<10

<10

<10

<10

<10

18:2
Linoleic acid (g)

AI

7

10

10

11

12

12

11

10

12

16

17

17

14

18:3
Linoleic acid (g)

AI

0.7

0.9

1.0

1.1

1.1

1.1

1.1

0.9

1.2

1.6

1.6

1.6

1.6

Calcium (mg)

RDA

700

1,000

1,300

1,300

1,000

1,000

1,200

1,000

1,300

1,300

1,000

1,000

1,000bIron (mg)

RDA

7

10

8

15

18

18

8

10

8

11

8

8

8

Magnesium
(mg)

RDA

80

130

240

360

310

320

320

130

240

410

400

420

420

Phosphorus
(mg)

RDA

460

500

1,250

1,250

700

700

700

500

1,250

1,250

700

700

700

Potassium (mg)

AI

2,000

2,300

2,300

2,300

2,600

2,600

2,600

2,300

2,500

3,000

3,400

3,400

3,400

Sodium (mg)

CDRR

1,200

1,500

1,800

2,300

2,300

2,300

2,300

1,500

1,800

2,300

2,300

2,300

2,300

Zinc (mg)

RDA

3

5

8

9

8

8

8

5

8

11

11

11

11

Calorie Level
Assessed
MacronutrientsMinerals

Page 133 | Dietary Guidelines for Americans, 2020-2025 | Appendix 1

Table A1-2 (continued)
Daily Nutritional Goals, Ages 2 and Older
MACRONUTRIENTS,
MINERALS & VITAMINSAge-Sex Groups
M/F
2-3

F
4-8

F
9-13

F
14-18

F
19-30

F
31-50

F
51+

M
4-8

M
9-13

M
14-18

M
19-30

M
31-50

M
51+

Sourceof Goala

1,000

1,200

1,600

1,800

2,000

1,800

1,600

1,400

1,800

2,200

2,400

2,200

2,000

Vitamin A(mcg RAEd)

RDA

300

400

600

700

700

700

700

400

600

900

900

900

900

Vitamin E(mg ATd)

RDA

6

7

11

15

15

15

15

7

11

15

15

15

15

Vitamin D (IUd)

RDA

600

600

600

600

600

600

600c

600

600

600

600

600

600c

Vitamin C (mg)

RDA

15

25

45

65

75

75

75

25

45

75

90

90

90

Thiamin (mg)

RDA

0.5

0.6

0.9

1.0

1.1

1.1

1.1

0.6

0.9

1.2

1.2

1.2

1.2

Riboflavin (mg)

RDA

0.5

0.6

0.9

1.0

1.1

1.1

1.1

0.6

0.9

1.3

1.3

1.3

1.3

Niacin (mg)

RDA

6

8

12

14

14

14

14

8

12

16

16

16

16

Vitamin B-6
(mg)

RDA

0.5

0.6

1.0

1.2

1.3

1.3

1.5

0.6

1.0

1.3

1.3

1.3

1.7

Vitamin B-12
(mcg)

RDA

0.9

1.2

1.8

2.4

2.4

2.4

2.4

1.2

1.8

2.4

2.4

2.4

2.4

Choline (mg)

AI

200

250

375

400

425

425

425

250

375

550

550

550

550

Vitamin K
(mcg)

AI

30

55

60

75

90

90

90

55

60

75

120

120

120

Folate(mcg DFEd)

RDA

150

200

300

400

400

400

400

200

300

400

400

400

400

Calorie Level
Assessed
Vitamins

a AI = Adequate Intake, CDRR = Chronic Disease Risk Reduction Level, DGA = Dietary Guidelines for Americans, 2020-2025 , RDA = Recommended

Dietary Allowance.

b Calcium RDA for males ages 71+ years is 1,200 mg.
c Vitamin D RDA for males and females ages 71+ years is 800 IU.
d AT = alpha-tocopherol, DFE = Dietary Folate Equivalent, IU = International Units, RAE = Retinol Activity Equivalents.

Sources: Institute of Medicine. Dietary Reference Intakes: The Essential Guide to Nutrient Requirements. Washington, DC: The National Academies
Press; 2006. Institute of Medicine. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: The National Academies Press; 2011.
National Academies of Sciences, Engineering, and Medicine. Dietary Reference Intakes for Sodium and Potassium. Washington, DC: The National
Academies Press; 2019.

Dietary Guidelines for Americans, 2020-2025 | Appendix 1 | Page 134

Table A1-3
Daily Nutritional Goals for Women Who Are Pregnant, by Age Group and Trimester
Age Group (Years)
14-18

MACRONUTRIENTS,
MINERALS & VITAMINS

19-30

31-50

Trimester
1st

2nd

3rd

1st

2nd

3rd

1st

2nd

3rd

Source of Goala

1,800

2,200

2,400

2,000

2,400

2,600

1,800

2,200

2,400

Protein (% kcal)

AMDR

10-30

10-30

10-30

10-35

10-35

10-35

10-35

10-35

10-35

Protein (g)

RDA

71

71

71

71

71

71

71

71

71

Carbohydrate (%kcal)

AMDR

45-65

45-65

45-65

45-65

45-65

45-65

45-65

45-65

45-65

Carbohydrate (g)

RDA

175

175

175

175

175

175

175

175

175

14g/ 1,000 kcal

25

31

34

28

34

36

25

31

34

Added Sugars (% kcal)

DGA

<10

<10

<10

<10

<10

<10

<10

<10

<10

Total lipid (% kcal)

AMDR

25-35

25-35

25-35

20-35

20-35

20-35

20-35

20-35

20-35

Saturated Fatty Acids(% kcal)

DGA

<10

<10

<10

<10

<10

<10

<10

<10

<10

18:2 Linoleic acid (g)

AI

13

13

13

13

13

13

13

13

13

18:3 Linolenic acid (g)

AI

1.4

1.4

1.4

1.4

1.4

1.4

1.4

1.4

1.4

Calcium (mg)

RDA

1,300

1,300

1,300

1,000

1,000

1,000

1,000

1,000

1,000

Iron (mg)

RDA

27

27

27

27

27

27

27

27

27

Magnesium (mg)

RDA

400

400

400

350

350

350

360

360

360

Phosphorus (mg)

RDA

1,250

1,250

1,250

700

700

700

700

700

700

Potassium (mg)

AI

2,600

2,600

2,600

2,900

2,900

2,900

2,900

2,900

2,900

Sodium (mg)

CDRR

2,300

2,300

2,300

2,300

2,300

2,300

2,300

2,300

2,300

Zinc (mg)

RDA

12

12

12

11

11

11

11

11

11

Iodine (mcg)

RDA

220

220

220

220

220

220

220

220

220

Vitamin A (mcg RAEb)

RDA

750

750

750

770

770

770

770

770

770

Vitamin E (mg ATb)

RDA

15

15

15

15

15

15

15

15

15

Vitamin D (IUb)

RDA

600

600

600

600

600

600

600

600

600

Calorie Level Assessed
Macronutrients

Fiber (g)Minerals

Vitamins

Page 135 | Dietary Guidelines for Americans, 2020-2025 | Appendix 1

Table A1-3 (continued)
Daily Nutritional Goals for Women Who Are Pregnant, by Age Group and Trimester
Age Group (Years)
14-18

MACRONUTRIENTS,
MINERALS & VITAMINS

19-30

31-50

Trimester
1st

2nd

3rd

1st

2nd

3rd

1st

2nd

3rd

Source of Goala

1,800

2,200

2,400

2,000

2,400

2,600

1,800

2,200

2,400

Vitamin C (mg)

RDA

80

80

80

85

85

85

85

85

85

Thiamin (mg)

RDA

1.4

1.4

1.4

1.4

1.4

1.4

1.4

1.4

1.4

Riboflavin (mg)

RDA

1.4

1.4

1.4

1.4

1.4

1.4

1.4

1.4

1.4

Niacin (mg)

RDA

18

18

18

18

18

18

18

18

18

Vitamin B-6 (mg)

RDA

1.9

1.9

1.9

1.9

1.9

1.9

1.9

1.9

1.9

Vitamin B-12 (mcg)

RDA

2.6

2.6

2.6

2.6

2.6

2.6

2.6

2.6

2.6

Choline (mg)

AI

450

450

450

450

450

450

450

450

450

Vitamin K (mcg)

AI

75

75

75

90

90

90

90

90

90

Folate (mcg DFEb)

RDA

600

600

600

600

600

600

600

600

600

Calorie Level Assessed
Vitamins

a AI = Adequate Intake, CDRR = Chronic Disease Risk Reduction Level, DGA = Dietary Guidelines for Americans, 2020-2025 , RDA = Recommended

Dietary Allowance.

b AT = alpha-tocopherol, DFE = Dietary Folate Equivalent, IU= International Units, RAE = Retinol Activity Equivalents.

Sources: Institute of Medicine. Dietary Reference Intakes: The Essential Guide to Nutrient Requirements. Washington, DC: The National Academies
Press; 2006. Institute of Medicine. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: The National Academies Press; 2011.
National Academies of Sciences, Engineering, and Medicine. Dietary Reference Intakes for Sodium and Potassium. Washington, DC: The National
Academies Press; 2019.

Dietary Guidelines for Americans, 2020-2025 | Appendix 1 | Page 136

Table A1-4
Daily Nutritional Goals for Women Who Are Lactating, by Age Group and Months Postpartum
Age Group (Years)
14-18

MACRONUTRIENTS,
MINERALS & VITAMINS

19-30

31-50

Months Postpartum
0-6

7-12

0-6

7-12

0-6

7-12

Source of
Goala

2,200

2,200

2,400

2,400

2,200

2,200

Protein (% kcal)

AMDR

10-30

10-30

10-35

10-35

10-35

10-35

Protein (g)

RDA

71

71

71

71

71

71

Carbohydrate (% kcal)

AMDR

45-65

45-65

45-65

45-65

45-65

45-65

Carbohydrate (g)

RDA

210

210

210

210

210

210

14g/1,000kcal

31

31

34

34

31

31

Added sugars (% kcals)

DGA

<10

<10

<10

<10

<10

<10

Total lipid (% kcal)

AMDR

25-35

25-35

20-35

20-35

20-35

20-35

Saturated Fatty Acids (% kcal)

DGA

<10

<10

<10

<10

<10

<10

18:2 Linoleic acid (g)

AI

13

13

13

13

13

13

18:3 Linolenic acid (g)

AI

1.3

1.3

1.3

1.3

1.3

1.3

Calcium (mg)

RDA

1,300

1,300

1,000

1,000

1,000

1,000

Iron (mg)

RDA

10

10

9

9

9

9

Magnesium (mg)

RDA

360

360

310

310

320

320

Phosphorus (mg)

RDA

1,250

1,250

700

700

700

700

Potassium (mg)

AI

2,500

2,500

2,800

2,800

2,800

2,800

Sodium (mg)

CDRR

2,300

2,300

2,300

2,300

2,300

2,300

Zinc (mg)

RDA

13

13

12

12

12

12

Iodine (mcg)

RDA

290

290

290

290

290

290

Calorie Level Assessed
Macronutrients

Fiber (g)Minerals

Page 137 | Dietary Guidelines for Americans, 2020-2025 | Appendix 1

Table A1-4 (continued)
Daily Nutritional Goals for Women Who Are Lactating, by Age Group and Months Postpartum
Age Group (Years)
14-18

MACRONUTRIENTS,
MINERALS & VITAMINS

19-30

31-50

Months Postpartum
0-6

7-12

0-6

7-12

0-6

7-12

Source of
Goala

2,200

2,200

2,400

2,400

2,200

2,200

Vitamin A (mcg RAEb)

RDA

1,200

1,200

1,300

1,300

1,300

1,300

Vitamin E (mg ATb)

RDA

19

19

19

19

19

19

Vitamin D (IUb)

RDA

600

600

600

600

600

600

Vitamin C (mg)

RDA

115

115

120

120

120

120

Thiamin (mg)

RDA

1.4

1.4

1.4

1.4

1.4

1.4

Riboflavin (mg)

RDA

1.6

1.6

1.6

1.6

1.6

1.6

Niacin (mg)

RDA

17

17

17

17

17

17

Vitamin B-6 (mg)

RDA

2

2

2

2

2

2

Vitamin B-12 (mcg)

RDA

2.8

2.8

2.8

2.8

2.8

2.8

Choline (mg)

AI

550

550

550

550

550

550

Vitamin K (mcg)

AI

75

75

90

90

90

90

Folate (mcg DFEb)

RDA

500

500

500

500

500

500

Calorie Level Assessed
Vitamins

a AI = Adequate Intake, CDRR = Chronic Disease Risk Reduction Level, DGA = Dietary Guidelines for Americans, 2020-2025 , RDA = Recommended

Dietary Allowance.

b AT = alpha-tocopherol, DFE = Dietary Folate Equivalent, IU= International Units, RAE = Retinal Activity Equivalents.

Sources: Institute of Medicine. Dietary Reference Intakes: The Essential Guide to Nutrient Requirements. Washington, DC: The National Academies
Press; 2006. Institute of Medicine. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: The National Academies Press; 2011.
National Academies of Sciences, Engineering, and Medicine. Dietary Reference Intakes for Sodium and Potassium. Washington, DC: The National
Academies Press; 2019.

Dietary Guidelines for Americans, 2020-2025 | Appendix 1 | Page 138

Appendix 2:
Estimated Calorie Needs
The total number of calories a person needs each day varies depending on the person’s age, sex, height, weight,
and level of physical activity. In addition, a need to lose, maintain, or gain weight, and other factors affect how many
calories should be consumed. Estimated amounts of calories needed to maintain energy balance for various age
and sex groups at three different levels of physical activity are provided in Table A2-1 for toddlers ages 12 through23 months and Table A2-2 for ages 2 and older. These estimates are based on the Estimated Energy Requirements(EER) equations, using reference heights (average) and reference weights (healthy) for each age-sex group. For
toddlers, children, and adolescents, reference height and weight vary by age. For adults, the reference man is 5 feet
10 inches tall and weighs 154 pounds. The reference woman is 5 feet 4 inches tall and weighs 126 pounds.
Estimates range from 700 to 1,000 calories for toddlers ages 12 through 23 months. Estimated needs for young
children ages 2 through 8 range from 1,000 to 2,000 calories. A wider range of 1,400 to 3,200 calories is estimatedfor older children and adolescents, with males generally having higher calorie needs than females.
Adult estimated calorie needs range from 1,600 to 2,400 calories per day for females and 2,000 to 3,000 calories per
day for males. As shown, males generally require more calories than females. Due to reductions in basal metabolic
rate that occur with aging, calorie needs generally decrease for adults as they age.
Estimated calorie needs during the first trimester of pregnancy generally do not increase compared to prepregnancy
needs. Additional calories needed for the later trimesters of pregnancy and during lactation are outlined in Table
A2-3 and include approximately 300 to 400 additional calories. It is recommended that women follow theirhealthcare provider’s guidance regarding appropriate caloric intake during pregnancy as many factors, including
prepregnancy weight status, gestational weight gain, and multiple pregnancies, may affect calorie needs. Women
with overweight or obesity have lower recommended gestational weight gain during pregnancy, which may affectcalorie needs.
These calorie needs are only estimates, and approximations of individual calorie needs can be determinedwith online tools. The DRI Calculator for Healthcare Professionals, available at nal.usda.gov/fnic/dri-calculator, canbe used to estimate calorie needs based on age, sex, height, weight, activity level, and pregnancy or lactation status.

Table A2-1
Estimated Calorie Needs per Day, by Age and Sex, Ages 12 Through 23 Months
AGE IN MONTHS

Males

Females

12

800

800

15

900

800

18

1,000

900

21 through 23

1,000

1,000

Source: Institute of Medicine. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids.
Washington (DC): The National Academies Press; 2002.

Page 139 | Dietary Guidelines for Americans, 2020-2025 | Appendix 2

Table A2-2
Estimated Calorie Needs per Day, by Age, Sex, and Physical Activity Level, Ages 2 and Older
Females

Males
AGE
Sedentary

Moderatelyb
ActiveActiveSedentary

Moderatelyb
ActiveActive

2

1,000

1,000

1,000

1,000

1,000

1,000

3

1,000

1,400

1,400

1,000

1,200

1,400

4

1,200

1,400

1,600

1,200

1,400

1,400

5

1,200

1,400

1,600

1,200

1,400

1,600

6

1,400

1,600

1,800

1,200

1,400

1,600

7

1,400

1,600

1,800

1,200

1,600

1,800

8

1,400

1,600

2,000

1,400

1,600

1,800

9

1,600

1,800

2,000

1,400

1,600

1,800

10

1,600

1,800

2,200

1,400

1,800

2,000

11

1,800

2,000

2,200

1,600

1,800

2,000

12

1,800

2,200

2,400

1,600

2,000

2,200

13

2,000

2,200

2,600

1,600

2,000

2,200

14

2,000

2,400

2,800

1,800

2,000

2,400

15

2,200

2,600

3,000

1,800

2,000

2,400

16

2,400

2,800

3,200

1,800

2,000

2,400

17

2,400

2,800

3,200

1,800

2,000

2,400

18

2,400

2,800

3,200

1,800

2,000

2,400

19-20

2,600

2,800

3,000

2,000

2,200

2,400

21-25

2,400

2,800

3,000

2,000

2,200

2,400

26-30

2,400

2,600

3,000

1,800

2,000

2,400

31-35

2,400

2,600

3,000

1,800

2,000

2,200

36-40

2,400

2,600

2,800

1,800

2,000

2,200

41-45

2,200

2,600

2,800

1,800

2,000

2,200

46-50

2,200

2,400

2,800

1,800

2,000

2,200

51-55

2,200

2,400

2,800

1,600

1,800

2,200

56-60

2,200

2,400

2,600

1,600

1,800

2,200

a

c

a

c

Dietary Guidelines for Americans, 2020-2025 | Appendix 2 | Page 140

Table A2-2 (continued)
Estimated Calorie Needs per Day, by Age, Sex, and Physical Activity Level, Ages 2 and Older
Females

Males
AGE
Sedentary

Moderatelyb
ActiveActiveSedentary

Moderatelyb
ActiveActive

61-65

2,000

2,400

2,600

1,600

1,800

2,000

66-70

2,000

2,200

2,600

1,600

1,800

2,000

71-75

2,000

2,200

2,600

1,600

1,800

2,000

76 and up

2,000

2,200

2,400

1,600

1,800

2,000

a

c

a

c

a Sedentary means a lifestyle that includes only the physical activity of independent living.
b Moderately Active means a lifestyle that includes physical activity equivalent to walking about 1.5 to 3 miles per day at 3 to 4 miles per hour, in

addition to the activities of independent living.

c Active means a lifestyle that includes physical activity equivalent to walking more than 3 miles per day at 3 to 4 miles per hour, in addition to theactivities of independent living.

Source: Institute of Medicine. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids.
Washington (DC): The National Academies Press; 2002.

Table A2-3
Estimated Change in Calorie Needs During Pregnancy and Lactation for
Women With a Healthya Prepregnancy Weight
STAGE OF PREGNANCY OR LACTATION

Estimated Change in Daily Calorie Needs
Compared to Prepregnancy Needs

Pregnancy: 1st trimester+ 0 calories

Pregnancy: 2nd trimester+ 340 calories

Pregnancy: 3rd trimester+ 452 calories

Lactation: 1st 6 months+ 330 caloriesb

Lactation: 2nd 6 months+ 400 caloriesc

a These estimates apply to women with a healthy prepregnancy weight. Women with a prepregnancy weight that is considered overweight orobese should consult their healthcare provider for guidance regarding appropriate caloric intake during pregnancy and lactation.

b The EER for the first 6 months of lactation is calculated by adding 500 calories/day to prepregnancy needs to account for the energy needed formilk production during this time period, then subtracting 170 calories/day to account for weight loss in the first 6 months postpartum.

c The EER for the second 6 months of lactation is calculated by adding 400 calories/day to prepregnancy needs to account for the energy needed

for milk production during this time period. Weight stability is assumed after 6 months postpartum.

Note: Estimates are based on Estimated Energy Requirements (EER) set by the Institute of Medicine. Source: Institute of Medicine. Dietary
Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. Washington, DC: The National Academies
Press; 2005.

Page 141 | Dietary Guidelines for Americans, 2020-2025 | Appendix 2

Appendix 3:
USDA Dietary Patterns
The Healthy U.S.-Style Dietary Pattern (Tables A3-1 and A3-2) is based on the types and proportions of foods
Americans typically consume but in nutrient-dense forms and appropriate amounts. The Healthy Vegetarian Dietary
Pattern (Tables A3-3 and A3-4) and the Healthy Mediterranean-Style Dietary Pattern (Table A3-5) are variations
that also exemplify a healthy dietary pattern. For the first time, the Healthy U.S.-Style and Healthy Vegetarian Dietary
Patterns are provided for toddlers ages 12 through 23 months who are no longer receiving human milk or infant
formula. These patterns are designed to meet nutrient needs while not exceeding calorie requirements and whilestaying within limits for overconsumed dietary components, such as added sugars, saturated fat, and sodium.
The methodology used to develop and update these Patterns builds on the rich history USDA has in developing foodguides. This methodology includes using current food consumption data to determine the mix and proportions offoods to include in each group. Food composition data is used to select a nutrient-dense representative for eachfood and calculate nutrient profiles for each food group. As would be expected, most foods in their nutrient-dense
forms do contain some sodium and saturated fat. In a few cases, such as in the case of whole-wheat bread, themost appropriate representative in current Federal databases contains a small amount of added sugars. Detailed
information about the representative foods, nutrient profiles, and patterns is available in the online appendix of the
Scientific Report of the 2020 Dietary Guidelines Advisory Committee.1
Amounts of each food group and subgroup within the patterns are based on nutrient and Dietary Guidelines
standards (see Appendix 1. Nutritional Goals for Age-Sex Groups). Standards for nutrient adequacy aim to meet the
Recommended Dietary Allowances (RDA), which are designed to cover the needs of 97 percent of the population,
and Adequate Intakes (AI), which are used when an average nutrient requirement cannot be determined. The
Patterns meet these standards for almost all nutrients. For a few nutrients (vitamin D and vitamin E for all ages, andcholine for ages 2 and older), amounts in the Patterns are marginal or below the RDA or AI standard for many or all
age/sex groups. In most cases, an intake of these nutrients below the RDA or AI is not considered to be of publichealth concern. For more information on dietary components of public health concern, see Chapter 1.
The Patterns have 12 calorie levels to meet the needs of individuals across the lifespan ages 2 and older. For
toddlers ages 12 through 23 months, who are no longer receiving either human milk or infant formula, the Patterns
are provided at 4 calorie levels. Chapters 2, 3, 4, 5, and 6 describe healthy dietary patterns and relevant calorie levels
for each life stage. To follow these Patterns, identify the appropriate calorie level, choose a variety of foods in eachgroup and subgroup over time in recommended amounts, and limit choices that are not in nutrient-dense forms sothat the overall calorie limit is not exceeded.

1Available at: dietaryguidelines.gov/2020-advisory-committee-report/food-pattern-modeling

Dietary Guidelines for Americans, 2020-2025 | Appendix 3 | Page 142

Table A3-1
Healthy U.S.-Style Dietary Pattern for Toddlers Ages 12 Through 23 Months Who Are No Longer
Receiving Human Milk or Infant Formula, With Daily or Weekly Amounts From Food Groups, Subgroups,
and Components
CALORIE LEVEL OFPATTERNa

700

900

1,000

Daily Amount of Food From Each Groupd(Vegetable and protein foods subgroup amounts are per week.)

FOOD GROUP OR SUBGROUPb,cVegetables (cup eq/day)

800

⅔

¾

1

1

Vegetable Subgroups in Weekly Amounts
Dark-Green Vegetables(cup eq/wk)

1

⅓

½

½

Red and Orange Vegetables(cup eq/wk)

1

1¾

2½

2½

Beans, Peas, Lentils(cup eq/wk)

¾

⅓

½

½

Starchy Vegetables(cup eq/wk)

1

1½

2

2

Other Vegetables (cup eq/wk)

¾

1¼

1½

1½

Fruits (cup eq/day)

½

¾

1

1

Grains (ounce eq/day)

1¾

2¼

2½

3

Whole Grains (ounce eq/day)

1½

2

2

2

Refined Grains (ounce eq/day)

¼

¼

½

1

Dairy (cup eq/day)

1⅔

1¾

2

2

Protein Foods (ounce eq/day)

2

2

2

2

Protein Foods Subgroups in Weekly Amounts
Meats, Poultry(ounce eq/wk)

8¾

7

7

7¾

Eggs (ounce eq/wk)

2

2¾

2¼

2¼

Seafood (ounce eq/wk)e

2-3

2-3

2-3

2-3

Nuts, Seeds, Soy Products(ounce eq/wk)

1

1

1¼

1¼

9

9

8

13

Oils (grams/day)a Calorie level ranges: Energy levels are calculated based on medianlength and body weight reference individuals. Calorie needs vary basedon many factors. The DRI Calculator for Healthcare Professionals
available at nal.usda.gov/fnic/dri-calculator/ can be used to estimate
calorie needs based on age, sex, and weight.

b Definitions for each food group and subgroup and quantity (i.e., cup orounce equivalents) are provided in Chapter 1 and are compiled in Table
A3-2 (footnote c).
c All foods are assumed to be in nutrient-dense forms and prepared withminimal added sugars, refined starches (which are a source of calories
but few or no other nutrients), or sodium. Food are also lean or in low-fat
forms with the exception of dairy, which includes whole-fat fluid milk,
reduced-fat plain yogurts, and reduced-fat cheese. There are no calories

Page 143 | Dietary Guidelines for Americans, 2020-2025 | Appendix 3

available for additional added sugars, saturated fat, or to eat more than
the recommended amount of food in a food group.
d In some cases, food subgroup amounts are greatest at the lower
calorie levels to help achieve nutrient adequacy when relatively small
number of calories are required.
e If consuming up to 2 ounces of seafood per week, children should
only be fed cooked varieties from the “Best Choices” list in the U.S. Foodand Drug Administration (FDA) and the U.S. Environmental Protection
Agency (EPA) joint “Advice About Eating Fish,” available at FDA.gov/
fishadvice and EPA.gov/fishadvice. If consuming up to 3 ounces of
seafood per week, children should only be fed cooked varieties from the“Best Choices” list that contain even lower methylmercury: flatfish (e.g.,
flounder), salmon, tilapia, shrimp, catfish, crab, trout, haddock, oysters,

Table A3-1 Footnotes (continued)
sardines, squid, pollock, anchovies, crawfish, mullet, scallops, whiting, clams, shad, and Atlantic mackerel. If consuming up to 3 ounces of seafood
per week, many commonly consumed varieties of seafood should be avoided because they cannot be consumed at 3 ounces per week by children
without the potential of exceeding safe methylmercury limits; examples that should not be consumed include: canned light tuna or white (albacore)tuna, cod, perch, black sea bass. For a complete list please see: FDA.gov/fishadvice and EPA.gov/fishadvice.

Table A3-2
Healthy U.S.-Style Dietary Pattern for Ages 2 and Older, With Daily or Weekly Amounts From Food Groups,
Subgroups, and Components
CALORIE LEVEL OFPATTERNa

1,000

1,200

1,600

1,800

2,000

2,200

2,400

2,600

2,800

3,000

3,200

3½

4

4

Daily Amountc of Food From Each Group(Vegetable and protein foods subgroup amounts are per week.)

FOOD GROUP OR SUBGROUPb
Vegetables (cup eq/day)

1,400

1

1½

1½

2

2½

2½

3

3

3½

Vegetable Subgroups in Weekly Amounts
Dark-Green Vegetables(cup eq/wk)

½

1

1

1½

1½

1½

2

2

2½

2½

2½

2½

Red and Orange Vegetables(cup eq/wk)

2½

3

3

4

5½

5½

6

6

7

7

7½

7½

Beans, Peas, Lentils(cup eq/wk)

½

½

½

1

1½

1½

2

2

2½

2½

3

3

Starchy Vegetables(cup eq/wk)

2

3½

3½

4

5

5

6

6

7

7

8

8

Other Vegetables (cup eq/wk)

1½

2½

2½

3½

4

4

5

5

5½

5½

7

7

Fruits (cup eq/day)

1

1

1½

1½

1½

2

2

2

2

2½

2½

2½

Grains (ounce eq/day)

3

4

5

5

6

6

7

8

9

10

10

10

Whole Grains (ounce eq/day)d

1½

2

2½

3

3

3

3½

4

4½

5

5

5

Refined Grains (ounce eq/day)

1½

2

2½

2

3

3

3½

4

4½

5

5

5

Dairy (cup eq/day)

2

2½

2½

3

3

3

3

3

3

3

3

3

Protein Foods (ounce eq/day)

2

3

4

5

5

5½

6

6½

6½

7

7

7

Protein Foods Subgroups in Weekly Amounts
Meats, Poultry, Eggs
(ounce eq/wk)

10

14

19

23

23

26

28

31

31

33

33

33

Seafood (ounce eq/wk)e

2-3f

4

6

8

8

8

9

10

10

10

10

10

Nuts, Seeds, Soy Products(ounce eq/wk)

2

2

3

4

4

5

5

5

5

6

6

6

Oils (grams/day)

15

17

17

22

24

27

29

31

34

36

44

51

Limit on Calories for Other Uses
(kcal/day)g

130

80

90

100

140

240

250

320

350

370

440

580

Limit on Calories for Other Uses(%/day)

13%

7%

6%

6%

8%

12%

11%

13%

13%

13%

15%

18%

a Patterns at 1,000, 1,200, and 1,400 kcal levels are designed to meet the nutritional needs of children ages 2 through 8 years. Patterns from 1,600

to 3,200 kcal are designed to meet the nutritional needs of children 9 years and older and adults. If a child 4 through 8 years of age needs moreenergy and, therefore, is following a pattern at 1,600 calories or more, his/her recommended amount from the dairy group should be 2½ cup eq
per day. Amount of dairy for children ages 9 through 18 is 3 cup eq per day regardless of calorie level. The 1,000 and 1,200 kcal level patterns are
not intended for children 9 and older or adults. The 1,400 kcal level is not intended for children ages 10 and older or adults.

Dietary Guidelines for Americans, 2020-2025 | Appendix 3 | Page 144

Table A3-2 Footnotes (continued)
b Foods in each group and subgroup are:Vegetables

Dark-Green Vegetables: All fresh, frozen, and canned dark-green leafy vegetables and broccoli, cooked or raw: for example, amaranth leaves,basil, beet greens, bitter melon leaves, bok choy, broccoli, chamnamul, chrysanthemum leaves, chard, cilantro, collards, cress, dandelion greens,
kale, lambsquarters, mustard greens, poke greens, romaine lettuce, spinach, nettles, taro leaves, turnip greens, and watercress.
Red and Orange Vegetables: All fresh, frozen, and canned red and orange vegetables or juice, cooked or raw: for example, calabaza, carrots, redchili peppers, red or orange bell peppers, pimento/pimiento, sweet potatoes, tomatoes, 100% tomato juice, and winter squash such as acorn,butternut, kabocha, and pumpkin.
Beans, Peas, Lentils: All cooked from dry or canned beans, peas, chickpeas, and lentils: for example, black beans, black-eyed peas, bayo beans,brown beans, chickpeas (garbanzo beans), cowpeas, edamame, fava beans, kidney beans, lentils, lima beans, mung beans, navy beans, pigeon
peas, pink beans, pinto beans, split peas, soybeans, and white beans. Does not include green beans or green peas.
Starchy Vegetables: All fresh, frozen, and canned starchy vegetables: for example, breadfruit, burdock root, cassava, corn, jicama, lotus root, lima
beans, immature or raw (not dried) peas (e.g., cowpeas, black-eyed peas, green peas, pigeon peas), plantains, white potatoes, salsify, tapioca, taro
root (dasheen or yautia), water chestnuts, yam, and yucca.
Other Vegetables: All other fresh, frozen, and canned vegetables, cooked or raw: for example, artichoke, asparagus, avocado, bamboo shoots,bean sprouts, beets, bitter melon (bitter gourd, balsam pear), broccoflower, Brussels sprouts, cabbage (green, red, napa, savoy), cactus pads
(nopales), cauliflower, celeriac, celery, chayote (mirliton), chives, cucumber, eggplant, fennel bulb, garlic, ginger root, green beans, iceberg lettuce,
kohlrabi, leeks, luffa (Chinese okra), mushrooms, okra, onions, peppers (chili and bell types that are not red or orange in color), radicchio, sproutedbeans (e.g. sprouted mung beans), radish, rutabaga, seaweed, snow peas, summer squash, tomatillos, turnips, and winter melons.

FruitsAll fresh, frozen, canned, and dried fruits and 100% fruit juices: for example, apples, apricots, Asian pears, bananas, berries (e.g., blackberries,
blueberries, cranberries, currants, dewberries, huckleberries, kiwifruit, loganberries, mulberries, raspberries, and strawberries); citrus fruit(e.g., calamondin, grapefruit, kumquats, lemons, limes, mandarin oranges, pomelos, tangerines, and tangelos); cherries, dates, figs, grapes, guava,
jackfruit, lychee, mangoes, melons (e.g., cantaloupe, casaba, honeydew, and watermelon); nectarines, papaya, passion fruit, peaches, pears,
persimmons, pineapple, plums, pomegranates, prunes, raisins, rhubarb, sapote, soursop, starfruit, and tamarind.

GrainsWhole Grains: All whole-grain products and whole grains used as ingredients: for example, amaranth, barley (not pearled), brown rice, buckwheat,bulgur, millet, oats, popcorn, quinoa, dark rye, triticale, whole-grain cornmeal, whole-wheat bread, whole-wheat chapati, whole-grain cereals andcrackers, and wild rice.
Refined Grains: All refined-grain products and refined grains used as ingredients: for example, white breads, refined-grain cereals and crackers,
corn grits, cream of rice, cream of wheat, barley (pearled), masa, pasta, and white rice. Refined-grain choices should be enriched.

Dairy

All fluid, dry, or evaporated milk, including lactose-free and lactose-reduced products and fortified soy beverages (soy milk), buttermilk, yogurt,
kefir, frozen yogurt, dairy desserts, and cheeses (e.g., brie, camembert, cheddar, cottage cheese, colby, edam, feta, fontina, goat, gouda, gruyere,limburger, Mexican cheeses [queso anejo, queso asadero, queso chihuahua], monterey, mozzarella, muenster, parmesan, provolone, ricotta, andSwiss). Most choices should be fat-free or low-fat. Cream, sour cream, and cream cheese are not included due to their low calcium content.

Protein Foods

Meats, Poultry, Eggs: Meats include beef, goat, lamb, pork, and game meat (e.g., bear, bison, deer, elk, moose, opossum, rabbit, raccoon, squirrel).
Poultry includes chicken, Cornish hens, dove, duck, game birds (e.g., ostrich, pheasant, and quail), goose, and turkey. Organ meats include brain,
chitterlings, giblets, gizzard, heart, kidney, liver, stomach, sweetbreads, tongue, and tripe. Eggs include chicken eggs and other birds’ eggs. Meatsand poultry should be lean or low-fat.
Seafood: Seafood examples that are lower in methylmercury include: anchovy, black sea bass, catfish, clams, cod, crab, crawfish, flounder,
haddock, hake, herring, lobster, mackerel, mullet, oyster, perch, pollock, salmon, sardine, scallop, shrimp, sole, squid, tilapia, freshwater trout, light
tuna, and whiting.
Nuts, Seeds, Soy Products: Nuts and seeds include all nuts (tree nuts and peanuts), nut butters, seeds (e.g., chia, flax, pumpkin, sesame, andsunflower), and seed butters (e.g., sesame or tahini and sunflower). Soy includes tofu, tempeh, and products made from soy flour, soy protein
isolate, and soy concentrate. Nuts should be unsalted.
Beans, Peas, Lentils: Can be considered part of the protein foods group as well as the vegetable group, but should be counted in one group only.

Page 145 | Dietary Guidelines for Americans, 2020-2025 | Appendix 3

c Food group amounts shown in cup equivalents (cup eq) or ounce equivalents (ounce eq). Oils are shown in grams. Quantity equivalents for eachfood group are:Vegetables, Fruits (1 cup eq): 1 cup raw or cooked vegetable or fruit; 1 cup vegetable or fruit juice; 2 cups leafy salad greens; ½ cup dried fruitor vegetable.
Grains (1 ounce eq): ½ cup cooked rice, pasta, or cereal; 1 ounce dry pasta or rice; 1 medium (1 ounce) slice bread, tortilla, or flatbread; 1 ounce ofready-to-eat cereal (about 1 cup of flaked cereal).
Dairy (1 cup eq): 1 cup milk, yogurt, or fortified soymilk; 1½ ounces natural cheese such as cheddar cheese or 2 ounces of processed cheese.
Protein Foods (1 ounce eq): 1 ounce lean meats, poultry, or seafood; 1 egg; ¼ cup cooked beans or tofu; 1 tbsp nut or seed butter;½ ounce nuts or seeds.
d Amounts of whole grains in the Patterns for children are less than the minimum of 3 ounce-eq in all Patterns recommended for adults.
e The U.S. Food and Drug Administration (FDA) and the U.S. Environmental Protection Agency (EPA) provide joint advice regarding seafood
consumption to limit methylmercury exposure for women who might become or are pregnant or breastfeeding, and children. Depending on bodyweight, some women and many children should choose seafood lowest in methylmercury or eat less seafood than the amounts in the Healthy
US-Style Eating Pattern. For more information, see the FDA and EPA websites FDA.gov/fishadvice; EPA.gov/fishadvice.
f If consuming up to 2 ounces of seafood per week, children should only be fed cooked varieties from the “Best Choices” list in the FDA/EPA joint“Advice About Eating Fish,” available at FDA.gov/fishadvice and EPA.gov/fishadvice. If consuming up to 3 ounces of seafood per week, children
should only be fed cooked varieties from the “Best Choices” list that contain even lower methylmercury: flatfish (e.g., flounder), salmon, tilapia,
shrimp, catfish, crab, trout, haddock, oysters, sardines, squid, pollock, anchovies, crawfish, mullet, scallops, whiting, clams, shad, and Atlantic
mackerel. If consuming up to 3 ounces of seafood per week, many commonly consumed varieties of seafood should be avoided because theycannot be consumed at 3 ounces per week by children without the potential of exceeding safe methylmercury limits; examples that should not be
consumed include: canned light tuna or white (albacore) tuna, cod, perch, black sea bass. For a complete list please see: FDA.gov/fishadvice and
EPA.gov/fishadvice.
g Foods are assumed to be in nutrient-dense forms, lean or low-fat and prepared with minimal added saturated fat, added sugars, refined
starches, or salt. If all food choices to meet food group recommendations are in nutrient-dense forms, a small number of calories remain within
the overall limit of the pattern (i.e., limit on calories for other uses). The amount of calories depends on the total calorie level of the pattern and theamounts of food from each food group required to meet nutritional goals. Calories up to the specified limit can be used for added sugars, added
refined starches, saturated fat, alcohol, or to eat more than the recommended amount of food in a food group.

NOTE: The total dietary pattern should not exceed Dietary Guidelines limits for added sugars, saturated fat, and alcohol; be within the Acceptable
Macronutrient Distribution Ranges for protein, carbohydrate, and total fats; and stay within calorie limits. Values are rounded.

Dietary Guidelines for Americans, 2020-2025 | Appendix 3 | Page 146

Table A3-3
Healthy Vegetarian Dietary Pattern for Toddlers Ages 12 Through 23 Months Who Are No Longer Receiving
Human Milk or Infant Formula, With Daily or Weekly Amounts From Food Groups, Subgroups, andComponents
CALORIE LEVEL OFPATTERN a

700

900

1,000

Daily Amount of Food From Each Groupd(Vegetable and protein foods subgroup amounts are per week.)

FOOD GROUP OR SUBGROUPb,cVegetables (cup eq/day)

800

1

1

1

1

Vegetable Subgroups in Weekly Amounts
Dark-Green Vegetables(cup eq/wk)

½

½

½

½

Red and Orange Vegetables(cup eq/wk)

2½

2½

2½

2½

Beans, Peas, Lentils (cup eq/wk)

¾

¾

¾

¾

Starchy Vegetables (cup eq/wk)

2

2

2

2

Other Vegetables (cup eq/wk)

1½

1½

1½

1½

Fruits (cup eq/day)

½

¾

1

1

Grains (ounce eq/day)

1¾

2¼

2¾

3

Whole Grains (ounce eq/day)

1¼

1¾

2

2

Refined Grains (ounce eq/day)

½

½

¾

1

Dairy (cup eq/day)

1½

1¾

1¾

2

Protein Foods (ounce eq/day)

1

1

1

1

Protein Foods Subgroups in Weekly Amounts
Eggs (ounce eq/wk)

3½

3½

3½

3½

Nuts, Seeds, Soy Products(ounce eq/wk)

4

4

4

4

9

8½

10

15

Oils (grams/day)a Calorie level ranges: Energy levels are calculated based on median length and body weight reference individuals. Calorie needs vary based on

many factors. The DRI Calculator for Healthcare Professionals available at nal.usda.gov/fnic/dri-calculator/ can be used to estimate calorie
needs based on age, sex, and weight.

b Definitions for each food group and subgroup and quantity (i.e., cup or ounce) equivalents are provided in Chapter 1 and are compiled inTable A3-2 (footnote c).
c All foods are assumed to be in nutrient-dense forms and prepared with minimal added sugars, refined starches (which are a source of calories
but few or no other nutrients), or sodium. Food are also lean or in low-fat forms with the exception of dairy which includes whole-fat fluid milk,
reduced-fat plain yogurts, and reduced-fat cheese. There are no calories available for additional added sugars, saturated fat, or to eat more than
the recommended amount of food in a food group.
d In some cases, food subgroup amounts are greatest at the lower calorie levels to help achieve nutrient adequacy when relatively small numberof calories are required.

Page 147 | Dietary Guidelines for Americans, 2020-2025 | Appendix 3

Table A3-4
Healthy Vegetarian Dietary Pattern for Ages 2 and Older, With Daily or Weekly Amounts From Food Groups,
Subgroups, and Components
CALORIE LEVEL OFPATTERNa

1,000

1,200

1,600

1,800

2,000

2,200

2,400

2,600

2,800

3,000

3,200

Daily Amountc of Food From Each Group(Vegetable and protein foods subgroup amountsb are per week.)

FOOD GROUP OR SUBGROUPb
Vegetables (cup eq/day)

1,400

1

1½

1½

2

2½

2½

3

3

3½

3½

4

4

Vegetable Subgroups in Weekly Amounts
Dark-Green Vegetables(cup eq/wk)

½

1

1

1½

1½

1½

2

2

2½

2½

2½

2½

Red and Orange Vegetables(cup eq/wk)

2½

3

3

4

5½

5½

6

6

7

7

7½

7½

Beans, Peas, Lentils (cup eq/wk)d

½

½

½

1

1½

1½

2

2

2½

2½

3

3

Starchy Vegetables (cup eq/wk)

2

3½

3½

4

5

5

6

6

7

7

8

8

Other Vegetables (cup eq/wk)

1½

2½

2½

3½

4

4

5

5

5½

5½

7

7

Fruits (cup eq/day)

1

1

1½

1½

1½

2

2

2

2

2½

2½

2½

Grains (ounce eq/day)

3

4

5

5½

6½

6½

7½

8½

9½

10 ½

10 ½

10 ½

Whole Grains (ounce eq/day)

1½

2

2½

3

3½

3½

4

4½

5

5½

5½

5½

Refined Grains (ounce eq/day)

1½

2

2½

2½

3

3

3½

4

4½

5

5

5

Dairy (cup eq/day)

2

2½

2½

3

3

3

3

3

3

3

3

3

Protein Foods (ounce eq/day)

1

1½

2

2½

3

3½

3½

4

4½

5

5½

6

Protein Foods Subgroups in Weekly Amounts
Eggs (ounce eq/wk)

2

3

3

3

3

3

3

3

3

4

4

4

Beans, Peas, Lentils(cup eq/wk)d

1

2

4

4

6

6

6

8

9

10

11

12

Soy Products (ounce eq/wk)

2

3

4

6

6

8

8

9

10

11

12

13

Nuts, Seeds (ounce eq/wk)

2

2

3

5

6

7

7

8

9

10

12

13

Oils (grams/day)

15

17

17

22

24

27

29

31

34

36

44

51

Limit on Calories for Other
Uses (kcal/day)e

170

140

160

150

150

250

290

350

350

350

390

500

Limit on Calories for Other Uses(%/day)

17%

12%

11%

9%

8%

13%

13%

15%

13%

13%

13%

16%

a, b, c See Table A3-2 footnotes.
d About half of beans, peas, lentils are shown as vegetables, in cup eq, and half as protein foods, in ounce eq. Beans, peas, lentils in the patterns, incup eq, is the amount in the vegetable group plus the amount in protein foods group (in ounce eq) divided by four.
e See Table A3-2 footnotes.

NOTE: The total dietary pattern should not exceed Dietary Guidelines limits for added sugars, saturated fat, and alcohol; be within the Acceptable
Macronutrient Distribution Ranges for protein, carbohydrate, and total fats; and stay within calorie limits. Values are rounded.

Dietary Guidelines for Americans, 2020-2025 | Appendix 3 | Page 148

Table A3-5
Healthy Mediterranean-Style Dietary Pattern for Ages 2 and Older, With Daily or Weekly Amounts From
Food Groups, Subgroups, and Components
CALORIE LEVEL OFPATTERNa

1,000

1,200

1,400

1,800

2,000

2,200

2,400

2,600

2,800

3,000

3,200

Daily Amountc of Food From Each Group(Vegetable and protein foods subgroup amounts are per week.)

FOOD GROUP OR SUBGROUPb
Vegetables (cup eq/day)

1,600

1

1½

1½

2

2½

2½

3

3

3½

3½

4

4

Vegetable Subgroups in Weekly Amounts
Dark-Green Vegetables(cup eq/wk)

½

1

1

1½

1½

1½

2

2

2½

2½

2½

2½

Red and Orange Vegetables(cup eq/wk)

2½

3

3

4

5½

5½

6

6

7

7

7½

7½

Beans, Peas, Lentils (cup eq/wk)

½

½

½

1

1½

1½

2

2

2½

2½

3

3

Starchy Vegetables (cup eq/wk)

2

3½

3½

4

5

5

6

6

7

7

8

8

Other Vegetables (cup eq/wk)

1½

2½

2½

3½

4

4

5

5

5½

5½

7

7

Fruits (cup eq/day)

1

1

1½

2

2

2½

2½

2½

2½

3

3

3

Grains (ounce eq/day)

3

4

5

5

6

6

7

8

9

10

10

10

Whole Grains (ounce eq/day)d

1½

2

2½

3

3

3

3½

4

4½

5

5

5

Refined Grains (ounce eq/day)

1½

2

2½

2

3

3

3½

4

4½

5

5

5

Dairy (cup eq/day)d

2

2½

2½

2

2

2

2

2½

2½

2½

2½

2½

Protein Foods (ounce eq/day)

2

3

4

5½

6

6½

7

7½

7½

8

8

8

Protein Foods Subgroups in Weekly Amounts
Meats, Poultry, Eggs
(ounce eq/wk)

10

14

19

23

23

26

28

31

31

33

33

33

Seafood (ounce eq/wk)e

3

4

6

11

15

15

16

16

17

17

17

17

Nuts, Seeds, Soy Products(ounce eq/wk)

2

2

3

4

4

5

5

5

5

6

6

6

Oils (grams/day)

15

17

17

22

24

27

29

31

34

36

44

51

Limit on Calories for Other
Uses (kcal/day)f

130

80

90

120

140

240

250

280

300

330

400

540

Limit on Calories for Other Uses(%/day)

13%

7%

6%

8%

8%

12%

11%

12%

12%

12%

13%

17%

a,b,c See Table A3-2 footnotes.
d Amounts of dairy recommended for children and adolescents are as
follows, regardless of the calorie level of the pattern: for age 2 years,
2 cup-eq per day; for ages 3 through 8 years, 2 ½ cup-eq per day; forages 9 through 18 years, 3 cup-eq per day.
e The U.S. Food and Drug Administration (FDA) and the U.S.
Environmental Protection Agency (EPA) provide joint advice regarding
seafood consumption to limit methylmercury exposure for women who
might become or are pregnant or lactating, and children. Depending on
body weight, some women and children should choose seafood lowest
in methylmercury or eat less seafood than the amounts in the Healthy
U.S.-Style Dietary Pattern. For more information, see the FDA and EPA
websites at FDA.gov/fishadvice and EPA.gov/fishadvice.
f Foods are assumed to be in nutrient-dense forms; lean or low-fat;

Page 149 | Dietary Guidelines for Americans, 2020-2025 | Appendix 3

and prepared with minimal added sugars, refined starches (which area source of calories but few or no other nutrients), saturated fat, or
sodium. If all food choices to meet food group recommendations arein nutrient-dense forms, a small number of calories remain within theoverall limit of the pattern (i.e., limit on calories for other uses). The
amount of calories depends on the total calorie level of the pattern
and the amounts of food from each food group required to meet
nutritional goals. Calories up to the specified limit can be used for
added sugars, saturated fat, and/or alcohol (for nonpregnant adults oflegal drinking age only) or to eat more than the recommended amountof food in a food group.
NOTE: The total dietary pattern should not Dietary Guidelines
limits for added sugars, saturated fat, and alcohol; be within
the Acceptable Macronutrient Distribution Ranges for protein,carbohydrate, and total fats; and stay within calorie limits. Values
are rounded.

DietaryGuidelines.gov

USDA Publication #: USDA-FNS-2020-2025-DGA
HHS Publication #: HHS-ODPHP-2020-2025-01-DGA-A