Saturated Fats, Trans Fats, and Cholesterol

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Saturated Fats

Healthy intake: Intake of saturated fats should be limited to less than 10 percent of calories per day by replacing them with unsaturated fats and while keeping total dietary fats within the age-appropriate AMDR. The human body uses some saturated fats for physiological and structural functions, but it makes more than enough to meet those needs. Individuals 2 years and older therefore have no dietary requirement for saturated fats.

Strong and consistent evidence shows that replacing saturated fats with unsaturated fats, especially polyunsaturated fats, is associated with reduced blood levels of total cholesterol and of low-density lipoprotein-cholesterol (LDL-cholesterol). Additionally, strong and consistent evidence shows that replacing saturated fats with polyunsaturated fats is associated with a reduced risk of CVD events (heart attacks) and CVD-related deaths.

Some evidence has shown that replacing saturated fats with plant sources of monounsaturated fats, such as olive oil and nuts, may be associated with a reduced risk of CVD. However, the evidence base for monounsaturated fats is not as strong as the evidence base for replacement with polyunsaturated fats. Evidence has also shown that replacing saturated fats with carbohydrates reduces blood levels of total and LDL-cholesterol, but increases blood levels of triglycerides and reduces high-density lipoprotein-cholesterol (HDL-cholesterol). Replacing total fat or saturated fats with carbohydrates is not associated with reduced risk of CVD. Additional research is needed to determine whether this relationship is consistent across categories of carbohydrates (e.g., whole versus refined grains; intrinsic versus added sugars), as they may have different associations with various health outcomes. Therefore, saturated fats in the diet should be replaced with polyunsaturated and monounsaturated fats.

Considerations: As discussed in Chapter 2, the main sources of saturated fats in the U.S. diet include mixed dishes containing cheese, meat, or both, such as burgers, sandwiches, and tacos; pizza; rice, pasta, and grain dishes; and meat, poultry, and seafood dishes. Although some saturated fats are inherent in foods, others are added. Healthy eating patterns can accommodate nutrient-dense foods with small amounts of saturated fats, as long as calories from saturated fats do not exceed 10 percent per day, intake of total fats remains within the AMDR, and total calorie intake remains within limits. When possible, foods high in saturated fats should be replaced with foods high in unsaturated fats, and other choices to reduce solid fats should be made (see Chapter 2).

Trans Fats

Individuals should limit intake of trans fats to as low as possible by limiting foods that contain synthetic sources of trans fats, such as partially hydrogenated oils in margarines, and by limiting other solid fats. A number of studies have observed an association between increased intake oftrans fats and increased risk of CVD. This increased risk is due, in part, to its LDL-cholesterol-raising effect.

Trans fats occur naturally in some foods and also are produced in a process called hydrogenation. Hydrogenation is used by food manufacturers to make products containing unsaturated fatty acids solid at room temperature (i.e., more saturated) and therefore more resistant to becoming spoiled or rancid. Partial hydrogenation means that some, but not all, unsaturated fatty acids are converted to saturated fatty acids; some of the unsaturated fatty acids are changed from a cis to transconfiguration. Trans fatty acids produced this way are referred to as “artificial” or “industrially produced” trans fatty acids. Artificial trans fatty acids are found in the partially hydrogenated oils[23]used in some margarines, snack foods, and prepared desserts as a replacement for saturated fatty acids. Although food manufacturers and restaurants have reduced the amounts of artificial transfats in many foods in recent years, these fats can still be found in some processed foods, such as some desserts, microwave popcorn, frozen pizza, margarines, and coffee creamers.

Naturally occurring trans fats, known as “natural” or “ruminant” trans fats, are produced by ruminant animals. Natural trans fats are present in small quantities in dairy products and meats, and consuming fat-free or low-fat dairy products and lean meats and poultry will reduce the intake of natural trans fats from these foods. Because natural trans fats are present in dairy products and meats in only small quantities and these foods can be important sources of nutrients, these foods do not need to be eliminated from the diet.

Alcohol

Alcohol is not a component of the USDA Food Patterns. The Dietary Guidelines does not recommend that individuals who do not drink alcohol start drinking for any reason. If alcohol is consumed, it should be in moderation—up to one drink per day for women and up to two drinks per day for men—and only by adults of legal drinking age.[6] There are also many circumstances in which individuals should not drink, such as during pregnancy. For the purposes of evaluating amounts of alcohol that may be consumed, the Dietary Guidelines includes drink-equivalents. One alcoholic drink-equivalent is described as containing 14 g (0.6 fl oz) of pure alcohol.[26] The following are reference beverages that are 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).[27] The amount of alcohol and calories in beverages varies and should be accounted for within the limits of healthy eating patterns so that calorie limits are not exceeded. See Appendix 9. Alcohol for additional information.

Caffeine

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Caffeine is not a nutrient; it is a dietary component that functions in the body as a stimulant. Caffeine occurs naturally in plants (e.g., coffee beans, tea leaves, cocoa beans, kola nuts). It also is added to foods and beverages (e.g., caffeinated soda, energy drinks). If caffeine is added to a food, it must be included in the listing of ingredients on the food label.[28] Most intake of caffeine in the United States comes from coffee, tea, and soda. Caffeinated beverages vary widely in their caffeine content. Caffeinated coffee beverages include drip/brewed coffee (12 mg/fl oz), instant coffee (8 mg/fl oz), espresso (64 mg/fl oz), and specialty beverages made from coffee or espresso, such as cappuccinos and lattes. Amounts of caffeine in other beverages such as brewed black tea (6 mg/fl oz), brewed green tea (2-5 mg/fl oz), and caffeinated soda[29] (1-4 mg/fl oz) also vary. Beverages within the energy drinks category have the greatest variability (3-35 mg/fl oz).

Much of the available evidence on caffeine focuses on coffee intake. Moderate coffee consumption (three to five 8-oz cups/day or providing up to 400 mg/day of caffeine) can be incorporated into healthy eating patterns. This guidance on coffee is informed by strong and consistent evidence showing that, in healthy adults, moderate coffee consumption is not associated with an increased risk of major chronic diseases (e.g., cancer) or premature death, especially from CVD. However, individuals who do not consume caffeinated coffee or other caffeinated beverages are not encouraged to incorporate them into their eating pattern. Limited and mixed evidence is available from randomized controlled trials examining the relationship between those energy drinks which have high caffeine content and cardiovascular risk factors and other health outcomes. In addition, caffeinated beverages, such as some sodas or energy drinks, may include calories from added sugars, and although coffee itself has minimal calories, coffee beverages often contain added calories from cream, whole or 2% milk, creamer, and added sugars, which should be limited. The same considerations apply to calories added to tea or other similar beverages.

Those who choose to drink alcohol should be cautious about mixing caffeine and alcohol together or consuming them at the same time; see Appendix 9. Alcohol for additional discussion. In addition, women who are capable of becoming pregnant or who are trying to, or who are pregnant, and those who are breastfeeding should consult their health care providers for advice concerning caffeine consumption.

Notes

[6] It is not recommended that individuals begin drinking or drink more for any reason. The amount of alcohol and calories in beverages varies and should be accounted for within the limits of healthy eating patterns. Alcohol should be consumed only by adults of legal drinking age. There are many circumstances in which individuals should not drink, such as during pregnancy. See Appendix 6. Alcohol for additional information.

[8] Institute of Medicine (IOM) and National Research Council (NRC). Weight gain during pregnancy: Reexamining the guidelines. Washington (DC): The National Academies Press; 2009.

[9] Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. J Am Coll Cardiol. 2014;63(25 Pt B):2985-3023. PMID: 24239920. Available at: http://www.ncbi.nlm.nih.gov/pubmed/24239920.

[10] Definitions for each food group and subgroup are provided throughout the chapter and are compiled in Appendix 3.

[11] In the form of provitamin A carotenoids

[12] American Academy of Pediatrics. Healthy Children, Fit Children: Answers to Common Questions From Parents About Nutrition and Fitness. 2011.

[13] In the form of provitamin A carotenoids

[14] Products that bear the U.S. Food and Drug Administration (FDA) health claim for whole grains have at least 51 percent of the total ingredients by weight as whole-grain ingredients; they also meet other criteria.

[15] Foods that meet the whole grain-rich criteria for the school meal programs contain 100 percent whole grain or a blend of whole-grain meal and/or flour and enriched meal and/or flour of which at least 50 percent is whole grain. The remaining 50 percent or less of grains, if any, must be enriched.http://www.fns.usda.gov/sites/default/files/WholeGrainResource.pdf. Accessed October 22, 2015.

[16] Adapted from the Food Safety and Inspection Service (FSIS) guidance on whole-grain claims. Available athttp://www.fsis.usda.gov/wps/portal/fsis/home. Accessed November 25, 2015.

[17] State and local advisories provide information to guide consumers who eat fish caught from local waters. See the EPA website, “Fish Consumption Advisories, General Information.” Available athttp://water.epa.gov/scitech/swguidance/fishshellfish/fishadvisories/general.cfm. Accessed September 26, 2015.

[18] Cooked, edible portion

[19] The U.S. Food and Drug Administration (FDA) and the U.S. Environmental Protection Agency (EPA) provide joint guidance regarding seafood consumption for women who are pregnant or breastfeeding and young children. For more information, see the FDA and EPA websites www.FDA.gov/fishadvice; www.EPA.gov/fishadvice.

[20] The term “fats” rather than “fatty acids” is generally used in this document when discussing categories of fatty acids (e.g., unsaturated, saturated, trans) for consistency with the Nutrition Facts label and other Federal materials.

[21] It is not recommended that individuals begin drinking or drink more for any reason. The amount of alcohol and calories in beverages varies and should be accounted for within the limits of healthy eating patterns. Alcohol should be consumed only by adults of legal drinking age. There are many circumstances in which individuals should not drink, such as during pregnancy. See Appendix 9. Alcohol for additional information.

[22] For more information, see: FDA. High-Intensity Sweeteners. May 19, 2014. [Updated November 5, 2014.] Available at:http://www.fda.gov/food/ingredientspackaginglabeling/foodadditivesingredients/ucm397716.htm. Accessed October 19, 2015. This page provides a link to “Additional Information about High-Intensity Sweeteners Permitted for use in Food in the United States” which includes more information on types and uses of high-intensity sweeteners and the scientific evidence evaluated by the FDA for safety for the general population.

[23] The FDA has determined that partially hydrogenated oils, which are the primary dietary source of industrially produced trans fats, are no longer generally recognized as safe (GRAS), with compliance expected by June 18, 2018. FDA. Final Determination Regarding Partionally Hydrogenated Oils. Federal Register. June 17, 2015;80(116):34650-34670. Available at: https://www.federalregister.gov/articles/2015/06/17/2015-14883/final-determination-regarding-partially-hydrogenated-oils. Accessed October 20, 2015.

[24] 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.

[25] The IOM set an Adequate Intake (AI) level for sodium to meet the sodium needs of healthy and moderately active individuals. Because of increased loss of sodium from sweat, the AI does not apply to highly active individuals and workers exposed to extreme heat stress, estimated to be less than 1 percent of the U.S. population. Institute of Medicine. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Washington (DC): The National Academies Press; 2005.

[26] Bowman SA, Clemens JC, Friday JE, Thoerig RC, and Moshfegh AJ. 2014. Food Patterns Equivalents Database 2011-12: Methodology and User Guide [Online]. Food Surveys Research Group, Beltsville Human Nutrition Research Center, Agricultural Research Service, U.S. Department of Agriculture, Beltsville, Maryland. Available at:http://www.ars.usda.gov/nea/bhnrc/fsrg. Accessed November 3, 2015. For additional information, see the National Institute on Alcohol Abuse and Alcoholism (NIAAA) webpage available at: http://rethinkingdrinking.niaaa.nih.gov/.

[27] Drink-equivalents are not intended to serve as a standard drink definition for regulatory purposes.

[28] Some dietary supplements such as energy shots also contain caffeine, but the amount of caffeine in these products is not required to be disclosed.

[29] Caffeine is a substance that is generally recognized as safe (GRAS) in cola-type beverages by the U.S. Food and Drug Administration for use by adults and children. Code of Federal Regulation Title 21, Subchapter B, Part 182, Subpart B. Caffeine. U.S. Government Printing Office. November 23, 2015. Available at: http://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=f8c3068e9ec0062a3b4078cfa6361cf6&ty=HTML&h=L&mc=true&r=SECTION&n=se21.3.182_11180.

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Limits on Calories That Remain After Food Group Needs Are Met in Nutrient-Dense Forms

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The USDA Food Patterns are designed to meet food group and nutrient recommendations while staying within calorie needs. To achieve this goal, the Patterns are based on consuming foods in their nutrient-dense forms (i.e., without added sugars and in the leanest and lowest fat forms, seeAppendix 6). For nearly all calorie levels, most of the calories in the USDA Food Patterns are needed for nutrient-dense food choices, and only a limited number remain for other uses. These calories are indicated in the USDA Food Patterns as “limits on calories for other uses.” For example, after food group needs are met in the Healthy U.S.-Style Eating Pattern from 1,000 to 1,600 calories, only 100 to 170 calories per day remain within the limit for other uses. In the 2,000-calorie pattern, the limit for other uses is 270 calories and in the 2800-calorie pattern, 400 calories (see Appendix 3, Appendix 4, and Appendix 5). Calories up to the limit for the specific pattern can be used to eat foods that are not in nutrient-dense forms (e.g., to accommodate calories from added sugars, added refined starches, or solid fats) or to eat more than the recommended amount of nutrient-dense foods. If alcohol is consumed, calories from alcoholic beverages should also be accounted for within this limit to keep total calorie intake at an appropriate level.

As discussed in Chapter 2, in contrast to the healthy choices that make up the Patterns, foods from most food groups as they are typically consumed in the United States are not in nutrient-dense forms. In addition, foods and beverages are consumed that are primarily composed of added sugars and/or solid fats, and provide excess calories without contributing to meeting food group recommendations. The excess calories consumed from these sources far exceed the limited number of calories available for choices other than nutrient-dense foods in each food group.

From a public health perspective, it is important to identify the calories that are needed to meet food group needs to help inform guidance on limits from calories from added sugars, solid fats, alcohol[21], or other sources, in order to help individuals move toward healthy eating patterns within calorie limits. The USDA Food Patterns can be used to plan and serve meals for individuals, households, and in a variety of organizational settings (e.g., schools, worksites, and other community settings). The limit on calories for other uses can assist in determining how to plan and select foods that can fit within healthy eating patterns, such as how many calories are available to select foods from a food group that are not in nutrient-dense forms. As discussed in the next portion of the chapter, additional constraints apply related to other dietary components when building healthy eating patterns.

Other Dietary Components

In addition to the food groups, it is important to consider other food components when making food and beverage choices. The components discussed below include added sugars, saturated fats, transfats, cholesterol, sodium, alcohol, and caffeine. For each component, information is provided on how the component relates to eating patterns and outlines considerations related to the component. SeeChapter 2 for a further discussion of each of these components, current intakes, and shifts that are needed to help individuals align with a healthy eating pattern.

Added Sugars

Healthy intake: Added sugars include syrups and other caloric sweeteners. When sugars are added to foods and beverages to sweeten them, they add calories without contributing essential nutrients. Consumption of added sugars can make it difficult for individuals to meet their nutrient needs while staying within calorie limits. Naturally occurring sugars, such as those in fruit or milk, are not added sugars. Specific examples of added sugars that can be listed as an ingredient include brown sugar, corn sweetener, corn syrup, dextrose, fructose, glucose, high-fructose corn syrup, honey, invert sugar, lactose, malt syrup, maltose, molasses, raw sugar, sucrose, trehalose, and turbinado sugar.

Healthy eating patterns limit added sugars to less than 10 percent of calories per day. This recommendation is a target to help the public achieve a healthy eating pattern, which means meeting nutrient and food group needs through nutrient-dense food and beverage choices and staying within calorie limits. When added sugars in foods and beverages exceed 10 percent of calories, a healthy eating pattern may be difficult to achieve. This target also is informed by national data on intakes of calories from added sugars, which as discussed in Chapter 2, account on average for almost 270 calories, or more than 13 percent of calories per day in the U.S. population.

The USDA Food Patterns show that an eating pattern with enough foods from all food groups to meet nutrient needs without eating too many calories has only limited room for calories from added sugars. At most lower calorie levels (i.e., 1,200 to 1,800 calories), the calories that remain after meeting food group recommendations in nutrient-dense forms (“limits on calories for other uses”) are less than 10 percent per day of calories; however, at higher calorie levels, the limits on calories for other uses are more than 10 percent per day. The recommendation to limit added sugars to no more than 10 percent of calories is a target that applies to all calorie levels to help individuals move toward healthy eating patterns within calorie limits.

Although the evidence for added sugars and health outcomes is still developing, the recommendation to limit calories from added sugars is consistent with research examining eating patterns and health. Strong evidence from mostly prospective cohort studies but also randomized controlled trials has shown that eating patterns that include lower intake of sources of added sugars are associated with reduced risk of CVD in adults, and moderate evidence indicates that these eating patterns are associated with reduced risk of obesity, type 2 diabetes, and some types of cancer in adults. As described earlier, eating patterns consist of multiple, interacting food components, and the relationships to health exist for the overall eating pattern, not necessarily to an isolated aspect of the diet. Moderate evidence indicates a relationship between added sugars and dental caries in children and adults.

Considerations: Added sugars provide sweetness that can help improve the palatability of foods, help with preservation, and/or contribute to functional attributes such as viscosity, texture, body, color, and browning capability. As discussed in Chapter 2, the two main sources of added sugars in U.S. diets are sugar-sweetened beverages and snacks and sweets. Many foods high in calories from added sugars provide few or no essential nutrients or dietary fiber and, therefore, may contribute to excess calorie intake without contributing to diet quality; intake of these foods should be limited to help achieve healthy eating patterns within calorie limits. There is room for Americans to include limited amounts of added sugars in their eating patterns, including to improve the palatability of some nutrient-dense foods, such as fruits and vegetables that are naturally tart (e.g., cranberries and rhubarb). Healthy eating patterns can accommodate other nutrient-dense foods with small amounts of added sugars, such as whole-grain breakfast cereals or fat-free yogurt, as long as calories from added sugars do not exceed 10 percent per day, total carbohydrate intake remains within the AMDR, and total calorie intake remains within limits.

It should be noted that replacing added sugars with high-intensity sweeteners may reduce calorie intake in the short-term, yet questions remain about their effectiveness as a long-term weight management strategy. High-intensity sweeteners that have been approved by the U.S. Food and Drug Administration (FDA) include saccharin, aspartame, acesulfame potassium (Ace-K), and sucralose.[22] Based on the available scientific evidence, these high-intensity sweeteners have been determined to be safe for the general population. This means that there is reasonable certainty of no harm under the intended conditions of use because the estimated daily intake is not expected to exceed the acceptable daily intake for each sweetener. The FDA has determined that the estimated daily intake of these high-intensity sweeteners would not exceed the acceptable daily intake, even for high consumers of each substance.

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Oils

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Healthy intake: Oils are fats that contain a high percentage of monounsaturated and polyunsaturated fats and are liquid at room temperature. Although they are not a food group, oils are emphasized as part of healthy eating patterns because they are the major source of essential fatty acids and vitamin E. Commonly consumed oils extracted from plants 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 do not resemble other oils in their composition. Specifically, they contain a higher percentage of saturated fats than other oils (see Dietary Fats: The Basics call-out box). The recommendation for oils in the Healthy U.S.-Style Eating Pattern at the 2,000-calorie level is 27 g (about 5 teaspoons) per day.

Key nutrient contributions: Oils provide essential fatty acids and vitamin E.

Considerations: Oils are part of healthy eating patterns, but because they are a concentrated source of calories, the amount consumed should be within the AMDR for total fats without exceeding calorie limits. Oils should replace solid fats rather than being added to the diet. More information on types of fats is provided in the Dietary Fats: The Basics call-out box, and information on the relationship between dietary fats and health is discussed in the Saturated Fats, Trans Fats, and Cholesterolsection, below.

Dietary Fats: The Basics

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Dietary fats are found in both plant and animal foods. They supply calories and help with the absorption of the fat-soluble vitamins A, D, E, and K. Some also are good sources of two essential fatty acids—linoleic acid and α-linolenic acid.

All dietary fats are composed of a mix of polyunsaturated, monounsaturated, and saturated fatty acids, in varied proportions (Figure 1-2). For example, most of the fatty acids in butter are saturated, but it also contains some monounsaturated and polyunsaturated fatty acids. Oils are mostly unsaturated fatty acids, though they have small amounts of saturated fatty acids.

Figure 1-2.Fatty Acid Profiles of Common Fats and Oils

Read text description of Figure 1-2

* Coconut, palm kernel, and palm oil are called oils because they come from plants. However, they are solid or semi-solid at room temperature due to their high content of short-chain saturated fatty acids. They are considered solid fats for nutritional purposes.

** Shortening may be made from partially hydrogenated vegetable oil, which contains trans fatty acids.

DATA SOURCE:U.S. Department of Agriculture, Agricultural Research Service, Nutrition Data Laboratory. USDA National Nutrient Database for Standard Reference. Release 27, 2015. Available at http://ndb.nal.usda.gov/. Accessed August 31, 2015.

• Polyunsaturated fatty acids (polyunsaturated fats[20]) are found in greatest amounts in corn, soybean, and cottonseed oils; walnuts; pine nuts; and sesame, pumpkin, and flax seeds. Only small amounts of polyunsaturated fats are found in most animal fats. Omega-3 (n-3) fatty acids are a type of polyunsaturated fats found in seafood, such as salmon, trout, herring, tuna, and mackerel, and in flax seeds and walnuts. EPA and DHA are long chain n-3 fatty acids found in seafood.
• Monounsaturated fatty acids (monounsaturated fats) are found in greatest amounts in olive, canola, peanut, sunflower, and safflower oils, and in avocados, peanut butter, and most nuts. Monounsaturated fats also are part of most animal fats such as fats from chicken, pork, beef, and wild game.
• Saturated fatty acids (saturated fats) are found in the greatest amounts in coconut and palm kernel oils, in butter and beef fats, and in palm oil. They also are found in other animal fats, such as pork and chicken fats and in other plant fats, such as nuts.
• Trans fatty acids (trans fats) are unsaturated fats found primarily in partially hydrogenated vegetable oils and foods containing these oils and in ruminant (animal) fats. They are structurally different from the unsaturated fatty acids that occur naturally in plant foods and differ in their health effects.

The proportions of fatty acids in a particular fat determine the physical form of the fat:

• Fats with a higher amount of polyunsaturated and monounsaturated fatty acids are usually liquid at room temperature and are referred to as “oils.”
• Fats with a higher amount of saturated fatty acids are usually solid at room temperature and are referred to as “solid fats.” Fats containing trans fatty acids are also classified as solid fats, although they may or may not be solid at room temperature.

A relevant detail in the complexity of making food-based recommendations that consider nutrients is the difference between the terms “saturated fats” and “solid fats.” Although they are closely related terms, saturated fats and solid fats are not synonymous. The term “saturated fats” refers to saturated fatty acids, a nutrient found in foods, while the term “solid fats” describes the physical manifestation of the fats in a food. Some solid fats, such as the strip of fat around a piece of meat, can easily be seen. Other solid fats are not so visible. For example, the solid fats in whole milk are suspended in the fluid milk by the process of homogenization.

Margarines and margarine-like vegetable oil spreads are food products composed of one or more oils or solid fats designed to replace butter, which is high in saturated fats. These products may be sold in sticks, tubs, bottles, or sprays. Margarine and vegetable oil spreads generally contain less saturated fats than butter. However, they vary in their total fat and calorie content and in the fat and oil blends used to make them and, thus, in the proportions of saturated, unsaturated, and trans fats they contain. It is important to read the Nutrition Facts label to identify the calorie and saturated and trans fats content of the spread and choose foods with no trans fats and lower amounts of saturated fats.

The Dietary Guidelines provides recommendations on saturated fats as well as on solid fats because its aim is to improve the health of the U.S. population through food-based guidance. It includes recommendations on saturated fats because of the strong relationship of this nutrient to a health outcome (CVD risk). It includes recommendations on solid fats because, as discussed in Chapter 2, they are abundant in the diets of the U.S. population, and reducing solid fats when making food choices is an important way to reduce saturated fats and excess calories

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Fruits

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Healthy intake: Healthy eating patterns include fruits, especially whole fruits. The fruits food group includes whole fruits and 100% fruit juice. Whole fruits include fresh, canned, frozen, and dried forms. The recommended amount of fruits in the Healthy U.S.-Style Eating Pattern at the 2,000-calorie level is 2 cup-equivalents per day. One cup of 100% fruit juice counts as 1 cup of fruit. Although fruit juice can be part of healthy eating patterns, it is lower than whole fruit in dietary fiber and when consumed in excess can contribute extra calories. Therefore, at least half of the recommended amount of fruits should come from whole fruits. When juices are consumed, they should be 100% juice, without added sugars. Also, when selecting canned fruit, choose options that are lowest in added sugars. One-half cup of dried fruit counts as one cup-equivalent of fruit. Similar to juice, when consumed in excess, dried fruits can contribute extra calories.

Key nutrient contributions: Among the many nutrients fruits provide are dietary fiber, potassium, and vitamin C.

Considerations: Juices may be partially fruit juice, and only the proportion that is 100% fruit juice counts (e.g., 1 cup of juice that is 50% juice counts as ½ cup of fruit juice). The remainder of the product may contain added sugars. Sweetened juice products with minimal juice content, such as juice drinks, are considered to be sugar-sweetened beverages rather than fruit juice because they are primarily composed of water with added sugars (see the Added Sugars section below). The percent of juice in a beverage may be found on the package label, such as “contains 25% juice” or “100% fruit juice.” The amounts of fruit juice allowed in the USDA Food Patterns for young children align with the recommendation from the American Academy of Pediatrics that young children consume no more than 4 to 6 fluid ounces of 100% fruit juice per day.[12] Fruits with small amounts of added sugars can be accommodated in the diet as long as calories from added sugars do not exceed 10 percent per day and total calorie intake remains within limits.

Grains

Healthy Intake: Healthy eating patterns include whole grains and limit the intake of refined grains and products made with refined grains, especially those high in saturated fats, added sugars, and/or sodium, such as cookies, cakes, and some snack foods. The grains food group includes grains as single foods (e.g., rice, oatmeal, and popcorn), as well as products that include grains as an ingredient (e.g., breads, cereals, crackers, and pasta). Grains are either whole or refined. Whole grains (e.g., brown rice, quinoa, and oats) contain the entire kernel, including the endosperm, bran, and germ. Refined grains differ from whole grains in that the grains have been processed to remove the bran and germ, which removes dietary fiber, iron, and other nutrients. The recommended amount of grains in the Healthy U.S.-Style Eating Pattern at the 2,000-calorie level is 6 ounce-equivalents per day. At least half of this amount should be whole grains (see the How To Make at Least Half of Grains Whole Grains call-out box).

Key nutrient contributions: Whole grains are a source of nutrients, such as dietary fiber, iron, zinc, manganese, folate, magnesium, copper, thiamin, niacin, vitamin B6, phosphorus, selenium, riboflavin, and vitamin A.[13] Whole grains vary in their dietary fiber content. Most refined grains are enriched, a process that adds back iron and four B vitamins (thiamin, riboflavin, niacin, and folic acid). Because of this process, the term “enriched grains” is often used to describe these refined grains.

Considerations: Individuals who eat refined grains should choose enriched grains. Those who consume all of their grains as whole grains should include some grains, such as some whole-grain ready-to-eat breakfast cereals, that have been fortified with folic acid. This is particularly important for women who are or are capable of becoming pregnant, as folic acid fortification in the United States has been successful in reducing the incidence of neural tube defects during fetal development. Although grain products that are high in added sugars and saturated fats, such as cookies, cakes, and some snack foods, should be limited, as discussed in the Added Sugars andSaturated Fats sections below, grains with some added sugars and saturated fats can fit within healthy eating patterns.

How To Make at Least Half of Grains Whole Grains

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A food is a 100-percent whole-grain food if the only grains it contains are whole grains. One ounce-equivalent of whole grains has 16 g of whole grains. The recommendation to consume at least half of total grains as whole grains can be met in a number of ways.

The most direct way to meet the whole grain recommendation is to choose 100 percent 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 grain in the ingredients 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 ingredients list.

Many grain foods contain both whole grains and refined grains. These foods also can help people meet the whole grain recommendation, especially if a considerable proportion of the grain ingredients is whole grains. Another way to meet the recommendation to make at least half of grains whole grains is to choose products with at least 50 percent of the total weight as whole-grain ingredients.[14],[15] If a food has at least 8 g of whole grains per ounce-equivalent, it is at least half whole grains.[16] Some product labels show the whole grains health claim or the grams of whole grain in the product. This information may help people identify food choices that have a substantial amount of whole grains.

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