The U.S. population consumes many different styles of eating patterns other than the “typical American pattern” that provides the basis for the Healthy U.S.-Style Eating Pattern (see Appendix 3 and Table 1-1). There are many ways to consume a healthy eating pattern, and the evidence to support multiple approaches has expanded over time. The Healthy Mediterranean-Style Eating Pattern and Healthy Vegetarian Eating Pattern, which were developed by modifying the Healthy U.S.-Style Eating Pattern, are two examples of healthy eating patterns individuals may choose based on personal preference. Similar to the Healthy U.S.-Style Eating Pattern, these patterns were designed to consider the types and proportions of foods Americans typically consume, but in nutrient-dense forms and appropriate amounts, which result in eating patterns that are attainable and relevant in the U.S. population. Additionally, healthy eating patterns can be flexible with respect to the intake of carbohydrate, protein, and fat within the context of the AMDR.
As with the Healthy U.S.-Style Eating Pattern, each provides recommended intakes at 12 different calorie levels (see Appendix 4 and Appendix 5). The 2,000 calorie level for each Pattern is shown here as an example (Table 1-2).
Table 1-2.Composition of the Healthy Mediterranean-Style and Healthy Vegetarian Eating Patterns at the 2,000-Calorie Level,a With Daily or Weekly Amounts From Food Groups, Subgroups, and Components
a Food group amounts shown in cup- (c) or ounce- (oz) equivalents (eq). Oils are shown in grams (g). Quantity equivalents for each food group are defined in Appendix 3. Amounts will vary for those who need less than 2,000 or more than 2,000 calories per day. See Appendix 4 and Appendix 5 for all 12 calorie levels of the patterns.
b Definitions for each food group and subgroup are provided throughout the chapter and are compiled in Appendix 3.
c Vegetarian patterns include 1½ cups per week of legumes as a vegetable subgroup, and an additional 6 oz-eq (1½ cups) per week of legumes as a protein food. The total amount is shown here as legumes in the vegetable group.
d The FDA and EPA provide additional guidance regarding seafood consumption for women who are pregnant or breastfeeding and young children. For more information, see the FDA or EPA websites www.FDA.gov/fishadvice;www.EPA.gov/fishadvice.
e Assumes food choices to meet food group recommendations are in nutrient-dense forms. Calories from added sugars, solid fats, added refined starches, alcohol, and/or to eat more than the recommended amount of nutrient-dense foods are accounted for under this category.
Note: The eating pattern should not exceed Dietary Guidelines limits for intake of added sugars, saturated fats, alcohol, and the AMDR for calories from protein, carbohydrate, and total fats. For some calorie patterns, there are not enough calories available after meeting food group needs to consume 10 percent of calories from added sugars and 10 percent of calories from saturated fats and still stay within calorie limits. Values are rounded.
Healthy Mediterranean-Style Eating Pattern
A Healthy Mediterranean-Style Eating Pattern (Appendix 4) was designed by modifying the Healthy U.S.-Style Eating Pattern, taking into account food group intakes from studies examining the associations between Mediterranean-Style eating patterns and health.
The Healthy Mediterranean-Style Eating Pattern contains more fruits and seafood and less dairy than does the Healthy U.S.-Style Eating Pattern. The healthfulness of the Healthy Mediterranean-Style Pattern was evaluated based on its similarity to Mediterranean-Style patterns described in studies with positive health outcomes rather than on meeting specified nutrient standards. However, nutrient content of the Pattern was assessed and found to be similar to the Healthy U.S.-Style Eating Pattern, except for calcium and vitamin D. Calcium and vitamin D are lower because the amounts of dairy were decreased, as shown in Appendix 4, to more closely match data from studies of Mediterranean-Style eating patterns.
Healthy Vegetarian Eating Pattern
A Healthy Vegetarian Eating Pattern (Appendix 5) replaces the previous Lacto-ovo Vegetarian Adaptation of the USDA Food Patterns from the 2010 Dietary Guidelines. The Healthy Vegetarian Eating Pattern was developed taking into account food choices of self-identified vegetarians in the National Health and Nutrition Examination Survey (NHANES) and provides recommendations to meet the Dietary Guidelines for those who follow a vegetarian pattern.
In comparison to the Healthy U.S.-Style Eating Pattern, the Healthy Vegetarian Eating Pattern includes more legumes (beans and peas), soy products, nuts and seeds, and whole grains. It contains no meats, poultry, or seafood, and is identical to the Healthy U.S.-Style Eating Pattern in amounts of all other food groups. The Pattern is similar in meeting nutrient standards to the Healthy U.S.-Style Pattern, but is somewhat higher in calcium and dietary fiber and lower in vitamin D, due to differences in the foods included in the protein foods group, specifically more tofu and beans and no seafood, as shown in Appendix 5.
 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.
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