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Page 1 — 2015-2020 Dietary Guidelines for Americans • Introduction
Introduction from Dietary Guidelines for Americans 2015-2020 comprises public domain material from the US
Department of Agriculture and the US Department of Health and Human Services.
very 5 years since 1980, a new
edition of the Dietary Guidelines
for Americans has been published.
Its goal is to make recommendations
about the components of a healthy
and nutritionally adequate diet to
help promote health and prevent
chronic disease for current and future
generations. Although many of its
recommendations have remained
relatively consistent over time, the
Dietary Guidelines has evolved as
scientific knowledge has grown. These
advancements have provided a greater
understanding of, and focus on, the
importance of healthy eating patterns
as a whole, and how foods and
beverages act synergistically to affect
health. Therefore, healthy eating
patterns is a focus of the 2015-2020
Dietary Guidelines.
Nutrition & Health
Are Closely Related
Over the past century, essential nutrient
deficiencies have dramatically decreased,
many infectious diseases have been
conquered, and the majority of the U.S.
population can now anticipate a long and
productive life. However, as infectious
disease rates have dropped, the rates of
noncommunicable diseases—specifically,
chronic diet-related diseases—have
risen, due in part to changes in lifestyle
behaviors. A history of poor eating and
physical activity patterns have a cumulative
effect and have contributed to significant
nutrition- and physical activity-related
health challenges that now face the U.S.
population. About half of all American
adults—117 million individuals—have
one or more preventable chronic diseases,
many of which are related to poor quality
eating patterns and physical inactivity. These
include cardiovascular disease, high blood
pressure, type 2 diabetes, some cancers,
and poor bone health. More than two-thirds
of adults and nearly one-third of children
and youth are overweight or obese. These
high rates of overweight and obesity and
chronic disease have persisted for more
than two decades and come not only with
increased health risks, but also at high
cost. In 2008, the medical costs associated
with obesity were estimated to be $147
billion. In 2012, the total estimated cost
of diagnosed diabetes was $245 billion,
including $176 billion in direct medical costs
and $69 billion in decreased productivity.[1]
Table I-1 describes the high rates of
nutrition- and physical activity-related
chronic diseases and their related
risk factors. These diseases affect all
ages—children, adolescents, adults,
and older adults—though rates vary by
several factors, including race/ethnicity,
income status, and body weight status.
Table I-1.
Facts About Nutrition & Physical Activity-Related
Health Conditions in the United States
Health Condition
& Obesity
• For more than 25 years, more than half of the adult population has been
overweight or obese.
• Obesity is most prevalent in those ages 40 years and older and in African
American adults, and is least prevalent in adults with highest incomes.
• Since the early 2000s, abdominal obesity[a] has been present in about
half of U.S. adults of all ages. Prevalence is higher with increasing age
and varies by sex and race/ethnicity.
• In 2009-2012, 65% of adult females and 73% of adult males were
overweight or obese.
• In 2009-2012, nearly one in three youth ages 2 to 19 years were
overweight or obese.
[1] For more information, see: Centers for Disease Control and Prevention (CDC). Chronic Disease Overview. August 26, 2015. Available at
Accessed November 3, 2015.
2015-2020 Dietary Guidelines for Americans • Introduction — Page 2
Table I-1.
Facts About Nutrition & Physical Activity-Related Health Conditions
in the United States
Health Condition
Cardiovascular Disease
(CVD) & Risk Factors:
Coronary Heart Disease
High Total Blood Cholesterol
Breast Cancer
Colorectal Cancer
Bone Health
• In 2010, CVD affected about 84 million men and women ages 20 years and
older (35% of the population).
• In 2007-2010, about 50% of adults who were normal weight, and nearly
three-fourths of those who were overweight or obese, had at least one
cardiometabolic risk factor (i.e., high blood pressure, abnormal blood lipids,
smoking, or diabetes).
• Rates of hypertension, abnormal blood lipid profiles, and diabetes are higher in
adults with abdominal obesity.
• In 2009-2012, almost 56% of adults ages 18 years and older had either
prehypertension (27%) or hypertension (29%).[b]
• In 2009-2012, rates of hypertension among adults were highest in African
Americans (41%) and in adults ages 65 years and older (69%).
• In 2009-2012, 10% of children ages 8 to 17 years had either borderline
hypertension (8%) or hypertension (2%).[c]
• In 2009-2012, 100 million adults ages 20 years or older (53%) had total
cholesterol levels ≥200 mg/dL; almost 31 million had levels ≥240 mg/dL.
• In 2011-2012, 8% of children ages 8 to 17 years had total cholesterol levels
≥200 mg/dL.
• In 2012, the prevalence of diabetes (type 1 plus type 2) was 14% for men and
11% for women ages 20 years and older (more than 90% of total diabetes in
adults is type 2).
• Among children with type 2 diabetes, about 80% were obese.
• Breast cancer is the third leading cause of cancer death in the United States.
• In 2012, an estimated 3 million women had a history of breast cancer.
• Colorectal cancer is the second leading cause of cancer death in the
United States.
• In 2012, an estimated 1.2 million adult men and women had a history of
colorectal cancer.
• A higher percent of women are affected by osteoporosis (15%) and low bone
mass (51%) than men (about 4% and 35%, respectively).
• In 2005-2010, approximately 10 million (10%) adults ages 50 years and older
had osteoporosis and 43 million (44%) had low bone mass.
[a] Abdominal obesity, as measured by waist circumference, is defined as a waist circumference of >102 centimeters in men and >88 centimeters
in women.
[b] For adults, prehypertension was defined as a systolic blood pressure of 120-139 mm mercury (Hg) or diastolic blood pressure of 80-89 mm Hg among those who
were not currently being treated for hypertension. Hypertension was defined as systolic blood pressure (SBP) >140 mm Hg, diastolic blood pressure (DBP) >90 mm Hg,
or taking antihypertensive medication.
[c] For children, borderline hypertension was defined as systolic or diastolic blood pressure at the 90th percentile or higher but lower than the 95th percentile or as
blood pressure levels of 120/80 mm Hg or higher (but less than the 95th percentile). Hypertension was defined as a systolic or diastolic blood pressure at the 95th
percentile or higher.
[d] The types of cancer included here are not a complete list of all diet- and physical activity-related cancers.
Page 3 — 2015-2020 Dietary Guidelines for Americans • Introduction
Concurrent with these diet-related health
problems persisting at high levels, trends
in food intake over time show that, at
the population level, Americans are not
consuming healthy eating patterns. For
example, the prevalence of overweight
and obesity has risen and remained high
for the past 25 years, while Healthy Eating
Index (HEI) scores, a measure of how food
choices align with the Dietary Guidelines,
have remained low (Figure I-1). Similarly,
physical activity levels have remained low
over time (Figure I-2). The continued high
rates of overweight and obesity and low
levels of progress toward meeting Dietary
Guidelines recommendations highlight
the need to improve dietary and physical
activity education and behaviors across
the U.S. population. Progress in reversing
these trends will require comprehensive
and coordinated strategies, built on
the Dietary Guidelines as the scientific
foundation, that can be maintained over
time. The Dietary Guidelines is an important
part of a complex and multifaceted
solution to promoting health and helping
to reduce the risk of chronic disease.
Figure I-1.
Adherence of the U.S. Population Ages 2 Years and Older to the
2010 Dietary Guidelines, as Measured by Average Total Healthy
Eating Index-2010 (HEI-2010) Scores
Maximum Total Score
HEI-2010 Total Score
Cycle of NHANES
DATA SOURCES: Analyses of What We Eat in America, National Health and Nutrition Examination Survey (NHANES) data from 1999-2000 through 2009-2010.
NOTE: HEI-2010 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.
2015-2020 Dietary Guidelines for Americans • Introduction — Page 4
Figure I-2.
Percentage of Adults Meeting the Physical Activity Guidelines
(Aerobic & Muscle-Strengthening Recommendations)
All Adults
75 85 +
DATA SOURCES: Analyses of the National Health Interview Survey, 2008 and 2013.
Healthy People 2020 PA-2.4. Increase the proportion of adults who meet the objectives for aerobic physical activity and for muscle-strengthening
activity. Washington, DC: U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion, June 3, 2015. Available
– 5072.
The Dietary Guidelines
for Americans: What It
Is, What It Is Not
The main purpose of the Dietary Guidelines
is to inform the development of Federal food,
nutrition, and health policies and programs.
The primary audiences are policymakers, as
well as nutrition and health professionals,
not the general public. The Dietary Guidelines
is a critical tool for professionals to help
Americans make healthy choices in their daily
lives to help prevent chronic disease and enjoy
a healthy diet. It serves as the evidence-based
foundation for nutrition education materials
that are developed by the Federal Government
for the public. For example, Federal dietary
guidance publications are required by law to
be consistent with the Dietary Guidelines. It
also is used to inform USDA and HHS food
programs, such as USDA’s National School
Lunch Program and School Breakfast Program,
which feed more than 30 million children each
Page 5 — 2015-2020 Dietary Guidelines for Americans • Introduction
school day, and the Special Supplemental
Nutrition Program for Women, Infants and
Children, which uses the Dietary Guidelines
as the scientific underpinning for its food
packages and nutrition education program
with about 8 million beneficiaries. In HHS,
the Administration on Aging implements
the Dietary Guidelines through the Older
Americans Act Nutrition Services programs
(i.e., nutrition programs for older adults),
with about 5,000 community-based nutrition
service providers who together serve more
The Importance
of Physical
Activity in a
Healthy Lifestyle
Although the primary focus of the
Dietary Guidelines is on nutrition
recommendations, physical activity
is mentioned throughout this
edition because of its critical and
complementary role in promoting
good health and preventing disease,
including many diet-related chronic
diseases. The following chapters
note the role of physical activity
in improving health and reducing
chronic disease risk; describe the gap
between current physical activity
recommendations and reported
levels of activity; and discuss how the
settings in which people live, learn,
work, and play can be enhanced to
encourage increased physical activity.
For more information, see the Physical
Activity Guidelines for Americans
than 900,000 meals a day across the United
States. Other Departments, such as the
Department of Defense and the Department
of Veterans Affairs, also use the Dietary
Guidelines to inform programs. The Dietary
Guidelines also may be used to inform the
development of programs, policies, and
communication by audiences other than
the document’s principal audiences. These
audiences, who share the common goal of
serving the general public, include businesses,
schools, community groups, media, the food
industry, and State and local governments.
The 2015-2020 Dietary Guidelines translates
science into succinct, food-based guidance
that can be relied upon to help Americans
choose foods that provide a healthy and
enjoyable diet. Its recommendations are
ultimately intended to help individuals
improve and maintain overall health and
reduce the risk of chronic disease—its focus
is disease prevention. The Dietary Guidelines
is not intended to be used to treat disease.
Regardless of an individual’s current health
status, almost all people in the United States
could benefit from shifting choices to better
support healthy eating patterns. Thus, the
Dietary Guidelines may be used or adapted
by medical and nutrition professionals to
encourage healthy eating patterns to patients.
Developing the Dietary
Guidelines for Americans
A greater understanding of the relationships
between nutrition and human health has and
will continue to evolve over time. Creating
each edition of the Dietary Guidelines is
a joint effort of HHS and USDA. A new
edition is published every 5 years to reflect
advancements in scientific knowledge and
translate the science current at the time
into sound food-based guidance to promote
health in the United States.[2] The process
to develop the Dietary Guidelines has
also evolved and includes three stages.
Figure I-3.
Science, Policy, Implementation:
Developing the 2015-2020 Dietary Guidelines for Americans
To develop each edition of the Dietary Guidelines for Americans, HHS and USDA collaborate during a 3-stage process.
Review the Science
First, an external Advisory Committee
creates the Advisory Report and submits
it to the Secretaries of HHS and USDA.
This report is informed by:

Original systematic reviews

Review of existing systematic
reviews, meta-analyses, and
reports by Federal agencies or
leading scientific organizations

Data analyses

Food pattern modeling analyses
Develop the Dietary Guidelines
Using the previous edition of the Dietary Guidelines, the
Advisory Report, and consideration of public and Federal
agency comments, HHS and USDA develop a new edition of
the Dietary Guidelines. The 2015-2020 Dietary Guidelines for
Americans includes:
5 Guidelines
Key Recommendations that support the Guidelines
Implement the
Dietary Guidelines
Federal programs apply
the Dietary Guidelines
to meet the needs of
Americans through food,
nutrition, and health
policies and programs—
and in nutrition education
materials for the public.
Science-based nutrition guidance for both professionals
and organizations working to improve our nation’s health.
[2] Public Law 101-445, Title III, Section 301, 7 U.S.C. 5341 et seq. requires that the U.S. Departments of Health and Human Services and of Agriculture publish a new edition of the Dietary Guidelines for
Americans every 5 years.
2015-2020 Dietary Guidelines for Americans • Introduction — Page 6
Stage 1:
Review of Current
Scientific Evidence
In the first stage, the Secretaries of
HHS and of USDA appoint an external
Dietary Guidelines Advisory Committee
(Advisory Committee). The use of a
Federal advisory committee is to ensure
the Federal Government is seeking
sound external scientific advice to
inform policy decisions. Nominations
from the public were sought for
candidates to serve on the 2015 Advisory
Committee. The 15 members of the 2015
Advisory Committee are prestigious
researchers in the fields of nutrition,
health, and medicine. Their role was to
provide advice and recommendations
to the Federal Government on the
current state of scientific evidence
on nutrition and health. Per Federal
Advisory Committee Act rules, Advisory
Committee members were thoroughly
vetted for conflicts of interest before
they were appointed to their positions
and were required to submit a
financial disclosure form annually.
The 2015 Advisory Committee was
charged with reviewing the 2010 edition
of the Dietary Guidelines to determine
the topics for which new scientific
evidence was likely to be available, and
to review that evidence to inform the
development of the 2015-2020 edition.
The Advisory Committee was asked to
place primary emphasis on evidence
published since the 2010 Advisory
Committee completed its work and on
evidence to support the development of
food-based recommendations that are of
public health importance for Americans
ages 2 years and older. It met in public
meetings to discuss its findings and
develop its recommendations. The public
was invited to submit written comments
to the Advisory Committee throughout
the entirety of its work as well as
oral comments at a public meeting.
The 2015 Advisory Committee used four
state-of-the-art approaches to review and
analyze the available evidence: original
systematic reviews; existing systematic
reviews, meta-analyses, and reports by
Federal agencies or leading scientific
organizations; data analyses; and food
pattern modeling analyses. Most of its
conclusion statements on nutrition and
health were informed by systematic
reviews, which are a gold standard for
informing clinical practice guidelines
and public health policies worldwide.
The Dietary Reference Intakes (DRIs), as
set by the Institute of Medicine (IOM),
also serve as a source of evidence for
the Advisory Report and the Dietary
Guidelines. This multifaceted approach
allowed the Advisory Committee to
ask and answer scientific questions
about the relationship of diet and
health to systematically, objectively,
and transparently synthesize research
findings and to limit bias in its evaluation
of the totality of the evidence for the
topics it reviewed. This approach
also allowed one or more methods
to be used that were best suited to
comprehensively answer each question.
These methods are described here.
Page 7 — 2015-2020 Dietary Guidelines for Americans • Introduction
• Original Systematic Reviews.
The Advisory Committee used this
approach to systematically search
the scientific literature for relevant
articles; assess the methodologic
rigor of each included article; and
summarize, analyze, and grade the
evidence presented in the articles.
For systematic reviews, all studies
published by the time the literature
search was conducted were screened
for inclusion to ensure all available
evidence was reviewed in a systematic
manner. To preserve the integrity of the
process, individual studies that were
published after the systematic review
was concluded were not included
on an ad hoc basis. Recent studies
that were not included in the 2015
Advisory Committee’s review will be
available for consideration during the
development of the next edition of the
Dietary Guidelines.
The USDA Nutrition Evidence Library
(NEL) uses a systematic review
methodology designed to analyze
food, nutrition, and public health
science. The medical field has used
systematic reviews as the standard
practice for more than 25 years to
inform the development of national
guidelines for health professionals.
• Review of Existing Systematic
Reviews, Meta-Analyses, and
Reports by Federal Agencies or
Leading Scientific Organizations.
The Advisory Committee used this
method when a high-quality existing
review or report had already addressed
a question under consideration.
The approach involved applying a
systematic process to assess the
quality of the existing revie …
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