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US dietary guidelines offer new guidance for infants, toddlers

Image courtesy of U.S. Departments of Agriculture and Health and Human Services.

December 30, 2020

The U.S. Departments of Agriculture and Health and Human Services have jointly published the Dietary Guidelines for Americans, 2020-2025. The guidelines, released every five years, provide science-based recommendations designed to foster healthy dietary patterns for Americans of all ages, according to a press release.

The latest edition expands the guidance for the first time to include recommended healthy dietary patterns for infants and toddlers.

The guidelines are designed for use by healthcare professionals and policy makers for outreach to the general public and provides nutritional foundation for federal nutrition programs. The guidelines should not be considered clinical guidelines for the treatment of disease.

"USDA and HHS have expanded this edition of the dietary guidelines to provide new guidance for infants, toddlers and pregnant and breastfeeding women, helping all Americans to improve their health, no matter their age or life stage," HHS Secretary Alex Azar said in the release.

The key recommendations look similar to those of the past and address two topics that garnered much attention throughout the development of the guidelines — added sugars and alcoholic beverages.

Dietary Guidelines for Americans, 2020-2025 carried forward the committee's emphasis on limiting these dietary components, but did not include changes to quantitative recommendations, as there was not a preponderance of evidence in the material the committee reviewed to support specific changes, as required by law. As in previous editions, limited intake of these two food components is encouraged and complements the four overarching guidelines, which encourage Americans to "Make Every Bite Count" by:

• Following a healthy dietary pattern at every life stage.
• Customizing and enjoying nutrient-dense food and beverage choices to reflect personal preferences, cultural traditions and budgetary considerations.
• Focusing on meeting food group needs with nutrient-dense foods and beverages from five food groups — vegetables, fruits, grains, dairy and fortified soy alternatives, and proteins — and staying within calorie limits.
• Limiting foods and beverages higher in added sugars, saturated fat, and sodium, and limiting alcoholic beverages.

The guidelines are:
1. Follow a healthy dietary pattern at every life stage.

• For about the first six months, 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 six months, introduce infants to nutrient-dense complementary foods. Introduce infants to potentially 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.

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

4. Limit foods and beverages higher in added sugars, saturated fat and sodium, and limit 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% of calories per day starting at age two. Avoid foods and beverages with added sugars for those younger than age two.
• Saturated fat — Less than 10% of calories per day starting at age two.
• 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 by limiting intake to two drinks or less in a day for men and one drink or 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.