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Dietary Guidelines for Americans

U.S. Department of Agriculture U.S. Department of Health and Human Services www.dietaryguidelines.gov

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TABLE 2 2. Top 25 Sources of Calories Among Americans Ages 2 Years and Older, a NHANES 2005–2006

Rank Overall, Ages 2+ yrs (Mean kcal/d; Total daily calories = 2,157)

Children and Adolescents, Ages 2–18 yrs (Mean kcal/d; Total daily calories = 2,027)

Adults and Older Adults, Ages 19+ yrs (Mean kcal/d; Total daily calories = 2,199)

1 Grain-based dessertsb (138 kcal) Grain-based desserts (138 kcal) Grain-based desserts (138 kcal)

2 Yeast breadsc (129 kcal) Pizza (136 kcal) Yeast breads (134 kcal)

3 Chicken and chicken mixed dishesd

(121 kcal) Soda/energy/sports drinks (118 kcal) Chicken and chicken mixed dishes

(123 kcal)

4 Soda/energy/sports drinkse (114 kcal) Yeast breads (114 kcal) Soda/energy/sports drinks (112 kcal)

5 Pizza (98 kcal) Chicken and chicken mixed dishes (113 kcal)

Alcoholic beverages (106 kcal)

6 Alcoholic beverages (82 kcal) Pasta and pasta dishes (91 kcal) Pizza (86 kcal)

7 Pasta and pasta dishesf (81 kcal) Reduced fat milk (86 kcal) Tortillas, burritos, tacos (85 kcal)

8 Tortillas, burritos, tacosg (80 kcal) Dairy desserts (76 kcal) Pasta and pasta dishes (78 kcal)

9 Beef and beef mixed dishesh (64 kcal) Potato/corn/other chips (70 kcal) Beef and beef mixed dishes (71 kcal)

10 Dairy dessertsi (62 kcal) Ready-to-eat cereals (65 kcal) Dairy desserts (58 kcal)

11 Potato/corn/other chips (56 kcal) Tortillas, burritos, tacos (63 kcal) Burgers (53 kcal)

12 Burgers (53 kcal) Whole milk (60 kcal) Regular cheese (51 kcal)

13 Reduced fat milk (51 kcal) Candy (56 kcal) Potato/corn/other chips (51 kcal)

14 Regular cheese (49 kcal) Fruit drinks (55 kcal) Sausage, franks, bacon, and ribs (49 kcal)

15 Ready-to-eat cereals (49 kcal) Burgers (55 kcal) Nuts/seeds and nut/seed mixed dishes (47 kcal)

16 Sausage, franks, bacon, and ribs (49 kcal)

Fried white potatoes (52 kcal) Fried white potatoes (46 kcal)

17 Fried white potatoes (48 kcal) Sausage, franks, bacon, and ribs (47 kcal)

Ready-to-eat cereals (44 kcal)

18 Candy (47 kcal) Regular cheese (43 kcal) Candy (44 kcal)

19 Nuts/seeds and nut/seed mixed dishesj (42 kcal)

Beef and beef mixed dishes (43 kcal) Eggs and egg mixed dishes (42 kcal)

20 Eggs and egg mixed dishesk (39 kcal) 100% fruit juice, not orange/grapefruit (35 kcal)

Rice and rice mixed dishes (41 kcal)

21 Rice and rice mixed dishesl (36 kcal) Eggs and egg mixed dishes (30 kcal) Reduced fat milk (39 kcal)

22 Fruit drinksm (36 kcal) Pancakes, waffles, and French toast (29 kcal)

Quickbreads (36 kcal)

23 Whole milk (33 kcal) Crackers (28 kcal) Other fish and fish mixed disheso

(30 kcal)

24 Quickbreadsn (32 kcal) Nuts/seeds and nut/seed mixed dishes (27 kcal)

Fruit drinks (29 kcal)

25 Cold cuts (27 kcal) Cold cuts (24 kcal) Salad dressing (29 kcal)

a. Data are drawn from analyses of usual dietary intakes conducted by the National Cancer Institute. Foods and beverages consumed were divided into 97 categories and ranked according to calorie contribution to the diet. Table shows each food category and its mean calorie contribution for each age group. Additional information on calorie contribution by age, gender, and race/ethnicity is available at http://riskfactor.cancer.gov/diet/foodsources/. b. Includes cake, cookies, pie, cobbler, sweet rolls, pastries, and donuts. c. Includes white bread or rolls, mixed-grain bread, flavored bread, whole- wheat bread, and bagels. d. Includes fried or baked chicken parts and chicken strips/patties, chicken stir-fries, chicken casseroles, chicken sandwiches, chicken salads, stewed chicken, and other chicken mixed dishes. e. Sodas, energy drinks, sports drinks, and sweetened bottled water including vitamin water. f. Includes macaroni and cheese, spaghetti, other pasta with or without sauces, filled pasta (e.g., lasagna and ravioli), and noodles.

g. Also includes nachos, quesadillas, and other Mexican mixed dishes. h. Includes steak, meatloaf, beef with noodles, and beef stew. i. Includes ice cream, frozen yogurt, sherbet, milk shakes, and pudding. j. Includes peanut butter, peanuts, and mixed nuts. k. Includes scrambled eggs, omelets, fried eggs, egg breakfast sandwiches/ biscuits, boiled and poached eggs, egg salad, deviled eggs, quiche, and egg substitutes. l. Includes white rice, Spanish rice, and fried rice. m. Includes fruit-flavored drinks, fruit juice drinks, and fruit punch. n. Includes muffins, biscuits, and cornbread. o. Fish other than tuna or shrimp.

Source: National Cancer Institute. Food sources of energy among U.S. population, 2005-2006. Risk Factor Monitoring and Methods. Control and Population Sciences. National Cancer Institute; 2010. http://riskfactor. cancer.gov/diet/foodsources/. Updated May 21, 2010. Accessed May 21, 2010.

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Table 2-2 provides the top sources of calories among Americans ages 2 years and older.32 The table reveals some expected differences in intake between younger (ages 2 to 18 years) and adult (ages 19 years and older) Americans. For example, alcoholic beverages are a major calorie source for adults, while fluid milk provides a greater contribution to calorie intake for children and adolescents. Further, while not shown in the table,33 there is additional variability in calorie sources among children, adolescents, and adults of different ages. For example, sugar-sweetened bever- ages34 and pizza are greater calorie contributors for those ages 9 to 18 years than for younger children. Also, dairy desserts35 and ready-to-eat cereals provide a greater contribution to calorie intake for those ages 71 years and older than they do among younger adults.

Although some of the top calorie sources by category are important sources of essential nutrients, others provide calories with few essential nutrients. Many of the foods and beverages most often consumed within these top categories are in forms high in solid fats and/or added sugars, thereby contributing excess

calories to the diet. For example, many grain- based desserts36 are high in added sugars and solid fats, while many chicken dishes37 are both breaded and fried, which adds a substantial number of calories to the chicken.

FOR MORE INFORMATION See Chapters 3, 4, and 5 for detailed discussions of solid fats and added sug- ars, additional information about the current dietary intake of Americans, and recommendations for improvement.

CALORIE BALANCE: FOOD AND BEVERAGE INTAKE

Controlling calorie intake from foods and beverages is fundamental to achieving and attaining calorie balance. Understanding calorie needs, knowing food sources of calories, and recognizing associations between foods and beverages and higher or lower body weight are all important concepts when build- ing an eating pattern that promotes calorie balance and weight management. Many Americans are

unaware of how many calories they need each day or the calorie content of foods and beverages.

Understanding calorie needs The total number of calories a person needs each day varies depending on a number of factors, includ- ing the person’s age, gender, height, weight, and level of physical activity. In addition, a desire to lose, maintain, or gain weight affects how many calories should be consumed. Table 2-3 provides estimated total calorie needs for weight maintenance based on age, gender, and physical activity level. A more detailed table is provided in Appendix 6. Estimates range from 1,600 to 2,400 calories per day for adult women and 2,000 to 3,000 calories per day for adult men, depending on age and physical activity level. Within each age and gender category, the low end of the range is for sedentary individuals; the high end of the range is for active individuals. Due to reductions in basal metabolic rate that occurs with aging, calorie needs generally decrease for adults as they age. Estimated needs for young children range from 1,000 to 2,000 calories per day, and the range for older children and adolescents varies substantially from 1,400 to 3,200 calories per day, with boys generally having higher calorie needs than girls. These are only estimates, and estimation of individual calorie needs can be aided with online tools such as those available at MyPyramid.gov.

Knowing one’s daily calorie needs may be a useful reference point for determining whether the calories that a person eats and drinks are appropriate in relation to the number of calories needed each day. The best way for people to assess whether they are eating the appropriate number of calories is to monitor body weight and adjust calorie intake and participation in physical activity based on changes in weight over time. A calorie deficit of 500 calories or more per day is a common initial goal for weight loss for adults. However, maintaining a smaller deficit can have a meaningful influence on body weight over time. The effect of a calorie deficit on weight does not depend on how the deficit is produced—by reducing calorie intake, increasing expenditure, or both. Yet, in research studies, a greater proportion of

32. Data are drawn from analyses of usual dietary intakes conducted by the National Cancer Institute. Source: National Cancer Institute. Food sources of energy among U.S. population, 2005-2006. Risk Factor Monitoring and Methods. Cancer Control and Population Sciences. 2010. http://riskfactor.cancer. gov/diet/foodsources/. Updated May 21, 2010. Accessed May 21, 2010. 33. Additional information on the top calorie contributors for various age groups, as well as by gender and race/ethnicity, are available at http://riskfactor. cancer.gov/diet/foodsources/. 34. Sodas, energy drinks, sports drinks, and sweetened bottled water including vitamin water. 35. Includes ice cream, frozen yogurt, sherbet, milk shakes, and pudding. 36. Includes cake, cookies, pie, cobbler, sweet rolls, pastries, and donuts. 37. Includes fried or baked chicken parts and chicken strips/patties, chicken stir-fries, chicken casseroles, chicken sandwiches, chicken salads, stewed chicken, and other chicken mixed dishes.

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the calorie deficit is often due to decreasing calorie intake with a relatively smaller fraction due to increased physical activity.

Carbohydrate, protein, fat, and alcohol Carbohydrate, protein, and fat are the main sources of calories in the diet. Most foods and beverages contain combinations of these macronutrients in varying amounts. Alcohol also is a source of calories.

Carbohydrates provide 4 calories per gram and are the primary source of calories for most Americans. Carbohydrates are classified as simple, including sugars, or complex, including starches and fibers. Some sugars are found naturally in foods (such as lactose in

milk and fructose in fruit), whereas others are added to foods (such as table sugar added to coffee and high fructose corn syrup in sugar-sweetened beverages). Similarly, fiber can be naturally occurring in foods (such as in beans and whole grains) or added to foods. Most carbohydrate is consumed in the form of starches, which are found in foods such as grains, potatoes, and other starchy vegetables. A common source of starch in the American diet is refined grains. Starches also may be added to foods to thicken or stabilize them. Added sugars and added starches generally provide calories but few essential nutrients. Although most people consume an adequate amount of total carbohydrates, many people consume too much added sugar and refined grain and not enough fiber.

TABLE 2-3. Estimated Calorie Needs per Day by Age, Gender, and Physical a Activity Level

Estimated amounts of calories needed to maintain calorie balance for various gender and age groups at three different levels of physical activity. The estimates are rounded to the nearest 200 calories. An individual’s calorie needs may be higher or lower than these average estimates.

Physical Activity Levelb

Gender Age (years) Sedentary Moderately Active Active

Child (female and male) 2–3 1,000–1,200c 1,000–1,400c 1,000–1,400c

Femaled 4–8 1,200–1,400 1,400–1,600 1,400–1,800

9–13 1,400–1,600 1,600–2,000 1,800–2,200

14–18 1,800 2,000 2,400

19–30 1,800–2,000 2,000–2,200 2,400

31–50 1,800 2,000 2,200

51+ 1,600 1,800 2,000–2,200

Male 4–8 1,200–1,400 1,400–1,600 1,600–2,000

9–13 1,600–2,000 1,800–2,200 2,000–2,600

14–18 2,000–2,400 2,400–2,800 2,800–3,200

19–30 2,400–2,600 2,600–2,800 3,000

31–50 2,200–2,400 2,400–2,600 2,800–3,000

51+ 2,000–2,200 2,200–2,400 2,400–2,800

a. Based on Estimated Energy Requirements (EER) equations, using reference heights (average) and reference weights (healthy) for each age/gender group. For children and adolescents, reference height and weight vary. 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. EER equations are from the 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. b. Sedentary means a lifestyle that includes only the light physical activity associated with typical day-to-day life. 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 light physical activity associated with typical day-to-day life. 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 the light physical activity associated with typical day-to-day life. c. The calorie ranges shown are to accommodate needs of different ages within the group. For children and adolescents, more calories are needed at older ages. For adults, fewer calories are needed at older ages. d. Estimates for females do not include women who are pregnant or breastfeeding.

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Protein also provides 4 calories per gram. In addition to calories, protein provides amino acids that assist in building and preserving body muscle and tissues. Protein is found in a wide variety of animal and plant foods. Animal-based protein foods include seafood, meat, poultry, eggs, and milk and milk products. Plant sources of protein include beans and peas, nuts, seeds, and soy products. Inadequate protein intake in the United States is rare.

Fats provide more calories per gram than any other calorie source—9 calories per gram. Types of fat include saturated, trans, monounsaturated, and poly- unsaturated fatty acids. Some fat is found naturally in foods, and fat is often added to foods during prepara- tion. Similar to protein, inadequate intake of total fat is not a common concern in the United States. Most Americans consume too much saturated and trans fatty acids and not enough unsaturated fatty acids.

Alcoholic beverages are a source of calories but provide few nutrients. Alcohol is a top calorie contributor in the diets of many American adults.

Alcohol contributes 7 calories per gram, and the number of calories in an alcoholic beverage varies widely depending on the type of beverage consumed.

FOR MORE INF ORMATION See Chapters 3 and 4 for additional discussion about the macronutrients and alcohol.

Does macronutrient proportion make a difference for body weight? The Institute of Medicine has established ranges for the percentage of calories in the diet that should come from carbohydrate, protein, and fat. These Acceptable Macronutrient Distribution Ranges (AMDR) take into account both chronic disease risk reduction and intake of essential nutrients (Table 2-4).

To manage body weight, Americans should consume a diet that has an appropriate total number of calories and that is within the AMDR. Strong evidence shows that there is no optimal proportion of macronutrients that can facilitate weight loss or assist with maintain- ing weight loss. Although diets with a wide range of macronutrient proportions have been documented to promote weight loss and prevent weight regain after loss, evidence shows that the critical issue is not the relative proportion of macronutrients in the diet, but whether or not the eating pattern is reduced in calories and the individual is able to maintain a reduced-calorie intake over time. The total number of calories consumed is the essential dietary factor relevant to body weight. In adults, moderate evidence suggests that diets that are less than 45 percent of total calories as carbohydrate or more than 35 percent of total calories as protein are generally no more effec- tive than other calorie-controlled diets for long-term weight loss and weight maintenance. Therefore, individuals who wish to lose weight or maintain weight loss can select eating patterns that maintain appropriate calorie intake and have macronutrient proportions that are within the AMDR ranges recom- mended in the Dietary Reference Intakes.

Individual foods and beverages and body weight For calorie balance, the focus should be on total calorie intake, but intake of some foods and beverages that are widely over- or underconsumed has been associated with effects on body weight. In studies that have held total calorie intake constant, there is little evidence that any individual food groups or beverages have a unique impact on body weight. Although total calorie intake is ultimately what affects calorie balance, some foods and beverages can be easily overcon- sumed, which results in a higher total calorie intake. As individuals vary a great deal in their dietary intake, the

TABLE 2-4. Recommended Macronutrient Proportions by Age

Carbohydrate Protein Fat

Young children (1–3 years) 45–65% 5–20% 30–40%

Older children and adolescents (4–18 years) 45–65% 10–30% 25–35%

Adults (19 years and older) 45–65% 10–35% 20–35%

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.

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best advice is to monitor dietary intake and replace foods higher in calories with nutrient-dense foods and beverages relatively low in calories. The follow- ing guidance may help individuals control their total calorie intake and manage body weight:

• Increase intake of whole grains, vegetables, and fruits: Moderate evidence shows that adults who eat more whole grains, particularly those higher in dietary fiber, have a lower body weight compared to adults who eat fewer whole grains. Moderate evidence in adults and limited evidence in children and adoles- cents suggests that increased intake of vegetables and/or fruits may protect against weight gain.

• Reduce intake of sugar-sweetened beverages: This can be accomplished by drinking fewer sugar- sweetened beverages and/or consuming smaller portions. Strong evidence shows that children and adolescents who consume more sugar-sweetened beverages have higher body weight compared to those who drink less, and moderate evidence also supports this relationship in adults. Sugar- sweetened beverages provide excess calories and few essential nutrients to the diet and should only be consumed when nutrient needs have been met and without exceeding daily calorie limits.

• Monitor intake of 100% fruit juice for children and adolescents, especially those who are over- weight or obese: For most children and adoles- cents, intake of 100% fruit juice is not associated with body weight. However, limited evidence sug- gests that increased intake of 100% juice has been associated with higher body weight in children and adolescents who are overweight or obese.

• Monitor calorie intake from alcoholic beverages for adults: Moderate evidence suggests that moderate drinking of alcoholic beverages38 is not associated with weight gain. However, heavier than moderate consumption of alcohol over time is associated with weight gain. Because alcohol is often consumed in mixtures with other beverages, the calorie content of accompanying mixers should be considered when calculating the calorie content of alcoholic beverages. Reducing alcohol intake is a strategy that can be used by adults to consume fewer calories.

Strong evidence in adults and moderate evidence in children and adolescents demonstrates that con- sumption of milk and milk products does not play a special role in weight management. Evidence also

suggests that there is no independent relation- ship between the intake of meat and poultry or beans and peas, including soy, with body weight. Although not independently related to body weight, these foods are important sources of nutrients in healthy eating patterns.

FOR MORE INFORMATION See Chapters 3 and 4 for recommendations for individual food groups and components.

Placing individual food choices into an overall eating pattern Because people consume a variety of foods and beverages throughout the day as meals and snacks, a growing body of research has begun to describe overall eating patterns that help promote calorie balance and weight management. One aspect of these patterns that has been researched is the concept of calorie density, or the amount of calo- ries provided per unit of food weight. Foods high in water and/or dietary fiber typically have fewer calories per gram and are lower in calorie density, while foods higher in fat are generally higher in calorie density. A dietary pattern low in calorie density is characterized by a relatively high intake of vegetables, fruit, and dietary fiber and a relatively low intake of total fat, saturated fat, and added sugars. Strong evidence shows that eating patterns that are low in calorie density improve weight loss and weight maintenance, and also may be associ- ated with a lower risk of type 2 diabetes in adults. The USDA Food Patterns and the DASH Eating Plan, described in Chapter 5, are examples of eating pat- terns that are low in calorie density.

Although total calories consumed is important for calorie balance and weight management, it is important to consider the nutrients and other health- ful properties of food and beverages, as well as their calories, when selecting an eating pattern for optimal health. When choosing carbohydrates, Americans should emphasize naturally occurring carbohydrates, such as those found in whole grains, beans and peas, vegetables, and fruits, especially those high in dietary fiber, while limiting refined grains and intake of foods with added sugars. Glycemic index and glycemic load have been developed as measures of the effects of carbohydrate-containing foods and bever- ages on blood sugar levels. Strong evidence shows that glycemic index and/or glycemic load are not associated with body weight; thus, it is not necessary to consider

38. Moderate alcohol consumption is the consumption of up to one drink per day for women and up to two drinks per day for men.

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these measures when selecting carbohydrate foods and beverages for weight management. For protein, plant-based sources and/or animal-based sources can be incorporated into a healthy eating pattern. However, some protein products, particularly some animal-based sources, are high in saturated fat, so non-fat, low-fat, or lean choices should be selected. Fat intake should emphasize monounsaturated and polyunsaturated fats, such as those found in seafood, nuts, seeds, and oils.

FOR MORE INF ORMATION See Chapter 5 for addi- tional discussion of eating patterns that meet nutrient needs within calorie limits.

Americans should move toward more healthful eating patterns. Overall, as long as foods and beverages consumed meet nutrient needs and calorie intake is

appropriate, individuals can select an eating pat- tern that they enjoy and can maintain over time. Individuals should consider the calories from all foods and beverages they consume, regardless of when and where they eat or drink.

CALORIE BALANCE: PHYSICAL ACTIVITY

Physical activity is the other side of the calorie balance equation and should be considered when addressing weight management. In 2008, the U.S. Department of Health and Human Services released a comprehensive set of physical activity recommendations for Americans ages 6 years and older. Weight management along with health outcomes, including premature (early) death, diseases (such as coronary heart disease, type 2 diabetes, and osteoporosis), and risk factors for disease (such as high blood pressure and high blood cholesterol) were among the outcomes considered in developing the 2008 Physical Activity Guidelines for Americans.39 Getting adequate amounts of physical activity conveys many health benefits independent of body weight.

Strong evidence supports that regular participation in physical activity also helps people maintain a healthy weight and prevent excess weight gain. Further, physi- cal activity, particularly when combined with reduced calorie intake, may aid weight loss and maintenance of weight loss. Decreasing time spent in sedentary behav- iors also is important as well. Strong evidence shows that more screen time, particularly television viewing,

is associated with overweight and obesity in children, adolescents, and adults. Substituting active pursuits for sedentary time can help people manage their weight and provides other health benefits.

The 2008 Physical Activity Guidelines for Americans provides guidance to help Americans improve their health, including weight management, through appropriate physical activity (see Table 2-5). The amount of physical activity necessary to successfully maintain a healthy body weight depends on calorie intake and varies considerably among adults, includ- ing older adults. To achieve and maintain a healthy body weight, adults should do the equivalent40 of 150 minutes of moderate-intensity aerobic activity each week. If necessary, adults should increase their weekly minutes of aerobic physical activity gradually over time and decrease calorie intake to a point where they can achieve calorie balance and a healthy weight. Some adults will need a higher level of physical activ- ity than others to achieve and maintain a healthy body weight. Some may need more than the equivalent of 300 minutes per week of moderate-intensity activity.

For children and adolescents ages 6 years and older, 60 minutes or more of physical activity per day is rec- ommended. Although the Physical Activity Guidelines do not include a specific quantitative recommendation for children ages 2 to 5 years, young children should play actively several times each day. Children and adolescents are often active in short bursts of time rather than for sustained periods of time, and these short bursts can add up to meet physical activity needs. Physical activities for children and adolescents of all ages should be developmentally appropriate and enjoyable, and should offer variety.

PRINCIPLES FOR PROMOTING CALORIE BALANCE AND WEIGHT MANAGEMENT

To address the current calorie imbalance in the United States, individuals are encouraged to become more conscious of what they eat and what they do. This means increasing awareness of what, when, why, and how much they eat, deliberately making better choices regarding what and how much they consume, and seeking ways to be more physically active. Several behaviors and practices have been shown to help people manage their food and beverage intake and calorie expenditure and ultimately manage body

39. U.S. Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans. Washington (DC): U.S. Department of Health and Human Services; 2008. Office of Disease Prevention and Health Promotion Publication No. U0036. http://www.health.gov/paguidelines. Accessed August 12, 2010. 40. One minute of vigorous-intensity physical activity counts as two minutes of moderate-intensity physical activity toward meeting the recommendations.

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TABLE 2-5. 2008 Physical Activity Guidelines

Age group Guidelines

6 to 17 years Children and adolescents should do 60 minutes (1 hour) or more of physical activity daily.

• Aerobic: Most of the 60 or more minutes a day should be either moderatea- or vigorousb- intensity aerobic physical activity, and should include vigorous-intensity physical activity at least 3 days a week.

• Muscle-strengthening:c As part of their 60 or more minutes of daily physical activity, children and adolescents should include muscle-strengthening physical activity on at least 3 days of the week.

• Bone-strengthening:d As part of their 60 or more minutes of daily physical activity, children and adolescents should include bone-strengthening physical activity on at least 3 days of the week.

• It is important to encourage young people to participate in physical activities that are appropriate for their age, that are enjoyable, and that offer variety.

18 to 64 years • All adults should avoid inactivity. Some physical activity is better than none, and adults who participate in any amount of physical activity gain some health benefits.

• For substantial health benefits, adults should do at least 150 minutes (2 hours and 30 minutes) a week of moderate-intensity, or 75 minutes (1 hour and 15 minutes) a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic activity. Aerobic activity should be performed in episodes of at least 10 minutes, and preferably, it should be spread throughout the week.

• For additional and more extensive health benefits, adults should increase their aerobic physi- cal activity to 300 minutes (5 hours) a week of moderate-intensity, or 150 minutes a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity activity. Additional health benefits are gained by engaging in physical activity beyond this amount.

• Adults should also include muscle-strengthening activities that involve all major muscle groups on 2 or more days a week.

65 years and older

• Older adults should follow the adult guidelines. When older adults cannot meet the adult guide- lines, they should be as physically active as their abilities and conditions will allow.

• Older adults should do exercises that maintain or improve balance if they are at risk of falling.

• Older adults should determine their level of effort for physical activity relative to their level of fitness.

• Older adults with chronic conditions should understand whether and how their conditions affect their ability to do regular physical activity safely.

a. Moderate-intensity physical activity: Aerobic activity that increases a person’s heart rate and breathing to some extent. On a scale relative to a person’s capacity, moderate-intensity activity is usually a 5 or 6 on a 0 to 10 scale. Brisk walking, dancing, swimming, or bicycling on a level terrain are examples. b. Vigorous-intensity physical activity: Aerobic activity that greatly increases a person’s heart rate and breathing. On a scale relative to a person’s capacity, vigorous-intensity activity is usually a 7 or 8 on a 0 to 10 scale. Jogging, singles tennis, swimming continuous laps, or bicycling uphill are examples. c. Muscle-strengthening activity: Physical activity, including exercise, that increases skeletal muscle strength, power, endurance, and mass. It includes strength training, resistance training, and muscular strength and endurance exercises. d. Bone-strengthening activity: Physical activity that produces an impact or tension force on bones, which promotes bone growth and strength. Running, jumping rope, and lifting weights are examples.

Source: Adapted from U.S. Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans. Washington (DC): U.S. Department of Health and Human Services; 2008. ODPHP Publication No. U0036. http://www.health.gov/paguidelines. Accessed August 12, 2010.

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weight. The behaviors with the strongest evidence related to body weight include:

• Focus on the total number of calories consumed. Maintaining a healthy eating pattern at an appropriate calorie level within the AMDR is advisable for weight management. Consuming an eating pattern low in calorie density may help to reduce calorie intake and improve body weight outcomes and overall health.

• Monitor food intake. Monitoring intake has been shown to help individuals become more aware of what and how much they eat and drink. The Nutrition Facts label found on food packaging pro- vides calorie information for each serving of food or beverage and can assist consumers in monitor- ing their intake. Also, monitoring body weight and

physical activity can help prevent weight gain and improve outcomes when actively losing weight or maintaining body weight following weight loss.

FOR MORE INFORMATION See Appendix 4 for more information about the Nutrition Facts label.

• When eating out, choose smaller portions or lower-calorie options. When possible, order a small-sized option, share a meal, or take home part of the meal. Review the calorie content of foods and beverages offered and choose lower-calorie options. Calorie information may be available on menus, in a pamphlet, on food wrappers, or online. Or, instead of eating out, cook and eat more meals at home.

• Prepare, serve, and consume smaller portions of foods and beverages, especially those high in calories. Individuals eat and drink more when provided larger portions. Serving and consuming smaller portions is associated with weight loss and weight maintenance over time.

• Eat a nutrient-dense breakfast. Not eating breakfast has been associated with excess body weight, especially among children and adolescents. Consuming breakfast also has been associated with weight loss and weight loss maintenance, as well as improved nutrient intake.

• Limit screen time. In children, adolescents, and adults, screen time, especially television viewing, is directly associated with increased overweight and obesity. Children and adolescents are encouraged to spend no more than 1 to 2 hours each day watching televi- sion, playing electronic games, or using the computer (other than for homework). Also, avoid eating while watching television, which can result in overeating.

Research has investigated additional principles that may promote calorie balance and weight manage- ment. However, the evidence for these behaviors is not as strong. Some evidence indicates that beverages are less filling than solid foods, such that the calories from beverages may not be offset by reduced intake of solid foods, which can lead to higher total calorie intake. In contrast, soup, par- ticularly broth or water-based soups, may lead to decreased calorie intake and body weight over time. Further, replacing added sugars with non-caloric sweeteners may reduce calorie intake in the short- term, yet questions remain about their effectiveness as a weight management strategy. Other behaviors have been studied, such as snacking and frequency of eating, but there is currently not enough evidence to support a specific recommendation for these behaviors to help manage body weight.

IMPROVING PUBLIC HEALTH THROUGH DIET AND PHYSICAL ACTIVITY

This chapter has focused on the two main elements in calorie balance—calories consumed and calories expended. These elements are critical for achiev- ing and maintaining an appropriate body weight throughout the lifespan, and they also have broader implications for the health of Americans.

Although obesity is related to many chronic health conditions, it is not the only lifestyle-related public health problem confronting the Nation. Eating pat- terns that are high in calories, but low in nutrients can leave a person overweight but malnourished. Nutritionally unbalanced diets can negatively affect a person’s health regardless of weight status. Such diets are related to many of the most common and costly health problems in the United States, particularly heart disease and its risk factors and type 2 diabetes. Similarly, a sedentary lifestyle increases risk of these diseases. Improved eat- ing patterns and increased physical activity have numerous health benefits beyond maintaining a healthy weight.

Improved nutrition, appropriate eating behaviors, and increased physical activity have tremendous potential to decrease the prevalence of overweight and obesity, enhance the public’s health, reduce morbidity and premature mortality, and reduce health care costs.

DIETARY GUIDELINES FOR AMERICANS, 2010 | Chapter Two

NCHS Data Brief ■ No. 49 ■ November 2010

u.s. depa

Trends in Intake of Energy and Macronutrients in Adults From 1999–2000 Through 2007–2008

Jacqueline d. Wright, dr.p.h., and chia-Yih Wang, ph.d.

Key findings

In 2007–2008 the average • energy intake for men was 2,504 kilocalories (kcals) and for women it was 1,771 kcals.

The average carbohydrate • intake was 47.9% of total kilocalories (% kcals) for men and 50.5% kcals for women; average protein intake was 15.9% kcals for men and 15.5% kcals for women; average total fat intake was 33.6% kcals for men and 33.5% kcals for women; and average saturated fat intake was 11.0% kcals for men and 11.1% kcals for women.

Energy intake appeared • relatively stable over the 10-year period from 1999–2008; there were no statistically significant linear increases or decreases in total energy intake.

There were statistically • significant trends in intake of the macronutrients: average carbohydrate intake decreased and average protein intake increased in both men and women.

The Surgeon General’s recent call for renewed efforts to address the high prevalence of obesity in the U.S. adult population highlights the need for better understanding of trends in consumption of energy and the macronutrients protein, carbohydrate, and fat (1). The National Health and Nutrition Examination Survey (NHANES) is the primary national data system that provides information to monitor the nutritional status of the U.S. population. A previous study using NHANES data to report on trends in intake of energy and macronutrients from 1971–1974 through 1999–2000 showed statistically significant increases in intake of energy and carbohydrate, and a decrease in intake of fat in men and women (2). The objectives of this report are to present current estimates of intake of energy and intake of protein, carbohydrate, total fat, and saturated fat, and to evaluate trends in intake of these nutrients over the past decade.

Keywords: nutrition surveys • caloric intake • diet • nutrients

What is the average energy intake for men and women?

In 2007–2008 the average energy intake for men was 2,504 kcals and for women it was 1,771 kcals (Figure 1).

rtment of health and human services centers for disease control and prevention

national center for health statistics

NOTE: Kcals are kilocalories. SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey.

kc al

s

Figure 1. Energy intake (kcals) by sex and race-ethnicity for adults aged 20 and over, 1999–2008

0

1,700

1,900

2,100

2,300

2,500

2,700

2,900

2007–20082005–20062003–20042001–20021999–2000

Mexican AmericanNon-Hispanic black

Non-Hispanic white All women

Mexican AmericanNon-Hispanic black

Non-Hispanic white

All men

Women

Men

NCHS Data Brief ■ No. 49 ■ November 2010

There were no statistically significant linear increases or decreases in total energy intake from 1999–2000 through 2007–2008. In 2007–2008, non-Hispanic white men had higher energy intakes than non-Hispanic black or Mexican-American men; however, these differences were not consistently significant across all earlier survey periods. No other differences were observed among other sex and race-ethnicity groups in 2007–2008.

What are the average macronutrient intakes for men and women?

In this report, intake of macronutrients is expressed as percent of total energy (% kcals). For 2007–2008, the average carbohydrate intake was 47.9% kcals for men and 50.5% kcals for women; average protein intake was 15.9% kcals for men and 15.5% kcals for women; average total fat intake was 33.6% kcals for men and 33.5% kcals for women; and average saturated fat intake was 11.0% kcals for men and 11.1% kcals for women (Figure 2).

■  2  ■

NOTE: Kcals are kilocalories. SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey.

Figure 2. Macronutrient intake (percent kcals) by sex in adults aged 20 and over, 1999–2008

P er

ce nt

k ca

ls

P er

ce nt

k ca

ls

0

10

20

30

40

50

60

Saturated fat

Protein

Fat

Carbohydrate

2007– 2008

2005– 2006

2003– 2004

2001– 2002

1999– 2000

0

10

20

30

40

50

60

Saturated fat

Protein

Fat

Carbohydrate

2007– 2008

2005– 2006

2003– 2004

2001– 2002

1999– 2000

WomenMen

NCHS Data Brief ■ No. 49 ■ November 2010

Were there any increases or decreases in carbohydrate intake in the population over the 10 years studied?

There was a decrease in carbohydrate intake in both men and women (Figure 2). There were trends in specific subgroups, including a decrease in carbohydrate intake in non-Hispanic white and black men and in non-Hispanic white women (Figure 3).

NOTE: Kcals are kilocalories. SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey.

Figure 3. Carbohydrate intake (percent kcals) by sex and race-ethnicity for adults aged 20 and over, 1999–2008

P er

ce nt

k ca

ls

P er

ce nt

k ca

ls

0

44

48

52

56

60

Mexican American

Non-Hispanic black

Non-Hispanic white

2007– 2008

2005– 2006

2003– 2004

2001– 2002

1999– 2000

0

44

48

52

56

60

Mexican American

Non-Hispanic black Non-Hispanic white

2007– 2008

2005– 2006

2003– 2004

2001– 2002

1999– 2000

WomenMen

Were there any increases or decreases in protein intake in the population over the 10 years studied?

There was an increase in protein intake in men and women (Figure 2); between 1999–2000 and 2007–2008 intake increased from 15.6% kcals to 15.9% kcals in men and it increased from 15.2% kcals to 15.5% kcals in women.

Were there any increases or decreases in intake of total fat in the population over the 10 years studied?

There were no significant trends in total fat intake in men and women of all race-ethnicities combined (Figure 2), however there was an increase in non-Hispanic black men and women; between 1999–2000 and 2007–2008 intake increased from 30.5% kcals to 33.7% kcals in non-Hispanic black men and it increased from 32.1% kcals to 34.4% kcals in non-Hispanic black women.

■  3  ■

NCHS Data Brief ■ No. 49 ■ November 2010

Were there any increases or decreases in intake of saturated fat in the population over the 10 years studied?

The increase in men and women was not statistically significant (Figure 2), but trends were seen in some subgroups with an increase in saturated fat intake in non-Hispanic black men and women and in non-Hispanic white women (Figure 4).

NOTE: Kcals are kilocalories. SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey.

Figure 4. Saturated fat intake (percent kcals) by sex and race-ethnicity for adults aged 20 and over, 1999–2008

P er

ce nt

k ca

ls

P er

ce nt

k ca

ls

0

4

8

12

16

20

Mexican AmericanNon-Hispanic black

Non-Hispanic white

2007– 2008

2005– 2006

2003– 2004

2001– 2002

1999– 2000

0

4

8

12

16

20

Mexican AmericanNon-Hispanic black

Non-Hispanic white

2007– 2008

2005– 2006

2003– 2004

2001– 2002

1999– 2000

WomenMen

Were there differences in nutrient intake between sex and race-ethnicity groups examined here that persisted across each of the five 2-year survey periods in the 10 years studied?

Men consume more total calories than women. Carbohydrate intake was higher in women than in men. Saturated fat intake was lower in Mexican-American men than in non-Hispanic white men.

■  4  ■

NCHS Data Brief ■ No. 49 ■ November 2010

Summary

These results show that while population energy intakes have been relatively stable over the past decade, there have been changes in intake of some macronutrients. Although these changes are modest in magnitude, they indicate statistically significant population-level trends have occurred. Some of these trends warrant further investigation. In 2007–2008, none of the groups examined met the recommendation in the Dietary Guidelines for Americans to consume less than 10% of energy from saturated fat, and there was a statistically significant upward trend in non-Hispanic black men and women and in non-Hispanic white women (3).

The most recent analysis of trends in obesity for the period from 2007–2008 indicate no significant increase from 1999–2000 for women; there was a significant increase for men although only for the period from 1999–2000 to 2001–2002 (4). These trends are not inconsistent with the relatively stable trends in total energy intake, although many factors affect the trends in population levels of obesity.

It is important to consider trends in energy and macronutrient intakes in the development and evaluation of program and policy initiatives aimed at nutrition education and obesity prevention in the population. These findings show broad population trends and indicate the need for analyses to examine factors associated with these trends.

Definitions

Total energy intake: Includes energy intake from protein, carbohydrate, and total fat and energy intake from alcohol. Because intake from alcohol is not presented here, the sum of percent kcals for any group will not add to 100.

Calculation of percent kcals for macronutrients: Intake of macronutrients is given in grams on the data files and the following standard conversion factors are used to convert grams to kcals: 4 kcals/gram for protein and carbohydrate and 9 kcals/gram for total fat and saturated fat.

Total fat: Includes all forms of fat—saturated, polyunsaturated, and monounsaturated.

■  5  ■

9/23/15, 4:05 PMDon’t Take Your Vitamins - The New York Times

Page 1 of 4http://www.nytimes.com/2013/06/09/opinion/sunday/dont-take-your-vitamins.html?pagewanted=all&_r=0

http://nyti.ms/17xILfc

SundayReview | O P I N I O N

Don’t Take Your Vitamins By PAUL A. OFFIT JUNE 8, 2013

PHILADELPHIA — LAST month, Katy Perry shared her secret to good health with her 37 million followers on Twitter. “I’m all about that supplement & vitamin LYFE!” the pop star wrote, posting a snapshot of herself holding up three large bags of pills. There is one disturbing fact about vitamins, however, that Katy didn’t mention.

Derived from “vita,” meaning life in Latin, vitamins are necessary to convert food into energy. When people don’t get enough vitamins, they suffer diseases like scurvy and rickets. The question isn’t whether people need vitamins. They do. The questions are how much do they need, and do they get enough in foods?

Nutrition experts argue that people need only the recommended daily allowance — the amount of vitamins found in a routine diet. Vitamin manufacturers argue that a regular diet doesn’t contain enough vitamins, and that more is better. Most people assume that, at the very least, excess vitamins can’t do any harm. It turns out, however, that scientists have known for years that large quantities of supplemental vitamins can be quite harmful indeed.

In a study published in The New England Journal of Medicine in 1994, 29,000 Finnish men, all smokers, had been given daily vitamin E, beta carotene, both or a

9/23/15, 4:05 PMDon’t Take Your Vitamins - The New York Times

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placebo. The study found that those who had taken beta carotene for five to eight years were more likely to die from lung cancer or heart disease.

Two years later the same journal published another study on vitamin supplements. In it, 18,000 people who were at an increased risk of lung cancer because of asbestos exposure or smoking received a combination of vitamin A and beta carotene, or a placebo. Investigators stopped the study when they found that the risk of death from lung cancer for those who took the vitamins was 46 percent higher.

Then, in 2004, a review of 14 randomized trials for the Cochrane Database found that the supplemental vitamins A, C, E and beta carotene, and a mineral, selenium, taken to prevent intestinal cancers, actually increased mortality.

Another review, published in 2005 in the Annals of Internal Medicine, found that in 19 trials of nearly 136,000 people, supplemental vitamin E increased mortality. Also that year, a study of people with vascular disease or diabetes found that vitamin E increased the risk of heart failure. And in 2011, a study published in the Journal of the American Medical Association tied vitamin E supplements to an increased risk of prostate cancer.

Finally, last year, a Cochrane review found that “beta carotene and vitamin E seem to increase mortality, and so may higher doses of vitamin A.”

What explains this connection between supplemental vitamins and increased rates of cancer and mortality? The key word is antioxidants.

Antioxidation vs. oxidation has been billed as a contest between good and evil. It takes place in cellular organelles called mitochondria, where the body converts food to energy — a process that requires oxygen (oxidation). One consequence of oxidation is the generation of atomic scavengers called free radicals (evil). Free radicals can damage DNA, cell membranes and the lining of arteries; not surprisingly, they’ve been linked to aging, cancer and heart disease.

To neutralize free radicals, the body makes antioxidants (good). Antioxidants

9/23/15, 4:05 PMDon’t Take Your Vitamins - The New York Times

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can also be found in fruits and vegetables, specifically in selenium, beta carotene and vitamins A, C and E. Some studies have shown that people who eat more fruits and vegetables have a lower incidence of cancer and heart disease and live longer. The logic is obvious. If fruits and vegetables contain antioxidants, and people who eat fruits and vegetables are healthier, then people who take supplemental antioxidants should also be healthier. It hasn’t worked out that way.

The likely explanation is that free radicals aren’t as evil as advertised. (In fact, people need them to kill bacteria and eliminate new cancer cells.) And when people take large doses of antioxidants in the form of supplemental vitamins, the balance between free radical production and destruction might tip too much in one direction, causing an unnatural state where the immune system is less able to kill harmful invaders. Researchers call this the antioxidant paradox.

Because studies of large doses of supplemental antioxidants haven’t clearly supported their use, respected organizations responsible for the public’s health do not recommend them for otherwise healthy people.

So why don’t we know about this? Why haven’t Food and Drug Administration officials made sure we are aware of the dangers? The answer is, they can’t.

In December 1972, concerned that people were consuming larger and larger quantities of vitamins, the F.D.A. announced a plan to regulate vitamin supplements containing more than 150 percent of the recommended daily allowance. Vitamin makers would now have to prove that these “megavitamins” were safe before selling them. Not surprisingly, the vitamin industry saw this as a threat, and set out to destroy the bill. In the end, it did far more than that.

Industry executives recruited William Proxmire, a Democratic senator from Wisconsin, to introduce a bill preventing the F.D.A. from regulating megavitamins. On Aug. 14, 1974, the hearing began.

Speaking in support of F.D.A. regulation was Marsha Cohen, a lawyer with the Consumers Union. Setting eight cantaloupes in front of her, she said, “You would need to eat eight cantaloupes — a good source of vitamin C — to take in barely

9/23/15, 4:05 PMDon’t Take Your Vitamins - The New York Times

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1,000 milligrams of vitamin C. But just these two little pills, easy to swallow, contain the same amount.” She warned that if the legislation passed, “one tablet would contain as much vitamin C as all of these cantaloupes, or even twice, thrice or 20 times that amount. And there would be no protective satiety level.” Ms. Cohen was pointing out the industry’s Achilles’ heel: ingesting large quantities of vitamins is unnatural, the opposite of what manufacturers were promoting.

A little more than a month later, Mr. Proxmire’s bill passed by a vote of 81 to 10. In 1976, it became law. Decades later, Peter Barton Hutt, chief counsel to the F.D.A., wrote that “it was the most humiliating defeat” in the agency’s history.

As a result, consumers don’t know that taking megavitamins could increase their risk of cancer and heart disease and shorten their lives; they don’t know that they have been suffering too much of a good thing for too long.

Paul A. Offit is the chief of the infectious diseases division of the Children’s Hospital of Philadelphia and the author of the forthcoming book “Do You Believe in Magic?: The Sense and Nonsense of Alternative Medicine.”

A version of this op-ed appears in print on June 9, 2013, on page SR4 of the New York edition with the headline: Don’t Take Your Vitamins.

© 2015 The New York Times Company

9/23/15, 4:04 PMFact or Fiction?: Vitamin Supplements Improve Your Health - Scientific American

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Fact or Fiction?: Vitamin Supplements Improve Your Health Americans pour billions of dollars into supplements every year—an investment in health or money down the drain?

By Coco Ballantyne | May 17, 2007 |

Vita means "life" in Latin, and vitamins are essential for life. The World Health Organization calls them the "magic wands" used by the body to synthesize enzymes, hormones and other chemical necessities. Unable to create vitamins from scratch, the body must fetch them from outside sources—typically food. But do the pills many pop for health deliver the same benefits? Humans need 13 vitamins to survive. Vitamins, also called "micronutrients" because they are required in minute quantities, can be grouped in two categories. There are those that dissolve in fat—A, D, E and K—and can accumulate in the body when consumed in excess. And there are those that are water soluble—C and B—which are easily excreted, as anyone who takes large quantities of vitamin C and riboflavin (B2) can testify. (Their urine is bright yellow or orange.)

The best way to get vitamins is through food, not vitamin pills, according to Susan Taylor Mayne, a professor at the Yale School of Public Health's Division of Chronic Disease Epidemiology. A major problem with supplements is that they deliver vitamins out of context, she says. The vitamins found in fruit, vegetables and other foods come with thousands of other phytochemicals, or plant nutrients that are not essential for life but may protect against cancer, cardiovascular disease, Alzheimer's disease and other chronic ailments. Carotenoids in carrots and tomatoes, isothiocyanates in broccoli and cabbage, and flavonoids in soy, cocoa and red wine are just a few examples.

The combined effect of all these vitamins and phytochemicals seems to have much greater power than one nutrient taken alone, Mayne explains. For example, lycopene—the carotenoid that gives tomatoes their red hue—has been associated with a lower risk for prostate cancer, causing many supplement makers to rush to market pills bearing this healthy stuff. But research suggests that taking it in supplement form does not confer the same benefit as eating tomatoes or tomato products, such as pasta sauce and ketchup, that preserve some of the tomato¿s chemical integrity.

A healthy diet is paramount, but is there ever a time for supplements? Meir Stampfer, professor of nutrition and epidemiology at the Harvard School of Public Health in Boston, recommends that healthy adults take a multivitamin and extra vitamin D, if they don't get a

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9/23/15, 4:04 PMFact or Fiction?: Vitamin Supplements Improve Your Health - Scientific American

Page 2 of 3http://www.scientificamerican.com/article/fact-or-fiction-vitamin-supplements-improve-health/?print=true

lot of sun. Taking more than the Institute of Medicine's recommended daily allowance (RDA) of certain vitamins may lower one's risk for certain chronic diseases, he says. For example, Stampfer's research suggests that men and women taking vitamin E supplements for years at a time have a lower risk for heart disease. "The evidence for benefit is weak," but there is also "good evidence for no harm" associated with taking 200, 400, or even 600 IUs (international units) per day, Stampfer explains. (The RDA levels for vitamin E are 22.5 IUs, or 15 milligrams, for men and women.)

Mayne disagrees, pointing to a recent meta-analysis suggesting that vitamin E supplementation increases mortality of all causes. "We can debate" whether this analysis shows that vitamin E supplements are harmful, she says, but "there certainly wasn't any benefit shown." With the possible exception of vitamin D, there is no need to consume more than the RDA of vitamins, Mayne contends. In fact, there is increasing evidence that excessive intake of certain micronutrients is deleterious.

SEE ALSO:

Mind: Animals Have More Social Smarts Than You May Think | Sustainability: How Modern Agriculture Can Save the Gorillas of Virunga | Tech: Are We on the Cusp of War—in Space? | The Sciences: The Mystery of the Cat's Inner Eyelid

Stampfer acknowledges that overdosing on certain vitamins can be dangerous. "The most common one to look out for is preformed [active form] … vitamin A. It does not take too much to get too much," he says. Try to avoid retinol, retinyl palmitate and retinyl acetate, which may increase the risk of hip fracture and certain birth defects when taken at levels exceeding 10,000 IUs.

But Mayne and Stampfer both agree that more randomized clinical trials are needed to determine the health effects of vitamin supplements—and that such supplements are critical for certain people. Many African-Americans and people living in sun-deprived areas are vitamin D–deficient and could benefit from supplements, Mayne explains. Pregnant women, and even women who might want to get pregnant, should be taking folic acid supplements to help prevent serious birth defects in their babies. People over 50 years of age can benefit from B12 supplementation because absorption of this vitamin in the digestive tract becomes less efficient with age, says Roberta Anding, spokeswoman for the American Dietetic Association. Finally, HIV-positive patients should take multivitamins to boost immunity and slow the rate of disease progression, says Wafaie Fawzi, professor of nutrition and epidemiology at the Harvard School of Public Health.

Ironically, "the people who are most likely to take vitamin supplements are the people who least need them," Mayne says. The affluent and health conscious are popping supplements faster than anyone. It may not be doing any good, and it could be harming them, she says. Anding concurs: "If you eat well, you probably don't need a multivitamin."

On the other hand, as Stampfer, who takes vitamin supplement himself, notes: "If I'm wrong, then I've wasted a few dollars. If I'm right, I've lowered my risk for some diseases I don't want to have."

9/23/15, 4:04 PMFact or Fiction?: Vitamin Supplements Improve Your Health - Scientific American

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  • DietaryGuidelines2010editv2
  • CDC diet breakdown
    • What is the average energy intake for men and women?
    • What are the average macronutrient intakes for men and women?
    • Were there any increases or decreases in carbohydrate intake in the population over the 10 years studied?
    • Were there any increases or decreases in protein intake in the population over the 10 years studied?
    • Were there any increases or decreases in intake of total fat in the population over the 10 years studied?
    • Were there any increases or decreases in intake of saturated fat in the population over the 10 years studied?
    • Were there differences in nutrient intake between sex and race-ethnicity groups examined here that persisted across each of the five 2-year survey periods in the 10 years studied?
    • Summary
    • Definitions
    • Data source and methods
    • About the authors
    • References
  • Don¹t Take Your Vitamins - The New York Times
  • Fact or Fiction Vitamin Supplements Improve Your Health Scientific American