Dietary Guidelines for Americans linked to lower death rates in population in southeast US

Adherence to the Dietary Guidelines for Americans (DGA) is linked to lower death rates in a low-income population in southeastern US.

In a low-income population from the southeastern US, higher adherence to the Dietary Guidelines for Americans (DGA) was linked with 14%-23% lower mortality from cardiovascular disease, cancer, and other diseases, according to a study published by Wei Zheng and colleagues from Vanderbilt University, Nashville, USA, in this week's PLOS Medicine.

The researchers analyzed data from the Southern Community Cohort Study (SCCS), a study including 84,735 American adults, aged 40-79 y, who were recruited mostly from community health centers that serve low-income populations from 12 southeastern US states during 2002-2009. Over half of the participants were poor with an annual household income of less than USD 15,000 and 65% were African American. Of the 77,572 participants with follow-up information over a mean period of 6.2 years, 6,906 participants died; including 2,244 from cardiovascular disease, 1,794 from cancer, and 2,550 from other diseases.

After controlling for factors such as age, weight, exercise, smoking, household income and the presence of specific chronic diseases, the researchers found that participants with better adherence to the DGA, as reported using a food frequency questionnaire, had a lower risk of dying from diseases in the follow-up period. Participants with the healthiest diet (those in the top one-fifth) had only about 80% of the risk of death than those with the least healthy diet (those in the bottom one-fifth). This reduction by approximately 20 percent was similar for the risk of death from any disease, death from cancer, and death from cardiovascular disease.

The results support the validity of the DGA for healthy eating across the US population, however the study had some limitations. For example, participants were asked only once about their diet, their household income, and about other factors that can change over time such as exercise habits and diseases they had been diagnosed with.

The authors say: "This is the first study to our knowledge reporting this association in a low-income population that largely comprises African-Americans, providing direct evidence for disease prevention through dietary modification in this underserved population."

Guidelines:

Foods and food components to reduce

• Reduce daily sodium intake to less than 2,300 milligrams (mg) and further reduce intake to 1,500 mg among persons who are 51 and older and those of any age who are African American or have hypertension, diabetes, or chronic kidney disease. The 1,500 mg recommendation applies to about half of the U.S. population, including children, and the majority of adults.
  
• Consume less than 10 percent of calories from saturated fatty acids by replacing them with monounsaturated and polyunsaturated fatty acids.
  
• Consume less than 300 mg per day of dietary cholesterol.
  
• Keep trans fatty acid consumption as low as possible by limiting foods that contain synthetic sources of trans fats, such as partially hydrogenated oils, and by limiting other solid fats.
  
• Reduce the intake of calories from solid fats and added sugars.
  
• Limit the consumption of foods that contain refined grains, especially
  refined grain foods that contain solid fats, added sugars, and sodium.
  
• If alcohol is consumed, it should be consumed in moderation—up to one drink per day for women and two drinks per day for men—and only by adults of legal drinking age.5
  

Foods and nutrients to increase
Individuals should meet the following recommendations as part of a healthy eating pattern while staying within their calorie needs.

• Increase vegetable and fruit intake.
  
• Eat a variety of vegetables, especially dark-green
  and red and orange vegetables and beans and peas.
  
• Consume at least half of all grains as whole grains. Increase whole-grain intake by replacing refined grains with whole grains.
  
• Increase intake of fat-free or low-fat milk and milk products, such as milk, yogurt, cheese, or fortified soy beverages.6
  
• Choose a variety of protein foods, which include seafood, lean meat and poultry, eggs, beans and peas, soy products, and unsalted nuts and seeds.
  
• Increase the amount and variety of seafood consumed by choosing seafood in place of some meat and poultry.
  
• Replace protein foods that are higher in solid fats with choices that are lower in solid fats and calories and/or are sources of oils.
  
• Use oils to replace solid fats where possible.
  
• Choose foods that provide more potassium,
  dietary fiber, calcium, and vitamin D, which are nutrients of concern in American diets. These foods include vegetables, fruits, whole grains, and milk and milk products.
  Building healthy eating Patterns
  

Recommendations for specific population groups
Women capable of becoming pregnant7
• Choose foods that supply heme iron, which is more readily absorbed by the body, additional iron sources, and enhancers of iron absorption such as vitamin C-rich foods.
• Consume 400 micrograms (mcg) per day of synthetic folic acid (from fortified foods and/or supplements) in addition to food forms of folate from a varied diet.8
Women who are pregnant or breastfeeding7
• Consume 8 to 12 ounces of seafood per week from a variety of seafood types.
• Due to their high methyl mercury content, limit white (albacore) tuna to 6 ounces per week and do not eat the following four types of fish: tilefish, shark, swordfish, and king mackerel.
• If pregnant, take an iron supplement, as recommended by an obstetrician or other health care provider.
Individuals ages 50 years and older
• Consume foods fortified with vitamin B , such 12
as fortified cereals, or dietary supplements.