Healthy US-Style Eating Pattern Research Articles

Adults Who Are Overweight or Obese and Consuming an Energy-Restricted Healthy US-Style Eating Pattern at Either the Recommended or a Higher Protein Quantity Perceive a Shift from “Poor” to “Good” Sleep: A Randomized Controlled Trial

Limited evidence suggests that consuming a higher-protein diet during weight loss improves subjective indices of sleep in overweight and obese adults. We sought to a priori assess the effects of consuming the recommended versus a higher protein Healthy US-Style Eating Pattern during energy-restriction on sleep quality indices. Using a randomized, parallel study design, 51 adults (mean±SEM age: 47±1 y; BMI: 32.6±0.5kg/m2) consumed a controlled USDA Healthy US-Style Eating Pattern containing 750kcal/d less than their estimated energy requirement for 12 wk. Participants were randomly assigned to consume either 5 or 12.5 oz-equivalent (eq)/d of protein foods. The additional 7.5 oz-eq/d came from animal-based protein sources and displaced primarily grains. Objective (wrist-worn actigraphy) and subjective (Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale) sleep quality indices were measured at baseline, week 6, and week 12. Among all participants, body mass decreased (-6.2±0.4kg). Dietary protein intake did not affect any objective or subjective sleep quality outcomes measured (repeated measures ANOVA). Over time, objective measures of time spent in bed, time spent sleeping, sleep onset latency, and time awake after sleep onset did not change; however, sleep efficiency improved (1±1%; P=0.027). Subjectively, global sleep scores [GSS: -2.7±0.4 arbitrary units (au)] and daytime sleepiness scores (-3.8±0.4 au; both P < 0.001) improved over time. The GSS improvement transitioned the participants from being categorized with "poor" to "good" sleep (GSS: >5 compared with ≤5 au of a 0-21 au scale; baseline 7.6±0.4 au, week 12: 4.8±0.4 au). Although objective sleep quality may not improve, adults who are overweight or obese and poor sleepers may become good sleepers while consuming either the recommended or a higher-protein energy-restricted Healthy US-Style Eating Pattern. This trial was registered at clinicaltrials.gov as NCT03174769.

Modeling the Impact of Fat Flexibility With Dairy Food Servings in the 2015-2020 Dietary Guidelines for Americans Healthy U.S.-Style Eating Pattern.

Background: The 2015–2020 Dietary Guidelines for Americans (DGA) recommends consuming low-fat or fat-free dairy foods due to concerns about energy and saturated fat intake. It also recommends consuming no more than 10% of daily calories from saturated fat.Objective: The objective was to assess the impact of replacing one serving of fat-free dairy foods in the Healthy U.S.-Style Eating Pattern (HUSEP) from the DGA with one serving of whole- or reduced-fat dairy foods. We hypothesized that this replacement would keep the HUSEP within calorie, saturated fat, and sodium limits.Methods: Utilizing the same modeling procedures as the 2015–2020 DGA, we assessed the nutrient composition of seven alternative models of the 2000-calorie HUSEP. These models replaced all three servings of dairy foods in the HUSEP with an updated fat-free dairy composite (Model 1) or one of three fat-free dairy servings in the HUSEP with: a whole-fat dairy food composite, a reduced-fat/low-fat dairy food composite, whole milk, reduced-fat milk, whole-fat cheese, or reduced-fat cheese (Models 2–7).Results: In all models, the amount of saturated fat did not exceed 10% of total calories, but the amount of energy increased by 45–94 calories. While still lower than current average intake (3,440 mg/d), sodium amounts in four of the seven models exceeded the 2,300 mg/d recommended intake level.Conclusions: Some reduced- and whole-fat dairy foods, especially milk, can fit into calorie-balanced healthy eating patterns that also align with saturated fat recommendations. Allowing some flexibility in fat level of dairy food servings aligns with the recommendations that calories from solid fats and added sugars are best used to increase the palatability of nutrient-dense foods.

Abstract P356: Modeling the Impact of Flexibility in Fat Levels of Dairy Foods Consumed to Meet Recommendations From the 2015 Dietary Guidelines for Americans Healthy U.S.-style Eating Pattern

Introduction: The 2015 Dietary Guidelines for Americans (DGA) recommends consuming low-fat or fat-free dairy foods due to concerns about excess intake of energy, which can lead to overweight or obesity, and saturated fat, a type of fat that can increase blood levels of low-density lipoprotein cholesterol, a blood biomarker used to predict cardiovascular disease risk. The 2015 DGA recommends limiting intake of saturated fats to less than 10% of calories per day and balancing energy intake. Hypothesis: The objective of this study was to assess the impact of replacing one serving of fat-free dairy foods provided in current models of the 2000-calorie Healthy U.S.-Style Eating Pattern (HUSEP) with one serving of whole- or reduced-fat dairy foods. We hypothesized that this replacement would still result in an eating pattern within calorie, saturated fat, and sodium limits. Methods: Utilizing the same food pattern modeling procedures used for the 2015 DGA, we assessed the energy and nutrient composition of six alternative models of the 2000-calorie HUSEP. In each pattern, we replaced 1 of the 3 servings of the USDA’s fat-free dairy food composite with whole- or reduced-fat dairy products or whole-/reduced-fat dairy composites. The 6 replacement models included replacements with: 1) a whole-fat dairy food composite, 2) a reduced-fat dairy food composite, 3) whole milk, 4) reduced-fat milk, 5) whole-fat cheese, and 6) reduced-fat cheese. Results: In all 6 models, the amount of saturated fat did not exceed 10% of total calories. In models 2, 3, and 4, saturated fat was 9% of total calories. The amount of energy increased slightly in all models. The original HUSEP provided 2003 calories, and the 6 models in this study provided an additional 45 (Model 4) to 94 (Model 5) additional calories. The amount of sodium also increased. The original HUSEP provides 1787 mg of sodium, and these models provided between 2082 and 2683 mg of sodium. While still lower than the current average sodium intake (3,440 mg/d), the amount of sodium in Models 1, 2, 5, and 6 exceeds 2,300 mg/d, the Chronic Disease Risk Reduction Intake level for sodium. Conclusions: Results of this study indicate that some reduced- and whole-fat dairy foods, especially milk, can fit into calorie-balanced healthy eating patterns that also align with saturated fat and sodium recommendations. Allowing some flexibility in fat level of dairy food servings aligns with the 2010 DGA recommendation that calories from solid fats and added sugars are best used to increase the palatability of nutrient-dense foods, which includes milk, cheese, and yogurt.

Nutrient Composition Comparison between the Low Saturated Fat Swank Diet for Multiple Sclerosis and Healthy U.S.-Style Eating Pattern

Multiple sclerosis (MS) is an incurable degenerative disease that attacks the central nervous system. Roy Swank proposed a low saturated fat diet to treat MS around 1950 and showed delayed disease progression in his patients. However, there is insufficient evidence to recommend this diet for MS and default dietary recommendations are the Dietary Guidelines for Americans (DGA). This study assessed the nutritional adequacy of seven-day menus developed by Swank and their compliance with the DGA; menus were modeled for comparison with the DGA Healthy US-Style Eating Pattern (HEP) for males and females 31–50 years. Swank recommended dietary supplements corrected menu shortfalls in vitamins D, E, calcium, folate and iron but not dietary fiber, potassium and choline. Healthy Eating Index-2015 score for Swank menus (93.2/100) indicated good compliance with the DGA. Nutritional adequacy of the Swank modeled diet was similar to HEP for 17 vitamins and minerals (Mean Adequacy Ratios ≥94%) with similar shortfall nutrients except magnesium (HEP males) and dietary fiber (Swank males). Alternate Healthy Eating Index-2010 scores for Swank male (90/110) and female (88/110) model diets were similar to HEP. Swank menus have similar nutritional adequacy as HEP. Inclusion of foods high in dietary fiber, potassium and choline may be advised as well as selection of foods to reduce sodium below the Tolerable Upper Intake Level.

Health Economic Evaluation Modeling Shows Potential Health Care Cost Savings with Increased Conformance with Healthy Dietary Patterns among Adults in the United States

BackgroundMany American adults have one or more chronic diseases related to a poor diet, resulting in significant direct and indirect economic impacts. The 2015-2020 Dietary Guidelines for Americans (DGA) recognized that dietary patterns may be more relevant for predicting health outcomes compared with individual diet elements and recommended three healthy patterns based on evidence of favorable associations with many chronic disease risk factors and outcomes. Health economic assessments provide a model to estimate the potential influence on costs associated with changes in chronic disease risk resulting from improved diet quality in the US adult population. ObjectiveTo estimate the impact on health care costs associated with increased conformance with the three healthy patterns recommended in the 2015-2020 DGA, including the Healthy US-Style, the Healthy Mediterranean-Style, and the Healthy Vegetarian eating patterns. MethodsRecent moderate- to high-quality meta-analyses of health outcomes associated with increased conformance with the Healthy US-Style eating pattern as measured by the Healthy Eating Index (HEI) or the Healthy Mediterranean-Style eating pattern measured by a Mediterranean diet score (MED) were identified. Given the lack of quantification of the association between an increased conformance with a vegetarian pattern and health outcomes, the analysis was limited to studies that evaluated Healthy US-style and Healthy Mediterranean-style eating patterns. The 2013-2014 What We Eat in America data provided estimates of conformance with these two eating patterns using the HEI-2015 and the 9-point MED among the US adult population. Risk estimates quantifying the association between eating patterns and health outcomes were combined with the eating pattern score increase under two conformance scenarios: increasing the average HEI-2015 and MED by 20% and increasing the average HEI-2015 and MED to achieve 80% of complete conformance. The resulting change in risk was combined with published data on annual health care and indirect costs, inflated to 2017 US dollars to estimate cost. To address double counting, costs were adjusted to minimize potential overlap of comorbidities. ResultsOverall modeled cost savings were $16.7 billion (range=$6.7 billion to $25.4 billion) to $31.5 billion (range=$23.9 billion to $38.9 billion) based on a 20% increase in the MED and HEI-2015, respectively, resulting from reductions in cardiovascular disease, cancer, and type 2 diabetes for both patterns and including Alzheimer’s disease and hip fractures for the MED. In the case that diet quality of US adults were to improve to achieve 80% of the maximum MED and HEI-2015, cost savings were estimated at $88.2 billion (range=$35.7 billion to $133 billion) and $55.1 billion (range=$41.8 billion to $68.2 billion), respectively. ConclusionsThis is the first study quantifying savings from all health outcomes identified to be associated with the HEI and the MED to assess conformance with two eating patterns recommended as part of the 2015-2020 DGA. Findings from this study suggest that increasing conformance with healthy eating patterns among US adults could reduce costs, with billions of dollars in potential savings.