Updated US Department of Agriculture Food Patterns Meet Goals of the 2010 Dietary Guidelines

The US Department of Agriculture Food Patterns were updated for the 2010 Dietary Guidelines for Americans to meet new nutrition goals and incorporate results of food pattern modeling requested by the Dietary Guidelines Advisory Committee. The purpose of this article is to describe the process used and changes in the updated patterns. Changes include renaming the Meat and Beans and Milk Groups to the Protein Foods and Dairy Groups, respectively, to be more encompassing of foods in each. Vegetable subgroups now provide more achievable intake recommendations. Calcium-fortified soymilk is now included in the Dairy Group because of its similarity to foods in that group. Increased amounts of seafoods are recommended in the Protein Foods Group, balanced by decreased amounts of meat and poultry. A limit on calories from solid fats and added sugars is included, replacing the previous discretionary calorie allowance and emphasizing the need to choose nutrient-dense forms of foods. Lacto-ovo vegetarian and vegan patterns that meet nutrition goals were created by making substitutions in the Protein Foods Group, and for vegan patterns, in the Dairy Group. Patterns identify food choices that meet nutritional needs within energy allowances and encourage choosing a variety of foods. They rely on foods in nutrient-dense forms, including a limited amount of calories from solid fats and added sugars. The Food Patterns provide a useful template for educating consumers about healthful food choices while highlighting a large gap between choices many Americans make and healthy eating patterns.     

Dietary-fat intake in the US population.

OBJECTIVE: This article looks at the food group choices by individuals grouped based on fat intake, saturated fat intake, and use of lowfat foods. METHODS: Food consumption data from USDA's National Food Consumption Surveys (NFCS) and the Continuing Survey of Food Intakes by Individuals (CSFII) were used to look at changes in the mean energy, percent calories from fat and saturated-fat and total-fat intakes over time. USDA's 1995 CSFII data were used to evaluate the diets of individuals grouped based on percent calories from fat and use of low-fat foods. Individuals six to 50 years old who had complete food intake records were included and five age-gender classifications were used. RESULTS: The percent of calories from total fat and saturated fat have steadily declined over the last 30 years, and the amount of fat in the diet has increased from 1989 to 1995. Those whose diets met the Dietary Guidelines Recommendations for fat and saturated fat had lower fat intakes. Except for adult males, those with low-fat diets had higher intakes of total-food amount. Also, lower saturated-fat intakes were associated with lower energy intakes. In general, high-fruit-and-grain-products consumption were seen in groups with low-fat intake. For those who included low-fat foods in their diets and also had low-fat intakes, rice and pasta were the major foods of choice for calories. Fried potatoes were one of the main sources of calories for high-fat groups. CONCLUSION: The study showed individuals whose diets included low-fat foods are more likely to have a diet that meets the dietary guidelines recommendations for fat and saturated fat.     

Concept of a nutritious food: toward a nutrient density score

The American diet is said to be increasingly energy-rich but nutrient-poor. To help improve the nutrient-to-energy ratio, the 2005 Dietary Guidelines for Americans recommend that consumers replace some foods in their diets with more nutrient-dense options. Such dietary guidance presupposes the existence of a nutrient density standard. However, a review of the literature shows that the concept of a nutritious food is not based on any consistent standards or criteria. In many cases, healthful foods are defined by the absence of problematic ingredients-fat, sugar, and sodium-rather than by the presence of any beneficial nutrients they might contain. Past attempts to quantify the nutrient density of foods have been based on a variety of calories-to-nutrient scores, nutrients-per-calorie indexes, and nutrient-to-nutrient ratios. The naturally nutrient rich (NNR) score, which is based on mean percentage daily values (DVs) for 14 nutrients in 2000 kcal food, can be used to assign nutrient density values to foods within and across food groups. Use of the NNR score allows consumers to identify and select nutrient-dense foods while permitting some flexibility where the discretionary calories are concerned. This approach has implications for food labeling, nutritional policy making, and consumer education. The Food and Drug Administration has considered approving nutrient claims based on the ratio of a beneficial nutrient to the food's energy content, as opposed to a specified minimum amount of a nutrient per serving size. Given the current dietary trends, the nutrient density approach can be a valuable tool for nutrition education and dietary guidance.     

Nutrition Knowledge and Food Choices of Elementary School Children

This research investigated the effect of a three-week school based nutrition education program on the nutrition knowledge and healthy food choices of 187 fifth graders who were randomly divided into a control ( n =97) or an experimental ( n =90) group. The control group received no nutrition education while the experimental group received 45 minutes of nutrition education, 4 days a week for 3 weeks. Nutrition knowledge scores and 3-day food records were collected at the beginning of the study and after 3 weeks. Food records were used to evaluate healthy food choices ( i.e. Dietary Guideline's recommended intake for macronutrients and the recommendations of the Food Guide Pyramid for each food group). In the experimental group there was a significantly greater increase in nutrition knowledge score ( p =0.001) and significant change in compliance in meeting the Dietary Guidelines ( p =0.0001) and the Food Guide Pyramid's recommendations ( p =0.0001). This study showed the effectiveness of a nutrition education program on nutrition knowledge scores and healthy food choices of fifth grade children.     

Energy allowances for solid fats and added sugars in nutritionally adequate U.S. diets estimated at 17-33% by a linear programming model

The 2010 Dietary Guidelines Advisory Committee has recommended that no more than 5-15% of total dietary energy should be derived from solid fats and added sugars (SoFAS). The guideline was based on USDA food pattern modeling analyses that met the Dietary Reference Intake recommendations and Dietary Guidelines and followed typical American eating habits. This study recreated food intake patterns for 6 of the same gender-age groups by using USDA data sources and a mathematical optimization technique known as linear programming. The analytic process identified food consumption patterns based on 128 food categories that met the nutritional goals for 9 vitamins, 9 minerals, 8 macronutrients, and dietary fiber and minimized deviation from typical American eating habits. Linear programming Model 1 created gender- and age-specific food patterns that corresponded to energy needs for each group. Model 2 created food patterns that were iso-caloric with diets observed for that group in the 2001-2002 NHANES. The optimized food patterns were evaluated with respect to MyPyramid servings goals, energy density [kcal/g (1 kcal = 4.18 kJ)], and energy cost (US$/2000 kcal). The optimized food patterns had more servings of vegetables and fruit, lower energy density, and higher cost compared with the observed diets. All nutrient goals were met. In contrast to the much lower USDA estimates, the 2 models placed SoFAS allowances at between 17 and 33% of total energy, depending on energy needs.     

Frequent Canned Food Use is Positively Associated with Nutrient-Dense Food Group Consumption and Higher Nutrient Intakes in US Children and Adults

In addition to fresh foods, many canned foods also provide nutrient-dense dietary options, often at a lower price, with longer storage potential. The aim of this study was to compare nutrient-dense food group intake and nutrient intake between different levels of canned food consumption in the US. Consumption data were collected for this cross-sectional study from 9761 American canned food consumers (aged two years and older) from The NPD Group’s National Eating Trends^® (NET^®) database during 2011–2013; and the data were assessed using The NPD Group’s Nutrient Intake Database. Canned food consumers were placed into three groups: Frequent Can Users (≥6 canned items/week); n = 2584, Average Can Users (3–5 canned items/week); n = 4445, and Infrequent Can Users (≤2 canned items/week); n = 2732. The results provide evidence that Frequent Can Users consume more nutrient-dense food groups such as fruits, vegetables, dairy products, and protein-rich foods, and also have higher intakes of 17 essential nutrients including the shortfall nutrients—potassium, calcium and fiber—when compared to Infrequent Can Users. Therefore, in addition to fresh foods, diets higher in nutrient-dense canned food consumption can also offer dietary options which improve nutrient intakes and the overall diet quality of Americans.     

Menu Modeling with MyPyramid Food Patterns: Incremental Dietary Changes Lead to Dramatic Improvements in Diet Quality of Menus

The MyPyramid food guidance system provides recommended food intake patterns for members of each sex at various age and activity levels. These food intake patterns are based on recommendations of the Dietary Guidelines for Americans 2005. Actual consumption patterns of American adults compared to MyPyramid recommendations indicate that substantial changes are needed to meet the goals of MyPyramid. One method for encouraging dietary change, known as the small steps approach, involves small, gradual changes to meet a desired endpoint. Menu modeling was used to evaluate the effects of gradual dietary changes on diet quality. Seven days of baseline menus were developed to model the intake of adult women aged 31 to 50 years. Incremental changes were made to each baseline menu to create a series of three transitional menus and a final target menu. Target menus met MyPyramid energy and nutrient intake goals. Diet quality was measured for each baseline, transitional, and target menu using the Healthy Eating Index-2005. The average Healthy Eating Index-2005 score for baseline menus compared to target menus increased by more than 50 points with incremental increases observed for each transitional menu. This analysis demonstrates that small, practical changes in food choices that bring consumers closer to meeting MyPyramid recommendations result in gradual and dramatic improvements in diet quality. Food and nutrition professionals can use menu modeling to provide concrete examples and specific guidance for making progressive changes in food selections to meet current dietary recommendations.     

Sources of food group intakes among the US population, 2001-2002

BACKGROUND: Food guides are typically built around a system of food groups. Accordingly, the US Department of Agriculture's MyPyramid includes both food groups and subgroups, as well as an allowance for discretionary calories, in its guidance. OBJECTIVE: To identify the major dietary contributors to food group intake in the US population. METHODS: This cross-sectional study used 2001-2002 National Health and Nutrition Examination Survey data to determine weighted population proportions for the contribution of each subgroup to its MyPyramid food group (ie, proportion), and the contribution of specific foods to the subgroups oils, solid fats, and added sugars (ie, major contributors). Food codes associated with each food were sorted into 96 categories, termed specific foods, and were linked to the MyPyramid Equivalents Database to obtain food group equivalents. RESULTS: In regard to proportion, dark green vegetables (6%), orange vegetables (5%), and legumes (6%) fell well short of recommended levels. Intake of whole grains (10% of total) was far below the recommendation that at least half of all grains be whole. In regard to major contributors, top sources of oils were potato chips, salad dressing, and nuts/seeds; major contributors of solid fats were grain-based desserts, cheese, and sausages. Sweetened carbonated beverages provided 37% of added sugars. CONCLUSIONS: Americans do not, in general, consume the most nutrient-dense forms of basic food groups, instead consuming foods that are high in solid fats and added sugars. The main culprits-the foods that contribute most to discrepancies between recommendations and actual intake-are sweetened carbonated beverages and other sweetened beverages, grain-based desserts, nonskim dairy products, and fatty meats.     

Development of the SoFAS (Solid Fats and Added Sugars) Concept: The 2010 Dietary Guidelines for Americans

The diets of most US children and adults are poor, as reflected by low diet quality scores, when compared with the recommendations of the Dietary Guidelines for Americans (DGAs). Contributing to these low scores is that most Americans overconsume solid fats, which may contain saturated fatty acids and added sugars; although alcohol consumption was generally modest, it provided few nutrients. Thus, the 2005 DGAs generated a new recommendation: to reduce intakes of solid fats, alcohol, and added sugars (SoFAAS). What precipitated the emergence of the new SoFAAS terminology was the concept of discretionary calories (a “calorie” is defined as the amount of energy needed to increase the temperature of 1 kg of water by 1°C), which were defined as calories consumed after an individual had met his or her recommended nutrient intakes while consuming fewer calories than the daily recommendation. A limitation with this concept was that additional amounts of nutrient-dense foods consumed beyond the recommended amount were also considered discretionary calories. The rationale for this was that if nutrient-dense foods were consumed beyond recommended amounts, after total energy intake was met then this constituted excess energy intake. In the 2010 DGAs, the terminology was changed to solid fats and added sugars (SoFAS); thus, alcohol was excluded because it made a minor contribution to overall intake and did not apply to children. The SoFAS terminology also negated nutrient-dense foods that were consumed in amounts above the recommendations for the specific food groups in the food patterns. The ambiguous SoFAS terminology was later changed to “empty calories” to reflect only those calories from solid fats and added sugars (and alcohol if consumed beyond moderate amounts). The purpose of this review is to provide an historical perspective on how the dietary recommendations went from SoFAAS to SoFAS and how discretionary calories went to empty calories between the 2005 and 2010 DGAs. This information will provide practitioners, as well as the public, with valuable information to better understand the evolution of SoFAS over time.     

Cost implications of alternative sources of (n-3) fatty acid consumption in the United States

The Dietary Guidelines for Americans 2010 provides authoritative advice on what Americans should eat to stay healthy. These guidelines provide a quantitative recommendation to consume 250 mg/d of (n-3) fatty acids (also known as omega-3 fatty acids). To achieve this goal, Americans would need to more than triple the amount of EPA and DHA currently consumed. This paper assessed the cost implications of increased levels of EPA and DHA from marine and nonmarine food sources using data from the 2007-2008 NHANES, USDA nutrient data base, and the USDA Center for the Nutrition Policy and Promotion food price data. Stearidonic acid (SDA)-enhanced soybean oil is a lower cost alternative to commonly consumed marine food as a source of EPA. In addition, given that SDA-enhanced soybean oil is intended to be used as an ingredient in a variety of products, this may enable consumers to increase consumption of EPA through commonly consumed foods.     

The 2005 USDA Food Guide Pyramid is associated with more adequate nutrient intakes within energy constraints than the 1992 Pyramid

The USDA issued the Food Guide Pyramid (FGP) to help Americans choose healthy diets. We examined whether adherence to the 1992 and 2005 FGP was associated with moderate energy and adequate nutrient intakes. We used data for 2138 men and 2213 women > 18 y old, from the 2001-2002 U.S. National Health and Nutrition Examination Survey (NHANES). Quadratic programming was used to generate diets with minimal departure from intakes reported for the NHANES 2001-02. We examined the effect of the number of servings/d of Food Pyramid groups set at 1992 and at 2005 FGP recommendations for 1600, 2200, and 2800 kcal (1 kcal = 4.184 kJ) levels. We calculated energy and nutrients provided by different FGP dietary patterns. Within current U.S. dietary practices, following the 1992 FGP without sodium restriction may provide 200 more kcal than recommended for each energy level. Although it can meet most of old nutrient recommendations (1989), it fails to meet the latest dietary reference intakes, especially for the 1600 kcal level. The 2005 FGP appears to provide less energy and more adequate nutrient intakes, with the exception of vitamin E and potassium for some groups. However, without discretionary energy restriction, Americans are at risk of having excessive energy intake even if they follow the 2005 FGP food serving recommendations. Our analysis suggests that following the 2005 FGP may be associated with lower energy and optimal nutrient intake. Careful restriction of discretionary calories appears necessary for appropriate energy intakes to be maintained.     

Update of the Healthy Eating Index: HEI-2010

The Healthy Eating Index (HEI) is a measure of diet quality in terms of conformance with federal dietary guidance. Publication of the 2010 Dietary Guidelines for Americans prompted an interagency working group to update the HEI. The HEI-2010 retains several features of the 2005 version: (a) it has 12 components, many unchanged, including nine adequacy and three moderation components; (b) it uses a density approach to set standards, eg, per 1,000 calories or as a percentage of calories; and (c) it employs least-restrictive standards; ie, those that are easiest to achieve among recommendations that vary by energy level, sex, and/or age. Changes to the index include: (a) the Greens and Beans component replaces Dark Green and Orange Vegetables and Legumes; (b) Seafood and Plant Proteins has been added to capture specific choices from the protein group; (c) Fatty Acids, a ratio of polyunsaturated and monounsaturated to saturated fatty acids, replaces Oils and Saturated Fat to acknowledge the recommendation to replace saturated fat with monounsaturated and polyunsaturated fatty acids; and (d) a moderation component, Refined Grains, replaces the adequacy component, Total Grains, to assess overconsumption. The HEI-2010 captures the key recommendations of the 2010 Dietary Guidelines and, like earlier versions, will be used to assess the diet quality of the US population and subpopulations, evaluate interventions, research dietary patterns, and evaluate various aspects of the food environment.     

Food pattern modeling shows that the 2010 Dietary Guidelines for sodium and potassium cannot be met simultaneously

The 2010 US Dietary Guidelines recommended limiting intake of sodium to 1500 mg/d for people older than 50 years, African Americans, and those suffering from chronic disease. The guidelines recommended that all other people consume less than 2300 mg sodium and 4700 mg of potassium per day. The theoretical feasibility of meeting the sodium and potassium guidelines while simultaneously maintaining nutritional adequacy of the diet was tested using food pattern modeling based on linear programming. Dietary data from the National Health and Nutrition Examination Survey 2001-2002 were used to create optimized food patterns for 6 age-sex groups. Linear programming models determined the boundary conditions for the potassium and sodium content of the modeled food patterns that would also be compatible with other nutrient goals. Linear programming models also sought to determine the amounts of sodium and potassium that both would be consistent with the ratio of Na to K of 0.49 and would cause the least deviation from the existing food habits. The 6 sets of food patterns were created before and after an across-the-board 10% reduction in sodium content of all foods in the Food and Nutrition Database for Dietary Studies. Modeling analyses showed that the 2010 Dietary Guidelines for sodium were incompatible with potassium guidelines and with nutritionally adequate diets, even after reducing the sodium content of all US foods by 10%. Feasibility studies should precede or accompany the issuing of dietary guidelines to the public.     

Nutrition Knowledge and Food Choices of Elementary School Children

This research investigated the effect of a three-week school based nutrition education program on the nutrition knowledge and healthy food choices of 187 fifth graders who were randomly divided into a control ( n =97) or an experimental ( n =90) group. The control group received no nutrition education while the experimental group received 45 minutes of nutrition education, 4 days a week for 3 weeks. Nutrition knowledge scores and 3-day food records were collected at the beginning of the study and after 3 weeks. Food records were used to evaluate healthy food choices ( i.e. Dietary Guideline's recommended intake for macronutrients and the recommendations of the Food Guide Pyramid for each food group). In the experimental group there was a significantly greater increase in nutrition knowledge score ( p =0.001) and significant change in compliance in meeting the Dietary Guidelines ( p =0.0001) and the Food Guide Pyramid's recommendations ( p =0.0001). This study showed the effectiveness of a nutrition education program on nutrition knowledge scores and healthy food choices of fifth grade children.     

Developing a food guidance system to implement the dietary guidelines

We developed a food guidance system to assist healthy Americans in making food choices for good health. The system differs from commonly used food guides in that it provides guidance for a total rather than a foundation diet. A framework of food groups—illustrated in the Food Wheel—is supplemented by additional information about food energy, total fat, fatty acids, sodium, sweeteners, and cholesterol. Goals for this system were based on the Dietary Guidelines, the 1980 Recommended Dietary Allowances, and usability considerations. These goals were restated as specific objectives based on a review of current concepts in nutrition science, recommendations by various scientific groups, and food consumption practices of the population. The first part of this article presents the rationale for the objectives and development of the food guidance system. The second part details the results of the research conducted to develop and evaluate the system. Expected levels of nutrients provided by diets selected according to system recommendations and expected levels of food energy, fat, fatty acids, cholesterol, sweeteners, and sodium are presented. The food guidance system provides the basis for the food guidance presented in the American Red Cross nutrition course, “Better Eating for Better Health”, and in “Dietary Guidelines and Your Diet”, a series of bulletins developed by USDA to help consumers use the Dietary Guidelines.     

Dietary Intakes of Children Enrolled in US Early Child-Care Programs During Child-Care and Non-Child-Care Days

BackgroundEarly-child-care (ECE) programs may substantially influence child diet quality.ObjectiveThe Study of Nutrition and Activity in Child Care Settings describes the usual food group intake of preschool-aged children attending ECE programs relative to Dietary Guidelines for Americans (DGA) recommendations, comparing intakes during child-care and non-child-care days.DesignMeal observations and parent-completed food diaries in a cross-sectional nationally representative multistage cluster sample of Child and Adult Care Food Program-participating ECE programs.Participants/settingOne thousand four hundred sixty-eight children aged 3 to 5 years attending 217 Child and Adult Care Food Program-participating ECE programs (eg, child-care centers and Head Start) during 2017.Main outcome measuresDaily energy intake, daily US Department of Agriculture Food Pattern Food Group intakes, and percentage of daily intakes meeting 2015-2020 DGA Food Pattern recommendations.Statistical analyses performedRegression-adjusted usual intakes and percentage of children meeting recommendations were estimated using the National Cancer Institute method. Single-day mean intakes were used to test for statistical differences between child-care and non-child-care days.ResultsMean usual energy intake was 1,524 ± 19.3 kcal during child-care days and exceeded the recommended range at 1,702 ± 30.2 kcal during non-child-care days; single-day means indicated significantly lower energy intake on child-care days (P < 0.001). The percent of children meeting DGA recommendations on a child-care day varied by DGA food group: fruits (51.4%), grains (50.1%), dairy (42.5%), vegetables (6.5%), whole grains (4.6%), and protein foods (0.1%). Recommended limits on calories from added sugar and solid fats were met by 28.2% and 14.6% of children, respectively. Compared with mean food group intakes during a single child-care day, non-child-care day intakes were similar for fruits and vegetables, lower for dairy and whole grains, and higher for total grains, protein foods, and calories from added sugars and solid fats.ConclusionsAlthough there is room to increase nutrient density inside and outside of child care, intakes on child-care days more closely align to DGAs.     

Putting the pyramid into action: the Healthy Eating Index and Food Quality Score

Consumption patterns are changing globally. As a result both researchers and policy makers require simple, easy to use measures of diet quality. The Healthy Eating Index (HEI) was developed as a single, summary measure of diet quality. The original HEI was a ten component index based on the US Dietary Guidelines and the Food Guide Pyramid. Research on the HEI indicates that the index correlates significantly with the RDA's for a range of nutrients and with an individual's self-rating of their diet. The revised HEI provides a more disaggregated version of the original index based on the 2005 Dietary Guidelines for Americans. Within each of the five major food groups, some foods are more nutrient dense than others. Nutrient Density algorithms have been developed to rate foods within food groups. The selection of the most nutrient dense foods within food groups lead to a dietary pattern with a higher HEI. The implications of using the HEI and nutrient density to develop interventions are discussed in this presentation.     

Following federal guidelines to increase nutrient consumption may lead to higher food costs for consumers

The federal Dietary Guidelines for Americans, 2010, emphasized the need for Americans to consume more potassium, dietary fiber, vitamin D, and calcium, and to get fewer calories from saturated fat and added sugar. We examined the economic impact of meeting these guidelines for adults in King County, Washington. We found that increasing consumption of potassium--the most expensive of the four recommended nutrients--would add $380 per year to the average consumer's food costs. Meanwhile, each time consumers obtained 1 percent more of their daily calories from saturated fat and added sugar, their food costs significantly declined. These findings suggest that improving the American diet will require additional guidance for consumers, especially those with little budget flexibility, and new policies to increase the availability and reduce the cost of healthful foods.     

The 2000 Dietary Guidelines for Americans: foundation of US nutrition policy

The Dietary Guidelines for Americans form the foundation of US federal nutrition policy. The Food Guide Pyramid, the most widely distributed and best‐recognised nutrition education tool ever produced in the US, is based partially on the Dietary Guidelines. In addition, every federal nutrition programme in the United States uses the Dietary Guidelines as part of their nutrition standards. Federal law requires that the guidelines be reviewed every five years. The Dietary Guidelines Advisory Committee was charged with answering the question, ‘what should Americans eat to be healthy?’ After rigorously reviewing the scientific, peer‐reviewed literature the committee recommended a new set of guidelines for the year 2000. The guidelines are intended for healthy children (ages 2 years and older) and generally healthy adults of any age. The guidelines were expanded from seven in 1995 to ten in 2000. The 2000 Dietary Guidelines for Americans are; (1) aim for a healthy weight; (2) be physically active each day; (3) let the pyramid guide your food choices; (4) eat a variety of grains daily, especially whole grains; (5) eat a variety of fruits and vegetables daily; (6) keep foods safe to eat; (7) choose a diet that is low in saturated fat and cholesterol and moderate in total fat; (8) choose beverages and foods that moderate your intake of sugars; (9) choose and prepare foods with less salt; and (10) if you drink alcoholic beverages, do so in moderation.     

Patterns of food and nutrient intakes in Italy and their application to the development of food-based dietary guidelines

Patterns of food and nutrient intakes in Italy were estimated starting from a nationwide food survey carried out by the National Institute of Nutrition (NIN) in 1994-6, called INN-CA 1995. The present analysis looks at food and nutrient intakes of the subsample of the adults (18-60-year-old individuals). In particular, the two extreme quartiles of the distribution of total fat intake expressed as percentage of energy were considered in the analysis. The results showed that the subjects included in the fourth quartile (high-fat consumers) consumed fewer vegetables than the subjects in the first quartile (low-fat consumers). Furthermore, high-fat consumers had a tendency to have an unbalanced diet, whereas the low-fat consumers present a better pattern. In synthesis, 50% of the adults reach the goal of at least 400 g of vegetables and fruit daily, and 25% consume less than 30% of energy from total fats. Convincing that part of the population whose diet does not comply with dietary goals to come back to the Mediterranean tradition might be a priority for nutrition education in Italy.