Annex four - Examples of foods in current sets of dietary guidelines and food guides(1)
1 The following examples illustrate how foods and food groups have been incorporated into dietary guidelines in selected countries. They also indicate the types of food guides that have been developed as visual aids and teaching tools to help implement the guidelines. The inclusion of these guidelines does not mean they are being endorsed or promoted as "recommended" dietary guidelines or food guides, especially since some of the scientific assumption underlying some statements have been overtaken by more recent research and knowledge.
A number of countries and organizations have developed dietary guidelines. While the consultation did not review them, examples of foods that feature in the current sets of dietary guidelines are provided in Table 8 (1) (the numbers in the set column refer to specific food guidelines). For example, in the Australian set guidelines 2, 6, 9 and 10 name foods, while guidelines 1, 3, 4, 5, 7 and 8 (not shown in the table) are expressed in other ways, without naming foods. The latter category predominates.
The foods that appear in these guidelines are usually large groups, e.g. vegetables, fruits, cereals, meat; but in some cases they are more specific, e.g. citrus fruits, bread, fatty fish, rice. A few guidelines specify processing or lack of processing (e.g. whole grain, smoked, full cream, saltcured, fresh).
Example 7(Fiji), is used throughout the South Pacific and in a number of African and other countries. It may have originated in the UK in World War 11. This three-food-groups system has one group of foods said to provide energy, another protein, and a third consisting of fruits and vegetables (in some sets termed as "health" or "selective" foods).
Example 5, is a four-food-group system proposed by Abrahamsson (2) for developing countries, especially for feeding children. It gives pride of place to the country's staple, which not only provides energy but also protein and other nutrients. For good nutrition it needs to be supplemented with foods from three groups: vegetables and fruits (for vitamins A, B and C), proteinrich food (especially for young children) and extra energy (most conveniently as some form of oil).
Example 4, in the Caribbean the food guide had more groups—six formerly and now seven. The current food guide strongly emphasizes fruit and vegetables, and includes, but de-emphasizes, fats and sugar.
In industrialized countries there are mostly four, five or three food groups. The foods that differ most between country systems are:
• Milk, which has its own group in Canada (3), USA (15), Australia (1), New Zealand (12), Denmark (6), Finland (8), Germany (9) and the UK (14), but not in the Netherlands (11) or Sweden (13). In the Netherlands, milk is grouped with other animal foods; in Sweden, it is grouped with cereal foods and potatoes as the basal diet in the bottom layer of the pyramid.
• Potatoes appear as a special food group in Finland (8). In some countries they are grouped with green vegetables (2) (3) (12). In other countries they are grouped with cereals (6) (11) (13) (14).
• Fats & oils do not appear in Canada (3). In some countries they appear as a small ("eat sparingly") separate group (1) (6) (8) (9) (11). In other countries they are combined with sugar in a small ("eat sparingly") group (8) (12) (14).
• Legumes appear with the meat group in some countries (1) (3) (14) (15), usually described as "dry legumes". In other countries they may be grouped with green vegetables.
Food groups are also being used to represent advice on vegetarian diets, therapeutic diets for diabetes mellitus, for lowering plasma LDL-cholesterol, and for describing an idealized Mediterranean diet.
It is much easier to illustrate unpackaged, single foods. Some countries have made suggestions where mixed dishes fit in their food group systems, e.g. in a reserve comprehensive list.
Note that these food guides in the table do not express all the dietary guidelines of the corresponding country. "Eat less or little fat" can be conveyed by having a fats and oils group and showing it very small (1) (11). In the US food pyramid fats are shown as small white circles against a black background. It remains to be seen how efficiently this pictorial symbolism can convey the message. It has proved very difficult to convey in visual form: "Balance energy intake against expenditure; avoid overweight/obesity" and "if you drink alcohol, do so in moderation".
In countries, the individual foods which are generally available and which educators wish to emphasize are mentioned in the text or shown in visual material. Preferred forms of the food can be described in accompanying text, e.g. Iow-fat meat, fatty fish, whole-grain cereals, etc.
The main forms in which dietary guidelines have been expressed as food groups are assembled in Table 10.
Table 8: Food groups included in current dietary guidelines
County |
Year |
Set |
|
Australia |
1992 |
2 |
Eat plenty of breads and cereals (preferably whole grain), vegetables (including legumes), and fruits |
6 |
Eat only a moderate amount of sugars and foods containing added sugars | ||
9 |
Eat foods containing calcium | ||
10 |
Eat foods containing iron | ||
Denmark |
1983 |
2 |
Eat more bread and corn products, potatoes, vegetables and fruit |
3 |
Eat less butter, margarine, fat, sugar, meat fat, and fewer fatty meat products and full-cream dairy products | ||
France |
1981 |
8 |
For sufficient fibre take wholemeal breads, vegetables, cereals (dry) legumes, and dried fruits, etc |
Germany |
1985 |
6 |
Eat sweets seldom |
7 |
Eat fresh foods (fruits, juices, vegetables, milk) | ||
Hungary |
1988 |
4 |
Reduce sugary snacks |
5 |
Drink ½ litre of low fat milk per day | ||
6 |
Eat fresh fruits, vegetables and salads more often | ||
7 |
Always have whole grain bread on the table; choose potatoes over rice | ||
9 |
Quench thirst with water | ||
Japan |
1985 |
1 |
Eat 30 (different) foodstuffs a day; take staple food (ie rice), main dish and side dish together |
Rep. of Korea |
1980 |
5 |
Drink milk every day |
New Zealand |
1982 & 1991 |
1 |
Eat a variety of foods from each of the four mayor food groups each day |
Singapore |
1989 |
8 |
Reduce intake of salt-cured, preserved and smoked foods |
10 |
Increase intake of fruit and vegetables and whole grain cereal products, thereby increasing vitamins A and C and fibre | ||
United Kingdom |
1990 |
4 |
Eat plenty of food rich in starch and fibre (examples given) |
7 |
Look after the vitamins and minerals in your food (milk, cheese, butter and margarine, eggs, green vegetables, carrots, liver, meat, fish, beans, bread, breakfast cereals, citrus fruits, fatty fish, dried fruit) | ||
USA - Dietary guidelines for Americans |
1995 |
4 |
Choose a diet with plenty of vegetables, fruits and grain products |
USA - NRC Diet and health |
1989 |
2 |
Eat five or more servings of vegetables and fruits each day (especially green and yellow vegetables and citrus fruits). Also increase intake of starches and complex carbohydrates such as breads, cereals and legumes. Increase of added sugars is not recommended |
Table 9: A selection of food guides for nutrition education of the general public
1. Australia |
Australian Nutrition Foundation (present) |
Eat most |
vegetables and fruit (including canned and frozen) |
Eat most |
cereal foods |
Eat moderately |
lean meat, eggs, fish, chicken (no skin), nuts |
Eat moderately |
milk, yoghurt, cheese |
Eat in small amounts |
fats- butter, oil, margarine |
Eat least |
sugar |
2. Australia |
Target on healthy eating (S. Australia and Victoria) |
Large area |
cereal foods |
Large area |
vegetables and fruit |
Intermediate area |
meat, fish, poultry, legumes, nuts, eggs |
Intermediate area |
milk, cheese and yoghurt |
Minimal area |
butter and margarine |
3. Canada |
Rainbow (1992) |
Outer largest quadrant |
grain products (5-12 serves/day) |
Next, second largest quadrant |
vegetables and fruit (including canned and frozen) (5-10 serves/day) |
Next, second smallest quadrant |
milk products |
innermost quadrant |
meats (lean), poultry, fish, dried legumes, eggs, tofu, peanut butter (2-3 serves/day) |
other foods and beverages | |
4. Caribbean |
New Circle |
Semi circle (180°) |
fruits and vegetables: 1.75 to 2.5 lb |
Next largest sector |
ground provisions - bananas, breadfruit, yam, potatoes :12-18 oz |
Next largest sector |
cereals: 6-9 oz |
Next largest sector (20°) |
food from animals: 4-6 oz |
Next largest sector |
legumes and nuts: 2-3 oz |
Equal smallest sector (5°) |
fats and oils: 1-1.5 oz |
Equal smallest sector (5°) |
sugar 1.5 oz |
5. Food Square for DEVELOPING COUNTRIES
(esp. children), L. Abrahamson (1977)
Staple food |
Protein supplement (milk powder, meat, beans or fish) |
Vitamins and minerals supplement (mixed vegetables and fruit) |
Energy supplement (oil) |
6. Denmark |
Kostcirclen |
170° |
bread, grains and potatoes |
60° |
vegetables |
57° |
meat, fish, egg |
40° |
fruit |
35° |
milk and cheese |
10° |
fats |
7. Fiji |
Three food groups of equal size |
Energy |
cereals, root crops, coconut, sugar, oil, butter |
Health |
vegetables, fruits, seaweed |
Body building |
meats, fish, chicken, eggs, milk, cheese, legumes, peanuts |
8. Finland |
Food circle, 1987 |
Largest sector |
vegetables and fruit |
Intermediate sector |
cereal foods |
Intermediate sector |
milk, cheese and yoghurt |
Somewhat smaller |
meat, poultry, fish, egg, nuts |
Smaller sector |
potatoes |
Smallest sector |
oil and fat |
9. Germany |
Seven food groups |
Largest area |
cereals group and potatoes |
Next largest |
vegetables, legumes and nuts |
Next |
faults |
Next |
drinks |
Next |
milk and dairy |
Next |
meat, sausages, fish, eggs |
Smallest |
fats and oils |
10. Islamic Rep. of Iran |
Four groups shown, of equal size in posters, and a miscellaneous group |
Milk group |
milk, yoghurt. cheese, ice cream |
Meat group |
beef, lamb, organ meats, poultry, fish, chicken, eggs, legumes |
Cereal group |
bread, rice, macaroni, corn, wheat, barley, fruit and vegetables |
Miscellaneous |
nuts, fats and oils, sweets, spices, beverages |
11. Netherlands |
Maaltijdschijf |
1/3 circle |
bread, cereal products and potato |
1/3 circle |
vegetables and fruit |
1/6 circle |
meat, fish, poultry, milk, egg and cheese |
1/6 circle |
a little fat |
12. New Zealand |
National Heart Foundation of NZ (present) |
Eat most |
fruits and vegetables (fresh) |
Eat most |
cereal foods |
Eat moderately |
lean meat, poultry, fish, dried bean, nuts, eggs |
Eat moderately |
milk, cheese, yoghurt |
Eat least |
salt, sugar, butter, margarine, oil |
13. Sweden |
Matpyramid |
Base |
bread and other cereals, potatoes, milk, cheese, table fat |
Middle |
vegetables, fruit, fruit juice, dry legumes |
Apex |
meat and fish |
14. UK |
Food plate (1994) |
Large sector |
fruit and vegetables (including canned and frozen) |
Large sector |
bread, other cereals and potatoes (choose high fibre) |
Intermediate sector |
meat, fish, dry legumes, nuts eggs |
Intermediate sector |
milk, yoghurts, cheeses |
Smallest sector |
fatty and sugary foods |
15. USA |
New (1992) Pyramid |
Base |
bread and other cereals, potatoes, milk, cheese, table fat |
2nd level |
vegetables group (3-5 servings) |
2nd level (a smaller area) |
fruit group (2-4 servings) |
3rd level |
milk, yoghurt and cheese (2-3 servings) |
3rd level |
meat, poultry, fish, dry beans, eggs and nuts (2-3 servings) |
Apex |
fats and sweets: use sparingly |
Table 10: Visual presentation of food guides related to dietary guidelines
1. Have a mixture of brief text with illustrations of major individual foods, with a spreadsheet for each food group (e.g. 'Eat well ... live well' by Guild of Food Writers and Coronary Prevention Group, UK, 1991)
2. Several food groups, with examples illustrated in each. Each group within the same sized rectangle (e.g. Australian posters of the late 1970s, with 5 groups; South Pacific Commission posters with 3 groups; UK World War II material).
3. Several food groups represented by rectangles, cubes or squares of different sizes (e.g. 'Are you overweight?' Australia 1985).
4. Steps or piles of blocks of different heights (e.g. New Zealand). Each block the same size. Like building blocks, these can convey servings—cereals 5 blocks piled up (= serves), vegetables 4, fruits 3, dairy 2 and meat or alternative 1 block serving.
5. Food circle, with food groups each the same sectoral size (e.g. Sweden food circle has 7 sectors of equal size).
6. Food circle with sectors of different area, typically largest for cereals and vegetable/fruit groups, smallest for fat (e.g. Netherlands Gezonde voeding met de maaltijdschiff, 1382; Finland has 6 sectors of different areas; Caribbean has 6 (old) or 7 (new)).
7. Circle with sectors for food groups of different area (narrow for fats) but also outer band of more processed products in each sector (group), with more fat, salt or sugar, so less recommended than the central area (inner circle) of unprocessed foods (e.g. South Australia 'Target on Healthy Eating').
8. The health food plate, which is a food circle, with sectors of different sizes, each illustrating major foods of the group, but the circle is seen as if tilted so drawn as an ellipse. It looks like a plate with a knife on one side and a fork on the other (UK Food Guide, 1994).
9. Triangle (some of these called a pyramid but drawn as 2-dimensional shape). Food groups that should tee eaten least are at the top; staple foods that should be eaten most are across the broad base of the triangle (e.g. Sweden 1977, USDA new food guide "pyramid" 1993; K. Baghurst (Australia) 1,2,3,4,5 + nutrition plan).
Pennington (1981) first suggested that the triangle or pyramid should be upside down, with the food group you should eat least of at the apex and below the other groups.
10. Pyramid, which shows different groups on two faces (e.g. Australian Nutrition Foundation from early 1980s; New Zealand National Heart Foundation).
11. Quarter rainbow, with 4 quadrants, the innermost one having the smallest area (so eat least) (e.g. Canada's Food Guide, 1992).
12. Traffic light: be careful with foods in red group; eat foods in orange group in moderation; eat as much as you like of foods in the green group (used especially for obesity and diabetic diets, e.g. UK Health Education Council, 1981).
OTHER SYMBOLS USED LESS OFTEN
Star
Arrows (e.g. Italy)
Groups of foods, shown without borders
Table with different size plates (under trial by USDA)
Supermarket trolley with different size columns (under trial by USDA)
1. Truswell AS. Dietary goals and guidelines: national and international perspectives. In Shils ME, Ohlson JA, Shike M. (eds) Modern nutrition in health and disease, 8th ea., Philadelphia: Lea and Febiger 1994, pp 1612-1625.
2. Abrahamsson L. Gebre Medhin M. The use of food group classification systems in developing countries. Human nutrition: applied nutrition, 1983, 37a:328-330.
