Modified Food Guide Pyramid for people over seventy years of age.

The second edition of The Dietary Guidelines for Americans was published in 1990 as a joint effort of the U.S. Department of Agriculture and the U.S. Department of Health and Human Services Dietary Guidelines for Americans 1990. Based on the Dietary Guidelines, a Food Guide Pyramid was constructed for educational purposes (The Food Guide Pyramid 1992). The principles underlying the Dietary Guidelines and Food Guide Pyramid hold for Americans of all ages above 2 y. However, a modification of the recommendations within the Food Guide Pyramid seems appropriate for use in educating healthy, active people above the age of 70 y to optimize their nutrient intake patterns consistent with the changes in nutrient and energy needs of older individual (Fig. 1). This elderly group is particularly vulnerable to compromised nutrient intake because with advancing age, energy needs decrease, necessitating a decrease in food intake. Among people over the age of 70 y surveyed in NHANES III, about 40% consumed below 2⁄3 of the RDA for energy (NHANES III 1988–94). Thus, for elderly people, the Food Guide Pyramid should highlight specific selections within each food group category to emphasize foods with a high ratio of nutrients to energy (nutrient density) to ensure adequate nutrient intakes, and should be narrowed to reflect lowered energy needs. This paper presents a suggested refinement of the Food Guide Pyramid to be applied to individuals who are 70 y old and older, and who are relatively healthy and active and wish to remain so. These individuals can generally be characterized as living independently, being free from major health disorders that would limit food access or intake, and participating in a variety of activities outside their homes. Given the shifting demographics in the United States, this is a growing segment of the population which has historically been underrepresented in previous recommendations for different age subgroups. Additionally, this group should be distinguished from the very elderly people who are not well and for whom different dietary considerations, such as energy density, arise. This modified Food Guide Pyramid which will be referred to as the Modified Food Pyramid for 701 Adults (Fig. 1) continues to be based on the principles of The Dietary Guidelines and those of other health organizations: plenty of variety; diets high in grain products, vegetables and fruits; diets low in saturated fatty acids and cholesterol; low to moderate use of sugar, salt and alcohol; and physical activity in balance with energy intake. However, we suggest one addition to the 701 Food Pyramid: a small supplement flag at the top and symbols for water and fiber. It will be very hard for a person above the age of 70 y to obtain adequate intakes of particular nutrients due to the reduced portion sizes, the reduced number of food servings being ingested and restrictions in food choices secondary to medical conditions (for example, lactose intolerance). The nutrients which are of particular concern in the elderly are calcium, vitamin D and vitamin B-12. Nutrient-dense/fortified foods. Right now, little guidance is provided within each food category of the Food Guide Pyramid regarding specific choices, with the exception of limiting foods high in fat or refined sugar. The importance of choosing a variety of food is emphasized. However, with respect to the elderly, many of whom have energy intakes at or below the minimum of that assumed in the Food Guide Pyramid (1600 kcal or 6.72 MJ), guidance is essential regarding the selection of foods that are high in nutrient density. Thus, within the bread, cereal, rice and pasta group, choices should be primarily among those that are whole-grain, enriched or preferably fortified, which are particularly important because the bread and cereal group comprises the bulk of the diet in elderly people, some of whom are at risk for malnutrition (Tucker and Rush 1992). In addition to products made with enriched flours and whole grains, breakfast-type cereals that are fortified should be consciously chosen. Recently, the Food and Drug Administration (FDA) issued regulations that require “enriched” cereal grains to be fortified with folic acid at a concentration of 140 mg/100 g of cereal grain product. This regulation was directed at eliminating folic-acid preventable birth defects. However, folate fortification may also benefit the elderly by lowering blood homocysteine levels, resulting in a potential reduction in risk of homocysteine-related cardiovascular disease. Higher intakes of folic acid pose a problem for individuals who may have subclinical vitamin B-12 deficiency by precipitating vitamin B-12–related neurologic symptoms. To prevent excessive folic acid intakes, the FDA chose a fortification level of folic acid to prevent the majority of the population (95%) from consuming greater than 1.0 mg/d of total folate. At this level of folate fortification, it is estimated that only 6% of the population would consume greater than 1.0 mg total folate per day (Tucker et al. 1996). Within the vegetable group, choices should be among those which are deeply colored. Dark green, orange or yellow fresh, frozen or canned vegetables contribute vitamin C, folic acid, vitamin A (in the form of provitamin A carotenoids) and a substantial amount of dietary fiber. Cruciferous vegetables, 1 This project has been funded at least in part with Federal funds from the U.S. Department of Agriculture, Agricultural Research Service under contract 53-3 06-5-10. 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