Dietary recommendations for health: Fact sheet
Compiled by: Prof M Senekal and colleagues, Division of Human Nutrition, Faculty of Health Sciences, University of Cape Town; Dr CE Naude, Centre for
Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University
1. Dietary recommendations for health have been published and are regularly updated by the World Health
Organization, United States of America and Canada (Institute of Medicine, Food and Nutrition Board), Europe
(the European Food Safety Authority), the Nordic countries (National Food Safety Agency) and Australia and
New Zealand (Australian and New Zealand Ministries of Health) (see detail below in Table 1).
2. Within the context of energy balance for health and weight maintenance, these recommendations provide
guidance on the macronutrienta composition of diets for the prevention of chronic diseasesb in healthy
populations (groups of individuals), while also ensuring adequate intake of micronutrientsc and other
beneficial compoundsd in foods. These guidelines may also apply to healthy individuals who have metabolic
risk indicatorse for chronic diseases, but do not apply to individuals diagnosed with such diseases.
3. Single “best values” for population level recommendations for healthy eating are seldom appropriate. It is for
this reason that recommendations across countries specify “safe ranges” for macronutrient contributions to
total energy intake. For carbohydrates the range varies between 45 to 75%, for protein between 10 to 35%
and for fat between 20 to 40%. As both quantity (% contribution to total energy intake) and quality (type and
nature) of macronutrients are of importance, guidance on the quality aspects of carbohydrates and fats are
also included in most recommendations.
4. Within the South African context these recommendations have been translated to the Food Based Dietary
Guidelines published by the National Department of Health (see detail below in Table 2),f as is recommended
and encouraged by the World Health Organization for all countries.
5. Good quality carbohydrates provide energy, especially glucose for the brain, as well as vitamins, minerals,
dietary fibre and other beneficial biologically active compounds. Food sources of good quality carbohydrates
include unprocessed or minimally processed grains, legumes and fruits and vegetables.
6. Good quality proteins provide essential amino acids for body protein synthesis, as well as vitamins and
minerals. Food sources of good quality proteins include fish, chicken without skin, lean meats, reduced fat
dairy products and eggs. Quality protein can also be obtained from soya and other plant sources if combined
to ensure provision all essential amino acids e.g. samp and beans.
7. Good quality fat in the diet is necessary to provide essential fatty acids, as well as for cell membrane integrity,
hormone production, protection of organs, absorption of some vitamins and other functions. Food sources of
good quality fats include oily fish, plant oils, most nuts and seeds and avocado pears.
8. Any diet that is promoted for health should be sustainable in the long-term, specifically in terms of ease of
adherence to guidelines, availability and affordability of foods, as well as social and cultural acceptability.
Sustainability of dietary recommendations should also consider the total life-cycle greenhouse gas (GHG)
emissionsg of the production, transportation and distribution of foods.
If it is about Nutrition, ask your Dietitian www.adsa.org.za
a
Macronutrients: carbohydrate, protein and fat
Chronic diseases: diabetes, coronary heart disease, stroke, cancer...
c
Micronutrients: vitamins and minerals
d
Other beneficial compounds: fibre, biologically active compounds e.g. flavonoids, phytoestrogens...
e
Metabolic risk indicators: poor glucose tolerance, high blood pressure, unhealthy blood lipid levels
f
http://www.fao.org/ag/humannutrition/nutritioneducation/fbdg/49849/en/zaf/
g
Shifting from red meat and dairy toward chicken/ fish/egg or vegetable based diets for 1 day a week reduces GHG emissions substantially1
b
Table 1: Macronutrient Recommendations from Selected Regions/Countries (Compiled by CE Naude)
Nordic countries
Carbohydrate
% of TE
Fibre
grams per day
Sugar
% of TE
Total Fat
% of TE
Saturated fat
% of TE
2-3
45 - 60
(population goal 55)
25 - 35
United States of
4
America and Canada
45 – 65
Europe
45 – 65
45 - 60
55-75
30 (males)
25 (females)
25
25
---
---
<10
(free sugars)
20 – 35
20 - 35
20 - 35
20 -35
As low as possible with
nutritionally adequate
diet
< 8 - 10
130 g minimum (RDA)
19-50 years: 38 (males);
25 (females)
>50 years: 30 (males); 21
(females)
< 10
< 25
(refined sugars)
(added sugar)
25 – 40
(population goal 30)
< 10
6
Australia and
5
New Zealand
As low as possible
with
nutritionally
adequate diet
World Health
7
Organization
h
i
< 10
Trans fat
As little as possible
<1
% of TE
Monounsaturated fat
------By difference
10 – 20
% of TE
Polyunsaturated fat
------6-10
5 – 10
% of TE
Omega-3
At least 0.5
0.5
1-2
Polyunsaturated fat (0.6 – 1.2
0.4/0.5 - 1
(AI)
linolenic acid) % of TE
Omega-6
3% when combined
4
Polyunsaturated fat
5-8
5 - 10
4/5 - 10
(AI)
with omega-3 fat
(linoleic acid) % of TE
Protein
10 – 20
--10-15
10 - 35
15 - 25
% of TE
Abbreviations: TE = Total Energy; RDA = Recommended Dietary Allowance; AI = Adequate Intake
h
Intake of at least 20% is consistent with good health
i
Acceptable for those who are highly active and consume diets rich in vegetables, legumes, fruits and whole grains, without the risk of unhealthy weight gain
Nordic Nutrition Recommendations, 2012 2-3: The Nordic Nutrition Recommendations (NNR) are primarily valid for groups of healthy individuals. They can
be used as guidelines for planning diets for groups, as a basis for teaching and dietary information, as a basis for food and nutrition policy and as a basis for
evaluation of dietary intake.
Dietary Reference Intakes, United States of America and Canada, 2002/2005 4: The Dietary Reference Intakes include Acceptable Macronutrient
Distribution Ranges (AMDR), defined as the range of intake for a particular energy source that is associated with reduced risk of chronic disease while
providing intakes of essential nutrients. Consumption in excess of the AMDR confers the potential of increasing the risk of chronic diseases and insufficient
intakes of essential nutrients. The AMDR is expressed as a percentage of total energy intake because its requirement, in a classical sense, is not independent
of other energy fuel sources or of the total energy requirement of the individual. The Recommended Dietary Allowance for carbohydrate is set at 130 grams
per day for adults and children based on the average minimum amount of glucose utilized by the brain.
Nutrient Reference Values for Australia and New Zealand, 2005 5: The Nutrient Reference Values include Acceptable Macronutrient Distribution Ranges
(AMDRs) to reduce chronic disease risk whilst still ensuring adequate micronutrient intake. They are aimed at healthy people and may not meet the specific
nutritional requirements of individuals with various diseases or conditions, pre-term infants, or people with specific genetic profiles. They are designed to
assist nutrition and health professionals assess the dietary requirements of individuals and groups. They may also be used by public health nutritionists, food
legislators and the food industry for dietary modelling and/or food labelling and food formulation.
Dietary Reference Values, European Food Safety Authority, 2010 6: The Dietary Reference Values apply to healthy populations and they are not intended as
reference values for the treatment of patients with diseases or conditions like diabetes, obesity, or cardiovascular disease. However, they apply to healthy
subjects with signs of metabolic disturbances like impaired glucose tolerance, elevated blood pressure, serum lipids, etc.
World Health Organization: Population nutrient intake goals for preventing diet-related chronic diseases, 20037: The WHO population nutrient intake
goals represent the population average intake that is judged to be consistent with the maintenance of health in a population. Health, in this context, is
marked by a low prevalence of diet-diseases in the population.
References
1. Weber CL, Matthews HS. Food-miles and the relative climate impacts of food choices in the United States. Environ Sci Technol. 2008 May 15;42(10):350813.
2. Becker W, Lyhne N, Pedersen AN, Aro A, Fogelholm M, Phorsdottir I, et al. Nordic Nutrition Recommendations 2004 - integrating nutrition and physical
activity. Scandinavian Journal of Nutrition. 2004;48(4):178-87.
3. Nordic Council of Ministers. Nordic nutrition recommendations 2012. Integrating nutrition and physical activity. Arhus: Nordic Council of Ministers 20012.
4. Institute of Medicine Food and Nutrition Board. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and
Amino Acids (Macronutrients). Washington, DC: National Academies Press; 2002/2005.
5. Australian National Health and Medical Research Council and the New Zealand Ministry of Health. Nutrient Reference Values for Australia and New
Zealand: Including Recommended Dietary Intakes. Canberra: Australian National Health and Medical Research Council and the New Zealand Ministry of
Health2006.
6. EFSA Panel on Dietetic Products Nutrition and Allergies (NDA). Dietary Reference Values Parma: European Food Safety Authority (EFSA)2010.
7. World Health Organization/Food and Agricultural Organization. Diet, Nutrition and the Prevention of Chronic Disease. Report of a Joint WHO/FAO Expert
Consultation. Chapter 5: Population nutrient intake goals for preventing chronic-diseases. Geneva: World Health Organization 2003.
Table 2: The South African Food Based Dietary Guidelines (FBDGs) for healthy adults and children 5
years and older
2012 FBDG Guideline
Key points
Evidence
General overview
FBDGs are science-based messages that aim to change the eating
behaviour of the general population towards more optimal diets
that meet energy and nutrient requirements, while helping to
protect against the development of non-communicable diseases
such as diabetes, heart disease and cancer.
Vorster HH et al. An introduction to
the revised food-based dietary
guidelines for South Africa. SACJN.
2013; 3:S5-S12
Healthy foods from all food groups should be consumed on a daily
basis, preferably foods from at least 2 groups at each meal. It is
important to remember that a single food cannot provide all the
nutrients we need for optimal health. Elimination of food groups can
lead to deficiencies and disease.
Steyn NP, Ochse R. “Enjoy a variety of
foods”: as a food based dietary
guideline for South Africa. SAJCN.
2013; 3:S13-S17
Make starchy foods part
of most meals
Healthy choices include unprocessed or minimally processed grains
such as whole-wheat bread, breakfast cereals, pasta, wraps,
brown/wild rice. Starchy vegetables such as potatoes and sweet
potatoes, preferably with the skins intact, are also healthy choices.
Vorster HH. “Make starchy foods part
of most meals”: a food-based dietary
guideline for South Africa. SAJCN.
2013; 3:S28-S35
Fish, chicken lean meat
or eggs could be eaten
daily
Healthy choices include oily fish such as pilchards and salmon,
chicken without skin, lean meats such as steak with all excess fat
trimmed, lean mince and ostrich. Intake of cheese and processed
meat should be limited and healthy low-fat cooking methods such
steaming, grilling and boiling should be used.
Schonfeldt HC, Pretorius B, Hall N.
“Fish, chicken, lean meat and eggs can
be eaten daily”: a food-based dietary
guideline for South Africa. SAJCN.
2013; 3:S66-S76
Eat plenty of vegetables
and fruit every day
At least 5 fruit and vegetables in total should be eaten each day.
Dark green leafy vegetables and yellow or orange fleshed vegetables
and fruit are specifically important for health. Some vegetables can
be eaten raw; others need to be cooked to make them more
digestible and palatable. Fruit should mostly be eaten fresh and raw,
but can be eaten cooked or dried, preferably without added sugar.
Naude CE. “Eat plenty of vegetables
and fruit every day”: a food-based
dietary guideline for South Africa.
SAJCN. 2013; 3:S46-S56
Eat dry beans, split peas,
lentils and soya regularly
These foods should be eaten at least 2 to 3 times per week. They
provide healthy and lower fat protein alternatives. Vegan
vegetarians should combine different plant proteins to ensure that
all essential amino acids are eaten e.g. combining samp with beans
and a peanut butter sandwich.
Enjoy a variety of foods.
Venter CS, Vorster HH, Ochse R, Swart
R. “Eat dry beans, split peas, lentils and
soya regularly”: a food-based dietary
guideline. SAJCN. 2013; 3:S36-S45
Use low fat or skim milk or maas and preferably low fat yoghurt.
Limit the use of milk products with added sugars.
Vorster HH et al.“Have milk, maas or
yoghurt every day”:a food-based
dietary guideline for South Africa.
SAJCN. 2013; 3:S57-S65
Use salt in small amounts when cooking and avoid adding salt at the
table. Reduce the intake of high salt containing foods e.g. salted
snacks, stock cubes, commercial soups, salad dressings and
processed meats. Check food labels for salt content. Use herbs,
garlic, spices and lemon juice to flavour foods instead of using salt.
Wentzel-Viljoen E, Steyn K, Ketterer E,
Charlton CE. “Use salt and foods high
in salt sparingly”: a food-based dietary
guideline for South Africa. SAJCN.
2013; 3:S105-S113
Eat fats sparingly, choose
vegetable oils rather
than hard fats.
Use a little fat at a time and choose plant fat or oils such as tub
margarine or canola, sunflower or olive oil. Fatty fish, nuts, seeds
and avocado pears also provide healthy fats.
Smuts CM, Wolmarans PW. The
importance of the quality or type of fat
in the diet: a food based dietary
guideline for South Africa. SAJCN.
2013; 3:S87-S99
Use foods and drinks
containing sugar
sparingly, and not
between meals
Use foods moderate to high in sugar, especially those containing
added sugar, sparingly. Consumption of sugar sweetened beverages
should be limited.
Temple NJ, Steyn NP. Sugar and
health: a food-based dietary guideline
for South Africa. SAJCN. 2013; 3:S100S104
Have milk, maas or
yoghurt every day
Use salt and food high in
salt sparingly.
Drink lots of clean, safe
water
Be active
Children and adults need 6 to 8 glasses of water per day. Water
needs may be higher for the elderly and for people who are involved
in exercise or hard physical labour.
Exercise at least 3 to 5 times a week for 20 to 50 minutes (min). This
can be accumulated in smaller bouts of at least 10 min during the
course of the day. It is recommended that children/adolescents
and those seeking additional health benefits such as weight loss
should do more exercise; up to 60 min most days of the week.
van Graan AE et al. “Drink lots of clean,
safe water”: a food-based dietary
guideline for South Africa. SAJCN.
2013; 3: S77-S86
Botha CR, Wright HH, Moss SJ, KolbeAlexander TL. “Be active!” Revisiting
the South African food-based dietary
guideline for activity. SAJCN 3: S18-S27