Tài liệu Incorporating the Australian Guide to Healthy Eating ppt

DRAFT Australian Dietary Guidelines- December 2011 5

2.4.4 Practical considerations: Lean meat and poultry, fish, eggs, legumes/beans and nuts/seeds 57
2.5 Milk, yoghurt, cheese and/or alternatives (mostly reduced fat) 61
2.5.1 Setting the scene 61
2.5.2 The evidence for ‘milk, yoghurt, cheese and/or alternatives’ 62
2.5.3 How drinking milk and eating yoghurt, cheese and/or alternatives may improve health outcomes
65
2.5.4 Practical considerations: Milk, yoghurt, cheese and/or alternatives 65
2.6 Water 68
2.6.1 Setting the scene 68
2.6.2 The evidence for ‘drink water’ 68
2.6.3 How drinking water may improve health outcomes 71
2.6.4 Practical considerations: Drink water 72

3. Limit intake of foods and drinks containing saturated and trans fats, added salt, added sugars and
alcohol 74
3.1 Limiting intake of foods and drinks containing saturated and trans fat 76
3.1.1 Setting the scene 76
3.1.2 The evidence for ‘limiting intake of foods and drinks containing saturated and trans fat’ 77
3.1.3 How limiting intake of foods and drinks containing saturated and trans fat may improve health
outcomes 79
3.1.4 Practical considerations: Limiting intake of foods and drinks containing saturated and trans fat 80
3.2 Limit intake of foods and drinks containing added salt 82
3.2.1 Setting the scene 82
3.2.2 The evidence for ‘limiting intake of foods and drinks containing added salt’ 83
3.2.3 How limiting intake of foods and drinks containing added salt may improve health outcomes 85
3.2.4 Practical considerations: Limiting intake of foods and drinks containing added salt85
3.3 Limit intake of foods and drinks containing added sugars 87
3.3.1 Setting the scene 87
3.3.2 The evidence for ‘limiting intake of foods and drinks containing added sugars’ 88
3.3.3 How limiting intake of foods and drinks containing added sugars may improve health outcomes
90
3.3.4 Practical considerations: Limiting intake of foods and drinks containing added sugars 91
3.4 Alcoholic drinks 92
3.4.1 Setting the scene 92
3.4.2 The evidence for ‘limiting alcohol’ 94
3.4.3 How limiting alcohol may improve health outcomes 97
3.4.4 Practical considerations: Limiting alcohol 98


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4. Achieve and maintain a healthy weight 1027
5.1 Setting the scene 109
4.2 The evidence for ‘achieving and maintaining a healthy weight’ 113
4.3 How dietary patterns can affect energy intake and balance and weight outcomes 119
4.4 Practical considerations: Achieving and maintaining a healthy weight 120

5. Encourage and support breastfeeding 131
5.1 Setting the scene 133
5.2 The evidence for ‘Encouraging and supporting breastfeeding’ 134
5.3 Practical considerations: Encourage and support breastfeeding 140

6. Food safety 144
6.1 Setting the scene 146
6.2 The evidence for ‘caring for your food; prepare and store it safely’ 146
6.3 Why it is important to prepare and store food safely 147
6.4 Practical considerations: Food safety 148

Appendix 1. History and timeline of Australian nutrition documents 150
Appendix 2. Process report 156
Appendix 3. Assessing growth and healthy weight in infants, children and adolescents, and healthy weight
in adults 163
Appendix 4. Physical activity guidelines 169
Appendix 5. Studies examining the health effects of intake of fruit and vegetables together 173
Appendix 6. Alcohol and energy intake 176
Appendix 7. Equity and the social determinants of health and nutrition status 178
Appendix 8: Glossary 191

References 209



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1. Introduction
1.1 Why the
Guidelines
matter
There are many ways for Australians to achieve dietary patterns that promote health and
wellbeing and reduce the risk of chronic disease. Diet is arguably the single most important
behavioural risk factor that can be improved to have a significant impact on health [1, 2]. As the
quality and quantity of foods and drinks consumed has a significant impact on the health and
wellbeing of individuals, society and the environment, better nutrition has a huge potential to
improve individual and public health and decrease healthcare costs. Optimum nutrition is essential
for the normal growth and physical and cognitive development of infants and children. In all
Australians, nutrition contributes significantly to healthy weight, quality of life and wellbeing,
resistance to infection, and protection against chronic disease and premature death.
Sub-optimal nutrition can be associated with ill-health. Many diet-related chronic diseases such as
cardiovascular disease, type 2 diabetes and some forms of cancer are the major cause of death and
disability among Australians [3]. More than one-third of all premature deaths in Australia are the
result of chronic diseases that could have been prevented [3]. Many of these are mediated by
overweight and obesity.
Poor nutrition is responsible for around 16% of the total burden of disease [1, 4] and is implicated
in more than 56% of all deaths in Australia [5]. The most recent available estimates for the total
cost of poor nutrition were more than $5 billion per year, based on 1990 costings [5]. Given that
the cost of obesity alone was estimated to be $8.283 billion per year in 2008 [6], the current cost
of poor nutrition in Australia is now likely to greatly exceed the 1990 estimates.
Most of the burden of disease due to poor nutrition in Australia is associated with excessive
intake of energy-dense and relatively nutrient-poor foods high in energy (kilojoules), saturated fat,
added or refined sugars or salt, and/or inadequate intake of nutrient-dense foods, including
vegetables, fruit and wholegrain cereals [2, 7]. Deficiency in some nutrients such as iodine, folate
[8], iron and vitamin D is also of concern for some Australians [9, 10].
Overconsumption of some foods and drinks, leading to excess energy intake and consequent
overweight and obesity, is now a key public health problem for Australia [7, 11]. The prevalence of
overweight and obesity has increased dramatically in Australia over the past 30 years and is now
62% in adults [12] and around 25% in children and adolescents [12, 13].
These Guidelines summarise the evidence underlying food, diet and health relationships that
improve public health outcomes.


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Dietary patterns consistent with the
Guidelines
improve health
Recent reviews of the evidence on food and health confirm that dietary patterns consistent with
the Guidelines are positively associated with indicators of health and wellbeing.
Two systematic reviews found that higher dietary quality was consistently associated with a 10–
20% reduction in morbidity. For example, there is evidence of a probable association between
consumption of a Mediterranean dietary pattern and reduced mortality (Grade B, Section 20.1 in
Evidence Report [14]) [15-17]. Previous studies have also indicated inverse associations between
plant-based diets and all-cause and cardiovascular mortality, particularly among older adults [18-
20]. The effects of dietary quality tended to be greater for men than women, with common
determinants being age, education and socioeconomic status [21, 22].
There is likely to be great variation in the interpretation and implementation of dietary guidelines.
Nevertheless, when a wide range of eating patterns was assessed for compliance with different
guidelines using a variety of qualitative tools, the assessment suggested an association between
adherence to national dietary guidelines and recommendations, and reduced morbidity and
mortality (Grade C, Section 20.3 in Evidence Report [14]) [21, 22].
More recent evidence from Western societies confirms that dietary patterns consistent with
current guidelines recommending relatively high amounts of vegetables, fruit, whole grains, poultry,
fish, and reduced fat milk, yoghurt and cheese products may be associated with superior
nutritional status, quality of life and survival in older adults [23, 24]. Robust modelling of dietary
patterns in accordance with dietary guidelines has demonstrated achievable reductions in
predicted cardiovascular and cancer disease mortality in the population, particularly with increased
consumption of fruit and vegetables [25].
In relation to obesity, actual dietary recommendations and measures of compliance and weight
outcomes vary greatly in published studies. Overall energy intake is the key dietary factor affecting
weight status (see Chapter 4).
1.2 Social determinants of food choices and
health
Life expectancy and health status are relatively high overall in Australia [12, 26]. Nonetheless,
there are differences in the health and wellbeing between Australians, including in rates of death
and disease, life expectancy, self-perceived health, health behaviours, health risk factors, and use of
health services [27-29].
The causes of health inequities are largely outside the health system and relate to the inequitable
distribution of social, economic and cultural resources and opportunities [27-29]. Employment,


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income, education, cultural influences and lifestyle, language, sex and other genetic differences,
isolation (geographic, social or cultural), age and disability, the security and standard of
accommodation, and the availability of facilities and services all interact with diet, health and
nutritional status[27, 28]. Conversely, a person’s poor health status can contribute to social
isolation and limit their ability to gain employment or education and earn an income, which can in
turn impact negatively on health determinants such as quality and stability of housing.
Australians who are at greater risk of diet-mediated poor health include the very young, the very
old, Aboriginal and Torres Strait Islander peoples and those in lower socioeconomic groups [27-
32]. The Guidelines address some of the issues these population groups face under ‘Practical
considerations for health professionals’ in each guideline. Further discussion of the social
determinants of health and food choices is provided in Appendix 7.
1.3 Scope and target audience
The Guidelines, together with the underlying evidence base, provide guidance on foods, food
groups and dietary patterns that protect against chronic disease and provide the nutrients
required for optimal health and wellbeing. They are important tools which support broader
strategies to improve nutrition outcomes in Australia, as highlighted in Eat Well Australia: an agenda
for action in public health nutrition, 2000-2010 [2]. They are consistent with the most recent
Australian Food and Nutrition Policy 1992 [33] in considering health and wellbeing, equity and the
environment.
The
Guidelines
apply to all healthy Australians
The Guidelines aim to promote the benefits of healthy eating, not only to reduce the risk of diet-
related disease but also to improve community health and wellbeing. The Guidelines are intended
for people of all ages and backgrounds in the general healthy population, including people with
common diet-related risk factors such as being overweight.
They do not apply to people with medical conditions requiring specialised dietary advice, nor to
the frail elderly who are at risk of malnutrition.
The
Guidelines
are based on whole foods
Dietary recommendations are often couched in terms of individual nutrients (such as vitamins and
minerals). People chose to eat whole foods not single nutrients, so such recommendations can be
difficult to put into practice. For this reason, these Guidelines make recommendations based only
on whole foods, such as vegetables and meats, rather than recommendations related to specific
food components and individual nutrients.



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This practical approach makes the recommendations easier to apply. Dietary patterns consistent
with the Guidelines will allow the general population to meet nutrient requirements, although some
subpopulations (for example, pregnant and breastfeeding women) may have some increased
nutrient requirements that are more difficult to meet through diet alone. This is noted for each
Guideline under ‘Practical considerations for health professionals’.
For information on specific micro- and macro-nutrients, refer to the Nutrient Reference Values for
Australia and New Zealand [9].
Issues related to food composition and food supply, such as fortification, use of food additives or
special dietary products are dealt with by Food Standards Australia New Zealand (see
http://www.foodstandards.gov.au).
Target audience for the Guidelines
The target audience for the Guidelines comprises health professionals (including dietitians,
nutritionists, general practitioners, nurses and lactation consultants), educators, government policy
makers, the food industry and other interested parties. A suite of resources for the general public,
including the revised Australian Guide to Healthy Eating has also been produced (see
www.eatforhealth.gov.au).
Companion documents
The Guidelines form part of a suite of documents on nutrition and dietary guidance (see Figure 1.1).
Other documents in this suite include:

Nutrient Reference Values for Australia and New Zealand

This details quantitative nutrient reference values (NRVs) for Australians of difference ages and
gender. These reference values detail the recommended amounts of nutrients (vitamins, minerals,
protein, carbohydrate etc.) required to avoid deficiency, toxicity and chronic disease. As an
example, you would refer to the NRVs document to know how much iron is needed by women
aged between 19 and 30.
The Food Modelling Document
(A modelling system to inform the revision of the Australian Guide to Healthy Eating)

This describes a range of computer-generated diets that translate the NRVs into dietary patterns
to describe the types, combinations and amounts of foods that deliver nutrient requirements for
each age and gender group of different physical activity level in the Australian population.
A range of models including omnivore, lacto-ovo vegetarian, pasta and rice-based dietary patterns
were developed, and dietary patterns were used to inform the Australian Guide to Healthy Eating.



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The Evidence Report
(A review of the evidence to address targeted questions to inform the revision of the
Australian dietary guidelines)

This is a systematic literature review relevant to targeted questions published in the peer-
reviewed nutrition literature from 2003-2009. This document is described further in Section 1.4.
As an example, if you would like to look at the evidence for a particular Evidence Statement, you
would refer to the Evidence Report.

The Australian Guide to Healthy Eating

This package of resources includes:
 the ‘plate’ graphic divided into portions of fruit, vegetables, grains, milk, yoghurt and cheese
products and lean meat and alternatives, representing the number of serves of each type of food
required per day
 the recommended number of serves of each of the food groups, and discretionary foods,
for different sub-population groups
 examples of what a serve size is for each food group
As an example, if you are would like to know how many serves of vegetables men aged between
19 and 50 should eat each day you would refer to the Australian Guide to Healthy Eating. This
information is also included in the Guidelines under ‘Practical considerations for health
professionals’ for each food group.

Related brochures and posters for health professionals and consumers

All these documents are available on the web at www.eatforhealth.gov.au.


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Figure 1.1: Relationship between the documents related to the Australian Dietary Guidelines

Supporting Documents

 Evidence Report to
inform the review of the
Australian Dietary
Guidelines
 Food Modelling System to
inform the Australian Guide
to Healthy Eating (2010)
 Pregnant and
breastfeeding women
literature review (2011)
 The previous Dietary
Guidelines for all
Australian (2003)
 Authoritative reports &
additional literature
 Nutrient Reference
Values for Australia and
New Zealand Including
the Recommended
Dietary Intakes (2005)

Australian Dietary
Guidelines
incorporating the
Australian Guide to Healthy
Eating

The Australian Dietary Guidelines are evidence-based
dietary advice for healthy Australians. The guidelines
incorporate the Australian Guide to Healthy Eating,
which is a practical guide on the types and amounts
of foods to eat each day.



Additional Resources

Brochures and posters
- Eat for health: Enjoy life

- Healthy eating: How to give
your children the best start
in life

- Eat for a healthy
pregnancy: Advice on eating
for you and your baby

- Giving your baby the best
start: The best foods for
infants


Summary Booklet
- Eat for health: Dietary
Guidelines for Australians

www.eatforhealth.gov.au

Nutrient Reference Values
publications and website
www.nrv.gov.au



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1.4 How the
Guidelines
were developed
These Guidelines are an evolution of the 2003 Dietary Guidelines, building upon their evidence and
science base. New evidence was assessed to determine whether associations between food,
dietary patterns and health outcomes had strengthened, weakened, or remained unchanged.
Where the evidence base was unlikely to have changed substantially (for example, the relationship
between intake of foods high in saturated fat and increased risk of high serum cholesterol),
additional review was not conducted.
The methods used to analyse the evidence were in accordance with international best practice
[14, 34]. They are summarised below, and provided in more detail in Appendix 2.
The Guidelines are further informed by substantial advances in the methodology for guideline
development and usability in the eight years since publication of the previous dietary guidelines.
Human feeding studies and clinical trials provide direct evidence of the impact of food
consumption on physiological responses and disease biomarkers. Although the breadth and depth
of knowledge generated from these kinds of studies is uneven, a consistent alignment of results
with plausible mechanisms adds confidence in the analysis of all studies combined.
1.4.1 Sources of information

Five key evidence streams

In developing the Guidelines, NHMRC drew upon the following key sources of evidence (see figure
1.1):
 the previous Dietary Guidelines for Australians series and their supporting documentation
[35-37]
 a commissioned literature review: A review of the evidence to address targeted questions
to inform the revision of the Australian dietary guidelines (referred to as ‘the Evidence
Report’) [14]
 NHMRC and the New Zealand Ministry of Health 2006: Nutrient reference values for
Australia and New Zealand including recommended dietary intakes (referred to as ‘the
NRV document’) [9]
 a commissioned report: A modelling system to inform the revision of the Australian Guide
to Healthy Eating (referred to as ‘the Food Modelling’ document) [10]
 key authoritative government reports and additional literature





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The Evidence Report – answers to key questions in the research
literature
NHMRC commissioned a literature review (A review of the evidence to address targeted questions to
inform the revision of the Australian dietary guidelines—the Evidence Report) on food, diet and
disease/health relationships, covering the period 2003–2009. This addressed specific questions
developed by the expert Dietary Guidelines Working Committee (the Working Committee) on
food, diet and disease/health relationships where evidence might have changed since the previous
dietary guidelines were developed.
NHMRC followed critical appraisal processes to ensure rigorous application of the review
methodology [34, 38]. Data were extracted from included studies and assessed for strength of
evidence, size of effect and relevance of evidence according to standardised NHMRC processes
[34, 39-41]. The components of the body of evidence—evidence base (quantity, level and quality of
evidence); consistency of the study results; clinical impact; generalisability; and applicability to the
Australian context—were rated as excellent, good, satisfactory or poor according to standard
NHMRC protocols [41].
The reviewers then summarised the evidence into draft body of evidence statements. The
Working Committee advised that a minimum of five high quality studies was required before a
graded draft evidence statement could be made. The individual studies in meta-analyses were
considered as separate studies. The draft Evidence Statements were graded A to D according to
standard NHMRC protocols [41].
 Grade A (convincing association) indicates that the body of evidence can be trusted to
guide practice
 Grade B (probable association) indicates that the body of evidence can be trusted to guide
practice in most situations
 Grade C (suggestive association) indicates that the body of evidence provides some
support for the recommendations but care should be taken in its application
 Grade D indicates that the body of evidence is weak and any recommendation must be
applied with caution.
Once the evidence statements and grades had been drafted, NHMRC commissioned an external
methodologist to ensure that the review activities had been undertaken in a transparent, accurate,
consistent and unbiased manner. This ensures that the work can be easily double-checked by
other experts in nutrition research.
In this way, the Evidence Report was used to develop the graded Evidence Statements included in
the Guidelines. It is important to note that these grades relate to individual diet-disease
relationships only—the Guidelines summarise evidence from a number of sources and across a
number of health/disease outcomes.

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