For the first time, nutrition recommendations for infants, toddlers, and women who are pregnant or breastfeeding were included in the updated Dietary Guidelines for Americans, 2020-2025, released by the US Department of Agriculture (USDA) and the Department of Health and Human Services (HHS).1

Additionally, the guideline appendix provides estimated calorie needs based on age, sex, height, weight, and exercise level. The USDA’s MyPlate website and app are available to help patients incorporate the new guidelines and meal plan. According to a USDA spokesperson, the HHS is developing a toolkit for healthcare professionals that is expected to be available later this year.

April N. Kapu, DNP, APRN, ACNP-BC, FAANP, FAAN

“It’s encouraging to see the USDA-HHS added new recommendations for pregnant women, infants, and toddlers,” said incoming President of the American Association of Nurse Practitioners (AANP) April N. Kapu, DNP, APRN, ACNP-BC, FAANP, FAAN, in an interview with Clinical Advisor. “Diets play a substantial role in health and the guidelines that the American public uses to guide their lifestyle choices should be based on research evidence.”

Previous editions of Dietary Guidelines for Americans covered people aged 2 and older, the USDA spokesperson said. “The Agricultural Act of 2014 [the ‘Farm Bill’]) mandated that the 2020-2025 edition and every edition to follow should include guidance for infants, toddlers, and women who are pregnant. Thus, the latest edition of the Dietary Guidelines for Americans includes recommendations for every stage of life in dedicated chapters, including infants and toddlers [Table 1], in addition to continuing the emphasis on healthy dietary patterns during pregnancy and lactation.”


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Table. 1. USDA-HHS Dietary Guidelines for Infants and Toddler1,2

Infants
Exclusively feed human breast milk for at least the first year of life (or longer) or use iron-fortified infant formula if breast milk is unavailable
At 6 months of age, introduce nutrient-dense foods
Include potentially allergenic foods
For infants at high risk for peanut allergy, introduce peanut-containing foods at age 4 to 6 monthsa
Include foods rich in iron and zinc
Avoid foods and drinks with added sugars
– Limit sodium intake
Start vitamin D supplements (400 IU/day) soon after birth unless the infant is exclusively formula fed
Toddlers, aged 1-2 years
Infant formula is not recommended
Calorie and nutrient needs should be met primarily from age-appropriate foods and beverages
Avoid foods and drinks with added sugar
Recommendations to limit higher fat versions of dairy milk and saturated fat start at age 2 years
Seafood high in methylmercury should be avoided
aInfants with severe eczema and/or egg allergy are at increased risk for peanut allergy. A peanut-specific IgE measurement and/or skin prick test should be strongly considered before introducing peanut into the diet.

“This approach recognizes that each life stage is distinct — an individual’s nutrient needs vary over their lifespan… At the same time, the 2020-2025 edition recognizes an important continuity, early food preferences influence later food choices, establishing a healthy dietary pattern early in life may have a beneficial impact on health promotion and disease prevention over the course of decades. Regardless of an individual’s life stage, it is never too early or too late to make healthy choices,” the USDA spokesperson said.

Age-group specific chapters provide “data on current dietary habits, identify gaps and areas for improvement, and provides guidance specific to the age group’s needs,” the USDA spokesperson told Clinical Advisor. “We hope users find this approach to be helpful in their everyday work with patients and clients.”

“I think it is especially important that the guidelines did include the committee’s recommendations that children younger than 2 years of age not consume added sugars in beverages or food,” said Allyson Hamacher, PA-C, RD, who is a physician assistant (PA) in the department of neurology at Mayo Clinic in Phoenix, Arizona, and a faculty member of the PA Foundation Nutrition Outreach Fellowship. “Anyone with a young toddler knows they mimic behaviors of adults, and PAs can suggest to patients who have children that they avoid intake of those foods to help their children create healthy behaviors.”

Ms. Hamacher was also excited that recommendations for women who are pregnant and breastfeeding (Table 2), given the specialized needs and particular challenges in these groups. “Women who are pregnant have increased calorie and nutrient needs, which means their increased calories should come from nutrient-dense foods rather than added sugars and fats,” Ms. Hamacher said. “The Dietary Guidelines include areas of improvement for diets of pregnant women, which can be areas that PAs initially focus on when educating women.”

Table 2. USDA-HHS Dietary Guidelines for Women Who Are Pregnant or Breastfeeding1

Core elements are similar to those for adult women who are not pregnant or lactating
Increased caloric needs should come from nutrient-dense foods and beverages with little added sugars, saturated fat, and sodium
Recommended weight gain in pregnancy is 25-35 lb for women with a healthy prepregnancy weight and ranges from 28-40 lb for underweight women to 11-20 lb for women who are obese
Change in caloric needs during lactation: first 6 months = +330 calories; second 6 months +400 calories

“Data shows that pregnant women generally meet the recommended intake of grains and protein, but are lacking intake of vegetables, fruits, and dairy or fortified soy-beverages,” Ms. Hamacher added. “Pregnant women are also not meeting guidelines for limited intake of sodium, added sugars, and fats, so that’s another area for improvement. The guidelines also make suggestions for physical activity during pregnancy, which is an important area of health for pregnant women that is sometimes overlooked.”

“I love the message of these Dietary Guidelines to ‘Make Every Bite Count,’” Ms. Hamacher said. “I think this message in and of itself is a great recommendation to patients. It emphasizes the importance of nutrient-dense foods and really savoring every bite.”

The updated USDA-HHS Dietary Guidelines were also criticized by some organizations for not lowering sugar and alcohol intake as recommended by an advisory committee. For more information on this controversy, click here.

References

1. U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2020-2025. 9th Edition. December 2020.

2. Togias A, Cooper SF, Acebal ML, et al. Addendum Guidelines for the Prevention of Peanut Allergy in the United States: Report of the National Institute of Allergy and Infectious Diseases-Sponsored Expert Panel. October 18, 2016. Accessed February 23, 2021. https://www.niaid.nih.gov/sites/default/files/addendum-peanut-allergy-prevention-guidelines.pdf