For numerous cycles, the need for increased intake of whole grains has been a focal point of the Dietary Guidelines for Americans. In the Scientific Report of the 2020 Dietary Guidelines Advisory Committee, the status of whole grains for the first time has been elevated to a level essentially on par with fruits and vegetables.
“A noteworthy difference from the 2015 Committee report is that whole grains are now identified with almost the same consistency as vegetables and fruits as beneficial for the outcomes examined, suggesting that these three plant-based food groups are fundamental constituents of a healthy dietary pattern,” the report said.
In the same breath, the committee is urging more repetitively than ever that intake of refined grains should be replaced with whole grains. The report retains the recommendation that at least half of total grains should come from whole grains, with total grains intake of 3 to 8 oz per day, based on energy intake.
The 835-page report was published July 15 and, subject to public comment, will form the basis of the 2020-2025 Dietary Guidelines for Americans. The US Department of Agriculture and the Department of Health and Human Services, which are jointly responsible for the Guidelines, will accept written public comments on the report through Aug. 13.
In reaching its conclusions, the committee said it used three approaches — data analysis, food pattern modeling and Nutrition Evidence Systematic Reviews (NESR). The committee acknowledged that for the third consecutive time, the DGA are being drafted against a backdrop of suboptimal American eating habits, with more than 70% of Americans overweight or obese (the figures have been rising), with obesity a public health problem and food insecurity and a lack of access to affordable healthy food another persistent problem.
A key feature of the 2020 report, building on efforts started by the 2015 committee, is a focus on dietary patterns.
“This emphasis acknowledges the reality that people do not consume nutrients or foods in isolation but in various combinations over time,” the researchers said. “It also reflects growing evidence that components of a dietary pattern may have interactive, synergistic, and potentially cumulative relationships that can predict overall health status and disease risk more fully than can individual foods or nutrients.”
It is in the context of dietary patterns that the committee repeatedly cast whole grains in a positive light and refined grains decidedly less so.
“Common characteristics of dietary patterns associated with positive health outcomes include higher intake of vegetables, fruits, legumes, whole grains, low- or non-fat dairy, lean meat and poultry, seafood, nuts, and unsaturated vegetable oils and low consumption of red and processed meats, sugar-sweetened foods and drinks, and refined grains,” the report said.
The researchers said average intake of total grains among Americans ages 2 years and older is 6.4 oz per day, a figure falling within the recommended range of 3 to 8 oz.
“More than 1 in 5 people exceeds recommended levels for total grains,” the researchers said. “However, only 0.9 oz eq/day are consumed from whole grains, which is well below recommended intakes. Whole grain intakes are well below recommended levels in all age-sex groups, with only 2% of the population meeting recommendations.”
While almost 75% of Americans consume more refined grains than recommended, the researchers found that about half of adults consume total grains in amounts lower than recommended. By contrast, only 16% of adult males and 20% of adult females consume more total grains than recommended.
“The top food subcategory contributor to total grain intake for all age-sex groups is burgers and sandwiches, providing a quarter or more of total grain intake on an average day,” the report said. “Among children ages 18 years and younger, rice, pasta, and other grain-based mixed dishes; chips, crackers, and savory snacks; and desserts and sweet snacks each provide more than 10% of total grain intakes. Among adults, yeast breads and tortillas, and rice, pasta, and other grain-based dishes are among the top total grain contributors.”
The researchers said the public selects from a narrower menu when it comes to whole grains.
“The top food subcategories that contribute to whole grain intake in the diets of US children and adults include breakfast cereals and bars (33% to 42%); burgers and sandwiches (17% to 21%); and chips, crackers, and savory snacks (14% to 19%),” the researchers said. “Yeast breads and tortillas are a significant whole grain contributor among adults, but not among youth.”
Hispanic and Asian communities are the heaviest consumers of total grains, the report said.
“The highest intake of whole grains occurs within the non-Hispanic Asian community (1.2 oz eq/day),” the researchers said. “Intakes of whole grains are higher among non-Hispanic Asian youth, particularly during adolescence, compared to other youth.”
Total grain intake does not differ by income level, but whole grain intake rises with income.
“Although total grain intakes remained steady between NHANES 2003-2004 and 2015-2016, whole grain intakes increased significantly among children ages 2 to 19 years but remain below recommended levels,” the researchers said.
The contribution of enrichment to dietary health is nearly completely absent in the lengthy report and is actually misstated in a summary section, describing refined grains as “nutrient poor.” The section discussed the need for most Americans to shift current food choices to “healthy, nutrient-dense foods and beverages across and within all food groups.”
“When diet quality is poor, as indicated by lower intakes of nutrient-dense foods like vegetables, fruit, legumes, or whole grains, then it is unlikely that individuals will achieve the targeted nutrient intakes from foods,” the report said. “When nutrient-dense foods account for a low proportion of the total energy intake, it follows that nutrient-poor but energy-rich foods, such as refined grains and foods and beverages with added sugars and saturated fats, contribute a higher proportion of energy intake, thereby contributing to a higher risk of overweight and obesity and a range of related chronic diseases.”
The lack of regard for the value of enrichment and folic acid fortification extended even in a section devoted to strategies for women of reproductive age aimed at promoting “optimal pregnancy outcomes.”
Dietary guidance for women before and during pregnancy included choosing “dietary patterns that are higher in vegetables, fruits, whole grains, nuts, legumes, seafood, and vegetable oils, and lower in added sugars, refined grains, and red and processed meats.”
While fortification of refined grains has been associated with a sharp decline in neural tube birth defects, the committee said reducing intake of refined growths “protects against poor maternal-fetal outcomes in pregnancy.”
Refined and whole grains also were drawn into discussions by the committee of excessive intake of added sugars.
“The five top food category sources of added sugars, primarily desserts and sweet snacks, and breakfast cereals and bars, account for 17.3% of total grain intake for individuals ages 2 years and older, with these foods making up a higher proportion of total grains intake for children ages 2 to 5 years (21.8%) and adults ages 71 years and older (24.8%) compared to other age groups,” the committee said. “Desserts and sweet snacks are typically made with refined grains, while breakfast cereals and bars often contain whole grains, which are underconsumed. Breakfast cereals and bars account for 40.3% of whole grains intake across the population ages 2 years and older and slightly more for children ages 2 to 5 (49.5%).”
Similarly, developing whole grain versions of sugary refined grain products should be avoided, the committee said.
“The redistribution of energy from refined to whole grains sources to better meet nutrient recommendations must be considered with caution, however,” the report said. “Specifically, certain food categories, such as breakfast cereals and bars, are both a source of whole grains and a top contributor to added sugars intakes. In these instances, shifting to a lower sugar or no-sugar added version of the breakfast cereal or bar would be preferable rather than shifting energy to other food sources.”