New US dietary guidelines expand nutrient considerations for life stages

Feature ArticlesFeature Articles | 28 January 2021 | Citation  |  PDF Link PDF

The US Department of Agriculture and Department of Health and Human Services have jointly published the Dietary Guidelines for Americans every 5 years since 1980 to provide science-based dietary recommendations to promote health and prevent chronic disease. The guidelines inform federal food and nutrition policy programs as well as local, state, and national health promotion and disease prevention initiatives. In addition, professionals in public health, healthcare, education, and other sectors use the guidelines to educate the public about diet and health. For the first time, the guidelines are organized by life stage to include infants and toddlers and expanded advice for pregnant and lactating women. Building on the previous edition, the new guidelines provide a customizable framework and offer consistent advice on healthy eating across the lifespan, as well as special nutrition considerations for each life stage.
More than ever, Americans need dietary guidelines that are relevant and achievable, as diet-related chronic disease rates have continued to rise in recent years and present a major public health problem. Today, 74% of US adults  are overweight or obese, and 60% have one or more diet-related chronic diseases, including cardiovascular disease and type 2 diabetes. About 40% of children and adolescents are overweight or obese, and 210,000 have diabetes.1  
Improving clarity
The new guidelines improve the clarity of the core four previously established guidelines. They advise individuals to consistently follow a healthy dietary pattern, customize nutrient dense foods, meet food group needs while watching calories, and limit added sugars, saturated fat, sodium and alcoholic beverages. A previous fifth guideline2 – a call on every segment of society to support healthy eating – has been incorporated as a theme in each life stage chapter of the new guidelines. Information has been added on government resources for food assistance and nutrition education to elevate awareness of food insecurity as a concern for many Americans.  
Carried over from previous guidelines are the core elements of a healthy eating pattern, which include vegetables of all kinds; whole fruits; grains, especially whole grains; low-fat or no-fat dairy; protein from lean meats, poultry, seafood, beans, peas, and lentils; nuts and seeds, as well as healthy oils. These basic elements support a dietary framework that can be customized to create meals people eat, whether they are generally healthy or have a chronic disease. Components of a healthy eating pattern are consistent across life stages.

The guidelines emphasize that nutritional needs should be met through nutrient-dense foods and beverages but also recognize that dietary supplements are useful when it is otherwise not possible to meet nutrient needs. About 94% of Americans are at risk of vitamin D inadequacy, and 44% are at risk of calcium inadequacy. Only 30% of Americans exceed the adequate intake for potassium, and 6%, for dietary fiber.3 Because low intakes of these nutrients are associated with health problems, they are designated nutrients of public concern for underconsumption. The guidelines posit that adequate amounts of all of these nutrients, except for vitamin D, can be obtained from healthy dietary patterns. Thus, there is a recognition that vitamin D supplementation is appropriate for the US population. However,  American diets do not currently align with guidance and the shift to healthy eating will take time. Meanwhile, nutrient shortfalls will likely continue as the guidelines miss the opportunity to recommend supplementation of all under-consumed nutrients of public health concern for almost everyone.
Special nutritional considerations
A strength of the 2020 guidelines is the inclusion of an expanded discussion on special nutritional considerations for each life stage. Many of these relate to specific nutrient supplementation. For infants, there is a spotlight on vitamin B12, which is not provided in sufficient amounts in human milk if the mother’s vitamin B12 status is inadequate. Thus, the guidelines state that mothers at risk for vitamin B12 deficiency and/or their infants, if fed human milk, may require a vitamin B12 supplement. Nutritional needs increase in pregnancy and lactation and the development and growth of the infant and health of the mother depend on adequate intake of nutrients, specifically, folate/folic acid, iron, iodine, choline, and vitamin D. The guidelines highlight these key nutrients and advise how adequacy can be achieved, including supplementation under consultation with a healthcare provider.
In addition, the guidelines note that pregnant and lactating women who follow healthy vegan or vegetarian dietary patterns may need to supplement to get adequate amounts of certain nutrients, such as iron, vitamin B12, choline, zinc, iodine, and omega-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid. For older adults, the ability to absorb vitamin B12 declines, thus vitamin B12 supplementation should be discussed with a healthcare provider. The guidelines better serve their purpose by recognizing unique nutritional needs for each life stage, even as healthy eating advice is consistent across the lifespan.
The current guidelines recognize the importance of continuity, as healthy eating during one life stage should continue into the next stage to achieve a lifelong healthy eating pattern. The 2020-2025 guidelines take a notably more encouraging tone to empower individuals to make dietary shifts, “one meal at a time, one day at a time.” Although the document is intended for a professional audience, the general public can grasp the key messages and heed the call to action.

  1. US Department of Agriculture and Department of Health and Human Services. Dietary Guidelines for Americans: 2020-2025. 9th ed. Released December 2020. Accessed 27 January 2021.
  2. US Department of Agriculture and Department of Health and Human Services. Dietary Guidelines for Americans, 2015-2020. 8th ed. Released December 2015. Accessed 27 January 2021.
  3. Dietary Guidelines Advisory Committee. Dietary Guidelines for Americans website. Report of the 2020 Dietary Guidelines Advisory Committee: Advisory report to the Secretary of Agriculture and the Secretary of Health and Human Services. Released 2020. Accessed 27 January 2021.
About the author
Haiuyen Nguyen is senior director, scientific & regulatory affairs at the Council for Responsible Nutrition. She focuses on developing regulatory and scientific comments on dietary supplement-related topics submitted to federal agencies, including the Food and Drug Administration, Department of Health and Human Services, and Department of Agriculture. She has more than 10 years of experience in facilitating industry compliance with dietary supplement regulations, including good manufacturing practices, and engaging in federal nutrition policy-making processes. Nguyen has a bachelor of science degree in cellular and molecular biology and genetics from the University of Maryland, College Park. She can be contacted at

Citation Nguyen H. New US dietary guidelines expand nutrient considerations for life stages. January 2021. Regulatory Focus. Regulatory Affairs Professionals Society.
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