The 2020–2025 Dietary Guidelines for Americans (DGA) were unveiled in late December of 2020, the culmination of years of research, scientific review, public involvement and U.S. government approval. This release marks the 9th edition of the DGA, which have been updated and approved by the Departments of Agriculture (USDA) and Health and Human Services (HHS) every five years since 1980.
What, exactly, are the DGA? These guidelines provide science-based advice on what to eat and drink to promote health, reduce the risk for chronic disease and meet nutrient needs. The DGA provide nutrition guidance for individuals, health professionals, public health and social service agencies, health care and educational institutions, researchers, agricultural producers and food and beverage manufacturers, among others. In addition, the U.S. government uses the DGA as the basis of its food assistance and meal programs, nutrition education efforts and decisions about national health objectives. These include initiatives like the National School Lunch Program, the Older Americans Act Nutrition Program and the Special Supplemental Nutrition Program for Women, Infants, and Children.
Using the slogan, “Make Every Bite Count,” the 2020–2025 DGA emphasize nutrient-dense foods and beverages, limiting those that are high in added sugar, saturated fat and sodium and staying within calorie limits. This iteration also puts a stronger focus on meeting dietary recommendations while keeping budget-consciousness, cultural preferences and personal customization in mind. Many resources have been made available by the USDA and HHS to help people eat healthy on a budget, customize the DGA and more.
The DGA are an unquestionably important part of public health promotion. And yet, for many, these recommendations may prove to be challenging to meet: Most Americans exceed the recommended limits on added sugars, saturated fat and sodium, and three in four have dietary patterns that are low in vegetables, fruit and dairy. As a result, the average American scores 59 out of 100 on the Healthy Eating Index (HEI), a measure of adherence to the DGA. Given these challenges, a sustained, effective communications effort is vital to translate these guidelines into practical, realistic adaptations for Americans.
What’s Stayed the Same:
- An emphasis on dietary patterns Since the 2015–2020 edition, the DGA focus on the combination of foods and beverages that make up an individual’s whole diet over time, not single foods or eating occasions in isolation. As with the previous version, the 2020–2025 DGA provide examples of three dietary patterns that align with recommendations: Healthy U.S.-Style, Healthy Vegetarian and Healthy Mediterranean–Style.
- MyPlate MyPlate is a graphic intended to visualize the food groups included in the DGA, in relative amounts recommended to meet food and nutrient guidelines. After replacing the well-known Food Pyramid in the 2010–2015 DGA, it serves as a reference for helping people learn more about each food group and choose healthful foods.
- Added sugars, saturated fat and sodium recommendations Encouraging Americans to eat less of these three food components has been a staple of previous DGA. The 2020–2025 DGA recommend:
- Limiting added sugars to less than 10% of calories per day for ages 2 and older and to avoid added sugars for infants and toddlers;
- Limiting saturated fat to less than 10% of calories per day starting at age 2; and
- Limiting sodium intake to less than 2,300 milligrams (mg) per day (or even less if younger than 14)
- These recommendations were consistent with the previous edition of the DGA; however, there has been controversy with respect to the added sugars recommendation since it did not align with the conclusions of the Scientific Report of the 2020 Dietary Guidelines Advisory Committee (DGAC), which called for limiting added sugars intake to no more than 6% of total calories. Citing that, “the new evidence reviewed since the 2015–2020 edition is not substantial enough to support changes to the quantitative recommendations.” The USDA and HHS did not take up the 2020 DGAC’s lower added sugars recommendation.
- Alcohol recommendations The 2020–2025 DGA recommend limiting alcoholic beverages (if consumed) to two drinks or less per day for men and one drink or less per day for women of legal drinking age. As with the added sugars recommendation, this recommendation was not consistent with the conclusions of the 2020 DGAC Report, which recommended that the guidelines be changed to state that, like women, men should consume one drink or less per day. The USDA and HHS cited the same rationale given for added sugars for not taking up the 2020 DGAC recommendation for alcohol.
What’s Changed: The Life Stage Approach
The 2020–2025 DGA establish a life stage approach to create recommendations specific to people of different ages and women who are pregnant or lactating. This iteration of the guidelines is the first to include recommendations for infants and toddlers (from birth through age 23 months), as well as for women who are pregnant or lactating, a change that was mandated by the Agricultural Act of 2014. Additional life stages include children and adolescents (ages 2 through 18), adults (ages 19 through 59) and older adults (ages 60 and older). Notable points for each of these life stages include:
Infants and Toddlers (ages birth through 23 months)
- For the first six months of life, infants should exclusively be fed human milk. Iron-fortified infant formula should be given if human milk is unavailable.
- Infants should be provided with supplemental vitamin D beginning soon after birth.
- At about 6 months, infants should be introduced to nutrient-dense complementary foods. They should continue drinking human milk or iron-fortified infant formula through at least the first year of life.
- Potentially allergenic foods should be introduced along with other complementary foods.
- In this age group, foods and beverages with added sugars should be avoided and those higher in sodium should be limited.
Children and Adolescents (ages 2 to 18)
- Establishing healthy dietary patterns during childhood and adolescence is crucial, since these habits tend to continue into the adult years. In contrast, unhealthy dietary patterns during this time contribute to chronic health conditions later in life, including overweight and obesity. Given that this age range has markedly different dietary needs, the 2020–2025 DGA highlight dietary patterns based on calorie levels appropriate for four age ranges: 2–8, 9–13 and 14–18.
- In addition to age- and calorie-range recommendations, the DGA also highlight the following special considerations for children and adolescents:
- Sugar-sweetened beverages: Beverages with added sugars such as soda, fruit drinks, sports and energy drinks are not essential to the diet because most are high in calories and do not significantly contribute to food groups or nutrient goals. The DGA recommend reducing the consumption of sugar-sweetened beverages and replacing them with beverages that contain no added sugars, such as water and unsweetened fat-free or low-fat milk—including low-lactose or lactose-free options or fortified soy beverages—and 100% juice, within recommended amounts.
- Juice: 100% fruit juice can be part of a healthy dietary pattern, as it contributes to fruit intake. The DGA recommend no more than 4 ounces at the lower–calorie levels and no more than 10 ounces at the highest calorie levels, while emphasizing that whole fruit should be the primary source of fruit intake.
- Dairy and fortified soy alternatives: Dairy and fortified soy alternatives contribute to intake of protein and various under–consumed nutrients such as calcium, potassium and vitamin D. The DGA recommend unsweetened, fat-free and low-fat varieties of dairy and fortified soy alternative foods and beverages.
Adults (ages 19 to 59)
- Adults ages 19 to 59 are encouraged to follow the recommendations that make up a healthy dietary pattern, focusing on nutrient-dense foods and limiting intakes of added sugars, saturated fat and sodium. In contrast to these nutrients to limit, the 2020-2025 DGA specify the following special considerations for this age group:
- Dietary fiber: More than 90% of women and 97% of men do not meet recommendations for dietary fiber intake, an important nutrient associated with reduced risk for several chronic diseases. High-fiber foods that are emphasized in a healthy dietary pattern include fruits, vegetables and whole grains.
- Calcium and vitamin D: These nutrients are vital for several physiological processes, particularly promoting optimal bone health and preventing osteoporosis. Calcium-rich foods, such as low-fat milk and yogurt, fortified soy alternatives and canned sardines and salmon, can help adults better meet intake recommendations. Consuming seafood and foods fortified with vitamin D, including milk, fortified soy-based beverages and soy-based yogurt, and some whole-grain cereals, can help adults meet their vitamin D needs.
- The core elements of a healthy diet for women who are pregnant or lactating are similar to the recommendations for women who are not. The needs for calories and some nutrients, however, increase as pregnancy progresses, and those needs remain elevated during lactation.
- Special nutrient and dietary considerations for pregnant and lactating women include folate, iodine, choline, seafood, alcoholic beverages, and caffeinated beverages.
- Folic acid: The United States Preventative Services Task Force recommends that all women who are planning for pregnancy take a daily supplement containing 400 to 800 micrograms of folic acid to prevent neural tube defects, in addition to folate from food as part of a healthy eating pattern. Most prenatal supplements sold in the United States contain folic acid, and folate is found inherently in dark-green vegetables, beans, peas, lentils and enriched grains.
- Iron: Iron needs increase during pregnancy compared with pre-pregnancy, and this nutrient is crucial for supporting fetal development. Heme iron, which is found in animal foods (e.g., lean meats, poultry and some seafood) is more easily absorbed by the body than the non-heme iron found in plant foods (e.g., beans, peas, lentils and dark-green vegetables). Additional iron sources include foods enriched or fortified with iron, such as many whole-wheat breads and breakfast cereals. Most prenatal supplements include iron.
- Iodine: The need for iodine increases significantly during pregnancy, as it is important for the neurocognitive development of the fetus. Although women of reproductive age generally have adequate iodine intake, some women, particularly those who do not regularly consume dairy products, eggs, seafood, or use iodized table salt, may not consume enough iodine to meet increased needs during pregnancy and lactation. Pregnant women should be sure that any table salt used in cooking or added to food at the table is iodized. Additionally, women who are pregnant or lactating may need a supplement containing iodine to achieve adequate intake.
- Choline: Choline needs also increase during pregnancy and lactation. Adequate intake of choline during these life stages helps both to replenish maternal stores and to support the growth and development of the child’s brain and spinal cord. Choline can be found throughout many foods, including eggs, meats and some seafood as well as the beans, peas and lentils. Many prenatal supplements do not contain choline, or only contain small amounts inadequate to meet recommendations, but choline supplements can often be found in stores or online.
- Seafood: Seafood intake during pregnancy is recommended, as it is associated with favorable measures of cognitive development in young children. Women who are pregnant or lactating should consume at least eight ounces and up to 12 ounces of a variety of seafood per week from choices lower in methylmercury. Additionally, certain species of seafood (e.g., shark, swordfish and king mackerel) should be avoided during pregnancy due to their high methylmercury content.
- Alcohol: Women who are or who may be pregnant should not drink alcohol. During lactation, moderate consumption of alcoholic beverages (up to one standard drink in a day) is not known to be harmful to the infant, especially if the woman waits at least 2 hours before nursing or expressing breast milk. However, the DGA note that not drinking alcohol is the safest option for lactating women.
- Caffeine: Caffeine can be consumed by healthy pregnant and lactating women, but amounts should be monitored. Caffeine passes from a mother to her infant in small amounts through breast milk, but usually does not adversely affect the infant when the mother consumes low to moderate amounts (about 300 milligrams or less per day, which is about two to three cups of coffee). Women are encouraged to talk with their healthcare provider about consuming caffeine during pregnancy or while lactating.
Older Adults (ages 60 and older)
- Older adults generally have lower calorie needs but similar or even increased nutrient needs compared with younger adults. The overall message for older adults in the DGA is to follow a healthy dietary pattern by increasing consumption of fruit, vegetables, whole grains and dairy; meeting protein intake recommendations; and reducing consumption of added sugars, saturated fat and sodium. The nutrients of public concern outlined in the “Adults” section—calcium, vitamin D and dietary fiber—apply to this age group as well. However, older adults have additional nutrition considerations, including dietary protein, vitamin B12 and beverage intake as it relates to hydration status.
- Protein: Many older adults fall short of recommendations for protein, which is an important nutrient for maintaining muscle mass and strength, bone health and other functions. Many older adults can improve their dietary pattern and better meet nutrient needs by choosing from a wider variety of plant and animal protein sources including poultry, eggs, beans, peas and lentils.
- B12: The ability to absorb vitamin B12 can decrease with age and the use of certain medications can decrease its absorption, making B12 a nutrient of concern for this age group. Older adults are encouraged to meet the recommendations for protein foods, a common source of vitamin B12, and include foods fortified with vitamin B12, such as breakfast cereals. Some individuals also may require vitamin B12 dietary supplements.
- Beverages: Many older adults do not drink enough fluids to stay hydrated. In addition to water, choosing unsweetened beverages such as 100% fruit or vegetable juice and low-fat or fat-free milk or fortified soy-based milk can support fluid intake while helping to achieve food group recommendations for this age group. The water found in foods like fruits, vegetables and soups also contributes to total fluid intake.
From vitamins and minerals and food groups to life stages and dietary patterns, the 2020–2025 DGA cover a lot of ground. But the overall principles remain simple: We should aim to meet our nutritional needs mainly from foods and beverages, choose a variety of foods from each food group and pay attention to portion size. An emphasis on dietary patterns sends an important message—that our overall diets are more than the sum of their parts—and the heightened focus on customization to fit budgetary, cultural and personal preferences provides an opportunity to make the DGA approachable to the diverse needs of the American population. While there are clear areas for improvement in the average American’s diet, the DGA provide a framework to work from as we aspire to live healthfully across the lifespan.
This article includes contributions from Kris Sollid, RD, and Alyssa Pike, RD.