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Food-based dietary guidelines

This HEART UK Nutrition Academy webpage has been funded by Novartis Pharmaceuticals UK Ltd who have had no input into the content or development of this material.
 

Food-based dietary guidelines target population nutrient needs to enhance overall health and prevent chronic diseases, including cardiovascular disease.

Take home messages

  • Food-based dietary guidelines (FBDGs) are essential national public health recommendations. They’re designed to meet the nutritional needs of a healthy population for optimal well-being.
  • FBDGs prioritise practicality and accessibility and have been adopted by over 80 nations worldwide. 
  • Most FBDGs are represented visually for easy understanding, usually as a plate or pyramid model which is segmented into food groups.
  • Globally, there is consensus in FBDGs. They emphasise a healthy plant-based dietary approach that is: 
    • rich in fruits, vegetables and whole grains 
    • favours plant proteins over meat 
    • endorses vegetable oils instead of animal fats
    • limits red and processed meat
    • discourages foods high in fat, sugars, and/or salt.
  • Evidence from both the UK's Eatwell Guide and FBDGs in over 80 countries highlight improved health outcomes with higher adherence. Shifting from current dietary habits towards FBDGs has been associated with a reduced premature mortality risk of 13%-16%, and a reduction in cardiovascular disease by a third.
  • Despite this global consensus, adherence to FBDGs is low. In the UK, less than 0.1% of the population sticks to the UK Eatwell Guide.

Food-based dietary guidelines (FBDG), established by governments and national health organisations around the world, target a nation’s macronutrient and micronutrient requirements to improve overall population health1–3. FBDGs aim to prevent nutrient deficiencies and chronic diseases, including cardiovascular disease (CVD). Recently, FBDGs have been evolving to incorporate environmental considerations3–5.

What are FBDGs? 

FBDGs translate nutrient needs into practical, easy-to-understand food recommendations. They are visually represented to convey complex recommendations in the most accessible manner1,2. FBDGs often divide an image such as a plate or pyramid into segments, allocating different proportions to specific food groups. Larger segments include lower calorie and nutrient-dense foods like fruits, vegetables and whole grains, with minimal allocation (and exclusion in some cases) of high calorie foods with little beneficial nutritional value.

These guidelines serve as public health messages, offering general advice on achieving a balanced diet for healthy older children and adults.

The UK Eatwell Guide: Crown copyright. OHID in association with the Welsh government, Food Standards Scotland and the Food Standards Agency in Northern Ireland.

FBDG and food groups

FBDG globally share similar recommendations, typically segmented into five main food groups1,2,4:

  • Fruit and vegetables – these occupy the largest segment
  • Carbohydrates – tubers and whole grains make up the second-largest segment
  • Protein foods – often prioritising plant proteins like beans, pulses, nuts, and seeds over animal proteins
    • Red and processed meat is often limited
    • Fish is encouraged
  • Dairy foods – with a focus on low-fat options
  • Fats and oils – mainly advocating vegetable fats over animal fats
  • Other segments:
    • Foods high in saturated fat, sugars, and/or salt – these are often discouraged and may not appear in the main visual
    • Hydration recommendations – these are included in many countries

Each food group includes examples, and some or all suggest portion sizes and frequency of consumption.

The large gulf between dietary habits and FBDGs

While there are calls to improve FBDGs, the stark reality is adherence to existing guidelines is extremely poor.  As an example, in the UK, 99% of the population fails to adhere to the current Eatwell Guide4, and similar patterns are seen globally6. The evidence demonstrates that a  shift towards FBDG recommendations could significantly improve overall health, especially cardiovascular health6,7. The primary focus should centre on assisting individuals in transitioning toward current guidelines. Changing dietary behaviour involves a complex interplay of multiple stakeholders, including individuals, health professionals, policymakers, and the food industry. A collaborative approach is essential to educate individuals, providing practical skills, and initiating changes in the food environment through robust government policies, particularly in regulating the marketing of unhealthy foods and ensuring the accessibility and affordability of healthier options.

FBDGs and health

FBDGs align with healthy plant-based diets and are made up of foods associated with cardiovascular benefits4,6. They’re rich in fruits, vegetables, whole grains and plant proteins, and low in meat and other animal products. Diets that follow these guidelines have a beneficial nutrient profile: low  in saturated fat (with saturated fat providing no more than 10% of energy), unsaturated fats are prioritised, they are high in fibre, and low in salt and sugars.

See our plant-based diets review for more details

Lipid management and cardiovascular health

Modelling and randomised controlled studies (RCTs) have consistently shown that following FBDGs leads to improvements in metabolic risk factors and cardiovascular outcomes.

In a 2015 RCT investigating the impact of following the UK national dietary recommendations, 165 participants aged 40-70 were either assigned to follow the national guidelines or stick to their usual diet8.  After 12 weeks, compared to usual eating habits, those following the UK dietary guidelines had a healthier dietary pattern that was higher in fibre, unsaturated fats, whole grains and oil-rich fish, and lower in free sugars, saturated fat and sodium.

Following the UK national dietary guidelines resulted in significant improvements in blood lipid profiles, including reductions in total cholesterol (-8%), low-density lipoprotein (LDL) cholesterol (-10%), apolipoprotein B (-7%), and triglycerides (-9%). Notably, systolic blood pressure fell by 4.2mmHg, associated with a 54% reduction in the risk of fatal strokes and a 39% reduction in the risk of ischaemic heart disease. Overall, there was a 15% reduction in fatal CVD risk and a 30% reduction in non-fatal CVD risk.

Subsequent studies have shown similar outcomes. A 2016 analysis of the revised UK FBDGs (Eatwell Guide) predicted over one million cases of coronary heart disease (CHD), stroke, and type 2 diabetes could be prevented over a 10-year period with full adoption of the guidelines7

Another study in 2020 reinforced the health benefits of the UK FBDG, showing a 7% lower risk of total mortality, with higher fruit and vegetable intake playing a significant role4.

Unfortunately, less than 1% of the UK population currently follows all the recommendations of the UK FBDG – the Eatwell Guide4. Half the population eat too much saturated fat, only a quarter meet free sugars and fruit and vegetable recommendations and only 7% achieve the 30g recommended daily fibre intake (see figure 1 above).

FBDGs globally can benefit cardiovascular health

Outside of the UK, following FBDGs will also improve health outcomes: 

  • Studies investigating the impact of adopting the Danish FBDG showed reduced body mass index, LDL cholesterol, blood pressure and incidence of type 2 diabetes9,10
  • A 2020 study investigating FBDGs across 85 countries revealed that adopting FBDGs resulted in higher intakes of legumes, whole grains, fish, nuts, seeds, fruits and vegetables, whilst intakes of meat, sugars and energy were reduced6. This shift was associated with a 13-16% reduction in premature mortality, mainly due to a fall in obesity.  Correlations were also found between specific food intakes and the risk of CHD, strokes and type 2 diabetes – red and processed meat increased risk, whilst whole grains, fruit and vegetables, nuts and legumes reduced risk.
Impact of specific food patterns on the risk of coronary heart disease, strokes and type 2 diabetes11

 

Relative risk 

Daily food intake

CHD Strokes Type 2 diabetes

Processed meat – for every 50g

 +27%

+17%

+37%

Red meat – for every 100g

+15%

+12%

+17%

Total fish – for every 15g increase (105g per week)

-6%

no impact

no impact

Legumes - per 4-weekly 100g serving

14%

NA

NA

Nuts – per 28g -29% NA -39%
Fruit – per 100g increase -5% -23% NA

Vegetables – per 100g increase

-16%

NA

NA

Whole grains – 30g

-13%

NA

-35%

NA=data not available

In summary

FBDGs around the world reflect healthy plant-based dietary recommendations. They encourage a way of eating that’s nutritionally rich and improves blood lipid levels and other metabolic risk factors and reduces the rates of cardiovascular disease. Unfortunately, adherence remains low in the UK population and globally.  An intensified commitment to transforming dietary behaviour is critical, requiring collaborative efforts from all stakeholders, including individuals, health professionals, government, and the food industry.

References

  1. Mariotti F, Havard S, Morise A, et al. Perspective: Modeling Healthy Eating Patterns for Food-Based Dietary Guidelines—Scientific Concepts, Methodological Processes, Limitations, and Lessons. Advances in Nutrition. 2021;12(3):590-599. doi:10.1093/advances/nmaa176
  2. Cámara M, Giner RM, González-Fandos E, et al. Food-Based Dietary Guidelines around the World: A Comparative Analysis to Update AESAN Scientific Committee Dietary Recommendations. Nutrients. 2021;13(9):3131. doi:10.3390/nu13093131
  3. Van Dooren C. Planet-based diets: improving environmental sustainability of healthy diets. Proc Nutr Soc. Published online October 13, 2023:1-7. doi:10.1017/S0029665123003737
  4. Scheelbeek P, Green R, Papier K, et al. Health impacts and environmental footprints of diets that meet the Eatwell Guide recommendations: analyses of multiple UK studies. BMJ Open. 2020;10(8):e037554. doi:10.1136/bmjopen-2020-037554
  5. The Carbon Trust. The Eatwell Guide: A More Sustainable Diet. Methodology and Results Summary. The Carbon Trust; 2016:8.
  6. Springmann M, Spajic L, Clark MA, et al. The healthiness and sustainability of national and global food based dietary guidelines: modelling study. BMJ. Published online July 15, 2020:m2322. doi:10.1136/bmj.m2322
  7. Cobiac LJ, Scarborough P, Kaur A, Rayner M. The Eatwell Guide: Modelling the Health Implications of Incorporating New Sugar and Fibre Guidelines. PLoS One. 2016;11(12):e0167859. doi:10.1371/journal.pone.0167859
  8. Reidlinger DP, Darzi J, Hall WL, Seed PT, Chowienczyk PJ, Sanders TA. How effective are current dietary guidelines for cardiovascular disease prevention in healthy middle-aged and older men and women? A randomized controlled trial23. The American Journal of Clinical Nutrition. 2015;101(5):922-930. doi:10.3945/ajcn.114.097352
  9. Arentoft JL, Hoppe C, Andersen EW, Overvad K, Tetens I. Associations between adherence to the Danish Food-Based Dietary Guidelines and cardiometabolic risk factors in a Danish adult population: the DIPI study. Br J Nutr. 2018;119(6):664-673. doi:10.1017/S0007114517003695
  10. Markanti L, Ibsen DB, Tjønneland A, Overvad K, Dahm CC. Adherence to the Danish food-based dietary guidelines and risk of type 2 diabetes: the Danish diet, cancer, and health cohort. Eur J Clin Nutr. 2021;75(5):836-844. doi:10.1038/s41430-020-00805-1
  11. Springmann M, Spajic L, Clark MA, et al. The healthiness and sustainability of national and global food-based dietary guidelines: modelling study. Supplementary information S1. BMJ. 2020;370(Supplementary Information S1):m2322. doi:10.1136/bmj.m2322.

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