jump to navigation

Part B. Section 2: The Total Diet Combining Nutrients, Consuming Food June 8, 2011


Part B. Section 2: The Total Diet Combining

Nutrients, Consuming Food









The 2010 Dietary Guidelines Advisory Committee (DGAC) supports a total diet approach to achieving dietary goals. The purpose of this chapter is to demonstrate how the scientific evidence presented in each of the topic-specific chapters in Part D: The Science Base—Energy Balance and Weight Management; Nutrient Adequacy; Fatty Acids and Cholesterol; Protein; Carbohydrates; Sodium, Potassium, and Water; Alcohol; and Food Safety and Technology—can be incorporated into an overall eating pattern that optimizes health outcomes.


Until recently, data were insufficient to document the impact of whole diets and eating patterns on health outcomes. The state of the evidence and the methodologic rigor regarding such questions have improved tremendously and the data can now be incorporated into this Report.


This chapter synthesizes the evidence on dietary components that contribute to excess energy and inadequate nutrient intakes in the United States (U.S.), and the foods that can provide these missing essential nutrients and other health benefits. It presents a brief, evidence-based comparison of worldwide eating patterns, including the Dietary Approaches to Stop Hypertension (DASH), Mediterranean, and other patterns, along with a description of the U.S. Department of Agriculture (USDA) Food Patterns with vegetarian variations.


A nutrient-dense total diet has multiple health benefits and can be implemented in various ways. The U.S. is comprised of individuals of all ages who come from many cultures and have a variety of food and taste preferences. All of these factors were considered in developing a recommended total diet that is flexible while meeting nutrient needs without exceeding energy requirements.

The Catalyst for the Total Diet Approach


Although there is no single “American” or “Western” diet, average American food patterns currently bear little resemblance to the diet recommended in the 2005

Dietary Guidelines for Americans. As documented by the latest data from the National Health and Nutrition Examination Survey (NHANES), Americans eat too many calories and too much solid fats, added sugars, refined grains, and sodium. Americans also eat too little dietary fiber, vitamin D, calcium, potassium, and unsaturated fatty acids (specifically omega-3s), and other important nutrients that are mostly found in vegetables, fruits, whole grains, low-fat milk and milk products, and seafood (see Part D. Section 2: Nutrient Adequacy).


Overweight and obesity are highly prevalent in the U.S. in both adults and children. This is of great public health concern because excess body fat is associated with a much higher risk of premature death and many serious disorders, as identified in Part D. Section 1: Energy Balance and Weight Management. Preventing overweight is highly preferable to initiating weight loss treatment after weight gain occurs, because the failure rate in achieving and maintaining weight loss is very high. Furthermore, the behaviors required to prevent

overweight are less daunting than the behaviors necessary to lose and sustain weight loss. Currently, the average American gains about a pound a year between the ages of

20 to 60 years. Some persons gain much more. Remaining conscious of one’s body weight throughout life and adopting a lifestyle early on that will achieve and sustain weight control across the lifespan are paramount to maintaining good health and quality of life.


A Special Focus on Children and Adolescents The single most significant adverse health trend among U.S. children in the past 40 years has been the dramatic increase in overweight and obesity (see Part D. Section

1: Energy Balance and Weight Management). Since the early 1970s, the prevalence of overweight and obesity has approximately doubled among children ages 2 to 11 years, and tripled among adolescents ages 12 to 19

years. Not only is obesity associated with adverse health



2010 Dietary Guidelines Advisory Committee Report                                                                                 11


effects during childhood, but evidence documents increased risk of future chronic disease in adult life.


Childhood obesity results from poorly regulated energy balance. Ideally, children and adolescents should consume foods that provide an adequate intake of all essential nutrients needed for normal growth and development, metabolism, immunity, and cognitive function, without exceeding caloric requirements. Factors associated with preventing excess adiposity in children are incorporated into the total diet described here, and include:


•     Energy intake balanced with expenditure

•     Greatly reduced intake of sugar-sweetened beverages

•     Increased intake of vegetables and fruits

•     Smaller amounts of fruit juice, especially for overweight children

•     Smaller portions of foods and beverages

•     Infrequent consumption of meals from quick service (i.e., fast food) restaurants

•     Habitual consumption of breakfast

•     Fewer hours of screen time (e.g., television, computer)

•     More hours of active play




Blending Science-based Recommendations into a Healthful Total Diet



The DGAC defines “total diet” as the combination of foods and beverages that provide energy and nutrients

and constitute an individual’s complete dietary intake, on average, over time. This encompasses various foods and food groups, their recommended amounts and frequency, and the resulting eating pattern. To achieve dietary goals and energy balance, Americans must become mindful, or “conscious,” eaters, that is, attentively choosing what and how much they eat. Since the mid-1980s, the USDA has provided recommended food patterns that represent a

total diet approach to dietary guidance (Britten, 2006). The most recent USDA Food Patterns have been visually conveyed as the MyPyramid Food Guidance System (Haven, 2006). This approach was intended to help people personalize dietary recommendations and offer flexibility based on individual preferences. The key core components of a nutrient-dense total diet for all Americans are presented below.

Moderate Energy Intake


The DGAC encourages Americans to achieve their recommended nutrient intakes by consuming foods within a total diet that meets but does not exceed energy needs. Overweight and obesity result from energy imbalance (intake exceeding expenditure) (see Part D. Section 1: Energy Balance and Weight Management). The increased incidence and current high proportion of overweight and obesity in the U.S. illustrates an energy imbalance across virtually all subgroups of the population. People consume too many calories (i.e., energy) relative to the calories they expend. As a start, all Americans are encouraged to know their energy needs in order to avoid inappropriate weight gain. Table B2.1 (see the end of this chapter) can help individuals identify their energy needs based on their age, sex, and level of activity. Self-monitoring of both calorie intake and time spent in physical activity is one of the most useful tools a person can use to engage in and maintain behaviors that sustain a healthy weight.


Because levels of leisure time physical activity in U.S. adults have remained stable or increased only slightly between 1990 and 2004, it is clear that an increased calorie intake has been the primary cause of the obesity problem. Hence, even though one can achieve a calorie deficit by increasing physical activity, the primary focus should be on reducing excessive calorie intake.


Overall, the top food sources of energy, and mean energy intake from each, for the U.S. population, as reported in the National Health and Nutrition Examination Survey (NHANES) 2005-2006, are (National Cancer Institute [NCI], 2010a):


•     Grain-based desserts (cakes, cookies, doughnuts, pies, crisps, cobblers, and granola bars; 139 calories per day)

•     Yeast breads (129 calories per day)

•     Chicken and chicken mixed dishes (121 calories per day)

•     Soda/energy/sports drinks (114 calories per day)

•     Pizza (98 calories per day)


While the top sources of energy intake vary by age group, many of these sources are foods and beverages that are not in nutrient-dense forms. For example, the

top energy source for adults ages 19 years and older and for children ages 4 to 13 years is grain-based desserts. These desserts are also among the top five sources of energy for teens and younger children. For teens ages 14




12                                                                                      2010 Dietary Guidelines Advisory Committee Report


to 18 years, the top energy source is soda/energy/sports drinks, and these beverages are also among the top five energy sources for adults ages 19 years and older and for children ages 9 to 13 years. For children ages 2 to 3 years only, the top energy source is whole milk (rather than low-fat milk). Other foods that are among the top five sources of energy for various age groups are yeast breads, chicken and chicken mixed dishes, pizza, and, for adults only, alcoholic beverages (NCI, 2010a; see Table B2.2 at the end of this chapter for the top five sources of energy for each age group, and Tables D1.1, D1.6, and D1.7 in Part D. Section 1: Energy Balance and Weight Management for more detailed lists of food sources of energy).


Total diets that are high in energy but low in nutrients can paradoxically leave a person overweight but undernourished and thus, at higher risk of cardiovascular disease (CVD), type 2 diabetes (T2D), and certain types of cancers. Of urgent concern is America’s youth, most of whom currently fit this pattern. Many children consume nutrient-poor sources of energy at the highest end of their respective energy ranges (see Figure D1.1 in Part D. Section 1: Energy Balance and Weight Management) and they are increasingly sedentary.


Beverages also contribute substantially to overall dietary and energy intake. Although they provide needed fluid, beverages often add calories to the diet without providing nutrients. Their consumption should

be planned in the context of total calorie intake and how they can fit into the total diet of each individual. Currently, U.S. adults ages 19 years and older consume an average of 394 calories per day as beverages. The major types of beverages consumed, and the mean caloric intake from each, are (NCI, 2010b):


•     Soda (112 calories per day)

•     Coffee and tea (26 calories per day)

•     Fluid milk (83 calories per day)

•     100 percent fruit juice and fruit drinks (66 calories per day)

•     Alcoholic beverages (106 calories per day)


Children (ages 2 to 18 years) consume an average of

400 calories per day as beverages. The major beverages for children and calories from each are somewhat different:


•     Fluid milk (160 calories per day)

•     Soda (118 calories per day)

•     100 percent fruit juices and fruit drinks (108 calories per day)


In children, the amount and source of calories from beverages differs by age. For example, 100 percent fruit juice is a prominent source of energy in children ages 2 to 3 years, while soda/sports/energy drinks are the most common source of energy among beverages (and energy overall) in children ages 14 to 18 years.


Portion control and the quantity of foods and beverages consumed within the total diet also are important considerations in moderating energy intake (see Part D. Section 1: Energy Balance and Weight Management). Excessive portion sizes are very common in the U.S.

and are linked to higher energy intakes and weight gain over time. This is particularly true when large portions of foods high in solid fats and added sugars (SoFAS) and refined grains are consumed.


Reduce Solid Fats and Added Sugars (SoFAS)


SoFAS contribute substantially (approximately 35% of calories) to total energy intakes of Americans, thereby leading to excessive saturated fat and cholesterol intakes and insufficient intake of dietary fiber and other

nutrients (see Part D. Section 2: Nutrient Adequacy; Part D. Section 3: Fatty Acids and Cholesterol; and Part D. Section 5: Carbohydrates).


The 2005 DGAC defined the term “discretionary calorie allowance” as “the difference between total energy requirements and the energy consumed to meet recommended nutrient intakes” (DGAC, 2004). Discretionary calories were intended to represent the calories available for consumption only after meeting nutrient recommendations and without exceeding total energy needs. Unfortunately, this concept has been difficult to translate into meaningful consumer education. To clarify translation, the 2010 DGAC focused specifically on reducing the intake of SoFAS which provide most of the non-essential or extra

calories that Americans consume. Major food sources of the two components of SoFAS are (Bachman, 2008):


•     Solid fats (percent of solid fat intake)

—  Grain-based desserts, including cakes, cookies, pies, doughnuts, and granola bars (10.9%)

—  Regular cheese (7.7%)

—  Sausage, franks, bacon, and ribs (7.1%)

—  Pizza (5.9%)

—  Fried white potatoes, including French fries and hash browns (5.5%)



2010 Dietary Guidelines Advisory Committee Report                                                                                 13


—  Dairy-based desserts, such as ice cream (5.1%)

•     Added sugars (percent of added sugars intake)

—  Soda (36.6%)

—  Grain-based desserts (11.7%)

—  Fruit drinks (11.5%)

—  Dairy-based desserts (6.4%)

—  Candy (6.2%)

Maximum limits on SoFAS are meant to be estimates and not necessarily daily targets (see limits from USDA Food Patterns, Table B2.3, end of this chapter). These foods should constitute a very small proportion of total energy intake in the total diet. Figure B2.1 contrasts the current disproportionately high intake of SoFAS with what is more appropriate from a healthy eating pattern.




Figure B2.1. What we eat versus recommended limits: calories from solid fats and added sugars (SoFAS)


What We Eat                                 Recommended Limits



Note: The depiction of the proportionate amounts of total calories consumed and the recommended limits are illustrative only. The figure illustrates about 35 percent of total calories consumed as SoFAS, on average, in contrast to a recommended limit of no more than about 5 to 15 percent of total calories for most individuals.




Americans currently consume 35 percent of their total calories from SoFAS. This is too high. They should reduce intake of calories from SoFAS by 20 to 30 percent. This means that no more than 5 to 15 percent of total calories should be derived from SoFAS. For example, the USDA Food Patterns limit SoFAS to about 120 calories in the 1600-calorie pattern, 160 calories in the 1800-calorie pattern, and 260 calories in the 2000-calorie pattern (Table B2.3, at the end of the chapter, lists SoFAS limits for all calorie levels). Reduction of calories from SoFAS to these amounts allows for increased intakes of nutrient-dense foods such as vegetables (including cooked dry beans and

peas), fruits, whole grains, and fat-free and low-fat fluid

milk and milk products, without exceeding overall calorie needs.


Consume Nutrient-dense Foods (But Not Too

Much of Them)


Currently, Americans consume less than 20 percent of the recommended intakes for whole grains, less than 60 percent for vegetables, less than 50 percent for fruits, and less than 60 percent for milk and milk products (Figure B2.2). Inadequate intakes of nutrient-dense foods from these basic food groups place individuals at risk for lower than recommended levels of specific nutrients, namely vitamin D, calcium, potassium, and dietary fiber.











14                                                                                      2010 Dietary Guidelines Advisory Committee Report


Figure B2.2. Dietary intakes in comparison to recommended intake levels or limits




Note: Bars show average intakes for all individuals (ages 1 or 2 years or older) as a percent of the recommended intake level or limit. Recommended intakes for food groups and limits for refined grains, SoFAS, solid fats, and added sugars are based on the USDA 2000-calorie food patterns. Recommended intakes for fiber, potassium, vitamin D, and calcium are based on the highest Adequate Intakes (AI) for ages 14 to 70 years. Limits for sodium are based on the AI and for saturated fat on 7 percent of calories.


Data source: What We Eat in America, National Health and Nutrition Examination Survey (WWEIA, NHANES)

2001-2004 or 2005-2006.




Food from all food groups are composed of a combination of the macronutrients carbohydrates, fats, and protein in varying proportions. These are the major sources of energy in any food or diet. Understanding their role in the diet will help Americans make appropriate food choices.


Carbohydrates (4 kcal/g) are the primary source of energy intake, and higher intakes of carbohydrates, especially complex sources, are recommended for active people. Sedentary individuals, and thus most

Americans, should lower their intakes of refined carbohydrates, greatly reducing intakes of sugar and sugar-sweetened beverages and refined grains that are high in calories, but relatively low in certain nutrients. Whole-grain versions of many grain products (such as plain white bread, rolls, bagels, muffins, pasta, breakfast cereals) should be substituted to meet the

recommendation that half of grains consumed be whole grains, also assisting in meeting dietary fiber recommendations (see Part D. Section 5: Carbohydrates).


Dietary fats (both solid fats and oils) are high in calories (9 kcal/g). Unsaturated fats, including omega-3 from seafood sources, should be increased and saturated fat and trans fatty acid intake should be minimized. Given typical patterns of consumption in the U.S., dietary saturated fat intake is highly correlated with total fat intake. Consuming the recommended intake of saturated fat (less than 10% of calories immediately as an interim step toward an eventual goal of less than 7% of calories) is more likely achievable when total fat intake is less than 30 percent of total calories. It is recommended that total fat should be in the range of 20 to 35 percent of total calories but derived mostly from oils within a



2010 Dietary Guidelines Advisory Committee Report                                                                                 15


nutrient-rich, energy-balanced dietary pattern. These oils should replace solid fats and not add calories to the total diet (see Part D. Section 3: Fatty Acids and Cholesterol).


Dietary protein (4 kcal/g) provides essential amino acids and energy, and assists in building and preserving body proteins. Both plant-based sources of protein (i.e., cooked dry beans and peas, nuts, seeds, and soy products) and animal-based sources (i.e., meat, poultry, seafood, eggs, and low-fat and fat-free milk) can be incorporated into the total diet, with further emphasis on increasing seafood (rich in omega-3 fatty acids as well

as protein) and cooked dry beans and peas (rich in dietary fiber as well as vegetable protein) (see Part D. Section 4: Protein).


Consumption of alcoholic beverages also contributes to calories (7 kcal/g), from the alcohol itself as well as accompanying mixers (e.g., soda, juice, or sweetened mixer). In many cases, the accompanying mixer (see Table D1.9 in Part D. Section 1: Energy Balance and Weight Management) has more calories than the alcohol itself, so careful attention to portion size is important for alcoholic beverages. Based on individual preferences among adults, a moderate amount of alcohol may be included in the total diet if calorie allowances are not exceeded and essential nutrient needs are met. For

adults who are attempting to reduce calorie intake, alcohol could be one of the energy sources that is reduced to lower total calorie intake. Pregnant women or individuals with certain medical conditions or on

certain medications as well as individuals who will take part in activities that require attention or skill should not consume alcohol (see Part D. Section 7: Alcohol).


Vegetables, fruits, high-fiber whole grains, seafood, eggs, and nuts prepared without added SoFAS are considered “nutrient-dense foods,” as are low-fat forms of milk and lean meat and poultry prepared without added SoFAS. Nutrient-dense foods are found in a variety of forms but ideally are minimally processed and minimize or exclude added SoFAS, starches, and sodium. Combined into a total diet, these foods should provide a full range of essential nutrients, including those of special concern (e.g., vitamin D, calcium, potassium, and dietary fiber).


Finally, the nutrient-dense total diet should be prepared using best practices for food safety to ensure that foods consumed do not induce foodborne illnesses (see Part

D. Section 8: Food Safety and Technology). A balanced grouping of a variety of foods among all the food

groups, consumed in moderation, that are culturally appealing will offer pleasurable eating experiences and promote health among Americans.


Reduce Sodium Intake


Even a nutrient-dense total diet that remains excessive in sodium can lead to health consequences such as elevated blood pressure. Excessive sodium intake raises blood pressure, a well-documented and extraordinarily common risk factor for heart disease, stroke, and kidney disease. Although most research has been conducted in adults, the adverse effects of sodium on blood pressure begin early in life, and reducing sodium intake has substantial health benefits. Given the fact that a higher potassium intake attenuates the adverse effects of sodium on blood pressure, ensuring increased intakes of dietary potassium also would have health benefits.

The current food supply is replete with excess sodium. In this setting, virtually all Americans exceed the recommended upper limit of sodium intake. Because approximately 75 percent of dietary sodium is added during food processing, food manufacturers and restaurant industries have a critically important role in reducing the sodium intake. In addition, individuals should choose and prepare foods with little or no

sodium (see Part D. Section 6: Sodium, Potassium, and





A Flexible Approach to Applying Total Diet




A healthful total diet is not a rigid prescription, but rather is a flexible approach that incorporates a wide range of individual tastes and preferences. Just as there is no one “American” or “Western” diet, there is no one recommendation for a healthful diet. As is evident in

the following sections, data are accumulating that certain dietary patterns consumed around the world are associated with beneficial health outcomes. Likewise,

the Food Patterns developed by the USDA illustrate that both nutrient and moderation goals can be met in a variety of ways.


Worldwide Dietary Patterns Provide Support for a Nutrient-dense Total Diet


Across the world and within the U.S., there are striking differences in diets and also in diet-related health outcomes. Although research on dietary patterns is complex, and many methodological issues remain in



16                                                                                      2010 Dietary Guidelines Advisory Committee Report


synthesizing data across studies, a consensus is emerging that consumption of certain dietary patterns is associated with a reduced risk of several major chronic diseases. The 2010 DGAC focused on the effects of dietary patterns on total mortality, CVD, and blood pressure (a major diet-related cardiovascular risk

factor). The World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR, 2007) recently reviewed the available evidence of the relationship of cancer with specific dietary factors and overall dietary patterns. While several dietary factors were associated with specific types of cancer, it concluded that no firm judgment can be made on the relationship of dietary patterns with cancer.


The 2010 DGAC focused on the DASH-style dietary patterns and Mediterranean-style dietary patterns

because considerable research exists on health outcomes as well as information on nutrient and food group composition. It also examined traditional Asian dietary patterns and vegetarian diets. Traditional Asian dietary patterns (e.g., Japanese and Okinawan dietary patterns) have been associated with a reduced risk of coronary heart disease, but documentation using contemporary research methods is scant. Most traditional dietary patterns provide for health at least moderately well, and their variety demonstrates that a person can eat healthfully in a number of ways. Vegetarian diets have been associated with a reduced risk of CVD, but information on nutrient content and food group composition is sparse.


Dietary patterns with health benefits are summarized below. An Appendix at the end of this chapter provides further detail on these dietary patterns as well as several summary tables.


DASH-style Dietary Patterns

DASH-style dietary patterns emphasize vegetables, fruits, and low-fat milk and milk products; include whole grains, poultry, seafood, and nuts; and are reduced in red meat, sweets, sodium, and sugar- containing beverages. As originally tested, the DASH diet is reduced in total fat (27% of kcal) with total protein intake of 18 percent of calories and

carbohydrate intake of 55 percent of calories. However, other versions of the DASH diet are available, in which carbohydrate is partially replaced with protein (about half from plant sources) or unsaturated fat (predominantly monounsaturated fat). The latter version is noteworthy because nutrient adequacy and a reduced saturated fat intake (6% of kcal) were both achieved in the setting of high monounsaturated fat (21% of kcal)

and total fat (37% of kcal) intake. In a free-living setting, care is needed to meet but not exceed energy needs in order to avoid weight gain.


Each of these DASH style diets lowers blood pressure, improves blood lipids, and reduces CVD risk. Blood pressure reduction is the greatest when the DASH diet is consumed with reduced sodium intake. At present, few adults, even those with hypertension, eat a diet that is consistent with the DASH dietary pattern.


Mediterranean-style Dietary Patterns

In view of the large number of cultures and agricultural patterns of countries that border the Mediterranean Sea, the “Mediterranean” diet is not a single dietary pattern. Although no well-accepted set of criteria exist, a traditional Mediterranean diet can be described as one that emphasizes breads and other cereal foods usually made from wheat, vegetables, fruits, nuts, unrefined cereals, and olive oil; includes fish and wine with meals (in non-Islamic countries); and is reduced in saturated fat, meat, and full-fat dairy products. Results from observational studies and clinical trials suggest that consumption of a traditional Mediterranean diet, similar to that of Crete in the 1960s, is associated with one of the lowest risks of coronary heart disease in the world. Over time, the diet of Crete has changed remarkably

and is now characterized by higher intake of saturated fat and cholesterol, and reduced intake of monounsaturated fats. At the same time, total fat consumption has fallen. These trends have been accompanied by a steady rise in heart disease risk.


Vegetarian Dietary Patterns

In some observational studies, vegetarian diets and lifestyle have been associated with improved health outcomes. The types of vegetarian diets consumed in the U.S. vary widely. Vegans do not consume any animal products, while lacto-ovo vegetarians consume milk and eggs. Although not strict vegetarians, many individuals consume small or minimal amounts of animal products. On average, vegetarians consume fewer calories from fat than non-vegetarians, particularly saturated fat, and have a higher consumption of carbohydrates than non-vegetarians. In addition, vegetarians tend to consume fewer overall calories and have a lower body mass index than non- vegetarians. These characteristics, in addition to the dietary pattern per se, may contribute to the improved

health outcomes of vegetarians (see the Appendix at the end of this chapter and Part D. Section 4: Protein for additional information on vegetarian diets).



2010 Dietary Guidelines Advisory Committee Report                                                                                 17


Other Dietary Patterns

In view of the increasing diversity of the U.S. population, interest in the health effects of non-Western diets is substantial. One group of diets with potential health benefits are those traditionally consumed in Asia, which has experienced some of the lowest rates of coronary heart disease in the world. Both traditional Japanese and Okinawan dietary patterns have been associated with a low risk of coronary heart disease. Nonetheless, compared to the evidence supporting DASH and Mediterranean diets, detailed information on diet composition as well as epidemiologic and clinical trial evidence on health benefits, similar to that

available for the other types of diets, is sparse. Also, over time, dietary intakes in these countries have changed and may no longer reflect the healthiest choices.


USDA Food Patterns Provide Guidance for

Meeting Dietary Guideline Recommendations


Applying results from carefully conducted studies of nutrition and health, the USDA has developed a number of different food guides over the past century. These guides have identified eating patterns that meet known nutrient needs and balance intake from various food groups. Based upon the Nation’s dietary intake at the time, early USDA food guides focused on nutrient adequacy only. Due to the health risks associated with overconsumption of specific dietary components, including the increasing obesity problem, recent guides have encompassed moderation goals while meeting nutrient adequacy goals. The current USDA Food Patterns also are aimed at primary disease prevention. For example, Table B2.4 (see end of chapter) compares the 2000-calorie USDA food pattern with the DASH

diet and with current consumption patterns. The types and amounts of foods recommended in the USDA patterns are very similar to the DASH diet, and both are very different from current intakes.


The USDA Food Patterns recommend the amounts of foods to eat each day from the five major food groups and subgroups, specifically in nutrient-dense forms. The Patterns allow for oils and limit the maximum number of calories that should be consumed from SoFAS. Table B2.3 (see end of chapter) shows recommended amounts and limits in the USDA Food Patterns at all 12 energy levels (Part D. Section 2: Nutrient Adequacy, Table D2.1 provides the specific nutritional goals for each pattern).

The USDA Food Patterns incorporate several important assumptions:


•     A variety of foods are used to meet recommended intakes from each food group or subgroup, in amounts proportionate to current consumption by the population.

•     Food choices selected for use in the analysis are in nutrient-dense forms, that is, with little or no SoFAS, and in most cases without added salt.

•     For each age-sex group, the pattern developed to meet nutrient needs is at a caloric level that meets but does not exceed energy needs for sedentary individuals.


The online Appendix E3.1: Adequacy of the USDA

Food Patterns, available at www.dietaryguidelines.gov, provides details of the analysis conducted for the

DGAC to determine whether the USDA Food Patterns meet nutritional goals for adequacy and moderation while staying within established calorie targets.


Recommended intake amounts in the USDA Food Patterns remain unchanged from 2005 with the exception of the vegetable subgroups. Several changes were made to decrease the wide discrepancy in number and amounts of vegetables consumed between the largest and the smallest subgroups. This resulted in moving tomatoes and red peppers from “other vegetables” to a new “red-orange vegetable” subgroup, which provided a greater focus on tomatoes without compromising the nutrient adequacy of the patterns (see the online Appendix E3.2: Realigning Vegetable Subgroups report at www.dietaryguidelines.gov, for details). The USDA Food Patterns meet almost all of their nutritional goals for adequacy and moderation, when evaluated using current food composition and consumption data.


USDA also developed and evaluated several variations on the base patterns, applying the same principles but modifying food choices to accommodate those wanting to eat a plant-based or vegetarian diet. An additional analysis investigated a possible modification of the patterns for those tracking carbohydrate intake, such as people with diabetes. The results of these analyses are presented below (see Part C: Methodology for a description of the methods used and a list of all food pattern modeling analyses).







18                                                                                      2010 Dietary Guidelines Advisory Committee Report


Vegetarian Patterns Based on USDA Food


The USDA Food Patterns include two animal-based food groups: the “meat, poultry, seafood, eggs, soy products, nuts, and seeds” group and the “milk, yogurt, and cheese” group. Although the groups contain some plant foods, the majority of consumption from them is from animal products. As is true in American diets, these two food groups in the Food Patterns are the major sources of protein, calcium, vitamin D, vitamin B12, riboflavin, choline, selenium, zinc, and the omega-

3 fatty acids eicosapentaenoic acid (EPA) and

docosahexaeonic acid (DHA).


The USDA Food Patterns were modified to replace some or all animal products with plant products (see the online Appendix E3.3: Vegetarian Food Patterns report at www.dietaryguidelines.gov for details). The plant- based (at least 50% of all protein from plant sources), lacto-ovo vegetarian (no meat, poultry, or seafood), and vegan (no meat, poultry, seafood, eggs, fluid milk or milk products) food patterns, collectively referred to as the “vegetarian patterns,” meet almost all goals for nutrient adequacy. Amounts of protein, including all essential amino acids, were adequate in all vegetarian patterns. Amounts of calcium and vitamins D and B12 were adequate because fortified sources of these nutrients were selected to replace milk and meat products. The estimated bioavailable iron in the vegan patterns was less than the RDA for some children and women. While no dietary standards exist for omega-3 fatty acids, levels of EPA and DHA are substantially lower than the base Food Patterns, especially in the vegan patterns. All moderation goals are met in the vegetarian patterns. If only plant foods are consumed, choices should include foods fortified with vitamin B12, vitamin D, and calcium. Other nutrients of potential concern include iron, choline, EPA, and DHA.


Considering an Alternative Placement for

Starchy Vegetables

To offer flexibility in selecting a food pattern that meets nutrient needs and accommodates food preferences, USDA evaluated a nutritionally adequate option that considers starchy vegetables as a grain alternative (see the online Appendix E3.4: Starchy Vegetables report at www.dietaryguidelines.gov for details). This pattern may be useful for individuals who wish to track the amount of carbohydrates they consume, who prefer a dietary pattern that groups all major sources of starch together, or who wish to integrate the USDA recommendations with other diet plans. In this pattern, individuals can substitute starchy vegetables for a

portion of the recommended grains, as long as they eat additional vegetables from other subgroups to replace the starchy vegetables. As with all of the modeling analyses, the vegetables and grains selected should be nutrient-dense forms, not forms with added fats, sugars, or salt. Although starchy vegetables remain part of the vegetable group in the USDA Food Patterns, this analysis identified an option for flexibility to help some individuals integrate the USDA recommendations with other dietary plans.


The Importance of Nutrient-dense Choices The USDA Food Patterns assume that foods in each food group will be consumed in the same relative proportions as they appear in the average American diet, but that most will be in nutrient-dense forms. Nutrient-dense choices are available to consumers, but they are not the forms most typically consumed. Consuming recommended amounts of foods, but in

forms that represent typical food choices rather than the “ideal” nutrient-dense choices, has a major impact on energy and nutrient intake. Excess intake of energy, sodium, saturated fat, and cholesterol results from using typical food choices in the recommended amounts for the patterns. For example, assuming typical food choices, the calorie intake in the 2000-calorie pattern is

almost 400 calories more per day than the target (see the online Appendix E3.5: “Typical Choices” Food

Patterns report at www.dietaryguidelines.gov for details of an analysis of the effect of typical versus ideal choices). If consumers act on the message about quantities to eat from each food group or subgroup, but fail to implement the moderation messages about choosing most foods in low-fat, no-added-sugars, and low-sodium forms, they will not meet the important moderation goals.




Chapter Summary



Good health and vitality across the lifespan are what Americans desire. The 2010 DGAC Report concludes that this is achievable but requires a lifestyle approach that includes a total diet that is:


•     Energy balanced, limited in total calories, and portion controlled

•     Nutrient-dense and includes:

—  Vegetables, fruits, high-fiber whole grains

—  Fat-free or low-fat fluid milk and milk products

—  Seafood, lean meat and poultry, eggs, soy products, nuts, seeds, and oils



2010 Dietary Guidelines Advisory Committee Report                                                                                 19


•     Very low in solid fats and added sugars (SoFAS)

•     Reduced in sodium


Physical activity will assist in the helping to achieve a balance between calorie intake and expenditure, leading to body weight maintenance. Children and adolescents are of particular concern because the dietary habits that they form during their youth will set the foundation for their choices and behaviors as adults.


Several distinct dietary patterns are associated with health benefits, including lower blood pressure and a reduced risk of CVD and total mortality. A common feature of these diets is an emphasis on plant foods. Accordingly, fiber intake is high and saturated fat is typically low. When total fat intake is high, that is, more than 30 percent of calories, the predominant fats are monounsaturated and polyunsaturated fats.

Carbohydrate intake is typically in the range of 50 to 60 percent of calories, but these often include whole grain products with minimal processing, as well as cooked

dry beans and peas. The totality of evidence documenting a beneficial impact of plant-based dietary patterns on CVD risk is remarkable and worthy of recommendation.


Americans have considerable flexibility in selecting a diet that includes foods they enjoy, meets nutrient requirements, reduces risk of preventable disease, and controls weight. No one specific dietary pattern provides the only way to incorporate the principles

listed above into a total diet. The daunting public health challenge is to accomplish population-wide adoption of healthful dietary patterns within the setting of powerful influences that currently promote unhealthy lifestyles. The 2010 DGAC is united in advocating that policy makers, stakeholders, and health-care providers

embrace and support these important, evidence-based guidelines for the benefit of all Americans.







Bachman JL, Reedy J, Subar AF, Krebs-Smith SM. Sources of food group intakes among the U.S. population, 2001-2002. J Am Diet Assoc.



Britten P, Marcoe K, Yamini S, Davis C. Development of food intake patterns for the MyPyramid Food Guidance System. J Nutr Educ Behav. 2006;38(6


Dietary Guidelines Advisory Committee (DGAC). Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 2005. Washington DC: U.S. Department of Agriculture, Agricultural Research Service, August 2004.


Haven J, Burns A, Britten P, Davis C. Developing the consumer interface for the MyPyramid Food Guidance System. J Nutr Educ Behav. 2006;38(6 Suppl):S124- S135.


Marcoe K, Juan W, Yamini S, Carlson A, Britten P. Development of food group composites and nutrient profiles for the MyPyramid Food Guidance System. J Nutr Educ Behav. 2006;38(6 Suppl):S93-S107.


National Cancer Institute (NCI). Food Sources of

Energy Among U.S. Children and Adolescents, 2005-

2006. Risk Factor Monitoring and Methods Branch

Website. Applied Research Program. National Cancer Institute, 2010a. http://riskfactor.cancer.gov/diet/foodsources/. Updated May 21, 2010. Accessed May 21, 2010.


National Cancer Institute (NCI). Distribution of Intake across Beverage Types, U.S. Population, 2005-2006. Risk Factor Monitoring and Methods Branch Website. Applied Research Program. National Cancer Institute,

2010b. http://riskfactor.cancer.gov/diet/foodsources/. Updated May 21, 2010. Accessed May 21, 2010.


World Cancer Research Fund and American Institute for Cancer Research Report (WCRF/AICR). Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective. Washington, DC: AICR,




20                                                                                      2010 Dietary Guidelines Advisory Committee Report






Male/ Sedentary

Male/ Moderately Active  

Male/ Active


Female/ Sedentary

Female/ Moderately Active  

Female/ Active

2 1000 1000 1000 1000 1000 1000
3 1000 1400 1400 1000 1200 1400
4 1200 1400 1600 1200 1400 1400
5 1200 1400 1600 1200 1400 1600
6 1400 1600 1800 1200 1400 1600
7 1400 1600 1800 1200 1600 1800
8 1400 1600 2000 1400 1600 1800
9 1600 1800 2000 1400 1600 1800
10 1600 1800 2200 1400 1800 2000
11 1800 2000 2200 1600 1800 2000
12 1800 2200 2400 1600 2000 2200
13 2000 2200 2600 1600 2000 2200
14 2000 2400 2800 1800 2000 2400
15 2200 2600 3000 1800 2000 2400
16 2400 2800 3200 1800 2000 2400
17 2400 2800 3200 1800 2000 2400
18 2400 2800 3200 1800 2000 2400
19-20 2600 2800 3000 2000 2200 2400
21-25 2400 2800 3000 2000 2200 2400
26-30 2400 2600 3000 1800 2000 2400
31-35 2400 2600 3000 1800 2000 2200
36-40 2400 2600 2800 1800 2000 2200
41-45 2200 2600 2800 1800 2000 2200
46-50 2200 2400 2800 1800 2000 2200
51-55 2200 2400 2800 1600 1800 2200
56-60 2200 2400 2600 1600 1800 2200
61-65 2000 2400 2600 1600 1800 2000
66-70 2000 2200 2600 1600 1800 2000
71-75 2000 2200 2600 1600 1800 2000
76 and up 2000 2200 2400 1600 1800 2000


Table B2.1. Estimated energy needs1  in calories per day, for reference-sized individuals by age, sex, and activity level

















































1Based on Estimated Energy Requirements (EER) equations, using reference heights (average) and reference weights (healthy) for each age/sex group, rounded to the nearest 200 calories. EER equations are from the Institute of Medicine. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. Washington DC: National Academies Press, 2002.

Source: Britten et al., 2006.













2010 Dietary Guidelines Advisory Committee Report                                                                                 21


Table B2.2. Top five sources of energy among U.S. children, adolescents, and adults by age, NHANES 2005-061





Mean Energy

Intake (kcal)


Ages 2+ years




218 years




23 years




48 years




913 years




1418 years




19+ years



1 Grain-based Grain-based Whole milk Grain-based Grain-based Soda/energy Grain-based desserts
  desserts1 desserts (104 kcal) desserts desserts /sports drinks2 (138 kcal)
  (138 kcal) (138 kcal)   (136 kcal) (145 kcal) (226 kcal)  
2 Yeast breads Pizza 100% fruit juice Yeast breads Pizza Pizza Yeast breads
  (129 kcal) (136 kcal) (not orange or (98 kcal) (128 kcal) (213 kcal) (134 kcal)
      (93 kcal)        
3 Chicken and Soda/energy/ Reduced fat Pasta and Chicken and Grain-based Chicken and chicken
  chicken mixed sports drinks milk pasta dishes chicken mixed desserts mixed dishes
  dishes (118 kcal) (91 kcal) (97 kcal) dishes (157 kcal) (123 kcal)
  (121 kcal)       (122 kcal)    
4 Soda/energy/ Yeast breads Pasta and pasta Pizza Yeast breads Yeast breads Soda/energy /sports
  sports drinks (114 kcal) dishes (95 kcal) (109 kcal) (151 kcal) drinks2
  (114 kcal)   (86 kcal)       (112 kcal)
5 Pizza Chicken and Grain-based Reduced fat Soda/energy/ Chicken and Alcoholic beverages
  (98 kcal) chicken desserts milk sports drinks chicken mixed (106 kcal)
    mixed dishes (68 kcal) (95 kcal) (105 kcal) dishes  
    (113 kcal)       (143 kcal)  

1Foods ranked by mean contribution to overall energy intake. Table shows each food category and its mean caloric contribution for each age group.

2Includes cakes, cookies, doughnuts, pies, crisps, cobblers, granola bars.

3Includes sodas, energy drinks, sports drinks, and sweetened bottled water including vitamin water.

Note: For a more detailed listing of food sources of energy, see Part D. Section 1. Energy Balance, Tables D1.1, D1.6, and D1.7.

Source: National Cancer Institute (NCI). Food Sources of Energy Among U.S. Population, 2005-06. Risk Factor Monitoring and Methods Branch Website. Applied Research Program. National Cancer Institute, 2010a. http://riskfactor.cancer.gov/diet/foodsources/. Updated May 21, 2010. Accessed May 21,



Table B2.3. USDA Food Patterns—recommended daily intake amounts1  from each food group or subgroup at all calorie levels. Recommended intakes from vegetable subgroups are per week


Energy Level of

Pattern2                                                1000       1200       1400       1600       1800        2000        2200        2400        2600        2800                                     3000       3200


Fruits                             1 c          1 c          1½ c        1½ c       1½ c        2 c           2 c           2 c            2 c           2½ c                                     2½ c        2½ c

Vegetables                    1 c          1½ c        1½ c        2 c          2½ c        2½ c        3 c           3 c            3½ c        3½ c                                     4 c          4 c

Dark green vegetables   ½ c/wk 1 c/wk     1 c/wk     1 ½ c/wk 1 ½ c/wk  1 ½ c/wk  2 c/wk   2 c/wk      2 ½ c/wk  2 ½ c/wk  2 ½ c/wk  2 ½ c/wk Red/Orange vegetables  2½ c/wk  3 c/wk                              3 c/wk      4 c/wk                                                   5 ½ c/wk  5 ½ c/wk  6 c/wk 6 c/wk                                     7 c/wk      7 c/wk                                                   7½ c/wk  7½ c/wk Cooked dry beans and

peas                             ½ c/wk    ½ c/wk    ½ c/wk    1 c/wk    1 ½ c/wk  1 ½ c/wk  2 c/wk    2 c/wk      2 ½ c/wk  2 ½ c/wk  3 c/wk           3 c/wk Starchy vegetables     2 c/wk  3½ c/wk  3½ c/wk  4 c/wk     5 c/wk      5 c/wk     6 c/wk                            6 c/wk     7 c/wk     7 c/wk      8 c/wk  8 c/wk Other vegetables          1½ c/wk  2½ c/wk  2½ c/wk  3½ c/wk  4 c/wk         4 c/wk     5 c/wk      5 c/wk  5½ c/wk   5½ c/wk   7 c/wk    7 c/wk Grains            3 oz eq                                       4 oz eq      5 oz eq    5 oz eq   6 oz eq    6 oz eq    7 oz eq     8 oz eq     9 oz eq                                      10 oz eq   10 oz eq                  10 oz eq Whole grains        1½ oz eq 2 oz eq     2½ oz eq 3 oz eq                        3 oz eq    3 oz eq    3½ oz eq   4 oz eq 4½ oz eq  5 oz eq   5 oz eq     5 oz eq Other grains                                    1½ oz eq 2 oz eq   2½ oz eq 2 oz eq  3 oz eq     3 oz eq    3½ oz eq   4 oz eq    4½ oz eq  5 oz eq                        5 oz eq    5 oz eq Meat and beans          2 oz eq     3 oz eq    4 oz eq   5 oz eq       5 oz eq                                      5½ oz eq  6 oz eq    6 ½ oz eq  6 ½ oz eq 7 oz eq               7 oz eq     7 oz eq Milk             2 c                                              2 c            2 c           3 c          3 c           3 c           3 c           3 c            3 c                                             3 c            3 c           3 c

Oils                               15 g        17 g        17 g        22 g        24 g         27 g         29 g         31 g          34 g         36 g                                     44 g        51g


Maximum SoFAS3  limit, 137






calories (%total calories) (14%)


(10%)     121(8%) 161(9%)

(13%)      266 (12%) 330 (14%) (14%)     395 (14%)459 (15%) 596 (19%)


1Food group amounts shown in cup (c) or ounce equivalents (oz eq). Oils are shown in grams (g). Quantity equivalents for each food group are:

•     Grains, 1 ounce equivalent is: ½ cup cooked rice, pasta, or cooked cereal; 1 ounce dry pasta or rice; 1 slice bread; 1 small muffin (1 oz); 1 ounce ready- to-eat cereal.

•     Fruits and vegetables, 1 cup equivalent is: 1 cup raw or cooked fruit or vegetable, 1 cup fruit or vegetable juice, 2 cups leafy salad greens.

•     Meat and beans, 1 ounce equivalent is: 1 ounce lean meat, poultry, fish; 1 egg; ¼ cup cooked dry beans; 1 Tbsp peanut butter; ½ ounce nuts/ seeds.

•     Milk, 1 cup equivalent is: 1 cup milk or yogurt, 1½ ounces natural cheese such as Cheddar cheese or 2 ounces of processed cheese.

2Food intake patterns at 1000, 1200, and 1400 calories meet the nutritional needs of children ages 2 to 8 years. Patterns from 1600 to 3200 calories meet the nutritional needs of children 9 years of age and older and adults. If a child ages 2 to 8 years needs more calories and, therefore, is following a pattern at 1600 calories or more, the recommended amount from the milk group should be 2 cups per day. Children ages 9 years and older and adults should not use the

1000, 1200, or 1400 calorie patterns.

3SoFAS are calories from solid fats and added sugars.


Table B2.4. Dietary Pattern Comparison: Current U.S. intake, DASH-sodium diet, and USDA Food Patterns. Description, nutrient composition, and food group amounts (adjusted to 2000 calories)




Dietary Pattern

Usual U.S.




DASH with

Reduced Sodium






USDA Plant-based






USDA Vegan

Citation NHANES 2001-

04; 2005-06; Ages 19+

Karanja et al., 1999

and Lin et al., 2003

Britten et al., 2006;

Online Appendix E-


Online Appendix E-


Online Appendix E-


Online Appendix E-




Emphasizes   Potassium-rich

vegetables, fruits, and low-fat milk products

Vegetables, fruits,

and whole grains,

low-fat milk products

Plant foods –

vegetables, fruits, whole grains, legumes, low-fat milk products

Plant foods –

vegetables, fruits, whole grains, legumes, nuts, seeds, soy foods, milk products

Plant foods –

vegetables, fruits, whole grains, legumes, nuts, seeds, soy foods

Includes   Whole grains,

poultry, fish, and nuts

Enriched grains, lean

meat, fish, and oils

Lean meat, eggs,

fish, and oils

Eggs, oils Non-dairy milk


Limits (small


  Red meats, sweets,

and sugar-containing beverages

Solid  fats

Added sugars

Solid  fats

Added sugars

No meat, poultry,


Added sugars

No animal products

Added sugars

Calories (kcal) 2000 2000 2000 2000 2000 2000

(% total kcal)

48.4% 58% 56.7% 55.8% 56.7% 56.8%

(% total kcal)

15.2% 18% 15.2% 16.3% 15.2% 13.3%
Total Fat

(% total kcal)

33.5% 27% 32% 31% 31% 33%
Saturated Fat

(% total kcal)

10.9% 6% 8.4% 7.8% 7.8% 6.8%

(% total kcal)

12.5% 10% 12.0% 11.4% 11.8% 12.4%

(% total kcal)

6.8% 8% 9.0% 9.3% 9.4% 12.0%
Cholesterol (mg) 269 143 229 170 160 17


Table B2.4 (continued). Dietary Pattern Comparison: Current U.S. intake, DASH-sodium diet, and USDA Food Patterns. Description, nutrient composition, and food group amounts (adjusted to 2000 calories)


  Usual U.S. Intake DASH with

Reduced Sodium




  USDA Lactoovo  
Dietary Pattern Adults 19 year+   Pattern1 USDA Plant-based Vegetarian USDA Vegan
Fiber (g) 15 29 30 37 39 43
Potassium (mg) 2909 4371 3478 3611 3610 3645
Sodium (mg) 2846 1095 1722 1582 1595 1224

Food Groups

Vegetables: total (c) 1.6 2.1 2.5 2.5 2.5 2.5
– Dark Green  (c) 0.1 nd 0.2 0.2 0.2 0.2
– Legumes2(c) 0.1 nd 0.2 0.2 0.2 0.2
– Red Orange (c) 0.4 nd 0.8 0.8 0.8 0.8
– Other Veg (c) 0.5 nd 0.6 0.6 0.6 0.6
– Starchy Veg (c) 0.5 nd 0.7 0.7 0.7 0.7
Calories (kcal) 2000 2000 2000 2000 2000 2000

Food Groups

Fruit & juices (c) 1.0 2.5 2 2 2 2

Grains: total (oz)













– Whole grains (oz) 0.6 3.9 3 3 3 3

Milk & milk




0.7 (whole)





products incl whole            
fat (c)

– Low-fat milk (c)












3 (non-dairy)3


Animal Proteins:

– Meat (oz) 2.5 1.4 2.5 0.6
– Poultry (oz) 1.2 1.7 1.5 0.4
– Eggs (oz) 0.4 nd 0.4 0.4 0.6
– Fish (total) (oz) 0.5 1.4 0.5 0.7
— Hi n3 (oz) 0.1 nd 0.1 nd
— Low n3 (oz) 0.4 nd 0.4 nd


Table B2.4 (continued). Dietary Pattern Comparison: Current U.S. intake, DASH-sodium diet, and USDA Food Patterns. Description, nutrient composition, and food group amounts (adjusted to 2000 calories)




Dietary Pattern

Usual U.S.


Adults 19 year+

DASH with

Reduced Sodium






USDA Plant-based






USDA Vegan

Plant Proteins:            
– Legumes (oz) nd 0.4 See vegetables. 1.4 1.4 1.9
– Nuts & seeds (oz) 0.5 0.9 0.6 1.1 1.9 2.1
– Soy products (oz) 0.0 nd 0.05 0.9 1.7 1.4

Oils (g)













Solid Fats (g) 43.2 nd 16 16 16 16
Added Sugar (g) 79.0 12 (snacks/sweets) 32 32 32 32
Alcohol (g) 9.9


1The USDA Base Food Pattern is slightly adapted from the 2000-calorie pattern presented in the 2005 Dietary Guidelines for Americans (DGA). Vegetable subgroups were realigned to include a Red/Orange subgroup. The base pattern and the vegetarian variations are subject to change as the 2010 DGA are developed. The measures are cup and ounce equivalents (Britten, 2006; Marcoe, 2006). Nutrient distribution updated with 2010 composites.

2On USDA patterns, total recommended legume amount is the sum of amounts recommended in the Vegetable and the Meat & Beans groups. An ounce equivalent of legumes in the Meat & Beans group is ¼ cup. For example, in the 2000-calorie pattern, total weekly legume recommendation is (13 oz eq /4) +

1.5 cups = 5 cups.

3Non-dairy options in Vegan pattern are calcium-fortified soymilk, rice milk, and tofu. All USDA patterns contain a small amount of soy milk. nd = Not described.

(-) = No recommendation.

Sources: Usual U.S. Intakes – WWEIA, NHANES 2001-2004 and WWEIA, NHANES 2005-2006, one-day mean intakes consumed per individual. Male and female intakes adjusted to 2000 calories, averaged, and rounded to one decimal point.



No comments yet — be the first.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: