Nutritious Dietary Patterns

Dietary patterns (also called eating patterns) are the combinations and quantities of food and beverages consumed over time. Consistent evidence indicates that, in general, a plant-based dietary pattern is more health-promoting than the current average U.S. diet. However, a “plant-based” eating patterns doesn’t mean only plants; pairing high-quality protein foods, like eggs, with plants is essential for the synthesis and maintenance of muscle tissue, and for achieving optimal vitamin and mineral intakes.

The 2015-2020 Dietary Guidelines for Americans recommend three healthy eating patterns, all of which include eggs. But what are the sample eating patterns, and what are the key differences between them?

To learn more about healthy eating patterns, including those recommended in the 2015-2020 Dietary Guidelines, and how eggs fit within those patterns, explore the following PowerPoint, and feel free to share it with friends!

Healthy Eating Patterns: How do Eggs Fit?

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Have an Egg-cellent Meatless Monday

Are you or your clients participating in Meatless Monday? It can be tricky for some individuals to redesign their plate and get a balanced, protein-rich meal. However, eggs pair well with many different foods, making it easy to create simple, affordable meals for any time of day.

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Idea # 1 Family Fun: Meatless Monday can be a great time to have breakfast at dinner,  especially if a  family might need help “getting in the groove” of trying meatless meals. Some nutritious examples include:

  • Whole wheat pancakes or waffles topped with fruit and a glass of skim milk on the side
  • Omelet or burrito station with different veggies and cheese – get the kids involved to make meal preparation fun for all!

Idea # 2 Busy Monday:  The great news is that many egg dishes can be made the night before and cooked the next day, saving time and energy.

  • Here are a few recipes (several meatless) that you can easily make ahead.
  • Make Monday dinner and have more to eat the rest of the week-casseroles reheat well, as do these Muffin Fritattas. You could even make these Sunday and have them reheated on Monday!
  • Keep hard-boiled eggs on hand for a quick snack or addition to a salad.

Need More Ideas:

Check out @IncredibleEggs on Twitter and Facebook-for a variety of great recipes , including this Mushroom and Spinach Frittata and Quinoa Egg Bake with Thyme and Garlic. I personally made this one for dinner (took a larger piece than the breakfast portion and added some fruit on the side). Delish!

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Egg Nutrition Center teamed up with our friends at the Produce for Better Health Foundation (PBH)/Fruits and Veggies More Matters to create this recipe for  Herbed Spinach Quiche Portabella Caps (pictured above). By pairing eggs with other nutrient-rich foods, it’s easy to build a well-balanced and colorful plate.

Do you have any favorite vegetarian egg dishes you recommend for your clients?

Eggs and Diabetes: Increased Risk or Guilt by Association?

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The Background

The 2010 Dietary Guidelines for Americans (1) recommended limiting dietary cholesterol and specifically egg consumption for individuals with type 2 diabetes (T2D). The recommendation was based on epidemiology studies reporting positive statistical association of increased cardiovascular disease (CVD) risk for individuals with T2D who consumed 7 or more eggs each week. While the Dietary Guideline Committee cited the concern about egg consumption for T2D, they acknowledged that the relationship was a statistical association with no proof of cause or mechanism and emphasized the need for more research.

Shortly after the Dietary Guidelines were presented, Drs. Mozaffarian and Ludwig at Harvard wrote a commentary arguing that the focus of the Dietary Guidelines on single nutrients or single foods was inadequate and misleading for evaluation of modern diverse diets. They argued Dietary Guidelines must consider the context of foods within food patterns and lifestyles to define health risks (2).

Recent Published Studies

A recent paper from Spain evaluating the Mediterranean diet emphasizes this point (3). These investigators specifically evaluated the relationship of egg consumption to diabetes risk in a cohort of adults following a Mediterranean diet pattern. They found no relationship of egg consumption (or cholesterol intake) with T2D risk suggesting that eggs were not a risk factor when consumed within a healthy dietary lifestyle.

Still, contrary to this report, a meta-analysis published in the British Medical Journal (4) evaluated 16 prospective cohort studies that specifically examined relationships of egg consumption with incidence of T2D and CVD and found a positive Risk Ratio (RR) of 1.54 for egg consumption with CVD within the population of T2D.

If you’re not used to thinking about RR, a RR of 1.0 means there is no association, and for comparison, a 50-year old smoking a pack per day has a RR of over 20 for lung cancer. So the true risk of heart disease in a 50-year old male with normal blood lipids and normal blood pressure is about 2% and a RR of 1.54 would increase the risk to 3%.

Perhaps more important than the potential small risk in T2D, these investigators found no association of egg intake with risk of CVD or stroke in non-diabetic adults with the RR less than 1.0 suggesting that greater egg intake reduced risk of both CVD and stroke. Further, they found a RR of 0.75 for egg consumption and stroke in adults with T2D.

Concerns about egg consumption by individuals with T2D remains a question that requires better research to determine if the risk is a true relationship to eggs or if it is a guilt by association with other aspects of overall diet quality. This would include dietary intakes such as total fat, types of fat, dietary fiber, green vegetables or fruit.

Bottom Line

What should not be lost within the debate about diabetes is that study after study shows there is no association
of egg consumption with CVD risk in non-diabetic adults and that egg consumption reduces risk for stroke in both diabetic and non-diabetic adults.

References

1. U.S. Department of Health and Human Services. Dietary Guidelines for Americans. http:/www.health.gov/dietaryguidelines/  Part D, Section 3.

2. Mozaffarian D, Ludwig DS. Dietary Guidelines in the 21st Century a Time for Food. JAMA 304:681, 2010.

3. Zazpe I, Beunza JJ, et al. Egg consumption and risk of type 2 diabetes in a Mediterranean cohort: the SUN project. Nutr Hosp 28:105, 2013.

4. Rong Y, Chen L, et al. Egg consumption and risk of coronary heart disease and stroke: dose-response meta-analysis of prospective cohort studies. BMJ 2013 (doi: 10.1136/bmj.e8539).

Food Patterns

The science of epidemiology is both a gold mine and a disaster for nutrition science. A quick look through the American Journal of Clinical Nutrition or simply scanning the news headlines and you find numerous new discoveries in nutrition health based on epidemiology studies. This research has uncovered many importance questions and led to multiple new lines of research. Unfortunately, epidemiology is too often misused and over-extrapolated to imply cause and effects based on simple statistical associations.

The problem with these studies is the health outcomes are related to dietary intakes of single nutrients or single foods and largely ignores the overall food patterns or lifestyles of the individuals at risk. The weakest part of the data are the food surveys that are supposedly validated, which simply means if you did the same survey 10 times you’d get the same answer 9 times, but it ignores the fact that the answer may be wrong.

A recent paper in Journal of Nutrition (JN 142:1652, 2012) highlights the problem. The investigators surveyed a large group of overweight individuals consuming higher protein diets for weight management and found a statistical association of higher intakes of “red meat and processed meats” with risk of colon cancer. However, after evaluating the overall food intake in greater detail, the investigators found that the higher risk of colon cancer occurred more specifically in individuals who were obese (ie. excess calories) and consumed limited dietary fiber, excess sugar, minimal fruit (ie. low vitamin C), high amounts of lettuce, spinach and beets (ie. high dietary nitrates), and high amounts of processed meats (ie. sausage and hotdogs). In the full context, it’s not surprising these individuals have increased health risks.

A second study in the Journal of Nutrition (JN 142:2112, 2012) sheds additional light on the importance of evaluating individual foods or nutrients in the context of the entire food pattern. These investigators evaluated the USDA NHANES dietary data related to cardiovascular risk factors (CVRF). They also used the food pattern model of the USDA Healthy Eating Index (HEI) which evaluates dietary outcomes against 10 food categories. They found that there was a strong inverse relationship of diet quality and CVRF. The better the overall diet quality the lower the health risks. So in an era when everyone wants to claim a new discovery about a magic or evil nutrient, we’re still finding that variety and moderation remain the most important goals for good nutrition.

To 2013, a Year of Nutritious Breakfasts!

We have almost survived the first week of 2013.  Hopefully you and your clients have focused on obtainable lifestyle changes for the New Year.  If you’re still looking for a goal to last a lifetime, try committing to eat breakfast.  If you are a breakfast skipper, consider making it a habit to start eating breakfast, and if you currently eat breakfast, aim to maximize the nutrition of your first meal of the day.
2013 Eggs

Breakfast has been a popular topic on Nutrition Unscrambled, as well as many other health related articles, blogs and tweets.  A breakfast that includes high quality protein, such as eggs, has shown multiple benefits including improved cognition, better appetite control,  muscle and strength building from the amino acids, as well as mind and body energy for our busy lives.  Here is a great blog post by Appetite for Health discussing the benefits of protein in the diet, particularly for weight loss.

A recent article on Epicurious that quoted ENC Health Professional Advisor, Kathleen Zelman, discussed some great breakfast tips.  A favorite quote from the article is: “She adds that there have been ’umpteen studies‘ that demonstrate the benefits of breakfast on all sorts of performance, including how children fare on tests.”  Despite the “umpteen studies,” we don’t seem to make breakfast a priority.  Let’s make a new habit and have breakfast be a priority in 2013 (and beyond).

Don’t know where to start or not sure how to talk to clients about eating breakfast?  You can use MyPlate as a guide for ideas.  The great news is that breakfast doesn’t have to take a long time to make (or eat).  Eggs are a great addition to breakfast because they are quick and easy, as well as delicious and pair well with other healthy foods. For simple recipe ideas, visit the Incredible Egg website.eggb
So here is a new challenge: show other health professionals and clients your commitment to eating a healthy breakfast that includes protein-rich options, like eggs.  You can tweet your breakfast photos at @IncredibleEggs or post them on Facebook at Incredible Edible Egg. Also be sure to add a comment about why you are committed to breakfast. Use the hashtag #eggbreakfast in your posts.

Chaotic Eating Contributes to Excessive Calories and Obesity

Today’s post comes from Dr. Donald Layman. Dr. Layman is the Director of Research at the Egg Nutrition Center and Professor Emeritus at the University of Illinois and a leading researcher studying dietary needs for protein and amino acids.

Variety may be the “spice of life” but it is also a factor leading to excess calorie intake and obesity. There is increasing evidence that the hectic American lifestyle that often leads to chaotic meal patterns combined with the almost unlimited availability of high calorie snacks and desserts plays a central role in expanding waistlines of adults.

Consuming a variety of foods is often recommended as an approach to good nutrition, but there is increasing evidence that consistency of meals and limiting variety of food choices – certainly snacks – may be important for controlling energy intake.

A recent study by Dr. Rena Wing at University of Tennessee (AJCN 95:1305, 2012) examined limiting the variety of high energy-low nutrient (HE-LN) foods consumed by adults during an 18-month weight loss study. These foods provide a lot of calories but with minimal nutrient density. Subjects were allowed to select two items from a list of snacks, desserts, candy, ice cream, breads, cereals and pastas. These two items could be consumed as part of any meal or snack throughout the study, but no other items from the list were allowed at any time. The researchers found that limiting the choices in the HE-LN categories to only two selections significantly reduced calorie intake.

Anyone trying to achieve weight loss must restrict total calorie intake; and calorie restriction creates the potential for increased hunger and desire to eat. Managing the desire to eat requires consistent meal patterns, including the types of foods, the amount of food, and the meal timing. It is unlikely that there is a single meal pattern that is ideal for everyone, however there is increasing evidence that skipping breakfast leads to increased snacking and consumption of excess calories late in the day. Consuming a consistent breakfast that contains about 30 grams of high quality protein and reduced amounts of high glycemic carbohydrates is an important factor for appetite regulation. Likewise, reducing the size of dinner is important related to portion control and total calorie intake.

Eating a variety of foods is important but a better message for adults may be to strive for consistent meals that are nutritionally balanced. There is nothing wrong with eating the same basic foods and having the same meals every day. Avoid chaotic eating and limit the variety of high energy-low nutrient foods to achieve weight management.