Tips on a Healthy Diet with a Food Pyramid

Food-based dietary guidelines (FBDG) are simple messages on healthy eating, aimed at the general public. They give an indication of what a person should be eating in terms of foods rather than nutrients, and provide a basic framework to use when planning meals or daily menus. Characteristics as described by the World Health Organization (WHO) are

The expression of the principles of nutrition education mostly as foods.
Intended for use by individual members of the general public, and
If not expressed entirely as foods, written in language that avoids, as far as possible, the technical terms of nutritional science.

FBDG should provide simple, food-based messages that are relevant to the population concerned and practical to follow. They can be broad and unspecific such as ‘eat a variety of foods each day’ or ‘eat plenty of fruits and vegetables’, or more specific such as ‘eat five portions of fruits and vegetables a day’. Messages may also indicate the type of food, such as ‘eat low fat dairy products and drink low fat milk’, or be meal specific such as ‘eat breakfast every day’.

FBDG avoid the use of numerical recommended intakes of nutrients (such as recommended daily allowances – RDA) or population targets, but provide a practical way of interpreting these into dietary advice for individuals within a population.

So, if the population target for saturated fat is 10% of total energy, and the current intake is higher, messages will include those designed to reduce saturated fat intake, such as ‘choose lean cuts of meat’. FBDG also address public health concerns, such as chronic diseases, by targeting nutrients that may influence the disease outcome (e.g., messages to reduce saturated fat intake are given greater emphasis where rates of coronary heart disease are high).

The Food Pyramid: A Dietary Guideline in Europe

Nowadays there is a mass of information and advice available from different sources about nutrition and health, and interested individuals can find details about the nutrients (e.g. carbohydrates, fat, protein, vitamins and minerals) they should be eating to achieve a healthy balanced diet.

Food labels can also provide useful details on the amounts of the different nutrients contained in a food. However, the nutrient information available can seem quite complex, is not well understood by the majority of consumers, and it is of limited use when preparing family menus without a good knowledge of nutrition. This makes it necessary to provide nutrient advice in a way consumers can understand.

What are Food-Based Dietary Guidelines (FBDG)?

the expression of the principles of nutrition education mostly as foods.
intended for use by individual members of the general public, and
if not expressed entirely as foods, written in language that avoids, as far as possible, the technical terms of nutritional science.

The history of FBDG

Long before the discovery of the vitamins, their role in the body, and the establishment of food composition databases, people knew that different foods were important for health. Dietary recommendations were often based on observations, such as those of James Lind, a surgeon in the British navy during the 18th century who demonstrated that limes and oranges cured scurvy in sailors whereas other remedies such as vinegar and cider did not. Forty years after he published his findings all ships in the British navy were ordered to carry lime juice, and scurvy on board ships was virtually eradicated.

Since World War II, food based advice has been given to ensure adequate intakes of both macronutrients (proteins, carbohydrates, and fats) and micronutrients (vitamins and minerals), often using a system of food groupings. This involved placing foods with similar characteristics into the same food group and advising people to eat from each group every day.

However, during the 1970s nutritionists became concerned with the over-consumption of fats, especially saturated fats, and sugars, and the lack of fibre in the diet. As a result, advice in developed countries tended to become more nutrient-based, with emphasis on macro- rather than micronutrients. This was mixed with some food-based advice to encourage eating more or less of those foods which were high or low in macronutrients of concern, but the use of traditional food groups became less popular.

Recognition of the value of FBDG

At an International Conference on Nutrition in Rome in 1992, a plan for action was adopted which called for the dissemination of nutrition information through sustainable food-based approaches that encourage dietary diversification through the production and consumption of micronutrient-rich foods, including appropriate traditional foods. The plan for action marked a change from policies dictated by numbers to policies focussing on prevailing public health problems. Following this, in 1996 the Food and Agricultural Organization (FAO) and the World Health Organization (WHO) of the United Nations published guidelines for the development of FBDG.2 Those guidelines remain the key reference work on the subject today.

The European International Life Sciences Institute (ILSI Europe) has organised two workshops focussing on FBDG. The first one was held in Vilnius (Lithuania) and Nitra (Slovakia) in 1997. It focussed on the ‘Development of local FBDG and nutrition education’.

Seven years later, ILSI Europe, in collaboration with the FAO, organised a follow up workshop with 6 out of the 19 countries that participated in the first workshop. The focus was extended to also comprise the implementation and monitoring of FBDG. The document ‘National Food Based Dietary Guidelines: Experiences, Implications and Future Directions’ summarises the outcome of the workshop and shows the progress achieved by the 6 participating countries with regard to both the development and implementation of FBDG.3 A framework for FBDG in the European Union was agreed in 2000 as part of the Eurodiet project, and published in 2001.4

In 2003, the WHO assessed the existence of FBDG among the Member States of the WHO European Region. The results showed that out of the 48 participating countries, 25 had national FBDG that had been endorsed by the government. Another 8 countries reported that FBDG were in preparation.1

In March 2006, the European Food Safety Authority (EFSA) held a scientific colloquium in Parma on FBDG as a prelude to their task of providing guidance on the translation of nutrient-based recommendations for a healthy diet into food-based recommendations for the European Community.

5 Prior to the scientific colloquium the EFSA Panel on Dietetic Products, Nutrition and Allergies reviewed the literature on the principles for developing FBDG, identified the necessary scientific information for establishing FBDG in European countries and summarised the steps for their implementation, monitoring and evaluation.6

In a separate parallel exercise, the European Commission (Research Directorate-General) funded the EURRECA (EURopean micronutrient RECommendations Aligned) Network of Excellence (2007-2011). The Network of Excellence is studying micronutrient requirements and the development of recommendations for vulnerable population groups.

Hereby, it seeks to create tools which should help EFSA and other institutions charged with setting micronutrient recommendations. as well as guide the future development of FBDG in European countries. The aim of EURRECA is to produce Europe-wide scientific consensus on the evidence appropriate for developing micronutrient recommendations. This in turn should enable rapid and convenient translation into recommendations published in national policy documents.

The EURRECA Network, originally made up of 34 partners based in 17 countries, has a large involvement from academia, food industry (including small and medium sized enterprises), consumer groups, national nutrition societies and the health professions. The Network will be collaborating throughout this project with EFSA.7

In May 2009 the Food and Agricultural Organization of the United Nations (FAO) in collaboration with the European Food Information Council (EUFIC) organised a workshop on the development, communication and evaluation of FBDG. Fourteen Central and Eastern European countries participated in this workshop in Budapest.

Food pyramids

The most popular graphic representation of FBDG is in the form of a pyramid. Austria, Belgium, Finland, Greece, Ireland, Latvia, Spain, Germany and Switzerland are some of the countries that make use of such a food guide pyramid.

The Irish food pyramid is typical in that it has five groups, each forming a layer. The base layer, across the widest part of the pyramid, is for the food group we should eat the greatest quantities of, i.e. ‘bread, cereal and potatoes’, and the narrow top depicts the group we should eat least of, i.e. ‘oils, fats and sugary foods’. Above the base layer are ‘fruits and vegetables’, the middle layer is ‘milk, cheese and yogurt’ and below the top layer is ‘meat, fish and alternatives’. Advice to drink plenty of water is given close by.

The Swiss pyramid differs from the Irish in that fruits and vegetables are in the layer below cereals, the milk and meat groups are combined in one layer and sugar-containing foods have a section of their own at the top above fats and oils.

The Belgian and Swiss pyramids depict fluids as an additional food group at the base. In addition, both the Belgian and the Swiss includes physical activity in the graphic, but on the outside of the pyramid.

The Spanish pyramid adds water and exercise recommendations below the base of the graphic, and depicts advice for moderate intakes of wine and beer on the side of the pyramid.

As all of the above examples, the Latvian graphic displays additional information on the side of the pyramid. Although here, percentages representing the ideal food groups’ contribution to a healthy diet are displayed. It also depicts fluids at the base of the pyramid.

Germany uses a three-dimensional pyramid that provides qualitative (nutritional role of the food) as well as quantitative (how much of this food relative to others) advice on food consumption.

The four sides of the pyramid are dedicated to the following food groups:

Foods primarily of plant origin; criteria for grouping at the base, middle or top of the pyramid being calorie density, nutrient density (vitamins, minerals, phytonutrients, fibre); preventive aspects (cancer, heart disease).Foods primarily of animal origin; criteria for grouping at the base, middle or top of the pyramid being calorie density, nutrient density (e.g., calcium, iron, zinc, selenium, B vitamins, vitamin D); fat quality (saturated fats, omega-3 fatty acids).
Dietary fats and oils; positioning criteria for fats being: fatty acid composition omega-3, omega-6, omega-9 fatty acids, saturated fats, ratio of omega-6:omega-3 fatty acids); vitamin E; cholesterol; trans fats; application in cooking; criteria for oils: ratio of omega-6:omega-3 fatty acids; vitamin E content.
Beverages; positioning criteria being: calorific value (moderate: 7% carbohydrates, high: 7% carbohydrates); essential nutrients; phytonutrients; stimulants; sweeteners.
The colours on the left of each of the four sides of the German pyramid are traffic lights that indicate the nutritional value of the foods and thereby give advice on the amounts to be consumed. The traffic lights apply to foods within the same food group.

The bottom of the 3D pyramid depicts a circle indicating the relative proportions of each group in the diet. For this, the plant-based foods are divided into ‘fruits and vegetables’ and ‘cereals’ and are given a much larger proportion of the circle than the animal-based foods. Fats are reduced to a very small proportion of the whole and water fills the centre.

Food circles

The other common graphical form used for FBDG in Europe is a circle divided into segments like a cake. Each segment contains one food group similar to those used in the pyramids. Circles have been developed in Portugal, Sweden and the UK (depicted as a plate). Finland and Spain use a circle as well as the pyramid, and the German pyramid depicts a circle at the base of its 3D pyramid.

The Netherlands have a wheel, the centre of which is used for food messages. Most circles are proportionally segmented in accordance with the recommended contributions from each food group. The Portuguese and German graphics have water at the centre of the circle whilst the Spanish circle depicts both water and exercise at the centre.

Other visual cues

Pictures of examples from each food groups are generally included within each food group either as photographs or drawings. A considerable amount of care and attention has to go into the choice and design of the pictures to ensure that typical foods are included, that nothing important is omitted, that there is a good mix for the local culture and that they are visually appealing. Where fluid and physical activity are included in the graphic, they are done so by illustrations.

Most of the time, different colours are used for different groups without a specific meaning, with some exceptions (e.g. the CINDI pyramid described above, and the German pyramid where colours indicate the quality of the different products found within a food group).

In Hungary, the guide is accompanied by a graphic in the shape of a house with the ground floor, first floor, roof and chimney depicting different food groups. The French FBDG are illustrated as stairs. Foods from which higher amounts can be consumed are found at the top of the stairs, whilst the ones that should only be consumed in small quantities are found at the bottom.

The French guidelines are also shown in a table containing recommendations on the amount of each of the six food groups, salt and fluids that should be consumed. The table also displays recommendations on physical activity.

Conclusions

Nearly all European countries have developed FBDG. They are all based on the principle to provide guidance for a healthy balanced diet that will help prevent non-communicable diseases such as heart disease and cancer. Common recommendations include eating plenty of fruits, vegetables and complex carbohydrates, and choosing foods which are lower in saturated fat, salt and sugar.

The use of food groups, as in food pyramids and circles, ensures the inclusion of all basic foods and gives positive messages about what we should be eating as well as some qualifying information to help us avoid eating too much of certain foods. Although the details may vary FBDG have been developed by different bodies at different times and for use in different cultures – there are many similarities between all the European FBDG.