Characteristics of a Healthful Diet

A healthful diet is a cornerstone of overall well-being, playing a crucial role in maintaining health, preventing disease, and ensuring optimal bodily function. It's about making informed food choices that provide the right nutrients in the right amounts. Good nutrition means eating the right foods, in the right amounts, to receive enough (but not too much) of the essential nutrients so that the body can remain free from disease, grow properly, work effectively, and feel its best.

The Cumulative Effect of Food

The phrase "you are what you eat" highlights the fact that food has cumulative effects on the body, with many nutrients becoming integral parts of our physical structure. For example, the protein and calcium from milk contribute to bone formation. What we eat impacts how we feel both immediately and in the long run. Achieving a healthy diet involves balancing the quality and quantity of food to provide an appropriate combination of energy and nutrients.

Key Properties of a Healthful Diet

Understanding what constitutes a healthful diet is essential for maintaining overall well-being. A healthful diet is characterized by five key properties:

• Adequacy: Ensuring sufficient intake of essential nutrients, including energy, vitamins, minerals, and fiber, to meet the body's needs. A diet is adequate when it provides sufficient amounts of calories and each essential nutrient, as well as fiber.
• Nutrient Density: Providing a high amount of nutrients relative to the calorie content. Nutrient Density is a measure of the nutrients that we’re usually trying to consume more of-vitamins, minerals, fiber and protein-per calorie of food, coupled with little or no solid fats, added sugars, refined starches, and sodium.
• Variety: Including a wide range of different foods to prevent nutritional imbalances. Eating a varied diet helps to ensure that you consume adequate amounts of all essential nutrients required for health.
• Balance: Representing all food groups in daily meals to ensure a comprehensive array of nutrients. A balanced diet means eating a combination of foods from the different food groups, and because these food groups provide different nutrients, a balanced diet is likely to be adequate in nutrients.
• Moderation: Consuming adequate amounts of nutrients without exceeding recommended limits, applicable to both calorie intake and specific vitamins and minerals. Moderation means not eating to the extremes, neither too much nor too little of any one food or nutrient.

Food Groups and Nutrient Contributions

Different food groups offer unique nutrients, making a balanced diet essential. For example, vegetables are an important source of potassium, dietary fiber, folate, vitamin A, and vitamin C. Grains provide B vitamins (thiamin, riboflavin, niacin, and folate) and minerals (iron, magnesium, and selenium). No one food is more important than the other.

The Role of Empty Calories

Foods become less nutrient dense when they contain empty calories - calories from solid fats and/or added sugars. Solid fats and added sugars add calories to a food but don’t provide other nutrients.

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Empty calories, derived from solid fats and added sugars, add calories to food without providing substantial nutrients. While often seen as detrimental, empty calories can sometimes play a positive role by enhancing the flavor of nutrient-dense foods, making them more enjoyable and sustainable in the diet. Adding a little fat and/or sugar to nutrient-dense foods can add flavor, making the food more enjoyable. A teaspoon of sugar in oatmeal, or a teaspoon of butter on steamed veggies is a great way to include empty calories.

Moderation and Enjoyment

Moderation means that small portions of higher-calorie, lower-nutrient foods like chips and candy can fit within a healthy diet. Including these types of foods can make healthy eating more enjoyable and also more sustainable.

Moderation is key to a sustainable, healthful diet. It allows for small portions of less nutrient-dense foods, like chips and candy, to be included, making healthy eating more enjoyable and sustainable. Extreme diets that forbid many foods are often short-lived, leading to overeating of the restricted items.

Variety for Adequate Nutrient Intake

Variety refers to consuming different foods within each of the food groups on a regular basis. Eating a varied diet helps to ensure that you consume adequate amounts of all essential nutrients required for health. One of the major drawbacks of a monotonous diet is the risk of consuming too much of some nutrients and not enough of others.

Regularly consuming a variety of foods within each food group ensures an adequate intake of all essential nutrients. A monotonous diet can lead to excessive consumption of some nutrients while lacking others.

Read also: The Hoxsey Diet

Nutrient Density in Practice

You can choose more nutrient-dense foods by making small modifications to your current eating pattern. Keep in mind that empty calories are not always a bad thing. In fact, empty calories can help promote eating more nutrient-dense foods.

Choosing nutrient-dense foods involves making small modifications to current eating patterns. For example, a 90 percent lean 3-ounce ground beef patty is considered more nutrient-dense than a 75 percent lean patty. In the 90 percent lean patty, for 184 calories you get protein, iron, and other needed nutrients.

Water Consumption

Water is the principal component of the body, constituting the majority of lean body mass and total body weight.

Water is crucial, constituting the majority of lean body mass and total body weight. It not only provides hydration but also carries micronutrients, including trace elements and electrolytes. Drinking water may supply as much as 20% of the daily recommended intake of calcium and magnesium.

Practical Advice for Maintaining a Healthy Diet

Fruit and Vegetables

Eating at least 400 g, or five portions, of fruit and vegetables per day reduces the risk of NCDs (2) and helps to ensure an adequate daily intake of dietary fibre. Fruit and vegetable intake can be improved by:

Read also: Walnut Keto Guide

• Always including vegetables in meals.
• Eating fresh fruit and raw vegetables as snacks.
• Eating fresh fruit and vegetables that are in season.
• Eating a variety of fruit and vegetables.

Fats

Reducing the amount of total fat intake to less than 30% of total energy intake helps to prevent unhealthy weight gain in the adult population (1, 2, 3). Also, the risk of developing NCDs is lowered by:

• Reducing saturated fats to less than 10% of total energy intake.
• Reducing trans-fats to less than 1% of total energy intake.
• Replacing both saturated fats and trans-fats with unsaturated fats (2, 3) - in particular, with polyunsaturated fats.

Fat intake, especially saturated fat and industrially-produced trans-fat intake, can be reduced by:

• Steaming or boiling instead of frying when cooking.
• Replacing butter, lard and ghee with oils rich in polyunsaturated fats, such as soybean, canola (rapeseed), corn, safflower and sunflower oils.
• Eating reduced-fat dairy foods and lean meats, or trimming visible fat from meat.
• Limiting the consumption of baked and fried foods, and pre-packaged snacks and foods (e.g. doughnuts, cakes, pies, cookies, biscuits and wafers) that contain industrially-produced trans-fats.

Salt, Sodium, and Potassium

Most people consume too much sodium through salt (corresponding to consuming an average of 9-12 g of salt per day) and not enough potassium (less than 3.5 g). blood pressure, which in turn increases the risk of heart disease and stroke (8, 11). Reducing salt intake to the recommended level of less than 5 g per day could prevent 1.7 million deaths each year (12).

People are often unaware of the amount of salt they consume. In many countries, most salt comes from processed foods (e.g. in large amounts (e.g. bread). Salt is also added to foods during cooking (e.g. bouillon, stock cubes, soy sauce and fish sauce) or at the point of consumption (e.g. table salt).

Salt intake can be reduced by:

• Limiting the amount of salt and high-sodium condiments (e.g. soy sauce, fish sauce and bouillon) when cooking and preparing foods.
• Not having salt or high-sodium sauces on the table.
• Limiting the consumption of salty snacks.
• Choosing products with lower sodium content.

Some food manufacturers are reformulating recipes to reduce the sodium content of their products, and people should be encouraged to check nutrition labels to see how much sodium is in a product before purchasing or consuming it.

Potassium can mitigate the negative effects of elevated sodium consumption on blood pressure. Intake of potassium can be increased by consuming fresh fruit and vegetables.

Sugars

In both adults and children, the intake of free sugars should be reduced to less than 10% of total energy intake (2, 7). A reduction to less than 5% of total energy intake would provide additional health benefits (7). Consuming free sugars increases the risk of dental caries (tooth decay). Excess calories from foods and drinks high in free sugars also contribute to unhealthy weight gain, which can lead to overweight and obesity. free sugars influence blood pressure and serum lipids, and suggests that a reduction in free sugars intake reduces risk factors for cardiovascular diseases (13).

Sugars intake can be reduced by:

• Limiting the consumption of foods and drinks containing high amounts of sugars, such as sugary snacks, candies and sugar-sweetened beverages (i.e. soft drinks, fruit or vegetable juices and drinks, liquid and powder concentrates, flavoured water, energy and sports drinks, ready‐to‐drink tea, ready‐to‐drink coffee and flavoured milk drinks).
• Eating fresh fruit and raw vegetables as snacks instead of sugary snacks.

Macronutrients

A healthy diet is one in which macronutrients are consumed in appropriate proportions to support energetic and physiologic needs without excess intake while also providing sufficient micronutrients and hydration to meet the physiologic needs of the body [10].

Macronutrients (i.e., carbohydrates, proteins, and fats) provide the energy necessary for the cellular processes required for daily functioning [11].

Carbohydrates are the primary source of energy in the diet and are found in the greatest abundance in grains, fruits, legumes, and vegetables [14]. In terms of deriving a health benefit, whole grains are preferred over processed grains, the latter having been stripped of germ and bran during the milling process, resulting in lower amounts of fiber and micronutrients [15]. Meta-analyses of prospective cohort studies have linked increased whole-grain intake to a reduced risk of coronary heart disease, stroke, cardiovascular disease, and cancer, as well as to the decreased risk of mortality due to any cause, cardiovascular disease, cancer, respiratory disease, diabetes, and infectious disease [15,16,17].

Fresh fruits and vegetables supply energy as well as dietary fiber, which promotes the feeling of satiety and has positive effects on gastrointestinal function, cholesterol levels, and glycemic control [18]. In addition, fresh fruits and vegetables are key sources of phytochemicals (e.g., polyphenols, phytosterols, carotenoids), which are bioactive compounds believed to confer many of the health benefits associated with fruit and vegetable consumption [19]. The mechanistic effects of these various phytochemicals are unclear but include their antioxidative properties, as well as their role in regulating nuclear transcription factors, fat metabolism, and inflammatory mediators. For example, flavonoids have been shown to increase insulin secretion and reduce insulin resistance, suggesting that these phytochemicals provide some benefits in obesity and diabetes [20]. Additionally, polyphenols interact with gastrointestinal microbiota in a bi-directional manner by enhancing gut bacteria and being metabolized by these bacteria to form more bioactive compounds [20].

Dietary proteins provide a source of energy as well as amino acids, including those that the human body requires but cannot produce on its own (i.e., essential amino acids). Dietary proteins are derived from both animal (meat, dairy, fish, and eggs) and plant (legumes, soya products, grains, nuts, and seeds) sources, with the former considered a richer source due to the array of amino acids, high digestibility, and greater bioavailability [27]. However, animal-based sources of protein contain saturated fatty acids, which have been linked to cardiovascular disease, dyslipidemia, and certain cancers. Although the mechanisms are unclear, red meat, and processed meat in particular, have been associated with an increased risk of colorectal cancer [28,29]. Animal-derived proteins also increase the dietary acid load, tipping the body’s acid-base balance toward acidosis [30,31]. Adequate dietary protein intake is important for maintaining lean body mass throughout the life span. In older adults, protein plays an important role in preventing age-related loss of skeletal muscle mass [32], preserving bone mass, and reducing fracture risk [33].

Fats (or lipids) are the primary structural components of cellular membranes and are also sources of cellular energy [35]. Dietary fats fall into 4 categories: monounsaturated fats, polyunsaturated fats, saturated fats, and trans fats. The fat content of food is generally an admixture of these different types [35]. Unsaturated fats are found in a variety of foods, including fish, many plant-derived oils, nuts, and seeds, whereas animal products (and some plant-derived oils) contribute a larger proportion of saturated fats [35,36]. Trans fats found in foods are predominantly the result of processing vegetable oils but are also present in small quantities in animal products (i.e., ruminant trans fats from cows, sheep, and goats) [35,36]. Among the types of dietary fats, unsaturated fats are associated with reduced cardiovascular and mortality risks, whereas trans fats and, to a lesser degree, saturated fats are associated with negative impacts on health, including increased mortality risk [36,37]. Two families of polyunsaturated fatty acids, omega-3 and omega-6, are described as essential fatty acids, because they are required for normal growth and reproduction but are not produced by the body and, therefore, must be obtained from dietary sources [10]. Omega-3 fatty acids, in particular, eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA), have been widely studied for their potential health benefits, with evidence suggesting positive effects including cardioprotection, preventing cognitive decline, reducing inflammation, sustaining muscle mass, and improving systemic insulin resistance [38,39,40]. Seafood, especially oily fish, provides EPA and DHA, and supplements are widely available for those not meeting recommended intakes with diet alone [41,42].

Micronutrients

Although required in trace amounts compared with macronutrients, micronutrients are necessary for normal growth, metabolism, physiologic functioning, and cellular integrity [12,13]. The shift from whole foods to processed, refined foods has reduced the micronutrient quality of the modern Western diet [44]. Vitamin and mineral inadequacies have been implicated in cellular aging and late-onset disease, as scarcity drives chronic metabolic disruption.

The Mediterranean Diet

The Mediterranean diet is based on components of the traditional dietary patterns of Euro-Mediterranean countries and encompasses not only the types of foods consumed and their relative contributions to daily nutrient intake, but also an approach to eating that is cognizant of how foods are sourced (e.g., sustainability and eco-friendliness), cooked, and eaten, as well as lifestyle considerations such as engaging in regular physical activity, getting adequate rest, and participating in fellowship when preparing and sharing meals [7].

Within the core framework of the Mediterranean diet, variations based on geography and culture are reflected in the emphasis on the inclusion of traditional and local food products. The primary basis of daily meals in the Mediterranean diet is cereals such as whole-grain bread, pastas, couscous, and other unrefined grains that are rich in fiber and a variety of fruits and vegetables of different colors and textures that are high in micronutrients, fiber, and phytochemicals (Table 1) [7,9,49,50,51,52]. Dairy products, preferably low-fat yogurt, cheese, or other fermented dairy products, are recommended daily in moderation as a source of calcium, which is needed for bone and heart health. Olive oil serves as the primary source of dietary lipids and is supplemented with olives, nuts, and seeds. Water (1.5-2.0 L/day or ~8 glasses) is recommended as the main source of hydration, whereas wine and other fermented alcoholic beverages are generally permitted in moderation, to be consumed with meals. Fish, white meat, and eggs are the primary sources of protein; red meat and processed meats are consumed less frequently and in smaller portions.

The health benefits of the Mediterranean diet were first described in 1975 by Ancel Keys, who observed a reduction in cardiovascular disease risk among populations whose nutritional model was consistent with practices of peoples from the Mediterranean Basin [53]. Since that time, research has revealed beneficial effects of the Mediterranean diet on a number of NCDs and related health measures, including cardiovascular and cerebrovascular disease [54], cancer [55], glycemic control [56], and cognitive function [57,58]. Substudies of PREDIMED have also shown that, compared with a low-fat control diet, the Mediterranean diet supplemented with olive oil or nuts is associated with a 30% reduced risk of major cardiovascular risk events [59] and reductions in systolic blood pressure (SBP) and diastolic blood pressure (DBP) of 5.8-7.3 mmHg and 3.3-3.4 mmHg, respectively [60]. In addition, cardiovascular factors such as mean internal carotid artery intima-media thickness (−0.084 mm; p < 0.05) and maximum plaque height (−0.091 mm; p < 0.05) are improved with the Mediterranean diet supplemented with nuts [61]. Greater intake of polyphenols (phytochemicals found in fruits, vegetables, tea, olive oil, and wine) correlated with a 36% reduced risk of hypertension (p = 0.015) [62] and improvements in inflammatory biomarkers related to atherosclerosis (i.e., interleukin [IL]-6, tumor necrosis factor-alpha, soluble intercellular adhesion molecule-1, vascular cell adhesion molecule-1, and monocyte chemotactic protein-1; p < 0.05 for each), as well as in high-density lipoprotein cholesterol (HDL-C; p = 0.004) [62,63].

The DASH Diet

The DASH diet derives its name from the Dietary Approaches to Stop Hypertension study, which evaluated the influence of dietary patterns on blood pressure [8]. Patients who consumed a diet that was rich in fruits, vegetables, and low-fat dairy and that included a reduced amount of saturated and total fat and cholesterol experienced significantly greater reductions in blood pressure than patients who consumed a control diet that was similar in composition to a typical American diet (difference in SBP/DBP, −5.5/−3.0 mmHg; p < 0.001) or a diet rich in fruits and vegetables with a reduced amount of snacks and sweets (−2.7/−1.9 mmHg; p ≤ 0.002). All 3 diets had a sodium content of 3 g per day.

Strategies for Healthful Eating

• Emphasize Fruits, Vegetables, Whole Grains, Dairy, and Protein: These food groups are essential for a balanced diet.
• Increase Intake of Fiber, Calcium, Vitamin D, and Potassium: Many people in the United States need to consume more of these nutrients.
• Reduce Intake of Added Sugar, Saturated Fat, and Sodium: Limiting these can significantly improve health outcomes.
• Choose a Variety of Colors: A colorful plate typically indicates a wider range of nutrients.

Affordability of a Healthy Diet

The UN Food and Agriculture Organization estimates that in 2023 40% of the world population, 2.8 billion couldn't afford a healthy diet. Dietary patterns that lead to non-communicable diseases generate productivity losses. A true cost accounting (TCA) assessment on the hidden impacts of agrifood systems estimated that unhealthy dietary patterns generate more than USD 9 trillion in health-related hidden costs in 2020, which is 73 percent of the total quantified hidden costs of global agrifood systems (USD 12.7 trillion).

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