ad- equate diet is consumed. Added Sugars BASIS FOR RECOMMENDATIONS It has been shown the increasing intakes of added sugars can result in decreased intakes of certain micronutrients in United States subpopulations. This can oc- cur because of the abundance of added sugars in energy-dense, nutrient-poor foods in a diet. As such, it is suggested that adults and children consume no more than 25 percent of energy from added sugars to ensure sufficient con- sumption of essential micronutrients. Note that a daily intake of added sugars that individuals should aim for to achieve a healthy diet was not set. Foods containing added sugars and few micronutrients include soft drinks, fruit drinks, cakes, cookies, and candies. The impact of total sugar intake on the intake of micronutrients does not appear to be as great as for added sugars. Total sugars include both the added sugars and the naturally occurring sugars found in fruits, milk, and dairy products. Copyright © National Academy of Sciences. All rights reserved. Dietary Reference Intakes: The Essential Guide to Nutrient Requirements http://www.nap.edu/catalog/11537.html 76 DRIs: THE ESSENTIAL GUIDE TO NUTRIENT REQUIREMENTS TABLE 2 Relationship of Macronutrients and Physical Activity to Chronic Disease Energy Fat Protein Cancer \u2022 Animal studies \u2022 High fat intakes have \u2022 No clear role for total suggest that been implicated in protein has yet energy restriction development of certain emerged. may inhibit cell cancers, although proliferation and evidence is mixed. tumor growth. \u2022 Epidemiological studies \u2022 Increased childhood have shown an inverse energy intakes have relationship between fish been associated with consumption and risk of increased cancer breast and colorectal mortality. cancer, possibly due \u2022 Excess energy to protective effects of contributes to n-3 fatty acids. obesity, which may increase risk of certain cancers. Heart Disease \u2022 Excess energy \u2022 Increased saturated fat \u2022 Independent effects contributes to intake can increase total of protein on heart obesity, which and LDL blood disease mortality increases risk of cholesterol levels. have not been shown. heart disease. \u2022 Increasing intakes of \u2022 Soy-based protein trans fatty acids and may reduce blood cholesterol increase total cholesterol, but the and LDL blood cholesterol evidence is mixed. levels, although there is wide interindividual variation in serum cholesterol response to dietary cholesterol. \u2022 Monounsaturated and polyunsaturated fatty acids decrease total and LDL blood cholesterol levels. \u2022 High intakes of n-6 and n-3 polyunsaturated fats are associated with decreased risk of heart disease. Copyright © National Academy of Sciences. All rights reserved. Dietary Reference Intakes: The Essential Guide to Nutrient Requirements http://www.nap.edu/catalog/11537.html MACRONUTRIENTS, HEALTHFUL DIETS, AND PHYSICAL ACTIVITY 77 Carbohydrate Fiber Physical Activity \u2022 Several case-control \u2022 High fiber diets may \u2022 Regular exercise has been studies have shown protect against colorectal negatively correlated with risk of increased risk of cancer, though the colon cancer. colorectal cancer in evidence is conflicting. \u2022 Numerous epidemiological studies people with high intakes \u2022 Fiber may protect suggest that regular physical of sugar-rich foods. against hormone-related activity decreases risk of breast \u2022 High vegetable and fruit cancers including cancer. intake and avoidance of prostate, endometrial, \u2022 Exercise may help compensate for foods with highly refined and ovarian cancer. potential cancer-promoting effects sugars have been \u2022 Certain cereal foods may of excess energy intake. negatively correlated to protect against some \u2022 Exercise may bolster the immune risk of colon cancer. types and stages of system. breast cancer. \u2022 High carbohydrate (low \u2022 Dietary fiber, particularly \u2022 Numerous studies have shown fat) intakes tend to naturally occurring an inverse relationship between increase plasma viscous fiber, reduces exercise and heart disease triacylglycerol and decrease total and LDL cholesterol mortality. plasma HDL cholesterol levels. \u2022 Regular exercise increases HDL levels. These effects are \u2022 Reduced rates of heart cholesterol; decreases more extreme if the source disease have been triacylglycerol, blood pressure, is monosaccharides, observed in individuals and risk of cardiac arrhythmias; especially fructose. consuming high fiber enhances fibrinolysis, glucose diets. effectiveness, and insulin \u2022 Dietary fiber intake has sensitivity; and lessens been shown to be platelet adherence. negatively associated with hypertension in men. continued Copyright © National Academy of Sciences. All rights reserved. Dietary Reference Intakes: The Essential Guide to Nutrient Requirements http://www.nap.edu/catalog/11537.html 78 DRIs: THE ESSENTIAL GUIDE TO NUTRIENT REQUIREMENTS Dental Caries Type II \u2022 Excess energy \u2022 Some studies show a Diabetes contributes to obesity, correlation between high Mellitus which may increase fat intakes and insulin risk of Type II diabetes. resistance, but it is not \u2022 Obesity, particularly clear whether the abdominal obesity, is association is due to fat a risk factor for Type or to obesity. II diabetes. Obesity \u2022 Excess energy intake \u2022 Available data on whether \u2022 Available data on causes obesity. diets high in total fat whether diets high in increase the risk for protein are associated obesity are conflicting; this with obesity are may be partly due to mixed: some have underreporting of food shown a positive intake, notably fat intake. association with protein intake and body fatness, others have demonstrated weight loss. Bone Health \u2022 The relationship between protein intake and bone health is very controversial with some studies showing bone loss and osteoporosis in relationship to high intakes and others showing no association in the presence of adequate calcium intakes. TABLE 2 Continued Energy Fat Protein Copyright © National Academy of Sciences. All rights reserved. Dietary Reference Intakes: The Essential Guide to Nutrient Requirements http://www.nap.edu/catalog/11537.html MACRONUTRIENTS, HEALTHFUL DIETS, AND PHYSICAL ACTIVITY 79 \u2022 Sugars play a role in development of dental caries (as do fluoride, oral hygiene and frequency of food intake). \u2022 While there is little evidence \u2022 Viscous soluble fibers \u2022 Increased physical activity levels that total carbohydrate is may attenuate the insulin improve insulin sensitivity in associated with Type II response and thus protect people with Type II diabetes. diabetes, there may be against Type II diabetes. \u2022 Physical activity can reduce increased risk when the risk of Type II diabetes and can glycemic index of a meal, reduce total and abdominal rather than total obesity, which are risk factors carbohydrate, is considered. for Type II diabetes. \u2022 Published reports have \u2022 Intervention studies \u2022 Physical inactivity is a produced conflicting suggest that high fiber major risk factor for results about the existence diets may assist in weight development of of a direct link between loss, although evidence obesity. high sugar intakes and overall is mixed. obesity; this may be partly due to underreporting of food intake. \u2022 Physical activity increases bone mass in children and adolescents and maintains bone mass in adults. \u2022 Physical activity enhances muscle strength, coordination, and flexibility, which may prevent falls and fractures in elderly adults. Carbohydrate Fiber Physical Activity Copyright © National Academy of Sciences. All rights reserved.