USA and Russia--East-West Nutrition: Dietary Guidelines and Issues
by Dr. Alex Pozhitsky

Nutrition is one of the most important factors influencing human health in both the United States and the Russian Federation. Balanced and adequate diet provides for normal growth and development of children, assists disease prevention, growing life expectancy and better working capacity, and creates conditions for people’s adequate adaptation to changing environment. In both countries an inappropriate, unhealthy diet involving either insufficient or excessive consumption of certain nutrients and trace elements, may be a cause of various diseases: heart disease, cancer, diabetes mellitus, obesity, anemia and other micronutrient deficiencies. Dietary guidlines are now available to assist people in both nations to lead a healthier life, but general public implementation of these guidlines is widely ignored.

The general health situation in Russia is characterised by a high rate of mortality from CVD and cancer. Animal fats and sugar dominate the diets of the population, while the consumption of vegetables and fruit is inadequate. Many regions are deficient in vitamins, minerals and trace elements (iodine and iron in particular). The prevalence of obesity is high, and an elevated serum blood cholesterol level is observed. A number of steps need to be taken to change the situation, so that the diets of the population can be healthier: providing for the growth, normal development and vital activities, promoting better health and preventing disease.

The general health situation in the United States, according to the CDC, is that Americans are slowly changing their eating patterns toward more healthful diets, but a considerable gap remains between public health recommendations and consumers' practices. About one-third of adults and one-fifth of adolescents in the United States are overweight. These results represent increases in the prevalence of overweight since the 1970's. Despite significant progress, 20 percent of Americans still have high serum cholesterol levels. Hypertension remains a major public health problem in middle-aged and elderly people. Non-Hispanic blacks have a higher age-adjusted prevalence of hypertension than non-Hispanic whites and Mexican Americans. Many Americans are not getting the calcium they need to maintain optimal bone health and prevent age-related bone loss, particularly adolescents, adult females, elderly people, and non-Hispanic black males. Less than one-third of American adults meet the recommendation to consume five or more servings of fruits and vegetables per day. While the availability of food, on a per capita basis, is generally adequate to prevent undernutrition and deficiency-related diseases, the data show Americans report not always getting enough to eat. Approximately 1 in 10 people living in low-income households or families experience some degree of food insufficiency. Chronic diseases accounted for 5 of the leading 6 causes of disease in 2002 in the United States. In addition, the prolonged illness and disability associated with many chronic diseases decrease the quality of life for millions of Americans. Much of the chronic disease burden is preventable. Physical inactivity and unhealthy eating contribute to obesity and a number of chronic diseases, including cancer, cardiovascular disease, and diabetes. Following dramatic increases in overweight and obesity among U.S. adults between 1976–1980 and 1999–2002, obesity has reached epidemic proportions—30% of adults are obese. Moreover, the epidemic is not limited to adults. The percentage of young people who are overweight has more than doubled in the last 20 years. Among children and adolescents aged 6–19 years, 16% are considered overweight. People who are obese are at increased risk for heart disease, high blood pressure, diabetes, arthritis-related disabilities, and some cancers. The estimated annual cost of obesity in the United States in 2000 was about $117 billion. Promoting regular physical activity and healthy eating and creating an environment that supports these behaviors are essential to reducing this epidemic of obesity.

Both the United States and the Russian Federation now have dietary guidlines.

USDA Dietary Guidelines for Americans 2005:
Key Recommendations for the General Population

ADEQUATE NUTRIENTS WITHIN CALORIE NEEDS
Consume a variety of nutrient-dense foods and beverages within and among the basic food groups while choosing foods that limit the intake of saturated and trans fats, cholesterol, added sugars, salt, and alcohol. Meet recommended intakes within energy needs by adopting a balanced eating pattern, such as the U.S. Department of Agriculture (USDA) Food Guide or the Dietary Approaches to Stop Hypertension (DASH) Eating Plan.

WEIGHT MANAGEMENT
To maintain body weight in a healthy range, balance calories from foods and beverages with calories expended. To prevent gradual weight gain over time, make small decreases in food and beverage calories and increase physical activity.

PHYSICAL ACTIVITY
Engage in regular physical activity and reduce sedentary activities to promote health, psychological well-being, and a healthy body weight. To reduce the risk of chronic disease in adulthood: Engage in at least 30 minutes of moderate-intensity physical activity, above usual activity, at work or home on most days of the week. For most people, greater health benefits can be obtained by engaging in physical activity of more vigorous intensity or longer duration. To help manage body weight and prevent gradual, unhealthy body weight gain in adulthood: Engage in approximately 60 minutes of moderate- to vigorous-intensity activity on most days of the week while not exceeding caloric intake requirements. To sustain weight loss in adulthood: Participate in at least 60 to 90 minutes of daily moderate-intensity physical activity while not exceeding caloric intake requirements. Some people may need to consult with a healthcare provider before participating in this level of activity. Achieve physical fitness by including cardiovascular conditioning, stretching exercises for flexibility, and resistance exercises or calisthenics for muscle strength and endurance.

FOOD GROUPS TO ENCOURAGE
Consume a sufficient amount of fruits and vegetables while staying within energy needs. Two cups of fruit and 2½ cups of vegetables per day are recommended for a reference 2,000-calorie intake, with higher or lower amounts depending on the calorie level. Choose a variety of fruits and vegetables each day. In particular, select from all five vegetable subgroups (dark green, orange, legumes, starchy vegetables, and other vegetables) several times a week. Consume 3 or more ounce-equivalents of whole-grain products per day, with the rest of the recommended grains coming from enriched or whole-grain products. In general, at least half the grains should come from whole grains. Consume 3 cups per day of fat-free or low-fat milk or equivalent milk products.

FATS
Consume less than 10 percent of calories from saturated fatty acids and less than 300 mg/day of cholesterol, and keep trans fatty acid consumption as low as possible. Keep total fat intake between 20 to 35 percent of calories, with most fats coming from sources of polyunsaturated and monounsaturated fatty acids, such as fish, nuts, and vegetable oils. When selecting and preparing meat, poultry, dry beans, and milk or milk products, make choices that are lean, low-fat, or fat-free. Limit intake of fats and oils high in saturated and/or trans fatty acids, and choose products low in such fats and oils.

CARBOHYDRATES
Choose fiber-rich fruits, vegetables, and whole grains often. Choose and prepare foods and beverages with little added sugars or caloric sweeteners, such as amounts suggested by the USDA Food Guide and the DASH Eating Plan. Reduce the incidence of dental caries by practicing good oral hygiene and consuming sugar- and starch-containing foods and beverages less frequently.

SODIUM AND POTASSIUM
Consume less than 2,300 mg (approximately 1 teaspoon of salt) of sodium per day. Choose and prepare foods with little salt. At the same time, consume potassium-rich foods, such as fruits and vegetables.

ALCOHOLIC BEVERAGES
Those who choose to drink alcoholic beverages should do so sensibly and in moderation—defined as the consumption of up to one drink per day for women and up to two drinks per day for men. Alcoholic beverages should not be consumed by some individuals, including those who cannot restrict their alcohol intake, women of childbearing age who may become pregnant, pregnant and lactating women, children and adolescents, individuals taking medications that can interact with alcohol, and those with specific medical conditions. Alcoholic beverages should be avoided by individuals engaging in activities that require attention, skill, or coordination, such as driving or operating machinery.

FOOD SAFETY
To avoid microbial foodborne illness: Clean hands, food contact surfaces, and fruits and vegetables. Meat and poultry should not be washed or rinsed. Separate raw, cooked, and ready-to-eat foods while shopping, preparing, or storing foods. Cook foods to a safe temperature to kill microorganisms. Chill (refrigerate) perishable food promptly and defrost foods properly. Avoid raw (unpasteurized) milk or any products made from unpasteurized milk, raw or partially cooked eggs or foods containing raw eggs, raw or undercooked meat and poultry, unpasteurized juices, and raw sprouts.
Note: The Dietary Guidelines for Americans 2005 contains additional recommendations for specific populations. The full document is available at www.healthierus.gov/dietaryguidelines.

Dietary Guidelines Russian Federation:

Twelve Steps to Healthy Eating
1. Eat a variety of foods, most of which should be vegetable, rather than animal products.
2. Bread, bakery foods, cereals, potatoes should be eaten several times a day.
3. Eat a variety of fruit and vegetables, preferably fresh and locally grown, several times a day (at least 400 g per day).
4. A moderate daily physical activity is needed to maintain the body mass within the recommended range (a body-mass index of 20 to 25).
5. Control your dietary fat intake (it should provide not more than 30% of total daily dietary energy) and substitute fat of vegetable oils for animal fat.
6. Replace fat meat and meat products with pulses, cereals, fish, poultry, or lean meat.
7. Eat low-fat milk and milk p roducts with a low fat and salt content, such as kefir, sour milk, yoghurt and cheese.
8. Select low-sugar foods and make your sugar intake moderate, limiting the amount of sweets and sweet drinks.
9. Eat less salt. The total content of salt in the diet, including the salt in bread, processed, cooked or preserved food, should not exceed one tea-spoonful, or 6 grammes, per day. Iodi sed salt should be consumed
10. If you drink alcoholic beverages, the total amount of pure alcohol in them should not exceed 20 grammes per day.
11. Cooking should ensure safety of food. Steaming, microwaving, baking or boiling will help reduce the amounts of fat, butter, salt and sugar used in the process of cooking.
12. Promote exclusive breastfeeding for 6 months. Complementary food should be introduced gradually, without stopping breastfeeding.

Russian Health Issues

In the recent decade, Russia has been facing a steady deterioration of public health indicator. Life expectancy continues to decline. In 1996, it was 57 for men and 72 for women. Total morbidity incidence has a tendency to grow. Mortality incidence per 100,000 people rose from 11.2 in 1990 to 15.0 in 1996. Cardiovascular diseases and cancer, which to a certain extent may be associated with nutrition, top the list of morbidity and death causes in Russia. The majority of Russia’s population suffer from inadequate nutrition due to both deficiency of vitamins, macro- and micronutrients (calcium, iodine, iron, fluorine, selenium, etc.), proteins, and well as unbalanced proportion of the above. Breast feeding period has been decreasing, and children’s health and their anthropometric status has also deteriorated. Malnutrition in low-income families is a serious issue of concern. Inadequate nutrition in Russia is triggered by crisis-stricken food production and food processing, as well as considerable reduction of the quality of life, which is true for the majority of Russians. One of the most acute problems is quality of foods and food raw materials. People in Russia are generally not aware of aspects of healthy and balanced diets. Healthy nutrition issues in Russia are not regulated by any comprehensive government policy.In general, the produce sold in Russia is better than what you can buy in multi-million dollar supermarkets in the United States. What is grown by individuals is almost always free from pesticides/insecticides, as individuals don't have the money to buy such chemicals. However, even that which is grown on farms in Russia, as well as some imports is better tasting. Some of the imports come from the CIS states, which, in turn, are also free of chemicals, or less is used (at least that is how they taste). For example, the tomatoes are juicy and sweet; the apples are sweet or sour, depending on the variety; other produce seem to have their full flavor. Even in the winter, where all produce are imported, the tomatoes, for example, are much better tasting and have their natural softness, as compared to what you can buy in the U.S., which are green-house, chemically grown and genetically altered.

The general food availability in Russia has improved with the fall of the Soviet Union. Now, fresh fruits and vegetables are available all year long. There are more places to buy such food, and gone are the long lines. As mentioned earlier, in general, the fresh produce is better than in the United States. This is due in part, that a large percentage is supplied by individuals selling what they grow on their dachas, as well as those who have small farms. The one advantage of being poor is, that you don't have the money to buy the pesticides, herbicides and genetically altered food that is used in the West. Also, with many of the countries that food is imported from, they use less chemicals and hybrid seeds. This, of course, affects not only the taste, but the health of the consumers. So, this is definitely one plus for Russia. www.ion.ru/concept_en.htm
www.chetday.com/russia.html
www.health.gov/dietaryguidelines/dga2005/recommendations.htm www.euro.who.int/nutrition/Policy/Barents