research paper on food pyramid

December 1, 2006

18 min read

Rebuilding the Food Pyramid

Dietary guides introduced in 1992 and 2005 have led people astray. Some fats are healthy for the heart, and many carbohydrates clearly are not

By Meir J. Stampfer & Walter C. Willett

In 2005 the U.S. Department of Agriculture officially released its newest Food Guide Pyramid, which was intended to help the American public make dietary choices that would maintain good health and reduce the risk of chronic disease.

The new pyramid attempts to provide individualized advice based on a person's age, gender and level of physical activity. It focuses on the consumption of grains, meat and beans, milk, vegetables, fruit, and oils.

The 2005 pyramid replaced a 1992 USDA pyramid that differed from it in several respects. The new pyramid provides more emphasis on whole grains and physical activity. It does not, however, solve all the problems associated with its predecessor, because it still places too much emphasis on grains and milk and does not sufficiently emphasize the adverse effects of some types of fat. Unlike the old pyramid's graphic representation, which showed the proportions of various foods that should be consumed as stacked layers of different sizes, the 2005 pyramid conveys no information about nutrition; it simply shows a figure ascending a rainbow-colored staircase [ see box on page 17 ].

On supporting science journalism

If you're enjoying this article, consider supporting our award-winning journalism by subscribing . By purchasing a subscription you are helping to ensure the future of impactful stories about the discoveries and ideas shaping our world today.

We have drawn up a revised pyramid that better reflects the current evidence regarding the relation between diet and health. Studies indicate that adherence to the recommendations in our revised pyramid can significantly reduce the risk of cardiovascular disease for both men and women.

The Old Food Pyramid THE USE OF IMAGES to promote dietary advice goes back nearly a century in the U.S. The recommendations embodied in the 1992 pyramid were widely adopted, and the image became an icon. The basic advice was that people should minimize their consumption of fats and oils but should eat six to 11 servings a day of foods rich in complex carbohydrates--bread, cereal, rice, pasta and so on. The food pyramid also recommended generous amounts of vegetables (including potatoes, another plentiful source of complex carbohydrates), fruit and dairy products, and at least two servings a day from the meat and beans group, which lumped together red meat with poultry, fish, nuts, legumes and eggs.

Even when the pyramid was being developed, though, nutritionists had long known that some types of fat are essential to health and can reduce the risk of cardiovascular disease. Furthermore, scientists had found little evidence that a high intake of carbohydrates is beneficial. After 1992 more and more research showed that the USDA pyramid was grossly flawed. By promoting the consumption of all complex carbohydrates and eschewing all fats and oils, the pyramid provided misleading guidance. In short, not all fats are bad for you, and by no means are all complex carbohydrates good for you.

How did the original USDA pyramid go so wrong? In part, nutritionists fell victim to a desire to simplify their dietary recommendations. Researchers had known for decades that saturated fat--found in abundance in red meat and dairy products--raises cholesterol levels in the blood. High cholesterol levels, in turn, are associated with a high risk of coronary heart disease (heart attacks and other ailments caused by the blockage of the arteries to the heart). In the 1960s controlled feeding studies, in which the participants ate carefully prescribed diets for several weeks, substantiated that saturated fat increases cholesterol levels. But the studies also showed that polyunsaturated fat--found in vegetable oils and fish--reduces cholesterol. Thus, dietary advice during the 1960s and 1970s emphasized the replacement of saturated fat with polyunsaturated fat, not total fat reduction.

The notion that fat in general is to be avoided stems mainly from observations that affluent Western countries have both high intakes of fat and high rates of coronary heart disease. This correlation, however, is limited to saturated fat. Societies in which people eat relatively large portions of monounsaturated and polyunsaturated fat tend to have lower rates of heart disease [ see box on page 21 ].

On the Greek island of Crete, for example, the traditional diet contained much olive oil (a rich source of monounsaturated fat) and fish (a source of polyunsaturated fat). Although fat constituted 40 percent of the calories in this diet, the rate of heart disease for those who followed it was lower than the rate for those who followed the traditional diet of Japan, in which fat made up only 8 to 10 percent of the calories. Furthermore, international comparisons can be misleading: many negative influences on health, such as smoking, physical inactivity and high amounts of body fat, are also correlated with Western affluence.

Unfortunately, many nutritionists decided it would be too difficult to educate the public about these subtleties. Instead they put out a clear, simple message: "Fat is bad." Because saturated fat represents about 40 percent of all fat consumed in the U.S., the rationale of the USDA was that advocating a low-fat diet would naturally reduce the intake of saturated fat. This recommendation was soon reinforced by the food industry, which began selling cookies, chips and other products that were low in fat but often high in sweeteners such as sucrose and high-fructose corn syrup.

When the original food pyramid was being developed, the typical American got about 40 percent of his or her calories from fat, about 15 percent from protein and about 45 percent from carbohydrates. Nutritionists did not want to suggest eating more protein, because many sources of protein (red meat, for example) are also heavy in saturated fat. So the "Fat is bad" mantra led to the corollary "Carbs are good." Dietary guidelines from the American Heart Association and other groups recommended that people get at least half their calories from carbohydrates and no more than 30 percent from fat. This 30 percent limit has become so entrenched among nutritionists that even the sophisticated observer could be forgiven for thinking that many studies must show that individuals with that level of fat intake enjoy better health than those with higher levels. But no study has demonstrated long-term health benefits that can be directly attributed to a low-fat diet. The 30 percent limit on fat was essentially drawn from thin air.

The wisdom of this direction became even more questionable after researchers found that the two main cholesterol-carrying chemicals--low-density lipoprotein (LDL), popularly known as bad cholesterol, and high-density lipoprotein (HDL), known as good cholesterol--have very different effects on the risk of coronary heart disease. Increasing the ratio of LDL to HDL in the blood raises the risk, whereas decreasing the ratio lowers it. By the early 1990s controlled feeding studies had shown that when a person replaces calories from saturated fat with an equal amount of calories from carbohydrates the levels of LDL and total cholesterol fall, but the level of HDL also falls. Because the ratio of LDL to HDL does not change, there is only a small reduction in the person's risk of heart disease. Moreover, the switch to carbohydrates boosts the blood levels of triglycerides, the component molecules of fat, probably because of effects on the body's endocrine system. High triglyceride levels are also associated with a high risk of heart disease.

The effects are more grievous when a person switches from either monounsaturated or polyunsaturated fat to carbohydrates. LDL levels rise and HDL levels drop, making the cholesterol ratio worse. In contrast, replacing saturated fat with either monounsaturated or polyunsaturated fat improves this ratio and would be expected to reduce heart disease. The only fats that are significantly more deleterious than carbohydrates are the trans-unsaturated fatty acids; these are produced by the partial hydrogenation of liquid vegetable oil, which causes it to solidify. Found in many margarines, baked goods and fried foods, trans fats are uniquely bad for you because they raise LDL and triglycerides while reducing HDL.

The New Food Pyramid THE 2005 PYRAMID provided a unique opportunity to draw on more than a dozen years of advances in nutritional science. Although the new pyramid improved on the 1992 version in several ways, overall it was a major disappointment to many nutrition experts. A big change is that the basic image no longer conveys any information about diet--the figure climbing the pyramid promotes physical activity, but to get any dietary advice, one must visit the Web site www.mypyramid.gov and make selections for age, gender and current level of physical activity. Thus, a marvelous opportunity to provide succinct dietary advice to consumers was squandered, and the impact of the new pyramid on diet most likely will be modest compared with what it might have been.

The dietary advice that accompanies the pyramid, for those who navigate the Web site, represents some clear improvements over the 1992 version. Whole grains are emphasized more; the distinction between types of fats is clearer; and healthier choices for protein sources are emphasized. But these are only incremental changes and do not fully reflect the best dietary advice available today.

The Big Picture TO EVALUATE FULLY the health effects of diet, one must look beyond cholesterol ratios and triglyceride levels. The foods we eat can cause heart disease through many other pathways, including raising blood pressure or boosting the tendency of blood to clot. And other foods can prevent heart disease in surprising ways; for instance, omega-3 fatty acids (found in fish and some plant oils) can reduce the likelihood of ventricular fibrillation, a heart rhythm disturbance that causes sudden death.

The ideal method for assessing all these adverse and beneficial effects would be to conduct large-scale trials in which individuals are randomly assigned to one diet or another and followed for many years. Because of practical constraints and cost, few such studies have been conducted, and most of these have focused on patients who already suffer from heart disease. Though limited, these studies have supported the benefits of replacing saturated fat with polyunsaturated fat, but not with carbohydrates. In the most expensive study ever conducted--the Women's Health Initiative--nearly 50,000 women were randomly assigned to either a low-fat diet or their usual diet. The results, reported in early 2006 after approximately eight years, showed no difference in health between the two groups.

The best alternative is to conduct large epidemiological studies in which the diets of many people are periodically assessed and the participants are monitored for the development of heart disease and other conditions. One of the best-known examples of this research is the Nurses' Health Study, which was begun in 1976 to evaluate the effects of oral contraceptives but was soon extended to nutrition as well. Our group at Harvard University has followed nearly 90,000 women in this study who first completed detailed questionnaires on diet in 1980, as well as more than 50,000 men who were enrolled in the Health Professionals Follow-Up Study in 1986.

After adjusting the analysis to account for smoking, physical activity and other recognized risk factors, we found that a participant's risk of heart disease was strongly influenced by the type of dietary fat consumed. Eating trans fat increased the risk substantially, and eating saturated fat increased it slightly. In contrast, eating monounsaturated and polyunsaturated fats decreased the risk--just as the controlled feeding studies predicted. Because these two effects counterbalanced each other, higher overall consumption of fat did not lead to higher rates of coronary heart disease. This finding reinforced a 1989 report by the National Academy of Sciences that concluded that the type of fat, but not the percentage of calories from total fat, is an important factor in the development of heart disease risk.

But what about illnesses besides coronary heart disease? High rates of breast, colon and prostate cancers in affluent Western countries have led to the belief that the consumption of fat, particularly animal fat, may be a risk factor. But large epidemiological studies have shown little evidence that total fat consumption or intakes of specific types of fat during midlife affect the risks of breast or colon cancer. Some studies have indicated that prostate cancer and the consumption of animal fat may be associated, but reassuringly there is no suggestion that vegetable oils increase any cancer risk. Indeed, some studies have suggested that vegetable oils may slightly reduce such risks.

Finally, one must consider the impact of fat consumption on obesity, the most serious nutritional problem in the U.S. Obesity is a major risk factor for several diseases, including type 2 diabetes (also called adult-onset diabetes), coronary heart disease, and cancers of the breast, colon, kidney and esophagus. Many nutritionists believe that eating fat can contribute to weight gain because fat contains more calories per gram than protein or carbohydrates. Also, the process of storing dietary fat in the body may be more efficient than the conversion of carbohydrates to body fat. But recent controlled feeding studies have shown that these considerations are not practically important. The best way to avoid obesity is to limit your total calories, not just the fat calories. So the critical issue is whether the fat composition of a diet can influence one's ability to control calorie intake. In other words, does eating fat leave you more or less hungry than eating protein or carbohydrates? There are various theories about why one diet should be better than another, but few long-term studies have been done. In randomized trials, individuals assigned to low-fat diets tend to lose a few pounds during the first months but then regain the weight. In studies lasting a year or longer, low-fat diets have consistently not led to greater weight loss.

The text accompanying the new pyramid provides some improvement over the 1992 version in recognizing that some fats (trans and saturated) are worse than others (poly and monounsaturated). Unfortunately, it treats trans and saturated fats the same way, even though trans fat from hydrogenated vegetable oils is at least twice as harmful, on a gram-for-gram basis. And unlike saturated fat, it can potentially be eliminated from the diet. Also, the new pyramid largely ignores the positive benefits of healthful oils.

Carbo-Loading NOW LET'S LOOK at the health effects of carbohydrates. Complex carbohydrates consist of long chains of sugar units such as glucose and fructose; sugars contain only one or two units. Because of concerns that sugars offer nothing but "empty calories"--that is, no vitamins, minerals or other nutrients--complex carbohydrates form the base of the USDA food pyramid. But refined carbohydrates, such as white bread and white rice, can be very quickly broken down to glucose, the primary fuel for the body. The refining process produces an easily absorbed form of starch--which is defined as glucose molecules bound together--and also removes many vitamins and minerals and fiber. Thus, these carbohydrates increase glucose levels in the blood more than whole grains do. (Whole grains have not been milled into fine flour.)

Or consider potatoes. Eating a boiled potato raises blood sugar levels higher than eating the same amount of calories from table sugar. Because potatoes are mostly starch, they can be rapidly metabolized to glucose. In contrast, table sugar (sucrose) is a disaccharide consisting of one molecule of glucose and one molecule of fructose. Fructose takes longer to convert to glucose, hence the slower rise in blood glucose levels.

A rapid increase in blood sugar stimulates a large release of insulin, the hormone that directs glucose to the muscles and liver. As a result, blood sugar plummets, sometimes even going below the baseline. High levels of glucose and insulin can have negative effects on cardiovascular health, raising triglycerides and lowering HDL (the good cholesterol). The precipitous decline in glucose can also lead to more hunger after a carbohydrate-rich meal and thus contribute to overeating and obesity.

In our epidemiological studies, we have found that a high intake of starch from refined grains and potatoes is associated with a high risk of type 2 diabetes and coronary heart disease. Conversely, a greater intake of fiber is related to a lower risk of these illnesses. Interestingly, though, the consumption of fiber did not lower the risk of colon cancer, as had been hypothesized earlier.

Overweight, inactive people can become resistant to insulin's effects and therefore require more of the hormone to regulate their blood sugar. Recent evidence indicates that the adverse metabolic response to carbohydrates is substantially worse among people who already have insulin resistance. This finding may account for the ability of peasant farmers in Asia and elsewhere, who are extremely lean and active, to consume large amounts of refined carbohydrates without experiencing diabetes or heart disease, whereas the same diet in a more sedentary population can have devastating effects.

The new pyramid appropriately provides more emphasis on whole grains, but it still implies that getting half of your grains as refined starch is desirable, whereas these carbohydrate sources should be used sparingly. Further, the new pyramid gives insufficient attention to added sugars and sugar soft drinks, which constitute about 8 percent of all calories consumed in the U.S.--more than any other food item.

Eat Your Veggies HIGH INTAKE OF FRUITS and vegetables is perhaps the least controversial aspect of the 1992 food pyramid, and the 2005 pyramid gives them even greater emphasis than before.A reduction in cancer risk has been a widely promoted benefit. But most of the evidence for this benefit has come from case-control studies, in which patients with cancer and selected control subjects are asked about their earlier diets. These retrospective studies are susceptible to numerous biases, and recent findings from large prospective studies (including our own) have tended to show little relation between overall fruit and vegetable consumption and cancer incidence. (Specific nutrients in fruits and vegetables may offer benefits, though; for instance, the folic acid in green leafy vegetables may reduce the risk of colon cancer, and the lycopene found in tomatoes may lower the risk of prostate cancer.)

The real value of eating fruits and vegetables may be in reducing the risk of cardiovascular disease. Folic acid and potassium appear to contribute to this effect, which has been seen in several epidemiological studies. Inadequate consumption of folic acid is responsible for higher risks of serious birth defects as well, and low intake of lutein, a pigment in green leafy vegetables, has been associated with greater risks of cataracts and degeneration of the retina. Fruits and vegetables are also the primary source of many vitamins needed for good health. Thus, there are good reasons to consume the recommended five servings a day, even if doing so has little impact on cancer risk. The inclusion of potatoes as a vegetable in the USDA pyramid has little justification, however; being mainly starch, potatoes do not confer the benefits seen for other vegetables.

Another flaw in both the old and new versions of the USDA pyramid is its failure to recognize the important health differences between red meat (beef, pork and lamb) and the other foods in the meat and beans group (poultry, fish, legumes, nuts and eggs). High consumption of red meat has been associated with an increased risk of coronary heart disease, probably because of its high content of saturated fat and cholesterol. Red meat also raises the risk of type 2 diabetes and colon cancer. The elevated risk of colon cancer may be related in part to the carcinogens produced during cooking and the chemicals found in processed meats such as salami and bologna.

Poultry and fish, in contrast, contain less saturated fat and more unsaturated fat than red meat does. Fish is a rich source of the essential omega-3 fatty acids as well. Not surprisingly, studies have shown that people who replace red meat with chicken and fish have a lower risk of coronary heart disease and colon cancer. Eggs are high in cholesterol, but consumption of up to one a day does not appear to have adverse effects on heart disease risk (except among diabetics), probably because the effects of a slightly higher cholesterol level are counterbalanced by other nutritional benefits.

Many people have avoided nuts because of their high fat content, but the fat in nuts, including peanuts, is mainly unsaturated, and walnuts in particular are a good source of omega-3 fatty acids. Controlled feeding studies show that nuts improve blood cholesterol ratios, and epidemiological studies indicate that they lower the risk of heart disease and diabetes. Also, people who eat nuts are actually less likely to be obese; perhaps because nuts are more satisfying to the appetite, eating them seems to have the effect of significantly reducing the intake of other foods.

Yet another concern regarding both versions of the USDA pyramid is that they promote overconsumption of dairy products, recommending the equivalent of three glasses of milk a day for most individuals. This advice is usually justified by dairy's calcium content, which is believed to prevent osteoporosis and bone fractures. But the highest rates of fractures are found in countries with high dairy consumption, and large prospective studies have not shown a lower risk of fractures among those who eat plenty of dairy products. Calcium is an essential nutrient, but the requirements for bone health have probably been overstated. What is more, we cannot assume that high dairy consumption is safe: in several studies, men who consumed large amounts of dairy products experienced an increased risk of prostate cancer, and in some studies, women with high intakes had elevated rates of ovarian cancer. Although fat was initially assumed to be the responsible factor, this has not been supported in more detailed analyses. High calcium intake itself seemed most clearly related to the risk of prostate cancer.

More research is needed to determine the health effects of dairy products, but at the moment it seems imprudent to recommend high consumption. Most adults who are following a good overall diet can get the necessary amount of calcium by consuming the equivalent of one glass of milk a day. Under certain circumstances, such as after menopause, women may need more calcium, but it can be obtained at lower cost and without saturated fat or calories by taking a supplement.

A Healthier Pyramid ALTHOUGH THE USDA'S food pyramid has become an icon of nutrition over the past decade, until recently no studies had evaluated the health of individuals who followed its guidelines. It very likely has some benefits, especially from a high intake of fruits and vegetables. And a decrease in total fat intake would tend to reduce the consumption of harmful saturated and trans fats. But the pyramid could also lead people to eat fewer of the healthy unsaturated fats and more starches, so the benefits might be negated by the harm.

To evaluate the overall impact, we used the Healthy Eating Index (HEI), a score developed by the USDA to measure adherence to the 1992 pyramid and its accompanying dietary guidelines in federal nutrition programs. From the data collected in our large epidemiological studies, we calculated each participant's HEI score and then examined the relation of these scores to subsequent risk of major chronic disease (defined as heart attack, stroke, cancer or nontraumatic death from any cause). When we compared people in the same age groups, women and men with the highest HEI scores did have a lower risk of major chronic disease. But these individuals also smoked less, exercised more and had generally healthier lifestyles than the other participants. After adjusting for these variables, we found that participants with the highest HEI scores did not experience significantly better overall health outcomes. As predicted, the 1992 pyramid's harms counterbalanced its benefits. The new pyramid has yet to be evaluated in this manner, but because its basic advice is similar to that given by the earlier pyramid, the effect on health outcomes will probably be similar as well.

The best feature of the new pyramid is its clear emphasis on physical activity. This is laudable but does not help people choose what to eat. The new pyramid provides "customized" dietary advice based on sex and age but regardless of body size--so a six-foot-six-inch-tall, 330-pound man gets the same advice as a 5-foot-3-inch-tall man weighing 120 pounds.

Because the goal of the USDA pyramids was a worthy one--to encourage healthy dietary choices--we have tried to develop an alternative derived from the best available knowledge. Our revised pyramid [ see box on page 18 ] emphasizes weight control through exercising daily and avoiding an excessive total intake of calories. This pyramid recommends that the bulk of one's diet should consist of healthy fats (liquid vegetable oils such as olive, canola, soy, corn, sunflower and peanut) and healthy carbohydrates (whole grain foods such as whole wheat bread, oatmeal and brown rice).

If both the fats and carbohydrates in your diet are healthy, you probably do not have to worry too much about the percentages of total calories coming from each. Fruits and vegetables should also be eaten in abundance. Moderate amounts of healthy sources of protein (nuts, legumes, fish, poultry and eggs) are encouraged, but dairy consumption should be limited to one to two servings a day. The revised pyramid recommends minimizing the consumption of red meat, butter, refined grains (including white bread, white rice and white pasta), potatoes and sugar.

Trans fat does not appear at all in the pyramid, because it has no place in a healthy diet. A multiple vitamin is suggested for most people, and moderate alcohol consumption can be a worthwhile option (if not contraindicated by specific health conditions or medications). This last recommendation comes with a caveat: drinking no alcohol is clearly better than drinking too much. But more and more studies are showing the benefits of moderate alcohol consumption (in any form: wine, beer or spirits) to the cardiovascular system.

Can we show that our pyramid is healthier than the USDA's? We devised a new Healthy Eating Index that measured how closely a person's diet followed our recommendations. Applying this revised index to our epidemiological studies, we found that men and women who were eating in accordance with the new pyramid had a lower risk of major chronic disease [ see box on opposite page ]. This benefit resulted almost entirely from significant reductions in the risk of cardiovascular disease--up to 30 percent for women and 40 percent for men. Following the new pyramid's guidelines did not, however, lower the risk of cancer. Weight control and physical activity, rather than specific food choices, are associated with a reduced risk of many cancers.

Of course, uncertainties still cloud our understanding of the relation between diet and health. More research is needed to examine the role of dairy products, the health effects of specific fruits and vegetables, the risks and benefits of vitamin supplements, and the long-term effects of diet during childhood and early adult life. The interaction of dietary factors with genetic predisposition should also be investigated, although its importance remains to be determined.

Another challenge will be to ensure that the information about nutrition given to the public is based strictly on scientific evidence. The USDA may not be the best government agency to develop objective nutritional guidelines, because it may be too closely linked to the agricultural industry. The food pyramid should be rebuilt in a setting that is well insulated from political and economic interests.

THE AUTHORS WALTER C. WILLETT and MEIR J. STAMPFER are professors of epidemiology and nutrition at the Harvard School of Public Health. Willett chairs the school's department of nutrition, and Stampfer heads the department of epidemiology. Willett and Stampfer are also professors of medicine at Harvard Medical School. Both of them practice what they preach by eating well and exercising regularly.

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings
• My Bibliography
• Collections
• Citation manager

Save citation to file

Email citation, add to collections.

• Create a new collection
• Add to an existing collection

Add to My Bibliography

Your saved search, create a file for external citation management software, your rss feed.

• Search in PubMed
• Search in NLM Catalog
• Add to Search

Working toward Healthy and Sustainable Diets: The "Double Pyramid Model" Developed by the Barilla Center for Food and Nutrition to Raise Awareness about the Environmental and Nutritional Impact of Foods

Affiliations.

• 1 Barilla G.e R. Fratelli S.p.A. , Parma , Italy.
• 2 Roma Tre University , Rome , Italy.
• 3 Life Cycle Engineering , Torino , Italy.
• 4 Sapienza - Università di Roma , Rome , Italy.
• PMID: 25988137
• PMCID: PMC4428432
• DOI: 10.3389/fnut.2015.00009

The Barilla Center for Food and Nutrition has produced an updated version of the traditional food pyramid based on the Mediterranean diet in order to assess the simultaneous impact that food has on human health and the environment. The Double Pyramid Model demonstrates how the foods recommended to be consumed most frequently are also those exerting less environmental impact, whereas the foods that should be consumed less frequently are those characterized by a higher environmental impact. The environmental impacts resulting from three different menus were compared. All menus were equally balanced and comparable in terms of nutrition, but they differed in relation to the presence of absence of animal flesh and animal products. The first dietary pattern (omnivorous) included both animal flesh and products; the second (lacto-ovo-vegetarian) included animal products (eggs and dairy) but no flesh; and the third (vegan) was solely plant-based. The results obtained suggest that a diet based on the principles of the Mediterranean diet, as suggested by the Double Pyramid, generates a lower environmental impact compared to diets that are heavily based on daily meat consumption.

Keywords: Mediterranean; carbon footprint; diet; ecological footprint; sustainability.

PubMed Disclaimer

Similar articles

• Application of dairy-free vegetarian and vegan USDA food pattern models for non-pregnant, non-lactating healthy adults. Hess JM, Comeau ME. Hess JM, et al. J Food Sci. 2022 Oct;87(10):4703-4713. doi: 10.1111/1750-3841.16314. Epub 2022 Sep 14. J Food Sci. 2022. PMID: 36102227 Free PMC article.
• Dietary Patterns and All-Cause Mortality: A Systematic Review [Internet]. Boushey C, Ard J, Bazzano L, Heymsfield S, Mayer-Davis E, Sabaté J, Snetselaar L, Van Horn L, Schneeman B, English LK, Bates M, Callahan E, Venkatramanan S, Butera G, Terry N, Obbagy J. Boushey C, et al. Alexandria (VA): USDA Nutrition Evidence Systematic Review; 2020 Jul. Alexandria (VA): USDA Nutrition Evidence Systematic Review; 2020 Jul. PMID: 35258870 Free Books & Documents. Review.
• Updating the Mediterranean Diet Pyramid towards Sustainability: Focus on Environmental Concerns. Serra-Majem L, Tomaino L, Dernini S, Berry EM, Lairon D, Ngo de la Cruz J, Bach-Faig A, Donini LM, Medina FX, Belahsen R, Piscopo S, Capone R, Aranceta-Bartrina J, La Vecchia C, Trichopoulou A. Serra-Majem L, et al. Int J Environ Res Public Health. 2020 Nov 25;17(23):8758. doi: 10.3390/ijerph17238758. Int J Environ Res Public Health. 2020. PMID: 33255721 Free PMC article.
• Evaluation of environmental performance of dietary patterns in the United States considering food nutrition and satiety. Chapa J, Farkas B, Bailey RL, Huang JY. Chapa J, et al. Sci Total Environ. 2020 Jun 20;722:137672. doi: 10.1016/j.scitotenv.2020.137672. Epub 2020 Mar 9. Sci Total Environ. 2020. PMID: 32192968
• Vegetarian Diets: Planetary Health and Its Alignment with Human Health. Fresán U, Sabaté J. Fresán U, et al. Adv Nutr. 2019 Nov 1;10(Suppl_4):S380-S388. doi: 10.1093/advances/nmz019. Adv Nutr. 2019. PMID: 31728487 Free PMC article. Review.
• Plant-Based Diets versus the Mediterranean Dietary Pattern and Their Socio-Demographic Determinants in the Spanish Population: Influence on Health and Lifestyle Habits. Sandri E, Sguanci M, Cantín Larumbe E, Cerdá Olmedo G, Werner LU, Piredda M, Mancin S. Sandri E, et al. Nutrients. 2024 Apr 25;16(9):1278. doi: 10.3390/nu16091278. Nutrients. 2024. PMID: 38732525 Free PMC article.
• What Is the Likely Impact of Alternative Proteins on Diet Quality, Health, and the Environment in Low- and Middle-Income Countries. Kapur M, Peña AN, Sreeram N, Bloem MW, Drewnowski A. Kapur M, et al. Curr Dev Nutr. 2024 Jan 2;8(Suppl 1):102064. doi: 10.1016/j.cdnut.2023.102064. eCollection 2024 Feb. Curr Dev Nutr. 2024. PMID: 38476726 Free PMC article.
• Assessing the Interlinkage between Biodiversity and Diet through the Mediterranean Diet Case. Mattas K, Raptou E, Alayidi A, Yener G, Baourakis G. Mattas K, et al. Adv Nutr. 2023 May;14(3):570-582. doi: 10.1016/j.advnut.2023.03.011. Epub 2023 Mar 28. Adv Nutr. 2023. PMID: 36997093 Free PMC article. Review.
• Environmental Impact of Two Plant-Based, Isocaloric and Isoproteic Diets: The Vegan Diet vs. the Mediterranean Diet. Filippin D, Sarni AR, Rizzo G, Baroni L. Filippin D, et al. Int J Environ Res Public Health. 2023 Feb 21;20(5):3797. doi: 10.3390/ijerph20053797. Int J Environ Res Public Health. 2023. PMID: 36900805 Free PMC article.
• Animal- and Plant-Based Protein Sources: A Scoping Review of Human Health Outcomes and Environmental Impact. Ferrari L, Panaite SA, Bertazzo A, Visioli F. Ferrari L, et al. Nutrients. 2022 Dec 1;14(23):5115. doi: 10.3390/nu14235115. Nutrients. 2022. PMID: 36501146 Free PMC article. Review.
• Bellarby J, Foereid B, Hastings A, Smith P. Cool Farming: Climate Impacts of Agriculture and Mitigation Potential. Amsterdam: Greenpeace; (2008).
• Stehfest E, Bouwman L, van Vuuren D, den Elzen M, Eickhout B, Kabat P. Climate benefits of changing diet. Clim Change (2009) 95:83–10210.1007/s10584-008-9534-6 - DOI
• Steinfeld H, Gerber P, Wassenaar T, Castel V, Rosales M, de Haan C. Livestock Long Shadow: Environmental Issues and Options. Rome: FAO; (2006).
• Garnett T. What is a Sustainable Healthy Diet? A Discussion Paper. Oxford: Food Climate Research Network; (2014).
• Tukker A, Goldbohm A, de Koning A, Verheijden M, Kleijn R, Wolf O, et al. Environmental impacts of changes to healthier diets in Europe. Ecol Econ (2011) 70:1776–8810.1016/j.ecolecon.2011.05.001 - DOI

Publication types

• Search in MeSH

Related information

Linkout - more resources, full text sources.

• Europe PubMed Central
• Frontiers Media SA
• PubMed Central

Other Literature Sources

• scite Smart Citations

• Citation Manager

NCBI Literature Resources

MeSH PMC Bookshelf Disclaimer

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

• View all journals
• Explore content
• About the journal
• Publish with us
• Sign up for alerts
• Correspondence
• Published: 17 February 2023

The Double Pyramid: bridging nutrition and sustainability recommendations with traditional ways of eating

• Katarzyna Dembska   ORCID: orcid.org/0000-0002-1827-7652 1 ,
• Marta Antonelli 1 ,
• Annalisa Giosuè 2 ,
• Ilaria Calabrese 2 ,
• Olga Vaccaro 3 &
• Gabriele Riccardi 2  

European Journal of Clinical Nutrition volume  77 ,  pages 841–842 ( 2023 ) Cite this article

388 Accesses

1 Citations

3 Altmetric

Metrics details

We have read with interest the article by Bonaccio et al. [ 1 ]. The authors underline how the UNESCO recognition of the Mediterranean Diet (MD) as a cultural heritage can be an invitation for each country to rediscover its own eating traditions and bind food choices to its territory, with notable advantages not only for people’s health but also for environmental preservation.

With less than ten years left to reach the Sustainable Development Goals [ 2 ], much still must be done to improve the way we produce and consume food and achieve global commitments making our food systems able to safeguard our health and the ecosystem by delivering affordable diets to everyone, everywhere and at all times [ 3 ]. In fact, unhealthy diets contribute to disability and death worldwide [ 4 , 5 ], and food systems account to up to 37% of anthropogenic GHG emissions and other environmental pressures [ 6 , 7 ].

This is a preview of subscription content, access via your institution

Access options

Subscribe to this journal

Receive 12 print issues and online access

251,40 € per year

only 20,95 € per issue

Buy this article

• Purchase on Springer Link
• Instant access to full article PDF

Prices may be subject to local taxes which are calculated during checkout

Data availability

Data described in the manuscript are available from the corresponding author on reasonable request.

Bonaccio M, Iacoviello L, Donati M, de Gaetano G. The tenth anniversary as a UNESCO world cultural heritage: an unmissable opportunity to get back to the cultural roots of the Mediterranean diet. Eur J Clin Nutr. 2021;76:179–83.

Article   PubMed   Google Scholar  

UN General Assembly. Transforming our world: the 2030 Agenda for Sustainable Development A/RES/70/1. 2015. https://www.refworld.org/docid/57b6e3e44.html .

FAO. How to Feed the World in 2050. 2019. http://www.fao.org/fileadmin/templates/wsfs/docs/expert_paper/How_to_Feed_the_World_in_2050.pdf .

Afshin A, Sur P, Fay K, Cornaby L, Ferrara G, Salama J, et al. Health effects of dietary risks in 195 countries, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2019;393:1958–72.

Article   Google Scholar  

Stanaway J, Afshin A, Gakidou E, Lim S, Abate D, Abate K, et al. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392:1923–94.

IPCC. Summary for Policymakers. In: Shukla PR, Skea J, Calvo Buendia E, Masson-Delmotte V, Pörtner H-O, Roberts DC, et al. editors. Climate Change and Land: an IPCC special report on climate change, desertification, land degradation, sustainable land management, food security, and greenhouse gas fluxes in terrestrial ecosystems. IPCC;2019. https://www.ipcc.ch/srccl/chapter/summary-for-policymakers/

Xu X, Sharma P, Shu S, Lin T, Ciais P, Tubiello F, et al. Global greenhouse gas emissions from animal-based foods are twice those of plant-based foods. Nat Food. 2021;2:724–32.

Article   CAS   PubMed   Google Scholar  

Barilla Foundation. Double Pyramid. 2022. https://www.fondazionebarilla.com/en/double-pyramid/ . 2022.

Riccardi G, Giosuè A, Calabrese I, Vaccaro O. Dietary recommendations for prevention of atherosclerosis. Cardiovasc Res. 2022;118:1188–204. https://doi.org/10.1093/cvr/cvab173 .

Nicholls J, Drewnowski A. Toward sociocultural indicators of sustainable healthy diets. Sustainability. 2021;13:7226.

FAO and WHO. Sustainable healthy diets – Guiding principles. Rome: FAO and WHO;2019.

Download references

GR is member of the Barilla Health and Well-being Advisory Board, of the Nutrition Foundation of Italy and of ‘Istituto Nutrizionale Carapelli’. The “Barilla Foundation” supported the Double Pyramid with a grant aimed at the development of an evidence-based reformulation of the Food Pyramid for the prevention of cardiovascular disease for the University of Naples Federico II. The funder had no role in the study design, collection, analysis, and interpretation of data. MA is a consultant of the Barilla Foundation.

Author information

Authors and affiliations.

Barilla Foundation, Via Madre Teresa di Calcutta, 3/a, Parma, Italy

Katarzyna Dembska & Marta Antonelli

Department of Clinical Medicine and Surgery, “Federico II” University of Naples, Via Sergio Pansini, 5, Naples, Italy

Annalisa Giosuè, Ilaria Calabrese & Gabriele Riccardi

Department of Pharmacy, “Federico II” University of Naples, Via Domenico Montesano, 49, Naples, Italy

Olga Vaccaro

You can also search for this author in PubMed   Google Scholar

Contributions

All authors contributed to acquiring data and interpreting results, drafted and revised the manuscript and approved the final version. All authors ensure any questions related to accuracy and integrity are appropriately investigated and resolved.

Corresponding author

Correspondence to Katarzyna Dembska .

Ethics declarations

Competing interests.

KD, MA, AG, IC, OV declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Cite this article.

Dembska, K., Antonelli, M., Giosuè, A. et al. The Double Pyramid: bridging nutrition and sustainability recommendations with traditional ways of eating. Eur J Clin Nutr 77 , 841–842 (2023). https://doi.org/10.1038/s41430-023-01278-8

Download citation

Received : 16 March 2022

Revised : 02 February 2023

Accepted : 07 February 2023

Published : 17 February 2023

Issue Date : August 2023

DOI : https://doi.org/10.1038/s41430-023-01278-8

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

Quick links

• Explore articles by subject
• Guide to authors
• Editorial policies

New healthy eating pyramid now freely downloadable from Harvard School of Public Health

For immediate release: May 13, 2008

Boston, MA — The Department of Nutrition at the Harvard School of Public Health (HSPH) has relaunched its popular website, The Nutrition Source ( www.thenutritionsource.org ), one of the most visited nutrition sites and an independent, trusted source of nutrition information on the web. One of the highlights of the new, improved site is a freely downloadable version of the  Healthy Eating Pyramid , built by Nutrition faculty at the School, which should appeal to educators and health professionals as well as institutions such as schools and hospitals.

Other new features of the site include a section of healthy  recipes  for home cooks from well-known chefs and cookbook authors, including Mollie Katzen, Ming Tsai and The Culinary Institute of America. The HSPH cafeteria, which features delicious healthy meals, also contributed. In addition, The Nutrition Source has a cleaner, more user-friendly design and the scientific references have been updated to reflect the latest research in the field.

The Nutrition Source site debuted in 2003 with the goal of providing an independent source of nutrition information based on the latest and best science. “We accept no advertising, so our site is free from any commercial influences,” said  Lilian Cheung , editorial director of The Nutrition Source and a lecturer in the Department of Nutrition. “We strive to inform the public with unbiased scientific information on healthy eating that can be incorporated into their daily lives.”

The Healthy Eating Pyramid is a practical guide to maintaining a healthy diet. At its foundation are daily exercise and weight control; as the Pyramid rises, it shows that one should eat more foods from the bottom part (whole grains, vegetables, fruits, healthy fats) than the top part (red meat, refined grains, sugary and salty snacks). An important feature of the Pyramid is that it focuses on the quality of foods, not the quantity-it doesn’t recommend specific serving sizes, which can vary from person to person. Rather, the Pyramid is meant to be an easy-to-understand, flexible guide to how one should eat.

Updates to the Pyramid include the addition of salt to the “Use Sparingly” section at the top. Also, the Pyramid now recommends at least 1,000 IUs of Vitamin D for most people.

To make The Nutrition Source more user-friendly, the site now gives readers quick summaries of each nutrition recommendation, so that they can get the “bottom line” on protein, fats, carbs, and other aspects of healthy eating. Each recommendation is accompanied by “5 Quick Tips” for how to put the advice into practice-how to choose high-fiber foods, achieve a healthy weight, stock a healthy kitchen and other topics. Also, the site is now fully searchable from each page. “There’s a lot of confusion out there about what to eat,” said Sari Kalin, program coordinator for The Nutrition Source. “The Nutrition Source’s new design helps people cut through the confusion and find clear answers to their nutrition questions.”

For more information, contact:

Todd Datz 617-432-8413 [email protected]

See the latest news from the  Harvard School of Public Health .

Harvard School of Public Health is dedicated to advancing the public’s health through learning, discovery, and communication. More than 400 faculty members are engaged in teaching and training the 1,000-plus student body in a broad spectrum of disciplines crucial to the health and well being of individuals and populations around the world. Programs and projects range from the molecular biology of AIDS vaccines to the epidemiology of cancer; from risk analysis to violence prevention; from maternal and children’s health to quality of care measurement; from health care management to international health and human rights. For more information on the school visit:  www.hsph.harvard.edu

• History & Society
• Science & Tech
• Biographies
• Animals & Nature
• Geography & Travel
• Arts & Culture
• Games & Quizzes
• On This Day
• One Good Fact
• New Articles
• Lifestyles & Social Issues
• Philosophy & Religion
• Politics, Law & Government
• World History
• Health & Medicine
• Browse Biographies
• Birds, Reptiles & Other Vertebrates
• Bugs, Mollusks & Other Invertebrates
• Environment
• Fossils & Geologic Time
• Entertainment & Pop Culture
• Sports & Recreation
• Visual Arts
• Demystified
• Image Galleries
• Infographics
• Top Questions
• Britannica Kids
• Saving Earth
• Space Next 50
• Student Center
• Introduction

Origins and evolution

Variations across countries and diets, debates regarding the food pyramid.

• Why is biology important?

food pyramid

Our editors will review what you’ve submitted and determine whether to revise the article.

• eMedicinehealth - What is the Food Pyramid Now?
• The European Food Information Council - Food Pyramids, Plates and Guides: Building a Balanced Diet
• Indiana Historical Bureau - Food Pyramid
• Harvard T.H. Chan School of Public Health - Food Pyramid
• Table Of Contents

food pyramid , a visual representation (in the shape of a pyramid) of the optimal number of servings of food a person should eat daily from each basic food group. The food pyramid first evolved in Sweden in the 1970s and was adapted by the U.S. Department of Agriculture (USDA) in 1992. The USDA revised it in 2005 to create what it called MyPyramid, which was replaced by MyPlate in 2011. Many countries across the globe have adapted versions of the food pyramid, sometimes discarding the pyramid shape altogether. Whatever form they take, such food guides are intended to help people cultivate a daily pattern of recommended (and thus presumably healthy) food choices.

The food pyramid has its origins not in recommendations for a balanced diet but in food shortages. The USDA released the Basic 7 food guide in 1943 to help U.S. citizens cope with food rationing during World War II . As its name indicates, this guide divided foods into seven groups, among them bread and cereals , several covering fruits and vegetables , and meat and poultry . In Sweden in the 1970s, the National Board of Health and Welfare was tasked with tackling rising food costs. It came up with two food groups, titled “basic” and “supplementary.” This was a nutritionally problematic categorization, however, because “supplementary” foods included fruits, vegetables, meat, and fish . The Swedish government also relied on a dietary circle that resembled a cake divided into seven pieces. It did not tell the reader how much to consume of each piece.

It was in this somewhat confusing context that Anna-Britt Agnsäter, an educator who worked for a Swedish grocery cooperative, designed the food pyramid, which was published for the first time in 1974 in an issue of the cooperative’s magazine. She divided the pyramid into three levels. The bottom level included bread and other grains, legumes , potatoes , and milk . The middle level comprised fruits, vegetables, and juices. The top level covered eggs, meat, and fish. Agnsäter used a pyramid shape so as to indicate that a person should eat more foods from the bottom of the pyramid—the widest section—than from the top. Other Nordic countries soon designed their own food pyramids, and the shape was also adopted elsewhere.

In 1992 the USDA rolled out its version of the food pyramid. It had four levels. The bottom level included bread, cereal, rice , and pasta , with a recommended 6 to 11 servings per day. The second level was split between a vegetable group (3 to 5 servings per day) and a fruit group (2 to 4 servings per day). The third level specified 2 to 3 daily servings from a group comprising milk , yogurt , and cheese and 2 to 3 daily servings from a group comprising meat, poultry, fish, dry beans, eggs , and nuts . The top level included fats , oils , and candy , which were to be eaten sparingly.

The USDA’s version led to similar pyramids being created for specific cuisines and diets such as Asian, Mediterranean , Latin American, vegetarian , and vegan , with the focus of each remaining on grains, fruits, and vegetables. About the same time, the governments of Mexico, Chile, Panama, and the Philippines also adopted a pyramid. Some countries, though, developed visual representations that were not pyramids, for cultural reasons or simply to do something different. Canada, for example, used a rainbow , Zimbabwe a square, Guatemala a family pot , and Japan the number 6. South Korea and China created pagodas . Australia designed both pyramids and plates .

The food pyramid was reimagined by many countries in the early 21st century. In 2005, for example, Japan inverted the pyramid to come up with a spinning top design . In the same year, the USDA created a new pyramid design, calling it MyPyramid . This featured colourful stripes of varying widths, reflecting the relative proportions of different food groups. It also included a person running up steps to highlight the importance of exercise.

In 2011 the USDA replaced MyPyramid with MyPlate , which displayed the basic food groups (fruits, grains, protein , and vegetables) as sections on a plate, with each section’s size representing the dietary proportions of each food group. MyPlate did not incorporate an exercise component, nor did it include a section for fats and oils.

The global variations of the food pyramid—ranging from rainbows and pots to pagodas and plates—reflect not only cultural differences and design decisions but, in some cases, fundamentally different nutritional recommendations. About the same time that the USDA replaced its food pyramid with MyPlate, for example, Australia released a pyramid. While MyPlate depicted larger portions of grains and vegetables in equal proportions and smaller portions of fruits and protein in equal proportions, Australia’s pyramid placed vegetables, legumes, and fruits together on the bottom level, recommending that this level cover 70 percent of what a person eats every day. The next level included grains; the third level had dairy or its alternatives with lean meat, poultry, fish, eggs, nuts, and seeds; and the top level included healthy fats. This pyramid also advised using herbs and spices in one’s diet, drinking water, and limiting salt and added sugar . These differences are significant.

Mediterranean food guides have typically replaced cow dairy with yogurt and goat’s milk products, since the region has a high prevalence of intolerance to dairy products from cows. Asian food guides include soy products to replace nutrients normally found in dairy products. The Asian Diet Pyramid created in 2000 has daily physical exercise as its foundation, and the bottom level includes rice, noodles, breads, millet , corn , and other whole grains. The level above that includes fruits, vegetables, legumes, nuts, and seeds. The third level is vegetable oils . The first three levels are marked for daily consumption . The fourth level, which includes fish, shellfish , and dairy, is marked as optional for daily consumption. Sweets, eggs, and poultry are marked as weekly, and meat as monthly. It also recommends drinking six glasses of water or tea per day.

In India the recommended food pyramid has four levels: cereals, grains, and milk to be consumed adequately; fruits and vegetables to be eaten liberally; meat, eggs, fish, salt , and oils to be eaten moderately; and sweets and junk food to be eaten sparingly. India’s pyramid also advises abstaining from alcohol and tobacco .

Creators of food pyramids have been accused of providing an overly simplified version of what constitutes an ideal diet. While the USDA’s 1992 pyramid can by no means be identified as a factor contributing to the rise in obesity over many decades among Americans, that food pyramid has been criticized for doing little to educate people on how to distinguish among carbohydrates , which have different nutritional profiles, and instead only recommending a number of servings to consume. So too, foods are typically not rich in only one kind of nutrient ; for example, rice contains some amount of protein and can to some extent contribute to daily protein intake . However, this sort of complexity is not reflected in most food pyramids. Last, fats are typically placed at the top of food pyramids, indicating that they are to be consumed in small quantities. However, this designation ignores the diversity of fat types; unsaturated fats have been shown to be healthier than saturated fats . Categorizing fats as a “low consumption” food has also led to weight-loss diets that eliminate them entirely, when in reality some amount of fat is essential to health .

Healthy Eating Pyramid

Generations of Americans are accustomed to the food pyramid design, and it’s not going away. In fact, the Healthy Eating Pyramid and the Healthy Eating Plate (as well as the Kid’s Healthy Eating Plate ) complement each other.

Consumers can think of the Healthy Eating Pyramid as a grocery list:

• Vegetables , fruits , whole grains , healthy oils , and healthy proteins like nuts , beans , fish , and chicken should make it into the shopping cart every week, along with a little yogurt or other dairy foods  if desired.
• The Healthy Eating Pyramid also addresses other aspects of a healthy lifestyle— exercise , weight control , vitamin D , and multivitamin supplements , and moderation in alcohol  for people who drink—so it’s a useful tool for health professionals and health educators.

Translating nutrition advice into a colorful pyramid is great way to illustrate what foods make up a healthy diet. The shape immediately suggests that some foods are good and should be eaten often, and that others aren’t so good and should be eaten only occasionally. The layers represent major food groups that contribute to the total diet. The problem with the US government’s original Food Guide Pyramid, released in 1992, was that it conveyed the wrong dietary advice. And MyPyramid, its 2005 replacement, was vague and confusing.

MyPyramid, unveiled in 2005, was essentially the Food Guide Pyramid turned on its side, without any explanatory text. Six swaths of color swept from the apex of MyPyramid to the base: orange for grains, green for vegetables, red for fruits, a teeny band of yellow for oils, blue for milk, and purple for meat and beans. The widths suggested how much food a person should choose from each group. A band of stairs running up the side of the Pyramid, with a little stick figure chugging up it, served as a reminder of the importance of physical activity.

Permission of use

The Healthy Eating Pyramid image on this Web site is owned by Harvard University. It may be downloaded and used without permission for educational and other non-commercial uses with proper attribution, including the following copyright notification and credit line:

Copyright © 2008. For more information about The Healthy Eating Pyramid, please see The Nutrition Source, Department of Nutrition, Harvard T.H. Chan School of Public Health, www.thenutritionsource.org , and   Eat, Drink, and Be Healthy, by Walter C. Willett, M.D., and Patrick J. Skerrett (2005), Free Press/Simon & Schuster Inc.”

Any other use, including commercial reuse or mounting on other systems, requires permission from the Department of Nutrition at the Harvard T.H. Chan School of Public Health. Please  contact us  to request permission.

Terms of Use

The contents of this website are for educational purposes and are not intended to offer personal medical advice. You should seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The Nutrition Source does not recommend or endorse any products.

Information

• Author Services

Initiatives

You are accessing a machine-readable page. In order to be human-readable, please install an RSS reader.

All articles published by MDPI are made immediately available worldwide under an open access license. No special permission is required to reuse all or part of the article published by MDPI, including figures and tables. For articles published under an open access Creative Common CC BY license, any part of the article may be reused without permission provided that the original article is clearly cited. For more information, please refer to https://www.mdpi.com/openaccess .

Feature papers represent the most advanced research with significant potential for high impact in the field. A Feature Paper should be a substantial original Article that involves several techniques or approaches, provides an outlook for future research directions and describes possible research applications.

Feature papers are submitted upon individual invitation or recommendation by the scientific editors and must receive positive feedback from the reviewers.

Editor’s Choice articles are based on recommendations by the scientific editors of MDPI journals from around the world. Editors select a small number of articles recently published in the journal that they believe will be particularly interesting to readers, or important in the respective research area. The aim is to provide a snapshot of some of the most exciting work published in the various research areas of the journal.

Original Submission Date Received: .

• Active Journals
• Find a Journal
• Proceedings Series
• For Authors
• For Reviewers
• For Editors
• For Librarians
• For Publishers
• For Societies
• For Conference Organizers
• Open Access Policy
• Institutional Open Access Program
• Special Issues Guidelines
• Editorial Process
• Research and Publication Ethics
• Article Processing Charges
• Testimonials
• Preprints.org
• SciProfiles
• Encyclopedia

Article Menu

• Subscribe SciFeed
• Recommended Articles
• PubMed/Medline
• Google Scholar
• on Google Scholar
• Table of Contents

Find support for a specific problem in the support section of our website.

Please let us know what you think of our products and services.

Visit our dedicated information section to learn more about MDPI.

JSmol Viewer

Healthy food pyramid as well as physical and mental activity in the prevention of alzheimer’s disease.

1. Introduction

2. food pyramid, 3. a diet to prevent alzheimer’s disease, mediterranean diet, 4. food products with beneficial/adverse effects on health, 4.1. advanced glycation end products (ages), 4.2. fatty acids, 4.3. milk and dairy products, 4.4. alcohol, 5. functions of l-carnitine in the brain, 6. lifestyle, physical exercise and mental activity in the prevention of ad, 6.1. physical activity, 6.2. mental activity, 7. conclusions, author contributions, institutional review board statement, informed consent statement, data availability statement, conflicts of interest.

• Strafella, C.; Caputo, V.; Galota, M.R.; Zampatti, S.; Marella, G.; Mauriello, S.; Cascella, R.; Giardina, E. Application of precision medicine in neurodegenerative diseases. Front. Neurol. 2018 , 9 , 701. [ Google Scholar ] [ CrossRef ] [ PubMed ] [ Green Version ]
• Mancuso, C.; Bates, T.E.; Butterfield, D.A.; Calafato, S.; Cornelius, C.; De Lorenzo, A.; Dinkova Kostova, A.T.; Calabrese, V. Natural antioxidants in Alzheimer’s disease. Expert Opin. Investig. Drugs 2007 , 16 , 1921–1931. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Poddar, J.; Pradhan, M.; Ganguly, G.; Chakrabarti, S. Biochemical deficits and cognitive decline in brain aging: Intervention by dietary supplements. J. Chem. Neuroanat. 2019 , 95 , 70–80. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Schliebs, R.; Arendt, T. The cholinergic system in aging and neuronal degeneration. Behav. Brain Res. 2011 , 221 , 555–563. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Wilczyńska, K.; Waszkiewicz, N. Diagnostic utility of selected serum dementia biomarkers: Amyloid β-40, amyloid β-42, tau protein, and YKL-40: A Review. J. Clin. Med. 2020 , 9 , 3452. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Kaźmierczak, A.; Adamczyk, A.; Benigna-Strosznajder, J. The role of extracellular α-synuclein in molecular mechanisms of cell heath. Post. Hig. Med. Dosw. 2013 , 67 , 1047–1057. [ Google Scholar ] [ CrossRef ]
• Tanzi, R.E. The genetics of Alzheimer disease. Cold Spring Harb. Perspect. Med. 2012 , 2 , a006296. [ Google Scholar ] [ CrossRef ]
• Dean, D.C., III; Jerskey, B.A.; Chen, K.; Protas, H.; Thiyyagura, P.; Roontiva, A.; O’Muircheartaigh, J.; Dirks, H.; Waskiewicz, N.; Lehman, K.; et al. Brain differences in infants at differential genetic risk for late-onset Alzheimer disease: A cross-sectional imaging study. JAMA Neurol. 2014 , 71 , 11–22. [ Google Scholar ] [ CrossRef ]
• Silva, M.V.F.; Loures, C.M.G.; Alves, L.C.V.; de Souza, L.C.; Borges, K.B.G.; Carvalho, M.D.G. Alzheimer’s disease: Risk factors and potentially protective measures. J. Biomed. Sci. 2019 , 26 , 33. [ Google Scholar ] [ CrossRef ] [ Green Version ]
• Engelborghs, S.; Gilles, C.; Ivanoiu, A.; Vandewoude, M. Rationale and clinical data supporting nutritional intervention in Alzheimer’s disease. Acta Clin. Belg. 2014 , 69 , 17–24. [ Google Scholar ] [ CrossRef ]
• Moore, K.; Hughes, C.F.; Ward, M.; Hoey, L.; McNulty, H. Diet, nutrition and the ageing brain: Current evidence and new directions. Proc. Nur. Soc. 2018 , 77 , 152–163. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Soininen, H.; Solomon, A.; Visser, P.J.; Hendrix, S.B.; Blennow, K.; Kivipelto, M.; Hartmann, T. LipiDiDiet clinical study group. 36-month LipiDiDiet multinutrient clinical trial in prodromal Alzheimer’s disease. Alzheimers Dement. 2021 , 17 , 29–40. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Parvez, M.K. Natural or plant products for the treatment of neurological disorders: Current knowledge. Curr. Drug Metab. 2018 , 19 , 424–428. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Alkhouli, M.F.; Hung, J.; Squire, M.; Anderson, M.; Castro, M.; Babu, J.R.; Al-Nakkash, L.; Broderick, T.L.; Plochocki, J.H. Exercise and resveratrol increase fracture resistance in the 3xTg-AD mouse model of Alzheimer’s disease. BMC Complement. Altern. Med. 2019 , 19 , 39. [ Google Scholar ] [ CrossRef ] [ PubMed ] [ Green Version ]
• Janeiro, M.H.; Ramírez, M.J.; Milagro, F.I.; Martínez, J.A.; Solas, M. Implication of trimethylamine N-oxide (TMAO) in disease: Potential biomarker or new therapeutic target. Nutrients 2018 , 10 , 1398. [ Google Scholar ] [ CrossRef ] [ PubMed ] [ Green Version ]
• Kępka, A.; Chojnowska, S.; Okungbowa, O.E.; Zwierz, K. The role of carnitine in the perinatal period. Dev. Period Med. 2014 , 18 , 417–425. [ Google Scholar ]
• Kępka, A.; Ochocińska, A.; Chojnowska, S.; Borzym-Kluczyk, M.; Skorupa, E.; Knaś, M.; Waszkiewicz, N. Potential Role of L-carnitine in autism spectrum disorder. J. Clin. Med. 2021 , 10 , 1202. [ Google Scholar ] [ CrossRef ]
• Kępka, A.; Ochocinska, A.; Borzym-Kluczyk, M.; Skorupa, E.; Stasiewicz-Jarocka, B.; Chojnowska, S.; Waszkiewicz, N. Preventive role of L-carnitine and balanced diet in Alzheimer’s disease. Nutrients 2020 , 12 , 1987. [ Google Scholar ] [ CrossRef ]
• Traina, G. The neurobiology of acetyl-L-carnitine. Front. Biosci. 2016 , 21 , 1314–1329. [ Google Scholar ] [ CrossRef ] [ Green Version ]
• Onofrj, M.; Ciccocioppo, F.; Varanese, S.; di Muzio, A.; Calvani, M.; Chiechio, S.; Osio, M.; Thomas, A. Acetyl-L-carnitine: From a biological curiosity to a drug for the peripheral nervous system and beyond. Expert Rev. Neurother. 2013 , 13 , 925–936. [ Google Scholar ] [ CrossRef ]
• White, H.L.; Scates, P.W. Acetyl-L-carnitine as a precursor of acetylcholine. Neurochem. Res. 1990 , 15 , 597–601. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Chauhan, N.B.; Siegel, G.J. Effect of PPF and ALCAR on the induction of NGF- and p75-mRNA and on APP processing in Tg2576 brain. Neurochem. Int. 2003 , 43 , 225–233. [ Google Scholar ] [ CrossRef ]
• Zhou, P.; Chen, Z.; Zhao, N.; Liu, D.; Guo, Z.Y.; Tan, L.; Hu, J.; Wang, Q.; Wang, J.Z.; Zhu, L.Q. Acetyl-L-carnitine attenuates homocysteine-induced Alzheimer-like histopathological and behavioral abnormalities. Rejuvenation Res. 2011 , 14 , 669–679. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Calvani, M.; Carta, A.; Caruso, G.; Benedetti, N.; Iannuccelli, M. The action of acetyl-L-carnitine in neurodegeneration and Alzheimer’s disease. Ann. N. Y. Acad. Sci. 1992 , 663 , 483–486. [ Google Scholar ] [ CrossRef ]
• Juliet, P.A.; Balasubramaniam, D.; Balasubramaniam, N.; Panneerselvam, C. Carnitine: A neuromodulator in aged rats. J. Gerontol. A Biol. Sci. Med. Sci. 2003 , 58 , 970–974. [ Google Scholar ] [ CrossRef ] [ Green Version ]
• Dougherty, R.J.; Boots, E.A.; Lindheimer, J.B.; Stegner, A.J.; Van Riper, S.; Edwards, D.F.; Gallagher, C.L.; Carlsson, C.M.; Rowley, H.A.; Bendlin, B.B.; et al. Fitness, independent of physical activity is associated with cerebral blood flow in adults at risk for Alzheimer’s disease. Brain Imaging Behav. 2020 , 14 , 1154–1163. [ Google Scholar ] [ CrossRef ]
• Solfrizzi, V.; Panza, F.; Frisardi, V.; Seripa, D.; Logroscino, G.; Imbimbo, B.P.; Pilotto, A. Diet and Alzheimer’s disease risk factors or prevention: The current evidence. Expert Rev. Neurother. 2011 , 11 , 677–708. [ Google Scholar ] [ CrossRef ]
• Mamcarz, A.; Podolec, P. Alcohol in the prevention of cardiovascular diseases—facts and myths (in Polish). Forum Medycyny Rodzinnej 2007 , 1 , 255–263. [ Google Scholar ]
• Galbete, C.; Kröger, J.; Jannasch, F.; Iqbal, K.; Schwingshackl, L.; Schwedhelm, C.; Weikert, C.; Boeing, H.; Schulze, M.B. Nordic diet, mediterranean diet, and the risk of chronic diseases: The EPIC-Potsdam study. BMC Med. 2018 , 16 , 99. [ Google Scholar ] [ CrossRef ]
• Blumenthal, J.A.; Smith, P.J.; Mabe, S.; Hinderliter, A.; Lin, P.H.; Liao, L.; Welsh-Bohmer, K.A.; Browndyke, J.N.; Kraus, W.E.; Doraiswamy, P.M.; et al. Lifestyle and neurocognition in older adults with cognitive impairments: A randomized trial. Neurology 2019 , 15 , e212–e223. [ Google Scholar ] [ CrossRef ] [ Green Version ]
• Sánchez-Muniz, F.J.; Macho-González, A.; Garcimartín, A.; Santos-López, J.A.; Benedí, J.; Bastida, S.; González-Muñoz, M.J. The nutritional components of beer and its relationship with neurodegeneration and Alzheimer’s disease. Nutrients 2019 , 11 , 1558. [ Google Scholar ] [ CrossRef ] [ PubMed ] [ Green Version ]
• Abbott, R.D.; White, L.R.; Ross, G.W.; Masaki, K.H.; Curb, J.D.; Petrovitch, H. Walking and dementia in physically capable elderly men. JAMA 2004 , 292 , 1447–1453. [ Google Scholar ] [ CrossRef ] [ PubMed ] [ Green Version ]
• Solfrizzi, V.; Frisardi, V.; Seripa, D.; Logroscino, G.; Imbimbo, B.P.; D’Onofrio, G.; Addante, F.; Sancarlo, D.; Cascavilla, L.; Pilotto, A.; et al. Mediterranean diet in predementia and dementia syndromes. Curr. Alzheimer Res. 2011 , 8 , 520–542. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Tolppanen, A.M.; Solomon, A.; Kulmala, J.; Kåreholt, I.; Ngandu, T.; Rusanen, M.; Laatikainen, T.; Soininen, H.; Kivipelto, M. Leisure-time physical activity from mid- to late life, body mass index, and risk of dementia. Alzheimers Dement. 2015 , 11 , 434.e6–443.e6. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Perrone, L.; Grant, W.B. Observational and ecological studies of dietary advanced glycation end products in national diets and Alzheimer’s disease incidence and prevalence. J. Alzheimers Dis. 2015 , 45 , 965–979. [ Google Scholar ] [ CrossRef ]
• Lubitz, I.; Ricny, J.; Atrakchi-Baranes, D.; Shemesh, C.; Kravitz, E.; Liraz-Zaltsman, S.; Maksin-Matveev, A.; Cooper, I.; Leibowitz, A.; Uribarri, J.; et al. High dietary advanced glycation end products are associated with poorer spatial learning and accelerated Aβ deposition in an Alzheimer mouse model. Aging Cell 2016 , 15 , 309–316. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Yusufov, M.; Weyandt, L.L.; Piryatinsky, I. Alzheimer’s disease and diet: A systematic review. Int. J. Neurosci. 2017 , 127 , 161–175. [ Google Scholar ] [ CrossRef ]
• Dochniak, M.; Ekiert, K. Nutrition in prevention and treatment of Alzheimer’s and Parkinson’s diseases (in Polish). Nurs. Public Health 2015 , 5 , 199–208. [ Google Scholar ]
• Abbatecola, A.M.; Russo, M.; Barbieri, M. Dietary patterns and cognition in older persons. Curr. Opin. Clin. Nutr. Metab. Care 2018 , 21 , 10–13. [ Google Scholar ] [ CrossRef ]
• Leri, M.; Scuto, M.; Ontario, M.L.; Calabrese, V.; Calabrese, E.J.; Bucciantini, M.; Stefani, M. Healthy effects of plant polyphenols: Molecular mechanisms. Int. J. Mol. Sci. 2020 , 21 , 1250. [ Google Scholar ] [ CrossRef ] [ Green Version ]
• Martínez-Lapiscina, E.H.; Clavero, P.; Toledo, E.; Estruch, R.; Salas-Salvadó, J.; San Julián, B.; Sanchez-Tainta, A.; Ros, E.; Valls-Pedret, C.; Martinez-Gonzalez, M.Á. Mediterranean diet improves cognition: The PREDIMED-NAVARRA randomised trial. J. Neurol. Neurosurg. Psychiatry 2013 , 84 , 1318–1325. [ Google Scholar ] [ CrossRef ] [ PubMed ] [ Green Version ]
• Abate, G.; Marziano, M.; Rungratanawanich, W.; Memo, M.; Uberti, D. Nutrition and AGE-ing: Focusing on Alzheimer’s disease. Oxid. Med. Cell Longev. 2017 , 2017 , 7039816. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Sato, T.; Shimogaito, N.; Wu, X.; Kikuchi, S.; Yamagishi, S.; Takeuchi, M. Toxic advanced glycation end products (TAGE) theory in Alzheimer’s disease. Am. J. Alzheimers Dis. Other Demen. 2006 , 21 , 197–208. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Li, G.; Tang, J.; Du, Y.; Lee, C.A.; Kern, T.S. Beneficial effects of a novel RAGE inhibitor on early diabetic retinopathy and tactile allodynia. Mol. Vis. 2011 , 17 , 3156–3165. [ Google Scholar ]
• Shahidi, F.; Ambigaipalan, P. Omega-3 polyunsaturated fatty acids and their health benefits. Annu. Rev. Food Sci. Technol. 2018 , 9 , 345–381. [ Google Scholar ] [ CrossRef ]
• Buckinx, F.; Aubertin-Leheudre, M. Nutrition to prevent or treat cognitive Impairment in older adults: A GRADE recommendation. J. Prev. Alzheimers Dis. 2021 , 8 , 110–116. [ Google Scholar ] [ CrossRef ]
• Cuesta-Triana, F.; Verdejo-Bravo, C.; Fernández-Pérez, C.; Martín-Sánchez, F.J. Effect of milk and other dairy products on the risk of frailty, sarcopenia, and cognitive performance decline in the elderly: A systematic review. Adv. Nutr. 2019 , 10 (Suppl. 2), S105–S119. [ Google Scholar ] [ CrossRef ]
• Lee, J.; Fu, Z.; Chung, M.; Jang, D.J.; Lee, H.J. Role of milk and dairy intake in cognitive function in older adults: A systematic review and meta-analysis. Nutr. J. 2018 , 17 , 82. [ Google Scholar ] [ CrossRef ]
• Reale, M.; Costantini, E.; Jagarlapoodi, S.; Khan, H.; Belwal, T.; Cichelli, A. relationship of wine consumption with Alzheimer’s disease. Nutrients 2020 , 12 , 206. [ Google Scholar ] [ CrossRef ] [ Green Version ]
• Anastasiou, C.A.; Yannakoulia, M.; Kosmidis, M.H.; Dardiotis, E.; Hadjigeorgiou, G.M.; Sakka, P.; Arampatzi, X.; Bougea, A.; Labropoulos, I.; Scarmeas, N. Mediterranean diet and cognitive health: Initial results from the Hellenic Longitudinal Investigation of Ageing and Diet. PLoS ONE 2017 , 12 , e0182048. [ Google Scholar ] [ CrossRef ] [ Green Version ]
• Peng, B.; Yang, Q.; Joshi, R.B.; Liu, Y.; Akbar, M.; Song, B.J.; Zhou, S.; Wang, X. Role of alcohol drinking in Alzheimer’s disease, Parkinson’s disease, and Amyotrophic lateral sclerosis. Int. J. Mol. Sci. 2020 , 21 , 2316. [ Google Scholar ] [ CrossRef ] [ PubMed ] [ Green Version ]
• Ruitenberg, A.; van Swieten, J.C.; Witteman, J.C.M.; Mehta, K.M.; van Duijn, C.M.; Hofman, A.; Breteler, M.M.B. Alcohol consumption and risk of dementia: The Rotterdam Study. Lancet 2002 , 359 , 281–286. [ Google Scholar ] [ CrossRef ]
• Luchsinger, J.A.; Tang, M.X.; Siddiqui, M.; Shea, S.; Mayeux, R. Alcohol intake and risk of dementia. J. Am. Geriatr. Soc. 2004 , 52 , 540–546. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Turner, R.S.; Thomas, R.G.; Craft, S.; van Dyck, C.H.; Mintzer, J.; Reynolds, B.A.; Brewer, J.B.; Rissman, R.A.; Raman, R.; Aisen, P.S. A randomized, double-blind, placebo-controlled trial of resveratrol for Alzheimer disease. Neurology 2005 , 85 , 1383–1391. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Anstey, K.J.; Mack, H.A.; Cherbuin, N. Alcohol consumption as a risk factor for dementia and cognitive decline: Meta-analysis of prospective studies. Am. J. Geriatr. Psychiatry 2009 , 17 , 542–555. [ Google Scholar ] [ CrossRef ]
• Waszkiewicz, N.; Zalewska-Szajda, B.; Chojnowska, S.; Szajda, S.D.; Zalewska, A.; Konarzewska, B.; Szulc, A.; Wojtulewska-Supron, A.; Kępka, A.; Knaś, M.; et al. The salivary β-HEX A% index as an excellent marker of periodontitis in smoking alcohol-dependent persons. Dis. Markers 2013 , 35 , 457–463. [ Google Scholar ] [ CrossRef ] [ Green Version ]
• Waszkiewicz, N.; Szajda, S.D.; Konarzewska, B.; Szulc, A.; Kepka, A.; Zwierz, K. Underappreciated role of binge drinking in the risk of lung cancer. Eur. J. Public Health 2010 , 20 , 6. [ Google Scholar ] [ CrossRef ] [ Green Version ]
• Kępka, A.; Szajda, S.D.; Waszkiewicz, N.; Płudowski, P.; Chojnowska, S.; Rudy, M.; Szulc, A.; Ładny, J.R.; Zwierz, K. Carnitine: Function, metabolism and value in hepatic failure during chronic alcohol intoxication. Post. Hig. Med. Dosw. 2011 , 65 , 645–653. [ Google Scholar ] [ CrossRef ]
• Jones, L.L.; McDonald, D.A.; Borum, P.R. Acylcarnitines: Role in brain. Prog. Lipid Res. 2010 , 49 , 61–75. [ Google Scholar ] [ CrossRef ]
• Virmani, A.; Binienda, Z. Role of carnitine esters in brain neuropathology. Mol. Aspects Med. 2004 , 25 , 533–549. [ Google Scholar ] [ CrossRef ]
• Ferreira, G.C.; McKenna, M.C. L-carnitine and acetyl-L-carnitine roles and neuroprotection in developing brain. Neurochem. Res. 2017 , 42 , 1661–1675. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Ribas, G.S.; Vargas, C.R.; Wajner, M. L-carnitine supplementation as a potential antioxidant therapy for inherited neurometabolic disorders. Gene 2014 , 533 , 469–476. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Aureli, T.; Di Cocco, M.E.; Puccetti, C.; Ricciolini, R.; Scalibastri, M.; Miccheli, A.; Manetti, C.; Conti, F. Acetyl-L-carnitine modulates glucose metabolism and stimulates glycogen synthesis in rat brain. Brain Res. 1998 , 796 , 75–81. [ Google Scholar ] [ CrossRef ]
• Sergi, G.; Pizzato, S.; Piovesan, F.; Trevisan, C.; Veronese, N.; Manzato, E. Effects of acetyl-L-carnitine in diabetic neuropathy and other geriatric disorders. Aging Clin. Exp. Res. 2018 , 30 , 133–138. [ Google Scholar ] [ CrossRef ]
• Smeland, O.B.; Meisingset, T.W.; Borges, K.; Sonnewald, U. Chronic acetyl-L-carnitine alters brain energy metabolism and increases noradrenaline and serotonin content in healthy mice. Neurochem. Int. 2012 , 61 , 100–107. [ Google Scholar ] [ CrossRef ]
• Epis, R.; Marcello, E.; Gardoni, F.; Longhi, A.; Calvani, M.; Iannuccelli, M.; Cattabeni, F.; Canonico, P.L.; Di Luca, M. Modulatory effect of acetyl-L-carnitine on amyloid precursor protein metabolism in hippocampal neurons. Eur. J. Pharmacol. 2008 , 597 , 51–56. [ Google Scholar ] [ CrossRef ]
• Nałęcz, K.A.; Miecz, D.; Berezowski, V.; Cecchelli, R. Carnitine: Transport and physiological functions in the brain. Mol. Aspects Med. 2004 , 25 , 551–567. [ Google Scholar ] [ CrossRef ]
• Bak, S.W.; Choi, H.; Park, H.H.; Lee, K.Y.; Lee, Y.J.; Yoon, M.Y.; Koh, S.H. Neuroprotective effects of acetyl-L-carnitine against oxygen-glucose deprivation-induced neural stem cell death. Mol. Neurobiol. 2016 , 53 , 6644–6652. [ Google Scholar ] [ CrossRef ]
• Respondek, M.; Buszman, E. Regulation of neurogenesis: Factors affecting of new neurons formation in adult mammals brain (in Polish). Post. Hig. Med. Dosw. 2015 , 69 , 1451–1461. [ Google Scholar ]
• Cristofano, A.; Sapere, N.; La Marca, G.; Angiolillo, A.; Vitale, M.; Corbi, G.; Scapagnini, G.; Intrieri, M.; Russo, C.; Corso, G.; et al. Serum levels of acyl-carnitines along the continuum from normal to Alzheimer’s dementia. PLoS ONE 2016 , 11 , e0155694. [ Google Scholar ] [ CrossRef ] [ Green Version ]
• Head, K.A. Peripheral neuropathy: Pathogenic mechanisms and alternative therapies. Altern. Med. Rev. 2006 , 11 , 294–329. [ Google Scholar ] [ PubMed ]
• Suchy, J.; Chan, A.; Shea, T.B. Dietary supplementation with a combination of alpha-lipoic acid, acetyl-L-carnitine, glycerophosphocholine, docosahexaenoic acid, and phosphatidylserine reduces oxidative damage to murine brain and improves cognitive performance. Nutr. Res. 2009 , 29 , 70–74. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Calabrese, V.; Ravagna, A.; Colombrita, C.; Scapagnini, G.; Guagliano, E.; Calvani, M.; Butterfield, D.A.; Giuffrida Stella, A.M. Acetylcarnitine induces heme oxygenase in rat astrocytes and protects against oxidative stress: Involvement of the transcription factor Nrf2. J. Neurosci. Res. 2005 , 79 , 509–521. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Zhao, J.; Li, H.; Lin, R.; Wei, Y.; Yang, A. Effects of creative expression therapy for older adults with mild cognitive impairment at risk of Alzheimer’s disease: A randomized controlled clinical trial. Clin. Interv. Aging 2018 , 13 , 1313–1320. [ Google Scholar ] [ CrossRef ] [ Green Version ]
• Corsi, M.; Di Raimo, T.; Di Lorenzo, C.; Rapp-Ricciardi, M.; Archer, T.; Ricci, S.; Businaro, R. Cognitive disability in Alzheimer’s disease and its management. Clin. Ter. 2016 , 167 , e123. [ Google Scholar ]
• Balouch, S.; Rifaat, E.; Chen, H.L.; Tabet, N. Social networks and loneliness in people with Alzheimer’s dementia. Int. J. Geriatr. Psychiatry 2019 , 34 , 666–673. [ Google Scholar ] [ CrossRef ]
• Kivipelto, M.; Mangialasche, F.; Ngandu, T. Lifestyle interventions to prevent cognitive impairment, dementia and Alzheimer disease. Nat. Rev. Neurol. 2018 , 14 , 653–666. [ Google Scholar ] [ CrossRef ]
• Cotman, C.W.; Engesser-Cesar, C. Exercise enhances and protects brain function. Exerc. Sport Sci. Rev. 2002 , 30 , 75–79. [ Google Scholar ] [ CrossRef ]
• Cotman, C.W.; Berchtold, N.C.; Christie, L.A. Exercise builds brain health: Key roles of growth factor cascades and inflammation. Trends Neurosci. 2007 , 30 , 464–472. [ Google Scholar ] [ CrossRef ]
• Laurin, D.; Verreault, R.; Lindsay, J.; MacPherson, K.; Rockwood, K. Physical activity and risk of cognitive impairment and dementia in elderly persons. Arch. Neurol. 2001 , 58 , 498–504. [ Google Scholar ] [ CrossRef ] [ Green Version ]
• Paillard-Borg, S.; Fratiglioni, L.; Xu, W.; Winblad, B.; Wang, H.X. An active lifestyle postpones dementia onset by more than one year in very old adults. J. Alzheimers Dis. 2012 , 31 , 835–842. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Rolland, Y.; Abellan van Kan, G.; Vellas, B. Physical activity and Alzheimer’s disease: From prevention to therapeutic per¬spectives. J. Am. Med. Dir. Assoc. 2008 , 9 , 390–405. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Law, L.L.; Rol, R.N.; Schultz, S.A.; Dougherty, R.J.; Edwards, D.F.; Koscik, R.L.; Gallagher, C.L.; Carlsson, C.M.; Bendlin, B.B.; Zetterberg, H.; et al. Moderate intensity physical activity associates with CSF biomarkers in a cohort at risk for Alzheimer’s disease. Alzheimers Dement. 2018 , 10 , 188–195. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Rossi Dare, L.; Garcia, A.; Alves, N.; Ventura Dias, D.; de Souza, M.A.; Mello-Carpes, P.B. Physical and cognitive training are able to prevent recognition memory deficits related to amyloid beta neurotoxicity. Behav. Brain Res. 2019 , 365 , 190–197. [ Google Scholar ] [ CrossRef ]
• Jahangiri, Z.; Gholamnezhad, Z.; Hosseini, M. Neuroprotective effects of exercise in rodent models of memory deficit and Alzheimer’s. Metab. Brain Dis. 2019 , 34 , 21–37. [ Google Scholar ] [ CrossRef ]
• Yu, F.; Lin, F.V.; Salisbury, D.L.; Shah, K.N.; Chow, L.; Vock, D.; Nelson, N.W.; Porsteinsson, A.P.; Clifford, J., Jr. Efficacy and mechanisms of combined aerobic exercise and cognitive training in mild cognitive impairment: Study protocol of the ACT trial. Trials 2018 , 19 , 700. [ Google Scholar ] [ CrossRef ] [ Green Version ]
• Kou, X.; Chen, D.; Chen, N. Physical activity alleviates cognitive dysfunction of Alzheimer’s disease through regulating the mTOR signaling pathway. Int. J. Mol. Sci. 2019 , 20 , 1591. [ Google Scholar ] [ CrossRef ] [ Green Version ]
• Rosenberg, A.; Mangialasche, F.; Ngandu, T.; Solomon, A.; Kivipelto, M. Multidomain interventions to prevent cognitive impairment, Alzheimer’s Disease, and dementia: From FINGER to World-Wide FINGERS. J. Prev. Alzheimers Dis. 2020 , 7 , 29–36. [ Google Scholar ] [ CrossRef ]
• Kim, S.; McMaster, M.; Torres, S.; Cox, K.L.; Lautenschlager, N.; Rebok, G.W.; Pond, D.; D’Este, C.; McRae, I.; Cherbuin, N.; et al. Protocol for a pragmatic randomised controlled trial of body brain life-general practice and a lifestyle modification programme to decrease dementia risk exposure in a primary care setting. BMJ Open 2018 , 8 , e019329. [ Google Scholar ] [ CrossRef ]
• Ngandu, T.; Lehtisalo, J.; Solomon, A.; Levälahti, E.; Ahtiluoto, S.; Antikainen, R.; Bäckman, L.; Hänninen, T.; Jula, A.; Laatikainen, T.; et al. A 2 year multidomain intervention of diet, exercise cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): A randomised controlled trial. Lancet 2015 , 385 , 2255–2263. [ Google Scholar ] [ CrossRef ]
• Stephen, R.; Ngandu, T.; Liu, Y.; Peltonen, M.; Antikainen, R.; Kemppainen, N.; Laatikainen, T.; Lötjönen, J.; Rinne, J.; Strandberg, T.; et al. FINGER Study Group. Change in CAIDE dementia risk score and neuroimaging biomarkers during a 2-year multidomain lifestyle randomized controlled trial: Results of a post-hoc subgroup analysis. J. Gerontol. A Biol. Sci. Med. Sci. 2021 , 76 , 1407–1414. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Wesselman, L.M.; Hooghiemstra, A.M.; Schoonmade, L.J.; de Wit, M.C.; van der Flier, W.M.; Sikkes, S.A. Web-based multidomain lifestyle programs for brain health: Comprehensive overview and meta-analysis. JMIR Ment. Health 2019 , 6 , e12104. [ Google Scholar ] [ CrossRef ] [ PubMed ] [ Green Version ]
• McMaster, M.; Kim, S.; Clare, L.; Torres, S.J.; D’Este, C.; Anstey, K.J. Body, brain, life for cognitive decline (BBL-CD): Protocol for a multidomain dementia risk reduction randomized controlled trial for subjective cognitive decline and mild cognitive impairment. Clin. Interv. Aging 2018 , 13 , 2397–2406. [ Google Scholar ] [ CrossRef ] [ PubMed ] [ Green Version ]
• Nousia, A.; Siokas, V.; Aretouli, E.; Messinis, L.; Aloizou, A.M.; Martzoukou, M.; Karala, M.; Koumpoulis, C.; Nasios, G.; Dardiotis, E. Beneficial effect of multidomain cognitive training on the neuropsychological performance of patients with early-stage Alzheimer’s disease. Neural Plast. 2018 , 2018 , 2845176. [ Google Scholar ] [ CrossRef ] [ Green Version ]
• Heger, I.; Deckers, K.; van Boxtel, M.; de Vugt, M.; Hajema, K.; Verhey, F.; Köhler, S. Dementia awareness and risk perception in middle-aged and older individuals: Baseline results of the MijnBreincoach survey on the association between lifestyle and brain health. BMC Public Health 2019 , 19 , 678. [ Google Scholar ] [ CrossRef ]

Share and Cite

Kępka, A.; Ochocińska, A.; Borzym-Kluczyk, M.; Chojnowska, S.; Skorupa, E.; Przychodzeń, M.; Waszkiewicz, N. Healthy Food Pyramid as Well as Physical and Mental Activity in the Prevention of Alzheimer’s Disease. Nutrients 2022 , 14 , 1534. https://doi.org/10.3390/nu14081534

Kępka A, Ochocińska A, Borzym-Kluczyk M, Chojnowska S, Skorupa E, Przychodzeń M, Waszkiewicz N. Healthy Food Pyramid as Well as Physical and Mental Activity in the Prevention of Alzheimer’s Disease. Nutrients . 2022; 14(8):1534. https://doi.org/10.3390/nu14081534

Kępka, Alina, Agnieszka Ochocińska, Małgorzata Borzym-Kluczyk, Sylwia Chojnowska, Ewa Skorupa, Małgorzata Przychodzeń, and Napoleon Waszkiewicz. 2022. "Healthy Food Pyramid as Well as Physical and Mental Activity in the Prevention of Alzheimer’s Disease" Nutrients 14, no. 8: 1534. https://doi.org/10.3390/nu14081534

Article Metrics

Article access statistics, further information, mdpi initiatives, follow mdpi.

Subscribe to receive issue release notifications and newsletters from MDPI journals

• Inside Levels
• Metabolic Basics

Weight Loss

Women's Health

• Mental Health

Metabolic Health

| Levels Investigates

Why the USDA Food Pyramid diet recommendations changed

The Food Pyramid was in every classroom in the 90s; here’s why it finally went away, and the challenges that remain.

Reviewed By

Dr. Robert Lustig

Updated: 06/09/2024

Published: 08/08/2023

Article highlights

• The USDA’s Food Pyramid, which aimed to educate Americans about nutrition, was controversial from the beginning.
• The Pyramid’s emphasis on eating carbohydrates and avoiding fats has been blamed for rising rates of obesity in the U.S.
• The nation’s food guide has since been updated several times, and now the USDA uses a plate graphic design to promote healthier eating—though it’s still far from ideal.

In the 1990s, the Food Pyramid was everywhere. The food guidance system, which was developed by the U.S. Department of Agriculture (USDA) as a nutrition education tool for Americans, was plastered on cereal boxes and bagged bread, in TV commercials, and elementary classrooms.

Not only that, it was published at a time when Americans had a dramatically different understanding of what constitutes a healthy diet, fueled by a combination of supply chain imbalances, outdated science, and good marketing. Back then, cholesterol was the enemy, and saturated fat was taboo. Egg whites were encouraged over egg yolks, margarine over butter, and fat-free over full-fat. But low fat invariably meant high carbohydrate—especially wheat—and America had lots of that.

The USDA Food Pyramid finally launched to the public in 1992 (after a  year-long delay  that many people suspected was to accommodate changes reportedly requested by meat and dairy lobbyists), and it had some peculiar advice. Bread and pasta became the base of the Food Pyramid, and all kinds of fat were at the top. This included olive oil and avocados. That advice would be questioned by both experts at that time and medical professionals who now say it contributed to the nation’s growing obesity crisis.

“The Food Pyramid came under immediate fire, even from those within government,” Robert Lustig, MD, MSL, a Levels Health advisor, writes in his 2021 book  Metabolical . In response to the growing obesity crisis, the USDA was forced to back away from the Food Pyramid and in 2011 introduced MyPlate.

What was the USDA Food Pyramid?

The original Food Guide Pyramid (also referred to as the “Eating Right Pyramid”) is a triangle-shaped guide that organizes food into six major food groups. It was intended to be a visual representation of the  most recent Dietary Guidelines for Americans in 1990.

The original Food Pyramid from 1992

The idea itself is pretty simple. Eat more of the foods listed at the widest part of the Pyramid and fewer of the foods at the top. The guidance was for Americans to eat 6–11 servings per day of starchy items like bread, pasta, cereal, potatoes, whole grains, and rice at the “base,” depending on the individual. Three to five servings of vegetables and two to four servings of fruit sit above carbs. Then comes two to three servings of milk, cheese, and dairy products, and two to three servings of meat, nuts, and beans. And finally, fats, oils, and sweets are listed at the top of the Pyramid, to be used “sparingly.” This includes everything from cooking oil to soda.

U.S. health officials  reportedly picked  the Pyramid over a bowl design because it did a better job communicating moderation and proportions. It also mimicked a popular food Pyramid created  in Sweden in the 1970s  that recommended healthy foods with a focus on affordability and avoiding fat.

The USDA Food Pyramid was controversial from the beginning. After work went into developing the Pyramid for several years, the brochure for the Pyramid was sent to the printer in early 1991. But then representatives for the National Cattlemen’s Association reportedly saw media coverage that “stigmatized their products”—by putting beef in the same category as fats and dairy . The organization joined other industry groups, such as the National Milk Producers Federation, protesting the Pyramid, and  the rollout was postponed , according to research published by Marion Nestle, a nutrition and food studies professor at New York University, in the International Journal of Social Determinants of Health and Health Services  in 1993.

The Pyramid reportedly spent another year in revisions— at a cost of about $900,000  to taxpayers—and when the updated version was released to the public in 1992, the nutrition experts who developed the guide were surprised by several of the changes. The suggested servings of grains were higher than their original recommendation, and the recommended number of servings of fruits and vegetables had shrunk.

These food-choice changes put the USDA’s own nutritionists at odds with the influential food industry.

“The U.S. Department of Agriculture has an  inherent conflict of interest : its primary mission is to ensure the success of the American agriculture industry, so its nutritional advice is an inevitable compromise of vested interests,” said an editorial in the medical journal  The Lancet  in 2005. “This conflict means the Pyramid cannot communicate what American consumers really need to hear.”

What was wrong with the Food Guide Pyramid?

To understand the Pyramid’s flaws, you have to think about what Americans were eating in those days. Back in the early ’90s, about  15% of the typical American diet  came from protein with the rest split between fat and carbs, according to Meir Stampfer and Walter Willett, both of whom are MDs and professors at the Harvard T.H. Chan School of Public Health.

In the 1970’s, very high-protein formula diets resulted in kidney failure, so nutritionists did not want to recommend that Americans eat more protein. Furthermore, sources like red meat are high in saturated fat. The American Heart Association at that time recommended no more than 30% of calories come from fat, in order to help prevent heart disease. What resulted was a simplified message to limit fat intake that didn’t quite stack up with the science.

“The ‘fat is bad’ mantra led to the reciprocal corollary ‘carbs are good,’” Stampfer and Willett wrote in  Scientific American  in 2006. “Even when the Pyramid was being developed, though, nutritionists had long known that some types of fat are essential to health and can reduce the risk of cardiovascular disease. Furthermore, scientists had found little evidence that a high intake of carbohydrates is beneficial.”

But that wasn’t the only issue with the Pyramid. Critics had a laundry list of concerns:

• Why were foods categorized the way they were? (Nuts, beans, and red meat were lumped in the protein category, while all fats and sweets were considered the same. Sugar was also considered a carbohydrate, whether it came from fruit or from soda.)
• Why did the Pyramid recommend all Americans eat at least six servings of grains a day?
• Why didn’t the USDA differentiate between the types of fats? (By the early 90s, researchers knew that monounsaturated and polyunsaturated fat — both unsaturated — contributed to a healthy diet, while  trans -fats were really bad.)

These questions and others eventually led to a revision, called MyPyramid, in 2005, and then the creation of a completely new format, called MyPlate, in 2011.

What came after the USDA Food Pyramid?

MyPyramid riffed off the original Pyramid while also putting in place a handful of changes. The new design didn’t include any details; instead,  it assigned a color  to each food category—green for vegetables, orange for grains—and promoted MyPyramid.gov, a website that had dietary recommendations while also suggesting people manage total calories and get physical exercise. It was the first federal food guide to have an interactive online component.

The new MyPlate guide

The changes were applauded by some, but by then, there were already concerns that the original Pyramid didn’t do enough to encourage Americans to limit their consumption of refined carbs, and was a driving factor in the growing obesity crisis.

“The goal [of the Pyramid] was to reduce the intake of saturated fat, which raised cholesterol levels,” John Kinney, MD,  wrote in an opinion piece  in the  Current Opinion in Clinical Nutrition and Metabolic Care  journal in 2005. “Subsequent data demonstrated that refined carbohydrates such as refined bread and rice caused damage to glucose regulation and insulin levels.”

A study in  The Journal of Nutrition  in 2006 that analyzed dietary habits for about 4,300 adults found that people who followed the MyPyramid recommendations were more likely to get their nutritional needs met than those who adhered to the original Pyramid. However, the researchers also said that following the newer recommendations could still  lead to excessive energy intake , a contributing factor to obesity, chronic diseases, and metabolic disorders.

That said, other researchers have said the Pyramid isn’t to blame for obesity rates. Research published by investigators at Tufts University in 2004  argued  that many Americans don’t adhere to dietary guidelines that make up the Pyramid. “The more likely causes of escalating obesity rates are increased per capita caloric consumption and larger portion sizes, along with a lack of adequate physical activity,” the Tufts researchers wrote.

The most sweeping change to America’s food-guide history came in 2011 with the introduction of  MyPlate , a totally new design that focuses on a plate with four food groups: vegetables, fruits, protein, and grains. Dairy is represented by a circle placed on the side of the plate, much like a glass of milk. It also recommends physical activity and eating fewer foods with added sugars, saturated fat, and sodium.

The easy-to-understand plate design was applauded by both scientists and the food industry, though there are still concerns about some of the recommendations and their purported health benefits, and some researchers have come up with their own food guides.

Tufts researchers in 2021 created the  Food Compass , which scores food on its healthfulness as a part of a nutrient-profiling system.

More than a decade earlier, Harvard University’s School of Public Health launched the  Healthy Eating Pyramid , which put daily exercise and maintaining a healthy weight as the foundation of the Pyramid (compared with eating grains, like the original Food Guide Pyramid). It also recommended focusing on the type of food instead of the serving size, eating plants, cutting back on “American staples” like red meat and sugary drinks, and taking a multivitamin or drinking a glass of wine.

“MyPlate mixes science with the influence of powerful agricultural interests, which is not the recipe for healthy eating,” Harvard’s Willett said in 2011.

That said, the MyPlate is still the nation’s nutrition guide.

“To its credit, at least MyPlate didn’t tout refined carbohydrates; however, its low-fat imperative continues to miss the point and it somehow still categorizes fruit juice and fruit and veggie straws as a vegetable,” Lustig wrote in  Metabolical . “The evidence base for any and all of these classification systems is spotty at least and nonexistent at worst.”

Want to learn more about Levels and CGM?

Levels, the health tech company behind this blog, helps people improve their metabolic health by showing how food and lifestyle impact your blood sugar, using continuous glucose monitoring (CGM), along with an app that offers personalized guidance and helps you build healthy habits.  Click here to learn more about Levels.

Get updates, new articles, exclusive discounts, and more

Levels Investigates

How healthy are school lunches?

The National School Lunch Program has succeeded in reducing student hunger. Now it needs to address the metabolic dysfunction it helped promote.

March 17, 2023

Why have dietary guidelines been so wrong, and how do they still need to change?

Official dietary guidelines play a significant role in setting policy and habits. Here’s why they once demonized fat in favor of carbs and why they still recommend added sugar.

Jennifer Chesak

October 7, 2021

12 min read

Expert Q&A

Big Ag feeds into Big Pharma: Metabolic health benefits from regenerative farming

Dr. Robert Lustig on our broken food system, and how it’s wreaking havoc on our health.

The Levels Team

September 1, 2022

22 minutes read

Dr. Robert Lustig on why current thinking about food and health is wrong and how we begin to change it

In a book club session for Metabolical, Dr. Lustig talks about why ultra-processed food is poison, why obese kids are victims, and why insulin is key

October 5, 2021

27 min read

The Latest From Levels

The Explainer

How continuous glucose monitoring (CGM) can help during menopause

Post-menopausal women have an increased risk of cardiometabolic disease. Here’s how a CGM can help you focus on metabolic health.

August 8, 2024

Anjali Dsouza, MD

Can meal tracking help you lose weight?

Research shows that logging meals regularly can help people hit nutrition goals, including losing weight. 

Monique Brouillette

July 31, 2024

5 mins read

Stephanie Greunke, RD

Can blood type affect my blood sugar? Probably not

A handful of studies show correlations between blood type and diabetes risk, but so far, the research is too thin to suggest a real connection.

Uzma Rentia

July 24, 2024

Rich Joseph, MD

Metabolic Markers

How does cortisol affect metabolic health?

Too much of this stress hormone may increase the risk of Type 2 diabetes and other conditions. But you can take action to keep cortisol in check.

Hallie Levine

July 18, 2024

Dominic D'Agostino, PhD

Sign up for the Levels Newsletter

Subscribe to our free Newsletter! →

Home › Historical News

How Ancient Egyptians built this iconic pyramid using an advanced hydraulic system

By StudyFinds Staff

Reviewed by Steve Fink

Research led by Xavier Landreau, CEA Paleotechnic Institute

Aug 05, 2024

Djoser or Step Pyramid, the first pyramid built in Egypt. (Photo by Punnawit Suwattananun on Shutterstock)

PARIS — The first pyramid built by ancient Egyptians may have been accomplished using an ingenious hydraulic system. An eye-opening study of the iconic Step Pyramid of Djoser at Saqqara challenges long-held beliefs about pyramid construction techniques and sheds new light on this ancient civilization’s engineering prowess.

The research, published in the journal PLOS ONE , proposes that a complex network of dams, water treatment facilities, and a hydraulic lift mechanism were employed to move massive stone blocks during the pyramid’s construction around 2680 BC. This finding could revolutionize our understanding of how these monumental structures were built.

At the heart of this theory is the idea that the ancient Egyptians harnessed the power of water from nearby wadis – dry riverbeds that occasionally flood during rainy seasons. The researchers identified a previously undocumented watershed west of the Saqqara site, which they believe was crucial to the hydraulic system.

The study suggests that a massive structure called the Gisr el-Mudir, long considered an unfinished building or fortress, actually served as a check dam. This dam would have trapped sediment and regulated water flow from the wadis, creating a controlled water supply for the construction site.

Downstream from this dam, the researchers identified what they believe to be an elaborate water treatment system. This includes a series of settling basins and filtration channels carved into the bedrock, which would have cleaned and purified the water before it was used in construction.

But the most intriguing aspect of this hypothesis is the proposed hydraulic lift mechanism. The researchers suggest that the ancient builders created a system of shafts and chambers within the pyramid itself, which could be filled with water. A large wooden float placed in this shaft could then be used to lift heavy stone blocks as the water level rose.

This method would have allowed the ancient Egyptians to raise massive stones with relatively little manpower, potentially explaining how they were able to build such enormous structures in a relatively short time.

If confirmed, this discovery could rewrite the history books on ancient Egyptian engineering and construction techniques. It suggests a level of hydraulic knowledge and expertise far beyond what was previously attributed to this early civilization.

The implications of this research extend beyond just pyramid construction. It paints a picture of an ancient Egypt that was incredibly advanced in its water management techniques, using these skills not just for agriculture and daily life, but also for monumental building projects.

This study opens up new avenues for research into other ancient Egyptian structures and may prompt archaeologists to re-examine sites with an eye for potential hydraulic systems. It also highlights the importance of interdisciplinary research, combining archaeology with geology, hydrology, and engineering to unlock the secrets of the past.

While more research is needed to confirm these findings, this study provides a fascinating new perspective on one of the world’s most enduring mysteries – how the pyramids were built. It reminds us that the ancient Egyptians were not just master builders, but also brilliant engineers and problem-solvers, capable of harnessing the power of nature in ways we’re only now beginning to understand.

Paper Summary

Methodology.

The researchers used a combination of high-resolution satellite imagery, digital elevation models, and geospatial data analysis to map the ancient watershed and identify potential hydraulic structures. They also conducted detailed analyses of archaeological reports and architectural plans of the Djoser complex. The team created 3D models and used computer simulations to test the feasibility of their proposed hydraulic lift mechanism.

The study identified a previously undocumented 15 km² watershed west of the Saqqara site, potentially connected to a larger 400 km² basin. It reinterpreted the Gisr el-Mudir structure as a check dam and identified a series of rock-cut compartments south of the Djoser complex as a water treatment system. The internal architecture of the Step Pyramid was found to be consistent with a hydraulic lift mechanism. Computer models suggested that the proposed system could have provided sufficient water and lifting capacity for pyramid construction.

Limitations

The study is largely based on analysis of existing archaeological data and remote sensing, without new on-site excavations. The exact dates and purposes of some structures remain uncertain. The proposed hydraulic system has not been physically proven, and alternative explanations for some features may exist. The study also relies on estimates of ancient rainfall and water availability, which have inherent uncertainties.

Discussion and Takeaways

The researchers argue that their findings suggest a much higher level of hydraulic engineering in ancient Egypt than previously recognized. They propose that this hydraulic system may have been used in conjunction with other known construction techniques like ramps. The study suggests that similar systems may have been used for other pyramids and calls for re-examination of other ancient Egyptian sites for potential hydraulic features. The researchers emphasize the need for interdisciplinary approaches in archaeology, combining traditional methods with modern technology and engineering principles.

Funding and Disclosures

The study was conducted by researchers from various institutions, including Paleotechnic (Paris), INRAE (Grenoble), and the University of Orléans. Some authors are affiliated with private companies (Sicame Group, AtoutsCarto, Verilux International), which provided support in the form of salaries. The specific roles of these authors are detailed in the paper. No conflicts of interest were reported.

About StudyFinds Staff

StudyFinds sets out to find new research that speaks to mass audiences — without all the scientific jargon. The stories we publish are digestible, summarized versions of research that are intended to inform the reader as well as stir civil, educated debate. StudyFinds Staff articles are AI assisted, but always thoroughly reviewed and edited by a Study Finds staff member. Read our AI Policy for more information.

Our Editorial Process

StudyFinds publishes digestible, agenda-free, transparent research summaries that are intended to inform the reader as well as stir civil, educated debate. We do not agree nor disagree with any of the studies we post, rather, we encourage our readers to debate the veracity of the findings themselves. All articles published on StudyFinds are vetted by our editors prior to publication and include links back to the source or corresponding journal article, if possible.

Our Editorial Team

Editor-in-Chief

Chris Melore

Sophia Naughton

Associate Editor

Related Content

Just how much alcohol is really safe to drink?

August 8, 2024

Going vegan vs. Mediterranean diet: Surprising study reveals which is healthier

August 9, 2024

Earth’s inner workings exposed in landmark mantle recovery

Leave a reply cancel reply.

©2024 Study Finds. All rights reserved. Privacy Policy • Disclosure Policy • Do Not Sell My Personal Information

Ancient Egyptians May Have Used Hydraulic Lift to Build Pyramid

Researchers propose that a system of water could have lifted heavy stones to the height necessary to construct the Step Pyramid

Will Sullivan

Daily Correspondent

Standing as much as hundreds of feet tall and made of stones weighing up to 100 tons, Egypt’s pyramids are a remarkable feat of ancient engineering. To this day, scientists aren’t entirely sure how they were constructed.

In a study published Monday in the journal PLOS One , researchers propose that ancient people may have relied on water to build the Step Pyramid of Djoser in Saqqara, Egypt. They suspect a hydraulic system may have helped lift stones from the center of the pyramid.

“This is a watershed discovery,” Xavier Landreau , first author of the new study and CEO of the private research institute Paleotechnic in France, tells Live Science ’s Jennifer Nalewicki. “Our research could completely change the status quo [of how the pyramid was built].”

Some other researchers are not yet convinced by the argument.

Judith Bunbury , a geoarchaeologist at the University of Cambridge in the U.K. who did not contribute to the findings, tells Ars Technica ’s Jennifer Ouellette that while there is evidence of Egyptians using other hydraulic technologies at the time, there isn’t evidence of a hydraulic lift system.

“While information from this period is sparse, it is not absent, and it is surprising when so many other details of daily life and technologies are recorded in the Old Kingdom tomb scenes and texts like the Red Sea Scrolls, that this type of device is omitted if it were in use,” she says to the publication.

The Step Pyramid of Djoser was built around 4,700 years ago as a burial complex for King Djoser . It’s the oldest important stone building in Egypt, according to Encyclopedia Britannica . The Step Pyramid was the first design to use a pyramid shape for the pharaoh's grave and was innovative in how it raised and precisely stacked stones that had been shaped in a particular fashion, per the new paper.

The stones used for the pyramid weighed more than 650 pounds, and the building stretched to about 200 feet high. Later pyramids would grow to taller heights and were made of even larger stones.

Researchers have proposed many techniques that ancient Egyptians may have used to raise stones to the heights needed to construct the pyramids, including ramps, cranes, hoists and pivots. But “no generally accepted wholistic model for pyramid construction exists yet,” the study authors write.

For the new study, the researchers propose that a massive enclosure to the west of the pyramid could have served as a dam that trapped sediment and water. Water could have then flowed east into a floodplain that was possibly once a lake, and from there into the Dry Moat surrounding the pyramid.

The researchers argue that compartments in the moat could have acted as a water treatment facility, purifying water and regulating its flow.

Finally, the water in the moat may have been used to elevate stones. Water entering a vertical shaft could have allowed a pulley system to raise a float and lower a platform, writes Science News ’ Bruce Bower. Then people could have placed rocks on the platform and drained the shaft, lowering the float and raising the platform, per Science News .

Researchers have previously found evidence that ancient Egyptians used hydraulics for other purposes, such as delivering materials, building ports and locks and constructing irrigation systems, the study authors write.

Bunbury tells CNN ’s Taylor Nicioli there may have been enough water to support a hydraulic lift. On the other hand, Oren Siegel , an archaeologist at the University of Toronto who was not involved in the research, tells Science News that the proposed dam could not have held enough water from occasional rain to maintain a hydraulic system.

Get the latest stories in your inbox every weekday.

Will Sullivan | | READ MORE

Will Sullivan is a science writer based in Washington, D.C. His work has appeared in Inside Science and NOVA Next .

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• v.5(3); 2014 May

The FINUT Healthy Lifestyles Guide: Beyond the Food Pyramid 1, 2, 3

Departments of 4 Biochemistry and Molecular Biology II

7 Iberomerican Nutrition Foundation (FINUT), Granada, Spain

Maria Dolores Ruiz-Lopez

5 Nutrition and Food Science, and

Miguel Fernandez-Gonzalez

Emilio martinez de victoria.

6 Physiology, Institute of Nutrition and Food Technology, Center of Biomedical Research, University of Granada, Granada, Spain; and

The WHO has proposed that health be promoted and protected through the development of an environment that enables sustainable actions at individual, community, national, and global levels. Indeed, food-based dietary guidelines, i.e., food pyramids, have been developed in numerous countries to disseminate nutritional information to the general population. However, wider recommendations are needed, with information on an active healthy lifestyle, not just healthy eating. The objective of the present work is to propose a three-dimensional pyramid as a new strategy for promoting adequate nutrition and active healthy lifestyles in a sustainable way. Indeed, the Iberoamerican Nutrition Foundation (FINUT) pyramid of healthy lifestyles has been designed as a tetrahedron, with its 3 lateral faces corresponding to the facets of food and nutrition, physical activity and rest, and education and hygiene. Each lateral face is divided into 2 triangles. These faces show the following: 1 ) food-based guidelines and healthy eating habits as related to a sustainable environment; 2 ) recommendations for rest and physical activity and educational, social, and cultural issues; and 3 ) selected hygiene and educational guidelines that, in conjunction with the other 2 faces, would contribute to better health for people in a sustainable planet. The new FINUT pyramid is addressed to the general population of all ages and should serve as a guide for living a healthy lifestyle within a defined social and cultural context. It includes an environmental and sustainability dimension providing measures that should contribute to the prevention of noncommunicable chronic diseases.

Introduction

In recent years, the definition of health has been under debate ( 1 ). The most commonly quoted definition of health was published by the WHO in the 1940s: “a complete state of physical, mental and social well-being, and not merely the absence of disease or infirmity” ( 2 ). At the end of the 20th century, Saracci ( 3 ) included the consideration of human rights, basic and universal, in the definition of health. In the present century, Bircher ( 4 ) related the term “health” to age, culture, and personal responsibility. Others consider the social, emotional, and spiritual wellness of the whole community in addition to the wellness of the individual ( 5 ).

In the Global Strategy on Diet, Physical Activity, and Health ( 6 ), the WHO has proposed developing an environment that enables sustainable actions at the individual, community, national, and global levels to promote and protect health and to reduce disease and death rates related to unhealthy diet and physical inactivity. Within this context, the FAO has established links between agriculture, health, and the environment and food industries in the document “Sustainable Diets and Biodiversity” ( 7 ). This document includes the concept of sustainable diets and their contribution to nutrition security and a healthy life for present and future generations. In addition, it proposes the double pyramid of healthy food for people and sustainable food for the planet and promotes the Mediterranean diet as a sustainable food model, which preserves both agriculture and health. Moreover, it also promotes the idea that biodiversity and traditional food systems can ensure food security in developing countries.

In addition to the WHO Global Recommendations on Physical activity and Health ( 8 ) and the position statement of the American College of Sports Medicine about fitness in healthy adults ( 9 ), the United Nations Educational, Scientific, and Cultural Organization (UNESCO) has emphasized sustainable active living as a way to better integrate sustainable development with physical education and sport (sustainable active living) and how they are related to a healthy society ( 10 ).

Since 1992, when the International Conference on Nutrition established the need for the development of food-based dietary guidelines as a new strategy to disseminate nutritional information to the general population, many countries have developed their own food guidelines. These guides promote sustainable foods and diversification of the diet through the production and consumption of foods that are rich in micronutrients ( 11 – 14 ). Several pictorial representations, mainly in the form of food pyramids, have been developed in a number of countries; the first one was proposed by the Food and Nutrition Board of the National Academy of Sciences ( 12 , 13 ). The European Food Information Council has reviewed the European food guidelines; most of these guidelines include recommendations on food consumption using a “triangle,” usually referred as to “food pyramid,” although others adopted other forms, such as circles mimicking a dish or truly three-dimensional figures ( 14 ). On the basis of the USDA Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans 2010 ( 15 ), the MyPlate pictorial was created; later, the Healthy Eating Plate was designed by nutrition experts at the Harvard School of Public Health and editors at Harvard Health Publications to address deficiencies in the USDA’s MyPlate ( 16 ).

Despite the nutritional recommendations and food guidelines, the pandemic of noncommunicable chronic diseases (NCCDs) 8 continues in both developed and developing countries ( 17 ). Therefore, wider recommendations are needed, with information on an active healthy lifestyle, not just on food. Thus, the recently revised Mediterranean pyramid includes some lifestyle recommendations, such as regular physical activity, eating with others, cooking at home, etc. ( 18 – 20 ). However, these recommendations do not appear to be enough to help the citizens worldwide reach an optimum health status. In addition to appropriate food guidelines, global health recommendations should promote physical activity and exercise, personal and food hygiene, education and other aspects associated with a sustainable environment, and human rights.

The Iberoamerican Nutrition Foundation (FINUT) is a nonprofit organization; its trustees are the International Union of Nutritional Sciences (IUNS), the Spanish Society of Nutrition (SEÑ), and the Latin American Federation of Nutrition Societies (SLAN). In consideration of all of the previously mentioned factors, FINUT has developed a new three-dimensional pyramid of food and active healthy lifestyles in a sustainable environment. The goal is to decrease the burden of NCCDs around the world and particularly in Latin America, where the double burden of malnutrition and obesity coexists with chronic diseases. The FINUT proposed this new pyramid at the recent 21st International Congress of Nutrition held in Granada, Spain.

The pyramid was developed from 2011 to 2013 as the central message of the exhibition “Nutrition, Source of Life,” which was open to the public at Parque de las Ciencias de Granada, Spain, on the occasion of the celebration of the IUNS 20th International Congress of Nutrition in September 2013.

To develop the FINUT pyramid concept, in addition to the information obtained through specific PubMed searches as described below, 3 different focus groups were organized in conjunction with a communication company (Ogilvy Action, Madrid, Spain) with the participation of people of different ages and socioeconomic status. A mixed scientific committee formed by members of the Parque de las Ciencias de Granada, 2 community members from secondary schools, and 3 full professors from the University of Granada, Spain (A.G., M.D.R.-L., and E.M.d.V.) were involved in the evaluation of focus group results.

At the request of the FINUT, the authors of the present article conducted a literature search and review on the food guidelines and healthy lifestyles. Reviewers, working independently, were to select, quality assess, and extract relevant data where appropriate and possible. Studies were restricted to those with human participants only and included prospective studies. We conducted the literature search by using the PubMed databases for articles cited through September 2013. Searches were conducted by using Medical Subject Headings (MeSH) combined with keyword searches to capture all indexed studies. Bibliographic searches were also conducted to ensure inclusion of all relevant studies. Initially, we performed a prospective and qualitative review by using combinations of the following selected MeSH terms, among others: “diet/standards,” “environment,” “environmental health,” “exercise,” “feeding behavior,” “food … habits,” “food guidelines,” “guidelines as topic,” “food pyramid,” “practice guidelines as topic,” “physical fitness,” “public health,” “sanitation,” “social conditions,” and “social environment.” Later, we performed a systematic review, and the search strategy retrieved 899 primary articles. The abstracts were reviewed and studies were included if they were related to food guidelines and recommendations for healthy lifestyles. Full-text copies of the articles meeting those criteria were then screened for their suitability for inclusion, and those meeting the inclusion criteria were manually cross-referenced. A total of 198 articles met the initial search criteria.

The following equations for specific searches were used to find and evaluate relevant literature related to food pyramid and healthy lifestyles: “Diet Pyramid” (“food habits” OR “diet”) AND (“environment” OR “conservation of natural resources” OR “agriculture”) AND (“guidelines as topic” OR “practice guidelines as topic”); “diet/standards” AND (“guidelines as topic” OR “practice guidelines as topic”); “Eating” AND “Pyramid” (“ exercise”) AND (“environment”) AND (“guidelines as topic” OR “practice guidelines as topic”); “exercise" OR ”Motor activity" OR “physical fitness" AND “Pyramid” (“feeding behavior” OR “nutrition policy” OR “food habits”) AND (“environment” OR “conservation of natural resources” OR “agriculture”) AND (“guidelines as topic”); “Food Pyramid” (“hygiene” OR “sanitation”) AND (“environment” OR “conservation of natural resources” OR “agriculture”) AND (“guidelines as topic”); “hygiene" AND “Pyramid” (“motor activity”) AND (“environment”) AND (“guidelines as topic” OR “practice guidelines as topic”); and (“physical activity” OR “physical fitness”) AND (“environment”) AND (“guidelines as topic” OR “practice guidelines as topic”). In addition, review bibliographies of books and review articles, and references from retrieved articles were explored.

On the basis of the title of publication and the abstract identified from the trial search, irrelevant citations were discarded by the reviewers (A.G., M.D.R.-L., and E.M.d.V.). If there was any possibility that the article could be relevant, the full-text article was retrieved for further assessment. Two reviewers (A.G. and E.M.d.V.) independently decided which trials met the inclusion criteria. Any disagreement was resolved by discussion between the reviewers, with referral to a third reviewer (M.D.R.-L.) to adjudicate any persisting differences.

On the basis of that review, we developed a new three-dimensional lifestyle pyramid (The FINUT pyramid) addressed to the general population, which included selected recommendations on the following 3 main facets of active healthy lifestyles: 1 ) food and nutrition, 2 ) physical exercise and rest, and 3 ) education and hygiene. Each of these facets occupies one-half of the 3 lateral faces of a tetrahedron. The other half of each face is paired with a number of practices and recommendations to increase environmental sustainability and to improve the local educational, social, and cultural surroundings. Hence, each lateral face of the tetrahedron is divided into 2 triangles. The right halves are structured recommendations as follows: 1 ) food consumption, arranged in ascending order on the basis of relative intake frequency; 2 ) adequate patterns of rest, physical activity, and exercise, also arranged by recommended frequency, with less frequent activities at the summit; and 3 ) appropriate measures and patterns of education and hygiene. The present FINUT pyramid of active healthy lifestyles has been designed as a simple and intuitive tool so that it does not need any additional information to be easily interpreted. The base of the FINUT pyramid makes the claim for healthy lifestyles in a sustainable planet. Citations for all of the claims included in a pyramid graphic are not feasible in this supplement article. However, to trace the scientific basis of the various claims for the FINUT pyramid, we have identified the major documents we considered in building up the evidence base of our pictorial ( 6 – 8 , 15 , 17 , 20 – 24 ).

Figures 1–3 depict the 3 facets corresponding to food and nutrition, physical activity and rest, and education and hygiene that constitute the FINUT pyramid. Figure 4 corresponds to the base of the pyramid, which makes the claim for healthy lifestyles for people within the context of a sustainable planet.

Food and nutrition face of the Iberoamerican Nutrition Foundation (FINUT) pyramid of healthy lifestyles. The images of the FINUT pyramid were previously registered as a trademark by the FINUT.

Physical activity and rest face of the Iberoamerican Nutrition Foundation (FINUT) pyramid of healthy lifestyles. The images of the FINUT pyramid were previously registered as a trademark by the FINUT.

Education and hygiene face of the Iberoamerican Nutrition Foundation (FINUT) pyramid of healthy lifestyles. The images of the FINUT pyramid were previously registered as a trademark by the FINUT.

Base of the Iberoamerican Nutrition Foundation (FINUT) pyramid, which makes a claim for healthy lifestyles for people in a sustainable planet. The images of the FINUT pyramid were previously registered as a trademark by the FINUT.

Food and nutrition

On this face of the tetrahedron, we show food-based guidelines and healthy eating habits as related to a sustainable environment ( Fig. 1 ) ( 6 , 15 , 20 – 22 ).

Right half of triangle.

In this triangle, guidelines for a varied, balanced, healthy diet, including daily, weekly, and occasional consumption of foods, are provided. The recommended frequency for intakes of the most important groups of foods is illustrated in ascending order from the most to the least frequent. These recommendations are in agreement with those recently proposed in the Mediterranean diet pyramid ( 18 – 20 ). Water and liquid foods are located at the base, promoting body hydration; 1.5–2 L/d of water is recommended. Water from different sources, namely tap or spring water, together with the water in infusions, teas, soups, fruit juices, and other low-sugar drinks, is represented.

On the next step, cereals and their main derivatives (bread, pasta, etc.) are shown. This contributes to a significant portion of the energy provided by the diet along with potatoes, which are frequently used in side dishes in the Mediterranean diet ( 18 – 20 ). From 4 to 6 portions daily of those foods (1 portion = 60–68 g of pasta or rice or 40–60 g of bread), with at least one-half of these from whole-grain cereals, are recommended.

Fruits, vegetables, and related products occupy the next level. This is a diverse food group, including plant roots, bulbs, stems, leaves, flowers, and fruits, which are rich in dietary fiber and micronutrients, as well as bioactive compounds ( 18 – 20 ). At least 5 portions (1 portion = 150–200 g), with a minimum of 2 fresh portions, are recommended.

The fourth level contains milk (i.e., low-fat milk) and dairy products, particularly fermented milks and cheese, which provide protein of a very high quality, as well as calcium and other minerals and vitamins ( 15 , 20 ); the recommended intake for this type of food is 2–3 portions daily (1 portion = 200–250 mL of milk, 200–250 g of yogurt, or 80 g of fresh cheese).

At the next level, virgin olive oil, a major food in the Mediterranean diet ( 18 – 20 ), as well as other healthy unsaturated oils, namely rapeseed or colza, including canola, sunflower, and soybean oils, are considered as the dietary fat of preference not only as part of salad dressing but also for food cooking and frying ( 15 ). This group includes olives, which are also rich in bioactive compounds and fiber. Daily consumption of 3 to 5 portions (1 portion = 10 mL) is recommended.

On the sixth level, the consumption of 2–3 portions daily of protein-rich foods of animal origin (range: 60–150 g), including poultry and other white meats, eggs and fish, as well as plant-based protein-rich foods, namely legumes and nuts, is recommended ( 15 , 18 – 20 ). These foods, which provide not only protein but also many micronutrients and a number of PUFAs ( 22 ), should be consumed by alternating them in main dishes during the week. Up to 4 portions of poultry and white meats (1 portion = 100–125 g), 4 eggs (1 portion = 60–80 g), 2–3 fish portions (1 portion = 125–150 g), and 2 servings of legumes (1 serving = 60–80 g) per week are recommended. In addition, 2 portions (1 portion = 20–30 g) of nuts should be consumed. At the vertex of the triangle, red meats, high-fat products, sweets, and other sugar-enriched products are grouped in the “consume occasionally” bracket ( 15 , 16 , 25 – 30 ).

Wine in moderation plays a role in most Mediterranean countries, and it is widely accepted that ∼1 glass/d of red wine (150–200 mL) might be beneficial mainly due to its relatively high amounts of polyphenols ( 20 ). However, the consumption of wine by North African and Asiatic Mediterranean countries is almost negligible. Because the FINUT pyramid constitutes a global healthy lifestyle guide and is intended not only for adults but also for teenagers we did not include the consumption of wine, even in moderation.

Even though salt has been used for years in the Mediterranean basin for food preservation, namely fish, the Mediterranean diet is intrinsically a relatively low-salt diet ( 20 ). In addition to the relative high consumption of fruits and vegetables, the wide use of spices and herbs in the preparation of meals provides a way to reduce the daily intake of salt.

Left half of triangle.

In this portion of the triangle, we tried to emphasize good food habits and behaviors favoring environmental sustainability and healthy living ( 7 , 23 ). The first pictogram, related to the familiar environment, states the importance of breastfeeding to sustain healthy growth and development ( 6 ). Other social messages include eating with others, particularly with family (i.e., conviviality), as well as cooking at home, which in turn leads to varied and slow eating with relatively small portions ( 20 )

With the label “sustainable agriculture,” we incorporate a new focus on food production linked to the environment and more socially centered on the ecologic sustainability of the production systems ( 7 ). Related to this, avoidance of pesticides for pest control is recommended to maintain the soil quality and healthy agrosystems. Finally, we emphasize the need to maintain biodiversity as a world heritage for present and future generations ( 7 , 23 ).

Agricultural policies are needed to support greater availability. In addition, food distribution policies to facilitate the acquisition of fruits and vegetables at lower prices by consumers should be considered ( 24 , 31 , 32 ). Indeed, fair pay and eating of local and seasonal products and sustainable agriculture and livestock are recommended ( Fig. 1 , left side ).

Physical activity and rest

On this face of the tetrahedron, we illustrate healthy lifestyles related to rest and physical activity ( Fig. 2 ) ( 8 – 10 ).

On this half of the triangle, we include the recommendations for rest and physical activity, the latter arranged by their importance in frequency, duration, and intensity in daily life. On the base of the triangle, we include the recommendation for sleeping at least 8 h/d, although this period should be higher in children and lower with advancing age. A brief daily resting period after lunch is also recommended (e.g., a “siesta”).

On the second level, 8 h of professional or daily labor activities with a brief resting period of at least 30 min are included. Small intervals for stretching are highly recommended for those activities associated with postural stress, such as working for hours in front of a computer (see yellow boxes in Fig. 2 ).

In the third level, relatively light activities (cooking, housekeeping, and quietly walking) are considered. Some daily time for leisure is also recommended (lectures, watching television, cinema, etc.).

The fourth level is devoted to mild physical activity, such as walking, and in the next level, moderate to intense physical activity is recommended, such as rhythmic walking (6 km/h), dancing, jogging, and other active play. The last 2 levels, close to the vertex of the triangle, are dedicated to practicing sports, with aerobic sports in the lower level and anaerobic sports in the upper level. All types of activities (light, mild, and moderate-intense) should be carried out on a daily basis, whereas sports should be played on a weekly basis.

Physical activity should be performed during free time or during time outside the home, at work, and at home, within the context of daily familiar and community activities. Recommendations related to frequency, duration, and intensity are at least 150 min/wk (ideally, 300 min/wk) of aerobic moderate physical activity and approximately half of this value for intense aerobic activities. The former should be split into 30-min periods of moderate exercise 5 times/wk. In addition, muscle-strengthening exercises are recommended at least 2 times/wk.

The left half of the triangle includes all aspects of physical activity and rest related to the environment and sustainability, as well as educational, social, and cultural issues ( 8 – 10 ). Thus, to avoid sedentary behavior, active leisure and transportation, physical activity at school, and the promotion of active aging populations are recommended. Similarly, social aspects related to physical activity, such as sportsmanship, and environmental aspects, such as adaptation and adequate design of outdoor spaces in towns for the practice of physical activity and sports, are envisioned.

Education and hygiene

On this face of the tetrahedron, we include the hygiene and educational habits that should contribute to healthy lifestyles ( Fig. 3 ) ( 6 , 15 , 17 ).

On this face, we show the most important aspects related to education and hygiene that, in conjunction with the other 2 faces, contribute to better health. Body hygiene is critical to preventing microbial contamination and avoiding infectious diseases. Similarly, keeping a home clean and well ventilated results in a suitable environment for domestic tasks, including cooking, playing, and resting, while preventing parasitic infections. An appropriate room design will also decrease the incidence of domestic accidents.

Food hygiene and the appropriate handling of foods, particularly cooking using safe and sustainable foods and noncontaminated tools as well as refrigerating and freezing raw foods and meals, allow people to maintain and preserve the maximum quality of foods, leading to improved food safety and disease prevention ( 15 ). Similarly, personal contribution to reducing enviromental pollution is important to avoiding cross-contamination. In addition, the global protection of children and the commitment to facilitate their education and to augment their social interaction appear to be critical in the acquisition of lifestyle habits that will result in maintaining health. Moreover, road safety and preventing work accidents are key to minimizing deaths worldwide. In addition, providing adequate access to safe drinking water is a key social commitment in the maintenance of health.

The left side of the triangle emphasizes how we should contribute to the sustainability of the environment, particularly by the responsible use and consumption of water and energy, including using sustainable means of transport, as well as maintaining a clean atmosphere by keeping the emissions of residues to a minimum and facilitating the collection and recycling of wastes ( 7 , 23 ).

Currently, health cannot be considered only the absence of disease or the presence of “positive health” as it was established by the WHO’s 1948 definition ( 32 ). In the 20th century, the WHO suggested that health conditions and contextual factors in the form of personal and environmental variables interact to influence two distinct components of health: 1 ) body functions and structures; and 2 ) activities and participation ( 33 ). Because an individual’s functioning and disability occur within specific contexts, the International Classification of Functioning, Disability and Health also included a list of environmental factors ( 33 ).

Considering those aspects of health related to healthy lifestyles in a sustainable environment ( 6 – 8 , 15 , 17 , 20 – 24 , 34 , 35 ), the FINUT has designed a novel three-dimensional pyramid, as a tetrahedron, that is addressed to the general population of all ages to serve as a guide to healthy lifestyles within a defined social and cultural context and with an environmental and sustainability dimension.

This guide is novel in that it reaches far beyond the current recommendations proposed in the current published and available guides of healthy lifestyles. Most current guides deal exclusively with food habits and physical activity, along with some recommendations related to alcohol abuse and tobacco consumption ( 12 – 14 , 18 – 20 , 36 – 45 ).

A three-dimensional, truncated, and staggered healthy lifestyle pyramid exclusively addressed to children and adolescents has also been developed ( 46 ). On this pyramid, 2 faces are formulated around achieving daily food intake (face 1) and daily activities (face 2). The third face is an adaptation of the traditional food guide pyramid, adapted to children’s energy, nutritional, and hydration needs; and the fourth face addresses both daily and life-long habits. However, this pyramid does not include any aspect related to interactions between the environment and food habits, physical activity, and education and hygiene.

The most recent Mediterranean pyramid is a food guide represented as a triangle. Its recommendations include basic information on active living. It mentions social aspects related to conviviality and cultural and environmental aspects, such as home and traditional cooking using local and seasonal products and agricultural sustainability ( 18 – 20 ). However, the guide does not consider any specific recommendations for physical activity and rest or other aspects related to health, namely educational and hygiene aspects, and their interaction with the environment.

One of the most important differences in the present FINUT healthy lifestyles pyramid is that in each of the 3 faces related to health, we devote 1 area to aspects related to frequency of consumption of different foods ( Fig. 1 ), patterns of physical activity and rest ( Fig. 2 ), and individual and community commitments and behaviors related to hygiene in a larger sense ( Fig. 3 ). We devote another area to social, cultural, and environmental aspects as they relate to sustainable development within each of the 3 pyramid faces ( Figs. 1–3 ).

On the face dedicated to food and nutrition, we have used the Mediterranean diet pattern with minimal differences, which has been repeatedly reported both in epidemiologic and intervention studies to have a role in the prevention of NCCDs with high mortality and morbidity, namely cardiovascular disease, cancer, diabetes, and depression ( 47 – 51 ). A number of authoritative reviews provided evidence that consumption of red meat, due to its high content of saturated fat, should be limited ( 25 – 30 ). Hence, in this context we adopted a similar recommendation to that of the Harvard School of Public Health’s Healthy Eating Plate and pyramid for Americans ( 16 ).

For the food and nutrition face, we emphasized the importance of breastfeeding not only to support adequate growth and development of infants but also to prevent NCCDs later in life. In fact, current scientific evidence related to early programming suggests that exclusive breastfeeding during the first months of life contributes to the prevention of obesity and associated chronic diseases ( 52 ). Many countries have included the promotion of breastfeeding in their nutritional goals because of its preventative aspects. In some of these countries, the average duration of breastfeeding has decreased to <2 mo in recent decades, which is much shorter than the WHO and UNICEF recommendations to maintain exclusive breastfeeding for at least the first 6 mo of life ( 52 ).

Similar to the Mediterranean diet pyramid, we recommend the consumption of seasonal and local products. Local food systems should not be designed to completely isolate themselves from trade but rather aim to adapt local food production and markets to suit the environmental and health priorities of a community ( 24 ). Eating locally contributes to the utilization and preservation of species and varieties, which has a clear impact on biodiversity ( 7 ), decreases CO 2 emissions, and improves the price of basic foods, promoting a fair market. Current research indicates that local food systems may offer social, environmental, and health benefits, although the links between use of local food systems and better eating habits and reductions in chronic diseases need to be more clearly established ( 7 , 24 , 31 , 32 ). We also recommend regulating food production, monitoring food quality and safety, and responding to nutritional and safety issues that arise through sustainable agriculture and the protection of biodiversity, as emphasized by the present FINUT pyramid ( 7 , 15 ).

With regard to the physical activity and rest face, our goal was to illustrate a daily or weekly routine, providing easy recommendations in terms of the frequency, duration, intensity, type, and total amount of physical activity needed to prevent NCCDs ( 8 – 10 , 34 ). Similarly, we emphasize how important it is to promote an appropriate environment for physical activity in all ages, especially at schools and for the elderly, creating spaces, particularly in urban areas, for exercising and sports. It is well known that physical inactivity is the fourth risk factor for mortality in the world. It considerably influences the prevalence of NCCDs and the health of the general population, and international recommendations on physical activity have been developed to prevent NCCDs ( 6 ). In addition, inadequate sleep and rest are associated with obesity and other chronic diseases ( 53 ). Hence, the FINUT pyramid can serve as a useful tool to promote physical activity and good resting habits, contributing to the prevention of NCCDs.

Body hygiene and food safety are essential factors in maintaining good health. Major sources of food poisoning in heavily populated and industrialized countries include pathogenic microorganisms, toxic agents, parasites and other organisms entering the food supply, and chemical contamination, including additives and contamination of the food supply by toxic industrial waste ( 54 , 55 ). Moreover, climate change can affect global food production with uncertain consequences for human health, particularly in developed countries ( 56 ). Similarly, adequate water supply and sanitation are critical for the prevention of many diseases. In fact, vast numbers of people are without improved sanitation ( 57 ), and too much wastewater still remains untreated ( 58 ). The FINUT pyramid emphasizes personal commitment to maintaining good personal hygiene habits and safely producing food while maintaining a clean home and environment. It also emphasizes a personal contribution to environmental hygiene and a social commitment to protecting children and providing safe sources of water. We recommend promoting the responsible use and consumption of water while keeping emissions of residues to a minimum and strengthening existing structures and policies to facilitate the collection and recycling of waste, as described in the current FINUT pyramid.

In conclusion, the FINUT healthy lifestyles pyramid, which is based on the 3 facets of food and nutrition, physical activity and rest, and education and hygiene, and their interactions with environmental sustainability, is a novel approach that provides healthy lifestyle guidelines in a holistic framework for populations of all ages. It provides individuals with the information needed to recognize and put into practice individual and social behaviors that promote better individual and community health and the health of future generations.

Acknowledgments

A.G. had primary responsibility for the FINUT Pyramid design, development, final content and contributed to the systematic review of the literature. M.D.R. and E.M.V. were involved in the design, data interpretation, and manuscript preparation; and M.F.-G. was in charge of the pictorials. All authors read and approved the final manuscript.

8 Abbreviations used: FINUT, Iberoamerican Nutrition Foundation; IUNS, International Union of Nutritional Sciences; NCCD, noncommunicable chronic disease.

Literature Cited

• Share full article

Advertisement

Supported by

Declaring ‘Crisis,’ South Korean Firms Tell Managers to Work 6 Days a Week

The move by some influential companies has raised concerns about work-life balance in a country where long hours at the office are common.

By Jin Yu Young

Reporting from Seoul

“Back in the day,” said Lim Hyung-kyu, a retired Samsung Electronics executive now in his 70s, “my weeks were Monday, Tuesday, Wednesday, Thursday, Friday, Friday, Friday.”

Mr. Lim joined Samsung, South Korea’s largest company, in 1976 and rose through the ranks to chief technology officer. For much of his 30-plus years at Samsung, working on the weekends was normal — and legal under the nation’s labor laws. “I didn’t mind,” Mr. Lim said. “It was fun for me.”

Things are different now. South Korean labor laws cap working hours to 52 a week: 40 standard hours with up to 12 for overtime. Weekends are generally considered off limits, and younger employees are mindful of their work-life balance in a way their parents or grandparents weren’t.

But over the past few months, some influential South Korean companies have told executives to work longer hours, in some cases telling them to come to the office six days a week. Some people in South Korean business are predicting that lower-ranked employees and managers at smaller companies will feel pressure to follow suit.

“It’s a signal that in South Korea, working six days a week is still acceptable,” said Kim Seol, a representative of the Youth Community Union, a labor group that represents workers between the ages of 15 and 39.

The pressure on workers, especially young workers, can be intense in South Korea, which has a shrinking, aging population with one of the world’s lowest fertility rates . Fears about job security and the rising costs of housing, child care and education have discouraged working-age Koreans from having children, contributing to a demographic crisis that looms over the economy.

We are having trouble retrieving the article content.

Please enable JavaScript in your browser settings.

Thank you for your patience while we verify access. If you are in Reader mode please exit and  log into  your Times account, or  subscribe  for all of The Times.

Thank you for your patience while we verify access.

Already a subscriber?  Log in .

Want all of The Times?  Subscribe .