nutrients

Article
Food-Based Dietary Guidelines around the World: A
Comparative Analysis to Update AESAN Scientific Committee
Dietary Recommendations
Montaña Cámara 1, * , Rosa María Giner 2 , Elena González-Fandos 3 , Esther López-García 4 , Jordi Mañes 5 ,
María P. Portillo 6 , Magdalena Rafecas 7 , Laura Domínguez 1 and José Alfredo Martínez 8

1 Nutrition and Food Science Department, Pharmacy Faculty, Complutense University of Madrid (UCM),
Plaza Ramón y Cajal, s/n, 28040 Madrid, Spain; ladoming@ucm.es
2 Department of Pharmacology, Faculty of Pharmacy, University of Valencia, 46100 Burjassot, Spain;
Rosa.M.Giner@uv.es
3 Department of Food Technology, CIVA Research Center, University of La Rioja, Madre de Dios,
26006 Logroño, Spain; elena.gonzalez@unirioja.es
4 Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid,
Instituto de Investigación Sanitaria Hospital Universitario La Paz (IdiPAZ), CIBER of Epidemiology and
Public Health (CIBERESP), 28029 Madrid, Spain; esther.lopez@uam.es
5 Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine,



Faculty of Pharmacy, University of Valencia, 46100 Burjassot, Spain; jordi.manes@uv.es

 6 Nutrition and Obesity Group, Department of Pharmacy and Food Sciences,
University of the Basque Country (UPV/EHU) and CIBERobn Physiopathology of Obesity and Nutrition,
Citation: Cámara, M.; Giner, R.M.;
Institute of Health Carlos III, and BIOARABA Health Research Institute, 01006 Vitoria-Gasteiz, Spain;
González-Fandos, E.;
mariapuy.portillo@ehu.eus
López-García, E.; Mañes, J.; 7 Departament de Nutrition, Food Science and Gastonomy, Faculty of Farmacy and Food Science,
Portillo, M.P.; Rafecas, M.; University of Barcelona, 08028 Barcelona, Spain; magdarafecas@ub.edu
Domínguez, L.; Martínez, J.A. 8 IMDEA + CSIC/UAM y CIBEROBN, 28049 Madrid, Spain; jalfredo.martinez@imdea.org
Food-Based Dietary Guidelines * Correspondence: mcamara@ucm.es; Tel.: +34-91-394-1802; Fax: +34-91-394-1799
around the World: A Comparative
Analysis to Update AESAN Scientific Abstract: Food-Based Dietary Guidelines (FBDG) include dietary recommendations based on food
Committee Dietary Recommendations. groups according to the general and accepted nutrition principles and current scientific evidence.
Nutrients 2021, 13, 3131. https://
Adoption of FBDG contributes to the prevention of malnutrition in all its forms, promotes human
doi.org/10.3390/nu13093131
health, and reduces environmental impact. The present review aims to perform an international
comparative analysis of the FBDG adopted in different countries from three different continents
Academic Editors: Clare Collins
and George Moschonis
(America, Asia, and Europe), with particular reference to the Spanish Food Safety and Nutrition
Agency (AESAN, Agencia Española de Seguridad Alimentaria y Nutrición) Scientific Committee
Received: 18 July 2021 dietary recommendations. A total of twelve countries with the most updated FBDG and/or closest
Accepted: 5 September 2021 to the traditional and cultural preferences of Spain were finally selected. All the reviewed FBDG pro-
Published: 8 September 2021 vided recommendations for fruits, vegetables, cereals, legumes, nuts, milk and dairy products, meat
and derivatives, fish, eggs, water, and oil; however, remarkable differences regarding recommended
Publisher’s Note: MDPI stays neutral amounts were found among countries.
with regard to jurisdictional claims in
published maps and institutional affil- Keywords: food-based dietary guidelines; national dietary recommendations; healthy eating; health
iations. promotion; public health

Copyright: © 2021 by the authors. 1. Introduction

Licensee MDPI, Basel, Switzerland. Foods are sources of macronutrients (carbohydrates, proteins, fats) and micronutrients
This article is an open access article
(vitamins and minerals) necessary to cover human metabolism requirements for life and
distributed under the terms and
survival, concerning energy demands for sustainability, growth, development, and repro-
conditions of the Creative Commons
duction [1]. In addition, foods contain biologically active components called “bioactive
Attribution (CC BY) license (https://
compounds” or “phytochemicals”, which are able to contribute to achieving an adequate
creativecommons.org/licenses/by/
health status [2].
4.0/).

Nutrients 2021, 13, 3131. https://doi.org/10.3390/nu13093131 https://www.mdpi.com/journal/nutrients

Nutrients 2021, 13, 3131 2 of 14

The knowledge of food composition (nutrients and bioactive compounds) as well as

defining the different food groups, where they are categorized, is fundamental for food
intake decision-making and promoting human health [1,3]. The consumption of foodstuffs
from different food groups in balanced proportions ensures the adequate intake of nutrients
and bioactive compounds with potential benefits for human health [4]. Scientific evidence
has demonstrated that a varied and balanced diet with a predominant consumption of
plant-based food groups (fruits, vegetables, legumes, cereals, nuts, etc.) over food groups
of animal origin promotes health and reduces environmental impact [5]. According to
EAT-Lancet Commission, the adoption of healthy and sustainable diets could reduce
19.0–23.6% of global deaths (10.8–11.6 million) every year [6]. Thus, focusing exclusively
on human health is not sufficient as inadequate eating patterns adversely affect the en-
vironment and jeopardize well-being, quality of life, and survival of present and future
generations [7,8].
In general, dietary recommendations are based on Dietary Reference Values (DRV)
(also named Recommended Nutrient Intake, RNI; or Recommended Dietary Allowances,
RDAs), which refer to specific nutrients and their recommended intake for each particular
group of the population in order to avoid nutritional deficiencies that can compromise
health. One example is Spain, where the Scientific Committee of the Spanish Agency for
Food Safety and Nutrition (AESAN) in 2019 approved a scientific report to update DRVs of
15 minerals and 13 vitamins for the Spanish population [9].
The European Food Safety Authority (EFSA) has encouraged Member States of the
European Union (EU) to establish dietary recommendations focused on food groups
based on DRVs [10]. In this context, The World Health Organization (WHO) and the Food
and Agriculture Organization of the United Nations (FAO) have promoted the development
of national food-based dietary recommendations in line with the Sustainable Healthy Diets;
that is, considering the economic, cultural, social, and environmental conditions of each
country [11].
In this context, Food-Based Dietary Guidelines (FBDG) are considered short messages
expressed as dietary recommendations based on food groups, in accordance with the
general and accepted nutrition principles and current scientific evidence [7]. FBDG are
focused on preventing malnutrition in all its forms, promoting human health, as well as
reducing environmental impact through the incorporation of the concept of sustainability
within the healthy diet definition [7,12,13].
The objective of the present review is to perform an international comparative analysis
of the FBDG adopted in different countries from three different continents (America, Asia,
and Europe), with particular reference to the AESAN (Agencia Española de Seguridad
Alimentaria y Nutrición) Scientific Committee dietary recommendations.

2. Materials and Methods

Different countries have established FBDG. On its website (http://www.fao.org/
nutrition/education/food-dietary-guidelines/en/, accessed on 6 September 2021), FAO [14]
offers a general description of food guides that include recommendations for approved
food groups in diverse countries. Inclusion criteria established to select FBDG subjected to
this review include the most updated dietary guidelines as well as those that are closest to
the traditional and cultural preferences of Spain.
Twelve countries were selected considering the inclusion criteria. As shown in Table 1,
the present work critically reviews the international food guides of the United States, China,
the Nordic countries (Finland, Norway, and Sweden), the United Kingdom, Germany, the
Netherlands, France, Portugal, Italy, and Spain.
Nutrients 2021, 13, 3131 3 of 14

Table 1. International overview of Food-Based Dietary Guidelines established in North America

(United States), Asia (China), and Europe (Finland, Norway, Sweden, United Kingdom, Germany,
The Netherlands, France, Portugal, Italy, and Spain). Adapted from [5,14].

Region/Country Food-Based Dietary Guidelines Reference

North America
United States Dietary guidelines for Americans 2015–2020 [15]
Asia
China Chinese Dietary Guidelines [16]
Europe
Finland Finnish nutrition recommendations 2014 [17]
Norway Norwegian guidelines on diet, nutrition, and physical activity [18]
Sweden Find your way to eat greener, not too much, and to be active! [19]
United Kingdom The Balance of Good Health [20]
Ten guidelines for wholesome eating and drinking from the
Germany [21]
German Nutrition Society
The Netherlands Dutch dietary guidelines 2015 [22]
The French National Nutrition and Health Program’s
France [23]
dietary guidelines
Portugal Food wheel guide [24]
Italy Dietary Guidelines for Healthy Eating [25]
NAOS Strategy. [26,27]
Spain
GENCAT Strategy (Generalitat de Catalunya) [28]

3. Results and Discussion

In general, all the national and international dietary guidelines selected and reviewed in
the present work were in accordance with the Sustainable Healthy Diets (healthy eating mod-
els with a low environmental impact) [29], as they provided the following recommendations:
• A varied, balanced diet: eat a wide range of food products from different food groups
and maintain an adequate balance between the energy ingested and the expenditure
of the individuals.
• A diet based mainly on plant-based food; that is, fruits, vegetables, minimally pro-
cessed tubers, cereals (preferably whole grains), unsalted seeds and nuts, as well as
oils and fats with a beneficial omega 3:6 ratio.
• Moderate consumption of meat and its derivatives and dairy products. The diet
should incorporate small amounts of fish and aquatic products from certified fisheries.
• Very limited consumption of food rich in fats, simple sugars, or salt, as well as low in
micronutrients (e.g., fried potatoes, confectionery products, sugary drinks, etc.).
• Intake of water as the main drink, limiting the consumption of other drinks, particu-
larly sugary soft drinks.

3.1. Illustrations Included in the Selected Food Guides

The most commonly used graphic representation in the reviewed dietary guidelines
was an illustration with comprehensible and clear key messages and traffic light colors:
green, amber/yellow, and red. The first one (green color) recommends an increase of
the consumption of certain food groups, above all plant-based food (fruits, vegetables,
legumes, etc.). The amber color promotes a replacement of one specific food group by a
better option (e.g., refined cereals by whole grains). Finally, the red color recommends a
reduction in the consumption of particular food groups, generally red and processed meat,
Nutrients 2021, 13, 3131 4 of 14

salt, sugar, and alcohol. The dietary guidelines of Sweden, The Netherlands, France, and
Spain (GENCAT, Generalitat de Catalunya) used this graphic representation [19,22,23,28].
The nutritional circle, oval, or wheel as well as the plate were the next illustrations most
often used in the selected dietary guidelines. Germany, the United Kingdom, and Portugal
used the nutritional circle, oval, and wheel, respectively [20,21,24], whereas the United
States, China, and Finland included the plate model in their food guides [15–17]. Except
for the Finnish model, both types of graphic representations are divided into segments
with a different size, which reflects how different food groups should contribute towards
the total diet. Although both illustrations depict the relative weight of each food group,
the nutritional circle, oval, and wheel refer to the whole diet, while the plate represents a
single meal.
The pyramid model was used in the dietary guidelines of Finland and Spain (AESAN)
and it is divided in segments or steps according to the contribution of each food group
to the whole diet, so that the lower the level (close to the bottom level), the higher the
importance in the diet [17,26,27].
The Chinese and Swedish food guides included other illustrations not used in other coun-
tries, such as the pagoda and the abacus as well as the keyhole symbol, respectively [16,19].
The pagoda model is similar to the pyramid as the most important food groups are located
in the lower levels. The abacus is directed to children (8–11 years old) and it contains
6 rows with colored beads. Each food group is represented by a specific color, and the
number of beads in each row indicates the portions recommended [16]. The Italian food
guides do not include graphic representations [25].
Table 2 provides a summary of the illustrations used in the selected food guides.

Table 2. International overview of Food-Based Dietary Guidelines established in North America (United States), Asia
(China), and Europe (Finland, Norway, Sweden, United Kingdom, Germany, The Netherlands, France, Portugal, Italy, and
Spain). Adapted from [5,14].

Country/Region
Graphic
Representations United United The Spain
China Finland Norway Sweden Kingdom Germany France Portugal Italy *
States Netherlands AESAN GENCAT
Abacus X
Key messages
X X X X
(e.g., traffic light)
Keyhole symbol X
Nutritional circle,
X X X
oval, or wheel
Pagoda X
Plate X X X
Pyramid X X

* The Italian guidelines do not include graphical representations. X: information included in the National Dietary Guidelines.

Herforth et al. carried out an interesting review of the current FBDG whose informa-
tion was available in the repository of the FAO in order to evaluate the similarities and
differences in the key nutrition messages among countries, although they do not include
information about FBDG that use key messages as graphic representations of the food
groups [30]. In the present manuscript, a total number of 90 FBDG from different regions
of the world were finally selected and reviewed: Europe (33 FBDG), Latin America and the
Caribbean (27), Asia and the Pacific (17), Africa (7), Near East (4), and North America (2).
The results revealed that the illustrations most commonly used in the above-mentioned
FBDG were the pyramid and the circle or plate (39.7% and 26.9%, respectively). In addition,
this review was mainly focused on the Spanish dietary recommendations.
Soy milk in the food group “dairy products” (milk, yogurt, cheese, etc.) as an alterna-
tive of the above-mentioned products was only considered in the United States and the
United Kingdom. In addition, Norway was the only country that specifically recommended
the consumption of lean dairy products.
Nutrients 2021, 13, 3131 5 of 14

3.2. Comparative Analysis of the Food Groups

The results from the comparative analysis of the selected national and international
food guides carried out by the authors of the present work are summarized in Table 3.

Table 3. Food groups and other important categories for which the international food guides have established dietary
recommendations.

Country/region
Food Group United United The Spain
China Finland Norway Sweden Germany France Portugal Italy
States Kingdom Netherlands AESAN GENCAT
Fruits X X X X X X X X X X X X X
Vegetables X X X X X X X X X X X X X
Starchy foods X X X X X X X X X X X X X
Legumes X X X X X X X X X X X X X
Nuts X X X X X X X X X X X X X
Soy products X X n.a. n.a. - - - - - - - - -
Dairy products X X X X X X X X X X X X X
Meat and
X X X X X X X X X X X X X
its products
Fish X X X X X X X X X X X X X
Seafood X - - - X - - - - - X - X
Eggs X X X X X X X X X X X X X
Water and other
X X X X X X X X X X X X X
liquids (tea, etc.)
Oil X X X X X X X X X X X X X
Salt X X X n.a. X X - X - X X X X
Sugar X X n.a. n.a. X - - - - - X - X
Alcohol X X n.a. n.a. X - - X X - X - -
Physical activity X X X X X X X X X X X X X

X: information included in the National Dietary Guidelines; n.a.: Information not available in the official English version of the National
Dietary Guidelines; -: food or food group not mentioned in the National Dietary Guidelines.

Focusing on plant-based food groups, it is important to highlight that the dietary

guidelines from Finland, Norway, Italy, and Spain (GENCAT) specifically recommended
the consumption of whole grains. In the rest of the countries (United States, China, Sweden,
United Kingdom, Germany, The Netherlands, France, Portugal, and Spain (AESAN)), it
was indicated that the consumption of whole products should be promoted versus the
consumption of refined ones. With respect to the soy products, advised consumption was
only recommended in the food guides of the United States and China.
Regarding the food groups of animal origin, all the selected dietary guidelines gener-
ally recommended reducing the consumption of meat, mainly red and/or processed meat.
The inclusion of seafood within the food group “fish” was only considered in the food
guides of the United States, Sweden, Italy, and Spain (GENCAT).
The consumption of virgin olive oil was particularly promoted in some of the countries,
except for the United States, China, The Netherlands, France, and Portugal. All the
reviewed dietary guidelines generally recommended reducing the intake of salt, simple
sugars, and alcohol, but only few countries suggested a maximum daily intake. Finally, the
performance of daily physical activity was promoted in all countries.
These results are in accordance with the studies by Montagnese et al. and Herforth et al. [30,31].
Montagnese et al. performed a comprehensive comparative analysis of the FBDG of
34 European countries. Although important differences among these dietary guidelines
were found due to geographical, social, and cultural factors, the great majority of the key
nutritional points were similar among countries (e.g., promotion of the consumption of
plant-based food such as fruits, vegetables, and cereals, and reduction of the consumption
of animal products, fats, sugars, and salt). Likewise, Herforth et al. reported that most of
the reviewed food guides recommended following a varied diet, with a clear predominance
Nutrients 2021, 13, 3131 6 of 14

of plant-based food groups (fruits, vegetables, legumes) and a limited consumption of fat,
salt, and sugar. The recommendations related to nuts, dairy products, red meat, and oil
were more variable among countries. In addition, the consumption of nuts, whole grains,
and healthy fats was not promoted in all the countries despite the WHO recommendations.

3.3. Recommendations for Specific Food Groups: Established Daily Intakes

A more comprehensive comparative analysis of the selected food guides regarding
the specific recommendations established for each food group was carried out. Tables 4–6
summarize the most important findings of all the reviewed dietary guidelines (see Table 1
for references). It is important to highlight that the Italian dietary guidelines establish
various daily and weekly intakes for each food group according to three different caloric
intakes (1500, 2000, and 2500 kcal/day). In the present work, Italian recommendations will
be provided as a range of the three caloric intakes.
Fruits and vegetables are low-energy density foods whose regular consumption con-
tributes to a diversified and nutritious diet by providing a wide range of micronutrients,
such as minerals (mainly magnesium and potassium) and water-soluble vitamins (C and
B9 or folic acid), and bioactive compounds, when consumed fresh and uncooked. Dietary
fiber is another important bioactive compound in these food groups, with a general pre-
dominance of the soluble fraction (pectins, gums, mucilages) in fruits. Carotenoids without
provitamin-A activity are present in some fruits and vegetables; for instance, lycopene
(above all in watermelon and tomato) and zeaxanthin (especially in corn), among others [1].
Cereals, particularly whole grains, contain high quantities of insoluble dietary fiber
(cellulose, hemicellulose, lignin), whereas the soluble fraction of fiber is present in sig-
nificant amounts in oat. An adequate daily intake of cereals also provides soluble and
insoluble carbohydrates, B-group vitamins such as B1 , B3 , B6 , and B9 , and minerals such as
magnesium, zinc, calcium, and iron (especially in whole grains) [1].
Legumes are foods high in carbohydrates, fiber, and protein, with an important
nutritional value. Starch, stachyose, and raffinose represent the main carbohydrates in these
plant-based foods. Except for methionine (present in grains), legumes contain all amino
acids, including lysine, which is limited in cereals. For this reason, it is recommended to
combine the consumption of legumes and cereals in the same meal to increase its nutritional
value. Other important compounds present in legumes are vitamins (B1 , B2 , B3 , B9 , C,
carotenes) and minerals (calcium, magnesium, zinc, potassium, iron). Fruits, vegetables,
and cereals’ fat content is low. Legumes have a proper lipid profile as monounsaturated
and polyunsaturated fatty acids are the predominant ones [1,32,33].
Nuts (walnuts, almonds, hazelnuts, peanuts) are high-energy foods due to their
important quantity of fat (nearly 50%); however, the lipid profile is adequate as nuts
contain mostly monounsaturated and polyunsaturated fatty acids, such as linoleic acid.
The consumption of nuts also provides some vitamins (B6 , E) and minerals (magnesium,
potassium) [1,3,34].
Focusing on the plant-based food groups (Table 4), all the reviewed dietary guidelines,
with the exception of the Swedish one, suggested specific recommendations for fruits and
vegetables. Norway, the United Kingdom, Germany, France, Italy, and Spain (AESAN
and GENCAT) recommended eating at least 5 servings/day. The Portuguese food guide
proposed a higher number of servings, as it recommended 3–5 servings/day for fruits
and 3–5 servings/day for vegetables; that is, a total of 6–10 servings/day counting both
food groups. China, Finland, and The Netherlands directly suggested specific amounts
(at least 200 g/day), instead of servings. In summary, all the selected dietary guidelines
promote the consumption of a great variety of fruits and vegetables, which contribute to
the maintenance of an appropriate health status. According to López-González et al., the
higher the quantity and variety in fruit and vegetables’ consumption, the better nutrient
adequacy and diet quality [35].
Nutrients 2021, 13, 3131 7 of 14

Table 4. Dietary recommendations for food groups of plant origin established by the international food guides selected in the present work.

Food Groups of Plant Origin

Country/Region
Fruits Vegetables Starchy Foods Legumes Nuts Soy Products
United States 2 cups-eq/day 2 12 cups-eq/day 6 oz-eq/day 1 12 cups-eq/week 5 oz-eq/week
300–500 g/day (150–250 g of
China 200–350 g/day 250–400 g/day (50–150 g of whole grains and legumes, 50–100 g of tubers) - At least 25 g/day
dark green vegetables)
Finland >500 g/day (potatoes not included) - - - -
Norway At least 5 servings/day - - - n.a.
Sweden - - - - - -
United Kingdom At least 5 servings/day - - - -
Germany At least 5 servings/day - - - -
At least 90 g/day of whole grain bread or At least 15 g/day of
The Netherlands At least 200 g/day At least 200 g/day - -
other whole grain products unsalted nuts
France At least 5 servings/day (80–100 g/day) 1 portion/meal - A handful/day -
4–11 servings/day (1 loaf of bread = 50 g;
1 thin slice of corn bread = 70 g; 1–2 servings/day (1 tablespoon of
3–5 servings/day (2 cups of raw 1 and 1/2 potato (medium size = 125 g); dried raw legumes (chickpeas, beans,
3–5 servings/day (1 piece of fruit;
Portugal vegetables = 180 g/day; 1 cup of 5 tablespoons of breakfast cereal = 35 g; lentils) = 25 g; 3 tablespoons of fresh raw - -
medium size = 160 g)
cooked vegetables = 140 g/day) 6 biscuits = 35 g; 2 tablespoons of uncooked legumes (peas, beans) = 80 g; 3 tablespoons
rice/pasta = 35 g; 4 tablespoons of cooked of cooked/ fresh legumes = 80 g)
rice/pasta = 110 g)
2 12 –4 12 servings bread/day
(1 serving = 50 g)1–1 21 servings rice and/or 1–1 12
Italy 2–3 servings/day (1 serving = 150 g) 2 12 –3 servings/day (1 serving = 200 g) pasta/ day (1 serving = 80 g)1 12 –3 servings 3 servings/week (1 serving = 150 g) servings/week -
breakfast cereals/week (1 serving = 30 g)1–2 (1 serving = 30 g)
servings potatoes/week (1 serving = 200 g)
2 servings/day (150 g raw in the
3 servings/day (120 g or a medium form of a salad (tomato, lettuce, etc.);
piece/a slice of pineapple/two 1 serving of sautéed/cooked
AESAN - At least 2–3 times/week - -
slices melon/watermelon; 150 mL of vegetables as a main course or as
fresh fruit juice) garnish of meat, fish or eggs
(zucchini, green beans, etc.)
Spain
3 servings/day = 1 piece of fruit
2 servings/day (1 dish of cooked
(1 orange, apple; 2–3 apricots,
vegetables (green beans, puree,
tangerines, plums, etc.); or 1 bowl A handful/day; 3–7
GENCAT stew); 1–2 tomatoes, carrots, - At least 3–4 times/week -
cherries, strawberries, grapes; or handfuls/week
cucumbers; 1 pepper, 1 zucchini,
1–2 slices of melon,
1 eggplant)
watermelon, pineapple)

n.a.: Information not available in the official English version of the National Dietary Guidelines; -: food or food group not mentioned in the National Dietary Guidelines; c-eq: cup-equivalents; oz-eq = ounce-equivalents.
Nutrients 2021, 13, 3131 8 of 14

Table 5. Dietary recommendations for food groups of animal origin established by the international food guides selected in the present work.

Food Group of Animal Origin

Country/Region
Dairy Products Meat and Its Products Fish Seafood Eggs
26 oz-eq/week 26 oz-eq/week
United States 3 cups-eq/day - 8 oz-eq/week
(meats, poultry, eggs) (meats, poultry, eggs)
280–525 g of poultry or lean
China 300 g of milk/day 280–525 g/week - 280–350 g/week
meat/week
5–6 dL of milk/day; 2–3 slices of
Finland <500 g/week - - -
low-fat cheese
Norway - - - - -
Sweden - <500 g/week - - -
2 servings/week (at least one of
United Kingdom - - - -
them must be oily fish)
Germany - - - - -
The Netherlands - - 1 serving/week (preferably oily fish) - -
2 servings/day (one serving = 150 mL of
France <500 g/week - - -
milk or 125 g of yogurt or 30 g of cheese)
2–3 servings/day (1 cup of milk = 250 mL;
1 liquid yogurt or 1 and 1/2 solid
Portugal yogurt = 200 g; 2 thin slices of cheese = 40 g; 1.5–4.5 servings/day (raw meat/fish = 30 g; cooked meat/fish = 25 g) - 1 egg (medium size) = 55 g
1/4 of fresh cheese (medium size) = 50 g;
1/2 curd (medium size) = 100 g)
3 servings milk and fermented
1–3 servings lean meat/week
products/day (1 serving = 125 mL milk, 2–4 times/week; 1 egg
Italy (1 serving = 100 g)1 serving red 2–3 servings/week (1 serving = 150 g of fish including seafood)
125 g yogurt)3 servings cheese/week (medium size) = 50 g
meat/week (1 serving = 100 g)
(1 serving = 100 g)
2–4 servings of fish/week
AESAN - - (1 serving ≈ 100–125 g of filleted fish - -
Spain or 200–250 g of whole fish (not filleted)
3–4 times/week (in case of red 3–4 servings of fish/week (alternate
GENCAT 1–3 times/day - 3–4 times/week
meat, maximum twice/week) oily fish with lean fish)
n.a.: Information not available in the official English version of the National Dietary Guidelines; -: food or food group not mentioned in the National Dietary Guidelines.
Nutrients 2021, 13, 3131 9 of 14

Table 6. Dietary recommendations for water and other liquids, oil, salt, sugar, and alcohol established by the international food guides selected in the present work.

Country/Region Water and Other Liquids Oil Salt Sugar Alcohol

<10% of the daily energy intake No more than 2 alcoholic drinks/day
United States - 27 g/day 5.75 g/day
from added sugars (men) and 1 alcoholic drink/day (women)
7–8 cups of water <50 g/day; <10% of the daily
China <25–30 g/day <6 g/day <25 g/day (men); <15 g/day (women)
(1500–1700 mL/day) energy intake
Finland - - <5 g/day n.a. n.a.
Norway - - n.a. n.a. n.a.
Sweden - - <6 g/day <10% of the daily energy intake <20 g/day (men); <10 g/day (women)
6–8 glasses or cups of
United Kingdom - <6 g/day - -
water/day
Germany At least 1.5 L/day - - - -
Do not consume alcohol or no more than
1 glass/day (1 glass ≈ 10 g of alcohol;
The Netherlands 3 cups of tea/day - <6 g/day - 250 mL of beer ≈ 5% alcohol, 100 mL of
wine ≈ 12% alcohol; 35 mL of
alcohol ≈ 35% alcohol)
No more than 2 glasses/day and
France - - - -
not everyday
1–3 servings/day (1 tablespoon of
olive oil/oil = 10 g; 1 teaspoon of
Portugal - lard = 10 g; 4 tablespoons of <5 g/day - -
cream = 30 mL; 1 tablespoon of
butter/margarine = 15 g)
2–4 servings/day No more than 2 alcoholic
1.2–2 L/day (at least
Italy (1 serving = 10 mL olive <5 g/day 5–10 g/day drinks/day (men) and 1 alcoholic
6–10 glasses of water)
and/or vegetable oil) drink/day (women)
At least 1.5 L/day (5–8 glasses
AESAN - <5 g/day - -
Spain of water or other liquids/day)
GENCAT - - <5 g/day <10% of the daily energy intake -
n.a.: Information not available in the official English version of the National Dietary Guidelines; -: food or food group not mentioned in the National Dietary Guidelines.
Nutrients 2021, 13, 3131 10 of 14

Regarding the starchy foods (cereals, preferably whole grains, bread, pasta, rice, and
potatoes), Portugal proposed the highest amounts (4–11 servings/day) as well as the best-
described recommendations for this group by indicating household measurement for each
food product and its equivalent in grams. Italy established different servings for each food
item (daily amounts for bread and pasta/rice, and weekly intakes for breakfast cereals
and potatoes), France 1 portion/meal, and the Chinese, Dutch, and the Italian guidelines
provided a specific daily amount for starchy foods.
The food group with the lowest number of specific recommendations was soy products
(only two food guides: the United States and China), followed by nuts (five countries: the
United States, The Netherlands, France, Italy, and Spain (GENCAT)) and legumes (six food
guides: the United States, China, Portugal, Italy, and Spain (AESAN and GENCAT)). Spain
only established the frequency for legumes’ consumption (2–3 times/week in AESAN food
guide and 3–4 times/week in GENCAT food guide) but not a specific weekly amount.
Finally, it is important to underline that the only country that provided specific
recommendations for all the plant-based food groups was the United States, where
they are expressed as cup-equivalents (c-eq) and/or ounce-equivalents (oz-eq), where
1 ounce = 0.25 cup = 29.6 mL.
Regarding recommendations for foods of animal origin, most of the dietary guidelines
include milk, dairy products, fish, eggs, meat, and derivatives.
Milk is considered the most complete food item in terms of nutritional composition as
it contains all essential nutrients for humans except for dietary fiber, vitamin C, and iron.
Dairy products (yogurt, cheese, etc.) are an excellent option to achieve an adequate intake
of certain nutrients such as calcium, phosphorus, retinol, vitamin D, and vitamin B12 [1].
Fish are high-protein foods with important quantities of fat (polyunsaturated fatty
acids) in oily fish such as salmon, tuna, mackerel, sardines, and herring, among others.
Liver fish or blue fish are good sources of vitamin D for humans. Eicosapentaenoic and
docosahexaenoic acids (EPA and DHA), other vitamins (retinol, B12 ), and minerals (calcium,
potassium, zinc, iron, phosphorus, iodine, selenium) are present in fish as well [1,32,33].
Eggs contain important quantities of proteins of high biological value (albumin,
ovovitellin, etc.), vitamins D, E, B2 , and B12 , retinol, iron, and iodine. Water and pro-
teins are mainly contained in the egg white, whereas the yolk is high-fat (cholesterol) and
has significant amounts of vitamin D [1,3,34].
Meat and its derivatives are high-protein and high-fat foods with important quantities
of iron, zinc, retinol, and vitamins B1 , B2 , B3 , B6 , and B12 ; however, the lipid profile (in terms
of fatty acids) is not entirely adequate and lean meat is preferred. In addition, the content of
vitamins E and K is very low, and they do not contain dietary fiber, carbohydrates (except
for glycogen and lactose in processed meat), or vitamin C [1].
With regard to the recommended intake of foods of animal origin (Table 5), the
United States, France, and Portugal provided similar recommendations for dairy products
(3 cup-equivalents/day, 2 servings/day, and 2–3 servings/day, respectively). The Chinese,
Finnish, and Italian dietary guidelines recommended specific amounts for milk (300 g/day,
5–6 dL/day, and 125–375 mL/day, respectively) and for cheese, in the case of Finland
(2–3 slices of low-fat cheese/day) and Italy (300 g cheese/week). Norway, Sweden, the
United Kingdom, Germany, The Netherlands, and Spain have no specific recommendations
about daily intakes for dairy products. Spain (GENCAT) only established the frequency for
dairy products’ consumption (1–3 times/day) but not a specific daily amount. The weekly
recommendations for meat and its products, as well as for fish, were quite equal in China,
Finland, Sweden, and France (<500–525 g meat/week). China was the only country that
directly recommended the consumption of poultry or lean meat, and Italy provided differ-
ent weekly servings for lean and red meat. Norway, the United Kingdom, Germany, and
The Netherlands did not include specific amounts for fish, meat, and its products in their
national dietary guidelines. Food groups with the least number of recommendations were
seafood and eggs. Out of the thirteen selected dietary guidelines, only one (United States
food guide) included one specific recommendation for seafood (8 oz-eq/week) and four
Nutrients 2021, 13, 3131 11 of 14

for eggs (United States, China, Portugal, and Italy). Spain (GENCAT) only established the
frequency for eggs’ consumption (3–4 times/week). Last but not least, the dietary guidelines
of the United States, Portugal, and Italy established one specific recommendation that covers
several food groups; that is, 26 oz-eq/week for meats, poultry, and eggs (United States),
1.5–4.5 servings/day for meat and fish (raw meat/fish = 30 g; cooked meat/fish = 25 g)
(Portugal), and 2–3 servings/week for fish and seafood (1 serving = 150 g) (Italy).
Water is fundamental for organism survival as it regulates temperature, protects
tissues and organs, allows nutrient absorption and transportation to cells, and other vital
bodily functions. For that reason, all national dietary guidelines selected in the present
study established recommendations related to water consumption, at least 1.2 L/day. The
recommendations of water and other liquids’ consumption were similar among countries.
China, the United Kingdom, Germany, Italy, and Spain (GENCAT) suggested a daily
consumption of at least 1.2 L/day; that is, between 5 and 8 cups/glasses of water. However,
it is important to highlight that in The Netherlands, the recommended daily intake was
established in just 3 cups of tea/day. This fact demonstrates once again the strong influence
of the cultural, social, and geographical factors.
Olive oil is one of the pillars of the Mediterranean Diet. It consists primarily of
oleic acid (C18:1, ω-9, cis) (80–90%), fatty acids such as linoleic acid (C18:2, ω-6, cis) and
palmitic acid (C16:0), and other bioactive compounds such as vitamin E (α-tocopherol),
phytosterols (especially β-sitosterol), and polyphenols (e.g., oleuropein, tyrosol) [32,33,36].
The dietary guidelines of the United States, China, Portugal, and Italy were the only ones
that recommend a specific daily intake of oil (27 g/day, <25–30 g/day, 10–30 g/day, and
20–40 mL/day, respectively).
Regarding salt consumption, most selected countries were in line with the WHO rec-
ommendations about the maximum daily intake (<5 g/day). The United States suggested
a slightly higher amount (<5.75 g/day), whereas China, Sweden, the United Kingdom, and
The Netherlands proposed the highest daily intake (<6 g/day). The United States, China,
Sweden, France, Italy, and Spain (GENCAT) proposed a maximum daily intake of sugar.
Another recommendation provided by some countries (United States, China, Sweden,
France, and Spain (GENCAT)) was related to the caloric intake from the consumption of
sugar, which should not exceed 10% of the total daily energy intake.
Finally, the consumption of alcohol was particularly limited in the food guides of the
United States, China, Sweden, The Netherlands, France, and Italy. Dutch guidelines had
the most restrictive limit, with the recommendation of no consumption (or not more than
1 glass/day, equivalent to 10 g of alcohol per day). This is followed by France (not everyone
should consume alcohol; <2 glasses/day ≈ 20 g alcohol/day), the United States, Sweden,
and Italy (<2 glasses/day in men ≈ 20 g alcohol/day; <1 glass/day in women ≈ 10 g
alcohol/day), and finally China with the highest limit (<25 g alcohol/day in men and <15 g
alcohol/day in women).
The dietary recommendations for water and other liquids, oil, salt, sugar, and alcohol
established by the selected international food guides are included in Table 6.
Based on previous considerations explained throughout the main text, the Scientific
Committee of AESAN has updated the dietary recommendations regarding each food
group for the Spanish population (Table 7), with the incorporation of portion sizes. Accord-
ing to Almiron-Roig et al., the establishment of adequate food portion sizes is essential to
avoid misunderstandings amongst consumers about the amounts of food that should be
consumed as well as to decrease their likelihood of overeating [37].
Nutrients 2021, 13, 3131 12 of 14

Table 7. Dietary recommendations for each food group and other important categories proposed by the Scientific Committee
of AESAN. Adapted from [5].

Food Group Frequency of Consumption Weight of Each Serving

3–5 servings/day 120–200 g of fresh fruit
Fruits
Sporadically substitute for juice 150 mL of juice
2–4 servings/day
Vegetables 150–200 g
Combine different products (raw and cooked)

Daily consumption 40–60 g of bread

Starchy foods (preferably whole grains)
4–6 servings/day 60–80 g of pasta, rice
Legumes 2–4 servings/week 50–60 g
20–30 g
Nuts Weekly, several times
No salt added
200–250 mL of milk
80–125 g of fresh cheese
Daily consumption
Dairy products 40–60 g of mature cheese
2–4 servings/day
125 g of yogurt, and other fermented
milks, with no added sugar
2–4 servings/week
Meat and its products Preferably chicken or rabbit meat 100–125 g
No more than 2 servings of red meat/week
At least 2 servings/week
Fish/seafood 125–150 g
1–2 servings of oily fish/week
Eggs 2–4 eggs/week Medium size (53–63 g)
Water 1.5–2.5 L/day 200–250 mL
Daily consumption
Virgin olive oil 10 mL
Preferably raw
<5 g salt/day = 2 g sodium/day
Salt Do not add during cooking -
Avoid food with added salt
<30 g/day
Sugar 5–10 g
Avoid foods with added sugar

4. Conclusions
All the reviewed dietary guidelines provided recommendations for the following food
groups: fruits, vegetables, starchy foods (cereals, preferably whole grains, bread, pasta, rice,
potatoes), legumes, nuts, milk and dairy products (yogurt, cheese), meat and derivatives,
fish, eggs, water, and oil (vegetable oils, most importantly virgin olive oil).
Spanish dietary recommendations proposed by the Scientific Committee of AESAN
include a varied and balanced diet characterized by a predominance of plant-based
foods and moderate consumption of foods from animal origin. That is, 3–5 servings
of fruits/day (it could occasionally be replaced by juice), 2–4 servings of vegetables (raw
and cooked)/day, 4–6 servings of cereals/day (preferably whole grains), 2–4 servings of
legumes/week, 2–4 servings of milk and dairy products/day, ≥2 servings of fish/week
(if possible, 1–2 servings oily fish/week), 2–4 eggs/week, and 2–4 servings of meat/week,
preferably chicken or rabbit, and consumption of red meat must not exceed 2 servings/week.
Consumption of nuts without added salt as well as virgin olive oil (preferably raw) is
recommended as well. Finally, 1.5–2.5 L of water/day should be consumed, and daily
intakes of salt and sugar must not exceed 5 and 30 g, respectively.
The present work provided a valuable international overview of twelve food-based
dietary guidelines from three different continents (Asia, North America, and Europe).
This selection includes dietary guidelines from diverse cultures and traditions directly
Nutrients 2021, 13, 3131 13 of 14

linked to their eating habits and patterns; however, a more comprehensive comparative
analysis including more Food-Based Dietary Guidelines approved in other countries and
geographic regions around the world could be addressed in future works based on the
results of the present study.

Author Contributions: Conceptualization, M.C. and L.D.; methodology, M.C., L.D., R.M.G., E.G.-F.,
E.L.-G., J.M., M.P.P., M.R. and J.A.M.; investigation, M.C., L.D. and J.A.M.; writing—original draft
preparation, M.C. and L.D.; writing—review and editing, M.C., L.D., R.M.G., E.G.-F., E.L.-G., J.M.,
M.P.P., M.R. and J.A.M.; funding acquisition, M.C. All authors have read and agreed to the published
version of the manuscript.
Funding: This research was funded by UCM ALIMNOVA Research Group, Ref: 951505, and Project
OTRI Art. 83, Ref: 252-2017, UCM-Fundación Sabor y Salud. Laura Domínguez is grateful for her
PhD grant (UCM-Santander; Ref: CT42/18-CT43/18).
Institutional Review Board Statement: Not applicable.
Informed Consent Statement: Not applicable.
Data Availability Statement: Not applicable.
Acknowledgments: This paper is related to the Report of the Scientific Committee of the Spanish
Agency for Food Safety and Nutrition (AESAN) on the review and update of Dietary Recommen-
dations for the Spanish population. The authors are grateful to all the members of the Scientific
Committee of AESAN (2019–2021) and AESAN staff from NAOS Strategy and Sub-directorate-
General for Food Safety Promotion.
Conflicts of Interest: The authors declare no conflict of interest.

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