Transitioning to Family Meals: Nutrient-Dense Foods for Infants and Toddlers

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Transitioning to Family Meals:

Nutrient-Dense Foods for Infants and Toddlers

Jen Houchins, PhD

Eggs Across the Lifespan

Nutritious Dietary Patterns

Key Messages

  • The 2020 DGAC says “every bite counts” when it comes to feeding infants and toddlers because it is a critical period for growth and development that is characterized by high nutrient needs in relation to the amount of food consumed.

  • The DGAC emphasizes offering developmentally appropriate forms of nutrient-rich animal- sourced foods, including meat, poultry, seafood, eggs and dairy products, as well as nut and seed containing foods, fruits, vegetables, and grain products in age-appropriate forms.


 

While children develop at different rates and individual circumstances can influence feeding needs, the 2020 Dietary Guidelines Advisory Committee summarizes, “A general principle is to view the period from ages 6 to 24 months as a continuous transition from diets appropriate for infants to diets that resemble family food patterns.”1

6 to 12 Months: Provide Complementary Foods with High Nutrient Density

During the first year of life, human milk or infant formula contribute a substantial proportion of total energy. When an infant is developmentally ready (around 4 to 6 months), complementary foods can be introduced.1

The 2020 DGAC recommends:

  • “…consumption of meat, egg, and seafood is an important strategy” for providing key nutrients such as iron, zinc, choline, and long-chain polyunsaturated fatty acids.
  • “Fortified infant cereals can contribute a substantial amount of some of these nutrients, particularly iron and zinc…”
  • “…fruits and vegetables…rich in potassium, vitamin A, and vitamin C…not only to provide adequate nutrition but also to foster acceptance of these healthy foods.”
  • “Introduction of peanut products and egg is advised…” to help reduce the risk of allergies to these foods and “to provide good sources of fatty acids and choline.”
  • “…diets at this age include no remaining energy for added sugars and little energy for added oils or added solid fats.”

12 to 24 Months: Continue to Provide a Variety of Complementary Foods and Beverages with High Nutrient Density

In their analysis for 12 to 24 months, the 2020 DGAC started with the same proportions in the 1,000 kcal pattern for 2 years and older and then adjusted in order to meet nutrient needs for toddlers. Guidance was provided for caregivers1:

  • “Provide a variety of animal-source foods (meat, poultry, seafood, eggs, and dairy),
    fruits, and vegetables, nuts and seeds, and whole grain products, beginning at ages 6 to 12 months and continuing thereafter…”
  • “For toddlers ages 12 to 24 months whose diets do not include meat, poultry, or seafood, provide eggs and dairy products on a regular basis, along with soy products and nuts or seeds, fruits, vegetables, grains and oils.”
  • “Avoid foods and beverages with added sugars during the first 2 years of life.”

Overall, these carefully crafted guidelines emphasize “every bite counts” – that is, infants and toddlers are not able to eat large amounts of food, but require significant amounts of essential nutrients during this critical period for growth and development.

Importantly, the 2020 DGAC provided examples of what infants and toddlers should eat, and suggest research is needed to better understand how infants and toddlers should be fed. The Scientific Report states, “Establishing healthy eating habits during the first 2 years of life is critical. Although the individual experience shapes food preferences (e.g., tastes), the collective modeling of food choices in young childhood through direct observation of food intake by peers and adults also is paramount.” This statement is supported by research that indicates caregivers can play an important role in helping to shape children’s eating habits by providing healthy food in the home and by modeling eating behaviors.2,3  In other words, one of the best ways to help baby learn to eat healthy is by providing nutrient-rich options for the entire family!

  1. Dietary Guidelines Advisory Committee. Scientific Report of the 2020 Dietary Guidelines Advisory Committee: Advisory Report to the Secretary of Agriculture and the Secretary of Health and Human Services. 2020

  2. Scaglioni, S., et al., Factors Influencing Children’s Eating Behaviours. Nutrients, 2018. 10(6).

  3. Yee, A.Z., M.O. Lwin, and S.S. Ho, The influence of parental practices on child promotive and preventive food consumption behaviors: a systematic review and meta-analysis. Int J Behav Nutr Phys Act, 2017. 14(1): p. 47.

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Every Bite Counts: Dietary Guidelines Advisory Committee Report Highlights Eggs as a Food that can Help Close Nutrient Gaps Across The Lifespan

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Every Bite Counts:

Dietary Guidelines Advisory Committee Report Highlights Eggs as a Food that can Help Close Nutrient Gaps Across the Lifespan

Mickey Rubin, PhD

Nutrition Across the Lifespan

Nutrients in Eggs

This past July, the Dietary Guidelines Advisory Committee released their Scientific Report1 which will serve to inform the development of the 2020-2025 Dietary Guidelines for Americans due out at the end of this year. The Committee examined the latest nutrition science using a life-stage approach, making dietary recommendations for Americans of all ages. Importantly, for the first time in the history of the Dietary Guidelines for Americans, these recommendations will include guidance for children from birth to 2 years of age.

Contained within the Scientific Report were several important conclusions regarding the role of eggs in healthy diets across the lifespan. The Committee highlighted science supporting eggs as a fundamental first food for infants and toddlers. Eggs provide several nutrients noted as important during this time of rapid brain development including high-quality protein, choline, and iodine. The Committee’s thorough review of the science recognized eggs’ role in providing these critical nutrients, including eggs in recommendations from the very moment infants are ready for solid foods.

Choline is under-consumed by most Americans, but the Committee noted that this poses special challenges for infants, toddlers, and pregnant women. A recent survey commissioned by ENC showed low levels of awareness of choline among both new and expecting mothers and the health professionals who care for them. Over 70% of these moms and over 40% of OBGYNs and pediatricians were unfamiliar with choline. With less than 10% of pregnant women meeting the Adequate Intake, this lack of knowledge represents a barrier to adequate choline consumption.2 Importantly, in our survey dietitians had almost 90% awareness of choline. Clearly, dietitians should play an important role in closing this knowledge gap.

Related, the Scientific Report highlighted iodine as a nutrient of public health concern for pregnant women and as a nutrient important for infant brain development. Eggs are an excellent source of iodine, containing 20% of the Daily Value. As an excellent source of both choline and iodine, new and expecting moms would benefit greatly from education on the importance of including eggs in their diets to achieve recommendations and support brain development.

The Scientific Report also recommended early introduction of eggs to reduce the risk of egg allergy. This conclusion aligns with previous recommendations from the American Academy of Pediatrics. Given older, contradictory guidance to avoid early introduction of allergens, it will be especially important to provide clear guidance and education on this new recommendation.

The Scientific Report recognized that eggs can help Americans meet nutrient needs at all ages and move towards achieving healthier diet patterns. In children, the Committee identified the diet quality benefits if energy were to be redistributed from added sugars to the Protein Foods group – highlighting eggs as a preferred nutrient-dense option. In pre-teens and adolescents – particularly girls – eggs were encouraged for their protein and choline content. Older adults were noted for poor nutritional status related to protein and vitamin B12, two nutrients for which eggs provide greater than 10% of the Daily Value. Eggs also were identified as one of the few natural food sources of vitamin D, a nutrient of public health concern for all Americans.

The Dietary Guidelines Advisory Committee Scientific Report represents a tremendous step forward in our understanding of the science on healthy eating. We look forward to the release of the Dietary Guidelines later this year which will provide the latest information to nutrition and health professionals about how to build healthy diets and how eggs, as a nutrient-dense food, contribute to health and wellbeing at every age and life stage in a variety of ways.

  1. Dietary Guidelines Advisory Committee. Scientific Report of the 2020 Dietary Guidelines Advisory Committee: Advisory Report to the Secretary of Agriculture and the Secretary of Health and Human Services. 2020
  2. Wallace, T.C. and V.L. Fulgoni, Usual Choline Intakes Are Associated with Egg adn Protein food Consumption in the United States. Nutrients, 2017. 9(8).

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What are the nutritional differences for different types of eggs?

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What are the nutritional differences for different types of eggs?

Jen Houchins, PhD

Nutrients in Eggs

There are some common misconceptions about the nutritional value of different types of eggs. For example, some people have the impression that brown eggs are nutritionally superior to white eggs, or that cage-free or free-range eggs are nutritionally superior to conventional eggs. In reality, none of these is true unless the hens’ diets have been altered.

Brown eggs come from hens with brown feathers and brown earlobes, and white eggs come from hens with white feathers and white earlobes, but the nutritional composition of those eggs is the same. Similarly, label claims such as “Cage-Free,” “Pasture-Raised,” “Enriched Colony,” “Free-Range,” “Conventional” and even “Organic” simply refer to the way the eggs were farmed and unless the feed is fortified (see below), do not denote meaningful nutritional differences.

The cost of one type of egg relative to another type of egg is also not an indicator of nutritional value; it is a reflection of the farming method used to produce the egg (or in the case of brown eggs, it is because the birds are slightly larger and require more food).

Yolk color is dependent on the hen’s diet, and specifically, carotenoid intake.  Carotenoids are color pigments that give egg yolks their yellow-orange hue.  Hen feed (regardless of the farming method) can be enhanced with carotenoids via carotenoid-rich extracts such as marigold which can lead to a darker yolk.

The only way to produce eggs with higher levels of nutrients is by feeding the hens that lay the eggs a diet of nutritionally fortified feed. In such cases, the eggs are marketed as nutrient- or nutritionally enhanced, and their packaging will specify nutrient content. For example, certain eggs may be enriched with omega-3 fatty acids or higher levels of vitamin D. When in doubt, always check the Nutrition Facts label on the carton.

Different types of eggs are available in order to accommodate people’s preferences and budgets. But at the end of the day, from a nutrition perspective, all eggs are nutrient-rich and can be part of healthy dietary patterns. And, unless they have been nutritionally enhanced, all eggs have the same essential nutrients— regardless of the shell color of the egg or the way the egg was farmed.

Please see the Egg Nutrition Center’s labeling handout for more details, and other common terms on egg cartons.  Regardless of the hen’s diet or farming method, egg farmers are committed to providing high-quality eggs, making the health and well-being of their hens top-priority, and continue to be dedicated to supporting sustainable eating patterns.

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Eggs, Diabetes, and the Current Scientific Evidence

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Eggs, Diabetes, and the Current Scientific Evidence

Jen Houchins, PhD

Cardiometabolic Health

Nutritious Dietary Patterns

The Dietary Guidelines for Americans no longer provide a limit for dietary cholesterol for healthy people,  however,1 some questions remain about the cardiovascular impact in people with diabetes or impaired fasting glucose.  New evidence supports that eggs can be included in a healthy dietary pattern without adverse effects linked to diabetes, and in some cases, can be linked to beneficial outcomes.

Data from the Framingham Offspring Study were used to evaluate the effects of dietary cholesterol alone and in combination with markers of a healthy diet.  No statistically significant differences in glucose levels across different categories of dietary cholesterol intake were found over 20 years follow-up, and there was not an increased risk of type 2 diabetes mellitus or impaired fasting glucose associated with higher cholesterol intake.2  In a separate analysis, these prospective data showed “…no adverse association between dietary cholesterol and serum lipid levels or CVD risk amongst those with impaired fasting glucose or Type 2 diabetes.”3  Although eggs contribute cholesterol to the diet, confounding factors have been thought to impact the relationship between egg consumption and risk of diabetes.  A recent study found egg consumption is not independently associated with type 2 diabetes risk.4

A 12-week randomized controlled trial in individuals with pre- and type 2 diabetes found that adding one large egg to the daily diet for 12 weeks did not have a negative impact on total cholesterol levels.  In this trial, fasting blood glucose was significantly reduced by 4.4% at the final measurement for the egg group.5  Finally, participants with prediabetes or type 2 diabetes had no adverse changes in cardiometabolic markers when 12 eggs/week were incorporated into a 3-month weight loss diet.6

The American Diabetes Association7 and the American Heart Association8 encourage people with diabetes to consume a healthy dietary pattern that includes nutrient-rich foods.  A large egg provides eight essential vitamins and minerals, 6 grams of protein (12% DV), as well as 252 mcg of  lutein and zeaxanthin, two carotenoids important for eye health.  These new data continue to support that eggs are a beneficial part of healthy dietary patterns.

  1. U.S. Department of Health and Human Services and U.S. Department of Agriculture.  2015-2020 Dietary Guidelines for Americans.  8th Edition.  December 2015.  Available at http://health.gov/dietaryguidelines/2015/guidelines/.
  2. Baghdasarian S, Lin H-P, Pickering RT, et al. Dietary Cholesterol Intake Is Not Associated with Risk of Type 2 Diabetes in the Framingham Offspring Study.  Nutrients 2018.  doi: 10.3390/nu10060665.
  3. Lin H-P, Baghdasarian S, Singer MR, et al.  Dietary Cholesterol, Lipid Levels, and Cardiovascular Risk among Adults with Diabetes or Impaired Fasting Glucose in the Framingham Offspring Study.  Nutrients 2018.  doi: 10.3390/nu10060770.  Diabetologia.2009;52:1479–1495.
  4. Sabaté J, Burkholder-Cooley NM, Segovia-Siapco G et al.  Unscrambling the relations of egg and meat consumption with type 2 diabetes risk.  Am J Clin Nutr 2018;108:1-8.
  5. Pourafshar S, Akhavan NS, George KS, et al.  Egg consumption may improve factors associated with glycemic control and insulin sensitivity in adults with pre- and type II diabetes.  Royal Society of Chemistry 2018.
  6. Fuller NR, Sainsbury A, Caterson ID, et al. Effect of a high-egg diet on cardiometabolic risk factors in people with type 2 diabetes: the Diabetes and Egg (DIABEGG) Study – randomized weight-loss and follow-up phase.  Am J Clin Nutr 2018;107:1-11.
  7. American Diabetes Association.  Standards of Medical Care in Diabetes – 2017.  Diabetes Care. 2017;40 (supplement 1): S33-43.
  8. Fox CS, Golden SH, Anderson C, et al. Update on Prevention of Cardiovascular Disease in Adults With Type 2 Diabetes Mellitus in Light of Recent Evidence: A Scientific Statement From the American Heart Association and the American Diabetes Association.  Diabetes Care 2015;38:1777-1803.

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Healthy Food Patterns. Where Do Eggs Fit In?

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Healthy Food Patterns. Where Do Eggs Fit In?

Kim Hoban, RDN, CDN, CPT

Nutritious Dietary Patterns 

The Egg Nutrition Center partnered with Kim Hoban, RDN, CDN, CPT to write this blog post.

The release of the 2020 Scientific Report from the Dietary Guidelines Advisory Committee (DGAC) brings anticipation of the final recommendations for the 2020-2025 Dietary Guidelines for Americans from the United States Department of Agriculture (USDA) and Department of Health and Human Services (HHS). Beginning in 2015, the USDA developed three different healthy food patterns that are mentioned in the report: U.S. Style Pattern, Vegetarian Pattern and Mediterranean Style Pattern. Rather than focusing on the differences in these eating patterns, let’s consider that each shares core components, such as encouraging a variety of plant-based foods, such as fruits, vegetables, legumes, whole grains, nuts and seeds. In addition, these patterns all emphasize protein and fats from nutrient-rich sources.

Nutrient-rich eggs are a good or excellent source of eight essential nutrients including high-quality protein, but they can also be a flavorful and fun vessel for other nutritious foods. If a goal is to eat more plant-based foods, eggs pair well with vegetables, grains, legumes and more. Plus, the fat-soluble vitamins in vegetables (vitamins A, D, E and K) are better absorbed with dietary fat from eggs.

Here are some simple strategies and recipe ideas to increase vegetable intake with eggs:

When it comes to heart health, the 2015 DGAC removed cholesterol from the list of nutrients of public health concern, and this conclusion remained unchanged in the 2020 DGAC Scientific Report. Plus in 2019, a nutrition committee with the American Heart Association published an advisory recognizing that despite containing cholesterol, eggs fit well into a heart-healthy eating pattern. This review contains even more information on the emerging science on eggs, cholesterol and heart health.

No matter what dietary pattern you choose to follow, eggs provide high-quality protein and essential nutrients, as well as a vehicle for including even more plant-based and health-promoting foods into your diet.

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Research Around the World

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Research Around the World

Eggs May Be an Important Part of the Solution for Mothers and Children

JEN HOUCHINS, PHD

Nutrients in Eggs

Nutritious Dietary Patterns

Childhood stunting impacts approximately 144 million children under the age of 5 around the world, a condition that “puts children at greater risk of dying from common infections; it is also associated with poor cognitive development.”1  Almost all stunting occurs within the first 1000 days of life,2 a period of rapid growth and development.  The impact of stunting can be lifelong, as cognitive and social development may also be impacted, so prevention is critical.  Improved nutrition is one factor that has the potential to positively impact growth and development for children, and around the world, current research demonstrates eggs may be part of the solution.3

In 2015, a randomized controlled trial was conducted in Cotopaxi Province, Ecuador to evaluate early introduction of eggs and the impact on growth in young children.  This intervention provided one egg per day to infants (beginning at 6 to 9 months of age) in the treatment group over a 6-month period.  The children in this egg treatment group had improved growth outcomes compared to the control, including a 47% decreased prevalence of stunting.4 

As a follow-up, another study was conducted in rural Malawi in order to evaluate if these initial results could be replicated in other populations at risk of stunting.5  Again, infants aged 6-9 months were randomized to an intervention of one egg per day, or a control group, over a 6-month period.  Although this intervention did increase reported egg consumption in the treatment group, there was no impact on linear growth and no effect on stunting prevalence.  The investigators noted that the children in Malawi had a higher mean baseline length-for-age than previously observed in this population, which might have limited the ability to measure a difference.  Importantly, though, fish consumption was very common in Malawi.  This is a significant difference between the Ecuador and Malawi studies, as the authors mention that in Ecuador, consumption of animal sourced foods other than the intervention eggs was low. 

Preliminary data from the study in Malawi also indicate that children who were in the egg intervention group consumed more choline as compared to the control group, although median intake levels remained below Adequate Intake levels.6  This observation raises new research questions, as a difference in physical growth was not detected in the intervention group that consumed eggs, but brain development and cognition were not measured.  Choline is one nutrient critical for brain health and development,7,8 and there is preliminary evidence that choline intake during pregnancy, and possibly lactation, could possibly have lasting beneficial neurocognitive impact.9,10  More research is needed, however, to evaluate how adequate choline intake might improve cognitive outcomes in children at risk of stunting.  Further, the study in Malawi indicates the combination of animal-sourced foods could be important in the context of interventions aimed at reducing risk of stunting in young children.

Overall, these studies build on existing evidence that eggs, and other animal sourced foods, have the potential to be an important part of the solution for sustainable nutrition for mothers and children around the world.

  1. United Nations. The Sustainable Development Goals Report. 2020; Available from: https://unstats.un.org/sdgs/report/2020/The-Sustainable-Development-Goals-Report-2020.pdf.
  2. Black, R.E., et al., Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet, 2013. 382(9890): p. 427-451.
  3. Iannotti, L.L., et al., Eggs: the uncracked potential for improving maternal and young child nutrition among the world’s poor. Nutr Rev, 2014. 72(6): p. 355-68.Sievenpiper JL, Kendall CWC, et al. Effect of non-oil-seed pulses on glycaemic control: a systematic review and meta-analysis of randomized controlled experimental trials in people with and without diabetes. Diabetologia.2009;52:1479–1495.
  4. Iannotti, L.L., et al., Eggs in Early Complementary Feeding and Child Growth: A Randomized Controlled Trial. Pediatrics, 2017. 140(1).
  5. Stewart, C.P., et al., The effect of eggs on early child growth in rural Malawi: the Mazira Project randomized controlled trial. Am J Clin Nutr, 2019.
  6. Bragg, M., et al., Choline Intake in Malawian Children Aged 6–9 and 12–15 Months in an Egg Intervention Trial. Current Developments in Nutrition, 2020. 4(Supplement_2): p. 816-816.
  7. Caudill, M.A., et al., Maternal choline supplementation during the third trimester of pregnancy improves infant information processing speed: a randomized, double-blind, controlled feeding study. Faseb j, 2018. 32(4): p. 2172-2180.
  8. Schwarzenberg, S.J. and M.K. Georgieff, Advocacy for Improving Nutrition in the First 1000 Days to Support Childhood Development and Adult Health. Pediatrics, 2018. 141(2).
  9. Wallace, T.C., et al., Choline: The Underconsumed and Underappreciated Essential Nutrient. Nutr Today, 2018. 53(6): p. 240-253.
  10. Bahnfleth, C., et al., Prenatal Choline Supplementation Improves Child Color-location Memory Task Performance at 7 Y of Age (FS05-01-19). Current Developments in Nutrition, 2019. 3(Supplement_1).

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How to Incorporate Eggs Into the Mediterranean Diet

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How to Incorporate Eggs Into the Mediterranean Diet

NATALIE RIZZO, MS, RD

Nutritious Dietary Patterns

The Egg Nutrition Center partnered with Natalie Rizzo, MS, RD to write this blog post.

 

Although it has the word “diet” in the name, the Mediterranean Diet is a flexible style of eating that isn’t centered around weight loss.

There aren’t any strict rules or calorie counting on the Mediterranean Diet, either. Rather, it encourages eating like people do in the Mediterranean region — a nutritious eating pattern full of whole foods.

Named as the #1 Best Overall Diet by US News & Report, the Mediterranean Diet is a healthy style of eating that promotes portion control, whole foods and an active lifestyle. Eating the Mediterranean way includes plenty of colorful fruits and vegetables, beans and legumes, whole grains, fish, poultry, eggs, olive oil and fresh herbs. Even a glass of red wine in moderation is encouraged. However, this eating pattern also involves limiting intake of refined grains, red meat, processed or packaged foods and foods that are high in added sugar. 

In addition, lifestyle factors are an important aspect of the Mediterranean Diet. Avoiding tobacco and exercising regularly are healthy habits no matter what, but the Mediterranean Diet also encourages cooking your own meals, choosing seasonal ingredients and enjoying mealtime with family and friends.

 

The benefits of the Mediterranean Diet

As one of the top diets in the world, there is an abundance of research surrounding the Mediterranean Diet and how it affects certain health conditions. Below are some of the most promising fields of study.

 

Heart health

The Med Diet is rich in nutrients that are associated with good heart health, like fiber, antioxidants, vitamins, minerals and healthy fats. With that, the Mediterranean Diet has been shown to help protect against cardiovascular disease. As a matter of fact, a large observational study of over 30,000 women found that those who followed the Med Diet for a 10-year period had lower risk of heart attacks, strokes, and heart failure. 

With the revision of the Dietary Guidelines in 2015 to remove cholesterol as a nutrient of concern, eggs have been considered a part of a heart healthy diet. On top of that, the American Heart Association (AHA) Nutrition Committee published a science advisory on Dietary Cholesterol and Cardiovascular Risk in 2019. The advisory stated that following a heart-healthy eating pattern, such as the Mediterranean Diet, is more important than adhering to a specific cholesterol number.  

The advisory also noted that healthy individuals can include one whole egg per day in their heart healthy eating patterns. Older adults can include up to two eggs per day, and vegetarians who do not consume cholesterol from animal foods may include more eggs in their diet, in moderation.

 

Type 2 Diabetes

According to a 2015 review, the Mediterranean diet is associated with better glycemic control in those with Type 2 Diabetes. Researchers attribute these positive results to the high intake of polyphenols (beneficial plant compounds) from fruits, vegetables, whole grains, and nuts. Pairing eggs with plant-based heart-healthy foods also helps with the absorption of important nutrients, like Vitamin E and carotenoids. In addition, eating an egg-based breakfast, rich in protein (about 26 grams of egg protein), has been shown to promote glycemic control in people with type 2 diabetes and pre-diabetes, as compared to a high-carbohydrate breakfast.

 

Brain function

Another reason to incorporate Mediterranean approved eggs into your diet is that nutrients in eggs have been shown to have brain benefits. Researchers at the University of Illinois published two studies looking at the relationship between lutein status, as measured using a non-invasive eye test called Macular Pigment Optical Density (MPOD), and cognition in children. They found that MPOD concentration was positively associated with academic performance. Eggs also contain choline, a nutrient that is vital for the development of brain and spinal cord development in utero. Plus, dietary choline has been shown in some studies to be linked with reduced risk of cognitive decline with age.

 

Eggs in the Mediterranean Diet

The Mediterranean Diet is not only nutritious, but it’s also very accessible. By incorporating plenty of whole foods in your diet, you’re already on your way to eating the Med way. Eggs are not only a staple of the Mediterranean Diet, but they also play a role in weight management, muscle strength, healthy pregnancy, brain function, eye health and more. Here are some meal examples that combine the power of the Med Diet with the benefits of eggs. 

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Addition, Not Subtraction to Best Support Clients

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Addition, Not Subtraction To Best Support Clients

Angela Gomez, RDN

Nutritious Dietary Patterns

 

Key messages

  • Focusing on what can be added rather than reduced or eliminated, when it comes to behavior change, may help build a growth mind-set and build self-efficacy in the clients we work with.
  • Supporting clients on their health journey by adding to the behaviors they are already engaged in is a more collaborative and positive approach that may increase success and reduce harm.

When discussing behavior change, emphasizing addition (rather than harping on subtraction), can create a mind shift in the individuals and families we work with. Focusing on the addition of health behaviors gives people more options and helps create an experimental environment, rather than a “pass-fail” environment. If we help develop this skill in parents or guardians, then they, in turn, can influence their family in a similar way. This is where the “think addition, not subtraction” phrase comes into play.

I have used this phrase in my work with private clients, youth sports teams, collegiate athletes, and clients with eating disorders. In my sessions, I’ll often redirect the “subtraction talk” and ask open-ended questions to elicit some “addition talk”. I am not as concerned with emphasizing the behavior a client wants to avoid; I am interested in the behavior they want to change – given what they have available to them now (i.e., time, food accessibility, etc.). There is hope and positivity in the idea of adding small behavior modifications, whereas only focusing on avoiding habitual behaviors can feel defeating.

Need more convincing on why we should emphasize addition over subtraction? Here are three reasons to consider implementing this mindset in your own practice:

1. Subtraction represents rules and restrictions, while addition calls attention to abundance and provides options. Restriction emphasizes the “don’t” without providing options for the “do”. There are simply more possibilities with addition. Supporting clients as they build a growth mindset fosters agency, self-efficacy, and honesty in their journey towards owning their positive health behaviors. In more vulnerable populations, such as clients with eating disorders, encouraging subtractions (or restrictions) will not aid in their recovery process.

Instead of: “Stop eating ‘junk food’ or no more ‘junk food’.”
Try: “What foods would you like to add? How do you feel about brainstorming some snack ideas together that incorporate the foods you’d like to add?”
Benefit: You are discussing foods the client is already interested in adding, instead of directing the client toward restrictions (and creating stress in the process).

2. Focusing on addition fosters a relationship of collaboration between the provider and the client. Many of our clients want to please their healthcare providers and don’t want to “fail”. We can encourage the people we work with to get out of this “pass or fail” mindset by emphasizing addition and treating goals like experiments. We can accept that clients are experts of their own bodies, experiences, and lives. We have the education and experience in our field, and more importantly, our clients have the experience of being in their own bodies and living their day-to-day life. Working collaboratively sets the client up for success as we guide and support them on their health journey.

Instead of: “You should eat breakfast every morning.”
Try: “What days work for you to eat something in the morning, even if it is not a full meal – like having some hard-boiled eggs? What are some foods that sound appealing to eat in the morning?”
Benefit: You open the door to possibilities that appeal to the client, and the client tells you what days they may be able to try and eat something for breakfast. Therefore, the focus is not eating breakfast seven days a week; instead it is creating manageable change by encouraging something in the morning when it works for the client.

3. Focusing on subtraction turns individualized care into generalized care. All of our clients do not have the same access or the same ability to work towards your idea of a desirable health behavior. If you are speaking to a family who has limited resources, it may be harmful to recommend specific subtractions (such as “don’t eat canned foods because they are too high in sodium”). If you are telling individuals to remove a food that strongly connects to their family or culture, it is unlikely they will comply. We need to work with the client to tailor the behavior modification to meet them where they are.

The health of the whole being is the most important. Relying on subtractions will restrict, and may ultimately hinder not only your relationship with the client, but also their personal progress. No one wants more rules to follow or more things to avoid. Shifting to addition will encourage our clients to focus on building positive, sustainable behaviors that work within their current lives, work for their families, and allow progress to occur at their own pace.

Angela Gomez, RDN is based out of both Peoria and Phoenix, Arizona and is a School Nutrition Dietitian, an Eating Disorder Dietitian, and a volunteer Dietitian for a collegiate soccer team.

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Let’s Get Cracking: Earth Month Recipes Using Pantry Staples

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Let’s Get Cracking: Earth Month Recipes Using Pantry Staples

Kim Hoban, RDN, CDN, CPT

Nutritious Dietary Patterns

The Egg Nutrition Center partnered with Kim Hoban, RDN, CDN, CPT to write this blog post.

Each year around Earth Day, we try to focus on ways we can conserve resources, such as reducing food waste. Now as we experience a global pandemic, we are looking to conserve for additional reasons, like reducing the frequency of trips to the grocery store. 

If you’re using this time to spring clean the pantry, save money or reduce food waste, it’s possible to create delicious, well-rounded meals with pantry staples like oats, rice, canned beans, tomato sauce, nut butter and more. Eggs are a perfect pairing with many of these staple foods, adding high-quality protein, vitamin D and key nutrients like choline, lutein and zeaxanthin.

Baking and cooking can be a fun family activity that can help teach kids math and science, but also important life lessons like patience and problem-solving. Baking can also be a great stress reliever, so get out the flour, sugar, and eggs to bake up sweet treats like Cinnamon Banana Bread. Found a can of pumpkin in the pantry? It might not be fall anymore, but this pumpkin bread is delicious any time of year!

When it comes to fueling yourself and your family throughout the day, start at breakfast by turning to pantry staples like oats and nut butters. This Almond Butter Oatmeal with Egg is a great option, as are more traditional family favorites like French toast and pancakes. Make a single serving pancake by mixing just one banana, one egg and two tablespoons of nut butter, then cooking on a griddle like any other pancake.

When it comes to more savory meals using pantry staples, think about canned foods like diced or crushed tomatoes, tuna, beans and dry goods like rice or quinoa. Use what you have on hand to make Shakshuka or Eggs in Purgatory. Put together an easy lunch using canned tuna, mixing in hard-boiled eggs or beans for more protein. Another easy option is a stir fry or fried rice using eggs and whatever vegetables you have in the cabinet, fridge or freezer.

With many people staying home and spring finally upon us, there’s no better time to start a home garden or a compost bin. Using dried crushed egg shells to add to the compost enriches your garden soil while also reducing kitchen waste. If you have some veggies that are on the verge but not quite ready for compost, utilize these infinitely swappable meal formulas to help reduce food waste.

If you have more eggs on hand than you’ll be able to use in the coming weeks, don’t hesitate to freeze them. Follow these tips on freezing eggs to save fresh eggs for up to a year.

With so much out of our control as we await a “new normal”, it’s important to focus on all we can do, like getting creative in the kitchen, enjoying time with family and doing our part to celebrate and honor the planet.

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5 Ways to Find Balance

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5 Ways To Find Balance

Stacey Mattinson, MS, RDN, LD

Nutritious Dietary Patterns

 

By Stacey Mattinson, MS, RDN, LD

The Egg Nutrition Center partnered with Stacey Mattinson, MS, RDN, LD to write this blog post.

During times of uncertainty, encouraging patients and clients to focus on aspects of their health they can control is even more important. When life throws curveballs and routines fall out of whack, self-care becomes even more essential. Here are five ways we can encourage balance during hectic times:

1. Fuel your Body (and Brain!) with Combination Meals and Snacks. Often people find themselves grazing or snacking frequently because their food choices aren’t bulky enough to promote satiety. Multi-food group combos pairing protein-rich foods, like eggs, with sources of fiber and healthful fats trigger satiety signals and provide maximum nutrients and absorption.

Great examples include:

Each of these examples provides nutrient-rich sources of protein, carbohydrate and fat, coupled with colorful plants, making a perfect macro- and micronutrient matrimony. With only 1 in 10 adults eating enough fruits and vegetables1 , eggs are a particularly great vehicle in a plant-forward diet. In fact, naturally nutrient-rich eggs can help with the absorption of nutrients found in plant foods like vitamin E and carotenoids. Plus, pairing plant foods with high-quality protein foods, like eggs, can help meet protein needs to help support healthy muscles and strong bones.

2. Prioritize Family Meals. Whether this means physically in your own home or virtually, mealtime is the perfect time to check in with family. Research indicates family meals are associated with greater consumption of fruits, vegetables, fiber, calcium-rich foods and vitamins.2 Kids also see improved grades, less participation in risky behaviors and less likelihood of developing eating disorders with more family meals eaten per week.3 Whether you choose breakfast, lunch or dinner, the benefits amplify with more meals eaten together each week. Try kid-friendly recipes like the Caprese Egg Muffins, Whole Wheat Chocolate Chip Pancake Poppers, or Egg Pita Snackers.

3. Eat Intuitively. Humans are born with innate hunger and fullness cues. Although these can be overridden over time when they are ignored, they can be uncovered by practicing mindfulness around eating experiences. Evaluating hunger before, during and after eating occasions helps sharpen personal awareness and unearth habits of eating in response to stress, boredom or emotions. Alternative coping mechanisms like walking, meditation, practicing a hobby or catching up with a friend are healthy responses to external triggers unrelated to hunger.

4. Sweep Out the Negative. Give permission to not be perfect. Successful long-term healthy habits are bred from someone’s ability to quickly dive back into positive behaviors rather than ruminate on unhealthy pitfalls. The week is not botched from a cookie, a missed workout or indulging in your favorite takeout. No one has tainted the next hour or the next day. Encourage clients to hop back on the healthy train and likewise consider removing negative social media influences that might make them feel poorly about themselves.

5. Add in One New Positive Habit. If nothing else, ask your clients, “What’s one thing you could change today that would help you live a healthier life?” This question invites clients to weigh their values, empowering manageable, realistic changes.

When clients are looking for advice on how to optimize health during uncertain times, remember to look at the big picture and point them toward long-term, sustainable lifestyle changes in ways that are meaningful to them!

  1. Lee-Kwan SH, Moore LV, Blanck HM, Harris DM, Galuska D. Disparities in State-Specific Adult Fruit and Vegetable Consumption — United States, 2015. MMWR Morb Mortal Wkly Rep 2017;66:1241–1247. DOI: http://dx.doi.org/10.15585/mmwr.mm6645a1.

  2. Adv Nutr. Come and Get It! A Discussion of Family Mealtime Literature and Factors Affecting Obesity Risk. 2014 May; 5(3): 235–247. Published online 2014 May 6. doi: 10.3945/an.113.005116

  3. Can Fam Physician. Systematic review of the effects of family meal frequency on psychosocial outcomes in youth. 2015 Feb; 61(2): e96–e106.

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