Progress in dietary behavior change.

Nutrition has important influences on health and mortality. Public response to current dietary guidance is indicated by positive movement on some indicators, notably reductions in calories from fat and in blood cholesterol levels. Downstream case finding and intensive educational and behavioral interventions are often effective for high risk and motivated subjects and for persons with diet-related disease. Midstream environmental changes (e.g., in grocery stores, schools) proffer improved nutritional choices and supports. Individualized dietary counseling has yet to become the norm. Despite recent upstream success in developing broad dietary guidance and improving nutrition labeling policies, numerous avenues remain open for aggressive national policy developments. Emerging studies and continuing improvement in intervention methods, measurement, and research design will help realize the preventive effects of healthful diets.