Download Dietary Guidelines for Americans

DietaryGuidelinesforAmericans
Update on the New U.S. Dietary Standards
Wayne Campbell, PhD
Professor, Department of Nutrition Science
• First published by the government in 1980
• National Nutrition Monitoring and Related Research Act of 1990 (P.L. 101‐445) – Mandates HHS and USDA jointly publish
– At least every 5 years
HHS USDA
Office of Disease Prevention Center for Nutrition Policy and Health Promotion (ODPHP) and Promotion (CNPP)
2015 Administrative lead agency
DietaryGuidelinesforAmericans
PolicyDevelopmentandImplementation
Phase 1
Federal Policy Document
Purpose
• Provide guidance and nutrition information for ages 2 years and older
• Prevention (not treatment) of chronic disease
• Based on high quality scientific evidence
• Foundational policy for all Federal food and nutrition programs
Target audience (of policy document)
• Policymakers, nutrition educators, and health professionals
Public Comment
to Committee
Public and Federal Agency Comment
to HHS/USDA
DGAC
Charter
2015 edition TBD
Committee Chartered
Public Committee Meetings: Review of Science
Advisory Report Submitted to Secretaries of HHS & USDA
HHS & USDA Develop Implemented Policy through Federal Document
Programs
Advisory Report and Policy Document are two different products. (Advisory Report is not a draft of the policy.)
Phase 2
Phase 3
Phase 4
DietaryGuidelinesAdvisoryCommittee
2015DietaryGuidelinesAdvisoryCommittee
Chair
Barbara Millen, DrPH, RD
Millennium Prevention
• Federal Advisory Committee
Vice Chair
Alice H. Lichtenstein, DSc
Tufts University
Members
– Non‐Federal experts
– “Special Government Employees”
– Served voluntarily Steven Abrams, MD
Baylor College of Medicine
Lucile Adams-Campbell, PhD
Georgetown University Medical Center
• Appointed by HHS and USDA Secretaries
• Governed by Federal Advisory Committee Act Cheryl Anderson, PhD, MPH
University of California, San Diego
– 2‐year “Charter”
– Independent review of science
– Advice and recommendations to Federal government
– Do not draft policy or implement policy
J. Thomas Brenna, PhD
Cornell University
Wayne Campbell, PhD
Purdue University
Steven Clinton, MD, PhD
The Ohio State University
Marian Neuhouser, PhD, RD
Fred Hutchinson Cancer Research Center
Rafael Perez-Escamilla, PhD
Yale University
Anna Maria Siega-Riz, PhD, RD
University of North Carolina, Chapel Hill
Frank Hu, MD, PhD, MPH
Harvard School of Public Health
Mary Story, PhD, RD
Duke University
Miriam Nelson, PhD
Tufts University
Consultant Subcommittee Members
Timothy Griffin, PhD
Tufts University
Michael Hamm, PhD
Michigan State University
Michael Perri, PhD, ABPP
University of Florida
5
TopicSelectionand
WorkGroup/SubcommitteeFormationFramework
Working Group 1
Working Group 2
Working Group 3
Environmental Determinants of Food, Diet, and Health
Dietary Patterns and Quality and Optimization through Lifestyle Behavior Change
Foods, Beverages, and Nutrients and Their Impact on Health Outcomes
Science Review Subcommittee Subcommittee 1
Subcommittee 2
Subcommittee 3
Food and Nutrient Intakes, and Health: Current Status and Trends
Dietary Patterns, Foods Subcommittee 2
and Nutrients, and Health Outcomes
Diet and Food and Food Physical Activity Sustainability Physical Activity Behavior Subcommittee 4
Environments
and Safety
Subcommittee X
Change
Subcommittee 4
Subcommittee 5
EvidenceReview
2015 Dietary Guidelines Advisory Committee through the subcommittees
• Developed questions to answer
• Approach to answer each question
• Synthesized the evidence
• Drafted conclusion and implications statements
• Brought the findings to the full Committee to deliberate and make decisions in public meetings
ApproachtoExaminingtheEvidence
Original
Systematic Reviews
Review of
Existing Reports
Food Pattern
Modeling
Data Analyses
TransparentProcess
www.DietaryGuidelines.gov
•
•
Open Committee meetings, materials online
Public comments – Archive of comments to the Committee
– Advisory Report posted online for public comment to the Federal government, comments in process of being posted
•
Advisory Report
– Online, searchable, printable
– Provides detailed description of Committee process and decisions, including process document
•
Online only appendices through section E‐2 and E‐3
www.NEL.gov
•
Nutrition Evidence Library: 2015 Committee’s original systematic reviews
2015 Advisory Report - at a glance
Part D: Science Base
Chapter 1: Food And Nutrient Intakes, and Health: Current Status
and Trends
Chapter 2: Dietary Patterns, Foods and Nutrients, and Health
Outcomes
Chapter 3: Individual Diet and Physical Activity Behavior Change
Chapter 4: Food Environment and Settings
Chapter 5: Food Sustainability and Safety
Chapter 6: Cross-Cutting Topics of Public Health Importance
Added Sugars, Sodium, Saturated Fat
Chapter 7: Physical Activity
Major Themes
• The Problem and the Gap
– Current dietary intakes are suboptimal and have caused poor health and higher
chronic disease rates.
• The Dietary Patterns
– Focus is on a healthy overall dietary pattern, rather than individual food groups
or nutrients.
– A healthy dietary pattern can be achieved in many ways—there is not one
“healthy” pattern.
• The Individual and the Population
– Interventions to change individual lifestyles, changes in the food and physical
activity environments, and changes in policies and standards.
• The Long-term View
– Compared to the current U.S. diet, a diet higher in plant-based foods and lower
in animal-based foods is more health promoting and associated with lesser
environmental impact.
Part B. Chapter 2
Key Themes
Key Themes
• The problem: Most Americans do not
consume a diet consistent with DGA
recommendations, which likely
contributes to suboptimal dietary and
nutrient intakes and reduced health and
higher chronic disease rates.
Integration of Findings
• The problem: Many people consume diets low
in vegetables, fruits, whole grains, and dairy,
and high in sodium, saturated fat, refined
grains, added sugars, and energy (calories).
• Mixed dishes, which include burgers and
sandwiches, pizza, and various
meat/rice/pasta/grain dishes, and snacks and
desserts are major sources of energy and
large contributors of sodium, saturated fat,
and added sugars to the diet.
Integration of Findings
Total Vegetables
Estimated percentage of persons below, at, or above recommendation
M 1 to 3
M 4 to 8
M 9 to 13
M 14-18
M 19-30
M 31-50
M 51-70
M 71+
Intake below
recommendation
Intake meeting
recommendation
F 1 to 3
F 4 to 8
F 9 to 13
F 14-18
F 19-30
F 31-50
F 51-70
F 71+
Intake above
recommendation
Whole Grains
Estimated percentage of persons below, at, or above recommendation
M 1 to 3
M 4 to 8
M 9 to 13
M 14-18
M 19-30
M 31-50
M 51-70
M 71+
Intake below
recommendation
Intake meeting
recommendation
F 1 to 3
F 4 to 8
F 9 to 13
F 14-18
F 19-30
F 31-50
F 51-70
F 71+
Intake above
recommendation
All 1+
All 1+
100 80 60 ‐100
‐80
‐60
100 ‐100
80 60 ‐80
‐60
40 ‐40
20 ‐20
0
20
40
60
80
DGAC Report Figure D1.11
40 ‐40
20 ‐20
0
20
40
60
80
100
100
% below recommendation % at or above recommendation
What We Eat in America NHANES 2007-10
% below recommendation % at or above recommendation
DGAC Report Figure D1.17
What We Eat in America NHANES 2007-10
Total Dairy
Refined Grains
Estimated percentage of persons below, at, or above recommendation
Estimated percentage of persons below, at, or above recommendation
M 1 to 3
M 4 to 8
M 9 to 13
M 14-18
M 19-30
M 31-50
M 51-70
M 71+
Intake below
recommendation
F 1 to 3
F 4 to 8
F 9 to 13
F 14-18
F 19-30
F 31-50
F 51-70
F 71+
Intake meeting
recommendation
Intake above
recommendation
All 1+
100 80 60 ‐100
‐80
‐60
40 ‐40
M 1 to 3
M 4 to 8
M 9 to 13
M 14-18
M 19-30
M 31-50
M 51-70
M 71+
Intake below
recommendation
Intake meeting
recommendation
F 1 to 3
F 4 to 8
F 9 to 13
F 14-18
F 19-30
F 31-50
F 51-70
F 71+
Intake above
recommendation
All 1+
20 ‐20
0
20
40
60
80
100
‐100
‐80
‐60
100 80 60 % below recommendation % at or above recommendation
DGAC Report Figure D1.18
‐40
40 20 ‐20
0
20
40
What We Eat in America NHANES 2007-10
DGAC Report Figure D1.19
Total Protein Foods
M 1 to 3
M 4 to 8
M 9 to 13
M 14-18
M 19-30
M 31-50
M 51-70
M 71+
FRUITS and
FRUIT JUICE
5%
F 1 to 3
F 4 to 8
F 9 to 13
F 14-18
F 19-30
F 31-50
F 51-70
F 71+
Intake meeting
recommendation
VEGETABLES
8%
BEVERAGES (NOT MILK or 100% FRUIT JUICE)
12%
CONDIMENTS, GRAVIES, SPREADS, SALAD DRESSINGS 2%
PIZZA 4%
MIXED DISHES
MEAT, POULTRY, SEAFOOD DISHES 4%
RICE, PASTA, GRAIN DISHES 5%
GRAINS
11%
All 1+
20 ‐20
0
20
40
60
80
100
BURGERS, and SANDWICHES 14%
Other
28%
SNACKS and SWEETS
16%
Intake above
recommendation
40 ‐40
100
What We Eat in America NHANES 2007-10
Intake below
recommendation
80 60 ‐80
‐60
80
Food sources of energy:
Percent from major food categories
Estimated percentage of persons below, at, or above recommendation
100 ‐100
60
% below recommendation % at or above recommendation
PROTEIN FOODS
11%
DAIRY
7%
SOUPS 1%
% below recommendation % at or above recommendation
DGAC Report Figure D1.20
What We Eat in America NHANES 2007-10
DGAC Report Figure D1.33
What We Eat in America, NHANES 2009-10
Conclusions Food Categories—sources of
sodium, saturated fat, and added sugars
• Mixed dishes are the largest contributor to intake of
sodium and saturated fat.
– Within mixed dishes, the sub-category of burgers and
sandwiches is the largest contributor for both.
• Sodium is ubiquitous in the food supply and many food
categories contribute to intake.
• Snacks and sweets are a major contributor to added
sugars and saturated fat intake.
• Beverages supply almost half of added sugars intake.
Food and Nutrient Intakes, and Health: Current Status and Trends
Key Themes
Research supports the benefits of consuming a
variety of foods and beverages as part of healthy
dietary patterns.
“Common characteristics of dietary patterns
associated with positive health outcomes include
• higher intake of vegetables, fruits, whole grains,
low- or non-fat dairy, seafood, legumes, and nuts;
• moderate intake of alcohol (among adults);
• lower consumption of red and processed meat,
and low intake of sugar-sweetened foods and
drinks, and refined grains.”
Integration of Findings
Percent of Total Intake from Mixed Dishes
0%
Fruit
Vegetables
Total Grains
Whole Grains
Refined Grains
Total Dairy
Milk
Cheese
Protein Foods
Oils
Sodium
Saturated fat
Added sugars
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1%
31%
45%
19%
48%
30%
3%
66%
45%
29%
43%
36%
6%
Fiber
Calcium
Potassium
vitamin D
29% of energy from mixed dishes
28%
29%
24%
16%
DGAC Report Figure D1.32
What We Eat in America, NHANES 2009-10
Key Themes
While there are many ways to achieve a
healthy dietary pattern, the DGAC report
emphasizes three USDA food patterns:
Healthy U.S.-Style
Healthy Vegetarian
Healthy Mediterranean-style
Integration of Findings
Composition of three USDA Healthy Food Patterns
Food Group
Healthy
US‐Style
Healthy
Vegetarian
Healthy Mediterranean
2
2
2 ½
Vegetables, cups/day
2 ½
2 ½
2½
• Legumes, cups/week
1½
3
1 ½
Fruit, cups/day
Whole Grains, oz eq/day
3
3
3
Dairy, cups/day
3
3
2
Protein Foods, oz eq/week
5½
3 ½
6 ½
• Meat, oz eq/week
12 ½
‐‐‐
12 ½
• Poultry, oz eq/week
10 ½
‐‐‐
10 ½
• Seafood, oz eq/week
8
‐‐‐
15
• Eggs, oz eq/week
3
3
3
• Nuts/seeds, oz eq/week
4
7
4
• Processed soy, oz eq/week
½
8
½
Oils, grams/day
27
27
27
2015 DGAC report Table D1.32
Key Themes – Individual Behaviors and
Environments
Successful and sustained improvements in
a person’s diet and health are greatly
influenced by their personal, social,
economic, and cultural environments.
Effective multi-component approaches and
policies (more so than individual ones) may
work together with a person’s own efforts to
improve their diet and health.
Integration of Findings
2015 DGAC
Contextual factors- Summary SC3
Scope SC 4:
Population level Behavior Change
1. Provide continuous support of Federal programs to
help alleviate the consequences of household food
insecurity
Food Environments
2. Food and nutrition assistance programs should take
into account the risk that immigrants have of giving
up their healthier dietary habits soon after arriving in
the United States
• Key settings – neighborhood and community food
access, early care and education, schools, worksites
3. Provide all individuals living in the United States
with the environments, knowledge, and tools needed
to implement effective individual- or family-level
behavioral change strategies to improve the quality
of their diets and reduce sedentary behaviors
Individual Diet and Physical Activity Behavior Change
Physical environment
• Understand and assess the role of food environment in
promoting or hindering healthy eating in various settings.
• Identify the most effective evidence-based diet-related
programs, practices, environmental and policy
approaches (“what works”) to improve health and reduce
disparities.
Food Environment and Settings
Actions for Individuals and
Families/Households
•
Improve food and menu choices, modifying recipes
(including mixed dishes and sandwiches), and watching
portion sizes.
•
Consume more vegetables (without added salt or fat),
fruits (without added sugars), whole grains, seafood,
nuts, legumes, low/non-fat dairy or dairy alternatives
(without added sugars).
•
Reduce consumption of red and processed meat, refined
grains, added sugars, sodium, and saturated fat;
substituting saturated fats with polyunsaturated
alternatives; and replacing solid animal fats with nontropical vegetable oils and nuts.
Key Themes – Food Security
Compared to the current U.S. diet, a diet
with more plant-based foods and less
animal-based foods and energy
promotes both improved human health
and food security (including food
sustainability associated with reduced
environmental impact).
Dietary Patterns, Foods and Nutrients, and Health Outcomes
Integration of Findings
Recommendation to reduce intakes of red and
processed meats
Recommendations on The Dairy Group
• ‘red’ and ‘processed’ are often linked
together in existing literature
• ‘reduce’ does not mean ‘eliminate’
• lean meats can be a part of a healthy dietary
pattern
Integration of Findings
• Dairy contributes important essential macro- and micronutrients, but also relatively high amounts of sodium,
especially from cheese
• “Increasing the proportion of fat-free milk consumed to meet
Dairy Group recommendations [by proportionately reducing
cheese intake] would increase levels of magnesium, potassium,
vitamin A, vitamin D, and choline in the patterns, and decrease
amounts of sodium, cholesterol and saturated fatty acids
• None of the alternatives to milk and milk products provide a
similar enough nutrient profile in terms of these impacted
nutrients to be considered for inclusion in the Dairy Group”
Integration of Findings
Summary
The DGAC report contains reliable, scientifically
rigorous information and conclusions to promote
healthy eating for improved health in America. The
committee urges the federal government to use this
information as a foundation to make population health
a national priority and to emphasize the importance of
healthy diets to prevent chronic disease and to
promote and sustain both human and environmental
vitality.
Integration of Findings
Thank you
Wayne Campbell, PhD
Professor, Department of Nutrition Science