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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