Download Understanding the Controversy of Implications of the 2015 Dietary

3/21/2016
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Co‐founder, Polyscience Consulting (1999)
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During the period of 2010 through 2016, Dr. Roger Clemens provided consultative services and/or served on an advisory council to the following: Abbott Nutrition; Academy of Nutrition and Dietetics; Almond Board of California; AMAXi Nutrition Products; American Society for Quality; Aspire Food Group; Assure Water; Authen
Technologies; Barilla; Bayer; Biothera; California Walnut Commission; Coca‐Cola (honorarium directly given to charity); Corn Refiners Association; Danish Agriculture and Food Council; Dairy Council of California; Dentons LLP; E.T. Horn; FMC (honorarium directly given to charity); Food Minds; HyCite; Jenner & Block LLP; Karma Agency; Kellogg; Kerry Ingredients; Malaysian Palm Oil Council; McDonalds; Mead Johnson; Mushroom Council; National Fisheries Institute; National Restaurant Association; Nestlé SA; Petcurean; Quaker Oats; Schwann Foods; Senomyx (honorarium directly given to charity); StitZii LLC; Spherix Consulting; U.S. Dept. of Agriculture; Whitewave and Yakult.
Roger Clemens, DrPH, CFS, CNS, FACN, FIFT, FIAFST
Adjunct Professor, Pharmacology & Pharmaceutical Sciences
USC School of Pharmacy
International Center for Regulatory Science
EVP, Scientific Operations
Polyscience Consulting, LLC
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The 2015 DGAC report prompted more than
29,000 comments from the public, trade
associations and scientific organizations.
Controversies surrounding evidence assessment
methodologies, invited consultants, and final
recommendations precipitated this large volume of
comments. Among the leading topics of interest to
the public include saturated fat, cholesterol, sugar
and sustainability. The quality of evidence
leveraged for the recommendations pertinent to
these and other topics will be presented. The
public policy and personal practice implications, as
well as communication challenges will be
discussed.
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Improve understanding of the DGA history
and process
Evaluate the dynamics in dietary
recommendations on total fat, saturated fat,
cholesterol and sugar
Consider public and private implications
Engage in future DGA process and
communications
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The exceptional and professional staff
associated with USDA, CNPP and HHS are
gratefully acknowledged for the extensive
expertise and guidance in the development and
execution of the Dietary Guidelines Advisory
Committee, and the final publication of the
Dietary Guidelines.
Forget government guidelines. Here’s how to
eat better, in 6 easy steps.
(Washington Post, January 4, 2016)
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No food is healthy. Not even kale.
(Washington Post, January 17, 2016)
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New Dietary Guidelines for Americans: Watch
your sugar, but enjoy the eggs and coffee
Goals (6)
◦ Energy balance to avoid overweight
◦ Increase consumption of complex CHO and “naturally
occurring sugars”
(LA Times, January 7, 2016)
◦ Reduce consumption of refined and processed sugars,
total fat, saturated fat, cholesterol, and sodium
◦ Increase consumption of fruits, vegetables, and whole
grains
◦ Decrease consumption of
Senator George McGovern
(1977)
Chairman, Senate Nutrition
Committee
 Refined and processed sugars
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 Foods high in total fat and animal fat; replace
SFA with PUFA
New Dietary Guidelines spark intense debate
among nutrition experts
 Eggs, butterfat and high-cholesterol foods
(LA Times, January 19, 2016)
 Salt and foods high in salt
 Choose low-fat and non-fat dairy
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Limitations
http://health.gov/dietaryguidelines/2015-BINDER/meeting1/historyCurrentUse.aspx
http://health.gov/dietaryguidelines/dga2005/report/HTML/G5_History.htm
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◦ Divergence of scientific opinion among experts
Congressional Hearing (Oct 7, 2015)
◦ Agriculture Committee: Advisory committee went
far beyond its scope when advising on issues such
as food sustainability and tax policy – areas in
which the committee does not have expertise,
evidence, or charter.
◦ Recommendations based on disappearance data
◦ Acknowledged differences between
disappearance data and household food
consumption data and intake data
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Senators George McGovern and
Robert Dole (2008)
World Food Prize Laureates 8
 How review nearly 30,000 comments
Credibility and Controversy
 Sustainability (deleted)
◦ Expert selection process
 Soda taxation (deleted)
◦ Experts identified by USDA and HEW
◦ Solicited broad, authoritative expertise
https://www.drmcdougall.com/misc/2012nl/oct/mcgovern.htm
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http://agriculture.house.gov/calendar/eventsingle.aspx?EventID=2731
http://www.nutrition-coalition.org/congress-is-concerned/
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Positives
◦ Added sugar limits
◦ Removed upper limits on
total fat
 Maintained limits on SFA vs CHO
◦ Removed upper limits on dietary cholesterol
◦ Emphasized healthy dietary patterns
2000
1980
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2010
1990
Negatives
◦ No comments on sustainability (politics?)
◦ No reduction on red / processed meat (part of protein
choices)
◦ No comments on soda tax / reduction (politics?)
1985
1995
2005
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http://health.gov/dietaryguidelines/2015/guidelines/executive-summary/
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Stronger
Evidence
RCT
Dbl Blinded
Systematic
review/
meta-analysis RCTs
RCT
Weaker
Evidence
Decreasing bias
RCT
Systematic review/meta-analysis NRCTs
Cohort Study
Non-randomized controlled trial (NRCT)
Case Control
Systematic review/meta-analysis cohort/case-control studies
cohort study/case-control study
Case Series
Cross-sectional study
Case Report
Case series/time series
Expert Opinion
Courtesy of J Slavin, University of Minnesota
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Seek to understand
Examine totality of evidence
Facilitate clear messages
Reduce confusion
Pursue trust and truth
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Media  Fear, Uncertainty, Doubt
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Expert opinion
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http://www.sign.ac.uk/guidelines/fulltext/50/annexb.html
http://www.cnpp.usda.gov/Publications/NutritionInsights/Insight38.pdf
http://www.nice.org.uk/niceMedia/pdf/GDM_Chapter7_0305.pdf
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Observational claims are not necessarily
validated via clinical trials.
Clinical studies among small populations do
not necessarily translate to total population
(think public policy)
Common words like “association,” “related,”
and “relative risk” imply strength, yet upon
review the work is generally quite weak
“Definitive solution will not come from
another million observational papers or a
few small randomized trials”
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Systematic reviews and meta-analyses
◦ Different inclusion/exclusion criteria
(screening & eligibility process) impact results
◦ Different statistical approaches and choices of
covariates impact results
◦ Current publications not consistent with
methodologic quality standards (AMSTAR)*
◦ Heterogeneity of data
◦ Dietary exposures are not accurate
◦ Associations  Causes
AMSTAR: Assessment of Multiple Systematic Reviews
Nicklas et al., J Nutr (in press)
Huedo-Medina et al.,AJCN 2016; doi: 10.3945/ajcn.115.112771
Alexander & Weed., AJCN 2016; doi: 10.3945/ajcn.115.130005.
Ioannidis JPA BMJ 2013;347: doi: 10.1136/bmj.f6698
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1.
2.
3.
4.
5.
6.
Total methodologic quality as a function of IPP. Each circle represents a review, and they are
sized proportionally to their number of studies included. AMSTAR, Assessment of Multiple
Systematic Reviews; IPP, impact per publication; MedSD, Mediterranean-style diet.
Huedo-Medina et al.,AJCN 2016; doi: 10.3945/ajcn.115.112771
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Key issues
◦ What is the question?
◦ What is study quality  systematic reviews or metaanalysis?
◦ Do quality variables differ between systematic
reviews and meta-analyses?
Was an ‘a priori’ design
provided?
Was there duplicate study
selection and data extraction?
Was a comprehensive
literature search performed?
Was the status of publication
used as an inclusion criterion?
Was a list of
included/excluded studies
provided?
Were the characteristics of the
included studies provided?
7.
Was the scientific quality of
the included studies assessed
and documented?
8. Was the scientific quality of
the included studies used
appropriately in formulating
conclusions?
9. Were the methods used to
combine the findings of
studies appropriate?
10. Was the likelihood of
publication bias assessed?
11. Was the conflict of interest
stated?
http://amstar.ca/Amstar_Checklist.php
Shea et al. BMC Medical Research Methodology 2007 7:10 doi:10.1186/1471-2288-7-10
Strong
The conclusion statement is substantiated by a large, high
quality, and/or consistent body of evidence that directly
addresses the question. There is a high level of certainty that the
conclusion is generalizable to the population of interest, and it is
unlikely to change if new evidence emerges.
Moderate
The conclusion statement is substantiated by sufficient
evidence, but the level of certainty is restricted by limitations in
the evidence, such as the amount of evidence available,
inconsistencies in findings, or methodological or generalizability
concerns. If new evidence emerges, there could be
modifications to the conclusion statement.
Limited
The conclusion statement is substantiated by insufficient
evidence, and the level of certainty is seriously restricted by
limitations in the evidence, such as the amount of evidence
available, inconsistencies in findings, or methodological or
generalizability concerns. If new evidence emerges, there could
likely be modifications to the conclusion statement.
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A conclusion statement cannot be drawn due to a lack of
Alexander & Weed., AJCN 2016; doi: 10.3945/ajcn.115.130005
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Grade not evidence, or the availability of evidence that has serious
assignable methodological concerns.
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Dietary fat - ~20
Saturated fat - ~560
Cholesterol - ~1,400
Sugar - ~ 1,300
Dietary patterns - ~250
http://health.gov/dietaryguidelines/dga2015/comments/readComments.aspx
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Of the nutrients that are underconsumed or
overconsumed, including over the Tolerable
Upper Limit of Intake (UL), which present a
substantial public health concern?
◦ Limit calories from added sugars and saturated fats
and reduce sodium intake
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Has the advice for low-fat diets been in error?
Dietary advice on optimizing types of dietary
fat, and not reducing total fat.
Part D. Chapter 6: Cross-Cutting Topics of Public Health Importance
Low-Fat Diets: < 35% total calories from fat (IOM, 2005)
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What are the top foods contributing to
sodium, saturated fat, and added sugars
intake by the U.S. population?
What would be the effect on food choices and
overall nutrient adequacy of limiting
saturated fatty acids to 6 percent of total
calories by substituting mono- and
polyunsaturated fatty acids?
What is the relationship between intake of
saturated fat and risk of cardiovascular
disease?
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Consume less than 10 percent of calories per
day from saturated fats.*
AHA/ACC report indicated saturated fat
intake exceeded current recommendations
The recommendation to limit intake of calories from saturated fats to less than 10 percent per day
is a target based on evidence that replacing saturated fats with unsaturated fats is associated with
reduced risk of cardiovascular disease. The limit on calories from saturated fats is not a UL set by
the IOM. For most calorie levels, there are not enough calories available after meeting food group
needs to consume 10 percent of calories from added sugars and 10 percent of calories from
saturated fats and still stay within calorie limits.
Executive Summary - 2015-2020 Dietary Guidelines - health.gov
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AHA/ACC report indicated saturated fat
intake exceeded current recommendations
http://health.gov/dietaryguidelines/2015-scientific-report/PDFs/Appendix-E-3.5.pdf
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Nutrient impact
◦ Nominal impact substituting saturated (solid) fats
with oils
◦ Differences noted in Na, choline, cholesterol,
vitamin D, vitamin A, vitamin E
 Oils substitution may raise vitamin E intake to 90% of
RDA
http://health.gov/dietaryguidelines/2015-scientific-report/PDFs/Appendix-E-3.5.pdf
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http://health.gov/dietaryguidelines/2015-scientific-report/PDFs/Appendix-E-3.5.pdf
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http://health.gov/dietaryguidelines/2015-scientific-report/PDFs/Appendix-E-3.5.pdf
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Of the nutrients that are underconsumed or
overconsumed, including over the Tolerable
Upper Limit of Intake (UL), which present a
substantial public health concern?
80
70
Percent Above 300 mg/d
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60
50
40
30
20
10
0
1‐3
4‐8
9‐13
14‐18
19‐30
31‐50
>50
Age (years)
Males
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Females
Data Source: What We Eat in America, NHANES 2007-2010, individuals 1 year and over (excluding breast-fed children
and pregnant or lactating females), dietary intake data. Prepared by the Food Surveys Research Group, Beltsville Human
Nutrition Research Center, Agricultural Research Service, U.S. Department of Agriculture.
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2010 DGA – limit dietary cholesterol < 300
mg/d
2015 DGA – “no appreciable evidence
between consumption of dietary cholesterol
and serum cholesterol (per AHA/ACC report)
◦ Cholesterol not a nutrient of concern for
overconsumption.
◦ Adverse blood lipid profiles (elevated LDL-C, low
HDL-C; high TG) considered CVD risk factors and
are prevalent in obese individuals
Eckel RH et al., Circulation 2013; 10.1161/01.cir.0000437740.48606.d1
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• Foundational Manuscripts:
What is the current contribution of fruit
products with added sugars to intake of
added sugars?
What is the relationship between the intake of
added sugars and cardiovascular disease,
body weight/obesity, type 2 diabetes, and
dental caries?
– Te Morenga et al., Dietary sugars and body weight:
systematic review and meta-analysis of randomised
controlled trials and cohort studies. BMJ
2013;346:e7492
• Isoenergetic exchange of dietary sugars with other
carbohydrates showed no change in body weight
(0.04 kg, −0.04 to 0.13).
• Hypercaloric ad libitum diets increased sugars intake
was associated with a comparable weight increase
(0.75 kg, 0.30 to 1.19; P=0.001).
• Hypocaloric ad libitum diets reduced intake of
dietary sugars was associated with a decrease
in body weight (0.80 kg, 95% confidence
interval 0.39 to 1.21; P<0.001);
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42
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Te Morenga et al. BMJ. 2012;345:e7492
Te Morenga et al. BMJ. 2012;345:e7492
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• Foundational Manuscripts:
Children
Te Morenga et al. BMJ. 2012;345:e7492
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– Malik et al., Sugar-sweetened beverages and weight gain in children and
adults: a systematic review and meta-analysis. Am J Clin Nutr 2013; doi:
10.3945/ajcn.113.058362
Adults
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Changes in BMI (95% CI) per 1-serving/d increase in sugar-sweetened beverages during the time period
specified in each study from prospective cohort studies in children. Horizontal lines denote 95% CIs; solid
diamonds represent the point estimate of each study. Open diamonds represent pooled estimates, and
the dashed line denotes the point estimate of the pooled results from the random-effects model.
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Foundational Manuscripts:
Foundational Manuscripts:
Kaiser et al., Will reducing sugar-sweetened beverage consumption
reduce obesity? Evidence supporting conjecture is strong, but evidence
when testing effect is weak. Obes Res 2013; doi: 10.1111/obr.12048.
Kaiser et al., Will reducing sugar-sweetened beverage consumption
reduce obesity? Evidence supporting conjecture is strong, but evidence
when testing effect is weak. Obes Res 2013; doi: 10.1111/obr.12048.
“There is sufficient scientific evidence that decreasing sugar‐sweetened beverage (SSB) consumption will reduce the prevalence of obesity and obesity‐related diseases.”
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48
8
Headlines:
Drink just one 12-ounce
can of sugary soda
every day, and you
might be unwittingly
increasing your risk of
dying from heart disease,
suggests a new study.
Deaths Attributable to Individual Risks
(x 1000) among Both Sexes
467
Smoking
395
High BP
216
High BMI
Physical…
191
High Blood…
190
110
High LDL-C
102
High Dietary Na
84
Low Dietary…
82
High Dietary tFA
64
Alcohol Use
Conclusions:
• Increased calories … from added sugar … associated with increased risk of
CVD mortality
• Consumption of SSB (aka sugar) is associated with elevated CVD mortality
Recommendation
• Limit intake of calories … from added sugar
35
25
SSBs
Low Intake PUFA…
0
15
50
100
150
200
250
300
350
400
450
500
Danaei et al. PLoS Med 6(4): e1000058. doi:10.1371/journal.pmed.1000058
http://circ.ahajournals.org/cgi/content/meeting_abstract/127/12_MeetingAbstracts/AMP22
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50
51
52
500
30
300
20
15
200
10
Kcal/d
400
25
100
5
0
55
Low Intake F/V
600
40
Prevalence (%)
Yang et al., JAMA Intern Med 2014; doi:10.1001/jamainternmed.2013.13563
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19601962
19711974
Caloric…
19761980
19881994
HFCS
19992000
Overweight
20072008
2009-
0
2010
Obese
U.S. Dept of Agriculture. Economic Research Service
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What are current consumption patterns of USDA Food Pattern
food groups by the U.S. population?
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USDA Food Patterns
◦ Describe types and amounts of food to consume that will
provide a nutritionally adequate diet
What are the trends in USDA Food Pattern food group
consumption by the U.S. population?
◦ Include recommendations for 5 major food groups and
subgroups, an allowance for oils, and limits on intake of
calories from solid fats and added sugars
What is the composition of dietary patterns with evidence of
positive health outcomes (e.g., Mediterranean-style patterns,
Dietary Approaches to Stop Hypertension (DASH)-style
patterns, patterns that closely align with the Healthy Eating
Index, and vegetarian patterns) and of patterns commonly
consumed in the United States?
What are the similarities (and differences) within and among
the dietary patterns with evidence of positive health
outcomes and the commonly consumed dietary patterns?
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Modeling determines the hypothetical effect on nutrient
content and adequacy of the USDA Food Patterns when
specific changes are made in amounts or types of foods
that might be included in the pattern.
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Used to develop new or revised USDA Food Patterns
based on various types of evidence.
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Nutrients considered in food patterns analysis
◦ Vitamins: A (including precursors), E, D, C, K, B1,
B2, B3, B6, B12, choline, total folate
◦ Minerals: Ca, Fe, Mg, Mn, P, K, Na, Zn, Cu, Se
◦ Macronutrients: Protein, CHO, Total lipid (SFA,
MUFA, PUFA, Linoleic (18:2), Linolenic (18:3), EPA,
DHA
◦ Other: Energy, cholesterol, total dietary fiber
The nutrients for which
adequacy goals are not met
in almost all patterns are
potassium, vitamin D,
vitamin E, and choline.
For cholesterol, bar shows percent of 300 mg. For sodium, the bar shows the percent of UL.
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http://health.gov/dietaryguidelines/2015-scientific-report/15-appendix-E3/e3-1.asp
Advise adults who would benefit from LDL-C lowering
Calorie Level
Consume dietary pattern that emphasizes intake of vegetables, fruits,
and whole grains; includes low-fat dairy products, poultry, fish,
legumes, nontropical vegetable oils and nuts; limits intake of sweets,
SSB and red meats
• Dietary patterns appropriate for calorie requirements, personal and
cultural preferences;
• Possible patterns include DASH, USDA Food Pattern, AHA Diet, Medstyle Diet
Macronutrients
Calories, Kcal
Protein, g
Protein, %en
Carbohydrates, g
Carbohydrates, %en
Reduce percent calories from SFA
Reduce percent calories from industrial trans fat
1200
1600
2000
2400
1204
1556
2003
2400
59
78
91
106
19.6
20.0
18.4
17.7
155
197
256
310
51.4
50.3
51.1
51.7
41
54
72
87
Total fat, % en
30.6
31.2
32.4
32.6
Saturated fats, g
10.1
12.9
18.7
22.6
7.5
7.5
8.3
8.5
Total fat, g
Aim for pattern that achieves 5%-6% calories from SFA
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Saturated fats, %en
Eckel RH et al., Circulation 2013; 10.1161/01.cir.0000437740.48606.d1
http://health.gov/dietaryguidelines/2015-scientific-report/15-appendix-E3/e3-1-a6.asp
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Shortfall
Nutrients/
Nutrients
of Public
Health
Concern
Vitamins A, D, E, and C, folate, calcium, magnesium, fiber,
and potassium are shortfall nutrients relative to their EAR or
AI.
Calcium, vitamin D, fiber and potassium, and iron for
adolescent and adult females are nutrients of public health
concern for under consumption.
Sodium and saturated fat are over consumed and at a level
that poses a health risk.
The DGAC did not bring forward the 2010 recommendation
for cholesterol because available evidence shows no
Cholestero
appreciable relationship between consumption of dietary
l
cholesterol and serum cholesterol, consistent with the
conclusions of the AHA/ACC report.
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Part D. Chapter601
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Food
Group
Intakes
Compared to recommended amounts in the USDA Food
Patterns, the majority of the U.S. population has low
intakes of vegetables, fruits, whole grains, and dairy. They
are important sources of the shortfall nutrients.
Healthy
Dietary
Patterns
Population intake is too high for refined grains and added
sugars.
Obesity and many other health conditions with a nutritional
Health
origin are highly prevalent.
Conditions
In general, the ranges of intake in dietary patterns with
positive health benefits are similar to those
recommended by the USDA Food Patterns, but amounts
of some specific food groups vary across the various
diet pattern types. A healthful diet can be achieved by
following any of these dietary patterns.
The composition of three dietary patterns—the Healthy
U.S.-style Pattern, the Healthy Mediterranean-style
Pattern, and the Healthy Vegetarian Pattern—were
identified and examined for nutrient adequacy. These
patterns include the components of a dietary pattern
associated with health benefits.
Part D. Chapter611
Part D. Chapter621
Common characteristics of dietary patterns associated with
beneficial 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)
Dietary
-- Lower consumption of red and processed meat, and
Patterns
low intake of sugar sweetened foods and drinks, and
and Health
refined grains
Outcomes Following a dietary pattern associated with reduced risk of
CVD, obesity and overweight will have additional positive
benefits on health.
Dietary patterns can be achieved in many ways and should
be tailored to the individual’s food and cultural preferences
and health conditions
Part D. Chapter632
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Congressional report (post 1980)
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Voluntary
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Mandate
◦ 1980, 1985, 1990
◦ USDA & HHS to convene advisory committee
◦ Require outside advice (formal and informal)
for future DGA
◦ 1990 National Nutrition Monitoring and Related
Research Act, Title III (P.L. 101-445)
◦ Calls for USDA/HHS to issue joint DGA every five
years based on preponderance of current scientific
and medical knowledge
 Experts outside the Federal sector  1985
◦ 1985 DGA, as modified by USDA & HHS,
formed guidance for consumers, scientific
and industry groups
◦ Calls for establishment of advisory committee
(DGAC)
◦ Calls for establishment of National Nutrition
Monitoring Advisory Council (NNMAC)
◦ 1995 – first DGA mandated by statute
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 HHS/USDA (1993) appoint 11-member DGAC for
1995
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Criteria for DGAC not specified (Title III)
Criteria for NNMAC specified (Title II)
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Criteria for NNMAC representation (Title II)
◦ At least two representatives from each
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

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◦ Selection solely on basis of established record of
distinguished service and eminence in the following
 public health, including clinical dietetics, public health
nutrition, epidemiology, clinical medicine, health
education, or nutrition education
 nutrition monitoring research, including nutrition
monitoring and surveillance, food consumption patterns,
nutritional anthropology, community nutrition research,
nutritional biochemistry, or nutrition status methodology;
or
 food production and distribution, including agriculture,
biotechnology, food technology, food engineering,
economics, consumer psychology or sociology, food
system management, or food assistance
Specified above
Various geographical areas
Private sector
Academia
Scientific and professional societies
Agriculture
Minority organizations
Public interest organizations, and
State or local government employee with a
specialized interest in nutrition monitoring
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Appropriations Bill (December 15, 2015)
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◦ Section 734
Key Points of Analysis
◦ How DGA can better prevent chronic disease,
ensure nutritional sufficiency, and accommodate a
range of individual factors?
◦ How the DGAC selection process can be improved?
◦ How NEL is compiled and utilized; do the
studies/data reflect rigorous and objective scientific
standards?
◦ How are systematic reviews conducted, including
studies from scientists with a range of viewpoints?
 DGA must be based on significant scientific agreement
 DGA must be limited in scope to nutritional and dietary
information
◦ Section 735
 National Academy of Medicine (formerly IOM) to
conduct a comprehensive study of the entire process
used to establish the Advisory Committee and
subsequent development of the DGA
http://docs.house.gov/billsthisweek/20151214/CPRT-114-HPRT-RU00-SAHR2029-AMNT1final.pdf
Posted December 15, 2015; Accessed January 19, 2016
http://docs.house.gov/billsthisweek/20151214/CPRT-114-HPRT-RU00-SAHR2029-AMNT1final.pdf
Posted December 15, 2015; Accessed January 19, 2016
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Congress provided $1MM for process DGAC review
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◦ How the DGAs can better ensure nutritional sufficiency for
all Americans?
◦ How the advisory committee
selection process be improved?
U.S. Secretary of Agriculture Tom Vilsack (L) and
Secretary of Health and Human Services Sylvia
◦ How the NEL is compiled and
Burwell (R) testify during a hearing before the House
Agriculture Committee October 7, 2015 on Capitol
utilized?
Hill in Washington, DC
◦ How systematic reviews are
conducted and include studies
with a range of viewpoints.
◦ Recommendations to improve
the process used to establish the
DG and to ensure the DG reflect
balanced sound science.
https://www.washingtonpost.com/news/wonk/wp/2015/12/18/congress-we-need-to-review-the-dietaryguidelines-for-americans/
Teicholz BMJ 2015; 351 doi: http://dx.doi.org/10.1136/bmj.h4962
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Three groups (scientific societies, industry, public interest)
Example themes/questions
◦ The current DGAC nomination process must be improved.
 Other experts with practical experience from diverse disciplines should
be engaged.
 Scientific integrity called into question
◦ NEL should be used more extensively; how is this populated?
 The DGAC research questions should be public.
◦ Were the dietary patterns models validated for the identified
conclusions?
◦ How are the nearly 30,000 public comments to be addressed?
◦ How frequently should DGAC convene to issue DGA? Could the
DGAs be “updated” on a “section” basis?
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February 19, 2016 (USDA invitation only)
Next meeting TBD
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3/21/2016
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Controversies
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Methodology
Total fat
Saturated fat
“Added” sugar
Dietary patterns
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Seek to understand
Examine totality of
evidence
Facilitate clear messages
Reduce confusion
Pursue trust and truth
Media  Fear, Uncertainty, Doubt
A Few Good Men wherein court martial lawyer Daniel Kaffee (played by Tom Cruise) exposes
Colonel Nathan R. Jessup’s (played by Jack Nicholson). A Few Good Men (7/8) Movie CLIP (1992)
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