Download MyPyramid Food Guidance System Turns One

2015 Dietary Guidelines: Pass the
bacon, but hold the added sugar
Joanne Slavin
Professor
Department of Food
Science and Nutrition
April 29, 2016
From the Science to Me
The Science
Policy
Me
There is no perfect diet!
• Humans are omnivores and are adaptable to a wide
range of foods
• Humans have survived and prospered on all kinds of
diets, mostly reflecting access to food supply
– Traditional Arctic diet: 80% of kcals from fat
– Traditional African diet: 80% of kcals from carbohydrate
• Because of concerns with fat and cardiovascular
disease, U.S. diet moved from higher fat (42% of kcal
in 1972) to lower fat (32% of kcal in 2000) –current
movement toward lower carbohydrate
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Nutrient Adequacy
- Meet nutrient needs without exceeding calorie needs
- Dietary Reference Intakes (DRIs)
- Acceptable Macronutrient Distribution Ranges (AMDR)
- Protein: 10 - 35% of kcal
- Carbohydrates: 45 - 65% of kcal
- Fat: 20 - 35% of kcal
- Recommended Dietary Allowance (RDA)
- Adequate Intake (AI)
- Tolerable Upper Level Intake (UL)
Senate Select Committee on Nutrition and Human Needs –
Dietary Goals the United States (1977)
•
•
•
•
•
•
Increase carbohydrates to 55%–60% of energy
Reduce fat to 30% of energy
SF, MF, PUFAs – 10%/10%/10%
Reduce cholesterol to 300 mg/day
Reduce sugar consumption by 40%
Reduce salt consumption to 3 g/day – 1200 mg
sodium
What are the Dietary Guidelines?
•
•
•
•
1st published in 1980
Federal nutrition policy established jointly by USDA & HHS
Updated every 5 years
Provide science-based advice for ages 2 and over to help prevent
chronic disease & promote health
• Foundation for Federal nutrition programs, nutrition education
programs, and a basis for research gaps and priorities
• Ensure that messages and materials are consistent through-out
the Federal government and that government speaks with “one
nutrition voice”
• Policy used by educators, health professionals, policy makers – for
consumers
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Dietary Guidelines for Americans 1980 - 2010
2000
2010
1990
1980
1995
1985
2005
Development of Dietary Guidelines Policy
Dietary Guidelines
for Americans, 2010
DGAC
Charter
(TBD)
U.S. Department of Agriculture
U.S. Department of Health and
Human Services
www.dietaryguidelines.gov
DGAC is
chartered
DGAC
Public Meetings:
Review of the
Science
The
New
“Pyramid”
DGAC
USDA & HHS
Advisory Report
write the
DG’s
submitted to the
Policy
implemented
Secretaries of
Document
through Federal
USDA & HHS
programs
Public comments encouraged/collected
Evidence-based Methodology Used to Review the Science
Indexing/Search
Topics
Available at:
www.NutritionEvidenceLibrary.gov
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NEL Process
Formulate
Systematic
Review
Questions
•Exploratory
searches
•Public
comment
•Dialogue
with
experts
•Analytical
Framework
•PICO
Literature
Search and
Sort
•Identify study
eligibility criteria
•Determine
search strategy
•Search for
relevant studies
•List included
studies
•List excluded
studies and
rationale
Extract
Evidence
From
Studies
Create
evidence
worksheets
Summarize
and
Synthesize the
Evidence
•Assess quality
of individual
studies
•Assess
applicability
•Summarize and
synthesize
evidence
Develop and
Grade
Conclusion
Statements
Define Research Recommendations
General Study Eligibility Criteria
•
•
•
•
•
Human studies
Developed countries
English language
Peer reviewed journals
Search and sort plans specified:
– Age of subjects, study setting, number of subjects
per study arm, attrition rate, characteristics of
intervention, outcome measures and study design
Hierarchy of
Evidence
Stronger
Evidence
RCT
Weaker
Evidence
Double Blinded
Intervention study
Prospective, cohort study
Clinical trial
Cross-sectional study
Case Report
Expert Opinion
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Grade Strength of Evidence
• Quality
– Scientific rigor and validity
– Consider study design and execution
• Quantity
– Number of studies
– Number of subjects in studies
• Consistency of findings across studies
• Impact
– Importance of studied outcomes
– Magnitude of effect
• Generalizability
Evidence Analysis Methodology
Rigorous
Minimizes bias
Transparent
Accessible to stakeholders and consumers
Defines state of the science
Foundation for updates
Answers precise questions • Illuminates research gaps
Food Pattern Modeling
- Important for “filling the gaps” in evidence
- Used intake data (NHANES) and nutrient composition
databases
- Identifies impact on nutrient adequacy of making specific
changes in food or dietary pattern (e.g., vegetarian
patterns)
- Essential in demonstrating what is “doable” for the American
public (e.g., alternatives to milk)
- Takes added sugar and solid fat from foods – to reduce
calories (Appendix E-3 in 2010 DGAC report)
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Calcium intake in children 4-8 Y as a function of
added sugar intake
Calcium, mg/day
1050
1000
950
900
850
*
800
*
750
700
650
600
0-5
5-10
10-15 15-20 20-25 25-30 30-35
% added sugars
2010 DG and dairy
• Dairy products are an important source of shortfall nutrients:
calcium, vitamin D, potassium
• Important nutrient source for children” “it is especially
important to establish the habit of drinking milk in young
children, as those who consume milk at an early age are more
likely to do so as adults.”
• Similar to 2005 DG – 3 dairy servings/day recommended –
children 4 – 8 yrs, increased from 2 – 2.5 dairy servings/d
• If you are lactose intolerant, the 2010 DG recognize dairy as
an important source of nutrients and recommend lactose-free
milk or smaller amounts of milk
Three daily servings of reduced-fat milk – an evidencebased recommendation?
• Growing acceptance that full fat dairy, including
cheese, linked to less disease risk, not more than low
fat dairy
• This recommendation for low fat dairy is based on
modeling – when you remove fat you remove
calories
• Recommendations in the DGAs for lower solid fat
and added sugar based on nutrient density, not link
to negative health outcome
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Diet modeling with dairy consumption
• Modeled recommended intakes of dairy from
the 2010 DGAs
• Most children and adults fall short on dairy
• Calcium, magnesium, and vitamin A intakes
improved when dairy intake was modeled
• Smaller, but significant increases in Vitamin D
and little change in potassium
• Quann EE et al. Nutr J. 2015;14:90
DGAC 2015
• “Settled science” – did not update all the
questions from 2010 DGAC
• Movement to whole foods and away from
nutrients
• Topics such as sustainability, sugar taxes, vegan
diets, and food processing were discussed and
increased interest and public comments
2015 DGAC – Dietary patterns, foods and nutrition,
and health outcomes
• The US population should consume dietary patterns
that are:
– Rich in vegetables, fruits, whole grains, fish/seafood,
legumes, and nuts
– Moderate in dairy products (e.g. low and non-fat dairy)
and alcohol and
– Lower in red and processed meat and
– Low in sugar-sweetened foods and beverages and refined
grains
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2015 DGAC – Chapter 6, Question 6: What is the relationship between
the intake of added sugars (AS) and cardiovascular disease, body
weight/obesity, type 2 diabetes (T2D), and dental caries?
•
•
•
•
Strong and consistent evidence shows that intake of AS from food and/or SSBs are associated
with excess body weight in children and adults. The reduction of AS and SSBs in the diet
reduces BMI in both children and adults. Comparison groups with the highest vs. the lowest
intakes of AS in cohort studies were compatible with a recommendation to keep added sugars
intake below 10 percent of total energy intake. DGAC Grade: Strong
Strong evidence shows that higher consumption of AS, especially SSBs increases risk of T2D
among adults and this relationship is not full explained by body weight. DGAC Grade: Strong
Moderate evidence from prospective cohort studies indicates that higher intake of AS,
especially in the form of SSBs, is consistently associated with increased risk of hypertension,
stroke and CHD in adults. Observational and intervention studies indicate a consistent
relationship between higher AS intake and higher BP and serum TG. DGAC Grade: Moderate
The DGAC concurs with the WHOs commissioned systematic review that moderate consistent
evidence supports a relationship between the amount of free sugars intake and the
development of dental caries among children and adults. Moderate evidence also indicates
that caries are lower when free sugars intake is less than 10 percent of energy intake. DGAC
Grade: Moderate
Nutrition Facts: 10% - DV for added sugars
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Chocolate milk wars
• Flavored low fat milks are chosen by 70% of school lunch
participants
• Nutrition is particularly prone to “white hat bias”, that is
strongly held positions staked on moral certainty and
proof not needed
• Campaigns against cholesterol, fat, and high-fructose
corn syrup all shared the same righteous surety as that
against added sugar.
• But we were wrong and did more harm than good”
• Murray R. et al. Pediatrics doi:10.1542/peds.2015-3202A
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Differences in nutrient content of milks – USDA
Nutrient Database
Type
Whole
1% white
FF white
1% choc
FF choc
Calories
146
102
91
158
130
Total fat - g
7.9
2.0
0.6
2.5
0.0
Protein - g
7.7
8.7
8.7
7.9
7.5
Sugar - g
11.0
11.0
12.3
26.0
22.0
Ca - mg
276
299
316
400
300
Flavored milk and nutrients
• Review of 53 studies
• Children drink more flavored milk than plain milk
• When flavored milk is not available, children drink less
plain milk
• There is no association between flavored milk intake and
weight status among normal weight children, and some
contradictory effects of flavored milk intake have been
observed in subgroups of overweight children.
• Flavored milk is a palatable beverage choice that helps
children to meet calcium targets.
• Fayet-Moore. Nutr Rev 2015;74:1-17
2015 Dietary Guidelines for
Americans
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2015-2020 DGAs
•
edition of DGAs released on 1-7-16
• Urge consumers to adopt healthy overall
eating patterns that include a variety of
vegetables, fruits, whole grains, low-fat dairy
or soy products, and low fat protein sources,
such as fish, lean meats, legumes, and soy
products
8th
2015-2020 DGAs
• Americans should limit consumption of
– added sugars to less than 10% of daily energy
intake
– Saturated fats to less than 10% of daily energy
intake
– And sodium to less than 2300 mg/day
– If they drink alcohol, women should limit their
consumption to one drink a day and men to two a
day
2015-2020 DGAs
• Other changes
– No limit on dietary cholesterol
– Solid fat is now called saturated fat
– Refined grains and fiber not addressed; no change
from 2010 – “a healthy eating pattern includes
grains, at least half of which are whole grains”
– Moderate coffee consumption (up to 400 mg/day
caffeine) can be incorporated into healthy eating
patterns
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2015 Healthy Eating Patterns
• US-Style
• Vegetarian
• Mediterranean
2015 Dietary Patterns
Why all the excitement
• The 2015 DGAC suggested that taxes be used
to discourage consumption of sugary drinks
and that the effects of diet on the
environment be considered when making
dietary decisions
• Critics argued these ideas were outside the
scope of the DGAC and charged that politics,
not science, were driving the panels’
recommendations
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Next steps
• Congressional hearing on the advisory panels’
methods and passage of legislation that
threatened to deny funding for the next
edition of the guidelines unless the secretaries
of agriculture and health and human services
ensured that any revisions were “based on
significant scientific agreement” and were
“limited in scope to nutritional and dietary
information”
Next steps
• Secretary of Agriculture must engage the
National Academy of Medicine to conduct a
“comprehensive study of the entire process”
used to establish the advisory panel, the
Dietary Guidelines Advisory Committee
• USDA is conducting listening session currently
to engage the broad nutrition community in
this effort
1943: Basic Seven
Margaret Mead:
“People don’t eat
nutrition – they eat
food”
Basic 7 did not specify
the number of
servings of each food
group needed daily
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Food advice: Evolution of USDA’s
Food Guidance – Moderation and Variety
1950s-1960s
1940s
Food for
Young
Children
1970s
1992
1916
2005
MyPlate.gov (6/2/11)
Conclusions
• Evidence-based reviews are limited in ability to define “healthy
foods”
• Other tools, such as modeling, are also used to set dietary guidelines
• Recommendations for less added sugar and saturated fats are based
on empty calories, not health outcomes – USDA modeling
• Strict rules on added sugars, saturated fats, or sodium make it
difficult for nutrient dense foods, including flavored milks, yogurts,
protein snacks, fruit snacks, cheese, to be recommended
• Expect greater scrutiny on the process to select the 2020 DGAC
• Since the 2020 DGAs will include recommendations for birth to 24
months, stakes are higher – stay tuned
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