Dietary Guidelines for Americans Anna Maria Siega-Riz, PhD Professor of Public Health Sciences and Obstetrics and Gynecology University of Virginia
Areas of Potential Public Policy Impact U.S. Department of Health U.S. Department of and Human Services Agriculture • • Food, agriculture and farm Healthcare systems policies, resources, and – Affordable Care Act products – Medicaid and Medicare • Federal Food Assistance • National Prevention strategy Programs : – National School Lunch Program • Grant funding for public health – Child and Adult Care Food research and infrastructure Program Nutrition – Supplemental Nutrition Assistance Program (SNAP) • Food and nutrition labeling – Commodity Supplemental Food – Nutrition Facts Label Program – – Restaurant and vending labeling Special Supplemental Nutrition Program for Women, Infants and Children (WIC) DGAC Report: Introduction, Evidence Base and Overall Findings
From Advisory Report to Policy Document: Creating the Dietary Guidelines for Americans, 2015 Available at www.DietaryGuidelines.gov
2015 Dietary Guidelines Advisory Committee • Provides science-based recommendations to the Federal government on – How food, nutrition, and physical activity • Can promote the health of the U.S. population • Help reduce the burden from major chronic diseases and other lifestyle-related health problems – How best to accomplish these goals at individual and population levels • Scientific report informs the Dietary Guidelines for Americans, 2015 policy document DGAC Report: Introduction, Evidence Base and Overall Findings
Committee Members • Chair- Barbara Millen, DrPH, RD , Millennium Prevention, Westwood, MA • Co-Chair- Alice Lichtenstein, DSc , Tufts University, Boston, MA • Members: – Steven Abrams, MD , Baylor College of Medicine, Houston, TX – Lucile Adams-Campbell, PhD, Georgetown University Medical Center, Washington, DC – Cheryl Anderson, PhD University of California, San Diego,CA – J. Thomas Brenna, PhD, Cornell University, Ithaca, NY – Wayne Campbell, PhD, Purdue University, West Lafayette, IN – Steven Clinton, MD, PhD , The Ohio State University, Columbus, OH – Frank Hu, MD, PhD , Harvard School of Public Health, Boston, MA – Miriam Nelson, PhD , Tufts University, Boston, MA – Marian Neuhouser, PhD, RD , Fred Hutchinson Cancer Research Center, Seattle, WA – Rafael Pérez-Escamilla, PhD, Yale School of Public Health,New Haven, CT – Anna Maria Siega-Riz, PhD, UNC-Chapel Hill, NC – Mary Story, PhD, RD , University of Minnesota, Minneapolis, MN/Duke University • Consultants- Timothy Griffin, PhD, Tufts University; Michael Hamm, PhD, Michigan State University; Michael Perri, PhD, ABPP, University of Florida
2015 DGAC Themes Core to the DGAC • Food, nutrient, and health-related recommendations Themes • Prevalent Nutrient and related Health Problems of Americans – Nutrition and Health Disparities • Overall Dietary Patterns and Health Outcomes • Strategies to improve dietary quality and health outcomes, especially overweight and obesity and chronic diseases – Individual and population levels • Food Safety, Security and Sustainability now and for future generations • Systems Approach DGAC Report: Introduction, Evidence Base and Overall Findings
DGAC Subcommittees 2015 DGAC Subcommittees Science Review Subcommittee SC 1 SC 2 SC 3 SC 4 SC 5 Food and Dietary Diet and Nutrient Patterns, Food and Physical Food Intakes, and Foods and Physical Activity Sustainability Health: Nutrients, and Activity Behavior and Safety Current Status Health Environments Change and Trends Outcomes Nutrients of concern Dietary patterns and Self-monitoring Settings: Food safety: health outcomes Food group intakes Eating out Schools/afterschool Preventing foodborne illness Food sources Household food Childcare Foods and nutrients insecurity Caffeine Eating behaviors Post-secondary and health outcomes Food/menu label use Aspartame Dietary patterns Worksites Mobile health Health concerns Acculturation Other Topics Food pattern modeling Other Topics: Screen time/sedentary Dietary patterns and Food access behavior sustainability Sleep patterns
Cross-cutting Topics of Public Health Importance • Added Sugars • Sodium • Saturated Fat • Physical Activity DGAC Report: Introduction, Evidence Base and Overall Findings
Examining the Evidence • NEL systematic reviews • Existing reports – Existing high-quality evidence-based reports – Existing systematic reviews – Existing meta-analyses www.DietaryGuidelines.gov Go to “Resources” • Data analyses a nd select “Data Analyses” • Food pattern modeling analyses • Public comments DGAC Report: Introduction, Evidence Base and Overall Findings
www . NEL . gov USDA NEL Process Step 1: Topic identification and systematic review question development Step 2: Literature search, screening, and selection Step 3: Data extraction and risk of bias assessment Step 4: Evidence synthesis Step 5: Conclusion statements and grading the evidence Step 6: Research recommendations and technical abstracts DGAC Report: Introduction, Evidence Base and Overall Findings
Conclusion Statements and Grading the Evidence • Conclusion statements: Overall summary statement worded as an answer to the question; tightly associated with the evidence • Grading the evidence: Considers risk of bias, quantity, consistency, impact, and generalizability of the body of evidence DGAC Report: Introduction, Evidence Base and Overall Findings
Grading the Evidence 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 Strong level of certainty that the conclusion is generalizable to the population of interest, and it is unlikely to change if new evidence emerges. 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 Moderate evidence available, inconsistencies in findings, or methodological or generalizability concerns. If new evidence emerges, there could be modifications to the conclusion statement. The conclusion statement is substantiated by insufficient evidence, and the level of certainty is seriously restricted by limitations in the evidence, such as the Limited 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. Grade not A conclusion statement cannot be drawn due to a lack of evidence, or the availability of evidence that has serious methodological concerns. assignable DGAC Report: Introduction, Evidence Base and Overall Findings
Implications and Recommendations • Build on the conclusion statement to provide needed context • Makes conclusion statements (the answer to the question) actionable • Describes what the Committee advises the government to consider in developing public policy DGAC Report: Introduction, Evidence Base and Overall Findings
Findings
Health Conditions: Evidence Base SC 1 • The overall problem : high rates of preventable chronic diseases and overweight/obesity • The solution : Need to shift the focus of healthcare and public health towards a greater emphasis on disease prevention and risk reduction through sound diet and lifestyle strategies DGAC Report: Integration and Recommendations Overall Findings 1 and 3
Overall Dietary Quality: Evidence Base SC 1 • The gap : suboptimal dietary intake – Low in vegetables, fruit, whole grains – High in sodium, saturated fat, refined grains, added sugars, and calories • The solution : Need to apply the best methods to improve dietary quality with sound interventions, services and product innovations. DGAC Report: Integration and Recommendations Overall Findings 2 and 3
Percent of population ages 2+ with usual intakes below EAR vitamin D vitamin E magnesium calcium vitamin A vitamin C zinc vitamin B6 folate iron thiamin copper phosphorus selenium vitamin B12 niacin riboflavin 0 20 40 60 80 100 Percent of population What We Eat in America, NHANES 2007-10 DGAC Report: Integration and Recommendations Overall Findings 2 and 3
2015 DGAC Added Sugars • Definition: Added sugars are sugars that are either added during the processing of foods, or are packaged as such, and include sugars (free, mono- and disaccharides), syrups, naturally occurring sugars that are isolated from a whole food and concentrated so that sugar is the primary component (e.g., fruit juice concentrates), and other caloric sweeteners. • The current intake of added sugars is high at 268 calories or 13% of total calories/day for the total population, and 15-17% in older children, adolescents, and young adults . Cross-Cutting Topics of Public Health Importance
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