WELCOME TO
THE 2025 DIETARY GUIDELINES
ADVISORY COMMITTEE MEETING 6.
WE'RE SO HAPPY TO HAVE THE
COMMITTEE BACK TOGETHER TO
RECORD UPDATES SINCE THEIR FIFTH
MEETING.
NEXT SLIDE PLEASE.
I'M HAPPY TO SHARE ALL OF THE
MEMBERS ARE PARTICIPATING TODAY.
WE HAVE TWO MEMBERS, JERNIGAN
AND RAYNOR, PARTICIPATING
VIRTUALLY.
NEXT SLIDE.
AS I MENTIONED, YOU CAN SEE ON
THE TIMELINE, THIS IS THE SIXTH
MEETING OF THE COMMITTEE AND
THERE WILL BE ONE ADDITIONAL
MEETING OCTOBER 21 AND 22 TO
PRESENT RESULTS OF SCIENTIFIC
REPORT.
REGISTRATION WILL OPEN SOON.
NOW I'D LIKE TO TURN IT OVER TO
OUR COMMITTEE CHAIRS, DOCTORS
BOOTH AND ODOMS-YOUNG FOR THE
UPDATE.
>> WELCOME, EVERYBODY, TO
MEETING NUMBER 6.
TO THOSE LISTENING IN, I CAN
ASSURE YOU THIS COMMITTEE HAS
BEEN WORKING AROUND THE CLOCK
SINCE WE LAST GOT TOGETHER AS A
COMMITTEE.
AND WE HAVE A REALLY EXCITING
AGENDA.
NEXT SLIDE PLEASE.
SO, TODAY WE'RE GOING TO START
WITH FOOD PATTERN MODELING LED
BY CHRIS TAYLOR.
DATA ANALYSIS, STRATEGIES FOR
INDIVIDUALS AND FAMILY RELATED
TO DIET QUALITY AND WEIGHT
MANAGEMENT AND DIETARY PATTERNS
AND SPECIFIC DIETARY COMPONENTS
ACROSS LIFE STAGES.
EACH OF THESE PRESENTATIONS WILL
INVOLVE PRESENTATIONS BY
MULTIPLE MEMBERS OF EACH OF THE
GROUPS.
THESE ARE THE LEAD.
NEXT SLIDE PLEASE.
AND THEN TOMORROW WE'LL DO MORE
UPDATES WITH THE DIET AND
PREGNANCY AND BIRTH THROUGH
ADOLESCENCE.
WE'RE GOING TO CONTINUE FOOD
PATTERN MODELING, AND THEN WE
ARE GOING TO DISCUSS HEALTH
EQUITY.
JANET DEJESUS WILL PROVIDE SOME
INFORMATION ON NEXT STEPS, AND
THE EXCITING DISCUSSION, WE'LL
HAVE A TWO-HOUR DISCUSSION ABOUT
INTEGRATING OUR FINDINGS, AND WE
ANTICIPATE A LOT OF ENGAGED
CONVERSATION.
NEXT SLIDE PLEASE.
EACH SUBCOMMITTEE AND WORKING
GROUP WILL BE PRESENTING
PROGRESS MADE SINCE MEETING 5
FOR COMMITTEE DISCUSSION.
WE HAVE MORE DRAFT CONCLUSION
AND SYNTHESIS STATEMENTS FOR
SCIENTIFIC QUESTIONS REVIEWED.
WE HAVE NEW ANALYSIS OF FOOD AND
BEVERAGE INTAKE BY
SOCIODEMOGRAPHIC GROUPS.
AND WE ALSO ARE GOING TO DO
RESULTS OF AN EVIDENCE SCANS ON
CULTURALLY TAILORED DIETARY
INTERVENTIONS.
NEXT SLIDE PLEASE.
SO, SINCE MEETING 4, WE HAVE --
WOW, WE HAVE IN TOTAL, ACTUALLY
WE'VE HAD 8443 WRITTEN PUBLIC
COMMENTS.
PUBLIC, THANK YOU FOR YOUR
ENGAGEMENT.
WE HAVE 417 CONTINUING
PROFESSIONAL EDUCATION
CERTIFICATES GRANTED, AND THESE
CONTINUING EDUCATION
CERTIFICATES ARE GRANTED FOR
DIETITIANS THAT WATCH THE
COMMITTEE MEETINGS.
WE'VE HAD, AS I SAY, THE NUMBERS
ARE GROWING.
MY DATA WAS INDICATING 296, SO
GO DIETITIANS FOR YOUR
ENGAGEMENT!
AND WE JUST WANT TO SAY PLEASE
GET INVOLVED, GO TO OUR WEBSITE.
YOU'RE GOING TO HEAR A LOT OF
CONVERSATION OVER THE NEXT TWO
DAYS.
AND WE REALLY WOULD LIKE TO HEAR
YOUR FEEDBACK ON WHAT YOU HEAR
IN THE NEXT TWO DAYS.
NEXT SLIDE PLEASE.
SO, JUST AS A REMINDER, I'M SURE
MANY OF YOU ARE, HMM, WE'VE SEEN
THIS BEFORE.
BUT I THINK IT'S REALLY, REALLY
IMPORTANT TO REMIND EVERYBODY
THAT YOU'RE GOING TO BE HEARING
A NUMBER OF GREAT CONCLUSION
STATEMENTS.
THE COMMITTEE USES NESR
METHODOLOGY TO CONDUCT REVIEWS,
AND THIS SLIDE IS A BRIEF
OVERVIEW OF METHODS USED TO
DEVELOP AND GRADE CONCLUSION
STATEMENTS.
THE NESR'S COMPLETE METHODOLOGY
IS AVAILABLE ON ITS WEBSITE,
WHICH IS INDICATED AT THE BOTTOM
OF THE GREEN.
SO, JUST AGAIN TO REINFORCE,
THIS COMMITTEE IS ENTIRELY
EVIDENCE DRIVEN.
THEY SYNTHESIZE, DEVELOP
CONCLUSION STATEMENT, GRADED
STRENGTH OF THE EVIDENCE, A
PROCESS WHICH THE COMMITTEE
REVIEWS ALL OF THE INCLUDED
EVIDENCE.
IT THOROUGHLY DESCRIBES,
COMPARES, CONTRASTS, AND
COMBINING ALL THE EVIDENCE TO
EXAMINE WHETHER THE INTERVENTION
OR EXPOSURE IS RELATED TO THE
OUTCOME OR OUTCOMES, IN THE
POPULATIONS OF INTEREST.
A CONCLUSION STATEMENT IS A
SUMMARY STATEMENT.
IT IS CAREFULLY CONSTRUCTED
BASED ON EVIDENCE REVIEWED TO
ANSWER THE QUESTION BEING ASKED.
NEXT SLIDE PLEASE.
SO, SINCE OUR LAST MEETING, WE
HAVE A LOT OF DISCUSSION ABOUT
OUR CONCLUSION STATEMENTS.
THE CONCLUSION STATEMENTS
COMMUNICATE THE STRENGTH OF THE
EVIDENCE BY CLEARLY STATING THE
GRADE AS PART OF THE STATEMENT,
AND BY FORMALLY PRESENTING THE
GRADE IN PARENTHESES AFTER THE
CONCLUSION, CRITICAL FOR
INTERPRETATION.
THIS COMMITTEE FELT WE NEEDED TO
FURTHER PROMOTE CLARITY AND
ACCURATE INTERPRETATION OF OUR
CONCLUSION STATEMENTS.
AND WE THEN DECIDED TO CHANGE
THE FORMAT OF OUR CONCLUSION
STATEMENTS.
SO THE CHANGE, AS HIGHLIGHTED IN
THIS TABLE HERE, INCLUDES MOVING
THE STATEMENT REGARDING THE
STRENGTH OF THE EVIDENCE TO THE
END OF THE STATEMENT.
AN EXAMPLE HERE IS DIETARY
PATTERNS WITH OUTCOMES OF TYPE 2
DIABETES IN THE PRIOR FORMAT WE
SAID STRONG EVIDENCE
DEMONSTRATES, AND THE GRADE IN
PARENTHESES, NOW IT'S A SEPARATE
STATEMENT.
SO THE CONCLUSION STATEMENT HERE
DOES NOT -- WE WANT TO EMPHASIZE
DOES NOT DRAW IMPLICATIONS, AND
IT SHOULD NEVER BE INTERPRETED
AS DIETARY GUIDANCE.
THE GRADES ARE ASSIGNED TO EACH
CONCLUSION STATEMENT BASED ON
ASSESSMENT OF UNDERLYING
EVIDENCE FOR FIVE ELEMENTS,
CONSISTENCY, PRECISION, RISK OF
BY AS, DIRECTNESS,
GENERALIZABILITY.
THE GRADE COMMUNICATES OUR LEVEL
OF CERTAINTY ON THE EVIDENCE,
AND THE DEFINITION OR
INTERPRETATION OF THE GRADES
WERE PRESENTED IN THE PRIOR
SLIDE.
I ALSO WANT TO EMPHASIZE WE HAVE
NOT CHANGED THE CONCLUSIONS.
WE'VE ONLY CHANGED THE FORMAT.
I ALSO WANT TO EMPHASIZE
PARTICULARLY TO THOSE LISTENING
IN, YOU MUST READ THE WHO
SENTENCES.
THEY GO TOGETHER.
SO WE WANTED TO INFORM THE
COMMITTEE BUT ALSO THE GENERAL
PUBLIC ABOUT THIS REASONING AND
JUST TO EMPHASIZE WE HAVEN'T
CHANGED OUR CONCLUSION; WE'RE
JUST CHANGING HOW WE'RE
FORMATTING IT TO IMPROVE
CLARITY.
SO, WITH THAT, I AM NOW
TRANSITIONING, NEXT SLIDE
PLEASE, TO THE FOOD PATTERN
MODELING AND DATA ANALYSIS LED
BY CHRIS TAYLOR.
>> THANK YOU, SARAH.
AND SO WE'RE GOING TO TALK ABOUT
SOME NEW DATA FROM FOOD PATTERN
MODELING AND WRAPPING UP OUR
ANALYSES ON THIS ASPECT.
SO, NEXT SLIDE PLEASE.
AGAIN, TO LIST OUT OUR AMAZING
SUBCOMMITTEE MEMBERS THAT WE
HAVE THAT HAVE TACKLED AN
INORDINATE AND MOUNDS OF DATA
WE'VE USED TO COLLECT ALL THIS
INFORMATION TO EVALUATE ALL
THESE QUESTIONS AND TO REALLY
MAKE THESE DETERMINATIONS
MEETING NUTRIENT GOALS, BASED ON
THE DIETARY PATTERN.
AND INCLUDED WITHIN THIS SET ARE
ALSO SEVERAL MEMBERS OF THE
HEALTH EQUITY WORKING GROUP SO
IT ALLOWS US TO OVERLAY THOSE
HEALTH EQUITY LENS WITHIN THE
WORK THAT WE'RE DOING.
AND ALSO TODAY PRESENTING WILL
BE DR. TAREGAWKAR
TOBIAS, AND MILLER PRESENTING
THE RESULTS.
NONE OF THIS WORK WITHOUT THE
POSSIBLE WITHOUT THE AMAZING
STAFF THAT WE HAVE THAT SUPPORT
US, SO JUST ONCE AGAIN.
TRANSITIONS INTO FINALIZING ALL
THESE DATA AND GETTING US READY
FOR INTEGRATION HAS BEEN A
MASSIVE LIFT, AND THE STAFF HAVE
BEEN AN AMAZING RESOURCE TO HELP
US TRANSLATE THESE HUNDREDS OF
THOUSANDS OF DATA POINTS INTO
SOMETHING THAT WE CAN TURN INTO
ACTIONABLE INTEGRATION
DISCUSSION, BOTH TOMORROW FOR
OUR SUMMARY AS WELL AS FOR THE
INTEGRATION DISCUSSION IN THE
AFTERNOON.
NEXT SLIDE PLEASE.
SO, THE COMMITTEE IS CHARGED
WITH ANSWERING ONE SINGLE
OVERAMPING QUESTION, WHICH IS
CONSIDERING EACH LIFE STAGE
SHOULD CHANGES BE MADE TO THE
U.S. DIETARY PATTERNS INCLUDE
HEALTHY U.S. PATTER,
MEDITERRANEAN, OR HEALTHY
VEGETARIAN PATTERN AND SHOULD
ADDITIONAL PATTERNS BE DEVELOPED
OR PROPOSED?
WE DEVELOPED MULTIPLE ANALYSES
DEFINED IN THE 11 PROTOCOLS
POSTED, AND POSTED ON DIETARY
GUIDELINES.GOV AND IMPLEMENTED
FOR OUR WORK.
THIS IS THE GRAPHICAL DEPICTION
OF THE WORK WE'VE CONDUCTED THAT
WE STARTED WITH NUTRIENT PROFILE
DEVELOPMENT, MOVED INTO THE FOOD
GROUPS AND SUBGROUPS ANALYSIS,
TODAY WHAT YOU'LL SEE, NEXT
SLIDE PLEASE, WITH STARS ARE THE
INFORMATION THAT WILL BE
PRESENTED FOR BOTH REDUCING
ANIMAL-BASED FOODS, REDUCING
CARBOHYDRATE-CONTAINING FOODS
AND RANGES OF FOOD DENSITY, OUR
LAST PHASE OF RECORDING.
TOMORROW WE'LL TALK ABOUT DIE
'EM SIMULATION, EVALUATION AND
RYE FINING OF DIETARY PATTERNS,
ANSWERING THE EVIDENCE WE NEED
FOR THE FULL QUESTION.
THAT GIVES A CONTEXT.
TODAY WE'LL WRAP UP WITH THE
REMAINING RESULTS, AND SYNTHESIS
AND INTEGRATION WILL BE A LARGE
PART OF TOMORROW'S CONVERSATION.
ALL OF THIS WILL BE DONE
CONSIDERING EACH LIFE STAGE AND
SHOULD CHANGES BE MADE WITHIN
THE PATTERN SO WE'VE BEEN
INCORPORATING SYSTEMATIC
REVIEWS, DATA ANALYSIS, FOOD
PATTERN MODELING RESULTS
TOGETHER AS WE CARRIED FORWARD
LOOKING AT POPULATION NORMS,
PREFERENCES, NEEDS OF DIVERSE
COMMUNITIES, FACTORING TOGETHER
WITH THE DATA WE HAVE.
NEXT SLIDE PLEASE.
SO, AGAIN, WE'LL BREAK THIS UP
WITH REMAINING RESULTS, WHICH
WILL BE REMOVING ANIMAL-BASED
FOODS, REDUCING
CARBOHYDRATE-CONTAINING FOODS,
RANGES OF NUTRIENT DENSITY.
TOMORROW WE'LL TRANSITION INTO
OUR SYNTHESIS AND INTEGRATION
OUTCOMES FROM OUR FOOD PATTERN
MODELING WORK.
AND WITH THAT, I WOULD LIKE TO
PASS THIS OVER TO SAMIRA TO LEAD
US IN THE FIRST SET OF RESULTS.
>> I'LL BE PRESENTING RESULTS
FOR THE PROTOCOL WE DISCUSSED AT
THE LAST MEETING, MOVING
ANIMAL-BASED FOODS.
INDIVIDUALS MAY AVOID ANIMAL
SOURCES OF FOODS AND BEVERAGES
FOR VARIOUS REASONS, RESULTING
DIETS VARY IN COMPOSITION,
BASICALLY IMPLICATIONS FOR
NUTRIENT INTAKES.
WE CURRENTLY DO NOT HAVE
NATIONALLY REPRESENTATIVE DATA
ON PREFERENCE OF VEGETARIAN
DIETS AND THOSE ARE NO ANIMAL
SOURCES, HOWEVER SURVEYS
ESTIMATE THE PREVALENCE OF THESE
DIETS IN THE U.S. IS LOW.
REMOVING ANIMAL SOURCED FOODS
AND BEVERAGES HAS NOT NOT BEEN
EXAMINED SINCE 2010.
SUPPORTED BY THE SUBINTEREST AND
THESE ANALYSES WERE INCLUDED TO
EXPLORE POTENTIAL FOR FUTURE
DIETARY PATTERNS.
NEXT SLIDE PLEASE.
SO THESE FOOD ANALYSES EXAMINED
HYPOTHETICAL MODIFICATIONS AND
IMPLICATIONS ON COMPOSITION AND
CONTRIBUTIONS OF 2020 HEALTHY
VEGETARIAN DIETARY PATTERNS 2
YEARS AND OLDER WHEN ANIMAL
SOURCES CONTRIBUTING TO THE
PATTERN WERE REMOVED.
SPECIFICALLY THE ANALYSIS
REMOVED ALL ANIMAL PRODUCTS FROM
THE DAIRY AND FORTIFIED SOY
ALTERNATIVE GROUP AND EGG
SUBGROUP FROM PROTEIN FOODS
GROUP.
IT IS IMPORTANT TO NOTE HERE
THAT THE DAIRY AND FORTIFIED SOY
GROUP ALREADY INCLUDE AN OPTION
FOR NON-ANIMAL SOURCE WHICH IS
FORTIFIED SOY.
SO WE ALSO LOOKED AT ANALYSES
WITHOUT EGGS AND WITH AND
WITHOUT FORTIFIED SOY.
THE GOAL OF THESE ANALYSES WAS
TO MODEL ANY POTENTIAL
NUTRITIONAL GAPS THAT MAY RESULT
FROM THE REMOVAL FROM ANIMAL
SOURCES THAT ARE RECOMMENDED AS
PART OF THE 2020 HEALTHY
VEGETARIAN DIETARY PATTERN
WITHOUT MAKING OTHER DIETARY
SUBSTITUTIONS.
AS YOU MIGHT RECOLLECT, AT
MEETING 5 THIS PROTOCOL WAS
PRESENTED.
THE COMMITTEE DECIDED THESE
WOULD NOT INCLUSION ADDITIONAL
ANALYSES THAT WOULD MODIFY FOOD
GROUPS AND SUBGROUPS TO ACHIEVE
ENERGY TARGET OR DEVELOP A NEW
PATTERN.
THIS WAS BASED ON LIMITED DATA
IN THE SCIENTIFIC LITERATURE ON
THE DIETARY INTAKES AND
POTENTIAL VARIATION AND
RESULTING REPLACEMENT OF FOODS
AND BEVERAGES AMONG THOSE WHO
AVOID ANIMAL SOURCE PRODUCTS.
THE RESULTS HELPED THE COMMITTEE
DISCUSS DEGREE TO WHICH
NUTRITIONAL GOALS MIGHT BE MET
AFTER REMOVAL OF ANIMAL SOURCES
AND USED TO PROVIDE ADVICE
AROUND REMOVAL, TO INFORM FUTURE
DECISIONS SUCH AS ADDITIONAL
INTAKE DATA AND NUTRITIONAL
COMPOSITION PRIORITIES FOR
REPLACEMENT FOODS.
NEXT SLIDE PLEASE.
SO THIS IS OUR SUMMARY STATEMENT
BASED ON THE ANALYSES CONDUCTED.
SEVEN NUTRIENT GAPS INTRODUCED
WHEN ALL ANIMAL SOURCES ARE
REMOVED FROM THE 2020 HEALTHY
VEGETARIAN PATTERNS FOR 2 YEARS
AND OLDER.
SPECIFIC NUTRIENTS THAT
DECREASED FROM THIS REMOVAL
INCLUDE PROTEIN, A, D, E,
RIBOFLAVIN, NIGH SIGN, B 6 AND
12, CHOLINE, MAGNESIUM AND SINK.
FORTIFIED SOY IS CURRENTLY
INCLUDED IN THE DAIRY GROUP.
WHILE THIS MAY AMELIORATE
NEGATIVE IMPLICATIONS FOR
SEVERAL NUTRIENTS, OTHER
NUTRIENT GAPS PERSIST.
NEXT SLIDE PLEASE.
WE BASED SUMMARY STATEMENT ON
EVIDENCE THAT EXCLUSION OF EGGS
AS WELL AS DAIRY AND FORTIFIED
SOY ALTERNATIVES WITHOUT
REPLACEMENT HAD NEGATIVE
IMPLICATIONS ON VARIOUS
NUTRIENTS AS PREVIOUSLY
MENTIONED.
SOME OF THESE ARE FOR ONLY
CERTAIN AGE AND SEX GROUPS BUT
OTHERS ARE FOR ALL AGE AND SEX
GROUPS.
CALCIUM AND VITAMIN B-12 IS
ACROSS ALL AGE AND SEX GROUPS.
SEVERAL OF THESE NUTRIENTS ARE
OF CONCERN FOR LIFE STAGES,
PROTEIN AN B-12 FOR ORDINARY
ADULTS, CALCIUM FOR ADOLESCENT
GIRLS.
NEXT SLIDE PLEASE.
WE ALSO AS I MENTIONED MODELED
FORTIFIED SOY ALTERNATIVES, SUCH
AS SOY MILK, REPLACEMENT FOR
MILK IN THE PATTERN.
THIS PATTERN WAS MODELED USING
FORTIFIED SOY MILK.
THIS REPLACEMENT LESSENED
NEGATIVE IMPLICATIONS SEEN IN
DAIRY AND FORTIFIED SOY
ALTERNATIVE FOOD GROUP REMOVED
NOT ALL GAPS ARE ADDRESSED.
INDIVIDUALS AVOID OR LIMIT
ANIMAL SOURCE FOODS FOR VARIOUS
REASONS, AND REPLACEMENT
DECISIONS VARY GREATLY.
THE COMMITTEE DID NOT MODEL
SCENARIOS WITH REPLACEMENT
ALTERNATIVES.
THE COMMITTEE CAUTIONS AGAINST
EXCLUDING GROUPS WITHOUT CAREFUL
PLANNING WITHOUTED WITHOUT ADEM
DIETARY SOURCES.
>> NOW CARBOHYDRATES.
>> WITH THE -- NEXT SLIDE
PLEASE.
WITH THE REDUCTION OF
CARBOHYDRATE-CONTAINING FOODS
OUR ANALYSIS PLAN WAS TO REMOVE
THE FOOD GROUPS THAT USED
HIGHLIGHTED IN RED, MAJOR
CONTRIBUTORS TO CARBOHYDRATES AT
THE FOOD LEVEL, AND I WILL
EMPHASIZE AGAIN UNLIKE THE LAST
PROTOCOL CARBOHYDRATES ARE A
MACRONUTRIENT, AND WE EAT FOODS,
SO THIS IS NOT JUST THE GRAINS
GROUP LIKE YOU MAY THINK BUT
MORE PERSISTENT ACROSS SEVERAL
OF THESE FOOD GROUPS.
SO DAIRY, GRAINS, FRUITS,
STARCHY VEGETABLES WERE INCLUDED
IN THESE REDUCTIONS.
NEXT SLIDE PLEASE.
SO STRAIGHT TO THE SUMMARY
STATEMENT, SEVERAL GAPS ARE
INTRODUCED WHEN
CARBOHYDRATE-CONTAINING
NUTRIENTS DENSE FOODS AND
BEVERAGES ARE REMOVED,
EMPHASIZING THIS IS STARTING
FROM NUTRIENT DENSE FOOD AND
BEVERAGES WITHIN RECOMMENDED
QUANTITIES ACROSS ALL SUBGROUPS
AND FOOD GROUPS.
FURTHER REMOVAL THAT OF THOSE
HIGHLIGHTED ILLUSTRATED GAPS IN
VITAMIN A, THIAMIN, RIBOFLAVIN,
NIACIN, POTASSIUM, FIBER, ACROSS
ALL AGE GROUPS AND CALORIE
LEVELS, AND THESE DROPPED BELOW
RECOMMENDED INTAKES ACROSS ALL
OF THEM.
THERE WERE ADDITIONAL DROPS
AMONG PREGNANCY AND LACTATION
FOR VITAMIN C, B 6, B-12.
WE'LL WALK THROUGH THE
SUPPORTING INFORMATION BEHIND
THIS.
SO THE MACRONUTRIENT MAKEUP OF
THE HUSS PATTERN ACROSS A
NUTRIENT-DENSE FORM OF FOODS AND
BEVERAGESES IS 52% CALORIES FROM
CARBS ACROSS ALL OF THE CALORIE
LEVELS.
THE FOOD GROUPS AND SUBGROUPS
THAT WE'VE REMOVED IN THE MODEL
TO EVALUATE INCLUDED GRAINS
WHICH ARE SHOWN THERE, RANGING
FROM 48 TO 160 GRAMS HER DAY
DEPENDING ON CALORIE LIVE,
FRUITS 24 TO 62, STARCHY
VEGETABLES 10 TO 30 AND
FORTIFIED BEVERAGES.
ADDED SUGARS IN THIS MODELING
REPRESENT LESS THAN 2% OF TOTAL
CALORIES PER DAY, NOT REMOVING
LUCKY CHARMS.
THIS IS REMOVING THE NUTRIENT
DENSE FORMS OF THE FOOD GROUPS
LISTED HERE.
NEXT SLIDE PLEASE.
SO REMOVING THE GRAINS, FRUITS,
DAIRY FORTIFIED SOY
ALTERNATIVES, STARCHY VEGETABLES
REDUCED TOTAL CALORIES BY 63%,
SO THAT'S JUST THE STRAIGHT UP
FOOD GAP THAT WE'RE SEEING IN
THIS MODEL.
THAT WOULD BE REMOVED ALTOGETHER
IN A CARBOHYDRATE-RESTRICTED
DIET.
THIS TOOK WITH IT 54% OF THE
PATTERN'S PROTEIN, AGAIN
REMOVING FOODS NOT
MACRONUTRIENTS.
FOODS ARE COMPLICATED, PROTEIN
IS FOUND IN HALF OF THE
CARB-CONTAINING FOODS THAT WERE
LISTED AND REMOVED.
AS WELL AS 27% OF TOTAL FAT.
SO THIS IS JUST RECAPPING WHAT
WAS IN THE SUMMARY STATEMENT.
THE LIST OF NUTRIENTS THAT FELL
BELOW THE GOALS WITH THIS
REMOVAL.
A LOT MAY BE ANTICIPATED BECAUSE
YOU'RE REDUCING CALORIES BY 63%,
DIET OF VOLUME IS REDUCED, BUT
AS WE'LL SEE ON THE NEXT SLIDE
IN A MINUTE THESE ARE INTRODUCED
BY SPECIFIC FOOD GROUPS IN
PARTICULAR, WHICH MAKES SENSE,
NUTRIENTS CLUSTER IN CERTAIN
FOODS, AND REMOVING THEM
ALTOGETHER DEPENDING ON THE
GROUP YOU REMOVE MAKES SENSE.
PREGNANCY AND LACTATION, YEAH.
OKAY.
SO, FOR THE GROUP-SPECIFIC
REMOVAL, THIS IS WHEN JUST
GRAINS ARE REMOVED, JUST FRUITS,
JUST STARCHY VEGETABLES, AND
JUST DAIRY AND FORTIFIED SOY
ALTERNATIVE YOU CAN SEE THE
REMOVAL.
THIAMIN AND NIACIN FELL BELOW
AND CREATED A GAP AMONG OLDER
MEN 51 AND PLUS, AND PREGNANCY,
CHILDREN, FEMALE ADOLESCENTS FOR
WHICH CALCIUM IS PARTICULARLY
IMPORTANT AND FOLATE, A GAP WAS
INTRODUCED WITH REMOVAL OF
GRAINS AND SO FORTH.
FRUITS, VITAMIN C WERE THE MAIN
CONTRIBUTOR TOWARDS REDUCTION IN
PREGNANCY AND LACTATION,
INTRODUCTION OF THAT GAP, AS
WELL AS MAGNESIUM AND POTASSIUM
FOR CERTAIN GROUPS.
FIBER FROM GRAINS AND FRUITS WAS
SEEN ACROSS ALL AGE RANGE AND
LIFE STAGES.
DAIRY AND FORTIFIED SOY
ALTERNATIVES HAVE MICRO NUTRIENT
IMPLICATIONS LISTED THERE.
STARCHY VEG, VITAMIN A AND
FIBER, HIGHLIGHTING THE
COMPLEXITY, REMOVAL OF A CERTAIN
MACRONUTRIENT OR FOODS THAT
CONTAIN IT IS COMPLICATED, AND
THIS IS ONE OF THE REASONS THAT
PRECLUDED US FROM BEING ABLE TO
DEVELOP A PATTERN ASSUMING WHAT
THAT SORT OF 63% OF CALORIES WAS
REMOVED WOULD BE MADE UP WITH,
BASED ON THE REMAINING FOODS
THAT DID NOT GET EXCLUDED FOR
THE CARB CONTENT.
AND THEN MY LAST SLIDE.
YEAH, SO THANK YOU.
>> I THINK WE'LL OPEN UP FOR
DISCUSSION.
CHRISTOPHER, THEN CHRISTINA.
>> THANKS FOR A GREAT
DISCUSSION.
SO, MAYBE I MISSED IT.
I SAW DEE DEE PRESENT 63% OF
CALORIES WOULD BE REMOVED IF YOU
GOT RID OF ALL THOSE GROUPS BUT
REMOVING ANIMAL SOURCES, WAS
THERE A PERCENT OF CALORIES
REMOVED IN THAT SLIDE?
>> THERE WAS, BUT I -- YES,
THERE WAS DECREASE IN CALORIES
AS WELL.
>> NO, BUT WHAT WAS IT?
WHAT WAS THE MAGNITUDE?
DOESN'T MATTER IF YOU FIND IT.
I'D LOVE TO -- I MAY HAVE
PROPOSED THIS LAST TIME.
ONE OPTION WOULD BE TO TAKE THE
HEALTHY U.S. PATTERN AND REDUCE
THE NUMBER OF PATTERNS ACROSS
THE BOARD AND SEE HOW MANY
NUTRIENTS WOULD BE DEFICIENT.
PART OF THE ISSUE HERE IS NOT
REPLACING.
HOW MANY NUTRIENTS WOULD BE
DEFICIENT?
LET'S SAY 40% OF CALORIES FROM
ANIMAL SOURCE FOOD.
IF YOU TOOK AWAY 40% OF CALORIES
YOU WOULD BE LOW IN MANY
NUTRIENTS.
IF YOU'RE JUST TAKING AWAY
ANIMAL SOURCE FOODS YOU'RE
OBVIOUSLY -- AND NOT REPLACING,
YOU'RE DEFICIENT IN MANY
NUTRIENT.
MIGHT BE AN INTERESTING
COMPARISON TO TAKE ACROSS THE
HEALTHY U.S. VERSUS ANIMAL
SOURCED FOODS.
A SECOND SUGGESTION COULD BE TO
START WITH HEALTHY VEGETARIAN
DIET, WHICH IS ALREADY GOTTEN
RID OF ALL THOSE FOODS, AM I
BEING REDUNDANT?
>> THAT WAS WHAT WE STARTED
WITH.
>> OH, IT WAS THE HEALTH
>> I.
>> YES, AND REMOVED REMOVED ANL
SOURCE FOODS AND VEGETABLES.
>> SO JUST REMOVING DAIRY AND
EGGS FROM VEGETARIAN?
>> YES.
>> DAK IT.
>> CHRIS, I THINK YOU WERE
REDDER IN YOUR LAST TIME YOU
MENTIONED THIS.
>> SORRY FOR GETTING THAT ONE
WRONG.
>> I DON'T UNDERSTAND ALL THE
SIMULATION THINGS.
BEAR WITH ME.
IF SOMEONE REMOVES, FOR EXAMPLE,
GRAINS, WOULDN'T THEY REPLACE IT
WITH SOMETHING ELSE LIKE IF YOU
REMOVE GRAINS, WOULDN'T YOU
INCREASE YOUR VEGETABLES?
SO WHAT HAPPENS IF YOU DO THAT?
>> SO, WE DO NOT HAVE
INFORMATION IN SCIENTIFIC
LITERATURE TO FIND OUT WHAT
EXACTLY ARE PEOPLE REPLACING IT
WITH.
THAT'S AN INDIVIDUAL LEVEL
PERSONAL CHOICE OR DECISION.
WE DID NOT HAVE INFORMATION FROM
THE DATA TO ACTUALLY INFORM
THOSE ANALYSES.
SO WHEN WE DID NOT HAVE THAT, WE
ACTUALLY HAD TO STOP THE
ANALYSES AND SAY WE DON'T KNOW
ENOUGH TO FIND OUT LIKE WHAT ARE
PEOPLE REPLACING IT WITH.
THERE'S ANECDOTAL OR CASE
STUDIES, NOT REALLY
REPRESENTATIVE DATA THAT SAYS
PEOPLE ARE REPLACING WITH THIS
SO WE COULD NOT MODEL THOSE
ANALYSES.
>> YEAH, AND FOR CARBOHYDRATE
MODELING IN TOOK, IT WAS SUCH A
LARGE GAP WITH THE REMAINING
FOODS WOULD REQUIRE EXCEEDING
FOR MANY OF THEM THE
QUANTITATIVE RECOMMENDATIONS.
SO IF YOU MADE UP FOR IT BY
INCREASING WITH ANY OF THE OTHER
FOOD GROUPS, THEN MAYBE THERE
WOULD BE CONCERNS ON THE OTHER
END.
ALSO, WE DIDN'T REMOVE EVERY
SINGLE CARB.
WE REMOVED THE LIKE CARBOHYDRATE
RICH FOODS AND SUBGROUPS.
SO IF YOU SORT OF LIKE INCREASE
AND TAKE FROM EVERYTHING ELSE,
YOU MAY STILL END UP DEFEATING
THE
THE PURPOSE OF A LOW CARB DIET
BECAUSE OTHER FOODS CONTAIN
SMALL AMOUNTS, DO YOU REMOVE
THOSE AS WELL AND SO FORTH?
SO WHAT WOULD MAKE UP WHAT THE
PATTERN COULD LOOK LIKE BUT
THAT'S AN AREA OF FUTURE
RESEARCH, HOW COULD THAT BE DONE
AND CONSISTENT, AS WELL AS BEING
CONSISTENT WITH OTHER
QUANTITATIVE RECOMMENDATIONS FOR
REMAINING FOODS.
BUT ALSO TO ADDRESS THE NUTRIENT
GAPS WHICH MAY OR MAY NOT EVEN
BE FEASIBLE WITH SOME OF THE
FOOD GROUPS THAT ARE REMOVED
BEING LIKE A PRIMARY SOURCE OF
THOSE.
>> I'LL FOLLOW UP.
ARE YOU RECOMMENDING SPECIFIC
FUTURE RESEARCH RECOMMENDATIONS
SO WE CAN GET THAT DATA AND HOW
WOULD THAT LOOK LIKE?
>> WELL, AND AS BOTH MENTIONED,
SUBSTITUTION BECOMES JUST AS
IMPORTANT AS REMOVAL.
THERE'S A LOT OF CONVERSATION ON
REMOVAL OF THIS AND REMOVAL OF
THAT INDEPENDENT OF NUTRITIONAL
IMPLICATIONS.
WHAT YOU PUT BACK IN BECOMES
JUST AS IMPORTANT AS WHAT YOU
PUT BACK IN.
JUST FILLING WITH WHAT THE REST
OF THE DIETARY PATTERN HAS --
YOU SEE WHAT DEE DEE SHOWED WAS
THE NUTRIENTS THAT WERE SPECIFIC
TO CORE FOOD GROUPS, WHEN YOU
TAKE OUT THAT FOOD GROUP THEY
MAY NOT BE RICH IN OTHER FOOD
GROUP SOURCES.
SO WHEN YOU TAKE SOMETHING OUT,
THERE MAY NOT BE THE SAME
NUTRIENTS IN ANOTHER FOOD SOURCE
SO THE NUTRITIONAL ADEQUACY
BECOMES AS MUCH OF A QUESTION AS
IT IS THE REMOVAL.
SO YOU NEED EVIDENCE AROUND WHAT
ARE PEOPLE AVOIDING OR REMOVING
FROM THESE DECISIONS.
AND THEN WHAT ARE THE FOODS
BEING PUT BACK IN SO THEN YOU
HAVE AN UNDERSTANDING OF HOW DO
YOU CREATE A PATTERN BASED ON
THAT CONSUMPTION AND THEN CAN
YOU EVALUATE THE PATTERN FOR IF
YOU TAKE OUT ALL OF THE GRAINS
THERE'S THE LIST OF NUTRIENTS,
IF YOU PUT EVERYTHING ELSE BACK
IN, THAT'S THE WAY IT'S TESTED,
DO NUTRIENTS REEMERGE OR DO
THOSE NUTRIENT GAPS PERSIST?
SO EVIDENCE NEEDS TO COME ON NOT
ONLY REMOVAL OF -- WE SEE THIS
ACROSS OUR DIETARY PATTERNS,
IT'S A DISTINCT DESCRIPTION OF
WHAT THE PATTERN IS AND NOT JUST
AN ESTIMATION OF CARBOHYDRATE
INTAKE.
>> GREAT.
I THINK JENNY GOES NEXT AND
FATIMA.
>> MOTHER OF A -- MORE OF A
COMMENT THIS PART OF THE
DISCUSSION IS IMPORTANT IN THIS
VENUE.
MOST NUTRITIONISTS, LONG HISTORY
ON SATURATED FAT, IT'S NOT JUST
ABOUT REPLACING FAT, WHAT TO
REPLACE IT WITH, MOVING FORWARD
HOW THIS WILL PROGRESS WITH
THOSE GOALS IN MIND.
>> FATIMA AND SHERRILL.
>> MY QUESTIONS IS WHETHER OR
NOT YOU COULD UTILIZE A.I. TO
SIMULATE THE SUBSTITUTION AS
OPPOSED TO WAITING FOR THAT DATA
TO BE GENERATED.
SO MY QUESTION REALLY RELIES ON
THAT SINCE WE KNOW THERE IS THE
RISE OF A.I. AND BEING ABLE TO
INCORPORATE THAT AND SIMULATE
WHAT SUBSTITUTIONS COULD LOOK
LIKE IN REAL LIFE.
SO THAT'S MY QUESTION.
>> I THINK THE BLACK BOX BEHIND
A.I. IS DRIVING THAT DECISION.
WHERE IS THE INFORMATION A.I. IS
USING TO GENERATE THE
SUBSTITUTION?
ARE WE GETTING A COMPUTER-BASED
MODEL THAT IDENTIFIES FOODS BUT
DO THE COMPUTERS FULLY
UNDERSTAND THE IMPLICATIONS OF
THE COMPLEX NATURE OF DIET THAT
DEE DEE WAS DESCRIBING?
>> SO THEN A FOLLOW-UP TO THAT
WOULD BE UTILIZING REAL LIFE,
REAL WORLD DATA TO THEN GENERATE
THE A.I. MODEL.
SO, FOR EXAMPLE, IF A PATIENT
COMES INTO AN OFFICE AN STATES
TO ME, THIS IS WHAT MY DIET IS,
SO I ASK MY PATIENTS WHAT IS A
TYPICAL BREAKFAST LUNCH SNACK,
LUNCH SNACK, DINNER SNACK, MANY
PATIENTS HAVE DIETS THAT MAY BE
WITHOUT, LET'S SAY, A MEAT
SOURCE, ANIMAL-BASED SOURCE, AND
THEY TELL ME WHAT THEIR
SUBSTITUTIONS ARE, HAVE X NUMBER
OF PATIENTS DO AND TELL YOU
SUBTUITIONS, EXTRAPOLATE THAT
INTO A REAL WORLD MODELING
SITUATION.
>> YEAH, AND I THINK THAT'S
ALWAYS BEEN OUR CHALLENGE,
COLLECTING COMPREHENSIVE DIETARY
INTAKE DATA IN A SHORT PATIENT
VISIT.
GETTING IT TO AN ANALYSIS
STANDPOINT, TO A POINT OF A
LARGE DATASET WILL BECOME ONE OF
THE CHALLENGES AND
IMPLEMENTATION.
IT BECOMES AN OPPORTUNITY, ALSO
COMPARING IT USUAL INTAKES WE'VE
SEEN ARE FAR BELOW WHAT MODEL
THAT WE'RE USING WITHIN THE
PATTERN SO WE'VE GOT TO PUT
THOSE TWO THINGS TOGETHER IN
TERMS OF WHAT ARE USUAL INTAKES
AND RECOMMEND ATIONINGS IN THE
PATTERN, THAT'S AN IMPORTANT
STRATEGY DEE DEE?
>> I'LL STOP TILL CHERYL HAS THE
FLOOR.
>> I DON'T HAVE A QUESTION SO
MUCH AS A COMMENT.
IN THINKING ABOUT THE QUESTION
AT HAND, WHICH IS SHOULD A
CHANGE BE MADE, RIGHT, TO THE
EXISTING PATTERNS, IN THIS
SHOULD WE REMOVE ANIMAL FAT IN
VEGETARIAN PATTERN, CARB HYDRATE
IN THE HEALTHY U.S. PATTERN, I
COMMEND THE SUBCOMMITTEE FOR NOT
ONLY ANSWERING THAT QUESTION,
SHOWING THE NEGATIVE
IMPLICATIONS, WHERE THEY WOULD
BE MAKING THOSE ADJUSTMENTS BUT
PARTICULARLY APPRECIATED THE
SUMMARY OF DO IT IF YOU WANT,
HOWEVER YOU REALLY HAVE TO BE
CAREFUL ABOUT HOW WE'RE GOING TO
ROUND OUT AND ENSURE ADEQUACY
ACROSS THE ENTIRE DIET.
I GET IT.
THERE AREN'T DATA RIGHT NOW FOR
US TO ANSWER THAT QUESTION OF
HOW WE'RE GOING TO ROUND OUT TO
ENSURE ADEQUACY.
AND THAT'S WHAT WE DO.
WE USE DATA TO INFORM THE
SUMMARY STATEMENTS.
SO I THOUGHT IT WAS A REALLY
NICE JOB DONE, AND I REALLY,
REALLY GOT IT WHEN THAT LAST BIT
WAS ADDED TO THE STATEMENT.
>> THANKS.
DEE DEE?
>> YEAH, THANK YOU.
I THINK -- I AGREE, I THINK IT'S
IMPORTANT WE DID LOOK AT THIS
AND TAKE THE QUESTION SERIOUSLY.
I ALSO FEEL LIKE IT'S WORTH
EMPHASIZING AGAIN BOTH ANALYSES
STARTED FROM THE HEALTHY
RECOMMENDED NUTRIENT-DENSE FORMS
OF THE FOODS AND BEVERAGES BEING
MODELED.
AND A LOT OF SORT OF LIKE THE
LOW CARB ADVICE, THE PLANT-BASED
ADVICE, IS CONSISTENT WITH WHAT
IS ALREADY EXCLUDED FROM THAT
HEALTHY PATTERN.
WE'RE NOT MODELING SUGARY
BEVERAGES AND POP TARTS AND
DORITOS.
THOSE ARE ALREADY NOT IN THE
PATTERN.
THE EXTENT TO WHICH THERE ARE
BENEFITS WITHIN THIS HEALTHY
PATTERN OF MANIPULATING THESE
FOODS OR THESE TYPES OF MODELING
ARE ALSO NOT KNOWN.
LIKE WE KIND OF TOOK A LEAP AND
LOOKED AT THE MODELING APPROACH
BUT THE SYSTEMATIC REVIEW
EVIDENCE AND OTHER LINES OF
EVIDENCE WERE NOT MOTIVATED
THAT, RIGHT?
LIKE SOME OF THE OTHER ANALYSES
THAT WE'LL LOOK AT MAY HAVE.
SO, AGAIN, I THINK IN TERMS OF
FUTURE DIRECTIONS FOR RESEARCH,
DOES REMOVING REMOVING FRUIT HA
BENEFIT?
GRAINS, WHOLE GRAINS, GIVING AN
ADDED BENEFIT, THAT I DON'T
THINK IS WHERE, YOU KNOW, THERE
IS AS MUCH RESEARCH AS MIGHT BE
STATED.
SO, AGAIN, JUST EMPHASIZING THAT
PIECE IS ALSO REALLY IMPORTANT
BECAUSE THERE'S A LOT OF
ALIGNMENT ALREADY WITH WHAT
WOULD NOT BE RECOMMENDED.
>> GREAT.
YES?
>> I THINK CHRIS MENTIONED
THERE'S A GAP BETWEEN HEALTHY
PATTERNS AND ACTUAL INTAKE.
SO DID THE COMMITTEE CONSIDER
WHAT ARE THESE GAPS AND WHAT
WOULD BE THE MOST IMPORTANT
RECOMMENDATION TO BRIDGE THE
IMPORTANT NUTRIENT GAPS AS WE
MOVE FORWARD?
>> YEAH, I THINK THAT WILL ALSO
BE PART OF A LOT OF INTEGRATION
DISCUSSION IS BECAUSE WITH THE
HEALTHY U.S. STYLE PATTERN,
WE'RE MODELING IT TO MEET THE
NUTRIENT GOALS AND WE'RE SEEING
FROM DATA ANALYSIS, I'LL STEAL
HEATHER'S THUNDER HERE, THE U.S.
ISN'T ALIGNED WELL WITH THE
CURRENT RECOMMENDATIONS, SO YOU
ALREADY HAVE A HURDLE TO GET
THERE BUT OUR GOAL IS REALLY TO
CREATE AN ACHIEVABLE PLAN TO
MEET THOSE NUTRIENT GOALS.
SO, THE IMPLEMENTATION SIDE HAS
GOT TO BE IN CHANGING THAT TO
GET THOSE, OUR FEDERAL PROGRAMS
WITH DOING THAT AND HELPING USE
WHAT WE'RE DEVELOPING FROM THE
PATTERN TO GET IMPROVEMENTS IN
THE PUBLIC'S INTAKE.
SO, IT'S THIS JUXTAPOSITION, WE
LOOK AT SYSTEM REVIEW EVIDENCE,
THE EVIDENCE IS WHAT ARE PEOPLE
CURRENTLY EATING AND MAKING
CHANGES.
WHICH IS DIFFERENT THAN THIS IS
THE PATTERN THAT ACTUALLY HAS
DEVELOPED AND BEEN DEVELOPED
OVER TIME WITH PREVIOUS
COMMITTEES TO REALLY MEET
NUTRIENT GOALS AND REPRESENT THE
EVIDENCE SO BRIDGING THAT GAP
BETWEEN THE TWO AND WE'RE USING
CURRENT INTAKES FROM RECENT
INTAKES FROM NHANES TO DEVELOP
THOSE NUTRIENT PROFILES BUT
WE'RE PUTTING IT INTO THE MODEL
FOR MEETING ACTUAL NUTRIENT
GOALS.
>> CHRIS, ARE YOU READY TO
CONTINUE WITH FOOD PATTERN
MODELING?
THIS HAS BEEN A GREAT
DISCUSSION.
>> YES, THANKS FOR ALL OF YOUR
COMMENTS ALONG THE WAY, I'LL
PASS OVER TO HEATHER FOR RANGES
AND NUTRIENT DENSITY.
>> THIS IS OUR LAST SET OF
RESULTS TO SHARE.
FOR THIS SEGMENT WE ARE DOING
THIS AT THE END BECAUSE IT'S
REALLY A LOOK AT AFTER WE
FULFILL THE PATTERNS AND USE
ENERGY FOR THAT, IS THERE ANY
ENERGY LEFT FOR OTHER USES?
SO, SOMETIMES THIS HAS BEEN
CALLED LIKE DISCRETIONARY
CALORIES, RECREATIONAL CALORIES
YOU COULD USE IN OTHER WAYS.
OUR QUESTION HERE WHAT
QUANTITIES OF FOODS AND
BEVERAGES LOWER IN NUTRIENT
DENSITY CAN BE ACCOMMODATED IN
THE USDA DIETARY PATTERNS WHILE
MEETING NUTRITIONAL GOALS WITHIN
CALORIE LEVELS.
AND IF YOU REMEMBER, WE DO HAVE
OVER 10-CALORIE LEVELS THAT ARE
FOR RECOMMENDED FOR DIFFERENT
AGE/SEX GROUPS IN THE U.S.
MOVING TO OUR SYNTHESIS
STATEMENT HERE, WE MADE FOR A
POTENTIAL MODIFICATION TO ALL
DIETARY PATTERNS ACROSS ALL LIFE
STAGES STARTING AT AGE 2, AND
OUR STATEMENT IS THAT THE ENERGY
FROM NUTRIENT DENSE
REPRESENTATIVE FOODS AND
BEVERAGES UNDERLYING THE
NUTRIENT PROFILE CALCULATION FOR
EACH FOOD GROUP AND SUBGROUP ARE
VARIABLE.
SO JUST KIND OF REFERRING BACK
TO SOMETHING THAT DEE DEE SAID,
EVERYTHING IN THE PATTERN
ALREADY IS ALREADY VERY NUTRIENT
DENSE.
AND THAT'S MODELED AND WE HAVE
THAT, THE AMOUNT OF CALORIES
THAT ARE GOING WITH THAT, BUT
THAT AMOUNT OF CALORIES IS
SOMEWHAT VARIABLE.
THAT PRECLUDES OUR ABILITY TO
ESTIMATE THE QUANTITY OF
REMAINING CALORIES PER DAY.
THERE'S SUPPORT TO SUPPORT
EXPLORING MODIFICATION THAT DOES
NOT INCLUDE LISTING SPECIFIC
QUANTITIES OF REMAINING DAILY
CALORIES FOR OTHER USES IN
PRESENTATION OF PATTERNS.
HERE WHAT WE'RE REALLY SAYING IS
BECAUSE WHEN WE MODEL PATTERNS,
WE'RE USING UP A CERTAIN AMOUNT
OF CALORIES.
THAT AMOUNT IS AN ESTIMATE BUT
IT'S IN ACTUALITY VARIABLE.
BECAUSE OF THAT VARIABILITY,
IT'S REALLY DIFFICULT TO SAY
WITH CERTAINTY HOW MUCH ENERGY
WOULD BE LEFT OVER EVEN WHEN
MAKING NUTRIENT DENSE CHOICES
THERE'S NONE LEFT OVER.
SO WE'RE PROPOSING TO NOT LIST
WHAT MIGHT BE LEFT OVER BECAUSE
IT'S NOT A GOOD -- IT'S NOT VERY
IT'S VARIABLE, BEST WAY TO SAY
IT I GUESS.
YOU CAN SEE ON THE TABLE HERE
THAT WE'VE PROPOSED CROSSING OUT
LINES WHERE WE SHOW WHAT THESE
ESTIMATES WERE.
AND SO IT'S REALLY JUST A
MODIFICATION IN PRESENTATION OF
OUR RESULTS, OF OUR MODELING.
SO IF WE COULD GO TO THE NEXT
SLIDE, I WANT TO EXPLAIN THIS
RATIONALE A LITTLE BIT MORE.
REMEMBERING BACK TO HOW WE'RE
CREATING THESE NUTRIENT
PROFILES, WE'RE BASING THIS ON
WEIGHTED AVERAGE OF THE
PROPORTION OF CONSUMPTION WITHIN
EACH OF THOSE FOOD GROUPS AND
SUBGROUPS.
AND SO FOR EXAMPLE FOR THE RED
AND ORANGE VEGETABLE WE ESTIMATE
THAT ONE CUP EQUIVALENT HAS
ABOUT 53 CALORIES.
BUT WITHIN THAT SUBGROUP, YOU
HAVE RAW TOMATOES WHICH HAVE 31
CALORIES PER CUP EQUIVALENT, ALL
THE WAY UP TO COOKED SWEET
POTATOES, 180 CUP EQUIVALENT.
ON ANY ONE DAY, THERE COULD BE
OVER 100 CALORIES DIFFERENCE
JUST FOR THAT ONE SUBGROUP.
SO, WHEN YOU THINK ABOUT THAT
AND THEN ALL THE VARIABILITY
WENT IN ALL THE OTHER FOOD
GROUPS, IT'S JUST, IT MEANS
EVERY DAY YOU COULD BE MAYBE
HAVING NO EXTRA ENERGY LEFT TO
MAKE ANY OTHER CHOICES.
MOVING TO THE NEXT SLIDE.
WHEN WE ESTIMATE HOW MUCH MODEL
BASED ON NUTRIENT PROFILES TAKES
UP WE USE ABOUT 86% OF CALORIES
IN THE PATTERN.
AND THERE'S LESS THAN 2% OF
CALORIES FROM ADDED SUGARS, 6%
FROM SATURATED FATS.
THEN BUT WHEN WE'RE MAKING
CHOICES WITHIN HERE IT'S VERY
VARIABLE, AND SO IN OUR
MODIFICATION WE WANT TO PROPOSE
TO NOT PRESENT THIS ESTIMATE OF
LIMIT ON CALORIES FOR OTHER USES
FOR AGING 2 AND OLDER.
MOVING FORWARD WE HAVE A SECOND
SYNTHESIS STATEMENT, AND THIS IS
AN ASSESSMENT OF ENERGY
CONTRIBUTIONS LOWER, DEMONSTRATE
CHALLENGES WHILE STAYING IN
DAILY ALLOTMENT FOR CALORIES,
ADDED SUGARS, SATURATED FATS.
BECAUSE OF THAT WE'RE NOT
PROPOSING TO DO ANALYSIS TO
FURTHER SEE WHAT WOULD FIT, AS
AS DISCRETIONARY CALORIES
BECAUSE THEY COULD ALREADY BE
TAKEN UP.
IT'S NOT FEASIBLE TO PROVIDE
RELIABLE ESTIMATE OF A LIMIT ON
CALORIES FOR OTHER USES.
THEREFORE THE SUBSEQUENT
EVALUATION OF FOODS AND
BEVERAGES LOWER IN NUTRIENT
DENSITY FOR FEASIBLE INCLUSION
IS NOT WARRANTED.
AND WE'LL FOLLOW WITH
DISCUSSIONS.
>> THANK YOU, HEATHER.
I'M GOING TO HAND OVER TO
ANGELA.
>> THAT WAS VERY INTERESTING.
THINKING ABOUT THE MODELING,
JUST CLARIFICATION QUESTION,
IT'S AS PREPARED, THE FOOD,
NUTRIENT PROFILES PUT TOGETHER,
WHEN YOU TALKED ABOUT RAW
TOMATOES AND SWEET POTATOES, IS
THAT WITHOUT ANY ADDITIONS?
>> YEAH, THAT'S A GREAT
QUESTION.
SO THEY ARE IN THEIR MOST
NUTRIENT DENSE FORMS.
SO, PROBABLY FOR THE SWEET
POTATO IT'S NOT LIKE WITH BUTTER
AND, YOU KNOW, BROWN SUGAR OR
ANY OTHER THING THAT YOU WOULD
ADD.
AND THEY ARE ALSO IN THE VERSION
OF THE FOOD THAT'S MOST
PREVALENTLY CONSUMED BUT ALSO
MOST NUTRIENT DENSE.
SO WHAT COULD BE PREPARED.
>> THAT'S HELPFUL.
THANK YOU.
>> SO, DO I UNDERSTAND THAT WHAT
WE'RE SAYING IS WE'RE GETTING
RID OF THE CONCEPT DISCRETIONARY
CALORIES?
OKAY, YOU DIDN'T SAY THOSE WORDS
BUT THAT'S WHAT I TOOK.
FAMILIES USE THAT IDEA, YOU CAN
HAVE ONE TREAT A DAY, IT STILL
FITS.
WHETHER OR NOT THAT'S A GOOD
IDEA IS A DIFFERENT DISCUSSION.
HOW DO WE REFRAME THAT IN THE BE
A SENSE OF THE CONCEPT OF
DISCRETIONARY CALORIES, IF WE
GET RID OF THAT, OKAY ONE TREAT
A
A DAY STILL FITS, HOW DO WE FIT
IN THE CONCEPT OF A KNACK OR
TREAT THAT'S OUTSIDE BOUNDARIES
OF CLEAR MEALS THAT ARE
PREPARED.
>> I MAY NOT HAVE THE BEST
ANSWER BUT I THINK JUST THINKING
ABOUT EVERY DAY'S CHOICES
TOGETHER, KIND OF LIKE ARE
YOU -- HOW ARE YOU MAKING
CHOICES THROUGHOUT THE DAY, NOT
KIND OF CONSIDERING THOSE
DISCRETIONARY CALORIES IN
ISOLATION, LIKE I ATE HEALTHY SO
NOW I CAN HAVE THIS EXTRA THING.
JUST THINKING MORE HOLISTICALLY
ABOUT ALL OF THE CHOICES
THROUGHOUT THE DAY, AND THAT
MIGHT BE A STARTING POINT BUT
MAYBE OTHER PEOPLE HAVE IDEAS
TOO.
>> I MEAN, THAT'S A REALLY BIG
QUESTION.
THE DIETARY GUIDELINES DON'T
ALLOW LIKE BIRTHDAY CAKE, HOT
COCOA IN THE WINTER, THE CONCEPT
OF TAKING IT OUT OF DAILY
ALLOWANCE IS WHAT'S BEING
PROPOSED, MORE ALONG THE LINES
OF RECREATIONAL FOODS AND
BEVERAGES YOU ENJOY ONCE IN A
WHILE.
AND MAYBE THAT'S NOT DAILY,
MAYBE THAT IS SOMETHING LIKE
WEEKLY OR MONTHLY BUT I DON'T
KNOW.
ALSO, EARLIER I WAS MENTIONING
THAT THIS ISN'T EVEN MODELING IN
THE FORMS THEY ARE CONSUMED SO
WITH THAT, NUTRIENT DENSE
VERSION, ALREADY IN SOME
COMBINATIONS OF THESE FOODS AND
BEVERAGES BEING AT OR OVER THE
CALORIE LIMIT FOR MANY OF THESE
CALORIE LEVELS, IT'S UNLIKELY
THAT IN THE REAL WORLD GIVEN OUR
FOOD ENVIRONMENT THAT WOULD BE,
YOU KNOW, EVEN LESS ACHIEVABLE.
SO, I DON'T KNOW, I THINK IT'S
SOMETHING THAT WE COULD PROBABLY
DESCRIBE AND MENTION BUT IT'S
THE REMOVAL FROM THE LINE ITEM
AND THE TABLE THAT'S WHAT'S
BEING DRIVEN BY THESE.
>> THERESA?
>> I THINK WHEN IT COMES TO
MESSAGING WE NEED TO BE CLEAR TO
DESCRIBE THAT HERE ARE THE FOOD
GROUPS AND PROPORTIONS THAT IS
NEEDED TO MEET NUTRIENT NEEDS
FOR THAT ENERGY LEVEL.
HOWEVER DEPENDING ON FOOD
CHOICES THERE MIGHT BE ROOM OR
MIGHT NOT BE ROOM FOR ADDITIONAL
FOODS THAT COULD BE HEALTHY,
NUTRIENT DENSE, OR LESS NUTRIENT
DENSE.
AS LONG AS THERE'S DESCRIPTION
THERE THAT PEOPLE ARE AWARE AND
THEN BECAUSE HEATHER, AS YOU
SAID, IT'S SO VARIABLE THAT IF
THERE'S ANY LEFTOVER CALORIES,
SO VARIABLE, THAT FOR SOME
PEOPLE IT MIGHT BE BENEFICIAL TO
WORK WITH A PROFESSIONAL
REGISTERED DIETITIAN TO FIND OUT
FOR THEIR USUAL INTAKE HOW MUCH
ROOM THERE ARE AND WHAT WOULD BE
SUITABLE FOR THAT.
>> THANK YOU.
DEANNA AND THEN CHRIS.
>> YES, I KIND OF SEE WE CAN
SPIN THIS IN A POSITIVE LIGHT
TOO.
FOR INSTANCE IF YOU HAVE A SNACK
RATHER THAN SAYING I WANT A
TREAT OR SOMETHING FROM THOSE
EXTRA CALORIES YOU MIGHT SAY,
WELL, MAYBE I WANT CARROTS AND
HUMMUS OR APPLE AND PEANUT
BUTTER OR YOGURT, DRAWING FROM
THOSE CALORIES RATHER THAN GOING
OUTSIDE OF THEM.
>> IT'S GREAT FOR INTEGRATION
DISCUSSION, HOW THOSE PIECES
COME TOGETHER, FORESHADOWING FOR
TOMORROW AT THE LOWER CALORIE
LEVELS IT BECOMES MORE IMPORTANT
FOR NUTRIENT DENSITY WITHIN THE
CALORIES, FOR OUR YOUNGER
CHILDREN WE'VE MODELED BASED ON
NEW EER CALCULATIONS WITHOUT
HIGH LEVEL OF PHYSICAL ACTIVITY,
LOWEST CALORIE LEVELS YOU MIGHT
NEED FOR AGE SEX GROUPS.
IT ALSO MEANS THAT THERE'S VERY
LITTLE WIGGLE ROOM TO MEET
NUTRIENT NEEDS AS LOWER CALORIES
BECAUSE CALORIE LEVELS NEED TO
BE SO NUTRIENT DENSE IT GIVES
LESS WIGGLE ROOM, OUR PLUG FOR
PHYSICAL ACTIVITY, MORE FOOD
GIVES MORE POE TENGE TO GET
NUTRIENTS PACKED WITHIN, SO
WE'RE LOOKING AT THESE WITHIN
TIGHT CALORIC RESTRICTIONS AND
UNTIL YOU GET UP SO FAR THE
DENSITY NEEDS TO BE PACKED IN.
>> OTHER QUESTIONS?
ANGELA?
>> I'M CURIOUS, SINCE THE
CALORIE CAP IS ALSO KIND OF
TIGHT, DO YOU HAVE THOUGHTS
ABOUT THINGS ADDED TO FOODS, YOU
KNOW, THE PERCENTAGE OF
SATURATED FAT AND SUGARS, THAT'S
EXTREMELY LOW COMPARED TO WHAT
PEOPLE ARE CONSUMING.
I'M WONDERING IF YOU HAD
RECOMMENDATIONS IN RELATION TO
THAT HOW MESSAGING SHOULD GO.
ESSENTIALLY I DON'T THINK IT'S
THE TREAT BUT IT'S WITHIN THE
PREPARATION OF THAT ADDED FAT
AND POTENTIALLY ADDED SUGAR THAT
WOULD MAKE IT MAYBE DIFFICULT
BECAUSE EVEN WITHIN COOKING, FOR
EXAMPLE, THAT A CERTAIN
PERCENTAGE OF SOMETHING MAY BE
ADDED THAT'S OUTSIDE OF WATER,
SO I'M JUST CURIOUS, WHAT WOULD
RECOMMENDATION BE OR DISCUSSION
PARTICULARLY IF SOMEBODY WAS A
NUTRITION EDUCATOR, PLAYING A
ROLE OR A DIETITIAN THAT'S
COUNSELING.
>> WE'LL LET HEATHER TAKE THAT.
>> THAT'S A HARD QUESTION TO
GRAPPLE WITH.
SOME ITS ARE -- IDEAS THINKING
ABOUT PORTION SIZE, MAYBE
PORTION SIZE IN THE BAG IS MORE
THAN YOU SHOULD THINK ABOUT
EATING AT ONE OCCASION OR THERE
COULD BE MORE WORK THAT COULD BE
DONE WITH MOTIVATION TOWARDS
INDUSTRY TO LOWER FORMULATION OF
SOME THINGS WITHIN THE PRODUCTS,
FOR INDIVIDUALS TRYING TO DO
THIS, ESPECIALLY WITHIN
FAMILIES, I LIKE THE IDEA OF
TRYING TO MOVE FOR TOWARDS
NUTRIENT DENSE SNACKS THAT ARE
WITHIN THE -- IN THE NUTRIENT
DENSE CHOICES ALREADY, IT'S A
CHALLENGE.
>> I THINK CHRISTINA.
>> BASED ON FOOD MODELING THERE
ARE SOME GRAMS FOR OIL.
YOU CAN STILL -- WHILE YOU'RE
LOOKING, A SWEET POTATO IS
COOKED WITHOUT ANYTHING, THERE
ARE SOME GRAMS ON OIL, I GUESS
NOT BUTTER BUT AT LEAST OIL TO
ADD TO THE FOOD PREPARATION,
THERE'S SOME.
HOWEVER MY QUESTION WAS THOSE
GRAMS OF OIL, WERE THEY BASED ON
WHAT'S ADDED TO THE PREPARATION
OR WHATEVER CALORIES ARE LEFT,
HOW WAS THAT CALCULATED?
>> OILS WERE INTRODUCED AS
COMMITTEES WERE BRINGING FORWARD
EVIDENCE PROMOTING INTAKE OF
UNSATURATED FATS OVER SOLID FATS
WITH MORE SATURATED FAT AND
PROVIDES THAT QUANTITY IN THE
PATTERN.
FOR 12-23 MONTHS PATTERN FOR
EXAMPLE THE OILS WERE
ESSENTIALLY THE REMAINING
CALORIES, BECAUSE AS CHRIS NOTED
AT THOSE VERY LOW CALORIE
LEVELS, AND RELATIVELY HIGH
NUTRIENT NEEDS, THE FOOD GROUPS
AND SUBGROUPS WERE NEEDED TO
MEET THOSE, STILL OILS
REMAINING.
>> DEE DEE AND CHERYL.
>> I LOVE HOW WE CAN HELP PEOPLE
FOLLOW GUIDELINES IN MORE CLEAR
AND I GUESS EASIER DAILY LIFE
WAY.
YOU MENTIONED FOOD PREPARATION,
ANGELA, AND THAT GOES INTO FOODS
THAT YOU BUY THAT ARE READY TO
EAT AND HEAT AS WELL, AGAIN,
AFTER YOU'VE COOKED ALL THESE
THINGS WHETHER IT'S A BEHAVIOR
CHOICE OR TREAT, YOU'RE
ALREADIED A SATURATED FAT, ADDED
SUGAR, SODIUM WHICH WE'VE NOT
TALKED ABOUT AND CAL CALORIES E
YOU'VE ADDED TREATS BASED ON
WHAT'S AVAILABLE IN OUR GROCERY
STORES.
TO CHECK ALL THE BOXES, STILL
NOT BE WHERE THE MOST NUTRIENT
DENSE FORMS AND FOODS AND
BEVERAGES ARE, BECAUSE THAT'S
AVAILABLE, IS ALSO A MAJOR
CHALLENGE.
A LOT OF THIS DOES COME DOWN TO
CHANGING THE FOODS THEMSELVES AS
WELL AS BEHAVIOR, BUT A LOT OF
IS THE FOODS.
>> I WANT TO ADD ONCE PIECE, IN
ADDITION TO OUR SHARED RESPONSE
ABILITY FOR ASSURING HEALTHY
PATTERNS WE OUTLINE BECOME
DEFAULT IN THE U.S. FOOD SYSTEM
SO PEOPLE CAN STAND A CHANCE OF
GETTING THERE.
IN THE GAP, BETWEEN HERE AND
THAT IDEAL IS SOME OPPORTUNITY
FOR TOOLS, AND SO IN ADDITION TO
THINKING THROUGH SOME
SUGGESTIONS THAT HAVE BEEN MADE
BY THE COMMITTEE AROUND R D
CONSULTATIONS, WE REALLY HAVE TO
CONSIDER COST AND AVAILABILITY.
YOU KNOW, WHEN WE LOOK AT THE
LEVEL OF ADHERENCE OR
NON-ADHERENCE TO DIETARY
GUIDELINES, WE KNOW A GOOD CHUNK
OF THE COUNTRY SITS IN NEED OF
ABILITY TO THINK THROUGH AM I
GOING TO REDUCE ANIMAL FAT,
CARBOHYDRATE FROM ALREADY
HEALTHY PATTERN, AM I GOING TO
HAVE ENERGY LEFT OVER FOR OTHER
USES AFTER I'VE MET A VERY
NUTRIENT DENSE PATTERN.
THESE AREN'T SIMPLE CALCULATIONS
FOR PEOPLE WITHIN OUR COUNTRY.
THEY ARE NOT SIMPLE CALCULATIONS
FOR THOSE AROUND THIS TABLE
TODAY.
AND SO I WANT TO ADD TO WHAT DEE
DEE SAID, THINKING ABOUT IN
ADDITION TO HUMAN TOOLS, OTHER
TOOLS THAT WHETHER IT'S DIGITAL
OR TECHNOLOGICAL ADVANCES THAT
WE CAN BE PROMOTING AND
RECOMMENDING TO HELP FILL THIS
GAP BECAUSE THERE'S A LOT OF
WORK THAT NEEDS TO BE PUT INTO
GETTING AMERICA TO WHERE THE
DATA SUGGESTS WE NEED TO GET TO.
>> THANK YOU.
YES, ANGELA?
>> I THINK THAT'S SUCH AN
IMPORTANT POINT, CHERYL, BECAUSE
NOT ONLY FOR INDIVIDUALS BUT
ALSO FOR OUR FOOD ASSISTANCE
PROGRAMS, THINKING ABOUT SCHOOL
LUNCH PLANNING, CACFP, SO A LOT
OF MODELED, WHEN YOU THINK ABOUT
DIETARY GUIDELINES TO BE
CONSISTENT AT THIS POINT, AND
THEY HAVE THEIR OWN CALORIE
RANGES.
SO I THINK THAT WHEN WE THINK
ABOUT TOOLS, MORE OF A COMMENT
THAN QUESTION, SOME
RECOMMENDATIONS, WE HAVE SOME
SECTIONS, WHEN WE HAVE
INTEGRATION CHAPTER, NOT
INTEGRATION CHAPTER, INTEGRATION
DISCUSSION TO THINK ABOUT
RESEARCH RECOMMENDATIONS,
RECOMMENDATIONS TO THE FEDERAL
PROGRAMS OR TO AGENCIES.
>> I WANT TO MAKE CERTAIN THAT
OUR TWO PARTICIPANTS ONLINE,
VALERIE OR HOLLIE, DO EITHER OF
YOU HAVE QUESTIONS YOU WANT TO
ASK?
>> THIS IS HOLLIE.
NO ADDITIONAL QUESTIONS FROM ME.
>> THANK YOU.
>> I HAVE NONE.
THANK YOU.
>> GREAT.
I'M ENCOURAGED THE COMMITTEE IS
TALKING ABOUT RANGES, WHEN WE'RE
TALKING ABOUT NUTRIENTS BECAUSE
THE DATA FOR FOODS IS WIDELY
VARIABLE, FOR INDIVIDUAL
NUTRIENTS, EVEN FOR INDIVIDUAL
FOODS, BUT LAYERING ONTO THIS
DISCUSSION WE ARE VIEWING THIS
THROUGH A HEALTH EQUITY LENS.
WHEN WE START TALKING ABOUT THE
RANGES, FOR EXAMPLE, YOUR
EXAMPLE, HEATHER, OF SWEET
POTATOES AND TOMATOES, YOU KNOW,
I HAVE POPULATION GROUPS
INDIVIDUALS CHOOSE DIFFERENT
FOODS FOR DIFFERENT REASONS.
I THINK BY STARTING TO TALK
ABOUT RANGES WE TAKE AWAY -- WE
START ACKNOWLEDGE THAT THERE --
THE LEVEL OF PRECISION PEOPLE
WOULD LIKE TO HAVE IS JUST NOT
FACILITATED BY THE DATA.
AND I THINK OWNING AT THAT AND
WORKING WITH IT IS JUST A REAL
CONTRIBUTION, SO I REALLY
COMMEND YOU FOR THIS, THIS
DISCUSSION.
>> ANY OTHER COMMENTS?
>> SO, WE ARE AHEAD OF TIME.
SO DO YOU WANT TO JUST DISCUSS
WHAT WE'RE TALKING ABOUT
TOMORROW?
>> TOMORROW -- THIS CONCLUDES
OUR NEW DATA PORTION THAT GETS
US INTO OUR SYNTHESIS AND
INTEGRATION.
SO TOMORROW WE'RE GOING TO TALK
ABOUT WHAT ARE MODIFICATIONS TO
DIETARY PATTERNS THAT WE'RE
PROPOSING, SYNTHESIZING THOSE
RESULTS, KIND OF THE EVALUATION
REFINEMENT OF THE DIETARY
PATTERNS WE'RE DOING THROUGH
DIET SIMULATIONS, AND THEN
FINALLY TALKING ABOUT
FLEXIBILITIES WITHIN THE DIETARY
PATTERNS THEMSELVES.
SO --
>> THANK YOU.
I THINK THAT WILL BE A VERY
EXCITING DISCUSSION.
WE'RE GOING TO HAVE A MEETING
BREAK.
WE'RE RUNNING AHEAD OF TIME.
BUT WE THOUGHT WE WOULD TAKE A
BREAK BECAUSE THE NEXT SESSION
WE'RE DOING IS DATA ANALYSIS,
WHICH I ANTICIPATE WILL GENERATE
QUITE A BIT OF COMMENTARY.
SO IT'S 10:07 NOW.
CAN WE MEET AT 10:25?
AND I JUST ASK THE PUBLIC THAT
YOU JOIN US AT 10:25.
THANK YOU VERY MUCH FOR GREAT
DISCUSSION.
>> WELCOME BACK.
LOOKING FORWARD TO A GREAT
DISCUSSION ON FOOD PATTERN
MODELING AND DATA ANALYSIS.
TAKE IT AWAY, HEATHER.
>> PART 2 HERE, NEXT SLIDE.
I WANT TO GO OVER WHAT WE'RE
GOING TO TALK ABOUT IN THIS
PORTION, FIRST I'M GOING TO
REVIEW PROCESS SINCE LAST
MEETING AND SHARE NEW ANALYSIS,
NEW RESULTS THAT WE HAVE THAT WE
DIDN'T HAVE A CHANCE TO SHARE
YET SINCE MEETING 5.
THEN WE'LL GO INTO YOUR DRAFT
CONCLUSION STATEMENTS AND IF YOU
REMEMBER WE ADDRESS FOUR
QUESTIONS.
WE'RE GOING TO GIVE CONCLUSION
STATEMENTS ON EACH OF THOSE FOUR
QUESTIONS.
I'LL EXPLAIN NEXT STEPS AND
WE'LL HAVE TIME FOR DISCUSSION.
I'D LIKE TO RECOGNIZE OUR
SUBCOMMITTEE MEMBERS FOR SC 3,
PART OF THIS WORK.
AND THEN AMAZING SUPPORT STAFF,
FOR THIS DATA ANALYSIS PORTION,
THEY DID A VERY HEAVY LIFT, SO
THANK YOU SO MUCH.
WE WANT TO RECOGNIZE THE DATA
ANALYSIS TEAM AND ALL OF OUR
INTERAGENCY COLLABORATIONS WHO
REALLY DID ALL OF THE ANALYSIS
FOR US, FROM ARS, CDC, AND THE
NIH.
THIS IS WHAT OUR FINDINGS RELY
ON.
MOVING FORWARD, WE CAN DIVIDE
OUR PROGRESS INTO TWO SETS.
WE HAVE THINGS THAT WERE LED BY
THE COMMITTEE AND THEN ALSO
THINGS LED BY THE STAFF.
SO, FOR THE COMMITTEE-LED
ACTIVITIES, FIRST WE WERE
REVIEWING AND SYNTHESIZING ALL
THE RESULTS TOGETHER.
IF YOU REMEMBER IN THE LAST
MEETINGS WE PRESENT WORK ON
EVIDENCE SCAN REGARDING DIETARY
INTAKES DURING THE COVID-19
PANDEMIC.
SO WE ALSO CONSIDERED THOSE
FINDINGS IN OUR SYNTHESIS,
CARING THE STATEMENTS FOR THE
SCIENTIFIC QUESTIONS AND WORKING
ON THE CHAPTERS FOR OUR
SCIENTIFIC REPORT.
FINALLY, WE'VE BEEN WORKING IN
COLLABORATION WITH THE HEALTH
EQUITY WORKING GROUP TO THINK
ABOUT OUR INTERPRETATIONS AND
HELP THOSE HEALTH EQUITY
CONSIDERATIONS IN OUR WORK.
THE STAFF ON THE OTHER HAND HAVE
BEEN WORKING WITH THOSE
INTERAGENCY PARTNERS TO COLLECT
ALL THOSE DATA ANALYSIS TOGETHER
AND THEN THEY HAVE BEEN DOING
THIS WORK TO DRAFT FIVE DATA
ANALYSIS REPORTS THAT ARE OVER
500 PAGES LONG THAT SUMMARIZE
ALL OF THE ANALYTIC RESULTS.
SO IF YOU CAN IMAGINE GOING
THROUGH PAGES AND PAGES OF THE
DATA ANALYSIS, AND THAT HAS BEEN
SUBMITTED FOR FEDERAL EXPERT
REVIEW ALREADY.
AND AS PART OF THAT, THEY HAVE
ALSO BEEN DRAFTING 41 FEDERAL
DATA ANALYSIS SUPPLEMENTS THAT
ARE OVER 4,700 PAGES LONG.
SO, IT'S A LOT OF RESULTS.
OF COURSE, IT'S SO MUCH MORE
THAN WE CAN HAVE TIME TO PRESENT
IN OUR -- YOU KNOW, IN THESE
MEETINGS, SO WE'VE SELECTED
HIGHLIGHTS THAT WE WANT TO
SHARE.
OKAY.
MOVING ON, NOW WE'LL GET TO
SHARING THIS UPDATED ANALYSIS
THAT WE -- THAT ARE GOING TO
ADDRESS TWO OF THE QUESTIONS.
SO WE'RE NOT GOING TO ADDRESS
ALL FOUR, JUST TWO OF THEM TODAY
BECAUSE WE'VE ALREADY ADDRESSED
THOSE OTHER TWO WITH COMPLETE
ANALYSIS THAT WE HAVE.
SO WE JUST WANT TO SHARE NEW
INFORMATION FOR THE QUESTION ON
CURRENT PATTERNS WHICH WE'LL
COVER FIRST AND ONE ON CURRENT
INTAKES.
SO, FOR THIS QUESTION WHAT ARE
THE CURRENT PATTERNS OF FOOD AND
BEVERAGE INTAIGS, WE'RE GOING TO
FOCUS MORE ON THE PATTERN PIECE,
SO WE HAVE THIS ANALYSIS THAT IS
SHOWING.
THESE ARE FASCINATING, SHOWING
DIFFERENT DEMOGRAPHIC GROUPS, IN
THE U.S., ALL TOGETHER WITH
RECORD TO THEIR HEALTHY EATING
INDEX 2020 SCORES.
AND AGAIN THIS, JUST TO REMIND
YOU, HEADING EATING INDEX SCORES
ARE EVALUATING DIET QUALITY AND
ALIGNMENT OF DIETS WITH THE
DIETARY GUIDELINES FOR
AMERICANS.
AND SO TO START OFF, WE -- I'M
GOING TO KIND OF WALK YOU
THROUGH GROUND VIEW ON THIS
SLIDE SO THE NEXT FOUR SLIDES
YOU'LL BE ABLE TO MORE EASILY
GET RIGHT AWAY.
SO, FIRST WE HAVE ON THE X-AXIS
HERE, WE HAVE ALL OF THE
DIFFERENT SOCIODEMOGRAPHIC
GROUPS.
WE'LL HAVE THE TOTAL POPULATION
ON THE FAR LEFT FOLLOWED BY
THESE TWO VERTICAL BLACK BARS
BOUNDING OUR RACE-ETHNIC GROUP
BREAKDOWNS IN THE U.S. FOR THE
DATA WE HAD AVAILABLE.
WE HAVE NON-HISPANIC WHITE,
NON-HISPANIC BLACK,
NON-HISPANIC, AND OTHER
RACE/ETHNICITY THERE.
FOOD SECURITY REFERS TO HAVING
ENOUGH FOOD FOR AN ACTIVE
HEALTHY LIFE, AND THAT WOULD BE
THE FOOD SECURE GROUP.
THE FOOD INSECURE GROUP ON THE
OTHER HAND HAS LIMITED
AVAILABILITY DUE TO RESOURCES
FOR GETTING ENOUGH FOOD FOR AN
ACTIVE HEALTHY LIFE.
SO THOSE ARE SHOWN THERE.
AND THEN FOLLOWED BY THE TWO
GROUPS ON THE FAR RIGHT SIDE,
WHICH ARE DIVIDED BY THEIR
POVERTY INCOME RATIO.
THIS IS A RATIO OF HOUSEHOLD
INCOME, DIVIDED BY THE POVERTY
THRESHOLD.
AND SO ESTIMATES THAT ARE --
THAT WOULD BE, YOU KNOW, BELOW
THAT THRESHOLD WOULD BE IN
POVERTY, WHEREAS THOSE ABOVE
WOULD HAVE WHOLE NUMBERS AND
HERE WE HAVE FIRST GROUP,
POVERTY INCOME RATIO LESS THAN
OR EQUAL TO 1.5, ON THE FAR
RIGHT POVERTY INCOME RATIO OF
GREATER THAN 1.85.
SO, THOSE ARE OUR GROUPS.
ON THE Y-AXIS WE HAVE OUR
SCORING FOR THE HEALTHY EATING
INDEX WHICH GOES ALL THE WAY TO
100, THAT WOULD BE PERFECT
ALIGNMENT WITH THE DIETARY
GUIDELINES.
SO JUST LOOKING AT THIS, YOU CAN
SEE THAT UNFORTUNATELY WE'RE NOT
AS A POPULATION OR IN ANY
SUBGROUPS IN ALIGNMENT WITH THE
DIETARY GUIDELINES FOR
AMERICANS.
AND OUR SCORES TEND TO BE KIND
OF IN A PRETTY CLOSE BAND OF
RANGES TOGETHER, RIGHT AROUND 53
TO 63.
AND I WANT TO INTERPRET THIS
SCORE A LITTLE BIT MORE FOR YOU.
SO WE DIDN'T DO SIGNIFICANT
TESTING IN A LOT OF THESE
ANALYSES BUT WHAT WE CAN SAY
ABOUT THE HEALTHY EATING INDEX
SCORES IS THAT DIFFERENCES IN
ABOUT FIVE OR SIX POINTS HAVE
BEEN SHOWN TO BE MEANINGFUL WITH
REGARD TO HEALTH INDICATORS.
SO, THERE'S CERTAINLY
DISPARITIES THAT WE CAN SEE
BETWEEN THESE DIFFERENT
SOCIODEMOGRAPHIC GROUPS IN THE
POPULATION, BUT I THINK THE
TAKEHOME, YOU KNOW, HERE IS THAT
ALL DIETS ARE QUITE POOR.
SO, AND THIS SLIDE IS, AGAIN,
FOR AGES 2 AND OLDER.
SO LET'S MOVE TO THE NEXT SLIDE.
AND HERE WE'LL SEE THE SAME KIND
OF GRAPH, BUT THIS IS WITH
REGARD TO THE HEALTHY EATING
INDEX TODDLERS 2020 SCORES.
AND SO THESE ARE SPECIFICALLY
FOR TODDLERS, AND THIS AGE GROUP
IS 12 TO 23 MONTHS.
AGAIN, ACROSS OUR SIMILAR
GROUPS, BUT WE ALSO HAVE THESE
ESTIMATES DIVIDED BY MALES AND
FEMALES.
AND SO HERE JUST TO INTERPRET
THESE, YOU CAN SEE THE SCORES
ARE GENERALLY HIGHER THAN WE SAW
FOR ADULTS, MORE OF THE SCORES
ARE IN THE RANGE OF 60 TO 66.
PERHAPS KIND OF TIGHTER RANGE
THERE.
BUT STILL, YOU KNOW, POORLY
ALIGNING TO THE RECOMMENDATIONS
OVERALL.
MOVING FORWARD, IN THIS SLIDE
WE'RE MOVING UP TO OUR CHILD AGE
GROUPS OF AGES 2-18 YEARS, AND
YOU CAN SEE THAT OUR SCORES IN
GENERAL KIND OF DECREASE.
AND THE RANGE WE HAVE IS FROM 50
FOR MALES IN OTHER RACE OR
ETHNICITY GOING UP TO 57 IN
NON-HISPANIC ASIAN GROUP.
THERE'S SOME VARIATION THERE
WITHIN OUR GROUPS.
MOVING FORWARD TO OUR ADULTS
SLIDE HERE, THIS IS FOR AGES 19
YEARS AND OLDER.
AND YOU CAN SEE THAT RANGE WIDEN
A BIT.
WE HAVE THAT GOING NOW FROM 52
TO 64.
I WANT TO POINT OUT HERE WE DO
HAVE A LITTLE BIT MORE RANGE FOR
THE FOOD INSECURITY, AND FOR THE
POVERTY INCOME RATIO GROUPS AS
WELL.
THOSE WERE KIND OF CLOSER
PERHAPS THAN SOME OF THE OTHER
SLIDES.
AND THERE IS, YOU KNOW, A LOT OF
VARIATION IN THE RACE/ETHNIC
GROUP SCORES AS WELL, STILL IN
GENERAL STILL QUITE POOR.
OKAY.
SO, MOVING ON, SO THAT KIND OF
WRAPS UP THOSE NEW RESULTS TO
SHARE FOR CURRENT PATTERNS.
AND NOW WE'RE GOING TO ADDRESS
THIS SECOND QUESTION WITH SOME
NEW RESULTS WE HAVE.
THIS QUESTION IS WHAT ARE THE
CURRENT INTAKES OF FOOD GROUPS,
NUTRIENTS, AND DIETARY
COMPONENTS?
AND HERE WE'RE GOING TO FOCUS ON
FOOD GROUPS.
AND SO JUST TO GROUND YOU HERE
INSTEAD OF LOOKING AT AGI SCORES
WE'LL LOOK AT HOW WELL INTAKES
ARE MEETING RECOMMENDATIONS.
IN THESE GRAPHS WE'RE AGAIN
SHOWING THE SAME
SOCIODEMOGRAPHIC GROUPS, BUT OUR
GRAPH IS DIFFERENT BECAUSE WE'RE
LOOKING LIKE THE BARS YOU SEE
ADD UP TO 100% OF THE GROUP, AND
THEN ON THE TOP, ABOVE THE ZERO
AXIS WE'RE SEEING THE PERCENTAGE
OF THE GROUP THAT IS AT OR ABOVE
RECOMMENDATION, THAT'S IN GREEN.
AND THEN THE PORTION IN BLUE IS
GOING TO BE THE PERCENT OF THE
GROUP THAT IS BELOW THE
RECOMMENDATION.
AND WE'RE GOING TO START WITH
FRUIT AND THEN GOING THROUGH
VEGETABLES, AND THE OTHER FOOD
GROUPS.
AND SO AGAIN, YOU KNOW, I JUST
WANT TO HIGHLIGHT THIS.
IT'S REALLY INTERESTING TO LOOK
ACROSS THESE DIFFERENT
SOCIODEMOGRAPHIC GROUPS.
I THINK IT'S KIND OF FASCINATING
TO SEE JUST THAT RANGE THERE AND
THAT COMPARISON THAT WE HAVE
THIS RICH DATA FROM.
SO, TOTAL FRUITS THEN YOU CAN
SEE REALLY AS A WHOLE GROUP, AS
A POPULATION, WE'RE NOT DOING
WELL AT MEETING THE FRUIT GROUP
RECOMMENDATION.
WE HAVE SOME VARIABILITY FROM
ABOUT 18% GOING UP TO 29% IN
COMPLIANCE WITH THOSE
RECOMMENDATIONS, IN AGES 1 AND
OLDER.
AND ALSO ALL OF THESE SLIDES ARE
GOING TO BE FOR AGES 1 AND
OLDER.
SO MOVING FORWARD TO TOTAL
VEGETABLES, HERE A LITTLE BIT
WORSE COMPLIANCE I WOULD SAY
COMPARED WITH FRUITS, AND WE
ONLY HAVE RANGE OF ABOUT 5 GOING
UP TO 21% OF OUR GROUPS,
SOCIODEMOGRAPHIC GROUPS, MEETING
TOTAL VEGETABLES
RECOMMENDATIONS.
WITHIN TOTAL VEGETABLES THERE'S
SEVERAL SUBGROUPS.
AND WE HAVE SOME INTERESTING
VARIETY THERE THAT NOW WE'LL GO
INTO.
MOVING FORWARD WE'LL START WITH
THE DARK GREEN VEGETABLES.
AND HERE YOU CAN SEE THAT THE
NON-HISPANIC ASIAN GROUP HAS 42%
COMPLIANCE, WHICH IS NOT QUITE
MAJORITY BUT PRETTY GOOD.
AND THEN THAT WE HAVE A LOW OF
ABOUT 10% IN THE HISPANIC GROUP
FOR MEETING OR ABOVE THE
RECOMMENDATIONS FOR DARK GREEN
VEGETABLES.
MOVING FORWARD, WITH RED AND
ORANGE VEGETABLES, WORSE
COMPLIANCE OVERALL.
A SMALLER RANGE, ONLY FROM
ABOUT -- IT'S HARD TO READ FROM
HERE, BUT 3 TO 7%, I THINK.
MAYBE A LITTLE HIGHER THAN THAT.
SO IT'S PRETTY TIGHT THOUGH.
MOVING FORWARD TO BEANS, PEAS,
LENTILS, A LITTLE BIT MORE
VARIATIONS IN OUR SUBGROUPS, AND
HERE WE HAVE THE HISPANIC GROUP
DOING MUCH BETTER WITH 45%
COMPLIANCE OR ABOVE THAT
RECOMMENDATION.
GOING FORWARD, FOR STARCHY
VEGETABLES, KIND OF LOWER
OVERALL RANGES FOR COMPLIANCE,
AND WE'VE GOT ABOUT, YOU KNOW, 3
TO 15% THERE WHO ARE MEETING OR
ABOVE THOSE RECOMMENDATIONS FOR
STARCHY VEGETABLES.
AND FINALLY, WE HAVE OTHER
VEGETABLES, AND HERE WE ALSO SEE
QUITE A BIT OF VARIATION IN
ACROSS, YOU KNOW, THE GROUPS
BUT, YEAH, GENERALLY WE'RE
SEEING THE MOST VARIATION WITHIN
THE RACE/ETHNIC GROUPS AS FAR AS
VEGETABLES ARE CONCERNED.
NEXT SLIDE WE WANTED TO PUT
THESE ALL TOGETHER FOR YOU, JUST
VISUALLY TO SEE FOR ALL OF THESE
FOR TOTAL VEGETABLES IN ALL
THESE VEGETABLE GROUPS, THE
VARIATION IN THE RACE/ETHNIC
GROUPS THERE BECAUSE AS I
HIGHLIGHTED WE SEEM TOE HAVE THE
MOST VARIATION FOR THAT
SOCIODEMOGRAPHIC
CHARACTERISTICS.
YEAH, AND FOR CERTAIN SUBGROUPS
HERE THERE'S NOT AS MUCH, JUST
POINTING OUT RED AND ORANGE
VEGETABLES, STARCHY VEGETABLES,
BUT THEN FOR SEVERAL WE DO HAVE
QUITE A BIG RANGE.
OKAY.
NOW WE'LL MOVE FORWARD WITH SOME
OF OUR OTHER FOOD GROUPS.
WHOLE GRAINS, THIS GROUP IS
PERHAPS KIND OF OUR WORST AT
COMPLYING AS A POPULATION.
VERY SMALL PERCENTAGES IN OUR
SUBGROUPS ARE COMPLYING OR ABOVE
THIS RECOMMENDATION GOING FROM
ABOUT 1 TO 7%.
MOVING FORWARD, TO REFINED
GRAINS, WE'VE MADE THE -- THOSE
THAT ARE AT OR ABOVE THE
RECOMMENDATION BARS HERE IN
ORANGE, BECAUSE THIS
RECOMMENDATION ALSO HAS A LIMIT
THAT IT SHOULD ONLY BE 50% OF
GRAINS AS REFINED GRAINS.
AND SO EVEN THOUGH WE'RE -- YOU
KNOW, THERE'S A MAJORITY OF US
WHO ARE AT OR ABOVE THE
RECOMMENDATIONS, IT'S TOO MUCH
ABOVE.
WE NEED TO BALANCE THAT WITH
THOSE WHOLE GRAINS WHICH WE'RE
NOT DOING.
SO YOU CAN SEE THOSE PERCENTAGES
ARE QUITE HIGH.
MOVING FORWARD TO TOTAL PROTEIN
FOODS, THIS IS ONE OF THE FOOD
GROUPS THAT WE ARE ALSO AT OR
ABOVE THE RECOMMENDATIONS IN
MAJORITY ESTIMATES FOR AGES 1
AND OLDER AGAIN, AND YOU CAN SEE
WE'VE GOT PRETTY BIG MAJORITY
HERE, ABOUT 51 GOING TO 64% OF
US WHO ARE MEETING THE TOTAL
PROTEIN FOODS RECOMMENDATIONS.
MOVING FORWARD FOR SEAFOOD, A
LITTLE MORE VARIETY BUT
GENERALLY VERY LOW PERCENTAGES
WHO ARE AT OR ABOVE
RECOMMENDATION, WE HAVE ESTIMATE
OF TOP END OF 34% IN THE
NON-HISPANIC ASIAN GROUP.
MOVING FORWARD, FOR MEAT,
POULTRY, EGGS, ONE OF THE
RECOMMENDATIONS WE'RE MEETING,
IN A LARGE PART FOR, AND THIS IS
FOR JUST TO REMIND YOU, FOR AGES
2 AND OLDER.
AND HERE WE HAVE ESTIMATES OF
56% GOING UP TO ABOUT 76% WHO
ARE MEETING THIS.
GOING AHEAD, FOR OUR LAST
PROTEIN GROUP HERE, NUTS, SEEDS,
SOY PRODUCTS, A LOT OF VARIATION
IN THESE ESTIMATES WHO ARE AT OR
ABOVE GOING FROM ABOUT 26% OR
27, TO UP TO 47 OR 49%.
AND THAT'S ALSO VARIATION IN --
BY FOOD SECURITY AND POVERTY
INCOME RATIO AS WELL AS ETHNIC
GROUPS.
MOVING FORWARD, NOW WE HAVE
TOTAL DAIRY AND FORTIFIED SOY
ALTERNATIVES FOOD GROUP.
MAJORITY ARE VERY PREVALENTLY
NOT MEETING THIS RECOMMENDATION.
IT'S QUITE LOW ACROSS ALL OF THE
SOCIODEMOGRAPHIC GROUPS THAT WE
LOOKED AT WITH OUR RANGE, ONLY
FROM 4 TO ABOUT 12% WHO ARE
MEETING THIS RECOMMENDATION.
AND MOVING FORWARD AGAIN, OUR
VERY LAST FOOD GROUP TO SHOW TO
YOU TODAY IS GOING TO BE OILS.
AND HERE WE'RE AGAIN DOING
PRETTY WELL.
ONE OF OUR GROUPS WHERE MAJORITY
OF US ARE AT OR ABOVE THE
RECOMMENDATION, AND THIS RANGES
FROM ABOUT 47 TO 59% OF US WHO
ARE MEETING THESE
RECOMMENDATIONS.
SO, THOSE ARE ALL OF THE NEW
RESULTS THAT WE WANTED TO SHARE
WITH YOU TODAY.
I JUST WANTED TO SAY A FEW
THINGS ABOUT THE CONSIDERATIONS
AND LIMITATIONS OF THIS DATA.
SO, AGAIN THIS IS THE FIRST TIME
WE SHARED THESE, ALSO THE FIRST
TIME DIETARY GUIDELINES ADVISORY
COMMITTEE HAS REALLY EXAMINED
ALL OF THESE INTAKES TOGETHER
AND ALL THIS EVIDENCE TOGETHER
WITH THE HEALTH EQUITY LENS AND
BY ALL OF THESE DIFFERENT GROUPS
THAT WE LOOKED AT.
THERE'S A LOT MORE DEMOGRAPHIC
GROUPS THAT WE LOOKED AT THAT WE
JUST DON'T HAVE THE TIME TO
PRESENT TODAY.
SO, COULD ONLY SHOW THESE MAJOR
GROUPS.
AND I ALSO WANTED TO REMIND
EVERYONE ALTHOUGH WE DO SEE THIS
VARIATION, AND WE SEE THAT MANY
OF THE GROUPS ARE NOT MEETING
THE RECOMMENDATIONS, IT'S -- YOU
KNOW, WE CAN'T REALLY SAY
THERE'S SIGNIFICANT DIFFERENCES
BETWEEN SOME OF THOSE, YOU KNOW,
RANGES OF ESTIMATES THAT WE SAW.
SO WE HAVE TO BE CAREFUL IN OUR
INTERPRETATION OF THAT.
WE CAN SAY, HOWEVER, THAT
THERE'S CERTAINLY A LOT OF
SHORTFALLS IN OUR POPULATION
DIETARY INTAKES AS FAR AS THEY
MEET THOSE RECOMMENDATIONS.
THERE'S MANY COMPLEX FACTORS AT
PLAY HERE THAT ARE ALSO NOT
CAPTURED WHEN WE JUST LOOK AT
INTAKES FOR CERTAIN GROUPS.
WE DON'T KNOW WHY THAT'S
HAPPENING.
AND WE NEED TO DIG A LOT DEEPER
TO TRY TO UNDERSTAND THAT.
ALL OF US, I JUST WANT TO
MENTION TOO, THAT ALL OF US ARE
REALLY REPRESENTED IN MULTIPLE
OF THESE CATEGORIES, AND JUST
LOOKING AT ONE ASPECT, ONE
CHARACTERISTIC, IS NOT GIVING US
A FULL PICTURE OF HOW ALL OF
THOSE, YOU KNOW, FACTORS AND
INFLUENCES AROUND US MAY BE
CONTRIBUTING TO DIETARY INTAKES.
ALL OF US ARE SHAPED BY THE
ENVIRONMENT AND SOCIAL SYSTEMS
AROUND US, SO THAT'S A BIG PIECE
OF THIS.
AND THEN I WANT TO REMIND
EVERYONE THESE DATA ARE
CROSS-SECTIONAL, AND WE
CERTAINLY CAN'T USE THEM TO
DETERMINE CAUSE AND EFFECT.
SO FOR THE FUTURE, HOPEFULLY WE
COULD DO MORE TO, YOU KNOW --
NOT JUST IN THIS COMMITTEE, ALSO
FOR OTHER RESEARCHERS, WE COULD
DO MORE TO CAPTURE MORE, YOU
KNOW, OF THESE FACTORS, DIG
DEEPER, AND UNDERSTAND THIS DATA
FURTHER WITH THE HEALTH EQUITY
LENS.
MOVING AHEAD, SO NOW WE GET TO
THE TIME WHERE WE CAN SHARE OUR
DRAFT CONCLUSION STATEMENT FOR
EACH OF THE FOUR QUESTIONS THAT
WE ADDRESSED.
AND GOING TO THE NEXT SLIDE,
JUST TO PROVIDE A BACKGROUND ON
THAT, I'M GOING TO HIGHLIGHT A
FEW THINGS.
WE'RE GOING TO GIVE SUMMARY
STATEMENTS OF THE EVIDENCE WE
REVIEWED TO ANSWER EACH OF OUR
QUESTIONS, FOR SOME OF THE
QUESTIONS WE HAVE A FEW
STATEMENTS.
AND IN THESE SUMMARIES WE DID
CONSIDER ALL OF THE NATIONALLY
REPRESENTED FEDERAL DATA ON
DIETARY INTAKES AND PREVALENCE
OF NUTRITION-RELATED CHRONIC
HEALTH CONDITIONS THAT WE
REQUESTED, EVEN THOUGH WE
HAVEN'T SHARED, YOU KNOW, ALL OF
THAT PUBLICLY, BUT IT ALL IS
GOING TO BE PUBLISHED OUT THERE
FOR EVERYONE TO LOOK AT.
AND ALSO JUST -- WE JUST WANT TO
MENTION THAT THE DATA ANALYSIS
IS DIFFERENT THAN THE SYSTEMATIC
REVIEWS IN THAT WE'RE NOT
APPLYING LIKE A GRADING RUBRIC
OF STRONG, MODERATE, LIMITED, TO
LOOK AT THIS EVIDENCE.
BUT WE DO -- YOU KNOW, WE DID
TAKE ON CERTAIN METHODS IN OUR
ANALYSIS TO TRY TO PROVIDE THE
HIGHEST QUALITY OF ESTIMATES
THAT WE COULD FOR THESE RESULTS.
SO, MOVING FORWARD TO JUST SHARE
A LITTLE BIT MORE ABOUT THAT, WE
DO HAVE LIMITATIONS IN THE DATA
THAT ARE WORTH MENTIONING HERE.
SO, DUE TO THE SAMPLE SIZES WE
HAD TO WORK WITH AND DATA
AVAILABILITY, THERE IS SOME
VARIATION WHEN YOU'RE GOING
TO -- IF YOU LOOK AT THOSE
REPORTS, AND DIG INTO THE
RESULTS THAT WE HAVE, THERE'S
GOING TO BE SOME VARIATION IN
THE ANALYSIS WITH REGARD TO
STANDARD ERRORS AND ESTIMATES
FOR THE DIFFERENT DEMOGRAPHIC
GROUPS FOR THAT DATA THAT WE HAD
AVAILABLE TO US.
AND ALSO WITH REGARD TO CUTOFFS
THAT WERE APPLIED FOR CERTAIN
SOCIODEMOGRAPHIC GROUPS, SO, YOU
KNOW, JUST TO MENTION, FOR
EXAMPLE, FOR WIC, WHEN WE LOOKED
AT WIC, NOT ALL SEX AGE GROUPS
ARE PART OF THAT DATA SO THAT'S
AN IMPORTANT CONSIDERATION WHEN
YOU LOOK AT THAT.
FOR THE DATA YEARS ANALYZED, WE
INCLUDED MULTIPLE CYCLES OF DATA
OVER LONGER TIMEFRAMES FOR
CERTAIN DEMOGRAPHIC GROUPS SO WE
COULD GET BETTER ESTIMATES.
AND WE ALSO USED A VARIETY OF
DATA SOURCES.
BUT THIS IS ALL OUTLINED IN
THOSE REPORTS.
AND IN OUR PROTOCOLS.
THEN WE DIDN'T -- JUST A
REMINDER, WE DIDN'T DO
STATISTICAL TESTING FOR MOST OF
THE ANALYSIS, AND OUR DIETARY
INTAKE DATA IS OF COURSE SUBJECT
TO MEASUREMENT ERROR.
AND THAT'S INHERENT TO
SELF-REPORTED INTAKE, FOR SOME
OF THE INTAKES WE HAD PROXY
REPORTERS, FOR EXAMPLE, PARENTS
REPORTING ON CHILDREN, AND
THERE'S GOING TO BE VARIATION IN
OUR FOOD COMPOSITION DATABASE AS
WELL.
SO THOSE COULD ALL BE SOURCES OF
ERRORS.
AND THEN WE HAVE INTERPRETATION
CHALLENGES, SEVERAL OF WHICH
I'VE ALREADY MENTIONED.
SO COMPLEX FACTORS CONTRIBUTING
TO THE RESULTS THAT WE CAN'T
CAPTURE IN JUST LOOKING AT THESE
ESTIMATES.
THE DATA IS CROSS-SECTIONAL.
AND, AGAIN, THAT
INTERSECTIONALITY THAT I ALREADY
MENTIONED BEFORE, WE DIDN'T
CAPTURE.
BUT WE DO HAVE SOME STRENGTHS.
SO, MOVING AHEAD, THE STRENGTHS
ARE THAT OUR DATA CAN BE MADE
REPRESENTATIVE OF THE U.S.
POPULATION, SO THAT'S REALLY
IMPORTANT.
IT MEANS THAT WE -- YOU KNOW, WE
CAN BE PRETTY CONFIDENT IN
THIS -- THE DATA THAT WE HAVE.
AND WE CAN USE IT TO CREATE
PRACTICAL RELEVANT AND
ACHIEVABLE RECOMMENDATIONS.
AND THEN, YOU KNOW, WE HAVE DONE
A LOT OF ANALYSIS.
WE'VE LOOKED AT THE POPULATION
MANY DIFFERENT WAYS AND JUST
HAVE THIS MASSIVE GREAT SET OF
DATA OVER 4,000 PAGES OF NEW
DATA TABLES THAT'S RELATIVELY
CURRENT TO MAKE OUR SUMMARY
FROM.
AND WE HAVE APPLIED, AS I
MENTIONED, SOME METHODS TO TRY
TO OVERCOME SOME OF THE
SHORTFALLS IN THE MEASUREMENT
ERROR.
FOR EXAMPLE, WE USED FIVE-STEP
MULTIPLE PASS METHOD, WHICH IS A
REALLY -- IT'S A MORE GOLD
STANDARD WAY OF COLLECTING
DIETARY RECALLS.
WE'VE ALSO USED STATISTICAL
ADJUSTMENTS TO HELP MITIGATE
SOME OF THAT MEASUREMENT ERROR
IN THE DIETARY INTAKES.
FOR EXAMPLE, THE NATIONAL CANCER
INSTITUTE METHOD WAS APPLIED.
AND THEN WE HAVE ENHANCED
ESTIMATES FOR DISEASE AND
BIOMARKER PREVALENCE FROM
PHYSICAL EXAM AND LABORATORY
DATA THAT ARE ALL COLLECTED.
AS PART OF NHANES.
SO THIS IS AN AMAZING DATASET O
USE AND WE SHOULD CELEBRATE THAT
STRENGTH WE HAVE.
WE ALSO INTEGRATED OR CONSIDERED
THOSE RESULTS FROM THE EVIDENCE
SCAN THAT WE'VE ALREADY SHARED
REGARDING THE DIETARY PATTERNS
DURING THE COVID-19 PANDEMIC.
AND IN THIS TIME TOO I WANT TO
HIGHLIGHT WE DID APPLY A HEALTH
EQUITY LENS TO EXAMINE DATA FOR
THIS WIDE VARIETY OF
SOCIODEMOGRAPHIC GROUPS, A MUCH
WIDER THAN WE COULD SHARE TODAY,
BUT JUST TO MENTION THOSE WE
LOOKED AT THE DATA BY AGE LIFE
STAGE, SEX, RACE, ETHNICITY,
POVERTY TO INCOME, SUPPLEMENTAL
PROGRAM FOR NUTRITION, WIC, BY
EDUCATIONAL LEVEL, FAMILY
INCOME, COUNTRY OF BIRTH, HEALTH
INSURANCE STATUS, DISABILITY
STATUS, GEOGRAPHIC AND
METROPOLITAN LOCATION, BMI
STATUS AND DIABETES STATUS.
MOVING AHEAD, NOW I'M GOING TO
FINALLY GET TO SHARE OUR SUMMARY
STATEMENTS FOR OUR FOUR
QUESTIONS.
SO, WHAT ARE THE CURRENT
PATTERNS OF FOOD AND BEVERAGE
INTAKE, WE HAVE TWO SUMMARIES.
ONE WILL FOCUS ON DIETARY
PATTERNS.
AND THE OTHER IS ON BEVERAGES.
SO FOR DIETARY PATTERNS, FOR
THOSE AGES 1 AND OLDER, DIETARY
INTAKE PATTERNS AS EVALUATED BY
THE HEALTHY EATING INDEX 2020
AND HEALTHY EATING INDEX
TODDLERS 2020, WE FAILED TO
ALIGN WITH DIETARY GUIDELINES
FOR AMERICANS 2020 TO 2025, IN
THE LIFE STAGES OR
SOCIODEMOGRAPHIC GROUPS THAT WE
EXAMINED.
THE MEAN SCORES FOR THE TOTAL
POPULATION AGES 2 AND OLDER WAS
58 OUT OF 100.
AND FOR TODDLERS, AGES 12 TO 23
MONTHS, THE MEAN WAS 63 OUT OF
100.
FOR BEVERAGES HERE WE HAVE
INTERESTING RESULTS TO
HIGHLIGHT.
AMONG ADULTS AND OLDER ADULTS,
BEVERAGES, THEY DO CONTRIBUTE TO
DAILY ENERGY NUTRIENT AND
DIETARY COMPONENT INTAKES.
AND THE TOP FIVE FOOD COMPONENTS
THAT ARE GOING TO BE PROVIDED BY
ALL BEVERAGES CONSUMED ARE ADDED
SUGARS, VITAMIN C, D, CALCIUM,
MAGNESIUM.
SO, THEN JUST TO SHARE WHAT ARE
SOME OF THESE TOP BEVERAGES,
AMONG INDIVIDUALS AGES 2 AND
OLDER, WATER IS THE MOST
CONSUMED BEVERAGES, BOTH IN MEAN
VOLUME AND PERCENT REPORTING
INTAKE AT LEAST ONCE A DAY.
SO THAT'S GOOD.
INTAKES ARE SIGNIFICANTLY HIGHER
COMPARED WITH THE 2007-2008
DATA, THAT'S A POSITIVE, WATER
INTAKE IN THESE GROUPS IS HIGHER
THAN OLDER YEARS.
AND THEN FOR OLDER CHILDREN AND
ADOLESCENTS AGES 6-11 YEARS AND
12-19 YEARS, THEY CONSUME
SIGNIFICANTLY HIGHER VOLUME
COMPARED WITH YOUNGER CHILDREN,
AGES 2-5, AND OLDER ADULTS 60
AND OLDER CONSUMED SIGNIFICANTLY
LOWER VOLUME COMPARED WITH
YOUNGER ADULTS AGES 20-39, 40-59
YEARS.
BASED ON MEAN VOLUME CONSUMES
SUGAR-SWEETENED BEVERAGES, MILK,
100% JUICE ARE OTHER TOP
BEVERAGES FOR CHILDREN AND
ADOLESCENTS.
FOR ADULTS, WE HAVE ALCOHOLIC
BEVERAGES, COFFEE AND TEA, AND
SUGAR-SWEETENED BEVERAGES BEING
SOME OF THE OTHER TOP BEVERAGES.
COMPARED WITH OUR OLDER DATA,
2007-2008, A LOWER PERCENTAGE
CONSUMING SUGAR SWEETENED
BEVERAGES, ALSO A WIN, BUT IT'S
ALSO A LOWER PERCENTAGE
CONSUMING MILK AND 100% JUICE IN
A DAY.
SO NOT AS GOOD THERE.
NONETHELESS SUGAR-SWEETENED
BEVERAGES ARE THE TOP FOOD
CATEGORY CONTRIBUTOR TO ADD
SUGAR INTAKES.
MOVING ON TO CONCLUSION
STATEMENTS FOR OUR NEXT
QUESTION, WHAT ARE THE CURRENT
INTAKES OF FOOD GROUPS,
NUTRIENTS, AND DIETARY
COMPONENTS, AND SO THESE ARE
REFLECTING BACK ON SOME OF THE
RESULTS WE SHARED TODAY.
FIRST WE'LL TALK ABOUT FOOD
GROUP AND SUBGROUPS, THEN
NUTRIENTS.
SO, IN GENERAL FOR FOOD GROUP
AND SUBGROUP INTAKES FOR AGES 1
AND OLDER WE'RE NOT ALIGNING
WITH THE DIETARY GUIDELINES FOR
AMERICANS, AND FOR THE MAJORITY
OF THOSE AGES 1 AND OLDER THE
INTAKES OF THE FOLLOWING FOOD
GROUPS AND SUBGROUPS ARE BELOW
DIETARY GUIDELINES
RECOMMENDATIONS.
THAT INCLUDES FRUITS, AS WE SAW,
TOTAL VEGETABLES, ALL THOSE
SUBGROUPS, BEANS, PEAS AND
LENTILS, STARCHY VEGETABLES, RED
AND ORANGE VEGETABLES, DARK
GREEN VEGETABLES, AND THEN ALSO
LOWER FOR DAIRY AND FORTIFIED
SOY ALTERNATIVES, SEAFOOD, NUTS,
SEEDS AND SOY PRODUCTS, AND
WHOLE GRAINS.
BUT ALSO FOR THE MAJORITY OF
INDIVIDUALS AGES 1 AND OLDER,
INTAKES OF THE FOLLOWING FOOD
GROUPS AND SUBGROUPS ARE AT OR
ABOVE DIETARY GUIDELINES
RECOMMENDATIONS, AND THOSE
INCLUDE TOTAL GRAINS, REFINED
GRAINS, TOTAL PROTEIN FOODS,
MEAT, POULTRY AND EGGS FOR AGES
2 AND OLDER.
AND UNFORTUNATELY THOUGH MANY OF
OUR TOP SOURCES OF FOOD GROUPS
ARE CONSUMED IN FORMS THAT ARE
HIGH IN NUTRIENTS TO LIMIT,
SATURATED FAT, SODIUM, ADDED
SUGARS.
MOVING ON TO OUR ANSWER TO THIS
QUESTION WITH REGARD TO
NUTRIENTS, OUR NUTRIENT INTAKES
DON'T ALIGN WITH THE
RECOMMENDATIONS, AND MANY OF
THOSE NUTRIENTS ARE
UNDERCONSUMED FOR AGES 1 AND
OLDER, AND THOSE INCLUDE DIETARY
PROTEIN, FIBER, CALCIUM,
POTASSIUM, MAGNESIUM, IRON, SINK
ZINC, COPPER, PHOSPHORUS,
VITAMIN B-12, C, D, E, AND K, A
BIG PROFILE THERE THAT WE'RE
UNDERCONSUMING.
HOWEVER, WE ARE OVERCONSUMING,
AS I ALREADY MENTIONED, SODIUM,
ADDED SUGARS, SATURATED FATS.
AND THE PROPORTIONS HERE WHO ARE
MEETING OR EXCEEDING THESE
INTAKE VARIES WITHIN OUR
POPULATION GROUPS BY AGE, SEX,
RACE, AND/OR ETHNICITY, AND
SOCIOECONOMIC POSITION.
AND THEN MANY OF OUR TOP FOOD
SOURCES AGAIN OF NUTRIENTS ARE
NOT CONSUMED IN THE MOST
NUTRIENT DENSE FORMS.
OKAY.
SO MOVING AHEAD TO OUR THIRD
QUESTION, WHICH WAS WHAT IS THE
CURRENT PREVALENCE OF
NUTRITION-RELATED CHRONIC HEALTH
CONDITIONS?
AND THESE RESULTS WERE REALLY
INTERESTING.
WE PRESENTED A LOT OF THESE IN
OUR LAST MEETING.
HERE WE HAVE WIDESPREAD
PREVALENCE OF NUTRITION-RELATED
CHRONIC HEALTH CONDITIONS.
AND THIS CONTINUES TO BE A BIG
PROBLEM FOR OUR POPULATION.
FOR EXAMPLE, WE HAVE A REALLY
HIGH PREVALENCE OF RISK FACTORS
AMONG ADOLESCENTS, HAVING ABOUT
38% OF 12-19 YEAR OLD WAS
PREDIABETES.
AND THIS IS PARTICULARLY
CONCERNING BECAUSE IT'S IN OUR
CHILD AGE GROUPS.
AND, YOU KNOW, HOW DOES THAT
BODE FOR FUTURE HEALTH THROUGH
THE ADULT LIFESPAN? AND THEN WE
ALSO SEE THAT OUR CHRONIC
DISEASE RATES ARE EVEN HIGH
AMONG MIDDLE AGED ADULTS, BEFORE
WE'RE GETTING TO OLDER
ADULTHOOD.
OF COURSE, THEY CONTINUE TO BE
QUITE HIGH FOR OLDER ADULTS.
JUST AS WE DID FOR INTAKES WE DO
HAVE A VARIATION IN THE
PREVALENCE, INCIDENCE, AND
MORTALITY RATES FOR OUR
DIFFERENT SOCIOECONOMIC,
SOCIODEMOGRAPHIC GROUPS THAT WE
HAVE YOU ALREADY HIGHLIGHTED
BEFORE BUT CERTAINLY DISPARITIES
IN PREVALENCE OF OBESITY AND
DIABETES AMONG THOSE OF LOWER
SOCIOECONOMIC POSITION.
THEN WE HAVE SOME CHRONIC HEALTH
CONDITIONS INCLUDING OBESITY,
DIABETES, OSTEOPOROSIS FOR
FEMALES THAT HAVE BECOME MORE
PREVALENT COMPARED TO 10 OR 20
YEARS AGO.
SO THESE ARE ESTIMATES WE NEED
TO KEEP A PULSE ON IN OUR
POPULATION AND UNDERSTAND WHY
THOSE ARE HAPPENING, AND THINK
ABOUT DIET AS PART OF THAT.
MOVING TO OUR LAST QUESTION,
WHICH NUTRIENTS AND/OR DIETARY
COMPONENTS PRESENT A SUBSTANTIAL
PUBLIC HEALTH CONCERN BECAUSE OF
UNDERCONSUMPTION OR
OVERCONSUMPTION.
AND SO HERE WE'RE JUST TRYING TO
HIGHLIGHT THESE NUTRIENTS WHERE
THEY ARE SIGNIFICANTLY
UNDERCONSUMED IN THE POPULATION,
AND THAT'S BASED ON AT LEAST
THREE SOURCES OF DATA WE LOOKED
AT.
AND SO FOR THOSE AGES 1 AND
OLDER, BASED ON DIETARY INTAKE
DATA, BIOMARKER DATA, AND
RELEVANCE TO HEALTH, FOR THOSE 1
AND OLDER, WE HAVE CONTINUED TO
IDENTIFY VITAMIN D, CALCIUM,
POTASSIUM, FIBER AS NUTRIENTS OF
PUBLIC HEALTH CONCERN DUE TO
UNDERCONSUMPTION.
AND I SAID CONTINUE BECAUSE
THESE WERE HIGHLIGHTED IN THE
LAST REPORT OF THE DIETARY
GUIDELINES.
WE ALSO CONTINUE TO OVERCONSUME
SODIUM, ADDED SUGARS, SATURATED
FAT FOR 2 AND OLDER, ALSO
NUTRIENTS OF PUBLIC HEALTH
CONCERN.
NOW WE HAVE SOME OTHER IMPORTANT
NUTRIENTS OF PUBLIC HEALTH
CONCERN FOR CERTAIN AGE GROUPS.
SO FOR INFANTS 6-11 MONTHS,
BASED ON DIETARY INTAKE DATA AND
PUBLIC HEALTH RELEVANCE, IRON IS
A NUTRIENT OF PUBLIC HEALTH
CONCERN FOR INFANTS 6-11 MONTHS
FED HUMAN MILK, FOR ADOLESCENT
FAMILIES WE'VE IDENTIFIED IRON
AS BEING OF PUBLIC HEALTH
CONCERN BASED ON DIETARY INTAKE
DATA FOR FEMALES 14-18, AND
BIOMARKER DATA FOR FEMALES 12.
FOR FEMALES 20-49 YEARS, BASED
ON THE DIETARY INTAKE DATA AND
BIOMARKER DATA, WE AGAIN
IDENTIFY IRON AS AN IMPORTANT
NUTRIENT OF PUBLIC HEALTH
CONCERN.
AND FOR PREGNANCY AND LACTATION,
BASED ON DIETARY INTAKE DATA, IN
FEMALES 20-44 YEARS, BIOMARKER
DATA IN PREGNANT FEMALES, WE
HAVE IRON IDENTIFIED AGAIN AS
BEING A PUBLIC HEALTH CONCERN
AMONG FEMALES WHO ARE PREGNANT.
AND THEN BASED ON DIETARY INTAKE
DATA AND RELEVANCE TO HEALTH,
FOLATE IS ALSO A PUBLIC HEALTH
CONCERN FOR FEMALES DURING THE
PRE-CONCEPTION PERIOD AND IN THE
FIRST TRIMESTER OF PREGNANCY.
BASED ON BIOMARKER DATA AND
RELEVANCE TO HEALTH, IN FEMALES
PREGNANT, IODINE IS OF PUBLIC
HEALTH CONCERN FOR THOSE WHO ARE
PREGNANT.
SO THAT CONCLUDES ALL OF OUR
SUMMARY STATEMENTS, AND NOW I'LL
SHARE NEXT STEPS.
SO, WE'RE GOING TO BE WORKING ON
FINALIZING OUR DATA ANALYSIS
CHAPTER OF THE SCIENTIFIC
REPORT.
AND THEN INTEGRATING OUR
EVIDENCE FROM THE DATA ANALYSIS
WITH THE OTHER EVIDENCE THAT
FROM THE SYSTEMATIC REVIEW AND
FROM FOOD PATTERN MODELING, AND
THEN CONSIDERING AND WRITING UP
OUR FUTURE DIRECTIONS AND ADVICE
TO THE DEPARTMENTS AND GETTING
OUR SCIENTIFIC REPORT OUT THERE
AND PUBLISHED FOR EVERYONE TO
LOOK AT.
FINALLY THE STAFF WILL PUBLISH,
MAKE SURE ALL OF THESE REPORT
DATA ANALYSIS REPORTS,
SUPPLEMENTS, AND THE PLAN ARE
ALSO OUT THERE FOR EVERYONE TO
HAVE SOME GREAT READING.
AND NOW WE'LL OPEN UP FOR
DISCUSSION IS OUR NEXT THING I
THINK.
YES.
>> YEAH, BEFORE WE OPEN UP FOR
QUESTIONS, HEATHER, I WANT TO
COMMEND YOU FOR A REALLY STRONG
PRESENTATION BECAUSE I REALLY
FEEL YOUR PRESENTATION IS
CONSISTENT WITH THE SPIRIT OF
THE COMMITTEE.
WE'RE GOING WHERE THE EVIDENCE
IS.
WE STOP WHERE THE EVIDENCE
STOPS.
AND YOU REALLY DID A BEAUTIFUL
JOB OF EXPLAINING THE GUARD
RAILS OF INTERPRETATION.
AND I THINK THAT'S SO CRITICAL.
SO, KUDOS TO YOU AND KUDOS TO
THE STAFF FOR GENERATING.
SO, WITH THAT, I'M GOING TO OPEN
UP FOR QUESTIONS.
FATIMA?
>> YES, THANK YOU FOR THAT
LOVELY PRESENTATION.
I WANT TO GO BACK TO YOUR
BEGINNING PORTION OF YOUR
PRESENTATION WHEN YOU WERE
BREAKING DOWN BY RACIAL/ETHNIC
GROUP.
WE SAW QUITE A BIT OF DATA
SPEAKING TO THOSE OF ASIAN
DESCENT WITH A HIGHER LIKELIHOOD
OF MEETING RECOMMENDATIONS.
WHAT I WANTED TO ASK, IF THIS
WAS ONE OF THE CONSIDERATIONS,
LOOKING AT IMMIGRANTS STATUS AND
TIME FROM IMMIGRATION, FOR
EXAMPLE, HAVING A HIGHER
LIKELIHOOD OF MAYBE MEETING THE
RECOMMENDATIONS, FOR EXAMPLE,
THERE'S ALWAYS A COMPARISON OF
THOSE OF US THAT HAVE LIVED HERE
IN THE UNITED STATES, NOT
MEETING RECOMMENDATIONS AND
MAYBE -- WHAT I HEAR FROM MY
PATIENTS, FOR EXAMPLE, IS THAT
THEY STATE THAT ONCE THEY HAVE
LIVED HERE FOR A LONGER PERIOD
OF TIME THEY ARE LESS LIKELY TO,
LET'S SAY, DEAL WITH THAT OR
LESS LIKELY TO MEET
RECOMMENDATIONS, FOR EXAMPLE.
I DON'T KNOW IF THIS HAS BEEN
SOMETHING OF CONSIDERATION.
IT'S NOT SOMETHING WE
SPECIFICALLY THOUGHT ABOUT BUT
AS WE THINK ABOUT IMMIGRANT
STATUS THE TIME THAT WE'VE SPENT
HERE IN THE COUNTRY, SOMEONE
HERE THAT HAS LIVED MY WHOLE
LIFE IN THE UNITED STATES, I
DON'T HAVE THAT AS A COMPARISON
POINT BUT I HEAR IT FROM
PATIENTS THAT COME FROM VARIOUS
COUNTRIES THAT THEY -- YOU KNOW
ASSIMILATE U.S. DIET SO CURIOUS
IF THIS IS A CONSIDERATION.
>> SURE, YEAH, THAT'S A REALLY
GREAT POINT.
AND WE WERE ABLE TO BREAK DOWN
OUR LOOK AT THOSE ATIs AND
INTAKE.
WELL, I'M NOT SURE EXACTLY WHAT
WE WERE ABLE TO APPLY THIS TO
BUT WE DID CONSIDER COUNTRY OF
BIRTH AS ONE OF THOSE FACTORS
THAT WE SPLIT OUR DATA BY.
AND, YOU KNOW, WE -- IF MY
MEMORY SERVES ME I THINK WE --
THE VARIATION YOU SEE HERE IS
PROBABLY KIND OF LIKE ONE OF THE
HIGHLIGHTS IN COMPARISON TO SOME
OF THESE OTHER THINGS THAT WE
LOOKED AT.
SO, BUT, YEAH, I ALSO WANT TO
RECOGNIZE THAT OF COURSE WITHIN
EACH OF THESE RACE/ETHNIC GROUPS
THERE'S A TON OF VARIETY,
PERHAPS MORE, YOU KNOW, I DON'T
KNOW, BUT LIKE THERE COULD BE
MORE VARIATION THAN WE EVEN SEE
AMONG THESE MAJOR GROUPS.
SO THAT'S REALLY AN IMPORTANT
THING TO THINK ABOUT, I THINK.
>> THERESA?
>> QUICKLY ABOUT PROTEIN, YOU'VE
SHOWN TOTAL PROTEIN ADEQUACY,
THAT IS BASED ON PROTEIN FOOD
GROUPS, NOT BASED ON 8 GRAMS OF
PROTEIN PER KILOGRAM, WHAT IS IT
BASED ON?
THEREFORE HOW MANY SERVINGS A
DAY, HOW MANY SERVINGS A DAY.
ALL RIGHT.
I WANT TO CLARIFY THAT.
I SEE QUITE A PORTION OF THE
POPULATION REGARDLESS OF WHAT
SEGMENT OF THE POPULATION,
THERE'S QUITE A PORTION UNDER
THE RECOMMENDATION, I WANT TO
CLARIFY UNDER RECOMMENDATION
ISN'T NECESSARILY -- DOESN'T
MEAN PROTEIN INADEQUACY, MEANING
BELOW 8 GRAMS PER KILL OH GRAM
FOR ACULTS BECAUSE PROTEIN IS
BASED ON AMDRs RATHER THAN
RDA?
I WANT TO MAKE SURE, IT SAYS
INTAKE.
IS IT BOTH?
AND WITHIN VARIATION --
>> POSSIBLY THE PROTEIN COMES
FROM NON-PROTEIN FOOD GROUPS
TOO.
THAT'S WHAT WE'RE GETTING AT.
>> THEREFORE IT'S NOT --
>> CAN WE JUST ASK FOR
VERIFICATION FROM THE STAFF?
>> YEAH, SO WE LOOK AT BOTH AMDR
AND RDA FOR PROTEIN, YEAH.
SO BOTH.
BUT PROTEIN DOES COME FROM A LOT
OF FOOD GROUPS OUTSIDE PROTEIN
FOOD GROUPS AS DEE DEE AND
OTHERS DISCUSSED THIS MORNING.
>> THE NUMBER OF FOOD GROUPS NOT
NECESSARILY MEETING INADEQUATE
PROTEIN.
>> NOT NECESSARILY.
IT COULD.
>> THANK YOU.
THAT'S THE CLARIFICATION.
>> ONE MORE THING.
SORRY, THERESA.
WE DID LOOK AT ACTUALLY THE
NUTRIENT PROTEIN INTAKE BUT
DIDN'T SHOW THAT TODAY.
>> THERE'S SO MANY QUESTIONS.
WHAT I THINK WE'LL DO IS START
WITH CHERYL AND WE'LL JUST GO
DOWN THE TABLE AND IF PEOPLE
DON'T HAVE A QUESTION JUST SAY
NO COMMENT OR NO QUESTION.
AND THAT WAY EVERYBODY GETS
HEARD WHICH IS THE POINT OF THIS
DISCUSSION.
CHERYL, TAKE IT AWAY.
>> YOU PROMISED A LIVELY ENGAGED
DISCUSSION AND WE'RE DELIVERING
ON THAT.
I HAVE A COMMENT FIRST ABOUT THE
BEAUTIFUL SLIDES THAT YOU SHOWED
AROUND ATI.
I WANT TO LINK THAT TO WHAT WE
ALL KNOW FROM READING SCIENTIFIC
LITERATURE THAT THE ATI IS
LARGELY ASSOCIATED AND SOMETIMES
SHOWN TO BE CAUSAL WITH
OUTCOMES, HEALTH OUTCOMES.
AND SO LIKE THAT'S UNDERLYING
ALL OF THE THINGS THAT I'M
THINKING ABOUT, NOW THAT WE'VE
ACTUALLY SEEN IT IN FRONT OF US.
THE OTHER QUESTION THAT I HAVE
IS AROUND THE APPROACH TO DATA
ANALYSIS, WITH REGARDS TO
PROPORTION OF PEOPLE WHO ARE
MEETING GUIDELINES.
WE USE AT OR ABOVE AS THE CUT
POINT, FOR REFINED GRAINS IN
PARTICULAR THAT CAN BE A LITTLE
BIT TRICKY BECAUSE WE'RE NOT
SURE WHO IS AT OR ABOVE.
WHAT ARE CONSIDERATIONS LOOKING
ABOVE BECAUSE I THINK IT TELLS
US SOMETHING DIFFERENT THAN
LOOKING AT AT OR ABOVE TOGETHER.
>> YEAH, THAT'S A GREAT
QUESTION.
I WOULD SAY, YOU KNOW, THE GRAPH
THAT WE SHOWED TODAY, WE WANTED
TO KIND OF MAKE THEM ALL SIMILAR
TO JUST BE EASY TO CONVEY THOSE,
HOW WELL AS A PROPORTION OF
POPULATION IS DOING.
BUT WE DID ALSO LOOK AT THE
ACTUAL ESTIMATES OF WHERE THOSE
MARKERS ARE FOR, YOU KNOW, WHAT
THE MEAN INTAKE IS, AND THEN
WHAT THE DISTRIBUTION LOOKS LIKE
FOR, FOR EXAMPLE, FOR REFINED
GRAINS.
SO, I DON'T REMEMBER WHAT THOSE
ESTIMATES ARE RIGHT NOW, BUT,
YEAH, THERE CERTAINLY IS A
PROPORTION THAT IS EXCEEDING
WHAT WE SET AS MAKE HALF GRAINS,
WHOLE GRAINS, MAKE THE OTHER,
THE OTHER HALF CAN BE REFINED
GRAINS.
BUT, YEAH, IT IS IMPORTANT TO
CONSIDER THAT WHEN WE'RE THEN
INTEGRATING EVIDENCE ALL
TOGETHER AND WITH FOOD PATTERN
MODELING AND SYSTEMATIC REVIEWS
FOR WHERE WE NEED TO BE.
>> IT ALSO OCCURRED TO ME AS WE
WERE LOOKING AT NUTRIENTS OF
CONCERN FOR OVER AND
UNDERCONSUMPTION, AND MOST OF
THE FINDINGS RESONATE REALLY
WELL.
THE ONE THING THAT STUCK OUT FOR
ME WAS FOLATE IN PREGNANCY.
SO MY QUESTION -- IT LED ME TO
THE QUESTION WHAT ARE THE
SOURCES OF FOLATE FOR WOMEN,
BIRTHING PERSONS, PERSONS WHO
ARE PREGNANT, AND WHAT'S BEEN
THE IMPACT OF FORTIFICATION
BECAUSE I THINK FORTIFICATION IS
IN SOME OF THOSE PROBABLY
REFINED GRAIN PRODUCTS.
SO I'M HAVING THIS MENTAL
GYMNASTICS AROUND -- BECAUSE
FOLATE IN NATURAL SOURCE CAN
COME FROM DARK GREEN VEGGIES,
AND THEN WITH THE ATTEMPT TO
TAKE CARE OF BIRTH DEFECTS WITH
FORTIFIED FOODS WHAT ARE THE
CARRIERS OF FORTIFICATION AND
HOW DOES THAT LINK BACK TO THIS,
WHAT WE SEE AS PROPORTION OF
PEOPLE ABOVE CONSUMPTION FOR
REFINED GRAINS, I'D LIKE TO HEAR
MORE ABOUT WHAT'S HAPPENING IN
PREGNANT PEOPLE.
>> YEAH, I THINK PUTTING
TOGETHER THOSE TWO PIECES OF
DATA ARE IMPORTANT, AND I'M
PRETTY SURE WE DO HAVE
INFORMATION ON THE SOURCES OF
FOLATE IN THAT AGE GROUP.
AND SO IT HAS IMPORTANT, LIKE
YOU SAID, RAMIFICATIONS FOR ANY
KIND OF MODIFICATION WE MIGHT
THINK ABOUT FOR REFINED GRAINS,
FOR WHOLE GRAINS, AND I DON'T --
YEAH, PLEASE DO.
>> I THINK IT'S A GREAT
QUESTION, CHERYL.
AND WE HAD A LOT OF DISCUSSION
WITHIN THE COMMITTEE ABOUT THE
PROPORTION OF THE WHOLE AND
REFINED GRAINS WITHIN THE TOTAL
GRAINS AND WHAT HAPPENS IF YOU
ALTER THAT PROPORTION.
AND ONE CAN'T GO TO WHOLE GRAINS
AND NOT MAKE THE FOLATE STORY
WORSE.
SO, THERE WAS QUITE EXTENSIVE
ANALYSIS IN THAT QUESTION, AND
SOME OF IT NOT PRESENTED HERE,
BUT I KNOW THAT IT'S GOING TO BE
IN THAT SCIENTIFIC REPORT.
>> GREAT JOB.
LOVE SEEING THE DATA.
SO, ONE OF THE THINGS I WANTED
TO BRING UP, IT'S ALREADY BEEN
BROUGHT UP BY DEE DEE AND
CHERYL, BUT WITH THE ATI BEING
RELATIVELY LOW, I DON'T THINK
IT'S -- THERE'S A LOT OF
CRITICISM ABOUT DIETARY
GUIDELINES, I THINK THE
GUIDELINES ARE GOOD AND BASED ON
THE SCIENCE, IT'S A LOT IN THE
IMPLEMENTATION.
THERE'S NOTHING WE CAN DO IF
INDIVIDUAL PREFERENCES AND
KNOWLEDGE OF FOOD PREP AND THEN
JUST ALL OF THE ENVIRONMENTAL,
AND YOU CAN SEE THAT IN THE
POVERTY INCOME RATIO AND FOOD
INSECURITY, SO ACCESSIBILITY TO
FOODS, MESSAGING ENVIRONMENT,
ALL OF THAT.
SO I THINK THAT'S SOMETHING FOR
US TO CONTINUE TO KEEP TOP OF
MIND AND TALK ABOUT
IMPLEMENTING, HOW DO WE DO A
BETTER JOB ABOUT IMPLEMENTING
ALL THIS GOOD SCIENCE THAT WE
HAVE ACCESS TO.
THE SECOND COMMENT REAL QUICKLY,
I REALLY LOVE SEEING THE
BREAKDOWN OF THE DIFFERENT
CULTURAL PATTERNS AND WHERE THEY
MET THE GUIDELINES OR NOT FOR
THE DIFFERENT FOOD GROUPS.
AND SO I THINK WE HAVE A LOT TO
LEARN ABOUT HOW CAN WE
INCORPORATE THOSE FOODS THAT ARE
ALREADY IN THE ENVIRONMENT, AND
USE THAT TO OUR ADVANTAGE WHEN
WE'RE PLANNING MEALS AND LOOKING
AT FOOD PATTERNS GOING FORWARD.
SO KEEPING ALL OF THE GOOD KIND
OF ADHERENCE TO THE DIETARY
GUIDELINES AND THOSE DIFFERENT
CULTURAL GROUPS AND BUILDING ON
THAT.
ANYWAY, I THOUGHT THAT WAS
REALLY GREAT TO SEE AND KIND OF
FUN.
>> I ECHO THAT.
WE CAN HAVE A GOOD DISCUSSION
LATER.
TWO QUESTIONS.
SEEMS LIKE WE HAVE A SHORTFALL
OF KEY NUTRIENTS.
ONE IS ARE WE CONSIDERING OTHER
SOURCES LIKE SUPPLEMENTS, AND IF
WE'RE NOT THEN ARE WE SEEING AN
INCREASE IN NEURAL TUBAL
DEFECTS, ANEMIA, IN NUTRIENTS OF
CONCERN BECAUSE THEY ARE LOW AND
THEY HAVE BEEN LOW FOR A LONG
TIME SO ARE WE SEEING MORE
RICKETS AND ALL THESE NUTRIENTS?
>> SO DATA WE'RE BASING THESE
STATEMENTS ON IS JUST FROM
DIETARY SOURCES.
BUT, YEAH, RECOGNIZING
SUPPLEMENTS IS OF COURSE GOING
TO MAKE A DIFFERENCE, AND IT'S
GOING TO BE DIFFERENTIAL ACROSS
THOSE DIFFERENT SOCIOECONOMIC
GROUPS TOO.
LIKE THERE'S A DIFFERENT
PROPORTION THAT TAKES
SUPPLEMENTS BY INCOME LEVEL, FOR
EXAMPLE.
SO I THINK THAT'S AN IMPORTANT
PIECE TO KEEP IN MIND, BUT HERE
WE'RE FOCUSED ON THE DIET, AND
-- BUT, YEAH, AND THINKING HOW
THAT WILL RELATE TO HOW THE DATA
ANALYSIS WILL RELATE TO THOSE
OUTCOMES IS IMPORTANT.
AND I THINK THAT'S WHERE THE
SYSTEMATIC REVIEWS CAN COME IN
AND HELP US WITH MORE -- MAKING
THAT LEAP, LIKE EVIDENCE BEHIND
THAT.
BUT IF SOMEONE WANTS TO HELP
WITH CHRISTINA'S QUESTION.
>> WE LOVE THE FACT YOU TOOK ON
THE HARDEST QUESTION.
I DON'T THINK A DISCUSSION OF
DIETARY SUPPLEMENTS IS
APPROPRIATE HERE.
WE'RE TALKING ABOUT DIETARY
GUIDANCE.
GOOD POINT.
WE CAN PUT IT IN THE DISCUSSION,
BUT I DON'T THINK THIS IS A
CONVERSATION OR TOPIC THAT
WE'RE -- APPROPRIATE TO DISCUSS
HERE.
>> A QUICK ONE, YOU IN THE
NUTRIENT CONCERNS 6 TO 11 MONTHS
YOU INDICATE IRON.
IS VITAMIN D LISTED SEPARATELY,
ALL AGES, BIRTH ONWARD?
WE'VE HAD SOME DISCUSSIONS WITH
STAFF ABOUT THAT.
I JUST SAW 6 TO 11 MONTH
NUTRIENT CONCERN IRON, THE MORE
COMMONLY CONCERNED IS VITAMIN D,
IS IT LISTED SOMEWHERE?
>> THE FOUR NUTRIENTS WE NEED
MORE OF, D, CALCIUM, FIBER,
POTASSIUM, THOSE ARE NUTRIENTS
OF CONCERN FOR AGES 1 AND OLDER.
YEAH, WITH REGARD TO YOUR
QUESTION ABOUT VITAMIN D FOR
AGES 6 TO 12 --
>> ACTUALLY 0 TO 12.
>> 0 TO 12, WONDER, DANA, IF YOU
MIGHT BE ABLE TO HELP US
>> WE HAVE A SECTION ON VITAMIN
D FOR 6 TO 11 MONTHS, A SPECIAL
CHALLENGE, NOT A NUTRIENT OF
PUBLIC HEALTH CONCERN.
>> I JUST DON'T WANT ANYTHING TO
MAKE IT SOUND LIKE WE'RE GOING
AGAINST EVERY RECOMMENDATION FOR
PROVIDING VITAMIN D TO BABIES
BECAUSE YOU CANNOT GET IT FROM
BREAST MILK IN THE FIRST 12
MONTHS OF LIFE, CAN'T BE DONE.
THAT RECOMMENDATION ACTUALLY IS
FROM BIRTH ON WARD, THOUGH I
REALIZE WE DON'T DO DATA FROM
BIRTH TO 6 MONTHS BUT WE'LL LOOK
AT NUTRIENTS OF CONCERN AND IF
YOU LEAVE VITAMIN D OUT THAT MAY
BE MISLEADING OR CONFUSING.
>> MAZE
>> MAY I PROPOSE THIS IS A VERY
IMPORTANT POINT BECAUSE WE'RE
CONSIDERING ACROSS THE ENTIRE
LIFE CYCLE, I THINK THIS IS A
POINT THAT WOULD BE GREAT IN
DISCUSSION AND RECOMMENDATIONS
TO RECOMMENDATIONS.
>> YEAH, TO HIGHLIGHT WHAT DANA
SAID, WE HAVE THESE OTHER --
WHAT WE'VE SHOWN HERE ARE
HIGHLIGHTS.
SO THERE ARE NUTRIENTS OF PUBLIC
HEALTH CONCERN BUT WE ALSO HAVE
A LIST THAT'S SOMEWHAT LENGTHY
OF NUTRIENTS OF SPECIAL
CONSIDERATION, AND IT'S NOT JUST
FOR INFANTS BUT THERE'S SOME
OTHERS, AGE, SEX GROUPS,
NUTRIENTS OF SPECIAL
CONSIDERATION FOR.
SO, THAT IS ALL, YOU KNOW,
AVAILABLE AND WE'LL SHARE IT.
>> WE HAVE TIME FOR ONE MORE
QUESTION.
>> OKAY.
I'M GOING TO HAND IT OVER TO
CHRISTOPHER.
IT'S BECAUSE I OFFERED THE WHOLE
SIDE OF THE TABLE AN OPTION.
I'M TRYING TO FOLLOW --
>> WE NEED BALANCE HERE
>> OKAY, YOU'VE GOT THE FLOOR.
YOU'RE THE LAST QUESTION BECAUSE
WE'VE GOT ANOTHER SESSION.
>> AMAZING PRESENTATION.
IT'S JUST INCREDIBLE WE HAVE
THIS KIND OF DATA.
WHAT STRUCK ME IS FOOD
SECURE/INSECURE AND
POVERTY/INCOME RATIO, I EXPECTED
A BIGGER DIFFERENCE IS ATI
SCORES.
IS IT BECAUSE U.S. SAFETY NET
PROGRAMS ARE SO EFFECTIVE ARE
PEOPLE ARE ABLE TO ACHIEVE
ALMOST THE THE ATI SCORE BECAUF
RESOURCES, A SHOUT OUT TO
PROGRAM OR A DAMNING CASE OF
PEOPLE WITH RESOURCES ARE NOT
EATING VERY WELL AND IS THAT
BECAUSE OF EDUCATION AND CHOICE?
TODAY'S FOOD AVAILABILITY.
DEFAULT, FOOD AVAILABILITY, THAT
WE HAVE, EVEN FOR THOSE WITH
RESOURCES, DOESN'T ALLOW PEOPLE
TO EAT WELL.
I DON'T KNOW THAT THERE'S AN
ANSWER BUT THAT'S LOOKING AT THE
POVERTY/INCOME RATIO AND FOOD
INSECURITY DIFFERENTIALS BEING
SO SMALL REALLY MAKES ME THINK.
>> CAN I -- THAT'S A GREAT WAY
TO END THIS SESSION.
I WANT EVERYONE TO HOLD THAT FOR
THE INTEGRATION PIECE, AND LET'S
GO TO OUR NEXT SESSION BECAUSE
YOU FRAMED IT VERY NICELY,
CHRISTOPHER, OF COURSE, RIGHT?
SO I'M GOING TO HAND IT OVER TO
YOU NOW, CRISTINA.
>> NOW WE MOVE TO THE STRATEGIES
FOR INDIVIDUALS AND FAMILIES
RELATED TO DIET QUALITY AND
WEIGHT MANAGEMENT.
WE WILL DISCUSS SOME STRATEGIES
THAT WE'RE TALKING ABOUT
PREVIOUSLY, AND HOW TO IMPLEMENT
THIS HEALTHY DIETARY PATTERN AND
STAY IN CALORIE LIMITS.
WE HAVE SOME EXCITING STATEMENTS
TO SHOW AND CAN DISCUSS MORE IN
OUR INTRODUCTION.
INTEGRATION, SORRY.
NEXT SLIDE.
YOU PROBABLY KNOW US BY NOW.
AND NEXT, IN ADDITION TO WHAT
OTHERS HAVE SAID ABOUT THE
AMAZING WORK THE STAFF DOES FOR
US, I WANT TO HIGHLIGHT THAT
THEY KEEP TRACK OF ALL OF OUR
NOTES IN OUR DISCUSSIONS, TO
MAKE SURE WE CAN INTEGRATE
EVERYTHING SO I WOULD LIKE TO
REALLY THANK YOU FOR ALL THE
DETAILED DISCUSSIONS AND NOTES
YOU DO FOR US.
NEXT SLIDE.
WE HAD SOME PROGRESS MADE SINCE
LAST MEETING.
WE HAVE A FEW SYSTEMATIC REVIEWS
SENT TO PEER REVIEW.
THEY WERE DISCUSSED IN PREVIOUS
MEETINGS.
AND YOU CAN SEE WHEN THEY WERE
DISCUSSED, IN MEETING 4, MEETING
5, AND WE DID REVISE A
CONCLUSION STATEMENT BASED ON
PEER REVIEW AND ED WILL PRESENT
ON THAT.
SO TODAY WE'LL BE PRESENTING ON
THAT SMALL CHANGE AND ALSO
AILEEN WILL BE PRESENTING ON THE
EXCITING CONCLUSION STATEMENTS
ON PORTION SIZE AND ENERGY
INTAKE AND THEN FATIMA AND
ANGELA WILL PRESENT ON EVIDENCE
SCAN.
>> THANKS, YES, SO WE HAD ONE
UPDATE.
SO JUST AS A REMINDER, THE FULL
SYSTEMATIC REVIEW QUESTION,
INCLUDED MULTIPLE CATEGORIES OF
FREQUENCY OF MEALS, AND/OR
SNACKING SUCH AS BREAKFAST,
SNACKING, NUMBER OF EATING
OCCASIONS, YOU CAN SEE THE
SYNTHESIS AT THE BOTTOM OF THE
SLIDE THERE.
SO ALL OF THE CONCLUSION
STATEMENTS THAT ADDRESSED THIS
QUESTION WERE PRESENTED AT THE
FOURTH PUBLIC MEETING, SEEMS SO
LONG AGO.
SYSTEMATIC REVIEW UNDERWENT PEER
REVIEW, CON WAS ON THE
RELATIONSHIP BETWEEN BREAKFAST
CON SUMMINGS IN ADULTS AND TOTAL
ENERGY TAKE.
PREVIOUSLY, THIS SHOWS PREVIOUS
AND UPDATED.
PREVIOUSLY WE HAD CONCLUDED
BREAKFAST CONSUMPTION COMPARED
TO NO BREAKFAST CONSUMPTION IN
ADULT DOES NOT DECREASE TOTAL
ENERGY INTAKE.
THIS CONCLUSION STATEMENT IS
BASED ON EVIDENCE GRADED AS
LIMITED.
YOU CAN SEE THE BODY OF EVIDENCE
WAS MOSTLY RANDOMIZED TRIALS, 19
ARTICLES OVERALL, 18 RANDOMIZED
TRIALS, ONE PROSPECTIVE COHORT
STUDY.
NOW, AFTER PEER REVIEW AND
REVISITING THE EVIDENCE, AND
MANY DISCUSSIONS, THE CONCLUSION
WAS CHANGED, A NEW STATEMENT AS
YOU CAN SEE, CONCLUSION
STATEMENT COULD NOT BE DRAWN
ABOUT RELATIONSHIP BETWEEN
BREAKFAST CONSUMPTION AND TOTAL
ENERGY INTAKE BECAUSE OF
STANDING CONCERNS, CONSISTENCY
AND GENERALIZABILITY IN THE BODY
OF EVIDENCE.
THE AVAILABLE EVIDENCE
CONTRIBUTED MIXED RESULTS, AND
HAD MANY LIMITATIONS, INCLUDING
LACK OF DIVERSITY OF
POPULATIONS, DIFFERENT STUDY
DESIGNS, INTERVENTIONS,
DURATIONS, AS WELL AS DIVERSITY
AND ENERGY INTAKE ASSESSMENTS.
SO, JUST TO GIVE A LITTLE BIT
MORE BACKGROUND, REMEMBER THERE
WERE ABOUT 18 TRIALS.
NOW, THERE WAS A LOT OF
VARIATION IN THE METHODOLOGY,
BRIEFLY NINE TRIALS WERE
CONSIDERED SHORT, LESS THAN SIX
WEEKS.
SOME WERE MUCH LESS THAN SIX
WEEKS.
THESE GENERALLY -- I'M SORRY,
YEAH, NINE TRIALS REPORTED OF
THE SHORTER TRIALS, ACTUALLY
MOST OF THE TRIALS, EXCUSE ME,
WERE SHORT.
SO ALMOST ALL BUT TWO WERE
CONSIDERED SHORT.
AMONG SHORT TRIALS THERE'S A LOT
OF INCONSISTENCY BUT ROUGHLY
HALF REPORTED THOSE WHO CONSUMED
BREAKFAST CONSUMED MORE ENERGY
INTAKE SO BREAKFAST, MORE ENERGY
INTAKE.
BUT ABOUT HALF THE TRIALS ALSO
REPORTED NO DIFFERENCE IN ENERGY
INTAKE.
INCONSISTENCY BECAUSE THERE WERE
TWO LONGER TRIALS, THESE WERE 12
AND 14 WEEKS.
AND IN THOSE TRIALS THE RESULTS
WERE QUITE DIFFERENT.
THOSE WHO CONSUMED BREAKFAST HAD
LOWER ENERGY INTAKE.
SO BECAUSE OF THE INCONSISTENCY
OF THE TRIALS, ESPECIALLY BY --
AN DIRECTION AND DIFFERENCES BY
DURATION, ONLY TWO TRIALS OF
LONG DURATION, THE COMMITTEE,
SUBCOMMITTEE CONCLUDED
ADDITIONAL STANDARDIZED STUDIES
ARE NEEDED IN LARGER AND
PARTICULARLY LONGER-TERM TRIALS
IN ORDER TO ESTABLISH A
CONCLUSION STATEMENT FOR THIS
TOPIC.
SO THAT'S A SUMMARY.
HAPPY TO TAKE QUESTIONS.
>> FIRST OF ALL, I THINK THIS
EXAMPLE REALLY SPEAKS OUT --
SPEAKS TO THE VALUE OF PEER
REVIEW.
AND I JUST WANT TO THANK ON
BEHALF OF THE COMMITTEE THE
INDIVIDUALS WHO ARE CONDUCTING
PEER REVIEW OF OUR CONCLUSION
STATEMENTS.
THE QUALITY OF YOUR FEEDBACK IS
AMAZING.
AND WE KNOW IT TAKES TIME SO
THANK YOU.
I ALSO REALLY WANT TO COMMEND
THE WORKING GROUP FOR TAKING THE
FEEDBACK, GOING BACK,
RECONSIDERING, LOOKING AT IT IN
A DIFFERENT PERSPECTIVE, AND I
SEE THIS AS COURAGE TO SAY, YOU
KNOW, BASED ON PEER REVIEW,
REEVALUATION OF THE LITERATURE,
THE DATA, WE'RE GOING TO UPDATE
OUR CONCLUSION STATEMENT.
SO TO ME THIS IS JUST A
BEAUTIFUL EXAMPLE OF HOW THE
PROCESS IS WORKING.
SO THANK YOU.
>> WHAT WAS THE CRITERIA OF
INCLUSION FOR DURATION OF THE
RCT?
HOW MANY WEEKS MINIMUM?
>> I DON'T REMEMBER OFFHAND.
>> WE INCLUDED ANYTHING IN A HAD
AT LEAST 24 HOURS, ENERGY INTAKE
IN THE 24 HOURS, IF I'M NOT
MISTAKEN.
>> WE CAN HAVE STAFF RESPOND.
>> IS THERE ANY MORE CLARITY IF
YOU DROP OUT THE VERY SHORT-TERM
ONES OR WAS IT ONLY AT THE TWO
LONGER TERMS OR JUST A MIXED
BAG?
>> YEAH, SO CHRISTINA WAS
CORRECT, WE DIDN'T -- WE WERE
JUST LOOKING AT TOTAL DAILY SO
THEY DID HAVE TO HAVE A 24-HOUR
PERIOD BUT DIDN'T EXCLUDE FOOD
FOR DURATION.
THE NEXT QUESTION, REALLY ONLY
THOSE TWO THAT WERE OF LONGER
DURATION FOUND THAT, THAT
RELATIONSHIP IN THE OPPOSITE
DIRECTION.
AND SO IF YOU WERE TO DROP OUT
SHORTER TRIALS YOU WOULD HAVE
ONLY HAD THOSE TWO, THOSE TWO
TRIALS.
>> OTHER QUESTIONS?
TAKE IT AWAY.
WE CAN MOVE ON THEN TO THE NEXT.
SO I WANTED TO REMIND EVERYONE,
NOW WE'RE GOING TO TALK ABOUT
PORTION SIZE AND ENERGY INTAKE.
LAST MEETING WE REPORTED ON
PORTION SIZE AND GROWTH BODY
COMPOSITION AND OBESITY
OUTCOMES, AND IN SUMMARY WE
COULD NOT MAKE ANY CONCLUSION
STATEMENTS IN ANY OF THE LIFE
STAGES BECAUSE OF EITHER LACK OF
EVIDENCE, MOSTLY IN CHILDREN,
PREGNANCY AND POSTPARTUM, OR
INCONSISTENCY IN INTERVENTIONS,
COMPETITORS, OUTCOMES IN ADULTS.
NOW WE'LL SHIFT FROM GBCO,
GROWTH BODY COMPOSITION OBESITY
TO ENERGY INTAKE IN A LEAN ROLE,
REPORT ON THAT.
>> LET'S GET STARTED.
A QUICK REMINDER ABOUT US ON THE
ANALYTICAL FRAMEWORK FOR THE
QUESTION, RELATIONSHIP BETWEEN
PORTION SIZE AND ENERGY INTAKE,
SO WE EVALUATED EVIDENCE FOR ALL
AGE GROUPS FROM AGE 1 UP TO
OLDER ADULTS INCLUDING
INDIVIDUALS DURING PREGNANCY AND
POSTPARTUM.
THE INTERVENTION EXPOSURE WAS
DEFINED AS PORTION SIZE THAT
CONSIDERED ENERGY DENSITY,
NUTRIENT DENSITY, AND/OR THE
QUALITY OR TYPE OF FOOD SERVED
AS WELL AS PRE-PORTIONED FOODS.
THE OUTCOME WAS SAID TO BE
ENERGY INTAKE AND EACH STUDY
DEFINED IT WHICH COULD BE FOR
MEALS, SEVERAL MEALS, OR A DAY.
SO MOVING ON, WE DEVELOPED TWO
CONCLUSION STATEMENTS FOR
PORTION SIZE AND ENERGY INTAKE
IN CHILDREN.
THE FIRST CONCLUSION STATEMENT
IS SERVING LARGER PORTIONS OF
ENERGY DENSE FOODS INCREASES
ENERGY INTAKE IN CHILDREN.
THIS CONCLUSION STATEMENT IS
BASED ON EVIDENCE GRADED AT
STRONG, INCLUDING 27 ARTICLES
REPRESENTING 28 ESTIMATES.
SECOND CONCLUSION STATEMENT THAT
WE DEVELOPED IS SEARCHING LARGER
PORTIONS OF FRUITS AND
VEGETABLES INCREASES INTAKE OF
THOSE FOODS WITHOUT INCREASING
ENERGY INTAKE IN CHILDREN.
THIS CONCLUSION STATEMENT IS
BASED ON EVIDENCE GRADED AS
MODERATE.
AND INCLUDED SIX STUDIES.
THE BODY OF EVIDENCE FOR BOTH
CONCLUSION STATEMENTS WAS MOSTLY
FROM WITHIN SUBJECTIVE DESIGN
WITH CROSSOVER RANDOMIZED
CONTROLLED TRIALS.
EVIDENCE SUGGESTS LARGER PORTION
SIDE OF ENERGY DENSE FOOD
PROMOTES ENERGY INTAKE AS MEALS
AS WELL ADAILY ENERGY INTAKE
SEARCHING LARGER PROPORTION OF
VEGETABLES AND FRUIT MAY INTAKE
INTAKE WITHOUT EXERTING
APPRECIABLE EFFECT ON ENERGY
INTAKE.
GRATING ELEMENTS WERE GENERAL
SIMILAR, STUDIES DIRECT,
FINDINGS CONSISTENT, MINOR
CONCERNS WITH PRECISION AND RISK
ADVISED GENERALLY LOW BECAUSE OF
USE OF RANDOMIZED CONTROLLED
TRIAL DESIGN.
THERE WAS CONCERN ABOUT
GENERALIZABILITY TO LACK OF
DIVERSITY FOR STUDY PARTICIPANTS
WITH REGARDS TO RACE AND
ETHNICITY AND SOCIOECONOMIC
POSITION.
AND MOVING TO YOUNG CHILDREN AND
ADULTS, FOR THEM CONCLUSION
STATEMENT COULD NOT BE DRAWN
ABOUT RELATIONSHIP BETWEEN
PORTION SIZE AND ENERGY INTAKE
BECAUSE THERE WAS NO STUDY
AVAILABLE.
SO FOR ADULTS AND OLDER ADULTS
THE COMMITTEE WAS ABLE TO DRAW
TWO STATEMENTS REGARDING PORTION
SIZE AND ENERGY INTAKE, FIRST IS
SEARCHING LARGER PORTIONS OF
FOOD INCREASES ENERGY AND FOOD
INTAKE IN ADULTS, OLDER ADULT,
THIS CONCLUSION STATEMENT IS
BASED ON EVIDENCE GRADED AS
STRONG, INCLUDINGELED 44
ARTICLES.
PORTION SIZE ANDS ENERGY DENSITY
ARE INDEPENDENT AND ADDITIVE IN
EFFECTS ON ENERGY INTAKE IN
ADULTS AND OLDER ADULTS.
AND THIS CONCLUSION STATEMENT IS
BASED ON EVIDENCE CREATED AS
MODERATE, INCLUDED FIVE ARTICLES
COMPRISING SIX INTERVENTIONS.
THERE WERE A FEW CONCERNS WITH
CONSISTENCY, PRECISION,
DIRECTNESS FOR BOTH.
BECAUSE THEY USED SIMILAR
DESIGNS AND METHODS AS WELL AS
DEMONSTRATING CONSISTENT
DIRECTION AND MAGNITUDE OF
EFFECT.
STUDIES WERE SUFFICIENTLY
POWERED, AND DIRECTLY DESIGNED
TO EXAMINE EFFECT OF PORTION
SIZE AND ENERGY DENSITY OR
ENERGY INTAKE.
THERE WERE SOME CONCERNS WITH
RISK OF BIAS DUE TO A LACK OF
INFORMATION ABOUT RANDOMIZATION
METHODS AND POTENTIAL FOR
SELECTIVE REPORTING OF ARESULTS,
SEVERAL CONCERNS WITH
GENERALIZABILITY DUE TO LACK OF
DIVERSITY OF STUDY PARTICIPANTS
AS MENTIONED, ON THE OTHER
STATEMENTS AS WELL.
MOVING ON TO THE INDIVIDUAL
DURING PREGNANCY AND POSTPARTUM
CONCLUSION STATEMENT COULD NOT
BE DRAWN ABOUT RELATIONSHIP
BETWEEN PORTION SIZE AND ENERGY
INTAKE BECAUSE THERE'S NO
EVIDENCE AVAILABLE.
THERE WAS NO ARTICLES FOUND FOR
THESE LIFE STAGES.
SO, LET'S MOVE ON TO THE OTHER
PART OF THE PORTION SIZE
INTERVENTION AND EXPOSURE THAT
WE LOOKED AT SO WE EXAMINED THE
PRE-PORTIONED FOODS AND ENERGY
INTAKE IN YOUNG CHILDREN,
CHILDREN AND ADULTS.
HERE CONCLUSION STATEMENT COULD
NOT BE DRAWN BECAUSE THERE'S NOT
ENOUGH EVIDENCE AVAILABLE.
WE FOUND ONLY ONE STUDY THAT WAS
PARALLEL RANDOMIZED CONTROLLED
TRIAL AND SO WE COULDN'T ANSWER
THIS QUESTION.
HOWEVER, IN ADULTS AND OLDER
ADULTS WE WERE ABLE TO DRAW A
CONCLUSION STATEMENT THAT STATES
THAT SEARCHING FOODS AS SMALLER
DEPREESED AMOUNTS MAY DECREASE
ENERGY INTAKE, INCLUDED EIGHT
ARTICLES.
THERE WERE A FEW CONCERNS WITH
DIRECTNESS.
THERE WERE SOME CONCERNS RELATED
TO CONSISTENCY FOR VARIED EFFECT
SIZE, FOR PRECISION WITH SMALL
SIZE OF STUDY GROUPS AND
VARIANTS IN EFFECT ESTIMATE,
RISK OF BIAS BECAUSE OF LACK OF
INFORMATION ABOUT RANDOMIZATION
METHOD AND POTENTIAL FOR
SELECTIVE REPORTING OF RESULTS.
SEVERAL CONCERNS RELATED TO
GENERALIZABLE THAT WE'VE NOTED.
MOVING TO THE INDIVIDUALS DURING
PREGNANCY AND POSTPARTUM, WE
DIDN'T FIND ANY STUDIES THAT
LOOKED AT PRE-PORTIONED FOODS
AND ENERGY INTAKE AND MET
INCLUSION CRITERIA SO WE
COULDN'T DRAW CONCLUSION
STATEMENT.
AND WITH THAT I'LL PASS IT TO
CRISTINA.
>> CAN WE GO BACK?
LET'S HAVE QUESTIONS BEFORE WE
MOVE TO THE NEXT VERY DIFFERENT.
DEE DEE?
>> YEAH, I WAS CURIOUS ABOUT THE
CONCLUSION STATEMENT THAT WAS
GRADED STRONG FOR ENERGY DENSE
FOODS BEING AVAILABLE IN LARGER
PORTIONS AND CALORIE INTAKE.
I BELIEVE THAT WAS AMONG KIDS.
LIKE A THIRD OF THE WAY THROUGH
THE SLIDES MAYBE.
>> CAN YOU GO BACK?
>> LET US KNOW WHICH ONE.
>> NOPE.
ONE MORE BACK.
THERE YOU GO.
>> HERE.
>> OKAY.
THAT'S A LOT OF RCTs AND
EXPERIMENTAL EVIDENCE, I'M
CURIOUS WHAT ENERGY-DENSE FOODS
MEANT OR INCLUDED?
TYPICALLY THOSE ARE YOUR ULTRA
PROCESSED FOODS BUT I DON'T KNOW
IF THAT WAS TERMINOLOGY OR THEY
DESCRIBED WHAT ENERGY-DENSE
FOODS MEANT, DO YOU REMEMBER?
>> I CAN JUMP IN.
I ALSO WANT TO ACKNOWLEDGE DR.
REENER ON THE ZOOM HAS EXPERTISE
AND CAN JUMP IN AS WELL.
IT STEMMED FROM THE FACT THAT
INITIALLY EVALUATING THE BODY OF
EVIDENCE IT WAS QUITE CLEAR THE
EARLY STUDIES WERE FOCUSED ON
ASPECTS OF OUR DIETARY
ENVIRONMENTS THAT MIGHT PROMOTE
EXCESSIVE INTAKES SO THEY WERE
DESIGNED SPECIFICALLY FROM A
FRAMEWORK OF, YOU KNOW, LOOKING
AT EXCESSIVE INTAKES, AS WORK
EVOLVED THEY BEGAN TO SUGGEST
STRATEGIES COULD BE USE FOR
INTAKES OF OTHER HEALTHFUL FOODS
AND SO WITHOUT SPECIFIC
DEFINITIONS OF ENERGY DENSITY IN
THESE STUDIES YOU COULD SEE THE
WORK BROADLY FELL INTO THOSE
AREAS, AND SO WE I THINK,
CORRECT ME IF YOU REMEMBER IT
DIFFERENTLY, SO WE CHOSE TO
SYNTHESIZE THE EVIDENCE
REFLECTING DESIGNS OF THOSE
STUDIES BUT NOT WITH SPECIFIC
DEFINITION IN MIND.
INITIAL STUDIES LOOKED AT THINGS
LIKE A PASTA ENTREE OR MAC AND
CHEESE, RIGHT?
IN YOUNG KIDS, MANY STUDIES DID,
WHEREAS LATER STUDIES WOULD LOOK
AT MANIPULATING THE PORTION
SIZES OF THINGS LIKE BROCCOLI
AND CARROTS.
>> SO THAT'S THE DECISION HERE.
>> YES.
>> SO ENERGY DENSE FOODS WAS
THINGS LIKE MAC AND CHEESE, NOT
--
>> WELL, I THINK THERE WAS A
VARIETY.
WE TOOK ALL THE FOODS THAT WERE
PART OF THE INTERVENTION, SO I
DON'T THINK -- AND THE
PREPARATION OF THE FOODS WERE
NOT AVAILABLE SO I DON'T THINK
WE CAN MAKE THE ASSUMPTION THAT
YOU MADE EARLIER.
IT'S TRULY MORE ENERGY DENSE
VERSUS NUTRIENT DENSE FOODS.
IT'S DIFFERENT.
>> INDIVIDUAL TRIALS VARIED IN
WHAT ENERGY DENSE FOOD WERE,
LARGER PORTION, MORE CALLY
INTAKES, FRUITS AND VEGETABLES,
DID NOT EQUAL MORE CALORIE
INTAKE.
>> THEY DID NOT INCREASE CALORIC
INTAKE BUT DID INCREASE AMOUNT
OF FOOD EATEN SO WE FEEL LIKE
THAT'S A REALLY IMPORTANT
STRATEGY TO DIFFERENTIATE ENERGY
DENSE FOODS, VEGETABLES AND
FRUITS, ONE MAY WANT TO REDUCE
PORTION SIDE, IN THE OTHER WE
MAY USE PORTION SIZE TO INCREASE
INTAKE.
>> EXACTLY, THANK YOU.
>> WE THINK IT'S A GREAT
STRATEGY FOR THE COMMITTEE TO
GIVE AND INTEGRATE WITH
EVERYTHING ELSE WE'LL BE
DISCUSSING NEXT DAY, TOMORROW.
SO WE'RE VERY EXCITED ABOUT
THAT.
OKAY.
MOVING ON TO -- GREAT, HERE.
SO WE'RE GOING TO MOVE TO THE
EVIDENCE SCAN, WE'VE BEEN
TALKING ABOUT THIS THROUGH THE
BEGINNING, WE COULD NOT DO A
SYSTEMATIC REVIEW BECAUSE WE
WERE NOT CLEAR ABOUT THE
OUTCOMES, AND YOU'LL SEE WHY.
FATIMA AND ANGELA ARE THE
PRESENTERS.
WE'LL POINT THIS OUT AGAIN.
I'LL REPEAT HERE.
THIS MAY NOT REPRESENT THE
ENTIRE ABSOLUTE NUMBER OF
PUBLISHED STUDIES.
WE -- THERE WERE SHOWERS OF
RECORDS IN THE PRE-SCREENING,
AND A LARGE AMOUNT MADE IT TO
THE EVIDENCE SCAN BUT WE WE WILL
DESCRIBE THIS MORE BUT WE WANT
TO BE CAUTIOUS, THERE COULD BE
OTHER STUDIES OUT THERE THEY
WERE NOT CAPTURED IN OUR SEARCH
THAT DID NOT MEET EXACTLY OUR
SEARCH CRITERIA.
SO WITH THAT IN MIND PLEASE,
FATIMA.
>> ABSOLUTELY.
NEXT SLIDE PLEASE.
>> LET'S LOOK AT ROLE OF
EVIDENCE SCAN IN DIETARY
GUIDELINES WORK.
WE HEARD THIS IDEA OF EVIDENCE
SCAN, EXPLORATORY EVIDENCE
DESCRIPTION PROJECT, SYSTEMATIC
METHODS DESCRIBE THE FOLLOW AND
CHARACTERISTICS OF EVIDENCE
AVAILABLE ON NUTRITION QUESTION
OR TOPIC OF PUBLIC HEALTH
IMPORTANCE.
DR. EICHER-MILLER REFERRED TO
THE SCAN EARLIER TODAY AND WE
KNOW THIS CAN PLAY AN IMPORTANT
SUPPLEMENTARY ROLE ALONGSIDE
SYSTEMATIC REVIEWS.
LET'S LOOK AT THE RATIONALE FOR
CULTURALLY TAILORED DIETARY
INTERVENTIONS IN TERMS OF
LOOKING AT THIS WITH EVIDENCE
SCAN.
INTERVENTION STUDIES DO
DEMONSTRATE APPROACHES FOR
TAILORING RECOMMENDATIONS FOR
CULTURAL GROUPS AND COMMUNITIES,
PARTICULARLY HERE IN THE UNITED
STATES WHETHER WE HAVE A VERY
HETEROGENEOUS POPULATION.
THIS INFORMATION IS IMPORTANT
FOR UNDERSTANDING IMPLEMENTATION
STRATEGIES ALIGNED WITH DIETARY
GUIDELINES FOR AMERICANS.
WHEN WE LOOK AT 2020 TO 2025
DIETARY GUIDELINE
RECOMMENDATIONS FOR AMERICANS,
SPECIFIC QUOTE THAT COMES OUT IS
CUSTOMIZE AND ENJOY NUTRIENT
DENSE FOOD AND BEVERAGE CHOICES
TO REFLECT PERSONAL PREFERENCES,
CULTURAL TRADITION AND BUDGETARY
CONSIDERATIONS.
WHEN WE LOOK AT THIS DEFINITION
OF CULTURE IT'S DEFINED HERE AS
SHARED VALUES, NORMS, CODES,
THAT COLLECTIVELY SHAPE A
GROUP'S BELIEFS, ATTITUDES,
BEHAVIOR THROUGH INTERACTION IN
AND WITH THEIR ENVIRONMENT.
NEXT SLIDE PLEASE.
NOW WHEN WE LOOK AT THIS
ANALYTIC FRAMEWORK THIS QUESTION
WAS POSED, WHAT EVIDENCE HAS
BEEN PUBLISHED ON THE
RELATIONSHIP BETWEEN
INTERVENTIONS AND DIET-RELATED
PSYCHOASSOCIATE FACTORS, INTAKE,
QUALITY AND HEALTH OUTCOMES.
WE'RE LOOKING ACROSS THE AGE
SPECTRUM FROM 2 TO 19 YEARS OF
AGE, ADULTS AND OLDER ADULTS,
INDIVIDUALS DURING THE PREGNANCY
AND POSTPARTUM YEARS.
YOU CAN SEE INTERVENTIONS HERE
LOOKING AT CULTURALLY TAILORED,
MODIFIED, ADAPTED TO AT ALTERED
INTAKE, OUTCOMES, DIET RELATED
PSYCHOSOCIAL FACTORS INCLUDING
NORMS, ATTITUDES, VALUES,
SELF-EFFICACY.
LOOKING AT DIETARY INTAKE
QUALITY, ENERGY INTAKE, RISK OF
CARDIOVASCULAR DISEASE, RISK OF
TYPE 2 DIABETES, BODY COMP
SITUATION AND OBESITY, INTAKE,
QUALITY INTAKE AS DESCRIBED
ABOVE, PREGNANCY AND
POSTPARTUM-RELATED WEIGHT
CHANGE.
NEXT SLIDE.
NOW WHEN WE LOOK AT, THIS GETS
TO WHAT WAS PREVIOUSLY DESCRIBED
BY DR. PALACIOS, TALKED ABOUT
THE FULL SCAN, WE HAD A LOT OF
ARTICLES INITIALLY PULLED OUT
BUT WHEN WE GOT DOWN TO WHAT
REALLY CAME OUT IN THE SCAN IT
CAME OUT TO 178 TOTAL ARTICLES,
COUNTRY OF ORIGIN, PREDOMINANTLY
FOR THE UNITED STATES, 6 FROM
CANADA.
WITH REGARDS TO INTERVENTION
DURATION, SINGLE SESSION TO FIVE
YEARS, ANALYTIC SAMPLE SHOWING
FROM N OF 20 PEOPLE BUT TO OVER
4,000 INDIVIDUALS.
WITH REGARDS TO RANDOMIZED
CONTROLLED TRIALS TO CLUSTER
STUDIES, 52 ARTICLES
REPRESENTING 29% OF THOSE 178
ARTICLES, NON-RANDOMIZED CONTROL
TRIALS, 22%, AND IF YOU LOOK AT
THAT ABOUT HALF OF THE STUDIES
ARE RCT PARALLEL STUDIES
REPRESENTING 87 OF THE ARTICLES
OF THAT 178.
NEXT SLIDE PLEASE.
NOW WHEN WE LOOK AT ARTICLES
PUBLISHED BY YEAR WE'RE TAKING
BACK TO 1985, BACK TO THE
'80s, AND BRING US BACK TO
2023, YOU CAN SEE VERY FEW WERE
PUBLISHED IN THE EARLIER YEARS,
VERY FEW, ONE, THREE, AND THREE,
MOVING INTO THE 2000s WE GET
INTO 13, 29, A LARGE BULK
PRESENTED OR PUBLISHED BETWEEN
2011 AND 2023.
LOOK AS WE'RE MOVING INTO THE
PANDEMIC YEARS, 2016 TO 2020,
53, AND 28 BEING PUBLISHED IN
THOSE PANDEMIC YEARS.
ARTICLES BY GENDER BREAK DOWN,
NOT REPORTED, ONLY ONE.
MALES THAT ARE CHILDREN, ONE.
MALES BY ITSELF, ONE.
SORRY, YOU GUYS, WE DON'T JUST
LIKE THIS, THOSE REPORTS.
FEMALES 3, BY ITSELF 45, MALE
AND FEMALE STUDIES YOU CAN SEE
LARGE MAJORITY OF THOSE BEING
REPORTED WITH BOTH GENDERS IN
THE STUDIES.
NEXT SLIDE PLEASE.
NOW LET'S LOOK AT THE EVIDENCE
SCAN BY OUTCOMES OF INTEREST.
YOU'LL NOTICE A LARGE MAJORITY
OF THESE ARE GROWTH BODY
COMPOSITION AND RISK OF OBESITY.
THIS IS WHAT REPRESENT A LARGE
MAJORITY OF THOSE, 178 ARTICLES
THAT WE TALKED ABOUT.
THE NEXT MOST FAVORED IS DIETARY
INTAKE, FOLLOWED BY RISK OF
CARDIOVASCULAR DISEASE,
PSYCHOSOCIAL FACTORS, DIABETES,
POSTPARTUM WEIGHT CHANGE, TERMS
OF OUTCOMES OF INTEREST.
ARTICLES BY RACIAL AND/OR ETHNC
GROUPS, LOOK AT THE LARGE
NUMBER, BLACK, AFRICAN AMERICAN,
AFRICAN DESCENT REPRESENTING THE
LARGEST NUMBER OF ARTICLES.
WHEN YOU LOOK HERE AT OUR
FURTHEST PORTION ON THE SLIDE IF
WE GO TO THE LEFT SIDE OF THE
SLIDE YOU CAN SEE MORE THAN 90%
OF PARTICIPANTS ARE FROM THAT
RACIAL/ETHNIC GROUP, 64 ARTICLES
REPRESENTED.
GETTING INTO THE LIGHT BLUE, 20
TO 49, FOR EXAMPLE, NINE OF
THOSE ARE IN THAT SUBSET.
WE COME FURTHER TO THE RIGHT,
HISPANIC OR LATINO, REPRESENTING
THAT NEXT MOST COMMON GROUP.
GETTING INTO OUR NATIVE GROUPS,
AMERICAN INDIAN, ALASKA NATIVE
OR INDIGENOUS, AND WHITE, ASIAN,
OTHER, SMALLEST BEING NATIVE
HAWAIIANS, PACIFIC ISLANDERS.
WE THOUGHT THIS WAS AN IMPORTANT
CONCEPT TO GET INTO, I WANT YOU
TO NOTICE THE PURPLE RECOMMENDS
HIGH COMMUNITY INVOLVEMENT.
HOW INVOLVED WAS THE COMMUNITY
IN THE INTERVENTION DESIGN?
WE'LL MOVE FROM 1985 AGAIN OVER
TO 2023, RECOGNIZING THAT THE
LARGEST SUBSET OF GROUP WAS
REPRESENTED BY 2016 TO 2020.
IN THE 2020 GROUP NOTICING THERE
WAS HIGH COMMUNITY INVOLVEMENT,
PARTICULARLY 29 STUDIES, 29
ARTICLES BEING REPRESENTED, HIGH
COMMUNITY INVOLVEMENT, LESSER AS
WE GO DOWN INTO THAT ORANGE,
ORANGE BEING REPRESENTED BY SOME
COMMUNITY INVOLVEMENT BUT
NOTICING THEY WERE TRYING TO
INVOLVE THE COMMUNITY IN THE
INTERVENTION DESIGN.
IF WE GO TO THE LAST SLIDE I'LL
PRESENT BEFORE HANDING IT OVER
TO MY PARTNER IN CRIME, I WANT
TO TALK ABOUT ARTICLES BY
OUTCOME AND LEVEL OF COMMUNITY
INVOLVEMENT AND WE'LL LOOK AT
THOSE MAJOR GROUPS THAT ARE
PRESENTED HERE, THE LARGEST
GROUP IS GROWTH BODY
COMPOSITION, HIGH
SOME, NOT REPORTED, LARGER
BLOCKS REPRESENT HIGHEST LEVEL
OF COMMUNITY INVOLVEMENT, DOWN
TO THE SMALLEST GROUP, WHICH IS
THAT POSTPARTUM WEIGHT CHANGE.
THIS IS A GREAT VISUAL SLIDE SO
YOU CAN SEE THAT AS WE GO
FURTHER TO THE RIGHT WE HAVE
LESS OUTCOME AND LEVEL OF
COMMUNITY INVOLVEMENT AS WE GO
TO THE RIGHT.
AND THEN I WANT TO TURN IT OVER
TO MY CO-LEAD HERE.
>> NEXT SLIDE.
THANK YOU, FOR THE EVIDENCE SCAN
IT WAS REALLY IMPORTANT THAT WE
USE SOME TYPE OF FRAMEWORK SO WE
WOULD HAVE CONSISTENCY ACROSS
THE WAY THAT WE CATEGORIZE THE
CULTURAL TAILORING, SO PART OF
THIS IS REALLY THINKING MORE
ABOUT CULTURAL RESPONSIVE
INTERVENTIONS, WHETHER THEY BE
MORE TARGETED, AND WE'LL TALK
MORE ABOUT THAT LATER, VERSUS
INDIVIDUALLY TAILORED.
SO LIKE COMMUNITY TARGETED,
THINKING ABOUT MAYBE TAILORED AT
THE INDIVIDUAL LEVEL, SO WE DREW
ON TWO APPROACHES AND
CLASSIFICATION SIS TESSMENTS
FIRST FROM KRUEGER AND
COLLEAGUES, THAT PROVIDES
OVERVIEW OF FIVE STRATEGIES AND
APPROACHES.
FIRST IS PERIPHERAL.
SO WHERE INTERVENTIONS SEEK TO
GIVE PROGRAMS OR MATERIALS
APPEARANCE OF CULTURAL
APPROPRIATENESS PACKAGING IN A
WAY THAT IS PERCEIVED THAT IT
WILL APPEAL TO CERTAIN GROUPS,
THE GROUPS THAT ARE BEING
INVOLVED IN THE INTERVENTION.
THERE'S EVIDENTIAL, LINGUISTIC
IS COMMON, SEEKING TO MAKE
MATERIALS ACCESSIBLE, MAKING
SURE INFORMATION WAS PROVIDED IN
DOMINANT OR NATIVE LANGUAGE OF
THAT GROUP.
THIS COULD INCLUDE LANGUAGE IN
TRADITIONAL SENSE OR TERMINOLOGY
THAT MIGHT BE COMMON IN A
SPECIFIC CULTURAL GROUP.
AND CONSTITUENT INVOLVING, SO
INCLUDING MEMBERS, AS WE TALKED
ABOUT, TARGET COMMUNITY OR
TARGET GROUP.
AND SOCIOCULTURAL, HEALTH ISSUES
DISCUSSED IN CONTEXT OF BROADER
SOCIAL AND CULTURAL VALUES OF
THAT INTENDED AUDIENCE.
NEXT SLIDE.
SO, SOME EXAMPLES OF PERIPHERAL
THINGS LIKE COLORS, IMAGES,
FONTS, PHOTOS, MUSIC, WE KNOW
THOSE INTERVENTIONS THAT REALLY
ARE DESIGNED TO RESONATE WITH
SOME OF THOSE PERIPHERAL FACTORS
OF THE TARGET GROUPS, OR
INCLUDING EPIDEMIOLOGIC EVIDENCE
OF A DIFFERENT POPULATION.
KEY FOCUS ON TRANSLATION OF
INTERVENTION MATERIALS,
INCLUDING BILINGUAL RESEARCH
STAFF OR THOSE THAT ARE
DELIVERING THE INTERVENTION,
INCLUDING COMMUNITY MEMBERS,
EITHER THROUGH FORMATIVE DATA OR
PART OF INTERVENTION TEAMS
INVOLVED IN THE PLANNING OR
IMPLEMENTATION OF THE
INTERVENTION.
AND THEN SOCIOCULTURAL FACTORS
LIKE COOKING METHODS,
TRADITIONAL FOODS, SPIRITUAL
MESSAGES, RELIGIOSITY, SOCIAL
SUPPORT, SOCIAL CIRCLES, AND
FAMILY-CENTERED INTERVENTIONS
THAT MAY EMPHASIZE A CERTAIN
TYPE OF FAMILY STRUCTURE OR
STRUCTURAL HIERARCHY WITHIN
FAMILIES OR FAMILY ROLES.
NEXT SLIDE.
SO WE COMBINED THIS WITH ANOTHER
TYPE OF FRAMING AROUND
DIMENSIONS OF CULTURAL
SENSITIVITY USING REFERENCE FROM
RESNICOW AND COLLEAGUES, DRAWING
ON HISTORY FROM CULTURAL STUDIES
AS WELL AS LINGUISTIC STUDIES TO
THINK ABOUT SURFACE STRUCTURE
VERSUS DEEP STRUCTURE, SURFACE
STRUCTURE, OBSERVABLE OR
SUPERFICIAL LIKE AS WE MENTIONED
KIND OF SIMILAR TO PERIPHERAL
STRATEGY, LIKE AUDIO AND VISUAL
MATERIALS, CHANNEL SETTINGS,
THAT ARE PERCEIVED TO BE
CULTURALLY APPROPRIATE WHEN IT
COMES TO INTERVENTION DELIVERY.
AND THEN ALSO DEEP STRUCTURE.
SO THOSE THINGS THAT ARE LINKED
TO MORE UNDERSTANDING OF A
CULTURE, HISTORY, ENVIRONMENTAL
AND PSYCHOSOCIAL FORCES, THAT
INFLUENCE A TARGET HEALTH
BEHAVIOR, IN THIS CASE DIET IN A
TARGET POPULATION.
SO, THINGS LIKE RELIGION, AGAIN
THERE'S SOME OVERLAP BETWEEN THE
TWO RUBRICS, FAMILY AND SOCIETY,
ECONOMICS, THAT MAY INFLUENCE
BEHAVIORS.
NEXT SLIDE.
SO I'M GOING TO TURN IT BACK
OVER TO MY COLLEAGUE.
>> ABSOLUTELY.
SO AS YOU CAN SEE HERE WHEN WE
LOOKED ACROSS OUR EVIDENCE SCAN,
WHEN WE LOOKED AT THOSE STUDIES
THAT WE TALKED ABOUT, WHEN WE
LOOKED AT THE THINGS THAT WE
JUST PRESENTED, WE CAN SEE
THERE'S A SPREAD OF THESE
PARTICULAR THINGS WHEN WE LOOKED
AT PERIPHERAL, YOU CAN SEE
THERE'S SOME PERIPHERAL STUDIES,
A VERY SMALL NUMBER OF THESE
WERE EVIDENTIAL, SOME
LINGUISTIC, CONSTITUENT
INVOLVING, AND SOCIAL CULTURAL.
YOU CAN SEE WHETHER THESE ARE
SURFACE STRUCTURE, DEEP, OR
SURFACE AND DEEP STRUCTURE.
WHEN YOU SEE THE LAYERING
BETWEEN THOSE, YOU CAN SEE THAT.
NEXT SLIDE PLEASE.
THESE LAYERS AND BUBBLED, WE
TALKED ABOUT WHETHER THEY ARE
GBCO, OR POSTPARTUM WEIGHT, AND
YOU CAN SEE HOW THESE FALL OUT
BY WHETHER OR NOT THESE ARE
SOCIAL, CULTURAL, CONSTITUENT
STROVING, -- INVOLVING, THOSE E
LARGER, PERIPHERAL NOTICING THEY
ARE LARGER AT THE BOTTOM,
EVIDENTIAL ARE NOT AS PROMINENT
IN THIS SLIDE, THINGS THAT WE
CAN TAKE NOTES OF AS WE THINK
ABOUT THESE FURTHER.
NEXT SLIDE PLEASE.
HERE'S AN EVIDENCE SCAN EXAMPLE,
JUST ONE OF THE PARTICULAR
ARTICLES, I WON'T SPEND A LOT OF
TIME HERE.
THIS IS A VERY -- YOU CAN SEE
IT'S A DENSE SLIDE, A PARTICULAR
ARTICLE FROM KWON 2022, A KOREAN
AMERICAN ARTICLE LOOKING AT
ADULTS IDENTIFIED AS RISK FOR
DIABETES IN THE METROPOLITAN NEW
YORK CITY AREA, INTERVENTION
STRATEGY.
IF YOU LOOK AT THIS FROM
PERIPHERAL PERSPECTIVE, USING
TYPICALLY KOREAN FOODS, THAT'S
THE SURFACE STRUCTURE.
FROM THE EVIDENTIAL, DIABETES
PREVENTION SESSIONS, CONCLUDED
DISCUSSION OF DIABETES
PREVALENCE, INCREASED RISK OF
DIABETES IN ASIAN AMERICAN
COMMUNITIES, LOOKS AT
EXPLANATION OF BMI, AT-RISK BMI,
DISPELLING MISCONCEPTION,
DEVELOPED IN ENGLISH, TRANSLATED
AND REVIEWS.
TOPICS TRANSLATED INTO KOREAN,
CLIP -- WHAT ABOUT DEEP
STRUCTURE?
COALITION OF COMMUNITY PARTNERS,
RESEARCHERS, HEALTHCARE, WE
DON'T LIKE PROVIDERS SOMETIMES
BUT CLINICIANS, COMMUNITY HEALTH
WORKES, ENGAGED AS ACTIVE AND
EQUAL PARTNERS IN RESEARCH
PROCESS, THAT'S A DEEPER
STRUCTURE.
COMMUNITY HEALTH WORKERS AND
STAFF, KOREAN AMERICANS SERVE ON
COMMUNITY-BASED ORGANIZATIONS,
ACTIVE MEMBERS AT COALITION,
SOURCE OF COMMUNITY KNOWLEDGE,
PROVIDING INPUT AND GUIDANCE,
AGAIN DEEP STRUCTURE.
INTERVENTION WAS LED BY THE
BILINGUAL KOREAN AMERICAN
COMMUNITY HEALTH WORKER.
FINDINGS WERE USED TO ADD
CULTURALLY RELEVANT TOPICS AND
STRATEGIES TO THE CURRICULUM,
AGAIN A DEEP STRUCTURE.
DISCUSSIONS INVOLVED SOCIAL
CULTURAL LEVEL, TRADITIONAL
KOREAN PRACTICE TO EAT FRUITS AS
AL
ALTERNATIVES TO HIGH FAT
DESSERTS, POTENTIAL DIABETES
TRIGGERS, SMALL PLATES IN
RELATION TO PLATE METHOD,
MANAGING CULTURAL EXPECTATIONS
WHEN INVITED IN HOMES AT -- ASA
GUEST.
YOU CAN SEE INTERVENTIONAL
STRATEGIES ON THE LEFT SIDE.
NEXT SLIDE PLEASE.
WHEN WE LOOK AT EVIDENCE SCAN
AND FUNDING SOURCES OF 178
ARTICLING CAN SEE LARGELY FUNDED
BY U.S. OR CANADIAN GOVERNMENT
FOLLOWED BY NON-PROFIT, ACADEMIC
SOURCES.
YOU CAN SEE THERE'S OTHER AN
NON-REPORTED, STATE GOVERNMENTS
AND INDUSTRY.
NEXT SLIDE PLEASE.
WITH REGARDS TO CONSIDERATIONS
AND LIMITATIONS THERE'S SOME
CHALLENGES IN THE NATURE OF THIS
WORK, THIS IS EXPLORATORY,
UNFORTUNATELY NO CONCLUSION
STATEMENTS OR GRADES UNLIKE WHAT
YOU HEARD PREVIOUSLY TODAY AND
WILL HEAR TOMORROW, RELIANCE ON
WHAT'S PRINTED VERSUS WHAT
HAPPENS IN PRACTICE.
AND THEN OUR SEARCH CRITERIA
CONSIDERATIONS, TIGHT SCOPE ON
SEARCH.
WE DID LIMIT TO PubMed AS
OUR DATABASE.
CITATION SEARCH INCLUDED
ARTICLES WAS NOT CONDUCTED.
NEXT SLIDE PLEASE.
WITH REGARDS TO RESEARCH
RECOMMENDATIONS AND FUTURE
DIRECTIONS THERE'S A NEED FOR
TAILORING TO COMMUNITIES IN
THEIR UNIQUE CHARACTERISTICS,
NOT SOLELY RACIAL AND ETHNIC
GROUP, EXAMPLE BY TIME AND U.S.
NATIVITY, WE TALKED ABOUT THIS
EARLIER TODAY.
THERE'S IMPORTANCE OF TAILORING
ACROSS HIERARCHY OF RESEARCH,
LIVED EXPERIENCE OF LEADERSHIP
AND STAFF.
COMMUNITY INVOLVEMENT AT ALL
STAGES OF THE WORK.
THAT'S REALLY IMPORTANT.
COMMUNITY INVOLVEMENT
INTERVENTIONS SUSTAINABILITY
PLAN SHOULD BE COMMUNICATED
WITHIN THE PUBLICATION, THAT'S
AN IMPORTANT POINT.
AND FOR FUTURE SYSTEMATIC
REVIEWS WE NEED TO DIVERSIFY
SEARCH TERMS, YOURS ITERATIVE
PROCESS FOR COMMON TERMINOLOGY,
EXPAND SEARCH DATABASES OF
COURSE, AND FOR SPECIFIC
POPULATIONS OF INTEREST TO
CONSIDER RELEVANT OUTCOMES WHICH
INCLUDE NUTRITIONAL ADEQUACY,
FOR EXAMPLE, IN BIRTHING
POPULATIONS.
I THINK THIS IS THE CONCLUSION
OF OUR SLIDES.
NEXT SLIDE PLEASE.
ABSOLUTELY.
THANK YOU SO MUCH FOR LISTENING
TO THIS.
THIS IS A NEW ADDITION TO THE
DIETARY GUIDELINES AND I'M
THANKFUL FOR ALL THOSE INVOLVED
IN OUR COMMITTEE.
THANKS SO MUCH.
>> SO WE'RE OPEN FOR DISCUSSION
QUESTIONS.
YES.
>> I HAVE A QUESTION.
AND A COMMENT.
SO, EXCELLENT.
THANK YOU FOR DOING THIS.
WE NEED IT SO DESPERATELY TO
HAVE THIS INFORMATION.
ON YOUR SLIDE WHERE YOU HAVE THE
KWON EXAMPLE ABOUT YOU EXTRACT
THAT INFORMATION BECAUSE THAT'S
RATHER UNUSUAL TO SEE THAT
FORMAT IN ARTICLES, THAT OFTEN
GIVE LIMITED INFORMATION ON
DEVELOPMENT BECAUSE OF THE
LENGTH OF THE ARTICLE.
I HAVE A FOLLOW-UP QUESTION THAT
I'LL ASK NOW.
AND THAT IS DID YOU ALSO LOOK
FOR ARTICLES BY THE SAME GROUP
FOR THE SAME PROJECT TO SEE IF
THEY HAD A DEVELOPMENT ARTICLE?
>> WE WERE DISCUSSING, THERE
WERE SEVERAL STUDIES ON KWAN.
>> YES, ALL THE INFORMATION ON
THAT EXAMPLE SLIDE WAS EXTRACTED
FROM THE ARTICLES WE COULD ONLY
RELY ON WHAT WAS PRINTED IN THE
TEXT.
SO WE UNDERSTAND THERE MAY BE
SOME UNSPOKEN THINGS THAT WERE
TAILORED THAT COULD HAVE BEEN
CONDUCTED DURING THE
INTERVENTION BUT AGAIN WE COULD
RELY ON PUBLISHED WORD.
IN SOME CASES WE WERE REFERRED
BACK TO FORMATIVE RESEARCH
ARTICLES OR, YOU KNOW, FOCUS
GROUPS, THERE COULD HAVE BEEN
MORE INFORMATION ON A GIVEN
INTERVENTION INCLUDED IN OUR
EVIDENCE SCAN SO IF WE FELT LIKE
WE NEEDED ADDITIONAL DETAILS
THERE WAS PROBABLY SOMETHING
WORTH LOOKING FOR IN SOME OF
THOSE FORMATIVE RESEARCH PAPERS,
WE DID TAKE A LOOK AT THEM AS
WELL.
>> BUT I WANT TO EMPHASIZE THAT
A PERSON DOING THIS TYPE OF
RESEARCH, DEANNA CAN TELL YOU,
THERE'S SO MUCH WE CAN PUT IN
THE PUBLICATION SO YOU'RE RIGHT,
THAT WAS ONE OF OUR CHALLENGES,
MANY THINGS ARE DONE IN THE BACK
END, AND NOT PUBLISHED.
LIKE EVIDENTIAL COMPONENT, THERE
WAS VERY SMALL NUMBER OF STUDIES
IN THE EVIDENTIAL COMPONENT,
MOST LIKELY USED THAT BUT DIDN'T
SPECIFICALLY SAY SO IN THE
PUBLICATION SO WE'RE LIMITED TO
WHAT'S WRITTEN THERE.
>> A RECOMMENDATION FOR
EXPANDING THIS AREA AND
UNDERSTANDING BETTER WOULD BE TO
ASK FOR JOURNALS TO BE MORE
ACCEPTING OF THESE DEVELOPMENTAL
PAPERS BECAUSE THERE'S NOT MANY
PLACES YOU CAN GO WITH THAT KIND
OF BACKGROUND INFORMATION ON
DEVELOPMENT.
>> GREAT RECOMMENDATION, THANKS.
>> REPORTING GUIDELINES IN
SPACE, WHAT NEEDS TO BE
REPORTED, WHAT DOESN'T HAVE TO
BE REPORTED, AND THAT
VARIABILITY, BECAUSE WE USE THIS
RUBRIC, BUT THERE IS NO STANDARD
TO SAY YOU NEED TO REPORT THIS,
THINGS NEED TO BE CATEGORIZED.
WHAT YOUR RECOMMENDATION IS, IS
REALLY KEY.
YOU CAN'T DO THAT IN THE
OUTCOMES PAPER.
A LOT OF THOSE THINGS HAVE TO BE
REPORTED.
>> A FOLLOW-UP, MAYBE WE CAN
PROVIDE JUST LIKE A TEMPLATE OF
THIS WOULD BE NICE TO INCLUDE
PARTICULARLY DOING INTERVENTION,
IF WE HAVE THIS FRAMEWORK WHICH
INCLUDES THESE ELEMENTS, IF YOU
HAVE THIS AVAILABLE PLEASE
INCLUDE THESE ELEMENTS.
AND THAT BECOMES BASELINE
FRAMEWORK FOR THIS LIKE A
CHECKLIST.
>> THAT'S WHY WE INCLUDED
EXAMPLE ARTICLE, BECAUSE ALLLI
AND TEAM MADE GREAT JOB OF
IDENTIFYING A STUDY, WELL
SEVERAL STUDIES, WE PICKED THIS
ONE TO SHOW THIS WILL BE GREAT,
INTERVENTION IS OUT THERE,
SOMETHING SIMILAR TO WHAT THIS
STUDY DID.
THEY WERE THOROUGH, THEY HAD IT
IN THEIR PUBLICATION.
SO WE'LL PUT IT AS PART OF THE
REPORT TO SHOW THESE ARE GREAT
EXAMPLES.
>> I WANT TO CONGRATULATE THE
SUBCOMMITTEE ON THIS WORK, IT'S
REALLY SHOWING MORE THAN JUST
CULTURALLY PLACED INTERVENTIONS.
IT'S CULTURALLY BASED
INTERVENTIONS WHICH I THINK
BECOMES A VERY DIFFERENT PIECE
OF LITERATURE.
I THINK IT HIGHLIGHTS THE EFFORT
GOING INTO THE WORK, AND HOW IT
TRANSLATES AS OPPOSED TO JUST
TRANSLATE IT AND IT WILL BE
FINE, SAME THING, SAME MESSAGE,
AND THAT SORT.
THE ABILITY TO USE SUPPLEMENTAL
MATERIALS WITHIN JOURNALS, TO
PROVIDE THOSE, SO WAS THERE
ANYTHING FROM THAT LEVEL OF
DISSECTION THAT RAISED IN YOUR
ASSESSMENT OF WHAT THE EVIDENCE
SCAN IS WHERE SOME MORE
SUCCESSFUL STRATEGIES AND THAT
KIND OF CULTURALLY BASED
INTERVENTIONS SEEMED TO SWING
FORWARD?
>> WE DIDN'T LOOK AT OUTCOMES.
SO THAT'S THE CHALLENGE.
WE DON'T KNOW WHICH ONE WAS
BETTER THAN ANOTHER ONE.
WE JUST LOOKED AT WHAT'S OUT
THERE.
BUT ONE THING THAT REALLY
STRUCK, WHEN I WAS REVEALING
THIS, I THINK IT WOULD BE FUTURE
COMMITTEES MAY HAVE TO SEE THE
EVIDENCE DIFFERENTLY DEPENDING
IF YOU'RE WORKING WITH
IMMIGRANTS VERSUS COMMUNITIES
THAT ARE ALREADY ESTABLISHED
HERE BECAUSE THE RESULT MAY BE
DIFFERENT LIKE FOR HISPANIC TYPE
OF INTERVENTIONS WE'RE LOOKING
FROM THEIR ASSIMILATING TO THE
CULTURE HERE, BUT FOR OTHER,
ANGELA DID MENTION SOMETHING
ABOUT THAT, BUT FOR OTHER NATIVE
AMERICANS THERE MAY BE MORE LIKE
A COMMUNITY TYPE OF INTERVENTION
DEPENDING WHERE THEY ARE, AND
NOT AN IMMIGRATION THING VERSUS
ASIANS OR HISPANICS, SO THEY MAY
HAVE TO BE DEALT INTO THE FUTURE
SEPARATELY, BECAUSE THERE COULD
BE IMPORTANT DIFFERENCES.
>> THAT'S THE OTHER THING NOT
REPORTED IN THIS ARTICLE, SOME
OF THE JUSTIFICATION FOR THE
APPROACHES.
TO CRISTINA'S POINT, THIS IS A
CULTURAL FOCUSED INTERVENTIONS,
AND THEY INDICATED WE HAD TO
HAVE SOME KIND OF CRITERIA FOR
THAT, BUT THINGS THAT ARE AROUND
SOCIAL DETERMINANTS, YOU KNOW,
THINKING HOW THESE
INTERVENTIONS, SO JUSTIFICATION
AND COMPONENTS IS REALLY
DIFFICULT TO GLEAN FROM THE
ARTICLES.
>> YEAH, BUT THAT POINT I THINK
IS REALLY WHEN THE BACKGROUND
FOR WHY MAY DIFFER ACROSS
SUBGROUPS.
>> JUST THINKING ABOUT WHAT
YOU'RE SAYING REGARDING THE
LIMITED AVAILABLE INFORMATION, I
DON'T THINK IT IS UNIQUE TO THIS
TOPIC.
I THINK EVERY DISCIPLINE IN
RESEARCH STRUGGLES WITH THIS.
BUT I NOTICED IN YOUR BREAKDOWN,
A MAJORITY FEDERALLY FUNDED, I
WOULD PROPOSE IN THE
RECOMMENDATION TO FEDERAL
AGENCIES THAT WE SHOULD BE
ASKING FOR SOME KIND OF
REPOSITORY WHERE YOU ASK THE KEY
QUESTIONS.
I'M THINKING AS A PARALLEL
clinicaltrials.gov, MANDATORY
TO PUBLISH ANY CLINICAL TRIAL,
IT'S A POWERFUL TOOL FOR
REVIEWERS, EDITORS, PEERS,
POLICYMAKERS, SO THE WEALTH OF
DATA HERE AND THIS REALLY DOES
SEEM AS YOU PRESENTED A
COMPELLING CASE, THIS IS THE
FUTURE.
SO WHY DON'T WE RECOMMEND THAT
TO A FEDERAL AGENCY?
AND START GETTING THE DATA
THERE.
THANK YOU.
THANK YOU AGAIN FOR A GREAT
PRESENTATION.
AND THANK YOU FOR BREAKING IT
DOWN BECAUSE SOMETIMES I THINK
WE OMIT THE BASICS AND THEN
WE'RE COMING AT IT OUT OF
CONTEXT.
SO THANK YOU, GREAT.
>> CAN I JUST ASK, VALERIE AND
HOLLIE DON'T WANT TO FORGET THAT
YOU'RE THERE.
I WONDERED IF EITHER OF YOU HAD
ANY QUESTIONS YOU WANTED TO ASK
OF THIS WORKING GROUP?
>> THIS IS HOLLIE.
NO ADDITIONAL QUESTIONS BUT I
APPRECIATE YOU REACHING OUT TO
US ONLINE.
>> HI.
I DON'T HAVE ANY ADDITIONAL
QUESTIONS.
I JUST WANT TO THANK EVERYONE ON
THE COMMITTEE.
THIS IS SUCH AN EXCITING STEP
FORWARD, AND REALLY GREAT
PRESENTATIONS.
THANK YOU.
>> THANK YOU BOTH.
WE REALLY APPRECIATE YOU WERE
ABLE TO JOIN US ALBEIT REMOTELY.
ANY OTHER QUESTIONS?
OKAY.
SO IF YOU DON'T -- IF THERE --
OKAY.
>> YES, NEXT STEPS.
>> RIGHT.
NEXT STEPS WE'RE GOING COMPLETE
THE PEER REVIEW, WAIT FOR THE
PEER REVIEW PROCESS TO COME BACK
AND IF WE NEED TO MAKE CHANGES
WE'LL INCORPORATE THOSE.
WE'LL COMPLETE THE SCIENTIFIC
REPORT CHAPTERS WHICH WE'VE BEEN
WORKING VERY HARD.
WE HAVE THE PORTION SIZE ALREADY
OUT TO OUR SCIENTIFIC WRITER AND
WE ARE ALMOST DONE WITH THE
FREQUENCY OF MEALS AND/OR
SNACKING.
AND NOW WE'RE STARTING WITH
CULTURALLY TAILORED DIETARY
INTERVENTIONS SO WE'VE BEEN VERY
BUSY AND WE'LL PRESENT THOSE
FINDINGS IN OUR NEXT MEETING.
THANKS.
>> WONDERFUL.
I THINK WE'LL TAKE A BREAK
THERE.
WE'RE GOING TO COME BACK AT
1:30.
AND WE WILL START WITH THE
REVIEW ON THE -- UPDATES ON DIE
APPEAR PATTERNS.
SO TO THE PUBLIC, ENJOY YOUR
BREAK.
WE'LL SEE YOU AT 1:30.
TAKE CARE.
THANK YOU, EVERYBODY.
SO WITHOUT FURTHER ADO, I'M
GOING TO HAND THE PODIUM OVER TO
MY COLLEAGUE, DEANNA.
>> THANK YOU.
I'M HAPPY TO PRESENT OUR
COMMITTEE'S FINDINGS ON DIETARY
PATTERNS AND SPECIFIC DIETARY
PATTERN COMPONENTS ACROSS LIFE
STAGES.
AND TODAY WE'LL HAVE SEVERAL
PRESENTERS FROM THE COMMITTEE,
SO DR. SARAH BOOTH, DR. ED
JIOVANUCCI, DR. FUNG, DR.
ANDERSON, DR. DEIRLEIN, DR.
TOBIAS, DR. GARDNER WILL JOIN ME
IN PRESENTING OUR RESULTS TODAY.
NEXT SLIDE.
SO, HERE YOU CAN SEE THE MEMBERS
OF OUR COMMITTEE.
I DID WANT TO POINT OUT SEVERAL
OF US SERVE ON THE HEALTH EQUITY
WORKING GROUP, SO THERE IS
CROSS-CONVERSATION GOING ON WITH
BOTH.
GREAT COMMITTEE, AND THE LAST
FEW WEEKS A SPRINT TOWARD THE
ENDS.
AS BEFORE, I'D LIKE TO GIVE A
SHOUT OUT TO OUR NESR AND
SUPPORT GROUP.
THEY HAVE BEEN A SUPPORT GROUP
DURING THE LAST FEW WEEKS, AS I
MENTIONED IT HAS BEEN A PRINT.
WE HAVE DONE -- ENGAGED IN A LOT
OF EXTRA MEETINGS ESPECIALLY
SATURATED FAT CONCLUSION
STATEMENTS DONE TODAY, WE
APPRECIATE YOUR HARD WORK IN
WORKING WITH US AND THE
COMMITTEE AS WELL.
AN UPDATE ON PROGRESS, SINCE
MEETING 5 SEVERAL SYSTEMATIC
REVIEWS HAVE UNDERGONE PEER
REVIEW INCLUDING DIETARY
PATTERNS AND GROWTH, BODY
COMPOSITION AND RISK OF OBESITY.
TYPE 2 DIABETES, RISK OF
CARDIOVASCULAR DISEASE, AND
PATTERNS WITH VARYING AMOUNTS OF
ULTRA PROCESSED FOOD AND GROWTH,
BODY COMPOSITION AND RISK OF
OBESITY.
THERE'S ACTUALLY FOUR THAT WE'VE
GONE THROUGH PEER REVIEW WITH.
WE HAVE SEVERAL SYSTEMATIC
REVIEWS WITH DRAFT CONCLUSION
STATEMENTS THAT WE WILL PRESENT
TODAY, AND THEY INCLUDE DIETARY
PATTERNS AND RISK OF COGNITIVE
DECLINE, DEMENTIA, ALZHEIMER'S
DISEASE, MILD COGNITIVE
IMPAIRMENT, AND RISK OF
COLORECTAL OR BREAST CANCER.
THESE ARE UPDATES.
SINCE MEETING 5 WE LOOKED AT
SEVERAL DIETARY PATTERN
COMPONENTS.
SO HERE WE HAVE SIX SYSTEMATIC
REVIEWS, THESE HAD TO DO WITH
OUTCOMES OF GROWTH, BODY
COMPOSITION, RISK OF OBESITY OR
TYPE 2 DIABETES, INCLUDING
BEVERAGE PATTERNS, DAIRY MILK
AND MILK ALTERNATIVES, LOW AND
NO CALORIE SWEETENED, 100% JUICE
AND RISK OF TYPE 2 DIABETES AND
SUGAR SWEETENED BEVERAGES.
WE'LL COVER ADULT, OLDER ADULTS,
PREGNANCY AND POSTPARTUM, WE
PRESENTED FOR CHILDREN AND
ADOLESCENTS AT MEETING 5.
THIS IS AN UPDATE BUT WE DO HAVE
A META-ANALYSIS, A NEW COMPONENT
TO THAT.
AND THEN THE LAST SET OF
SYSTEMATIC -- LAST SYSTEMATIC
REVIEW, FOOD SOURCES OF
SATURATED FAT, RISK OF
CARDIOVASCULAR DISEASE.
WE'LL HAVE 31 CONCLUSION
STATEMENTS, AFTER THE BREAK
TODAY.
BUT WE KNOW THAT YOU'LL FIND IT
WILL BE A RIVETTING CONVERSATION
AND DISCUSSION.
I WANT TO REMIND THOSE WHO CAME
IN DURING THE BREAK THAT MISSED
THIS MORNING AND THOSE OF YOU
HERE JUST TO REMIND YOU AGAIN
WE'RE GOING TO PRESENT A LOT OF
CONCLUSION STATEMENTS WITH A LOT
OF GRADES SO I WANTED TO
EMPHASIZE WHAT THEY MEAN.
AND FOR STRONG, REMEMBER THE
LEVEL OF CERTAINTY IS STRONG AND
THAT IF NEW EVIDENCE EMERGES,
MODIFICATIONS TO THE CONCLUSION
STATEMENT ARE UNLIKELY TO BE
REQUIRED.
WITH MODERATE, IF NEW EVIDENCE
EMERGES, MODIFICATIONS TO THE
CONCLUSION STATEMENT MAY BE
REQUIRED.
AND THEN FOR LIMITED, IF NEW
EVIDENCE EMERGES, MODIFICATIONS
TO THE CONCLUSION ARE LIKELY TO
BE REQUIRED.
SO, IT'S GOOD FOR EVERYBODY TO
KEEP THAT IN MIND.
AND THEN GRADE NOT ASSIGNABLE
THAT MEANS WE CAN'T GIVE A
CONCLUSION STATEMENT, EITHER
BECAUSE WE HAVE A LACK OF
EVIDENCE OR THE EVIDENCE HAS
SEVERE LIMITATIONS.
AND WE CAN TALK ABOUT THOSE AS
WE GO THROUGH THE CONCLUSION
STATEMENTS THIS AFTERNOON.
AND SO WITH THAT, I'D LIKE TO
TURN TO THE DIETARY PATTERNS
WITH THE NEXT SLIDE.
I'LL TURN IT OVER TO DR. BOOTH.
>> NEXT SLIDE PLEASE.
SO, THIS REPRESENTS AN UPDATE TO
A PREVIOUS REVIEW EVALUATING
RELATIONSHIP BETWEEN DIETARY
PATTERNS, CONSUMED, RISK OF
COGNITIVE DECLINE, DEMENTIA,
ALZHEIMER'S DISEASE AND MILD
COGNITIVE IMPAIRMENT.
AS A REMINDER, HERE IS THE
ANALYTICAL FRAMEWORK.
ALTHOUGH THE OUTCOMES ARE
DEFINED IN ADULTS AND OLDER
ADULTS, WE DID INCLUDE SEVERAL
STUDIES THAT MET CRITERIA AND
ASSESSED DIETARY PATTERNS DURING
CHILDHOOD AND ADOLESCENCE.
WE PLANNED TO SYNTHESIZE DATA BY
ADULTS, OLDER ADULTS SEPARATELY,
IF SUFFICIENT DATA WERE
AVAILABLE.
THE GROUP HAD EXTENSIVE
DISCUSSION ABOUT WHAT ARE THE
CRITICAL TIME POINTS OVER THE
COURSE OF LIE LIFE AFFECTING
AGE-RELATED DECLINE OR DEMENTIA.
WE FELT IT WAS IMPORTANT TO
COMBINED ADULTS AND ORDINARY
ADULTS GIVEN WE DON'T KNOW
CRITICAL WINDOWS WHERE DIETARY
PATTERNS CAN HAVE AN IMPACT ON
BRAIN HEALTH.
I'LL START WITH CONCLUSION
STATEMENT.
WE CONCLUDED DIETARY PATTERNS
CONSUMED BY ADULTS AND OLDER
ADULTS WITH HIGHER INTAKES OF
VEGETABLES, FRUITS, LEGUMES OR
BEANS, NUTS, FISH, SEAFOOD,
UNSATURATED VEGETABLE OILS/FATS,
LOWER INTAKES OF RED AND
PROCESSED MEATS AND SUGAR
SWEETENED BEVER YADGESZ
ASSOCIATED WITH LOWER RISK OF
AGE RELATED COGNITIVE DECLINE,
BASED ON EVIDENCE GRADED AS
MODERATE.
THIS CONCLUSION STATEMENT CAME
AFTER REVIEWING 83 ARTICLES THAT
WERE PUBLISHED BETWEEN MARCH
2020 AND JANUARY 24, AS WELL AS
EVIDENCE THAT WAS EXCLUDED FROM
PREVIOUS REVIEWS THAT MET THE
NEW EXCLUSION CRITERIA OF THE
THE PRIOR REVIEW EVALUATE THE
STRENGTH OF EVIDENCE AS
MODERATE, WE DETERMINED THE
STRENGTH OF THAT EVIDENCE WAS
STILL MODERATE BASED ON
ASSESSMENT OF GRADING ELEMENT.
THERE WERE SOME CONCERNS OF
MINIMAL VARIABILITY IN DIRECTION
OF RESULTS.
HOWEVER, THERE WAS MINIMAL TO
MODERATE VARIABILITY IN THE
MAGNITUDE OF THESE RESULTS.
MOST OF THE ARTICLES, 54 OUT OF
83, REPORTED STATISTICALLY
SIGNIFICANT ASSOCIATIONS BETWEEN
DIETARY PATTERNS AND LOWER RISK.
ADVERSE COGNITIVE OUTCOMES.
THERE WERE SOME SERIOUS CONCERNS
NOTED REGARDING THE ONLY
ELIGIBLE ONE, RANDOMIZED
CONTROLLED TRIAL, AND CONFIDENCE
INTERVALS RANGED FROM NARROW TO
WIDE ACROSS REPORTED RESULTS IN
THE OBSERVATIONAL STUDY.
WE ALSO HAD EXTENSION OF
DISCUSSION ABOUT THE
MEASUREMENTS USED FOR THE
OUTCOMES, THERE IS A WIDE RANGE
OF TOOLS THAT PEOPLE -- THAT
INVESTIGATORS USE TO ASSESS
THESE OUTCOMES, AND THEY ARE NOT
HARMONIZED.
THEY ARE NOT STANDARDIZED.
AND THERE WAS A LOT OF CONCERN
ABOUT WHAT ACTUALLY WAS BEING
MEASURED.
AND THIS I THINK REALLY WEIGHED
INTO THE RISK OF BIAS, THE
OUTCOME MEASUREMENT ERROR.
SO, WE, AS I SAY, CONCLUDED A
MODERATE, YEAH, GRADE.
AND I DO BELIEVE THAT'S IT.
>> THANK YOU.
AND SO WE'LL DISCUSS ALL OF
THESE ONCE WE FINISH THE
COLORECTAL AND BREAST CANCERS,
ED?
>> THANK YOU.
YES, THIS IS AN UPDATE ON
RELATIONSHIP BETWEEN DIETARY
PATTERNS AND COLORECTAL CANCER
RISK.
YOU CAN SEE OUR OLD FRIEND THE
ANALYTIC FRAMEWORK.
I'LL POINT OUT WE'RE LOOKING AT
A RANGE OF POPULATIONS, ALTHOUGH
OUR CONCLUSIONS WILL BE BASED ON
ADULTS, THAT'S WHERE THE DATA
ARE.
IN TERMS OF THE OUTCOME, I'LL
JUST NOTE THAT WE DID LOOK AT
TUMOR SUBSITE, PARTS OF THE
COLON AND RECTUM.
THERE'S A LIST OF CONFOUNDERS
THAT'S VERY SIMILAR TO LIST OF
CONFOUNDERS, I WILL NOTE THAT WE
HAVE SCREENING FOR COLORECTAL
CANCER AS POTENTIALLY IMPORTANT
CONFOUNDER.
NEXT SLIDE PLEASE.
RIGHT.
SO, THIS IS THE MAIN CONCLUSION
STATEMENT IN GRAY.
SO AGAIN WE'RE LOOKING AT
DIETARY PATTERNS IN COLORECTAL
CANCER, AND I'LL JUST READ THE
SLIDE FOR THE CONCLUSION.
DIETARY PATTERNS CONSUMED BY
ADULT IT'S AND OLDER ADULTS THAT
ARE CHARACTERIZED BY HIGHER
INTAKES OF VEGETABLES, FRUITS,
LEGUMES AND NUTS, WHOLE GRAINS,
LOWER INTAKES OF RED AND
PROCESSED MEATS, REFINED GRAINS,
FRIED POTATOES, SATURATED FAT,
SUGAR-SWEETENED FOODS AND
BEVERAGES ARE ASSOCIATED WITH
LOWER RISK OF COLON AND RECTAL
CANCER.
SOME OF THESE DIETARY PATTERNS
ALSO INCLUDED FISH, LOW-FAT
DAIRY, TEA AND COFFEE.
THIS CONCLUSION STATEMENT IS
BASED ON EVIDENCE GRADED AS
MODERATE.
YOU CAN SEE THE BODY OF EVIDENCE
IS BASED ON 29 STUDIES, MOSTLY
PROSPECTIVE COHORT STUDIES.
SUMMARIZING BRIEFLY THE CRITERIA
THAT WE RELIED ON, CONSISTENCY,
THERE WERE VERY FEW CONCERNS
ACTUALLY WITH VARIABILITY IN
MAGNITUDE OF THE RESULTS.
MOST OF THE RESULTS WERE IN THE
RIGHT DIRECTION, PROTECTIVE
DIRECTION.
FOR PRECISION, DEPENDING ON SIZE
OF THE STUDY, CONFIDENCE
INTERVALS VARIED, SOME DID HAVE
WIDE CONFIDENCE INTERVALS BUT
AGAIN MOST OF THE STUDIES WERE
IN THE SAME DIRECTION.
FOR RISK OF BIAS, THERE WAS SOME
CONCERNS AND THE MAIN CONCERN
WAS DUE TO CONFOUNDING.
ONE OF THE KEY CONFOUNDERS THAT
WAS MISSING IN A NUMBER OF
STUDIES WAS SCREENING FOR
COLONOSCOPY WHICH COULD ACT AS
CONFOUNDER.
THERE WAS SOME CONCERN ABOUT THE
EXPOSURES ONLY MEASURED AT ONE
TIME AND COLORECTAL CANCER IS A
DISEASE THAT TAKES MANY YEARS
OTHER DECADES.
THERE WAS CONCERN ABOUT
SELECTION OF REPORTED RESULTS.
DIRECTNESS, THERE WERE A FEW
CONCERNS OF EXPOSURE COMPARATORS
AND OUTCOMES BEING EXAMINED THAT
WERE DIRECTLY RELATED TO THE
SYSTEMATIC REVIEW QUESTION.
GENERALIZABILITY, THERE WAS SOME
CONCERNS, THERE WAS A LACK OF
DIVERSITY IN THE STUDIES, AND
THE ONLY OTHER NOTE I'LL MAKE IS
I MENTIONED WE DID LOOK AT TUMOR
LOCATION, BUT AT THE END WE
DIDN'T FEEL THERE WAS ENOUGH
EVIDENCE FOR A SEPARATE
CONCLUSION STATEMENT SO OTHER
CONCLUSION IS FOR COLORECTAL
CANCER.
>> THANK YOU.
THERESA?
>> I WILL PRESENT DRAFT
CONCLUSION STATEMENT ON
RELATIONSHIP BETWEEN DIETARY
PATTERNS AND RISK OF BREAST
CANCER.
THIS IS AN UPDATE BECAUSE WE'VE
COME UPON CONCLUSION STATEMENT
ALREADY, SO OUR DATA IS BASED ON
MOSTLY 2014 AND 2023, AND
COMPARED WITH THE CONCLUSION
STATEMENTS AND EVIDENCE FROM THE
PAST COMMITTEES AS WELL.
HERE IS REMINDER OF ANALYTIC
FRAMEWORK, ORIGINAL INTENTION TO
INCLUDE ALL LIFE STAGES,
CONCLUSION STATEMENT NOW THAT WE
HAVE IS ONLY BASED ON ADULT DATA
BECAUSE WE COULD NOT FIND OF
DATA ON DIET CONSUMED DURING
YOUNGER YEARS.
OUR OUTCOME IS INCIDENT BREAST
CANCER, KEY CONFOUNDERS, THERE'S
TWO KEY CONFOUNDERS SPECIFICALLY
ADDED FOR THIS OUTCOME WHICH IS
SCREENING FOR BREAST CANCER AS
WELL AS USE OF POST-MENOPAUSAL
HORMONES.
THIS IS BY POPULATION, THEN BY
MENOPAUSAL STATUS.
WE HAVE ENOUGH EVIDENCE, THEN WE
WILL EVALUATE MOLECULAR TYPES.
NEXT SLIDE PLEASE.
OUR UPDATED CONCLUSION STATEMENT
THAT IS BASED ON 26 INCLUDE
ARTICLES, ONE RCT, 24
PERSPECTIVE AND ONE CASE STUDY.
SO 26 FROM 20142023.
COMPARING WITH PAST REVIEWS, WE
COME TO THIS DRAFT STATEMENT
DIETARY PATTERNS CHARACTERIZED
BY HIGH INDEX OF VEGETABLES,
FRUITS, LEGUMES, NUTS, WHOLE
GRAINS AND ALSO LOWER INTAKES OF
RED AND PROCESSED MEATS, REFINED
GRAINS, SUGAR SWEETENED FOODS
AND BEVERAGED ASSOCIATED WITH
LOWER RISK.
DATA IN PRE-MENOPAUSAL BREAST
CANCER POINTS THE SAME
DIRECTION, EVIDENCE IS LESS
CONSISTENT.
THE GRADE WE CAME UP WITH IS
MODERATE, SAME AS PAST
COMMITTEES.
AND SO THE ELEMENTS AND CRITERIA
WE BASED ON GRADE ON WITH
CONSISTENCY, IT'S QUITE GOOD,
GENERALLY POINTING TO THE SAME
DIRECTION, PRECISIONS THAT MORE
VARIABILITY ESPECIALLY THOSE
STUDIES THAT DID NOT REACH
STATISTICAL SIGNIFICANCE.
RISK OF BIAS, SOME CONCERN,
MOSTLY BECAUSE OF CONFOUNDING
AND MOST OF THE TIME DIET WAS
ONLY MEASURED AT ONE TIME POINT
AT BASELINE.
DIRECTNESS WAS NOT MUCH OF A
CONCERN, BOTH OUTCOME AND
EXPOSURE WAS PRECISELY MEASURING
WHAT WE WANT TO MEASURE.
GENERALIZABILITY, ON THE OTHER
HAND, IS A DIFFERENT STORY.
WE HAVE SERIOUS CONCERNS ON THE
GENERALIZABILITY TO THE U.S.
POPULATION BECAUSE THE DATA
REALLY LACKS ETHNIC AND RACIAL
DIVERSITY IN THE OVERALL BODY OF
EVIDENCE, AND ONLY TWO STUDIES,
PRIMARILY FROM ETHNIC MINORITY
GROUPS, NON-WHITE.
I'M SURE EVERYBODY IS THINKING
ABOUT PRE-MENOPAUSAL BREAST
CANCER AS WELL AND THERE'S A
CONSIDERABLE AMOUNT OF EVIDENCE
ON THIS OUTCOME.
AND SO WE LOOK ACROSS DATA FROM
PAST REVIEWS AS WELL AS CURRENT
TIME PERIOD, AND ALTHOUGH THE
DATA GENERALLY POINTS TO THE
SAME DIRECTION AS POSITIVE
BREAST CANCER, MORE CURRENT BODY
OF EVIDENCE, THE VARIABILITY WAS
MORE VARIED THAN DIETARY
PATTERNS IN POSTMENOPAUSAL
STUDIES.
WHAT I MEANT, THE COMPONENTS OF
THE DIETARY PATTERNS WAS -- BODY
OF EVIDENCE, LESS CONSISTENT
WITHIN THE PRE-MENOPAUSAL BREAST
CANCER STUDIES, AND THEN WITHIN
EACH FOOD GROUP OF THOSE DIETAY
PATTERNS WHAT IS CONSIDERED WAS
ALSO MORE VARIED.
SO THEREFORE THAT MAKES MAKING A
SEPARATE CONCLUSION STATEMENT
MORE DIFFICULT.
HOWEVER, THERE IS INDEED A
PATTERN, SIMILARITIES, AND THE
DIRECTION IN GENERAL, SO WE
ADDED -- INCLUDED A STATEMENT ON
PRE-MENOPAUSAL BREAST CANCER IN
OUR CONCLUSION AND OVERALL
CONCLUSIONS.
WE WANTED TO EXAMINE MOLECULAR
SUBTYPES BUT STUDIES WAS MORE
NARROW.
WE TRIED TO LOOK AT EVERYTHING,
ESTROGEN RECEPTORS,
PROGESTERONE, HER-2,
COMBINATION, TRYING TO FIND
PATTERNS WITHIN THEM BUT THE
NUMBER OF STUDIES IS REALLY FEW
ON EACH OF THEM AND SO WE'RE
UNABLE TO MAKE SPECIFIC SUBTYPE
CONCLUSION STATEMENT ON THAT.
NEXT SLIDES.
OVER TO CHERYL UNLESS WE WANT TO
ASK QUESTIONS.
>> YEAH, JUST TO GIVE SOME
ORIENTATION TO THIS, WE HAD TO
UPDATE THE CONCLUSION STATEMENT
FOR DIETARY PATTERNS CONSUMED
AND RISK OF CARDIOVASCULAR
DISEASE.
SO CHERYL WILL TELL YOU ABOUT
THAT.
>> THANK YOU.
THE NEXT TWO SLIDES SHOW OUR
WORK ON DIETARY PATTERNS AND
RISK OF CARDIOVASCULAR DISEASE
IN CHILDREN.
AND SIMILAR TO WHAT YOU'VE SEEN
THUS FAR IN OTHER PORTIONS OF
THE AFTERNOON'S PRESENTATIONS
HERE IS THE ANALYTIC FRAMEWORK.
THE PORTION THAT'S RELEVANT TO
CHILDREN IS OUTLINED IN THIS
ORANGE BOX.
I WANT TO TALK ABOUT WHAT DEANNA
MENTIONED, WE PRESENTED RESULTS
OF THIS SYSTEMATIC REVIEW TO YOU
ALL DURING OUR LAST PUBLIC
MEETING, THE FIFTH MEETING, AND
AS A REMINDER IT INCLUDES
ARTICLES THAT WERE PUBLISHED
BETWEEN 2014 AND 2023.
IT TURNS OUT AFTER THE LAST
PUBLIC MEETING WE ACTUALLY FOUND
AN ADDITIONAL ARTICLE, AND
NEEDED TO INCLUDE IT.
AND SO THAT ARTICLE WAS
RANDOMIZED CLINICAL TRIAL, IT
HAD ALL OF THE CRITERIA MET FOR
INCLUSION, SO WE RE-REVIEWED
EVIDENCE AND WANTED TO LOOK AT
OUR CONCLUSION STATEMENT AND OUR
GRADE AND ENSURE IT REFLECTED
THE ENTIRE BODY OF EVIDENCE
INCLUDING THIS NEXT ARTICLE.
SO LET ME HAVE YOU GO TO THE
NEXT SLIDE.
SHOW YOU WHERE WE LANDED.
HERE IS CONCLUSION STATEMENT AND
GRADE.
READ IT ALONG WITH ME.
DIETARY PATTERNS CONSUMED BY
CHILDREN AND ADOLESCENTS
CHARACTERIZED BY HIGHER INTAKES
OF VEGETABLES, FRUITS, LEGUMES,
NUTS, WHOLE GRAINS, FISH AND/OR
SEAFOOD, UNSATURATED FATS AND
OILS AND LOWER INTAKES OF SUGAR
SWEETENED BEVERAGES AND FOODS
AND RED AND PROCESSED MEATS ARE
ASSOCIATED WITH LOWER SYSTOLIC
AND DIASTOLIC BLOOD PRESSURE AND
TRIGLYCERIDES LATER IN LIFE.
THE CALL-OUT OF THOSE THREE
PIECES ARE REALLY IMPORTANT IN
THAT THE MAJORITY OF WHAT WE
THINK ABOUT FOR CARDIOVASCULAR
DISEASE RISK AS RELATED TO
CHILDREN IS BASED ON FINDINGS IN
THOSE THREE HEALTH CONDITIONS.
THIS CONCLUSION STATEMENT IS
BASED ON EVIDENCE GRADED AS
MODERATE.
BODY OF EVIDENCE AS YOU SEE
INCLUDED 19 ARTICLES, THERE WERE
SOME CONCERNS WITH CONSISTENCY,
SO DESPITE HETEROGENEITY IN THE
FINDINGS, THE STUDIES REPORTED
INVERSE ASSOCIATION BETWEEN
DIETARY PATTERNS THAT WE
OUTLINED AND SYSTOLIC AND
DIASTOLIC BLOOD PRESSURE AND
TRIGLYCERIDES.
WHEN WE LOOK AT BODY OF STUDIES,
WE DON'T SEE A STATISTICALLY
SIGNIFICANT ASSOCIATION BETWEEN
THIS DIETARY PATTERN AND LDL OR
HDL.
SO THAT'S TAKEN INTO
CONSIDERATION WHEN IT COMES TO
CONSISTENCY.
WITH REGARD TO PRECISION, THERE
ARE SOME CONCERNS WITH A FEW
STUDIES HAVING A WIDE CONFIDENCE
INTERVAL, WE ALSO HAVE STUDIES
WITH REALLY GOOD SAMPLE SIZE, A
THOUSAND PARTICIPANTS IN SEVERAL
ARTICLES, AND THERE'S CONCERN OF
RISK OF BIAS WHERE SOME STUDIES
HAVE HIGH OR VERY HIGH RISK OF
BIAS DUE TO CONFOUNDING AND
MISSING THIS, YOU SAW THE LIST
ON THE PRIOR SLIDE.
FOR EXAMPLE, ALTHOUGH STUDIES
HAD CONFOUNDERS ACCOUNTED FOR,
SOMETIMES THEY DIDN'T ACCOUNT
FOR PHYSICAL ACTIVITY,
RACE/ETHNICITY, OR SOCIOECONOMIC
POSITION.
SO THAT WAS OF CONCERN IN THE
RISK OF BIAS.
WHEN IT COMES TO DIRECTNESS, IT
WAS GENERALLY A FEW CONCERNS.
THE POPULATION EXPOSURE TO
COMPARATOR AND OUTCOMES WERE
DIRECTLY RELATED TO THE QUESTION
IN MOST OF THE STUDIES.
BUT WHEN IT CAME TO
GENERALIZABILITY THERE WERE
SERIOUS CONCERNS, WE HAD ONLY
ONE STUDY CONDUCTED IN THE U.S.
SO ALL THINGS TAKEN INTO
ACCOUNT, WE LANDED ON THE GRADE
OF MODERATE.
>> THANK YOU.
SO ANY QUESTIONS OR DISCUSSION?
CRISTINA?
>> YOU MENTIONED THERE WAS A
CHANGE.
WHAT WAS THE CHANGE?
I DIDN'T GET THAT PART.
IT WAS BEFORE WHAT?
>> [OFF MICROPHONE].
>> OH, NOW IT'S MODERATE.
>> THE QUESTION, WHAT WAS THE
GRADE BEFORE, BEING ASSIGNED
MODERATE, IT WAS LIMITED.
>> QUESTION FOR ED.
ON YOUR SLIDE CONCLUSION IT
MENTIONS SOME DIETARY PATTERNS
ALSO INCLUDE FISH, LOW FAT
DAIRY, TEA AND COFFEE.
WAS THERE A DIRECTION, HIGHER OR
LOWER?
>> THOSE WERE ALL IN -- LET ME
MAKE SURE I'M SAYING IT RIGHT.
SO COFFEE, YEAH, THOSE WERE ALL
IN THE GOOD DIRECTION,
PROTECTIVE.
>> QUESTION FOR CHERYL.
THE WAY THE STATEMENT READS,
ASSOCIATED WITH LOWER BLOOD
PRESSURE AND TRIGLYCERIDES LATER
IN LIFE.
IS THAT REVERSIBLE OR BECAUSE
PEOPLE MAINTAIN THE PATTERN?
SO IS IT REVERSIBLE ONCE YOU'VE
HAD THE EXPOSURE IN CHILDHOOD?
>> SO THE QUESTION, DO WE
UNDERSTAND TRAJECTORY, FOR THOSE
WHO MAY GO FROM EITHER STAY THE
SAME, GET BETTER, GET WORSE, THE
ASSOCIATIONS WERE PROSPECTIVE,
AND I DON'T THINK WE HAVE THE
ABILITY TO GO AS GRANULAR AS
COULD YOU CORRECT FOR IT AND SEE
A DIFFERENT OUTCOME.
THAT'S NOT IN THE LITERATURE,
THE 19 ARTICLES RIGHT NOW.
>> ARE THERE OTHER QUESTIONS ON
THESE PRESENTATIONS?
I CONGRATULATE EVERYONE, BUT I
SPOKE SO I FEEL WEIRD DOING
THAT.
EVERYBODY ELSE, YOU DID A GREAT
JOB.
[LAUGHTER]
ARE THERE ANY OTHER QUESTIONS ON
THE DIETARY PATTERNS THAT WAS
JUST PRESENTED?
HOLLIE AND VALERIE, I'M NOT SURE
IF YOU'RE ON SCREEN.
I BELIEVE YOU ARE.
IF YOU HAVE ANY QUESTIONS,
PLEASE LET US KNOW.
>> NO ADDITIONAL QUESTIONS.
THANK YOU.
>> NO QUESTIONS.
THANK YOU.
>> THANK YOU.
>> DEE DEE HAS A QUESTION.
>> IT WAS FROM YOUR
PRESENTATION, WHICH ALREADY
FEELS LIKE A LOT OF EVIDENCE
AGO.
SO WHEN LOOKING AT OUTCOMES,
RELATED TO COGNITIVE HEALTH AND
AGING, WHERE THESE ARE
OCCURRING, DECADES LATER THAN
SOME OTHER HEALTH OUTCOMES WE'RE
LOOKING AT FOR FUTURE DIRECTIONS
BECAUSE THIS IS SUCH AN
IMPORTANT AREA OF RESEARCH AND
THE ETIOLOGY OR RELEVANT TIME
WINDOWS NOT KNOWN, RIGHT?
SO YOU THINK ABOUT INTERVENING
WITH SHORTER-TERM TRIALS AMONG
OLDER POPULATIONS THAT MAY NOT
BE IN THE RELEVANT WINDOW, WE'LL
NEED LONGER TERM FOLLOW-UP
STUDIES.
MY QUESTION, ARE THERE
INTERMEDIATE RISK FACTORS OR --
I MEAN, NOT BIOMARKERS BUT
ANYTHING THAT CAN BE USED TO
HELP AUGMENT THE OUTCOME
LITERATURE, OR IS IT MORE ALL
LIKE ASSESSMENT SCORES WHICH YOU
CAN'T GO BACK AND DO, WHAT'S
FEASIBLE IN THIS SPACE?
>> THIS IS A GREAT QUESTION.
AND IF YOU THINK ABOUT IT, ONE
OF THE CHALLENGES IS MOST PEOPLE
WHO ARE EXPERIENCING COGNITIVE
DECLINE LATER IN LIFE, THEY ARE
ACTUALLY NOT AWARE OF IT UNTIL
IT'S PRETTY MARKED.
AND YET MOST OF OUR ASSESSMENT
TOOLS ARE RELYING ON MEMORY OF
WHAT PEOPLE ATE, BUT ALSO THE
TOOLS THEMSELVES, THERE'S A LOT
OF TRAINING COMPONENT.
WE DID NOT DISCUSS THIS AS PART
OF OUR SMALL SUBCOMMITTEE GROUP
SO I WOULD WELCOME INPUT.
THERE IS A LOT OF RESEARCH
ACTIVITY IN THE SPACE OF
BIOMARKERS.
THERE WAS A VERY RECENT STUDY
RELEASED I THINK THREE WEEKS
AGO, WHERE THERE'S AN
INTERNATIONAL STUDY WHERE THERE
IS A PANEL OF BLOOD BIOMARKERS
THAT SEEMED TO BE QUITE ROBUST
IN PREDICTING DEMENTIA, I THINK,
YEAH, DEMENTIA.
SO I DO BELIEVE THAT'S THE WAY
IT'S GOING TO GO.
BECAUSE THIS IS IN PARTICULAR AN
OUTCOME THAT YOU WANT TO HAVE AS
LITTLE AS POSSIBLE EMPHASIS OR
RELIANCE ON MEMORY.
I DON'T KNOW IF THE OTHERS WOULD
LIKE TO -- BUT IT'S A GREAT
COMMENT, DEE DEE, AND I AGREE WE
SHOULD PUT THIS IN THE FUTURE
DIRECTIONS.
>> NOW WE'LL CONTINUE WITH
EVIDENCE REVIEW FOR BEVERAGES.
ANDREA?
>> OKAY.
GREAT.
NEXT SLIDE.
SO, THIS SLIDE IS SHOWING
ANALYTIC FRAMEWORK FOR THE FULL
QUESTION ON SUGAR-SWEETENED
BEVERAGE CONSUMPTION WITH
GROWTH, BODY COMPOSITION, RISK
OF OBESITY, INCLUDING SYSTEMATIC
REVIEW AND META-ANALYSIS.
AS DEANNA NOTED EARLIER IN THE
PRESENTATION, THE CONCLUSION
STATEMENTS FOR INFANTS, YOUNG
CHILDREN, AND ADOLESCENTS WERE
PRESENTED AT PUBLIC MEETING 5 IN
MAY.
SO, AS YOU CAN SEE BY THE RED
BOX, TODAY'S CONCLUSIONS ARE
GOING TO FOCUS ON ADULTS AND
OLDER ADULTS AS WELL AS
INDIVIDUALS DURING PREGNANCY AND
POSTPARTUM.
SO THIS QUESTION INCLUDED, IF
YOU LOOK DOWN THE COMPARATOR
COLUMN, THIS QUESTION INCLUDED
COMPARISON OF SUGAR-SWEETENED
BEVERAGE CONSUMPTION WITH LOW
AND NO-CALORIE SWEETENED
BEVERAGES, NOT INCLUDED IN THE
QUESTION WILL LOW AND NO CALORIE
SWEETENED BEVERAGE CONSUMPTION
PRESENTED DURING PUBLIC MEETING
4.
LOOKING AT KEY CONFOUNDERS YOU
CAN SEE THERE WERE SOME KEY
CONFOUNDERS INCLUDED WHEN
LOOKING DURING PREGNANCY AS WELL
AS POSTPARTUM.
OKAY.
NEXT SLIDE.
SO WHEN EXAMINING THE QUESTION
OF SUGAR SWEETENED BEVERAGE
CONSUMPTION IN RELATION TO BODY
COMPOSITION AND RISK OF OBESITY
AMONG ADULTS AND OLDER ADULTS WE
DREW SEPARATE STATEMENTS FOR
BODY COMPOSITION AND RISK OF
OBESITY OUTCOMES.
THIS SLIDE SHOWS THE CONCLUSION
STATEMENT FOR BODY COMPOSITION.
SUGAR-SWEETENED BEVERAGE
CONSUMPTION BY ADULTS AND OLDER
ADULTS ASSOCIATED WITH
UNFAVORABLE BODY COMPOSITION.
AND THIS CONCLUSION WAS BASED ON
EVIDENCE GRADED AS MODERATE.
THE DEVELOPMENT CONSIDERED BODY
OF EVIDENCE FROM RESULTS OF THE
META-ANALYSIS AS WELL AS ALL OF
THE ARTICLES THAT WERE INCLUDED
IN THE SYSTEMATIC REVIEW.
ROUGHLY HALF THE STUDIES
INCLUDED IN THIS SYSTEMATIC
REVIEW WERE ALSO INCLUDED IN AT
LEAST ONE META-ANALYSIS.
THIS IS PRIMARILY DUE TO TOO FW
STUDIES.
SO FOR THE META-ANALYSIS, THE
BODY COMPOSITION OUTCOMES THAT
WE FOCUSED ON WERE WAIST
CIRCUMFERENCE, CHANGE IN FAT
MASS.
THIS IS DUE AGAIN RELATIVELY TO
TOO FEW STUDIES REPORTING ON
OTHER OUTCOMES.
AND THEN FOR THE SYSTEMATIC
REVIEW, THE DATA WAS ON THE
BROADER SET OF BODY COMPOSITION
OUTCOMES.
SO WHEN WE LOOK AT GRADING
ELEMENTS STARTING WITH
CONSISTENCY, OVER HALF THE
STUDIES EXAMINING BODY
COMPOSITION OUTCOMES FOUND
RELATIONSHIP BETWEEN SUGAR
SWEETENED BEVERAGE CONSUMPTION
AND ONE BODY COMPOSITION
OUTCOMES INDICATING IT WAS
RELATED TO UNFAVORABLE BODY
COMPOSITION OUTCOMES, AND MANY
OF THE NON-SIGNIFICANT FINDINGS
TRENDED IN THAT DIRECTION.
DATA ON SUGAR SWEETENED BEVERAGE
CONSUMPTION VERSES LOW AND NO
CALORIE CAME FROM TRIALS. THERE
WERE NO NOTICEABLE DIFFERENCES
IN FINDINGS WHEN COMPARING SUGAR
SWEETENED BEVERAGE CON SUMMINGS
TO LOW AND NO CALORIE SWEETENED
BEVERAGES AND SUGAR SWEETENED
BEVERAGE CONSUMPTION VERSUS
WATER, SO NOT SEPARATE
CONCLUSION STATEMENTS DRAWN FOR
THESE SEPARATE COMPARATORS.
FOR THE META-ANALYSES,
SPECIFICALLY FINDINGS ON CHANGE
AND WARES CIRCUMFERENCE, WITH
HIGHER INTAKE INCREASES IN
CIRCUMFERENCE.
POOLED EFFECT SIZE SMALL,
CONFIDENCE INTERVALS INCLUDED
ZERO, STATISTICAL POWER LIMITED,
MODERATE TO HIGH HETEROGENEITY
IN MANY ANALYSES.
PRECISION, SAMPLE SIZES VARIED
CONSIDERABLY, MOST WERE
ADEQUATELY POWERED AND VAST
MAJORITY OF OBSERVATIONAL
STUDIES INCLUDED A THOUSAND
PARTICIPANTS.
TWO TRIALS DID NOT REPORT ON
POWER CALCULATIONS, AND APPEARED
TO BE UNDERPOWERED.
STUDIES HAD A MIX OF REASONABLE
OR WIDE 95% CONFIDENCE
INTERVALS.
PRIMARY SOURCE OF BIAS
INADEQUATE RANDOMIZATION METHODS
AND HIGH ATTRITION.
RISK OF BIAS WAS MORE PRONOUNCED
IN OBSERVATIONAL STUDIES WITH
MANY FAILING TO ADEQUATELY
ADJUST FOR CONFOUNDING OR
MISSING DATA.
DIRECTNESS MOST TRIALS WERE
DESIGNED TO TEST EFFECT OF
SWITCHING FROM SUGAR SWEETENED
BEVERAGE CONSUMPTION TO ANOTHER
TYPE SUCH AS LOW AND NO-CALORIE
SWEETENED BEVERAGES AND MAJORITY
OF OBSERVATIONAL STUDIES
EXAMINED THE RELATIONSHIP OF
INTEREST.
SO CONCERNS ABOUT DIRECTNESS
WITH THOSE WAS MINIMAL.
GENERALIZABILITY WAS LIMITED,
PARTICULARLY FOR TRIALS,
DIFFERENT GROUPS WERE BETTER
REPRESENTED IN OBSERVATIONAL
STUDIES THOUGH MULTIPLE STUDIES
DID NOT REPORT ON THIS
INFORMATION.
DIVERSITY AND SOCIOECONOMIC
POSITION AND AGE WAS MORE COMMON
IN THE OBSERVATIONAL STUDIES.
AND STUDIES INCLUDED IN
META-ANALYSIS WERE SIMILAR IN
GENERAL.
EXCEPT THAT THEY TEND TO SHOW
LESS RACIAL AND ETHNIC
DIVERSITY.
NEXT SLIDE.
THIS SLIDE IS SHOWING CONCLUSION
STATEMENT FOR RISK OF OBESITY.
SO CONSUMPTION IS ASSOCIATED
WITH HIGHER RISK OF OBESITY, AND
THIS CONCLUSION WAS BASED ON
EVIDENCE GRADED AS MODERATE.
SUBSTANTIALLY LARGER NUMBER
EXAMINED RISK OF OBESITY
OUTCOMES, AS BODY COMPOSITION
ROUGHLY HALF OF THE STUDIES
INCLUDED IN THE SYSTEMATIC
REVIEW WERE INCLUDED IN AT LEAST
ONE META-ANALYSIS.
AND THE OUTCOMES IN BOTH
META-ANALYSIS AND SYSTEMATIC
REVIEW WERE SIMILAR, WHEN WE
LOOK ACROSS GRADING COMPONENTS,
GRADING WAS SIMILAR FOR BODY
COMPOSITION AND THAT WAS BECAUSE
OF AN OVERLAP IN THE STUDIES
INCLUDED.
SO LOOKING AT CONSISTENCY, OVER
HALF EXAMINING RISK OF OBESITY
OUTCOMES FOUND A RELATIONSHIP
BETWEEN SUGAR SWEETENED BEVERAGE
CONSUMPTION AND ONE RISK OF
OBESITY OUTCOME.
MOST OF THE SIGNIFICANT FINDINGS
INDICATED THAT SUGAR SWEETENED
BEVERAGE CONSUMPTION WAS RELATED
TO HIGHER RISK OF OBESITY, AND
WITH NON-SIGNIFICANT FINDINGS
THEY STILL TRENDED IN THAT
DIRECTION.
FOR THE META-ANALYSIS, FINDINGS
ON CHANGE IN WEIGHT AND RISK OF
OVERWEIGHT OR OBESITY INDICATED
SIMILAR DIRECTION, WITH HIGHER
SUGAR SWEETENED BEVERAGE INTAKE
RELATED TO UNFAVORABLE OUTCOMES.
CONFIDENCE INTERVALS DID INCLUDE
ZERO, MODERATE TO HIGH
HETEROGENEITY IN MANY.
MOST TRIALS WEREE ADEQUATELY
POWERED, SAMPLE SIZES OVER A
THOUSAND PARTICIPANTS.
AND STUDIES HAD A MIX OF
REASONABLE OR WIDE 95%
CONFIDENCE INTERVALS.
FOR RISK OF BIAS, IN GENERAL,
RISK OF BIAS LOW IN TRIALS, MORE
SUBSTANTIAL IN THE OBSERVATIONAL
STUDIES, AND, AGAIN, THESE
OBSERVATIONAL STUDIES NORMALLY
THERE WERE ISSUES WITH ADJUSTIG
FOR CONFOUNDING OR MISSING DATA.
WITH DIRECTNESS AGAIN MOST
TRIALS WERE DESIGNED TO AFFECT
IN COMPARISON TO ANOTHER
BEVERAGE, MOST OF THE
OBSERVATIONAL STUDIES WERE
DIRECTLY ADDRESSING THIS
QUESTION.
AND AGAIN LASTLY FOR
GENERALIZABILITY IT WAS LIMITED
PARTICULARLY IN TRIALS, AND
AGAIN WE SAW BETTER
REPRESENTATION OF RACIAL AND
ETHNIC GROUPS IN OBSERVATIONAL
STUDIES, AND AGAIN FOR THE
META-ANALYSIS THERE WAS LESS
RACIAL AND ETHNIC DIVERSITY.
NEXT SLIDE.
SO NOW WE'LL LOOK AT PREGNANCY
AND GESTATIONALLY WEIGHT GAIN.
CONCLUSION STATEMENT COULD NOT
BE DRAWN RELATING SUGAR
SWEETENED BEVERAGE CONSUMPTION
BY INDIVIDUALS DURING PREGNANCY
AND GESTATIONAL WEIGHT GAIN DUE
TO CONCERNS WITH CONSISTENCY,
PRECISION, RISK OF BIAS,
DIRECTNESS, GENERALIZABILITY.
SO THERE WAS A SMALL NUMBER OF
ARTICLES WITH RELATIVELY SMALL
SAMPLE SIZES, RANGING FROM ABOUT
A HUNDRED TO 1400, BUT MOST
SAMPLE SIZES WERE IN THE
HUNDREDS.
IN SEVERAL CASES, THE DEFINITION
OF GESTATIONAL WEIGHT GAIN WAS
POORLY DEFINED.
SERIOUS CONCERNS WITH
CONSISTENCY ACROSS EXPOSURE AND
OUTCOME ASSESSMENTS SO EXPOSURE
WAS MEASURED AT DIFFERENT TIME
POINTS IN PREGNANCY USING
DIFFERENT ASSESSMENT METHODS.
STUDIES USED DIFFERENT
DEFINITIONS OF SUGAR SWEETENED
BEVERAGES SO SOMETIMES THEY ONLY
INCLUDED SOFT RANGES, OTHERS A
RANGE, GESTATIONAL WEIGHT GAIN
WAS MEASURED AT TIME POINTS,
TIMEFRAMES FOR GESTATIONAL
WEIGHT GAIN VARIED BETWEEN
BETWEEN STUDIES, MANY DID NOT
TAKE INTO ACCOUNT GESTATIONAL
AGE.
THESE CONCERNS PRECLUDED ABILITY
TO DISCERN THE RELEVANCE OF
FINDINGS TO THE U.S. POPULATION.
AND BECAUSE OF SMALLER SAMPLE
SIZES THERE WERE CONCERNS ABOUT
BEING UNDERPOWERED PARTICULARLY
FOR ADEQUACY OF GESTATIONAL
WEIGHT GAIN.
STUDIES ASSESSED HAVING HIGH
RISK OF BIAS IN AT LEAST ONE
DOMAIN AND MOST COMMONLY THIS IS
NOT ACCOUNTING FOR KEY
CONFOUNDERS, MISCLASSIFICATION,
NOT ACCOUNTING FOR MISSING DATA.
NONE OF THE STUDIES WERE
DESIGNED TO ASSESS RELATIONSHIP
BETWEEN SUGAR SWEETENED BEVERAGE
CONSUMPTION AND GESTATIONAL
WEIGHT GAIN SO ALL OF THEM ARE
LOOKING AT MULTIPLE DIETARY --
DIFFERENT DIETARY EXPOSURES.
NEXT SLIDE.
SO, HERE WE'RE LOOKING AT
RELATIONSHIP BETWEEN SUGAR
SWEETENED BEVERAGE CONSUMPTION
IN POSTPARTUM WITH WEIGHT
CHANGE, AND UNFORTUNATELY AGAIN
CONCLUSION STATEMENT COULD NOT
BE DRAWN BECAUSE THERE WAS NOT
ENOUGH EVIDENCE AVAILABLE SO
THERE WERE ONLY FOUR ARTICLES
THAT ASSESSED THIS RELATIONSHIP,
AND THEY SHOWED LITTLE
CONSISTENCY IN EXPOSURE
DEFINITION, EXPOSURE ASSESSMENT
TIMING AND METHOD, AS WELL AS
DURATION OF FOLLOW-UP.
AND LIKE THE EVIDENCE-BASED AND
INDIVIDUAL DURING PREGNANCY ALL
ARTICLES IN INDIVIDUALS DURING
POSTPARTUM WERE ASSESSED HAVING
HIGH RISK OF BIAS IN AT LEAST
ONE DOMAIN, ONLY ONE OF THESE
ARTICLES WAS SPECIFICALLY
DESIGNED TO ASSESS THIS
RELATIONSHIP.
NEXT SLIDE PLEASE.
THAT'S IT.
>> THAT WAS A GREAT
PRESENTATION.
>> I'M GOOD AT READING.
[LAUGHTER]
>> QUESTIONS?
>> WE'RE GOING TO TALK ABOUT
ADEQUACY OF WEIGHT GAIN IN
PREGNANCY, LOOKING DID THEY GAIN
ENOUGH OR TOO MUCH?
>> WE WERE USING THE IOM
GUIDELINES.
>> WITHIN A RANGE.
>> YEAH.
>> OKAY.
>> YOU MIGHT CLARIFY THAT A
LITTLE BIT.
>> REVIEWS INCLUDING ADULTS,
WERE ADOLESCENTS DURING
PREGNANCY TAKEN OUT OF THESE
ANALYSES?
I DON'T THINK THAT'S GENERALLY
COMMONLY REPORTED.
>> HI.
I BELIEVE THERE WAS ONE OF THE
ARTICLES IN INDIVIDUALS DURING
PREGNANCY THAT WAS SPECIFICALLY
IN ADOLESCENTS DURING PREGNANCY.
THERE'S ONE ARTICLE WITH
POPULATION BUT VERY RARE WE
WOULD SEE THAT CAPTURED.
>> PREGNANCY STUDIES ARE SMALL
ANYWAY, SO FEW OF THEM BUT
CURIOUS IF THERE WAS ANY TYPE OF
GUIDELINE WHEN IT COMES TO
INCLUDING ADOLESCENTS WITHIN
THOSE STUDIES.
>> THAT WOULD BE A GOOD
FOLLOW-UP OR RECOMMENDATION, AN
AREA YOU MIGHT SEE HIGHER
CONSUMPTION IN ADOLESCENTS.
>> CAN I ASK YOU A QUESTION
THAT'S RELATED TO WHAT WE'VE
SEEN OVER DIETARY PATTERNS?
I'LL PUT YOU ON THE SPOT.
SORRY.
I DO BELIEVE I MADE THIS COMMENT
BEFORE BUT I'VE HAD SO MANY
MEETINGS I DON'T KNOW WHICH ONE.
IT'S REALLY REMARKABLE TO ME
THAT PRIOR COMMITTEES CONDUCT A
SYSTEMATIC REVIEW AND THIS GRADE
THE CONCLUSION STATEMENT AS
MODERATE.
AND WE CAN ADD 80, 100 MORE
STUDIES, AND THE CONCLUSION
STATEMENT, THE FOODS DON'T
CHANGE, AND THE GRADE STAYS
MODERATE.
BUT ONCE IN A BLUE MOON IT GOES
FROM MODERATE TO STRONG.
I WONDERED IN YOUR REVIEW WHERE
DO YOU THINK -- WELL, LET'S JUST
TAKE THE SUGAR-SWEETENED
BEVERAGES.
WHAT DO WE NEED FROM SCIENCE,
FROM RESEARCH, TO GET US FROM
MODERATE TO STRONG?
WHAT WERE SOME FACTORS THAT
JUST -- SORRY, I ASKED A HARD
QUESTION.
>> I HAVE A GENERAL ANSWER TO
THAT.
BASED ON FIVE CRITERIA THAT WE
USED IN GRADING, ESPECIALLY I
HAVE TO SAY BASED ON THE
SECTIONS AND OUTCOMES, IT IS
REALLY CONFOUNDING.
CONFOUNDING IS ONE THING.
SOMETIMES CONFOUNDERS WERE NOT
MEASURED AND ADJUSTED IN
SUFFICIENT DETAILS.
THAT'S NUMBER ONE.
NUMBER TWO THING IS DIET WAS
ONLY MEASURED AT ONE TIME POINT
ALONG, AND GENERALIZABILITY,
SITTING THROUGH THE SIXTH
MEETING, GENERALIZABILITY SEEMS
TO BE ONE THAT'S NOT QUITE THERE
YET.
PEOPLE ARE NOT PAYING ATTENTION.
BUT GENERALIZABILITY, IT COMES
FROM THE BAT.
AND DATA,GOOD OBSERVATIONAL DATA
REQUIRES A LOT OF FUNDING TO DO.
AND SO THEREFORE BACKTRACK IT
BACK, THEN IT ALMOST COMES FROM
THE FUNDING, ALSO SOMETHING
THAT'S GOING TO DRIVE THE
QUALITY OF THE DATA THAT WE
HAVE.
THE DIRECTION IS NOT THE
PROBLEM.
IT'S REALLY THE DIET
MEASUREMENT, FUNDING TO DO
MULTIPLE MEASUREMENTS, GOOD
MEASUREMENTS AND CONFOUNDERS FOR
THAT ARE.
>> I'M GOING TO LET HOLLI GO
FIRST.
>> TO ECHO THERESA'S COMMENT, I
THINK THE ISSUE OF
GENERALIZABILITY IS CONSISTENT
ACROSS MANY OF OUR SYSTEMATIC
REVIEWS, ESPECIALLY PUTTING THE
HEALTH EQUITY LENS, YOU BEGIN TO
NOTICE THAT MORE.
I THINK WHICH PREVIOUSLY MIGHT
NOT HAVE, YOU KNOW, BEEN
SOMETHING THOUGHT ABOUT QUITE AS
MUCH BUT THAT GENERALIZABILITY
ISSUE SEEMS TO BE PRETTY
CONSISTENT ACROSS MANY OF OUR
QUESTIONS.
>> THANK YOU, HOLLIE.
DEE DEE HAS A COMMENT.
>> WHAT ADDITIONAL EVIDENCE
WOULD BE NEEDED, I WROTE IT DOWN
IN A LIST BECAUSE I HAD THE SAME
QUESTION.
I THOUGHT OF, BECAUSE I THINK
THE CERTAINTY OF SUGARY
BEVERAGES AS A CAUSAL DIETARY
EXPOSURE FOR OBESITY IS NOT
WHAT'S BEING DEBATED AS MUCH AS
MAYBE SOME OF THE NUANCE THAT
PERHAPS THE PUN U. PUBLIC --
PUBLIC OR INDUSTRY MAY BE MORE
INTERESTED IN THAT COULD BE
DRIVING UNCERTAINTY, LIKE DOSE
AND FREQUENCY, HOW MANY CAN I
HAVE, RIGHT?
WE DON'T NEED ANY.
IF IT'S RECREATIONAL, IS THERE A
CUT POINT?
ARE THERE TYPES THAT MAYBE ARE
MORE OR LESS CONSISTENT WITH THE
EVIDENCE IN EXAMPLES WE HEARD
LIKE MILK AND COFFEE DRINKS,
FLAVORED MILK, SPORTS DRINKS,
WHATEVER, ARE THESE ALL THE SAME
OR ARE THERE MAYBE SOME NUANCE
THERE.
AND WHAT'S THE REPLACEMENT
BEVERAGE, WHICH PRESUMABLY IS
WATER BUT THERE'S A LOT OF OTHER
THINGS PEOPLE ARE CONSUMING,
ARTIFICIALLY SWEETENED
BEVERAGES, REAL QUESTIONS IF YOU
SAY THEY ARE BAD THAT MAY
REQUIRE THAT NUANCE.
THOSE ARE ALL IMPORTANT AREAS OF
RESEARCH.
BUT I AGREE IT STILL SEEMS FUNNY
THAT IT'S MODERATE WHEN THIS
IS -- I DON'T THINK IT'S
SOMETHING THAT WE'RE GOING TO
SUDDENLY COME TO THE CONCLUSION,
OH, LET'S ADD IT IN, RIGHT?
SO BUT THERE ARE SOME GAPS,
IMPLEMENTATION OF ADVICE I'D
LOVE TO SEE FILLED BECAUSE I
THINK WE SAW IN SOME DATA
TRENDS, IT'S THE ONE FOOD AND
BEVERAGE ITEM THAT'S GONE DOWN
SIGNIFICANTLY, THAT'S HUGE, ONE
OF VERY FEW SUCCESS STORIES
TODAY.
THANK YOU FOR BRINGING UP THAT
QUESTION.
>> FATIMA?
>> OH, SORRY?
>> IN CONJUNCTION WE SAW NHANES
DATA YESTERDAY SEEING DECLINE OR
STABILIZATION OF OBESITY RATES
FOR THE FIRST TIME SINCE THEY
HAVE BEEN RECORDED.
I KNOW THAT WE'VE BEEN LOOKING
AT NHANES DATA FOR A LONG TIME,
MAYBE SOME INFORMATION WE'RE
REPORTING ON MAY JUXTAPOSE WHAT
YOU WERE SPEAKING OF, DEE DEE,
SOME OF THESE TRENDS THAT WE'VE
BEEN FOLLOWING.
WE HAVE A LOT OF WORK FOR
IMPROVEMENT SO I DON'T THINK WE
CAN PAT OURSELVES ON THE BACK OR
JUMP FOR JOY YET, BUT TO SEE THE
TREND, NOW WE DID SEE AN
INCREASE IN RATES OF SEVERE
OBESITY, IN THE CONTEXT OF DATA
THAT CAME OUT YESTERDAY SO WE
HAVE SIGNIFICANT WORK TO BE DONE
BUT SOME TRENDS ARE IMPROVING
OVER TIME AND SO I THINK WE CAN
CONTINUE TO MAKE KEY EFFORTS BUT
SOME TRENDS ARE SHOWING SOME
POTENTIAL PROMISE.
>> I LOVE POSITIVE NEWS.
>> THIS IS NOT NECESSARILY TO
SUGAR SWEETENED BEVERAGES BUT
OTHER SYSTEMATIC REVIEWS, BUT
ONE OF THE THINGS THAT WE FIND
IS EVIDENCE COMES FROM OTHER
COUNTRIES WITH LONG PROSPECTIVE
COHORT STUDIES, AND THE COHORT
STUDIES IN THE U.S. ARE NOT
BEING FUNDED AT THE SAME RATE AS
THEY WERE.
AND WHEN THEY COME FROM OTHER
COUNTRIES THE DIETARY PATTERNS
CAN BE VERY DIFFERENT TOO, SO
THERE'S SEVERAL FACTORS THERE.
I THINK ANOTHER THING IF YOU
LOOK AT OUR STRONG EVIDENCE,
LIKE THE CARDIOVASCULAR DISEASE,
WE WERE ABLE TO HONE DOWN TO
U.S. STUDIES AND STILL HAD A
VERY ROBUST BODY OF EVIDENCE,
DIABETES THE SAME WAY, BECAUSE
WE'VE HAD -- WE HAD A LARGE BODY
OF EVIDENCE AND THOSE ARE FUNDED
BY NHLBI FOR THE MOST PART,
NIDDK, WHEN YOU SEE THE U.S.
STUDIES, OTHER GROUPS AS WELL,
AMERICAN HEART, AMERICAN
DIABETES ASSOCIATION.
SO YOU KNOW YOU DO HAVE GROUPS
THAT ARE FUNDING THIS.
SO THINK THOSE ARE SOME
CONTRIBUTORS TO THAT.
>> I SEE A RECOMMENDATION TO
FEDERAL AGENCIES FORMING AS WE
SPEAK.
GREAT DISCUSSION.
OTHER QUESTIONS?
>> ONE MORE FUN FACT NOT TO PILE
ON POSITIVE NEWS BUT SUGARY
BEVERAGES STILL 10% OF OUR
CALORIE INTAKE, STILL REALLY
HIGH.
IT'S THE NUMBER ONE SOURCE OF
CALORIES ESPECIALLY IN TEENS.
THEY ARE GOING DOWNWARD BUT IT'S
GOT A LONG WAY TO GO.
>> THANKS.
I THINK WE HAVE A BREAK NOW.
>> I'M SO ENGAGED.
SO EXCITED ABOUT POSITIVE NEWS.
WE DO.
WE HAVE A BREAK.
MY APOLOGIES TO THE PUBLIC.
I'M LOSING TRACK OF TIME.
WE HAVE A BREAK UNTIL 2:40.
THANK YOU FOR THE GREAT
DISCUSSION.
AND LET'S CONTINUE.
THE LAST
SESSION OF THE DAY, AND WE HAD A
GREAT DISCUSSION BEFORE THE
BREAK, SO I'M GOING TO HAND IT
BACK TO YOU, DEANNA, TO LEAD THE
LAST SESSION
>> THANK YOU.
BEFORE WE GET STARTED ON THIS,
AGAIN I WANT TO THANK THE STAFF
AND THE COMMITTEE MEMBERS FOR
DOING THIS BECAUSE WE DID A LOT
OF WORK IN A SHORT PERIOD OF
TIME AND PEOPLE WILL TO BE
RESPONSIVE AND THEY WERE.
I APPRECIATE THAT.
TO START US OFF, JUST TO TELL
YOU HOW MASSIVE THIS WAS, WE
STARTED OUT WITH 36,000
ARTICLES.
AND SO WE ENDED UP WITH 100.
AND ALL OF THOSE HAD MULTIPLE
OUTCOMES.
SO YOU'LL SEE WHEN WE LOOK AT IT
WE'LL POINT THAT OUT AS WE GO
ALONG.
WE'RE GOING TO START OFF BY DR.
TOBIAS GIVING US SOME GROUND
RULES WE USED AND SOME OF THE
DATA BECAUSE WE'RE USING
SLIGHTLY DIFFERENT DATA THAN
WHAT WE'VE USED BEFORE,
DIFFERENT METHODOLOGIES, SO
SHE'LL EXPLAIN THAT.
AND THEN I'LL TALK ABOUT DAIRY
UNSATURATED FAT AND THEN DR.
GARDNER WILL COME IN AND TALK
ABOUT MEAT AND PLANT SOURCES OF
SATURATED FAT, AND I'LL END UP
WITH A SUMMARY BECAUSE WE DON'T
EXPECT YOU TO REMEMBER ALL 31 AS
WE GO THROUGH.
WE'LL GIVE A SUMMARY AT AT THED
AND HAVE A DISCUSSION.
>> I THINK WE SHOULD HAVE A TEST
AT THE END OF THIS SESSION.
[LAUGHTER]
>> ALL RIGHT.
THANK YOU.
NEXT SLIDE PLEASE.
THIS IS THE FRAMEWORK THAT WE
DEVELOPED OUR QUESTIONS FROM.
AND AS YOU CAN SEE, INTERVENTION
EXPOSURE COLUMN INCLUDE
CONSUMPTION OF SATURATED FATTY
ACID-RICH FOODS.
THOSE INCLUDED ANIMAL SOURCES OF
SATURATED FAT, DAIRY AND MEAT
WHICH INCLUDED WHITE MEAT,
PROCESSED MEAT, MILK, CHEESE,
YOGURT, BUTTER, GHEE, PLANT
SOURCES INCLUDING TROPICAL FOOD
SOURCES OF OILS, PALM OIL,
COCONUT OIL, CO-COA BUTTER,
SHORTENING, BAKED GOODS.
LOOKING WITHIN SATURATED FAT
FOODS AND THOSE THAT DON'T
QUALIFY, THE OUTCOMES LISTED
HERE ARE CARDIOVASCULAR DISEASE,
INTERMEDIATES AMONG CHILDREN,
ADOLESCENTS, AS WELL AS ADULTS,
BASED ON INCIDENCE OF
CARDIOVASCULAR EVENTS IN ADULTS
WE LOOKED ONLY AMONG THEM FOR
MORBIDITY AND MORTALITY.
MORBIDITY WOULD INCLUDE HEART
ATTACKS AND STROKE.
THAT WERE FATAL OR NON-FATAL.
KEEP THAT IN MIND WHEN POSSIBLE.
WE ATTEMPTED TO TEASE OUT
CARDIOVASCULAR DISEASE MORTALITY
AS ITS OWN ENDPOINT.
AS A SUBSET OF CVD MORBIDITY,
YOU'LL SEE MORTALITY IN SOME
CASES AS ITS OWN CONCLUSION
STATEMENT OR LISTED WITH OTHER
ENDPOINTS AND THAT'S FOR THAT
REASON.
KEY CONFOUNDERS ARE LISTED IN
THE FINAL COLUMN THERE.
NEXT SLIDE.
AND AS DEANNA MENTIONED JUST
SOME EPI101 OR MAYBE 1001
CONTEXT FOR WHAT THESE -- THE
COHORT ANALYSES IN PARTICULAR
ARE DOING.
REITERATING THREE BROAD
CATEGORIES, DAIRY, MEAT WHICH
INCLUDES POULTRY AND EGGS, PLANT
BASED SOURCES OF SATURATED FAT.
ALL THE OTHER FOODS AS WELL THAT
ARE NOT SATURATED FAT-CONTAINING
FOODS AND EVERY POSSIBLE
COMBINATION BETWEEN THEM.
IF YOU LOOKED AT RANDOMIZED
TRIAL LITERATURE YOU MIGHT SEE
SOMETHING LIKE HIGH FAT MILK
COMPARED TO LOW FAT MILK,
BUTTERMILK VERSUS BUTTER, LEAN
MEAT VERSUS EGGS AND
COMBINATIONS.
THE INTENT OF THIS QUESTION
OVERARCHING ALL OF THIS IS TO
REALLY UNDERSTAND IF THERE IS
NUANCE BETWEEN SATURATED
FAT-TAKE FOOD, ACKNOWLEDGING
FOODS ARE COMPLEX AND IF THERE
IS A DIFFERENCE BETWEEN ONE
SOURCE OF SATURATED FAT AND
ANOTHER, WHETHER ANIMAL OR PLANT
BASED SOURCE, THIS COULD BE
RELEVANT FOR TAILORING OR
MESSAGING OR EVEN MODIFYING.
SO, THIS IS THE HEAD-TO-HEAD
COMPARISON, REALLY AT THE FOOD
LEVEL WHAT WE WANTED TO
UNDERSTAND BETTER.
BUILDING ON PAST GUIDELINE
CYCLES THAT ESTABLISHED
OVERARCHING GUIDANCE AROUND
SATURATED FATS.
INCLUSION OF COHORT STUDIES
DESIGNING A RANDOMIZED
CONTROLLED TRIAL INTERESTED IN
DAIRY VERSUS SOMETHING ELSE, YOU
WOULD PROBABLY SPECIFY THAT
SOMETHING ELSE AND YOU MAY FEED
HALF OF YOUR PARTICIPANTS CHEESE
AND THE OTHER HALF BROCCOLI OR
WHATEVER IT MIGHT BE.
YOU WOULDN'T JUST FEED ONE HALF
CHEESE AND THEN GIVE THE OTHER
HALF NOTHING, SO THAT
SPECIFICATION OF A COMPARATOR IS
INHERENT IN DESIGN OF A TRIAL.
TRADITIONALLY, THE EPIDEMIOLOGIC
LITERATURE OF INDIVIDUAL FOODS
DOES NOT NECESSARILY HAVE TO
SPECIFY THAT COMPARATOR.
YOU CAN ASK QUESTIONS LIKE DO
PEOPLE WHO CONSUME HIGHER
AMOUNTS OF RED MEAT HAVE HIGHER
RISK OF CARDIOVASCULAR DISEASE
THAN THOSE WHO EAT LESS RED
MEAT?
IT'S VALID BUT VAGUE IF YOU'RE
TRYING TO UNDERSTAND COMPARED TO
WHAT.
SO WHAT ARE THE PEOPLE WHO ARE
NOT CONSUMING YOUR TOP CATEGORY
OF RED MEAT CONSUMING INSTEAD,
THAT'S INHERENT IN YOUR CONTROL
GROUP IN AN RCT.
IF YOU ARE FAMILIAR WITH
LITERATURE AROUND CARDIOVASCULAR
AND DIET YOU CAN ENVISION A
FOREST PLOT, MAYBE MESSY, MAYBE
NOT CONSISTENT ENOUGH TO DRAW A
CONCLUSION FROM ONE GIVEN FOOD,
PART COULD BE NOISE AND
CONFUSION AND DON'T KNOW WHAT TO
RECOMMEND BUT IT'S ACTUALLY AS
WE'VE ACCUMULATED THIS EVIDENCE
ACROSS GLOBAL COHORTS, WE HAVE
TO ACKNOWLEDGE THAT THERE'S THIS
REALLY MEANINGFUL COMPARATOR
GROUP THAT'S VERY DIFFERENT
ACROSS ALL POPULATIONS.
SO IF YOU'RE LOOKING IN 20
COUNTRIES AMONG COHORTS WHERE
YOU HAVE THE CATEGORY OF HIGH
RED MEAT INTAKE VERSUS LOW RED
MEAT INTAKE, THAT COMPARATOR,
WHAT ARE THE PEOPLE WHO AREN'T
EATING THAT AMOUNT OF RED MEAT
EATING INSTEAD, COULD LOOK VERY,
VERY DIFFERENT.
IT MIGHT BE SOMETHING HEALTHY,
MIGHT BE SOMETHING COMPLETELY
UNHEALTHY.
SO, WHEN YOU'RE NOT SPECIFYING
IT'S ACTUALLY STATISTICALLY THE
AVERAGE OF THE BACKGROUND DIET.
IF IT'S A HEALTHY POPULATION,
UNHEALTHY MIX, ALL OF THAT
MATTERS AND IN FACT MAY EXPLAIN
A LOT OF THAT SORT OF VISUALLY
SEEMING CONFUSION AND
HETEROGENEITY.
SO, TO ANCHOR THE SORT OF
SUBSTITUTION ANALYSES THAT WE'LL
INTRODUCE HERE AS WE'RE
COMPARING FOOD VERSUS FOOD, IS
BUILDING ON THE SORT OF SINGLE
FOOD EPIDEMIOLOGIC HYPOTHESES BY
SIMPLY SPECIFYING WHAT YOUR
COMPARATOR IS JUST LIKE AN RCT.
SO, IF THERE WERE ANALYSES OR
PAPERS THAT YOU'LL SEE WHERE
IT'S MAYBE POULTRY VERSUS TEN
DIFFERENT FOODS, WHAT THESE
ANALYSES ARE DOING IS SIMPLY
SWAPPING OUT WHAT THAT CONTRAST
SPECIFICALLY IS, SO IF IT'S RED
MEAT VERSUS POULTRY, DAIRY,
VEGETABLES, IT'S SAYING INSTEAD
OF PEOPLE WHO EAT RED MEAT
COMPARED TO PEOPLE WHO DON'T
IT'S PEOPLE WHO EAT RED MEAT
VERSUS PEOPLE WHO EAT LESS RED
MEAT AND MORE DAIRY, MORE
VEGETABLES, GETTING LEVEL OF
SPECIFICITY THAT YOU WOULD WANT
TO UNDERSTAND, YOU KNOW, DOES
THAT COMPARED TO WHAT MATTER FOR
YOUR EXPOSURE GROUPS OF
INTEREST.
SO, THAT WAS A LOT.
CONGRATULATIONS, YOU GOT 2.5
CREDITS, NUTRITIONAL
EPIDEMIOLOGY.
LET ME MAKE SURE THERE WEREN'T
ANY OTHER IMPORTANT POINTS WHILE
WE'RE GEEKING OUT ON METHODS
BEFORE I TURN TO RESULTS.
I REALLY THINK THAT COVERS IT.
AND, OH, SO THE FINAL SET OF
BULLETS HERE IS JUST THE
LANGUAGE WE'RE PUTTING AROUND,
WHEN WE ARE DRAWING CONCLUSIONS
FROM PREDOMINANTLY RCT EVIDENCE,
WHERE YOU HAVE THIS EXPLICIT
REPLACING OR CONTRASTING OF
FOODS VERSUS SUBSTITUTING WHICH
IF YOU'RE REFERRING TO
SUBSTITUTION ANALYSES, FOR SOME
CONCLUSIONS, IT'S A MIXED BAG,
WHATEVER WAS MOST I GUESS
PREDOMINANT STUDY DESIGN TYPE.
OH WITH THAT I'LL TURN IT OVER
TO TO DEANNA TO KICK OFF WITH
DAIRY.
>> THANKS FOR GOING INTO THAT
EXPLANATION.
YOU NEED IT WHEN YOU START TO
SEE THE EVIDENCE HERE.
SO I'M GOING TO TALK ABOUT DAIRY
SOURCES OF SATURATED FAT.
I HAVE SIX SLIDES WITH EIGHT
CONCLUSION STATEMENTS ON THEM.
SO, THE FIRST ONE HAS TWO
CONCLUSION STATEMENTS ON THEM.
SO I'LL START ON THE LEFT.
SUBSTITUTING HIGHER FAT DAIRY
WITH LOWER FAT DAIRY BY ADULTS
AND OLDER ADULTS IS NOT
ASSOCIATED WITH DIFFERENCE IN
RISK OF CARDIOVASCULAR DISEASE
MORBIDITY.
THIS CONCLUSION STATEMENT IS
BASED ON EVIDENCE GRADED AS
LIMITED.
SO FOR THIS I WANTED TO CALL OUT
A FEW POINTS.
FIRST IS IN THIS WHEN WE SAY
HIGHER FAT DAIRY WE MEAN VARIETY
OF DAIRY PRODUCTS.
SO IN THIS CASE WE HAD DAIRY NOT
SPECIFIED.
WE HAD MILK, CHEESE, YOGURT,
THEY WERE THE DAIRY PRODUCTS
INVOLVED IN THIS.
THE COMPARISONS AS DEE DEE
MENTIONED, SO BECAUSE THIS IS
MORBIDITY IT IS LIKELY TO HAVE
INCLUDED SOME MORTALITY IN IT AS
WELL.
LAST THING IS THIS STATEMENT,
JUST COMPARES THE TWO DAIRY,
HIGHER FAT AND LOWER FAT, WITH
CARDIOVASCULAR DISEASE RISK FOR
MORBIDITY SO IT DOESN'T COMPARE
THEM WITH CARDIOVASCULAR DISEASE
THEMSELVES, A IT'S A ONE-TO-ONE
COMPARISON.
BODY OF EVIDENCE FOR THIS WERE
EIGHT ARTICLES, ALL PROSPECTIVE
COHORT STUDIES, 14 COMPARISONS
WE LOOKED AT.
THERE WERE A FEW CEREBRAL
CORTEXES, MOST STUDIES
CONFIDENCE INTERVALS WERE
NARROW.
RISK OF BIAS WE HAD ISSUES WITH
SENSITIVITY, HOW EXPOSURE WAS
MEASURED AND REPORTED.
DAIRY WAS NON-SPECIFIED DAIRY,
THEY WOULD HAVE DAIRY LOW FAT,
DAIRY MIGHT HAVE INCLUDED 1%,
2%, YOU DIDN'T KNOW THE EXACT
PERCENTAGE.
STUDIES DID NOT HAVE A
PRE-SPECIFIED ANALYSIS PLAN SO
THAT RESULTED IN CONCERNS WITH
THE SELECTION OF REPORTED
RESULTS.
SO THE DIRECTNESS, THERE WERE
SOME CONCERNS WITH DIRECTNESS,
MAINLY BECAUSE WE DIDN'T HAVE
ANY TRIALS.
SO THOSE WERE THE CONCERNS
THERE.
THERE WERE SERIOUS CONCERNS WITH
GENERALIZABILITY, MOST STUDIES
CONDUCTED IN NON-U.S. SETTINGS.
SO RACE AND/OR ETHNICITY,
SOCIOECONOMIC POSITION WERE
OFTEN NOT REPORTED.
A LOT OF THE GRADING ELEMENTS
ARE THE SAME SO I WILL SKIP
THROUGH THEM WITH SOME OF THE
OTHER STATEMENTS AS I GO THROUGH
BECAUSE IT'S SIMILAR AS WHAT I
JUST SAID.
SO, ON THE RIGHT THE SECOND
CONCLUSION STATEMENT IS A
CONCLUSION STATEMENT CANNOT BE
DRAWN ABOUT THE RELATIONSHIP
BETWEEN HIGHER FAT DAIRY
CONSUMPTION COMPARED TO LOWER
FAT VERSIONS, BY ADULTS AND
OLDER ADULTS, AND BLOOD LIPIDS,
BLOOD PRESSURE, AND
CARDIOVASCULAR DISEASE MORTALITY
BECAUSE THERE'S NOT ENOUGH
EVIDENCE AVAILABLE.
THAT WAS A GRADE NON-ASSIGNABLE.
THERE WERE CEREBRAL CORTEXES
-- THERE WERE
CONCERNS WITH RISK OF BIAS, WITH
EXPOSURE WITH DAIRY
NON-SPECIFIED.
CONCERNS WITH GENERALIZABILITY.
NEXT SLIDE.
NEXT TWO SLIDES ARE COMPARING TO
FOOD SOURCES OF UNSATURATED
FATTY ACIDS.
THIS IS COMPARING DAIRY TO FOOD
SOURCES OF UNSATURATED FATTY
ACIDS.
SUBSTITUTING DAIRY WITH FOOD
SOURCE S MAY BE ASSOCIATED WITH
LOWER RISK, BASED ON EVIDENCE AS
LIMITED.
TO GROUND YOU, FOOD SOURCES OF
UNSATURATED FATTY ACIDS THAT
WERE THE COMPARATOR INCLUDED
FISH, OLEIVE OIL, AVOCADO,
EXAMPLES OF SOME STUDIES.
BODY OF EVIDENCE INCLUDED SEVEN
A LITTLER, TWO RCTs, FIVE
COHORT STUDIES BUT WE HAD 11
COMPARISONS.
AS BEFORE THERE WAS SOME
CONCERNS WITH CONSISTENCY, WITH
PRECISION, THE TRIALS HAD
SMALLER SAMPLE SIZES, HOWEVER
THE PROSPECTIVE COHORT STUDIES
HAD LARGE SAMPLE SIZES,
CONFIDENCE INTERVALS WERE
NARROW.
THERE WERE SOME CONCERNS WITH
RISK OF BIAS, USUALLY THOSE WERE
DUE TO CONFOUNDING DIRECTNESS,
AGAIN THERE WERE A LOT OF
MODELING STUDIES, NOT AS MANY
RCTs, SERIOUS CONCERNS WITH
GENERALIZABILITY.
THIS IS ONE THAT FIVE STUDIES
WERE CONDUCTED IN THE U.S. BUT
PARTICIPANTS ENROLLED STILL HAD
LIMITED DIVERSITY.
THIS IS BUTTER COMPARED TO
UNSATURATED FATTY ACIDS, ALL ARE
ADULTS AND OLDER ADULTS THAT I'M
GOING THROUGH NOW.
CONCLUSION STATEMENT TO THE LEFT
IS REPLACING BUTTER WITH
PLANT-BASED OILS WITH
UNSATURATED FATTY ACIDS BY
ADULTS AND OLDER ADULTS
DECREASES LDLC LEVELS, DOES NOT
AFFECT HDLC OR TRIGLYCERIDE
LEVELS, EVIDENCE STRONG.
PLANT BASED OILS AND SPREADS
INCLUDED OLIVE OIL, MARGARINES
WITH LOW FAT CONTENT,
BUTTER
MIXES.
12 RCTs, 11 WERE CROSSOVERS,
ONE A PARALLEL RCT, AND THEN
THERE WERE 21 COMPARISONS.
THIS WAS EXTREMELY CONSISTENT
RESULTS.
OF ALL OF THE -- THIS WAS THE
ONLY STRONG CONCLUSION STATEMENT
WE HAD, AND IT WAS VERY
EAVEDDENED, SO CHRISTOPHER LIKES
TO SAY BUTTER IS NOT BACK.
WHEN YOU LOOK AT ITS RESULTS ON
THE OUTCOMES OF LDL CHOLESTEROL
LEVELS IT SHOWED AN ASSOCIATION
WITH THAT.
IF THERE FEW CONCERNS WITH
PRECISION, LACK OF BIAS,
RANDOMIZATION METHODS, A FEW
CONCERNS WITH DIRECTNESS BECAUSE
OF THE TRIALS, BUT MAJORITY OF
THE TRIALS WERE NOT CONDUCTED IN
THE U.S.
THE SECOND CONCLUSION STATEMENT
HERE SUBSTITUTING BUTTER WITH
PLANT BASED OILS AND SPREADS BY
ADULTS AND OLDER ADULTS MAY BE
ASSOCIATED WITH DECREASED RISK
OF CARDIOVASCULAR DISEASE
MORBIDITY AND MORTALITY.
THIS IS BASED ON EVIDENCE GRADED
AS LIMITED.
THIS EVIDENCE BASE CONSISTED OF
SIX PROSPECTIVE COHORT STUDIES,
12 COMPARISONS.
AND SO THERE WERE SOME
SUBSTANTIAL CONCERNS WITH
CONSISTENCY, SOME CONCERNS WITH
PRECISION, RISK OF BIAS, AND
DIRECTNESS BECAUSE THERE WEREN'T
ANY TRIALS ASSOCIATED WITH THIS.
AND THEN SERIOUS CONCERNS WITH
GENERALIZABILITY.
THE EVIDENCE WASN'T AS STRONG
FOR LONG-TERM OUTCOMES.
NEXT SLIDE.
WE'RE COMPARING ONE FORM OF
DAIRY TO ANOTHER FORM FOR ADULTS
AND OLDER ADULTS.
CONCLUSION STATEMENT IS
SUBSTITUTING REPLACING ONE FORM
OF DAIRY AND THIS INCLUDED MILK
YOGURT CHEESE BUTTER, BUTTERMILK
WITH ANOTHER FORM OF DAIRY, NOT
ASSOCIATED WITH DIFFERENCE IN
RISK OF CARDIOVASCULAR DISEASE.
THIS CONCLUSION STATEMENT IS
BASED ON EVIDENCE GRADED AS
MODERATE.
HERE WE HAD TEN ARTICLES, SIX
RCTs, FOUR COHORT STUDIES WITH
66 COMPARISONS.
A LOT OF COMPARISONS HERE.
THERE WAS SOME CONCERNS WITH
CONSISTENCY BECAUSE WE DID HAVE
MANY STUDIES SHOWING NO EFFECT
OR ASSOCIATION, SOME CONCERNS
WITH PRECISION, RISK OF BIAS,
AGAIN CONCERNS WITH DIRECTNESS
AS I MENTIONED BEFORE, AND AGAIN
GENERALIZABILITY, A LOT OF THE
STUDIES WERE NOT CONDUCTED IN
THE U.S.
CHEESE TO LOW FAT OR WHOLE FAT
YOGURT OR WHOLE FAT YOGURT TO
BUTTERMILK, EVERY COMBINATION
YOU COULD THINK OF IN THESE
FORMS OF DAIRY.
NEXT SLIDE.
WE DID LOOK AT DAIRY SOURCES OF
SATURATED FAT COMPARED TO
CARBOHYDRATE AND PROTEIN, GRADE
NOT ASSIGNABLE, 12 ARTICLES, 10
RCTs, TWO COHORTS, 19
COMPARISONS.
THIS IS QUITE A FEW ARTICLES FOR
THIS, BUT THERE WERE A LOT OF
CONCERNS WITH CONSISTENCY IN THE
FINDINGS AND THEN THERE WAS
HETEROGENEITY IN BOTH
INTERVENTION AND COMPARATORS.
AN EXAMPLE THERE WERE STUDIES
THAT LOOKED AT EGGS,
SUGAR-SWEETENED BEVERAGES AND
LEGUMES, HARD TO FIND ENOUGH OF
ONE COMPARATOR TO PUT IT IN A
GROUP.
THIS IS DEFINITELY AN AREA WHERE
WE NEED MORE CONSISTENCY.
AND MORE WORK IN THE FUTURE.
SO NEXT SLIDE.
WE DID LOOK AT DAIRY SOURCES OF
SATURATED FAT IN CHILDREN AND
ADOLESCENTS.
CONCLUSION STATEMENT IS
CONCLUSION STATEMENT CANNOT BE
DRAWN ABOUT DAIRY SOURCES OF
SATURATED FAT AND COMPARATORS
CONSUMED BY CHILDREN AND
ADOLESCENTS AND RELATIONSHIP
WITH LIPIDS OR BLOOD PRESSURE.
COMPARATORS CONSIDERED INCLUDED
SIMILAR FOOD SOURCES WITH
DIFFERENT AMOUNTS OF TOTAL FAT,
FOOD SOURCES UNSATURATED FAT,
CARBOHYDRATE OR PROTEIN, GRADE
NON-ASSIGNABLE.
SO REALLY IN LOOKING AT THESE WE
SAW MIXED FINDINGS AND THERE WAS
A LOT OF HETEROGENEITY SO AGE
RANGE OF THE CHILDREN WAS VERY
DIFFERENT, BECAUSE THE AGE RANGE
VARIED THEY HAD DIFFERENT
REQUIREMENTS FOR DAIRY
CONSUMPTION.
THERE WAS SIMILAR CONCERNS WITH
GENERALIZABILITY ONLY ONE STUDY
CONDUCTED IN THE U.S.
SO THIS WAS SURPRISING TO US.
WE REALLY THOUGHT THERE WOULD BE
A LOT MORE STUDIES ON THIS
PARTICULAR TOPIC WITH KIDS.
ONE MORE CONCLUSION STATEMENT TO
GO.
THIS IS DAIRY COMPARED TO MEAT
SOURCES OF SATURATED FAT, A VERY
INTERESTING COMPARISON.
WE LOOKED AT TWO COMPARISONS AND
THIS IS IN ADULTS AND OLDER
ADULTS.
FIRST CONCLUSION STATEMENT IS
SUBSTITUTING PROCESSED MEAT AND
RHETT
RED MEAT IS ASSOCIATED WITH
LOWER RISK OF CARDIOVASCULAR
RISK MORTALITY, EVIDENCE GRADED
AS MODERATE.
SO HERE THE MEAT COMPARISONS
INCLUDED PROCESSED MEAT, RED
MEAT, TOTAL RED MEAT.
DAIRY INCLUDED LOW FAT AND HIGH
FAT DAIRY, NOT SPECIFIED, WHOLE
MILK AND CHEESE.
WE DID LOOK AT PROCESSED AND RED
MEAT SEPARATELY AND COMBINED
THEM BECAUSE THE RESULTS WERE
SIMILAR ACROSS THE TWO.
WE HAD TWO SIMILAR CONCLUSION
STATEMENTS.
SO THERE WERE SIX ARTICLES WHICH
WERE ALL PROSPECTIVE COHORT
STUDIES, 18 COMPARISONS.
THERE WERE FEW CONCERNS WITH
CONSISTENCY.
THIS WAS REALLY PRETTY
CONSISTENT ACROSS THE BOARD.
THERE WERE CONCERNS WITH
PRECISION, AGAIN WITH THE MEAT
OR THE DAIRY, EXACT SATURATED
FAT THERE.
CONCERNS WITH RISK OF BIAS,
DIRECTNESS, GENERALIZABILITY.
HERE MOST STUDIES WERE CONDUCTED
IN THE U.S., PARTICIPANTS HAD
LIMITED DIVERSITY.
THE LAST CONCLUSION STATEMENT
HERE IS CONCLUSION STATEMENT
CANNOT BE DRAWN ABOUT THE
RELATIONSHIP BETWEEN REPLACING
DAIRY WITH MEAT CONSUMPTION BY
ADULTS AND BLOOD LIPIDS, BLOOD
PRESSURE, CARDIOVASCULAR DISEASE
MORTALITY, BECAUSE THERE'S NOT
ENOUGH EVIDENCE AVAILABLE.
THERE WAS ONLY ONE NESTED CASE
CONTROL STUDY HERE, AND THERE
WERE SUBSTANTIAL CONCERNS
BECAUSE IT WAS A VERY LIMITED
BODY OF EVIDENCE.
AND SO WITH THAT, I'M GOING TO
TURN IT OVER TO CHRISTOPHER, FOR
THE MEAT AND PLANT SOURCES.
>> THANK YOU, DEE DEE AND DEANNA
FOR SETTING ME UP LIKE THIS.
THANKS TO CHERYL ANDERSON AND TO
CHRIS FOR HELPING US AND THE
WHOLE COMMITTEE.
BEFORE I GO TO THE NEXT SLIDE I
HAVE TO DO 11 SLIDES, 16
CONCLUSIONS.
SO THEY GROUP NICELY INTO A
COUPLE SETS.
THAT'S GOING TO HELP.
I'M GOING TO END UP WITH 7
MODERATE CONCLUSIONS, 3 LIMITED
GRADED CONCLUSIONS, 7 THAT ARE
NOT GRADED, 4 HAD NO PAPERS AT
ALL, TO SET YOU UP AHEAD OF
TIME.
AS YOU GO THROUGH IT, I DON'T
THINK I CAN READ THROUGH ALL THE
DIFFERENT PARTS, THERE'S A
LITTLE ONE THAT GETS TWEAKED
EACH TIME.
WHEN IT COMES TO PROCESSED AND
UNPROCESSED MEATS IT WAS
STUNNING WE NEVER SEPARATED THEM
OUT.
IT'S USUALLY TOTAL AND
PROCESSED, AND UNPROCESSED,
BECAUSE THEY WERE SO CONSISTENT
THERE'S NOT ENOUGH STUDIES,
WE'LL FIND SOMETHING ELSE,
MOSTLY YOU'LL SEE PROCESSED AND
UNPROCESSED WHICH MEANT TOTAL.
IF YOU WANT TO KNOW WHAT RED
MEAT IS, ALMOST ALWAYS BEEF.
SOMETIMES IT'S PORK.
VERY INFREQUENTLY LAMB.
COMPARATORS ARE A WHOLE SET OF
PLANT THINGS, WATCH THE
COMPARATORS CHANGE.
IT'S GOING TO BE PROTEIN PLANT
SOURCES, A COMBINATION OF
LEGUMES, BEANS, NUTS, SOY.
IT'S GOING TO BE ANIMAL BASED
SOURCES, WHITE MEAT, FISH AND
SEAFOOD, EGGS OR DAIRY BUT NOT
DAIRY FOR ME JUST YOU JUST
COVERED IT.
THAT ONE IS ALREADY TAKEN.
EVERYTHING IS IN ADULTS AND
OLDER ADULTS, NOTHING IS IN
KIDS.
ALL THOSE HAD ZERO PAPERS.
WHEN IT COMES TO OUTCOME, TO
SUMMARIZE IT'S FUN LOOKING
THROUGH IT.
TOPIC IS CARDIOVASCULAR DISEASE.
THE WAY WE APPROACHED IT, DEE
DEE SET US UP SO NICELY, IF IT'S
INTERMEDIATE IT WAS A RANDOMIZD
CONTROLLED TRIAL, LIPIDS AND
BLOOD PRESSURE.
YOU COULD TELL FROM WHAT DEANNA
WAS PRESENTING IF IT WAS AN RCT
QUITE OFTEN ONLY LDL, FINDINGS
FOUND NO ASSOCIATION, INSTEAD OF
SAYING LDL, HDL, TRIGLYCERIDES
SAID LIP ITS.
BLOOD PRESSURE IS ALWAYS
INCLUDED, NOT ALWAYS STATED.
NO REAL MECHANISM TO EXPLAIN
CHANGE IN BLOOD PRESSURE BUT
PART OF INTERMEDIATE OUTCOMES,
NO, OUTCOMES --
NOT ALWAYS CONSISTENTLY
MEASURED.
ALMOST ALL OF WHAT I'LL PRESENT
IS MORBIDITY, INCLUDING
MORTALITY, NOT NECESSARILY, BUT
IT CAN.
FEW STUDIES SAID ANYTHING ABOUT
MORTALITY.
ONLY PLACE YOU'LL SEE THAT WHEN
WE REFER TO NULL FINDINGS,
NOTHING FOR CARDIOVASCULAR
DISEASE, EITHER LIPIDS OR
MORBIDITY AND MORTALITY.
ALL THESE THINGS KEEP CHANGING
IN MY 16 CONCLUSIONS, DRUM ROLL
PLEASE.
NEXT SLIDE.
LET'S START WITH RED MEAT VERSUS
PLANT SOURCES OF PROTEIN.
LOOK AT THE TOP.
PROCESSED AND UNPROCESSED MEATS.
SPECIFICALLY THE PLANT SOURCES
OF PROTEIN, LEGUMES AND NUTS,
SOY.
IT'S SPECIFICALLY MORBIDITY.
AND IT'S A LOWER RISK OF
MORBIDITY WITH THE PLANT
RELATIVE TO THE RED MEAT, AND
MODERATE.
AND THE NEXT ONES WILL BE WHOLE
GRAINS AND -- WHAT'S THE OTHER
ONE?
VEGGIES.
IT'S SORT OF THE SAME PILE OF
CONSISTENCY, PRECISION, RISK OF
BIAS, DIRECTNESS,
GENERALIZABILITY, ALMOST ALL
IDENTICAL.
ALMOST ALL OF THEM ARE SOME ARE
FEW.
SOME WERE NOT IN THE U.S.,
RARELY ADDRESSED RATE AND
ETHNICITY, RARELY ADDRESSED
SOCIOECONOMIC POSITION SO
NOTHING EVER ROSE TO STRONG.
THEY ARE ALL JUST LIKE THIS.
THREE PLANT SOURCES ARE
STUNNINGLY CONSISTENT.
NEXT SLIDE.
ALMOST IDENTICAL.
LOOK AT THE EXPOSURE, OUTCOME,
GRADE, DIRECTION.
IF YOU WENT THROUGH THE FIVE
CRITERIA, WITH A GRADE, VERY,
VERY MODEST DIFFERENCE BUT ALL
THE SUM OR FEW,
GENERALIZABILITY, WE NEED MORE
STUDIES.
NEXT IS SAME, SWITCH TO VEGGIES.
SAME EXPOSURE, DIFFERENT
COMPARATOR.
SAME OUTCOME, STILL ADULTS AND
OLDER, SAME GRADE.
FIRST WAS EIGHT STUDIES, ALL
PROSPECTIVE, NO RCTs, 33
COMPARISONS.
THESE LAST TWO WITH FOUR
STUDIES, EACH WITH 10 OR 12
COMPARISONS.
BASICALLY THE FIRST ONE AT EIGHT
STUDIES SAME AS FOUR IN THE
OTHER ONEs BUT THE FOUR OTHER
ONES DIDN'T ALWAYS ADDRESS
PLANT-BASED SOURCES OF PROTEIN.
IT'S THE SAME SET OF STUDIES
AGAIN AND AGAIN AND AGAIN USING
MULTIPLE SETS OF COMPARATORS,
AND STUNNINGLY CONSISTENT IN
FINDINGS.
I WANT TO WRAP THAT UP AND I
LOVE THAT SARAH TOTALLY SET ME
UP FOR THIS.
WHAT WOULD IT TAKE TO MOVE THIS
TO STRONG?
THEY ARE ALL IN THE SAME
DIRECTION, SAME KIND OF
CONCLUSIONS.
WHAT WOULD IT TAKE TO BRING
HEALTH EQUITY UP?
ONE CONCLUSION THIS TIME IS
CARDIOVASCULAR DISEASE AND DIET.
WITH A PATTERN WE'VE GOT STRONG
AND HEALTH EQUITY.
FROM THE HEALTH EQUITY
PERSPECTIVE, NO SOCIOECONOMIC
POSITION.
CALL OUT TO FUTURE TRIALISTS AND
EPIDEMIOLOGISTS, YEAH, LET'S
INCLUDE THAT.
WHAT WOULD IT TAKE TO MAKE IT
STRONG AFTER THAT?
IT WOULD TAKE DIRECT RCTs.
WHO IS GOING TO SIGN UP TO BE
RANDOMIZED FOR 10 OR 20 YEARS TO
RED MEAT OR BEANS?
NO ONE.
MAYBE YOU COULD IMPROVE
GENERALIZABILITY BUT WE'LL NOT
IMPROVE DIRECTNESS.
THIS CONCLUSION WILL LIKELY
NEVER MOVE TO STRONG.
NOTICE NO TRIALS ON
INTERMEDIATES, NOTHING ON RED
MEAT VERSUS BABIES AND PEACE OR
VEGGIES OR WHOLE GRAINS, WITH
LIPIDS AND BLOOD PRESSURE.
I FIND THAT STRIKING.
I CAME TO THIS EPIPHANY TODAY.
I THINK I'VE DONE THREE TRIALS
THAT COULD BE INCLUDED THERE.
BUT WHAT IS CHALLENGING ABOUT
THIS TOPIC WHEN WE WENT FROM
36,000 PAPERS WHICH WAS
OBVIOUSLY UNMANAGEABLE TO 100,
THE CHALLENGE WAS THE SEARCH
TERMS.
I THOUGHT OF THE THREE TRIALS,
I'VE DONE THAT COULD HAVE
ADDRESSED THIS, THERE'S NO WAY
THEY WERE WRITTEN UP THAT THEY
WOULD HAVE BEEN IDENTIFIED IN A
STANDARD SEARCH.
IT WASN'T THE PURPOSE OF MY
TRIAL.
SO THINKING ABOUT BROADENING
THIS LITERATURE IT MIGHT ALSO
INVOLVE APPROACHING THIS SEARCH
IN A DIFFERENT WAY BUT COULD BE
MORE DIRECT WITH INTERMEDIATES
BUT WE'LL NEVER HAVE MORBIDITY
AND MORTALITY TRIAL WHERE YOU
RANDOMIZE PEOPLE TO RED MEAT AND
PLANTS.
SO THIS MAY NEVER MOVE PAST
MODERATE, JUST AS A STATEMENT,
LOVE THAT YOU SET ME UP, SARAH,
WE SHOULD GO FOR STRONG
CONCLUSIONS WITH HEALTH EQUITY.
NEXT SLIDE PLEASE.
NOW ANOTHER THREE TRIALS ALL IN
A SET.
THIS ONE HAS A FOURTH MINI
CONCLUSION RCTs.
WHITE MEAT STARTS WITH EIGHT
STUDIES, SIX CONTROL.
IF YOU WATCH FROM RED MEAT TO
WHITE MEAT, THERE'S NO
DIFFERENCE, NO ASSOCIATION, NO
DIFFERENTIAL ASSOCIATION FOUND
IN CARDIOVASCULAR DISEASE.
AND THAT'S WHAT YOU'LL SEE FOR
ALL OF THE RED MEAT VERSUS
SWITCH TO ANOTHER SOURCE OF
ANIMAL FOOD.
ALL MODERATE, ALL NO
ASSOCIATION.
ALL ASSOCIATIONS WITH
DIRECTIONALITY WERE RED MEAT
SWITCHING TO PLANT SOURCES.
SO, THIS ONE IS SAME KIND OF FEW
CONCERNS WITH CONSISTENCY, FEW
SUBSTANTIAL, SOME, SOME, PRETTY
MODERATE FOR WHITE MEAT,
REASONABLE NUMBER OF COHORT
STUDIES.
AGAIN, THIS IS STILL --
INTERESTING, THIS JUST SAYS ONLY
PROCESSED.
OH, GOOD, I'M ON THE WRONG
SLIDE.
CVD SAME THING.
VERY SIMILAR EXCEPT FOR LACK OF
DIRECTION, NO ASSOCIATION HERE.
AS YOU MOVE TO THE RIGHT OF THE
PAGE, THIS WAS PROBLEMATIC.
WHEN YOU LOOKED AT RED MEAT
STUDIES VERSUS WHITE MEAT
STUDIES, INTERESTINGLY THEY WERE
BOTH ALWAYS IN LEAN AND
UNPROCESSED.
IF YOU READ ALL THE PAPERS THEY
WERE GAMED A LITTLE BIT.
THEY WERE SET UP TO MAKE IT SOME
WHITE MEAT ARMS HAD AS MUCH OR
MORE SATURATED FAT THAN RED MEAT
ARMS WHICH DOESN'T MAKE MUCH
SENSE TO ME FROM A FOOD
PERSPECTIVE.
THREE OR FOUR WERE OUT OF THE
U.S.
FOUR OUT OF SIX FUNDED BY MEAT
INDUSTRY.
AS WE GO DOWN FOR CONCERNS MORE
SUBSTANTIAL CONCERNS IN THIS.
THERE WASN'T A DIRECTIONALITY.
IT LOOKED LIKE THERE WAS NO
DIFFERENCE BUT LIMITED FOR A
GRADE BECAUSE OF MULTIPLE
CONCERNS.
THIS IS ONE OF THE FEW RCT
STATEMENTS THAT WE HAVE IN HERE.
WE HAD A FEW RCTs AND MANY
CONCLUSIONS WITH ONE OR TWO,
THIS IS THE ONLY ONE WITH SIX.
THERE'S ONE OTHER ONE THAT MIGHT
HAVE HAD SIX BUT USUALLY THE
RCTs WE HAD TO TOSS BECAUSE WE
ONLY HAD ONE.
NEXT SLIDE, DIFFERENT ANIMAL
SOURCE.
FISH AND SEAFOOD.
SAME THING.
NOT ASSOCIATED.
JUST WITH MORBIDITY.
THESE ARE ONLY PROSPECTIVE
COHORT TRIALS.
GRADE IS LIMITED.
ALL THE SAME FEW, SOME, FEW,
SOME, SUBSTANTIAL.
THIS IS -- I WANT TO BRING OUT A
POINT THAT DEE DEE OR DIANA OR
BOTH SAID.
BEING LIMITED, OTHERS WERE
MODERATE, BEING LIMITED, ONE OF
THE THINGS IF YOU'VE GOT MORE
STUDIES, MORE LIKELY IT'S
POSSIBLE TO OVERTURN IT.
SO WHEN WE SAY LIMITED, OH, IT'S
THERE, BUT WOULDN'T TAKE ALL
THAT MUCH MORE TO GET US TO
CHANGE OUR MIND.
INTERESTINGLY THE FISH AND
SEAFOOD WOULD PROVIDE
OMEGA-3s, LOWER SOURCES OF
SATURATED FAT, WOULD OFFERING
SOMETHING ELSE, MIGHT BE A
HYPOTHESIS FOR BENEFIT.
FOR FISH.
I WAS SURPRISED TO SEE THIS BE
LIMITED.
NO ASSOCIATION.
MAYBE THE FISH MIGHT HAVE BEEN
BETTER, MAYBE ANOTHER DAY, BUT
WE'RE EXAMINING DATA, THIS IS
THE EVIDENCE, NO ASSOCIATION.
HERE IS EGGS.
THIS IS THE LAST OF THE TRIO OF
REPLACING RED MEAT WITH ANIMAL
SOURCE OF LOWER SATURATED FAT
AND IT'S THE SAME.
EGGS IS A COMPARATOR, NOT
ASSOCIATED, MODERATE GRADE,
SEVEN ARTICLES, 12 COMPARISONS,
SOME FEW, SUBSTANTIAL SOME,
SUBSTANTIAL.
THIS WHOLE SET OF THREE WAS VERY
INTERESTINGLY SORT OF AT THE
SAME LEVEL OF MODERATE BECAUSE
IT WAS ALMOST THE SAME NUMBER OF
PROSPECTIVE COHORT TRIALS, SAME
NUMBER OF MULTIPLE COMPARISONS,
THE SAME LIMITATION.
DIFFERENT COUNTRIES, NOT SO MANY
IN THE U.S., NO SOCIOECONOMIC,
VERY LITTLE RACE AND ETHNICITY.
THIS IS ANOTHER INTERESTING
CLUSTER OF THREE, ESPECIALLY
COMPARED TO THE LAST THREE THAT
I SHOWED YOU.
NEXT SLIDE PLEASE.
WHITE MEAT IS NOT A SOURCE OF
SATURATED FAT BUT WE WERE
LOOKING FOR EVERY POSSIBLE
COMPARISON.
AND THIS ONE HAD ENOUGH STUDIES
THAT WE THREW IT IN THERE.
WE'VE GOT FROM RED MEAT TO WHITE
MEAT.
SO WHITE MEAT VERSUS PLANT
BASED, NOW TALKING ABOUT
EVERYTHING, TALKING ABOUT BEANS,
PEAS, AND LENTILS AND WHOLE
GRAINS AND VEGGIES, IF THAT'S
WHAT THEY LOOKED AT.
STILL ONLY ADULTS AND OLDER
ADULTS, STILL ONLY MORBIDITY, NO
ASSOCIATION, AND IT'S MODERATE.
SAME KIND OF THING IN THE BODY
OF EVIDENCE.
SIX ARTICLES, 11 COMPARISONS,
SOME, FEW, SOME, SOME, SOME.
NEXT SLIDE PLEASE.
WHITE MEAT VERSUS FISH, PRETTY
MUCH THE SAME AS THE LAST ONE,
VERY, VERY REPRODUCIBLE HERE.
ADULTS AND OLDER ADULTS, NOT
ASSOCIATED, MODERATE CONCLUSION,
SIX ARTICLES, SOME COMPARISONS,
VERY, VERY CONSISTENT.
SO THOSE ARE THE ONLY TWO FOR
WHITE MEAT.
ONE OF THE DIFFERENCES HERE IT
WAS NOT A PROCESSED AND
UNPROCESSED WHITE MEAT, STILL
NOT SURE WHY WE DID WHITE MEAT.
WE WERE GOING TO DO DAIRY, RED
MEAT, PLANT BASED SOURCES, THIS
ONE STICKS OUT AS BEING A LITTLE
ODD.
BUT SWITCHING WHITE MEAT FOR
ANOTHER ANIMAL SOURCE MADE NO
DIFFERENCE.
THAT'S THE OVERALL CONCLUSION.
SWITCH TO THE NEXT SLIDE PLEASE
NOW WE'VE GOT ALL THE GRADE NOT
ASSIGNED.
HERE WE'VE GOT AT THE VERY TOP
LET'S KEEP THESE BRIEFER, FIVE
ARTICLES, ALL RCTs, THIS
PARTICULAR TOPIC IS UNPROCESSED
MEAT CONSUMPTION, COMPARED TO
ALL PLANT FOODS AND THIS IS ONLY
ON LIPIDS AND BLOOD PRESSURE.
AND THEY ARE SO DIFFERENT.
THERE'S NO WAY TO POOL THEM.
THAT'S THE SUM OF ALL PLANT
FOODS AGAINST UNPROCESSED RED
MEAT, LIPIDS AND BLOOD PRESSURE
WAS TOO MUCH.
COULDN'T FIND ANYTHING THERE.
NEXT ONE WAS EVEN WORSE.
RED MEAT WITH DIFFERENT AMOUNTS
OF SATURATED FAT.
OH MY GOD.
DIFFERENT AMOUNT OF SATURATED
FAT COULD HAVE BEEN RIDE RANGE,
WE ONLY HAD TWO RCTS, ONE COHORT
STUDY.
THE NEXT ONE IS MEAT WITH
DIFFERENT AMOUNTS OF SATURATED
FAT, ZERO ARTICLES, WORTHWHILE
QUESTION AT THE TIME.
HOPE YOU DON'T MIND IF I MOVE
PAST THAT QUICKLY.
WE TRIED TO LOOK AT 31 QUESTIONS
THAT BRANCHED OUT OF THE MAIN
QUESTION.
NEXT SLIDE PLEASE.
THERE WERE MORE, SORRY.
THERE'S ANOTHER SAID OF GRADE
NOT ASSIGNED.
ONE RCT, FIVE COHORT STUDIES,
PROCESSED VERSUS UNPROCESSED,
ISN'T THAT AN OPENED QUESTION?
LOOK AT AVAILABLE DATA FROM THE
TRIALS WE WERE ABLE TO FIND,
THERE WAS NO CONSISTENCY AND
THEY WERE ASKING THE QUESTION IN
DIFFERENT WAYS, TOO MANY WAYS TO
CHOOSE DIFFERENT COMPARATORS AND
EXPOSURES, ZERO ARTICLES FOR THE
NEXT TWO QUESTIONS, PROCESSED
VERSUS UNPROCESSED WHITE MEAT,
NOTHING.
MEAT SOURCES OF SATURATED FAT
VERSUS PLANT SOURCES, YEW
LOOKING FOR A TRIAL THAT
COMPARES STEAK TO COCONUT OIL,
NO ONE DECIDED TO LOOK AT TAKE
VERSUS COCONUT OIL, NO PAPERS.
NOTHING IN KIDS.
NO ARTICLES.
NOT EVEN ON LIPIDS OR BLOOD
PRESSURE.
WE'RE GOING TO PAUSE AND DO ONE
MORE.
I ALSO GOT TROPICAL OILS
ASSIGNED BUT THAT'S THE END OF
MY BUCKET.
SO THREE FOR RED MEAT VERSUS
PLANTS, THREE VERSUS ANIMAL
SOURCES, TWO FOR WHITE MEAT, AND
OTHER ANIMAL SOURCES, AND SIX
WITH GRADE NOT ASSIGNED, ONE
KID.
DONE.
NEXT SLIDE PLEASE.
IT'S A WHOLE DIFFERENT QUESTION.
THERE'S PLANT SOURCES, COCONUT
OIL, COCONUT BUTTER, PALM OIL.
NEXT SLIDE PLEASE.
I HAVE FOUR SLIDES NOW BUT I
ONLY HAVE TWO GRADED CONCLUSIONS
AND A LOT OF GNA.
THIS ONE WAS DOABLE.
THESE ARE ALL RCTs, NINE
RCTs, 11 COMPARISONS, PLANT
SOURCES HIGHER IN SATURATED
FAT.
I HAVE TO STOP UNLESS THERE'S
SEED OIL CONSPIRACY THEORISTS.
VEGETABLE AND SEED OILS, WE
DECIDED NOT TO PUT SEED OILS IN.
IT'S NOT VEGETABLE OILS, IT'S
PLANT OILS, ALL FROM PLANTS.
NO, ACTUALLY QUITE A FEW OF
PAPERS SAID THESE ARE VEGETABLE
OILS.
EVEN IF THEY MAYBE BOTANICALLY
WEREN'T VEGETABLES, DOES NOT
INCLUDE PLANT OILS, DOESN'T SAY
SEED OILS BUT CONTAINS ALL
THOSE.
VEGETABLE OILS WERE CANOLA,
SUNFLOWER, OLIVE, THINK OF ALL
THE OILS.
NOT ALL WERE STUDIED.
ANYTHING THAT WE FOUND FIT INTO
THIS CATEGORY, AND ANYTIME YOU
HAD SATURATED TYPE OF TROPICAL
OIL, YOU REPLACED IT, NOW WE
REPLACE IT BECAUSE IT'S A
CROSSOVER TRIAL, MOST OF THEM
WERE CROSSOVERS, IT DECREASES
LDL BUT DOESN'T HAVE EFFECT ON
BLOOD PRESSURE.
THE REASON YOU WON'T SEE HDL AND
TRIGLYCERIDE IT WAS DIFFERENT,
HARD TO FEEL COMFORTABLE PUTTING
IT IN THE STATEMENT SO IT WILL
BE THE NOTES BUT REALLY NOTHING
HERE I PRESENTED SO FAR HAD ANY
IMPACT ON BLOOD PRESSURE.
OFTEN IT WAS LEFT OUT, FOCUS HAS
BEEN ON LDL BUT THIS IS
MODERATE.
FEW CONCERNS, SOME CONCERNS,
SOME CONCERNS, FEW CONCERNS, WE
COULD USE MORE STUDIES IN THE
U.S., BETTER RACE AND ETHNICITY
AN BETTER SOCIOECONOMIC POSITION
COVERAGE.
WE WERE AT MODERATE.
HERE WE HAVE A LIMITED -- SO AN
INTERESTING THING HAPPENED WHEN
THE DATA WERE SET OUT FOR US,
FIRST WE WOULD LOOK AT THE WHOLE
THING TO SEE WHAT KIND OF
BUCKETS WE MIGHT COME UP WITH.
SOME INSIDE BASEBALL HERE TO
BEGIN THIS THERE WERE SO MANY
POSSIBLE BUCKETS THAT DEANNA AND
I SPENT A COUPLE SESSIONS WITH
SUPPORT STAFF THINKING HOW MANY
BUCKETS COULD THERE BE?
ONE OF THE WAYS WE LOOKED WAS
LOOKING DOWN AFTER SORTING, WHAT
POPS OUT?
THIS ONE DID.
SOMEWHAT CONSISTENT FINDINGS
ABOUT PALM OLEIN.
FOR THOSE NOT FAMILY WITH PALM
OLEIN, YOU CAN GROW IT
DIFFERENTLY OR PROCESS
DIFFERENTLY.
PALM OLEIN IS NOT AS HIGH AS
COCONUT OIL, COCOA BUTTER OR
PALM OIL.
HIGHER IN UNSATURATED FAT,
WASN'T AN EFFECT ON BLOOD LIPIDS
DIFFERENCE IS NOT AS BIG AS
PREVIOUS CATEGORY.
SIX ARTICLES, ALL RCTs, ALL
COMPARISONS.
SOME, SOME, SOME, FEW CONCERNS,
SUBSTANTIAL ONCE AGAIN AT THE
END.
LIMITED GRADE.
NEXT SLIDE.
SO THESE SEEM TO BE REASONABLE.
OTHER COMPARISONS BUT FOOD
SOURCES OF CARBOHYDRATE AND
PROTEIN COMPARED TO HIGH PLANT
SATURATED FAT, JUST TWO
ARTICLES, NOT ENOUGH.
HOW ABOUT THE TROPICAL OILS
COMPARED TO DIFFERENT FOOD
SOURCES OF SATURATED FAT?
THAT'S TOO MANY.
BY THE TIME YOU TRY TO LOOK AT
THESE COMPARE TONS YOU COULDN'T
BUCKET THEM TOGETHER AND POOL
IT.
IN SOME OTHER CASES SIX RCTs
WAS ENOUGH.
IT WAS TOO HARD TO COME UP WITH
A CONCLUSION.
GRADE NOT ASSIGNED.
NEXT SLIDE PLEASE.
NOTHING IN KIDS.
ONE MORE SLIDE.
THAT'S ME.
BACK TO YOU, DEANNA.
>> OKAY.
I KNOW WE WENT THROUGH A LOT OF
CONCLUSION STATEMENTS.
NOW WE'LL SUMMARIZE THEM FOR YOU
IN BUCKETS.
THANKS, CHRISTOPHER, FOR THE
GREAT JOB.
AND NEXT SLIDE.
SO THESE ARE ALL THE FOOD
SOURCES OF SATURATED FAT
CONCLUSION STATEMENTS INCREASING
DECREASED CVD OUTCOME, ADULTS
AND OLDER ADULTS, ONE STRONG
REPLACED BUTTER WITH UNSATURATED
FATTY ACIDS, FIVE MODERATE, ONE
PROCESSED MEAT WITH DAIRY, WITH
PLANT SOURCES LIKE CHRISTOPHER
SAID, PROCESSED OR UNPROCESSED,
REPLACING PLANT SOURCES HIGHER
IN SATURATED FAT THAT
CHRISTOPHER WENT OVER WITH
VEGETABLE OILS, HIGHER IN
UNSATURATED FAT, DECREASE THE
LDLC.
AND WE HAD TWO LIMITED.
SO SUBSTITUTING DAIRY WITH FOOD
SOURCES OF UNSATURATED FATTY'S A
ITS, THAT WAS OLIVE OIL AND SO
ON.
SUBSTITUTING BUTTER WITH
PLANT-BASED OILS AND SPREADS
WITH PREDOMINANTLY UNSATURATED
FAD.
NEXT SLIDE WHAT WE HAVE LEER
FIFER MODERATE STATEMENTS AND
FOUR LIMITED.
THESE WERE WHETHER YOU HAD NO
DIFFERENCE IN CARDIOVASCULAR
DISEASE RISK WHEN YOU COMPARED
THE TWO.
SO, ONE WAS ONE FORM OF DAIRY
WITH ANOTHER FORM OF DAIRY,
PROCESSED OR UNPROCESSED RED
MEAT WITH WHITE, RED MEAT WITH
EGGS, WHITE MEAT WITH PLANT
BASED FOODS, WHITE WITH PLANT
BASED SEAFOOD, SUBSTITUTING
HIGHER WITH LOW FAT DAIRY WAS
LIMITED.
LEAN MEAT WAS LIMITED, AND PALM
OLEIN WAS LIMITED.
THE THIRD BUCKET, IF WE COULD
HAVE THE NEXT SLIDE, THESE HAD
CONCLUSION STATEMENTS THAT
COULDN'T BE DRAWN.
SO A LOT OF THESE ARE THE HIGHER
FAT DAIRY AND DAIRY PRODUCTS
COMPARED TO LOWER FAT VERSIONS,
DAIRY COMPARED TO FOOD SOURCES
OF CARBOHYDRATE AND PROTEIN,
UNPROCESSED WITH PLANT BASED
FOOD, RED MEAT WITH DIFFERENT
AMOUNTS OF SATURATED FAT, WHITE
MEAT, PROCESSED RED MEAT
COMPARED TO UNPROCESSED RED MEAT
AND THE SAME WITH WHITE MEAT.
MEAT SOURCES COMPARED TO PLANT,
AND THEN THE LAST ONE PLANT
SOURCES HIGHER IN SATURATED FATE
COMPARED TO A DIFFERENCE SOUTH
OF SATURATED FAT.
A LOT OF THINGS WE DON'T KNOW
THE ANSWER TO.
WE COULDN'T DRAW A CONCLUSION
STATEMENT.
LAST SUMMARY, NEXT SLIDE, JUST
WITH KIDS.
AS YOU SAW NO MATTER WHAT YOU
COMPARED, THERE WASN'T ENOUGH
DATA FOR US TO DERIVE A
CONCLUSION STATEMENT.
SO, WE DON'T NEED HAVE A QUIZ
NOW ON ALL OF THESE BUT I THINK
WE'VE JUST MAPPED OUT A RESEARCH
AGENDA FOR THE NUTRITION
COMMUNITY FOR THE NEXT TEN
YEARS.
>> I CAN COMMENT I THINK OUR
FIRST CONCLUSION STATEMENT TOOK
US SIX WEEKS AND WE DID SIX
CONCLUSIONS IN ONE MONTH.
SO WE LEARNED A LOT FROM THE
STAFF.
THANK YOU.
>> WOW, I'M EXHAUSTED.
I FEEL LIKE I JUST GOT OFF A
ROLLER COASTER.
WOW, I'M SO IMPRESSED.
AND KUDOS TO ALL OF YOU.
AND DEE DEE, ANYTIME YOU WANT TO
TEACH ME NUTRITIONAL
EPIDEMIOLOGY, I'M GAME.
SO WE'RE GOING TO OPEN IT UP FOR
QUESTIONS BUT CAN I JUST TAKE
PURVIEW OF BEING THE CHAIR FOR
ONCE AND ASK A QUESTION.
WHY ARE MOST OF THE STUDIES FOR
THESE QUESTIONS NOT CONDUCTED IN
THE UNITED STATES?
>> OH.
>> A LOT OF PROSPECTIVE COHORT
STUDIES WERE FROM OTHER
COUNTRIES SO THERE WERE DANISH
STUDIES, I FORGET WHERE ELSE.
>> DAIRY IS VERY POPULAR IN
DANISH STUDIES.
>> I REMEMBER THE DANISH STUDY.
TROPICAL OILS SEEMED LIKE ASIAN
STUDIES, MALAYSIA.
>> THAT WAS ONE OF THE MOST
SURPRISING OBSERVATIONS I MADE
IN YOUR PRESENTATION BECAUSE I
AGREE WITH WHAT YOU SAID,
CHRISTOPHER, TALKING ABOUT
SUBSTITUTION OF FOOD, IF FOOD
SUBSTITUTIONS ARE NOT FOODS
NORMALLY CONSUMED IN THE U.S.
THAT MAKES THESE COMPARISONS
EVEN MORE CHALLENGING.
I FOUND THAT AN EXTRAORDINARY
OPTS OBSERVATION.
>> TWO RED MEAT STUDIES VERSUS
WHITE MALE WERE DONE IN SPAIN,
AND THEY MADE A POINT TO SAY HOW
SPECIAL THEIR LAMB WAS THAT THEY
WERE USING.
WELL, YEAH, THAT'S RED MEAT
VERSUS WHITE BUT AMOUNT OF LAMB
EATEN AS RED WHEAT PALES IN
COMPARISON.
>> REALLY INTERESTING.
I'M WONDERING ABOUT TWO OF THE
FINDINGS YOU PRESENTED WITH
MODERATE EVIDENCE, THAT WAS FOR
THE RED MEAT WITH SUBSTITUTING
THAT WITH -- I DON'T REMEMBER, I
THINK SUBSTITUTING BECAUSE THEY
WERE BOTH PROSPECTIVE COHORT
STUDIES, SUBSTITUTION WITH WHOLE
GRAINS AND VEGETABLES.
BOTH WERE BASED ON FOUR
PROSPECTIVE COHORT STUDIES SO I
WONDERED WITH LIKE WHATEVER
YOU'RE DOING COHORT STUDIES,
MEASURING SO MANY DIFFERENT
POTENTIAL CONFOUNDERS, STARTING
POINTS, ALL THESE THINGS BECOME
IMPORTANT, TO HAVE FOUR STUDIES
IS KIND OF LIMITED.
AND ANOTHER THING I WONDERED
WERE THE AUTHOR GROUPS
DIFFERENT, WONDER IF YOU COULD
SHARE MORE INFORMATION.
>> GREAT.
PICTURE US ORGANICALLY GOING
THROUGH THIS.
OH, LET'S JUST DO ALL PANTS.
AND THEN THE STAFF
SUBCATEGORIZED INTO THE
VEGETABLES AND BRAINS AND
PROTEIN GROUPS.
WE SAW A SIMILAR PATTERN ACROSS
THE ENTIRE THING.
VERY STRIKINGLY SIMILAR.
WELL, WAIT, ARE THERE ENOUGH
WHOLE GRAINS AND ENOUGH
VEGETABLE STUDIES.
MANY HAD FOUR AND FIVE
COMPARISONS, DIDN'T LOOK LIKE
THERE WERE FOUR FINDINGS, BUT
THERE WEREN'T.
WE DID WRESTLE WITH THAT, WE
COULD HAVE CALAMITIES THE WHOLE
GROUP AND JUST SAID PLANT FOODS.
I'D LOVE TO HEAR WHAT DEANNA OR
CHERYL OR DEE DEE HAVE TO SAY,
SO WE DID STRUGGLE.
WAIT, THERE'S FOUR.
BUT THERE'S MULTIPLE
COMPARISONS.
OH MY GOD, IT'S CONSISTENT,
SHOULD WE GO THERE?
ALL THE CHRIS KITSCH, WE'RE
QUITE SIMILAR.
WE DECIDED TO BREAK IT APART
INSTEAD OF LUMP THEM TOGETHER.
IF WE DID THAT, SOMEBODY WOULD
HAVE SAID WHAT ABOUT THE WHOLE
GRAINS, DID THAT STICK OUT, WHAT
ABOUT THE VEGGIES, DID THAT
STICK OUT?
SO WE DID THEM SEPARATELY.
>> YEAH, RESULTS WERE VERY
CONSISTENT WITH THOSE.
AND SO THEY WERE ALSO LARGE
COHORTS, SO THEY WERE NARROW
CONFIDENCE INTERVALS.
SOME OF THOSE GRADING ELEMENTS
KENNED TO
KENNED -- TENDED TO BE MODERATE
OR STRONG.
>> ONE MORE QUESTION WITH THAT.
THAT WAS THINKING ABOUT THOSE
FINDINGS AND THEN I KNOW A LOT
OF THE STUDIES WEREN'T DONE IN
THE U.S. BUT DATA I JUST
PRESENTED WERE DIETARY INTAKES
WE SEE USUALLY MEAT INTAKES ARE
ABOVE RECOMMENDATIONS, AND
VEGETABLES AND WHOLE GAINS ARE
BELOW.
AND SO YOU JUST WONDER PUTTING
THAT TOGETHER IS IT REALLY
BRINGING PEOPLE DOWN TO THE
RECOMMENDATIONS THAT IS LINKED
WITH LOWER CVD RISK.
>> YES, THAT'S WHAT INTEGRATION
IS ALL ABOUT.
THIS TOTALLY -- I'M LOVING THE
DISINTEGRATION STAGE BECAUSE
THAT SUPPORTS YOUR MODELING.
>> CHRIS, DID YOU HAVE A
RESPONSE TO HEATHER'S FIRST
QUESTION?
>> YEAH, I THINK THAT WAS WHAT
MADE THINGS DIFFERENT WHEN WE
MADE THESE SLIDES, LOOK AT
NUMBER OF STUDIES, ALSO ADD
NUMBER OF COMPARISONS BECAUSE I
HEARD COMMENTS AROUND HOW MANY
ARTICLES ARE SCREENED AND HOW
MANY ENDED UP GETTING HERE TO
ANSWER THESE COMPLEX QUESTIONS
FOR THE DATA.
BUT THE NUMBER OF COMPARISONS
MADE FOR A REALLY BIG RICH BODY
OF EVIDENCE.
THEY WERE COMING ACROSS AS
DIFFERENT RESEARCH GROUPS.
THERE WERE MULTIPLE OUTCOMES AND
MULTIPLE RESEARCH GROUPS THAT
ARE EVIDENT.
SO, YOU KIND OF HAD THIS -- IT
WAS LIKE FACTORIAL IN A WAY
BECAUSE YOU'RE GETTING SO MANY
COMPARISONS, NOT HAVING TO SAY
WHAT IF YOU DID THIS AND YOU
HAVE TO ASSUME WHAT HAPPENED IF
THEY MADE THIS COMPARISON TO
THAT.
THEY MAPPED THEM ALL OUT.
AND THAT ALLOWED US TO REALLY
SEE I THINK WHAT THE
BEAUTIFUL -- WITH A WOULD BE
BEAUTIFUL IS TO HAVE COLORED
ARROWS, YOU LOOK AT IT, ALL OF
THESE ARE GREEN UP ARROWS SAYING
THERE'S AN -- IT HELPS TO SEE
THE STRIKING IMPACT OF WHERE
SOME CONSISTENCIES OR
INCONSISTENCIES LIE ACROSS THE
MULTIPLE COMPARISONS.
>> THE REAL FUN WAS GOING FROM
ALL TO NONE OF THEM.
IT'S JUST STAGGERING.
ALL THE PLANT BASED
SUBSTITUTIONS WERE UP AND
POSITIVE, ALL ANIMAL FOR ANIMAL
WERE NOTHING.
>> WE HAVE A LOT OF PEOPLE WITH
QUESTIONS.
THERESA, ED, CRISTINA, ANGELA,
AND THEN WE'LL START AGAIN.
>> YOU DID A GOOD JOB REMINDING
US WHAT'S IMPORTANT.
FROM THE RESULTS THEY DIVE INTO
GIVING RECOMMENDATIONS WITHOUT
THINKING OF CONTEXT THAT SETS
THE STAGE AND AFFECTING
EVERYTHING DOWNSTREAM.
THANK YOU FOR REMINDING US THAT
WILL SET YOU THE IN THE RIGHT
DIRECTION.
>> I'M GOING TO ASK THAT YOU
SPEAK MORE IN THE MICROPHONE.
>> THE QUESTION FOR CHRISTOPHER.
LOOKING AT INDIVIDUAL FOODS,
FOODS ARE NOT CONSUMED IN
ISOLATION, SO HOW WELL WERE
THOSE STUDIES ADJUSTING FOR
OTHER COMPONENTS OF THE DIET?
>> YEAH, GREAT QUESTION.
THAT'S WHY IT'S MODERATE.
IT'S NOT STRONG.
THESE ARE ALL OBSERVATIONAL EPI
STUDIES, NOT GETTING AT THAT
LEVEL OF DETAIL, LOOKING AT FOOD
GROUPS.
BECAUSE IT'S THE SUBSTITUTION
THOUGH IT'S SO MUCH BETTER THAN
WHAT DEE DEE DESCRIBED.
YEAH, SO THERE'S ANOTHER LEVEL
YET, WHAT DID YOU PUT ON THE
WHOLE GRAIN?
WHAT DID YOU COOK YOUR VEGGIES
IN?
ABSOLUTELY NOT, NO WAY TO GET AT
THAT FROM THE FOOD FREQUENCY
QUESTIONNAIRES THAT WERE USED TO
GENERATE DATA FOR POPULATION
THAT THEY WERE FINDING.
I WILL ADD IF ANYBODY WANTS AN
EXTENSION OF THE GREAT DEE DEE
TALK YOU JUST HEARD SHE HAS A
GREAT EDITORIAL ON EXACTLY
WHAT'S GOING ON WHICH IS A
CHOLESTEROL CARDIOVASCULAR
DISEASE EDITORIAL, SHE DID IT
FOR THE WORLD ALREADY.
>> I WILL ADD IN A LOT OF THESE
MODELS THE COMPONENTS WHEN
CONSIDERING MULTIPLE DIETARY
CONTRASTS ADJUST FOR ALL THOSE
FACTORS WHICH SPEAKS TO
CONSISTENCY IF IT WERE JUST
GRAINS THEN IN THESE TYPES OF
ANALYSES THAT WOULD BE WHERE THE
SIGNAL IS AND EVERYTHING ELSE
ADJUSTING FOR GRAINS BUT MAYBE
CORRELATED WITH GRAINS WOULD BE
RELATIVELY NULL.
CONSISTENCY INDEPENDENTLY ACROSS
ALL THESE NON-SATURATED FAT
EXPOSURES IS WHAT OVERALL WAS
STRIKING.
>> GREAT.
ED, CHRISTINA, AND THEN ANGELA.
>> A LOT OF GREAT WORK.
A QUESTION, I DON'T KNOW IF THIS
IS MAYBE TECHNICAL TYPE OF
QUESTION BUT ONE OF THE
CONCLUSION STATEMENTS
SUBSTITUTING PROCESSED AND
UNPROCESSED RED MEAT WITH PLANT
SOURCES OF PROTEIN, IN
PARENTHESES BEANS, PEAS,
LENTILS, ET CETERA.
LIKE ARE THESE STUDIES LIKE ARE
THEY COME LIKE ALL PLANT
SOURCES?
LIKE THE RED MEAT CONSUMPTION IS
SO MUCH HIGHER THAN LET'S SAY
PEAS, I DON'T KNOW HOW YOU
COMPARE PROTEIN FROM RED MEAT TO
PROTEIN FROM PEAS IN AN
OBSERVATIONAL STUDY BECAUSE IT'S
PROBABLY LIKE 100:1 RATIO IN
TERMS OF GRAMS OF PROTEIN.
SO IS THAT LIKE COMBINING ALL OF
THE OTHER PLANT SOURCES, LOOKING
AT THEM INDIVIDUALLY?
>> LET ME ANSWER ONE WAY AND ASK
DEE DEE TO HELP.
AS YOU LOOK DOWN COMPARATORS,
ONE WOULD BE LEGUMES, ONE BEANS,
ONE NUTS, ONE WOULD BE LEGUMES
AND BEANS, ONE LEGUMES AND NUTS,
ONE WOULD BE NUTS AND BEANS.
CLEARLY THERE'S A SET THAT
BELONGS TOGETHER.
WE WEREN'T TEASING THAT APART
FOR A SERVING SIZE, JUST WE HAD
A COMPARATOR AND THE STAFF DID
AN AMAZING JOB.
IF YOU WENT INTO FURTHER DETAILS
YOU'D SEE HOW MANY GRAMS OF
BEANS, HOW MANY GRAMS OF NUTS,
HOW MANY OUNCES OF MEAT.
AT THAT LEVEL WE WEREN'T TEASING
ANYTHING APART.
WE COULD FIND ALL THE OUNCES,
ALL THE GRAMS, BUT LOOKING AT
PATTERNS.
WE DIDN'T TAKE THAT INTO ACCOUNT
FOR SERVING SIZE OR AMOUNT.
IT WAS SUBSTITUTION ANALYSIS
MAYBE DEE DEE WILL HELP ME WITH
FURTHER.
I CAN SPEAK TO SUBSTITUTION PART
OF THAT.
SO, YOU'RE CORRECT IN THAT THE
FREQUENCY AND AMOUNT OF INTAKE
COULD VARY DRASTICALLY AMONG TWO
EXPOSURES OF INTEREST.
IF DISTRIBUTION AND SOMETHING
LIKE RED MEAT IS REALLY WIDE,
BUT IT'S CONTRASTED AGAINST LIKE
ALL-COME UP NUTS, WALNUTS,
WHATEVER, PEANUTS, THE
DISTRIBUTION IS SO TINY.
IF YOU'RE MODELING TWO SERVINGS
A WEEK, PER SERVING PER WEEK,
IT'S EVEN MORE REMARKABLE HOW
JUST THAT MUCH OF A SHIFT WOULD
BE -- IS RELATED TO THAT
MAGNITUDE OF POTENTIAL BENEFIT.
BUT WHAT MODELS DO NOT DO, IF
YOU'RE AN UP EPIDEMIOLOGIST DOT
EXTRAPOLATE BEYOND YOUR
DISTRIBUTION.
IF WE REPLACE WITH NUTS BUT
NOBODY IS EATING THAT
CONSUMPTION OF NUTS YOU MAY BE
ABLE TO GENERATE A NUMBER
ANALYTICALLY BUT THAT'S NOT
WHAT'S HAPPENING HERE.
IT'S USUALLY AT THE LEVEL OF
SERVING PER WEEK, PER DAY,
THERE'S ENOUGH CONSUMPTION AT
THAT LEVEL.
>> YEAH, THAT'S RIGHT.
THERE IS AN ASSUMPTION OF
LINEARITY, LIKE EFFECTS ARE
GOING TO BE LINEAR BECAUSE IF
THEY ARE NOT LINEAR THEN THE
ASSUMPTION MIGHT NOT HOLD
ENTIRELY.
>> CAN I JUMP IN, GIVEN THE
PROBLEMS YOU SUGGESTED WATT IT
DRIVE CONCLUSION TOWARD THE
NULL, NOT TOWARDS ASSOCIATION
THAT'S SIGNIFICANT?
>> NOT NECESSARILY, BUT --
>> OKAY.
>> YEAH, I DON'T KNOW IF YOU
WANT TO GET INTO THAT HERE.
>> WE'RE HERE TO LEARN.
WE LEARN SO MUCH TOGETHER WHEN
WE'RE HERE.
>> NON-LINEARITY ISSUE, AT A
POPULATION, HIGH INTAKE HAS
FLATTENED OUT, SHIFTING TO MAYBE
NOTHING BUT IF YOU'RE DOWN AT
LOWER INTAKE, YOU'RE STILL
GETTING BENEFIT, LIKE PER
ADDITIONAL SERVING, MAYBE YOU
WOULD.
DEPENDS.
>> IF THERE'S A THRESHOLD, YOU
GET A BAD EFFECT WHEN YOU REACH
A HIGH AMOUNT BUT ONLY ONE OF
THE PEOPLE IS REACHING THAT HIGH
AMOUNT, THE OTHER PEOPLE ARE NOT
REACHING THAT AMOUNT SO THAT'S
LIKE A NON-LINEAR REACTION.
SO THEN COMPARISON ISN'T QUITE
HERE.
>> CRISTINA?
>> MY QUESTION TO THERESA.
SO YOU SAID THAT NOT ALL THE
STUDIES CONTROL FOR ENERGY
INTAKE.
IF YOU WOULD HAVE -- NO?
THAT WAS NOT?
SHE WAS QUESTIONING ABOUT -- YOU
SAID IT WAS MODERATE, NOT
STRONG.
>> I CANNOT TALK ABOUT ADJUSTED
FOR ENERGY INTAKE.
>> THAT'S THE CONFOUNDER,
SOMETHING WE ASSESSED.
>> OKAY.
SINCE COMPETITORS WERE DIFFERENT
SUBSTITUTING DAIRY WITH MAYBE
YOGURT WITH BUTTER MIGHT HAVE
SIGNIFICANT CHANGE IN CALORIE
INTAKE.
HOW DO YOU -- SO -- I'M STILL
TRYING TO UNDERSTAND COMPARISONS
BECAUSE IT SEEMS LIKE CALORIES
WILL BE VERY DIFFERENT.
>> SIMULATION.
SIMULATION ATTEMPTS TO ADDRESS
THAT.
I TAKE IT BACK.
>> SOMETIMES IT'S A PRAGMATIC
QUESTION, A SERVING VERSUS A
SERVING, THAT'S HOW YOU EAT THIS
ENTREE VERSUS THAT ENTREE,
THAT'S THE CONTRAST OF INTEREST,
CALORIC, MAYBE IF YOU WERE
DESIGNING A FEEDING TRIAL GIVE
500 CALORIES OF THIS VERSUS
THAT, LOOKING AT EFFECT OF FOOD,
NOT THROUGH ENERGY CHANGES.
THEN THAT WOULD BE HOW THE
SUBSTITUTE MODELS COULD ALSO
REFLECT, AND IMPRECISION IS A
CONCERN BUT THE IMPRECISION
BETWEEN THE FOODS IS SOMETHING
TO CONSIDER AND THAT MAY NOT BE
AS BIG OF A DEAL.
YOU COULD SET UP SERVING PER
SERVING, 100 CAL CALORIES OF TS
VERSUS THAT, IT MAY HAVE BEEN A
COMBINATION, SERVINGS OR EGGS
PER DAY, SOMETHING THAT MADE
SENSE RATHER THAN 50 CALORIES OF
EGGS.
>> YOU WERE MENTIONING SOME
STUDIES THAT YOU HAVE DONE MAY
HAVE -- THAT WERE NOT INCLUDED
THAT COULD HAVE, WONDERING IF
WERE THERE ANY PROSPECTIVE
STUDIES THAT YOU KNOW IN THE
U.S. THAT YOU WERE SURPRISED
THAT WERE NOT CAPTURED?
MAYBE NOT EXACTLY DOING WHAT
YOU'RE DOING BUT THEY WERE NOT
CAPTURED?
I WAS JUST -- I WAS THINKING
ABOUT THAT.
>> I WAS TALKING ABOUT TRIALS.
SO I DID A TRIAL IN 2005 THAT
MATCHED SATURATED FAT, ONE WAS
CONVENIENCE FOOD, ONE WAS
VEGETARIAN.
IT OCCURRED THAT WOULD HAVE BEEN
FIT ALTHOUGH IT WAS WEIRD
BECAUSE I MATCHED SATURATED FAT,
A CONTRIVED PORTION BUT ONE WAS
HIGHER IN PLANTS, ONE HIGHER IN
MEAT, EVEN SO SATURATED WAS
MATCHED LDL CHOLESTEROL WENT
DOWN TWICE AS MUCH IN THE PLANT
GROUP.
>> WHAT ABOUT THE OTHER
PROSPECTIVE STUDY IN THE U.S.,
WE HAVE LONG AND -- THEY WERE
NOT CAPTURED?
>> I THINK THAT'S A REALLY GOOD
QUESTION.
I THINK MAYBE THIS -- I DON'T
KNOW IF WE REITERATED AS
STRONGLY AS WE DID.
INDIVIDUAL FOODS AND SATURATED
FAT HAS BEEN EXHAUSTIVELY
REVIEWED.
QUESTIONS WE WERE TRYING TO
GRAPPLE WITH WERE WITHIN SOURCES
OF SATURATED FAT OR SATURATED
FAT FOODS VERSUS NON-SATURATED
FAT, IS THERE A HIERARCHY OR
WITHIN THE HETEROGENEITY ACROSS
THESE FOODS AND COMPARISONS, IS
THERE SOMETHING THAT COULD BE,
YOU KNOW, ARE THERE SECTIONS,
SUBTYPES THAT DEVIATE FROM
OTHERS OR WHATEVER THAT MAY
OFFER ADDITIONAL NUANCE TO
SATURATED FAT CONVERSATION.
SO THE EXPLICIT COMPARISON IS IN
ADDITION TO THE ALREADY EXISTING
LITERATURE ON JUST SATURATED FAT
FOODS IN GENERAL LIKE DAIRY,
WHICH WOULD BE A LOT OF COHORTS
THAT AREN'T DOING SUBSTITUTION
MODELING BUT LOOKING DO PEOPLE
EAT MORE DAIRY HAVE HIGHER RISK
OF CARDIOVASCULAR DISEASE THAN
THOSE WHO DON'T, THOSE ARE
REPRESENTED ELSEWHERE, NOT
NECESSARILY CONTRASTING
EXPOSURE.
>> CAN I BUILD ON THAT ABOUT THE
U.S. STUDY?
SARAH MENTIONED IT.
NOW YOU MENTIONED IT.
I THINK I EXAGGERATED HOW OFTEN
U.S. WAS NOT REPRESENTED.
IN SOME OF THEM, MOST STUDIES
WERE IN U.S., SOME HALF THE
STUDIES IN U.S., AND IN MY NOTES
I ADDED THEM AND I THINK I TRIED
TO TALK ABOUT ADDING THEM TO THE
SLIDES SO WE HAD A LITTLE
DISCUSSION ABOUT THAT.
I WAS LOOKING AT MY SLIDES,
LOOKING AT NEW SLIDES, RAN OUT
OF TIME.
I MAY HAVE BEEN INACCURATE IN
DISMISSING U.S.
GENERALIZABILITY WAS MORE OFTEN
NO RACE AND ETHNICITY, NO
SOCIOECONOMIC POSITION, I
APOLOGIZE IF I MISREPRESENTED.
IT WAS MORE LIKE HALF IN
GENERAL.
I DON'T THINK WE WERE MISSING
MAJOR U.S. STUDIES LIKE NURSES
HEALTH.
>> THANK YOU FOR THE
CLARIFICATION.
>> DID YOU WANT TO SAY
SOMETHING?
>> THAT'S RIGHT.
WE DID CAPTURE A NUMBER OF U.S.
STUDIES, A APPROPRIATE TO SEE
THE DIVERSITY WAS NOT THERE.
IT WAS INCLUDED.
WE HAD AN EQUAL PROPORTION,
AUSTRALIA, NEW ZEALAND, EUROPEAN
COHORTS.
U.S. STUDIES GOT CAPTURED BUT
NOT HAVING THE DIVERSITY IN
DPCBD WAS MUCH RICHER.
>> WHEN WE WERE DECIDING WHAT TO
DO FOR FOOD SOURCES WE DECIDED
WITH DIETARY PATTERNS WE ALREADY
CAPTURE A LOT OF DIETARY
PATTERNS HIGHER IN SATURATED FAT
SO WE DIDN'T TO REPEAT WORK THAT
WE HAD DONE SO THAT'S WHY
ANOTHER RATIONALE FOR WHY WE DID
THIS.
>> THANK YOU FOR THE
CLARIFICATION.
IT'S AN IMPORTANT DISTINCTION.
I'M GOING TO HAND IT OVER TO
ANGELA.
>> IT'S SUPER INTERESTING.
I HAD TWO QUICK QUESTIONS.
ONE IS PROCESSED VERSUS
UNPROCESSED.
WITH PLANT PROTEIN SOURCES THEY
DIDN'T INCLUDE PROCESSED.
WAS IT ONLY UNPROCESSED PLANT?
>> THAT CAN'T BE ANSWER RIGHT
NOW, BEYOND MEAT, IMPOSSIBLE
MEAT, THEY WEREN'T AVAILABLE,
MOST WERE COHORT STUDIES.
YOU'RE NOT GOING TO -- IT WAS
WHOLE GRAINS, VEGGIES, BABIES,
PEAS, LENTILS.
I DON'T THINK FOOD FREQUENCY
QUESTIONNAIRES WOULD CAPTURE
THAT.
.1% WAS PROCESSED MEAT
ALTERNATIVES, TOFU WAS THE
CATEGORY.
>> SO THEY DIDN'T --
>> NOT CAPTURED.
>> THEY DIDN'T CAPTURE IT.
>> NO.
>> THEY ONLY LOOKED AT
UNPROCESSED IT.
>> PROSPECTIVE STUDIES WITH
MORBIDITY WOULD BE QUITE OLD.
>> SUBSTITUTING VERSUS
REPLACING, SOMEBODY ASKED THE
QUESTION LIKE THIS, AS FAR AS --
ASSUMING THEY HAD A
DOSE-RESPONSE ESSENTIALLY, THE
IDEA ABOUT IS REPLACING ONE
THING AND SUBSTITUTING SOMETHING
DIFFERENT OR IS THE IDEA OF
USING THOSE DIFFERENT
TERMINOLOGIES, DO THEY MEAN
SOMETHING DIFFERENT OR --
>> VERY.
DEE DEE CAPTURED IT.
>> WHAT'S THE DIFFERENCE?
>> YEAH, WE ONLY HAD A COUPLE
BULLETS, JUST DEFINING IT.
MORE FOR OUR INTERNAL
CONSISTENCY.
I DON'T KNOW THAT THERE'S
NECESSARILY LIKE OFFICIAL
LANGUAGE AROUND WHICH IS
PREFERRED.
WE FELT REPLACING WAS CONSISTENT
WITH WHAT'S OCCURRING IN A
FEEDING TRIAL OR CROSSOVER STUDY
WHERE YOU HAVE INDIVIDUALS
CONSUMING ONE THING, REPLACING
WITH ANOTHER.
SUBSTITUTION IS REFLECTING LIKE
MODELING, SUBSTITUTION MODEL,
COULD BE CONTRASTING OR
SOMETHING.
>> DID IT GET ELIMINATED IN THAT
CROSSOVER?
I'M CURIOUS, ESSENTIALLY IN THE
OTHER STUDIES MORE ABOUT AMOUNT
OR FREQUENCY OF CONSUMPTION.
>> THOSE THAT AREN'T INCLUDED
HERE?
>> YEAH.
>> SO, THOSE I MEAN THAT'S LIKE
WHY WE'RE BUILDING ON IT IN THIS
WAY.
YOU DON'T KNOW WHAT PEOPLE WHO
AREN'T CONSUMING YOUR FOOD OF
INTEREST ARE EATING INSTEAD.
IT'S NOT DEFINED IN YOUR
HYPOTHESIS.
PEOPLE WHO EAT MEAT, IT'S NOT
CLEAR WHAT PEOPLE WHO AREN'T
EATING MEAT ARE EATING INSTEAD.
REPLACING, SUBSTITUTING,
WHATEVER IT MIGHT BE,
SPECIFICALLY.
IT'S JUST THE BACKGROUND AVERAGE
DIET FOR THAT SPECIFIC
POPULATION.
I DON'T KNOW IF THAT'S ANSWERING
YOUR QUESTION.
>> SUBSTITUTION THAT YOU'RE
MODELING IS THE IDEA THAT --
THESE ARE COHORT STUDIES, YOU
HAVE VARIABILITY OF PEOPLE, SOME
EATING ZERO, SOME EATING ALL I
GUESS.
SO IN THE MODEL DOES IT ACCOUNT
FOR THAT OR REMEMBER I'M NOT AN
EPIDEMIOLOGIST SO WE CAN PUT
THAT TOGETHER.
>> IT'S IMPORTANT TO REMEMBER
DISTRIBUTION OF THESE FOODS THAT
ARE THAT ARE BEING LOOKED AT CAN
BE WIDE WITHIN A POPULATION.
BENEFIT OF COHORTS, YOU'RE NOT
LIMITED TO 100 GRAMS VERSUS ZERO
BUT ACROSS POPULATIONS YOU HAVE
SOME REGIONALLY CONSUMING VERY
DIFFERENT AMOUNTS, IT'S HARD TO
PUT A QUANTITY OF WHAT YOU ARE
IN THAT.
>> WHEN YOU SAY REPLACING, IT
ACCOUNTS FOR DISTRIBUTION IS
WHAT I'M ASKING?
>> REPLACING WITH A TRIAL.
>> SUBSTITUTING.
>> YEAH, SUBSTITUTING WOULD BE A
ONE-TO-ONE SLOT OF WHATEVER FOOD
YOU'RE CONTRASTING AND QUANTITY
YOU'RE SPECIFYING.
>> AILEEN?
>> WE SHOULD HAVE STARTED WITH
THIS ONE IN THE MORNING, RIGHT?
SO, SORRY.
SO, I'M TRYING TO LIKE GO
THROUGH AGAIN AND AGAIN THE
SUMMARY SLIDES TO WRAP MY HEAD
AROUND.
I UNDERSTAND WHAT YOU'RE TRYING
TO DO, WHICH IS NOT FOCUS ON
SATURATED FAT BUT THE FOOD
COMPONENT, RIGHT?
SO WHEN YOU FOUND NO DIFFERENCE
IN CARDIOVASCULAR RISK FOR HIGH
FAT DAIRY VERSUS LOW FAT DAIRY
FOR EXAMPLE OR PROCESSED RED
MEAT AND SEAFOOD THAT'S COUNTER
TO WHAT WE WOULD HAVE EXPECTED.
ESPECIALLY IN THE FIRST ONE,
HIGH FAT VERSUS LOW FAT,
WOULDN'T BE OTHER COMPONENT LIKE
FROM ANIMAL VERSUS PLANT, RIGHT?
IT COULD BE MAYBE A FIBER
CONTENT OR SOMETHING ELSE IN
THAT FOOD BECAUSE IT'S JUST FAT
CONTENT THAT'S REDUCED.
I WAS WONDERING IF YOU COULD
KIND OF COMMENT ON THAT.
BECAUSE MAYBE I WAS TAKEN ABACK
BY THE RESULTS, I'M SURE YOU ALL
WERE TOO.
AND WHAT DOES THAT MEAN MAYBE ON
SOME OF THE THINGS THAT WE
THOUGHT WAS BETTER TO GO WITH
LOW FAT DAIRY FOR RISK OF
CARDIOVASCULAR DISEASE.
>> LET ME START WITH THE FIRST
STATEMENT WHICH I WISH I SAID, I
MEANT TO.
I THOUGHT AN IMPORTANT PART WAS
NOT JUST ENOUGH TO GET LOWER
UNSATURATED FAT, AND HIGH IN
FIBER IS THE THING THAT STUCK
OUT.
I CAN'T BELIEVE NOBODY ASKED
UNTIL YOU DID, LOW FAT DAIRY,
HIGH FAT DAIRY ARE NOT DAIRY IT
SAID, IT'S A LIMITED CONCLUSION.
WHAT WAS MORE STRIKING HOW
INADEQUATE THAT DATABASE WAS.
IT WAS NOT ASSOCIATED.
>> YEAH, PART OF THE REASON WAS
THEY SAID LIKE LOW FAT, IT WOULD
BE 2% AND 1%, AND SO DEFINITIONS
FOR HIGH AND LOW FAT OFTEN
WEREN'T GIVEN.
SO IT WAS KIND OF HARD TO
DEDUCE.
THEY JUST WOULD SAY HIGHER
VERSUS LOWER.
OR THEY WERE NON-SPECIFIED.
SO --
>> AND FEWER TRIALS THAN WE
WOULD HAVE SHOT.
SHOULDN'T WE BE DOING TRIALS
LIKE THAT?
WAS IT MOSTLY EPI?
THAT'S AN ANSWERABLE QUESTION
FOR SOMETHING LIKE LIPIDS.
NOTHING IN KIDS.
REMEMBER, NOTHING IN KIDS.
THIS IS ONLY IN ADULTS AND OLDER
ADULTS, NOT EVEN IN OLDER ADULTS
AND ADULTS AND SHOULD BE KIDS IF
WE'RE MAKING THAT KIND OF
FEDERAL DECISION ABOUT ONLY
SKIM, LOW FAT MILK, NO WHOLE FAT
MILK IN SCHOOL.
>> WHAT ABOUT RED MEAT AND THE
FISH?
>> SAY THAT AGAIN.
YEAH.
>> CAN PEOPLE USE MICROPHONES
WHOLE MILK IS 50%, SO 50% OF
CALORIES IN WHOLE MILK ARE FROM
FAT.
SO WHATEVER PROPORTION OF
SATURATED FAT, FROM 2% TO 1%,
SOMETHING LIKE 35% TOTAL FAT IN
2%, 15% TOTAL FAT IN 1%, AND
ZERO IN SKIM BECAUSE THAT'S THE
DEFINITION.
>> WHAT YOU'RE GETTING AT IS
EFFECT SIZE?
>> OR MAGNITUDE OF EXPOSURE.
IF IT'S ONE GLASS OF MILK OR TWO
GLASSES OF MILK, GRAMS OF
SATURATED FAT, IF YOU WANTED TO
LOOK AT THAT LEVEL SOME OF THE
COMPARISONS OF AMOUNT OF
SATURATED FAT BETWEEN THE
EXPOSURE AND COMPARATOR WERE
QUITE MODEST.
WHICH WOULD EXPLAIN LACK OF
ASSOCIATION OR EFFECT IN A
TRIAL.
>> YEAH, IT WAS CHEESE AND
YOGURT TOO, IT WAS OTHER FOODS
THAT THEY LOOKED AT WITHIN THAT,
THAT WE LOOKED AT WITHIN THAT
CATEGORY.
>> THERE WERE THREE CATEGORIES
OF HIGH FAT DAIRY, LOW FAT
DAIRY.
MILK, CHEESE, YOGURT.
>> ARE THERE OTHER QUESTIONS
FROM COMMITTEE MEMBERS?
YES, HEATHER.
>> THANKS.
I WANTED TO FOLLOW UP ON
ANGELA'S COMMENT.
THAT REALLY WAS MAKING ME WONDER
MORE, LIKE IT ALMOST SOUNDS LIKE
WITH THE PROSPECTIVE COHORT
STUDIES MEAT VERSUS LIKE WHOLE
GRAINS AND VEGETABLE STUDIES,
WERE THOSE MODELING EXERCISES OR
WERE THEY ACTUALLY LIKE MEASURED
INTAKES GOING PROSPECTIVELY OVER
TIME?
SOUNDS LIKE THEY WERE MODELING
EXERCISES.
>> MODELING AND LIKE REGRESSION
MODELING?
THEY ARE NOT SIMULATIONS.
>> WRONG WORD, I APOLOGIZE.
>> IN PROSPECTIVE COHORT DIE SET
CAPTURED IN A NUMBER OF WAYS,
FOOD FREQUENCY QUESTIONNAIRES
ARE THE MOST COMMON.
I WOULD HAVE A QUANTITY AND
FREQUENCY OF X NUMBER OF FOODS,
AND
AND -- .
>> THEY DID MEASURE LIKE A
BASELINE IN TIME.
>> IF THEY WERE INTERESTED IN
DAIRY ONLY, CONTRASTING YOUR
BETA COEFFICIENT FROM DAIRY AND
WHOLE GRAINS AND FISH, THAT'S
REGRESSION MODEL BUT NOT A
SIMULATION.
>> SOUNDED LIKE IT WAS A
SIMULATION BUT THEY WERE ACTUAL
INTAKES MEASURED SELF-REPORTED.
>> CORRECT, YES, YES.
ABSOLUTELY.
>> CAN I GO ONE STEP FURTHER?
CORRECT ME, WHEN YOU FIRST HAD
36,000 AND THEN GOT TO 100, AND
THEN THEY SAID WE'RE GETTING RID
OF SIMULATION MODELS, OH MY GOD
NOW THERE'S NOTHING.
WE HAD TO GO BACK.
NO, NO, NO, WE WOULD BE
INTERESTED -- DID I SAY
SIMULATION AGAIN?
SUBSTITUTION.
IF WE DON'T DO SUBSTITUTION.
I SAW THE WORD MODELING MULTIPLE
TIMES.
CAN WE USE THE WORD MODELING?
>> YOU'RE RUNNING A REGRESSION
MODEL.
>> I WOULD ALSO DO WHEN LOOKING
AT RCT DATA.
>> OKAY.
>> BUT NOT MODELING IF THAT'S
LIKE SIMULATION MODELING.
>> I'M GOING TO HAVE YOU SHUT
YOUR MICROPHONE OFF,
CHRISTOPHER, AND LET ANGELA --
>> CAN I ELABORATE ON THIS?
WHEN WE KIND OF HONED DOWN TO
THE NUMBER, WE WANTED HEAD TO
HEAD OR ONE-TO-ONE COMPARISONS.
THAT'S WHY WE ENDED UP USING THE
MODEL THAT WE DID.
>> THAT'S THROWING ME A LITTLE
BIT.
IN A PROSPECTIVE COHORT STUDY
YOU HAVE PEOPLE, IT'S THE VERB
THAT IS THROWING ME, REPLACING
OR SUBSTITUTING, BECAUSE IS IT
PEOPLE SUBSTITUTING OR IS IT
PEOPLE COMPARED TO OTHER PEOPLE,
EATING -- PEOPLE EATING ONE
THING AND ANOTHER PERSON EATING
ONE THING VERSUS WE TELL PEOPLE
IF WE'RE DOING EDUCATION, WE SAY
SUBSTITUTE BLANK FOR BLANK, AND
THEN ONCE THEY SUBSTITUTE THEN
THEY ACTUALLY SHOULD BE IN A
BETTER POSITION.
BUT WHEN YOU SAY, OH, YOU
REPLACE BLANK FOR BLANK THAT
MAKES ME THINK THAT A PERSON,
ALONG -- YOU KNOW, THIS TIME,
LIKE THERE'S A TIME GRADIENT,
THAT THEY ACTUALLY REPLACED
BLANK AND THEIR BLANK WENT DOWN
VERSUS THE IDEA OF SAYING THAT A
PERSON A IN CONTRAST TO PERSON B
ATE MORE OR LESS OF SOMETHING.
THAT'S -- I'M WONDERING THE
REPLACING AND SUBSTITUTING, IF
THAT GETS -- SOME OTHER THINGS
ARE EXPRESSED IN DIFFERENT WAY,
IT'S LIKE A AND B ARE RELATED
BUT IT'S NOT SUBSTITUTING.
>> I THINK WE CAN WORKSHOP THE
NOMENCLATURE FOR SURE BECAUSE
THE INTENT IS NOT TO MAKE
CONFUSION BUT TO MAKE CLEAR.
TO YOUR POINT ABOUT ARE
INDIVIDUALS SUBSTITUTING, THE
ANALYSES CAN DO THAT, COHORTS
WITH REPEATED MEASURES OF DIET
ARE LIMITED.
AND SOME WILL BE CHANGE ANALYSES
WHERE YOU'RE DEFINING DID THIS
INDIVIDUAL DECREASE SUGARY
BEVERAGES AND INCREASE
ARTIFICIALLY SWEETENED
BEVERAGEDDAGES, AT THE
INDIVIDUAL LEVEL, WHICH WOULD BE
WHAT YOU'RE DESCRIBING.
BUT OTHER TIMES IT'S NOT.
AND IT IS THE, YOU KNOW, IF
EVERYBODY HAD BEEN CONSUMING
THIS VERSUS CONSUMING THAT, AND
YOU'RE CONTRASTING CONSUMERS OF
THIS VERSUS THAT, ALL OF THE
ASSUMPTIONS AROUND THAT WHICH OF
COURSE ARE IMPERFECT, IT'S THE
CONSISTENCY THAT HELPS, I THINK,
WITH THAT.
>> THANK YOU.
>> I WANTED TO ASK HOLLIE AND
VALERIE IF THEY HAD ANY
QUESTIONS OR COMMENTS ON THESE
ANALYSES.
>> THIS IS HOLLIE.
I DON'T HAVE ADDITIONAL
QUESTIONS BUT I'M IMPRESSED WITH
THE WORK OF THE SUBCOMMITTEE,
THANK YOU SO MUCH FOR THAT.
>> NO, NO ADDITIONAL COMMENTS OR
QUESTIONS.
THANK YOU.
>> THANK YOU BOTH.
ARE THERE ANY OTHER QUESTIONS OR
COMMENTS?
YES, CRISTINA?
>> I WAS SURPRISED TO SEE, MAYBE
AGAIN IT'S THE LACK OF
UNDERSTANDING OF THE ANALYSIS,
WHEN YOU WERE RECEIVING RESULTS
ON DAIRY PRODUCTS LOOKING AT
BUTTER, OKAY, BUTTER VERSUS --
SO YOGURT, THERE WAS NOTHING
WITH YOGURT?
IF YOU SUBSTITUTE BUTTER WITH
YOGURT WOULDN'T THAT BE BETTER?
I'M PROBABLY NOT UNDERSTANDING
ANALYSIS.
>> YEAH, WHEN WE LOOKED AT THE
SOURCES THERE WAS NO DIFFERENCE.
YEAH, SO THERE WERE ALL THOSE
COMPARISONS.
NO, A LOT OF IT, YOU KNOW, THERE
WERE ISSUES WITH SATURATED FAT
CONTENT OF THE COMPARISONS, SO
THAT PROBABLY WEIGHED IN ON IT.
BUT, NO, WE DIDN'T SEE ANY
CHANGES.
>> BACK TO THE POINT.
>> NO, CHRISTOPHER.
CHRISTOPHER, DON'T.
THERESA HAS A QUESTION.
>> WAS SATURATED FAT CONSTANT?
IF YOU HOLD IT CONSTANT --
>> NO.
>> OH.
>> THAT'S WHY IT'S FOOD SOURCES
OF SATURATED FAT.
NOT MATCHING THE SATURATED FAT.
>> LIKE BUTTERMILK COMPARED TO
YOGURT, BUTTERMILK COMPARED TO
BUTTER, THERE WERE COMPARISONS
THERE.
WE DID LOOK SEPARATELY AND ENDED
UP COMBINING THEM.
IF YOU BROKE THEM APART THERE
WASN'T ANY DIFFERENCE.
>> I'M GOING TO TURN THE FLOOR
OVER TO CHERYL.
>> A QUICK POINT.
OFTEN IF YOU DON'T DESIGN THE
PRIMARY STUDY TO ANSWER THE
QUESTION, BUT YOU HAVE THE
EXISTING DATA AND FOR
EFFICIENCILY YOU CREATE A
QUESTION AND DO SECONDARY DATA
ANALYSIS IT MAKES IT HARD TO DO
WHAT THERESA ASKED ABOUT SO WE
SEE A LOT OF LITERATURE
ATTEMPTING TO DO THIS IN A
SECONDARY ANALYSIS.
>> CHRIS?
>> JUST THE OTHER THING I WANTED
TO ADD FOR CONTEXT, I DO THE
REAL QUICK MATH, 2,000 CALORIES
AT 10% UNSATURATED FAT AND 9
GRAMS OF CALORIES, 9 CALORIES
PER GRAM OF SATURATED FAT WE'RE
TALKING ABOUT 22 GRAMS OF
SATURATED FAT BEING DISTRIBUTED
ACROSS MULTIPLE FOOD SOURCES,
WHICH MEANS WHEN YOU START
GETTING INTO BREAKING IT APART
FROM MEAT AND DAIRY AND OTHER
SOURCES OF SORT IN THE DIET WHEN
YOU CHANGE THE SATURATED FROM
ONE DAIRY SOURCE TO ANOTHER
YOU'RE REALLY LOOKING AT JUST A
SMALL PORTION OF THAT 22 GRAMS
ACROSS THE DAY.
SO IT ADDS AN EXTRA LAYER OF
COMPLEXITY, AROUND THE PRECISION
OF THAT GRAM DIFFERENCE BUT THE
MAGNITUDE OF THE GRAM DIFFERENCE
THAT COMPLICATES THINGS A LITTLE
BIT MORE THAT MAY NOT
IMMEDIATELY JUMP OUT.
>> TO REMEMBERA LOT OF OUR DATA
ARE DIETS HIGHER IN SATURATED
FAT ARE LOWER, TO CHRIS' POINT,
IF YOU'RE CHANGING ONE THING IN
THE DIET, YOU DO HAVE A CERTAIN
AMOUNT OF SATURATED FAT SO
PEOPLE MIGHT WANT TO TAKE IT IN
DIFFERENT FORMS.
SO, THAT'S SOMETHING ELSE TO
CONSIDER.
SO THANKS, CHRIS.
>> CHRISTOPHER, I'M GOING TO
GIVE YOU THE LAST WORD.
>> WHAT I REALLY LIKED ABOUT
BEING ABLE TO CLUSTER THESE WAS
WHAT IF WHITE MEAT HAS A LITTLE
LESS SATURATED FAT, IF FISH HAS
LESS THAN THAT BUT PLANTS HAVE
AN EVEN BIGGER DECREMENT AND
THEY HAVE FIBER, YOU DON'T SEE
IT BUT GET A BIGGER DIFFERENCE
AND THE HAVE THE FIBER THAT'S
WHEN YOU START NOTICING.
>> OKAY.
I GAVE CHRISTOPHER THE LAST
WORD.
I JUST WANT TO MAKE SURE THOUGH
THAT YOU HAD MORE SLIDES.
>> ONE MORE SLIDE.
>> THAT'S WHAT I THOUGHT.
I'M GIVING IT TO YOU SO THAT WE
CAN WRAP THE DAY UP.
>> WE HAVE NEXT TO COMPLETE PEER
REVIEW, SO SOMEONE WILL HAVE A
LOT OF FUN WITH OUR CONCLUSION
STATEMENTS.
AND THEN INCORPORATE CHANGES TO
SYSTEMATIC REVIEWS AS NEEDED,
WE'RE WORKING ON OUR CHAPTERS
BASED ON THESE SYSTEMATIC
REVIEWS, A CHAPTER ON BEVERAGES
IS IN GOOD SHAPE ALREADY, AND
WE'LL PRESENT AN OVERVIEW ACROSS
REVIEWS AT OUR NEXT MEETING.
SO THANK YOU.
>> WHAT A FANTASTIC DAY AND RICH
DISCUSSION.
THANKS SO MUCH TO THE COMMITTEE
FOR YOUR LOVELY PRESENTATIONS
AND WONDERFUL STAFF FOR YOUR
SUPPORT IN GETTING HERE.
IT'S A LOT OF PREP IN ADVANCE OF
MEETINGS.
SO TOMORROW WE'RE STARTING AT
8:30 A.M. EASTERN TIME, 30
MINUTES EARLIER THAN TODAY.
JUST THE BRIEF OVERVIEW OF THE
AGENDA, THERE WILL BE AN UPDATE
ON FEDERAL EFFORTS, RELATED TO
THE DIETARY GUIDELINES,
COMMITTEE WILL DISCUSS DIET IN
PREGNANCY AND BIRTH THROUGH
ADOLESCENCE, MORE FOOD PATTERN
MODELING, UPDATE ON HEALTH
EQUITY WORKING GROUP, AND I WILL
GO OVER NEXT STEPS IN THE
DIETARY GUIDELINES PROCESS,
AFTER WE RECEIVE THE COMMITTEE'S
REPORT AND THEN WE'LL WRAP UP
TOMORROW WITH A COMMITTEE
FACILITATED DISCUSSION.
I THANK THE PUBLIC FOR TUNING
IN.
WITH THAT I WILL CONCLUDE THE
MEETING.
THANK YOU VERY MUCH.