>> GOOD MORNING AND WELCOME AND
THANKS FOR JOINING US AGAIN
TODAY.
I'M GOING TO TURN IT OVER RIGHT
NOW TO DR. EVE STOODY TO GIVE AN
UPDATE ON OUR FEDERAL ACTIVITIES
RELATED TO DIETARY GUIDELINES
AND THE COMMITTEE'S GOING TO BE
DISCUSSING DIET AND PREGNANCY
THROUGH ADOLESCENCE AND PATTERN
MODELLING AND UPDATE FROM THE
HEALTH EQUITY WORKING GROUP.
I WILL DISCUSS NEXT STEPS IN THE
DIETARY GUIDELINES PROCESS AND
WE'LL FINISH OFF THE DAY WITH A
FACILITATED DISCUSSION FROM THE
COMMITTEE.
SO WITHOUT FURTHER ADO I'D LIKE
TO TURN IT OVER TO DR. EVE
STOODY.
>> THANKS, JANET.
GOOD MORNING.
SO JUST LIKE SOME OF OUR
PREVIOUS COMMITTEES I'LL GIVE
UPDATES RELATED TO THE WORK OF
THE COMMITTEE.
THE NEXT SLIDE KARA THANKS FOR
ADVANCING THE SLIDES ALL
MEETING, KARA AND SARA.
THE FIRST ARE UPDATES FROM
PREVIOUS MEETINGS ALCOHOLIC
BEVERAGES AND HEALTH AND INTAKE
AND SUSTAINABILITY IN THE
DIETARY GUIDELINES.
THE NEXT TWO ARE NEW UPDATES
RELATED TO PROJECTS SOME OF OUR
FEDERAL PARTNERS HAVE BEEN
SUPPORTING RELATED TO SEAFOOD
AND CHILD DEVELOPMENT AND BREAST
FEEDING FOR INFANTS AND CHILDREN
AND GIVE A HEADS UP ABOUT AN
UPCOMING WORKSHOP SUPPORTED BY
FDA AND NIH AND A NEW CAMPAIGN.
FIRST IS ALCOHOLIC BEVERAGES.
SINCE AS WE TALKED ABOUT FROM
THE BEGINNING WE DID NOT INCLUDE
QUESTIONS ON ALCOHOLIC BEVERAGES
AND HEALTH FOR THIS ADVISORY
COMMITTEE TO CONSIDER.
WE FELT WE WERE AT A TIME WHERE
THAT DESERVED A FOCUSSED REVIEW.
THERE'S TWO ACTIVITIES RELATED
TO ALCOHOLIC BEVERAGES IN
HEALTH.
BOTH ACTIVITIES HAVE HAPPENING
IN PARALLEL BUT COMPLEMENTARY
NOT DUPLICATIVE.
THEY'RE COVERING SLIGHTLY
DIFFERENT QUESTIONS USING
DIFFERENT METHODS.
BOTH PROJECTS ARE EVIDENCE
REVIEW PROJECTS.
NEITHER RESULT IN THE
DEVELOPMENT OF GUIDANCE ON
ALCOHOLIC BEVERAGES AND HEALTH.
SIMILAR TO THE ADVISORY
COMMITTEE'S REPORTS, THOSE WILL
RESULT IN REPORTS PROVIDED TO
THE DEPARTMENTS OF HEALTH AND
HUMAN SERVICES AND USDA TO BORNE
THE NEXT EDITION OF IT THE
DIETARY GUIDELINES.
THIS IS INTEREST THE HHS AND
SAMHSA SPECIFICALLY THE
INTERAGENCY COORDINATING
COMMITTEE ON THE PREVENTION OF
UNDER AGE DRINKING OR ICCPUD.
THIS IS A BIG PROJECT HHS
SUPPORTS EVERY YEAR.
THIS IS THE WORK RELATED TO
ALCOHOL INTAKE IN HEALTH FOR
SPIFF
SPECIFICALLY ADULT POPULATION.
THIS IS PART OF A MUCH LARGER
ACTIVITY.
IT'S A STUDY CONSIDERING ALCOHOL
IN TAKE IN ADULTHOOD AND
ESTIMATE RISKS ASSOCIATED WEDGE
LIFE TIME ALCOHOL CONSUMPTION
AND VARIOUS HEALTH OUTCOMES.
FOR THIS WORK THEY IDENTIFIED A
SIX-MEMBER EXTERNAL SCIENTIFIC
REVIEW PANEL THAT WILL REPORT TO
A TECHNICAL REVIEW SUBCOMMITTEE
THAT IS COMPRISED OF FEDERAL
EXPERTS.
SINCE WE LAST MET IN MAY, THAT
EXPERT SCIENTIFIC REVIEW PANEL
HAS POSTED THE STUDY METHODS FOR
THAT WORK ON THEIR WEBSITE AND
THAT WAS OPEN FOR PUBLIC
COMMENT.
SO THAT INFORMATION WAS POSTED
IN JULY AND THERE WAS A PUBLIC
COMMENT PERIOD ACROSS JULY AND
AUGUST AND THEY ALSO HELD A
PUBLIC MEETING THAT DISCUSSED
THOSE METHODS AS WELL AS THE
OPPORTUNITY FOR PUBLIC COMMENTS.
WHERE THAT PROFESSION IS AT THIS
POINT IS EXTERNAL SCIENTIFIC
REVIEW PANEL IS CONSIDERING
PUBLIC COMMENT AS IT WORKS TO
CONDUCT THE ANALYSES AND DRAFT
FINDINGS ARE EXPECTED TO BE
PUBLIC AVAILABLE AND OPEN FOR
PUBLIC COMMENT LATER THIS YEAR.
OUR NEXT ACTIVITY RELATED TO
ALCOHOLIC BEVERAGES IS BEING
CONDUCTED BY THE NATIONAL
ACADEMIES.
THIS WAS MANDATED BY CONGRESS
THAT USDA COMMISSION A STUDY
WITH THE NATIONAL ACADEMIES
ESSENTIALLY A SYSTEMATIC REVIEW
PROJECT LOOKING AT A REVIEW OF
EVIDENCE ON ALCOHOL INTAKE AND
HEALTH.
WHEN WE LAST MET WE NOTED A 15
MEMBER COMMITTEE HAD BEEN
FINALIZED THAT HAS HELD TWO
PUBLIC MEETINGS.
ONE IN JANUARY AND MARCH.
SINCE WE LAST MET IN MAY, THE
SYSTEMATIC REVIEW PROTOCOLS FOR
THE QUESTIONS THEY ARE REVIEWING
HAVE BEEN POSTED TO THE NASEM
STUDY PANEL YOU CAN GO TO THE
NASEM WEBSITE.
I THINK IT'S UNDER RESOURCES
THERE'S A LINK TO A PDF THAT
INCLUDES LINKS TO THE PROTOCOLS
AND THEY'VE BEEN POSTED ON
PROSPERO.
IF YOU'RE INTERESTED WE
ENCOURAGE YOU TO GO THERE AND
CHECK THEM OUT.
THERE'S A DEDICATED E-MAIL FOR
THAT STUDY WHERE THE PUBLIC CAN
PROVIDE PUBLIC COMMENT AT ANY
TIME AND THE LINK IS ON THE THIS
SLIDE.
THE FINDINGS FROM THE NASEM
STUDY WILL BE MADE PUBLICALLY
AVAILABLE LATER THIS YEAR.
SO FOR BOTH OF THESE THE PROJECT
AND THE LAST PROJECT THE METHODS
FOR THE ICCPUP STUDY ARE STILL
AVAILABLE AND SEE THE METHODS ON
TE WEBSITE.
LINKS ARE AVAILABLE AT DIETARY
GUIDELINES.gov UNDER THE RELATED
PROJECTS PAGE.
SO THAT'S ALCOHOLIC BEVERAGES.
THE NEXT TOPIC AREA IS RELATED
TO THE DIETARY REFERENCE
INTAKES.
WE NOTED PREVIOUSLY THERE'S A
JOINT U.S.-CANADIAN DRI WORKING
GROUP AND WE THOUGH THEED WE ARE
SUPPORTING UPDATES TO THE ENERGY
AND MACRO NUTRIENT DRIs.
AND WE'VE TALKED PREVIOUSLY WE
COMMISSIONED SYSTEMATIC REVIEWS
TO INFORM FUTURE DRI UPDATES FOR
CARBOHYDRATE, PROTEIN AND FAT.
THIS GROUP ALSO SUPPORTS A
STANDING COMMITTEE FOR THE
REVIEW OF THE DIETARY REFERENCE
INTAKES FRAMEWORK.
THERE'S A STANDING COMMITTEE
THAT THE FEDERAL GOVERNMENT
SUPPORTS THAT ADDRESSES VARIOUS
TOPICS.
THE WORK INFORMS FUTURE DRI
COMMITTEES AND THEIR
APPLICATIONS.
RECENTLY THIS SUMMER THERE IS A
REPORT PUBLISHED ON RETHINKING
THE ACCEPTABLE MACRO NUTRIENT
DISTRIBUTION RANGE FOR THE 21st
CENTURY.
THIS WILL BE OF INTEREST AS WE
LOOKED TO UPDATING THE DRIs FOR
THE MACRO NUTRIENTS BUT WANTED
TO NOTE IT'S PUBLICALLY
AVAILABLE AND FOR THE NEXT
UPDATE SUSTAINABILITY.
I THINK AT A HIGH LEVEL AS WE'VE
NOTED PREVIOUSLY, USDA AND HHS
CONVENED A WORK GROUP TASKED
WITH THE MERITS OF VARIOUS
PATHWAYS TO CONSIDER INTEGRATING
SUSTAINABILITY TO FUTURE
EDITIONS OF THE DIETARY
GUIDELINES AS WELL AS OTHER
FEDERAL POLICIES AND PROGRAMS AS
APPROPRIATE.
SINCE OUR LAST MEETING I WILL
NOTE THIS WORK HAS CONTINUED.
THERE ARE STILL PLANS FOR A
REPORT TO BE MADE PUBLICLY
AVAILABLE AND FOR PUBLIC MEETING
TO OCCUR.
THE DATES OF THOSE SPECIFIC
ITEMS ARE STILL TO BE
DETERMINED.
JUST WANTED TO ACKNOWLEDGE THAT
WORK CONTINUES.
WE DON'T HAVE SPECIFIC DETAILS
ON THE REPORT OR THE PUBLIC
MEETING TIMING JUST YET.
HOWEVER, WE WILL INCLUDE
INFORMATION ABOUT THIS AND
CONTINUE TO AT DIETARY
GUIDELINES.gov UNDER RELATED
PROJECTS AND ONCE THAT
INFORMATION AND MAKE SURE TO
ANNOUNCE THAT THROUGH OUR GOV
DELIVERY AND NEWS ALERTS.
AS WE TALKED ABOUT BEFORE, IN
DEVELOPMENT OF THE DIETARY
GUIDELINES AND ACROSS OR WORK IN
THE NUTRITION SPACE WE TRY NOT
TO DUPLICATE EFFORTS.
WE WORK WITH OUR FEDERAL FAMILY
TO KNOW WHO'S COVERING WHAT AND
WE'RE NOT BEING DUPLICATIVE.
WE WANTED TO NOTE THIS PROJECT
UNDERWAY ON SEAFOOD AND CHILD
DEVELOPMENT SUPPORT ED BY THE
FOOD AND DRUG ADMINISTRATION.
THEY COMMISSIONED A 20 MONTH
STUDY WITH THE NATIONAL
ACADEMIES TO LOOK AT SYSTEMIC
REVIEW ON SEAFOOD NUTRITION AND
TOXICOLOGY TAKEN TOGETHER TO
FORM RECOMMENDATIONS ON SEAFOOD
CONSUMPTION.
FDA PARTNERED WITH A NUMBER OF
AGENCIES AS NOTED IN THE SECOND
BULLET AND IT WAS PART OF THEIR
CLOSER TO ZERO INITIATIVE.
WE WANTED TO NOTE THAT THAT
STUDY RECENTLY COMPLETED EARLIER
THIS SUMMER AND THEY PUBLISHED A
REPORT ON THE ROLE OF SEAFOOD
CONSUMPTION AND CHILD GROWTH AND
DEVELOPMENT AND AS PART OF THE
WORK COMMISSIONED REVIEWS AND
ADDITIONAL REVIEWS RELATED TO
TOXICOLOGY.
I'LL NOTE ONE OF THE FINDINGS
NOT FINDING EVIDENCE THAT WOULD
SUGGEST THERE SHOULD BE CHACNGE
TO THE SEAFOOD RECOMMENDATIONS
AND DIETARY GUIDELINES.
FDA IS CONSIDERING THE FINDINGS
FROM THE NASEM REPORT WITH OTHER
INFORMATION TO INFORM THEIR
JOINT ADVICE ABOUT EATING FISH
WE ELEVATE AND IMPLEMENT IN THE
DIETARY GUIDELINES AS WELL AS
PART OF THEIR CLOSER TO ZERO
INITIATIVE.
AS USUAL THE LINK FOR THAT IS AT
THE BOTTOM OF THE PAGE AND THE
DOI NUMBER.
THE NEXT ACTIVITY IS RELEVANT TO
DIETARY GUIDANCE THAT NOW WE'RE
WE'RE INTEGRATING THE BIRTH TO
24 MONTH POPULATION.
WE WANTED TO NOTE OUR COLLEAGUES
AT THE CENTERS FOR DISEASE
CONTROL AND PREVENTION
COMMISSIONED A SYSTEMATIC REVIEW
PROJECT WITH THE HHS AGENCY FOR
HEALTH CARE RESEARCH AND QUALITY
LOOKING AT THE ASSOCIATION
BETWEEN BREAST FEEDING AND HUMAN
MILK CONSUMPTION AND VARIOUS
HEALTH OUTCOMES AMONG INFANTS
AND CHILDREN AND HOW THE
ASSOCIATIONS VARY BY INTENSITY,
VARIATION AND SOURCE OF HUMAN
MILK.
THE DRAFT SYSTEMATIC REVIEW WAS
RELEASED SEPTEMBER 23 AND OPEN
FOR PUBLIC COMMENT UNTIL OCTOBER
23.
WE WELCOME PUBLIC COMMENTS.
THE LINK AT THE BOTTOM OF THE
SLIDE.
ON THE NEXT SLIDE WE WANTED TO
HIGHLIGHT A WORKSHOP THAT NIH
AND FDA RECENTLY ANNOUNCED THAT
IS ON NUTRITION REGULATORY
SCIENCE THAT WILL BE DECEMBER 17
AND 18 AND THE PUBLIC IS INVITED
TO PARTICIPATE UP THAT WORKSHOP
REMOTELY.
WE WANTED TO HIGHLIGHT IT FOR A
COUPLE REASONS.
ONE IT'S ABOUT RESEARCH AND
RESEARCH RECOMMENDATIONS WHICH
IS OBVIOUSLY A VERY BIG
CONVERSATION WITHIN THIS
COMMITTEE.
THEY'RE GOING TO HIGHLIGHT HOW
NUTRITION SCIENCE CAN INFORM
FOOD RELATED POLICY AND
REGULATORY DECISION MAKING AND
THIS IS PART OF JUST A REGULAR
PARTNERSHIP BETWEEN NIH AND FDA
IN RESEARCH.
WE WANTED TO FLAG IT BECAUSE
TOPIC AREAS ARE AREAS Y'ALL HAVE
SPOKEN ABOUT.
SOME ARE ULTRA PROCESSED FOODS
AND IMPLEMENTATION SCIENCE.
THE REGISTRATION FOR THAT
WEBINAR IS CURRENTLY OPEN AND
IT'S AVAILABLE THROUGH THE LINK
AT THE BOTTOM OF THE PAGE.
YOU CAN GO TO THE WEBSITE TO
LEARN MORE.
AND THEN FINALLY WE WANTED TO
CLOSE OUT WITH A LITTLE UPDATE
ABOUT MY PLATE.
AND MY PLATE IS THE CONSUMER
TRANSLATION OF THE DIETARY
GUIDELINES.
AND USDA HAS RECENTLY LAUNCHED A
NEW CAMPAIGN CALLED WHAT'S ON MY
PLATE AND THIS IS A CAMPAIGN TO
HIGHLIGHT HOW MY PLATE FITS MANY
LIFE STYLES AND CAN BE USED TO
FIT FOOD PREFERENCES, CULTURAL
TASTE AND THEY'RE INTENDED TO BE
A FRAMEWORK THAT CAN BE
CUSTOMIZED.
THE PURPOSE OF THIS CAMPAIGN IS
TO HIGHLIGHT THAT WHETHER YOU
EAT ON A PLATE, IN A BOWL OR
ANOTHER WAY, THERE'S A LOT OF
WAYS TO EAT HEALTHY.
SO THERE IS A DIGITAL HUB AT MY
PLATE.gov THERE'S A NUMBER OF
HEALTHY EATING TOOLS AT MY
PLATE.gov/WHAT'S ON MY PLATE.
IF YOU SCROLL DOWN TO THE BOTTOM
OF THAT PANEL THERE'S A SOCIAL
MEDIA TOOL KIT AND REALLY
ENCOURAGE HEALTH PROFESSIONALS
TO HELP LIFT THIS UP AND SHOW
DIFFERENT WAYS TO EAT PROMOTE
HEALTHY EATING AND ENCOURAGE YOU
TO TAG MY PLATE AND THAT
INCLUDES IN FACEBOOK, INSTAGRAM
AND X.
I REALLY APPRECIATE THE
OPPORTUNITY TO PROVIDE THESE FEW
DIFFERENT FEDERAL UPDATES AND
NOW ARE GOING TO TURN IT OVER TO
THE COMMITTEE AND I'LL TURN IT
OVER TO DR. JENNIFER ORLET
FISHER.
>> GOOD MORNING IT'S A PLEASURE
TO BE ABLE TO KICK OFF THE
SECOND DAY OF SCIENCE AND IT'S
REALLY MY PLEASURE AND PRIVILEGE
TO PRESENT OUR SUBCOMMITTEES
REVIEW OF THE EVIDENCE ON DIET
AND PREGNANCY AND BIRTH THROUGH
ADOLESCENCE WITH DR. BE A RAMS
ON MY LEFT.
SO LET'S GET STARTED BUT BEFORE
WE BEGIN, AS ALL OF US HAVE AND
WANT TO ACKNOWLEDGE OUR
FANTASTIC SUBCOMMITTEE MEMBERS.
THIS SUBCOMMITTEE IN PARTICULAR
IS ONE THAT BRINGS TOGETHER
DIVERSE SET OF EXPERTISE
CRITICAL FOR UNDERSTANDING THE
RELATIONSHIPS IN THE CONTEMPT OF
DYNAMIC DEVELOPMENT THAT OCCURS
FROM PREGNANCY THROUGH
ADOLESCENCE.
NOT ONLY IN TERMS OF BIOLOGICAL
AND COGNITIVE DEVELOPMENT AND
SOCIO EMOTIONAL DEVELOPMENT AND
EATING BEHAVIORS AND DIETARY
PATTERNS WE'LL CONSIDER TODAY.
IT TAKES A SCIENTIFIC VILLAGE TO
TAKE ON THESE KINDS OF QUESTIONS
AND WANT TO ACKNOWLEDGE THAT
BEFORE MOVING FORWARD.
SEVERAL OF US SIT ON THE HEALTH
EQUITY COMMITTEE AND BRING THOSE
VERY IMPORTANT PERSPECTIVES
WHACK TO OUR WORK.
AND THEN LASTLY BEFORE WE LAUNCH
IN SPEAKING OF THE VILLAGE, WE
WANT WANT TO STOP AND THANK THE
TREMENDOUS WORK OF THE STAFF.
THANK YOU.
THE EXPERTISE IS VAST AND AT
TIMES IT'S LIKE HERDING CATS, I
KNOW SO IT'S VERY MUCH
APPRECIATED.
SO LET US MOVE ON.
AND REALLY START WITH TALKING
ABOUT WHAT WE'VE BEEN UP TO
SINCE WE LAST MET.
I'M PLEASED TO SAY AT THE LAST
MEETING WE PRESENTED OUR
FINDINGS ON COMPLIMENTARY
FEEDING AND THE SYSTEMATIC
REPORT OF THE REVIEW HAS UNDER
GONE THE PEER REVIEW PROCESS AND
WE REVISED THE WORK TO RESPOND
TO THAT FEEDBACK.
AND PROBABLY THE MOST EXCITING
NEWS IS THAT WE HAVE COMPLETED
OUR REVIEW OF THE SCIENTIFIC
EVIDENCE AND QUESTIONS TO WHICH
WE'VE BEEN ASSIGNED WHICH IS
QUITE EXCITING AND AS A
REMINDER, OUR SUBCOMMITTEE WAS
TASKED WITH LOOKING AT EIGHT
DIFFERENT QUESTIONS FOR RELATED
TO DIET DURING PREGNANCY STEVE
WILL PRESENT AND FOUR QUESTIONS
INVOLVING DIET THROUGH INFANCY
AND ADOLESCENCE.
TODAY WE ARE GOING TO PRESENT
OUR LAST OUTCOMES AS WELL AS THE
WORK THAT WE'VE DONE IN
CAREGIVER FEEDING STYLES AND
PRACTICES AND THEY'RE
ASSOCIATIONS WITH DIETARY
INTAKES AND BODY COMPOSITION AND
RISK OF OBESITY DURING
CHILDHOOD.
WITH THAT I'LL TURN IT OVER TO
DR. ABRAMS.
>> WE'LL TALK ABOUT DIETARY
PATTERNS DURING PREGNANCY.
THE EXISTING SYSTEMATIC REVIEW
WHICH HAD A LIMITED EVIDENCE
CONCLUSION STATEMENT THIS
SYNTHESIZED THE DATA FROM 1980
THROUGH MAY OF 2023.
THE POPULATION COMPARATIVE
OUTCOME DISCUSSIONS AND TOPICS
WERE ESSENTIALLY THE SAME AS
REPRESENTED AT THE LAST MEETING.
DATA WERE SYNTHESIZED AT THE
LEVEL OF POPULATION AND FOR THIS
ANALYSIS WE'LL REFER TO THE
PRETERM BIRTH AS A MATTER OF
PUBLIC HEALTH CONCERN.
SO, THE CONCLUSION I'LL START
WITH FIRST IS DIETARY PATTERNS
CONSUMED DURING PREGNANCY MAY IN
THE BE ASSOCIATED WITH RISK OF
PRE TERM BIRTH.
THE BODY OF EVIDENCE CONSISTENCY
RISK AND BIAS AND
GENERALIZABILITY ARE SHOWN
THERE.
THIS IS DATA THAT'S VERY
DIFFICULT TO COLLECT FOR THE
ARTICLES HOWEVER, WHAT'S
IMPORTANT IS THEY GENERALLY WERE
NOT DESIGN TO DIRECT EXAMINE THE
RELATIONSHIP AND HAVE A HIGH
RISK OF BIAS AS WELL AS CONCERNS
ABOUT THE PRECISION AND
CONSISTENCY.
NOW, I WANT TO MAKE A COMMENT OR
TWO ABOUT THE REASON AND
INTERPRETATION OF THE DATA.
FIRST OF ALL, IN NO WAY DO THESE
DATA GO AGAINST THE IDEA THAT
HEALTHY DIET DURING PREGNANCY
ISN'T IMPORTANT FOR BIRTH
OUTCOMES.
OF COURSE IT IS.
BUT PRE TERM BIRTH AFFECTS 11%
AND THE VALUE GOES UP AND DOWN A
LITTLE BIT OVER TIME BUT HAS NOT
SUBSEQUENTLY DECREASED AND PRE
TERM BIRTH IS RELATED WITH
SPECIFICS AND SORTING IT OUT IS
DIFFICULT.
36 WEEKS IS A FAIRLY ARBITRARY
END POINT.
WE MAY BE MORE CONCERNED AND FEW
STUDIES LOOK AT VARIABLE BIRTH
WEIGHT AND DELIVERY OF 36 WEEKS
GESTATION WHICH IS RELATIVELY
FEWER COMPLICATED.
IT'S NOT SURPRISING WE'RE NOT
ABLE TO IDENTIFY ANYTHING WITH
LIMITED CONCLUSION AND THAT DOES
RELATE TO OUTCOMES WE MIGHT
THINK OR RECOMMENDATIONS ABOUT
HAVING A HEALTHY DIET DURING
PREGNANCY.
WHEN WE LOOK AT BIRTH WEIGHT, WE
ALSO ARE LOOKING AT DIETARY
PATTERNS IN BIRTH WEIGHT.
THE NUMBER OF WAYS IN WHICH TO
LOOK AT THESE AND THE PICO
ELEMENTS ARE THE SAME AND THE
CONFOUNDERS BUT WE HAVE A
VARIETY OF DIFFERENT TERMS AS WE
LOOK AT WHAT MIGHT BE CONSIDERED
ABNORMALITIES OF BIRTH WEIGHT
AND THEY EACH NEED TO BE
DISCUSSED AND THEN WE'LL GO
THROUGH WHAT THE RESULTS WERE.
WE'LL TALK ABOUT LARGE
GESTATIONAL AGE AND LOW BIRTH
WEIGHT, LBW AND MACROSOMIA.
SO DEFINITIONS ARE MEDICAL.
I USED THE MEDICAL LITERATURE
THAT DOESN'T NECESSARILY MEAN
THEY'RE PHYSIOLOGICALLY THE MOST
RELEVANT OUTCOMES.
SO SMALL FOR GUEESTATIONAL AGE
10th PERCENTILE WHICH MEANS YOU
HAVE NORMAL BABIES OF THE
REFERENCE POPULATION IT DOES NOT
IMPLY DISEASE PER SE.
AND LARGE FOR GESTATIONAL AGE
ABOVE 90th PERCENTILE AND OVER
THE LAST DECADES WE'VE SEEN AN
INCREASED IN BIRTH WEIGHTS
WHEREAS THE 90th PERCENTILE
WITHOUT HAVE BEEN 4,000 GRAMS
AND CLINICALLY MANY HOSPITALS
USE THAT AS A CUT-OFF FOR
CONSIDERING A BABY LGA IN
REALITY BASED RECENT CURVES IT'S
WELL WITHIN THE 90th PERCENTILE
AND HAVE SEEN MANY BABIES
CLINICALLY BORN AT THE WEIGHTS
WITH NO PROBLEM AT ALL.
ON THE OTHER HAND LOW BIRTH
WEIGHT ONE RELATE TO THE
GESTATIONAL AGE AND THE OTHER IS
SIMPLY A WEIGHT MAY HAVE MORE
CONSEQUENCES AND THERE'S BEEN A
RELATIVELY SMALLER SECULAR
CHANGE IN THOSE CONCERNS.
SO I GIVE YOU THAT BACKGROUND AS
WE LOOK AT THE CONCLUSIONS FOR
UNDERSTANDING WHY THERE MAY BE
MORE FOCUS ON THE SMALL FOR
GESTATIONAL AGE GROUP.
SO I'LL START WITH SMALL FOR
GESTATIONAL AGE AND HIGHER
INTAKES OF VEGETABLES AND FRUITS
AND LEGUMES AND DAIRY AND
UNSATURATED FAT AND LOWER
INTAKES OF RED AND PROCESSED
MEAT MAY BE ASSOCIATED WITH
SMALL FOR GESTATIONAL AGE AND
THIS STATEMENT IS LIMITED.
AGAIN THE CHALLENGE IS LOOKING
AT THE STUDIES ARE DESCRIBED
BELOW WITH SOME OF THE USUAL AND
COMMON CONCERNS.
THE MOST IMPORTANT ONE BEING
GENERAL STUDIES ARE NOT DESIGN
TO DIRECTLY LOOK AT THIS
RELATIONSHIP.
MOST HAD AN IMMEDIATE OUTCOMES
BEING CONSIDERED.
NONETHELESS THERE IS SOME
DIRECTIONALITY TO THESE RESULTS.
AND I THINK WHEN WE CONSIDER THE
FACT THAT SMALL FOR GESTATIONAL
AGE DOES HAVE SOME PHYSIOLOGICAL
CONSEQUENCES THOUGH IT'S
IMPRECISELY DEFINED I THINK OF
THIS IF YOU DON'T HAVE A GOOD,
HEAL
HEALTHY, ADEQUATE DIET WITH
ENOUGH PROTEIN FROM A GOOD
SOURCE YOU MAY IN FACT NOT HAVE
ADEQUATE PLACENTAL FUNCTION AND
BIRTH WEIGHT IN THE SMALL FOR
GESTATIONAL AGE.
IT'S SUPPORTED BY THIS TYPE OF
DATA.
IT BECOMES MORE DIFFICULT THAN
ON THE OTHER DEFINING
CHARACTERISTICS FOR THE REASONS
I EXPLAINED AND THEY'RE POORLY
DEFINED AND SO MUCH INTERACTION
OR SO MUCH THAT FITS WITHIN THE
DEFINITIONS OF LGA AND
MACROSOMIA THAT ARE NORMAL
WITHIN THE POPULATION OF DATA.
IN TERMS OF RESEARCH WE
ABSOLUTELY NEED TO LOOK AT THE
LARGER EXTREMES AND 4 SKIKILOS
SHOULD BE DEFINED AND WE HAVE TO
CONSIDER THE IMPLICATIONS OF
GESTATIONAL DIABETES AND OTHER
HEALTH OUTCOMES AND HOW THEY ARE
TREATED.
IT'S NOT SURPRISING THE
CONCLUSION STATEMENT COULD NOT
BE DRAWN AT ALL RELATED TO THESE
OUTCOMES AT BASELINE THESE TYPES
OF DIETARY ISSUES WE'VE SEEN
WITH A LARGE AMOUNT OF
INCONSISTENT DATA REGARDING
THAT.
IF I COULD SUMMARIZE OUR
CONCLUSION IS MAINTAINING A
RELATIVELY HEALTHY DIET
CONSISTENT WITH PATTERN HAS
LIMITED EVIDENCE OF HELP
PREVENTING ADEQUATE GROWTH AND
IT MAY BE RELATED TO PRE TERM
BIRTH BUT IT'S IMPOSSIBLE TO
TEASE OUT FROM THIS TYPE OF DET
AND STUDIES BEING DONE AND
THOUGH LARGE FOR GESTATIONAL AGE
IS NOT ENTIRELY BENIGN THE TYPE
OF DATA WE HAVE DOESN'T ALLOW US
TO IDENTIFY CLEARLY HOW DIET
MIGHT RELATE TO THAT.
THANK YOU.
>> THANK YOU, DAVE.
FOR THE REMAINDER OF OUR
PRESENTATION I'M GOING TO SHIFT
GEARS AND FOCUS ON CAREGIVER
FEEDING STYLES AND PRACTICE.
I THINK I MENTIONED THIS IS NEW
FOR THE DIETARY GUIDELINES
ADVISORY COMMITTEE.
OUR COMMITTEE IS REALLY THE
FIRST TO COMPREHENSIVELY REVIEW
THE BEHAVIORAL SCIENCE AND
FEEDING AND WE'RE CON DUPTHED
THIS WORK WITH THE ULTIMATE GOAL
OF FEEDING AND I'LL SUMMARIZE
THE REVIEW OF THE SCIENCE IN THE
AREA FIRST LOOKING AT DIETARY
OUTCOMES RELATED TO DIETARY
INTAKES.
I WANT TO COMMENT THE SCHOLARLY
WORK ON PARENTING DATES BACK TO
THE EARLY 1900s, HOWEVER WORK IN
THIS AREA OF FEEDING YOUNG
CHILDREN IS RELATIVELY MORE
RECENT.
IT STARTED IN THE 90s AS A SMALL
AND NICHE INTERSECTION OF
NUTRITION AND DEVELOPMENTAL WHEN
INTERESTS AROUND ENVIRONMENTAL
CONTRIBUTIONS TO OBESITY AND ITS
PREVENTION WERE CONSIDERED.
AND SINCE THAT TIME THE FIELD
HAS RAPIDLY EXPANDED.
I SAY THIS AS A WAY OF
INTRODUCING STARTING WITH TERMS
BECAUSE OUR FIELD IS RIPE WITH
TERMS.
WHAT DO WE MEAN WHEN WE TALK
ABOUT STYLES AND PRACTICES?
HOW ARE THEY DIFFERENT?
I WANT TO START WITH
NOMENCLATURE THAT IS BASIC
DEFINITION.
FIRST, WHEN WE USE THE WORD
CAREGIVERS WE'RE INCLUSIVE OF
INDIVIDUALS WHO PROVIDE CARE FOR
AND FEED CHIRP WE'RE TALKING
PARENTS AND AND GRANDPARENTS AND
GUARDIANS.
THAT'S A STARTING PLACE.
LET'S MOVE ON TO FEEDING STYLES
AND PRACTICES.
THERE'S MUCH DISCUSSION ON WHAT
THESE MEAN AND IT'S IMPORTANT TO
OUTLINE THEM.
FEEDING STYLES HAVE BEEN USED TO
REFER TO AN OVER ALL ATTITUDE OR
APPROACH CAREGIVERS GIVE IN
FEEDING CHILDREN AND THE
EMOTIONAL CLIMATE AROUND
FEEDING.
THEY'RE VERY GLOBAL IN NATURE.
HISTORICALLY THEY'VE BEEN
CHARACTERIZED ALONG LINES OF
DEMANDINGNESS AND
RESPONSIVENESS.
WHAT DO THOSE MEAN.
DEMANDINGNESS MEANS MATURITY
DEMANDS CAREGIVERS PLACE ON THE
CHILD AND RESPONSIVE IS THE
CAREGIVER'S SENSITIVITY TO THE
CHILD'S NEEDS.
FEEDING STYLES ARE LOOKED AT A
NUMBER OF WAYS BUT ALONG THE
DIMENSIONS CATEGORIZED OR
CONTINUOUSLY BUT THE MAIN
TAKEAWAY IS THESE ARE OVER ALL
BROAD APPROACHES AND
CHARACTERIZE THE CLIMATE IN
WHICH CHILDREN'S EATING
BEHAVIORS ARE SOCIALIZED.
IN CONTRAST TO STYLES, FEEDING
PRACTICES REFER TO SPECIFIC
GOAL-DIRECTED BEHAVIORS USED BY
CAREGIVERS TO GUIDE CHILDREN'S
FEEDING.
THE SLIDE SHOWS WHAT IS THE
PREVAILING FRAMEWORK IN THE
FIELD THE CONCEPTUAL FRAMEWORK
CITED CLOSE TO 700 TIMES.
IF YOU FOCUS ON THE FAR
RIGHT-HAND SIDE OF THE SLIDE
YOU'LL SEE A WIDE NUMBER OF
PRACTICES HAVE BEEN IDENTIFIED
IN THE LITERATURE AND PROBABLY
MANY MORE SO SINCE THIS PAPER
HAS BEEN PUBLISHED.
BUT THE IMPORTANT THING HERE IS
THAT THIS CONCEPTUAL FRAMEWORK
SUGGESTS THE RANGE OF PRACTICES
CAN BE GROUPED ACCORDING TO
HIGHER ORDER CONCEPTUAL THEMES
OR SIMILARITIES.
THOSE ARE STRUCTURE, AUTONOMY,
SUPPORT AND CONTROL.
WE HAVE SYNTHESIZED AND
STRUCTURE IS ENVIRONMENTS AND
BEHAVIORS AND REFER TO PHYSICAL
ASPECT AROUND EATING AND SOCIAL.
AUTONOMY SUPPORT AND PRACTICES
THAT PROVIDE DEVELOPMENTALLY
SUPPORT OR SCAFFOLDING FOR
CHILDREN'S EATING EVERYTHING
FROM SELF-FEEDING SKILLS TO
EATING CHOICES AND ISSUES AROUND
APPETITE.
AND THEN FINALLY THE LAST
DIMENSION INVOLVES CONTROL.
CONTROLLING FEEDING PRACTICES
ARE CAREGIVER PRACTICES THAT ARE
AGAIN MORE PARENT OR CAREGIVER
DRIVEN OPPOSED TO THE CHILD.
SO AGAIN GOAL DIRECTED BEHAVIORS
THAT CAN BE GROUPED ACCORDING TO
THESE HIGHER ORDER THEMES.
THAT BRINGS ME TO THE ANALYTICAL
FRAMEWORK.
WE LOOK AT THE DIETARY PATTERN
WITH DIETARY GUIDELINE.
THIS IS A NEW REVIEW WHICH IS
SKIING TO US.
THE POPULATION INTERVENTION
COMPARATOR AND OUTCOMES AND KEY
CONFOUNDERS ARE SHOWN HERE.
THE PROTOCOL WAS ORIGINALLY
SPECIFIED TO EVALUATE PRACTICES
FROM CHILDREN FROM BIRTH TO
ADOLESCENCE AND IT WAS IN
RECOGNITION OF WORK LOAD AND DO
IT WELL IN THE TIME REMAINING.
AND SOCIALIZATION IS THOUGHT TO
BE IMPORTANT AND THE REVISION
WAS BEFORE WE SYNTHESIZED THE
ERC
EVIDENCE.
OUTCOMES OF INTEREST HERE WERE
DIET QUALITY AS MEASURED BY AGI
AND CHILDREN'S DIETARY INTAKE
EMPHASIZED IN FRUITS AND
VEGETABLES, WHOLE GRAINS,
SUGAR-SWEETENED BEVERAGES.
WE SYNTHESIZED THE EVIDENCE AT
THE LEVEL OF CAREGIVING STYLES
AND THREE HIGHER ORDER
DIMENSIONS OF STRUCTURE,
AUTONOMY, SUPPORT AND CONTROL.
I'M GOING TO START BY REVIEWING
THE EVIDENCE OF FEEDING STYLES
AND WANTED TO POINT OUT IN THE
WORK AGAIN IT'S REALLY A MIX OF
DIFFERENT WAYS OF LOOKING AT
STYLES THAT CAN EITHER BE ON A
CONTINUUM IF YOU LOOK AT
DEMANDINGNESS AND RESPONSIVENESS
OR AT CERTAIN TYPES AND THESE
ARE TYPES THAT HAVE A LONG
HISTORY IN THE DEVELOPMENTAL
LITERATURE LOOKING AT GENERAL
PARENTING BUT APPLIED TO
FEEDING.
YOU CAN SEE FOR INSTANCE
INDULGENT FEEDING ARE STYLES
THAT INVOLVE HIGH LEVELS OF
RESPONSIVENESS TO THE CHILD AND
LOWER DEMANDS ON THE CHILD'S
BEHAVIOR AND AUTHORITARIAN
PRACTICES AND AU AUTHORITATIVE
FEEDING STYLES HAVE THOUGHT TO
BALANCE DEMANDINGNESS AND
RESPONSIVENESS HISTORICALLY AND
ASSOCIATED WITH THE MOST
POSITIVE OUTCOMES IN THE
PARENTING LITERATURE BUT NOT ALL
STUDIES AND I THINK THERE'S
IMPORTANT CAVEATS AND FINALLY IT
INVOLVES STYLE LOW IN BOTH.
ALL THAT TO BRING TO THE FIRST
CONCLUSION HERE.
WE'RE ONLY ABLE TO IDENTIFY TWO
THAT MET THE CRITERIA.
DUE TO LACK OF EVIDENCE WE COULD
NOT DRAW A CONCLUSION REGARDING
THE RELATIONSHIP BETWEEN FEEDING
STYLES BY CAREGIVERS AND
CHILDREN 2 TO YEARS OF AGE AND
CONSUMING A PATTERN ALIGNED WITH
THE DIETARY GUIDELINES FOR
AMERICANS.
MOVING ON TO FEEDING PRACTICES
I'M GOING TO GIVING A BROAD
DEFINITIONS BUT I WANTED TO GIVE
YOU LIKE OPERATIONALLY WHAT ARE
WE TALKING ABOUT?
STRUCTURED PRACTICES HAVE BEEN
USED TOE DESCRIBE THOSE WHO
ORGANIZE SOCIAL AND PHYSICAL
ASPECTS OF CHILDREN'S FEEDING
ENVIRONMENT, SETTING LIMITS,
PROVIDE CHOICES, HAVING ROUTINES
AROUND MEALS AND SNACKS AND
MODELLING HEALTHY BEHAVIORS AND
REFERS TO THE AVAILABILITY AND
ACCESSIBILITY OF FOODS TO
CHILDREN AND HOMES AND THE
ENVIRONMENTS WHERE CHILDREN
ROUTINELY EAT.
THE SYSTEMATIC REVIEW IDENTIFIED
22 ARTICLES AND COHORT STUDIES
AND 12 RANDOMIZED CONTROL TRIALS
THAT MET INCLUSION CRITERIA.
AND THE TYPES OF STRUCTURED
PRACTICES EVALUATING THE
ARTICLES INCLUDED AVAILABILITY
OF HEALTHY FOODS IN THE HOME IN
THREE ARTICLES AND FREQUENCY AND
ENVIRONMENT OF FAMILY MEALS IN
HOMES, MONITORING OF CHILDREN'S
EATING IN FOUR ARTICLES, SOCIAL
MODELLING IN TWO ARTICLES AND
HAVING RULES RELATED TO EATING.
I ELABORATE THESE ONLY TO GIVE
YOU A FLAVOR OF THE EVIDENCE AND
THE EXPOSURES UPON WHICH THIS
CONCLUSION STATEMENT IS BASED.
THE 12 RCTs INCLUDE MATERIALS
AND ACTIVITIES AIMED AT
INCREASING THE AVAILABILITY OF
FRUITS AND VEGETABLES IN THE
HOME AND STRUCTURING FAMILY MEAL
TIMES.
IN TERMS OF THE OUTCOMES, 17 OF
22 ARTICLES EVALUATED FRUIT AND
VEGETABLE INTAKE AMONG CHILDREN
AND EIGHT EVALUATED ASSOCIATIONS
WITH SUGAR SWEETENED BEVERAGE
AND TWO WITH WHOLE GRAINS AND
GLOBAL QUALITY AS MEASURED BY
HGI.
BASED ON THE REVIEW OF THE
EVIDENCE WE CONCLUDED FOOD
PARENTING PRACTICES BY
CAREGIVERS OF CHILDREN AGE 2- 6
THAT STRUCTURE CHILDREN'S
PHYSICAL AND SOCIAL ENVIRONMENTS
ARE ASSOCIATED WITH HIGHER
INTAKES OF FRUITS AND VEGETABLES
AND THIS WAS CREATED AS MODERATE
AND WHY AND HOW IS THIS GRADED
AT MODERATE?
I THINK THE PRIMARY
CONTRIBUTIONS WERE STRENGTHS IN
CONSISTENCY AND DIRECTNESS.
SPECIFICALLY THE FINDINGS WERE
CONSISTENT IN POSITIVE
ASSOCIATIONS WERE SEEN BETWEEN
STRUCTURED PRACTICES IN 17 OF 22
SUDDEN STUDIES.
THERE WERE CONCERNS OF RISK OF
BIAS WITH KEY CONFOUNDERS AND
GENERALIZABILITY ECHOING SOME OF
THE COMMENTS FROM YESTERDAY.
MORE THAN HALF THE STUDIES WERE
CONDUCTED IN THE U.S., THE
MAJORITY OF PARTICIPANTS WERE
WHITE IN THE STUDIES AND ONLY A
FEW INCLUDED PARTICIPANTS WITH
OF DIVERSE RACE AND CAREGIVERS
OTHER THAN MOTHERS.
FEEDING PRACTICES WITH AUTONOMY
SUPPORT WITH A WIDE RANGE LIKE
TEACHING CHILDREN ABOUT FOODS
AND EATING AND NUTRITION
EDUCATION AS THEY CLASSICALLY
UNDERSTAND IT AND SHOPPING AND
GROWING AND PREPARING FOODS AND
ENCOURAGING KIDS TO TRY NEW
FOODS AND ENGAGING IN REASONING
AND NEGOTIATION.
THESE ARE THE TYPE OF PRACTICES
WE'RE LOOKING AT WHEN WE'RE
REVIEWING THE LITERATURE ON
AUTONOMY SUPPORT.
THE SYSTEMATIC REVIEW IDENTIFIED
FOUR ARTICLES, TWO PROSPECTIVE
COHORT AND TWO RANDOMIZED STUDY
THAT MET INCLUSION CRITERIA.
THE COMMITTEE FAILED TO DRAW A
CONCLUSION REGARDING THE
ASSOCIATION OF AUTONOMY SUPPORT
WITH DIETARY INTAKES AMONG
CHILDREN 2- 6 YEARS OF AGE DUE
TO A LACK OF STUDIES.
AND THERE'S PRESSURE
INTRUSIVENESS AND INCLUDING
THINGS LIKE OVERT RESTRICTIONS
ON ABOUT WHAT KIDS ARE EATING,
USING THREATS AND BRIBES AND
NEGATIVE EMOTIONS.
I FEEL COMPELLED TO SAY IN THE
FIELD OF FOOD PARENTING IT'S
RECOGNIZED MOST PARENTS ENGAGE
IN A WIDE VARIETY OF STRATEGIES
AND MY PERSONAL EXPERIENCE I
HAVE USED ALL OF THESE INCLUDING
THESE ON THE SLIDE.
I FEEL LIKE IT'S IMPORTANT
BECAUSE IN PRESENTING THE WORK
IT'S REALLY IMPORTANT THAT WE'RE
TRYING TO IDENTIFY SUPPORTIVE
APPROACHES.
AND SUPPORT CAREGIVERS.
SO LET US MOVE ON TO THE
EVIDENCE.
HERE THERE WERE FIVE PROSPECTIVE
COHORT STUDIES AND ONE
RANDOMIZED CONTROL TRIAL THAT
MET THE CONCLUSION OF THE SIX
ARTICLES.
THREE FOCUSSED ON RESTRICTED
PRACTICES AND PRESSURE TO EAT
AND ONE STUDY EVALUATED CONTROL
AND NOT ALLOWING CHILDREN TO
CONSUME SUGAR SWEETENED
BEVERAGES.
AND THERE WERE A SMALL NUMBER OF
STUDIES AND THE INCONSISTENCIES
AND ONE OF OUR STRENGTH OF
APPROACH AT THE BROAD DIMENSIONS
IS PULLING WORK ACROSS A DIVERSE
SET OF PRACTICES.
AND SOMETIMES WITH THE SMALL
NUMBER OF STUDIES IT'S DIFFICULT
TO KNOW WHETHER THIS IS TRULY
DUE TO DIFFERENCES IN FINDINGS,
DIFFERENCES IN FEEDING PRACTICES
AND METHODS AND WE'RE NOT ABLE
TO DISENTANGLE THAT WE'LL LOOK
AT GROWTH BODY COMPOSITION AND
RISK OF OBESITY OUTCOMES IN
CHILDREN.
THIS IS THE FRAMEWORK AND THE
SAME POPULATION AND COMPARATORS
AND CONFOUNDERS WITH GROWTH,
BODY COMPOSITION AND RISK OF
OBESITY OUTCOMES AS PRESENTED IN
PREVIOUS MEETINGS.
WE REVISED THE PROTOCOL WITH THE
EVIDENCE ON CHILDREN 2-6 FOR THE
SAME REASONS IN THE PREVIOUS
REVIEW AND THIS IS ISN'T NEW PUT
COMPLEMENTS A SYSTEMATIC REVIEW
AS THE B24 PROJECT ON FEEDING
PRACTICES AND LATE OUTCOMES
AMONG CHILDREN.
AS WITH THE PREVIOUS ANALYTICAL
FRAMEWORK WE SYNTHESIZED THE
EVIDENCE BASED ON FEEDING STYLES
AND THE THREE BROAD DIMENSIONS
OF FEEDING PRACTICES.
THERE WERE NINE PROSPECTIVE
COHORT STUDIES FOR ASSOCIATION
BETWEEN FEEDING STYLES USED BY
CHILDREN 2 TO 6 YEARS WITH CHILD
GBC OUTCOME.
WE WERE UNABLE TO DRAW
CONCLUSIONS PRIMARILY DUE TO
INCONSISTENCIES THAT WERE
DIFFICULT TO INTERPRET IN LIGHT
OF HETEROGENEITY IN THE COMPARE
-- COMPARATORS.
SOME COMPARED INDULGENT STYLES
AND THE LITERATURE AND FINDINGS
WERE DIVERSE.
THERE WAS A CONCLUSION STATEMENT
ABOUT MONITORING A SPECIFIC
PRACTICE WITHIN THE DOMAIN OF
STRUCTURE.
AND IT REFERS TO CAREGIVERS'
KNOWLEDGE OF CHILDREN'S EATING
LESS HEALTHY FOODS IN THE WORK.
THAT'S HOW IT'S BEEN
OPERATIONALLY DEFINED.
THE EVIDENCE ON MONITORING
INCLUDED 15 PROSPECTIVE COHORT
STUDIES.
IN TERMS OF OUTCOMES 13 OF 15
EVALUATED EITHER CHILD BMI
SCORES CONTROLLING FOR BASELINE
VALUES OR MATHEMATICALLY SIMILAR
CHANGE IN BMIZ.
BASED ON THE EVIDENCE WE
CONCLUDED FOOD PARENTING
PRACTICES INVOLVING MONITORING
OF CHILDREN AGE 2 OF 6 ARE NOT
ASSOCIATED WITH OUTCOMES RELATED
TO GROWTH.
THIS STATEMENT WAS BASED ON
EVIDENCE GRADED AS LIMITED.
SO STUDY WERE DIRECT AND FAIRLY
CONSISTENT.
NINE OF 15 STUDIES REPORTED
NON-SIGNIFICANT ASSOCIATIONS
BETWEEN MONITORING AND GROWTH.
THE SIX REMAINING STUDIES
REPORTED SIGNIFICANT FINDINGS
HOWEVER FOUR WERE INTEREST THE
SAME COHORT AND GRADE OF LIMIT
WERE ASSIGNED DUE TO PRECISION
RISK OF BIAS AND
GENERALIZABILITY STEM FROM SMALL
SAMPLE AND FAILURE TO TAKE IN
KEY CONFOUNDERS AND ACCOUNT FOR
DATA AND MEASUREMENTS AND
DIFFERENCES AS PREVIOUSLY
DESCRIBED.
SO, IN CONTRAST TO THAT SPECIFIC
CONCLUSION ABOUT MONITORING, THE
COMMITTEE WAS UNABLE TO DRAW
CONCLUSIONS ABOUT THE BROADER
CONSTRUCT OF STRUCTURE AND
ASSOCIATIONS OF STRUCTURED
PRACTICES WITH CHILD GROWTH BODY
COMPOSITION AND RISK OF OBESITY
OUTCOMES BASED ON THE ASSESSMENT
OF SEVEN PROSPECTIVE COHORT
STUDIES.
THE INABILITY TO DRAW CONCLUSION
STEMMED FROM THE SMALL NUMBER OF
STUDIES AN INCONSISTENCY IN
FINDINGS AS WELL AS
HETEROGENEITY AND EXPOSURES THAT
MADE THE EVIDENCE DIFFICULT TO
SYNTHESIZE.
MOVING ON TO AUTONOMY SUPPORTED
PRACTICES AND GBC OUTCOMES FIVE
MET THE INCLUSION CRITERIA AND
HERE THE COMMITTEE WAS UNABLE TO
DRAW CONCLUSIONS DUE TO A SMALL
NUMBER OF STUDIES AND PLAYING
ANY TUDE OF RESULTS AND OTHER
ISSUES I PREVIOUSLY DESCRIBED.
AND BETWEEN BODY COMPOSITION AND
RISK OF OBESITY OUTCOMES.
HERE THERE WERE 28 PROSPECTIVE
COHORT STUDIES.
DESPITE THE OUTCOMES AND
DEVELOPMENTAL LITERATURE AND IN
THE CONTEXT OF THIS WORK THE
LARGE NUMBER OF STUDIES WE WERE
UNABLE TO DRAW CONCLUSIONS.
TRUST ME, WHEN WE SIT AROUND AND
LOOKED AT THE STUDIES AND LOOK
AT THE COMMONALITIES HERE AND
UNFORTUNATELY IN THE CASE OF
THESE STUDIES, THE FINDINGS ARE
INCONSISTENT.
IN 7 OF THE 28 STUDIES
CONTROLLING FEEDING PRACTICES
POSITIVELY ASSOCIATED WITH BMI
AND CHANGE FROM BASELINE TO
FOLLOW-UP AND IN SIX OF THE 28
NEGATIVITY ASSOCIATED AND OTHER
STUDIES NUL RESULTS.
IT WAS A MIXED BAG.
AND IN SAYING ARE WE MISSING ?
IS THERE GOING TO ON WITH
INDIVIDUAL PRACTICES.
WE DOES THE EXAMINATION AND
CALLED NOT DRAW ASSOCIATIONS
BECAUSE WHEN YOU PARS OUTS
THERE'S A RELATIVELY SMALL
NUMBER OF STUDIES.
I WANTED TO GIVE THOSE
QUALIFICATIONS BECAUSE I KNOW
PART OF THIS SOUNDED LIKE A
BROKEN RECORD BUT THERE'S BEEN A
LOT OF DELIBERATION AND
EVALUATION AND CAREFUL
CONSIDERATION OF THE SCIENCE WE
REVIEWED.
SO I WANT TO MOVE ON TO THE LAST
SLIDE WHICH IS A SUMMARY.
THIS IS REALLY A SUMMARY OF THE
CONCLUSIONS OUR SUBCOMMITTEE HAS
DRAWN ABOUT THE EVIDENCE THE
FIRST COMPREHENSIVE EVALUATION
BY THE DIETARY GUIDELINES
ADVISORY COMMITTEE.
AND I HAVE TO SAY AS SOMEONE
WHOSE BEEN INVOLVED IN THE WORK
MANY DECADES IT'S NOTHING SHORT
OF DRILLING -- THRILLING IT'S
BEEN CONSIDERED IN THE VENUE AS
PART OF THE EVIDENCE ON DIET AND
HEALTH.
SO IT'S BEEN TRULY I THINK
EXCITING FOR US ALL.
I THINK THE MAIN FINDING THAT
HAS COME FROM THE WORK THAT I'VE
PRESENTED TODAY IS THAT WE FOUND
MODERATE EVIDENCE THAT
STRUCTURED FEEDING PRACTICES
USED WITH CHILDREN 2 TO 6 YEARS
OF AGE MAY HAVE BENEFICIAL
ASSOCIATION WITH CHILD FRUIT AND
VEGETABLE INTAKES.
AND I THINK IF YOU THINK ABOUT
THIS CONCLUSION IT'S ACTUALLY
QUITE CONSISTENT WITH SYSTEMATIC
REVIEW WE PREVIOUSLY PRESENTED
ON REPEATED EXPOSURE WHICH IS
CONSIDERED A SPECIFIC TYPE OF
STRUCTURED PRACTICE WHERE
CAREGIVERS PROVIDER THE REPEATED
AVAILABILITY OF HEALTHFUL FOODS
AT MEALS AND SNACKS.
AND ROBUST EVIDENCE OF AGAIN
BENEFITS FOR ACCEPTANCE OF
FRUITS AND VEGETABLES.
EVEN THOUGH WE'VE SEEN A LOT OF
GRAY SPACES WHERE WE DON'T HAVE
ANSWERS, THERE IS SOME
CONSISTENCY ACROSS THESE TWO
REVIEWS AS WELL AS OTHERS WHICH
WE MAY TALK ABOUT AND I THINK
TAKEN TOGETHER THESE CONCLUSIONS
POINT TO THE IDEA THAT FRUIT AND
VEGETABLE INTAKE AMONG YOUNG
KIDS MAY BE SUPPORTED VIA
STRUCTURED FEEDING PRACTICES
THROUGH THINGS LIKE MAKING
FRUITS AND VEGETABLES AVAILABLE
IN THE ENVIRONMENTS WHERE
CHILDREN ROUTINELY EAT AND
PROVIDING REPEATED EXPOSURE TO
THOSE FOODS AND HAVING
CONSISTENT EATING ROUTINES THAT
INVOLVED THOSE FOODS AND
PROVIDING POSITIVE SOCIAL MODELS
OF EATING.
I SHARE THAT ENTHUSIASM AND WITH
IMPORTANT CAVEATS AND I THINK I
KNOW YOU TALKED ABOUT THESE AS
GUARDRAILS FOR INTERPRETATION.
BECAUSE WE'RE TALKING ABOUT HOW
CAREGIVERS ARE RAISING YOUNG
CHILDREN AND THESE SEEM LIKE
GENERAL RECOMMENDATIONS, LET'S
TALK ABOUT WHAT WE SHOULD BE
THINKING ABOUT NEXT.
SO EVEN THOUGH I THINK THERE'S A
LOT OF UTILITY IN LOOKING AT THE
EVIDENCE ALONG THE BROAD
DIMENSIONS, IT HAS CLEAR APPEAL
FOR PUBLIC HEALTH TRANSLATION
SIG QUANS.
IT DOESN'T ALLOW US TO HAVE THE
GRANULARITY TO HAVE PRACTICES
WITH REPEATED EXPOSURE WITH GOOD
EVIDENCE.
IT'S AN IMPORTANT LIMITATION AND
SO RELATED THESE DIMENSIONS
WHILE ROOTED IN DEVELOPMENTAL
SCIENCE WHETHER THEY ARE THE
ONLY DIMENSIONS IN FEEDING THAT
MATTER.
THEY'RE THE MOST SALIENT
RELEVANT DIMENSIONS, I THINK
THOSE ARE IMPORTANT QUESTIONS
THAT MERIT FURTHER INQUIRY AND
WE DON'T HAVE THE ANSWERS TO.
AND I'LL END WITH WHAT'S MOST
IMPORTANT IS OUR COMMITTEE HAS
SPOKEN A LOT ABOUT THE FACT THAT
YOU CANNOT INTERPRET A FEEDING
PRACTICE WITHOUT CONSIDERATION
OF THE CULTURE, OF THE CONTEXT
AND THE ENVIRONMENT IN WHICH
FEEDING AND CARE GIVING OCCURS.
IT'S IMPORTANT.
IT'S NOT JUST AN ADDENDUM IT'S
CENTRALLY IMPORTANT.
I THINK IN THINKING FORWARD THAT
WE'RE GOING TO BE TALKING A LOT
MORE ABOUT TRYING TO UNDERSTAND
THOSE FACTORS IN ORDER TO
UNDERSTAND THE MEANING OF THESE
PRACTICES AND STYLES WE'RE
LOOKING AT AND OUR SUBCOMMITTEE
REALLY NOTED NEEDS FOR RESEARCH
IN THIS AREA.
THE LAST POINT IS THAT THERE ARE
A LOT OF IN ADDITION TO THE
CONCLUSIONS WE DRAW THERE'S A
LOT OF CONCLUSIONS WE COULD NOT
DRAW AND POINTS TO THE GAPS IN
OUR KNOWLEDGE AND NEED FOR
RESEARCH AND WE'LL CONTINUE OUR
WORK AND AND WRAP IT UP WITH
SYSTEMATIC REVIEW REPORTS WITH
OUR CHAPTER AND WE'RE FINALLY
GETTING TO DISCUSSION OF
INTEGRATION WHERE I THINK A LOT
OF THE THOUGHT WILL OCCUR.
THANK YOU.
>> I JUST WANT TO COMMEND BOTH
OF YOU FOR IN AN AMAZING
CONTEXT.
I FEEL LIKE YOU HAVE DONE
GREAT -- YOU HAVE TAKEN GREAT
STRIDES TO EDUCATE THE FULL
COMMITTEE ON AREAS THAT MOST OF
US ARE NOT FAMILIAR WITH.
AND I JUST WANT TO SAY THAT THIS
PUBLIC MEETING, THE FULL
COMMITTEE MEETING THESE TWO DAYS
WE'VE HAD A LOT OF EDUCATION
FROM LEARNING ABOUT SUBSTITUTION
ANALYSIS TO BIRTH WEIGHT AND
PARENTING PRACTICES SO THANK YOU
VERY MUCH.
AND I ALSO THINK WE SHOULD THANK
THE STAFF BECAUSE THIS HAS BEEN
AMAZING.
I OPEN IT UP FOR QUESTIONS.
SHERYL THAN FATIMA.
>> I WANT TO ADD MY SUPPORT FOR
COMMENTS SARA JUST MADE AROUND
THE WAY THIS WAS PRESENTED AND
THE REAL CARE AND THOUGHT GIVEN
TO THE ANALYSES.
MY QUESTIONS ARE BRINGING ME
BACK TO THE PRINCIPLES THAT
APPLY WE START TO LOOK AT
NUTRIENT AND HEALTH OUTCOMES.
SO RHYME -- I'M GOING TO GO
THERE TO TALK ABOUT STUDIES PUT
FORWARD.
MY FIRST ISSUE IS ABOUT
POTENTIAL CONFOUNDING WITH
REGARDS TO CAREGIVER SEX IN
FEEDING STYLES AND DIETARY
PATTERNS ALIGNED WITH THE
GUIDELINES.
I NOTICED THAT THE POTENTIAL
CONFOUNDING FACTOR OF CHILD SEX
WAS INCLUDED BUT NOT CAREGIVER
SEX.
THERE'S ONLY TWO STUDIES
APPARENTLY FOUND.
THE LIST OF CONFOUNDERS
IDENTIFIED A, PRIORITY DID THEY
HOLD WHEN THE LITERATURE RESULTS
CAME THROUGH AND WHAT WAS THE
THOUGHT PROCESS AROUND NOT
INCLUDING CAREGIVER SEX BUT
INCLUDING CHILD SEX.
I HOPE IT'S QUICK.
>> I CAN START.
THESE ARE GREAT QUESTIONS.
AND I THINK WE JUST ACKNOWLEDGED
THE INCREDIBLE COMPLEXITY OF
WHAT WAS STUDIED.
THE REALITY OF THIS BODY OF
LITERATURE IS THAT IT IS
EXTREMELY SMALL AND PROVIDES FAR
FEWER ANSWERS THAN I THINK --
AND LESS NUANCE THAN I THINK IS
NEEDED.
MOVING BACK TO KEY CONFOUNDERS
IT'S A GREAT OBSERVATION.
THE ISSUE WHEN WE STARTED THE
WORK WAS TRYING TO FOCUS OUR
CONVERSATIONS OF IDENTIFICATION
AROUND THE EVIDENCE OF
CONFOUNDERS.
GIVEN THE STATE OF THE SCIENCE
THERE'S FEW STUDIES OF FATHERING
OUT THERE TO THERE'S MAYBE A FEW
AND THEY'RE ACTUALLY A NUMBER
UNDERWAY BUT WE SIMPLY WHILE WE
RESPECT THAT MIGHT BE INCREDIBLY
IMPORTANT, WE I THINK OUR
GENERAL CONSENSUS WAS WE WANTED
TO TRY TO KEEP THOSE CONFOUNDERS
THAT CLEARLY REFLECTED A HEALTH
EQUITY LENS OR WHICH THERE WAS
EMPIRICAL EVIDENCE LEADING TO A
SHORT AND PROBABLY
UNSATISFACTORY LIST.
WHAT THE IMPLICATIONS OF THE KEY
CONFOUNDERS AND REVIEW THE
EVIDENCE.
THE LONGER THE LIST THE LESS WE
CAN SAY.
I THINK WE HAD TO BALANCE THAT
TENSION AS WELL.
NOT THAT IT'S THE RIGHT APPROACH
BUT IT WAS THE APPROACH WE
DELIBERATED AND CONSIDERED.
>> THIS QUESTION IS AT THE CRUX
OF IT ABOUT MEASUREMENT ERROR
AND DON'T KNOW HOW IT FUNCTIONS
IN THE QUESTION BUT THE FIRST
CONCEPT WHERE IT STRUCK ME WAS
ON CONTROLLED FEEDING PRACTICES.
I COULDN'T FIGURE OUT IF THERE
WAS POTENTIALLY A DILUTION IN
THE EXPOSURE BECAUSE I'M NOT
SURE HOW EXPOSURE ASCERTAINMENT
HAPPENS IN A QUESTION LIKE THIS.
FOR EXAMPLE IF THE MEASUREMENT
ERROR IS LARGE YOU CAN LACK THE
RESULT AND I COULDN'T TELL
BECAUSE I SUSPECT IN MY
PEDESTRIAN UNDERSTANDING OF
WHAT'S HAPPENING HERE THERE MAY
BE DILUTION OF THE EXPOSURE
BECAUSE PEOPLE GO IN AND OUT OF
DIFFERENT STYLES.
SO PERHAPS CONTROLLED FEEDING
PRACTICES AND SOME OTHER NUL
FINDINGS THAT OCCURRED MAY BE A
RESULT OF MEASUREMENT ERROR.
SO I WANTED TO THROW THAT OUT
FOR CONSIDERATION.
I THINK THAT ONE HAS SIX
ARTICLES AND THEN A SIMILAR
THING STRUCK ME AS YOU WERE
DISCUSSING CAREGIVER FEEDING
STYLES WITH NINE ARTICLES.
I THINK IT'S A MATTER OF WAS IT
ON A RANGE WHERE YOU COULD TELL
IN QUARTILES OR QUINTILES WHAT
WAS HAPPENING RELATIVE ON THE
EXPOSURE ASSESSMENT OR WAS IT
PRESENT/NOT PRESENT.
I WANTED TO GIVE MORE VISIBILITY
ON THAT.
>> I'M HAPPY TO ANSWER BUT DOES
ANYONE ELSE WANT TO?
WHEN WE TALK ABOUT MEASUREMENT
OF BEHAVIOR IN FILLING OUT A
QUESTIONNAIRE, WHAT ARE YOU
CAPTURING?
YOU'RE CAPTURING YOUR SENSE OF
GENERAL BEHAVIOR AND HOW WELL
DOES THAT REFLECT HOW THAT
TRANSLATES.
WE CLEARLY SEE CASES WHERE OUR
LABORATORY EXPERIMENTS LOOKING
AT THE EFFECTS OF ONE PRACTICE
LIKE PROMPTING KIDS TO EAT A
SOUP CAN LEAD TO DIFFERENT
OUTCOMES AND WHEN WE USE THE
SELF-REPORT MEASURES OR EVEN
OBSERVATIONS THAT REFLECT A MORE
NATURALISTIC CONTEXT IT'S ALWAYS
BEEN A CHALLENGE OF WORK AROUND
BEHAVIOR AND LONG STANDING
TRADITION AND PSYCHOLOGY THAT
POINTS TO PSYCHOMETRIC TESTING
COMING BACK TO THE MEASURE.
DOUGH WE HAVE A GOOD DEGREE OF
CERTAINTY OF THE CONSTRUCT.
DO PEOPLE ANSWER THE SAME WAY
OVER TIME?
ALL THOSE THINGS ARE IMPORTANT
ASPECTS OF TRYING TO BUILD A
CASE AND GET A BETTER SENSE OF
HOW PRECISE THE MEASUREMENTS
ARE.
WE HAVE GREATER DEGREE OF
CERTAINLY WHEN THE MORE WE KNOW
ABOUT THE PSYCHO METRIC
QUESTIONNAIRES.
THE PROBLEM IN THE FIELD IS MANY
ARE 20 YEARS OLD NOW OR MORE.
THERE IS A REAL NEED FOR
CONTINUED ATTENTION TO
MEASUREMENT.
BEHAVIORS IS MESSY.
WE'RE NOT LOOKING AT AN INTAKE
OF A NUTRIENT BUT CAPTURING
SOMETHING BY DEFINITION IS GOING
TO HAVE MORE VARIABILITY AND
ERROR AROUND ITS CERTAINTY.
I THINK THOSE POINT ARE WREL
TAKEN.
>> ONE MORE ON THE ANALYTICS AND
THE CONSTRUCT VALIDITY AND
POTENTIAL ERROR WITHIN THE
MEASUREMENT AND IN EPIDEMIOLOGY
WE WILL SOMETIMES YOU DIFFERENCE
METRICS AND PLAY GET LOST AND
TIMES IT'S QUARTILE OR DECILE
BECAUSE YOU WORRY YOU
CONDITIONED FIND WHERE THE SHIFT
HAPPENS AND MAY BE FOR
CONSIDERATION IN THE REPORT
AROUND HOW THE WORK GETS DONE
AND THE EXPOSURE AND ONCE ITS
ASCERTAINED.
>> THOSE ARE INCREDIBLY
IMPORTANT POINTS AND I WOULD ADD
THERE'S A REAL NEED FOR
DIFFERENT RESEARCH DESIGNS.
OFTEN WE DISCOUNT RESEARCH UP
MORE CONTROLLED SETTING AS A
ARTIFICIALLY CONSTRAINED BUT CAN
PROVIDE A MORE PRECISE VIEW OF
MECHANISMS.
I WOULD ADD THAT'S IMPORTANT.
I WOULD SAY IN ALL THIS WORK
HISTORICALLY BECAUSE OF WHERE
THE FUNDING STARTED OUT, THE
HARD OUTCOMES WERE THE PRIMARY
INTERESTS.
I WOULD ARGUE THAT WE'RE ON
TENUOUS GROUND TO DRAW FIRM
CONCLUSIONS ABOUT HOW CAREGIVING
INFLUENCES A CHILD'S GROWTH
WITHOUT KNOWING HOW FEEDING
INFLUENCES EATING.
I THINK THE FOCUS ON MEASUREMENT
AND WAYS OF WAYS OF GETTING
GREATER NUANCE IS WHERE I WOULD
SAY ARE THE GREATEST NEEDS.
>> I WAS HOPING WE CAN GO BACK
TO YOUR CONCLUSION SLIDES FOR --
CAN WE PULL THOSE UP?
>> WHEN WE LOOK AT THESE SLIDES
AND IN THINKING ABOUT THE
PEDIATRIC POPULATION AND GBCO
AND THE IDEA WHEN WE LOOK AT
THAT IN OBESITY TECHNICALLY WE
CAN'T DRAW CONCLUSIONS BECAUSE
WE DON'T DEFINE OBESITY RIGHT
UNTIL THEY HIT THE GROWTH CHART
AT THE AGE OF 2.
IT'S A LITTLE BIT TO MAKE THAT
CONCLUSION STATEMENT SURROUNDING
EVEN OBESITY BECAUSE WE DON'T
DEFINE OBESITY IN THE PEDIATRIC
POPULATION IN THE THEY HIT THE
GROWTH CHART AT THE AGE OF 2.
EVEN THE QUESTION ITSELF WHEN WE
POSE IT IN THIS PEDIATRIC
POPULATION IS A LITTLE BIT NOT
QUITE RELEVANT.
WE CAN'T DESIGN OBESITY AS A
RISK FACTOR UNTIL THE AGE OF 2
AND NOT SOMETHING WE CAN STATE.
WE SHOULD HAVE BEEN CAUTIOUS
ABOUT MAKING THAT A QUESTION
BECAUSE WE CAN'T DEFINE OBESITY
BY DEFINITION UNTIL THE AGE OF
2.
ONE OF THE THINGS I DO WANT TO
THINK ABOUT IN THE PEDIATRIC
POPULATION MAY GO BACK TO ONE OF
THE THINGS SHERYL DID IS IN
TALKING ABOUT MACROSOMIA AND
LOOKING AT 4500 AS A POTENTIAL
CHANGE AND WHETHER OR NOT THAT
WOULD BE SOMETHING FOR
CONSIDERATION.
DO YOU THINK THAT WILL HAPPEN?
WHEN DO YOU THINK THAT WILL
HAPPEN, IF YOU THINK IT WILL
HAPPEN AND HOW AND WANT YOUR
THOUGHTS SINCE YOU THAT UP IN
YOUR DISCUSSION TODAY.
>> ON THE FIRST PART, WE THINK
OF THE CONSEQUENCES OF THESE
LOWER OR HIGH BIRTH WEIGHTS WE
HAVE CONCERNS OF SOME BABIES
BEING HYPOGLYCEMIC AND WE
HAVEN'T TALKED ABOUT FETAL
PROGRAMMING BUT WE CAN SAY
THERE'S SOME RISK TO THE SGA
BABIES THAT HAD A HIGHER RISK OF
OBESITY.
NOBODY POINTS TO OBESITY PER SE
AS THE OUTCOME AND STUDIES MAY
HAVE LOOKED AT ONE OR THE OTHER
OR MAY NOT HAVE FOCUSSED ON
EITHER ONE.
ALL I CARE ABOUT IS THE BABY
GOING TO BE SICK AND YOU HAVE A
GLOBAL PERSPECTIVE.
WE CAN SAY A THIRD OF ALL BABIES
ARE LOW BIRTH WEIGHT AND SGA AND
HOW DOES THAT AFFECT THE PATTERN
OF OBESITY AND FETAL PROGRAM ALL
WHICH ARE SOMEWHAT OUTSIDE OF
OUR SCOPE.
THAT ALL COMPLICATES THE BIG
PICTURE LITERATURE.
MOST OF THIS IS FOCUSSED ON THE
NEONATAL PERIOD AS YOU POINT OUT
NOT ABOUT FETAL PROGRAMMING OR
LONG-TERM OBESITY RISK.
IN TERMS OF DEFINING MACROSOMIA
DO WE NEED TO CHECK BLOOD
GLUCOSE ON THIS AND IT'S MORE
IMPORTANT TO LOOK AT LGA AND SGA
AND LOOKING AT TIMING OF
DELIVERY AND ALL KIND OF THINGS
THAT CAN AFFECT THE DEFINITIONS.
THE REAL QUESTION IS DO WE
REALLY NEED TO REDEFINE THE
CONCEPT OF SGL AND LGA TO BE
LESS BROAD THAN THE 10
PERCENTILE.
YOU DILUTE OUT A BUNCH OF THINGS
BECAUSE WE'RE CONCERNED ABOUT
THE BABY'S SCORES OR SOMETHING
OF THAT SCORE.
IT'S REALLY SMALL OR REALLY BIG.
ESPECIALLY LOOK AT THE LONG-TERM
OUTCOMES OF FETAL PROGRAMMING
AND THOSE AFFECTS.
PEOPLE HAVE BEEN SIMPLIFIED
BECAUSE CLINICALLY WE INITIALLY
IDENTIFIED BABIES AS LGA OR SGA
BUT PROBABLY NOT THE OUTCOMES TO
LOOK AT LONG TERM.
THE FIELD NEEDS TO LOOK AT
SCORES THAT ARE SPECIFIC MOVING
FORWARD AND IDENTIFYING NOT JUST
THE 10 PERCENTILE WHICH IS AN
ARCHAIC WAY OF LOOKING AT
THINGS.
>> THEN FOR THE COMMITTEE AS A
WHOLE AS WE LOOK AT TWO PLUS
WHICH IS THE GROUP WHERE WE DO
GET INTO THE GBCO OUTCOMES HAVE
YOU BEEN ABLE TO EXTRAPOLATE TO
THE 2+ AGE RANGES AND PREGNANCY
AND WHETHER THEY'RE LEADING TO
OUTCOMES IN 2+?
>> I DON'T THINK WE DID THAT --
>> AND IS THAT A FUTURE
DIRECTION?
>> IT'S IMPORTANT.
THE FETAL PROGRAMMING IS
CRITICALLY IMPORTANT.
I DON'T BELIEVE IT WAS IN OUR
LIST OF TOPICS AT ALL BUT IT'S
ONE THAT'S IMPORTANT.
ALSO A LOT OF LITERATURE IS
EXPANDING NOW AND I THINK TO BE
ACCURATE AND MEANINGFUL ONE IS
WHEN YOU THINK OF THE SGA
DEFINITION.
IF YOU'RE SMALL THERE'S BEEN
CONTROVERSY OUTSIDE THIS
DISCUSSION BUT I DON'T THINK
THAT WAS PART OF REVIEWS I DID.
>> AND I THINK WHEN WE REVIEW
THE LITERATURE ONE OF THE THINGS
THAT WE IDENTIFIED IS THAT THE
MEASUREMENT OF THE DIETARY
PATTERNS DURING PREGNANCY IS A
HUGE CHALLENGE.
WHEN WAS IT DONE, HOW EARLY WAS
IT DONE AND HOW OFTEN TO
CHARACTERIZE THE DIETARY PATTERN
DURING THAT CRITICAL PERIOD.
SO I THINK THERE ARE A LOT OF
CHALLENGES TO IDENTIFYING THAT
AND THAT WILL BE PART OF OUR
RECOMMENDATION AS WELL BECAUSE
IF WE CAN'T DEFINE THAT EXPOSURE
SPECIFICALLY WE CAN'T REALLY
APPLY TO LATER IN LIFE OUTCOME.
>> GREAT, DIANNA.
>> FIRST OF ALL I WANTED TO
COMMEND YOU.
I THOUGHT IT WAS A GREAT
PRESENTATION.
SO I'M GOING TO KIND OF PICK UP
WHERE SHERYL AND FATIMA LEFT
OFF.
I'M TALKING ABOUT OUTCOMES ON
GROWTH BODY COMP AND OBESITY.
SO WITH THOSE WERE MOST THE
STUDIES BMI ORIENTED OR -- DO
YOU RECALL?
>> YES, MOST STUDIES WERE EITHER
LOOKING AT BMI AT A FOLLOW UP
POINT CONTROLLING FOR BASELINE
LEVELS OR CHANGE IN BMIC.
>> AT THAT ABLE THERE'S NOT MANY
POUNDS CHANGING FROM ONE BMI TO
THE OTHER AND BMIZ DEPENDING ON
WHAT POPULATION YOU'RE IN MIGHT
NOT REFLECT MUCH HOME AT THAT
AGE.
-- REFLECT MUCH MOVEMENT AT THAT
AGE AND ONE WAS GENERALIZABILITY
IN TERMS OF DIVERSITY IN THE
POPULATIONS.
AND SO IT MIGHT BE IF YOU WERE
IN A MORE DIVERSE POPULATION OR
POPULATION IN THE SOUTH WHERE
YOU SEE MORE VARIABILITY IN
GROWTH BODY COMP YOU MAY SEE
BETTER OUTCOMES.
AS YOU SAID IT'S GOING TO BE
HARD TO SEE BMI OUTCOMES IN KIDS
THAT AGE.
>> I THINK POINT WELL TAKEN.
I AGREE.
THE ISSUES AROUND
GENERALIZABILITY ARE
MULTI-FACETED IN TERMS OF TRYING
TO REPRESENT THE DIVERSITY OF
CAREGIVERS, CAREGIVING CONTEXT
AND CERTAINLY DIFFERENT
ENVIRONMENTS.
YOU CAN IMAGINE IN CASES WHERE
THERE IS GREATER VARIABILITY
BEING MORE LIKELY TO HAVE A
BETTER OPPORTUNITY TO DETECT
RELATIONSHIPS OF THOSE
RELATIONSHIPS IF THEY'RE IN FACT
PRESENT.
>> AND OKAY.
SURE.
>> SO WHEN WE WERE LOOKING AT
THE DATA WE LOOK AT BMIC SCORE
POINT 1, POINT 2 CHANGES.
SO SMALL.
YOU'RE RIGHT.
SOME WERE SIGNIFICANT BECAUSE
BMIC SCORE IS SMALL CHANGES ARE
GETTING YOU OFF TRACK.
SO WE WERE CAREFUL ABOUT LOOKING
AT THE SMALL CHANGES BUT YOU'RE
RIGHT, THEY ARE WERE VERY SMALL
CHANGES FOR THE AGE GROUP.
>> AND EXPANDED THE GROWTH
CHARTS MAY BE HELPFUL IN THE
FUTURE.
ONE OTHER QUESTION FOR YOU WITH
THE GROWTH BODY COMP, DO YOU
THINK IT WOULD BE HELPFUL IN THE
FUTURE TO MAYBE LOOK AT EARLY
CHILDHOOD AND TRACK TO
ELEMENTARY SCHOOL BECAUSE THAT
MIGHT BE WHERE YOU SEE THE
OUTCOMES MIGHT BE A LITTLE
BETTER.
IF YOU WAIT LONGER THEY GET
BIGGER.
YOU GOT MORE WIGGLE ROOM IN
TERMS OF BMI OUTCOMES.
>> QUITE POSSIBLY.
I FEEL LIKE OUR EPIDEMIOLOGISTS
WOULD BE CURIOUS IN HEARING YOUR
PERSPECTIVES ON THIS BECAUSE IF
WE LOOK AT FEEDING PRACTICES AT
ONE POINT IN TIME THINK ABOUT
FEEDING A PRESCHOOLER VERSUS A
SCHOOL-AGED CHILD AND THE
ENVIRONMENT IN WHICH THEY'RE IN
THEY'RE DIFFERENT.
THE DEVELOPMENT LOOKS DIFFERENT.
TO ASK QUESTIONS ABOUT A
PRACTICE AT ONE POINT IN TIME
AND LOOK OFF IN THREE YEARS DOWN
THE FUTURE, I DON'T KNOW IF
THOSE ARE THE RIGHT QUESTIONS TO
BE HONEST.
I THINK WHERE THE FIELD NEEDS TO
START IS UNDERSTANDING AT THE
TIME THEY'RE USED HOW PRACTICES
AND APPROACHES ARE SHAPING
BEHAVIOR AND THEN START TO ASK
QUESTIONS ABOUT ASK THIS MATTER
OVER TIME.
I JUST DON'T FEEL LIKE WE HAVE
THE ANSWERS IN THE SHORT TERM.
SO IN LOOKING LONGER ACROSS TIME
I THINK IT WILL JUST RAISE
QUESTIONS UNTIL WE HAVE A BETTER
SENSE OF WHAT WE'RE LOOKING AT
IN THE SHORT TERM.
AND I DON'T KNOW IF THAT'S A
SHORT-SIGHTED ANSWER AND HOW
THAT MAKES CON TEXT BECAUSE
IT'S A QUESTION IN THE MEETING.
I WOULD INVITE OTHER OPINIONS.
>> I JUST WANTED TO CHIME IN ON
THAT ONE, JEN.
I REMEMBER WITH SOME EVIDENCE WE
HAD WAS A MIXED BACK.
THERE WERE STUDIES THAT CARRIED
OUT INTO THE SCHOOL AGE GROUPS.
BUT THEN THEY WOULD BE TAKING
THE MEASURE AT DIFFERENT TIMES
LIKE MAYBE ONES IN THIRD GRADE
AND ONES AT FIFTH GRADE.
AND SOMETIMES THE RESULTS WOULD
CHANGE DEPENDING ON THAT EVEN IN
THE SAME STUDY.
SO LIKE IT JUST BECAME -- IT WAS
DIFFICULT TO MAKE SENSE OF
THOSE.
>> YEAH, THANKS.
>> THIS IS A GREAT DISCUSSION.
DOES ANYBODY ELSE HAVE ANY
QUESTIONS?
>> JUST A COMMENT THOUGH WE
FOCUSSED ON 2 TO 6, PATERNAL
STYLES DEVELOP BEFORE THAT BABY
HITS AGE 2 AND THINKING OF
THINGS TO GO FORWARD YOU CAN
BEGIN WITH PATTERNS OF BREAST
FEEDING AND SOLID FOODS AND
ETCETERA AND AE ETCETERA AND
THAT'S WHAT'S EASIEST FOR THE
STUDIES TO LOOK AT IF WE'RE
LOOKING AT THE FEEDING BEHAVIORS
IT BEGINS AT BIRTH.
>> GREAT POINT AND GREAT WAY TO
END THE CONVERSATION.
I WANT TO THANK THE GROUP AGAIN.
I THINK MANY OF US HAVE LEARNED
A GREAT DEAL TODAY SO THANK YOU.
AND WE HAVE A BREAK FOR 15
MINUTES SO WE RECONVENE FOR
THOSE WHO ARE WATCHING THIS WE
RECONVENE AT 10:00.
THANK YOU VERY MUCH.
WE ARE NOW MOVING
TO FOOD PATTERN MODELLING AND
DATA ANALYSIS AND I'LL HAND IT
OVER TO CHRIS.
>> THANK YOU, ALL.
WELCOME BACK FOR TODAY'S
INSTALLMENT OF FOOD PATTERN
MODELLING FOLLOWING UP ON THE
FINALIZED RESULTS WE PRESENTED
YESTERDAY.
AND TALK ON THE INTEGRATION SIDE
AND DIET SIMULATIONS WE'VE ALL
BEEN LOOKING FORWARD TO SINCE
THEY TOLD US ABOUT IT AT MEETING
1.
WE'LL BE WORKING OUR WAY THROUGH
THE RESULTS TODAY.
AGAIN I'D LIKE TO ACKNOWLEDGE
OUR COMMITTEE THAT HAS KIND OF
WORKED OVERTIME SINCE THE LAST
MEETING WITH ALL OF THE DATA
THAT'S COME THROUGH AS FAR AS
THE SIMULATIONS, THE COMBINING
AND THE GROUP THAT HAS WORKED
SUPER OVERTIME IS THERE'S SOME
CATEGORY.
AND THAT WILL BECOME EXCEEDINGLY
EVIDENT AS WE START WORKING OUR
WAY ESPECIALLY THROUGH THE DATA
IN THE SIMULATIONS THEMSELVES.
A LOT OF DECISION MAKING
HAPPENING, A LOT OF INTEGRATION
HAPPENING AND NEW DATA AND
TRYING TO FACILITATE THIS ALL AT
ONCE.
THIS SHOULD THEN LOOK FAMILIAR.
I FEEL LIKE WE'VE SAID IT BEFORE
AND WILL STAY IT AGAIN.
THIS IS OUR OVER ARCHING
SCIENTIFIC QUESTION FOR FOOD
PATTERN MODELLING CONSIDERING
EACH LIFE STAGE SHOULD CHANGES
BE MADE TO THE U.S. DIETARY
PATTERNS, THE HEALTHY U.S. STYLE
AND HEALTHY MEDITERRANEAN STYLE
AND VEGETARIAN AND SHOULD
DIETARY PATTERNS BE DEVELOPED
BASED ON THE SCIENTIFIC EVERYDAY
FROM THE SYSTEMIC REVIEWS AND
PATTERN MODELLING WORK.
SO AGAIN KIND OF A LOOK AT OUR
TRAJECTORY OF THE WORK COMPLETED
THROUGHOUT THIS PROCESS ON DAY
ONE YESTERDAY WE TALKED ABOUT
REMOVING ANIMAL BASED FOODS AND
REDUCING CARBOHYDRATE FOODS AND
NUTRIENT DENSITY.
TODAY WE'RE GOING TO FOCUS ON
HOW WE EVALUATE AND REFINE THE
DIETARY PATTERNS, HOW THIS PLAYS
OUT FROM OUR POPULATION GROUPS
AND LOOKING AT THAT ASSESSMENT
AND THEN HOW THIS ULTIMATELY
GETS TRANSLATED INTO TESTING THE
DIET SIMULATIONS OF OUR PROPOSED
REVISED PATTERN.
TODAY WE'RE GOING TO WORK OUR
WAY THROUGH MODIFICATIONS.
SARA'S GOING TO GUIDE US THROUGH
OUR MODIFICATIONS OF DIETARY
PATTERNS.
WE'RE LOOK TO LOOK AT REFINEMENT
OF THE DIETARY PATTERNS AND TALK
THROUGH DIET SIMULATIONS AND
PASS IT TO THERESE FOR
FLEXIBILITIES ON THE DIETARY
PATTERNS.
TAKE IT AWAY, SARAH.
>> SO, I HAVE TO SAY DOING THIS
ON THE HEELS OF OUR MORNING
SESSION WITH SUCH ELEGANT
INSTRUCTION I JUST ASK FOR YOUR
FORGIVENESS AS A STUMBLE THROUGH
THIS.
SO, SINCE MEETING 5 AS CHRIS
MENTIONED, THE SUBCOMMITTEE HAS
BEEN IN OVERDRIVE IN INTEGRATING
AND SYNTHESIZING THE EVIDENCE.
AND SINCE MEETING 5 AS YOU CAN
SEE FROM THE SLIDES WE HAVE
CONSIDERED THE SYSTEMATIC REVIEW
EVIDENCE.
WE'VE CONSIDERED THE DATA
ANALYSIS EVIDENCE AND WHAT WE
DID WAS WE EXAMINED ALL THE
POTENTIAL MODIFICATIONS TO THE
PATTERN TOGETHER.
WE EXAMINED THE RESULTS OF THE
SIMULATIONS REFLECTING WHAT WE
ARE REFERRING TO HERE AS THE
DRAFT MODIFIED 2020 PATTERN AND
THE TITLE OR THE TERM WILL
BECOME EVIDENT AS WE MOVE
THROUGH THE PRESENTATION.
AND WE ALSO EXAMINED ALL THE
POTENTIAL FLEXIBILITIES TO THE
PATTERNS.
AND THE NEXT STEP FOR THE
SYNTHESIS ON DRAFT PATTERNS AND
FLEXIBILITIES.
WE WILL FINALIZE FLEXIBILITIES
TO THOSE STANDARDS.
I JUST WANT TO EMPHASIZE WE HAVE
DISCUSSED THIS BEFORE AND AT THE
RISK OF STATING WHAT MANY OF YOU
KNOW BUT I AM DOING THIS MORE
FOR MY OWN PURPOSE, THIS IS
NOT -- THESE ARE MODELLING.
I THINK IT'S REALLY IMPORTANT
THINKING ABOUT THE HEALTHY
U.S. STYLE DIETARY PATTERN.
IT IS ALREADY DESIGNED -- THE
PATTERN DEVELOPED BY THE LAST
COMMITTEE ITERATIVELY BUILT ON
PRIOR DIETARY COMMITTEE
RECOMMENDATIONS IT'S HEALTHY.
AND WHAT WE'RE DOING IS SEEING
WHAT IF BASED ON ALL THIS
SYNTHESIS OF THE KNOWLEDGE THE
DATA ANALYSIS AND THE FOOD
PATTERN MODELLING, ARE THERE
POTENTIAL MODIFICATIONS THAT
WOULD ACTUALLY REFLECT THE DETE
DATA WE HAVE BEEN REVIEWING FOR
COLLECTIVELY AS A COMMITTEE FOR
ALMOST TWO YEARS SO WHAT WE
PRESENTED IN MEETING 6 AND WE
WANTED EVERYBODY TO KNOW THAT
THIS REALLY WAS PRESENTED FROM
MEETING 5 WE WANTED TO LOOK AT
MODIFYING VEGETABLE SUBGROUPS
AND WERE GOING TO -- WE WANTED
TO LOOK AT INFECTIOUSING BEANS,
PEAS AND LENTILS AND DARK GREEN
VEGETABLES.
WE ALSO WANTED TO LOOK AT TOTAL
GRAINS AND PROTEIN FOODS AND
DAIRY AND FORTIFIED SOY
ALTERNATIVES.
THESE ARE THE POTENTIAL
MODIFICATIONS WE WANTED TO
EXPLORE.
AND IT WAS THE INDIVIDUAL FOOD
PATTERN MODELLING ANALYSIS THAT
INFORMED THIS LIST.
AS PART OF THE SYNTHESIS PHASE
WE HAVE TO PUT IT TOGETHER
BECAUSE ONE DOES NOT CONSUME ONE
FOOD IN ISOLATION.
SO THAT'S WHAT WE'RE GOING TO
TALK ABOUT TODAY.
SO ONCE WE STARTED DOING THE
SYNTHESIS AND INTEGRATING THE
EVIDENCE, A FEW OF THE PROPOSED
MODIFICATIONS FELL OFF THE LIST.
LET'S TAKE FOR EXAMPLE MODIFYING
VEGETABLE SUBGROUPS.
SO DARK GREEN VEGETABLES HAVE
CONTAINED NUTRIENTS THAT ARE
VERY IMPORTANT FOR HEALTH AS
EVIDENCED BY THE DRIs AND OTHER
GUIDANCE ON THE ASSOCIATION
BETWEEN INDIVIDUAL NUTRIENTS AND
HEALTH OUTCOMES.
HOWEVER, THE SYSTEMATIC REVIEWS
DO NOT HAVE THAT GRANULARITY.
WE WEREN'T SEEING IN THE
SYSTEMATIC REVIEWS THAT
INVESTIGATORS WERE CALLING OUT
DARK GREEN VEGETABLE S PER SE AS
A PATTERN LINKED TO THE OUTCOME
OF INTEREST.
WE TOOK THAT OFF THE LIST
BECAUSE IT WASN'T SUPPORTED BY
THE EVIDENCE.
THE OTHER EXAMPLES HERE IS IF WE
WERE TO INCREASE BEANS, PEAS AND
LENTILS WHILE KEEPING TOTAL
VEGETABLES CONSTANT WE HAD TO
THINK OF A CONCURRENT DECREASE
SO WE CONSIDERED DECREASED
STARCHY VEGETABLE.
IT'S PUTTING THE PIECES OF THE
JIGSAW PUZZLE WE'RE STARTING TO
PUT IT TOGETHER NOW.
SO, TO START WITH, IT'S REALLY
AGAIN THESE ARE MODIFICATIONS TO
MODELLED PATTERNS.
AND WE SAW IN THE PRESENTATION
YESTERDAY AND FROM HEATHER AND
FROM MEETING FIVE THE CURRENT
INTAKES GENERALLY DO NOT ALIGN
WITH THESE PATTERNS.
THEREFORE THE DIRECTION OF THE
MODIFICATION MAY NOT APPLY TO
THE DIRECTION NEEDED TO IMPROVE
INTAKE.
SO WE MAY SAY DECREASE A CERTAIN
FOOD GROUP BUT IT DOESN'T MEAN
PEOPLE SHOULD EAT LESS OF IT IF
THEY'RE ALREADY NOT EATING
ENOUGH.
WHAT WE'RE DOING IS JUST THE
MODIFICATIONS TO THE MODEL
PATTERN.
THIS IS FROM MY EDIFICATION SO I
REMIND MYSELF AND NOT WRONGLY
SPEAK.
OUR SUMMARY OF THE PROPOSED
MODIFICATIONS ARE THE SYSTEMATIC
REVIEW EVIDENCE DOES SUPPORT,
EMPHASIZING DIETARY INTAKES OF
BEANS, PEAS AND LENTILS.
AND REDUCE INTAKES OF RED AND
PROCESSED MEATS.
OUR SYSTEMATIC REVIEW EVERYDAY
AND WE HAD RICH DISCUSSION ON
THIS YESTERDAY DOES NOT SPECIFY
A SPECIFIC AMOUNT.
I THINK THE DISCUSSION YESTERDAY
AFTERNOON REALLY EMPHASIZED THAT
IT'S ALL RELATIVE HIGHER OR
LOWER BUT WE DO NOT HAVE
SPECIFIC AMOUNTS BASED ON THE
SYSTEMATIC REVIEW.
HOWEVER, WITH THE BEANS, PEAS
AND LENTILS IT'S A SUBGROUP WITH
A SMALL WEEKLY QUANTITY
RECOMMENDED IN THE CURRENT 20
HEALTHY U.S. STYLE DIETARY
PATTERN.
AND WE THOUGHT PUTTING
RECOMMENDING AN INCREASED
QUANTITY WAS IN LINE WITH AGE
EMPHASIZE ON BEANS, PEAS AND
LENTILS.
THE SECOND MODIFICATION WAS THE
ENERGY PROPOSED INCREASE OF
BEANS, PEAS AND LENTILS WOULD BE
OFFSET BY A DECREASE IN STARCHY
VEGETABLES.
AS THAT CHANGE WITHIN THE TOTAL
VEGETABLE GROUP WOULD HAVE THE
MOST NUTRIENT IMPROVEMENTS.
WE ALSO SHOULD DO A CALL OUT ON
POTASSIUM BECAUSE WE HAD QUITE A
BIT OF DISCUSSION ABOUT
POTASSIUM.
SO WHEN THE PRIOR USDA DIETARY
PATTERNS WERE DEVELOPED, THE
POTASSIUM A.I. WAS MUCH HIGHER
THAN IT IS NOW WHEN IT WAS
REVISED.
SO THE IMPLICATIONS OF MODIFYING
STARCHY VEGETABLES NOW DO NOT
HAVE THE IMPACT ON POTASSIUM AS
THEY WOULD HAVE IN THE PAST WHEN
WE HAD PRIOR A.I. LEVELS.
SO WITH THIS MODIFICATION, THE
NEW A.I. FOR POTASSIUM IS
ACHIEVED AND GENERALLY EXCEEDED
IN THE PROPOSED MODEL.
THE THIRD ONE IS THE VARIABILITY
AND ENERGY CONTRIBUTION AMONG
NUTRIENT DENSE FOOD BEVERAGES
MODELLED PRECLUDE A PRECISE
LIMIT OF CALORIES OR OTHER USES.
THIS WAS PRESENTED YESTERDAY BY
DIDI.
WE PROPOSED ELIMINATING THOSE
TWO LAST ROWS.
THE FOURTH IS THAT OVER ALL
IMPROVEMENTS RELATED TO
ACHIEVING NUTRIENT GOALS ARE
SMALL AND GENERALLY APPLY TO A
SMALL MEMBER OF AGE, SEX GROUPS.
NOW, WHEN I FIRST WERE DOING THE
DISCUS
DISCUSS
DISCUSSIONS, THE STATEMENT
ITSELF I HAD TO REMIND MYSELF
EXISTING DIETARY PATTERNS WERE
DEVELOPED BY OUR PREDECESSORS
AND THEY WERE ALSO REVIEWING
SYSTEMATIC EVIDENCE.
SO THE PATTERNS HERE ARE DESIGN
TO ALIGN WITH THAT EVIDENCE ON
DIET AND HEALTH AND MEAT NEWT
REPRESENT NEEDS AND -- NUTRIENTS
AND WOULDN'T EXPECT LARGE
TWEAKING FOR IMPLICATIONS AND
THE FINAL SUMMARY IS THE DIET
SIMULATION RESULTS CHRIS WILL BE
PRESENTING SUGGEST NUTRIENT
REQUIREMENTS ARE GENERALLY MET
WHEN YOU CONSIDER VARIATION IN
DIETARY INTAKE.
SO THIS SLIDE SHOWS THE
DIFFERENCE BETWEEN HEALTHY
U.S. STYLE DIETARY PATTERNS.
WHAT WE ARE REFERRING TO IS THE
U.S. STYLE DIETARY PATTERN AND
REMINDING US WE'RE BUILDING ON
AN EXISTING HEALTHY DIETARY
PATTERN.
AS YOU CAN SEE WE HAVE BEANS,
PEAS AND LENTILS AND STARCHY
VEGETABLES.
WE DID NOT PROPOSED INCREASING
AT THE HIGH CALORIE LEVELS AND
WE WILL DISCUSS THAT COMING UP
LATER AND CHRIS ACTUALLY
DISCUSSED THIS YESTERDAY ABOUT
WHEN YOU DO DECREASE -- SO WE
ARE PROPOSING WE DECREASE TOTAL
PROTEIN FOODS SPECIFICALLY MEAT,
POULTRY AND EGGS, WHEN YOU GET
TO THE LOWER CALORIES WE HAVE TO
CONSIDER NEWT REPRESENT DENSITY.
THESE WERE THE PROPOSED
MODIFICATIONS WHEN WE PUT IT ALL
TOGETHER.
SO THIS ACTUAL LY PROVIDES THE
FOOD GROUP AND SUB GROUP
QUANTITIES.
THE CURRENT DIETARY PATTERN
PROPOSES INTAKES OF BEANS, PEAS
AND LENTILS AT THREE CUPS
EQUIVALENT PER WEEK.
THIS IS ALREADY AT THE 95th
PERCENTILE OF WHAT PEOPLE ARE
EATING.
WE FELT IF WE ADDED MORE OF THE
HIGHER CALORIE LEVELS THE DATA
DID NOT SUPPORT GOING THAT
HIGHER INTAKE.
I'M JUST GOING TO ORIENT YOU TO
THE COLOR CODING THE BLUE IS 5%
CHANGE IN NUTRIENT ADEQUACY WHEN
THE EXISTING DIETARY PATTERN IS
ALREADY AT OR ABOVE THE
ESTABLISHED GOALS.
YOU CAN SEE THERE'S SEVERAL
PLACES WHERE NEWT REPRESENTS
INCREASE OR DECREASE BY 5% OR
MORE.
IT DOES NOT HAVE IMPLICATIONS
FOR MEETING THE GOAL.
FOR EXAMPLE, LET'S PULL OUT THE
PROTEIN.
EVEN WITH THE DECREASE IN THE
MACRO NUTRIENT ALL ARE ABOVE THE
PROTEIN RDA AND THE RANGE FOR
THE MODIFYING PATTERN IS BETWEEN
132 AND 465% OF THE RDA.
SO EVEN THOUGH YOU SEE A
DECREASE IT'S STILL ABOVE WHAT
WE NEED.
THE DARK BLUE AND THERE'S SOME
FOR FOLATE DURING PREGNANCY AND
THIS PERTAINS TO THE DISCUSSION
YESTERDAY WE HAD ABOUT GRAINS
AND PREGNANCY AND FOLATE.
THE PROPOSED MODIFICATIONS WOULD
INCREASE THE FOLATE BY 5% BUT
DESPITE THAT INCREASE FOLATE IS
NOT MEETING THE RDA YET.
WE'RE GETTING CLOSER FOR
PREGNANT WOMEN.
SO THIS SLIDE JUST EMPHASIZES
THAT THE EXISTING DIETARY
PATTERN WAS DESIGN TO ALIGN WITH
THE SYSTEMIC REVIEW EVIDENCE ON
DIET AND OUTCOMES AND MEET
NUTRIENT NEEDS.
THIS SLIDE INDICATES THAT WITH
THE PROPOSED MODIFICATION
THERE'S GOING TO BE ADDITIONAL
IMPROVEMENTS ON INDIVIDUAL
NUTRIENTS BUT THEY'RE LESS THAN
5%.
AS WE HAVE A DISCUSSION
YESTERDAY THERE'S LARGE
VARIABILITY IN FOOD COMPOSITION
OF FOOD AND BEVERAGES
PARTICULARLY WITHIN EACH FOOD
GROUP AND SUB GROUP.
THIS IS TRUE I THINK HEATHER
PRESENTED A BEAUTIFUL EXAMPLE
FOR EXAMPLE OF ENERGY COMPARED
WITH TOMATOES AND SWEET
POTATOES.
WHEN WE'RE THINKING ABOUT THIS
THROUGH A HEALTH EQUITY LENS AND
FLEXIBILITIES, I THINK IT'S GOOD
TO NOTE THERE'S GENERALLY
INCREASES BUT I THINK THESE ARE
MODEST AND I DON'T THINK THAT
THESE -- I THINK THEY'RE MODEST.
WE'RE GOING IN THE RIGHT
DIRECTION BUT THEY'RE NOT GOING
TO CHANGE MUCH WHICH IS WHY THE
THIRD BULLET EMPHASIZES THE FACT
THESE IMPROVEMENTS ARE SMALL.
LET'S DO THE RATIONALE FOR THE
PROPOSED MODIFICATION.
AND I JUST REALLY WANT TO THANK
THE STAFF FOR TAKING WHAT WERE
EXTENSIVE DISCUSSIONS AND
SUMMARIZING THEM HERE IN A FAR
MORE ARTICULATE WAY THAN I
COULD.
SO IN THE NEXT FEW SLIDE WE'RE
GOING TO DISCUSS THE RATIONALE
FOR THE MODIFICATION CONSIDERING
THE EVIDENCE WE COLLECTIVELY AS
A COMMITTEE PRESENTED AND DATA
ANALYSIS AND FOOD PATTERN
MODELLING.
SO FOR THE VEGETABLE SUB GROUP,
OUR PROPOSED MODIFICATION FOR
THE 2020 DIETARY PATTERN FOR
AGES 2 YEARS AND OVER AND I
SHOULD EMPHASIZE THIS IS 2 YEARS
AND OLDER IS TO INCREASE BEANS,
PEAS AND LENTILS AND REDUCE
STARCHY VEGETABLES.
WE NEED TO GET THE DISCUSSION
OVER AND DONE WITH HERE IN TERMS
OF NOMENCLATURE.
IN SYSTEMATIC REVIEWS, THE
MAJORITY OF INVESTIGATORS USED
THE TERM LEGUMES AND USE THE
WORD OR LEGUMES OR LEGUMES AND
NUTS AND CORRESPONDS TO BEANS,
PEAS AND LENTILS BUT NOT
EXPLICITLY STATED AS STUCH -- SO
SUCH SO WE'RE TALKING ABOUT
BEANS, PEAS AND LENTILS AND WANT
TO THROW THAT OUT WITH
CONSIDERABLE DISCUSSION ABOUT
THAT.
AND DIETARY PATTERNS HIGHER IN
VEGETABLES AND LEGUMES AND
RELATED TO BENEFICIAL HEALTH
OUTCOMES.
AGAIN, IT'S RELATIVE.
SO HIGHER IS RELATIVE TO LOW OR
LOWER THE DIETARY PATTERN.
IT'S NOT -- THERE'S NO DEFINED
QUANTITY RELATIVE TO THE CURRENT
INTAKES.
CONCLUSION STATEMENTS FROM
SYSTEMATIC REVIEWS DID NOT
SPECIFY VEGETABLE INTO FURTHER
FOOD SUB GROUPS THOUGH THERE ARE
SYSTEMATIC REVIEWS THAT HAVE
REVIEWS LOWER IN FRIED POTATOES
WHICH IS WHY THEY'RE HERE.
THE DATA ANALYSIS INDICATES THE
LARGEST WEEKLY RECOMMENDATION
FOR BEANS IS NEAR THE 95th
PERCENTILE OF CURRENT POPULATION
INTAKE.
AND THE FOOD PATTERN MODELLING
CONFIRMED THE SAME OR IMPROVED
NUTRIENT ADEQUACY OF THE DIETARY
PATTERNS WITH THIS MODIFICATION.
FOR PROTEIN FOODS OUR PROPOSED
MODIFICATIONS INCLUDE TOTAL
PROTEIN FOODS AND MEAT, POULTRY
AND EGGS FOR THE 2200 CALORIE
LEVEL AND ABOVE.
THE RATIONALE IS THE EVIDENCE
FROM OUR SYSTEMATIC REVIEWS THAT
INCLUDED DIETARY PATTERNS
INCLUDING THOSE WE HEARD ABOUT
YESTERDAY REGARDING SATURATED
FOOD SOURCES OF FAT.
THEY'RE LOWER IN RED AND
PROCESSED MEATS.
THERE'S IMPROVED ADEQUACY OF THE
PATTERN WITH MODIFICATION OF
REDUCING MEAT, POULTRY AND EGGS.
THIS IS THE RATIONALE FOR THE
LIMIT OF CALORIES FOR OTHER
USES.
AND YOU DID A BEAUTIFUL JOB
EXPLAINING THIS YESTERDAY.
SO I THINK WE CAN GO TO --
HEATHER, I'M SORRY.
I THOUGHT IT WAS DIDI.
MY APOLOGIES.
HEATHER YOU DID SUCH A BEAUTIFUL
JOB AND IT WAS SO SEAMLESS --
OKAY.
WE LOOKED AT INTERVENTION
EXPOSURES IN RELATED TO HEALTH
OUTCOMES.
THOSE SYSTEMATIC REVIEWS SUPPORT
DIETARY PATTERNS HIGHER IN
FRUIT.
I SHOULD POINT OUT THE 2020
DIETARY GUIDELINE ADVICE IS AT
LEAST HALF OF FRUIT COMES FROM
WHOLE FRUIT AND DID NOT
RECOMMENDATION ANY MODIFICATION
TO THAT.
AND THE DATA ANALYSIS INDICATES
THAT POPULATION IS BELOW
RECOMMENDATIONS AND THE FOOD
PATTERN MODELLING DOES NOT
SUPPORT MODIFICATION BECAUSE
FRUIT IS THE MAIN CONTRIBUTOR OF
VITAMIN C AND POTASSIUM IN THE
DIETARY PATTERN.
WE DID NOT PROPOSE ANY
MODIFICATIONS TO THE CURRENT
GUIDANCE ON GRAINS.
WE EXPLORED MODIFICATION TO
GRAINS THAT REDUCED THE TOTAL
GRAINS THAT ULTIMATELY WE'VE
DECIDED THIS WOULD NOT BE A GOOD
MODIFICATION AT THIS TIME.
WE RECOGNIZE A MAJORITY OF
ENERGY OF EACH CALORIE LEVEL IS
ACCOUNTED FOR AND REDUCING TOTAL
GRAINS MIGHT HAVE BEEN A WAY TO
REDUCE THE TOTAL ENERGY
CONTRIBUTED BY THE PATTERN AND
TO ALLOW MORE FLEXIBILITY
HOWEVER, THE FOOD PATTERN
MODELLING AND THIS IS A GREAT
EXAMPLE WHERE YOU'VE GOT
SYSTEMATIC REVIEW AND PATTERN
MODELLING TOGETHER AND IT'S
COLLECTIVELY INFORMING THE
GUIDANCE.
FOOD PATTERN MODELLING INDICATED
IF WITH REDUCE TOTAL GRAINS
THERE WOULD BE NUTRIENT
INADEQUACIES IN THE PATTERN.
FURTHERMORE ANY SMALL
IMPROVEMENTS GAINED BY
INCREASING BEANS, PEAS AND
LENTILS WE'D WIPE OUT IF WE
REDUCE THE TOTAL GRAINS.
THIS IS THE RATIONALE FOR NOT
PROPOSING A MODIFICATION.
WE ALSO DID NOT RECOMMEND A
MODIFICATION FOR DAIRY AND
FORTIFIED SOY ALTERNATIVES.
WE DID TAKE THE PUBLIC COMMENTS
AGAIN THANK YOU VERY MUCH FOR
THOSE WHO SUBMITTED THEM BECAUSE
IT DID -- WE DID ACKNOWLEDGE
THEM AND DISCUSS THEM.
THE PUBLIC COMMENTS OF NOTICE
THAT DAIRY ITSELF IS NOT
CONSUMED BY SOME LACTOSE
INTOLERANCE FROM MANY IN THE
POPULATION.
AND THE QUANTITY OF THE DAIRY IN
THE CURRENT PATTERN COULD BE
LOWER TO MEET PEOPLE WHERE THEY
ARE SINCE 88% OF THE POPULATION
BASED ON THE DATA ANALYSIS FALL
SHORT OF RECOMMENDATIONS DAIRY
INTAKES.
WE ALSO DISCUSSED THE FACT THAT
LIGHT GRAINS, IF THERE WAS A
REDUCTION OF DAIRY, WE MIGHT BE
ABLE TO REDUCE THE TOTAL ENERGY
CONTRIBUTES BY THE PATTERN AND
THAT WOULD AGAIN ALLOW FOR MORE
FLEXIBILITY.
HOWEVER, THE SYNTHESIS FROM THE
FOOD PATTERN MODELLING DID NOT
ULTIMATELY SUPPORT CHANGES TO
DAIRY AND FORTIFIED SOY
ALTERNATIVES.
IT'S MAINLY BECAUSE THERE WOULD
BE NEGATIVE IMPLICATIONS ON
NUTRIENTS FOR MANY AGE SEX
GROUPS AND PARTICULARLY
CHILDREN, ADOLESCENTS AND OLDER
ADULTS FOR WHOM NUTRIENT NEEDS
RELATES TO BONE HEALTH ARE
HIGHER.
ADDITIONALLY SOME OF THE
IMPROVEMENTS WE WOULD GAIN WITH
SOME OTHER MODIFICATIONS WOULD
AGAIN BE LOST IF WE REDUCED
DAIRY AND FORTIFIED SOY
ALTERNATIVES.
WE ALSO THE RATIONALE ALSO
CONSIDERS OUR SYSTEMATIC REVIEW
WHICH SUPPORT DIETARY PATTERNS
THAT INCLUDE LOW OR NON-FAT
DAIRY.
WE DID EXPLORE NON-DAIRY MILK
ALTERNATIVES.
THE COMMITTEE ACKNOWLEDGED THIS
IS AN AREA OF GROWING POPULARITY
HOWEVER, WE DID NOT PROVIDE A
RECOMMENDATION OR CONCLUSION ON
THAT BECAUSE THE MODIFICATION OF
FLEXIBILITY FOR NON-DAIRY MILK
ALTERNATIVES SIMPLY DOES NOT
HAVE THE DATA YET.
THERE WAS NO EVIDENT TO IDENTIFY
THE SYSTEMATIC REVIEWS.
THIS IS A RAPIDLY EVOLVING
CHANGE IN THE FOOD SUPPLY, THE
NUTRIENT DATABASES MAY NOT HAVE
ALL THE CURRENT FORM
FORMLATIONS AND THERE WAS A LOT
OF CONCERNS ABOUT THE PRACTICES
IN THE FOOD SUPPLY AND THEY AS A
GROUP THERE'S WIDE VARIATION IN
NUTRIENT CONTENT.
SO WE CHOSE NOT TO EXPLORE THAT
MODIFICATION OR FLEXIBILITY.
WE HAVE A COMMITTEE DISCUSSION.
THANK YOU I'LL OPEN IT UP FOR
DISCUSSION.
CHRIS DO YOU WANT TO LEAD THE
DISCUSSION?
>> YES, BECAUSE THE THINGS WE'RE
TALKING ABOUT COMING FORWARD ARE
BASED ON THESE MODIFICATION
CHANGES SO WE WANTED A CHANCE TO
TAKE A FEW QUESTIONS.
GO AHEAD, DIDI.
>> THIS IS NOT GOING TO BE A
COMFORTABLE CONVERSATION.
WE HAD PROPOSED MODIFICATIONS
CROSSED OUT AND I KNOW THERE WAS
A SLIDE YOU WALKED THROUGH
CAREFULLY LIST GRAINS
DISCUSSION BUT A COUPLE
IMPORTANT POINTS.
GRAINS ARE EIGHT SERVINGS A DAY
AND VEG TWO SERVES PER DAY AT
THE 2400 CALORIE LEVEL.
I PICKED A RANDOM COLUMN.
WITHIN GRAINS THERE'S THE
QUALITATIVE RECOMMENDATION FOR
HALF BEING WHOLE AND REFINED
WHICH WE KNOW NOBODY EATS WHOLE
GRAINS.
THAT'S FOUR SERVINGS OF REFINED
GRAINS MORE THEN THE
RECOMMENDATION THAN FRUIT AND
VEG.
THAT BOTHERS ME AS SOMETHING TO
PROMOTE BUT IT'S A LOT BUT IT'S
MORE THAN VEGETABLES AND MORE
THAN FRUIT OF REFINED GRAINS.
I THINK THIS IS A MISSED
OPPORTUNITY AND IT REALLY
BOTHERS ME AND I THINK THERE IS
RATIONALE DISCUSSED AT SOME
POINT BUT I WOULD LOVE THE
PUBLIC TO HEAR THE RATIONALE A
BIT MORE.
>> DIDI, WE THANK YOU FOR
RAISING THIS BECAUSE I THINK
THIS IS THE POINT OF THE
COMMITTEE DISCUSSION.
THIS IS CONSENSUS BASED AND IT'S
IMPORTANT FOR PEOPLE TO PRESENT
PERSPECTIVES.
I CAN'T TALK ABOUT THE SPECIFICS
WHICH IS ABOUT THE SPECIFICS IN
TERMS OF THE QUANTITIES.
I THINK THIS IS WHERE CHRIS'S
VAST EXPERTISE IN THIS WILL
REALLY HELP.
BUT DON'T FORGET THE SYSTEMATIC
REVIEWS GO HIGHER OR LOWER.
THERE WAS AN EXTENSIVE AMOUNT OF
FOOD PATTERN MODELLING IN THIS
EXERCISE.
AND WHAT WE WERE FINDING WAS
THAT THE ENRICHMENT OF GRAINS
AND EVEN FORTIFICATION OF READY
TO EAT CEREALS REALLY HAVE
PUBLIC HEALTH BENEFITS ON
NUTRIENT INSIGHTS.
I THINK WE HAVE TO INCREASE THE
PROPORTION OF GRAINS WE WOULD
NEED TO DO WOULD NEED TO DO A
DIFFERENT PATTERN OF MODELLING
TO ALIGN THE GRAINS TYPES TO
WHOLE GRAIN AND THE NUTRIENT
DENSE FORMS, ETCETERA.
I THINK THE COMMITTEE FELT THE
NUTRIENT NEEDS WERE THE MOST
IMPORTANT THINGS AND A CRITICAL
GROUP FOR MEETING NEEDS AT
DIFFERENT GROUPS BUT I'LL HAND
IT OVER TO CHRIS.
>> IT TIES BACK TO THE
CONVERSATION YESTERDAY FOLLOWING
THE CURRENT PATTERN WE HAVE
CHALLENGES MEETING THE FOLATE
LEVELS FOR PREGNANT WOMEN AND
THE FORTIFICATION LEVELS IN
REFINED GRAINS TO HELP MEET THAT
BUT IF YOU LOOK BACK TO
HEATHER'S PRESENTATION ON DATA
ANALYSIS SHE HAD A BUSY DAY
YESTERDAY, SHOWS THAT THE PLACES
WE'RE GETTING FOLATE THEY'RE
CONSIDERABLY LOWER IN THE TOTAL
DIET.
PART IS GOING TO BE THIS SKREP
AN SI BETWEEN THE SYSTEM REVIEW
EVIDENCE SAYING 90% OF OUR
GRAINS ARE COMING AS REFINED
GRAINS AND ABOVE RECOMMENDATIONS
WHICH WE'RE A PERCENT ABOVE AND
BELOW AS WELL AS THE LACK OF
NUTRIENTS THAT COME FROM THE
OTHER SIDE OF WHERE THESE ARE
COMING FROM BUT GETS INTO A FAR
MORE COMPLEX QUESTION OF
COMPARING THE SYSTEMATIC REVIEWS
OF POTENTIALLY OVER AND UNDER
CONSUMPTION AND MODIFYING THAT
SLIGHTLY VERSUS WITH THE FOOD
PATTERN MODELLING AND GETTING TO
THE NUTRIENT LEVEL AND THE
MODELLING OF GRAINS OF WHAT
HAPPENS IF YOU REDUCE ONLY
REFINED OR WHOLE GRAINS OR A
LITTLE BIT OF BOTH IN THOSE
MODIFICATIONS REALLY HAS RAY
COMPLEX STORY LINE AROUND THE
FORTIFICATION QUESTIONS AND THE
ENRICH
ENRICHMENT THAT IS A BACK STORY
TO SO MUCH OF ALL THIS WORK.
J I'D ENCOURAGE THE COMMITTEE TO
HAVE A THOUGHTFUL DISCUSSION IN
THE REPORT IS THERE FOR THE NEXT
COMMITTEE, FOR EXAMPLE, IS THERE
A SPECIFIC FOOD PATTERN
MODELLING QUESTION THAT WOULD
ADDRESS WHAT YOU'RE ASKING FOR
WHICH WE WILL NOT BE -- WE WILL
NOT HAVE DONE.
>> TWO QUICK FOLLOW UPS.
I APPRECIATE BOTH OF YOU
SPELLING THOSE OUT.
I THINK IN THE REPORT IT DOES
NEED TO BE CAREFULLY DESCRIBED
IN A VERY SORT OF HONEST WAY THE
SYSTEMATIC REVIEW DOESN'T NOT
PARTICULARLY ALIGN WITH THE
ULTIMATE DECISION NOT TO TOUCH A
GRAIN CATEGORY GIVEN THERE'S NO
QUANTITY IT'S STILL NOT
CONSISTENT WITH OUR EVIDENCE
FROM THE DIETARY PATTERN REVIEW
THAT REFINED GRAINS SHOULD BE
CONSUMED MORE PER DAY AT A
SERVING LEVEL THAN VEGETABLES
AND FRUIT.
SO THAT PIECE IS THE
INCONSISTENCY EVEN IF QUANTITY
CAN BE PUT ON THAT.
IF IT'S ABOUT FOLATE WHICH I
AGREE IS AN IMPORTANT
MICRONUTRIENT AS IT NOT INHERENT
IN MANY PRODUCTS.
IT'S AN INDUSTRIAL MANUFACTURED
ADDITIVE.
IF THAT'S HOLDING US FROM
TOUCHING THE GRAIN
RECOMMENDATION IT'S ON FURTHER
POLICY TO MAKE SURE THE
FORTIFICATION, IF THAT'S WHAT'S
MAKING THE DECISION, EXTENT TO
WHOLE GRAIN OR OTHER
ALTERNATIVES SO REFINED GRAINS
ARE NOT BEING CONSUMED JUST TO
GET A MULTI VITAMIN.
>> DIDI IT'S A GOOD POINT AND
ENDORSE IT GOES IN THE CHAPTER
FOR FUTURE DIRECTIONS AND
GUIDANCE TO FEDERAL AGENCIES.
I THINK YOU RAISED A GOOD POINT
AND THANK YOU FOR THAT.
RECOMMENDATION IT'S ON FURTHER
GUIDANCE TO FEDERAL A>> CAN YOU
LEAFY GREENS AND THINKING ABOUT
THE CULTURAL DIETS AS WELL THAT
WOULD BE ONE OF THE THINGS AND
THE DAIRY REDUCTION.
I KNOW THOSE WERE TWO THINGS
WOULD BE GREAT TO HAVE A MORE
DETAILED EXPLANATION WHY WE
CAN'T CONSIDER THOSE THINGS.
>> THE CHALLENGE IS THE
SYSTEMATIC REVIEW EVIDENCE DOES
NOT SINGLE OUT THAT VEGETABLE
SUB GROUP.
POINT TAKEN THE DARK LEAFY
GREENS HAVE IMPORTANT ROLES IN
DIFFERENT INDIVIDUAL POPULATION
GROUP DIETS.
BUT AT IF THE EVIDENCE FROM THE
SYSTEMATIC REVIEWS DID NOT CALL
OUT DARK LEAFY VEGETABLES AND
SAYING DIETS HIGHER IN DARK
LEAFY VEGETABLES THEN WE CAN'T
IMPOSE OUR ASSUMPTIONS WITHOUT
THE EVIDENCE.
DON'T FORGET THERE'S A
RECOMMENDATION FOR DARK LEAFY
VEGETABLES AND BASED ON THE DATA
ANALYSIS WE ARE WOEFULLY BELOW
THE RECOMMENDED INTAKE AND THIS
IS MODELLING AND ISN'T ABOUT
TELLING PEOPLE TO -- PEOPLE
AREN'T EVEN MEETING THE CURRENT
DIETARY PATTERN SO THAT WAS THE
RATIONALE FOR THE DARK LEAFY
VEGETABLES.
CHRIS, WOULD YOU MIND TAKING THE
DAIRY?
>> WE USE VEGETABLES ARE
GENERALLY REPORTED AS
VEGETABLES.
THERE'S SOME EVIDENCE IN THE
CANCER THAT WILL FOCUS ON
NON-STARCHY VEGETABLES VERSUS
VEGETABLE SO YOU GET A LITTLE
BIT FIDELITY THERE IN TERMS OF
WHAT'S BEING ASSESSED.
WITH THE DAIRY ITSELF WAS
LOOKING SPECIFICALLY AT A LOT OF
THE NUTRIENT GAPS WITH PRIMARY
CONCERNS OF NUTRIENTS ESPECIALLY
IN AAGE -- AGE GROUPS WHERE THE
CALORIE LEVELS WERE LOWER AND
HAD IMPACT ON A MULTITUDE OF
NUTRIENTS.
>> I WANT TO ADD ANGELA, AND I
THINK THIS IMPORTANT RELATIVE TO
THE HEALTH EQUITY LENS AS WELL,
WHEN WE SAY DAIRY WE'RE NOT
BEING PRECISE IN OUR LANGUAGE
AND I OWN THAT SLIPPINESS.
WE'RE TALKING ABOUT DAIRY AND
FORTIFIED SOY ALTERNATIVES SO
THE RECOMMENDATIONS INCLUDE
PRODUCTS THAT WHERE THE LACTOSE
IS REMOVED AND THERE'S THE ALSO
THE SOY.
I WANTED TO EMPHASIZE THAT WE'RE
NOT JUST TALKING ABOUT COW MILK
AND THAT'S MY SLOPPINESS.
>> I WAS THINKING ABOUT WHAT
MIGHT BE RAISED BECAUSE WHAT'S
BEEN RAISED IS AN INCREASE IN
DARK LEAFY GREENS IN ADDITION TO
THE IDEA OF A REDUCTION IN
DAIRY.
IN SOME DISCUSSIONS AROUND
CULTURAL DIETS AND THE MORE WE
HAVE A JUSTIFICATION AND
THINKING AROUND NOT NECESSARILY
MODELLING AND INCREASE IN DARK
LEAFY GREENS AT THIS POINT WHICH
MAY BE A RECOMMENDATION FOR THE
FUTURE BUT I WANT TO MAKE SURE
WE GET THAT OUT THERE ABOUT SOME
OF THE LIMITATIONS BECAUSE THERE
COULD BE A DISCUSSION ABOUT
INCREASE IN DARK LEAFY GREENS TO
THINK ABOUT NUTRIENTS.
OF COURSE BECAUSE MUCH OUR
SYSTEM WE CAN'T MAKE UP ALL THE
NUTRIENTS BUT SINCE THAT WAS PUT
ON THE TABLE FOR A REASON, I
THINK IT'S A SOMETHING WE SHOULD
DISCUSS AND CLARIFY WHAT THE
LIMITATIONS OF THE PROCESS MAY
BE.
>> ONE MORE THING BECAUSE WE
LOOKED AT THE DATA ANALYSIS
EVIDENCE ON THE QUANTITY OF
CONSUMPTION AND THE DISTRIBUTION
WE WERE BELOW AND THE QUANTITY
THAT WOULD HAVE TO BE ADDED TO
BRING IT UP WHERE IT WAS AND
WHERE IT WAS GOING STARTED TO
SHIFT TOWARDS UNREALISTIC DATA
BASED ON POPULATION CONSUMPTION
LEVELS THAT EVEN WITH SOME
SMALLER INCREMENTAL CHANGES PER
DAY LED TO SUBSTANTIAL AMOUNTS
OF GREEN LEVY VEGETABLES WHEN
YOU LOOK AT UNCOOKED VEGETABLES.
SO PULLING IN THOSE PIECES AS
WELL.
>> I'D LIKE TO FOLLOW UP ON
DIDI'S COMMENT HERE.
FEEL FREE TO CORRECT ME IF I'M
WRONG.
FORTIFICATION OF RIBOFLAVIN,
IRON TO LEVELS THE WHOLE GRAINS
WOULD HAVE HAD AND THERE'S
PROBABLY MULTIPLE NUTRIENTS THAT
AREN'T INCLUDED IN FORTIFICATION
THAT ARE LOST WHEN YOU GET TO
REFINED GRAIN.
AND FOLATE IS THE ONLY ONE THAT
IS HIGHER IN REFINED GRAINS THAN
WOULD HAVE BEEN IN THE WHOLE
GRAINS IT'S LIKE A
MULTI-VITAMIN.
AT ONE POINT NUTRIENTS WOULD BE
LOST IF YOU GOT RID OF FINE
GRAINS.
I KNOW IRON IS A NUTRIENT OF
CONCERN FOR INFANTS AND PREGNANT
WOMEN BUT WITH A FOCUS AND I
HAVE A FOLLOW-UP BUT HAVE THE
FOCUS MOSTLY FOLATE?
>> WITH THE CONSUMPTION OF
PATTERN THAT DRIVES WHAT THE
NUTRIENT PROFILE LOOKS LIKE
FORTIFIED BREAKFAST CEREALS HAS
A DISPROPORTIONATE IMPACT BEYOND
FOLATE FORTIFICATION SO YOU GET
A MORE NUTRIENT COMPLEX NUTRIENT
FROM FORTIFIED BREAKFAST CEREALS
MORE COMMONLY THE SOURCE HAVING
AN IMPACT ON THE NUTRIENTS.
>> INTERESTING.
IT MAKES SENSE.
TO FOLLOW UP ON THE FOLATE FOR
WOMEN OF CHILDBEARING AGE AND I
DON'T KNOW HOW SUCCESSFUL
PRENATAL VITAMIN SUPPLEMENTATION
IS?
I ASSUME IT'S FAIRLY SUCCESSFUL
AND FOLATE IS ONE YOU HAVE TO
GET EVEN BEFORE YOU KNOW YOU'RE
PREGNANT SO THAT IS A PROBLEM
AND PUT IN A PITCH FOR BEANS,
PEAS AND LENTILS BECAUSE ONE OF
THE BEST SOURCES OF FOLATE ARE
BEANS, PEAS AND LENTILS.
GREENS, BEANS AND CITRUS AND IT
BRINGS BEANS, PEAS AND LENTILS
BACK AGAIN.
>> SO TALKING ABOUT THE FOLATE,
IN 1966 WE ADDED FOLIC ACID TO
OUR GRAINS TO PREVENT NEURAL
DEFECTS AND FEELING PEOPLE WERE
NOT MAKING GRAIN DECISIONS BASED
ON THAT.
THAT WAS 28 YEARS AGO.
PERHAPS IT'S TIME AND FEDERAL
PEOPLE KNOW MORE ABOUT THE
HISTORY OF THIS THAN I DO, THE
ISSUE HAS COME UP A GOOD BIT
WITH IRON WITH THE GUIDANCE THAT
JUST CAME OUT THAT DEALT WITH
THIS EXTENSIVELY INVOLVING
ISSUES WITH IRON AND WHOLE GRAIN
BUT YOU'RE FUNDAMENTALLY RIGHT
WE PERHAPS NEED TO TAKE A LOOK
AT THAT.
THE RATIONALE IS WHAT YOU SAID
PEOPLE MIGHT NOT BE TAKING
PRENATAL VITAMIN WITHOUT KNOWING
THEY'RE PREGNANT AND WE PROTECT
THE POPULATION.
IT'S BEEN PROFOUNDLY SUCCESS
PROGRAM IN DECREASING NEURAL
TUBE DEFECTS SO NO ONE WANTS TO
TAKE THAT AWAY BUT I'M NOT
SURE -- I WOULD AGREE IT'S AN
ISSUE THAT COULD BE RECONSIDERED
IN SOME WAYS.
>> I WANT TO ADD ONE ADDITIONAL
DIMENSION TO THE CONVERSATION
WITH REGARDS TO THE ORIGINAL
PREMISE OF HAVING MORE WHOLE
REFINED GRAINS IN THE HUS
PATTERN THAN YOU MIGHT SEE FOR
FRUIT AND VEGETABLE INTAKE AND
BIO AVAILABILITY IS SOMETHING TO
CONSIDERING AND PUT IN A PLUG
NOT FOR '25 BUT ANOTHER POINT
THINKING THROUGH THE CUT POINTS
FOR THE VARIOUS NUTRIENT INTAKE
WITHIN THE HUS BECAUSE THAT'S A
WHOLE DIFFERENT QUESTION IT
APPEARS THAN TRYING TO DO IT
FROM A MODELLING PERSPECTIVE.
SO THE HUS RIGHT NOW TELLS US
ONE THING THALT THE JUMPING OFF
POINT FOR THE MODELLING.
IT'S NOT THE PREHUS.
IT'S START BEING WITH THE HUS
AND NOW LET'S MODEL.
I THINK THE QUESTION OR SOME
QUESTIONS THAT HAVE COME UP SO
FAR RELATE TO HOW DO WE GET TO
THAT HUS AND MAYBE THAT'S
ANOTHER POINT OF CONTENTION FOR
THE NEXT GROUP.
>> ONE MORE COMMENT.
>> YES, I'M GOING BACK TO THE
DARK GREEN VEGETABLE BECAUSE
DARK GREEN VEGETABLES ARE
VEGETABLES AND THE SYSTEMATIC
REVIEW POINTED TO HIGHER AMOUNT
OF FRUITS AND VEGETABLES.
ONE OF THE RATIONALES IS THE
SYSTEMATIC REVIEW DIDN'T CALL
SPECIFICALLY FOR DARK GREEN BUT
DID CALL FOR VEGETABLES.
>> DON'T FORGET BEANS, PEAS AND
LENTILS ARE IN THE VEGETABLE
GROUP SO ANY MODIFICATION HAS TO
BE CONSIDERED RELATIVE TO THE
OTHERS AS WELL BUT THE
SYSTEMATIC REVIEWS DID NOT CALL
OUT DARK LEAFY VEGETABLES
SPECIFICALLY.
>> IN THE INTEREST OF TIME WE
HAVE TO MOVE FORWARD AND I'LL
PASS IT OFF TO HEATHER.
>> ANOTHER PIECE OF OUR
SYNTHESIS POPULATION GROUP IN
OUR PROFILES IN OUR SYNTHESIS.
YOU MAY REMEMBER THAT DURING THE
DEVELOPMENT OF NUTRIENT PROFILES
WE HAD A PROTOCOL THAT FOCUSED
ON THE DEVELOPMENT OF PROFILES
USING OUR DIFFERENT POPULATION
GROUPS.
AND WE DID PRESENT THE RESULTS
OF THESE ANALYSIS AT MEETING.
THE SUMMARY OF THOSE FINDINGS
WAS THAT THE POPULATION GROUP
DATA WOULD NOT BE USED TO CREATE
THE NUTRIENT PROFILES BUT WOULD
USE THOSE POPULATION GROUP DATA
OF VARIOUS GROUPS TO EVALUATE
AND SOMEONE THE PROPOSED
PATTERNS ONCE WE CREATED THEM.
SO THAT'S WHAT I'M GOING TO
SHARE HERE.
IT'S COMPLICATED IN HOW WE DID
THE MODELLING AND PLACE THIS
PIECE WITHIN THAT CONTEXT IS
WHAT I WANT TO MAKE CLEAR RIGHT
NOW.
SO OUR FOOD MODELLING IS BASED
ON THESE PROFILES.
WE CAN CREATE A WEIGHTED AVERAGE
NUTRIENT PROFILE TO DEVELOP OUR
NUTRIENT PROFILES FOR EACH FOOD
GROUP AND SUB GROUP LIKE THE
EXAMPLE IS THEN GIVING RED AND
ORANGE VEGETABLES.
AND SO THE CALCULATION OF THESE
NUTRIENT PROFILES CONSIDERED THE
PROPORTION CONTRIBUTION FROM
MULTIPLE ITEM CLUSTERS.
THINK OF ALL THE ITEMS THAT FIT
IN RED AND ORANGE VEGETABLES.
THESE ARE BASED ON THE
POPULATIONS DIETARY INTAKES
REPORTED IN WHAT WE EAT IN
AMERICA NHANES.
HERE'S WHERE THE POPULATION
PIECE COMES IN.
WHEN YOU THINK OF THE ITEMS THAT
ARE IN RED AND ORANGE VEGETABLES
AND THEN THINK ABOUT THE
PROPORTIONS THAT THE POPULATION
CONSUMES OF EACH OF THOSE ITEMS.
THE PERCENT CONTRIBUTION OF EACH
ITEM CLUSTER WITHIN A FOOD GROUP
OR SUBGROUP MULTIPLIED BY THE
ENERGY AND NUTRIENTS IN THEIR
ASSIGNED NUTRIENT DENSE
REPRESENTATIVE FOODS.
THEN WE SUM THOSE RESULTS TO
DETERMINE THE OVER ALL NUTRIENT
PROFILE FOR THAT FOOD GROUP OR
SUBGROUP.
THAT'S OUR STARTING POINT AND
WE'VE BEEN USING THE TOTAL
POPULATION WEIGHTED CONTRIBUTION
TO THOSE DIFFERENT ITEMS.
HERE WE WANTED TO DETERMINE IF
THEY'RE RELIANCE ON THE
POPULATION INTAKES AT THE BASIS
OF THE PERCENT OF THOSE ITEM
CLUSTERS WOULD MEET NUTRITIONAL
GOALS IN THE SAME WAY IF WE USED
THE BREAK DOWN RACE, ETHNIC AND
INCOME-BASED POPULATION GROUPS
AND USING THE PER PORTION OF
THEIR INTAKES EACH LOOKING AT
THOSE SEPARATELY AS THE BASIS OF
THOSE PROFILES.
SO I FEEL LIKE THIS PIECE IS
REALLY AN INTEGRATION OF THE
HEALTH EQUITY CONSIDERATIONS AND
IT GIVES US A WAY TO TEST THAT
THE PATTERNS WE'RE PROPOSING ARE
MEETING EACH OF THOSE SUB GROUPS
WHERE THEY ARE.
NOW WE'LL SURE THOSE RESULTS.
MOVING ON TO THE NEXT SLIDE AND
SUMMARY STATEMENT WAS PRESENTED
AT MEETING 5 AND SO THAT WAS AS
PART OF THE FINAL SYNTHESIS
ANALYSIS THE PROPOSED PATTERNS
AGAINST NUTRITIONAL GOALS USING
THE POPULATION NUTRIENT PROFILE
AND THE INDIVIDUALLY CALCULATED
PROFILES FOR THE POPULATION
GROUPS CLASSIFIED BY RACE AND
HISPANIC ORE DPIN AND INCOME.
FOR THE RESULTS MOVING TO THE
NEXT SLIDE AFTER WE DRAFTED THIS
MODIFIED HUSS PATTERN IN THE
ABILITY TO MEET NUTRIENT GOALS
WHEN THE UNDERLYING NUTRIENT
PROFILES FOR EACH GROUP WAS
ESTIMATED USING POPULATION GROUP
SPECIFIC NUTRIENT PROFILES FOR
THE GROUPS THAT ARE SHOWN HERE.
AND SO THOSE AGAIN WERE BY RACE
FOR NON-HISPANIC BLACK,
NON-HISPANIC WHITE AND ETHNICITY
BY POPULATION LEVEL, BY UNDER
131% OF THE POVERTY LEVEL AND
350% OF THE POVERTY LEVEL AND
OVER 350% OF THE POVERTY LEVEL.
THE RESULTS WERE WHEN WE USED
THESE DIVERSE POPULATION
SPECIFIC PROFILES TO ESTIMATE
NUTRIENTS THERE WERE NO
DIFFERENCES IN THE NUTRIENTS
THAT FELL BELOW THE ESTABLISHED
GOALS.
THAT WAS OVER ALL.
WE DID HAVE TWO WE WANTED TO
NOTE AND LOOKING AT HOW WELL THE
PATTERNS MET THE NUTRIENT WE
WANTED TO DO THAT IN A WAY THAT
WOULD STRONGLY ADHERE TO THE
RECOMMENDATIONS.
WE USED A CUT POINT OF 90%.
WE WANTED OUR PATTERNS TO MEET
90% OF THE GOAL AND FOR THE
NON-HISPANIC ASIAN GROUP THAT
WAS AGES 2-6 THE PATTERN FOR
FIBER MET 88% OF THE ADEQUATE
INTAKE AND FOR AGES 14 TO 18
YEARS FOR IRON, IRON MET 87% OF
THE RECOMMENDATION.
SO THESE ARE GREATER THAN OUR
CUT POINT OF 80% BUT IN GENERAL
STILL VERY GOOD.
AS A REMINDER THE NUTRIENTS EVEN
IN THE GENERAL PROFILE ARE NOT
QUITE MEETING THE 90% GOAL.
WE WANT TO EMPHASIZE THE
ANALYSIS WERE CONDUCTED TO
EVALUATE THE FLEXIBILITY OF THE
MODIFIED HUSS DIETARY PATTERN
AND EACH ANALYSIS AND CALCULATED
FOR EACH GROUP IN THE PATTERN
AND FOUND THE MODIFIED HUSS
PATTERN GENERALLY MET THE
NUTRIENT GOALS IN THE ANALYSIS.
SO THE MODIFIED HUSS MODIFIED
PATTERN IS EXPECTED TO MEET
GOALS IF UTILIZED AMONG THE
DIVERSE GROUPS IN THE POMP.
THAT'S IT.
OPEN FOR DISCUSSION.
>> WHAT PROPORTION OF
NON-HISPANIC ASIANS WERE NOT AT
90% OF THE GUIDE LINE.
?
AM I MISSING THE POINT?
WERE THEY ARE BEFORE THE SWITCH?
>> SO WHEN WE WORKED ON ALL THE
MODELLING OF THE PATTERN TO
BETTER UNDERSTAND IF WE COULD
MODIFY PIECES OF THE PATTERN TO
MAKE IT BETTER, WE BASED THAT ON
THE WEIGHTED PROPORTION OF THE
TOTAL POPULATION'S INTAKES.
>> YEAH.
>> THEN WE KIND OF TESTED THAT
OUT BASED ON DIFFERENT
POPULATION GROUPS.
SO WE DIDN'T TEST OUT WHAT THE
PRIOR PATTERN BEFORE WE MODIFIED
IT HOW THAT MET THE DIVERSE
POPULATION GROUPS.
>> WOULDN'T THAT HELP TO SHOW
THAT WAS BETTER THAN BEFORE?
MAYBE I'M NOT UNDERSTANDING.
IT SEEMS I WOULD WANT TO KNOW
THE DIFFERENCE THE MODELLING
CREATES COMPARED TO THE PREVIOUS
MODEL.
>> WE CAN LOOK AT THAT.
I THOUGHT YOU WERE TALKING ABOUT
DIETARY INTAKES VERSUS MODELS
AND LOOKED AT THE PROFILES TO
THE DRAFT MODEL PATTERN.
YOU CAN GO BACK AND LOOK TO SEE
HOW IT CHANGED BETWEEN THE
2000s.
>> THE FIRST QUESTION WAS
DEVELOPING THE BASIS PATTERN
WITH REMOVING FOODS OF LOWER
NUTRIENT DENSITY.
THE SECOND WAS TO TEST IF THE
NUTRIENT PROFILES NEEDED TO BE
DIFFERENT BASED ON THE SUBGROUPS
FOR THAT POPULATION GROUPS THAT
WE DEMONSTRATED HERE.
WE DIDN'T SEE A BIG DIFFERENCE
IN THE NUTRIENT PROFILES SO WE
DIDN'T MOVE FORWARD WITH A
POPULATION GROUP SPECIFIC
ANALYSIS OF ALL THESE BUT ON A
SYNTHESIS SIDE WHAT HEATHER WAS
JUST REPORTING WAS IT STILL HELD
TOGETHER AND MET NUTRIENT NEEDS
GENERALLY WITH JUST A FEW
EXCEPTIONS.
ONE IS ON A POPULATION GROUP
LEVEL OR THE TOTAL NUTRIENT
PROFILE WITHIN THE GROUPS.
>> WE PULLED UP THE DATA AND IT
DID IMPROVE.
>> ARE THERE ANY OTHER
QUESTIONS?
OKAY.
CHRIS, I THINK YOU'RE GOING TO
NOW PRESENT SOME NEW DATA ON
DIET SIMULATIONS.
>> YES.
>> JUST TAKE A FEW MINUTES.
>> YOU RAISE A QUESTION AND
INSTANTLY THE DATA IS ANALYZED.
DOES IT SPEAK IT HOW GREAT THE
STAFF ARE?
TAKE IT AWAY.
>> IN THE INTEREST OF TIME I'LL
BE WORKING MY WAY THROUGH A VERY
COMPLEX STATISTICAL ADDITION
ADDED TO THE DIETARY GUIDELINES
THIS TIME FROM DIET SIMULATIONS.
IT'S KIND OF IMPORTANT TO LEVEL
SET AROUND WHAT WE'RE LOOKING
AT, HOW WE'RE TESTING IT, HOW
WE'RE GOING TO TEST THE NEW
MODIFIED PATTERN AND KIND OF
MORE OF A REAL WORLD SITUATION.
THE FOOD PATTERN MODELLING AS WE
TALKED ABOUT IS BASED ON THIS
NUTRIENT DENSE VERSION OF THE
DIFFERENT FOODS AND BEVERAGES TO
BE INCLUDED IN THE PATTERN AND
HOW WELL THAT MEETS NUTRIENT
GOALS.
AGAIN, HARKENING BACK TO
YESTERDAY WHAT THE CONSUMPTION
LEVELS CURRENTLY ARE IN MEETING
THESE RECOMMENDATIONS.
PRIOR COMMITTEE DID SOME WORK ON
WHAT USUAL CHOICES COMPARED TO
THE NUTRIENT DENSE CHOICES AND
HOW THOSE INFLUENCE LIKE THE
CALORIE LEVELS AND WHAT THE
CALORIE LEVEL WOULD BE FOR USUAL
CHOICES VERSUS CONSUMING THE
REPRESENTATIVE FOOD AND THAT
TIES INTO THE CALORIES FOR OTHER
USES THAT WE TALKED ABOUT
YESTERDAY CAME FORWARD ON WHAT
THE VARIABILITY IS WITHIN THIS.
WHAT WE ARE DOING IS A SPECIFIC
QUESTION ADDRESS THE ANALYSIS OF
DO SIMULATED DIETS MEET THE
UPDATED U.S. DIETARY PATTERNS
AND REFLECT VARIATION AND
DIETARY INTAKES TO ACHIEVE
NUTRITIONAL ADEQUACY.
THIS IS SHOWING THE RECOMMENDED
AMOUNTS SARA JUST DESCRIBED AND
WERE CONDUCTED TO TEST THE DRAFT
PATTERN AMOUNTS FROM EACH FOOD
GROUP THAT MET NUTRIENT GOALS
REGARDLESS OF WHICH
PREDOMINATELY NUTRIENT DENSE
FOOD SOURCE WERE SELECTED FROM
EACH GROUP.
THE DIETARY PATTERNS ARE
INTENDED TO PROVIDER A FLEXIBLE
FRAMEWORK ON REQUIREMENTS AND S,
TRADITIONS.
THIS IS THE FIRST TIME DIET
SIMULATIONS WAS CONDUCTED TO
TEST THE PATTERNS FOR VARIATION
AND INTAKE.
AS PART OF OUR CONTINUOUS
QUALITY IMPROVEMENT ASPECT OF
THE COMMITTEE'S WORK, THE
ADDITION TO THE DIET SIMULATIONS
WAS IDENTIFIED AS A WAY TO TEST
WHAT THE PATTERNS LOOK LIKE OUT
IN THE WILD PER SE.
AND PATTERN METHODOLOGY.
IT'S DEFINED AS A MATHEMATICAL
MODEL THAT DESCRIBES OR
RECREATES COMPUTATIONALLY A
SYSTEMS PROCESS AND USED IN THIS
PROTOCOL TO RECREATE DAILY
DIETS.
SO FOOD PATTERN MODELLING LIKE
DIET SIMULATIONS CONSIDER A
BROAD RANGE OF NUTRIENT INTAKES
BUT INSTEAD OF USING A COMPOSITE
NUTRIENT PROFILE BASED ON THE
REPRESENTATIVE FOOD THE ENERGY
AND NUTRIENT COMPOSITION IS FROM
RANDOMLY SELECTED FOODS THAT FIT
WITHIN THE FOOD GROUPS AND SUB
GROUPS THAT COME FROM OUR FNDDS
DATABASES FROM WHAT WE EAT IN
AMERICA.
INSTEAD OF BUILDING THE NUTRIENT
PROFILES ON THE PROPORTIONAL
CONTRIBUTION THAT COMES FROM
NHANES, WE'RE NOW ALLOWING FOODS
TO BE SELECTED TO MEET THESE
DIETARY PATTERNS AND THEN
TESTING THE NUTRIENT
IMPLICATIONS.
IT ALLOWS A SYSTEMS SCIENCE
APPROACH TO ENSURE THE FINAL
PATTERN WE PROPOSED TO THE
DEPARTMENT IS INCLUSIVE OF
BROADER RANGE OF DIETARY INTAKES
AND THE NOT JUST THE
REPRESENTATIVE FOODS.
FOR THOSE THAT DON'T LIKE THE
PUNCH LIKE BEFORE THE JOKE, SO
DIET SIMULATION RESULTS NUTRIENT
REQUIREMENTS CAN BE GENERALLY
MET WHEN CONSIDERING VARIATION
IN DIETARY INTAKE.
AGAIN, I'M GOING TO LINK BACK TO
SARA'S COMMENTS THE DIETARY
PATTERN IS CONSTRUCTED AND BEEN
EVOLVING OVER COMMITTEES TO
REALLY FOCUS ON MEETING THE
NUTRIENT GOALS AND WE'VE BEEN
LOOKING AT WAYS TO REFINE AND
TIGHTEN BUT IT'S A PATTERN THAT
VERY MUCH HELPS MEET NUTRIENT
GOALS AND GIVEN THE QUANTITIES
NUTRIENT REQUIREMENTS ARE MET
WHEN CONSIDERING DIETARY INTAKE
WITH THE EXCEPTION FROM FOOD
PATTERN MODELLING OF VITAMIN D
AND E AND REDUCING THE
PROBABILITY OF THOSE FOODS LOWER
IN NUTRIENT DENSITY INCLUDED TO
15% OF PROBABILITY OF FOODS
HIGHER IN NUTRIENT DENSITY IS
NEEDED TO MEET GOALS FOR ADDED
SUGAR.
SO WE TOOK REPRESENTATIVE FOODS
WITHIN THE FOOD PATTERN
MODELLING THAT MINIMIZED THE
CONTRIBUTION OF SATURATED FAT,
ADDED SUGAR AND SOME OF SODIUM.
OUR SIMULATIONS CONSIDERED ALL
FOODS OR POTENTIALLY LIMITING
FOODS THE INCLUSION OF FOODS
LOWER IN NUTRIENT DENSITY.
AND WITH THE EXCLUSION OF FOODS
LOWER IN NUTRIENT DENSITY,
SIMULATIONS EXCEEDED THE CDRR
FOR SODIUM.
IT GIVES A LITTLE BIT OF CONTEXT
AROUND THE ANALYSES COMING
FORWARD.
THE SUPPORT FOR THE STATEMENT
WE'LL WALK THROUGH IS NUTRIENTS
AN EAR WE WERE LOOKING FOR THIS
LEVEL OF DATA FROM ALL THE
SIMULATIONS.
POOLING THOSE TOGETHER WE WANTED
TO LESS THAN 10% OF THE
SIMULATED DIETS TO HAVE AN
INTAKE DISTRIBUTION BELOW THE
AND WANT LESS 10% TO BE BELOW
THE EXCEPT FOR VITAMINS D AND E
WE KNEW WOULD BE A CHALLENGE.
FOR NUTRIENTS WITH AN AEI
THEY'LL BE XRARD COMPARED AND
WANTED DISTRIBUTION TO BE
GREATER THAN AI BUT FALLS SHORT
FOR CHOLIN AND FIBER FOR SELECT
AGE GROUP AND LINOLEIC ACID AND
LOOKING AT DENSITY AS REDUCED OR
EXCLUDED.
THE MODEL LAD TO ADDRESS HAD TO
ADDRESS LEVELS OF NUTRIENT
DENSITY.
SODIUM EXCLUDE THE EAR AND
MEDIAN ENERGY CONTENT OF THE
DISTRIBUTION IS GREATER THAN THE
ESTIMATED ENERGY NEEDS AND WE
KIND OF TALKED ABOUT THIS AROUND
THE TIGHT NATURE MEETING NEEDS.
SIMULATION OF EACH GROUP IN
ISOLATION OILS PRECLUDE ENERGY
AND REMIND YOU OF WHAT THE
APPROACH WAS IN TERMS OF HOW
THESE WERE CALCULATED.
WE'LL TALK ABOUT WHAT WE
SUBMITTED IN THE PREVIOUS
MEETING.
TO CONDUCT THE SIMULATED DIETS,
INDIVIDUAL FOODS AND BEVERAGES
WERE RANDOMLY SELECTED FROM ALL
THE FOODS AND BEVERAGES WE HAD
AVAILABLE WITHIN FNDDS.
EXCEPT IT HAD TAKEN OUT
COMBINATION FOODS AND LASAGNA
WOULD NOT BE INCLUDED BUT THE
INDIVIDUAL INGREDIENTS WITHIN
THE FOOD WOULD BE AVAILABLE TO
BE SELECTED.
IT MAY NOT HAVE A SANDWICH FOR A
PASTA DISH TOGETHER BUT THE
INDIVIDUAL ITEMS WERE AVAILABLE
TO BE PUT INTO THE SIMULATION.
THEN THE RANDOM SELECTION OF THE
ITEMS RESULTED IN -- I'LL LET
THIS SINK IN FOR A SECOND, 2500,
SEVEN DAY DIETS FOR EACH AGE SEX
GROUP BY RANDOMLY SELECTING
FOODS TO MEET THE VEGETABLE,
DARK GREEN LEVY AND THE AMOUNT
OF INFORMATION THAT'S GENERATED
FROM THIS, 2500, SEVEN DAY DIETS
TO GET TO THIS VARIABILITY OF
FOODS FOR EACH AGE SEX GROUP TO
BE ABLE TO TEST THIS MODEL.
SO WE CREATED THE PATTERN WE HAD
A DEADLINE AND MET IT WITH ABOUT
45 SECONDS LEFT.
THEY HAVE MORE CAPACITY TO
GENERATE THE PROFILES AND
CONDUCTED THESE NOT ONLY WITH
ALL FOODS INCLUDED BUT
PROPORTIONALLY REDUCING THE
PROBABLE OF FOODS LOWER IN
NUTRIENT DENSITY.
SO FOODS HIGHER IN ADDED FAT,
SHUGAR TO HAVE THE ANY FOODS
COUNT SLIGHTLY HIGHER DENSITY
AND 75% PROBABILITY AND 50 AND
25 AND 15 PERCENT WHAT YOU NEED
TO GET TO THE OUTCOMES.
AND WE LOOKED AT THOSE HIGHER IN
SATURATED FAT OR ADDED SUGARS
AND THAT WAS OUR INITIAL
APPROACH AND THEN AS WE DID THE
ANALYSIS REFINED IT IN AS A
SODIUM LEVEL AND THE CRITERIA
USED WERE A COMBINATION OF THE
FOOD AND DRUG ADMINISTRATION'S
PROPOSED CRITERIA FOR
DETERMINING ELIGIBILITY OF FOODS
AND BEVERAGES TO BEAR A DIETARY
GUIDANCE STATEMENT.
AND SUGAR CRITERIA FOR THE
STANDARD PORTION SIZES BASED ON
CANADA'S FOOD CLASSIFICATION
SYSTEM.
WE'RE LOOKING TO SEE AND SETTING
CRITERIA FOR FOODS AND BEVERAGES
TO BE LOWER IN NUTRIENT DENSITY.
AND PROPORTION LESS THAN 30
GRAMS AND GREATER THAN 10% OR
GRAMMED OF SATURATED FAT OR
GREATER THAN 10% OF THE DAILY
VALUE, 5 GRAMS OR GREATER THAN
15% OR 350 MILLIGRAMS OF SODIUM
WERE USED TO CREATE THE
CRITERIA.
AND FOR FOOD AND BEVERAGES WITH
A STANDARD PORTION GREATER THAN
30 GRAMS WE WENT UP TO 15% OF
THE DAILY VALUE FOR THOSE WITH
THE EXCEPTIONS FOR FATS AND OILS
SO HIGHER IN SATURATED FAT
GREATER THAN 30% OF TOTAL
UNSATURATED FAT AND NOT APPLIED
TO NUTS AND SEEDS BASED ON THE
COMPOSITION.
STEP TWO, MAKE LOTS OF DATA.
WHEN WE CONSIDER 2500, SEVEN DAY
DIET SIMULATIONS THAT'S 17,500
DIET SIMULATIONS.
THE NERNL AND NUTRIENT -- THE
ENERGY AND NUTRIENT WERE USED TO
SUMMARIZE THE ENERGY AND
NUTRIENT CONTENT AGGREGATED
ACROSS THE SIMULATED DIETS FOR
THE SEX GROUPS.
ONCE THE DIETS WERE CONSTRUCTED
THEY WERE PULLED AND USED TO
ILLUSTRATE THE DIET AND
PERCENTILE DISTRIBUTIONS USED TO
ESSENTIALLY DETERMINE SUCCESS OF
MEETING NUTRIENT GOALS.
THIS IS THE SAME SLIDE WE SHOWED
BEFORE TALKING THROUGH OUR
PROTOCOL IN LOOKING HOW THE
PERCENTILE DISTRIBUTION MAPPED
OUT IN TERMS OF HOW MUCH VITAMIN
C AND POTASSIUM AN ZINC AND IRON
WOULD BE ACROSS THE PATTERNS TO
DETERMINE HOW THE DISTRIBUTION
WOULD LOOK.
ON ANY GIVEN DAY FROM THAT
RANDOM SELECTION YOU MIGHT
CHOOSE A HIGH VITAMIN C FRUIT OR
CHOOSE A LOWER VITAMIN C FRUIT
AND WHETHER BANANAS MAKE IT IN
MORE THAN ORANGES WILL CHANGE
THAT DISTRIBUTION AND IT WILL BE
BASED ON VERSIONS OF A RAW
APPLE, BANANA AND RASBERRY AND
FOR THE RANGE OF VITAMIN C
CONTENTS 4 TO 8 TO DETERMINE THE
AVERAGE AND THE PERCENT OF DIET
WITH LOW AND HIGH VITAMIN C
CONTENT FOR THOSE BELOW AND THE
UPPER PERCENTILES AN GIVES US
THE DATA WE'LL LOOK AT FOR THE
DISTRIBUTIONS.
STEP 3 OF THE ANALYSIS IN THE
THIRD STEP OF THE ANALYTICAL
APPROACH THE PERCENT OF
DISTRIBUTIONS ENERGY AND 26
NUTRIENTS WERE COMPARED TO THE
NUTRIENT GOALS FOR EACH AGE, SEX
GROUP IT DIFFERS WITH AN EAR AND
AI AS MENTIONED EARLIER.
BECAUSE DIET SIMULATIONS ARE
DESIGN TO BE A FRAMEWORK FOR
VARIABILITY IN THE POPULATION,
THE GOALS WOULD BE A LOW PERCENT
OF SIMULATED DIETS OR 10% BELOW
THE EAR THIS DIFFERS IN THE USE
OF THE RDA WITHIN FOOD PATTERN
MODELLING.
WE WERE TRYING TO ON THE
INDIVIDUAL LEVEL GET ABOVE THE
RDA.
IN SIMULATIONS WE'RE LOOKING AT
POPULATION DISTRIBUTIONS AND
COMPARING IT TO THE EAR.
WHEN THE EAR NOT ESTABLISHED,
THE A.I. IS USED TO SIMULATE THE
DIETS WITH THE NUTRITIONAL GOAL
OF THE MEDIAN BEING MEDIAN
CONTENT AT OR ABOVE THE A.I.
THE NUTRITIONAL GOALS EXCEEDED
THE CDRR FOR SODIUM WITH A LESS
THAN 20% OF SIMULATED DIETS
OUTSIDE THE ADEQUATE MACRO
NUTRIENT DISTRIBUTION RANGE FOR
CARBOHYDRATE, PROTEIN AND TOTAL
LIPID CONTENT.
LESS THAN 10% FOR TWO PLUS FROM
SATURATED FATS AND ADDED SUGARS
AND THE MEDIAN ENERGY CONTENT AT
OR ABOVE THE ASSIGNED ESTIMATED
ENERGY REQUIREMENT.
A CULMINATION OF USING ALL THE
DRIs.
AND FROM A HEALTH EQUITY LENS IN
THE SPACE WAS TO ALSO INCLUDE
SIMULATION OF FOODS AND
BEVERAGES IDENTIFIED AS INCLUDED
IN SELECTED AMERICAN INDIAN AND
ALASKA NATIVE DIETS.
SO IT'S NOT SIMULATING INTAKE
BUT ALL FOODS AND BEVERAGES
REPORTED IN NHANES ITEFIDE TO BE
INCLUDED WITHIN THE DIETS
THEMSELVES.
WE HAVE TO PUT THAT CAVEAT HOW
THE INTERPRETATION FALLS.
IT'S SUPPORTED BY PUBLIC INPUT
CALLING FOR MORE INCLUSIVE
NATURE OF LOOKING AT DIETARY
PATTERNS AND TRADITIONAL EATING
PATTERNS.
FOR FOODS IDENTIFIED IN THE
AMERICAN INDIAN AND ALASKA
NATIVE DIETS WERE REVIEWED FOR
THOSE WITH EXPERIENCE AND THE
NAVAJO NATION OR DENAE AND
CHEROKEE AND ONE EXPERT WITH
EXPERTISE IN ALASKAN NATIVE FOOD
WAYS IDENTIFIED FOODS AND
BEVERAGES IN THE DATABASES AND
FNDDS AND SR LEGACY.
AND FOODS WERE CLASSIFIED AS
INTEGRAL TO CULTURAL CUISINE,
EATEN BUT NOT INTEGRAL AND THEN
NEVER KWON ASSUMED AS PART OF
THE CUISINE.
SO THEN THE FOODS WERE
IDENTIFIED IN THESE THREE
CATEGORIES AND THEN SIMULATED
FOLLOWING THE SAME STEPS OF THE
FRAMEWORK OUTLINED IN THE
EARLIER PRESENTATION.
SIMULATION WAS CONDUCTED
COMBINING THE FOODS AND
BEVERAGES IDENTIFIED BY THE
EXPERTS WITH PROFESSIONAL LIVED
EXPERIENCE.
A SEPARATE SIMULATION FOR EACH
ONE OF THESE PATTERNS OF FOODS
IDENTIFIED AND THE ENERGY AND
NUTRIENT CONTENT OF AGGREGATED
SIMULATED DIETS FOR THE SELECT
AMERICAN INDIAN AND ALASKA
NATIVE WERE EVALUATED AGAINST
THE SAME NUTRITIONAL GOALS FOR
THE NUTRIENTS AND ENERGY.
IT DOESN'T ACCOUNT FOR ALL THE
REPRESENTATIVENESS OF ALL THE
GROUPS BUT GIVES AN OPPORTUNITY
TO FIRST STEP TEST THE APPROACH
AND ABOUT WHAT IT GIVES FOR THE
OUTCOMES AND HELPS US REFINE THE
PROCESS FOR FUTURE APPLICATION.
IT'S KIND OF EXCITING IT'S THE
FIRST STEP.
WHAT ARE WE PUTTING IN THE
SIMULATED MODEL?
IT GIVES AN ACCOUNT OF THE FOODS
FROM FNDDS THAT CAN BE RANDOMLY
SELECTED TO MAKE 2500, SEVEN DAY
DIETS ACROSS EACH OF THE FOOD
GROUPS AND SUB GROUP.
YOU CAN SEE WE HAVE 106
DIFFERENT DARK GREEN VEGETABLES
WHICH IS THE FOCUS MUCH OUR
CONVERSATION.
NOW WE'VE GOT 106 DIFFERENT WAYS
YOU CAN CONSUME DARK GREEN
VEGETABLES FROM FNDDS.
108 RED AND ORANGE VEGETABLES
AND SO ON AND SO FORTH.
THESE VARIOUS OPTIONS WOULD THEN
BE WALKING IN THE PRAN TRY AND
-- PANTRY AND GENERATE THE
INTAKE BASED ON THESE FOODS.
YOU SEE SIMILARLY THE NUMBER OF
FOODS IDENTIFIED AS FOR
INCLUSION FOR THE AMERICAN
INDIAN SIMULATION AND FOR THE
ALASKAN NATIVE SIMULATION TO
SHOW DIFFERENTIATION IN FOOD
IDENTIFIED BY THE EXPERTS.
THIS IS WHERE WE GET INTO OUR
STARTING WITH ALL FOODS HAVE A
CHANCE TO FIT.
THE DIFFERENCE WE HAVE FROM FOOD
PATTERN MODELLING WAS THE
NUTRIENT PROFILES WERE GENERATED
BASED ON THE PROPORTIONAL C
CONSUMPTION FROM NHANES.
THE MOST COMMON FOOD AND
VEGETABLE AND THE NUTRIENT
PROFILE GETS WEIGHTED OR SKEWED
TO WHAT THE MOST COMMON
SELECTIONS ARE.
THIS ANALYSIS WE USED EQUAL
PROBABILITY.
SO NOW THE FOODS THAT ARE
CONSUMED LESS FREQUENTLY STILL
HAVE AN EQUAL CHANCE OF GETTING
IN THE SIMULATIONS OPPOSED TO
BASICALLY RECREATING FOOD
PATTERN MODELLING WHERE IT'S THE
TOP SOURCES OF FRUITS AND
VEGETABLES THAT CONTRIBUTE TO
OUR PATTERN.
WE HAVE EQUAL CONTRIBUTION AND
THAT HITS ACROSS OUR MAIN
ANALYSIS WHERE FOODS AREN'T
EXCLUDED.
THEN OUR SUPPLEMENTAL ANALYSES
FOR MODEL 1, 2, 3, 4 AND 5
DECREASE THE PROPORTION OF LESS
NUTRIENT FOODS OR BEVERAGES
INCLUDED IN THE SIMULATIONS.
FOR OUR RESULTS SO EVALUATION OF
MICRONUTRIENT CONSENT OF
SIMULATED DIETS OUR CRITERIA IS
WE WANT LESS THAN 10% OF THE
SIMULATIONS TO HAVE A SIMULATED
ESTIMATE BELOW THE EAR.
AND AGAIN AS SARA MENTIONED THE
PATTERN IS WELL DEVELOPED TO
HELP MEET NUTRIENT GOALS.
SO WITH THE SELECTION OF A
VARIETY OF FOODS CONTRIBUTING
AND NOT JUST FOR FOOD PATTERN
MODELLING THERE'S PRETTY
ASTOUNDING RESULTS THE MODIFIED
PATTERN BASED ON SIMULATIONS IS
MEETING THE EAR WITH IN SOME
CASES FOR CALCIUM 0% OF OUR
SIMULATIONS WERE BELOW THE EAR.
SO EVIDENCE FOR HOW THIS IS
PLAYING OUT.
SO REGARDLESS OF INCLUSION OF
LESS NUTRIENT FOODS SIMULATED
FOR THIS, FOODS AND BEVERAGES
REPORTED AS CONSUMED AND FOODS
AND BEVERAGES AS IDENTIFIED
INCLUDED IN SELECT AMERICAN
INDIAN AND ALASKA NATIVE DIETS
WERE MEETING NUTRIENT
RECOMMENDATIONS FOR THE ONES YOU
SEE HERE.
AGAIN FOR OUR GOAL HERE IS THE
STARS ARE LESS THAN 10% OF THE
DIETS WERE BELOW THE EAR FOR AGE
SEX GROUPS AT THE ASSIGNED
CALORIE LEVELS FOR AGES 2 AND
OLDER AND MET THE NUTRIENT
CONTENT CRITERIA FOR VITAMINS
B12 AND ZINC AND NOT D AND E AS
ANTICIPATED AND REGARDLESS OF
THE NUTRIENT DENSE FOODS.
WITH THE EXCEPTION FOR VITAMIN E
WITH FOODS IDENTIFIED WITH
ALASKAN NATIVE DIETS AND VITAMIN
E ADEQUACY WAS NOT ACHIEVED WIN
SOME GROUP RESULTING UP TO 12%
SIMULATED DIETS NOT MEETING THE
CRITERIA.
EVALUATING NUTRIENT CONTENT FOR
THOSE WITH AN A.I. THE CRITERIA
IS MEDIAN INTAKE WOULD BE AT
ABOVE THE A.I. FOR EACH AGE SEX
GROUP AND CALORIE LEVEL AND THE
SIMULATED DIETS WERE ABLE TO
MEET ALPHA LINOLENICLINOLENIC I
DIET.
AND THIS IS FOR GENERALLY NOT
MET FOR SIMULATED DIETS FOR OVER
30 YEARS.
AND THESE WERE ACROSS THE
SIMULATION IN THE DIETS AND
ADEQUACY MEETING LINOLENIC ACID
AND RESULTS DELIVERED FOR FOODS
IDENTIFIED WITH ALASKAN NATIVE
DIETS AND ADEQUACY OF SIMULATED
DIETS WAS CONSISTENTLY NOT MET
FOR DRAFT DIETARY PATTERNS FOR 4
TO 8 AND 31 TO 50 AND NOT MET
FOR MALES 30 PLUS WITH PROBABLE
MUCH LOWER NUTRIENT DENSITY TO
NUTRIENT DENSITY OF 15 TO 0%.
SO THESE RESULTS REQUIRE FURTHER
WORK IN EVALUATION.
EVALUATING NUTRIENT CONSENT FOR
FIBER, THE SLIDE DISPLAYS THE
PERCENT WITH CARBOHYDRATE,
PROTEIN OR FAT CONTENT OUTSIDE
THE ADEQUATE MACRO NUTRIENT
RANGE OUTSIDE THE AMDR.
SHOULD THE SIMULATED DIETS MEET
THE CRITERIA FOR CARBOHYDRATE
AND PROTEIN SIMULATED 2 TO 3
YEAR DRAFT DIETARY PATTERNS WERE
HIGH IN PROTEIN CONSENT
EXCLUDING LOWER NUTRIENT DENSITY
CONSISTENT FOR FOODS SIMULATED
FOR U.S. AMERICAN INDIAN AND
ALASKAN NATIVE DIETS AND ALL THE
SIMULATIONS.
FOR THE A.I. FOR FIBER ADEQUACY
WAS CONSISTENCY MET FOR FIBER
FOR 9 TO 13 YEARS MALES AND
FEMALES 14 TO 30 AND FEMALES 31
PLUS BUT NOT FOR ALL OTHER AGE
SEX GROUPS.
THE FINDINGS WERE CONSISTENT
ACROSS SIMULATIONS VARIATION
INCLUSION OF LOWER NUTRIENT
DENSITY, FOODS AND BEVERAGES
CONSUMED IN THE U.S. AND IN
AMERICAN INDIAN AND ALASKAN
NATIVE DIETS.
SATURATED FAT.
THEY MET IF 10% OF THE DIETS MET
OR EXCEEDED THE RECOMMENDATION
AND LESS THAN 10% WERE FROM
SATURATED FAT AND MORE THAN HALF
THE SIMULATED DIETS EXCEEDED
SATURATE FAT WHEN FOODS AND
BEVERAGES LOWER IN NUTRIENT
DENSITY WERE INCLUDED AND MORE
FREQUENTLY.
THE PERCENT THAT EXCEEDED THE
LIMIT DECREASED AS WE DECREASE
THE CONTRIBUTION OF FOODS LOWER
IN NUTRIENT DENSITY.
WERE NOT MET UNTIL LOWER
NUTRIENT DENSE FOODS WERE
EXCLUDED FROM THE SIMULATIONS
AND THE FINDINGS WERE CONSISTENT
ACROSS OUR OTHER SIMULATIONS FOR
SELECT AMERICAN INDIAN AND
ALASKAN NATIVE.
AND FOLLOWING UP WITH ADDED
SUGARS IN THE SAME VEIN LESS
THAN 10% OF DIETS WITH LESS THAN
10% OF CALORIES FROM ADDED
SUGAR, THE PERCENT OF SIMULATED
DIET DECREASED AS WE DECREASED
THE CONTRIBUTION OF LOWER
DENSITY FOODS TO 15% SIMILAR TO
WHAT WE SAW WITH SATURATED FAT
OCCURRING AT 15% PROBABILITY OF
LOWER DENSE FOODS AND SATURATED
FAT WAS 0 AND CONSISTENT WITH
THE SELECT AMERICAN INDIAN AND
ALASKAN NATIVE.
THE OTHER SOMEWHAT NOT
SURPRISING COMMENT THAT CARRIED
FORWARD FROM SODIUM THE INITIAL
ANALYSIS WE CONDUCTED WAS LESS
FOCUSSED ON SODIUM AND REVISED
OUR ANALYSIS AND INCLUDED A MORE
STRINGENT SODIUM CRITERIA FOR
THIS LEVEL OF ANALYSIS AND WE
WERE LOOKING FOR THE DRAFT
SIMULATED DIETS TO MEET THE
DRAFT DIETARY PATTERNS OF THE
CRITERIA OF LESS THAN 10% OF
DIETS EXCEED THE CDRR AND WE
DIDN'T GET THERE.
OR CLOSE.
THE ANALYSIS REVEALED ALL
SIMULATED DIETS EXCEEDED IT
REGARDLESS OF AGE SEX GROUPS,
FREQUENCY OF EXCLUSION OF LOWER
DENSITY FOODS AND SIMULATION WAS
BASED ON FOODS IN THE U.S. DIET,
SELECT AMERICAN INDIAN AND
ALASKAN NATIVE.
WE HAD A REDUCTION FROM 3400
MILLIGRAMS AT EQUAL FREQUENCY
DOWN TO 2748 WHEN LOWER NUTRIENT
DENSE WAS EXCLUDE BUT STILL
DIDN'T COME CLOSE TO THAT 10%
WHICH GETS TO A BROADER
CONVERSATION.
AND THEN FINALLY LOOKING AT
ENERGY TRYING TO MOVE AS QUICKLY
AS POSSIBLE WITH LOTS OF DATA.
THE ENERGY CONTENT WAS EVALUATED
BY THE MEDIAN CONTENT OF THE
DISTRIBUTION FOR EACH AGE SEX
GROUP COMPARED TO THE EAR.
THE TABLE SHOWS THE EXTENT TO
CONSIDER THE DIET SIMULATED
EXCEEDED EER AND SIMULATED DIETS
EXCEEDED BY MORE THAN 450
CALORIES THE EXTENT TO WHICH
THEY DECREASED AS THE INCLUSION
OF LOWER NUTRIENT DENSE FOODS IN
THE SIMULATION DECREASED AND
THREE AGE SEX GROUPS, MALES 14
TO 18 AND 19 TO 30 AND 31 TO 50
AND SIMULATIONS THAT EXCLUDED
LOWER DENSITY FOOD AND IT'S
INCLUSIVE DUE TO THE OIL CONTENT
WITHIN FOODS BUT THEN ALSO
ADDING IT AS A COMPONENT OF THE
DIETARY PATTERNS AS WELL.
WE NEED FURTHER WORK IN THIS
SPACE TO ADDRESS THAT.
SO CONSIDERATIONS AND
LIMITATIONS FOCUS ON THE
SIMULATED FRUITS AND BEVERAGES
REPORTED IN NATIONAL DIETARY
SURVEYS USED.
AS A RESULT THERE.
VARIATIONS OF BASIC FOODS AND
BEVERAGES REPORTED THAT MAY HAVE
MULTIPLE FOOD CODES DIFFERENT
WAYS OF COMPARING GREEN BEANS.
THEY MAY HAVE A CHANCE TO GET IN
SEVERAL TIMES IF PREPARED IN
DIFFERENT WAYS.
SO THE BASIC FOOD IS MORE LIKELY
TO BE SELECTED IF IT HAS MORE
OPTIONS.
SO FUTURE ANALYTIC FRAMEWORKS
SHOULD ADDRESS AS THE CONCERNS.
SIMULATION WAS CONDUCTED BY FOOD
GROUP OR SUB GROUPS AND
CONTRIBUTING TO MORE THAN ONE
GROUP WERE NOT INCLUDED.
CRITERIA FOR IDENTIFYING FOODS
IN SUGARS WERE RELAXED FOR
HIGHER PROPORTION SIZED FOODS
AND THE IMPACT WILL REQUIRE
FURTHER EVIDENCE AROUND WHAT THE
CRITERIA LEVELS MIGHT BE.
AGAIN THE STRICTER SODIUM
CRITERIA MAY BE NECESSARY AS
WELL AS THE WAY OILS CONTRIBUTE
TO THE PATTERN AND THE WAYS THEY
ARE COME FORWARD FROM FOODS AS
PREPARATION BUT ALSO HOW THEY'RE
INCLUDED AS PART OF THE PATTERN
WILL NEED TO BE TRAEFD.
-- ADDRESSED.
LIMITATIONS OF THE PILOT TO
SIMULATE FOODS AND BEVERAGES
IDENTIFIED IN AMERICAN INDIAN
AND ALASKAN NATIVES AND FOODS
AND BEVERAGES FROM THE DATA
SOURCES THAT BY EXPERTS WERE
DETERMINED TO REPRESENT FOODS
AND BEVERAGES CONSUMED.
SO WHILE THE EXPERTS IDENTIFIED
FOODS AND HAD PROFESSIONAL LIVED
EXPERIENCE IT WAS LIMITED AND
THE FOODS AND BEVERAGES
IDENTIFIED WERE NOT PARTICULARLY
REPRESENTATIVE OF ALL AMERICAN
OR ALASKA NATIVE POPULATIONS.
IT'S ALSO IMPORTANT TO RECOGNIZE
THE EQUAL PROBABILITY OF
SELECTION USED FOR ALL
SIMULATIONS SO AS TO NOT
REPRESENT INFREQUENTLY CONSUMED
FOODS MIGHT OVER REPRESENT
FREQUENTLY CONSUMED TO NOT OVER
REPRESENTATIVE FOODS DIFFERS
FROM FOOD PATTERN MODELLING WITH
MODELLING AND DIET SIMULATIONS
DO NOT INCLUDE FOODS OR
BEVERAGES THAT DO NOT CONTRIBUTE
TO A FOOD GROUP OR SUB GROUP
INCLUDING BEVERAGES WE HAVE
LISTED HERE.
>> OKAY.
THANK YOU, CHRIS, FOR PRESENTING
AN AMAZING AMOUNT OF DATA AND I
JUST WANTED TO CALL OUT TO THE
STAFF AS WELL FOR REALLY DOING
CREATIVE WORK.
WE OMITTED TO SAY AT THE
BEGINNING OF THIS THAT DR. HOLLY
RAINER IS NOT JOINING US TODAY
BUT WE DO HAVE ON ZOOM
DR. VALERIE JURNIGAN AND I'M
GOING TO HAND IT TO YOU FOR THE
PRIVILEGE OF THE FIRST QUESTION.
>> THANK YOU, SO MUCH.
I DON'T ACTUALLY HAVE ANY
QUESTIONS BECAUSE I'VE BEEN SO
INVOLVED IN EVERY STEP OF THIS
BUT I WANT IT ALSO ECHO WHAT
YOU'VE SAID.
A HUGE THANK YOU TO THE STAFF
AND THE COMMITTEE AND IT
REPRESENTS SUCH AN EXCITING NEW
STEP FORWARD TO BE ABLE TO DO
THIS WORK.
WE KNOW IT'S NOT REPRESENTING
ALL AMERICAN INDIAN AND ALASKAN
NATIVES BUT A HUGE STEP FORWARD
WITH OUR HEALTH EQUITY FOCUS.
THANK YOU SO MUCH.
>> SO I'LL OPEN IT UP TO OTHER
MEMBERS OF THE COMMITTEE FOR
QUESTIONS AND COMMENTS.
SHERYL.
>> I DON'T THINK I HAVE
QUESTIONS BUT WE'LL SEE.
FIRST COMMENT IS WHAT A GREAT
STATE OF AFFAIRS WHEN WE CAN
ACTUALLY COME UP WITH THOUSANDS
OF FOOD ITEMS AND POTENTIAL
PATTERNS BECAUSE WHEN YOU THINK
OF THE NUMBER OF PEOPLE WE'RE
SUPPOSED TO EVERYBODY SERVE AND
REPRESENT WITH THE MODELLING IT
MAKES SENSE.
I'M GLAD WE HAVE STAFFING
ABILITIES AND THE TECHNICAL
ABILITY TO DO THIS AND SO CHEERS
ON THAT.
WE ALSO IN THINKING ABOUT THE
VARIOUS PLACES WHERE THIS KIND
OF FALLS APART FOR WHAT IDEALLY
WE KNOW IS IMPORTANT FOR HUMAN
HEALTH AND WHERE SIMULATIONS GET
US.
SODIUM LOOKS DARK AND DIRE AND
IF WE LOOK AT THE DECADES OF
EPIDEMIOLOGY, INTERVENTION
EVIDENCE, WITH A LITTLE SEE
UNLESS WE'RE IN A TIGHTLY
CONTROLLED NUTRITION
INTERVENTION SITUATION IT'S A
VERY HARD FOR PEOPLE TO MEET --
TO NOT EXCEED THE CDRR.
I THINK THAT'S REFLECTED HERE IN
THE DATA.
IF IT WEREN'T I'D BE REALLY
SURPRISED.
AGAIN, I THINK IT'S REASONABLE.
AND IT BRINGS TO THE
CONVERSATION THE IMPORTANT
POLICY ANGLE THAT I THINK IS
MISSION CONSISTENT BUT OUT OF
SCOPE FOR US AROUND THINKING
THROUGH HOW DO WE GET OUR FOOD
SUPPLY TO A PLACE WHERE IT MAKE
IT POSSIBLE TO NOT EXCEED THE
CDRR.
SO THANK YOU FOR THE WORK AND
WHILE IN SOME PLACES IT SEEMS
FROM AN EQUITY PERSPECTIVE AND
HUMAN HEALTH PERSPECTIVE
DAUNTING, WE ARE ON THE PATH TO
GETTING THERE.
THE EXPECTATION I DON'T THINK IS
THE CGA2025 SOLVES IT BUT WE'RE
WELL ON OUR WAY.
THANKS.
>> THANK YOU, SHERYL.
OTHER COMMENTS, QUESTIONS,
OBSERVATIONS?
ALLENE?
>> WONDERFUL WORK AND A LOT OF
WORK BEHIND ALL THAT.
I WAS JUST WONDERING FOLLOWING
CHERYL'S COMMENT TOO WE FALL
SHORT ON SODIUM AND OTHER
NUTRIENTS YOU POINTED OUT, I
THINK VITAMIN D, E, CHOLINE IF I
REMEMBER CORRECTLY.
I WAS WONDERING OF THE EXERCISE
OF SIMULATION WILL HELP US
REFINE THE DIETARY PATTERN AND
IS THAT THE GOAL ULTIMATELY OR
WILL THAT INFORM THAT.
>> THE FOOD PATTERN MODELLING
WAS BASED ON PROFILE IN THE
REPRESENTATIVE FOOD WORLD.
SIMULATIONS TAKE US TO ANY FOOD
WITHIN THE FOOD GROUP THAT AGAIN
I THINK THIS REALLY JUST UNDER
SCORES VARIETY OF FOODS.
SO THE FOODS ARE CLUSTERED INTO
FOOD GROUPS FOR NUTRITIONAL
CONTRIBUTION IN THERE BUT SOME
WILL BE SLIGHTLY HIGHER IN SOME
THINGS THAN OTHERS.
FOR THE MOST PART ACROSS THE
BOARD THE PATTERN IS WORKING TO
MEET THE NUTRIENT PROFILE.
WHEN YOU RELAX THE CRITERIA FROM
REPRESENT FOOT -- FOOD AND YOU
START TO IDENTIFY SOME OF THOSE
POTENTIAL CHALLENGES LIKE FIBER.
OUR GUIDANCE GOES TOWARDS
PROMOTING FIBER AND CHELLINE
RICH SOURCES AND LAT
CONVERSATION AROUND FOLATE AND
THE PATTERN NOT MEETING IN
PREGNANCY OUR RECOMMENDATIONS
NEED TO ENCOURAGE CONSUMPTION
AND CHOOSING FOODS THAT ARE
HIGHER IN THE NUTRIENTS TO MEET
THE GOALS AND THIS IS LIKE
PERFECT TIMING FOR THE STAFF OF
THE DIETARY GUIDELINES.gov
RELEASED THE DIFFERENT NUTRIENTS
AND THEN SAYS HEY, IF WE NEED IT
PROMOTE FIBER HERE'S FOODS HIGH
UP FIBER AND BECOMES A NICE
COMPLEMENT IN THE TARGET
POPULATIONS.
>> I'D LIKE TO FOLLOW UP TOO CAN
YOU COMMENT ON WHAT YOU USED TO
GET FOOD COMPOSITION AND WHAT DO
YOU THINK ARE POTENTIAL
IMPROVEMENT THERE TO GET TO
MAYBE GREATER ESTIMATION OF
SIMULATION.
>> IT'S AN AMAZING RESOURCE,
FNDDS AND THE IMPROVEMENTS BEING
MADE BUT AT THE SAME TIME IT
STILL BECOMES A POINT ESTIMATE
FOR THE COMBINATION OF FOODS
REPORTED.
OATMEAL COOKIE IS REPRESENTING A
WIDE VARIETY OF OUR FOOD SUPPLY.
NOW, I'LL ADMIT WHEN WE DID THIS
FIRST SET OF ANALYSIS I
ENCOURAGED US NOT TO INCLUDE
SODIUM AS A LIMITING FACTOR, ONE
VARIABILITY DATABASE GOING TO BE
RELATIVELY HIGH AND HOW MUCH OF
THE FOODS WOULD IT CUT OUT FOR
REPRESENTATIVE NATURE OF BEING
ABLE IT RANDOMLY SELECT FOODS IN
THAT CASE BUT WHEN WE GOT THE
DATA BACK ON SODIUM WAS WORSE
THAN RESTRICTIONS.
SO THE DATABASE IN AND OF ITSELF
IS A GREAT RESOURCE CONTINUES TO
NEED MORE RESOURCES BECAUSE AS
WE TALKED ABOUT WITH THE DAIRY
ALTERNATIVES IT'S LIMITED AND
THE DATABASE BUILT ON
QUANTITATIVE ASSESSMENT AND NOT
JUST FOOD LABEL DATA PER SE THAT
IS RESTRICTED THE LIMITS.
IT'S GOT TO MEET ALL THE
NUTRIENTS THAT NEED TO BE
INCLUDED.
SO THERE ARE RESOURCES THAT
REQUIRE THE DATABASE TO BE
UPDATED.
SO IT'S A HERCULEAN TASK TO HAVE
A DATABASE THAT REPRESENTS
POPULATION-BASED CONSUMPTION AND
AVAILABILITY BASED ON A
CONSTANTLY VARYING FOOD SUPPLY.
WE NEED A LOT OF RESOURCES
CONTINUING IT MOVE IN THAT SPACE
TO CONTINUE TO HAVE THIS AMAZING
RESOURCE AVAILABLE.
>> THANK YOU.
DIANA.
>> IT'S FUN TO SEE ALL THESE
ANALYSES.
THANK YOU.
I HAD A QUESTION FOR YOU ABOUT
YOU SAID MIXED DISHES AREN'T
INCLUDED IN THE SIMULATION.
IT'S THE INGREDIENTS.
SO DO INGREDIENTS LIKE CLUSTER
TOGETHER?
DO YOU HAVE A CLUSTER FOR
LASAGNA OR SANDWICH OR SOMETHING
LIKE THAT?
>> IN THE FIRST STAGE OF THINGS
WE DO NOT BECAUSE THAT
ULTIMATELY THEN MEANS WHEN
YOU'RE PULLING THINGS FORWARD
AND RANDOMLY SELECTING ITEMS YOU
RANDOMLY SELECT ITEMS.
WHEN YOU RANDOMLY SELECT A
SANDWICH YOU THEN HAVE TO PULL
OUT THE ITEMS THAT COME WITH IT
THAT START TO MAKE IT A FAR MORE
COMPLICATED RANDOM SELECTION
THAN IT DOES.
IN THAT CASE YOU MAY NOT BE
CAPTURING A LASAGNA IN A DAY SO
IT BECOMES A LIMITATION AND ONE
THING WE GRAPPLED WITH AND A
FUTURE DIRECTION HOW THIS
CARRIES FORWARD.
HOW DO YOU REDUCE SO YOU DON'T
GET AN INCREASED PROBABILITY
BECAUSE YOU HAVE FIVE OR EIGHT
KINDS OF GREEN BEANS OR HOW A
LASAGNA COMES OUT YOU HAVE
NOODLES BUT NOTHING ELSE THAT
NORMALLY GOES WITH THE LASAGNA
NOODLE.
IT'S A WHICH WILL BUT A FIRST
STEPS FORWARD.
>> I WANTED TO CLARIFY THAT
BECAUSE I THOUGHT THAT THE WHAT
YOU SAID ALONG THERE.
I HAVE A FOLLOW-UP QUESTION,
WITH SATURATED FAT WE KNOW MIXED
DISHES ARE A BIG SOURCE OF
SATURATED FAT IN THE DIET.
SO WHEN Y'ALL DID THE LOW
NUTRIENT FOODS WOULD THINGS LIKE
HIGHER FAT DAIRY BE EXCLUDED AND
MEAT, HIGH SATURATED FAT MEAT?
>> SO WITH THE LOWER NUTRIENT
DENSE ITEM SIMULATIONS
ESSENTIALLY YOU'RE MIXED DISH
INGREDIENTS WOULD BE PULLED AS
REDUCING THE CONCENTRATION TO
LOWER DENSITY FOODS.
IF YOU'RE MAKING LASAGNA THERE'S
A LOWER FAT MEAT OR LESSER SUGAR
TOMATO SAUCE OR SOMETHING THAT
THEN SIMULATES THE INGREDIENTS
AT THAT LOWER LEVEL.
>> YEAH.
SO I THINK MY POINT HERE IS THAT
THIS IS A GOOD INTEGRATION PIECE
WHERE WE CAN KIND OF TAKE WHAT
WE'RE DOING WITH THE SATURATED
FOOT FOODS AND LOOKING AT WHAT
HAPPENED HERE AND INCLUDING THAT
IN OUR WRITE UP.
>> GREAT.
I LOVE THE WAY YOU'RE THINKING,
DIANA.
OTHER QUESTIONS OR COMMENTS?
THANK YOU AGAIN, CHRIS.
THANK YOU AGAIN, STAFF.
I THINK AFTER THAT WE'RE GOING
DO DRAFT SUMMARY.
ACTUALLY I THINK WHAT -- HOW
MANY SLIDES?
>> THREE.
>> OKAY.
>> SO IN MEETING 5, CHRIS
PRESENTED FIVE POTENTIAL
FLEXIBILITIES IN THE HEALTHY
U.S. DIET AND VEGETARIAN
PATTERNS WE'RE GOING TO TRY TO
EXPLORE IN TERM OF MODIFIED AND
LABELLED AND LAID OUT.
THE FLEXIBILITIES ARE WITHIN THE
SUB GROUPS WITHOUT EXACTLY
LAYING IT OUT.
THOSE ARE THE FIVE FLEXIBILITY.
STAFF HAS COLLECTED MILLIONS OF
DATA POINTS AND ORGANIZED THEM
AND REVIEWED EVIDENCE AND LOOKED
AMOUNT THE DATA AND COME TO THE
SUMMARY OF THOSE DATA.
OF THE FIVE, THREE DO NOT
SUPPORT THOSE FLEXIBILITIES.
TWO OF THEM THE FIRST TWO
INVOLVE BEANS AND PEAS AND
REDUCING GRAINS OR INCREASING
STARCHY VEGETABLES AN GREENS AND
THEY'VE BEEN EXPLAINED IN TERMS
OF THE NUTRIENT COMPETITION OF
THE DIET.
BESIDES THAT, THESE KIND OF
FLEXIBILITIES HAVE THE
ASSUMPTION PEOPLE ARE ALREADY
MEETING THE BEANS, PEAS AND
LENTILS OR STARCHY
RECOMMENDATIONS AND WE'RE NOT
CLOSE TO MEETING THE
RECOMMENDATIONS.
THEREFORE WITH THAT IT IS
DIFFICULT TO SUPPORT THE
FLEXIBILITIES.
AND EVEN IN ORDER TO SIMULATE
THOSE FLEXIBILITIES IN
SUBSTITUTION WE NEED TO KNOW
PEOPLE ARE INCREASING BEANS,
PEAS AND LENTILS OR STARCHY
VEGETABLES WHAT PARTS OF THE
TOTAL GRAINS THEY ARE REDUCING.
WHOLE GRAINS, REFINED GRA D GRO
WITHOUT THAT EVERYDAY UP TRYING
TO SIMULATE AND CALCULATE THIS
FLEXIBILITY WITH SUBSTITUTION
ANALYSIS BECOMES DIFFICULT.
TO CONCLUDE CURRENT EVIDENCE
DOES NOT SUPPORT THOSE TWO
FLEXIBILITIES.
THE THIRD REGARDING THE
FORTIFIED MILK HAS BEEN
EXPLAINED I WILL NOT ELABORATE
AND TWO FLEXIBILITIES WITH
PROTEIN FOOD THE EVIDENCE DOES
SUPPORT INCLUDING THOSE
FLEXIBILITIES.
HOWEVER, RE-ORGANIZING THAT TO
PLACE IT IN THE HEALTHY
U.S. DIETARY PATTERNS AND ONE
BEING ORIGINALLY PROPOSED IN THE
VEGETARIAN PATTERN.
THE DATA DOES SUPPORT THE
FLEXIBILITY OF INCREASING ANIMAL
SOURCES OF PLANT PROTEINS AND
REDUCING ANIMAL SOURCES OF
PROTEIN AND THAT SHIFT MAY
PRESENT WHAT SOME MIGHT CONSIDER
AS A PESCATARIAN PATTERN WHERE
SEAFOOD AND PLANT PROTEINS ARE
THE MAIN PROTEINS AND LITTLE
OTHER MEAT PROTEINS.
IT CAN ALSO INCREASE BEANS, PEAS
AND LENTILS MAY BE TO THE EXTENT
THAT REPRESENT A LACTO
VEGETARIAN PATTERN AND THEN
THEREFORE INCLUDING FISH AS A
FLEXIBILITY IN THE VEGETARIAN
PATTERNS CAN BE PLACED IN THE
HEALTHY U.S. PATTERN ALREADY AND
THE FLEXIBILITY IS ONE
DIRECTIONAL.
AS IT ABOUT DECREASING THE
ANIMAL AND NOT FLEXIBILITY OF
THE OTHER WAY AROUND INCREASING
ANIMAL PROTEINS AND REDUCE PLANT
PROTEINS.
SO THE LAST SLIDE IS WHAT WE
PROPOSED AS THE FLEXIBILITY
WITHIN THE MODIFIED PATTERN
CHRIS PRESENTED AND MEETS NEEDS
WITH VARIOUS ANIMAL PLANT
PROTEIN IN ADDITION THE FOOD
PATTERN MODELS DOES SUPPORT THE
FLEXIBILITY IN THE PROPORTION OF
ANIMAL AND PLANT BASED PROTEIN
INCREASING THE FLEXIBILITY OF
WHAT IS ALREADY IN THERE IN
TERMS OF INCREASING PLANT BASED
PROTEIN AND DECREASING ANIMAL
PROTEINS AND THE NUTRIENT GOALS
ARE ABLE TO BE MET.
SO THAT'S IT.
>> WOW, THANK YOU.
THANK YOU FOR THAT ANALYSES.
QUESTIONS OR COMMENTS?
SHERYL.
>> THANK YOU FOR THE SUMMARY IN
THE SECOND SLIDE YOU SHOWED
SHOWING THE EVIDENCE SYNTHESIS.
GIVEN THE CONVERSATIONS TODAY I
FEEL IT'S IMPORTANT TO POSSIBLY
ALTER THE WAY THAT TEXT IS
PRESENTED.
SO, FOR EXAMPLE IF IT STARTED
WITH IN THE CONTEXT OF A DIET
WHERE THE BEANS, PEAS AND
LENTILS REQUIREMENTS ARE MET,
COMMA, THE FLEXIBILITY OF
INCREASING AND DECREASING WON'T
HOLD.
I THINK IT WOULD REALLY HELP TO
ARRANGE OUR MIND SETS FOR WHAT'S
HAPPENING AND IN THE CONTEXT OF
A DIET WHERE IT'S ALREADY WHERE
IT SHOULD BE.
>> THAT'S RIGHT.
DIETS IF YOU MEET ALL THESE
REQUIREMENTS AND INCREASING
PLANT PROTEINS AND REDUCING
ANIMAL PROTEINS.
IT HAS A LITTLE BIT OF BENEFITS
IN TERMS OF MICRONUTRIENTS.
ALSO FIBER.
>> THAT'S MY RECOMMENDATION FOR
ALL THREE BULLETS TO
CHARACTERIZE THEM IN WHERE THE
STARTING POINT IS.
>> SHERYL, I THINK THAT'S A GOOD
OBSERVATION.
WE HAD A LOT OF DISCUSSION ABOUT
IT AND HAVE TO REMEMBER PEOPLE
READING THESE DON'T HAVE THE
BENEFIT OF OUR DISCUSSIONS.
OTHER QUESTIONS OR COMMENTS?
THAT WAS QUITE VERY RICH
DISCUSSION.
I REALLY WANT TO THANK EVERYONE
FOR ALL THEIR THOUGHTFUL
PRESENTATIONS AND PREPARATION
AND WILLINGNESS TO EDUCATE THE
ENTIRE COMMITTEE ON THEIR AREAS
DISCUSSED TODAY.
SO WITH THAT WE'RE GOING TO TAKE
A BREAK AND WE WILL RECONVENE AT
1:00.
SEE YOU THEN.
WE'LL HAVE THE FINAL
PRESENTATION ON HEALTH EQUITY
AFTER THE BREAK.
>> WE'RE GOING TO SHIFT GEARS
FROM FOOD PATTERN MODELLING SO
THE PROGRESS ON THE HEALTH
EQUITY WORKING GROUP.
>> GOOD AFTERNOON.
I CHAIR HEALTH EQUITY WORKING
GROUP I WOULD LIKE TO PROVIDE A
SHORT UPDATE ON THE PROGRESS
SINCE MEETING FIVE.
SINCE IS JUST A REMINDER OF THE
MEMBERSHIP OF THE HEALTH EQUITY
WORK GROUP.
WE HAVE REPRESENTATION ACROSS
THE SUBCOMMITTEE AND I WOULD
LIKE TO THANK THE ROLES FOR
TAKING AN ACTIVE ROLE IN OUR
HEALTH EQUITY WORKING GROUP
MEETINGS.
AS OTHER CHAIRS OF THE
SUBCOMMITTEES HAVE MENTIONS WE
CANNOT DO OUR WORK WITHOUT THE
FEDERAL STAFF.
THANK YOU VERY MUCH FOR ALL YOUR
HELP AND SUPPORT.
THIS IS PROBABLY FAMILIAR TO ALL
MEMBERS OF THE COMMITTEE AND
DON'T NEED A REMINDER.
HOWEVER THOSE VIEWING OUR
DELIBERATIONS FOR THE FIRST TIME
I'D LIKE TO NOTE THE 2025
DIETARY GUIDELINES ADVISORY
COMMITTEE HAD BEEN CHARGED WITH
EXAMINING ALL THE SCIENTIFIC
QUESTIONS WITH THE HEALTH EQUITY
LENS TO WHY ENSURE THE NEXT THE
NEXT EDITION IS RELEVANT TO
CULTURAL BACKGROUNDS AND IF YOU
ATTENDED SUBCOMMITTEE
PRESENTATIONS YESTERDAY AND
EARLIER TODAY YOU MAY HAVE
NOTICED WE'RE INTENTIONALLY
ADDRESSING HEALTH EQUITY UP OUR
DELIBERATIONS AN REVIEW OF THE
EVIDENCE.
SPECIFICALLY SINCE MEETING FIVE,
THE HEALTH EQUITY WORKING GROUP
HAS COME WITH EFFORTS TO ENSURE
HEALTH EQUITY CONSIDERATIONS ARE
INCORPORATED IN ALL THE
APPROACHES TAKEN BY THE
COMMITTEE IN ITS WORK.
THE WORKING GROUP MEMBERS HAVE
COMPLETED MOST THE WRITING FOR
THE HEALTH EQUITY CHAPTER AND
RECENTLY OUR WORKING GROUP
MEETINGS HAVE FOCUSSED ON
DEVELOPING OVERARCHING THEMES,
RECOMMENDATIONS AND FUTURE
DIRECTIONS TO ENSURE IT
CONTINUES VIA RESEARCH
RECOMMENDATIONS AND
RECOMMENDATIONS TO FEDERAL
AGENCIES.
SO AT MEETING FIVE THE WORKING
GROUP PRESENTED A DRAFT OF THE
HEALTH EQUITY INFO GRAPHIC TO
VISUAL USING HEALTH EQUITY
APPROACH IN THE COMMITTEE'S
WORK.
AND ICONS IN THE EVIDENCE FOR
DIETARY HEALTH AND THE BOX THAT
YOU SEE THERE TO REPRESENT A
MORE DIVERSE GROUP OF
INDIVIDUALS AND CHANGES FOR
CLARITY.
WE WOULD LIKE FOR THE COMMITTEE
TO ACTUALLY PROVIDER FURTHER
INPUT IF THEY HAVE ANY BEFORE WE
FINALIZE AND PRESENT THE INFO
GRAPHIC AND INCLUDE IT IN OUR
REPORT TO THE AGENCIES.
SO I'LL JUST WALK YOU THROUGH EN
CASE YOU'VE FORGOTTEN THE
COMPONENTS FOR THOSE SEEING THIS
FOR THE FIRST TIME SO WE HAVE
HEALTH EQUITY VISUALIZED THROUGH
THE CONSIDERATIONS FOR HEALTH
EQUITY WHICH INCLUDE SOCIO
ECONOMIC POSITION, RACE AND
ETHNICITY AND CULTURE AND THEN
IN THE NEXT INFO GRAPHIC THE
NEXT BAR WHICH IS NUMBER 2 YOU
CAN SEE EACH EXAMINING THE
EVIDENCE FOR UPDATING THE
GUIDELINES AND EACH HAVE
INCLUDED CONSIDERATION FOR
HEALTH EQUITY IN ITS
DELIBERATIONS.
THIS PROCESS IS INFORMED BY
NUTRITION RESEARCH AND
SURVEILLANCE AND MONITORING YOU
CAN SEE IN THE BOXES ABOVE AND
BELOW.
EXAMPLES INCLUDE SYSTEMATIC
REVIEW AND RACE AND ETHNICITY
WHEN GRADING THE STRENGTH OF THE
EVIDENCE AND MUST HAVE REALIZED
A LOT OF THE MEMBERS SMOKE SPOKE
ABOUT THIS IN THE SUMMARY
STATEMENT FOR SYSTEMATIC
REVIEWS.
THEN YOU HAVE THE DATA ANALYSIS
ON DIETARY INTAKES AND NUTRITION
CREATED HEALTH CONDITIONS FOR
DEMOGRAPHIC POPULATIONS FOR DATA
ANALYSIS AND THIS IS WHERE WE
LOOKED AT THE DIFFERENCES BY THE
DIFFERENT POPULATION GROUPS.
WE ALSO EARLIER THIS MORNING
LOOKED AT EVALUATING THE VARIOUS
MODELLING PROTOCOLS THAT WERE
PRESENTED INCLUDING SPECIFIC
PROTOCOLS DEVELOPING NUTRIENT
PROFILES TO ADDRESS DIETARY
INTAKES, TESTING NUTRITIONAL
IMPLICATIONS OF FLEXIBILITIES OF
DIETARY PATTERNS BASED ON THE
TYPE OF FOODS CONSUMED BY PEOPLE
ACROSS ALL DIFFERENT CULTURAL OR
ETHNIC GROUPS AND THIS WAS
PRESENTED EARLIER THIS MORNING
BY CHRIS, SARA AND TERESA.
THE REVIEW IS UNDERTAKEN ACROSS
THE LIFE SPAN AND LOOKING AT NOT
JUST ADULTS AND OLDER ADULTS BUT
ACROSS THE LIFE SPAN.
THAT'S INDICATED BY THE GRAPHIC
AND THIS WAS A PLACE WHERE A LOT
OF SUGGESTIONS HAD COME THE LAST
TIME AND SO WE TOOK THAT AND
EDITS HAVE BEEN MADE AND THE
REVIEW TAKES INTO CONSIDERATION
PUBLIC COMMENTS AND ANYTHING
THAT'S BEEN ON THE WEBSITE FOR
REVIEW BY THE COMMITTEE.
THAT'S ALSO TAKEN INTO
CONSIDERATION BEFORE WE COME UP
WITH OUR RECOMMENDATIONS FOR THE
DRAFT DIETARY PATTERNS.
AS YOU SAW IN THE PRESENTATION
BY CHRIS EARLIER BEFORE THESE
WERE TURN IF REFINED OR
PRESENTED IN THE FORM OF LOOKING
AT AND WHETHER THE PROPOSED
DIETARY PATTERNS ARE
REPRESENTATIVE OF THE
U.S. POPULATION.
IN ADDITION TO THE INFO GRAPHIC
WE HAVE A BOX WHICH WORKS
THROUGH THE CONSIDERATIONS WE
HAVE THOUGHTFULLY PUT IN PLACE
IN THE PILLARS OF EXAMINING THE
EVIDENCE.
THE LAST ONE I'D LIKE TO CALL
OUT IS THE SYSTEMATIC REVIEW
CONDUCTED AND PRESENTED BY
ANGELA ON LOOKING AT CULTURALLY
TAILORED INTERVENTION.
THAT WAS PUT FORTH OR BROUGHT TO
ADDRESS HEALTH EQUITY IN OUR
CONSIDERATIONS.
AS NEXT STEPS WE'RE CONTINUING
TO WORK WITH THE SUBCOMMITTEES
SINCE WE HAD REPRESENTATION
ACROSS ALL OF THEM.
WE'RE MAKING SURE THAT HEALTH
EQUITY IS FRONT AND CENTER TO
THE SCIENTIFIC REPORT WE WILL BE
SUBMITTING AND THEN WE LOOK
FORWARD TO HAVING A GOOD
DISCUSSION THIS AFTERNOON AS WE
INTEGRATE ALL THE WORK THAT WE
HAVE SPENT ON FOR THE LAST
ALMOST 18 MONTHS THAT'S THE
UPDATE.
ANY QUESTIONS?
>> THANK YOU, SAMEERA.
QUESTION, DISCUSSION, ANY INPUT
ON THE GRAPHIC.
THE QUALITY OF THE INTERACTION
IN MEETING FIVE HELPED.
>> FIRST, THANK YOU SO MUCH.
I WAS PROBABLY THE ONE THAT GAVE
THE FEEDBACK SO I REALLY
APPRECIATE YOU FOR INCORPORATING
PARTICULARLY OUR INDIVIDUALS
THAT LIVE IN BODIES THAT ARE
DISABLED AND THE INFO GRAPHIC
REFLECT THE FULL POPULATION SO
THANK YOU FOR TAKING THAT INTO
CONSIDERATION.
THANKS SO MUCH.
>> I HAVE A COMMENT OR REQUEST.
THE INTEGRATION ALONG THE WAY
HAS BEEN ACTUALLY VERY
INTENTIONAL AND PRODUCTIVE AND
NOT A BOX TO BE CHECKED.
SOME OF THE DISCUSSION IN THE
LAST COUPLE DAYS MAKES WE ALSO
HOPE YOU GUYS TAKE A CAREFUL
LOOK AT FUTURE DIRECTIONS AND
POTENTIAL PROPOSED SOLUTIONS OR
BEHAVIORAL CHANGE
RECOMMENDATIONS OR POLICIES
BECAUSE WHAT STRUCK ME WAS THE
CONSISTENCY OF THE AGI SCORES.
THE ADHERENCE OR ALIGNMENT TO
THE DIETARY GUIDELINE
RECOMMENDATIONS ACROSS FOR RACE,
ETHNICITY AND SOCIO ECONOMIC
POSITION PARAMETERS INCREDIBLY
CONSISTENT AND IF SOLUTIONS ARE
PROPOSED AND HAPPENING TO BE
EFFECTIVE AT RAISING THOSE
SCORES I HOPE IT RAISES
EVERYBODY'S SCORES AND IF IT'S A
BEHAVIOR OR NOT AFFORDABLE OR
ACCESSIBLE TOOL THAT HELPS
PEOPLE ADHERE BETTER THAT WOULD
PROBABLY ONLY CREATE THESE GAPS
RATHER THAN HELP EVERYONE.
I DON'T KNOW WHAT SOLUTIONS
MIGHT BE DOWN THE ROAD BUT THAT
WOULD BE IMPORTANT TO INTEGRATE
TO THE BEST OF OUR ABILITY NOW
OR AT LEAST INCLUDE MONITORING
OF THE DISPARITIES SO THAT THEY
DON'T PERSIST OR GET WORSE.
>> I WAS THINKING IN TERMS OF
TRANSLATIONAL WORK, WHAT WAS
PRESENTED WITH MY PLATE WAS A
GREAT TOOL.
YOU CAN SEE THE APPLICATION OF
THE GUIDELINES ON LIKE CULTURAL
SPECIFIC EATING.
YOU CAN SEE YOURSELF IN THE
EATING PATTERN RECOMMENDED.
I THOUGHT THAT WAS A GREAT STEP
TOWARDS MORE TRANSLATIONAL AND
MORE NUTRITION EDUCATION.
>> GREAT.
SHERYL.
>> WAY I WANTED TO ADDRESS
DIDI'S COMMENT BECAUSE IN
ADDITION TO THE AGI SCORES AND
VARIABILITY THERE AND WHAT WE
KNOW AROUND THE AGI AND ITS
ASSOCIATION IN OBSERVATIONAL AS
WELL AS STRONGER CAUSAL
INFERENCE DESIGNS WITH HEALTH
OUTCOMES A KEY PART OF OUR
DISCUSSIONS SO FAR HAS BEEN WHEN
WE MOVE UPSTREAM ON THE INFO
GRAPHIC FROM THIS BLANKET
STATEMENT THAT WE'RE GOING TO
START WITH HEALTH EQUITY, WE
KNOW THAT NOT EVERYBODY AGREES
THAT WE SHOULD BE JUST STARTING
WITH HEALTH EQUITY.
BUT IT COMES OFF FROM THE INFO
GRAPHIC AS THOUGH WE'RE ALL
THERE, LET'S GO.
SO THE PRECURSORS TO GETTING TO
A PLACE WHERE HEALTH EQUITY HAS
TO BE PART OF THE AROUND FOOD
AND HEALTH ISN'T YET
INCORPORATED BUT I THINK WE'LL
BE TRYING TO DO THAT.
FOR EXAMPLE, SOCIAL COMMITMENT
CAME UP IN OUR DISCUSSIONS LIKE
THERE HAS TO BE A SOCIAL
AGREEMENT THAT THAT'S WHERE WE
NEED TO BE.
THE IDEA AROUND HIE AND DO WE
ALL AGREE THAT IF THE HEALTHY
EATING INDEX HAS CAUSAL
INFERENCE, DO WE THINK IT SHOULD
BE UNIFORM FOR ALL PEOPLE?
SO IF WE AGAIN HAVE A SOCIAL
COMMITMENT AND AGREEMENT ALL
INDIVIDUALS SHOULD EXPERIENCE
ADHERENCE TO THE GUIDELINES IN A
REASONABLY UNIFORM WAY, THEN I
THINK THAT GETS US A LITTLE BIT
FURTHER ALONG.
HOPEFULLY WE'LL SEE THE INFO
GRAPHICS SHIFT A BIT TO BRING IN
THOSE TWO THINGS.
>> THANK YOU FOR THAT
CLARIFICATION.
GREAT DISCUSSION.
OTHER POINTS?
YES.
>> IN THE DISCUSSION WHAT I
NOTICE WAS SOME SUB GROUPS MEET
THE RECOMMENDATIONS AND FOCUS ON
THE 80% NOT THE 20%.
I WAS WONDERING WITHIN THE DATA
SET WHAT IS THE CAPACITY TO
UNDERSTANDING THE PROFILE OF
THOSE DIFFERENT RACE, ETHNIC
GROUP OR INCOMES THAT WERE
IDENTIFIED AS MEETING THOSE
RECOMMENDATIONS AND CAN WE LEARN
FROM THEM?
>> THAT'S A REALLY INTERESTING
POINTS AND TO REPEAT AN ESTIMATE
I HEARD BEFORE THAT IS LIKE 3%
OR SOMETHING OF THE POPULATION
MAY ACTUALLY MEET THE
GUIDELINES.
IT'S VERY SMALL, YEAH.
THAT MAY NOT BE QUITE ACCURATE
BUT IT'S VERY SMALL BUT YEAH I
THINK IT'S A GREAT IDEA WHAT IF
WE PULLED THOSE PEOPLE OUT AND
TRIED TO DIG A LITTLE BIT DEEPER
IN KNOWING WHAT'S GOING ON
THERE.
I THINK IT WOULD BE ENLIGHTENING
AND COULD BE HELPFUL.
IT PROBABLY DOES MEAN THEY MIGHT
HAVE CERTAIN CHARACTERISTICS
THAT MAY BE DIFFERENT FROM THE
REST OF US BUT STILL IT COULD BE
HELPFUL.
>> GREAT.
ANY OTHER?
THANK YOU SAMEERA FOR LEADING US
IN THIS REALLY IMPORTANT AREA
AND THANK YOU TO THE STAFF WHO
HAVE REALLY BEEN SUPPORTIVE.
AND NOW WE'RE HANDING IT OVER TO
JANET TO TALK ABOUT OUR NEXT
STEPS.
>> I CAN'T BELIEVE WE'RE HERE
TODAY.
IT'S BEEN AN AMAZING JOURNEY BUT
WANTED TO SHARE WITH THE
COMMITTEE AS YOU THINK OF
FINALIZING YOUR REPORT IN THE
NEXT MONTH OR SO THE NEXT STEPS
IN OUR PROCESS ESPECIALLY AFTER
WE RECEIVE YOUR REPORT.
SO HERE WE ARE AT MEETING SIX.
THERE'S GOING TO BE ONE MORE
MEETING IN OCTOBER, YOUR
SCIENTIFIC REPORT MEETING
OCTOBER 21 AND 22 AT A HIGH
LEVEL AND THE DEPARTMENT'S WE
ARE CHARGED AND MANDATED TO
RELEASE THE DIETARY GUIDELINES
EVERY FIVE YEARS WHICH WILL
OCCUR IN 2025.
WE'LL WORK OVER 2025 TO UPDATE
AND RELEASE THE NEXT EDITION.
SO NOW I'M GOING TO TELL YOU A
LITTLE BIT MORE ABOUT WHAT WE DO
IN THAT INTERIM PERIOD AS WE
UPDATE AND DEVELOP THE DIETARY
GUIDELINES.
SO ONCE THE DEPARTMENTS RECEIVE
YOUR SCIENTIFIC REPORT IT WILL
BE PREPARED FOR POSTING AND
PUBLISHED ON DIETARY
GUIDELINES.gov.
SO THIS IS LOON WITH ALL THE
SUPPLEMENTAL DOCUMENTS A WEALTH
OF INFORMATION INCLUDING DATA
ANALYSIS REPORTS, ALL THE FOOD
PATTERN MODELLING REPORTS AND
FULL SYSTEMATIC REVIEWS YOU
COMPLETED THAT GO WITH YOUR
SCIENTIFIC REPORT.
ONCE THE REPORT IS RELEASED
WE'LL OPEN A NEW DEDICATED
COMMENT PERIOD IN WHICH THE
PUBLIC CAN COMMENT AND CURRENTLY
THE PUBLIC COMMENT IS DIRECTED
AT THE THE COMMITTEE AND YOUR
WORK BUT THE NEXT PUBLIC COMMENT
PERIOD WILL BE DIRECTED TO THE
DEPARTMENT USDA AND FOLLOWING
THE RECEIPT AND PUBLICATION
WE'LL MOVE INTO STEP FOR AND
DEVELOPMENT PROCESS.
SO IN THIS DEVELOPMENT PROCESS
WE HAVE WE'LL FORM A FEDERAL
WRITING TEAM THAT UPDATES THE
DIETARY GUIDELINES SO IT IS
COMPOSED WITH REPRESENTATIVES
WEDGE EXPERTISE IN NUTRITION
SCIENCE, DIETARY GUIDELINES,
RELATED RESEARCH PROGRAMS AND
COMMUNICATION SPECIALISTS WITH
EXPERTISE IN COMMUNICATING
NUTRITION INFORMATION.
I KNOW ACROSS YOUR CONVERSATIONS
YOU'VE TALKED ABOUT LIKE HOW
THIS CAN BE COMMUNICATED.
WE DO THAT WITHIN OUR TEAM AS
WELL HOW TO COMMUNICATE SO IT'S
UNDERSTOOD BY THE PEOPLE WHO ARE
USING IT.
SO PRIOR TO THE WRITING WE GET
TOGETHER WITH OUR TEAM AND
DISCUSS MAJOR TEAMS FROM YOUR
SCIENTIFIC REPORT ALSO
RECOMMENDATIONS FROM PREVIOUS
EDITIONS THE COMMITTEE
RECOMMENDED FORWARD AND NOT
FORWARD WITH AND THIS IS WHERE
YOUR ADVICE IS CRITICAL AND
WE'VE BEEN TALK BEING ABOUT THIS
PROCESS YOUR ADVICE SECTION IN
YOUR CHAPTERS ARE HELPFUL TO US.
WE ALSO LOOK AT COMMENTS FROM
THE PUBLIC AND FROM FROM
AGENCIES.
FOLLOWING RECEIPT OF YOUR REPORT
WE USUALLY HAVE LIKE A WEBINAR
WITH OUR FEDERAL COLLEAGUES TO
SHARE MORE INFORMATION AND
HIGHLIGHTS FROM YOUR REPORT AND
DO ASK FOR THEIR INPUT SINCE
THEY'RE A MAJOR USER OF THE
DIETARY GUIDELINES.
SO OUR TEAM DRAFTS THE CHAPTERS
AND WE DEVELOP THE DIETARY
GUIDELINES.
WE ALSO HAVE A REVIEW PROCESS.
WE HAVE A REVIEW BY FEDERAL
SCIENTISTS INCLUDING STAFF WHO
SUPPORT THE ADVISORY COMMITTEE.
WE DO HAVE A PEER REVIEW PROCESS
SO WE HAVE EXTERNAL FOLKS REVIEW
THE DRAFT, DIETARY GUIDELINES
WHICH INCLUDE MEMBERS OF YOUR
COMMITTEE THAT WILL BE REVIEWING
IT.
AND LASTLY DEPARTMENT CLEARANCE.
SO IT DOES GO THROUGH FULL HHS
AND USDA DEPARTMENT CLEARANCE
AND FINALLY THE APPROVAL BY BOTH
SECRETARIES OF USDA AND HHS.
SO WHAT INFORMS THE DIETARY
GUIDELINES?
YOUR SCIENTIFIC REPORT IS A
MAJOR PIECE OF WHAT INFORMS.
WE HAVE A VARIETY OF INPUTS
INCLUDING THE DRIs WHICH SHE
DESCRIBED AND EXISTING FEDERAL
GUIDANCE.
THERE'S A LOT OF SCIENTIFIC AND
GUIDANCE AND OTHER PROJECTS
GOING ON WITHIN OR FEDERAL
GOVERNMENT WE'VE NOT ASKED YOU
TO REVIEW BECAUSE THAT WOULD BE
DUPLICATION AND THE PREVIOUS
EDITION OF THE DIETARY
GUIDELINES.
WE START WITH THAT AS OUR BASIS
AND SEE WHAT NEEDS TO BE
UPDATED, DO THINGS NEED TO
CHANGE, BE ADDED, REMOVED BASED
ON YOUR ADVICE AND ALL THESE
INPUTS.
NEXT SLIDE.
I JUST MENTIONED STARTING FROM
THE PREVIOUS EDITION THE OVER
ALL GOAL IS TO HELP AMERICANS
MEET NUTRIENT NEEDS, PROMOTE
HEALTH AND REDUCE RISK OF
DISEASE.
AS WE KNOW LIKE AS SCIENCE
EVOLVES RECOMMENDATION ON DIET
AND HEALTH MAY STAY THE SAME AND
MAY BE UPDATED ORDER NO LONGER
CARRIED FORWARD IN THE NEXT
EDITION OF THE DIETARY GUIDE
LIPS.
-- GUIDELINES.
AND EVE TALKED ABOUT THE DRIs
AND YOU KNOW YOU'RE WELL AWARE
OF THE DRIs AND PROVIDE A
REFERENCE VALUE FOR MINERALS AND
NUTRIENTS MEETING THE NEEDS OF
MOST TAKE AND INTAKE LEVELS NOT
TO EXCEED HARM AND AIM TO REDUCE
THE RISK OF CHRONIC DISEASE.
SO THE DIETARY PATTERNS PROVIDE
FOOD BASED RECOMMENDS MEET THE
NUTRIENT NEEDS AND THE DRI
VALUES.
A NOTE ON EXISTING FEDERAL GUIDE
ANTS AND DELAYS ACTIVITIES
HAPPENING NOW AND THESE ARE
OTHER EXAMPLES OF GUIDANCE IN
THE FEDERAL GOVERNMENT THAT WE
CAN PULL IN TO THE DIETARY
GUIDELINES.
FOR EXAMPLE, LIKE FOOD SAFETY
ARE A WEALTH OF INFORMATION AND
OFTEN GET QUESTIONS WHY OUR
COMMITTEES AREN'T LOOKING AT
FOOD SAFETY WELL COVERED BY OUR
PARTNER AGENCIES AND HHS AND
USDA.
ORAL HEALTH.
WE HEAR A LOT ABOUT THAT TOPIC.
IT'S WELL COVERED BY NIH AND
CDC.
HEALTHY FOOD ENVIRONMENT.
C.D.C. HAS A COMMUNITY
PREVENTATIVE TASK FORCE AND
FINDINGS OF IMPLEMENTATION OF
THINGS IN SYSTEMS AND
COMMUNITIES.
WE LOOK TO THAT AND EVE
DESCRIBED THE SEAFOOD ACTIVITY
AND OF COURSE PHYSICAL ACTIVITY.
I KNOW THAT'S BEEN MENTIONED
CRITICALLY IMPORTANT FOR OVER
ALL HEALTH AND THAT HAS LED IN
MY OFFICE AT HHS AND THEY'LL BE
STARTING AN UPDATE PROCESS SOON.
SO YOUR SCIENTIFIC REPORT
PROVIDES CRITICAL UPDATES TO THE
EVIDENCE THAT INFORM OUR
GUIDELINES.
AND I'VE ALREADY TO NOTE OUR
TEAM, OUR FEDERAL WRITING TEAM
IS GOING TO BE CLOSELY EXAMINING
YOUR SECTIONS AND REVIEW OF THE
SCIENCE AND INTEGRATION,
DISCUSSION, YOUR RESEARCH
RECOMMENDATIONS AND YOUR ADVICE
TO THE DEPARTMENT.
ALL THESE SECTIONS ARE
CRITICALLY IMPORTANT AND WE
APPRECIATE YOUR WORK ON YOUR
CHAPTERS.
JUST ADDING THE COMMITTEE'S
ADVICE TO THE DEPARTMENT OVER
THE LAST TWO YEARS YOU'VE
REVIEWED THOUSANDS OF PAPERS OF
DATA ANALYSIS REPORTS, COUNTLESS
FOOD PATTERN MODELLING
SIMULATION THAT HAVE COME TO
THIS POINTS.
SO WE ARE REALLY LOOKING FORWARD
TO RECEIVING YOUR REPORT AND
CHEERING YOU ON OVER THE NEXT
MONTH AS YOU COMPLETE YOUR
REPORT AND JUST APPRECIATE ALL
YOU'VE PUT INTO THIS IN YOUR
DETAILED REVIEW OF THE EVIDENCE.
I'LL PAUSE THERE AND SEE IF
THERE'S ANY QUESTIONS YOU WOULD
LIKE TO ASK ME OR COMMENTS.
JUST WANTED TO OPEN THE FLOOR.
>> THANK YOU, JANET FOR
SUMMARIZING THIS.
I FEEL THAT HAVING THE
PRESENTATION ON ALL THE WORK
THAT FOLLOWS WE HAVE SPENT EIGHT
OF TIME TOGETHER AND WE HAVE
APPRECIATED THE STAFF EFFORTS
BECAUSE OUR TIME IS COMING TO AN
END.
I THINK WE FORGET THE WORK IS
NOW JUST STARTING FOR MANY MORE
PEOPLE AND THE SAME PEOPLE THAT
HAVE BEEN HELPING US HAVE MORE
WRITING THAN WE DO.
THANK YOU SO VERY MUCH FOR THE
PRESENTATION.
>> THERE'S A SUSTAINABILITY
GROUP WORKING.
THAT LISTED PHYSICAL ACTIVITY
AND WASN'T ON YOUR LIST.
IS IT BECAUSE IT HASN'T MOVED
FORWARD ENOUGH TO BE ON THE
LIST?
>> GREAT QUESTION.
THERE'S A FEDERAL WORK GROUP
LOOKING AT THE MERIT OF
SUSTAINABILITY IN FUTURE
EDITIONS OF THE DIETARY
GUIDELINE.
THERE WILL BE A PUBLIC MEETING
AND OPPORTUNITY FOR PUBLIC
COMMENT COMING SOON IS WE DON'T
HAVE A DATE HAPPENING AND
THERE'S A PARALLEL AND
SCIENTIFIC PROCESS CALLED
ADVANTAGE BEING LED AT NIH.
THAT'S HIGHLIGHTED ON THE
RELATED PAGE AS WELL.
THAT'S A SCIENTIFIC ACTIVITY
THEY HAVE LIKE FIVE WORK GROUPS,
EXTERNAL WORK GROUPS AND THEY'LL
BE PUBLISHING THEIR RESULTS AS
WELL ON THIS VERY IMPORTANT
TOPIC.
>> QUICK QUESTION.
YOU ALSO SAID THERE WERE TWO
COMMITTEES LOOKING AT ALCOHOL.
WILL THOSE BE AVAILABLE SOON
ENOUGH TO INCORPORATE IN THE
DIETARY GUIDELINES?
>> ABSOLUTELY.
THOSE TWO PROJECTS, SCIENTIFIC
ACTIVITIES THE RESULTS SHOULD BE
AVAILABLE BY THE END OF THE
YEAR.
WE WILL HAVE THOSE.
GREAT QUESTION.
THANK YOU.
>> OTHER QUESTIONS, COMMENTS?
THANK YOU VERY MUCH.
PASSING IT TO YOU.
>> SO FOR OUR DISCUSSION I'M
GOING TO HAND OVER THE PODIUM TO
MY COLLEAGUE ANGELA.
>> THANK YOU SO MUCH JANET FOR
THE DETAILED EXPLANATION AS WHAT
HAPPENS AS WE MOVE FORWARD.
TO SET THE STAGE FOR OUR
DISCUSSION THIS AFTERNOON WE'LL
BE GOING THROUGH HIGH LEVEL KEY
POINTS AND HIGH LEVEL REVIEW
WITHIN THE SLIDES TO REALLY
ORIENT THE COMMITTEE OF WHAT HAS
BEEN, WHERE WE'RE GOING BUILDING
ON JANET'S POINT AND WHERE WE
NEED TO BE.
WE HAVE THE FINAL MEETING IN
OCTOBER 21 AND 22 AND THEN WE'RE
SUBMITTING THE REPORT TO THE
SECRETARIES OF HHS AND USDA BY
OCTOBER 31.
THAT IS IN 2024 WHICH IS PRETTY
SCARY.
[LAUGHTER]
>> WE CAN DO IT.
>> WE WILL DO IT.
IF YOU RECALL THE CHARGE TO THE
2025 DIETARY GUIDE LIPS ADVISORY
COMMITTEE WAS TO EXAMINE THE
EVIDENCE ON NUTRITION AND HEALTH
ACROSS THE LIFE SPAN, DEVELOP A
REPORT THAT OUTLINE OUR
SCIENTIFIC FINDINGS AND CONTAINS
INDEPENDENT SCIENCE-BASED ADVICE
AND SUBMIT OUR REPORT TO THE
SECRETARIES OF HHS AND USDA FOR
CONSIDERATION AS THE DEPARTMENTS
DEVELOP THE NEXT EDITION OF THE
DIETARY GUIDELINES.
SO IF YOU THINK ABOUT THE TO
DATE, BEFORE I GO FORWARD I WANT
YOU TO GIVE YOURSELVES A HAND
BECAUSE WE'VE GIVEN INDIVIDUAL
KUDOS BUT THIS HAS BEEN
PHENOMENAL WORK WITHIN THE
SUBCOMMITTEES OF STAFF AND
COMMITTEE MEMBERS.
AS FAR AS THE DATA ANALYSIS WE
REVIEWED AND SYNTHESIZED THE
ANALYTIC RESULTS FROM 45
EXISTING DATA PUBLICATIONS.
I MEAN LIKE NUMEROUS PAGES AND
SUPPLEMENTS, EVIDENCE SCAN ON
DIETARY INTAKES DURING COVID,
INCLUDING NOVEL EXAMINATIONS OF
SOCIO ECONOMIC GROUPS AND
LOOKING AT WHAT IS PRACTICAL AND
RELEVANT AND ACHIEVABLE.
REVIEWING THE EVIDENCE FOR MORE
THAN 1,000 ARTICLES TO DEVELOP
DOZENS OF CONCLUSION STATEMENTS
AND 28 SYSTEMATIC REVIEW
QUESTIONS INCLUDING 11 NEW
QUESTIONS.
CONDUCTED A NOVEL EVIDENCE SCAN
ON CULTURALLY TAILORED DIETARY
INTERVENTIONS AND THE FOOD
PATTERN MODELLING IS WILD.
WHEN YOU THINK OF THE ANALYSIS
OF ALL THESE DATA POINTS AND
2700 DIETS -- I MEAN 350,000
DATA POINTS AND TONS OF DIETS.
I DON'T EVEN REMEMBER HOW MANY
DIETS FROM 11 PROTOCOLS TO
ANSWER THE OVERARCHING FOOD
PATTERN MODELLING QUESTION AND
CONDUCTING NOVEL ASSIMILATIONS
TO TEST THE NUTRITIONAL ADEQUACY
OF A BROAD RANGE OF DIETARY
INTAKES AND PILOT SIMULATION OF
FOODS IDENTIFIED AS CONSUMED BY
SELECT NATIVE AMERICAN AND
NATIVE ALASKAN POPULATIONS.
SO WE'RE GOING TO HAVE A
CONVERSATION ABOUT THE KEY
INTEGRATION DELIVERABLES.
AND I FORGOT TO MENTION, WE'VE
DONE ALL THIS AND KUDOS TO
SAMEERA'S COMMITTEE WITH KEEPING
A HEALTH EQUITY LENS IN MIND.
SO WHEN WE THINK ABOUT THOSE KEY
INTEGRATION DELIVERABLES THIS IS
AN ITERATIVE PROCESS.
AN OVER ARCHING DIETARY PATTERN
BASED ON SYSTEMIC REVIEWS
INCLUDING CONSIDERATION FOR
SPECIFIC LIFE STAGES AND
POPULATIONS IN HEALTH EQUITY.
WE REALLY NEED TO CONTINUE TO
REFLECT ON THIS WHEN WE THINK OF
THE INTEGRATION OF ALL THIS
WORK.
I THINK JENNY SAID THE IDEA OF I
THINK YOU SAID IF WE TAKE
EVERYTHING CONSIDERING
EVERYTHING HOW DO WE THINK ABOUT
INTEGRATING THIS WORK WELL
WITHIN THE REPORT?
CONSIDERATIONS FOR DIETARY
ADVISED BASED ON PATTERNS AND
FOOD SOURCES OF SATURATED FAT
AND COMPLIMENTARY FEEDING WITH
ATTENTION TO SPECIFIC LIFE
STAGES AND FOOD PATTERN
MODELLING ANALYSIS AND
ASSIMILATIONS.
BUILD CONSENSUS ON PROPOSED
DIETARY PATTERNS INCLUDING
MODIFICATIONS OR FLEXIBILITIES
BASED ON SYSTEMATIC REVIEWS AND
FOOD PATTERN MODELLING THAT
CONSIDER LIFE STAGES AND
POPULATIONS IN HEALTH EQUITY AND
PREPARE RECOMMENDATIONS TO THE
DEPARTMENT FOR DISCUSSION.
FROM CONCLUSION STATEMENT TO
ADVICE THE COMMITTEE LOOKS
ACROSS THE STATEMENTS AND
TOTALITY TAKEN TOGETHER WHICH IS
SORT OF THIS IDEA THAT IS THE
TOTALITY OF ALL OF THE WORK OF
OUR SCIENTIFIC REVIEW TO DEVELOP
OVERARCHING ADVICE FOR HHS AND
USDA TO CONSIDER AS DEPARTMENT
AS DEVELOP THE DIETARY GUIDE
LIPS.
THE 2025 TO 2030 DIETARY
GUIDELINES.
SO THE 2025 DIETARY GUIDELINES
REPORT WILL INCLUDE AN EXECUTIVE
SUMMARY AND THEMES AND
METHODOLOGY AND ALL THE
EXTENSIVE WORK THAT'S BEEN DONE
THAT WE TALKED ABOUT TODAY AND
IT'S BEEN DONE OVER THESE TWO
YEARS.
EVIDENCE ON DIET AND HEALTH AND
FUTURE DIRECTIONS AND THEN WE'LL
HAVE A LOT IN THE APPENDICES.
INCLUDING A HEALTH EQUITY
CHAPTER AND I KNOW WE'VE BEEN
WORKING ON THESE CHAPTERS TO
INCORPORATE EACH OF THE THREE
SCIENTIFIC APPROACHES THE
COMMITTEE USED.
THE EVIDENCE THE COMMITTEE USED
INCLUDING DATA ANALYSIS AND
SYSTEMATIC REVIEWS AND FOOD
PATTERN MODELLING.
SO PART D THE EVIDENCE ON DIET
AND HEALTH, WHEN WE THINK ABOUT
THIS CURRENT DIETARY INTAKES
THROUGH THE LIFE COURSE.
SO CHAPTER ONE IS PREVALENCE OF
NUTRITION RELATED CHRONIC
CONDITIONS.
DIETARY PATTERNS AND SPECIFIC
COMPONENTS ACROSS LIFE STAGES SO
CHAPTER 2, DIETARY PATTERNS AND
THREE BEVERAGES AND 4 SOURCES OF
SATURATED FAT AND PRACTICES AND
BEHAVIORS THROUGH ADOLESCENCE.
CHAPTER 5, COMPLIMENTARY FEEDING
AND PRACTICES DURING CHILDHOOD,
STRATEGIES FOR INDIVIDUALS AND
FAMILIES RELATED TO DIETARY
QUALITY AND WEIGHT MANAGEMENT
AND FREQUENCY OF MEALS AND
SNACKING AND PORTION SIZE AND
DIETARY INTERVENTIONS AND FOOD
PATTERN MODELLING, 9, 10, 11 AND
12 AND THE NUTRIENT PROFILE
DEVELOPMENT AND ANALYSIS AND
DIET ASSIMILATIONS, PROPOSED
DIETARY PATTERNS.
AND JANET MENTIONED WE'RE KIND
OF PULLING EVERYTHING TOGETHER
TO MAKE RECOMMENDATIONS, ADVISE
TO HHS AND USDA.
I WANT US TO KEEP THAT IN MIND
IN A BROADER SENSE AS WE MAKE
RECOMMENDATIONS.
PEOPLE ALWAYS SAY YOU'RE GOING
TO BE MAKING THE DIETARY
GUIDEL
GUIDELINES.
WE'RE THE DIETARY GUIDELINES
ADVISORY COMMITTEE.
WHEN WE THINK ABOUT OUR ROLE IN
OTHER RECOMMENDATIONS THAT WE
WANT TO MAKE AROUND RESEARCH OR
RECOMMENDATIONS TO THE
DEPARTMENT, NEXT STEPS, ALL
THOSE THINGS ARE INCLUDED IN OUR
RESEARCH REPORT.
SO FUTURE DIRECTION, SUPPORT FOR
FEDERAL DATA AND DIETARY INTAKES
RELATED TO DIETARY GUIDELINES.
FUTURE DIRECTION FOR THE DIETARY
GUIDELINE PROCESS, RESEARCH
RECOMMENDATIONS AND
CONSIDERATIONS FOR FUTURE
COMMITTEES RELATED TO SCIENTIFIC
QUESTIONS OVERARCHING METHOD OWE
LOGICAL CONSIDERATIONS AND THE
SYSTEMIC REVIEWS AND QUESTIONS
THAT WERE EXAMINED AND THE FOOD
PATTERN MODELLING QUESTION THAT
WAS EXAMINED.
SO WE HAVE A COUPLE OF PROMPTS
FOR DISCUSSION AS WE THINK MORE
ABOUT THIS INTEGRATION AND ALSO
RECOMMENDATIONS TO THE
COMMITTEE'S RECOMMENDATIONS TO
THE AGENCIES.
THE FIRST QUESTION IS REFLECTED
ON THE WORK SHARED BETWEEN
YESTERDAY AND THIS MORNING GOING
INTO THE AFTERNOON.
WHAT ARE THE IMPORTANT
CONSIDERATIONS AND THEMES WHEN
WE THINK ABOUT THOSE KEY
INTEGRATION DELIVERABLES AND
WE'RE GOING TO START THERE BUT I
DON'T KNOW IF THE SECOND
QUESTION IS ON THE SLIDE TOO.
ANY OTHER THOUGHTS YOU HAVE
BECAUSE WE ALSO SHOULD CHAT AS
WE GO INTO THE LAST MEETING
ABOUT THOSE RECOMMENDATIONS THAT
MAYBE AS IT RELATES TO THOSE
AREAS.
WHEN WE THINK OF PART E, SO
FUTURE DIRECTIONS, ETCETERA AS
WE MAKE
>> ONE THING THAT CAME UP IN THE
SYSTEMATIC REVIEWS WAS A LACK OF
DIVERSITY.
MORE DIVERSE SAMPLES THAN THE
RESEARCH WE DO.
>> THAT WOULD BE FUNDING.
>> CAN I ASK FOR POINT OF
CLARIFICATION, MY APOLOGIES FOR
JUMPING IN.
I THINK IT'S AN IMPORTANT ISSUE
AND WE DISCUSSED IT BUT I
WONDERED PARTICULARLY FOR FUTURE
DIRECTION, I THINK WE NEED MORE
GRANULARITY.
TALK ME THROUGH IT.
>> I THINK INCLUSION OF MORE
RACIAL ETHNIC GROUPS BECAUSE WE
DIDN'T SEE THAT AND HAVING MORE
U.S. COHORTS BECAUSE THE COHORTS
WE WERE LOOKING AT WE TEND TO
RELY ON THOSE FROM OTHER
COUNTRIES AND I THINK MORE CHILD
AND ADOLESCENT DATA AND AGAIN
WITH THE DIVERSITY IN TERMS OF
RACIAL ETHNIC MAYBE EVEN
REGIONAL SEEMS LIKE WE KNOW
CHRONIC DISEASE IS WORSE IN THE
SOUTH PART OF THE U.S. AND SEEMS
LIKE YOU DON'T HAVE AS MUCH AS
GOING ON THERE AS YOU HAVE OTHER
PLACES.
SO I THINK THERE'S A OF VARIETY
OF PARAMETERS IN TERMS OF
DIVERSITY.
>> THANK YOU, CAN I ADD
PREGNANCY?
WE ARE MISSING POSTPARTUM
PERIOD.
>> FATIMA.
>> WREN WE ALL APPLY FOR OUR
FEDERALLY FUNDED GRANT IN
TALKING ABOUT CULTURALLY
TAILORED FOODS A LOT OF THOSE
STUDIES WERE FEDERALLY FUNDED WE
HAVE TO INCLUDE FOR WOMEN IN THE
STUDIES.
WE DON'T TYPICALLY HAVE TO
OUTLINE A PLAN FOR OUR INCLUSION
OF ETHNIC AND DIVERSE
POPULATIONS.
THAT SHOULD BE INCLUDED TO HAVE
A REPRESENTATIVE SAMPLE THAT
REFLECTS THE HETEROGENEITY OF
THE POPULATION IN THE UNITED
STATES TO HAVE A SAMPLE THAT
REFLECTS WHAT WE SEE AMONGST THE
POPULATION SO WE CAN HAVE A
DISCUSSION.
ONE OF THE KEY THEMES WE SAW
ACROSS THE POPULATION AND ACROSS
THE WORK WE'VE DONE HERE WITH
OUR SPECIFIC ADVISORY COMMITTEE
IS THIS THEME OF EQUITY.
THE REASONABLE WE COULDN'T GET
TO THE EQUITY PIECE WE WANTED TO
IS WE KEPT RUNNING INTO THE
ISSUE OF NOT HAVING STUDIES THAT
REFLECTED WHAT WE WANTED TO GET
TO IN OUR QUESTIONS.
SO WE KEPT RUNNING INTO A BRICK
WALL BECAUSE WE KEPT FINDING
THAT THE DATA WAS NOT THERE TO
REFLECT WHAT WE NEEDED BECAUSE
THE DATA DIDN'T REFLECT WHAT WAS
BEING ASKED OF.
PEOPLE WEREN'T REQUIRED AND THE
INDIVIDUALS BEING FUNDED WEREN'T
SEEKING TO REALLY STUDY THESE
POPULATIONS WITH ANY VIGOR.
I THINK THIS NEEDS TO BE
OUTLINED SPECIFICALLY WITHIN OUR
FUTURE RECOMMENDATIONS THAT THIS
SHOULD BE JUST LIKE WE DO FOR
WOMEN.
WHAT IS YOUR PLAN FOR STUDYING
WOMEN AND INCLUDING THEM JUST
LIKE MENTIONED WHAT IS YOUR
INCLUSION FOR STUDIES THE
POSTPARTUM PERIOD THAT ARE
PREGNANT, ETCETERA, CAN WE
OUTLINE THOSE SO WE MAKE SURE
THESE POPULATION INCLUDED TO
ACTUALLY HAVE RECOMMENDATIONS
THAT REFLECT THE POPULATIONS.
>> POINT OF CLARIFICATION.
WOULD YOU LIKE US TO GIVE YOU
ALL THE THINGS WE'RE THINKING
ABOUT OR BECAUSE I HAVE NINE.
>> I WAS THINKING THAT MAYBE I
KNOW WE JUMPED TO RESEARCH
RECOMMENDATIONS BUT THERE ARE
RECOMMENDATIONS WHEN WE THINK OF
KEY CONSIDERATIONS ACROSS THE
WORK.
I'M THINKING WE SHOULD START
THERE.
SO WHEN WE THINK ABOUT THE KEY
CONSIDERATIONS FOR INTEGRATION
AND I'D SAY GO BACK AND THINK
MUCH KEY CONSIDERATIONS I THINK
THAT'S ALSO GOING TO HAVE AN
IMPACT ON WHEN WE THINK ABOUT
THE RECOMMENDATIONS RELATED TO
THE PROCESS, THE COMMITTEE,
METHODOLOGY, ETCETERA.
YOU CAN GIVE ALL NINE BUT WE'LL
START WITH THINKING ABOUT SOME
OF THOSE THINGS LIKE WHAT MIGHT
BE THE KEY CONSIDERATIONS ACROSS
ALL THE WORK THAT'S HAPPENED.
>> START WITH WHAT YOU HAVE AND
THIS IS A COMMITTEE-WIDE
DISCUS
DISCUSSION.
WE HAVE THIS UNIQUE OPPORTUNITY.
SHERYL, I WOULD SAY START AND
PEOPLE FEEL FREE TO JUMP IN IS
HOW I WOULD DO IT.
>> HERE'S THE TOP LINE.
IF YOU GO FOR 20 MINUTES WE'LL
CUT YOU.
>> I CAN'T STAND TO HEAR MYSELF
TALK FOR TWO MINUTES.
ONE IS ACROSS ALL THE WORK THAT
WE'RE DOING I THINK WE SHOULD
KEEP TOP OF MIND THAT THE
MAJORITY OF THE U.S. POPULATION
IS ACTUALLY NOT MEETING THE
RECOMMENDATIONS FOR DIETARY
PATTERNS AND THAT SEEMS TO BE A
THEME THROUGH EVERYTHING.
NE
THE OTHER THING IS WHEN WE TRY
TO MAKE ADJUSTMENTS AROUND THE
PATTERN WE USUALLY FIND
OURSELVES WITH LESS THAN IDEAL
OUTCOMES FOR THE POPULATION AND
THAT AGAIN GOES ACROSS THE
VARIOUS WORK.
I ALSO THINK THAT IN THINKING
ABOUT ADHERENCE TO THE HEALTHY
PATTERNS, A GREAT DEAL OF MEAL
PLANNING IS REQUIRED AND WHETHER
WE'RE LOOKING AT IT FROM THE
STATE IT IDEOLOGICAL COMPONENTS
OR MODELS OR PRACTICES AND
WHETHER IT'S FEEDING OR
CAREGIVER.
TOOLS AND HUMAN RESOURCES LIKE
DIETATIONS ARE IMPORTANT PARTS
OF THOSE CONVERSATIONS.
ALSO THE VARIOUS COMPONENTS
WHETHER NUTRIENT OUTCOMES OR
BEHAVIORAL OUTCOMES, MORE
MODELLING THAT WE'VE GOT TO
THINK ABOUT THE INDIVIDUAL IN A
GREATER CONTEXT WHETHER FEDERAL
AGENCIES ARE PLAYING A ROLE WITH
THE OTHER STRATIFICATION
VARIABLES THAT WE'RE USING AND
THE ROLE OF AGENCY BEHAVIOR IS
SOMETHING WE SHOULD BE THINKING
THROUGH.
>> CAN I JUMP IN THERE, SHERYL
FOR A SECOND.
I LOVE THIS CONCEPT OF ASKING WE
TALK ABOUT WHAT PEOPLE SHOULD
EAT BUT WE DON'T ASK THE
QUESTIONS AROUND WHY DO PEOPLE
EAT WHAT THEY DO.
I'M GOING TO GIVE YOU A BREAK.
I'M EXCITED TO HEAR OTHER'S
SUGGESTIONS BUT I WOULD LOVE TO
THROW THE CONVERSATION TO JENNY
TO START TALKING ABOUT BEHAVIOR
BECAUSE I THINK YOU RAISED A
REALLY IMPORTANT CONSIDERATION.
JENNY, WOULD YOU LIKE TO
COMMENT?
>> I THINK YOU HAVE AN IDEA.
>> I JUST WANT TO HEAR YOU TALK
MORE ABOUT BEHAVIOR.
>> THE WHYs I FEEL IN OUR
DISCUSSION ABOUT HEALTH EQUITY
THAT'S ONE PIECE IN THE FUTURE
THAT IS IMPORTANT TO CONSIDER.
WE TALKED ABOUT SOCIAL
DETERMINATES BUT WHAT DO WE KNOW
HOW HAS OUR SCIENTIFIC WORK
HELPED US UNDERSTAND THE FACTORS
SHAPE THE ABILITY TO ENGAGE
INDICT WE THINK ARE HEALTHY
WHATEVER THAT LOOKS LIKE.
I SEE THAT AS A BIG OPPORTUNITY
FOR THE FUTURE TO REALLY BRING
THAT SCIENCE TOGETHER AS PART OF
THE PROCESS TO INFORM THE WAY WE
THINK ABOUT WHAT HAPPENS NEXT.
THAT'S WHAT I WOULD SAY.
>> THAT'S GREAT.
DOES ANYBODY ELSE WANT TO
COMMENT ON BEHAVIOR?
I DON'T WANT TO LOSE BEHAVIOR?
>> IN THINKING OF WHAT WE
DISCUSSED EARLIER ABOUT WE'RE
DEPENDENT TO MEET NUTRIENT NEEDS
AND THINKING ABOUT FLEXIBILITY
AND OTHER THINGS FOR GRAINS AND
WONDERING IF AS THE EARLY
CHILDHOOD BEHAVIOR IF YOU CAN
GET LITTLE KIDS TO ACCEPT EATING
TONS OF FRUITS AND VEGETABLES
AND WHOLE GRAINS THEN WE CAN GET
TO A WORLD IN WHICH WE'RE LESS
DEPENDENT ON FORTIFICATION AND
THE DATA ANALYSIS NUMBERS WOULD
LOOK BETTER.
AND WHAT WE'LL SEE IN OUR
ANALYSIS OF CHRONIC DISEASES AND
SO ON AND SO FORM.
>> I THINK CAROL WANTED TO SAY.
>> ONE THING WE NEED TO KNOW
MORE ABOUT IS THE ENVIRONMENT.
WE LIVE UP A LOT OF
ENVIRONMENTS.
OUR HOME, OUR COMMUNITY AND THEN
THE POLICY ENVIRONMENT OF THE
FEDERAL LEVEL FOR EXAMPLE AND I
THINK OUR UNDERSTANDING -- I
THINK WE ALL AGREED THE
ENVIRONMENTS DO HAVE AFFECTS ON
OUR BEHAVIOR AND THE CHOICES
THAT WE MAKE BUT WE DON'T
UNDERSTAND HOW THOSE
ENVIRONMENTS ARE REALLY
AFFECTING US.
THINKING OF A SOCIAL, ECOLOGICAL
MODEL, ORGANIZATION, HOW DOES
THAT COMMUNITY, THE UNITED
STATES HOW DO WE FUNCTION IN
THOSE ENVIRONMENTS AND THE
CHOICES THAT WE MAKE?
>> DIANA, I THINK HEALTH
COMMUNICATIONS WOULD BE A GOOD
PLACE TO GO BECAUSE I KNOW WHEN
YOU LOOK AT DIFFERENT
POPULATIONS THE MESSAGING IS
VERY DIFFERENT.
SO WE'VE DONE SOME MORE ON THAT
IN TEXAS AND IT'S REALLY
INTERESTING TO SEE WHAT MIGHT
SET PEOPLE OFF AND WHAT DOESN'T
AND HOW WE LOOK THAT IN IN TERMS
OF DIET WOULD BE INTERESTING.
>> VALERIE.
>> I DO A LOT OF WORK IN POLICY
SYSTEMS AND ENVIRONMENTS THAT'S
REALLY BEEN A FOCUS OF MY
CAREER.
I EMPHASIZE THAT BECAUSE I THINK
WE TO THE SO MUCH MORE THAN WE
GIVE OURSELVES CREDIT FOR.
WE HAVE A LOT OF KNOWLEDGE AND
LACK THE POLITICAL WILL TO PUT
IN PLACE THE SCIENCE WE SPENT
THE LAST SEVERAL DECADES
COLLECTING.
THERE'S LARGE POPULATION GROUPS
NOT INCLUDED IN THE SCIENCE,
AMERICAN INDIAN AND ALASKAN
NATIVES AND TESTING THE DIETARY
GUIDELINES WITHIN THE
POPULATIONS BUT I THINK THE DATA
POINT US OVER AND OVER TO THE
FACT THAT NOBODY CAN MEET THESE
GUIDELINES.
AND I THINK 3% OR WHATEVER THE
VERY LOW PERCENTAGE IS THAT
MEETING THE GUIDELINE MAY BE A
WORTHWHILE ENDEAVOR TO STUDY HOW
THEY ARE PLAY BE DIFFERENT.
I THINK IT WOULD BE -- IT POINTS
TO LARGE STRUCTURAL AND SYSTEMS
CHANGES THAT NEED TO BE MADE.
SO IF WE'RE INVESTING IN FUTURE
RESEARCH AND REALLY ADVOCATE
THAT WE LOOK AT THESE DIETARY
GOOD LINES IN REAL WORLD
SETTINGS -- GUIDELINES IN REAL
WORLD SETTINGS AND INCLUDE
PEOPLE FROM THESE COMMUNITIES ON
THE COMMITTEE.
WE REALLY NEED MORE DIVERSITY ON
THIS COMMITTEE.
WE NEED TO MAKE SPACE FOR
DIVERSE VOICES SO WE CAN REALLY
HEAR WHAT THE PROBLEMS ON THE
GROUND ARE AND WE NEED TO BE
PRETTY CANDID IN OUR PUSH FOR
STRUCTURAL AND SYSTEMS CHANGES.
>> THANK YOU, VALERIE.
ANYBODY ELSE OR WE CAN GO BACK
TO SHERYL.
CHRIST
CHRISTINE.
>> MY COMMENT IS MORE PRACTICAL
COMMENT.
SO I THINK MANY OF OUR
CONCLUSION STATEMENTS WE HAVE TO
STOP BECAUSE WE DIDN'T HAVE THE
DATA AVAILABLE IN THE PUBLISHED
WORK.
THERE'S SO MUCH MORE THAT GETS
DONE IN THE BACK END.
I THINK THERE'S A CALL FOR
RESEARCHERS TO AND WE DIDN'T
MENTION THIS YESTERDAY OR THIS
MORNING TO WRITE MORE ABOUT THE
THINGS THAT GO IN THE BACK END.
WE PROBABLY HAVE ALL THESE
BEHAVIOR INTERVENTIONS WE BASE
OUR INTERVENTIONS ON BUT DON'T
ASK THE INDIVIDUALS OR MAYBE WE
DO BUT DON'T PUBLISH THEM ON
FROM ALL THOSE THINGS WHAT
REALLY WORKED FOR THEM.
WHAT HELPED THEM MAKE THE
CHANGES.
AND SO I THINK MORE GRANULARITY
OF HOW PEOPLE ARE MAKING THOSE
CHANGES AND MAYBE WE ARE
GATHERING SOME INFORMATION FROM
QUALITATIVE WORK PICKED UP IN
OUR SYSTEMATIC REVIEWS.
I THINK THERE IS QUALITATIVE
WORK SHOWING HOW PEOPLE ARE
MAKING THOSE CHANGES.
MAYBE WE HAVE TO INCORPORATE
SOME OF THOSE SYSTEMATIC REVIEWS
AND QUALITATIVE WORK HOW PEOPLE
ARE MAKING THOSE CHANGES.
THERE'S MANY INTERVENTIONS OUT
THERE SHOWING EFFECTIVE CHANGES
TO IMPROVING SOME COMPONENTS AND
MAYBE NOT EVERYTHING BUT AT
LEAST SOME COMPONENTS OF FRUITS
AND VEGETABLES AND MAYBE HAVING
THAT MORE GRANULARITY, HAVE THEY
DONE THAT WORK AND HOW THEY MAKE
THE CHANGE WILL INFORM FUTURE
GUIDELINES.
>> I DON'T KNOW HOW MUCH HAS
BEEN LOOKED AT IN THE PAST BUT
THINKING ABOUT THE PEOPLE AND
HOW THEY GET WORK AND YOU SEE
RELIANCE ON OTHER INDIVIDUALS,
CAREGIVERS, OTHER SUPPORT
SYSTEMS IN THINKING HOW THOSE
PEOPLE ALSO SHAPE THE FOOD
ENVIRONMENT AND ACCESSIBILITY.
>> I THINK THAT'S IMPORTANT
BECAUSE WE HAVE A LOT OF THE
DATA.
WHAT WOULD BE THE PROCESS FOR
INCLUDING A LOT OF THESE
QUESTIONS IN THE QUESTION WITHIN
THE DIETARY GUIDELINE?
>> IN PRESENTING THE CULTURAL
BELIEFS AND WHEN YOU MOVE TO THE
UNITED STATES ARE THEY
ASSIMILATING OR STAYING TOGETHER
TO THEIR BELIEFS AND EATING A
CERTAIN WAY AND HOW DOES THAT
INFLUENCE OVER ALL HEALTH.
MAYBE THAT WAS TRYING TO GET AT
THE EVERYDAY BUT NOT QUITE
THERE.
>> CAN YOU CLARIFY, ARE WE ON
THE QUESTION THAT'S ON THE
SCREEN PROMPT FOR DISCUSSION OR
FUTURE DIRECTION SECTION E?
WHICH CONVERSATION ARE WE
ALLOWED TO BE IN?
>> I THINK WE'RE STARTING WITH
THE KEY INTEGRATION BUT IF YOU
HAVE COMMENT ABOUT EITHER I
THINK IT'S PERMISSIBLE.
>> MINE IS NOT FOR FUTURE
DIRECTIONS BUT THINKING NOW
RELATING TO THE DISCUSSION OF
ENVIRONMENT I AGREE WITH VALERIE
THERE'S MASSIVE DATA AND
BEHAVIORAL INTEGRATIONS ARE
FIGHTING THE ENVIRONMENT.
YOU'RE TRYING TO PREPARE PEOPLE
TO STEP OUT INTO A REALLY
UNHEALTHY FOOD CONTEXT AND IT'S
NOT SO MUCH ABOUT CHOOSING
FRUITS AND VEGETABLES AS IT'S
COMBATTING THE NOISE AROUND IT.
BRINGING IN THE FOOD PATTERN
MODELLING THIS MORNING THE
HEALTHY FOOD PATTERN WHEN WE
MODEL OUR NUTRIENT DENSE IDEAL
FOODS WITHIN EACH OF OUR FOOD
GROUPS AND NON IDEAL FOODS WERE
INTRODUCED FROM LESS NUTRIENT
DENSE VERSIONS EVERYTHING GOT
WORSE BUT THAT'S STILL WITHIN
THE CONTEXT OF THE HUSS JUST
USING THE ACTUAL FOODS CONSUMED.
AND TO ME THIS IS NOT A BEHAVIOR
BECAUSE EVEN IF YOU FOLLOWED
HUSS TO THE T IN TERMS OF
QUANTITY, WHAT'S AVAILABLE ARE
VERSIONS THAT DOESN'T FEEL
RIGHT.
IF YOU'RE PULLING THE GUIDELINES
YOU SHOULDN'T HAVE SATURATED
FAT, ADDED SUGAR AND CALORIES
ABOVE LIMITS AND MICRO
NUTRIENTS GOT WORSE AND WHY IS
THERE A GAP BETWEEN AVAILABILITY
AND THE DENSE VERSION.
THIS IS QUALITY.
THIS IS DIETARY QUALITY.
I DON'T KNOW HOW TO CAPTURE THAT
BUT IT HAS TO BE PART OF THE
DISCUSSION.
EVEN FOODS AND NUTRIENTS HAVE A
VERY WIDE RANGE OF QUALITY.
INTEGRATING FINDINGS WITH WHAT
WE ALSO KNOW AND MASSIVE
EVIDENCE OF QUALITY IN THAT
PATTERN IS IMPORTANT TO KEEP IN
MIND AND BEYOND MICRO NUTRIENTS
AND VITAMINS AND MINERALS AND
FATS AND SUGARS THERE'S A
MASSIVE GAP IN THE AVAILABILITY
OF WHAT WE HAVE AROUND AND
SELECT FROM EVEN FROM WHAT WE'RE
HEARING AND THAT'S CONCERNING
AND THAT'S ENVIRONMENTAL.
THAT'S CHOOSING TO FOLLOW THE
GUIDELINES WOULD BE BAD.
>> THANKS, DIDI.
CHRIS OR HEATHER DO YOU WANT TO
MAKE A COMMENT IN RELATION TO
THAT?
>> OUR WORK IS DIRECTLY RELEVANT
BUT WE DON'T ADDRESS THAT.
I FEEL LIKE WE HAVE TO -- WHEN
WE'RE THINKING ABOUT INTEGRATION
OF THE IDEAS WE CAME UP WITH WE
DO HAVE TO INCORPORATE THAT
BACKGROUND OR MAKE SURE WE DON'T
DISREGARD IT AND ADDING TO WHAT
DIDI SAID I WORK WITH BEHAVIOR
AND PSYCHOLOGISTS BEFORE AND I
REMEMBER HEARING THEM SAY LOW
POWER IS A LIMITED RESOURCE WE
HAVE AND THE MORE THAT GETS
TESTED THE MORE IT GETS USED UP
AND IN THE CONTEXT OF ALL THE
ENVIRONMENTS YOU'RE IN WHERE
THERE'S DISCRETIONARY CALORIES I
THINK IT DOES BECOME UNREALISTIC
FOR ALL OF US PRETTY MUCH TO NOT
HAVE THOSE UNNUTRIENT DENSE
FOODS.
I DON'T KNOW BUT ARE SO
RECOGNIZE THAT.
>> THERE ARE CERTAIN SECTIONS IN
THE REPORT WE CAN TALK ABOUT
CONTEXT.
IF YOU LOOK AT THE PREVIOUS
REPORT THERE'S AN ENTIRE
DISCUSSION OF CONTEXT AS IT
RELATES.
I THINK THOSE IMPORTANT POINTS
IF YOU LOOK RAT THE CHARGE AND
WHAT WE'RE PROVIDING IT DOESN'T
LIMIT US IN THE FUTURE
DIRECTIONS SECTION TO TALK ABOUT
INFORMATION THAT COULD BE
INCORPORATED THAT MIGHT PUT A
BROADER OR DIFFERENT LIGHT ON
SOME OF THESE ANALYSES OR EVEN
METHODO
METHODOLOGY.
AS WE GO THROUGH I THINK WE CAN
THINK ABOUT CONCRETE THOUGHTS OF
WHAT COULD BE INCLUDED TO BRING
THE BROADER PERSPECTIVE.
CHRIS AND THEN STEVE.
>> I THINK WHAT THIS BRINGS
FORWARD ESPECIALLY WITH THIS
CONVERSATION IS I THINK THERE'S
AN ASSUMPTION NUTRITION RESEARCH
AND SCIENCE IS EASY BECAUSE IT'S
BEHAVIOR CHANGE AND MAKING
RECOMMENDATIONS AND PEOPLE WILL
EAT BETTER.
WE ALREADY KNOW EATING WELL
LEADS TO BETTER CHRONIC DISEASE
OUTCOMES SO WHY DO WE INVEST IN
IT?
WE ALREADY KNOW THAT BUT WE'RE
ALREADY SEEING A HUGE CHASM.
FOOD IS SOCIAL.
FOOD IS CULTURAL.
FOOD IS NOURISHMENT IT'S DRIVEN
BY ACCESSIBILITY IN THE MIDST OF
OTHER DEMANDS.
THE COMPLEX NATURE TO GETTING TO
THE HEALTHY U.S. STYLE PATTERN
LEAD TO A LOT OF CHALLENGES THAT
HAVE TO BE OVERCOME.
I THINK THE EVIDENCE WE'RE
SEEING IS THERE ARE A LOT OF
FACTORS AND I THINK SODIUM
COMING OUT IN THE SIMULATIONS IS
ONE PRIME EXAMPLE.
WE CAN CONTINUE TO PUSH FOR
COMBATTING HYPERTENSION IN THE
HEALTH CARE SYSTEM BUT WITHOUT
THE EVIDENCE WE'RE GETTING THAT
SAYING IF WE TRY TO LIMIT FOODS
WITH SODIUM IT'S GOING TO BE
HIGH BECAUSE IT'S UBIQUITOUS IN
OUR FOOD SUPPLY BUT WITHOUT THE
EVIDENCE IT WILL CONTINUE TO BE
MAYBE KICK THE CAN DOWN THE ROAD
AND NOW WE HAVE KEY ASPECTS FROM
THE EVIDENCE TO MAKE THE
ARGUMENT.
>> STEVE AND THEN I THINK TERESA
HAD HER HAND UP.
>> IT'S BASED ON LIFE CYCLE.
LIFE CYCLE IS WHERE PEOPLE BUY
FOOD FOR FAMILY AND WE HAVE TO
CONSIDER -- AN EXAMPLE IS LOW
FAT VERSUS HIGH FAT MILK.
1 YEAR OLDS GET FULL FAT AND
ADULTS MAY GO SKIM MILK.
PEOPLE DON'T WANT TO WASTE FOOD.
THEY PURCHASE FOOD AS A FAMILY
AND WE HAVE TO LOOK AT THE
FLEXIBILITY AND THE PATTERNS
THAT ALLOW US TO OPERATE FOOD
PURCHASING AS A FAMILY
FINANCIALLY EFFICIENT AND MEETS
THE NEEDS OF THE FAMILY AS WELL
AS TRYING TO MEET THE CHILDREN'S
REQUIREMENT.
AS LONG AS WE CONTINUE TO LOOK
AT EVERYTHING BY AN AGE CYCLE WE
MAY LOSE PEOPLE EATING TOGETHER
AS THE A FAMILY AND MAKE FOOD
CHOICES AS A FAMILY.
>> IN RESPONSE TO SAMEERA'S FOOD
EQUITY POINT HOW THEY ASSIMILATE
TO THE U.S. DATA THAT MAY NOT
COME FROM QUANTITATIVE DATA IT
MAY COME FROM QUALITATIVE DATA
TO UNDERSTAND WHAT PEOPLE ARE
DOING IN BEHAVIOR AND SOME WAY
TO HARNESS THE DATA AND USED
QUALITATIVE DATA WOULD BE GREAT.
>> FATIMA.
>> AND AS SOMEONE WHO TREATS
PEOPLE FROM TWINKLE TO WRINKLE
IT'S IMPORTANT TO THINK ABOUT
THE DIETARY PATTERN ACROSS THE
LIFE SPAN.
AS HUMANS WE DON'T REALLY THINK
IN CONCRETE AND SOMEONE WHO
TREATS PATIENTS I DON'T THINK
ABOUT MY 2-YEAR-OLD WHERE THIS
IS JUST THE 2-YEAR-OLD AND
10-YEAR-OLD OR 20 OR 50 OR
90-YEAR-OLD.
THESE PATIENTS ARE COMING TO ME
ACROSS THE LIFE SPAN AND I HAVE
TO THINK ABOUT THE HUMAN IN
FRONT OF ME AND THE CONTEXT OF
THEM IN THAT FAMILY.
YOU'RE RIGHT THEY'RE FROT JUST
BUYING ONE THING FOR ONE PERSON
IN THE HOUSEHOLD BUT FOR THE
FAMILY.
AS WE THINK ABOUT THIS FROM AN
INTEGRATION MODEL WE DO HAVE TO
THINK ABOUT THIS ACROSS THE
SPECTRUM, ACROSS THE LIFE COURSE
AND I LOVE THE TWINKLE TO
WRINKLE CONCEPT OF THINKING HOW
ARE WE GOING TO INTEGRATE THIS
FROM A HEALTH EQUITY PERSPECTIVE
ACROSS THE LIFE SPAN AND MEET
THE NEEDS OF THE AMERICAN PUBLIC
FROM ALL OF OUR DIVERSE LENSES
ACROSS THAT LIFE SPAN.
THANKS SO MUCH FOR BRINGING THAT
UP AND ALLOWING MY COMMUNITY
MEMBERS TO ALLOW ME TO INTEGRATE
THAT TOGETHER.
>> WE MENTIONED THE LIFE SPAN.
I WANT TO BRING FORWARD TO THE
COMMITTEE WE HAD ONLY ONE
SPECIFIC QUESTION RELATED TO
OLDER ADULT -- WE HAD ONE
SPECIFIC AND I THINK THAT'S KIND
OF PROBLEMATIC BECAUSE WE DID
LOOK AT SARCOPENIA, FRAILTY AND
REALIZE WE DIDN'T HAVE DATA OR
WHICH WEREN'T ENOUGH STUDIES AND
DIDN'T DO SYSTEMATIC REVIEW ON
IT.
THAT'S THE POPULATION FAST
GROWING AND WE'RE NOT LOOKING AT
THAT AT ALL.
I THINK THAT'S A HUGE --
>> THANK YOU FOR RAISING THAT.
THE DATA SUGGESTS IN 20 YEARS
FROM NOW THERE'LL BE MORE PEOPLE
65 AND OLDER THAN 18 AND YOUNGER
AND THE FASTEST DEMOGRAPHIC
GROUP IS 85 YEARS AND OLDER.
SO I HAVE STRUGGLED A BIT WITH
UNDERSTANDING HOW WE DEFINE
HEALTH IN OUR QUESTIONS WHEN
LOOKING THROUGH THE LENS OF THE
EVIDENCE FOR OLDER ADULTS
BECAUSE THERE'S CHRONIC DISEASE
PREVENTION AND THAT'S CRITICAL.
THE REALITY IS PEOPLE ARE LIVING
LONGER RAND THEY'RE INDEPENDENT
AND ARE LIVING WITH CHRONIC
DISEASES AND WE SHOULD BE
THINKING ABOUT THE EVIDENCE OF
WHAT PEOPLE SHOULD BE EATING IN
THEIR 70s AND 80s TO EXTEND THE
HEALTH STAN.
WE LOOK AT LONGEVITY CONSIDERED
LIFE SPAN BUT IT'S HEALTH SPAN
AND I THINK IT'S REALLY
IMPORTANT THAT YOU CAN'T TELL A
7-YEAR-OLD WELL YOU SHOULD HAVE
BEEN EATING FRUITS AND
VEGETABLES AT THE TIME YOU WERE
2.
SHERYL YOU ARTICULATED IT SO
WELL, THIS IS FOR ALL THE PEOPLE
IN THE U.S.
SO I THINK THESE ARE REALLY
IMPORTANT CONSIDERATIONS AND I
THINK THE DEFINITION OF HEALTH I
WOULD RECOMMEND FOR THE NEXT
SETS OF QUESTIONS GENERATED FOR
FUTURE COMMITTEES LIKE REALLY
THINK ABOUT WHAT IS THE ACTUAL
HOW YOU'RE DEFINING HEALTH.
THANK YOU.
>> THIS ECHOS THE SAME THOUGHTS
AND THIS IS JUST THINKING OUT
LOUD AND THERE'S MANY ISSUES OF
HEALTH ARE FUNDAMENTALLY TIED TO
DEVELOPMENT AND THE COGNITIVE
AND SOCIAL DEVELOPMENT AND I
COULDN'T HELP BUT THINK IN
DIETARY PATTERN CONVERSATIONS
CHRONIC DISEASE AND IT'S
CHILDREN AND THINK ONE OF THE
OPPORTUNITIES HERE FOR FUTURE
COMMITTEES IS TO BUILD ON THE
MOMENTUM OF THINKING OF LIFE
STAGE AND LOOK AT GOALS TO ALLOW
TO YOU ASK QUESTIONS AND FRAME
HEALTH MAYBE IN WAYS THAT WERE
UNIQUE TO LIFE STAGE.
SO IT'S MORE OF A CONCEPTUAL
IDEA BUT IT COULD DRIVE THE
QUESTIONS AND WE ONLY GET THE
ANSWERS FROM THE QUESTIONS WE
ASK.
I'M WITH YOU IT WOULD BE A GREAT
DIRECTION TO TRY TO ARTICULATE
WHAT THAT WOULD LOOK LIKE.
>> IN TERMS OF ENVIRONMENT, SOME
THINGS WE SHOULD DO IS BUILD ON
WHAT'S ALREADY HAPPENING.
SO IN TERMS OF THE ENVIRONMENT
AND POLICY CHILD NUTRITION
RE-AUTHORIZATION HASN'T HAPPENED
FOR YEARS.
CAN WE MAKE RECOMMENDATIONS FOR
THAT BASED ON WHAT WE FOUND.
CACFP PART OF THAT ARE PLACES
WHERE WE CAN CONTROL FOR
ENVIRONMENT.
ANOTHER THING IS WE REALLY NEED
TO LOOK AT THE FOOD AS MEDICINE
WHAT'S GOING ON THERE AND HOW
CAN OUR RECOMMENDATIONS FIT INTO
THERE AND HOW DO YOU FEED AN
OLDER PERSON YOU'RE BRINGING
FOOD TO.
THOSE ARE ALL THINGS AND
REQUIREMENT -- THERE'S
RECOMMENDATIONS FOR CHARITABLE
FOOD SYSTEMS, WHAT CAN WE TWO
THERE.
HOW CAN WE BUILD ON WHAT'S
ALREADY OUT THERE AND INSERT THE
DIETARY GUIDELINES.
>> SO GOING BACK TO THE QUESTION
AND WHAT PEOPLE ARE PURCHASING
AS A FAMILY WOULD WE HAVE THE
HUSS THE MODIFICATIONS OF
PORTION SIZE AND HAVE THE
PORTION COMPONENT SOLVED OF
CERTAIN FOODS.
I THINK WE SAW IT AS A LIFE
STAGE BUT NOW WE HAVE THE
OPPORTUNITY OF THE HUSS ACROSS
THE LIFE STAGES AND PORTION SIZE
AND CULTURALLY TAILORED FOODS.
I THINK THERE'S INTEGRATION
DELIVERABLES WE CAN TAKE FROM
HERE THOUGH WE TOOK THE LIFE
SPAN AND HAVE ALL THE THINGS
ACROSS AND PARTICULAR
INTERVENTIONS TO HELP MEET THOSE
AMOUNTS THAT ARE RECOMMENDATIONS
IN THE HUSS BY LIMITING PORTION
SIZE THEN TAILORED TO THE AGE
GROUP YOU'RE WORKING WITH
BECAUSE IT CANNOT SERVE
EVERYBODY THE SAME AMOUNT OF
MEALS.
THOUGH YOU'RE PURCHASING FOR THE
ENTIRE FAMILY YOU HAVE TO LOWER
THE PORTIONS AND HAVE SMALLER
PORTION SIZES FOR CHILDREN,
LARGER FOR OTHER INDIVIDUALS IN
THE FAMILY AND HAVE TO MODIFY
THE AMOUNT.
INTEGRATING THAT I THINK IS
IMPORTANT.
>> THREE MORE THINGS.
ACROSS EACH SECTION I WOULD
THINK ABOUT STUDY DESIGN.
WE SAW SOME OF THE ISSUES AROUND
EXPOSURE ASSESSMENT AND OUTCOMES
ASSESSMENT AND THE INTERMEDIATE
VARIABLES AND HOW THEY'RE
MEASURED, IF THEY'RE MEASURED,
HOW THAT IMPACTS EVERYTHING
WE'RE DOING.
THE OTHER IN ADDITION TO WHAT
DIDI RAISED ABOUT DIET QUALITY
THINKING ABOUT BIO AVAILABILITY
OF NUTRIENTS IN EACH PARTS OF
OUR REPORT AND THEN LASTLY THE
IDEA THAT WE HAVE NUTRIENTS OF
SPECIAL CONSIDERATION BECAUSE AS
WE DO THAT FIRST PART OF THE
REPORT WHERE WE'RE THINKING
ABOUT IDEOLOGIC RELATIONSHIPS WE
DON'T YET LOOK AT
OVERCONSUMPTION AND UNDER
CONSUMPTION AND THERE'S A BUCKET
SITTING SOMEWHERE OF THINGS THAT
ARE SPECIAL CONSIDERATIONS AND
PULLING THAT THROUGH AND NOT
FORGETTING TO STRING THOSE
ALONG.
>> FOR ME INTEGRATION WOULD BE
ALSO WHAT WOULD BE THE TOP
PRIORITY FOR THE HIGHEST IMPACT
ON TAKING CURRENT INTAKE AND
RAISING THEM CLOSER TO THE
DGA.
WE TALK ABOUT THE IDEAL HUSS
WE'RE REALLY FAR.
SO WHAT ARE THE STEPS TO MOVE
THE NEEDLE THE MOST CONSIDERING
RESOURCES ARE LIMITED
CONSIDERING THERE'S MER
KNOWLEDGE THAN EVEN THE
COMMITTEE IS BRINGING LIKE
VALERIE WAS TALKING ABOUT AND
CAN WE PRIORITIZE SO THERE MAY
BE MORE REWARDS ON THE GAPS THAT
WOULD BE FUELED BY PRIORITIZING
OUR RECOMMENDATIONS TO
PRIORITIZE THOSE STEPS IF THAT
MAKES ANY SENSE.
>> CAN I COMMENT ON THAT?
JUST A REMINDER OF HOW BAD IT IS
AND HOW MUCH ROOM THERE IS TO
GROW.
WE CAN ONLY GROW FROM HERE,
HOPEFULLY.
LIKE EVEN WITHIN A SIX-POINT
DIFFERENCE IS CLINICALLY
MEANINGFUL.
SO A 10, 20-POINT INCREASE
POPULATION WIDE NOT JUST THOSE
WHO CAN AFFORD OR ACCESS
WHATEVER IT IS AND INTERVENING
TO INCREASE THAT.
I THINK IF EVERYONE WALKED OUT
THE DOOR TOMORROW MORNING, I'M
GOING TO FOLLOW THE DIETARY
GUIDELINES IS THE FOOD SUPPLY
EVEN AMPLE TO HANDLE THAT?
I DON'T KNOW THE AVAILABILITY IS
THERE.
HAVING THE ULTRA PROCESSED FOODS
I DON'T KNOW MOVE TOWARDS THE
GUIDELINES RATHER THAN AWAY IF
THEY'RE HERE TO STAY AND TO WHAT
EXTENT THEY ARE, I DON'T KNOW
BUT THEIR HOPEFULNESS IS NOT
HELPING.
ACCOMMODATING THE FACT THAT
SOCIETY'S CHANGED THOUGH DIET
HAS BEEN VERY STABLE OVER THE
LAST COUPLE DECADES LOOKING AT
PROPORTION OF DIFFERENT FOOD
GROUPS IT'S BEEN FAIRLY STAGNANT
BUT THE FOODS HAVE CHANGED A
LOT.
IF ANYTHING IT SAYS IT'S
MODIFIABLE TO GO BACK IN SOME
WAY OR ADDRESS SUGARS AND SODIUM
AND SATURATED FAT.
IF YOU MAKE A CHANGE AT THE
POPULATION LEVEL IT BENEFIT
EVERYONE BECAUSE WE'RE ALL AT
THE BOTTOM OF THE SCORE AND NOT
DOING WELL.
FOR BEHAVIOR CHANGE IT'S GREAT.
WE WANT PEOPLE EATING MORE
FRUITS AND VEGETABLES BUT THE
FOODS OUT THERE NEED TO GET
BETTER AND HAVE A MORE IMMEDIATE
WIDESPREAD IMPACT AT THE
POPULATION LEVEL TOO.
>> FROM A LARGE PERSPECTIVE I
SEE TWO THINGS A LITTLE BIT
INCONGRUOUS CLEARLY MOST OF US
WOULD AGREE, MAYBE ALL OF US
THAT DIET QUALITY IS POOR IN THE
U.S. AND IF WE IMPROVED IT
UNDOUBTEDLY WE'D HAVE BETTER
HEALTH OUTCOMES.
ON THE OTHER HAND THE WORK WE'VE
BEEN DOING THE LAST TWO YEARS
AND A LOT OF TOPICS WE LOOKED AT
WE ARE HAPPY WHEN WE GET LIMITED
CONCLUSIONS INSTEAD OF DATA NOT
AVAILABLE FOR ANY CONCLUSION.
I THINK TO ME THEY SEEM
DIFFERENT LIKE OUTCOMES.
ONE YEAH, DIET CAN DEFINITELY
BEING IMPROVED WITHOUT A DOUBT
AND SOME DISEASE WOULD BE
REDUCED BUT WHEN YOU LOOK AT
THINGS LIKE COGNITIVE FUNCTION
THERE ARE LARGE BODIES OF
CANCERS.
WE JUST TOUCHED A LITTLE BIT ON
TWO CANCERS AND EVEN
PREMENOPAUSAL WE HAVE NO
CONCLUSION OF PRE-MENOPAUSAL
BREAST CANCER.
THERE'S A LOT WE HAVE TO LEARN
A
AND WE DEFINITELY NEED BETTER
STUDY DESIGNS.
THAT'S KIND OF A VERY BROAD
RECOMMENDATION.
I DON'T KNOW IF IT WILL GET
IMPLEMENTED AND HOW AND WHO
DECIDES WHAT A GOOD STUDY DESIGN
IS.
SOME PEOPLE ONLY ACCEPT
RANDOMIZED TRIALS WHICH ARE
INFEASIBLE SO THERE'S STILL A
LOT TO THINK ABOUT.
>> THANKS, ED.
HEATHER.
>> IN THINKING WHAT WE CAN
HIGHLIGHT FOR INTEGRATION, I
HOPE WE DON'T LOSE -- WE KNOW
THERE'S A STORY TO TELL THERE'S
A LOT OF POOR DIETS BUT DON'T
WANT TO LOSE THE SUCCESSES WE
SAW AND BUILDING ON THE
STRENGTHS OF SOME OF THE WINS WE
SAW ARE REALLY IMPORTANT TO
REMEMBER.
WE SAW THE WATER INTAKE TWO UP
IN THE POPULATION SO WHY DID
THAT HAPPEN, HOW DID THAT HAPPEN
AND HOW CAN WE BUILD ON THAT AND
THEN IN THE SUBCOMMITTEE TOO WE
SAW STRATEGIES THAT HELP IMPROVE
VEGETABLE INTAKE.
THAT'S GREAT.
HOW CAN WE MAKE SURE THAT'S
HIGHLIGHTED AND BUILD ON THAT
BECAUSE THAT'S DEFINITELY
SOMETHING LOOKING AT THE INTAKE
WE NEED TO INCREASE.
I JUST WANT TO LIFT THOSE UP.
>> THANK YOU, HEATHER.
I LIKE POSITIVES.
CAN I GO BACK AND FOLLOW UP ON
ED'S COMMENT BECAUSE I'VE HEARD
TODAY AND ALSO I'VE HEARD
THROUGH OUR VARIOUS COMMITTEE
MEETINGS WE NEED SMARTER STUDIES
WHEN WE TALK ABOUT STUDY
DESIGNS, FOR EXAMPLE.
THERE WERE ISSUES RAISED ABOUT
THIS IS THE QUESTION WE CAN'T
ANSWER THE QUESTION WITH THE
DATA AT HAND.
I'M NOT SUBJECTING THAT THE PRUR
RESEARCH IS WRONG OR INFERIOR
BUT I THINK WHAT WE NEED TO
REALLY THINK ABOUT CRITICALLY IS
WITH THE EVOLVING KNOWLEDGE
WHERE SHOULD FUTURE STUDIES BE
PRIORITIZED?
I THINK THERE'S ALSO I LIKED THE
DIVE DEEP RECOMMENDATION FA TEE
PLA.
IT'S GOING TO BE OUR FEDERAL
AGENCIES US AS ADVOCATORS.
IT'S GOING TO BE PEOPLE WHO ARE
FUNDING THE STUDIES.
CREATE THE FRAMEWORKS SUCH AS WE
NOW HAVE TO JUSTIFY OR EXPLAIN
HOW WE INCLUDE WOMEN IN OUR
RESEARCH FOR CERTAIN FUNDING
AGENCIES.
SHOULD WE TAKE IT FURTHER.
THE OTHER POINT I KEPT HEARING
IS WHAT WE HAVE AVAILABLE TO US
THROUGH THE PUBLICATIONS.
I WOULD LIKE TO SUGGEST WE STEP
BACK AND LOOK AT THE OVER ALL
SYSTEM BECAUSE THERE'S A LOT OF
GRANULARITY WE NEED AND DON'T
GET BECAUSE OF THE SPACE
REQUIREMENTS, ETCETERA.
WE SHOULD BE THINKING ABOUT THAT
AS WELL.
I'M JUST THINKING ABOUT OUR
REPORT.
WE'RE WRITING OUR REPORT BUT
WE'RE GOING TO HAVE SO MANY
PAGES MUCH DATA AND HAVE
EXTENSIVE DETAILS THANKS TO OUR
VERY GIFTED STAFF ON
METHODOLOGY.
PEOPLE CAN GO BACK AND LOOK
EXACTLY WHAT WE DID AND THE RAW
DATA BUT WE DON'T GET THAT WITH
OUR PEERS.
I THINK WE NEED TO THINK ABOUT
WHAT WE'RE DOING AND HOW WE'RE
FRAMING OUR RESEARCH MOVING
FORWARD.
SO THANK YOU.
>> CONTINUING WITH THE GOOD NEWS
WE HAVE GREAT THINGS TO REMIND
EVERYBODY WE SAW REGULAR
BREAKFAST CONSUMPTION WAS
ASSOCIATED WITH GOOD OUTCOMES
AND HAVING GREATER NUMBER OF
EATING OCCASIONS AS WELL.
INTEGRATE
INTEGRATING --
[AUDIO DIGITIZING]
IN TERMS OF BEHAVIOR CHANGE.
CONTINUING WITH THE UPLIFTING
INFORMATION.
>> SHERYL AND THEN TERESA.
>> SOMETHING THAT OCCURRED TO ME
AS CHRISTINA WAS TALKING ABOUT
THE GOOD NEWS, I WONDER
THROUGHOUT EACH OF OUR SECTIONS
WE WANT TO THINK THROUGH
CONTEMPORARY PRACTICES IN THE
COUNTRY THAT MIGHT BE IMPACTING
WHAT WE'RE FINDING ACROSS THE
REPORT.
SO FOR EXAMPLE WE DIDN'T
PRIORITIZE THESE TWO ISSUES THAT
I'M GOING TO RAISE AS QUESTIONS
TO MOVE FORWARD BUT I DO WONDER
IF THE AMERICAN PUBLIC MIGHT
THINK WE ARE OUT OF TOUCH OR OUT
TO LUNCH, PUN INTENDED, GIVEN IF
WE DECIDE TO LEAVE THESE OUT OF
THE REPORT MEANING THESE ARE
THINGS THAT WE'RE THINKING ABOUT
MAYBE SOME INTEGRATION
DISCUSSION AROUND.
ONE IS FROING -- GROWING BODY
OF LITERATURE AROUND FASTING AND
INTERMITTENT FASTING MOVING FROM
ANIMAL TO HUMAN STUDIES.
THERE'S BEEN A FEW REVIEWS IN
WELL RESPECTED NUTRITION
JOURNALS AND I THINK IT'S
PLAYING ON NOT THE NOISE BUT THE
BACKGROUND AND IMPACTING
PEOPLE'S DIETARY PRACTICES.
THE OTHER ONE IS ELIMINATIONS
FOR HEALTH CONDITIONS SO IF YOU
LOOK IN OUR GROCERY STORES IT'S
UNMISTAKABLE AFTER ELIMINATION
EXERCISES MANY AMERICANS HAVE
DECIDED TO LEAVE GLUTEN OUT OF
THEIR DIETS AND SEE IT IN
RESTAURANTS AND WHAT IT'S DOING
TO SHIFT PRACTICE I DON'T THINK
WE KNOW BUT I DON'T US TO SEEM
TONE DEAF TO THAT AND THERE'S A
GROWING MOVEMENT TOWARDS NIGHT
SHADES BECAUSE OF THE ALKALOID
AND PAIN THEY PERCEIVE FOR
INFLAMMATION AND THROWING IT OUT
AS WE THINK ABOUT INTEGRATING.
>> CAN I ASK YOU TO EXPAND A
LITTLE BIT.
HOW DO YOU SEE IT WOULD BE
INTEGRATED?
>> FOR EXAMPLE, WHEN WE THINK
ABOUT THE WORK THROUGHOUT
SUBCOMMITTEE 1 AND 3, AS WE'RE
LOOKING AT WHAT ARE THE DIETARY
PATTERNS THAT HAVE IDEOLOGICAL
RELATIONSHIP WITH HEALTH
OUTCOMES YOU THINK WE'RE BOUND
BY THE QUESTIONS WE PRIORITIZE
AND BOUND BY THE AVAILABILITY OF
DATA TO SUPPORTS THE QUESTIONS
THAT WE PRIORITIZE.
HOWEVER RELATED TO THOSE
QUESTIONS ARE THESE ISSUES FOR
WHICH THERE ARE EMERGING DATA.
FOR EXAMPLE CHRISTINA MENTIONED
THE IMPORTANCE OF EATING
BREAKFAST.
I WOULD IMAGINE THE PUBLIC WHO
ARE LISTENING TO US RIGHT NOW
PROBA
PROBABLY FLINCHED BECAUSE IF I
BREAK MY FAST AT 2:00 IN THE
AFTERNOON METABOLIC CONDITIONS
RESOLVE.
I'M ASSUMING SOME PORTION OF THE
POPULATION IS FLINCHING AT THAT.
>> WE ONLY SAW THAT IN CHILDREN.
>> THANK YOU FOR QUALIFYING
THAT.
A NOD TO EMERGING DATA IN THAT
AREA FOR EXAMPLE SUBCOMMITTEE
1'S WORK MAY BE IMPORTANT AND
SWITCHING TO SUBCOMMITTEE 3 IS
WE'RE MODELLING FROM CERTAIN
JUMP OFF POINTS AND OFTEN THOSE
ARE THE THINGS WE WERE HANDED
FROM 2020.
NOW WHEN 2030 COMES THEY'RE
GOING TO BE JUMPING OFF FROM
WHERE WE LEFT.
I THINK SOME NOD TO THE EMERGING
TRENDS AROUND WHETHER IT'S
INTERMITTENT FASTING, WHETHER
IT'S GLUTEN FREE OR NIGHT SHADE
ELIMINATION BECAUSE GLUTEN FREE
WILL IMPACT WHOLE GRAINS AND
NIGHT SHADES WILL IMPACT
VEGETABLES AND FRUITS.
AGAIN, BASICALLY GIVING A NOD TO
THE FACT WE'RE NOT LIVING IN A
BUBBLE.
WE'RE BOUND ONLY TO THE
QUESTIONS WE PRIORITIZE AND
REALIZE THE NUTRITIONAL WORLD IS
MOVING ALONG WHILE WE'RE IN THIS
TWO-YEAR PROCESS.
>> THIS SPEAKS TO EVEN A
BROADER -- I'M SURE PREVIOUS
COMMITTEES BECAUSE THESE AREN'T
THE ONLY DIETARY PATTERNS THAT
HAVE EMERGED.
THEY'VE BEEN EMERGING THE LAST
50 YEARS OR LONGER.
I'M WONDERING WITHIN THE PROCESS
WHEN YOU THINK OF PRIORITIZING
QUESTIONS WHAT RECOMMENDATION WE
COULD MAKE IN THE PROCESS FOR
BEING ABLE TO UNDERSTAND WHAT
THESE THINGS ARE AND HOW THEY
GET INCORPORATED INTO QUESTIONS
BECAUSE THAT SEEMS TO ME TO BE A
LONG STANDING ISSUE.
I'M SURE PREVIOUS COMMITTEES HAD
TO CONSIDER IT BUT ALSO PART OF
HOW THE QUESTIONS GET DEVELOPED
IS SOMEWHAT INTEREST WHAT PEOPLE
HERE AND FROM THE PUBLIC.
I THINK PART IN THINKING ABOUT
THE PROCESS AND PRIORITIZATION
THAT MAY BE A RECOMMENDATION TO
THE ACTIONS TO CONSIDER THAT.
THOSE ARE SPECIFIC THINGS NOT
THAT I DON'T THINK THEY MAY BE
IMPORTANT BUT THERE'S PROBABLY
WE ONLY KNOW ABOUT MAYBE THESE
THINGS BUT THERE'S PROBABLY
EMERGING EVERY DECADE THINGS
EMERGING.
THEY HAVE TO BE ABLE TO TO BE
CONSIDERED SOMEHOW IN THIS
PROCESS.
I'M NOT SURE AND THAT MAY BE A
RECOMMENDATION HOW YOU CONSIDER
THE PATTERNS THAT HAPPEN WITH
THE U.S. POPULATION.
>> I THINK OF ONE EXAMPLE FROM
2020, THEY PUNTED TO US TO SAY
WE'RE NOT GOING TO REVIEW
DIETARY PATTERNS AND CVB BUT
NEXT TIME THAT SHOULD HAVE A
NEXT DIVE BECAUSE THINGS WOULD
HAVE LIKELY MATURE D.
MAYBE IT'S WITHIN SUBCOMMITTEE 1
DELIBERATIONS.
WE'RE AWARE OF THE POTENTIAL
TRENDS WITHIN SUBCOMMITTEE 3
WHERE 2030 STARTS.
>> THIS IS GREAT.
CAN I JUST ASK EVE AND/OR JANET
JUST TO REMIND US HOW THE
QUESTIONS ARE CHOSEN BECAUSE I
THINK IS REALLY IMPORTANT IN
THIS CONTEXT.
>> ABSOLUTELY.
THE QUESTIONS ARE IDENTIFIED
FIRST WE WORKED IN A FEDERAL
PROCESS TALKING TO OUR FEDERAL
PARTNERS.
AND WE CONSIDERED THE PREVIOUS
ADVISORY COMMITTEE'S WORK AND SO
FOR EXAMPLE MOST THE QUESTIONS
YOU LOOKED AT WERE CONSIDERED BY
THE 2020 COMMITTEE AND MANY
CONSIDERED BY THE 2015 COMMITTEE
AND WE LOOKED AT PREVIOUS
COMMITTEE'S REPORT AND WHAT THEY
ARE RECOMMEND FOR THE NEXT
COMMITTEE AND THEY'RE
PRIORITIZED BASED ON RELEVANCE,
IMPORTANCE, POTENTIAL IMPACT TO
FEDERAL PROGRAMS AND AVOIDING
DUPLICATION.
SO TO SOME OF AS THE TOPICS
YOU'RE RISING I THINK THEY'VE
BEEN DISCUSSED BUT THERE'S BEEN
THIS QUESTION WHAT'S THERE --
ARE THEY OF BROAD PUBLIC -- IS
IT SOMETHING A LOT OF PEOPLE ARE
DOING OR A GROUP OR HOW TO
HANDLE THAT PIECE OF IT?
SO THAT'S KIND OF THE FIRST STEP
TO WORK WITHIN OUR FEDERAL
FAMILY AND THEN WE POSE THEM FOR
PUBLIC COMMENT.
WE THEN CONSIDER THOSE FOUR
CRITERIA ACROSS THOSE COMMENTS
RECEIVED AND WITH THIS COMMITTEE
WE DID PROPOSE THE QUESTIONS TO
YOU AND YOU HAD THE OPTION TO
REFINE, ADD, RENEWED QUESTION AT
HIGH LEVEL THERE'S A PROCESS AND
SOME OF THESE TOPICS THAT HAVE
COME UP IN THE PAST FOR SURE AND
HOW BIG OF A TOPIC IS THIS AND
IN ALL THIS YOU LOVE THE
CONVERSATION ABOUT DEFINING WHAT
LEATH -- HEALTH IS IF YOU HAVE
THOUGHTS ON AREAS THAT DON'T
NEED TO BE RE-EXAMINED ARE SUPER
HELPFUL AND WE'RE CHATTING LIKE
YOU DON'T KNOW AT THE BEGINNING
MANY QUESTIONS AND HOW MUCH WORK
AND I THINK IF Y'ALL WERE TO
COME IN AND ADDED ADDITIONAL
QUESTIONS THINKING ABOUT THE
GIVE AND TAKE AND IF THERE ISN'T
ANYTHING WE SHOULD ADD WELCOME
TO HEAR IF THERE'S THINGS YOU
THINK ARE LOWER PRIORITY.
WE WOULDN'T NECESSARY RECOMMEND
THAT FOR A FUTURE EXPLORATION.
>> THANK YOU FOR THAT.
TERESA AND FATIMA AND DIANNE.
>> WHAT I'M HEARING IN WHAT
WE'VE BEEN DOING IN PREVIOUS
COMMITTEES THE DIETARY GUIDELINE
HAS FOCUSSED ON WHAT TO EAT AND
I HEARD VALERIE AS WELL AS DIDI
MENTIONING THE FOOD ENVIRONMENT
DETERMINING WHETHER PEOPLE CAN
EAT WHAT WE RECOMMEND TO EAT AND
ONE COMPONENT HAS NOT BEEN
EXPLORED BROUGHT UP BY CHRISTIE
IN AND SHERYL HOW WE'RE EATING
AND TIMING AND HOW MUCH WE EAT
EN ONE MEAL IS ALSO PART OF THE
HOW WE ARE EATING.
WHAT WE'RE EATING WITH ALL THE
PORTIONS IN THE HOUSE WE CAN
SPACE OUT 24 HOURS IN MANY
DIFFERENT WAYS AND SO MAYBE IN
THE FUTURE COMMITTEES THOSE ARE
ALSO HAVE THE NUTRITION PART MAY
HAVE INFLUENCE AND SCIENCE MAY
NEED TO LOOK AT THE FOOD
ENVIRONMENT AND OTHER TYPES OF
EATING BEHAVIORS BESIDES WHAT IS
BEING EATEN.
>> I THINK THE IMPLICATIONS
BEHIND SHERYL'S COMMENTS ARE
REALLY IMPORTANT.
THINGS LIKE INTERMITTENT FASTING
WHICH WE KNOW CAN LEAD TO WEIGHT
SIZING WHICH LEADS TO HIGHER
RATES OF OBESITY ARE NOT SMALL
TRENDS, THEY'RE LARGE TRENDS
ACROSS THE POPULATION YOU SEE
THIS INFILTRATING THINGS LIKE
SOCIAL MEDIA AND THE VOLUME OF
HITS AND WHAT WE'RE SEEING IN
THE CLINIC SIDE FOR LARGE TRENDS
THAT PEOPLE ARE USING AND ACROSS
THE POPULATION THAT VARIOUS LIFE
STAGES.
SO I DO THINK THIS IS IMPORTANT
FOR US TO THINK ABOUT WHAT WE'RE
GOING TO BE SEEING IN THE NEXT
FIVE YEARS IS HARD TO KNOW
BECAUSE THE TRENDS ARE CHANGING
SO QUICKLY PARTICULARLY IN THIS
AGE OF SOCIAL MEDIA AND A.I.,
ETCETERA AND WHAT'S INFLUENCING
WHAT PRACTICES ARE BEING DONE.
THINGS LIKE INTERMITTENT
FASTING, HIGH PROTEIN AND
ELIMINATION DIETS ARE POPULAR
AMONGST THE POPULATION
PARTICULARLY ON THE CLINICAL
SIDE.
I DO THINK WE NEED TO PAY
CREDENCE TO THIS.
THE DATA DOES SHOW HOWEVER, WITH
MANY OF THESE THINGS
UNFORTUNATELY PEOPLE DO THEM IN
SHORT TERM DURATION BUT LEAD TO
TYPICALLY GREATER ADIPOSITY.
>> WHEN CHRISTINA WAS TALKING I
WAS THINKING ABOUT AN
INTEGRATION OPPONENT TALKING
ABOUT BREAKFAST FOR KIDS AND
WHEN WE THINK OF EATING
OCCASIONS, ONE OF THE PROBLEMS I
HAVE WITH THAT IS KID SNACK A
LOT.
SHERYL PRESENTED THE DATA THAT
SHED MOST OF WHAT THEY ARE GET
FROM -- SHOWED MOST OF WHAT THEY
ARE GET FROM SNACKS IS NOT
HEALTHY AND DIDI WAS TALKING
ABOUT HOW PARENTS ARE IN A HURRY
AND IF YOU CAN'T GET IT IN A
PACKAGE -- WE DID A STUDY AND
THEY INCREASED PACKING VEGETABLE
AND THEY PUT BABY CARROTS IN
BECAUSE THEY'RE EASY TO PACK SO
IT DEPENDS ON THE FOOD SYSTEM
AND YOU CAN BRING THAT IN AND
TALK ABOUT CHRIS'S ANALYSIS
WHERE YOU IF YOU HAVE HIGH
SATURATED FAT FOODS OR FOOD OF
KNNUTRITIONAL VALUE THAT CAN
CONTRIBUTE TO NOT MEETING THE
GUIDELINES.
THEN YOU CAN BRING IT IN TO THE
SCHOOL LUNCH PROGRAM.
THIS IS GUIDANCE WE CAN GIVE
THEM IN TERMS OF THAT.
SO IT KINDS OF BRINGS IN ALL THE
COMMITTEES WITH THOSE GUIDE
HINES.
>> MOST AMERICANS DON'T MEET THE
GUIDELINES.
THEY'RE OFTEN USED FOR SAFETY
NET PROGRAMS.
THEY HAVE TO FOLLOW THE
GUIDELINES.
IT WILL BE INTERESTING TO THINK
MORE OF SCHOOL LUNCH AND SCHOOL
BREAKFAST WHICH HAVE TO FOLLOW
THESE.
UNIVERSAL SCHOOL LUNCH APPROVED
ACROSS THE BOARD.
THEY'RE NOT SERVING HEALTHY
MEALS BUT WHAT KIND OF DPAP
COULD WE FILL THERE -- GAP COULD
WE FILL THERE IN TERMS OF
PROGRAMS AND SUGAR SWEETENED
BEVERAGES AND THERE'S WHERE
GENERAL AMERICANS AREN'T
FOLLOWING THE GUIDELINES BUT THE
SAFETY NET PROGRAMS HAVE TO.
WAS THERE ANYTHING WE CAM UP
WITH IN THE LAST ROUND WE JUST
FINISHED HELP MODIFY THE SAFETY
NET PROGRAMS?
>> I'LL ADD TO THAT.
THE ISSUE ON MEETING GUIDELINES
AND HOW THE DETAILS I WOULDN'T
NECESSARILY MAKE A STATEMENT TO
SAY THE PROGRAMS ARE NOT MEETING
THE GUIDELINES.
WHEN THE GUIDELINES GET
INCORPORATED IN THE PROGRAMS
THERE'S MONITORING BUT WE KIND
OF VIEW RESEARCH AS VERY
SEPARATE THEN SURVEILLANCE AND
MONITORING IN THESE PROCESSES.
MAYBE BECAUSE THEY'RE NOT
CONTROLLED IN A WAY.
I LEAR STATEMENTS PEOPLE MAKE
ABOUT FEDERAL PROGRAMS WITHOUT
DATA.
THEY HAVE SENDA 1, 2 AND 3 ABOUT
HOW THE FEDERAL PROGRAMS MIGHT
HELP PEOPLE AND WHAT IS OFFERED.
WE PROBABLY COULD HAVE MORE
DATA.
WE HAVEN'T BEEN LOOKING AT DATA
REALIZATION DATA, FEDERAL
REPORTS, REALIZATION REPORTS.
WE TALKED ABOUT QUALITATIVE
RESEARCH.
THERE MAY BE OTHER SOURCES OF
DATA WHICH GETS INCORPORATED IN
SOME WAY AFTER THE OUTSIDE OUR
PROCESS.
IT HAPPENS WHEN THE GUIDELINES
ARE MADE.
WE PROBABLY COULD HAVE MORE DATA
THAT GETS INCORPORATED INTO THIS
PROCESS LINKED TO SURVEILLANCE
THAT MAYBE GOES BOTH WAYS AS YOU
SAID.
BECAUSE WE ARE NOT LOOKING AT
THAT DATA UNLESS IT'S IN THE
PUBLISHED ALL RIGHT --
LITERATURE AND THINK MORE OF
WHAT'S HAPPENING IN THE FEDERAL
PROGRAMS.
>> WE'LL TAKE HEATHER AND
CHRISTINA AND THEN WRAP UP.
>> I ALSO WANTED TO SAY ONE
THING WITH REGARD TO THAT
COMMENT ABOUT SNAP.
WHEN WE THINK ABOUT THE
ENVIRONMENT OF INDIVIDUALS THAT
LIVE IN HOUSEHOLDS WITH LOW
INCOMES THAT MAY BE MORE
CONSTRAINED.
I THINK THAT'S ALSO IMPORTANT TO
CONSIDER WHEN WE'RE TALKING
ABOUT HOW WE'RE GOING TO
IMPLEMENT GUIDELINES THROUGH
PROGRAMS BECAUSE WE DON'T WANT
TO MAKE IT EVEN MORE DIFFICULT
FOR PEOPLE TO FULFILL
GUIDELINES.
SO I THINK WE NEED TO
INCORPORATE THE ENVIRONMENT
ASPECT ALL THROUGHOUT.
>> I NO WE HAVE TO CLOSE BUT TO
ADD TO CHRIS' POINT THE
MODELLING WE COULD DO USING THE
DIETARY GUIDELINES TO THINK HOW
CAN PEOPLE MEET THE GUIDELINES
WITHIN THE FEDERAL PROGRAMS.
MAYBE AN INTERESTING PERSPECTIVE
AS WELL.
>> CHRISTINA, LAST COMMENT.
>> THIS IS JUST RECOMMENDATIONS
TO ADDING OUR SCIENTIFIC REPORT.
AS EVE MENTIONED HOW QUESTIONS
HAVE DEVELOPED MAYBE QUESTIONS
WE THINK RESEARCHERS SHOULD TAKE
INTO ACCOUNT TO PICK UP IN THE
NEXT ROUND OF GUIDELINES AND I'M
PRETTY SURE MANY RESEARCHERS
HAVE THAT INFORMATION BUT
HAVEN'T PUBLISHED THE
GRANULARITY OF FOODS AND SNACKS
AND BREAKFAST WHAT THEY'RE
EATING AND THE TYPES OF SNACKS
WHERE WE WERE STUCK WITHOUT
INFORMATION.
BEING VERY DETAILED ON ABOUT
WHAT ARE THE THINGS WE WERE
MISSING THAT WE CAN HAVE A CALL
OUT ON TIME FOR RESEARCHERS TO
START PUBLISHING THE DATA WE
ALREADY HAVE SO THEY CAN BE PART
OF THE DATA NEXT TIME.
>> THIS HAS BEEN A FANTASTIC
DISCUSSION.
THIS HAS BEEN A FANTASTIC PUBLIC
MEETING.
AND WE HAVE A LOT OF WORK TO DO
OVER THE NEXT MONTH BEFORE WE
GET TO MEET AT OUR NEXT MEETING
BUT I KNOW WE CAN DO IT BECAUSE
GO TEAM, 2025, DGAC.
>> THANKS SO MUCH TO THE
COMMITTEE AND STAFF AND PUBLIC
FOR ATTENDING TODAY.
I REALLY APPRECIATE YOUR TIME
AND WITH THAT I WILL CONCLUDE
OUR MEETING.