>>GOOD MORNING AND WELCOME TO
THE SECOND MEETING OF THE 2025
DIETARY GUIDELINES ADVISORY
COMMITTEE AND I'M JANET de JESUS
FEDERAL OFFICER AND WE'RE HAPPY
TO HAVE COMMITTEE MEMBERS TO
GIVE UPDATES.
AS ALWAYS WE THANK THE PUBLIC
FOR YOUR PARTICIPATION AND
ENGAGEMENT THROUGHOUT THE
PROCESS.
I'M HAPPY TO SHARE ALL OF OUR
MEMBERS OF THE COMMITTEE ARE IN
ATTENDANCE IN PERSON TODAY.
JUST A REMINDER ON THE TIME
LINE, THE COMMITTEE WILL HAVE
SIX PUBLIC MEETINGS.
TODAY IS OUR SECOND MEETING.
MEETING THREE WILL BE IN
SEPTEMBER AND THAT WILL INCLUDE
AN OPPORTUNITY FOR ORAL COMMENTS
FROM THE PUBLIC AND WE'LL
PROVIDE MORE INFORMATION ON THAT
SOON.
MEETING SIX WILL INCLUDE THE
COMMITTEE'S PRESENTATION ON
THEIR DRAFT REPORT AND WE'VE
ASKED THE COMMITTEE SUBMIT THEIR
REPORT BY OCTOBER 2024.
FOLLOWING THE RELEASE OF THE
SCIENTIFIC REPORT HHS AND USDA
WILL BEGIN THE PROCESS TO UPDATE
THE DIETARY GUIDELINES.
THAT WILL BE PUBLISHED IN 2025.
HERE'S A BRIEF AGENDA FOR TODAY.
WE'RE GOING TO START OFF WITH
SOME OPENING REMARKS.
WE'LL ALSO HAVE UPDATES ON
PROJECTS RELATED TO THE DIETARY
GUIDELINES.
WE'LL HAVE REMARKS FROM OUR
CHAIR AND VICE CHAIR OF THE
COMMITTEE AND THEN MOST OF THE
MEETING TODAY WILL BE
SUBCOMMITTEE AND WORKING GROUP
PRESENTATIONS PRESENTED TO THE
ENTIRE COMMITTEE ON THEIR
PROGRESS SINCE FEBRUARY.
A REMINDER OF THE CHARGE OF THE
COMMITTEE.
THE COMMITTEE WILL EXAMINE THE
EVIDENCE ON TOPICS AND
SCIENTIFIC QUESTIONS IDENTIFIED
BY THE DEPARTMENTS.
THEY'LL DEVELOP A REPORT THAT
OUTLINES THEIR SCIENCE-BASED
REVIEW AND RECOMMENDATIONS WITH
RATIONALE AND FINALLY SUBMIT
THEIR REPORT TO THE SECRETARIES
OF HHS AND USDA FOR
CONSIDERATION AS WE DEVELOP THE
NEXT DIETARY GUIDELINES.
THE COMMITTEE HAS A VERY
IMPORTANT ROLE TO DESCRIBE THE
STATE OF CURRENT NUTRITION
SCIENCE.
SO EACH EDITION OF THE DIETARY
GUIDELINES BUILDS ON THE
PREVIOUS EDITION IN ADDITION TO
THE SCIENTIFIC REPORT FROM THE
COMMITTEE ALONG WITH INPUT FROM
OUR FEDERAL AGENCIES AND PUBLIC.
A REMINDER OF THE QUESTION
DEVELOPMENT PROCESS.
HHS AND USDA CONDUCTED A
YEARLONG PROCESS TO GATHER
INFORMATION, RECEIVE INPUT FROM
FEDERAL EXPERTS AND DOCUMENT TO
DEVELOP THE PROPOSED SCIENTIFIC
QUESTIONS.
THE LIST OF QUESTIONS PROVIDED
INCLUDES QUESTIONS EXAMINED BY
THE 2020 COMMITTEE AND NEWLY
DEVELOPED QUESTIONS ADDRESSING
DIET AND HEALTH.
WE ALSO REVIEWED EXISTING
FEDERAL RESOURCES THAT MAY
INFORM THE DIETARY GUIDELINES.
AND THERE'S A RANGE OF HEALTH
OUTCOMES INCLUDING PREGNANCY AND
INFANT HEALTH OUTCOMES,
CARDIOVASCULAR DISEASE, TYPE 2
DIABETES AND CANCER.
THE PROPOSED QUESTIONS WILL BE
EXAMINED USING SYSTEMATIC
REVIEWS AND PATTERN MODELS.
OUR COMMITTEE HAS A FINITE TIME
IN MEMBERSHIP.
A REMINDER WE HAVE A WIDE
VARIETY OF FEDERAL GUIDANCE
THAT'S AVAILABLE THAT WE CAN
UTILIZE IN THE DIETARY
GUIDELINES.
SO THIS IS JUST A SHORT LIST BUT
JUST TO SHARE SOME EXAMPLES,
HEALTHY FOOD ENVIRONMENTS AS
COVERED BY CDC, THE COMMUNITY
PREVENTIVE TASK FORCE FINDINGS,
ORAL HEALTH IS WELL COVERED BY
CDC AND NIH.
FOOD SAFETY, SPECIFIC
RECOMMENDATIONS SUCH AS THE
D.R.I.s.
WORK ON HUMAN MILK, SEAFOOD,
EATING DISORDERS AND PHYSICAL
ACTIVITY FROM THE PHYSICAL
ACTIVITY GUIDELINES FOR
AMERICANS.
YOU CAN FOLLOW ALONG ON THE
COMMITTEE PROCESS ON DIETARY
GUIDELINES.gov IF YOU CLICK WORK
UNDERWAY YOU GET THE LATEST
INFORMATION FROM THE COMMISSION.
IT'S MY PLEASURE TO INTRODUCE
REAR ADMIRAL PAUL REED WHO WILL
BE GIVING OPENING REMARKS.
THE DEPUTY ASSISTANT SECRETARY
FOR HEALTH AND THE DIRECTOR OF
MY OFFICE, THE OFFICE OF DISEASE
PREVENTION AND HEALTH PROMOTION
IN THE OFFICE OF THE ASSISTANT
SECRETARY FOR HEALTH AT HHS.
HIS PRIMARY RESPONSIBILITY IS TO
ADVISE THE ASSIST AND THE
SECRETARY FOR HEALTH ON DISEASE,
PREVENTION AND HEALTH PROMOTION
PROGRAMS AND POLICIES.
ADDITIONALLY HE PROVIDES
DIRECTION AND OVERSIGHT FOR
NATIONAL INITIATIVES SUCH AS
HEALTHY PEOPLE 2030, DIETARY
GUIDELINES FOR AMERICANS,
PHYSICAL ACTIVITY GUIDELINES AND
THE PRESIDENT'S COUNCIL ON
SPORTS FITNESS AND NUTRITION.
IN ADDITION HE CHAMPIONS AND IS
CHAMPIONING THE IMPLEMENTATION
OF A FEDERAL PLAN FOR EQUITABLE
LONG-TERM RECOVERY AND
RESILIENCE WHICH LAYS OUT A
GOVERNMENT-WIDE APPROACH FOR
FEDERAL AGENCIES TO STRENGTHEN
THE CONDITIONS NECESSARY FOR I
AM PROVING INDIVIDUAL AND
COMMUNITY AND WELL BEING
NATIONWIDE.
HE'S HELD NUMEROUS LEADERSHIP
ROLES WITHIN HHS BEFORE COMING
TO ODPHP AND SO GLAD HE JOINED
US.
HE BEGAN HIS CAREER AS A UNIFORM
OFFICER IN THE NAVY AFTER
GRADUATING FROM BOSTON
UNIVERSITY SCHOOL OF MEDICINE
AND IS A PEDIATRICIAN.
IT'S MY HONOR TO INVITE REAR
ADMIRAL REED TO THE COMMITTEE
AND KICK OFF OUR MEETING TODAY.
>>GOOD MORNING, EVERYBODY.
IT'S MY PLEASURE TO BE WITH YOU
TODAY AND I APOLOGIZE FOR NOT
HAVING BEEN HERE FOR THE FIRST
MEETING SOMETHING THAT TOOK ME
AWAY AS IS OFTEN THE CASE AND
GREAT TO BE WITH YOU ALL TODAY.
WE'RE EXCITED TO WELCOME BACK
THE 2025 DIETARY GUIDELINE
COMMITTEE FOR THEIR SECOND
MEETING TODAY.
TO OPEN THE DIALOGUE I'D FIRST
LIKE TO SAY AT THE OFFICE OF
DISEASE PREVENTION AND HEALTH
PROMOTION OUR MISSION IS TO
ENCOURAGE ALL AMERICANS TO LEAD
HEALTHY AND ACTIVE LIVES.
ONE OF THE MOST IMPORTANT THINGS
WE CAN DO AT OUR HEALTH IS TO
ROUTINELY EAT A NUTRITIOUS DIET.
THAT'S WHY THE WORK OF THIS
COMMITTEE IS VITALLY IMPORTANT
TO UPDATE THE DIETARY GUIDELINES
FOR AMERICANS OF COURSE AND MORE
BROADLY IN ADVANCING THE HEALTH
AND WELL BEING OF THE AMERICAN
PUBLIC.
SOMETHING WE TAKE VERY VERY
SERIOUSLY.
AS YOU KNOW THE WHITE HOUSE
CONFERENCE ON HUNGER, NUTRITION
AND HEALTH HELD LAST SEPTEMBER
RENEWED NATIONAL ATTENTION AND
ISSUED THE CALL TO ACTION TO END
HUNGER AND REDUCE THE PREVALENCE
OF HUNGER BY 2030 AND OUTLINES
NUMEROUS ACTIVITY THE GOVERNMENT
WILL UNDERTAKE INCLUDING ACCESS
AND AFFORDABILITY, INTEGRATING
NUTRITION AND HEALTH, EMPOWERING
ALL CONSUMER TO MAKE AND HAVE
ACCESS TO HEALTHY CHOICES AND
ENHANCING FOOD AND NUTRITION
SECURITY RESEARCH ALL ACTIONS
DESIGN TO INCREASE HEALTHY
LIVING AND HEALTHY EATING BY
2030.
NOW, UNDER PINNING MANY OF THESE
ACTIONS IN THE NATIONAL
TECHNOLOGY IS OF COURSE THE
DIETARY GUIDELINES MORE
AMERICANS.
THE GUIDELINES TRANSLATE SCIENCE
TO POLICY AND GUIDANCE AND
PROVIDE ADVICE ON DIETARY INTAKE
TO PROMOTE HEALTH AND PREVENT
DISEASE.
I THINK AS JANET ALLUDED TO IN
THE WORK WE DO AND I'VE HAD THE
PLEASURE OF OFFERING GUIDANCE
AROUND BEYOND THE DIRECT
IMPLICATIONS OF IMPROVED HEALTH
WE LOOK AHEAD TO HOW THE DIETARY
GUIDELINES FOR AMERICANS AND
SUPPORT IMPROVED OVER ALL WELL
BEING, EQUITY AND ENHANCED
RESILIENCE FOR INDIVIDUALS AND
COMMUNITIES ACROSS THE COUNTRY.
FOCUSSING EFFORTS SUCH AS THE
DIETARY GUIDELINES FOR AMERICANS
NOT ONLY AFFORDS HEALTH BUT THE
BROADER CONCEPTS OF IMPROVED
WELL BEING, OPPORTUNITIES TO
THRIVE AND ULTIMATELY ENHANCED
RESILIENCE IS IMPERATIVE AS
EVIDENCE BY WHAT HAS BEEN
BLATANT THE PAST SELF YEARS.
WE'LL HEAR FROM YOU ON THE WORK
DONE SINCE JANUARY AND THE
PROPOSED SCIENTIFIC QUESTIONS
AND THE DEVELOPMENT OF DRAFT
PROTOCOLS FOR YOUR REVIEW OF THE
EVIDENCE.
YOUR THOUGHTFUL WORK REVIEWING
THE SCIENTIFIC EVIDENCE ON
NUTRITION AND HEALTH ENSURES THE
NEXT EDITION OF THE DIETARY BIDE
LIN
-- GUIDELINES IS BASED ON
EVIDENCE AND YOU SUPPORT THE
WORK OF THE DIETARY GUIDELINES
OF PROMOTING HEALTH AND
RESILIENCE AND WELL BEING FOR
ALL AMERICANS AND STRIVING FOR
THIS FOR ALL MUST BE A PRIORITY.
EQUITY ENSURES EVERYONE HAS THE
FULLEST AND FAIREST
OPPORTUNITIES AND CONDITIONS TO
THRIVE.
IT ALLOWS FOR RESOURCE
ALLOCATION BASED ON AND
COMMENSURATE TO NEED REGARDLESS
OF CIRCUMSTANCE.
TODAY WE WILL ALSO HEAR ABOUT
THE COMMITTEE'S WORK SINCE YOUR
FIRST MEETING TO DEVELOP AND
APPLY A HEALTH EQUITY LENS TO
YOUR REVIEW OF THE EVIDENCE.
BY INCORPORATING HEALTH
EQUITIENCE INTO EACH STEP OF
YOUR WORK, IT ENSURES ITS
COMMITMENT ALL PEOPLE CAN
CONTINUOUSLY THRIVE A GOAL
SHARED BY POLICY AND PROMOTION
AT THE USDA AND GUIDING
PRINCIPLE OF THE EQUITABLE PLAN
FOR LONG-TERM RECOVERY AND
RESILIENCE AND HEALTHY PEOPLE
2030.
HHS WORKS HAND IN HAND WITH USDA
TO DEVELOP THE DIETARY
GUIDELINES FOR AMERICANS.
I THINK WE GAVE A FEW HIGH FIVES
TO EACH OTHER THIS MORNING AND
WORKED TOGETHER COLLABORATELY
DATING BACK TO 1980 ON THE
GUIDELINES WHEN THE FIRST
EDITION WERE RELEASED THOUGH I
DOUBT ANY OF US WERE HERE AT THE
TIME.
I'D LIKE TO EMPHASIZE MY THANKS
AT THOSE PARTNERS HERE FOR THE
WORK FOR DIETARY GUIDELINES FOR
AMERICANS AND LOOK FORWARD TO
OUR CONTINUED COLLABORATION IN
THE COMING YEARS.
THANK YOU, JACKIE AND THE WHOLE
TEAM.
AND NOW IMPORTANTLY, IT'S ALSO
I'D LIKE TO EMPHASIZE WE GREATLY
RELY ON FEEDBACK FROM
RESEARCHERS, PUBLIC HEALTH
ORGANIZATIONS HEALTH CARE
PROVIDERS AND VARIOUS OTHER
ORGANIZATIONS AND PROGRAMS TO
CONTRIBUTE THEIR KNOWLEDGE AND
EXPERIENCE TO THIS EFFORT AS
WELL.
THAT'S WHY LAST WEEK HHS AND
USDA RELEASED A CALL TO ACTION
PUBLISHED IN THE AMERICAN
JOURNAL OF NUTRITION ENCOURAGING
THE PUBLIC TO PLAY AN ACTIVE
ROLE IN THE DEVELOPMENT OF THE
NEXT ITERATION OF THE DIETARY
GUIDELINES.
TODAY THE COMMITTEE WILL DEVELOP
PROTOCOLS DEVELOPED SINCE THE
MEETING IN JANUARY AND PUBLIC
COMMENTS TO THE COMMITTEE ARE
WELCOME AND WE ASK YOU SUBMIT
THEM BY THE END OF JUNE TO BE
MOST USEFUL.
WE ENCOURAGE PUBLIC COMMENT AND
ALL COMMENTS WILL BE TAKEN INTO
CONSIDERATION BY THE COMMITTEE
AND ENCOURAGE THE PUBLIC TO
LEARN ABOUT THE PROCESS,
PARTICIPATE IN THE PUBLIC
MEETINGS AND ENCOURAGE OTHERS TO
DO THE SAME.
TO WRAP UP, AND TO MOVE ALONG TO
THE MEAT OF THE WORK, I WANT TO
THANK AGAIN THE DEDICATED
FEDERAL STAFF WHO LEAD THE
DIETARY GUIDELINES PROCESS.
I'M GOING ASK THEM ALL TO STAND
UP.
LET'S RECOGNIZE YOU GUYS.
THANK YOU VERY MUCH.
I THINK IT GOES WITHOUT SAYING
THEY PUT IN EXTRAORDINARY TIME
AND THE BREADTH OF EXPERTISE IS
INCOMPARABLE AND I'D LIKE TO
THANK THE PUBLIC FOR
PARTICIPATING IN TODAY'S MEETING
AND MOST IMPORTANTLY OUR
ESTEEMED COMMITTEE MEMBERS FOR
YOUR WORK AND YOUR COMMITMENT TO
THIS VERY VERY IMPORTANT WORK.
THANK YOU.
>>THANK YOU, REAR ADMIRAL REED.
WHAT WE THOUGHT WE'D DO BEFORE
WE TURN IT OVER TO THE COMMITTEE
IS WE HAVE SOME QUESTIONS FOR
MEMBERS OF THE COMMITTEE AND
SOME QUESTIONS FROM STAKEHOLDERS
AS WELL AS REAR ADMIRAL REED
QUICK COMMENTS AND YOU'LL NOTICE
SOME TOPICS FROM THE PUBLIC
COMMENT AREN'T ADDRESSED IN THE
COMMITTEE'S WORK BUT WE WANT TO
ACKNOWLEDGE THERE'S OTHER WORK
HAPPENING IN PARALLEL TO THE
COMMITTEE'S WORK THAT ADDRESSES
THE NUMBER OF COMMENTS THAT HAVE
BEEN RECEIVED.
SO I'M GOING TO GIVE UPDATES ON
FIVE DIFFERENT PROJECTS.
THE HEALTHY EATING INDEX,
ALCOHO
ALCOHOLIC BEVERAGES AND HEALTH
AND DIETARY REFERENCE INTAKE AND
SUSTAINABILITY AND NUTRITION.
THE FIRST IS HEALTHY EATING
INDEX, HEI.
IT'S DESIGN TO EVALUATE HOW WELL
A SET OF FRUITS AND BEVERAGES
ALIGN WITH THE RECOMMENDATIONS
IN THE DIETARY GUIDELINES.
THE HEALTHY EATING INDEX IS
DEVELOPED IN PARTNERSHIP BETWEEN
USDA CENTER FOR NUTRITION POLICY
AND PROMOTION AND HHS'S NATIONAL
CANCER INSTITUTE.
THE HEI2015 SCORES RECOMMEND
RECOMMENDATIONS IN THE DIETARY
GUIDELINES.
WE HAVE BEEN WORKING ON THE
HEI2020.
THE HEI 2015 IT THE MOST
REFERENCED ARTICLE IN JAND AND
THERE'S QUESTIONS WHEN THE NEW
ONE WILL BE OUT AND IT WILL
PUBLISHED IN JAND AND EXPECTED
TO BE PUBLISHED THIS SEPTEMBER.
WE'LL HAVE TWO HEIs IN HEI 2020
AND IT HAS A NEW NAME BUT SAME
13 COMPONENTS BECAUSE THE CORE
RECOMMENDATIONS IN THE DIETARY
GUIDELINES FOR AGES TWO YEARS
AND OLDER DIDN'T CHANGE SO IT
WILL HAVE A NEW NAME BUT THE
SAME GENERAL COMPONENTS.
HOWEVER, WE HAVE A NEW HEI FOR
TODDLERS 2020.
THAT WILL BE A NEW TOOL THAT
WILL REFLECT NEW GUIDANCE IN THE
DIETARY GUIDELINES FOR AGES 12
TO 23 MONTHS.
WE'RE EXCITED TO HAVE THOSE
TOOLS FINALLY NEAR THE FINISH
LINE.
WE ARE CREATING A PUBLIC WEBINAR
LIKELY IN SEPTEMBER TO TALK MORE
ABOUT THE TOOLS AND THOSE WILL
BE CROSS-PROMOTED FOR LISTENERS.
THOSE INTERESTED WE'LL MAKE SURE
THAT INFORMATION IS SHARED.
NEXT TOPIC IS ALCOHOLIC
BEVERAGES AND HEALTH AND WHEN WE
POST THE TOPICS AND QUESTIONS
FOR PUBLIC COMMENT IT INCLUDED
GUIDANCE FOR ALCOHOLIC BEVERAGES
SINCE THE FIRST EDITION BUT IT'S
A UNIQUE ASPECT OF THE DIET AND
REQUIRES SPECIFIC EXPERTISE AND
WE FELT LIKE IT WAS TIME TO HAVE
A FOCUS REVIEW WITH A NUMBER OF
EXPERTISE BROUGHT TOGETHER -- A
NUMBER OF EXPERTS BROUGHT
TOGETHER SPECIFICALLY FOR THAT
TOPIC.
SO WE MADE A DECISION PRIOR TO
DEVELOPING THE TOPICS IN
QUESTION THAT THAT WOULD BE
HANDLED IN A SEPARATE EFFORT
FROM THE DIETARY GUIDELINES
SCIENTIFIC COMMITTEE REVIEW.
WE HAVE BEEN WORKING WITH THE
HHS STANDING COMMITTEE WITHIN
HHS'S SAMHSA AND THEIR PLAN IS
TO DEVELOP A TECHNICAL COMMITTEE
TO HAVE EXPERTISE IN ADULT
ALCOHOLIC BEVERAGES AND MAKE
RECOMMENDATIONS ON ADULT ALCOHOL
CONSUMPTION.
THAT WILL BE HANDLED IN A
SEPARATE EFFORT LED BY SAMHSA.
THEY PLAN TO PREPARE A
SUBCOMMITTEE REPORT TO BE
PUBLISHED AND AVAILABLE TO THE
PUBLIC IN 2025 AND THE GOAL STO
HAVE THE DIETARY GUIDELINES
RELEASED BY END OF 2025.
THAT WORK WILL BE PRIOR TO AND
CAN INFORM THE DEVELOPMENT OF
THE NEXT EDITION OF THE
GUIDELINES.
ADDITIONALLY, THE 2023
APPROPRIATIONS ACT MANDATED USDA
TO ENTER INTO A CONTRACT WITH
THE NATIONAL ACADEMIES TO
CONDUCT A SERIES OF SYSTEMIC
REVIEWS OF ALCOHOLIC BEVERAGES
AND HEALTH.
I WANT TO NOTE THE CONTACT
PROCESS HAS BEEN INITIATED
THROUGH THE CENTER FOR NUTRITION
POLICY AND PROMOTION AND
EXPECTED TO BEGIN THIS SUMMER.
WE'RE NEARING GETTING THAT WORK
UNDERWAY.
THE FINDINGS FROM THAT STUDY
WILL BE CONSIDERED BY THE SAMHSA
SUBCOMMITTEE IN DEVELOPING
ALCOHOL RECOMMENDATIONS.
THAT IS AN UPDATE ON THAT TOPIC
FOR YOU.
OKAY.
SYSTEM SCIENCE.
AS MANY PEOPLE ARE AWARE, THERE
WAS A STUDY CONDUCTED BY THE
NATIONAL ACADEMIES IN 2016, 2017
ABOUT THE PROCESS WE USE TO
DEVELOP THE DIETARY GUIDELINES.
THAT RESULTS IN A SERIES OF
RECOMMENDATIONS.
THERE WAS A SUBSEQUENT STUDY
THAT BY NASEM AND LOOKED AT THE
IMPLEMENTATIONS OF THE
GUIDELINES.
IN BOTH STUDIES THE NATIONAL
ACADEMIES COMMITTEES
ACKNOWLEDGED AN IMPORTANT STEP
FOR CONTINUING TO MOVE THE
PROCESS FORWARD IN DEVELOPMENT
WAS TO CONSIDER SYSTEM SCIENCE.
SYSTEM SCIENCE APPROACHES IN
INFORMING THE DIETARY
GUIDELINES.
SO WE HAVE A NUMBER OF
ACTIVITIES THAT ARE UNDERWAY IN
REGARDS TO THIS, FOR EXAMPLE
WITH OUR PATTERN MODELLING THAT
DR. TAYLOR WILL TALK ABOUT LATER
TODAY.
SIMULATED DIETS WE'RE GOING TO
SIMULATE DIETS PART MUCH THE
RECOMMENDATION IN REGARDS TO
SYSTEMS SCIENCE.
WE'RE IMPLEMENTING ADDRESSING
THAT RECOMMENDATION THROUGH THAT
AVENUE.
IN ADDITION, OUR OFFICE HAS A
CONTRACT UNDERWAY WITH THE GOAL
TO GAIN INSIGHT FROM FEDERAL AND
NON-FEDERAL EXPERTS ON THE
APPLICABLE OF SYSTEMS MAPPING
AND MODELLING, BEFORE, DURING
AND AFTER THE DIETARY GUIDELINES
DEVELOPMENT PROCESS.
SO FOR EXAMPLE IN INFORMING THE
RESEARCH THAT INFORMS THE
GUIDELINES IN OUR ACTUAL
GUIDELINE EVIDENCE REVIEW
PROCESS AS WELL AS
IMPLEMENTATION OF THE DIETARY
GUIDELINES.
WE ACTUALLY HELD AN IN-PERSON
WORKSHOP IN WASHINGTON, D.C.
THIS PAST MARCH AND OUR
CONTRACTOR IS WORKING ON A
REPORT THAT WILL DISCUSS OPTIONS
FOR MOVING FORWARD IN REGARDS TO
SYSTEMIC REVIEWS AND EXPECT THAT
BY THE END OF THIS YEAR.
OKAY, THE DIETARY REFERENCE
INTAKES.
AS WE HAVE TALKED ABOUT IN THE
GUIDELINES AT THE LAST PUBLIC
MEETING, THE DRI HAS IMPORTANT
INPUT INTO THE DEVELOPMENT OF
THE GUIDELINES.
THEY PROVIDE NUTRIENT
RECOMMENDATIONS AND PROVIDE
FOOD-BASED RECOMMENDATIONS AND
WE DON'T DUPLICATE EFFORTS.
THE INTENT IS TO CARRY FORWARD
THOSE NUTRIENT RECOMMENDATIONS
DEVELOPED IN THE DRI PROCESS.
THE DRIs ARE ESTABLISHED BY THE
NATIONAL ACADEMIES HOWEVER, THEY
ARE INFORMED BY A FEDERAL
WORKING GROUP AND THAT IS THE
JOINT U.S.-CANADIAN D.R.I.
WORKING GROUP AND HAS MEMBERS
FROM HHS AND DEPARTMENT OF
DEFENSE AND CANADA AND THE
WORKING GROUP PRIORITIZED THE
REVIEW AT THE D.R.I. VALUES FOR
ENERGY AND MACRO NUTRIENTS LAST
UPDATES IN THE 2000s.
A FEW UPDATES IN REGARDS TO THAT
WORK.
NEW D.R.I.s FOR ENERGY ARE NOW
VALUABLE AND NO WILL INFORM THE
WORK OF THE COMMITTEE
PARTICULARLY RELATED TO
FOOD-PATTERN MODELLING AND
POTENTIALLY IN RELATION TO SOME
OF OUR DATA ANALYSIS WORK.
WE ALSO WANT TO UPDATE WE HAVE
COMMISSIONED SYSTEMIC REVIEWS TO
INFORM SUBSEQUENT D.R.I.s FOR
PROTEIN AND CARBOHYDRATES.
WE'LL DO ADDITIONAL SYSTEMIC
REVIEWS BUT HAVE TWO PACKAGES OF
REVIEWS THAT HAVE BEEN FUNDED
AND IT WILL BE COMPLETED THROUGH
HHSs AGENCY FOR HEALTH CARE
QUALITY OR ARP.
THE FIRST ARE IN DIETARY PROTEIN
AND THOSE ARE A LITTLE BIT
FURTHER ALONG AND ARC WILL POST
PROTOCOL FOR THE SYSTEMATIC
REVIEWS ON THEIR WEBSITE THIS
SUMMER.
AND THEN WE HAVE MORE RECENTLY
FUNDED ANOTHER SET OF SYSTEMIC
REVIEWS ON DIGESTIBLE
CARBOHYDRATES AND THOSE WILL BE
FOLLOWING SHORTLY AFTER PROTEIN.
OF COURSE WE HAVE GOTTEN A
NUMBER OF COMMENTS ON
CARBOHYDRATE DIETS AND FEEL IT
ALL BEGINS WITH THE D.R.I.s AND
THINKING ABOUT THAT.
THE WORK IS UNDERWAY AND WE'LL
BEGIN WITH THE SYSTEMATIC REVIEW
AND NASEM WILL ESTABLISH
COMMITTEE TO WORK ON THOSE
SUBSEQUENT D.R.I.s.
SO IF YOU'RE INTERESTED IN THAT
WORK I ENCOURAGE FOLLOWING THE
WORK ON H.R.Q.s WEBSITE.
THE FINAL TOPIC IS ON
SUSTAINABILITY AND NUTRITION.
THERE'S IMPORTANT TOPICS ACROSS
BOTH DEPARTMENTS.
AND WE HAVE ACTIVITIES UNDERWAY
IN BOTH DEPARTMENTS TO INFORM
OUR WORK.
WE JUST WANTED TO HIGHLIGHT A
COUPLE OF ACTIVITIES THAT WERE
RECENTLY UNDERWAY.
THE FIRST IS A PROJECT CALLED
ADVANTAGE.
IT IS LED BY NICHD AND HHS.
THEY HAVE FIVE WORKING GROUPS
THAT ARE EXPLORING RESEARCH TO
BETTER UNDERSTAND THE
INTERSECTION OF FOOD SYSTEMS,
DIET, NUTRITION AND HEALTH IN A
CHANGING ENVIRONMENT.
THEY HAVE A VIRTUAL MEETINGS
THAT ARE OPEN TO THE PUBLIC AND
WE INCLUDED THE LINK AND IF
THERE'S INTERESTED IN FOLLOWING
THAT WORK YOU CAN LEARN MORE
THROUGH THAT LINK.
AND THERE WILL BE A FEDERAL WORK
GROUP THAT LOOKS AT PATHWAYS TO
CONSIDER INTEGRATING
SUSTAINABILITY INTO FUTURE
EDITIONS OF THE DIETARY
GUIDELINES.
AT THAT COMMITTEE WILL BE
ESTABLISHED THROUGH -- WE HAVE
AN INTERAGENCY COMMITTEE ON
HUMAN NUTRITION RESEARCH AND
PUBLIC MEETINGS WILL BE HELD TO
DISCUSS THAT TOPIC AND THE WORK
GROUP WILL DEVELOP
RECOMMENDATIONS FOR MOVING
FORWARD AND THOSE RECOMMENDED
APPROACHES WILL BE RELEASED
QUICKLY.
AND WE HAVE A SECTION ON OUR
WEBSITE CALLED RELATED PROJECTS
THAT GIVES UPDATES AND FOR THOSE
THINGS THAT WE HAVE PROVIDED
UPDATES ON TODAY WE'RE GOING TO
TRY TO DO SOME UPDATES ON THE
WEBSITE TODAY TO CARRY FORWARD
THIS INFORMATION BUT AS YOU CAN
SEE THERE'S A NUMBER OF
DIFFERENT ADDITIONAL TOPICS WE
ADDRESS ON THE WEBSITE AND FOR
THOSE INTERESTED AND MORE FOLLOW
THAT WORK AND WE'LL TRY TO KEEP
THAT UPDATED FOR FUTURE
REFERENCE.
>>SO BEFORE WE TURN IT OVER TO
THE COMMITTEE I WANTED TO TAKE
ONE SECOND TO ACKNOWLEDGE A
MEMBER OF OUR TEAM THAT IS
RETIRING.
JOANNE SPON I THINK SHE'S IN THE
OVERFLOW ROOM BUT SHE'S BEEN
WITH CPP 15 YEARS AND HAS BEEN
INSTRUMENTAL IN DEVELOPING THE
METHODS FOR NUTRITION INDEX
LIBRARY NOW IN THE MEDICAL
REVIEW BRANCH.
SHE'S BEEN WITH US ALMOST SINCE
DAY ONE.
CONGRATULATIONS.
THIS IS HER FOURTH COMMITTEE
SHE'S SUPPORTED AND SHE WILL BE
STAYING WITH US THROUGH THE
SUMMER BUT THIS IS HER LAST
PUBLIC MEETING I JUST WANTED TO
SAY THANK YOU FOR YOUR
CONTRIBUTIONS AND BEST OF LUCK
AS YOU SAIL OFF TO RETIREMENT.
IN ADDITION TO THE 15 YEARS WITH
US SHE HAD 23 YEARS HERE.
WITH THAT WE WILL -- FIRST, I'LL
NOTE ARE THERE ANY QUESTIONS --
THERE SHE IS.
THERE'S JOANNE.
THANK YOU.
SO ANY QUESTIONS ON ANYTHING
THAT JANET AND I CAN ADDRESS
BEFORE WE TURN IT OVER TO ALL OF
YOU?
ALL RIGHT.
SO WITH THAT WE'LL TURN IT OVER
TO THE COMMITTEE.
THANK YOU.
>>THANK YOU.
ON BEHALF OF THE TEAM, 2025,
DGAC, FIRST, THANK YOU REAR
ADMIRAL REED FOR YOUR SUPPORT
AND INSPIRING WORK AND WE
COMPLETELY CONCUR WITH YOU, THIS
IS AN AMAZING FEDERAL STAFF SO I
WOULD LIKE ANOTHER ROUND OF
APPLAUSE.
WE'RE VERY ENTHUSIASTIC HERE.
THE GOAL OF THIS PUBLIC MEETING
IS FOR THE INDIVIDUAL
SUBCOMMITTEES AND WORKING GROUPS
TO SHARE THEIR UPDATES, THEIR
HARD WORK WITH THE FULL
COMMITTEE.
IT'S A DAUNTING ENDEAVOR AS
WE -- AS MANY OF US HAVE BEEN
DISCUSSING SO THE COMMITTEE HAS
DIVIDED UP THE IMPORTANT TASK AT
HAND AND THE STRUCTURE WHICH MY
COLLEAGUE, DR. ANGELA
ODOMS-YOUNG AND I WILL BE
SUMMARIZING.
AS MENTIONED BY BOTH JANET AND
BY EVE, WE SIMPLY CANNOT ADDRESS
ALL THE SCIENTIFIC QUESTIONS AT
HAND WITH GIVEN THE TIME AND
RESOURCES.
SO WE WILL DISCUSS HOW WE HAVE
REFINED AND PRIORITIZED
SCIENTIFIC QUESTIONS DRAWING ON
TEAM 2025s DGAC'S EXPERTISE AND
THAT'S WHAT THE CRUX OF TODAY'S
MEETING IS EACH OF THE
COMMUNICATE CHAIRS DESCRIBE
THEIR QUESTION REFINEMENT AND
PRIORITIZATION CRITERIA.
WE'RE REALLY EXCITED TO DESCRIBE
THE PROTOCOLS THAT HAVE BEEN
DEVELOPED AND FINALLY TO ECHO
WHAT REAR ADMIRAL REED MENTIONED
AND JANET AND EVE, WE ENCOURAGE
THE PUBLIC TO STAY ENGAGED WITH
THE PROCESS.
YOU'RE INPUT IS GREATLY VALUED
BY THIS TEAM.
OKAY, DISCLOSURES.
SO AS THE COMMITTEE KNOWS WHEN
WE WERE FIRST REVIEWED PART OF
OUR VETTING PROCESS ABOVE AND
BEYOND OUR SCIENTIFIC EXPERTISE
WAS A BACKGROUND CHECK.
BY BACKGROUND CHECK BY HEALTH
AND HUMAN SERVICES TO DETERMINE
IF ANY OF THE CANDIDATES HAVE A
FINANCIAL, ETHICAL, LEGAL AND/OR
CRIMINAL CONFLICT OF INTEREST.
AND WE ALL WORKED WITH THE HHS
ETHICS COMMITTEE.
WE REVIEWED OUR DISCLOSURES NOW,
WHAT IS VERY UNIQUE ABOUT THIS
COMMITTEE BECAUSE WE REALLY
VALUE TRANSPARENCY, THE
COMMITTEE DECIDED THAT IN
ADDITION TO THE COMPLIANCE WITH
THE FEDERAL ETHIC LAWS AND
REGULATIONS THAT GOVERN CONFLICT
OF INTEREST WE'D DO SOMETHING
MORE.
WE WERE GOING TO VOLUNTARILY
DISCLOSE ANY RELATIONSHIPS,
ACTIVITIES THAT COULD
POTENTIALLY BE RELATED TO THIS
SCIENTIFIC REVIEW AND WE
COLLECTED THEM AND WE COLLATED
THEM IN ACCORDANCE TO THE
HIGHEST STANDARD OF JOURNALS THE
INTERNATIONAL COMMUNITY OF
JOURNAL EDITORS AND COMPLIED ALL
OUR DISCLOSURES.
NOW, RELATED MEANS ANY RELATION
WITH A FOR PROFIT OR NOT FOR
PROFIT THIRD PARTY WHOSE
INTERESTS MAY BE AT ALL AFFECTED
BY THE CONTENT.
THESE DISCLOSURES HAVE BEEN
POSTED ON DIETARY GUIDELINES.gov
AND I THINK SPEAKING PERSONALLY,
MY PERSONAL OPINION, I THINK WE
ALL SHOULD BE SO PROUD OF
OURSELVES FOR OUR COMMITMENT TO
TRANSPARENCY AND I THINK ALSO
WHEN YOU LOOK AT OUR COLLECTIVE
DISCLOSURES WHICH INCLUDES ALL
OUR FUNDING AND PROFESSIONAL
RESPONSIBILITIES.
WE ROCK, WE ARE AMAZING.
WE HAVE SO MUCH ENGAGEMENT IN
THE SCIENCE WHICH IS THE VERY
REASON EACH AND EVERY ONE OF US
WAS CHOSEN TO BE ON THIS
COMMITTEE.
BUT I ALSO WANT TO EMPHASIZE
THERE'S NOT A SINGLE DECISION
THAT IS RELATED TO AN
INDIVIDUAL.
THIS IS A TEAM.
THIS IS A COMMITTEE, WE WORK
TOGETHER AND DEBATE AND DISCUSS
AND ENGAGE AND COME TOGETHER AND
THAT FINAL SCIENTIFIC REPORT IS
A REFLECTION OF ONE ENTITY.
THIS COMMITTEE NOT AN
INDIVIDUAL.
FROM ANY PERSPECTIVE, THANK YOU
ALL I COMMEND EVERYONE TO THEIR
LEVEL OF TRANSPARENCY AND
HIGHEST LEVEL OF ETHICS AND
THANK YOU VERY MUCH FOR THAT.
PROGRESS SINCE LAST MEETING.
AS WE SAID THIS IS A WELL OIL
MACHINE AND THE AMOUNT OF WORK
WE HAVE AHEAD OF SUS -- US IS
DAUNTING.
INITIALLY THEY WERE WORK GROUPS
WITH THE EXPECTATION THERE WOULD
BE REORGANIZATION BASED ON HOW
THE TOPICS PLAYED OUT AND
PRIORITIZATION AND EXPERTISE.
HOWEVER, FEDERAL STAFF WERE SO
HAD SO MUCH WISDOM AND FORESIGHT
THAT OUR WORKING GROUPS BECAME
AUR SUBCOMMITTEE.
WE HAD MINOR SHIFTS IN
MEMBERSHIP AND IT MEANS
CONTINUITY FOR EVERY COMMITTEE
TO ANOTHER SUBCOMMITTEE AND
THERE'S CONTINUITY WITH THE
WORKING GROUPS.
SO THE WORKING GROUPS ZRUFD THE
SCIENTIFIC QUESTIONS RELATED TO
THE TOPIC AREAS.
THEY REFINE AND PRIORITIZE THE
QUESTIONS AND IMPORTANTLY
IDENTIFY THE ORDER IN WHICH --
WE WILL DEVELOP THE PROTOCOLS.
WE'RE NOT DOING THIS ALL AT
ONCE.
AS I SAY IT'S A WELL OILED
MACHINE AND SPEAKS TO THE
HIGHEST LEVEL OF ORGANIZATIONAL
PRINCIPLES.
WE HAVE TWO REALLY EXCITING NEW
WORKING GROUPS.
ONE IS THE HEALTH EQUITY WORKING
GROUP WHICH WE WILL BE HEARING
MORE ABOUT LATER AND THIS WAS
FORMED TO DISCUSS HOW TO
INCORPORATE PRINCIPLES OF HEALTH
EQUITY ACROSS ALL THE
SUBCOMMITTEES.
WE ALSO HAVE A BRAND NEW
META-ANALYSIS WORKING GROUP
WORKING CLOSELY WITH THE
SYSTEMATIC REVIEW TEAM TO REFINE
PROTOCOLS FOR A LIMITED NUMBER
OF QUESTIONS.
AS JANET SAID WE HAVE A FINITE
TIME OF MEMBERSHIP AND WE'RE
GOING TO BE LOOKING AT A FINITE
NUMBER OF QUESTIONS WITHIN THE
SYSTEMATIC REVIEWS AND AS WE
WILL BE TALKING ABOUT MORE
TODAY, WE PRIORITIZED QUESTIONS
AND DRAFTED PROTOCOLS.
FOR ANYBODY LISTENING IN WHO IS
NOT FAMILIAR WITH THIS PROCESS,
THIS GROUP HAS BEEN MEETING
EVERY -- EACH SUBCOMMITTEE HAS
BEEN MEETING EVERY WEEK.
EVERY SINGLE MEMBER OF THIS
COMMITTEE HAS BEEN PARTICIPATING
IN MULTIPLE ZOOM CALLS JUST TO
REVIEW AND PRIORITIZE AND MOVE
THE WORK.
WE HAVE HAD PEOPLE CALL FROM
HOTEL ROOMS, CONFERENCES, AND
IT'S AN ENGAGED GROUP SO THANK
YOU.
NEXT SLIDE.
I WOULD NOT ASK YOU TO READ
THIS.
I THINK THE IMPORTANT STRUCTURE
HERE THE IMPORTANT MESSAGE HERE
IS WE HAVE FOUR SUBCOMMITTEES.
DIETARY PATTERNS AND SPECIFIC
DIETARY PATTERNS ACROSS THE LIFE
STAGES AND WE HAVE PREGNANCY AND
BIRTH FOR ADOLESCENCE FOOD
PATTERNING AND DATA ANALYSIS AND
STRATEGY FOR FAMILIES RELATED TO
DATA QUALITY MANAGEMENT.
EACH OF THOSE SUBCOMMITTEE
CHAIRS WILL HAVE THEIR PROTOCOLS
AND PRIORITIZIZATION TODAY.
WE LOOK FORWARD TO THE
DISCUSSION.
OVERRIDING THE WORKING GROUP IS
THE HEALTH EQUITY WITH THE
INTENT OF LOOKING AT EACH OF THE
SUBCOMMITTEES TRUE THE LENS OF
HEALTH EQUITY AND THEN WE ALSO
HAVE THE META-ANALYSIS WORKING
GROUP.
THERE'S THREE APPROACHES FOR
EXAMINING THE EVIDENCE.
WE HAVE THE SYSTEMIC REVIEWS AND
FOOD PATTERN MODELLING AND THEN
THE DATA ANALYSIS.
THE GROUP BEEN FOCUSSING
PRIMARILY ON THE FOOD PATTERN
MODELLING AND THERE'S NOW WORK
COMING UP WITH THE DATA ANALYSIS
AND AGAIN THESE WILL BE
DISCUSSED BY OUR COMMITTEE
CHAIRS WORKING GROUP AND THE
META-ANALYSIS WILL FALL UNDER
THE SYSTEMIC REVIEW APPROACH.
THE COMMITTEE USES THE SAME
CRITERIA AS HEALTH AND HUMAN
SERVICES IN THE U.S. DEPARTMENT
OF AGRICULTURE IN THEIR
REFINEMENT AND -- WE HAVE A MIX
THERE BUT THAT'S OKAY.
WE HAVE A COVERAGE OF THE TOPICS
IN THE COMMITTEE REVIEW.
IT'S REALLY IMPORTANT TO
CONSIDER THE WORK OF THE GROUP
COLLECTIVELY SO WE KNOW WE TALK
ABOUT INDIVIDUAL QUESTIONS BUT
THEY MAY NOT BE IN ISOLATION IN
TERMS OF THE COMMUNICATES OR
QUESTIONS.
FOR EXAMPLE WHEN WE TALK ABOUT
DIETARY PATTERNS IT'S GOING TO
BE COVERED BY MORE THAN ONE
SUBCOMMITTEE TO ENCOMPASS
MULTIPLE LIFE STAGES.
SO FOR EXAMPLE, DIETARY PATTERNS
IN SUBCOMMITTEES ONE, TWO AND
THREE, OLDER ADULTS ARE INCLUDED
IN REVIEWS ACROSS SUBCOMMITTEE
ONE, THREE AND FOUR.
THE FLIP IS THAT SOME TOPICS MAY
NOT BE COVERED IN THE
SUBCOMMITTEE BUT MAY BE IN
ANOTHER.
SO FOR EXAMPLE THE DIETARY
PATTERNS GROUP SUBCOMMITTEE ONE
IS GOING TO BE EXAMINING THE
AMOUNTS OF ALL ULTRAPROCESSED
FOODS AND FOODS WITH ADDED
SUGARS WILL BE ADDRESSED IN THE
QUESTIONS ON BEVERAGES IN
SUBCOMMITTEE ONE AND IN THE FOOD
PATTERN MODELS AND DATA ANALYSIS
AND SUBCOMMITTEE THREE.BEVERAGE
AND IN THE FOOD PATTERN MODELS
AND DATA ANALYSIS AND
SUBCOMMITTEE THREE.
THESE ARE EXAMPLES TO HIGHLIGHT
TO THE PUBLIC WE VALUE YOUR
INPUT AND THESE WERE TOPICS
RAISED IN THE PUBLIC COMMENTS
AND WE'RE MAKING EVERY EFFORT TO
ADDRESS THESE IF NOT IN ALL
COMMITTEES AT LEAST ONE.
THE COMMITTEE USE THE SAME
CRITERIA AS HEALTH AND HUMAN
SERVICES IN THE U.S. DEPARTMENT
OF AGRICULTURE IN REFINING THE
QUESTIONS BUT ALSO PRIORITIZING
THEM.
WE JUST REALLY WANT TO EMPHASIZE
PRIORITIZATION WAS NOT TAKEN
LIGHTLY.
WE HAVE ONLY SO MUCH TIME AND
RESOURCES.
THIS GROUP MADE A CONCERTED
EFFORT AND PASSIONATE EFFORT TO
PRIORITIZE WHAT WOULD BE
REASONABLY ACHIEVED THAT WOULD
HAVE THE MAXIMUM BENEFIT FOR THE
AMERICAN PEOPLE.
SO WE HAVE IN TERMS OF RELEVANCE
THE QUESTIONS WE DISCUSSED HAVE
TO BE WITHIN THE SCOPE OF THE
DIETARY GUIDELINES AND IT'S
FOCUSSED ON FOOD-BASED
RECOMMENDATIONS.
SO WE JUST WANT TO EMPHASIZE WE
DO NOT PRIORITIZE WE DO NOT
TACKLE CLINICAL GUIDELINES FOR
MEDICAL TREATMENT.
WE ADDRESS QUESTIONS THAT ARE
ADDRESS PUBLIC HEALTH CONCERN OR
UNCERTAINTY.
IMPORTANCE IS SOMETHING WE
DISCUSS A GREAT DEAL IN OUR
PRIORITIZATION.
THERE'S HAS TO BE A HIGH
PROBABILITY THE QUESTIONS WE
ADDRESS WILL PROVIDE THE
SCIENTIFIC FOUNDATION FOR
GUIDANCE THAT WILL INFORM THE
FEDERAL FOOD AND NUTRITION
POLICIES AND PROGRAMS.
I APPRECIATE THE REVIEWING AND
WE'RE NOT ADDRESSING WHAT CAN BE
ADDRESSED THROUGH PLANNED
EVIDENCE BASE OR FEDERAL
GUIDANCE OTHER THAN THE DIETARY
GUIDELINES FOR EXISTING ONES.
THERE'S A CONCERTED EFFORT TO
COMPLEMENT EACH OTHER'S
ACTIVITIES BUT KEEP EACH OTHER
INFORMED.
FINALLY, RESEARCH RELIABILITY
AND AS A PLEA TO EARLIER STAGE
INVESTIGATORS OUT THERE TAKE
NOTE WHERE THE IS AND WHY THE
GAPS IS.
IT'S A TOUGH ISSUE.
WHEN WE LOOK AT THE WE HAVE TO
LOOK AT THE AVAILABILITY OF THE
EVIDENCE FOR THE PROPOSED
QUEST
QUESTIONS WE HAVE TO DETERMINE
IF THERE'S SUFFICIENT EVIDENCE
TO UPDATE AN EXISTING VIEW.
WE MAY BE PASSIONATE ABOUT AN
EMERGING TOPIC BUT IF WE DON'T
HAVE THE RESEARCH, THE QUESTION
IS GOING TO BE IDENTIFIED AN
AREA AS NEEDING MORE RESEARCH TO
A PLEA TO EARLIER STAGE
INVESTIGATORS AND PEOPLE
INSPIRED IN THE RESEARCH DOMAIN,
THIS IS WHERE YOU CAN SEE
THERE'S REALLY IMPORTANT PUBLIC
HEALTH QUESTIONS WHERE WE DON'T
HAVE ENOUGH EFFORT TO DRAW
CONCLUSIONS.
WITH THAT I'LL HAND IT OVER TO
MY COLLEAGUE DR. ODOMS-YOUNG.
>>THANK YOU SO MUCH.
AND I JUST WANT TO REITERATE
JUST THE POSITIVE ENERGY OF THE
COMMITTEE, THE GREAT WORK OF THE
SUBCOMMITTEES.
THERE ARE A FEW THINGS THAT HAVE
COME UP.
ONE SORT OF CROSS-CUTTING
OUTCOMES THAT HAVE BEEN REFINED
RELATED ACROSS QUESTIONS.
ONE OF THOSE IS GROWTH SIZE BODY
COMPOSITION AND RISK OF OBESITY
AND WEIGHT LOSS AND MAINTENANCE.
SEVERAL QUESTIONS WERE PROPOSED
TO THE COMMITTEE WITH THE
OUTCOME OF GROWTH SIZE, BODY
COMPOSITION AND RISK OF
OVERWEIGHT AND OBESITY AND
WEIGHT LOSS AND MAINTENANCE.
ACROSS QUESTION THE WORDING OF
THIS OUTCOME HAS BEEN REFINED TO
GROWTH BODY COMPOSITION AND RISK
FOR OVERWEIGHT.
THE ORIGINAL WORDING IS THE
RELATIONSHIP BETWEEN DIETARY
PATTERNS CONSUME AND GROWTH SIZE
AND RISK OF OVERWEIGHT AND
OBESITY AND WEIGHT LOSS
MAINTENANCE.
THE NEW WORDING REFINES THAT
QUESTION IN THE OUTCOME ACROSS
QUESTIONS TO BE WHAT IS THE
RELATIONSHIP BETWEEN DIETARY
PATTERNS CONSUMED, GROWTH, BODY
COMPOSITION AND RISK FOR
OBESITY.
THE RATIONALE FOR THE CHANGE AND
THIS YOU WILL SEE AS YOU GO
THROUGH THE SUBCOMMITTEES IS
CLARITY AND CONSISTENCY.
SO THE IDEA OF HAVING CLARITY
AND CONSISTENCY ACROSS THE
QUESTIONS AS IT RELATES TO THE
REFINEMENT AND PRIORITIZATION TO
MAKE SURE THAT WE HAVE SORT OF
THE FULL RANGE AND CONSISTENCY
AS WE CONSIDER RECOMMENDATIONS
ACROSS THE LIFE STAGES.
SO IT STILL INCLUDES A FULL
RANGE OF RELATED OUTCOMES.
THEY WILL BE ADDRESSED SO GROWTH
SIZE, GROWTH AND SIZE FOR
INFANTS, TODDLERS, CHILDREN AND
ADOLESCENT AND HEIGHT AND AGE
AND BODY COMPOSITION AND RISK
FOR OVERWEIGHT -- SORRY, RISK
FOR OBESITY AND RISK IN ADULTS
AND PREGNANCY AND POSTPARTUM
WHICH IS A CRITICAL CHANGE
RELATED TO WEIGHT CHANGE.
SO WHEN WE THINK ABOUT WHAT IS
GUIDING THE WORK, WHAT IS OUR
PLAN.
A PROTOCOL IS A PLAN AND THIS IS
ESSENTIAL GIVEN THE STAGE WE'RE
AT AND FOOD PATTERN MODEL ILING
AND COMMITTEES EXCEPT FOR THREE.
CHRIS IS GOING TO DIG DEEP IN
FULL PATTERN MODELLING.
AND OVER ALL A PROTOCOL IS A
PLAN FOR HOW THE SCIENTIFIC
APPROACH WILL BE USED TO EXAMINE
THE EVIDENCE RELATED TO EACH
QUESTION.
SO PROTOCOLS WERE CREATED FOR
EACH QUESTION BEFORE THE
COMMITTEE EXAMINES ANY EVIDENCE
AND SO DRAFT PROTOCOLS WILL BE
DISCUSSED BY EACH SUBCOMMITTEE
AND REFINED.
AS WE TALK TODAY AND THE
PROTOCOLS ARE POSTED ONLINE FOR
PEOPLE TO REVIEW TO UNDERSTAND
THE APPROACH USED TO ANSWER THE
SCIENTIFIC QUESTIONS.
A DRAFT PROTOCOLS ARE EXPECTED
TO BE POSTED ON DIETARY
GUIDELINES.gov AND ON NESR, AND
KUDOS, PHENOMENAL WORK.
THIS PRESPECIFIED PLAN FOR HOW
NESR AND THINGS LIKE POPULATION,
INTERVENTION AND EXPOSURE
COMPARATORS, OUTCOMES, WHAT ARE
THOSE KEY CONFOUNDERS AND
DEFINITIONS OF KEY TERMS.
SO A SYNTHESIS PLAN THAT
OUTLINES HOW THIS EVIDENCE WILL
BE ORGANIZED WILL BE PRESENTED
AND THEN I WANT TO TALK A LITTLE
BIT ABOUT THE INCLUSION AND
EXCLUSION CRITERIA THAT WILL BE
USED TO DETERMINE WHICH ARTICLES
WILL BE INCLUDED IN EACH REVIEW.
SO THE PROTOCOLS DISCUSSED TODAY
AGAIN WILL BE POSTED ONLINE TO
PROVIDE TRANSPARENCY AND I THINK
THEY ALSO SERVE AS A MODEL WHEN
WE THINK ABOUT APPROACHES FOR
SYSTEMIC REVIEWS.
THEY CAN PROVIDE IMPORTANT
INSIGHT WITHIN THE FIELD OVER
ALL SO THAT TRANSPARENCY TO
PROTECT AGAIN SELECTIVE
REPORTING AND FACILITATE PUBLIC
COMMENTS BECAUSE YOU CAN'T
COMMENT ON THE PROTE -- YOU CAN
COMMENT ON THE PROTOCOLS AT
NESR@FDA.gov AND IT'S APPLIED
ACROSS COMMITTEE REVIEWS AND IN
SOME CASES FOR SPECIFIC
QUESTIONS AND LIFE STAGES THERE
WILL BE SOME TAILORING FOR EACH
QUESTION.
AS A GENERAL OVERARCHING
PERSPECTIVE WHEN IT COMES TO
STUDY DESIGN, RCTs ARE INCLUDED,
NON-RANDOMIZED CONTROL TRIALS
AND QUASI-EXPERIMENTAL STUDIES,
PERSPECTIVE COHORT STUDIES AND
RETROSPECTIVE STUDIES AND CASE
CONTROL STUDIES AND THERE'S
UNCONTROLLED STUDIES AND
ECOLOGICAL STUDIES AND NARRATIVE
REVIEWS AND SYSTEMIC REVIEWS AND
META-ANALYSIS ARE EXCLUDED.
ONLY HUMANS.
THE DIETARY GUIDELINES IS
FOCUSSED ON HUMAN STUDIES NOT
NON-HUMANS.
AND WE ARE LOOKING AT THE PEER
REVIEW ARTICLES PUBLISHED IN
RESEARCH JOURNALS.
TO THE POINT THAT IF IT'S NOT IN
THE EVIDENCE IT'S NOT INCLUDED
FOR CONSIDERATION IN THE
PROTOCOLS SO IT'S ESSENTIAL THAT
THAT PEER-REVIEWED EVIDENCE
CONTINUES TO GROW WHEN WE LOOK
AT SOME OF THESE ISSUES.
SO AGAIN I WANT TO SAY THAT IT'S
NOT OPINION IT'S INCLUDED IN
THOSE SYSTEMIC REVIEWS OR PEER
REVIEWED ARTICLES PUBLISHED IN
RESEARCH JOURNALS.
PUBLISHED IN ENGLISH, NOT
PUBLISHED IN ENGLISH ARE
INCLUDED AND STUDIES CONDUCTED
IN COUNTRIES CLASSIFIED AS HIGH
OR VERY HIGH ON THE HUMAN
DEVELOPMENT INDEX.
THE YEARS THE INTERVENTION OR
EXPOSURE DATA WAS COLLECTED.
SO AS I MENTIONED THE CRITERIA
HAS BEEN TAILORED TO EACH
QUESTION TO ENSURE IT'S
APPLICABILITY ACROSS THE LIFE
STAGES OF INTEREST.
INCLUSION CRITERIA ARE
EXCLUSIVELY STUDIES THAT ENROLL
PARTICIPANTS NOT DIAGNOSED WITH
A DISEASE BUT INCLUDED ARE
STUDIES THAT ENROLL SOME
PARTICIPANTS THAT ARE DIAGNOSED
WITH A DISEASE OR A DISORDER
THAT AFFECTS FEEDING AND EATING,
SEVERE UNDER NUTRITION, FAILURE
TO THRIVE.
THOUGH STUDIES THAT EXCLUSIVELY
ENROLL PARTICIPANTS WITH A
DISEASE ARE NOT INCLUDED BUT
STUDIES THAT ENROLL SOME
PARTICIPANTS THAT ARE DIAGNOSED
WITH A DISEASE AND OTHER
CRITERIA IS INCLUDED THERE.
AND THEN EXCLUSION CRITERIA ARE
STUDIES THAT EXCLUSIVELY ENROLL
PARTICIPANT ARE DIAGNOSED WITH A
DISEASE, DIAGNOSED WITH A
DISORDER THAT AFFECTS FEEDING OR
EATING ETCETERA, UNDER
NUTRITION, BORN PRE TERM
ETCETERA AS YOU LOOK AT THE
EXCLUSION CRITERIA AND AGAIN
THIS WILL BE POSTED FOR REVIEW
AND PUBLIC COMMENT AT THE
DIETARY GUIDELINES.gov.
SO THE COMMITTEE HAS RECEIVED
APPROXIMATELY 300 WRITTEN
COMMENTS SINCE JANUARY.
WE APPRECIATE YOUR INPUT AND
ENGAGEMENT IN THIS PROCESS.
IT'S SO IMPORTANT TO UNDERSTAND
THAT VOICE FROM THE PUBLIC.
AND SO IT'S GREAT WE'RE GETTING
MORE PUBLIC COMMENTS.
COMMENTS ON PROTOCOLS DISCUSSED
TODAY ARE WELCOMED AS WAS
MENTIONED AND PLEASE SUBMIT THE
COMMENTS TO THE COMMITTEE BY THE
END OF JUNE.
THE WRITTEN COMMENT PERIOD WILL
REMAIN OPEN THROUGHOUT THE
COMMITTEE'S WORK AND IN THE FALL
OF 2024.
SO WE WANT TO HEAR FROM YOU AS
IT SAYS WRITE ON THE SLIDE.
SO PLEASE SUBMIT YOUR COMMENT.
PLEASE SUBMIT COMMENTS AND
PARTICULARLY THOSE WITH THE
LIVED EXPERIENCE.
WE WANT TO HEAR FROM PEOPLE.
WE WANT TO HEAR FROM AMERICANS
THAT THIS WILL INFORM THE DIETS
OF.
SO I'M GOING TO TURN IT OVER TO
THE HEALTH EQUITY WORKING GROUP
TODAY'S AGENDA WHERE WE WILL
HEAR FROM THE HEALTH EQUITY
WORKING GROUP SUBCOMMITTEE ONE
DIETARY PATTERNS AND SPECIFIC
DIETARY COMPONENTS ACROSS THE
LIFE STAGES.
COMMITTEE TWO DIET AND PREGNANCY
AND BIRTH THROUGH ADOLESCENCE
AND THEN WE'LL BREAK FOR LUNCH
AND THEN SUBCOMMITTEE FOUR WILL
GO NEXT TO TALK ABOUT STRATEGIES
FOR INDIVIDUALS AND FAMILIES
RELATED TO DIET QUALITY AND
WEIGHT MANAGEMENT AND THEN WE'LL
HEAR FROM SUBCOMMITTEE THREE WHO
PATTERN MODELLING AND DATA
ANALYSIS AND THEN WE'LL OPEN FOR
DISCUSSION AND ADJOURN AT 3:30.
I'LL TURN IT OVER TO THE HEALTH
EQUITY SUBCOMMITTEE.
>>THANK YOU, GOOD MORNING.
I'M SAMEERA TALEGAWKAR AND I
CHAIR THE HEALTH EQUITY WORKING
GROUP.
I WOULD LIKE TO THANK ALL THE
HEALTH EQUITY WORKING GROUP
MEMBERS FOR THEIR INSIGHT AND
DISCUSSIONS AND THE FEEDBACK AT
THE WORKING GROUP MEETINGS.
WE WOULD LIKE TO THANK THE
WONDERFUL USDA AND HHS STAFF FOR
THEIR SUPPORT AND ASSISTANCE AS
WE CONDUCT OUR MEETINGS.
WE'RE LOOKING FORWARD TO
DISCUSSING THE TOPIC AND AT THE
OUTSET WE'D LIKE TO STATE THE
DEFINITIONS AND CONCEPTS OF THE
WORKING GROUP WE'RE PRESENTING
ARE NOT FINAL THEY'LL BE FURTHER
REF
REFINED.
WE WELCOME FEEDBACK AND INPUT AS
WE INFORM THIS IMPORTANT WORK.
THE DIETARY GUIDELINES FOR
AMERICANS PROVIDES ADVICE ON
WHAT TO EAT AND DRINK TO MEET
NUTRIENT NEEDS, PROMOTE HEALTH
AND PREVENT DISEASE.
IT PROVIDES A FRAMEWORK FOR
HEALTHY EATING THAT CAN BE
TAILORED TO MEET PREFERENCES.
HISTORICALLY AND THERE IS NOW A
RENEWED SENSE OF URGENCY AND
IMPORTANCE FOR THE WORK.
THE ADVISORY COMMITTEE WAS
THEREFORE CHARGED WITH ENSURING
ALL THE SCIENTIFIC QUESTIONS
THAT WOULD BE REVIEWED WOULD BE
REVIEWED FOR THE HEALTH EQUITY
LENS TO ENSURE THE UPDATE IS
RELEVANT TO PEOPLE WITH DIVERSE
ETHNIC AND SOCIO ECONOMIC AND
CULTURAL BACKGROUNDS.
TO ENSURE THIS THE HEALTH AND
HUMAN SERVICES AND THE USDA IS
SUPPORTING THE COMMITTEE TO
DESCRIBE AND CONSIDER FACTORS
SUCH AS SOCIO ECONOMIC POSITION,
RACE, ETHNICITY AND CULTURE TO
THE GREATEST EXTENT POSSIBLE
BASED ON THE INFORMATION
PROVIDED IN THE SCIENTIFIC
LITERATURE AND DATA.
IT'S IMPORTANT TO NOTE THIS IS
AN ALIGNMENT WITH NEW STRATEGIES
TO ADVANCE EQUITY IN THE UNITED
STATES THAT THE HEALTH AND HUMAN
SERVICES AND THE USDA HAVE
INVOLVED PURSUANT TO THE
EXECUTIVE ORDER 13985 DATED
JANUARY 20 OF 2021 ON ADVANCING
RACIAL EQUITY AND SUPPORT FOR
UNDER SERVED COMMITTEE
THROUGHOUT THE FEDERAL
GOVERNMENT.
-- THROUGH THE FEDERAL
GOVERNMENT.
THE HEALTH EQUITY WORKING GROUP
EXAMINED VARIOUS DEFINITIONS
CONCEPTS AND FRAMEWORKS
INCLUDING THOSE PUT FORTH BY THE
WHITE HOUSE HEALTH EQUITY TASK
FORCE, THE CDC AND USDA AMONG
OTHERS.
IT'S ADAPTING ACROSS ALL THESE
TO COME UP WITH ITS OWN
DEFINITION OF HEALTH EQUITY AND
THE NEXT THREE SLIDES WILL
SUMMARIZE THE DEFINITIONS.
WE NOTE AT THE BOTTOM OF EACH OF
THE SLIDES WHERE THE DEFINITIONS
HAVE BEEN ADAPTED FROM.
THE HEALTH EQUITY WORKING GROUP
BELIEVES THAT EQUITY IS THE
CONSISTENT AND SYSTEMATIC
TREATMENT OF ALL INDIVIDUALS IN
A FAIR, JUST AND IMPARTIAL
MANNER INCLUDING INDIVIDUALS WHO
BELONG TO COMMUNITIES THAT HAVE
BEEN -- OFTEN DENIED SUCH
TREATMENT SUCH AS BLACK, LATINO,
INDIGENOUS AND NATIVE AMERICAN
AND ASIAN AMERICAN, NATIVE
HAWAIIAN AND PACIFIC ISLANDER
PERSONS.
AND OTHER PERSONS OF COLOR.
MEMBERS OF VARIOUS MINORITIES,
WOMEN'S AND GIRLS, LGBTQ I +
PERSONS AND PERSONS WHO LIVE IN
RURAL AREAS OR STIGMA HEALTH
CONDITIONS OR FACED WITH
INEQUALITY AND DEFORMITY OR
BELONG TO SUCH COMMUNITY.
WE BELIEVE THIS MEANS
RECOGNIZING THAT PEOPLE'S
FRUSTRATIONS RUN DEEP AND ARE
ROOTED IN THEIR OWN DAILY
BATTLES TO MAKE ENDS MEET TO
PRACTICE AND PRIORITIZE AT THE
HEALTH SELECTION TO PUT FOOT ON
THEIR TABLES AND GIVE THEM A
SHOT AT ECONOMIC OPPORTUNITY AND
RECOGNIZING THE ABILITY TO
SELECT FRUITS AND BEVERAGES IS
LIMITED BY INCOME AND
ENVIRONMENTAL CONSTRAINS NOT IN
THE INDIVIDUAL'S CONTROL
PROMOTING EQUITY MEANS PROMOTING
HEALTHY SELECTION FOR
INDIVIDUALS, ORGANIZATIONS AND
ENVIRONMENTS FOCUSSING ON GROUPS
AND CONTEXT WHERE HELPFUL
DIETARY SELECTION IS MOST
LIMITED.
LASTLY, WE BELIEVE HEALTH EQUITY
SHOULD BE CONSIDERED AS THE
STATE IN WHICH EVERYONE HAS A
FAIR SHARE AND JUST OPPORTUNITY
TO ATTAIN THE HIGHEST LEVEL OF
HEALTH.
ACHIEVING THIS REQUIRES ONGOING
SOCIETAL EFFORT TO ADDRESS
HISTORICAL AND CONTEMPORARY
INJUSTICES TO REMOVE ECONOMIC
SOCIAL AND OTHER OBSTACLES TO
FOOD ACCESS, HEALTH AND HEALTH
CARE SUCH AS POVERTY,
DISCRIMINATION AND THEIR
CONSEQUENCES AND POURLESSNESS
AND ACCESS TO GOOD JOBS WITH
THERAPY AND SAFE ENVIRONMENTS
AND HEALTH CARE.
AND TO ELIMINATE PREVENTIBLE
HEALTH DISPARITIES.
WE WILL NOW DISCUSS THE
COMMITTEE CONSIDER APPLYING
HEALTH EQUITY LENS THROUGH THE
THREE APPROACHES USED TO EXAMINE
THE EVIDENCE FOR THE GUIDELINES.
AS WE KNOW AND HAS BEEN
DISCUSSED THE THREE APPROACHES
ARE THE SYSTEMIC REVIEWS AND
FOOD PATTERN MODELLING AN DATA
ANALYSIS.
EACH APPROACHES HAVE ITS OWN
RIGOROUS PROTOCOL AND PLAYS A
UNIQUE AND COMPLIMENTARY ROLE IN
EXAMINING THE EVIDENCE.
SUBSEQUENT SUBCOMMITTEE
PRESENTATIONS WILL DISCUSS
PROTOCOLS IN DETAIL BUT THE
HEALTH WHY THE WORKING GROUP
WILL LIKE TO PROVIDE CONTEXT ON
HOW HEALTH EQUITY IS CONSIDERED
IN THE PROTOCOLS AS THEY'RE
BEING DEVELOPED AND CONSIDERED.
THE FIRST IS THE SYSTEMIC
REVIEWS WHICH IS SUPPORTED BY
USDA TEAM.
DURING THE PROTOCOL DEVELOPMENT
PROCESS THE SYSTEMIC REVIEW
SUBCOMMITTEE WILL IDENTIFY KEY
VARIABLES OF INTEREST RELATED TO
HEALTH EQUITY TO CONSIDER
THROUGHOUT THE REVIEW PROCESS.
IN THE DATA EXTRACTION AND
ASSESSMENT OF RISK BY STEPS THE
PROTOCOL WILL EXTRACT
DESCRIPTIVE DATA FOR VARIABLES
TO THE EXTENT POSSIBLE AND
ADDRESS HEALTH EQUITY KEY
CONFOUNDERS AND OTHER VARIABLES
IN THE RISK OF BIAS ASSESSMENT.
FOR THE NEXT SET OF PROTOCOL
STEPS DEVELOPING CONCLUSION
STATEMENTS AND READING THE
STRENGTH OF THE EVIDENCE A
HEALTH EQUITY LENS WILL BE
APPLIED BY CONSIDERING SPECIFIC
SUB GROUPS WHEN SYNTHESIZING THE
EVIDENCE AND DOCUMENTING
RESEARCH RECOMMENDATIONS THAT
ADDRESS GAPS AND LIMITATIONS.
THE NEXT APPROACH IS FOOD
PATTERN MODELLING.
NOW, VARIATIONS IN DIETARY
PRACTICES INCLUDING FOODS AND
TRADITIONS WILL BE DISCUSSED AND
CONSIDERED IN MANY OF THE
PRIORITIZED ANALYSIS FOR FOOD
PATTERN MODELLING.
EXAMPLES INCLUDE FLEXIBILITY FOR
THOSE WHO HAVE LACTOSE IN
TOLERANCE OR DO NOT CONSUME MILK
PRODUCTS AND LOOKING AT
CARBOHYDRATES SUCH AS THOSE WHO
CONSUME STARCHY VEGETABLES BUT
LESS GRAINS AND THOSE WHO
CONSUME PLANT BASED VERSUS
ANIMAL PROTEINS AND TO THE
MODELLING WORKING GROUP IS
EXPLORING A NEW METHODOLOGY AND
MODELLING THAT TEST THE
APPLICABILITY OF DIETARY
PATTERNS ACROSS CULTURES AND
CONSIDERS REFINEMENTS NEEDED TO
THE DIETARY PATTERNS TO IMPROVE
CULTURAL INCLUSION.
LASTLY WE HAVE THE DATA ANALYSIS
WHICH IS A COLLECTION OF ALL THE
ANALYSIS THAT USE NATIONAL DATA
SETS TO DESCRIBE THE PATTERNS OF
HEALTH AND DIETARY INTAKES IN
THE UNITED STATES.
NOW, DATA ANALYSIS IS LED BY THE
FEDERAL STAFF AND DELIVERED TO
THE COMMITTEE.
THE 2020 COMMITTEE EXAMINED
DEMOGRAPHIC GROUPS INCLUDING
SEX, RACE AND ETHNICITY, SOCIO
ECONOMIC STATUS INCLUDING FAMILY
INCOME, INCOME TO POVERTY RATIO
AND EDUCATION AS WELL AS AGE AND
LIFE STAGE.
HOWEVER, WE KNOW THE
DEMOGRAPHICS ARE ONLY ONE PIECE
OF THE HEALTH EQUITY AND WE
WANTED TO EXPLORE THE USE OF THE
ADDITIONAL DATA ANALYSIS
VARIABLES TO ALIGN WITH THE
WORKING GROUP CONVERSATIONS WE
ARE HAVING.
IN PROPOSING THESE NEW VARIABLES
TO EXAMINE THERE MAY BE A NEED
TO PRIORITIZE WHICH OF THESE
WOULD BE MOST IMPACTFUL
ANSWERING THE RESEARCH QUESTIONS
AND SUPPORTING WHICHEVER HEALTH
EQUITY FRAMEWORK WE DECIDE TO GO
WITH AS A WORKING GROUP.
TWO IMPORTANT FACTORS IN THESE
DISCUSSIONS WILL BE THE
GENERALIZABILITY OF THE PROPOSED
VARIABLES AND IF THERE'S
SUFFICIENT SAMPLE SIZE FOR
ANALYSIS AND WE ALREADY STARTED
INITIAL CONVERSATIONS WITH OUR
FEDERAL DATA ANALYSTS TO GET A
SENSE FOR WHAT IS POSSIBLE.
WE PROPOSE ANY NEW ANALYSIS OR
VARIABLES TO THE DATA IN THE
ANALYSTS AND THERE'S AN
OPPORTUNITY TO FRAME
RECOMMENDATIONS FOR FUTURE
RESEARCH.
THIS SLIDE LIST THE ADDITIONAL
VARIABLES WE STARTED EXPLORING.
YOU MIGHT SEE THERE'S A STRIKE
THROUGH SOME VARIABLES AND THE
REASON IS THAT WE MIGHT NOT HAVE
SUFFICIENT SAMPLE SIZE AND NO
LONGER CONSIDERED TO BE FEASIBLE
FOR DATA ANALYSIS AND WE'LL
CONTINUE TO REFINE THESE AS WE
WORK WITH THE FEDERAL TEAM AND
THE WORKING GROUP AS WELL.
AND THEN NOW LASTLY WE CONCLUDE
THE DESCRIPTION OF THE WORK DONE
SO FAR.
OUR NEXT STEPS ARE TO CONTINUE
TO REFINE THE VARIABLES FOR
HEALTH EQUITY TO BE CONSIDERED
BY THE COMMITTEE DURING THE
REVIEW OF THE EVIDENCE TO
INCORPORATE CONSIDERATIONS INTO
THE REVIEW OF THE SCIENTIFIC
EVIDENCE AND TO DEVELOP AND
OUTLINE FOR INCORPORATING HEALTH
EQUITY INTO SCIENTIFIC REPORT.
I WOULD LIKE TO END THE
PRESENTATION BY ACKNOWLEDGING
AGAIN OUR WORKING GROUP AND THE
WONDERFUL USDA AND HHS STAFF,
OUR WORKING GROUP IS HAPPY TO
TAKE QUESTION OR COMMENTS YOU
MAY HAVE.
THANK YOU.
>>MAY I JUST START BY SAYING
THANK YOU SAMEERA FOR CHAIRING
THIS REALLY IMPORTANT INNOVATIVE
WORKING GROUP.
THANK YOU FOR A WONDERFUL
PRESENTATION.
WE HAVEN'T HAD ENOUGH COFFEE I
DON'T THINK.
ANY COMMENTS OR QUESTIONS ON THE
HEALTH EQUITY WORKING GROUP?
OKAY.
WE'VE GOT A THUMBS UP FROM
CHRISTOPHER.
OKAY, THANK YOU, SAMEERA AGAIN
AND FOR EVERYONE ON THE
COMMITTEE.
IT'S BEEN A REALLY INFORMED
DISCUSSION UP TO NOW AND I
APPRECIATE THE EVIDENCE PEOPLE
ARE BRINGING TO THE TABLE.
SO THANK YOU.
SO I DO BELIEVE OUR NEXT
PRESENTATION IS SUBCOMMITTEE
ONE, DEANNA, TAKE IT AWAY.
>>THANK YOU, DR. BOOTH.
I AM GOING TO PRESENT SOME OF
THE WORK THAT WE'VE BEEN DOING
IN SUBCOMMITTEE ONE AND I WILL
BE JOINED BY MY FELLOW COMMITTEE
MEMBERS DOCTORS TOBIAS,
GIOVANNUCCI AND RAYNOR.
THIS SAY RATHER LENGTHY
PRESENTATION BECAUSE WE HAVE A
RATHER LARGE AGENDA.
TO LET YOU KNOW WE'LL GO THROUGH
APPROXIMATELY A THIRD OF IT AND
HAVE A PAUSE FOR DISCUSSIONS AND
QUESTIONS AND ANOTHER THIRD,
ANOTHER PAUSE AND THEN QUESTIONS
AT THE END.
JUST WANTED TO LET YOU KNOW THE
LAYOUT.
SO THIS AS WITH PREVIOUS
COMMITTEES I WOULD LIKE TO
ACKNOWLEDGE THE HARD WORK THE
COMMITTEE HAS DONE.
IT'S BEEN A TEAM EFFORT AND WE
HAVE EXCELLENT SXETS ON THIS
COMMITTEE.
AND I'D LIKE TO ACKNOWLEDGE OUR
SUPPORT STAFF.
WE'VE BEEN OVERJOYED TO THEM
WORK WITH US AND APPRECIATED OUR
EXPERTISE AND HAVE DONE A LOT TO
HELP GUIDE US THROUGH THE
PROCESS.
FIRST I'M GOING TO DISCUSS THE
SCIENTIFIC QUESTION REFINEMENT
AND PRIORITIZATION.
WE DEAL MOSTLY WITH SYSTEMIC
REVIEWS AND AS I GO THROUGH THE
PROTOCOLS THERE'S A LOT OF
REDUNDANCY IN THE PROTOCOLS.
SO I WILL SHOW THOSE AND POINT
OUT AREAS THAT ARE NEW.
I'LL HIGHLIGHT THOSE.
I WON'T SPEND A LOT OF TIME
READING THROUGH THE SLIDES ONCE
WE GO THROUGH THEM THE FIRST
TIME.
I WANTED TO ORIENT YOU TO THAT.
SO OUR PRIORITIZED SCIENTIFIC
QUESTIONS THE FIRST GROUP HAS TO
DEAL WITH DIETARY PATTERNS.
AND SO THESE WERE QUESTIONS THAT
WERE OPPOSED TO US BY HHS, USDA.
THERE IS ONE ADDITIONAL QUESTION
THAT WE HAVE ON HERE THAT WAS
PROPOSED BY SUBCOMMITTEE ONE FOR
RISK OF DEPRESSION.
THE REASON THAT WE DID THIS IS
BECAUSE OF FEDERAL STAKEHOLDER
AND PUBLIC COMMENT INTEREST IN
THIS AREA AS WELL AS NEW
EVIDENCE IS AVAILABLE.
IT HASN'T BEEN UPDATED SINCE THE
2015 DIETARY GUIDELINES ADVISORY
COMMITTEE REPORT.
THERE'S A POSSIBILITY OF FINDING
A DIFFERENT RESULT.
THE PRIORITIZATION QUESTIONS
I'LL GO THROUGH ARE LISTED IN
THE ORDER IN WHICH WE HAVE
PRIORITIZED THEM.
SO BASED ON THE COMMITTEE
ENGAGED IN THE PRIORITIZATION
PROCESS.
HOW MANY WE GET THROUGH DEPENDS
ON THE EFFICIENCY OF THE
REVIEWS.
SO THE ONES TOWARDS THE END MAY
NOT BE COMPLETED.
SO IT DEPENDS ON HOW THE REVIEWS
GO.
WE ALSO HAVE PROPOSED SCIENTIFIC
QUESTIONS.
THE PREVIOUS ONES WERE ON
DIETARY PATTERNS.
THESE ARE ON SPECIFIC DIETARY
COMPONENTS.
SO THE FIRST ONE HAS TO DO WITH
THE RELATIONSHIP BETWEEN BENCH
CONSUMPTION AND GROWTH BODY COMP
AND RISK OF OBESITY.
WE'RE LOOKING AT DIFFERENT
BEVERAGE TYPES PRIORITIZED FOR
REVIEW.
TWO ARE NEW.
THE BEVERAGE PATTERNS AND THE
COFFEE AND TEA ARE NEW.
ONE OF THE QUESTIONS I FORGOT TO
MENTION THAT'S NEW ON THE
DIETARY PATTERNS IS ABOUT ULTRA
PROCESSED FOODS.
WE'LL TALK MORE ABOUT THAT LATER
AS WELL.
THE SECOND GROUP THE
RELATIONSHIP BETWEEN BEVERAGE
CONSUMPTION AND RISK OF TYPE II
DIABETES THE BEVERAGE TYPES
PRIORITIZED FOR REVIEW THE
QUESTION IS NEW.
THE RISK OF OUTCOME AND THEN THE
LAST QUESTION IS A NEW ONE AS
WELL WHAT IS THE RELATIONSHIP
BETWEEN FOOD SOURCES OF
SATURATED FAT CONSUMED AND RISK
OF CARDIOVASCULAR DISEASE.
SO THESE ARE GOING ALONG IN
PARALLEL WITH THE DIETARY
PATTERNS SYSTEMIC REVIEW.
THEY'LL BOTH BE HAPPENING AT THE
SAME TIME.
ONE OF THE THINGS I WANTED TO
SAY WITH THE PREVIOUS SLIDE AND
I FORGOT WITH THE DIETARY
PATTERNS, THANK YOU, IF YOU LOOK
AT THE TOP ONES, THOSE ALL HAVE
STRONG STATEMENTS, STRONG
ASSOCIATIONS.
WE ARE LOOKING AT THEM THOUGH
BECAUSE WHAT SAMEERA POINTED OUT
IN TERMS OF HEALTH EQUITY SO
THERE'S NEW DATA PRESENTED ON
THIS AND SO WE REALLY WANTED TO
KIND OF BE UP WITH THAT.
THE OTHER THING THAT I DID WANT
TO POINT OUT IS ONE OF THE
QUESTIONS THAT WE DEPRIORITIZED
AND DON'T HAVE ON THE LIST IS
FOR ALL CAUSE MORTALITY.
AND THE REASON WHY EVEN THOUGH
THERE'S A ROBUST BODY OF
LITERATURE IN THE AREA, THE
STATEMENTS ARE VERY STRONG
REGARDING DIET AND ALL CAUSE
MORTALITY AND WE THOUGHT SOME OF
THESE WERE HIGHER PRIORITY.
SO THERE WERE SEVERAL QUESTIONS
NOT PRIORITIZED FOR REVIEW.
ONE OF THOSE ON HERE IS THE
DIETARY PATTERNS AND ALL-CAUSE
MORTALITY.
MOST OF THESE OTHERS WERE NOT
PRIORITIZED BECAUSE OF A LACK OF
RESEARCH.
SO NESR HAS CONTINUING EXISTING
REVIEWS.
THEY CONTINUALLY MONITOR THE
EVIDENCE.
A LOT OF THESE HAVE LACK OF
RESEARCH AVAILABLE SO DECIDED
THEY WEREN'T PRIORITY FOR THIS
AND THERE WERE ISSUES ASSOCIATED
WITH THEM.
FOR EXAMPLE THE FOOD SOURCES OF
ADDED SUGARS AND GROWTH AND BODY
COMP AND RISK OF OBESITY AND
RISK OF TYPE 2 DIABETES THERE
WERE OTHER EXISTING SYSTEMIC
REVIEWS AND THEY POINTED TO
LOOKING AT SUGAR-SWEETENED
BEVERAGES.
YOU'LL HEAR MORE WHEN WE TALK
ABOUT THE BEVERAGE QUESTION SO
WE WILL ADDRESS THAT.
ALL RIGHT.
SO WE'RE GOING TO BEGIN THE
DRAFT PROTOCOLS.
SO THE DRAFT PROTOCOLS FOR
COMMITTEE REVIEW TODAY INCLUDE
THE DIETARY PATTERNS AND GROWTH
BODY COMP AND RISK OF OBESITY.
THE RISK OF CARDIOVASCULAR
DISEASE AND CERTAIN TYPES OF
CANCER, BREAST, COLORECTAL AND
PROSTATE.
AGAIN WE'RE NOT LOOKING AT LUNG
CANCER BECAUSE OF THE
CONFOUNDING WITH SMOKING AND
RISK OF DEPRESSION.
THE DIETARY PATTERNS WITH
VARYING AMOUNTS OF
ULTRAPROCESSED FOOD AND RISK OF
OBESITY AND BEVERAGES IN GROWTH
BODY COMPOSITION AND RISK OF
OBESITY AND RISK OF TYPE 2
DIABETES.
SO AS WITH WHAT DR. ODOMS-YOUNG
SAID WE'RE FOLLOWING THE
STANDARD INCLUSION AND EXCLUSION
CRITERIA.
SO I'M NOT GOING TO REVIEW THOSE
AGAIN.
TO BEGIN I THINK IT'S IMPORTANT
TO TALK ABOUT WHAT WE MEAN BY
DIETARY PATTERNS.
SO DIETARY PATTERNS THE
DEFINITION IS THE QUANTITIES,
PROPORTIONS, VARIETY OR
COMBINATION OF DIFFERENT FOODS,
DRINKS AND NUTRIENTS WHEN
AVAILABLE IN DIETS AND THE
FREQUENCY WITH WHICH THEY'RE
HABITUALLY CONSUMED.
THE NEXT SLIDE GETS A LITTLE
MORE GRANULAR IN WHAT WE'RE
LOOKING AT.
SPECIFICALLY THE INTERVENTION
EXPOSURE FOR DIETARY PATTERNS
ARE STUDIES THAT EXAMINE THE
CONSUMPTION OR ADHERENCE TO
DIETARY PATTERNS.
FOR INCLUSION IN THE SYSTEMIC
REVIEW THERE HAS TO BE A CLEAR
DESCRIPTION OF WHAT'S CONSUMED.
IN TERMS OF FOODS ARE NUTRIENTS.
IF THEY LIST A SPECIFIC TYPE OF
DIET THEY DON'T GIVE ANY
INFORMATION ABOUT IT THAT WOULD
NOT BE INCLUDED IN THE REVIEW.
THEY ALSO ARE -- WE ALSO ARE
LOOKING AT MULTI-COMPONENT
INTERVENTIONS WHERE THE ISOLATED
INTERVENTION OF INTEREST IS THE
OUTCOME ON THE OUTCOMES OF
INTEREST IS PROVIDED OR CAN BE
DETERMINED DESPITE MULTIPLE
COMPONENTS.
JUST TO LET YOU KNOW WITH THE
OUTCOME WE NEED TO HAVE THAT
OUTCOME CLEARLY DEFINED.
SO THE COMPARATOR HERE IS EITHER
CONSUMPTION OF OR ADHERENCE TO A
DIFFERENT DIETARY PATTERN.
SO YOU MIGHT BE COMPARING ONE TO
ANOTHER.
OR DIFFERENT LEVELS OF
CONSUMPTION OF AND/OR ADHERENCE
TO A DIETARY PATTERN.
SO FOR EXAMPLE IF YOU WERE
LOOKING AT QUINTILES OF
ADHERENCE TO A CERTAIN GUIDE.
THE PROTOCOLS ALL LOOK LIKE
THIS.
THIS IS A BUSY SLIDE.
I'LL BE GOING THROUGH IT ONE AT
A TIME THE COLUMNS TO SHOW YOU
THE PICO ELEMENTS AS WE GOOD
THROUGH.
SO WITH THIS PARTICULAR ANALYTIC
FRAMEWORK FOR THIS QUESTION THE
QUESTION IS WHAT IS THE
RELATIONSHIP IN BODY COMP AND
RISK OF OBESITY AND THE APPROACH
WILL BE AN UPDATE TO AN EXISTING
NESR SYSTEMATIC REVIEW AND HAVE
A REVIEW WE'RE UPDATING NOW.
THE POPULATIONS ARE DIVIDED BY
LIFE CYCLE.
YOU HAVE INFANTS AND TODDLERS
AND CHILDREN AND ADOLESCENTS 2
TO 19 MONTHS AND ADULTS AND
OLDER ADULTS 19 YEARS AND OLDER
AND INDIVIDUALS DURING PREGNANCY
AND POSTPARTUM.
ONE THING TO POINT OUT HERE IS
IT MAY BE -- WE MAY BE ABLE TO
DEFINE THIS A LITTLE BIT MORE
GRANULARLY.
FOR EXAMPLE CHILDREN AND
ADOLESCENCE WE MAY BE ABLE TO
DIVIDE INTO CHILDREN AND
ADOLESCENCE INTO WHAT THE
RESEARCH IS OR MAY BE ABLE TO
PULL OUT OLDER ADULTS.
THAT KIND OF DEPENDS ON WHAT IS
FOUND WITH THE SYSTEMIC REVIEW.
THE NEXT COUPLE OF COLUMNS TALK
ABOUT THE INTERVENTION OR THE
EXPOSURE AND HERE IT'S
CONSUMPTION OF A CERTAIN DIETARY
PATTERN.
AND THEN THE COMPARATOR AS I
MENTIONED BEFORE IS EITHER
DIFFERENT PATTERNS OR ADHERENCE
OR CONSUMPTION TO THE SAME
DIETARY PATTERN.
SO THE NEXT COLUMN TALKS ABOUT
THE OUTCOMES.
AND SO DR. ODOMS-YOUNG WENT OVER
SOME OF THIS IN WHAT SHE
PRESENTED EARLIER BUT IF YOU
NOTICE THE OUTCOMES CORRESPOND
TO THE AGE GROUPS.
SO FOR INSTANCE FOR INFANTS AND
TODDLERS WE WOULD LOOK AT
OUTCOMES IN GROWTH AND THEY'RE
LISTED THERE.
THEY'RE APPROPRIATE FOR THAT AGE
GROUP AND THEN WE'LL ALSO LOOK
AT BODY COMPOSITION IF THEY'RE
FOLLOWED LATER IN LIFE.
AND THAT INCLUDES INFANTS,
TODDLERS, CHILDREN, ADOLESCENCE
ADULTS AND OLDER ADULTS AND FOR
BODY COMPOSITION FOR THAT YOU
CAN SEE THE MEASURES THERE SKIN
FOLD, THICKNESS, FAT MASS,
ECTOPIC MASS AND WAIST
CIRCUMFERENCE.
FOR CHILDREN AND ADOLESCENCE
WE'LL ASSESS OUTCOMES AS GROWTH,
BODY COMPOSITION AND RISK OF
OBESITY BOTH IN CHILDHOOD,
ADOLESCENCE AND ADULTS AND OLDER
ADULTS AND LATER IN LIFE AS
WELL.
FOR ADULTS AND OLDER ADULTS, WE
WILL LOOK AT BODY COMPOSITION.
THOSE WITH A LIST OF OUTCOMES
STATED ABOVE AS WELL AS RISK OF
OBESITY AND HERE WE'LL LOOK AT
WEIGHT LOSS AND WEIGHT
MAINTENANCE.
AND FINALLY FOR INDIVIDUALS
DURING PREGNANCY AND DURING
POSTPARTUM WE'LL LOOK AT
GESTATIONAL WEIGHT GAIN AND
POSTPARTUM WEIGHT GAIN DURING
POSTPARTUM.
THE LAST COLUMN DELINEATES ALL
THE KEY CONFOUNDERS.
THE KEY CONFOUNDERS ARE USED TO
ASSESS RISK OF BIAS.
AND SO THESE ARE GOING TO BE
STANDARD ACROSS MANY OF THE
PROTOCOLS THAT YOU'LL SEE.
BUT THEY INCLUDE SEX, AGE,
PHYSICAL ACTIVITY, ANTHROPOMETRY
AND WE'RE USING THOSE MEASURES
AT BASELINE, RACE, ETHNICITY,
SOCIO ECONOMIC POSITION,
SMOKING, ONLY FOR ADULTS, OLDER
ADULTS AND DURING PREGNANCY.
ALCOHOL INTAKE FOR ADULTS AND
OLDER ADULTS AND PREGNANCY FOR
POSTPARTUM AND DIABETES IN
CURRENT PREGNANCY FOR PREGNANCY,
HYPERTENSIVE DISORDERS IN THE
CURRENT PREGNANCY FOR PREGNANCY
AND IN HUMAN MILK AND
POSTPARTUM.
I WON'T REPEAT THOSE AGAIN.
I JUST WANTED TO GO THROUGH THE
LIST TO GET AN IDEA OF WHAT THEY
WERE.
SO FOR THE INCLUSION AND
EXCLUSION CRITERIA AND THE
RELATIONSHIP BETWEEN DIETARY
PATTERNS AND GROWTH BODY COMP
AND RISK OF OBESITY THE
PUBLICATION DATE IS JANUARY 1980
TO THE PRESENT.
THE INTERVENTION LINK IS SET AT
12 WEEKS OR MORE.
SO 12 WEEKS WAS SET BECAUSE
THAT'S DETERMINED TO BE MORE
HABITUAL CONSUMPTION RATHER THAN
A SHORTER FEEDING STAY FOR
EXAMPLE.
AND THE FOLLOW-UP DURATION HERE
FOR WEIGHT LOSS WAS CONSIDERED
SIX MONTHS OR MORE.
THE FOLLOW-UP DURATION FOR
WEIGHT MAINTENANCE WAS 12 MONTHS
OR MORE.
AND THEN THE SIZE OF THE STUDY
GROUPS JUST TO NOTE FOR
INTERVENTION STUDIES THERE NEEDS
TO BE 30 OR MORE PARTICIPANTS
PER STUDY GROUP FOR BETWEEN
SUBJECT ANALYSES OR POWER
CALCULATION INDICATING THE STUDY
IS APPROPRIATELY POWERED FOR THE
OUTCOME OF INTEREST.
FOR OBSERVATIONAL STUDIES,
ANALYTIC SAMPLE SIZE OF 1,000 OR
MORE PARTICIPANTS IS REQUIRED
AND THIS IS ONLY FOR ADULTS AND
OLDER ADULTS.
OKAY.
SO WE'RE ON TO THE SECOND
QUESTION.
AGAIN, THIS WILL BE A LITTLE
SHORTER, I WON'T REPEAT A LOT OF
THIS BUT WHAT IS THE
RELATIONSHIP BETWEEN DIETARY
PATTERNS CONSUMED AND RISK OF
CARDIOVASCULAR DISEASE.
SO ONCE AGAIN THIS IS AN UPDATE
TO AN EXISTING NESR SYSTEMIC
REVIEW.
IF YOU LOOK AT THE POPULATION WE
DO NOT HAVE PREGNANCY OR
POSTPARTUM HERE.
THAT'S SOMETHING DIFFERENT THAN
WHAT WE SAW BEFORE.
SOME OF THIS WILL BE ADDRESSED
IN SUBCOMMITTEE TWO.
THE INTERVENTION EXPOSURE AND
COMPARATOR ARE THE SAME AS
PREVIOUSLY MENTIONED.
THE OUTCOMES HERE ARE FOCUSSED
ON CARDIOVASCULAR DISEASE.
SO INCLUDE BLOOD LIPID LEVELS,
BLOOD PRESSURE, HYPERTENSION,
CARDIOVASCULAR DISEASE,
MORBIDITY, STROKE AND
CARDIOVASCULAR DISEASE RELATED
MORTALITY.
IN TERMS OF KEY CONFOUNDERS, A
LOT OF THE CONFOUNDERS THAT WERE
ASSOCIATED WITH PREGNANCY AND
POSTPARTUM ARE NOT HERE AS I
MENTIONED.
SMOKING IS APPLIED TO ADULTS AND
OLDER ADULTS AND THEN ALCOHOL
INTAKE IS FOR ADULTS AND OLDER
ADULTS.
OTHERWISE THE KEY CONFOUNDERS
ARE FAIRLY THE SAME.
ONE DIFFERENCE IS ANTHROPOMETRY
IS SEEN AS A MORE GENERAL
ASSESSMENT AND RISK OF OBESITY
OUTCOMES.
AND THIS IS SIMILAR TO WHAT A
PRESENTED EARLIER.
NOW I'D LIKE TO TURN IT OVER TO
DR. TOBIAS.
>>THANK YOU VERY MUCH.
SO THIS IS FOLLOWING
CARDIOVASCULAR DISEASE AND
YOU'LL SEE THE PROTOCOLS ARE
SIMILAR.
I'M GOING TO POINT OUT SOME KEY
DIFFERENCES.
FOR TYPE 2 DIABETES WE SIMILARLY
DO NOT INCLUDE PREGNANT WOMEN
BUT NOTE THERE IS A PROJECT
WITHIN SUBCOMMITTEE TWO LOOKING
AT DIABETES AND PREGNANCY
INCLUDING GESTATIONAL DIABETES
SO THAT WILL BE COVERED THERE.
WE HAVE DIFFERENCES IN OUTCOMES
ACROSS THE LIFE SPAN
ACKNOWLEDGING TYPE 2 DIABETES
WOULD BE LESS PREVALENT IN
CHILDREN AND TODDLERS AND
ADOLESCENTS BUT WE'LL INCLUDE
THOSE AS WELL AS THE GLYCEMIC
TRAIT BIOMARKERS.
KEY CONFOUNDERS THAT WE
PRIORITIZE ARE THE SAME FOR
CARDIOVASCULAR DISEASE.
SO BUILDING ON THE PREVIOUS NESR
SYSTEMIC REVIEW WE'LL BE
EVALUATING LITERATURE INCLUDING
THE DATA PUBLISHED SINCE 1980
INTERVENTION LENGTH AND OTHER
STUDIES AND CONSIDERATIONS ARE
THE SAME AS THE OTHER CRITERIA
FOR CARDIOVASCULAR DISEASE.
>>SO NOW WE'D LIKE TO OPEN THE
FLOOR FOR COMMITTEE DISCUSSION.
SO DOES ANYONE HAVE ANY
QUESTIONS FOR THE COMMITTEE?
COMMENTS?
>>I HAVE A COMMENT AS ONE WHO
ALWAYS HAS AN OPINION.
I WAS REALLY STRUCK, FIRST,
THANK YOU, DEANNA FOR TALKING
ABOUT TYPE 2 AND SUBCOMMITTEE
ONE AND TYPE 2 DIABETES AND WHAT
STRIKES ME IS WHAT THE CRITERIA
IS FOR INCLUSION AND EXCLUSION.
AND I WAS SIGNATURE HERE
THINKING, HMM, IMAGINE IF YOU
DID A SPECTACULAR PROJECT BUT
YOU OMITTED TO DESCRIBE THE
DETAILS OF YOUR DIETARY PATTERNS
SO IT WAS EXCLUDED.
SO I THINK THAT WE AS A
COMMITTEE WHEN WE COME TO
WRITING UP OUR REPORT WE NEED TO
EMPHASIZE THE NEED FOR RIGOROUS
METHODOLOGY SO THAT ALL THAT
RESEARCH BEING CONDUCTED CAN BE
INCLUDED IN ACTIVITIES SUCH AS
HERE.
SO I JUST WANT TO COMMEND THE
COMMITTEE -- SUBCOMMITTEE
BECAUSE SEEING THE EXCLUSION I
THINK IS AS POWERFUL AS SEEING
WHAT STE INCLUSION IS SO THANK
YOU VERY MUCH.
JUST TO REMIND EVERYONE TO BRING
THE MICROPHONE CLOSE SO WE CAN
HEAR YOU.
THANK YOU.
>>I HAD A QUESTION IN
RELATIONSHIP BETWEEN DIETARY
PATTERN CONSUMED AND THE RISK OF
TYPE 2 DIABETES I SEE HISTORY OF
DIABETES AND I DON'T SEE
GESTATIONAL DIABETES FOR THE
ADULTS AND WONDERING WHAT WAS
THE COMMITTEE DISCUSSION ON
THAT.
HISTORY OF THE CONFOUNDERS OR
SUBSEQUENT TYPE 2.
>>I AGREE.
WE CAN BRING THAT BACK.
THANK YOU.
>>I'M WONDERING IF YOU'LL TALK
ABOUT YOUR CRITERIA YOU SET FOR
SAMPLE SIZE AND INTERVENTION
LINK.
>>I CAN ADDRESS THE
INTERVENTION LINK.
INTERVENTION LINK WAS DETERMINED
BY PREVIOUS REVIEWS TO BE ABOUT
THE AMOUNT OF TIME FOR TYPICAL
DIET.
AND THE BEST --
>>CAN I ADD AN ADDITIONAL
COMMENT FOR THE DIABETES REALM
THE THREE-MONTH TIME PERIOD IS
WHERE YOU WOULD SEE A CHANGE FOR
EXAMPLE IN HEMOGLOBIN A1C.
>>THANK YOU, OTHER COMMITTEE
MEMBERS WANT TO COMMENT ON THAT?
>>I'M ON THE COMMITTEE SO I'M
EMBARRASSED TO ASK THIS BECAUSE
LIPIDS AND BLOOD PRESSURE CAN
CHANGE IN FOUR WEEKS AND I CAN'T
REMEMBER WHY WE KEPT IT AT 12
AND IT CHANGES IN TWO WEEKS FOR
SOME OF THOSE RISK FACTORS IN
FOUR WEEKS AND HOLDING SOME AND
I PROPOSE THE STUDY TO 12 WEEKS
UNNECESSARY AND SOME OF MY OWN
STUDIES WOULD PROBABLY BE
EXCLUDED FOR THAT REASON.
I WOULD BE SAD.
>>I THINK WE LOOKED AT IT AND
MADE THE PERIOD OF TIME TO BE
CONSISTENT WITH THE OTHER
STUDIES THAT HAVE LOOKED AT THAT
AND WHAT'S BEEN DONE IN THE
PAST.
AND THEN WE HAVE THAT WHOLE LIST
OF OTHER CBD OUTCOMES THERE.
>>I CAN SEE FOR THE OTHER ONES
BUT MAYBE NOT FOR LIPIDS AND
BLOOD PRESSURE.
IT MAY BE THE LITERATURE IS
OVERWHELMING AND WE DON'T NEED
IT BUT I'D BE AFRAID WE CUT OFF
VALUABLE TRIALS.
MAYBE WE CAN KEEP THAT IN THE
KNOWS.
>>PART OF THE CONSIDERATION WAS
RELATED TO THE DIETARY EXPOSURE
BEING REFLECTIVE OF THE MORE
HABITUAL INTAKE.
>>BECAUSE IT'S A DIETARY AND A
NEW THING WE'LL FIND IN STUDIES
IS THE NEW FOOD DELIVERY
STUDIES.
YOU GET ADHERENCE QUITE QUICKLY
IF YOU SIGN SOMEONE UP FOR FOOD
DELIVERY BECAUSE WE'VE BEEN
DOING THAT MORE OFTEN NOW.
INSTANT ADHERENCE.
>>WE ALSO HAVE REALLY CLASSIC
GREAT STUDIES THAT SHOW YOU
COULD TAKE PEOPLE FROM HABITUAL
INTAKE AND PUT THEM ON A GREAT
DIETARY PATTERN.
AND YOU'RE RIGHT, THE LIPIDS AND
BLOOD PRESSURE WILL SHIFT IN TWO
WEEKS IMMEDIATELY.
I DO THINK THIS DESERVES
REFINING.
AND NESR HAS IDENTIFY A LARGE
BODY OF EVIDENCE FOR THIS
PARTICULAR QUESTION FOLLOWING
THOSE INCLUSION/EXCLUSION
CRITERIA SO THERE MIGHT BE AN YM
OF IMPACT ON WORK LOAD.
I DID WANT TO CLARIFY ONE POINT
AS WELL IS I TALKED ABOUT
DEPRIORITIZING MORE ALL-CAUSE
MORBIDITY, MORTALITY.
I MEANT ALL CAUSE
MORBIDITY/MORTALITY BECAUSE
WE'RE LOOKING AT IT FOR CVB.
I WANTED TO CLARIFY THAT POINT.
>>ANY OTHER QUESTIONS?
THANK YOU.
GOOD POINTS.
DR. GIOVANNUCCI.
>>THANK YOU, DEANNE.
I'LL TALK ABOUT CANCER AS
MENTIONED CONSIDERING BREAST,
COLORECTAL AND PROSTATE CANCER.
I'LL NOTE THE REVIEWS WILL
EXAMINE INCIDENT CASES NOT
MORTALITY, SURVIVORSHIP OR
OCCURRENCE THOUGH THEY MAY BE
POSSIBLE TOPICS OF INTEREST IN
THE FUTURE.
SO THE FRAMEWORKS WILL BE
PRESENTED SEPARATELY FOR BREAST
AND COLORECTAL AND PROSTATE
CANCER AND YOU'LL PROBABLY
GETTING USED TO THESE NOW AND
I'LL HIGHLIGHT THE MAJOR POINTS.
THERE'S INFANTS THROUGH OLDER
ADULTS AT THE INTERVENTION
EXPOSURE.
THE OUTCOME OF INTEREST IS
INCIDENT BREAST CANCER, WE WILL
NOT CONSIDER IN SITU.
THE CONFOUNDERS PROBABLY LOOK
SIMILAR TO YOU.
I'LL HIGHLIGHT THE KEY
DIFFERENCES.
WE NOW CONSIDER SCREENING AND
THIS IS WILL BE FOR ALL CANCERS
AS A KEY CONFOUNDERS AND FOR
BREAST CANCER, POST MENOPAUSAL
HORMONAL THERAPY.
THE COMMITTEE ALSO DECIDED TO
REMOVE FAMILY HISTORY AS A KEY
CONFOUNDER.
THIS IS AN IMPORTANT RISK FACTOR
FOR CANCER BUT IT'S NOT RELATED
TO THE EXPOSURE SO BY DEFINITION
IT'S NOT A CONFOUNDER.
WE ALSO PROPOSE TO REMOVE ORAL
CONTRACEPTIVE USE AND I'LL
HIGHLIGHT A LITTLE BIT OF THE
SYNTHESIS PLAN.
THE EVIDENCE WILL FIRST BE
SYNTHESIZED BY POPULATION,
MENOPAUSAL STATUS IS IMPORTANT
STRATIFICATION AND WE ALSO WILL
CONSIDER THE OUTCOME BASED ON
ESTROGEN RECEPTOR STATUS ALONE
OR IN COMBINATION WITH
PROGESTERONE RECEPTOR AND HR2
STATUS AND WE ALSO DECIDED TO
INCLUDE CANCER STAGE AND
DIAGNOSIS FOR ALL CANCERS.
THIS IS THE ANALYTIC FRAMEWORK
OF DIETARY PATTERNS COLORECTAL
CANCER.
VERY SIMILAR TO BREAST CANCER.
THE KEY CONFOUNDERS ARE LISTED
IN THE SLIDE AND THE SCREENING
IS A NEW KEY CONFOUNDER.
THERE'S MULTIPLE TYPES OF
SCREENING TESTS FOR COLORECTAL
CANCER AND AS I MENTIONED WE
WILL NOT CONSIDER FAMILY HISTORY
AS A KEY CONFOUNDER.
JUST A FEW HIGHLIGHTS OF THE
SYNTHESIS PLAN.
THE EVIDENCE -- FIRST WE
SYNTHESIZE BY POPULATION AND
TUMOR LOCATION AND THERE'S DATA
ON COLORECTAL AND DISTAL AND
PROXIMAL COLON AND RISK FACTORS
INCLUDING DIET AND VARY BY THE
SUBSITE OF CANCER AND WE'LL LOOK
AT THAT AS THE DATA'S AVAILABLE.
WE WON'T CONSIDER MOLECULAR SUB
SITE SUCH AS MICROSATELLITE AND
THERE'S LIKELY TO BE DATA
AVAILABLE OR SUFFICIENT DATA.
ANOTHER KEY POINT IS CONSIDERED
WHETHER TO INCLUDE INFLAMMATORY
BOWEL DISEASE OR POLYPS AS KEY
CONFOUNDERS AND WE WON'T INCLUDE
THOSE AS KEY CONFOUNDERS.
THOSE ARE VARIABLES OF INTEREST
BUT AT LEAST FOR POLYPS THE
INFORMATION IS PROBABLY
CONFOUNDING FROM THE SCREENING
AS POLYPS ARE REALLY ONLY
USUALLY DIAGNOSED THROUGH
SCREENING COLONOSCOPY AND
INFLAMMATORY BOWEL DISEASE IS A
PERSPECTIVE OF COLORECTAL CANCER
AND MOST EXCLUDE THE INDIVIDUALS
AND REPRESENT A SMALL AMOUNT OF
CASES FOR COLORECTAL CANCER.
OKAY.
GOING ON TO THE NEXT SLIDE
PLEASE AND PROSTATE CANCER.
AGAIN, QUITE SIMILAR.
MAIN CHANGES FOR KEY CONFOUNDERS
INCLUDING SCREENING FOR PROSTATE
CANCER WHICH IS TYPICALLY PSA
SCREENING.
PSA SCREENING HAS HAD A DRAMATIC
EFFECT ON THE EPIDEMIOLOGY OF
PROSTATE CANCER AND DETECTS MANY
MORE CANCERS THAN PREVIOUSLY AND
AT AN EARLIER STAGE.
IT'S OFTEN RELATED TO EXPOSURE
OF DIET AND DEFINITELY RELATED
TO OUTCOME.
IT CAN BE A KEY CONFOUNDER.
THE OTHER THING I WANT TO
HIGHLIGHT THAT'S QUITE IMPORTANT
FOR PROSTATE CANCER IS FOR THE
OUTCOME BESIDES INCIDENT
PROSTATE CANCER WILL ALSO
CONSIDER ADVANCE STAGE BY GRADE
AND FATAL AND LETHAL AND THAT'S
USUALLY METASTATIC PROSTATE
CANCER.
THE MEMBERS OF THE COMMITTEE
NOTED DIFFERENCES IN
AGGRESSIVENESS OF PROSTATE
CANCER SUBTYPES AND THERE'S
EVIDENCE OF SOME SUBTYPES.
THE SUBTYPES THAT ARE MORE
AGGRESSIVE TEND TO HAVE STRONGER
ASSOCIATION WITH DIET.
ALSO LOOKING AT AGGRESSIVE
SUBTYPES MAY REDUCE SOME
DETECTION BIAS BY PSA SCREENING.
THIS IS THE INCLUSION/EXCLUSION
CRITERIA.
THERE'S STUDIES THE REVIEW WILL
INCLUDE STUDIES PUBLISHED
BETWEEN JANUARY 2000 TO PRESENT.
THE STUDY DURATION CRITERIA
CONSISTENT WITH THE PREVIOUSLY
PRESENTED PROTOCOL AND THERE'S
NO CRITERIA FOR THESE QUESTIONS.
THANK YOU.
>>THANK YOU, ED.
THE ANALYTIC FRAMEWORK THAT I'M
GOING TO PRESENT NOW IS FOR
DIETARY PATTERNS CONSUMED AND
RISK OF DEPRESSION.
AND SO THIS IS AN UPDATE TO AN
EXISTING NESR SYSTEMIC REVIEW
UNLIKE THE REVIEWS TO DATE THEY
WERE UPDATED FOR THE 2020
GUIDELINES REPORT.
THIS WAS NOT -- LAST UPDATED IN
2015 THIS HAS A LONGER TIME.
THE POPULATION IS ADULTS AND
OLDER ADULTS, 19 YEARS AND OLDER
INCLUDING INDIVIDUALS DURING
PREGNANCY.
ONE OF THE THINGS WE DID DISCUSS
WAS ADDING ADOLESCENCE TO THIS
AND FOR THE TIME BEING WE'RE NOT
GOING TO ADD ADOLESCENCE.
THAT WILL BE IN OUR
RECOMMENDATION FOR THE 2030
DIETARY GUIDELINES.
SO WE DO UNDERSTAND THAT THIS IS
AN EMERGING ISSUE IN ADOLESCENCE
RIGHT NOW.
THE INTERVENTION EXPOSURE AND
COMPARATOR ARE SIMILAR TO WHAT
WE'VE SEEN BEFORE.
THE OUTCOME IS DEPRESSION IN
ADULTS AND OLDER ADULTS AND THEN
POSTPARTUM DEPRESSION.
DURING POSTPARTUM.
THE POPULATION -- IN TERMS OF
KEY CONFOUNDERS, WE'RE ALSO
ADDING A HISTORY OF DEPRESSIVE
SYMPTOMS BECAUSE WE KNOW THAT
DEPRESSION CAN KIND OF ABATE AND
THEN RETURN SO WE'RE REALLY
LOOKING AT THAT AS PART OF THAT.
A FEW OTHER THINGS TO NOTE.
STUDIES WHERE 100% OF
PARTICIPANTS HAVE DEPRESSION AT
BASELINE WOULD BE EXCLUDED BUT
IF SOME OF THE POPULATION HAS
DEPRESSION AT BASELINE THEY WILL
BE INCLUDED.
STUDIES SOMEEXAMINING SCORES OF
DEPRESSION CAN BE INCLUDED
SEPARATELY IN THE SYNTHESIS.
SO THE INCLUSION/EXCLUSION
CRITERIA INCLUDE THE SAME AS
PREVIOUSLY STATED JANUARY 1980
TO THE PRESENT.
THE 12 WEEK INTERVENTION LINK
AND FOR INTERVENTION STUDIES
THAT'S THE SAME AS WHAT WE HAD
TALKED ABOUT PREVIOUSLY.
THERE WILL NOT BE ADDITIONAL
CRITERIA FOR OBSERVATIONAL
STUDIES.
SO THIS IS A NEW NESR SYSTEMIC
REVIEW.
THIS IS THE RELATIONSHIP BETWEEN
DIETARY PATTERNS WITH VARYING
AMOUNTS ULTRAPROCESSED FOODS AND
BODY COMPOSITION AND RISK OF
OBESITY.
THIS IS A TOPIC WE RECEIVED A
LOT OF COMMENTS ABOUT AND
THERE'S A LOT OF PUBLIC INTEREST
IN.
SO WE'RE VERY EXCITED TO BE
INITIATING THIS.
SO JUST A LITTLE BIT ABOUT THE
INTERVENTION EXPOSURE.
THERE'S CURRENTLY SEVEN EXISTING
FOOD CLASSIFICATION SYSTEMS FOR
ULTRAPROCESSED FOODS.
RATHER THAN GOING IN WITH A
DEFINITION WE'RE LOOKING AT ALL
OF THOSE AND HOW IT'S DEFINED BY
THE LITERATURE.
I JUST WANTED TO MAKE THAT POINT
BECAUSE RIGHT NOW THERE'S A LOT
OF DIFFERENT DEFINITIONS.
SO THE COMPARATOR IS A DIFFERENT
DIETARY PATTERN OR COULD BE
DIFFERENT ADHERENCE OR
CONSUMPTION LEVELS TO THE SAME
DIETARY PATTERN.
AGAIN LOOKING AT SOMETHING LIKE
QUINTILES OR QUARTILES OF
CONSUMPTION OF ULTRA-PROCESSED
FOODS.
SO THE OUTCOMES ARE CONSISTENT
WITH WHAT I MENTIONED BEFORE FOR
GROWTH BODY COMPOSITION AND RISK
OF OBESITY.
WE ARE LOOKING AT ALL AGES FOR
THIS INCLUDING INDIVIDUALS
DURING PREGNANCY AND DURING
POSTPARTUM AND THEN THE KEY
CONFOUNDERS ARE SIMILAR TO WHAT
WE HAD WITH OUR FIRST QUESTION
ON GROWTH BODY COMPOSITION.
RISK OF OBESITY.
SO THE INCLUSION CRITERIA, THESE
ARE A LITTLE BIT DIFFERENT
BECAUSE THIS IS A NEW REVIEW.
SO THIS IS JANUARY 2000 TO THE
PRESENT AND THE INTERVENTION
EXPOSURE IS DIETARY PATTERNS
WITH VARYING AMOUNTS OF ALL TRA
PROCESSED FOODS.
SO WE WILL BE LOOKING AT THAT
WITH VARYING AMOUNTS OF ULT
ULTRA-PROCESSED FOOD AND WITH
BODY COMPOSITION AND RISK OF
OBESITY IT COULD BE A
MULTI-COMPONENT INTERVENTION
WHERE YOU CAN LOOK AT THE
OUTCOME OF INTEREST.
THE STUDY DURATIONS ARE THE SAME
AS WHAT I MENTIONED PREVIOUSLY.
AND THEN THE SIZE OF THE STUDY
GROUPS IS THE SAME AS WHAT I
MENTIONED PREVIOUSLY.
SO WE WANTED TO OPEN IT UP ONCE
AGAIN FOR COMMITTEE DISCUSSION.
DISCUSSING THE CANCER PROTOCOLS,
THE DEPRESSION AND THE
ULTRA-PROCESSED FOODS.
ARE YOU LOOKING FOR HOMEMADE
BABY FOODS VERSUS COMMERCIAL
PROCESSED BABY FOODS?
YOU WENT TO INFANT AND NOT SURE
WHAT YOU'LL FIND IN THE FIRST
YEAR OF LIFE UNLESS YOU LOOK AT
PROCESSED BABY FOODS.
>>THAT'S A VERY GOOD QUESTION.
THE EASIEST ANSWER TO THAT IS
THE STUDY WILL DEFINE IT.
I WOULD IMAGINE IN THAT CASE THE
STUDY MIGHT DEFINE IT AS FORMULA
VERSUS BREAST FEEDING.
I DON'T KNOW IF THE OTHER
COMMITTEE MEMBERS WANT TO ANSWER
THAT OR HAVE A COMMENT ABOUT
THAT.
>>THIS CAST A WIDE NET TO MAKE
SURE WE CAPTURED THE EVIDENCE IN
THE AGE GROUP.
[INDISCERNIBLE] WE CAN ALWAYS
DECIDE TO DO WITH THE EVIDENCE
AND DECIDE IF THERE'S SUFFICIENT
EVIDENCE [INDISCERNIBLE].
>>I DON'T DISAGREE WITH THAT.
1 TO 2 YEARS MAY BE DIFFICULT
AND THE INTRODUCTION TO SOLID
FOO
FOODS.
>>THANK YOU VERY GOOD COMMENT.
I APPRECIATE THAT.
OTHER COMMENTS?
>>I WOULD AGREE WITH THE PRIOR
COMMENT.
I WAS WONDERING HOW WILL YOU
CONSIDER THE FIRST POINTS FOR
ULTRA PROCESSED FOODS IF THERE'S
NO CLEAR DEFINITION AND
THEREFORE WILL BE VARIABILITY
DUE TO THE CLASSIFICATION USE IN
THE STUDY.
I WAS WONDERING HOW MAYBE THE
SYNTHESIS WILL TAKE CARE OF THAT
OR HOW DO YOU APPROACH THAT?
>>I THINK YOU CAN -- IT'S AN
LOUSE SITUATION TO THE PATTERNS.
WE'RE NOT LOOKING AT
MEDITERRANEAN VERSUS VEGETARIAN
AND WHAT'S DEFINED AND THEN WHEN
WE GATHER THE DATA.
IT WILL BE SIMILAR.
THIS IS THE FIRST TIME THAT THIS
HAS BEEN DONE SO AGAIN TO
DR. FUNG'S COMMENT WE WANT TO
CAST A WIDER NET AND THEN WE'LL
LOOK AT IT ON THE SYNTHESIS
SIDE.
>>I'LL ALSO SAY WE DID HAVE
QUITE A BIT OF DISCUSSION
SURROUNDING THE POINT ACTUALLY.
A LENGTHY DISCUSSION BECAUSE OF
ISSUES WITH REGARDS TO HOW WE
DEFINE ULTRA PROCESSED FOODS AND
THE EVOLVING DEFINITION OF
CONSIDERING THIS.
THAT WILL BE PART OF OUR
DISCUSSION SINCE IT WAS SO
ROBUST WITHIN THE COMMITTEE AND
WE THOUGHT ABOUT AND CONSIDERED
IN THE PARTICULAR QUESTION.
>>THANK YOU.
>>I HAD ONE QUESTION ABOUT THE
EXCLUSION OF ADOLESCENCE ABOUT
THE RISK OF DEPRESSION.
AND THE COMMITTEE'S THINKING
AROUND EXCLUDING THAT FOR NOW
AND THINKING ABOUT THAT AS
CONSIDERATION FOR LATER.
>>I THINK THE MONITORING THAT'S
BEEN DONE WAS IN ADULTS.
SO AND THERE'S SOME RESEARCH
THERE IN THAT AREA SO WE'RE
THINKING THAT THAT MIGHT MOVE
THINGS FORWARD SO THE
ADOLESCENCE WOULD PRESENT
ADDITIONAL WORK LOAD AND DECIDED
AGAINST IT FOR THIS GO-ROUND.
>>TO ADD TO THAT A DISCUSSION
SURROUNDING THIS IS THE EVIDENCE
IS BECOMING MORE ROBUST IN THE
POST COVID-19 ERA SO WHILE THERE
ARE STUDIES ONGOING THEY'RE
GOING TO BE MORE ROBUST AND
AVAILABLE FOR THE 2030 GROUP AND
THAT WAS PART OF OUR DISCUSSION
SURROUNDING THAT SPECIFIC ISSUE.
>>THANKS.
THAT WAS GOING TO BE MY NEXT
FOLLOW-UP SO THANK YOU FOR THAT.
THANK YOU FOR THAT
CLARIFICATION.
>>WE ACTUALLY DID HAVE QUITE A
BIT OF DISCUSSION ABOUT THIS AND
WENT AROUND ABOUT IT.
OTHER QUESTIONS OR CONCERNS?
>>THANK YOU VERY MUCH.
>>OH, WE'RE NOT FINISHED.
WE'RE TWO-THIRDS.
OKAY.
SO I'M GOING IT TURN IT OVER TO
DR. RAYNOR.
>>THANK YOU VERY MUCH.
I WILL ACTUALLY BE DISCUSSING
THE PROPOSED PROTOCOLS FOR
QUESTIONS WITH BEVERAGES AS THE
EXPOSURE.
SO WE HAVE ONE BEVERAGE PATTERN
QUESTION AND THIS IS DEFINED
SIMILARLY TO THE DIETARY
PATTERNS QUESTION.
SO BEVERAGE PATTERNS ARE THE
QUANTITIES OR PROPORTION OR
COMBINATION OF DIFFERENT
BEVERAGES INDICT -- UP DIETS AND
THE HABITUAL NATURE IN WHICH
THEY'RE CONSUMED.
IN REGARD TO THE FIRST QUESTION
OF OVER ALL BEVERAGE PATTERNS
AND GROWTH BODY COMPOSITION AND
RISK OF OBESITY AS WELL AS
INDIVIDUAL BEVERAGE QUESTIONS IN
THE AREA THE BEVERAGE TYPES
WE'LL EXAMINE ARE LISTED IN THE
INCLUSION CRITERIA AND THIS
INCLUDES DAIRY MILK AND MILK
ALTERNATIVES, 100% JUICE, LOW OR
NO-CALORIE SWEETENED BEVERAGE,
SUGAR-SWEETENED BEVERAGE AND
COUGH AND/OR TEA AND I'LL
PRESENT A FRAMEWORK FOR EACH
BEVERAGE TYPE IN RELATION TO THE
TWO OUTCOMES BEING ASSESSED FOR
BEVERAGES SO THE GROWTH BODY
COMPOSITION AND RISK OF OBESITY
AS WELL AS THE RISK OF TYPE 2
DIABETES.
ON THIS SLIDE WE ALSO HAVE
EXCLUDED INTERVENTIONS OR
EXPOSURES SO WE WILL NOT BE
EXAMINING TODDLER FORMULA OR
MILKS.
OTHER BEVERAGE TYPES INCLUDING
NUTRITIONAL BEVERAGES, STUDIES
FOCUSSING ON SPECIFIC NUTRIENTS,
ADDITIVE BEVERAGES INSTEAD OF A
BEVERAGE AS A WHOLE.
BEVERAGES THAT ARE NOT
COMMERCIALLY AVAILABLE,
SUPPLEMENTS AND ALCOHOL AND THE
COMPARE TORS ARE LISTED ON THE
SLIDE.
FOR BEVERAGE PATTERNS STUDIES
EXAMINING CONSUMPTION OF OR
ADHERENCE TO A DIFFERENT
BEVERAGE PATTERN OR DIFFERENT
LEVELS OF CONSUMPTION OR
ADHERENCE TO BEVERAGE PATTERN
WILL BE INCLUDED SIMILARLY TO
THE DIETARY PATTERNS.
FOR ALL BEVERAGE TYPES
COMPARATORS WILL INCLUDE NO
CONSTITUTION AND VERSIONS
DILUTED WITH WATER AND
CONSUMPTION OF THE BEVERAGE
TYPES EXAMINED VERSUS WATER.
WE ALSO IDENTIFIED SPECIFIC
COMPARISONS OF INTEREST BASED ON
THE CRITERIA PRESENTED THIS
MORNING AND WE'LL HIGHLIGHT
THESE ON EACH ANALYTIC FRAMEWORK
AS WE GO THROUGH THEM.
WE'LL LOOK AT THE DIFFERENCES IN
THIS ANALYTIC FRAMEWORK COMPARED
TO OUR EARLIER ANALYTIC
FRAMEWORKS.
THIS SLIDE SHOWS THE PROPOSED
FRAMEWORK FOR BEVERAGE PATTERNS
AND GROWTH BODY COMPOSITION AND
RISK OF OBESITY.
WE PLAN TO EXAMINE THE
RELATIONSHIP BETWEEN BEVERAGE
COMPOSITION AND GROWTH BODY
COMPOSITION AND RISK OF OBESITY
FOR BEVERAGE PATTERNS AND FIVE
ADDITIONAL BEVERAGE TYPES I'LL
DESCRIBE.
STUDIES THAT HAVE CONSUMPTION OF
A BEVERAGE PATTERN IN CHILDREN,
ADOLESCENTS AND THOSE INCLUDED
IN THE REVIEW.
A SET OF OUTCOMES FOR THE
OUTCOMES AS SIMILAR AS PRESENTED
SIMILAR FOR OTHER QUESTIONS WITH
GROWTH, BODY COMPOSITION AND
RISK OF OBESITY OUTCOME EXCEPT
OUTCOME SPECIFIC TO INFANTS AND
TODDLERS ARE NOT INCLUDED AND
THE KEY CONFOUNDERS WHICH WE
DESCRIBED PREVIOUSLY ARE ALSO
LISTED ON THE SLIDE.
THIS SLIDE SHOWS THE PROPOSED
ANALYTIC FRAMEWORK FOR DAIRY
MILK AND MILK ALTERNATIVES AND
GROWTH BODY COMPOSITION AND RISK
OF OBESITY.
IN TERMS OF OUR COMPARATOR,
DAIRY MILK AND MILK AN TERN TIFS
WITH DIFFERENT AMOUNTS FATS AND
WHOLE MILK AND SWEETENERS
FLAVORED VERSUS UNFLAVORED MILK
WILL BE INCLUDED AS A COMPARATOR
AND OUTCOMES AND KEY CONFOUNDERS
FOR THE REVIEW ARE THE SAME AS
FOR THE BEVERAGE PATTERNS
REVIEW.
THIS SLIDE SHOWS THE PROPOSED
ANALYTIC FRAMEWORK AND GROWTH
BODY COMPOSITION AND RISK OF
OBESITY.
FOR THE COMPARATOR 100% JUICE
VERSUS SOLID AND JUICE VERSUS
WHOLE FRUIT FOR EXAMPLE AND THIS
QUESTION ALSO HAS AND INCLUDING
FOR INFANTS AND TODDLERS.
MEMBERS FOR SUBCOMMITTEE ONE AND
SUBCOMMITTEE TWO WILL
COLLABORATE ON THE SYNTHESIS FOR
INFANTS AND TODDLERS AN BECAUSE
OF THIS OUTCOMES AND KEY
CONFOUNDERS SPECIFIC TO INFANTS
AND TODDLERS ARE ALSO LISTED ON
THE SLIDE.
THIS SLIDE SHOWS A PROPOSED
ANALYTIC FRAMEWORK FOR
SUGAR-SWEETENED BEVERAGES AND
RISK OF OBESITY AND
SUGAR-SWEETENED BEVERAGES VERSUS
LOW AND NO-CALORIE BEVERAGES
WILL BE USED AS A COMPARATOR AND
HAS BEEN PRIORITIZED FOR
SYSTEMIC REVIEW FOR
META-ANALYSIS ACROSS THE ENTIRE
LIFE SPAN INCLUDING INFANTS AND
TODDLERS.
SIMILARLY TO THE PREVIOUS SLIDE
SUBCOMMITTEE ONE AND TWO WILL
COLLABORATE ON THE SYNTHESIS FOR
INFANTS AND TODDLERS.
THIS SLIDE SHOWS THE ANALYTIC
FRAMEWORK FOR LOW OR NO-CALORIE
BEVERAGE CONSUMPTION AND RISK OF
OBESITY.
IT'S CONSISTENT WITH THE
BEVERAGE PATTERNS PROTOCOL
PREVIOUSLY PRESENTED.
THIS SLIDE SHOWS THE ANALYTIC
FRAMEWORK FOR THE RELATIONSHIP
BETWEEN COFFEE AND TEA.
COFFEE AND/OR TEA CONSUMPTION
AND BODY COMPOSITION AND RISK OF
OBESITY.
OUR SUBCOMMITTEE DECIDED TO
COMBINE COFFEE AND TEA SINCE
THEY'RE OFTEN REPORTED TOGETHER
IN STUDIES HOWEVER, IF WE ARE
ABLE TO SYNTHESIZE COFFEE AND
TEA SEPARATELY AND DRAW SEPARATE
CONCLUSIONS WE WILL DO SO.
COFFEE AND/OR TEA WITH VARYING
LEVELS OF FAT OR SWEETENERS ARE
INCLUDED AS A COMPARATOR IN THIS
ANALYTIC FRAMEWORK.
WHAT IS THE RELATIONSHIP BETWEEN
BEVERAGE CONSUMPTION AND GROWTH
BODY COMPOSITION AND RISK OF
OBESITY?
WHAT WE HAVE HERE IN TERMS OF
TIME FRAME WE WILL BE LOOKING AT
THE SIMILARLY TO PREVIOUS
ANALYTIC FRAMEWORK STUDIES
PUBLISHED FROM JANUARY 2000 TO
PRESENT AND WE HAVE A SIMILAR
STUDY DURATION FOR THE OTHER
GROWTH BODY COMPOSITION AND RISK
OF OBESITY FRAMEWORKS.
SO I'M TRANSITIONING.
THIS NOW I'LL BE GOING OVER THE
ANALYTIC FRAMEWORK FOR BEVERAGE
TYPES.
AND THE RISK OF TYPE 2 DIABETES.
THIS SLIDE IS FOR DAIRY MILK AND
MILK ALTERNATIVES.
THESE REVIEWS WILL INCLUDE
STUDIES THAT ASSESS BEVERAGE
CONSUMPTION IN INFANTS,
TODDLERS, ADOLESCENTS AND ADULTS
AND OLDER ADULTS AND ENDPOINT
OUTCOMES WILL BE ASSESSED ACROSS
THE LIFE SPAN AND SHOWN ON THE
SLIDE.
IN ADDITION TO THE KEY
CONFOUNDERS FOR BEVERAGES AND
GROWTH BODY COMPOSITION AND RISK
OF OBESITY QUESTIONS WE HAVE
INCLUDED FAMILY HISTORY OF
DIABETES AND ALCOHOL INTAKE AS
KEY CONFOUNDERS.
DIET QUALITY IS NOT INCLUDED AS
A KEY CONFOUNDER FOR BEVERAGES
AND RISK OF TYPE 2 DIABETES
QUESTIONS.
GIVEN OUR PREVIOUS CONVERSATION
WE MIGHT WANT TO BRING IN A
HISTORY OF GESTATIONAL DIABETES.
THIS SLIDE SHOWS THE ANALYTIC
FRAMEWORK FOR 100% JUICE AND
RISK OF TYPE 2 DIABETES AND
CONSISTENT WITH WHAT HAS BEEN
PRESENTED SO FAR.
THIS SLIDE SHOWS THE ANALYTIC
FRAMEWORK FOR SUGAR-SWEETENED
BEVERAGES AND TYPE 2 DIABETES
AND ALSO CONSISTENT WITH WHAT
HAS BEEN PRESENTED SO FAR.
THIS SLIDE SHOWS THE ANALYTIC
FRAMEWORK FOR LOW OR NO-CALORIE
SWEETENED CONSUMPTION AND RISK
OF TYPE 2 DIABETES AND ALSO
SIMILAR TO THE PREVIOUS
FRAMEWORKS.
AND THIS IS OUR LAST PROPOSED
FRAMEWORK.
SHOWS THE FRAMEWORK FOR COFFEE
AND/OR TEA CONSUMPTION AND RISK
OF TYPE 2 DIABETES AND ALSO
SIMILAR TO WHAT IS PRESENTED
PREVIOUSLY.
AND FOR THE PROPOSED BEVERAGE
CONSUMPTION AND RISK OF TYPE 2
DIABETES QUESTIONS SIMILARLY TO
WHAT HAS BEEN DESCRIBED
PREVIOUSLY STUDIES PUBLISHED
FROM JANUARY 2000 TO PRESENT
WILL BE INCLUDED.
THE HEALTH STATUS CRITERIA ARE
CONSISTENT WITH WHAT WE HAVE
DESCRIBED PREVIOUSLY AND AGAIN
THE INTERVENTION LINKS ARE AT
LEAST 12 WEEKS AND THIS IS FOR
HEMOGLOBIN AND TRIALS OF FOUR
WEEKS MAY BE AFFORDED.
AND I'LL TURN IT BACK OVER.
>>THANK YOU, DR. RAYNOR.
AS YOU CAN SEE THERE'S A LOT OF
WORK HERE IN ADDITION TO WORKING
THROUGH THE PROTOCOLS, MEMBERS
HAVE ALSO BEEN GOING ONLINE AND
MAKING CHANGES TO THESE.
SOME QUITE LATE AT NIGHT.
SO OUR NEXT STEPS ARE TO DEVELOP
PROTOCOLS FOR THE REMAINING
QUESTIONS.
THEY INCLUDE THE DIETARY
PATTERNS AND RISK OF COGNITIVE
DECLINE MILD COGNITIVE
IMPAIRMENT AND ALZHEIMER'S
DISEASE AND DIETARY PATTERNS IN
BONE HEALTH AND THE NEW PROTOCOL
FOR RISK OF CARDIOVASCULAR
DISEASE.
WE'VE BEGUN OUR DISCUSSIONS ON
THAT AND WE'LL CONTINUE THOSE.
WE WILL REFINE AND IMPLEMENT
PROTOCOLS FOR THE QUESTIONS THAT
WE JUST REVIEWED HERE TODAY.
WE HAVE DONE QUITE A BIT OF WORK
AND STILL HAVE QUITE A BIT OF
WORK TO DO AS YOU CAN SEE.
SO THANK YOU AGAIN TO THE
COMMITTEE MEMBERS AND THE
FLOOR'S OPEN FOR QUESTIONS.
HEATHER.
>>THANK YOU.
THAT WAS AN INTERESTING QUESTION
AND I HAVE AN QUESTION FOR HOLLY
FOR ALL OF YOU ABOUT THE
BEVERAGE QUESTIONS THAT WILL BE
ASKED.
DIET IS NOTORIOUSLY DIFFICULT TO
MEASURE AND MEASURING BEVERAGES
CAN BE MORE DIFFICULT BECAUSE OF
THE WAY WE MAY CONSUME THEM
THROUGHOUT THE DAY NOT JUST AT
ONE OCCASION OR A FEW OCCASIONS
IN A DAY BUT THROUGHOUT AND I'M
WONDERING WHAT THE COMMITTEE
MIGHT HAVE DISCUSSED REGARDING
QUANTIFYING OR LABELLING WHO IS
DRINKING A CERTAIN BEVERAGE.
I'M SURE ALL THE STUDIES HAVE
DEFINED THAT IN DIFFERENT WAYS
AND SO I JUST WONDER IF THERE'S
ANY CRITERIA FOR THAT YOU MAY
HAVE DISCUSSED FOR QUANTIFYING
DRINKING FRUIT AND BEVERAGES OR
FOR THE BEVERAGES YOU JUST.
>>I'D SAY SIMILAR TO WHAT WAS
DESCRIBED SIMILARLY.
FOR EXAMPLE IN THE PATTERNS
QUESTION WOULD BE SIMILAR TO
WHAT WE DESCRIBED FOR THE
DIETARY PATTERNS AND LL BE
WHAT'S REPORTED IN THE STUDIES.
HOWEVER, I THINK WHAT YOU BRING
UP THINKING AHEAD TO OUR REPORT
AND ESPECIALLY AS OUR DIETARY
ASSESSMENT TECHNOLOGY CHANGES
OVER TIME I THINK IT WOULD BE AN
IMPORTANT COMPONENT TO DESCRIBE
IN THE REPORT.
WE'LL BE TALKING ABOUT OTHER
QUESTIONS THAT TRADITIONALLY
POTENTIALLY WE'VE HAD MORE
PROBLEMS THAN OTHER WORKING
GROUPS AND SOME OF OUR
QUESTIONS, MORE PROBLEMS IN THE
DIETARY ASSESSMENT AREA AND I
THINK ADDING BEING ABLE TO BRING
THIS FORWARD AND AGAIN THINKING
ABOUT OUR NEWER TECHNOLOGIES AND
WHAT DOES THAT MEAN FOR RESEARCH
AND WHAT WE NEED TO REPORT ON
WOULD BE AN IMPORTANT
CONTRIBUTION TO THE LITERATURE.
>>CHRIS.
>>I THINK IT'S AN IMPORTANT
OVERARCHING THEME FOR EVERYTHING
WE TALKED ABOUT FOR COMMITTEE
ONE AND GO INTO COMMITTEE TWO
AND FOUR FOR THE NESR REVIEW IS
THE DETAIL AND THE FUNDAMENTALS
OF THE DESIGN, THE INTERVENTION,
WHAT IT IS AND WHAT IT ISN'T,
THE COMPOSITION, HOW WE'RE
MEASURING IT AND RIGOR AND
DETAIL OF THE DATA WE GET OUT.
THAT'S GOING TO BE THE
UNDERLYING THEME WE HAVE TO READ
ACROSS ALL OF THE STUDIES TO BE
ABLE TO MAKE CONSISTENT
RECOMMENDATIONS.
AND WHEN WE HAVE CHALLENGES AND
DESCRIPTIONS OF INTERVENTIONS,
DEPLOYMENT, FIDELITY AND
MEASUREMENT AFTER THAT EVERY ONE
OF THOSE ERRORS COMPOUNDS
LOOKING AT IT FROM A SYSTEMS
EVALUATION.
THAT WILL BE REALLY IMPORTANT AS
WE'RE EVALUATING EVERY STUDY HOW
IT HELPS GAUGE SYNTHESIS.
>>THANK YOU.
I DO WANT TO RESPOND HEATHER TO
ONE OF YOUR QUESTIONS WE DECIDED
NOT TO INCLUDE WATER AND PART OF
THAT IS THE PROBLEMS WITH
MEASURING WATER INTAKE.
IT'S KIND OF COMPOUNDED THE
ISSUES YOU BROUGHT UP AND IT'S
OFTEN USED AS A COMPARATOR IN A
LOT OF THE RCTs SO WE DECIDED
NOT TO INCLUDE IT AND I THINK
THAT HAS SOME RELEVANCE TO WHAT
YOU WERE ASKING ABOUT.
>>WHEN WE USE NDSR WE ARE
ALWAYS PROBING FOR FREQUENCY
TIME OF DAY.
IT'S NOT A MEAL ORIENTED DAY IN
THE FIVE-PASS SYSTEM WE'RE
ALWAYS SAYING FOR A SNACK ARE
YOU SURE YOU DIDN'T HAVE
SOMETHING AND TIME OF DAY IS
RECORDED.
AT LEAST THAT ASSESSMENT
APPROACH CAN CAPTURE THAT.
>>MY QUESTION IS ABOUT COFFEE
AND TEA OFTEN COMBINED WITH
OTHER BEVERAGES MILK AND OTHER.
HOW DO YOU TEASE OUT THE EFFECTS
OF ALL THE BEVERAGES INCLUDED.
>>WE'LL BE LOOKING AT THAT.
WE HOPE IT TEASE A PART IF
POSSIBLE COFFEE AND TEA AND THE
ADDITIONS TO COFFEE AND TEA
WHICH WOULD BE DAIRY PRODUCTS,
SUGAR/SWEETENER AND ARE HOPING
TO TEASE THAT A PART WITH WHAT
WE SPEEP -- WE SEE.
>>THAT WOULD BE THE MOCHA
CRAPOCCINO EFFECT.
>>SOME HAVE DATA ON DECAF AND
REGULAR TEA AS WELL.
DEPENDING ON HOW MUCH DATA IS
AVAILABLE [INDISCERNIBLE].
>>YOU CAN TELL THERE'S SOME
QUESTIONS WE'RE REALLY EXCITED
ABOUT.
ANY OTHER COMMENTS?
THANK YOU AGAIN FOR THE
COMMITTEE MEMBERS AND ALL THE
MEMBERS AND FOR ASSISTANCE WITH
NESR.
WE HAD GREAT STAFF SUPPORT SO I
REALLY APPRECIATE ALL THAT.
THANK YOU.
>>AND GREAT LEADERSHIP.
>>I ECHO CHRISTOPHER'S COMMENT.
GREAT LEADERSHIP.
THANK YOU, ED, THANK YOU, HOLLY
AND DEANNE FOR MEMBERS OF THE
SUBCOMMITTEE AND THANK YOU FOR
THE BROADER COMMITTEE AND ALL
THE GREAT SUGGESTIONS BECAUSE I
KNOW SUBCOMMITTEE ONE WILL GO
BACK AND HAVE ANOTHER VERY
PASSIONATE DISCUSSION ABOUT YOUR
COMMENTS.
10-MINUTE BREAK.
HOW ABOUT THAT?
IT'S RIGHT NOW 11:04.
LET'S BE BACK AT 11:14 BECAUSE
THEN WE ARE GOING TO DRUM ROLL,
SUBCOMMITTEE TWO LED BIENY.
THANK YOU.
-- JENNY.
THANK YOU.
SO EVERYBODY IS SO ENTHUSIASTIC
ABOUT TALKING ABOUT THE LAST
PRESENTATION AND THEY'RE ALL
EXCITED BUT TIME IS APPRECIATION
SO WERE NOW GOING OVER TO
SUBCOMMITTEE TWO LED BY JENNIFER
FISHER.
GO AHEAD.
>>I'M DELIGHTED TO REPORT BACK
THE WORK OUR SUBCOMMITTEE HAS
UNDERTAKEN TO EVALUATE THE
SCIENTIFIC EVIDENCE ON DIET AND
PREGNANCY AND BIRTH THROUGH
ADOLESCENCE.
AND PLEASED TO SAY I'LL BE
JOINED IN PRESENTING OUR
SYSTEMIC REVIEW PROTOCOLS.
BEFORE WE GET STARTED I WANTED
TO ACKNOWLEDGE THE CONTRIBUTIONS
OF OUR SCIENTIFIC MEMBERS.
OUR SUBCOMMITTEE BRINGS TOGETHER
A TALENTED AND PASSIONATE GROUP
OF SCIENTISTS, CLINICIANS AND
PUBLIC HEALTH EXPERTS AND HUGE
THANKS TO THE FEDERAL SUPPORT
STAFF.
WE WOULD NOT HAVE MUCH TO
DELIBERATE, SYNTHESIZE WITHOUT
THE WORK SO THANK YOU SO NESR
STAFF WITH FEDERAL LIAISONS SO
THANK YOU.
WE PRIORITIZED EIGHT QUESTIONS
THAT SPAN THE WIDE LIFE STAGES
FROM PREGNANCY, INFANCY,
TODDLERHOOD AND EARLY AND MIDDLE
CHILDHOOD THROUGH ADOLESCENCE.
IF YOU WORK IN THIS AREA YOU
KNOW IS SIGNIFICANT.
IF YOU REMEMBER YOUR CHILDHOOD
IT'S SIGNIFICANT AND IF YOU
CARED FOR CHILDREN YOU KNOW
THIS.
IT'S A WIDE RANGE.
WE SHARE COMMON INTERVENTION
EXPOSURE OF DIETARY PATTERNS AND
HAVE UNIQUE MATERNAL AND HEALTH
OUTCOMES.
AND WE LOOK AT GESTATIONAL AGE
AT BIRTH AND BIRTH WEIGHT AND
LOOK AT QUESTIONS AND WE LOOK AT
RISK OF OBESITY OUTCOMES AND THE
REMAINING QUESTIONS REPRESENT A
FIRST IN DIETARY GUIDELINES
ADVISORY COMMITTEE HISTORY.
AND CONSIDER THE FEEDING OF
CHILDREN AND THESE QUESTIONS HAD
THE GOAL OF SUPPORTING
CAREGIVERS BY OFFERING EVIDENCE
BASED STRATEGY TO HELP PROMOTE
HELPFUL PATTERNS OF FOOD
ACCEPTANCE AND DIETARY INTAKE
AND GROWTH AMONG YOUNG CHILDREN.
ONE SHORT AND PERSONAL NOTE IS
THAT MY GRADUATE ADVISER A
RENOWN DEVELOPMENTAL
PSYCHOLOGIST AND WIDELY
REGARDING THE FIELD OF STUDY
AROUND CHILDREN'S FEEDING
BEHAVIORS AND PASSED IN 2019.
I KNOW WITHOUT A DOUBT SHE WOULD
BE SO PLEASED WITH THE
SIGNIFICANCE OF MOVING THIS WORK
FORWARD IN BETTERING THE
INTEREST OF HEALTH OF FAMILIES.
AND MOVING FORWARD ONE OF OUR
QUESTIONS ON COMPLIMENTARY
FEEDING AND IRON AND ZINC STATUS
WAS NOT PRIORITIZED DUE TO LACK
OF RESEARCH.
SINCE A RELATIVELY RECENT NESR
REON -- RECENT REVIEW AND I'LL
TAKE A LITTLE BIT MORE ON
SUBSEQUENT SLIDES.
WE'LL LOOK AT THE DEVELOPMENT OF
OUR DRAFT PROTOCOLS.
I'M PLEASED TO SAY OUR
SUBCOMMITTEE WAS ABLE TO DRAFT
SYSTEMIC REVIEW PROTOCOLS FOR
ALL THE EIGHT PRIORITIZED
QUESTIONS AND THOSE WILL SOON BE
POSTED TO DIETARY GUIDELINES.gov
ALL BUT ONE ARE UPDATES TO
EXISTING NESR REVIEWS AS PART OF
THE PREGNANCY AND BIRTH TO 24
MONTHS INITIATIVE TO INFORM THE
2020 GUIDELINES.
WHEN COMPREHENSIVE GUIDANCE FOR
PREGNANCY AND LACTATION LIFE
STAGES WERE INCLUDED IN THE
GUIDELINES FOR THE FIRST TIME
FOR THE SIGNIFICANT UNDERTAKING
THAT INVOLVED YESTERDAY.
THE NESR B24 REVIEWS WERE
PUBLISHED IN 2019.
THEY'RE RELATIVELY RECENT.
SO OUR SUBCOMMITTEE WILL UPDATE
THOSE REVIEWS CERTAINLY TO
CAPTURE NEW EVIDENCE THAT'S COME
OUT SINCE THOSE HAVE BEEN
PUBLISHED.
WE'LL ALSO EXPAND THOSE REVIEWS
TO INCLUDE OLDER CHILDREN SINCE
THOSE REVIEWS ARE PUBLISHED ON
B24.
ADDITIONALLY WE ADDED A NEW AND
DIETARY GUIDELINE FOR AMERICANS.
EACH OF THE EIGHT QUESTIONS WE
HAVE PRIORITIZED WILL EMPLOYEE
THE NESR INCLUSION AND EXCLUSION
CRITERIA PREVIOUSLY DESCRIBED.
I WON'T SAY MUCH MORE ABOUT
THAT.
AT THIS POINT I'LL TURN IT OVER
TO DR. DEIERLEIN FOR PROTOCOLS
RELATED TO DIETARY PATTERNS
REGARDING PREGNANCY.
>>THANK YOU.
SO SUBCOMMITTEE TWO IS ALSO
REVIEWING DIETARY PATTERNS AND
WILL BE USING THE SAME KEY
DEFINITION FOR DIETARY PATTERNS
AS THE OTHER SUBCOMMITTEES.
THIS DEFINITION APPLIES TO ALL
FOUR PREGNANCY QUESTIONS.
SO REGARDING THE INCLUSION AND
EXCLUSION CRITERIA, THEY'RE THE
SAME AS WHAT WAS OUTLINED BY
SUBCOMMITTEE ONE REGARDING
DIETARY PATTERNS AND THEY APPLY
TO ALL FOUR PREGNANCY QUESTIONS.
THE SAME DEFINITIONS WILL BE
USED ACROSS SUBCOMMITTEES.
SO FOR THE FOUR QUESTIONS WE ARE
TAKE TO PREGNANCY WHICH WILL BE
PRESENTED ON THIS SLIDE AND THE
FOLLOWING THREE SLIDES THE
POPULATION IS ALWAYS GOING TO BE
INDIVIDUALS DURING PREGNANCY AND
THE INTERVENTION, EXPOSURE AND
COMPARATOR OF DIETARY PATTERNS.
FOR THE QUESTION ON THIS SLIDE
WHAT IS THE RELATIONSHIP FOR
DIETARY PATTERNS CONSUMED DURING
PREGNANCY AND THE RISK OF
HYPERTENSIVE DISORDERS AND THE
OUTCOMES WE'RE LOOKING AT ARE
BLOOD PRESSURE, PROTEIN IN THE
URINE, ECLAMPSIA AND
PREECLAMPSIA AND HYPERTENSION
AND WE LOOKED AT SOCIO ECONOMIC
POSITION AND ANTHROPOMETRY AND
SMOKING AND DIABETES IN THE
PREGNANCY AND HISTORY OF
HYPERTENSIVE DISORDERS DURING
PREGNAN
PREGNANCY.
FOR THE QUESTION WHAT IS THE
RELATIONSHIP FOR DIETARY
PATTERNS DURING PREGNANCY AND
GESTATIONAL DIABETES MALITIS WE
LOOKED AT FASTING BLOOD GUE
CLOSE OR INSULIN RESISTANCE AND
GESTATIONAL DIABETES.
THE KEY CONFOUNDERS ARE THE SAME
AS FOR THE PREVIOUS QUESTION AND
LOOKING THE HISTORY OF GDM FOR
KEY CONFOUNDER.
FOR THE QUESTION WHAT IS THE
RELATIONSHIP BETWEEN DIETARY
PATTERNS CONSUMED DURING
PREGNANCY AND GESTATIONAL AGE AT
BIRTH THE OUTCOME WILL BE
GESTATIONAL AGE AT BIRTH AND THE
KEY CONFOUNDERS ARE THE SAME FOR
AGE THROUGH PARITY AND INCLUDING
DIABETES IN THE CURRENT
PREGNANCY AS WELL AS
HYPERTENSIVE DISORDERS IN THE
CURRENT PREGNANCY.
FOR THE LAST QUESTION WHAT IS
THE RELATIONSHIP BETWEEN DIETARY
PATTERNS BETWEEN PREGNANCY AND
BIRTH WEIGHT WE'LL LOOK AT
OUTCOMES SO INTRAUTERINE GROWTH
AND KEY CONFOUNDERS ARE THOSE
THE SAME AS FOR THE PREVIOUS
QUESTION.
AND EXISTING AND THE PUBLICATION
DATES WILL BE BEGIN IN 1980 AND
UPDATES MADE TO THESE EXISTING
REVIEWS.
I'LL PAUSE FOR COMMITTEE
DISCUSSION.
>>THANK YOU FOR THE OVERVAU.
>>I ASSUME THAT'S WHAT'S IN
THE -- OVERVIEW AND LUKE AT THE
LITERATURE.
>>MAYBE THE NESR TEAM CAN LOOK
AT THAT.
>>ANY OTHER QUESTIONS?
>>OKAY.
CONTINUE.
>>THANK YOU.
>>NOW WE'LL GO TO COMPLIMENTARY
FEEDING.
SO THIS PROTOCOL PERTAINS TO
COMPLIMENTARY FEEDING WHICH USE
THE FOLLOWING DEFINITION.
SO IT'S THE PROCESS THAT STARTS
WHEN HUMAN MILK OR INFANT
FORMULA IS COMPLIMENT OTHER
FOODS AND BEVERAGES.
IT CONTINUES TO 24 MONTHS AS THE
YOUNG CHILD TRANSITION TO FAMILY
FOODS
AND FOODS AND BEVERAGE DEFINED
AS FOODS AND BEVERAGES PROVIDED
TO AN INFANT OR YOUNG CHILD TO
PROVIDE NUTRIENTS AND ENERGY.
SO THIS IS THE ANALYTIC
FRAMEWORK FOR OUR QUESTION WHICH
IS WHAT IS THE RELATIONSHIP
BETWEEN COMPLIMENTARY FEEDING
AND GROWTH BODY COMPOSITION AND
RISK OF OBESITY WHICH UPDATES AN
EXISTING NESR SYSTEMATIC REVIEW
DURING THE PREGNANCY AND BIRTH
24 MONTHS PROJECT MENTIONED.
AND AS MENTIONED EARLIER IN THE
PRESENTATIONS THE ORIGINAL
WORDING OF THIS QUESTION WAS
WHAT IS THE RELATIONSHIP BETWEEN
TIMING OF INTRODUCTION AND TYPES
AND AMOUNTS OF COMPLIMENTARY
FOODS AND BEVERAGES AND BROTHER
SIZE, BODY XOIGS AND RI --
COMPOSITION AND RISK OF OBESITY
AND THIS WAS SIMPLIFIED WHILE
LOOKING AT ASPECTS OF
COMPLIMENTARY FEEDING AND DOES
NOT CHANGE THE SCOPE OF THE
REVIEW.
THE POPULATION AT EXPOSURE FOR
THE REVIEW IS INFANTS AND
TODDLERS FROM BIRTH UP TO 24
MONTHS AND SUBDIVIDED TO
CATEGORIES.
FIRST TIMING OF THE FIRST
INTRODUCTION OF ANY
COMPLIMENTARY FOOD OR BEVERAGE
WHICH WILL BE COMPARED TO A
DIFFERENT TIMING OF THE
INTRODUCTION OF ANY
COMPLIMENTARY FOOD OR BEVERAGE
AND SECOND IS TIMING OF THE
FIRST INTRODUCTION OF A SPECIFIC
TYPE OF COMPLIMENTARY FOOD OR
BEVERAGE WHICH IS GOING TO BE
COMPARED TO THE COMPLIMENTARY
FOOD OR BEVERAGE.
THIRD TYPES OF FOOD AND
BEVERAGES COMPARED TO A
DIFFERENT AMOUNT OF THE SAME
COMPLIMENTARY FOOD OR BEVERAGE
OR TYPE OF COMPLIMENTARY FOOD OR
BEVERAGE.
FOR THE TIMING OF THE FIRST
INTRODUCTION AND SYSTEMIC
REVIEWS WITH META-ANALYSIS WILL
BE CONDUCTED ON THE
RELATIONSHIPS BETWEEN ING A
SUGAR-SWEETENED FOODS AND
INFANTS AND TODDLERS WILL BE
INCLUDE.
FOR THE OUTCOMES WE'LL BE
EXAMINING GROWTH IN INFANTS AND
TODDLERS AND CHILDREN AND
ADOLESCENTS, BODY COMPOSITION IN
INFANTS AND TODDLERS, CHILDREN
AND ADOLESCENTS AND ADULTS AND
OLDER ADULTS AND RISK OF OBESITY
IN CHILDREN AND ADOLESCENTS AND
ADULTS AND OLDER ADULTS.
THE SPECIFIC OUTCOMES ARE THE
SAME AS PREVIOUSLY DESCRIBED BY
SUBCOMMITTEE ONE AND THE KEY
CONFOUNDERS ARE SOCIO ECONOMIC
POSITION, SEX, INTERNAL AGE,
RACE AND ETHNICITY, MILK FEEDING
PRACTICES AND GESTATIONAL AGE.
AS DESCRIBED IN THE ANALYTIC
FRAMEWORK THE INCLUSION CRITERIA
FOR THE INTERVENTION EXPOSURE
ARE TIMING OF THE FIRST
INTRODUCTION OF ANY
COMPLIMENTARY FOOD OR BEVERAGE,
TIMING OF THE FIRST INTRODUCTION
OF A SPECIFIC TYPE OF
COMPLIMENTARY FOOD OR BEVERAGE
OR TYPES AND AMOUNTS OF
COMPLIMENTARY FOODS OR
BEVERAGES.
THE EXCLUSION CRITERIA FOR THE
INTERVENTION EXPOSURE ARE
ISOLATED CONSUMPTION OF HUMAN
MILK, INFANT FORMULAS OR FOR
TIMING OF THE SPECIFIC TYPE OF
COMPLIMENTARY FOOD OF BEVERAGE
AND TYPES AND AMOUNTS OF FOODS
OR BEVERAGES THE EXCLUSION
CRITERIA ARE EXAMINING DIETARY
PATTERNS AND NOT DESCRIBING THE
AMOUNT OR TYPE OF FOOD OR
BEVERAGE AS DESCRIBED IN THE
ANALYTIC FRAMEWORK THE INCLUSION
CRITERIA FOR THE INTERVENTION
EXPOSURE ARE DIFFERENT TIMING OF
THE FIRST INTRODUCTION OF ANY
COMPLIMENTARY FOOD OR BEVERAGE,
DIFFERENT TIMING OF THE FIRST
INTRODUCTION OF A SPECIFIC TYPE
OF COMPLIMENTARY FOOD OR
BEVERAGE AND DIFFERENT TYPES AND
AMOUNTS OF COMPLIMENTARY FOODS
OR BEVERAGES INCLUDING
CONSUMPTION OF A DIFFERENT
AMOUNT OF THE SAME COMPLIMENTARY
FOOD OR BEVERAGE AND CONSUMPTION
OF A DIFFERENT TYPE OF
COMPLIMENTARY FOOD OR BEVERAGE.
SO STUDIES WITHOUT A COMPARATOR
WILL BE EXCLUDED.
IN REGARD TO THE PUBLICATION
DATES PUBLISHED FROM 1980 TO
PRESENT WHILE STUDIES PUBLISHED
BEFORE JANUARY 1980 ARE EXCLUDED
PER LIFE STAGE AND INTERVENTION
OR EXPOSURE THE INCLUSION
CRITERIA ARE INFANTS AND
TODDLERS FROM BIRTH TO 24
MONTHS.
THE EXCLUSION CRITERIA ARE
CHILDREN AND ADOLESCENTS AND
ADULTS AND OLDER ADULTS 19 YEARS
AND OLDER FOR LIFE STAGE
OUTCOMES PARTICIPANTS OF ALL
STAGES WILL BE INCLUDED.
>>THANK YOU, ANDREA.
NOW WE'LL MOVE BACK TO THE LAST
SCIENTIFIC QUESTIONS PERTAINING
TO THE HOW'S OF FEEDING YOUNG
CHILDREN AND START WITH A DRAFT
PROTOCOL USED TO EVALUATE THE
EVIDENCE ON REPEATED EXPOSURE
AND FOOD ACCEPTANCE AMONG
CHILDREN.
WHAT IS REPEATED EXPOSURE?
IT'S IN THE CONTEXT OF THIS
REVIEW WILL REFER TO THE NUMBER,
DURATION AND FREQUENCY WITH
WHICH FOODS ARE OFFERED TO
DOWNCHILDREN IN THE INTEREST --
TO YOUNG CHILDREN IN THE
INTEREST OF PROMOTING OR FOOD
ACCEPTANCE AND THERE'S A COUPLE.
TASTE EXPOSURE AND CONSUMING
TARGET FOODS, PRETTY
STRAIGHTFORWARD AND THERE'S
ANOTHER BODY OF LITERATURE THAT
CONSIDERS NON-TASTE EXPOSURE.
WHAT IS THAT?
THAT REFERS TO THE PROVISION OF
OTHER SENSORY EXPOSURE TO FOODS
SUCH AS VISUAL, TACTILE AND
OLFACTORY EXPOSURES.
THIS COULD BE THING LIKE SITTING
DOWN WITH CHILDREN AND READING
PICTURE BOOKS WITH VEGETABLES.
IT COULD HAVE CHILDREN USE
FRUITS TO CREATE AN ART PROJECT.
NON-TASTE SENSORY EXPOSURE.
AND I'LL BE REFERRING TO THAT
THROUGHOUT THE PROTOCOL.
THIS SLIDE SHOWS YOU THE
ANALYTIC FRAMEWORK THAT WILL BE
USED TO EVALUATE THE EVIDENCE ON
REPEATED EXPOSURE AND FOOD
ACCEPTANCE AND CHILDREN FROM
BIRTH TO 12 YEARS OF AGE
CATEGORIZED IN THREE SEPARATE
DEVELOPMENT STAGES.
INFANTS AND TODDLERS, YOUNG
CHILDREN AND SCHOOL AGE
CHILDREN.
IN EACH CASE THE INTERVENTION OR
EXPOSURE WILL BE REPEATED
EXPOSURE TO A PARTICULAR FOOD OR
TYPE OF FOODS ON OCCASION.
THE COMPARATORS WILL BE PRE TO
POST-TEST CHANGE WITHIN SUBJECT
DESIGN AND EXPOSURE VERSUS NO
EXPOSURE BETWEEN SUBJECT'S
DESIGNS AND TASTE VERSUS
NON-SAFETY EXPOSURE.
THERE ARE A VARIETY OF DIFFERENT
INDICATORS OF FOOD ACCEPTANCE IN
THE LITERATURE AND WE'RE GOING
TO BE INCLUSIVE AS POSSIBLE.
THOSE INCLUDE THE AMOUNT, THE
RATE OR THE LENGTH OF INTAKE OR
FEED SPECIFICALLY IN INFANT
LITERATURE, FACIAL OR BODY
EXPRESSIONS MADE WHILE EATING
THE TARGET OR TARGET FOODS,
VERBAL COMMENTS, YUM, YUCK,
CAREGIVER PERCEPTION OF THE
CHILD'S LIKING AND CHILDREN'S
WILLINGNESS TO TRY AND
RESPONSES.
KEY CONFOUNDERS WILL BE
CAREGIVER RACE AND ETHNICITY AS
WELL AS SOCIO ECONOMIC POSITION.
THE TYPE OF EXPOSURE WILL
INCLUDE TASTE AND NON-TASTE
EXPOSURES AS WELL AS EXPOSURE TO
SINGLE AND MULTIPLE FOODS AS
SAID.
BUT IMPORTANTLY WE WILL INCLUDE
MULTI-COMPONENT INTERVENTIONS
ONLY WHEN THOSE INTERVENTIONS
CAN ISOLATE THE EFFECT OF
ROUTINE EXPOSURE.
THIS REVIEW AND THE EXCLUSION I
THINK ARE IMPORTANT IF YOU WORK
IN THE FIELD.
THE REVIEW WILL NOT INCLUDE
STUDIES OF FOOD OR FLAVOR
EXPOSURE IN UTERO OR DURING
HUMAN MILK FEEDING BECAUSE WE'RE
INTERESTED IN THE EXPOSURES ON
FOOD ACCEPTANCE FROM
COMPLEMENTARY FEEDING ONWARD.
IN SOME SENSE THE REVIEW WILL
NOT INCLUDE STUDIES OF TASTE
EXPOSURE AND EXPOSURE TO
SWEETNESS AND FLAVOR EXPOSURE
LIKE CARROTS OPPOSED TO FOOD
EXPOSURE AND FINALLY AGAIN WITH
OUR EMPHASIS ON ACCEPTANCE
STUDIES IN WHICH THE OUTCOME AND
THE NUTRIENT INTAKE OR SODIUM
INTAKE OPPOSED TO FOOD INTAKE OR
LIKING WILL BE EXCLUDED.
ALL RIGHT.
INCLUDED AND EXCLUDED OUTCOMES
ARE DETAILED AND REFLECTING THE
2019 NESR REVIEW AMONG INFANTS
AND TODDLERS AND THE PUBLICATION
RATES IN THAT POPULATION ARE
1980 TO PRESENT AND OLDER
CHILDREN WILL INCLUDE STUDIES
PUBLISHED 2000 TO PRESENT.
LIFE STAGES AT INTERVENTION AND
EXPOSURE WILL BE THOSE
PREVIOUSLY DESCRIBED IN THE
ANALYTIC FRAMEWORK AND WILL BE
INCLUDED ADOLESCENTS AND
OUTCOMES.
THAT BRINGS ME TO THE END OF
THIS DRAFT PROTOCOL AND THAT
BRINGS US TO OUR LAST TWO
QUESTIONS WHICH REALLY BRING
TOGETHER WIDE DISCIPLINARY
PERSPECTIVES ON PARENTING,
DEVELOPMENT PSYCHOLOGY AND
DEVELOPMENT NUTRITION TO
EVALUATE ASSOCIATIONS OF
CAREGIVER FEEDING STYLES AND
PRACTICES WHICH WE'LL TALK A BIT
ABOUT IN A SECOND WITH CHILD
DIETARY PATTERNS AND IMPROVE
OUTCOMES.
AGAIN WE'LL START WITH
DEFINITIONS AND IN THIS
LITERATURE IT'S IMPORTANT WE
JOKE THERE'S PROBABLY AS MANY
TERMS AS THERE ARE DATA SO LET'S
START BY MAKING SURE WE'RE ALL
ON THE SAME PAGE.
SO FIRST IN TERMS OF THE
DEFINITION OF CAREGIVER, THIS
REVIEW WILL PERTAIN TO PARENTS,
GRANDPARENTS AND GUARDIANS AND
THOSE WHO PROVIDE DIRECT CARE IN
THE HOME AND POINT TO CAREGIVING
SUCH AS CHILDREN ROUTINE EATING
IN SCHOOLS AND CAREGIVING
SETTINGS AND IS WITHIN THE SCOPE
OF THE FIRST REVIEW.
SECOND, EATING PRACTICES AND
INFANTS AND TODDLERS.
IN GENERAL, THE LITERATURE ON
INFANTS AND TODDLERS IS SOMEWHAT
DISTINCT FROM THE SAME TOPICS OF
OLDER CHILDREN AGAIN IN GENERAL
DURING THE INFANCY AND
TODDLERHOOD STUDIES OF HUMAN
MILK AND COMPLEMENTARY FEEDING
TENDED TO FOCUS ON CAREGIVER'S
RECOGNITION AND RESPONSIVENESS
TO HUNGER AND WELLNESS CUES AND
DEVELOPMENTALLY APPROPRIATE
CONTINGENT AND THIS AND REFLECT
A LACK OF RECIPROCITY BETWEEN
CAREGIVER AND CHILD AND SOME
PRACTICES AND EVALUATED IN OLDER
CHILDREN LIKE PRESSURE TO EAT IN
RESTRICTION WHERE OTHERS ARE
DEVELOPMENTALLY SITUATED LIKE
FEEDING TO SOOTH A DISTRESSED
INF
INFANT.
THOSE ARE THE KEY DEFINITION FOR
INFANTS AND TODDLERS.
FOOD PARENTING STYLES AND
PRACTICES INVOLVING OLDER
CHILDREN AS YOU MIGHT EXPECT
REFLECT MORE COMPLEX GOALS
RELATED TO SOCIALIZATION AND
CHILD DEVELOPMENT AND
PARENT-CHILD RELATIONSHIP AND
NUTRITIONAL EATING GOALS.
IN GENERAL THIS MAKES
DISTINCTION BETWEEN PRACTICES
AND DRAWN FROM LITERATURE ON
PARENTING TO CHARACTERIZE THE
OVER ALL ATTITUDE AND EMOTIONAL
CLIMATE SURROUNDING FEEDING AND
IMPORTANTLY IN ADDITION TO
RESPONSIVENESS, FEEDING STYLES
ALSO REFLECT CAREGIVER DEMAND
AND EXPECTATIONS FOR THE CHILD'S
BEHAVIORS.
SO BOTH OF THOSE DIMENSIONS
DEMANDING RESPONSIVENESS ARE
TYPICALLY USED TO CATEGORIZE THE
FEEDING STYLES LISTED ON THE
SLIDE.
ALTERNATIVELY WHEN WE TALK ABOUT
PRACTICES THESE REFER TO A VERY
WIDE RANGE OF GOAL-DIRECTED
BEHAVIORS THAT CAREGIVERS USE TO
DIRECT CHILDREN'S EATING FROM
PRAISING CHILDREN TO PRESSURING
CHILDREN TO EAT TO PROVIDING
GUIDED CHOICES TO MAKING FOODS
AVAILABLE IN THE HOME.
AND WE TALKED ABOUT THIS
YESTERDAY IN SUBCOMMITTEE FOUR.
THE CURRENT THINKING IS THE WIDE
RANGE OF PRACTICES REFLECT
HIGHER ORDER DIMENSIONS OF
COERCIVE CONTROL, AUTONOMY
SUPPORT AND STRUCTURE THE LATTER
TWO LEAD TO THE SUPPORTIVE
INTEREST IN OUR REVIEW.
AND THERE'S STUDIES INCLUDING
MOMENTARY ASSESSMENT AND
PROTOCOLS WILL ONLY INVOLVE
MULTI-COMPONENT INTERVENTIONS
WHERE THE STYLES AND PRACTICES
COULD BE ISOLATED.
IN CONTRAST STUDIES INVOLVING
CHILDCARE AND SCHOOL-BASED
EXPOSURE WHERE'S FEEDING EFFECTS
CANNOT BE ISOLATED WILL BE
EXCLUDED.
SO IN THIS CASE IN THESE
PROTOCOLS THE COMPARATOR WILL
EITHER BE DIFFERENT DEGREES OF
USE OF A PARTICULAR PRACTICE
MORE OR LESS PRESSURE TO EAT FOR
INSTANCE OR DIFFERENT TYPES OF
STYLES AND PRACTICES.
ALL RIGHT.
WE HAVE TWO MORE SLIDES OR
SEVERAL MORE AND THESE PRESENT
THE ANALYTIC FRAMEWORK FOR THE
PROTOCOL EVALUATING CHILD
GROWTH, BODY COMPOSITION AND
RISK OF OBESITY OUTCOMES AND
HERE THE POPULATION ARE CHILDREN
FROM BIRTH TO 19 YEARS OF AGE
GROUPED IN FOUR DISTINCT DEVELOP
STAGES AND INFANTS AND TODDLERS
WERE INCLUDED IN THE B24 IN AS
NESR REVIEW AND EVIDENCE ON
OLDER CHILDREN WILL CONSTITUTE
DIFFERENT ASPECTS OF THE
SYSTEMIC REVIEWS AND THE
EXPOSURES AND COMPARATORS AND
USING THE CATEGORIZATION
DESCRIBED BY OUR CHAIRS IN OTHER
SUBCOMMITTEES AND THE KEY
CONFOUNDERS ARE RACE AND
ETHNICITY AND SOCIO ECONOMIC
COMPOSITION AND ANTHROPOMETRY AT
BASELINE AND THE FINAL FRAME
WORK FOR THE NEW SYSTEMIC REVIEW
LOOKING AT DIETARY OUTCOMES AND
THE COMPARATORS ARE THE SAME AS
IN THE PREVIOUS PROTOCOLS.
THE OUTCOME ALIGN WITH THE DGA
AS INDICATED BY THE HEALTHY
EATING INDEX HOWEVER, OUR
SUBCOMMITTEE HAD DISCUSSION
AROUND THE OUTCOMES AND ALSO
PROPOSED TO INCLUDE SEVERAL
SPECIFIC GROUPS THAT ARE WELL
REPRESENTED IN THE LITERATURE ON
FOOD PARENTING AND THOSE ARE
FRUIT AND VEGETABLES, WHOLE
GRAINS AND SUGAR-SWEETENED
BEVERAGES.
WE CHOSE TO INCLUDE THESE
BECAUSE WE ALSO ACKNOWLEDGE
THESE GROUPS IN PARTICULAR ARE
ASSOCIATED WITH CONSUMPTION OF
OVER CONSUMING DRINKS IN THE
SIDEWAYS OF SUGAR-SWEETENED
BEVERAGES.
THE SAME CONFOUNDER IS THE SAME
AS THE PREVIOUS FRAMEWORK EXCEPT
SOME OUTCOMES.
THE PUBLICATION DATES AND
POPULATION EXCLUSION CRITERIA
FOR THESE PROTOCOLS VARIES
SLIGHTLY BASED ON PROTOCOL
OUTCOME.
PUBLICATION DATE LOOKING AT
GROWTH, BODY COMPOSITION AND
RISK OF OBESITY OUTCOMES IN
CHILDREN BIRTH TO 24 MONTHS
REACH BACK TO 1980 GIVEN THE
PORTION OF THE REVIEW UPDATES
THE 2019 NESR REVIEW.
WHILE THE REVIEW OF EVIDENCE 2
TO 19 YEARS OF AGE IS PUBLISHED
FROM 2000 TO PRESENT.
POPULATION LIFE STAGES INCLUDE
INFANTS AND TODDLERS AND
BASELINE AT INTERVENTION
HOWEVER, THE PROTOCOL WILL
INCLUDE OUTCOMES ASSESSED ACROSS
THE LIFE SPAN.
AND FINALLY, GIVEN THE NEW
REVIEW LOOKING AT FOOD PARENTING
AND DIETARY OUTCOMES IS ENTIRELY
NEW IT WILL INCLUDE STUDIES
PUBLISHED FROM 2000 TO PRESENT.
THE POPULATION LIFE STAGES
INCLUDE TODDLERS, 12 TO 24
MONTHS AND CHILDREN OF
ADOLESCENTS AT BASELINE
INTERVENTION AND I WANTED TO
POINT OUT WITH THIS PROTOCOL WE
ARE NOT INCLUDING INFANTS SINCE
WE ACKNOWLEDGE THE COMMITTEE HAD
DISCUSSION AROUND DIETARY
PATTERNS OF INFANTS LOOK QUITE
DIFFERENT THAN THOSE OF OLDER
CHILDREN AND DR. ABRAMS MADE THE
POINT IT'S BASED ON CONSUMPTION
OF MILK AND FORMULA AND
INTRODUCTION OF COMPLIMENTARY
FOOD AND BEVERAGES PROVIDING
LIMITED ENERGY UNTIL CLOSER TO
THE ENDS OF THE FIRST YEAR OF
LIFE.
ALL RIGHT.
I THINK THAT CONCLUDES THE
DESCRIPTION OF OUR DRAFT
PROTOCOLS FOR THE EIGHT
SCIENTIFIC QUESTIONS WE
PRIORITIZED.
LIKE OTHER SUBCOMMITTEES THE
NEXT STEP ARE RELATED TO REFINE
THE PROTOCOLS BASED ON
DISCUSSION AND FEEDBACK AS WELL
AS PUBLIC COMMENTS AND THEN TO
GET TO THE BUSINESS OF
IMPLEMENTING PROTOCOLS SO THANK
YOU TO THE SUBCOMMITTEE AND THE
LARGER COMMITTEE FOR YOUR
ATTENTION AND WE CERTAINLY
WELCOME YOUR THOUGHTS OR
QUESTIONS.
>>THANK YOU SO MUCH FOR
PRESENTING.
I HAVE A QUESTION FOR THE
CONFOUNDER AND COMPLIMENTARY
FEEDING PRACTICE FOR INFANTS AND
COMING BACK TO THE CAREGIVER
FEEDING STYLE AND PRACTICES.
I DIDN'T SEE MATERNAL AND
PATERNAL OBESITY CONSIDERED,
WEIGHT STATUS OF THE PARENTS IS
OF SIGNIFICANT CONCERN
PARTICULARLY THROUGHOUT THE
CHILDHOOD PROCESS SO I WAS
WONDERING IF YOU GUYS CONSIDERED
THAT AS A KEY CONFOUNDER IN
THOSE AREAS AND IF NOT WHY.
>>I THINK THAT'S A GREAT
QUESTION AND ONE THE
SUBCOMMITTEE SPENT AN OF TIME
TALKING ABOUT FOR THE REASONS
YOU OUTLINED.
AND FOR THOSE ON THE
SUBCOMMITTEE PLEASE FEEL FREE TO
JUMP IN.
I THINK ULTIMATELY BASED ON THE
NESR DEFINITION OF KEY
CONFOUNDERS WHILE WE RECOGNIZE
THAT MATERNAL BMI MAY HAVE
STRONG ASSOCIATION WITH CHILD
PATTERNS OF GROWTH WE DID NOT
BELIEVE THE EVIDENCE ROSE TO THE
LEVEL THAT WOULD BE APPROPRIATE
TO INCLUDE AS A KEY CONFOUNDER
IN TERMS OF THE BODY SIZE
PREDICTS CERTAIN WAYS OF FEEDING
CHILDREN.
SO I THINK THE EVIDENCE IS
LACKING A LITTLE BIT IN THAT
AREA.
IN FACT THERE'S SOME STUDIES
WHICH SUGGEST THE ALTERNATIVE
SIZE AND THERE'S NOT A
PARTICULAR APPROACH OR PATTERN
AND TYPES OF PRACTICES THAT IS
GOVERNED BASED ON PERSON'S BODY
SIZE.
I THINK WE WENT AROUND AND
AROUND ABOUT IT BECAUSE YOU'RE
RIGHT AND I FEEL LIKE IN MOST
THE RESEARCH THAT NEEDS TO BE
TAKEN INTO CONSIDERATION BUT FOR
OUR GUIDING PRINCIPLES FOR THE
KEY CONFOUNDERS I THINK WE CAME
TO THAT CONCLUSION BASED ON THE
PREDICTOR SIDE.
DOES ANYONE HAVE ANYTHING TO
ADD?
OKAY.
>>I THINK MAYBE TO CONSIDER IN
THE REPORT IS THAT YOU EVALUATED
LIKE NOT NECESSARILY AS A KEY
CONFOUNDER BUT MATERNAL AND
PATERNAL BMI BECAUSE IT AN
INFLUENCE EATING PRACTICES AND
THE DESIRE TO ENSURE THEY'RE
FEEDING IN A SIMILAR PATTERN
THAT FITS THEIR OWN.
JUST SOMETHING CONSIDER.
>>YES, THANK YOU FOR THAT
FEEDBACK.
WE'LL BRING THAT BACK FOR
DISCUSSION.
>>I ALSO HAVE A QUESTION ABOUT
CONFOUNDERS.
THIS IS WITH REGARDS TO THE
REPEATED EXPOSURE TO FOOD
ACCEPTANCE.
I'M CURIOUS ABOUT CAREGIVER
AGEP, THE RELATIONSHIP OF THE
CAREGIVER TO THE CHILD AS WELL
AS THE FEEDING SETTING.
AND SINCE YOU DID SUCH A
BEAUTIFUL JOB IN TALKING ABOUT
FEEDING STYLE IT MAY COME INTO
PLAY.
CAN WE HAVE INFORMATION ABOUT
HOW THOSE THINGS WERE DETERMINED
WITHIN THE CONVERSATIONS?
I THINK THOSE ARE GREAT
QUESTIONS.
YOU'RE RIGHT YOU CANNOT CONSIDER
THE PRACTICE OUTSIDE THE CONTEXT
AND IT'S SO IMPORTANT TO ALL OF
OUR DISCUSSIONS.
I WOULD SAY THAT SO THE FIRST
QUESTION WAS REPEATED EXPOSURE
AND AGE OF THE CAREGIVER.
>>THE CONFOUNDING WITH FOOD
ACCEPT AN
ACCEPTANCE.
>>WE HAD A LOT OF DISCUSSION
ABOUT POTENTIAL CONFOUNDERS AND
I THINK THERE WERE A NUMBER
WHERE CONCEPTUALLY WE IDENTIFIED
INFLUENCES THAT WE THOUGHT COULD
BE IMPORTANT BUT WHEN IT DOWN TO
REALLY THINKING ABOUT GRADING
POTENTIAL BIAS IN THE WORK AND
GIVEN WHAT WE KNOW OF THE
LITERATURE WE DIDN'T -- I THINK
IN THOSE CASES AS A GREAT
EXAMPLE THAT CONCEPTUALLY COULD
IMAGINE WOULD BE QUITE IMPORTANT
BUT I DON'T THINK THERE'S
EVIDENCE TO SUPPORT THE
INCLUSION IF WE'RE USING
EVIDENCE TO DRIVE THE INCLUSION
OF THESE KEY CONFOUNDERS.
IT'S A GREAT EXAMPLE OF CASE
WHERE'S I DON'T KNOW IF OTHER
SUBCOMMITTEES WRESTLED WITH THIS
WHERE WE'RE ON THE FENCE ABOUT
HOW TO LOOK AT KEY CONFOUNDERS
AND WHERE THOSE LINES ARE DRAWN
AND WHAT THE IMPLICATIONS ARE
FOR HOW WE THINK ABOUT THE
STRENGTH OF THE EVIDENCE OR
STRENGTH OF THE LITERATURE.
>>IN SUBCOMMITTEES ONE AND FOUR
IT FEELS LIKE THAT'S ALL WE TALK
ABOUT IS CONFOUNDING BUT WE DO
HAVE THIS SORT OF NORTH STAR
AROUND HOW WE THINK OF A
CONFOUNDER TRADITIONALLY AND
THEN YOU'RE RIGHT I THINK THE
NEXT STEP IS DO YOU DOWNGRADE
THE EVIDENCE BECAUSE THIS IS
DETERMINED TO BE KEY?
I WAS JUST CURIOUS AS TO WHETHER
OR NOT THESE THINGS MADE THEIR
WAY TO THE TABLE FOR
CONVERSATION AND PERHAPS YOU
COULD IDENTIFY THEM AS POTENTIAL
CONFOUNDERS BUT IN THE CONTEXT
OF THESE QUESTIONS THEY'RE NOT
GOING TO BE KEY CONFOUNDERS
WHERE YOU FEEL CONFIDENCE IN
DOWNGRADING THE EVIDENCE BECAUSE
IT'S ABSENT.
>>THANK YOU FOR THAT FEEDBACK
AND THAT'S AN EXCELLENT POINT.
IN EACH OF THE FRAMEWORKS -- I
SHOULDN'T SAY I DON'T KNOW IF
THAT'S THE CASE IN PREGNANCY BUT
CERTAINLY FOR THE FRAMEWORKS
WITH OLDER KIDS WE TALKED ABOUT
THE VARIABLES WE NEED TO
CONSIDER IMPORTANT AS SHOULD
TAKE INTO CONSIDERATION THE
EVIDENCE BUT MAYBE WOULDN'T BE
INCLUDED AS KEY CONFOUNDERS.
THANK YOU.
>>DOES ANYONE HAVE ANYTHING TO
ADD?
>>WE HAVE ONE ADDITIONAL
QUESTION.
WITH REPEATED EXPOSURE WOULD YOU
CONSIDER PULLING OUT MATERNAL
EDUCATION SEPARATE FROM THE
SOCIO ECONOMIC POSITION BECAUSE
THAT MIGHT -- AGAIN,
[INDISCERNIBLE]
>>I'M MAKING EYE CONTACT WITH
OTHER SUBCOMMITTEE MEMBERS ONLY
BECAUSE WE SPENT A LOT OF TIME
TALKING ABOUT ALL THESE GENERAL
ISSUES.
SO YES, WE TALKED AT LENGTH AT
LEAST IN ONE OF THE FRAMEWORKS
ABOUT WHETHER OR NOT TO
SEPARATELY EVALUATE AND PULL OUT
INTERNAL EDUCATION BECAUSE WE
ACKNOWLEDGE THAT EDUCATION IS
NOT CONCEPTUALLY AND COULD BE
DISTINCT FROM SOCIO ECONOMIC
DECISION AND OTHER INDICATORS.
I THINK AND PLEASE, AGAIN,
SUBCOMMITTEE MEMBERS CORRECT ME
IF YOU HAVE A DIFFERENT VIEW BUT
I THINK WHAT WE CAME AROUND TO
IS CERTAINLY WE WANTED TO BE
CONSISTENT AND LOOK TO THE
HEALTH EQUITY GROUP TO GUIDE THE
DECISIONS AND I KNOW THE HEALTH
EQUITY GROUP HAS GIVEN GENERAL
GUIDANCE BUT REALLY PUT IT BACK
TO THE SUBCOMMITTEES TO THINK
ABOUT WHAT THAT MEANS.
SO I'LL LEAD TO THE LAST POINT
WHICH IS WE ULTIMATELY DECIDED
TO INCLUDE MATERNAL EDUCATION
STILL UNDER THE UMBRELLA OF
SOCIO ECONOMIC POSITION.
WITH THE IDEA THAT A LOT OF THE
INDICATORS ARE NOT EQUAL TO ONE
ANOTHER AND THAT ALL SHOULD BE
CONSIDERED AND AGAIN I'M LOOKING
AROUND, ARE THERE OTHER ASPECTS
OF OUR CONVERSATION?
>>I THOUGHT ONE THING WE SAID
WAS WE WANTED TO EXTRACT ALL
THESE THINGS BUT ONLY REQUIRES
ONE SOCIO ECONOMIC INDICATOR AND
NOT ALL OF THEM.
AND IT'S IMPOSSIBLE TO MEASURE
AT CERTAIN AGE GROUPS AND
CONSIDERED OTHER DIETARY
EXPOSURES SO THE THAT GOES ALONG
WITH PROVIDING SUGARY BEVERAGES
FOR EXAMPLE.
>>ANOTHER QUESTION.
AND PHYSICAL ACTIVITY WAS
INCLUDED IN THE PROTOCOLS THAT
WE INITIALLY WERE PRESENTED WITH
FOR THE PROJECT AND AGAIN I
THINK I DON'T KNOW WHETHER OUR
COMMITTEE REALLY JUST WRESTLED
WITH THE CONFOUND EERS BUT ANOTR
EXAMPLE OF WHERE AND LOOKED AT
THE PRECISION TO PROVIDE REPEAT
EXPOSURE AND DIDN'T FEEL THERE
WAS AN EMPIRICAL BASIS TO
JUSTIFY THE INCLUSION IN THE
TRADITIONAL REQUIREMENTS OR WAYS
OF THINKING ABOUT CONFOUNDERS
BUT RELATED TO THE EXPOSURE AND
THE OUTCOMES.
AND AGAIN, I THINK CONCEPTUALLY
ALL OF US WOULD AGREE THESE ARE
IMPORTANT AND HOPEFULLY THESE
COMMENTS WILL BRING US BACK TO A
LARGER DISCUSSION HOW TO ADDRESS
SOME FACTORS BOTH WHEN WE
EXTRACT THE INFORMATION AS WELL
AS MOVE TO INTERPRETING THE
EVIDENCE BECAUSE I THINK THEY'RE
EXCELLENT WHERE KIDS ARE
CONCERNING.
AND ONE OF OUR KEY CHALLENGES
AND GOALS IS TO PROVIDE FEEDBACK
THAT WILL SUPPORT CAREGIVERS AND
IN THEIR EFFORTS TO PROMOTE
HELPFUL EATING AND IT'S AN
INTERPRETED TO BE JUDGMENT
ORIENTED AND HISTORICALLY AND
THE WORK FIRST STARTED IN THE
CONTEXT OF OBESITY RISK AND ALL
THIS BACK TO SAY I THINK WE WANT
TO TAKE SPECIAL CARE TO SHOW
THIS IN ALL THE EVIDENCE IN
DETERMINING HOW A CAREGIVER
MIGHT APPROACH FEEDING OR HOW
CHILDREN MIGHT EAT.
THOSE DISCUSSIONS ARE ONGOING.
>>BUILDING ON THAT PERHAPS DID
YOU ALL CONSIDER PHYSICAL
ACTIVITY WITH THE DIETARY
PATTERNS CONSUMED DURING
PREGNANCY AND RISK OF
HYPERTENSIVE DISORDERS OR
GESTATIONAL DIABETES?
>>I LOOK BACK AND I WAS MAKING
A MENTAL NOTE THAT WE SHOULD GO
BACK AND HAVE FURTHER DISCUSSION
ABOUT IT.
>>ANY MORE QUESTIONS?
UNFORTUNATELY WE CANNOT SEE A
LOT OF THE MICROPHONES HERE.
ANY MORE QUESTIONS?
THANK YOU GROUP TWO FOR A GREAT
SET OF PRESENTATION.
AND TO SOUND LIKE A BROKEN
RECORD, THANK YOU EVERYONE FOR
SUCH THOUGHTFUL COMMENTS.
THIS WILL COLLECTIVELY
CONTRIBUTE TO STRONGER
PROTOCOLS.
I HATE TO BE THE TASK MASTER BUT
IT IS 12:00 NOON AND WE ARE
GOING TO BREAK FOR LUNCH.
I AM SORRY, COMMITTEE MEMBERS,
WE'RE COMING BACK AT 12:30.
SO ENJOY YOUR LUNCH.
THANK YOU VERY MUCH EVERYONE.
THANK YOU, EVERYONE, I KNOW THAT
WAS A SHORT LUNCH AND WE HAVE
GREAT DISCUSSION AND WANT TO
MAKE SURE EVERY SUBCOMMITTEE HAS
AN OPPORTUNITY TO PRESENT THEIR
WORK AND WE ENCOURAGE ACTIVE
FEEDBACK SO OUR NEXT COMMITTEE
IS SUBCOMMITTEE FOUR, AND NO, WE
DO KNOW HOW TO COUNT.
AS IT JUST THAT ONE, TWO AND
FOUR ARE ALL FOCUSSED ON
SYSTEMIC REVIEWS AND THE DATA
ANALYSIS AND FOOD MODELLING
UNDER SUBCOMMITTEE THREE WILL
THEN COME AFTER THIS ONE.
SO WITH THAT I WOULD LIKE TO
HAND OVER THE PODIUM TO CHRI
CHRISTINA TO DISCUSS
SUBCOMMITTEE FOUR.
THANK YOU.
>>I'LL BE PRESENTING WITH
CHERYL ANDERSON THE RESULTS OF
WHAT WE HAVE DONE IN
SUBCOMMITTEE USE FOR RELATED TO
DIET QUALITY IN WEIGHT
MANAGEMENT.
BEFORE GETTING TO THIS
SUBCOMMITTEE FOUR WORK I WANTED
TO POINT OUT ALL THE QUESTIONS
THAT WE'LL BE DISCUSSING AND
PROTOCOLS WE HAVE NOTHING FROM
BEFORE.
WE HAD DISCUSSION TO REALLY
PRIORITIZE THE STRATEGIES THAT
WILL HELP THE AMERICAN PUBLIC
TAKING INTO ACCOUNT WHAT WE
HEARD THIS MORNING ABOUT HEALTH
EQUITY AND WHAT WILL BE THE AND
WHAT IS AVAILABLE.
I WOULD LIKE TO ACKNOWLEDGE OUR
AMAZING TEAM AND THANK YOU FOR
THE VERY RICH CONVERSATIONS THAT
WE'VE HAD AROUND THIS TOPIC.
I WOULD ALSO LIKE TO ACKNOWLEDGE
OUR AMAZING SUPPORT STAFF THAT
HAVE GUIDED US THROUGH THE
PROCESS.
YOU PROBABLY ARE SEEING A LOT OF
OVERLAP AND THAT HAS BETWEEN THE
SUBCOMMITTEES AND THAT HAS
HELPED A BIT IN TERMS OF MAKING
SURE WE HAVE CONSISTENCY
THROUGHOUT DIFFERENT PROTOCOLS
AND BRINGING NEW ISSUES TO THE
TABLE.
AND WE HAVE QUESTIONS PROVIDED
TO US INITIALLY.
THIS IS WHAT WE WERE GIVEN WHEN
WE STARTED HERE.
THESE QUESTIONS ARE UNIQUE
BECAUSE THEY'RE NEW AND WE HAVE
A DIFFERENT VARIETY OF OPTIONS
TO CONSIDER FOR OUR EXPOSURES.
WE HAVE TWO MAIN QUESTIONS.
WHAT IS THE RELATIONSHIP BETWEEN
TIMING OF EATING LOCATIONS SUCH
AS BREAKFAST AND LATE AT NIGHT
AND OUTCOMES WE HAVE HEARD
THROUGHOUT THE MORNING SO I
WON'T REPEAT THEM AND RELATED TO
THE FOOD-BASED STRATEGIES
BETWEEN EDIBLE AND THIS OUTCOME
WE HAVE DISCUSSED.
AND WE HAVE TIMING OF EATING
LOCATIONS AND FOOD-BASED
STRATEGIES WE HAVE BEEN
DISCUSSING AND TRYING TO SELECT
THE BEST ONE THAT MORE ALIGN
WITH THE DIETARY GUIDELINES
TAKING INTO CONSIDERATION THE
PUBLIC HEALTH CONCERNS WE
GATHERED THROUGH THE COMMENTS
POTENTIAL TO IMPACT OF PROGRAMS,
AVOIDING DUPLICATION WITH OTHER
GUIDELINES OUT THERE AND
RESEARCH AND THE NEXT SLIDE
SHOWS THE SCIENTIFIC QUESTIONS
WE PRIORITIZED SO FAR AND WE'RE
STILL IN THE PROCESS.
THE FIRST IS RELATIONSHIP
BETWEEN FREQUENCY OF MEALS
AND/OR SNACKING THREE THREE
OUTCOMES.
I WANT IT POINT OUT A COUPLE
DIFFERENT THINGS.
WE FIND THE QUESTION OF TIMING
OF EATING TO FREQUENCY OF MEALS
AND/OR SNACKING.
WE HAD ORIGINALLY TWO OUTCOMES
AND BASED ON OUR DISCUSSION WE
ADDED THE ENERGY INTAKE BECAUSE
WE THOUGHT THAT WILL HELP US
UNDERSTAND HOW THIS INTERVENTION
EXPOSURE AFFECTED THE ENERGY
CONSUMED BY THE DIFFERENT
POPULATIONS.
THE SECOND QUESTION WAS IN
RELATIONSHIP BETWEEN PORTION
SIZE AND THIS IS THE FIRST
FOOD-BASED STRATEGY THAT WE
PRIORITIZED AND LOOKING AT THIS
WITH RISK OF OBESITY AND ENERGY
INTAKE.
OTHER TECHNOLOGIES ARE HOME FOOD
AVAILABILITY, CULTURE AND
TRADITION OF FOODS WE HAVE A LOT
OF DISCUSSION AROUND THOSE AND
WE'LL EXPLORE OTHER FOOD-BASED
STRATEGIES SO MORE TO COME
DURING OTHER PUBLIC MEETING.
NOW WE'LL GO INTO THE DETAILS OF
THE PROTOCOLS DRAFTED SO FAR.
WE'LL SHOW WE HAVE FIVE
PROTOCOLS TODAY.
THE FIRST YIN INTERVENTION AND
PORTION SIZE RELATED TO
OUTCOMES.
WE HEARD ABOUT THE STANDARD
INCLUSION, EXCLUSION CRITERIA
HAS BEEN THE SAME ONE USING ALL
MORNING.
I'M NOT GOING TO MENTION THOSE.
HERE FREQUENCY OF MEALS AND/OR
SNACKING, HOW WILL WE DEFINE THE
EXPOSURE?
BASICALLY WE DID NOT DEFINE THE
EXPOSURE WE ARE LOOKING INTO
BREAKFAST, SNACKING AND EATING
LOCATIONS BUT WILL MAKE A LIST
OF THE DEFINITIONS BASED ON THE
STUDIES THAT WE SELECT BECAUSE
IT WAS VERY DIFFICULT TO REALLY
POSE IT TO OUR SPECIFIC
DEFINITION AND HAVE IT OPEN TO
WHAT DIFFERENT AUTHORS THINK HOW
THEY DEFINE THIS EXPOSURE
INTERVENTION.
WE ARE NOT INCLUDING LOOKING AT
AT A SINGLE FOOD OR BEVERAGE OR
CATEGORY OF FOODS AND/OR
BEVERAGES.
WE'RE LOOKING AT TIMING AND
FREQUENCY OF THESE MEALS IN
SNACKING.
SO THIS IS WHAT WE HAVE SEEN
THIS MORNING FOR THE FIRST
QUESTION THE RELATIONSHIP
BETWEEN FREQUENCY OF MEALS
AND/OR SNACKING AND GROWTH BODY
COMPOSITION AND RISK OF OBESITY.
THIS IS A TOTALLY NEW PROTOCOL.
I'LL HIGHLIGHT THE POPULATION
WE'RE INCLUDING TO SAY WE ARE
FROM ONE YEAR OLD ALL THE WAY TO
ADULTS, OLDER ADULTS AND
PREGNANCY AND POSTPARTUM.
I MENTIONED THE FREQUENCY OF
EXPOSURE AND COMPARATOR.
THE OUTCOMES ARE THE SAME AS
HEARD THIS MORNING AND KEY
CONFOUNDERS I'LL LIST THE FIRST
TIME AND YOU'LL SEE THE REST.
WE HAVE SEX, AGE, PHYSICAL
ACTIVITY, RACE, ETHNICITY, SOCIO
ECONOMIC POSITION ANTHROPOMETRY
AT BASELINE AND DEPENDING ON THE
AGE GROUP, SMOKE, HYPERTENSIVE
DISORDERS DURING PREGNANCY AND
OTHERS AND THESE WILL BE
CONSISTENT THROUGH THE
PROTOCOLS.
I WILL NOT MENTION THEM AGAIN.
THIS WAS ALSO MENTIONED EARLIER
THIS MORNING IN TERMS OF STUDY
DURATION.
WE'LL SUES SIMILAR TO WHAT
DEANNA AND HER GROUP MENTIONED
THIS MORNING SO I WON'T MENTION
IT AGAIN.
IT'S THERE.
FOR THE SECOND QUESTION WHAT IS
THE RELATIONSHIP BETWEEN
FREQUENCY OF MEALS AND/OR SNACK
AND A DIETARY PATTERN ALIGNED
WITH THE DIETARY GUIDELINES.
HERE WE'LL USE THE SAME
POPULATION AND INTERVENTION AND
THE OUTCOME IS DIFFERENT WHICH
IS DIET QUALITY AS MEASURED BY
THE HEALTHY EATING INDEX.
CONFOUNDERS ARE THE SAME.
AND THE RELATIONSHIP BETWEEN
FREQUENCY OF MEALS AND/OR
SNACKING AND ENERGY INTAKE AND
AGAINST THIS IS A NEW PROTOCOL
AND THE ONLY DIFFERENCE HERE IS
THE OUTCOME OF ENERGY TAKE.
I'LL PAUSE HERE FOR QUESTIONS
AND COMMENTS.
>>FOR THE HEALTHY EATING INDEX
IT SAYS 2005, 2010, 2015.
WILL YOU INCLUDE THE NEW 2020
AND THE OTHER ONE?
YOU HAVE AGE ONE 19 AND
DIABETES.
>>IF THE STUDIES -- WE MAY NOT
BE ABLE TO CAPTURE THAT BECAUSE
THE STUDIES WILL BE PROBABLY
COMING LATER THIS YEAR OR NEXT
YEAR.
WE MAY NOT BE ABLE TO CAPTURE
THE STUDIES WITHIN THE SEARCH
WHICH WILL HAPPEN SOME TIME
DURING THE SUMMER.
>>WITH THE FREQUENCY WERE YOU
THINK OF THE TIME OF DAY TO
CAPTURE INFORMATION NIGHT OR
MORNING?
>>FREQUENCY AND TIME.
EACH EATING OCCASION CAPTURE
EATING AND SNACKING LATE AT
NIGHT.
OKAY.
NOW I'LL PASS IT ON TO CHERYL.
THANK YOU.
>>THANK YOU, CHRISTINA.
ALL RIGHT.
SO I WILL COVER OUR COMMITTEE'S
WORK ON PROPORTION SIZE
PROTOCOLS AND THERE ARE TWO I'LL
GO OVER.
THE FIRST IS RELATED TO PORTION
SIZE AND THAT'S BEING DEFINED AS
THE AMOUNT OF FOOD OR BEVERAGE
SERVED AT ONE TIME AND ONE
EATING OCCASION AND I'LL COVER
ENERGY DENSITY.
AND THAT'S DEFINED AS THE AMOUNT
OF CALORIES OR ENERGY IN A GIVEN
WEIGHT OF FOOD AND KEEPING IN
MIND THAT THESE ARE GOING TO BE
RELATED TO GROWTH, BODY
COMPOSITION AND OBESITY AS WELL
AS TO ENERGY INTAKE.
I'LL START FIRST COVERING THE
PICO FOR GROWTH BODY COMPOSITION
AND RISK OF OBESITY.
SO HERE LET'S FOCUS YOUR
ATTENTION ON THE FIRST THREE
COLUMNS, POPULATION,
INTERVENTION EXPOSURE AND THE
COMPARATOR.
WE WILL USE A POPULATION THAT
GOES ALL THE WAY DOWN TO AGE ONE
WITH REGARDS TO THE DEFINITION
OF PORTION SIZE YOU'LL SEE IT
CONSIDERS ENERGY DENSITY AS WELL
AS NUTRIENT DENSITY AND/OR THE
QUALITY OR TYPE OF FOOD THAT IS
SERVED OR CONSUMED.
WE'RE ALSO GOING TO BE INCLUDING
PREPORTIONED FOODS AND THEN WHEN
IT COMES TO THE COMPARATOR, WE
HAVE DIFFERENT PORTION SIZES
THAT IS SERVED OR CONSUMED
KEEPING IN MIND ON THIS SCREEN
EVERYTHING ON THE RIGHT SIDE
OUTCOMES, KEY CONFOUNDERS,
YOU'VE SEEN MULTIPLE TIMES
ALREADY.
WITH REGARDS TO INCLUSION AND
EXCLUSION CRITERIA, I JUST WANT
TO HIGHLIGHT HERE THE STUDY
DURATION WHICH WILL INCLUDE
THOSE THAT HAVE INTERVENTION
LENS THAT ARE GREATER THAN 12 OR
EQUAL THAN 12 WEEKS AND THE
FOLLOW UP DURATION GREATER THAN
SIX MONTHS WHEN IT COMES TO
WEIGHT LOSS AND MAINTENANCE AND
WE HAVE FOLLOW UP DURATION
GREATER OR EQUAL TO 12 MONTHS.
WOMEN OUR ENERGY INTAKE OUTCOME
WE'LL NOTE THIS IS GOING TO BE
WHATEVER THE STUDY AUTHORIZE
DECIDE
DECIDED HOW TO REVIEW THE
EVIDENCE BASED ON THE
DEFINITIONS.
THE COMMISSION DISCUSSION CAME A
LITTLE TOO EARLY.
THAT'S OKAY.
WE'LL GO BACKWARDS.
THERE ARE OFTEN MOMENTS IN THE
PROCESS THAT WILL HUMBLE A
PERSON AND ALSO MAKE US
APPRECIATE HOW MUCH WORK NEEDS
TO BE DONE IN THE FIELD AND
COMES UP OFTEN FOR THIS
SUBCOMMITTEE WHEN WE TALK ABOUT
HOME FOOD AVAILABILITY AND
TRADITIONAL FOODS AND WE HAVE
DISCUSSION LEFT TO DO IN THOSE
SPACES BUT KNOW AS WE THINK
ABOUT WHAT STRATEGIES THE
AMERICAN PUBLIC NEEDS AND THE
DIVERSITY WITHIN THE AMERICAN
PUBLIC WE'RE GOING TO BE GIVING
THIS QUITE A BIT OF THOUGHT AND
UPDATE YOU AT THE NEXT PUBLIC
MEETING AND WILL CONTINUE TO
REFINE PROTOCOLS DISCUSSED
AROUND FREQUENCY OF MEALS AND/OR
SNACKING WEDGE THE OUTCOMES
GROWTH BODY COMPOSITION AND RISK
OF OBESITY AND DIETARY PATTERNS
BETTER ALIGNED WITH THE DGAs AND
INTAKE AND PROTOCOLS AROUND
PORTION SIZE AND GROWTH BODY
COMPOSITION AND RISK OF OBESITY
AND ENERGY INTAKE.
WITH THAT WE'LL OPEN UP FOR
COMMITTEE DISCUSSION.
>>WHEN IT COMES TO THE TIMING
OF THE MEALS ARE YOU THINKING
FROM THE TIME RESTRICTED FEEDING
PERSPECTIVE THINKING ABOUT IF
SOMEBODY EATS FROM 6:00 A.M. TO
3:00 P.M. VERSUS SOMEONE WHO
EATS FROM 11:00 A.M. TO 8:00
P.M.
ARE YOU THINKING FROM THAT
PERSPECTIVE AS WELL?
BECAUSE I SEE THE OUTCOME IS ON
OBESITY AND GROWTH.
I PRESUME WHEN IT COMES TO
OBESITY WEIGHT CHANGE WILL BE
PART OF IT.
AND PART OF THE OUTCOME YOU'RE
CONSIDERING REGARDLESS OF THE
DIRECTION OF WEIGHT CHANGE.
THERE'S ALSO A THE TIME
RESTRICTED FEEDING LITERATURE
THERE'S ALSO SOME FOCUSSED ON
LIPIDS AND BLOOD PRESSURE
CONTROL AND WONDERING IF ANYONE
IN THE COMMITTEE IS CONSIDERING
THAT OR IF THERE'S A TOPIC WE
DECIDED NOT TO INCLUDE IN THIS
ROUND
>>YES.
SO THE FREQUENCY OF MEALS AND/OR
SNACKING DOESN'T INCLUDE
RESTRICTED EATING.
IT'S ONLY LOOKING AT THE
DIFFERENT NUMBER OF MEALS,
EATING PATTERNS THAT DIFFERENT
INDIVIDUALS ARE USING.
WE HAD A LONG LIST OF
INTERVENTIONS WE'RE LOOKING AT
MUMP THOSE ARE RESTRICTIVE
EATING.
THOSE WE'RE STILL REVIEWING AND
WE LOOKED AT CULTURAL FOODS BUT
AND WE LOOK AT SEVERAL THINGS
CHERYL MENTIONED ABOUT THE
AVAILABILITY OF CULTURE FOODS
AND RESEARCH.
WE MAY INCLUDE OTHERS DOWN THE
ROAD.
>>WE'LL HAVE MORE.
>>I WANT TO ADD A CLARIFYING
COMMENT WITH THE TIMING.
IN OUR PRIORITIZATION WE SET
THAT ASIDE.
THE VERY TIME RESTRICTED EATING
PARADIGMS.
WE WERE THINKING ABOUT TIMING
MORE IN TERMS OF THE PATTERN OF
MEALS AND SNACKS BEING AWARE
MEALS AND SNACKS MAY BE
OCCURRING AT DIFFERENT TIMES OF
THE DAY AND PULLING THAT
INFORMATION AND BEING ABLE TO
LOOK AT THAT RATHER THAN 8:00 TO
2:00 OR 10:00 TO 6:00 TYPE OF
QUESTION.
>>SKIPPING BREAKFAST AS THE
QUESTION FOR FOOD INSECURITY
ASSESSMENT AND SKIPPING MEALS.
>>DO YOU MEAN IN TERMS OF KEY
CONFOUNDER?
I'M THINKING MORE ON THE FOOD
INSECURITY SIDE WHERE QUESTIONS
ARE ASSESSING ALONG THE EXACT
SAME LINES LIKE DO YOU SKIP
MEALS FREQUENTLY OR FOR
DIFFERENT REASON?
>>I THANK WHAT YOU'RE PROBABLY
RAISING FOR US IS EFFECT
MODIFICATION BY STATUS OF FOOD
INSECURITY.
>>SURE.
ABSOLUTELY.
WE TALKED ABOUT WHETHER FACTORS
RESPONSIBLE FOR RELATIONSHIPS
AND WE DON'T YET HAVE I THINK WE
FIGURED OUT THE CONFOUNDER
STRATEGY FOR RIGHT NOW WE
HAVEN'T FIGURED OUT THE TOOLS OR
FACTORS.
I THINK WE CAN MAKE SOME
ANALYSIS OR IF WE HAVE ENOUGH
STUDIES THAT HAVE MENTIONED
SOMETHING LIKE THAT
>>AND IT MAY HAVE IMPLICATION
FOR THE SEARCH TERMS I DON'T
KNOW WHAT SCOPE WOULD BE
INCLUDED IF IF THERE'S NOR
QUESTIONS MA MAY HAVE THE TITLE
OF SKIPPING BREAKFAST OR MISSING
MEALS IN TERMS OF THE SEARCH
STRATEGY.
>>THAT'S THE NEXT PART OF THE
PROTOCOL AND IF IT'S NOT WE HAVE
LOOKED AT OTHER VARIABLES THAT
WILL BE INCLUDED AS JUST FOR
INFORMATION BUT NOT FOR KEY
CONFOUNDERS OR EXPOSURE.
WE COULD AS THOSE IF WE HAVE
INFORMATION THAT'S RECORDED.
>>WE'RE LOOKING AT SOCIO
ECONOMIC POSITION WHICH WILL BE
PROBABLY HIGHLY CORRELATED WITH
FOOD INSECURITY AND I THINK WE
TALKED ABOUT LOOKING AT THAT IN
SYNTHESIS FOOD INSECURITY
BECAUSE I KNOW IT WAS BROUGHT UP
DURING THE CONVERSATION.
>>A QUESTION QUESTIONS HOW YOUR
OPERATIONALIZING AND YOUR
DISCUSSIONS AROUND
OPERATIONALIZING MEALS AND
SNACKS AND HOW THAT'S PRESENTED
BECAUSE SOMEBODY HAS A COFFEE
AND DONUT ON THE CAR ON THE WAY
TO WORK AND IT'S BREAKFAST AND
THEY GET TO WORK AND HAVE
BREAKFAST VERSUS THE DID I CALL
THAT FIRST ONE A SNAM CK OR DOE
THEY CALL THAT A BREAKFAST AND
HOW THE DISCUSSIONS WENT.
>>AND WE FINED IT TO THE
ULTRAPROCESSED FOOD DEFINITION
BECAUSE IT'S DEPENDING ON HOW
IT'S PRESENTED.
SNACKS ARE HARD TO DEFINE AND
THE DIFFERENT RESEARCHERS WILL
DEFINE IT DIFFERENTLY AND HAVE A
LIST OF THE DEFINITIONS USED.
THAT WILL BE PROBABLY A
DIFFICULT TASK TO REALLY
PINPOINT AND MAKE SURE THAT
EVERYTHING IS THE SAME.
>>THE AMERICAN PUBLIC IS
FASCINATED WITH INTERMITTENT
FASTING.
I'M SORRY, I MISSED A LOT OF
MEETINGS BECAUSE I WAS TEACHING
BUT IT'S NOT TIME RESTRICTED
EATING BUT FIVE DAYS A MONTH OR
TWO DAYS A WEEK AND THE
LITERATURE IS LIMITED AND SPARSE
THERE AND ADHERENCE IS HARD TO
FIGURE OUT FOR SOME OF THESE.
THOUGH THE AMERICAN PUBLIC IS
FASCINATED, MY IMPRESSION UNLESS
I'M WRONG IS THE LITERATURE BASE
ISN'T THERE YET.
>>SOME OF THOSE MUCH LESS FOR
EXAMPLE SOME DAYS YOU EAT AND
DON'T EAT AND THAT BODY OF
LITERATURE IS MORE LIMITED AND
RELATIVELY SPEAKING THE BODY OF
LITERATURE ON TIMING OF DAY IS A
BIT MORE BUT I HAVE NOT DONE THE
COMPREHENSIVE SEARCH BUT --
>>THERE WERE DISCUSSIONS ABOUT
THE FOOD-BASED STRATEGIES AND WE
HAD TEN OR MORE.
SO TAKING INTO ACCOUNT THIS IS A
LIMITED TIME, LIMITED RESOURCES,
WE HAD TO PRIORITIZE AND SOME
WERE PUT MORE TOWARDS LOWER END
BUT WE WILL STILL REVISE THOSE
BASED ON OUR RECENT DISCUSSIONS
ON LACK OF DATA FOR SOME OF HOME
BASED STRATEGIES WE HAD ALREADY
PRIORITIZED SO WE'LL HAVE TO GO
BACK TO OUR LIST AND MAYBE BRING
SOME OF THOSE BACK.
>>I WANTED TO BRING A
DISCUSSION BACK FROM THE
SUBCOMMITTEE TWO.
I KNOW WE ALL HAVE CHALLENGES
TRYING TO COME UP WITH THE
APPROPRIATE KEY CONFOUNDERS.
WE WERE THINKING ABOUT MORE WHEN
WE ARE DOING RESEARCH WITH
FAMILIES AND WITH SMALL INFANTS
IT'S WE HAVE REALLY LIMITED TIME
WITH THEM AND SO WE WERE KIND OF
GOING BACK TO ADDING MORE KEY
CONFOUNDERS AND AND BECAUSE WE
HAVE LIMITED TIME BEFORE THE
INFANTS ARE NOT WANTING TO BE
THERE MORE AND THE PARENTS GET
RESTLESS AND EVERYONE GETS
RESTLESS WE LIMIT THE TYPE OF
QUESTIONNAIRES, THE TYPE OF
OUTCOMES THAT WE'RE LOOKING FOR
AND KEY CONFOUNDERS WERE SHORTER
BASED ON THE EXPERIENCE OF BEING
IN CLINIC AND ASKING THE PARENTS
AND THE CHILD IS ASKING MOM TO
GIVE A SNAM OR -- THERE'S SO
MANY THINGS THAT HAPPEN WHEN YOU
LOOK AT PARENTS WITH SMALL
INFANTS USUALLY YOU REALLY AND
IRB WILL ALSO LOOK INTO THAT AND
MAKE SURE YOU ARE LOOKING AT THE
MOST IMPORTANT OUTCOME.
WE'LL BRING BACK TO THE TABLE
AND A WANTED TO BRING THAT UP
BECAUSE AS A RESEARCH IN THE
COMMUNITY WE OFTEN EXPERIENCE
THAT AND HAVE TO BE MINDFUL OF
THE THINGS WE CAN ADD AND THE
LITERATURE MAY REFLECT THAT TOO.
SAID IT BEAUTIFULLY BUT I
APPRECIATE THE DISCUSSION AFTER
THE SUBCOMMITTEE TWO
PRESENTATION.
YOU ALL RAISED REALLY GOOD AND
THOUGHTFUL POINTS ABOUT FACTORS
THAT COULD POTENTIALLY BE
IMPORTANT.
WE ARE TALKING DURING THE BREAK
ABOUT THE NEED FOR MAYBE A
LARGER CONVERSATION AND TENSION
THAT EXISTS BETWEEN THE RIGOROUS
EVIDENCE-BASED PROCESS OF HOW
WE'RE LOOKING AT AND LOOKING AT
CONCEPTUAL RATIONALES AND JUST
FICTIONS WE THINK ARE QUITE
COMPELLING AND HOW TO BALANCE
THOSE IN A WAY AS THE
APPROPRIATE THAT'S APPROPRIATE.
IN THE CASE OF LITERATURE WITH
KIDS ALL THE FACTORS YOU POINTED
OUT ARE CRITICAL AND IN REALITY
FEW STUDIES ASSESS THOSE AN
THOSE THINGS MATTER IN A WAY WE
PUT THEM IN IN KEY CONFOUNDERS
IN THE CONTEXT OF RIGOROUS
REVIEW.
THAT'S THE TENSION I FEEL WOULD
BE GREAT TO SORT THROUGH.
>>IT'S AN IMPORTANT POINT AND
CROSS CUTTING.
AT THE END OF THE DAY THE
ASSESSMENT OF INDIVIDUAL STUDIES
AND WE BELIEVE THE FINDING TO BE
VALID VERSUS REMAINING QUESTIONS
OR CONCERNS WE'LL BE ABLE TO
CROSS-LINK THE TOTALITIES ON
BREAKFAST AND WHATEVER.
AND IF YOU'RE STILL QUESTIONS IS
IT THE DIET EXPOSURE PER SE OR
IS IT SOMETHING ELSE THESE
PARTICIPANTS ARE ALSO DOING.
IF THAT DOUBT'S THERE THEN
DOWNGRADING SHOULD BE
APPROPRIATE.
THE KEY CONFOUNDER LIST ARE IF
IT DOESN'T JUST FOR RACE,
ETHNICITY OR SOCIO ECONOMIC P
POSZ -- POSITION WOULD I STILL
WANT THAT AND HAVE A LITTLE BIT
LESS RELIABILITY AND FINDING
BECAUSE I DON'T KNOW.
AND THERE'S KEY CONFOUNDERS AND
I DO THAT BY DESIGN ALL THE
MEASURED, KNOWN AND UNKNOWN AND
EVERYTHING.
AND TO HAVE CONSIDERATIONS YOU
DO HAVE TO BE SELECTIVE AND IF
YOU HAVE THE DATA AT THE TIME OF
ANALYSIS YOU HAVE TO BE
SELECTIVE OFTEN.
NOT TO SAY YOU WANT SOME BIG
LAUNDRY LIST THAT'S NOT
ACHIEVABLE BUT AT THE SAME TIME
YOU DO WANT IT TO REFLECT WHAT
YOU WOULD CONSIDER THE MOST
RIGOROUS EVEN IF MOST OF THE
STUDIES DON'T QUITE FIT THAT AND
THERE'S CONCERN OF A RISK OF
BIAS TO WHEN YOU LOOK ACROSS THE
LITERATURE MAYBE THERE'S A
SUBSET WHERE THEY DID MEET ALL
THE CRITERIA AND THE FINDINGS
ARE THE SAME AS OMITTED SOME KEY
CONFOUNDER.
THEY WEIGHS INTO THE EVIDENCE
A
AND THEY'RE OUTCOME SPECIFIC.
IT COMES DOWN TO OWNING IN ON
THAT.
>> I WANT TO EXPAND WHERE
YOU'RE GOING AT THIS STAGE
BECAUSE THE MAGNITUDE OF
ASSOCIATION WE SEE BETWEEN
WHATEVER EXPOSURE AND OUTCOME IS
ON THE TABLE FOR DISCUSSION VEND
THERE'S ESTIMATE OF ASSOCIATION
OR ONCE WE BEGIN TO LOOK AT THE
POTENTIALLY CONFOUNDERI II IING
CONFOUNDING FACTOR WE ADJUST
DOWNWARD THE MAGNITUDE OF
ASSOCIATION.
AND WE DON'T LOSE STUDIES AND
THE OPPORTUNITY TO GET SIGNAL
ABOUT WHAT'S HAPPENING IN A BODY
OF LITERATURE BY PUTTING THINGS
ON A KEY CONFOUNDER LIST STO THE
EARLIER POINT BEING MADE WE DO
NEED TO HAVE A CINCINNATI OF
WHAT IS THE MAGNITUDE OF THE
ASSOCIATION AND I DON'T THINK WE
CAN RELY -- I DON'T THINK WE CAN
THEY CAN MAKE THAT ASSESSMENT
PROPERLY WITHOUT HAVING THE
CONFOUNDERS EXAMINED.
I WOULD ENCOURAGE ALL OF US TO
THINK ABOUT DRIVING THE SCIENCE
INTO A PLACE WE CAN GET TO
EFFECT SIZES AND MAGNITUDES OF
ASSOCIATIONS WE TRUST AND THAT
WOULD INCLUDE DRIVING THE
THINKING OF OUR RESEARCH
COMMUNITY TOWARD GETTING
ADDITIONAL FACTORS WE THINK
COULD BE DISTORTING THE EFFECT
BETWEEN ANY TWO VARIABLES.
>>DEPENDING ON THE QUESTION,
SOME OF THESE ARE VERY WELL
ESTABLISHED.
THEY HAVE STRONG EVIDENCE.
THE DIETARY PATTERNS AND
CARDIOVASCULAR DISEASE FOR
EXAMPLE.
THE CONFOUNDERS ARE VERY WELL
ESTABLISHED AND OTHERS OF THESE
QUESTIONS NOT SO MUCH.
SO I JUST WANTED TO REMIND US
THAT IT'S GOING TO VARY
DEPENDING ON THE INDIVIDUAL
QUESTION AND THE BODY OF
LITERATURE AS CHERYL REFERRED
TO.
>>AND THE AGE GROUP.
YOU MAY NOT FIND THE EVIDENCE
FOR PHYSICAL ACTIVITY BEING
IMPORTANT OR PARENTAL WEIGHT BUT
FOR CERTAIN AGE GROUPS WE MAY
HAVE TO BE MORE INTO LOOKING TO
WHAT EXACTLY THE LITERATURE
SAYS.
WE'LL GO BACK AND LOOK BY AGE
GROUP AND QUESTION WHICH MAKES
SENSE IN TERMS OF THE EVIDENCE
BUT THANKS FOR THE POINTS.
I THINK THIS DISCUSSION VERY
FRUITFUL AND HELPS INFORM FUTURE
GUIDANCE.
>>THANK YOU.
I KNOW WE WENT A LITTLE OFF
SCHEDULE BUT I THINK THIS WAS A
REALLY IMPORTANT DISCUSSION TO
HAVE BECAUSE IT IS AS MENTIONED
A COMMON CROSS-CUTTING THEME.
SO THANK YOU AND I'M SURE WE'LL
BE REVISITING THE TOPIC MANY
TIMES.
SO LAST BUT NOT LEAST WE HAVE
SUBCOMMITTEE THREE.
I DO BELIEVE WE'LL HAVE HEATHER
PRESENT THE DATA ANALYSIS FIRST
FOLLOWED BY CHRIS WHO IS GOING
TO TALK ABOUT FOOD PATTERN
MODELLING.
TAKE IT AWAY, HEATHER.
>>THANK YOU VERY MUCH.
I'M HERE TO INTRODUCE OUR
SUBCOMMITTEE THREE FOOD PATTERN
MODELLING AND DATA ANALYSIS.
AND BEFORE I REALLY GET INTO IT
I WANT TO THANK AND ACKNOWLEDGE
ESPECIALLY THE GOVERNMENT STAFF
THAT HAVE BEEN SUPPORTING OUR
COMMITTEE ALL THROUGHOUT THIS.
THEIR EDUCATION TO US ON THE
PROCESS THEY'VE BEEN SO PATIENT
AND HELPING US LEARN THIS STUFF
ALONG THE WAY SO WE APPRECIATE
THAT.
I ALSO WANT TO THANK ALL OF OUR
MEMBERS WHO ARE STAYED EXTREMELY
ENGAGED THROUGHOUT THE WHOLE
PROCESS OF CATCHING UP ON THE
DETAILS OF THE DIFFERENT PIECES
OF THE PROCESS.
NOW I'LL GO AHEAD AND JUST
REMIND EVERYONE THAT THE THREE
APPROACHES ARE THE SYSTEMIC
REVIEWS WHICH WE SPENT THE
ENTIRE TIME TO NOW TALKING ABOUT
WHICH IS REALLY CRITICAL TO HELP
US UNDERSTAND THE LINK BETWEEN
HEALTH OUTCOMES AND DIET.
NORTH APPROACH THAT WE INTEGRATE
WITH THE SYSTEMIC REVIEWS IS THE
DATA ANALYSIS.
AND WE CAN KIND OF THINK OF THAT
AS THE BASELINE OF WHAT WE'RE
EATING AND WHAT OUR HEALTH
OUTCOMES IN THE UNITED STATES
LOOK LIKE THEN WE HAVE THE FOOD
PATTERN MODELLING THE THIRD
APPROACH THAT HELPS US TEST OUT
THE KIND OF RECOMMENDATIONS
WE'RE MAKING.
SO I'M JUST GOING TO THEY'RE
BRIEFLY ABOUT THE DATA ANALYSIS
APPROACH AND WHAT WE'VE BEEN
DOING.
WE COULD DEFINE DATA ANALYSIS AS
A COLLECTION OF ANALYSIS THAT
USES NATIONAL DATA SET TO
DESCRIBE THE CURRENT HEALTH AND
DIETARY INTAKES OF AMERICANS.
AND AGAIN THIS HELPS US CEASE
WHERE WE ARE.
WE HAVE TO KNOW THAT BEFORE WE
CAN THINK ABOUT HOW WE CHANGE TO
THINK ABOUT WHERE WE WANT TO BE
WITH OUR DIET AND HEALTH.
HAVING THESE SET OF ANALYSES
ACROSS THE POPULATION HELP US
REALLY MAKE THE DIETARY
GUIDELINES PRACTICAL, RELEVANT,
ACHIEVABLE AND ACTIONABLE.
SO COMPRISING THE DATA ANALYSIS,
THE QUESTIONS THAT WE'RE GOING
TO BE ADDRESSING ARE FIRST WHAT
ARE THE CURRENT PATTERNS OF FOOD
AND BEVERAGE INTAKE AND WE CAN
THINK ABOUT THAT AS ADDRESSING
DIETARY QUALITY AND THINK OF THE
HEALTHY EATING INDEX AND HOW WE
AS A POPULATION ARE MEETING THE
GOALS FOR THE DIETARY GUIDELINES
THERE.
THINKING ABOUT THE VARIETY.
THE SECOND QUESTION WOULD BE
DELVING INTO THE COMPONENTS OF
DIET A LITTLE FURTHER THINKING
HOW WELL WE'RE MEETING CURRENT
INTAKES OF FOOD GROUPS AND THEN
THE NUTRIENTS THAT ARE WITHIN
THOSE FOODS.
HOW WE'RE DOING THERE.
OTHER DIETARY COMPONENTS WE KNOW
ARE IMPORTANT.
AND THEN THEN THE THIRD PIECE,
QUESTION, IS ADDRESSING WHEN WE
THINK ABOUT THE INTAKES PERHAPS
OF THE COMPONENTS OF THE FOOD
GROUPS AND OF THE NUTRIENTS HOW
WE'RE DOING MEETING THE
RECOMMENDATIONS.
SO LIKE ARE WE UNDER CONSUMING
THOSE ARE WE OVER CONSUMING
CERTAIN THINGS WITHIN OUR DIET
THAT ULTIMATELY LEAD TO POOR
HEALTH OUTCOMES AND FINALLY TO
PUT THIS ALL INTO CONTEXT WE
NEED TO UNDERSTAND WHAT THOSE
HEALTH OUTCOMES IN THE
U.S. POPULATION ARE THAT WE ARE
TRYING TO PREVENT AND AGAIN AS A
REMINDER WITH THE DIETARY
GUIDELINES WE'RE DIRECTING THOSE
TOWARDS THE CHRONIC OUTCOMES
THAT ARE THE MAIN KILLERS OF
AMERICANS AND THE BIGGEST MOST
SERIOUS HEALTH PROBLEMS IN THE
U.S.
WE FIRST HAVE TO UNDERSTAND OUR
BASELINES AND UPDATE THAT.
MOVING ON, WE WILL USE SEVERAL
SEVERAL FEDERAL DATA SOURCES FOR
COMPLETING THE ANALYSIS.
THE FIRST SOURCE IS IS FROM THE
NUTRITION SURVEY AND WE'RE
FORTUNATE TO HAVE SUCH A SURVEY
IT'S AN ONGOING POPULATION LEVEL
SURVEY THAT CAN BE MADE
U.S. POPULATION AND ASSESSES
DIET.
THIS AND THIS IS CALLED WHAT WE
EAT IN AMERICA AND THERE'S
ADDITIONAL DATABASES THAT
SUPPORT THIS AND WE HAVE THE
USDA FOOD AND NUTRITION AND
THERE'S A FOOD COMPOSITION
DATABASE.
FOR EVERY FOOD THAT'S REPORTED
IN THE POPULATION WE HAVE AND
OTHER DIET COMPONENTS THAT ARE
PARTS OF THAT FOOD IN THE
DATABASE.
THE SECOND DATABASE IS THE USDA
FOOD PATTERN EQUIVALENTS
DATABASE WHICH BREAKS DOWN FOOD
AND THE VEGETABLE GROUP, FOOD
GROUP, ETCETERA.
-- FRUIT GROUP, ETCETERA.
THE DATABASE SUPPORTS US
UNDERSTANDING AND BEING ABLE TO
DO THAT.
THE THIRD OF THOSE DATABASES IS
WHAT WE EAT IN AMERICA FOOD
CATEGORIES.
THIS IS THE SYSTEMATIC CORE --
CATEGORIZATION AND THEY'RE
NEEDED TO UTILIZE THAT N HANES
DATA AND BE ABLE TO MAKE
NATIONAL-LEVEL ESTIMATES OF
DIET.
OTHER SOURCES WE'LL BE DRAWING
FROM ARE THE NATIONAL HEALTH
INTERVIEW SURVEY.
THE SURVEILLANCE AND
OBSERVATIONAL SURVEY AND WILL
HELP UNDERSTAND THE HEALTH
OUTCOMES IN THE U.S. AT A
NATIONAL LEVEL.
MOVING ON, OUR PROGRESS.
OUR DATA ANALYSIS SO FAR HAS
BEEN TO USE THE NHANES AS DATA
AND WE'LL BE UPDATING ALL OF THE
DATA ANALYSIS FROM THE LAST DGA
AND CONSIDER INCORPORATING
ADDITIONAL VARIABLES TO THE
ANALYSIS HAS MENTIONED BY THE
HEALTH EQUITY HEALTH GROUP.
SO WE'RE THINKING ABOUT YOU WILL
ALL THE CONFOUNDERS WE WANT TO
STRATIFY ANALYSIS BY.
WE'LL WORK ON A FORMAL DATA
ANALYSIS PLAN.
THAT'S FORTHCOMING.
WE'RE ALSO CONSIDERING LOOKING
FOR DIETARY INTAKE DATA DURING
THE COVID-19 PANDEMIC.
FINALLY THIS IS THE WORK IN
PROGRESS.
WE HAVEN'T SPENT QUITE AS MUCH
AS TIME ON THE DATA ANALYSIS
WORKING UP TO NOW BECAUSE OF THE
MORE PRESSING NEEDS OF WORKING
THROUGH THE FOOD PATTERN
MODELLING PROTOCOLS.
SO WE WILL BE BRINGING YOU MORE
ON DATA ANALYSIS IN SOME OF OUR
NEXT MEETINGS.
SO AT THIS POINT I WILL GO AHEAD
AND TURN IT OVER TO CHRIS.
>>SO I'M NOW GOING TO MAKE THE
TRANSITION INTO SOMETHING
COMPLETELY DIFFERENT.
WE ARE IN TO FOOD PATTERN
MODELLING AND WE'VE GONE INTO
THE NESR REVIEWS AND EVALUATING
THE CURRENT SCIENCE AROUND
BEHAVIORS AND OUTCOMES AND HOW
DO WE THEN TAKE OUR
EVIDENCE-BASED APPROACH.
THIS IS WHERE WE TRANSLATE THESE
RECOMMENDATIONS, THESE FOOD
PATTERNS WE KEEP TALKING ABOUT
THE DIFFERENT DIETARY PATTERNS
AND FOODS WE PROMOTE IN
MODERATION AND HOW DOES THIS
TRANSLATE INTO NOT ONLY EATING A
DIVERSE DIET BUT ALSO EATING A
DIVERSE DIET WITH NUTRITIONAL
ADEQUACY IN MIND AND LOOKING AT
VARIOUS INTAKES THAT MAY BE
SPECIFIC TO VARIOUS HEALTH
OUTCOMES AND THE LENS WE'RE
LOOKING AT FOOD PATTERN
MODELLING IS HOW DO WE PROMOTE A
DIVERSITY OF FOOD INTAKES WHILE
ALSO MEETING THE NUTRIENT
INTAKES FROM THE DRIs.
THE FOOD PATTERN MODELLING IS A
WAY TO LOOK AT THE WHOLE DIETARY
PATTERN AND HOW DOES IT
TRANSLATE INTO THE NUTRIENT
NEEDS PER SE.
SO WE'LL GO THROUGH A COUPLE
SEGMENTS OF THE WORK WE'VE DONE.
THE FIRST PART WE DID WAS TO GO
THROUGH AND ACTUALLY REFINE THE
SCIENTIFIC QUESTIONS AS ALL IS
THE OTHER SUBCOMMITTEES HAVE HAD
TO DO AND HAD OUR SERIES OF
SCIENTIFIC QUESTIONS WE THEN HAD
TO TWEAK AND REFINE BASED ON THE
DATA WE HAVE AVAILABLE FROM THE
NHANES AMERICA DATABASE AND HAD
TO CREATE OUR PRIORITIZATION ON
WHAT SPECIFIC QUESTIONS WE WERE
GOING TO ADDRESS.
AND IN WHAT ORDER.
WHAT THIS DOESN'T SAY IS WE'RE
NOT CHANGING WHAT FOODS COUNT OR
FOOD GROUP INTAKES.
WE'RE NOT CHANGING THE FNDDS OR
DATABASE BUT WHAT WE'RE DOING IS
UTILIZING THIS DATA TO HELP US
UNDERSTAND WHAT ARE THE
IMPLICATIONS OF LOOKING AT WHAT
FOODS MAKE UP WHAT FOOD GROUPS,
HOW MUCH WOULD WE RECOMMEND
WITHIN EACH ONE OF THE DIETARY
PATTERNS AND WHAT'S THAT RESULT
IN NUTRIENT INTAKE AND WHAT DOES
THAT MAKE UP AS FAR AS WHAT
AMERICANS ARE EATING?
THIS IS IS THE POSED SCIENTIFIC
QUESTION SHOULD THE U.S. DIETARY
PATTERNS BE MODIFIED DUE TO THE
SYSTEMATIC PATTERNS AND THE
OTHER VARIOUS STEPS.
AT THE SAME TIME IT'S LOOKING AT
DIFFERENT CULTURAL FOOD WAYS AND
LIMITATIONS LIKE LACTOSE IN
TOLERANCE WE TALKED ABOUT THIS
MORNING HOW DO WE THEN
INCORPORATE THOSE CHANGES TO
MAKE CHANGES THROUGH FOOD
PATTERN MODELLING AND WHAT ARE
THE IMPLICATIONS OF CHANGES
WITHIN THAT?
IT MIGHT BE RECATEGORIZATION OF
FOODS OR SUB GROUPS AND
SUBSEQUENT CHANGES TO THE
CALORIE LEVELS.
ONE OF THE COMMENTS WAS ABOUT
THE CHANGE IN THE ENERGY D.R.I.
THAT CAME OUT RECENTLY.
WHEN WE LOOK AT STANDARDS OF
HEIGHT AND WEIGHT AND HOW DOES
THAT TRANSLATE TO CALORIC LEVEL
MODEL TO ENSURE INDIVIDUALS
ACROSS LIFE STAGES CAN MEET THE
NEEDS BASED ON THE CALORIC
LEVELS.
SO THE WORK WE'RE DOING IS
REALLY BASED IN TWO BIG PHASES.
ONE OF THEM IS THE HOW WE'RE
LOOKING AT WHAT THE DIETARY
PATTERNS ARE AND WILL REREVISE
ANY OF THESE PARTICULAR PATTERNS
TO ADDRESS THE QUESTIONS WE'LL
TALK ABOUT TESTING HOW THEY
MIGHT MEET NUTRIENT INDICATIONS
AND ANOTHER THING THAT WAS
MENTIONED IS WHERE WE CAN DO THE
SIMULATED DIETS AND IF WE PUT
THIS INTO PLACE HOW DOES IT
CHANGE THE OUTCOME?
HOW DO WE THEN TAKE 100 WAYS TO
ASSESS WHAT SOMEBODY MIGHT EAT
AND WHAT ARE IMPLICATIONS ON THE
NUTRIENT OUTCOMES AS WELL AS IF
WE MAKE CHANGES IN THE DIETARY
PATTERNS IN THE BEGINNING DOES
IT SHIFT THE NUMBER OF CALORIES
NEEDED FOR A FOUNDATIONAL DIET
BUT THEN PROVIDES MORE LATITUDE
WITHIN THE MEETING ENERGY NEEDS?
SO OUR FIRST PROTOCOL IS LOOKING
AT SHOULD FOODS AND BEVERAGES
WITH LOWER NUTRIENT DENSITY AND
FITTING WITHIN A FOOD CATEGORY
BUT BY THEIR NATURE HAVE HIGHER
ADDED SUGARS AND SATURATED FAT
AND SODIUM, SHOULD THEY
CONTRIBUTE TO THE ITEM CLUSTERS
AND REPRESENTATIVE FOODS AND
THEREFORE BE INCLUDED AS PART OF
THE FOOD GROUP OR WOULD WE
REMOVE THOSE AND TIGHTEN THE
NUTRIENT COMPOSITION THAT COMES
FROM THOSE AND THE CALORIC
CONTRIBUTION.
THAT WILL BE THE PROTOCOL THAT
WE'LL BE TALKING ABOUT TODAY.
SO FOLLOWING UP ON THAT THE
BASIS OF THE DIETARY PATTERNS
WAS OUR PRIORITIZATION PROCESS
IN TERMS OF WHICH OF THE SUB
ITEMS WERE WE GOING TO REVIEW
AND WHAT ARE THE DIFFERENT TYPES
OF FOOD GROUPS.
WHAT TYPES OF POTENTIAL
SUBSTITUTIONS, MODIFICATIONS FOR
PARTICULAR DIETARY PATTERNS
MIGHT HAVE AN IMPACT ON NUTRIENT
ADEQUACY.
SO I THINK IT'S IMPORTANT THINK
ABOUT JUST FUNDAMENTAL TO THE
FOOD PATTERN MODELLING PROCESS
IS THAT WE'RE TRYING TO GET TO
THE NUTRITIONAL ADEQUACY OF THE
DIET IN FOLLOWING THE PATTERN.
SO WE HAVE A LOT OF STUDIES THAT
ARE FOCUSSED ON VARIOUS PATTERNS
TOWARDS ONE OUTCOME, WEIGHT
MANAGEMENT, DIABETES, WHATEVER
THAT MIGHT BE.
BUT THE PRIMARY LENS THAT WE'RE
LOOKING AT FOR FOOD PATTERN
MODELLING IS THAT NUTRITIONAL
ADEQUACY.
SO IT'S REALLY THEN FOCUSSED ON
THAT COMPONENT AND HISTORICALLY
OUR FOODS HAVE BEEN GROUPED
TOGETHER INTO THEIR FOOD GROUPS
BASED ON ESSENTIALLY THEIR
SOURCE ORIGIN, ANIMAL PRODUCTS,
DAIRY, VEGETABLES, FRUIT,
GRAINS, FROM THE SOURCE THEY
COME FROM AND THEN ALSO THE
NUTRITIONAL COMPOSITION.
SO FOODS WITHIN A FOOD CATEGORY
ARE GOING TO HAVE A VERY SIMILAR
NUTRIENT COMPOSITION.
AND EVERY DIETARY CHANGE IS
NEWTONIAN SO THE FOOD PATTERN
MODELLING ALLOWS US TO LOOK
THROUGH THE QUESTIONS WE WERE
TRYING TO ASSESS AND OPPOSED AND
LOOKING AT CONCERN AND
MAINTAINING THE END POINT OF
NUTRITIONAL ADEQUACY.
AS WAS BROUGHT UP THIS MORNING,
ULTRA PROCESSED FOODS WAS ONE OF
THE PROPOSED AREAS ESPECIALLY
AROUND PUBLIC COMMENT AND CAME
FORWARD AS NOT PART OF THE
QUESTION BUT EIGHT OF SUPPORT IN
PUBLIC COMMENT AND AS MENTIONED
THIS MORNING THERE WERE A COUPLE
CHALLENGES BETWEEN TAKING THE
CURRENT LEVEL OF SCIENCE IN THIS
EMERGING FIELD AND WHAT'S THE
OPERATIONAL DEFINITION WE CAN
TAKE AND BE ABLE TO PUT IN TO
IDENTIFY A FOOD, A COMPOSITION
AND THE NUTRIENT PROFILE AND
OVERLAY THAT WITHIN THE NHANES
DATABASE WHICH MAY NOT BE ABLE
TO ADEQUATELY CAPTURE THE
NUANCES THAT HAPPEN WITHIN HOW
WE DEFINE ULTRA PROCESSED FOODS
BECAUSE IF THERE'S ONLY ONE
RECIPE FOR A PARTICULAR TYPE OF
FOOD IN SOME CASES IF IT'S
DEFINED AS HOMEMADE IT'S NOT
CONSIDERED ULTRA PROCESS BUT IF
IT WAS PURCHASED THAT WAY THEN
DEFINITIONS MAY VIEW THE SAME
FOOD DIFFERENTLY.
SOME OF THE CHALLENGES IS
OPERATIONALIZING THAT AND THE
DEFINITIONS USED MEANT WE FELT
IT WAS TOO EARLY TO TACKLE THIS
BEFORE WE HAD THE SYSTEMIC
REVIEW FROM NESR FROM THE
SUBCOMMITTEE ONE.
IT IS AN EMERGING AREA BUT WE
FELT WE WEREN'T GOING TO BE ABLE
TO MAKE THOSE DECISIONS TO HOW
TO PUT THAT INTO THE DATA TO BE
ABLE TO GET TO THE OUTCOMES
WE'RE LOOKING FOR.
THE NEXT QUESTION WAS FOOD GROUP
AND SUB GROUP MODIFICATIONS.
THIS IS ONE OF THOSE AREAS WHERE
WE CAN LOOK TO THE CULTURAL FOOD
WAYS COMING FROM THE NESR
REVIEWS AROUND FOOD PATTERN
MODELLING OR DIETARY PATTERNS
AND ARE THERE WAYS WE CAN MAKE
MODIFICATIONS TO THE DIFFERENT
SERVE PER SE OF EACH KIND OF
FOOD AND ADD ADDITIONAL
FLEXIBILITY WITHIN THE DIETARY
PATTERNS THEMSELVES.
THE THIRD ONE THAT CAME FORWARD
WAS AROUND STABLE CARBOHYDRATE
SOURCES WHICH MAY VARY
CONSIDERABLY ESPECIALLY AMONG
DIVERSE POPULATIONS AND
DIFFERENT CULTURAL FOOD WAYS
THAT MAY USELESS GRAIN
BASED FOODS BUT MAY USE STARCHY
VEGETABLES.
WHAT ARE WAYS TO LOOK AT STARCHY
CARBOHYDRATE FOODS AND BE
BROADER IN THE DEFINITION BEYOND
REFINED GRAINS AND WHOLE GRAINS
AND WHAT'S IT DO TO THE
NUTRITIONAL IMPLICATIONS IF WE
SHIFT THE FOODS AROUND TO HAVE
MORE VARIABILITY IN THEIR ROLE?
PROTEIN FOODS.
ANOTHER AREA WHERE WE'VE HAD A
LOT OF PUBLIC COMMENT AND WORK
THAT'S COME FORWARD FROM DGA
COMMITTEES.
THE FOCUS BETWEEN PLANT-BASED
AND PROMOTING PLANT-BASED
SOURCES OF PROTEIN INTAKES WHICH
GETS TO VARYING DEGREES AND
REASONS AROUND MAKING PROTEIN
FOOD CHOICES.
SO BEING ABLE TO GO IN AND
IDENTIFY WHAT ARE THE
IMPLICATIONS OF PLANT-BASED
SOURCES AND VARIABILITY OF
SOURCES AND WHAT IMPLICATIONS
THOSE HAVE.
AND FINALLY AS WE GO DOWN THE
LIST LOOKING AT INDIVIDUALS THAT
MAY NOT BE ABLE TO CONSUME
CERTAIN FOODS OR CHOOSE NOT TO
CONSUME CERTAIN FOODS FOR
EXAMPLE DAIRY IS AN IMPORTANT
SOURCE FOR SOME KEY NUTRIENTS
BUT THE GLOBAL PREVALENCE OF
LACTOSE INTOLERANCE AND LACTOSE
MALDIGESTION MEANS FOR SOME
INDIVIDUALS IT IS NOT A VIABLE
SOURCE AND HOW DO WE ROOK AT
PATTERNS FOR THOSE WHO CHOOSE
NOT TO CONSUME ANIMAL PRODUCT OR
DAIRY AND WHAT ARE THE
IMPLICATIONS IF WE WERE TO BUILD
A PROFILE ON NUTRIENT
INADEQUACY?
FINALLY LOW-CARBOHYDRATE DIETS
WAS ANOTHER AREA THAT'S HAD A
LOT OF PUBLIC COMMENT.
AND WE ADDED THIS ONE TO THE END
BECAUSE WE'RE HOPING TO HAVE THE
DRI DIGESTIBLE CARBOHYDRATE
REVIEW COMING FORWARD FROM
PRESENTATION TO GIVE US A BETTER
HANDLE ON WHAT THE DEFINITIONS
OF LOW CARBOHYDRATE MAY BE AND
LOOK AT THOSE WHO CHOOSE A LOW
CARBOHYDRATE INTAKE WHATEVER THE
THRESHOLD MAYBE AND THE
IMPLICATIONS OF SPREADING THE
CALORIES OUT ACROSS OTHER FOOD
CATEGORIES AND WHAT THOSE
INTAKES WOULD BE.
ON TO THE PHASE 2 ONCE WE
IDENTIFY POTENTIAL WAYS TO
EXPLORE DIVERSIFYING AND
REVIVING OUR DIETARY PATTERNS WE
HAVE.
WE'LL BE TAKING A LOT OF NOTES
AS WE GO THROUGH PROTOCOL ONE
THAT WILL INFLUENCE HOW WE WORK
THROUGH WITH PROTOCOL EIGHT
BECAUSE THE PREVIOUS COMMITTEE
AND THERE ARE CERTAIN FOOT IN
THE AMERICAN DIET NOT ASSOCIATED
WITH A PARTICULAR DIETARY
PATTERN BASED ON SATURATED FAT,
ADDED SUGAR AND COMPOSITION.
GENERALLY THEY HAVEN'T BEEN
INCLUDED IN SOME OF THE FOOD
PATTERNS THEMSELVES.
BUT THEY'RE APART OF THE
AMERICAN DIET.
IF WE LOOK AT REFINING THAT
NUTRIENT PROFILE AND LOOKING AT
THAT AND FOODS WITH HIGHER
NUTRIENT DENSITY WHAT
IMPLICATIONS DOES THAT HAVE IN
OPENING THE DOOR IN INCLUDING
THESE FOODS GENERALLY EXCLUDED
INTO THE DIETARY PATTERN.
AND FINALLY THE SIMULATED DIETS,
THIS IS THE NEW APPROACH THAT'S
COMING FORWARD AS WAS MENTIONED
THIS MORNING THIS WAS THE FUN
PLAYGROUND TO GET TO SEE WHAT
HAPPENS WHERE WE CAN TAKE A FOOD
WITH A PATTERN THAT SAY HAS
THREE VEGETABLES IN A DAY AND
HAVE THREE VEGETABLE CHOICES AND
WHEN YOU PUT THE DAYS OF FOOD
INTAKES WHAT ARE THE RESULTANT
NUTRIENT ADEQUACY PROFILES YOU
WERE TO EAT A VARIETY OF FOODS
WITHIN CATEGORIES PLAYING OUT IN
ACTIONABLE STRATEGY.
SO I'LL TAKE A QUICK DEEP BREATH
HERE AND ASK IF WE HAVE
QUESTIONS ON OUR PROCESS GOING
FORWARD BEFORE I START MELTING
MINDS.
CHRISTOPHER.
>>I WAS BLOWN AWAY WITH HOW
IMPRESSIVE THIS WAS YESTERDAY
BUT IT JUST OCCURRED TO ME I
DIDN'T HOW NUTRIENT ADEQUACY
WOULD BE OPERATIONALIZED.
WILL THAT BE IN THE SLIDES?
I'LL STOP AND HOLD.
>>THANK YOU, CHRIS.
THAT WAS HELPFUL AND LOOKING
BACK ON YOUR SLIDE ON HOW YOU
PRIORITIZE THE ANALYSES AND I
LOVED SEEING THE RATIONALE FOR
THEM HOUR IT RACES A QUESTION
AROUND STABLE FOODS AND THERE'S
A RATIONALE HERE FOR TESTING
FLEXIBILITIES RELATED TO SOURCES
OF CARBOHYDRATES WITH CULTURAL
RELEVANCE AND I WONDER ABOUT
OTHER ANALYSIS TOPICS AND
PARTICULARLY BEFORE WE GO OUT TO
THE PLAYGROUND THE THOUGHT
PROCESS AROUND CULTURAL
RELEVANCE AND WORKING WITHIN
ANALYSIS TOPICS TO MAKE SURE
WE'RE TESTING AND FLEXING AROUND
A VARIETY OF CULTURAL BRIDGES.
AT THE STABLE FOODS CAME FROM
PROGRAM STAFF AND REVIEWS AND
THAT ASPECT AROUND CREATE THAT
PARTICULAR PROFILE THE OTHER
CATEGORIES UNDERNEATH WERE MORE
SPECIFIC TO I'D SAY FOOD
CATEGORIES.
THE OTHER PART THAT FITS INTO
THIS WHICH IS KIND OF THE NEXT
STEP PART OF THIS IS BASED ON
THE DIETARY INTAKES FROM NHANES
TO GET A BROADER REPRESENTATION
OF FOOD GROUP OR INDIVIDUAL'S
INTAKES WITH THE SAME
LIMITATIONS WE TALKED ABOUT IN
THE FIRST MEETING AROUND WHAT
SOME OF THOSE SUB GROUPS THAT
MAY OR MAY NOT BE INCLUDED OR
INCLUDED IN THE LARGER ASPECT
AND THE SIMULATIONS BECOMES A
WAY TO REALLY THEN DIG
SPECIFICALLY INTO SOME OF THOSE
CULTURE FOOD WAYS, USE THOSE
PATTERNS OR USE THOSE FOODS AS A
WAY TO BUILD THAT AND SEE HOW
THAT CARRIES FORWARD SO THE
LITMUS TEST HOW WELL DOES IT
TRANSLATE LOOKING INTO DIFFERENT
CULTURE FOOD WAYS AND
TRANSLATING THAT OUT.
>>THANK YOU.
I WANT TO MAKE SURE I'M COMING
TO THE RIGHT PLACE IN MY HEAD
HERE.
FOR EXAMPLE, I CAN IMAGINE THERE
BEING CULTURE RELEVANCE TO
CONSUMPTION AND BIOLOGICAL AND
OTHERWISE.
ARE YOU SAYING THAT WOULD BE
INCLUDED AROUND THE ANALYSIS OF
DAIRY OR DONE MOSTLY DONE
THROUGH THE ANALYSIS OF STABLE
CARBOHYDRATES?
I'LL SAY YES AND NO PARTIALLY
BECAUSE THE NEXT STEP WILL HELP
START DISENTANGLE THE COMPONENTS
OF HOW WE GET THROUGH THE FOODS
THEMSELVES BECAUSE WE HAVE THE
AMERICAN FOOD CATEGORIES THAT
SAY THIS IS A MILK AND DAIRY AND
FLUID MILK AND THIS IS AN APPLE
OR BANANA.
IT CLASSIFIES THE FOODS REPORTED
INTO CATEGORIES WHAT I'LL TALK
ABOUT NEXT WE'RE DECONTSTRUCTING
FOODS NOW AND GETTING DOWN TO
THE FUNDAMENTAL ELEMENTS AND
THEN USING WHAT PEOPLE TYPICALLY
CONSUME FROM NHANES AS A WAY TO
SET THE DISTRIBUTION.
I THINK THE NEXT STEP WILL HELP
TO ADDRESS THAT.
WE HAVE SOME LIMITATIONS WITHIN
THE NHANES DATA ITSELF BUT WE'RE
GETTING DOWN TO NOT JUST THE
SANDWICH BUT WHAT'S IN IT.
AND I THINK THAT WILL BE ONE OF
THE WAYS WE CAN HELP ADDRESS
SOME OF THOSE AND THEN WE CAN
CARRY FORWARD WITH SOME OF THE
SIMULATED DIETS TO ADDRESS HOW
THOSE PLAY OUT WHEN YOU CREATE,
SAY, A MENU FOR THOSE FOOD
INTAKES.
>>THERE WAS A HEALTHY
VEGETARIAN PATTERN CONSIDERED
BUT I NOTICED THE COMMITTEE
INCLUDED VEGAN IN THE PROTOCOL
BUT NOT VEGETARIAN.
CAN YOU TALK MORE ABOUT THAT?
>>WE WERE BUILDING OFF THE
PREVIOUS HEALTHY VEGETARIAN
DIETARY PATTERN AND THE WORK
WE'RE DOING FOR PROTOCOL ONE IS
GOING TO BE BASED ON THE HEALTHY
U.S. STYLE SO WE HAVE ONE PLACE
OF TEST IING THE THEY WILL THE
VEGETARIAN STYLE HAD DIFFERENT
WAYS OF INCORPORATING AND
DEFINING VEGETARIAN BUT THERE
WERE PUBLIC COMMENTS THAT WERE
GOING ALL THE WAY TO THE LEVEL
OF MORE VEGAN STYLE OR NO ANIMAL
PRODUCT.
SO WE'RE GOING TO BUILD FROM
THAT AND TAKE THAT TO THE FINAL
>>WITH OUR CONSIDERATION OF THE
PROTEIN GROUP WE'LL BE ABLE TO
TEST OUT SOME OF THOSE THINGS
AND WITH A LOT OF THOSE THAT WE
LISTED THERE IS LIKE A CONTINUUM
OF DIFFERENT MORE OR LESS THINGS
WE CAN TRY OUT AND THAT'S WHAT
WE'LL BE DOING.
DO YOU THINK MODELLING
SIMULATION HAS POTENTIAL FOR
LOOKING AT EQUITY ISSUES AROUND
AFFORDABILITY AND FLEXIBILITIES
AROUND COST.
HAVE YOU HAD DISCUSSIONS AROUND
THAT?
I'VE HAD A LOT OF DISCUSSIONS
AROUND THAT.
THERE'S ONLY SO MANY THINGS BUT
ALSO I'M THINKING ESPECIALLY
WITH THE DATA ANALYSIS THERE'S
STEPS TO ADDRESS HOW THESE PLAY
OUT LOOKING AT WHAT MAKES UP THE
FOOD THE FOOD GROUPS.
>>WE TALKED ABOUT THE EXACT
ISSUE AND IT'S IMPORTANT AND
WE'RE TRYING TO CAPTURE ALL
THESE IMPORTANT ASPECTS OF
THINKING ABOUT THE FOODS PEOPLE
CAN EAT AND HAVE ACCESS TO AND
ARE ABLE TO INCLUDE IN THEIR
DIETS.
>>IF YOU CAN HEAR THE GEARS
WHIRRING IN MY AHEAD EVERY TIME
WE HAVE THE CONVERSATION IT
WOULD BE DEAFENING.
THAT'S WHERE THE WORK IS
EXCITING AND ACTIONABLE AND HAS
SO MANY APPLICATION STRATEGIES
NOT ONLY FROM JUST LOOKING AT
THE NUTRITIONAL SIDE BUT THE
IMPLICATIONS AROUND THE FOODS IT
CONTAINS AND SUCH.
WITH THAT MY NEXT THING I'M
GOING TO DO IS WALK THROUGH OUR
DRAFT PROTOCOL AND IN DOING THAT
OUR DRAFT PROTOCOL ONE IS AROUND
NOT INCLUDES FOODS WITH LOWER
NUTRIENT DENSITY WITH RELATION
TO SATURATED FAT, ADDED SUGAR
AND SODIUM BUT TO GET THERE YOU
KIND OF HAVE TO GET THE WHOLE
PROCESS.
I'M GOING TO WALK THROUGH IT FOR
THE FOOD PATTERN MODELLING
APPROACH.
HOW DO WE GET FROM FOODS AND
INTAKES DOWN TO ITEMS TO
REPRESENT THAT TO A PATTERN AND
BACK TO NUTRITIONAL ADEQUACY?
WE PROBABLY SHOULD HAVE MEASURED
D.O.T. MAX AT THE BEGINNING OF
OUR FIRST MEETING AND UP THE
STEEP LEARNING HILL AND IT STILL
BECOMES THE MIND BENDING STRETCH
FOR ME.
I'LL TRY TO HELP STILL DOWN HOW
WE'RE GETTING THERE AND HOW IT'S
DIFFERENT THAN JUST SAY DATA
ANALYSIS AND LOOKING AT NUTRIENT
INTAKES AND HOW DOES IT
TRANSLATE BACK TO US BEING ABLE
TO TEST OUT THE FOOD GROUP
INTAKES.
PROTOCOL ONE SHOULD THOSE WITH
ADDED SUGARS, SATURATED FAT AND
SODIUM CONTRIBUTE TO THE ITEM
CLUSTERS.
THE GROUPING OF FOODS
REPRESENTATIVE FOODS AND
THEREFORE THE NUTRIENT PROFILES
WITHIN EACH OF THE SUB GROUPS.
AND THE APPROACH WE'RE USING IS
TO LOOK AT THE NHANES DIETARY
DATA IT'S CREATING AN APPROACH
TO MEET PEOPLE WHERE THEY ARE
AND NOT SAYING THESE ARE OUR
MOST NUTRIENT DENSE FRUITS AND
VEGETABLE WE THINK PEOPLE SHOULD
BE EATING I CAN TELL YOU THE
CONSUMPTION BRUSSEL SPROUTS IS
LOWER THAN NHANES AND IF WE'RE
TALKING A
TALKING ABOUT CRUCIFEROUS
VEGETABLES DIFFERENT THINGS WILL
SHOW UP AND LOOKING AT WHOLE
GRAINS AND IT'S AN APPROACH TO
MEET PEOPLE WHERE THEY ARE BASED
ON THE DATA WE HAVE OF
CONSUMPTION.
WHAT ARE WE DOING, HOW ARE WE
DOING IT AND HOW WILL WE KNOW
WHEN WE GET THERE?
THIS IS THE MILLION DOLLAR
QUESTION.
THANK YOU NUTRIENT PROFILES FROM
THE PREVIOUS DGA COMMITTEE
REPRESENT NUTRIENT INTAKES OF
ALL FOODS THAT WENT INTO A FOOD
CATEGORY.
SO EVERY TYPE OF VEGETABLE,
EVERY TYPE OF FRUIT, EVERY TYPE
OF GRAIN, EVERY TYPE OF MEAT.
THERE'S SOME FOODS AS I
MENTIONED BEFORE THAT DON'T HAVE
A PARTICULAR FOOT CATEGORY OR
CONTRIBUTE SPECIFICALLY LIKE
ALCOHOL DOESN'T HAVE AN ITEM
CLUSTER THAT CARRIES FORWARD BUT
THE CONCERNS ARE SHOULD ALL THE
FOODS OF IS THAT WERE PROMOTING
TO LIMIT SHOULD THEY CONTRIBUTE
TO THE ITEM CLUSTERS AND
NUTRIENT PROFILE BECAUSE THEY
REPRESENT SOMETHING SLIGHTLY
DIFFERENT THAN THE PROFILE OF
NUTRIENT DENSE FOODS.
THE CURRENT APPROACH HAS ALL THE
FOODS WITHIN THE NUTRIENT
PROFILES.
AND PUBLIC COMMENT COMMENTS
SUGGEST MAYBE A REVISED PROFILE
WITH LOWER IN SATURATED FAT,
SUGAR AND SODIUM TO CREATE THE
NUTRIENT PROFILE.
THAT CREATES A TIGHTER STORY
LINE AROUND WHAT MAKES UP EACH
DIFFERENT FOOD GROUP AND THEN IT
THEN CREATES A DIFFERENT TOTAL
NUMBER OF CALORIES WITHIN EACH
OF THOSE DIETARY PATTERNS TO
HAVE BROADER SELECTIONS OF FOODS
WITHIN EACH CATEGORIES.
WE'LL TEST THE MODELS BY TAKING
OUT THE FOODS OF LOWER DENSITY
AND RECREATE THE NUTRIENT
PROFILE AND COMPARE DOES IT MAKE
A DIFFERENCE DENSITY WITHIN THE
FOODS CONSUMED AND DOES IT
CREATE MORE ENERGY DIFFERENCE
BETWEEN THE ENERGY WITHIN THE
PROFILE AND WHAT YOU WOULD GET
FROM FOLLOWING THAT WITH THE
NUTRIENT DENSE VERSION.
A SET OF KEY DEFINITIONS TO
START YOU WITH BUT I'LL WALK
THROUGH THE PROCESS ITSELF SO WE
CAN UNDERSTAND WHAT ALL THE
WORDS MEAN.
ONE OF THE SUMMER JOBS DURING
COLLEGE THEY HANDED ME THE
MANUAL OF EVERYTHING YOU HAD TO
READ AND YOU THOUGHT THAT'S WHAT
YOU MEAN BY THAT YOU READ A
BUNCH OF DEFINITIONS AN WHEN YOU
SEE THEM IN PLAY YOU THINK THAT
MAKES SENSE.
THE NUTRIENT PROFILES THEN
BECOME ESTIMATED NUTRIENT INTAKE
WE EXPECT FROM A PARTICULAR FOOD
GROUP.
WE SAY VEGETABLES.
WHAT DO WE EXPECT THE VITAMINS
AND MINERALS AND CARBOHYDRATES
REPRESENTING THE TYPES OF
VEGETABLES?
THE ITEM CLUSTERS BECOME THE WAY
WE THEN IDENTIFY THE PARTICULAR
FOODS THAT MAKE UP THAT
CATEGORY.
SO WITHIN VEGETABLES WE'LL HAVE
CARROTS AND CELERY AND ONIONS
AND THE LIST GOES ON AND THE
ITEM CLUSTERS GO TO THE FOODS
THAT MAKE UP THE GROUP AND THE
NUTRIENT DENSE REPRESENTATIVE
FOODS BECOME WHAT IS LOOKING AT
THE NUTRIENT DENSE VERSION
EQUIVALENT TO THE FOOD CONSUMED
REPORTED AS CONSUMED AND FOR
EXAMPLE WHOLE MILK WOULD HAVE A
NUTRIENT DENSE REPRESENTATIVE
FOOD OF SKIM MILK.
IT'S THE MOST NUTRIENT DENSE
VERSION AND LIMITING ADDED
SUGARS, SODIUM AND SATURATED
FAT.
SO WE ALL SAW THIS SLIDE DURING
THE FIRST MEETING AND
REPRESENTING THE DIETARY INTAKES
IN AMERICA AND SOMEBODY SAYS I
HAD FOOD ONE, I HAD FOOD TWO
ANDED TO THREE.
-- FOOD ONE AND TWO AND THREE.
IN THIS EXAMPLE OUR LIGHTNING
BOLT WOULD BE THE WHOLE GRAIN.
THE FOOD ON THE LEFT WAS WHOLE
GRAIN BREAD TOASTED WITH VARIOUS
THINGS ON TOP, PEANUT BUTTER AND
APPLE SLICES AND HONEY OR
WHATEVER IT MIGHT BE THEY PUT
ON.
THE SECOND ONE MIGHT BE A PEANUT
BUTTER AND JELLY SANDWICH WITH
WHOLE BREAD, PEANUT BUTTER AND
JELLY.
OUR SQUARES REPRESENT PEANUT
BUTTER THAT SHOW UP ON THE FIRST
AND SECOND FOOD AND THE THIRD
FOOD JUST MIGHT BE TOASTED WHOLE
WHEAT BREAD.
THE FOOD ITSELF NOW IS THE
INDIVIDUAL FOOD.
WE'RE GOING ACROSS THE FOOD
REPORTED AND TAKING INGREDIENTS
AND SEPARATING THEM OUT AND THE
WHOLE WHEAT BREAD IS THEN GOING
TO BE LINKED TO A WHOLE WHEAT
BREAD THAT REPRESENTS THE
NUTRIENT DENSE VERSION.
AND THEN WE'VE GOT OUR SQUARES.
WE HAVE OUR Ls AND THE FOODS GET
DISAGGREGATED TO THE CONSUMPTION
OF THE REPRESENTATIVE FOODS.
SO WHAT DOES THAT MEAN WHEN WE
START TO DISENTANGLE THESE IN
CREATING NEW NUTRIENT PROFILES
BASED ON THE FOODS THAT GO IN?
HERE IN THIS CASE OUR NUTRIENT
PROFILES HOW WOULD WE REPRESENT
RED AND ORANGE VEGETABLES?
THESE ARE ALL THE ITEM COLORS
THAT REPRESENT RED AND ORANGE
VEGETABLES.
AS YOU ARE PROBABLY NOT
SURPRISED TOMATOES COMPRISED
ABOUT THREE QUARTERS OF THE RED
AND ORANGE VEGETABLES FROM
CONSUMPTION BUT ALSO COOKED AND
RAW CARROTS AND RED CHILE
PEPPERS.
ALL THEE INDIVIDUAL FOOD ITEMS
MAKE UP THIS SUB GROUP OF RED
AND ORANGE VEGETABLES.
WE'RE CREATING A PROFILE TO
REPRESENT RED AND ORANGE
VEGETABLES.
HOW DO WE GET THERE?
WE DON'T EAT PILES OF
INGREDIENTS.
WE EAT FOODS AS FOODS AND WHEN
WE CAPTURE DATA IN NHANES, EACH
ONE OF THESE FOODS IS LINKED
SPECIFICALLY TO AN EIGHT-DIGIT
FNDDS FOOD CODE AND IF YOU'RE
FOLLOWING ALONG AT 416413010,
LENTIL SOUP.
IT'S A FOOD-BASED DIGIT AND IT
INCLUDES LENTILS, COOKED
CARROTS, TOMATOES, CELERY,
COOKED ONIONS AND BROTH WHICH
BROTH DOESN'T CONNECT TO A FOOD
CATEGORY OF WATER.
WE DON'T HAVE A WATER SUB GROUP
AND THE LENTILS WILL GET
ASSOCIATED WIN LENTILS AND THE
COOKED TOMATO WILL BE
REPRESENTATIVE OF RED AND ORANGE
VEGETABLES.
SO WE'RE TAKING A PART THE
RECIPES OF PEOPLE REPORT AND THE
INDIVIDUAL INTO -- THAT GO IN
THERE.
WHEN WE TAKE SOMEONE WITH A
VARIED DIETARY INTAKE LENTIL
SOUP WILL HAVE CARROTS AS PART
OF THE RECIPE.
CARROT CAKE AND VEG TIBBLE SOUP
AND COME UP WITH A FANCY SOCIAL
MEDIA GLAZED CARROTS BUT GLAZED
CARROTS WILL PROVIDE CARROTS.
THEN WE'RE TAKING OUT THE
CARROTS THAT SHOW UP ACROSS
EVERY ONE OF THESE INDIVIDUAL
FOODS AND MAKING THAT COOKED
CARROTS ITEM CLUSTER.
WE'RE ABLE TO TRACK THE
CONSUMPTION OF COOKED CARROTS
ACROSS ALL THE FOODS PEOPLE ARE
CONSUMING.
IT'S WHAT'S IN THE FOOD YOU EAT
NOT JUST THE FOOD YOU EAT.
WE GET TO THE CLUSTER LEVEL AND
THEN WE SAY THE REPRESENTATIVE
FOOD IS STEAMED CARROTS.
THAT'S THE MOST NUTRIENT DENSE
VERSION WHILE LIMITING ADDED
SUGAR, SATURATED FAT AND SODIUM
TO REPRESENT COOKED CARROTS.
NOW, THERE'S 400 ITEM CLUSTERS
AND COOKED CARROT SHOWS UP IN
ABOUT 250 FOOD INTAKES WHEN WE
EXTRACT OUT CARROTS.
WE'RE TAKING ALL THE CARROT
CONTAINING FOODS AND BRINGING
OUT DOWN AND IDENTIFYING THE
NUTRITIONAL COMPOSITION WHERE
COOKED CARROTS SHOWS UP.
WHAT ARE THE INDIVIDUAL BUCKETS
OF FOOD ITEMS THAT WE'RE USING
TO CREATE A NUTRIENT PROFILE AND
THE COMPOSITION OF COOKED
CARROTS YOU CAN SAY I CAN FIGURE
THAT OUT BASED ON PREPARATION
STYLES BUT OUR NUTRIENT DENSE
REPRESENTATIVE FOOD SAYS LET'S
ASSUME WHENEVER WE SEE CARROTS
IN A RECIPE LET'S USE THE
NUTRIENT PROFILE FOR STEAMED
CARROTS.
NOW WE'RE ABLE TO TAKE THE FOOD
INTAKES AND THE CONSUMPTION OF
COOKED CARROTS AND CAN IDENTIFY
OF ALL THOSE RED AND ORANGE
VEGETABLES WE SAW AND TAKEN ALL
THE CARROTS OUT AND TOMATOES
FROM A SALAD AND ALL THE PLACES
IT MAY BE AND THE COOKED
TOMATOES AND THE PLACES WHERE
THEY ARE WE CAN GET THE
PROPORTION SO 44% OF ALL THE RED
AND ORANGE VEGETABLES COME IN
THE FORM OF A COOKED TOMATO.
HOW THE NUTRITIONAL COMPOSITION
OF TOMATOES, 44% OF THAT
LYCOPENE WOULD BE ADDED TO WHAT
WE SAY A RED AND ORANGE
VEGETABLE IS.
COOKED CARROTS CONSUME LESS.
ONLY 9% OF THE CARBOHYDRATE FROM
THE COOKED CARROTS WILL BE USED
TO CREATE THAT CARBOHYDRATE
ESTIMATE.
OUR NUTRIENT PROFILES ARE
WEIGHTED BY HOW MUCH INDIVIDUAL
FOODS ARE CONSUMED AND GETTING
DOWN TO THE INGREDIENT LEVEL.
WHAT THAT ULTIMATELY MEANS IS
YOU TAKE THE BIG WHEEL, YOU
WEIGHT CALORIES BY THE
PROPORTION, YOU WEIGHT PROTEIN
AND IT GIVES THE PICTURE THAT
SAYS FOR RED AND ORANGE
VEGETAB
VEGETABLES BASED ON THE
REPRESENTATIVE FOOD AND
PROPORTIONALITY THIS IS THE
NUTRIENT PROFILE WE WOULD GET
OKAY.
THIS IS GREAT SO WHY DO WE NEED
THIS AND WHAT WILL WE USE IT
FOR?
HERE ARE HEALTHY U.S. STYLE
DIETARY PATTERNS.
THE RED AND ORANGE VEGETABLES
WE'RE LOOKING FOR THE 12 TO 23
MONTHS AND GOT ONE SERVING OF
THAT FOOD GROUP OUR NUTRIENT
PROFILE FOR TESTING OUT THESE
DIFFERENT FOOD PATTERNS THAT
WHEN I HAVE TWO SERVINGS I'M
GOING TO DOUBLE THE NUTRIENT
COMPOSITION THAT COMES FROM
THOSE ITEM CLUSTERS WE PUT
TOGETHER TO CREATE THIS.
WE'RE TAKING ALL THE FOOD.
WE'RE TAKING A PART THE
INGREDIENTS AND PUTTING THEM IN
THEIR BUCKETS AND LOOKING AT THE
PROPORTION
PROPORTIONALITY AND ESTABLISHING
THE NUTRITIONAL PROFILE AND
COMING BACK TO IF WE DO THIS AND
FOLLOW THIS PATTERN, THIS IS
WHAT THE NUTRIENTS WOULD BE AT
THE CALORIC LEVEL AND WITHIN THE
AGE GROUPS IF WE TAKE A
19-YEAR-OLD WE'LL HAVE DRI FOR
19-YEAR-OLD BASED ON AGE, SEX
AND ACTIVITY LEVEL AND HAVE
RANKS OF CALORIES AND FOR
SOMEBODY WHO HAS ESTIMATED
ENERGY NEED OF 2,000 CALORIES,
THIS IS HOW MANY OF THOSE BASED
ON THE AGE AND SEX WE WOULD THEN
ALSO KNOW THE DRI AND WE CAN
THEN GET TO THE STAGE OF DOES
THIS ACTUALLY MEET NUTRIENT
ADEQU
ADEQUACY.
I'LL STOP HERE BECAUSE THIS IS
HOW WE MAKE THE TRANSITION OF
WHAT WE'LL DO WITH THIS.
THIS IS ANOTHER TIME FOR
QUESTIONS TO GET CLARIFICATION.
>>I HAVE A COUPLE QUESTIONS.
FIRST, SEEMS LIKE ALL THIS IS
ALREADY DONE BECAUSE WE SEE IT
IN THE DIETARY GUIDELINES AND
NOW YOU'LL BE MODELLING FOR THE
DIFFERENT TYPES OF DIETS OR
THINGS HAVE CHANGED OVER TIME?
>>IT WILL NOW BE DONE WITH THE
2017, 2018 DATA.
THAT'S OUR MOST RECENT COMPLETE
VERSION OF NHANES DIETARY DATA
BECAUSE THERE WAS THIS THING
CALLED THE COVID-19 PANDEMIC
THAT THE DATA COLLECTED IN
TWO-YEAR CYCLE AND 1920 KIND OF
HAD THE THING HAPPEN WHICH MEANT
THERE WAS A DISRUPTION IN THE
DATA COLLECTION WHICH THEN MEANT
'19-'20 WAS NOT A REPRESENTATIVE
SAMPLE AND HAVE TO RELY ON 2017,
2018 DATA THAT IS OUR MOST
COMPLETE NATIONALLY
REPRESENTATIVE DATA AND NEWER
DATA THAN FROM THE PREVIOUS
COMMITTEE.
AND SOME OF THE TRENDY DIETARY
PATTERNS WE MIGHT SEE NOW AREN'T
GOING TO SHOW UP IN 2017, 2018
THIS IS A LIMITATION AND AN
OPPORTUNITY WITH AN AMAZING DATA
SET BUT LIMITED BY HISTORICAL
PERSPECTIVE OF WHAT HAPPENS FOR
US BEING LIMITED TO 2017, 2018.
MY OTHER QUESTION IS RELATED TO
SPICES AND CURVES AND MANY WILL
HAVE THOSE INCLUDED.
ARE YOU CONSIDERING THOSE?
>>THEY DON'T CONTRIBUTE TO AN
ITEM CLUSTER FOR SPICES BUT FROM
A NUTRIENT PERSPECTIVE AND
QUANTITY OF CONSUMPTION
PERSPECTIVE THERE'S ALREADY --
WE'RE ALREADY LOOKING AT A LEVEL
OF NOISE AROUND THE ESTIMATES
FROM FOOD INTAKES AND NUTRIENT
DATABASE TO GET TO PRECISELY TO
WHAT PEOPLE EAT.
BUT THEY AREN'T INCLUDED FROM
THAT ASPECT BECAUSE OF THE
NUTRIENT COMPOSITION WE'RE
LOOKING AT AND THE QUANT OF
CONSUMPTION IN TERMS OF HOW IT
PLAYS WITHIN THE TOTAL NUTRIENT.
THEY'LL HAVE LACE OF AN IMPACT
ON CALORIE INTAKE AND IMPACT ON
SODIUM INTAKE BUT WE'RE LOOKING
AT THESE WITHOUT THOSE
COMPONENTS AS THE FOOD AND
DIVERSITY AND IMPLEMENT AND
SPICES COME INTO PLAY.
>>AND AS PART OF THE
COMPOSITION OF THE FOOD THOSE
WOULD BE -- IF THAT WAS PART OF
THE INGREDIENTS AND COMPOSITION
OF A CERTAIN FOOD IT WOULD BE IN
THE DATABASE.
MAYBE THAT DIDN'T TAKE INTO
ACCOUNT TRADITIONAL AND CULTURAL
FOODS.
MAYBE THE WAY THE LENTIL SOUP IS
DONE IN DIFFERENT CULTURAL
GROUPS WILL HAVE DIFFERENT
INGREDIENTS.
THAT'S WHERE I WAS GOING.
>>FROM A LENTIL SOUP IT HAS
FRESH PARSLEY AND I PULLED THAT
UP EARLIER AND
>>IT MAY BE DIFFERENT FROM A
LENTIL SOUP FROM MEXICO WHICH
WOULD PROBABLY NOT HAVE PARSLEY
BUT CILANTRO OR FROM ANOTHER
COUNTRY OR CULTURE.
>>WHICH GETS BACK TO OUR
LIMITATION.
>>I HOPE MUSHROOMS COME FIRST.
WHEN I GET TO YOUR SATURATED
SODIUM AND FATS THERE MUST BE
SOME CUT POINT.
HAVE YOU OPERATIONALIZED THE CUT
POINT OF TRYING TO DO THAT?
>>THEY FOR COMING SLIDES.
>>IF THERE'S SHIFT IN THAT BUT
IT DOESN'T IMPACT THE GOAL OF
WHAT DOES THIS DO TO THE DRI
THEN IT'S BLOW THE RADAR ANYWAY.
HOW ARE YOU DEFINING AND YOU
ASKED ABOUT NOT EXCESS AND HOW
DO YOU LOOK AT THAT?
I THINK YOU'RE GOING TO TALK
ABOUT THAT SO I'M LOOKING
FORWARD TO THAT BUT I HAD A
QUESTION ABOUT AND YAMS ARE 3%
OF WHAT'S CONSUMED IF I
UNDERSTAND CORRECTLY BUT THAT'S
GOING TO VARY TO CHRISTINA'S
PERSPECTIVE IT MAY VARY ACROSS
CULTURAL GROUPS, SUBPOPULATIONS.
ARE YOU TAKING THAT INTO
CONSIDERATION?
>>WELL, THE FIRST PART OF THAT
IS THAT BASED ON THE CURRENT
CONSUMPTION PATTERNS MAKING THE
NUTRIENT PROFILE IT'S
CONTRIBUTING BASED ON MEETING
PEOPLE WHERE THEY ARE RIGHT NOW
AND I FEEL LIKE ONE, WHEN WE GET
TO SOME PLACES WHERE INDIVIDUALS
MAY NOT CONSUME GRAINS BUT MAY
CONSUME POTATOES, SWEET
POTATOES, THE OTHER CULTURAL
FOOD WAYS IT GIVES US AN
OPPORTUNITY TO SHIFT WHERE THOSE
ARE AND IN THE SIMULATED DIETS
HOW IT PLAYS OUT IN BEING THE
REPRESENTATIVE VEGETABLES.
AND TELL ME IF YOU'RE THINKING
ABOUT THIS CORRECT.
SHE'S SAYING IF YOU HAVE CANDIED
YAMS AND THE WAY THAT'S PREPARED
THAT MAY BE DIFFERENT THAN YAMS
PREPARED IN A DIFFERENT WAY IS
THAT WHAT YOU'RE SAYING?
>>I WAS THINKING MORE ABOUT
WHEN LOOKING AT THE POPULATION
YOU'RE LOOKING AT 3% OF YAMS AND
IF YOU LOOK AT SUBPOPULATIONS
YOU MAY SEE 20% OF YAMS.
IN THE SUB POPULATIONS AND YOU
PUT 3% OF THAT AND IT'S WEIGHTED
IF I'M UNDERSTANDING CORRECTLY.
THE WEIGHTING BECOMES A
PERCENTAGE OF THE SUB GROUPS.
HAVE YOU THOUGHT OF CONSIDERING
SOME VARIABILITY THAT CAN GET
BIG QUICKLY BUT IT'S SOMETHING
TO THINK BAND THERE'S BEEN OTHER
PROCESSES THAT TRIED TO LOOK AT
THIS TYPE OF THING WITH FRUITS
AND VEGETABLES COMPARED TO
GRAINS.
I THINK THE WEIGHTING AND
PREPARATION AND MY CONCERN WAS
AROUND THE WEIGHTING.
YOU MENTIONED CANDIED YAMS THAT
MAY BE COOKED DIFFERENTLY THE
REPRESENTATIVE FOOD WOULD THEN
BE YAMS.
SO YOU WOULDN'T IN THIS CASE IT
ISN'T TAKING CANDIED YAMS AS
HIGHER REPRESENTED FOODS BUT
REPRESENTING YAMS AS YAMS COOKED
AND NOT THE CALORIC AND ADDED
SUGAR VALUE OF YAMS BECAUSE IF
YOU SAY WE'RE NOT GOING TO LET
YOU EAT YAMS BECAUSE OF THE
CALORIES IF YOU LOOK AT IT AS
FITTING IN THE PATTERN YOU'RE
LOOKING AT THE NUTRIENT.
YOU'RE GETTING THE NUTRIENT
DENSE VERSION TO CAPTURE THE
FOOD WITHIN THE FOOD PATTERN AND
THE CHOICES THAT WE MAKE AROUND
FOOD PREPARATION AND THAT FITS
INTO MAKING FOOD CHOICES WITHIN
THE ENERGY RECOMMENDATIONS.
>>ARE THEY USER DETERMINED?
>>THE DATA IS BASED ON RECORDED
NHANES DATA FROM FOOD
COMPOSITION DATA NATIONALLY
REPRESENTATIVE FOOD COMPOSITION
DATA.
IT'S THE THIS IS THE TUG AND
POOL BETWEEN THE OPPORTUNITIES
WE HAVE WITH A LARGE AMOUNT OF
DATA AND ABOUT 7400 FOOD CODES
OF WHAT'S BEING REPRESENTED IN
MATERIALS OF THE 2017 FNDDS.
YOU HAVE THE WIDE SCOPE OF FOODS
BUT IT'S STILL LIMITED BY THE
THINGS DISCUSSED AROUND THE
INCLUSION AND REPRESENTATIVE AND
DIVERSITY OF THE SAMPLE.
IT GIVES A STARTING POINT IF WE
AND THIS IS AN AREA AROUND
CONVERSATIONS AROUND BEING ABLE
TO AND TAKING THE FOOD PATTERNS
AND USING THEM IN DATA ANALYSIS
TO IDENTIFY AREAS WHERE WE SEE
DIFFERENCES IN FOOD EQUITY AND
FOOD INSECURITY AND INCOME AND
ADDRESSING THE DIFFERENT
CONCERNS BUT IN CREATING THE
BROADER U.S. STYLE HEALTHY
EATING PLAN IS BASED ON THE
LARGER NATIONAL DATA BUT KNOWING
IT HAS THE LIMITATIONS
>>THIS IS SOMETHING FOR THE
COMMITTEE TO CONSIDER.
I UNDERSTAND YOU CAN'T DO
PROTEIN FOODS AND DO STABLE
FOODS AND FRUITS AND VEGETABLES
MAY BE INTERESTED TO LOOK AT
VARIED WHEN YOU PICK THE FOODS
AND DO THE NUTRIENT COMPOSITE, I
GUESS, TO LOOK AT VARIABILITY
THERE TO SEE AND MAY BE
INTERESTING TO TAKE A LOOK AT.
>>MY MIND IS WHIRRING AND STAFF
TELLS ME WE CAN ONLY DO SO MUCH.
THESE ARE THE GREAT -- I THINK
IT'S GETTING TO THE BOOTS ON THE
GROUND AND LOOKING AT THE
DIVERSITY OF FOODS WITHIN THE
CATEGORIES.
LOOKING AT THE INDIVIDUAL FOOD
BEING CONSUMED AND THE
COMPONENTS AND HOW DOES THIS
CREATE THE FOUNDATIONAL
NUTRIENT-LEVEL DATA.
>>WE THINK IT'S IMPORTANT TO
TEST OUT DIFFERENT CULTURAL FOOD
WAYS AND SEEING WHAT THE MOST
FREQUENTLY CONSUMED FOODS ARE
AND MODELLING SOME OF THOSE
THINGS.
IT'S IMPORTANT TO KEEP THINKING
ABOUT IN THOSE --
>>SORRY REGIONAL TOO.
>>OKAY.
NEXT SLIDE.
SO NOW SO THE ACTUAL PROTOCOL
NOW THAT YOU KNOW WHAT I'M
TALKING ABOUT OR AT LEAST I HOPE
SO.
SO OUR PROTOCOL WE DEVELOPED
FIRST AND WE ARE LOOKING AT
SODIUM AND SATURATED FAT
CONTRIBUTE ITEM CLUSTERS AND
THEREFORE NUTRIENT PROFILE.
TAKING A LOOK AT THE FOODS AND
THE ITEM CLUSTERS THAT EXIST AND
SHOULD WE CREATE A REVISED
PATTERN THAT REPRESENT THAT
REMOVES THE LOWER NUTRIENT DENSE
FOODS AND ONLY FOCUSES ON THE
HIGHER NUTRIENT DENSE FOODS.
SO OUR ANALYTIC FRAMEWORK WE'LL
BE LOOKING AT THE DIETARY INTAKE
DATA FROM NHANES FOR BASICALLY
ONE YEAR OF AGE AND OLDER AND WE
HAVE SEPARATE DIETARY PATTERNS
FOR 12 TO 23 MONTHS AND 12 YEARS
AND OLDER.
INE OVERVIEW OF BASICALLY ALL
THE DIFFERENT QUESTIONS WE'LL
HAVE IS TO IDENTIFY THE
INDIVIDUALS WE HAVE FOR THE
DIETARY INTAKE FOR.
AND SO CREATING AN ENERGY LEVEL
FOR THE PARTICULAR PATTERNS,
IDENTIFYING NUTRITIONAL GOALS OF
THAT PATTERN ON THE HEALTHY
STYLE WE JUST LOOKED AT AND IT
HAD REPRESENTATIONS FROM EACH OF
THE DIFFERENT FOOD GROUPS ACROSS
MY PLATE AND THE QUANTITIES FROM
THAT.
ESTABLISHING THE FOOD GROUPINGS
AND THE FOOD GROUP AMOUNTS AND
THEN DETERMINING THE AMOUNT OF
ENERGY AND NUTRIENTS THAT THEN
COMPRISE THE FOODS WITHIN THE
FOOD GROUPS AND SUB GROUPS.
WE WENT THROUGH THE EXAMPLE OF
RED AND ORANGE VEGETABLES BUT IF
WE WERE MODELLING AND IN THIS
CASE FOODS WITH HIGHER ADDED
SUGAR AND SATURATED FAT AND
SODIUM.
THE CARROT CAKE IS PROBABLY
GOING TO BE ONE OF THE FOODS FOR
THE CONTRIBUTION OF CARROTS FOR
THE COMPOSITION WITHIN THE FOOD
MAY BE A FOOD THAT WOULD NOT BE
CARRIED FORWARD AND EVALUATING
THE NUTRIENT LEVELS WITHIN THE
PATTERN AND SEEING HOW IT
PERFORMS IN TERMS OF NUTRITIONAL
ADEQUACY AND THE PROFILES THAT
COME FROM THAT AND THEN REVISING
THE FIRST GUT REACTION GIVES YOU
A STARTING POINT BUT NOT AN
ANSWER.
SO THE PROCESSES THAT WE'LL WALK
THROUGH HERE FOR STEP ONE ARE
THE FOUR STEPS WE CONCEPTUALIZED
BUT ONE OF THOSE THINGS YOU
DON'T KNOW UNTIL YOU START
WORKING WITH THE DATA TO SEE HOW
THEY'LL MANIFEST AND WHAT WE EAT
IN AMERICA DATA FROM FNDDS AND
WHEN THE FOOD CODES ARE
SEPARATED SOME SOME ARE SR AND
IF SOMEBODY HAS PIZZA IT WILL BE
FLAGGED UNDER THAT CATEGORY.
WE CAN LOOK AT IT FROM THE FOOD
AND INGREDIENT LEVEL.
OUR
OUR NEW -- NUTRITIONAL GOALS
AND FROM THE GUIDELINES AND THE
ENERGY LEVELS FROM UPDATED DRIs
AS WELL AS THE HEIGHT AND WEIGHT
POPULATION NORM DATA FROM
NHANES.
OKAY.
SO IN OUR OVER ARCHING FRAMEWORK
FOR PROTOCOL ONE IS IDENTIFYING
FRUITS AND BEVERAGES LOWER IN
NUTRIENT DENSITY TO CREATE THE
NUTRIENT PROFILE.
SO WE'RE LOOKING AT WHAT ARE THE
POTENTIAL STRATEGIES THAT WE
IDENTIFY LOWER NUTRIENT DENSITY
FOODS WE WOULD EXCLUDE AND IF
YOU TAKE OUT FOODS HIGHER IN
ENERGY AND THE ENERGY ASSOCIATED
WITH THOSE ITEM CLUSTERS IS
GOING TO GO DOWN?
-- GO DOWN.
YOU'LL GET MORE NUTRIENTS FOR
THE SAME AMOUNT OF ENERGY.
WE'RE GOING TO TEST THIS WITHIN
THE U.S. HEALTHY U.S. STYLE
DIETARY PATTERN.
THESE ARE THE STEPS WE'VE
DISCUSSED.
WE ASKED THE STAFF TO DO A SCAN
OF THE DIFFERENT APPROACHES THAT
VARIOUS GROUPS HAVE USED TO
IDENTIFY FOODS THAT GET EXCLUDED
FROM CREATING THE NUTRIENT
PROFILES AND THE PREVIOUS
ADDITION USED ALL FOODS TO
CREATING THE NUTRIENT PROFILE.
IF YOU HAVE A HIGHER CONSUMPTION
OF FOOD THAT IS A MORE ENERGY
DENSE VERSION, THE CALORIES
ASSOCIATED WITH THAT CATEGORY
WILL GO UP.
THE STEPPED WE IDENTIFIED WE'LL
USE TO TEST THIS STEP WISE
PROGRESSION OF CREATING THIS
REVIVED NUTRIENT PROFILE
INCLUDING FOODS AND BEVERAGES
FOR COMPANION ITEM CLUSTERS THAT
ARE TYPICALLY HIGHER IN ENERGY
AND LOWER IN NUTRIENT DENSITY.
THINGS LIKE BAKED GOODS WERE ONE
AREA WHERE WE HAD DISCUSSIONS
AROUND THE NUTRIENT COMPOSITION.
THE NEXT STEP WILL THEN BE TO
IDENTIFY FOODS AND BEVERAGES AND
WE NEED TO DEFINE A PROPORTION
OF THE TOTAL INGREDIENTS THAT
CONTRIBUTE TO A TOTAL FOOD OR
SUB GROUP.
SO YOU MIGHT HAVE ITEMS THAT ARE
A PART OF SOMETHING THAT DON'T
FULLY REPRESENT THE FOOD ITSELF
A SMALL INGREDIENT AND EXCLUDING
ITEM CLUSTERS WITH A NUTRIENT
DENSE REPRESENTATIVE FOOD THAT
WOULDN'T BE A NUTRIENT DENSE
ALTERNATIVE FOR THE FOOD AND HOW
WE MIGHT IDENTIFY HOW WELL THE
ITEM CLUSTERS LIKE COULD YOU
MAKE THE FOOD FROM THE ITEM
CLUSTER BEING SELECT AND HOW
WELL DO THE FOODS REPRESENT AND
THE FINAL STEP INCLUDING ITEM
CLUSTERS WHEN REPRESENTATIVE
FOOD AS AN OUTLIER WITHIN ALL
THE OTHER FOODS WITHIN AN ITEM
CLUSTER BASED ON THEIR SUGAR,
SATURATED FAT OR SODIUM INTAKE
BASED ON COMPOSITION OR
PROCESSING PREPARATION IT TAKES
TO CREATE THE FOOD ITSELF.
WHAT THAT MEANS IS WE'LL TWO
BACK TO THE DRAWING BOARD AND
SEE HOW THEY'RE WORKING AN
UPDATE THE PROFILES BASED ON
EXCLUDING FOODS OF LOWER
NUTRIENT DENSITY AND TESTING HOW
WELL THAT COMPARES TO THE
EXISTING NUTRIENT PROFILES WITH
USING THE HEALTHY U.S. STYLE
DIETARY PATTERN.
HOW DO WE THEN TAKE THOSE
PROFILES WE GENERATED ON THE
SLIDE WITH THE TABLE DIFFERENTLY
TO THE U.S.-STYLE DIETARY
PATTERN COMPARED TO NUTRIENT
PROFILES COMPARED TO THE
PREVIOUS APPROACH WHERE ALL
FOODS ARE INCLUDED.
WHICH THEN MEANS WE MIGHT HAVE
TO TAKE STEP ONE OR IDENTIFY
PARTICULAR FOODS AND THEN
EVALUATE HOW THAT CREATES A
NUTRIENT PROFILE AND WHAT ARE
THE IMPLICATIONS OF THAT AND
HAVING A LARGE EFFECT, SMALL
EFFECT, NO EFFECT OR EFFECTS WE
WEREN'T ANTICIPATING AND HOW DO
WE TRY TO USE AS MUCH OF A
SCIENTIFIC AND EMPIRICAL BASIS
AND ALSO WHAT WE'VE SEEN IS
THERE'S NOT A REAL SOLID
EMPIRICAL BASIS FOR A LOT OF THE
DIFFERENT WAYS FOODS HAVE BEEN
EXCLUDED.
HOW DO WE MAKE THESE DECISIONS
IN AN EMPIRICAL SCIENTIFIC BUT
NON-BIASSED WAY AND IMPLEMENT IT
AND SEE WHAT IMPLICATIONS IT HAS
AND WORK OUR WAY DOWN TO SEE IF
WE'RE CREATING A NEW DIETARY
PROFILE OR DOES IT MATTER.
SO OUR NEXT STEPS SO THOSE
ARE -- THAT'S PROTOCOL 1.
WHICH HAS BEEN LEARNED FOOD
PATTERN MODELLING AND FIGURE OUT
A CONCEPTUAL FRAMEWORK OTHERS
HAVEN'T QUITE DONE YET.
SO THEN PROTOCOLS TWO THROUGH
NINE WILL BE OUR NEXT BIG STEP
FOR DEVELOPING THE PROTOCOLS FOR
OUR NEXT MEETING AND STARTING
ONCE WE GET THE PUBLIC COMMENTS
AND BE ABLE TO ADDRESS THE
CONVERSATIONS WE'VE HAD HERE,
START CREATING THE NUTRIENT
PROFILES AND SEE HOW THEY CARRY
OUT.
>>AGAIN, MIND BENDING.
NUTRIENT DENSITY IS PORNOGRAPHY
LIKE HARDER TO FIND.
SAID ADRs OR RDAs AND YOU HEARD
YOU SAY LYCOPENE.
NOT A VITAMIN.
NOT A MINERAL.
SO THE TERM NUTRIENT ADEQUACY
SEEMS KEY TO OPERATIONALIZING
THIS.
I DIDN'T HEAR IT IN YOUR TALK.
HOW DO YOU OPERATIONIZE IT AND
I'D BE HAPPY TO CONTRIBUTE
BECAUSE I LOVE THIS TOPIC IF
IT'S NOT OPERATIONALIZED
ALREADY.
>>IT'S GOING TO BE ONE OF THOSE
WHERE I HAVE TO GO TO THE STAFF
BECAUSE I'M GETTING TO THAT
ABSOLUTE --
>>WE OPERATIONALIZE NUTRIENT
ADEQUACY USING THE RDA BECAUSE
THEY'RE INTENDED TO BE
IMPLEMENTED AT AN INDIVIDUAL
LEVEL AND TAKE THE CONSERVATIVE
APPROACH.
>>DOES EVERYBODY HAVE TO HIT
THE RDA FOR ALL THE NUTRIENTS
WHICH LIKELY MEANS AT SOME LEVEL
SOME VITAMIN YOU'RE GOING TO LIT
THE RDA AND SOME YOU'LL DOUBLE
AND SOME YOU'LL TRIPLE.
COULD YOU WEIGHT THEM FOR THE
NUTRIENT OF CONCERN IDENTIFIED
OR TAKE THEM ACROSS THE BOARD?
>>WE'RE LOOKING ACROSS THE
BOARD AND FOR THE MOST PART IT'S
AT LEAST 85% OF THE RDA FOR
ANYTHING THAT MIGHT FALL SHORT.
>>OOH, 85%.
>>I THINK 85%, 90%, I'LL DOUBLE
CHECK.
>>WOULD YOU CONSIDER WEIGHTING
THEM OF THE GREATEST CONCERN?
I'LL TOSS THAT OUT FOR
CONSIDERATION.
>>THIS IS A MORE CONCEPTUAL
QUESTION AND SO CAN YOU SAY MORE
ABOUT THE CONCEPTUAL APPROACH TO
RUNNING YOUR MODELLING WITH AND
WITHOUT THE LOW NUTRIENT DENSE
FOODS?
I THINK YOUR POINT ABOUT MEETING
POPULATION WHERE THEY'RE AT WE
KNOW THERE'S CERTAIN NUTRIENTS
BOTH CONSUMED AND RELATED TO
HEALTH OUTCOMES WE'RE CONCERNED
ABOUT AND I'M WONDERING HOW
YOU'RE QUESTION IS DIFFERENT
THAN ASKING WHAT THE TOLERANCE
OF THESE VARIOUS PATTERNS ARE TO
SOME OF THOSE FOODS IN TERMS OF
THE LIKELIHOOD OF ACHIEVING
ADEQUACY.
IT'S PROBABLY A DIFFERENT
QUESTION BUT I'M WONDERING HOW
YOU'RE THINKING ABOUT IT.
>>THE COMMENTS ABOUT PARTICULAR
FOODS CAME FORWARD BOTH FROM
PUBLIC COMMENTS AND ALSO FROM
THE PREVIOUS COMMITTEE IN TERMS
OF WHAT FOODS REPRESENT A
REFINED GRAIN AND JUST TO TAKE
ONE EXAMPLE WE LOOKED AT
DESSERTS AND A FOOD CATEGORY
THAT MIGHT BE A PLACE WHERE WE
START.
THE NUTRIENT COMPOSITION AND
ADDED SUGAR AND SATURATED FAT
AND COMPOSITION OF A BROWNIE AND
ENERGY IS DIFFERENT THAN THAT OF
SLICED BREAD OR A ROLL AND IF
YOU HAVE FOODS WITH A DIFFERENT
ENERGY DENSITY AND NUTRIENT
DENSITY THEN AND IF THOSE FOODS
ARE CONSUMED MORE FREQUENTLY
IT'S DRIVING UP THAT ENERGY
PROFILE FOR THAT FOOD SO NOW
WHEN YOU WANT TO ASSIGN THE
CALORIES FOR THE NUMBER OF
GRAINS IF WE KEEP THE NUMBER OF
GRAINS WHERE THEY ARE AND WE USE
ALL FOODS YOUR USING UP A LOT OF
YOUR CALORIE NEEDS FOR THE DAY
BASED ON THE NUTRIENT PROFILE
THAT INCLUDES MORE ENERGY DENSE,
LESS NUTRIENT DENSE FOODS.
THE COMMENTS COMING FORWARD
SHOULD WE COUNT THE CALORIES
FROM BROWNIES AS A GRAIN AND A
LOT OF THE COMMENTS THAT CAME
FORWARD FROM THE PUBLIC WERE
AROUND SHOULD WE BE USING THOSE
AND COUNTING THOSE THAT WAY OR
NOT REDEFINING WHAT COUNTS AS A
GRAIN VERSUS NOT BUT WHAT WE'RE
DOING IS WOULD WE USE THAT AS
THE NUTRIENT DENSE VERSION OF
THE FOOD OR WOULD WE HAVE MORE
CALORIES IN PROTOCOL EIGHT THAT
SAYS IF YOU NEAT THE NUTRIENT
DENSE VERSIONS THIS IS WHAT THE
CALORIC LEVEL WOULD BE AND THEN
IN MEETING THAT IT CREATES MORE
OPPORTUNITIES FOR CHOICE WITHIN
THE GROUPS THEMSELVES.
DOES THAT ANSWER YOUR QUESTION?
>>I HAVE A RELATED QUESTION
BECAUSE I THINK IT GETS BACK TO
THE REPRESENTATIVENESS OF WHAT
WE END UP MODELLING OUT.
I THINK ULTIMATELY AS I SEE IT
OUR END GAME IS TO TRY TO PUT
FORWARD A FOOD PATTERNS
MODELLING OUTPUT THAT IS USEFUL
TO ALL AMERICANS.
SO WHAT I'M GRAPPLING WITH IS
HOW DO WE BEST ENSURE WHAT WE
END UP CHOOSING AS THE MOST
NUTRIENT DENSE APPROACH IS
ACTUALLY NOT DRIVEN BY HIGHEST
CONSUMPTION AND REPORTING VERSUS
JUST BY HAVING A DIVERSE AMOUNT
OF THINGS TO CHOOSE FROM.
FOR EXAMPLE, YOU COULD HAVE
SOMETHING THAT'S INCREDIBLY
NUTRIENT DENSE THAT MIGHT APPLY
TO CERTAIN SUBPOPULATIONS IN
AMERICA BUT BECAUSE THE
REPORTING ISN'T DRIVEN BY THOSE
SUBPOPULATIONS IN AMERICA IT
DOESN'T EMERGE AS SOMETHING THAT
YOU MIGHT LIKELY WANT TO PUT
FORWARD.
IT GETS BACK TO THE LIMITATIONS
OF THE DATA AND THE FOOD
CLUSTERS AND CATEGORIES WE'RE
LOOKING AT.
THE NUTRIENTS BETWEEN RED AND
ORANGE VEGETABLES WILL BE
WEIGHTED ON THE MORE COMMONLY
REPORTED FOODS IN NHANES BUT
WE'RE ALSO LOOKING AT A NUTRIENT
PROFILE WITHIN THE FOOD SUB
GROUPS AND THE TOTAL GROUPS BUT
IT WILL BE ESPECIALLY BASED ON
THE DESIGN OF NHANES AND THE
DATA WE HAVE THE REPRESENTATIVE
NATURE OF THE DATA COLLECTED TO
OVER SAMPLE AFRICAN AMERICAN,
MEXICAN AMERICAN, OTHER HISPANIC
AND ASIAN AMERICAN AND WE HAD
THE CONVERSATION THAT ASIAN
AMERICAN IS ASIAN AMERICAN.
SO IT'S NOT IT HELPS IN THAT
QUESTION BUT DOESN'T SOLVE THAT
QUESTION AND THAT'S WHERE I
THINK IT WILL BE IMPORTANT FOR
THE INSIGHT WE'LL HAVE FOR
MAKING THOSE RECOMMENDATIONS FOR
SIMULATED DIETS TO PUT THAT INTO
PLAY.
AND THEN BE ABLE TO TEST IF WE
THEN USE JAMS AS THE VEGETABLE
OR USING YAMS AS THE GRAIN
STABLE CARBOHYDRATE OPPOSED TO
THE VEGETABLE THOSE ARE THE
PLACES WE'LL BE ABLE TO ANSWER
THOSE KINDSES OF.
-- KINDS OF QUESTIONS BUT WE'RE
STIM LI-- STILL LIMITED BY THE
DATA AND IT'S AN AMAZING DATA
SET BUT WE KNOW IT HAS
LIMITATIONS.
>>DR. TAYLOR, I WAS JUST
THINKING FOR THE 2020 DIETARY
GUIDELINE COMMITTEE THE INTEREST
WAS AROUND LIFE STAGES.
THEY DID LOOK AT NUTRIENT
PROFILE AT DIFFERENT LIFE STAGE
AND WONDER IF IT COULD BE
DISCUSSED WITHIN THE NHANES DATA
AND THAT COULD BE EXPLORED AND
ALSO THE SIMULATED DIET I FEEL
LIKE THERE'S MORE TO COME.
IT'S BEEN ONE PROTOCOL DISCUSSED
BUT I THINK WHAT YOU'RE GETTING
AT WITH YOUR LAST COMMENTS ARE
SEVERAL QUESTIONS THAT WILL GET
TO THE CULTURAL FOODS INCLUDING
THE SIMULATED DIET ACTIVITY.
I THINK THE STAFF HAS BEEN
PINGING BACK AND FORTH ABOUT
THOUGHTS TO BRING TO THE NEXT
SUBCOMMITTEE CONVERSATION TO
REACT TO THIS.
JUST WANTED TO REFLECT ON THE
2020 DID SUBPOPULATION ANALYSES
AND IT WILL BE -- IT IS NHANES
SO WHAT THE BROADER CATEGORIES
ARE BUT MAY BE HELPFUL IN THE
CONVERSATION.
>>ANY OTHER COMMENTS?
YES.
>>IN TERMS OF DATA SOURCES ARE
ANY OF THOSE CONSIDERING OR
REPORTING ON INFANTS, TODDLERS?
>>YES, WE HAVE THAT
INFORMATION.
I THINK IN OUR FIRST PUBLIC
MEETING WE WERE DISCUSSING THE
POSSIBILITY I DON'T KNOW IF THAT
WAS -- IF WE REACHED OUT TO GET
DATA FROM WIC IN TERMS -- I KNOW
HAVE LIMITED DATA BUT HAVE DATA
THEY COLLECT THROUGHOUT ALL THE
WIC CLINICS.
I KNOW THERE WAS EFFORT TO GET
DATA.
>>THANK YOU.
>>I LOVE THAT INTERACTION.
>>ANY OTHER QUESTIONS OR
COMMENTS?
>>THANK YOU FOR ALL YOUR
THOUGHTFUL PRESENTATIONS AND
DISCUSSES.
I FEEL REALLY BADLY HAVING MY
BACK TO ALL OF YOU.
I KNOW THE GENTLEMAN WILL BE
ANGRY BECAUSE I'M MOVING AWAY
FROM THE MIC.
THANK YOU VERY MUCH.
LIKE WE DID LAST TIME WE'D LIKE
TO GO AROUND THE ROOM AND HAVE
EACH OF YOU MAKE JUST ONE
COMMENT AND ONE IMPRESSION
THAT'S COME OUT OF THIS GREAT
PUBLIC MEETING AND JUST BEFORE
WE START I WANT TO LET EVERYBODY
KNOW THAT I BELIEVE EVERY
SUBCOMMITTEE AND WORKING GROUP
HAS TAKEN MANY NOTES AND OUR
TEAM HAS TAKEN NOTES AND EVERY
SUBCOMMITTEE BENEFITTED FROM THE
RICH DISCUSSION TODAY AND WILL
USE THESE COMMENTS TO FURTHER
REFINE THEIR PROTOCOLS BUT ALSO
THINK WHEN THEY MOVE FORWARD
WITH THE TASK AT HAND AND I ALSO
WANT TO IN ADVANCE THANK ALL OF
YOU FOR ALL THE WORK YOU'LL DO
BETWEEN TODAY AND THE NEXT
PUBLIC MEETING IN SEPTEMBER.
I KNOW SOMETIMES IT FEELS LIKE
WE SPEND MORE TIME TOGETHER THAN
WE DO WITH OUR FAMILIES.
IT'S REALLY PATIENTS.
I WANT TO DO A HEARTFELT THANKS
THERE AND THEN THOUGHT WE CAN GO
AROUND AND START WITH SAMEERA
TODAY.
>>I WAS EXCITED TO SEE WHAT THE
OTHER WORKING GROUPS AND
SUBCOMMITTEES HAVE BEEN WORKING
ON.
IT WAS INTERESTING TO SEE ALL
THE PROTOCOLS.
LOOKING FORWARD, I GUESS MOSTLY
LOOKING FORWARD TO THE SIMULATED
PATTERN MODELLING.
THAT'S THE ONE I'M MOST
INTERESTED IN PERSONALLY AND
LOOKING FORWARD TO WORKING WITH
THE SUBCOMMITTEE.
THANK YOU.
>>VALERIE.
>>THANK YOU TO SAMEERA FOR
SUMMARIZING THE WORKING GROUP
AND FEEL PROUD OF ALL WE
ACCOMPLISHED.
THANK YOU.
I'M INSPIRED THAT FOR THIS
VERSION CONSIDERING HEALTH
EQUITY AND DID A WONDERFUL JOB
IN PRESENTING WHERE WE'RE GOING
WITH THAT AND IT'S INSPIRING WE
CAN HIT THAT WORK FOR THE NEXT
ITERATION.
>>I'VE BEEN THINKING HOW IN THE
WORLD WE CAN MAKE PROGRESS ON
THIS ISSUE AND SOMETHING IS
CONCEPTUALLY COMPELLING AND SO
I'M EXCITED ABOUT GOING BACK TO
SUBCOMMITTEE TWO AND TRYING TO
THINK COLLECTIVELY ABOUT THAT.
>>I'M EXCITED TO SEE US TAKING
COMPETING STYLES AND PATTERNS IN
ONE TO TWO-YEAR-OLDS AN AREA
RARELY LOOKED AT AND HOW LITTLE
WE KNOW ABOUT BABIES BETWEEN SIX
AND 24 MONTHS AND UNDERSTANDING
WHAT WE HAVE.
>>I FEEL OVERWHELMED HUMBLED
AND HOPEFULLY BY THE TIME I GET
HOME LESS OVERWHELMED.
>>I'M EXCITED ABOUT ALL THE NEW
DIRECTION WITH THE DIETARY
GUIDELINES COMMITTEE.
I THINK IT'S GOING TO ADD AND
PUSH THE DIETARY GUIDELINES
FURTHER AND SO EXCITING TO SEE
THE SYSTEMATIC REVIEWS AND OTHER
WORK BEING DONE.
>>I WAS EXCITED TO HEAR WHAT
THE OTHER WORKING GROUPS WERE
DOING BECAUSE WE HADN'T HEARD A
REPORT SINCE JANUARY AND
ASTONISHING THE AMOUNT OF WORK
ACCOMPLISHED ALREADY SINCE
FEBRUARY AND I CAN'T IMAGINE
WHERE WE'LL GO FROM HERE.
IT'S GOING TO BE AMAZING.
>>I'M STRUCK BY INCLUSION OF
SOME REALLY IMPORTANT CHANGES IN
EVOLUTIONS WITH HOW THE PROCESS
IS GOING AND WHAT'S ON THE TABLE
WITHIN THE PROCESS AND DEEP
PROFESSION FOR HOW MUCH WORK WE
HAVE YET TO DO IN THE ENTIRE
FIELD OF NUTRITION.
AND INSPIRED WHAT WHAT WE'LL
TACKLE.
>>INCREDIBLE STAFF LOOKING
ACROSS PROTEIN AND SATURATED
HEALTH I CAN TELL WE'RE HEADED
TOWARDS MORE BEANS.
>>NOT SURE HOW TO FOLLOW THAT.
I CONTINUE TO BE INCREDIBLY
IMPRESSED BY THE DEPTH OF THIS
COMMITTEE AND HOPE AMERICANS
APPRECIATE WHAT SO MANY OF YOU
BRING TO THE TABLE AND THE
HEALTH EQUITY CHARGE FEELS
GENUINE INITIALLY IT COULDN'T
CONCEPTUALIZE HOW IT'D PLAY A
ROLE.
I THOUGHT IT'D LOOK LIKE AN
AFTER THOUGHT BUT FEELS LIKE A
REAL PART OF THE CONSIDERATION
AND THE SYNTHESIS PIECE I THINK
WILL BE DAUNTING BUT I'M EXCITED
TO SEE WHAT IT BRINGS AND I
DON'T FLOW IF WE'RE GOING
TOWARDS BEANS PER SE BUT ALL
RIGHT.
>>I ALSO APPRECIATED HEARING
ABOUT WORKING GROUP TWO AND
THREE SINCE I'M A PART OF THAT
AND APPRECIATED CHRIS, YOUR
EXPLANATION YOU GAVE US BECAUSE
THAT WAS HELPFUL FOR ME AND I
ALSO AGREE ABOUT THE HEALTH
EQUITY LENS.
WLEB WE LEST I DIDN'T KNOW WHAT
IT WOULD LOOK LIKE AND PART OF
THE WORKING GROUP THAT'S BEEN
WONDERFUL AND GREAT AND A LOVE
THE CONVERSATION AND STRUCK BY
HOW WELL THAT HAS YOU CAN SEE IT
IN ALL SUBCOMMITTEES WHICH IS
WONDERFUL AND NICE.
>>I'M NOT SURE I'M GOING TO ADD
ANYTHING NECESSARILY NEW TO THIS
BUT I HAVE BEEN INCREDIBLY
IMPRESSED AND ECHO THE THINGS
THE DIVERSITY AND CONSIDERATIONS
OF DIVERSITY AND EQUITY AND IT'S
BEEN REALLY EXCITING TO HEAR
WHAT EVERYONE ELSE HAS BEEN
WORKING ON DURING THIS TIME.
I CAN SAY I'M MOTIVATED TO GET
BACK INTO COMMUNITY WORK AND
GOING TO THE NEXT STEPS WHICH I
THINK ARE MORE DAUNTING AND
QUITE EXCITING.
>>I'M STRUCK BY THE
DELIBERATIONS FROM HEARING THE
PRESENTATIONS AND DISCUSSIONS
AND THERE'S A DEEP AND DETAILED
DELIBERATIONS TO BRING US TO
WHAT IS BEING PRESENTED.
AND I'M THANKFUL FOR THE STAFF
BECAUSE IN THE LAST FEW MONTHS
AND EVERY TIME WE SAY CAN WE TRY
THIS AND THEY'LL SAY YEAH, SURE
WE'RE LOOKING INTO IT.
THANK YOU FOR BEING SO HELPFUL
AND SUPPORTIVE OF OUR WORK AND
IT'S A HUGE TEAM EFFORT SO THANK
YOU.
>>I THINK WITH EACH ITERATION
OF THE DIETARY GUIDELINES WE
HAVE THIS OPPORTUNITY AND IT
MAKES ME GRATEFUL FOR OTHER
COLLEAGUES THAT WE'RE NOW ABLE
TO CONSOLIDATE AND USE TO UPDATE
WHAT WE HAVE DONE AND THERE ARE
LIMITATIONS BUT I THINK IT'S
SPURRING US TO GO FURTHER.
AND LOOKING AT DIVERSITY AND
EQUITY AND THINKING OF THOSE
WITH FOOD AND NUTRITION
INSECURITY ISSUES AND HOW WE CAN
MAKE OUR PROCESS RAISE ALL BOATS
AS WE GO FORWARD.
>>I'M GLAD CHRISTOPHER MOVED
FROM MUSHROOMS TO BEANS.
THAT'S OUR FIRST MAJOR
ACCOMPLISHMENT OF THE MEETING
TODAY.
AND SO I HAVE ONE AND BRING THE
SCIENTIFIC RIGOR AND
UNDERSTANDING OF THE DATA WE
NEED TO ANSWER THESE QUESTIONS
AND IT'S ONLY AS SOLID AS THE
EVIDENCE AND THE STRONGER THE
SCIENCE THE STRONGER
RECOMMENDATIONS WE HAVE BUT WE
HAVE THE MINDS HERE THAT
UNDERSTAND THE IMPLICATIONS OF
DATA AND DESIGN DECISIONS BUT
ALSO THE IMPLEMENTATION SIDE.
BECAUSE WE CAN DESIGN GREAT
RANDOMIZED TRIALS THAT HAVE NO
LIFE APPLICABILITY AND WE'RE
LOOKING AT THESE FROM BOTH
SIDES.
AND EVERYONE IS SAYING YES BUT I
ALSO APPRECIATE THE STAFF THAT
TELL US NO.
MEGAN KEEPS ME IN LINE AND JOE
KEEPS ME IN LINE.
WE CAN DO THAT.
AND TELL US YES AND NO WHEN THEY
NEED TO.
>>I'M HAPPY TO BE HERE AMONGST
GREAT MINDS THAT BRING TOGETHER
KNOWLEDGE, WISDOM AND POWER AND
COALESCE THAT WITH THE WORK OF
THE STAFF AS WE TACKLE THESE
REALLY IMPORTANT ISSUES
PARTICULARLY SURROUNDING OBESITY
AND DISEASE THAT PARTICULARLY
AFFECTS RACIAL AND ETHNIC
MINORITIES AND LOOKING AT
EQUITY, INCLUSION AND BELONGING
AND MY CHARGE IS WE STRIVE TO DO
OUR WORK SO WELL SO NO PERSON
BORN OR LIVING OR YET TO BE BORN
CAN DO IT BETTER BECAUSE WE'RE
DOING THIS FOR THE AMERICAN
PEOPLE.
THANK YOU.
>>IT'S HARD TO SPEAK AFTER
SOMEONE SO ARTICULATE AND I
AGREE, I WAS GOING TO SAY THAT.
NO.
I'M LEARNING SO MUCH MY BRAIN IS
FULL AND OVER FLOWING.
THE STAFF HAS BEEN INCREDIBLE.
WE ALWAYS KNOW WHAT WE HAVE TO
DO AND WHAT TO DISCUSS.
IT WAS GREAT TO HAVE THE MEETING
BECAUSE WE'VE GONE THROUGH ALL
THE ZOOM MEETING AND DOING
IMPORTANT WORK BUT IT'S NICE TO
SEE THIS STARTING TO COME
TOGETHER I FEEL LIKE THERE'S SO
MANY MOVING PARTS AND THINGS TO
CONSIDER THE DATA AND QUALITY
AND EQUITY ISSUES.
I LOOK FORWARD TO THE FINAL
PRODUCT AND I'LL ALSO MENTION I
WAS HAPPY TO SEE LYCOPENE
MENTIONED.
IT'S ONE OF MY FAVORITE -- NOT
NUTRIENTS BUT PHYTO CHEMICAL.
>>I DON'T HAVE ANYTHING TO ADD.
THE ONLY ADDITION IS KUDOS TO
JANET AND EVE.
S AND A WONDERFUL COMMITTEE AND
LOOK FORWARD TO WORK TO COME.
>>GO TEAM, 2025, DGAC.
JANET, DO YOU MIND ARE WE
CLOSING?
NO, WE'RE NOT CLOSING IT YET.
JANET HAS A FEW ITEMS
HOUSEKEEPING ITEMS.
>>I'LL COVER NEXT STEPS.
CONGRATS TO THE COMMITTEE BY
COMPLETING MEETING TWO AND I'M
FOLLOWING EVE IN THE LAST ROUND
AND AFTER THE LAST MEETING WE
PUT A CHECK MARK SO CONGRATS.
THERE'S BEEN SO MUCH IMPORTANT
WORK THAT'S GONE INTO PREPARING
THE SUBCOMMITTEE AND WORKING
GROUP PROGRESS FOR YOUR MEETING
AND I'M APPRECIATIVE OF YOUR
TREMENDOUS EFFORT TO DATE.
IT WILL ONLY GET MORE EXCITING
WHEN THE EVIDENCE IS AVAILABLE
AND THE SYNTHESIS HAPPENS AND
THE MODELLING ACTIVITIES BEGIN.
IT'S A LOT OF WORK BUT IT'S
GOING TO BE A LOT OF FUN.
SO MUCH FUN TO COME.
THE NEXT STEPS TO DRAFT
PROTOCOLS WILL BE REFINED BASED
ON COMMITTEE FEEDBACK AND POSTED
ON DG.gov LATER THIS MONTH.
PUBLIC COMMENTS ARE WELCOME AND
APPRECIATED BY THE END OF JUNE
SO IF THE COMMITTEE CAN GET THEM
AS SOON AS POSSIBLE AND CONSIDER
THEM IN UPDATING THEIR
PROTOCOLS.
OUR SUBCOMMITTEES AND WORKING
GROUPS WILL CONTINUE CONDUCTING
THEIR EVIDENCE REVIEWS AND
MEETING THREE IS SEPTEMBER 13th.
THIS WILL INCLUDE AN ORAL
COMMENT OPPORTUNITY.
MORE DETAILS WILL BE AVAILABLE
ON HOW TO REGISTER FOR YOUR
OPPORTUNITY TO PROVIDE ORAL
COMMENTS AND REGISTRATION FOR
THE MEETING WILL OPEN AT LEAST
15 DAYS PRIOR.
TO OUR WONDERFUL COMMITTEE.
THANK YOU FOR YOUR DEDICATION TO
THIS IMPORTANT WORK SO FAR IN
YOUR SUBCOMMITTEES AND
PRIORITIZING QUESTIONS,
DEVELOPING PROTOCOLS.
I KNOW IT WAS A HEAVY LIFT.
WE APPRECIATE YOUR EXPERTISE AND
THOUGHTFULNESS ALONG THE WAY.
ON BEHALF OF STAFF I'VE ALREADY
LEARNED SO MUCH FROM YOU.
THANK YOU FOR SHARING YOUR
WISDOM.
IT IS A WONDERFUL PARTNERSHIP
COLLABORATING WITH YOU.
THANKS TO OUR WONDERFUL STAFF,
WE ARE SO APPRECIATIVE.
REITERATING AND THANKS TO JOANNE
ON NESR AND CONGRATULATING HER
ON HER RETIREMENT.
SHE'S IN THE BACKGROUND.
I ALSO WANT TO ACKNOWLEDGE TWO
DETAILEES AT OHDP JOY IRWIN AND
OUR TEAM IS SMALL BUT MIGHTY WE
SOUGHT DETAILEES AND
APPRECIATIVE OF YOUR TIME
JUMPING IN AND KICKING OFF THE
COMMITTEE'S WORK.
AND THANK YOU FOR THE PUBLIC FOR
YOUR CONTINUED ENGAGEMENT AND
WITH THAT I'LL ADJOURN MEETING
TWO.
THANK YOU.