GOOD MORNINH AND WELCOME TO MEETING 4 2024 DIETARY GUIDELINES
ADVISORY COMMITTEE. I'M JANET
DE JESUS AT HHS.
NEXT SLIDE, PLEASE.
THIS IS OUR WONDERFUL COMMITTEE
AND WANTED TO JUST NOTE THAT
EVERYONE IS IN ATTENDANCE TODAY
VIRTUALLY. WE MOVED TO A
VIRTUAL MEETING WITH THE SNOW
THAT IS HAPPENING IN DC. WE
WILL HAVE ALL 20 ADVISORY
COMMITTEE MEMBERS IN ATTENDANCE
TODAY.
NEXT.
OKAY. HERE IS OUR OVERALL
TIMELINE FOR THE DEVELOPMENT OF
THE NEXT ADDITION OF THE DIETARY
GUIDELINES IN 2023.
WE HAD THREE MEETINGS OF THE
ADVISORY COMMITTEE IN FEBRUARY,
MAY AND SEPTEMBER AND NOW ARE
HERE JOINED FOR MEETING 4.
THE GOAL IS FOR THE COMMITTEE TO
SUBMIT THEIR CALENDAR FALL OF
2024 AND 2025 WILL WORK ON
DEVELOPMENTS AND RELEASE THE
NEXT ADDITION OF THE DIETARY
GUIDELINES.
I'M REALLY HONORED TODAY TO HAVE
OUR LEADERSHIP FROM HHS AND USDA
PROVIDING OPENING REMARKS.
FIRST, WE WILL START WITH
ADMIRAL RACHEL LEVINE THE
ASSISTANT SECRETARY OF HEALTH
AND -- AND FOLLOWING THAT WE
WILL HAVE STACY DEAN THE DEPUTY
UNDER SECRETARY AT FOOD,
NUTRITION AND CONSUMER SERVICES
AT THE US DEPARTMENT OF
AGRICULTURE AND WITHOUT FURTHER
ADO, I WOULD LIKE TO HAVE
ADMIRAL LEVINE PROVIDE REMARKS.
>> THANK YOU TO THOSE WOULD ARE
IN PERSON AND TO THOSE WHO ARE
JOINING VIRTUALLY FOR THE 4TH
MEETING OF THE 2025 DIETARY
GUIDELINES ADVISORY COMMITTEE
AND I WOULD LIKE TO BEGIN BY
CONGRATULATING THE COMMITTEE ON
THE ANNIVERSARY OF ITS
APPOINTMENT THAT HAPPENED ONE
YEAR AGO TODAY ON JANUARY 19TH,
2023. THANK YOU FOR YOUR
DEDICATION TO YOUR SCIENTIFIC
EVIDENCE REVIEW AND THE HARD
WORK YOU HAVE PUT INTO
ACCOMPLISH THE DUTIES SET FORTH
BY HHS AND USDA.
I KNOW THAT THIS HAS BEEN NO
SMALL TASK. THE COMMITTEE HAS
HELD THREE PUBLIC MEETINGS AND
COLLABORATED DURING
SUB-COMMITTEE MEETINGS
PARTICIPATING IN THE DEVELOPMENT
OF EVIDENCE REVIEW PROTOCOLS YOU
HAVE ALL REVIEWED AND
SYNTHESIZED BEGUN PRESENTING
SCIENTIFIC FINDINGS AND HAD
NEARLY 1,000 PUBLIC COMMENTS.
THAT IS NOT ALL. OVER THE LAST
YEAR THE COMMITTEE EXAMINED THE
RELATIONSHIP BETWEEN DIET AND
HEALTH IN ALL LIFE STAGES USING
THREE RIGOROUS APPROACHES
SYSTEMATIC REVIEWS FOOD PATTERN
MODELING AND DATA ANALYSIS AND
MOREOVER THIS COMMITTEE HAS
APPLIED A HEALTH EQUITY LENS
ENSURE FACTORS SOCIOECONOMIC
STATUS RACE ETHNICITY AND
CULTURE DESCRIBED AND CONSIDERED
ITS WORK TO GREATEST EXTENT
POSSIBLE AND COMMITTEE TOOK
STEPS TO ENSURE WORK REFLECTS
GROWING DIVERSITY OF THOSE
LIVING IN THE UNITED STATES.
ADDRESSING INEQUITIES IS KEY TO
AMELIORATING HEALTH DISPARITIES
AT HHS OUR MISSION IS TO ENHANCE
THE HEALTH AND WELLBEING OF ALL
AND WORK YOU ARE DOING IS
ESSENTIAL ENSURING DIETARY
RECOMMENDATIONS CAN BE APPLIED
TO ALL OF THE DIVERSE
POPULATIONS IN OUR GREAT
COUNTRY.
THAT IS WHY I'M ESPECIALLY
IMPRESSED AND PROUD OF THE BROAD
EXPERTISE THAT EVERYONE ON THIS
COMMITTEE BRINGS TO ADVISING HHS
AND USDA.
AS NATIONALLY RECOGNIZED
SCIENTISTS AND RESEARCHERS, YOU
HAVE EXPERTISE NOT ONLY ON THE
RELATIONSHIP BETWEEN NUTRITION
AND HEALTH OUTCOMES ACROSS ALL
LIFE STAGES AND YOU ALSO HAVE
BROAD KNOWLEDGE OF THE DIVERSE
POPULATIONS ACROSS THE UNITED
STATES AND THE IMPORTANCE OF
HEALTH EQUITY IN YOUR RESEARCH
AND RECOMMENDATIONS AND YOUR
WORK AND REPORT YOU WILL DELIVER
WITH YOUR FINAL RECOMMENDATIONS
ARE CRITICAL TO THE DEVELOPMENT
OF THE NEXT ADDITION TO THE
DIETARY GUIDELINES FOR AMERICANS
AND ULTIMATELY TO THE MANY
FEDERAL PROGRAMS RELYING ON
DIETARY GUIDELINES TO HELP
ENSURE FAMILIES AND THOSE THAT
NEED EXTRA SUPPORT CAN MEET
THEIR NUTRITION NEEDS.
SOME PROGRAMS ARE THE
SUPPLEMENTAL NUTRITION
ASSISTANCE PROGRAM COMMONLY
KNOWN AS SNAP, THE SPECIAL
SUPPLEMENTAL NUTRITION PROGRAM
FOR WOMEN, INFANTS AND CHILDREN
OR WICK. CHILD NUTRITION
PROGRAMS THAT SET NUTRITION
STANDARDS FOR MEALS LIKE
BREAKFAST AND LUNCH THAT
CHILDREN EAT IN SCHOOLS AND
PROGRAMS THAT HELP OLDER ADULTS
STAY HEALTHY AND CONNECTED TO
ONE ANOTHER.
THESE ARE A FEW OF THE FEDERAL
PROGRAMS THAT RELY ON DIETARY
GUIDELINES AND HELP ENABLE ALL
AMERICANS TO LIVE HEALTHIER
LIVES INCREASING ACCESS AND
ADOPTION OF HEALTHY DIETARY
CHOICES.
THESE FEDERAL PROGRAMS ARE ALSO
HIGHLIGHTED IN THE NATIONAL
STRATEGY ON HUNGER, NUTRITION,
AND HEALTH THAT WAS DEVELOPED AS
PART OF THE 2022 WHITE HOUSE
CONFERENCE ON HUNGER NUTRITION
AND HEALTH AND NATIONAL STRATEGY
REMAINS A PRIORITY AT HHS AND
FOR THIS ADMINISTRATION AND
THANK ALL OF YOU AND THE
COMMITTEE ON YOUR WORK IN
ADVANCING THESE EFFORTS AND
WOULD LIKE TO THANK THE PUBLIC
FOR ROBUST PARTICIPATION IN THE
DIETARY GUIDELINES DEVELOPMENT
PROCESS AND WANT TO MAKE SURE
YOU HEAR ME LOUD AND CLEAR, EACH
PUBLIC COMMENT IS TAKEN INTO
CONSIDERATION THROUGHOUT THE
COMMITTEE'S EVIDENCE REVIEW
PROCESS.
THERE IS STILL TIME FOR THE
PUBLIC TO WEIGH IN.
RECORDINGS OF PREVIOUS COMMITTEE
MEETINGS AND MATERIALS ARE
AVAILABLE ON DIETARY
GUIDELINES.GOV. WE CONTINUE TO
ACCEPT PUBLIC COMMENTS.
I'M LOOKING FORWARD TO FOLLOWING
THE REMAINDER OF THE COMMITTEE'S
EVIDENCE REVIEW WHICH WILL
CONCLUDE WITH DELIVERY OF
SCIENTIFIC REPORT LATER THIS
YEAR.
LASTLY, I WOULD BE REMISED IF I
DIDN'T ACKNOWLEDGE THE FEDERAL
STAFF SUPPORTING WORK OF
ADVISORY COMMITTEE IN DIETARY
GUIDELINES EFFORTS. THANK YOU
FOR RISING TO THE OCCASION AND
DEDICATING YOUR WORK TO THE
NATION'S HEALTH.
CONGRATULATIONS, AGAIN, TO THE
COMMITTEE ON THE ONE-YEAR
ANNIVERSARY FOR YOUR APPOINTMENT
AND CONTINUED WORK TO SUPPORT
HEALTH OF ALL AMERICANS AND WITH
THAT I'M EXCITED FOR THE MEETING
TO BEGIN AND TO HEAR MORE ABOUT
YOUR REVIEW OF THE EVIDENCE.
THANK YOU.
>> GOOD MORNING, EVERYONE. ON
BEHALF OF USDA, GREETINGS TO THE
2025 DIETARY GUIDELINES ADVISORY
COMMITTEE AND ALL OF YOU JOINING
THE COMMITTEE'S 4TH MEETING
TODAY ONLINE AND HOPE YOUR 2024
IS OFF TO A BRIGHT START AND
JOIN ADMIRAL LEVINE SAYING
CONGRATULATIONS AND THANK YOU TO
THE ESTEEMED COMMITTEE ON ONE
YEAR ANNIVERSARY OF YOUR
APPOINTMENT AND WHAT WE HAVE
ASKED OF YOU IS NO SMALL TASK.
YOU HAVE ACCOMPLISHED SO MUCH
ALREADY IN THE PAST YEAR. TODAY
IS AN IMPORTANT TOUCHPOINT FOR
US TO HEAR MORE ABOUT YOUR WORK
REVIEWING THE EVIDENCE OF HOW
EATING PATTERNS IMPACT THE
HEALTH ACROSS THE LIFESPAN.
THIS COMMITTEE'S CONSIDERABLE
WORK TO EXAMINE THROUGH HEALTH
EQUITY LENS IS CONSIDERABLE AND
NUTRITION AND PUBLIC HEALTH
WORLDS AND YOUR WORK SHINES A
SPOTLIGHT ON GAPS IN EVIDENCE
THAT NEED TO BE FILLED AND IS
NOT AN UNDERSTATEMENT TO SAY
THAT DIETARY GUIDELINES ARE
ESSENTIAL PART OF USDA'S WORK TO
ADVANCE NUTRITION SECURITY AND
ULTIMATELY HEALTH EQUITY
NUTRITION SECURITY MEANING
CONSISTENT AND EQUITABLE HEALTH
OPTIMAL HEALTH AND WELLBEING IS
CENTRAL TO WHITE HOUSE NATIONAL
STRATEGY ON HUNGER AND NUTRITION
AND HEALTH AIMING HUNGER IN
AMERICA AND INCREASED EATING IN
PHYSICAL ACTIVITY BY 2030 SO
FEWER AMERICANS EXPERIENCE DIET
RELATED DISEASES INFORMING HHS
AND USA'S DEVELOPMENT NEXT
ADDITION OF GUIDELINES FOR
AMERICANS THIS COMMITTEE'S WORK
IS HELPING TO ADVANCE NATIONAL
STRATEGY AND WITHIN USDA
MISSIONARY OF FOOD NUTRITION AND
CONSUMER SERVICES NUTRITION
SECURITY INEQUITY AND WORK
COMMITTEE DOES TO SUPPORT GOALS
ARE PARTICULARLY MEANINGFUL. WE
REACH PUBLIC WITH INITIATIVES
LIKE MY PLATE RIGHT UP HERE
TRANSLATING DIETARY GUIDELINES
INTO ACTIONABLE TIPS TO HELP
PEOPLE EAT HEALTHY AND WE
ADMINISTER 16 FEDERAL NUTRITION
ASSISTANCE PROGRAMS TOGETHER
SERVING 1 IN 4 PEOPLE IN THE
UNITED STATES. DIETARY
GUIDELINES ARE NUTRITION
BACKBONE FOR USDA'S NUTRITION
ASSISTANCE PROGRAMS. UPDATED
GUIDANCE IS ESSENTIAL ENSURING
PROGRAM'S NUTRITION MATCHES
SCIENCE AND ADMIRAL MENTIONED A
FEW PROGRAMS SNAP, WICK, SCHOOL
MEALS AND THIS SUMMER THRILLED
TO ROLL OUT NUTRITION ASSISTANCE
PROGRAM FOR CHILDREN SUMMER EBT
COMPLEMENTING LONGSTANDING
SUMMARY PROGRAMS SUMMER BT
FAMILY PARTICIPATING STATES
TERRITORIES AND TRIBES ELIGIBLE
SCHOOL-AGED CHILDREN TO BUY
GROCERIES THIS SUMMER AND
ANNOUNCED LAST WEEK 35 STATES US
TERRITORIES AND FOUR TRIBES PLAN
TO BE FIRST TO LAUNCH SUMMER EBT
IN SUMMER 2024 SERVING CLOSE TO
20 MILLION CHILDREN AND MORE
STATES AND TRIBES ARE EXPECTED
TO OFFER THE PROGRAM IN 2025.
RESEARCH SHOWS THIS TYPE OF
SUMMER GROCERY BENEFIT CAN
REDUCE CHILD HUNGER BY 33% AND
SUPPORT HEALTHIER DIETS WITH
FRUITS VEGETABLES AND WHOLE
GRAINS ONE OF THE MANY WAYS
USDA'S FOOD NUTRITION WORK IS
DRIVEN BY SCIENTIFIC ANALYSIS
AND THOROUGH EVALUATION AND
DIETARY GUIDELINES ARE PART OF
THAT COMMITMENT. IN CLOSING,
COMMITTEE MEMBERS,
CONGRATULATIONS, AGAIN, ON YOUR
ONE YEAR ANNIVERSARY AND HUGE
THANK YOU FOR VOLUNTEERING YOUR
TIME AND EXPERTISE.
THANK YOU FOR YOUR DEDICATION TO
THE IMPORTANT WORK AND FOR YOUR
CONTRIBUTIONS TO HELP CLOSE THE
NUTRITION SECURITY AND HEALTH
EQUITY GAP.
I LOOK FORWARD TO THE
CULMINATION OF YOUR WORK
REVIEWING THE EVIDENCE ON THE
NUTRITION AND HEALTH ACROSS THE
LIFESPAN AND HUGE THANKS TO
FEDERAL STAFF FOR ALL YOUR
INVALUABLE SUPPORT TO THE
COMMITTEE OVER THE PAST YEAR AND
EXPERTISE AND TIRELESS WORK IN
SEVERAL MONTHS TO COME FOR THOSE
JOINING THE MEETING VIRTUALLY
THANK YOU AND MANY THANKS TO
THOSE SUBMITTING COMMENTS TO THE
COMMITTEE AND FORMS OF
ENGAGEMENT PARTICULARLY COMMENTS
MATTER. PLEASE STAY ENGAGED
THROUGHOUT OUR PROCESS.
THANK YOU.
>> THANK YOU SO MUCH, ADMIRAL
LEVINE AND DEPUTY UNDER SECT
DEAN. WE APPRECIATE THE OPENING
REMARKS AND I'M HAPPY TO TURN TO
OUR CHAIRS FOR OPENING REMA SHGS
TO SARAH BOOTH AND ANGELA
ODOMS-YOUNG. TAKE IT AWAY.
>> THANK YOU, JANET AND ADMIRAL
LEVINE AND STACY DEAN FOR THEIR
ENCOURAGING REMARKS AND THEIR
TREMENDOUS SUPPORT OF THE
COMMITTEE.
I THINK WE ARE ALL REALLY HAPPY
TO SEE EACH OTHER AGAIN, ALL
TOGETHER.
ALBEIT ON VIRTUALLY BECAUSE OF
THE WEATHER, OUR FEDERAL STAFF
WORKED WITH US TO HOW TO PROVIDE
THIS PUBLIC MEETING WHILE ALSO
RESPECTING CHALLENGES IN TRAVEL
DURING THESE MONTHS.
SO, I WILL BE PRESENTING THE
OPENING REMARKS FOR -- ON BEHALF
OF MY COLLEAGUE ANGELA ODOMS
YOUNG AND MYSELF AND MY
COLLEAGUE WILL BE LEADING THE
DISCUSSION AT THE END OF THE
MEETING.
SO, WE ARE GOING TO HAVE MY
OVERVIEW IS GOING TO TALK ABOUT
TWO THINGS, WHAT WE HAVE DONE
TODAY AND WHAT WE ARE GOING TO
DO IN THE FUTURE.
SO, AS WAS MENTIONED, THIS IS
OUR FIRST YEAR ANNIVERSARY. GO
TEAM. 2025, DGAC. IT HAS BEEN
A WONDERFUL YEAR AND KNOW WE
WILL HAVE ANOTHER WONDERFUL YEAR
OF BEING TOGETHER.
BEFORE I GOT NEXT SLIDE, I WANT
TO RECOUNT AN ANECDOTE.
I WAS HAVING DINNER WITH A
COLLEAGUE WHO SAID, DO YOU KNOW
THE DGAC, THE DIETARY GUIDELINES
AND THE DIETARY COMMITTEE, SO,
WHAT DO YOU DO? DO YOU JUST GET
TOGETHER SIX TIMES A YEAR AND
SORT OF REVIEW THINGS AND COME
UP WITH CONCLUSIONS?
IT MADE ME REALIZE THAT EVEN MY
COLLEAGUES IN THE FIELD DO NOT
APPRECIATE THE INCREDIBLE WORK
THAT THIS COMMITTEE IN
PARTNERSHIP WITH THE FEDERAL
STAFF HAS BEEN DOING FOR THE
LAST 12 MONTHS.
NEXT SLIDE, PLEASE.
WE WORK TOGETHER. I AM GOING TO
SAY THAT OUR FEDERAL STAFF ARE
OUR PARTNERS.
WE HAVE FOUR SUB-COMMITTEES AND
WORK GROUPS AND FOUR
SUB-COMMITTEES DIETARY PATTERN
AND DIET IN PREG NANNY AND BIRTH
THROUGH ADOLESCENCE AROUND FOOD
PATTERN MODELING AND DATA
ANALYSIS AND STRATEGIES FOR
INDIVIDUALS AND FAMILIES RELATED
TO DIET QUALITY AND WEIGHT
MANAGEMENT AND HAVE A
METAANALYSIS WORKING GROUP. MY
APOLOGIES.
WHAT IS UNIQUE ABOUT THIS GROUP
IS ONE OF OUR MANDATES IS TO
LOOK AT ALL THIS AMAZING WORK
THROUGH THE LENS OF HEALTH
EQUITY.
WE HAVE BEEN WORKING IN
SUB-COMMITTEES AND CROSS-CUTTING
WORKING GROUP THAT BEING HEALTH
EQUITY WORKING GROUP IN ORDER TO
MOVE THE PROGRESS FORWARD.
NEXT SLIDE, PLEASE.
SO, LAST YEAR WE MET THREE
TIMES: JANUARY, MAY, AND
SEPTEMBER.
NEXT.
WHEN YOU ARE IN-BETWEEN THAT,
THOSE MEETINGS, THIS IS WHAT WE
ACTUALLY DID.
WE ACTUALLY CONDUCTED 35
SYSTEMATIC REVIEW PROTOCOLS,
INCLUDING FOR THE FIRST TIME TWO
THAT HAD METAANALYSIS.
WE DID TWO EVIDENCE SCAN
PROTOCOLS AND 10 FOOD PATTERN
MODELING PROTOCOLS, INCLUDING A
COMPREHENSIVE REVIEW OF EACH
PATTERN COMPONENT, AND FOR THE
FIRST TIME, WE WILL BE DOING
DIET STIMULATIONS. I REALLY
THINK THAT YOU WILL BE HEARING
SOME EXCITING NEWS TODAY IN THIS
PUBLIC MEETING.
TO ENSURE THAT WE HAVE THE
HIGHEST PRIORITY QUESTIONS
COMPLETED BY -- IN THE NEXT
YEAR, WE CONTINUE TO PRIORITIZE
AND REFINE OUR WORK AND
PRESENTATION THAT WE HAVE
OCCURRED AT MEETING 3 AND LATER
TODAY, WE WILL SHARE MORE ABOUT
THE PROTOCOLS THAT WILL BE
REVISED AND WHICH HAVE BEEN
DISCONTINUED.
WE ALSO ARE DOING A
METAANALYSIS, WHICH IS A
QUANTITATIVE SYNTHESIS TECHNIQUE
THAT COULD BE USED IN
CIRCUMSTANCES TO COMBINE DATA
FROM INDIVIDUAL STUDIES.
THE COMMITTEE IS USING THIS
SYNTHESIS TECHNIQUE IN THOSE
REVIEWS WITH THE DATA.
AGAIN, THE UPDATES ON THE DIET
STIMULATION PLANS WILL BE SHARED
IN THE HEALTH EQUITY
PRESENTATION.
NEXT SLIDE, PLEASE.
SO, TO ACHIEVE ALL THAT, WE HAVE
H
HAD 200,000 SCIENTIFIC ARTICLES
SCREENED AND DOING WORK IN
PARTNERSHIP WITH FEDERAL STAFF
AND IN PUBLIC MEETINGS AND WE DO
EXTENSIVE SCREENINGS TO IDENTIFY
ARTICLES MEETING CRITERIA FOR
INCLUSION IN THE COMMITTEE'S
SYSTEMATIC REVIEW.
WE HAVE ALSO REVIEWED 400
ARTICLES TO DEVELOP THE
CONCLUSION STATEMENTS WE FIRST
PRESENTED AT MEETING 3.
WE WILL CONTINUE TO PRESENT THIS
MEETING AND FUTURE MEETINGS.
NEXT, PLEASE.
ADMIRAL LEVINE'S COMMENTS,
PUBLIC ENGAGEMENT HAVE BEEN
ENORMOUS. WE ARE GRATEFUL AND
ENCOURAGE YOU TO CONTINUE TO BE
ENGAGED AND WE HAVE RECEIVED 874
WRITTEN PUBLIC COMMENTS AND WE
HAVE LISTENED TO 82 ORAL PUBLIC
COMMENTS.
THESE MEETINGS HAVE BEEN VIEWED
BY OVER 5,000 PEOPLE FROM OVER
49 COUNTRIES.
WE HAVE HAD OVER 4,000 VIEWS OF
NEW NESSER WEB CONTENT FROM OVER
20 COUNTRIES AND HAD OVER
132,000 VIEWS OF THE CONTENT ON
DIETARY GUIDELINES.GOV RELATED
TO OUR WORK AND HAD 145
CONTINUING EDUCATION
CERTIFICATES GRANTED FOR
DIETICIANS WHO WATCH THE
MEETING.
IN OTHER WORDS, WE HAVE HAD A
LOT ENGAGEMENT WITH THE PUBLIC.
WE ARE VERY, VERY HOPEFUL THAT
THE NUMBERS WILL DOUBLE IN THE
NEXT YEAR AS WE CONTINUE OUR
WORK.
NEXT SLIDE, PLEASE.
SO, SPEAKING ABOUT OUR SECOND
YEAR, WE HAVE THREE MORE
MEETINGS, INCLUDING TODAY'S
MEETING.
OUR NEXT ONE WILL BE MAY 30TH.
OUR FINAL PUBLIC MEETING WILL BE
ON SEPTEMBER 26TH.
WE WILL BE CONTINUING TO REVIEW
THE RESULTS OF THE DATA
ANALYSIS.
WE WILL REVIEW EVIDENCE AND
DRAFT CONCLUSION STATEMENTS AND
WE WILL SYNTHESIZE RESULTS OF
THE FOOD PATTERN MODELING AND
DIET STIMULATION ANALYSIS. THIS
WILL BE BROUGHT TOGETHER TO
PRODUCE THE SCIENTIFIC REPORT OF
THE COMMITTEE.
WE WANT TO JUST -- I WANT TO
EMPHASIZE THAT SCIENTIFIC REPORT
IS GOING TO BE THE INTEGRATION
OF ALL THIS EVIDENCE, EVIDENCE
ACROSS SYSTEMATIC REVIEWS AND
ACROSS THE DATA ANALYSIS AND THE
FOOD PATTERN MODELING.
SO, RIGHT NOW, IT APPEARS IT IS
VERY SEGMENTED AND CHARGE THE
COMMITTEE TO BRING THAT TOGETHER
TO INTEGRATE THE EVIDENCE THAT
WILL BE PRESENTED IN THE
SCIENTIFIC REPORT.
WE ANTICIPATE THAT OUR REPORT
WILL BE COMPLETE BY LATE 2024.
NEXT SLIDE, PLEASE.
TODAY, WE HAVE A PACKED AND
EXCITING AGENDA.
WE ARE GOING -- EXCUSE ME.
WE WILL START WITH THE HEALTH
EQUITY PRESENTATION THAT IS LED
BY OUR SEMERA AND MOVE TO FOOD
PATTERN MODELING AND DATA
ANALYSIS LED BY CLIFF AND
HEATHER.
CHRISTINA WILL PRESENT
STRATEGIES FOR INDIVIDUALS AND
FAMILIES RELATED TO QUALITY AND
WEIGHT MANAGEMENT.
HERE, THE CHAIR OF THE
SUB-COMMITTEE, HOWEVER, THIS IS
A TEAM EFFORT THAT WE WILL BE
HEARING PRESENTATIONS BY THE
MAJORITY OF THE MEMBERS OF OUR
ENTIRE COMMITTEE.
WE WILL TAKE A BREAK AND MOVE ON
TO THE DIETARY PATTERNS AND
DIETARY COMPONENTS ACROSS THE
LIFE STAGES LED BY DEANNA AND
WILL MOVE TO DIET AND PREGNANCY
AND BIRTH ADOLESCENCE LED BY JAN
AND COLLEAGUE ANGELA ODOMS YOUNG
WILL WRAP UP THE DISCUSSION.
NEXT SLIDE, PLEASE.
EACH SUB-COMMITTEE OR WORKING
GROUP IS GOING TO BE PRESENTING
WHAT THEY HAVE DONE SINCE
MEETING 3 FOR COMMITTEE
DISCUSSION.
THIS IS THE FIRST TIME THAT
ENTIRE COMMITTEE HAS COME
TOGETHER.
WE ARE LOOKING FOR LIVELY,
ININFORMED DISCUSSION AS WE
PRESENT PROGRESS FROM EACH OF
THE SUB-COMMITTEES THAT WILL
RANGE FROM NEW PROTOCOLS AND
REVISION TO SOME PROTOCOLS AND
TO ENHANCE CLARITY OR PERHAPS
ENABLE FOCUS ON A STRONGER BODY
OF EVIDENCE.
WE WILL ALSO BE DISCUSSING THE
PROTOCOLS THAT WE SIMPLY DO NOT
HAVE THE RESEARCH AVAILABILITY,
WORKLOAD OR CAPACITY TO COMPLETE
IN THE TIME ALLOCATED.
WE HAVE -- WE ALSO DO THIS TO
ENSURE THAT WHAT WE DO FOCUS ON
HAS THE GREATEST POTENTIAL
IMPACT TO SEVERAL PROGRAMS, AS
THOSE AR ARTICULATED BY DEPUTY
STACY DEAN AND WE HAVE DRAFTED
CONCLUSIONS FOR QUESTIONS THAT
HAVE BEEN REVIEWED TO DATE.
NEXT SLIDE, PLEASE.
SO, AS NEEDED, PROTOCOLS WILL BE
REVISED AFTER TODAY'S MEETING TO
REFLECT THE COMMITTEE'S
DISCUSSION.
I WAS THROWN OFF A LITTLE BY THE
PHOTO AND WHEN WE WERE TOGETHER
PHYSICALLY AND WE HOPE TO BE
TOGETHER, AGAIN, IN THE NEXT
PUBLIC MEETING.
SORRY FOR THE DISTRACTION.
PROTOCOL WILL BE POSTED ONLINE
FOR THE PUBLIC TO VIEW AND
BETTER UNDERSTAND THE APPROACH
THAT WAS USED TO ANSWER A
SPECIFIC SCIENTIFIC QUESTION.
THE DRAFT PROTOCOLS ARE EXPECTED
TO BE POSTED AT DIETARY
GUIDELINES.GOV AND
NESSER.USDA.GOV BY NEXT WEEK AND
CONTINUE TO ENCOURAGE EVERYONE
TO SIGN UP FOR THE LISTSERV ON
DIETARY GUIDELINES.GOV SO YOU
CAN RECEIVE UPDATES.
FINALLY, IF YOU, AS A PUBLIC,
MEMBER OF THE PUBLIC HAVE
COMMENTS SPECIFIC TO PROTOCOLS
DISCUSSED TODAY, PLEASE SUBMIT
THEM TO THE COMMITTEE ONE MONTH
AFTER THEY ARE POSTED.
PUBLIC COMMENTS ARE TAKEN VERY
SERIOUSLY BY THIS COMMITTEE.
NEXT SLIDE, PLEASE.
N
NOW, AS PART OF THE PRESENTATION
TODAY YOU WILL HEAR A NUMBER OF
GRADED STATEMENTS. REMINDER
THAT COMMUNITY IS USING NESR
METHODOLOGY TO DO REVIEWS AND
OVERVIEW OF METHODS USED TO
DEVELOP AND GRADE CONCLUSION
STATEMENTS.
NESR'S METHODOLOGY IS AVAILABLE
ON THE WEBSITE.
BEFORE WE MOVE ON TO WHAT THE
CONCLUSION STATEMENTS ARE, I
WANT TO EMPHASIZE THAT A
CONCLUSION STATEMENT DOES NOT
DRAW IMPLICATION.
A SIMPLE CONCLUSION STATEMENT
FROM THEN TO TODAY SHOULD NOT BE
INTERPRETED AS DIETARY GUIDANCE.
AS I MENTION PREVIOUSLY, WE TAKE
ALL OF THE CONCLUSION STATEMENTS
AND ALL OF THE DATA THERE
INTEGRATED TO COME UP WITH FINAL
RECOMMENDATIONS.
SO, THE CONCLUSION STATEMENT
INSTEAD IS A SUMMARY STATEMENT
CAREFULLY CONSTRUCTED BASED ON
EVIDENCE REVIEWED TO DO
SYSTEMATIC REVIEW QUESTION AND
GRADES ASSIGNED TO EACH
CONCLUSION STATEMENT BASED ON
ASSESSMENT OF THE UNDERLYING
EVIDENCE FOR FIVE ELEMENTS:
CONSISTENCY, PRECISION, RISK OF
BIAS, DIRECTNESS, AND
GENERALIZABILITY.
ANY GRADE COMMUNICATES THE
COMMITTEE'S LEVEL OF UNCERTAINTY
IN THE EVIDENCE.
AND THE DEFINITION OR THE
INTERPRETATION OF THE GRADE IS
FOUND ON THIS SLIDE.
IN OTHER WORDS, A CONCLUSION
STATEMENT IS GRADED AS STRONG
INDICATES THE LEVEL OF CERTAINTY
AND CONCLUSION IS STRONG SUCH
THAT IF NEW EVIDENCE EMERGED,
MODIFICATIONS TO THE CONCLUSION
ARE UNLIKELY TO BE REQUIRED.
NOW, IF IT IS MODERATE OR
LIMITED, THE GRADE INDICATES
THAT THERE IS LESS CERTAINTY
ABOUT THE CONCLUSIONS SUCH THAT
IF THERE IS NEW EVIDENCE THAT
MERGES, MODIFICATION MAY OR
LIKELY BE REQUIRED.
FINALLY, IN SOME CASES, A
CONCLUSION STATEMENT SIMPLY
CANNOT BE DRAWN DUE TO EITHER
THE LACK OF EVIDENCE OR EVIDENCE
HAS SEVERE LIMITATIONS AND IN
THOSE CASES WE ASSIGN A GRADE
NOT ASSIGNABLE.
YOU WILL SEE THROUGHOUT TODAY'S
PRESENTATIONS THAT THERE IS
GOING TO BE QUITE -- THERE THERE
ARE MULTIPLE LEVELS OF GRADING
WILL BE PRESENTED DEPENDING ON
SPECIFIC SYSTEMATIC REVIEW
QUESTIONS.
NEXT SLIDE, PLEASE.
SO, WITH THAT, I AM REALLY HAPPY
TO TRANSITION TO MYRA'S UPDATED
FROM HEALTH EQUITY WORKING GROUP
AND HOLD ON TO YOUR SEATS THERE
IS LOTS OF INFORMATION IN THE
PRESENTATION AND THANK YOU VERY
MUCH AND FOR ALL YOUR SUPPORT.
>> NOW I'M HAPPY TO TURN IT TO
SAM EARA EERA AND THE REST OF T
WORKING GROUP.
>> THANK YOU. I WILL PRESENT
THE UPDATE ON BEHALF OF THE
WORKING GROUP MEMBERS.
NEXT SLIDE, PLEASE.
THIS SLIDE IS A LIST OF WORKING
GROUP MEMBERS AND NOTING HERE
THAT THE WORKING GROUP IS TRULY
CROSS-CUTTING AND OUR MEMBERS
THAT ARE ON SEVERAL OF THE
SUB-COMMITTEES.
OUR WORK WOULD NOT HAVE BEEN
POSSIBLE BUT FOR THE EXCELLENT
SUPPORT THAT HAS BEEN PROVIDED
BY THE FEDERAL STAFF. WE WOULD
LIKE TO ACKNOWLEDGE AND THANK
THEM FOR THIS.
NEXT SLIDE, PLEASE.
NOW, THE HEALTH EQUITY FOCUS AND
DIETARY GUIDELINES FOR AMERICANS
PROCESS IS NOT NEW.
HISTORICALLY HAS BEEN A
CONSIDERATION OF HEALTH EQUITY
AS PART OF THE GUIDELINES.
HOWEVER, THERE IS NOW A RENEWED
SENSE OF URGENCY AND IMPORTANCE
FOR THIS WORK.
THEM FASIS IS IN ALIGNMENT WITH
FEDERAL EFFORTS INCLUDING PEOPLE
IN 2030 AND EFFORTS BY USDA AND
HEALTH AND HUMAN SERVICES TO
ENSURE EQUITY IS -- THIS SLIDE
INCLUDES LANGUAGE POSTED ON
DIETARY GUIDELINES.GOV WEBSITE
ALONG WITH SCIENTIFIC QUESTIONS
AND DIETARY GUIDELINES ADVISORY
COMMITTEE HAS BEEN CHARGED WITH
ENSURING ALL SCIENTIFIC
QUESTIONS ARE VIEWED WITH HEALTH
EQUITY LENS TO ENSURE 2025
UPDATE OF DIETARY GUIDELINES IS
RELEVANT TO PEOPLE WITH DIVERSE
RACIAL/ETHNIC SOCIOECONOMIC AND
CULTURAL BACKGROUNDS.
NEXT SLIDE, PLEASE.
OUR WORKING GROUP MEMBERS HAVE
STRIVED TO ENSURE TENANTS OF
HEALTH EQUITY ARE INCORPORATED
ABOUT APPROACH TAKEN BY
COMMITTEE IN WORK AND
DELIBERATIONS AND BETWEEN PUBLIC
MEETINGS 3 AND 4 OUR WORKING
GROUP HAS PROVIDED PROTOCOLS AND
PLANS FOR SCIENTIFIC QUESTIONS
RELATED TO HEALTH EQUITY AND
WORK RELATED TO DIET SIMULATIONS
DISCUSSING IN MORE DETAIL IN
SUBSEQUENT SLIDES AND HEALTH
EQUITY CONSIDERATIONS INTO
COMMITTEE'S REVIEW INCLUDING
CONSIDERATION OF PUBLIC COMMENTS
DEVELOPING OUTLINES FOR
INCORPORATING HEALTH EQUITY
CONTENT INTO SCIENTIFIC REPORT.
NEXT SLIDE, PLEASE.
THE OVERARCHING GOAL OF THE
HEALTH EQUITY WORKING GROUP IS
DEFINE SCOPE EQUITY 2025 DIETARY
COMMITTEE ENSURING QUESTIONS IN
REVIEW OF CONTEXT INCLUSIVE OF
PEOPLE WITH ALL BACKGROUNDS AND
LIVED EXPERIENCES.
TO THIS END FOR THE SYSTEMATIC
REVIEWS WORKING GROUP CONTINUED
TO SUPPORT HEALTH EQUITY
CONSIDERATIONS AND EXAMPLE OF
THIS IS PROVIDING INPUT HOW TO
CONSISTENTLY EVALUATE
SOCIOECONOMIC POSITION REVIEWING
EVIDENCE FOR SYSTEMATIC REVIEW
AND DATA ANALYSIS INVOLVES
EXAMINING DATA ON DIETARY INTAKE
AND HEALTH CONDITIONS FOR
DEMOGRAPHIC SUBPOPULATIONS AND
HOUSEHOLD SNAP BENEFITS AMONG
OTHERS AND FOOD PATTERN MODELING
INCLUDING DISCUSSION OF
REPRESENTATION DEVELOPING
NUTRIENT PROFILES ADDRESSING
ABILITY IN DIETARY INTAKE ACROSS
PROTOCOLS AND EMPHASIZING NEW
FOODS IN DIET SIMULATIONS PRO S
ES AND LASTLY WORKED ON OUTLINE
FOR HEALTH EQUITY CHAPTER AND
CROSS-CUTTING TOPICS IN THE
SCIENTIFIC REPORT AND ENSURED
CONSIDERATION OF PUBLIC COMMENTS
IN RELATION TO TOTALITY OF THE
EVIDENCE EXAMINED AND SCIENTIFIC
REVIEW.
NOW, THIS CONCLUDES MY PART IN
THE PRESENTATION.
WITH THAT, I WOULD LIKE TO
REQUEST MY COLLEAGUES DR. CHRIS
TAYLOR AND [INDISCERNIBLE] TO
INTRODUCE DIET SIMULATIONS
PROTOCOL AND PRIORITIZED
POPULATION SIMULATION ANALYSIS
THAT IS REPRESENTATIVE OF HOW
THE COMMITTEE AND FEDERAL STAFF
HAVE ENSURED HEALTH EQUITY FOCUS
BE CENTRAL TO DELIBERATIONS AND
THEREFORE ARE HIGHLIGHTED HERE
IN THE HEALTH EQUITY UPDATE.
THANK YOU.
>> THANK YOU SO MUCH SAMEERA FOR
THE INTRODUCTION. IT IS
EXCITING TO PRESENT THIS DATA.
I'M NOT PERSONALLY A MEMBER OF
THE HEALTH EQUITY WORKING GROUP.
AS WE HAVE WORKED TOGETHER AS
CHAIR OF THE FOOD PATTERN
MODELING SUB-COMMITTEE, WE
WORKED REALLY CLOSELY WITH THE
HEALTH EQUITY GROUP TO INFORM A
LOT OF THE DECISIONS.
SO, ONE OF THE REALLY IMPORTANT
AND INNOVATIVE ASPECTS THAT WE
ARE ADDING THIS YEAR IS THE
ABILITY TO DO DIET SIMULATIONS
AND WE HAVE TALKED ABOUT IT
PREVIOUSLY AND SOMEWHAT
NEBULOUSLY.
BUT, WHAT WE CAN ACTUALLY DO
WITH THIS DATA AND BE ABLE TO
EXPLORE VARIOUS EATING PATTERNS
IS REALLY EXCITING.
SO, WHAT I WILL DO IS KIND OF
SET THE STAGE WITH WHAT THE DIET
SIMULATIONS ACTUALLY ARE.
AND THE PROCESS THAT WE WILL
USE, I WILL PASS IT ALONG TO MY
COLLEAGUE TO SHARE HOW WE WILL
USE THIS IN A MUCH MORE ENGAGING
HEALTH EQUITY WAY THAT IS REALLY
EXCITING.
NEXT SLIDE, PLEASE.
SO, WITH THE NEW PROTOCOL THAT
WE ARE PRESENTING HERE IS THE
DIET SIMULATIONS AND PURPOSE OF
DOING THE DIET SIMULATIONS
REALLY GIVES US A WAY TO TEST
THESE DIETARY PATTERNS THAT WE
ARE PROPOSING.
SO, WE HAVE TALKED ABOUT
PROTOCOLS FOR THE DIETARY --
LOOKING AT DIETARY PATTERNS FROM
THE DIFFERENT FOOD PATTERN
PROTOCOLS AND WHAT DIFFERENT
FOOD GROUPS AND CONSUMPTION AND
CONTRIBUTION AND HOW ALL THOSE
COME TOGETHER.
THESE ARE ALL THEN BASED ON
NUTRIENT-DENSE FOODS WITHIN DIET
AND REPRESENTATIVE FOOD
CONTRIBUTIONS FROM THOSE AND
WHAT WE ARE ABLE TO DO WITH THE
DIET SIM YOU'LLATION THAT IS A
MATHEMATICAL MODEL THAT
DESCRIBES AND RECREATES
COMPUTATION ALLEY AND A SYSTEMS
PROCESS THAT IS USED FOR US TO
RECREATE DAILY DIETS FROM WHAT
PEOPLE COULD CONSUME WITHIN THE
FOOD GROUPS INSTEAD OF RELYING
ON THE REPRESENTATIVE FOODS
SOLELY IN THEIR -- THEIR KIND OF
DISTRIBUTION WITHIN WHAT PEOPLE
NORMALLY CONSUME.
NOW IT ALLOWS US TO KIND OF TAKE
THIS TO A REAL-WORLD SITUATION
AND SAY, ALL RIGHT. FOR FRUITS,
WHAT ARE POSSIBLE FRUITS THAT
COULD BE CONSUMED AND CREATING
DIFFERENT KINDS OF MIX AND MATCH
SCENARIOS ALLOWING US TO LOOK AT
A BROAD RANGE OF INTAKES ACROSS
A RANDOMLY SELECTED SET OF FOODS
AND BEVERAGES THAT COULD BE
CONSIDERED.
AND THEN IN ADDITION TO THIS
SYSTEM SCIENCE APPROACH, IT
REALLY GIVES US A CHANCE TO
REFINE PATTERNS TO IDENTIFY IF
THERE ARE PARTICULAR AREAS THAT
WHEN YOU RELY ON NUTRIENT-DENSE
FOOD OR REPRESENTATIVE FOODS
THAT THERE MAY BE IN THE WAYS
THAT IT HAPPENS MORE IN A
REAL-WORLD SITUATION AND WHAT
ARE SOME POTENTIAL CHALLENGES
THAT MIGHT POP UP TO ALLOW US TO
REFINE BASED ON THAT.
NEXT SLIDE, PLEASE.
SO, WHAT YOU SEE HERE IS A
EXAMPLE OF THE HEALTHY US DIAL
DIETARY PATTERN WITH CONSUMPTION
AMOUNTS FOR DIFFERENT FOOD
SUBGROUPS.
WHAT WE WILL DO IS DO SIMULATED
DIETS THAT MEET UPDATED DIETARY
PATTERNS THAT REFLECT THE
VARIATION AND DIETARY INTAKES
AND REALLY MEET NUTRIENT
INADEQUACY.
WE ARE ABLE TO TEST ADDING AND
USING DIFFERENT FOODS FROM EACH
FOOD GROUP AND SUBGROUP AND
REALLY ASSESS HOW THOSE MEET THE
NUTRIENT RECOMMENDATIONS.
AND LOOK AT HOW THAT FLEXIBILITY
MIGHT REALLY PLAY IN, IN TERMS
OF FOOD CHOICE BEHAVIORS RATHER
THAN FOCUSING ON KIND OF THE
USUAL INTAKE APPROACH WITHIN THE
FOOD PATTERN MODELING AND THAT
DISTRIBUTION AND ALLOWING AND
REALLY TESTING THOSE
FLEXIBILITIES AROUND PEOPLE'S
INDIVIDUAL DIETARY REQUIREMENTS,
PREFERENCES, TRADITIONS,
EVIDENCE.
THIS IS A PERSON WITH DIET
SIMULATIONS WILL BE USED WITHIN
THIS PROCESS.
IT IS REALLY EXCITING THAT HAS
LED TO LOTS OF IN-DEPTH
DISCUSSIONS AND REALLY THINKING
ABOUT WHAT RAMIFICATIONS OF
VARIOUS DECISIONS ARE.
IT HAS BEEN A REALLY EXCITING
OPPORTUNITY AND IS A REALLY
GREAT OPPORTUNITY FOR US TO
EXPAND OUR -- OUR FOCUS ON HOW
THIS REALLY HITS WITH A HEALTH
EQUITY LENS AROUND EVALUATING
WHAT DIFFERENT DIETARY INTAKE
PATTERNS MAY REPRESENT.
NEXT SLIDE, PLEASE.
SO, WHAT WE ARE SEEING HERE IS
IT IS KIND OF A DIFFERENT --
SHOWING THE DIFFERENCE BETWEEN
HOW WE CONSTRUCT THE NUTRIENT
PROFILES THAT WE HAVE BEEN
TALKING ABOUT IN FOOD PATTERN
MODELING AND HOW DIET
SIMULATIONS MAY -- MAY TAKE INTO
ACCOUNT FOODS WITHIN A
PARTICULAR FOOD GROUP.
ON THE LEFT, YOU WILL SEE A
SIMILAR KIND OF GRAPH THAT WE
HAVE PRESENTED BEFORE THAT TAKES
ALL OF THE FOODS THAT SHOW UP IN
THE -- WHAT WE EAT AMERICA
DIETARY DATA AND ALL OF THE RED
AND ORANGE VEGETABLES.
AND THE LARGEST PROPORTION OF
RED AND ORANGE VEGETABLES ARE
REPRESENTED BY TOMATOES COOKED
THAT YOU SEE IN THAT UPPER
RIGHT-HAND QUADRANT AND PROFILE
WE USE FOR FOOD MODELING IS
PREVALENCED BY COOKED TOMATOES
AND RAW TOMATOES AND INCLUDES
CARROTS AND CARROT JUICE AND
SMALLER PROPORTION FROM WINTER
SQUASH OR PUMPKIN AND SLIDES OF
SLIVERS IN PIE CHART ON THE LEFT
REALLY SHOW HOW MUCH EACH
INDIVIDUAL FOOD IS FREELY
CONTRIBUTING TO NUTRIENT
PROFILES FOR RED AND ORANGE ALL
TOGETHER AND RIGHT-HAND SIDE IS
ULTIMATELY SHOWING TO CONSUME
RED AND ORANGE VEGETABLES THESE
ARE ALL DIFFERENT INDIVIDUAL
CHOICES THAT SOMEBODY MIGHT MAKE
AND INSTEAD OF SAYING IF I EAT
RED AND ORANGE IT WILL BE
ROUGHLY 65% AS TOMATO, YOU WILL
EAT ONE OF THE RED OR ORANGE
VEGETABLES.
WHAT WE ARE REALLY ABLE TO DO IS
TAKE A LOOK AT ALL OF THE FOODS
THAT EXIST IN THE DATA BASE AND
BE ABLE TO USE THOSE AND PLUG
THEM IN AS A SIMULATED DIETARY
INTAKE FOR THE DAY BASED ON THE
PROFILE WE LOOKED AT ON THE
PREVIOUS SCREEN AND REALLY TEST
THEN IF IT IS CONSUMED IN THE
FORM AND IN THIS AMOUNT TO MEET
THE RECOMMENDED INTAKES.
WHAT DID THE NEWT TREEIENTS FOR
THE DAY ACTUALLY LOOK LIKE?
HOW DOES THAT LOOK LIKE ACROSS
THE TOTAL POPULATION?
IT IS A REALLY EXCITING
OPPORTUNITY TO BE ABLE TO TEST
THIS.
SO, NEXT SLIDE, PLEASE.
I WILL HIT ON A FEW OF THE QUICK
DEFINITIONS THAT WILL BE BECAUSE
OF THE DIETARY GUIDELINES THAT
ARE SET UP TO FOCUS ON
NUTRIENT-DENSE FOODS AND
BEVERAGES IN THE DIETARY
SIMULATIONS THAT WE WILL BE
EMPHASIZING NUTRIENT-DENSE FOOD
AND BEVERAGES AND EVALUATING
THEIR CONTRIBUTION TO THE
DIETARY ESTIMATES THAT WE GET
POPULATION.
SIMULATION IS A SYSTEM SCIENCE
METHOD USED TO THAT MATHEMATICAL
MODEL TO RECREATE COMPUTATION
ALLEY ACROSS THE SYSTEM.
IT REALLY ALLOWS US TO REALLY
TEST IN A MUCH MORE LIKE
REAL-WORLD TYPE OF SITUATION HOW
THIS -- HOW THIS WILL WORK.
NEXT SLIDE, PLEASE.
SO, HOW DOES THIS FIT WITHIN THE
-- HOW DO DIET SIMULATIONS
REALLY WORK WITHIN THE BATTERY
OF WORK THAT WE HAVE BEEN
TALKING ABOUT THE FOOD PATTERN
MODELING GROUP AND WE LOOK AT
PROTOCOLS ON THE LEFT AND ONE
AND TWO THAT WE HAVE DISCUSSED
IN THE PRIOR MEETINGS.
WE WILL DISCUSS A FEW TODAY AND
LOOK AT DIFFERENT RANGES AND
NUTRIENT DENSITY AFTER WE FINISH
GOING THROUGH ALL OF OUR
PROTOCOLS IN ONE AND 2.
ONCE WE GET TO A STATE WHERE WE
HAVE PROPOSED DIETARY PATTERNS,
WE CAN THEN TEST THOSE DIETARY
PATTERNS USING DIET SIMULATIONS
AND BECOMES OUR LAST STEP, A
KIND OF CONFIRMATORY AND TEST
STEP AT THE VERY END AFTER WE
HAVE DONE ALL OUR BASE WORK TO
BUILD THOSE PROPOSED DIETARY
PATTERNS.
NEXT SLIDE, PLEASE.
OKAY. SO, THIS IS THE FIRST
KIND OF OVERVIEW OF WHAT IT IS
THAT WE WILL DO THAT WE WILL
WALK THROUGH IN A FEW OF THE
STEPS HERE.
BUT, OUR PROPOSED ANALYTIC
FRAMEWORK REALLY KIND OF STARTS
FROM THE HIGHER LEVEL OF
SIMULATING DIETARY INTAKES THAT
WE WILL CONSTRUCT 500, SEVEN-DAY
DIETS FOR EACH AGE AND SEX GROUP
STARTING ABOUT I ONE YEAR BY
RANDOMLY SLEKING A DIFFERENT
COMBINATION OF FOOD AND
BEVERAGES FROM THE DIFFERENT
FOOD AND SUBGROUPS AND AMOUNTS
THAT ARE RECOMMENDED IN THE
PATTERN.
OUR SECOND STEP, ONCE WE CREATE
THE 500, SEVEN-DAY DIETS, WE
WILL USE THE ENERGY AND NUTRIENT
COMPOSITION OF EACH FOOD AND SIM
YOU'L
-- SIMULATION ACROSS ALL 500
DAYS WHAT IS DISTRIBUTION OF
INTAKES AND ENERGY COMING FROM
AGGREGATED OR ALL PUT TOGETHER
CLUSTER OF SIMULATED DIETS.
THEN FROM THERE, WE ARE GOING TO
EVALUATE THAT DISTRIBUTION
COMPARED TO OUR PREDEFINED
NUTRITIONAL GOALS FOR EACH AGE
AND SEX GROUP HEAVILY RELYING AS
YOU WILL SEE ON THE LIST IN THE
DRI AND DRI COMPONENTS THAT WE
WILL SPEAK TO THAT A LITTLE BIT
MORE IN A MOMENT.
SO, IT REALLY THEN MEANS ON ONE
DAY THAT IT MIGHT NOT MEET FOR
EVERY SINGLE NUTRIENT. AS YOU
START TO PUT THEM TOGETHER IS A
LARGER PATTERN AT A
POPULATION-BASED SET AND HOW THE
OVERALL DISTRIBUTION DOES AT
MEETING NUTRIENT
RECOMMENDATIONS.
NEXT SLIDE, PLEASE.
SO, OUR FIRST STEP IS ACTUALLY
CONDUCTING SIMULATIONS AND
ASSEMBLING WHAT 500-DAY DIETS
WILL LOOK LIKE AND BEFORE
CONDUCTING THE ANALYSIS WE WILL
NEED TO IDENTIFY FOODS AND
BEVERAGES THAT ARE WITHIN WHAT
WE EAT IN AMERICA DATA AND THAT
IS PART OF UN-HANES DIETARY
DATA.
GUIDELINES ARE FOCUSING ON
NUTRIENT-DENSE FOODS TO MEET
DIETARY PATTERNS AND WE WANT TO
PRIORITIZE FOODS THAT ARE
NUTRIENT DENSE FOODS AND
BEVERAGES NUTRIENT DENSE IN THE
DIET SIMULATION. WHAT WE HAD TO
DO WAS KIND OF FIGURE OUT HOW WE
OPERATIONALIZED THAT WITHIN THE
-- WITHIN THE SCOPE OF ALL OF
THE DIFFERENT FOODS THAT MAY BE
POSSIBILITIES FOR ENTRY INTO THE
DIET SIMULATIONS AND MEMBERS OF
THE FOOD PATTERN MODELING
SUB-COMMITTEE AND HEALTH EQUITY
WORK GROUP TOGETHER REVIEWED AND
COMMENTED ON CRITERIA USED TO
IDENTIFY FOODS AND BEVERAGES FOR
SATURATED FAD AND SODIUM ADDED
SUGARS AND OPTION FOR SELECTED
PROBABILITY SELECTION AND
STARTED WITH THIS SERIES AND
DISCUSSION AND THE CONSENSUS WAS
THAT WE WOULD USE IN THE
SIMULATION ANALYSIS NUTRIENT
DENSE FOODS WILL HAVE AN EQUAL
PROBABILITY IN DAILY DIETS THAT
MEANS EVERY FOOD HAS AN EQUAL
CHANCE OF BEING SELECTED INSTEAD
OF WHAT WE LOOKED AT WITH FOOD
PATTERN MODELING WHICH WAS BASED
ON WHAT IS MOST COMMONLY
CONSUMED. WE WOULD LOOK AT ALL
OF THE FOODS AND HAVING EQUAL
PROBABILITY OF BEING INCLUDED OF
NUTRIENT-DENSE FOODS AND FOODS
HIGHER IN SATURATED FATS WOULD
HAVE HIGHER PROBABILITY OF BEING
SELECTED SO THAT WAY WE GET
EQUAL PROBABILITY TO HELP
SELECTION THAT IS NUTRIENT DENSE
AND GETS TO A BROADER SWATH OF
AVAILABLE FOODS THAT IS ALSO NOT
TO UNDERREPRESENT FOODS THAT ARE
LESS FREQUENTLY CONSUMED OR
OVERREPRESENT FOODS THAT ARE
COMMONLY CONSUMED IN THE
SIMULATED DIETS.
NEXT SLIDE, PLEASE.
SO, OUR CRITERIA THAT WE WERE
SETTING OUT WAS REALLY TO FIGURE
OUT WHAT ARE THRESHOLDS WE WOULD
LIKE TO USE IN ACTUALLY
IDENTIFYING THE FOODS THAT MEET
THE NUTRIENT-DENSE AND -- AND
FOR FOODS THAT ARE HIGHER IN
SATURATED OR IN IDENTIFYING
FOODS HIGHER IN SATURATED FAT
AND HIGHER IN SUGAR.
SO, WE TOOK A BIT OF A MODIFIED
APPROACH FROM THE FDA'S PROPOSED
CRITERIA FOR DETERMINING
ELIGIBILITY FOR FOODS AND
BEVERAGES TO BEAR A DIETARY
STATEMENT AND WERE LESS
RESTRICTIVE IN SATURATED FAT
CRITERIA FOR MEATS, CHEESES SOY
AND SOY ALTERNATIVES BASED ON
FOOD GUIDELINES CLASSIFICATION
SYSTEM AND WERE LESS RESTRICTIVE
ON SATURATED FAT AND ADDED
SUGARS FOR LARGER STANDARD
PORTION SIDES APPLIED TO FOOD
CLASSIFICATION SYSTEM AND
PROTOCOL CRITERIA APPLIED FOR
STANDARD PROPORTION AMOUNT BASED
ON HOW MUCH IS TYPICALLY
CONSUMED.
WE HAD TO SET SOME STANDARDS
THAT WOULD ALLOW FOR A
REPRESENTATION OF THE FOODS TO
BE INCLUDED BUT NOT INCLUDE SOME
FOODS THAT MIGHT KIND OF FALL
WITHIN A CUSP OF VARIOUS
THRESHOLDS AND BE ABLE TO BETTER
REPRESENT THE FOOD CATEGORIES AS
WELL. FOODS TYPICALLY CONSUMED
IN LESS THAN, SAY, A 30-GRAM
PORTION APPROXIMATELY THERE.
MEATS, CHEESE AND SOY AND SOY
CHEESE ITEMS CONTAIN 30% OF
TOTAL FAT WILL BE SATURATED FAT
AND AMONG ALL FOOD ITEMS GREATER
THAN 10% OF DAILY VALUE OF
SATURATED FAT WILL BE CONSIDERED
HIGH AND FOOD ITEMS CONTAINING
GREATER THAN 10% OF DAILY VALUE
OF FOOD PROPORTION █WILL BE HIG
IN SUGARS AND FOODS CONSUMED IN
PORTIONS THAT ARE GREATER THAN
30 GRAMS THAT USUAL PROPORTION
AND THRESHOLDS OF GREATER THAN
10% AND GREATER THAN 15% OF
DAILY VALUE FOR SATURATED FAT
AND ADDED SUGAR WILL BE USED.
NEXT SLIDE, PLEASE.
THIS GIVES A EXAMPLE OF WHAT
DIET SIMULATIONS WILL LOOK LIKE.
2000-CALORIE DIETARY PATTERN YOU
SEE AMOUNT OF VEGETABLES, FRUITS
GRAINS AND DAIRY AND OUR
SIMULATED DAY 1 WE RANDOMLY
SELECTED A SERIES OF VEGETABLES
SERIES OF FRUITS AND GRAINS AND
FOR DAY 2, ANOTHER SIMULATED
DIET FOR DAY 3 ANOTHER SIMULATED
DIET. DAY 3500, AN INCREDIBLE
JOB BY OUR STAFF TO FIND OUR
REPRESENTATION OF FOODS HERE.
IT IS A LITTLE EASIER TO READ
WITHOUT HAVING ALL 3500 ON THIS
SLIDE.
WHAT WE SEE HERE AND WHEN YOU
LOOK AT THE OVERALL PATTERN IS
IT IS GENERALLY REPRESENTED BY
FOODS OF HIGHER NEWT TREENT
DENSITY AND WE ALSO SEE FOODS
WITH LOWER NUTRIENT DENSITY
BASED ON PRIOR CRITERIA EMERGING
IN THE DATA SHOWING AND
CONTRIBUTING TO OVERALL
SIMULATED DIETS THAT REALLY
ALLOWS US TO USE THOSE CRITERIA
TO INCREASE THE PROPORTION OF
NUTRIENT-DENSE FOODS AND ALSO
GIVE A LITTLE BIT OF A BROADER
LOOK AT HOW TOTAL DIET
SIMULATIONS MAY PLAY OUT WITH
INCREASED FLEXIBILITIES.
NEXT SLIDE, PLEASE.
OKAY. SO, THE DIET SIMULATIONS
FOR CALCULATING THE NUTRIENT AND
ENERGY CONTENT OF THE FOODS.
WE WILL TAKE THOSE 3500 DAYS
THAT WE JUST SAW IN THE GRAPHIC.
LOOK AT THE INDIVIDUAL FOODS
THAT WERE SELECTED AND TAKE
THOSE PORTION SIZES THAT THEN
ALLOWS US FOR EACH DAY TO
COMPUTE THE HYPOTHETICAL
NUTRITION INTAKES FROM THAT
HYPOTHETICAL SIMULATED DIET FOR
THE DAY.
SO, THEN WE WILL HAVE 3500
DIFFERENT DAYS OF NUTRIENT
INTAKE FROM SIMULATED DIETS THAT
GIVES US A POPULATION
DISTRIBUTION IF YOU EAT ALL
THESE DIFFERENT WAYS, WHAT DOES
TOTAL PICTURE OF ENERGY AND
NUTRIENTS LOOK LIKE?
WE ARE ABLE TO CALCULATE THE
CONTENT AND SUMMARIZE AT
AGGREGATED LEVEL PUTTING ALL
THOSE TOGETHER FOR EACH AGE AND
SEX GROUP AND THEN BE ABLE TO
EVALUATE THOSE.
NEXT SLIDE, PLEASE.
WE WILL SEE WHAT THE
DISTRIBUTIONS MIGHT LOOK LIKE.
THESE ARE HYPOTHETICAL GRAPHS TO
KIND OF GIVE YOU AN IDEA WHAT
KINDS OF THINGS WE MIGHT SEE.
WHEN YOU LOOK AT ALL OF THE 3500
DIFFERENT DIETARY INTAKES, WE
MIGHT SEE A LITTLE BIT HIGHER
PEAK IN VITAMIN C AND WIDER
CURVE PERHAPS IN POTASSIUM
DEPENDING ON TYPES OF FOODS
CONSUMED AND SELECTED AND
VARIABILITY OF EACH NUTRIENT IT
WILL THEN SHOW US A SLIGHTLY
DIFFERENT GRAPHIC AND YOU CAN
SEE WHERE THE MIDPOINT IS FOR
EACH OF THESE AND HOW THE
INTAKES WILL VARY DEPENDING ON
THE FOODS THAT ARE SELECTED.
NEXT SLIDE, PLEASE.
OKAY. THEN OUR FINAL STEP ONCE
WE HAVE THAT ACTUAL VARIABILITY
OF THE DATA, SO, WE HAVE OUR
GRASS AND HAVE BEEN ABLE TO LOOK
AT WHAT THE DISTRIBUTION LOOKS
LIKE. WE GET AN IDEA WHAT
NUTRIENT INTAKES LOOK LIKE IF
YOU CHOOSE FROM A RANDOM SET OF
FOODS THROUGHOUT THE DATA TO
CONTRIBUTE TO THOSE AND WE WILL
LOOK AT THOSE PERCENTILE
DISTRIBUTIONS FOR ENERGY AND 26
NEWT TREENTS COMPARING THEM TO
NUTRITIONAL GOALS FOR THE AGE
AND SEX GROUP AND WE WILL
COMPARE THEM TO THE EER AND
ACCEPTABLE MACRONUTRIENT
DISTRIBUTION RANGE AND EAR WHEN
WE HAVE THEM AVAILABLE AND IF WE
DON'T HAVE EARS WE USE ADEQUATE
INTAKES AND COMPARE TO TOLERABLE
UP INTAKE LEVELS AND COLONIC
DISEASE RISK REDUCTION INTAKE
AND DIETARY RECOMMENDATIONS.
SO, WE WILL LOOK AT THESE FOR
ALL OF THESE NUTRIENTS AND
REALLY THEN EVALUATE HOW WELL
DOES THIS SIMULATED DIET AS A
FRAMEWORK FOR EVALUATING
VARIABILITY AND ENERGY NUTRIENT
INTAKES IN A POPULATION.
ARE WE ABLE TO MEET A LOW
PERCENTAGE, FOR EXAMPLE, LESS
THAN 10% OF THE SIMULATED DIETS
FALLING BELOW THE EAR FOR NEWT
TREENTS HAVING AN EAR?
THIS WILL BE DIFFERENT THAN
USING RDA AND DEVELOPING A
DIETARY PATTERN THAT IS REALLY
SET FOR INDIVIDUALS AND LOOKING
AT THIS FROM A TOTAL
POPULATION-BASED PERSPECTIVE AND
WHEN EAR IS NOT ESTABLISHED, EI
WILL BE COMPARED TO NUTRIENT
VALUES FOR SIMULATED DIETS USING
MEDIAN COMPOSITION AND MIDPOINT
WE HAVE IN DISTRIBUTION ON
INTAKES FROM PREVIOUS SLIDE AND
COMPARING MEDIAN INTAKE TO THE
AI FOR OUR ASSESSMENT FOR
NUTRIENTS THAT HAVE AN AI.
NUTRIENT GOALS INCLUDE ALSO A
LOW PERCENT OF SIMULATED DIETS
EXCEEDING THE UL OR CDRR FOR
SODIUM.
ONE REASON WHY WE DID NOT
INCLUDE SODIUM AS PART OF THE
NUTRIENT-DENSE FOOD SELECTION
WAS THE UBIQUITOUS NATURE OF
SODIUM WITHIN DIE INTAKES AND
WITHIN FOODS AND VAST AMOUNT OF
VARIABILITY AND SODIUM INTAKES
MAY GET OVERLY RESTRICTIVE ON
FOODS THAT WOULD ACTUALLY GET
CONTRIBUTED AND USED WITHIN OUR
NUTRIENT-DENSE SOURCE AND SOME
FOODS ARE SOMEWHAT HIGHER IN
SODIUM THAT WOULD BE OTHERWISE
CONSIDERED NUTRIENT DENSE.
WE WERE GOING TO EVALUATE THE
SODIUM AS A FACTOR AT THE
ENDPOINT AND BE ABLE TO
INTERPRET THAT DATA A LITTLE
MORE IN TERMS WHAT IMPLICATIONS
AND ROLE OF SODIUM MAY BE FROM
THE SIMULATED DIETS.
WE ARE ALSO LOOKING FOR -- AT
DIETS OUTSIDE OF THE ADEQUATE
MACRONUTRIENT DENSITY
DISTRIBUTION RANGE FOR CARBO
HYDRATE LIPID CONTENT EVALUATING
WHICH ONES FALL WITHIN OR
OUTSIDE OF THE AMDR AND LOOKING
FOR LESS THAN 10% OF ENERGY
OUTSIDE OF THE EAR THAT IS A WAY
FOR US TO EVALUATE WHAT
PROPORTION OF THE SIMULATED
DIETS ARE FALLING BELOW THIS 10%
OF THEM NOT MEETING THESE
NUTRIENT RECOMMENDATIONS THAT IS
KIND OF OUR THRESHOLD.
NEXT SLIDE, PLEASE.
SO, THIS IS JUST A VISUAL
DEPICTION OF WORK FROM KATAMAY
ET AL FROM THOSE THAT USED THIS
SIMILAR APPROACH. RIGHT-HAND
SIDE IS THE PRESENTATION OF
DISTRIBUTION OF FOLATE INTAKES
FROM SIMULATED DIETS FOR MALES
OVER 70 YEARS OF AGE AND SEE
MEDIAN FOLATE INTAKE FROM
SIMULATED DIET APPROACH IS 461
MICROGRAMS AND ON THE LEFT-HAND
SIDE YOU WILL SEE THE INTAKE
DISTRIBUTION FOR HOW THE EAR IS
SET OR AVERAGE ESTIMATED
REQUIREMENT.
IN THIS CASE, WE CAN SEE THAT
THE MEDIAN IS HIGHER THAN THE
EAR.
AND WHEN YOU LOOK AT THE
POPULATION DISTRIBUTION OF
THOSE, ONLY 3.6% OF THE
SIMULATED DIETS FELL BELOW THE
EAR AND USING A 10% QUOTE ON
QUOTE SUCCESS RATE OF ONLY LESS
THAN 10% OF THE SIMULATED DIETS
WOULD FALL BELOW THE EAR. WE
ARE THEN SEEING THE SIMULATED
DIETS WOULD BE DOING A FAIRLY
GOOD JOB AT HAVING A NUTRIENT
DENSITY THAT WOULD MEET
NUTRITIONAL GOALS.
NEXT SLIDE, PLEASE.
SO, AGAIN, JUST TO KIND OF
SUMMARIZE OUR SIMULATED DIET
FRAMEWORK THAT IS REALLY LOOKING
AT THIS IDEA OF CONSTRUCTING
THESE 507 DAY DIETS ACROSS EACH
AGE AND SEX GROUP AND REALLY
LOOKING AT HOW THE DISTRIBUTION
AND WHAT THE NUTRIENT INTAKES
ARE ESTIMATED IN NUTRIENT
INTAKES LOOKING AT THE
DISTRIBUTION AND EVALUATING
NUTRITIONAL DISTRIBUTION TO --
TO OUR NUTRIENT GOALS.
WITH THAT, I WOULD LIKE TO TURN
IT OVER TO MY COLLEAGUE, DR.
VALARIE BLUE BIRD JERNIGAN.
>> THANK YOU, CHRIS. SIMULATION
OF DATA WILL BE CONDUCTED BY 14
AGE SEX GROUPS AS DESCRIBED IN
THE PREVIOUS SLIDES.
HOWEVER, WE KNOW NOT ALL
POPULATION GROUPS ARE ADEQUATELY
REPRESENTED IN NHANES DUE TO
DATA SAMPLING AND WE WILL
CONDUCT DIET SIMULATION OF FOODS
AND BEVERAGES CONSUMED BY
SPECIFIC POPULATION GROUPS
FEELING IT WILL ENHANCE
EVALUATION OF DRAFT DIETARY
PATTERNS.
THE COMMITTEE WILL LEVERAGE WORK
UNDERWAY BY USDA'S CENTER FOR
NUTRITION POLICY AND PROMOTIONS
NUTRITION EDUCATION AND
INNOVATION DIVISION TO IDENTIFY
FOODS AND BEVERAGES THAT ARE
INTEGRAL TO AND INCLUDED IN THE
CUISINES OR FOODWAYS OF ABOUT 20
DIFFERENT POPULATION GROUPS.
APPLICATION OF THIS WORK TO DIET
SIMULATIONS TO EVALUATE THE
PROPOSED DIETARY PATTERNS IS
UNDER DEVELOPMENT.
IT WILL BE PILOTED BY THE
COMMITTEE TO ADVANCE INCLUSION
OF DIVERSE FOODWAYS IN THE
DIETARY GUIDELINES PROCESS.
THE PURPOSE OF THE PILOT TO
EMPHASIZE IS TO TEST A PROCESS
TO EVALUATE THE PROPOSED DIETARY
PATTERNS THAT ARE CONSIDERING
THE DIETARY PRACTICES AND
FOODWAYS OF DIFFERENT
POPULATIONS IN THE US.
NEXT SLIDE.
CONDUCTING THIS PILOT, SORRY.
MY SLIDES ARE -- COMMITTEE
SELECTED AMERICAN INDIAN AND
ALASKA NATIVE POPULATIONS FOR
THE PILOT.
CONDUCTING THE PILOT IS
CONSISTENT WITH DIETARY
GUIDELINES ADVISORY COMMITTEE'S
COMMITMENT TO INCLUDE
REPRESENTATION OF FOODS THAT ARE
CONSUMED BY DIVERSE POPULATIONS
AND SIMULATION ANALYSIS.
CONDUCTED TO EVALUATE OUR
DIETARY PATTERNS.
THIS SELECTION IS SUPPORTED BY
PUBLIC INPUT CALLING FOR DIETARY
GUIDELINES TO BE INCLUSIVE OF
AMERICAN INDIAN AND ALASKA
NATIVE POPULATIONS EMPHASIZING
TRADITIONAL FOODS IN THE DIETARY
GUIDELINES AND FEDERAL PROGRAMS
AND THE SELECTION ALSO SUPPORTS
THE WHITE HOUSE NATIONAL
STRATEGY ON HUNGER NUTRITION AND
HEALTH TO SUPPORT FOOD
SOVEREIGNTY AND IMPROVE ACCESS
TO TRADITIONAL FOODS ENSURE
TRIBAL COMMUNITIES ARE EQUITABLY
SERVED IN FEDERAL PROGRAMS AND
THE WHITE HOUSE STRATEGY FURTHER
ACKNOWLEDGES THAT AMERICAN
INDIANS AND ALASKA NATIVES FACE
SOME OF THE HIGHEST RATES OF
DIET-RELATED DISEASE IN THE US.
YET, POPULATIONS CONTINUE TO
FACE BARRIERS TO ACCESSING AND
IMPLEMENTING MANY OF THE FEDERAL
NUTRITION PROGRAMS.
NEXT SLIDE. THE WORK UNDERWAY
FOR THIS PILOT INVOLVES TWO
EXPERTS WITH PROFESSIONAL LIVED
EXPERIENCE IN AMERICAN INDIAN
FOODWAYS AND ONE EXPERT WITH
EXPERTISE IN ALASKA NATIVE
FOODWAYS.
I DO HAVE ADDITIONAL INFORMATION
ON THE EXPERTISE.
WITH REGARDS TO THE EXPERT WITH
PROFESSIONAL AND LIVED
EXPERIENCE AND AMERICAN-INDIAN
FOODWAYS FIRST EXPERT IS
REGISTERED DIETARY NUTRITIONIST
WITH BS IN NUTRITION AND MASTERS
IN PUBLIC HEALTH DEGREE AND
MEMBER OF DENAE AND NAVAJO
TRADITION AND RUNNING INTO WATER
CLAN AND BORN FOR THE COYOTE
PASS PEOPLE AND FOUNDER AND
OWNER OF NUTRITION EDUCATION
CONSULTANT COMPANY THAT PROVIDES
INCLUSIVE AND EVIDENCE-BASED
NUTRITION AND EDUCATION FOR
ORGANIZATIONS HONORING
AMERICAN-INDIAN HERITAGE AND
SECOND EXPERT WITH PROFESSIONAL
LIVED EXPERIENCE AND AMERICAN
INDIAN FOODWAYS HAS A BACHELOR'S
DEGREE ENVIRONMENTAL ENGINEERING
AND MASTER'S DEGREE AND WORKS
WITH MANY NATIVE COMMUNITIES
THAT IS A MEMBER OF THE BLACK
FETE AND CHEROKEE TRIBES GROWING
UP IN NORTHWEST MONTANA. THIS
INDIVIDUAL IS FOUNDER AND OWNER
OF AN ONLINE COOKING SHOW
DEDICATED TO REINDIJ NIEZING
NATIVE DIETS USING INDIGENOUS
STORIES AND DIGITAL MEDIA.
THE EXPERT WITH PROFESSIONAL AND
LIVED EXPERIENCE AND ALASKA
NATIVE FOODWAYS HAS AN
ASSOCIATE'S DEGREE IN
OCCUPATIONAL STUDIES AND
CULINARY ARTS, APPLIED SCIENCE,
RURAL NUTRITION AND
INTERDISCIPLINARY STUDIES AND IS
A MEMBER OF THE ADABASKIN
CULTURAL COMMUNITY BORN IN
ALASKA AND LIVING IN WISILA
ALASKA IN LAND OF ADABASKIN
PEOPLE AND 2350DS THAT THIS
INDIVIDUAL FOCUSES ON IN ALASKA
IS QUITE DIVERSE AND THIS
INDIVIDUAL HAS WORKED IN CAMPS
IN ALASKA AND ANT-ARCTIC KA AND
TEACHES SKILLS AND LOCAL FOODS
TO PREVENT DIABETES.
EACH EXPERT WILL REVIEW AND
IDENTIFY FOODS AND BEVERAGES AND
NATIONAL SURVEY DATA AS INTRICAL
TO THE CULTURAL CUISINE EATEN
AND NOT -- AND ARE NEVER
CONSUMED AS PART OF THE CUISINE
FOODS IDENTIFIED AS EATEN AND
NONINTRICAL WILL BE SIMULATED IN
SAME STEPS OUTLINED IN DR.
TAYLOR'S PRESENTATION AND
SIMILAR -- AND FOR ALASKA NATIVE
POPULATION.
ENERGY AND NUTRIENT CONTENT OF
AGGREGATED SIMULATED DIETS FOR
EACH GROUP WILL BE EVALUATED
AGAINST NUTRITIONAL GOALS AS
PRESENTED THAT IS IMPORTANT TO
ACKNOWLEDGE THAT CONDUCTING THIS
PILOT DOES NOT INCREASE OR
ADDRESS REPRESENTATIVENESS OF
THE DIETARY PATTERNS FOR ALL
TRIBAL ORGANIZATIONS.
OR FOR THE MANY DIFFERENT
POPULATION GROUPS IN THE US.
IT TESTS A PROCESS TO EXPAND THE
REPRESENTATIVENESS OF THE
PROPOSED PATTERNS TO BE MORE
INCLUSIVE AND REALLY IS A
STARTING POINT FOR FUTURE WORK.
AND NEXT SLIDE, PLEASE.
I WILL TURN IT BACK OVER TO MY
COLLEAGUE SAMEERA TO FACILITATE
OUR DISCUSSION.
THANK YOU.
>> THANK YOU. ANY QUESTIONS
REGARDING WHAT WAS PRESENTED
REGARDING THE HEALTH EQUITY
WORKING GROUP UPDATE?
>> CONGRATULATIONS. THIS IS
JUST SUCH AN AMAZING DEVELOPMENT
THAT I CAN'T IMAGINE 3500 DAYS.
I CAN'T IMAGINE 500 SIMULATIONS
FOR SEVEN DAYS.
VALARIE, IT WAS WONDERFUL TO
HEAR YOUR NEWS AND YOUR
PRESENTATION AND REALLY LOOK
FORWARD TO SEEING HOW THIS
EVOLVES.
THANK YOU AND THANK YOU TO
EVERYBODY INVOLVED IN THIS. I
THINK INTEGRATION OF THE HEALTH
EQUITY WORKING GROUP AND THE
SUB-COMMITTEE THROUGH THE
PATTERN MODELING AND ALL OF THE
FEDERAL STAFF PARTNERSHIP REALLY
HAS COME TOGETHER IN THIS REALLY
EXCITING PRESENTATION.
THANK YOU.
>> ANY OTHER QUESTIONS OR
COMMENTS FROM THE COMMITTEE? I
KNOW WE ARE ALL BLOWN AWAY BY
THAT PRESENTATION THAT WAS
FABULOUS. UH-HUH. YEAH. GO
AHEAD, TERESA.
>> WHEN DO YOU EXPECT TO HAVE
THE RESULTS FOR THE SIMULATIONS
AND ALSO THE NATIVE AMERICAN
EXPERT? WOULD IT BE READY BY
THE NEXT PUBLIC MEETING THAT WE
CAN HEAR ABOUT IT?
>> I WILL FIELD THAT. WITH THIS
BEING THE LAST STEP IN OUR
PROCESS, GETTING THAT FAR INTO
THE GRAPHIC WE WILL HAVE TO
CONDUCT WORK FROM INITIAL
PROTOCOLS FROM THE LAST MEETING
NUTRIENT DENSITY THAT WILL
PRESENT AND THE POPULATION
ANALYSIS.
THEN FROM THERE, WE WILL DO ALL
OF THE FOOD GROUPS AND THEN LOOK
AT THE CALORIES FOR ADDITIONAL
USES AND THEN THE DIET
SIMULATIONS WILL FOLLOW AT THE
END AND WILL BE OUR LAST STEP
AFTER WE CONDUCTED ALL OF THE
OTHER WORK TO THAT POINT.
WHEN WE GET TO THE FINAL STATE
OF THIS IS WHAT OUR PROPOSED
DIETARY PATTERNS WILL BE, FROM
THAT, WE WILL ACTUALLY DO THE
SIMULATION ANALYSIS THAT IS THAT
THIS IS KIND OF THE -- THIS IS
THE CART. THEN WE WILL PRESENT
THE HORSE.
>> THANK YOU. GO AHEAD, DR.
GARDNER.
>> THAT WAS AMAZING. I LOVE
LISTENING TO THIS AND TRYING TO
PICTURE THIS ALGORITHM I DON'T
KNOW IF YOU CAN DESCRIBE THIS.
YOU SAID THERE WAS A LOWER
PROBABILITY INCLUDING FOODS
HIGHER IN SATURATED FAT OR ADDED
SUGARS CAN YOU DIAL IT DOWN
LOWER IS CONTINUOUS AND HOW DO
YOU DRAW THE LINE BETWEEN LOWER
AND LOWEST AND REALLY LOWER AND
MAYBE JUST A LITTLE BIT LOWER?
>> YEAH. THAT IS A QUESTION
THAT WE HAVE BEEN GRAPPLING
WITH. WE WANTED TO HAVE THE
DEFINITION OF THE NUTRIENT DENSE
A LITTLE BIT MORE STANDARDIZED
AND GET TO THIS AND TO BE ABLE
TO LOOK AT THE DATA AND SEE WHAT
WE HAVE. WE DON'T HAVE A
DEFINITIVE LEVEL OF WHAT THAT
PROPORTIONALITY LOOKED LIKE JUST
YET.
BECAUSE ESPECIALLY STEPPING INTO
THIS NEW REALM, YOU KIND OF
DON'T KNOW WHAT YOU WILL GET.
AND THAT IS WHY IT IS -- IT IS
EXCITING AND TERRIFYING ALL IN
THE SAME TIME AND IT IS SO NEW
AND SO INNOVATIVE WITH WHAT WE
CAN DO AS A NEXT STEP TO REALLY
TEST IT.
ESPECIALLY ACROSS A VARIETY OF
FOOD SELECTIONS AND AS DR.
HOOVER INDICATED THAT IT REALLY
GIVES US SUCH A GREATER EXPANSE
TO LOOK AT PARTICULAR FOODWAYS
THAT YOU CAN SET PARAMETERS AND
IS A REALLY EXCITING NEXT STEP.
THAT IS WHY IT IS NESTED IN THE
HEALTH EQUITY PRESENTATION THAT
WE ARE ABLE IT LOOK AT THIS FROM
A POPULATION PERSPECTIVE AND
NEXT STEP REALLY ALLOWS US TO
TWEAK KNOBS ON PARAMETERS HOW
MUCH AND WHAT ARE IMPLICATIONS
OF THOSE AND HOW DOES THAT WORK
WITHIN DIFFERENT POPULATIONS?
IT IS REALLY EXCITING.
>> GREAT DISCUSSION. GO AHEAD,
DEANNA.
>> HI. EXCELLENT WORK. SO,
JUST A REAL QUICK QUESTION THAT
I KNOW THAT WE SAID IT BEFORE AT
A PREVIOUS MEETING.
I KNOW THAT THIS IS GOING TO BE
DONE BY LIFE STAGES AS WELL;
RIGHT?
COULD YOU JUST GIVE A FEW -- A
PREVIEW WHAT THOSE LIFE STAGES
WILL BE LIKE?
I THINK THAT IS AN EXCITING PART
TOO.
>> YEAH. LIFE STAGES WILL MIMIC
ALL OF THE WORK OR GROUPINGS
THAT WE HAVE USED WITHIN ALL OF
THE OTHER FOOD PATTERN MODELING
STEPS.
SO, IT WILL FOLLOW MUCH THAT
SAME -- IT WILL FOLLOW THAT SAME
PATTERN AND WHY WE WILL BE ABLE
TO DO IT FOR ALL AGE 6 GROUPS WE
USE IN FOOD PATTERN MODELING, WE
WILL BE ABLE TO TEST THEM AT
CALORIE LEVELS ALL THE WAY
FORWARD.
IT WILL GIVE US NOT ONLY THAT
POPULATION LOOK BUT POPULATION
LOOK BASED ON EACH OF THE AGE
SEX GROUPS AS WE CARRY FORWARD.
>> ANY OTHER QUESTIONS OR
COMMENTS FROM THE COMMITTEE?
THANK YOU SO MUCH FOR THAT
REALLY RICH PRESENTATION AND
DISCUSSION. NOW WE WILL
TRANSITION TO THE NEXT GROUP
THAT WE WILL PRESENT ON FOOD
PATTERN MODELING AND DATA
ANALYSIS. THIS WORK IS LED BY
CHRIS TAYLOR AND HEATHER
EICHER-MILLER. YOU MAY PROCEED,
DR. MILLER.
>> THANK YOU SO MUCH, JANET.
LET'S GET GOING.
I'M PLEASED TO BE ABLE TO
PRESENT ABOUT DATA ANALYSIS
TODAY.
NEXT SLIDE, PLEASE.
SO, WITHIN THIS TALK, I WILL
FIRST KIND OF UPDATE WHERE --
WHAT WE HAVE DONE AND WHERE WE
ARE IN THE PROCESS OF DATA
ANALYSIS.
THEN I WILL FOCUS A LITTLE BIT
MORE ON SOME SPECIAL WORK THAT
WE HAVE DONE TO COMPLETE AN
EVIDENCE SCAN ON DIETARY INTAKES
IN THE UNITED STATES FROM MARCH
OF 2020 THROUGH DECEMBER OF 2022
THAT WILL COVER THE COVID-19
PANDEMIC.
THEN I WILL CLOSE WITH
DESCRIBING THE NEXT STEPS AND A
DISCUSSION.
NEXT SLIDE, PLEASE.
FIRST, I JUST LIKE TO GIVE KUDOS
AND THANKS TO OUR WONDERFUL TEAM
THAT HAS BEEN SUPPORTING US WITH
DATA ANALYSIS THAT IS LED BY
DEANNA DE-SILVA AND COLLEEN
CRUZ. THANKS SO MUCH AND
WONDERFUL STAFF FROM OFFICE OF
DISEASE PREVENTION AND HEALTH
PROMOTION AND CENTER FOR
NUTRITION POLICY AND PROMOTION.
FINALLY, I WANT TO THANK SO MUCH
OUR COLLABORATORS IN MANY
DIFFERENT FEDERAL AGENCIES THAT
ARE SUPPORTING THE WORK ON
COMPLETING THE DATA ANALYSIS FOR
US. THEY ARE ALL LISTED THERE
AND THANKS TO THEM FOR THE TIME
AND EFFORT IN PREPARING THE
ANALYSIS FOR US.
NEXT SLIDE.
SO, FIRST, I JUST WANT TO KIND
OF GROUND EVERYONE AND REMIND
YOU THAT IN DATA ANALYSIS, THIS
IS ONE OF THE THREE APPROACHES
THAT IS SUPPORTING AND INFORMING
UPDATES TO THE GUIDELINES.
WITH DATA ANALYSIS, THE GOAL IS
TO HELP US MAKE THE GUIDELINES
PRACTICAL BY INFORMING US ON
CURRENT DIETARY INTAKES IN THE U
SCH
US.
WE HAVE TO KNOW WHERE WE ARE
STARTING FROM TO INFORM WHAT
GUIDELINES SHOULD BE SET. THAT
IS -- PART OF THAT ALSO WE WANT
TO UNDERSTAND WHAT DIET RELATED
COLONIC DISEASES ARE IN THE US
THESE ARE TWO MAIN GOALS IN THE
PROCESS AND AS WE START THAT ONE
THING WE NEED TO DO IS SPECIFY
AND PLAN OUT WHAT LOOKING AT
OVERALL POPULATION IS OF COURSE
AND SPECIFYING WHAT OTHER
DEMOGRAPHIC GROUPS WE WANT TO
LOOK AT WITHIN THE OVERALL
POPULATION AND WE HAVE MADE
PROGRESS THERE AS WELL AS
DISCUSSING THOSE GROUPS WITH
HEALTH EQUITY WORKING GROUP TO
MAKE SURE THAT WE ARE
PRIORITIZING HEALTH EQUITY IN
THIS WORK AND MOVING FORWARD I
WILL UP DATE YOU ON THAT FIRST
AND ALSO WILL DISCUSS PROGRESS
OF THE ANALYSIS.
THEN THAT IS THE MAIN THINGS WE
ARE WORKING ON AND IF I DIDN'T
REMISS THE PANDEMIC IN THE ROOM
THAT IS UNDERSTANDING, YOU KNOW,
SINCE THE LAST GUIDELINES WERE
SET AND WE -- THAT TIME PERIOD
COVERED THE COVID-19 PANDEMIC A
BIG DISRUPTION TO DIETARY INTAKE
AND MONITORING OF THAT IN THE
US.
SO, WE WANTED TO TRY TO ADDRESS
THAT AND TRY TO UNDERSTAND WHAT
COULD BE GOING ON WITH DIE
INTAKES WITHIN THE US DURING
THAT TIME COMPLETING AN EVIDENCE
SCAN. I WILL FOCUS A LITTLE BIT
MORE ON THE RESULTS OF THAT IN
THIS PRESENTATION TODAY.
I KNOW WE MENTIONED THIS IN SOME
OF OUR EARLIER MEETINGS.
NOW WE HAVE A MORE FULL PICTURE
TO PROVIDE TO YOU.
SO, MOVING FORWARD, FIRST, IN
THE NEXT SLIDE, I WANT TO REMIND
EVERYONE OF THE WORK AND
PROGRESS THAT WE HAVE DONE
TOWARDS OUR MAIN GOAL OF
UNDERSTANDING CURRENT NUTRIENT
INTAKES.
THAT IS WITH REGARD TO
SPECIFYING THESE ADDITIONAL
DEMOGRAPHICS THAT WILL STRATIFY
OUR ANALYSIS BY AS WE -- AS WE
LOOK AT WHAT KIND OF DIETARY
PATTERNS AND INTAKES THERE ARE
WITHIN THE US.
WE WILL CONTINUE TO CARRY
FORWARD ANALYSIS THAT THE 20205
COMMITTEE DID BY FOCUSING ON --
ON GROUPS IN US POPULATION BY
SEX, RACE, AND/OR ETHNICITY AND
BY SOCIOECONOMIC POSITION THAT
COULD INCLUDE EXAMPLES BY FAMILY
INCOME AND POVERTY INCOME RATIO
AND EDUCATION.
THEN AT AGE GROUPS AND LIFE
STAGES WITHIN THE POPULATION.
THEN AFTER WORKING WITH THE
HEALTH EQUITY WORK GROUP, WE
HAVE PRIORITIZED SOME ADDITIONAL
DEMOGRAPHICS TO LOOK AT INTAKES
BY.
THOSE INCLUDE FOOD SECURITY
CATEGORY AT THE HOUSEHOLD LEVEL.
RECEIPT OF HOUSEHOLD FOOD
BENEFITS FROM SUPPLEMENTAL NUT
TRIGS ASSISTANCE PROGRAM AND
SOMETIMES THAT IS REFERRED TO AS
THE FOOD STAMP PROGRAM AND ALSO
BENEFITS FROM THE CHILD FOCUSED
WICK PROGRAM.
SO, WE HAVE ALREADY BEEN ABLE TO
TAKE A LOOK AT SOME OF THE
PRIORITIZED DEMOGRAPHICS AND
DETERMINE THAT THERE LIKELY WILL
BE ENOUGH SAMPLE SIZE TO DO
ANALYSIS ON THESE GROUPS.
WE ARE -- YOU KNOW, AS WE
CONTINUE, WE MAY KIND OF REFINE
THESE A LITTLE BIT FURTHER.
NEXT SLIDE.
SO, AFTER THAT PROCESS, THE NEXT
THING WE DID WAS TO SUBMIT ALL
OF THE REQUESTS FOR ANALYSIS OUT
TO OUR INTERAGENCY COLLABORATORS
DOING ANALYSIS FOR US.
I WANTED TO REMIND EVERYONE JUST
THE BREADTH OF WHAT THAT
ANALYSIS INCLUDES THAT IS GOING
TO LOOK AT CURRENT PATTERNS OF
FOOD AND BEVERAGE CONSUMPTION
OVERALL IN THE TOTAL DIET. AN
EXAMPLE OF THAT WOULD BE
DETERMINING THE HEALTHY EATING
INDEX SCORES THAT ARE METRICS
THAT WE CAN APPLY TO BETTER
UNDERSTAND HOW DIETS ARE
ALIGNING WITH THE DIETARY
GUIDELINES FOR AMERICANS.
WE ALSO WILL HAVE REQUESTED
CURRENT INTAKES OF FOOD GROUPS
AND A HUGE PANEL OF NUTRIENTS.
THEN TO DIG IN DEEPER HERE, WE
ARE ESPECIALLY INTERESTED IN
NEWT TREENTS OF PUBLIC HEALTH
CONCERN.
SOME ANALYSIS WILL INCLUDE
LOOKING AT -- TO PUT THIS
DIETARY INTAKE INFORMATION INTO
A BIGGER CONTEXT OF THE
RELATIONSHIPS TOGETHER TO HEALTH
REQUESTING ANALYSIS PREVALENCE
NUTRITION RELATED CHRONIC HEALTH
CONDITIONS THAT WILL INCLUDE
SOME MAJOR CONDITIONS IN THE US
AND OBESITY AND DIABETES AND
CARDIOVASCULAR DISEASE, ET
CETERA.
THESE REQUESTS ARE OUT AS I
MENTIONED. THE WORK IS UNDERWAY
AND WE HAVE BEEN ABLE ALREADY TO
COLLECT AND ARE -- YOU KNOW, ARE
CONTINUING TO DO THAT, THE
RESULTS OF THE ANALYSIS.
WE HAVE MANY OF THEM. THERE ARE
MANY MORE TO STILL COME IN.
WE WON'T SHARE THOSE SUMMARIES
OR SYNTHESIS UNTIL WE HAVE THEM
AS A COMPLETE SET.
WE CAN REALLY CONTEXTUALIZE ALL
OF THOSE RESULTS TOGETHER.
MOVING ON TO THE NEXT SLIDE.
OKAY. SO, THAT IS OUR PROGRAM
TOWARDS OUR MAIN GOALS OF
DETERMINING DIETARY INTAKE.
AS I MENTIONED, WE ALSO WANTED
TO UNDERSTAND WHAT HAPPENED WITH
REGARDS TO DIETARY INTAKE DURING
THE PANDEMIC AS THAT WAS A, YOU
KNOW, MAJOR DISRUPTION IN THE US
SINCE OUR LAST DIETARY
GUIDELINES UPDATE CAME OUT.
SO, IN ORDER TO DO THAT WE
COMPLETED THIS PROJECT OF DOING
AN EVIDENCE SCAN ON INTAKES FROM
MARCH 2020 THROUGH DECEMBER OF
2022. NEXT SLIDE, PLEASE.
DESCRIBING MORE WHAT AN EVIDENCE
SCAN IS BEFORE I SHARE MORE
ABOUT THE WORK THAT WE DID
THERE.
SO, AN EVIDENCE SCAN IS KIND OF
A MORE EXPLORATORY TECHNIQUE AND
PROJECT THAT WE USE SYSTEMATIC
METHODS FOR TO SEARCH FOR AND
DESCRIBE THE VOLUME AND
CHARACTERISTICS OF EVIDENCE
AVAILABLE FOR A SPECIFIC
QUESTION.
SO, DOING A SCAN ALLOWS US MORE
OF KIND OF AN OVERVIEW OF WHAT
IS THERE.
IT IS NOT AS MUCH FOCUSED ON
GLEANING AND SYNTHESIZING
CONCLUSION.
IT USUALLY DOES INCLUDE THINGS
LIKE SPECIFYING AND DEFINING A
PROTOCOL BECAUSE WE HAVE TO KNOW
WHAT WE ARE FOCUSED ON AND
LOOKING FOR IN THE LITERATURE.
THEN CARRYING OUT THAT
SYSTEMATIC SEARCH THAT -- AND
SCREENING STUDIES TO SEE WHAT
FITS AND WHAT STUDIES ARE
ADDRESSING OUR QUESTION.
THEN ONCE WE HAVE THOSE STUDIES,
WE EXTRACT MINIMAL DATA FROM
THEM.
WE DON'T DO THINGS LIKE A RISK
OF BIAS ASSESSMENT OR A
SYNTHESIS OF THE RESULTS OR
CREATING, YOU KNOW, GRADED
CONCLUSION STATEMENTS AS WE
WOULD WITH OTHER KINDS OF
SYSTEMATIC REVIEWS.
MOVING FORWARD.
SO, THE RATIONALE BEHIND OUR
EVIDENCE SCAN THAT I HAVE
ALREADY KIND OF MENTIONED THIS.
THE PANDEMIC WAS THIS MAJOR
DISRUPTION.
AND UNFORTUNATELY, THAT CAUSED A
DISRUPTION IN THE COLLECTION OF
OUR NATIONAL FEDERAL SURVEYS
PROVIDING NUTRITION-RELATED DATA
INCLUDING WHAT WE RELY ON MOST
FOR INTAKES IN THE US THAT IS
WHAT WE EAT IN AMERICA NATIONAL
HEALTH AND NUTRITION EXAMINATION
SURVEY.
ALSO, THE PANDEMIC BROUGHT A LOT
OF ATTENTION TO FOOD INSECURITY
IN THE US AND PREVALENCE OF
DIET-RELATED DISEASES AND HEALTH
DISPARITIES AND FOR THAT REASON
IT IS ALSO IMPORTANT FOR US TO
TRY TO UNDERSTAND WHAT IS OUT
THERE AND WHAT MAY HAVE OCCURRED
IN DIETARY INTAKES DURING THE
PANDEMIC AND RESEARCH QUESTION
WE FOCUSED ON FOR THIS EVIDENCE
SCAN IS WHAT EVIDENCE HAS BEEN
PUBLISHED ON THE PATTERNS OF
FOOD AND BEVERAGE INTAKE FROM
MARCH TWENTD 20 THROUGH DECEMBER
2022 INCLUDING POTENTIAL CHANGES
IN DIETARY INTAKE DUE TO THE
COVID-19 PANDEMIC.
NEXT SLIDE.
I WILL OVERVIEW BRIEFLY CRITERIA
WE HAD FOR STUDIES WE ARE
LOOKING FOR TO ADDRESS THIS
QUESTION AND WANTED TO BE
INCLUSIVE ON STUDY DESIGN AND
INCLUDED ALL TYPES OF TRIALS AND
RANDOMIZED CONTROLLED TRIALS
UNCONTROLLED TRIALS, ET CETERA.
COHORT STUDIES AND CASE CONTROL
STUDIES AND CROSS-SECTIONAL
STUDIES AND NARRATIVE AND
SYSTEMATIC REVIEWS.
OF COURSE, ALL OF THE STUDIES
NEEDED TO BE INCLUDING MEASURING
DIETARY INTAKE AMONG GENERALLY
HEALTHY POPULATIONS.
SO, WE DIDN'T INCLUDE STUDIES
THAT WERE ONLY FOCUSED ON
INDIVIDUALS WITH A PARTICULAR
DISEASE OR HEALTH CONDITION.
AND THEN THE PUBLICATION DATES
WERE THE BEGINNING OF THE
PANDEMIC, MARCH OF 2020 UP TO
DECEMBER OF 2022.
THAT WAS A CLOSING OR ENDING
DATE FOR OUR SEARCH.
THAT IS WHEN WE ACTUALLY STARTED
THIS PROJECT.
SO, WE DID NOT -- WE WERE NOT
ABLE TO GO BEYOND THAT.
WE INCLUDED ALL OF THE MOST, YOU
KNOW, COMPREHENSIVE TYPES OF
DIETARY ASSESSMENT METHODS THAT
WOULD BE MULTIPLE PAST 24 HOUR
FOOD CALLS FOOD FREQUENCY
QUESTIONNAIRES AND FOOD RECORDS
AND ARTICLES NEEDED TO BE PEER
REVIEWED OR IN THE GRAY
LITERATURE MEANING THAT THEY
WERE FROM GOVERNMENT OR
NON-GOVERNMENTALMENTAL
ORGANIZATIONS.
THEY NEEDED TO BE ENGLISH AND
WITHIN THE US WE ARE FUSED FOCU
ON US INTAKES AND HUMAN
PARTICIPANTS.
NEXT SLIDE.
WHAT WE CAME UP WITH AFTER OUR
ELECTRONIC DATA BASE SEARCH IS
OVER 17,000 STUDIES.
WE HAVE SHOWED THIS SLIDE IN THE
LAST MEETING.
I WON'T GO THERE YOU THIS IN TOO
MUCH DETAIL.
THIS WAS A VERY, YOU KNOW, TIME
CONSUMING AND EXTENSIVE PROCESS
TO SCREEN ALL THESE THROUGH THE
TITLE STAGE AND ABSTRACT STAGE
AND FULL TEXT STAGE.
ULTIMATELY, WE GOT TO TEN
STUDIES FROM THE ELECTRONIC DATA
BASE SEARCH AND ONE MORE WAS
IDENTIFIED FROM THE MANUAL
SEARCH FOR A TOTAL OF 11
ARTICLES.
ONLY THAT ARE COVERING OR
INCLUDING DIETARY INTAKES, YOU
KNOW, DURING THE PANDEMIC.
NEXT SLIDE.
SO, OF THE 11 STUDIES, FOUR WERE
PROSPECTIVE COHORT STUDIES AND
SIX WERE CROSS-SECTIONAL AND ONE
WAS A NARRATIVE REVIEW.
THE POPULATIONS COVERED WERE
MAINLY ADULTS THAT WE ALSO HAD
ONE STUDY FOCUSING ON KIDS, ONE
ON ADOLESCENTS AND ONE ON
INDIVIDUALS THAT ARE PREGNANT.
DEMOGRAPHICS, THERE WAS OVER --
YOU KNOW, OVER 23 UNIQUE
VARIABLES THAT WERE
CHARACTERIZED IN LOOKING AT THE
DEMOGRAPHICS OF POPULATIONS
INCLUDED AND MORE FOCUSED OR
INCLUDED CAPTURING GENDER SEX
RACE ETHNICITY AGE BODY MASS
INDEX AND EDUCATION.
NEXT SLIDE, PLEASE.
FIVE OF THE STUDIES WERE
COMPARING INTAKE FROM BEFORE TO
DURING THE PANDEMIC.
WHEREAS, FIVE OF THEM WERE JUST
LOOKING AT INTAKE DURING THE
PANDEMIC WITHOUT A COMPARISON.
ONE WAS DOING BOTH OF THOSE
THINGS.
WE SEE ALL OF THE METHODS OF
DIETARY ASSESSMENT WE INCLUDED
THAT ARE REPRESENTED HERE.
AND FOR THE OUTCOMES THAT WERE
INCLUDED IN THE STUDIES, THERE
WERE SIX THAT WERE FOCUSED ON
OVERALL DIETARY INTAKE.
SO, THAT -- AN EXAMPLE OF THAT
WOULD BE THE HEALTHY INDEX
LOOKING AT OVERALL DIET QUALITY
AND FIVE OF THE STUDIES WERE
INCLUDING LOOKING AT DIETARY
COMPONENTS.
AND SOME EXAMPLES ARE SHOWN
THERE LIKE CERTAIN FOOD GROUPS
OR FOOD COMPONENTS LIKE
SATURATED FAT OR LOOKING AT
CERTAIN TYPES OF FOODS LIKE
SUGAR SWEETENED BEVERAGES.
NEXT SLIDE, PLEASE.
SO, OVERALL, AFTER THIS WORK, WE
HAD -- WE DO HAVE SOME
CONCLUSIONS TO THIS WORK THAT WE
CAN DRAW.
ONE OF THE MAIN ONES IS THAT
THERE IS JUST VERY FEW STUDIES
THAT HAVE EXAMINED DIETARY
INTAKES IN HEALTHY INDIVIDUALS
DURING THIS TIME PERIOD.
THIS SUGGESTS THAT NOT ONLY DID
THE PANDEMIC DISRUPT OUR
NATIONAL PUBLIC HEALTH
MONITORING OF NUTRITION AND THAT
SYSTEMATIC COLLECTION AND ALSO
DISRUPTED INDIVIDUAL
INVESTIGATORS AND EVALUATIONS OF
DIETARY INTAKE IN THEIR OWN
STUDIES DURING THIS TIME.
SOME OTHER THINGS WE CAN GLEAN
FROM THIS ARE FROM THE FEW
STUDIES IDENTIFIED. THERE WERE
NONE THAT WERE NATIONALLY
REPRESENTATIVE.
I THINK THAT THIS HIGHLIGHTS THE
VALUE OF OUR SYSTEM THAT WE DO
HAVE TO COLLECT, YOU KNOW,
THROUGH THE NHANES TO GET
POPULATION DIETARY DATA THAT IS
VERY VALUABLE TO US IN PROCESS
OF UPDATING THE DIETARY
GUIDELINES.
IN ADDITION FOR MOST OF THE
STUDIES WE SAW HERE, THEY WERE
USING A CROSS-SECTIONAL STUDY
DESIGN.
THEY HAD VERY SMALL SAMPLE
SIZES.
ONLY, YOU KNOW, REPRESENTING
CERTAIN GROUPS OR CERTAIN
REGIONS OF THE UNITED STATES.
ANOTHER RESULT WE HAVE IS WITHIN
THIS EVIDENCE SCAN THAT MOST OF
THE STUDIES DID NOT SHOW
DIFFERENCES IN TOTAL INTAKE FROM
BEFORE.
COMPARED WITH DURING THE
PANDEMIC OR THEY FOUND INTAKES
TO SIMILAR -- SIMILAR THAT WE
WOULD HAVE EXPECTED BASED ON
NATIONAL PRE-PANDEMIC DATA SETS.
THE DIETARY INTAKES THAT WERE
DOCUMENTED HERE WERE NOT IN
ALIGNMENT WITH THE DIETARY
GUIDELINES FOR AMERICANS.
SOME GREAT THINGS WE CAN SEE IN
THE STUDIES IS THERE WERE SOME
OTHER RELATED OUTCOMES CLEKED
INCLUDING FOOD SECURITY STATUS,
PARTICIPATION AND FEDERAL
NUTRITION ASSISTANCE PROGRAMS
AND FEDERAL POVERTY LEVEL. WE
CAN USE THAT INFORMATION TO
PROVIDE MORE CONTEXT ON HOW THE
PANDEMIC EFFECTED INDIVIDUALS
AND US FAMILIES.
SO, IN CONCLUSION, THEN, WE DID
HAVE INSUFFICIENT RESEARCH TO
WARRANT INVESTIGATION OF FOOD
INTAKE DURING COVID-19 PANDEMIC.
WE CAN'T DRAW BIG CONCLUSIONS
ABOUT US INTAKE DURING THE
PANDEMIC AND ALSO WE DON'T
REALLY HAVE ENOUGH HERE TO DO
FURTHER SYNTHESIS OF THE RESULTS
OR ANY KIND OF RAPID REVIEW OR
SYSTEMATIC REVIEW.
NEXT SLIDE.
BEFORE I MOVE ON THEN, I WANT TO
JUST REALLY THANK THE
INDIVIDUALS WHO HELPED WITH THAT
EVIDENCE SCAN THAT WAS A LOT OF
WORK.
MULLY HIGGINS WAS THE LIBRARIAN
THAT WORKED ON IDENTIFYING ALL
OF THE STUDIES FOR US AND
SPECIAL THANKS TO RAMKRIPA AND
JULIAN AND CAROLYN. NEXT SLIDE.
THIS BRINGS US TO NEXT STEPS AND
A LITTLE TIME FOR DISCUSSION.
NEXT SLIDE, PLEASE.
SO, WHERE -- AS I MENTIONED, WE
ARE STILL WAITING FOR THE
RESULTS TO COME IN FROM THE DATA
ANALYSIS.
WE WILL BE WORKING ON DRAFTING
SUMMARIES OF THE RESULTS FOR THE
COMMITTEE TO REVIEW.
THE COMMITTEE WILL BE ABLE TO
LOOK AT THOSE RESULTS AND
DISCUSS THEM AND DRAFT
CONCLUSIONS.
AND TO DETERMINE THE FUTURE
DIRECTIONS.
I WANT TO ALSO MENTION THAT WE
WILL KEEP OUR DATA ANALYSIS PLAN
UPDATED TO REFLECT NEWER REVISED
ANALYSIS.
AND I FORGOT TO MENTION THAT
WITH REGARD TO THAT EVIDENCE
SCAN THAT I REVIEWED, THE FULL
DESCRIPTIONS OF THAT WILL SOON
BE COMING OUT ON DIETARY
GUIDELINES.GOV.
IT WAS NICE TO BE ABLE TO SHARE
MORE ABOUT THAT AND THOSE
RESULTS THAT ARE COMING OUT IN
THIS TALK TODAY.
SO, AT THIS POINT, I HAVE
CONCLUDED DATA ANALYSIS PORTION.
I THINK THERE IS A LITTLE BIT OF
TIME FOR SOME DISCUSSION OR
QUESTIONS.
>> THANK YOU SO MUCH, HEATHER.
COMMITTEE MEMBERS, FEEL FREE TO
RAISE YOUR HAND AND ASK
QUESTIONS AND PROVIDE COMMENTS.
IT WAS A GREAT PRESENTATION.
GO AHEAD, ANGELA.
>> YEAH. I WANT TO JUST SAY
THIS IS REALLY AMAZING WORK.
IT IS SO EXTENSIVE.
IT IS UNFORTUNATE TO SEE THAT WE
DON'T HAVE ANY STUDIES OF ACTUAL
DIETARY INTAKE DURING SUCH A
MAJOR, YOU KNOW, EVENT OR
OCCURRENCE, YOU KNOW, GLOBALLY
EVEN BUT SPECIFICALLY THAT IS
RELATED TO THE US.
YOU KNOW, IN THIS CONTEXT.
I NOTICE THAT IN THE DIETARY
INTAKES, YOU KNOW, THERE WAS
ABOUT FOUR 24-HOUR RECALLS IN
FOOD RECORDS OR TWO FOOD RECORDS
THAT WAS IN ONE OF ANOTHER
METHOD.
I WAS CURIOUS WHAT THAT METHOD
WAS.
I WAS JUST CURIOUS, WAS IT
SCREENERS?
I WOULD -- I WOULD EXPECT THERE
WAS A LOT OF -- THERE WOULD BE
MORE STUDIES, HONESTLY, WITH
MORE SCREENERS, PARTICULARLY
STUDIES FOCUSED ON FOOD
INSECURITY AND NOTICED THERE
WERE NOT MANY WITH SCREENERS.
>> THANK YOU, ANGELA.
THAT IS A GREAT QUESTION.
YEAH. I CAN SPEAK TO PART OF
THE ANSWER TO YOUR QUESTION.
I MAY NEED A LITTLE HELP FROM
STAFF AS WELL.
SO, WE DID LOOK FOR STUDIES, AS
I MENTIONED THAT HAVE THREE MAIN
METHODS AND WE EXCLUDED STUDIES
THAT WERE JUST USING SOME MORE
KIND OF BRIEF SCREENERS.
THERE WERE A LOT OF STUDIES THAT
WERE USING SCREENERS SO YOU ARE
RIGHT ABOUT THAT.
AND I'M NOT QUITE SURE ABOUT
WHAT THAT OTHER STUDY MAY --
WHAT METHOD THAT OTHER STUDY
MIGHT HAVE INCLUDED AND WHAT I'M
WONDERING IF ANYONE ON THE STAFF
MIGHT BE ABLE TO CHIME IN.
>> DANA AND COLLEEN ARE YOU ABLE
TO SHARE MORE INFORMATION ON
THOSE STUDIES?
THANK YOU.
>> THANK YOU, HEATHER.
I WILL GO BACK TO CONFIRM AND
FOLLOW UP.
I BELIEVE THAT MIGHT HAVE BEEN
REFERRING TO THE ONE NARRATIVE
REVIEW THAT WAS IDENTIFIED THAT
IS BECAUSE IT CONTAINED MULTIPLE
STUDIES THAT WAS REALLY HARD TO
ASSIGN IT TO JUST ONE METHOD
THAT WAS USED.
SO, I BELIEVE THAT MIGHT HAVE
BEEN WHAT IT WAS REFERRING TO.
WE CAN FOLLOW UP WITH YOU TO
CONFIRM THAT, ANGELA.
GREAT QUESTION.
>> THANK YOU. THAT IS HELPFUL
ABOUT THE SCREENERS AND DIDN'T
SEE THAT EXCLUSION.
THAT IS REALLY INTERESTING.
THANKS.
>> OKAY. GO AHEAD, CHERYL.
>> YEAH. I JUST WANTED TO ALSO
SAY THANK YOU FOR THAT BRILLIANT
SUMMARY OF THE ACTIVITIES,
HEATHER.
I, TOO, WAS STRUCK BY THE LACK
OF DATA HERE.
I AM WONDERING IF WE GLEANED
ANYTHING FROM THE COPE
INITIATIVE AND COPE CONSORTIUM
THAT WAS FORMED OR BEING TALKED
ABOUT WHILE THE PANDEMIC WAS
HAPPENING AND CORONAVIRUS
EPIDEMIOLOGY CONSORTIUM AND
THINK THAT ONE OF THE EXPRESSED
GOALS IN THE PUBLICATIONS THAT
CAME OUT WAS TO TRY TO LOOK AT
LIFESTYLE CHANGES AND HOW THEY
MIGHT BE IMPACTING IMPORTANT
OUTCOMES THAT THESE WELL-FUNDED
COHORTS WERE THEN GOING TO TRY
TO COME TOGETHER TO EXAMINE.
IT IS -- CAN YOU GIVE US A SENSE
OF WHETHER OR NOT THAT EVER
MATERIALIZED AND HOW THAT MIGHT
BE INFORMING THE CONCLUSION THAT
WE HAVE DRAWN?
>> SO, I MAY HAVE TO REACH OUT
TO STAFF AGAIN FOR HELP WITH
THIS ONE.
THAT IS ALSO ANOTHER GREAT
QUESTION.
I DO THINK, YOU KNOW, BECAUSE OF
THE -- ONE FACTOR HERE COULD
HAVE BEEN THAT WE NEEDED TO DO
THIS EVIDENCE SCAN STARTING IN
DECEMBER OF 2022.
SO, THERE COULD POTENTIALLY BE
ADDITIONAL STUDIES THAT ARE
STILL COMING OUT AND BEING
PUBLISHED AFTER THAT.
BUT BECAUSE OF OUR NEED TO DO
THIS WORK NOW, WE HAD TO KIND OF
BEGIN RIGHT AWAY.
BUT, OTHERWISE, I DON'T KNOW IF
COLLEEN OR DANA MIGHT NOW KNOW
MORE ABOUT THAT SPECIFIC GROUP
OR STUDY THAT CHERYL WAS
REFERRING TO.
>> I SEE DEANNA HAS HER HAND
RAISED. DID YOU HAVE A COMMENT
ON THAT PARTICULAR STUDY? OKAY.
I SEE DEANNA WENT ON. THANK YOU
DANA DESIL VA.
>> THANK YOU FOR THE QUESTION.
RELATING TO COPE WAS NOT
INCLUDED IN THE EVIDENCE FOR THE
SCAN AND COPY OF THE PAPER WILL
BE PUBLISHED ON COPE BUT JUST
WASN'T INCLUDED AS PART OF THIS
AND CAN TAKE A LOOK TO SEE IF
THERE WAS ANYTHING WE CAN GLEAN.
THANKS.
>> THANK YOU, DANA.
DEANNA?
>> YES. VERY INTERESTING
RESULTS, I THINK.
ONE OF THE QUESTIONS THAT I HAD
FOR YOU ALL, HAVE YOU TALKED
ABOUT RECOMMENDATIONS?
YOU KNOW, WHAT IF THERE IS
ANOTHER DISRUPTION?
YOU KNOW, DO YOU ALL HAVE IDEAS
HOW TO MAKE THE SURVEILLANCE
SYSTEM MORE REBUST TO WITHSTAND
SOMETHING LIKE THIS THAT MIGHT
HAPPEN IN THE FUTURE?
I'M JUST -- I'M CURIOUS ABOUT
THAT.
I'M REALLY -- I REALLY THINK WE
NEED TO LEARN FROM WHAT HAS
HAPPENED DURING THE PAST FEW
YEARS.
>> THANK YOU, DEANNA.
THAT IS A MILLION DOLLAR
QUESTION AND EVEN MORE.
>> YEAH.
>> I DO KNOW THAT THERE -- YOU
KNOW, BECAUSE OF THE PANDEMIC
AND OTHER SITUATIONS WITH REGARD
TO THREATENS TO FUNDING FOR
NHANES THERE IS A LOT MORE
ATTENTION HOW WE CAN STRENGTHEN
NHANES FOR THE FUTURE AND ALSO
TRY TO LOOK AT MANY DIFFERENT
ASPECTS OF OUR SURVEY AND DATA
COLLECTION AND KIND OF BE
MODERNIZING THAT AND ALSO JUST
GAINING SUPPORT AND ATTENTION
FOR HOW MUCH IT REALLY DOES ADD
TO THINGS LIKE THE DIETARY
GUIDELINES PROCESS.
BUT I CERTAINLY OPEN IT UP FOR
OTHERS.
THOSE ARE SOME THOUGHTS I HAD.
>> YEAH. GREAT QUESTION,
DEANNA.
I THINK THAT WE -- WE WOULD LOVE
TO HEAR FROM CDC. YOU KNOW.
THIS WAS OBVIOUSLY THE FIRST
COVID PANDEMIC THAT I KNOW THAT
WE HAD TRUCKS JUST ABOUT TO GO
OUT IN MARCH OF 2020. THEN IT
WAS STOPPED AND WOULD BE
INTERESTING TO HEAR NOW THAT WE
HAVE BEEN THROUGH THIS COULD
SOMETHING CONTINUE?
THAT IS OUT OF MY DEPARTMENT.
GREAT POINT.
I'M SURE. I'M SURE THEY HAVE
TALKED ABOUT IT SO --
ARE THERE ANY OTHER QUESTIONS OR
COMMENTS OR DATA ANALYSIS?
OKAY. THANK YOU SO MUCH.
NOW WE ARE GOING TO TRANSITION
TO THE FOOD PATTERN MODELING
PRESENTATION THAT IS LED BY
CHRIS TAYLOR.
>> GREAT. THANK YOU, AGAIN.
THIS HAS BEEN REALLY EXCITING
PROGRESS ON ALL OF THE WORK.
IT IS KIND OF STRANGE TO FEEL IT
HAS BEEN A YEAR ALREADY.
BUT WE HAVE REALLY ACCOMPLISHED
A LOT.
SO, WHAT I WILL TALK THROUGH IN
THIS PORTION IS THE NEW
PROTOCOLS THAT WE HAVE FOR FOOD
PATTERN MODELING.
NEXT SLIDE, PLEASE.
JUST A REMINDER SUB-COMMITTEES
MAKING UP OUR FOOD PATTERN
MODELING AND DATA ANALYSIS
SUB-COMMITTEE AND GROUP OF
AMAZING MINDS THAT COME TOGETHER
THAT GRAPPLE WITH COMPLICATED
QUESTIONS.
AND ALSO WORKING TOGETHER WITH
THE HEALTH EQUITY WORKING GROUP
THAT HELPED US REALLY KEEP IN
MIND HOW TO ADDRESS THE
VARIABILITY AND DIETARY INTAKES
AND USING THAT WITHIN THE
PROTOCOLS THAT WE DEVELOP.
NEXT SLIDE, PLEASE.
NONE OF THIS WORK WOULD BE
POSSIBLE WITHOUT OUR AMAZING,
AMAZING STAFF THAT REALLY HELP
TO DRIVE THE SHIP FOR US.
SO, IT IS -- IT HAS BEEN A GREAT
PARTNERSHIP BETWEEN THE
COMMITTEE AND STAFF AND REALLY
BEING ABLE TO MAKE ALL THIS WORK
A REALITY.
NEXT SLIDE, PLEASE.
SO, THIS IS THE GRAPHIC THAT WE
HAVE USED PREVIOUSLY THAT YOU
SAW IN THE PREVIOUS MEETING TO
INDICATE THE TYPES OF WORK WE
HAVE DONE AND WHAT OUR
OVERARCHING BLUEPRINT IS FOR
GETTING TO THE ENDPOINT.
I JUST TALKED ABOUT DIET
SIMULATIONS, WHICH, BASED ON THE
QUESTION WE HAD: WHEN WILL DIET
SIMULATIONS AND SIMULATIONS THAT
WILL BE AT THE END.
IN OUR PRIOR PUBLIC MEETING, WE
TALKED ABOUT THE POPULATION
SUBGROUPS AND PROTEIN, DAIRY AND
STAPLE CARBOHYDRATE PROTOCOLS.
CLICK AGAIN, PLEASE.
WHAT I WILL TALK ABOUT NOW WILL
BE VEGETABLES, FRUIT, VEGAN AND
THEN DIFFERENT RANGES OF NEWT
TREENT DENSITY PROTOCOLS.
I WILL WORK THROUGH THE FOUR
PROTOCOLS THAT WE HAVE DEVELOPED
SINCE THEN.
WE JUST DISCUSSED THE DIET
SIMULATIONS.
NEXT SLIDE, PLEASE.
SO, WHAT WE WILL BE LOOKING AT
IS VEGETABLES AND WE WILL START
WITH THE VEGETABLE PROTOCOL AND
MOVE TO THE FRUIT PROTOCOL.
THEN THAT WILL CONCLUDE LOOKING
AT EACH OF THE INDIVIDUAL FOOD
GROUPS AND SUBGROUPS ANALYSIS
FOR OUR OVERARCHING PROPOSED
DIETARY PATTERNS.
THEN WE WILL ALSO LOOK AT THE
VEGAN PROTOCOL AS A DIETARY
APPROACH. FINALLY, AFTER --
AFTER WE GET THROUGH ALL OF THE
INDIVIDUAL GROUPS AND LOOK AT
THE PROPOSED PLANS, WE WILL HAVE
OUR DIFFERENT RANGES OF NEWT
TREENT DENSITY WE EVALUATE.
FINALLY, WE WILL GO WITH NEXT
STEPS IN WHERE WE ARE HEADED.
NEXT SLIDE, PLEASE.
SO, AGAIN, HERE ARE THE
PROTOCOLS THAT WE WILL BE
LOOKING AT.
OKAY.
SO, ONCE AGAIN, WE WILL BE
FOLLOWING OUR SAME PROCESS OF
THE FOOD PATTERN MODELING AND
WHAT OUR RATIONALE IS WE ARE
USING FOR PURPOSE BEHIND EACH
PROTOCOL AND ASSESSMENTS WE WILL
DO AND ANY KEY DEFINITIONS
PERTINENT TO THE ANALYSIS,
ESPECIALLY SINCE SOME OF THE
DEFINITIONS ARE VERY SPECIFIC TO
EACH OF OUR PROTOCOLS THAT WE
DEVELOP.
AS WE MOVE FORWARD, EACH OF THE
PROTOCOLS MAY BE REFINED AND
GETTING FURTHER INTO THE DATA
STARTING TO IDENTIFY WHERE SOME
PATTERNS OR SHIFTS MIGHT HAPPEN
OR THE FURTHER YOU GET DOWN INTO
THE DATA, THE MORE YOU REALIZE
WHAT THE DIFFERENT DECISIONS
MAKE AS FAR AS BROADER
IMPLICATIONS.
WE WILL BE REFINING THESE
PROCESSES AS WE GO.
AND OUR RESULTS FROM INTERIM
ANALYSIS MOVING FORWARD MIGHT
HELP US REFINE PROTOCOLS AND
MAKE THEM MORE POIGNANT TOWARDS
THE ENDPOINT GOAL.
THESE TECHNICAL DOCUMENTS
PROVIDE THAT DETAILS INFORMATION
WHY WE ARE DOING WHAT WE ARE
DOING AND HOW WE WILL IMPLEMENT
THEM.
WE WILL REALLY WALK THROUGH THIS
RATIONALE AND KEY DEFINITIONS
ANALYSIS SUMMARY.
THEN HOW THESE MIGHT DIFFER
BETWEEN PROTOCOLS THEMSELVES.
NEXT SLIDE, PLEASE.
SO, FIRST, I WILL LEAD OFF WITH
THE VEGETABLE PROTOCOL.
NEXT SLIDE, PLEASE.
THE PURPOSE OF LOOKING AT OUR
VEGETABLE PROTOCOL AND VEGETABLE
FOOD GROUP THAT IS COMPRISED OF
A VARIETY OF DIFFERENT PLANT
SOURCES THAT WE ARE LOOKING AT
DARK GREEN AND RED AND ORANGE
VEGETABLES BEANS PEAS AND
LENTILS AND STARCHY VEGETABLES
AND OTHER VEGETABLES AND HAVE
DIFFERENT SUBGROUPS COMBINED TO
CREATE THE VEGETABLE FOOD GROUP.
MANY OF THEM ARE CLUSTERED
TOGETHER BECAUSE OF A VARIETY OF
DIFFERENT NUTRIENTS WITHIN EACH
DIFFERENT SUBGROUP TYPE.
SO, THE VARIETY BECOMES A REALLY
IMPORTANT ASPECT WE ARE
EVALUATING WITH A VEGETABLE.
INTAKES OF DIFFERENT SUBGROUPS
MIGHT BE MODIFIED BASED ON NEED,
BUDGET, CULTURAL OR RELIGIOUS
NORMS AND ARE LOTS OF DIFFERENT
VEGETABLES CONSUMED BY VARIETY
OF GROUPS FOR VARIOUS REASONS
AND OUR PRIOR SYSTEMATIC REVIEWS
HAVE REALLY SHOWN THAT STRONG
LINK BETWEEN DIETARY PATTERNS
INCLUDING VEGETABLES AND OTHER
PLANT-BASED COMPONENTS WITH
LOWER CHRONIC DISEASE RISK AND
AS WE HAVE SEEN HEATHER HAS
SHOWN IN PREVIOUS DATA AND
INITIALLY FROM DATA ANALYSIS
SIZE IS CURRENT DIE INTAKES ARE
BELOW RECOMMENDED INTAKE LEVELS
FOR DIETARY GUIDELINES AND
DIETARY GUIDELINES AND
SYSTEMATIC REVIEWS SHOWING
HIGHER INTAKE OF VEGETABLES AND
OTHER PLANT-BASED PRODUCTS HAVE
HEALTH BENEFITS AND PROVIDE
NUTRITIONAL ADEQUACY AND INTAKE
LEVELS ARE BELOW RECOMMENDED
LEVELS.
PREVIOUS WORK THAT EVALUATED
INTAKES OF AND RECOMMENDED
AMOUNTS IN THE FOOD PATTERNS ARE
BASED ON PREVIOUS AI FOR
POTASSIUM AND THIS IN THE LAT
ITERATION, POTASSIUM AI HAVE
BE
BEEN LOWERED AND THESE HAVE
BEEN USED PREVIOUSLY AND WILL
GET FOLDED INTO OUR WORK.
ULTIMATELY, WHAT WE ARE LOOKING
AT IS WHAT ARE HYPOTHETICAL
MODIFICATIONS IN THE TOTAL
AMOUNT OF VEGETABLES OR
VEGETABLE SUBGROUP TYPES?
HOW DOES THAT MEET POPULATION
NORMS, PREFERENCES AND
NUTRITIONAL NEEDS?
NEXT SLIDE, PLEASE.
SO, OUR OVERARCHING VEGETABLE
QUESTION IS WHAT IS THE
IMPLICATIONS OF NEWT TREE
INTAKES MODIFYING THE VEGETABLE
FOOD GROUP OR SUBGROUP
QUANTITIES AND HEALTHY US DIAL
DIETARY PATTERN? ONCE AGAIN,
THEY WERE INCLUDED IN THE 2020
PLAN AND THE COMPOSITION OF
PROTEIN FOOD OR GREATER -- THAT
WE ARE REALLY LOOKING AT WHAT
THE VEGETABLE COMPONENT
PROVIDES.
AND THIS REALLY ALLOWS US TO
TEST WITHIN GROUPS AND SUBGROUPS
IF FLEXIBILITIES COULD BE
IMPLEMENTED TO MORE EQUITABLY TO
BE CONSIDERED POPULATION NORMS,
PREFERENCES, AND NEEDS ALIGNING
WITH A SYSTEMATIC REVIEW
EVIDENCE.
NEXT SLIDE, PLEASE.
SO, OUR FIRST OBJECTIVE THAT WE
WILL TEST IS REALLY TO TAKE THE
VEGETABLES THAT EXIST WITHIN OUR
CURRENT PLAN AND IDENTIFY THE
GROUPS AND SUBGROUPS THAT
PROPORTIONAL DISTRIBUTION OF THE
CONSUMPTION AND ESTABLISH THE
NUTRITIONAL COMPOSITION OF THE
FOOD GROUP AND SUBGROUPS BASED
ON DATA THAT WE HAVE FROM WHAT
WE IN AMERICA AND FOLLOWING SAME
PATTERN WHAT TYPICAL NUTRIENT
COMPOSITION LOOKING AT RED AND
ORANGE VEGETABLES BASED ON
DISTRIBUTION OF RED AND ORANGE
VEGETABLES LIKE WE DISCUSSED IN
THE DIET SIMULATION PROTOCOL.
WHAT IS NUTRITIONAL COMPOSITION
OF THE FOOD GROUP ALONE AND HOW
IT COMPARES TO THE CURRENT
INTAKES.
NEXT SLIDE, PLEASE.
OUR SECOND OBJECTIVE WILL BE TO
AS WE HAVE DONE WITH ALL OTHER
PROTOCOLS TO INCREMENTALLY
REDUCE VEGETABLE INTAKES FROM
CURRENT RECOMMENDED LEVEL DOWN
TO 0 USING QUARTER CUP
EQUIVALENCE FOR LOWER CALORIE
LEVELS AND 1 CUP EQUIVALENCE FOR
HIGHER LEVEL DIETARY PATTERNS
AND ASSESSING WHAT NUTRITIONAL
IMPLICATIONS ARE FOR
HYPOTHETICAL REDUCTIONS WITHIN
VEGETABLE CONSUMPTION ALL THE
WAY DOWN TO ZERO.
IF YOU GET DOWN TO ZERO AND TAKE
VEGETABLES OUT WHAT ARE
NUTRITIONAL IMPLICATIONS?
HOW DOES THAT HAPPEN AS YOU
REDUCE THAT QUANTITY?
NEXT SLIDE, PLEASE.
THEN OUR FINAL OBJECTIVE WITHIN
THIS GROUP WILL THEN BE TO -- TO
TEST WITHIN THE SUBGROUP
QUANTIFICATIONS AND SHIFTING THE
PROPORTIONS OF SUBGROUP --
SUBGROUP CONTRIBUTIONS TO TOTAL
VEGETABLES THAT WE WILL LOOK AT
THIS IN TWO WAYS.
ONE WILL BE TO -- TO SHIFT THE
PROPORTIONS OF SUBGROUPS,
INCREMENTALLY REDUCE SUBGROUP
QUANTITY AND INCREASE OTHER
SUBGROUPS.
WE WILL ALSO LOOK AT IT FROM A
STANDPOINT OF WHAT IF ALL OF THE
VEGETABLES CAME FROM ONE
INDIVIDUAL SUBGROUP ITSELF?
SO, IT REALLY HELPS US TO ASSESS
WHAT THE VARIETY OF VEGETABLES
LOOKS LIKE AND WHAT HAPPENS WHEN
WE GET MORE VEGETABLES FROM ONE
SUBGROUP VERSUS ANOTHER AND THEY
ARE PUT INTO SUBGROUPS GIVING
LOTS OF NUTRITIONAL DIVERSITY
WITHIN THOSE DIFFERENT SUBGROUPS
AND TESTING THIS INCREMENTAL
PROPORTIONALITY HELPS US TO
REALLY SEE WHERE VARIETY PLAYS A
ROLE IN OUR NUTRITIONAL
ESTIMATES.
NEXT SLIDE, PLEASE.
SO, THAT WILL CONCLUDE OUR NEW
VEGETABLE PROTOCOL.
WE WILL TALK ABOUT THE FRUITS
FOOD GROUP PROTOCOL NEXT.
NEXT SLIDE, PLEASE.
MUCH LIKE VEGETABLES, FRUITS
COME TO US IN A VARIETY OF
DIFFERENT SOURCES THAT MIGHT BE
RAW OR COOKED FRUIT OR CANNED OR
FROZEN OR DRIED AND COME IN THE
FORM OF FRUIT JUICE AND SOME OF
THE TERMINOLOGY THAT MIGHT GET A
LITTLE CONFUSING AT TIMES IS
WHEN WE TALK ABOUT WHOLE FRUIT
VERSUS FRUIT JUICE.
WHOLE FRUIT WOULD THEN BE ANY
FRUIT CONSUMED THAT WASN'T IN A
JUICE FORM 100% JUICE FORM AND
RAW ARE COOKED CANNED OR FROZEN
OR DRY FRUIT REPRESENT THAT IDEA
AND MODIFIED BY NEED AND BUDGET
AND CULTURE AND RELIGIOUS NORMS
AND DRIVING TYPES OF FRUITS THAT
ARE CONSUMED AND AGAIN OUR
SYSTEMATIC REVIEWS AND AMAZING
NSER STAFF HAVE LICHGED
COMPONENTS WITH FRUIT AND
CHRONIC DISEASE RISK AND WITH
VEGETABLES NATIONAL CONSUMPTION
LEVELS ARE BELOW INTAKES FROM
DIETARY GUIDELINES AND WHAT WE
WILL LOOK AT IN MUCH THE SAME
FORM WHAT ARE HYPOTHETICAL
MODIFICATIONS THAT MIGHT HAPPEN
AND FLEXIBILITIES OF FRUIT, TYPE
OF FRUIT CONSUMED, AND THE --
WHAT HAPPENS AS WE REDUCE THE
QUANTITY OF FRUIT IN THE DIET?
NEXT SLIDE, PLEASE.
SO, TO OUR FRUIT QUESTION THAT
WE WILL LOOK FOR A 2025 ANALYSIS
AND WHAT ARE IMPLICATIONS FOR
NUTRIENTS AND QUANTITIES IN THE
HEALTHY US DIETARY PATTERN AND
HERE 2020 HEALTHY US PATTERN FOR
1,000 CALORIES PER DAY IS 1 CUP
EQUIVALENT AND 3,000 CALORIES
2.5 CUP EQUIVALENCE PER DAY TO
GIVE YOU A REFERENCE OF SCALE.
NEXT SLIDE, PLEASE.
SO, MUCH LIKE THE VEGETABLE
PROTOCOL SEEING A PATTERN HERE.
WHAT WE WILL LOOK AT, AGAIN, IS
WITHIN THE FRUIT FOOD GROUP,
WHAT ARE PROPORTIONAL
CONSUMPTIONS OF FRUIT WITHIN THE
WHAT WE EAT AMERICA DATA.
HOW DOES THAT COMPARE TO
INTAKES?
WITH FRUIT, WE DID EXPLORE THE
IDEA OF SUBGROUPS.
AS WE CONTINUE TO -- WE DID
ASSESSMENT TO IDENTIFY SUBGROUPS
MIGHT BE A VIABLE APPROACH THAT
WE DIDN'T SEE ENOUGH OF AN
OVERARCHING PATTERN IN
DIFFERENCES FROM NUTRIENTS FROM
DIFFERENT FRUITS TO CARRY
FORWARD WITH A SUBGROUP ANALYSIS
AND WILL LOOK AT THIS FROM
ENTIRETY OF THE TOTAL FOOD GROUP
FOR THIS ANALYSIS AND WILL DO
THIS FOR AGES 12 TO 23 MONTHS
AND 22 YEARS AND OLDER.
NEXT SLIDE, PLEASE.
OUR SECOND OBJECTIVE, AGAIN,
WILL BE TO INCREMENTALLY REDUCE
QUANTITIES OF FRUIT FROM THE
CURRENT RECOMMENDATION BY ONE
1/2 FOR LOWER LEVELS AND HALF
CUP IMCREMENTS FOR HIGHER LEVELS
AND SEE WHAT INCREMENTAL
REDUCTIONS ARE DOWN TO ZERO TO
WHAT HAPPENS TO THE NUTRIENT
PROFILE REMOVING FRUIT FROM THE
DIETARY PATTERN.
NEXT SLIDE, PLEASE.
OUR FINAL OBJECTIVE IN THE FOOD
GROUP IS SIMILAR TO WAY WE
LOOKED AT VEGETABLES IN
VEGETABLE SUBGROUPS AND WE WILL
LOOK AT IMPLICATIONS OF WHOLE
FRUIT VERSUS FRUIT JUICE.
IN FRUIT JUICE, WE HAVE LESS
FIBER AND SOME OTHER NUTRIENTS
SO THE FORM OF FRUIT VERSUS
FRUIT JUICE MAY HAVE
IMPLICATIONS ON SOME OF THE
NUTRITIONAL GOALS AND CALORIE
INTAKES.
SO, WE WILL LOOK AT THE
PROPORTIONALITY OF WHOLE FRUITS
VERSUS FRUIT JUICE WITHIN THE
PATTERN FOR ROUGHLY 2/3 WHOLE
FRUIT TO HAVE TO AND THEN
PROPORTIONS AND QUARTER CUP
INCREMENTS TO IDENTIFY HOW THE
SHIFTING IN WHOLE FRUIT VERSUS
FRUIT JUICE HAS IMPLICATIONS ON
THE DIETARY PATTERN.
SO, NEXT SLIDE, PLEASE.
AND THAT WILL CONCLUDE LOOKING
AT EACH OF THE PROTOCOLS THAT
LOOK AT EACH OF THE INDIVIDUAL
FOOD GROUPS MAKING UP DIETARY
PATTERNS.
WE TALKED ABOUT GRAINS AND
PROTEIN FOODS IN THE PREVIOUS
AND TALKED ABOUT FRUIT AND
VEGETABLE HERE AND TALKING ABOUT
DAIRY IN THE PREVIOUS.
SO, THE NEXT PROTOCOL IS
SOMEWHAT OF A NEXT STEP FROM THE
MODIFICATIONS IN PROTEIN FOODS
INTAKE WHERE PROTEIN FOODS
ALLOWED US TO SHIFT A LITTLE
MORE OF THE DISTRIBUTIONS OF
DIFFERENT TYPES OF PROTEIN
FOODS.
AND WITH PUBLIC COMMENTS AND A
LOT OF THE CURRENT TRENDS,
SOCIAL MEDIA, ET CETERA,
FOCUSING ON A VEGAN DIETARY
PATTERN, WE WANTED TO GO IN AND
EXPLORE FROM A NUTRITIONAL
COMPOSITION STANDPOINT WHAT A
VEGAN DIETARY PATTERN MIGHT LOOK
LIKE AND WHAT NUTRITIONAL
IMPLICATIONS ARE FOR THE REMOVAL
OF ANIMAL PRODUCTS.
NEXT SLIDE, PLEASE.
SO, AS WE -- AS WE HAVE HEARD IN
MANY OF OUR PUBLIC COMMENTS THAT
HAVE ADDRESSED THESE EMERGING
WITHIN THE LITERATURE, ET CETERA
INTAKE OF ANIMAL SOURCE FOODS
AND BEVERAGES ARE MAYBE MODIFIED
OR ELIMINATED BASED ON PERSONAL
PREFERENCE OR NEEDS OR BUDGET OR
CULTURAL OR RELIGIOUS NORMS.
THERE ARE LOTS OF DIFFERENT
FACTORS DRIVING FOOD SELECTIONS
THAT INDIVIDUALS MAKE.
SO, VEGAN DIETS MIGHT BE ADOPTED
FOR A VARIETY OF REASONS THAT
MIGHT BE ETHICAL CONSIDERATIONS
OR MIGHT BE HEALTH
CONSIDERATIONS OR MIGHT BE
NUTRITIONAL CONCERNS.
ALL OF THOSE DECISIONS AROUND
WHAT WE ADD TO OUR DIETS AND
WHAT WE TAKE OUT HAVE
NUTRITIONAL IMPLICATIONS.
AGAIN, OUR DIETARY CHANGE IS
NEWT OWNIUM AND TAKING SOMETHING
ELSE IT IS ALSO IMPORTANT WHAT
YOU PUT BACK IN AND NATIONALLY
REPRESENTATIVE DATA FOR
INDIVIDUALS FOLLOWING A VEGAN
DIET IS NOT AVAILABLE.
HAVING A SUITABLE AMOUNT OF DATA
TO FULLY ASSESS WHAT A PATTERN
WOULD LOOK LIKE AND WHAT TYPES
OF SUBSTITUTIONS MIGHT BE MADE
AND WITH THE SECOND BULLET OF
VARIOUS REASONS WHY PEOPLE MIGHT
AVOID CERTAIN FOODS AND WHAT
TYPES OF SUBSTITUTIONS ARE MADE
VERSUS EXCLUSIONS MEANS WE DON'T
HAVE NATIONALLY REPRESENTATIVE
STANDARD OR SET OF DATA TO FALL
BACK ON TO REALLY ASSESS SOME OF
THE DECISIONS THAT WOULD BE
USED.
WH
WHAT WE WILL DO TAKING 2010 FOOD
PATTERN ANALYSIS DETERMINED THAT
FORTIFIED FOODS ARE NECESSARY TO
MEET SPECIFIC RECOMMENDATIONS
AND IS A CHANGE IN FOODS
AVAILABLE SINCE THAT TIME AS
WELL AND OUR OVERARCHING
OBJECTIVE HERE IS ASSESSING
MEETING NUTRIENT GOALS WITHIN OR
MOVING AND/OR REPLACING FOOD
GROUPS SUCH AS A VEGAN DIET THAT
WILL BE THE FRAMEWORK WE USE
MOVING FORWARD HERE.
NEXT SLIDE, PLEASE.
SO, THIS SLIDE SHOWS THE CURRENT
QUANTITIES FOR DAIRY AND
FORTIFIED SOY ALTERNATIVES
PROTEINS FOODS AND EGGS FROM
2000 CALORIE OF HEALTHY
VEGETARIAN DIETARIAN PATTERN
HEALTHY VEGETARIAN DIETARY
PATTERN WILL SERVE AS OUR
FOUNDATION TO START FOR THE
ANALYSIS THAT WE WILL DO HERE.
ANIMAL SOURCES OF FOODS AND
BEVERAGES CONTRIBUTING TO DAIRY
AND FOOD AND FORTIFIED SOY
ALTERNATIVES PROTEINS AND
SUBGROUPS ARE REMOVED WITH
ANALYSIS WITH PLANT-BASED
SOURCES FOR OUR TEST FOR
ANALYSIS THAT WILL BE APPLIED TO
THE HEALTHY VEGETARIAN PATTERN
AND CAN THE HEALTHY VEGETARIAN
PATTERN, CAN WE ADOPT THIS FOR A
VEGAN DIETARY PATTERN?
SO, THE HEALTHY VEGAN OR THE
HEALTHY VEGETARIAN DIETARY
PATTERN WILL BE BASE AS I
MENTIONED AND PATTERN WAS USING
NATIONALLY REPRESENTATIVE DATA
FROM THE SELF-IDENTIFIED
VEGETARIAN INDIVIDUALS FROM
NHANES2007 TO 2010.
THE FOUNDATION WE WILL USE FROM
THE HEALTHY VEGETARIAN DIET WAS
FROM THE US NATIONAL DATA.
NOW, WE WILL TRY TO TAKE IT TO
THE NEXT STEP FOR ASSESSING FOR
REMOVAL OF ANIMAL PRODUCTS.
NEXT SLIDE, PLEASE.
SO, A FEW QUICK DEFINITIONS.
FOR THE PURPOSE OF OUR ANALYSIS,
A VEGAN DIET WILL INCLUDE
SOURCES OF THESE AND INGREDIENTS
THAT CONTRIBUTE TO FOODS AND
SUBGROUPS AND WILL EXCLUDE
ANIMAL SOURCE FOODS AND
INGREDIENTS CONTRIBUTING TO
FOODS AND SUBGROUPS.
SO, ANIMAL SOURCE INGREDIENTS
DON'T CONTRIBUTE TO FOOD GROUPS
AND SUBGROUPS LIKE GELATIN, LARD
AND HONEY WON'T BE CAPTURED TO
PROFILES NOT CONTRIBUTING TO
FOOD GROUPS FROM FOOD MODELING
PATTERN DISCUSSIONS TALKING
ABOUT FOODS USED TO CREATE AND
CONTRIBUTE TO FOOD GROUPS
THEMSELVES.
BUT THE -- SOME OF THE
UNDERLYING FOODS ARE INGREDIENTS
LIKE GELATIN, LARD AND HONEY
DON'T FALL INTO THE PATTERN AS
IT CURRENTLY EXISTS. BY NATURE,
THEY WILL ALREADY BE OUTSIDE OF
THE PURVIEW OF THE WAY THAT
ANALYSIS IS CONDUCTED AND
ANOTHER IMPORTANT CONSIDERATION
AS WE LOOK AT THESE ANALYSIS IS
THE SHIFT IN THE MARKETPLACE AND
NEW -- THE NEWER PLANT-BASED
MEAT ALTERNATIVES THAT EXIST
FROM WORK THAT WE ARE LOOKING AT
CURRENTLY THAT WE ARE ALSO
SEEING THE VAST DIFFERENT
SOURCES OF ESSENTIALLY MEAT
ALTERNATIVES MADE FROM PLANTS
THAT HAVE A VARYING NUTRITIONAL
COMPOSITION THAT YOU HAVE SOME
PRODUCTS THAT ARE PLANT-BASED
MEAT ALTERNATIVES DEVELOPED TO
BASICALLY MIMIC ANIMAL SOURCE
PROTEIN FOODS FROM A TASTE,
FEEL, NUTRITIONAL COMPOSITION.
OTHERS ARE MADE PRIMARILY TO BE
A -- A PLANT-SOURCE PROTEIN FOOD
THAT IS ONLY BASED ON JUST BEING
MADE FROM PLANTS.
SO, IS IT KIND OF AN ANIMAL
PROTEIN MIMICKING MEAT
ALTERNATIVE VERSUS MEAT
ALTERNATIVES MADE FROM JUST
PLANTS THEMSELVES THAT IS AN
IMPORTANT CONSIDERATION AS WE
CARRY FORWARD.
NEXT SLIDE, PLEASE.
SO, OUR FIRST OBJECTIVE FOR
OBJECTIVES WORKING THROUGH THE
VEGAN PROTOCOL IS TO COMPARE THE
NUTRITIONAL CONTRIBUTION OF
PLANT SOURCE PROTEIN FOOD
SUBGROUPS AND THE NUTS AND SEEDS
AND SOY PRODUCTS, BEANS, PEAS,
AND LENTILS WILL ALLOW US TO
UNDERSTAND WHAT SIMILARITIES AND
DIFFERENCES ARE BETWEEN
NUTRIENTS PROVIDED BY EACH OF
THE SUBGROUPS AND BASED ON
RESULTS, NUTRIENT PROFILES FOR
PLANT-SOURCE PROTEIN FOOD
SUBGROUP MIGHT BE MODIFIED FOR
SUBSEQUENT ANALYSIS WITHIN THE
PROTOCOL ITSELF AND REALLY THEN
CREATING A NEWER NUTRITIONAL
CONTRIBUTION FOR SUBGROUPS AFTER
REMOVAL OF THE ANIMAL-BASED
PROTEIN FOOD PRODUCTS.
NEXT SLIDE, PLEASE.
OUR SECOND OBJECTIVE WILL THEN
BE ANALYSIS OF PLANT-BASED MEAT
ALTERNATIVES AND THERE ARE LOTS
OF PRODUCTS OUT IN THE
MARKETPLACE.
SO, WHAT WE WANT TO BE ABLE TO
EVALUATE ARE WHAT ARE THE
PLANT-BASED MEAT ALTERNATIVES
THAT ARE AVAILABLE?
WE WILL LOOK AT PRE-PANDEMIC
NHANES AND WHAT WE EAT AMERICA
DATABASES THAT PREDATES LOTS OF
NEWER MEAT ALTERNATIVES WE ARE
SEEING IN THE MARKET NOW.
WHAT WE EAT AMERICA DOES AN
AMAZING JOB BEING ABLE TO
CAPTURE NUTRIENT INTAKE AND
REALLY GIVE US NUTRIENT
ESTIMATES THAT ARE BASED ON THE
DIETARY DATA OF THE TIME.
BUT, IT IS UNABLE TO BE ABLE TO
KIND OF FORESEE WHAT IS COMING
IN THE FUTURE.
SO, THE PURPOSE OF THIS
OBJECTIVE WOULD BE TO REALLY
EXAMINE SIMILARITIES AND
DIFFERENCES BETWEEN DIFFERENT
PLANT SOURCE PROTEIN FOODS THAT
EXIST AND TO BE ABLE TO INFORM
OUR NEXT STEPS FOR ANALYSIS.
NEXT SLIDE, PLEASE.
OKAY. THEN OUR THIRD OBJECTIVE
WILL BE TO EVALUATE THE
IMPLICATIONS ON NUTRITIONAL
GOALS AND REMOVING EGGS AND EGG
SUBGROUP AND DAIRY FORTIFIED SOY
GROUP AT THE CALORIE LEVELS FROM
HEALTHY VEGETARIAN.
SO, WHAT HAPPENS WHEN WE REMOVE
THOSE AND EVALUATE NUTRITIONAL
IMPLICATIONS FROM JUST REMOVAL
OF EGGS AND DAIRY FROM THE
DIETARY PATTERNS AND PURELY AS A
REMOVAL WITHOUT SUBSTITUTION.
THE NEXT SLIDE, PLEASE.
IS TO DO MORE OF A MODIFICATION
AND REPLACEMENT ASSESSMENT IN
THE OBJECTIVE TO REPLACE EGGS
WITH PLANT-SOURCED PROTEIN FOODS
OR OTHER FOOD GROUPS REPLACING
DAIRY WITH FORTIFIED NONDAIRY
ALTERNATIVES INFORMED FROM DAIRY
PROTOCOL AND EVALUATE NUTRITION
IMPLICATIONS OF SUBSTITUTION OF
PLANT-BASED OR ANIMAL-BASED
PROTEIN SOURCES WITH PLANT-BASED
PROTEIN SOURCES TO ALLOW US TO
SEE WHAT HAPPENS WHEN
SUBSTITUTIONS ARE MADE AND HOW
DO SUBSTITUTIONS IMPACT
NUTRITIONAL GOALS?
NEXT SLIDE, PLEASE.
SO, OUR LAST PROTOCOL IS TALKING
ABOUT DIFFERENCE AND DIFFERENT
RANGES OF NUTRIENT DENSITY AND
THIS WILL THEN FOLLOW. IF YOU
REMEMBER, ONCE WE DO ALL OF THE
DIETARY PATTERNS AND INDIVIDUAL
ELEMENTS THAT WE WILL HAVE OUR
PROPOSED DIETARY AND BE ABLE TO
MAKE OUR STEP TOWARDS PROPOSED
DIETARY PATTERNS AFTER DOING
SUBGROUP ANALYSIS AND VEGAN AND
LOW CARB PROTOCOLS, NEXT STEP
WILL BE TO EVALUATE RANGES OF
NUTRIENT DENSITY.
REALLY TO HELP US TO FULLY
UNDERSTAND AND KIND OF
COMMUNICATE ABOUT NUTRIENT
DENSITY IN THE PATTERNS AND
DIETARY PATTERNS WILL INCLUDE --
NEXT SLIDE, PLEASE.
DIETARY PATTERNS WILL INCLUDE AN
AMOUNT OF REMAINING CALORIES
AFTER YOU MEET THE NUTRIENT
NEEDS FROM OUR NUTRIENT-DENSE
FOODS.
AND SO ONCE WE HAVE MET OUR
QUANTITATIVE FOOD GROUP
RECOMMENDATIONS THERE WILL BE A
NUMBER OF REMAINING CALORIES
WITHIN THAT PROTOCOL.
CALORIES ARE LIMITS AND CALORIES
FOR OTHER USES.
SO, THESE ARE ONLY AVAILABLE
WHEN FOODS OR BEVERAGES THAT ARE
SELECTED FROM MEETING YOUR
INDIVIDUAL FOOD GROUP GOALS ARE
IN NEWT TREENT DENSE FORMS AND
ANALYSIS WILL EXPLORE REMAINING
CALORIES AND USES COULD BE USED
IF FOOD GROUP GOALS AND SUBGROUP
GOALS ARE MET.
THIS WILL BE, AGAIN, CONDUCTED
AFTER DRAFT PATTERNS ARE
PROPOSED BY THE COMMITTEE AND
HAVE DONE THE PRIOR PROTOCOL
WORK.
NEXT SLIDE, PLEASE.
OKAY. SO, OUR QUESTION HERE,
THEY ARE WHAT ARE QUANTITIES OF
FOODS AND BEVERAGES AND LOWER
DENSITY CAN BE ACCOMPLISHED IN
DIETARY PATTERNS WHILE MEETING
NUTRITIONAL GOALS WITHIN THE
CALORIE LEVELS?
FROM 2020US HEALTHY STYLE
DIETARY PATTERN, YOU WILL SEE
HERE CALORIES FOR OTHER USES
FROM THE FOOD PATTERN MODELING
ANALYSIS.
ONCE THE NUTRIENT-DENSE FOODS
WERE USED TO MEET EACH OF THE
RECOMMENDED INTAKE LEVELS, YOU
CAN SEE THE VARIETY OF RANGE OF
CALORIES FOR OTHER USES AFTER
THE FOOD GROUP CONSUMPTION HAS
BEEN MET AND RANGE THAT WE WILL
SEE.
WE WILL CONDUCT THIS WORK,
AGAIN, AFTER WE HAVE DEVELOPED
OUR DRAFT DIETARY PATTERNS TO
IDENTIFY WHAT THOSE ADDITIONAL
CALORIES FOR OTHER USES WOULD BE
AND USE THAT TO INFORM OUR NEXT
STEPS.
SO, NEXT SLIDE, PLEASE.
SO, OUR FIRST OBJECTIVE WILL BE
TO EXAMINE THE VARIATION AND
RANGE OF THOSE LIMITS ON
CALORIES FOR OTHER USES.
WE WILL BE ABLE TO CALCULATE
THESE AT EACH OF OUR ENERGY
LEVELS FOR THE TOTAL POPULATION
OF THE 12 MONTHS AND OLDER
MEETING EACH OF THE CALORIE
LEVELS WITH THE PLAN AND
IDENTIFYING WHAT THE LIMITS OF
CALORIES FOR USES WOULD BE FOR
TOTAL POPULATION AND LOOK AT
OTHER POPULATION GROUPS LOOKING
AT THEM BY RACE AND ETHNICITY AS
HEATHER JUST DISCUSSED
PREVIOUSLY LOOKING AT
NON-HISPANIC BLACK AND
NON-HISPANIC ASIAN AND
NON-HISPANIC WHITE AND HISPANIC
THAT HAS DATA WITHIN THE NHANES
ITSELF AND WILL ALSO LOOK AT
THEM BASED ON PERCENT OF POVERTY
INCOME RATIO TO ALLOW US TO
ADDRESS MANY DIFFERENT
DIFFERENCES THAT WE MAY SEE
BASED ON DIETARY PATTERNS AS
THEY EMERGE AND WILL BE ABLE TO
LOOK AT THE TOP LINE AS WHAT IT
WOULD BE FROM THE CURRENT TOTAL
POPULATION AND SEE ALSO WHAT THE
RANGE IS ACROSS OUR DIFFERENT
POPULATION GROUPS THAT WE WILL
BE ABLE TO ASSESS THAT WILL HELP
US UNDERSTAND THAT RANGE OF
CALORIES A LITTLE MORE.
NEXT SLIDE, PLEASE.
THEN OUR SECOND OBJECTIVE WILL
BE TO EXAMINE IMPLICATIONS ON
MEETING GOALS AND STAYING WITHIN
CALORIES SATURATED FAT AND ADDED
SUGAR LIMITS WHEN DIFFERENT
CHOICES ARE MADE AND OBJECTIVE 2
IS A SIMPLE COMPARISON OF SOY
AND FORTIFIED SOY ALTERNATIVES
FOR HIGHER FAT AND YOGURT
CONSUMPTION AND WHAT IF WE USE
WHOLE MILK REDUCED FAT MILK
FLAVORED MILK AND MODIFICATIONS
FOR YOGURT WHAT IMPLICATIONS FOR
NUTRIENT PROFILE FOR OTHER
VERSIONS OF OR PARAMETERS USED
FOR MILK AND DAIRY CONSUMPTION
GIVING CONTEXT IN SYNTHESIS FOR
SUBSEQUENT ANALYSIS.
NEXT SLIDE, PLEASE.
FOR OUR OBJECTIVE 3 WE WILL
EXAMINE IMPLICATIONS FOR
NUTRIENT INTAKES AND CALORIE
USES FOR GOALS EXCEPT IN SOY AND
DAIRY ALTERNATIVE WITHOUT USING
NUTRIENT-DENSE CHOICES AND WILL
SEE VARIOUS EXAMPLES OF TYPES OF
SUBSTITUTIONS WE MIGHT USE
WITHIN THIS TO IDENTIFY WITHIN
FOOD GROUPS AND USING FOODS THAT
ARE RELAXED WITH CRITERIA FOR
NUTRIENT DENSE AND HOW IT HAS AN
IMPLICATION FOR SELECTING FOODS
HIGHER WITH SATURATED FAT AND
HIGHER SUGARS TO OVERALL
NUTRIENT PROFILE. NEXT SLIDE,
PLE
PLEASE.
4TH OBJECTIVE EXAMINES
IMPLICATION ON NUTRIENT INTAKES
FOR USES WITH FOOD GROUPS ARE
HELD CONSTANT USING NUTRIENT
DENSE PROFILE AND ADDITION OF
FOOD GROUPS WE PREVIOUSLY
EXCLUDED IN FIRST PROTOCOL.
ALCOHOL SUGAR SWEET BEVERAGES
COFFEES TEAS CANNEDEES AND SUGAR
AND INCLUDING THOSE WITHIN
DIETARY PATTERN HOLDING NUTRIENT
DENSE FOODS WITHIN FIVE FOOD
GROUPS. NEXT SLIDE, PLEASE.
FINAL OBJECTIVE WITHIN THIS WILL
BE THE ADDITION OF FOODS AND
BEVERAGES THAT COULD BE PARTIAL
CONTRIBUTORS TO FOOD GROUPS AND
DESSERTS AND SWEET SNACKS
BREAKFAST CEREALS AND BARS AND
CONTRIBUTE SO THAT FOODS THAT
MAY HAVE BEEN REMOVED IN OUR
EARLIER STEPS FROM LOOKING AT
NUTRIENT DENSE VERSIONS FROM
INITIAL BASIS PROTOCOL AND
SEEING WHAT HAPPENS AS THOSE
FOODS ARE REINTRODUCED TO THE
FOOD PATTERN MODELING EXERCISE
AND WHAT IMPLICATIONS ARE FOR
NUTRIENT AND MEETING NUTRIENT
GOALS AND CALORIE LEVELS.
NEXT STEPS OR SLIDE, PLEASE.
ONE MORE. WE ARE WORKING
TOWARDS ANALYSIS ON PREVIOUS
PROTOCOLS WE HAVE PRESENTED.
OUR BASIS PROTOCOL AND
POPULATION SUBGROUPS PROTOCOLS
AND ANALYSIS IS FINALIZED TO
INFORM SECOND STAGE THAT WILL
DEVELOP LOW CARBOHYDRATE
PROTO
PROTOCOL.
MOVING FORWARD TOWARDS DIFFERENT
RANGES OF NUTRIENT DENSITY AND
DIET SIMULATIONS AND PLANS FOR
MEETING 5 ARE REALLY LOOKING AT
ANALYSIS DETAILED IN LOTS OF
PROTOCOLS WE PRESENTED IN
PREVIOUS AND IN THIS CURRENT
MEETING.
FROM THAT WE CAN MOVE TO
DISCUSSION AND QUESTIONS.
>> WOW. REALLY EXCITING WORK.
HAPPY TO TAKE QUESTIONS AND
COMMENTS FROM THE COMMITTEE.
CHRISTOPHER.
>> LOTS OF MAYBE -- I WILL TAKE
TURNS OR KEEP GOING UNTIL
SOMEBODY'S HAND GOES UP.
MINDBLOWINGLY FUN, CHRIS. SUPER
EXCITING AND FIRST QUESTION
WOULD BE HOW OFTEN I SAW
D.A.R.E..IAN FORTIFIED SOIL
ALTERNATIVES GROUPED TOGETHER
SPECIFICALLY FOR VEGAN
CATEGORIES AND SEEMED ODD THAT A
MODEL WOULD LOOK AT REPLACING
DAIRY AND FORTIFIED SOY WITH
VEGAN OPTIONS AND FORTIFIED SOY
IS A VEGAN OPTION. THAT
CONFUSED ME A LITTLE. CAN YOU
CLARIFY?
>> IT IS MORE OF A SHIFT IN
DISTRIBUTION AND SOURCE.
AND PARTIALLY FROM A NAMING
NOMENCLATURE STANDPOINT WHAT
SUBGROUP IS AND STAFF MIGHT NEED
TO SUPPORT ME MORE IN THIS AS WE
MOVE FORWARD AND WOULD BE USING
FORTIFIED ALTERNATIVES AS
OPPOSED TO THE ANIMAL-BASED
DAIRY IN THAT.
SO, IT WILL BE REMOVAL OF THE
ANIMAL PRODUCT.
>> THAT MAKES SENSE AND IS NOT
THE WAY IT LOOKED LIKE IT WAS
WRITTEN NOW.
GOOD.
I WILL SAY THAT IS THE CURRENT
NAME OF THE GROUP, DAIRY PLUS
SOY ALTERNATIVES SINCE SOY HAS
BEEN APPROVED IN THE DAIRY GROUP
AND AGREED THAT IT WOULD BE
VEGETABLE SOURCES REPLACING
ANIMAL SOURCES.
>> YEAH.
>> OKAY. LET'S SEE. MONTH MORE
HANDS YET. TOWARDS END --
ANGELA, GO AHEAD. I WILL TAKE
MY TURN LATER.
>> I CAN WAIT.
>> OKAY. STOP ME WHEN READY.
COFFEES AND TEAS WAS IN THERE.
COFFEES AND TEAS RANGE SO MUCH
IN MATERIALS OF ADDED DAIRY AND
SUGAR REPLACING WITH BLACK
COFFEE AND GREEN TEA AND BLACK
COFFEE WITH LITTLE TEA AND
LITTLE SUGAR AND BLACK COFFEE
AND TEA WITH BUCKETS OF DAIRY
AND SUGAR SO MUCH IT IS COFFEE
AND TEA FLAVORED DAIRY AND ADDED
SUGAR WILL YOU BE ABLE TO
ACCOUNT FOR THAT?
>> WITH FOODS TAKEN DOWN TO
COMPONENTS, TAKING BACK TO
DISAGGREGATING TO REP FOODS WILL
HELP ADDRESS CONCERNS AND
GETTING DOWN TO RECIPE LEVEL AND
I SEE HER THERE READY TO SUPPORT
ME IN STEPS AND HOW IT WILL
CARRY FORWARD.
>> I WAS GOING TO SAY CHRIS WE
CAN LOOK AT HOW SOME MIGHT BE
CATEGORIZED IN MORE SIMILAR
GROUPINGS OF COMPOSITION BASED
ON WHAT IS INCLUDED IN COFFEE OR
TEA BEVERAGE.
>> THANK YOU.
>> LOWER DENSITY VEGAN DIET AND
HIGHER DENSITY VEGAN DIET WILL
THAT BE PART OF IT CAN YOU --
>> THAT IS AN IMPORTANT PART OF
REASON AND RATIONALE BEHIND
DOING THE ANALYSIS IS REMOVAL
AND SUBSTITUTION ARE VERY
DIFFERENT CONCEPTS.
SO, WE ARE STARTING WITH HEALTHY
VEGETARIAN PATTERN IDENTIFYING
WHAT WOULD HAPPEN WITH REMOVAL
AND WHAT WOULD HAPPEN WITH
SUBSTITU
SUBSTITUTION.
AND HOW DOES THAT PLAY OUT IN
NUTRIENT ADEQUACY AND MEETING
THOSE NUTRIENT GOALS?
AS YOU SAID, THERE ARE VARYING
REASONS WHY SOMEBODY WILL MAKE
THE DECISIONS AND SUBSTITUTIONS
FOR FOOD DECISIONS MAY BE DRIVEN
BESIDES THINGS BEYOND
NUTRITIONAL ADEQUACY OR HEALTH
OUTCOMES AND THIS DATA GIVES A
CHANCE TO UNDERSTAND WHAT
HAPPENS WHEN REMOVALS HAPPENS
BASED ON HEALTHY VEGETARIAN
PATTERN AND IT -- AT THE SAME
TIME WE HAVE TO DO THIS AND
DON'T HAVE A NATIONAL SET OF
DATA HELPING US SAY VEGETARIANS
OR WHAT VEGANS WILL NORMALLY DO
AS A SUBSTITUTION PATTERN AND
HAVE TO TEST SOME OF THESE
DIFFERENT SCENARIOS AND NOT SET
OF NHANES DATA VEGAN AND WHAT
THEY WILL TYPICALLY EAT FOR
PROTEIN FOODS TYPE OF PORTION
AND STARTING WITH HEALTHY
VEGETARIAN AND BE ABLE TO
IDENTIFY WHAT ARE MEAT
ALTERNATIVES AND WHAT
NUTRITIONAL PROFILES WILL LOOK
LIKE AND HOW DOES REDISTRIBUTING
PROTEIN FOODS LOOK DIFFERENTLY
IF YOU TAKE OUT THE ANIMAL
SOURCES.
>> THANK YOU. GREAT. REALLY
EXCITING.
>> ANGELA?
>> YEAH. I HAVE ACTUALLY JUST
SOME BASIC CLARIFICATION
QUESTIONS.
I WAS REALLY EXCITED ABOUT THE
VEGETABLE PROTOCOL AND FRUIT
PROTOCOL.
I MEAN, IT IS PHENOMENAL TO
THINK ABOUT JUST -- YOU KNOW,
AROUND FOOD SELECTIVITY, IF YOU
GET A CERTAIN -- YOU KNOW, WHAT
MIGHT BE THE IMPLICATIONS OF
CHOOSING CERTAIN TYPES OF FRUITS
OR VEGETABLES.
I JUST -- I'M SO EXCITED ABOUT
THAT.
JUST TO SEE WHAT THE RESULTS
WILL BE.
ONE THING I WASN'T QUITE SURE I
UNDERSTOOD IS THAT AS YOU REDUCE
THE FRUITS OR VEGETABLES LIKE IF
YOU GET DOWN TO NO FRUIT OR
VEGETABLE, IS EVERYTHING ELSE
HELD CONSTANT?
IF SO, WHAT ARE YOU DOING WITH
CALORIES?
I GUESS I GOT CONFUSED ABOUT
THAT.
COULD YOU CLARIFY THAT MORE IF
YOU TAKE OUT THAT FOOD GREW ARE
YOU REPLACING IT OR IS IT
DISPLACED WITH OTHER FOODS OR IS
IT ESSENTIALLY A CALORIE
REDUCTION AS WELL?
>> IT WOULD BE A CALORIE
REDUCTION AS WELL.
WHAT WE ARE DOING IS LOOKING AT
EACH OF THESE FOOD GROUPS IN A
SILO.
BECAUSE WITHIN THE TOTAL
PATTERN, EACH TOTAL PATTERN WILL
BE PUT TOGETHER BASED ON EACH
ONE OF THE FOOD GROUPS AND IF
YOU REMOVE THE FOOD GROUPS YOU
ARE REMOVING NUTRIENTS.
IT ALLOWSTOUS SEE EVERY TIME YOU
TURN THE KNOB ON FRUITS DOWN TO
ZERO WHAT DOES IT DO TO THE
CALORIE LEVEL OR NUTRIENTS THAT
GO AWAY?
WHAT THAT MEANS IS EVERY TIME
YOU REDUCE, DON'T MEET OR
EXCLUDE A FOOD GROUP, YOU ARE
EXCLUDING THE CALORIES AND
NUTRIENTS FROM THAT, THAT THEN
MEANS THAT MODIFICATIONS HAVE TO
HAPPEN DOWNSTREAM.
AND JUST LIKE DR. GARDNER'S
QUESTIONS HERE ABOUT THE VEGAN
DIET IS WHEN YOU TAKE SOMETHING
AWAY IT IS JUST AS IMPORTANT AS
WHAT YOU PUT BACK.
AS WE TURN KNOBS DOWN TO ZERO,
IT DOESN'T MEAN THAT OUR DIETARY
PATTERN WILL SAY ACTUALLY YOU
CAN STILL MEET ALL YOUR FRUIT
RECOMMENDATIONS IF YOU TURNED
OFF OTHER VEGETABLES AND WE ARE
STILL FINE AND YOU DON'T NEED
THOSE AND THAT IS NOT THE
IMPLICATION AND HELPS US
IDENTIFY AS YOU GO DOWN TO THE
LEVEL OF ZERO, WHAT ARE REAL
IMPLICATIONS OF THE FOOD GROUP
TO THE TOTAL PLAN?
SO, IT REALLY HELPS US TO KIND
OF ISOLATE THAT WE ARE DOING A
MASSIVE JIGSAW PUZZLE AND
MASSIVE JIGSAW PUZZLE IS BASED
ON ALL OF THE INDIVIDUAL PIECES
THAT ARE PUT TOGETHER THAT MAKE
UP ALL OF THE DIFFERENT FOOD
GROUPS AND SO THAT LET'S US
ACROSS ALL OF THE DIFFERENT
PROTOCOLS AND SEE WHAT HAPPENS
WHEN YOU START TO CHANGE ALL OF
THE KNOBS AND IDENTIFY NUTRIENT
VALUE AT THE END.
>> THANK YOU, CHRIS. THAT IS
REALLY HELPFUL.
>> HE IS BACK.
>> BUILDING ON ANGELA'S COMMENT.
AS YOU REDUCE BY A QUARTER OR
HALF A CUP EACH TIME ARE YOU
STARTING AT US DIET OR FIVE
SERVINGS A DAY TYPE OF THING?
>> STARTING AT CURRENT PATTERN.
>> CURRENT PATTERNS ARE ALREADY
LOW. IS THERE ANY POSSIBILITY
OF GOING UP A QUARTER OR HALF A
CUP?
ALL I SAW WAS REDUCING OPPOSED
TO IF GOAL IS TO HAVE THEM
INCREASED I WOULD IMAGINE THAT
YOU WOULD ALSO MODEL GOING UP.
IS THAT -- IS THAT WITHOUT
DISPLACEMENT AND WITHOUT ADDING
CALORIES AND OH, SO MANY
CALORIES ADDING SO MANY VEGGIES
AND FRUITS AND GAINING WEIGHT
AND THERE IS LOTS TO TAKE INTO
CONSIDERATION AND BALANCE.
HOW WILL IT BE HANDLED?
>> I SAW THAT REBECCA UNMUTED.
GO FIRST.
>> I WAS MAKING SURE WE WERE
TALKING ABOUT THE SAME PATTERN.
WE WILL START WITH THE HEALTHY
US STYLE DIETARY PATTERN. THE
RECOMMENDED QUANTITIES NOT
CURRENT DIETARY INTAKE
QUANTITIES.
I DON'T KNOW IF THAT CLARIFIES
THE QUESTION.
I THOUGHT THAT I HEARD A
MISUNDERSTANDING IN THE TWO.
>> SOUNDS GREAT TO SORT OF BACK
UP.
ISN'T THERE -- WE HAVE ALSO --
IF YOU LOOK AT THE
RECOMMENDATION, I MEAN,
SOMETIMES IT IS FIVE A DAY OR
SOMETIMES FIVE TO 9.
I CAN'T REMEMBER WHAT THE
CURRENT US RECOMMENDATIONS ARE
IN TABLES AND THEY ARE GREAT AND
WOULD YOU GO UP IN NINE OPPOSED
TO GOING UP ZERO?
>> ESTABLISHED IN CALORIE LEVELS
THEMSELVES AND WOULD BE
PROPORTIONALITY AND SAME WAY
THAT THE HEI HEALTHY EATING
INDEX SCORE IS PROPORTIONAL TO
CALORIES THAT IF YOU EAT MORE
CALORIES YOU WILL ALSO NEED TO
PROPORTIONALLY EAT MORE THEN IT
IS TO YOUR POINT KIND OF I MET
MY 4 AND NOW I CAN EAT WHATEVER
I WANT. IT DOESN'T MATTER AND
NOW I MET FOUR AND CAN EAT
WHATEVER AND WHERE IT IS BASED
ON CALORIE LEVEL THE FOOD GROUPS
THAT ARE PROPORTIONALLY SET UP.
YOU HAVE A NUTRIENT-DENSE
DIVERSE DIET AT EVERY STAGE OF
THE CALORIE LEVEL THAT YOU WILL
CONTINUE TO PROPORTIONALLY EAT
THE SAME WAY WITH MORE CALORIES
NOT I CAN NOW MEET SOME MINIMUM
CRITERIA OF ALL RIGHT I ONLY
NEEDED THREE GRAINS OR WHATEVER
AND CAN EAT WHAT I WANT AND GET
ALL FRUIT OR VEGETABLE. THOSE
IMPLICATIONS ARE AS YOU START TO
MOVE EXTRA CALORIES TO OTHER
FOOD GROUPS IT HAS NUTRITIONAL
IMPLICATIONS AND KEEPING A
PATTERN VERY DIVERSE AND
PROPORTIONAL HELPS TO MEET THE
NUTRIENT NEEDS ACROSS THE
DIFFERENT GROUPS AND STAYING
WITHIN CALORIE LEVELS.
>> GO AHEAD, ANGELA.
>> OKAY. DON'T KILL ME. THIS
IS A QUESTION.
THAT GOES BACK TO WHAT YOU
PRESENTED BEFORE ABOUT THE EAR
POPULATION-BASED.
AT THE END OF THIS, WILL IT BE A
SAMPLE, YOU KNOW, THINGS TO
THINK ABOUT THE EAR OR
ESSENTIALLY IS IT BASICALLY
LOOKING AT NUTRITIONAL ADEQUACY
WITHIN?
THAT WOULD BE REALLY HARD.
I KNOW IT WOULD BE PRETTY
INTENSE TO LOOK AT A POPULATION
LEVEL AND IS MORE OF A QUESTION
TO SEE IF THAT IS SOMETHING THAT
WAS -- IT IS BEING THOUGHT
ABOUT.
>> MRS. REBECCA CAN PROBABLY
PROVIDE POIGNANT DISCUSSION
AROUND.
>> IF I UNDERSTAND YOUR QUESTION
CORRECTLY, THE SIMULATIONS ARE
OUR OPPORTUNITY TO EVALUATE
PATTERNS WITHIN INDIVIDUAL FOODS
AT A SIMULATED POPULATION LEVEL.
SO, THAT IS OUR NEW AND LIKE --
THAT IS OUR BIG NEXT STEP, WHICH
YOU NOTED IS WORK AND
COMPLICATED AND VERY EXCITING.
FOOD PANELING ANALYSIS WE FOCUS
AT GIVING RECOMMENDATION S AT
INDIVIDUAL LEVEL FOR INDIVIDUALS
WITHIN A POPULATION MEET ORING
COMPARING FOOD GROUPS IN
PATTERNS COMPARING TO
CONSERVATIVE MEASURE.
>> THANK YOU.
>> THAT IS WHAT I WANTED TO SAY
I'M AFRAID WE MIGHT BE WRONG.
GETTING TO THE POPULATION
DISTRIBUTION IS SIMULATIONS
ACROSS 3500 DAYS AND ACTUAL
PATTERNS THEMSELVES GIVES A
TELLING US HOW MANY FRUITS TO
PUT IN NUTRITIONAL PROFILE --
TOTAL NUTRIENTS WE GET BASED ON
WHAT THOSE FINAL NUTRIENT
PROFILES LOOK LIKE.
THAT IS THAT BASIS PROTOCOL AND
PROTOCOL 1 AND 2 POPULATION
SUBGROUPS HOW IT CARIES FORWARD
INTO WHAT REPRESENTS A CUP OF
FRUIT WHEN WE DO THAT ANALYSIS
AND WHAT HAPPENS WHEN YOU TURN
KNOBS AND COMPARE THAT TO THE
RDA?
>> YEAH. I WAS CURIOUS IN I'M
NOT AFRAID TO ASK A STUPID
QUESTION BUT I WAS CURIOUS WHAT
HAPPENS WHEN YOU HAVE A
PERCENTAGE OF THE POPULATION
THAT DOESN'T EAT A CERTAIN LIKE
ARE NUTRIENTS WOULD IT BE THE
IMPLICATION AND NUTRITIONAL
IMPLICATIONS ON A POPULATION
LEVEL FOR PEOPLE THAT FALL
WITHIN CATEGORIES IF YOU ASSUME
THAT THERE IS A CERTAIN
PERCENTAGE OF THE POPULATION
THAT WILL BE IN THAT CATEGORY.
SO, BUT THAT IS -- THAT IS
REALLY HELPFUL AND THIS IS
REALLY EXCITING WORK TO SEE. IT
HAS A LOT OF IMPLICATIONS FOR
EQUITY ACROSS THE BOARD.
SO, IT IS GREAT TO HEAR ABOUT.
>> GREAT TO BE ABLE TO LOOK AT
IT FROM FOOD GROUPS THEMSELVES
AT THIS POINT AND NEXT STEP THAT
TAKES IT ALL THE WAY TO THE
SIMULATION LEVEL OF ALL RIGHT.
LET'S ACTUALLY PUT IT INTO PLAY.
YOU CAN RANDOMLY DRAW A CARD OUT
OF EACH DECK TO REPRESENT FOOD
AND WHAT PROFILE LOOKS LIKE IN
TOTAL POPULATION THAT IS A
REALLY COOL WAY TO USE
INVALUABLE DATA WE HAVE WHAT WE
IN AMERICA SHOULD REALLY HELP
AND KIND OF ACTUAL, ACTIONABLE
STRATEGIES FOR ACTUALLY MAKING
DIETARY SELECTIONS.
IT IS REALLY COOL.
ANY OTHER QUESTIONS?
>> WONDERFUL.
THANK YOU SO MUCH.
SO, NOW WE ARE GOING TO TAKE A
MUCH EARNED BREAK AND COME BACK
>> THANK YOU SO MUCH FOR JOINING
THE 2025 DIETARY GUIDELINES
ADVISORY COMMITTEE TODAY. WE
ARE BACK FROM BREAK AND NOW WILL
HEAR ABOUT STRATEGIES FOR
INDIVIDUALS AND FAMILIES THAT
ARE RELATED TO DIET QUALITY AND
WEIGHT MANAGEMENT LED BY CHAIR
CHRISTINA MRASAS. TAKE IT AWAY.
>> GOOD MORNING EVERYONE. WE
ARE EXCITED TO PRESENT THE FIRST
RESULTS FOR THIS COMMITTEE.
HOLD ON. I JUST LOST MY SLIDES.
OKAY. SO, THIS IS OUR
SUB-COMMITTEE. INDIVIDUALS IN
OUR SUB-COMMITTEE AND YOU
PROBABLY KNOW ALL OF THEM
ALREADY IN THE NEXT SLIDE,
PLEASE.
AS WITH THE OTHER SUB-COMMITTEES
WE HAVE PRESENTED SO FAR I WOULD
LIKE TO THANK SUPERHEROES FOR
THIS WORK THAT MAKE WORK EASIER
AND GO ON TO PRESENT DATA IN
DIFFERENT WAYS TO TRY TO COME UP
WITH SOME CONCLUSION STATEMENT.
THANK YOU. AGAIN.
NEXT SLIDE.
WE HAVE MADE A BIT OF PROGRESS
SINCE MEETING 3.
WE WILL SHOW TODAY TWO
CONCLUSION STATEMENTS FOR THE
FIRST TWO SYSTEMATIC REVIEWS.
THERE ARE THREE SYSTEMATIC
REVIEWS STILL ON THE WAY.
WE HAVE AN EVIDENCE SCAN ON THE
WAY TOO AND CONTINUED LAST
EVIDENCE SCAN BECAUSE OF THE
AMOUNT OF WORK AND CULTURAL
INTERVENTION SCAN THAT HAS BEEN
SO FAR THOUSANDS OF ARTICLES TO
SCAN.
TO GIVE AND PRIORITIZE OTHER
QUESTIONS AND TO HAVE MORE TIME
FOR THE STAFF AND BE ABLE TO
FINISH THIS YEAR THIS WILL
CONTINUE WITH THE AVAILABILITY
EVIDENCE SCAN.
NEXT SLIDE.
SO, TODAY WE WILL PRESENT THE
CONCLUSION STATEMENTS FOR THE
EVIDENCE REVIEW WITH QUESTIONS
ON FREQUENCY OF NEWS AND/OR
SNACKING.
SO, THE NEXT QUESTION, PLEASE.
THIS IS THE FIRST QUESTION WE
HAVE COMPLETED SO FAR.
WHAT IS THE RELATIONSHIP BETWEEN
FREQUENCY OF MEALS AND SNACKING
CONSUMING DIETARY PATTERN
ALIGNED WITH DIETARY GUIDANCE
PATTERNS FOR AMERICANS AND THIS
IS A NEW SYSTEMATIC REVIEW
INCLUDING ARTICLES PUBLISHED
FROM JANUARY 2000 TO MAY 2023
AND WE SHOW THE PICO TABLE AND
POPULATION -- INTERVENTION OR
EXPOSURE AND WE INCLUDED THE
FREQUENCY OF NEWS AND/OR
SNACKING AND VARIED A BIT ACROSS
DIFFERENT STUDIES AND HOW THE
AUTHORS DEFINED THIS.
THIS WAS A DIFFERENT FREQUENCY.
OUTCOMES WAS DIET QUALITY
MEASURED BY HEALTHY EATING INDEX
IN ANY OF THE VERSIONS AND KEY
CONFOUNDERS ARE SHOWN THERE.
THE SYNTHESIS PLAN WAS INTENDED.
HOWEVER, IF THERE WERE ENOUGH
STUDIES WE WOULD GROUP THEM IN
DIFFERENT CATEGORIES.
FOR EXAMPLE, BREAKFAST AND
SNACKING AND NUMBER OF EATING
OCCASIONS.
IN THE CASES WHERE WE DIDN'T
HAVE ENOUGH STUDIES PER
CATEGORY, THEN WE FORM OUR
CONCLUSION STATEMENT FOR THE
BROADER QUESTION, WHICH IS
FREQUENCY OF MEALS AND/OR
SNACKING.
NEXT SLIDE, PLEASE.
JUST MENTIONING THREE SYNTHESIS
CATEGORIES ARE BREAKFAST AND
NUMBER OF EATING OCCASIONS AND
SNACKING THAT YOU CAN SEE THEM
HERE.
WE HAVE THEM FOR CHILDREN AND
ADLESSIENTS AND ADULTS AND OLDER
ADULTS.
BECAUSE THERE IS NOT ENOUGH
STUDIES THAT WERE PUBLISHED IN
THESE THREE CATEGORIES IN THIS
LIFE STAGE WE WERE NOT ABLE TO
DRAW A CONCLUSION AND WILL GIVE
MORE DETAILS IN THE NEXT SLIDE,
PLEASE.
OKAY. SO, AGAIN, A CONCLUSION
STATEMENT WAS NOT -- WE WERE NOT
ABLE TO DRAW ONE ABOUT THE
RELATIONSHIP BETWEEN FREQUENCY
OF NEWS IN OR SNACKING CONSUMING
DIETARY PATTERN BETTER ALIGNED
WITH DIETARY GUIDANCE OF
AMERICANS AND TWO PROSPECTIVE
COHORT STUDIES THAT ARE INCLUDED
IN OUR EVIDENCE AND NOT ABLE TO
ANSWER THIS QUESTION THAT IS TWO
PARTICULAR STUDIES WHERE ON
BREAKFAST AND THEY WERE VERY
SPECIFIC TO 10TH GRADERS AND
MILITARY RECRUITS.
SO, THIS DIDN'T ALLOW US 2% TO
DRAW OUR CONCLUSION STATEMENT.
NEXT RESULT WILL BE PRESENTED BY
ALINE.
>> THANK YOU, CHRISTINA AND TO
INCREDIBLE TEAMS THAT WORKED ON
THIS QUESTION TOGETHER.
ESPECIALLY AMAZING SUPPORT
STAFF.
THE SECOND SYSTEMATIC REVIEW
QUESTION THAT WE ANSWERED WAS
WHAT IS THE RELATIONSHIP BETWEEN
FREQUENCY OF MEAL AND/OR
SNACKING AND ENERGY INTAKE?
AS WITH THE LAST QUESTION, THIS
IS A NEW SYSTEMATIC REVIEW
INCLUDING ARTICLES PUBLISHED
FROM JANUARY 2000 TO MAY OF 2023
AND THE OUTCOME COULD BE
REPORTED MEASURE OF INTAKE
DEFINED BY AUTHOR AND WHEN THERE
IS EVIDENCE LIKE BEFORE, WE
CATEGORIZE AND ORGANIZE THE
EVIDENCE BY DIFFERENT FREQUENCY
OF MEALS AND SNACKING AND
BREAKFAST SNACKING AND NUMBER OF
EATING OCCASION AND CATEGORIES
BY AGE AND OUTCOME.
SO, NEXT SLIDE, PLEASE.
SO, LIKE I -- JUST LIKE I LOOKED
AT SIMILARLY TO WHAT CHRISTINA
PRESENTED, ALL OF THE DIFFERENT
FREQUENCY OF MEALS AND SNACKING
IN THE TWO LIFE STAGE GROUPS YOU
CAN SEE FOR CHILDREN AND
ADOLESCENTS WE DIDN'T HAVE
ENOUGH EVIDENCE FOR CONCLUSION
STATEMENT AND WILL REVEAL A
LITTLE BIT OF EVIDENCE RIGHT
AFTER THIS.
FOR ADULTS AND OLDER ADULTS THAT
THERE WAS A LITTLE BIT MORE
EVIDENCE THAT ALLOWS US TO
EVALUATE THE THREE DIFFERENT
FREQUENCY OF MEALS AND SNACKING
CATEGORIES.
NEXT SLIDE, PLEASE.
SO, THE FIRST SECTION OF THE
EVIDENCE THAT WAS ANALYZED FOR
THIS QUESTION WAS IN FREQUENCY
AND MEAL AND SNACKING AND IN
CHILDREN AND ADOLESCENTS SO
EARLY AGE GROUP CONCLUSION
STATEMENT COULD NOT BE DRAWN
ABOUT THE RELATIONSHIP BETWEEN
FREQUENCY AND MEAL AND/OR SNACK.
>> I THINK I MIGHT HAVE TO TAKE
OVER. ALINE WAS HAVING ISSUES
WITH HER CONNECTION.
I WILL GIVE HER A FEW MORE
SECONDS JUST IN CASE IT COMES
BACK.
SO, IT SEEMS I WILL HAVE TO
CONTINUE.
ALL RIGHT. HERE WE SHOW
EVIDENCE FOR DETAILS IN CHILDREN
AND IN ADOLESCENTS.
AS ALINE WAS MENTIONING, A
CONCLUSION STATEMENT COULDN'T BE
DRAWN ABOUT RELATIONSHIP BETWEEN
FREQUENCY OF MEALS AND SNACKING
AND ENERGY INTAKE IN THIS GROUP
DUE TO TWO MAIN ISSUES.
FIRST, NUMBER OF STUDIES WITH
ONLY FIVE ARTICLES ACROSS ALL
RANDOMIZED CLINICAL TRIALS AND
ALSO DIFFERENCES IN EXPOSURES
AND THREE ASSESSED BREAKFAST
CONSUMPTION AND ONE SNACKING AND
ONE NUMBER OF EATING PATIENTS SO
THEY ALLOW US TO HAVE ENOUGH
ARTICLES FOR DIFFERENT
CATEGORIES AND TO DRAW
CONCLUSIONS.
NEXT SLIDE, PLEASE.
OKAY. NOW WE SHOW THE EVIDENCE
ON BREAKFAST AND ENERGY INTAKE
IN ADULTS AND OLDER ADULTS AND
CONCLUSION IS THERE IS LIMITED
EVIDENCE THAT BREAKFAST
CONSUMPTION COMPARED TO NO
BREAKFAST CONSUMPTION THAT DOES
NOT DECREASE TOTAL ENERGY INTAKE
IN ADULTS AND CONCLUSION CAME
FROM 19 ARTICLES AND ORIGINALLY
HAVE 26 ARTICLES AND
SUB-COMMITTEE DECIDED TO FOCUS
REVIEW ON STUDIES THAT HAD A
MEASURE OF TOTAL DAILY ENERGY
INTAKE AND OTHER STUDIES THAT
WERE LOOKING AT BREAKFAST
CONSUMPTION AND THEN THE ENERGY
INTAKE OF THE NEXT MEAL THAT WE
THOUGHT WAS BEST TO LOOK AT THE
ENTIRE DAY SO THAT IT REDUCES
EVIDENCE TO 19 ARTICLES.
AMONG 19 ARTICLES, EVIDENCE WAS
PRETTY MUCH CONSISTENT AND 17
REPORTED NO IMPACT OF TOTAL
ENERGY INTAKE OR THERE WAS A
HIGHER TOTAL DAILY ENERGY INTAKE
WHEN BREAKFAST WAS CONSUMED
COMPARED TO NO BREAKFAST AND
THERE WAS NO REASON FOUND TO
EXPLAIN DIFFERENCES.
WE DIDN'T SEE ANYTHING BASED ON
DURATION OR AGE OR DESCRIPTION
OF PARTICIPANTS OR STUDY
METHODOLOGIES THAT IS ALL OVER
THE PLACE AND THE EVIDENCE.
IN TERMS OF RISK OF BIAS, THERE
WERE SERIOUS CONCERNS DUE TO
SMALL SAMPLE SIZE RANGING FROM
10 PARTICIPANTS TO 178 AND SOME
CONCERNS THAT ARE RELATED TO NOT
HAVING DETAILS OF THE
RANDOMIZATION OR CONCEILMENT OR
NOT ENOUGH POWER REGULATIONS AND
HAVING PRE-REGISTERED DATA
ANALYSIS PLAN OR HAVING HIGH
ATTRITION.
IN TERMS OF DIRECTNESS, THERE
WERE MINIMAL CONCERNS.
IN TERMS OF PRECISION, THERE
WERE SERIOUS CONCERNS WITH THE
GENERALIZABILITY OF THE EVIDENCE
AND MOST STUDIES WERE IN YOUNG
ADULTS BETWEEN 19 TO 30 YEARS
OLD AND A FEW REPORTED RACE,
ETHNICITY OR SOCIOECONOMIC
POSITION.
IN OLDER ADULTS, CONCLUSION
STATEMENT CANNOT BE DRAWN ABOUT
THE RELATIONSHIP BETWEEN
BREAKFAST AND ENERGY INTAKE.
IT WAS JUST NOT ENOUGH STUDIES
AND WERE ONLY ONE STUDY
INCLUDING INDIVIDUALS OLDER THAN
50. THAT IS IT.
WE COULDN'T DRAW CONCLUSION
STATEMENTS.
IS ALINE BACK?
>> I AM. GO AHEAD, CHRISTINA.
THANKS SO MUCH FOR TAKING OVER.
>> GO AHEAD AND CONTINUE.
>> NEXT SLIDE.
>> ARTICLES THAT WERE ANALYZED
IN THIS CATEGORY REPORTED NUMBER
OF TIMES PARTICIPANT ATE
ANYTHING OR HAD AN EVENT ACROSS
THE DAY.
THE NEXT SUBSET OF ARTICLES WE
ASSESSED IS ON THE NUMBER OF
EATING OCCASION AND ENERGY
INTAKE IN ADULTS AND OLDER
ADULTS AND IN THAT EVIDENCE A
CONCLUSION STATEMENT CANNOT BE
DRAWN ABOUT THE RELATIONSHIP
BETWEEN NUMBER OF EATING
OCCASION AND ENERGY INTAKE IN
ADULTS AND OLDER ADULTS AND DUE
TO -- NEXT SLIDE, PLEASE.
THE NEXT SUBSET OF ARTICLES WE
ASSESS IS SNACKING ENERGY INTAKE
ON ADULTS AND OLDER ADULTS.
LOTS OF OVERLAP WITH PREVIOUS
SECTION ON NUMBER OF EATING
OCCASION AND AUTHORS COMPARE
THREE VERSUS 6 EATING OCCASION
PER DAY THIS COULD INTERPRETED
THREE MAIN MEALS VERSUS THREE
MEALS AND SNACKS PER DAY AND
ARTICLES NUMBER OF EATING
OCCASION UB SET THAT WE INCLUDED
HERE AND RESULTS OF THERE BEING
SO FEW ARTICLES INCLUDED IN
CATEGORY AND THAT OVERLAP
CONCLUSION THAT IS SIMILAR TO
LAST AND CONCLUSION CAN'T BE
DRAWN ABOUT RELATIONSHIP BETWEEN
SNACK INTAKE AND OLDER ADULTS
DUE TO LACK OF ARTICLES AND
SERIOUS LIMITATION RELATED TO
GENERALIZABILITY.
AGAIN, THERE WERE A FEW ARTICLES
AND ALSO THEY WERE NARROWLY
FOCUSED ON SNACKING AND CONTEXT
OF WAIT LOSS INTERVENTION TRIALS
AND OVERWEIGHT AND WOULDN'T BE
EFFECTIVE OF US POPULATION AND
CONCLUDES WORK THUS FAR
COMPLETED FOR QUESTION WHAT IS
THE RELATIONSHIP BETWEEN
FREQUENCY OF MEALS AND/OR
SNACKING ENERGY INTAKE. THANK
YOU.
>> NEXT SLIDE, PLEASE.
NOW, WE ARE OPEN TO COMMENTS OR
QUESTI
QUESTIONS.
>> SARAH?
>> YES. THANK YOU SO MUCH FOR
THE PRESENTATION.
I JUST WANT TO DO A -- TWO
COMMENTS.
I WANT TO THANK YOU. THIS IS A
CALLOUT FOR YOU ACTUALLY
CONSIDERING OLDER ADULTS AS AN
AGE GROUP AND THINK THAT YOU ARE
FINDING A LACK OF RESEARCH THAT
IS REALLY IMPORTANT BECAUSE I
THINK THAT IT IS SENDING A
MESSAGE WHERE WE HAVE REALLY
TRUE GR GAPS IN KNOWLEDGE. I'M
LITTLE STUNNED BY YOUR FINDINGS
IN THE SENSE THAT IF ONE WAS TO
LISTEN TO MEET POPULAR MEDIA AND
LOTS OF DISCUSSION IN THE
NUTRITION FIELD, ONE WOULD JUST
MAKE THE ASSUMPTION THAT THERE
WERE MANY, MANY STUDIES
AVAILABLE.
THE FACT THAT WE HAVE A LOT OF
DISCUSSION AND CONCLUSIONS, BUT
THERE IS NOT THE EVIDENCE, I
THINK THAT YOUR FINDINGS ARE SO
IMPORTANT.
IT IS A CALL TO THE NUTRITION
COMMUNITY TO DO THE STUDIES NOW
IN ORDER FOR US TO REALLY
UNDERSTAND THE OUTCOMES OR THE
IMPLICATIONS OF DIFFERENT EATING
PATTERNS AND KUDOS TO THIS
GROUP. IT WAS AN AMAZING AMOUNT
OF WORK THAT YOU HAVE ALSO
CALLED OUR COMMUNITY TO ACTION.
THANK YOU.
>> WE WERE ACTUALLY VERY
SURPRISED TO.
SO STUDIES OUT THERE AND
BREAKFAST AND BECAUSE OF THE
PICOTABLE AND WAY WE SET UP
SOMETIMES AND WAY WE SET UP
QUESTIONS.
SOMETIMES WE RESTRICT STUDIES TO
CERTAIN PARTICULAR STUDIES AND
WE WERE VERY SURPRISED AND ALSO
WITH RESULTS FOR BREAKFAST AND
STARTED TO LOOK AT DIFFERENT
WAYS AND ASKING AND SAYING AT
THE BEGINNING TO THANKING THE
STAFF.
WE ASK AND ARE LIKE CAN YOU ALSO
LOOK AT IT THIS OTHER WAY?
CAN WE SEE THIS OTHER
INFORMATION TO TRY TO MAKE SENSE
OF THE DATA?
SO, I DON'T KNOW IF THERE ARE
ANY OTHER COMMITTEE MEMBERS THAT
WOULD LIKE TO COMMENT ON THIS.
>> THANK YOU.
GREAT POINT CRISTINA AND
THINKING ABOUT THIS LITERATURE I
HAVE DONE WORK ON SNACKING
INSTANCE AND HOST OF STUDIES AND
MANY ARE CROSS-SECTIONAL AND
THINK IT REALLY -- YOU KNOW,
THIS COMMUNITY'S WORK IS FOCUSED
ON MORE RIGOROUS RESEARCH AND
ARE ONLY CONSIDERING STUDIES
WITH RANDOMIZED CONTROL OR
REMOTE CONTROL DESIGNS FOLLOWING
PEOPLE OVER TIME AND LOOKING AT
TEMPORAL ORDERING AND THINK IT
REALLY DOES OR SHOULD BE LIFTED
OUT TO THE RESEARCH COMMUNITY TO
REALLY HIGHLIGHT NEEDS TO MOVE
PAST CROSS-SECTIONAL STUDIES AND
FUND THIS TYPE OF WORK.
>> I AGREE, JEN.
MAYBE PEOPLE DO HAVE OR MANY
RESEARCHERS MAY HAVE THIS DATA
AND MAYBE THEY HAVE NOT
PUBLISHED IT IN A WAY THAT WE
CAN USE IT.
IT IS ALSO A -- A STATEMENT OR A
-- TO -- MAYBE WE CAN START TO
LOOK AT DATA IN DIFFERENT WAYS
TO HELP US WITH OUR QUESTIONS.
CHRIS?
>> YEAH. I KNOW THIS IS
SOMEWHAT NESTED WITHIN THE
PRESENTATION AND HOW ARTICLES
ARE KIND OF SIFTED IN AND OUT.
I THINK AS WE MOVE FORWARD WITH
THIS, AND KIND OF OUR
CONVERSATION BEFORE AROUND WHAT
SUBSTITUTION AND SHIFTING DOES.
DOES THE COMMITTEE HAVE ANY
DISCUSSION WHERE WERE GAPS THAT
YOU SAW FROM THE STUDIES
THEMSELVES THAT DIDN'T MAKE IT
IN. YOU CAN LOOK AT SNACKS AND
LOOK AT WHAT SNACKS CHANGED AND
LOOKING AT THAT DIFFERENCE
BETWEEN MEALS VERSUS SNACKS FOR
FUTURE RESEARCH WE NEED.
>> I CAN ACTUALLY TALK FOR
ENERGY INTAKE AND THINK THERE IS
ALSO STUDIES THAT LOOKED AT A
MEAL AND IMPACT ON A MEAL FOR
EXAMPLE THAT ARE VERY
RESTRICTIVE TIME PERIOD.
SO, I THINK THAT IS WHERE
PROBABLY THE LACK ALSO OF
EVIDENCE THAT WE ARE PRESENTING
IS; RIGHT?
WE ARE TRYING TO UNDERSTAND LIKE
YOU ARE DOING, YOU KNOW, MORE OF
A TEMPORAL EFFECT.
SO, I THINK THAT IS PART OF IT.
SO, I THINK THAT IS A BIG
LIMITATION AND THEN JEN HONED IN
ON THE RIGOROUSNESS OF THE
DESIGN AND THINK THAT THOSE TWO
ARE THE MAJOR DRIVERS OF LOW EVIDENCE.
I ALSO WANT TO ADD THAT MANY OF
THE STUDIES THAT WE SAW WERE
WEIGHT LOSS INTERVENTION TRIALS
AND EFRD WAS NOT APPLICABLE TO
THE REST OF THE GENERAL
POPULATION AND ALSO HAD AN
ISSUE.
DEANNA?
>> YES. KIND OF FOLLOWING UP ON
WHAT CRISTINA SAID THAT THE LACK
OF GENERALIZABILITY WAS KIND OF
-- IT WAS INTERESTING TO ME.
EVEN DIFFERENT AGE GROUPS, YOU
DIDN'T HAVE DIFFERENT
RACIAL/ETHNIC GROUPS WERE NOT IN
THE STUDY.
THERE WASN'T MUCH VARIATION
THERE AT ALL.
>> GOING BACK TO A PREVIOUS
QUESTION THAT I THINK WAS CHRIS
OR WHAT IS LACKING THERE.
I THINK THAT THERE ARE MAIN
STUDIES AMONG COLLEGE STUDENTS
LOOKING AT SNACKING. BIG ISSUE
OF COLLEGE STUDENTS AND MOST OF
THEM ARE CROSS-SECTIONAL AND WE
ARE NOT ABLE TO INCLUDE THOSE.
TERESA?
>> YEAH. THANK YOU. THIS TALK
IS CROSS -- THIS IS
CROSS-SECTION IN TERMS OF
CROSS-POPULATION SEGMENTS THAT I
CAN SEE IT FROM THE OLDER ADULTS
POPULATION THAT YOU DON'T HAVE
ANY STUDIES AND TO THEM WAIT
MANAGEMENT IS MAINTAINING WAIT
OR MUSCLE MASS. YOU KNOW,
CROSSING INTO CRYTOPENIA AREA
AND FOR THEM LOSING MUSCLE MASS
AND APPETITES GOES DOWN SNACKING
AND TIMING OF EATING IS REALLY
IMPORTANT THAT BECOMES SOMETHING
THAT CLINICIANS MIGHT BE ABLE TO
TAKE ADVANTAGE OF IF WE HAVE
DATA TO BETTER ADVISE THE OLDER
POPULATION IN MAINTAINING MASS
AND HOPE THAT FOR RESEARCHERS IN
THE NEXT FEW YEARS WILL TAKE UP
THIS TOPIC AND FOR ME WILL BE
THE OLDER POPULATION THAT WE
REALLY NEED DATA ON.
>> WE AGREED THAT ALSO IN
CHILDREN THAT WE COULD NOT DRAW
CONCLUSION STATEMENTS WITH DATA
FOR CHILDREN AND ADLESSIENTS AND
MANY OF THE -- ON THE OTHER SIDE
OF THE SPECTRUM, THIS IS A TIME,
PEAK, CRITICAL PERIOD TO PREVENT
EXCESSIVE WEIGHT GAIN AND
GETTING TO OVERWEIGHT
CATEGORIES.
>> YEAH.
>> I THINK WE ARE MISSING BOTH
SPECTRUMS.
>> AND AGE OF THE LIFESPAN,
YEAH.
>> YEAH. BUT GREAT POINTS OR
COMMENTS.
>> ANYTHING ELSE?
SO WE STILL HAVE ONE MORE SLIDE
PENDING TO SHOW -- IF YOU CAN
SHOW THE NEXT ONE.
SO, OUR NEXT STEPS, SO, FOR,
HOPEFULLY, BY NEXT PUBLIC
MEETING, WE WILL BE ABLE TO SHOW
THE CONCLUSION STATEMENTS ON THE
FREQUENCY OF MEALS AND/OR
SNACKING WITH GROWTH BODY
COMPOSITION AND RISK OF OBESITY
AND CONSUMING A DIETARY PATTERN
MORE ALIGNED TO DIETARY
GUIDELINES AND WITH ENERGY
INTAKE AND WE ALREADY STARTED TO
WORK ON PORTION SIZE AND THESE
TWO OUTCOMES.
AND THEN WE WILL SEE HOW FAR WE
GET WITH THE EVIDENCE SCAN. AS
I MENTIONED BEFORE, WE OWN
THOUSANDS OF ARTICLES WITH OUR
EVIDENCE SCAN ON CULTURAL
TAILORED DIETARY INTERVENTIONS
THAT WILL BE INTERESTING TO SEE THE RESULTS.
THANK YOU.
>> THANK YOU FOR THE VERY RICH
DISCUSSION THIS MORNING AND NOW
WE WILL TAKE A BREAK UNTIL 12:15.
SO, WE WILL REJOIN AT 12:15 EASTERN TIME. THANK YOU VERY MUCH
>> OKAY. WELCOME BACK. THANKS
AGAIN FOR JOINING THE 4TH
MEETING OF THE 2025 GUIDELINES
ADVISORY COMMITTEE AND THANKS
FOR JOINING ON A FRIDAY.
FROM MULTIPLE TIME ZONES AND FOR
AN ALL-DAY ZOOM MEETING. I
APPRECIATE IT. IT IS A LONG
HAUL AND APPRECIATE EVERYONE
STICKING IN AND PARTICIPATING
AND WE SHOULD HAVE A GREAT
AFTERNOON WITH THESE FINAL
PRESENTATIONS AND WE WILL
CONTINUE WITH COMMUNITY
PRESENTATIONS AND DISCUSSION.
NEXT UP WE HAVE OUR PRESENTATION
FROM OUR SUB-COMMITTEE THAT IS
FOCUSING ON DIETARY PATTERNS AND
SPECIFIC DIETARY COMPONENTS
ACROSS LIFE STAGES. THAT IS BY
DEANNA AND WE WILL TURN IT TO
YOU.
>> THANKS, EVE. I WANT TO SAY
GOOD AFTERNOON OR GOOD MORNING
DEPENDING ON WHERE YOU ARE.
TODAY'S PRESENTATION ON DIETARY
PATTERNS AND SPECIFIC DIETARY
PATTERN COMPONENTS ACROSS LIFE
STAGES WILL INCLUDE
PRESENTATIONS BY MYSELF AND OUR
OTHER FABULOUS COMMITTEE
MEMBERS.
DR. CHERYL ANDESON AND
CHRISTOPHER GARDNER HOLLY,
DEDE-TOBIAS AND TERESA FUNG AND
ANDREA DEIERLAN. YOU WILL HEAR
FROM THEM LATER. THE NEXT SLIDE
SHOWS THE REST OF THE COMMITTEE
MEMBERS AND WANT TO POINT OUT AS
YOU HAVE SEEN PREVIOUSLY THAT
SEVERAL COMMITTEE MEMBERS SERVE
ON THE HEALTH EQUITY WORKING
GROUP INCLUDING THE CHAIR OF THE
GROUP AND SAMEERA WHO IS ON OUR
COMMITTEE.
ONCE AGAIN WE WOULD JUST LIKE TO
REITERATE OUR THANKS AND
APPRECIATION FOR EVERYTHING THAT
THE SUPPORT STAFF DOES FOR US.
THE NESR STAFF IS FANTASTIC. WE
HAVE MADE THEM ARRANGE AND
REARRANGE DATA MANY TIMES TO
COME TO THESE CONCLUSION
STATEMENTS.
I REALLY APPRECIATE THEIR
FLEXIBILITY AS DOES THE REST OF
THE TEAM.
SO, AS I GO ON, I JUST WANTED TO
KIND OF HIGHLIGHT WHAT I WILL
TALK ABOUT TODAY.
WHAT WE WILL ALL TALK ABOUT.
SO, FIRST OF ALL, WE WILL GIVE
YOU THE PROGRESS THAT WE HAVE
MADE SINCE THE LAST MEETING.
SECONDLY, WE WILL HIGHLIGHT FOUR
PROTOCOL REVISIONS THAT HAVE
BEEN MADE.
THEN WE WILL FOLLOW THAT BY
TALKING ABOUT THE EVIDENCE
REVIEW ON DIETARY PATTERNS AND
GROWTH BODY COMPOSITION AND RISK
OF OBESITY.
THE 4TH PART IS TALKING ABOUT
SPECIFIC DIETARY PATTERN
COMPONENTS.
TODAY, WE WILL TALK ABOUT
BEVERAGES.
AND THE GROWTH BODY COMPOSITION
AND RISK OF OBESITY AND FINALLY
WILL TALK ABOUT NEXT STEPS.
AS WE GO THROUGH THESE, YOU WILL
SEE A FEW PLACES WE HAVE
HIGHLIGHTED HEALTH EQUITY.
SINCE THE LAST MEETING, OUR
COMMITTEE HAS BEEN BUSY AS ALL
OF THE COMMITTEES.
COMING UP WITH SYSTEMATIC
REVIEWS WITH DRAFT CONCLUSION
STATEMENTS.
SO, THE ONES THAT WE ARE SHOWING
YOU TODAY ARE GROWTH BODY COMP
AND BODY COMPOSITION AND RISK OF
OBESITY.
AS I MENTIONED BEFORE, WELL, AS
I WILL MENTION LATER, THERE IS
SEVERAL LIFE STAGES WE WILL TALK
ABOUT.
IT ENDS UP BEING SEVERAL
DIFFERENT CONCLUSION STATEMENTS
THAT WE WILL PRESENT.
SO, THERE IS SEVERAL SYSTEMATIC
REVIEWS CURRENTLY UNDERWAY.
THEY INCLUDE ULTRAPROCESSED
FOODS AND DIETARY PATTERNS IN
TERMS OF TYPE II DIABETES AND
CARDIOVASCULAR DISEASE AND
COGNITIVE DECLINE AND DEMENTIA
AND ALZHEIMER'S DISEASE AND
BREAST AND COLORECTAL CANCER AND
BONE HEALTH AND WE HAVE
CONTINUED SYSTEMATIC REVIEW THAT
IS ON THE RELATIONSHIP BETWEEN
DIETARY PATTERNS AND RISK OF
PROSTATE CANCER.
THE REASON THAT WE HAVE
DISCONTINUED THIS ONE IS THE
LITERATURE ON DIETARY PATTERNS
AND RELATION TO HEALTH AND TO
THIS HEALTH OUTCOME THAT HAS NOT
GROWN SUBSTANTIALLY SINCE THE
PREVIOUS REVIEWS THAT ARE
CONDUCTED BY THE 2020 DIETARY
GUIDELINES ADVISORY COMMITTEE.
OTHER QUESTIONS ARE HIGHER
PRIORITY FOR US FOR THIS
GO-ROUND.
SO, IN TERMS OF SPECIFIC DIETARY
PATTERN COMPONENTS, SYSTEMATIC
REVIEWS WITH DRAFT CONCLUSION
STATEMENTS THAT WE WILL PRESENT
TODAY ARE DAIRY MILK AND MILK
ALTERNATIVES AND BODY COMP AND
RISK OF OBESITY AND 100% JUICE.
SO, WE STILL HAVE SEVERAL
SYSTEMATIC REVIEWS UNDERWAY.
MOST ARE WITH SUGAR SWEETENED
BEVERAGES AND WE HAVE ALSO LOW
AND NO CALORIE SWEETENED
BEVERAGES WITH TYPE II DIABETES
AND FOOD SOURCES WITH FAT AND
CARDIO RISK AND CARDIOVASCULAR
DISEASE AND WE UNDERWENT A
REPRIORITIZATION AND WE
DISCONTINUED SEVERAL SYSTEMATIC
REVIEWS THAT INCLUDE COFFEE
AND/OR TEA IN BOTH OF THE GROWTH
BODY COMPOSITION AND RISK OF
OBESITY AND RISK OF TYPE II
DIABETES AND DAIRY MILK AND MILK
ALTERNATIVES AND RISK OF TYPE II
DIABETES AND 100% RISK OF JUICE
AND TYPE II DIABETES.
SOME OF THESE WILL BE EXPLAINED
IN OTHER FOOD PATTERN MODELING.
SYSTEMATIC REVIEW QUESTIONS
ALSO.
WE THOUGHT IT WAS MORE IMPORTANT
TO LOOK AT DIETARY PATTERNS
INSTEAD OF LOOKING AT SPECIFIC
DIETARY PATTERN COMPONENTS FOR
THESE.
IT IS NOT THAT THEY ARE NOT
IMPORTANT BUT THEY WERE
DEPRIORITIZED COMPARED TO ALL OF
THE OTHER WORK WE HAVE RIGHT
NOW.
SO, RIGHT NOW, I WILL PRESENT
ALONG WITH MY COMMITTEE MEMBERS
FOUR PROTOCOL REVISIONS THAT WE
HAVE WORKED ON.
THESE ARE -- WERE PRESENTED
PREVIOUSLY.
WE MADE CHANGES TO STREAMLINE
REVIEWS AND TO REALLY FOCUS ON
HIGHER QUALITY EVIDENCE?
SO, THE GROWTH AND BODY
COMPOSITION AND RISK OF OBESITY
AND REVISING EXCLUSION AND
INCLUSION CRITERIA TO EXCLUDE
DIFFERENT DIETARY PATTERNS.
SO, WHAT -- WHEN YOU LOOK AT
THEM, THEY REALLY VARY IN LOTS
OF DIFFERENT FOODS AND FOOD
GROUPS.
SO, IT WAS HARD TO STANDARDIZE
THEM.
WE MODIFIED THE COMPARATOR TO
BETTER ISOLATE EFFECTS OF
DIETARY PATTERNS AND DIFFERENT
AMOUNTS OF ULTRA PROCESSED FOODS
AND WHAT THE COMPARATOR IS GOING
TO BE NOW IS DIFFERENT LEVELS OF
CONSUMPTION AND/OR ADHERENCE TO
SAME DIETARY PATTERN WITH
DIFFERENT AMOUNTS OF ULTRA
PROCESSED FOOD.
FOR EXAMPLE, IF USING THE ANOVA
CLASSIFICATION IT MIGHT BE NOEFA
1 VERSUS ANOVA 4. IT IS NOT
ONLY ULTRA PROCESSED FOOD
CLASSIFICATION WE ARE LOOKING AT
THOUGH FOR THIS REVIEW AND
PUBLICATION DATE HAS ALSO BEEN
CORRECTED AND GOES UNTIL JANUARY
9TH, 2024.
SO, I WANTED TO POINT THAT OUT.
AND ALSO, THESE REVISIONS WERE
MADE BEFORE EVIDENCE WAS
SYNTHESIZED ON THIS QUESTION.
WE HAVE NOT BEGUN THAT PROCESS
YET.
SO, WITH THAT, I WOULD LIKE TO
TURN IT OVER TO DR. ANDERSON.
>> THANK YOU SO MUCH.
THIS SLIDE SHOWS OUR PROTOCOL
REVISIONS FOR OUR DIETARY
PATTERNS AND RISK OF
CARDIOVASCULAR DISEASE PROTOCOL
MAKING CHANGES BEFORE ANY
EVIDENCE WAS SYNTHESIZED AND
NOTICE THAT CHANGES RELATE TO
INCLUSION AND EXCLUSION CRITERIA
AND I WILL GO THROUGH THE FOUR
CHANGES THAT HAVE HAPPENED.
THE FIRST IS WE REVISED
INCLUSION AND EXCLUSION CRITERIA
FOR POPULATION THAT NOW EXCLUDES
INFANTS AND TODDLERS.
AS YOU CAN IMAGINE, DIETARY FAT
INTAKE REQUIREMENTS WILL DIFFER
FOR INFANTS AND TODDLERS
COMPARED TO ALL OTHER LIFE
STAGES AND SECOND CHANGE IS
RELATED TO STUDY DURATION AND
CRITERION NOW INCLUDES STUDIES
HAVING A DURATION OF AT LEAST
FOUR WEEKS AND PREVIOUSLY
PROTOCOL SPECIFIED THAT STUDIES
HAVE TO BE AT LEAST 12 WEEKS TO
BE INCLUDED AND WE CAN NOW
BETTER CAPTURE INTERMEDIATE
CARDIO VAS SLAR DISEASE OUTCOMES
WITH WHICH AN INVESTIGATOR MIGHT
EXPECT TO SEE CHANGES HAPPEN IN
A FOUR-WEEK PERIOD AND YOU WILL
NOTICE THAT WE REMOVED SIZE OF
STUDY GROUPS CRITERION
PREVIOUSLY SPECIFIED
OBSERVATIONAL STUDY ENROLLING IN
AT LEAST 1,000 ENROLLED
PARTICIPANTS AND HOPE THAT AFTER
WE REMOVED THIS CAP WE WILL BE
ABLE TO LOOK AT OBSERVATIONAL
STUDIES THAT ENROLL
UNDER-REPRESENTED POPULATIONS
AND LIFE STAGES THAT MAY HAVE
LED TO A SMALLER STUDY SIZE AND
LASTLY WE REVISE THE CRITERION
FOR STUDIES THAT WERE CONDUCTED
IN ALL COUNTRIES TO INCLUDE
STUDIES CONDUCTED IN THE US
LOOKING AT ADULTS AND OLDER
ADULTS THAT ALLOWS US TO
LEVERAGE ALREADY STRONG
CONCLUSION STATEMENT WE HAVE FOR
ADULTS AND ALLOW US TO FOCUS ON
STUDIES MOST APPLICABLE TO THE
US POPULATION.
THANK YOU, DEANNA.
>> CHRISTOPHER GARDNER WILL TALK
ABOUT THE PROTOCOL REVISIONS FOR
SATURATED FAT.
>> SORRY ABOUT THAT. THIS IS A
REALLY EXCITING TOPIC THAT I'M
HAPPY TO SAY WE HAVE ACTUALLY A
LOT OF PAPERS IN THIS AREA.
LOOKING AT IT HOPING TO MAKE
STRONGEST CONCLUSIONS BASED ON
STRONGEST DATA WE DECIDED TO
MODIFY CRITERIA INCLUDING
STUDIES AT LEAST 30 PARTICIPANTS
PER STUDY AND HAVE A POWER
CALCULATION THAT IN SOME WAY
JUSTIFIED FEWER PARTICIPANTS
THAN THAT.
THIS WILL ADD TO THE RIGOR OF
PAPER IN GENERAL AND WILL ALSO
MAKE IT MORE CONSISTENT WITH
WHAT CHERYL SHARED WITH US IN
TERMS OF DIETARY PATTERNS AND
CARDIOVASCULAR DISEASE AND SAID
ALL THESE REVISIONS ARE MADE
BEFORE ANY EVIDENCE WAS
SYNTHESIZED.
PASSING THIS BACK TO YOU,
DEANNA.
I'M PASSING IT TO ANDREA.
>> GREAT. WE MADE A FEW
REVISIONS TO BEVERAGES PROTOCOLS
AND FOR OUR 100% JUICE AND
GROWTH BODY COMPOSITION RISK AND
OBESITY PROTOCOL LIMITING
METAANALYSIS TO BIRTH UP TO 19
YEARS POPULATION AND MADE CHANGE
TO FOCUS METAANALYSIS EFFORTS
POPULATION MOST LIKELY TO YIELD
RESULTS INFORMING GUIDANCE AND
QUANTITATIVE SYNTHESIS WAS
UPDATED TO CLARIFY TWO STUDIES
ARE NECESSARY AND NOT
NECESSARILY SUFFICIENT TO
CONDUCT METAANALYSIS AND LASTLY
REVIEWED EXAMINING SUGAR
SWEETENED BEVERAGES AND RISK OF
TYPE 2 DIABETES WE REVISED
INCLUSION AND EXCLUSION CRITERIA
FOR STUDY DESIGN TO EXCLUDE
OBSERVATIONAL STUDIES AMONG
ADULTS THAT EXAMINED
INTERMEDIATE OUTCOMES OF FASTING
BLOOD GLUCOSE AND GLUCOSE
TOLERANCE AND RESISTANCE
HEMOGLOBIN A1C AND PREDIABETES
AND CHANGE IS MADE FOCUSING ON
STRONGER BODY OF EVIDENCE AND
INCLUDING TRIAL DATA FROM ADULTS
EXAMINING INTERMEDIATE OUTCOMES
AND WILL INCLUDE TRIAL AND
OBSERVATIONAL DATA AMONG
CHILDREN THAT EXAMINES
INTERMEDIATE OUTCOMES.
>> THANK YOU. NOW, WE ARE
OPENING IT UP TO A COMMITTEE
DISCUSSION.
IF THERE IS ANY QUESTIONS ON OUR
PROTOCOL REVISIONS?
>> CHRISTINA.
>> YES. THANK YOU SO MUCH FOR
YOUR PRESENTATIONS AND I'M VERY
EXCITED THAT YOU WILL BE
INCLUDING OTHER MEASURES OF
ULTRA PROCESSED FOODS LIKE ANOVA
AND WANTED TO UNDERSTAND WHAT
WAS THE REASONING FOR DOING THIS
AND FOR MAKING THIS CHANGE.
>> WHEN YOU START LOOKING AT IT,
THE COMPARATOR GOT TO BE A
LITTLE DIFFICULT WHEN YOU LOOKED
AT OTHER DIETARY PATTERNS.
SO, IF IT WAS SAY THE WAY THAT
PEOPLE KIND OF DESIGNATED A
DIETARY PATTERN WITH ULTRA
PROCESSED FOODS, A LOT OF TIMES
IT WASN'T SPECIFIC TO THOSE
FOODS THAT WOULD CHANGE EVERY
TIME AND WASN'T A STANDARD WHAT
FOODS WERE NULL TRA PROCESSED
AND WHAT WEREN'T WHEN YOU LOOKED
AT OTHER DIETARY PATTERNS.
IN LOOKING AT THAT, IT MADE IT
MUCH MORE STANDARD IN THE
ABILITY TO HAVE US COME UP WITH
A BETTER CONCLUSION STATEMENT.
WE DECIDED TO GO WITH DIFFERENT
LEVELS OF AN ULTRA PROCESSED
SYSTEM THAT WAS ALREADY DONE
THERE.
SO THAT YOU HAD A LITTLE BIT
MORE STANDARDIZATION ACROSS.
>> YEAH.
>> THERE IS SO MUCH DEBATE WITH
ANOVA SYSTEM THAT IT IS GOOD TO
SEE OTHER -- OTHER SYSTEMS USED
OUT THERE AND MORE MODERN AND
MORE ADVANCED.
THANK YOU FOR INCLUDING THAT.
>> YEAH.
>> ALINE.
>> YEAH. MY QUESTION IS MORE
FOR CHRISTOPHER AND APPRECIATING
NEED FOR REDUCTION ON DATA WITH
CRITERIA OF [INDISCERNIBLE]
PARTICIPANT PER GROUP AND WONDER
IF YOU HAD CONSIDERATION FOR
UNDER-REPRESENTED GROUPS AND
MINORITIES AND WHETHER IT WILL
EFFECT YOUR OUTCOMES.
>> THAT IS A GREAT POINT THAT,
THAT DIDN'T COME INTO
CONSIDERATION AS I RECALL IN THE
CONVERSATION.
IT WAS REALLY MORE ABOUT THE
SIZE OF THE LITERATURE BASE.
I KNOW WE CHANGED EPIGUIDELINES
FOR OVER 1 THOUSAND AND UNDER
1,000.
THAT MAKES SENSE TO ME, ALINE IF
YOU HAVE HUNDREDS AND HUNDREDS
OF THOUSANDS BUT NOT QUITE A
THOUSAND AND GETTING BELOW 30
AND EQUITY AND DIVERSITY CULTURE
ISSUES THAT BECOMES HARDER AND
HARDER AS YOU HAVE JUST A FEW
PARTICIPANTS AND SUSPECT THAT
PAPERS WILL STILL BE OUT THERE
AND FOCUS WILL BE ON THOSE MORE
RIGOROUS WITH AT LEAST 30 THAT
FOR AN INTERVENTION TRIAL IS NOT
MANY TO BEGIN WITH TO BE HONEST
AND SO PRETTY LOW BAR.
>> THANK YOU.
>> WE HAVE QUESTIONS OR COMMENTS
OR DISCUSSION AROUND PROTOCOL
REVISIONS.
IF NOT TURNING IT BACK TO DEANNA
TO CONTINUE DISCUSSION AROUND
DIETARY PATTERNS.
>> THANK YOU. SO, AS WE GO INTO
THIS, I WANT TO JUST REMIND YOU
THAT THE CONCLUSION STATEMENTS
WE WILL PRESENT TODAY ARE KIND
OF FOLLOWING WHAT SARAH SAID AT
THE BEGINNING OF TODAY'S
MEETING.
THEY WILL BE LOOKED AT
COLLECTIVELY WITH FOOD PATTERN
MODELING AND DATA ANALYSIS
FINDINGS TO INFORM THE
RECOMMENDATIONS IN THE
SCIENTIFIC REPORT.
THESE WON'T STAND ALONE.
THEY WILL BE TAKEN TOGETHER WITH
ALL OUR FINDINGS.
SO, I WANTED TO GIVE A QUICK
REMINDER ABOUT THAT.
I WOULD LIKE TO TURN IT OVER TO
DEDE-TOBIAS.
>> OKAY. I THINK --
>> SORRY I HAVE ONE MORE SLIDE.
>> YEAH. YEAH.
>> I GOT AHEAD OF MYSELF THERE.
SO, BEFORE WE GET INTO ALL OF
THESE, I WANTED TO JUST PRESENT
THE ANALYTIC FRAMEWORK AND JUST
REMIND YOU ALL ABOUT THIS.
SO, THE POPULATION, AS YOU SEE,
WE HAVE DIVIDED IT INTO SEVERAL
LIFE STAGES AND INTERVENTION
EXPOSURE FOR ALL CONCLUSION
STATEMENTS YOU WILL SEE IS
CONSUMPTION OF A DIETARY PATTERN
AND COMPARATOR IS A DIFFERENT
DIETARY PATTERN OR DIFFERENT
ADHERENCE OR CONSUMPTION TO THE
SAME DIETARY PATTERN AND WE ARE
LOOKING AT GROWTH BODY
COMPOSITION AND RISK OF OBESITY
AND ALL OUTCOMES ARE THERE.
IF YOU NOTICE, GROWTH IS FOR
INFANTS AND TODDLERS AND
CHILDREN AND ADULTS IS BODY
COMPOSITION AND RISK OF OBESITY.
FOR PREGNANCY AND POSTPARTUM IS
GESTATIONAL WEIGHT GAIN DURING
PREGNANCY AND POSTPARTUM WEIGHT
CHANGE DURING POSTPARTUM AND KEY
CONFOUNDERS ARE LISTED THERE TO
JUST BRING YOUR ATTENTION TO
SOME KEY CONFOUNDERS THAT ARE
SPECIFIC FOR DIFFERENT
POPULATIONS.
SO, HUMAN MILK FEEDING FOR
EXAMPLE WAS OR WOULD HAVE JUST
BEEN EXAMINED IN THE POST-PARTUM
POPULATION.
OKAY. NOW I WILL HAND IT OVER
TO DR. TOBIAS.
>> THANK YOU. THIS SLIDE IS
JUST BRIEFLY SUMMARIZING THAT WE
EVALUATED THESE DIETARY PATTERNS
ACROSS FOUR DISTINCT LIFE STAGES
AND POINT OF THAT IN OUR
PROTOCOL WAS TO JUST EVALUATE
WHETHER DIETARY PATTERNS MAY
HAVE A UNIQUE COMPOSITION WITH
RESPECT TO THESE ENDPOINTS THAT
ARE DEPENDING ON LIFE STAGES OF
THIS POSTPARTUM WINDOW AND
ADULTS AND OLDER ADULTS AND
CHILDREN AND ADOLESCENTS
SEPARATELY AND A PHASE OF BIRTH
24 MONTHS THAT ARE INDEPENDENT
OF THOSE.
NEXT SLIDE, PLEASE.
SO, THIS IS OUR CONCLUSION THAT
RESULTS FROM THE SYSTEMATIC
REVIEW OF DIETARY PATTERNS AND
POSTPARTUM WEIGHT CHANGE IN THE
POSTPARTUM PERIOD.
WE IDENTIFIED THROUGH SYSTEMATIC
REVIEW PROCESS ONE RANDOMIZED
TRIAL AND SIX PROSPECTIVE COHORT
STUDIES AND THIS AVAILABLE
EVIDENCE WE DEEMED WAS TOO
INCONSISTENT TO DRAW CONCLUSIONS
FOR THE RELATIONSHIP OF A
SPECIFIC OR SET OF DIETARY
PATTERNS WITH RISK OF POSTPARTUM
WEIGHT CHANGE OR WEIGHT GAIN
SPECIFICALLY.
FURTHER EVEN AMONG THESE
STUDIES, WE IDENTIFIED
LIMITATIONS, INCLUDING A HIGH
RISK OF BIAS AND PRECISION AND
GENERALIZABILITY THAT CONCLUDED
TO A DECISION THAT A CONCLUSION
COULDN'T BE DRAWN.
NEXT SLIDE, PLEASE.
EVALUATING DIETARY PATTERNS IN
OLDER ADULTS AND ADULTS IN
OUTCOMES OF BODY COMPOSITION AND
RISK OF OBEETTY WAS A DIFFERENT
LANDSCAPE THAT WE INCLUDED WITH
ELIGIBILITY CRITERIA OVER 100
ARTICLES AND 106 ARTICLES
INCLUDING 26 RANDOMIZED TRIALS
AND OBSERVATIONAL STUDIES, 80,
THAT FROM THIS INCREDIBLY
COMPREHENSIVE SET OF LITERATURE
AND QUALITATIVE SYNTHESIS OF
EVIDENCE AND RESULTS THAT THEY
PRESENTED, WE CONCLUDE THAT THIS
LITERATURE IDENTIFIES MODERATE
EVIDENCE THAT DIETARY PATTERNS
CONSUMED BY ADULTS AND OLDER
ADULTS THAT EMPHASIZED A
COMBINATION OF VEGETABLES FRUITS
WHOLE GRAINS FISH SEA FOID NUTS
LEGUMES AND DEEMPHASIS LOWER
AMOUNTS OF MEET AND INCLUDE
REPROCESSED MEETS AND REFINED
BEVERAGES WERE ASSOCIATED WITH
FAVORABLE OUTCOMES IN OUR
COMPREHENSIVE CATEGORY OF BODY
WEIGHT AND RISK OF OBESITY
COMPOSITION AND DIETARY PATTERNS
ASSOCIATED WITH FAVORABLE
OUTCOMES INCLUDED ALSO HIGHER
INTAKES OF UNSATURATED FATS AND
LOWER INTAKES OF UNSATURATED
FATS AND SODIUM AND WITH GRADING
OF BODY OF EVIDENCE WE GIVE A
GRADE OF MODERATE THAT IS BASED
ON ROWS BELOW THE BODY OF
EVIDENCE THAT YOU SEE
CONSISTENCY PRECISION RISK OF
BIAS AND GENERALIZABILITY AND
CONSISTENCY IS MINIMAL VARIATION
AND MAGNITUDE AND EFFECT SIZE
ACROSS STUDIES AND PRECISION WAS
NOT A CONCERN.
THERE WERE ADEQUATE SAMPLE SIZES
AND POWER, STATISTICAL POWER
ACROSS STUDIES THAT INCREASED
CONFIDENCE IN THIS CONCLUSION OF
THE EVIDENCE AND RISK OF BIAS,
THERE WAS VARIABILITY CONCERNS
WHERE THERE WAS POTENTIAL BIAS
INCLUDING CONFOUNDING AND
POTENTIAL SELECTION OF REPORTED
RESULTS.
NOT NECESSARILY APPLYING TO ALL
STUDIES BUT TO AT LEAST A
PORTION OF US TO NOTE THAT
DIRECTNESS AND WE WERE NOT
CONCERNED THERE AND MOST
DIRECTLY EVALUATED OUTCOMES THAT
ARE LISTED ABOVE AND HENCE WHY
THEY WERE ULTIMATELY INCLUDED
AND GENERALIZABILITY WE HAVE A
FEW CONCERNS WITH PARTICIPANTS
INCLUDED AND PATTERNS EVALUATED
AND OUTCOMES RELATIVE TO THE US
POPULATION THAT MOST SEEMED
LARGELY REPRESENTATIVE OF THE --
AT LEAST FROM THE DIET THAT IS
CONSUMED BY OUR POPULATION.
>> AND I THINK THAT IS IT FROM
MY SLIDE.
>> SO, YEAH. THE NEXT ONE LOOKS
AT DIETARY PATTERNS CONSUMED BY
CHILDREN AND ADOLESCENTS AND
UNFAVORABLE BODY GROWTH
COMPOSITION AND RISK OF OBESITY
AND RISK OF CONCLUSION STATEMENT
IS THAT LIMITED EVIDENCE
SUGGESTS THAT DIETARY PATTERNS
CONASSUMED DURING CHILDHOOD AND
ADOLESCENT ARE ASSOCIATED WITH
UNFAVORABLE GROWTH PATTERNS AND
BODY COMPOSITION AND HIGHER
OBESITY IN CHILDHOOD UP TO EARLY
ADULTHOOD AND AFTER REVIEWING
EVIDENCE PUBLISHED FROM 2000 TO
2023 SUGING UPDATES TO EXISTING
CONCLUSION STATEMENT THAT I JUST
READ ON THIS SLIDE AND WE
DETERMINED STRENGTH OF EVIDENCE
WAS LIMITED BASED ON ASSESSMENT
OF GRADING ELEMENTS.
WE HAVE 62 ARTICLES AND THREE
TRIALS AND 59 PROSPECTIVE COHORT
STUDIES AND 1/3 OF THE STUDIES
REPORTED DIETARY PATTERNS
CONSUMED DURING CHILDHOOD ARE
ASSOCIATED SIGNIFICANTLY WITH
UNFAVORABLE OUTCOMES AND ARE
THINGS LIKE HIGHER RISK OF
OBESITY AND LARGER WASTE
CIRCUMFERENCE AND FOUND THAT
EFFECT SIZES WERE RELATIVELY
SMALL AND DIETARY PATTERNS THAT
WERE ASSOCIATED WITH HIGH --
WITH UNFAVORABLE GROWTH PATTERNS
INCLUDED THOSE THAT HAD HIGH
INTAKES OF FRIED POTATOES AND
REFINED GRAINS AND RED AND
PROCESSED MEAT AND SUGAR
SWEETENED DRINKS AND SUGAR
SWEETENED SALTY FOODS AND LOWER
INTAKES OF VEGETABLES, FRUITS
AND WHOLE GRAINS AND OTHER
SELECT COMPONENTS KIND OF VARIED
WIDELY AMONG DIFFERENT DIETARY
PATTERNS THAT INCLUDED -- THEY
INCLUDED FACTORS SUCH AS DIETARY
PRODUCTS OR DAIRY PRODUCTS AND
SOURCES OF FAT.
THERE WERE SERIOUS CONCERNS WITH
PRECISION DUE TO SMALLER SAMPLE
SIZES AND WIDER CONFIDENCE
INTERVALS ACROSS FINDINGS.
AND THERE WERE CONCERNS WITH
RISK OF BIAS.
USUALLY THOSE WERE ASSOCIATED OR
DUE TO IMPORTANT CONFOUNDING
DOMAINS NOT BEING ACCOUNTED FOR.
SO, FOR EXAMPLE, ANTLOEPOMETRY
AT BASELINE OR PHYSICAL
ACTIVITY.
THEN THERE WAS THE RISK FOR
POTENTIAL EXPOSURE
MISCLASSIFICATIONS BECAUSE SOME
OF THE DIETARY ASSESSMENT TOOLS
WERE NOT CLEARLY VALIDATED IN
CHILDREN OR DIDN'T ASSESS
DIETARY CHANGE OVER TIME.
THERE WERE ONLY A FEW CONCERNS
WITH DIRECTNESS BECAUSE MOST OF
THE OBSERVATIONAL STUDIES WERE
DIRECTLY EXAMINING RELATIONSHIP
OF INTEREST FOR THIS QUESTION
AND THE OUTCOME EXAMINED ACROSS
THE BODY OF EVIDENCE THAT WERE
APPLICABLE BUT SOME PARTICIPANT
CHARACTERISTICS AND DIETARY
PATTERNS MIGHT NOT BE -- MIGHT
BE LESS GENERALIZABLE TO THE US
POPULATION.
SO, AS AN EXAMPLE, ONE STUDY
EXAMINED A MODERN DIETARY
PATTERN AND THEIR GNOMEN
CHICANO/CHICANA
LATINO/LATINATURE CHARACTERIZED
BY HIGH INTAKES OF FRENCH FRIED
UNPROCESSED MEATS SWEET POTATOES
CEREALS NOODLES AND STAR FRUIT A
STAR CHI TROPICAL FRU AND TARO A
STAR CHI ROOT VEGETABLE THIS WAS
CONDUCTED IN SAM OE AN CHILDREN
AGES 2 AND 4 YEARS.
THERE WAS ISSUES WITH
GENERALIZABILITY.
SO THE NEXT CONCLUSION STATEMENT
IS -- SEEMS TO BE BUT IS NOT
THAT JUST THE OPPOSITE OF WHAT
WE JUST PRESENTED.
THESE ARE DIETARY PATTERNS
CONSUMED BY CHILDREN AND
ADLESSIENTS AND FAVORABLE GROWTH
AND BODY COMPOSITION AND RISK OF
OBESITY AND CONCLUSION STATEMENT
IS LIMITED EVIDENCE SUGGESTS
DIETARY PATTERNS CONSUMED IN
CHILDHOOD ADOLESCENTS ARE
ASSOCIATED WITH FAVORABLE BODY
PATTERNS AND HEALTH COMPOSITION
AND LOWER RISK OBESITY LATER IN
CHILDHOOD TO EARLY ADULTHOOD.
THIS ONE AS YOU SEE WAS ALSO
JUDGE LIMITED AND BODY OF
EVIDENCE WAS THE SAME AS WHAT I
PRESENTED PREVIOUSLY WITH THE
SAME NUMBER OF STUDIES.
IN ABOUT ANOTHER 1/3 OF THE
STUDIES DIETARY PATTERNS
CONSUMED DURING CHILDHOOD WERE
SIGNIFICANTLY ASSOCIATED WITH
FAVORABLE PATTERNS AND GROWTH
BODY COMPOSITION AND HERE
EMPHASIZING VEGETABLES FRUITS
LEGUMES NUTS WHOLE GRAINS FISH
SEA FOID DAIRY PARTICULARLY LOW
FAT AND UNSWEETENED LOWERED IN
RED AND PROCESSED MEET AND SUGAR
SWEETENED DRINKS AND SUGAR
SWEETENED AND SAVORY OR SALTY
SNACK FOODS AND IS PARTICULARLY
INTERESTING I THINK GIVEN
CONVERSATION ABOUT SNACK
OCCASIONS AND LOTS OF THE FOODS
ARE SERVED DURING SNACK
OCCASIONS AND EFFECT SIZES HERE
RANGED FROM SMALL TO MODEST.
AND EVIDENCE SUPPORTING THIS
CONCLUSION HAD SIMILAR CONCERNS
WITH PRECISION AND RISK OF BIAS
I MENTIONED PREVIOUSLY.
TWO TRIALS OF THREE TRIALS WERE
INDIRECT.
ONE WAS DESIGNED TO TREAT MILD
ASTHMA.
ONE WAS DESIGNED TO TREAT
METABOLIC SYNDROME, FOR EXAMPLE.
SO, OBSERVATIONAL STUDIES WERE
DIRECT IN ASSESSING THE
RELATIONSHIP OF INTEREST FOR
THIS QUESTION.
BUT, SIMILAR TO THE PREVIOUS
SLIDE AND CONCLUSION STATEMENT,
OUTCOMES WERE APPLICABLE AND
PARTICIPANT CHARACTERISTICS AND
DIETARY PATTERNS WERE LESS
GENERALIZABILITY AND LESS
GENERALIZABLE TO THE US
POPULATION AND FOR EXAMPLE ONE
STUDY WAS CONDUCTED IN IRAN AND
ENROLLED ONLY FEMALE ADOLESCENTS
WITH METABOLIC SYNDROMES AND
GENERALIZABILITY WAS ASSESSED AS
LOWER FOR THIS.
I WOULD LIKE TO TURN IT OVER TO
DR. FUNG.
>> THANK YOU. I WOULD LIKE TO
PRESENT THE CONCLUSIONS FOR
DIETARY PATTERNS CONSUMED FROM
BIRTH TO 24 MONTHS AND BODY
COMPOSITION WITH RISK OF OBESITY
AND NOT ABLE TO DRAW A
CONCLUSION ON THIS TOPIC MAINLY
BECAUSIN CONSISTENT DIRECTION OF
THE RESULTS AS WELL AS VARIATION
ON THE MAGNITUDE OF THE RESULTS.
WE DID FIND ONE RCT AND 18
PROSPECTIVE COHORT STUDIES AND
HOWEVER DIETARY COMPOSITION OF
THE STUDIES WERE VERY VARIED
INTO A CERTAIN EXTENT IT WAS
EXPECTED BECAUSE OF THIS AGE
GROUP THAT IS TWO YEARS AGE SPAN
THAT REPRESENTS TREMENDOUS
DEVELOPMENT AND GROWTH IN THE
STAGE OF LIFE AND DIET THAT CAN
CHANGE VERY QUICKLY AND
DRASTICALLY WITHIN A SMALL FEW
MONTHS OF TIME SPAN.
SO, THE DIETARY COMPOSITION IN
STUDIES EXTRACTED FROM THE
SEARCH ALSO COMES FROM AROUND
THE WORLD THAT THERE WERE A FEW.
THERE WAS FIVE COMING FROM THE
US AND THEN SEVERAL THAT IS FROM
ELSEWHERE AND TOTAL OF NINE
COUNTRIES INVOLVED IN THIS BODY
OF LITERATURE AND SO THE WAY
THAT THE INVESTIGATORS DEFINED
THE DIET WAS VERY DIFFERENT AND
PART OF THE BIRTH TO 24 AGE SPAN
INCLUDING SOME BREASTFEEDING OR
FORMULA FEEDING AND THEREFORE
BASED ON VARIATION OF THE
DIETARY PATTERNS INCLUDED, IT IS
VERY DIFFICULT TO ACTUALLY NAIL
DOWN WHAT WAS THE PATTERN THAT
HAD SOME CONSISTENCY.
MOREOVER, DIET ASSESSMENT WAS
ALSO VERY VARIED AND TIME POINTS
IN TERMS OF AGE THAT WAS
ASSESSED FOR THE DIET WAS ALSO
VERY VARIED AND ASSESSMENT
TIMESPAN OF SIX MONTHS IS A BIG
DIFFERENCE FOR THIS AGE GROUP
AND IN ADDITION MANY STUDIES
HAVE WORRIES ON CONFOUNDERS NOT
MEASURED OR ADJUSTED FOR AND
PARTICULARLY ETHNICITY AND
INFORMATION WAS NOT AVAILABLE IN
A GOOD NUMBER OF THE STUDIES AND
ALSO A GOOD NUMBER OF THEM HAVE
QUITE HIGH OF AN ATTRITION RATE
AS WELL.
STUDIES ACTUALLY OVERALL WERE
MEASURING DIFFERENT MEASURES OF
BODY COMPOSITION OBESITY THAT IS
VERY DIRECT.
BUT, IN TERMS OF GEOGRAPHIC
LOCATION, IT IS VARIOUS DIETARY
DEFINITIONS AND PATTERN
CHARACTERISTICS WAS VERY VARIED
AND ALSO BECAUSE OF THE RISK OF
BIAS ISSUE WE WERE UNABLE TO
DRAW A CONCLUSION FOR THIS THERE
IS ALSO A GRADE THAT CONCLUSION
WAS ALSO NOT ASSIGNABLE.
NEXT SLIDE, PLEASE.
THIS IS THE SUMMARY OF THE
ENTIRE LIFESPAN AND BODY OF
EVIDENCE ON GROWTH AND BODY
COMPOSITION AND RISK OF OBESITY
AND FROM THE LEFT I MENTIONED WE
WERE NOT ABLE TO DRAW CONCLUSION
FROM BIRTH TO 24 MONTHS GROUP
AND CHILDREN AND ADOLESCENTS AND
DR. TOBIAS SAID THAT IS ACTUALLY
DR. HOSHER AND EVIDENCE WAS
LIMITED FOR BOTH PATTERNS THAT
IS UNFAVORABLE TO THIS OUTCOME
AND PATTERNS FAVORABLE TO THIS
OUTCOME AND ADULTS AND OLDER
ADULTS DR. TOBIAS SAID THAT
EVIDENCE IS DEFINITELY COMPARED
WITH OTHERS MUCH MORE CONSISTENT
AND MORE EVIDENCE INDICATING
DIETARY PATTERNS EMPHASIZING
VEGETABLES WHOLE GRAINS AND
COMMONLY RECOMMENDED FOODS AND
LOW IN COLONY FOODS HAVE
FAVORABLE OUTCOMES FOR BODY
COMPOSITION AND WEIGHT AND IN
OBESITY AND RISK OF OBESITY AND
OVERWEIGHT. POSTPARTUM STAGE,
CONCLUSION WAS UNABLE AND NOT
ABLE TO DRAW CONCLUSIONS.
ONCE AGAIN, OTHERS HAVE SAID
THESE CONCLUSIONS DON'T DIRECTLY
TRANSLATE TO GUIDANCE AND NEED
DATA ANALYSIS RESULTING MODELING
RESULTS IN ORDER TO DO OVERALL
SYNTHESIS IN RATE OF FOR
SCIENTIFIC REPORT AND NEXT
SLIDE, PLEASE.
ARE THERE QUESTIONS OR COMMENTS
FROM THE REST OF THE COMMITTEE?
>> QUESTIONS OR DISCUSSIONS
RELATED TO DIETARY PATTERNS?
CRISTINA?
>> THANK YOU. THERESA, I'M
INTERESTED IN WHAT YOU PRESENTED
IN DIETARY PATTERNS FROM BIRTH
TO 24 MONTHS.
YOU HAVE 18 PROSPECTIVE COHORT
STUDIES AND SEEMS THERE IS A LOT
OF VARIABILITY AND CAN YOU TELL
US MORE ABOUT WHAT DIETARY
PATTERNS THEY EVALUATED?
>> MANY DIFFERENT PATTERNS AND
SOME PATTERNS ON EARLY AGE GROUP
0 TO 12 THAT WERE LIKE FOR
EXAMPLE DIFFERENT LEVELS OF
BREASTFEEDING PLUS SOLID FOODS
AND DIFFERENT LEVELS OF FOREIGN
FEEDING AND DIFFERENT SOLID
FOODS AND OLDER AND THE OLDER 24
GIVES THAT IS DIFFERENT FOR
EXAMPLE THERE IS AN AUSTRALIAN
STUDY CORE AUST TRAILIAN PATTERN
AND STUDY FROM BRAZIL AND STABLE
DIETARY PATTERNS IN BRAZIL AND
WAY THAT STUDIES AND
[INDISCERNIBLE] WAS DIFFERENT
AND SOME WERE BASED ON
[INDISCERNIBLE] AND SOME WERE
BASED ON DATA DRIVEN METHOD SUCH
AS FACTOR ANALYSIS AND THEREFORE
FOOD COLONATION WAS VERY, VERY
DIFFERENT AND THOSE THAT WOULD
THINK AND NOT A NUMBER FROM A
GEOGRAPHICAL LOCATION AND THE
DIFFERENCE IN AGE AND
INVESTIGATORS EXTRACTED AND
IDENTIFYING PATTERNS AND IS
CONSISTENCY THAT WAS NOT
ACTUALLY THERE.
>> SO SORRY SEEMS THERE IS
ENOUGH EVIDENCE THAT WE COULD --
>> 18 IS.
>> YEAH.
>> IT IS QUITE A LARGE NUMBER.
>> YEAH.
>> SO, THIS IS A VERY
INTERESTING AGE GROUP YOU CAN
IMAGINE 6 MONTHS OLD VERSUS 12
MONTHS OLD DIETARY PATTERN IS
RATHER DIFFERENT FROM 18 MONTHS.
SO, IT IS DIFFICULT TO -- EVEN
18 WHEN YOU START LOOKING INTO
AGE GROUPS THAT IS -- THEN IT
BECOMES NOT SO MANY ANYMORE.
>> OKAY.
>> JUST TO FOLLOW UP WHAT DR.
FUNG SAID THIS IS TRUE ACROSS
ALL OF THE STUDIES IDENTIFY IIN
PATTERNS AND IT IS HARD TO BRING
THAT OUT IN ARTICLES AND THINK
THAT IS SOMETHING THAT IS A
RECOMMENDATION FOR THE FUTURE
THAT IS TO THINK ABOUT IF YOU
ARE DOING AN INTERVENTION WHAT
KIND OF DIETARY PATTERN YOU HAD
AND EXPLAINING IT CLEARLY.
SO, THAT IS WHERE I THINK LOTS
OF THESE WE GET STUCK.
THEN IT IS HARD TO MAKE A
CONCLUSION WITH THAT.
I DON'T KNOW IF OTHER MEMBERS OF
THE COMMITTEE WANTED TO COMMENT
ON THAT OR FOLLOW UP.
>> DIETARY [INDISCERNIBLE] IS
ISSUE OVERALL IS ACROSS THE
BOARD AND REGARDLESS WHAT AGE
GROUP AND OUTCOMES AND METHODS
THERE AND DIFFERENT PEOPLE FOCUS
ON DIFFERENT ENDPOINTS THAT
CERTAIN MEASURES AND CERTAIN
DIETARY PATTERNS ARE RELEVANT TO
CERTAIN ENDPOINTS THAT IS AN
ONGOING -- AN ONGOING NOT
LIMITATIONS BUT COMPLEXITIES IN
TERMS OF INTERPRETING.
SO, I THINK IN A WAY MORE
STUDIES WOULD HELP AND THEN EACH
OF THE DIETARY DIFFERENT
CHARACTERISTICS OF DIFFERENT
DIETARY PATTERNS WOULD HAVE MORE
NUMBERS ON IT AND EASY TO DRAW
CONCLUSIONS AND IS EFFORT IN
TRYING TO COME UP WITH A LITTLE
MORE STANDARDIZED MORE
COMMONALITY IN DIFFERENT DIETARY
PATTERNS FOR COMPARISON AND
SYNTHESIZING INFORMATION BECOMES
MORE EASIER ON THAT.
>> HEATHER?
>> THANK YOU. I CAN SEE HOW
CHALLENGING THIS WOULD BE TO,
YOU KNOW, TO BE ABLE TO KIND OF
GET CONSENSUS ON PATTERN IING.
ONE THING ABOUT THIS, WERE THERE
CERTAIN METHODS OR METRICS USED
MORE PREVALENTLY THAN OTHERS IN
KIND OF DEFINING WHAT THE
PATTERNS WERE?
I MEAN, I KNOW YOU PULLED OUT A
GREAT STATEMENT FROM THE
EVIDENCE.
I WONDERED ABOUT THE ACTUAL
METRICS THAT WOULD -- THAT WERE
USED IN STUDIES.
>> I THINK THAT LOREL, IF YOU
COULD GIVE US THE DEFINITION, I
DON'T -- I KNOW YOU CAN PROBABLY
GIVE US THE EXACT DEFINITION FOR
WHAT A DIETARY PATTERN AND HOW
YOU DETERMINE THAT.
>> YEAH. WE APPLY THE SAME
DEFINITION FOR DIETARY PATTERNS
THAT HAS BEEN APPLIED AND
PRESENTED ON ALL OF THE DIETARY
PATTERNS AND ANALYTIC
FRAMEWORKS.
SO, IT IS -- IT IS APPLYING THAT
SAME DEFINITION.
I AM CURIOUS, HEATHER, IF I CAN
FOLLOW UP WITH IF YOU ARE ASKING
ABOUT DEFINITION OF DIETARY
PATTERN OR METHODS OR APPROACHES
USED TO DEFINE DIETARY PATTERN
IN SET FOR 24.
>> LATTER PART.
>> THAT YOU SAID.
>> YEAH.
>> OKAY. THERE WAS A SORT OF
VARIETY IN TERMS OF INDISS JIZ
AND SCORES AND FACTOR CLUSTER
THAT REALLY KIND OF SPLIT.
SO, THERE WAS OBVIOUSLY ONE
INTERVENTION AND 8 OF THE
ARTICLES USED INDICES AND SCORES
AND 10 USED FACTOR CLUSTER AND
LATENT CLASSIC ANALYSIS AND
REGRESSION AND IN TERMS OF
ASSESSMENT METHODS VARIETY OF
FOOD FREQUENCY QUESTIONNAIRES
THAT WERE PRETTY COMMON AND MORE
COMMON FOR FOOD FREQUENCY
QUESTIONNAIRE AND LESS COMMON
FOR 24 HOUR RECALLS AND
CAREGIVER SURVEY AND INTERVIEWS.
>> THANKS.
>> YEAH.
>> THANKS.
>> CHRISTOPHER?
>> YEAH. TO JUST KEEP IN MIND I
LIKE PUSHING PEOPLE TO THINK
FORWARD AND WHAT STUDIES WE NEED
AND DEFINING PATTERNS IS ALWAYS
HARD. IF YOU SAID LOW CASH,
THERE COULD BE MULTIPLE LEVELS
OF LOW CASH. SAYING MED
TERRAINIAN NOT EVERYBODY DEFINES
IT SAME WAY AND DEFINING IT
CHECKING ADHERENCE TO DIETARY
PATTERNS IS REALLY CRITICAL TO
SEE IF THEY WERE FOLLOWING
ASSIGNED DIET THAT IS A GREAT
AND REALLY IMPORTANT FIELD AND
METHODOLOGICALLY LOTS OF WORK
WILL BE DONE TO FOLLOW UP AND
MAKE SENSE OF THIS FOR FUTURE
GUIDELINES.
>> I WOULD JUST LIKE TO
REITERATE THAT WE HAVE HAD A LOT
OF GREAT DISCUSSIONS ABOUT THIS
VERY ISSUE.
I KNOW THAT DEDEHAS BEEN REALLY
ACTIVE AND HAVING US LOOK AT
THAT AND CHRISTOPHER, YOU KNOW,
SEVERAL PEOPLE ACROSS THE
COMMITTEE.
SO, LOTS OF DISCUSSION ABOUT
THIS AREA.
>> I WANT TO THANK THE FEDERAL
STAFF FOR DOING EVERYTHING THAT
THEY CAN TO REFLECT AND PRESENT
THE PATTERNS AND CHARACTERISTICS
AND PATTERNS IN MANY DIFFERENT
WAYS SO WE CAN SEE IT FROM
DIFFERENT ANGLES.
>> AWESOME. THANK YOU ALL.
ALINE SEEING YOUR HAND UP DIDN'T
WANT TO MISS YOU. YOU GOOD?
EVERYTHING YOU NEEDED?
>> TERRY ANSWERED QUESTION IN
PREVIOUS ONE. THANK YOU.
>> DISCUSSION ON DIETARY
PATTERNS PIECE BEFORE WE SWITCH
GEARS A LITTLE?
>> DEANNA, TURNING IT BACK TO
YOU TO TALK ABOUT SPECIFIC
DIETARY PATTERN COMPONENTS.
>> YEAH. NOW WE WILL SWITCH TO
BEVERAGES THAT IS A LITTLE BIT
MORE CLEARCUT THAN WHAT WE HAVE
BEEN TALKING ABOUT.
SO, I WILL HAND IT OVER TO
ANDREA AND HOLLY WHO WILL
PRESENT THIS SECTION.
>> OKAY. GREAT. ALL RIGHT.
SO, THIS SLIDE IS PRESENTING
ANALYTIC FRAMEWORK FOR THE
QUESTION OF WHAT IS THE
RELATIONSHIP BETWEEN BEVERAGE
PATTERNS CONSUMED AND GROWTH
BODY COMPOSITION AND RISK OF
OBESITY.
SO, THE POPULATION GROUPS ARE
THE SAME FROM CHILDREN 2 TO 19
YEARS AND ADULTS OLDER ADULTS
AND INDIVIDUALS DURING PREGNANCY
AND INTERVENTION AND EXPOSURE IS
CONSUMPTION OF A BEVERAGE
PATTERN AND IN PROTOCOL WE
DEFINE BEVERAGE PATTERNS
QUANTITIES PROPORTIONS VARIETY
OR COMBINATION OF BEVERAGES OR
DIETS AND FREQUENCY WITH WHICH
THEY ARE HABITUALLY CONSUMED
COMPARATORS ARE CONSUMPTION OF
OR ADHERENCE TO DIFFERENT
BEVERAGE PATTERN OR DIFFERENT
LEVELS OF CONSUJTS OF OR
ADHERENCE TO BEVERAGE PATTERN
AND SEEING LIST OF KEY
CONFOUNDERS WE CONSIDERED.
ING NOTING FOR THIS QUESTION
AND BEVERAGE QUESTIONS THAT
TOTAL ENERGY INTAKE WAS NOT
CONSIDERED A KEY CONFOUNDER AND
WE DID TAKE INTO ACCOUNT WHETHER
OR NOT STUDIES CONTROLLED FOR
TOTAL ENERGY INTAKE WHEN
SYNTHESIZING EVIDENCE.
>> OKAY. FOR RESEARCH QUESTION
WE FOUND THAT THE CONCLUSION
STATEMENT COULDN'T BE DRAWN.
THERE IS NOT ENOUGH AVAILABLE
EVIDENCE LOOKING AT BODY OF
EVIDENCE IT WAS VERY SMALL AND
WE HAD FOUR ARTICLES WITH ONLY
TWO STUDIES AMONG CHILDREN AND
ONE STUDY AMONG ADULTS AND ONE
STUDY AMONG INDIVIDUALS DURING
PREGNANCY AND ADDITIONALLY TWO
STUDIES IN CHILDREN HAD VERY
DIFFERENT METHODS AS WELL AS
RESULTS.
NEXT SLIDE.
OKAY. THIS STUDY OR SLIDE
PRESENTS ANALYTIC FRAMEWORK FOR
THE RELATIONSHIP BETWEEN OR FOR
THE QUESTION OF THE RELATIONSHIP
BETWEEN 100% JUICE CONSUMPTION
AND GROWTH OF BODY CONSUMPTION
AND RISK OF OBESITY AND
PRIORITIZED FOR SYSTEMATIC
REVIEW WITH ANALYSIS FOR YOUNGER
POPULATIONS FROM INFANCY THROUGH
ADLESSIENTS AND INTERVENTION
EXPOSURE LIMITING QUESTIONS TO
STUDIES THAT HAVE JUICE
INDEPENDENTLY FROM BEVERAGES
FRUIT JUICES AND ADDED SUGAR
WILL BE INCLUDED IN SYSTEMATIC
REVIEW AND IN REVIEW FOR SUGAR
SWEETENED BEVERAGES AND IN
ADDITION TO COMPARATORS USED FOR
OTHER BEVERAGE TYPES IN ADDITION
TO COMPARING FOR CONSUMPTION OF
DIFFERENT AMOUNT OR WATER AND
STUDIES COMPARING 100% JUICE TO
A SOLID SUCH AS SOLID FRUIT WERE
ALSO ELIGIBLE FOR INCLUSION.
AND LOOKING AT THE KEY
CONFOUNDERS THAT WE ARE
INCLUDING ADDITION OF INFANTS
AND YOUNG CHILDREN UP TO TWO
YEARS OF AGE WE CONSIDERED KEY
CONFOUNDERS FOR AGE GROUPS AND
SEE IN TOP IN BOLD MATERNAL AGE
MILK FEEDING PRACTICES AND
GESTATIONAL AGE.
OKAY.
NEXT SLIDE.
THIS IS THE SUMMARY SLIDE THAT
IS SHOWING THE SUMMARY OF THE
DIFFERENT CONCLUSION STATEMENTS
WE HAVE MADE ACROSS THE
DIFFERENT LIFE STAGES WE LOOKED
AT.
I WILL DETAIL FINDINGS IN THE
NEXT SLIDES.
OKAY. FIRST, FOR 100% JUICE
CONSUMPTION IN CHILDREN AND
ADOLESCENTS WE FOUND MODERATE
EVIDENCE INDICATES 100% JUICE
CONSUMPTION IS NOT ASSOCIATED
WITH BODY COMPOSITION AND RISK
OF OBESITY IN YOUNG CHILDREN
THROUGH ADOLESCENTS AND
DEVELOPMENT OF CONCLUSION
STATEMENT IS BODY OF EVIDENCE
AND RESULTS OF METAANALYSIS AS
WELL AS ALL ARTICLES INCLUDING
SYSTEMATIC REVIEW AND FEWER
ARTICLES INCLUDING METAANALYSIS
AND SEEING 16 ARTICLES OUT OF 28
INCLUDED IN THE METAANALYSIS
THAT IS GENERALLY DUE TO TOO
FEW.
STUDENT: IES REPORTING COMMON
OUTCOMES OR SUFFICIENT
INFORMATION ESTIMATING COMMON
EFFECT SIZES AND NOTED THAT BODY
OF EVIDENCE INCLUDED FOUR
STUDIES IN BIRTH TO 24 MONTH
POPULATION AND ONLY ONE OF THE
STUDIES WAS INCLUDED IN THE
METAANALYSIS.
SO, THIS CONCLUSION STATEMENT
SHOULD BE INTERPRETED WITH
CAUTION WHEN WE ARE THINKING
ABOUT THE POPULATION OF THE
YOUNGER AGE GROUPS.
ADDITIONALLY, THE CURRENT
DIETARY GUIDELINES FOR AMERICANS
RECOMMENDS NO JUICE CONSUMPTION
BEFORE THE AGE OF 12 MONTHS THAT
YOU CAN SEE IN THE CONCLUSION
STATEMENT WE HAVE USED THE TERM
YOUNG CHILDREN TO DESIGNATE
YOUNG CHILDREN STARTING AT AGE
OF ONE YEAR GOING UPWARDS TO
ADOLESCENTS.
BMI AND WEIGHT WERE FOCUSED ON
AND DUE TO RELATIVELY FEW
STUDIES REPORTING ON BODY
COMPOSITION OUTD COMES.
BUT WITH INNER METAANALYSIS
RESULTS FINDINGS WERE CONSISTENT
WITH GENERAL AGREEMENT AND
DIRECTION AND MAGNITUDE OF
FINDINGS AND LOWER HETEROGENEITY
AND SYSTEMATIC REVIEW THINKING
OUTSIDE OF THE METAANALYSIS
FINDINGS THAT IS NOT ABLE TO
INCLUDE BODY COMPOSITION
OUTCOMES STUDIES INCLUDING
SYSTEMATIC ROOU VIEW THOUGHT
ABOUT THE OUTCOMES AND THINKING
OF WASTE CIRCUMFERENCE AND
PERCENT BODY FAT INCLUDED AND
ABLE TO LOOK AT THOSE PART OF
SYSTEMATIC REVIEW AND
CONSISTENCY FINDINGS WERE
CONSISTENT ACROSS STUDIES AND
FOR THOSE ESPECIALLY ADJUSTING
FOR TOTAL ENERGY INTAKE AND
FINDINGS WERE MIXED IN STUDIES
NOT ADJUSTING FOR TOTAL ENERGY
INTAKE AND THOSE THAT LOOKED
AMONG ADOLESCENT POPULATIONS AND
MAJORITY OF STUDIES STILL SHOWED
NULL FINDINGS METAANALYSIS
RESULTS SHOWED CONSISTENCY AND
DIRECTION OF FINDINGS ACROSS
ANALYSIS HELPING CONFIRM A LACK
OF RELATIONSHIP BETWEEN JUICE
CONSUMPTION WITH WEIGHT AND BMI.
SORRY ABOUT THIS.
PRECISION, ONE TRIAL, THERE IS
ONE TRIAL WITH A VERY SMALL
SAMPLE SIZE AND MULTIPLE COHORTS
THAT HAD A SMALLER SAMPLE SIZE
AROUND LESS THAN 100
PARTICIPANTS AND THOUGH THERE
WAS MANY COHORTS WITH SAMPLE
SIZES IN THE THOUSANDS AND
METAANALYSIS, THERE WERE A FEW
UNIQUE SAMPLES AND ALL ANALYSIS
WERE AROUND SIZABLE SAMPLE
SIZES.
FOR RISK OF BIAS, THE MAJORITY
OF COHORT STUDIES HAD RISK OF
BIAS DUE TO CONFOUNDING AS WELL
AS MISSING DATA AND DIRECTNESS
STUDIES DID CONSISTENTLY MEASURE
100% JUICE CONSUMPTION AND
MEASURING 100% FRUIT JUICE
CONSUMPTION AND LASTLY
GENERALIZABILITY BODY OF
EVIDENCE HAD GREATER DIVERSITY
LOOKING AT RACE AND ETHNICITY
AND SOCIOECONOMIC POSITION
COMPARED TO OTHERS THAT WE HAVE
SEEN IN THE BEVERAGE REVIEW AND
ONE SUBSTANTIAL CONCERN IS
GENERALIZABILITY AS I MENTIONED
IS WITH A SMALL NUMBER OF
STUDIES THAT ARE AMONG YOUNG
CHILDREN THAT LIMITS REALLY OUR
ABILITY TO MAKE CONCLUSIONS
ABOUT THAT POPULATION.
OKAY. NEXT SLIDE.
SO, HERE WE ARE LOOKING AT 100%
JUICE CONSUMPTION IN ADULTS
LOOKING AT BOTH BODY COMPOSITION
AND RISK OF OBESITY AND WE MADE
SEPARATE CONCLUSION STATEMENTS
FOR BODY COMPOSITION AND RISK OF
OBESITY AS WELL OR WEIGHT GAIN.
FIRST, STARTING WITH WEIGHT
GAIN, THERE IS LIMITED EVIDENCE
SUGGESTING 100% JUICE
CONSUMPTION MAY NOT BE
ASSOCIATED WITH WEIGHT GAIN IN
ADULTS AND YOU CAN SEE BODY OF
EVIDENCE WAS FOR CTS AND 11
PROSPECTIVE COHORT STUDIES AND
FOR CONSISTENCY THERE WAS
CONCERN WITH CONSISTENCY WITH
DIRECTIONS OF FINDINGS OVERALL
ESPECIALLY IN THE COHORT STUDIES
AND FINDINGS FROM TRIALS TENDED
TO BE MORE CONSISTENT WITH ALL
BUT ONE FINDING NULL RESULTS AND
FOR PRECISION THERE WERE
CONCERNS WITH -- AS WELL AS
LOOKING AT CONTINUOUS AND
CATEGORICAL EXPOSURES.
MAKING IT DIFFICULT TO COMPARE
EFFECT SIZES AND CONFIDENCE
INTERVALS ACROSS THE STUD JIZ
AND RISK OF BIAS TRIALS WERE
IMPACTED BY RISK OF BIAS AND
RANDOMIZATION TECHNIQUE AND
SELECTION IS REPORTED RESULTS
AND INADEQUATE ANALYSIS DETAILS
IN PRE-REGISTERED PROTOCOLS AND
COHORT STUDIES HIGH RISK OF BIAS
DUE TO CONFOUNDING AND MISSING
DATA AND DIRECTNESS AND TRIALS
WERE DESIGNED TO ANSWER THIS
QUESTION AND THEY ALL LOOKED AT
DIFFERENT INDIVIDUAL JUICE TYPES
AND FOR COHORT STUDIES WE DIDN'T
SEE NOTICEABLE ISSUES WITH
DIRECTNESS AND THEY OBVIOUSLY
HAVE BROADER DESIGNS OR
PURPOSES.
AND FOR GENERALIZABILITY, ALL
TRIALS WERE LIMITED TO
INDIVIDUALS WITH OVERWEIGHT OR
OBESITY AT BASELINE AND MOSTLY
TARGETING WEIGHT LOSS AND COHORT
STUDIES REPORTING RACE AND
ETHNICITY DATA PREDOMINANTLY
WHITE PARTICIPATE YNS WITH
HIGHER OR LOWER SOCIOECONOMIC
POSITION AND ONE HAD LOWER
SOCIOECONOMIC POSITION.
LOOKING FOR OTHER CONCLUSION
STATEMENTS WE FOUND THERE IS
MODERATE EVIDENCE TO INDICATE
THAT 100% JUICE INTAKE IS NOT
ASSOCIATED WITH BODY COMPOSITION
IN ADULTS AND HERE BODY OF
EVIDENCE IS THREE TRIALS AND 7
PROSPECTIVE COHORT STUDIES AND
CONSISTENCY HERE, FINDINGS
ACROSS ALL OF THE STUDIES WERE
NULL FOR 100% JUICE CONSUMPTION
AND MEASURES OF BODY COMPOSITION
IN ADULTS AND PRECISION AGAIN WE
HAD SIMILAR CONCERNS I MENTIONED
BEFORE IN TERMS OF SMALL NUMBER
OF TRIALS AND SMALL SAMPLE SIZES
AND COHORT STUDIES WITH VARYING
METRICS FOR EXPOSURES AND
SIMILAR CONCERNS FOR RISK OF
BIAS AGAIN AND SIMILAR TRIALS
PROOEND SPECULATIVE COHORT
STUDIES INCLUDED AND ISSUES WITH
RISK AND BIAS AND RANDOMIZATION
TECHNIQUE FOR TRIALS AS WELL AS
CONFOUNDING AND MISSING DATA FOR
COHORT STUDIES AND DIRECTNESS
AND TRIALS DESIGNED TO ANSWER
THIS QUESTION AS WELL AS COHORT
STUDIES AND SIMILARLY FOR
GENERALIZABILITY ISSUES THAT
TRIALS WERE BASED IN POPULATIONS
THAT WERE OVERWEIGHT OR OBESE AT
BASELINE AND LESS REPORTING OF
RACE AND ETHNICITY AND
SOCIOECONOMIC POSITION.
OKAY. 100% JUICE CONSUMPTION BY
INDIVIDUALS DURING PREGNANCY AND
GESTATIONAL WEIGHT GAIN AND
CONCLUSION STATEMENT COULDN'T BE
DRAWN AND NO EVIDENCE AVAILABLE
FOR EXAMINING THIS QUESTION.
LASTLY, SIMILAR TO DURING
PREGNANCY WE SEE IN AMONG
INDIVIDUALS DURING POSTPARTUM
WITH POSTPARTUM WEIGHT CHANGE WE
COULDN'T DRAW CONCLUSIONS ABOUT
THIS. AGAIN, THERE ARE NO
ARTICLES EXAMINING THIS QUES
QUESTION.
OKAY. NOW HOLLY.
>> THANK YOU, ANDREA. I WILL
MOVE ON TO LOOKING AT THE
RELATIONSHIP BETWEEN DAIRY MILK
AND MILK ALTERNATIVE CONSUMPTION
AND BODY COMPOSITION AND RISK OF
OBESITY AND SEEING THIS SLIDE
SHOWS ANALYTIC FRAMEWORK THAT
HOPEFULLY BY NOW LOOKS VERY
FAMILIAR AND WANT TO NOTE THAT,
EXCUSE ME.
WE EXAMINE EVIDENCE FOR FOETAL
MILK CONSUMPTION AND MILK
ALTERNATIVES AND MILK WITH
DIFFERENT AMOUNTS OF FAT AND/OR
SWEETENER AND SYNTHESIZE
EVIDENCE BY LIFE STAGE.
NEXT SLIDE.
>> THIS SLIDE PROVIDES A SUMMARY
OF ALL OUR CONCLUSION
STATEMENTS.
OUR NEXT SLIDES WE WILL GO
THROUGH ACTUALLY I WILL GO IN
MORE DETAIL ABOUT EACH OF THE
CONCLUSION STATEMENTS.
NEXT SLIDE.
SO, STARTING WITH TOTAL DAIRY
MILK AND MILK ALTERNATIVE
CONSUMPTION IN CHILDREN AND
ADLESSIENTS WE DEVELOPED
ACTUALLY TWO CONCLUSION
STATEMENTS.
ONE FOR YOUNGER CHILDREN AND ONE
FOR OLDER CHILDREN AND
ADOLESCENTS.
I WILL GO AHEAD AND START WITH
THE CONCLUSION STATEMENT FOR
YOUNGER CHILDREN AND CONCLUSION
STATEMENT IS LIMITED EVIDENCE
SUGGESTS TOTAL MILK CONSUMPTION
IN YOUNGER CHILDREN MAY BE
ASSOCIATED WITH FAVORABLE GROWTH
AND BODY COMPOSITION AND LOWER
RICK OF OBESITY IN CHILDREN AND
IN REGARDS TO AGE, CHILDREN IN
THESE STUDIES IN BODY OF
EVIDENCE RANGED IN AGE FROM 2 TO
5 YEARS AND BODY OF EVIDENCE
INCLUDED 13 PROSPECTIVE COHORT
STUDIES AND CONSISTENCY FINDINGS
WERE SPLIT WITH HALF SHOWING
NULL EVIDENCE AND -- SAMPLE
SIZES WERE ON SMALLER SIDE FOR
OFRPGSAL RESEARCH AND EXPOSURE
LINE WAS UNCLEAR AND DAIRY
INCLUSION OF MILK ALTERNATIVES
AND MOST LOOKED AT CONTINUOUS
INTAKE SOME DESCRIBES INTAKE
WITH VARYING CATEGORICAL
DEFINITIONS AND RISK OF BIAS
CONCERNS WERE CONFOUNDING AND
MISSING DATA AND WE HAD FEW
CONCERNS ABOUT DIRECTNESS AND
GENERALIZABILITY AND 1/3 OF
STUDIES DIDN'T REPORT RACE AND
ETHNICITY DATA.
OF THOSE THAT DID ALL ABOUT YOU
ONE ENROLLED PREDOMINANTLY
NON-HISPANIC WHITE CHILDREN AND
-- AND NO STUDIES IN LOWER
SOCIOECONOMIC POSITION
POPULATIONS AND MOVING TO OLDER
CHILDREN AND ADLESSIENTS, WE
DECIDED A CONCLUSION STATEMENT
COULDN'T BE DRAWN ABOUT THE
RELATIONSHIP BETWEEN TOTAL MILK
CONSUMPTION AND GROWTH BODY
COMPOSITION AND RISK OF OBESITY.
AVAILABLE EVIDENCE HAS
SUBSTANTIAL CONCERNS WITH
DIRECTNESS AND CONSISTENCY AND
RISK OF BIAS.
CHILDREN IN THE STUDIES IN THIS
BODY OF EVIDENCE RANGED IN AGE
FROM 8 TO 6 TA ENYEARS AND IN
REGARDS TO THE OVERALL BODY OF
EVIDENCE, THERE WERE FIVE
ARTICLES OF RANDOMIZED TRIALS
ONE NONRANDOMIZED TRIAL AND 14
PROSPECTIVE COHORT STUDIES.
THE -- FOR THE RANDOMIZED
TRIALS, THERE WERE FIVE ARTICLES
AND THREE INDEPENDENT TRIALS AND
OVERALL RATIONALE FOR DRAWING
CONCLUSION, TRIALS DIDN'T
ACCOUNT FOR ENERGY INTAKE AND
DIFFICULT TO TELL IF THE
FINDINGS WERE ATTRIBUTABLE TO
MILK OR ADDITIONAL CAL GORIES
AND TRIAL FINDINGS WERE MIXED
AND OBSERVATIONAL ARE MIXED AND
STUDIES VARY WIDELY AND STUDIES
USE MIXED AND CATEGORICAL
COMPARATORS WITH VARYING
CATEGORICAL DEFINITIONS AND RISK
OF BIAS PRIMARILY IMPACTED
CONFOUNDING AND MISSING DATA.
NEXT SLIDE.
SO, THESE ARE OUR CONCLUSION
STATEMENTS REGARDING DAIRY MILK
CONSUMPTION BY MILK FAT CONTENT
IN CHILDREN AND ADOLESCENTS AND
HAD TWO CONCLUSION STATEMENTS
AND ONE FOR YOUNGER CHILDREN AND
ONE FOR OLDER CHILDREN AND
ADOLESCENTS AND FOR YOUNGER
CHILDREN CONCLUSION STATEMENT
WAS LIMITED EVIDENCE THAT
SUGGESTS THAT CONSUMPTION OF
HIGHER FAT DAIRY MILK COMPARED
TO LOWER FAT DAIRY MILK IS
ASSOCIATED WITH FAVORABLE GROWTH
AND BODY COMPOSITION AND RISK OF
OBESITY AND AGE RANGE FOR
CHILDREN AND STUDIES IN THIS
BODY OF EVIDENCE IS 2 TO FIVE
YEARS AND THIS BODY OF EVIDENCE
INCLUDED SIX PROSPECTIVE COHORT
STUDIES IN REGARDS TO
CONSISTENCY FINDINGS WERE SPLIT
HALF SHOWING NULL EFFECT AND
HALF SHOW INCREASED MILL INTAKE
IS ASSOCIATED WITH INCREASED
HIGHER FAT CONTENT MILK INTAKE
IS ASSOCIATED WITH MORE
FAVORABLE OUTCOMES AND PRECISION
FINDINGS WERE CONSISTENT AND
OVERALL NUMBER OF STUDIES IS
RELATIVELY SMALL AND EXPOSURE
DEFINITION VARIED ACROSS
STUDIES.
FOR EXAMPLE SKIN PLUS 1% --
THERE IS A MIXTURE OF STUDIES
AND RISK OF BIAS CONCERNS WERE
CONFOUNDING MISSING DATA FOR
DIRECTNESS, THE LARGEST CONCERN
IS THAT THERE WERE NO TRIALS
DESIGNED TO ANSWER THE QUESTION
AND FOR GENERALIZABILITY LARGEST
PROPORTION OF PARTICIPANTS WERE
NON-HISPANIC WHITE AND IN ALL
STUDIES SOCIOECONOMIC POSITION
WAS DIVERSE AND NO STUDIES IN
ECONOMIC POPULATIONS.
AND MOVING TO OLDER CHILDREN AND
ADULTS, WE DECIDED THAT A
CONCLUSION STATEMENT CANNOT BE
DRAWN ABOUT THIS RELATIONSHIP.
AVAILABLE EVIDENCE THAT HAS
SUBSTANTIAL CONCERNS WITH
CONSISTENCY WITH QUANTITY AND
RISK OF BIAS.
SO, THE AGE RANGE IN THIS BODY
OF EVIDENCE FOR STUDIES INCLUDED
IN BODY OF EVIDENCE WAS 8 TO 18
YEARS -- THE NUMBER OF STUDIES
BEING SMALL AND MAJORITY OF
STUDIES USED UNADJUSTED OUTCOME
DATA AND SXOEBURE DEFINITIONS,
AGAIN, VARY WIDELY AND FINDINGS
ARE MIXED AND STUDIES USE A MIX
OF CONTINUOUS AND CATEGORICAL
COMPARATORS AND RISK OF BIAS
PRIMARILY IMPACTED CONFOUNDING
AND MISSING DATA.
NEXT SLIDE.
FROM MILK ALTERNATIVE
CONSUMPTION BY CHILDREN AND
ADOLESCENTS WE DECIDED A
CONCLUSION STATEMENT CAN'T BE
DRAWN ABOUT RELATIONSHIP BETWEEN
CONSUMPTION OF MILK ALTERNATIVES
AND RISK OF OBESITY AND CHILDREN
AND ADOLESCENTS THERE IS NOT
ENOUGH EVIDENCE AVAILABLE ONE
NONRANDOMIZED TRIAL WAS
IDENTIFIED.
NEXT SLIDE.
SWEETENED MILK CONSUMPTION BY
CHILDREN AND ADOLESCENTS WE HAD
AGAIN TWO CONCLUSION STATEMENTS
AGAIN ONE FOR YOUNGER CHILDREN
AND ONE FOR OLDER CHILDREN AND
ADOLESCENTS AND OLDER CHILDREN
WE DECIDED A CONCLUSION
STATEMENT COULDN'T BE DRAWN
ABOUT RELATIONSHIP BETWEEN
CONSUMPTION OF SWEETENED MILK
AND GROWTH AND BODY RISK
COMPOSITION AND OBESITY BECAUSE
THERE WAS NO AVAILABLE EVIDENCE.
FOR OLDER CHILDREN AND
ADOLESCENTS, CONCLUSION
STATEMENT WAS LIMITED EVIDENCE
THAT SUGGESTS THAT THERE IS NO
RELATIONSHIP BETWEEN CONSUMPTION
OF SWEETENED MILK AND GROWTH
BODY COMPOSITION AND RISK OF
OBESITY.
FOR THE BODY OF EVIDENCE FOR
THIS CONCLUSION STATEMENT THAT
CHILDREN IN THE STUDIES RANGED
IN AGE FROM 10 TO 15 YEARS AND
THERE WERE THREE PROSPECTIVE
COHORT STUDIES AND IN REGARDS TO
CONSISTENCY, THE FINDINGS TENDED
TOWARDS THE NULL ACROSS THE
BOARD AND ESPECIALLY WHEN
UNADJUSTED OUTCOME DATA WAS
REMOVED AND PRECISION WAS SMALL
NUMBER OF STUDIES OVERALL AND
ONE STUDY HAD A PARTICULARLY
SMALL SAMPLE SIZE FOR COHORT
STUDY AND RISK OF BIAS, IT IS A
WHOLE -- IT WAS LOWER AS
COMPARED TO MANY OTHER
OBSERVATIONAL STUDIES AND ONE OF
THE STUDIES HAD A HIGH RISK OF
BIAS FOR MISSING DATA AND ALL
HAD CONCERNS ACROSS MULTIPLE
DOMAINS AND FOR DIRECTNESS,
THERE WAS A LACK OF TRIAL DATA.
GENERALIZABILITY, TWO STUDIES
ENROLLED PRIMARILY WHITE
PARTICIPANTS AND SOCIOECONOMIC
POSITION WAS HIGHER IN TWO
STUDIES THAT REPORTED IT.
NEXT SLIDE.
NOW, MOVING INTO ADULTS FOR
TOTAL DAIRY INTAKE AND MILK
ALTERNATIVE CONSUMPTION
CONCLUSION STATEMENT WAS
MODERATE EVIDENCE INDICATES THAT
TOTAL MILK CONSUMPTION IS NOT
ASSOCIATED WITH COMPOSITION AND
RISK OBESITY IN ADULTS BODY
EVIDENCE WE HAVE 8 RANDOMIZED
TRIALS AND 17 PROSPECTIVE COHORT
STUDIES AND CONSISTENCY MAJORITY
OF FINDINGS FOUND A NULL EFFECT.
WE HAD A SMALL NUMBER OF STUDIES
THAT WERE ALSO FINDING DEBT
TREMENTAL AND POSITIVE EFFECT
AND PRECISION MEASURES OF
EXPOSURE COMPARATOR VARIED
ACROSS STUDIES COMPARISON OF
EFFECT SIZES AND CONFIDENCE
INTERVALS DIFFICULT AND SMALL
EFFECT SIZES AND RISK OF BIAS
MOST TRIALS WERE FLAGGED FOR
INADEQUATE INFORMATION ON
RANDOMIZATION TECHNIQUE AND RISK
OF BIAS AND OBSERVATIONAL
STUDIES WAS PRIMARILY
CONFOUNDING MISSING DATA AND
DIRECTNESS, WE HAD A FEW
CONCERNS AND GENERALIZABILITY,
MAJORITY OF THE STUDIES DID NOT
REPORT RACE AND/OR ETHNICITY AND
ROUGHLY HALF OF THEM THAT DID
REPORT ON THESE VARIABLES AND
WERE RURAL PRIMARILY WHITE
PARTICIPANTS AND SOCIOECONOMIC
POSITION WAS HIGHER ACROSS
STUDIES.
NEXT SLIDE.
DAIRY MILK CONSUMPTION BY MILK
CONTENT IN ADULTS WE FELT THAT A
CONCLUSION STATEMENT COULDN'T BE
DRAWN ABOUT THE RELATIONSHIP
BETWEEN CONSUMPTION OF MILK BY
FAT CONTENT AND BODY COMPOSITION
AND RISK OF OBESITY IN ADULTS
AVAILABLE EVIDENCE HAS
SUBSTANTIAL CONCERNS WITH
DIRECTNESS CONSISTENCY AND
ABSENCE OF TRIAL DATA BODY OF
EVIDENCE 14 PROSPECTIVE COHORT
STUDIES WERE IDENTIFIED AND NONE
ELIGIBLE FOR RATIONALE
CONCLUSION STATEMENT THERE WAS
NO ELIGIBLE TRIALS THAT EXAMINED
THIS QUESTION.
FINDINGS FOR HIGHER FAT MILK
INTAKE WERE SUBSTANTIALLY MIXED
WITH STUDIES FINDING NEGATIVE,
POSITIVE AND NULL ASSOCIATIONS
AND EXPOSURE DEFINITION IN XOR
TORS VARIED SUBSTANTIALLY,
AGAIN, ACROSS STUDIES.
LOW FAT MILK WAS DEFINED AS SKIM
AND 1% SKIM AND 1% OR 2%.
NEXT SLIDE.
MILK ALTERNATIVE CONSUMPTION IN
ADULTS AND FELT THAT CONCLUSION
STATEMENT COULD NOT BE DRAWN
ABOUT THE RELATIONSHIP BETWEEN
CONSUMPTION AND MILK
ALTERNATIVES AND BODY
COMPOSITION AND RISK OF OBESITY
IN ADULTS. NOT ENOUGH EVIDENCE
AVAILABLE AND ONE PROSPECTIVE
COHORT STUDY WAS IDENTIFIED.
NEXT SLIDE.
FOR SWEETENED MILK CONSUMPTION
IN ADULTS WE FELT A CONCLUSION
STATEMENT COULDN'T BE DRAWN
ABOUT THE RELATIONSHIP BECAUSE
THERE IS NOT ENOUGH EVIDENCE
AVAILABLE AS NO ARTICLES WERE
IDENTIFIED FOR THIS.
NEXT SLIDE.
I THINK -- DID WE SKIP A SLIDE?
FOR DAIRY MILK AND MILK
ALTERNATIVE CONSUMPTION FOR
INDIVIDUALS DURING PREGNANCY AND
GESTATIONAL WEIGHT GAIN
CONCLUDED THAT A STATEMENT COULD
NOT BE DRAWN ABOUT THIS
RELATIONSHIP. THERE IS NOT
AVAILABLE EVIDENCE AND TWO
PROSPECTIVE COHORT STUDIES WERE
IDENTIFIED AND STUDIES VARIED
SUBSTANTIALLY ON EXPOSURE
DEFINITION AND ANALYSIS
TECHNIQUE AND DIRECTION OF
FINDINGS.
NEXT SLIDE.
DAIRY MILK AND MILK ALTERNATIVE
CONSUMPTION BY INDIVIDUALS
DURING POSTPARTUM AND POSTPARTUM
WEIGHT CHANGE WE FELT A
CONCLUSION STATEMENT COULDN'T BE
DRAWN. THERE IS NO EVIDENCE
AVAILABLE AS NO ARTICLES WERE
IDENTIFIED.
NEXT SLIDE.
SO, THIS REPRESENTS THE QUESTION
WHAT IS THE RELATIONSHIP BETWEEN
LOW AND NO CALORIE SWEETENED
BEVERAGE CONSUMPTION AND BODY
COMPOSITION AND RISK OF OBESITY
AND SLIDE SHOWS ANALYTIC
FRAMEWORK THAT HOPEFULLY, AGAIN,
LOOKS VERY FAMILIAR.
ONE IMPORTANT ITEM TO NOTE IN
REGARDS TO COMPARATORS IS THAT
THE COMPARATORS FOR THIS REVIEW
ARE CONSUMPTION OF A DIFFERENT
AMOUNT OF LOW AND NO CALORIE
SWEETENED BEVERAGE OR WATER AND
ARTICLES COMPARING LOW AND NO
CALORIE SWEETENED BEVERAGE AND
SUGAR SWEETENED BEVERAGES WILL
BE INCLUDED IN SUGAR SWEETENED
BEVERAGES REVIEW NEXT SLIDE.
THIS IS AN OVERALL SUMMARY OF
CONCLUSION STATEMENTS I WILL GO
INTO IN DETAIL IN NEXT SLIDE.
FOR LOW AND NO CALORIE --
CONCLUSION STATEMENT WAS LIMITED
HE EVIDENCE THAT SUGGESTS THAT
LOW AND NO CALORIE SWEETENED
BEVERAGE CONSUMPTION 17
PROSPECTIVE COHORT STUDIES SO NO
TRIALS AND ALSO AS A WHOLE
REPORTED LOW AND NO CALORIE
SWEETENED BEVERAGE CONSUMPTION
THAT WAS VERY LOW IN THESE LIFE
STAGES.
IN REGARDS TO CONSISTENCY
FINDINGS WERE MOSTLY NULL.
THERE WERE MORE NEGATIVE THAN
BENEFICIAL FINDINGS AND MANY
UNFAVORABLE ASSOCIATIONS BETWEEN
LOW AND NO CALORIE SWEETENED
BEVERAGE CONSUMPTION WITH
OUTCOMES USED UNADJUSTED BMI
DATA MAKING FINDINGS DIFFICULT
TO INTERPRET AND PRECISION
SAMPLE SIZES ON SMALLER SIDE
OBSERVATIONAL STUDIES MANY
OBSERVATIONAL STUDIES AND
ARTICLES WITH COMPARATOR
CONTINUOUS INTAKE AND HAD A
HANDFUL COMPARING LOW AND NO
CALORIE SWEETENED BEVERAGE
CONSUMPTION CATEGORY AND RISK OF
BIAS BIGGEST CONCERNS
CONFOUNDING AND MISSING DATA AND
FOR DIRECTNESS CONCERNS MOSTLY
FOCUSED ON LACK OF TRIAL DATA
AND FOR GENERALIZABILITY ABOUT
1/3 OF THE ARTICLES DIDN'T
REPORT RACE AND/OR ETHNICITY
DATA.
OF THOSE THAT REPORTED ALL BUT
THREE ENROLLED PREDOMINANTLY
NON-HISPANIC WHITE CHILDREN.
NEXT SLIDE.
LOW AND NO CALORIE CONSUMPTION
WITH ADULTS.
COMPARED WITH WATER AND LOW
AMOUNTS OF CALORIE AND NO
SWEETENED BEVERAGES BODY OF
EVIDENCE INCLUDED 8 TRIALS AND
PROSPECTIVE COHORT STUDIES AND
FOR CONSISTENCY, RESULTS FROM
THE TRIALS WERE FAIRLY
CONSISTENT WITH MOST
DEMONSTRATING NO DIFFERENCE FROM
THE CONTROL OR ACTUALLY HAVING A
LESSER EFFECT THAN A WATER
CONTROL FOR REDUCING WEIGHT OR
BMI BUT ACTUALLY BOTH LOW AND NO
CALORIE SWEETENED BEVERAGE
CONSUMPTION AND WATER THAT
GENERALLY SHOWED WEIGHT LOSS IN
THE TRIALS.
RESULTS FROM THE PROSPECTIVE
COHORT STUDIES LACK CONSISTENCY
IN DIRECTION OF FINDINGS AND
PRECISION MOST OF THE TRIALS HAD
SMALLER SAMPLE SIZES AND MIX OF
CONTINUOUS AND CATEGORICAL
COMPARATORS ACROSS THE STUDY AND
RISK OF BIAS THERE WAS
SUBSTANTIAL CONCERNS RELATED TO
CONFOUNDING AND MISSING DATA AND
OBSERVATIONAL STUDIES.
THERE WERE SOME CONCERNS WITH
DIRECTNESS IN THE OBSERVATIONAL
STUDIES AND GENERALIZABILITY,
ALL BUT -- IN THE TRIALS, ALL
PARTICIPANTS WERE WITH
OVERWEIGHT OR OBESITY EXCEPT FOR
ONE TRIAL.
MOST STUDIES THAT REPORTED RACE
AND/OR ETHNICITY DATA CONDUCTED
IN PREDOMINANTLY WHITE
NON-HISPANIC -- POSITION DATA
WERE CONDUCTED IN MIDDLE TO
HIGHER SOCIOECONOMIC POPULATIONS
AND HALF OF THE ARTICLES DIDN'T
REPORT RACE AND ETHNICITY DATA
AND 1/3 DIDN'T REPORT
SOCIOECONOMIC POSITIONED DATA.
NEXT SLIDE.
LOW AND NO CALORIE SWEETENED
BEVERAGE CONSUMPTION BY
INDIVIDUALS DURING PREGNANCY, WE
DECIDED THAT A CONCLUSION
STATEMENT COULDN'T BE DRAWN
ABOUT THE RELATIONSHIP BETWEEN
LOW AND NO COLOREE SWEETENED
BEVERAGE DURING PREG NANNY AND
GESTATIONAL WEIGHT GAIN NO
EVIDENCE AVAILABLE AND ZERO
EVIDENCE WAS IDENTIFIED.
NEXT SLIDE, PLEASE.
AND FOR LOW AND NO CALORIE
SWEETENED CONSUMPTION BEVERAGE
FOR INDIVIDUALS DURING
POSTPARTUM AND POSTPARTUM WEIGHT
CHANGE WE DECIDED A CONCLUSION
STATEMENT COULDN'T BE DRAWN AND
NOT ENOUGH AVAILABLE EVIDENCE
AND ONE COHORT STUDY WAS
IDENTIFIED IN THE BODY OF
EVIDENCE.
WITH THAT, I WILL TURN IT BACK
OVER TO DEANNA.
>> THANK YOU. YOU CAN SEE THAT
WE HAVE BEEN VERY BUSY WITH A
LOT OF REVIEWING OF ARTICLES FOR
ALL OF THE DIFFERENT QUESTIONS.
SO, WE CAN OPEN IT UP FOR
QUESTIONS AND EVE WILL MODERATE.
>> THANK YOU.
>> GREAT. AMAZING WORK, DEANNA,
AND THE GROUP AND KUDOS FOR
PRESENTING IT IN SUCH A GREAT
FASHION.
TRYING TO FOLLOW UP ON A COUPLE
QUESTIONS.
ANYWAY, FIRST ONE IS FOR ANDREA
ON 100% JUICE AND RISK OF
OBESITY.
I THINK THAT YOU MADE A
STATEMENT THAT I WANTED
CLARIFICATION THAT MOST OF THE
POPULATION IN THAT EVIDENCE WERE
ALREADY IN THE OVERWEIGHT AND
OBESE CATEGORY MAYBE.
IN FACT, WE HAVE THIS RIGHT AND
THEN I WAS WONDERING HOW
ACCURATE YOU CAN ASSESS THE RISK
OF OBESITY IF THEY ARE ALREADY
IN MORE INTO THAT RISK CATEGORY.
>> GOOD QUESTION AND ONE PART IS
BODY XOGS COMPOSITION AND WEIGHT
GAIN AND NULL FINDINGS IN RCT
WEIGHT GAIN THAT PARTICIPANTS
WERE CONSUMING 100% JUICE.
>> OKAY.
>> MAKE SENSE?
I SEE WHAT YOU ARE SAYING.
THERE WASN'T ANY -- YEAH. DOES
THAT MAKE SENSE?
>> YEAH. THANK YOU.
>> HOLY WANT TO JUMP IN?
>> I CAN IMAGINE YOU SAYING THAT
WAS PURPOSEFUL AND BECAUSE OF
THE VERY REASON YOU BROUGHT UP
AND WE RECOGNIZE WE COULDN'T USE
THE USUAL TERMINOLOGY BECAUSE OF
THE VERY THING THAT YOU SAID.
SO, AS A GROUP, WE FELT LIKE
THAT SPECIFIC WORDING BEST
CAPTURED WHAT WE WERE SEEING.
>> THANK YOU.
>> SARAH?
>> YES. THANK YOU, EVERYONE.
GREAT, GREAT WORK.
SORRY I HAD A MORE GENERAL
QUESTION THAT IS BROAD. I WAS
LISTENING, PARTICULARLY, HOLLY,
YOUR PRESENTATION ON THE REASONS
WHY THERE WAS LIMITED EVIDENCE.
YOU MADE COMMENTS SUCH AS THERE
WAS NO INFORMATION ON
RANDOMIZATION AND THERE WAS VERY
SMALL STUDIES.
YOU KNOW, JOURNALS HAVE REALLY
IN RECENT YEARS TRIED VERY HARD
TO INCREASE THE ARIGOR OF HOW WE
REPORT THESE TRIALS.
IT IS A GREAT DEAL OF DETAIL IN
MOST JOURNALS.
MY QUESTION TO YOU IS: ARE YOU
FINDING A LOT OF THESE STUDIES
THAT YOU STRUGGLED WITH FROM A
METHODOLOGICAL PERSPECTIVE, WERE
THESE OLDER STUDIES?
DO WE STILL STRUGGLE AS A
COMMUNITY WITH ARIGOR IN OUR
REPORTING OF THESE TRIALS?
ALSO, OBSERVATIONAL STUDIES FROM
WHICH I THINK WE HAVE LAST
STRUCTURED HOW WE REPORT THEM.
>> THAT IS A SUPER GREAT
QUESTION.
I WOULD WELCOME ANYONE FROM THE
GROUP TO RESPOND ABOUT THE RIGOR
COMPONENT AND TO BE HONEST WITH
YOU, I CAN'T REMEMBER IF IT
SEEMED LIKE THERE WAS A
DIFFERENCE IN THE RIGOR OF
REPORTING BY PUBLICATION DATE.
WHAT WE DEFINITELY SAW THAT I
THINK THAT PROBABLY EVERYBODY
SEES IS THERE IS JUST AN
INCONSISTENTLY FOR SURE IN TERMS
OF THE EXPOSURE AND HOW THE
EXPOSURE WAS DEFINED THAT IS
DEFINITELY -- THERE IS NO
CONSISTENT TERMINOLOGY THAT IS
DEFINITELY ALL OVER THE PLACE.
THERE IS DEFINITELY A DIFFERENCE
IN THE RIGOR THAT IS REPORTED.
I DON'T KNOW.
ANDREA OR EDOR CHRISTOPHER THAT
IS GENERALLY ON THAT GROUP AND
DON'T KNOW IF ANYONE ELSE CAN
RECALL A PATTERN BY PUBLICATION
DATE OR ANY OF THAT.
>> I DON'T RECALL A PATTERN BY
PUBLICATION DATE.
BUT, YOU KNOW, I THINK THAT AT
-- I THINK IT HAS MORE TO DO
WITH LIKE IT SAYS IT WAS SAID
DIVERSITY HOW THE EXPOSURE IS
DEFINED AND COMPARISONS AND
LENGTH OF FOLLOWUP.
THERE IS LOTS OF ISSUES.
SO, I THINK THEY ARE INHERENT
AND DON'T THINK THE REPORTING IS
THE MAJOR ISSUE.
IT CAN BE IMPROVED, OF COURSE.
I THINK IT IS MORE DIVERSITY OF
THE DIFFERENT APPROACHES THAT
ARE TAK TAKEN STUDIES WERE NOT
DESIGNED AND COHORT STUDIES FOR
MORE REASONS AND QUESTIONNAIRES
MAY NOT HAVE DETAIL ON SOME
SPECIFICS ON BEVERAGES LIKE
SEPARATING 1% AND 2% AND ARE
MAIN ISSUES NOT SO MUCH
REPORTING THAT COULD OF COURSE
BE IMPROVED.
>> I WILL ADD I DON'T RECALL
PAPERS BEING FROM 21 AND 22 AND
23 AND LOOKING AT THESE WE HAVE
15 YEAR OLD 10 AND 12 YEAR OLD
PAPERS NO THE SUPER GREAT WE GET
TO UPDATE GUIDELINES BECAUSE OF
A SLEW OF NEW PAPERS THAT IS
USUALLY A BROAD RANGE OF YEARS
THAT SOME ARE QUITE A BIT OLDER.
>> REACTION TO THE CONVERSATION?
>> YEAH. EVE, ONE OTHER THING
THAT WE HAVE DISCUSSED SOMEWHAT
IS PUBLICATION BIAS THAT THERE
MIGHT BE A BIAS THAT QUESTIONS
ARE ALREADY ANSWERING.
SOMETIMES IT MIGHT BE DIFFICULT
TO GET PAPERS PUBLISHED OR
FUNDED, YOU KNOW, THAT ARE ALONG
THOSE WAYS.
THAT ANSWERED THOSE QUESTIONS
AND IS SOMETHING ELSE THAT WE
HAVE TALKED ABOUT.
>> ALINE?
>> I HAD A QUESTION FOR HOLLY ON
YOUR -- ON -- ON THE QUESTION OF
THE DAIRY MILK CONSUMPTION AND
GROWTH BODY RISK CONSUMPTION AND
RISK OF OBESITY AND RECALL
CORRECTLY YOUNG CHILDREN WERE
DEFINED 2 TO 5 AND OLDER I THINK
YOU SAY 8 TO MAYBE 19 OR 18.
SO, IS THERE A GAP IN THE
EVIDENCE BETWEEN THAT 5 AND 8
YEARS?
>> DID I GET IT WRONG.
>> YOU GOT IT RIGHT. I WAS
TRYING TO PULL BACK UP THE SLIDE
TO LOOK.
SIMILAR TO WHAT HAS BEEN
DESCRIBED BEFORE WE HAD
OBVIOUSLY THE DATA ORGANIZED IN
LOTS OF DIFFERENT WAYS TO BE
ABLE TO LOOK AT THINGS AND ONE
THING WE DID SEE WITH OVERALL AS
WELL AS WITH FAT CONTENT IS IT
LOOKED LIKE THERE IS AN AGE
DIFFERENCE PATTERN.
SO, WHEN WE -- WHEN WE
CATEGORIZED OR SORTED THINGS BY
AGE, YOU KNOW, YOU COULD REALLY
CLEARLY SEE THAT.
THERE IS DEFINITELY -- I THINK
THERE IS A GAP BETWEEN 5 TO 8.
THERE WAS A DEFINITE CLEAR BREAK
AT LEAST IN TERMS OF AGE GROUPS
THAT WE SAW IN THE STUDIES.
>> THANK YOU. ONE LAST QUESTION
IF NOBODY HAS ONE.
I THINK THAT CONCLUSION
STATEMENT IS MODERATED AND THERE
IS SUBSTANTIAL CONCERN ON TWO
CRITERIA AND SOME CONCERNS ON
THREE CRITERIA IF I CAN PICTURE
THE SLIDE.
I WAS WONDERING LIKE THE -- HOW
THE DISCUSSION CAME ABOUT TO
RATE THOSE AS MODERATE
CONSIDERING MAYBE THOSE
CONCERNS?
>> I'M LOOKING BACK AT OUR SLIDE
QUICKLY AND THINK THE BIG ISSUE
IS THAT IS A QUESTION THAT HAD
LARGEST NUMBER OF TRIALS IN IT.
AND THE TRIALS AS A WHOLE HAD
MOST CONSISTENT FINDINGS AND
LARGE NUMBER OF TRIALS AND
CONSISTENCY OF FINDING THAT IS
WHAT DRILLED THAT OVERALL SCORE.
>> WHAT OTHERS HEAR FROM OTHER
GROUPS AND RECALL TWO TRIALS
THAT WERE DECENT AND 20
EPISTUDIES AND WE WENT WITH THE
EPISTUDIES AND THERE WERE TWO
TRIALS AND SOMETIMES IS HALF AND
HALF AND SO I MEAN WE WAITED
TRIALS MORE HEAVILY THAN EPIONLY
IF THEY WERE THERE AND YOU HAD
TO GRADE IT IF ONE OR TWO AND
GOT TO GRADING AND GRADING
TRIALS AND EPISEPARATELY FOR SIX
CRIT EAR YA IS A LITTLE AWKWARD
AFTER A WHILE THINKING THAT IS
ONLY ONE OR TWO TRIALS AND YOU
HAVE TO BALANCE ALL THAT OUT IS
A CHALLENGE.
>> ADDITIONAL COMMENTS OR
QUESTIONS AND LAST DISCUSSION
PERIOD DIETARY PATTERNS AND
SPECIFIC DIETARY PATTERN
COMPONENT PRESENTATIONS AND ANY
FINAL QUESTIONS RELATED TO
SPECIFIC XOEN NENS COMPONENTS O
DIETARY PATTERNS BROADLY? IF
NOT WE WILL WRAP THE ASPECT UP
WITH NEXT STEPS.
>> THANK YOU AND TO ALL OF THE
COMMITTEE MEMBERS THAT PRESENTED
TODAY.
AND ALL OF THE NESR SUPPORT
STAFF AND FOR THE NEXT STEP WE
WILL CONTINUE THE WORK.
WE HAVE -- EXCUSE ME.
MANY MORE SYSTEMATIC REVIEWS TO
GO.
ONE MORE IN DIETARY PATTERNS
WITH THE ULTRA PROCESSED FOOD
AND GROWTH BODY COMP AND RISK OF
OBESITY AND GETTING TO OTHER
DISEASE OR CHRONIC DISEASE
OUTCOMES THAT YOU SEE OUTLINED
THERE.
IN TERMS OF SPECIFIC DIETARY
PATTERN COMPONENTS AS YOU HAVE
HEARD TODAY, YOU WILL BE WORKING
ON THE SUGAR SWEETENED BEVERAGES
AND LOW AND NO CALORIE SWEETENED
BEVERAGES WITH TYPE II DIABETES
AND FINALLY FOOD SOURCES WITH
SATURATED FAT AND LOTS OF WORK
LEFT TO DO EVEN THOUGH WE HAVE
DONE A LOT UP TO THIS POINT AND
LOOKING FORWARD TO THE NEXT
MEETING AND BEING ABLE TO
PRESENT SOME OF THE RESULTS AND
OUR CONCLUSION STATEMENTS.
THANKS.
>> EXCELLENT. GIVEN WE HAD MANY
STOPPED TO HAVE LUNCH OR
BREAKFAST DEPENDING WHERE YOU
ARE, WE WILL PAUSE HERE FOR A
QUICK BREAK AND STOP HERE FOR 10
MINUTES AND RECONVENE AT 1:55
EASTERN TIME JUST OVER 10 MINUTES. THANK YOU.
>> WELCOME BACK. I HOPE
EVERYBODY HAD A NICE BREAK. WE
WILL HAVE A FINAL SUB-COMMITTEE
PRESENTATION AND DIET AND
PREGNANCY AND ADOLESCENCE.
>> THANK YOU, EVE. CHANGING
VIEW TO GALLERY TO SEE YOU ALL
MUCH BETTER.
GOOD AFTERNOON, EVERYONE. IT IS
A PLEASURE TO WRAP UP OUR
PRESENTATIONS TODAY AND TO
PRESENT ON BEHALF OF
SUB-COMMITTEE 2 THAT IS
EXAMINING EVIDENCE ON DIET AND
PREGNANCY AND BIRTH AND
ADOLESCENCE AND DELIGHTED TO BE
JOINED BY CAROL AND SO THANK
YOU, CAROL, FOR JOINING.
NEXT SLIDE.
ALL RIGHT. BEFORE WE BEGIN,
LIKE OTHER SUB-COMMITTEES WE
WANT TO THANK THE NESR TEAM FOR
TREMENDOUS SUPPORT AND FEDERAL
STAFF WORKING WITH US INCLUDING
FEDERAL LIAISONS WHO HAVE BEEN
FANTASTIC AND DENNIS ANDERSON.
THANK YOU TO THEM. NEXT SLIDE.
ALSO, OF COURSE, OUR FANTASTIC
SUB-COMMITTEE MEMBERS THAT ARE
ALWAYS ALL IN ON THE
DELIBERATIONS AND REVIEWS.
I THINK THAT HAS BEEN A
FANTASTIC EXPERIENCE FOR ALL OF
US TO BE ABLE TO CONTRIBUTE TO
THIS.
I WILL NOTE LIKE OTHERS HAVE
THAT A NUMBER OF US ON HEALTH
EQUITY SUB-COMMITTEE AND SO WE
BRING THOSE IMPORTANT
PERSPECTIVES BACK TO THE
DELIBERATIONS IN THIS WORK THAT
WILL BE EVIDENCE IN SOME
COMMENTS.
NEXT SLIDE, PLEASE.
ALL RIGHT. WHAT HAVE WE BEEN
DOING? I FEEL WE HAVE BEEN
WORKING HARD AND MAYBE NOT THE
VOLUME THAT SUB-COMMITTEE 1 HAS
THAT IS IMPRESSIVE ALL OVER THAT
ALL OF THE WORK HAS BEEN TODAY.
COMMITTEE WAS TASKED WITH
REVIEWING THE EVIDENCE ON 8
SCIENTIFIC QUESTIONS AND FOUR OF
THE QUESTIONS WERE IN DIET
DURING PREGNANCY AND FOUR
INVOLVE DIET AND INFANCY AND
ADOLESCENCE AND LAST MEETING WE
PRESENTED EVIDENCE ON SYSTEMATIC
REVIEWS AND REPEATED SXOESH YOUR
FOR BIRTH 24 TO AGE GROUP AND
PROTOCOLS REVIEWING EVIDENCE AND
DIETARY PATTERNS AND MATERNAL
CHILD HEALTH OUTCOMES AND SINCE
THAT TIME WE HAVE COMPLETED A
NEW REVIEW FOR THE ITERATION OF
DIETARY GUIDELINES AND REPEATED
EXPOSURE CHILDREN 2 TO 6 YEARS
OF AGE PRESENTING TODAY AND
DELIGHTED TO SAY WE HAVE ALMOST
FINISHED A FULL SYSTEMATIC
REVIEW REPORT ON THIS TOPIC THAT
COMBINES EVIDENCE IN 2 TO 6 YEAR
OLDS WITH B24 [INDISCERNIBLE]
AND FINALLY COMMITTEE MEMBERS
HAVE COMPLETED REVIEW OF
EVIDENCE ON DIETARY PATTERNS AND
HYPERTENSIVE DISORDERS DURING
PREGNANCY THAT WILL BE PRESENTED
TOED BY CAROL.
OKAY. LET'S MOVE ON.
OKAY. WE WILL BEGIN WITH
EVIDENCE ON REPEATED EXPOSURE
AND FOOD ACCEPTANCE DURING
CHILDHOOD AND BY WAY OF
BACKGROUND AND TERMS OF
SIGNIFICANCE, IT IS REALLY WELL
ESTABLISHED THERE IS A STRONG
BIOLOGICAL COMPONENT FOR TASTE
PREFERENCES IN YOUNG CHILDREN
AND PREFERENCES FOR
[INDISCERNIBLE] AND FOOD
PREFERENCES ARE ALMOST LARGELY
ACQUIRED THROUGH EXPERIENCE THAT
ARE EXPERIENCES THAT ARE
INHERENTLY SOCIAL AND WHILE
FOODS THAT ARE THOSE THAT ARE
SWEET ARE READILY ACCEPTED BY
YOUNG CHILDREN AND MANY FOODS
INCLUDING THOSE THAT ARE
RECOMMENDED IN THE DIETARY
GUIDELINES ARE NOT.
RIGHT?
QUESTION IN REPEATED EXPOSURE IS
LARGER INTEREST IN ITERATION OF
DIETARY GUIDELINES AND
IDENTIFYING STRATEGIES THAT
SUPPORT DEVELOPMENT OF HEALTHFUL
EATING BEHAVIORS IN YOUNG
CHILDREN IN LINE WITH DIETARY
GUIDELINES AND IN THIS CASE
CONSIDERING CHILDREN'S
ACCEPTANCE OF HEALTHFUL FOOD AND
THIS SHOWS ANALYTIC FRAMEWORK WE
USED TO EVALUATE EVIDENCE AND
REMINDER THAT B24 COMPONENT OF
REVIEW THAT WE PRESENTED LAST
TIME IS AN ACTUAL UPDATE TO A
2019NESR REVIEW FOR THE LAST
ITERATION OF THE DIETARY
GUIDELINES.
HOWEVER, EVIDENCE, TODAY, AGAIN,
IS NEW TO DIETARY GUIDELINES AND
THIS ITERATION FOCUSES ON
CHILDREN 2 TO 6 YEARS OF AGE AND
PICO ELEMENT HAVE BEEN THE SAME
ACROSS TWO LIFE STAGES THAT WE
HAVE CONSIDERED AND TO REORIENT
YOU TO WHAT WE ARE LOOKING AT IN
THE STUDIES WE HAVE CONSIDERED
STUDIES OF TASTE EXPOSURE
CHILDREN ARE GIVEN OPPORTUNITY
TO TASTE AND CONSUME FOODS AND
THESE STUDIES INVOLVE SENSORY
EXPOSURE PLAYING WITH FOODS
READING PICTURE BOOKS ABOUT
FOODS AND METHODS OF STUDIES ARE
VARIABLE.
IN GENERAL, THIS STUDY IN THIS
BODY OF EVIDENCE ARE PROVIDING
TASTE AND NONTASTE EXPOSURE TO
FOODS BETWEEN 1 TO 14 TIMES AND
EITHER OCCURRING LIKE ON A DAILY
BASIS OR WITH A RANGE OF UP TO
ONCE TO TWICE A WEEK TO GIVE A
SENSE WHAT LITERATURE LOOKS LIKE
AND IN TERMS OF OUTCOMES THERE
IS A NUMBER OF INDICATORS OF
FOOD ACCEPTANCE REPORTED IN THE
LITERATURE WE CONSIDER. YOU CAN
SEE IT ALONG THE STANDARD
OUTCOME COLUMN. I WILL NOT READ
THROUGH ALL OF THOSE.
TO SAY THAT WE OPERATIONALLY
DEFINED A POSITIVE OUTCOME IN
TRIALS AS IN STATISTICALLY
INCREASE IN ONE OR MORE
INDICATORS.
FOR MOST STUDIES THAT WE
CONSIDERED, MOST STUDIES
ASSESSED AND INCLUDED WEIGHT
FOOD INTAKE MEASURES FOLLOWED BY
MEASURES OF LIKING AND
UNWILLINGNESS TO TRY AND WHAT I
WOULD LIKE TO DO NEXT IS PRESENT
FIVE CONCLUSION STATEMENTS WE
DEVELOPED BASED ON REVIEW OF
EVIDENCE BASED ON 2 TO 6 YEARS
OF AGE.
NEXT SLIDE.
THERE WILL BE TWO CONCLUSION
STATEMENTS ON THIS SLIDE THAT
WILL FOCUS ON ONE THAT IS
ACTUALLY SHOWN HERE.
THESE TWO STATEMENTS REFER TO
THE EFFECTS OF REPEATED TASTE
EXPOSURE TO VEGETABLES AND IN
STUDIES WERE THINGS LIKE SPINACH
BELL PEPPERS ZUCCHINI AND
ARTICHOKES AND FOODS NOVEL TO
CHILDREN AS WELL AS THAT ARE
FAMILIAR AND MORE OFTEN
INITIALLY DISLIKED FOODS AND
REVIEWING MODERATE EVIDENCE TO
INDICATE REPEATED TASTE EXPOSURE
TO SINGLE MULTIPLE OR DISLIKED
VEGETABLE TO INCREASED
ACCEPTANCE -- AGES 2 TO 6 YEARS
AND THIS CONCLUSION WAS BASED ON
THE DESIGN AND RESULTS OF 14RCTS
IN ONE NONRANDOMIZED CONTROL
TRIAL REPORTED IN 15 ARTICLES
ASSIGNING GRADE OF MODERATE
BASED ON COMMITTEE'S ASSESSMENTS
BASED ON STRENGTH AND DIRECTNESS
AND CONSISTENCY OF EVIDENCE AS
WELL AS PROTECTIONS OF EVIDENCE
OF BIAS AND STRENGTHS WERE
WEIGHED AGAINST SIGNIFICANT
CONCERNS ABOUT GENERALIZABILITY.
SO, I WILL SAY A LITTLE ABOUT
EACH OF THESE ELEMENTS STARTING
WITH THE STRENGTH AS WE PERCEIVE
THEM.
SO, FIRST STUDIES THAT ARE
DESIGNED TO DIRECTLY ANSWER THE
QUESTIONS THAT MOST INVOLVED
RANDOMIZED CONTROL TRIALS THAT
WERE DESIGNED SPECIFICALLY TO
ANSWER THIS QUESTION.
SECOND, RESULTS WERE REMARKABLY
CONSISTENT.
14 OUT OF THE 15 STUDIES
DEMONSTRATED STATISTICALLY
SIGNIFICANT INCREASES IN ONE OR
MORE MEASURES OF FOOD
ACCEPTANCE.
AGAIN, MOST STUDIES IN THIS AREA
INVOLVED OR SHOWED SIGNIFICANT
INCREASES IN OBJECTIVE MEASURES
OF WEIGHT INTAKE.
REGARDING RECISIONS STUDIES
ADEQUATE SAMPLE SIZES WERE
SUFFICIENTLY POWERED.
FINALLY, USE OF RCT DESIGNED
WERE AFFORDING MODERATE
PROTECTIONS AGAINST BIAS AND
NEXT COMMENTS REFER IN SOME WAYS
BACK TO THE CONVERSATION THAT WE
HAD BEFORE THE BREAK.
IN REVIEWING THESE STUDIES, WE
NOTED THAT REPORTING ELEMENTS
WERE MISSING DETAIL ABOUT LACK
OF -- LACK OF DETAIL ABOUT THE
RANDOMIZATION PROCESS OR A LACK
OF PRE-SPECIFIED ANALYSIS PLAN.
IN OUR CASE, THE COMMITTEE DID
NOT REVIEW THE -- THEY DID NOT
VIEW THESE AS SIGNIFICANT
CONCERNS GIVEN THAT GOOD NUMBER
OF STUDIES WERE PUBLISHED PRIOR
TO THE REGISTRATION OF CLINICAL
TRIALS AND PRIOR TO TIME WHEN
ASPECTS OF STUDIES OF DESIGN
WERE CONSIDERED TO BE STANDING
REPORTING REQUIREMENTS IN MOST
JOURNALS.
SO, DESPITE SIGNIFICANT
STRENGTHS, WE IDENTIFIED
SIGNIFICANT CONCERNS REGARDING
GENERALIZABILITY OF FINDINGS TO
THE US POPULATION.
SO, I WILL DETAIL THOSE FIRST.
STUDIES LACK DIVERSITY IN TERMS
OF RACE AND ETHNICITY AND ONLY
FIVE OR 15 STUDIES REPORTED DATA
ON RACE AND ETHNICITY AND 70% OR
MORE PARTICIPANTS IN STUDIES
WERE WHITE AND LACK DIVERSITY IN
TERMS OF ECONOMIC POSITION AND 7
IN 15 STUDIES SO LESS THAN HALF
REPORTED PARTICIPANT EDUCATION
AND EDUCATION LEVEL WAS HIGH IN
ALL OF THE STUDIES AND MEASURES
OF SEP WERE LESS FREQUENTLY AND
INCONSISTENTLY REPORTED AND
FINALLY MAJORITY OF STUDIES WERE
ACTUALLY CONDUCTED OUTSIDE OF
THE US IN 12 AND 15 AND WIDE
RANGE OF CULTURAL DIFFERENCES
INSTANCE CULTURAL FOODS CHILD
REARING PRACTICES EATING NORMS,
ET CETERA, COULD INFLUENCE FOOD
ACCEPTANCE PATTERNS AND YOUNG
CHILDREN TO CALL INTO QUESTION
THE GENERALIZABILITY OF FINDINGS
TO THE US POPULATION AND GOING
TO THE NEXT CONCLUSION
STATEMENT, PLEASE.
THANK YOU.
THE SECOND CONCLUSION STATEMENT
ADDRESSES THE EXTENT TO WHICH
EFFECTS OF REPEATED EXPOSURE TO
VEGETABLES MIGHT GENERALIZE TO
OTHER FOODS AND FOR EXAMPLE
WHETHER PROVIDING REPEATED
EXPOSURE TO ONE TYPE BRCA LEE
MIGHT BENEFIT CHILD'S ACCEPTANCE
OF ANOTHER TYPE OF VEGETABLE
LIKE GREEN BEANS AND IN THIS
CASE WE FOUND LIMITED EVIDENCE
TO SUGGEST EXPOSURE TO TARGET
VEGETABLE IS LIKELY TO INCREASE
ACCEPTANCE OF A DIFFERENT
VEGETABLE IN YEARS AGES 2 TO 6
YEARS OF AGE AND EVIDENCE FOR
THIS CONCLUSION STATEMENT CAME
FROM 6RCTS AND HERE WE ASSIGNED
A GRADE OF LIMITED PRIMARILY DUE
TO CONCERNS ABOUT CONSISTENCY AS
WELL AS GENERALIZABILITY OF
EVIDENCE TO A LESSER EXTENT
PRECISION AND WAS THE CASE FOR
PREVIOUS CONCLUSION AND GROUP OF
STUDIES, USE OF RCT DESIGNS
PROVIDED DIRECT ASSESSMENT OF
THE QUESTION AND BELIEVE
AFFORDED MODERATE PROTECTION
AGAINST BIAS AND HOWEVER IN THIS
AREA OF SCIENCE, FINDINGS WERE
QUITE INCONSISTENT AND ONLY SIX
STUDIES AND HALF OF THOSE
STUDIES REPORTED POSITIVE
EFFECTS AND OTHER STUDIES
REPORTED NO EFFECTS AND WERE
CURRENT CONCERNS REGARDING
PRECISION BECAUSE OF SAMPLE
SIZES THAT WERE SMALL.
THERE WAS A LACK OF POWER
ANALYSIS.
FINALLY, AS WITH THE PREVIOUS
STATEMENT, COMMITTEE IDENTIFIED
CONCERNS REGARDING
GENERALIZABILITY.
MOST STUDIES DIDN'T REPORT DATA
ON RACE ETHNICITY AND
SOCIOECONOMIC CONDITION AND
STUDIES WERE CONDUCTED OUTSIDE
OF THE US.
NEXT SLIDE, PLEASE.
THE NEXT TWO CONCLUSION
STATEMENTS PERTAINED TO EFFECTS
OF REPEATED TASTE EXPOSURE TO
FRUITS AND UNFORTUNATE UNLIKE
THE REVIEW OF B24 EVIDENCE, WE
WERE UNABLE TO IDENTIFY STUDIES
ON THIS TOPIC AMONG CHILDREN 2
TO 6 YEARS OF AGE AND THEREFORE
CONCLUSION STATEMENTS COULDN'T
BE DRAWN ABOUT THE EFFECTS OF
REPEATED TASTE EXPOSURE TO
FRUITS.
ON CHILDREN'S ACCEPTANCE OF
TARGET FRUIT THAT IS SHOWN IN
THE LEFT STATEMENT OR ON
CHILDREN ACCEPTANCE OF A
DIFFERENT FRUIT MEANING WHETHER
EFFECTS OF REPEATED EXPOSURE
WOULD GENERALIZE TO DIFFERENT
FRUITS AND ARE ABLE TO MAKE
HEADWAY IN THE AREA.
ALL RIGHT.
MOVING ON LET'S GO TO THE FINAL
CONCLUSION STATEMENT.
THIS CONCLUSION STATEMENT
PERTAINS TO STUDIES OF NONTASTE
EXPOSURE AND HERE WE FOUND
MODERATE EVIDENCE THAT REPEATED
NONTASTE EXPOSURE ALONE OR
TOGETHER WITH TASTE EXPOSURE TO
A TARGET FRUIT OR VEGETABLE
INCREASES ACCEPTANCE
SPECIFICALLY YOUNG CHILDREN'S
WILLINGNESS TO TRY TARGET FRUIT
OR VEGETABLE AND CONCLUSION
STATEMENT IS BASED ON FOUR RCTS
AND NOT ONE RANDOMIZED CONTROL
TRIAL EXPOSURE TO TARGET FRUIT
OR VEGETABLE USING STORYBOOKS OR
SENSORY PLAY ACTIVITIES WHERE
CHILDREN WERE INVOLVED
PHYSICALLY IN MANIPULATING FOODS
AND TWO OF THOSE SIX STUDIES
ACTUALLY COMBINED NONTASTE
EXPOSURE WITH TASTE EXPOSURE AND
GRADE OF MODERATE REFLECTED
STRENGTHS IN CONSISTENCY OF
FINDINGS AND DIRECTNESS OF
EVIDENCE AND ADEQUATE PRECISION
AND PROTECTIONS AGAINST BIAS AND
I WILL SUMMARIZE THE STRENGTH
AND AGAIN HERE WE SAW USE OF RCT
DESIGNS PROVIDED DIRECT
ASSESSMENT AND AFFORDED MODERATE
PROTECTIONS OF BIAS AND FOUND
THAT ALL FIVE STUDIES SHOWED
POSITIVE EFFECTS OF NONTASTE
EXPOSURE OF ACCEPTANCE IN
CHILDREN AND PARTY OF EVIDENCE
FOUR OF THE FIVE STUDIES
MEASURED CHILDREN'S WILLINGNESS
TO TRY TARGET FRUIT OR VEGETABLE
AND STUDIES FOUND POSITIVE
EFFECTS ON OUTCOME AND WHY
CONCLUSION STATEMENT
SPECIFICALLY MENTIONS
WILLINGNESS TO TRY AND POSITIVE
EFFECTS ON LIKING AND ON INTAKE
AND IN TERMS OF PRECISIONS
STUDIES HAD ADEQUATE SAMPLE
SIZES BEING ADEQUATELY POWERED
LIKE OTHER EVIDENCE WE REVIEWED
THERE WERE SIGNIFICANT CONCERNS
ABOUT LACK OF DIVERSITY AND
PARTICIPANT RACE AND ETHNICITY
AND SEP AND GENERALIZABILITY OF
THE INTERNATIONAL STUDIES.
ALL RIGHT.
LET'S MOVE TO THE LAST SLIDE ON
REPEATED EXPOSURE.
SO, THE SLIDE SHOWS YOU A
SUMMARY OF THE CONCLUSION
STATEMENTS THAT WE HAVE DRAFTED
BASED ON THE EVIDENCE OF
REPEATED EXPOSURE IN CHILDREN
FROM BIRTH UP TO SIX YEARS OF
AGE.
AND I WILL POINT OUT THAT THE
BODY OF EVIDENCE INVOLVES 36
RANDOMIZED CONTROL TRIALS AND
FIVE NONRANDOMIZED CONTROL
TRIALS.
IT REALLY -- I THINK IT
PROVIDES A FAIRLY XREE
HADDENCESIVE EXAMINATION OF THE
SCIENTIFIC EVIDENCE OF THIS
TOPIC DURING EARLY CHILDHOOD.
IN SHORT, WE FOUND THAT THE
EVIDENCE ON REPEATED TASTE
EXPOSURE AND VEGETABLE
ACCEPTANCE IS FAIRLY ROBUST
DURING EARLY CHILDHOOD AND
POSITIVE ACCEPTANCE OF TARGET
VEGETABLES IN BOTH GROUPS AND
EVIDENCE THAT BENEFITS ACCEPT
ANESS TO EXTEND TO DIFFERENT
VEGETABLES FOR INFANTS AND
TODDLERS NOT OLDER CHILDREN AND
REPEATED TASTE EXPOSURE IT
FRUITS IN CONTRAST COMES FROM
TODDLERS STUDIES OF INFANTS AND
TODDLERS WITH MODULATE INCREASED
ACCEPT ANESS TO TARGET FRUITS
AND LIMIT EVIDENCE EFFECTING
GENERALIZED TO DIFFERENT GROUPS
AND FINALLY FIRST TIME POINTING
OUT WE IDENTIFIED A NUMBER OF
STUDIES IN OLDER CHILDREN
INDICATING PROVIDING SENSORY
EXPOSURE BEYOND TASTING PROMOTE
FOOD ACCEPTANCE AND CHILDREN'S
WILLINGNESS TO TRY FOOD AND
IMPORTANT CAVEAT OF THIS WORK IS
THAT ALTHOUGH THE STUDIES IN
LITERATURE AS A WHOLE IS -- WERE
VIEWED TO BE FAIRLY ROBUST, WE
IDENTIFIED SIGNIFICANT
LIMITATIONS IN THE BODY OF EVERY
AS A WHOLE AROUND
GENERALIZABILITY THAT WE BELIEVE
ARE IMPORTANT TO ADDRESS IN
FUTURE WORK AND CERTAINLY HAVE
IMPLICATIONS AROUND HEALTH
EQUITY.
SO, LET'S MOVE FORWARD TO THE
NEXT SLIDE.
THAT CONCLUDES OUR REVIEW OF
EVIDENCE ON REPEATED EXPOSURE IN
CHILDHOOD.
WITH THAT, I WILL TURN IT OVER
TO CAROL WHO WILL NOW PRESENT
EVIDENCE ON DIETARY PATTERNS
DURING PREGNANCY AND
HYPERTENSIVE DISORDERS ON
PREGNANCY.
>> THANK YOU EVERYONE FOR BEING
HERE AND THE HOME STRETCH AND
RESEARCH QUESTION IF WE CAN HAVE
THE NEXT SLIDE. THE RESEARCH
QUESTION FOR THIS REVIEW IS WHAT
IS A RELATIONSHIP BETWEEN
DIETARY PATTERNS CONSUMED DURING
PREGNANCY AND HYPERTENSIVE
DISORDERS OF PREGNANCY AND THIS
IS AN UPDATE TO EXISTING
SYSTEMATIC REVIEW PUBLISHED IN
2019 AND PART OF THE PREGNANCY
AT BIRTH TO 24 MONTHS AT PROJECT
AND THAT REVIEW HAD A LIMITED
EVIDENCE CONCLUSION STATEMENT
AND DECIDED TO SYNTHESIZE ALL OF
THE EVIDENCE FROM JANUARY OF
1980 TO MAY OF 2023 AND REVIEW
UPDATE.
THE PICO ELEMENTS AND KEY
CONFOUNDERS ARE PRESENTED ON
THIS SLIDE AND NOT CHANGED SINCE
PROTOCOL IS PRESENTED AT LAST
MEETING AND SYNTHESIZED AT LEVEL
OF POPULATION AND CONSIDERED ALL
OUTCOMES UNDER THE UMBRELLA OF
HYPERTENSIVE DISORDERS OF
PREGNANCY YOU SEE LISTED ON THE
SLIDE THAT IS DONE TO NOT
EXCLUDE PARTICIPANTS AT RISK OF
HYPERTENSIVE DISORDERS OF
PREGNANCY AND MIGHT NOT MEET THE
THRESHOLD FOR THIS DIAGNOSIS.
NEXT SLIDE, PLEASE.
FOR THIS RESEARCH QUESTION, A
CONCLUSION STATEMENT CAN'T BE
DRAWN ABOUT THE RELATIONSHIP
BETWEEN DIETARY PATTERNS DURING
PREGNANCY AND HYPERTENSIVE
DISORDERS OF PREGNANCY AND THERE
IS SUBSTANTIAL CONCERNS ABOUT
DIRECTNESS, PRECISION AND
CONSISTENCY AND BODY OF
LITERATURE AND BODY OF EVIDENCE
INCLUDES 31 ARTICLES AND 61
PROSPECTIVE COHORT STUDIES AND
SIX RANDOMIZED CONTROL TRIALS
AND ONE NONRANDOMIZED CONTROL
TRIAL AND GRADE IS NOT
ASSIGNABLE FOR THESE REASONS
DIRECTNESS AND NONPRECISION AND
DESIGNED TO DIRECTLY EXAMINE
RELATIONSHIP BETWEEN DIETARY
PATTERNS DURING PREGNANCY AND
HYPERTENSIVE DISORDERS OF
PREGNANCY AND ACCORDING WILL I
INTERVENTION STUDIES WERE NOT
SUFFICIENTLY POWERED TO DETECT
DIFFERENCES BETWEEN GROUPS OF
HYPERTENSIVE DISORDERS NOT
PROVIDING POWER CALCULATIONS FOR
OUTCOMES OF INTEREST SUCH AS
BLOOD PRESSURE AND IN
OBSERVATIONAL STUDIES POWER
ANALYSIS WERE NOT COMMON AND ONE
NOTED A LARGE ENOUGH SAMPLE SIZE
TO DETECT DIFFERENCES IN
HYPERTENSIVE DISORDER OF
PREGNANCY OUTCOME WITH ADEQUATE
STATISTICAL POWER AND CONCERNS
ABOUT CONSISTENCY AND 31
ARTICLES FROM 22 UNIQUE TRIALS
OR COHORTS, AVAILABLE EVIDENCE
WAS TOO INCONSISTENT TO DRAW A
CONCLUSION ON RELATIONSHIP OF
DIETARY PATTERNS DURING PREYING
NNCY AND RISK OF HYPERTENSIVE
DISORDERS DURING PREGNANCY AND
DIRECTION OF RESULTS FROM
INTERVENTION STUDIES AND
OBSERVATIONAL STUDIES AND SOME
DIETARY PATTERNS WITH SIMILAR
FOODS AND BEVERAGES HAD A BEN
FIRNL AND DETRIMENTAL EFFECT
AND/OR NONSIGNIFICANT
ASSOCIATION WITH OUTCOMES.
ADDITIONAL DIETARY PATTERNS AND
OUTCOMES ASSESSED IN DIFFERENT
TRIMESTERS AND DIFFERENT WAYS
ACROSS STUDIES AND FOR EXAMPLE
13 ARTICLES USED IN INDEX ARE
SCORED FOR THE DIET AND 10
ARTICLES USING FACTOR ANALYSIS
AND CLUSTERAL ANALYSIS AND --
CONSISTENTLY ASSOCIATED FOOD AND
BEVERAGES WITH LOWER RISK OF
HYPER-10SIVE DISORDER OF
PREGNANCY AND THANK YOU ALL FOR
YOUR ATTENTION AND MOVING TO THE
NEXT SLIDE TO ASK FOR INPUT FROM
THE COMMITTEE.
>> YES, FATIMA?
>> THIS IS FOR DR. FISCHER WHO I
ALWAYS GET EXCITED AND LET DOWN
AND FEEL I'M ON A ROLLER COASTER
LISTENING TO YOUR RESULTS AND
OBVIOUSLY SOMEONE TAKING THIS
FROM DR. ANDERSON TAKING
PATIENTS FROM WRINKLE TO WRINKLE
AND WHAT I CAN OFFER MY PATIENTS
EXPOSURES AND CHANGING
PREFERENCES FOR FOODS MORE
BENEFICIAL AND YOU SPECIFICALLY
TALKED ABOUT MODERATE EVIDENCE
FOR VEGETABLES AND CHANGING
PREFERENCE AND I TALK ABOUT MY
PATIENT POPULATION THAT DOES
HAVE A LARGE POPULATION THAT IS
RACIAL AND ETHNIC MINORITY AND
HOW DO I, YOU KNOW, TRANSLATE
THAT BECAUSE OF GENERALIZABILITY
TO THAT POPULATION THAT IS
HIGHLY PREDOMINANT IN ACTUAL
PATIENT POPULATION AND PEOPLE I
DO CARE FOR?
I GUESS, YOU KNOW, THAT IS
FUTURE RECOMMENDATIONS IN TERMS
OF OUR REPORT THAT IS MAKING
SURE WE INCLUDE POPULATIONS THAT
REFLECT MORE OF WHAT WE ARE
SEEING IN THE POPULATION IN
PARTICULARLY IN THE US AND WANT
TO HEAR YOUR THOUGHTS THAT I
WOULD LOVE TO SEE THAT AND I
WOULD LIKE TO KNOW HOW TO
TRANSLATE DATA TO ADULT PATIENTS
AND PEDIATRIC PATIENTS AND
RELATE TO HUSBAND DON'T TELL HIM
I SAID THAT HE CAN'T HEAR WHAT
I'M SAYING.
JUST WANT TO HEAR YOUR THOUGHTS
ABOUT THESE KEY ISSUES AND
GENERALIZABILITY ISSUE AND
MINORITY POPULATIONS.
>> YEAH. I'M SO GLAD THAT YOU
-- YOU ARE ASKING THIS QUESTION.
AND MAKING THOSE POINTS.
I THINK IT BEAUTIFULLY
ILLUSTRATES OUR LEVEL OF
CONCERNS THAT OVERALL IS A QUITE
ROBUST AREA THAT IS A VERY
NARROW ROBUST AREA OF SCIENCE
AND STUDIES HAVE NOT BEEN DONE
AND COMMUNITY FELT UNCOMFORTABLE
WRITING A BODY OF EVIDENCE THAT
IS SMALL PROVIDING STRONG
EVIDENCE FOR THAT EFFECT REASON
THERE IS A LACK OF
REPRESENTATION OF THE DIVERSITY
OF US POPULATION AND THAT IS
CERTAINLY ARTICULATED BETTER
THAN I COULD.
CERTAINLY, WE KNOW THAT INSTANCE
THERE ARE STUDIES THAT ARE IN
POPULATIONS WITH LOWER
SOCIOECONOMIC POSITION WHERE
THERE ARE SIGNIFICANT CONCERNS
ABOUT FOOD WASTE AND THERE IS A
REASON WHY REPEATED EXPOSURE
MIGHT NOT BE A VIABLE STRATEGY
FOR CERTAIN PARTS OF THE
POPULATION.
DO WE KNOW EFFECTS WOULD BE
SIMILAR?
NO. WE DON'T HAVE THAT EVIDENCE
ACTUALLY AND IT POINTS TO,
AGAIN, JUST AS YOU SAID, YOU
KNOW, A REAL -- WILL THIS TYPE
OF WORK BE FUNDED AT THIS POINT
IN THE SCIENCE?
I DON'T KNOW.
CERTAINLY IT IS IMPORTANT TO
CALL OUT THE NEED FOR WORK GOING
FORWARD TO -- TO HAVE A LENS OF
-- OF GREATER INCLUSION.
JUST FOR THE REASONS THAT YOU
DESCRIBED.
SO, I THINK THAT WE ALL SHARED
THAT PERSPECTIVE AND DOES ANYONE
ELSE ON THE COMMITTEE WANT TO
ADD ANYTHING?
THANK YOU.
>> ANY ADDITIONAL QUESTIONS FOR
THE SUB-COMMITTEE?
>> JENNY, ANYTHING ELSE YOU WANT
TO ADDRESS BEFORE WE MOVE TO THE
NEXT ITEM?
>> NO. I THANK YOU FOR YOUR
ATTENTION AND PARTICIPATING IN
THE DISCUSSION.
>> AWESOME. OUR NEXT AGENDA
ITEM IS A CHAIR AND VICE CHAIR
WRAP-UP FACILITATED BY DR.
ANGELA ODOMS-YOUNG.
>> THANK YOU, EVE. THIS HAS
BEEN EVEN BEFORE WE MOVED TO
VIRTUAL IT HAS BEEN A WONDERFUL
MEETING WHERE WE GET AN
OPPORTUNITY TO HEAR ABOUT THE
ROBUST EFFORT IN EACH OF THE
SUB-COMMITTEES THAT HAS HAPPENED
BETWEEN THE PREVIOUS PUBLIC
MEETING AND SARAH AND I HAD A
CHAT BEFORE THE MEETING THAT WE
WANTED TO GIVE EVERYBODY THE
OPPORTUNITY.
MAYBE WE CAN STOP SHARING.
LET'S SEE. MAYBE WE ARE NOT
SHARING AND MIGHT BE ME WHEN I
HAVE SPEAKER HIGHLIGHTED.
OKAY. NOW I'M BACK TO GALLERY
VIEW.
BUT WHERE WE COULD KIND OF GO
AROUND AND JUST, YOU KNOW, SHARE
OUR REFLECTIONS OR ANYTHING THAT
WE WANTED TO MENTION BEFORE WE
CLOSE AND MOVE INTO THINKING
ABOUT THE -- OUR COMMITTEE WORK
IN THE NEXT MEETING.
SO, WE ARE GOING TO DO A
HOLLYWOOD SQUARE SINCE WE ARE
VIRTUAL.
AND ACTUALLY, THE FIRST PERSON I
SEE ON MY SCREEN IS CHRIS
TAYLOR.
WE WANT TO HAVE REFLECTION WHEN
YOU THINK ABOUT THE WORK THAT
HAS BEEN DONE IN-BETWEEN THE
MEETING AND THINK ABOUT WHAT HAS
BEEN PRESENTED TODAY, DO YOU
HAVE ANY FINAL OR CLOSING
COMMENTS?
>> I THINK MY BIGGEST TAKEAWAY
IS EVALUATING THE MAGNITUDE OF
THE EVIDENCE THAT WE ARE SIFTING
THROUGH.
THE WORK THAT THE STAFF ARE
DOING ON THE BACKEND THAT KIND
OF IS THE FOUNDATION OF
EVERYTHING WE ARE DOING HERE.
BUT KIND OF BACK TO SARAH'S
COMMENT IN THE BEGINNING SHOWING
UP AND DISCUSSING WHAT IS
PRESENTED HERE AND MAGNITUDE OF
THE WORK BEING SIFTED THROUGH
AND [INDISCERNIBLE] THAT ALL OF
THE COMMITTEE MEMBERS YOU CAN
TELL FROM THE CONVERSATION ARE
BRINGING FORWARD ON LOOKING AT
COMPLEXITY OF RESEARCH DESIGN
AND CRITICAL NATURE OF DEFINING
DIETARY PATTERNS IN ALL OF THESE
WERE CONSTRAINED BY THE QUALITY
OF THE DATA AND PRESENTATION OF
THE DATA.
BUT, IT IS REALLY IMPORTANT WORK
WE ARE DOING IN REALLY TRYING TO
TAKE THIS MASSIVE BODY OF
SCIENCE AND CONDENSE IT DOWN TO
WHAT IS SUPPOSED TO BE THE FINAL
REPORT NOT TOO LONG FROM NOW AND
SUMMARIZES EVERYTHING FROM THE
SCIENTIFIC DATA THROUGH FOOD
PATTERN MODELING SIMULATIONS AND
JUST A HUGE CUEDO TO OUR
COMMITTEE AND STAFF SUPPORTING
US.
>> THANK YOU, CHRIS. I WILL
HAVE YOU POPCORN IT LIKE WE DO
IN CLASS.
MY CLASS ANYWAY WE CAN'T POPCORN
AROUND. SO, IF YOU COULD
POPCORN IT TO ANOTHER COMMITTEE
MEMBER? MAYBE WE COMPLETED THE
OUTSIDE AND ARE WORKING ON
INSIDE PUZ THAT'LL SAY LITTLE
MORE CHALLENGING.
I THINK IT IS GREAT AND SO FUN
TO LOOK AT WHAT THE DIFFERENT
COMMITTEES HAVE DONE AND TO SEE
HOW THEY FIT TOGETHER AND JUST
ANOTHER ROUND OF KUDOS FOR THE
STAFF. YOU DO AN INCREDIBLE JOB
OF KEEPING US ORGANIZED. WE
WOULD BE LOST WITHOUT THEM.
>> I'M GOING TO GIVE IT TO JENNY
WHO IS NEXT TO ME.
>> THANK YOU. I HAVE FURTHER
COMMENTS THAT HAVE BEEN MADE
BEFORE.
I AM STRUCK BY THIS COMMITTEE'S
DEDICATION TO THE TASK AT HAND.
I ACTUALLY THINK OUR LEADER
SARAH AND ANGELA HAVE A LARGE
ROLE IN THAT.
I HAVE NEVER BEEN PART OF A
GROUP WHERE PEOPLE HAVE JUST
LEFT THEIR EGOS AT THE DOOR AND
ROLLED UP THEIR SLEEVES AND DONE
HARD WORK AND BROUGHT THEIR BEST
CONVERSATIONS IN A WAY THAT IS
FORTHRIGHT AND HONEST AND OPEN.
WE OWE THAT TO YOU ALL FOR
MAKING EVERYONE FEEL INCLUDED
AND IMPORTANT AND REALLY THE
IMPERATIVE TO PARTICIPATE AND
BRING EVERYTHING WE HAVE TO T
THIS.
JANET BEGAN AND THEY MUST HAVE
KNOWN.
SO, THANK YOU TO BOTH OF YOU.
I AM GOING TO PICK HOLLY. YOU
ARE UNDERNEATH ME.
>> WOW. I DON'T KNOW HOW TO TOP
ALL OF THE COMMENTS.
THOSE ARE I WOULD AGREE 100%.
I GUESS MY ONLY OTHER COMMENT.
I AM KIND OF BLOWN AWAY BY IT
ALL. IT IS PRETTY AMAZING.
LET'S SEE. I WILL HAND IT OVER
TO CHRISTOPHER.
>> OKAY. THANK YOU.
REITERATING WHAT EVERYBODY SAID,
THIS IS A HUMBLING EXPERIENCE.
YES. MY WORDS WILL BE NOW THAT
WE HAVE MULTIPLE CONCLUSIONS AND
LAST TIME HAD ONE TO TWO
CONCLUSIONS; RIGHT? THREE
MONTHS AGO AND MOST CONCLUSIONS
ARE NOT ENOUGH DATA OR LIMITED
OR RARELY MODERATE.
INTERESTING THING IS THE
AMERICAN PUBLIC WILL EAT TODAY
AND TOMORROW.
SO, WE WILL NEVER HAVE ENOUGH
STUDIES THIS YEAR OR NEXT YEAR.
SO, IT IS A DAUNTING TASK TO
TAKE THOUSANDS OF RESEARCH
PAPERS THAT THERE ARE AND DEFINE
WHAT THE QUESTION IS.
IDENTIFY THE PAPERS THAT COULD
ADDRESS THAT AND COME UP WITH A
REASONABLY SOUND STATEMENT THAT
IS TO BE QUITE HONEST
DISAPPOINTING AND WHAT A
FANTASTIC GROUP OF PEOPLE TO
FIND THAT BALANCE OR HOW STRONG
OR WEAK THAT STATEMENT SHOULD BE
AND COME UP WITH PROPOSALS WHAT
RESEARCH WE NEED NEXT AND
HONORED TO JOIN ALL OF YOU IN
THE PROCESS.
POPCORNING IT TO FATIMA WHO IS
NEXT TO ME.
>> THANK YOU, CHRISTOPHER.
I THINK ONE OF THE KEY THINGS WE
HAVE LEARNED PARTICULARLY AS WE
SEE A KEY FOCUS IN A DIETARY
GUIDELINE ON EQUITY AND SAMEERA
I THANK YOU FOR TAKING AND
LEADING THIS CHARGE OF EQUITY
THROUGHOUT THIS WORK THAT IS
REALLY SEEING HOW, YOU KNOW,
LOTS OF THE RESEARCH THAT HAS
BEEN DONE EVEN THE REALLY -- THE
RESEARCH WE GOT BACK MODERATE
EVIDENCE THAT DOESN'T LEND
ITSELF TO THE DIVERSITY OF THE
POPULATION THAT REFLECTS THE
ACTUAL US POPULATION.
LOTS OF THE RESEARCH THAT IS
FUNDED JUST DOESN'T REALLY
CAPTURE THOSE THAT REFLECT THOSE
THAT ARE DESCENDENT ENSLAVED
LIKE MYSELF AND ARE NATIVE AND
HUBERT JERN ABEGAN THAT IS NEXT
PERSON AND PREPARE YOURSELF AND
WE HAVE TO BE THOUGHTFUL ABOUT
THIS AND DO WE HAVE RESEARCH
THAT IS FUNDED AND REFLECTS
POPULATION AND STUDIES OF RIGOR
AND DESIGN THAT REFLECTS WHO WE
ARE TALKING TO WHEN THINKING
ABOUT THE POPULATION THAT IS THE
US POPULATION AND IT IS BECOMING
MORE AND MORE DIVERSE EVERY
SECOND.
CHRISTOPHER, YOU SAID THAT
PEOPLE WILL EAT AND SOME OF US
WERE EATING AND WE ATE BETWEEN
BREAKS AND DURING BREAKS AND
WHILE ON BREAKS SIPPING
BEVERAGES WHILE HERE AND YOU
DIDN'T KNOW WHAT IT WAS AND
STRATEGIC NOT LETTING YOU KNOW
WHAT IT WAS. THIS WILL CONTINUE
TO BECOME PART OF WHAT WE DO.
OUR GOAL IS TO MAKE SURE
COMMITTEE AFTER COMMITTEE WE CAN
MAKE SURE WE ARE INFORMING
DECISIONS THAT REFLECT WHAT THE
REALITY IS OF THE AMERICAN
PEOPLE.
SO, THE GOAL IS WHEN YOU ARE
DESIGNING YOUR STUDIES, THINK
ABOUT THE PEOPLE THAT YOU SEE
WALKING DOWN THE STREETS AND IN
THE PLACES THAT YOU EAT, LIVE,
BREATHE AND PRAY.
IF YOUR WORK IS NOT REFLECTING
THAT, GO BACK AND RESIGN AND
RE-CONFIGURE.
DO THE WORK.
IT IS HARD WORK.
MAKE SURE IT REFLECTS PEOPLE
AROUND YOU.
SO, VALERIE BLOOMBERG JURN EGG
AN I WILL PASS THE TORCH TO YOU.
THANKS SO MUCH.
>> THANK YOU, FATIMA.
I WILL TREE TO SUMMARIZE ALL OF
THIS GRATITUDE I HAVE FOR
EVERYBODY ON THE COMMITTEE.
AND ALL OUR STAFF THAT HELP US
AND MAKE THIS POSSIBLE.
THEY REALLY DO INCREDIBLE WORK
THAT ALLOWS US TO DO WHAT WE
NEED TO DO. I HAVE NEVER WORKED
WITH A GROUP OF PEOPLE THAT ARE
SO INCREDIBLY PROFESSIONAL AND
JUST IT IS A JOY TO WORK WITH
ALL OF YOU AS WELL AS JUST I
WORK ON LOTS OF DISPARITIES
COMMITTEES.
FOR WHATEVER REASON, THERE IS A
MAGICAL CONNECTION WITHIN THIS
GROUP I FEEL PEOPLE IN THIS
GROUP REALLY GET IT AND ARE
REALLY HERE TO REALLY GIVE
OPPORTUNITIES TO VOICES THAT
HAVE NOT BEEN HEARD.
I ALWAYS TALK OPENLY ABOUT I
GREW UP ON COMMODITY FOODS AND
ARE FOODS I ATE WHEN I WAS A KID
IN THE 80S.
YOU KNOW, BACK THEN, THEY WERE
JUST WHATEVER WAS AVAILABLE FOR
POOR PEOPLE.
AND IT IS VERY MOVING TO SEE
THINGS DO CHANGE AND NEEDS OF
POPULATIONS ARE CONSIDERED AND
VOICES ARE BEING HEARD.
I WANT TO SAY THANK YOU SO VERY
MUCH FOR HELPING ME DO THIS AND
MAKING THIS ALL POSSIBLE.
I WILL PASS IT TO, LET'S SEE. I
WILL PASS IT TO OUR HEALTH
EQUITY CHAIR SAMEERA.
>> THANK YOU, VALARIE.
>> IT IS EXCITING TO BE AT THE
COMMITTEE MEETING AND
SUB-COMMITTEES YOU SEE WHAT THEY
HAVE BEEN WORKING ON AND
SUB-COMMITTEES PRESENTING
RESULTS IS REALLY NICE TO SEE
THE WORK THAT IS BEING PRESENTED
TOGETHER.
I WOULD ALSO LIKE TO APPRECIATE
THE COMMITTEE AND NOT JUST
HEALTH EQUITY WORKING GROUP AND
COMMITTEE TO BE CAREFUL IN
DELIBERATIONS TO MAKE SURE THAT
HEALTH EQUITY IS BEING
CONSIDERED IN ALL OF THE ASPECT
AND EVERY SUB-COMMITTEE
PRESENTED SPOKE ABOUT
GENERALIZABILITY AND HOW THEY
CONSIDER THE REPRESENTATIVENESS
OF THE US POPULATION.
NOT JUST HEALTH EQUITY WORKING
GROUP BUT EVERY SINGLE COMMITTEE
DID THAT AND THANK YOU FOR THAT.
I'M LOOKING FORWARD TO SEEING --
I GUESS MORE RESULTS COME IN THE
NEXT MEETING AND DIET
SIMULATIONS IS ONE THAT EXCITES
ME MOST TO SEE WHAT COMES FOR
THAT, THAT IS RIGHT TOWARDS THE
END.
I GUESS I CAN GIVE IT TO CHERYL.
>> THANK YOU, SAMEERA.
I AM ALSO REALLY GRATEFUL FOR
EVERYTHING WE HAVE BEEN DOING AS
A TEAM AND FOR SUPPORT WE HAVE,
YOU KNOW, WITH OUR STAFF THAT
WORKS SO CLOSELY WITH US.
IT IS CLEAR TO ME THAT WE HAVE
REALLY EMBRACED THE
RESPONSIBILITY THAT COMES ALONG
WITH THIS WORK IN IGNITING
POSITIVE CHANGE. AND WHILE THE
DIETARY GUIDELINES ADVISORY
COMMITTEE REPORT IS ABEAUTIFUL
PIECE OF SCIENCE AND REPRESENTS
THE MOST UP TO DATE STATE OF
AFFAIRS IT ALSO MATTERS FOR
HOUSEHOLDS AND FOR COMMUNITIES
AND SO I AM THINKING ABOUT ALL
OF THE SCIENCE THAT WE HAVE BEEN
GOING THROUGH IN OUR CLIBRATIONS
AND I'M STRUCK BY THE FACT THAT
THE WAY THAT WE DO SCIENCE IS
NOT NECESSARILY ALIGNED WITH
THIS PROCESS.
BY THAT, I MEAN THAT WHEN EACH
OF US THINK ABOUT PUTTING A NEW
SCIENTIFIC ENDEAVOR INTO
PROPOESAL AND SEND FOR PEER
REVIEW WE ARE OFTEN TALKING
ABOUT MAKING SCIENCE MOST
DISTINGUISHED FROM EVERYTHING
THAT HAS BEEN REDUCED AND SIT IN
A TEAM AND LOOKING AT BODY OF
SCIENCE TO FIND THAT YOU DON'T
HAVE ENOUGH REPLICATION AND
LITERATURE AND WE HAVE BEEN BUSY
FIGURING OUT HOW TO MAKE
OURSELVES FEEL DIFFERENT.
I'M THINKING ABOUT THAT ALL
MYSELF AND SUSPECT IT MIGHT BE
ON YOUR MINDS AS WELL.
I WANT TO DRAW THAT OUT FOR
PONDERING AS WE THINK ABOUT HOW
WE APPROACH SCIENCE THAT IS
IMPORTANT FOR FORMING DIETARY
GUIDELINES.
NONETHELESS, THAT SAID, I'M,
AGAIN, GRATEFUL WE HAVE MADE
SUCH AMAZING PROGRESS AND THINK
THAT THE WORK WE HAVE DONE AND
HAVE YET TO DO WILL BE REALLY
HELPFUL IN THINKING ABOUT HOW
ALL, I UNDERSCORE ALL
[INDISCERNIBLE] SEE THEMSELVES
AS PART OF RESULTS OF THIS
PROCESS AND HOW ALL OF US GET TO
CHART A PATH FORWARD TOWARDS A
HEALTHY AND DIETARY PRACTICE.
WITH THAT, I WILL MOVE ON.
>> THANK YOU, CHERYL.
ACTUALLY, FIRST OF ALL, I WOULD
LIKE TO SAY I'M GRATEFUL TO BE
PART OF THIS PROCESS.
IT IS A PLEASURE WORKING WITH
EVERYBODY ON THE COMMITTEE AND
WITH THE STAFF AND TO THE POINT
THAT CHERYL BEAT ME TO THE POINT
THAT I WOULD BRING SOMETHING
DIFFERENT IN TERMS OF THE
RESEARCH.
YOU KNOW, I -- I THINK THAT, YOU
KNOW, IT IS TREMENDOUS TO BE
ABLE TO LOOK AT ALL OF THIS DATA
AND STUDIES THAT ARE DONE.
YOU KNOW, THERE IS A LOT OF
PEOPLE OUT THERE INCLUDING ALL
OF US THAT ARE WORKING ON THE
DATA.
THE ONE THING THAT IS A LITTLE
BIT FRUSTRATING SOMETIMES IS
THAT THERE IS A LOT OF -- A
LARGE NUMBER OF STUDIES THAT ARE
DONE AND IN SLIGHTLY DIFFERENT
WAYS AND PERSPECTIVES AND THERE
COULD BE 80 STUDIES IN SOME OF
THE BINS WE HAVE GOTTEN AND
STILL CAN'T COME UP WITH A REAL
AND CONCLUSIVE STATEMENT THAT IS
MAYBE THE NATURE OF RESEARCH.
I THIS I THAT WHEN THINKING
AHEAD WE WON'T SOLVE THAT IN
THIS YEAR.
BUT LIKE IN THE -- IN MORE ABOUT
FUTURE STUDIES, I THINK THAT THE
COMMUNITY HAS TO THINK OF WAYS
TO -- YOU KNOW, TO DESIGN THE
STUDY OR RESEARCH OR MAYBE DO
POOLING TYPE OF STUDIES AND YOU
POOL STUDIES WHERE YOU CAN
ORGANIZE DATA IN A WAY TO GET
MORE PRECISE ANSWERS RATHER THAN
TRYING TO SYNTHESIZE STUDIES
THAT THINGS ARE DONE A LITTLE
DIFFERENTLY AND EXPOSURE IS DONE
DIFFERENTLY AND AT END OF THE
DAY HARD TO MAKE THE CONCLUSION
AND HAVING SAID THAT, I THINK
THAT LOOKING AHEAD, SOME OF THE
TOPICS THAT I -- YOU KNOW, THAT
I'M JUST THINKING AHEAD THAT WE
WILL ADDRESS AND I ANTICIPATE
THAT WE WILL BE ABLE TO MAKE
MORE CONCLUSIVE STATEMENTS AND
THINK THAT TOPICS THAT WE HAVE
DEALT WITH ARE ONES IN SOME WAYS
HAVE BEEN TOUGHER TO DEAL WITH
AND MAYBE I'M OPTIMISTIC THAT BY
NEXT YEAR THAT WE WILL HAVE
IMPORTANT THINGS TO SAY.
IN ANY CASE, I'M REALLY GRATEFUL
TO BE WORKING WITH EVERYONE
HERE.
SO, NEXT, I WILL GO TO EDEAND
STICK WITH BOSTON.
>> THANK YOU. I ECHO SENTIMENTS
ABOUT STAFF SUPPORT AND
COMMUNITY WITHIN OUR GROUP AND I
WILL GEEK OUT ABOUT THE SCIENCE.
I WILL EMPHASIZE WHAT MY BIG
TAKEAWAY WITH DIETARY PATTERNS
IS.
AND IN THE 2015 GUIDELINES, THEY
PIVOTED FROM FOCUSING ON
INDIVIDUAL NUTRIENTS AND FOODS
TO REALLY DEVELOPING A PATTERN
APPROACH TO THE RECOMMENDATION
AND RECOGNIZING WE DON'T EAT
NUTRIENT ISOLATION AND RATHER
THROUGH THE COURSE OF A DAY OR
WEEK OR YEARS AND THIS PATTERN
IS ULTIMATELY WHAT PREDICTS LOTS
OF HEALTH OUTCOMES OF INTEREST
AND NOW THAT WE ARE REVIEWING A
VALUE OF LITERATURE FOR PATTERNS
WITH SPECIFIC POPULATIONS AND
ENDPOINTS IT IS REALLY
INTERESTING TO SEE WHERE AREAS
NEED TO CATCH UP AND DIETARY
PATTERN APPROACH HASN'T BEEN
REALLY EMPLOYED SCIENTIFICALLY
AND AREAS ADULT OBESITY AND VAST
LITERATURE AND THAT CONFIRMS
DIETARY PATTERN APPROACH THAT IS
ACTUALLY ADEQUATE TO ADDRESS A
BULK OF THAT RISK AND
RELATIONSHIP OF OUTCOMES AND
VAST DIVERSITY WHAT PATTERN IS
DEFINED AS AND DOESN'T APPEAR
THERE IS ONE OPTIMAL DIET FOR
ALL AND RATHER A FLEXIBILITY
THAT CAN ENCOMPASS VARIABILITY
AND HOW WE ARE EXPLORING HOW
DIFFERENT POPULATIONS WITHIN THE
US CAN ADAPT OR EXPAND OR BUILD
ON WHATEVER DIETARY PATTERN WE
MIGHT PUT FORTH AND IT IS JUST
I'M OPTIMISTIC THERE IS
FLEXIBILITY IN THE PATTERN TO BE
BUILT TO ACCOMMODATE DIFFERENT
WAYS OF DEFINING A HEALTHY
PATTERN WITHOUT NEEDING TO PUT
OUT ONE OPTIMAL ONE-SIZE FITS
ALL SCAFFOLDING.
THANKS.
I DON'T KNOW WHO IS LEFT.
THERESA?
>> SURE.
>> OKAY.
>> DR. FUNG.
>> I'M [INDISCERNIBLE] AND DOING
WEEKLY MEETINGS MANY HOARS AND
GENERAL PUBLIC MIGHT NOT KNOW
BESIDES EVERY FEW MONTHS MEEING
DO YOU MEET EVERY WEEK WE ARE IN
SEVERAL DIFFERENT SUB-COMMITTEES
AND NEED SEVERAL HOURS ADDING
EVERYTHING UP TOGETHER AND
HOMEWORK WE DO BEFORE AND COMING
TO WEEKLY MEETINGS AND DURING
MEETINGS HOW HONEST AND FRANK WE
CAN HAVE DISCUSSION ON
SCIENTIFIC DATA EVERYBODY IS
WILLING TO E- -- IT IS WONDERFUL
TO SEE HOW EVERYBODY VOICES AND
LISTENS TO EACH OTHER'S OPINION
AND DIFFERENT OPINIONS AND WAYS
OF SEEING DATA WE VOICE THAT AND
LISTEN AND CONSIDER EVERYBODY'S
VIEWPOINTS.
I REALLY, REALLY -- ENVIRONMENT
OF THE OPENNESS I WOULD REALLY
LIKE TO BRING IT TO OTHER PARTS
OF MY WORKSPACE AS WELL AND IS
ONE POINT AND ANOTHER POINT THAT
IS THE DEDICATION THAT WE ARE
ALL DOING THIS ON TOP OF OUR DAY
JOB AND WE DIVE INTO THIS AND
SEE THIS AS A HIGH PRIORITY ON
WORK LIST AND DO A VERY DETAILED
JOB AND DELIBERATE DETAILS WE
THINK OF AND DETAILS AND NO
STONE GOING UNTURNED MAKING SURE
EVERY ASPECT IS DISCUSSED SO WE
-- ALL OF THE BASIS HAVE BEEN
TOUCHED AND EVERYTHING IS A
COMPREHENSIVE REVIEW THAT WHEN
SCIENTIFIC REPORT COMES OUT
EVENTUALLY IT IS DETAIL AND HOPE
IT WILL BE VERY CONFIDENT IN THE
REPORT THAT WE HAVE REALLY
LOOKED INTO EVERY SINGLE ASPECT
AND EVERYTHING THAT HAS TO BE
DELIBERATED HAS BEEN DELIBERATED
AND MAYBE YOU CAN TAKE NEXT?
>> THANK YOU, THERESA.
YEAH. I JUST ECHO WONDERFUL
COMMENTS THAT HAVE BEEN SHARED
AND I'M SO THANKFUL TO BE PART
OF THE COMMITTEE AND EVERYONE IS
JUST VERY DEDICATED TO AS
THERESA WAS SAYING ALL OF THE
MEETINGS EVERY WEEK.
THE TIME THAT EVERYONE PUTS IN
AND THE KIND OF THINKING EFFORT
THAT EVERYONE BRINGS TO EACH OF
THE QUESTIONS THAT WERE -- WE
ARE CONSIDERING AND EVALUATING
AND JUST THE CONTINUED SUPPORT
OF THE STAFF TO LOOK UP ANSWERS
TO QUESTIONS THAT WE HAVE AND
REVIEW ALL OF THE DIFFERENT AND
COMPLICATED METHODS FOR EXAMPLE
THAT CHRIS DESCRIBED TO US SO
WELL IN FOOD PATTERN MODELING
AND SIMULATIONS WE HEARD ABOUT.
IT IS SO COMPLEX.
WE NEED REMINDERS OF ALL OF THE
DIFFERENT DETAILS AND PROCESSES
AND EVERYTHING THAT IS WILLING
TO HELP US WITH THAT.
ALSO TO CRITICALLY THINK ABOUT
WHAT THE DECISIONS THAT WE MAKE
IN THE -- IN PLANNING ALL OF THE
METHODS WILL MEAN TO THE ANSWERS
WE GET.
I THINK THAT IS THE PART THAT IS
REALLY EXCITING AS WELL IS
BECAUSE WE ARE -- WE SAW IN THIS
MEETING ALL OF THE PROGRESS.
IN THE NEXT TWO MEETINGS AFTER
THIS, WE WILL BE WORKING MORE
AND MORE TO PUTTING IT ALL
TOGETHER.
AND I'M REALLY EAGER TO SEE ALL
OF THE RESULTS AND BE PART OF
THAT. SO, THANK YOU.
I WILL TURN IT OVER TO
CHRISTINA.
>> THANK YOU, HEATHER.
I ECHO MANY THINGS SAID ABOUT
THE TYPE OF EVIDENCE THAT WE
HAVE FOUND.
I'M IMPRESSED BY THE LACK OF
STUDIES IN CERTAIN KEY AREAS
THAT WE SHOULD HAVE TO HAVE MORE
STUDIES.
I ALSO IMPRESS ABOUT THE RESULTS
OF CERTAIN QUESTIONS.
THEY FEEL SURPRISING TO SEE SOME
RESULTS.
I ALSO -- I LIKE THOUGH THAT WE
TRUST THE SCIENCE AND TRUST THE
PROCESS EVEN IF WE HAVE
PRE-CONCEIVED IDEAS OF SOME OF
THE ANSWERS AND SOME OF THE
QUESTIONS AND WE TRUST THE
PROCESS AND WE -- WE TRUST WHAT
WE FOUND AND I THINK THAT IT IS
IMPORTANT FOR THE PUBLIC TO KNOW
THAT WE ARE FOLLE OWING A VERY A
RIGOROUS PROCESS AND TRUSTING IN
THE RESULTS THAT WE FIND.
SO, I THINK THAT I HAVE BEEN
IMPRESSED BY HOW THE COMMITTEE
AND ALL OF THE COMMITTEES HAVE
WORKED WITH THE RESULTS THAT WE
HAVE FOUND SO FAR.
I WILL PASS IT TO ANDREA.
>> OKAY. NORMALLY I'M LAST AT
THIS POINT AND THERE IS LOTS
THAT HAS BEEN SAID AND I WANT TO
DEFINITELY ECHO LOTS OF THE
THINGS ABOUT OUR STAFF SUPPORT
AND HOW WONDERFUL THE COMMITTEE
IS AND THE WORK WE HAVE BEEN
DOING AND ONE THING I WAS STRUCK
BY TODAY THAT HAS BEEN SORT OF
BROUGHT UP TODAY ALREADY IS SOME
OF THE -- WHEN WE ARE HEARING
OURSELVES TALK ABOUT ALL OF THE
ISSUES WE FOUND WITH PRECISION
AND CONSISTENCY AND ALL OF THE
HOLES THAT WE HAVE DISCUSSED AND
THE RESEARCH AND AT THE SAME
TIME THERE IS A -- THERE IS A
MORE POSITIVE OUTLOOK TO TAKE
THAT IT SHOWS THE ARIGOR WE HAVE
BEEN DOING THIS WITH AND
REFLECTING WE HAVE BEEN DOING ON
DIFFERENT STUDIES AND CRITICALLY
EVALUATING THEM AND ALSO THAT
THERE ARE LOTS OF CONCLUSIONS
THAT CAN BE MADE FROM THE
EVIDENCE THAT IS THERE AND ALSO
WE ARE FINDING YOU KNOW WAYS TO
IMPROVE RESEARCH AND GETTING
RECOMMENDATIONS ON THAT AND
HAVING A HEALTH EQUITY LENS AS
WELL AND ADDING THAT PIECE IN
AND I'M SURE THAT EVEN FROM
TODAY WHAT WE TALKED ABOUT IN
TERMS OF THINKING ABOUT THE
VEGAN DIET AND ALL OF THE
DIFFERENT CULTURAL ASPECTS TO
DIFFERENT DIETARY PATTERNS THAT
ALL OF THAT IS GOING TO COME OUT
WITH THESE GUIDELINES AND ALSO
GIVING, YOU KNOW, FUTURE
DIRECTIONS.
SO, YEAH. SO, TODAY WAS A
WONDERFUL DAY TO HEAR ALL OF THE
PROGRESS WE HAVE ALL MADE AND
VERY ENJOYABLE.
I THINK THAT, CAROL --
>> SO, I HAVE TO ECHO THAT
EVERYTHING THAT EVERYBODY HAS
SAID IS AN AMAZING PROCESS.
ONE OF THE THINGS THAT REALLY
STRUCK ME TODAY AND HAS BEEN
STRIKING ME IS THE DIETARY
PATTERNS CHALLENGES THAT WE
FACE.
IT WAS VERY VALIDATING TO HEAR
THAT WORKING GROUP ONE HAD THE
SAME STRUGGLE THAT WORKING GROUP
2 HAD AND DIDN'T HAVE CROSS-TALK
TO SPEAK OF.
THAT IS PRETTY INTERESTING.
THE ONE THING I HEARD TODAY IN
PARTICULAR THAT REALLY CAUGHT MY
EAR IS I THINK DEANNA YOU SAID
IT IS PUBLICATION BIAS.
IF THERE IS A PUBLICATION BIAS
BY EDITORS OR EVEN GRANT REVIEW
AGENCIES AND GROUPS, THAT THE
QUESTION HAS BEEN ANSWERED.
WE DON'T NEED MORE RESEARCH IN
THAT AREA. I THINK WE NEED TO
GET THAT MESSAGE OUT ABOUT THERE
MIGHT BE A LOT OF STUDIES.
THEY REALLY NEED TO BE
REPLICATED AS WHAT SOMEONE HAS
JUST SAID AND IF WILLING TO HAVE
OR GOING TO HAVE THAT ROBUST
SENSE OF DATA TO BE ABLE TO MAKE
STRONGER CONCLUSION STATEMENTS.
SO, ALL RIGHT. I WILL PASS IT
TO ALINE.
>> THANK YOU, CAROL. I THINK,
YOU KNOW, IT GETS OVERWHELMING
AFTER SO MANY WONDERFUL COMMENTS
AND CALL WHAT EVERYONE HAS SAID
AND I'M GRATEFUL TO BE PART OF
THE GROUP FOR WOND HERBFUL
SUPPORT WE GET FROM THE STAFF.
I WAS SO EXCITED TO SEE THE
RESULTS TODAY AND I WAS INSPIRED
LISTENING TO VALARIE'S
PRESENTATION AND HOW YOU ARE
ENGAGING EXPERTS WITHIN THE
COMMUNITIES AND MAKING SURE THAT
WE ARE NOT MAYBE LOOKING AT
THINGS TOO HIGH UP AND ARE
REALLY HAVING FOOD ON THE GROUND
TO THINK THROUGH AND YOU KNOW
HOW DO WE ADVANCE WITH THAT
HEALTH EQUITY LENS.
THANK YOU FOR DRIVING THOSE NEW
VISIONS FOR THE DIETARY
GUIDELINES AND I THINK I AGREE
WITH YOU THAT I'M HOPEFUL AND
KNOW THE SCIENCE IS NOT PERFECT
AND WE IDENTIFY THE GAPS AND
WHAT WE CAN AND CAN'T DO IN THE
FUTURE AND SEE MORE OF LESSONS
LEARNED AND HOW TO GUIDE THE
NUTRITION COMMUNITY TO FIELD
THOSE GAPS IN THE FUTURE AND
GUESS THAT IS WHERE KIND OF THE
FEELINGS OF THE DAY.
I WILL PASS IT TO JAN.
>> I THINK I HAVE GONE ALREADY.
>> SORRY, JAN.
>> STEVE MIGHT BE THE --
>> STEVE.
>> SO, I WAS STRUCK BY ALL OF
THE DIFFERENT COMMITTEES TALKING
ABOUT WHAT CHILDREN SHOULD DRINK
AND ADULTS TOO AND DISCUSSION
ABOUT LOW FAT AND HIGH FAT AND
MILKS AND JUICES AND THINK THAT
EVERY SINGLE PANEL AND GROUP HAS
SOMETHING TO SAY ABOUT HOW
CHILDREN DRINK AND HAVE TO
FIGURE OUT HOW TO INTEGRATE THAT
AND FIGURING OUT WHAT CHILDREN
SHOULD DRINK AND WHAT
ALTERNATIVES ARE AND DOES A
PARENT REALLY UNDERSTAND LIMITED
VERSUS MODERATE EVIDENCE VERSUS
HIGH FAT OR LOW FAT AND 18
MONTHS OR 6 MONTHS AND WHETHER
OR NOT YOU ARE CHANGING AND
THINK THE CHALLENGE COMMITTEE IS
NOT RATING THINGS AS LOW, MEDIUM
OR HIGH IN TERMS OF QUALITY OF
THE EVIDENCE AND THAT IS
IMPORTANT AND FIGURING OUT WHAT
CHILDREN SHOULD BE DRINKING IS A
EXAMPLE THAT STRUCK ME AND WE
HAVE TO GET TOGETHER AND THESE
SEPARATE GROUPS AND FIGURING OUT
ANSWERS AND QUESTIONS ABOUT WHAT
PEOPLE SHOULD EAT AND DRINK AND
QUESTIONS FOR NEXT YEAR AND
VALUE AND THEY ARE IMPORTANT BUT
NOT TELL PEOPLE WHAT THEY SHOULD
EAT OR DRINK.
>> THANK YOU. I DON'T THINK WE
MISSED ANYBODY. TURNING IT TO
SARAH FOR FINAL COMMENTS. DID I
MISS SOMEBODY?
NO. OKAY. TURNING IT OVER TO
SARAH FOR CLOSING COMMENTS.
>> THANK YOU, ANGELA AND
EVERYONE. I ALWAYS GET
EMOTIONAL AT END OF THE
MEETINGS.
IT IS AN OVERWHELMING AMOUNT OF
POSITIVE THOUGHTS.
I TH THINK TODAY LISTENING TO
EVERYONE'S COMMENTS WE HAVE SEEN
A REAL SHIFT WHAT PEOPLE ARE
THINKING AND TODAY IS AROUND
METHODOLOGY AND RIGOR OF
METHODOLOGY AND INTERPRETATION
OF EACH REVIEW.
AND I HOPE THAT EVERY MEMBER OF
THE NUTRITION COMMUNITY IS
LISTENING TODAY.
I ALSO HOPE ENTITIES THAT FUND
NUTRITION RESEARCH ARE
LISTENING.
IN MY OPINION, WE HAVE MOST
THOUGHTFUL AND KNOWLEDGEABLE
PEOPLE IN THE FIELD TOGETHER
BEING HONEST AND PUTTING HEART
INTO THIS AND THEY BASICALLY ARE
LAYING OUT -- THEY ARE LAYING
OUT THE FUTURE AGENDA FOR
NUTRITION RESEARCH AND INFORMING
AMERICANS ON WHAT THEY WANT TO
EAT TO PROMOTE HEALTH.
I HOPE THAT THIS MEETING AND THE
NEXT YEAR OF OUR ACTIVITIES,
THAT WE CAN COME TOGETHER AND
PARTNER WITH A BROADER COMMUNITY
SO THAT THE NEXT DIETARY
GUIDELINES AND SCIENTIFIC
COMMITTEE WILL HAVE LOTS MORE TO
WORK WITH.
SO, I REALLY WANT TO THANK
EVERYONE. YOUR THOUGHTS AND
HARD WORK AND YOUR PASSION IS
UNRIVALLED. WITH THAT ENDING
THIS PORTION OF THE MEETING AND
HANDING IT OVER TO JANET.
>> I WANT TO THANK THE PUBLIC
FOR JOINING TODAY AND ENGAGING
IN THE COMMITTEE'S PROCESS.
MANY THANKS TO THE COMMITTEE FOR
YOUR FANTASTIC WORK SINCE YOUR
LAST MEETING.
FOR A YEAR NOW TODAY, HAPPY
ANNIVERSARY.
YOUR DEDICATION TO YOUR TASK AS
SPECIAL GOVERNMENT EMPLOYEES IS
IMPRESSIVE AND APPRECIATED AND
BIG THANKS TO STAFF IN THEIR
SUPPORT OF THE COMMITTEE AND OUR
COMMITTEE AND STAFF
COLLABORATION IS SO STRONG. WE
ALL HAVE THE SAME GOAL IMPROVING
PUBLIC HEALTH USING RIGOROUS
METHODS TO REVIEW EFRD AND
COMMITTEE'S ADVICE IN SCIENTIFIC
REPORT WILL INFORM DIETARY
GUIDANCE AND WE SO APPRECIATE
MEMBERS TAKING THIS ROLE SO
SERIOUSLY AND ALONG SAME LINES
AND STAFF WHO HAVE INSTITUTED
CONTINUOUS QUALITY AND
IMPROVEMENT TO METHODS FOR EACH
ROUND OF THE DIETARY GUIDELINES
DEVELOPMENT AND FINALLY THANKS
TO EVERYONE THAT PIVOTED FROM
IN-PERSON TO VIRTUAL ON VERY
SHORT NOTICE.
YOU KNOW WHO YOU ARE. YOU ARE
ALL APPRECIATED AND IT IS SO
WONDERFUL WORKING WITH A
TALENTED AND KIND AND
UNDERSTANDING COMMITTEE AND
STAFF TEAM.
NEXT SLIDE.
CONGRATULATIONS TO COMMITTEE AND
STAFF FOR WONDERFUL
ACCOMPLISHMENTS IN ADVANCE OF
MEETING 4 THAT WE ARE ABOUT TO
CONCLUDE.
THE NEXT PUBLIC MEETING IS
SCHEDULED FOR MAY 30TH.
NEXT SLIDE, PLEASE.
WE ARE SO APPRECIATIVE OF THE
PUBLIC ENGAGING IN THE PROCESS
AND PUBLIC COMMENTS ARE
APPRECIATED AND IT IS REQUESTED
THAT COMMENTS BE SUBMITTED IN
REGULATIONS.GOV INSTEAD OF TO
INDIVIDUAL COMMITTEE MEMBERS AND
SUBMITTING COMMENTS AND INPUT IN
THE DOCKET WILL ENSURE THEY
REACH THE FULL COMMITTEE AND
FIND THE LINK TO THE DOCKET TO
SUBMIT YOUR INPUT IN THE LINK ON
THIS SLIDE.
DIETARY GUIDELINES.GOV AND GET
INVOLVED SECTION.
THERE IS MANY WAYS TO ENGAGE IN
THE PROCESS AS YOU CAN SEE ON
THIS SLIDE.
I JUST NOTED PROVIDING PUBLIC
INPUT AND ATTENDING VIRTUAL
MEETINGS LIKE WE ARE DOING TODAY
AND SIGNING UP FOR UPDATES ON
OUR GET INVOLVED PAGE AND
VISITING DIETARY GUIDELINES.GOV
AND WE REGULARLY UPDATE DIETARY
GUIDELINES.GOV WITH INFORMATION
ON THE PROCESS AND AFTER EACH
MEETING ALL MATERIALS FROM THE
MEETING WILL BE PUBLISHED WITHIN
A MONTH.
IT IS ALSO APPRECIATED IF MEDIA
INQUIRIES REGARDING THE
COMMITTEE'S WORK BE SENT TO OUR
ODPHP INBOX.
THE ADDRESS IS ON THE SLIDE.
WHILE THE COMMITTEE IS WORKING,
THEY DISCUSS THEIR WORK IN
PUBLIC MEETINGS FOR BENEFIT OF
THE PUBLIC AND ALL OF US AND
THEY ARE NOT CONDUCTING
INTERVIEWS ON THEIR WORK
CURRENTLY BECAUSE THEIR WORK IS
STILL IN PROGRESS.
SO, ONCE THEIR SCIENTIFIC REPORT
IS RELEASED COMMITTEE MEMBERS
CAN TALK ABOUT THEIR REPORT THAT
THEY DEVELOPED COLLECTIVE WILL I
AND MEDIA, PLEASE FEEL FREE TO
REACH OUT TO THE ODPHP INBOX.
WE ARE HAPPY TO ANSWER YOUR
QUESTIONS.
NEXT SLIDE, PLEASE.
NEXT STEP IN THE PROCESS NEXT
MONTH UPDATED SYSTEMATIC REVIEW
PROTOCOLS WILL BE POSTED AND NEW
AND UPDATED FOOD PATTERN
MODELING PROTOCOLS INCLUDING
DIET SIMULATIONS YOU HEARD ABOUT
TODAY WILL BE POSTED AT DIETARY
GUIDELINES.GOV AND PUBLIC
COMMENTS ON PROTOCOLS ARE
APPRECIATED WITHIN A MONTH
FOLLOWING THE POSTING AND
SUB-COMMITTEES AND WORKING
GROUPS WILL CONTINUE CONTUKTING
THEIR EVIDENCE REVIEWS.
AS I MENTIONED EARLIER THAT
MEETING 5 IS TENTATIVELY
SCHEDULED FOR MAY 30TH.
WITH THAT I WILL ADJOURN MEETING
4.
THANK YOU AND HAVE