WELCOME TO THE 2025 DIETARY
ADVISORY COMMITTEE WE HAVE ALL
MEMBERS PRESENT TODAY.
THIS IS OUR DEVELOPMENT TIME
LINE AS YOU CAN SEE HERE THE
COMMITTEE HAS COMPLETED FOUR
MEETINGS AND TODAY WE'RE AT
MEETING FIVE WITH ONE MORE
MEETING LEFT IN SEPTEMBER.
WE EXPECT THE COMMITTEE'S REPORT
TO BE DELIVERED LATER THIS FALL.
WE REALLY APPRECIATE THE PUBLIC
ENGAGEMENT.
THERE'S MANY WAYS TO
PARTICIPATE.
YOU CAN PROVIDE PUBLIC COMMENTS
TO THE COMMITTEE VIA THE PUBLIC
DOCKET ONLINE AND ATTEND VIRTUAL
COMMITTEE MEETINGS LIKE TODAY
AND SIGN UP FOR UPDATES ON
DIETARY GUIDELINES.gov AND VISIT
DIETARY GUIDELINES.gov.
ALL THE COMMITTEE'S WORK IS
BEING UPDATED REGULARLY ON
DIETARY GUIDELINES.gov AND
FINALLY FOR MEDIA REQUESTS GO TO
O
ODPHS INFO AT HHS.gov.
IT'S MY PLEASURE TO TURN IT OVER
TO ANGELA ODOMS-YOUNG.
>> WELCOME BACK.
WE'RE HAPPY TO HAVE THE
COMMITTEE BACK TOGETHER TO SHARE
PROGRESS SINCE THE LAST MEETING.
THANK YOU SO MUCH FOR YOUR HARD
WORK.
THE COMMITTEE HAS MADE
SIGNIFICANT PROGRESS SO IT'S
REALLY EXCITING TO GET BACK
TOGETHER.
WE'LL HAVE HEALTH EQUITY RELATED
TO DIETARY QUALITY AND
MANAGEMENT AND FOOD PATTERN
MODELLING.
BOOTH THE IN YOUR FOLDER AND
ONLINE THE COMMITTEE CHAIRS ARE
LISTED BUT THERE WILL BE SEVERAL
PRESENTERS WITHIN EACH
SUBCOMMITTEE.
FOOT PATTERN MODELS WILL HAVE
PROTOCOLS AND STRATEGIES FOR
WEIGHT MANAGEMENT AND PROTOCOL
REVISIONS AND DISCONTINUED
PROTOCOLS AND DRAFTS OF
COLLUSION STATEMENTS AND THEN
ALSO THE DIETARY PATTERNS THE
SPECIFIC DIETARY PATTERN
COMPONENTS ACROSS THE LIFE
COURSE AND LIFE STAGES IS GOING
TO PRESENT PROTOCOL REVISIONS
AND DISCONTINUE PROTOCOLS AND
DRAFT REVISION STATEMENTS WHICH
WE'LL REVIEW AND DISCUSS.
THE SAME WITH DIET AND PREGNANCY
AND BIRTH THROUGH ADOLESCENCE
WE'LL HAVE DRAFT CONCLUSION
STATEMENTS.
FOR TOMORROW THE AGENDA WITH A
LITTLE WE'LL HAVE A PRESENTATION
ON RELATED PROJECTS AND UPDATES
AND DATA ANALYSIS WE'LL HAVE A
DIET AND PREGNANCY AND BIRTH
THROUGH ADOLESCENCE AND THE
COMPONENTS ACROSS THE LIFE
STAGES AND WRAP UP WITH THE
CHAIR AND VICE CHAIR.
EACH SUBCOMMITTEE AND WORKING
GROUP WILL REPORT ON PROGRESS
MADE SINCE MEETING FOR
DISCUSSION.
WE HAVE NEW PROTOCOLS AND VERY
VISIONS MAY BE MADE DURING THE
REVIEW PROCESS TO ENHANCE
CLARITY OR ENABLE A FOCUS ON THE
STRONGER BODY OF EVIDENCE.
IF YOU'RE INTERESTED IN MORE
DETAIL, I KNOW THERE'S PEOPLE
WATCHING ONLINE AND THERE'S
PROTOCOL REVISIONS ONLINE SO IF
YOU WANT TO DIG DEEPER, YOU CAN
DO SO ONLINE AS WELL AS THE
AGENDA IS POSTED ONLINE.
WE HAVE SOME PROTOCOLS THAT WERE
DEPRIORITIZED AND SUBCOMMITTEES
CONTINUED TO DEPRIORITIZE THE
SCIENTIFIC QUESTIONS TO ENSURE
TO THE QUESTIONS ADDRESSED ARE
RELEVANT, IMPORTANT AND HAVE THE
GREATEST IMPACT ON FEDERAL
PROGRAMS.
AND THEN OTHER CONSIDERATIONS C
THERE'S BEEN A DISCUSSION IN
DEPRIORITIZING AND WORK LOAD AND
CAPACITY AND MAKING SURE EACH
GROUP LOOKS THROUGH A HEALTH
EQUITY LENS.
CRAFT CONCLUSIONS AND THE
SYNTHESIS STATEMENTS FOR
QUESTIONS WILL BE PRESENTED OF
WHAT WE REVIEW TODAY.
THANK YOU, THANK YOU, THANK YOU,
PUBLIC FOR YOUR COMMENTS.
WE'VE HAD A LOT OF ENGAGEMENT.
OVER 4,000 WRITTEN COMMENTS AND
THEN AND MANY ARE DIETITIANS.
IT'S EXCITING TO SEE THE PUBLIC
ENGAGEMENT.
CONTINUE TO GET INVOLVED.
WE WANT TO HEAR FROM YOU.
PEER REVIEWERS ARE EXTERNAL AND
HAVE EXPERTISE AS IT RELATES TO
SPECIFIC QUESTION AND ALL
REVIEWERS HAVE A DOCTORATE
DEGREES AND APPOINTMENTS AT A
COLLEGE OR UNIVERSITY.
I'M TURN IT OVER TO SAMEER RA TO
ON THE WORKING GROUP.
>> I CHAIR THE HEALTH EQUITY
WORKING GROUP AND WILL BE
PRESENTING THE UPDATE ON OUR
WORKING GROUP.
MEMBERS ARE REPRESENTED IN THE
SUBCOMMITTEES AND THANK YOU TO
THE FEDERAL STAFF WITHOUT THEIR
HEALTH AND SUPPORT WE WOULDN'T
BE ABLE TO DO THE WORK HERE
TODAY.
THE 2025 DIETARY GUIDELINES WERE
CHARGED WITH EXAMINING THE
QUESTIONS WITH THE HEALTH EQUITY
LENS TO MAKE SURE THEY WERE
RELEVANT TO INDIVIDUALS AND
PEOPLE WITH SOCIAL AND ECONOMIC
BACKGROUNDS THE WORKING GROUP
HAS CONTINUED THE WORK HAS BEEN
APPLIED IN ALL THE WORK IT'S
BEEN DOING AND HAVE BEEN SURE TO
INCORPORATE THE PUBLIC COMMENTS
THAT HAVE COME AND SPECIFICALLY
MADE SIGNIFICANT PROGRESS ON THE
CHAPTER FOR THE OVER ALL
SCIENTIFIC REPORT.
NOW, ONE HAS FOCUSSED ON THE
VISUAL OR DRAFTING OF THE VISUAL
TO REPRESENT THE WHOLE PROCESS
TO MAKE SURE HEALTH EQUITY IS
INCORPORATED INTO OUR
DELIBERATIONS.
WE HAVE SEVERAL MEMBERS HAVE
SEEN THIS VISUAL AND HOPING TO
GET FEEDBACK FROM ALL OF YOU
HERE TODAY.
I'LL PAUSE SO YOU CAN TAKE A
LOOK AT THE VISUAL AND WALK
THROUGH THE STEPS IN THE VISUAL.
>> I LOVE THE REPRESENTATION.
THE ONLY THING IS THAT IN ALL OF
THE THINGS IF WE'RE LOOKING AT
ABLISM, THEY ALL HAVE LIMBS SO
IF YOU'RE THINKING OF PEOPLE
THAT MAY NOT HAVE ALL OF THEIR
LIMDZ I WOULD MAKE -- LIMBS WE
WANT TO BE INCLUSIVE OF THOSE
WHO DON'T HAVE FULL ABILITIES IN
TERMS OF MAY NOT BE BORN WITH
ALL THEIR LIMBS, MAY NOT HAVE
ACCESS TO ALL THEIR LIMBS SO
EVEN IN THE PERSON NOT BODIED SO
IN A WHEELCHAIR HERE STILL HAVE
ALL THEIR LIMBS SO I WANT TO
INCLUDE THOSE INDIVIDUALS FROM
DIVERSE BODIES.
>> I'LL WALK YOU THROUGH THE
STEPS.
THIS ONE TALKS ABOUT THE HEALTH
EQUITY LENS AND THE FACT WE'RE
MAKING SURE EACH OF OUR
DELIBERATIONS IS ENSURING THE
HEALTH EQUITY IS APPLIED ACROSS
EVERY STEP AND THE OTHER TALKS
ABOUT THE THREE APPROACHES THIS
COMMITTEE IS TAKING TO REVIEW
THE EVIDENCE.
THIS INCLUDES THE SYSTEMATIC
REVIEWS, FOOD PATTERN MODELLING
AND DATA ANALYSIS.
ALL THESE THREE APPROACHES ARE
INFORMED BY NUTRITIONAL RESEARCH
AS WELL AS SURVEILLANCE AND
MONITORING REPRESENTED ON THE
BOTTOM.
AND TO GIVE AN EXAMPLE IN
SYSTEMATIC REVIEWS WE ARE MAKING
SURE WE ARE CONSISTENTLY
EVALUATING SOCIO ECONOMIC
POSITION WHEN RATE BEING THE
STRENGTH OF EVIDENCE FOR SYS
SYSTEMATIC REVIEW AND MAKING
SURE HEALTH EQUITY IS BEING
CONSIDERED IS LOOKING AT THE
DATA BASED ON DIFFERENT
DEMOGRAPHICS SPECIFIED FROM THE
BEGINNING OF THE PROCESS.
AND WE LOOK AT NUTRIENT EXAMPLES
AND ANOTHER SLIDES DISCUSSES
MORE IN DETAIL WHAT STEPS EACH
PILLARS OR APPROACHES HAVE
MAKING SURE HEALTH EQUITY IS
BEING ADDRESSED IN
CONSIDERATION.
THE THIRD VISUAL YOU SEE IS
MAKING SURE OR HELPING THE
READER UNDERSTAND THAT WE ARE
GOING AND LOOKING AT THE
RELATIONSHIP BETWEEN DIET AND
HEALTH THROUGH THE LIFE SPAN.
IT IS MAKING SURE THAT IT'S
TELLING THE READER IT'S NOT JUST
ONE AGE BRACKET BUT ACROSS THE
ENTIRE LIFE SPAN.
THE FOURTH ACTUALLY DISCUSSES
THOUGHTS ABOUT THE NEXT STEPS WE
ARE TAKING WHICH IS MAKING SURE
WE ARE DISCUSSING OUR FINDINGS.
WE ARE INTEGRATING THE EVIDENCE
FROM WHAT WE'RE FINDING WITH
CONSIDERATION OF PUBLIC COMMENTS
AND THEN MAKING SURE WE TAKE ALL
OF THIS INTO CONSIDERATION WHEN
WE DEVELOP THE FINAL OR THE
DRAFT DIETARY PATTERNS AROUND
UPDATES.
THE LAST STEP WHICH IS ACTUALLY
PART OF THE FOOD PATTERN
MODELLING BUT REPRESENTING HERE
BECAUSE IN OUR PROCESS IT DOES
COME TOWARDS THE END IS THE
SIMULATION PROCESS WHATEVER
DRAFT PATTERNS WE TRY TO INFORM
THE DIET SIMULATIONS PROCESS TO
TEST WHETHER THESE PROPOSED
PATTERNS ARE REPRESENTATIVE.
AS WE HAD MENTIO MENTIONED IN M4
WE HAVE THE ALASKAN NATIVE AND
INDIAN AND THE REPORT THEN TO BE
CONSIDERED TO THE DEPARTMENT OF
HEALTH AND HUMAN SERVICES AND
AGRICULTURE.
SO THIS IS OUR VISUAL AND ANY
SUGGESTIONS ARE WELCOME.
WOULD OU LIKE ME TO PAUSE FOR
DISCUSSION?
>> MAKING SURE YOU HAVE
REPRESENTATION OF THOSE HEARING
AND/OR VISION WHY IMPAIRED.
NOT SURE HOW YOU COMPLETELY
REPRESENT THAT BUT --
>> SO IF THERE ARE NO FURTHER
DISCUSSION ON THE VISUAL WE'D
LIKE TO CONTINUE OUR WORK AND
ARE MAKING SURE TO INTEGRATE AND
YOU'LL SEE THIS IN ALL OUR
PRESENTATION THAT HEALTH EQUITY
HAS BEEN ADDRESSED IN ALL OF OUR
THREE APPROACHES.
WE ARE DEFINITELY READING ALL
THE PUBLIC COMMENTS AND
CONTINUING TO WORK ON OUR
SCIENTIFIC REPORT.
WE HAVE A BIT OF THAT CHAPTER IN
THE SCIENTIFIC REPORT.
>> IT SORRY, I WAS TOO LATE WHEN
YOU PAUSED FOR BUT I THINK THIS
MAY BE WELL REPRESENTED IN THE
VISUAL THERE HAS BEEN A LOT OF
FEEDBACK LOOPS IN THIS FIRST AND
SECOND BOX THAT HAVE BEEN SO
HELPFUL AND IT'S MORE THAN
CHECKING A BOX TO MAKE SURE WHAT
OTHER GROUPS ARE DOING ADD
ADHERE TO WHAT YOU SET FORTH BUT
HAVE BEEN AN INFLUENTIAL
INFLUENCE IN MAKING DECISIONS
AND SETTING THE DATA WITH THIS
LENS IN A MORE TANGIBLE WAY THAN
THE LANGUAGE CAN CONVEY.
I DON'T KNOW IT'S A DIRECT EDIT
BUT I WANTED TO POINT OUT I
THINK IT'S BEEN MORE IMPACTFUL
THAN ONE INFO GRAPHIC CAN
SUMMARIZE SO THANK YOU.
>> THANK YOU.
I HAVE A COMMENT LIKE DIDI
THERE'S SO MANY TIMES IN OUR
COMMITTEE DELIBERATIONS WE SAY
WE BETTER CONSULT WITH A HEALTH
EQUITY GROUP AND THOSE INFORMAL
BUT FREQUENT IN THE ACTIONS MAY
NOT COME OFF AS STRONG AS IT'S
SHOWING IN THE GRAPHIC BUT
THERE'S A LOT OF INTERACTIONS
BETWEEN THE COMMITTEES AND YOU
FOLKS.
I WANT TO MAKE SURE IT SHOWS UP.
>> THERE'S A SORT AND ALL HAVE A
DISCUSSION IN REGARD TO HEALTH
EQUITY.
WITH NUMBER ONE THERE'S THE
REVIEWING OF THE EVIDENCE AND
THE THINKING OF HOW YOU
SYNTHESIZE IT ALL BRA THAT
DOCUMENT GETS FINALIZED.
MAYBE IT'S SOMEWHERE IN THERE
AND ALONG THE SAME LINES I WAS
THINKING ABOUT THE MORE EXPLICIT
WORK.
THERE'S THE MAYBE UNDER
CELEBRATED DAY TO DAY WORK BUT
THERE'S THE CULTURALLY TAILORED
INTERVENTIONS APPROACH THIS
TIME.
IT DOESN'T REALLY COME OUT AS
WELL HERE SO MAYBE IT'S BETWEEN
FIVE AND SIX WE ADD A LITTLE
SLIVER ORE A NOD TO THE WORK
DIDI AND TERESA MENTIONED PLUS
THE CULTURALLY TAILORED WORK.
>> AND THERE'S MORE EXAMPLES.
IT'S NOT PART OF THIS IT COMES
IN THE TEXT IT WILL BE BELOW BUT
YOU'RE RIGHT MAYBE IT SHOULD BE
IN THE VISUAL ITSELF.
ANY OTHER SUGGESTIONS?
WELL, THAT WAS ALL I HAD.
THANK YOU.
>> HI, EVERYONE.
I'LL BE PRESENTING ON BEHALF OF
SUBCOMMITTEE 4 WHICH IS NICE NOT
TO BE LAST FOR FOOD-BASED
STRATEGIES TO HELP AMERICANS TO
INCLUDE IN THEIR DIET AND
ULTIMATELY THEIR HEALTH BY
IMPROVING WEIGHT.
AS A REMINDER ALL THE TOPICS
WE'RE PRESENTING ARE NEW TO THE
COMMITTEE.
I'LL BE PRESENTING.
THE SLIDE KNOWS SEVERAL
COMMITTEE MEMBERS PART OF HEALTH
EQUITY.
WE HAVE THAT CROSS-COLLABORATION
BETWEEN COMMITTEES.
AND THIS IS OUR GROUP OF AMAZING
STAFF THAT HELP KEEP US UP TO
DATE IN EVERYTHING AND HU THANK
YOU FOR PRESENTING THE DATA IN
SO MANY WAYS TO HELP DRAW OUR
CONCLUSIONS WELL SHOW TODAY.
THIS SLIDE SHOWS THE PROGRESS
SINCE THE LAST MEETING.
THE LAST MEETING WE PRESENTED
THE FIRST GROUP OF SYSTEMATIC
REVIEWS WHICH WERE RELATED TO
THE FREQUENCY OF NEWS WITH DIET
POLICIES AND THESE ARE UNDER
PEER REVIEW.
TODAY WE'RE GOING TO PRESENT THE
NEXT GROUP WHICH IS THE
FREQUENCY OF MEALS AND/OR
SNACKING AND GROWTH BODY
COMPOSITION AND RISK OF OBESITY
IN THE PORTION SIZE AND GROWTH
BODY COMPOSITION AND RISK OF
OBESITY.
THERE ARE OTHER TWO REVIEWS THAT
ARE UNDERWAY AND HOPEFULLY WILL
BE PRESENTING THOSE NEXT
MEETING.
SO I JUST WANTED TO REMIND
EVERYONE THAT ALL THE DETAILS
ARE POSTED IN THE DGA WEBSITES
IF YOU'D LIKE TO SEE MORE
DETAILS FOR THOSE CONNECTING NEW
TO THE PROCESS.
SO WE'LL START WITH THE EVIDENCE
REVIEW.
THE FREQUENCY OF MEALS AND/OR
SNACKING.
WE'LL START WITH THE ANALYTIC
FRAMEWORK.
I'M GOING TO SPEND SOME TIME
DESCRIBING THIS FOR THOSE WHO
ARE -- THIS IS THE FIRST TIME
THEY'RE CONNECTING.
FOR EACH QUESTION WE HAVE
OUTCOMES AND KEY CONFOUNDERS.
THE PARTICULAR QUESTION WE'RE
ANSWERING IS THE RELATIONSHIP
BETWEEN SNACKING AND RISK OF
OBESITY.
WE ONLY INCLUDED TRIALS AND
PROSPECTIVE COHORT STUDIES.
SO THAT WILL MAKE SENSE WHEN YOU
SEE THE RESULTS.
FOR THE POPULATION WE INCLUDED
1-YEAR-OLD AND INDIVIDUALS FOR
PREGNANCY AND POSTPARTUM.
THE FREQUENCY OF IS EXPOSURE IS
FREQUENCY OF MEALS AND/OR
SNACKING AND DID NOT APPLY
PREDETERMINED SUBMISSION.
WE JUST REVIEW EVERYTHING THAT
WAS IN THE EVIDENCE.
HOWEVER, THANK YOU AUTHORS OR
RESEARCHERS DEFINE SNACKING AND
THE DIFFERENT MEALS.
IT WAS VERY OPEN.
THE COMPARER WAS A DIFFERENT
TYPE OF EXPOSURE AND CONSUMPTION
AND FREQUENCY OF MEALS.
FOR CHILDREN WE HAVE OUTCOMES
RELATE
RELATED GROWTH AND BODY
COMPOSITION AND FOR PREGNANT
INDIVIDUALS WE HAVE WEIGHT
CHANGE DURING THIS TIME THE KEY
CONFOUNDERS ON THE RIGHT SIDE.
THIS IS A SUMMARY OF THE
CONCLUSION STATEMENTS.
BASED ON THE EVIDENCE WE CAME UP
WITH THESE FOUR GROUPS.
BREAKFAST CONSUMPTION OR
BREAKFAST SKIPPING, SNACKING,
NUMBER OF EATING OCCASIONS AND
MEAL FREQUENCY.
IT'S IMPORTANT TO NOTE WE DID
NOT LOOK AT THE FOODS CONSUMED
JUST IF THEY WERE CONSUMED OR
NOT.
WE DID NOT LOOK AT THE QUALITY
OF THE SNACKS OR NUTRIENT
COMPOSITION OR CALORIES OR
BREAKFAST.
THE BEHAVIOR IF THIS WAS DONE OR
NOT.
THE X REPRESENTS IF WE HAVE A
CONCLUSION STATEMENT FOR CERTAIN
AGE GROUPS.
WE DID NOT HAVE ENOUGH EVIDENCE
TO GRADE THAT AND I'LL EXPLAIN
THAT IN THE NEXT SLIDE.
FOR SNACKING AND LOOKING AT
SNACKING IN GROWTH BODY
COMPOSITION WE DID NOT HAVE
ENOUGH STUDIES TO LOOK AT OLDER
ADULTS AND SAME WITH NUMBER OF
EATING OCCASIONS AND MEAL
FREQUENCY AND FOR PREGNANCY AND
POSTPARTUM WE HAD VERY FEW
SUDDENIES BUT I'LL GIVE MORE
DETAILS IN THE NEXT SLIDE.
THE NEXT SLIDE SHOWS FOR EACH
PARTICULAR QUESTION WHY WE DID
NOT ASSIGN A GRADE.
FOR FREQUENCY OF MEALS THERE WAS
PREGNANCY OR POSTPARTUM AND
WEIGHT GAIN IN THE PERIOD.
THERE WAS NOT EVIDENCE TO DRAW A
CONCLUSION.
THERE WERE ONLY ZERO TO ONE
STUDY LOOKING AT SNACKING AND
NUMBER OF EATING OCCASIONS IN
OLDER ADULTS.
ALSO LOOKING AT BODY COMPOSITION
AND RISK OF OBESITY.
WE COULD NOT DRAW A CONCLUSION
STATEMENT.
FOR MEAL FREQUENCY THE LAST
BOTTOM ROWS OR SKIPPING IN
CHILDREN, ADOLESCENTS AND LOOK
AT GROWTH AND BODY COMPOSITION
THERE WERE FIVE STUDIES BUT A
LOT OF VARIABILITY IN THE
EXPOSURES AND OUTCOMES AND
YOU'LL THE STUDY WERE SO
DIFFERENT THERE WAS NO WAY TO
DRAW A CONCLUSION WITH DATA
AVAILABLE.
FOR LUNCH AND DINNER FREQUENCY
AND RISK OF OBESITY IN ADULTS
AND OLDER ADULTS, SIMILAR, ONLY
FIVE STUDIES BUT SEVERAL
LIMITATIONS RELATED TO
GENERALIZABILITY AND THE
EXPOSURES WERE VERY DIFFERENT.
IT WAS VERY HARD TO LOOK AT THE
EVIDENCE AND DRAW A CONCLUSION
ABOUT THAT.
SO NEXT DEANNA WILL CONTINUE.
>> THANKS, CHRISTINA.
SO NOW WE'RE GOING TO PRESENT TO
THE CONCLUSION STATEMENTS THAT
WERE SYNTHESIZED IN THE CATEGORY
OF BREAKFAST AND WE'LL START OUT
WITH CHILDREN AND ADOLESCENTS.
SO THE CONCLUSION STATEMENT IS
MODERATE MODERATE EVIDENCE
SUGGESTED REGULAR BREAKFAST
CONSUMPTION MAY BE ASSOCIATED
WITH FAVORABLE OUTCOMES RELATED
TO GROWTH BODY COMPOSITION
AND/OR LOWER RISK OF OBESITY.
THIS BODY OF EVIDENCE INCLUDED
50 ARTICLES.
ONE TRIAL AND 49 OBSERVATIONAL
ARTICLES DERIVED FROM 32 UNIQUE
COHORTS OF PARTICIPANTS.
WHILE THERE WERE SOME CONCERNS
WITH THE CONSISTENCY OF THE
SIGNIFICANCE OF THE RESULTS, THE
DIRECTIONS AND THE FINDINGS WERE
CONSISTENT IN THE MAJORITY OF
THE ARTICLES REVIEWED ONE
INCONSISTENCY WAS REPRESENTED BY
CATEGORIES AND YES, NO AND A
CONTINUOUS VARIABLE.
HOWEVER, THIS HETEROGENEITY OF
COMPARATORS DID GO TO THE
SIGNIFICANCE OF RESULTS.
THIS WAS MADE OF ONE TRIAL AND
TO THE SUBCOMMITTEE HAD SERIOUS
CONCERNS WITH THE RISK OF BIAS
WITH MANY OF TO THE
OBSERVATIONAL STUDIES THERE WAS
THE BREAKFAST VARIABLE AND
COMPOUNDING MISSING DATA AND THE
AWARD OF REPORTED RESULTS.
WE RECOGNIZED IT'S DIFFICULT TO
DO TRIALS WITH CONCERNS WITH
ACCESS TO BREAKFAST FOR CHILDREN
AND ADOLESCENTS.
THE NEXT CONCLUSION STATEMENT IS
FOR ADULTS.
AND THIS SHOWS WE FOUND LIMITED
EVIDENCE SUGGESTED BREAKFAST
SKIPPING IN ADULT AND OLDER
ADULTS IS NOT ASSOCIATED WITH
FAVORABLE OUTCOMES RELATED TO
BODY WEIGHT AND COMPOSITION AND
RISK OF OBESITY.
SO WITH THIS STATEMENT THERE
WERE 24 ARTICLES, TWO TRIALS AND
THEN 22 OBSERVATIONAL STUDIES.
THE BODY OF EVIDENCE DIRECTLY
ANSWERED THE QUESTION AND WAS
MOSTLY GENERALIZABLE TO THE
U.S. POPULATION.
WE HAD A FEW CONCERNS WITH THE
DIRECTNESS OF THE INTERVENTIONS.
THERE WERE CONCERNS DUE TO
CONFOUNDING AND THE DEFINITION
AND MEASUREMENT OF THE EXPOSURE
SO ONCE AGAIN BREAKFAST SKIPPING
WAS DEFINED AS SKIP BREAKFAST OR
NOT AND THEN THE NUMBER OF DAYS.
SO WE DEFINE IT IN HERE AS THEY
HAD NO BREAKFAST OR IT WAS LESS
THAN 7 DAYS OUT OF THE WEEK AS
BREAKFAST GIVING.
BOTH TRIAL INTERVENTIONS WERE
INTERPRETED AS HAVING S AND
THERE WAS A MIXTURE OF BREAKFAST
SKIPPING ASSOCIATED WITH
UNFAVORABLE OUTCOMES THAT WAS
MOST STUDIES, FAVORABLE OUTCOMES
AND NUL RESULTS.
SO THE MEAN AGE RANGE WAS 30 TO
68.
BOTH THE TRIALS AND ABOUT EIGHT
OBSERVATIONAL STUDIES WERE
CONDUCTED IN THE U.S.
THIS REVIEWS WHAT I SAID WITH
CHILDREN AND ADOLESCENCE WITH
THE MODERATE GRADE AND WITH
ADULTS AND OLDER ADULTS AS THE
LIMITED GRADE.
AND SO ON TO SNACKING AND HOLLY.
>> OKAY.
I JUST WANT TO GIVE A REMINDER
TO EVERYONE FOR SNACKING, THIS
IS EATING OCCURRING BETWEEN
MEALS AND IS NOT SPECIFIC TO A
TYPE OF FOOD CONSUMED.
SO OUR CONCLUSION STATEMENT FOR
CHILDREN IN ADOLESCENTS IS
LIMITED EVIDENCE SUGGESTS
FREQUENCY OF DAILY SNACKING MAY
NOT BE ASSOCIATED WITH OUTCOMES
RELATED TO GROWTH, BODY
COMPOSITION OR RISK OF OBESITY.
THE BODY OF EVIDENCE INCLUDED
SEVEN OBSERVATIONAL STUDIES.
THE RESULTS WERE CONSISTENTLY
NULL WITH CONCERNS AROUND RISK
OF BIAS AND GENERALIZABILITY AND
DIRECTNESS.
CONCERNS WITH RISK OF BIAS WERE
PARTICULAR TO CONFOUNDING AS
WELL AS THE CATEGORIZATION AND
MISCLASSIFICATION OF EXPOSURES.
WE HAD CONCERNS WITH THE
GENERALIZABILITY OF THE EVIDENCE
WITH ONLY THREE ARTICLES FROM
THE U.S. AND THREE CONDUCTED IN
SOUTH KOREA.
AND ONE IN THE U.K.
WE ALSO HAD CONCERNS WITH THE
VARIATION OF EXPOSURES AND HOW
DIRECTLY THESE MAY BE ANSWERING
THE SYSTEMATIC REVIEW QUESTION.
SOME STUDIES REPORTED THE
EXPOSURE CONTINUOUSLY.
SOME CATEGORICALLY.
AND SOME DICHOTOMOUSLY AND IN
PARTICULAR FOR THE DICHOTOMOUS
WHICH WOULD BE SNACKING YES OR
NO, ONE ARTICLE REPORTED ALL
SNACKING, ONE REPORTED SNACKING
IN THE MORNING, AFTERNOON AND
EVENING AND ONE WAS ABOUT
FREQUENT NIGHT SNACKING.
AND WE -- WE DIDN'T HAVE ANY
INFORMATION ON THE TYPES OF THE
QUALITY OF THE SNACKS.
FOR ADULTS OUR CONCLUSION
STATEMENT IS LIMITED EVIDENCE
SUGGESTED SNACK IN ADULTS MAY
NOT BE ASSOCIATED WITH OUTCOMES
RELATED TO BODY COMPOSITION AND
RISK OF OBESITY HOWEVER, LIMITED
EVIDENCE SUGGESTS AFTER DINNER
OR EVENING SNACKING IN ADULTS
MAY BE ASSOCIATED WITH LESS
FAVORABLE OUTCOMES RELATED TO
BODY COMPOSITION AND RISK OF
OBESITY.
FOR THIS BODY OF EVIDENCE THERE
WERE 12 ARTICLES.
ONE TRIAL AND 11 OBSERVATIONAL
STUDIES.
WHILE THERE WAS SOME
INCONSISTENCY AND THE
SIGNIFICANCE OF EFFECTS WHEN
LOOKING AT OVER ALL SNACKING
ALONE ASSESSED IN SEVEN ARTICLES
THERE WERE NULL FINDINGS FOR
SNACKING THROUGHOUT THE DAY AND
BODY COMPOSITION AND RISK OF
OBESITY, HOWEVER, WHEN ISOLATED
THE SIX ARTICLES THAT ONLY
LOOKED AT SNACKING AFTER DINNER
AND THE EVENING THERE WAS MUCH
MORE CONSISTENT ASSOCIATION
BETWEEN SNACKING AT THIS TIME
AND LESS FAVORABLE OUTCOMES.
AGAIN, IT'S IMPORTANT TO NOTE
THE TYPES AND QUALITY CONSUMED
WAS NOT CONSIDERED IN THE
SYNTHESIS AND THERE'S POTENTIAL
THAT THIS DIFFERENCE IN TIMING
OF SNACKING MAY BE DRIVEN BY A
DIFFERENCE IN THE QUALITY OF THE
SNACKS BEING CONSUMED AT THIS
TIME COMPARED TO OTHER TIMES BUT
NOT ABLE TO INCLUDE THIS IN THE
STATEMENT.
THERE WERE CONCERNS WITH SIZE OF
STUDIES AND FEW STUDIES AND RISK
OF BIAS WITH CONFOUNDING
EXPOSURE MISCLASSIFICATION AND
AWARD OF REPORTED RESULTS.
THIS IS THE OVER ALL SUMMARY BY
LIFE STAGE.
YOU SEE LIMITED EVIDENCE FOR
CHILDREN AND LIMITED NO
CONCLUSION STATEMENT FOR OLDER
ADULTS.
NOW WE ARE MOVING TO EATING
OCCASIONS.
AND FOR CHILDREN AND ADOLESCENTS
OUR CONCLUSION STATEMENT IS
LIMITED EVIDENCE SUGGESTS HIGHER
NUMBER OF EATING OCCASIONS PER
DAY DURING CHILDHOOD MAY BE
ASSOCIATED WITH FAVORABLE
OUTCOMES RELATED TO GROWTH, BODY
COMPOSITION AND/OR LOWER RISK OF
OBESITY.
THERE WERE EIGHT OBSERVATIONAL
STUDIES OR ARTICLES THAT
CONTRIBUTED TO THIS CONCLUSION
STATEMENT.
THERE WERE CONCERNS OF
GENERALIZABILITY OF THE EVIDENCE
DUE TO THE MAJORITY OF THE
STUDIES BEING CONDUCTED OUTSIDE
OF THE U.S. AS WELL AS RISK OF
BIAS CONCERNS PARTICULARLY TO
CONFOUNDING EXPOSURE MEASUREMENT
AND THE DATA.
THERE WERE ALSO SOME CONCERNS
WITH VARIED COMPARATORS ACROSS
THE EVIDENCE SO WHILE ALL THE
ARTICLES MEASURE NUMBER OF
EATING OCCASIONS PER DAY AS THE
EXPOSURE, FOUR ANALYZED
CONTINUOUSLY AND FIVE USED
DIFFERENT COMPARISONS.
LOOKING AT EATING COMPOSITION
AND RISK OF OBESITY IN ADULTS
MODERATE EVIDENCE SUGGESTS
NUMBER OF EATING OCCASIONS IS
NOT ASSOCIATE WITH OUTCOMES
RELATED TO CHANGE IN BODY
COMPOSITION AND WEIGHT.
THERE WERE 13 ARTICLES THAT
CONTRIBUTED TO THIS BODY OF
EVIDENCE WITH FIVE TRIALS AND
EIGHT OBSERVATIONAL STUDIES.
FOUR THE FIVE TRIALS, ALL
COMPARED SIX VERSUS THREE EATING
OCCASIONS PER DAY WITH A SIXTH
EATING OCCASION GENERALLY BEING
THREE MEALS AND SNACKS.
THREE MEALS AND THREE SNACKS PER
DAY.
IT'S IMPORTANT TO NOTE THAT ALL
OF THESE TRIALS WERE WITHIN THE
CONTEXT OF WEIGHT LOSS TRIALS IN
PARTICIPANTS WITH OVERWEIGHT OR
OBESITY AT BASELINE.
YOU'LL THE INTERVENTIONS WERE
HYPERCALORIC DIETS WHERE ENERGY
WAS CONTROLLED ACROSS ALL TRIAL
ARMS.
THE TRIALS GENERALLY RECORDED NO
DIFFERENCE IN OUTCOMES BETWEEN
THE TWO TRIAL ARMS.
IN ADDITION TO THE TRIALS, THERE
WERE EIGHT OBSERVATIONAL
ANALYSES AND THE SUBCOMMITTEE
FELT SUPPORTED CONCLUSIONS FROM
THE TRIALS AND MADE THE
CONCLUSIONS GENERALIZABLE TO
ADULTS IN THE U.S. POPULATION
MORE THAN JUST IN POPULATIONS
INTENDING FOR WEIGHT LOSS AND
THERE WAS ADEQUATE
REPRESENTATION IN THE
PARTICIPANTS IN TERMS OF RACE
AND/OR ETHNICITY AND SOCIO
ECONOMIC POSITION.
THE CONCLUSION STATEMENT IS
DEVELOPED ONLY FOR ADULTS AND
NOT OLDER ADULTS BECAUSE THERE
WAS ONLY ONE STUDY THAT INCLUDED
AN OLDER ADULT POPULATION.
LASTLY, THERE WERE CONCERNS AND
THE RISK OF BIAS OF THE
OBSERVATIONAL STUDIES
PARTICULARLY WITH CONFOUNDING
MISSING DATA AND AWARD OF
REPORTED RESULTS.
THIS IS OUR SUMMARY SLIDE OF
NUMBER OF EATING OCCASIONS.
YOU CAN SEE LIMITED EVIDENCE
SUGGESTS HIGHER NUMBER OF EATING
OCCASIONS PER DAY DURING
CHILDHOOD IS ASSOCIATED WITH
FAVORABLE OUTCOMES AND MODERATE
EVIDENCE SUGGESTS THAT NUMBER OF
EATING OCCASIONS PER DAY IN
ADULTS IS NOT ASSOCIATED WITH
OUTCOMES.
AND FOR OLDER ADULTS A
CONCLUSION STATEMENT CANNOT BE
DRAWN.
MOVING ON TO MEAL FREQUENCY
LIMITED DATA SHOWS MEAL SKIPPING
BY CHILDREN AND ADOLESCENCE MAY
NOT BE RELATED TO RISK OF
OVERWEIGHT OR OBESITY.
11 OBSERVATIONAL ARTICLES
CONTRIBUTED TO THIS BODY OF
EVIDENCE.
WHILE ALL 11 ARTICLES CONTR
CONTRIBUTED UNIQUE DATA WITH
DIFFERENT OUTCOMES OR
CATEGORIZATION OF EXPOSURE THERE
WERE ONLY EIGHT COHORTS OF
PARTICIPANTS AND TWO ARTICLES
FROM THE NHLBI GROWTH STUDY AND
WE TO FROM PROJECT BEAT.
WHILE THERE WERE SOME
INCONSISTENCIES IN DIRECTION AND
SIGNIFICANCE OF FINDINGS THEY
WERE ALL FROM THE SAME COHORT
REPORTING CONFLICTING RESULTS
LEADING TO CONCERNS WITH RISK OF
BIAS WITH THE EXPOSURE
MISCLASSIFICATION AND CONCERNS
WITH DIRECTNESS OF THE
HETEROGENEITY OF EXPOSURES.
THE EVIDENCE THAT LOOKED AT MEAL
FREQUENCY OR SKIPPING OR JUST
LUNCH FREQUENCY OR SKIPPING OR
DINNER FREQUENCY AND WHILE SIX
OF THE 11 ARTICLES WERE
CONDUCTED IN THE U.S. THEY WERE
FROM THREE UNIQUE COHORTS
PARTICIPANTS.
NEXT WE'RE MOVING ON TO THE
EVIDENCE REVIEW FOR PORTION SIZE
IN REGARDS TO GROWTH BODY
COMPOSITION AND RISK OF OBESITY.
SO HERE IS OUR ANALYTIC
FRAMEWORK WHICH CHRISTINA
DESCRIBED PREVIOUSLY.
I JUST WANT TO CALL ATTENTION TO
THE INTERVENTION EXPOSURE AND
COMPARATOR AREA.
SO THE INTERVENTION EXPOSURE WAS
PORTION SIZED.
IT CONSIDERS ENERGY DENSITY,
NUTRIENT DENSITY AND/OR THE
QUALITY OR TYPE OF FOOD SERVED
OR CONSUMED.
AS WELL AS PREPORTIONED FOODS
AND THE COMPARATOR WAS DIFFERENT
PORTION SIZE SERVED OR CONSUMED.
FOR PORTION SIZE AND RISK OF
OBESITY IN CHILDREN, OUR
CONCLUSION STATEMENT WAS THAT A
CONCLUSION COULD NOT BE DRAWN
ABOUT THE RELATIONSHIP BETWEEN
PORTION SIZES CONSUMED BY
CHILDREN AND ADOLESCENTS AND
GROWTH, BODY COMPOSITION AND
RISK MUCH OBESITY BECAUSE
THERE'S NO ENOUGH EVIDENCE.
A TRIAL WAS IDENTIFIED IN ONE
OCCASION.
THE CONCLUSION STATEMENT WAS A
CONCLUSION CANNOT BE DRAWN
BETWEEN PORTION SIZES CONSUMED
BY ADULTS AND BODY COMPOSITION
AND RISK OF OBESITY BECAUSE OF
INCONSISTENCIES AND THE BODY OF
EVIDENCE INCLUDED 11 ARTICLES
INCLUDING 10 TRIALS AND ONE
OBSERVATIONAL STUDY.
BUT THE BODY OF EVIDENCE WAS
INCONSISTENT AND INTERVENTION
COMPARATORS AND OUTCOMES.
ALL INCLUDED ARTICLES WERE PART
OF WEIGHT LOSS TRIALS AND SIX OF
THE TRIALS TESTED PRE-PORTIONED
FOODS AS THE INTERVENTION OR
EXPOSURE, FIVE TRIALS, EDUCATED
PARTICIPANTS ON PORTION CONTROL
BEHAVIORS AS PART OF THE WEIGHT
LOSS INTERVENTION AND THE TRIALS
VARIED IN TRIAL DURATION AND
WHAT MEAL OR FOOD GROUP WAS
TARGETED FOR PORTION CONTROL SO
THAT COULD HAVE BEEN LUNCH AND
DINNER OR LUNCH ONLY, VEGETABLES
ONLY OR ENERGY DENSE FOODS ONLY.
NINE TRIALS MEASURED WEIGHT LOSS
OR MEASUREMENTS AS THE OUTCOME
OF BODY COMPOSITION AND OBESITY
MEASURED LESS OFTEN.
AND THEN OUR CONDITION COLLUSION
STATEMENT DURING PREGNANCY AND
POSTPARTUM WAS A CONCLUSION
STATEMENT CANNOT BE DRAWN ABOUT
THE RELATIONSHIP BETWEEN PORTION
SIZES CONSUMED DURING PREGNANCY
AND GESTATIONAL WEIGHT GAIN
BECAUSE THERE'S NOT ENOUGH
EVIDENCE AVAILABLE ONLY ONE
ARTICLE WAS IDENTIFIED AND A
CONCLUSION STATEMENT CANNOT BE
DRAWN ABOUT THE RELATIONSHIP
BETWEEN PORTION SIZES CONSUMED
DURING POSTPARTUM AND POSTPARTUM
WEIGHT CHANGE BECAUSE THERE'S NO
EVIDENCE AVAILABLE AS NO
ARTICLES WERE IDENTIFIED.
AND I'LL TURN IT OVER TO
CHRISTINA.
>> THANK YOU.
THIS IS REALLY INTERESTING.
SO LISTENING TO THE PRESENTATION
OF DATA AND I'M SURE THE GROUP
DISCUSSED IT.
I JUST LOVE TO HAVE THE PUNCH
LINE.
I'M ASSUMING YOU'RE WORKING OFF
THE PREMISE THAT A PATTERN OR
HOW PEOPLE EAT IS THREE MEALS A
DAY BUT A LOT OF POPULATIONS
DON'T EAT THREE MEALS A DAY OR
THEY HAVE DIFFERENCES AS TO WHEN
THE PRIMARY MEAL IS.
HOW DID YOU RECONCILE THAT IN
YOUR ANALYSES?
I THINK ALL THE STUDIES WERE
DIFFERENT AND IT WAS BASED ON
THE EVIDENCE.
SO IT WAS BASED ON WHAT THEY
SAID AND SOMETIMES THEY SAID
THREE MEALS, SOMETIMES THEY SAID
TWO OR HAD DIFFERENT MEALS.
IT WAS VERY INCONSISTENT IN
TERMS OF HOW THEY DEFINE THAT
PATTERN AND WHAT WAS THE
COMPARATOR AND THE INTERVENTION.
SO IT VARIES SO MUCH ACROSS TO
THE STUDIES I DON'T KNOW IF YOU
HAVE ANYTHING ELSE TO ADD.
>> IT WAS AN INVESTIGATOR
DEFINED OR PARTICIPANT DEFINED
IF FOR EXAMPLE IN TERMS OF HOW
DIET WAS REPORTED AS TO THE
PARTICIPANTS SAID YES, I SKIPPED
BREAKFAST.
IT WOULD BE A PARTICIPANT
DEFINING THAT.
IN TERMS OF OUR EATING
OCCASIONS, OFTEN TIMES THEY
ACTUALLY MIGHT NOT HAVE BEEN
DESCRIBED, FOR EXAMPLE OR TALKED
THROUGH WITH THE PARTICIPANT BUT
WERE GIVEN GUIDANCE IN TERMS OF
HOW MANY DIFFERENT
COMMUNICATIONS SHOULD OCCUR.
SOME MAY HAVE BEEN ABOUT SIZE
ALSO BUT NOT NECESSARILY.
I DON'T THINK WE REALLY
SYNTHESIZED EVIDENCE OF THE MAIN
MEAL AND DIDN'T LOOK AT ENERGY
AT THE TYPES OF EATING
OCCASIONS.
>> CAN I WANT TO GIVE A SHOUT
OUT TO THE COMMITTEE AND
OVERWHELMED WITH THE SUBJECT AND
PUTTING THE GROUPS AND THERE'S
HUNDREDS OF PUBLICATIONS BUT
ONCE YOU DIVVY IT UP IT'S
DIFFICULT AND THE WORDSMITHING
PART WAS AMAZING AND FAVORABLE
OUTCOMES.
HOW DO YOU SAY THIS IS GOOD OR
HEALTHY WHEN SAYS SHOULD GROW
BUT NOT TOO MUCH AND ADULTS
AREN'T GROWING AND WE'D LIKE
THEM TO LOSE WEIGHT?
ARE THEY GAINING OR LOSING?
AND SO HATS OFF TO THE COMMITTEE
FOR FIGURING THAT ALL OUT AND
FOR THE PUBLIC THAT DOESN'T
APPRECIATE THIS I THINK IN THE
PARTICULAR SET WHAT I THOUGHT
WAS FASCINATING WAS THE PUBLIC
REALIZE WE HAVE DO -- TO COME
UP WITH A SET OF TRIAL AND
OBSERVATIONAL AND ONE TRIAL AND
10 OBSERVATIONAL AND ONE HAD 10
TRIALS AND ONE OBSERVATIONAL AND
WE WERE RIGHT.
WOE HAVE SEPARATE AND THEN
COMBINE THE TWO CATEGORIES.
ON TOP OF EVERYTHING ELSE THIS
IS A UNIQUE DATA SET TO LOOK AT
AND LOTS MORE STUDIES NIGHTED
AND I THINK FUTURE DIRECTIONS
WILL BE REALLY INFORMATIVE BUT
KUDOS FOR TURNING THESE INTO
WELL DEFINED CONCLUSIONS BUT THE
PUBLIC READING THEM WILL HAVE TO
LOOK CAREFULLY AT THOSE WORDS OF
FAVORABLE AND WHAT THE OUTCOMES
WERE.
HATS OFF.
I WANT TO ADD THE COMMITTEE WAS
SURPRISED WHEN LOOKING AT
SNACKING AND BREAKFAST OF NOT
HAVING THAT MANY STUDIES AND SHE
HAS DONE THINGS ON BREAKFAST AND
SNACKING AND I THOUGHT THIS
CANNOT BE RIGHT SO WHAT'S GOING
ON?
THE MAJORITY OF THE STUDIES ARE
CROSS SECTIONAL.
WE ENDED UP REMOVING ALL THOSE
STUDIES BECAUSE THEY DON'T MEET
THE CRITERIA.
THAT'S VERY IMPORTANT BECAUSE WE
WERE SURPRISED BY THE LIMITED
NUMBER OF STUDIES.
I ALSO WOULD LIKE TO THANK THE
CO-LEADERS OF HOLLY AND DEANNA
FOR THE AMAZE BEING WORK BECAUSE
REVIEWING ALL THE ARTICLES IS
QUITE A CHALLENGE.
>> WHAT IS THE PREVALENCE OF THE
BEHAVIORS IN THE
U.S. POPULATION?
IS THAT SOMETHING THAT WOULD BE
INCLUDED IN THE BACKGROUND OF
THE REPORT?
DO WE HAVE A SNACKING/BREAKFAST
SKIPPING PROBLEM?
WHAT'S THE PREVALENCE OF THESE?
>> SNACKING IS HIGH IN THE
U.S. AND AMONG COLLEGE STUDENTS
BREAKFAST SKIPPING IS PREVALENT.
>> IT GOES UP WITH AGE AND I'M
MORE FAMILIAR WITH THE ADULT
THAN CHILD LITERATURE AND THE
DEFINITION OF BREAKFAST SKIPPING
A LOT OF TIMES THE ADOLESCENT
WILL SKIP BREAKFAST BUT MAYBE
WAKE UP AT 10:00.
TRYING TO NAIL DOWN THAT
BEHAVIOR CAN BE DIFFICULT BUT
CAN BE UP TO 20%, 25% IN THE
ADOLESCENTS DEPENDING ON WHICH
POPULATION YOU LOOK AT WE JUST
GOT EPI-DATA FROM TEXAS AND
SNACKING IS VERY HIGH, THREE OR
MORE SNACKS A DAY FOR A LOT OF
KIDS.
>> IT MAY BE INTERESTING TO
UNDERSTAND NOT JUST HOW MANY
INDIVIDUALS LIKE SKIP A MEAL OR
SNACK, YES, NO BUT WHAT PERCENT
OF DIET COMES FROM THESE
INDIVIDUAL OCCASIONS OR OVER
ALL?
>> I THINK IT VARIES BY AGE
GROUP.
IT COULD SNACKS HIGHER IN
ADOLESCENTS AND COLLEGE STUDENTS
AND SO MAYBE HEATHER CAN TALK
ABOUT THESE THINGS.
IT'S IN OUR DATA FOR TOMORROW IN
DATA ANALYSIS.
STAY POSTED.
>> IT WAS INTERESTING AND ON MY
CLINICAL HAT HERE, WHEN WE LOOK
AT THE CLINICAL DATA THERE WAS A
MAJOR SHIFT ON THE CLINICAL SIDE
TO MOVE PERSONS WITH CERTAIN
CHRONIC DISEASES I KNOW WE'LL
TALK ABOUT TYPE II DIABETES
TOMORROW SO MOVING TOWARDS MANY
NILS AND MORE OF A SNACK STYLE
BEHAVIOR IN TERMS OF LOOKING AT
CHRONIC DISEASES.
SO HAVING PERSONS CONSUME SIX
MINI MEALS IN THE CLINICAL REALM
INSTEAD OF ACTUAL MEALS.
LIKE WHAT WE THINK OF AS A
STANDARD DIET WHICH IS MORE OF
BREAKFAST, LUNCH, DINNER.
THAT SHIFT HAPPENED ABOUT 2000
ON THE CLINICAL SIDE AND MOVING
TOWARDS MINI MEALS OPPOSED TO
FULL MEALS TO KEEP THEIR GLUCOSE
MORE STABLE ACROSS THE DAY.
SO THERE'S BEEN THAT SHIFT ON
THE CLINICAL SIDE WHICH I KNOW
THESE ARE CLINICAL GUIDELINES
BUT HAVE TO THINK IN THE CONTEXT
OF MINI MEALS WE EQUATE TO A
SNACK SO THERE'S THAT SHIFT IN
THE GENERAL PUBLIC.
SOMETHING TO THINK ABOUT THERE.
>> I ALSO WANT TO BRING UP
SOMETHING MY TEAM WAS TALKING
ABOUT, EVEN THOUGH WE HAVE 10
TRIALS LOOKING AT PORTION SIZE,
THEY ARE WERE SO DIFFERENT, ALL
OF THEM AND SO DIFFICULT TO WORK
WITH THAT DATA BUT I MEAN I ALSO
WAS FRUSTRATED AND DISAPPOINTED
OF NOT BEING ABLE TO DO A
STATEMENT WITH 10 TRAILS.
THAT COULD BE QUITE ENOUGH BUT
THEY WERE ALL SO DIFFERENT AND
SO SO DIFFERENT WE COULDN'T COME
UP WITH SOMETHING.
MAYBE HAVING SOME IN THE FUTURE
MAYBE WITH MORE TRIALS WIRE ABLE
TO COME UP WITH SOMETHING.
MAYBE OTHERS WOULD LIKE TO
COMMENT.
>> I WAS GOING TO COMMENT ON
THAT AND ALSO WHAT THE TEAM
MENTIONED BECAUSE IT'S IMPORTANT
TO THROUGHOUT AS WE HEAR THE
DIFFERENT PRESENTATIONS
SOMETIMES IT'S NOT AMOUNT BUT
CONSISTENCY AND INTERESTING
BEING IN THIS SUBCOMMITTEE THAT
THERE MAY BE ASSUMPTIONS THAT
WE'VE MADE WITH WHAT THE
EVIDENCE IS.
YOU MENTION CROSS SECTIONAL.
WE HAVE SO MUCH CROSS-SECTIONAL
EVIDENCE THAT IS NOT A PART OF
THIS REVIEW THAT IT DOESN'T MEET
THE STANDARD OF THE REVIEW AS
PROSPECTIVE COHORT STUDIES AND
ECTs BUT WHEN YOU HAVE A LOT OF
RCTs AND TRIALS THAT DON'T
MEASURE OR ARE INCONSISTENT AND
THAT'S IMPORTANT AS WE LOOK AT
EACH OF THE GROUPS.
IT'S IMPORTANT BECAUSE WE TALK
ABOUT THE AMOUNT OF STUDIES BUT
WE COULD HAVE A LOT OF STUDIES
BUT WITH CONSISTENCY AND RISK OF
BIAS AND OTHER FACTORS COME INTO
PLAY.
IT'S INTERESTING WHAT PEOPLE --
WHAT WE ALL EVEN THINK WITH THE
BODY OF EVIDENCE BUT WHEN YOU
GET INTO IT AND DIG DEEPER YOU
REALIZE THE STANDARD OF EVIDENCE
THAT MEETS THE STANDARD OR
DESIGNS MAY NOT BE APPROPRIATE
WITHIN THE REVIEW.
>> I JUST WANTED TO ADD I THINK
DIDI'S COMMENT WAS GOOD TO
PROVIDE MORE CONTEXT.
I THINK THAT WILL BE GOOD TO
INCORPORATE WITHIN OUR FINAL
REPORT SO THANKS.
>> I'M NOT DONE.
NEXT STEP, MAYBE WE MAY SEE
SOMETHING DIFFERENT WITH ENERGY
INTAKE.
MAYBE PORTION SIZE.
WE COULDN'T CONCLUDE WITH THE
BODY COMPOSITION BUT MAYBE WE DO
SEE SOME EFFECTS ON ENERGY
INTAKE WHEN YOU CONTROL THE
PORTION SIZE SO THAT'S COMING
AND HOPEFULLY WE'LL PRESENT THAT
NEXT SEPTEMBER AND JUST WANT TO
REMIND EVERYBODY THAT WE ARE
ALSO WORK ON THE EVIDENCE ON
CULTURALLY TAILORED DIETARY
RECOMMENDATIONS.
THIS IS A NEW GUIDELINE IN THE
COMMITTEE TIME REPORT AND ONLY
BE AN EVIDENCE TO UNDERSTAND
WHAT'S OUT THERE AND YOU'LL BE
THE NEXT COMMITTEE GROUP TO
DEFINE THE QUESTIONS.
THAT WILL BE PRESENTED NEXT
TIME.
I THINK WE'RE DONE.
>> OKAY.
I'M GOING TO START PRESENTING ON
THE FOOD MODELLING ANALYSIS AND
DATA SUBCOMMITTEE.
GET READY FOR AN ABRIDGED
VERSION OF WAR AND PEACE AS FAR
AS THE AMOUNT OF DATA WE'VE GOT
FOR TODAY THE VOLUME IS
TREMENDOUS AND WE'LL TALK ABOUT
THE HIGHLIGHTS TODAY.
HERE'S THE LIST OF OUR
SUBCOMMITTEE MEMBERS THAT HAVE
TAKEN ON THE MASSIVE TASK
BETWEEN FOOD PATTERN MODELLING
WE'LL TALK ABOUT NOW AND DATA
ANALYSIS TOMORROW.
DIVIDING UP OR WORK AND
INDICATING THE MEMBERS OF THE
WORK EQUITY GROUP IS PART OF
THIS GROUP SO HOW IT'S ENGRAINED
IN THE ANALYSIS WE'RE DOING
THROUGHOUT THE PROCESS.
ALSO TODAY, SARAH, CAROL AND
DIDI AND SAMEERA WILL PRESENT
AND ONCE AGAIN WE WOULD NEVER BE
ABLE TO GET THROUGH THE DATA
WITHOUT OUR TREMENDOUS STAFF AND
WE NEEDED THE SUPPORT AND
GUIDANCE IN THE PROCESS AND
CAN'T BE UNDER STATED AS FAR AS
THE PROCESS GOES.
THE SIMPLE TASK AT HAND IS THE
COMMITTEE PRIORITIZED SEVERAL
ANALYSES TO INFORM ADVICE ON
DIETARY PATTERNS AND THE
COMMITTEE'S CHARGED WITH
ANSWERING THE SINGLE OVERARCHING
QUESTION.
THAT IS SHOWN IN THE BLUE BOX
CONSIDERING EACH LIFE STAGE
SHOULD CHANGES BE MADE TO THE
USDA STANDARDS FOR MEDITERRANEAN
STYLES AND OTHER STYLES AND FOOD
MODELLING AND CULTURAL FOOD
NORMS AND FOOD WASTE.
A MINOR TASK WE'RE TAKING ON AND
PRESENTING DATA AND THE CHANGES
WE MIGHT MAKE TO THE DIETARY
PATTERNS MAY INCLUDE INCREASES
IN THE AMOUNTS OF FOOD GROUPS OR
SUB GROUPS, RECATEGORIZITIETION
RECATEGORIZETIONATION OF FOODS
AND EVALUATE THE DIETARY
PATTERNS BEING RECOMMENDS AS A
HEALTHY U.S. STYLE PATTERN TO
GENERATE THERE THESE ANALYSES.
A REMINDER THAT THIS IS GOING TO
BE SETTING UP THE DIETARY
PATTERN BASED ON A SERIES OF
STEPS WE'LL MAKE FOR MAKING THE
NUTRIENT PROFILES, ETCETERA.
THEY DON'T NECESSARILY MAKE
INTAKES OF KEY NUTRIENTS OR NOT
MEETING CERTAIN NUTRIENTS IN THE
U.S. POPULATION.
AND WE LOOK AT THE PATTERN UP
FOR THE REPRESENTATIVE FOODS.
WILL BE INFORMED BY CURRENT
CONSUMPTION TO LOOK AT WHAT THE
PATTERNS REPRESENTATION BUT
THEY'RE NOT NECESSARILY INTAKES
AS THEY ARE MODELLING OUT THE
NUTRITIONAL COMPOSITION BASED ON
THE PATTERN WE'RE LOOKING AT.
SINCE MEETING 4 WE'VE EXAMINED 7
OF THE 10 PROTOCOLS SHOWN IN
PURPLE.
SO WE'LL BE PRESENTING A SUMMARY
OF THE RESULTS SHORTLY AND WILL
HAVE A DISCUSSION TO HELP INFORM
THE SYNTHESIS PLAN AS WE MOVE
FORWARD BUT WHAT WE WILL ALSO
SHOW IS SINCE MEETING 4 WE
DRAFTED THE LAST FOOD PATTERN
MODELLING PROTOCOL.
IT WILL BE POSTED ON DIETARY
GUIDELINES.gov NEXT MONTH AND
THE DRAFT NAME FOR THE PROTOCOL
IS REMOVING CARBOHYDRATE
CONTAINING FOODS.
IN EARLIER MEETINGS WE REFERRED
TO THAT AS THE LOW CARBOHYDRATE
PROTOCOL AND PRESENT THE
ANALYSIS FOR INPUT TOWARDS THE
END OF THE PRESENTATION.
AND THEN FINALLY SINCE MEETING
4, WE'VE BEEN DISCUSSING A
PROPOSED REVISION TO A PROTOCOL
PREVIOUSLY POSTED ON DIETARY
GUIDELINES.gov.
THIS PROTOCOL DRAFT NAME CHANGE
TO REMOVING ANIMAL-BASED FOODS
PREVIOUSLY REFERRED TO AS THE
VEGAN PROTOCOL AND PLANNING
REVISIONS TOWARDS THE END OF THE
PRESENTATION AS WELL.
WE'LL GO THROUGH THE MODELLING
PRESENTATION JUST A LITTLE BIT
OF DATA.
WE'LL LOOK AT THE NEWT REPRESENT
AROUND TRANSITION INTO THE FOOD
GROUP AND SUB GROUP RESULTS
ACROSS THE SPECIFIC PROTOCOLS
EXPLORING THE MODIFICATIONS TO
THE HEALTHY DIETARY PATTERN OR
WITH FLEXIBILITIES AND STILL
MEETING NUTRIENT GOALS.
WE'LL HAVE A BREAK BETWEEN EACH
ONE TO HAVE DISCUSSION.
THE ONE THING I WANT TO REALLY
SAY AD NOSIUM ME SUPPORTING
PROFILES WILL BE ON DIETARY
GUIDELINES.gov AND THE COMMITTEE
REPORT.
AND -- AD NAUSEAM AND WE'LL
HIGHLIGHT THE KEY RESULTS THAT
REALLY SHAPE THE SUMMARY REPORT
WE HAVE FROM EACH OF THE
PROTOCOLS.
AGAIN, THIS IS A PIECE OF THAT
LARGER PUZZLE WE'VE BEEN WORKING
THROUGH.
AFTER WE LOOK AT INTAKES FROM
THE TOTAL POPULATION WE'LL
EXAMINE DIFFERENCES IN NUTRIENT
PROFILES BASED ON POPULATION
GROUPS.
SO WE'LL START WITH THE BASIS
PATTERN AND THE GOAL IS TO SEE
WHETHER THE NUTRIENT PROFILES
WERE DIFFERENT BASED ON THE
INTAKES OF DIFFERENT POPULATION
GROUPS.
SO FIRST WE'LL PRESENT THE
NUTRIENT FILE DEVELOPMENT FROM
THE BASIS AND HOW IT PLAYS OUT
WITHIN OUR DIFFERENT POPULATION
GROUPS THAT ARE DEFINED BY
NHANES WITH RACE AND HISPANIC
ORIGIN AND BY POVERTY LEVEL.
OUR FIRST BIG LAYER OF RESULTS
IN THE NUTRIENT PROFILE FOR THE
BASIS PROFILE.
THE NUTRIENT PROFILES WE'RE
USING ARE ESSENTIALLY A WEIGHTED
AVERAGE OF THE NUTRIENTS AND THE
FOODS AND BEVERAGES OF A FOOD
GROUP BASED ON THE PROPORTIONAL
CONSUMPTION WITHIN THE
POPULATION.
OF ALL THE FOODS THAT ARE FRUIT
OR VEGETABLE OR DAIRY AND SOY OR
PROTEIN FOODS, ALL THE DIFFERENT
FOODS THAT MAKE UP THAT FOOD
CATEGORY, FOOD GROUP, WHAT'S THE
PROPORTIONAL CONSUMPTION OF THE
DIFFERENCE SOURCES THAT ARE
CONSUMED AND HOW IS THAT USED TO
THEN CONSTRUCT PROFILE OF THAT
FOOD GROUP THAT'S THEN USED IN
THE MODELLING ANALYSES THAT
WE'RE GOING TO DO.
SHOULD FOODS AND BEVERAGES WITH
LOWER NUTRIENT DENSITY, ADDED
SUGAR, FAT AND SODIUM CONTRIBUTE
TO ITEM CLUSTERS AND FOOD GROUP
AND SUB GROUP WITHIN THE
PATTERN?
SO FOR EACH ONE OF THESE FOODS
THAT EXISTS, WE CHOOSE A
REPRESENTATIVE FOOD THAT IS THE
MOST NEWT RINT DENSE WITH THE
LOWEST AMOUNT OF ADDED SUGAR AND
SATURATED FAT AND SODIUM.
AS A COMPONENT OF FOOD PATTERN
MODELLING IT ADDRESSES SOME OF
THE CONCERNS AROUND TRYING TO
MINIMIZE ADDED SUGAR AND
SATURATED FAT AND SODIUM.
THERE'S ALSO ALSO A VARIETY OF
FOODS WITHIN THE CATEGORY THE
REPRESENTATIVE FOOD THAT
REPRESENTS THAT LOWEST AMOUNT OF
ADDED SUGAR AND SATURATED FAT
STILL CONTAINS LOADED SUGAR AND
SATURATED FAT AND SODIUM AND
LOOKING IF THERE'S EVIDENCE IN
THE DATA REMOVING THE FOODS TO
GET AT THOSE KEY FOOD GROUPS.
IT'S NOT ABOUT ADDRESSING
WHETHER SOME FOODS ARE NUTRIENT
DENSE CONTRIBUTORS TO THE
WEIGHTED AVERAGE AND NUTRIENT
DENSE FAT-FREE MILK SHOULD A
DESSERT WITH MILK ADDED AS AN
INGREDIENT PROPORTION TO THE
FLUID MILK BEING CALCULATED?
THIS IS THE CONCEPT WE'RE
LOOKING AT IN TERMS OF THE
SOURCES OF THE FOODS WHEN YOU
SEPARATE OUT EACH ONE OF THE
FOODS THAT ARE INTO THEIR
COMPONENT ITEMS.
AT THE EXISTING METHODS YOU TAKE
A LOOK LIKE LASAGNA AND SEPARATE
IT INTO THE NOODLES AND PEPPER
AND SAUCE AND MEAT AND GOES INTO
INDIVIDUAL GROUPS AND ALL THOSE
ITEMS WITHIN THE CHEESE ALL
THOSE ITEMS WOULD BE SEPARATED
OUT INTO THEIR OWN ITEMS TO
CREATE THE NUTRIENT PROFILE.
CURRENTLY ALL FOODS ARE
SEPARATED OUT AND MATCHED TO A
REPRESENTATIVE FOOD AND HOW YOU
CREATE THE PROFILE.
THE QUESTION WAS THEN SHOULD
SOME ITEMS BE REMOVED FROM
CONTRIBUTING TO THE DEVELOPMENT
OF THE NUTRIENT PROFILE UP
HIGHER IN SATURATED FAT AND SHUG
AND SODIUM.
THE NUTRITIONAL COMPOSITION MAY
DIFFERENT AND THE SUBCOMMITTEE
CONSIDERED QUANTITATIVE METHODS
FOR OBJECTIVELY DETERMINING
WHICH FOODS TO EXCLUDE AND SOME
WERE NOT IDEAL.
WE DID NOT WANT TO BE LEFT WITH
ONLY A LIST OF INGREDIENTS AND
MISSED THE OPPORTUNITY FOR HOW
INGREDIENTS ARE CONSUMED WITHIN
VARIOUS FOOD WASTE.
SO WHAT WE ULTIMATELY CAME TO
WAS TO CHOOSE FOODS CATEGORIZED
AS DESSERTS AND SNACKS AND
SWEETS AND DAIRY DESSERTS BECAME
THE DIFFERENTIATING FACTOR
WITHIN THE FOOD GROUPS.
SO WE LOOKED AT THOSE FROM THE
WHAT WE EAT IN AMERICA FOOD
CATEGORIES AND THEY'RE ITEM
CLUSTERS AND USED THAT FOR THE
REVISED NUTRIENT PROFILE.
TO CONDUCT THE WORK WE USED THE
WHAT WE EAT IN AMERICA NHANES
DATA FOR INDIVIDUALS OVER 1 YEAR
AND PRODUCE ESTIMATES AND THE
DATABASES WHAT WE EAT IN AMERICA
FOOD CATEGORIES AND THE SR DATA
FOR THE NUTRIENT COMPOSITION.
WHAT THIS PRESENTS IS NOT A LIST
OF ALL FOOD AND BEVERAGES LOW IN
DENSITY BUT THE LIST OF WHAT WE
EAT IN AMERICA FOOD CATEGORIES
WE EXCLUDED FROM THE ANALYSIS
FOR THE MODIFIED NUTRIENT
PROFILE.
AS NOTED PREVIOUSLY WE'RE TRYING
TO DEFINE ALL FRUITS AND
BEVERAGES FOR THE PURPOSE OF
EXCLUSION HAD SEVERAL
CHALLENGES.
SO TRYING TO IDENTIFY VARIATIONS
OF DIFFERENT TYPES AND SIMILAR
FOODS THAT MAY HAVE DIFFERENT
NUTRIENT COMPOSITIONS.
CREATED A LOT OF CHALLENGES AND
IN SOME PLACES A HIGHER NATURAL
SODIUM INTAKE WOULD MAKE
SOMETHING LESS DESIRABLE THAT
MAY BE OTHERWISE CONSIDERED
DESIRABLE.
SO SODIUM KIND OF CREATED A
CHALLENGE SOMEWHAT WITHIN
LOOKING AT THE FOODS.
THE UBIQUITOUS NATURE OF IT.
WITHIN THIS THE SUBCOMMITTEE WAS
IN AGREEMENT THE CATEGORIES ARE
LOWER IN NUTRIENT DENSITY AND
SOURCES OF ADDED SUGAR AND
SATURATED FAT AND BECAME THE
FOODS WE CHOSE TO EXCLUDE FROM
THE NUTRIENT PROFILE.
THERE ARE TWO FOOD GROUP WHERE
THE EXCLUSIONS MADE A DIFFERENCE
IN THE FOOD GROUP NUTRIENT
PROFILE.
THE DAIRY AND FORTIFIED SOY
GROUP AND THE REFINED GRAINS
WERE THE TWO MAJOR AREAS WHERE
WE SAW THE COLLUSIONS FROM
DESERTS, SWEETS AND MILK SHAKES.
SO WHEN WE REMOVED MILK SHAKES,
THE FLUID MILL AND THE REDUCTION
OF FLUID MILK WITHIN THE PROFILE
MEANS A GREATER PROPORTIONAL
INCREASE IN CHEESE IN THE DAIRY
GROUP.
SO CHEESE HAD A SLIGHTLY HIGHER
CONTRIBUTION OF COUNTING TOWARDS
THE TOTAL CUP EQUIVALENCE BUT
SLIGHTLY LOWER CALORIE LEVEL
WITH REPRESENTATIVE FOOD.
THERE WAS A 17 CALORIE DECREASE
IN THE CUP EQUIVALENCE FOR MILK.
THE QUOTE, UNQUOTE, IF YOU HAD A
MILK OR DAIRY OR FORTIFIED SOY
SERVING OR OUNCE EQUIVALENT.
THIS HAS IMPLICATIONS FOR
CALCIUM, VITAMIN A AND D AND
SODIUM RELATED TO THE REDUCTION
IN THE PROPORTION OF FLUID MILK
COUNTING TOWARDS THE FOOD GROUP.
SIMILARLY WITHIN REFINED GRAINS
THE IMPLICATIONS FOR NUTRIENTS
WERE SMALL.
DIFFERENCES DUE TO DECREASE IN
SUGAR AND THE SHIFT TO CHEESE AS
FEWER CALORIES PER CUP
EQUIVALENT.
THIS WOULD BE PART OF OUR
CONVERSATIONS THROUGHOUT THE DAY
IN TERMS OF WHAT HAPPENS WHEN
SMALL CHANGES ARE MADE BUT WITH
LESS FLUID MILK AND MORE CHEESE
AND SLIGHTLY FEW IR ADDED SHUCK
SUGARS AND THE CALORIE LEVELS
DROPPED.
THE SUMMARY STATEMENT WAS THAT
WE DID NOTE DIFFERENCES IN THE
NUTRIENT PROFILE WITHIN THE
EXCLUSION OF SOME FOODS LOWER IN
NUTRIENT DENSITY.
FOR THE REMAINDER OF THE FOOD
PATTERN MODELLING ANALYSES WE
USED THIS REVISED BASIS NUTRIENT
PROFILE FOR THE REST OF THE
ANALYSES.
ONCE WE HAD THE REVISED PROFILE
WE LOOKED AT HOW THIS WOULD BE
IMPLEMENTED BASED ON DIFFERENT
POPULATION GROUPS IN THE INTAKES
THAT WERE REPORTED IN WHAT WE
EAT IN AMERICA 2017, 2018 BASED
ON DIFFERENT POPULATION GROUPS.
WHAT ARE DIFFERENCES IN THE
NUTRIENT PROFILES WHEN
CALCULATING USING DIETARY
INTAKES FROM U.S. POPULATION AND
POPULATION SUBGROUPS?
SO THE GROUPS THAT WE LOOKED AT
EARLIER HISPANIC ORIGIN AND
INCOME INTEREST THE ANALYSES
WE'LL LOOK AT HERE.
THERE WERE ONLY A FEW PARTICULAR
AREAS WHERE THE POPULATION GROUP
INTAKES SHOWED DIFFERENCES IN
HOW THE NUTRIENT PROFILES WOULD
CALCULATE.
IN FLUID MILK OR IN DAIRY AND
FORTIFIED SOY WE NOTICED A
DIFFERENCE IN NON-HISPANIC ASIAN
AS A HIGHER PROPORTION OF THEIR
SOY PRODUCTS COMING FROM FLUID
MILK AND LESS FROM CHEESE.
AND THE PROPORTION OF CHEESE WAS
HIGHEST IN THE PROFILE FOR THE
NON-HISPANIC BLACK POPULATION
AND THE PROPORTION OF CHEESE
INCREASES AS THE PERCENT OF
MAKING UP THE DAIRY AND
FORTIFIED SOY CATEGORY.
THERE'S DAIRY AND SOY AND THE
NON-HISPANIC ENERGY INTAKE WILL
BE SLIGHTLY HIGHER BECAUSE THE
LOWER PROPORTION OF CHEESE AND
HIGHER PERCENT OF FLUID MILK AND
VITAMIN A WOULD BE HIGHER.
MILK HAS HIGHER PERCENTAGES OF
VITAMINS COMPARED TO CHEESE.
THE ITEM CLUSTERS ARE NOTABLY
DIFFERENT AMONG THOSE CLASSIFIED
AS NON-HISPANIC ASIAN WHERE
WHITE RICE CONTRIBUTES A LARGER
PROPORTION TO THE NUTRIENT
PROFILE THAN IT DOES FOR OTHER
POPULATION GROUPS.
THE MAIN DIFFERENCES ARE FOR
VITAMIN A AND FOLATE AND CALCIUM
AND MORE RICE AND LESS BREAD
PRODUCTS THAT ARE ENRICHED OR
FORTIFIED.
WE'LL SEE THAT IN THE DATA BY
WHOLE GRAINS BY POPULATION
GROUP.
SIMILARLY THE PROFILE FOR WHOLE
GRAIN STANDS OUT THE PROPORTION
FOR NON-HISPANIC ASIAN.
THE PROFILE FOR NON HISPANIC
ASIAN HAD A HIGHER AMOUNT OF
BROWN RICE AND WHOLE WHEAT PETA
AND TORTILLAS AND READY TO EAT
CEREAL BARS THAT MAY HAVE MORE
FORTIFICATION.
SEEING THOSE DIFFERENCES PLAY
OUT WITHIN EACH OF THE NUTRIENT
PROFILES THEMSELVES.
WE'LL TAKE THE BASIS PROTOCOL
AND MOVE THAT FORWARD AND LOOK
AT THE POPULATION LEVEL PROTOCOL
AND THEN CALCULATE THE A
PATTERNS USING THE POPULATION
SPECIFIC GROUP PROFILE TO SEE IF
WE SEE DIFFERENCES IN THE
NUTRIENT OUTCOMES OF THE PATTERN
BASED ON THE DIFFERENT
POPULATION GROUPS.
WE HAVE POPULATIONS 1 AND OLDER
AND INTEGRATED IN THE ANALYSES
IN THE CENTER COLUMN AND THOSE
YET TO BE COMPLETED.
WE USED THE GROUP SPECIFIC
NUTRIENT PROFILES DURING THE
FINAL SYNTHESIS PHASE IN THAT
YELLOW HIGHLIGHTED SECTION TO
TEST THE PROPOSED PATTERNS
AGAINST NUTRITIONAL GOALS WHILE
CONSIDERATION VARIATIONS IN
DIETARY INTAKES.
SO, WE HAVE MORE GROUND TO COVER
BUT SOME HAVE BEEN HOLDING
QUESTIONS OR A LONG TIME MAYBE.
GO AHEAD.
>> WHEN THINKING ABOUT THE
NUTRIENT PROFILE DEVELOPMENT AND
LOOKING AT MILK AND SOY
FORTIFIED PRODUCTS, WHAT WAS THE
SUBCOMMITTEE'S DISCUSSION ABOUT
PERHAPS INTOLERANCES ACROSS SOME
OF THE POPULATION GROUPS AND WAS
IT DISCUSSED WHETHER TO SEPARATE
OUT THE NON-DAIRY BASED OPTIONS
VERSUS OTHER MILKS,
ALTERNATIVES.
>> SO WITHIN THE DATA THEY'LL BE
CODED BASED ON AND TAKING OUT
THE FOODS THROUGHOUT FROM THE
CONSUMPTION AROUND LOOKING AT
THE DISTRIBUTION.
BUT I'M GOING TO PUT A PAUSE
BUTTON ON THE MILK ALTERNATIVES
BECAUSE THAT FALLS IN OUR
PROTOCOLS WE'RE LOOKING AT
BECAUSE IN THE '17, '18 DATA
ONLY SOY FORTIFIED BEVERAGES
COUNTED IN THE MILK ALTERNATIVES
BUT MOVING FORWARD WE HAVE MORE
TO COME.
SO IT WILL BE BASED ON THE
PATTERN AND DEVELOPING THE
NUTRIENT PROFILE WITH THE
PROPORTION OF CONTRIBUTION AS IT
COMES FROM THE GROUP FOLLOWING
THE HEALTHY U.S. STYLE PATTERN
AND GETTING TO THE FORTIFIED SOY
CONVERSATION WE CAN INSERT THAT
BACK IN GETTING BACK IN OUR
SYNTHESIS STATEMENT OR SYNTHESIS
ASPECTS LATER.
>> I'M TRYING TO UNDERSTAND THE
IMPLICATIONS.
WOULD THAT THEN ALLOW FOR A
SUBPOPULATION FOR ALLERGIES OR
INTOLERANCES MORE LIKELY TO
OCCUR TO NOT HAVE GUIDANCE THAT
SUGGESTS FOODS TRADITIONALLY
MILK BASED WOULD BE INCLUDED?
>> YES, THAT IS WHAT'S COMING
SOON AFTER WE GET THROUGH A FEW
MORE.
>> IT SEEMS LIKE YOU CAN
CALCULATE IT.
THE LIST OF LOW NUTRIENT DENSE
FOODS YOU DECIDED TO REMOVE FOR
THE SAKE OF THE EXERCISE, THAT
WAS A COMPLETE LIST NOT AN
EXAMPLE LIST.
IS THAT TRUE?
>> CORRECT.
>> AS A COMPLETE LIST DID YOU
EVER CALCULATE THE PROPORTION OF
U.S. CALORIES THAT COME FROM
THAT LIST?
IS IT 5%, 10% OR 20% OF THE
U.S. DIET?
IT WOULD BE INTERESTING TO KNOW
WHAT YOU HAD TO EXCLUDE TO MAKE
THE REVISED LIST?
>> THIS IS LIKE DEFENDING YOUR
CANDIDACY EXAM.
THERE ARE SO MANY DATA POINTS
AND I KNOW WHERE WE ULTIMATELY
LOOKED AT WHAT THE NUTRIENT
PROFILE LOOKED LIKE IF YOU TOOK
THIS OUT AND THIS OUT AND THIS
OUT.
ULTIMATELY WHEN YOU DIRECT FOOD
PIECE ACCOUNTS FOR A LOT OF WHAT
HAPPENS IN THE DATA.
YOU'LL HAVE A WIDE VARIETY OF
SATURATED FOOT AND SAY PROTEIN
FOODS BUT WHEN YOU TAKE IT TO
THE REPRESENT FOOD IT HELPS
CONSTRAIN THAT A LITTLE BIT.
THEN WHEN YOU LOOK AT HOW DOES
THE PROFILE CHANGE?
THESE WERE I'D SAY INCREMENTAL
SMALL DIFFERENCES BUT ENOUGH TO
SHOW NUTRITIONAL IMPLICATIONS OF
THE PREVIOUS COMMENT AND WHY YOU
INCLUDE THESE OR THAT.
THERE'S AN EXERCISE TO TEST TO
SEE IF IT'S NECESSARY AND SAW
TWO CATEGORIES WHERE IT HAD A
CONSIDERABLE DIFFERENCE TO COME
FORWARD WITH THE CHANGE.
>> THIS IS REALLY EXCELLENT WORK
AND HARD WORK.
SO KUDOS JUST TO START.
I HAVE TWO QUESTIONS AND ONE IS
A CLARIFYING QUESTION.
I WANT TO MAKE SURE THAT I
UNDERSTAND WHEN YOU LOOK AT THE
PERCENTAGES ACROSS RACIAL AND
ETHNIC GROUPS OR ETHNIC
CLASSIFICATION AND INCOME AS FAR
AS PERCENTAGES IT'S THE DAIRY
AND FLUID MILK AS A PERCENTAGE
OF THE OVER ALL CONSUMPTION OF
DAIRY THAT TAKES OUT THE IDEA OF
[INDISCERNIBLE]
>> SAYING OF HOW MUCH OF THE
MILK -- HOW MUCH OF THE DAIRY
AND FORTIFIED SOY CATEGORIES
BEING CONSUMED HOW MUCH COMES
FROM EACH OF THOSE SUBGROUPS.
IT'S NOT SO MUCH ONE GLASS AND
TWO SLICES BUT IT LOOKS AT THE
PROPORTIONAL CONTRIBUTION OF
THAT BUT THEN LOOKING AT HOW
MUCH IS COMING FROM THE
CONSUMPTION DATA WE HAVE FROM
THE LIMITATION.
IS THERE MORE CHEESE
COMPARATIVELY?
LESS CHEESE, MORE YOGURT, LESS
YOGURT?
THAT HELPS CONSTRUCT SO IF IT'S
45% CHEESE AND THE NUTRIENT
PROFILE WILL BE BASED ON CHEESE
THAT HELPS GET AT MORE SPECIFIC
TO THE REPORTED FOODS THAT ARE
REPORTED WITHIN NHANES 2017,
2018 FOR THOSE POPULATION
GROUPS.
>> THAT'S HELPFUL.
I KNOW WE DISCUSSED AGE BUT WE
HAVE RACE AND ETHNICITY AND
ETHNIC CLASSIFICATION AND THE
CLASSIFICATION WE HAVE AND WE
DON'T HAVE AGE AND I'M ASSUME
I
ING -- ASSUMING LOOKING AT
ADULTS AND YOUNG CHILDREN AND
ARE THERE CONSIDERATION OF AGE
WITHIN THE CONSTRUCTION?
>> SO AGE -- OUR ANALYSES WE'LL
CARRY FORWARD WILL ALL BE BASED
ON AGE, SEX GROUPS FOR THE WHOLE
CADRE OF ANALYSIS.
THE PREVIOUS COMMITTEE LOOKED AT
THE FOOD PATTERNS CARRY FORWARD
AND NOT AT ME OR SAY THAT'S NOT
WHERE WE ARE.
THOSE WERE CONVERSATIONS MANY
SLEEPS AGO.
SO THERE WILL BE SOME OF THAT
FACTORED IN BUT THE POPULATION
WEIGHTED PROPORTIONALITY HELPS
ADDRESS SOME OF THAT AS WELL IN
TERMS OF HOW THIS PLAYS FOR THE
NATIONAL REPRESENTATIVE DATA.
>> THANK YOU.
GREAT WORK.
THINKING ABOUT THE DATA YOU'RE
WORKING WITH HOW ARE YOU
CONSIDERING THE GROUPS THAT MAY
NOT BE REPRESENTED AND WHAT YOU
SHOWED TODAY?
>> THE GROUPS NOT REPRESENTED,
THAT'S THE LIMITATION WE HAVE
FROM THE NHANES DATA.
WE'RE ABLE TO LOOK AT IT FROM
THIS PIECE.
I THINK THIS IS WHERE THE DIET
SIMULATIONS BECOMES A REALLY
COOL AND INNOVATIVE WAY TO LOOK
AT FOOD WAYS OUTSIDE WHAT WE'RE
ABLE TO QUANTIFY BASED ON THE
POPULATION DISTRIBUTION.
THAT BECOMES.
IT'S SOMEWHAT THE THEME WE HAVE
THROUGH THE FOOD PATTERN
MODELLING.
WE HAVE GREAT DATA WE CAN LOOK
AT TO LOOK AT THE NATIONAL
REPRESENTATIVE SET OF INTAKES
NOT PERFECT AND NOT FULLY
REPRESENTATIVE BUT IT ALSO SHOWS
WHERE WE HAVE GAPS WHERE WE
WOULD HAVE TO MAKE ASSUMPTIONS
AROUND I THINK THE CHALLENGE
WE'VE HAD IS TAKING AN EMPIRICAL
APPROACH IF WE CAN'T HAVE THE
DATA, WE CAN'T MAKE THE
CONCLUSION.
SO FROM THIS WE'RE ABLE TO LOOK
AT THE SPECIFIC GROUPS THAT WE
HAVE AVAILABLE BUT IT CAN INFORM
WHAT CAN BE DONE INDICT
SIMULATIONS AND IN OTHER SPACES
TO HELP INCREASE THAT.
>> CHRIS, DO WE WANT TO TAKE A
BREAK NOW TO LET PEOPLE DIGEST
BEFORE WE DIVE IN OR HOW DOES
THE COMMITTEE FEEL?
ARE WE READY TO KEEP GOING?
>> WE HAVE TIME.
>> OKAY.
>> I IT WILL BE GREAT BECAUSE WE
HAVE HAD GREAT PRESENTATIONS.
WE HEARD ABOUT HEALTH EQUITY AND
WORKING GROUP AND WE HEARD THE
PREQUEL TO EVERYTHING WE'LL HEAR
MORE ON WAR AND PEACE AND SO
LET'S TAKE A BREAK.
SO THANK YOU VERY MUCH.
FIVE.
SESSION FROM WORKING GROUP 3 AND
CHRIS, I THINK YOU'RE BACK ON.
>> ONCE AGAIN WE'LL LEVEL SET
WITH THIS VERY SIMPLE QUESTION
THAT WE HAVE TO ANSWER AROUND
THE LIFE STAGE APPROACH AND
SHOULD CHANGES BE MADE TO THE
U.S. DIETARY PATTERNS.
SO WHAT I'M GOING TO DO IS WALK
THROUGH THE HEALTHY U.S. STYLE
PATTERN THAT'S GOING TO BE THE
FOUNDATION OF THE PROTOCOLS WE
HAD THAT WE'RE GOING TO PRESENT
TODAY.
DOING LEVEL SETTING AROUND
WHAT'S HAPPENING WHEN WE'RE
WORKING WITH THE LEVERS WITHIS
THE SYSTEM ITSELF.
AS GO GO THROUGH THE PROTOCOL
IT'S LIKE DRIVING A GOLF CART
THERE'S ONE PEDAL, PUSH TO GO OR
LET GO TO STOP.
AND IT OME HAPPENS WITH THAT AND
EVERYTHING ELSE STAYS THE SAME
AND OUR SYNTHESIS IS GOING TO BE
FLYING THE PLANE WITH ALL THE
MULTIPLE LEVERS AND SWITCHES AND
BUTTONS EVERY.
SO WHAT WE HAVE TO CONSIDER IS
WHEN WE'RE LOOKING AT THIS,
WE'RE MAKING CHANGES WITHIN
FOODS AND WHEN YOU TEST THE
VARIATIONS WHERE YOU REDUCE OR
INCREASE GROUPS OR SUB GROUPS IT
CHANGES THE NUTRIENTS THEY
PROVIDE.
ALL THESE DIETARY CHANGES WHEN
YOU TAKE OUT THE FOODS YOU'LL
TAKE OUT THE NUTRIENTS WITH
THEM.
WE'LL LOOK AT HOW THESE CHANGES
HAPPEN.
WHAT'S IT DO TO THE NUTRIENT
CONTENT AND MEET OUR NUTRIENT
GOAL FOR THAT PATTERN.
IT GETS US IN THE MIND FRAME OF
WHERE WE'LL GO WITH THE
ANALYSES.
SO THIS IS THE HEALTHY
U.S. STYLE PATTERN FOR AGES 2+
AND LOOKS AT THE QUANTITY OF THE
DIFFERENT FOOD GROUPS.
FOR THE VEGETABLE GROUPS FOR A
DIETARY PATTERN CONSUMED DAILY
AND THEN OUR SUBGROUPS WE HAVE
WITHIN VEGETABLES PERFECT
PRESENTED IN WEEKLY AMOUNTS.
SO DAILY CONSUMPTION OF
VEGETABLES BUT THE SUBGROUPS
DIVIDED AMONG THE WEEK TO GET TO
DIETARY VARIETY.
THE FOOD GROUP THAT HAS NO SUB
GROUPS AND THE GRAINS IS DIVIDED
UP AS WHOLE GRAINS INTO TWO SUB
GROUPS, DAIRY AND FORTIFIED SOY
AND THE PROTEIN FOODS HAVE THREE
SUB GROUPS AS WELL.
SO WHEN WE DO OUR ANALYSIS IT
WILL BE TAKE THE NUTRIENT
PROFILE FOR VEGETABLES, ADD TWO
HALF CUP EQUIVALENTS AND GIVES
THE NUTRIENT FOR EACH INDIVIDUAL
NUTRIENT WITHIN THE PATTERN.
YOU SUM THAT UP FOR THE DAY AND
THAT GIVES US THE QUANTITY OF
ENERGY OF CARBOHYDRATE AND
VITAMIN C FROM THE PATTERN BASED
ON THESE DISTRIBUTIONS.
WHAT IS IT THEY'RE CONTRIBUTING
TO THE TOTAL INTAKE FOR THE DAY?
WHEN WE LOOK AT INTAKE FOLLOWING
THESE PATTERNS AND WE HAVE
CERTAIN THINGS WE THINK ABOUT
WITH CERTAIN FOOD GROUPS AS FAR
AS NUTRIENTS GO BUT OUR TOTAL
DIETARY INTAKE IS THE CUMULATIVE
SUM OF THE PARTS.
THE SYNERGISTIC PART TOWARDS THE
TOTAL INTAKES.
SO WHAT YOU'LL SEE THE
CONTRIBUTION OF EACH ONE OF
THESE INDIVIDUAL FOOD GROUPS
CONTRIBUTING TO A RANGE WITHIN
THE CALORIE LEVEL FOR THE LOWER
CALORIE 1,000 PROFILE UP TO THE
HIGHER PROFILE.
VITAMIN K VEGETABLES CONTRIBUTE
61% TO 74% OF THE VITAMIN K IN
THE DIETARY PATTERN FROM
VEGETABLES.
41% TO 54% FROM VITAMIN C.
THE SEE CUMULATIVE CONTRIBUTION
OF EACH OF THE UNIQUE NUTRIENTS
COMING FROM THE VEGETABLE
PROFILE.
WE CAN THINK REINA FOR THE
LOVELY GRAPHIC AND AS A QUICK
ORIENTING AND I'LL HAVE TO ZOOM
IN ON MY OWN SCREEN TO SEE.
ON THE BOTTOM BLUE IS DAIRY,
DARKER BLUISH GREEN THE BLUE ARE
THE PROTEIN FOODS, THE NEXT UP
HIGHER IS GRAINS, THE ORANGE
COLOR IS VEGETABLES AND THEN YOU
HAVE FRUITS AND THEN OILS AT THE
TOP AS CREATING THIS DIETARY
PATTERN.
SO WE'RE LOOKING AT THE DIETARY
PATTERN AN WHAT'S THE
CONTRIBUTION OF VITAMIN A ACROSS
EACH OF THE FOOD GROUPS?
THE LINES ACROSS THERE ARE THE
DIFFERENT RDA THRESHOLDS FOR THE
AGE SEX GROUPS.
SO YOU'RE GOING TO HAVE A LOWER
RDA CUT POINT FOR THE YOUNG
CHILDREN THAT MIGHT BE IN THE
1,000 CALORIE RANGE BUT WHAT YOU
SEE HERE IS VITAMIN A WHEN YOU
ADD THEM UP ACROSS ALL THE
GROUPS IS NEEDING OR EXCEEDING
THE RDA FOR THAT LOWEST AGED SEX
GROUP.
WE SEE THE PROPORTIONAL
CONTRIBUTION AND WHAT HAPPENS
WHEN YOU TAKE VEGETABLES OUT?
SO THE SIMPLE MATTER OF
SUBTRACTION TELLS US VEGETABLES
ARE CONTRIBUTING A KEY AMOUNT OF
VITAMIN A IN TERMS OF MEETING
THE NUTRIENT GOALS WITHIN THE
PATTE
PATTERNS.
SO HOLDING EVERYTHING ELSE THE
SAME, WHEN WE TAKE VEGETABLES
OUT, WE NOW HAVE A PATTERN THAT
DOESN'T MEET MOST THE NUTRIENT
GOALS FOR VITAMIN A AND IN THE
HIGHER VALUES THAT WE NEED WE'RE
NOT EVEN HALF THE AMOUNT.
IT'S ALL THE TWEAKING WITHIN
EACH ONE OF THESE GROUPS AND
UNDERSTANDING WHAT THE
CONTRIBUTIONS OF EACH OF THESE
FOOD GROUPS ARE.
I TOLD YOU THIS WOULD BE THE FUN
PART.
NEXT FOR FRUITS THE LIST THEY
CONTRIBUTE MORE IS SMALLER IN
TERMS OF VITAMIN C, FIBER AND
POTASSIUM ARE MORE OF OUR
SYNERGISTIC CONTRIBUTORS HERE
AND ONE OF THE OTHER ASPECTS
THAT WE AREN'T ASSESSING HERE
ESPECIALLY WITHIN THE DATA
ITSELF AND THERE'S EVIDENCE
AROUND THE PHYTO CHEMICAL
BENEFIT OF FRUITS SO WE LOOK AT
OUR PATTERN AND SEE HOW VITAMIN
C IS BEING CONTRIBUTED AND FOR
THE MOST PART IT'S PREDOMINANTLY
FRUITS AND VEGETABLES ARE
PRIMARY CONTRIBUTORS.
IF WE REDUCE OTHER FOOD GROUPS
WON'T HAVE AS MUCH AS AN IMPACT
ON VITAMIN C.
IF YOU TAKE FRUITS OUT VITAMIN C
BECOMES MUCH LOWER AND NOT
MEETING A LOT OF OUR DRI
NUTRIENT GOALS.
SO THEN HOLOOKING AT GRAINS, WHE
GRAINS AND REFINED GRAINS
ACCOUNTING FOR THE FOLATE AND
62% OF IRON IN THE DIET.
SEE THE RANGE OF CONTRIBUTIONS
WE'RE GETTING COMING FROM EACH
OF THE FOOD GROUP INTO OUR TOTAL
NUTRIENTS.
SO AN EXAMPLE OF LOOKING AT IRON
WITHIN THE DIET WE CAN SEE THE
PROTEIN FOODS THAT ARE THERE IN
BLUE AND THE CONCENTRATION OF
GRAINS IN THE LIGHT TANNISH
WHATEVER THAT COLOR IS.
YOU CAN SEE WITH THE REMOVAL OF
GRAINS IN THE DIETARY PATTERN
THE IMPLICATIONS WE HAVE ON
MEETING IRON GOALS ACROSS THE
LEVELS.
AND DAIRY AND FORTIFIED SOY
ALTERNATIVES?
THE CONTRIBUTIONS THAT COME FROM
EACH OF THESE, VITAMIN D,
CALCIUM, B12, PHOSPHORUS,
ETCETERA.
YOU SEE THE RANGE OF NUTRIENTS
COMING FROM DAIRY AND FORTIFIED
ALTERNATIVES.
LOOK AT THE FOOD GROUPS AND HOW
THEY CONTRIBUTE.
IF WE REMOVE DAIRY FROM THE
DIETARY PATTERN ALL THE DIETARY
PATTERNS ARE BELOW THE LOWEST
CALCIUM RDA WITHIN THE GROUP.
THERE'S CERTAIN NUTRIENTS AND
OTHERS OBTAINED FOR PROTEIN
FOODS.
AND THIS ONE IS PROBABLY ONE
THAT'S NOT BEEN AN OVERARCHING
PUBLIC COMMENT.
PLEASE DON'T TAKE AWAY PROTEIN
FOODS BECAUSE CHOLINE MAY DROP
AND WE HAVE TO CONSIDER THAT IN
THE INTERPRETATION OF THE DATA
AND WHAT THE IMPLICATIONS ARE
AROUND MEETING AND NOT MEETING
AND HOW THE A.I. IS SET BUT
BECOMES ONE OF THOSE PLACES
WHERE IT MIGHT NOT BE THE FIRST
NUTRIENT THAT WE THINK ABOUT IN
TERMS OF MAKING A MODIFICATION.
IF WE REMOVE PROTEIN FOODS THIS
IS THE IMPLICATION OF CHOLINE.
WE LOOK AT VARIATIONS OF IF IT'S
REMOVED WHAT ARE THE
IMPLICATIONS AND WHAT HAPPENS IF
WE REDUCE AND HOW DO THE STEP
WISE FEATURES HAPPEN AS WE MAKE
THESE CHANGES?
SO I ASK THE QUESTION -- I'D
LIKE TO BE ABLE TO SAY ABOUT HOW
MANY DATA POINTS WE LOOKED AT
WITH FOOD PATTERN MODELLING.
SO FOR EVERY ONE OF THE
PROTOCOLS WE DID, WE HAD THE
ANALYSES BASED ON THE AGE SEX
GROUPS, THE QUANTITY OF THE
ITEMS IN THE PATTERN, THE
NUTRIENTS ASSOCIATED WITH THE
PATTERN AND THAT CHANGE AND
EVERY TIME WE DID A REDUCTION WE
DID AN INCREMENTAL REDUCTION AND
LOOKED AT THE NUTRIENT IF YOU
TOOK OUT ONE OR TWO OR THREE
OUNCES OF GRAIN AND THEN THE
NUTRIENT, THE DRI AND PERCENT OF
THE DRI TO HELP US REALLY LOOK
AT EVERYONE ONE OF THESE
INCREMENTAL STEPS.
IF YOU TAKE SOMETHING OUT,
WHAT'S THE NUTRIENT OF THE
PATTERN.
AND IF WE'RE WORKING WITHIN THE
PROTEIN FOODS, ALL THE OTHERS
ARE STAYING THE SAME WORKING
WITH GRAINS AND EVERYTHING ELSE
IS STAYING THE SAME UNLESS THE
QUESTION LOOKS AT SHIFTS BUT THE
VOLUME OF DATA POINTS OVER
350,000 THAT'S ROUGHLY 38,000
POINTS PER COMMITTEE MEMBER.
SO, WHEN YOU ASK EXACTLY WHAT
THE AMOUNT OF VITAMIN C FROM
THAT ONE IS I WON'T BE ABLE TO
ANSWER THAT QUESTION BUT BECAUSE
WE HAVE AN IMMENSE AMOUNT OF
DATA WE'RE LOOKING AT.
SO ONCE AGAIN WE'RE GOING TO
REALLY TALK ABOUT WHAT THOSE KEY
SYNTHESIS DATA POINTS ARE AND
HOW THEY INFORM THE DECISIONS
THAT WE MADE WITHIN THIS BECAUSE
WE'D ALL LIKE TO GO HOME AT SOME
POINT.
OKAY.
SO THEN COMING BACK TO WHAT
WE'LL BE DOING WITHIN ALL OF
THESE ANALYSES ONCE WE'RE DONE
TODAY WE'LL TALK ABOUT FRUITS,
VEGETABLES, SOY, PROTEINS AND
ALTERNATIVES AND COULDN'T GET TO
THE SYNTHESIS DATA FOR EVERY
SCENARIO ACROSS EVERY AGE GROUP.
ALL THE DATA WILL BE AVAILABLE
FOR PUBLIC USE.
IF YOU REALLY LIKE SPREAD SHEETS
YOU'LL REALLY HAVE FUN.
TODAY WE'LL FOCUS SPECIFIC ON
THE DATA THAT ARE DIRECTLY
RELATED TO THE OBJECTIVES OF
THAT OVER ARCHING QUESTION
AROUND THE MODIFICATIONS,
FLEXIBILITIES OR VARIATION IN
THE PATTERN.
AND WE'LL TAKE ALL THIS DATA
TOGETHER AND OUR SYNTHESIS IS
GOING TO BE TAKING ALL OF OUR
CONCEPTS THAT WE'VE TAKE --
CHANGES TO FRUIT OR NOT AND
GRAIN OR NOT WE DID
INDEPENDENTLY AND NOW WE'RE
GOING TO PUT THEM TOGETHER IN
ONE LARGE BUCKET TO DO THEM ALL
AT ONCE.
AND SEE WHAT THE IMPLICATIONS
ARE BECAUSE YOU CAN PULL ONE
LEVER AND SEE WHAT HAPPENS AND
PULL ANOTHER LEVER AND SEE BUT
WHAT HAPPENS WITH THE CARTOON AS
A KID WITH 15 LEVERS AND YOU
PULL ALL AT ONCE?
THE SYNTHESIZE WILL GET THERE
BUT THE UTONIAN PROCESS IS WHEN
YOU REDUCE SOMETHING DO WE HAVE
ROOM IN THE PATTERN TO REDUCE IN
SOME PLACES DO WE HAVE TO BRING
OTHERS BACK UP?
IT'S A BIG JIGSAW PUZZLE IN
TERMS OF HOW PIECES FIT
TOGETHER.
AND WE'LL TAKE 350,000 DATA
POINTS AND LAYERING ACROSS THE
SYSTEMATIC REVIEWS AND DATA
ANALYSIS AS WELL.
AND SHOULD CHANGES BE MADE TO
THE U.S. DIETARY PATTERNS WE'LL
WORK OUR WAY THROUGH THE
PROTOCOLS BUT WHAT I WANT TO
HIGHLIGHT BEFORE WE GET STARTED
IS WE WATCH THE TO SEE IF
THERE'S -- WANT TO SEE IF
THERE'S MODIFICATIONS TO THE
PATTERN WE'D RECOMMEND?
ONE OF THE THINGS WE WANT THEM
TO MEET THE NUTRIENT GOALS.
IN SOME CASES THEY HAVE PLENTY
OF WIGGLE ROOM.
IN SOME PLACES WE'RE TIGHT
AROUND CERTAIN NUTRIENTS.
BUT WITH ALL OF THAT TAKING THE
CALORIES OR ENERGY OF THE
PATTERN BASED ON THE WAY THE
CURRENT NUMBER OF QUANTITIES ARE
WITHIN THE PATTERNS MEAN WE HAVE
A TIGHT WINDOW UNLESS WE'RE
CONSUMING THE RIGHT FOODS WE
HAVE A HARDER TIME WITH ENERGY.
HOW DO WE OPTIMIZE THE PATTERN
TO MEET NUTRIENT NEEDS BUT OFFER
FLEXIBILITIES FOR HOW PEOPLE
CONSUME FOODS WITHIN THE FOOD
GROUPS?
SO OUR MODIFICATIONS MEAN ARE WE
GOING TO INCREASE OR DECREASE
THE NUMBER OF THE QUANTITY OF
THE FOOD GROUPS OR SUBGROUPS?
SO ON THAT TABLE WE HAD OF THE
HUSS PATTERN ARE WE GOING TO
REDUCE THE NUMBER OF OUNCE
EQUIVALENTS OR INCREASE?
WHAT HAPPENS WHEN WE CHANGE THE
AMOUNTS?
MODIFICATIONS WOULD CHANGE THE
WHOLE HUSS PATTERN TO SAY THE
QUANTITIES CONSUMED AND THE
FLEXIBILITIES ARE NOT CHANGES TO
THE PATTERN BUT THIS GOES TO
CHERYL'S QUESTION EARLIER IN
TERMS OF IF YOU'RE NOT GOING TO
CONSUME FLUID MILK AND THERE'S A
FLEXIBILITY FOR IF YOU CHOOSE
CHOOSE OR UNABLE TO CONSUME
CERTAIN ITEMS WHAT'S THE IMPACT
ON MEETING NUTRITIONAL GOALS AND
WHAT ARE THE CONSIDERATIONS TO
MAKE THAT HAPPEN?
SO, FLEXIBILITY ARE THE OUNCE
EQUIVALENTS OF WHATEVER AND THEN
IF YOU CHOOSE NOT TO EAT THEM OR
IF WE HAVE ALTERNATIVE
FLEXIBILITIES, WHAT ARE THE
POTENTIAL NUTRIENT IMPLICATIONS
AND HOW DO WE ADDRESS THOSE
GAPS?
AND THEN THE THIRD IS CREATING A
WHOLE SEPARATE PATTERN.
WE HAVE THE HEALTHY U.S. STYLE
AND HEALTHY MEDITERRANEAN AND
HEALTHY VEGETARIAN PATTERN.
MAYBE WE DECIDE WE NEED A WHOLE
SEPARATE PATTERN THAT IS X.
CREATE BEING A SEPARATE PATTERN
IS DIFFERENT THAN A MODIFICATION
WHICH IS HEALTHY U.S. STYLE AND
HOW MUCH IS FLEXIBILITIES WHICH
IS THIS IS HOW MUCH IS IN A FOOD
GROUP BUT IF YOU CHOOSE TO DO
THIS WHAT ARE THE CONSIDERATIONS
AND THEN A WHOLE DIFFERENT
PATTERN.
WE'LL LOOK AT SOME
MODIFICATIONS, SOME
FLEXIBILITIES AND THEN WHEN WE
LOOK AT THAT CONCEPT OF THE
VEGAN PATTERN WOULD BE AN
ALTERNATIVE PATTERN IF WE HAD
GONE DOWN THAT ROUTE IN TERMS OF
THEN IT WOULD BE WHAT WE WOULD
BE RECOMMENDING AS FAR AS THOSE
QUANTITIES.
THAT'S AN EXAMPLE OF A DIFFERENT
PATTERN INDEPENDENT OF THE
HEALTHY U.S. STYLE.
>> WHAT YOU DISCUSSED IN YOUR
PRIOR PRESENTATION IS
INFORMATIVE AND I CAN THINK OF
THE CONVERSATIONS WE'VE BEEN
HAVING IN SUBCOMMITTEE 1 WHERE
NOW WE'LL SEE THE PRESENTATION
OF THOSE DATA SHOWING WHAT
DIETARY PATTERNS ARE RELATED TO
VARIOUS OUTCOMES AND BECAUSE OF
CRPA AND THE TEAMS' ELEGANT
EXPOSÉ ON THOSE DATA, WE CAN
ACTUALLY SEE WHAT FOODS AND FOOD
GROUPS ARE DRIVING THOSE
PATTERNS AND THE SUBCOMMITTEE
HAS DONE THE WORK OF CALLING OUT
SOME OF THOSE THINGS.
WHAT HAS OCCURRED TO ME IN OUR
DELIBERATIONS IS WE COULD HAVE
SOME DIFFICULTIES WITH MEETING
THE RDA FOR CERTAIN NUTRIENTS.
PARTICULARLY CALCIUM AND WHAT
BECAME OBVIOUS WHEN YOU SHOWED
THAT MODIFICATION OF WHAT
HAPPENS WHEN YOU ARE MOVE DAIRY
FOR EXAMPLE, TO THE RDA FOR
CALCIUM, IT CLICKED.
MAYBE IT'S TIME TO HAND THOSE
DATA OVER TO THE FOOD PATTERN
MODELLING GROUPS SO THAT THE
MODIFICATIONS ARE DRIVEN BY THE
CONTEMPORARY LITERATURE AND HAVE
A CONCERN ABOUT PROTEIN FOODS
DRIVEN BY PEOPLE WHO CONSUME A
LOT OF MEAT AND RIGHT NOW THE
LITERATURE IS SUGGESTING AS
YOU'LL SEE IN THE LATER
PRESENTATIONS IT DOESN'T HAVE TO
BE THAT WAY FOR HEALTH OUTCOMES.
YET WHEN IT COMES TO WHERE THE
RDAs ARE AND HOW PEOPLE GET
THERE YOU MAY WANT TO USE IT TO
INFORM HOW THE MODIFICATIONS GO.
>> TWO COMMENTS TO THAT.
ONE, WITH THE REPRESENTATIVE
FOODS THAT ARE USED FOR THE FOOD
PATTERN MODELLING IT DOES
ADDRESS SO IF WE'RE TALKING
ABOUT SAY ANIMAL PROTEIN FOODS
FROM YOUR EXAMPLE THEY MAY BE HY
IN SATURATED FAT AND THE
REPRESENTATIVE FOOD MAY HELP
ADDRESS THE AMOUNT OF SATURATED
FAT IN TERMS OF MODELLING THE
PATTERN.
I THINK WHAT IS ALSO STRIKINGLY
DIFFERENT BETWEEN DOING THE FOOD
PATTERN MODELLING WHICH IS
TAKING THE PROFILE AND PUTTING
IT OUT INTO WHAT THE
RECOMMENDATIONS ARE FOR THE
AMOUNTS YOU CAN HOLD ON THE
CALCIUM THOUGHT BECAUSE THOSE
NUTRIENTS ARE COMING SOON.
THREES -- THERE'S INTAKES THAT
SAY IT'S BELOW CONSUMPTION BUT
DOESN'T ALIGN WITH THE DIETARY
GUIDELINES.
IN THIS CASE YOU'RE TAKING THE
PATTERN AND SAYING IF YOU
CONSUME THE DIETARY GUIDELINES
PATTERN WITH NUTRIENT-DENSE
FOODS LOWER IN SATURATED FAT AND
ADDED SUGARS AND REPRESENTATIVE
FOODS NOW WE CAN QUANTIFY THE
NUTRITIONAL IMPLICATIONS.
SO IT GOES BEYOND THE WELL, IF
YOU HAVE MORE -- IT'S A
QUANTITATIVE, IF YOU REMOVE THIS
THESE ARE THE TRADITIONAL
IMPLICATIONS.
WE HAVE THE QUANTITATIVE DATA TO
SAY THESE ARE ALSO GOING TO BE
BASED ON ESTIMATES BUT AT THE
SAME TIME IT'S STILL MEETING
PEOPLE WHERE THEY ARE BECAUSE
THE NUTRIENT PROFILE IS BASED ON
THE CONSUMPTION OF FOODS WITHIN
THAT VEGETABLES AND FRUITS AND
DAIRY AND FORTIFIED SOY.
SO IT'S NOT TAKING QUOTE,
UNQUOTE, ALL THE OPTIONS WITHIN
EACH BUT LOOKING AT THE
CONSUMPTION CURRENTLY, PUT THAT
IN THE REP FOOD THAT MAKES IT
THE MOST NUTRIENT-DENSE AND THEN
CREATING THAT AND TESTING THE
PATTERN OUT WHICH GETS OUT OF
THE WELL, IF YOU AREN'T
FOLLOWING THE DATE RY -- DIETA
GUIDELINES AND DO A LITTLE BIT
BETTER IN THE EVIDENCE VERSUS
HOW DOES THE PATTERN MEET THE
NUTRIENT GOALS AS THE PATTERNS
UP FOR THOSE.
>> ANY ISSUE IS WITH THE RDA BUT
THE RDA FOR FEMALES STARTED AT
14 WHICH MUST BE CORRELATING
WITH THE ONSET OF MENSES WHICH
HAS SHIFTED FORWARD AND THIS
DATA HAS BEEN SHOWN FOR 15 YEARS
I DON'T KNOW IF YOU HAVE SHOWN
THE AGE OF MENSES FOR THOSE OF
RACIAL AND ETHNIC MINORITIES
HAVE SHIFTED SIGNIFICANTLY
FORWARD FOR OVER 15 PLUS YEARS
AROUND TAKING THAT INTO
CONSIDERATION WHEN LOOKING AT
THIS PARTICULAR DATA EVEN FOR
THOSE WHO ARE NOT OF
NON-HISPANIC WHITES AND OTHER
MINORITIES SHOWS A SHIFT IN
MENARCHE IN THE U.S. TODAY AND
WANT TO BRING THAT UP FOR
CONSIDERATION.
>> THERE'S LOTS OF EXAMPLES IN
TERMS OF THE EVIDENCE THAT'S
EVOLVED SINCE THE DEVELOPMENT OF
THE DRIs.
AND SOME THINGS WE'VE BEEN
HEARING OF OTHER THINGS
HAPPENING ARE UPDATES WITHIN THE
DRI AND THE UPDATE OF THE EER
WAS USED IN THE UPDATES OF WHAT
IS USED FOR ENERGY AND
CALCULATING THE ENERGY LEVELS
FOR THE AGE SEX GROUPS AND AS
THE ERIs HAVE EVOLVED, WE'RE
ABLE CARRY THAT FORWARD BUT
RIGHT NOW WE HAD THE ESTABLISHED
RDA WITHIN THAT.
WE CAN CONSIDER THAT WHEN WE GET
TO SYNTHESIS AND HOW IT MIGHT
IMPACT YOUNGER AGE GROUPS WHEN
THAT MAY BE AT EARLIER ONSET OF
MENARCHE THAT MAY HAVE
IMPLICATIONS.
>> FOODS FORTIFIED OR ENRICHED
IN TERMS OF THE CONTRIBUTIONS OF
THE NUTRIENTS.
>> SO, ALL THE DATA WILL BE
BASED ON FNDDS AND THE SR DATA
CODES BEHIND THAT WHICH WILL --
ET CREATES OUR WEST POINT
ESTIMATE FOR THE VALUE AND WE
HAVE TO REMEMBER ITEMS WITHIN FN
DS ARE A REPRESENTATION OF THE
FOOD SUPPLY AS WELL.
THERE'S ALSO A RANGE OF ERROR
AROUND WHAT A SINGLE FOOD CODE
DOES TO REPRESENT A COLLECTION
OF FOODS.
SO AND WHERE A VEGETABLE IS
GROWN AND THERE'S VARIATIONS
WITHIN FORTIFICATION AND
DIFFERENT PRODUCTS AND HOW WELL
OR BASICALLY WE'RE TRYING TO GET
A POINT ESTIMATE AT A
POPULATION-BASED ON SOME VERY
HIGHLY VARIABLE ITEMS AND HAVE
TO FIRST QUARTER THAT IN WITHIN
THE GRAND SCHEME DON'T KNOW
ABOUT THE DATA OF CEREALS AND
THERE'S FOOD CODES WITHIN THAT
AND IT WILL BE BASED ON THE
ABILITY TO CAPTURE THAT
INFORMATION AND QUANTIFY IT INTO
A FOOD CODE.
>> IT CAN YOU COMMENT ON THE SUB
GROUP FOR VEGETABLES AND
PARTICULARLY THE BEANS, PEAS,
LENTILS AND THEIR BELONGINGS?
>> IF YOU HAVE THAT QUESTION
YOU'LL LOVE WHAT WE HAVE COMING
FORWARD.
>> I'M GOING TO HOLD ON THAT
BECAUSE I BELIEVE THAT'S
SAMEERA, SORRY.
DON'T WORRY.
LET'S JUST SAY THERE'S A LOT OF
PROTOCOLS, A LOT OF DATA AND A
LOT OF MOVING PARTS AND MY
APOLOGIES, SAMEERA, FOR GIVING
YOU A HEART ATTACK.
SOMEONE ELSE WILL DO THAT PART.
>> IN LOOKING AT INADEQUACY WHEN
YOU REMOVE DIFFERENT CATEGORIES,
HAVE YOU THOUGHT ABOUT AND AGAIN
IT MAY BE HARD TO ESTIMATE BUT
THE IDEA OF EXCESSES.
I GUESS I'M CURIOUS ON IF
THERE'S LOOKING AT CHANGES IN
INADEQUACY BUT ESSENTIALLY YOU
WOULD THINK IF ONE IF THERE IS
SOMETHING TAKEN AWAY THERE IS
SOMETHING IN EXCESS AND THAT IT
MIGHT DRIVE THE NUTRIENTS OVER
VERSUS UNDER.
THE SECOND QUESTION AND I THINK
WE TALKED ABOUT THIS BEFORE, BUT
THESE ARE INDIVIDUAL GUIDELINES
WITH POPULATION HEALTH
IMPLICATIONS.
AND I KNOW YOU'RE NOT
CALCULATING THE PERCENTAGE OF
INADEQUACY FROM A POPULATION
STANDPOINT OR IN A SENSE IT'S AN
INDIVIDUAL BUT I WAS CURIOUS ON
AND THINKING ABOUT BOTH OF THESE
INADEQUACY COMPARED TO EXCESS.
HOW IS THAT BEING CONSIDERED
SORT OF ACROSS THE BOARD?
>> THE ONE ANSWER TO THAT IS
SYNTHESIS.
AS WE LOOK AT EACH ONE AND WE
MAKE CONCLUSIONS BASED ON EACH
OF OUR PROTOCOLS, WE'RE LOOKING
AT WHAT HAPPENS WING THE
NUTRIENTS WITHIN THEM AND IF WE
MAKE A CHANGE ARE WE CREATING A
GAP?
SOME START WELL ABOVE THE RDA,
TWO TO THREE TIMES THE RDA AND
IF WE TAKE EXPECT IT MAY GO FROM
50% TO 248%, AND WE THINK GREAT.
BUT IF WE TAKE IT AWAY AND
CREATE A NUTRIENT GAP IN
SOMETHING AS AN UNINTENDED
CONSEQUENCE, PART OF WHAT WE
HAVE TO DO IS SAY FOUR ADULTS
MAGNESIUM IS SENSITIVE AND IF
YOU REMOVE CERTAIN THINGS
MAGNESIUM BECOMES A CHALLENGE
AND HERE'S A FOOD GROUP HAS
MAGNESIUM AND IF WE MOVE THE
LEVERS WE'RE ABLE TO LOOK AT HOW
THE PATTERN MIGHT -- BECAUSE IT
MIGHT BE I THINK GAIN SOMETHING
THAT WE STRUGGLE WITH HERE BUT
I'M GOING TO LOSE A LITTLE BIT
HERE BUT IF I'M GOING TO LOSE A
LITTLE BIT HERE I CAN GET THAT
HERE.
AND THIS PLAYS WITH THIS
MODIFICATION OR AWARD --
SELLECTION AND HOW DO WE USE TO
TO MEET AS MANY NUTRIENTS AS
POSSIBLE.
-- SELECTION OR HOW DO WE MEET
THAT NUTRIENTS AND IT'S NOT LIKE
ZERO VEGETABLES.
>> WE TESTED IT SO WE KNOW WHAT
THE IMPLICATIONS ARE WITHIN
BECAUSE THERE'S COMMENTS THAT
HAVE BEEN FROM THIS GROUP OR
THIS GROUP AND WE'RE ABLE TO
LOOK AT THAT FROM A NUTRIENT
STANDPOINT TO SAY SO WE'RE ABLE
TO BUILD A PATTERN AND SAY WE
NEED TO MEET THESE NUTRIENT
GOALS AND THESE FOOD GROUPS WILL
CONTRIBUTE TO THAT BUT IT ALSO
HELPS US SEE HOW MUCH IN WE WERE
TO SEE A MODIFICATION, A
REDUCTION, HOW MUCH OF A
REDUCTION IN A FOOD GROUP BEFORE
YOU SEE A NUTRIENT GAP.
>> AND ANGELA TO YOUR QUESTION
ABOUT EXCEEDING, WE LOOKED AT
THAT AND AS YOU MAY GUESS WITH
SODIUM IS WHERE WE RUN INTO THAT
A LOT IN THE PATTERN.
>> CHRISTOPHER, CAN THIS BEING
THE LAST QUESTION AND WE WANT TO
HEAR YOUR VOICE BUT WONDERING IF
EVERYONE CAN HOLD THEIR
QUESTIONS BECAUSE WE HAVE A LOT
OF SLIDES TO GO THROUGH.
>> MY HEAD IS EXPLODING WITH ALL
THE POSSIBILITIES.
PART OF THE LAST SEGMENT THE
POSSIBILITY OF LOOKING FOR
ANOTHER HEALTHY DIETARY PATTERN
IS THAT WHAT YOU SAID BEYOND THE
VEGETARIAN AND MEDITERRANEAN AND
U.S.
>> ONE OF THE THREE POTENTIAL
MODELLING OUTCOME FROM FOOD
PATTERNING ANALYSES.
>> IT SEEMS LIKE YOU COULD
DISCOURAGE THAT.
I THINK THE THREE WE HAVE
OVERLAP TREMENDOUSLY.
I DON'T KNOW HOW MANY HEARD OF
THE ATLANTIC DIET THE HOT NEW
THING SIMILAR TO THOSE THREE.
I'M STRUCK BY WE HAVE AN
ACCEPTABLE MACRO NUTRIENT RANGE
AND VEGAN AND KETO ARE CLEARLY
OUTSIDE THOSE.
IF YOU WERE GOING TO PICK THAT
MAYBE YOU CAN GO IMMEDIATELY TO
A POPULAR CONTROVERSIAL DIETS
LIKE THAT AND IF YOU DID, I
ASSUME YOU'D STILL GO AFTER A
HEALTHY VEGAN AND KETO DIET
BECAUSE THERE'S HEALTHY WAYS TO
FOLLOW THOSE PATTERNS.
HOW DO YOU GET A GROUP OF PEOPLE
TO SAY HERE'S THE BEST VEGAN AND
BEST KETO AND HOW'S IT WORK?
>> PLEASE HOLD UNTIL THE
PROTOCOL --
>> STARK QUESTION.
>> I CAN SEE THE BEANS, PEAS AND
LENTILS EXPLODING OUT OF HIS
HEAD AS HE GETS EXCITED.
OKAY.
SO, AGAIN WE'RE LEVEL SETTING
AROUND THE QUESTIONS AND WORK
OUR WAY THROUGH THE DIFFERENT
FOOD GROUPS.
WE'RE GOING TO START WITH FRUIT
AND I'M GOING IT PASS IT OVER TO
CAROL.
>> FOR FRUITS WE USED FOOD
PATTERN ANALYSIS TO EXAMINE THE
IMPLICATIONS MUCH REDUCING THE
RECOMMENDED QUANTITY OF FRUIT IN
THE U.S. HEALTHY DIET PATTERN AS
WELL AS MODIFYING THE
RECOMMENDED RATIO OF WHOLE FRUIT
TO 100% FRUIT JUICE.
FOOD PATTERN MODELS RESULTS
SUPPORT THE QUANTITIES OF FOODS
AND NO MODIFICATION IN THE FOOD
GROUP IN THE DIETARY
U.S. PATTERN ARE PROPOSED.
THE NEXT SLIDE SUMMARIZES THE
EVIDENCE AND CONSIDERATIONS FOR
THE FRUIT SYNTHESIS STATEMENT.
IN REDUCE THE FOOD GROUP DOWN TO
ZERO AND SEVERAL IMPLICATIONS
WERE NOTED.
VITA
VITAMIN C, FIBER AND POTASSIUM
FELL BELOW AND OTHER NUTRIENTS
FELL FURTHER BELOW THE 50%
INCLUDING FOLATE AND CHOLINE.
FOOD PATTERN MODELS RESULTS DOES
NOT SUPPORT FOOD SUB GROUPS
BASED ON NUTRIENTS.
THE SUBCOMMITTEE EXPLORED
SPECIAL SUBGROUPS BASED ON TYPE
AND THEY SHOWED VARIABILITY
ACROSS THE FOOD TYPES AND NOT AN
A PATTERNIZATION OF FOOD TYPES
TESTED.
ANALYSIS LOOKED AT VARYING
PROPORTIONS OF WHOLE FRUITS AND
FRUIT JUICE AND THE MODIFICATION
TO INCLUDE MORE OR ALL WHOLE
FRUITS VERSUS LESS OR NO 100%
FRUIT JUICE RESULTS SHOWED
HIGHER FIBER BUT THE
RECOMMENDATIONS TO MAKE HALF
YOUR FRUIT WHOLE SUPPORTS SHOW
NO NEGATIVE NUTRIENT
IMPLICATIONS WERE NOTED AT THOSE
LEVELS AND SINCE THERE WERE NO
RDAs OR DRIs FOR PHYTO NUTRIENTS
IT DID NOT INCLUDE THOSE VALUES
BUT THE SUBCOMMITTEE DISCUSSED
THE POTENTIAL AS A FUTURE
DIRECTION.
WITH THAT OVER TO SARAH.
IT DID NOT INCLUDE THO
>> THIS FOOD PATTERN MODELLING
EXAMINED THE IMPLICATIONS FOR
MODIFYING QUANTITIES AND
PROPORTIONS OF THE VEGETABLE
FOOD GROUP AND THE SUBGROUPS.
TO THAT RECOMMENDED IN THE
HEALTH PATTERNS.
WE LOOKED AT QUANTITIES OF THE
TOTAL VEGETABLE FOOD GROUP
MODIFIED FROM A RANGE OF TO
ANSWER YOUR QUESTION, ZERO.
TO THE CURRENT QUANTITIES
RECOMMENDED IN THE HEALTHY
U.S. STYLE DIETARY PATTERN
RANGING FROM ONE HALF TO FOUR
CUPS EQUIVALENT PER DAY.
WE ALSO LOOKED AT SUBGROUPS
MODIFIED WITHIN THE RECOMMENDED
TOTAL AMOUNT.
NEXT SLIDE.
SO SIMILAR TO THAT OF THE
FRUITS, THE CONCLUSION WAS THERE
WAS NO POTENTIAL MODIFICATIONS
TO THE HEALTHY DIETARY PATTERN
BECAUSE THE FOOD PATTERN
MODELLING RESULTS SUPPORTED THE
EXISTING QUANTITIES OF TOTAL
VEGETABLES IN THE OVER ALL
SYNTHESIS THAT INTEGRATES THE
FOOD GROUPS IN A HEALTHY DIETARY
PATTERN.
WE HAD SUPPORT WILL EVIDENT AND
COMMENTS TO THAT -- EVIDENCE AND
COMMENTS IN THE NEXT SLIDE.
IN CHRIS'S EARLIER STATEMENT
ABOUT VEGETABLES, VEGETABLES
CONTRIBUTE MORE THAN 15% OF
MULTIPLE NUTRIENTS TO THE
HEALTHY U.S. STYLE DIETARY
PATTERN.
WHEN REDUCE TOTAL VEGETABLES OR
REMOVE THEM FROM THE DIETARY
PATTERN THERE'S NEGATIVE
NUTRIENT IMPLICATIONS.
WITHIN SOME AGE SEX GROUPS THE
NEGATIVE NUTRIENT IMPLICATIONS
WERE NOTED EVEN WITH SMALL
REDUCTIONS LIKE .5 CUP
EQUIVALENT REDUCTION PER DAY.
AND THE PRIMARY NUTRIENTS ARE
LISTED HERE INCLUDING FIBER AND
VIT VITAMIN A SHOWED IN THE BAR
GRAPHS.
WE FOUND THERE WERE CERTAIN AGE
GROUPS AND THERE WERE VERY
NEGATIVE NUTRIENT IMPLICATIONS
NOTED HENCE THE CONCLUSION WE
WOULD NOT REMOVE TOTAL
VEGETABLES FROM THE HEALTHY
U.S. STYLE DIETARY PATTERN.
I'M STILL THINKING ABOUT THE
SLIDES.
AND THE NEXT LOOKED AT DARK
GREEN VEGETABLE AND LENTILS AND
THE SYNTHESIS THAT INTEGRATES
THIS FOOD GROUP IN A HEALTHY
DIETARY INTAKE.
WE NOTED THAT WHEN YOU REDUCE
THE BEANS, PEAS AND LENTILS SUB
GROUP OR REMOVE THEM TOTALLY,
THE FIBER FELL BELOW 90% OF THE
GOAL FOR MOST AGE SEX GROUPS AND
THE MAGNITUDE OF DECLINE OF
SEVERAL ADDITIONAL NUTRIENTS
ACROSS LIFE STAGES WERE ALSO OF
CONCERN FOR EXAMPLE, FOLATE
DURING PREGNANCY.
IN THE SPIRIT OF FULL DISCLOSURE
WE DID REVIEWS OF DIFFERENT
NUTRIENTS AND THEY'RE AVAILABLE.
WE HAVE TOO REMEMBER AND THIS
WAS DISCUSSED EARLIER WHEN QUE
DO THIS, THERE'S LARGE VARIABLE
ACROSS THE NUTRIENTS ACROSS
VEGETABLES.
SO THE OVER ALL GIST IS THERE
ARE DECLINES.
WHEN WE REMOVE THE DARK GREEN
VEGETABLE SUB GROUP FROM THE
DIETARY PATTERN FIBER FELL BELOW
THE GOAL FOR SEVERAL SEX GROUPS.
I DON'T THINK WE APPRECIATED
IT'S .5 CUPS PER WEEK AND I
THINK YOU POINTED THAT OUT,
CHRIS, THAT IT'S NOT PER DAY.
IT'S PER GROUP.
SO THIS GROUP HAS FLEXIBILITY
FOR BEING ADDED.
IF YOU HAD EACH OF THE TOTAL
AMOUNT AND EVERY GROUP WAS
EQUAL, WHEN THE PEAS, BEANS AND
LENTILS AND THE DARK GREENS WERE
POSITIVE NUTRIENT IMPLICATIONS
AND IN THAT CONTEXT THE RED AND
ORANGE STARCHY VEGETABLES WOULD
DECREASE.
AND WE ALSO NOTICED WHEN YOU
MADE ALL THE VEGETABLES COME TO
ONE VEGETABLE SUBGROUP IF THEY
ALL CAME FROM BEANS, PEAS AND
LENTILS YOU COULDN'T ACHIEVE
YOUR VITAMIN A OR IF YOU ONLY
ATE ONE SPECIFIC THING THE FIBER
COULDN'T BE ACHIEVED AND
SUPPORTS FURTHER ANALYSIS TO
DETERMINE THE OPTIMUM QUANTITIES
WITHIN THE TOTAL AMOUNT.
I DO BELIEVE THE NEXT GROUP IS
THERESA TO TALK ABOUT THE BEANS,
PEAS AND LENTILS.
>> SO THE TWO MAJOR QUESTIONS
THAT WE ARE GOING TO ANSWER
WITHIN THE GRAINS GROUP IS WHAT
ARE THE IMPLICATIONS WHEN THE
QUANTITIES CHANGE IN THE HEALTHY
U.S. DIETARY PATTERN AND THE
SECOND QUESTION IS WHAT IS THE
DIFFERENT GROUPS OF GRAINS BEING
REPLACED BY EACH OTHER.
IT'S GOING TO TO BE GRAINS
REPLACED WITH BEANS, PEAS AND
LENTILS OR GRAINS REPLACED WITH
OTHER VEGETABLES.
THOSE ARE THE MAIN TWO QUESTIONS
THE PARTICULAR SECTION IS GOING
TO SHOW NUTRIENT CHANGES.
THE RESULTS FOUND IT PROVIDES
EXPLORING THE MODIFICATION THAT
REDUCED TOTAL GRAINS.
WHEN WE FEED THESE INFORMATION
INTO THE MIXED STAGE OF
SYNTHESIS WHERE THE CHANGES OF
VEGETABLES AND GRAINS CHANGES
AND COMING UP IN DAIRY AND OTHER
CHANGES AND DOES SUPPORT MAYBE A
CHANGE IN QUANTITY MIGHT WORK.
IN TERMS OF TOTAL QUANTITIES
CHANGE AND THE GOALS CAN BE
ACHIEVED IF THE REDUCTION IS UP
TO ABOUT ONE OUNCE EQUIVALENT IN
TOTAL GRAIN WHILE THE REMAINING
GRAINS STILL THERE IS STILL 50%
OF WHOLE GRAINS.
HOWEVER, IF THE REDUCTION IS
EXCEEDING THAT AMOUNT TO ONE AND
A HALF OUNCE EQUIVALENTS THEN
THERE'S IMPLICATIONS OF FIBER
AND MAGNESIUM BUT THERE'S ALSO
POSSIBLE IMPLICATIONS AND A
MAJORITY SHOWS QUANTITIES BELOW
THE MAXIMUM OF RECOMMENDATIONS
WHEN GRAINS ARE THE A THIS
CURRENT LEVEL BUT IN SOME CASES
MEANING SOME EXPERTS THE SODIUM
LEVEL MIGHT EXCEED THAT.
THAT'S ONE ONCE REDUCTION OF THE
TOTAL GRAINS.
FOR CERTAIN AGE GROUPS AGE 14 TO
50 AND THOSE PREGNANT, THEN THE
REDUCTION HAVE SOME NEGATIVE
IMPLICATIONS.
SO IRON CAN DROP IN BELOW THE
90% OF THE RD LEVEL AND ALSO
FOLATE DOESN'T ACHIEVE THE
LEVELS FOR THE OTHER PREGNANT
WOMEN.
IT IS BECAUSE FOLATE IS
FORTIFIED IN GRAINS.
THAT'S EFFECTED.
ALL RIGHT.
SO THE SECOND THING IS IN
FLEXIBILITY.
IF WE INCREASE BEANS, PEAS AND
LENTILS AND TOTAL GRAINS WHAT
HAPPENS TO THE NUTRIENT PROFILE
OF THE MELT THE U.S. DIETARY
PATTERNS?
AND IN THIS CASE IT IS THE ONE
IS INCREASED THEMES IS BECAUSE
EARLIER THE BEANS, PEAS AND
LENTILS ARE IN THE VEGETABLE
GROUP AND WE'RE NOT IN THIS
PARTICULAR MODELLING IT IS NOT
TAKING AWAY FROM THE VEGETABLE
GROUPS.
IT'S THAT RECOMMENDATION TO STAY
THERE AND WE ARE INCREASING THE
BEANS, ADDING MORE BEANS IN THE
TOTAL GRAINS GROUP AND WHILE
TAKING AWAY SOME OF THE WHOLE
GRAINS.
ALL RIGHT.
WHEN WE HAVE MORE BEANS, LESS
GRAINS AND TOTAL GRAINS ARE
REDUCED BY ONE OUNCE A WEEK AND
BEANS, PEAS AND LENTILS
INCREASED BY HALF A CUP OF WEEK,
VERY SMALL AMOUNTS AND FOR MOST
AGE AND SEX GROUPS THE MODEL
RESULTS SHOWS THERE'S POSITIVE
IMPLICATIONS FOR CHOLINE AND
POTASSIUM FOR AGE 1 AND OLDER.
WE'RE NOW REDUCING GRAINS AND
LESS THAN HALF A COUPLE AND
INCREASING BEANS AND PEAS AND
THE FIBER ARE ALREADY ABOUT 90%
OF THE RDA BUT BY INCREASING
MORE GRAINS AND -- INCREASING
BEANS AND PEAS AND LENTILS AND
GRAINS THE LEVEL GOES UP A
LITTLE BIT MORE.
WHEN IT COMES TO CHOLINE AND
FRUITS AND VEGETABLES IN GENERAL
AND BEANS, PEAS AND LENTILS WILL
BE NEEDED TO UP THE CHOLINE
CONTRIBUTION OF THE HEALTHY
U.S. PATTERN TO ABOUT 90% OF THE
ADEQUATE INTAKE.
IRON IS REDUCED WHEN FORTIFIED
WITH IRON AND SUBSTITUTION TO
THE WHOLE GRAIN IS THE IRON
IMPLICATION WHEN THE RESULTS
FEED INTO THE MIXTURE OF WHEN
THE 10,000 LEVERS ARE BEING
MOVED AROUND.
SO THE NEXT STATEMENT IS ABOUT
REDUCING TOTAL GRAINS AND THE
SAME TIME INCREASING THE STARCHY
VEGETABLES.
SO THAT IS A FLEXIBILITY.
A TOTAL QUANTITY IS NOT BEING
CHANGED BUT SWAPPED OUT.
QUICK THAT MORE STARCHY
VEGETABLES AN GRAINS AND ONE
OUNCE REDUCTION OF THE TOTAL
GRAINS BE IT WHOLE GRAINS OR
REFINED GRAINS INCREASED BY HALF
A CUP OF STARCHY VEGETABLES PER
WEEK.
TINY AMOUNTS OF CHANGES.
AS THE NOT MUCH NUTRIENT
IMPLICATIONS FOR NUTRIENT GOALS.
POSSIBLE AND YOU CAN HAVE MORE
STARCHY AND ORANGE VEGETABLES BY
HALF CUP EQUIVALENT PER WEEK.
IT INCREASES VITAMIN A
COMPOSITION IN THE PATTERN FOR
OLDER MALES, 51 TO 70 AND ONE
CUP INCREASES FOR RDA 4 IS MET
FOR DURING LACTATION.
HOWEVER, AGAIN BECAUSE BRAINS
ARE FORTIFIED WITH IRON AND
FOLATE AND YOU REDUCED GRAINS
EVEN IF THE VITAMIN A IS
INCREASED BECAUSE OF THE STARCHY
VEGETABLES THERE'S IMPLICATIONS
FOR LOWER LEVELS OF IRON AND
FOLATE IN THE TEST COMPOSITION
FOR THAT.
THAT'S THE END OF GRAINS.
AND BEANS, PEAS AND LENTILS
WON'T SHOW UP AGAIN.
WHAT ARE YOU TRYING TO DO IN
HERE.
THESE ARE THE TWO PATTERNS OR
QUESTIONS.
FIRST, WHAT HAPPENS IF WE CHANGE
THE QUANTITY TO THE NUTRIENT
PROFILE AND WHAT IF WE START
SUBBING THINGS OUT.
EXPLORE MODIFICATION OF THE
HEALTHY U.S. PATTERN.
THAT REDUCED TOTAL PROTEIN FOODS
IN THAT PATTERN.
THE MODELS FOUND MEAT, POULTRY
EGGS CAN BE REDUCED BY FOUR
OUNCES EQUIVALENTS OR MORE PER
WEEK IS NOT DRASTIC BUT MOST THE
NUTRIENTS ARE OKAY BUT FOR SOME
AGE AND SEX GROUP, POTASSIUM,
MAGNESIUM AND ZINC MAY FALL PLOE
THE GOAL AND THIS IS ABOUT THE
U.S. HEALTHY PATTERNS OF GROUPS
IN WHICH THE PROTEINS AND BEANS,
PEAS AND LENTILS GENERATE THE
PATTERN.
AND BEANS, POULTRY AND FISH AND
WE'RE IN THE SWAPPING THINGS
HERE.
BY DECREASING THAT ANY REDUCTION
IS GOING TO REDUCE CHOLINE
FOLATE AND MAGNESIUM.
MOST OF THEM WASN'T EVEN AT THE
REGULAR PATTERN.
THEY WERE NOT AT NUTRIENT GOALS
ANYWAY THE FOOD PATTERN
MODELLING RESULTS WERE
SUPPORTIVE OF FLEXIBILITY THAT
INCREASES BEANS, PEAS AND
LENTILS AND SOY PRODUCTS
REDUCING MEAT, POULTRY AND EGGS
AND THIS IS WHAT IS GOING TO SEE
IN TERMS OF THE NUTRIENT PROFILE
CHANGE.
WITH HIGHER BEANS, PEAS LEN TELL
US AND LESS MEAT, PROTEINS AN
EGGS THERE'S SOME NUTRIENT
INCREASES FOR THE 12 THROUGH 23
MONTHS HIGH FIBER AND HIGH
VITAMIN E AND FOLATE AND CHOLINE
AND CALCIUM AND POE TRAS YUM AND
SODIUM AND FOR YEARS AND OLDER
HIGHER FIBER, VITAMIN E AND
FOLATE AND MAGNESIUM AND
REDUCTION IN VITAMIN D AND
CHOLINE FOR 2 YEARS AND HIGHER
AND LESS MEAT, POULTRY AND EGGS
THE IRON PROFILE COMES MORE FROM
THE NON-HEME IRON AND THEREFORE
THE ABSORPTION BECOMES AN ISSUE
AND THAT NEEDS TO BE CONSIDERED
WHEN IT COMES TO THE FINAL
SYNTHESIS.
AND WE SWAP WITH BEANS, PEAS AND
THE FINAL SECTION IS ABOUT THE
HEALTHY VEGETARIAN SO FAR I'VE
TALKED ABOUT THE HEALTHY
U.S. PATTERN.
THIS IS WHEN THEY HAVE EXTRA
SEAFOOD ADDED WHAT WILL CHANGE
TO THE NUTRIENT PROFILE.
LET'S TAKE A LOOK AT THE
RESULTS.
SEAFOOD GIVEN SOME SEAFOOD ARE
HIGH IN VITAMIN D WE CAN SEE
THAT AS AN IMPLICATIONS FOR
SAGE SEX GROUPS AND LOOKING AT
THE NUTRIENT GOALS FOR AGE 2 AND
ABOVE.
WHEN PLANT-BASED PROTEINS ARE
DECREASED AND REPLACED FOR
YOUNGER AGE 12 TO 23 MONTHS.
SO I THINK THIS IS DEPENDING ON
THE PROTEIN SOURCE.
>> TERESA, YOU ARE ONE HARD ACT
TO FOL SCRO.
FOLLOW.
OKAY.
SO I AM GOING TO TALK ABOUT THE
DAIRY FORTIFIED SOY ALTERNATIVES
AND HOPEFULLY CHERYL THIS WILL
BE ADDRESSING SOME OF YOUR
QUESTIONS.
AROUND I'M LOOKING TO INTERACT
WHEN I MAKE A MISTAKE.
THESE FOOD PATTERN ANALYSES
EXAMINE THE HYPOTHETICAL
MODIFICATIONS AND IMPLICATIONS
FOR MEETING THE NUTRIENT GOALS
USING THE HEALTHY U.S. STYLE
DIETARY PATTERN WHEN WE MODIFIED
THE QUANTITIES OF THE DAIRY AND
FORTIFIED SOY ALTERNATIVE FOOD
GROUPS AS RECOMMENDED IN THE
HEALTHY STYLE U.S. DIETARY
PATTERN AND LOOKED AT WHAT
HAPPENS WHEN THE FOODS WITHIN
THE FOOD GROUPS ARE REPLACED
WITH NON-DAIRY ALTERNATIVES.
THE RESULTS PROVIDE SUPPORT TO
FURTHER EXPLORE A MODIFICATION
IN WHICH DAIRY AND FORTIFIED SOY
ALTERNATIVES ARE DECREASED.
AS PART OF THIS PROPOSED
MODIFICATION AND OTHER ANALYSIS
RELATED TO FOOD LOWER IN DENSITY
THAT CHRIS DESCRIBED EARLIER IN
HIS PRESENTATION, THE COMMITTEE
IS GOING TO CONTINUE TO EXPLORE
FLEXIBILITIES WHICH WE TALKED
ABOUT OPTIONS FOR MEETING
NUTRIENT NEED OUTSIDE OF
QUANTITATIVE PATTERN
RECOMMENDATIONS.
YOU CAN TELL THAT I STRUGGLED
WITH THESE DEFINITIONS WHICH IS
WHY I HAVE TO REPEAT, MY
APOLOGIES.
WE'LL CONTINUE TO EXPLORE
FLEXIBILITIES RELATED TO THE SUB
GROUPS FOR MILK, YOGURT AND
CHEESE AND THEIR CONTRIBUTIONS
TO SATURATED FAT AND SODIUM
DEPENDING ON THE RANGE OF FAT
LEVELS.
SO FOR EXAMPLE WE HAVE HAD A LOT
OF DISCUSSION IN THE GROUP THAT
OUR REPRESENTED FOOD FOR CHEESE
IS FAT FREE AND THERE'S BEEN
DISCUSSION WHO EATS FAT FREE
CHEESE.
LET'S LOOK AT WHAT WILL BE THE
IMPLICATIONS IF FOR EXAMPLE IT
WAS FULL FAT CHEESE, ETCETERA.
AND THIS MODIFICATION IS
PRESENTED HERE IS CONSIDERED
PART OF A COLLECTION OF PROPOSED
MODIFICATIONS THAT UNDERSTAND
THE IMPLICATIONS FOR MEETING
NUTRITIONAL NEEDS.
THE SUPPORTING EVIDENCE AND
CONSIDERATIONS, DEPENDING ON THE
AGE, SEX OR LIFE STAGE GROUP,
DAIRY AND FORTIFIED SOY CAN BE
REDUCED BY .25 TO 1.5 CUP
EQUIVALENTS BELOW THE
RECOMMENDATIONS DEPENDING ON THE
AGE SEX GROUP BEFORE YOU SEE
ADDITIONAL GAPS.
I WANT TO EMPHASIZE THE
ADDITIONAL.
THIS IS ABOVE AND BEYOND WHAT IS
NOT BEING MET.
SO WHAT WE MEAN BY THE NEW GAPS
IS WE KNOW THE EXISTING HEALTHY
U.S. STYLE DIETARY PATTERN DOES
NOT ACHIEVE GOALS FOR NUTRIENTS
FOUND IN DAIRY FORTIFIED SOY.
FOR EXAMPLE, VITAMINS D AND E
ARE BELOW THE RDA FOR ALL AGE
SEX GROUPS AND LIFE STAGES.
WE KNOW VITAMIN A IN THE CURRENT
DIETARY PATTERN FALLS BELOW THE
RDA FOR FEMALES WHO ARE
LACTATING.
WHEN WE TALK ABOUT DAIRY AND I
THINK CHERYL YOU RAISED IT, WE
OFTEN THINK OF THE CONTRIBUTION
TO CALCIUM AND A HEALTHY DIETARY
PATTERN AND WHEN YOU REDUCE
DAIRY AND FORTIFIED SOY THE
NUTRIENT THAT IS GOING TO BE
BELOW THE 90% IS CALCIUM FOR
CHILDREN AND ADOLESCENTS AND
FEMALES AND FOR MALES 30 TO 50
THE FIRST NUTRIENT YOU SEE
FALLING BELOW THE 90th
PERCENTILE WHEN REDUCE THE DAIRY
AND SOY IS MAGNESIUM AND FOR
OLDER IS VITAMIN A.
THERE'S NUANCES THE GROUP IS
WORKING WITH.
ACROSS ALL AGE SEX GROUPS
VITAMIN D FALLS BELOW THE
ALREADY LOW NUTRIENT GAP AS DOES
VITAMIN A.
ONE THING WE DID NOTE IS THERE'S
ALREADY A PRECEDENT FOR LOOKING
AT LOWER DAIRY AND FORTIFIED SOY
AND THE EXISTING MEDITERRANEAN
STYLE FOR AGES 2 YEARS AND OLDER
HAVE A QUANTITY OF DAIRY AND
FORTIFIED SOY GENERALLY LESS
THAN THE CURRENT HEALTHY
U.S.-STYLE PATTERN.
IT'S 2 TO 2.5 CUPS EQUIVALENT
COMPARED TO THE THREE-CUP
EQUIVALENT IN THE HEALTHY U.S.
THE FOOD PATTERN MODELLING
RESULTS PROVIDED SUPPORT FOR A
FLEXIBILITY WHERE PLANT-BASED
MILK ALTERNATIVES ARE
SUBSTITUTED FOR THE SOY FOOD
GROUPS.
THIS ADDRESSES YOUR QUESTION,
CHERYL.
SO BASED ON THE STRENGTH FOOD
COMPOSITION DATA AND THE
POPULARITY OF PRODUCTS THE
COMMITTEE DECIDED TO FOCUS ON XA
COMPARISON OF SKILL MANY MILK
AND NUTRIENT DENSE SOY, ALMOND
AND OAT MILK ALTERNATIVES.
WE RECOGNIZE THE DATA PRESENTED
HERE REFLECT EXISTING FOOD
COMPOSITION DATA THOR THESE
PRODUCTS BUT ALSO HAD A LOT OF
DISCUSSION AROUND THE FACT IT'S
A RAPIDLY EVOLVING FOOD MARKET
AND THE FOOD COMPOSITION DATA WE
HAVE TO RECOGNIZE IT MAY NOT YET
BE EXCEPT UP TO PACE WITH THE
ACTUAL FOOD MARKET.
THE TABLE HERE ILLUSTRATES SOME
SIMILARITIES AND DIFFERENCES
BETWEEN THE DAIRY MILK AND PLANT
BASED ALTERNATIVES.
THE PLANT-BASED ALTERNATIVES
HAVE SIMILAR OR HIGHER
QUANTITIES OF CALCIUM AND
VITAMIN D.
SO FOR EXAMPLE IF WE LOOK AT
ALMOND MILK COMPARED TO SOY MILK
AND ALMOND MILK STAND OUT FOR
MORE VITAMIN A AND VITAMIN D AND
OAT MILK FOR MORE FAT AND AND
ALMOND MILK AND OAT MILK
ALTERNATIVES HAVE ALMOST NO
PROTEIN, LESS MAGNESIUM AND THE
ALMOND MILK HAS LESS POTASSIUM.
THIS IS THE DATA AND WE NEED TO
HAVE TALK ABOUT THE BIO
AVAILABILITY AND CALCIUM AND FOS
FORUM AND PROTEIN FOR YOUNG
CHILDREN AND WITH THIS I'LL HAND
IT OVER TO STEVE.
>> THE COMPARISON IS MIXED IN
THAT WE'RE COMPARING FOR
FORTIFIED SOY MILK ONE
UNFORTIFIED ALMOND AND OAT MILK.
IN THE STORE OFTEN THEALTHE ALM
MILKS ARE NOT FORTIFIED.
SOMETIMES WE CAN OVER FOCUS ON
CALCIUM WHEN YOU'RE A CHILD YOU
NEED THIS FOR BONES AND IN SOME
POPULATIONS CAN HAVE EXCESS OF
PHOSPHORUS BUT YOU CAN RUN WELL
ON PHOSPHORUS INTAKE.
A SOURCE WITH AN ABNORMAL RATIO
OF PHOSPHORUS AND CALCIUM AN
ANDC -- AND THE CALCIUM AND M
MAG -- MAGNESIUM.
WE DON'T HAVE AS MUCH
INFORMATION ABOUT THE OTHERS BUT
I DO WANT TO POINT OUT SOMETIMES
WE GET OVERLY FOCUSSED ON THE
SINGLE NUTRIENT OF CALCIUM AND
FORGET BONES ARE A COMBINATION
OF CALCIUM, PHOSPHORUS,
MAGNESIUM AND ZINC AND WE HAVE
TO KEEP THAT IN MIND.
>> THANK YOU, STEVE.
I HAND IT BACK TO YOU.
>> I'VE BEEN TRYING TO ASK THIS
QUESTION FOR SOME TIME AND
THOUGHT IT WAS SILLY BUT STILL
GOING TO ASK.
WHEN YOU DO MODIFICATIONS AND
FOOD PATTERNING THAT ARE
COMPLICATED ARE YOU TAKING INTO
ACCOUNT TO THE DIFFERENCE IN THE
FOOD MATRIX?
IF THEY'RE COMING FROM CANNED OR
FROZEN FOODS OR FRESH?
THERE'S PROBABLY A LOT OF
VARIABILITY.
WHEN YOU ADDING AND REMOVING IN
MY MIND I'M NOT QUITE CLEAR.
ULTIMATELY IT'S TAKING ALL THE
REPRESENTATIONS TO THE
REPRESENTATIVE FOOD.
IT REPRESENTS THE MOST NUTRIENT
DENSE WITH THE SATURATED FAT AND
ADDED SUGAR.
SO IT IS GOING TO TAIC INTO
ACCOUNT ALL OF THOSE AND TRY TO
COMPILE THEM AS TO WITHIN
REFERENCE AND I HEARD A QUESTION
OF I NEED A FOOD CODE FOR
BROCCOLI WITHOUT SODIUM BECAUSE
THE RECIPE FOR BROCCOLI FOR THE
FOOD CODE THAT HAS SODIUM SO
THAT'S BEEN REMOVED FROM THAT.
SO IT'S GETTING DOWN TO THE
BROCCOLI OR TO THE CARROT.
SO IT ISN'T GOING TO BE A QUOTE,
UNQUOTE, CANNED CARROT VERSUS
FROZEN BUT GET DOWN TO THE RAW
CARROT IS THE REPRESENTATION.
>> THERE'S MORE VARIABILITY THEN
BECAUSE PEOPLE EAT FROZEN AND
CANNED AND PROBABLY ALL THE
NUTRIENT PROFILE IS VERY
DIFFERENT.
YOU'RE LOOKING AT THE BEST
SCENARIO, CORRECT?
OKAY.
EVEN WITH THAT BEST SCENARIO
WE'RE STILL BELOW THE GAP IN
SUBSTITUTING?
IMAGINE IF YOU'RE LOOKING AT THE
BEST SCENARIO OF WHAT IS FRESH
AND
>> AND PART OF IT GETS INTO THE
CONVERSATIONS WE'VE HAD AND I
MENTIONED BEFORE ABOUT WE'RE
ALREADY KIND OF HIGH ON THE
CALORIE LEVEL AND THIS IS THE
MOST IDEAL SITUATIONS.
THAT MAKING THE PATTERN HAVE
MORE FLEXIBILITY TO BE ABLE TO
CONSUME FOODS OUTSIDE THE
REPRESENTATIVE FOOD RANGE AND
STILL BE ABLE TO MEET THE
NUTRIENT GOALS.
IT'S TRYING TO OPTIMIZE AND
TIGHTEN THE PATTERN MORE THAT
OFFERS THE FLEXIBILITIES BEYOND
THE SINGLE REPRESENTATIVE FOOD
AND START TO CAPTURE THE BROADER
FOOD VARIABILITY.
>> I HAD A SIMILAR QUESTION AND
CAN'T REMEMBER BUT THE IN THE
SODIUM, I CAN'T REMEMBER WHICH
WAS THE TRADE-OFF FOR BEANS,
PEAS AND LENTILS.
I WAS WONDERING IF THERE WAS A
FORM OF CAN.
I'M TRYING TO REMIND WHAT IT WAS
A TRADE-OFF FOR IN MY NOTE.
PROTEIN FOODS.
LIKE, WHY WAS THERE AN INCREASE
IN WHEN YOU TRADED OFF THE
BEANS, PEAS AND LENTILS THE IN
SODIUM?
>> WAS THAT IN THE GRAINS -- IF
YOU ATE LESS GRAINS AND ATE MORE
BEANS, PEAS AND LENTILS THE
SODIUM WENT DOWN BECAUSE OF THE
UBIQUITOUS AMOUNT OF SODIUM.
>> NO, THE SODIUM WENT UP.
WHEN I TRADED OUT MORE BEANS,
PEAS AND LENTILS THERE WAS AN
INCREASE.
>> TERESA DO YOU REMEMBER IN
YOUR PRESENTATION WAS THERE A
SCENARIO WHERE YOU INCREASE
BEANS, PEAS AND LENTILS AND
SODIUM WENT UP?
>> I'M WONDERING WAS IT RELATED
TO CAN?
BUT IT'S NOT RELATED TO CAN.
>> IN.
THERE WERE SOME AND SODIUM
CREEPED UP IN SOME SCENARIOS BUT
NOT LIKE GOING FROM 100 TO 120.
IT WAS CREEPING UP ONLY A FEW
PERCENTAGE POINTS.
I REMEMBER FROM LOOKING AT THE
MASSIVE AMOUNT OF EXCEL SPREAD
SHEETS.
>> WHEN BEANS, PEAS OR LENTILS
NUTS AND SOY ARE INCREASED AND
THERE'S FOR 2 AND OLDER AND IT
CAN INCLUDE SODIUM OR INCREASED.
>> WE CAN LOOK INTO WHAT'S
DRIVING THAT AND THE MAGNITUDE
OF CHANGE.
>> IF IT'S NOT TAKEN INTO
ACCOUNT, CANNED BEANS, WHO EATS
CANNED BEANS WITHOUT SODIUM?
ASIDE FROM CHRISTOPHER.
WE EAT ALL THESE FOODS WITH
SODIUM AND SO JUST GOING TO
THE -- IT'S THE ONLY WAY OF
DOING THE EXERCISE BUT
>> IT'S ABOUT THE AVAILABLE OF
LOW SODIUM CANNED BEANS AS WELL.
>>
>> IN THIS CASE IT'S NOT TAKING
INTO CONSIDERATION THE FORM.
>>
>> YOU CAN CANS VERSUS --
>> NO, THE DIRECT FOOD WE ARE
USING.
>> WE WOULD HAVE CHOSEN THE MOST
NUTRIENT DENSE VERSION OF THAT
FOOD.
IT WOULD HAVE BEEN A LOW SODIUM
VERSION IF THAT WAS A
POSSIBILITY.
>> AND THE UBIQUITOUS NATURE OF
SODIUM THROUGH A VARIETY OF
FOODS MAKES SODIUM MORE
CHALLENGING WITHIN THE PROCESS.
TO TRY TO OPTIMIZE SODIUM INTAKE
TO GET TO THAT SPACE BUT IT IS
STILL EVEN LOOKING AT THE GRAINS
DATA, GRAINS DON'T HAVE A LOT OF
SODIUM IN THEM AND CONSUMING A
LARGER QUANTITY THE CONTRIBUTION
OF SODIUM GETS LARGER.
SO THE IMPLICATIONS OF HAVING
LESS OF GRAIN AND INCREASING
YOUR VEGETABLES FROM GREENS,
PEAS AND LENTILS AND STARCHY
VEGETABLES HAS THE IMPLICATIONS
FOR EATING A BIT OF SODIUM IN IT
AND THERE'S THE CAVEAT AROUND
SODIUM DATA AND THE STABILITY TO
GET PRECISION AROUND THE FOOD
CODES KNOWING IT'S THE FOOD
ESTIMATE.
CHERYL.
>> THANK YOU FOR CLEARING THAT
UP.
>> I WAS WONDERING ABOUT THE
FOODS DRIVEN BY MEAT, POULTRY
AND EGGS.
IN CONTRAST, WHAT WAS THE
DISCUSSION AROUND TOTAL GRAINS
VERSUS WHOLE GRAINS AND REFINED
GRAINS?
I'M CURIOUS ABOUT THE SEPARATION
OF REFINED GRAINS AND IN THE
PROTEIN FOODS THE LUMMING OF ALL
MEATS, ALL EGGS, ALL POULTRY.
>> WE LOOKED AT TO THE PROCESS
OF REDUCING ALL GRAINS
INCREMENTALLY AND REDUCING WHOLE
OR FINE GRAINS AND ULTIMATELY
THEY PROVIDE SOME UNIQUE
CONTRIBUTION.
IF YOU REMOVE ONE YOU REMOVE
THAT WILL CONTRIBUTION SO THE
IMPACTS OF FORTIFICATION AND
ENRICHMENT ON GRAINS HAS AN
IMPACT ON THE NUTRIENT PROFILE.
ULTIMATELY LIKE FRUIT YOU CAN GO
ONE WAY OR ANOTHER AS FAR AS ALL
WHOLE GRAINS REPIPEDD -- REFINE
SO ULTIMATELY THE 50% STAYED
WITHIN THAT.
WE HAD YOU'LL SORTS OF VARYINGS
WITHIN THE PROTEIN FOODS TO
REDUCE EVERY POSSIBLE
COMBINATION.
IT'S A VERY LARGE DATA FILE.
IT WAS DONE AT THE PER WEEK
LEVEL AND AS MENTIONED
ULTIMATELY YOU GOT FOUR OUNCES A
WEEK AND BELOW THAT IF IF YOU
HAD A DIFFERENT CONTRIBUTION OF
CHOLINE BY EGGS IN COMPARISON.
WE LOOKED AT THAT GAMUT HOW
THOSE ARE DISTRIBUTED AROUND THE
WEEKLY CONSUMPTION PIECE SIMILAR
TO WHAT THE VEGETABLES DID.
WE HAVE THE DATA AND THERE WAS
ROOM FOR REDUCTION AND KEEPING
THE BREADTH OF PROTEIN SOURCES.
>> OVER THE YEARS THERE'S
EMPHASIS ON VITAMIN D INTAKE AND
IT'S VIRTUALLY IMPOSSIBLE TO GET
VITAMIN D FROM DIET NO MATTER
WHAT YOU DO.
YOU DECIDE YOU'RE GOING TO TAKE
A SUPPLEMENT BECAUSE YOU'RE
GOING TO GET THE RDA AND NOT
KNOWING THE TARGET OF THE RDA OR
PERHAPS RECOGNIZE THAT THE
LIMITATIONS IN THIS RDA ARE
OPPOSED TO THE EXPOSURE AND
CLEARLY THERE'S CHALLENGES IN
THAT DATA IN IDENTIFYING A TRULY
OPTIMALOO -- OHD LEVEL AND TO
RECOGNIZE THE IMPOCKET OF
REACHING RDA WHETHER OR NOT
YOU'RE 80% OR 90% DOESN'T
MATTER.
ON THE FLIP SIDE WE MAY BE UNDER
EMPHASIZING THE IMPORTANCE OF
THE CHANGES AND IRON BIO
AVAILABILITY.
SOME PULSES ARE 1% OR 2% AND IT
MAY BE FINE IF WE'RE TALKING
ABOUT A 2-YEAR-OLD WE MAY LOOK
AT CHANGES.
ALL THIS IS GREAT STUFF.
I THINK WE INTO HE HAD TO FOCUS
IN AS WE PULL OUT OF THE
NUTRIENT AND SAY WE'RE NOT
REACHING AND NOT HAVE AN REAL
CHANGE AND MAKE SURE WE
UNDERSTAND THE IMPOSSIBILITIES
OF THE SORT.
>> DID WE LOOK AT UNSWEETENED
SOY AND WHEN THE MEAT WENT DOWN,
FOLATE WENT DOWN?
IT'S FROM BEANS, GREENS AND
CITRUS AND HOW DID THAT GO DOWN?
I THOUGHT IT WAS TRIVIAL AND
MINOR.
YOU DON'T HAVE TO FIGURE IT OUT
BUT CAN YOU DOUBLE CHECK.
>> I NOTICED THAT --
>> THAT WAS ODD.
>> AS WELL.
>> SO HERE'S MY REAL QUESTION.
GRAINS.
IS THIS WHAT AMERICANS EAT AND I
DID A PROJECT AND SAW AMERICANS
AS A WHOLE EAT 90% WHEAT.
I KNOW THERE'S RICE, I KNOW
THERE'S OATS AND OTHER THINGS.
AS YOU MODEL IT, ISN'T IT
MODELLED ON WHAT AMERICANS ARE
EATING.
SO IS THE GROUP OF GRAINS 90%
WHEAT?
>> THIS IS MEETING PEOPLE WHERE
THEY ARE BASED ON THE FOODS
PEOPLE ARE CONSUMING.
>> WE WITH HE SEE -- WHY WE SEE
THE REDUCTION.
>> I'D LIKE TO SEE OATS AND
BARLEY FOR KWHEET -- WHEAT.
NOT TODAY.
IT WAS MIND BLOWING QUESTIONS.
THANK YOU.
>> I THINK THE DATA CAN INFORM
INVENTION.
LOOKING AT A SMALL DECREASE IN
VEGETABLES HAS A BIG IMPACT OWN
NUTRIENTS IN THE DIET.
IN PLANNING INTERVENTIONS YOU
CAN USE THESE DATA TO KIND OF BE
MORE PRECISE OR TARGET WHERE THE
POPULATION IS.
ANYWAY, GREAT WORK.
>> ONE COMMENT.
>> THIS IS AMAZING WORK.
IT'S GREAT TO LOOK AT THE
SUBSTITUTION AND HOW FLEXIBLE
THE COMMITTEE HAS BEEN SO BRAVO.
>> MORE FUNDING WILL COME WHEN
WE CAN PUT IT TOGETHER AND SEE
WHAT COMES UP.
>> AT THE SAME TIME I THINK WE
NEED TO DEFLECT TO OUR STAFF.
THE HOURS TO PREPARE THIS DATA,
THE HOURS TO GET IT READY FOR US
IS ONE THING TO REP IT ALL AND
ANOTHER TO GET INTO A PIECE WE
CAN LOOK AT 350,000 DATA POINTS
TO MAKE INFORMED DECISIONS AND
THAT'S NEVER HAPPENING WITHOUT
THE WORK OF OUR STAFF AND EVEN
GETTING US TO THIS POINT.
SO, ANY OTHER COMMENTS OR
QUESTIONS ABOUT THE FOOD PATTERN
MODELLING?
I PROMISED THERE'D BE A LOT.
>> I KNOW YOU LOOKED AT MILK
BASED DRINK EARLY.
I WAS WONDERING ABOUT THINGS
PEOPLE DRINK IN THE AMERICAN
DIET, SMOOTHIES WHICH MAY NOT BE
MILK BASED.
I HAD A QUESTION THEY PLAY BE
FRUIT-BASED DRINK AND CURIOUS TO
THAT EARLY ON IN YOUR
CONVERSATION, WHERE DOES THAT
GO?
I'M SORRY FOR OPENING UP THAT
CAN OF WORMS BUT IN EVERY PLACE
YOU GO IN AMERICA THERE'S A
MAKMA
MAKIE -- SMOOTHIE BEING MADE.
THE FRUIT-BASED SMOOTHIE NOTE
NOT MILK.
>> IF WE'RE ABLE TO TELL FROM
THE NEAR LYING DATA OF A
SMOOTHIE FOOD CODE IT IS A
FRUIT-BASED SMOOTHIE AND
STRAWBERRIES AND BANANAS IT WILL
BE DISAGGREGATED TO STRAWBERRIES
AND BANANAS BUT ANY FOOD GROUP
NOT IN THESE WILL NOT
CONTRIBUTE.
>> AND TO MUCK THINGS UP A BIT,
WHEN THEY ADD ALL THE ADDITIVES
THAT WE DON'T KNOW WHAT THEY
REALLY ARE, WHAT DO YOU DO WITH
THAT?
>> IT ALSO MEANS ARE AREN'T 750
FOOD CODES FOR FRUIT SMOOTHIE
AND THERE'S NOT BANANA,
STRAWBERRY AND PEANUT BUTTER.
>> AND THROW IN A WHEY POWDER
AND THIS AND THAT.
>> IT CREATES A POINT ESTIMATE
FOR FRUIT SMOOTHIE WITH AN
ESTIMATION OF A RECIPE THAT
BASED ON ALL THE DIFFERENT
PIECES OF DATA IN TERMS OF
TRYING TO FIGURE OUT WHAT TO
CALL THAT ONE SO WHENEVER THEY
DO THE UPDATES FOR FNDDS THEY
HAVE TO LOOK AT THE FOODS
REPRESENTED AND THE WAYS OF
LOOKING AT RECIPES AND OTHER
FACTORS THAT ARE GOING TO DRIVE,
THEY MAY COME UP WITH ONE FRUIT
SMOOTHIE CODE.
THEN THE ASSUMPTION IS FRUIT
SMOOTHIE IS PROBABLY THIS RAND
IN THE GOING TO CAPTURE ALL THE
NUANCES.
IF THEY PUT IN A PROTEIN POWDER
THE FOOD CODE WILL GET REMOVED.
PROTEIN POWDER IS NOT THE FOOD
ITEM.
IT WOULD NOT WOMAN AN ITEM
CLUSTER.
IT WILL TAKE THE COMPONENTS OUT
AND TURN THEM INTO CLUSTERS.
>> FOR THOSE WHO MIGHT GET A
SMOOTHIE AT THE AIRPORT OR
SOMEWHERE ELSE, I SAW PEOPLE
WITH STARBUCKS.
>> CAN I QUESTION A QUESTION.
I THINK CHRIS MENTIONED THE
PHYTO NUTRIENTS AND
ACKNOWLEDGING WE CAN'T REALLY
ADDRESS THEM.
COULD YOU COMMENT MORE AND WHERE
SHOULD WE GO WITH THAT QUESTION
FOR THE NEXT ROUND.
>>
>> THERE'S A LOT OF WORK BEING
DONE IN THAT SPACE IN TERMS OF
IDENTIFYING WHAT'S THERE.
THERE'S ALSO CALLED THE GRAY
MATTER OF SPACE ALL THE STUFF IN
THERE THAT WE DON'T KNOW.
SO IT'S ADDRESSING THE SCIENCE
AND LOOKING AT FOOD GROUPS THAT
DON'T COUNT AS NUTRIENTS.
THERE'S CERTAIN NUTRIENTS WE
AREN'T LOOKING AT THAT EXIST
THAT HAVE RDAs.
SO WE'RE LOOKING AT WHAT'S IN
THE FNDDS TO THE DATABASES WOULD
HAVE TO CATCH UP FOR
QUANTIFICATION TO BE ABLE TO
QUANTIFY THEM HAVING THE SCIENCE
BEHIND WHY ONES TO EVALUATE,
ETCETERA.
WE'RE SEEING WITHIN CERTAIN FOOD
GROUPS BECAUSE YOU LOOK AT FOOD
GROUPS AND IT'S CONTRIBUTING A
SIGNIFICANT AMOUNT OF VITAMIN C
AND LOOK AT REVIEWS AS A
COMPONENT.
IT ISN'T IT HELPS SEE WHERE IT
FITS WITHIN THE NUTRIENT PROFILE
AND HOW INCLUSION IS BASED ON
FACTORS IN THE SYNTHESIS PHASE.
>> WE TRIED TO DETERMINE COULD
THERE BE SUBGROUPS LIKE
VEGETABLE SUBGROUPS AND MAY BE
ABLE TO SET SUBGROUPS.
BASED ON THE NUTRIENTS WE
WEREN'T ABLE TO DO THAT AND
COULDN'T CONSIDER THE PHYTO
NUTRIENTS BECAUSE WE DON'T HAVE
A DATABASE.
BUT THAT'S SOMETHING IN THE
FUTURE HOPEFULLY WE'LL BE ABLE
TO DO AND MAYBE FRUITS WILL BE
IN GROUPS LIKE VEGETABLES ARE.
>> I'M GOING TO SUGGEST WE TAKE
A FIVE-MINUTE BREAK BECAUSE WE
STILL HAVE TO REVIEW SOME NEW
PROTOCOLS AND I THINK THERE'S
BEEN A LOT OF INFORMATION.
LET'S GIVE EVERYONE FIVE MINUTES
TO DIGEST.
SEE YOU BACK IN FIVE MINUTES.
INCREASE BEANS, PEAS AND LENTILS
AND HAVE A REDUCTION IN TOTAL
GRAINS WHAT WOULD BE THE
NUTRITIONAL IMPLICATIONS.
THE LIST OF OUR FLEXIBILITIES
FOR BEANS, PEAS AND LENTILS AND
STARCHY VEGETABLES WITH A
SUBSEQUENT REDUCTION IN TOTAL
GRAINS, INCREASING BEANS, PEAS
AND LENTILS AND SOY AND
REDUCTION IN MEAT, POULTRY AND
EGGS AND ADDING SEAFOOD TO THE
HEALTHY VEG FOR A MORE
PESCATARIAN PATTERN AND EXPLORE
OF PLANT-BASED MILK ALTERNATIVES
FOR DAIRY AND FORTIFIED SOY.
NOW WE'LL CHANGE GEARS AND LOOK
AT ONE NEW PROTOCOL AND ONE
REVISED PROTOCOL.
IN LOOKING AT THESE
INDEPENDENT -- WELL, NOT
INDEPENDENT OF BUT WITH THE ONE
OF THE OTHER OPTIONS CREATING AN
ALTERNATIVE PATTERN AS OPPOSED
TO MAKING A MODIFICATION TO THE
CURRENT PATTERN AND AS WE LOOK
AT THAT AND WHAT THOSE TYPES OF
CHANGES, WHEN WE MAKE REDUCTIONS
WE COULD HAVE TO REPLACE THOSE
FOODS WITH OTHER FOOD GROUPS.
SO THE ACT OF REPLACEMENT WOULD
HAVE TO HAPPEN CONCURRENTLY WITH
REDUCTIONS.
THAT WILL SAME THE WAY WE LOOK
AT SOME OF THE NEXT PROTOCOLS
WITHIN THE REDUCING CARBOHYDRATE
FOODS AND AN MOOL-BASED FOODS.
I'LL PASS IT FORWARD.
START WITH REDUCING CARBOHYDRATE
RETAINING FOODS WITH DI.
>> THIS IS A PROTOCOL AND WE
LOOK FORWARD TO ALL OF YOUR
FEEDBACK.
WE ARE PROPOSING THE FOLLOWING
QUESTION TO LOOK AT NUTRIENT
GOALS AND WHICH CAN OR CANNOT BE
MET WHEN CARBOHYDRATES ARE
REDUCED IN FOOD.
THE RDA FOR CARBOHYDRATE IS SET
AT 130 GRAMS A DAY AND 65% OF
TOTAL ENERGY FOR AGES 2 AND
OLDER.
THE MAN TO ADDRESS THE FIRST
OBJECTIVE IS TO LOOK AT THE
CONSEQUENCES OR EFFECTS OF
REDUCING CARBOHYDRATE CONTAIN
FOOD GROUPS AND SUB GROUPS AND
THE LAST PART OF THE SENTENCE IS
IMPORTANT BECAUSE WE ARE
STARTING FROM THE BASE PATTERN
LIKE WE HAVE ALL THE OTHER FOOD
PATTERN MODELLING AND
MODIFICATION AND FLEXIBILITIES.
SO THIS IS NOT REDUCING SODA,
COOKIE, CAKES, SUGARY SNACKS AND
THOSE ARE ALREADY OFF THE TABLE
AND FURTHER REDUCING
CARBOHYDRATE CONTAINING FOODS
AND SEPARATE FROM GAINS AND
CARBOHYDRATE FOODS ARE FOUND
MOST THE FOOD GROUPS.
FOODS, STARCHY VEGETABLES AND
ALTERNATIVES NOT JUST GRAINS IF
THAT'S WHERE YOU'RE THINKING
WITH CARBOHYDRATE.
UNLIKE OTHER PROTOCOLS TO
UNDERSTAND HOW TO FILL IN GAPS
AND SUBSTITUTIONS AS CHRIS WAS
MENTIONING, THIS IS NOT GOING TO
BE USED TO CREATE A NEW PATTERN
BUT RATHER TO LOOK AT THE
IMPLICATIONS OF REMOVAL OF THE
FOODS AND BEVERAGES.
THE RATIONALE FOR THIS APPROACH
AND IT APPLIES TO THE FOLLOWING
PROTOCOL REVISIONS FOR THE
CARBOHYDRATE REDUCTION THERE'S A
LACK OF CONSENSUS HOW FAR OR HOW
LOW TO GO.
THAT MADE IT VERY DIFFICULT TO
DEFINE WHAT CUT POINT OR
THRESHOLD TO GET TO SO KEEP THAT
IN MIND.
WE'LL BE LOOKING AT THE RANGE
BUT THERE'S ALSO IMPORTANTLY
LACK OF CON SEN SHES WITHIN THE
HEALTHY U.S. PATTERN THERE'S
SPECIFIC FOODS TO PRIORITIZE TO
LEAVE IN OR REMOVE OR IF ALL
CARBOHYDRATE CONTAINING FOODS
ARE EQUAL AND THEREFORE SHOULD
BE REDUCED TO INFORM WHETHER
SOME SHOULD BE REDUCED OVER
OTHERS.
WE'LL LOOK AT THE VARIOUS FOOD
GROUPS AND OVER ALL TOTAL
CARBOHYDRATE REDUCTION.
AND IMPORTANTLY WITH RESPECT TO
NOT DEVELOPING THE FURTHER
PATTERN THERE'S A LACK OF
CONSENSUS FOR WHICH FOODS SHOULD
BE CONSUMED IN PLACE OF
CARBOHYDRATE CONTAINING FOOD.
WE DON'T EAT WHAT WE REMOVE.
WE EAT WHAT'S LEFT.
IF THERE'S NO CONSENSUS FOR WHAT
THAT SHOULD BE IT MADE IT
DIFFICULT TO KNOW WHERE TO BEGIN
GIVEN THAT CARBOHYDRATE CONTAIN
FOODS ARE UBIQUITOUS ACROSS THE
FOOD GROUPS AND WHAT TO EAT IN
PLACE OF THEM WAS NOT SOMETHING
THAT WAS READILY AVAILABLE IN
THE LITERATURE TO OUT AS A
STARTING PLACE.
I'LL NOW AND IT OVER TO SAMEERA.
>> I'LL BE PRESENTING VERY
VISIONS TO THE FORMALLY KNOWN AS
VEGAN PROTOCOL.
WE MADE THE CHANGE IN THE NAME
TO WIDER REFERENCE TO A SPECIFIC
DIET.
WE DECIDED TO KEEP OBJECTIVES 1
AND 3.
OBJECTIVE 1 IS EXAMINE THE
NUTRIENT CONTRIBUTIONS OF
PLANT-BASED PROTEIN FOODS IN THE
HEALTHY VEGETARIAN PATTERN AND
EXPLORE THE REMOVAL OF EGGS AND
DAIRY IN THE VEGETARIAN DIETARY
PATTERN.
WE DECIDED TO MOVE OBJECTIVES 2
AND 4 INTERRELATED.
OBJECTIVE 2 WAS THE PREVIOUS
OBJECTIVE WAS BASICALLY LOOKING
AT THE AVAILABILITY AND
USABILITY OF PLANT-BASED
PRODUCTS IN THE USDA'S DATA
CENTRAL TO LOOK AT REPLACING THE
EGGS AND DAIRY WITH THE
PLANT-BASED FOODS.
NOW, THE RATIONALE BEHIND THIS
REMOVAL OF OBJECTIVES 2 AND 4
WAS THAT THE COMMITTEE HAD HEARD
DISCUSSION ON WHAT OTHER REASONS
WHY PEOPLE ARE ACTUALLY REMOVING
ANIMAL FOODS FROM THEIR DIET.
IF WE PRIMARILY PUT IN TO THE
REPLACEMENT FOODS AND DON'T HAVE
EVIDENCE TO SUGGEST PEOPLE ARE
ACTIVELY SEEKING THE REPLACEMENT
FOODS.
IT MAKES SENSE TO NOT CONSIDER
AND WE DON'T HAVE EVIDENCE AS TO
WHAT PEOPLE ARE CONSUMING IN
PLACE OF THE ANIMAL BASED FOODS.
WE DECIDED TO LEAVE IT OUT.
THE SECOND REASON WAS THE
PRODUCTS IN THE MARKET ARE
RAPIDLY EVOLVING.
BY THE TIME WE DO THE ANALYSIS
THERE MAY BE A DIFFERENT SET IN
THE MARKET NOT APPLICABLE AND
THE OPTIONS WE DID HAVE CODES
FOR WERE NOT THE THREE REASONS
THAT WE DECIDED NOT TO REPLACE
THE PLANT BASED MEAT
ALTERNATIVES AS A SUBSTITUTION.
>> WE WILL NOT CHANGE, EDIT OR
CREATE NEW DIETARY PATTERN THEN
HOW WOULD YOU USE IT?
>> IT HELPS TO IDENTIFY WHAT THE
NUTRITIONAL IMPLICATIONS ARE FOR
REMOVAL IN CREATING NEW PATTERNS
YOU WOULD HAVE TO SAY IF YOU'RE
NOT GOING TO EAT THIS, REPLACE
IT WITH THIS.
AND THE REPLACE IT WITH THIS IS
A VERY NEBULOUS ISSUE BETWEEN
PRODUCT, PRODUCT AVAILABILITY
AND PRODUCT COMPOSITION AND WHAT
PEOPLE ARE CONSUMING.
SO CREATING A PATTERN AFTER THAT
TO SAY IF NOT THIS, THEN THIS,
THE LOW CARBOHYDRATE EVIDENCE
WAS AROUND CARBOHYDRATE QUANTITY
BUT NOT ALWAYS AROUND A PATTERN
OF THE FOODS.
SO LOOKING AT WHAT TO PUT BACK
IN WOULD BE THE THING YOU YOU'D
NEED TO CREATE A PATTERN.
IT'S QUESTIONS THAT HAVE COME
FORWARD.
THINGS THAT CAME FORWARD FOR
PUBLIC COMMENT AS WELL TO
ADDRESS THESE BUT WE MADE THE
REVISION TO THE VEGAN PROTOCOL
BECAUSE IN THE SPACE WE DIDN'T
HAVE ANSWERS TO BUILD -- PUT
BACK IN TO BUILD IT.
>> SO THE RESULTS ARE THE
NUTRIENTS AFFECTED BY JUST THAT
REMOVAL?
YEAH.
>> WE HEARD PUBLIC COMMENT ON
REMOVING CARBOHYDRATE AND
REMOVING ANIMAL PRODUCTS IN
VEGAN AND BECOMES A WAY TO
IDENTIFY THE NUTRITIONAL
IMPLICATIONS IF.
>> BOTH PROTOCOLS SHARE THAT IN
COMMON WHERE THE RATIONALE TO
FOR THE REMOVAL FOR WHATEVER
REASON THESE TYPES OF FOODS
SHOULD BE REMOVED OR REDUCED BUT
WHAT'S CONSUMED IN PLACE IS
POORLY DEFINED AND EVEN WHERE IT
IS MAY BE COMPLETELY DIFFERENT
FROM ONE INTERPRETATION OR USE
TO ANOTHER.
SO WITHOUT -- WHEN THE FOODS ARE
REMOVED THERE'S A LOT OF HOLES
WITHIN FOOD GROUPS AND HOW TO
FILL THEM IN.
SO IT SEEMS IMPOSSIBLE TO TACKLE
ALL THE WAYS IT CAN BE DONE AND
TO LOOK AT THE SPECIFIC GAPS IN
NUTRIENTS AND CONSIDER THESE
WHEN DEVELOPING WHATEVER PATTERN
BASED ON THOSE SPECIFIC
PREFERENCES.
YEAH.
>> I THINK MY RESPONSE APPLIES
TO BOTH.
IN NOVEMBER OF 2023 WE PUBLISHED
A VEGAN VERSUS OMNI VORE AND SAW
30% OF CALORIES COMING FROM
ANIMAL SOURCED FOODS AND
OMNIVOROUS DIET AND WHAT YOU
MODELLED AND AT THE COMPARISON
DIET WAS WHATEVER THE 70% WAS
THAT THE OMNI -- OMNI VORES
WERE EATING.
IT'S JUST A HIGHER PROPORTION I
DON'T SEE REPLACING IT WITH THE
SAME NUMBER OF CALORIES.
IF YOU SAY IT'S MORE OF THE SAME
AND PICKED A HEALTHY VEGAN --
LIKE YOU PICK A HEALTHY KETO OR
ANYTHING LIKE THAT.
I DON'T KNOW WHO I'M LOOKING AT,
SAMEERA, CHRIS, DEDE RA.
-- DEIDRE.
>> WE HAD REMOVAL AND INCREASING
EVERYTHING ELSE.
WITH THE VEGAN YOU'RE STARTING
WITH THE VEGETARIAN PATTERN IN
ANALYSES WHICH IS PROBABLY
CLOSER TO THAT LINE.
WITH THE CARBOHYDRATE YOU'RE
POKING SO MANY HOLES IN THE
EXISTING PATTERN SAYING
REPLACING FRUITS BY INCREASE IN
>> I THOUGHT OF THIS DIFFERENTLY
IN MY HEAD BECAUSE YOU'VE
ALREADY TAKEN CARE OF THIS.
IT'S A GREAT PUBLICATION SHOWING
40% OF OUR CALORIES COME FROM
ADDED SUGARS AND REFINED GRAINS
AND THOUGHT GREAT, THAT'S OUR
LOW-CARB DIET AND GET RID OF
THAT AND WOULD LIKE TO SEE
REPLACE MANIMENT -- REPLACEMENTS
AND THAT'S GETTING RID OF CRAPPY
CARBS BUT I THINK YOU CAN SAY
WE'LL GET RID OF SOME NUMBER OF
CALORIES FROM CARBS, MAYBE TWO
AND I'D LOVE -- COULDN'T IT BE
WORK OUT YOU DID OF THE CALORIES
THAT ARE YOU DID THAT AS THE BIG
THING REPLACE IT WITH ALMOST LOW
CARBS AND IF YOU LOWER IT YOU
CAN'T REPLACE IT WITH ALL CARBS
OR ALL FAT -- NOW I'M STUCK.
>> THINK TO THE BRAIN PROTOCOL
THERE'S A CLEAR BEHAVIORAL
SUBSTITUTE IF YOU CAN REPLACE
DAIRY WITH SOY ALTERNATIVE IN A
BEHAVIORAL SWAP.
WHEN CARBOHYDRATE CONTAINING
FOODS ACROSS THE BOARD IS NOT A
POSSIBLE ASSUMPTION TO MAKE IN
HOW PEOPLE WILL REPLACE THOSE
GAPS WHERE THERE'S NO OBVIOUS
SUBSTITUTION.
AND WITH THE ANIMAL BASED
PROTOCOL SEE OBJECTIVE DROPPED
BECAUSE ANIMAL WITH PLANT-BASED
IS WHERE WITH WANTED TO GO BUT
THERE WASN'T A LOT OF DATA ON
THESE TYPES OF PRODUCTS.
>> SO WE DON'T KNOW THE
MOTIVATION BEHIND SOMEONE TROMP
THE ANIMAL-BASED OATS.
ARE THEY EATING JUST MORE OF
SOMETHING ELSE OR SEEKING OUT
ALTERNATIVES?
WE DON'T HAVE AN ANSWER.
THERE'S NOTHING IN THE
LITERATURE THAT POINTS UTS TO
WHAT THIS IS WHAT PEOPLE ARE
DOING.
IF WE PUT IN SOMETHING WE'RE
MAKING THAT ASSUMPTION.
LET'S NOT INVESTIGATE FURTHER
THE PLANT-BASED ALTERNATIVES
THERE.
>> BECAUSE WHEN YOU TAKE
SOMETHING OUT SUBSTITUTION
BECOMES AS IMPORTANT AS REMOVAL
BUT IF YOU TAKE SOMETHING OUT
THAT HAS GOING TO BACK TO THE
FOOD GROUPS AND THE NUTRIENTS
COMING FROM IT, YOU TAKE OUT
LOOK AT DAIRY AND CALCIUM AND
TAKE OUT OTHER NUTRIENTS.
WHEN YOU TAKE IT OUT AND PUT
SOMETHING ELSE BACK IN, WHAT YOU
PUT BACK IN BECOMES JUST AS
IMPORTANT AS WHAT YOU TAKE OUT.
AND WHAT YOU PUT BACK IN
ULTIMATELY WOULD HAVE TO MEET
THOSE NUTRIENT GOALS SO THAT
YOUR STILL GETTING -- SO THERE'S
A DIFFERENCE BETWEEN DIETARY
COMPONENT AND NUTRIENT ADEQUACY.
NUTRIENT ADEQUACY IS AN ENTIRE
PATTERN MEETING YOUR NUTRIENT
GOALS FOR THE DRIs.
WE HAVE TO HAVE AN INFORMED
DECISION WHAT GOES BACK IN
TAKING THEM OUT WILL GIVE US THE
DATA THAT SHOWS WHAT THE
NUTRIENT GAPS ARE WHEN YOU
REMOVE AND NOW GIVES YOU A
BLUEPRINT FOR NOW I HAVE TO FIND
WHATEVER THE NUTRIENTS MAY BE
BECAUSE JUST REPLACING IT WITH
SOMETHING ELSE MAY NOT COVER A
GAP THAT EXISTING FOR REMOVING
FOOD GROUPS.
>> I THINK THIS IS A GOOD FIRST
STEP YOU'RE DOING BECAUSE NOT
ONLY WHAT COULD YOU REPLACE IT
WITH WHICH COULD BE A MULTITUDE
OF OPTIONS BUT WHAT IF IT
DOESN'T GET REPLACED ALL THE WAY
WHEN PEOPLE GO ON LOW CARB DIETS
THEY USUALLY TAKE IN LOWER
CALORIES SO WHAT IS THE FEWER
NUMBER OF CALORIES THAT DOESN'T
GET REPLACED AND HOW DO WE MODEL
THAT AND PUT THAT IN THE WHOLE
EQUATION?
I THINK GETTING THIS STEP DONE
GETS US A LITTLE BIT FURTHER
DOWN THE ROAD.
THERE'S STILL MORE TO DO AFTER
THIS.
>> I HEAR YOU.
I THINK WHEN PEOPLE MAKE THE
OMNIVOROUS PATTERN TO REMOVING
ANIMAL-BASED FOODS THERE IS THIS
TRANSITION PERIOD TO A
MEAT-BASED ALTERNATIVES WITH THE
SLEW OF MARKETS THAT EXISTED IN
THE U.S. MARKET.
YOU DON'T JUST GO FROM ONE
EXTREME TO THE NEXT.
THERE'S A SUBSTITUTION WHERE WE
SEE RESTAURANTS OR GROCERY
STORES WHERE YOU CAN BUY
MEAT-BASED ALTERNATIVES TO
SUBSTITUTE MEAT ALTERNATIVES AND
PEOPLE WILL MAKE IT TO LIKE I
DON'T WANT THE SUBSTITUTES AND I
WORK WITH PATIENTS BUT I SEE THE
TRANSITION GOING FROM I DECIDED
TO GO TO THIS -- I DON'T KNOW
THE TERMINOLOGY, THAT
ANIMAL-BASED TAKING AWAY FROM
REMOVAL OF ANIMAL-BASED FOODS
OVER TO GOING TO THE MEAT-BASED
ALTERNATIVES OR I WANT NONE OF
THESE ANIMAL BASED ALTERNATIVES
TO OKAY I WANT STRICTLY THINGS
THAT COME FROM THE EARTH, NO
ROAMING OR PRETENDING THEY
ROAMED THE EARTH TYPE PRODUCTS.
THIS IS WHAT I SEE.
I KNOW IT COMPLICATES THE
PROCESS THAT'S USUALLY THE
TRANSITION THAT WE SEE WHEN
PEOPLE MAKE THE TRANSITION THEY
DON'T TYPICALLY FROM ONE SPACE
TO THE COMPLETE REMOVAL OF
ANIMAL-BASED FOODS.
THE TRANSITION PERIOD IS WHY
SOME PRODUCTS HAVE BECOME
POPULAR IN THE U.S. MARKET
EITHER IN RESTAURANT MENUS OR IN
GROCERY STORES HERE IN THE
UNITED STATES.
I KNOW OTHER PEOPLE HAVE HAD
THEIR HAND RAISED BUT TOMORROW I
WAKE UP AND I'M JUST STOPPING
AND RARELY DO WE SEE THAT LIGHT
OFF AND ON SWITCH AND THAT
SHIFT.
>> WHAT HAPPENS IF YOU'RE
VEGETARIAN ALREADY AND WANT TO
MOVE FROM THE REMOVAL OF
EVERYTHING?
YOU WOULDN'T SEEK OUT THE
PLANT-BASED ALTERNATIVES.
>> THERE'S FAKE EGGS NOW.
THERE'S FAKE CHEESE AND MILK SO
VEGETARIANS CAN MAKE THE
TRANSITION WITHOUT AN ALT
ALTERNATIVE DATA.
>> WE DIDN'T LOOK AT EVERY
ALTERNATIVE DATA UNDERSTAND THE
SUN AND THERE'S SO MANY PRODUCTS
REPRESENTED AND THE DATABASE
WOULD BE REALLY LIMITED DATA.
>> THERE'S NOT ENOUGH PUBLISHED
LITERATURE.
IT'S NOT DOCUMENTED THIS IS HOW
THEY DO IT AND THIS IS MAYBE
CONSIDERED THIS.
SO WE HAVE TO LOOK AT WHAT WAS
THERE AND THOUGHT IT MADE SENSE.
WE'RE MAKING AN ASSUMPTION THIS
IS WHAT FOLKS ARE DOING.
>> ONE OF THE OTHER ISSUES IS
THAT LIKE NOT ONLY IS IT THAT
BUT WE'RE INFORMING THE OTHER
PATTERNS BY INTAKE DATA IN
NHANES.
IN THAT DATA WE DON'T HAVE
SELF-IDENTIFIED VEGANS OR LOW
CARB AND GET SEE THE FOODS THOSE
GROUPS ARE CHOOSING TO INFORM
THOSE PATTERN.
WE COULD DO IT BUT WE WOULD JUST
BE OPERATING ON ASSUMPTIONS AND
DIFFERENT STYLES THAT WE THINK
OF.
>> I'M GOING TO GIVE THE FLOOR
TO CHERYL WHO HAS BEEN VERY
PATIENT.
>> I WAS GOING TO FOLLOW UP ON
WHAT DEANNA SAID EARLIER BECAUSE
I TOO INITIALLY WAS THINKING
ABOUT WHERE DOES TO THE
SUBSTITUTION HAPPEN BUT
REASSURED BY WHAT SAMEERA
INTRODUCED REGARDING THE LACK OF
PRODUCTS AN LACK OF NUTRIENT
COMPOSITION OF POTENTIAL
REPLACEMENT PRODUCTS AND WE
WOULDN'T BE HOLDING TRUE TO I
THINK OUR GUIDING FRAME WORE FOR
LETTING THE SCIENCE DRIVE WITH
WHERE WE GO FOR ANSWERING
QUESTIONS.
IN THE ABSENCE OF STUDIES OR
NHANES DATA WE DON'T USE A
SCIENCE DRIVEN APPROACH AND FEEL
ASSURED WHERE THE SUBCOMMITTEE
HAS LANDED.
>> I LIKE IT'S A FIRST STEP AND
WOULD LIKE FOLLOW UP STEPS.
YOU CAN MAKE KETO VERSUS VEGAN
OR SOMETHING GUESS.
I'LL FLIP THIS TO A CONFERENCE I
WENT TO LAST YEAR ON ULTRA
PROCESSED FOOD AND SOMEBODY SAID
WHAT IF YOU ELIMINATED ULTRA
PROCESSED FOODS?
LET ME SHOW YOU ALL THE
NUTRIENTS YOU'D BE MISSING.
I SAID WHAT THE F, 60% OF YOUR
DIET IS UPF AND YOU TOOK THEM
ALL OUT.
YES, YOU'RE GOING TO EAT
SOMETHING ELSE.
WHY ARE YOU SAYING WHAT YOU'RE
GOING TO BE MISSING AFTER YOU
TOOK 60% OF MY CALORIES AWAY.
THAT WAS ABSURD.
I WAS PISSED THAT DAY AND
CHANNELLING THAT WITH APE UPF,
REMOVING BUT NOT REPLACING.
EVEN IF YOU DON'T KNOW WHAT TO
REPLACE IT WITH, I'D BE HAPPY TO
COME UP WITH SEVERAL REASONABLE
SUBSTITUTIONS.
NOT ONE BUT SEVERAL REASONABLE
SUBSTITUTIONS.
I THINK IT'S A MISS LEADING
QUESTION UNLESS YOU DO THAT.
>> ULTRA PROCESSED FOODS ARE NOT
DIETARY FWIED LINE.
SO REMOVING ANIMAL BASED FOODS
WHICH ARE SOME FOODS AND
CARBOHYDRATES WHICH ARE GRAINS
AS A GROUP BUT ALSO INE RNA
MACRO NUTRIENT, THOSE HAVE
DIFFERENT IMPLICATIONS THAN
REMOVING FOODS THAT DOESN'T
EXIST A FEW DECADES AGO ANYWAY.
YOU'RE ASKING WITH THE TWO WE
PROPOSED REMOVING PIECES
INTENTIONALLY THERE OR NUTRIENT
CONTENT?
WHETHER IT'S FIBER OR ALL THE
GUIDELINES AND ULTRA PROCESSED
FOODS AREN'T RECOMMENDED AND NOW
WE'RE TAKING IT UP.
SO I DON'T KNOW THAT ANALOGY
COUNTS.
>> CHRISTOPHER, YOU'RE
ENTHUSIASM FOR THIS QUESTION IS
COMMENDABLE WHICH IS PART OF THE
REASON WHY WE DECIDED TO TAKE A
BREAK BECAUSE WE KNEW WE'D HAVE
ACTIVE DISCUSSION ON THIS.
I THINK ONE THING WE HAVE TO
REMEMBER IS THIS COMMITTEE
STRUGGLES BETWEEN THE BALANCE
BETWEEN OUR ASPIRATIONS AND WHAT
WE CAN ACTUALLY DO.
AND I THINK THE POINTS THAT HAVE
BEEN MADE ABOUT THIS IS A FIRST
STEP, THIS IS WHERE THE
ENTHUSIASM IS .
I DON'T THINK WE CAN CONSIDER
DOING MORE MODELLING ON THIS IN
THIS COMMITTEE GIVEN ALL THE
OTHER SYNTHESIS ACTIVITIES THAT
NEED TO BE DONE WITH FOOD
PATTERN MODELLING BUT WE HAVE
FUTURE DIRECTION SECTIONS AND I
THINK IT WILL BE HELPFUL TO TALK
ABOUT WHERE WE WANT THIS TO GO
IN SUBSEQUENT STEPS AND
HOPEFULLY THE NEXT COMMITTEE
THAT MEETS WILL HAVE LOADS OF
DATA TO WORK WITH.
THAT WOULD BE MY CONCLUSION.
>> I WAS GOING TO ADD, ONCE THE
REPORT IS MADE IT'S NOT TO SAY
THAT THIS IS AN ADVISORY
COMMITTEE OF WHICH A REPORT IS
MADE TO THE ENTITIES THAT MAKE
THE GUIDELINES.
IN A LOT OF CASES WE TALK ABOUT
IN WHICH WE'RE CREATING THE
GUIDELINE AND THIS IS THE
ADVISORY COMMITTEE WHICH IS
REALLY FOCUSSED ON THE TASK AT
HAND AND SO I SAY THAT BECAUSE
AND I HAD SOME OTHER QUESTIONS
TOO AND MAYBE I'LL HOLD THEM BUT
I'LL TEMPER MY OWN ENTHUSIASM.
I THINK IT'S IMPORTANT WHEN WE
LOOK AT AS SARAH SAID THE TASKS
BECAUSE THAT'S IMPORTANT AS WE
THINK ABOUT WHAT CAN HAPPEN NEXT
IT DOESN'T HAVE TO BE IN THE
NEXT COMMITTEE.
THERE'LL BE SOMETHING THAT
HAPPENS NEXT AFTER THIS REPORT
IS DONE.
THIS REPORT WILL BE TAKEN AND
THEN THERE WILL BE ADDITIONAL
STEPS AND I THINK THAT'S
IMPORTANT TOO.
>> ANOTHER IMPORTANT TAKEAWAY
BECAUSE THAT IS -- I DIDN'T WANT
TO SAY YOUR CONCERN OF -- YOU'RE
CONCERN'S NOT VALID AND SAYING
WE CAN'T MEET LIKE THIS WOULDN'T
BE THE UTILITY OF THE ANALYSIS.
IT COULD BE TO I THINK HIGHLIGHT
WHERE THERE ARE NUTRIENT
CONCERNS WITH THE REMOVAL SO
THERE CAN BE INFORMED
REPLACEMENT WITH WHATEVER THE
PATTERN INDIVIDUALS WOULD CHOO
CHOOSE TO MAKE WITH THE GAP IN
CALORIES WITH THEIR FOOD OF
CHOICE.
THAT WOULD BE IMPOSSIBLE TO
PREDICT WHAT BEHAVIOR CHANGES OR
WHAT FOODS WOULD BE CONSUMED IN
PLACE OF THESE THERE'S
IMPLICATIONS AND WE HAVE TO HAVE
HEALTHY FOODS TO MAKE UP FOR IT
AND NOT LOOK AT THE GAPS AND SAY
THERE'S NO WAY.
IT'S TO INFORM WHAT THE
PLACEMENTS SHOULD BE.
>> I HAVE A SUGGESTION.
I SUGGEST YOU TAKE THE
MEDITERRANEAN, VEGETARIAN AND
WHATEVER CALORIES YOU CUT BACK
ON CARBS OR ANIMAL SOURCES YOU
MATCH TO THE NEUTRIENTS IF YOU
COMPARE THEM IN THE DIET SO
YOU'LL SEE IF IT'S A DROP IN
CALORIES HIGH IN CARBS OR
CALORIES IN ANIMAL-SOURCED
FOODS.
HOW ABOUT THAT?
IS THAT POSSIBLE?
>> WHAT ABOUT THE NUTRIENTS YOU
TAKE AWAY YOU HAVEN'T ADDED BACK
IN.
TOOK THAT AWAY FROM ME.
I'VE BEEN ASKING FOR THAT.
6:
>> THE SUBSTITUTION IS FOR
EDUCATIONAL GAPS AND THE
CALORIES BUT IF YOU GET A LITTLE
BIT HERE AND HEAR BUT NOT ENOUGH
TO COVER -- HERE BUT NOT TO
COVER AND SAY YOU'RE TAKING OUT
IRON.
WILL YOU GET SUFFICIENT IRON
FROM ALL THE OTHER FOODS THAT
YOU'RE GOING TO ADD BACK IN
EITHER AS ONE FOOD OR
PROPORTIONALLY TO MAKE THAT UP
THAT GAP OF IRON?
SO, WE CAN LOOK AT SUBSTITUTIONS
WE CAN LOOK AT OVER ALL PATTERNS
OF MACRO NUTRIENT DISTRIBUTION
AND LOOK AT OUTCOMES BUT DIETARY
PATTERNS ARE AS MUCH AS ABOUT
THE FOODS BUT THE NUTRITIONAL
ADEQUACY OF THE PACKAGE AND THAT
SUBSTITUTION BECOMES AN
INTENTIONAL CONVERSATION THAT
FOR US GIVES US AN EVIDENCE BASE
THE COMMITTEE NEEDS TO SEE
EITHER FROM THE SCIENTIFIC
EVIDENCE TO KNOW WHAT TO PUT
BACK IN OR WHAT'S BEING USED TO
PUT BACK IN AND TO KNOW WHAT
NEEDS TO BE FILLED BACK IN SO
THAT YOU CAN INFORM REPLACEMENT
APPROPRIATELY.
BECAUSE REPLACING WITH OTHER
HEALTHY THINGS BUT NOT REPLACING
THE NUTRITIONAL GAP STILLS
LEAVES A GAP AT THE END AND THE
VARIETY GETS TO THAT.
>> I KNOW YOU MENTIONED THE
POSSIBILITY OF NOT ADDING MORE
PATT
PATTERNS.
DO YOU THINK THERE'S A
POSSIBILITY THAT GET ELIMINATED
WITHIN THE PROCESS?
I KNOW IN SOME WAYS IN THINKING
ABOUT MY DISCUSSIONS ABOUT THE
HEALTHY U.S. DIETARY PATTERN
WITH FLEXIBILITIES BEING ABLE TO
MEET A LOT OF DIFFERENT FEEDS
AND CULTURAL DIETS AND IN THE
COMMENTS THERE'S BEEN COMMENTS
ABOUT THE MEDITERRANEAN DIETS
AND DIFFERENT DIETS.
ARE THOSE DIETS NOT NECESSARY
BALANCED?
I WAS CURIOUS IF THERE MIGHT
EVEN BE -- IS THAT A POSSIBILITY
THAT'S BEEN EXPLORED OR IS THE
IDEA TO MAINTAIN THE CURRENT
PATTERNS?
>> WE'VE DONE MOST OF OUR WORK
ON THE US PATTERN AS INE
OVERARCHING AND LOOKED AT THE
FLEXIBILITIES.
SOME OF THE OTHER PATTERNS LIKE
THE HEALTHY VEGETARIAN WE CAN
APPLY THE THINGS THAT WE'VE DONE
HERE.
WE CAN SEE IF IT CONDITIONS LIKE
IF WE REDUCE GRAINS AND CARRY
THAT FORWARD AND DOES IT GIVE
THE SAME NUTRIENT OUTCOMES.
SO WE HAVE THE ABILITY TO LOOK
AT THOSE PATTERNS.
THAT GETS TO OUR SYNTHESIZE
PHASE NEXT ONCE WE LOOK AT THE
PROPOSED PATTERN AND THIS IS
PROBABLY A GOOD TIME TO GO TO
OUR SLIDE TO SUMMARIZE WITH OUR
SUGGESTED DRAFT SYNTHESIZE.
OUR POTENTIAL MODIFICATIONS TO
THE HUSS WOULD BE INCREASING
BEANS, PEAS AND LENTILS AND
DARK-GREEN VEGETABLES IN THE
SUBCATEGORIES.
REDUCING TOTAL GRAINS AND
PROTEIN FOODS ALL THESE FOR ONE
PLUS AND THEN IN 2 AND OLDER
REDUCING DAIRY AND FORTIFIED SOY
ALTERNATIVES.
NO MODIFICATIONS TO THE
QUANTITIES OF FRUIT AND TOTAL
PATTERN AT 1+ AND LOOKING AT
REDUCTION OF GRAINS AND
INCREASING BEANS, PEAS AND
LENTILS OR STARCHY VEGETABLES
ABOVE THE CURRENT VEGETABLE
RECOMMENDATIONS WITHIN THE HUSS,
INCREASING BEANS, PEAS AND
LENTILS AND PLANT-BASED PROTEINS
OPPOSED TO ANIMAL-BASE AND
ADDING SEAFOOD AND HEALTHY
VEGETARIAN PATTERN AND EXPLORING
THE SUBSTITUTION OF PLANT-BASED
MILK ALTERNATIVES FOR THE DAIRY
AND FORTIFIED SOY.
THESE COME TO CREATE A MODIFIED
HUSS AND SEEING HOW THAT
TRANSLATES INTO THOSE OTHER
PATTERNS AND WOULD WE MODIFY
THEM ACCORDINGLY TO WHAT WE
FOUND HERE AND BOUNCE TO THE END
OF OUR WRAP UP.
>> CAN I MAKE ONE MORE COMMENT
BECAUSE I THINK IT'S AN
IMPORTANT QUESTION.
WE'VE TALKED ABOUT WHAT DO WE DO
WITH THE DATA A LOT IN OUR
GROUP.
I DON'T THINK THAT WILL BE LIKE
WHAT PATTERN OR PATTERNS ARE THE
ULTIMATE LIKE STUDY ON THE FOOD
PATTERN MODELLING GROUP.
I HOPE WHAT WE'VE BEEN
REINFORCING WILL BE A
COMMITTEE-WIDE EFFORT THAT
INCORPORATES ALL THE PIECES OF
EVIDENCE.
AND WHETHER THESE MODIFICATIONS
AND FLEXIBILITIES HAVE ANOTHER
SPIN OFF OR ABSORB ONE IN WILL
BE A COMMITTEE DECISION AND NOT
JUST THE FOOD PATTERN MODELLING
BUT THE HEALTH EQUITY AND
SYSTEMATIC REVIEW AND EVERYTHING
THE MODELLING WILL BE THERE AS A
NICE CHECK TO DEFINE AND TAILOR
THE PATTERN OR PATTERNS TO MAKE
SURE WE'RE NOT INTRODUCING THE
GAP WE HAVE EVERY LOOKED IN
NUTRIENT PROFILING.
I THINK THAT'S HOW WE'LL GET
THERE.
>> AND THE FLEXIBILITIES THAT
Y'ALL ARE LOOKING AT ARE VERY
SIMILAR TO WHAT WE FOUND IN THE
DIETARY PATTERNS AND THE
PATTERNS EMERGING SO IT WILL BE
NICE TO HAVE THAT.
>> WHERE WE ARE IN NEXT STEPS
SINCE WE KIND OF ALREADY MY
FWR --
MIGRATED TO THAT AND LOOKING AT
THE HUSS PATTERN AND LOOK AT
NUTRIENT GOALS WILL COME INTO
PLAY WHEN WE GET INTO RANKS OF
NUTRIENT DENSITY AND WHAT
ADDITIONAL CALORIES THERE MAY BE
IN TERMS OF THE VARIETIES AND
FLEXIBILITIES WITHIN THAT.
WE'LL TAKE ALL THESE INDIVIDUAL
RESULTS, LOOK AT THE
MODIFICATIONS, PUT THEM ALL
TOGETHER INTO THE SYNTHESIS AND
WE HAVE TO COME UP WITH OUR
HEALTHY U.S. STYLE PROPOSED
PATTERN BECAUSE THAT IS WHAT'S
GOING TO BE USED IN THE DIET
SIMULATIONS TO LOOK AT THE
POTENTIAL ITERATIONS THAT WILL
INCLUDE THE POPULATIONS WE'RE
UNABLE TO CAPTURE WITHNHWITH NH
AND SEE HOW IT SERVES IN THE
SIMULATION SPACE BY SERVING THE
FOODS AND SEEING WHAT THAT LOOKS
LIKE.
THE NEXT MEETING WILL BE AN
EXCITING MEETING WHEN WE GET TO
THAT SPACE AND FACTORED INTO
THIS IN OUR SYNTHESIS WILL BE
THE IMPACT FROM DATA ANALYSIS
WE'RE SEE TOMORROW IN TERMS OF
FEASIBILITY OF CHANGING FOOD
GROUP QUANTITIES AND WHERE WE'RE
SEEING NUTRIENT GAPS AND CHRONIC
DISEASE MARKERS AND SYSTEMATIC
REVIEWS AND PULLED TOGETHER AND
LOTS OF CROSS-TALK BETWEEN THIS
MEETING AND NEXT MEETING TO GET
TO THE FINAL STATE.
>> THANK YOU, ALL.
FIRST, I WANT TO APPLAUD THE
COMMITTEE.
AND THANK OUR WONDERFUL STAFF.
WITH THAT I WILL CONCLUDE DAY
ONE OF MEETING 5 OF THE 2025
DIETARY GUIDELINES ADVISORY
COMMITTEE.
WE WILL START AGAIN TOMORROW
MORNING AT 8:30 A.M. EASTERN
TIME.
SORRY FOR THE WEST COASTERS.
THANKS FOR YOUR ATTENTION TODAY
AND WITH THAT WE'LL CONCLUDE THE
MEETING.