>> GOOD MORNING AND WELCOME TO
DAY TWO OF THE DIETARY ADVISORY
MEETING 2025 AND THE SECOND DAY
THE COMMITTEE IS REPORTING ON.
TODAY THE AGENDA WILL BE AS
FOLLOWS.
WE'LL START WITH RELATED
PROJECTS UPDATE AND HAVE A
DISCUSSION ON DATA ANALYSIS
FOLLOWED BY DIET AND PREGNANCY
AND BIRTH THROUGH ADOLESCENCE,
AT SOME POINT WE'LL HAVE A LUNCH
BREAK, TBD, THEN THERE'LL BE A
DISCUSSION ON DIETARY PATTERNS
AND SPECIFIC DIETARY COMPONENTS
ACROSS THE LIFE STAGES AND THEN
A WRAP-UP BY OUR CHAIRS.
SO WITHOUT FURTHER ADO, I'M
GOING TO PASS IT OVER FOR
UPDATES ON RELATED PROJECTS.
>> THANK YOU.
SO WE GAVE AN UPDATE ON RELATED
ACTIVITIES DURING THE SECOND
COMMITTEE MEETING AND SO WE
THOUGHT WE'D JUST GIVE AN UPDATE
ON WHERE THINGS ARE SINCE THAT
TIME.
SO IN THE NEXT SLIDE YOU CAN SEE
I'LL GIVE UPDATES ON FOUR
ACTIVITIES.
UPDATES ON WORK RELATED TO
SUSTAINABILITY IN THE DIETARY
GUIDELINES AND RELATED TO A
RECENT ARTICLE THE FEDERAL TEAM
PUBLISHED.
WHEN USDA AND HHS WERE TALKING
ABOUT THE TOPICS AN SKOEPDZ WE
TALKED ABOUT ALCOHOLIC BENCHES
INCLUDED IN THE DIETARY
GUIDELINES SINCE THE FIRST
EDITION.
WE FELT WE WERE AT TIME WHERE
THAT TOPIC IS COMPLEX AND UNIQUE
CONSIDERATIONS RELATED TO OTHER
ASPECTS OF THE DIET AND FELT WE
WERE AT A TIME WHERE THAT TOPIC
DESERVED A COMPREHENSIVE REVIEW
WITH A NUMBER OF EXPERTS IN THAT
TOPIC AREA.
OFTEN TIMES WE HAVE THE ABILITY
TO BRING IN 20 FANTASTIC EXPERTS
BUT IT'S DIFFICULT TO BRING IN
20 EXPERTS ON A RANGE OF TOPICS
AND PLUS Y'ALL HAVE SEEN YOU
HAVE A LOT OF IN YOUR SCOPE
ALREADY.
IT'S PROBABLY OKAY THAT WE
PULLED ONE TOPIC AREA WE WANTED
TO HAVE YOU GUYS LOOK AT.
SO USDA AND HHS ARE ADDRESSING
THE TOPIC OF ALCOHOLIC BEVERAGES
THROUGH EFFORTS SEPARATE THROUGH
THE WORK OF THE COMMITTEE AND
THERE WILL BE DISCUSSION AROUND
CONSIDERATIONS OF ALCOHOL AND
DIETARY PATTERNS AND HOW Y'ALL
TALKED ABOUT THAT.
SO WHAT IS THE WORK THAT'S
HAPPENING?
THERE'S TWO ACTIVITIES
HAPPENING, HAPPENING ON PARALLEL
TRACKS AND I WANT TO NOTE THOSE
ARE COMPLEMENTARY ACTIVITIES NOT
DUPLICATE.
THERE'S ONE ACTIVITY BEING
SUPPORTED BY A COMMITTEE WITHIN
HHS' SUBSTANCE ABUSE AND HEALTH
SERVICES ADMINISTRATION, SAMHSA,
AND A SEPARATE ACTIVITY RECEIVED
FROM CONGRESS TO CONDUCT A STUDY
WITH NATIONAL ACADEMIES ON
ALCOHOLIC BEVERAGES AND HEALTH
AND TALK MORE WHAT THE TWO
PROJECTS WERE DOING IN THE NEXT
SLIDE.
A COUPLE NOTES, BOTH PROJECTS
ARE EVIDENCE REVIEW PROJECT.
SIMILAR TO DOING REVIEWS OF
SCIENTIFIC EVIDENCE.
BOTH PROJECTS WILL INCLUDE
OPPORTUNITIES FOR PUBLIC
PARTICIPATION.
I'LL NOTE BOTH PROJECTS HAVE WEB
PAGES AND IF THERE'S INTEREST IN
MORE SPECIFICS ON WHAT'S
HAPPENING ON THOSE, YOU CAN GO
TO DIETARY GUIDELINES.gov, THE
RELATED PROJECTS TAB AND THERE'S
A SECTION ON ALCOHOLIC BEVERAGES
AND LINKS TO WEBSITES THAT
PROVIDE MORE INFORMATION ON HHS
AND NASEM.
I'LL ALSO NOTE THAT BOTH OF
THOSE PROJECTS ARE SCIENTIFIC
ACTIVITIES AND WILL INCLUDE
EXTERNAL SCIENTIFIC PEER REVIEW.
BOTH ARE UNDERWAY AT DIFFERENT
STAGES BUT BOTH SLATED TO BE
COMPLETED BY THE END OF THE
CALENDAR YEAR.
SO OBVIOUSLY WE TALKED ABOUT THE
TIME LINE FOR THIS COMMITTEE
WITH THE KWOEL TO BE COMPLETED
LATE 2024 AND BEVERAGES AND
HEALTH WILL BE LATE 2024 AROUND
NOT SOMETHING WE'LL HAND TO YOU
REACT TO BUT REPORTS THAT WILL
BE DEVELOPED FOR THE TWO
PROJECTS THAT WILL THEN COME
DIRECTLY TO USDA AND HHS IN
CONSIDERATION OF DEVELOPING THE
NEXT EDITION OF THE DIETARY
GUIDELINES.
I'LL NOTE BOTH PROJECTS AS I
SAID NOW SEVERAL TIMES THEY'RE
EVIDENCE REVIEW PROJECTS.
THOSE REPORTS WILL HAVE FINDINGS
BUT NOT RECOMMENDATIONS.
THEY'RE NOT GOING TO DEVELOP
RECOMMENDS ON ALCOHOL AND HEALTH
BUT PROVIDE THE FIND BEINGS FRO
THE STUDIES AND SUBMITTED TO THE
DEPARTMENTS.
THE NEXT SLIDE GIVES INFORMATION
ABOUT THE TWO DIFFERENT
PROJECTS.
ON THE TOP YOU SEE THE NASEM
STUDY AND ON THE BOTTOM THE HHS
STUDY.
THE NASEM STUDY IS DIFFERENT AND
IT'S A SYSTEMATIC REVIEW RELATED
TO ALCOHOLIC BEVERAGES AND
HEALTH OUTCOMES YOU SEE LISTED
THERE.
AND THE HHS STUDY IS MORE
ORIGINAL ANALYSES.
CONDUCTING ANALYSES THAT LOOK AT
RISK ESTIMATES ASSOCIATED WITH
DIFFERENT LEVELS OF ALCOHOL
BEVERAGES.
THE WORK WILL BE COMPLETED LATER
THIS YEAR AND YOU CAN GO TO THE
WEBSITE IF THERE'S INTEREST IN
MORE DETAIL ON THE PROJECTS.
ON THE NEXT SLIDE A LITTLE BIT
OF UPDATE ON DIETARY REFERENCE
INTAKES AND DRIs CAME UP
YESTERDAY AND TODAY.
THE DRIs PROVIDE NUTRIENT
RECOMMENDATIONS WHERE THE
GUIDELINES BRING THOSE TO LIFE
THROUGH FOOD-BASED
RECOMMENDATIONS.
BUT THE DRIs ARE NOT ESTABLISHED
BY THROUGH THE PROCESS.
THEY'RE ESTABLISHED THROUGH
SEPARATE ACTIVES THROUGH THE
NATIONAL ACADEMIES.
THOSE STUDIES WITH THE NATIONAL
ACADEMIES ARE FUNDED AND
SUPPORTED WE A JOINT
U.S.-CANADIAN DRI WORKING GROUP
WITH REPRESENTATIVES FROM HHS
AND USDA AND HEALTH CANADA AND
WE WORK TOGETHER DO STRATEGIC
PLANNING AND SUPPORT DRI UPDATE.
A FEW YEARS AGO THE DRI WORKING
GROUP PRIORITIZED DRIs UPDATED
ON ENERGY AND THE MACRO
NUTRIENTS.
SO THAT WORK HAS BEEN MOVING
FORWARD AND SO AS ALL OF YOU
KNOW A NEW DRI FOR ENERGY THAT
WAS PUBLISHED ABOUT A YEAR AGO.
AND THE DRI WORKING GROUP JUST
AS WE USE SYSTEMIC REVIEWS TO
INFORM THE DIETARY GUIDELINES WE
USE SYSTEMATIC REVIEWS TO
SUPPORT THE DRI UPDATES.
WHAT'S BEEN GOING ON IS THAT
THIS WORKING GROUP HAS FUNDED A
SERIES OF SYSTEMATIC REVIEWS
WITH THE HHS AGENCY FOR RESEARCH
AND QUALITY FOR ARCH.
SO WE HAVE FUNDED SYSTEMATIC
REVIEWS ON DIETARY PROTEIN AND
DIFFERENT HEALTH OUTCOMES AND
CARBOHYDRATES, FIBER AND FAT AT
DIFFERENT STAGES OF COMPLETION
OR STARTING IN SOME CASES.
WE'LL STAND UP A COMMITTEE TO
UPDATE THE DRIs FOR MACRO
NUTRIENTS AND ENERGY WHICH WERE
LAST UPDATED ABOUT 20 YEARS AGO.
WE'RE IN A GOOD SPOT TO BE
UPDATING THOSE.
I'LL JUST NOTE WE ORIGINALLY
THOUGHT ABOUT DOING THE MACRO
NUTRIENTS INDIVIDUALLY BECAUSE
THEY HAVE DIFFERENT EXPERTISE.
BUT WE HAVE A STANDING COMMITTEE
WITH THE NATIONAL ACADEMIES ON
THE DRIs AND THAT RECOMMENDED
JUST AS WAS DONE 20 YEARS AGO --
THEY'RE ALL INTERRELATED.
IT'S HARD TO DO ONE WITHOUT
CONSIDERATION OF THE OTHER.
THE STANDING COMMITTEE
RECOMMENDED DOING A BIG
COMPLICATED COMPLEX COMMITTEE SO
THAT'S WHAT WE'RE GOING TO
PURSUE.
IF THERE'S INTEREST IN THAT,
THAT IS WORK THAT IS THE
SYSTEMATIC REVIEW WORK IS
UNDERWAY NOW AND WE HOPE TO HAVE
THAT NASEM COMMITTEE PROBABLY
WITHIN THE NEXT YEAR WE'LL
HOPEFULLY BE ABLE TO START
MOVING ON THAT.
AND NEXT UPDATE IS ON
SUSTAINABILITY.
WE HAVEN'T ASKED YOU TO CONSIDER
ISSUES RELATED TO SUSTAINABILITY
IN YOUR REVIEW BUT NOT TO SAY
IT'S NOT IMPORTANT.
USDA AND HHS FIND THEM IMPORTANT
TOPICS.
WHAT WE DID SAY WE WOULD DO
EARLY ON IN THE PROCESS TO
UPDATE THE NEXT EDITION WE SAID
WE WOULD ESTABLISH A WORK GROUP
THAT WOULD SAY, OKAY, WHAT ARE
THE MERITS OF INCLUDING
CONSIDERATIONS RELATED TO
SUSTAINABILITY IN THE DIETARY
GUIDELINES AND IF WE WERE TO DO
IT WHAT WOULD BE THE PROCESS?
WE HAVE A WORK GROUP ESTABLISHED
WITH MEMBERS FROM DIFFERENT
AGENCIES IN USDA AND HHS WHO ARE
EXAMINING A PROCESS FRAMEWORK
FOR CONSIDERING INCORPORATING
SUSTAINABILITY IN THE DIETARY
GUIDELINES PROCESS AND/OR
THROUGH OTHER ACTIVITIES IN THE
DEPARTMENTS.
THAT WORK GROUP IS PLANNING A
PUBLIC MEETING AND SO JUST
PUTTING A FLAG FOR THOSE
INTERESTED IN THIS TOPIC
THERE'LL BE A PUBLIC MEETING
RELATED TO THIS AND THAT PUBLIC
MEETING WILL BE ANNOUNCED
THROUGH THE FEDERAL REGISTER BUT
FOR THOSE PEOPLE WHO DON'T
FOLLOW THE FEDERAL REGISTER ALL
THE TIME WE'LL INCLUDE THAT
INFORMATION ON OUR WEBSITE AND
DO REGULAR UPDATES THROUGH OUR
LIST SERVE AND WILL MAKE SURE TO
INCLUDE THAT NOTE IN THERE.
IF THERE'S INTEREST WE ENCOURAGE
PEOPLE TO TUNE IN FOR THAT.
THE RECOMMENDATIONS FOR THAT
WORK GROUP WILL BE RELEASED
PUBLICALLY AIMED FOR THE
BEGINNING OF 2025.
AND THEN FINALLY, JUST WANTED TO
NOTE A RECENT PUBLICATION BY
STAFF AND THE WORK IMPORTANT FOR
ENHANCING PUBLIC WORK AND WE
STOOD UP THE WORK THAT YOU DO
BUT WE ALSO STILL KNOW THERE'S A
LOT OF MISUNDERSTANDING OR
MISINFORMATION ABOUT THE WORK
AND IT'S MULTI-YEAR.
WE HEAR THE DIETARY GUIDELINES
IS FOR HELPING PEOPLE AND WE
SPEAK TO MISINFORMATION WE WERE
CONSISTENTLY HEARING.
AND THE DIETARY GUIDELINES IS
FOR HEALTHY POPULATIONS TO
ADDRESS THAT THROUGH THE
APPLICATION.
AT THE END OF THE DAY AND ALSO
WITH THE PUBLIC TO SUPPORT
UPTAKE OF THE RECOMMENDATIONS
AND HOPE THE INFORMATION ON
DIETARY GUIDELINES.gov AND THIS
WEBSITE WILL HELP PROVIDE MORE
TRANSPARENCY AND TRUST IN THE
RIGOR AND WORK THAT YOU DO, THE
WORK THE STAFF DOES AND THE WORK
OF THE PROCESS.
WITH THAT I'M HAPPY TO ANSWER
ANY QUESTIONS OR ANY.
>> HOW WILL THE WORK THAT THE
SUBCOMMITTEE 3 IS WORKING ON THE
MODELLING OF THE DIETS
INCORPORATED WITH THE
SUSTAINABILITY?
BECAUSE IT WILL BE NIGHT TO BE
ABLE TO PAIR THOSE AND SEE IF
WHAT WE ARE SUGGESTINGS HAN
IMPACT OR EVEN POSSIBLE -- WILL
BE THE IMPLICATIONS?
IS THERE A TIME TO COMPLEMENT
THOSE THINGS?
>> IT'S A CONCURRENT WITH THE
FOOD MODELLING WORK Y'ALL ARE
DOING.
ARE CONSIDERATIONS AROUND
SUSTAINABILITY IS THAT A
SYSTEMATIC REVIEW OR WITHIN A
MODELLING ACTIVITY.
I WOULD SAY PROBABLY FOR THIS
COMMITTEE WORK WE WON'T
INTEGRATE IT YOUR CONSIDERATIONS
IN THE MODELLING
RECOMMENDATIONS.
BUT IT'S A GREAT CONSIDERATION
WHERE IT COULD BE CONSIDERED
WITHIN THE PROCESS.
>> MY QUESTION IS SIMILAR.
BECAUSE I NOTICE THE PLANNING
HAPPENING IN THE 2025 REVIEW OF
THE PROCESS.
I WONDER IF THE 2020 GUIDELINES
MAY BE A TEST RUN FOR WHATEVER
IS HAPPENING WING THE
SUSTAINABILITY CONVERSATION AND
UPDATED WITH REAL TIME
INFORMATION ONCE THE
DELIBERATION IS OVER.
>> I THINK THAT'S GREAT INPUT.
THERE ARE A FEW OF US WHO
SUPPORT THAT WORK GROUP.
IT IS A WORK GROUP SUPPORTED BY
USDA RESEARCH AND ECONOMICS
COMMITTEE AS WELL AS HHS' OASH.
WE HAVE NUMBERS BUT NOT LEADING
IT.
WE CAN BRING THE COMMENTS BACK
TO THAT FROUP.
-- GROUP AS THEY CONTINUE TO
WORK ON THIS TOPIC.
>> ONE OF THE REASONS YOU
PUBLISHED IS THE ISSUE WITH
TRANSPARENCY IN OUR WORK AND WE
STRUGGLED WITH MAKING SURE
TREMENDOUS SYSTEMATIC REVIEWS
ARE TRANSPARENT TO THE PUBLIC.
MAKING SURE THE WORK WE PUT INTO
THIS IS SEEN BY THE PUBLIC I
THINK WHEN WE LOOK AT THIS SET
OF GUIDELINES AND MAKE SURE THE
TREMENDOUS NUMBER OF WORK HOURS
THE STAFF HAS PUT IN AND THE
COMMITTEE'S PUT IN IS PUBLIC SO
THEY GET TO SEE THE VOLUME OF
WORK THAT'S BEEN PUT IN.
THE TRANSPARENCY EITHER THROUGH
ANOTHER OUTLET IS MADE KNOWN TO
THE PUBLIC AND MAKING SURE THIS
ISN'T JUST FOR HEALTHY AND
REVALING THAT TO THE PUBLIC AND
IF YOU WANT TO COMMENT ON THAT,
THAT'D BE GREAT.
>> AGREE 100%.
THERE'S A NUMBER OF PRODUCTS
FROM THE COMMITTEE'S WORK AND
PROVIDES INFORMATION ON WHAT WAS
DONE AND SUGGESTIONS MADE AND
THE FULL SYSTEMATIC REVIEWS
AVAILABLE AND ALSO PROVIDE AND
THAT WILL BE THE FULL SYSTEMATIC
REVIEW REPORT AND THEN WE'LL
ALSO HAVE ALL THE FOOD PATTERN
MODELLING ANALYSES AVAILABLE
THROUGH DIETARY GUIDELINES.gov
AND ACCESS THE REVIEWS THROUGH
THAT WILL AS A FUNNEL FOR ALL
THESE PIECES.
WE'VE BEEN OPEN AND HAVE HAD
CONVERSATIONS ABOUT DOING ALSO
PUBLISHING AND JOURNAL ARTICLES
AND PREVIOUS COMMITTEES HAVE
DONE THAT IN CERTAIN TOPICS BUT
WE THINK THAT'S REALLY IMPORTANT
TO THE PROCESS AS WELL THE.
SO IF THERE'S INTEREST IN DOING
ANY PUBLICATION OF ANY OF THE
SYSTEMATIC REVIEW, FOOD PATTERN
MODELLING OR OTHER WORK WE'D BE
HAPPY TO SUPPORT THAT WITH THE
COMMITTEE.
>> WITH THAT I'LL TURN IT OVER
TO DR. EICHER-MILLER TO CONTINUE
THE ANALYSIS.
>> I HAVE RESULTS FROM THE DATA
ANALYSIS PORTION.
I WANT TO REMIND EVERYBODY THE
DATA ANALYSIS IS ONE OF THE
THREE APPROACHES THAT WE USE IN
ULTIMATELY INFORMING OUR REPORT
FOR THE GUIDELINES.
AND DATA ANALYSIS GIVES US
ANALYSIS ON THE UPDATES MOST
CURRENTLY AND I WANT TO
RECOGNIZE I HAVE THREE WONDERFUL
ADDITIONAL PRESENTERS TODAY FROM
OUR COMMITTEE, DR. TOBIAS AND
DR. FUNG TO HELP GIVE THE
RESULTS OF THE WORK.
LET'S GET STARTED THEN.
FIRST I'LL QUICKLY REVIEW OUR
PROGRESS TO REMIND YOU WHERE WE
ARE WE'LL BE SHARING OUR
HIGH-LEVEL SUMMARY OF WHAT WE
FOUND AND THEN MOVE AND THEN WE
HAVE AN A DISCUSSION AND BEFORE
WE SURED THE RESULTS I WANT TO
KEEP IN YOUR MIND YOU OF A FEW
THINGS OF COMMITMENT.
WE HAD REQUESTED OUT TO SEVERAL
FEDERAL PARTNERS THE AGRICULTURE
RESEARCH SERVICE, THE CENTER FOR
DISEASE CONTROL AND PREVENTION
AND THE NATIONAL CANCER
INSTITUTE DATA SOURCE EXPERTS TO
ANALYZE DATA FOR US.
AND WE'VE BEEN ABLE TO COLLECT
THE RESULTS TOGETHER AND OUR
STAFF HAVE LED CREATING
SUMMARIES OF THE MAGNITUDE OF
DATA AND THOSE ARE ALL RELATED
TO THE FOUR QUESTIONS THAT WE
ASKED IN DATA ANALYSIS THAT I'LL
GET TO IN A MINUTE.
THEN WE AS A COMMITTEE HAVE
TALKED ABOUT THOSE RESULTS AND
SYNTHESIZED THEM AND HAVE BEEN
IN CLOSE COLLABORATION WITH THE
HEALTH EQUITY WORKING GROUP TO
BRING IN THAT INTEGRATION OF
HEALTH EQUITY ANALYSIS AND
INTERPRETATION OF THAT.
MOVING FORWARD, WHEN WE REVIEWED
THE EVIDENCE WE ADDRESSED THESE
FOUR QUESTIONS SO WE'LL GO OVER
THEM TODAY IN THIS ORDER AS
WELL.
THE FIRST WAS WHAT ARE THE
CURRENT PATTERNS OF FOOD AND
BEVERAGE CONSUMPTION IN THE
POPULATION AND TO REMIND YOU OF
WHAT WE MEAN BY PATTERNS, THIS
IS GETTING TO OVER ALL DIET
QUALITY AND A LOOK AT THE
DIFFERENT EATING OCCASIONS LIKE
EATING BREAKFAST, EATING SNACKS.
AND CONSUMPTION OF BEVERAGES.
THOSE ARE THINGS WE COVER IN
PATTERNS.
THEN WE ALSO GATHERED ANALYSIS
ON THE CURRENT INTAKE OF FOOD
GROUPS, NUTRIENTS AND DIETARY
COMPONENTS AND WE TOOK A LOOK AT
WHERE WE ARE WITH AS A
POPULATION WITH REGARD TO
NUTRITION-RELATED CHRONIC HEALTH
CONDITIONS BECAUSE DIET IS
HEAVILY RELATED TO THE
PREVALENCE OF THOSE CONDITIONS.
SO WE NEED THAT TO GROUND US.
FINALLY, WE USED THAT CURRENT
INTAKE INFORMATION FOR OUR
QUESTION 2 TO INFORM HOW WE ARE
FLAGGING CERTAIN NUTRIENTS AND
DIETARY COMPONENTS THAT ARE A
PROBLEM IN THEIR MAGNITUDE OF
UNDER OR OVER CONSUMPTION IN THE
U.S. THEY RISE TO THE LEVEL OF
PUBLIC HEALTH CONCERN.
THAT WAS OUR FOURTH PIECE OF THE
ANALYSIS.
AND THEN REMIND YOU WHERE WE'RE
GETTING THE DATA.
WHAT THE RESULTS -- WHO THEY
REPRESENT AND WHERE THAT DATA'S
COMING FROM.
SO WE'VE ALREADY MENTION ED 42
WHAT WE EAT IN AMERICA DATA UP
TO TWO 24-RECALLS FOR EACH
PERSON IN THE SAMPLE FROM THE
NATIONAL HEALTH AND NUTRITION
EXAMINATION SURVEY.
WITH THAT DATA WE CAN CREATE
ESTIMATES OF USUAL INTAKE FOR
THE POPULATION OR FOR OUR
SUBGROUPS.
THAT DATA RELIES ON THREE
ADDITIONAL DATABASES TO SUPPORT
THAT.
FROM THAT DATA WE GET THE FOODS
BUT WE ALSO NEED TO UNDERSTAND
THE COMPONENTS OF THE FOODS AND
THE NUTRIENTS.
SO THAT'S COMING FROM THE FOOD
AND NUTRIENT DATABASE FOR
DIETARY FOOD BASE AND WE TALKED
ABOUT LASAGNA AND TALKING ABOUT
THE GRAIN GROUP, VEGETABLE
GROUP, PROTEIN GROUP.
THE FOOD PATTERN EQUIVALENCE
DATABASE ALLOWS US TO DO THAT
AND THEN WITH NEED TO CATEGORIZE
THOSE FROM THE
WWEIA FOOD CATEGORIES.
THE RESOURCE ON CURRENT INTAKES
FROM THE DATA SOURCE IS TRULY
SUPER IMPORTANT FOR UPDATING THE
GUIDELINES.
WE'VE USED THAT TO ADDRESS ALL
FOUR OF OUR QUESTIONS.
WE RELIED ON A FEW ADDITIONAL
DATA SOURCES.
FOR DATA ON BREAST FEEDING
INITIATION AND DURATION, WE'VE
USED THE NATIONAL IMMUNIZATION
SURVEY FOR THE CHILD.
WE'VE ALSO GOTTEN INFORMATION ON
BREAST FEEDING INITIATION AND
DURATION AND MATERNAL
GESTATIONAL CONDITIONS FROM THE
NATIONAL VITAL STATISTICS
SYSTEM.
THEN WE'VE USED THE NATIONAL
HEALTH INTERVIEW SURVEY FOR
SELF-REPORTED DATA ON CHRONIC
HEALTH CONDITIONS IN ADDITION TO
CLINICAL TO CHRONIC HEALTH
CONDITIONS WE'VE GOTTEN FROM
NHANES AND UTILIZED THE
SURVEILLANCE EPIDEMIOLOGY AND
CANCER BASED REGISTRIES AND
THAT'S WHERE OUR DATA IS COMING
FROM.
WE HAVE SOME -- THOUGH THIS IS A
WONDERFUL RESOURCE FOR US WE
STILL HAVE SOME LIMITATIONS AND
CONSIDERATIONS WE HAVE TO KEEP
IN MIND WITH THIS DATA.
WHEN WE'RE DOING ANALYSIS AND
BREAKING OUR POPULATION DOWN TO
LOOK AT CERTAIN SUB GROUPS.
AND WE CAN HAVE SMALLER SAMPLE
SIZES SOMETIMES WE HAVE TROUBLE
FWETH RELIABLE ESTIMATES FROM.
SO WHEN YOU SEE -- WHEN WE
DIDN'T HAVE THAT ROBUSTNESS IN
THE CONFIDENCE INTERVALS IN THE
DATA, WE'LL INDICATE THAT IN THE
SLIDES WITH THE STAR.
SO WE DON'T SHOW SOME OF THOSE
ESTIMATES WHERE WE HAVE TROUBLE
THERE.
ALSO TO GET RELIABLE ESTIMATES
SOMETIMES WE HAD TO ADD TOGETHER
MULTIPLE YEARS OF SURVEY DATA.
IN THOSE CASES IT WOULDN'T
REPRESENT THE CURRENT COUPLE
YEARS.
IT'S MORE OF AN ESTIMATE OVER
TIME.
AND FOR THE DIFFERENT GROUPS WE
BROKE DOWN THE INTAKE LOOKS AT,
WE DIDN'T TEST FOR STATISTICALLY
SIGNIFICANT DIFFERENCES AMONG
THOSE GROUPS.
SO YOU HAVE TO REMEMBER WHEN YOU
SEE PREVALENCE ESTIMATES THAT
ARE A FEW PERCENTAGE POINTS
DIFFERENT THEY MAY NOT REPRESENT
ACTUAL DIFFERENCES THAT ARE
MEANINGFUL.
AND THEN THEN FINALLY WITH A LOT
OF THE DIETARY DATA IT'S ALL
SELF-REPORTED.
SO WE DO KIND OF HAVE MORE
KNOWLEDGE OF WHAT KINDS OF
ERRORS FOR ADULTS REPORTING
THEIR DIET.
BUT FOR PROXY REPORTING OF
ADULTS ON KIDS DATA WE HAVE LESS
OF AN UNDERSTANDING OF WHAT KIND
OF ERROR MIGHT BE PART OF THOSE
ESTIMATES.
SO THAT'S JUST IMPORTANT TO KEEP
IN MIND WHEN WE'RE CONSIDERATION
ALL THIS DATA.
MOVING ON, THEN I MENTIONED WE
BROKE OUR DATA DOWN TO LOOK AT
THE DIFFERENT POPULATIONS
SUBGROUPS AND FOR MOST ANALYSES
WE WERE ABLE TO DO THAT FOR THE
7 THINGS LISTED ON THE LEFT, AGE
GROUP AND LIFE STAGE, SEX, RACE
AND/OR ETHNICITY, POVERTY INCOME
RATIO, FOOD SECURITY, RECEIVING
FOOD STAMPS OR SNAP OR NOT OR
RECEIVING WIC OR NOT.
WHEN AVAILABLE WE ALSO LOOKED AT
SEVERAL OTHER KINDS OF
CHARACTERISTICS OR SITUATIONS.
AND I WON'T REVIEW EACH ONE OF
THOSE.
I ALSO WANT TO NOTE WHAT WE'RE
SAYING TODAY I SAID BEFORE IT
CAN'T BE EVERYTHING BUT YOU CAN
SEE EVERYTHING IN THE REPORT
THAT WE WILL BE PUBLISHING
ONLINE.
SO THAT WILL ALL BE OUT THERE
FOR ANYONE TO LOOK AT.
WE DIDN'T ALWAYS DO STATISTICAL
TESTING.
WE ALREADY ADDRESSED THAT.
THERE'S ALSO MANY COMPLEX
FACTORS AT PLAY HERE LIKE SO
WHEN WE'RE BREAKING DOWN GROUP
BY SOCIO ECONOMIC STAT FOR
EXAMPLE WE CAN'T SAY THE REASONS
ARE ATTRIBUTED TO THAT FACTOR
AND THAT RELATES TO THE NEXT
POINT TOO ON EACH OF US BELONG
TO MANY GROUPS.
WHEN WE BREAK DOWN BY JUST ONE
GROUP, THERE CAN BE THINGS
HIDDEN IN THE DATA THAT COULD BE
PART OF THE REASON FOR THE
DIFFERENCES BUT WE DON'T ALWAYS
SEE THAT BASED ON HOW WE BROKE
IT DOWN.
THEN TO REMEMBER TOO ALL THE
DATA ARE CROSS SECTIONAL.
THEY'RE NOT CAUSAL.
WE CONSENT SAY THOSE FACTORS ARE
THE REASON FOR THOSE DIFFERENCES
OR THERE'S CAUSE AND EFFECT
GOING ON THERE.
IT'S A SNAPSHOT WE HAVE.
WITH THAT WE'LL MOVE FORWARD AND
GIVE A BRIEF SUMMARY OF WHAT THE
PRIOR COMMITTEE FOUND BEFORE WE
TALK ABOUT OUR RESULTS.
THE 2020 COMMITTEE CONCLUDED THE
U.S. DIETARY LAND SCAPE DIDN'T
CHANGE THAT MUCH WITH REGARD TO
THE QUALITY OF THE DIETS AND
INTAKES OVER THE LAST DECADE.
AND THE PATTERNS OF FOOD GROUP
INTAKE ACROSS THE LIFE COURSE
THAT THEY FOCUSSED ON IN THAT
COMMITTEE WERE CONTRIBUTING TO
HIGHER THAN RECOMMENDED INTAKES
OF ADDED SUGARS, SODIUM AND
SATURATED FATS AND NOT ENOUGH
INTAKE OF FRUITS, VEGETABLES AND
WHOLE GRAINS.
AND THAT WAS FOR PRETTY MUCH
EVERYONE ACROSS THE POPULATION.
AND THEY ALSO PROPOSED
GUIDELINES THEY INFORMED
GUIDELINES TO HELP EVERYONE MEET
THOSE NUTRITIONAL GOALS.
AND TO GIVE YOU OUR OVER ALL
SUMMARY, WE SIMILARLY FOUND THAT
DESPITE HAVING THOSE GOALS THE
POPULATION ARE STILL NOT MEETING
THE INTAKES THAT ALIGN WITH THE
DIETARY GUIDELINES AND FOR MANY
NUTRIENTS AND DIETARY COMPONENTS
THE REQUIREMENTS ARE NOT BEING
MET.
THERE IS SOME VARIATION AMONG
THE SUBGROUPS THAT WE LOOKED AT.
AND YOU'LL SEE THAT IN THE DATA
WE PRESENT BUT THE TAKE HOME
MESSAGE IS THE ENTIRE POPULATION
IS STRUGGLING TO MEET THE
GUIDANCE AND DOING WORK THAT
HELPS EVERYONE IMPROVE.
WE'RE GETTING TO GIVE YOU THE
RESULTS AND THAT WILL BE OUR
FIRST QUESTION WHICH ARE WHAT
ARE THE CURRENT PATTERNS OF FOOD
AND BEVERAGE INTAKE AND I'LL
TURN IT OVER TO CAROL.
>> THANK YOU, HEATHER.
TODAY OUR FIRST QUESTION THAT
WE'RE GOING TO ANSWER IS WHAT
ARE THE CURRENT PATTERNS OF FOOD
AND BEVERAGE INTAKE.
FOR EACH DATA ANALYSIS QUESTION
WE'LL BE LOOKING AT WE'VE
IDENTIFIED KEY THEMES.
ONE MAJOR THEME IS THE HEI 2020
SCORES DIETARY PATTERNS DO NOT
ALIGN WITH THE DIETARY
GUIDELINES AMONG ANY SOCIO
ECONOMIC GROUPS AND NOTICE KEY
THEMES FOR BEVERAGE PATTERNS
RELATIVE TO SUBCOMMITTEE 1,
HUMAN MILK FEEDING AND EATING
OCCASIONS INCLUDE BREAKFAST,
SNACKING AND LATE-EVENING
CONSUMPTION RELEVANT TO
SUBCOMMITTEE 4.
MOVING ON, AS YOU MAY RECALL
FROM MEETING 3 WE PRESENTED DATA
ON THE HEI 2020 SCORES WE WANT
TO REFRESH YOUR MEMORY ON.
THE HEALTHY EATING ARE MEASURES
OF DIET QUALITY WITH 13
COMPONENTS USED TO ASSESS HOW
WELL A SET OF FOODS ALIGN WITH
THE KEY RECOMMENDATIONS FOR THE
DIETARY GUIDELINES FOR
AMERICANS.
THE HEI 2020 IS FOR AGE 2 AND
OLDER AND TODDLERS 2020 IS 12 TO
24 MONTHS.
HEI USES A DENSITY APPROACH PER
1,000 CALORIES.
THE IDEAL OVER ALL HEI SCORE IS
100 AND YOU CAN TELL BY A QUICK
GLANCE INDIVIDUALS ARE NOT
ALIGNING WITH THE DIETARY
GUIDELINES WE HAVE HEI SCORES
BETWEEN EACH CROSS SECTIONAL
DATA YEAR FOR AGES 2 AND OLDER
AND ON THE RIGHT A BAR GRAPH
WITH HEI FOR 2 AND OLDER.
THE-EI FOR TODDLERS IS 63 FOR
AGES 12 TO 24 MONTHS AND FOR 2
PLUS IS 58.
HOWEVER, VARIATION IS OBSERVED
BY AGE GROUP THOUGH STATISTICAL
DIFFERENCES CAN'T BE DETERMINED.
THE YOUNGEST CHILDREN AND OLDEST
ADULTS HAVE HIGHER SCORES
COMPARED TO OTHER AGE GROUPS,
HOWEVER, HEI 2020 ZEROES ARE LOW
RANGING FROM 49 TO 63.
MOVING ON TO THE SLIDE THAT
SHOWS HOW THE HEI2020 SCORES
RANGE FROM 53 FOR FEMALES, 20 TO
44 WHO ARE NOT PREGNANT OR
LACTATING TO A HIGH OF 65 AMONG
INDIVIDUALS NON-HISPANIC ASIAN.
HOWEVER, SIMILAR TO THE DATA BY
AGE TO THE PREVIOUS SLIDE THE
MAIN MESSAGE IS NO SOCIO
DEMOGRAPHIC GROUPS ALIGN WITH
THE DIETARY GUIDELINES AND FAR
BELOW THE RECOMMENDATIONS.
THE NEXT FEW SLIDES ON BREAKFAST
LATE EVENING CONSUMPTION AND
THERE'S THE FREQUENCY OF MEALS
AND/OR SNACKING AND GROWTH BY
COMPOSITION OF RISK OF OBESITY
AND CONSUMING A DIETARY
GUIDELINES ALIGNED WITH THE
GUIDELINES OF AMERICANS.
AMONG BREAKFAST CONSUMERS IT
REPRESENTS 21% OF CALORIES DAILY
AND IT VARIES AMONG SOCIO
GROUPS.
THERE'S NO STATISTICAL
DIFFERENCE BETWEEN FEMALES AND
MALES WHO ARE BREAKFAST
CONSUMERS AND NO DIFFERENCE BY
RACE AND/OR ETHNICITY OR BY
FAMILY INCOME.
AND THE PREVALENCE OF BREAKFAST
CONSUMPTION IS HIGHEST AMONG
CHILDREN 2-5 AND LOWEST AMONG
12-19.
THE NEXT SLIDE TALKS ABOUT THE
DATA FOR ADULTS AND OLDER ADULTS
WHO ARE BREAKFAST CONSUMERS.
SAME AS WITH THE CHILDREN, 21%
OF THE DAILY CALORIES AND THIS
IS AMONG GROUPS AND STATISTICAL
TESTING SHOWS BREAKFAST
CONSUMPTION DOES NOT DIFFER
BETWEEN MALES AND FEMALES BUT
OLDER ADULTS AGES 60 PLUS ARE
LIKELY TO CONSUME BREAKFAST THAN
THOSE THAT ARE 20 TO 39 AND
THOSE 40 TO 59.
A LOWER PERCENTAGE OF THOSE
NON-HISPANIC BLACK CONSUMED
BREAKFAST THAN NON-HISPANIC
WHITE AND NON-HISPANIC ASIA YOON
AND OLDER ADULTS WITH FAMILY
INCOMES BETWEEN 131% AND 350% OF
THE POVERTY LINE ARE MORE
LIKELY TO CONSUME BREAKFAST THAN
THOSE WHO ARE LESS THAN 131% OF
THE NATIONAL POVERTY LINE AND
THE LATE EVENING EATING ARE FOR
THOSE WHO REPORT ANY FOOD OR
BEVERAGE INTAKE OTHER THAN PLAIN
WATER YOU SEE THE RANGES AND
MALES CONSUME SIGNIFICANTLY MORE
ENERGY IN THE LATE EVENING
COMPARED TO FEMALES WITHIN SOCIO
DEMOGRAPHIC GROUPS FOR AGES 12
TO 15 AT A RATE OF 124 CALORIES.
BETWEEN 16 AND 9 AT
AND 19 CONSUME 121 AND SOME HAVE
HIGHER INTAKE COMPARED TO
NON-LATE CONSUMERS OR ADDITIONAL
320 CALORIES.
THERE ARE NO SIGNIFICANT
DIFFERENCES IN THE CALORIE
INTAKE OF LATE EVENING OCCASIONS
BETWEEN NON-HISPANIC WHITE,
NON-HISPANIC BLACK AND HISPANIC
ADOLESCENTS.
ON THE BOTTOM RIGHT WE CAN SEE
OF THOSE WHO ARE LATE EVENING
CONSUMERS, 91% REPORT HAVING
FOOD AND 71% REPORT HAVING
BEVERAGES.
THE TOP FOOD SOURCES ARE SNACKS
AND SWEETS AND MIXED DISHES AND
TOP BEVERAGE CHOICES ARE
SWEETENED BEVERAGES AND MILK AND
DAIRY DRINKS.
WE'LL LOOK AT LATE NIGHT
CONSUMPTION OF ADULTS WHICH
INDICATE THAT THERE'S
SIGNIFICANTLY LOWER INTAKE
DURING THE TIME PERIOD AMONG
ADULTS AGES 60 PLUS AT A RATE OF
57% COMPARED TO AGES 20 TO 29
AND 40 TO 59 YEARS AT A
PREVALENCE RATE OF 66% FOR BOTH
AGE GROUPS.
LATE EVENING CONSUMERS HAVE
HIGHER TOTAL DAILY CALORIES AT
2243 CALORIES THAN NON-LATE
EVENING CONSUMERS CONSUMING 1930
CALORIES.
THAT'S A DIFFERENCE OF 313
CALORIES.
ON THE RIGHT WE HAVE DATA FOR
ADULTS AND OLDER ADULTS WHO ARE
LATE EVENING CONSUMERS AND AMONG
AGES 20 AND OLDER MALES HAVE A
SIGNIFICANTLY HIGHER ENERGY
INTAKE THAN FEMALES.
INDIVIDUALS NON-HISPANIC BLACK
HAVE A SIGNIFICANTLY HIGHER
ENERGY INTAKE FROM LATE EVENING
CONSUMPTION THAN THOSE
NON-HISPANIC WHITE AND
NON-HISPANIC ASIAN AND
INDIVIDUALS WHO ARE NON-HISPANIC
WHITE HAVE LOWER INTAKE FROM
LATE EVENING CONSUMPTION THAN
THOSE NON-HISPANIC BLACK.
89% OF LATE EVENING CONSUMERS
REPORT FOOD CONSUMPTION AND 77%
REPORT BEVERAGE CONSUMPTION OF
FOOD IT'S SNACKS AND SWEETS AND
MIXED DISHES SAME AS WITH
CHILDREN.
AND OF LATE EVENING THERE'S
ALCOHOLIC BEVERAGES.
SNACKS ARE DEFINED AS EATING
OCCASIONS WHERE AT LEAST ONE
FOOD OR BEVERAGE IS DESIGNATED
BY PARTICIPANT AS A SNACKING
OCCASION.
SNACKS COMPRISED OF WATER ARE
NOT INCLUDED.
OVER ALL, 93% OF CHILDREN AND
ADOLESCENTS REPORT HAVING ONE OR
MORE SNACKS ON A GIVEN DAY.
THE PERCENT OF CHILDREN AND
ADOLESCENTS WHO REPORT SNACKING
IS NOT DIFFERENT AMONG MALES AND
FEMALES.
95% OF CHILDREN IN THE 2-5 YEAR
AND 6-11 YEAR RANGE REPORT
SNACKING DAILY WHEREAS 90% OF
ADOLESCENTS HAVE THEM AND SNACKS
CONTRIBUTE ABOUT A QUARTER OR
LESS OF NUTRIENTS FOR CHILDREN
AND ADOLESCENTS WITH THE
EXCEPTION OF 42% OF ADDED SUGARS
FROM SNACKS.
AS SNACK OCCASIONS TOP SOURCES
OF SNACKS ARE SWEETS AND SNACKS
AND FRUIT AND THE TOP SOURCES OF
BEVERAGES ARE SWEETEN BEVERAGES.
THIS DOES NOT INCLUDE PLAIN
WATER.
ON THE LEFT, 95% OF ADULTS
REPORT ONE SNACK EVERY DAY.
ON THE RIGHT AMONG ALL ADULTS
AND OLDER ADULTS, THOSE
REPORTING SNACKS AND THOSE NOT
REPORTING SNACKS SO ALL ADULTS
SNACKS REPORT DIETARY FIBER AND
SATURATED FAT AND SODIUM,
POTASSIUM AND IRON AND 43% OF
DAILY ADDED SUGARS.
SNACKERS REPORT MORE CALORIES AT
221 VERSUS NONE SNACKERS OF A
DIFFERENCE OF 16%.
ON THE RIGHT YOU CAN SEE SNACKS
CONTRIBUTE 24% OF TOTAL DAILY
ENERGY INTAKE AND AMONG THOSE
WHO CONSUME SNACKS THE TOP
SOURCES OF ENERGY INCLUDE SNACKS
AND SWEETS, NON-ALCOHOLIC
BEVERAGES AND ALCOHOLIC
BEVERAGES.
AND NOW WE'LL TRANSITION TO
HUMAN MILK FEEDING INITIATION
AND EXCLUSIVITY.
IT'S DEFINED OF ONLY BREAST MILK
AND NO SOLIDS.
THE PREVALENCE IS 84% ACCORDING
TO BIRTH CERTIFICATE ESTIMATES.
AMONG MATERNAL RACIAL OR ETHNIC
GROUPS BREAST FEEDING INITIATION
GOES FROM 7 4.5 TO 91%.
ACCORDING TO RETROSPECTIVE DATA
REPRESENTING CHILDREN BORN IN
2020 INFANTS ARE FALLING SHORT
OF THE HEALTHY PEOPLE 2030
TARGET OF 54.1% BREAST FEEDING
PREVALENCE AT 12 MONTHS.
THE CURRENT PREVALENCE IS ABOUT
38%.
LET'S LOOK AT EXCLUSIVE BREAST
FEEDING THROUGH SIX MONTHS.
ESTIMATES ON THIS SLIDE FROM
SURVEY DATA COLLECTED
RETROSPECTIVELY FOR CHILDREN
BORN IN 2020.
AMONG SOCIO DEMOGRAPHIC GROUPS
THE RANGE IS 73% FOR MOTHERS
WITH EDUCATION OF LESS THAN HIGH
SCHOOL TO 92% OF MATERNAL
EDUCATION OF A COLLEGE DEGREE.
THERE'S VARIATION BETWEEN YOUNG
MOTHERS AND MOTHERS 30 PLUS AND
BETWEEN RACIAL AND ETHNIC GROUPS
AND POVERTY RACIAL GROUP AND
MATERNAL EDUCATION LEVELS.
WE SEE THERE'S ALSO A SMALL
VARIATION IN THE PREVALENCE OF
EXCLUSIVE BREAST FEEDING THROUGH
SIX MONTHS BY SOCIO DEMOGRAPHIC
GROUPS FROM 19% FROM MATERNAL
EDUCATION LESS THAN HIGH SCHOOL
TO ABOUT 30% FOR MATERNAL
EDUCATION OF A COLLEGE DEGREE.
HOWEVER, AMONG ALL GROUPS THE
HEALTHY PEOPLE 2030 TARGET OF
42.4% IS NOT BEING MET.
EXCLUSIVE BREAST GROUPS IS FOR
30 AND OLDER COMPARED TO THOSE
20 TO 29 YEAR RANGE AND HIGHER
AMONG NON-HISPANIC WHITE INFANTS
COMPARED TO NON-HISPANIC BLACK
AND WHITE AND INFANTS TWO OR
MORE RACES.
LOWER AMONG THOSE WITH THE
POVERTY INCOME RATIO OF LESS
THAN 100 COMPARED TO OTHER
POVERTY INCOME RATIO GROUPS AND
HIGHER AMONG MOTHERS WHO ARE
COLLEGE GRADUATE COMPARED TO ALL
OTHER MATERNAL EDUCATION GROUPS.
MOVING ON TO BEVERAGE INTAKE
PATTERNS WE'LL START WITH
INFANTS 6 TO 12 MONTHS AND YOUNG
CHILDREN 12 TO 24 MONTHS.
FOR INFANTS THE MAIN ENERGY
INTAKES ARE 103 CALORIES FROM
HUMAN MILK, 375 CALORIES FROM
INFANT FORMULA AND 25 CALORIES
FROM OTHER BEVERAGES.
OF THE OTHER BEVERAGES CONSUMED
CONTRIBUTIONS IN THE GRAPH ON
THE LEFT OVER HALF INFANTS ARE
CONSUMING PLAIN WATER.
MOST CALORIES FROM BREAKFAST
FROM BEVERAGES ARE PROVIDED BY
WHOLE MILK AND 100% JUICE.
TOTAL FAT AND VITAMIN D FROM
BEVERAGES CONTRIBUTED BY WHOLE
MILK AND MOST CALCIUM POTASSIUM
BY MILK AND 100% JUICE.
SO MOVING ON TO THE YOUNG
CHILDREN MAIN ENERGY INTAKES ARE
ABOUT 18 CALORIES FROM HUMAN
MILK, 30 CALORIES FROM INFANT
FORMULA AND YOUNG CHILDREN
RECEIVE OTHER BEVERAGES AND
ALMOST 80% OF YOUNG CHILDREN
CONSUME PLANE WATER.
-- PLAIN WATER AND VITAMIN D
AND POTASSIUM ARE PROVIDED BY
WHOLE MILK AND SWEETEN BEVERAGE
CONTRIBUTE 73% OF THE TOTAL
DAILY ADDED SUGARS COMING FROM
BEVERAGES.
IN THE NEXT SLIDE WE'RE LOOKING
AT CHILDREN AND ADOLESCENT
CONSUMPTION AND 43% OF THE MEAN
DAILY INTAKE AND SUGAR INTAKE.
DAILY SWEETENED BEVERAGE
CONSUMPTION VARIES BY RACE AND
ETHNICITY WITH 61% OF CHILDREN
AND ADOLESCENTS WHO ARE HISPANIC
AND 60% OF THOSE NON-HISPANIC
BLACK CONSUMING SWEETENED
BEVERAGES COMPARED TO 35% OF
THOSE WHO ARE NOT NON-HISPANIC
ASIAN.
MILK, SWEETENED BEVERAGES AND
YOU SEE THE SHIFT IN DAILY
INTAKE FROM MILK AND SWEETEN
BEVERAGES AMONG THE AGE GROUPS.
SOFT DRINKS CONTRIBUTE THE
HIGHEST PERCENTAGE OF CALORIES
AND FRUIT DRINKS FOR THE AGE
GROUP OF 2-5 YEARS.
AND 2-5 YEARS WHOLE MILK MAKES
UP THE LARGEST PERCENTAGE OF
TOTAL MILK CALORIES AT 25%.
FINALLY, BEVERAGE PATTERNS IN
ADULTS AND OLDER ADULTS.
BEVERAGES CONTRIBUTE 17% OF
DAILY ENERGY INTAKE.
THIS IS 422 CALORIES FOR MALES
AND 296 CALORIES FOR FEMALES.
HALF THIS COMES FROM SWEETENED
BEVERAGES AND ALCOHOLIC
BEVERAGES ALONE.
THOUGH THERE'S VARIATION BY RACE
AND ETHNICITY AMONG NON-HISPANIC
ASIAN BEING LESS LIKELY TO
CONSUME THEM COMPARED TO OTHER
GROUPS.
BEVERAGES CONTRIBUTE TO FOOD
GROUP INTAKES FOR FRUIT AND
DAIRY AND FORTIFIED SOY
ALTERNATIVES PROVIDING 30% OF
THE DAILY RECOMMENDATIONS AND
CONTRIBUTE TO DAILY INTAKES OF
VITAMIN C AND D, CALCIUM,
POTASSIUM AND MAGNESIUM.
WITH THAT I'LL TURN IT BACK TO
HEATHER.
>> THANK YOU, SO MUCH, CAROL.
WE'LL MOVE ON TO OUR SECOND
QUESTION OF WHAT ARE THE CURRENT
INTAKES OF FOOD GROUPS,
NUTRIENTS AND DIETARY COMPONENTS
AND WE HAVE DIDI DOING THIS ONE.
>> THIS IS GOING TO BE A LOT OF
DATA AND TRIGGER WARNING IT'S
NOT GOOD NEWS.
WE CONTINUE THE TREND OF
UNHEALTHY FOOD ENVIRONMENT AT
THE FOOD GROUP SUBGROUP LEVEL
THE OVER ALL TAKEAWAY IS WE'RE
NOWHERE NEAR DIETARY GUIDELINES
FOR ALMOST ALL THE GROUPS.
EXCEPTIONS ARE GOING TO BE
HIGHLIGHTED WHERE THOSE OCCUR
BUT MANY OF THE TOP FOOD
CATEGORIES IN ADDITION TO NOT
MEETING THE REQUIRED OR
RECOMMEND ED AMOUNTS ARE NOT
COMING FROM THE OPTIMAL SOURCES
AND THE GOALS BEING MET WITH
FOODS NUTRIENT DENSE AND LOWER
IN SATURATED FAT AND SUGAR THEY
SEEM TO BE THE OPPOSITE.
KEEP THAT IN MIND AS WELL.
COLLECTIVELY, BOTH THE QUANTITY
AND QUALITY OF FOODS CONSUMED
ARE NOT IN ALIGNMENT OF THE
DIETARY GUIDELINE.
THIS IS THE BIG PICTURE GRAPH
AND INDICATING SUBGROUP INTAKES
FOR AMERICANS AGES 1 AND UP
REPRESENTED HERE ARE NOT IN
ALIGNMENT AND THE DEGREE OF
SHIFT IS THE PERCENTAGE OF THE
POPULATION THAT ARE ABOVE OR
BELOW THE RECOMMENDATION
DEPENDING ON THE DIRECTIONALITY.
THE BLUE BAR ON THE LEFT FOR
TOTAL VEGETABLES THE DARK BLUE
INDICATES 10% OF THE POPULATION
ARE AT OR ABOVE THE RECOMMENDED
INTAKE OF VEGETABLES WITH THE
REST BELOW.
SO EXCEPTIONS TO THIS AS
MENTIONED THERE WERE A FEW ARE
TOTAL GRAINS AND PROTEIN FOODS.
IT'S MORE AMERICANS MEETING THAN
NOT MEETING THE BINARY CUT
POINT.
BUT TOLD GRAINS IS MISLEADING
BECAUSE WITHIN THAT IT'S
RECOMMENDED TO CONSUME WHOLE
OVER REFINED GRAINS AND YOU CAN
SEE THE TOTAL GRAINS IS
PREDOMINANTLY COMING FROM
REFINED GRAINS.
SO WITHIN TOTAL WE'RE NOT
MEETING THE GUIDANCE FOR WHOLE
GRAINS AND EXCEEDING THE
RECOMMENDED INTAKES OTHER.
THE NEXT SEVERAL SLIDES ARE
GOING TO LOOK SIMILAR TO THIS
ONE AND WHAT IT'S INDICATING IN
THE SQUARES OR BARS ARE WHAT THE
RECOMMENDATIONS ARE ACROSS THE
LIFE STAGES AND BY THAT.
FROM SIX TO 12 MONTHS UP TO 71
PLUS YEARS.
IT'S STRATIFIED BY MALE AND THE
DOTS WITHIN THE SAME COLUMNS
REPRESENT WHAT THE AVERAGE
INTAKE FOR THAT DEMOGRAPHIC
STRATA IS.
SO A DOT WITHIN A COLUMN THAT'S
CLOSE TO THE SQUARE WOULD MEAN
WE'RE DOING OKAY, WELL BELOW
WOULD BE WE'RE FAR OFF FROM
MEETING THE FWIEDANCE AND
EVERYTHING IN BETWEEN.
THE TOTAL VEGETABLE INTAKE WHERE
YOU CAN SEE THE TOP THREE
SOURCES OF GROUPS ARE
NON-STARCHY, BEANS, PEAS AND
LENTILS.
STARCHY VEGETABLES AND BURGERS
AND SANDWICHES.
NOT SHOWN IN THE GRAPH I'LL
HIGHLIGHT THE SOCIO DEMOGRAPHIC
SUBGROUP FINDINGS WE PULLED OUT
FOR YOU.
STARCHY REG VEGETABLES HAVE THE
HIGHEST CONTRIBUTION AMONG
NON-HISPANIC BLACKS 21% OF THAT
AMOUNT AND HIGHEST CONTRIBUTOR
TO TOTAL VEGETABLES AND
NON-HISPANIC ASIANS HAVE THE
HIGHEST CONTRIBUTION TO TOTAL
VEGETABLES COMING FROM
NON-STARCHY VEGETABLES.
COMPARED TO MALES, FEMALES
OBTAIN MORE OF THEIR TOTAL
VEGETABLE INTAKE FROM
NON-STARCHY VEGETABLES THAN
MALES.
AND MALES HAVE A HIGHER
CONTRIBUTION FROM THIS BURGER
AND SANDWICH CATEGORY.
THE TOTAL VEGETABLE INTAKE DOES
NOT VARY BY DEMOGRAPHICS OF
FAMILY INCOME AS A PERCENT OF
THE POVERTY LEVEL.
OF EDUCATION AND FOR VARIOUS
RACE THERE WERE SOME MODERATE
DIFFERENCES SUCH AS NON-HISPANIC
ASIAN INDIVIDUALS REPORTING
HIGHER MEAN DAILY INTAKE OF
NON-STARCHY VEGETABLES COMPARED
TO OTHER GROUPS.
SO MOVING ON NOW LOOKING
SPECIFICALLY AT DARK GREEN
VEGETABLES WITHIN THE TOTAL
VEGETABLE CATEGORY.
FOR THIS SUBGROUP INTAKES ARE
VERY LOW.
AND THIS IS WHERE WE REACHED THE
1.5 CUP EQUIVALENT PER WEEK
GOAL.
EVEN THAT INCREDIBLY MODEST
RECOMMENDATION SEEMS DIFFICULT
TO ACHIEVE ACROSS THE BOARD.
DARK GREEN VEGETABLE INTAKE DID
NOT VARY DRASTICALLY BY RACE AND
ETHNIC SUBGROUP BUT VARIES BY
EDUCATIONAL ATTAINMENT AND
OBESITY STATUS AND HEALTH
INSURANCE STATUS.
THERE WERE HIGHER INTAKE OF
VEGETABLES WITH THOSE WITH
COLLEGE DEGREES AND AMONG THOSE
WHO ARE ENSURED.
-- INSURED.
AGAIN WITH RECOMMENDATIONS
RANGING FROM ONE TO FOUR OR FIVE
CUP EQUIVALENTS PER WEEK, ALL
SUB GROUPS FALL BELOW FROM 1 TO
2 CUP EQUIVALENCE PER WEEK.
BREAD INTAKE DOES NOT VARY MUCH
PER SEX AND AGE AND NOT VARY
MUCH ACROSS ETHNIC RACIAL
SUBGROUPS BUT DID VARY BY
EDUCATIONAL ATTAINMENT AND
OBESITY STATUS AND INSURANCE
STATUS AS SEEN WITH THE DARK
GREEN VEGETABLES.
THE RECOMMENDATIONS FOR THE
STARCHY VEGETABLE SUBGROUP.
WHERE WE FALL WITH THOSE ARE
STILL QUITE SHORT AND POINTING
OUT THESE ARE EQUIVALENTS PER
WEEK GUIDELINES.
BEANS, PEAS AND LENTILS FROM ONE
OR TWO CUP EQUIVALENTS PER WEEK
OF THE VEGETABLE SUBGROUP.
MANY GROUPS CONSUMING TO LESS
THAN ONE CUP EQUIVALENT PER WEEK
OF THIS SUBGROUP.
INTAKES OF OTHER VEGETABLES ARE
BELOW RECOMMENDATIONS AND WOULD
INCLUDE ITEMS LIKE ARTICHOKE,
CELERY, CAULIFLOWER AND OTHERS.
FRUIT.
KIDS UNDER THE AGE OF 9 ARE
FALLING SHORT BY HALF.
THE CATEGORY OF FRUIT WERE WHOLE
FRUIT, 1█00% FRUIT JUICE AND THN
THE THIRD BEING SUGAR SWEETENED
AND DIETARY BEVERAGES.
THE DIET QUANTITY AND QUALITY.
THERE'S AN EXCEPTION IN
NON-HISPANIC WHITE POPULATIONS
FOR BREAKFAST CEREALS AND BARS
ARE THE THIRD LEADING SUB
CATEGORY EXCEPT FOR THE SUGAR
SWEETENED BEVERAGES AS THE TOP
CONTRIBUTOR TO FOOD INTAKE.
THE HIGHEST OVER ALL
CONTRIBUTION OF WHOLE FRUITS SO
EXCLUDING THE JUICES WAS SEEN
AMONG NON-HISPANIC ASIAN
POPULATIONS.
TOTAL PROTEIN FOODS,
CONGRATULATIONS AMERICA, THIS IS
THE ONE CATEGORY MOST GROUPS
ACTUALLY ACHIEVED.
FOR THE RECOMMENDED INTAKES IN
THE BARS WITH MANY GROUPS
MEETING SOME EXCEEDING THE
RECOMMENDED AMOUNTS.
YOU COULD SEE THE DIFFERENCES
ARE MORE STRIKING COMPARED TO
OTHER FOOD GROUPS FOR MALES
VERSUS FEMALES.
MALES IN THE LIGHT BLUE DOTS
BEING ABOVE FOR SOME AGE STRATA
AND SOME FEMALES ARE BELOW
INTAKE.
OVERALL THE THREE CONTRIBUTORS
TO TOTAL PROTEIN FOODS IN AGE 2+
INCLUDED BURGERS AND SANDWICHES,
POULTRY AND MEAT, POULTRY AND
SEAFOOD MIXED DISHES.
MOSTLY ANIMAL PRODUCTS.
THE ORDER AND PROPORTION OF
THESE WITHIN THE CONTRIBUTION TO
TOTAL PROTEIN DID VARY ACROSS
RACE, ETHNIC SUBGROUPS AND BASED
ON THE MEAN INTAKES THE PROTEIN
FOOD GROUP DID VARY CONSIDERABLY
ACROSS SUBCOMPONENTS OF AGE AND
SEX, RACE AND ETHNICITY AND
INCOME AND HOUSEHOLD SECURITY.
FOR EXAMPLE, MALES 20 YEAR PLUS
HAVE A HIGHER OF POULTRY AND
SEAFOOD COMPARED TO FEMALES AT
THE SAME AGE.
LOOKING AT THE MEAT, POULTRY EGG
SUB GROUP THIS IS BACK ON A
WEEKLY EQUIVALENT RECOMMENDATION
SCALE AND SIMILAR TO TOTAL
PROTEINS GIVEN THIS WAS A MAIN
CONTRIBUTOR FOR MOST STRATA WE
SEE SIMILAR TIMES FOR AGE AND BY
SEX ARE IN THIS CATEGORY AS
WELL.
OUNCE EQUIVALENTS PER WEEK ARE
SHOWN IN THE BARS AND THE INTAKE
IS BELOW THE RECOMMENDATIONS OF
INTAKE.
NUTS, SEEDS AND SOY PRODUCTS
WITHIN TOTAL PROTEIN FOODS
THERE'S THE EQUIVALENT GOALS AND
AMONG AGES 2-5 YEARS AND 20
YEARS AND OLDER AND INTAKE OF
SEEDS AND NUTS ARE HIGHER AMONG
THOSE WITH HIGHER INCOMES
COMPARED TO LOWER POVERTY
LEVELS.
YOU CAN HAVE UP EQUIVALENTS A
DAY AFTER 5 YEARS OLD STABLE
ACROSS THE REST OF THE AGE
GROUPS WITH THE SLIVER OF A BAR
AT THE TOP OF THREE CUP
EQUIVALENTS A DAY AND THERE'S DE
DECLINE OVER THE OLDER AGE GROUP
CATEGORIES.
THE TOP THREE FOOD CATEGORIES
SOURCES TO THE DAIRY AND
FORTIFIED SOY ALTERNATIVE FOOD
GROUP.
FOR MOST GROUPS WERE BURGERS AND
SANDWICHES, HIGHER FAT MILK
YOGURT AND BREAKFAST CEREALS AND
BARS AND MALES HAVE A HIGHER
INTAKE FROM BURGERS AND
SANDWICHES.
AND FOR NON-HISPANIC ASIANS THE
SUBCATEGORIES THAT CONTRIBUTE TO
TOTAL DAIRY AND ALTERNATIVES
ARE COFFEE AND TEA IN CONTRAST
TO FOODS THAT CONTRIBUTED TO THE
OVER ALL PICTURE AND FAT AND
YOGURT.
TOTAL GRAINS, NEW FOOD GROUP,
TOTAL GRAINS AGAIN
CONGRATULATIONS FOR THE TOTAL
GRAIN SUCCESS BUT IT'S A LEADING
SUCCESS STORY, MEAN DAILY INTAKE
IS AT THE RECOMMENDED AMOUNTS
ARE FOR OUNCE EQUIVALENTS PER
DAY AMONG CATEGORIES.
THE TOP THREE ARE BURGERS AND
SANDWICHES, RICE, PASTA AND
CHIPS, CRACKERS AND SAVORY
SNACKS.
SO WITHIN THE TOTAL GRAINS THERE
ARE RECOMMENDATIONS SPECIFICALLY
FOR LOWER AMOUNTS OF REFINED
GRAINS AND HIGHER AMOUNTS OF
WHOLE GRAINS.
SO THE TOTAL GRAIN SLIDE DOES
NOT REFLECT THE NUANCE FOR
REFINED GRAINS WHICH IS
EXCEEDING INTAKE AT ALMOST ALL
AGE SEX STRATA BEGINNING WITH
THE LOWEST AGE GROUPS FOR
CHILDREN 6-12 MONTHS NONE ARE
RECOMMENDED AROUND YOU CAN SEE
THAT IMMEDIATELY IN THE CATEGORY
OF 12 AND UP THAT JUMPS UP HIGH
AND PERSISTS THROUGH MOST THE
LIFE SPAN AND THE TOP
CONTRIBUTORS ARE BURGERS AND
SANDWICHES.
AND WE LOOKED AT PASTA AND MIXED
DISHES.
LAST ONE.
WHOLE GRAINS WHICH ARE
RECOMMENDED TO BE CONSUMED MORE
OF ARE VIRTUALLY NON-EXISTENT AT
LESS THAN ONE OUNCE EQUIVALENT
ACROSS MOST AGE AND SEX STRATA.
THE TOP THREE FOOD CATEGORIES
SOURCES OF THE LOW INTAKES SUPER
FOOD AND CHIPS AND SAVORY SNACKS
AND FOR NON-HISPANIC ASIANS IT'S
BURGERS AND SANDWICHES.
>> WE TALKED ABOUT FOOD
MODELLING AND HAVE MORE
FLEXIBILITY AND VARIATIONS TO
BUILD ING INTO GUIDELINES AND WE
HAVE TALKED ABOUT THE DIFFERENT
INTAKE.
EVERYTHING FROM EATING PATTERNS
TO NUTRIENT INTAKES THAT WILL
INFORM THE WORK TO RECOMMEND.
I'M GOING TO TALK ABOUT THE
PREVALENCE OF CHRONIC HEALTH
CONDITIONS.
HOW IS THIS FEEDING INTO WHAT
WE'LL EAT?
WHAT I'LL TALK ABOUT AND LATER
THIS AFTERNOON WHEN WE TALK
ABOUT THE SYSTEMIC REVIEW OF
DIETARY PATTERS AND CHRONICS CAN
BE AND AIM TO REDUCE THE
INSTANCE IN THE CHRONIC
CONDITIONS.
AND SOMETIMES IT TAKES PIECES
THAT AND MOST OF THE DATA COMES
FROM WHAT HEATHER HAS MENTIONED
AND THE TIME LINE IS GENERALLY
2015 TO 2021 DATA THAT I'M GOING
TO SHOW YOU.
SO ON A VERY KEY PIECES OF
THINGS WHEN ARE VIEW THE DATA WE
FOUND THE PREVALENCE OF
NUTRITION AND CHRONIC CONDITIONS
VARIES BY SOCIO ECONOMIC, AGE
AND SEX AND THE HEALTH DISPARITY
SHOWED UP COMMON IN SEVERAL
CHRONIC HEALTH CONDITIONS THE
PREVALENCE VARY BY SOCIO
ECONOMIC GROUPS AND SHOW DATA TO
ILLUSTRATE THE DIFFERENCES.
AND WE'LL LOOK AT CHILDREN AND
ADOLESCENTS.
ADULTS AND OLDER ADULTS LOOK AT
CHRONIC DISEASE RISK FACTORS
SUCH AS OBESITY, HYPERTENSION
AND LIPIDS AND LIPID PROFILE
INCLUDING TRIGLYCERIDES.
WE'LL START I WE'LL LOOK AT
CHILDREN'S HEALTH BASED ON
W.H.O. GROWTH STANDARDS.
NOTABLY HIGH WEIGHT IS 9.6%.
AT THE SAME TIME, LOW BIRTH
WEIGHT IS 8.52%.
WE HAVE HIGH AND YET AT THE SAME
TIME ANOTHER ISSUE IS LOW BIRTH
WEIGHT.
SO THIS IS MORE GRANULAR DATA
THAN DIFFERENT AGE GROUPS FOR
MATERNAL AGE AS WELL AS AGE AND
ETHNIC
ETHNICITY.
THERE'S VARIATION LOOKING AT THE
RANGE OF MATERNAL AGE IS ROUGHLY
AROUND 8% FOR LOW BIRTH WEIGHT
SOME VARIATION RANGES FROM AS
LOW AS 8% OF MATERNAL AGE AS
HIGH AS 16. 2% WHEN MATERNAL
AGE IS TO 4R5E
54 YOU SEE CHILDREN AGE 2 AND
ABOVE AND SEE THE TWO PANELS AND
ADULTS.
OF NOTE, OVERWEIGHT AND OBESITY
IN CHILDREN IS SOMEWHERE BETWEEN
16. 8% AND 19.2% AND PREVALENCE
IS HIGHER IN ADULTS WITH 31%
OVER WEIGHT AND OBESITY AND THE
TWO CATEGORIES DO NOT OVERLAP.
IT'S EXCEEDS 50% FOR OBESITY AND
OVERWEIGHT TOGETHER.
>> ON THE LEFT PANEL THE HIGHEST
PREVALENCE IS THE AMOUNT OF
TEENAGERS 19 YEARS OLD AND
SIGNIFICANTLY HIGHER THAN 2 TO 5
YEARS OLD.
THE AMOUNT 6 TO 11 YEARS OLD THE
PREVALENCE IS HIGHER AMONG MALES
THAN FEMALES.
IN THE MIDDLE PANEL WHEN THERE
IS LOOKING AT ETHNICITY
DIFFERENCE AND SEX DIFFERENCE,
THERE IS THE HISPANIC BLACK
PREVALENCE HIGHER AMONG FEMALES
AND HIGHER THAN THE NON-HISPANIC
WHITE FEMALES AND ALSO THE
HISPANIC BLACK FEMALES ARE
HIGHER PREVALENCE THAN THE
HISPANIC FEMALES.
WHEN IT COMES TO INCOME AND
POVERTY LEVEL THE LOWEST IS AT
THE HIGHEST INCOME LEVEL.
SO NEXT SLIDE.
TO THE ADULTS ON THE TOPIC OF
OBESITY, SOME VARIATION IS STILL
SEEN AND WHEN IT COMES TO THE
LEFT PANEL AMONG MALES THERE'S
SIGNIFICANT DIFFERENCE BETWEEN
THE MIDDLE AGE GROUP AND 48 TO
59 YEARS OLD HIGHER THAN THE 60
PLUS YEARS OLD.
WHEN IT COMES TO ETHNICITY, THAT
IS BASED ON BMI, THE GROUP
NON-HISPANIC ASIANS IS
SIGNIFICANTLY LOWER THAN THE
OTHER ETHNIC GROUPS.
AND WHEN IT COMES TO INCOME AND
POVERTY LEVEL THE FEMALES OF
HIGHEST INCOME LEVEL IS
SIGNIFICANTLY LOWER PREVALENCE
OF OBESITY THAN THE OTHER FEMALE
GROUPS.
OKAY.
SO, WE'RE NOW MOVING ON TO THE
OTHER CHRONIC CONDITIONS,
CARDIOVASCULAR AND HYPERTENSION
AND HEART DISEASE SO AMONG
CHILDREN AND ADOLESCENTS
HYPERTENSION WE HAVE 5% RANGE
AND OF COURSE MUCH HIGHER AMONG
IN ADULTS AND SEE FOR
HYPERTENSION THE STANDARD IS
SYSTOLIC OF 103 AND ABOVE OR
DIASTOLIC WHICH IS 80 AND ABOVE.
SO ACCORDING TO THAT STANDARD,
ALMOST HALF OF AMERICAN ADULTS
IS CONSIDERED TO BE
HYPERTENSIVE.
SO MORE DETAILS IN THE FULL
REPORT.
ON THE CARDIOVASCULAR FRONT OF
OF TRIGLYCERIDES THERE'S SOME
PERCENTAGE OF CHILDREN OF
ADOLESCENTS HAVE HIGH LDL OR LOW
HDL.
BECAUSE AND BECAUSE IT'S A
MARKER FOR CARDIOVASCULAR
DISEASE AND HDL IS TO THE RISK
FACTOR.
FOR ADULTS AGE 20 AND ABOVE OVER
50% OF AMERICAN ADULTS HAVE HIGH
LDL CHOLESTEROL.
SO DIABETES AND PRE-DIABETES.
LOOK AT THE PRE-DIABETES.
THERE'S PREVALENCE OF
PREDIABETES.
THE CHILDREN OF DIABETES IS
30.8% WHICH IS QUITE CHUNK OF
CHILDREN IN THERE.
FOR ADULTS ALMOST 15% OF
AMERICAN ADULTS HAVE BEEN
DIAGNOSED WITH DIABETES.
A LITTLE MORE DETAILS ON THE
PREDIABETES AND THE SEX AND
ETHNICITY DIFFERENCES OF THAT SO
MALES HAVE HIGHER PRE-DIABETES
THAN FEMALES AND THEN THERE ARE
SOME DIFFERENCE WITH ETHNICITY
AS WELL.
THE ACTUAL DIABETES THESE ARE
THE DIFFERENT DEMOGRAPHIC GROUPS
AND THERE'S VARIATION AMOUNT OF
THEM.
THE AMOUNT OF ETHNIC GROUPS, THE
HIGHEST IS AMONG NON-HISPANIC
BLACKS AND AS WE WOULD EXPECT
THAT THOSE OLDER HAVE HIGHER
PREVALENCE OF ACTUAL DIABETES.
THESE ARE ADULTS ROUGHLY 40% OF
ADULTS HAVE METABOLIC SYNDROME
AND IT'S NOT MUCH DIFFERENCE IN
TERMS OF PERCENTAGES AND WHAT
WE'RE SEEKING BY EYEBALLING THE
PERCENTAGES IN TERMS OF MALES
AND FEMALES.
A LITTLE BIT MORE GRANULAR DATA
ON AGE AND ETHNICITY AS WE COULD
EXPECT THE OLDER AGE GROUP HAS
THE HIGHEST PREVALENCE OF
METABOLIC SYNDROME AND DIFFERENT
ETHNIC GROUPS THERE'S SOME
DIFFERENCES WITH THE LOWEST
AMOUNT OF NON-HISPANIC ASIANS
AND NOT MUCH DIFFERENCE BETWEEN
THE HISPANIC WHITES AND
HISPANICS.
ON GESTATIONAL DIABETES,
CURRENTLY THE GESTATIONAL
DIABETES RATE IS 7.8 PER 100
LIVE BIRTHS AND HYPERTENSION IS
84 CASES FOR 1,000 LIVE BIRTHS.
A LITTLE MORE GRANULAR DATA ON
THE DIFFERENT PREVALENCE BY AGE
AND ETHNICITY AS WELL AS
PRE-PREGNANCY BMI WE SEE
VARIATION WITH THE LOWEST ON
GESTATIONAL DIABETES AMONG THE
YOUNGEST MOTHERS AND OLDEST
MOTHERS.
SO VARIATION ETHNICITY WITH THE
HIGHEST ON THE NON-HISPANIC
ASIANS AND FOR WEIGHTS STATUS
AND PRE-PREGNANCY BMI HIGHEST
AMONG MOTHERS WHOSE BMI IS IN
THE OBESITY CATEGORY BEFORE
PREGNANCY.
AND WE SEE VARIATION AMONG THE
DIFFERENT ETHNICITY WITH LOWEST
HISPANIC MOTHERS.
WE ARE LOOKING AT ADULTS 50 AND
ABOVE ONLY AND THESE DATA ON THE
LEFT PANEL COMBINES MEN AND
WOMEN AND OLDER ADULTS 50 AND
OLDER IS 12.6% AND LOW BONE MASS
IS 43.1%.
WHEN IT COMES TO SEX DIFFERENCE
AS EXPECTED, THE FEMALES THE
PREVALENCE IS A FEW TIMES HIGHER
THAN THE MALES AND ALSO AGE
DIFFERENCE WE CAN SEE VARIATION
AS WELL WITH THE HIGHER
PREVALENCE OF THAT.
SO NEXT IS AND THE MOST COMMON
CANCER TYPES.
SO THESE DATA COMES FROM THE
SURVEILLANCE AND RESULTS AND
HERE THE OLDER FEMALES OF BREAST
CANCER AND MALES CAN GET IT TOO
BUT THE FRACTION IS VERY TINY
AMONG ALL BREAST CANCER CASES.
THE MORTALITY SLIDE IS FOR
FEMALES ONLY.
AND MORTALITY IS HIGHEST FOR THE
FEMALES WHO ARE OLDEST.
SO NEXT IS WE'RE STILL ON BREAST
CANCER BUT THIS IS RACE AND
ETHNICITY.
THERE'S SOME VARIATION ON
INCIDENTS THE LEFT PANEL WITH
THE LOWEST INCIDENTS WHICH IS
HISPANIC AND HIGHEST INCIDENTS
IS NON-HISPANIC WHITES AND
MORTALITY THERE'S VARIATION AS
WELL WITH THE LOWEST AMOUNT
NON-HISPANIC ASIAN AND HIGHEST
AMOUNT HISPANIC BLACKS.
INCIDENTS, WHAT IS NOT SHOWN IS
TIME TREND AND INCIDENTS HAVE
INCREASED BUT MORTALITY WILL BE
DECREASING AND WE HAVE
TREATMENTS DRIVING THE REDUCING
MORTALITY.
AND ON COLORECTAL CANCER BY AGE
INCIDENTS AND MORTALITY,
INCIDENTS IS HIGHEST BY THE
OLDEST AMERICANS AND THE
MORTALITY IS ALSO THE HIGHEST OF
AMERICANS AND ONE MORE SLIDE.
THIS IS THE LAST SLIDE WHICH IS
MORTALITY AND INCIDENTS OF
MORTALITY AS WELL AND I'LL TURN
IT BACK TO HEATHER.
>> THANKS SO MUCH.
THAT WAS GREAT TO WALK THROUGH
ALL THE DETE SO NOW WE'VE MADE
IT TO OUR LAST QUESTION THAT
WE'RE ADDRESSING AND THIS ONE IS
FOCUSSED ON IDENTIFYING THOSE
NUTRIENTS THAT PRESENT A
SUBSTANTIAL PUBLIC HEALTH
CONCERN.
IN ORDER TO GET HERE WE HAD TO
HAVE THE INTAKE DATA AND NOW
WE'RE CONSIDERING THAT INTAKE
DATA IN THE PREVALENCE AND
MAGNITUDE OF THE SHORT MAYBE
UNDER CONSUMPTION OR OVER
CONSUMPTION TO GET TO THE STAGE
TO CLASSIFY THESE.
MOVING FORWARD I JUST LIKE THE
OTHER SECTIONS I WANTED TO PULL
OUT A FEW KEY THEMES FOR YOU
HERE.
SO AS YOU HAVE SEEN OVER ALL OUR
NUTRIENT INTAKES ARE NOT
ALIGNING WITH RECOMMENDATIONS IN
THE STANDARDS FOR NUTRIENT
INTAKES COMING FROM THE DRIs
THAT WERE MENTIONED EARLIER BY
DR. STOODY AND ALSO FOR FOOD
COMPONENTS, DIETARY COMPONENTS
IN THE DIETARY GUIDELINES, 2020
TO 2025.
AND WE HAVE MANY THAT AREN'T
MEETING THESE RECOMMENDATIONS.
WE'VE BEEN ABLE TO LOOK AT THOSE
AND PULL FORWARD SOME OF SPECIAL
CHALLENGES FOR UNDER AND OVER
CONSUMPTION AND ARE OF PUBLIC
HEALTH CONCERN WHEN WE WENT
THROUGH THE EXERCISE TO CLASSIFY
THOSE WHAT ALIGNED WITH THE
PRIOR COMMITTEE.
WE DON'T HAVE ANY NEW NUTRIENTS
CONSIDERED IN THE DIFFERENT
CLASSES.
WE'RE PULLING OVER THOSE RESULTS
WERE THE SAME FROM THE PRIOR
COMMITTEE.
SO MOVING ON TO GIVE YOU A
BETTER SENSE OF WHAT WE WERE
DOING HERE IN THE CLASSIFICATION
I FIRST WANT TO TALK ABOUT
THIS -- THE APPROACH WE USE AND
ALSO GIVE CREDIT TO THE FORMER
COMMITTEE FOR REALLY DOING A
GREAT JOB MORE FORMALLY OUTLYING
THE PROCESS OF HOW WE CLASSIFY
THE NUTRIENTS OF PUBLIC HEALTH
CONCERN WE'RE RELYING HEAVILY ON
OUR INTAKE DATA.
THAT'S ONE OF THE PIECES.
BUT IN ORDER TO RISE TO A
NUTRIENT OF PUBLIC HEALTH
CONCERN WE'RE LOOKING AT TWO
OTHER CONSIDERATIONS ONE IS
BIOLOGICAL END POINTS AND AN
EXAMPLE MAY BE SERUM VITAMIN B
LEVEL AND A MARKER OF NUTRIENT
IN THE BODY TO HELP US
UNDERSTAND HOW INTAKES MIGHT BE
IMPACTING STATUS.
WE'RE ALSO LOOKING AT THE
CLINICAL HEALTH CONSEQUENCES OF
MAYBE A SHORTFALL OR
OVERCONSUMPTION OF A CERTAINLY
NUTRIENT.
AN EXAMPLE MAY BE IRON
DEFICIENCY ANEMIA.
IT'S VERY TIED TO IRON INTAKES
AND IT'S REALLY IMPORTANT WITH
REGARD TO BRAIN DEVELOPMENT,
GROWTH, ETCETERA.
WE LOOK AT THESE TO CLASSIFY A
NUTRIENT OF PUBLIC HEALTH
CONCERN.
MOVING ON WE HAVE OTHER
CLASSIFICATIONS THAT WE WERE
MAKING HERE.
SO FIRST THERE'S OVER CONSUMED
AND UNDER CONSUMED NUTRIENT AND
ONCE A NUTRIENT IS IN EITHER OF
THESE BUCKETS THEY'D BE
CONSIDERED AS A NUTRIENT OF
PUBLIC HEALTH CONCERN BUT FOR
UNDER CONSUMPTION THE WAY WE
DETERMINE THAT WERE BY FINDING A
GROUP OR SUBGROUP WHERE 5% OR
MORE WAS NOT MEETING THE
ESTIMATED AVERAGE REQUIREMENT
FOR THAT NUTRIENT ORE THAT WAS
EXCEEDING THE ADEQUATE INTAKE.
TO EXPLAIN THAT A LITTLE BIT
MORE WHEN THERE'S A LOT OF
SCIENTIFIC ESTIMATE AN AVERAGE
CAN BE SET AND THIS TELLS US THE
REQUIREMENT FOR HEALTH.
THIS TELLS WHAT PERCENTAGE IS
NOT MEETING THAT.
WHEN THERE'S NOT ENOUGH EVIDENCE
WE HAVE AN A.I. AND THAT GIVES
US A MARKER OF ADEQUACY BUT WE
CAN'T SAY BELOW THAT THE INTAKE
IS INADEQUATE FOR SURE SO WE
TALK ABOUT IT IN THE REVERSE.
WE LOOK FOR THE PERCENTAGE
EXCEEDING THAT MARKER AND
CONSIDER THEM TO BE ADEQUATE.
THEN FOR OVER CONSUMED NUTRIENTS
WE USED A MARKER OF THE UPPER
LIMIT OR UPPER LEVEL ALSO THE
CHRONIC DISEASE RISK REDUCTION
MARKER OR OTHER RECOMMENDATIONS
FOR EXAMPLE FOR FOOD COMPONENTS
IN ADDED SUGARS IN THE DIETARY
GUIDELINES AND LOOK FOR 5% OR
MORE OF THE POPULATION EXCEEDING
THESEFIDE -- GUIDELINES.
I ALREADY REVIEWED THAT
CLASSIFICATION FOR NUTRIENTS OF
PUBLIC HEALTH CONCERN AND THEN
OUR FINAL CLASSIFICATIONS WAS A
NUTRIENT OR FOOD THAT POSES
SPECIAL CHALLENGES.
AND SO THIS WAS A CLASSIFICATION
WE USED WHEN IT WAS REALLY
DIFFICULT TO IDENTIFY AN AT RISK
GROUP BECAUSE OF CHALLENGING
INTAKE DATA, FOR EXAMPLE FOR
MANY OF THE INFANT GROUP
SOMETIMES WE DON'T HAVE REALLY
GOOD INTAKE DATA ON WHICH TO
MAKE THESE KIND OF BASIS.
THIS IS A SPECIAL CATEGORY THAT
WE USED FOR THAT.
OKAY.
MOVING ON, I'M NOT GOING TO WALK
THROUGH THIS IN DEPTH BUT THIS
IS THE FORMALIZED SET OF
PATHWAYS THAT WE USED TO MAKE
THESE DETERMINATIONS FOR
NUTRIENTS OF PUBLIC HEALTH
CONCERN.
YOU CAN SEE IN THE THREE
DIAMOND-SHAPED BOXES ON THE TOP
ROW HOW WE WERE ABLE TO
INCORPORATE LOOKING AT THE DATA
AND BIOMARKER DATA AND INTAKE
DATA.
SO EACH NUTRIENT THAT WE
REVIEWED MAY HAVE HAD A SLIGHTLY
DIFFERENT PATH AND SOMETIMES FOR
EXAMPLE WITH IODINE WE DON'T
HAVE REALLY GOOD INTAKE DATA AND
SO WE HAVE TO RELY MORE ON
BIOMARKER DATA.
THIS IS ALL AVAILABLE FOR ANYONE
TO REVIEW AND AGAIN WE HAVE THE
FORMER COMMITTEE TO THANK FOR
FORMALLY OUTLINING THIS FOR US.
SO MOVING ON WE'LL GET TO OUR
RESULTS.
SO FIRST THOSE NUTRIENT
CLASSIFICATIONS FOR INFANTS AND
YOUNG CHILDREN AND WE'RE GOING
TO START WITH THIS 6 TO 12 MONTH
AGE GROUP IN THE NEXT SLIDE.
FOR NUTRIENTS AND WITH THE YOUNG
CHILDREN BECAUSE OF DIFFERENT
INTAKE COMPOSITION OF HUMAN
BREAST MILK WE LOOKED AT THE TWO
DIFFERENT FEEDINGS.
FOR NUTRIENTS OF PUBLIC HEALTH
CONCERN FOR HUMAN MILK FED
INFANTS WITH THE CONSIDERATION
OF THOSE COMPLIMENTARY FOODS WE
FOUND THAT IRON WAS A NUTRIENT
OF PUBLIC HEALTH CONCERN FOR
UNDER CONSUMPTION AND NUTRIENTS
OR ZINC AND PROTEIN IN THE HUMAN
FED PROTEINS AND THEY HAVE EARs.
WE CLASSIFIED POTASSIUM, VITAMIN
D AND CHOLINE AS COMPONENTS THAT
POSE SPECIAL CHALLENGES FOR ALL
INFANTS.
BOTH OF THOSE SETS.
AND THEN SPECIFICALLY FOR THE
INFANT FORMULA-FED INFANTS WE
CLASSIFIED ZINC AND RETINAL AND
OVERCONSUMED NUTRIENTS THAT POSE
SPECIAL CHALLENGES.
TO SHOW YOU THE EVIDENCE FROM
THE INTAKE DATA, YOU CAN SEE OUR
CHART WITH THE NUTRIENTS ON THE
LEFT SIDE THESE ARE THE ONES
THAT HAVE AN EAR THAT EXCEEDED
THE UL AND NEXT COLUMN IS
LOOKING BELOW THE EAR FOR ALL
INFANTS AND NEXT FOR THE
HUMAN-MILK FED INFANTS AND THE
INFANT FORMULA FED INFANT
PERCENTAGES.
TO POINT OUT FOR IRON AND FOR
THE HUMAN MILK FED WE HAVE 74%
FALLING BELOW THE EAR FOR ZINC
47% AND FOR PROTEIN 22%.
THEN FOR THE UL MARKER FOR THE
INFANT FORMULA-FED INFANTS WE
HAVE 78% ABOVE FOR ZINC AND 24%
ABOVE FOR RETINAL.
MOVING FORWARD HERE WE HAVE
THOSE NUTRIENTS THAT POSE
SPECIAL CHALLENGES FOR UNDER
CONSUMPTION THAT HAVE AN A.I.
AND AGAIN THE NUTRIENTS ON THE
LEFT SIDE FOR THIS
CLASSIFICATION WE LOOKED AT THE
CONTRIBUTION FROM THE
COMPLIMENTARY FOODS AND THAT
ESTIMATED CONTRIBUTION IS SHOWN
IN THE MIDDLE COLUMN AND THEN
THE ACTUAL INTAKES OF ALL
INFANTS IS SHOWN ON THE RIGHT.
SO WE LOOKED AT THE MEAN IN
COMPARISON TO THAT CONTRIBUTION.
THESE ARE BOTH THE CONTRIBUTIONS
FROM COMPLEMENTARY FOODS BUT WE
LOOKED AT THE INTAKE COMPARED
WITH THAT ESTIMATED MARKER AND
CHOLINE AND POTASSIUM ARE LOWER
AND SHADED WITH THE DARK BLUE.
WE HAVE A LAUNDRY FLAGGED FOR
UNDER CONSUMPTION IN COMPARISON
TO THE EAR.
AND WE HAVE FOUR COMPARED TO
A.I. BASED ON THE INTAKE DATA
AND THEN I DEAN AS I MENTIONED
BEFORE IS BASED ON THE BIOMARKER
DATA THAT WE FLAGGED FOR UNDER
CONSUMPTION.
FOR OVER CONSUMPTION WE HAVE --
WE COMPARED THE INTAKES AGAIN TO
THE UL FOR THE THOSE FOUR LISTED
THERE.
WE USED THE CDRR FOR SODIUM AND
FOR SATURATED FAT AND ADDED
SUGARS OR GUIDE POST WAS THE
2020, 2025 DIETARY GUIDELINES.
OUT OF THOSE LISTED WE LOOKED AT
EACH TO CONSIDER WHICH ONES
SHOULD BE FLAGGED AS NUTRIENTS
OF PUBLIC HEALTH CONCERN.
AGAIN, THIS IS A HOLDING PATTERN
FROM THE LAST COMMITTEE.
BASED ON UNDER CONSUMPTION WE
AGAIN HAVE VITAMIN D, CALCIUM,
POTASSIUM AND FIBER BASED ON
OVER CONSUMPTION, SODIUM, ADDED
SUGARS AND SATURATED FAT AND FOR
SATURATED FAT FOR 2 AND OLDER,
FOR THE OTHERS IT'S THE FULL
POPULATIONS AND WE LOOK AT ALO
EIC ACID FOR 12 TO 13 MONTHS AND
LOOKING AT THIS INTAKE DATA FOR
THOSE NUTRIENTS THAT HAVE AN EAR
AGAIN REMEMBER WE'RE LOOKING FOR
THOSE THAT HAVE INTAKES BELOW
THAT MARKER AND THOSE ARE SHADED
WITH THE LIGHT BLUE.
WE HIGHLIGHTED FURTHER THE TWO
THAT ROSE TO THE LEVEL OF BEING
A NUTRIENT OF PUBLIC HEALTH
CONCERN, VITAMIN D AND CALCIUM
WITH THE BLACK BOXES.
SO SOMETHING I WANTED TO POINT
OUT HERE WAS LOOKING DOWN THE
ROWS SHOWN BY AGE GROUP.
YOU CAN SEE FOR THE ADOLESCENT
GIRLS 14 TO 18 ON THE RIGHT SIDE
WE SEE SHORTFALLS FOR THE AGE
GROUP AND CONTINUES TO YOUNG
ADULTHOOD.
THE MALES AREN'T DOING THAT MUCH
BETTER BUT THERE ARE MANY GAPS
HE
HERE IN MEETING THE AVERAGE
REQUIREMENTS.
MOVING FORWARD WE HAVE THE DATA
BROKEN DOWN BY RACE ETHNICITY,
POVERTY LEVEL AND FOOD SECURITY
AND YOU CAN SEE ACROSS THE GROUP
THERE'S DIFFERENCES AND CALCIUM
YOU CAN SEE FOR RACE ETHNICITY
THE 20% DIFFERENCE THERE BUT
WHEN WE LOOK BY POVERTY LEVEL
AND FOOD SECURITY LEVEL WE DON'T
SEE MUCH VARIETY IN THE
PERCENTAGES.
THE TWO THAT ROSE TO THE LEVEL
OF PUBLIC HEALTH CONCERN WERE
DIETARY FIBER AND POTASSIUM AND
FOR DIETARY FIBER LESS THAN 3%
EXCEEDING THE ADEQUACY MARKER SO
IT'S REALLY UNDER CONSUMED IN
THE POPULATION.
WE HAVE THIS BROKEN DOWN BY
RACE, ETHNICITY AND POVERTY
LEVEL AND FOOD SECURITY.
AND WE DON'T SEE TOO MUCH
VARIATION IN A LOT OF THESE.
MOVING FORWARD WE AGAIN
IDENTIFIED THE NUTRIENTS OVER
CONSUMED COMPARED WITH THE UL
AND SHOWS SHADED 5% OR MORE IN
THE LIGHT BLUE.
THOSE HIGHLIGHTED FOR THE VERY
YOUNG AGE GROUP OF 1-3.
HERE'S WHERE WE LOOK AT THE
OTHER DIETARY COMPONENTS
OVERCONSUMED AND THIS IS FOR
ADDED SUGARS.
AGAIN WE HAVE MALES ON THE LEFT
AND FEMALES ON THE RIGHT AND
BROKEN DOWN BY THE AGE GROUPS
AND ON THE Y AXIS THE PERCENTAGE
OF EACH GROUP IN DARK ORANGE.
THOSE EXCEEDING THE INTAKES FOR
ADDED SUGARS AND IN THE DARK
BLUE THOSE THAT ARE UNDER OR
WITHIN THOSE LIMITS AND SO JUST
TO POINT OUT AGAIN OUR CHILD AGE
GROUPS 5 TO AGE 13 ARE THE MOST
CHALLENGED WITH THIS DIETARY
COMPONENT.
MOVING FORWARD TO SATURATED
FATS, YOU CAN SEE AGAIN THE
VARIATION IN THE AGE GROUPS BUT
STILL THE DIFFICULTY WITH CHILD
AGE GROUPS GROWING AND WE WANT
TO PROMOTE HEALTH AS MUCH AS
POSSIBLE FOR THEM AS THEY'RE
DEVELOPING.
MOVING FORWARD WE LOOKED AT
POVERTY INCOME RATIO AND DO HAVE
SOME VARIATION BY RACE
ETHNICITY.
WE HAVE OUR LOOK AT THE
PERCENTAGE OF INDIVIDUALS WITH
SODIUM INTAKES EXCEEDING THE
CHRONIC DISEASE RISK MARKER.
AND YOU CAN SEE IT'S QUITE HIGH
FOR SODIUM AT 86% AND UPWARD
AMONG THE DIFFERENT AGE GROUPS
AND NOT MUCH DIFFERENT BETWEEN
RACE AND POVERTY LEVEL.
AND LOOKING AT THE FOOD SOURCES
WE'VE CONSIDERED FOOD SOURCES IN
SOME OF THE OTHER DATA YOU'VE
SEEN TODAY BUT THIS IS HELPING
CONCEPTUALIZE WHERE THESE OVER
NUTRIENTS ARE COMING FROM.
THIS SHOWS THE TOP CATEGORY
SOURCES FOR SUGARS IN MALES AND
FEMALES AND A LOT OF IS COMING
FROM DESERTS AND SWEET SNACKS
AND SUGAR-SWEETENED BEVERAGES.
FOR THOSE CATEGORY SOURCES OF
SATURATED FAT, WE'VE MENTIONED
BURGERS AND SANDWICHES BEFORE AS
POPULATION EATING A LOT OF THOSE
AND THEY HAVE A LOT OF SATURATED
FATS FOR MALE AND FEMALES AND
ALSO SEE DESERTS AND SWEET
SNACKS COME UP AGAIN AND MEAT,
POULTRY AND SEAFOOD MIXED
DISHES.
AND FINALLY FOR SODIUM, A LOT OF
CALORIES COME FROM BURGERS AND
SANDWICHES AND THERE'S A LOT OF
SODIUM AS WELL AS SPREAD THROUGH
FOOD GROUPS AND MEAT, POULTRY
AND SEAFOOD MIXED DISHES AND
RICE, PASTA AND GRAIN-BASED
DISHES AS WELL COMING OUT.
LAST IS PREGNANCY AND LACTATION.
FOR UNDER CONSUMPTION FOR
NUTRIENTS OF PUBLIC HEALTH
CONCERN WE IDENTIFIED FOLATE IN
THE FIRST SEMESTER AND THEN
BASED ON BIOMARKER DATA WE
IDENTIFIED IRON FOR REPRODUCTIVE
AGE FOR FEMALES AND IODINE AS
MENTIONED BEFORE AND ALSO TO
REMIND YOU THAT IODINE NEEDS TO
INCREASE BY MORE THAN 50% DURING
PREGNANCY TO MEET THE DEMANDS OF
FETAL DEVELOPMENT AND NEURAL
GROWTH AND THE MEDIAN IODINE
CONCENTRATIONS OF PREGNANT WOMEN
FELL BELOW THE W.H.O. CUT-OFF
FOR INSUFFICIENCY.
THAT IS PART OF THE CRITERIA
USED TO IDENTIFY IODINE.
WE DON'T HAVE VERY GOOD INTAKE
DATA FOR THAT NUTRIENT.
WE IDENTIFIED TWO NUTRIENTS TO
BE FLAGGED FOR OVER CONSUMPTION
POSING SPECIAL CHALLENGES FOLATE
AND IRON.
AND AGAIN WE CAN SEE OUR
NUTRIENTS WITH EAR IN THE FIRST
TABLE ON THE LEFT AND WE HAVE
TWO GROUPS HERE, FEMALES THAT
ARE NOT USING SUPPLEMENTS IN THE
LEFT SIDE, THOSE THAT ARE USING
SUPPLEMENTS ON THE RIGHT SIDE
AND NOT PREGNANT OR LACTATING
AND PREGNANT AND LACTATING.
AND WE SHADED THOSE IN LIGHT
BLUE WHERE THE PERCENTAGE OF
INDIVIDUALS INTAKES WERE BELOW
THE 5% OR MORE.
FOR THE UPPER LEVEL, THAT TABLE
THAT INTAKE DATA IS SHOWN ON THE
RIGHT AND HERE IS WHERE WE
IDENTIFIED FOLIC ACID FOR THOSE
USING SUPPLEMENTS.
THAT WAS A LOT, RIGHT.
BUT NOW WE GET TO THE FUN PART.
SO QUICKLY I WANT TO SHARE NEXT
STEPS AND THEN HAVE A
DISCUSSION.
WE'VE SYNTHESIZED ALL THE DATA
FOR ANALYSIS AND NOW THE NEXT
JOB WILL BE TO CONSIDER THIS
TOGETHER WITH THE FOOD PATTERN
MODELLING RESULTS AND SYSTEMATIC
REVIEW RESULTS.
AFTER THAT WE'LL DRAFT
CONCLUSIONS AND RECOMMENDATIONS
FOR THE FUTURE AND PUBLISHING
THIS IN OUR REPORT OR
SPECIFICALLY FOR THIS GROUP
WE'LL HAVE OUR DATA ANALYSIS
CHAPTER AND THEN WE'LL ALSO BE
WORKING ON AND COMBINING THESE
FOR GRAPHS AND RECOMMENDATIONS
AND I WANT TO THANK THE STAFF
ESPECIALLY COLLEEN AND DANA AND
MOVING TO THE NEXT SLIDE WE ALSO
THANK THE FULL TEAM OF ALL THE
STAFF WHO HAVE BEEN SUPPORTING
OUR WORK HERE AND ALL OF OUR
INTERAGENCY COLLABORATORS WHO
GAVE US THE DATA AND GAVE US
THOSE RESULTS.
SO NOW WE'LL TAKE QUESTIONS.
>> I DIDN'T HEAR MENTION OF THIS
BUT WE KNOW HOW MUCH OF THIS IS
BASED ON SELF-REPORT.
SELF-REPORT INVOLVES UNDER
REPORTING.
WILL THERE BE NOTE MADE, WE
PROBABLY DON'T THINK UNDER
REPORTING IS PROPORTIONAL AND
THEY REPORT THE HANDFUL OF M &
Ms AND SOME OF THE THINGS MAY BE
AN OVER REPRESENTATION OF WHAT
THEY'RE UNDER CONSUMING AND SOME
OF WHAT THEY'RE REPORTING MAY
BUMP UP A LITTLE BUT MAYBE NOT
PROPORTION ALLY.
WILL THERE BE ROOM FOR UNDER
ACKNOWLEDGEMENT?
>> GREAT POINT.
THERE'S BEEN GREAT RESEARCH TO
EVALUATE THE UNDER AND OVER
REPORTING PREVIOUSLY BY OTHER
RESEARCHERS BUT YEAH, THAT'S
EXACTLY TRUE THAT WE KNOW THAT
THERE ARE A LOT OF TIMES THE
FOODS THAT WE'RE EMBARRASSED OF
REPORTING LIKE ADDED SUGARS AND
MAYBE FOODS THAT AREN'T SEEN AS
HEALTHY ARE MORE UNDER REPORTED
THAN MORE HEALTHFUL FOODS.
SO WE WANT TO MAKE SURE TO
ACKNOWLEDGE THAT AND WITH ADULTS
WE HAVE MORE OF A SENSE OF WHAT
THE STRUCTURES LOOK LIKE AND
WITH KIDS IT MAY BE MORE
CHALLENGING UNDERSTAND THAT BUT
YEAH THAT IS PART OF THE DATA.
>> I'VE HAD THE GUEST LECTURE
AND I'VE HEARD A LECTURE ON DIET
RECALL AND I HIGHLY RECOMMEND
IT.
AND I THINK THE BIGGEST
TAKEAWAYS OF THE BEHAVIOR OF
REPORTING IN THE CONTEXT IS MORE
WITH ERROR DRIVEN BY INABILITY
TO ESTIMATE THAN NOT-REPORTING
SOMETHING ALTOGETHER.
I HAD M & Ms OR ALCOHOL, I MIGHT
INTENTIONALLY UNDER REPORT THE
AMOUNT OR TRY TO REPORT IT BUT
BE TERRIBLE AT WHAT'S AN OUNCE,
A CUP, A FLUID OUNCE.
I THINK THAT'S OBVIOUSLY THE
PRECISION IN THE ESTIMATES IS
NOT AS CONCRETE AS THE DATA MAY
REFLECT AND I MAY UNDER REPORT
THINGS PERCEIVED AS UNHEALTHY
AND OVER REPORT HEAVY GREENS.
DO THE SYSTEMATIC ERROR MAY
REPORT IT WORSE.
WE'RE LOOKING AT MAYBE BEST CASE
SCENARIO OF OVER REPORTING SO
MORE BAD NEWS.
>> AND WE'VE SHOWN THE DATA HOW
SOME NUTRIENTS THE GAP BETWEEN
RECOMMENDED AND MEANING IS SO
BIG EVEN WITH THE ERROR IT'S
STILL BIG.
>> NO ONE IS REPORTING THE
FOLATE INTAKE IT COMES BACK TO A
DATABASE AND WHAT TODAY'S APPLE
CONTAINS AND NUTRIENTS WILL HAVE
THAT ADDITIONAL LAYER THAT IS
HIGHLY VARIABLE ACROSS A SINGLE
FOOD ITEM BECAUSE OF THE NATURE
OF WHERE THEY'RE GROWN AND SOIL
CONTENT AND WHAT NOT.
>> AND THERE'S GAPS.
I SEE THE ERRORS.
>> I'M NOT SURE THE CONCLUSIONS
OR THE BIG PICTURE CHANGES IN
THE CONTEXT OF THE ERROR WHICH
IS THE MOST IMPORTANT TAKEAWAY.
>> THAT'S RIGHT.
>> TO THE BREAST FEEDING DATA
NEED TO BE LOOKED AT WITH
CAUTION AND BABY START SOLID
FOODS BEFORE SIX MONTHS AND ALSO
FINALLY I'LL POINT OUT THE GOALS
ARE ARBITRARY.
WHY IS 40% THE GOAL?
WHY SHOULDN'T IT BE 70% OR 80%.
THESE ARE ARBITRARY GOALS MAYBE
DIFFERENT FOR THE HEALTH OF OUR
CHILDREN AND SETTING THE GOAL
FOR BREAST FEEDING IS ARBITRARY
AND THERE'S A ZINC ISSUE IN
SMALL CHILDREN AND THERE'S A
CALCULATION OF THE UPPER LEVEL
OF ZINC AND CHALLENGED BY
EXPERTS AND WRITTEN ENDLESS
AMOUNTS WHY THERE'S A VALUE WE
DON'T HAVE A PROBLEM WITH ZINC
TOXICITY IN 1-3-YEAR-OLDS AND
GETTING IT ALL OUT OF THE DIET
IS NOT TRUE AND THE DETAILED
ANALYSIS IS BEYOND THE
DISCUSSION AND ONE NEED NOT
PANIC ABOUT ZINC IN
1-3-YEAR-OLDS.
>> I DIDN'T SEE VITAMIN D AS A
PUBLIC CONCERN ON BREAST FEEDING
AN CONTRAST.
>> VITAMIN D IS HIGHLIGHTED FOR
THE ENTIRE POPULATION AND 1 AND
OLDER IS FOR THE AGE STAGE AS
WELL.
THE ONES WE HIGHLIGHTED FOR
PREGNANCY AND LACTATION ARE OME
FOR THAT AGE STAGE.
THE OTHERS CARRY TO THAT GROUP
TOO.
>> I WANTED TO FOLLOW UP WITH
STEVE MOTHER BREAST FEEDING
ADDING COMPLIMENTARY FEEDING THE
IRON WAS LOW IF I GOT IT RIGHT.
EXTREMELY LOW.
WE MAY NEED TO STRESS IF YOU'RE
STILL BREAST FEEDING YOU NEED TO
ADD THINGS BECAUSE IRON IS LOW.
I WANT TO DOUBLE CHECK I GOT IT
RIGHT.
>> YOU DID.
I PUBLISHED A PAPER IN DETAILED
ANALYSIS I CAN MAKE SURE YOU
HAVE BUT WE'VE SEEN A SHIFT FROM
MEAT AND IRON CONTAINING CEREALS
IN 6 TO 12 MONTHS OLD AND
INFANTS USED TO GO TO THESE
CEREALS AND THERE'S BEEN A HUGE
CHANGE AND THERE'S A CHANGE IN
THE IRON OF BABIES BUT TO THE
DATA ARE CORRECT AND VERIFIED BY
OTHER STUDIES NOT REPRESENTED
HERE.
>> IS IT OKAY TO ASK MULTIPLE
QUESTIONS?
I WAS STRUCK BY THE DATA
ANALYSIS ON BEVERAGE SOURCES
AMONG CHILDREN AND ADOLESCENTS
WITH REGARDS TO DAIRY.
MY QUESTION IS DO WE KNOW WITHIN
THE DATA SETS THAT WE'RE LOOKING
AT ABOUT DAIRY ALTERNATIVES
WITHIN THE YOUNG POPULATION
BECAUSE IT DOESN'T APPEAR IN
EARLY AGE WE SEE THOSE BEING
INCORPORATED TO WHAT'S BEING
PRESENTED.
>> AS PART OF THE DAIRY GROUP
THE FORTIFIED SOY IS INCLUDED
THERE.
YOU WOULDN'T SEE THEM TORN A
PART IN WHAT WE LOOKED AT.
BUT WE DO PROBABLY HAVE -- MAYBE
I'LL LET REBECCA LOOK AT THAT
AND I THINK WE HAVE THOSE
ESTIMATES.
WHILE WE FIND IT I'M CURIOUS
BECAUSE WE KNOW DIETARY PATTERNS
GET SET EARLIER IN LIFE AND SEE
THIS TRANSITION HAPPENING IN THE
GENERAL AMERICAN POPULATION
AROUND OAT MILK AND ALMOND MILK
AND SOME DATA WE SAW YESTERDAY
WOULD SUGGEST WE WANT TO KNOW
ABOUT EARLIER INTAKES OF THOSE
AS WELL.
>> ALSO THE DATA IS OLD.
THIS IS FROM 2017, 2018,
CORRECT?
SO THE TRENDS MAY BE NEWER AND
MAYBE THEY'RE NOT --
>> I DON'T THINK SO.
WHILE WE LOOK FOR THAT MAYBE
WE'LL GO TO THE NEXT QUESTION IN
THE INTEREST OF TIME.
>> WE DIDN'T REPORT THIS
ESTIMATE BECAUSE IT'S LESS
PRECISE BUT YOUNG CHILDREN 6 TO
24 MONTHS A SMALL PROPORTION
THAT CONSUME MILK SUBSTITUTES
I'LL SHARE 12 TO 23 MONTHS AND
MILK SUBSTITUTES WERE ONLY
CONTRIBUTING 9 CALORIES PER DAY.
SO PRETTY SMALL CONTRIBUTIONS
FOR THAT AGE GROUP.
>> THAT WILL HAVE IMPLICATIONS
FOR HOW WE THINK OF DIETARY
PATTERS AND THE IMPLICATIONS OF
THOSE PATTERNS WE'LL HEAR ABOUT
LATER ON TODAY.
THE OTHER QUESTION I HAVE I
THINK DIDI PRESENTED ON CHRONIC
DISEASE NUTRIENTS.
OH TERESA.
WHAT WERE THE SUBCOMMITTEES
DISCUSSION AROUND THE NEW
METABOLIC KIDNEY AXIS.
CHRONIC KIDNEY DISEASE IS
GROWING DRIVEN BY HIGH BLOOD
PRESSURE AND DIABETES, WHAT ARE
THIS COLLECTIVE THOUGHTS ON
THAT?
>> IT'S GETTING MORE PREVALENT
AS A RESULT OF DIABETES AS A
RESULT OF OVERWEIGHT AND
OBESITY.
WE HAVEN'T LOOKED AT THE DATA
BUT PROBABLY CAN LOOK AT NHANES
AND OTHER DATA COLLECTED.
AND COMBINATION OF DIDI AND
HEATHER, DIDI SHOWED US
CONSISTENT TRENDS AROUND FOOD
INTAKES AND WE SAW THAT THE
RANGE RECOMMENDED FOR TOTAL
PROTEIN AND WHERE AMERICANS ARE
WAS REVERSED.
IN TERMS OF MOST THE DATA THAT
IS SHOWN OVER CONSUMPTION OR
WITHIN RANGE.
THEN I WAS STRUCK BY PROTEIN
BEING SO FAR OFF FROM THE EAR IT
WAS NOTED AS UNDER CONSUMED IN
THE DATA THAT WERE PRESENTED
LATER.
I'M TRYING TO RECONCILE THAT.
THE TOTAL PROTEIN FOODS
QUALIFIES AND MOSTLY CONTRIBUTED
THERE ANIMAL PROTEIN SOURCES.
AND WHAT MAKES UP MEETING THIS
GOAL.
SO WHETHER THAT CONTRIBUTES
ENOUGH FOR THE MACRO NUTRIENT OF
PROTEIN WOULD BE HOW YOU CAN
PAIR THE DATA BUT THE FOODS FROM
WHICH THE NUTRIENTS WOULD BE
MORE WEIGHTED TOWARD.
THE QUESTION OF DIET QUALITY IS
SOMETHING THAT I THINK THE PURE
INTAKE LEVELS ARE OBSCURING BUT
IMPORTANT.
IF PROTEIN SOURCES INCLUDE
BURGERS AND SANDWICHES WHICH ARE
INTERESTING TO ME YOU WOULD EAT
MORE OF OF THAT TO GET MORE
PROTEIN.
SO HOW DO YOU INCREASE PROTEIN
AND THE MACRO NUTRIENT FROM
PROTEIN FOODS THAT ARE MORE LIKE
PROTEIN RICH I GUESS AND IS WHAT
MORE MIXED DISHES OR SUBOPTIMAL
SOURCES.
BECAUSE THE FOOD LEVEL DATA
WHICH MAY NOT BE THE RICHEST
SOURCES OF THE MACRO NUTRIENT
PROTEINS.
>> WE'RE MISSING THE MARK HOW TO
GET TO HIGH-QUALITY PROTEIN
CONSUMPTION AS A COUNTRY.
>> AND YOU SEE WITH FIBER IT'S
THE SAME THING.
FIBER WAS LOW AND MOST THE TOTAL
RATHER THAN WHOLE.
WHAT FOODS IN THE FOOD LEVEL
DATA ARE THE MOST COMMONLY
BIGGEST SOURCES PROBABLY WHERE
THE NUTRIENT DISCREP BUT THAT'S
A GOOD POINT.
>> WE NEED TO TEASE THAT OUT AS
WE PRESENT THE DATA.
>> ONE ANSWER TO THIS TOO MAY BE
THAT THE DATA THAT DIDI WAS THE
MEAN INTAKES AND WE LOOKED AT
THE PERCENTAGE THAT WAS NOT
MEETING THE EAR.
WHEN THAT WAS 5% OR MORE.
THAT'S 5% IS -- THERE'S A
DISTRIBUTION THERE AND SO THAT
WAS HOW WE CLASSIFIED IT SO %UT
FOR EXAMPLE FOR TEEN GIRLS
THERE'S BIGGER THAN 5% GAP THERE
IN MEETING THE PROTEIN SO THAT
IS PROBABLY ADDING TO THE
DISPARITY BUT INTERESTING TO
POINT THAT OUT.
>> IN THE FEMALES IT WAS
STRIKING.
I DID MAKE NOTE OF THAT.
OKAY.
FIRST OF ALL, I WANT TO COMMEND
ALL OF YOU FOR ALL THIS WORK.
IT'S BEAUTIFULLY DONE.
THANK YOU AND THANK YOU STAFF.
AMAZING.
SO ONE OF THE WONDERFUL
PRIVILEGES OF BEING ON THIS
COMMITTEE IS I THINK MANY OF US
FOCUS ON PART OF THE LIFE CYCLE
AND ONE ASPECT OF FOOD IS THAT
LIFE CYCLE.
SO FOR ME SEEING ACROSS THE LIFE
STAGES WAS REALLY INTRIGUING AND
I WONDERED AND IT'S FOLLOWING UP
ON THE LAST CONVERSATION.
I WAS SO STRUCK ABOUT ADOLESCENT
FEMALES AND AT EVERY MEASURE,
EVERYTHING WE'VE PRESENTED, THIS
IS THE GROUP THAT'S SO
VULNERABLE.
SO I HAVE BEEN VERY INFLUENCED
IN MY WORK IN OLDER ADULTS BY
PEOPLE LIKE STEVE WHO HAVE
ALWAYS TALKED ABOUT HOW FOR
EXAMPLE WITH BONE THERE'S
CRITICAL PERIODS WHERE YOU LAY
DOWN BONE IN ADULTHOOD YOU TRY
TO PRESERVE THAT AND THEN IN
OLDER AGE IT'S THE RATE OF LOSS.
SO I'M LOOKING AT THIS WHOLE
PICTURE AND WONDERING, OH, MY
GOD, ADOLESCENT FEMALES ARE NOT
AT THE TRAJECTORY OR SLOPE IS
NOT GOING TO ACHIEVE MAXIMUM
BONE COGNITIVE HEALTH ETCETERA.
WAS THERE DISCUSSION ABOUT THIS,
ABOUT AT THE RELATIVE LIFE
STAGES WITH ALL YOUR DATA?
ANYONE CAN CHIME IN.
ONE OF THE GREAT THINGS ABOUT
BEING ON THE COMMITTEE IS THAT
WE DO HAVE EXPERTS IN THE
DIFFERENT LIFE STAGES
REPRESENTED.
AND DURING THE DISCUSSION, IT
WAS VERY IMPORTANT TO HEAR
ACROSS THE SPECTRUM.
I DON'T KNOW IF YOU WERE GOING
TO SAY SOMETHING, DIDI.
>> I THINK IT'S A GOOD POINT
WE'RE JUST LOOKING AT CROSS
SECTIONAL ACROSS THE CHRONIC
DISEASES LIKE OSTEOPOROSIS BUT
MOST ARE REFLECTING HABITUAL
WORK IN DIET AND LIFESTYLE AND
THE COLORECTAL CANCER WE'RE
SEEING IT RISE IN YOUNGER AGES.
TO PREVENT IT DOWN THE ROAD THE
CHANGES HAVE TO HAPPEN NOW TO
THE BIGGEST RISK FACTORS INDICT.
IT'S IMPORTANT TO THINK OF THE
CRITICAL TIME WINDOWS FOR WHAT
ROLES DIET MAY PLAY THAT GET
MISSED WITH THIS AND BIG PICTURE
THE LAST SEVERAL YEARS OF NHANES
DATA INDICATE THERE ISN'T ONE
DEMOGRAPHIC STRATA OR FACTOR OR
HEALTH OUTCOME WITH SUSTAINED
IMPROVEMENT AND EVERYTHING SEEMS
TO BE GETTING WORSE.
STOPPING THAT TREND EVEN IT
CAN'T BE TOTALLY REVERSED AND
YEARS TO COME IMPACT ON
PREVENTING ALL THE DOWN STREAM
PUBLICATIONS WOULD BE HUGE BUT
JUST SEEMS LIKE DAUNTING AT THIS
POINT.
>> LOOKING AT PREDIABETES DATA
AMONG CHILDREN THERE'S 83%
PREVALENCE OF PREDIABETES AND
THE REVERSAL FOR PREVENTION HAS
TO COME BEFORE AND STARTING BIG
SOLID FOODS AND BREAST FEEDING.
>> THIS IS A REAL PROBLEM RIGHT
NOW BECAUSE WE TO GET A LOT OF
NUTRITION EDUCATION THROUGH THE
SCHOOLS AND WHEN THEY TOOK OUT
HOME ECONOMICS AND PUT MORE
ACADEMIC SUBJECTS THERE IS WHERE
YOU GET BASIC NUTRITION AND
THERE'S NOT A LOT OF ROOM IN THE
SCHOOL CURRICULUM AND SINCE
COVID SCHOOLS HAVE BEEN SLAMMED
IT'S SEEN AS AN EXTRA.
THEY NUTRITION INFORMATION CAN
GET DROPPED THEN YOU RELY ON THE
PARENTS AND THE PARENTS HAVE A
LOT OF THRUST ON THEM ALREADY.
THEN YOU HAVE ISSUES WITH SOCIAL
MEDIA WITH ADOLESCENT GIRLS AND
DIETS ARE COMING ACROSS ON
SOCIAL MEDIA.
I THINK THERE'S A LOT OF FACTORS
IN THE SECULAR SPACE THAT
INFLUENCE SOME OF THIS.
IT'S IMPORTANT TO GET
BEHAVIORALLY BASED NUTRITION
INFORMATION AND FOOD ENVIRONMENT
AROUND KIDS IN PARTICULAR.
>> I THINK WHAT'S BEEN
INTERESTING ESPECIALLY ACROSS
ALL THE DIFFERENT DATA PIECES
THAT WE HAVE IS WE HAVE THE LIFE
STAGE APPROACH AND YOU CAN SEE
WHAT THE GAPS ARE IN ADOLESCENT
FEMALES.
WE HAD CONVERSATIONS ABOUT
MIDDLE-AGED ADULTS BECAUSE WE
LOOK AT THE TRANSITION TOWARDS
HEALTHY AGING AND THE DIET
QUALITY CHALLENGES IN THE AGE
GROUP AND THE NUTRIENT
CHALLENGES AND THE FOOD GROUP
CHALLENGES OVER ALL DIET QUALITY
AND AT THE SAME TIME WE HAVE THE
PER CAPITA CALORIES 7 CALORIES
FROM MILK ALTERNATIVES BUT WHEN
YOU GET TO THIS IDEA, THE MEANS
SOMETIMES MASK WHAT THE
PROPORTIONALITY IS.
SO THE MEANS OF THE CERTAIN
NUTRIENT MAY BE HIGHER BECAUSE
THOSE THAT CONSUME HIGHER ARE
MASKING THE PROPORTION THAT ARE
BELOW.
SO WHEN YOU LOOK AT WHAT WE HAD
WITH THE MEAN NUTRIENT INTAKES
AND THE PUBLIC HEALTH CONCERN
THE MEAN MAY BE HIGHER BUT MASK
THE PROPORTION OF PEOPLE THAT
AREN'T MEETING THE
RECOMMENDATIONS AS WE LOOK
ACROSS THOSE AT THE LIFE STAGE
IT'S IT BRINGS UP THOSE KEY
ASPECTS THAT LINK BACK TO THE
CHRONIC DISEASE MARKERS AND
EVERYTHING ELSE.
THE VOLUME OF DATA THAT EXISTS
HERE TO HELP US DISENTANGLE
WHAT'S HAPPENING AND BRING UP
KEY ASPECTS ACROSS THE LIFE
STAGES WAS AN EXCITING PART OF
THE CONFERENCE AND ENLIGHTENING
PART.
>> IT BRINGS US TO THE NUMBER
ONE PERSON THEY'LL ASK IS
PEDIATRICIAN AND PRIMARY CARE
PHYSICIAN AND DOCTOR.
THEY'RE GOING TO GO IN
PARTICULARLY THOSE DEALING WITH
CHRONIC DISEASES AND ASK DOC
WHAT AM I SUPPOSED TO EAT AND
THOSE OF US SITTING HERE AND IN
MEDICAL SCHOOLS THEY'RE LEARNING
NOTHING ABOUT NUTRITION.
THEY NEED GUIDANCE ON WHAT THEY
TEACH IN THE DIFFERENT SETTING
WITH REGARDS TO NUTRITION.
WHAT WE'RE LEARNING IS THERE'S
NOT MUCH IN TERMS OF WHAT
THEY'RE TEACHING AND WE HAVE TO
PROVIDE GUIDANCE AND WHILE THESE
AREN'T CLINICAL GUIDELINES WE
HAVE TO RECOGNIZE THE NUMBER ONE
PERSON THEY'RE ASKING IS THEIR
DOCTORS OR ADVANCED PRACTICE
PROVIDERS WHAT ARE THEY SUPPOSED
TO BE EATING AND NEED
SIGNIFICANT GUIDING REGARDING
THE CHRONIC DISEASE BURDEN
AROUND THE COUNTRY.
>> ABIG FOCUS OF THE HEALTH
EQUITY LENS WE'RE SEEING IT IN
DIFFERENT DIET AND WHAT'S
STRIKING ABOUT THE WHEN YOU HAVE
THE BREAK DOWN BY RACE AND
ETHNICITY PARTICULARLY LOOKING
AT PERCENTAGE MEETING THE EAR
AND ALSO THE DATA ON INTAKE THAT
DIDI PRESENTED AND I KNOW FOR
MANY YEARS WE'VE UNDERSTOOD THAT
PEOPLE HAVE BEEN PUSHED AWAY
FROM THEIR CULTURAL DIETS.
ESSENTIALLY THROUGH
ENVIRONMENTAL INFLUENCES AND I'M
WONDERING IF THERE'S BEEN
DISCUSSION HOW TO RECONCILE
THAT.
I THINK TLAETZ A FEW PIECES OF
THIS THAT WERE MENTIONED.
THE DARK LEAFY GREEN INTAKE, THE
BEANS, PEAS AND LENTILS I DIDN'T
HEAR THE BREAKDOWN ON RACE AND
ETHNICITY AND THE PRESENTATION
IS NOT ABOUT CULTURAL DIETS IT'S
ABOUT THE PUSH AWAY FROM
CULTURAL DIETS.
SO I'M CURIOUS THOUGH THE EAR
DATA IS DIFFERENT WHEN YOU LOOK
AT THE DIFFERENCES AND CONTRAST
TO SOME OF THE AREAS.
I'M CURIOUS WAS THERE ANY
DISCUSSION AROUND HOW THIS DATA
MAYBE PLAYS INTO THE EQUITY
CONVERSATION AS IT LINKS TO
CULTURAL DIET.
BECAUSE THE DISPARITIES ARE
THERE LIKE ALWAYS THERE BY RACE
AND ETHNICITY THOUGH SOME THINGS
BY INCOME ARE A LITTLE
SURPRISING.
IN THINKING ABOUT THE
INCONSISTENCY BECAUSE THE
CULTURAL DIETS ARE NOT
CONSISTENT WITH THE INTAKE
PATTERNS ANYMORE OR THE
PERCENTAGE OF THE EAR THOUGH
THERE ARE SOME EXCEPTIONS.
>> I THINK THIS IS AN IMPORTANT
POINT AND I DON'T RECALL THAT IN
EXPLICIT DISCUSSION ON THIS BUT
THERE WAS DISCUSSION ON WHAT THE
INTAKE DATA REPRESENTS.
IS IT BEHAVIOR OR FOOD
ENVIRONMENT AND YOU CAN'T REALLY
TELL BY LOOKING AT WHAT PEOPLE
ARE EATING IF IT'S WHAT THE FOOD
ENVIRONMENT IS PUTTING OUT THERE
AND PUSHING ALL THAT OUT OR IF
THE SUPPLY/DEMAND THERE'S NO
DIRECTIONALITY TO TELL.
BUT I THINK THAT WOULD BE
RELEVANT FOR THE QUESTION YOU'RE
ASKING IS THE FOOD ENVIRONMENT
LIKE OVERWHELMING AND THE
INTENTION TO EAT IN A SPECIFIC
WAY WHETHER IT'S CULTURAL OR
WANTING TO FOLLOW GUIDELINES BUT
BEING HARD TO DO SO.
I'M NOT SURE BUT IT ALSO TIES
BACK TO THE EDUCATION PIECE AND
BEHAVIOR.
I DON'T DOUBT EDUCATING PATIENTS
ON EATING HEALTHY WOULD HELP BUT
I DON'T KNOW PEOPLE HAVE NOT
BEEN HEARING THE GUIDELINES THE
LAST 20 YEARS AND STILL NO
CHANGE OVER ALL.
THE FOOD ENVIRONMENT
OVERWHELMING THE CHOICES AT THE
END OF THE DAY COULD BE ONE
POTENTIAL INTERPRETATION FOR THE
DATA.
>> NOT ONLY THE FOOD
ENVIRONMENT, WHICH ACTUALLY
EMBEDDED WITHIN THE FOOD
ENVIRONMENT YOU HAVE THE
INGREDIENTS AND HOW ARE YOU
PREPARING IT AND WHAT ARE YOU
EATING WITH IT AS WELL AND THAT
CAN BRING IN HEALTHY
INGREDIENTS.
YOU CAN HAVE AN EGG WITH HIGH
FATS OR SODIUM OR VEGETABLES AND
YOU SEE THE SUPPLY ISSUE BUT
WHAT ELSE IS CONSUMED IN CONTEXT
AND BRINGING IN CULTURAL FOODS
WE NEED TO BRING IN MORE OF
THOSE INGREDIENTS BUT ALSO WANT
TO BRING IN THINK BACK TO HOW
BEFORE ALL THESE MORE OF THE
PROCESSING AND AND THE COOKING
AND SEASONING AND NOT JUST
INGREDIENTS ITSELF THAT BRINGS
TOGETHER THE CULTURE.
>> ANOTHER THING WE DIDN'T SHOW
IN THE DATA TODAY IT DOESN'T
DIRECTLY GET AT THIS BUT DOES
OFFER INSIGHT AND WERE ABLE TO
BREAK DOWN DATA BY COUNTRY OF
BIRTH AND SO BY LOOKING AT THAT
YOU DON'T KNOW HOW WELL PEOPLE
HO WERE BORN IN A DIFFERENT
COUNTRY OF BIRTH ARE ABLE TO
ADHERE TO THEIR CULTURAL DIETS
ONCE THEY'RE HERE BUT STILL IT
PLAY SHED INSIGHT AND WE HAVE
THE DATA THAT WILL BE IN THE
REPORT.
AS I REMEMBER GOING THROUGH IT
WE STILL DIDN'T SEE A LOT OF
DIFFERENCE FOR MANY THINGS.
>> I THINK IT'S HELPFUL BECAUSE
IN THE COMMENTS ABOUT EQUITY IS
LINKED TO CULTURAL DIETS AND
THINKING HOW WE USE THE DATA TO
REALLY IDENTIFY AND THINK ABOUT
RECOMMENDATIONS THAT ALIGN WITH
CULTURAL DIETS AND SOME OF THE
INTAKE IS DEFINITELY NOT
CONSISTENT WHAT WOULD THINK OF
AS CONSISTENT WITH THE
TRADITIONAL DIETARY PATTERNS
PEOPLE THINK OF AS TRADITIONAL
DIETS.
SO I THINK THAT WAS HELPFUL.
>> I'M GLAD YOU'RE BRINGING UP
THE CULTURAL COMPONENT.
ONE OF THE THINGS THE COMMITTEE
IS CHARGED IS TO LOOK AT
DIFFERENT INTERVENTIONS AND ONE
OF OF THE INTERVENTIONS IS THE
CULTURAL INVENTION WHICH WE WILL
NOT HAVE DATA WE'LL JUST HAVE
THE EVIDENCE PREVIEW.
SO THERE'S DATA SO TO MAYBE
INCORPORATE ALSO WHEN WE'RE
TALKING ABOUT CULTURAL
INTERVENTIONS BECAUSE WE'RE
TALKING ABOUT WE'RE GETTING
WORSE IN TERMS OF MEETING
GUIDELINES AND MAYBE GIVING
THOSE FEW TIPS THAT WE CAN HELP
THE POPULATION GET THERE AND
MAYBE SINCE WE'RE NOT GOING TO
HAVE THE DATA MAYBE HAVING SOME
OF THAT ANALYSIS YOU GUYS ARE
DOING AND I DO APPRECIATE YOU
PRESENTING SOME OF THE RESULTS
OF THE THINGS WE'RE WORKING ON
THE BREAKFAST AND LATE EVENING
SNACKING IS HELPFUL.
IT WOULD BE NICE TO LOOK AT IF
IT'S POSSIBLE TO COMBINE WITH
WHAT DEANA SAID WHAT ARE DIETS
THEY'RE REPORTING THEY'RE DOING
AND IF THERE ARE DIETS HELPING
IMPROVE GUIDELINES AND IF THAT'S
POSSIBLE MAYBE IT'S TOO LATE BUT
THE CULTURAL COMPONENT WOULD BE
NICE TO COLLABORATE AND PART OF
OUR REPORT.
>> MAYBE BUILDING ON THAT AND
DIDI IT'S DEPRESSING HOW MUCH WE
HAVE WORK ON BUT ENJOYED THE
ALGORITHM FOR THE NUTRIENTS OF
CONCERN AND TRENDS ON FIBER AND
SODIUM BECAUSE THEY'RE HEADING
IN THE WRONG DIRECTION AND THIS
GROUP HAS THE ABILITY TO LOOK AT
THE CULTURAL DIET AND DARK
GREENS FOR EXAMPLE AS A SOLUTION
OR BEANS, PEAS AND LENTILS AND
MODEL IT IN THE DATA SET WE HAVE
AND WHAT TO WORK ON FIRST AND
ADD TRENDS TO THOSE NUTRIENTS OF
CONCERN.
YOU SAID TO THE SAME ONES SINCE
2020.
ARE THERE ANY GREATER CONCERNS
AMONG THE NUTRIENTS THAT GOT
ISOLATED WE NEED TO SEE THE
TREND DATA TO FIGURE OUT?
>> SO WE WERE ABLE TO LOOK AT
THOSE COMPARISONS OVER TIME BUT
THEY ARE VERY STEADY.
CHERYL.
>> I WAS STRUCK BY WHAT DIDI
PRESENTED AND WAS THINKING BACK
TO YESTERDAY'S PRESENTATIONS
AROUND FOOD PATTERN MODELLING
AND SOME OF WHAT SUBCOMMITTEE
HAS BEEN DOING AROUND DIETARY
PATTERNS.
PUT ALL THE PIECES TOGETHER AND
AND WONDERING ON THE
PRIORITIZATION AND NUTS, GRAINS,
LEGUMES AND DAIRY STRIKE ME AS
POTENTIAL THINGS WE SHOULD BE
ABLE TO COMMENT ON GIVEN WHERE
THE SCIENCE IS RIGHT NOW.
WHAT ARE THE CONVERSATIONS
AROUND BUILDING THE PRIORITIES
BECAUSE AS WE SEE THROUGH THE
PRESENTATIONS 245 THESE ARE GOI
BE TARGETS AND YESTERDAY AS I
WAS LISTENING I THOUGHT IN FOOD
WAYS I'M FAMILIAR WITH IT'S RARE
TO FIND WHAT PEOPLE CONSUME
BEANS WITHOUT RICE.
YET WE HAVE THE ISSUE OF TOTAL
GRAINS AND REFINED GRAINS AND
PERHAPS THINKING ABOUT DO WE
HAVE A WHOLE GRAIN APPROACH WITH
NUTS, GRAINS, LEGUMES.
WHAT ARE WE THINKING IN THE
SPACE AND WHAT IS THE
PRIORITIZATION PROCESS AND WHAT
DO WE PUT ON THE TOP OF THE
LIST.
>> IT GETS BACK TO THE
CONVERSATION AT THE END OF THE
DAY, WE'RE LOOKING AT THE
QUANTITIES IN THE PATTERN AND
NUTRIENT PROFILE AND IF YOU
REMOVE OR SUBSTITUTE THEIR
NUTRITIONAL IMPLICATIONS.
EACH ONE OF THE PROTOCOLS WERE
WHAT HAPPENS WITH THE
MODIFICATION OF THE QUANTITIES
AND DISTRIBUTION AND THE
NUTRIENT PROFILE.
BECAUSE IF YOU DECIDE IT TAKE
FOOD GROUPS AWAY YOU'RE TAKING
THE NUTRIENTS AWAY.
SO THEN WHAT YOU PUT BACK IN
BECOMES JUST AS IMPORTANT AS
WHAT'S TAKEN OUT AND WE HAD A
COUPLE WHERE WE WERE
RECOMMENDING A REDUCTION IN THE
OVER ALL PATTERN TO GET MORE
FLEXIBILITY IN THE SPACE AND
WITH THE REDUCTION IT MEANS A
REDUCTION IN NUTRIENTS.
SO WHEN WE MODEL THOSE WE HAD TO
DETERMINE IF WE REDUCE, DOES IT
CREATE A NUTRIENT GAP.
AND IF IT CREATES A NUTRIENT GAP
WE'RE SHOOTING OURSELVES IN THE
FOOT TO SAY WE'RE TAKING THIS
OUT AND THE NUTRIENTS ARE GONE
BUT THAT'S OKAY AND TRYING TO
CREATE A PATTERN THAT MEETS THE
NUTRIENT GOALS.
WE LOOKED AT EACH ONE OF THE
FOOD GROUPS TO ADDRESS THAT AND
FILL THE GAP FOR THE
NUTRIENTSES.
-- NUTRIENTS.
IF WE MAKE A PATTERN THAT
INTRODUCES NUTRIENT GAPS WHAT
WE'RE ULTIMATELY DOING IS
PUTTING OURSELF FURTHER DOWN THE
PATH OF NOT MEETING NUTRIENT
GOALS.
IF WE MAKE DECISIONS TO REMOVE
THING WITHOUT AN EVALUATION OF
THE NUTRIENT PROFILE WE'RE
CREATING THE PROBLEM RATHER THAN
ADDRESSING THE PATTERN AND
THAT'S WHERE THE MODELLING TAKE
THE NUTRIENT DATA AND SAYS IF
THIS, THEN WHAT.
SO THE FLEXIBILITY IS LOOKED AT
IF YOU REMOVE THIS OR MAKE A
CHOICE OR PATTERN OR HAVE TO
MAKE THE CHANGE AND IDENTIFIES
THE NUTRIENTS AND SAYS IF THIS,
THEN BE SURE TO --
>> SO WE WILL HAVE THE
OPPORTUNITY TO LOOK AT THE
SHIFTS AND CALL OUTS AND
DISTINGUISHING FEATURES SHOWN IN
WHAT DIDI PRESENTED AND
REGARDING CULTURAL APPROACHES TO
PUTTING FOOD TOGETHER.
I'M INTERESTING TO UNDERSTAND
HOW CHOICES GET MADE.
>> THE SYNTHESIS IS SEEING OUT
IT GETS TRANSLATED TO THE DIET
SIMULATION AND IS THE FUN
PLAYGROUND TO EXPLORE THE
CULTURAL FOOD WAYS IN THAT
SPACE.
>> I'M GOING TO INTERJECT THERE.
THERE'S AN A LOT OF WORK TO BE
DONE OVER THE NEXT FEW MONTHS
AND WE ALSO HAVE SOME PHENOMENAL
PRESENTATIONS COMING UP.
THIS WAS FANTASTIC DISCUSSION.
HOW ABOUT WE TAKE A 10-MINUTE
BREAK AND I JUST WANT TO THANK
ALL THE PRESENTERS.
GREAT JOB.
>> GREAT PRESENTATIONS AND OVER
TO JEN TO TALK ABOUT DIET AND
PREGNANCY AND BIRTH THROUGH
ADOLESCENCE.
>> THANK YOU.
GOOD MORNING, EVERYONE.
IT'S MY PLEASURE TO PRESENT THE
WORK AND PROGRESS OF
SUBCOMMITTEE 2 WHICH IS DIET AND
PREGNANCY AND BIRTH THROUGH
ADOLESCENCE.
I'M GOING TO BE JOINED IN THE
PRESENTATION BY DR. ANDREA
DEERVINE.
I'D LIKE TO ACKNOWLEDGE NOTE
THAT THERE ARE SEVERAL WHO SERVE
ON THE HEALTH EQUITY COMMITTEE
AS DISCUSSED IN PREVIOUS
PRESENTATIONS I THINK IT'S BEEN
IMPORTANT THE HEALTH EQUITY
GROUP AND OTHER CONSIDERATIONS
IN THE LIFE STAGES TO THE HEALTH
EQUITY GROUP.
I THINK THAT'S BEEN POSITIVE.
WE WANT TO ACKNOWLEDGE THE
TREMENDOUS WORK AN AND SUPPORT
OF THE STAFF AND CHARLOTTE WHO
HAS LED THE WORK ON THE STAFF
SIDE WE'VE PRESENTED TODAY AND
ACKNOWLEDGE AS ALWAYS OUR
FEDERALLY LIAISON.
WHAT HAVE WE BEEN UP TO SINCE
THE LAST MEETING?
FOR THOSE WHO MAY NOT REMEMBER,
OUR SUBCOMMITTEE HAS BEEN TASKED
WITH REVIEWING THE EVIDENCE FOR
EIGHT SCIENTIFIC QUESTIONS
REGARDING DIET DURING PREGNANCY
AND FROM INFANCY THROUGH
ADOLESCENCE.
WE'VE COMPLETED OUR WORK ONE ON
REPEATED EXPOSURE AND FOOD AC
ACCEPTANCE AND FOOD PATTERNS ON
PREGNANCY AND MATERNAL OUTCOMES.
WE'VE DONE SYSTEMATIC REVIEW OF
THE EVIDENCE TO LOOK AT
ASSOCIATIONS OF COMPLIMENTARY
FEEDING WITH GROWTH BODY
COMPOSITION AND RISK OF OBESITY
THROUGH A -- CHILDHOOD AND
ADULTHOOD.
WE HAVE FOUR QUESTIONS YET TO
ADDRESS.
TWO GO TO KOIR GIVER FEELINGED
PROONTSS AND INFOONT OUT
>> CAREGIVER FEEDING AND INFANT
OUTCOMES.
BEFORE WE GET INTO THE REVIEW OF
THE COMPLEMENTARY FEEDING I
WANTED TO TAKE A FEW MOMENTS TO
TALK ABOUT SEVERAL REVISIONS TO
THE PROTOCOLS FOR REVIEWS ON
COMPLIMENTARY FOODS AS WELL AS
PROTOCOLS ON THE REMAINING
REVIEWS TO BE DONE.
FOR THOSE LISTENING THESE
PROTOCOLS REFER TO THE METHODS
THAT WE'RE USING TO CONDUCT THE
SYSTEMATIC REVIEWS THAT ALLOW US
TO EVALUATE THE SCIENTIFIC
EVIDENCE ON THESE TOPICS.
THIS SLIDE GIVES INFORMATION ON
THE COMPLEMENTARY FEEDING
REVISIONS AND THEY WERE MADE
DURING THE COURSE OF THE REVIEW.
I'LL TRY TO SUMMARIZE WHY WE
MADE THE REVISIONS.
YOU'LL HEAR THE COMPLEMENTARY
FEEDING REVIEW COVERED A WIDE
RANGE OF FOOD AND BEVERAGES
OFFERED TO CHILDREN IN THE FIRST
24 MONTHS OF LIFE.
WE CONSIDERED THE TYPES AND
AMOUNTS OF THE FOODS AS WELL AS
THE TIMING OF INTRODUCTION TO
THOSE FOODS AND ASSOCIATIONS
WITH BIRTH BODY COMPOSITION AND
RISK TO OBESITY OUTCOMES.
AS WE BEGIN TO SYNTHESIZE THE
EVIDENCE IT BECAME VERY CLEAR
THERE'S TREMENDOUS HETEROGENEITY
AND COMPARATORS THAT PARS THE
DATA AND PRONOUNCED IN TRIALS
THAT MET OUR INCLUSION PRIORITY
BUT NOT DESIGNED WITH THE GOAL
OF EVALUATING THE OUTCOMES OF
INTEREST.
THAT MAY BE ARBITRARY BUT THESE
THINGS ARE ALL IMPORTANT.
WE MAY HAVE EXPOSURES AND
COMPARE TORS -- COMPARATORS BUT
THE CONTROLS ARE ALL IMPORTANT
AND SO IN THE STUDIES WE MAY
HAVE HAD MEAT COMPARED TO INFANT
CEREAL BUT WERE THEY PROVIDED IN
EQUAL NUMBERS OF CALORIES.
WHAT DID THE REST OF THE DIET
LOOK LIKE AND WHAT, INSTRUCTIONS
WERE CAREGIVERS GIVEN AND WHEN
YOU LOOK AT IRON STATUS OR ZINC
STATUS THOSE CONTROLS MAY LOOK
DIFFERENT TO LOOK AT GROWTH
OUTCOMES.
THAT'S A LONG WAY OF SAYING THE
DATA WAS COMPLEX AND FELT IT WAS
IMPORTANT TO REMOVE THE STUDIES
CREATING NOISE RATHER THAN
AHOWING US TO EXAMINE THE
ASSOCIATION EXPOSURE AND OUTCOME
OF INTEREST.
WE GOT RID OF THOSE STUDIES.
THE SECOND REVISION THAT WAS
RELATED IN LIGHT OF THE
HETEROGENEITY WE DECIDED TO NOT
CONDUCT A REVIEW.
WE LOOKED AT A NUMBER OF FOOD
GROUPS BUT DECIDED NOT TO REVIEW
A GROUP REFERRED TO AS THE OTHER
FOOD GROUP WITH COMPLIMENTARY
FOODS OUTSIDE THE DEFINITIONS
FOR 100% FRUIT, JUICE,
VEGETABLES, GRAINS, ETCETERA.
WE MADE THE DECISION FIRST FOR
TWO REASONS.
ONE IN LIGHT OF THE
HETEROGENEITY WHICH WE THOUGHT
WOULD BE IMPOSSIBLE TO MAKE
SENSE OF SUCH A DIVERSE GROUP
AND BECAUSE WE PRIORITIZED THE
REMAINING QUESTIONS I'LL SAY A
BIT MORE ABOUT.
SO THE FINAL REVISION WITH THIS
WORK IS WE DEPRIORITIZED REVIEW
STUDIES EVALUATING THE TIMING OF
ANY FIRST INTRODUCTION TO
COMPLIMENTARY FOODS AND
BEVERAGES AND MADE THE DECISION
AGAIN IN INTEREST OF TRYING TO
COMPLETE THE WORK WE HAVE
REMAINING AND WITH BROAD
ACKNOWLEDGEMENT OF THE PRIORITY
OF THE WORK AND ALSO BECAUSE WE
HAVE A CONCLUSION IN THE B24
WORK AND FELT WE COULD DRAW FROM
THAT EVIDENCE AND WOULD BE
UNLIKELY TO CHANGE AND USED OUR
TIME ON WHAT WE HAD LEFT TO DO.
SO LET'S GO TO THE NEXT SLIDE
THE NEXT REVISION PERTAIN TO
THESE SYSTEMIC REVIEW ON
CAREGIVER FEEDING PRACTICES AND
THIS IS ONE WE HAVE NOT YET
BEGUN.
SO IT'S BEEN VERY CLEAR
ABUNDANTLY CLEAR THE ORIGINAL
SCOPE OF THE WORK FOR THIS
REVIEW WHICH SPANNED FROM BIRTH
TO ADOLESCENCE WAS TOO BROAD TO
BE COMPLETED.
I THINK WE'RE ALL IN AGREEMENT
THIS IS A VERY IMPORTANT
QUESTION.
AND LOOKING AT OUTCOMES BUT
ULTIMATELY REVIEW EVIDENCE ON
BOTH EVIDENCE BUT NARROW OUR AGE
RANGE AND FOCUS ON EARLY
CHILDHOOD AND COMPLETE THE WORK
AND DO IT WELL.
AND I THINK OUR COMMITTEE IS
QUITE EXCITED ABOUT DOING THIS
WORK AND THINK THIS WILL BE A
GOOD FIRST STEP SINCE THIS WILL
BE A NEW REVIEW FOR THE DIETARY
GUIDELINES.
THE LAST REVISION I'LL SAY
BRIEFLY WE REVISED THE PROTOCOLS
FOR THE REVIEWS AND DIETARY
PATTERNS TO ENABLE A FOCUS ON
BIRTH OUTCOMES OF GREATEST
PUBLIC HEALTH CONCERN.
AND REPORT CATEGORICAL
GESTATIONAL AGE OF OUTCOMES AND
FOCUS ON THAT LITERATURE THIS IS
THE ANALYTICAL FRAMEWORK USED TO
ANSWER THE QUESTION, THE BROAD
QUESTION, WHAT IS THIS
RELATIONSHIP BETWEEN
COMPLEMENTARY FEEDING AND
BROTHER BODY COMPOSITION AND
RISK OF OBESITY.
SO JUST AS A REMINDER FOR THOSE
WHO MAY NOT WORK DIRECTLY IN
THIS AREA, COMPLEMENTARY FEEDING
STARTS WITH HUMAN MILK OR INFANT
FORMULA IS COMPLEMENTED AND THIS
IS TYPICALLY THIS IS AT 6 MONTHS
FOR MOST FOODS AND UNTIL 24
MONTHS OF AGE AS CHILDREN
TRANSITION TO FAMILY FOODS.
SO EXPOSURES OF INTEREST SHOWN
IN THE SECOND COLUMN WERE
INVOLVED THAT BOTH THE TIMING OF
INTRODUCTION TO VARIOUS FOODS AS
WELL AS BEVERAGES AND THEN THE
TYPES AND AMOUNTS OF THOSE
FOODS.
YOU CAN SEE THE FOOD GROUPS
THERE WERE SIX DIFFERENT FOOD
GROUPS OF INTEREST IN THE SECOND
COLUMN.
COMPARATORS WERE TIMING AND
AMOUNTS RESPECTIVELY AND THE
GROWTH BODY COMPOSITION OUTCOMES
FROM ADOLESCENCE ARE TO THE SAME
AS THOSE SPECIFIED IN OTHER
SYSTEMIC REVIEW BY OUR
SUBCOMMITTEE SO I WON'T GO INTO
THOSE AND THE KEY CONFOUNDERS
INCLUDED RACE AND ETHNICITY AS
WELL SEP WITH OUR HEALTH EQUITY
LENS APPLIED ACROSS ALL REVIEWS
AS WELL AS OTHER POTENTIALLY
IMPORTANT VARIABLES SPECIFIC TO
LIFE STAGES SHOWN IN THE LAST
COLUMN.
SO MOVING ON TO THE DATA OF
INTEREST.
THIS SLIDE PROVIDES AN OVERVIEW
OF 20 CONCLUSION STATEMENTS.
QUITE A FEW THAT WERE DEVELOPED.
WE HAD THE FOOD GROUPS THAT ARE
SHOWN ON THE FIRST COLUMN ON THE
LEFT AND TWO DIFFERENT QUESTIONS
ONE REFERRING TO THE TYPES AND
THE SECOND TO TIMING OF
INTRODUCTION.
AND SO ONE THING I'LL POINT OUT
IS THAT FOR THE TIMING OF
INTRODUCTION, OUR INCLUSION
CRITERIA WORKED BROAD AND
LOOKING AT STUDIES THAT HAD
INTRODUCTION OF VARIOUS FOODS AT
ANY POINT FROM ZERO TO 24 MONTHS
RATHER THAN FOCUSSING NARROWLY
ON CURRENT RECOMMENDATIONS TO
BEGIN COMPLIMENTARY FEEDING AT
SIX MONTHS OR LATER TIME POINTS
FOR SUGAR SWEETENED BEVERAGES.
THE MAIN TAKEAWAY FROM THE
REVIEW AND IT'S THERE'S A
PAUCITY OF DATA FOR THE RISK OF
OBESITY OUTCOMES AN LIKELY TO
REFLECT THE METHODOLOGY WHICH
FOCUSES ON THE MOST RIGOROUS
EVIDENCE AND STUDY DESIGN.
WE WERE QUITE FRANKLY SURPRISED
IN SOME OF THESE CASES THERE
WERE SO LITTLE DATA TO REVIEW.
SO WHILE THERE MAY BE PUBLISHED
DATA THIS SLIDE CLEARLY SHOWS
YOU THAT THERE ARE LIMITED
PROSPECTIVE COHORT AND CONTROL
TRIALS THAT REALLY SPEAK TO THE
FUNDAMENTAL QUESTION OF HOW
COMPLIMENTARY FEEDING CAN
SUPPORT OPTIMAL GROWTH THE FIRST
YEAR OF LIFE.
THERE'S A NEED FOR RIGOROUS
EMPIRICAL EVIDENCE AND IN ANDREA
EASE COMMENTS EVEN FOR FOOD
GROUPS WHERE THERE WAS STUDIES
THAT MET INCLUSION, EXCLUSION
CRITERIA THERE WAS HETEROGENEITY
IN THE FOODS THAT ABILITY TO
DRAW CONCLUSIONS IN BROAD
CATEGORIES OF INTEREST.
FOR INSTANCE, I EXPECT MEMBERS
OF THE SUBCOMMITTEE TO TWITCH A
BIT BECAUSE WE SPENT TIME HERE
THE PROTEIN FOODS GROUP IS
INCLUSIVE OF A BROAD RANGE OF
FOODS BUT WHEN YOU STARTED
LOOKING AT THE STUDIES THAT MET
OUR INCLUSION CRITERIA THEY WERE
EXTREMELY VARIED AND FOCUSSED ON
FOOD SUCH AS MEATS AND THOSE WHO
CONSIDERED A RANGE BUT
VARIABILITY IN TERMS OF THE
TYPES OF FOODS COMBINED FOR
ANALYSIS.
UP ADDITION TO THOSE THINGS THE
COMPARATORS OF INTEREST WERE
VARIED IN THE PROSPECTIVE COHORT
STUDIES THERE WERE DIFFERENT
FREQUENCIES AND AMOUNTS AND IN
THE RCTs THEY COMPARED MEAT TO
INFANT CEREAL OR DAIRY.
SO IT FELT AT TIMES LIKE APPLES
AND ORANGES, IF YOU WILL OR IN
THIS CASE MEAT AND EGGS.
IT WAS CHALLENGING.
AND ONE EXCEPTION WAS THE
EVIDENCE ON SUGAR SWEETENED
BEVERAGES BY INFANTS AND
DOWNCHILDO
BETWEEN CHILDREN AND THE
FINDINGS ARE GOING TO BE
PRESENTED IN THE NEXT
PRESENTATION.
SO WITH THAT, I WILL TURN IT
OVER TO ANDREA.
THANK YOU.
>> OKAY.
>> SO FIRST WE'RE GOING TO
REVIEW THE CONCLUSION STATEMENTS
PERTAINING TO THE TYPES AND
AMOUNTS OF COMPLIMENTARY FOODS.
IS THIS SLIDE SHOWS THE
INCLUSION STATEMENT WE'RE ABLE
TO MAKE REGARDING TYPES AND
AMOUNTS OF GRAINS.
SO THERE WAS LIMITED EVIDENCE
THAT SUGGESTED GRAINS
CONSUMPTION BY INFANTS AND YOUNG
CHILDREN FROM INFANTS 6 MONTHS
TO 24 MONTHS OF AGE IS NOT
ASSOCIATED WITH UNFAVORABLE
OUTCOMES RELATED TO GROWTH
PATTERNS AND RISK OF OBESITY
DURING CHILDHOOD.
BASED ON EVIDENCE FROM NINE
STUDIES.
WE HAD TWO RANDOMIZED CONTROL
STUDIES AND SEVEN PROSPECTIVE
COHORT STUDIES.
LOOKING AT THE GRADING ELEMENTS
SO WE DID THERE WERE CONCERNS
WITH INCONSISTENCIES ACROSS
STUDY RESULTS HOWEVER, MANY
STUDIES WERE REPORTING NUL
CONSUMPTION ON GRAIN FINDING AND
RISK OF OBESITY AND I'LL SAY
THIS A LOT FOR OTHER FOODS AS
WELL THERE WAS VARIATION IN THE
GRAINS PRODUCTS EXAMINED WITH
SOME LOOKING AT SPECIFIC
PRODUCTS LIKE INFANT CEREAL OR
MILK CEREAL DRINK AND OTHERS
WERE LOOKING AT BROADER
CATEGORIES.
SO FULL AND REFINED GRAINS OR
CEREAL FOODS AS WELL AS
CEREAL-BASED PRODUCTS.
FOR PRECISION THERE'S CONCERN
BECAUSE STUDIES REPORTED
INSUFFICIENT POWER OR DIDN'T
PROVIDE INFORMATION ON POWER.
THERE WERE SEVERAL RISK OF BIAS
CONCERNS.
IN PARTICULAR THERE WAS CONCERNS
DUE TO RANDOMIZATION AND WITH
THE OBSERVATIONAL STUDIES WE SAW
CONCERNS DUE TO CONFOUNDING,
EXPOSURE MEASUREMENT AS WELL AS
MISSING DATA.
FOR GENERALIZABILITY, THERE WERE
CONCERNS SO THERE WERE STUDIES
THAT HAD REPRESENTATION OF
INDIVIDUALS ACROSS RACIAL AND
ETHNIC GROUPS AS WELL AS SOCIO
ECONOMIC GROUPS AND HALF THE
STUD WERE CONDUCTED IN THE
UNITED STATES AND IN THE STUDIES
THE GRAIN PRODUCTS BEING
EXAMINED TEND TO BE LESS
GENERALIZABLE TO PRODUCTS
CONSUMED IN THE U.S.
THIS SHOWS TYPE AND AMOUNTS OF
FRUITS AND VEGETABLES AN
STATEMENTS FOR FRUIT AND
VEGETABLE CONSUMPTION.
FIRST LOOKING AT FRUIT
CONSUMPTION, WE FOUND LIMITED
EVIDENCE TO FIND FRUIT
CONSUMPTION FOR CHILDREN 8 TO 24
MONTHS IS NOT ASSOCIATED WITH
UNFAVORABLE OUTCOMES RELATED TO
GROWTH PATTERNS DURING
CHILDHOOD.
THIS RELATES TO GROWTH PATTERNS
SPECIFICALLY.
THIS WAS BASED ON FOUR
PROSPECTIVE COHORT STUDIES AND
HAD MINIMAL CONCERNS ON THE
DIRECTION OF THE FINDINGS.
MOST WERE REPORTED NUL FINDING
AND THEY WERE CONSISTENT ACROSS
STUDIES.
THERE WAS CONCERN WITH PRECISION
BECAUSE WE HAD STUDIES AND
CONFIDENCE INTERVALS TENDED TO
BE WIDE AND NONE OF THE STUDIES
REPORTED ON POWER CALCULATIONS.
FER FOR RISK OF BIAS THEY LOOKED
AT FRUIT CONSUMPTION AND GROWTH
PATTERNS AND CONCERN ABOUT
GENERALIZABILITY WITH FEW
STUDIES CONDUCTED IN THE UNITED
STATES.
WE FOUND VEGETABLE CONSUMPTION
WAS NOT RELATED TO ADVERSE
GROWTH PATTERNS IN CHILDHOOD
FROM COHORT STUDIES AND
SIMILARLY USHGS
MINIMAL CONCERNS AND RISK OF
BIAS RELATED TO CONFOUND IING A
MISSING DATA.
OKAY, NOW WE'RE GOING TO SHOW
SOME REVIEWS REMAINING
CONCLUSION STATEMENT AND THESE
WERE ONES WE WERE UNABLE TO
ASSIGN A GRADE TO.
THE CONCLUSION STATEMENTS KOVENT
BE DRAWN.
COULDN'T BE DRAWN DUE TO
DIFFERENCES IN METHODOLOGIES AND
MADE IT DIFFICULT TO SYNTHESIZE
THE EVIDENCE AND COMPARE ACROSS
STUDIES OR A LACK OF EVIDENCE
FOR LOOKING AT THE QUESTION.
STARTING WITH PROTEIN FOODS A
CONCLUSION STATEMENT COULD NOT
BE DRAWN REGARDING CONSUMPTION
AND CONSIDERING THIS PROTEIN
FOOD AS A FOOD GROUP.
DUE TO CONCERNS AND EXPOSURES IN
THE PROTEINS FOODS GROUPS.
SOME FOCUSSED NARROWLY ON A
SPECIFIC FOOD GROUP AND SOME
LOOKED AT MEAT ALONE OR SEAFOOD
ALONE AND OTHER STUDIES COULD
COMBINE CERTAIN FOODS WITHIN THE
PROTEIN FOOD GROUPS WITHIN THEIR
ANALYSIS AND CONSIDERABLE
HETEROGENEITY OF WHICH FOODS
THEY CHOSE TO INCLUDE IN THE
GROUPING OF FOODS WITHIN THE
PROTEIN FOODS GROUP.
WE FELT THE BODY OF EVIDENCE WAS
NOT REPRESENTATIVE OF THE
PROTEINS FOODS GROUP.
THE COMPARATORS IN STUDIES ALSO
VARIED AS WE MENTIONED.
WITH TRIALS COMPARING MAY BE
COMPARED TO INFANT CEREAL OR
DAIRY AND THE COHORT STUDIES
COMPARED DIFFERENT AMOUNTS OF
FOODS OR FREQUENCY OF
CONSUMPTION OF THE PROTEIN FOODS
AND SOME WERE LOOKING AT IT
CATEGORICALLY WHILE OTHERS WERE
LOOKING AT CONSUMPTION
CONTINUOUSLY.
FOR DIRECTNESS, THERE WAS
CONCERN DUE TO THE FEW STUDIES
EXAMINING PROTEIN FOODS AS A
FOOD GROUP AND AGAIN THERE WERE
STUDIES LOOKING AT SMALLER
SUBSETS WITHIN THIS AS WELL AS
STUDIES THAT INCLUDED EGG OR
PLANT PROTEIN SOURCES SO BEANS
AND LEGUMES.
SO THAT'S PROTEIN FOODS.
FOR DAIRY, A CONCLUSION
STATEMENT COULD NOT BE DRAWN
ABOUT THE CONCLUSION OF DAIRY IN
INFANTS AND YOUNG CHILDREN DUE
TO CONCERNS WITH CONSISTENCY.
PART OF THE PROBLEM OF THE
EXPOSURES WERE MEASURED VARIED
FROM BIRTH TO 24 MONTHS.
SO FOR INSTANCE SOME OF THE
STUDIES WERE EXAMINING DAIRY
CONSUMPTION PARTICULARLY COWS
MILK EARLY IN INFANCY AND OTHERS
WERE EXAMINING DAIRY CONSUMPTION
IN THE UPPER AGES OF THE GROUP
AROUND 18 MONTHS OF AGE.
THE COMPARATORS VARIED WIDELY.
SOME STUDIES COMPARED DAIRY OR
COWS MILK TO DIFFERENT PRODUCTS
COMPARED TO MEAT OR TODDLER MILK
WHILE OTHERS WERE COMPARING
DIFFERENT AMOUNTS OF COW'S MILK
OR DAIRY AND ACROSS FAT
CONTENTS.
LASTLY THE STUDIES VARIED IN THE
OUTCOMES EXAMINING AND THE AGES
AT WHICH THE OUTCOMES WERE BEING
MEASURED FROM 6 MONTHS TO 11½
YEARS OF AGE.
FOR 100% JUICE, A CONCLUSION
STATEMENT COULD NOT BE DRAWN AND
AGAIN THIS IS DUE TO SUBSTANTIAL
CONCERNS WITH CONSISTENCY AND
PRECISION.
SO, WITH CONSISTENCY THERE WAS
CONCERNS WITH THE SIGNIFICANCE
OF THE RESULTS AND OUTCOME THE
STUDIES WERE EXAMINING.
EACH OF THE FOUR STUDIES
EXAMINED A UNIQUE OUTCOME WHICH
LIMITED OUR COMPARABILITY ACROSS
STUDIES AND PRECISION IS ALSO A
CONCERN BECAUSE WE ONLY HAD FOUR
PROSPECTIVE STUDIES THAT WERE
EXAMINING 100% JUICE
CONSUMPTION.
FINALLY YOU SEE CONCLUSION
STATEMENTS THAT COULD NOT BE
DRAWN BECAUSE WE FELT THERE WAS
NOT ENOUGH EVIDENCE AVAILABLE.
FOR GRAINS WE WERE NOT ABLE MAKE
A CONCLUSION STATEMENT REGARDING
BODY COMPOSITION.
FOR FRUIT AND VEGETABLES WE WERE
UNABLE TO MAKE STATEMENTS
REGARDING BODY COMPOSITION AS
WELL AS RISK OF OBESITY AND THEN
FOR FOOD SOURCES OF ADDED SUGARS
WE WERE NOT ABLE TO MAKE
CONCLUSION STATEMENT FOR GROWTH
BODY COMPOSITION OR RISK OF
OBESITY.
NOW WE'RE GOING TO LOOK AT THE
CONCLUSION STATEMENTS PERTAINING
TO TIMING OF INTRODUCTION OF
THESE DIFFERENT COMPLIMENTARY
FOODS.
JUST AS A REMINDER WE LOOKED AT
STUDIES INTRODUCTION OF THE
FOODS FROM BIRTH TO 24 MONTHS OF
AGE.
SO THIS IS OR ONE AND ONLY
CONCLUSION STATEMENT.
SO FROM THIS GROUP SO WE FOUND
LIMITED EVIDENCE SUGGESTS
INTRODUCING GRAINS AT OR BEFORE
FOUR MONTHS OF AGE IS ASSOCIATED
WITH HIGHER BMIZ SCORES DURING
CHILDHOOD.
SO THIS STATEMENT WAS BASED ON
EVIDENCE FROM SIX PROSPECTIVE
COHORT STUDIES AND SO WITH
CONSISTENCY THERE WAS A CONCERN
ACROSS THE BODY OF EVIDENCE WITH
APPROXIMATELY HALF THE STUDIES
REPORTING A MIX OF STATISTICALLY
SIGNIFICANT AND
NON-STATISTICALLY SIGNIFICANT
RESULTS.
AND HALF REPORTING EXCLUSIVELY
NUL RESULTS HOWEVER, THE
DIRECTION AND MAGNITUDE OF THE
RESULTS THAT WERE STATISTICALLY
SIGNIFICANT WERE CONSISTENT.
FOR PRECISION THERE WAS A
CONCERN BECAUSE OF THE SMALL
NUMBER OF STUDIES AS WELL AS
SMALL EFFECT SIZES OBSERVED FOR
RISK OF BIAS THERE US -- WAS A
CONCERN DUE TO CONFOUNDING AND
EXPOSURE MEASUREMENT AND FOR
DIRECTNESS BECAUSE MANY STUDIES
LOOKED DIRECTLY AT THE QUESTION
AND GENERALIZABILITY WAS A
CONCERN.
THOUGH HALF THE STUDIES INCLUDED
PARTICIPANTS FROM THE UNITED
STATES, THESE STUDIES OFTEN HAD
POPULATIONS THAT TENDED TO BE
HIGHER SOCIO ECONOMIC POSITIONS
AS WELL AS PARTICIPANTS
PREDOMINANTLY WHITE OR EUROPEAN
WITH LITTLE REPRESENTATION FROM
OTHER RACIAL OR ETHNIC GROUPS.
SIMILAR TO AMOUNTS AND THE
TIMING OF INTERDICTION --
INTRODUCTION OF FOODS AND
THERE'S FELT THERE WAS A LACK OF
EVIDENCE.
WHEN LOOKING AT PROTEIN FOODS,
AGAIN A CONCLUSION STATEMENT
COULDN'T BE DRAWN AND A LOT OF
THIS HAD TO DO AGAIN WITH THE
ISSUES OF CONSISTENCY I
MENTIONED.
THERE WAS REGARD OF CONSISTENCY
OF EXPOSURES AND HOW THEY WERE
ASSESSED AND PROTEIN FOODS
EXAMINED IN STUDIES EITHER
LOOKING AT THEM CATEGORICALLY OR
CONTINUOU
CONTINUOUSLY MOST LOOKED AT EGGS
AND MEAT RATHER THAN
INTRODUCTION TO HIGH PROTEIN
FOODS MORE BROADLY AND AGAIN
MOST THE STUDIES WERE LOOKING AT
INTRODUCTION CONTINUOUSLY RATHER
THAN LOOKING AT SPECIFIC TIME
POINTS FOR INTRODUCTION.
FOR DAIRY A CONCLUSION STATEMENT
COULD NOT BE DRAWN WHEN LOOKING
AT THE DAIRY FOOD GROUP AND
OUTCOMES RELATED TO GROWTH
PATTERNS AND RISK OF OBESITY
BECAUSE THERE WAS NOT ENOUGH
EVIDENCE AVAILABLE AND THE
EVIDENCE THAT WAS AVAILABLE WE
HAD SUBSTANTIAL CONCERNS
REGARDING CONSISTENCY.
SO, CONSISTENCY WAS A CONCERN
DUE TO HETEROGENEITY BECAUSE OF
TIME POINTS ACROSS STUDIES AND
THE ANALYSES CONSIDERED THE
EXPOSURES CONTINUOUSLY.
ADDITIONALLY, THERE WAS MINIMAL
EVIDENCE FOR CERTAIN EXPOSURES
AND OUTCOMES OTHER THAN A LOT OF
THESE STUDIES FOCUSSED ON COW'S
MILK AS WELL BODY COMPOSITION.
FOR SUGAR SWEETENED BEVERAGES WE
COULDN'T MAKE A CONCLUSION ON
THIS AGAIN DUE TO CONCERNS WITH
CONSISTENCY.
THERE WERE SEVERAL AREAS OF
INCONSISTENCIES ACROSS THE BODY
OF EVIDENCE.
FIRST, STUDIES VARIED IN
EXPOSURES WITH HALF EXAMINING
SUGAR SWEETENED BEVERAGES SUCH
AS SODA AND SOFT DRINKS WHILE
HALF ARE EXAMINING JUICE THAT
WAS NOT DEFINED OR COULD NOT BE
CONFIRMED AS BEING 100% JUICE
THIS WENT TO AGE OF INTRODUCTION
ANALYZED AND CUT POINTS UP TO
AGE 12 MONTHS AS WELL AS
CONTINUOUS ASSESSMENT.
AND FINALLY THE OUTCOMES WERE
ASSESSED ACROSS A LARGE RANGE OF
AGES.
FINALLY, SEVERAL CONCLUSION
STATEMENTS COULDN'T BE DRAWN
BECAUSE YOU DIDN'T HAVE ENOUGH
EVIDENCE THERE WERE FEW STUDIES
FOR THE REMAINING FOODS WE WERE
LOOKING AT.
SO, WE WERE UNABLE TO LOOK AT
THE AGE AT WHEN CHILDREN WERE
INTRODUCED WITH BODY COMPOSITION
AND RISK OF OBESITY AND LOOKING
AT FRUITS, VEGETABLE AND FOOD
CONSUMPTION AND ADDED SUGARS
RELATED TO GROWTH BODY
COMPOSITION AND RISK OF OBESITY.
THAT WAS A LOT AND THANK YOU.
>> TRACY, YOU WANT TO GO FIRST.
>> THE FIRST SET OF RESULTS WITH
THE FOOD GROUPS AND LIMITED
[INDISCERNIBLE] THE WORDINGS CAN
YOU EXPLAIN WHY YOU CHOSE
THAT --
>> TALK INTO THE MIC.
I'M SORRY.
>> SO THE WORDING FOR THE
LIMITED CONCLUSION STATEMENT
THAT IS LIMITED EVIDENCE
SUGGESTS THAT SUCH FOOD GROUP
WAS NOT ASSOCIATED WITH
UNFAVORABLE -- YOU MUST HAVE A
REASON FOR THIS.
>> YES, WE SPENT A SIGNIFICANT
AMOUNT OF TIME DISCUSSING EVERY
SINGLE WORD IN EACH OF THOSE
STATEMENTS AND FOR THE MOST PART
I THINK IT'S JUST THE CHALLENGE
IS RIGHT AS THE DISCUSSION
YESTERDAY WHAT DO THESE METRICS
MEAN IN TERMS OF OBVIOUSLY WE
EXPECT YOUNG CHILDREN TO BE
GROWING.
WE WANTED TO WORD THE STATEMENTS
SO THERE WAS NO LATEST
INTERPRETABLE MISINFORMATION AND
FELT THAT USING THE PHRASE WAS
BETTER THAN THE FLIP SIDE OF
SHOWING EFFECTS ON UNFAVORABLE
PATTERNS.
IT'S A LONG WAY OF SAYING WE
FELT IT WAS THE BEST CONVEY NUL
RESULT WITHOUT MAKING CONFUSING
STATEMENTS ABOUT THE ROLE OF
THESE.
>> WILL FANTASTIC PRESENTATION.
JEN, AT THE BEGINNING YOU TALKED
ABOUT A LOT OF LIMITATIONS OF
STUDIES THAT PARTICULARLY THE
ONES THAT DROVE YOUR DECISION TO
EXCLUDE THEM FROM CONSIDERATION
AND MEETING 3 WE HAD DISCUSSION
ABOUT THE REALITY THERE IS A LOT
OF PUBLISHED STUDIES ON MANY
TOPICS WE ARE REVIEWING HERE BUT
WHEN YOU COME TO THE SYSTEMATIC
REVIEW PROCESS THEY DON'T MEET
THE RIGOR WE NEED TO MAKE
EVIDENCE-BASED DECISIONS.
ARE YOU GOING TO TAKE TIME IN
THE FUTURE DIRECTION DISCUSSION
AND IT SEEMS TO ME THIS IS A
WONDERFUL OPPORTUNITY TO INFORM
THE BROADER COMMUNITY AND
FRANKLY FEDERAL FUNDING AGENCIES
ON WHAT NEEDS TO BE DONE BUT
MORE IMPORTANTLY HOW IT SHOULD
BE DONE.
>> WE SPENT A GOOD DEAL OF TIME
TALKING ABOUT THIS WITH ANOTHER
REVIEW WE WERE IN FACT I THINK A
NUMBER OF US WERE SURPRISED
THERE WERE SO FEW STUDIES.
THE EVIDENCE LOOKS LIKE IT BUT
IN FACT THIS REVIEW AND WE'VE
LOOKED AT ONE LENS AND THERE MAY
BE A WHOLE BODY WE LEFT OUT.
I THINK THEY'RE IMPORTANT
MESSAGES THAT SHOULD BE CONVEYED
TO THE SCIENTIFIC COMMUNITY AS
WELL AS THE NATIONAL INSTITUTES
OF HABING AND OTHER
ORGANIZATIONS THAT FUND THIS
WORK BECAUSE -- THE OF HEALTH
AND OTHER ORGANIZATIONS THAT
FUND THIS WORK AND WHEN YOU LOOK
HEAT DESIGNS IT'S AN IMPERATIVE
AND OPPORTUNITY TO CONVEY THE
NEED FOR THESE TYPES OF RIGOROUS
DESIGNS.
ANYONE ELSE?
>> ON TOP OF THE PERSPECTIVE OF
THE CLINICAL TRIAL THAT ARE
NEEDED HOW DO WE DEFINE EXPOSURE
AND OUTCOMES FOR DIFFERENT GROUP
IT WAS HARD TO UNDERSTAND THE
GLOBAL TREND BECAUSE OF THE NEED
TO HAVE COW'S MILK AND THE
COMPARATOR IS DIFFERENT.
WE HAD DISCUSSION ABOUT WHAT
COWL BE THE GUIDELINES MOVING
FORWARD FOR THE DESIGN AS WELL.
AND MEET THE RIGOR OF THE
EXPERIMENTAL DESIGN BUT HOW DO
WE STANDARDIZE AND OUTCOME IN A
WAY THAT IS MORE FRUITFUL IN THE
FUTURE AND PUT IN THE
RECOMMENDATION FOR FUTURE
RESEARCH.
>> I ALSO THINK MOST THE STUDIES
CAPTURED IN THE SEARCH WERE NOT
DIRECTLY ASSESSING THIS.
WE ENDED UP LOOKING AT INCOME
FORMULA WITH OR WITHOUT AND
ENDED UP WITH STUDIES THAT WERE
LIKE THIS IS NOT ACTUALLY
RESPONDING BECAUSE OF THE SEARCH
THEY DIDN'T MAKE SENSE AND SO I
THINK MOST THE BODY OF
LITERATURE WERE NOT RESPONDING
THEY WERE TRYING TO USE WHATEVER
THERE WAS TO SEE IF WE CAN
ANSWER SOMETHING.
WE ENDED UP -- AND THIS IS SUCH
AN INCREDIBLY DYNAMIC LIFE STAGE
AND SPAN OF DEVELOPMENT WHEN WE
THINK ABOUT GOING FROM A SINGLE
FOOD TO THE INTRODUCTION OF MANY
FOODS AND ONE MONTH OF THE YEAR
AND THEN WE HAVE THE TREMENDOUS
CHANGES IN DEVELOPMENT INCLUDING
SELF FEEDING AND VERBAL
DEVELOPMENT.
I THINK ONE OF THE CHALLENGES IN
LOOKING AT THIS GENERAL QUESTION
IS THERE ARE MANY QUESTIONS
WITHIN SPECIFIC STAGES SO FOR
INSTANCE THERE WERE STUDIES
LOOKING AT VERY EARLY
INTRODUCTION TO FOODS RATHER
THAN ASKING WHAT IS THE OPTIMAL
TIMING OF INTRODUCTION.
AND SO WE LOOKED AT THE EVIDENCE
IN MULTIPLE WAYS IT SAY ARE
THERE ANY WAYS WE CAN BRING
THESE STUDIES TOGETHER
CONCEPTUALLY THAT MAKES SENSE.
THERE WERE SO MANY DIFFERENT
SCIENTIFIC QUESTIONS WITHIN THE
GROUP OF STUDIES AND SO FEW
STUDIES AT THE SAME TIME IT WAS
CHALLENGING.
I THINK ONE OF THE FUTURE
DIRECTIONS IS TO TRY TO OUTLINE
SOME OF THESE IMPORTANT
CONCEPTUAL QUESTIONS TO POINT
THE RESEARCH TO THE AREAS WE'D
LIKE TO INFORM THE GUIDELINES
THAT WE THINK WOULD BE HELPFUL
TO RAISE CHILDREN WITH OPTIMAL
PATTERNS OF GROWTH.
>> OKAY.
SO WE ARE GOING TO START WITH
THE DIETARY PATTERNS AND
SPECIFIC DIETARY PATTERN
COMPONENT ACROSS LIFE STAGES
NOW.
SO WE'LL COVER ABOUT HALF OF IT
NOW AND THEN THE REST OF IT
AFTER LUNCH.
SO THE ADDITIONAL PRESENTERS
WILL BE DOCTORS GIOVENICCI,
DEARLINE AND TALAGWAKA AND CODY
STANFORD AND I'LL BE PRESENTING
ALONG WITH THEM.
SO THIS IS OUR COMMITTEE AS YOU
CAN SEE SEVERAL ARE MEMBERS EF
THE HEALTH EQUITY WORKING GROUP
INCLUDING SAMEERA AND THE STAFF
WHO SUPPORT US AND WHEN YOU SEE
THIS THERE'S HUNDREDS OF
ARTICLES THAT HAVE TO BE
DISTILLED DOWN AND WITH CBD AND
TYPE II DIABETES GETTING IN A
WORKABLE FORMAT FOR US HE'S BEEN
A HEAVY LIFT.
AT MEETING 4 WE PRESENTED
SEVERAL STATEMENTS UNDER PEER
REVIEW.
WE HAD BEVERAGE PATTERNS AND
GROWTH, BODY COMP AND RISK OF
OBESITY.
WE LOOKED AT DAIRY MILK AND BODY
COMPOSITION AND RISK OF OBESITY.
LOW AND NO-CALORIE SWEETENED
BEVERAGES AND THE GROWTH BODY
COMPOSITION AND RISK OF OBESITY
AND FINALLY 100% JUICE.
THOSE WERE SENT OUT FOR PEER
REVIEW AND THE SECOND GROUP HAVE
DRAFTS INCLUDING LOW AND
NO-CALORIE SWEETENED BEVERAGES
AND RISK OF TYPE II DIABETES AND
SUGAR SWEETENED BEVERAGES AND
RISK OF TYPE II DIABETES AND
SUGAR SWEETENED BEVERAGES AND
GROWTH BODY COMPOSITION AND RISK
OF OBESITY IN CHILDREN AND THAT
HAS META-ANALYSIS ASSOCIATED
WITH IT.
AND WE HAVE SUGAR SWEETENED
BEVERAGES AND BODY COMPOSITION
AND RISK OF OBESITY IN ADULTS
AND OLDER ADULTS.
WE'LL CONTINUE WITH THE ADULT
PART OF THAT AND WE'RE ALSO
DOING FOOD SOURCES OF SATURATED
FAT AND RISK OF CARDIOVASCULAR
DISEASE.
SO DURING THE COURSE OF THE LAST
FEW MONTHS WE'VE MADE SEVERAL
PROTOCOL REVISIONS THAT WE
PRESENTED ON PROTOCOLS PRESENTED
PREVIOUSLY AND MAINLY TO
STREAMLINE OUR REVIEWS AND FOCUS
ON THE HIGHEST QUALITY EVIDENCE.
THE FIRST WAS FOR DIETARY
PATTERNS AND RISK OF TYPE II
DIABETES.
THE REVISION THAT WAS DONE HERE
WAS TO ALIGN THE OUTCOME
CRITERIA FROM THIS SYSTEMATIC
REVIEW ON DIETARY PATTERNS IN
TYPE II DIABETES WITH THE
CRITERIA USED FOR BEVERAGES AND
TYPE II DIABETES BEFORE ANY
EVERYDAY WAS SYNTHESIZED.
WE HAVE INTERMEDIATE OUTCOMES
AND LOOK AT DISEASE OUTCOMES.
THAT'S WHAT WE ALIGN WITH OUR
BEVERAGES.
THE SECOND IS ON FOOD SOURCES OF
SATURATED FAT AND RISK OF
CARDIOVASCULAR DISEASE.
THOUGH THE WHOLE SUBCOMMITTEE
MADE COMMENTS ON THESE I DID
WANT TO PARTICULARLY THANK
CHRISTOPHER GARDNER AND CHERYL
ANDERSON BECAUSE WE HAD A COUPLE
EXTRA COMMITTEE MEMBERS TO
REVIEW OVER THIS AND GET TO
WHERE WE NEEDED TO BE.
WE HAD THREE REVISIONS.
IN LOOKING AT THIS WAS THE
AMOUNT OF STUDIES ASSOCIATED
WITH THIS WAS VAST.
HUNDREDS OF STUDIES.
WHEN WE LOOKED AT IT AND
ESPECIALLY AFTER DOING ALL THE
DIETARY PATTERNS REVIEWS WE KIND
OF CAME UP WITH A MORE FOCUSSED
APPROACH.
THE FIRST PROTOCOL REVISION WAS
WE REMOVED THE COMPARATOR THAT
LOOKED AT CONSUMPTION OF
DIFFERENT AMOUNTS OF THE SAME
FOOD SOURCE.
FOR EXAMPLE, WE DIDN'T LOOK AT
SOMETHING LIKE QUINTILES OF
WHOLE MILK CONSUMPTION OR
LOW-FAT MILK CONSUMPTION, THINGS
LIKE THAT.
WE MADE THAT REVISION TO FOCUS
ON STUDIES THAT COMPARE SPECIFIC
FOOD SOURCES AND THEIR
REPLACEMENT WITH OTHER FOODS.
WE HAVE ALREADY ADDRESSED THE
DIFFERENT AMOUNTS OF THE FOOD
SOURCE IN THE PREVIOUS WORK.
WE DIDN'T WANT TO REPLICATE THAT
WORK AND SO YOU CAN LOOK AT OUR
PREVIOUS DIETARY PATTERS AND CAN
SEE THE FOODS POINTED OUT.
THE SECOND REVISION WAS THE
INCLUSION/EXCLUSION CRITERIA
WERE UPDATED TO BE MORE
SPECIFIC.
SO WE EXCLUDED STUDIES THAT
EVALUATED TOTAL CONSUMPTION OF
DAIRY FOODS IF THEY COMBINED
NON-FAT, WHOLE FAT AND LOW-FAT
VERSIONS BECAUSE IT WAS HARD TO
GET A READ ON THE EXACT
SATURATED FAT CONTENT AND THOSE
THAT COMBINE COW'S MILK WITH
MILK ALTERNATIVES AND FINALLY
STUDIES THAT EVALUATED TOTAL
MILK CONSUMPTION WHERE THEY
COMBINED MEAT WITH SEAFOOD OR
COMBINED WITH RED OR PROCESSED
MEAT.
WE WANTED TO ISOLATE THE
SATURATED FATTY FOOD.
LAST IS REVISED THE INCLUSION
AND EXCLUSION CRITERIA FOR STUDY
DESIGN TO INCLUDE MODELLING
STUDIES.
SO WHILE WE REALIZED THAT WE'RE
GOING TO LOOK AT ALL THE
EVIDENCE ACROSS HERE SO THE FOOD
PATTERN MODELLING AND ALL THE
OTHER WORK WE INCLUDED MODELLING
BECAUSE THERE'S STUDIES THAT DO
MODEL SUBSTITUTION AND FOOD
SOURCES OF SATURATED FATTY ACIDS
AND THOUGHT IT WAS IMPORTANT TO
LOOK AT THE BODY OF EVIDENCE FOR
THIS PARTICULAR QUESTION.
SO ANY QUESTIONS ABOUT THE
PROTOCOL REVISIONS?
>> GREAT PRESENTATION.
THANK YOU.
THE MODELLING, CAN YOU TALK A
LITTLE BIT MORE ABOUT WHAT THE
STUDIES ARE?
THAT YOU DECIDED TO INCLUDE TO
YOUR LAST POINT?
>> A LOT OF THOSE STUDIES DO A
REPLACEMENT SO IT MIGHT BE
BUTTER WITH OLIVE OIL.
I CAN'T REMEMBER THE EXACT
REPLACEMENTS SO THEY DO AND I
DON'T KNOW -- CHRISTOPHER, DIDI,
YOU MIGHT HAVE -- I CAN'T
REMEMBER ALL THE EXAMPLES BUT
IT'S LIKE YOU'RE REPLACING ONE
SOURCE WITH ANOTHER IN THE
MODELLING.
>> IT MAY BE RED MEAT WITH
LENTIL OR WITH CHICKEN OR WHOLE
FAT BEVERAGE WITH SOMETHING
ELSE.
A SET OF OPTIONS FOR
REPLACEMENT.
ALL MODELS IN PROSPECTIVE COHORT
STUDIES NOT TRIALS WITH OUTCOMES
WHERE THEY SEE WHAT
CARDIOVASCULAR HEART OUTCOMES
OTHERWISE WE'VE MISSED THOSE.
>> I THINK YOU EXPLAINED IT WELL
AND THE RATIONALE WAS TO AVOID
THE STUDY THAT LOOKED AT A
SINGLE FOOD WITHOUT
CONSIDERATION OF WHAT THE
COMPARATOR WAS AND IT GETS
DIFFICULT TO INTERPRET IF YOU
DON'T KNOW WHAT THE CONTRAST IS.
AND ANALYSES THAT INDICATES WHAT
THAT CONTRAST WAS BETWEEN TWO
FOODS FOR WHAT THE MODELS ARE
REFERRING TO.
IT'S DIFFERENT FROM SIMULATION
STUDIES WHICH WE DIDN'T REALLY
GET INTO IN DISCUSSION BUT I
THINK WANTED TO AVOID ANYTHING
NOT BASED ON THE ACTUAL DATA AND
OUTCOMES.
>> OTHER QUESTIONS?
THANK YOU.
WITH THAT WE'LL GO TO A SPECIFIC
DIETARY PATTERN COMPONENTS WITH
BEVERAGES AND SO ED.
>> THIS IS THE ANALYTIC
FRAMEWORK AND THE FIRST QUESTION
IS THE RELATIONSHIP BETWEEN LOW
AND NO-CALORIE SWEETENED
BEVERAGE AND WE'RE LOOKING AT
LOW AND NO-CALORIE SWEETENED
BEVERAGE CONSUMPTION.
IN RANDOMIZED TRIALS YOU USUALLY
HAVE A COMPARATOR LIKE WATER AND
IN COHORT STUDIES THE COMPARISON
IS MORE LOOKING AT MORE VERSUS
LOWER SO IT'S MORE LIKE A
GRADIENT.
THE OUTCOMES YOU CAN SEE THE
LIST AND TO KEEP IN MIND MOST
THE PROSPECTIVE COHORT STUDIES
HAVE DIABETES IN THE OUTCOME AND
ALMOST ALL THE RANDOMIZED TRIALS
LOOKED AT BIOMARKERS LIKE
FASTING BLOOD GLUCOSE.
YOU CAN SEE THE CONFOUNDERS.
THIS IS THE FIRST CONCLUSION LOW
AND NO CALORIE SWEETENED
BEVERAGES BY INFANTS, CHILDREN
AND ADD LESS -- ADOLESCENTS.
NOT ENOUGH EVERYDAY TO DRAW ANY
KIND OF KWON COLLUSION.
THERE IS MORE DATA AND THE
CONCLUDING STATEMENT IS EVIDENCE
SUGGESTS THAT LOW AND NO-CALORIE
SWEETENED BEVERAGE CONSUMPTION
BY ADULTS AND OLDER ADULTS MAY
NOT BE ASSOCIATED WITH RISK OF
TYPE II DIABETES THE EVERYDAY
WAS LIMITED.
THE BODY OF EVIDENCE IS FAIRLY
EXTENSIVE WITH 11 RANDOMIZED
TRIALS AND ARTICLES AND 21
PROSPECTIVE COHORT STUDIES.
NCC IS A CONTROL STUDY
ESSENTIALLY A PROSPECTIVE STUDY.
THERE WERE SEVERAL CONCERNS DUE
TO VARIATION DIRECTION AND
MAGNITUDE OF EFFECTS.
THE RANDOMIZED TRIALS WERE SHORT
TERM AND SOME SMALL LOOKED MORE
AT THE BIOMARKERS.
THEY DIDN'T HAVE DIABETES AS THE
END POINT.
AMONG THE PROSPECTIVE COHORT
STUDIES THERE WAS CONSIDERABLE
VARIATION.
THE STUDIES TENDED TO SHOW NO
ASSOCIATION OR SOME HAD A
POSITIVE ASSOCIATION.
THERE WAS NO REAL ISSUE FROM THE
COHORT STUDIES.
THERE WERE LARGE STUDIES.
THE MAIN ISSUE LEADING TO
LIMITED EVIDENCE IS THE
POTENTIAL FOR CONFOUNDING.
AND THIS WAS MEASURED BY BMI AND
STUDIES CONTROL THE BMI
ASSOCIATIONS GO WEAKER AND MAYBE
SOME POSITIVE ASSOCIATIONS MAY
GO TO ORIGINAL CONFOUNDING.
SOME CATEGORIES WERE COMBINED
WITH WATER AND THERE WERE ISSUES
WITH DIRECTEDNESS.
FOR GENERALIZABILITY I THINK
HALF THE STUDIES WERE IN THE
U.S. AND GENERALLY SKEWED
TOWARDS NON-HISPANIC WHITE SO
THERE WERE CONCERNS WITH
GENERALIZABILITY.
THILS
THIS IS A SUMMARY OF THE INFANTS
STUDIES AND A CONCLUSION
STATEMENT COULD NOT BE DRAWN AND
LIMITED EVIDENCE SUGGESTS LOW OR
NO CALORIE SWEETENED BEVERAGE
MAY NOT BE ASSOCIATED WITH TYPE
II DIABETES WITH LIMITS.
THIS IS THE ANALYTIC FRAMEWORK
LOOKING AT SUGAR-SWEETENED
BEVERAGE CONSUMPTION AND RISK OF
TYPE II DIABETES.
IT'S VERY SIMILAR FOR THE LOW
AND NO-CALORIE BEVERAGES.
THE ONLY POINT I'LL MAKE IS THE
COMPARATOR IS A SUGAR SWEETENED
BEVERAGE VERSUS LOW AND NO
CALORIE SWEETENED BEVERAGES.
I SHOULD HAVE MENTIONED THAT FOR
THE LOW AND NO-CALORIE BEVERAGES
IF THE COMPARISON IS WITH SUGAR
SWEETENED BEVERAGES IN THIS
GROUP.
TO THE COMPARISON USUALLY LOOKS
AT A GRADIENT OF CONSUMPTION.
SO THIS IS INFANTS AND YOUNG
CHILDREN.
SEE IN THE STUDIES THIS TOOK
WORK FOR US TO -- WE HAD MANY
DISCUSSION ON THIS AND NO
STATEMENT COULD BE MADE OR
CONCLUSION.
BODY OF EVIDENCE AND FIVE
ARTICLES ALL PROSPECTIVE COHORT
STUDIES AND CONCERNS WITH
DIRECTEDNESS AND STUDIES
EXAMINING THE PRIMARY OUTCOME OF
INTEREST.
SO CONCLUDE COULD NOT BE DRAWN.
FOR SUGAR SWEETENED BEVERAGES IN
ADULTS AND OLDER ADULTS AND RISK
OF TYPE II DIABETES, THERE WERE
A LOT OF MORE STUDIES AND THE
CONCLUSION WAS MODERATE EVIDENCE
REFLECTS SUGAR SWEETENED
BEVERAGES IN ADULTS AND OLDER
ADULTS MAY BE ASSOCIATED WITH
HIGHER RISK OF TYPE II DIABETES.
SEE A FAIRLY ROBUST BODY OF
EVIDENCE AND 41 ARTICLES.
NONETHELESS THE EVIDENCE WAS
LIMITED FROM RANDOMIZED TRIALS
WITH FOUR STUDIES.
THERE WAS MINIMAL VARIATION IN
THE DIRECTION AND SIGNIFICANCE
OF THE FINDINGS MOST SHOW A
POSITIVE ASSOCIATION THEY WERE
LIMITED BY SAMPLE SIZE AND
LIMITED DURATION IN SOME CASES.
FOR RISK OF BIAS THERE WERE SOME
CONCERNS AND SOME STUDIES DID A
GOOD JOB IN CONFOUNDING.
FOR DIRECT ED NESS THERE WERE
CONCERNS AND MOST STUDIES WERE
DESIGN TO LOOK AT SUGAR
SWEETENED BEVERAGES.
FOR GENERALIZABILITY HALF THE
STUDIES WERE CONDUCTED IN
U.S. POPULATION BUT THERE WERE
SOME CONCERNS WITH LOW DIVERSITY
AND REPORT RACE.
THIS IS THE CONCLUSION OF SUGAR
SWEETENED BEVERAGES, INFANT,
CHILDREN, ADOLESCENTS, NO
CONCLUSIONS.
MODERATE EVIDENCE INDICATES
SUGAR SWEETENED CONSUMPTION IS
ASSOCIATE WITH HIGHER RISK OF
DIABETES.
I THINK THAT'S IT.
>> SO ON TO -- SO THIS QUESTION
WE'RE LOOKING AT THE
RELATIONSHIP BETWEEN SUGAR
SWEETENED BEVERAGES CONSUMPTION
AND GROWTH BODY COMPOSITION AND
RISK OF OBESITY WAS FOR
META-ANALYSIS FOR INFANCY
THROUGH ADOLESCENCE AND ADULTS
AND OLDER ADULTS.
TODAY WE'LL BE PRESENTING THE
CONCLUSION STATEMENT FOR INFANCY
THROUGH ADOLESCENCE AND THE
REMAINING LIFE STAGES AND
ADULTS, OLDER ADULTS AND
INDIVIDUALS THROUGH PREGNANCY
AND POSTPARTUM WILL BE AT THE
NEXT MEETING.
HERE WE SEE THE AN HITT T TIC -
ANALYTIC FRAMEWORK FOCUSSING ON
CHILDREN AND ADD LESS --
ADOLESCENTS AN SUGAR SWEETENED
BEVERAGES CONSUMPTION INCLUDED
FRUIT DRINKS AND JUICE EXPOSURES
THAT WERE NOT VERIFIED AS 100%
JUICE.
ANYTHING THAT WAS 100% JUICE
WOULD NOT BE INCLUDED IN THIS.
LOOKING AT COMPARE TORS IN
ADDITION TO COMPARATORS FOR
OTHER BEVERAGE TYPES AND
CONSUMPTION OF A DIFFERENT
AMOUNT OR WATER WE DID INCLUDE
STUDIES LOOKING AT SUGAR
SWEETENED BEVERAGES TO LOW AND
NO-CALORIE AND LOOK ING AT THE
CONFOUNDERS THEY WERE DIFFERENT
FOR CHILDREN AND ADOLESCENTS AND
YOU CAN SEE WE INCLUDED MILK
FEEDING PRACTICES AND INCLUDED
PHYSICAL ACTIVITY AS WELL AS
DIET QUALITY.
SO FOR THE LIFE STAGES OF
INFANCY THROUGH ADOLESCENCE WERE
SYNTHESIZED TOGETHER AND WE'RE
ADDRESSING THEM WITH ONE
CONCLUSION STATEMENT.
MODERATE EVIDENCE INDICATES
SUGAR SWEETENED BEVERAGES
CONSUMPTION IS ASSOCIATED WITH
UNFAVORABLE GROWTH PATTERNS AND
BODY COMPOSITION AND HIGHER RISK
OF OBESITY DURING CHILDHOOD AND
UP THROUGH EARLY ADULTHOOD.
THE DEVELOPMENT CONSIDERED THE
RESULTS FROM BOTH THE
META-ANALYSIS AS WELL AS ALL THE
ARTICLES FROM SYSTEMIC REVIEW
AND TWO-THIRDS IN THE EVIDENCE
BASE WERE INCLUDED IN THE
META-ANALYSIS.
YOU CAN SEE YOU'LL FIVE WERE
INCLUDED AND THE OBSERVATIONAL
STUDIES WERE INCLUDED IN THE
META-ANALYSIS.
COMMON REASONS WHY AN ARTICLE
NAY NOT BE INCLUDES IS RECORDING
ON LESS COMMON OUTCOMES AND
SCORES AND ADIPOSITY AND WHEN
LOOKING AT AGE WITHIN THE
EVIDENCE BASE, 17 ARTICLE WERE
IN INFANTS AND CHILDREN UP TO 12
MONTHS AND EIGHT WERE INCLUDED
IN THE META-ANALYSES.
THE REMAINDER OF ARTICLES WERE
IN CHILDREN AND ADOLESCENTS AND
16 ARTICLES INCLUDED FOLLOW-UP
TIMES TO ADULTHOOD.
FOR THE SYSTEMATIC REVIEW
FINDINGS AND IT SHOWED A
CONSISTENT DIRECTIONALITY ACROSS
THE DIFFERENT OUTCOMES.
ALL ARTICLES FROM THE RANDOMIZED
CONTROL TRIALS REPORTED ONE
DIRECT EFFECT OF SUGAR SWEETENED
BEVERAGE CONSUMPTION VERSUS THE
COMPARATOR WITH THE OUTCOMES.
OVER HALF FOUND ONE DIRECT
ASSOCIATION BETWEEN SUGAR
SWEETENED BEVERAGE CONSUMPTION
AND THE GROWTH BODY COMPOSITION
AND RISK OF OBESITY OUTCOMES.
NO ARTICLES REPORTED AN INDIRECT
EFFECT OR ASSOCIATION.
THERE WEREN'T STUDIES THAT
SHOWED SUGAR SWEETENED BEVERAGES
CONSUMPTION WAS RELATED TO
FAVORABLE OUTCOMES FROM INFANCY
THROUGH ADOLESCENCE.
FOR OUR META-ANALYSIS IT
INCLUDED OUTCOME WITHIN EACH OF
THE BUCKET S BUCKETS FINDINGS W
CONSISTENT WITH THAT OF OUR OVER
ALL QUALITATIVE SYNTHESIS WITH
GENERAL AGREEMENT IN DIRECTION
OF FINDINGS AND LOW
HETEROGENEITY.
PER -- PROPORTIONATELY THE
OUTCOME WERE LESS FREQUENTLY
REPORTED IN THE SCORE FOR
ADOLESCENTS.
WHEN WE LOOK AT THE GRADING
ELEMENT FOR CONSISTENCY FINDINGS
ACROSS THE ARTICLES WERE
GENERALLY CONSISTENT IN THE
DIRECT OF EFFECT WHILE THERE WAS
A MIX OF STATISTICALLY
SIGNIFICANT AND NON-SIGNIFICANT
FINDINGS WITHIN ARTICLES SUCH AS
REPORTING ON MORE THAN ONE
OUTCOME OR SUBGROUP ANALYSES,
FINDINGS WERE OF DIRECT OR
DIRECT ASSOCIATION OR NO
ASSOCIATION.
NO ARTICLES REPORTED IN DIRECT
EFFECT OR ASSOCIATION AND WHEN
WE LOOKED AT THE META-ANALYSIS
RESULTS SHOWED SIMILAR
CONSISTENCY IN THE MAGNITUDE OF
FINDINGS.
FOR PRECISION THERE WERE NO
OVERT CONCERNS WITH POWER
ARTICLES FROM THE RANDOMIZED
CONTROL TRIALS AND NEARLY HALF
THE OBSERVATIONAL STUDIES HAD
SAMPLE SIZES GREATER THAN 1,000
AND ALL THE ANALYSES HAD A
SAMPLE SIZE 15,000 TO 17,000 FOR
OBSERVATION.
THERE WAS A HIGH RISK OF BIAS
DUE TO CONFOUNDING AND MISSING
DATA.
TESTS OF ASYMMETRY SUGGESTED A
FEW EFFECT SIZES MAY BE MISSING
FROM THE DATA ANALYSIS AND COULD
BE DUE TO CHANCE BUT MORE LIKELY
THERE WAS SOME NONE-REPORTING
BIAS INCLUDING PUBLICATION BIAS.
FOR DIRECTNESS MOST THE ARTICLES
CONSISTENTLY MEASURED THE
RELATIONSHIP OF INTEREST AND
LOOKING AT GENERALIZABILITY THE
BODY OF EVIDENCE HAD GREATER
DIVERSITY IN RAGE AND ETHNICITY
AND SOCIO ECONOMIC CONDITIONS
FROM THE OBSERVATIONAL STUDIES.
THERE WERE CONCERNS WITH
GENERALIZABILITY INCLUDING A
LACK OF TRIAL DATA FOR CHILDREN
YOUNGER THAN 8 YEARS OF AGE AND
THE FACT THERE WAS A SMALLER
NUMBER AND SMALLER PER PORTION
INCLUDED IN THE META-ANALYSIS
FROM INFANTS AND YOUNG CHILDREN
LIFE STAGE COMPARED TO THE OLDER
CHILDREN AND ADOLESCENTS.
>> SO ANY QUESTIONS OR COMMENTS?
>> I HAVE AN OBSERVATION.
I'M SO STRUCK BY HOW LITTLE
EVIDENCE THERE IS FOR YOU TO
WORK WITH ON THESE TOPICS.
GIVEN HOW MUCH ATTENTION THEY'VE
BEEN RECEIVING I'M STRUCK.
I THINK IT'S MORE OF AN
OBSERVATION AND BEFUDDLEMENT WHY
THERE ISN'T MORE LITERATURE.
I'M GOING TO SAY THE SAME THING
I DID TO THE LAST GROUP, I HOPE
THERE'S GOING TO BE DISCUSSION
IN THE CHAPTER ON WHAT IS NEEDED
TO ANSWER THESE QUESTIONS.
>> WE HAVE LOTS OF IDEAS.
I DID WANT TO SAY ESPECIALLY
WITH WHAT ANDREA PRESENTED AND
THEN WHAT WE SAW WITH THE DATA
ANALYSIS EARLIER ON THE SUGARY
BEVERA
BEVERAGES IT'D PRETTY MUCH OUT
OF BALANCE.
THAT'S INTERESTING GIVEN THE
EVIDENCE WE'VE SEEN WITH
CHILDREN.
>> I'LL TURN IT OVER TO SARAH
AND WE'LL HAVE I A BREAK AND
FINISH WITH THE DIETARY
PATTERNS.
>> WE'LL KNEW TAKE A BREAK FOR
LUNCH FOR 45 MINUTES.
THANK YOU.
>> OKAY.
WE'RE GOING TO RESUME WELCOME
BACK.
DEANNA, I'M GOING TO HAND IT
OVER TO YOU.
>> THANK YOU.
WE'RE GOING TO CONTINUE WITH
DIETARY PATTERNS AND I JUST
WANTED TO REMIND EVERYONE THAT
THE CONCLUSION STATEMENTS THAT
WE'RE GOING TO PRESENT TODAY ARE
GOING TO BE LOOKED AT
COLLECTIVELY WITH FOOD PATTERN
MODELLING AND DATA ANALYSIS
FINDINGS TO INFORM THE
RECOMMENDATIONS AND THE
SCIENTIFIC REPORT SO JUST A
REMINDER FOR EVERYONE.
BUT WE'VE MADE A LOT OF PROGRESS
SINCE MEETING 4.
THIS SLIDE SHOWS OUR PROGRESS SO
WE HAVE ONE SYSTEMATIC REVIEW
UNDER PEER REVIEW.
RIGHT NOW WE'RE WORKING TO
CONSIDER THE COMMENTS AND
ADDRESS ALL OF THE REVISIONS.
AND THAT WAS DIETARY PATTERNS
AND BODY COMPOSITION AND RISK OF
OBESITY.
DIFFERENT AGE CATEGORIES.
IT'S QUITE A BIG SYSTEMATIC
REVIEW.
SO SINCE MEETING 4, WE HAVE
COMPLETED THREE SYSTEMATIC
REVIEWS DIETARY PATTERNS AND
RISK OF TYPE II DIABETES,
DIETARY PATTERNS AND ULTRA
PROCESSED FOODS AND GROSS BODY
COMPOSITION AND RISK OF OBESITY
AND WE HAVE THREE SYSTEMATIC
REVIEWS UNDERWAY WE'LL COMPLETE
IN THE NEXT FEW MONTHS.
DIETARY PATTERNS AND RISK OF
COGNITIVE DECLINE, DEMENTIA,
ALZHEIMER'S DISEASE AND MILD
COGNITIVE IMPAIRMENT.
DIETARY PATTERNS AND RISK OF
BREAST CANCER AND DIETARY
PATTERS AND RISK OF COLORECTAL
CANCER.
IN LOOKING AT THE WORK THAT
REMAINS TOCK DONE, WE HAVE
DISCONTINUED ONE OF OUR
SYSTEMATIC REVIEWS WE REMOVED AT
THE BEGINNING ON DIETARY
PATTERNS AND BONE HEALTH.
THIS IS AN IMPORTANT OUTCOME AND
THE COMMITTEE PRIORITIZED IT BUT
THE LITERATURE ON DIETARY
PATTERNS AND BONE HEALTH HAS NOT
GROWN SUBSTANTIALLY SINCE THE
PREVIOUS REVIEWS CONDUCTED BY
THE 2020 DIETARY GUIDELINES
ADVISORY COMMITTEE.
SO WE DEPRIORITIZED IT COMPARED
TO THE ONES THAT WE HAVE
UNDERWAY.
THAT WE'LL LEAVE TO FUTURE
COMMITTEES AND WITH THAT I'LL
HAND IT TO SAMEERA.
>> I'LL BE AFTERNOON THE
ASSOCIATIONS BETWEEN DIETARY
PATTERNS AND TYPE II DIABETES.
THIS IS THE RELATIONSHIP BETWEEN
DIETARY PATTERNS AND RISK OF
TYPE II DIABETES WE LOOKED AT
THE QUESTION ACROSS ALL LIFE
STAGES.
THE INTERVENTION OUR EXPOSURE OF
THE DIETARY PATTERN.
WE LOOKED AT CONSUMPTION LEVELS
OF THE SAME DIETARY PATTERN.
JUST AS WE HAD SEEN FOR THE
BEVERAGES THE SIMILAR AND SAME
FOR THE KEY CONFOUNDERS.
WE ALSO HAVE MADE SURE WE
ADDRESSED OR LOOKED AT FAMILY
HISTORY OF DIABETES.
JUST TO ALSO NOTE THIS ACTUALLY
IS AN UPDATE TO A SYSTEMATIC
REVIEW THAT HAD BEEN DONE
PREVIOUS.
SO THIS LISTS THE LIFE STAGES WE
EXAMINED INCLUDING CHILDREN AND
ADULTS AND OLDER ADULTS.
I WILL BE PRESENTING OUR
FINDINGS FOR THE FIRST TWO.
WE HAD NO ARTICLES THAT MET
INCLUSION CRITERIA FOR INFANTS
AND YOUNG CHILDREN UP TO AGE OF
24 MONTHS, INDIVIDUALS DURING
PREGNANCY AND DURING POSTPARTUM.
A CONCLUSION CANNOT BE DRAWN AND
THE RISK OF TYPE II DIABETES
BECAUSE OF SUBSTANTIAL CONCERNS
WITH DIRECTNESS.
WE HAD ABOUT 14 ARTICLES YOU,
ONE RANDOMIZED AND A COHORT
STUDY AND HAD VARIATION IN THE
MAGNITUDE OF DEFECTS, LACK OF
STATISTICAL SIGNIFICANCE OR THE
WIDTH OF THE CONFIDENCE INTERVAL
YOU, RISK OF BIAS BECAUSE OF NOT
ACCOUNTING FOR FAMILY HISTORY OF
DIABETES AND EXPOSURE
MISCLASSIFICATION AND HAD
CONCERNS ABOUT DIRECTNESS
BECAUSE THERE WERE NO STUDIES
EXAMINING THE PRIMARY OUTCOMES.
AND HENCE WE HAD TO GO WITH THAT
NO CONCLUSION COULD BE DRAWN.
FOR THE ASSOCIATION BETWEEN
DIETARY PATTERNS CONSUMED BY
ADULTS AND OLDER ADULTS AND THE
RISK OF DIABETES WE CONCLUDED
THERE WERE STRONG EVIDENCE TO
DEMONSTRATE DIETARY PATTERNS
CONSUMED BY ADULTS AND OLDER
ADULTS RELATIVELY HIGHER IN
VEGETABLES, FRUITS AND WHOLE
GRAINS, LEGUMES, NUTS AND FISH
OR SEAFOOD AND LOWER IN
PROCESSED MEATS,S HIGH FAT DAIRY
PRODUCTS, REFINED GRAINS AND
SUGAR SWEETENED BEVERAGES ARE
ASSOCIATED WITH A LOWER RISK OF
TYPE II DIABETES.
WE HAD A ROBUST AMOUNT OF
LITERATURE TO LOOK THROUGH FOR
COMING UP WITH THE EVIDENCE.
WE HAD ABOUT 118 ARTICLES.
14 WERE INTERVENTIONS.
104 FROM OBSERVATIONAL STUDIES.
FINDING WERE CONSISTENT AND
EFFECT SIZES HAD APPRECIABLE
MAGNITUDE AND MOST SAW A
SIGNIFICANT ASSOCIATION BETWEEN
DIETARY PATTERNS AND TYPE II
DIABETES AND MOST HAD CONFIDENCE
INTERVALS.
WR50ESHG
THOUGH WE LOOKED AT RISK OF BIAS
WITH RESPECT TO GENERALIZABILITY
WE HAD CONCERNS WITH THE DIETARY
PATTERNS AND THE OUTCOME
EXAMINED.
WE FOUND THEY WOULD BE EVEN IF
THE STUDY HAD BEEN DONE OUTSIDE
THE U.S. IT WOULD BE
UNCOMPARABLE.
WHEN WE LOOKED AT THE STUDIES
THERE WERE DIFFERENCES IN
EDUCATION ETCETERA AND GAVE A
GRADE OF STRONG.
THIS SLIDE SUMMARIZES THE
RESULTS SO FAR.
FOR CHILDREN AND ADOLESCENTS FOR
THE FORMER WE HAD NO ARTICLES
THAT MET THE INCLUSION CRITERIA
SIMILAR FOR INDIVIDUALS PREGNANT
OR POSTPARTUM.
FOR CHILDREN AND ADULTS WE COULD
NOT DRAW CONCLUSION STATEMENT
AND DID DRAW A STRONG EVIDENCE
STATEMENT REGARDING THE PATTERNS
LINKING PATTERNS IN TYPE II
DIABETES.
QUESTIONS?
>> GREAT JOB SAMEERA.
I'LL PRESENT CARDIOVASCULAR
DISEASE.
SHUT OUT TO MY CO-LEAD
DR. CHERYL ANDERSON AND I'LL
GIVE OTHER THANKS TO THE
COMMITTEE AND STAFF.
WE HAVE CHILDREN, ADOLESCENTS,
ADULT AND OLDER ADULTS AND THE
DIETARY PATTERN IS ALWAYS
CONFUSING.
THERE'S LOTS OF ASPECTS OF THE
DIETARY PATTERN.
YOU'LL SEE IN SUBTLE WORD BEING
CHANGES IN OUR CONCLUSIONS SINCE
2015 WE MADE MODIFICATIONS BASED
ON THE UPDATE AND COMPARATORS
AND IMPORTANT TO DIFFERENTIATE
WE'LL BE LOOKING AT RCTs THAT
PRIMARILY LOOK AT CARDIOVASCULAR
BIOMARKERS AND LOOKING AT
PROSPECTIVE COHORT STUDIES WITH
OUTCOMES.
WITH ALL THE SOCIAL MEDIA PEOPLE
WHO DON'T SEEM TO LIKE
PROSPECTIVE COHORT STUDIES, THIS
IS JUST ANOTHER GREAT EXAMPLE IF
WE DON'T HAVE THOSE, WE DON'T
HAVE OUTCOMES SO THOSE ARE
HUGELY IMPORTANT IN PUTTING THIS
RECOMMENDATION TOGETHER.
KEY CONFOUNDERS ARE PRETTY MUCH
USUAL.
WE'LL DO CHILDREN AND
ADOLESCENTS AND AADULTS AND
OLDER ADULTS AND COULDN'T FIND
ANYTHING POSTPARTUM.
BACK IN 2014, 2015 THEY REMAIN
LIMITED WE WENT THROUGH THIS
AGAIN AND I FORGOT TO CHECK
CHERYL BUT I DON'T FINK THE
WORDING CHANGED BUT THE GRADING
WAS LIMITED BEFORE.
WE FOUND 18 NEW ARTICLES.
AN IMPORTANT STATEMENT TO MAKE I
FORGOT TO MAKE AT THE BEGINNING,
THIS IS A DATA RICH ENVIRONMENT.
ESPECIALLY FOR ADULTS SO I
SHOULD KEEP THE COMMENTS FOR THE
NEXT PHASE BUT THERE WERE A LOT
OF STUDIES OUT THERE IN ADULTS
AND OLDER ADULTS.
NOT SO MUCH IN KIDS.
WE DID FIND 18 NEW STUDIES SINCE
2018, ALL OBSERVATIONAL, MO
RCTs.
YOU MAY NOT WONDER WHY.
WE'RE NOT BLEEDING A LOT OF KIDS
FOR THEIR BIOMARKERS OR WAITING
TO SEE IF THEY HAVE
CARDIOVASCULAR EVENTS.
SO WHEN YOU LOOK AT THE 18 THERE
WERE SERIOUS CONCERNS WITH
CONSISTENCY.
SOME CONCERNS WITH WIDE
CONFIDENCE INTERVALS AND SERIOUS
CONCERNS WITH MISSINGNESS OF
DATA AND NOT ADJUSTING FOR
CONFOUNDERS, A FEW OTHER
CONCERNS FOR DIRECTNESS BUT
MOSTLY GENERALIZABILITY OF THE
18 TRIALS ONLY ONE WAS DONE IN
THE U.S. POPULATION.
SO THIS REALLY DID NOT ADD TO
THE LITERATURE VERY MUCH IT WAS
LIMITED 10 YEARS AGO AND REMAINS
LIMITED.
NEXT FOR ADULTS BECAUSE THIS WAS
A FANTASTIC OPPORTUNITY, THERE
WAS SO MUCH LITERATURE HERE TO
LOOK AT THAT IN DISCUSSING THIS
WITH THE GROUP, WE HAD TO
RESTRICT ARTICLES TO ONLY THOSE
IN THE U.S.
NOT SURE IF WE'VE EVER DONE THAT
BEFORE.
WE HAD 104 ARTICLES COMBINATION
OF RCTs AND OBSERVATIONAL
STUDIES JUST FROM THE U.S. AND
IT WAS ALREADY A STRONG
CONCLUSION A DECADE AGO.
SOME MIGHT ASK WHERE ARE WE
TAKING A STRONG CONCLUSION AND
LOOKING AT IT AGAIN AND THIS IS
PART OF HAVING SAMEERA AND THE
GROUP AND THOUGHT IF THERE'S
THIS MANY STUDIES IT MAY BE A
GOOD OPPORTUNITY TO DO THE
DEEPER DIVE AND SEE TO WHAT
EXTENT WE CAN EXPLORE THIS IN
RACE ETHNIC GROUPS OR SOCIO
ECONOMIC POSITION.
SO WE DID.
I'LL QUICKLY GO THROUGH THE
CONSISTENCY IT WAS PRETTY
CONSISTENT IN THE SAME
DIRECTION.
OBSERVATION STUDIES WERE HUGE
AND THE AND DONE WELL AND THIS
IS FUN, ALL THE STUDIES FROM THE
U.S. SO THEY APPLIED.
THE UNIQUE THING WAS HOW MUCH
DIFFERENT RACE ETHNIC GROUPS AND
DATA WE HAD.
YOU SHOULD SEE TO THE EXCEL
SHEET AND IMAGINE THE TRIALS AND
SOME WITH MULTIPLE PAPERS.
THAT PART WAS PRETTY DAUNTING.
PICTURE DIETARY PATTERN.
THE WAY THE DATA IS EXTRACTED
FOR US AND I DON'T THINK HAS
BEEN DISCUSSED IN MUCH DETAIL,
THERE ISN'T ONE DIET PATTERN.
WE HAD 30 COMPONENTS TO INCLUDE
OR MIGHT HAVE BEEN PART OF THE
PATTERN TO AVOID BUT WE'RE NOT
CONSISTENT ACROSS EVERY STUDY.
SO THERE WERE COLOR CODED WITH A
BLUE ARROW UP AND RED ARROW DOWN
FOR WHAT EACH PATTERN WAS ACROSS
EVERY STUDY.
WE WERE TRYING TO SEE TO WHAT
EXTENT COULD WE SEPARATE THOSE
OUT WITH RACIAL GROUP AND THERE
WAS A SORT BUTTON IN EXCEL AND
WE COULD PUNCH IT AND THE FIRST
SAID FIVE STUDIES WERE 100%
AFRICAN AMERICAN OR ASIAN
AMERICAN OR MEXICAN AND ONLY
FIVE OF THE TOTAL ALL THE OTHER
STUDIES HAD RACE ETHNIC
DESCRIPTIONS TO FILL WHAT
PROPORTIONS WERE IN EACH STUDY.
AS A FIRST CUT THROUGH THE SWATH
LOOKED AT ANYBODY WITH A STUDY
WITH OR THE THAN 25% NON-WHITES.
I'M PRETTY SURE ANGELA WHO SAID
A CUT OFF STRICTER THAN THAT AND
ADDED ANOTHER CUT-OFF IF THERE
WERE NO MORE THAN 40%
NON-HISPANIC CAUCASIANS IN THERE
AND THAT ENDED UP YIELDING 20
STU
STUDIES.
THEN WE GOT TO LOOK AT THE SAME
DIETARY PATTERN COMPONENTS TO
SEE HOW CONSISTENT IT WAS WITH
THE ORIGINAL STATEMENT.
HERE ARE SUBTLE WAYS IT CHANGED
SINCE THEN AND DIDN'T HAVE THE
WORDING SIDE BY SIDE.
ONE FACTOR WE CHANGED WAS IN THE
RACE ETHNIC GROUPS AND I HAVE TO
SAY WE DIDN'T GET A LOT OF
DIVERSITY AROUND SOCIO ECONOMIC
CONDITIONS AND RACE-ETHNICITY WE
DID AND FOUND MULTIPLE STUDIES
FROM THAT PARTICULAR GROUP
ACTUALLY HAD NOT ISOLATED LOW
FAT DAIRY OR SEAFOOD AND FISH.
THOSE WERE PART OF THE MAIN
CONCLUSION.
IF YOU LOOK AT THE STATEMENT,
STRONG EVIDENCE WITH A STRONG
GRADE WAS REALLY HARD TO PICK
OUT IN THE FIRST LIST OF WHAT
THE PATTERN IS, THAT IS CHANGED
UP A PATTERN WAY AND NOW SAYS
VEGETABLES, FRUITS, NUTS AND
LEGUMES WEREN'T IN THERE.
THEY WERE DOWN BELOW AND I'LL
SHOW YOU HOW THIS WORKS.
HANG ON A SEC.
AND SAID WHOLE GRAINS AND THE
UNSATURATED FATS, LOWER SODIUM
RED AND PROCESSED MEATS AND
LEGUMES AND NUTS GOT PUSHED UP
BECAUSE THE SEAFOOD WEREN'T IN
THE RACIAL ETHNIC GROUPS AND
THINK HOW MUCH THAT MAKES WITH
LACTOSE IN TOLERANCE AND ONE
EXAMPLE OF THE DAIRY ISN'T GONE
BUT GOT MOVED TO THE BOTTOM
WHERE IT SAYS SOME OF THE
DIETARY PATTERNS INCLUDED
LOW-FAT DAIRY AND SEAFOOD.
IT'S NOT GONE IT'S JUST LEGUMES
AND NUTS GOT MOVED UP AND DAIRY
AND SEAFOOD GOT MOVED DOWN.
THE FINDINGS WERE CONSISTENT
AMONG SOCIO ECONOMIC POSITIONS.
WE DON'T USUALLY HAVE THE DATA
TO PURSUE IT THAT FAR.
IT'S GREAT WORK WITH SAMEERA AND
WITH OUR WHOLE TEAM AND CHERYL
WHO WORKED ON THIS AS COLEAD.
IT IS STRONG.
I THINK IT'S STRONGER NOW.
THE SUMMARY WAS LIMITED BEFORE
FOR KIDS, STILL IS LIMITED
THOUGH WE HAVE NEW STUDIES AND
WHAT IS STRONG FOR ADULTS
ADDRESSING HEALTH EQUITY TO AN
EXTENT THAN BEFORE AND NOTHING
FOR PREGNANCY AND POSTPARTUM.
THAT'S MY SUMMARY.
THANKS.
>> WE'VE GONE THROUGH MEETINGS,
1, 2, 3, AND NOW 5 AND PRESENT
FOR THE FIRST TIME.
I FEEL LIKE I'M RUNNING
ARCHINARCHING
ER ANCHOR AND BACK IN THE '90s
AS WE TALK ABOUT A TOPIC WE ALL
HEARD ABOUT AND TALKED ABOUT
DIETARY PATTERNS PARTICULARLY
ADDS WE TALK ABOUT ULT
ULTRAPROCESSED FOOD AND LOOKING
AT THE BODY COMPOSITION AND RISK
OF OBESITY WE'RE LOOKING AT
POPULATIONS AND INFANTS AND
YOUNG CHILDREN UP TO THE AGE OF
24 MONTHS.
CHILDREN AND ADOLESCENTS FROM 2
AND 19, ADULTS AND OLDER ADULTS
AND OF COURSE INDIVIDUALS DURING
PREGNANCY AND OR DURING
POSTPARTUM AND IN LOOKING AT
THIS I WANT US TO REALIZE WE'RE
NOT JUST LOOKING AT ONE FOOD
LOOKING AT ULTRA PROCESSED
FOODS.
WE'RE LOOKING AT A WHOLE GROUP
TOGETHER.
A PATTERN, NOT ONE INDIVIDUAL
FOOD.
I ALSO WANT US TO RECOGNIZE WE
HAD STRUGGLES BECAUSE THERE'S
NOT ONE UNIFORM DEFINITION WHEN
WE'RE LOOKING AT ULTRAPROCESSED
FOOD AND WE'RE LOOKING AT THE
REVIEW PRESENTED BASED ON GROWTH
AND BODY COMPOSITION AND THE KEY
CONFOUNDERS ARE LISTED.
YOU MAY BE AWARE ULTRA PROCESSED
FOODS ARE HIGHLY PREVALENT IN
THE U.S. DIET AND ARE NUTRIENTS
OF CONCERN FOR OVER CONSUMPTION.
AS YOU HEARD THROUGHOUT
DISCUSSIONS THEY'RE NOT
CONSISTENT WITH HEALTHY DIETARY
PATTERNS.
AND THERE'S ADDED SUGARS AND
SODIUM.
YOU NOTICE THAT FROM EARLIER
TODAY AND ON YESTERDAY.
THIS NEW QUESTION HAS
SUBSTANTIAL INTEREST BOTH FROM
FEDERAL PARTNERS AND THE PUBLIC.
WE THANK THE PUBLIC FOR RAISING
THIS CONCERN AND THE EVIDENCE
SUGGESTS ASSOCIATION BETWEEN
ULTRA PROCESSED FOODS AND HEALTH
OUTCOMES FROM LOOKING AT THE
CHRONIC DISEASE HERE IN THE
UNITED STATES AND SCIENTIFIC
LITERATURE.
I WANT TO SHOW YOU HETEROGENEITY
IN THE LITERATURE AND HAD A HARD
TIME NAILING DOWN ONE PARTICULAR
DEFINITION LOOKING AT ULTRA
PROCESSED FOOD AND SEE PEER
REVIEWED ARTICLES INCLUDING FROM
A GUIDELINE MEMBER LOOKING AT
THE SPECTRUM OF LEAST PROCESSED
TO MOST PROCESSED FOODS.
LOOK AT WHAT WE'RE SEEING ON THE
SLIDE.
TAKING US FROM THINGS MINIMALLY
TO MOST PROCESSED IN ARTICLES TO
2019.
SO THERE'S A GRADATION FROM
LEAST PROCESSED TO MOST
PROCESSED ACROSS TIME.
AS WE GET INTO MOST PROCESSED I
WANT YOU TO NOTICE ON THE RIGHT
SIDE YOU'LL SEE THINGS WITH
PROCESS OF INDUSTRIAL ORIGIN
READY TO CONSUME, INTENSE
PROCESSING AND SUGARS YOU, FATS
AN SALTS AND PROCESSED FOODS AND
DRINKS.
MOVE TO THE NEXT LABEL WE LOOK
AT ULTRA PROCESSED TO SIMPLE
PROCESSED AND IN THE ARTICLES
THERE WAS NO SIGNIFICANT
CONGRUENCE IN THE TRUE
DEFINITION OF WHAT'S CONSIDERED
TO BE ULTRA PROCESSED.
I WANTED TO SHOW THAT TO YOU SO
WE'RE ABLE HAVE ONE DEFINITION
BUT TO SHOW THERE'S DIFFERENCES
BETWEEN WHAT'S CONSIDERED ULTRA
PROCESSED TO WHAT'S CONSIDERED
PROCESSED.
NOW, HERE'S EXAMPLE DESCRIPTIONS
OF DIETARY PATTERNS THAT VARY
AND ULTRA PROCESSED IN THE
REVIEW.
THE MOST COMMON THING WE SAW IN
THE LITERATURE WAS THE NOVA
CLASSIFICATION AND WE'RE GOING
TO USE THE NOVA CLASSIFICATION
MORE COMMONLY IN OUR DISCUSSION
BECAUSE THAT'S WHAT WE SAW
MOSTLY IN THE LITERATURE.
DIETARY PATTERNS INCLUDED IN THE
REVIEW COMPRISED OF ALL OR
MOSTLY FOODS SPECIFICALLY ULTRA
PROCESSED VERSUS NOT ULTRA
PROCESSED AND HERE'S EXAMPLES.
IN THE FIRST EXAMPLE YOU COULD
SEE SOFT DRINKS, SWEET OR SAVORY
SNACKS, CHOCOLATE CANDIES AND
MAYONNAISE WHICH I THINK IS
DISGUSTING AND PASTRIES AND
PACKAGED SOUPS AND MY MOM IS
LAUGHING BECAUSE SHE KNOWS HOW
MUCH I HATE THAT AND COMPARED TO
EXAMPLE 2, FRESH, CHILLED FROZEN
DRIED, VACUUM PACKED FRUITS
VEGETABLES FUNGI, TUBERS YOU,
ROOTS, GRAINS, LEC YOU'LLS,
UNSALTED NUTS AND THE REMAINDER
OF THE LIST.
THIS IS A COMPARISON OF INTEREST
IN CONSUMING THE NOVA 4
CLASSIFICATION VERSUS NOVA GROUP
2.
LET'S GO TO THE NEXT SLIDE.
AND WHAT VARY IN ULTRA PROCESSED
ARE THINGS THAT ARE AN EXAMPLE
THREE POSITIVE LOADINGS FOR
HAMBURGERS, DR. TOBIAS, HOTDOGS,
FALAFAL AND PROCESSED MEATS AND
PRE COOKED FOOD AND PIZZA AND
SOMETHING YOU KNOW I DON'T LIKE,
MAYONNAISE AND KETCHUP AND
ADHERENCE OR CONSUMPTION LEVELS
OF A DIETARY PATTERN LIKE
EXAMPLES THREE OR FOUR IN
RELATION TO OUTCOMES.
NOW, WHEN WE GET INTO LOOKING AT
THIS COMPARING LIKE EXAMPLE A TO
B WE LOOKED AT DIETARY PATTERNS
VERIFIED ADDS AS ULTRA
PROCESSED FOOD AND COULD NOT BE
DETERMINED IN EXAMPLE A, FOR
EXAMPLE, HIGHER LOW FAT FOODS
AND RICH IN VITAMINS OR WHOLE
GRAINS TALKING ABOUT VITAMINS
AND MINERALS WITH DR. MILLER AND
FRESH FRUITS FREE OF ADDED
SUGAR, OATMEAL, MUESLI,
UNSWEETENED PLAIN CEREALS AND
MILK AND HIGH FAT PRODUCTS AND
SWEETENED MILK, MAYONNAISE OR
NUT-BASED SPREAD AND BISCUITS,
PACKAGED PASTRIES OR EXAMPLE B A
POSITIVE SCORE WITH THIS LIST.
VEGETABLE OR ANIMAL PROTEIN AND
NEGATIVELY SCORED WHEN WE SEE
RED MEAT, PROCESSED MEAT,
SATURATED FAT AND THE GRAIN
CONSUMPTION WAS COMPOSED OF
REFINED GRAINS AND ALCOHOL WHICH
IS BEER AND SPIRITS AND MOVING
ON TO NEXT SLIDE.
WE'RE GOING TO LOOK AT LIFE
STAGES AND EVERYTHING PREVIOUSLY
MENTIONED CHILDREN ADOLESCENTS
AND OLDER ADULTS, INFANTS AND
YOUNG CHILDREN UP TO 24 MONTHS
AND INDIVIDUALS IN POST
PREGNANCY OR THE POSTPARTUM
PERIOD AND LOOK AT OUR
CONCLUSIONS.
DON'T BE UNDER WHELMED WHEN WE
GET TO THE CONCLUSION
STATEMENTS.
IN TERMS OF OUR DIETARY PATTERNS
CONSUMPTION WAS 2 TO 19 YEARS OF
AGE.
AND THESE WILL FEEL ACADEMIC AND
THEY ARE.
THE SCORE ANALYSIS AND ARTICLES
AND NOVA CLASSIFICATION I TOLD
YOU ABOUT WAS THE MOST COMMONLY
USED CLASSIFICATION SYSTEM USED
TO DEFINE ULTRA PROCESSED FOODS.
THERE WAS A FACTOR OF CLUSTER
ANALYSIS AND LATENT CLASS IN
THREE ARTICLES.
DR. ENGLISH THANK YOU FOR THE
WORK YOU'VE DONE AND THE AMOUNT
OF ULTRAPROCESSED FOODS LOOKING
AT THE CONTEXT OF ENERGY OR
WEIGHT.
LOOKING AT 100 GRAM INCREASE
WHEN WE LOOKED AT THE EXAMPLES.
THE NUMBERS AND TYPES OF ITEMS
CLASSIFIED AS ULTRA PROCESSED
WITHIN A DIETARY PATTERN VARIED
ACROSS THE STUDIES.
THERE WAS LOSS OF INCONSISTENT
ITEM AND SUGAR SWEETENED
BEVERAGES AND MEAT PRODUCTS AND
REFINED GRAIN PRODUCTS HAVE BEEN
A COMMON THREAD IN TODAY
DISCUSSION.
NOW LET'S GET TO OUR CONCLUSION
STATEMENT.
WE'RE GOING TO FIRST START WITH
LOOKING AT THE DIETARY PATTERNS
THAT VARY IN ULTRA PROCESSED
FOOD AND GROWTH BODY COMPOSITION
AND THE RISK OF OBESITY LOOKING
FIRST AT CHILDREN AND
ADOLESCENTS.
THIS IS UP TO 19 YEARS OF AGE.
OUR CONCLUSION STATEMENT IS AS
FOLLOWS, LIMITED EVIDENCE
SUGGESTS DIETARY PATTERNS WITH
HIGHER AMOUNTS OF FOODS
CLASSIFIED AS ULTRA PROCESSED
FOODS ARE ASSOCIATED WITH
GREATER ADIPOSITY AND FAT MASS
AND WAIST CIRCUMFERENCE AND HOW
DID WE DISCERN THIS?
WE LOOKED AT 25 ARTICLES FROM
PROSPECTIVE COHORT STUDIES.
I WILL TELL YOU WE USED 10 TOTAL
MEETINGS TO LOOK AT ALL THIS AND
THE CONSISTENCY WAS SUCH THERE
WAS CONCERNS FOR VARIATION IN
THE MAGNITUDE OF EFFECTS.
THERE WERE CONCERNS DUE TO
SMALLER SAMPLE SIZE AND WIDE
VARIANCE.
SOME CONCERNS DUE TO THE
POTENTIAL FOR EXPOSURE
MISCLASSIFICATION AND VARIANCE
IN WHAT WAS CONSIDERED ULTRA
PROCESS AND SERIOUS CONCERNS
WITH STUDIES DESIGN TO COMPARE
PATTERNS WITH ULTRA PROCESSED
FOODS AND SERIOUS CONCERNS WITH
ULTRA PROCESSED FOODS THROUGH
THE U.S. POPULATION GIVEN GLOBAL
DIFFERENCES IN FOOD SUPPLY.
SO THIS IS HOW WE GOT TO A GRADE
OF LIMITED.
I WANT TO MAKE SURE YOU'RE AWARE
AS YOU'RE LISTENING AND
WONDERING HOW WE GOT TO THIS
LIMITED GRADE IN LIGHT OF WHAT
HAS BEEN PRESENTED EARLIER TODAY
IN TERMS OF ALL TRA PROCESSED
FOODS AND LOOKING AT WHAT THE
U.S. DIET LOOKS LIKE.
I WANT TO MOVE ON TO OUR NEXT
SLIDE.
AS WE LOOK AT ADULTS AND OLDER
ADULTS.
WE'RE TALKING ABOUT THOSE UP TO
75 YEARS OF AGE AND I DO WANT TO
TALK ABOUT WHAT WIRE LOOKING AT
HERE.
WE'RE LOOKING AT THE CONSUMPTION
EXAMINE AND THE METHODS USED.
WE USED SCORE ANALYSIS IN 14
ARTICLES.
YOU'RE SEEING THE NOVA
CLASSIFICATION OF HERE AND
DEFINING ULTRA PROCESSED FOODS.
A REDUCED RANK REGRESSION AND
FACTOR ANALYSIS IN ONE ARTICLE.
THE AMOUNT OF ULTRAPROCESSED
FOOD WITH A CONTRIBUTION OF
ENERGY AND WEIGHT AND 10%
INCREASE IN ENERGY AND INCREASE
FROM 700 GRAMS A DAY VERSUS 234
GRAMS PER DAY.
THE NUMBER AND TYPES OF ITEMS
CLASSIFIED AS ULTRA PROCESSED
FOOD WITHIN DIETARY PATTERN WAS
VARIED ACROSS STUDIES AND HERE
AGAIN NOT SURPRISINGLY THE TYPE
OF ALL TRA PROCESSED FOOD
CONTRIBUTED TO DIETARY PATTERNS
AS SEEN PREVIOUSLY, REFINED
GRAINS, PROCESSED MEAT PRODUCTS
AND SUGAR SWEETENED BEVERAGES.
IN THE NEXT SLIDE WE'LL SEE THE
CONCLUSION STATEMENT FOR ADULTS
AND OLDER ADULTS LOOKING NOT
DISSIMILAR TO BEFORE AND LIMITED
EVIDENCE SHOWING HIGHER AMOUNTS
OF FOODS AND CLASSIFIED AS ULTRA
PROCESSED FOODS CONSUMED BY
ADULTS AND OLDER ADULTS ARE
ASSOCIATED WITH GREATER
ADIPOSITY.
THAT THE FAT MASS, WAIST
CIRCUMFERENCE AND BMI AND RISK
OF OBESITY.
THE BODY OF LIMITED WAS 16
ARTICLES.
15 FROM OBSERVATIONAL STUDY AND
ONE RANDOMIZED CONTROL AND
CONSISTENCY WAS MINIMAL
VARIATION AND SIGNIFICANCE OF
FINDINGS.
FEW CONCERNS WITH SAMPLE SIZE
AND POWER OF VARIANCE.
THERE WERE SERIOUS CONCERNS FOR
THE RISK OF BIAS DUE TO EXPOSURE
MISCLASSIFICATION AND CONCERNS
WITH STUDIES NOT DIRECTLY
COMPARING DIETARY PATTERNS WITH
AMOUNTS OF ALL ULTRAPROCESSED
FOODS AND WE HAD ALL
U.S. STUDIES WE HAD ISSUES HERE
ABOUT NOT HAVING AS MANY
U.S. STUDIES REPRESENTED HERE.
LET'S MOVE ON TO THE NEXT SLIDE.
LET'S LOOK AT INFANTS AND YOUNG
CHILDREN AND A CONCLUSION CANNOT
BE DRAWN BY CHILDREN UP TO 24
MONTHS WITH A GRADE NOT
ASSIGNABLE.
WE HAD FIVE ARTICLES AND FIVE
PROSPECTIVE COHORT STUDIES AND
LIMITATIONS IN THE CONSISTENCIES
IN ASSESSMENT AND TIMING AND
OUTCOME REPORTING AND DIRECTION
AND MAGNITUDE OF AFFECTS AND THE
METHODS AND DERIVED PATTERNS
WERE NOT DESIGN TO QUANTIFY
PROCESSED FOOD LIMITING THE
DIRECTNESS OF THE EVIDENCE.
THERE WAS A GREAT NOT ASSIGNABLE
FOR THIS AGE COHORT.
AND YOU CAN ALSO SEE SOMETHING
VERY SIMILAR SPECIFICALLY DURING
PREGNANCY AND DURING THE
POSTPARTUM COHORT WHERE WE ALSO
HAVE A GRADE NOT ASSIGNABLE FOR
BOTH GROUPS.
YOU'LL NOTICE FOR ONE GROUP
THERE WAS ONLY TWO ARTICLES BOTH
WERE PROSPECTIVE COHORT STUDIES
DURING PREGNANCY AND DURING THE
POSTPARTUM PERIOD AND
PROSPECTIVE COHORT STUDY, GRADE
NOT ASSIGNABLE AND BODY OF
EVIDENCE COULD NOT BE ADEQUATELY
ASSESSED.
UNFORTUNATELY WE'RE NOT ABLE TO
DRAW SIGNIFICANT CONCLUSION FOR
EITHER OF THESE TWO IMPORTANT
TIME PERIODS.
IF WE LOOK AT THE CONCLUSION
STATEMENTS BY LIFE STAGE YOU CAN
SEE FOR CHILDREN AND ADOLESCENTS
FOR ADULTS AND OLDER ADULTS WE
HAVE THOSE LIMITED CONCLUSIONS
THAT WERE DRAWN BASED ON WHAT
WAS PREVIOUSLY PRESENTED FOR THE
PREGNANCY AND POSTPARTUM PERIOD.
WE COULD NOT DRAW CONCLUSION
STATEMENTS AND THE GRADE WAS NOT
ASSIGNABLE DUE TO THE LIMITED
EVIDENCE PROVIDED DURING THOSE
TIME PERIODS.
WHAT WE WANT TO SAY BECAUSE WE
REALIZE IT'S A VERY IMPORTANT
ISSUE PARTICULARLY AS WE LOOK AT
ULTRAPROCESSED FOODS, WE WANT TO
TEST THE EFFECTS OF DIETARY
PATTERNS WITH WELL CONTROLLED
TRIALS IN THE U.S.
THIS IS OF SIGNIFICANT
IMPORTANCE WE RECOGNIZE HOW
COMMON THESE ARE IN THE
U.S. DIET.
REPORTS DETAILED INFORMATION ON
THE STATUS OF FOODS AND FOOD
GROUP ITEMS AS HOMEMADE OR
COMMERCIAL AND INDUSTRIALIZED
AND PROVIDES RATIONALE FOR
ULTRAPROCESSED AND PROVIDES
CLARITY ON THE DEGREE OF
PROCESSING AND THE AMOUNT AND
TYPE OF INGREDIENTS AND
EMULSIFIERS AND PRECISE AMOUNTS
OF INDIVIDUAL ULTRAPROCESSED
FOODS IN DIETARY PATTERNS BY
PARTICIPANTS IS THE TOTAL WEIGHT
OF GRAMS PER DAY AND
CONTRIBUTION TO OVER ALL DIETARY
INTAKE WHICH IS THE PERCENT OF
ENERGY SO THE LEVEL OF
ULTRAPROCESS FOOD INTAKE CAN BE
COMPARED AND HELP DEFINE LOW AND
HIGH PROCESSED FOOD.
WE RECOGNIZE IT'S IMPORTANT.
WE THINK MORE SHOULD BE DONE AND
COMMITTED TO DOING THAT WORK AND
KNOW THIS IS VERY IMPORTANT
PARTICULARLY IN LIGHT OF WHAT
HAS BEEN PRESENTED TODAY AND
DONE SUBSEQUENTLY BY OTHER
DIETARY GUIDELINE COMMITTEES.
THANK YOU FOR YOUR TIME.
>> ANY QUESTIONS OR COMMENTS?
>> TELL US ABOUT YOUR DISCUSSION
AND WHY YOU HAD SERIOUS CONCERNS
WITH THE CLASSIFICATION FOR THE
U.S.?
CAN YOU ELABORATE WHAT THE
COMMITTEE DISCUSSED?
>> WE DIDN'T HAVE AS MANY
STUDIES WE THOUGHT SHOULD BE
PRESENT.
THE NUMBER OF STUDIES FROM THE
U.S. AUTO LONE WERE RELATIVELY
LIMITED TO COMPARED TO THE TOTAL
NUMBER OF STUDIES.
COMPARING AN CONTRASTING TO WHAT
WE SAW FROM CHRISTOPHER'S BODY
OF WORK AND LOOK AT U.S. STUDIES
ALONE WITH THE ROBUST NUMBER OF
STUDIES.
SOME WE LOOKED AT WASN'T THE
U.S. ALONE BUT SEVERAL DIFFERENT
COUNTRIES PULLING THAT DATA
FROM.
DESPITE THE FACT THAT WE KNOW
WHEN WE'RE LOOKING AT THE
U.S. DATA OR JUST LOOKING AT THE
DATA THAT HAS BEEN ALREADY
VIEWED FROM SEVERAL OTHER
SUBCOMMITTEES WE KNOW OUR DIET
COULD USE SOME WORK HERE IN THE
UNITED STATES.
WE WOULD LIKE TO SEE OTHER
STUDIES THAT REALLY GIVE US MORE
INFORMATION ABOUT ULTRA
PROFES
PROCESSED FOODS IN THE UNITED
STATES.
>> IN OTHER COUNTRIES THE PO
PROPORTION IS MUCH LOWER AND IN
THE U.S. IT'S 60% PROCESSED
FOODS AND OTHERS 10% AND 20%.
IT'S NOT THE SAME QUESTION SO
POOLING THEM BECOMES HARDER.
>> IT'S NOT ABOUT THE
CLASSIFICATION INAPPROPRIATE FOR
THE U.S. BUT LESS STUDIES IN THE
U.S.
>> THAT PARTICULAR CONCERN WAS
THE DIFFERENT PROPORTIONS IN
COUNTRIES MADE IT HARD TO
ASSIMILATE AND COMBINE THE DATA.
>> THE CLASSIFICATION SYSTEM WAS
DIFFERENT.
WE DIDN'T HAVE IT IN THE
U.S. AND DIFFERENT FOODS WE WERE
LOOKING AT.
SO IT'S LARD TO LOOK ACROSS ALL
THOSE STUDIES AND COME UP WITH A
CONSISTENT DEFINITION.
>> THANK YOU FOR THE
PRESENTATION.
IN THINKING ABOUT THE ULTRA
PROCESSED FOOD IS DIFFERENT AND
WE HAVE NUTRIENTS AND HERE WE'RE
TALKING ABOUT A MIXTURE OF ALL
OF THAT TOGETHER I'M TRYING TO
SEE WHERE IT FITS WITH THE REST
OF THE BODY WORK DONE BECAUSE
YOU IDENTIFIED REFINED GRAINS
AND SWEETS AND THINGS THAT WERE
ALREADY MENTIONED AND HOW IS
THAT A COMBINATION OF WORK
ALREADY DONE IN A WAY?
>> SO A BIG PART, THERE'S A HUGE
OVERLAP WITH THE SODIUM
SATURATED FAT AND ADDED SUGAR
BUT IT'S BEYOND THAT.
THE CLASSIFICATION OF UPF HAS
MORE TO TO WITH COLORANTS,
EMULSIFIERS, ADDITIVES.
THERE'S A STRANGE PHRASE THAT
COMES UP IN THE INGREDIENTS OF
RARE CULINARY USE.
AND AT ONE POINT HIGH FRUCTOSE
SYRUP GOT INCLUDED IN THAT AND
SOMEONE SAID IT'S NOT RARE AND
IT'S RARE BECAUSE A HOME COOK
WOULDN'T LIKELY USE HIGH
FRUCTOSE CORN SYRUP.
THERE'S ADDITIVES IN COSMETICS
AND GELLING AGENTS AND OTHERS
THAT GO IN THE QUALIFICATION AND
IT'S HARD TO TEASING THAT AA
PART AND IS IT NEW BEYOND WHAT
WE SAID AND OTHER STUDIES
ADJUSTED FOR THE SATURATED FAT
AND SODIUM AND THERE'S STILL AN
EFFECT THERE.
S -- WE SPOKE ABOUT OUR DATABASE
AND DO WE HAVE ACCURATE MINERALS
IN OUR DATABASE?
NOT ALWAYS.
DO WE HAVE DATA ON EMULSIFIERS
AND COLORANTS?
AND WE DON'T AND MOST WEREN'T
DESIGNED TO CAPTURE THOSE DATA
SO WHAT WE HAVE TO RELY ON ARE
PROXIES FOR THOSE WHICH ARE
OFTEN THE FOOD IS HIGH IN
SODIUM, SATURATED FAT AND ADDED
SUGAR.
IT'S WRESTLING WITH A LOT SO
IT'S A CALL OUT FOR OUR
DATABASES TO GET UP TO SPEED ON
SOME OF THOSE THINGS AND WORKING
WITH INDUSTRY TO HAVE SOME OF
THAT INFORMATION MADE MORE
TRANSPARENT SO WE CAN TRACK IT .
>> AND I THINK THIS QUESTION IN
PARTICULAR WAS ASKING ABOUT
DIETARY PATTERNS WITH LOTS OF
ULT
ULTRAPROCESSED FEUDS VERSUS
FEWER.
IT PROVED TO BE MORE DIFFICULT
THAN WE THOUGHT.
I'M WONDERING IF THERE'S ISSUES
OF CONCERN WE SHOULD THINK ABOUT
FROM THE HEALTH EQUITY LENS.
>> ABSOLUTELY.
IT WAS BECAUSE WE WERE LIMITED
UP OUR STUDIES WE HAD SOME
STRUGGLES IN TRYING TO TEASE OUT
SOME OF THESE SPECIFIC HEALTH
EQUITY ISSUES BUT IF WE GO BACK
TO THE WORK THAT EACH OF YOU
HAVE DONE IN YOUR RESPECTIVE
SUBCOMMITTEES OR EVEN THE WORK
WE'VE DONE IF WE GO BACK AND
LOOK AT THE WORK SPECIFICALLY
AROUND CARDIOVASCULAR DISEASE,
TYPE II DIABETES, ETCETERA, WE
KNOW THERE'S EQUITY ISSUES THAT
PUSH CERTAIN GROUPS TO HAVING
HIGHER ULTRA PROCESS FOODS
VERSUS OTHERS.
WITH OUR STUDIES SO LIMITED IT
WAS HARD TO CALL OUT ON THIS
PARTICULAR TOPIC AND GETTING
BACK TO THAT QUESTION ASKED BY
CHRISTINA WHY DID WE SAY THIS
WAS DIFFICULT TO LOOK AT FROM A
U.S. LENS?
WE HAD FEWER STUDIES FROM THE
U.S. LENS TO LOOK AT THIS TO GET
INTO SOME OF THESE ISSUES THAT
SAMEERA WE HAD A HARDER TIME
LOOKING AT THIS FROM THE
U.S. BUT IT'S GERMANE TO THE
U.S.
WE CAN MAP OUT WHERE CERTAIN
RESTAURANTS ARE LOCATED IN
CERTAIN COMMUNITY PROXIMITY AND
THE PRICE POINTS IN CERTAIN
MEALS IN CERTAIN COMMUNITIES.
LIKE MY COMMUNITY IN SOUTHWEST
ATLANTA WHERE I GREW UP BUT IT'S
IMPORTANT TO CALL OUT AND THE
FIRST TIME WE LOOKED AT THIS AND
THINGS IN STUDY YOU HAVE
PERFORMED BUT THESE ARE
IMPORTANT CALLOUTS AS WE LOOK AT
ULTRA PROCESS FOOD.
>> CAN I BUILD ON THAT AND 60%
OF FOOD SUPPLY IS ULTRA PROCESS
FOOD.
PART IS MAKING IT ECONOMICAL AND
ACCESSIBLE AND IF YOU WERE TO
DEMONIZE IT WITHOUT ANYTHING TO
REPLACE IT IT WOULD BE HUGELY
PROBLEMATIC.
WE DON'T HAVE A CRISP CLEAR
DEFINITION OF WHAT IT IS AND
SOME WOULD GET TOSSED OUT
INAPPROPRIATELY AND IN OUR
GUIDELINES WE ALREADY SAY LIMIT
THINGS TO THE EXTENT YOU CAN AND
IT'S A TOUCHY SUBJECT TO
DEMONIZE THAT MASSIVE OF A
CATEGORY OF FOOD GROUPS WITHOUT
HAVING SOMETHING READY TO
REPLACE IT WITH PEOPLE WITH
LIMITED ACCESS SO WE HAVE TO
VERY SENSITIVE HERE.
>> ALONG THE LINES OF WHAT ALINA
ASKED BUT ONE OF THE CONCERNS
THAT I CAN KIND OF SEE WITH THE
LABELLING OF THE USE OF THE
LABELLING OF ULTRAPROCESSED TO
PATTERNS LIKE IF IT'S MORE ABOUT
THE ADDED SUGARS AND SODIUM AND
SATURATED FAT WE HAVE LINKS TO
CHRONIC DISEASE WITH THOSE
NUTRITIONAL COMPONENTS.
IF IT'S ABOUT THE TRADITIONAL
THINGS ADDED TO FOODS, IT'S SO
VAGUE AND WHY NOT JUST LOOK AT
EVIDENCE SPECIFICALLY FOCUSSED
ON THOSE THINGS AND GUIDING THE
POPULATION TO CONSIDER WHAT'S IN
THEIR FOOD AS FAR AS THE
NUTRIENTS AND FEEL LIKE THIS
SHIFT TO THINKING OF PROCESSING
COULD TAKE PEOPLE'S ATTENTION
AWAY FROM THINKING ABOUT THE
NUTRIENTS.
>> MOST THE INGREDIENTS OF FOOD
THAT WOULD PUSH FOOD TO ULTRA
PROCESS FOOD IS NOT ON THE
LABELLING.
AS A TOOL FOR CONSUMERS THAT
WOULDN'T BE APPLICABLE.
MOST THESE INGREDIENTS ARE NOT
LISTED BECAUSE THEY'RE EITHER
NOT PREVALENT WHERE YOU HAVE TO
DISCLOSE OR MAYBE IT'S A FEATURE
OF WHAT HAPPENS DURING
MANUFACTURING NOT NECESSARILY A
PHYSICAL ADDITIVE.
I CAN'T WALK BACK AND REQUIRE
EVERYONE TO GET THEIR FOOD FROM
COOKING MEAL AT HOME BUT IT'S
DIFFICULT TO SEPARATE PROCESSING
FROM FOOD CHOICE BECAUSE THE
FOOD SUPPLY IS DRIVEN BY THE
NEED TO PROCESS FOR CERTAIN
REASONS TO HAVE AFFORDABLE AND
CONVENIENT AND SHELF STABLE
OPTIONS WHERE YOU CAN GET THINGS
ON THE FLY AND READY TO EAT.
THE SAME FOODS SHOULDN'T BE
MAKING YOU SICK EITHER.
RETAINING THE BENEFITS OF
PROCESSING WHILE ELIMINATING THE
RAPIDLY EVOLVING NATURE OF THESE
FOODS THAT ARE REALLY NOT THERE
FOR THE CONSUMER BUT FOR
REDUCING THE PRICE AND
CONVENIENCE OF THE ITEMS I THINK
IS A PRIORITY.
YOU CAN'T SEPARATE THAT FROM THE
NUTRIENTS.
EVEN IF THEY'RE DIFFERENT
CONSTRUCTS.
I WANT TO ADD TO WHAT DIDI IS
SAYING THE METHODOLOGICAL ISSUES
AND WHAT'S RAISED IS VALUABLE.
THE OTHER COMPONENT TO OUR
CHARGE IS WE ANSWER QUESTIONS OR
LOOK AT THE SCIENCE AROUND
QUESTIONS REACHING GREAT FEDERAL
INTEREST AND STAKEHOLDER
INTEREST.
RIGHT NOW WE'VE COME TO THE
CONCLUSION THAT WE'VE COME TO
BECAUSE IT'S A NOVEL TOPIC AREA
AND THE SCIENCE ISN'T RIPE YET.
SO WE'VE TALKED ABOUT THINGS WE
NEED TO SHIFT WITH REGARDS TO
DATABASES AND HOW WE APPROACH
THIS QUESTION.
OUR CHARGE AS A COMMITTEE IS TO
PURSUE THINGS THAT HAVE INTEREST
FOR A FEDERAL TEAM AS WELL AS
SHAREHOLDERS AND THAT'S PART OF
WHAT IS PUTTING THIS ON THE
TABLE.
>> I WOULD SAY AS AN EXTENSION
AT THE BEGINNING OF THE ULTRA
PROCESS FOOD STORY WHAT IS
PRESENTED HERE IS ON THE GROWTH
AND BODY COMPOSITION AND
OBESITY.
THERE'S LITERATURE ON ULTRA
PROCESS FOOD AND DIABETES AND
CARDIOVASCULAR DISEASE AND OTHER
CHRONIC HEALTH CONDITIONS.
TODAY IS ONLY THE BEGINNING AND
BROUGHT OTHER ISSUES HOW DO YOU
SEPARATE OUT THE NUTRIENTS OUT
FROM THE INGREDIENTS AND A LOT
OF AND MANY FOODS ARE HIGH IN
SODIUM AND SATURATED FAT AND
ADDED SUGAR.
THERE'S A DIET QUALITY ISSUE AS
WELL.
NOT ALL HAVE TRIED TO CONTROL
FOR BAD QUALITY UP ONE WAY OR
ANOTHER AND GETS TO TRYING TO
TEASE OUT IS ULTRA PROCESSED
FOODS IS IT REPRESENTATIVE OF A
LOW-QUALITY DIET IN SOME IT'S
NOT AS DRAMATICALLY HIGH AS ONE
WOULD EXPECT.
ANOTHER THING THERE'S ULTRA
PROCESSED FOODS WITH LITTLE
NUTRITIONAL VALUE AND THERE'S
WHOLE GRAIN CEREALS.
IT WILL STILL BE CLASSIFIED AS
ULTRA PROCESS FOOD.
ONE OF THE RESEARCH IDEAS TO
PASS ON TO OTHER INVESTIGATORS
IS TO LOOK DEEPER INTO THE
DIFFERENT FOOD GROUPS WITHIN
ULTRA PROCESS FOOD, THE ULTRA
PROCESS FOOD CEREALS AND WHOLE
GRAIN CEREALS AND LOOKING DEEPER
AND SEE MAYBE THERE'S A
DIFFERENCE BETWEEN THE ULTRA
PROCESS FOOD AND LOW-NUTRIENT
QUALITY FOODS VERSUS THE ULTRA
PROCESS FOOD AND THE MINIMALLY
PROCESSED AND HIGH NUTRITION AND
A DEEPER DIVE IN THAT AND MAY
HELP REFINE A METRIC OF LEVEL OF
PROCESSING IN THE FOOD SUPPLY.
>> THERE'S METHODOLOGICAL
CONSIDERATION BECAUSE IF YOU
TALK ABOUT DIET QUALITY MOST OUR
OPERATIONALIZATION OF DIET
QUALITY AND THE AGI SCORE OF
FOOD GROUPS SO QUANTITIES P
PPER
1,000 CALORIES AND TALK ABOUT
DIET QUALITY SCORES AND DESIGNS
FOR DIFFERENT LEVELS OF QUALITY
BUT A LOT OF WHAT THAT IS HOW
MUCH OF A FOOD GROUP ARE ARE YOU
PUTTING IN.
IF ULTRAPROCESSED IS MORE
REFINED GRAINS IT'S GOING TO HIT
A REFINE GRAIN SCORE WITH
MODERATION AND SATURATED FAT
WILL HAVE A DIET QUALITY SCORE.
AND IT WILL BE BASED ON THE FOOD
GROUPS WE TALKED ABOUT AROUND
NOT SO MUCH ABOUT THE LEVEL OF
PROCESSING BECAUSE ON OUR LIST
WE HAD TWO TYPES OF FRUITS AND
VEGETABLES ON WHAT WERE
ULTRAPROCESSED AND ADDITIVES AND
NOT.
THERE'S AN IDEA OF DIET QUALITY
AND HOW WE ASSESS ISN'T ALWAYS
TIED TO THE ELEMENTS BEING
ASSESSED WITHIN ULTRA PROCESS
FOOD.
THERE'S NUANCE THERE THAT WHEN
YOU'RE CAPTURING FRUIT AND
VEGETABLE INTAKE YOU MAY NOT BE
CAPTURING THAT BREADTH AND TYPE
OF PROCESSING THAT GETS IN
THERE.
IT'S DIFFICULT TO PULL APART
THAT DIET QUALITY IDEA.
>> I THINK THE NUTRIENT VERSUS
PROCESSING DISCUSSION I WANTED
TO REMIND AND I KNOW WE TALKED
ABOUT THE ONE TRIAL THAT'S BEEN
CONDUCTED ON ULTRA PROCESS FOOD
TO UNDERSTAND AND THE CONSTRUCT
OF THE CLASSIFICATION DOES NOT
INCLUDE A SINGLE NUTRIENT IN THE
DEFINITION OF HOW IT CATEGORIZES
AND BASED ENTIRELY ON PROCESSING
TECHNIQUE.
IT'S NOT SODIUM AND HOW IT'S
APPLIED TO OUR FOOD SUPPLY AND
THE TRIAL WAS SHORT TERM.
I DON'T KNOW THE RCT LISTED WAS
KEVIN HALL MATCHED THE CROSSOVER
DIET FOR ALL THESE NUTRIENTS OF
CONCERN.
ALL SATURATED FAT, REFINED SUGAR
AND MACRO NUTRIENT COMPOSITION
WERE MATCHED CAREFULLY.
THE ONLY THING ALLOWED TO DIFFER
FROM THE MENUS WERE THE DEGREE
OF PROCESSING SO UNPROCESSED
VERSUS ULTRA PROCESSING AND IT
LED TO HIGHER CALORIE INTAKE AND
WEIGHT GAIN AND ARTIFICIAL AND
METABOLIC SETTING.
YOU TAKE AWAY THE CONVENIENCE
AND AFFORDABILITY AND I HAVE TO
RUSH BETWEEN JOBS, WHATEVER IT
MIGHT BE YOU MAY THINK AS
CONFOUNDERS LEANING TOWARDS
ULTRA PROCESS FOODS AND TAKE
AWAY THE SUGAR, SALT AND FAT AND
THE PROCESSING WAS DRIVING
SEVERAL HUNDRED CALORIES MORE
PER DAY OF CONSUMPTION AND
WEIGHT GAIN.
SO WHAT THAT IS WE DON'T KNOW.
MORE RESEARCH WILL ELUCIDATE BUT
THE PROCESSING DOES SEEM TO HAVE
AN IMPORTANCE ABOVE AND BEYOND
WHAT OTHER ASPECTS OF DIET
QUALITY, CLUSTER IN THE FOODS IN
THE U.S. AND ARE IN THE
U.S. CATEGORY.
OVER TO YOU NOW.
>> MY QUESTION I CONSEQUENT
REMEMBER THE RECOMMENDATIONS FOR
RESEARCH BUT ARE YOU COMMENTING
ON WHAT SHOULD RESEARCHERS USE
AND WHICH CLASSIFICATION TO USE
BECAUSE I THINK IT'S A BIG
DEBATE AND MAYBE IF YOU SAW
DIFFERENCES IN THE LITERATURE
YOU CAN PROVIDE LIGHT THAT WOULD
BE GREAT.
>> A QUICK COMMENT TO FOLLOW ON
THE TRIAL.
THE INTERESTING THING ABOUT THE
TRIAL WAS I THINK THE ONE BIG
FACTOR WAS OBVIOUSLY WAS FIBER.
I THINK THE CONTROL GROUP HAD
AROUND 40 GRAMS A DAY OF FIBER
WHICH IS VERY HIGH.
THAT'S THREE TIMES HIGHER AND
FIBER IS A BIG COMPONENT OF
HAVING A DIET NATURALLY HIGH IN
FIBER AND I DON'T THINK MAKING
MAKING WOOD WITH SUBSTITUTE
FIBER WOULD BE A GOOD SUBSTITUTE
FOR THAT.
>> COMING BACK TO CHRISTINA, WE
DIDN'T WANT TO ENDORSE ONE
CLASSIFICATION OVER ANOTHER BUT
STATED NOVA SEEMS TO BE THE MOST
COMMONLY USED CLASSIFICATION.
WE THINK THAT WILL STILL EMERGE
AS BEING THE MOST COMMONLY USED
CLASSIFICATION FOR EVALUATING
ULTRA PROCESS FOODS.
I THINK THAT WILL CONTINUE TO BE
THE CASE.
WE DIDN'T WANT TO ENDORSE ONE
VERSUS ANOTHER BUT WILL STILL
EMERGE AS THE MOST COMMONLY USED
AND WOULD LIKE MORE STUDIES
PERFORMED IN THE UNITED STATES
WHETHER THAT CLASSIFICATION OR
ANOTHER BUT DON'T ENDORSE ONE
OVER THE OTHER.
>> I WANT TO BRING UP THE SEGA
CLASSIFICATION THAT BUILDS ON
NOVA.
IF YOU HAVE AN EMULSIFIER OR
ANTI-GELLING AGENT YOU SHIFT
OVER AND SEGA SAYS HOW MANY DO
YOU HAVE?
ONE, TWO, THREE, FOUR SO IT'S
MORE COMPLICATED BUT MORE
SPECIFIC BUT HASN'T BEEN TESTED
NEARLY AS MUCH AS NOVA.
.
I THINK IT COULD BE BETTER BUT
HASN'T BEEN TESTED BUT THERE
WILL SURELY BE OTHER CHALLENGES
FOR THIS.
>> THERE HAVE BEEN VIRTUALLY ALL
INGREDIENTS ADDED TO FOODS GO
THROUGH THE REGULATORY SYSTEM
HOWEVER, I THINK THE INTENT WAS
NOT TO HAVE PEOPLE CONSUME SO
MUCH OF THEIR DIET FROM THESE SO
MAY BE MORE UNINTENDED
CONSEQUENCES SO WE DON'T KNOW
THAT YET.
THERE'S STILL A LOT OF
UNANSWERED QUESTIONS.
WE DO KNOW THE ENHANCED FLAVORS
YOU CAN MAKE A BANANA FLAVORING
THAT WILL TASTE BETTER THAN ANY
BANANA YOU'LL EAT WITH SEASONAL
VARIATION THAT DOES ELICIT MORE
CONSUMPTION DIDI TALKED A LITTLE
BIT ABOUT THAT.
>> IT'S NOT ALWAYS ADDITIVE AND
I DON'T THINK IT SHOULD BE A
SCARE TACTIC OF FOOD ADDITIVES
BECAUSE THERE'S OTHER FEATURES
OF CONCERN LIKE ENERGY DENSITY
AND YOU HAVE A CONDENSED CALORIE
VERSION OF IT AGAIN PROBABLY
REMOVING FIBER AND OTHER ASPECTS
OF HOW THE FOOD ORIGINALLY
LOOKED AND HOW IT LOOKS NOW AS A
PRODUCT ON THE SHELF.
THAT MAY NOT NECESSARILY BE
ADDITIVE BUT ANOTHER FEATURE FOR
PARAMETER THAT CAN BE QUANTIFIED
BUT MAYBE NOT A TANGIBLE
INGREDIENT.
JUST TO REMIND IT'S NOT JUST
INGREDIENTS BUT MANY OTHER
ASPECTS THAT COULD BE AS
RELEVANT.
>> I RESPECTFULLY DISAGREE.
NOVA, IF YOU READ IT BECAUSE I'M
WRITING A PAPER ON THIS RIGHT
NOW THE PROCESSING ASPECT ISN'T
NECESSARY BUT THE ADDITIVES ARE.
I DON'T WANT TO HAGGLE OVER THAT
I JUST WANT TO BUILD ON YOUR
GRASS THING.
I KNOW THERE'S A RECENT BROMATED
VEGETABLE OIL IN 2023 THEY
APPROVED TO TAKE IT OFF THE
GRASS LIST.
IN THOSE 20 YEARS THE NUMBER OF
GRASS ITEMS INCREASED FROM 80 TO
8,000 AND THE IDEA IT TOOK 20
YEARS TO GET ONE ITEM OFF THE
GRASS LIST IS DAUNTING WHEN THE
GRASS LIST GROWS AND GROWS AND
GROWS.
>> IT I'M GOING TO INTERJECT.
THIS HAS BEEN A GREAT DISCUSSION
AND I THINK I'M GOING TO HAND IT
OVER TO ARCHING LA.
-- ANGELA.
>> THIS IS A SHORT COMMENT ABOUT
THE RESEARCH RECOMMENDATIONS.
I KNOW YOU ALL HAVEN'T INCLUDED
THE RESEARCH RECOMMENDATIONS
THOSE WILL BE FORTHCOMING
ESSENTIALLY AND WE TALKED ABOUT
IT FROM THE PERSPECTIVE.
WHAT I THINK IS STRIKING ACROSS
THIS ENTIRE PRESENTATION WHICH
IS EXCELLENT IS THERE'S TWO
CATEGORIES, CHILDREN AND
ADOLESCENTS OF WHICH WE SAW A
HUGE CONCERN ABOUT.
THE OTHER IS EXCESS WEIGHT GAIN
AND PREGNANCY AND ALSO ANYTHING
RELATED TO PREGNANCY AND
POSTPARTUM.
MAYBE IT'S MORE OF A COMMENT
THAN A QUESTION, ARE THERE
CERTAIN RESEARCH RECOMMENDATIONS
YOU SEE IN THOSE TWO POPULATIONS
BECAUSE WE JUST HEARD THAT THE
DIETARY QUALITY IN ADOLESCENCE
LOOKING AT CERTAIN POPULATIONS
SPECIFICALLY, WERE THERE THINGS
I'M ASSUMING A LOT OF THE DATA
IS CROSS-SECTIONAL AND THEY
DON'T JUST DON'T EXIST.
>> NOT JUST IN ULTRA PROCESS
FOOD BUT ACROSS THE BOARD AND
PREGNANCY AND POSTPARTUM.
>> THERE WERE ONE OR TWO IN
ALMOST ALL THE THINGS
REPRESENTED.
>> I MEAN IN THE BROADER
LITERATURE.
I'M QUITE SURPRISED WITH THESE
GIVEN THE AMOUNT OF DISCUSSION
AROUND EXPRESS WEIGHT GAIN AND
PREGNANCY.
>> I'M GOING TO PUT ON MY
CLINICAL HAT.
SO I FIND IN THE OB-GYN SPACE
AND IT'S ONE OF THE THINGS I DID
NOT DO, THERE'S JUST NOT MUCH
ATTENTION IN THIS PARTICULAR
TIME.
THERE'S ATTENTION TO THE FETUS
AND THE MOM AND HEALTH OF THAT
PERIOD BUT NOT NECESSARILY TO
THE PATTERN EXCEPT A HEALTHY
CHILD AND THE MOM SURVIVING THAT
PERIOD.
I THINK THE REASON WHY YOU'RE
NOT SEEING MUCH IN THE SPACE IS
THE FACT THAT MOST THE PEOPLE
DOING THE RESEARCH ARE NOT
BETTER TRAINED IN THIS DOMAIN.
I THINK THE PEOPLE SITTING
AROUND THIS TABLE NEED TO
CONSIDER PARTNERING WITH THOSE
IN THE OB-GYN SPACE TO DO THAT
WORK.
THEY AREN'T TRAINED AND THIS
ISN'T THEIR AREA OF RESEARCH AND
THEY'RE NOT THINKING ABOUT THAT
TYPE OF WORK.
THEY NEED THOSE PEOPLE THAT HAVE
THAT EXPERTISE WHICH ARE THE
PEOPLE SITTING AT THE TABLE NOT
JUST AT THE TABLE BUT MAYBE
LISTENING TO MY VOICE TO PARTNER
TO DO THIS WORK.
THE PAUCITY OF STUDIES COME FROM
THE LACK OF KNOWLEDGE IN THAT
SPACE AND ACROSS ALL THE DOMAINS
OF THE LAST TWO DAYS THERE'S
LIMITED LITERATURE DUE TO THE
LIMITED KNOWLEDGE WE'RE SEEING
AND LIMITED CONCENTRATION IN
THAT SPACE.
>> WE HAVE A HUGE MCA NUTRITION
COMMUNITY AND I'M CURIOUS
BECAUSE THIS IS UNEXPECTED AND I
KNOW THERE'S PAPERS BUT CURIOUS
IF THEY DON'T MEET OR IS IT JUST
MISSING?
I THINK THAT'S A KEY
RECOMMENDATION BUT CURIOUS GIVEN
THE EMPHASIS IN INVESTMENT
AROUND MCA AND NUTRITION IN MOST
OF THESE WE DIDN'T HAVE ENOUGH
STUDIES TO DEVELOP A CONCLUSION.
I'M CURIOUS WHY.
>> WHEN WE WENT BACK IN THE
ORIGINAL STATEMENT LOOKING AT
GESTATIONAL WEIGHT GAIN AND THAT
PERIOD IS HARD TO CAPTURE.
PEOPLE DON'T KNOW THEY'RE
PREGNANT IN THE LATER IN THE
PREGNANCY.
DIETS CHANGE FROM WHAT PEOPLE
ARE EATING FIRST, SECOND AND
THIRD TRIMESTER AND TRYING TO
CAPTURE THE DIFFERENCES IS
DIFFICULT AND THINKING ABOUT THE
COHORTS YOU CAN CAPTURE YOU'RE
RECRUITING IN THE FIRST
TRIMESTER AND GETTING THAT
INFORMATION VERSUS PEOPLE WHO
MIGHT BE FINDING OUT THEY'RE
PREGNANT LATER AND BEING
CAPTURED THAT WAY.
THE OTHER THING THAT CAME UP
WHEN WE LOOKED AT OFFSETTING
GESTATIONAL WEIGHT GAIN DATA FOR
THE COHORTS THEY END UP
MEASURING DIET DURING THIS TIME
PERIOD AND CAPTURING TIME
PERIODS PRIOR TO PREGNANCY.
OR SPECIFIC TRIMESTER OR DON'T
LINE UP WITH SOME OUTCOMES WE'RE
LOOKING AT.
OR THE DIETARY TOOLS ARE NOT
REALLY ACCURATELY MEASURING WHAT
WE NEED THEM TO.
AND ALSO THINKING ABOUT THE
GESTATIONAL WEIGHT GAIN
GUIDELINES SIMILAR TO CHILDREN
NEEDING TO GROW, PERSONS
PREGNANT NEED TO GAIN WEIGHT
DURING PREGNANCY OR OFTEN SHOULD
GAIN WEIGHT DURING PREGNANCY.
COMING OUT OF THIS -- I THINK
IT'S STRIKING ALSO THERE'S
PRETTY MUCH NOTHING ON
POSTPARTUM.
POSTPARTUM WEIGHT CHANGE AND THE
IMPLICATIONS FOR THAT FOR
WOMEN'S HEALTH GOING FORWARD.
>> THERE'S NOTHING ON TODDLERS.
THERE'S AN EXPLOSION OF SNACKS
FOR BABIES, ALL THESE LITTLE
FOODS FOR BABIES THAT ARE
ULTRAPROCESSED AND COULD BE
ANOTHER OPPORTUNITY TO DO
RESEARCH ON ALL THOSE NEW FOODS
OUT THERE.
>> ALSO DURING PREGNANCY WE LIKE
TO SEE MEASUREMENT OF DIET
THROUGHOUT AND PREGNANCY IS KIND
OF QUICK AND TURNING AROUND TWO
MONTHS LATER AND ASKING FOR
ANOTHER FOOD FREQUENCY
QUESTIONNAIRE AND IT'S AN EXTRA
BURDEN ON TOP OF EVERYTHING
ELSE.
IT'S DEFINITELY NEEDS TO BE AN
AREA EXAMINED AND GIVEN
GESTATIONAL DIABETES FOLLOWING
THAT IN THE POSTPARTUM PERIOD
WHAT HAPPENS WITH WEIGHT LOSS
AND DIET AFTER THAT.
WE HAVE A LOT OF WORK TO DO.
>> ANY OTHER QUESTIONS OR
COMMENTS?
OKAY.
SO OUR NEXT STEPS ARE WE'RE
GOING TO CONTINUE TO WORK ON OUR
SYSTEMATIC REVIEWS SO OUR
DIETARY PATTERNS WE'RE GOING TO
START ON RISK OF AND WE ALREADY
GOT THE PAPERS LINED UP SO
THAT'S KIND OF EXCITING TO WORK
ON THAT AND THEN WE'LL LOOK AT
DIETARY PATTERNS AND RISK OF
BREAST CANCER AND COLORECTAL
CANCER AND WAS NICE TO SEE THE
DATA ON THAT AND WITH SPECIFIC
DIETARY PATTERN COMPONENTS WE'LL
BE DOING THE SUGAR SWEETENED
BEVERAGES AND BODY COMP AND RISK
OF OBESITY IN ADULTS AND OLDER
ADULTS AND THEN OUR FOOD SOURCES
OF SATURATED FAT AND RISK OF
CARDIOVASCULAR DEED.
-- DISEASE.
SO LOTS OF WORK REMAINING BUT
WE'RE VERY PROUD OF THE
COMMITTEE AND THE GROUPS AND
WHAT DONE TO DATE.
>> WE HAVE A CHANGE IN THE
AGENDA AND WE'RE GOING TO WRAP
UP BECAUSE SOME COMMITTEE
MEMBERS HAVE EARLIER FLIGHTS
BECAUSE OF TRAVEL DELAYS,
ETCETERA.
SO WHAT I'D LIKE TO DO IS WHAT
WE ALWAYS DO BECAUSE I FIND THIS
SOME OF THE RICHEST DISCUSSION
IS ONE IMPRESSION EACH OF THIS
MEETING, SOMETHING THAT'S REALLY
MADE AN IMPRESSION ON YOU.
CHERYL, I'M GOING TO START WITH
YOU.
PLEASE GO AHEAD.
>> THANK YOU, SARAH.
I WANT IT SAY THANK YOU TO
EVERYONE FOR WHAT'S REALLY BEEN
AN INTERESTING AND FRUITFUL TWO
DAYS OF DISCUSSION.
WE HEARD IT SAID A COUPLE TIMES
DURING THE DISCUSSION THAT
CONTEXT MATTERS AND I WANT TO
JUST SAY THAT AS WE'VE BEEN
DOING OUR WORK SINCE THE LAST
MEETING AND THIS MEETING, THE
CONTEXT FOR ME AROUND WHAT'S
BEEN GOING ON IN THE WORLD HAS
REALLY BEEN CRITICAL TO HOW I'VE
BEEN EXPERIENCING THE PROCESS.
AND YOU CAN'T REALLY LOOK AT THE
NEWS MEDIA RIGHT NOW AND NOT BE
STRUCK BY HOW MUCH DISTRESS
THERE IS GOING ON IN OUR NATION
AS WELL AS ACROSS THE GLOBE.
WE ALL KNOW THAT HAS
IMPLICATIONS FOR HOW PEOPLE EAT
AND ACCESS FOOD AND NUTRITION
BUT FOR ME, JUST LISTENING TO
HOW FAR WE'VE COME AND WHAT
WE'VE BEEN DOING IT'S BEEN NICE
TO HAVE A PLACE AND A PROCESS
AND A GROUP OF COLLEAGUES THAT
ARE DIVERSE UP YOUR BACKGROUNDS
AND THINKING.
WE HAVE TO DEAL WITH COMPLEX AND
STICKY SUBJECTS AND WE DO IT
WITH SUCH RIGOR AND RESPECT FOR
EACH OTHER.
I JUST WANTED TO CALL THAT OUT
AS AN IMPRESSION FROM THIS
SESSION.
>> GREAT IMPRESSION.
THE IMPREG I'VE HAD AND AT MOST
THE MEETINGS WE'VE HAD IS OUR
DATA ARE VERY RICH BUT NOT
ANSWERING THE QUESTIONS WE'RE
TRYING TO ANSWER.
WE NEED A CALL TO ACTION I THINK
FOR ALL OF OUR COLLEAGUES ABOUT
REPLICATING SOME OF THESE
STUDIES, IMPROVING OUR
METHODOLOGY AND STANDARDIZING IT
TO ANSWER THESE QUESTIONS IN THE
NEXT COMMITTEE AND COMMITTEES
AFTER THAT.
>> I KNOW WE'VE SAID THIS
MULTIPLE TIMES BUT I JUST WANTED
TO GIVE A SHOUT OUT TO THE
NESSER TEAM.
I THINK ESPECIALLY NOW THAT
WE'RE GETTING CRUNCHED FOR TIME
AND JUST SEEING THE VOLUME OF
DATA PRESENTED AND THE NICE WAY
THAT THEY VISUALIZE IT AND HELP
US IN WHATEVER WE ASK FOR THEY
GET US SO I DON'T KNOW HOW Y'ALL
SLEEP AT NIGHT BUT I JUST WANTED
TO SAY WE'RE VERY GRATEFUL FOR
EVERYTHING Y'ALL DO TO SUPPORT
US.
>> MY TAKE IS I'M IMPRESSED WITH
THE COLLABORATIONS BETWEEN
GROUPS AND PRESENTED ON SNACKS
AND BREAKFAST AND THEN HAD THE
PREVALENCE OF SNACK AND
BREAKFAST AND BEING IN TUNE WITH
EACH OTHER AND COLLABORATING AND
ADDING INFORMATION WE'LL NEED SO
I THINK THAT'S AWESOME.
>> I'M STILL STRUCK BY SOMETHING
YOU GUYS BROUGHT UP IS THE
DATABASE FOR FREQUENCY TO AGE 2
IS LESS THAN THE OTHER YEARS OF
LIFE AND THAT HASN'T CHANGED AND
THAT'S AN AREA OF FOCUS AND MAKE
A PITCH AS WE THINK ABOUT THE
NEXT DIETARY GUIDELINES 10% OF
BABIES ARE BORN LOW BIRTH WEIGHT
AND PREMATURE AND DON'T SAY ONE
WORD AND I UNDERSTAND THERE'S
DIFFERENT PROCESSES ABOUT THEM
BUT I DO THINK WE NEED TO
CONSIDER THAT IN UTERO TIME
PERIOD AND WHAT COMES OUT OF
THAT TIME PERIOD AND THE
CONCLUSIONS AND DATABASE ARE
VASTLY DIFFERENT FOR THAT TIME
PERIOD.
>> I WAS GOING TO SAY SOMETHING
VERY SIMILAR.
IT IS IMPOSSIBLE ON THE JOURNEY
OF COMPLEMENTARY FEEDING WITHOUT
BEING PROFOUNDLY STRUCK BY HOW
LITTLE AND UNDER REPRESENTED
EARLY DEVELOPMENT IS IN OUR
UNDERSTANDING OF HOW DIET
INFLUENCES HEALTH.
WHAT STRUCK ME ALSO IS GOING
BACK TO ANGELA AND OTHERS'
COMMENTS I THINK THERE NEEDS TO
BE STRONG MESSAGES ABOUT THE
TYPE OF SCIENCE THAT WILL HELP
US MAKE MOVEMENT FORWARD AND
I'VE PUBLISHED A BAZILLION CROSS
SECTIONAL STUDIES BUT THE
SCIENCE HAS NEVER BEEN DONE IN
THIS DISCUSSION AND I THINK
THAT'S AN IMPORTANT MESSAGE IN
TERMS OF HOW WE MOVE FORWARD IN
SCIENCE AND TO MAKE HEADWAY.
I THANK YOU FOR MAKING THOSE
COMMENTS IN AN ARTICULATE WAY
AND I WANT TO SEE US MAKE THE
PUSH FOR RIGOROUS SCIENCE IN
SOME OF THESE AREAS.
>> I THINK WHAT I'LL TAKE TODAY
IS THE RIGOR AND THOUGHTFULNESS
OF ALL THE COMMITTEE AND THE
PROCESS THAT'S INCREDIBLE TO
BRING ALL THOSE RESULTS OVER THE
PAST TWO DAYS IT WAS INCREDIBLE
TO SEE HOW MUCH WORK HAS BEEN
DONE.
I THINK ANOTHER MESSAGE I'M
GOING TO TAKE AWAY IS WE HAVE
WORK TO DO ON COMMITTEE AND WE
ASK THE QUESTION AFTER EVERY
PRESENTATION WHAT ABOUT CULTURAL
FOOD AND DARK GREENS EVEN WITHIN
THE DATA ANALYSIS SECTION.
I THINK THERE'S A LOT OF TO DO
AND RECOMMENDATION WITHIN THAT
ON HOW TO APPROACH IT WILL BE
CRITICAL.
>> I WOULD SAY A HUGE THANK YOU
AGAIN TO OUR COMMITTEE
CO-CHAIRS, SARAH AND ANGELA AND
SAMEERA LEADING UP OUR HEALTH
EQUITY GROUP.
YOU'RE SO EXCELLENT SO THANK YOU
FOR ALL YOU DO.
I WAS SAD AND DISHEARTENED AT
HOW WE'RE DOING IN THIS COUNTRY.
THESE DATA ARE REALLY DE
PRESSING.
THEY REPRESENTS STORIES OF
INEQUITY AND THERE'S SOME
SIGNIFICANT DISPARITIES.
SO I REALLY HOPE THAT WE CAN GET
GREATER COMMUNITY ENGAGED
SCIENCE AND HEAR FROM THE
COMMUNITIES MOST IMPACTED FROM
THE ISSUES, WHAT PEOPLE ARE
EATING, WHAT ARE THE NEEDS AND
HOW WE CAN MAKE MAJOR CHANGES
BECAUSE WE NEED THOSE CHANGES.
>> I THINK WE SAW NOT A LOT OF
RESULT INS PATTERN MODELLING AND
LOOKING AT IT POSITIVELY AND
WOULD BE NICE TO PUT EVERYTHING
TOGETHER NOW THAT WE HAVE A LOT
OF THIS INFORMATION TO SEE HOW
WE CAN PUT FORTH OUR
RECOMMENDATIONS TO THE
DEPARTMENTS.
THAT IS WHAT I'M LOOK BEING
FORWARD TO.
I THINK OF IT AS POSITIVE.
WE HAVE GOOD DISCUSSION AND
LOOKING FORWARD TO THE NEXT
STEPS.
THE NEXT FEW MONTHS WILL BE
CRUCIAL.
>> ONE THING THAT STRUCK ME IS
THERE ARE LOTS OF SCIENTIFIC
QUESTIONS AND THERE'S TONS OF
DATA OVER ALL AND SOME TOPICS
HAVE A LOT OF DATA AND SOME HAVE
ALMOST ZERO.
THE ONE THING THAT'S CONSISTENT
IS THE TEAM DOES AN INCREDIBLE
JOB IN ORGANIZING AND
SYNTHESIZING THE DATA FOR US.
SO, THAT MAKES OUR JOB EASIER
BUT IT IS SOMEWHAT -- THERE'S
TWO IMPREG -- IMPRESSIONS THAT
WAS THE FIRST.
THE SECOND IS THOUGH I SORT OF
KNEW IT THIS MORNING WAS PRETTY
DE PRESSING LOOKING AT THE DATA.
MY SON TEXTED ME THIS MORNING
AND HE'S IN HIGH SCHOOL AND SAID
WHAT ARE YOU LEARNING ABOUT AT
YOUR MEETING AND I RESPONDED HOW
POOR THE AMERICAN DIET IS.
I GUESS THAT'S ALL I CAN SAY.
WE HAVE A LOT OF WORK TO DO.
THE FIRST MEETING I SAID TODAY'S
THURSDAY AND TODAY'S THURSDAY
AGAIN AND THE REASON I SAY THAT
ALWAYS IS BECAUSE TODAY'S THE
DAY MY FAMILY IS AT THE FOOD
PANTRY LIVE IN ATLANTA, GEORGIA
AND THE CHURCH IN MY HOMETOWN.
I LIVE IN BOSTON BUT ATLANTA
WILL ALWAYS BE HOME SO THANK YOU
GUYS THERE IN ATLANTA FOR
WATCHING.
THEY'RE A FOOD PANTRY WHERE
PERSONS WHO ARE FOOD INSECURE GO
TO OBTAIN FOOD.
I THINK ABOUT THIS ALSO THROUGH
A LENS OF THOSE PEOPLE WHO HAVE
TO GO TO THE FOOD PANTRY EVERY
WEEK.
MANY OF WHOM HAVE GONE YEAR
AFTER YEAR.
THEY'RE ALSO HOUSING INSECURE
AND LOOK LIKE ME AND MOSTLY
ABOUT 95% NON HISPANIC BLACK
INDIVIDUALS BEING GIVEN FOOD
DISTRIBUTED BY MY PARENTS EACH
AND EVERY WEEK.
IT HURTS WHEN I THINK ABOUT WHAT
WE HAVE TO DISCUSS HERE FROM A
LENS OF RELATIVE POWER AND FROM
THE HOUSE OF ACADEMIA.
HOW DO THESE GUIDELINES AFFECT
THEM AND HOW ARE WE GOING TO
CHANGE WHAT WE HAVE LEARNED
THROUGH THE LAST TWO DAYS AND
FIVE MEETINGS AND ULTIMATELY IN
OUR 2025 GUIDELINES?
HOW DO WE FIX THE STATUS QUO?
THE DONATIONS THAT COME INTO THE
FOOD PANTRY DO REFLECT A DIET
THAT IS DIFFERENT FROM WHAT WE
HAVE ACTUALLY TALKED ABOUT
TODAY.
IT IS NOT THE BURKERS AND
SANDWICHES DR. TOBIAS TALKED
ABOUT SEVEN TIMES TODAY IN HER
PRESENTATION OR REFINED GRAINS
BUT THESE PEOPLE ARE HOUSING
INSECURE AND CAN'T STORE THE
LOVELY FRUITS AND VEGETABLES
HIGH IN VITAMINS AND THE
NUTRIENTS WE ESPOUSE AND THE
THINGS WE WANT AND ULTIMATELY
THE CHRONIC BURDEN IS HIGH TO
THE FOOD PANTRY.
FROM AN EMOTIONAL STANDPOINT I
STILL COME WITH LOTS OF HURT AND
PAIN TO THESE MEETINGS AS I
THINK ABOUT HOW CAN I ULTIMATELY
TRY TO INFLUENCE THE AMERICAN
DIET STARTING WITH THE FOOD
PANTRY AT THE CHURCH.
AND THE THING IS I CAN KEEP
DONATING AND KEEP DOING THIS
WORK BUT ULTIMATELY HOPING TO
MAKE A CHANGE AND WHERE I LEAVE
THIS AND PASS IT ON TO YOU,
CHRIS TAYLOR.
>> I THINK ONCE AGAIN I'M STRUCK
WITH THE VOLUME OF INFORMATION
THAT BASICALLY THE 20 BRAINS HAD
TO PROCESS AFTER IT HAD BEEN
PROCESSED BY THE CAPABLE HANDS
OF OUR STAFF TO MAKE IT VIABLE.
WE'VE ALSO GOT A SERIES OF
QUESTIONS THAT BASICALLY OVERLAY
ACROSS EACH OF THE GROUPS IN THE
HEALTH EQUITY LENS.
ALL THE CONVERSATIONS ARE BEING
INFLUENCED BY THE EVIDENCE AND
THE HEALTH EQUITY QUESTION AND
HEALTH EQUITY LENS AND I THINK
IT'S BETWEEN NOW AND SEPTEMBER
WHEN WE SEE THE SYNTHESIS IS
WHERY YOU ARE -- IS WHERE
YOU'LL SEE ALL THE SYSTEMIC
REVIEWS AND DATA ANALYSIS AND
WE'RE TALKING ABOUT THIS MUCH OF
GREEN LEAFY VEGETABLES BUT THE
CONSUMPTION IS THIS MUCH.
IT'S NOT AN OVERWHELMING HURDLE
AS IT IS GETTING THE VARIETY.
WE'RE BUILDING THIS PATTERN THAT
ISN'T UNACHIEVABLE BUT IT
REQUIRES ATTENTION AND WE'RE
LINKING THIS NOW BACK TO THE
HEALTH OUTCOMES AND THE
EVIDENCE.
THAT'S WHY I THINK ALL THIS
SYNTHESIS WE'LL BE DOING BETWEEN
NOW AND THE NEXT TIME WE'RE
SITTING IN THESE CHAIRS IS GOING
TO BE OUTSTANDING.
>> I APPRECIATED LISTENING TO
EVERYONE'S COMMENTS SO FAR AND
AT THE END IT'S ALWAYS LIKE WHAT
DO I SAY THAT'S NEW.
ONE THING I NOTICED JUST
LISTENING TODAY AND IN THE DATA
WE PRESENTED IS I WANT TO LIFT
UP THAT AGE GROUP THAT'S LIKE
MIDDLE CHILDHOOD THROUGH
ADOLESCENCE AND YOUNGER TOO BUT
I FEEL LIKE THEY'RE STRUGGLING
WITH SO MUCH BEING ABLE TO
CHOOSE HEALTHFUL DIETS AND
THEY'RE KIDS.
I DON'T THINK -- WE SHOULDN'T
THINK ABOUT THEM SO MUCH AS
THEIR CHOICE BUT WHAT WE'VE
CREATED HERE FOR THEM.
AND WHAT KIND OF ENVIRONMENTS
ARE THEY IN AND ABLE TO GET FOOD
FROM AND WE'RE THE ADULTS.
WE'RE IN CHARGE.
I JUST FEEL LIKE WE HAVE A
RESPONSIBILITY TO TRIO MAKE
THINGS BETTER FOR OUR KIDS AND
ADOLESCENTS AS THEIR STILL
MAKING THEIR WAY AND THAT'S WHAT
I THINK WE NEED MORE SERIOUS
ATTENTION AND SHOWS UP IN THE
SYSTEMATIC REVIEWS, IT SHOWS UP
EVERYWHERE CUTTING ACROSS ALL
THE DIFFERENT THINGS WE LOOKED
AT.
SO THAT'S ONE THING I WANT TO BE
MORE MINDFUL OF AS WELL.
>> THIS IS MEETING 5 AND WHERE
WE'RE SHIFTING THE FOCUS OF WHAT
WE'RE TALKING ABOUT.
THE FIRST FEW MEETINGS ARE WHAT
WE'RE GOING TO DO AND THE
METHODOLOGY AND PROTOCOL.
LAST MEETING THERE WAS SOME
CONCLUSION STATEMENTS PRESENTED
AND THIS MEETING WE ARE A LITTLE
OVERWHELMED WITH THE DATA WITH
MIXED RESULTS.
WE'RE TURNING FROM FIGURING OUT
DOING THINGS TO WE HAVE RESULTS
AND A LOT OF RESULTS TO PRESENT.
SO MY FEELING IS THAT THINGS ARE
COMING TOGETHER WE HAVE DATA AND
SOME SYSTEMIC RESULT AND
CONCLUSION STATEMENT AND
PROVIDING RECOMMENDATIONS AND
MODELLING DIRECTIONS IN WHICH WE
CAN START PUTTING TOGETHER
THINGS AND CONSIDER EVERYTHING
CONSIDER TO MODIFY AND ADJUST
PATTERNS.
SO WE HAVE SOMETHING THAT WE CAN
HAND OVER TO THE PEOPLE WHO ARE
GOING TO ESTABLISH THE NEXT
GUIDELINES TO WORK ON IT.
>> YES, SO FINALLY THIS IS THE
END AND I KEEP THINKING OF
THINGS AND LOSE TRACK OR
SOMEBODY SAYS SOMETHING AND I
CAN'T THINK OF ANYTHING ANYMORE.
THE FIRST IMPRESSION I WAS GOING
TO SAY ORIGINALLY IS IT HAS
BEEN -- I'M ALWAYS STRUCK AROUND
THERE'S BEEN COMMENTS MADE HOW
COLLABORATIVE EVERYBODY IS AND
HOW EVERYBODY'S PUTTING A LOT OF
ENERGY INTO THIS WORK SO
EVERYBODY.
I COMMEND EVERYBODY FOR THAT AND
HEATHER BROUGHT UP LOOKING AT
THE PATTERNS AT THE ATI OVER
TIME AND HOW IT DIPS.
I'M BIASSED BECAUSE I'M MORE
INTERESTED IN PREGNANCY BUT WE
ALSO THINK ABOUT PRECEPTIN
PRECEPTINGTIONTION --
PRECONCEPTION HEALTH AND WE
CAN'T EXPECT PEOPLE TO CHANGE
ALL THEIR DIETARY PATTERNS AT
THAT POINT.
THAT STRUCK ME AS WELL.
I THINK WHAT WE'LL BE TALKING
ABOUT LATER IN THE NEXT MEETING
FOR SUBCOMMITTEE 2 WE'LL TALK
ABOUT THE FEEDING PRACTICES.
MAYBE THAT'S ALSO SOMETHING
WE'VE BEEN ABLE TO ADD TO THIS
IN TERMS OF HELPING TO CHOOSE
AND IMPROVE THEIR DIETARY
PATTERNS.
THAT'S ALL I COULD THINK OF AT
THIS MOMENT.
>> I THINK FOR ME I ALSO FEEL
LIKE THERE'S A SHIFT OF WHAT
WE'RE HEARING IN OUR MEETINGS.
FOR ME IT FEELS LIKE THE FIRST
MEETING WHERE I CAN SEE HOW IT
STARTS TO COME TOGETHER.
GENERALLY IN OUR SUBCOMMITTEE
MEETINGS WE'RE FOCUSSED IN ONE
AREA TO HEAR EVERYTHING COME
TOGETHER IS NICE AND EXCITING
AND INTERESTING.
I APPRECIATED THAT.
ON THE OTHER HAND I REALLY SEE
THERE NEEDS TO BE A CALL TO
ACTION FOR ALL NUTRITION
SCHOLARS.
WE JUST REALLY NEED TO ADDRESS
SO MANY THINGS BUT AT THIS POINT
IN TIME I ONLY HAVE ONE
RECOMMENDATION THAT HAS EMBEDDED
IN IT ANYTHING ABOUT HEALTH
EQUITY SPEAKS TO OUR FIELD AND
WHAT WE THESE TO WORK ON.
ALSO AS AN EXPERIMENTAL
BEHAVIORIST I LOOK AT THE DATA
TO SAY WE IS SO MUCH TO FIGURE
OUT TO OUR SOCIETY MAKING
CHANGES IN REGARDS TO DIETARY
INTAKE AND HOW WE NEED TO DESIGN
STUDIES ESPECIALLY EXPERIMENTAL
STUDIES TO HELP US ANSWER THESE
QUESTIONS.
HOPEFULLY THOSE WATCHING WILL
REALLY READ THE REPORT SO THEY
CAN SEE THESE RESEARCH
RECOMMENDATIONS.
>> I GET TO THE LITERALLY LAST
EXCEPT FOR THE CHAIR.
SO DITTO TO WHAT EVERYBODY SAID
AND THANK YOU FOR BEING
ARTICULATE AND I'LL CLOSE SAYING
BEANS, PEAS AND LENTILS IS
WORKING THE CROSS SECTION OF
PATTERNS AND HEALTH EQUITY AND
NUTRITION AND NOW AND WHOLE
GRAIN.
THANK YOU, ALL.
>> SO THIS IS SO EXCITING.
I THINK IN A VARIETY OF WAYS IT
PROVIDES A LOT OF INSIGHT FROM A
PRACTITIONER HAT ON AND WE THINK
OF INDIVIDUAL PEOPLE BUT WE HAVE
VERY LARGE FOOD AND NUTRITION
PROGRAMS PEOPLE WORK ON THE
FRONT LINES WITH COMMUNITIES AND
WHEN I LOOK AT THIS FROM A
RESEARCHER'S HAT AND TRY TO
SHIFT IN MY MIND AS A
PRACTITIONER OR THINKING ABOUT
PEOPLE I'M WORKING WITH OR
CACFP.
IT'S STRIKING HOW IMPORTANT IT
IS WE HAVE RECOMMENDATIONS
PEOPLE CAN TAKE AND REALLY PUT
INTO PRACTICE.
KUDOS TO ALL THE WORK BUT
KEEPING THAT IN OUR MINDS IT
GOES OUT INTO ACTION AND PEOPLE
ARE IMPLEMENTING THIS AND IT'S
IMPORTANT WE FILL THE GAPS IN
RESEARCH SO PEOPLE CAN TAKE
STRONG SCIENTIFIC-BASED
RECOMMENDATION OF
RECOMMENDATIONS AND CHANGE
PEOPLE'S LIVES.
THANK YOU SO MUCH.
>> I GET THE LAST WORD.
I WANT TO THANK ALL OF YOU.
I WANT THANK ALL THE PEOPLE
BEHIND THE STAFF WHO SHOULD BE
IN THE FRONT.
AND TO ECHO WHAT A NUMBER OF YOU
ARE SAYING, I FEEL THE
PREPARATION FOR THIS MEETING WAS
WHERE THE RUBBER HIT THE ROAD
AND WHERE OUR ASPIRATIONS CAME
INTO CLASHING WITH REALITY AND I
JUST WANT TO COMMEND ALL OF YOU
FOR THE GRACE, THE HARD WORK,
THE DETERMINATION UP GETTING
THIS ALL DONE AND -- IN GETTING
THIS ALL DONE AND I GET TO LAUGH
WHEN I MOVE FROM THE MICROPHONE
INCLUDING THE STAFF.
IT WAS AMAZING TO SEE HOW
EVERYBODY CAME TOGETHER WITH
SUCH GRACE AND RESPECT FOR EACH
OTHER.
SO THANK YOU.
I DON'T THINK THERE IS A
COMMITTEE ON THE PLANET AND TWO
GDAC2025.
>> I AGREE.
CONGRATULATIONS TO YOU IN
MEETING 5 AND THE REVIEW OF THE
EVIDENCE IS SO APPRECIATED.
ON BEHALF OF TEAM IT'S A
PLEASURE AND HONOR TO BE
SUPPORTING YOU IN YOUR REPORT
DEVELOPMENT.
THANK YOU FOR BEING WONDERFUL
HUMAN BEINGS THAT YOU ARE.
IT MAKES OUR JOBS THAT MUCH MORE
WONDERFUL.
THANK YOU SO MUCH.
NOW WE'LL TALK ABOUT NEXT STEPS.
I CAN'T BELIEVE YOU'VE COMPLETED
MEETING 5.
WHEW.
IT'S BEEN A LONG HAUL BUT THE
NEXT STEPS WILL BE PRETTY MO
MOMENTMOM
MOMENTOUS THE NEXT MEETING WILL
BE SEPTEMBER 25 AND 26 TWO DAY
MEETING AND YOUR REPORT IS
EXPECTED LATER THIS FALL.
FOLLOWING THAT --
>> END OF OCTOBER JANET.
>> MARK HER WORD.
THE DEPARTMENTS WILL USE YOUR
WONDERFUL REPORT AND OTHER
SOURCES DESCRIBED TO DEVELOP THE
DATA DIETARY GUIDELINES IN 2025.
MORE NEXT STEPS.
SO NEXT MONTH SINCE WE'RE AT THE
END OF THIS MONTH AND THE
UPDATED SYSTEM REVIEW AND FOOD
MODELLING PROTOCOLS OVER THE
LAST TWO DAYS WILL BE POSTED ON
DG.gov AND THE NESR .USDA.gov
AND MEETING 6, SEPTEMBER 25 AND
26.
SO WITH THAT, I WANT TO THANK
YOU ALL AND THANK THE PUBLIC OF
COURSE FOR TUNING IN, THANK THE
COMMITTEE AND OUR WONDERFUL
STAFF TEAM AND HOPE YOU HAVE A
WONDERFUL REST OF THE DAY.
I WILL ADJOURN THE MEETING.