>> GOOD MORNING AND WELCOME TO
DAY TWO OF TODAY'S DIETARY
GUIDELINES ADVISORY COMMITTEE MEETING.
WE'LL START REPORTING ON
COMPLIMENTARY FEEDING AND
FEEDING PRACTICES DURING
CHILDHOOD.
THEY'LL MOVE TO DESCRIBING THEIR
EFFORTS REVIEW AND ADVICE ON
BEVERAGES AND FOOD SOURCES OF
SATURATED FAULT FOLLOWING THAT
FREQUENCY OF MEALS AND SNACKING
AND PORTION SIZE AND WRAP UP
WITH NEXT STEPS AND ADJOURNMENT.
WITH THAT I'D LIKE TO TURN IT
OVER TO DR. FISHER AND ANDRES.
>> GOOD MORNING, EVERYONE.
IT'S REALLY EXCITING TO BE ABLE
TO PRESENT OUR DRAFT ADVICE TO
THE DEPARTMENT ALONG WITH ALIGN
ING THING WITH ANDRES AND WE
LOOKED AT PREGNANCY AND BIRTH
THROUGH ADOLESCENCE AND WE LOOK
AT CRITICAL ROLE REVIEW AND
INTEGRATION OF THE EVIDENCE ON
QUESTIONS RELATED TO
COMPLEMENTARY FEEDING AND
FEEDING STYLES AND PRACTICES
DURING CHILDHOOD.
BEFORE WE GO FURTHER WE'D LIKE
TO RECOGNIZE THE CONTRIBUTIONS
OF OUR COMMITTEE MEMBERS AND THE
WONDERFUL STAFF WHO HAVE BEEN
VERY COMMITTED TO THIS WORK.
SO OUR REVIEW OF THE EVIDENCE
AND ADVICE TO THE DEPARTMENTS
PERTAIN TO THE HOWs AND WHATs OF
FEEDING YOUNG CHILDREN.
IN CHAPTER 5 OF OUR REPORT WE
SUMMARIZE FROM REVIEWS ON THE
RELATIONSHIPS BETWEEN TIMING AND
TYPES OF FOODS AND BEVERAGES
INTRODUCED DURING THE
COMPLIMENTARY FEEDING PERIOD AND
GROWTH, BODY COMPOSITION AND
RISK OF OBESITY AMONG CHILDREN.
COMPLIMENTARY FEEDING REFERS TO
THE PERIOD WHEN CHILDREN
TRANSITION TO FROM A SOLELY
MILK-BASED DIET INVOLVING HUMAN
MILK AND/OR FORMULA TO ONE WHERE
MILK IS COMPLIMENTED FROM
INTRODUCTION OF FOODS AND
BEVERAGES.
FOODS AND BEVERAGES TAKE ON AN
INCREASINGLY IMPORTANT ROLE IN
SUSTAINING ADEQUATE GROWTH FROM
THE LATTER PART OF INFANCY TO
THE SECOND YEAR.
IMPORTANTLY THEY INTRODUCE
CHILDREN TO THE FOODS OF THEIR
FAMILIES AND CULTURE AND THEIR
LOCAL ENVIRONMENTS.
IN THIS CHAPTER WE'RE PRESENTING
OUR FINDING ON ASSOCIATION OF
CAREGIVER PRACTICE STYLES AND
PRACTICES.
WITH OUTCOMES RELATED TO FOOD
ACCEPTANCE, DIETARY INTAKE AND
GROWTH.
SO FEEDING STYLES REALLY REFER
TO THE OVER ALL OR BROAD
APPROACH THAT PARENTS USE TO
FEEDING CHILDREN WHEREAS FEEDING
PRACTICES REFER TO VERY SPECIFIC
GOAL ORIENTED BEHAVIORS USED TO
GUIDE, SHAPE AND DIRECT
CHILDREN'S EATING BEHAVIORS.
OUR REVIEW OF THE EVIDENCE
CONSIDERED BOTH THESE BROAD
STYLES AS WELL AS SPECIFIC
PRACTICES USED BY CAREGIVERS OF
CHILDREN AGE 2-6 YEARS OF AGE.
ONE THING WE'D LIKE TO POINT OUT
IS IN THIS WORK WE LIKE TO USE
THE WORD CAREGIVERS TO BE
INCLUSIVE OF ALL INDIVIDUALS
PROVIDING PRIMARY CARE AND
FEEDING YOUNG CHILDREN IN THE
HOMES.
THIS INCLUDES PARENTS,
GRANDPARENTS AND OTHER FAMILY
MEMBERS AS WELL AS LEGAL
GUARDIANS.
THE COMMITTEE CONDUCTED FOUR
SYSTEMATIC REVIEWS AND IN THE
INTEREST OF UNDERSTANDING HOW
COMPLIMENTARY FEEDING BEST
SUPPORTS HEALTHY GROWTH.
WE REVIEWED THE SCIENCE
ADDRESSING THE QUESTION WHAT IS
THE RELATIONSHIP BETWEEN
COMPLIMENTARY FEEDING AND GROWTH
AND BODY COMPOSITION AND RISK OF
OBESITY.
THIS IS SHOWN AS A SINGLE
QUESTION.
IT'S IMPORTANT TO POINT OUT THAT
WE REVIEWED THE EVIDENCE ACROSS
A WIDE RANGE OF COMPLEMENTARY
FOODS FROM VEGETABLES TO GRAINS
TO PROTEIN FOODS AND NEW
EVALUATED THE EVIDENCE IN TERMS
OF TIMING OF INTRODUCTION AS
WELL AS THE AMOUNT CONSUMED.
SO THERE'S A LOT OF DIFFERENT
COMPONENTS IN A SINGLE QUESTION.
THE REMAINING THREE QUESTIONS
REALLY PERTAIN TO THE HOWs OF
FEEDING.
WE ASKED TWO QUESTIONS THAT
SOUGHT TO IDENTIFY DIFFERENT
TYPES OF FEEDING STYLES ALIGNED
WITH THE DIETARY GUIDELINES AND
ASSOCIATED WITH FAVORABLE GROWTH
OUTCOMES AND THESE WERE IN
CHILDREN 2-6 YEARS OF AGE.
FINALLY, WE LOOKED AT THE
EVIDENCE ON A VERY SPECIFIC
FEEDING PRACTICE WHICH IS
PROVIDING REPEATED EXPOSURE TO
NEW FOODS BY ASKING THE
QUESTION, WHAT IS THE
RELATIONSHIP BETWEEN REPEATED
EXPOSURE TO FOOD AND FOOD
ACCEPTANCE.
HERE WE CONSIDERED STUDIES OF
REPEATED EXPOSURE DURING INFANCY
UP TO AGE 6.
REALLY IT WAS A WIDE SLOT OF
EARLY CHILDHOOD, IF YOU WILL.
WE PRESENTED FINDINGS AT OUR
PREVIOUS PUBLIC MEETING SO WE'D
LIKE TO FOCUS ON THE INTEGRATION
OF THESE FINDINGS AS THE AS
ADVICE TO THE DEPARTMENT TO
SUPPORT THE NEXT EDITION OF THE
DIETARY GUIDELINES FOR
AMERICANS.
WITH THAT I'D LIKE TO TURN IT
OVER TO ALINE ANDRES TO FOCUS ON
DIETARY FEEDING.
>> IT'S A PLEASURE TO BE WITH
YOU TODAY.
AS JENNY SAID, COMPLIMENTARY
FEEDING IS A PROCESS OF STARTING
IN HUMAN MILK OR FORMULA
COMPLEMENTED BY OTHER FOODS AND
PREFER
BEVERAGES AND TYPICALLY
CONTINUES UP TO 24 MONTH AS THE
YOUNG CHILD TRANSITIONS TO
FAMILY FOODS.
PREVIOUS COMMITTEE AND
ORGANIZATIONS CAREFULLY
CONSIDERED NUTRIENTS
REQUIREMENTS AND OTHER ASPECTS
OF THE DIET DURING COMPLEMENTARY
FEEDING.
WE WERE SPECIFICALLY TASKED WITH
REVIEWING THE EVIDENCE ON THE
AMOUNT AND TIMING OF
INTRODUCTION OF PARTICULAR FOODS
TO UNDERSTAND THE BODY OF
EVIDENCE IN THIS ASPECT AND
PROVIDE A SCIENTIFIC BASIS FOR
MAKING CHANGES TO THE CURRENT
GUIDANCE.
FIRST THE COMMITTEE DREW THREE
CONCLUSION STATEMENTS THAT
HIGHLIGHTED FRUIT AND VEGETABLE
CONSUMPTION UP TO 24 MONTHS IS
NOT UNFAVORABLY ASSOCIATED WITH
GROWTH PATTERN IN CHILDHOOD.
AND CONSUMPTION FROM AGE 6 UP TO
24 MONTHS IS NOT FAVORLY
ASSOCIATED WITH GROWTH PATTERN
AND RISK OF OBESITY IN
CHILDHOOD.
ALL THESE THREE CONCLUSION
STATEMENTS WERE BASED ON
EVIDENCE CREATED AS LIMITED AND
FRUITS, VEGETABLES AND GRAINS
AROUND 6 MONTHS AND THE
COMPLIMENTARY FEEDING PERIOD.
SO THE COMMITTEE DREW A
CONCLUSION STATEMENT THAT
HIGHLIGHTED INTRODUCTION OF
GRAIN AT/OR BEFORE 8 MONTHS IS
ASSOCIATED WITH HIGHER BMI SCORE
DURING CHILDHOOD BASED ON
EVIDENCE GRADED AS LIMITED.
THIS CONCLUSION STATEMENT
REINFORCES A COMPLIMENTARY
FEEDING SHOULD NOT BEGIN BEFORE
AGE 4 MONTHS WHICH ALIGNS WITH
THE CURRENT DIETARY GUIDELINE
RECOMMENDATION TO INTRODUCE
COMPLIMENTARY FOOD AROUND AGE 6
MONTHS.
A CONCLUSION COULD NOT BE DRAWN
FOR SEVEN AREAS FOR THE AGE OF
INTRODUCTION FOR SPECIFIC
COMPLEMENTARY FOODS AND BROTHER
BODY COMPOSITION AND RISK OF
OBESITY.
FIRST CONCLUSION STATEMENTS WERE
NOT DRAWN IN FOUR AREAS DUE TO A
LACK OF EVIDENCE.
AND THESE INCLUDED THE AGE OF
INTRODUCTION OF 100% JUICE,
FRUITS AND VEGETABLES AND BODY
COMPOSITION AND OBESITY AS WELL
AS GRAINS IN BODY COMPOSITION.
CONCLUSION STATEMENT WAS NOT
DRAWN IN THREE ADDITIONAL AREAS
DUE TO CONCERNS REGARDING THE
CONSISTENCY OF THE BODIES OF
EVIDENCE AND THOSE INCLUDED THE
AGE OF INTRODUCTION OF PROTEIN
FOODS, DAIRY FOOD,
SUGAR-SWEETENED BEVERAGES AND
GROWTH BODY COMPOSITION AND RISK
OF OBESITY.
CONCLUSION STATEMENT COULD NOT
BE DRAWN FOR ANOTHER SIX AREAS
RELATED TO THE AMOUNT OF FOOD
EATEN DURING THE COMPLIMENTARY
FEEDING PERIOD AND RISK OF
OBESITY.
FIRST, CONCLUSION STATEMENT WERE
NOT DRAWN IN THREE AREAS BECAUSE
OF THE LACK OF EVIDENCE AND THAT
INCLUDED THE AMOUNT OF FOOD
SOURCES OF ADDED SUGAR CONSUMED
AND GROWTH BODY COMPOSITION AND
RISK OF OBESITY.
AMOUNT OF FRUITS AND VEGETABLES
CONSUMED AND BODY COMPOSITION
AND RISK OF OBESITY AND
CONCLUSION STATEMENTS WERE NOT
DRAWN IN THREE ADDITIONAL AREAS
OF THESE INCLUDED THE AMOUNT OF
DAIRY CONSUMED DUES OF PROTEIN
AND FOOD CONSUMED DUE TO
CONCERNS IN CONSISTENCY AND
DIRECTNESS AND AMOUNT OF 100%
JUICE CONSUMED DUE TO CONCERNS
OF CONSISTENCY.
-- CONSISTENCY AND PRECISION.
SO THERE ARE UNIQUE
CONSIDERATION FOR THE INFANCY
AND EARLY CHILDHOOD LIFE STAGES
WITH THE COMPLEMENTARY FEEDING
PERIOD.
WE SUPPORT THE RECOMMENDATION TO
INTRODUCE COMPLEMENTARY FOOD
AROUND AGE 6 MONTHS AND
INTRODUCTION OF GRAIN AT/OR
BEFORE 6 MONTHS IS ASSOCIATED
WITH HIGHER BMI SCORES IN
CHILDHOOD.
TO ESTABLISH A HEALTHY DIETARY
PATTERN IT'S IMPORTANT TO
ENCOURAGE A VARIETY OF FOOD FROM
ALL FOOD GROUPS.
INCLUDING FOODS RICH IN IRON AND
ZINC PARTICULARLY FOR INFANTS
FED HUMAN MILK.
BASED ON THIS COMMITTEE'S REVIEW
OF THE EVIDENCE FRUITS,
VEGETABLES AND GRAIN ARE
COMPLIMENTARY FOOD OPTION
BETWEEN 6 AND 24 MONTHS NOT
ASSOCIATED WITH UNFAVORABLE
OUTCOME AND RISK OF OBESITY AND
SINCE THEY'RE NUTRIENT DENSE
OPTION THAT ARE PART OF HEALTHY
DIETARY PATTERNS RECOMMENDED FOR
ALL LIFE STAGES AND THE
COMMITTEE SUPPORTS THE INCLUSION
OF FRUITS, VEGETABLES AND GRAINS
AS COMPLIMENTARY FOODS.
DURING THE LIFE STAGE, YOU
SHOULD AVOID OFFERING FOOD AND
BEVERAGES WITH ADDED SUGAR AND
OFFER FOOD BEVERAGES HIGH IN
SODIUM.
THIS ADVICE REGARDING ADDED
SUGAR IS IN LINE WITH THE
CONCLUSION STATEMENT DRAWN AS
PART OF THE SYSTEMATIC REVIEW
WITH THE META-ANALYSIS ON
SUGAR-SWEETEN BEVERAGE
CONSUMPTION AND GROWTH BODY
COMPOSITION AND RISK OF OBESITY
ACROSS THE LIFE SPAN AND THAT
ANALYSIS AND SYSTEMATIC REVIEW
FOUND SUGAR-SWEETENED BEVERAGES
IN INFANT, CHILDREN AND ADULTS
IS ASSOCIATED WITH UNFAVORABLE
GROWTH PATTERN AND BODY
COMPOSITION AS WELL AS HIGHER
RISK OF OBESITY IN CHILDHOOD UP
TO EARLY ADULTHOOD.
IT'S ALSO TO INTRODUCE FOOD OF
VARYING FLAVORS AND TEXTURES AND
PROMOTE ACCEPTANCE OF A VARIETY
OF FOODS.
THIS IS ESPECIALLY IMPORTANT IN
THE LIFE STAGE AS CHILDREN DON'T
HAVE MUCH ROOM TO INCLUDE
ENERGY-DENSE FOOD.
CONTINUE TO RECOMMEND OFFER
DEVELOPMENTALLY APPROPRIATE SIZE
AND TEXTURE OF FOOD TO PREVENT
CHOKING.
I'LL TURN IT BACK.
>> NOW TO THE WORK ON FEEDING
STYLES AND PRACTICES.
FOR THOSE WHO MAY NOT HAVE
ATTENDED OR OUR PREVIOUS
MEETINGS, THIS IS THE FIRST
DIETARY GUIDELINES ADVISORY
COMMITTEE TO HAVE THE GOAL OF
EVIDENCE-BASED STRATEGIES TO
SUPPORT THE DEVELOPMENT OF
HEALTHY EATING BEHAVIORS.
IN SIMPLE TERMS WE KNOW
VEGETABLES ARE HEALTHY FOODS FOR
KIDS BUT HOW DO WE GET KIDS TO
EAT VEGETABLES AND FROM A
BEHAVIORAL STANDPOINT HOW DO YOU
GET CHILDREN TO LIKE VEGETABLES?
THE EVIDENCE AND CAREGIVERS NOTE
CHILDREN DO NOT EAT WHAT THEY DO
NOT LIKE.
WITH THAT I'D LIKE TO PRESENT
THE SUMMARY OF OUR FINDINGS AND
ADVICE RELATED TO FEEDING STYLES
AND PRACTICES AND THEIR
ASSOCIATION WITH FOOD ACCEPTANCE
AND DIETARY INTAKE AND OUTCOMES
RELATED TO GROWTH BODY
COMPOSITION AND RISK OF OBESITY
FROM CHILDREN 2-6 YEARS OF AGE.
WE ORGANIZED OUR FINDINGS BASED
ON THE DIRECTION OF ASSOCIATIONS
WE SAW WITH OUTCOMES OF INTEREST
IN SYSTEMATIC REVIEWS.
THE COMMITTEE DREW STATEMENTS
DRAWING FAVORABLE ASSOCIATIONS
OF FEEDING STYLES AND PRACTICES
WITH FOOD ACCEPTANCE AND DIETARY
INTAKE DURING CHILDHOOD.
ONE CONCLUSION FOCUSSED ON THE
USE OF STRUCTURED FEEDING
PRACTICES AND THIS REFERS TO
PRACTICES THAT ORGANIZE PHYSICAL
AND SOCIAL ASPECTS OF CHILDREN'S
EATING ENVIRONMENT TO SHAPE
DESIRABLE EATING BEHAVIORS AND
BASED ON PROSPECTIVE COHORT
STUDIES THE COMMITTEE CONCLUDED
FEEDING PRACTICES THAT PROVIDE
STRUCTURE FOR CHILDREN'S EATING
ARE ASSOCIATED WITH HIGHER
INTAKES OF VEGETABLES AN FRUITS
AMONG CHILDREN 2-6 YEARS OF AGE.
BASED ON THE TYPES OF PRACTICES
EVALUATED IN THIS LITERATURE,
THIS CONCLUDES CHILDREN'S INTAKE
OF VEGETABLES AND FRUITS AN
STRUCTURE ENVIRONMENT MAKING
FRUITS AND VEGETABLES AVAILABLE
AND ACCESSIBLE TO CHILDREN AND
PRACTICES THAT STRUCTURE SOCIAL
ASPECTS OF EATING.
THINGS LIKE HAVING REGULAR
ROUTINES THAT INVOLVE FRUITS AND
VEGETABLES AND SETTING LIMITS ON
OTHER LESS NUTRIENT DENSE FOODS
AND WHERE CAREGIVERS EAT AND
ENJOY HEALTHY FOODS WITH
CHILDREN.
NEXT THERE WERE SEVEN CONE
COLLUSION STATEMENTS DEVELOPED
TO CHARACTERIZE FAVORABLE
EFFECTS OF FRUIT AND VEGETABLE
ACCEPTANCE AMONG CHILDREN.
PROVIDING CHILDREN WITH REPEATED
EXPOSURE WAS A FEEDING PRACTICE
OF PARTICULAR INTEREST WITHIN
THIS BROAD CATEGORY OF
STRUCTURED FEEDING PRACTICE.
FIVE OF THE CONCLUSIONS ON
REPEATED EXPOSURE WERE SUPPORTED
FROM EVIDENCE FROM CONTROLLED
TRIALS.
IT HIGHLIGHTS THE ROBUST NATURE
OF THE EVIDENCE.
AMONG CHILDREN AND WE SAW
REPEATED EXPOSURE WAS PROMOTED
ACCEPTANCE OF A PARTICULAR FUT
OR VEGETABLE CHILDREN WERE
EXPOSED AND ACCEPTANCE OF
NON-EXPOSED FOOD WITHIN THE SAME
CATEGORY.
FOR INSTANCE, PROVIDED REPEATED
EXPOSURE TO PEAS YOU MAY SEE
FAVORABLE ACCEPTANCE SAME WITH
BROCCOLI.
THE EFFECTS OF REPEATED EXPOSURE
ARE GENERALIZED SUGGESTING THE
STRATEGY MAY NOT ONLY PROMOTE
ACCEPTANCE OF SPECIFIC FOODS BUT
GENERALLY ENCOURAGE ACCEPTANCE
OF A VARIETY OF HEALTHFUL FOODS
DURING COMPLIMENTARY FEEDING
WHEN CHILDREN ARE INTRODUCED TO
NOW FOODS THAT LAY A FOUNDATION
TO EARLY DIETARY PATTERNS.
AND WE SAW ACCEPTANCE FOR NOVEL
MEANING NEW FOODS, FAMILIAR
FOODS AND PREVIOUSLY DISLIKED
FOODS AND THESE WERE
SPECIFICALLY VEGETABLES.
THIS CONCLUSION AND REPEATED
EXPOSURE MAY HAVE FAVORABLE
EFFECTS OF CHILDREN'S ACCEPTANCE
OF VEGETABLES AND FOR VEGETABLES
THEY MAY OR MAY NOT INITIALLY
LIKE.
THE COMMITTEE ALSO INCLUDED
PROVIDING OTHER TYPES OF SENSORY
EXPOSURE TO FRUITS AND
VEGETABLES OUTSIDE OF TASTINGS
SO THINGS LIKE TOUCHING AND
SMELLING FOODS AND LISTENING TO
STORY ABOUT FOOD AND HAVING
ACTIVITIES THAT INVOLVE
PREPARING FOODS ALSO APPEAR TO
BENEFIT ACCEPTANCE AMONG
CHILDREN 2-6 YEARS OF AGE AND
SPECIFICALLY CHILDREN'S
WILLINGNESS TO TRY FOODS.
SO THIS CONCLUSION SUGGESTS
PROVIDING CHILDREN WITH DIVERSE
TYPES OF POSITIVE EXPERIENCES
WITH NEW FOODS EVEN OUTSIDE
ASKING THEM TO TRY THOSE FOODS
MAY INCREASE THE EFFECTIVENESS
OF REPEATED EXPOSURE BY
INCREASING CHILDREN'S
WILLINGNESS TO TASTE THOSE
FOODS.
SO COLLECTIVELY THE EVIDENCE
PROVIDES A ROBUST EMPIRICAL
BASIS FOR GUIDANCE ON FEEDING
THAT HIGHLIGHTS STRUCTURED
FEEDING PRACTICES AND REPEATED
EXPOSURE IN PARTICULAR AS
EVIDENCE-BASED STRATEGIES FOR
PROMOTING YOUNG CHILDREN'S
ACCEPTANCE AND INTAKE OF
HEALTHFUL FOODS.
MOVING FROM FAVORABLE
ASSOCIATIONS TO AREAS IN WHICH
WE SAW NO ASSOCIATIONS, WE SAW
ELT WAS NOT ASSOCIATED WITH
CHILD GROWTH BODY COMPOSITION
AND RISK OF OBESITY OUTCOMES
SUGGESTI IING MONITORING OF
CHILDREN'S EATING DOES NOT HAVE
CONSEQUENCES FOR WEIGHT-RELATED
OUTCOMES BUT IT'S IMPORTANT TO
POINT OUT ASSOCIATIONS OF A
SINGLE PRACTICE WITH A FAIRLY
DISTAL OUTCOME RELATED TO WEIGHT
IS REALLY SHOULD BE INTERPRETED
WITH CAUTION HOW IN THE PRACTICE
INFLUENCES CHILDREN'S EEKT.
YOU SEE CONCLUSION STATEMENTS.
THERE WERE FIVE CASES WHERE WE
CALLED TO THE DRAW CONCLUSIONS
DUE TO A LACK OF STUDY IN THE
AREA AND THESE INVOLVE
ASSOCIATIONS FOR SUPPORT WITH
DIETARY INTAKE AMONG KIDS,
ASSOCIATIONS OF STRUCTURED FEETH
PRACTICES WITH BODY COMPOSITION
AND RISK OF OUTCOMES AND
REPEATED EXPOSURE AND ACCEPTANCE
OF FRUITS MUN CHILDREN 2-6 YEARS
OF AGE.
AND THERE WERE OTHER CASES WHERE
THE CONCERNS OF CONSISTENCY OR
INCONSISTENCIES IN THE FINDINGS
MADE IT DIFFICULT TO DRAW
MEANINGFUL CONCLUSIONS AND THERE
TENDING TO BE A SMALL NUMBER OF
STUDIES AND CONTRIBUTION.
THIS WITH YOU THE CASE FOR
ASSOCIATIONS OF CAREGIVER
FEEDING STYLES AND PRACTICED AND
CONTROLLING PRACTICES EARLY
CHILDHOOD IS RECOGNIZED AS A
CRITICAL PERIOD FOR THE
ESTABLISHMENT OF CHILDREN'S
EATING BEHAVIORS AS WELL AS FOR
THE SOCIALIZATION OF CHILDREN'S
EATING BEHAVIORS.
THE SYSTEMATIC REVIEW FINDINGS
ACTUALLY PROVIDE THREE SEPARATE
LINES OF EVIDENCE POINTING TO
FAVORABLE ASSOCIATIONS OF
STRUCTURED FEEDING PRACTICES
WITH FRUIT AND VEGETABLE
CONSUMPTION AMONG CHILDREN 2-6
YEARS OF AGE.
THE CURRENT ADDITION OF THE
DIETARY GUIDELINES INCLUDE
EXAMPLES OF THESE TYPES OF
PRACTICES BUT BASED ON THE
SYSTEMATIC REVIEW FINDINGS, THE
COMMITTEE RECOMMENDS THAT THIS
GUIDANCE SHOULD BE STRENGTHENED.
GUIDANCE DISTINGUISHED PRACTICES
THAT ORGANIZE PHYSICAL ASPECTS
OF CHILDREN'S EATING ENVIRONMENT
FROM ORGANIZED SOCIAL AS
PROSPECTS.
YOU CAN SEE IN THE FIGURE
THERE'S A NUMBER OF DIFFERENT
PRACTICES THAT FALL UNDER THE
GENERAL DIMENSION OF STRUCTURE.
PRACTICES THAT EMPHASIZE
PHYSICAL ASPECTS THAT ORGANIZE
PHYSICAL ASPECTS OF CHILDREN'S
EATING ENVIRONMENT COULD BE
POTENTIALLY IMPORTANT BECAUSE
THEY DICTATE THE TYPES AND AMS
OF FOODS AVAILABLE TO CHILDREN
AND BECOME FAMILIAR TO CHILDREN.
THESE INCLUDE THINGS LIKE MAKING
HEALTHY FOODS AVAILABLE IN THE
HOME IN FORMS ACCESSIBLE TO
CHILDREN, PROVIDING APPROPRIATE
PORTION SIZE AND EXPOSURE.
AS A COMMITTEE MEMBER SAID
YESTERDAY, THESE TYPES OF
STRUCTURED FEEDING PRACTICES MAY
BE CRITICAL BECAUSE THEY MAKE
THE HEALTHY CHOICE THE EASY
CHOICE.
BUT ALSO THERE ARE STRUCTURED
PRACTICES IN THIS LIST THAT
REALLY EMPHASIZE ORGANIZATION OF
SOCIAL AS INSPECTIONS AROUND
EATING.
AND THESE MAY BE IMPORTANT
BECAUSE THEY MAY DIRECTLY GUIDE
CHILDREN'S BEHAVIORS AS WELL AS
SHAPE POSITIVE EXPERIENCES
AROUND EATING.
SO THESE THINGS INCLUDE REGULAR
EATING ROUTINES, OFFERING
CHILDREN GUIDED CHOICES THAT
ALLOW THEM TO CHOOSE BETWEEN TWO
HEALTHY OPTIONS AND PROVIDING A
POSITIVE SOCIAL ENVIRONMENT
WHERE CAREGIVERS ARE EATING AND
OTHERS IN A FAMILY ENJOY HEALTHY
FOODS TOGETHER WITH CHILDREN.
THE COMMITTEE ALSO RECOMMENDS
THAT TO FACILITATE
IMPLEMENTATION, GUIDANCE ON
STRUCTURED MEETING SHOULD
PROVIDE CONCRETE EXAMPLES OF HOW
SUCH STRATEGIES CAN BE EMPLOYED
BY CAREGIVERS AT HOME AND
POTENTIALLY IN OTHER SETTINGS
WHERE CHILDREN ROUTINELY EAT.
THE SECOND PART OF OUR ADVICE TO
DEPARTMENT FOCUSES ON THE
SPECIFIC REPEATED PRACTICE OF
REPEATED EXPOSURE.
IF YOU THINK ABOUT IT STRUCTURES
FIS -- PHYSICAL ASPECTS LIKE
HOW OFTEN A PARTICULAR FOOD IS
AVAILABLE TO CHILDREN AT MEALS
AND SNACKS AND IT'S MOSTLY
RANDOMIZED CONTROL TRIALS
REVEALS CONSISTENT FAVORABLE
ACCEPTANCE OF FOODS UP TO 6
YEARS OF ABLE.
IT'S A STRAIGHTFORWARD STRATEGY
AND ONE ALL CAREGIVERS CAN ADAPT
INCLUDING EARLY CHILDCARE
EDUCATORS.
BASED ON THE SYSTEMATIC REVIEW
FINDINGS THE COMMITTEE
RECOMMENDS THE DEPARTMENTS
CONTINUE WITH CURRENT GUIDANCE
AND ENCOURAGE CAREGIVERS OF
YOUNG CHILDREN TO 24 MONTHS TO
OFFER NEW FOODS EIGHT TO 10
TIMES TO PROMOTE THE ACCEPTANCE
OF THOSE FOODS AND THE COMMITTEE
RECOMMENDS THE GUIDANCE SHOULD
BE ENHANCED TO BENEFIT REPEATED
EXPOSURE FOR CHILDREN UP TO 6
YEARS OF AGE AND ENHANCEMENT
SHOULD PROVIDE REPEATED EXPOSURE
IN A POSITIVE EATING CONTEXT.
MEANING WITHOUT PRESSURE.
AND IT'S IMPORTANT TO POINT OUT
THAT OUR EVIDENCE WOULD SUGGEST
THAT CAREGIVERS CAN SUPPORT
CHILDREN'S ACCEPTANCE OF NEW
FOODS IN A POSITIVE ENVIRONMENT
AGAIN BY EATING AND ENJOYING
THOSE FOODS WITH CHILDREN.
THE COMMITTEE ALREADY PROVIDES
OTHER TYPES OF SENSORY TO
EXPOSURE TO HEALTHY FOODS SUCH
AS READING PICTURE BOOKS AND IT
INDICATES PROVIDING CHILDREN
WITH THE NON-SENSORY TYPES OF
EXPOSURES MAKE CHILDREN MORE
WILLING TO TRY AND TASTE THE
FOODS.
THE COMMITTEE RECOMMENDS
EXPLICIT PORTION ON PORTION
SIZE.
AND THE FOODS AND BEVERAGES
REPRESENT ANOTHER ASPECT OF
STRUCTURE THAT SHAPES THE
PHYSICAL ENVIRONMENT AROUND
EATING THE LOCAL ENVIRONMENT AT
THE TABLE, IF YOU WILL.
THE EVIDENCE AND PORTION SIDE IN
CHIRNLZ EATING WILL BE DETAILED
AS PART OF CLAPTER 7 ON PORTION
SIZES.
HOWEVER WE BRIEFLY WANTED TO
HIGHLIGHT THE FINDINGS HERE AS
PART OF THE SCIENTIFIC BASIS FOR
SUPPORTING GUIDANCE ON
STRUCTURED APPROACHES TO FEEDING
YOUNG CHILDREN.
AS YOU'LL HEAR THE SYSTEMATIC
REVIEW FINDINGS PROVIDE MODERATE
EVIDENCE THAT PROVIDING LARGE
PORTIONS OF ENERGY DENSE FOODS
PROMOTES DAILY ENERGY INTAKE
OVER SHORT PERIODS.
THIS FINDING SUGGESTS THAT
GUIDANCE ON HOW FEEDING SHOULD
BE ENHANCED TO INCREASE
ATTENTION TO THE IMPORTANCE OF
PROVIDING CHILD SIZE PORTION AND
THIS GUIDANCE SHOULD EMPHASIZE
PRACTICAL STRATEGIES FOR PORTION
CONTROL.
THE COMMITTEE ALSO FOUND
EVIDENCE THAT INCREASING FRUIT
AND VEGETABLE PORTIONS CAN BE
USED STRATEGICALLY TO PROMOTE
INTAKE WITHOUT PRESSURABLE
EFFECTS ON ENERGY INTAKE.
BECAUSE VEGETABLES ARE AMONG THE
LEAST PREFERRED FOOD GROUP BY
CHILDREN WE BELIEVE THE STRATEGY
IS POTENTIALLY PROMISING BUT
SHOULD BE IMPLEMENTED WITH
CAREFUL CONSIDERATION OF OTHER
APPROACH FOR PROMOTING
CHILDREN'S ACCEPTANCE OF THOSE
FOODS.
AND THE COMMITTEE NOTED TWO
OTHER CONSIDERATIONS REGARDING
ADVICE ON THE FEEDING CONSISTENT
WITH CERTAIN CONSENSUAL
FRAMEWORKS.
WE REVIEWED THE EVIDENCE ON
FEEDING PRACTICES ALONG THESE
VERY HIGH ORDER CONCEPTUAL
DIMENSIONS OF AUTONOMY, SUPPORT
AND CONTROL.
THE COMMITTEE BELIEVES THE
CONCEPTUAL DIMENSIONS ARE USEFUL
AND SHOULD BE INCORPORATED IN
THE GUIDANCE IN FEEDING.
HOWEVER, GIVEN THE LACK OF
CONCLUSIONS DRAWN ON CONTROL AND
AUTONOMY SUPPORT, THE COMMITTEE
ALSO RECOMMENDS THAT THIS
GUIDANCE ON THE HOWS OF FEEDING
SHOULD EMPHASIZE STRUCTURED
PRACTICES TO A GREATER DEGREE
THAN THOSE INVOLVING CONTROL AND
AUTONOMY SUPPORT.
IT'S IN THE INTEREST OF
EMPHASIZING EVIDENCE-BASED
GUIDANCE.
AND FINALLY WHILE THE EVIDENCE
REVIEWED BY THE COMMITTEE
PERTAINS TO CHILDREN UP TO SIX
YEARS OF AGE, THE COMMITTEE
BELIEVES STRUCTURED MEETING
PRACTICES MAY IN FACT SUPPORT A
HEALTHY DIETARY PATTERN
THROUGHOUT CHILDHOOD AND
ADOLESCENCE WHICH IS THE LIFE
SPAN PERIOD ASSOCIATED WITH
LOWEST DIETARY QUALITY.
STRUCTURED FEEDING PRACTICES WE
BELIEVE MAY SUPPORT HEALTHY
DIETARY PATTERNS BY INCREASING
AVAILABILITY OF MORE NUTRIENT
DENSE FOODS AND THOSE WITH LOWER
NUTRIENT DENSE IF I.
WHILE SYSTEMATIC REVIEWS POINT
TO STRUCTURE THERE'S STUDIES IN
THE PARENTING LITERATURE THAT
SHOW OVERLY STRUCTURED
APPROACHES TO PARENTING COULD BE
DETRIMENTAL.
THE EVIDENCE WE REVIEWED DID NOT
ALLOW TO US EVALUATE THIS
POSSIBILITY BUT GIVEN EVIDENCE
IN OTHER AREAS WE BELIEVE IT'S
PRUDENT TO TAKE INTO ACCOUNT THE
POSSIBILITY WHEN DEVELOPING
GUIDANCE IN STRUCTURE AND
FEEDING.
THE COMMITTEE ACKNOWLEDGES THE
APPROACH TO FEEDING CHILDREN
REALLY REFLECTS A COMPLEX
INTERPLAY OF CULTURE, CONTEXT
AND THE ENVIRONMENT IN WHICH
FEEDING OCCURS AND SO AS SUCH
I'M TRYING TO UNDERSTAND HOW A
PARTICULAR PRACTICE EFFECTS
DEVELOPMENTAL OUTCOMES, INTAKE,
ETCETERA AND REQUIRES
CONTRIBUTION OF THE COMPLEXITY
AND THE COMMITTEE HAS SPENT A
LOT OF TIME TALKING ABOUT THESE
ISSUES AND HIGHLIGHTED NEED FOR
RESEARCH AND MEASUREMENT TOOLS
TO ADDRESS HOW DIVERSE CULTURAL
PERSPECTIVES, SOCIO ECONOMIC
CONTEXT AND ENVIRONMENTS SHAPE
APPROACHES TO FEEDING YOUNG
CHILDREN.
THANK YOU.
>> THANK YOU, JENNY AND ALINE.
I'D LIKE TO ASK THE COMMITTEE TO
TURN ON YOUR CAMERAS.
GREAT.
THANK YOU.
THANK YOU TO YOU AND YOUR GROUP
BECAUSE I FEEL YOU'VE DONE AN
OUTSTANDING JOB OF CONTINUING
THE GROUNDBREAKING WORK THE
PREVIOUS 2020 GUIDELINE ADVISORY
COMMITTEE DID ON BIRTH TO 24
MONTHS BUT I REALLY AM IMPRESSED
HOW WE'RE GOING THROUGH THE
HOUSE.
VERY INTERESTING.
>> THAT WAS A BEAUTIFUL
PRESENTATION.
THE SLIDES WERE ELEGANT.
THE FLOW WAS AMAZING AND MADE IT
EASY TO FOLLOW THE THOUGHT
PROCESS THE SUBCOMMITTEE HAS
BEEN GOING THROUGH.
WHAT I LOVED ABOUT THE WAY I
SOTE UP -- SET UP THE PORTION
OF THE REPORT IS THIS IS WHERE
YOU INTRODUCE INDIVIDUALS THE
FOODS OF THEIR VARIOUS THINGS.
THEIR FAMILIES, THEIR CULTURE
AND THE LOCAL ENVIRONMENT AROUND
THEM.
SO THINKING BACK TO YESTERDAY
AROUND HOW THE THINGS THAT WE
NOTED TO BE NUTRIENTS OF
CONCERN, HOW IMPORTANT IT IS TO
LINK THIS BACK TO THE SUPPLY OF
FOODS IN THOSE ENVIRONMENTS THAT
PEOPLE ARE EXPOSED TO I KEPT
THINKING ABOUT THE FACT
BEHAVIORS GET SET IN CHILDHOOD
AND THE DATA IS CLEAR IF YOU CAN
REPEATEDLY EXPOSE CHILDREN TO
HEALTHFUL FOODS AND GIVE THEM
NEW FOODS IN A SUSTAIN WAY IT
WILL INCREASE THEIR WILLINGNESS
TO TRI TRY THEM AND IF WE CAN
GET CHILDREN TO CONSUME THE
FOODS IT BECOMES IMPORTANT FOR
HEALTHY BODY GROWTH AND
COMPOSITION.
IF LOCAL ENVIRONMENTS AREN'T
ALIGNED WITH THE GUIDE ANDS IT
MAKES IT HARD TO DO THESE
THINGS.
I HAD A FLASH BACK TO THE
HEALTHY EATING INDEX FOR THE
YOUNGEST OF OUR AMERICAN
CITIZENS WHICH, RIGHT NOW IT'S
SUGGESTING THE ENVIRONMENTS THAT
THEY'RE EXPOSED TO IN THE EARLY
AGES SET THEM UP TO HAVE HEIs IN
THE HIGH 50s.
SO I WONDERED AND THE FINAL
RECOMMENDATIONS, WAS THERE A
CONVERSATION AROUND THE
STRUCTURED FEEDING WITH PHYSICAL
AND SOCIAL COMPONENTS OF
STRUCTURE AND THINK SYSTEMS THAT
SUPPORT THE PHYSICAL AND SOCIAL
ENVIRONMENTS?
I DIDN'T SEE THAT CALLED OUT
EXPLICITLY AND I WONDERED WHAT
WAS THE CONVERSATION LIKE AND
WHETHER OR NOT THERE'S AN
OPPORTUNITY TO BE A BIT MORE
EXPLICIT ABOUT NEEDING TO LINK
THIS BACK AS WE THINK THROUGH
THE HEALTH EQUITY LENS TO HOW
ARE THEY SUPPLIED IN THE
ENVIRONMENTS WITH THINGS TO
ULTIMATELY SET THEN UP
POSITIVELY FOR FOOD PREP,
AVAILABILITY, ACCESS, ETCETERA.
>> I WAS THINKING ALONG THE SAME
LINES THIS MORNING ABOUT OUR
DISCUSSION OF SYSTEM SCIENCE AND
THERE ARE A LOT OF SOCIO
ECOLOGICAL MODELS HAVE BEEN
AROUND A LONG TIME AND HAVE
HELPED US CONCEPTUALIZE
INDIVIDUAL BEHAVIOR AND EATING
BEHAVIORS IN CHILDREN AS NOT
BEING VIEWED IN ISOLATION BUT
RATHER IN THE CONTEXT OF THE
FAMILY ENVIRONMENT AND IN THE
ENVIRONMENTS WHICH FAMILIES ARE
LIVING AND EXPOSED TO.
I THINK ADOPTING THAT LENS AND
ALLOWING THAT SORT OF COMPLEXITY
IS ACTUALLY A REALLY GREAT
SUGGESTION BECAUSE IT OFFERS US
THE OPPORTUNITY TO START
ARTICULATING AS YOU MENTIONED
THE HOWS NOT ONLY OF INDIVIDUAL
BEHAVIOR AND REALLY OF
SUPPORTING THOSE AT HIGHER
LEVELS OF THE SYSTEMS.
I JUST WANT TO SAY I ABSOLUTELY
THINK YOUR POINT IS WELL TAKEN
AND I WOULD SAY CERTAINLY WE
VIEWED OUR WORK THROUGH SOCIO
ECOLOGICAL LENS AND I THINK THAT
IS SOMETHING WE SHOULD BE
ENCOURAGING FUTURE COMMITTEES TO
REALLY DEVELOP.
DOES ANYONE ELSE HAVE ANYTHING
TO ADD?
>> I'LL ADD THE COMMITTEE ALSO
TALKED ABOUT EARLY CHILDCARE,
SCHOOLS AND ALL THOSE HAVE A
VARIETY OF PROGRAMS THAT HELP
SUPPORT THE HEALTHY EATING BUT
WE CAN POINT OUT ALL THE
RECOMMENDATIONS NEED TO BE
INTEGRATED FOR ALL OF THE PLACES
WHERE THE CHILDREN ARE EXPOSED
TO THOSE FOODS.
DEANNA.
>> FIRST OF ALL THANKS FOR THE
PRESENTATION.
ONE THING THAT'S IMPORTANT IS
YOU POINT OUT STRUCTURE.
IT'S NOT A SURPRISE NECESSARILY
THAT WOULD BE IMPORTANT BECAUSE
IF YOU LOOK ACROSS THE CHILDHOOD
DEVELOPMENTAL LITERATURE I KNOW
LIKE OUR STUDIES HAVE SHOWN IF
PARENTS HAVE A REGULAR BED TIME,
ALL THE OTHER BEHAVIORS ARE
BETTER.
IF YOU HAVE A REGULAR FAMILY
MEAL TIME, YOU HAVE BETTER
NUTRIENT INTAKES.
REALLY I THINK EMPHASIZING THAT
AND SO A LOT OF THIS IS PARENT
RELATED.
I SEE AN OPPORTUNITY IN WIC TO
DO PARENT EDUCATION ESPECIALLY
ABOUT INTRODUCING THE
COMPLIMENTARY FOODS AND WE'VE
BEEN DOING IT FOR A WHILE.
HOW ARE Y'ALL PROPOSING TO REACH
PARENTS BECAUSE ALL THESE ARE
PARENT BEHAVIORS IS WHAT THEY
ARE COME DOWN TO.
>> THAT'S A GREAT QUESTION AND
WE HAVE HAD DISCUSSIONS BUT I
SEE THAT AS IMPLEMENTATION OF
THE GUIDANCE AND WE WERE TASKED
WITH ANSWERING THE QUESTIONS FOR
THE FIRST TIME ABOUT DOES IT
MATTER AND IF SO, WHAT MATTERS?
WHAT CAN WE FIND IN THE
LITERATURE THAT CAN BE HELPFUL?
THIS IS REALLY A FIRST STEP IN
IDENTIFYING SKETCH OUT THOSE
PIECES AND YOUR ABSOLUTELY SPOT
ON THAT THESE FINDINGS REALLY --
I MEAN IT'S ACTUALLY RENICE --
VERY NICE TO SEE THEM BECAUSE
THEY PARALLEL THE DEVELOPMENTAL
LITERATURE ON PARENTING.
SO I THINK THEY'RE NICE AND
CONSISTENT IN THOSE MESSAGES.
I THINK IT WILL BE IMPORTANT TO
UNDERSTAND HOW TO GET THOSE
MESSAGES OUT AND FOR ME I THINK
OUR WORK -- THIS WORK IS -- MANY
OF YOU HAVE POINTED OUT HOME IS
ONLY ONE CONTEXT IN WHICH
CHILDREN ARE ROUTINELY EATING
AND WHILE WE THINK OF THIS AS
INDIVIDUAL TRANSACTIONS BETWEEN
CAREGIVERS AND CHILDREN, THAT'S
WHAT THE RESEARCH SPECIFICALLY
WAS DESIGN TO LOOK AT.
THERE'S OTHER RESEARCH THAT
CONSIDERS HOW THOSE APPROACHES,
WHAT THEY ARE MEAN WHEN THEY'RE
ROLLED OUT IN POLICY IN FEDERAL
PROGRAMS AND PLACES WHERE
CHILDREN ROUTINELY EAT AND
THAT'S GOING TO BE AN IMPORTANT
FUTURE FOR THIS WORK IN MY VIEW
GIVEN THE IMPORTANCE OF THESE
GUIDELINES FOR ALL FEDERAL
PROGRAMS THAT REACH YOUNG
CHILDREN.
>> YEAH, AND I REALLY AGREE
ABOUT REACHING THE PARENTS.
I KNOW WITH THE SCHOOL-BASED
WORK THAT'S ALWAYS THE HOLY
GRAIL IS HOW DO YOU REACH THE
PARENTS AND GET TO THEM AND AT
CERTAIN AGES IT'S EASIER THAN
OTHER AGES.
BUT WE JUST DON'T HAVE THE SAME
INTERVENTIONS OR PLACES TO GO TO
INFLUENCE PARENTS OR TO EDUCATE
PARENTS AS WE DO WITH KIDS.
>> I AGREE.
I THINK THERE'S A LOT OF
OPPORTUNITIES INCLUDING --
FATIMA WAS ON THE CALL AS A
CLINICIAN BECAUSE I THINK SHE
WOULD PROBABLY SAY A LOT OF THIS
IS RELEVANT IN WELL CHILD
VISITS.
I KNOW WHEN I HAD CHILDREN IN
2005 I WAS GIVEN A TYPE-WRITTEN
PAGE THAT WAS JUST LIKE FROM THE
TWILIGHT ZONE ON FEEDING KIDS.
I THINK THIS HAS A LOT OF
POTENTIAL TO BRING EVIDENCE,
STRONG BEHAVIORAL EVIDENCE TO
THOSE INTERACTIONS WHERE
CAREGIVERS ARE REALLY LOOKING
FOR INFORMATION.
>> GREAT.
>> I WANTED TO ADD TO DEANNA
YOUR POINT.
NOT ONLY THE PARENTS AND
CAREGIVERS BUT WE SAW FROM THE
VIEW THE REPEATED EXPOSURES THE
IMPORTANCE OF THAT AND ALSO IN
SCHOOLS SO THE SCHOOL LUNCH
PROGRAM I KNOW FROM OUR
EXPERIENCE THAT KIDS WILL NOT
CONSUME CERTAIN WHOLE GRAIN
FOODS AND ALL THE VEGGIES AND
FRUITS IN THEIR TRAY SO BEING
CONSISTENT WITH THE MESSAGE FROM
THE SCHOOLS AND IN THE HOME
ABOUT REPEATED EXPOSURES AND
INCREASING THE LIKELINESS OF
THEM TO TRY IT.
IT'S THE SYSTEM AND MAKING SURE
THAT THEY ARE ALSO HEARING THE
SAME MESSAGES IN SCHOOL AND IN
HOME AND IN DIFFERENT PLACES.
>> OTHER QUESTIONS FOR JENNY OR
ALINE.
>> GREAT PRESENTATION AND IT'S
BEEN GREAT TO BE OFTEN THE
COMMITTEE AND WATCH THIS
LITERATURE SEE WHERE SOME OF THE
LIMITATIONS ARE.
AND ONE OF THE THINGS THAT WAS
SO STRIKING AND I'M CURIOUS WHAT
KIND OF RECOMMENDATIONS, WE TALK
WITH PARENTS BUT A LOT OF THIS
LITERATURE WAS MOTHERS.
WE DIDN'T INCLUDE A LOT OF
FATHERS OR OTHER CAREGIVERS.
THERE WASN'T A LOT OF STUDIES
DONE AND I WAS WONDERING IF
THERE'S ANY COURTS ABOUT HOW TO
BE MORE INCLUSIVE WHEN IT COMES
TO OTHER CAREGIVERS AND
GRANDPARENTS AND FATHERS AND WE
TALK ABOUT PARENTS BUT THE
LITERATURE WHICH IS SO STRIKING
WAS REALLY PRIMARILY OR ALMOST
EXCLUSIVELY MOTHERS.
>> THANKS FOR POINTING THAT OUT.
AS YOU KNOW WE SAW A LOT OF
NEEDS FOR GREATER REPRESENTATION
OF DIVERSITY NOT ONLY IN TERMS
OF WHO THE CAREGIVERS ARE BUT
FAMILIES, CULTURAL PERSPECTIVES,
SOCIO ECONOMIC POSITION.
I THINK THERE'S ONE OF THE
CHALLENGES IN TRYING TO MAKE
GENERALIZATIONS ON BEHAVIOR IS
IT'S REALLY HARD TO THINK OF HOW
ONE SPECIFIC STRATEGY COULD
POSSIBLY BE ONE SIZE FITS ALL.
AND DEVELOP GUIDANCE THAT IS
REPRESENTATIVE OF THAT DIVERSITY
AND MAKES CONTACT.
I KNOW OF A NUMBER OF SCIENTISTS
WHO ARE INTERESTED IN FATHERS
AND HOPEFULLY SOME OF THAT WORK
WILL BE COMING OUT IN THE NEAR
FUTURE BUT I'M GLAD YOU POINTED
THAT OUT BECAUSE I THINK THAT
WAS JUST HAS BEEN A HISTORICAL
PERSPECTIVE IN THIS AREA IN
TERMS OF PARTICIPATION.
BUT I THINK THE RESEARCH CLEARLY
NEEDS TO GO IN A WAY THAT
PROVIDES BROADER PERSPECTIVES.
SO THANK YOU.
>> GREAT.
HEATHER.
>> I JUST WANTED TO ADD ON TO
THAT MAYBE JEN YOU CAN TALK A
LITTLE BIT MORE TOO ABOUT KIND
HOW -- LIKE ONE THING WE
STRUGGLED WITH WAS WHEN WE WERE
TRYING TO PUT TOGETHER SOME OF
THE EVIDENCE ON THE FEEDING
STYLES AND PRACTICES WAS JUST
HOW WHEN YOU DO CONSIDER THE
DIVERSITY, HOW IT'S HARD TO
SOMETIMES MAKE MEANING OF WHAT
DIFFERENT CULTURES MAY -- WHAT
VALUE THEY MAY ASSIGN TO
DIFFERENT FEEDING STYLES AND
PRACTICES AND HOW THAT IS KIND
OF LIKE AN AREA WHERE WE'D LOVE
TO HAVE MORE INFORMATION, MORE
RESEARCH.
I THOUGHT THAT WAS SUCH A GREAT
CONVERSATION WE HAD.
YOU CAN ARTICULATE IT BETTER
THAN ME.
>> NOT AT ALL.
THIS RESEARCH I WOULD SAY IN A
BROAD SENSE MOST THESE STUDIES
USE QUESTIONNAIRE-BASED MEASURES
AND QUESTIONNAIRES HAVE BEEN
CERTAINLY USED AND SUBJECTIVE TO
VARIOUS PSYCHO METRIC TESTING IN
DIVERSE GROUPS FOR THE MOST
PARTS BUT MANY OF THESE
INSTRUMENTS ARE NOW OLD AND MAY
NOT REFLECT WHAT PEOPLE ARE
CURRENTLY DOING BUT IT'S ONE
THING TO SORT OF DEVELOP AN
INSTRUMENT AND THEN SAY IT LOOKS
SIMILAR IN A DIFFERENT GROUP
VERSUS TO ACTUALLY GO INTO
DIVERSE GROUPS AND USE
QUALITATIVE METHODS TO IDENTIFY
THEMES AND PRACTICES AND VALUES
THAT ARE RELEVANT TO THOSE
GROUPS.
I THINK THAT IS REALLY WHERE THE
RESEARCH NEEDS TO HAPPEN MORE SO
THAN JUST USING THE SAME
MEASURES WITH DIFFERENT GROUPS,
SO TO SPEAK, IF THAT MAKES
SENSE.
WE'RE ONLY GEPTH ANSWERS FROM
QUESTIONNAIRES THE
QUESTIONNAIRES ASK AND THAT'S
THE ISSUE.
IT'S SUCH AN IMPORTANT POINT AND
I THINK CAROL NOTED THIS A LONG
TIME AGO WE REALLY NEED
QUALITATIVE STUDIES, COGNITIVE
INTERVIEWING TO DO THAT.
I THINK IT'S IMPORTANT TO HAVE A
DESCRIPTION OF THE LIVED
EXPERIENCES OF TO THE PEOPLE
THAT YOU'RE TRYING TO
UNDERSTAND.
SO, YEAH, THANKS FOR BRINGING
THAT UP, HEATHER, I THINK THAT'S
A REALLY IMPORTANT POINT.
>> WELL, THANK YOU AGAIN, JENNY,
ALINE AND THE SUBCOMMITTEE FOR
THE GREAT PRESENTATION AND GREAT
WORK.
AND I'M NOW GOING TO HAND OVER
THE PODIUM TO DEANNA WHO WILL BE
INTER-DUFFING OUR CONTINUATION
OF THE DIETARY PATTERNS GROUP
AND I'D LIKE EVERYBODY TO NOT
SPEAKING TO TURN YOUR CAMERA OFF
DURING THE PRESENTATION.
THANK YOU.
>> THANKS, SARAH.
SO YESTERDAY YOU HEARD ONE OF
THE THREE CHAPTERS OF OUR
DIETARY PATTERNS SUBCOMMITTEE.
SO THIS MORNING YOU'LL HEAR THE
OTHER TWO CHAPTERS.
AND THESE CHAPTERS HAVE TO DO
WITH DIETARY PATTERNS AND
COMPONENTS CROSS LIFE STAGES.
I'D LIKE TO HAND IT OVER TO
HOLLIE RAYNOR AND ANDREA
DEIERLEIN.
>> AS I GET STARTED I WANT TO
ACKNOWLEDGE THE CONTRIBUTIONS OF
THE COMMITTEE AS WELL AS THE
STAFF WHO HAVE WORKED IN THIS
AREA.
SO, BEVERAGES SUCH AS WATER,
MILK AND SUGAR-SWEETENED
BEVERAGES CONTRIBUTE TO THE
INTAKE AND IMPORTANT NUTRIENTS
LIKE CALCIUM AND VITAMINS D AND
C.
FOR EXAMPLE AMONG CHILDREN IN
ADOLESCENTS, BEVERAGES
CONTRIBUTE 42% OF DAILY CALCIUM
INTAKE AND OVER HALF OF DAILY
VITAMIN D INTAKE AND FOR ADULTS
VEGETABLES CONTRIBUTE ONE-THIRD
OF DAILY VITAMIN C INTAKES AND
CONSUMPTION OF HIGHER QUANTITIES
OF CERTAIN BEVERAGES CAN
CONTRIBUTE TO EXCESS ENERGY AND
CERTAIN NUTRIENTS THAT SHOULD BE
LIMITED.
THE 2025 COMMUNITY SCIENTIFIC
QUESTIONS ABOUT BEVERAGES WERE
DEVELOPED TO FOCUS ON COMMON
BEVERAGES THAT PROVIDE BENEFIT
SUCH AS VITAMIN C, D AND
CALCIUM.
LIKE 100% JUICE AND MILK AND
BEVERAGES THAT DO NOT PROVIDE
DIETARY BENEFITS BUT CONTRIBUTE
ADDED SUGARS AND EXCESS ENERGY
LIKE SUGAR-SWEETENED BEVERAGES.
WHILE LOW AND NO-CALORIE
SWEETENED BEVERAGES ARE NOT
CONSIDERED TO BE PROMOTE ENERGY
OR ESSENTIAL NUTRIENTS IN THE
DIET THEY WERE INCLUDES BECAUSE
APPROXIMATELY 1 IN 10 ADULTS
CONSUME THE BEVERAGES AND
UNCERTAINTY EXISTS FOR GROWTH,
BODY COMPOSITION AND RISK OF
OBESITY AND TYPE II DIABETES.
THE COMMITTEE CONSIDERED MORE
THAT.
ONE BEVERAGE USUALLY CONSUMED IN
A TYPICAL DIET AND EXAMINING ONE
BEVERAGE IN ISOLATION TO
DETERMINE IMPACTS ON HEALTH DOES
NOT REALLY REPRESENT HOW
BEVERAGES ARE TYPICALLY CONSUMED
AND SHOULD INSTEAD BE EXAMINED
WITHIN A PATTERN OF INTAKE
SIMILAR TO HOW WE LOOK AT FOOD
AND DIETARY PATTERNS.
IT LOOKS AT THE OVER ALL
BEVERAGE INTAKE AND HEALTH
OUTCOMES.
THE 2020 WHICH THE LOOKED AT
BEVERAGE CONSUMPTION RELATED TO
GROWTH, SIZE, BODY COMPOSITION
AND RISK OF OBESITY.
THEY EXPANDED WORK IN SEVERAL
WAYS.
WE EXAMINED THE EVIDENCE FOR
BEVERAGE PATTERNS IN RELATED TO
GROWTH, BODY COMPOSITION AND
RISK OF OBESITY.
THEY LOOKED AT SUGAR SWEETENED
BEVERAGES AND FOR TYPE II
DIABETES THEY LOOKED AT
LONG-TERM OBSERVATIONAL STUDIES
WITH TYPE II DIABETES AS THE
OUTCOME AND INTERMEDIATE
OUTCOMES SUCH AS HEMOGLOBIN A1C
AND LOOKED AT META-ANALYSIS FOR
SUGAR SWEETENED BEVERAGES AND
GROWTH AND BODY COMPOSITION AND
RISK OF OBESITY FROM INFANCY
THROUGH ADULTHOOD.
AND THEY ARE LOOKED RAT AGE OF
19 YEARS.
42% OF CHILDREN AGES 2-5, 28%
6-11 YEARS AND 16% OF CHILDREN
IN ADOLESCENCE CONSUMED 100%
FRUIT JUICE ON A GIVEN DAY.
EYE
THE COMMITTEE CONDUCTED SYS
SYSTEMATIC REVIEWS AND EXAMINE
THE RISKS AND EXPOSURES ARE
PATTERNS, DAIRY MILK
ALTERNATIVES AND LOW AND
NO-CALORIE BEVERAGES AND THE
RISK OF TYPE II DIABETES FOR THE
EXPOSURES OF YOU OF SUGAR
SWEETENED BEVERAGES.
SIMILAR TO YESTERDAY WE VIEWED
CONCLUSION STATEMENTS BY
ORGANIZING REVIEWS AND FAVORABLE
ASSOCIATIONS WITH BEVERAGES AND
GREATER BEVERAGE INTAKE AND NO
ASSOCIATION BETWEEN BEVERAGES
AND HEALTH OUTCOMES AND A
CONCLUSION STATEMENT COULD NOT
BE DRAWN AND FOUND FAVORABLE
ASSOCIATIONS.
AND THE EXPOSURES WERE TOTAL
MILK AND THEN HIGHER FAT DAIRY
MILK IN COMPARISON TO LOWER FAT
DAIRY MILK AND THEY COMPARED TO
LOWER FAT DAIRY MILK MAY NOT
EXCESSIVE ENERGY FOR CHILDREN'S
2-5 YEARS THOUGH THEY WERE BASED
ON EVIDENCE GRADED AS LIMITED.
THESE BEVERAGES MAY PROVIDE
IMPORTANT NUTRIENTS FOR GROWTH
BUT NUTRIENTS SUCH AS PROTEIN,
VITAMIN D, PHOSPHORUS AND
MAGNESIUM AND CALCIUM.
WE IDENTIFIED OR HAD FOUR
CONCLUSION STATEMENTS THAT
IDENTIFIED UNFAVORABLE
ASSOCIATIONS ALL OF WHICH
EXAMINES SUGAR SWEETENED
BEVERAGES CONSUMPTION AND
INCLUDED A META-ANALYSIS AND
WERE BASED ON EVIDENCE GRADED AS
MODERATE.
THE LIFE STAGES INCLUDED IN THE
CONCLUSION STATEMENTS WERE
INFANCY THROUGH ADOLESCENCE WITH
UNFAVORABLE GROWTH PATTERNS AND
BODY COMPOSITION AND IN ADULTS
WITH HIGHER RISK OF OBESITY AND
RISK OF TYPE II DIABETES.
THIS SETTING SUGAR SWEETENED
BEVERAGES INTAKE CONTRIBUTE TO
EXCESS ENERGY INTAKE AND
UNFAVORABLE HEALTH OUTCOMES.
FOUR CONCLUSION STATEMENTS LAD
EVIDENCE GRADE D AS MODERATE AN
THERE WAS NO ASSOCIATION WITH
BODY COMPOSITION AND RISK OF
OBESITY FOR ADOLESCENCE FOCUSSED
ON 100% JUICE AND ADULTS AND
100% JUICE AND MILK AND NO
ASSOCIATION EXISTS BETWEEN
CONSUMPTION OF THESE BEVERAGES
AND RISK OF OBESITY IN THE
POPULATIONS THAT WERE EXAMINED.
WE ALSO HAD FOUR CONCLUSION
STATEMENTS IN WHICH THE EVIDENCE
WAS GRADED AS LIMITED AND ONE OF
THOSE OUTCOMES WAS NO
ASSOCIATION WITH GROWTH, BODY
COMPOSITION AND RISK OF OBESITY
AND THIS WAS FOR CHILDREN AND
ADOLESCENCE FOR LOW AND
NO-CALORIE SWEETENED BEVERAGES
OR FOR SWEETENED MILK, ADULTS
FOCUSSED ON WEIGHT GAIN FOR 100%
JUICE AND NO ASSOCIATION WITH
RISK OF TYPE 2 DIABETES AND THE
WAS FOR ADULTS WITH LOW AND NO
CALORIE SWEETENED BEVERAGES AND
GIVEN THE LACK OF CONSISTENCY
AND FINDINGS A SMALL NUMBER OF
RANDOMIZED TRIALS IN THE POOR
GENERALIZABILITY MORE RESEARCH
IS NEEDED IN THIS AREA.
WE ALSO HAD 19 CONCLUSION
STATEMENTS IN WHICH A CONCLUSION
COULD NOT BE DRAWN PREGNANCY AND
POSTPARTUM INDICATED NOT ENOUGH
FOR SIX CONCLUSION STATEMENTS
EVIDENCE WAS AVAILABLE.
AND WITH THAT I WILL TURN IT TO
ANDREA.
>> THANK YOU.
THIS COMMITTEE HAD A GREATER
NUMBER OF CONCLUSION STATEMENTS.
29 COMPARED TO 12 FOR THE
PREVIOUS COMMITTEE.
AND WE ALSO DEVELOPED CONCLUSION
STATEMENTS FOR ADDITIONAL LIFE
STAGES INCLUDING INFANTS AND
YOUNG CHILDREN, PREGNANCY AND
POSTPARTUM AND THE 2020
COMMITTEE DEVELOPED STATEMENT
ONLY FOR CHILDREN AND ADULTS.
FOR EXAMPLE THE EVIDENCE GROUPS
CHANGES IN SOME CASES AND THIS
COMMITTEE WAS ABLE TO DRAW
SEPARATE CONCLUSION STATEMENTS
FOR MILK LOOKING AT TOTAL MILK
AS WELL AS SWEETENED MILK.
AND THEY LOOKED AT CONCLUSION
STATEMENT COMPARED TO THE 2020
COMMITTEE'S FINDING, MILK WAS
THE BEVERAGE WITH THE GREATEST
CHANGE IN CONCLUSION STATEMENTS.
WHEN WE LOOK AT WITH THIS
COMMITTEE FOUND CONCERNING
CHILDREN AND ADOLESCENCE,
FAVORABLE GROWTH AND BODY
COMPOSITION AND LOWER RISK OF
OBESITY IN YOUNGER CHILDREN 2-5
YEARS FOR HIGHER MILK AND HIGHER
FAT VERSUS LOWER FAT AND WE
FOUND NO ASSOCIATION WITH
GROWTH, BODY COMPOSITION OR RISK
OF OBESITY FOR SWEETENED MILK IN
OLDER ADULTS AND ADOLESCENCE AND
THIS IS A GRADE OF LIMITED.
THIS COMPARES TO WHAT THE 2020
COMMITTEE FOUND.
THERE WAS NO RELATIONSHIP
BETWEEN TOTAL MILK AND ADIPOSITY
IN CHILDREN AND GRADE OF LIMITED
FOR THAT COMMITTEE AND THEY WERE
UNABLE TO DRAW CONCLUSION FOR
TYPE OF MILK INCLUDING FLAVORED
AND MILK-FAT CONTENT WIN
ADIPOSITY IN CHILDREN.
FOR ADULTS THERE WAS AN INCREASE
IN THE STRENGTH OF THE EVIDENCE
FROM LIMITED TO MODERATE FOR THE
CONCLUSION STATEMENT OF NO
ASSOCIATION BETWEEN TOTAL MILK
AND BODY COMPOSITION OR RISK OF
OBESITY.
THE ABILITY TO DRAW ADDITIONAL
AND DIFFERENT CONCLUSION
STATEMENTS WAS MOST LIKELY DUE
TO A LARGER BODY OF EVIDENCE
THAT ENABLED THIS COMMITTEE TO
MORE FINALLY ORGANIZE THE
EVIDENCE BY LIFE STAGE AS WELL
AS SEPARATE THE EVIDENCE FOR THE
DIFFERENT TYPES OF MILK.
LOOKING AT 100% JUICE AND OUR
FINDINGS VERSUS THE 2020
COMMITTEE, THE STRENGTH OF THE
EVIDENCE UNDERLYING TWO
CONCLUSION STATEMENTS INCREASED
FROM LIMITED TO MODERATE FOR
CONSUMPTION OF 100% JUICE.
WE FOUND NO ASSOCIATION WITH
GROWTH, BODY COMPOSITION AND
RISK OF OBESITY IN CHILDREN AND
ADOLESCENTS AND FOUND NO
ASSOCIATION FOR 100% JUICE
CONSUMPTION WITH BODY
COMPOSITION IN ADULTS.
AND FOR THE CONCLUSION STATEMENT
IN CHILDREN/ADOLESCENTS THOUGH
THIS WAS NO DIFFERENCE THEY
WOULD DIFFER THERE WAS LITTLE
EVIDENCE FOR THE YOUNGER LIFE
STAGES.
AND SO IT'S IMPORTANT IN THESE
YOUNGER LIFE STAGES THAT HAVE
LOWER ENERGY INTAKES THAT 100%
JUICE NOT REPLACE OTHER NUTRIENT
DENSE FOODS LIKE WHOLE FRUITS
AND VEGETABLES.
LOOKING AT SUGAR SWEETENED
BEVERAGES AND THE CONCLUSION
STATEMENTS FOR THIS COMMITTEE
VERSUS THIS 2020 COMMITTEES, THE
STRENGTH OF EVIDENCE UNDERLYING
THE CONCLUSION STATEMENT FOR
BODY COMPOSITION AND RISK OF
OBESITY IN ADULTS INCREASED FROM
LIMITED TO MODERATE.
THE CONCLUSION STATEMENT FOR
UNFAVORABLE ASSOCIATION WITH
GROWTH, BODY COMPOSITION AND
RISK OF OBESITY EXTENDED TO
OUTCOMES.
THERE WERE OUTCOMES MEASURED
DURING CHILDHOOD AND ADOLESCENCE
THROUGH EARLY ADULTHOOD.
THIS IS BASED ON MODERATE
EVIDENCE.
WE DID NOT INCLUDE A SEPARATE
CONCLUSION STATEMENTS FOR SUGAR
SWEETENED BEVERAGES VERSUS NO
AND LOW-CALORIE SUGAR SWEETENED
BEVERAGE BECAUSE THEY WERE
COMPARING HIGHER VERSUS LOWER
AMOUNTS OF SUGAR SWEETENED
BEVERAGES AND CONSUMPTION OF
SUGAR SWEETENED BEVERAGES TO
WATER CONSUMPTION AS WELL AS
SUGAR SWEETENED BEVERAGES
CONSUMPTION TO LOW AND
NO-CALORIE BEVERAGE CONSUMPTION
AND INCLUDED AN YOU EVER
FAVORABLE ASSOCIATION WITH RIFF
OF TYPE II DIABETES BASED ON
MODERN EVERYDAY.
SO OVER ALL, THE EVIDENCE
LINKING SUGAR SWEETENED BEVERAGE
TO UNFAVORABLE OUTCOMES HAS
STRENGTHENED OVER TIME.
GIVEN THE EVIDENCE AND PRACTICAL
AND ETHICAL CHALLENGES OF
CONDUCTING LONG-TERM RANDOMIZED
CONTROL TRIALS IN THIS AREA, THE
FOCUS SHOULD SHIFT TO RESEARCH
AND COMMUNICATION STRATEGIES FOR
HELPING INDIVIDUALS LIMIT THEIR
SUGAR SWEETENED BEVERAGE
CONSUMPTION.
LOOKING AT KNOW LOW AND NO
CALORIE-SWEETENED BEVERAGES
COMPARED TO THE 2020 COMMITTEE'S
FINDINGS, WE FOUND AN INCREASE
IN THE STRENGTH OF EVIDENCE AND
CHANGE IN DIRECTIONALITY FOR
BODY COMPOSITION AND RISK OF
OBESITY.
THERE WAS LIMITED ASSOCIATION
FOR RISK OF ADIPOSITY AND FOUND
MODERATE EVIDENCE FOR NO
ASSOCIATION.
WE ALSO INCLUDED A CONCLUSION
STATEMENT FOR RISK OF TYPE II
DIABETES BASED ON LIMITED
EVIDENCE.
SO THE FIND BEINGS FROM THE
SYSTEMATIC REVIEWS SUPPORT THE
EXISTING GUIDANCE THE PRIMARY
BEVERAGES CONSUMED SHOULD BE
CALORIE-FREE BEVERAGES AND THOSE
THAT CONTRIBUTE FAT-FREE AND
LOW-FAT MILK AND 100% JUICES AND
INTAKE OF BEVERAGES THAT CONTAIN
CALORIES WHILE LIMITED OR NO
BENEFICIAL NUTRIENTS OR ADDED
SUGARS IN SATURATED FAT SHOULD
BE REDUCED.
WHILE THIS COMMITTEE DID NOT
SPECIFICALLY EXAMINE COFFEE AND
TEA DATA FROM THE DATA ANALYSIS
SUPPORT THE EXISTING
RECOMMENDATIONS COFFEE, TEA AND
FLAVORED WATERS ARE ALSO
OPTIONS.
BUT THE MOST NUTRIENT DENSE
OPTIONS INCLUDE LITTLE, IF ANY,
SWEETENERS OR CREAMS AND
CAFFEINE CONTENT SHOULD BE
CONSIDERED OR LIMITED BASED ON
LIFE STAGE.
THE COMMITTEE SUGGESTED
ENHANCEMENTS TO THESE BEVERAGES.
THE FIRST IS RECOMMENDING PLAIN
DRINKING WATER AS THE PRIMARY
BEVERAGE FOR PEOPLE TO CONSUME.
WATER BEVERAGES WITH A SMALL
AMOUNT OF FRUIT JUICE MAY ALSO
BE SUGGESTED AS A HEALTHY
OPTION.
MILK CONSUMPTION IS FAT FREE OR
LOW-FAT DAIRY MILKS OR SOY
BEVERAGES.
THOUGH SWEETENED BEVERAGES
CONTAIN NUTRIENTS THEY CONTAIN
SUGAR AND FOR CHILDREN IT WAS
CONSIDERED NOT TO CHANGE THE
EXISTING RECOMMENDATIONS TO ARE
PRIMARY CONSUMPTION OF LOWER FAT
MILKS IN THIS AGE RANGE.
THE 2020-2025 EDITION OF THE
GUIDELINES DOES NOT RECOMMEND
CONSUMPTION OF COW'S MILK IN
PLACE OF HUMAN MILK OR INFANT
FORMULA BEFORE 12 MONTHS.
UNSWEETENED SOY BEVERAGES CAN BE
OFFERED AGES 12-23 MONTHS WITH
TRANSITION TO FAT-FRE OR LOW-FAT
UNSWEETENED DAIRY MILK START
STARTING AT 24 MONTHS.
PRODUCTS ADDED TO BEVERAGES WITH
HIGH CALORIES AND SATURATED FATS
AND/OR ADDED SUGARS SUCH AS HALF
AND HALF, CREAM AND NON-DAIRY
CREAMERS SHOULD BE REPLACED WITH
LOWER FAT VERSIONS WITHOUT ADDED
SUGARS.
FOR SUGAR SWEETENED BEVERAGES
AND OTHER BEVERAGES THAT CONTAIN
SUGAR WITH NO ADDED NUTRIENTS
THEY SHOULD STICK TO MODERATE
INTAKES AND SUGARS ARE
ASSOCIATED WITH BODY COMPOSITION
AND RISK OBESITY AND WITH
UNFAVORABLE BODY POSITION AND
HIGHER RISK OF OBESITY AND
HIGHER RISK OF TYPE II DIABETES
IN ADULTS.
THE DIETARY GUIDELINES OF
2020-2025 ACKNOWLEDGE THEY'RE
NOT NECESSARY IN THE DIETS OF
CHILDREN AND ADOLESCENTS AND
RECOMMENDS DECREASING
CONSUMPTION.
THESE RECOMMENDATIONS SHOULD BE
STRENGTHENED TO STATE CHILDREN
AND ADOLESCENTS SHOULD LIMIT
CONSUMPTION OF SUGAR SWEETENED
BEVERAGES.
SIMILARLY, AMERICAN HEART
ASSOCIATE STATEMENT RECOMMENDS
CHILDREN AND ADOLESCENTS LIMIT
SUGAR SWEETENED BEVERAGES TO ONE
OR FEWER EIGHT OUNCE BEVERAGES
PER WEEK.
AND CONSENSUS STATEMENT FROM
LEADING HEALTH ORGANIZATIONS
RECOMMEND SUGAR SWEETENED
BEVERAGES AND FAVORED MILK NOT
IN BE CONSUMED BY CHILDREN
YOUNGER THAN 5 YEARS AND FOR
ADULTS THE RECOMMENDATION IS
LIMITING CONSUMPTION OF SUGAR
SWEETENED BEVERAGES AND GIVEN
THE LONG-TERM EFFECTIVENESS OF
LOW AND NO-CALORIE BEVERAGES
CONSUMPTION SHOULD BE WATER AND
NUTRIENT DENSE BEVERAGES.
THE 2020-2025 RECOMMENDATIONS
SHOW THE REPLACEMENTS MAY AID IN
WEIGHT GAIN BUT THEY NOT NOT BE
SORTED WITH BODY COMPOSITION AND
RISK OF OBESITY IN CHILDREN AND
ADOLESCENTS SUPPORTED IN
EVIDENCE GRADED AS LIMBED AND
PAY NOT BE ASSOCIATED WITH
CHANGE OF BODY COMPOSITION AND
ADULTS WITH EVIDENCE GREAT --
GRADED AS MODERATE.
GIVEN UNCERTAINTY ABOUT THE
BEVERAGES FOR MANAGEMENT
EMPHASIS SHOULD BE ON WATER AND
NUTRIENT DENSE BEVERAGES.
THIS IS IMPORTANT FOR CHILDREN
AND CONSENSUS STATEMENT
RECOMMENDS CHILDREN YOUNGER THAN
5 YEARS NOT CONSUME LOW AND
NO-CALORIE SWEETENED BEVERAGES
AND THOUGH THERE WAS
INSUFFICIENT EVIDENCE FOR
POSTPARTUM CHANGE GENERAL
BEVERAGE RECOMMENDATIONS SHOULD
APPLY TO PREGNANT AND POSTPARTUM
POPULATIONS.
THE 2025 EDITION ONLY MENTIONS
MODERATION OF CAFFEINE DURING
PREGNANCY AND LACTATION BUT
HYDRATION IS CRITICAL DURING
THESE TIME PERIODS AND THE
GUIDELINES SHOULD STATE WATER
AND NUTRIENT DENSE BEVERAGES
SHOULD BE THE PRIMARY BEVERAGES
CONSUMED DURING PREGNANCY AND
LACK TAKE.
OF -- LACTATION.
NOW FOR DISCUSSION.
>> THIS COMPLEMENTS WHAT WE DID
IN CHAPTER 2 AND DIETARY
PATTERNS.
WE COULDN'T GET TO THE
GRANULARITY Y'ALL GOT WHEN YOU
LOOKED AT THE BEVERAGES BY
THEMSELVES.
FOOD SOURCES OF SATURATED FAT.
REACHING OUT TO THE COMMITTEE,
ANY QUESTIONS FOR HOLLIE AND
ANDREA?
>> YOU SAID WE HAVE THE
INFORMATION AND RESOURCE AND
EMPHASIS SHOULD GO TO EDUCATION
AND THAT'S AN IMPORTANT METHOD
BECAUSE SOMETIMES WE KEEP DOING
THE RESEARCH WHEN THE ANSWER IS
CLEAR BUT THERE ISN'T THE
PRIORITIZATION OF THE EDUCATION.
SO THAT REALLY, REALLY RESONATED
SO THANK YOU VERY MUCH.
GREAT PRESENTATION.
>> THANKS, SARAH.
>> WONDERFUL PRESENTATION,
Y'ALL.
I WAS STRUCK BY THE FINDING ON
FAT CONTENT OF MILK AND IT'S
FAVORABLE ASSOCIATION WITH
OUTCOMES IN LITTLE KIDS.
I'M GLAD YOU NOTED THE IT WAS
GRADED AT LIMITED AND DIDN'T
HAVE EMPIRICAL EVIDENCE FOR
CHANGING THE EVIDENCE BUT WONDER
WHAT YOUR DISCUSSION AND
THOUGHTS ARE WHETHER IT RAISES
FLAGS OR NEXT STEPS IN TERMS OF
QUESTIONS THAT MIGHT BE ASKED.
I KNOW THERE'S BEEN SOME TALK IN
OUR SUBCOMMITTEE ON LITTLE KIDS
THAT FAT IS IMPORTANT FOR
COGNITIVE DEVELOP.
IN EARLY CHILDHOOD AND WONDERING
IF THE FINDING -- OBVIOUSLY YOU
WEREN'T LOOKING AT COGNITIVE
DEVELOPMENT BUT GROWTH AND
WONDERING WHAT THE SUBCOMMITTEE
WAS THINKING IN TERMS OF WHERE
TO GO NEXT.
DO YOU THINK IT'S A BLIP IN THE
DATA OR IS THERE SOMETHING THERE
OR SOMETHING WORTH LOOKING AT IN
MORE DETAIL?
>> I WAS JUST GOING TO SAY WE
HAVE HAD DISCUSSIONS ABOUT THIS
AND THIS DOES SEEM LIKE IT'S
SOMETHING THAT SHOULD BE
CONTINUED TO BE INVESTIGATED
BECAUSE I THINK THIS IS DEBATED
AND CLEARLY I THINK PART OF THE
CONVERSATION WE HAD WAS WITH THE
LIMITED EVIDENCE IT WASN'T CLEAR
WE SHOULDN'T CHANGE THE EXISTING
GUIDANCE BUT GIVEN AS YOU
MENTIONED FIRST OF ALL MILK HAS
A LOT OF NUTRIENTS IN IT AS
HOLLIE MENTIONED AND PROTEIN SO
FOR THIS AGE GROUP MAY NOT BE AS
PROBLEMATIC AND FOR THE OTHER
DEVELOPMENT NEURAL OUTCOMES -- I
WOULD AGREE PROBABLY THIS SHOULD
REMAIN AS SOMETHING THAT
ESPECIALLY SINCE IT WOULD
INFLUENCE FEDERAL GUIDANCE AND
PROGRAMMING.
>> THANKS.
>> I JUST WANT TO ECHO WHAT
ANDREA WAS SAYING.
WHEN WE BEGAN TO ORGANIZE THE
EVIDENCE THERE WAS A BREAK DOWN
IN THE PATTERN.
IT WAS INTERESTING TO SEE THAT
AND I THINK ESPECIALLY GIVEN
WHAT YOU'RE TALKING ABOUT, AND
THEN ALSO SEEING IT DOES NOT
HAVE A DETRIMENTAL EFFECT PEOPLE
MAY THINK OF THE EXCESS ENERGY
INTAKE THAT MAY BE CONSUMED WE
DIDN'T SEE THAT OUTCOME I THINK
IT WOULD BE A VERY IMPORTANT
THING TO KEEP OUR EYES ON.
>> CAN I ASK A QUICK FOLLOW-UP
WHAT IS THE BASIS FOR GRADING
EVIDENCE?
WAS A SMALL NUMBER OF STUDIES OR
WERE THERE OTHER ISSUES WITH THE
DATA THAT MADE IT DIFFICULT TO
EVALUATE?
>> IT DEFINITELY WAS A SMALL
NUMBER OF STUDIES.
I DO REMEMBER THAT.
I MAY BE MISSPEAKING BUT I DON'T
THINK THERE WERE TRIALS, FOR
EXAMPLE.
>> THANK YOU.
>> THIS POINTS TO THE IMPORTANCE
OF LOOKING AT DIETARY INTAKE AND
OUTCOMES BY LIFE STAGES CAUSE IT
VARIES 5I89 DEPENDING ON -- A
LOT DEPENDING ON WHAT'S
HAPPENING.
ALINE.
>> THANK YOU WONDERFUL
PRESENTATION HOLLIE AND ANDREA.
MY QUESTION TO TIE ON TO
CHERYL'S QUESTION WHICH IS FOOD
SYSTEMS AND AVAILABILITY OF THE
BEVERAGES THAT ARE PUT ON THE
MARKET FOR FAMILIES.
AND ESPECIALLY TODDLER MILKS.
SO WE'RE TALKING ABOUT THE
PERIOD OF TIME WHERE THERE'S
QUITE A BIT OF MARKETING FOR
CERTAIN BEVERAGES THAT MAY NOT
BE THE BEST FROM A HEALTH
PERSPECTIVE SO WHAT WOULD BE THE
GUIDANCE FROM THE COMMITTEE
CONSIDERING THOSE?
>> WE DID NOT REVIEW TODDLER
MILKS IN OUR REVIEWS BUT I
BELIEVE THERE'S EXISTING
GUIDANCE ON NOT PROVIDING
CHILDREN WITH TODDLER MILKS.
I DON'T KNOW IF ANYBODY ELSE
WANTS TO COMMENT ON THAT.
>> THE TODDLER MILKS WERE AN
EXAMPLE.
I THINK THERE ARE OTHER PRODUCTS
WHERE THEY MAY BE MARKETED AS
ALTERNATIVES MAYBE NOT WHAT
YOU'RE RECOMMENDING.
>> THIS FOCUSSED ON COW'S MILK
AND FORTIFIED SOY BEVERAGES.
THERE'S OTHER GUIDANCE REGARDING
TODDLER MILK BUT THANKS FOR
ASKING THAT QUESTION.
IT GETS CONFUSING WHEN THINGS
ARE MARKET ED AND NOT TIED TO
THE EVIDENCE.
ANY OTHER QUESTION OR COMMENTS?
I THINK IT WAS AMAZING WE HAD SO
MANY MORE CONCLUSION STATEMENTS
AND LOOKED AT SO MANY OTHER
BEVERAGES THIS TIME SO KUDOS TO
THE GROUP FOR DOING THIS.
THANKS AGAIN FOR YOUR HARD WORK.
WE'LL TRANSITION TO CHAPTER 4,
FOOD SOURCES OF SATURATED FAT
AND CARDIOVASCULAR DISEASE
OUTCOMES.
DIDI AND CHRISTOPHER WILL BE
PRESENTING AND I'LL TURN IT OVER
TO DIDI.
>> THANK YOU, DEE AN FLA.
FUN FACT, WE FOUND OUT OVER THE
PROCESS WE BOTH PLAYED LACROSSE
FOR RIVAL D1 COLLEGES.
FOR AN INTRODUCTION TO SATURATED
FAT IN THE GUIDELINES THE PAST
GUIDELINES HAD 10% AS THE LIMIT
STARTING AT AGE 2 WITH SATURATED
FAT WITH A FOCUS ON SUBSTITUTION
AND WHERE CALORIES WOULD COME
FROM IF SATURATED FAT IS REMOVED
OR REDUCED AND RECOGNIZING
REFIND CARBOHYDRATES MAY NOT
HAVE AN ADDITIONAL BENEFIT.
THERE WAS A LIMIT ON THE CON
SUPPLEMENTS OF SATURATED FAT.
THIS IS ONE OF THE MOST LONG
STANDING AND CONSISTENT
RECOMMENDATION AND THE QUANTITY
OF CALORIES WAS PUT IN PLACE.
THE GUIDANCE AROUND THIS HAS
BEEN REVIEWED MANY TIMES SINCE
AND HAS ONLY BECOME STRONGER IN
ITS CONCLUSION FOR THE ROLE OF
SATURATED FAT PARTICULARLY IN
ITS RELATIONSHIP WITH HIGHER
RISKS OF CARDIOVASCULAR DISEASE,
CORONARY HEART DISEASE IN
PARTICULAR.
IN LOOKING THE INTAKES OF FOODS
IN THE U.S. SATURATED FAT
REMAINS A MAJOR NUTRIENT OF
PUBLIC HEALTH CONCERN.
LESS THAN ONE-FIFTH OF THE
U.S. POPULATION MEETS THE
RECOMMENDATION.
SO MOST AMERICANS ARE CONSUMING
ABOVE THE LIMIT OF 10% OF ENERGY
FROM SATURATED FAT IN FACT IN
ADOLESCENTS 12-19 THE PERCENTAGE
OF ENERGY OF SATURATED FAT HAS
INCREASED IN THE LAST DECADE AND
NOW 12% OF CALORIES FROM FAT AND
SATURATED FAT.
SO IN ORDER TO HELP FURTHER MEET
THIS GOAL WITH MANY AMERICANS
ABOVE THE LIMIT, THERE WAS
GUIDANCE FROM THE PUBLIC AS WELL
AS THE 2020 COMMITTEE.
SO OVER THE LAST DAY YOU HEARD
US COME UP WITH POSSIBLE
RECOMMENDATIONS FOR NEXT ROUND.
SO THE LAST ROUND HAD A
RECOMMENDATION TO REVIEW FOOD
SOURCES OF FAT.
THIS WAS ALSO MENTIONED IN A
NUMBER OF PUBLIC COMMENTS AS
WELL.
SO JUST TO ORIENT EVERYONE TO
WHERE WE'RE OUR SATURATED FAT
FROM IN THE U.S., THE TOP MAJOR
CATEGORIES THAT CONTRIBUTE TO
SATURATED FAT INCLUDE MIXED
DISHES, SNACKS AND SWEETS AND
PROTEIN FOOD GROUPS AND THE TOP
CONTRIBUTORS OF FOODS WITHIN
THOSE ARE BURGERS AND SANDWICHES
INCLUDING TACOS AND BURRITOS,
RICE, PASTA AND GREEN BEAN
DISHES AND THEY COME IN THE FORM
OF DAIRY S AND PLANT AND
PROCESSED MEAT AND COCONUT AND
PALM OIL.
THOSE ARE THE SATURATED FAT
INGREDIENTS COME FROM IN THOSE
PRODUCTS I MENTIONED.
AND A MOUNTING AGAINST SATURATED
FAT HAS BEEN ESTABLISHED FOR
HEART DISEASE AND CHOLESTEROL
LEVELS AND THE SHIFTING OF FOOD
LEVEL TO OFFER MORE PRACTICAL OR
ACTIONABLE SUBSTITUTIONS IS THE
ACTION THE IT COMMITTEE WAS NEXT
TAKING.
THE REPLACEMENT FOODS IS
ACKNOWLEDGING THE FACT THAT NOT
ONLY DO FOODS THAT HAVE
SATURATED FAT OAR THOSE THAT
HAVE SOMETHING LIKE POLY
UNSATURATED FAT, NOT ONLY ARE
THEY DIFFERENT IN THEIR FATTY
ACID COMPOSITION AND OTHERS
BESIDES SATURATED AND POLY
UNSATURATED WITHIN THEM THERE'S
OTHER CONSTITUENTS THAT MAY GO
TO THE NET HARM OR BENEFIT OVER
ONE FOOD OR ANOTHER.
WE OBVIOUSLY EAT FOODS NOT
NUTRIENT AND LOOKING AT THE
TOTALITY OF FOOD AND WHAT IT'S
DELIVERING AS YOU A WHOLE IS
WHAT ULTIMATELY WOULD BE MOST
IMPORTANT.
WE'RE TASKED WITH FOCUSSING ON
THE SUBSTITUTION AND LOOKING AT
THE CARDIOVASCULAR DISEASE
OUTCOME AND INCIDENTS AND HEART
ATTACKS AND STROKES AND DEATH
AND THE IMMEDIATE RISK FACTORS
OF BLOOD CHOLESTEROL LEVELS AND
LIPIDS AND BLOOD PRESSURE.
SO WE COMPARED DIRECTLY THE
FOODS WITH DIFFERENT AMOUNTS OF
SATURATED FAT, HIGHER OR LOWER
FAT VERSIONS OF A GIVEN FOOD
PRODUCT THAT WOULD BE HIGH IN
SATURATED FAT AS WELL AS FOODS
THAT DON'T NECESSARY CONTAIN
SATURATED FOOD SUBSTITUTING FOR
FOOD AND HIGHER IN MONO OR
UNSATURATED FAT AND OIL AND NUTS
AND FISH.
SO THIS IS OUR OVERARCHING
SCIENTIFIC QUESTION WHICH THE
NEXT COUPLE OF SLIDES WHEN
CHRISTOPHER TAKES OVER YOU'LL
GAIN AN APPRECIATION FOR WAS NOT
SINGLE QUESTION BUT MANY SUB
QUESTIONS, WHAT IS THE
RELATIONSHIP BETWEEN THE FOOD
LEVEL AND SOURCES OF SATURATED
FAT AND CARDIOVASCULAR DISEASE
OUTCOMES?
I WILL TURN IT OVER TO YOU NOW,
CHRISTOPHER, OR OUR TAKEAWAYS.
>> GREAT, THANKS FOR SETTING US
UP, DIDI.
WHEN WE SWITCH FROM NUTRIENTS TO
FOODS IT BECOMES MORE
COMPLICATED.
MORE GENERALIZABLE BUT LESS
RIGOROUS.
WHAT WE'LL SEE IS THAT WE HAVE
31 CONCLUSION STATEMENTS FROM
THIS ONE ORIGINAL QUESTION AND
KEEP IN MIND WE ALREADY NARROWED
THIS DOWN TO CARDIOVASCULAR
DISEASE AS AN OUTCOME.
MOST STUDIES WERE PROSPECTIVE
COHORT STUDIES LOOK BEING AT
ASSOCIATIONS IN A SUBSTITUTION
MODEL WHAT WOULD HAPPEN IF YOU
SUBSTITUTED RED MEAT OR DAIRY OR
TROPICAL OILS FOR SOMETHING
ELSE?
FEW WERE RANDOMIZED TRIALS BUT
THEY TENDED TO BE FOCUSSED ON
SHORT-TERM STUDIES WITH LIPIDS
AND REDUCTIONIST MODEL WITH
SATURATED FAT OIL STARTING POINT
MOVING TO AN UNSATURATED FATTED.
THAT'S WHAT YOU'LL SEE.
AND BECAUSE THERE WERE SO MANY
CONCLUSIONS AS WE NOTED ABOUT A
MONTH AGO IN THAT PUBLIC HEALTH
MEETING WE TRIED TO ORGANIZE
THESE TO BE EASIER TO FOLLOW IN
TERMS OF DIRECTIONALITY.
WE HAVE QUITE A FEW AND EIGHT
DIFFERENT CONCLUSION STATEMENTS
THAT SUGGEST THE POTENTIAL
BENEFIT FROM SWITCHING.
WE ALSO HAVE SIX CONCLUSIONS
THAT SUGGEST THERE MAY NOT BE A
BENEFIT FROM SWITCHING AND THOSE
WERE INTERESTING IN AND OF
THEMSELVES.
THIS DEPENDED ON WHAT THE
INTERVENTION EXPOSURE WAS AND
YOU HAD CONCLUSIONS WITH NO
GRADABLE -- NO GRADE ASSIGNED
BECAUSE IT WAS TOO -- THE
LITERATURE WAS TOO SPARSE OR THE
OUTCOMES AND THE EXPOSURES WERE
TOO INCONSISTENT OR
INAPPROPRIATELY DEFINED.
AND BY THE WAY THIS IS ONLY IN
ADULTS AND OLDER ADULTS.
NOTHING FOR PREGNANCY AND
LACTATION OR CHILDREN AND
INFANTS AND ONLY OLDER ADULTS.
THE THREE MAIN CATEGORIES WERE
DAIRY, MEAT AND PLANT SOURCES OF
SATURATED FAT.
EVEN WITHIN THESE CATEGORIES IT
CAN BE CONFUSING.
DAIRY WAS MOSTLY MILK, EGG AND
CHEESE AND ICE CREAM DIDN'T COME
UP SO CAN'T ANSWER THAT.
WE HAD HIGH FAT AND LOW-FAT AND
SKIM VERSIONS THERE WAS RED
MEAT, PROCESSED, RED MEAT, WHITE
MEAT AND DIFFERENT CATEGORIES
AND THE COMPARATORS OFTEN
DIFFERED.
SOME SAID LEGUMES, SOME SAID
PEAS AND BEANS AND SOME SAID
LEGUMES AND NUTS.
WE HAD TO PUT TOGETHER TO SEE
WHAT THE CONCLUSIONS WILL YIELD.
AND THERE WAS DIFFERENT OILS AND
MOST PROSPECTIVE COHORT STUDIES
LOOKED AT MORBIDITY AND
MORTALITY.
OF THOSE MOST LISTED THE
OUTCOMES AS BEING MORBIDITY.
IF YOU DIG DEEPER, YOU'LL FIND
MORBIDITY OFTEN INCLUDES
MORTALITY SO IT'S A LITTLE BIT
OF INSIDE BASELINE.
MOST THE CONCLUSIONS ARE ONLY
GOING TO REFER TO MORBIDITY BUT
KEEP IN MIND THE BIG DIFFERENCE
IS IN THE SHORTER RCTs WHERE THE
FOCUS IS IMMEDIATE OUTCOMES LIKE
LIPIDS IS DIFFERENT THAN
LONG-TERM 30 OR 40 YEARS OF
FOLLOW UP OF MORBIDITY AND/OR
MORTALITY.
IT FOCUSSED ON LIPIDS AND BLOOD
PRESSURE.
WE EXTRACTED DATA AND THANKS TO
THE AMAZING TEAM THAT PULLED ALL
THIS DATA TOGETHER FOR US AND
ALL THE COLLEAGUES ON OUR
COMMITTEE, THERE WASN'T REALLY A
STRONG REASON FOR A LINK IN
BLOOD PRESSURE BUT IT WAS OFTEN
ASSESSED.
SO WHEN THEY DID RCTs THEY
LOOKED AT BOTH LIPIDS AND BLOOD
PRESSURE.
THAT'S A BIG DIFFERENCE BETWEEN
PROSPECTIVE COHORT STUDIES AND
OUTCOMES AND RCTs AND MORE RIGOR
WITH RCTs BUT FOR THE
PERSPECTIVE COHORT STUDIES WE
HAVE TO LOOK AT SUBSTITUTION
ANALYSES.
SO HERE ARE EIGHT DIFFERENT
FAVORABLE OUTCOMES.
THESE SUGGEST ONE STRONG
CONCLUSION, FIVE MODERATES AND
TWO LIMITED THERE WOULD BE A
POTENTIAL BENEFIT FROM TAKING
THIS KIND OF ACTION.
IF WE'RE TRYING TO GET AMERICANS
TO LOWER THEIR FAT INTAKE HERE
ARE THINGS THAT COULD, MIGHT OR
SHOULD WORK.
WE'LL START WITH STRONG AND THIS
IS OLD NEWS, BUTTER IS NOT BACK.
BUTTER IS WORSE FOR YOUR LDL
CHOLESTEROL THAN ALL KINDS OF
OILS AND SPREAD, HIGHER IN
UNSATURATED FAT AND REINFORCING
THERE'S A LARGE DATABASE.
IT'S NOT MORBIDITY OR MORTALITY
BUT LOOK BEING AT BLOOD LIPIDS
AND LDLC IN PARTICULAR SUGGESTS
YOU WOULD DO BETTER SWAPPING OUT
BUTTER FOR THE UNSATURATED PLANT
OILS AND SPREADS.
FIVE CONCLUSIONS WERE MODERATE
AND THE FIRST BULLET POINT IS A
HEAD SCRATCHER BUT PRETTY
STUNNING LOOKING AT HOW
CONSISTENT IT WAS AND CVB
MORBIDITY AND PROFESSIONED AND
RED MEAT VERSUS DAIRY PRODUCTS,
SWAPPING OUT THE RED MEAT WITH
THE PRODUCTS WAS ASSOCIATED WITH
LOWER RISK.
SO WHAT'S THAT MEAN?
I'M TRYING TO DECIDE IF I SHOULD
HAVE A STEAK OR GLASS OF MILK
TONIGHT.
THAT DOESN'T SEEM LIKE A
PRACTICAL SUBSTITUTION BUT COULD
HAVE BEEN YOGURT OR CHEESE.
WHAT WAS MORE STUNNING IS HOW
CONSISTENT AND MANY PROSPECTIVE
COHORT STUDIES HAVE LOOKED AT
THE QUESTION AND ENDED UP WITH A
MODERATE GRADE.
I THINK THAT MERITS LOOKING INTO
MORE OF THE DETAILS OF WHAT THAT
PRACTICAL SWAP WOULD BE.
IT ENDED UP IN OUR MODERATE
FAVORABLE DIFFERENCE LIST THE
NEXT IS PROCESSED OR UNPROCESSED
RED MEAT AND CONSISTENT FOR
PLANT SOURCES OF PROTEIN, BEANS,
PEAS, LENTILS, LEGUMES OR NUTS
OR WHOLE GRAINS OR VEGETABLES
AND THERE WERE ENOUGH IN EACH OF
THOSE SEPARATE CATEGORIES THAT
THEY GENERATED SEPARATE
CONCLUSIONS.
AT ONE POINT IT WAS JUST GOING
TO BE PLANT FOODS BUT THERE WERE
ENOUGH WE SEPARATED THEM OUT
EACH ONE WARRANTED A MODERATE
CONCLUSION AGAIN THE OUTCOME IS
THESE ARE PROSPECTIVE COHORT
STUDIES AND FOR THE DIFFERENCE
YOU'RE GETTING NOT ONLY ARE THE
PLANT SOURCES OF PROTEIN, WHOLE
GRAINS AND VEGETABLES LOWER IN
SATURATED FAT THAN PROCESSED OR
UNPROCESSED RED MEAT OR FIBER
BUT WE WEREN'T LOOK THE --
LOOKING AT THE CONSTITUENTS AND
I MAY HAVE MORE ANTIOXIDANTS OR
OTHER DIFFERENCES, FIBER WOULD
BE THE OBVIOUS ONE FOR A
MECHANISM FOR LOWERING LDL
CHOLESTEROL BUT THAT'S NOT WHAT
WE'RE LOOKING AT.
WE'RE LOOKING AT THE
ASSOCIATIONS OF FOOD SOURCES.
IF YOU WANTED TO TEASE APART
WHAT IT WAS YOU HAVE TO GET INTO
A MORE GRANULAR ANALYSIS AND THE
LAST ONE ONE THE THREE TYPES OF
TROPICAL OILS AND REPLACING THEM
WITH VEGETABLE OILS HIGHER IN
UNSATURATED FAT AND NOW BACK TO
RCTs MORE OF A RIGOROUS TRIAL
SWAP OUT ONE KIND OF FAT FOR
ANOTHER AND SEE WHAT HAPPENS.
IT LOWERS LDL CHOLESTEROL LIKE
SUBSTITUTING BUTTER FOR THE SAME
OILS AND SPREAD WITH LOWER LDL
CHOLESTEROL.
FOR THE FAVORABLE DIFFERENCES WE
FINISH OF WITH SUBSTITUTING
DAIRY AS A WHOLE WITH FOOD
SOURCES AS A WHOLE OF
UNSATURATED FATTY ACIDS
ASSOCIATED WITH A LOWER RISK OF
CVD AND TAKING THE WHOLE
CATEGORY THERE WAS LESS
CONSISTENCY AND DOES NOT YET
MERIT CONCLUSION OF MODERATE.
AND LOOPING BACK TO THE FIRST OF
THESE CONCLUSIONS, THE ONE THAT
WAS STRONG, SO BUTTER UP TOP WAS
ASSOCIATED STRONGLY WITH LOWER
LDL CHOLESTEROL BUT DIDN'T IT
MATTER IF WE KEEP YOU OUT OF THE
HOSPITAL OR NOT?
LOOKING AT THE PROSPECTIVE
COHORT STUDIES AND SUBSTITUTING
BUTTER WITH OILS AND SPREAD PRE
DOMINANTLY UNSATURATED WE SAW
LOWER RISK OF CVD AND MORTALITY
BUT THAT DETE WAS MORE LIMITED
AND COULDN'T COME UP WITH A
STRONGER GRADE THAN LIMITED.
WE FOUND A NUMBER OF OPTIONS FOR
TRYING TO LOWER SATURATED FAT
CONTENT AND AN IMPACT ON BLOOD
LIPIDS OR SWAPPING OUT FOR THE
DIFFERENT FOOD SOURCES OF
SATURATED FAT.
THEN ALMOST AS INTERESTING WERE
SOME OF THE COMPARISONS WHERE
THERE WAS NO DIFFERENCE.
SO FIVE CONCLUSION STATEMENTS
WITH A MODERATE GRADE WHERE WE
DIDN'T SEE A DIFFERENCE.
SO, LOOK AT THE BULLET POINTS.
SWAPPING ONE FORM OF DAIRY FOR
ANOTHER FORM OF DAIRY AS A
PROSPECTIVE COHORT STUDIES AND
THOSE ARE BOTH SOURCES OF
SATURATED FAT.
SO THE MAGNITUDE OF THE
SATURATED FAT DIFFERENCE ISN'T
GOING TO BE AS LARGE AS SWAPPING
OUT ANIMAL SOURCES FOR PLANT
SOURCE FOR THE PLANT SOURCE
WOULD BE MUCH LOWER.
NO ASSOCIATION BETWEEN PROCESSED
AN UNPROCESSED RED MEAT WITH
WHITE MEAT OR EGGS.
LESS OF A DIFFERENCE THERE AND
NO FIBER INCLUDED IN THE WHITE
MEAT OR EGGS.
MAYBE LESS OF AN OPPORTUNITY FOR
THAT IN THE SHIFT.
THE LAST ONE WAS ODD.
LOOKING AT SUBSTITUTING WHITE
MEAT FOR OTHER SOURCES AND WE
WERE TALKING ABOUT DAIRY AND RED
MEAT AND TROPICAL OILS.
BECAUSE WE WERE LOOKING AT ALL
THE COMPARISONS WHERE DATA WAS
AVAILABLE WE LOOKED AT WHITE
MEAT VERSUS PLANT-BASED FOODS OR
FISH SEAFOOD AND WASN'T ENOUGH
OF A SHIFT IN SATURATED FAT TO
SEE A DIFFERENCE.
THERE'S A MODERATE CONCLUSION
FOR NO DIFFERENCE.
YES FOR RED MEAT AND SWAPPING
OUT BUT NOT SO MUCH FOR WHITE
MEAT AND TIME LIMITED CONCLUSION
WAS WITH A TYPE OF TROPICAL OIL,
IT'S NOT AS HIGH AS SATURATED
FAT AS COCONUT OR COCOA BUTTER
OR PALM.
IT SEEMS TO BE LOWER IN
SATURATED FAT.
AND THIS ONE NO CONCLUSION
125I789S
ADOLESCENTS FOR CARDIOVASCULAR.
WE HAVE FOUR BITS OF ADVICE.
I'LL FOCUS ON THE TEXT AND GREEN
BOX ON THE RIGHT LOOKING AT THIS
IN MORE DETAIL AND OUR
ANALYSISES WAS ONLY IN ADULTS.
IT WASN'T IN KIDS.
THAT INTERESTING FINDING FROM
BEVERAGES OF TOTAL FAT, SKIM AND
LOOK AT THE AGE GROUP.
CLEARLY THE DATA EMPHASIZED
SWITCHING OUT PLANT FORWARD
DIETS CONSISTENT WITH OUR
CONVERSATION ABOUT PROTEIN
SOURCES YESTERDAY.
THOSE FINDINGS WERE TWO OF THE
BITS OF ADVICE WE WOULD LIKE TO
OFFER THE DEPARTMENTS.
THOSE HAD A LOT OF TO DO WITH
CARDIOVASCULAR MORBIDITY/MORE
TRALT.
-- MORTALITY.
AND THESE WERE BOTH THE LDL
CHOLESTEROL FINDINGS.
THESE ARE MORE RIGOROUS AND MORE
RANDOMIZED CONTROL TRIALS AND
MORE CAUSE AND EFFECT PUT A
NARROWER QUESTION TO REPLACE
BUTTER WITH UNSATURATED FATS AND
REPLACING COCONUT BUT WITH
VEGETABLE OILS LOWER IN
UNSATURATED FAT.
THESE ARE STUDIES SHORTER IN
DURATION AND STUDIES CAN BE MORE
COMPELLING.
THAT'S ABOUT WHAT WE WERE ABLE
IT GENERATE LOOKING AT OUR ONE
QUESTION OF FOOD SOURCES OF
SATURATED FAT AND TRYING TO TAKE
A STEP BACK AND SEE WHAT WE
SHOULD OFFER THE DEPARTMENTS AS
ADVICE.
I THINK THAT'S IT.
WE'RE READY TO DISCUSS.
>> THANKS, CHRISTOPHER AND DIDI.
I THINK YOU CAN SEE THIS IS
ANOTHER PUZZLE PIECE THAT FITS
INTO WHAT WE'VE BEEN TALKING
ABOUT WITH DIETARY PATTERNS AND
INTEGRATION CONVERSATIONS
YESTERDAY.
ANY QUESTION FOR CHRISTOPHER OR
DIDI.
ANGELA.
>> EXCELLENT PRESENTATION.
I THINK THIS IS EXCITE BEING
BECAUSE WE HAVE A LOT OF
EVIDENCE WHEN PROSPECTIVE COHORT
STUDIES IN ADULTS.
I WAS CURIOUS BECAUSE I WANT TO
CLARIFY THE LANGUAGE OF SWAPPING
AND SUBSTITUTING.
WE TALKED ABOUT THAT BEFORE.
WHEN I THINK OF SWAPPING, I
THINK OF A CHANGE IN AN
INDIVIDUAL VERSUS A DIFFERENT
PERSON EATING A DIFFERENT
DIETARY PATTERN.
NOT EATING BUTTER BUT EATING A
PLANT-BASED OILS OR NOT EATING
BLANK BUT ANOTHER PERSON EATING
B.
>> I'LL LET DIDI GO BECAUSE
SHE'S AMAZINGLY ARTICULATE.
YOU GET A MUFFIN MADE WITH
BUTTER AND ONE MADE WITH
SUNFLOWER OIL OR COCONUT OIL AND
LOOK AT LDL CHOLESTEROL AND THAT
PERSON SWITCHED AND ATE
SOMETHING DIFFERENT.
IN A PROSPECTIVE COHORT STUDY
IT'S MODELLING A SUBSTITUTION.
DIDI, WHY DON'T YOU TAKE IT.
>> IT'S AN IMPORTANT QUESTION.
THE SUMMARY SLIDES I THINK
CHRISTOPHER TRIED TO PUT IT
TOGETHER IN TERMS OF
RECOMMENDATIONS AND BEHAVIOR.
ANALYTICALLY WHAT'S HAPPENING IN
THE TRIALS YOU MIGHT HAVE OR
STUDIES THAT ARE PARALLEL ARM,
THE EPIDEMIOLOGY IS VARIABLE BUT
A LOT OF IS COMPARING CONSUMING
HIGH AMOUNTS OF MEAT VERSUS
PLANT SOURCES INSTEAD OR
SOMETHING ALONG THOSE LINES.
THAT'S AN IMPROVEMENT UPON THE
EPIDEMIOLOGY THAT MIGHT COMPARE
HIGH VERSUS LOW AMOUNTS OF
BUTTER OR THOSE IN THE LOW
AMOUNT GROUPS BUT YOU DON'T KNOW
WHAT THIS CONTRAST IS.
IT ALSO GETS TO EXAMINE THE
HETEROGENEITY OF THE PAIR WISE
FOODS YOU CAN THINK OF, POULTRY
OR EGGS OR RED MEAT OR PROCESSED
MEAT, YOU CAN PROCESS THE
SUBSTITUTIONS.
THERE ARE NOW ANALYSES AT THE
INDIVIDUAL STAGES BUT MOST
COMPARE BETWEEN PEOPLE.
>> YEAH, THAT'S WHAT I WAS
THINKING OF THE TERMINOLOGIES
THERE'S PROSPECTIVE COHORT
STUDIES WITH THE TERMINOLOGY.
WE MAY BE IN THE ANALYSES
LOOKING AT A VERSUS B BUT I WAS
WONDERING CAN WE REALLY SAY
SWAPPING OR CAN WE REALLY SAY
SUBSTITUTIONS?
BECAUSE ARE THEY ACTUALLY
SUBSTITUTIONS OR CONSUMPTION
PATTERNS?
>> YEAH.
IT'S A LITTLE BIT BEYOND THE
PATTERN BECAUSE YOU CAN ISOLATE
A COMPONENT OF CALORIES BUT TO
YOUR POINT, THE SUBSTITUTION IS
THE LEGACY TERM THE MODELS THE
RESEARCH APPROACH HAS ALWAYS
CALLED IT.
IN TERMS OF NOMENCLATURE YOU
THINK OF SUBSTITUTION AS A
BEHAVIOR IT MAY SEEM DIFFERENT
BUT THAT'S A POINT WELL TAKEN I
KNOW WE DISCUSSED BEFORE HOW TO
SORT OF DISTINGUISH.
SO ANY RECOMMENDATIONS,
TERMINOLOGY WISE ARE CERTAINLY
WELCOME.
CHRISTOPHER YOU HAD SOMETHING
TOO.
>> I LIKE HOW YOU DESIGNED IT
DIDI ONE TIME.
YOU HAVE ONE SET OF PEOPLE
REPLAC
REPLACING HAMBURGERS WITH FRENCH
FRIES OR REPLACING WITH LENTILS
AND IF YOU'RE JUST LOOKING AT
THE FEWER BURGERS THE COMPARISON
GROUP IS EVERYONE ELSE.
SOME MAY HAVE BEEN A BENEFICIAL
CHANGE AND SOME A WORSE CHANGE
AND YOU'RE GETTING NO CHANGE.
AND AS THE FOLKS SUBSTITUTING
REFINED GRAINS FOR RED MEAT AND
ONES DOING BEANS, PEAS AND
LENTILS.
OH, MY GOSH, NOW THAT WE
SEPARATED THOSE OUT YOU CAN DO
STATISTICAL ANALYSES AND THERE'S
AN IMPACT TOGETHER BUT CAN'T
LUMP THEM TOGETHER AS LOW RED
MEAT EITHER.
IF YOU'RE EATING LESS RED MEAT
YOU'RE EATING MORE OF SOMETHING
AND THEY DON'T ALL HAVE THE SAME
EFFECT ON YOUR HEALTH.
>> I GET IT'S THE TERMINOLOGY.
I THINK IT'S THE HOW VERSUS THE
WHAT.
BECAUSE SUBSTITUTING IS A
PRACTICE LIKE IT'S HOW I GUESS
AND IT MAY BE VERSUS A BLANK
THAT IS AN ACTION A PERSON MAY
BE TAKING VERSUS THE CONSUMPTION
COMPONENT.
>> SO THE OTHER POINT I'LL
ADHERE IS YOU'LL NEVER GET A
RANDOMIZED TRIAL WHERE YOU GET
PEOPLE TO SWAMP OUT RED MEAT FOR
30, 40 YEARS TO SEE WHAT HAPPENS
IF YOU SWAP IT OUT SO A
PROSPECTIVE COHORT STUDY IS THE
ONLY WAY YOU'LL EVER BE ABLE TO
SEE CARDIOVASCULAR MORBIDITY AND
MORTALITY.
ALL HAVE YOU IS CHANGES LDL FROM
A RANDOMIZED TRIAL AND IT'S A
TRUE SUBSTITUTION AND MAYBE
THEIR LDL WENT DOWN AND
SOMETHING ELSE WENT UP.
I WOULD LIKE TO SEE WHAT THE
DECADES LONG IMPLICATION OF THAT
IS.
THE PROSPECTIVE COHORT STUDIES
IS THE ONLY WAY TO LOOK AT THAT
AND WOULD LEAVE A HUGE GAP IN
THE KNOWLEDGE BASE.
IT'S MODELLING THE SUBSTITUTION.
CAN'T GET AN INTERVENTION TO GO
FOR 30 AND 40 YEARS.
>> TO UNDERSTAND OUR CONCLUSION
STATEMENTS YOU NEED TO
UNDERSTAND THE METHODOLOGY
BEHIND IT.
SO THEY DID A GREAT JOB
EXPLAINING IT.
SARAH.
>> THANK YOU FOR THIS.
IT WAS A GREAT PRESENTATION AND
YOU REALLY CLEARLY WENT THROUGH
YOUR STEPS AND LOGIC OF YOUR
DECISIONS WHICH WAS SO HELPFUL.
MY BRAIN'S EXPLODING BECAUSE I'M
THINKING OF JENNY AND ALINE'S
PRESENTATION AND I GUESS I
QUESTION IS HAS THERE BEEN
STUDIES ABOUT THE BEHAVIOR?
IF YOU INTRODUCE OR EXPOSE
CHILDREN TO SOME FOODS VERSUS
OTHERS, HOW DOES THAT IMPACT
DIETARY PATTERNS LATER ON?
WHAT ARE THE IMPLICATIONS LONG
TERM?
>> STUDIES HAVE LOOKED AT
CHILDREN AND THEIR EXPOSURES AND
LATER ON WHAT HAPPENS WITH MEAT
AND BEAN CONSUMPTION.
I ASSUME EARLY EXPOSURE IS
CRITICAL IN SCHOOL LUNCH AND
SCHOOL BRING -- BREAKFAST
ETCETERA.
I DON'T KNOW OF THOSE STUDIES.
MAYBE OTHERS DO.
>> DIETARY BEHAVIORS TRACK OVER
TIME TO YOUNG ADULTHOOD.
THAT WOULD AND IT TRACKS TO
EARLY ADULTHOOD IS WHAT WE KNOW.
>> IT'S THE MILLION DOLLAR
QUESTION AND MANY SCIENTISTS ARE
SKEPTICAL OF THE IDEA OF DOES IT
MATTER.
IF YOU FEED SOMEONE A CARROT HOW
DOES THIS IMPACT AND IT'S A GOOD
QUESTION.
YOU CAN LOOK AT THESE STUDIES
THAT LOOK AT TRACKING OF INTAKE
OVER TIME TO GET A SENSE OF
THAT.
IF YOU THINK MORE BROADLY ABOUT
CROSS CULTURAL DIFFERENCES IN
FOOD CONSUMPTION AND
PREFERENCES, IF YOU LOOK AT
COMFORT FOODS ACROSS THE WORLD
THEY LOOK VERY DIFFERENT.
WHAT REPRESENTS SOMETHING
DELICIOUS AND EMOTIONALLY
ATTRACTIVE TO OTHER CULTURE MAY
DISGUST ANOTHER CULTURE.
ABOUT WHAT THE RESEARCH ON
EXPOSURES SAYS IS IT IS NOT
NECESSARY AN EXPOSURE THAT SETS
THE COURSE FOR A LIFE TIME BUT
HELPS CHILDREN TRANSITION FROM
ONE DEVELOPMENTAL PERIOD TO
ANOTHER.
FLAVORS OF THE MATERNAL DIET ARE
CARRIED IN UTERO AND GO TO
ACCEPTANCE DURING COMPLIMENTARY
FEEDING AND IF YOU EXPOSE THEM
DURING THIS COMPLIMENTARY
FEEDING PERIOD THEY'RE MORE
LIKELY TO ACCEPT THE FOODS IN
LATER PERIODS.
I THINK THERE'S A FAIR AMOUNT OF
EVERYDAY THAT WOULD SUGGEST
THESE EARLIER EXPERIENCES ABOUT
FOOD HELP CHILDREN LEARN ABOUT
THEIR FOODS AND FAMILY AND
CULTURE AND ENVIRONMENT AND SET
THEN UP TO ENGAGE IN A WAY THAT
INCREASES THE LIKELIHOOD OF
SURVIVAL BY ACCEPTING THE FOODS
THAT ARE THERE AND SO THE IDEA
IS THAT THOSE THINGS REALLY ARE
IMPORTANT BECAUSE THEY SERVE AS
A BASIS FOR WHAT BECOMES
FAMILIAR TO US.
THAT DRIVES A LOT OF OUR
BEHAVIOR.
DO THE STUDIES EXIST OUT THERE
TO SAY IF YOU PROVED THIS
EXPOSURE YOU ARE GOING TO SEE
THESE OUTCOMES?
I DON'T THINK WE HAVE THOSE
ANSWERS.
IT'S AN IMPORTANT QUESTION.
>> NEW FOR THAT.
>> THE SAME THEME AS YESTERDAY
OF BEHAVIOR AND CHANGE AT THE
INDIVIDUAL LEVEL VERSUS WHAT
WE'RE SEEING MORE
ENVIRONMENTALLY IS SOMETHING
THAT WE REALLY NEED TO UNDER
SCORE ACROSS ALL OF OUR
CHAPTERS.
WE DON'T KNOW HOW TO CHANGE
BEHAVIOR OR THE TOOLS WE HAVE
WE'RE NOT CERTAIN ON ACROSS LIFE
STAGES AND THEIR DURABILITY.
AND IN ADDITION TO SODIUM,
SATURATED FATS COME AS AN
INGREDIENT FOR A LOT OF THE FOOD
SOURCES AND TEAMS IN PARTICULAR.
IT ISN'T THAT KIDS ARE CHOOSING
STEAK BUT IT'S IN ALL THE
PROCESSED FOODS AS SATURATED FAT
FROM DAIRY AND BUTTER AND LIKE
MIXED DISHES.
SO IN THE ABSENCE OF REALLY
SOLID BEHAVIOR CHANGE
APPROACHES, WHICH IT'S GREAT
WE'RE GETTING DIRECTION FOR KIDS
ACROSS ALL OF THIS IT'S STILL
COMING BACK TO THE INGREDIENTS
AND FOODS THEMSELVES AS A KEY
PLAYER BUT ALSO SORT OF THE WAY
TO MAKE IT MAKE THE BIGGEST,
BROADEST CHANGES.
>> YEAH, AND TO FOLLOW UP ON
THAT, DIDI, I KNOW THE FOOD
SUPPLY WENT FROM TRANS FATS TO
SATURATED FATS IN MANY AREAS AND
SO THE CHANGE IN THE FOOD SUPPLY
EFFECTS ALL OF US.
WE NEED A COHESIVE ENVIRONMENTAL
CHANGE AND AFTER THE SCHOOL DAY
IF IT'S NOT A COMMUNITY WIDE
POLICY THEY'LL JUST GO ACROSS
THE STREET AND BUY SODAS THERE.
WHATEVER WE WANT TO DO IT'S
IMPORTANT THAT IT BE INTEGRATED
AND CONSISTENT FOR THE BEHAVIOR
CHANGE.
WE COULD DO IT JURISDICTION BY
JURISDICTION BUT THE PLAYING
FIELD WHEN LEVELED ALLOWS FOR
GREATER IMPACT AND WE THINK
ABOUT THIS FACT IF YOU START AN
INITIATIVE IN ONE JURISDICTION
AND NEW YORK CITY'S UNSATURATED
FAT MOVEMENT HAD A DIFFERENCE
FOR THE AREA AND THE REST OF THE
WORLD AND WHEN THE REDUCTION
AROUND SODIUM IN THE EARLY 2010s
THAT STARTED TO TRICKLE OVER AND
BASED ON WHAT HAPPENED IN THE
U.K. BECAUSE A LOT OF
CORPORATIONS DON'T JUST MAKE
FOOD FOR TEXAS, CALIFORNIA, NEW
YORK BUT THE NATION AND HOPE
WE'LL REMEMBER AS WE THINK
THROUGH HOW TO LAY OUT
RECOMMENDATIONS THAT INDUSTRIES
TEND TO BE BIGGER THAN ANY ONE
LOCALE.
ONE POINT THAT MAY NEED FOR
CLARIFIED AND THIS IS A QUESTION
AIMED AT Y'ALL BUT YOU MAY WANT
TO REITERATE THESE WERE
COMPARISONS OF CVD AND LOOKING
AT NO THE JUST DAIRY BUT THE
REPLACEMENT.
>> WE'VE JUST THIS BEFORE.
AND I THINK WHAT YOU'RE SAYING
IS WHERE WE HAVE LIMITED OR NO
CONCLUSION AROUND CERTAIN FOOD
COMPARISONS IT'S NOT SAYING WE
HAVE LIMITED EVIDENCE FOR THE
FOODS THEMSELVES.
IT'S THE SPECIFIC PAIR WISE
CONTRASTS.
THE HEAD-TO-HEAD COMPARISON
ITSELF OF PLANT VERSUS DAIRY OR
WHATEVER IT MIGHT BE IS WHERE
WE'RE THIN.
THANK YOU FOR REMINDING US TO
EMPHASIZE THAT.
DOES THAT RING A BELL?
>> ABSOLUTELY, YEAH.
ALL THOSE WHERE SOMETHING WASN'T
GRADE ASSIGNABLE AND THE
SUBSTITUTION AND COMPARISON NOT
THE RED MEAT OR DAIRY OR THE
TROPICAL OIL.
>> TO SAY A PAIR WISE COMPARISON
IS HELPFUL OR COMPARISON
THINKING VERSUS THE ACTION WAS
HELPFUL.
>> THANKS.
DIDI.
>> CAN I KEEP GOING ON THE SAME
POINT?
>> SURE.
>> THANKS, ANGELA.
THE MONOUNSATURATED AND POLY
SATURATED BEING CALLED OUT IN
THE GUIDELINES WHAT TO BE
REPLACED WITH LOOKING AT THE
FOOD LEVEL AND WHAT IS
INTERESTING IS SOME LANGUAGE
THAT HAVE NOT LOOKED AT FOODS
SPECIFICALLY HAD RECOMMENDATIONS
FOR SUBSTITUTIONS FOR LEANER
VERSIONS OF MEAT OR PROCESSED
MEAT AND WE SEE THE MEAT TO MEAT
SUBSTITUTIONS WITH THE PRODUCTS
YOU DON'T GAIN THE BENEFIT.
IT'S POSSIBLE LIKE YOU'RE NOT
REDUCING THE SATURATED FAT BY
THAT MUCH IF YOU GO TO A LEANER
VERSION BUT YOU'RE ALSO NOT
GAINING THE BENEFIT OF SOMETHING
LIKE A PLANT-BASED OPTION OR
WHOLE GRAINS IN THE SUBSTITUTION
EITHER.
SO THINKING ABOUT WHAT ADVICE WE
MIGHT PUT FORWARD WOULD BE CAN
WE CLARIFY THE SUBSTITUTION
WHICH RIGHT NOW IS POLY AND M
MONOUNSATURATED OR LEAN VERSIONS
OF AND MAKE IT MORE CONSISTENT
WITH WHAT WE'RE DOING AND CALL
OUT ACTUAL FOOD GROUPS AND SUB
GROUP INCLUDING THOSE THAT ARE
LIKE THE PLANT SOURCES OF THESE
INSTEAD OF JUST LIKE A LEANER
CUT OR LEANER VERSION OF MEAT OR
WHERE WE SAW NO DIFFERENCE IN
CARDIOVASCULAR RISK THERE.
>> GREAT, THANKS, DIDI.
HEATHER.
>> I LIKE THE IDEA OF BEING
CAREFUL WITH THE WORD CHOICES
ANGELA WAS RAISING BECAUSE I
ALSO DO FIND IT CONFUSING WITH
THE USE OF THAT TERM
SUBSTITUTION.
LIKE IT MAKES ME THINK SO MUCH
OF MODELLING AND DOING SOME
DIRECT SWAPPING IN A MODELLING
EXERCISE AND IT'S MORE CAREFUL
HOW TO GET THE IDEA ACROSS THAT
SEEMS MORE TRUE TO SAY THESE ARE
FOODS PART OF A PATTERN OR
SOMETHING THAT ARE BEING
COMPARED IN TWO GROUPS OVER TIME
THAN TO JUST SAY SUBSTITUTION.
SO I DON'T KNOW.
I WONDER IF THAT CAN -- I DON'T
KNOW HOW THE ULTIMATE STATEMENT
WILL BE MADE BUT I FEEL IT'S
PROBABLY IMPORTANT TO REALLY GET
THE MEANING ACROSS OF THE
EVIDENCE THAT WAS REVIEWED.
>> THANKS, HEATHER.
CHRISTOPHER.
>> LET ME BUILD ON THE NUANCE OF
ALL THIS.
SO IN OUR WORLD OF FOOD SCIENCE,
THE MORE RIGOROUS STUDIES ARE
THE EASIER ONES TO MAKE CLEAN.
SO IF IT'S JUST A SWAP OF
SATURATED FAT FOR POLY
UNSATURATED FAT IT'S CLEAN YOU
DON'T HAVE TO CHANGE CARBS OR
CALORIES OR ANYTHING ELSE.
WHAT WE'RE SEEING IS FOUR-FIFTHS
OF THE COUNTRY ISN'T MEETING THE
SATURATED FAT GUIDELINE SO HOW
CAN YOU GET A BIGGER SHIFT AND
HEALTH BENEFIT IF YOU'RE
RESTRICTING YOURSELF TO
SOMETHING WHERE IT COULD BE
RIGOROUSLY COMPARED CAUGHT
COMPARING OTHER VARIABLES YOU'RE
SELLING YOURSELF SHORT.
WHAT IF YOU'RE HAD SOMETHING
WITH FEWER CALORIES AND
SOMETHING ELSE AND FIBER.
IF YOU WANT TO SEE A HEALTH
BENEFIT HAS BEEN PATTERNS AND
OUR TALK HAS BEEN ON PATTERNS
AND THIS IS A PORTION OF THE
PATTERN THAT FULLY SUPPORTS THE
HEALTHY PATTERN AND LESS SUGAR
SWEETENED BEVERAGES AND MORE
WHOLE FOODS, IT TIES IN.
WHEN YOU PUT IT TOGETHER IT'S
THE BEAUTY OF THE PATTERNS AND
IT'S BEEN IMPORTANT TO MOVE PAST
THE SWAP OF ONE TYPE OF FAT FOR
ANOTHER TYPE OF FAT WITHOUT
APPRECIATING THE LARGER CONTEXT
OF FOOD CHOICES TO MAKE A
MEANINGFUL DIFFERENCE AND OH,
CHOOSE LEANER OR THE LOWER FAT
VERSION ISN'T GOING TO GET US
THERE IS WHAT I SUGGEST WE'RE
SEEING FROM THE EVIDENCE BASE WE
REVIEWED.
>> THANKS, CHRISTOPHER.
DIDI DID YOU WANT TO FOLLOW UP
WITH ANYTHING?
>> I APPRECIATE THE FEEDBACK ON
TERMINOLOGY.
AND IT'S THE SAME WITH PARALLEL
RCTs AS WELL.
IT'S NOT NECESSARILY UNIQUE OR
ANYTHING WHERE YOU DON'T HAVE A
CROSSOVER DESIGN AND COMPARING
TO INDEPENDENT GROUPS.
WE IN CA -- CAN THINK OF A KWON
CONTRAST OR COMPARISON AND LOOK
AT WHAT IS HAPPENING
ANALYTICALLY.
YOU MADE ALL THE POINTS.
>> THANKS FOE -- TO BOTH OF YOU.
ANY OTHER QUESTION OR COMMENTS?
ALL RIGHT.
I'D LIKE TO THANK Y'ALL AGAIN
FOR A GREAT PRESENTATION AND
CLARIFYING THAT SINCE IT WAS A
NEW AREA FOR THE DIETARY
GUIDELINE ADVISORY COMMITTEE.
WITH THAT I'LL HAND IT OVER TO
SARAH.
>> DEANNA THANK YOU SO VERY MUCH
FOR YOUR LEADERSHIP.
WE HEARD MULTIPLE PRESENTATIONS
FROM THE WORKING GROUP AND
YOU'VE DONE AN AMAZING JOB OF
LEADING AND THANK YOU SO MUCH TO
ALL THE STAFF WITHOUT WHOM ALL
THE GREAT COMPARISONS WOULD NOT
HAVE BEEN MADE.
SO THANK YOU.
SO, WE'RE KIND OF AHEAD OF TIME.
WHAT I'M GOING TO SAY IS WE'RE
GOING TO BREAK NOW TO 1:45 AND
COMMITTEE MEMBERS, JUST TURN
YOUR CAMERAS AND MICROPHONES OFF
AND TO THE PEOPLE IN THE
AUDIENCE WE'LL BE BACK AT 1:45
EASTERN TIME.
THANK YOU VERY MUCH AND EVERYONE
REHYDRATE.
WORKING GROUP AND THE RESULTS.
>> THIS IS A FUN COMMITTEE TO
WORK WITH.
THE FIRST PART OF OUR
PRESENTATION WILL BE ON THE
FREQUENCY OF MEALS AND/OR
SNACKING AND DR. GIOVANUCCI WILL
PRESENT.
>> IT'S BEEN A PLEASURE WORKING
WITH THE SUBCOMMITTEE AND STAFF
HAVE BEEN GREAT.
I'LL BEGIN THE PRESENTATION AND
KRISTINA WILL TAKE OVER.
I'LL SUMMARIZE THE DRAFT REPORT.
SO EATING OCCASIONS INCLUDE
MEALS AND SNACKS THOUGH NO
CONSENSUS EXISTS ON THE
DEFINITIONS OF EATING OCCASIONS.
DIETS IN MANY CONTEXTS INCLUDING
IN THE U.S. ARE ORGANIZED AROUND
DAILY MEALS, TYPICALLY
BREAKFAST, LUNCH AND DINNER AND
MEALS INCLUDE SET MEALS AT
SPECIFIC TIMES AT THE DAY AND
SNACKS ARE SMALLER AMOUNTS OF
FOODS OUTSIDE TYPICAL MEAL TIMES
AND THOUGH THEY'RE IN TERMS OF
PREFERENCES AND TYPES AND
AMOUNTS OF FOODS INGESTED DURING
THE MEALS, FREQUENCY OF EATING,
TIMING AND SIZE OF EATING
OCCASIONS CAN ALSO BE CONSIDERED
AND EATING BEHAVIOR WHICH COULD
AFFECT HEALTH STATUS.
THIS FOR EXAMPLE, COMMON DIETARY
PRACTICES SUCH AS BREAKFAST
SKIPPING AND AFTER DINNER MEALS
OR SNACKING MAY HAVE RISK OF
OBESITY REPRESENTING PATTERNS OF
TIME-RESTRICTED EATING.
FREQUENCY OF MEALS AND/OR
SNACKING HAS BEEN A TOPIC OF
INTEREST FOR MULTIPLE ITERATIONS
OF THE DIETARY GUIDELINES FOR
AMERICANS.
THE 2010 AND 2020 COMMITTEES
COMPLETED SYSTEMATIC REVIEWS ON
RELATED TOPICS.
HOWEVER, THE 2025 COMMITTEES
FOCUS ON IDENTIFYING STRATEGIES
FOR INDIVIDUALS AND FAMILIES
RELATED TO DIET, QUALITIES AND
WEIGHT MANAGEMENT LED TO
APPROACH THE QUESTIONS PRESENTED
IN THIS CHAPTER AS NEW
SYSTEMATIC REVIEWS.
THE COMMITTEE CONDUCTED
SYSTEMATIC REVIEWS ACROSS LIFE
STAGES FROM YOUNG CHILDREN TO
OLDER ADULTS INCLUDING WOMEN
DURING PREGNANCY AND POST PARTUM
PERIODS.
SO THE COMMITTEE'S WORK
EVALUATED SCIENTIFIC LITERATURE
ON EATING OCCASION-BASED
MEASURES SUCH AS MEALS, SUCH AS
FOR EXAMPLE BREAKFAST, SNACKING
AND NUMBER OF EATING OCCASIONS
AS DEFINED BY THE STUDIES.
THE OUTCOMES WE FOCUSSED ON
INCLUDED DIET QUALITY, ENERGY
INTAKE AND GROWTH BODY
COMPOSITION AND RISK OF OBESITY.
THIS IS DATA ANALYSIS ON
FREQUENCY OF MEALS AND SNACKING.
BRIEFLY THE COMMITTEE ALSO USED
DATA ANALYSIS FROM SOME RECENT
SURVEYS.
THESE INCLUDE WHAT WE EAT IN
AMERICA, WWEIA AND NHANES, THE
NATIONAL HEALTH AND NUTRITION
EXAMINATION DATA AND LOOKED AT
POPULATION LEVEL EATING
BEHAVIORS.
THESE ARE THINGS SUCH AS MEALS
AND SNACKING.
THIS ALSO SERVED AS A SYSTEMATIC
REVIEW ON THE TOPIC.
THIS HAS SOME OF THE FIND
BEINGS.
I'LL GO OVER SOME OF THESE
BRIEFLY.
THERE WAS A LOT OF INTERESTING
DESCRIPTIVE DATA IN THE
SYNTHESIS.
SO FOR BREAKFAST -- NOW MOST
CHILDREN CONSUME BREAKFAST AND
IT'S 96% AMONG CHILDREN AGES 2-5
AND 88% AGES 6-11.
CONSUMPTION DURING THESE AGES
ARE PRETTY HIGH.
BREAKFAST CONSUMPTION IS
SIGNIFICANTLY LOWER AMONG
YOUNGER CHILDREN AND ADOLESCENTS
ABOUT 72%.
THIS IS FOR THE AGE RANGE 12-19.
NOW, BREAKFAST CONSUMPTION IS
SIGNIFICANTLY HIGHER AMONG
ADULTS AGES 60 AND OLDER ABOUT
93% THEN GOES DOWN AND AMONG
YOUNGER ADULTS, IT'S 77%.
YOU CAN SEE ALMOST A U-SHAPED
DISTRIBUTION WHERE CONSUMPTION
IS HIGHER AND THEN GOES TO 70%
RANGE IN ADOLESCENTS AND YOUNGER
ADULTS.
DIFFERENCES IN BREAKFAST
CONSUMPTION ALSO EXIST AMONG
DIFFERENT RACE AND/OR ETHNICITY
GROUP AS WELL AS AMONG FAMILY
INCOME LEVELS WITH INDIVIDUALS
OF HIGHER REPORTING MORE
FREQUENT BREAKFAST CONSUMPTION
COMPARED TO LOWER INCOME.
IN TERMS OF SNACKING, IT'S
HIGHLY PREVALENT IN THE UNITED
STATES WITH 93% OF CHILDREN IN
ADOLESCENTS AGES 2-19 AND 86% OF
ADULTS AGES 20 YEARS AND OLDER
REPORTING ONE OR MORE SNACKS IN
A GIVEN DAY.
AND AMONG THOSE 2-9 YEARS SNACKS
CONTRIBUTE TO 27% OF TOTAL
ANOTHER AND 42% OF ADDED SUGARS,
26% OF SATURATED FAT AND 17% OF
SODIUM THEY CONSUME IN A DAY.
AMONGST SNACK CONSUMERS, 20
YEARS AND OLDER SNACKS
CONTRIBUTE 23% TOTAL ENERGY, 43%
OF ADDED SUGARS, 21% OF THE
DAILY SATURATED FAT AND 14% OF
DAILY SODIUM.
AMONG ADULTS AGES 20 AND OLDER,
THOSE WHO REPORT SNACKS CONSUMED
304 MORE KILO CALORIES A DAY
COMPARED TO ADULTS THAT DON'T
REPORT SNACKS AND SNACKS
CONTRIBUTE AN AVERAGE OF 520 K
CALS A DAY AND SNACKS AND
SNACKING CONTRIBUTESES TO THE
OVER ALL INTAKE OF ENERGY AND
SATURATED FAT, ESPECIALLY ADDED
SUGARS AND SODIUM AND VARIATIONS
AMONG DEMOGRAPHIC GROUPS.
THE OTHER CATEGORY IS LATE
EVENING CONSUMERS.
AND CONSUMPTION IS FAIRLY HIGH
WITH MORE THAN HALF OF
REPORTING.
IT'S ACTUALLY SIGNIFICANTLY
LOWER AMONG ADULTS AGES 60 AND
OLDER, 57% STILL HIGH COMPARED
TO YOUNGER ADULTS, 20 TO 59
YEARS AT 66%.
NOW, AMONG ADULTS SO THIS ADULTS
20 YEARS AND OLDER WHO ARE LATE
EVENING CONSUMERS, THE LATE
EVENING CONSUMERS HAVE ABOUT 300
CALORIES HIGHER TOTAL ENERGY
INTAKE COMPARED TO THE NON-LATE
EVENING CONSUMERS.
AND AMONG THE LATE EVENING
CONSUMERS, THE MOST COMMONLY
REPORTED FOOD CATEGORIES
CONSUMED DURING THE LATE EVENING
PERIODS ARE SNACKS AND SWEETS.
THE AVERAGE INTAKE FROM FRUITS
AND VEGETABLES IS 550 CALORIES
IN THE LATE EVENING ABOUT 25% OF
TOTAL ENERGY INTAKE AND LATE
EVENING CONSUMPTION PROVIDES 26%
OF THE TOTAL DAILY INTAKE OF
ADDED SUGARS, 26% SATURATED FAT
AND 22% SODIUM INTAKE.
THEY LOOKED AT THE RELATIONSHIP
BETWEEN FREQUENCY OF MEALS AND
SNACKING AND A DIETARY PATTERN
IN LINE WITH THE DIETARY
GUIDELINES FOR AMERICANS AND
WHAT IS THE RELATIONSHIP BETWEEN
FREQUENCY OF MEALS AND/OR
SNACKING IN ENERGY INTAKE?
WHAT IS THE RELATIONSHIP BETWEEN
FREQUENCY OF MEALS AND SNACKING
AND BODY COMPOSITION AND RISK OF
OBESITY.
GIVEN THE FOCUS ON SPECIFIC LIFE
STAGES AND EVIDENCE FOR CHILDREN
AND ADOLESCENTS AND ADULTS AND
OLDER ADULTS.
EVIDENCE FOR INDIVIDUALS DURING
PREGNANCY AND POSTPARTUM WAS
SYNTHESIZED IF AVAILABLE FOR
EACH OUTCOME.
IN ADDITION THE OUTCOMES OF
GESTATIONAL WITH A BIT GAIN AND
POSTPARTUM GAIN WERE INCLUDED IN
THE BODY COMPOSITION AND RISK OF
OBESITY.
SO THIS SLIDE GIVES A BIG
PICTURE IN HOW THE COMMITTEE
LOOKED AT THE TOPIC AND THE
SLIDE PROVIDES A ROAD MAP FOR
THE NEXT FEW SLIDES.
BRIEFLY WHEN SUFFICIENT EVIDENCE
WAS AVAILABLE, THE EVIDENCE WAS
ALSO SYNTHESIZED BY THE EXPOSURE
CATEGORIES WHICH AGAIN ARE
BREAKFAST CONSUMPTION OR
SKIPPING, SNACKING, NUMBER MUCH
EATING OCCASIONS AND FREQUENCY
OF MEALS.
NOW, EVIDENCE WAS NOT AVAILABLE
FOR ALL OUTCOMES AGE GROUPS OR
EXPOSURE CATEGORIES THEREFORE
CONCLUSION STATEMENTS WERE
DEVELOPED ONLY WHEN THERE WAS
SUFFICIENT EVIDENCE AVAILABLE.
FOR THIS OUTCOME AS WHOLE THERE
WERE POPULATIONS WE WEREN'T ABLE
TO DRAW CONCLUSIONS ON.
FOR THE SYSTEMIC REVIEW
RELATIONSHIP BETWEEN FREQUENCY
OF MEALS AND/OR SNACKING AND
CONSUMING A DIETARY PATTERN
BETTER ALIGNED WITH THE DIETARY
GUIDELINES, NO CONCLUSION
STATEMENTS WERE DEVELOPED
BECAUSE NOT ENOUGH EVIDENCE WAS
AVAILABLE AND NO CONCLUSION FOR
CHILDREN AND ADOLESCENTS DUE TO
THE BODY OF EVIDENCE.
FOR THE RELATIONSHIP BETWEEN
FREQUENCY OF MEALS AND SNACKING
AND GROWTH, BODY COMPOSITION AND
RISK OF OBESITY, CONCLUSION
STATEMENTS COULD NOT BE
DEVELOPED FOR WOMEN DURING
PREGNANCY OR POSTPARTUM BECAUSE
THERE WAS NOT ENOUGH EVIDENCE.
AT THIS POINT AND CHRISTINA WILL
REPORT ON THE FINDINGS OF THE
COMMITTEE.
>> WE HAVE PRESENTED THIS BEFORE
BUT TO REMIND EVERYONE, IN
RELATION TO BREAKFAST WE FOUND
IN CHILDREN AND ADOLESCENTS
REGULAR BREAKFAST CONSUMPTION
MAY BE RELATED TO FAVORABLE BODY
COMPOSITION AND RISK AND LACK OF
OBESITY.
IN ADULTS AND OLDER ADULTS WE
LOOKED MOSTLY AT BREAKFAST
SKIPPING AS THAT IS WHAT THE
EVIDENCE WAS SHOWING AND WE
DIDN'T SEE ANY ASSOCIATION -- IT
WAS NOT ASSOCIATED WITH
FAVORABLE BODY WEIGHT,
COMPOSITION OR RISK OF OBESITY.
THEY COULD NOT DRAW A CONCLUSION
STATEMENT BETWEEN BREAKFAST AND
ENERGY INTAKE BECAUSE THE
EVIDENCE WAS NOT AVAILABLE.
REGARDING SNACKING, SO IN
ADULTS, OVER ALL SNACKING MAY
NOT BE ASSOCIATED WITH BODY
COMPOSITION AND RISK OF OBESITY.
HOWEVER, WE DID SEE AND WHY HE
PRESENTED SOME ANALYSIS THAT
AFTER DINNER AND EVENING
SNACKING MAY BE RELATED TO LESS
FAVORABLE BODY COMPOSITION AND
RISK OF OBESITY AND DIDN'T SEE A
RELATIONSHIP BETWEEN CHILDREN
AND SNACKING AND BODY
COMPOSITION AND RISK OF OBESITY
AND DIDN'T HAVE ENOUGH EVIDENCE
TO LOOK AT THAT FOR OLDER ADULTS
AND AS MENTIONED BY ED, WE
COULDN'T SEE THE RELATIONSHIP
WITH ENERGY INTAKE AS WELL.
IN RELATION TO THE NUMBER OF
EATING OCCASIONS, IN CHILDREN WE
SAW A HIGHER NUMBER OF EATING
OCCASIONS MAY BE ASSOCIATED WITH
FAVORABLE GROWTH BODY
COMPOSITION AND LOWER RISK OF
OBESITY.
WHILE THERE WAS NO ASSOCIATION
IN ADULTS WITH THIS OUTCOMES,
AND WE CANNOT DRAW ANY
CONCLUSION STATEMENTS WITH OLDER
ADULTS AND IN RELATION TO THIS
EXPOSURE AND ENERGY INTAKE.
SO LASTLY, UP RELATION TO MEAL
FREQUENCY IN CHILDREN AND
ADOLESCENTS, MEAL FREQUENCY OR
SKIPPING MAY NOT BE ASSOCIATED
WITH OUTCOMES RELATED TO RISK OF
OV
OVERWEIGHT OR OBESITY AND
COULDN'T DRAW CONCLUSIONS IN
LUNCH AND DINNER WITH ADULTS AND
OLDER ADULTS.
PUTTING THIS TOGETHER WE HAVE
FOUR RECOMMENDATIONS WE'D LIKE
TO DISCUSS TODAY.
OUR FIRST RECOMMENDATION IS TO
CONTINUE TO RECOMMEND REGULAR
BREAKFAST CONSUMPTION AS PART OF
A DIETARY PATTERN THAT IS BETTER
ALIGNED WITH THE DIETARY
GUIDELINES PARTICULARLY IN
CHILDREN AND ADOLESCENTS.
WE JUST FOUND OR MENTIONED OUR
REVIEW FOUND IN CHILDREN AND
ADOLESCENTS REGULAR AND
BREAKFAST CONSUMPTION MAY BE
RELATED TO FAVORABLE OUTCOMES
RELATED TO GROWTH, BODY
COMPOSITION AND LACK OF OBESITY
BUT IN OLDER ADULTS BREAKFAST
SKIPPING WAS NOT ASSOCIATED BUT
BREAKFAST PROVIDES AN IMPORTANT
OPPORTUNITY TO IMPROVE
STRATEGIES OF THE FOODS CONSUMED
TO MEET KEY NUTRIENT AND ALIGN
WITH THE DIETARY GUIDELINES.
OFTEN INDIVIDUALS CHOOSE NOT TO
CONSUME BREAKFAST FOR VARIOUS
REASONS.
IN CHILDREN THEY COULD SKIP
BREAKFAST BECAUSE THEY DON'T
HAVE TIME, THEY'RE NOT HUNGRY IN
THE MORNING, FOOD PREFERENCES,
NOT UNDERSTANDING THE BENEFITS
OF BREAKFAST AND POSSIBLY STIGMA
FOR PARTICIPATING IN THE SCHOOL
PROGRAM FOR BREAKFAST.
IN ADULTS THERE'S REASONS FOR
SKIPPING AND A REASON COULD BE
WEIGHT LOSS STRATEGY, LACK OF
TIME OR LIMITED KNOWLEDGE OF THE
BENEFITS OF BREAKFAST.
SO WE RECOMMEND TO MAYBE THERE
COULD BE SOME THINGS WE COULD DO
IN RELATION TO THE SCHOOL
BREAKFAST PROGRAM SINCE THIS IS
A KEY FACILITATOR OF BREAKFAST
CONSUMPTION BUT MAY NEED TO WORK
AROUND THE STIGMA ASSOCIATED
WITH THE STIGMA CONSUMPTION IN
SCHOOLS.
STRATEGIES COULD MAKE BREAKFAST
UNIVERSAL PROVIDING GRAB AND GO
BREAKFAST AND BREAKFAST TO BE
SERVED AFTER THE BELL OR
IMPLEMENTING EDUCATION
STRATEGIES ABOUT THE BENEFITS OF
BREAKFAST IN GENERAL.
OUR SECOND RECOMMENDATION IS TO
CONTINUE TO RECOMMEND NUTRIENT
DENSE SNACKS AS PART OF A
DIETARY PATTERN BETTER ALIGNED
WITH THE DIETARY GUIDELINE FOR
CHILDREN AND ADOLESCENTS.
THOUGH OUR REVIEW DID NOT
SPECIFICALLY FIND A RELATIONSHIP
BETWEEN SNACKING BODY
COMPOSITION AND RISK OF OBESITY
DATA ANALYSIS SHOWED SNACK
OCCASIONS ARE RELATED TO FRUITS
AND VEGETABLES HIGH IN CALORIES
AND LOW IN NUTRIENT.
BECAUSE MUCH CHILDREN AND
PARTICULARLY YOUNG CHILDREN IN
RAPID PERIODS OF GROWTH,
RECOMMENDING NUTRIENT DENSE
SNACKS SUCH AS FRUITS AND
VEGETABLES AND WHOLE GRAIN AND
DAIRY PRODUCTS COULD BE
IMPORTANT OCCASIONS TO MEET KEY
NUTRIENT FOR GROWTH AND
DEVELOPMENT.
AS MENTIONED EARLIER BY ALINE,
YOUNG CHILDREN DO NOT HAVE ROOM
IN THEIR DIETS FOR ENERGY DENSE
FOODS PARTICULARLY YOUNGER
CHILDREN AT THE LOWER CALORIE
LEVELS.
THEREFORE THE COMMITTEE
RECOMMENDS STRATEGIES IMPROVE
THE NUTRITIONAL QUALITY OF THE
FOODS AND BEVERAGES CONSUMED AS
A SNACK.
FOR SCHOOLS IN THE PAST 10 YEARS
THERE'S BEEN CRITERIA SET FOR
ALL THE FOODS SOLD INSIDE THE
SCHOOLS BUT MAYBE WE NEED TO
ENSURE THAT OTHER PROGRAMS,
CAREGIVERS AND OUTSIDE THE
SCHOOL THE BUILT ENVIRONMENT
WHICH WE'VE BEEN DISCUSSING ALSO
FOLLOW SOME OF THESE TOOLS THAT
WE HAVE AND ACTUALLY THE USDA
HAS A SMART SNACK GUIDE IN TERMS
OF HEALTHY SNACKS AND ENCOURAGE
OTHER PROGRAMS AND CAREGIVERS TO
USE THE TOOLS.
THE THIRD RECOMMENDATION IS
AFTER DINNER AND EVENING SNACK
GUIDELINES.
IN ADULTS AFTER DINNER AND
EVENING SNACKING MAY BE RELATED
TO LESS FAVORABLE OUTCOMES FOR
RISK OF OBESITY AND THE TYPES OF
FOOD CONSUMED LATE ENERGY ARE
HIGH IN ENERGY DENSITY AND LOW
IN MANY NUTRIENT.
WE RECOMMEND INCLUDING STRATEGY
TO IMPROVE THE QUALITY OF THE
FOODS AND BEVERAGES AFTER DINNER
TO BE BETTER INLINE.
AND THE LAST IS THE HIGHER
NUMBER OF EATING OCCASIONS IN
CHILDREN MAY BE ASSOCIATED WITH
FAVORABLE OUTCOMES RELATED TO
BODY COMPOSITION AND OUR ADVICE
IS TO DIVIDE NUTRIENT DENSE
FOODS TO SMALLER MEALS AND
SNACKS TO ALLOW CHILDREN TO MEET
KEY NUTRIENT FOR HEALTHY GROWTH
AND DEVELOPMENT.
WE'RE NOW OPEN TO YOUR
QUESTIONS, COMMENTS,
SUGGESTIONS.
>> I'M CURIOUS ABOUT YOUR
INTERPRETATION OF THE BRECK
FACILITY IN -- BREAKFAST IN
ADULT IF I UNDERSTAND CORRECTLY
YOUR DATA DIDN'T SHOW AN
ASSOCIATION WITH BREAKFAST
CONSUMPTION IN ADULTS AND THE
OUTCOMES OF INTEREST.
SO DO YOU BELIEVE THIS IS AN
IMPORTANT METHOD?
I MEAN THERE'S PART OF ME
THINKING I'M STILL THINKING OF
THIS MORNING'S SECTIONS WHERE WE
LEARNED THE ROUTINE AND THE
WHOLE ENVIRONMENT AROUND YOUNG
CHILDREN IS IMPORTANT BUT MOU
IMPORTANT DO YOU THINK IS
BREAKFAST FOR ADULTS AND DOES
THAT NEED TO BE A STRONGER
MESSAGE OR SUGGESTION?
>> I THINK THE DATA DID NOT
ALLOW US TO BE ABLE TO SEE THIS
CLEARLY JUST BECAUSE MOST OF THE
QUESTIONERS IN THE STUDIES
INCLUDED JUST ASK ABOUT
BREAKFAST CONSUMPTION AND DID
NOT INCLUDE THE QUALITY OF THE
BREAKFAST OR THE TYPE OF FOODS
CONSUMED SO I THINK WE NEED MORE
AND IF YOU ASSOCIATE WITH TYPES
THEY DIDN'T SEE CLEAR
RELATIONSHIPS OR SIGNIFICANT
ASSOCIATIONS.
I THINK WE NEED MORE DETAILS IN
THE STUDIES WE LOOKED AT BUT I
KNOW DEANNA WAS A LEAD FOR THE
BREAKFAST.
IF YOU WANT TO ADD SOMETHING,
DEANNA, PLEASE.
>> SOMETIMES THEY'D SAY YES OR
NO, CHRISTINA TALKED ABOUT THAT
OR SOMETIMES THEY'D SAY FROM THE
PAST WEEK HOW MANY TIMES HAVE
YOU DONE IT AND SOMETIMES THE
DATA WOULD BE DIVIDED AND THEY'D
PUT IT IN THREE CATEGORIES AND
THE OUTCOMES COULD BE ONE DAY OR
SEVERAL DAYS.
THERE WAS A LOT OF HETEROGENEITY
IN THE STUDIES.
THE CHILD STUDIES WERE MORE
CONSISTENT.
>> CLARIFY YOUR FOURTH
RECOMMENDATION WHEN IT COMES TO
INCREASING THE NUMBER OF
PATIENTS.
DO YOU MEAN BEYOND EATING
BREAKF
BREAKFAST, LUNCH AND DINNER OR
JUST NOT EATING BREAKFAST?
>> GOOD QUESTION, TERESA.
WE DID NOT HAVE THAT CLEAR
EVIDENCE HOW THEY DID THIS.
THEY DIVIDED LESS THAN THREE
BETWEEN THREE AND FOUR MORE THAN
FIVE AND EATING OCCASIONS
MEANING A SNACK.
THEY DID NOT SPECIFY BREAKFAST,
LUNCH AND DINNER SO IT'S NOT
CLEAR IF THEY WERE TALKING ABOUT
ALWAYS -- WE COULD ASSUME
BECAUSE MOST CONSUME BREAKFAST,
LUX AND DINNER PARTICULARLY
CHILDREN THEY WERE SEVERAL
SNACKS BUT THEY COULD HAVE BEEN
SMALLER MEALS AND ALL TREAT THE
SAME WAY.
IT SEEMS LIKE EONS AGO.
>> THE DATA IS PRETTY WEAK
BECAUSE A LOT OF THE STUDIES
WERE FOOD FREQUENCY
QUESTIONNAIRES HAVE LIMITATIONS
AND PARTICULARLY FOR THIS TYPE
OF QUESTION THEY'RE GEARED MORE
TOWARD OVER ALL EATING AND WHAT
PEOPLE ARE EATING BUT FEW
QUESTIONS ON TIME OF DAY OR MAY
HAVE A SIMPLE QUESTION SKIPPING
BREAKFAST OR WHAT THEY'RE EATING
AT LUNCH, FOR EXAMPLE.
THE TRIALS AND PROBABLY SOMEONE
ELSE CAN COMMENT BETTER ON THE
TRIALS BUT THERE WERE ISSUES ON
DURATION.
SO THE TRIALS WEREN'T AS
INFORMATIVE AS YOU MIGHT HAVE
HOPED.
IT REMAINS TO ME AN INTERESTING
AREA BUT THE DATA ARE PRETTY
WEAK AT THIS POINT.
>> MOST STUDIES ASK ALL THESE
THINGS LIKE DO YOU REGULARLY EAT
BREAKFAST, A RECOMMENDATION IS
TO BE ABLE TO SEE THE ENTIRE
DIET AND I THINK CHRISTOPHER YOU
WERE TALKING ABOUT OR YESTERDAY
WE WERE TALKING ABOUT WELL,
MAYBE WE DON'T EAT THIS BUT
MAYBE EAT SOMETHING DIFFERENT.
CONSIDERING THE ENTIRE DAY AND
MORE DETAILS AND TO BE ABLE TO
LOOK AT ALL THESE DETAILS AND
I'VE DONE THAT AND IT'S VERY
TEDIOUS.
I KNOW THAT'S WHY MOST PEOPLE
USE IT BECAUSE IT'S EASIER TO
LOOK AT THAN GOING IN THE
DETAILS OF 24 HOUR RECALLS TO
LOOK AT THE TIME, HOUR, THE
TYPE.
THESE ARE THE DETAILS WE
PROBABLY NEED.
>> FOR THE HIGHER NUMBER OF
EATING OCCASIONS IN CHILDREN, IS
THERE A NUMBER THAT'S ASSOCIATED
WITH THAT AND IT SOUNDS LIKE
FROM WHAT YOU'RE SAYING IT'S NOT
NECESSARILY.
>> WE DIDN'T HAVE A NUMBER BUT
WE KNOW FROM JUST SUBCOMMITTEE 2
WE HAVE DISCUSSED IN SMALL
CHILDREN THEY MAY NOT BE ABLE TO
EAT BIG MEALS AND HAVING SMALLER
MEALS TO COMPLEMENT THE BIG
MEALS PLAY BE A WAY TO -- MAY BE
A WAY TO ADD TO THAT.
>> I WONDER IF THE DATA WAS ON A
CERTAIN AGE GROUP AND MAKE
FOCUSSED MORE ON THE YOUNGER AGE
GROUPS.
HOW INCLUSIVE WAS IT, I GUESS?
>> OH, MY GOD.
I CAN'T REMEMBER.
MAYBE IF OTHERS CAN HELP OR I
DON'T KNOW IF THE STUDY'S
AVAILABLE -- UM -- LET'S SEE.
I CAN'T REMEMBER.
EMILY, YOU'RE HERE.
>> IT RANGES FROM 2 YEARS TO 10
YEARS.
>> THEY WERE THE SMALLER AGE
RANGE.
DEANNA.
>> PART OF IT TOO IF YOU LOOK AT
THE BREAKFAST CONSUMPTION,
THAT'S KIND OF CONSISTENT WITH
NUMBER OF EATING OCCASIONS AND I
THINK IF YOU THINK ABOUT SNACKS
THAT NEED TO BE PROVIDED FOR
KIDS LIKE AN AFTERNOON SNACK OR
MAYBE A MID MORNING SNACK, I
THINK WHAT'S IMPORTANT THERE IS
EMPHASIZING IT NEEDS TO BE
HEALTHY FOOD AT THOSE MEALS AND
YOU NEED TO PAY ATTENTION TO
PORTION SIZES WHICH WE'LL TALK
ABOUT IN JUST A SECOND.
>> JEN.
>> I JUST WANTED TO ADD THIS IS
AN AREA EESPECIALLY --
ESPECIALLY IN KIDS THAT LENDS
ITSELF WELL TO CLINICAL TRIALS
BECAUSE IN AT LEAST IN THE SHORT
TERM YOU CAN SYSTEMICALLY
MANIPULATE THE AND IT'S PROBABLY
VERY PRUDENT TO ENCOURAGE
SCIENCE THAT DOES THAT BECAUSE I
THINK THIS HAS BIG IMPLICATIONS
FOR THINGS LIKE FEDERAL PROGRAMS
AND HOW OFTEN CHILDREN ARE FED,
HOW MUCH THEY'RE FED IN THE
PROGRAMS.
TO ME IT STRIKES ME AS AN AREA
WHERE THERE'S A NEED FOR SCIENCE
THAT WOULD HELP TEASE OUT THESE
ISSUES BECAUSE THEY ARE
INTERESTING AND IT'S QUITE
COMPLICATED.
ARE THESE MEALS?
ARE THEY SNACKS?
WHAT IS THIS?
I DON'T THINK WE REALLY KNOW
BASED ON THIS TYPE OF DATA.
IT'S AN IMPORTANT QUALIFICATION
OF WHAT WE'RE RECOMMENDING.
>> YEAH, AND FOLLOWING UP ON
WHAT JEN SAID, THERE MAY BE
DIFFERENT PERCEPTIONS OF WHAT A
MEAL AND SNACK IS DEPENDING ON
THE CULTURE.
THAT'S SOMETHING THAT WE MAY
NEED ALSO QUALITATIVE WORK TO BE
ABLE TO UNDERSTAND THIS.
MOST OF US DO CONSUME OUR THREE
MAIN MEALS AND SNACKS BUT IT MAY
BE DIFFERENT IN OTHER CULTURES.
>> I JUST WANTED TO REITERATE
WHAT JENNY SAID.
WE NEED MORE STUDIES IN THIS
AREA AND I CAN THINK FROM A
PRACTICAL IMPLICATION I KNOW
FROM OUR WORK IN SCHOOL MEALS
THAT SOMETIMES IF THE SCHOOL
LUNCH WAS LATE BECAUSE THERE
WERE A LOT OF KIDS IN THE
SCHOOL, THE KID WOULD START ACT
BEING UP IF THEY COULDN'T GO TO
LUNCH UNTIL ABOUT 1:00.
IN SOME SCHOOLS THAT'S HOW YOU
HAVE TO MANAGE THE SCHOOL FOOD
SERVICE.
SO GOING BACK TO WHERE IT WOULD
BENEFIT IN FEDERAL PROGRAMS, I
THINK THAT'S A REALLY GOOD
RECOMMENDATION.
>> THANK YOU.
ALL RIGHT.
I THINK THIS IS A GREAT WAY TO
GET US TO THE NEXT PRESENTATION
ON FOOD PORTION SIZE AND THAT
WILL BE ALINE AND HOLLIE
PRESENTING.
SO PLEASE.
>> THANKS, CRISTINA, I'LL GET
OUT START AND ALINE WILL TAKE
OVER.
I WANT TO ACKNOWLEDGE THE WORK
OF THE COMMITTEE AS WELL AS THE
STAFF IN THIS AREA.
THE COMMITTEE DEFINED PORTION
SIZE AS THE AMOUNT OF FOOD OR
BEVERAGE SERVED OR CONSUMED AT
ONE TIME IN ONE EATING OCCASION
AND THIS INCLUDES PREPORTIONED
FOODS SELF-SERVED AND PACKAGED
FOODS AND BEVERAGES.
THE COMMITTEE PRIORITIZED ITS
QUESTIONS ON PORTION SIZE IN
ORDER TO UNDERSTAND HOW PORTION
SIZE INFLUENCES SELECTION AND
CONSUMPTION OF FOOD.
WE BELIEVE THIS WAS CRITICAL FOR
IDENTIFYING STRATEGIES TO HELP
INDIVIDUALS FOLLOW A HEALTHY
DIETARY PATTERN WITH APPROPRIATE
CALORIES TO ACHIEVE OR MAINTAIN
HEALTHY WEIGHT.
THE QUESTIONS RELATED TO PORTION
SIZE PRIORITIZED BY THE
COMMITTEE EXPAND UPON PREVIOUS
REVIEW IN THE LITERATURE AND A
SYSTEMATIC REVIEW HAD NOT BEEN
DONE BY THE DIETARY GUIDELINES
COMMITTEE.
WE INCORPORATED FOOD SIZE AND
DENSITY AND PORTION SIZE TO
ACHIEVE GUIDELINE
RECOMMENDATIONS.
WE HAD TWO SYSTEMATIC REVIEWS
CONDUCTED.
THE FIRST WAS ON THE
RELATIONSHIP BETWEEN PORTION
SIZE AND BODY COMPOSITION AND
RISK OF OBESITY AND THE SECOND
WAS ON THE RELATIONSHIP BETWEEN
PORTION SIZE AND ENERGY INTAKE.
THIS IS OUR HIGH-LEVEL VIEW OF
WHAT WE WILL REVIEW BUT FOR OUR
FIRST QUESTION THE COMMITTEE WAS
UNABLE TO DRAW CONCLUSIONS
ACROSS LIFE STAGES FROM
CHILDHOOD TO ADULTHOOD INCLUDING
PREGNANCY AND POSTPARTUM FOR THE
QUESTION ON PORTION SIZE AND
GROWTH BODY COMPOSITION AND RISK
OF OBESITY.
HOWEVER, THERE WAS A MUCH LARGER
BODY OF EVIDENCE FOR THE
COMMITTEE QUESTION ON THE
RELATIONSHIP BETWEEN PORTION
SIZE AND ENERGY INTAKE.
SUCH THAT CONCLUSION STATEMENTS
WERE DRAWN FOR CHILDREN AND
ADULT AND OLDER ADULTS BUT DUE
TO LACK OF EVIDENCE AMONG YOUNG
CHILDREN, ADOLESCENTS AND
INDIVIDUALS DURING POST
PREGNANCY CONCLUSIONS COULD NOT
BE DRAWN AMONG THE GROUPS.
AND AS I MENTIONED, WE WERE NOT
ABLE TO DRAW CONCLUSION
STATEMENT BETWEEN PORTION SIZE
AND BODY COMPOSITION AND RISK OF
OBESITY.
THE RATIONALE WAS FOR YOUNG
CHILDREN, CHILDREN AND
ADOLESCENTS THERE WAS JUST ONE
RANDOMIZED TRIAL WHICH HAD
METHODOLOGICAL LIMITATIONS.
FOR ADULTS AND OLDER ADULTS
THERE WERE 11 STUDIES HOUR
INCONSISTENCIES WITH THE
COMPARATORS AND OUTCOME TO DRAW
CONCLUSION.
THESE 11 STUDIES WERE PART OF
LOSS TRIALS.
FOR INDIVIDUALS DURING PREGNANCY
THIS WAS ONE PROSPECTIVE COHORT
STUDIES AND FOR INDIVIDUALS NO
EVIDENCE AVAILABLE HIGHLIGHTING
THE NEED FOR MORE RESEARCH IN
THIS AREA.
I'LL TURN IT OVER TO ALINE.
>> THANK YOU.
SO, RELATED TO THE QUESTION WHAT
IS THE RELATIONSHIP BETWEEN
PORTION SIZE AND ENERGY INTAKE.
THE COMMITTEE WAS ABLE TO
DEVELOP SEVERAL CONCLUSION
STATEMENTS AND CONSISTENT WITH
OTHER COMMITTEES, REVIEWS THE
DISTINCTION WAS MADE BETWEEN
FAVORABLE AND UNFAVORABLE
RELATIONSHIP BETWEEN PORTION
SIZE AND ENERGY INTAKE.
SO FOR THE PURPOSE OF THIS
REVIEW, THE FAVORABLE
RELATIONSHIP MEANS THAT THERE
WAS A REDUCTION IN ENERGY INTAKE
AND UNFAVORABLE RELATIONSHIP
MEANS AN INCREASE IN ENERGY
INTAKE.
AND FINALLY BECAUSE THE EVIDENCE
FOR PORTION SIZE AND ENERGY
INTAKE WAS LARGE ENOUGH, THE
COMMITTEE WAS ABLE TO
STRATEGICALLY ORGANIZE THE
EVIDENCE AND SEPARATE CONCLUSION
STATEMENT COULD BE DEVELOPED FOR
PORTION SIZE AND TYPE OF FOODS.
SO LOOK ENERGY DENSE FOOD,
FRUITS AND VEGETABLES AND PER
PRE-PORTIONED FOODS.
WE WERE ABLE TO DRAW TO
CONCLUSION STATEMENT THAT
DEMONSTRATED FAVORABLE
RELATIONSHIP BETWEEN PORTION
SIZE AND ENERGY INTAKE.
AMONG CHILDREN, LARGER PORTIONS
OF FRUITS AND VEGETABLES WAS NOT
RELATED TO GREATER ENERGY INTAKE
DUE TO THE LOW DENSITY OF THESE
FOODS.
AMONG ADULTS AND OLDER ADULTS,
THE USE OF PRE-PORTION FOODS
DECREASES ENERGY INTAKE AND WE
WERE ABLE TO DRAW THREE
CONCLUSION STATEMENT THAT
DEMONSTRATED UNFAVORABLE
RELATIONSHIP BETWEEN PORTION
SIZE AND ENERGY INTAKE.
AMONG CHILDREN, LARGER PORTION
OF ENERGY-DENSE FOODS WERE
RELATED TO GREATER ENERGY
INTAKE.
AMONG ADULTS AND ADULTS, LARGER
PORTIONS OF FOOD WERE RELATED TO
GREATER ENERGY INTAKE AND FOR
THOSE ADULTS AND OLDER ADULTS,
PORTION SIZE AND ENERGY DENSITY
WERE INDEPENDENT AND ADDITIVE IN
THEIR EFFECT ON ENERGY INTAKE.
SO THIS CONCLUSION WERE GRADES
AS MODERATE AND STRONG.
POINTING TO THE THIS POTENTIAL
PORTION SIZE TO BE USED AS A
FAVORABLE STRATEGY TO MANAGE
ENERGY INTAKE.
SO, THE BODY OF EVIDENCE
CONSIDERED ON ENERGY INTAKE
DEMONSTRATED INFERENCES OF FRUIT
AND BEVERAGE SIZE AMONG CHILDREN
AND ADULTS AND THE RELATIONSHIP
BETWEEN PORTION SIZE AND ENERGY
INTAKE IN YOUNG CHILDREN, OLDER
ADULTS AND INDIVIDUALS DURING
PREGNANCY AND POSTPARTUM.
SO NO CONCLUSION STATEMENT COULD
BE DRAWN FOR PORTION SIZE AND
ENERGY INTAKE AMONG YOUNG
CHILDREN AND ADULTS BECAUSE
THERE WAS NO EVIDENCE AVAILABLE.
SO IN OUR PROTOCOL THE INCLUSION
AGE WAS 1 UP TO 19 YEARS OF AGE
HOWEVER, OUR BODY OF EVIDENCE
RANGED FROM 2-9 YEARS WITH THE
MOST STUDIES EXAMINING CHILDREN
BETWEEN AGE 4-5.
NO CONCLUSION STATEMENT COULD BE
DRAWN FROM PRE-PORTIONED FOODS
AND ENERGY INTAKE AMONG YOUNG
CHILDREN AND PORTION SIZE AND
ENERGY DURING PREGNANCY AND
PARTUM AND PRE-PORTIONED FOOD
DURING PREGNANCY AND POSTPARTUM
COULD NOT BE EVALUATED BECAUSE
THERE WAS NO EVIDENCE.
SO, AMONG FOOD AND BEVERAGE
INTAKE DEPENDS ON THE ENERGY
DENSITY OF THE FOOD OR BEVERAGE
CONSUMED.
FOR GENERAL AND ADULTS PORTION
SIZE REFERS TO THE VOLUME OF THE
FOOD CONSUMED AND IF THE LARGER
PORTION IS OF ENERGY DENSE FOOD,
THEN ENERGY INTAKE INCREASES.
IF THE LARGER PORTION IS OF
LOWER ENERGY DENSE FOOD OR
BEVERAGES, ENERGY INTAKE MAY NOT
CHANGE THOUGH THE FOOD INTAKE
INCREASES PARTICULARLY AMONG
CHILDREN.
THE EVIDENCE WAS CONSISTENT
ACROSS PARTICIPANT
CHARACTERISTICS, SUCH AS AGE AND
BODY MASS INDEX AND AMONG MANY
TYPE OF FOOD SUCH AS UNIQUE FOOD
OR MACARONI AND CHEESE.
AND OUR ADVICE AS A DEPARTMENT
IS FOR CHILDREN AND ADULTS TO
CONSUME SMALLER PORTION OF
ENERGY DENSE FOODS TO STAY
WITHIN ENERGY REQUIREMENT AND
FOR CHILDREN, USE PORTION SIZE
STRATEGICALLY TO PROMOTE FRUITS
AND VEGETABLES WHICH ARE
NUTRIENT OF PUBLIC HEALTH
CONCERN SUCH AS POTASSIUM,
CALCIUM AND FIBER.
SO PRE-PORTIONED FOODS WHICH
GENERALLY ARE FOODS THAT ARE
BEEN PORTIONED AS A RECOMMENDED
STANDARD SERVING SIZE REDUCES
ENERGY INTAKE IN ADULTS AND
OLDER ADULTS AND CONSUMING
PRE-PORTIONED FOODS MAY RESULT
IN LOWER ENERGY INTAKE AND FOR
ADULTS TO USE PRE-PORTIONED
FOODS TO REDUCE INTAKE OF ENERGY
DENSE FOOD AND WE MADE TWO
SPECIFIC RECOMMENDATIONS.
ONE FOCUSSED ON FOOD PREPARED IN
THE HOME MORE MEAL PLANNING
COULD BE CONSIDERED OR PREPARING
FOOD FOR MULTIPLE MEALS IN THE
HOME STARRING ENERGY DENSE FOOD
AND PRE-PORTIONED FOODS
BENEFICIAL.
FOR FOODS CONSUMED AWAY FROM
HOME, SUCH AS IN COMMERCIAL,
NON-COMMERCIAL FOOD SERVICES
ESTABLISHMENT, CHOOSING ENERGY
DENSE FOOD IN SMALLER
PRE-PORTIONED FOODS IN PACKAGES
WILL BE BENEFICIAL.
YOU US
>> THANK YOU.
DO YOU WE HAVE QUESTION OR
COMMENTS.
>> FRUITS AND VEGETABLES TO BE
USED STRATEGICALLY FOR NEWT
ROE --
NUTRIENTS THAT MAY BE UNDER
CONSUMED AND CHILDREN HAVE
SMALLER STOMACHS AND WAS THERE
DISCUSSION OF THE BULK OF THE
FOODS AND THE ABILITY OF
CHILDREN TO EAT THE OTHER FOODS
OFFERED AT THE MEAL IF YOU'RE
GOING TO OFFER LARGER SERVINGS
OF THESE FOODS?
>> THAT'S A GREAT QUESTION.
>> I CAN TAKE THAT.
THE EVIDENCE WE SAW WAS ACROSS
EXPERIMENTS WHERE THE CHILDREN
WERE OFFERED DIFFERENT TYPES OF
FOOD AND SO THE RESEARCH
SPECIFICALLY DID NOT TALK ABOUT
THE VOLUME NECESSARILY, WHICH I
THINK WHAT YOU'RE REFERRING TO
OF THE FRUITS AND VEGETABLES
VERSUS MORE OF SERVING OR LARGER
PORTION SIZE INCREASE THEIR
INTAKE WITHOUT NECESSARILY
AFFECTING OTHER FOODS.
>> THERE ARE SOME STUDIES THAT
LOOK AT AS YOU CHANGE THE
PORTION SIZE WITHIN AN EATING
OCCASION HOW DOES IT INFLUENCE
OTHER FOODS WITHIN THE EATING
OCCASION.
THERE WASN'T ENOUGH LITERATURE,
BODY OF EVIDENCE TO PULL THAT
TOGETHER.
THINGS WERE DESCRIBED IN TERMS
OF VOLUME BUT EVERYTHING WAS
PRESENTED AS A GRAM WEIGHT
PORTION AND CHANGES IN THAT GRAM
WEIGHT PORTION.
SO THAT'S HOW IT'S PRESENTED IN
THE LITERATURE.
YOU BRING UP AN IMPORTANT POINT
YOU ANTICIPATE AS YOU ALTER
PORTION SIZES OF DIFFERENT FOODS
WITHIN AN EATING OCCASION IT
WILL HAVE EFFECTS ON DIFFERENT
FOODS.
>> DID THEY TRAP THE AMOUNT OF
OTHER FOODS CONSUMED AT THE SAME
MEAL OR UP OR DOWN?
>> THERE WASN'T ENOUGH
LITERATURE TO LOOK AT IT THAT
WAY.
>> THERE ARE WERE COOKED CARROTS
AND BROCCOLI AND DO YOU
REMEMBER?
>> I THINK IN THE LITERATURE
IT'S FAIRLY MIXED IN TERMS OF
HOW IT'S PRESENTED.
SO I DON'T THINK EVERYTHING IS
JUST A COOKED VEGETABLE.
>> THERE'S NOT ENOUGH DEPTH IN
THE LITERATURE TO SORT THAT OUT.
>> THERE WAS A CONCLUSION
STATEMENT RELATED TO THE
PRE-PORTIONED FOODS.
WAS THERE INFORMATION IN THE
TYPE OF THE PRE-PORTIONED FOODS
BECAUSE FOR CHILDREN THERE'S A
SPECIFIC NOTE ON FRUITS AND
VEGETABLES.
WAS THERE NOT ENOUGH EVIDENCE OR
WAS THAT A QUESTION NOT ASKED?
>> I DON'T THINK WE HAD
QUESTIONS ON THE TYPES OF FOODS.
WHAT WE DID WAS WHEN THE
EVIDENCE BASE WAS PRESENTED WE
ORGANIZED IT IN A WAY TO LOOK AT
THINGS AND THE QUESTIONS ARE
SPECIFIC ABOUT FRUITS AND
VEGETABLES WHICH DOESN'T OCCUR
AS MUCH IN THE ADULT LITERATURE
PER SE.
SO I THINK IN THE ADULT
LITERATURE THERE'S MORE VARIETY
IN TERMS OF THE DIFFERENT TYPES
OF FOODS BEING LOOKED AT AND
GENERALLY OFTEN TIMES AND JENNY
CHIME IN FOR THE ADULT STUDIES
IN THE PRE-PORTIONED STUDIES
IT'S MORE THE MAIN TYPE OR
ENTREE OF THE MEAL.
>> I'M WONDERING ABOUT THE
PORTION SIZE IN RELATINGTION TO
THE TIMING.
WITHIN THE MEAL ARE THE EATING
MORE CALORIES OR ALSO WITHIN 24
HOURS WITH COMPENSATORY EFFECTS.
>> I BELIEVE AND OTHER COMMITTEE
MEMBERS JUMP IN, I BELIEVE FOR
THE ENERGY QUESTIONS WE LOOKED
AT THINGS IN RELATION TO A MEAL
BECAUSE THAT'S WHERE A LOT OF
THE LITERATURE WAS COMPARED TO
WHEN WE LOOKED AT THE FREQUENCY
OF EATING OCCASION QUESTIONS WAS
MORE OVER A DAY.
AND SO THERE WAS NOT A LOOK AT
COMPENSATION OVER TIME I THINK.
>> IF YOU SERVE A LARGE PORTION
OF X WHAT HAPPENS TO ENERGY AT
THE MEAL AND FOOD INTAKE AT THE
MEAL.
SUBSEQUENT STUDIES AND THERE'S A
NUMBER OF THEM AND LOOKING AT
PORTION SIZES OF ALL FOODS
SERVES ACROSS THE DAY, MULTIPLE
DAYS, DO PEOPLE START TO
COMPENSATE, DO YOU SEE EFFECTS
AND WE SAW WHERE PORTION SIZES
WERE INCREASED OVER LONGER
PERIODS, STUDIES WERE PRETTY
CONSISTENT IN REPORTING
INCREASES IN DAILY ENERGY INTAKE
THOUGH THESE WERE RCT STUDIES SO
FAIRLY SHORT TERM IN DURATION
AND STAFF PROBABLY HAS AS BETTER
RECOLLECTION AND OVER DAYS AND
WEEKS WERE MOST STUDIES.
>> I'M CURIOUS ABOUT THE
PREPORTIONED SNACKS?
MORE COMMERCIAL OR TEACHING
FAMILIES HOW TO PREPORTION AND
THINKING OF COST OF MEASURING
CUPS AND THINKING OF WAYS FOR
PEOPLE TO DO THIS AT HOME AND
SAVE MONEY WITH THE LARGER
PACKAGES.
>> YOU BRING UP A GREAT POINT.
AGAIN, THAT MAY GO TO THE
IMPLEMENTATION STRATEGY WITHIN
THE STUDIES.
THE STUDIES WE LOOKED AT THEY
WERE NOT PROVIDED WITH TOOLS.
THAT'S A LITTLE BIT OF WHY WE
HAVE PROBLEMS COMING THE
CONCLUSION WITH BODY COMPOSITION
AND RISK OF OBESITY.
WE SAW A VARIETY OF STRATEGIES
AND NO ONE YOU COULD PULL
TOGETHER.
IN THE CHILD LITERATURE IT WAS
USUALLY PRE-PORTIONED BY THE
INVESTIGATIVE TEAM.
>> GREAT COMMENTS, EVERYONE.
THREW FOR EVERYONE WORKING ON
THIS TO GET THIS DONE IN GREAT
EXAMPLES OF STRATEGYIES FOR THE
NEXT DIETARY GUIDELINES.
WE'LL TALK ABOUT THE LAST
CHAPTER OF OUR SUBCOMMITTEE ON
CULT
CULTURALLY TAILORED DIET
INTERVENTIONS.
WE'LL FIRST PRESENT THE
BACKGROUND AND FRAME WORKS USED
AND THEN TALK ABOUT THE FINDINGS
IN OUR RECOMMENDATIONS AND
GUIDANCE.
>> THANK YOU TO THE SUBCOMMITTEE
AND THE STAFF WHICH HAVE BEEN
PHENOM FLAL.
THIS OF COURSE IS A NEW ENDEAVOR
WHEN IT COMES TO THE DIETARY
GUIDELINES AND WE'LL TALK ABOUT
THE EVIDENCE AND KUDOS TO THE
SUPPORT AND TALKING ABOUT THE
NEXT QUESTION.
SO CULTURE PLAYS AN IMPORTANT
ROLE IN INDIVIDUALS EXPERIENCES
WITH FOODS AND BEVERAGES AND
INFORMS THE SIGNIFICANCE AND
SYMBOLIC MEANING ATTACHED AND
GUIDES BELIEFS ABOUT
RELATIONSHIPS WITH DIET AND
HEALTH AND DIETARY BEHAVIOR COME
FROM THE COMPLEX INTERPLAY OF
PSYCHOLOGICAL AND SOCIO LOGIC
AND ECONOMIC AND SENSORY FACTORS
ALL OF WHICH ARE INFLUENCED BY
CULTURE.
WHAT WE THINK ABOUT CULTURE IN
THE WORK IT'S DEFINED AS THE
SHARED VALUES, NORMS AND BELIEF
SYMPTOMS THAT COLLECTIVELY SHAPE
ATTITUDES AND PERCEPTIONS
THROUGH WHICH THEY ARE INTERACT
WITH EACH OTHER AND THEIR
ENVIRONMENT.
IT PLAYS AN IMPORTANT ROLE IN
INDIVIDUALS' EXPERIENCES WITH
FOOD.
IT INFORMS THE SYMBOLIC MEANING
THEY ATTACH TO CERTAIN FOODS AND
GUIDES THEIR BELIEFS ABOUT THE
RELATIONSHIP BETWEEN FOOD AND
HEALTH.
DESPITE MODEST IMPROVEMENTS IN
DIETARY QUALITY, WE STILL SEE
THE RACIAL, ETHNIC, SOCIO
ECONOMIC AND IN SOME CASES
GEOGRAPHIC DISPARITIES INDICT
AND CHRONIC DISEASE RELATED
OUTCOME.
THESE OUTCOMES UNDER SCORE THE
NEED FOR CULTURALLY TAILORED
DIETARY INTERVENTIONS THAT
ADDRESS SPECIFIC HEALTH OUTCOMES
THAT HAVE A HIGH PREVALENCE IN
GROUPS AND INTERVENTIONS ARE
DESIGN TO ALIGN WITH SPECIFIC
CULTURAL PRACTICES, BELIEFS AND
PREFERENCES OF THE TARGET
POPULATION WITH THE AIM OF
INCREASING THEIR EFFECTIVENESS
AND ACCEPTANCE.
IT REALLY HELPS US DEEPEN OUR
UNDERSTANDING ABOUT THE
SIGNIFICANCE OF CULTURE AND HOW
IT CAN REALLY PLAY A ROLE IN
HELPING US LEVERAGE AND CHANGE
AND SUPPORT PEOPLE IN CHANGING
THEIR DIETARY PATTERNS.
AND IN 2025, WE PRIORITIZED THIS
IN CONTRAST TO OTHER COMMITTEE'S
IDEA OF INCORPORATING CULTURE,
EMPHASIZES THIS ABILITY TO APPLY
A HEALTH EQUITY LENS AND LOOKING
AT INTERVENTIONS AND STRATEGIES
THAT HELP PEOPLE MODIFY THEIR
BEHAVIORS.
THIS IS IMPORTANT AND LOOKING AT
CULTURALLY RESPONSIVE DIETS.
WE HAVE A VERY RACIALLY AND
ETHNICALLY DIVERSE POPULATION IN
THE U.S. AND IT CONTINUES TO
GROW AND THEN WE GOT A LOT OF
PUBLIC COMMENTS ABOUT THE
CONCERN FOR REPRESENTATIVENESS
OF THE GUIDELINES AND HOW THEY
CAN BE APPLIED ACROSS DIVERSE
POPULATIONS.
SO WHAT WE EAT IN AMERICA IN
NHANES SHOWS REGARDLESS OF RACE,
ETHNICITY AND SOCIO DEMOGRAPHIC
FACTORS, FEW INDIVIDUALS REALLY
MEET THE GUIDELINES OR CONSUME
FOOD GROUPS AND SUB GROUPS IN
ALIGNMENT WITH RECOMMENDATIONS.
BUT WE DO SEE SOME DIFFERENCES
AND VARIATIONS BY RACE AND
ETHNICITY AND IT EMPHASIZES THE
IMPORTANCE AGAIN OF HAVING THE
CULTURALLY RESPONSIVE DIETARY
APPROACHES.
SO FOR EXAMPLE A RELATIVELY HIGH
PERCENTAGE OF HISPANIC OR LATINO
POPULATIONS ARE AT OR ABOVE THE
RECOMMENDATIONS FOR BEANS, PEAS
COMPARED TO NON-HISPANIC WHITES.
YOU SEE A PERCENTAGE OF
NON-HISPANIC ASIAN POPULATIONS
ABOVE RECOMMENDATIONS FOR FRUITS
AND VEGETABLES, DARK GREEN
VEGETABLES AND OTHER VEGETABLES,
WHOLE GRAIN, NUTS, SEED AND SOY.
WE SEE THE AVAILABILITY AND THIS
EVIDENCE SCAN WAS CONDUCTED TO
UNDERSTAND THE BREADTH AND DEPTH
OF THE BODY OF EVIDENCE ON
CULTURALLY RESPONSIVE DIETARY
INTERVENTIONS AND IDENTIFY THOSE
STRENGTHS AND GAPS WITHIN
EXISTING LITERATURE TO GATHER
INSIGHT TO BE IMPLEMENTED IN A
SYSTEMATIC REVIEW IN THE FUTURE
AND HELP DEVELOP THAT PROTOCOL.
THE COMMITTEE OR SCAN OVER
SYSTEMATIC REVIEW BECAUSE THERE
WAS A NEED TO FURTHER DEFINE THE
SCOPE OF THIS WORK BEFORE MOVING
FORWARD INTO A SYSTEMATIC REVIEW
AND TAKE THE LESSONS LEARNED.
THE OTHER SCAN IS TO LOOK AT
EXPLORATORY EVIDENCE IS A
PROJECT TO DESCRIBE IN WHICH
SYSTEMATIC METHODS ARE USED TO
SEARCH FOR AND DESCRIBE THE
VOLUME AND CHARACTERISTICS OF
EVIDENCE ON THE NUTRITION
QUESTION OR TOPIC OF PUBLIC
HEALTH IMPORTANCE.
THE COMMITTEE CONDUCTED WITH
SUPPORT OF THE STAFF AND LOOK AT
THE QUESTION, WHAT EVIDENCE HAS
BEEN PUBLISHED ON THE
RELATIONSHIP BETWEEN CULTURALLY
TAILORED, DIETARY INTERVENTIONS
AND DIET RELATED PSYCHOSOCIAL
FACTORS AND DIETARY INTAKE AND
QUALITY AND HEALTH OUTCOMES.
SO FOR THIS SCAN WE USED SOME
EXISTING APPROACHES AND
CONCEPTUALIZATION THAT APPEARS
IN THE LITERATURE TO CATEGORIZE
CULTURALLY RESPONSIVE STRATEGIES
INTO THESE CATEGORIES.
WE USE TWO LAYERS OF THIS
CLASSIFICATION SYSTEM.
THE FIRST WAS DEVELOPED TO
PROVIDE A COMPREHENSIVE OVERVIEW
OF FIVE COMMON STRATEGIES WHICH
WE PRESENTED BEFORE.
EIGHT OF IT IS USED IN PUBLIC
HEALTH PROMOTION PROGRAMS AND
COMMUNICATION.
AND THE FIRST IS PERIPHERAL.
IT SEEKS TO GIVE PROGRAMS OR
APPEARANCE OF RELEVANCE TO A
PARTICULAR CULTURAL GROUP.
IT'S THE PACKAGING IN WHICH IT'S
GIVE EN TO A GROUP AND SEEKS TO
HIGHLIGHT THE PERFORM RATES OR
THE PREVALENCE OF A CERTAIN
HEALTH CONDITION AND WHEN
PRESENTING THE EVIDENCE AND HOW
IT IMPACTS THE GROUP.
LINGUISTIC SEEKS TO MAKE HEALTH
EDUCATION PROGRAMS AND MATERIALS
MORE ACCESSIBLE BY PROVIDING
THEM IN THE DOMINANT OR NATIVE
LANGUAGE OF THE TARGET GROUP.
CONSTITUENT INVOLVING IS WHERE
YOU HAVE DIRECT EXPERIENCE OF
MEMBERS FROM THE CULTURAL GROUP
BOTH FROM THE COMMUNITY AS WELL
AS REFLECTING THE CULTURAL
BELIEFS AND ATTITUDES OF THE
GROUP AND SOCIO-CULTURAL.
CONTEXT OF THE BROADER SOCIAL
AND CULTURAL VALUES AND
CHARACTERISTICS OF INTENDED AUD
HYANNIS.
-- AUDIENCE.UD
HYANNIS.
-- AUDIENCE.D
HYANNIS.
-- AUDIENCE.
HYANNIS.
-- AUDIENCE.YANNIS.
-- AUDIENCE.ANNIS.
-- AUDIENCE.NNIS.
-- AUDIENCE.NIS.
-- AUDIENCE.IS.
-- AUDIENCE.S.
-- AUDIENCE..
-- AUDIE--
AUDIENCE.
SOME MAY BE IN BOTH AND I'LL
TALK ABOUT THE SECOND
CONCEPTUALIZATION WE'LL USE AND
COOKING METHODS OR ACTIVITIES
WITHIN AN INTERVENTION.
HIRING PEOPLE FROM THE TARGET
GROUP AND SO THOSE ARE SOME
STRATEGIES AND THEY APPEAR IN
THE LITERATURE WHEN WE START
TALKING ABOUT THE RESULTS OF THE
SCAN.
THE SECOND BUILDS ON THE LONG
HISTORY OF DEEP STRUCTURE AND
CULTURAL CONCEPTS THAT COME OUT
OF ETHNIC STUDIES SORT OF ETHNIC
FOCUS ON LOOKING AT BIPOC
POPULATION OR BLACK AND
INDIGENOUS TRADITIONS AS IT
RELATES TO CULTURAL PSYCHOLOGY
AND SO THESE WERE USED IN THE
CONTEXT OF PUBLIC HEALTH TO
THINK ABOUT INTERVENTIONS AT A
SURFACE STRUCTURE.
SIMILAR TO THE PERIPHERAL
CLASSIFICATION THE IDEA YOU HAVE
OBSERVABLE AND SUPERFICIAL
CHARACTERISTIC OF A POPULATION
INCLUDED IN THE INTERVENTIONS
LIKE AUDIO/VISUAL MATERIALS,
CHANNELS, THE SETTING FOR WHICH
AN INTERVENTION IS DELIVERED AND
THEN THOSE DEEP STRUCTURE
FACTORS WHICH ARE UNDERSTANDING
THE CULTURAL SOCIAL HISTORICAL,
ENVIRONMENTAL AND PSYCHOLOGICAL
FORCES THAT INFLUENCE TARGET
HEALTH BEHAVIOR IN THE
POPULATION.
SO PERCEPTIONS OF RELIGION, A
COLLECTIVE IDENTITY, FAMILY AND
SOCIETY, ALL OF THESE MAY BE
TARGETED IN AN INTERVENTION ON A
DEEP STRUCTURE.
THE CORE VALUES THAT MAY BE IN
VERBAL COMMUNICATION OR BELIEFS
ABOUT ANCESTORS.
THOSE FACTORS CAN BE
INCORPORATED INTO AN
INTERVENTION THAT HAVE DEEPER
CULTURAL MEANING VERSUS THE
SURFACE STRUCTURE.
SO I'M GOING TO TURN IT OVER TO
CRISTINA TO TALK ABOUT FEE
FINDINGS AND THEN OUR
RECOMMENDATIONS TO THE
DEPARTMENT.
>> WE PRESENTED THIS LAST MONTH
WHEN FATIMA PRESENTED THIS TO
THE TEAM.
SO I'M GOING TO BRIEFLY
SUMMARIZE THE MAIN FINDINGS.
SO THE EVIDENCE INCLUDED 178
ARTICLES, 139 CAME FROM
RANDOMIZED CLINICAL TRIALS AND
39 FROM NON-RANDOMIZED CLINICAL
TRIAL.
MOST PUBLISHED AFTER 2011.
MOST ARTICLES WERE IN ADULTS AND
INCLUDED MALE OR FEMALE THOUGH
MOST STUDIES WERE PROMINENTLY IN
FEMALE.
MOST ARTICLES REPORTED EITHER
HIGH LEVEL OF COMMUNITY
INVOLVEMENT OR AT LEAST SOME
COMMUNITY INVOLVEMENT IN THE
DESIGNING THE INTERVENTION AND
THE PROPORTION OF ARTICLES
REPORTING A HIGH DEGREE OF
COMMUNITY INVOLVEMENT GREW OVER
TIME THE STUDY WERE PUBLISHED.
THE MOST COMMON WERE BODY
COMPOSITION AND RISK OF OBESITY
AND MOST FUNDED BY THE U.S. OR
CANADIAN GOVERNMENT.
AMONG THE STRATEGIES USED, MOST
FREQUENTLY USED WERE THE
CONSTITUENT INVOLVING STRATEGIES
AND THESE ARE THIS STRATEGIES
THAT DRAW ON THE EXPERIENCE OF
THE MEMBERS OF THE TARGET GROUP.
AND WE THINK THE INVOLVEMENT
STRATEGIES INCLUDED A RANGE OF
SURFACE AND DEEP STRUCTURAL
LEVELS OF CULTURAL SENSITIVITY.
THE NEXT STRATEGY WAS THE SOCIO
CULTURAL STRATEGY AND THESE WERE
STRUCTURE FOLLOWED BY THE OTHER
THREE, THE PERIPHERAL,
EVIDENTIAL AND LINGUISTIC
STRATEGIES WHICH WERE ALL NEARLY
SURFACE STRUCTURE.
SO, BECAUSE THE EVIDENCE DID NOT
ASSESS THE EFFECTIVENESS OF THE
INTERVENTIONS ON THE OUTCOMES OF
INTEREST, THE PRIMARY OUTPUT OF
THIS EFFORT WAS TO PROVIDE
FUTURE DIRECTIONS.
WE'LL FIRST HIGHLIGHT THE FUTURE
DIRECTIONS FOR FEDERAL PROGRAMS
AND CULTURALLY TAILORING MAY
HELP PROMOTE BETTER NUTRITION
AND FOOD SECURITY BY PROVIDING
INDIVIDUALS WITH FOOD THAT ARE
FAMILIAR AND ALIGN WITH THEIR
CULTURAL PRACTICES AND
PREFERENCES.
OUR TWO CONSIDERATIONS ARE
FLEXIBILITY FOR FEDERAL
ASSISTANCE PROGRAMS TO TAILOR TO
THEIR COMMUNITIES WHICH MAY HELP
IN THEIR IMPLEMENTATION,
DELIVERY AND ACCEPTANCE.
AND PROVIDING MORE FUNDING TO
CONDUCT MORE RESEARCH IN THIS
AREA.
THE NEXT SLIDE IS CONSIDERATIONS
FOR FUTURE RESEARCH AND WE HAVE
A FEW ONES WE HAVE BEEN
DISCUSSING.
SO BECAUSE WE THINK IT'S
IMPORTANT TO APPLY THE
CULTURALLY RESPONSIVE APPROACH
ACROSS ALL LEVELS OF RESEARCH,
ENSURING THE LIVED EXPERIENCE OF
LEADERSHIP AND STAFF ARE REFLECT
THE IN THE COMMUNITY IS
INTEGRATED AT EVERY STAGE OF THE
WORK WE HAVE THE FOLLOWING FOUR
CONSIDERATIONS.
FIRST, TO PLAN FOR COMMUNITY
INVOLVEMENT AND INTERVENTION
SUSTAINABILITY SHOULD BE
COMMUNICATED WITH MORE DETAILS
IN PUBLICATIONS.
THE MAJOR CHALLENGE THAT WE SAW
WHEN THE STAFF WAS EXTRACTING
THE DATA WAS IT WAS NOT REALLY
STATED IN THE METHODS HOW THEY
DID THINGS AND THIS IS PROBABLY
RELATED TO LIMITS OF NUMBER OF
WORDS THAT CAN BE ADDED AND SO
OFTEN INFORMATION WAS MISSING.
SO TO BE MORE SPECIFIC ABOUT
WHEN -- HOW THEY USE THE
COMMUNITY-BASED PARTICIPATORY
RESEARCH APPROACH AT DIFFERENT
STAGES.
THE SECOND ONE, WHICH KIND OF
FLOWS INTO THE PREVIOUS ONE IS
TO DEVELOP SOME SORT OF
CLASSIFICATION SYSTEM AND
CHECKLIST SIMILAR TO THE CONSORT
SO COMMON AUTHORS ARE PUBLISHING
IN THIS TYPE OF WORK, THEY
SPECIFICALLY NOTE ALL THESE
THINGS THAT ARE IMPORTANT AND
BECAUSE OF THE LIMITED NUMBER OF
SPACE THEY DID NOT
COMPREHENSIVELY DESCRIBE WHAT
WAS DONE AND HOW IT WAS DONE.
THIRD, AND I SAID THAT FOR THE
PREVIOUS SLIDE, WE NEED MORE
FUNDING IN THIS TYPE OF RESEARCH
BECAUSE THIS TYPE OF RESEARCH
TAKES TIME, PERSONAL RESOURCES
AND ENERGY FROM EVERYONE.
AND ANOTHER CONSIDERATION IS
FUTURE RESEARCH SHOULD ADDRESS
NON-MEDICAL DRIVERS OF HEALTH
LOOKING AT THEIR EFFECTIVENESS
AND EQUITY.
WE HAVE CONSIDERATIONS FOR THE
FUTURE COMMITTEE AND BE ABLE TO
CONDUCT AND LOOK AT THE EFFECTS
OF THE CULTURAL TAILORED
INTERVENTIONS ON HEALTH
OUTCOMES.
WE ENCOURAGE THE COMMITTEE TO
LOOK AT FACTORS BEYOND RACE,
ETHNICITY AND CONSIDERING THE
TIME SPENT IN THE U.S., COUNTRY
OF ORIGIN, DIRECT LOCATION WHEN
THEY'RE DEVELOPING THEIR
PROTOCOL.
EXPANDING THE EVIDENCE TO
INCLUDE QUALITATIVE STUDIES AND
WE DISCUSSED A BIT IN DIFFERENT
MEETINGS WE HAD ABOUT
CONSIDERING THE QUALITATIVE WORK
TO BE ABLE TO CAPTURE ALL THE
THINGS NOT CAPTURED BY
QUESTIONNAIRES.
THANK YOU FOR EVERYONE INVOLVED
AND WE WERE STARTING TO FIND A
WAY OF DEVELOPING THE PROTOCOL
WITH THE STAFF RECOMMENDED THE
EVIDENCE SCAN.
IT MADE TOTAL SENSE.
I THANK THE STAFF FOR COMING UP
WITH THE IDEA AND BEING ABLE TO
CONTINUE WITH THE WORK.
THANK YOU.
HEATHER.
>> THANK YOU FOR ALL THE WORK
THEY DID TO THINK ABOUT THE
FRAMEWORK AND EVERYTHING WAS SO
HELPFUL.
ONE THING I WONDERED ABOUT IN
THE RECOMMENDATIONS WAS YOU MADE
ABOUT TAILORING MORE TAILORING
TO THE DIFFERENT GROUPS THAT
THESE INTERVENTIONS WOULD BE
MADE FOR WHICH I SUPPORT AND
AGREE WITH BUT WHENEVER WE DO
THAT AND I'M JUST THINKING ABOUT
THIS IN RELATIONSHIP TO A
PROGRAM LIKE THE SNAP ED PROGRAM
THAT DOES ALLOW TAILORING FOR
THE DIFFERENT STATES AND GROUPS
WHERE IT'S USED.
WHENEVER THERE'S MORE TAILORING,
IT CAN MAKE IT MORE DIFFICULT TO
DRAW MEANING OUT OF EVALUATING
THOSE PROGRAMS OR INTERVENTIONS
BECAUSE THEY'RE SO DIFFERENT.
SO WITH THAT ABILITY TO MEET THE
GROUPS WHERE THEY ARE MORE
DIRECTLY, IT JUST MAKES THE
INTERVENTIONS MORE DIFFICULT
MAYBE TO SYNTHESIZE TOGETHER AND
TO UNDERSTAND IF THEY'RE
EFFECTIVE.
I WONDER IF YOU HAVE
RECOMMENDATIONS FOR HOW TO DO
BOTH, WHICH JUST MAYBE A PUSH
AND PULL.
MAYBE IT'S DIFFICULT.
I WONDER IF YOU HAD DISCUSSIONS
ABOUT THAT.
>> I DON'T THINK WE GOT THERE
BECAUSE I DON'T THINK WE HAD
THAT TIME BUT JUST DRAWING ON MY
EXPERIENCE, THE WIC PUERTO RICO
IN THE LUNCH PROGRAM IN PUERTO
RICO
>> CRISTINA, DO YOU MIND MUTING
YOUR PHONE.
WE'RE GETTING AN ECHO.
THANK YOU.
CONTINUING PLEASE.
>> DRAWING ON MY EXPERIENCE IN
PUERTO RICO, THE LUNCH PROGRAM
DID TAILOR A LITTLE BIT THE FOOD
SPACE ON WHAT IS AVAILABLE.
I THINK NOT TO LOWER THE
STANDARDS BECAUSE THAT'S WHAT
THE KIDS WILL CONSUME BUT TO USE
WHAT'S AVAILABLE AMONG THE
VEGGIES THERE ARE WITHIN THE
STANDARDS AND USE THE ONES MORE
AVAILABLE, MORE CULTURALLY
ACCEPTED SO I THINK THERE ARE
SMALL THINGS THAT CAN BE DONE
WITHOUT COMPROMISING THE
STANDARDS BUT I DON'T KNOW IF
OTHERS CAN -- ARRANGE --
ANGELA I DON'T KNOW IF YOU HAVE
EXPERIENCE IN THIS.
>> I THINK WITH THE EVALUATION
OF PREVIOUS EXPERIENCE OF USING
CORE STRATEGIES AND I KNOW WE
DIDN'T LOOK AS MUCH AT THAT AND
THAT'S A GOOD QUESTION.
I DIDN'T THINK ABOUT THAT
BEFORE.
I KNOW IN OUR EXPERIENCE OF
WORKING ON INTERVENTIONS, YOU
USE THE SAME THING EXCEPT
MODIFYING IT TO BE MORE
MEANINGFUL.
I THINK IN WEIGHT LOSS
INTERVENTION, GOAL SETTING OR
SELF-MONITORING.
THOSE CONCEPTS ARE STILL
IMPORTANT BUT WHY AND HOW YOU
INCORPORATE THEM AND SO IN
THINKING ABOUT EVEN THE
NUTRITION EDUCATION PROGRAM,
SOME ARE MORE TARGETED VERSUS
BEING TRAILE TAILORED VERSUS TH
COMMUNITY LEVEL AND SO I THINK
THERE'S A PREVIOUS REVIEW THAT
NONE OF OUR TEAM LED USING
RECRUITER IN WEIGHT LOSS
STRATEGIES AND INTERVENTIONS.
PART IS THOSE STRATEGIES AND
CONCEPTS CAN BE VERY SIMILAR
EXCEPT YOU MODIFY HOW THEY'RE
DONE IN THE DIFFERENT
POPULATIONS WHERE IT OCCURS.
THINGS ARE STILL MEANINGFUL TO
ALL POPULATIONS AROUND THAT'S
ONE OF THE THINGS WE PROBABLY
NEED TO LOOK AT.
ONE OF THE THINGS THAT CAME OUT
WE DIDN'T PRESENT THIS TIME BUT
LAST TIME IS THE RESPONSIVE
INTERVENTIONS INCLUDING WHITE
POPULATIONS AND SO PART OF THIS
IDEA WAS YOU ALWAYS THINK, OKAY,
IT'S GOING TO BE A CERTAIN TYPE
OF POPULATION THAT YOU INCLUDE
THESE STRATEGIES BUT I THINK
THEY'RE RELEVANT ACROSS THE
BOARD.
WE HAVE TO FIGURE OUT HOW
THEY'RE RELEVANT AND TO WHO BUT
I THINK THE THEORY -- I KNOW IN
THE LITERATURE IT'S LIKE
CULTURALLY TARGETED OR TAILORED
INTERVENTION ONLY HAPPENS WITH
PEOPLE THAT ARE MINORITIZED IN
THE LITERATURE NOT LIKE THIS
BROADER IDEA THAT WE HAVE
SPECIFIC CULTURAL VALUES OR
THINGS THAT CAN BE IMPORTANT
ACROSS GROUPS AND CAN WE STUDY
THAT LIKE THE ADAPTATION ITSELF
AND I KNOW IN OTHER AREAS LIKE
HIV, THEY'VE DONE A LOT OF THAT.
LIKE THAT THING VERSUS THE IDEA
OF THINKING THESE INTERVENTIONS
ARE SO DIFFERENT.
SO THAT I THINK IS A GOOD
QUESTION I DIDN'T THINK ABOUT
BEFORE.
>> THANKS, ANGELA.
CHERYL.
>> YEAH, MY COMMENT IS DIFFERENT
FROM WHAT I'M ABOUT TO SAY WHICH
IS A RESPONSE TO ANGELA WHICH IS
THE CVD WORLD NOW THERE'S A
GROWING MOVEMENT AROUND STUDYING
THE ACTUAL PROCESS AS WELL.
IT'S A COMMUNITY-DRIVEN METHODS
LIKE REALLY TRYING TO ADVANCE
HOW THOSE THINGS GET DONE FOR
CARDIOVASCULAR HEALTH OUTCOMES.
SO THERE'S PROBABLY SOMETHING TO
BE LEARNED THERE.
ONE OF THE PROJECTS IS IN FOOD
JUSTICE.
THAT'S GOING TO HOPEFULLY BE
INSTRUCTIVE FOR THE NEXT
COMMITTEE.
THE THING THAT WE DISCUSSED IN
OUR COMMITTEE DELIBERATIONS IS
MAYBE WE HAVEN'T WORDED THE
RECOMMENDATION AROUND FUTURE
RESEARCH AS OPTIMALLY AS WE
COULD ON CULTURALLY TAILORED
INTERVENTION TAKE TIME AND
PERSONNEL AND RESOURCES.
WE ADDRESS FUNDING AND THIS
AMOUNT OF TIME WE HAVE.
I LOVED CHRISTOPHER'S EXAMPLE
AROUND YOU'RE NEVER GOING TO GET
THE CLASSIC INTERVENTION 40
YEARS OF STUDY OF SOMEONE TO DO
THE KINDS OF MANIPULATIONS OF
EXPOSURE AND WHEN WE THINK OF
CULTURALLY TAILORED
INTERVENTIONS I WONDER OFTEN IF
THE CURRENT PARADIGM WITHIN MOST
OF NUTRITION RESEARCH IN THIS
SPACE BEING FUNDED MAKES ANY
SENSE AT ALL?
THE TIME IT'S GOING TO TAKE TO
BUILD RELATIONSHIPS TO HAVE
THOSE RELATIONSHIPS TURN INTO
TRUSTING RELATIONSHIPS.
TO HAVE THE TRUSTING
RELATIONSHIPS TURN INTO
BI-DIRECTIONAL COMMUNICATION
AROUND THE CULTURAL ISSUES WE
SHOULD BE TAILORED.
TO HAVE THOSE BI-DIRECTIONAL
QUESTIONS THAT GET TURNED INTO
FULLY DEVELOPED PROJECTS THAT
THEN GET TURNED INTO POTENTIAL
ANSWERS THAT ARE SUSTAINABLE.
AND SO PERHAPS IT IS WRITTEN A
LITTLE TOO NARROWLY TO ALLOW FOR
ALL THOSE THINGS TO HAPPEN IN
ITS MOST OPTIMAL FORM AND PLAY
WANT TO GO BACK AND REVISIT THE
TEXT.
I'D LOVE TO HEAR WHAT OTHERS
THINK ABOUT THAT.
>> GREAT RECOMMENDATION, CHERYL
AND PLEASE DO SO.
ALWAYS HAVING A DIFFERENT SET OF
EYES AND WE NEED SOME TIME ALSO
TO THINK ABOUT SOME OF THESE
THINGS AND LIKE HEATHER'S
QUESTION GOT US TO LIKE, OH, WE
HAVEN'T HAD TIME.
TAKING MORE TIME AND THOUGHT
THAT'S NEEDED.
PLEASE, WE STILL HAVE TIME.
WE STILL HAVE A FEW DAYS BEFORE
WE HAVE TO SUBMIT THIS.
LET'S IMPROVE AND MAKE SURE IT
IS COMPLETE AND CAPTURING ALL
IT'S NEEDING TO CAPTURE.
>> I THINK THE OTHER THING AND
GOING BACK ON THE COMMENT ABOUT
THE RACIAL CATEGORIZATION,
BECAUSE SOME INTERSECTED WITH
HOW PEOPLE CLASSIFY THEIR RACE
AS COMPARED TO HOW THEY CLASSIFY
THEIR ETHNICITY.
I THINK YOU MENTIONED BECAUSE WE
KNOW VERY LITTLE ABOUT HOW AND
WHY THEY CHANGE AND WE COULD
HAVE MORE EXTENSIVE EVIDENCE AND
WHAT YOU'RE TALKING ABOUT
FUNDING NOT ONLY TAKES TIME TO
BUILD TRUST, IT TAKES TIME TO DO
THE FORMATIVE WORK TO UNDERSTAND
WHY PEOPLE MAKE DECISIONS
OUTSIDE OF THOSE THAT MAY BE
ABLE -- EVEN SOME OF THE PEOPLE
THAT ARE IN THESE EIGHT WEEK
TRIALS ARE VERY DIFFERENT THAT
MAY BE HIGH RISK WE NEED TO
LEARN MORE ABOUT BUT WE MIGHT
ONLY BE GETTING A CUT OF THE
POPULATION AS FAR AS
CHARACTERISTICS WE MIGHT WANT TO
DEVELOP INTERVENTIONS FOR.
>> GREAT, THANK YOU.
COMMENCE AND THOUGHTS?
SARAH.
>> I'M SPELL BOUND BY THE WORK
OF THE ENTIRE WORKING GROUP.
YOU'VE DONE GROUNDBREAKING WORK
AND I THINK IT'S ASKING ALL OF
US TO THINK ABOUT OUR ACTIVITIES
DIFFERENTLY.
I'M TO RECONCILE THE WORK AND
THOUGHT UNDER THE CULTURALLY
TAILORED DIETS AND OUR
DISCUSSION YESTERDAY ABOUT
BUILDING IN FLEXIBILITIES AND
THERE WAS A LOT OF DISCUSSION
ABOUT GUARDRAILS AND HOW
FLEXIBLE CAN WE GO.
I'D LOVE TO THROW IT TO YOU AS A
COMMITTEE THAT UNDERSTANDS THIS.
ARE THERE RECOMMENDATIONS WE CAN
OR ARE THERE FUTURE DIRECTIONS
WHERE WE CAN TAKE WHAT YOU'RE
TALKING ABOUT AND SOMEHOW
COMPLEMENT AND DOVETAIL WITH THE
FLEXIBILITIES OF THE DIETARY
PATTERNS?
SO THEY'RE NOT MUTUALLY
EXCLUSIVE.
I THINK THAT'S WHAT I'M TRYING
TO SAY.
RIGHT NOW IT FEELS LIKE THEY'RE
NOT HARMONIZED AND WONDER IF
THERE WAS DISCUSSION AROUND
THAT.
SORRY OR ASKING SUCH VAGUE --
>> MAYBE I'LL TAKE A STAB AT
THIS IF IT'S OKAY.
WHEN CHRISTOPHER MENTIONED THE
MY PLATE I THINK HE CALLED IT 20
PLATES, SO I THINK THAT WAS
BRIDGING TO THE POINT YOU JUST
ASKED SARAH AROUND WHAT DO WE
MAKE OF A LANDSCAPE REVIEW
AROUND CULTURALLY TAILORED
DIETARY INTERVENTIONS IN LIGHT
OF ALL THAT WE SEE WITH REGARDS
TO WHERE PEOPLE CURRENTLY ARE,
HOW DO WE MEET PEOPLE ARE THEY
ARE ARE AND HOW DO WE MAKE
RECOMMENDATIONS THAT STAND A
CHANCE OF HOPEFULLY I THINK IN
FIVE YEARS IS TOO SHORT BUT
MAYBE 10 OR 15 YEARS STARTING TO
GET THE UPTICK IN THE ADHERENCE
AND CONSUMPTION I THINK WE'RE
ALL DOING THIS WORK IN HOPE OF.
SO, THE ACKNOWLEDGEMENT
THROUGHOUT I HEARD YESTERDAY
THROUGHOUT ALL THE VARIOUS
CHAPTERS AROUND AND WE STEP BACK
AND LOOK AT WHAT MAKES IT
POSSIBLE FOR PEOPLE REGARDLESS
OF WHAT THEIR BACKGROUNDS ARE,
WHERE THEIR FAMILIES LIVE, HOW
ACULTERATED -- ACCULURATED THEY
ARE AND WE DON'T WANT TO
OVERSTATE WHAT ANYONE CAN MAKE
BUT WHEN WE LOOK AT THE
STRATIFIED ANALYSES PRESENTED
AROUND AGE, RACE AND SEX GROUPS
AND WHAT IT MEANS FOR WHERE
PEOPLE CURRENTLY ARE IN INTAKES
AROUND THE VARIOUS NUTRIENTS, I
THINK IT WOULD BE VERY HARD TO
NOT CONSIDER THE OPPORTUNITY TO
BRING THESE INTO THE DIETARY
PATTERNS CONVERSATIONS.
>> WE HAVE THE HOW AND WE'RE
THINKING ABOUT THE WHAT AND WE
WE SHOULD BE THINKING ABOUT THE
WHY.
SORT OF GOING AND PUTTING THESE
PIECES TOGETHER AND THE
FLEXIBILITIES ALLOWS US TO LOOK
AT THE WHAT OF THE CULTURAL DIET
AND THE SCAN IS LOOKING AT THE
HOW AND PORTION SIZE AND THEN
THE CULTURALLY TAILORED INSTEAD
OF LOOKING AT THE HOW AND WHAT.
I DON'T THINK WE SPENT AS MUCH
TIME AS MUCH THINKING ABOUT THE
WHAT.
I KNOW WE TALKED ABOUT THE
SYSTEMS RECOMMENDATIONS BUT
THERE ARE PROBABLY SOME
INDIVIDUAL LEVEL RECOMMENDATIONS
OR GROUP LEVEL AT THE FAMILY
LEVEL THAT MAY BE OUTSIDE OF
INFANTS OR TODDLERS THAT PLAY
PLAY A ROLE WITHIN THAT AND I
KNOW WE HAD TO DEPRIORITIZE SOME
OF THOSE QUESTIONS LIKE HOME
FOOD AVAILABILITY, FOR EXAMPLE,
AND LOOKING AT THE HOW AND HOW
TO CONSIDER THE WHY.
>> ANY OTHER QUESTIONS ON THE
TOPIC?
THIS IS PROBABLY A GOOD SEGUE TO
OUR NEXT SECTION.
KUDOS TO THE WORKING GROUP.
DID A GREAT GREAT JOB.
THANK YOU.
SO WE'RE COMING TO AN END.
AND WE'RE GOING TO TALK ABOUT
FUTURE DIRECTION AND MORE
INFORMATION FOR THE COMMITTEE
AND/OR OUR AUDIENCE AND THEN
WE'LL HAVE A DISCUSSION ON
CROSS-CUTTING THEMES WHICH IS
PROBABLY SIMPLY PULLING ALL THE
PIECES TOGETHER FROM THE LAST
TWO DAYS.
SO UP TO NOW WE'VE BEEN TALKING
ABOUT CHAPTER 10.
THAT'S ALL THE EVIDENCE WE'VE
BEEN LARGER FOR THE DURATION OF
THE MEETING AND NOW TALK ABOUT
FUTURE DIRECTIONS CHAPTER.
SO THE PURPOSE OF CHAPTER E,
FUTURE DIRECTION IS TO HIGHLIGHT
RESEARCH RECOMMENDATIONS.
THE PREVIOUS CONVERSATION WAS
VERY RELEVANT AND IT'S A
BEAUTIFUL SEGUE TO THIS.
WE'RE GOING TO HIGHLIGHT THE
RESEARCH RECOMMENDATIONS
IDENTIFIED DURING DATA ANALYSIS,
THE SYSTEMATIC REVIEWS WE
LEARNED ABOUT TODAY AND THE FOOD
PATTERN MODELLING WE LEARNED
ABOUT YESTERDAY AND GOING TO
EMPHASIZE THE SUPPORT NEEDED FOR
FEDERAL DATA AND OTHER
ACTIVITIES RELATED TO THE
DIETARY GUIDELINES AND AS WE
HAVE JUST DISCUSSED SUGGEST
CONSIDERATIONS FOR FUTURE JOU
JOURNEYS AND OUR TIME IS COMING
TO AN END AND SO NOW WE'RE
THINKING ABOUT PASSING IT ON TO
THE NEXT GENERATION OF DIETARY
ADVISORY COMMITTEES BUT ALSO
CONCRETE ADVICE TO THE PROCESS
OF DIETARY GUIDELINES.
YOU HEARD IN PRIOR PRESENTATIONS
YESTERDAY AND TODAY EACH
COMMITTEE DEVELOPED FUTURE
DIRECTION AND THE RATIONALE IN
THEIR RESPECTIVE CHAPTERS.
THIGHS ARE BEING COLLATED BY
STAFF AND PULLED TOGETHER IN ONE
CHAPTER CALLED FUTURE DIRECTION.
WE AS A FULL COMMITTEE WILL BE
REVIEWING THEM AS WE FINALIZE
OUR SCIENTIFIC REPORT.
SO THIS WILL BE THE TIME TO
REFINE AND WE CAN PROBABLY
HARMONIZE QUITE A FEW.
JUST AS AN EXAMPLE, WE ALREADY
PULLED SOME FROM THE INDIVIDUAL
CHAPTERS.
WE HEARD A LOT ABOUT THE
IMPORTANCE OF HAVING
SURVEILLANCE DATA AND WE REALLY
EMPHASIZED THE VALUE OF NHANES
BUT WE HAVE ALSO IDENTIFIED
WHERE NHANES WOULD BENEFIT FROM
EXPANSION PARTICULARLY WHEN WE
WERE TALKING ABOUT POPULATION
GROUPS NOT REPRESENTED IN
NHANES.
AND WHEN WE ERROR TALKING ABOUT
FOOD PATTERN MODELLING, PERHAPS
LESS IN THE PUBLIC MEETINGS 7
BUT MAYBE MORE IN PUBLIC
MEETIMEET
MEETINGS 5 AND 6 WE NEEDED FOOD
COMPOSITION DATA AND THEY NEED
TO BE NIMBLE TO REFLECT A VERY
RAPIDLY EVOLVING FOOD MARKET.
NORTH OF THE FUTURE DIRECTIONS
AND RECOMMENDATIONS IS THE
PRIORITIZING UPDATES TO AN
EXPANSION OF THE FOOD NUTRITION
DATABASE FOR DIET STUDIES TO
KEEP IT INTERSTATE WITH THE
CURRENT MARKET AND UPDATED FOOD
COMPOSITION DATA IN THE USDA
NUTRIENT DATABASES WHICH FALLS
UNDER THE UMBRELLA OF FOOD DATA
CENTRAL IN A TIMELY MANNER.
I THINK TIMELY IS REALLY
CRITICAL AND I THINK THIS CAME
UP A LOT WHEN WE HAD THE
DISCUSSIONS AND MEETINGS ON
PLANT MILK ALTERNATIVE.
WE HAVE TALKED A LOT ABOUT
REPRESENTATION OF POPULATION IN
WHICH EVIDENCE IS LACKING.
I THINK TODAY'S DISCUSSION WAS
VERY RICH AND SUPPORTED THAT AND
WE CONTINUE FOR CONSIDERATION
FUTURE COMMITTEES.
WE'RE CONTINUING TO -- WE WANT
TO CONTINUE TO CONSIDER HEALTH
EQUITY IN DATA ANALYSIS OF
FUTURE DIETARY GUIDELINES
ADVISORY COMMITTEES.
THESE ARE SIMPLE EXAMPLES.
THEY'RE BY NO MEANS AN
EXHAUSTIVE LIST AND AS I SAID,
THESE WILL BE COMPLIED AND IN
THE FINAL REPORT.
NOW, WE TALKED ABOUT SECTION D,
WE TALKED ABOUT SECTION E.
PART B OF OUR REPORT IS REALLY
SETTING THE STAGE FOR THE ENTIRE
REPORT AND IT'S CROSS CUTTING
THEMES -- ITS CROSS-CUTTING
THEMES.
SO WE'VE BEEN LISTENING AND
TALKING WITH ALL OF YOU IN THE
WORKING GROUPS ABOUT WHAT ARE
THE CROSS CUTTING THEMES ACROSS
OUR REPORT.
AND THIS IS WHERE WE ARE NOW.
WE IDENTIFIED FIVE CROSS-CUTTING
THEMES.
HEALTH EQUITY IS ONE.
FLEXIBILITY AND INCLUSION IS
TWO, UNDERSTANDING NOT JUST WHAT
BUT ALSO HOW TO EAT TO ACHIEVE
HEALTHY EATING, THEME NUMBER
FOUR IS FOOD SYSTEMS.
WE HAD A LOT OF DISCUSSION
AROUND THAT YESTERDAY AND THEME
FIVE IS THE LIMITATIONS OF AND
THE NEED FOR MORE EVIDENCE.
NOW THE NEXT ONE IS DISCUSSION.
I'LL ASK THE PERSON CONTROLLING
THE SLIDES TO LEAVE THEM HERE.
WE CAN GET SOME REACTION FROM
THE ENTIRE COMMITTEE.
I'M HOPING EVERYONE CAN TURN ON
THEIR CAMERAS AND WE JUST WOULD
LOVE REACTION TO THIS.
IT DEFINITELY NEEDS WORDSMITHING
BUT WE MORE IMPORTANTLY WANT TO
KNOW ARE WE CAPTURING OUR FULL
COMMITTEE'S REPORT?
ARE THINGS MISSING OR THINGS
THAT CAN BE TAKEN OFF?
AND WITH THAT, ANGELA, I WOULD
LOVE YOU TO MAKE COMMENTS AND
THEN OPEN IT UP FOR DISCUSSION.
>> I WOULD LOVE TO HEAR WHAT
PEOPLE HAVE TO SAY.
LOOKING FOR FEEDBACK.
>> GREAT.
WITH THAT, BRING IT ON.
WE WANT TO HEAR YOUR REACTIONS.
WE WANT TO HEAR YOUR
RECOMMENDATIONS.
WE WANT TO HEAR YOUR CRITICISM.
THIS IS OUR REPORT.
AND THESE ARE THE THEMES OF OUR
REPORT AS DGAC 2025.
>> I FEEL THE THEME IS
ENCOMPASSING ALL THE OTHERS
RATHER THAN BE ONE.
I WONDER IF THERE'S A WAY FOR
FLEXIBILITY AND INCLUSION IS THE
NEED FOR MORE EVIDENCE OF
HEALTHY QUITTING AND HOW DO WE
COMBINE THOSE WOULD BE IMPORTANT
EVEN FOR THE FOOD SYSTEMS.
THANK YOU.
>> THANK YOU, ALINE, WE'RE
STRUGGLING WITH THAT.
THANK YOU FOR POINTING IT OUT.
POINT TAKEN.
DEANNA.
>> THEME THREE IS THAT THE
IMPLEMENTATION SCIENCE AND
BEHAVIORAL SCIENCE KIND OF
THEME?
I FEEL LIKE THAT'S A DIRECTION
THE GUIDELINES NEED TO GO IN
WHAT IS THE SCIENCE FOR GETTING
THESE IMPLEMENTED AND
STRATEGIES.
WE DID SOME HERE BUT WOULD BE
GOOD TO EXPAND ON THAT.
I THINK THAT'S WHAT THAT IS,
RIGHT?
IT'S A CLUNKY WAY TO SAY THAT
AND A WAY TO SAY IT AND THE
BEHAVIOR WORK.
SO ANY SUGGESTIONS AND DON'T
FEEL WE HAVE TO WORDSMITH IT
HERE.
I DON'T THINK THAT WOULD BE A
GOOD USE OF OUR TIME BUT MORE
CONCEPTS AND IF PEOPLE HAVE
CREATIVE IDEAS, LET US KNOW.
THIS IS STILL DRAFT.
BUT YES, IMPLEMENTATION SCIENCE,
THANK YOU.
CHERYL.
>> SO MY OVER ALL REACTION IS
THANK YOU FOR JUST TRYING TO PUT
IT INTO THESE FIVE CLEAR SPACES.
I AGREE WITH HEALTH EQUITY AND
INSTEAD PERHAPS THE THING THAT
STRUCK ME THE DEEPEST IS
ADHERENCE.
JUST THE LAST 10, 15 YEARS WHEN
WE LOOK AT THE TREND LINES,ING
IN THE '50s, MIDDLE '60s ON THE
HEI IS NOT WHERE WE NEED TO BE
AND TALK ABOUT IN EVERY PORTION
OF THIS REPORT INDIRECTLY AND
SOMETIMES DIRECTLY.
I THROW THAT OUT FOR
CONSIDERATION.
IN ADDITION TO TALKING ABOUT
WHAT AND HOW, I THINK IT'S
CRITICALLY IMPORTANT PEOPLE
UNDERSTAND THE WHY.
WE TALK ABOUT EDUCATION.
EDUCATION.
I'M A LITTLE TORN ON THE FOOD
SYSTEM AND FOOD SUPPLY AND
INDUSTRY PARTNERS.
UNTIL PEOPLE UNDERSTAND WHY THE
SHIFTS ARE BEING ASKED TO BE
MADE, IT MAY BE DIFFICULT TO GET
TO THE LEVEL PLAYING FIELD AND
GET INDUSTRY EXCITED AND
MOTIVATED TO SHIFT AND OFFER
PRODUCTS THAT ARE HEALTHFUL.
MAYBE THAT'S WHAT DEANNA MEANT
ON THE SCIENCE PART.
IT'S A DIFFERENT WHY WHEN IT
COMES TO INDUSTRY.
I DO SENSE INDUSTRY PARTNERS
HAVE SOCIALLY CONSCIENCE AND
WANT TO DO GOOD THINGS IN THE
FOOD SUPPLY AND SHOULD BRIDGE TO
THEM AS EFFECTIVELY AS POSSIBLE.
>> LET ME ASK A POINT OF
CLARIFICATION BECAUSE WITH THEME
THREE THERE'S THE ADHERENCE
PIECE OR LACK THERE OF.
IS THIS SOMETHING MUCH BROADER?
>> IT DIDN'T OCCUR TO ME WHEN I
READ THEME THREE SO I THINK IT'S
PROBABLY A DISCUSSION FOR THE
OTHER COMMITTEE MEMBERS AS WELL
BECAUSE IF IT'S RESONATING WITH
PEOPLE THAT'S FINE BUT I
CERTAINLY DIDN'T JUMP OUT TO ME.
>> THANK YOU.
>> I WAS WONDERING THEME TWO
FLEXIBILITY AND INCLUSION.
IS THAT SPECIFICALLY TALKING
ABOUT OUR DRAFT DIETARY PATTERNS
THEY ARE ARE FLEXIBLE IN GENERAL
WITH RESPECT TO THE FOODS AND WE
ARE TRYING OUR BEST TO INCLUDE
OR MAKE SURE THEY'RE INCLUSIVE
OF MOST INDIVIDUALS IN THE U.S.
THAT'S A VERY DIETARY PATTERN
SPECIFIC THEME.
I DON'T KNOW, IS THAT A THEME?
THE OTHERS ARE MORE HIGHER LEVEL
AND THIS ONE IS SPECIFIC.
I WAS WONDERING ABOUT THAT.
I WAS THINKING ABOUT THAT.
>> NOW YOU'RE SAYING IT AND I
THINK ONE OF THE CHALLENGES FOR
ANY OF YOU ON SUBCOMMITTEE 3
KNOWS, WE REALLY STRUGGLED WITH
SOME OF OUR TERMINOLOGY BECAUSE
WE VIEW MODIFICATION MUCH
FLEXIBILITY BOTH AS TERMS FOR
METHODOLOGY BUT ALSO IN OUR
GENERAL LANGUAGE.
SAMEERA, THIS IS RESONATING.
WE CAN'T USE LANGUAGE THAT
OVERLAPS WITH METHODOLOGY FOR
THIS VERY REASON.
DO I WANT TO COMMENT ON THAT?
I KNOW YOU HAD SOME -- YOU LAD
SOME IDEAS ABOUT THAT ONE.
>> YEAH, I DON'T KNOW IF WE
SHOULD USE THE SAME LANGUAGE,
THANKS, SAMEERA FOR THAT.
IT'S SORT OF A PROCESS TOO WE
HAD THERE WAS A LOT OF INCLUSION
AND THEY OVERLAP WITH HEALTH
EQUITY THE IDEA OF LOOKING AT
HAVING SOME FLEXIBILITY WHICH
MIGHT ONLY APPLY TO THE DIETARY
PATTERN BUT ALSO IS ALL THESE
RELATE TO EACH OTHER WHEN YOU
THINK ABOUT IT.
IT MAKES IT HARD.
THE CULTURAL EVIDENCE SCAN IS
REALLY NOT LIKE LOOKING AT
THINGS AND ONLY ONE WAY.
MAYBE FLEXIBILITY IS NOT THE
RIGHT TERM TO LOOK AT THINGS IN
DIFFERENT WAYS TO MAKE SURE THAT
THE IDEA OF INCLUSION WAS
REACHED.
>> ALINE.
>> THERE WAS DISCUSSION IN
PREGNANCY AND POSTPARTUM IS MORE
OF AN OPTIMIZATION OF HEALTH AND
IN OLDER ADULTS.
YOU WANT TO MAYBE AVOID
SARCOPENIA AND THOSE DISEASES
BUT ALSO ELEVATE QUALITY OF LIFE
WHICH I'M NOT SURE IS LEADING TO
CHRONIC DISEASE PER SE AND MORE
ON THE PREVENTION SIDE.
SO I FEEL LIKE WE TALKED QUITE A
BIT ON THAT ACROSS THE GROUPS
BUT I DON'T SEE IT HERE.
I DON'T KNOW WHAT TO NAME IT BUT
THE CONCEPT WE NEED TO BE
CAREFUL WHEN WE CONSIDER THE
LIFE STAGES.
>> I'LL BE HONEST, WE DID HAVE
CHRONIC DISEASE REDUCTION THERE
THINKING BEYOND IT AND THEN WE
HAD THE DISCUSSION YESTERDAY SO
IN MY SLEEP-DEPRIVED STATE THIS
MORNING I TOOK IT OUT BUT YOU'RE
RIGHT, I PROBABLY SHOULDN'T OF.
I THINK PART OF THAT WAS I
COULDN'T THINK OF SOMETHING
CREATIVE.
I THINK WHAT I HEARD YESTERDAY
AND THOSE PEOPLE WHO COMMENTED
ON THIS, I'D LOVE TO HAVE YOUR
INPUT.
IT'S NOT JUST -- IT'S NOT GOING
AWAY FROM CHRONIC DISEASE
REDUCTION MODEL.
IT'S THE CHRONIC DISEASE
REDUCTION MODEL PLUS I LIKE THIS
DEVELOPMENT FRAMEWORK.
I THINK I DID A CLASS AT
THROWING OUT SOMETHING WHEN IT
WAS BUILDING.
THANK YOU.
I'M GETTING EIGHT OF NODS.
DIDI, DID YOU HAVE A COMMENT.
>> HOLLIE, I SAW YOURS BEFORE ME
BUT MINE IS DIRECTLY ON THIS.
>> YOU GO FIRST.
>> OKAY.
SO, YESTERDAY'S SLIDE AND I LOST
SLEEP OVER THIS REDUCING FOCUS
ON THE DIETARY GUIDELINES ON
CHRONIC DISEASE RISK REDUCTION
WHICH SEEMS COMPLETELY AGAINST
THE ENTIRE OBJECTIVE OF WHY WE
PUT FORTH A HEALTHY PATTERN.
AND I ACTUALLY DID WANT TO
ADDRESS THIS JUST TO UNDERSTAND
AND FOR PUBLIC TO UNDERSTAND
WHERE THAT COMMENT OR POINT PLAY
HAVE COME FROM BECAUSE I KNOW WE
ALL HAVE GOOD INTENTIONS BEHIND
EVERYTHING WE'RE PUTTING OUT SO
MAYBE THERE WAS SOMETHING I'M
MISSING THAT HAPPENED IN A SUB
GROUP BECAUSE THESE ARE NOT
ENTIRE COMMITTEE ENDORSED BUT
DRAFT AND PROPOSALS.
I PERSONALLY WOULD RECOMMEND
COMPLETELY STRIKING THAT
SENTENCE FROM OUR REPORT.
HAVING AN ADDITIONAL FOCUS ON
OTHER IMPORTANT HEALTH METRICS,
QUALITY OF LIFE I AGREE WITH BUT
THE REDUCTION OF THE ROLE OF
DIETARY GUIDELINES ON CHRONIC
DISEASE PREVENTION IS NOT AND
SOME THEMES HAVE GONE VIRAL.
I THINK IT WOULD BE HELPFUL TO
UNDERSTAND WHERE THAT COMMENT
ORIGINATED FROM TO MAKE IT CLEAR
WHAT THE INTENT WAS.
I'M CURIOUS WHAT MOTIVATED THAT.
BUT I WOULD BE AGAINST
RESURRECTING THAT FOR A THEME.
>> I THINK IT WAS IN THE
WORDING.
I THINK IT SHOULD HAVE ADDED NOT
WAS A TAKEAWAY.
I THINK IT WAS IN THE WORDING
THAT IT SHOULD HAVE BEEN LOOKING
AT BECAUSE THE LIFE STAGE LIKE
IN INFANCY PLAY HAVE OTHER
OUTCOMES OR IN PREGNANCY OR IN
THE OLDEST LIKE OLDER ADULTS MAY
HAVE OTHER OUTCOMES AND AND I
THINK IT HAPPENED IN THE WORDING
TO SAY REDUCE WHEN REALLY I
THINK WHAT WAS TALKED ABOUT
ORIGINALLY WAS THE ADDITIVE.
IT WAS IN THE WORDING AND GONE
CONSOLIDATED TO SHIFT WHEN ET IT
WAS ADDITIVE.
>> THIS WAS A WHOLE CONCEPTS OF
THE CURRENT STRUCTURE OF CHRONIC
DISEASE MODEL AND COULD WE
EXPAND IT.
I WAS DISCUSSED AS THE FULL
COMMITTEE IN MEETING NUMBER 5.
BUT I AGREE WITH ANGELA.
I THINK IN THE EFFORTS TO BE THE
WORDING WAS PROBABLY UNFORTUNATE
BUT PROBABLY WHY WE'RE HAVING
THE DISCUSSION NOW.
>> I APPRECIATE THE
CLARIFICATION.
AND I ASSUMED IT WASN'T THAT WE
DIDN'T WANT TO FOCUS ON CHRONIC
DISEASE.
THAT'S HELPFUL AND FOR THE
RECORD THE DIETARY GUIDELINES IS
VERY MUCH FOCUSSED ON CHRONIC
DISEASE.
>> THANK YOU FOR BRINGING THAT
UP.
>> I'M GOING BACK TO SOME
COMMENTS I BELIEVE BUILDING ON
SOMETHING CHERYL SAID.
ANYWAY, IN REGARDS TO THEME 3,
I'M WONDERING IF THE WORDING
COULD BE SUCH THAT IT COULD BE
FOCUSSED A BIT ON MULTI-LEVELS.
IT'S NOT THAT WE'RE SAYING WE
DON'T WANT TO INCLUDE ANY
INDIVIDUAL LEVEL APPROACHES.
CERTAINLY SOME OF THE THINGS WE
TALKED ABOUT IN OUR
SUBCOMMITTEES ARE A LITTLE BIT
MORE FOCUSSED THAT WAY AND OF
COURSE WE HAVE FAMILIES.
BUT WE'RE ALSO RECOGNIZING WE
NEED TO GO BEYOND THAT.
THE WAY IT'S WORDED TO ME COMES
ACROSS VERY INDIVIDUAL LEVEL.
HOW CAN IT BE WORDED TO CAPTURE
THIS NEEDS TO BE MULTI-LEVEL AND
I UNDERSTAND WHAT CHERYL WAS
SAYING ABOUT ADHERENCE AND I
THINK OF THAT AT THE INDIVIDUAL
LEVEL.
AGAIN, HOW CAN WE BROADEN OUR
LANGUAGE TO CAPTURE ALL THOSE
DIFFERENT LEVELS.
>> THANK YOU, HOLLIE.
>> IN RESPONDING TO HOLLIE'S
COMMENT, I UNDERSTAND WHAT YOU
MEANT BY THE DIFFERENT LEVELS
AND TO ENABLE THE PERSON TO
ADHERE TO WHATEVER
RECOMMENDATION IT IS AND MAKING
IT MORE AFFORDABLE SO IN THE
SOCIAL ECOLOGICAL MODEL IN TERMS
OF THAT.
SO GOING BACK TO THE CHRONIC
DISEASE, MY THINKING IS WE CAN
CLARIFY THE LANGUAGE IN A WAY
AND THERE'S VERY LIFE STAGES.
AND MAYBE WE DID SPEND A LOT
TIME ON THE FOOD PATTERN
MODELLING AND DID MORE IN THAT
APPROACH AND ALSO WE DID SO MUCH
WITH TESTING AND WAYS OF MEETING
THE PATTERNS.
SO I FEEL LIKE THAT THEME SHOULD
MAYBE BE MORE ABOUT KIND OF
ADDRESSING THAT.
AND I FEEL LIKE THE INCLUSION
KIND OF GOES MORE ALONG WITH THE
THEME ONE.
AND IT WOULDN'T HAVE TO BE ABOUT
PATTERN MODELLING BUT OTHER
FINDINGS FROM THE SYSTEMATIC
REVIEWS ABOUT HEALTHY PATTERNS
AND SOME OF THE WORK WE SAW
PRESENTED TODAY AS WELL.
AND MY SECOND COMMENT WAS WITH
THE THEME FIVE.
I ALSO MAYBE THIS IS MORE OF A
MINOR COMMENT BUT I FEEL LIKE
THAT'S ALWAYS A NEED AND
LIMITATION SO MAYBE WE REALLY
DON'T NEED THAT ONE AS A THEME.
>> THANK YOU.
DEANNA.
>> MY COMMENT IS AND THEME FOUR
TALKING ABOUT FOOD SYSTEMS BUT
DON'T KNOW IF WE CAN EXPAND THAT
TO THE FOOD ENVIRONMENT.
THERE'S A MARKETING ENVIRONMENT,
FOODS AVAILABLE LIKE IN THE
SCHOOL LUNCH PROGRAM OR SO IT'S
BROADER THAN JUST FOOD SYSTEMS.
AND WORDS IN THERE.
>> THANK YOU.
CAROL.
>> I VOICE WE NEED TO GET THE
FOOD ENVIRONMENT AT ALL LEVELS
IN THERE BUT I WANTED TO RESPOND
TO HEATHER'S COMMENT ABOUT THEME
FIVE.
I THINK IT'S AN INTERESTING YOU
THOUGHT YOU HAVE, HEATHER,
THAT'S TRUE, DO WE ALWAYS HAVE
LIMITATIONS BUT HONESTLY, WE
WERE REALLY STYMIED IN SO MANY
OF OUR SYSTEMATIC REVIEWS, NOT
ONLY THE LIMITATION OF DATA BUT
THE REPORTING OR THE MIGHT THE
LACK OF SPECIFICITY IN A LOT OF
THE REPORTING.
WHAT WERE THOSE FOODS PEOPLE
WERE EATING IN THE GROUPS THAT
WERE WE THERE ARE TRYING TO
BREAK A PART FOR EXAMPLE.
AT WHAT TIME OF THE DAY WERE
THEY ARE EATING.
WE CAN MOVE THE WORK OF FUTURE
COMMITTEES.
WE JUST NEED THE DATA.
>> THANK YOU, CAROL.
THANK YOU FOR THINKING OF THE
NEXT GENERATION.
THAT'S A NICE POINT.
ALINE.
>> WE IDENTIFIED SOME OTHER GAPS
I THINK WE'LL BE ABLE TO TALK
ABOUT THOSE AND THE QUALITATIVE
DATA THAT HAS BEEN TALKED ABOUT
AND ACKNOWLEDGING THE LIMITATION
IS ALSO IDENTIFYING OTHER TYPES
OF POTENTIALLY EVIDENT AND WHAT
WE NEED ACROSS THE DIFFERENT
THEMES WHETHER DATA ANALYSIS OR
SYSTEMATIC REVIEWS.
>> THANK YOU.
DEANNA.
AND LOOKING AT DIETARY PATTERNS
AND A LOT OF TIMES WE COULDN'T
GET THE EVIDENCE BECAUSE WE
DON'T HAVE SIMILAR COHORTS IN
THE U.S. AND WE NEED OTHER TERMS
IN TERMS OF BETTER DEFINITIONS
OF CERTAIN TERMS AND WE TALKED A
LOT ABOUT THAT.
IT DEFINITELY SHOULD BE
INCLUDED.
>> THANK YOU.
DIDI.
>> JUST ONE OTHER THOUGHT ON THE
SAME THEME, MAYBE NOT
HIGHLIGHTING LIMITATIONS
NECESSARILY BUT THE FACT THAT WE
NEED MORE RIGOROUS EVIDENCE OR
RIGOROUS RESEARCH AND RESEARCH
FUNDING.
SO TO BE ABLE FOR THE WISH LISTS
RESEARCH WE PUT OUT THERE IS
REALLY JUST STRETCHING THE
LIMITS OF ANY RESEARCH FUNDING
THE U.S. WOULD BE ABLE TO
ACCOMMODATE AND IF WE HAVE THESE
BURNING QUESTIONS THAT NEED TO
BE ADDRESSED IN THE WAY WE WANT
TO ASK THE QUESTIONS NOW INSTEAD
OF LEVERAGING THE INTERNATIONAL
DATA WE HAVE FROM DECADES AGO WE
NEED RESEARCH FUNDING TO SUPPORT
THE IMPORTANT AGENDAS AS THEY'RE
DESIGN NOW THAT WE WOULD WANT
FOR THE QUESTIONS.
I THINK RESEARCH FUNDING AND
MAYBE NOT SO MUCH LIMITATIONS
BUT JUST OUR FUTURE DIRECTIONS.
>> GREAT, I APPRECIATE THE
EMPHASIS ON THE POSITIVE SO
THANK YOU.
CAROL.
>> I WANTED TO BUILD ON TO WHAT
DIDI JUST SAID ABOUT RIGOR.
OF COURSE WE WANT RIGOROUS
RESEARCH BUT ONE OF THE THINGS
THAT WOULD HAVE HELPED US IF
THERE HAD BEEN BETTER MORE
DETAIL, MORE CONSISTENT REPORT
BEING OF RESULTS BECAUSE SOME OF
THE DAY MAY EXIST AND I BET IT
DOES BUT WE DON'T KNOW BECAUSE
OF SPACE LIMITATIONS AND PAGES
AND WHATEVER IT MIGHT HAPPEN TO
BE.
THE IDEA THAT SOMEONE PUT OUT ON
A SLIDE TODAY ABOUT HAVING A
CONCERT TYPE CHECKLIST FOR
METHODOLOGY FOR THE CULTURAL
ASPECTS, WE NEED TO DO THAT
ACROSS EVERYTHING.
WHAT ARE THE DEFINITIONS YOU'RE
USING FOR BREAKFAST, FOR
EXAMPLE?
SO WE UNDERSTAND WHAT IS BEING
MEASURED.
WE NEED MORE DETAIL ON METHODS
TO MAKE RESULTS OF WHAT IS
REPORTED.
>> THANK YOU, CAROL.
I THINK WE PROBABLY TO YOUR
POINT THAT WAS A REALLY NICE
SLIDE ON FUTURE DIRECTIONS IN
THE LAST WORKING GROUP ABOUT
SOMETHING VERY CONCRETE ABOUT
WHAT THE PEER REVIEWED JOURNALS
MAY WANT TO CONSIDER SO SOME OF
THE DATA YOU'RE TALKING ABOUT IS
ACCESSIBLE TO ALL RESEARCHERS.
SO THAT'S A REALLY GOOD POINT.
THANK YOU.
OTHER REACTIONS TO THESE THEMES?
WELL, WE HAVE COPIOUS NOTES AND
WE'LL GET BACK TO PULLING THIS
TOGETHER AND WITH THAT IF
THERE'S NO MORE COMMENTS ON THE
CROSS CUTTING THEMES WE'LL SKIP
TO THE NEXT SLIDE AND GO TO THE
NEXT FINAL COMMENTS.
TO REMIND US AS A COMMITTEE AND
OUR AUDIENCE, THE PURPOSE OF
THIS MEETING WAS FOR THE
COMMITTEE TO DISCUSS OUR DRAFT
SCIENTIFIC REPORT AND
PARTICULARLY OUR ADVICE TO THE
DEPARTMENTS FOR THE NEXT
ADDITION OF THE DIETARY
GUIDELINES BASED ON OUR REVIEWS
FROM THE DATA ANALYSIS,
SYSTEMATIC REVIEWS AND FOOD
PATTERN MODELLING.
AND I JUST WANTED TO EMPHASIZE
THAT THIS WAS WHAT WE PRESENTED
TODAY THE DRAFT.
AND IT WILL BE REVISED TO
REFLECT THE DISCUSSION AT THE
MEETING.
AND THE REPORT THAT WE ARE
DISCUSSING IS STILL CONSIDERED A
DRAFT UNTIL IT IS IN THE ED --
SUBMITTED TO THE HEALTH AND
HUMAN SERVICES AND THE
U.S. DEPARTMENT OF AGRICULTURE
AND WITH THAT I'LL HAND IT OVER
TO ANGELA.
>> THANK YOU SO MUCH FOR ALL OF
YOUR WORK AND AS SARAH
MENTIONED, THIS IS FOR THE
PUBLIC THIS IS A DRAFT.
IT'S NOT THE FINAL -- WE HAD AN
OPPORTUNITY A GREAT OPPORTUNITY
TO REALLY COME TOGETHER OVER
THIS TWO YEARS OF WORK AND WE
STILL HAVE STILL MORE WORK TO DO
BUT IT'S IMPORTANT THAT YOU JUST
REALLY PAT YOURSELVES ON THE
BACK BECAUSE OF ALL OF THE
STRONG WORK AND REALLY GIVE
YOURSELF A HAND OF WHAT'S LAND
SO FAR.
SO, I'M GOING TO TURN IT OVER TO
EVE AND JANET TO TALK ABOUT NEXT
STEPS AND DO A WRAP-UP.
>> THANKS SO MUCH, SARAH AND
ANGELA.
AND TO START OFF IF THE MEMBERS
FOR THOSE WHO CAN, KEEP YOUR
CAMERA ON.
WE JUST WANTED TO GIVE A
HIGH-LEVEL WRAP UP OF THE WORK
THAT'S BEEN DONE AND TALK A
LITTLE BIT ABOUT NEXT STEPS AND
PROVIDE ACKNOWLEDGEMENTS AND
THEN WE'LL ADJOURN THE FINAL
MEETING OF THE 2025 DIETARY
GUIDELINES ADVISORY COMMITTEE.
SO FIRST, I WANT TO START OFF BY
ACKNOWLEDGING SARAH AND ANGELA.
THANK YOU VERY MUCH FOR AGREEING
TO SERVE AS CLAIR AND VICE CHAIR
OF OUR COMMITTEE.
AND THANK YOU FOR YOUR
LEADERSHIP ACROSS THIS ENTIRE
PROCESS.
SO I WANTED TO START OFF THERE.
WHAT WE WANTED TO DO IS START BY
TAKING A MINUTE TO ACKNOWLEDGE
ALL THE WORK THAT'S BEEN DONE
SINCE THE COMMITTEE'S FIRST
MEETING IN FEBRUARY OF 2023.
SO AT THE FIRST MEETING YOU
BEGAN BY REFINING AND
PRIORITIZING THE SCIENTIFIC
QUESTIONS THAT YOU OUTLINED AND
DESCRIBED HERE IN FULL DURING
THE MEETING OVER THE LAST TWO
DAYS.
AND THAT QUICKLY EVOLVED INTO
DEVELOPING PROTOCOLS OR PLANS
FOR REVIEWING THE SCIENTIFIC
EVIDENCE AND THEN MOVED INTO
CONDUCTING THOSE SCIENTIFIC
REVIEWS AND DEVELOPING
EVIDENCE-BASED ADVICE BASED ON
THE SCIENTIFIC REVIEWS.
THROUGHOUT THIS PROCESS, YOU
REVIEWED AND CONSIDERED PUBLIC
COMMENT AND THE COMMITTEE
RECEIVED MORE COMMENTS THAN ANY
OTHER TIME AND PARTICIPATED IN
SUBCOMMITTEE MEETINGS AND THE
FULL COMMITTEE MEETINGS AND THE
FULL COMMITTEE MEETINGS OF WHICH
THERE WERE SEVEN WERE OPEN TO
THE PUBLIC AND CULMINATED IN THE
SCIENTIFIC REPORT WHICH WAS THE
FOCUS OF THE DISCUSS OVER THE
LAST TWO DAYS.
SO ON THE NEXT SLIDE WE WANTED
TO JUST GIVE A LITTLE BIT OF A
SNAPSHOT OF THE COMMITTEE'S
REVIEW OF THE EVIDENCE.
AS ANGELA REMINDED EVERYONE
YESTERDAY AND OVER THE LAST TWO
DAYS, THE COMMITTEE REVIEWED THE
EVIDENCE USING THREE DIFFERENT
APPROA
APPROACHES, SYSTEMATIC REVIEWS
AND DATA ANALYSIS AND REVIEWED
EVIDENCE OVER 1,000 ARTICLES TO
DEVELOP DOZENS OF CONCLUSION
STATEMENTS ANSWERING 28
SYSTEMATIC REVIEW QUESTIONS
INCLUDING 11 NEW QUESTIONS.
THE COMMITTEE CONDUCTED A SCAN
ON CULTURALLY TAILORED DIETARY
INTERVENTIONS.
REGARDING DATA ANALYSIS, THE
COMMITTEE REVIEWED AND
EMPHASIZED RESULTS FROM 45
EXISTING DATA PUBLICATION AND
MORE THAN 4,700 PAGES OF DATA
ANALYSIS SUPPLEMENTS INCLUDING
NOVEL EXAMINATION OF DATA FOR
SOCIO ECONOMIC GROUPS AND A SCAN
ON DIETARY INTAKES DURING
COVID-19.
ALL THIS WORK AND DATA ANALYSIS
RESULTED IN DRAFTING CONCLUSION
STATEMENTS BEFORE DATA ANALYSIS
QUESTIONS.
REGARDING FOOD PATTERN
MODELLING, THE COMMITTEE
ANALYZED MORE THAN 350,000 DATA
POINTS TO EXAMINE OBJECTIVES FOR
11 PROTOCOLS AND EVALUATES USING
A NOVEL APPROACH AS NOTED
YESTERDAY, THE FIRST TIME WE
USED DIET SIMULATIONS WHICH IS A
SYSTEMS SCIENCE APPROACH TO
EVALUATE THE NUTRITIONAL
ADEQUACY OF OVER 35,000 DIETS TO
MEET DIETARY PATTERNS USING A
BROAD RANGE OF FOODS AND
BEVERAGES AND FOODS SELECTED IN
AMERICAN INDIAN AND ALASKAN
NATIVE DIETS AND THEY ARE USED
AN EQUITY LENS AND WAS A THEME
ACROSS AND THROUGH ALL THE
DIFFERENT WORK.
SO THANK YOU FOR YOUR DEDICATION
TO THIS WORK AND FOR
VOLUNTEERING YOUR TIME AND
EXPERTISE TO THIS PROCESS.
AS MENTIONED OVER EVERY PUBLIC
MEETING INCLUDING TODAY, HHS AND
USDA PROVIDED STAFF SUPPORT TO
THE COMMITTEE FOR A NUMBER OF
ACTIVITIES ACROSS THE
COMMITTEE'S WORK THAT INCLUDES
REVIEWING THE EVIDENCE,
COORDINATING MEETINGS,
DOCUMENTING DECISIONS,
SUPPORTING TRANSPARENCY AND
MORE.
WE DO WANT TO NOTE FEDERAL STAFF
SUPPORT THE COMMITTEE BUT THE
PROTOCOLS AND FINDINGS AND
CONCLUSION STATEMENTS AND
INTEGRATION OF THE EVIDENCE AND
ULTIMATE ADVICE TO THE
DEPARTMENTS ARE THAT OF THE
COMMITTEE.
AND WE WANT TO JUST SAY THANK
YOU TO THE HHS AND USDA TEAM FOR
ALL THIS WORK AND JANET WILL DO
A FEW ACKNOWLEDGEMENTS IN HER
REMARKS AND I WANT TO
ACKNOWLEDGE THE LEADERSHIP.
JUST HIGH LEVEL NEXT STEPS.
JANET TALKED ABOUT THIS AT THE
LAST PUBLIC MEETING BUT IN TERMS
OF NEXT STEPS THE COMMITTEE WILL
WORK TO FINAL I'D ITS REPORT ON
THE DISCUSSION AT THIS MEETING.
THE COMMITTEE WILL THEN SUBMIT
ITS REPORT TO HHS AND USDA.
ONCE HHS AND USDA RECEIVES IT IT
TAKES TIME TO PREPARE IT FOR
POSTING TO OUR WEBSITE.
AND SO WE'LL BE PREPARING THE
REPORT AND POSTING IT TO DIETARY
GUIDELINES.gov.
WE WANT TO NOTE WHEN WE POST THE
REPORT WE'LL BE POSTING ALL THE
SYSTEMATIC REVIEWS, ALL THE FOOD
PATTERN MODELLING REPORT AND
DATA ANALYSIS REPORTS AND
SUPPLEMENTS.
SO THE COMMITTEE'S REPORT ALONG
WITH THE SUPPLEMENTARY
MATERIALS.
WHEN HHS AND USDA POSE THE
REPORT AT DIETARY GUIDELINES.gov
WE'LL OPEN A PUBLIC COMMENT
PERIOD ON THE ADVISORY
COMMITTEE.
UNLIKE THE PUBLIC COMMENT PERIOD
THAT JUST CLOSED, THE PERIOD THE
COMMITTEE HAD OPENED THROUGH
THEIR PROCESS WAS TO MEMBERS OF
THE COMMITTEE OR COMMITTEE AS A
WHOLE.
IT WILL INCLUDE COMMENTS TO USDA
AND HHS ABOUT THE COMMITTEE'S
REPORT FOR CONTRIBUTION AS WE
USE THE COMMITTEE'S REPORT IN
INFORMING THE DEVELOPMENT OF THE
NEXT EDITION OF THE DIETARY
GUIDELINES.
WE WILL ANNOUNCE THE PUBLIC
COMMENT PERIOD THROUGH THE
FEDERAL REGISTER FOR THOSE WHO
DON'T FOLLOW THE FEDERAL
REGISTER, WE'LL SHARE
INFORMATION ON OUR WEBSITE AND
ALSO SEND MESSAGES TO THE LIST
SERVES AND SOCIAL MEDIA.
IF YOU'D LIKE TO MAKE YOU ARE
SURE TO RECEIVE THE NOTIFICATION
SIGN UP AT DIETARY
GUIDELINES.gov.
THREW FOR THE TEAM AND THE WORK
AND NOW TO JANET FOR THE FINAL
WRAP UP.
THANK YOU.
>> THANKS SO MUCH, EVE.
NOW I'LL PROVIDE HIGH LEVEL
OVERVIEW OF THE PROCESS SO FAR.
I NOW WE HAVE NEW PEOPLE JOIN
MEETING FOR EACH PUBLIC MEETING.
SO STARTING IN 2021, NOT SHOWN
ON THE SLIDE, HHS AND USDA BEGAN
THE PROCESS TO DETERMINE
SCIENTIFIC SCOPE YOUR COMMITTEE
HAS BEEN REVIEWING.
WE CONDUCTED A YEAR-LONG PROCESS
TO DETERMINE THE SCOPE.
IN 2022, WE POSTED THE
SCIENTIFIC QUESTION FOR PUBLIC
COMMENT FOR 30 DAYS.
IN JUNE OF THE SAME YEAR IN
2022, WE SOUGHT NOMINATIONS FOR
COMMITTEE MEMBERS.
WE REVIEWED NOMINATION AND IN
EARLY 2023, YOUR COMMITTEE WAS
APPOINTED IN JANUARY.
YOUR COMMITTEE CONDUCTED ITS
FIRST MEETING IN FEBRUARY 2023
AND HELD TWO ADDITIONAL MEETINGS
IN MAY AND SEPTEMBER OF THAT
YEAR.
AND IN THE SEPTEMBER MEETING THE
PUBLIC PROVIDED AN OPPORTUNITY
TO PRESENT ORAL COMMENTS TO THE
COMMITTEE.
MOVING INTO 2024, YOU MET IN
JANUARY, MAY AND SEPTEMBER AND
HERE WE ARE TODAY YOU'RE
CONDUCTING YOUR FINAL MEETING OR
CONCLUDING YOUR FINAL REPORT
MEETING.
EVE JUST TALKED ABOUT THE STEPS
OF RECEIVING THE COMMITTEE'S
REPORT WHICH WILL BE POSTED
ONLINE AND INVITE PUBLIC
COMMENCE TO HHS AND USDA.
IN 2025 IN HHS AND USDA TEAM
WILL WORK ON UPDATING THE
DIETARY GUIDELINES FOR AMERICANS
INFORMED BY YOUR COMMITTEE
REPORT AND OTHER SCIENTIFIC
INPUTS.
AS I MENTIONED WE PUT OUT OUR
CALL FOR NOMINATIONS IN 2022.
WE BROUGHT TOGETHER A COMMITTEE
FOR THE TASKS WE PRIORITIZED AND
SUPPORTING THE DEPARTMENT FOR
INCLUSIVE GUIDELINES AND
REPRESENTATIVE OF THE S IN THE
UNITED STATES.
BEING -- OPTIONS IN THE UNITED
STATES.
THE SCOPE ON DIET AND LEATH
OUTCOMES ACROSS THE LIFE SPAN
FROM PREGNANT INDIVIDUALS AN
INFANT TO OLDER ADULT.
WE INCLUDED HEALTH OUTCOMES SUCH
AS CVD, CANCER, DIABETES,
GROWTH/SIZE BODY COMPOSITION AND
RISK OF OVERWEIGHT AND RISK OF
OBESITY AND COGNITIVE DECLINE.
THE TASK WAS ENORMOUS.
WE ALSO PROPOSED A NEW QUESTION
ON ULTRA PROCESSED FOODS AND
FOOD-BASED STRATEGIES TO SUPPORT
IMPLEMENTATION OF THE DIETARY
GUIDELINES AND ALSO PREVENT
OVERWEIGHT AND OBESITY.
IN ADDITION TOE FOCUS ON DIETARY
PATTERNS WE ASKED FOR A REVIEW
ON BEVERAGES AND SOURCES OF
SATURATED FAT.
AS IMPORTANT AS THESE TOPICS OF
REVIEW ARE WE LOOKED FOR
EXPERTISE IN THE SCIENTIFIC
APPROACH.
SYSTEMATIC REVIEW, FOOD PATTERN
MODELLING AND DATA ANALYSIS.
IT WAS A TALL ORDER TO FIND A
COMMITTEE WITH THIS BROAD RANGE
OF EXPERTISE BUT EVEN I CAN SAY
IT WAS ACCOMPLISHED.
GIVE YOURSELF A ROUND OF
APPLAUSE.
YOU EXCEEDED THE CHARGE AND
WE'RE APPRECIATIVE OF THE TIME
AND WISDOM YOU DEDICATE AND
SHARED WITH THE COMMITTEE AND
ALL OF US.
TOGETHER AS A COMMITTEE YOU
COMBINED YOUR KNOWLEDGE AND
SKILLS AND CRAFT YOUR ADVICE TO
HHS AND USDA.
BEING A SPECIAL GOVERNMENT
EMPLOYEE FOR THIS COMMITTEE IS
AN UNPAID EXTRA JOB FOR YOU.
IN YOUR DAY JOB YOU'RE CENTER
AND PROGRAM DIRECTORS, DEANS,
DEPARTMENT CHAIRS AND PROFESSORS
AND CLINICIANS.
IN ADDITIONAL LEADERSHIP IN
PROFESSIONAL ASSOCIATIONS.
THAT'S IS YOUR WORK-RELATED
RESPONSIBILITIES.
IN YOUR REAL LIFE YOU HAVE
FAMILY COMMITMENTS INCLUDING
AIMING PARENT AND CHILDREN.
TAKING KIDS TO COLLEGE FOR THE
FIRST TIME OR SUPPORTING YOUR
KIDS' SPORTS TEAMS AND CARING
FOR PARENTS AS ROLES REVERSE AND
THEY NEED US MORE THAN EVER AND
WE EXPERIENCE THAT TOGETHER AND
THERE ARE WONDERFUL PETS WE
SHARED THROUGHOUT THE
SUBCOMMITTEE MEETINGS THAT PLAY
HAVE BEEN WAITING LONGER TO GO
OUT FOR WALKS AS YOU FINISH YOUR
SUBCOMMITTEE CALLS SO GIVE
THANKS TO YOUR PETS.
ON COMPLETION OF YOUR WORK, WE
WILL GIVE YOU FULL ATTENTION
BACK TO YOUR UNIVERSITIES,
MEDICAL CENTERS, FAMILIES AND
PETS.
IT'S BEEN AN HONOR TO SUPPORT
AND CHEER YOU ON AS YOU FINISH
YOUR WORK.
I'M A SENSITIVE ONE.
IT'S MY MOM'S FAULT.
WE'LL MISS YOU DEARLY AND HOPE
TO SEE YOU SOON AND FROM THE
BOTTOM OF EVE AND MY HEART, WE
THANK YOU DEARLY FOR YOUR
WONDERFUL WORK AND COMMITMENT.
THANK YOU SO MUCH.
TO OUR WONDERFUL STAFF TEAMS AND
HHS AND USDA, YOU HAVE PROVIDED
A WONDERFUL FOUNDATION FOR THE
COMMITTEE'S WORK.
EVE AND I ARE SO THANKFUL TO
HAVE YOU ON OUR TEAMS AND HEARD
THE COMMITTEE RAVE ABOUT YOUR
TERRIFIC WORK OVER THE YEARS.
YOUR EXPERTISE ON THE METHODS OF
SYSTEMATIC REVIEW, FOOD PATTERN
MODELLING AND DATA ANALYSIS ARE
TOP NOTCH.
THANK YOU FOR CONTINUING TO
ADVANCE THE METHODS.
YOU MAKE ALL OF US LOOK GOOD.
THANK YOU TO OUR COMMUNICATION
TEAMS.
WE VALUE YOUR ONGOING SUPPORT
WITH THE IMPORTANT TASK OF
EFFECTIVE COMMUNICATION.
IN ADDITION TO THIS STAFF AT
ODPCP WE'RE THANKFUL TO THE DATA
ANALYSIS SUPPORT FROM USDA, CDC
AND NIH.
A SPECIAL THANKS TO OUR
CONTRACTORS OUR NIH TECH SUPPORT
AND THE TOWER CONFERENCE CENTER
FOR HOSTING OUR MEETINGS.
A SHUT OUT TO THE PEER REVIEWER
AND APPRECIATE OF THE NICHD
COLLEAGUES FOR FACILITATING THE
PEER REVIEW.
I KNOW THAT WAS A MAJOR
UNDERTAKING.
YOU'LL SEE OUR STAFF TEAMS AND
MANY OF THE TEAMS I NOTED.
A BIG THANK YOU TO YOU ALL.
A LITTLE MORE ABOUT STAFF.
AS I REFLECT ON STAFF TEAM AND
THE DEPARTMENTS AT HHS AND USDA,
IT'S BEEN MY PLEASURE WORKING
WITH THIS ALL-STAR TEAM.
I LEARN FROM YOU EVERY DAY.
THANK YOU FOR YOUR HARD WORK,
PATIENCE AND GRACE.
I WAS REFLECT BEING ON MY RUN
THIS MORNING HOW TIME PASSES
WHEN WE WORK ON LONG PROJECTS
TOGETHER.
ON OUR TEAM THERE'S BEEN NEW
BABIES, ENGAGEMENTS, WEDDINGS,
HOUSES, SPORTS AND SCHOOLS AND
OUR OLDER CHILDREN APPLYING TO
COLLEGE AND GOING TO COLLEGE.
THIS IS ALL WHILE DOING
FANTASTIC WORK ON YOUR DAY,
NIGHT, WEEKEND JOB OF SUPPORTING
RIGOROUS SCIENTIFIC PROCESS.
I'D LIKE TO EXPRESS MY EXTREME
GRATITUDE TO MY PARTNER EVE ON
THE PROCESS SINCE 2018 AND I
COULD NOT ASK FOR A BETTER OTHER
HALF.
YOUR SCIENTIFIC AND LEADERSHIP
SKILLS ARE TOP NOTCH AND ON TOP
OF EVERYTHING YOU'RE A KIND,
PATIENT AND FUN TO WORK WITH.
THANK YOU, EVE.
FINALLY, A BIG THANKS TO THE
LEADERSHIP AT HHS AND USDA AND
ODPCP AND CNPP.
THE SUPPORT IS REALLY
APPRECIATED.
TO THE PUBLIC, THANK YOU FOR
YOUR ENGAGEMENT THROUGHOUT THE
PROCESS AND FOR FOLLOWING THE
COMMITTEE ON THEIR JOURNEY.
PLEASE STRAY TUNED FOR THE
REPORT POSTING AND THE PUBLIC
COMMENT OPPORTUNITY.
AND NOW I WOULD LIKE TO ADJOURN
THE REPORT MEETING OF THE 2025
DIETARY GUIDELINES ADVISORY
COMMITTEE.
THANK YOU VERY MUCH.