2020-2025 Dietary Guidelines for Americans

The U.S. Departments of Agriculture (USDA) and Health and Human Services (HHS) are seeking public comments on topics and supporting scientific questions to inform the development of the 2020-2025 Dietary Guidelines for Americans. This is a new step in the development process. View the Federal Register Notice here.

Topics and questions proposed by USDA and HHS are based on four criteria: relevance, importance, potential federal impact, and avoiding duplication. The topics for 2020-2025 Dietary Guidelines are within a life stages approach, focusing on priority scientific questions from birth through older adulthood. In addition, the topics reflect a continued focus on patterns of what we eat and drink as a whole, on average and over time.

Learn more on the development of the dietary guidelines hereSubmit your comments here.

Listed below are the five life stages with proposed topics and scientific questions. The guidelines will also describe current dietary patterns, including intakes of food groups and nutrients, for each stage of life.

Infants and toddlers from birth to 24 months (healthy, full-term infants)

Topic Question(s)
Recommended duration of exclusive human milk or infant formula feeding What is the relationship between the duration of exclusive human milk or infant formula consumption and 1) growth, size, and body composition; 2) food allergies and other atopic allergic diseases; and 3) long-term health outcomes?
Frequency and volume of human milk and/or infant formula feeding What is the relationship between the frequency and volume of human milk and/or infant formula consumption and 1) micronutrient status; and 2) growth, size, and body composition?
Dietary supplements (e.g., iron, vitamin D, vitamin B12) What is the relationship between specific micronutrient supplements for infants fed human milk and/or infant formula and 1) micronutrient status; and 2) growth, size, and body composition?
Complementary foods and beverages*: Timing of introduction, types, and amounts

*Beverages (cow’s milk, water, 100% fruit juice, sugar-sweetened beverages, milk alternatives)

What is the relationship between complementary feeding and 1) micronutrient status; 2) growth, size, and body composition; 3) developmental milestones; 4) food allergies and other atopic allergic disease; and 5) bone health?

What is the relationship between complementary feeding, including foods and beverages, and achieving nutrient and food group recommendations of infants and toddlers?

Note: Evidence related to dietary patterns (including beverage patterns) consumed during the complementary feeding period will be considered as part of these questions.

 

Children and adolescents, ages 2-18 years old (with data reviewed by age group)

Topic Question(s)
Dietary patterns to promote health and normal growth and meet nutrient needs What is the relationship between specific dietary patterns (Dietary Guidelines-related, Mediterranean-style, Dietary Approaches to Stop Hypertension (DASH), vegetarian/vegan, and low-carbohydrate diets) consumed during childhood and adolescence and 1) growth, size, and body composition; and 2) bone health?

Are changes to the USDA Food Patterns needed based on the relationships identified? If so, how well do USDA Food Pattern variations meet nutrient recommendations for children and adolescents?

Beverages (cow’s milk, water, 100% fruit juice, sugar-sweetened beverages, milk alternatives, caffeinated beverages) What is the relationship between beverage consumption during childhood and adolescence and achieving nutrient and food group recommendations?
Added sugars What is the relationship between added sugars consumption during childhood and adolescence and achieving nutrient and food group recommendations?

How much added sugars can be accommodated in a healthy diet during childhood and adolescence while still meeting food group and nutrient needs?

 

Adults, ages 19-64 years old (with data reviewed by age group)

Topic Question(s)
Dietary patterns to promote health, prevent disease, and meet nutrient needs What is the relationship between specific dietary patterns (Dietary Guidelines-related, Mediterranean-style, Dietary Approaches to Stop Hypertension (DASH), vegetarian/vegan, and low-carbohydrate diets) consumed during adulthood and 1) body weight or obesity; 2) risk of cardiovascular disease; 3) risk of type 2 diabetes; and 4) risk of certain types of cancer?

Are changes to the USDA Food Patterns needed based on the relationships identified? If so, how well do USDA Food Pattern variations meet nutrient recommendations for adults?

Beverages (cow’s milk, water, 100% fruit juice, sugar-sweetened beverages, milk alternatives, caffeinated beverages) What is the relationship between beverage consumption during adulthood and achieving nutrient and food group recommendations?
Added sugars What is the relationship between added sugars consumption during adulthood and achieving nutrient and food group recommendations?

How much added sugars can be accommodated in a healthy diet during adulthood while still meeting food group and nutrient needs?

Saturated fats What is the relationship between saturated fats consumption (types and amounts) during adulthood and risk of cardiovascular disease?

 

Pregnancy and lactation

Topic Question(s)
How additional calorie needs should be met during pregnancy and lactation What is the relationship between specific dietary patterns (Dietary Guidelines-related, Mediterranean-style, Dietary Approaches to Stop Hypertension (DASH), vegetarian/vegan, and low-carbohydrate diets) consumed among women who are pregnant and 1) risk of gestational diabetes; 2) risk of hypertensive disorders during pregnancy; 3) gestational age at birth; and 4) birth weight standardized for gestational age and sex?

What is the relationship between specific dietary patterns (Dietary Guidelines-related, Mediterranean-style, Dietary Approaches to Stop Hypertension (DASH), vegetarian/vegan, and low-carbohydrate diets) consumed among women who are lactating and human milk composition and quantity?

Are changes to the USDA Food Patterns needed based on the relationships identified? If so, how well do USDA Food Pattern variations meet nutrient recommendations for women who are pregnant or lactating?

Dietary supplements (e.g., iron, folate, vitamin D) What is the relationship between micronutrient supplements consumed during pregnancy and lactation and 1) micronutrient status; 2) birth outcomes; and 3) human milk composition and quantity?
Diet during pregnancy and lactation and risk of food allergy in the infant What is the relationship between maternal diet during pregnancy and lactation and risk of infant allergies and other atopic allergic disease?
Seafood What is the relationship between seafood consumption during pregnancy and lactation and neurocognitive development of the infant?
Beverages (cow’s milk, water, 100% fruit juice, sugar-sweetened beverages, milk alternatives, caffeinated beverages) What is the relationship between beverage consumption during pregnancy and lactation and 1) achieving nutrient and food group recommendations; 2) birth outcomes; and 3) human milk composition and quantity?
Alcoholic beverages What is the relationship between maternal alcohol consumption during lactation and human milk composition and quantity?

 

Older adults, ages 65 years and older (with data reviewed by age group)

Topic Question(s)
Dietary patterns to promote health, prevent disease, and meet nutrient needs What is the relationship between specific dietary patterns (Dietary Guidelines-related, Mediterranean-style, Dietary Approaches to Stop Hypertension (DASH), vegetarian/vegan, and low-carbohydrate diets) consumed across the lifespan and 1) body weight or obesity; 2) risk of cardiovascular disease; 3) risk of type 2 diabetes; 4) risk of certain types of cancer; and 5) risk of osteoporosis?

What modifications to dietary patterns are effective in preventing or reversing declines in muscle mass or bone density in older adults?

Are changes to the USDA Food Patterns needed based on the relationships identified? If so, how well do USDA Food Pattern variations meet nutrient recommendations for older adults, age 65-80 years and those age 81+ years?

Specific nutritional needs related to older adults What modifications to food and beverage choices promote meeting nutrient needs in older adults with impaired dentition, dry mouth, or other aspects of aging that interfere with food and beverage consumption?

Comments are accepted through March 30, 2018. If you have a new topic or question to suggest, provide a brief summary including information pertaining to the four prioritization criteria. After the review of comments and finalization of topics and supporting questions, USDA and HHS will post a public call for the Dietary Guidelines Advisory Committee nominations.

Read more about the Dietary Guidelines here.

If you have any suggestions to inform ASN’s comments please reach out to Sarah Ohlhorst, Senior Director of Advocacy and Science Policy, at sohlhorst@nutrition.org or 240-428-3647.

 

 

The leading causes of death in the United States include heart disease, cancer, stroke, diabetes, and kidney disease (1). These conditions are strongly associated with poor diet, sedentary lifestyle, and excessive weight gain. Currently, 2 out of 3 Americans are either overweight or obese (2). As such, 75% of total healthcare costs are used for the treatment of these chronic conditions (3). Research continues to show that nutrition intervention can drastically improve one’s health and reduce the risk for many of these chronic diseases. Nutrition counseling by a registered dietitian nutritionist (RDN) can make a world of difference for chronic disease management, treatment, and prevention. Nutrition counseling that promotes lifestyle changes to include healthier diets and more physical activity have the potential to reduce incidence of type II diabetes by 34% (4), heart disease by 31%, and stroke by 20% (5). Utilizing these services can make a profound difference in the trajectory of health outcomes and healthcare costs for American’s. However, only 3% of all healthcare expenses are spent on preventive services (3). This is primarily due to a lack of coverage for these services by insurance companies. Medicare covers dietetic services only for patients who have diabetes or kidney disease. As such, patients who are prediabetic, obese, or have cardiovascular disease are not covered by Medicare to see a dietitian. Many people seek nutrition services and choose to pay out of pocket, recognizing the long term benefits these services provide. Yet, many individuals who need these services simply can’t afford to pay for them, costing around $118 an hour (6).

Under the Affordable Care Act (ACA), preventive services are covered more now than ever. The ACA mandated that insurance companies cover preventive services that were identified by the U.S. Preventive Services Task Force (USPSTF) (7). These services include “healthy diet and physical activity counseling” and “obesity screening and counseling (8).” Congress is currently proposing the American Health Care Act which threatens to discontinue the inclusion of these services. Such reform would be a step backwards in reducing the rates of chronic diseases and the rising healthcare costs. According to the Academy of Nutrition and Dietetics President Lucille Beseler, the American Healthcare Act will, “reverse advancements made in disease prevention and chronic care management (9).” With healthcare costs continuously on the rise, investing in prevention is a much-needed solution for our nation’s healthcare costs.

In addition to the inclusion of prevention services, the ACA also includes the Prevention and Public Health Fund. These funds are distributed to the states to be used for community specific programs, including prevention initiatives, surveillance, and research (10). Investing in these types of community programs can reduce healthcare costs. For every $1.00 spent, $6.60 in healthcare costs are saved over a five year period (3). The current healthcare reform proposal will repeal this fund, hurting the communities that have been benefiting from these public programs. The House of Representatives passed the American Health Care Act in May sending it to the Senate for deliberation. In June, the Senate released their revised version of the bill and titled it the Better Care Reconciliation Act. The Senate was unable to repeal the ACA by the September 30th deadline. In October, President Trump passed an Executive Order Promoting Healthcare Choices and Competition, which allows agencies to modify how they implement the ACA. As nutrition professionals, the implications of preventive services is extremely apparent, yet without proper support for these services we risk their exclusion from future healthcare reforms.

  1. FastStats. (2017). Available at: https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm. (Accessed: 15th December 2017)
  2. Overweight & Obesity Statistics | NIDDK. Available at: https://www.niddk.nih.gov/health-information/health-statistics/overweight-obesity. (Accessed: 15th December 2017)
  3. Prevention and Public Health Fund. Available at: https://www.apha.org/topics-and-issues/health-reform/prevention-and-public-health-fund. (Accessed: 15th December 2017)
  4. The data are in: Eat right, reduce your risk of diabetes – Harvard Health Blog – Harvard Health Publishing. Available at: https://www.health.harvard.edu/blog/the-data-are-in-eat-right-avoid-diabetes-2017010510936. (Accessed: 15th December 2017)
  5. Guide to Insurance and Reimbursement – Today’s Dietitian Magazine. Available at: http://www.todaysdietitian.com/newarchives/0217p40.shtml. (Accessed: 15th December 2017)
  6. Preventing Heart Disease | The Nutrition Source | Harvard T.H. Chan School of Public Health. Available at: https://www.hsph.harvard.edu/nutritionsource/disease-prevention/cardiovascular-disease/preventing-cvd/. (Accessed: 15th December 2017)
  7. Health Care Reform and Preventive Services. www.eatrightpro.org Available at: https://www.eatrightpro.org/resource/payment/nutrition-services/health-care-reform/healthcare-reform-and-preventive-services. (Accessed: 15th December 2017)
  8. USPSTF A and B Recommendations – US Preventive Services Task Force. Available at: https://www.uspreventiveservicestaskforce.org/Page/Name/uspstf-a-and-b-recommendations/. (Accessed: 15th December 2017)
  9. Academy of Nutrition and Dietetics Announces Opposition to American Health Care Act. www.eatrightpro.org Available at: http://www.eatrightpro.org/resource/media/press-releases/public-policy/academy-announces-opposition-american-health-care-act. (Accessed: 15th December 2017)
  10. Prevention and Public Health Fund | HHS.gov. Available at: https://www.hhs.gov/open/prevention/index.html. (Accessed: 15th December 2017)

Lifestyle interventions targeted at obtaining/maintaining a healthy body weight and/or incorporating physical activity and healthy eating habits have great potential in improving outcomes in cancer survivors. Cancer diagnosis is a “teachable moment” wherein many patients are highly motivated to make changes (1). Furthermore, a balanced diet and moderate exercise can improve prognosis, quality of life, physical function, and survival across the cancer continuum. As such, groups such as the Amercian Cancer Society, National Comprehensive Cancer Network and the American College of Sports Medicine have released lifestyle guidelines for cancer survivors.

However, implementing changes in individuals and healthcare systems is challenging, to say the least. This is a recent topic covered by Karen Basen-Engquist and a number of colleagues as part of a special Issue of Obesity (Transdisciplinary Research on Energetics and Cancer)(2). Their article provides a 6-point agenda for translating research into clinical and community action, as follows:

  1. Increase the availability of different types of activities for weight management, nutrition counseling, and physical activity. One size will never fit all when it comes to improving health. Individual goals/preference, resources, and logistics all come into play, and cancer-specific programs may be needed.
  2. Improve screening and referral to lifestyle interventions. A system for evaluating and triaging patients for health programs should be developed. Importantly, an individual’s physical status, health needs, and goals should be considered.
  3. Improve the health care provider’s ability to screen, assess, and refer survivors for lifestyle programs. Oncology providers have a powerful role in helping cancer survivors; however, they often do not feel confident in screening, giving advice, or administering recommendations for lifestyle-related constructs. Implementation of processes such as the 5As (Ask, Advise, Assess, Assist, Arrange), which has been successful in tobacco cessation (3) and obesity management (4) might prove beneficial.
  4. Expand the support of oncology-specific professional training and certification. Professional organizations of dietitians, exercise professionals, psychiatrists, and physical therapists have additional certification programs for oncology or are working on developing one for its members. However, professionals with specific expertise in oncology are still greatly needed to address the unique needs of this population.
  5. Expand dissemination and implementation research. Many research programs do not address how a program could be implemented in a real-world setting (external validity). Dissemination of research findings with consideration of the sustainability and generalizability of programs is essential for broader impact.
  6. Advocate for health care policies that support lifestyle services for cancer survivors. Coverage for health programs is highly variable and often has barriers such as large co-payments, no coverage in grandfathered plans, and cost sharing. A potential solution could be incentivizing nutrition and exercise services, although more research is needed to determine the effectiveness of such actions.

As the authors eloquently articulate, the time has come to enable research into action for optimal healthcare in all cancer survivors.

References:

  1. Demark-Wahnefried W, Aziz NM, Rowland JH, Pinto BM. Riding the crest of the teachable moment: promoting long-term health after the diagnosis of cancer. J Clin Oncol 2005;23:5814–30.
  2. Basen-Engquist K, Alfano CM, Maitin-Shepard M, Thomas CA, Schmitz KH, Pinto BM, et al. Agenda for Translating Physical Activity, Nutrition,and Weight Management Interventions for Cancer Survivors into Clinical and Community Practice. Obesity 2017; 25, S9-S22.
  3. Siu AL, Force USPST. Behavioral and pharmacotherapy interventions for tobacco smoking cessation in adults, including pregnant women: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2015;163:622-634.
  4. Rueda-Clausen CF, Benterud E, Bond T, Olszowka R, Vallis MT, Sharma AM. Effect of implementing the 5As of Obesity Management framework on provider-patient interactions in primary care. Clin Obes 2013; 4, 39-44.

 

USDA Logo
By: R. Alex Coots, Student Blogger

The below interview is a continuation of an interview with Angela Tagtow, Executive Director of the Center for Nutrition Policy and Promotion at the USDA. Part 1 of this interview can be found here.

Tell me about the challenges of nutrition policy.

I imagine health policy falling into one of two categories, little-p policy (LPP) or big-p policy (BPP). LPP is a socioecological approach to policy, using individuals and organizations to make decisions to improve public health that don’t require an elected official. BPP requires elected officials to create broader, more top-down initiatives to improve public health. Both types of policy working in concert can create greater collective impact.

Many people see BPP as the primary driver of policy, but LPP can be very effective to improve community health. The Northeast Iowa Food and Fitness Initiative exemplifies the power of LPP. Through the initiative they recruited hundreds of community stakeholders to make commitments to improve public health whether that is at home, school, workplace or throughout the community. Starting the initiative was a slow process built on networking and strengthening relationships, but proved to make an impact in the lives of community members.

BPP also creates change, but has its own challenges. It can take several years for State or Federal programs to be fully implemented. For example, the Healthy Hunger-Free Kids Act was signed into law back in 2010, and we’re still seeing elements roll out. At the Federal level, Congress is another aspect that makes BPP challenging. Each Congressperson has a different perspective and set of values with respect to healthy food access, nutrition, public health. The ability to recognize their priorities and influencers is an important part of building support behind an initiative.

Given the number of different opinions and interests regarding public health, do you think there’s a way to make everyone happy?

There’s always going to be struggle. Every organization out there has a set of goals that are different from the next organization. Industry has an interest to protect its products and public health has an interest to keep people healthy. These goals are not always aligned, so there are challenges.

The media often reports on about industry trying to make changes to their offerings in the name of public health. Do you think these efforts are genuine?

Not all industry should be discounted. Some companies do consider how their products and services contribute to public health and are trying to make a difference. But for others, they need to evaluate whether they are doing all that they could be doing.

 

What are some of the future goals for the USDA and the CNPP?

The CNPP does much more than just produce the Dietary Guidelines for Americans (DGA) and the iconic MyPlate. The Nutrition Evidence Library, a very rigorous review of the literature that directly informs the DGA. The CNPP also makes many tools and online resources available to assist individuals with eating and physical activity goals. ChooseMyPlate.gov and Supertracker.usda.gov are dynamic online resources for individual, families and professionals that put the Dietary Guidelines for Americans into action.

In the near term, the launch of the 2015 Dietary Guidelines for Americans and the Healthy Hunger-Free Kids Act are the top priorities. Some policymakers are challenging the validity of improving child health, and the House and Senate have inserted language in appropriation bills that will restrict USDA and HHS’s  abilities to create the Dietary Guidelines. It’s a very interesting political time regarding advancing the nutritional health of Americans.

Do you have any final advice for students?

Yes, be engaged. Having a good grasp of the content knowledge and political processes are good, but having contacts and networks is just as important. Knowing key people who create change and understanding how to work with them will allow you to be more effective in your endeavors. We need more people to get engaged with nutrition and public health efforts.

By: R. Alex Coots

The field of nutrition is diverse. Some nutrition researchers pursue their work to better understand human metabolism, while others seek to help people build healthy eating habits. Despite the different approaches in their research programs, nutrition researchersall aim to improve public health. But simply producing the information isn’t enough. The entirety of scientific knowledge must be evaluated and used to create effective policies to fully realize the benefits of nutrition research.

Angela Tagtow, Executive Director of the Center for Nutrition Policy and Promotion at the USDA, continues an illustrious career in health promotion at the USDA. She’s worked in nutrition, public health and food systems at levels ranging from local initiatives to international endeavors. She and I had a conversation about her career, her advice for students interested in policy, and her thoughts on the challenges of policy work.

How did you get your start in nutrition and policy?

Growing up, food and meals were very important in my family. We maintained a large garden which provided diverse foods for our day-to-day meals. In college I had an intense interest in health promotion, but clinical dietetics was focused on treatment rather than prevention of illness. Health promotion at the time was nascent but I saw the potential and oriented my life towards it.

After graduation from college I started work at the American Heart Association as a program director. This position helped build out my network and gave me my start in the health promotion world, however I quickly realized I’d need graduate-level training to take my career further. After graduate school I started work as a consultant in the WIC program at the Iowa Department of Public Health. Here I worked more broadly in the public health domain with a variety of groups such as the county boards of health and Title V Maternal and Child Health Services.

After 9 years, I decided to expand my areas of expertise to include food systems as well as public health and nutrition. I founded a consulting company where I provided education, informed policy, and developed communication tools around health, the environment, and food systems. After 9 years of consulting, I moved back to government to work at the CNPP.

What are the key lessons or skills that you took away from these endeavors?

Consulting work affords you a good deal of flexibility in the types of work that you take on. I was able to broaden my skillsets, increase my knowledge base, and diversify my network in ways that I wouldn’t have been afforded in government. Consulting does have a bit more uncertainty with respect to job security. A career in government is a much different experience. The scope of the work is more defined and the position is more secure compared to consulting, but it may be difficult to advance upward.

The key skillsets that today’s students should focus on are critical thinking, communication, and engagement. As dietitians and nutritionists, we need to feel comfortable being assertive and asking the difficult questions. Of these three skills, engagement and networking are the hardest to teach. Students should continually practice this skill throughout their careers. Networking is something that takes time and is an ongoing learning experience.

When creating nutrition policy, are particular data or data types more useful than others?

All of the different data types must be considered, especially systematic reviews and randomly controlled trials. We need to be looking at the preponderance of data to reach a conclusion, not create policy based on one particular study or study type, as each type of study has strengths and weaknesses. After evaluation of the data, we have to be able to translate the body of research into appropriate policy or interventions. Policy is like a puzzle and data are the pieces.

Do you feel that there’s siloing of academic fields, and that crosstalk can improve health outcomes?

There’s still some siloing of research topics, but there has been improvement. Some land grant institutions with great agricultural research programs focus on food production or food processing issues, but this work is not necessarily connected to the greater picture of human health. Some schools have recognized this issue and have started interdisciplinary programs aimed towards interconnectivity – programs in food systems is a good example. People have recognized the value of an integrated approach, but it’s a process that takes time to develop.

Part 2 of this interview will be posted in my next entry.

By Emily Roberts

For nutrition professionals, deciphering the Nutrition Facts labels on food packages may be second nature. However, for the general public it is often difficult to understand and interpret this information. The FDA took this into consideration when proposing new requirements for Nutrition Facts labels in 2014 (1). Two main changes were proposed: new information on labels as well as design changes and new serving and package size requirements (2). The appearance of the label will be quite different if they are accepted.

This is of course to be the biggest change since 1993. The only alteration in the past 20 years has been the requirement of the amount of trans fat to the label in 2006 (1). This month the FDA proposed two more changes to the label. The one getting the most attention is the percent daily value of added sugars.

The most notable changes issued in March 2014 were (1):
• increased font size of calories
• changing of serving size requirements
• placement and update of percent daily value
• including added sugars
• removing calories from fat
• including the gram amount of micronutrients
• including vitamin d and potassium
• making vitamin C and vitamin A voluntary

As of this July 2015, two new changes were proposed (1):
• require the percent daily value of added sugars
• change the footnote to help consumers understand daily values

What are considered added sugars?
Simply stated added sugars are not naturally occurring and are added to the product. ChooseMyPlate says they are sugars that are added when processed or prepared. USDA lists some common sources of added sugars seen on ingredient lists including corn syrup, honey, fructose and lactose. However, for many manufactures this can be quite difficult to quantify because fructose and lactose are naturally occurring in fruits and milk. Yet, when they are added during processing they are now considered an “added sugar”. The current requirements from the FDA states in The Code of Federal Regulations Title 21 (101.60 c) that manufactures can use the claim “No added sugars” if “no sugar or sugar-containing ingredient is added during processing” (3).

Why does the FDA want percent daily value of added sugars?
Currently, there is no percent daily value of sugars because the FDA recommends that consumers limit their sugar intake to as low as possible. Things changed this month when the FDA argued that the percent daily value helps consumers understand how much is too much added sugars. Added sugars provide no nutrient value, increase caloric intake and replace nutrient dense foods. Susan Mayne, director of the FDA’s Center for Food Safety and Applied Nutrition, argued this change will help consumers reduce their intake of added sugars (4).

How much is too much of added sugars?
FDA recommends that daily intake of added sugars should not exceed 10% of total calories (1). If you are eating a 2,000 calorie diet you can easily exceed this 10% mark by consuming one 20 fl oz Minute Maid Lemonade.

How are food manufacturers reacting?
Food companies argue that including added sugars and a percent daily value could be misleading because the body utilizes added sugars the same as natural sugars and question the amount and quality of scientific evidence the FDA used to support their new proposal. Manufacturers claim that nutrition information seldom alters consumer’s food intake, so these changes would be more costly than they would be beneficial (5).

When can the public see these new changes?
The two new proposed changes will go through a comment period before they are accepted.

References
1. http://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/LabelingNutrition/ucm385663.htm#supplemental
2. http://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/LabelingNutrition/ucm387533.htm
3. http://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/LabelingNutrition/ucm064911.htm
4. http://www.npr.org/sections/thesalt/2015/07/24/425908798/no-more-hidden-sugar-fda-proposes-new-label-rule
5. http://www.wsj.com/articles/fda-proposes-listing-added-sugar-on-food-labels-1437774370
6. http://www.natlawreview.com/article/calorie-count-delay-fda-extends-compliance-date-menu-labeling-rules
7. http://www.choosemyplate.gov/weight-management-calories/calories/added-sugars.html
8. http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm
9. http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/cfrsearch.cfm?fr=101.9
10. http://www.minutemaid.com/content/minutemaid/en/home/products/lemonade/lem

Interview with NIH Office of Dietary Supplements Director Dr. Paul Coates

By: R. Alex Coots

Academia is changing.

Today’s universities increasingly rely on adjunct faculty to teach courses and reserve the coveted full-time academic position for the science superstars. This phenomenon, coupled with decreasing paylines from funding agencies, makes a science career especially challenging to pursue. And that’s not even considering the project difficulties!

The problem has become so pressing that even the NIH has realized it. New initiatives, such as the BEST Innovation Award, aim to ensure that graduate students and post-docs have increased opportunities to expand their skill sets for a future outside of academia.

Policy is one of the many areas that nutrition experts can serve. The current Director of the Office of Dietary Supplements (ODS), Dr. Paul Coates, successfully made the transition from bench research as a geneticist to a career in science policy. He spoke with me about his career and transition to ODS.

What motivated your interest into policy?
I was curious. For all these years, I had been funded to do research by the NIH and other organizations, but what I concentrated most on was my own research. I was pretty naïve when I came to the NIH, not knowing what life was like for people who worked on the government side. There were plenty of them like me, PhD’s in one setting or another, who had come to the NIH to work as extramural program directors.

What are the important skills or knowledge that someone should have when moving into policy?
One of the things I understood was the importance of making connections. My first job at the NIH was focusing on diabetes research efforts. I learned how to work with other people within an institute, and then gradually in other institutes and beyond to achieve common goals. I think the art of science policy is knowing who else works in this field that you can benefit from, and flip it around and ask “How can I help other people benefit from working together with them?” Recognize the talent that’s out there in other organizations.

What advice would you give to students?
You need to pay your dues as a scientist first. You need to understand the scientific method. You don’t have to spend an eternity in science, but you must have spent some time doing it. Author publications and write grants. My observation is that the people best prepared for this kind of experience “get it” about what a scientist does. They must be prepared to critically analyze data and know what to look for in the literature to inform policy.

What types of projects do the AAAS and Milner fellows work on?
The AAAS Science and Technology Policy Fellowship is beautifully designed to encourage people at different levels of experience in science to work closely with federal agencies to learn about the science-to-policy transition. In ODS, we’re recent partners in that program. Fellows are engaged in projects that my office works on. We have a very active role in translating science into policy, but also in identifying research needs.

The Milner fellowship has a different side to it. Jointly funded by ODS and the Beltsville Human Nutrition Research Center, the Milner fellowship brings in one or two people per year for a two-year stint that will allow them to conduct research in one of the labs at Beltsville. At the same time, they participate at ODS in work on science policy.

How do you see ODS changing in the future?
ODS is getting a little older. A fairly urgent challenge is identifying people who can come up behind us and continue to identify opportunities for research—particularly those that have public health implications— and be committed to help tackle them.

By Banaz Al-khalidi

First released in 1980, the Dietary Guidelines for Americans are updated and jointly published by the U.S. Department of Agriculture (USDA) and the U.S. Department of Health and Human Services (HHS) every 5 years. These guidelines provide recommendations on nutrition and physical activity for Americans aged 2 and older, and are the driving force behind Federal nutrition policies, nutrition education and food procurement programs. As such, these guidelines are used by both the public and industry, and by a wide variety of audiences including educators, health professionals and government agencies.

Earlier the 2015 Dietary Guidelines Advisory Committee (DGAC) released a Scientific Report based on the latest evidence, which will shape the finalized guidelines later this year. The committee’s work was influenced by two fundamental connections between nutrition and lifestyle-related health issues facing the U.S population:

1) Chronic diseases, overweight and obesity: about half of all American adults (~117 million) have one or more preventable chronic diseases such as type 2 diabetes, cardiovascular diseases, hypertension, and diet related cancers, and about two-thirds of adults and one-third of children are overweight or obese due to poor dietary habits and physical inactivity.
2) Food environment and settings: diet and lifestyle behaviors are strongly influenced by personal, social, organizational, and environmental context and systems. As such, the DGAC developed their recommendations based on a conceptual model of socio-ecological framework to provide recommendations at the individual, social, organizational, and environmental level.

What does the DGAC’s report say about the latest research on diet and lifestyle-related health outcomes?

The DGAC found that the current average American diet is low in vegetables, fruits, and whole grains and too high in refined grains, added sugars, saturated fat, and sodium. Furthermore, inadequate consumption of vitamin D, calcium, fiber, and potassium were categorized as nutrients of public health concern for the majority of the U.S population. Lifestyle-related health problems in the U.S. have persisted for more than 2 decades and the DGAC’s report calls for urgent preventative actions at the national, state, and local community levels. The DGAC recommended a shift in focus to a more environmentally friendly, sustainable plant-based diet that focuses on whole foods rather than specific nutrients. The overall body of evidence examined by the committee is summarized below:

“A diet higher in plant-based foods, such as vegetables, fruits, whole grains, legumes, nuts, and seeds, and lower in calories and animal based foods is more health promoting and is associated with less environmental impact than is the current U.S. diet.”

This is not to say that any food groups need to be eliminated completely to improve health and sustainability outcomes. In fact, the DGAC recommended three dietary patterns to provide options that can be adopted by the U.S. population and are also aligned with lower environmental impacts. These dietary patterns include the Healthy U.S. style Pattern, the Healthy Mediterranean style Pattern, and the Healthy Vegetarian Pattern. Furthermore, the 2015 DGAC left out cholesterol restrictions where previously, the 2010 DGAs recommended that cholesterol intake be limited to no more than 300 mg/day. The up-to-date evidence on cholesterol showed no substantial relationship between dietary consumption of cholesterol and blood cholesterol. Thus, the 2015 DGAC concluded, “Cholesterol is not a nutrient of concern for overconsumption.”

The message is clear—the 2015 DGAC recommends the U.S population consume dietary patterns that are rich in vegetables, fruits, whole grains, seafood, legumes, and nuts; moderate in low- and non-fat dairy products and alcohol; lower in red and processed meat; and low in saturated fat (less than 10% of total calories consumed per day), added sugars (maximum of 10% of total calories consumed per day), and sodium (2,300 mg per day or age-appropriate Dietary Reference Intake amount). Whether the USDA and the HHS will choose to adopt or ignore these recommendations put forth by the 2015 DGAC remains uncertain at this point. Meanwhile, dozens of health and environmental groups support the committee’s recommendations regarding sustainability, as viewed in the open letter found at My Plate My Planet, Food for a Sustainable Nation.

The advisory recommendations put forth by the 2015 DGAC are also closely aligned with recent research highlighting the urgency of shifting global diets, where healthy dietary patterns (i.e. Vegetarian, Pescetarian, and Mediterranean diets) are found to be associated with more favorable health as well as environmental outcomes. Thus, the available data strongly suggest that diets that are higher in plant-based foods will not only improve personal and public health, but also boost our planet’s health via “weight” reduction in greenhouse gases mainly due to reduction in livestock production.

By Ann Liu, PhD

Systematic reviews are the basis for nutrition policy and guidance, but gaps in the evidence base can impact recommendations. Presenters at the symposium “Creating the Future of Evidence-Based Nutrition Recommendations, Using Lipid Research Case Studies” sponsored by ILSI North America spoke on various aspects that inform the process of developing dietary guidance and its implementation on Saturday, March 28. Major policy and regulatory groups such as the Dietary Guidelines for Americans Scientific Advisory Committee, American Heart Association, and the Institute of Medicine use systematic reviews as the basis for their decision making, but often the ability to make recommendations can be hampered by a lack of strong evidence.

The process of developing evidence-based reviews, such as the one used by the USDA Nutrition Evidence Library, must be rigorous, transparent, and minimize bias, because these reviews inform federal nutrition policy and programs. At the outset, key systematic review questions are developed which should reflect important decisional dilemmas in public health nutrition guidance.

The next critical step is deciding on inclusion and exclusion criteria, which determines what literature is included in the evidence base. Criteria that may be considered include study design, study duration, size of groups, drop out rates, and the health status of participants. This process is thoroughly documented and transparent so it can easily be determined why a study was included or excluded. The evidence base will go on to be evaluated by expert panels in order to make recommendations and guidances.

How can scientists ensure that their research is included in the evidence base?

– When designing studies, it is important to consider the validity of the study design, the impact of endpoints, and the relevance and feasibility of interventions. Are the outcomes meaningful and are they translatable? If not, what additional information do you need? Researchers can also use the gaps in the literature identified in Nutrition Evidence Library systematic reviews to inform future investigations.
– If studying chronic disease risk, use validated surrogate biomarkers.
– Carefully consider your comparator group. One of the most common reasons studies are discounted from systematic reviews is they did not include appropriate control groups.
– Once you are ready to report your results, follow established reporting standards such as the Consolidated Standards of Reporting Trials (CONSORT) for randomized clinical trials or the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. This can help ensure that key information is included and is available for data abstraction in future systematic reviews and meta-analyses.
– Participate in the process. Once draft reports such as the Dietary Guidelines for Americans Scientific Report are issued, there is the opportunity for public comment. Feedback from scientists with expertise is strongly encouraged.

By Brett Loman

Carbs increase belly fat. Gluten-free diets cure cancer. Artificial sweeteners cause diabetes. It seems like the more we hear about nutrition, the less we actually “know.” Facts and data give way to beliefs and assumptions. In the hands of the media and laypeople even solid research is boiled down to broad sweeping generalizations about marvelous miracles and perilous poisons. Since my last blog post(1) I’ve been contemplating this dilemma and paused on a thought – can we blame them?

There are three key players at work here: scientists, media, and laypeople. As I discussed last time, scientists are sensationalizing their work under the stress of the current scientific machine. As a result, scientists relay eye-catching yet complicated messages to the media. Members of the media generally aren’t scientists. Plus, to receive newly published studies requires a subscription or email request. Just like any other industry, the media’s ultimate goal is to make a profit. To make this profit they need to sell advertising and to sell advertising they need to capture viewers/listeners/web surfers (the laypeople).

This throws a wrench into things. Detailed data turns into 25 seconds of broad reaching conclusions spoken over images of test tubes and lab coats.

Audiences everywhere hear “drinking more coffee could prevent diabetes, a new Harvard study reveals.” Joe Schmo, who has limited scientific interpretation skills, type I diabetes, and no healthy dose of skepticism, runs out for a Frappuccino. We’ve not accomplished the goal.

So who is to blame, and what can we do to fix it? As scientists, we need to take ownership of our work and ensure that we deliver our findings to the public in a way that is both responsible and comprehensible. To take it a step further, scientists need to become a bigger part of the mechanism by interacting with the media. Public service announcements and PBS specials aren’t going to cut it. We need charismatic scientists who are committed to expressing complex scientific information in an interesting and accessible way. However, this isn’t traditionally part of our training. This will take some work to acquire a new skill set, but the payoff will be instrumental to society.

As a population, we need to make sure that scientific reasoning is a skill that is stressed in our schools prior to higher education and that information is made publicly available. Science is not a body of static facts as it is presented to children today, but a fluid system of critical thinking that asks you to sort through good and bad information and decide the facts for yourself. A good discussion and suggestions for accomplishing this feat can be found at Science Direct.

We all share the blame, but there are definite steps that we can make to repair the system. It may take a little ingenuity, but I have the confidence that we can adapt. What do you think?