*This Guest Blog Post was written by Anna Berner, a Medical University of South Carolina Dietetic Intern.
The 2019 World Series wasn’t the only important event going on at the end of October in Washington, DC! On October 24th and 25th, the Dietary Guidelines for Americans Advisory Committee reconvened for their third public meeting in the Jefferson Auditorium of the U.S. Department of Agriculture Building. Now, the seats weren’t sold out like the Nationals Stadium, but nearly 1,200 participants did attend the meeting either in person or through webcast. You might be wondering, just what are the Dietary Guidelines for Americans (DGAs) and how do they impact me? The DGA’s are a set of guidelines published jointly by the United States Department of Agriculture (USDA) and the United States Department of Health and Human Services (HHS) in collaboration with programmatic and scientific experts. Although the public may not be aware of the full impact of the DGAs, they have a pretty extensive impact on us all. Not only are the DGAs used to develop education materials for schools, colleges, businesses, community groups, media, and the food industry, but they have a huge impact on federal food, nutrition, health policies and programs. If you want to stay informed and involved with the DGA’s, but simply don’t know where to start, then let me break it down for you!
Let’s travel back in time to the beginning of the Dietary Guidelines for Americans, so that you can better understand what makes the 2020 round of DGAs so unique. The DGAs have consecutively been published every five years since 1980 and have significantly evolved as nutrition science has progressed. The purpose of these Dietary Guidelines for Americans is to provide advice on what to eat and drink to build a nutritious diet that can promote health, help prevent diet-related chronic disease, and meet nutrient needs. The DGAs from 1980 to 2015 provided general nutrition and nutrition-related health recommendations for those two years of age or older. For the first time ever, the 2020 DGAs will include nutrition recommendations for infants and toddlers below two years of age, as well as women that are pregnant. With such specific and crucial topics on the line, there must be a group experienced and knowledgeable enough to know how to approach these distinct nutrition topics. That is where the Dietary Guidelines Advisory Committee (DGAC) comes in. The members of the DGAC are nutrition experts, ranging from nutrition scientists, researchers, and Registered Dietitians. Each expert has a diverse background in nutrition, and in turn this creates an ideal environment where they can dive deep into the nutrition science research and evidence. As the committees begin to draw conclusions from the research, a scientific recommendation report will be formulated and submitted to the Secretaries of the USDA and HHS for review. The USDA and HHS takes the DGAC report and the various oral and written comments from the public into account as they construct the final DGAs for the next five years.
At this point, you may be wondering how the DGAs may have impacted you in the past and what the future of DGAs hold for you and your family. The DGAs have likely impacted you through three different means: (1) federal nutrition policy and programs, (2) local, state, and national health promotion and disease prevention initiatives, and (3) various organizations and food and beverage industries.
First, the DGAs play an important role in forming nutrition related policies and programs. Just a few of these programs include the National School Lunch Program (NSLP), School Breakfast Program (SBP), Head Start Program, Supplemental Nutrition Assistance Program (SNAP), Women, Infants, and Children (WIC), and the Elderly Nutrition Program (ENP). These programs are required to base their nutrition recommendations off the current DGAs. The DGAs affects the standards by which schools, daycares, and Meals on Wheels menus are developed, the nutrition education materials provided through SNAP, and the packages distributed to various WIC participants. In addition, the government programs mentioned previously feed one in four Americans each year and therefore this can become a huge source of income for many food-company suppliers.
Second, the DGAs help guide local, state, and national health promotion and disease prevention initiatives. These initiatives aim to engage and empower individuals and communities to choose healthy behaviors. One of these initiatives includes the formation of the MyPlate model. As a result of the 2010 Dietary Guidelines for Americans, the Food Pyramid was replaced by the current MyPlate model as the government's primary food group symbol.
Third, the DGAs have an impact on various organizations and food and beverage industries which in turn affect the health of Americans. DGAs help guide the consumer towards various food products, and in turn the DGAs shape the market. Many manufactures formulate their products based on the DGAs, so that they can participate in the nutrition programs, which buy $100 billion of food a year.
Innovation in the 2020-2025 DGAs Process
Topic and Question Development- For the first time, the Department of Health and Human Services and the U.S. Department of Agriculture, which oversee the committee, have predetermined the topics that will be addressed. During the process of predetermining the topics and questions for the 2020-2025 DGAs, comments from the public and various other professionals were taken into account. In the past, the DGAC has had the freedom to develop their own topics and questions. At the third meeting, Dr. Eve Stoody, Designated Federal Officer and Lead Nutritionist for the U.S. Department of Agriculture, discussed the USDA and HHS reasoning behind this choice. She stated that choosing the topics and questions for the DGAC would promote a more “deliberate and transparent process”. Unfortunately, these predetermined topics and questions have narrowed the research of the DGAC members. As the 2020 DGAC works to answer the scientific questions from the USDA and HHS, they are using a three-approach method to examine the evidence: data analysis, food pattern modeling, and systematic reviews. Each of these approaches has its own meticulous and protocol-driven methodology, that plays a complementary role in examining the science.
Birth to 24 Months Subcommittee and Pregnancy and Lactation Subcommittee- It is widely known that good nutrition during pregnancy and in the first 2 years of life is vital for growth, development, and health throughout the lifespan, but only until this edition of the DGAs, were the DGAC assigned the task of developing dietary guidelines for this age group. From 1980 to 2015, the DGAs have only provided nutrition recommendations for Americans ages 2 years and older. For the first time, the 2020-2025 DGAs will include recommendations for those under two years old and pregnant women. In February 2014, Congress passed the Farm Bill mandating that the DGAs be expanded to include dietary guidance for infants, toddlers, and women who are pregnant. The Birth to 24 months (B-24), Data Analysis and Food Pattern Modeling, Dietary Fats and Seafood, Beverage and Added Sugar, and Pregnancy and Lactation subcommittees will all be looking at nutrient needs related to the B-24 age range. The B-24 subcommittee will directly address questions related to the relationships between various health outcomes and duration of exclusive human milk and/or infant formula feeding, frequency and volume of human milk and/or infant formula feeding, dietary supplements, and complementary feeding. The Birth to 24 Months and Pregnancy and Lactation Subcommittees will be pulling a significant portion of their research from the Pregnancy and Birth to 24 months (P/B-24) Project developed by the USDA and HHS in 2012.
Key Takeaways from the Third Public Meeting
Progress since the second public meeting:
Many of the 40 protocols have been refined based on the committee’s discussion and public comments.
Some of the subcommittees were able to implement the plan and assign a grade to their conclusion statements.
The USDA and HHS members as well as the DGAC placed a huge emphasis on the 2020-2025 DGAs being transparent, inclusive, and science driven.
Many members of the committee highlighted the importance of shaping future research. Topics such as nutrigenomics even came up from Dr. Scott Hutchins, the Deputy Under Secretary of the Research, Education, and Economics of the U.S. Department of Agriculture. The future research recommendations will be in the appendices of the final scientific report.
The Committee and Nutrition Evidence Systematic Review (NESR) support staff concluded that the final scientific report should be arranged in lifespan phases for organizational and readability purpose.
For the Dietary Patterns Subcommittee, it was decided that the NOVA food classification system will not be addressed in the 2020-2025 DGAs.
NOVA is a system that categorizes foods according to the extent and purpose of food processing, rather than in terms of nutrients. NOVA is beginning to be looked at worldwide.
For the Dietary Fats and Seafood Subcommittee, it was decided that the committee would only look at seafood consumption in their studies and they would not include studies that used supplements. (Example: Fish Oil)
For the Beverage and Added Sugar Subcommittee, they will be evaluating research on the relationships between alcohol consumption and various health outcomes.
For the Frequency of Eating Subcommittee, the definition for fasting was updated to include the consumption of water.
For the Birth to 24 Months Subcommittee, the group will be looking more at “What to feed” and won’t be addressing “How to feed” infants and toddlers less than 2 years old. Responsive feeding was brought up as a potential research topic for the future.
Responsive feeding is a two-way relationship between you and your child. Your child communicates feelings of hunger and fullness (verbally or non-verbally) followed by an immediate response from you, such as feeding your child or ending a feeding.
For the Pregnancy and Lactation Subcommittees, there was discussion among the committee surrounding the difficulty in evaluating studies that look at quantity of human milk production and composition of human milk. Many members of the committee pointed out that measuring the quantity of human milk production in participants is difficult because production is often based on demand. They also discussed the difficulty of identifying the composition of human milk in reference to hind milk vs. foremilk, night pumping vs. day pumping, etc.
The committee decided that the methodologies (such as pumping) for the collection of milk need to be similar across studies.
For the Data Analysis and Food pattern Modeling Subcommittee, they discussed standardizing the language for how individuals address added sugars and caffeine. They would like to see these compounds labeled as “dietary components” or “food components” instead of nutrients.
Upcoming DGA Work & Dates
The committee is still hard at work, but their time is slowly winding down. There are two more public meetings- one in January in Houston and one in March in Washington, DC. The Houston meeting will be the final opportunity for public oral comments. The DGAC will continue to accept written comments well into 2020. Everyone can stay up to date on the process by visiting www.dietaryguidelines.gov.