Report of the 2020 Dietary Guidelines Advisory Committee: Setting the Stage and Integrating the Evidence

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Our series on the newest scientific report from the Dietary Guidelines for Americans Committee continues with a closer look at section B of the review. If you missed our post about part A, the Executive Summary, check it out here

Let's take a look at the next few sections of the scientific report from the Dietary Guidelines for Americans Committee! Today's post will address...

  • Part B: Setting the Stage and Integrating the Evidence
    • Chapter 1: Introduction
    • Chapter 2: Integrating the Evidence

"This chapter provides an overview of the themes that emerged from the 2020 Dietary Guidance Advisory Committee’s examination of the evidence pertaining to the questions addressed."

This portion of the report highlights the importance of a look at dietary patterns and nutrient intake in a culturally sensitive manner, exploring the full lifespan for the very first time. Why a lifespan approach? Here are a few of the answers...

  • "A lifespan approach highlights the importance of implementing dietary patterns that are most associated with nutrition adequacy, energy balance, and reduced risk of diet-related chronic health conditions starting at the earliest life stages."
  • This approach focuses on the importance of sticking to these eating patterns at each distinct life stage in order to stay healthy.
  • Further, this approach emphasizes how vital it is to consider eating patterns that can reduce the risk of obesity and obesity-related illnesses, along with other chronic diseases.
  • "As opposed to a focus on weight status at one point in life, the recommended dietary intakes support healthy weight trajectories at each stage of life."

There is a high prevalence of diet-related chronic disease in the United States, which poses a public health challenge. The committee found a skyrocketing increase in severe obesity, while total obesity in America has climbed to include over 70% of all adults. According to the Centers for Disease Control and Prevention (CDC), chronic disease is also on the rise. "Various factors contribute to the prevalence of chronic disease. Prominent among these are poor nutrition, lack of physical activity, and excessive alcohol use."

This report is continuing to explore the impact of eating patterns rather than individual food groups and nutrients, building off of foundations laid in previous editions and further expanding their scope. The committee has also drawn on the section What We Eat in America (WWEA) from the National Health and Nutrition Examination Survey (NHANES) to determine whether people in the United States are adhering to the advice put forth in the previous editions of the dietary guidelines (spoiler alert: they're not). Most people are eating...

  • Too few fruits, vegetables, whole grains, low-fat dairy
  • Too many added sugars, sodium, and solid fats
  • An improperly balanced range of protein foods

The committee maintains "Efforts are needed at every life stage to improve typical eating patterns and reinforce the recommended eating patterns for Americans to achieve adequate nutrient intakes, avoid excess energy intake, and lower risk of chronic diseases."

The Importance of Considering Life Stages in Dietary Guidelines for Americans: According to this report, "Achieving goals at each life stage not only supports health at that point in time but also provides a sound basis for transitioning to the next life stage from a position of nutritional advantage." Establishing healthy patterns very early in life sets people up well for continuing in those patterns while focusing on foods that are not nutrient-dense and setting up unhealthy eating patterns not only makes it harder to change those patterns in the future but also may "initiate subclinical biologic processes that lead to disease expression in later years."

The report further asserts, "Throughout all the life stages, physical activity levels, sleep quality and duration, and other unique personal lifestyle factors may affect health and nutrient requirements. Knowledge of healthful dietary patterns and strategies to reinforce healthy behaviors should be promoted and encouraged in all settings of home life, work, and play (e.g., daycare, schools, workplace food service) and at all life stages to promote improved health outcomes." Each life stage provides a chance to build health through food and activity choices.

Dietary Patterns as a Framework for Recommendations Within and Across Life Stages: The link between healthful eating patterns and lower risk of certain chronic diseases have been strengthened by lots of new evidence since it was first explored in the 2015-2020 edition of the guidelines. The committee asserts "the most important features of dietary patterns are the quality and types of foods recommended for greater intake and the nature of the foods to be used in a more limited fashion."

Couching recommendations in terms of eating patterns have lots of positive aspects, including...

  • Emphasizing foods, which are familiar, over nutrients, which may not be familiar.
  • Highlighting the fact that food choices as a whole, not their components, are what's most important to good health.
  • "Dietary recommendations are only as good as the level of adherence to them, and respecting culture-based preferences with relevant eating patterns should help improve adherence and health outcomes."

The committee explored a variety of different studies, both from the United States and from other countries, to examine different kinds of populations and demographics, and they found that a healthful eating pattern can be made to fit a wide range of cultures and regions with the same positive health effects, highlighting the effectiveness and flexibility of an eating pattern approach.

The researchers explain "One of the most important steps many Americans can take to achieve a dietary pattern associated with health and lowered risk of chronic diseases is to identify the foods that provide energy with little or no recommended nutrients or fiber in their current eating pattern, reduce their intake of these items, and shift their food choices to more healthful foods and beverages to meet energy goals."

The context for the Dietary Guidelines for Americans: These guidelines inform federal policy and shape paths for further research. Some of the recommendations have had measurable impacts on the health of Americans. For example...

  • Trans fat labeling
  • Added sugar labeling
  • New emphasis on whole grains

Further, "The 2020 Committee was asked to address certain questions that consider not only what individuals eat but how they eat." Though the guidelines call for their recommendations to be explored in the context of the overall food system, that could not be addressed in this edition. The committee hopes that it will be considered in the future, because "Understanding and mapping these factors can enable decision-making that supports the health and well-being of the U.S. population."

Resources that are Important for Science-Based Dietary Guidelines: These guidelines are released every five years in order to address any scientific breakthroughs that happen in the intervening years. "To meet this standard and provide science-based advice to the Secretaries, the Committee based its conclusions and recommendations on robust, well-defined protocols for systematic reviews of peer-reviewed literature, analysis of data from NHANES, food composition data that can be used for modeling, and the Dietary Reference Intakes (DRIs) established by NASEM." Before the next steps are taken, the committee hopes to see updated DRIs for the new groups they explore in this edition, including infants and toddlers, breastfeeding women, and pregnant women. They also hope to see more research about nutrition and health topics relating to these groups.

Considerations for Updating the Guidelines: You can find the full list on pages 14-16 here, but here are the highlights of the main considerations for the next update...

  • Follow a healthy eating pattern across the lifespan.
  • Focus on variety, nutrient density, and amount.
  • Limit calories from added sugars and saturated fats and reduce sodium intake.
  • Shift to healthier food and beverage choices.
  • Support healthy eating patterns for all.

Remember, this report is not an officially-approved version of the Dietary Guidelines. According to Barbara Jerka, "The Committee’s Scientific Report is not a draft of the Dietary Guidelines. The primary audience of the Committee’s Scientific Report is USDA and HHS. It provides the review of the current state of nutrition science and includes independent, evidence-based advice for consideration as USDA and HHS develop the next edition of the Dietary Guidelines. The primary audiences of the Dietary Guidelines are health professionals and policy makers, including Federal programs, which implement the Dietary Guidelines through the programs and services they provide to the American public."

You can read the full report here. This report is now open for public comment, and there will be an online meeting on August 11 to discuss thoughts on the initial report before it goes into the next phase of development.

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