Redesigning the Process for Establishing the Dietary Guidelines for Americans (2017) / Chapter Skim
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5 Current Process for Developing the Dietary Guidelines for Americans: Key Findings
5 Current Process for Developing the Dietary Guidelines for Americans: Key Findings
Pages 103-132
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From page 103... ...
. The memorandum indicates which agency will serve as the administrative lead for that particular DGA cycle,2 states the intent to establish the Dietary Guidelines Advisory Committee (DGAC)
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From page 104... ...
and describes the plan to identify co-executive secretaries. In the past three editions, the memorandum of understanding was executed between 18 and 29 months after the prior DGA Policy Report was released.
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From page 105... ...
. The DGAC's advice is provided to the secretaries in the form of a report called the Scientific Report of the Dietary Guidelines Advisory Com ittee, m referred to in this report as the DGAC Scientific Report.
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From page 106... ...
Additional guidance stated that topics could be explored if they potentially enhanced how the DGA Policy Report was implemented, such as the social, behavioral, and food environmental factors related to diet outcomes such as intake of foods, food groups, and dietary patterns. USDA and HHS also suggested that health outcomes of public health concern ought to be considered by the DGAC, including cardiovascular disease, body weight status, cancer, diabetes, bone health, and prevention of food-borne illness, among others (HHS/USDA, 2013a,b)
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From page 107... ...
consider topics of public health concern, informed by the 2010 DGA Policy Report and 2010 DGAC Scientific Report, and (2) develop a set of questions based on the importance and likelihood of informing the next edition of the DGA (Millen, 2017)
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From page 108... ...
. Members of the public were invited to comment throughout the DGAC process through the public comments database.
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From page 109... ...
In addition to the co-executive secretaries who represented USDA and HHS throughout the 2015 DGAC process, the Dietary Guidelines Management Team provided administrative support to the DGAC and its subcommittees, the NEL staff helped the DGAC conduct systematic reviews according to NEL systematic review methods, and the Data Analysis Team presented analyses and summaries of data from USDA and HHS as requested by the DGAC.
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From page 110... ...
The DGAC Scientific Report is written by the DGAC itself, with support from a science writer and federal staff. If consensus is not reached, it is up to each DGAC to determine the processes for addressing the differences.
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From page 111... ...
Upon submission of the report, the DGAC disbands. Solicit and Review Comments on the DGAC Scientific Report No official peer review takes place of the DGAC Scientific Report, but after it is submitted, the report is subject to a formal public comment period and a federal interagency review.
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From page 112... ...
The amount of time from the release of the DGAC Scientific Report to the release of the DGA Policy Report has ranged from 5 months, to 8 months, to 11 months for the past three editions respectively. Dietary Guidelines Writing Team The DGA writing team's role is to accurately translate the "preponderance of scientific evidence"5 -- based on the DGAC Scientific Report, public comments, and federal interagency review comments -- into language for health professionals and policy makers to advance the scientific basis of federal nutrition programs.
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From page 113... ...
. In conducting its work, the writing team identifies major themes in the DGAC Scientific Report and builds on previous editions of the DGA Policy Report.
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From page 114... ...
used as basis for creation of 27-page DGA consumer brochure 1995 DGAC's collective knowledge Consumers Healthy Americans, Technical report (52 7 guidelines of nutrition ages 2 years and older, pages) used as basis for to help promote health creation of 43-page DGA and prevent disease consumer brochure 2000 DGAC's collective knowledge Consumers, Healthy Americans, Technical report (87 10 guidelines of nutrition policy officials, ages 2 years and older, pages)
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From page 115... ...
, data analyses, food promote health and information at NEL.gov specific population pattern modeling analyses, and decrease risk of major used as basis for creation groups) other scientific reports chronic diseases of 108-page DGA policy document 2015 DGAC's systematic review Policy officials, Americans ages 2 years Technical report 5 overarching of scientific literature using nutritionists, and older, including (567 pages)
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From page 116... ...
. Incorporating Evidence into the DGA The DGA Policy Report is informed by the totality of the science described in the DGAC Scientific Report.
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From page 117... ...
The writing team also takes into account the difference between association and causation, as studies directly determining causes and health outcomes are not always available. Ever since graded conclusions were included in the DGAC Scientific Report, the policy report has been able to incorporate specific statements describing the strength of evidence.
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From page 118... ...
. Review of the DGA Policy Report After a draft of the DGA Policy Report is compiled by the writing team, the document undergoes three distinct types of review and revision to ensure clarity and technical accuracy: federal expert technical review, external peer review, and departmental clearances.
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From page 119... ...
. Individuals are generally asked to review the draft for clarity and technical accuracy and are directed to refer back to the DGAC Scientific Report if any substantive science-based questions arise.
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From page 120... ...
Activities included making the final product accessible to people with disabilities and producing HTML and PDF versions. Other operating expenses included the use of a science writer/editor and the hosting of a public comment meeting to receive feedback about the DGAC Scientific Report.
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From page 121... ...
A change occurred when the Agricultural Act of 2014 mandated that the 2020–2025 DGA Policy Report include pregnant women, infants, and young children 0–24 months. The inclusion of dietary guidance for pregnancy and infancy is timely because the emerging evidence that supports the developmental origins of disease (Hanson and Gluckman, 2015)
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From page 122... ...
in the 2020–2025 DGA. USDA and HHS accordingly adjusted their plan, such that topics and questions of public health importance would be explored and some systematic reviews would be conducted for these population subgroups and made publicly available.
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. KEY FINDINGS FROM AN ASSESSMENT OF THE PROCESSES USED TO DEVELOP THE 2005, 2010, AND 2015 EDITIONS OF THE DGA POLICY REPORTS In its first report, this National Academies committee delineated a set of values, which, if taken together, can enhance the integrity of the selection process: enhance transparency, promote diversity of expertise and experience, support a deliberative process, manage biases and conflicts of interest, and adopt state-of-the-art processes and methods (NASEM, 2017)
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From page 124... ...
The process for considering the DGAC Scientific Report to the DGA Policy 7. Report is completed internally by USDA and HHS without an accounting of differences between the two reports.
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. Additionally, although the National Nutrition Monitoring and Related Research Act specifies that the guidelines are for the general public, the stated audience of the DGA Policy Report after 2000 does not include the general public.
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"The Dietary Guidelines provides evidence-based food and beverage recommen dations for Americans ages 2 and older. These recommendations aim to: • Promote health • Prevent chronic disease • Help people reach and maintain a healthy weight Public health agencies, health care providers, and educational institutions all rely on Dietary Guidelines recommendations and strategies.
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From page 127... ...
"The Dietary Guidelines is an important part of a complex and multifaceted solution to promote health and help to reduce the risk of chronic disease." (Secretaries' statement from 2015–2020 DGA) "These analyses will assist professionals and policy makers as they use the Dietary Guidelines to help Americans adopt healthier eating patterns and make healthy choices." (Secretaries' statement from 2015–2020 DGA)
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From page 128... ...
The current process is not as transparent as it could be, and does not sufficiently explain how diversity of expertise and experience is achieved. Additionally, as concluded in this National Academies committee's first report, more transparency is needed throughout the selection process and an emphasis ought to be placed on managing both financial and nonfinancial conflicts of interest (NASEM, 2017)
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From page 129... ...
Notably, the DGA Policy Report differs in that the DGAC is responsible for reviewing and assessing the quality of the evidence while the federal writing team develops the guidelines. The separation in the DGA process stems from the Federal Advisory Committee Act and the National Nutrition Monitoring and Related Research Act.6 The federal writing team ought not be exempted from adhering to explicit and transparent standards for developing clinical practice guidelines.
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From page 130... ...
The process for considering each DGAC Scientific Report is not as transparent as it should be and does not encourage a deliberative process. The final key finding of this National Academies committee regarding transparency is that the P/B–24 project process has not been as clear as it could be.
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From page 131... ...
2013b. 2015 Dietary Guidelines Advisory Committee first meeting transcript.
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From page 132... ...
2015b. Scientific report of the 2015 Dietary Guidelines Advisory Committee.
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