Redesigning the Process for Establishing the Dietary Guidelines for Americans (2017) / Chapter Skim
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2 Role and Purposes of the Dietary Guidelines for Americans: Evaluation and Findings
2 Role and Purposes of the Dietary Guidelines for Americans: Evaluation and Findings
Pages 33-54
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From page 33... ...
. While the presence of a relationship between dietary habits and chronic disease can be identified, the precise relationship between dietary patterns and health is complex, involving dynamic interactions among physical, social, behavioral, genetic, environmental, and other determinants of health.
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From page 34... ...
.1 1 Per the National Nutrition Monitoring and Related Research Act of 1990, "At least every five years the Secretaries [of USDA and HHS] shall publish a report entitled ‘Dietary Guidelines for Americans.' Each report shall contain nutritional and dietary information and guidelines for the general public, and shall be promoted by each Federal agency in carrying out any Federal food, nutrition, or health program." Refer to Chapter 1, Box 1-1, for an explanation of how the term DGA is used throughout this National Academies report.
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From page 35... ...
To make the DGA attainable by the general population and subpopulations, the DGA have been designed to have an important role in federal food policies and programs. As the basis for the types and composition of food provided in government food programs, the DGA can be used as a basis for the development of and access to more healthful products by food manufacturers, supermarkets, restaurants and food service operations, and other segments of the food sector.
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From page 36... ...
Some of the confusion about the purposes and audiences of the DGA stems from the multiple outputs of the process used to derive the DGA, such as the Dietary Guidelines Advisory Committee (DGAC) Scientific Report and the DGA Policy Report (see Table 2-1)
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From page 37... ...
TABLE 2-1 Delineating the Functions and Audiences of Products Related to the DGA Process Product Example Audience Function Product Type DGAC Scientific Report 500+-page 2015 DGAC Secretaries of USDA To synthesize the Science-based technical Scientific Report and HHS evidence base for report, including developing the DGA background, rationale, and recommendations analysis DGA Policy Report 100-page 2015–2020 Federal staff, health To convey scientific A report centered on the DGA professionals, policy and policy-related DGA recommendations makers, industry information per se supporting the DGA recommendations to fulfill the National Nutrition Monitoring and Related Research Act DGA recommendations "Follow a healthy General public To provide easy-to- Brief, consumer-oriented eating pattern across understand nutritional guidelines that can stand the life span" and dietary information alone or be incorporated for public use into other products of the DGA process DGA disseminations "Choose MyPlate" General public or To promote Easy-to-understand subsets thereof implementation of the bulletins, graphics, and DGA recommendations others based on the DGA recommendations NOTE: Bold text indicates a proposed addition.
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From page 38... ...
However, this National Academies committee found the entire DGA process has not been comprehensively reconsidered in a manner that effectively allows it to adapt to change while also protecting the integrity of the process. For example, to keep up to date with improvements in the evidence base, the Nutrition Evidence Library was introduced to conduct original systematic reviews.
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From page 39... ...
In addition to the 5-year cycle time specified in the National Nutrition Monitoring and Related Research Act, the scientific review conducted by the DGAC is limited to a 2-year term by the Federal Advisory Committee Act.3 Component tasks related to the DGAC -- including identifying topics, requesting analyses be conducted, evaluating the science, and developing conclusions -- all need to be completed within the 2-year term limit in order to inform the development of the DGA Policy Report. As described in Chapter 5, the 2015 DGAC, which followed a process similar to that of the 2005 and 2010 DGACs, spent one-third of its time (8 out of 24 months)
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From page 40... ...
This confluence of roles adds to the appearance that decisions may not be made independently throughout the DGA process. Additionally, the secretaries have directed each new cycle of the DGA to begin with a DGAC to evaluate the previous version of the DGAC Scientific Report and DGA Policy Report to determine whether updates of previous conclusions are required.
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From page 41... ...
A fundamental value of the DGA process redesign is to enhance transparency of the process. It is a multilayered process that needs to be transparent at each level, requiring each step of the process be documented and updated, and that such documentation be readily available to the public.
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From page 42... ...
Other ongoing federal activities exist to help coordinate federal nutrition e fforts, such as the Interagency Committee on Human Nutrition Research, with the goal of increasing effectiveness and productivity of federally supported or con ducted human nutrition research (NAL, 2017)
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From page 43... ...
The food sector can help highlight the implications of specific DGA recommendations on the food supply or production. The transfer of knowledge from science-based recommendations into actionable guidance that may be adopted by the general public can be challenging.
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From page 44... ...
. Additionally, while there is a difference between actual and perceived conflicts, the perception is sometimes enough to promote mistrust." "But given the breadth of this National Academies committee's definitions of biases and conflicts of interest to include nonfinancial conflicts, the committee does not believe these influences can be eliminated entirely.
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From page 45... ...
All stakeholders could provide input into the process; however, only experts as appointed by the secretaries of USDA and HHS ought to be involved in decisionmaking processes throughout the development of the DGA, including the DGA Policy Report. Supporting a More Deliberative Process Another value of the process redesign is to support a more deliberative approach that is adaptive to dynamic shifts in the system in which it operates.
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From page 46... ...
After review and discussion, this National Academies committee believes that the secretaries of USDA and HHS have flexibility in interpreting the National Nutrition Monitoring and Related Research Act and are able to adopt a more flexible process for reviewing, updating, and publishing the DGA. Given how the purpose and audience of the DGA have changed over time, the breadth and content of each required report ought to be interpreted such that not all topics require a detailed review every 5 years.
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From page 47... ...
To guide a restructuring effort, this National Academies committee believes continuity needs to be integral to the DGA process to develop a more strategic approach to accomplish the goals and vision of the DGA. Development of such an approach can help provide additional opportunities for stakeholder participation and increase transparency of what is included in the DGAC Scientific Report and the DGA Policy Report, and can shape the scope of future DGA in more predictable ways.
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From page 48... ...
Transparent and participatory continuous quality improvement can also help improve the integrity of the DGA process. To best assess the growth and the adequacy of the process to update the DGA, the secretaries of USDA and HHS will need to implement a monitoring and evaluation plan as soon as possible.
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From page 49... ...
The DGA can play a key role in advancing the understanding of the role of diet within the larger system of factors that affect health. However, understanding the precise role of each DGA recommendation in improving health and reducing chronic disease risk is a long-term iterative process that will take multiple DGA cycles to complete, but over time will lead to increasing clarity.
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From page 50... ...
. Given the prevalence of chronic disease and risk for chronic disease in the population, this National Academies committee believes it will also be essential for the DGA Policy Report to include all Americans whose health can benefit by improving their diet based on the scientific evidence.
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From page 51... ...
. The process redesign will provide opportunities to expand the methodological approaches to develop the DGA to include broader groups of people with a range of physiological needs, metabolic health, and chronic disease states.
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From page 52... ...
2015. Dietary Guidelines for Americans 2015 – 2020: Eighth edition.
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From page 53... ...
2013. Barriers and facilitators for consumer adher ence to the Dietary Guidelines for Americans: The HEALTH study.
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From page 54... ...
2003. Diet, nutrition and the prevention of chronic diseases: Report of a joint WHO/FAO expert consultation.
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