Milling & Baking News - September 26, 2017 - 18

Nutrition and Health X

Significant overhaul sought for
Dietary Guidelines process
Continued from Page 1

committee was Robert M. Russell, professor emeritus, nutrition and medicine, Tufts University, School of Medicine, Boston.
The Dietary Guidelines for Americans has been published in a five-year
cycle since 1980 jointly by the U.S. Department of Agriculture and the Department of Health and Human Services. The Guidelines are developed
based on recommendations from the
Dietary Guideline Scientific Advisory
Committee, a group of external experts
named by the U.S.D.A. and the H.H.S.
Following the publication of the 2015
Guidelines, Congress decided to order
a review to improve the advisory committee selection process and to provide
greater transparency, eliminate bias
and include committee members with
a range of scientific viewpoints.
At the most basic level, concern
about the effectiveness of the D.G.A.
stems from the small percentage (less
than 10%) of Americans who actually
follow the Guidelines, an issue that
has dogged the recommendations from
the time the D.G.A. were introduced in
1980 and especially more recently as
problems like obesity have worsened.
The review committee noted a twopart role for the D.G.A.:
1. To provide the public "with science-based dietary advice on eating
patterns that can help to reduce the
risk of developing a chronic disease;"
2. Providing guidance for foods to
be included in federal nutrition programs, such as the National School
Lunch Program, the Special Supplemental Nutrition Program for Women,
Infants, and Children (WIC) program,
and many others.
An earlier report on the D.G.A.,
published in February 2017, suggested
changes in the selection process for the
D.G.A.C.
The report recommends changes to the
D.G.A. process to reduce and manage
sources of bias and conflicts of interest.
Concerns about the D.G.A. increased
following publication of the 2015 edition, the review committee said. Discussion about the role of added sugars
was a particular lightning rod.
"More than 29,000 public comments
were submitted in response to the Scientific Report of the 2015 D.G.A.C. both
in support of and against the conclusions made," the review committee said.
"The predominant topic addressed in the
18 / September 26, 2017 XMilling & Baking News

public comments was added sugars,
with suggestions ranging from overall
limitations to 'a focus on total calories
and portion sizes.' The 2015 D.G.A.C.'s
inclusion of sustainability concerns was
also controversial. In response to these
criticisms, Congress mandated that the
National Academies of Sciences, Engineering, and Medicine (the National
Academies) evaluate the entire process."
Also to be reviewed
as part of the mandate
were how the Nutrition Evidence Library
(N.E.L.) is compiled and
utilized, how systematic
reviews are conducted
on longstanding D.G.A.
recommendations, including whether scientific studies are included
from scientists with a
range of viewpoints;
and ways the D.G.A.
may result in less chronic disease, ensure nutritional sufficiency for all
Americans and accommodate a range
of individual factors, including age,
gender and metabolic health.
A number of important challenges
were identified with regard to the current process. Confusion has arisen over
the purpose and the target audience of
the D.G.A., the review committee said.
The five-year Guidelines cycle also
is flawed, particularly the constraints
that come from the two-year Dietary
Guidelines Advisory
Committee
terms. Improvement is needed in the
overall process to update the D.G.A.
"The methodological approaches
to evaluating the scientific evidence
require increased rigor," the review
committee said.
Specifically identified for criticism
was the long duration between systematic reviews on a topic under the
current system. As a result, recommendations often fail to "keep pace
with the emerging science; thus ongoing surveillance of the literature needs
to be instituted," the committee said.
The committee said analytic findings
and conclusions "compromise the integrity of the D.G.A. and limit its ability
to develop a full body of evidence on a
continuous basis over time."
To enhance the integrity of the
Guidelines process and make the recommendations more trustworthy, the
review committee identified a number

of "values" to pursue:
1. Enhance transparency;
2. promote diversity of expertise
and experience;
3. support a deliberative process;
4. manage biases and conflicts of interest; and
5. adopt state-of-the-art processes
and methods.
Judged from the strength of the underlying science used to develop the
Dietary Guidelines, the present system
is strong, the review committee said. In
fact, the process has become "more evidence-based" than ever,
thanks to the integration
of food pattern modeling
into deliberations and
because the committee
has the ability to conduct
systematic reviews.
While supportive of
the food pattern modeling that is the basis for
developing recommendations, the approach
has limited applicability to those who follow
different consumption
patterns, an issue the
committee said needs
to be addressed. A more standardized
process for identifying nutrients of concern would be helpful.
The review committee also faulted
the process for its failure to adapt to
changes in food diversity and the increasing prevalence of chronic disease.
The committee advocated the use of
"systems approaches" to help clearly
define the roles and limitations of diet
in reducing chronic disease.
According to the N.I.H., the application of systems-level approaches to the
study of nutrition has "helped to elucidate the complex interactions between
nutrition and neurobiological, endocrinological, genetic, gut microbial,
behavioral and environmental factors,
and how these interactions influence
metabolic health and the development
of chronic diseases such as obesity and
type 2 diabetes." The committee said
systems approaches remain in their infancy in the nutrition field.
To explain the application of systems approaches, the committee noted
that inadequate intake of iron may result in anemia.
While addressing nutrient deficiency historically has been a focus of
dietitian recommendations, the relationship between eating and health is
more complicated, the committee said.
"Through years of scientific investigation in nutrition and health, an
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