Dietary Guidelines Advisory Committee -...

December 15, 2014 2015 DGAC: MEETING 7

Science Base Chapter:

Food and Nutrient Intakes, and Health:

Current Status and Trends

Subcommittee 1

MEETING 7 December 15, 2014 2015 DGAC:

Subcommittee 1 Membership

Marian Neuhouser SC 1 Chair

Alice H. Lichtenstein DGAC V ice Chair

Steve Abrams Cheryl Anderson Mary Story Barbara Millen

2015 DGAC: MEETING 7

Introduction Chapter provides a broad examination of

food and nutrient intakes by the U.S population, the food and eating environment, prevalence of chronic health conditions.

Provides an understanding of the relationship of food intake and the food environment to nutrition-related health conditions. Documents high rates of diet-related health conditions and provides compelling reasons to study them in greater detail. Provides context for actions to facilitate and implement behavior change and adoption of healthy eating practices in the U.S. population.

Taken together, our analyses inform the remaining chapters in the report, which will provide the contextual and scientific foundation for the 2015

Dietary Guidelines for Americans.

Food and Nutrient Intakes, and Health: Current Status and Trends


Topics Addressed

Nutrient intakes/nutrients of concern for under or over-consumption

Food groupscurrent intakes and trends

Food categoriescurrent intakes and sources of energy, nutrients, and food group intakes

Eating behaviorscurrent intakes and trends

Prevalence and trends in health conditions

Dietary patterns composition



Methodology

Data analyses (21 questions) National Health and Nutrition Examination Survey (NHANES), including What We Eat in America (WWEIA) Additional data sources:

SEER/NCI; SEARCH for Diabetes in Youth Study; CDC population-based birth defects surveillance system; National Health Interview Survey; Alzheimer's Association; other CDC publications

Food pattern modeling analyses (7 questions) In addition, brought forward summaries from analyses by previous DGACs for several questions.



Status Update

No substantive changes since the work was previously reported in a public meeting.



Nutrient Intakes and Nutrients of Concern

Based on intake data, together with nutritional biomarker and health outcomes data, identified nutrients that may pose a public health concern:

Vitamin D, calcium, potassium, and fiber are underconsumed across the entire US population. Iron is underconsumed for adolescent and premenopausal females. Sodium is overconsumed across the entire US population Saturated fat is overconsumed and may pose the greatest risk to those > 50 years old.

Cholesterol is not considered a nutrient of concern for overconsumption.


vitamin D

vitamin E magnesium

calcium vitamin A vitamin C

zinc vitamin B6

folate iron

thiamin copper

phosphorus selenium

vitamin B12 niacin

riboflavin

20 40 60 80 100

Percent of population 0


Percent of population ages 2+ with usual intakes below EAR

What We Eat in America, NHANES 2007-10



Ages 1-3

Ages 4-8

Ages 9-13

Ages 14-18

Ages 19-30

19-30

Males: Ages 1-3 Ages 4-8

Ages 9-13 Ages 14-18 Ages Ages 31-50 Ages 51-70

Ages71+

Females:

Ages 31-50 Ages 51-70

Ages71+


Sodium: Percent of age/sex group with usual intakes above the UL

0 10 20 30 40 50 60 70 80 90 100



Nutrient IntakesSupplements, Caffeine

Overconsumption of nutrients from foods and beverages, including fortified foods, is rare.

However, folate, calcium, iron, and vitamin D may be overconsumed in some supplement users, especially those taking high-dose supplements.

In general, caffeine intakes do not exceed what are currently considered safe levels for any age group.



Adequacy of the USDA Food Patterns USDA Food Patterns provide food-based guidance. The Patterns meet nutrient adequacy goals across a broad range of age and energy levels.

When adjusted for the food choices of young children, Patterns meet their nutrient needs.

Patterns do not meet recommendations for potassium (AI) and vitamin D (RDA).

Additional fortification or supplementation strategies may be needed to reach RDA levels for vitamin D intake.

Recommended amounts of food groups and their component subgroups fall within the broad range of usual food group intakes for the U.S. population.



Food groupsCurrent Intakes

Food groups include fruits, vegetables, grains, dairy, and protein foods, and are based on the USDA Food Pattern classification. Limits for solid fats and added sugars (empty calories) are also part of the patterns.

Across all age and sex groups, the vast majority of the U.S. population does not meet recommended intakes for fruit, vegetables, whole grains, and dairy food groups.

Across all age and sex groups, the vast majority of the U.S. population exceeds recommended intakes of refined grains, solid fats, and added sugars.

Many young children consume recommended amounts of fruit and dairy foods, but these intakes drop as children reach school age and beyond.


-100 100

All 1+

F 71+ F 51-70 F 31-50 F 19-30 F 14-18

F 9 to 13 F 4 to 8 F 1 to 3

M 71+ M 51-70 M 31-50 M 19-30 M 14-18

M 9 to 13 M 4 to 8 M 1 to 3

-80 -60 -40 -20

80 60 40 20 0 20 40 60 80 100

Percent of population below recommendation Percent of population at or above recommendation

Intake below recommendation Intake meeting recommendation Intake above recommendation


Total fruits: Estimated percentage of persons below, at, or above recommendation

NHANES 2007-10



-100 -80 -60 -40 -20 0 20 40 60 80 100 Percent of population at or below limit Percent of population at or above limit

100 80 60 40 20

All 1+

F 71+ F 51-70 F 31-50 F 19-30 F 14-18

F 9 to 13 F 4 to 8 F 1 to 3

M 71+ M 51-70 M 31-50 M 19-30 M 14-18

M 9 to 13 M 4 to 8 M 1 to 3

Intake below limit

Intake at limit

Intake above limit

*Empty calories are the total of calories from solid fats + added sugars NHANES 2007-10

Current Status and Trends Food and Nutrient Intakes, and Health:

Empty Calories*: Estimated percentage of persons below, at, or above limits


Food GroupsTrends over Time

The U.S. population has made few dietary changes over the time period from 2001-04 to 2007-10:

Fruit intakelow but stable Vegetable intake has declined Whole grain intake increased, but still low , and refined grain intake decreased, but still high. Dairy intakelow but stable for most groups. Added sugars intake has decreased but still exceeds the limit in the USDA food patterns.



Food Categoriessources of energy and food groups Food categories identify and group foods as consumed. Nine major categories and 32 subcategories analyzed.

Mixed dishes (e.g., sandwiches, burgers, pizza, pasta/rice/ meat/ poultry mixed dishes, stir-fries, soups)

Major contributor to 3 food groupsgrains, vegetables, and protein foods. Contributes heavily to intake of energy, saturated fat, and sodium.

Fruit and fluid milk intake seldom consumed as part of mixed dishes. Beverages contribute 19% of total energy intake.

Major sources are sugar-sweetened beverages, milk and milk drinks, and 100% fruit juices.


0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%


Percent of Total Intake from Mixed Dishes

Fruit Vegetables 31%

Total Grains Whole Grains

Refined Grains Total Dairy

Milk Cheese

Protein Foods Oils

Sodium Saturated fat

Added sugars

Fiber Calcium

Potassium vitamin D

45%

48%

1%

19%

30% 3%

29%

36% 6%

28% 29%

24% 16%

66% 45%

43%

29% of energy from mixed dishes



Other


Food sources of energy: Percent from major food categories

CONDIMENTS, GRAVIES, SPREADS, SALAD DRESSINGS 2%

FRUITS and FRUIT JUICE

5%

DAIRY 7% PROTEIN FOODS

11%

GRAINS 11%

SNACKS and SWEETS 16%

VEGETABLES 8%

BEVERAGES (NOT MILK or 100% FRUIT

JUICE)

12%

MIXED DISHES

28%

PIZZA 4%

BURGERS, and SANDWICHES

14%

MEAT, POULTRY, SEAFOOD DISHES 4%

RICE, PASTA, GRAIN DISHES 5%

SOUPS 1%




Food Categoriessources of sodium, saturated fat, and added sugars

Mixed dishes are the largest contributor to intake of sodium and saturated fat.

Within mixed dishes, the sub-category of burgers and sandwiches is the largest contributor for both.

Sodium is ubiquitous in the food supply and many food categories contribute to intake.

Snacks and sweets are a major contributor to added sugars and saturated fat intake.

Beverages supply almost half of added sugars intake.




2015 DGAC: MEETING 7 Food sources of added sugars:

Percent from major food categories FRUITS+FRUIT JUICE

1% VEGETABLES

1% CONDIMENTS, GRAVIES,

SPREADS, SALAD DRESSINGS

2%

DAIRY4%

PROTEIN FOODS 0%

MIXED DISHES

6%

GRAINS 8%

SNACKS AND SWEETS 31% BEVERAGES (NOT MILK or

100% FRUIT JUICE) 47%

ALCOHOLIC BEVERAGES 1%

COFFEE and TEA 7%

SOFT DRINKS 25%

FRUIT DRINKS 11%

SPORT and ENERGY DRINKS 3%

Sugar Sweetened Beverages

39%


Eating BehaviorsMeals and Snacks The majority of the U.S. population consumes three meals a day plus at least one snack.

Children ages 2-5 yearsmost likely to consume three meals a day.

Adolescent females, young adult males, non-Hispanic Blacks, Hispanics, and individuals with lower incomesleast likely toconsume three meals a day.

Breakfast tends to have a higher overall dietary quality compared to other meals and snacks. Adolescents andyoung adults are the least likely to eat breakfast. Snacks contribute about one-fourth of daily energy intakeand are lower in nutrients of concern relative to energy intake than are meals.


50

45

0

5

10

15

20

25

30

35

40

BREAKFAST LUNCH DINNER SNACKS

Iron

Food energy

Dietary fiber

Calcium

Vitamin D

Potassium

Iron

Sodium

Saturated Fat Added sugars


Percent of Total Daily Intake from each Eating Occasion Males and Females Ages 2+

What We Eat in America NHANES 2009-10



Eating BehaviorsL ocation of Purchase About two-thirds of the calories consumed by the U.S. population are purchased at a store, such as a grocery store or supermarket, and consumed in the home.

The percent of calories eaten away from home has remained about the same since 2003-2004.

Food group content and nutrient quality vary by where food is obtained.

No matter where the food is obtained, diet quality of the U.S. population is low in fruit, vegetables, dairy, whole grains, and high in sodium, saturated fats, refined grains, solid fats, and added sugars.



0.00

0.10

0.20

0.30

0.40

0.50

0.60

0.70

0.80

0.90

2003-04 2005-06 2007-08 2009-10

Cup

s

2003-04 2005-06 2007-08 2009-10

a Food and Nutrient Intakes, and Health: Current Status and Trends

By where food is obtained Store Restaurant Quick serve restaurant school/day care

At home-from store At restaurant At QS restaurant At school

HEI Standard

By where food is eaten

Fruit Group Density Cups per 1000 kcal by where obtained and eating location

What We Eat in America, NHANES 2003-04, 2005-06, 2007-08, 2009-10


Health ConditionsOverweight and Obesity

Current rates of overweight and obesity are extremely high among children, adolescents, and adults. These high rates have persisted for more than 25 years.

About 65% of adult females and 70% of adult males are overweight or obese. Rates of overweight and obesity are highest in adults 40+ years, and vary by race/ethnicity.

Abdominal obesity is present in U.S. adults of all ages, increases with age, and varies by sex and race/ethnicity. Nearly one in three youth, ages 2 to 19 years, is now overweight or obese and these rates vary by age and ethnicity.


100

90

10

0

80

Per

cent

of p

opul

atio

n

70

60

50

40

30

20

100

90

80

10

0

Per

cent

of p

opul

atio

n

70

60

50

40

30

20

2015 DGAC: MEETING 7 Trends in Overweight and Obesity: Adult Males and Females ages 20+

Males Females Extremely Obese*** Extremely Obese***

NHANES 1988-94, 1999-02 through 201 1-12

Overweight*

Obese**

Overweight*

Obese**

*BMI =25 to


Health ConditionsRisk Factors

At least one cardio-metabolic risk factor in 56% of adults who are normal weight,

70% of adults who are overweight,

75% of those who are obese.

Rates of elevated blood pressure, dyslipidemia, and diabetes are highest in adults with elevated abdominal obesity.

90% of children with type 2 diabetes are overweight or obese. 93% of children with type 2 diabetes are 12 to 19 years old.


80

0

10

20

30

40

50

60

70

P

erce

nt

3+ Risk Factors 2 Risk Factors 1 Risk Factor


Prevalence of Number of CVD Risk Factors by Weight Category, among Adults 18 Years and Older

Normal weight Overweight Obese Morbidly Obese

Risk factors included: total diabetes; total hypertension; total dyslipidemia; and self-reported smoking

Saydah et al., Obesity, 2014 (NHANES 2007 -2010)



Health Conditions

At all ages, rates of chronic disease are linked to overweight and obesity . Adults have high rates of high blood pressure, CVD, diabetes, and various forms of cancer . Children and adolescents also have nutrition-related chronic diseases, including borderline high blood pressure and type2 diabetes. Prevalence of osteoporosis and of low bone mass increases with age, particularly in post-menopausal women. Nutrition-related neurological and psychological conditions are a growing concern. Congenital anomalies are a relatively rare, but important pregnancy outcome.



Dietary Patterns Composition Dietary patterns observed to have health benefits in intervention and cohort studies had certain common elements.

A healthful diet can be achieved by following a variety of dietary patterns.

In many cases, the ranges of intake in dietary patterns with positive health benefits are close to those recommended by the USDA Food Patterns.

The data from the intervention trials and the cohort studies examined provide empirical data that the USDA Food Patterns provide an evidence-based guide to healthy patterns of food consumption.



Fruit intake (g/1000 kcal) for Healthy Dietary Patterns

0

50

100

150

200

250

300

350

400

Gra

ms

DASH/ Predimed Med Diet Other Factor/

Range in USDA Food Patterns

Range of usual adult consumption

OMNI CHO

OMNI UNSAT

OMNI PRO

DASH

SUN EPIC PAN F NHS EPIC SPAIN EPIC PAN M SUN F SUN M

EPIC POT F WHI

EPIC POT M HPFS

HPFS

SHANGHAI

WHITEHALL NHS

NHS FOS

EVOO NUTS

Cups/ 1000 kcal

2 cups

2 cups

1 cups

1 cup

1/2 cup

OMNI Score score cluster


Per

cent

of m

axim

um s

core

100

90

80

70

60

50

40

30

20

10

0

2 -3 4-8 9-13 14-18 19-30 31-50 51-70 >=71


Average HEI-2010 scores for Americans by age group




Dietary PatternsIntakes vs. Recommendations

Average HEI score in the U.S. population is 57 points out of a total of 100 points.

The best component scores were for: total protein foods, seafood and plant proteins, dairy.

The poorest component scores were for: whole grains, sodium, fatty acid ratio, greens and beans, and empty calories.

Best HEI scores: Young children ages 2 -3 years, middle aged, and older adults.

Poorest HEI scores: Preadolescents and adolescents.



Dietary PatternsUSDA Food Patterns

Food Pattern Modeling demonstrates that healthy eating patterns can be achieved with:

Healthy U.S.-style Pattern

Healthy Mediterranean-style Pattern

Healthy Vegetarian Pattern

Although some differences exist across the three eating patterns, comparable amounts of nutrients can be obtained by consuming nutrient-dense foods while maintaining energy balance.



Chapter Summary The US population has low intakes of certain key nutrients vitamin D, potassium, fiber, calcium, and for females also iron. These low intakes are a public health concern because inadequate intakes are linked to health problems.

The US population overconsumes sodium and saturated fat. Excess intakes of these nutrients are also linked to health problems.

Many of the food groups that are good sources of underconsumed nutrients are consumed in low amounts by the U.S. population.

Many of the food groups and food categories that have high levels of sodium, saturated fat, and added sugars are consumed in high amounts.



Chapter Summary

The US population purchases and consumes food in a variety of locations.

The diet quality is low regardless of where food is

purchased or consumed.

Rates of diet-related chronic conditions are high. Obesity, CVD, CVD risk factors, diabetes, cancer, and osteoporosis are all very common. Improving diet quality will help reduce risk of these diseases with major morbidity, mortality and health care expenditures.



Research Recommendations

Nutrition Surveillance, NHANES/WWEIA needs more respondents from a variety of racial/ethnic minority groups, more non-U.S. born residents and increase the number of pregnant women and older Americans - all of these groups are currently under-represented.

Research is needed to understand the driving forces

behind the decline in diet quality that begins in mid childhood, through adolescence, through adulthood.

Improvements are needed in the quantity and quality of food composition databases.



Research Recommendations Investigate the validity, reliability and reproducibility of new biomakers of dietary intake and nutritional status. Evaluate the effects of fortification and supplement use on consumer behavior related to intakes of nutrients of public health concern. Understand the health effects from high-dose dietary supplements. Develop standardized research definitions for meals and snacks. Understand better the food landscape where foods are purchased and consumed and how the food environment effects nutritional status. Understand better the concept of dietary patterns and develop standardized methods for dietary patterns research.



Special Thanks

Staff leads: Trish Britten Essie Yamini Yat Ping Wong

Shanthy Bowman

Science Writer: Anne Rodgers

Analyses Provided by:

Wen Yen Juan Cynthia Ogden Nadine Braunstein Alanna Moshfegh Brian Kit Kirsten Herrick Hazel Hiza Pamela Pehrsson Melissa Nickel

Additional assistance from:

Eve Essery Stoody Kristin Koegel Kevin Kuczynski Sue Krebs-Smith Jill Reedy


December 15, 2014 2015 DGAC: MEETING 7

Science Base Chapter: Food and Nutrient Intakes,

and Health: Current Status and Trends

(Subcommittee 1)

Discussion

Structure Bookmarks2015 DGAC: MEETING 7 2015 DGAC: MEETING 7 December 15, 2014 Science Base Chapter: Food and Nutrient Intakes, and Health: Current Status and Trends Subcommittee 1 Subcommittee 1 Membership Marian Neuhouser SC 1 Chair Alice H. Lichtenstein DGAC V ice Chair Steve Abrams Cheryl Anderson Mary Story Barbara Millen Introduction Chapter provides a broad examination of Chapter provides a broad examination of Chapter provides a broad examination of Chapter provides a broad examination of food and nutrient intakes by the U.S population, food and nutrient intakes by the U.S population, food and nutrient intakes by the U.S population,

the food and eating environment, the food and eating environment,

prevalence of chronic health conditions. prevalence of chronic health conditions.

Provides an understanding of the relationship of food intake and the food environment to nutrition-related health conditions. Provides an understanding of the relationship of food intake and the food environment to nutrition-related health conditions.

Documents high rates of diet-related health conditions and provides compelling reasons to study them in greater detail. Documents high rates of diet-related health conditions and provides compelling reasons to study them in greater detail.

Provides context for actions to facilitate and implement behavior change and adoption of healthy eating practices in the U.S. population. Provides context for actions to facilitate and implement behavior change and adoption of healthy eating practices in the U.S. population.

Taken together, our analyses inform the remaining chapters in the report, which will provide the contextual and scientific foundation for the 2015 Dietary Guidelines for Americans. Topics Addressed Nutrient intakes/nutrients of concern for under or overconsumption Nutrient intakes/nutrients of concern for under or overconsumption Nutrient intakes/nutrients of concern for under or overconsumption -

Food groupscurrent intakes and trends Food groupscurrent intakes and trends

Food categoriescurrent intakes and sources of energy, nutrients, and food group intakes Food categoriescurrent intakes and sources of energy, nutrients, and food group intakes

Eating behaviorscurrent intakes and trends Eating behaviorscurrent intakes and trends

Prevalence and trends in health conditions Prevalence and trends in health conditions

Dietary patterns composition Dietary patterns composition

Methodology Data analyses (21 questions) National Health and Nutrition Examination Survey (NHANES), including What We Eat in America (WWEIA) National Health and Nutrition Examination Survey (NHANES), including What We Eat in America (WWEIA) National Health and Nutrition Examination Survey (NHANES), including What We Eat in America (WWEIA)

Additional data sources: Additional data sources: Additional data sources: SEER/NCI; SEARCH for Diabetes in Youth Study; CDC population-based birth defects surveillance system; National Health Interview Survey; Alzheimer's Association; other CDC publications SEER/NCI; SEARCH for Diabetes in Youth Study; CDC population-based birth defects surveillance system; National Health Interview Survey; Alzheimer's Association; other CDC publications SEER/NCI; SEARCH for Diabetes in Youth Study; CDC population-based birth defects surveillance system; National Health Interview Survey; Alzheimer's Association; other CDC publications

Food pattern modeling analyses (7 questions) In addition, brought forward summaries from analyses by previous DGACs for several questions. Status Update No substantive changes since the work was previously reported in a public meeting. Nutrient Intakes and Nutrients of Concern Based on intake data, together with nutritional biomarker and health outcomes data, identified nutrients that may pose a public health concern: Based on intake data, together with nutritional biomarker and health outcomes data, identified nutrients that may pose a public health concern: Based on intake data, together with nutritional biomarker and health outcomes data, identified nutrients that may pose a public health concern: Based on intake data, together with nutritional biomarker and health outcomes data, identified nutrients that may pose a public health concern: Vitamin D, calcium, potassium, and fiber are underconsumed across the entire US population. Vitamin D, calcium, potassium, and fiber are underconsumed across the entire US population. Vitamin D, calcium, potassium, and fiber are underconsumed across the entire US population.

Iron is underconsumed for adolescent and premenopausal females. Iron is underconsumed for adolescent and premenopausal females.

Sodium is overconsumed across the entire US population Sodium is overconsumed across the entire US population

Saturated fat is overconsumed and may pose the greatest risk to those > 50 years old. Saturated fat is overconsumed and may pose the greatest risk to those > 50 years old.

Cholesterol is not considered a nutrient of concern for overconsumption. Cholesterol is not considered a nutrient of concern for overconsumption.

Percent of population ages 2+. with usual intakes below EAR. FigureFigure

What We Eat i n Ameri ca, NHANES 2007-10 Sodium: Percent of age/sex group with usual intakes above the UL. FigureFigure

Nutrient IntakesSupplements, Caffeine Overconsumption of nutrients from foods and beverages, including fortified foods, is rare. Overconsumption of nutrients from foods and beverages, including fortified foods, is rare. Overconsumption of nutrients from foods and beverages, including fortified foods, is rare.

However, folate, calcium, iron, and vitamin D may be overconsumed in supplement users, especially those taking high-dose supplements. However, folate, calcium, iron, and vitamin D may be overconsumed in supplement users, especially those taking high-dose supplements. some

In general, caffeine intakes do not exceed what are currently considered safe levels for any age group. In general, caffeine intakes do not exceed what are currently considered safe levels for any age group.

Adequacy of the USDA Food Patterns USDA Food Patterns provide food-based guidance. The Patterns meet nutrient adequacy goals across a broad range of age and energy levels. When adjusted for the food choices of young children, Patterns meet their nutrient needs. When adjusted for the food choices of young children, Patterns meet their nutrient needs. When adjusted for the food choices of young children, Patterns meet their nutrient needs.

Patterns do not meet recommendations for potassium (AI) and vitamin D (RDA). Patterns do not meet recommendations for potassium (AI) and vitamin D (RDA). Patterns do not meet recommendations for potassium (AI) and vitamin D (RDA). Additional fortification or supplementation strategies may be needed to reach RDA levels for vitamin D intake. Additional fortification or supplementation strategies may be needed to reach RDA levels for vitamin D intake.

Recommended amounts of food groups and their component subgroups fall within the broad range of usual food group intakes for the U.S. population. Recommended amounts of food groups and their component subgroups fall within the broad range of usual food group intakes for the U.S. population.

Food groupsCurrent Intakes Food groups include fruits, vegetables, grains, dairy, and protein foods, and are based on the USDA Food Pattern classification. Limits for solid fats and added sugars (empty calories) are also part of the patterns. Across all age and sex groups, the vast majority of the U.S. population does not meet recommended intakes for fruit, vegetables, whole grains, and dairy food groups. Across all age and sex groups, the vast majority of the U.S. population does not meet recommended intakes for fruit, vegetables, whole grains, and dairy food groups. Across all age and sex groups, the vast majority of the U.S. population does not meet recommended intakes for fruit, vegetables, whole grains, and dairy food groups.

Across all age and sex groups, the vast majority of the U.S. population exceeds recommended intakes of refined grains, solid fats, and added sugars. Across all age and sex groups, the vast majority of the U.S. population exceeds recommended intakes of refined grains, solid fats, and added sugars.

Many young children consume recommended amounts of fruit and dairy foods, but these intakes drop as children reach school age and beyond. Many young children consume recommended amounts of fruit and dairy foods, but these intakes drop as children reach school age and beyond.

Total fruits: Estimated percentage of persons below, at, or above recommendation FigureFigure

NHANES 2007-10 Empty Calories*: Estimated percentage of persons below, at, or above limits *Empty calories are the total of calories from solid fats + added sugars FigureFood GroupsTrends over Time The U.S. population has made few dietary changes over the time period from 2001-04 to 2007-10: Fruit intakelow but stable Fruit intakelow but stable Fruit intakelow but stable

Vegetable intake has declined Vegetable intake has declined

Whole grain intake increased, but still low, and refinedgrain intake decreased, but still high. Whole grain intake increased, but still low, and refinedgrain intake decreased, but still high.

Dairy intakelow but stable for most groups. Dairy intakelow but stable for most groups.

Added sugars intake has decreased but still exceeds the limit in the USDA food patterns. Added sugars intake has decreased but still exceeds the limit in the USDA food patterns.

Food Categoriessources of energy and food groups Food categories identify and group foods as consumed. Nine major categories and 32 subcategories analyzed. Mixed dishes (e.g., sandwiches, burgers, pizza, pasta/rice/ meat/ poultry mixed dishes, stir-fries, soups) Mixed dishes (e.g., sandwiches, burgers, pizza, pasta/rice/ meat/ poultry mixed dishes, stir-fries, soups) Mixed dishes (e.g., sandwiches, burgers, pizza, pasta/rice/ meat/ poultry mixed dishes, stir-fries, soups) Mixed dishes (e.g., sandwiches, burgers, pizza, pasta/rice/ meat/ poultry mixed dishes, stir-fries, soups) Major contributor to 3 food groupsgrains, vegetables, and protein foods. Major contributor to 3 food groupsgrains, vegetables, and protein foods. Major contributor to 3 food groupsgrains, vegetables, and protein foods.

Contributes heavily to intake of energy, saturated fat, and sodium. Contributes heavily to intake of energy, saturated fat, and sodium.

Fruit and fluid milk intake seldom consumed as part of mixed dishes. Fruit and fluid milk intake seldom consumed as part of mixed dishes.

Beverages contribute 19% of total energy intake. Beverages contribute 19% of total energy intake. Beverages contribute 19% of total energy intake. Major sources are sugar-sweetened beverages, milk and milk drinks, and 100% fruit juices. Major sources are sugar-sweetened beverages, milk and milk drinks, and 100% fruit juices. Major sources are sugar-sweetened beverages, milk and milk drinks, and 100% fruit juices.

Percent of Total Intake from Mixed Dishes. Fruit Fruit Fruit 1%

Vegetables 31% Vegetables 31%

Total Grains Total Grains 45%

Whole Grains Whole Grains 19%

Refined Grains Refined Grains 48%

Total Dairy Total Dairy 30%

Milk Milk 3%

Cheese Cheese 66%

Protein Foods Protein Foods 45%

Oils Oils 29%

Sodium Sodium 43%

Saturated fat Saturated fat 36%

Added sugars Added sugars 6%

29% of energy from mixed dishes 29% of energy from mixed dishes

Fiber Fiber 28%

Calcium Calcium 29%

Potassium Potassium 24%

vitamin D vitamin D 16%

What We Eat i n Ameri ca, NHANES 2009-10 Food sources of energy:. Percent from major food categories. CONDIMENTS,GRAVIES,SPREADS,SALADDRESSINGS2%.. .CONDIMENTS,GRAVIES,SPREADS,SALADDRESSINGS2%.. .

FRUITSandFRUITJUICE5%.. FRUITSandFRUITJUICE5%..

What We Eat i n Ameri ca, NHANES 2009-10 Food Categoriessources of sodium, saturated fat, and added sugars Mixed dishes are the largest contributor to intake of sodium and saturated fat. Mixed dishes are the largest contributor to intake of sodium and saturated fat. Mixed dishes are the largest contributor to intake of sodium and saturated fat. Mixed dishes are the largest contributor to intake of sodium and saturated fat. Within mixed dishes, the sub-category of burgers and. sandwiches is the largest contributor for both.. Within mixed dishes, the sub-category of burgers and. sandwiches is the largest contributor for both..

Sodium is ubiquitous in the food supply and many food categories contribute to intake. Sodium is ubiquitous in the food supply and many food categories contribute to intake.

Snacks and sweets are a major contributor to added sugars and saturated fat intake. Snacks and sweets are a major contributor to added sugars and saturated fat intake.

Beverages supply almost half of added sugars intake.. Beverages supply almost half of added sugars intake..

Food sources of added sugars:. Percent from major food categories. FRUITS+FRUITJUICE1%.. FRUITS+FRUITJUICE1%.. FRUITS+FRUITJUICE1%..

VEGETABLES1%.. VEGETABLES1%..

CONDIMENTS,GRAVIES,SPREADS,SALADDRESSINGS2%.. CONDIMENTS,GRAVIES,SPREADS,SALADDRESSINGS2%..

ALCOHOLICBEVERAGES1%.. ALCOHOLICBEVERAGES1%.. ALCOHOLICBEVERAGES1%..

SPORTandENERGYDRINKS3%.. SPORTandENERGYDRINKS3%..

PROTEINFOODS0%.. PROTEINFOODS0%..

Eating BehaviorsMeals and Snacks The majority of the U.S. population consumes three meals a day plus at least one snack. The majority of the U.S. population consumes three meals a day plus at least one snack. The majority of the U.S. population consumes three meals a day plus at least one snack. The majority of the U.S. population consumes three meals a day plus at least one snack. Children ages 2-5 yearsmost likely to consume three meals a day. Children ages 2-5 yearsmost likely to consume three meals a day. Children ages 2-5 yearsmost likely to consume three meals a day.

Adolescent females, young adult males, non-Hispanic Blacks, Hispanics, and individuals with lower incomesleast likely toconsume three meals a day. Adolescent females, young adult males, non-Hispanic Blacks, Hispanics, and individuals with lower incomesleast likely toconsume three meals a day.

Breakfast tends to have a higher overall dietary quality compared to other meals and snacks. Adolescents andyoung adults are the least likely to eat breakfast. Breakfast tends to have a higher overall dietary quality compared to other meals and snacks. Adolescents andyoung adults are the least likely to eat breakfast.

Snacks contribute about one-fourth of daily energy intakeand are lower in nutrients of concern relative to energy intake than are meals. Snacks contribute about one-fourth of daily energy intakeand are lower in nutrients of concern relative to energy intake than are meals.

Percent of Total Daily Intake from each Eating Occasion Males and Females Ages 2+ FigureFigure

What We Eat i n Ameri ca NHANES 2009-10 Eating BehaviorsL ocation of Purchase About two-thirds of the calories consumed by the U.S. population are purchased at a store, such as a grocery store or supermarket, and consumed in the home. About two-thirds of the calories consumed by the U.S. population are purchased at a store, such as a grocery store or supermarket, and consumed in the home. About two-thirds of the calories consumed by the U.S. population are purchased at a store, such as a grocery store or supermarket, and consumed in the home.

The percent of calories eaten away from home has remained about the same since 2003-2004. The percent of calories eaten away from home has remained about the same since 2003-2004.

Food group content and nutrient quality vary by where food is obtained. Food group content and nutrient quality vary by where food is obtained.

No matter where the food is obtained, diet quality of the U.S. population is low in fruit, vegetables, dairy, whole grains, and high in sodium, saturated fats, refined grains, solid fats, and added sugars. No matter where the food is obtained, diet quality of the U.S. population is low in fruit, vegetables, dairy, whole grains, and high in sodium, saturated fats, refined grains, solid fats, and added sugars.

Fruit Group Density Cups per 1000 kcal by where obtained and eating location By where food is obtained FigureFigure

By where food is eaten FigureFigure

What We Eat in America, NHANES 2003-04, 2005-06, 2007-08, 2009-10 Health ConditionsOverweight and Obesity Current rates of overweight and obesity are extremely high among children, adolescents, and adults. These high rates have persisted for more than 25 years. Current rates of overweight and obesity are extremely high among children, adolescents, and adults. These high rates have persisted for more than 25 years. Current rates of overweight and obesity are extremely high among children, adolescents, and adults. These high rates have persisted for more than 25 years. Current rates of overweight and obesity are extremely high among children, adolescents, and adults. These high rates have persisted for more than 25 years. About 65% of adult females and 70% of adult males are overweight or obese. About 65% of adult females and 70% of adult males are overweight or obese. About 65% of adult females and 70% of adult males are overweight or obese.

Rates of overweight and obesity are highest in adults 40+ years, and vary by race/ethnicity. Rates of overweight and obesity are highest in adults 40+ years, and vary by race/ethnicity.

Abdominal obesity is present in U.S. adults of all ages, increases with age, and varies by sex and race/ethnicity. Abdominal obesity is present in U.S. adults of all ages, increases with age, and varies by sex and race/ethnicity.

Nearly one in three youth, ages 2 to 19 years, is now overweight or obese and these rates vary by age and ethnicity. Nearly one in three youth, ages 2 to 19 years, is now overweight or obese and these rates vary by age and ethnicity.

Trends in Overweight and Obesity:. Adult Males and Females ages 20+ .Males FigureFigure

Females FigureFigure

NHANES 1988-94, 1999-02 through 201 1-12 Health ConditionsRisk Factors At least one cardio-metabolic risk factor in At least one cardio-metabolic risk factor in At least one cardio-metabolic risk factor in At least one cardio-metabolic risk factor in 56% of adults who are normal weight, 56% of adults who are normal weight, 56% of adults who are normal weight,

70% of adults who are overweight, 70% of adults who are overweight,

75% of those who are obese. 75% of those who are obese.

Rates of elevated blood pressure, dyslipidemia, and diabetes are highest in adults with elevated abdominal obesity. Rates of elevated blood pressure, dyslipidemia, and diabetes are highest in adults with elevated abdominal obesity.

90% of children with type 2 diabetes are overweight or obese. 90% of children with type 2 diabetes are overweight or obese. 90% of children with type 2 diabetes are overweight or obese. 93% of children with type 2 diabetes are 12 to 19 years old. 93% of children with type 2 diabetes are 12 to 19 years old. 93% of children with type 2 diabetes are 12 to 19 years old.

Prevalence of Number of CVD Risk Factors by Weight Category, among Adults 18 Years and Older FigureFigure

Risk factors included: total diabetes; total hypertension; total dyslipidemia; and self-reported smoking Saydah et al., Obesity , 2014 (NHANES 2007 -2010) Health Conditions At all ages, rates of chronic disease are linked to overweightand obesity. At all ages, rates of chronic disease are linked to overweightand obesity. At all ages, rates of chronic disease are linked to overweightand obesity.

Adults have high rates of high blood pressure, CVD,diabetes, and various forms of cancer. Adults have high rates of high blood pressure, CVD,diabetes, and various forms of cancer.

Children and adolescents also have nutrition-related chronic diseases, including borderline high blood pressure and type2 diabetes. Children and adolescents also have nutrition-related chronic diseases, including borderline high blood pressure and type2 diabetes.

Prevalence of osteoporosis and of low bone mass increases with age, particularly in post-menopausal women. Prevalence of osteoporosis and of low bone mass increases with age, particularly in post-menopausal women.

Nutrition-related neurological and psychological conditions are a growing concern. Nutrition-related neurological and psychological conditions are a growing concern.

Congenital anomalies are a relatively rare, but important pregnancy outcome. Congenital anomalies are a relatively rare, but important pregnancy outcome.

Dietary Patterns Composition Dietary patterns observed to have health benefits in intervention and cohort studies had certain common elements. Dietary patterns observed to have health benefits in intervention and cohort studies had certain common elements. Dietary patterns observed to have health benefits in intervention and cohort studies had certain common elements.

A healthful diet can be achieved by following a variety of dietary patterns. A healthful diet can be achieved by following a variety of dietary patterns.

In many cases, the ranges of intake in dietary patterns with positive health benefits are close to those recommended by the USDA Food Patterns. In many cases, the ranges of intake in dietary patterns with positive health benefits are close to those recommended by the USDA Food Patterns.

The data from the intervention trials and the cohort studies examined provide empirical data that the USDA Food Patterns provide an evidence-based guide to healthy patterns of food consumption. The data from the intervention trials and the cohort studies examined provide empirical data that the USDA Food Patterns provide an evidence-based guide to healthy patterns of food consumption.

Fruit intake (g/1000 kcal) for Healthy Dietary Patterns. Figure0 50 100 150 200 250 300 350 400 Grams DASH/ Predimed Med Diet Other Factor/ Range in USDA Food Patterns Range of usual adult consumption OMNI CHO OMNI UNSAT OMNI PRO DASH SUN EPIC PAN F NHS EPIC SPAIN EPIC PAN M SUN F SUN M EPIC POT F WHI EPIC POT M HPFS HPFS SHANGHAI WHITEHALL NHS NHS FOS EVOO NUTS Cups/ 1000 kcal 2 cups 2 cups 1 cups 1 cup 1/2 cup

Average HEI-2010 scores for Americans by age group. FigureFigure

What We Eat i n Ameri ca, NHANES 2009-10 Dietary PatternsIntakes vs. Recommendations Average HEI score in the U.S. population is 57 points out of a total of 100 points. Average HEI score in the U.S. population is 57 points out of a total of 100 points. Average HEI score in the U.S. population is 57 points out of a total of 100 points.

The best component scores were for: total protein foods, seafood and plant proteins, dairy. The best component scores were for: total protein foods, seafood and plant proteins, dairy.

The poorest component scores were for: whole grains, sodium, fatty acid ratio, greens and beans, and empty calories. The poorest component scores were for: whole grains, sodium, fatty acid ratio, greens and beans, and empty calories.

Best HEI scores: Young children ages 2 -3 years, middle aged, and older adults. Best HEI scores: Young children ages 2 -3 years, middle aged, and older adults.

Poorest HEI scores: Preadolescents and adolescents. Poorest HEI scores: Preadolescents and adolescents.

Dietary PatternsUSDA Food Patterns Food Pattern Modeling demonstrates that healthy eating patterns can be achieved with: Food Pattern Modeling demonstrates that healthy eating patterns can be achieved with: Food Pattern Modeling demonstrates that healthy eating patterns can be achieved with: Food Pattern Modeling demonstrates that healthy eating patterns can be achieved with: Healthy U.S.-style Pattern Healthy U.S.-style Pattern Healthy U.S.-style Pattern

Healthy Mediterranean-style Pattern Healthy Mediterranean-style Pattern

Healthy Vegetarian Pattern Healthy Vegetarian Pattern

Although some differences exist across the three eating patterns, comparable amounts of nutrients can be obtained by consuming nutrient-dense foods while maintaining energy balance. Although some differences exist across the three eating patterns, comparable amounts of nutrients can be obtained by consuming nutrient-dense foods while maintaining energy balance.

Chapter Summary The US population has low intakes of certain key nutrients vitamin D, potassium, fiber, calcium, and for females also iron. These low intakes are a public health concern because inadequate intakes are linked to health problems. The US population has low intakes of certain key nutrients vitamin D, potassium, fiber, calcium, and for females also iron. These low intakes are a public health concern because inadequate intakes are linked to health problems. The US population has low intakes of certain key nutrients vitamin D, potassium, fiber, calcium, and for females also iron. These low intakes are a public health concern because inadequate intakes are linked to health problems.

The US population overconsumes sodium and saturated fat. Excess intakes of these nutrients are also linked to health problems. The US population overconsumes sodium and saturated fat. Excess intakes of these nutrients are also linked to health problems.

Many of the food groups that are good sources of underconsumed nutrients are consumed in low amounts by the U.S. population. Many of the food groups that are good sources of underconsumed nutrients are consumed in low amounts by the U.S. population.

Many of the food groups and food categories that have high levels of sodium, saturated fat, and added sugars are consumed in high amounts. Many of the food groups and food categories that have high levels of sodium, saturated fat, and added sugars are consumed in high amounts.

The US population purchases and consumes food in a variety of locations. The diet quality is low regardless of where food is .purchased or consumed.. Rates of diet-related chronic conditions are high. Obesity, CVD, CVD risk factors, diabetes, cancer, and osteoporosis are all very common. Improving diet quality will help reduce risk of these diseases with major morbidity, mortality and health care expenditures. Research Recommendations Nutrition Surveillance, NHANES/WWEIA needs more respondents from a variety of racial/ethnic minority groups, more non-U.S. born residents and increase the number of pregnant women and older Americans - all of these groups are currently under-represented. Nutrition Surveillance, NHANES/WWEIA needs more respondents from a variety of racial/ethnic minority groups, more non-U.S. born residents and increase the number of pregnant women and older Americans - all of these groups are currently under-represented. Nutrition Surveillance, NHANES/WWEIA needs more respondents from a variety of racial/ethnic minority groups, more non-U.S. born residents and increase the number of pregnant women and older Americans - all of these groups are currently under-represented.

Research is needed to understand the driving forces .behind the decline in diet quality that begins in mid. childhood, through adolescence, through adulthood.. Research is needed to understand the driving forces .behind the decline in diet quality that begins in mid. childhood, through adolescence, through adulthood..

Improvements are needed in the quantity and quality of food composition databases. Improvements are needed in the quantity and quality of food composition databases.

Investigate the validity, reliability and reproducibility of new biomakers of dietary intake and nutritional status. Investigate the validity, reliability and reproducibility of new biomakers of dietary intake and nutritional status.

Evaluate the effects of fortification and supplement use on consumer behavior related to intakes of nutrients of public health concern. Evaluate the effects of fortification and supplement use on consumer behavior related to intakes of nutrients of public health concern.

Understand the health effects from high-dose dietary supplements. Understand the health effects from high-dose dietary supplements.

Develop standardized research definitions for meals and snacks. Develop standardized research definitions for meals and snacks.

Understand better the food landscape where foods are purchased and consumed and how the food environment effects nutritional status. Understand better the food landscape where foods are purchased and consumed and how the food environment effects nutritional status.

Understand better the concept of dietary patterns and develop standardized methods for dietary patterns research. Understand better the concept of dietary patterns and develop standardized methods for dietary patterns research.

Special Thanks Staff leads: Trish Britten Trish Britten Trish Britten

Essie Yamini Essie Yamini

Yat Ping Wong.Yat Ping Wong.

Shanthy Bowman Shanthy Bowman

Science Writer:. Anne Rodgers Analyses Provided by: Wen Yen Juan Wen Yen Juan Wen Yen Juan

Cynthia Ogden Cynthia Ogden

Nadine Braunstein. Nadine Braunstein.

Alanna Moshfegh. Alanna Moshfegh.

Brian Kit Brian Kit

Kirsten Herrick Kirsten Herrick

Hazel Hiza Hazel Hiza

Pamela Pehrsson. Pamela Pehrsson.

Melissa Nickel Melissa Nickel

Additional assistance from: Eve Essery Stoody .Eve Essery Stoody .Eve Essery Stoody .

Kristin Koegel Kristin Koegel

Kevin Kuczynski Kevin Kuczynski

Sue Krebs-Smith Sue Krebs-Smith

Jill Reedy Jill Reedy

December 15, 2014 2015 DGAC: MEETING 7 Science Base Chapter: Food and Nutrient Intakes, and Health: Current Status and Trends (Subcommittee 1) Discussion

Accessibility Report

Filename:

SC 1 Final Diana.pdf

Report created by:

Organization:

[Enter personal and organization information through the Preferences > Identity dialog.]

Summary

The checker found problems which may prevent the document from being fully accessible.

Needs manual check: 0

Passed manually: 2

Failed manually: 0

Skipped: 1

Passed: 28

Failed: 1

Detailed Report

Document

Rule NameStatusDescription

Accessibility permission flagPassedAccessibility permission flag must be set

Image-only PDFPassedDocument is not image-only PDF

Tagged PDFPassedDocument is tagged PDF

Logical Reading OrderPassed manuallyDocument structure provides a logical reading order

Primary languagePassedText language is specified

TitlePassedDocument title is showing in title bar

BookmarksPassedBookmarks are present in large documents

Color contrastPassed manuallyDocument has appropriate color contrast

Page Content


Tagged contentFailedAll page content is tagged

Tagged annotationsPassedAll annotations are tagged

Tab orderPassedTab order is consistent with structure order

Character encodingPassedReliable character encoding is provided

Tagged multimediaPassedAll multimedia objects are tagged

Screen flickerPassedPage will not cause screen flicker

ScriptsPassedNo inaccessible scripts

Timed responsesPassedPage does not require timed responses

Navigation linksPassedNavigation links are not repetitive

Forms


Tagged form fieldsPassedAll form fields are tagged

Field descriptionsPassedAll form fields have description

Alternate Text


Figures alternate textPassedFigures require alternate text

Nested alternate textPassedAlternate text that will never be read

Associated with contentPassedAlternate text must be associated with some content

Hides annotationPassedAlternate text should not hide annotation

Other elements alternate textPassedOther elements that require alternate text

Tables


RowsPassedTR must be a child of Table, THead, TBody, or TFoot

TH and TDPassedTH and TD must be children of TR

HeadersPassedTables should have headers

RegularityPassedTables must contain the same number of columns in each row and rows in each column

SummarySkippedTables must have a summary

Lists


List itemsPassedLI must be a child of L

Lbl and LBodyPassedLbl and LBody must be children of LI

Headings


Appropriate nestingPassedAppropriate nesting

Back to Top

Dietary Guidelines Advisory Committee -...

Documents

Transcript of Dietary Guidelines Advisory Committee -...