US Dietary Guidelines A Road Map with a Detour
Transcript of US Dietary Guidelines A Road Map with a Detour
Pat Crawford, DrPH, RD
CE Specialist
Sr. Director of Research
Nutrition Policy Institute UCANR
And Co-founder and Director
Atkins Center for Weight & Health
UC Berkeley
US Dietary GuidelinesA Road Map
with a Detour
In 2014 UC ANR founded the UCANR Nutrition
Policy Institute (NPI)
Lorrene Ritchie, PhD, RD; Director of Research at the
Atkins Center for Weight & Health was selected as the
Director.
In July 2015, I moved to NPI with staff and projects.
Nutrition Policy Institute was created
Prevention of:
food insecurity
obesity
diabetes
Promotion of:
healthy eating & activity
Targeted to:
low-resource communities
children and families
What topics does NPI focus on?
30 year increase in prevalence of child obesity (ages 6-19 years)
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
1975 1980 1985 1995 2000 2005
NHANES, 2012-2014
This is a bigger story than obesity
Diabetes and pre-diabetes in adolescence
are rising
9%
23%
0
5
10
15
20
25
2001 2009
May, 2012. Pediatrics NHANES
THE SCIENCE OF FAT
After ‘The Biggest Loser,’ TheirBodies Fought to Regain Weight
Contestants lost hundreds of pounds during Season 8, but gained them back. A study
of their struggles helps explain why so many people fail to keep off the weight they lose.
By GINA KOLATA MAY 2, 2016
Diet quality in the US
Wang DD, et al. JAMA. 2014
1
6
11
16
21
26
31
36
41
46
1999-2008 2009-2010
Low SES Med SES High SES
Dietary Guidelines for Americans
Our nation’s nutrition policy and
nutrition education “backbone”
1980 – 1st
2015 – 8th
DGAC Tasks
Formulate research questions
Analyze evidence
Answer questions
Make recommendations for action
Evidence analysis process
Nutrition
Evidence
Library
Process
Systematic
Reviews &
Meta-
Analyses
Primary
Data
Analysis
27%
45%
30%
The scientific report guiding the US
dietary guidelines: is it scientific?IT HAS A BIG IMPACT ON THE DIET OF AMERICAN CITIZENS, AND
THOSE OF MOST WESTERN NATIONS, SO WHY DOES THE EXPERT
ADVICE UNDERPINNING US GOVERNMENT DIETARY GUIDELINES
NOT TAKE ACCOUNT OF ALL THE RELEVANT SCIENTIFIC
EVIDENCE?
NINA TEICHOLZ JOURNALIST, NEW YORK CITY, USA
British Med Journal 2015;351:h4962
Advantages Considerations
Resource intensive
Time-consuming
Evidence examined
depends on
question asked
Systematic
Thorough
Inclusive of all
study designs
Transparent
Minimizes bias
Dietary Guidelines 2015 Topics
• Food and nutrient intakes, and health: current status
and trends;
• Dietary patterns, foods and nutrients, and health
outcomes;
• Individual diet and physical activity behavior change
• Food environment and settings
• Food sustainability and safety
• Cross-cutting topics of public health importance
• Physical activity
Dietary Guidelines Overarching Themes
• The problem - ~1/2 of Americans have > 1 preventable disease related to diet and physical activity;
• The gap: food consumption patterns are poor;
• Dietary patterns: no specific diet recommended but healthy patterns of intake are clear;
• The individual: counseling, group education and proven tools, new technology should be used;
• The long-term view: recommended dietary patterns must be sustainable for the population and planet;
• The population: policy and environmental initiatives are effectively changing diet and physical activity.
• Annualize the adjusted decrease in prevalence
Assume that annual decrease continues until 2015
• Apply this to ALL kids in CA
• ~ 100,000 kids DROP OUT of the obese category
• Assuming a savings of at least $220 per child**
• State savings of more than $20 million
Estimated medical cost
savings/child*
* Madsen K, UC Berkeley, personal communication
**(based on MEPS data from 2001 to 2003, as reported in NY state comptroller
report from Oct 2012)
Selected recommendations
• Think prevention at individual level
• Most people would benefit from reducing consumption of red and processed meats, refined grains, added sugars, sodium, and saturated fat;
• Nutrients should be obtained through healthy foods rather than supplements.
• Seek help from nutrition and exercise experts as needed.
• Pay special attention that children eat healthy foods.
• Make healthy lifestyles and disease prevention local and national priorities.
• Seek a paradigm shift in health care and public health toward a greater focus on prevention and in school and early childhood environments
• Establish healthy food environments
• Implement Nutrition Facts labels and Front-of-Package labelsto help consumers.
• Questioning the players, the topics, the entire process may
undermine scientific underpinnings of the DGA.
• Sustainability issue removed in its entirety
• Recommendation to reduce red meat and processed meat
changed to men and adolescent boys who consume high
levels of meat should reduce consumption.
• Specifics on sugar sweetened beverages de-emphasized in
final report
• Water promotion de-emphasized in final report.
The Detour
Big take away: Calories from added
sugars…
• Should be limited to no more than 10% of total
calories/day
• High sugar intake is associated with risk of obesity,
heart disease and diabetes
• HFCS, agave, honey, dextrose, turbinado, molasses,
sucrose, fructose, evaporated cane juice
Big take away: Sodium
should be consumed at less
than 2300 milligrams/per day
for the general population (14 years and older).
Sodium intake has a linear
relationship with blood pressure.
Big take-away: Replacing saturated fats with
polyunsaturated fats is associated with
reduced risk of cardiovascular disease events
and death.
As before, consume less than 10% of calories
from saturated fats.
Change: limiting dietary cholesterol to 300
mg/day was not included in the new
guidelines!
Take away: Dietary patterns of the
following composition are associated with
healthier weight lower risk of obesity and
good health:o High in vegetables, fruit, whole grains, unsaturated fats
o Inclusive of seafood and legumes
o Moderate in low and non-fat dairy products
o Low in meat (particularly processed and red), sugar-
sweetened foods/beverages, refined grains, saturated
fats, cholesterol, sodium