Evaluating the Process to Develop the
Dietary Guidelines for
Americans, 2020-2025
A MIDCOURSE REPORT
Kathleen M. Rasmussen, Ann L. Yaktine,
and Katherine M. Delaney, Editors
Committee on Evaluating the Process to Develop
the Dietary Guidelines for Americans, 2020–2025
Food and Nutrition Board
Health and Medicine Division
A Consensus Study Report of
THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu
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This activity was supported by a contract between the National Academy of Sciences and the U.S. Department of Agriculture (Contract 12319821C0003). Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-27408-1
International Standard Book Number-10: 0-309-27408-7
Digital Object Identifier: https://doi.org/10.17226/26406
Library of Congress Catalog Number: 2022930018
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the process to develop the Dietary Guidelines for Americans, 2020–2025: A midcourse report. Washington, DC: The National Academies Press. https://doi.org/10.17226/26406.
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COMMITTEE ON EVALUATING THE PROCESS TO DEVELOP THE DIETARY GUIDELINES FOR AMERICANS, 2020–2025
KATHLEEN M. RASMUSSEN (Chair), Cornell University, Ithaca, New York
STEPHANIE A. ATKINSON, McMaster University, Hamilton, Ontario, Canada
KELLY D. BROWNELL, Duke University, Durham, North Carolina
MARTHA S. FIELD, Cornell University, Ithaca, New York
SHARON I. KIRKPATRICK, University of Waterloo, Waterloo, Ontario, Canada
BRUCE Y. LEE, City University of New York, New York
DOUGLAS A. LUKE, Washington University in St. Louis, Missouri
ESTHER MYERS, Myers Consulting, St. Louis, Missouri
EMILY OKEN, Harvard University, Boston, Massachusetts
JOSÉ M. ORDOVÁS, Tufts University, Boston, Massachusetts
A. CATHARINE ROSS, The Pennsylvania State University, University Park, Pennsylvania
JOHN B. WONG, Tufts University School of Medicine, Boston, Massachusetts
Health and Medicine Division Staff
KATHERINE M. DELANEY, Program Officer
ALI SCHKLAIR, Research Associate (until November 2021)
NICOLE CUNNINGHAM, Research Assistant (from December 2021)
MELANIE ARTHUR, Senior Program Assistant
ANN L. YAKTINE, Director, Food and Nutrition Board
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Reviewers
This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.
We thank the following individuals for their review of this report:
DAVID B. ALLISON, Indiana University School of Public Health-Bloomington
CAROL BOUSHEY, University of Hawai‘i Cancer Center
WENDY DEMARK-WAHNFRIED, The University of Alabama at Birmingham
JOSEPH LAU, Brown University School of Public Health
ANGELA M. ODOMS-YOUNG, Cornell University
MARGARET SLAVIN, George Mason University
PATRICK J. STOVER, Texas A&M AgriLife Research
KATHERINE L. TUCKER, University of Massachusetts Lowell
PARKE WILDE, Tufts University
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the report nor did they see the final draft before its release. The review of this report was overseen by SUZANNE P. MURPHY, University of Hawai’i Cancer Center, and CUTBERTO GARZA, Cornell University. They were responsible for making certain that an independent examination of this report was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies.
Preface
The Dietary Guidelines for Americans (DGA) play a central role in the development of federal nutrition policy and programs in the United States. As a result, they are of great interest to a variety of individuals from policy makers to the general public. A prior edition of the guidelines created questions about the process used to update the DGA over a 5-year cycle. In response, Congress mandated that a comprehensive review of the entire process of developing the DGA be carried out by the National Academies of Sciences, Engineering, and Medicine (the National Academies). The final report, Redesigning the Process for Establishing the Dietary Guidelines for Americans, was released in 2017 and included seven recommendations directed at improving this process. Subsequently, in 2020, Congress mandated that the National Academies convene a new ad hoc committee to assess how well the U.S. Department of Agriculture (USDA) and the U.S. Department of Health and Human Services (HHS) implemented these recommendations. In particular, this committee was asked to answer three overarching questions:
- How did the process used to develop the Dietary Guidelines for Americans, 2020–2025, compare to the seven recommendations included in the 2017 National Academies report? (task 1)
- Did the criteria used to include scientific studies used to inform the Dietary Guidelines for Americans, 2020–2025, ensure that the evidence base was current, rigorous, and generalizable or applicable to public health nutrition guidance? (task 2)
- How would the process with full implementation of the seven recommendations included in the 2017 National Academies report compared to the process used to develop the Dietary Guidelines for Americans, 2020–2025, have affected the time line, cost, and/or integrity of the more recently issued guidelines? (task 3)
This midcourse report is the first product of the Committee on Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020–2025. In this report, the committee provides its analysis of data relative to task 1 and a subset of task 2. The results of completing the remainder of task 2 as well as task 3, along with additional findings and conclusions will compose the committee’s final report in response to the study task.
This report is grounded in evidence from publications in the peer-reviewed literature that describe innovations in the 2020–2025 DGA as well as changes to the process of preparing these guidelines made in response to the 2017 National Academies report. In open meetings, the committee received additional information from key staff members from USDA and HHS. The committee also used the information contained in numerous federal websites that describe the DGA as well as the basis for the guidelines and descriptive material about how they were developed.
It is noteworthy that this report is not an assessment of the merits of the 2020–2025 DGA, but rather, it is an assessment of the process by which they were created relative to the specific recommendations of the 2017 National Academies report. During its analysis, the committee considered the principles on which the recommendations in the 2017 National Academies report were based. The committee was cognizant of the timing of the release of the 2017 National Academies report relative to the time line required to produce the 2020–2025 DGA in conducting its analysis. This meant that it was, in some cases, not feasible to implement the 2017 National Academies recommendations during this DGA cycle. Importantly, the committee was guided by the preponderance of evidence relative to any single recommendation or scientific issue that it considered. Given the central role of systematic reviews in the development of the DGA, the committee developed a comprehensive systematic review matrix summary to facilitate its comparison of the content of these reviews and assessment of their application to the DGA process. The committee gave priority to addressing1 task 1, which it viewed as providing time-sensitive
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1 This text, and similar text throughout the report, was modified after release of a prepublication version of the report to the sponsor to clarify that additional context and information relating to tasks 1 and 2 of the statement of task may be presented in the final report.
information to USDA and HHS for the development of the 2025–2030 DGA, and presents its findings and conclusions herein.
I am especially grateful to the members of the committee, Stephanie Atkinson, Kelly Brownell, Martha Field, Sharon Kirkpatrick, Bruce Y. Lee, Douglas Luke, Esther Myers, Emily Oken, José Ordovás, Catharine Ross, and John B. Wong (see Appendix A) for their exceptional dedication to producing this midcourse report following the congressional mandate.
The committee offers its thanks to Julie Obbagy and Eve Stoody from USDA and Janet de Jesus from HHS, and their staff members, for providing essential information to the committee. The committee also thanks Rose Gladstein for preparing the Systematic Review Matrix Summary (see Appendix C). The committee thanks the National Academies’ study staff, Katherine Delaney, study director; Ali Schklair, research associate; Nicole Cunningham, research assistant; Melanie Arthur, senior program assistant; and Ann Yaktine, director of the Food and Nutrition Board, for their assistance to the committee in carrying out its task.
Kathleen M. Rasmussen, Chair
Committee on Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020–2025
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4 ANALYSIS OF THE SCIENTIFIC STUDIES USED TO DEVELOP THE DIETARY GUIDELINES FOR AMERICANS
Identifying the Body of Evidence
A COMMITTEE MEMBER BIOGRAPHIES
B OPEN SESSION AGENDAS AND COMMENTS
C SYSTEMATIC REVIEW MATRIX SUMMARY
E SUMMARY OF SELECTED SYSTEMATIC REVIEW PRACTICES
F SELECTED SYSTEMATIC REVIEW METHODOLOGIES 2015 VERSUS 2020
G SYSTEMATIC REVIEW QUESTIONS ADDRESSING DIET-RELATED METABOLIC DISEASES
Acronyms and Abbreviations
| AHA | American Heart Association |
| AHRQ EPC | Agency for Healthcare Research and Quality Evidence-based Practice Centers Program |
| AI | Adequate Intake |
| AMDR | Acceptable Macronutrient Distribution Range |
| AMSTAR | A Measurement Tool to Assess Systematic Reviews |
| ARS | Agricultural Research Service (U.S. Department of Agriculture) |
| ARS NND | Agricultural Research Service National Nutrient Database for Standard Reference |
| B-24 | children from birth to 24 months |
| BMI | body mass index |
| CDC | Centers for Disease Control and Prevention |
| CNPP | Center for Nutrition Policy and Promotion |
| COI | conflict of interest |
| CQA | Continuous Quality Advancement |
| CSFII | Continuing Survey of Food Intakes by Individuals |
| CVD | cardiovascular disease |
| DASH | Dietary Approaches to Stop Hypertension |
| DAT | data analysis team |
| DGA | Dietary Guidelines for Americans |
| DGAC | Dietary Guidelines Advisory Committee |
| DGPCG | Dietary Guidelines Planning and Continuity Group |
| DGSAC | Dietary Guidelines Scientific Advisory Committee |
| DRI | Dietary Reference Intake |
| EAR | Estimated Average Requirement |
| EER | Estimated Energy Requirement |
| FACA | Federal Advisory Committee Act |
| FDA | U.S. Food and Drug Administration |
| FNDDS | Food and Nutrient Database for Dietary Studies |
| FTE | full-time equivalent |
| GRADE | Grading of Recommendations Assessment, Development and Evaluation |
| HDI | Human Development Index |
| HHS | U.S. Department of Health and Human Services |
| IOM | Institute of Medicine |
| NEL | Nutrition Evidence Library |
| NEL BAT | Nutrition Evidence Library Bias Assessment Tool |
| NESR | Nutrition Evidence Systematic Review |
| NFC | nutrient or food component |
| NHANES | National Health and Nutrition Examination Survey |
| NHIS | National Health Interview Survey |
| NIH | National Institutes of Health |
| P/B-24 | Pregnancy and Birth to 24 Months |
| PICO | population, intervention/exposure, comparator, and outcome of interest |
| RCT | randomized controlled trial |
| RDA | Recommended Dietary Allowance |
| ROB | risk of bias |
| SEER | Surveillance, Epidemiology, and End Results (National Cancer Institute) |
| SR | systematic review |
| TEC | Technical Expert Collaborative |
| TEP | technical expert panel |
| UL | Tolerable Upper Intake Level |
| USDA | U.S. Department of Agriculture |
| USPSTF | U.S. Preventive Services Task Force |
| WHO | World Health Organization |
| WIC | Special Supplemental Nutrition Program for Women, Infants, and Children |
| WWEIA | What We Eat in America |
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