Page 153 Cite

Suggested Citation:"Appendix C: Systematic Review Matrix Summary." 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. doi: 10.17226/26406.

×

Appendix C

Systematic Review Matrix Summary¹

The committee’s approach to task 2 was to determine whether the body of evidence used to develop the DGA included those studies with diet-related metabolic disease and were the most current and rigorous scientific studies available. Although evidence from existing (not updated) systematic reviews is used to develop the DGA (see Table C-5), the committee elected to focus on the new and updated systematic reviews. The systematic review matrix summary was thus created based on those new and updated reviews.

TABLE C-1 Strength of Evidence Grades Assigned in the New and Updated Systematic Reviews Conducted for the 2020–2025 Dietary Guidelines for Americans

TABLE C-2 Summary of Included and Excluded Study Participants in the New and Updated Systematic Reviews for the 2020–2025 Dietary Guidelines for Americans, by Age or Life Stage

___________________

¹ This appendix contains summarized information from the individual systematic reviews that were either new or updated for the 2020–2025 DGA. Further information can be found in the individual systematic reviews on the NESR website. In addition, Table C-5 has been added to capture the full spectrum of data used to create the 2020–2025 DGA and to clarify which components (new or updated systematic reviews) were focused on by this committee. This clarifying footnote has been added since the release of a prepublication version of the report to the sponsor.

Page 154 Cite

Suggested Citation:"Appendix C: Systematic Review Matrix Summary." 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. doi: 10.17226/26406.

×

TABLE C-3 Summary of Included and Excluded Study Participants in the New and Updated Systematic Reviews for the 2020–2025 Dietary Guidelines for Americans, by Health Status

TABLE C-4 Summary of Inclusion and Exclusion Criteria Used in the New and Updated Systematic Reviews for the 2020–2025 Dietary Guidelines for Americans Related to Study Design

TABLE C-5 Summary of Approach to Answering Questions in the 2020 DGAC Scientific Report

FIGURE C-1 Publication date ranges for literature searches in the systematic reviews conducted for the 2020–2025 DGA that updated a previous systematic review

FIGURE C-2 Date ranges of literature searches done for new systematic reviews in the 2020–2025 Dietary Guidelines for Americans

Page 155 Cite

Suggested Citation:"Appendix C: Systematic Review Matrix Summary." 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. doi: 10.17226/26406.

×

TABLE C-1 Strength of Evidence Grades Assigned in the New and Updated Systematic Reviews Conducted for the 2020–2025 Dietary Guidelines for Americans

Systematic Review	Strength of Evidence Grade by Age Group, Life Stage, or Subtopic
Dietary Patterns
Dietary Patterns and Growth, Size, Body Composition, and/or Risk of Overweight or Obesity	Children - Grade: Limited Adults - 2015 DGAC Grade: Moderate^a Diets based on macronutrient distribution - Grade Not Assignable for Children (no evidence) and Adults (insufficient evidence)
Dietary Patterns and Risk of Cardiovascular Disease	Children - Grade: Limited Adults - 2015 DGAC Grade: Strong^a Diets Based on Macronutrient Distribution: Children - Grade Not Assignable (no evidence) Diets Based on Macronutrient Distribution: Adults - Grade: Limited
Dietary Patterns and Risk of Type 2 Diabetes	Children - Grade Not Assignable (insufficient evidence) Adults - 2015 DGAC: Moderate^a Diets Based on Macronutrient Distribution - Grade Not Assignable for Children (no evidence) and Adults (insufficient evidence)
Dietary Patterns and Breast, Colorectal, Lung, and Prostate Cancer	Breast cancer risk - Grade: Moderate Colorectal cancer - Grade: Moderate Lung cancer - Grade: Limited Prostate cancer - Grade: Limited
Dietary Patterns and Bone Health	Adults - Grade: Moderate Children - Grade: Not Assignable (insufficient evidence)
Dietary Patterns and Neurocognitive Health	Grade: Limited
Dietary Patterns and Sarcopenia	Grade: Not Assignable (insufficient evidence) Diets based on macronutrient distribution - Grade Not Assignable (insufficient evidence)
Dietary Patterns and All-Cause Mortality	Grade: Strong Diets based on macronutrient distribution - Grade Not Assignable (insufficient evidence)
Pregnancy and Lactation
Dietary Patterns During Pregnancy and Gestational Weight Gain	Grade: Limited

Page 156 Cite

Suggested Citation:"Appendix C: Systematic Review Matrix Summary." 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. doi: 10.17226/26406.

×

Systematic Review	Strength of Evidence Grade by Age Group, Life Stage, or Subtopic
Dietary Patterns During Lactation and Postpartum Weight Loss	Grade Not Assignable (insufficient evidence)
Dietary Patterns During Lactation and Human Milk Composition and Quantity	Grades: Limited Not Assignable (insufficient evidence and no evidence)
Dietary Patterns During Lactation and Developmental Milestones, Including Neurocognitive Development, in the Child	Grade Not Assignable (no evidence)
Folic Acid from Fortified Foods and/or Supplements During Pregnancy and Lactation and Health Outcomes	Micronutrient status during Pregnancy - Grades: Strong, Not Assignable (insufficient and no evidence) Micronutrient status during Lactation - Grades: Moderate, Not Assignable (insufficient and no evidence) Gestational diabetes - Grade Not Assignable (insufficient evidence) Hypertensive disorders of pregnancy - Grades: Moderate, Limited, Not Assignable (no evidence) Human milk composition: Pregnancy - Grade Not Assignable (no evidence) Lactation - Grades: Moderate; Not Assignable (no evidence) Developmental milestones - Grade Not Assignable for Pregnancy (insufficient and no evidence) and Lactation (no evidence)
Omega-3 Fatty Acids from Supplements Consumed Before and During Pregnancy and Lactation and Developmental Milestones, Including Neurocognitive Development, in the Child	Pregnancy - Grades: Limited, Not Assignable (insufficient and no evidence) Lactation - Grade Not Assignable (insufficient evidence and no evidence)

Page 157 Cite

Suggested Citation:"Appendix C: Systematic Review Matrix Summary." 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. doi: 10.17226/26406.

×

Systematic Review	Strength of Evidence Grade by Age Group, Life Stage, or Subtopic
Maternal Diet During Pregnancy and Lactation and Risk of Child Food Allergies and Atopic Allergic Diseases	Food allergy: Pregnancy - Grades: Limited, Not Assignable (insufficient and no evidence) Lactation - Grade Not Assignable (insufficient and no evidence) Atopic dermatitis/eczema: Pregnancy - Grades: Moderate, Limited, Not Assignable (insufficient and no evidence) Lactation - Grade Not Assignable (insufficient and no evidence) Allergic rhinitis: Pregnancy - Grades: Moderate, Not Assignable (insufficient and no evidence) Lactation - Grade Not Assignable (insufficient and no evidence) Asthma: Pregnancy - Grades: Limited, Not Assignable (insufficient and no evidence) Lactation - Grade Not Assignable (insufficient and no evidence)
Birth to 24 Months
The Duration, Frequency, and Volume of Exclusive Human Milk and/or Infant Formula Consumption and Overweight and Obesity	Ever vs never consuming human milk - Grade Moderate Other subquestions - Grade Not Assignable (insufficient and no evidence)
The Duration, Frequency, and Volume of Exclusive Human Milk and/or Infant Formula Consumption and Nutrient Status	Ever vs never consuming human milk - Grades: Moderate, Not Assignable (insufficient and no evidence) Other subquestions - Grades Not Assignable (insufficient and no evidence)
Iron from Supplements Consumed During Infancy and Toddlerhood and Growth, Size, and Body Composition	Grades: Moderate, Not Assignable (insufficient and no evidence)
Vitamin D from Supplements Consumed During Infancy and Toddlerhood and Bone Health	Grades: Limited, Not Assignable (insufficient evidence)

Page 158 Cite

Suggested Citation:"Appendix C: Systematic Review Matrix Summary." 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. doi: 10.17226/26406.

×

Systematic Review	Strength of Evidence Grade by Age Group, Life Stage, or Subtopic
Beverages and Added Sugars
Beverage Consumption and Growth, Size, Body Composition, and Risk of Overweight and Obesity	Milk - Grade: Limited Juice - Grade: Limited Sugar-sweetened beverage - Grades: Moderate, Limited, Not Assignable (insufficient evidence) Low and no-calorie sweetened beverages - Grade: Limited
Beverage Consumption During Pregnancy and Birth Weight	Grade Not Assignable (insufficient evidence)
Alcohol Consumption and All-Cause Mortality	Primary comparisons (among those who currently drink alcohol) Grade: Moderate Secondary comparison (between those who currently drink alcohol and those who have never consumed alcohol) Grade: Limited
Added Sugars Consumption and Risk of Cardiovascular Disease	Grades: Limited, Not Assignable (insufficient evidence)
Dietary Fats and Seafood
Types of Dietary Fat and Cardiovascular Disease	Children - intermediate outcomes: Grades: Strong, Moderate, Not Assignable (insufficient evidence) Children - endpoint outcomes: Grade Not Assignable (insufficient evidence) Adults - intermediate outcomes: Grades: Strong, Not Assignable (insufficient evidence) Adults - endpoint outcomes: Grades: Strong, Moderate, Limited
Seafood Consumption During Pregnancy and Lactation and Neurocognitive Development in the Child	Pregnancy - Grades: Moderate, Limited, Not Assignable (insufficient and no evidence) Lactation - Grade Not Assignable (no evidence)
Seafood Consumption during Childhood and Adolescence and Neurocognitive Development	Grade Not Assignable (insufficient and no evidence)

Page 159 Cite

Suggested Citation:"Appendix C: Systematic Review Matrix Summary." 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. doi: 10.17226/26406.

×

Systematic Review	Strength of Evidence Grade by Age Group, Life Stage, or Subtopic
Seafood Consumption during Childhood and Adolescence and Cardiovascular Disease	Grade Not Assignable (insufficient evidence)
Frequency of Eating
Frequency of Eating and Growth, Size, Body Composition, and Risk of Overweight and Obesity	Grade Not Assignable (insufficient evidence)
Frequency of Eating and Cardiovascular Disease	Grade Not Assignable (insufficient evidence)
Frequency of Eating and Type 2 Diabetes	Grade Not Assignable (insufficient evidence)
Frequency of Eating During Lactation and Postpartum Weight Loss	Grade Not Assignable (insufficient evidence)
Frequency of Eating During Pregnancy and Gestational Weight Gain	Grade Not Assignable (no evidence)
Frequency of Eating and All-Cause Mortality	Grade Not Assignable (no evidence)

^a The 2020 DGAC committee determined that the conclusion drawn by the 2015 Dietary Guidelines Advisory Committee generally reflects the current state of science and carried forward the conclusion from the 2015 committee.

Page 160 Cite

Suggested Citation:"Appendix C: Systematic Review Matrix Summary." 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. doi: 10.17226/26406.

×

TABLE C-2 Summary of Included and Excluded Study Participants in the New and Updated Systematic Reviews for the 2020–2025 Dietary Guidelines for Americans, by Age or Life Stage *

Systematic Review	Age or Life Stage of Study Participants at Intervention or Exposure and Outcome^a,b
Systematic Review	Infants (birth to 24 months)	Children (2–18 years)	Adults (19–64 years)	Older Adults (65 years and older)	Women During Pregnancy	Women During Lactation
Dietary Patterns
Dietary Patterns and Growth, Size, Body Composition, and/or Risk of Overweight or Obesity	Exclude	Include	Include	Include	Include	Include
Dietary Patterns and Risk of Cardiovascular Disease	Exclude	Include	Include	Include	Include	Include
Dietary Patterns and Risk of Type 2 Diabetes	Exclude	Include	Include	Include	Include	Include
Dietary Patterns and Breast, Colorectal, Lung, and Prostate Cancer	Exclude	Include	Include	Include
Dietary Patterns and Bone Health	Exclude	Include	Include	Include	Include	Include
Dietary Patterns and Neurocognitive Health	Exclude	Include (only at intervention or exposure)	Include	Include	Include	Include

Page 161 Cite

Suggested Citation:"Appendix C: Systematic Review Matrix Summary." 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. doi: 10.17226/26406.

×

Systematic Review	Age or Life Stage of Study Participants at Intervention or Exposure and Outcome^a,b
Systematic Review	Infants (birth to 24 months)	Children (2–18 years)	Adults (19–64 years)	Older Adults (65 years and older)	Women During Pregnancy	Women During Lactation
Dietary Patterns and Sarcopenia	Exclude	Exclude (ages 2–12 years at intervention or exposure) Exclude (ages 2–18 years at outcome) Include (ages 12–18 years at intervention or exposure)	Include	Include	Exclude	Exclude
Dietary Patterns and All-Cause Mortality	Exclude	Include	Include	Include	Exclude	Exclude
Pregnancy and Lactation
Dietary Patterns During Pregnancy and Gestational Weight Gain					Include^c,d,e
Dietary Patterns During Lactation and Postpartum Weight Loss						Include^c,d,f,g
Dietary Patterns During Lactation and Human Milk Composition and Quantity						Include^h,i

Page 162 Cite

Suggested Citation:"Appendix C: Systematic Review Matrix Summary." 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. doi: 10.17226/26406.

×

Systematic Review	Age or Life Stage of Study Participants at Intervention or Exposure and Outcome^a,b
Systematic Review	Infants (birth to 24 months)	Children (2–18 years)	Adults (19–64 years)	Older Adults (65 years and older)	Women During Pregnancy	Women During Lactation
Dietary Patterns During Lactation and Developmental Milestones, Including Neurocognitive Development, in the Child	Include (at outcome)	Include (at outcome)	Exclude (at outcome)	Exclude (at outcome)		Include (at intervention or exposure)
Folic Acid from Fortified Foods and/or Supplements During Pregnancy and Lactation and Health Outcomes	Include^j	Include^j	Exclude^j	Exclude^j	Include^k,l	Include^k,m
Omega-3 Fatty Acids from Supplements Consumed Before and During Pregnancy and Lactation and Developmental Milestones, Including Neurocognitive Development, in the Child	Include (at outcome)	Include (at outcome)	Exclude (at outcome)	Exclude (at outcome)	Include^c,d,e,n (at intervention or exposure)	Include^c,d,e (at intervention or exposure)

Page 163 Cite

Suggested Citation:"Appendix C: Systematic Review Matrix Summary." 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. doi: 10.17226/26406.

×

Systematic Review	Age or Life Stage of Study Participants at Intervention or Exposure and Outcome^a,b
Systematic Review	Infants (birth to 24 months)	Children (2–18 years)	Adults (19–64 years)	Older Adults (65 years and older)	Women During Pregnancy	Women During Lactation
Maternal Diet During Pregnancy and Lactation and Risk of Child Food Allergies and Atopic Allergic Diseases	Included (at outcomes: food allergies, atopic dermatitis, and allergic rhinitis) Excluded (at outcomes: asthma)	Included (at all outcomes)	Excluded (at all outcomes)	Excluded (at all outcomes)	Include (at intervention or exposure)	Include^o (at intervention or exposure)
Birth to 24 Months
The Duration, Frequency, and Volume of Exclusive Human Milk and/or Infant Formula Consumption and Overweight and Obesity	Include^p (at intervention or exposure and at outcome: rapid weight gain)	Include^p (at outcome)	Include^p (at outcome)	Include^p (at outcome)
The Duration, Frequency, and Volume of Exclusive Human Milk and/or Infant Formula Consumption and Nutrient Status	Include	Exclude	Exclude	Exclude

Page 164 Cite

Suggested Citation:"Appendix C: Systematic Review Matrix Summary." 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. doi: 10.17226/26406.

×

Systematic Review	Age or Life Stage of Study Participants at Intervention or Exposure and Outcome^a,b
Systematic Review	Infants (birth to 24 months)	Children (2–18 years)	Adults (19–64 years)	Older Adults (65 years and older)	Women During Pregnancy	Women During Lactation
Iron from Supplements Consumed During Infancy and Toddlerhood and Growth, Size, and Body Composition	Include	Include (at outcome)	Include (at outcome)	Include (at outcome)
Vitamin D from Supplements Consumed during Infancy and Toddlerhood and Bone Health	Include	Include (at outcome)	Exclude	Exclude
Beverages and Added Sugars
Beverage Consumption and Growth, Size, Body Composition, and Risk of Overweight and Obesity	Exclude	Include^q	Include^q	Include^q	Include^q	Include^q
Beverage Consumption During Pregnancy and Birth Weight	Include					Include^c,d,e,r
Alcohol Consumption and All-Cause Mortality			Include^q,s	Include^q,s

Page 165 Cite

Suggested Citation:"Appendix C: Systematic Review Matrix Summary." 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. doi: 10.17226/26406.

×

Systematic Review	Age or Life Stage of Study Participants at Intervention or Exposure and Outcome^a,b
Systematic Review	Infants (birth to 24 months)	Children (2–18 years)	Adults (19–64 years)	Older Adults (65 years and older)	Women During Pregnancy	Women During Lactation
Added Sugars Consumption and Risk of Cardiovascular Disease	Include^q (at intervention or exposure)	Include^q	Include^q	Include^q
Dietary Fats and Seafood
Types of Dietary Fat and Cardiovascular Disease	Include^t	Include^t	Include	Include	Include	Include
Seafood Consumption During Pregnancy and Lactation and Neurocognitive Development in the Child	Include (at outcome)	Include (at outcome)	Exclude (at outcome)	Exclude (at outcome)	Include (at intervention or exposure)	Include (at intervention or exposure)
Seafood Consumption During Childhood and Adolescence and Neurocognitive Development	Include (at intervention or exposure)	Include	Include (at outcome)	Include (at outcome)
Seafood Consumption During Childhood and Adolescence and Cardiovascular Disease	Include (at intervention or exposure)	Include^t	Include (at outcome)	Include (at outcome)
Frequency of Eating

Page 166 Cite

Suggested Citation:"Appendix C: Systematic Review Matrix Summary." 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. doi: 10.17226/26406.

×

Systematic Review	Age or Life Stage of Study Participants at Intervention or Exposure and Outcome^a,b
Systematic Review	Infants (birth to 24 months)	Children (2–18 years)	Adults (19–64 years)	Older Adults (65 years and older)	Women During Pregnancy	Women During Lactation
Frequency of Eating and Growth, Size, Body Composition, and Risk of Overweight and Obesity	Exclude	Include	Include	Include	Include^u
Frequency of Eating and Cardiovascular Disease	Exclude	Include	Include	Include	Include^u
Frequency of Eating and Type 2 Diabetes	Exclude	Include	Include	Include	Include^u
Frequency of Eating During Lactation and Postpartum Weight Loss						Include^c,d,f,g,v
Frequency of Eating During Pregnancy and Gestational Weight Gain					Include^c,d,f,w
Frequency of Eating and All-Cause Mortality^x					Include^u

* Data in this table are from the Inclusion and Exclusion Criteria tables provided in each systematic review.

^a All systematic reviews excluded non-human participants (e.g., animal or in vitro models).

^b Age of study participants is at intervention/exposure and outcome, unless otherwise noted.

^c Excluded pregnancies conceived only using assisted reproductive technologies.

^d Excluded studies that only enroll multiple gestation pregnancies.

^e Excluded studies that enroll both singleton and multiple pregnancies and do not account for singleton and multiple gestation in the design or analyses and only present aggregate findings.

Page 167 Cite

Suggested Citation:"Appendix C: Systematic Review Matrix Summary." 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. doi: 10.17226/26406.

×

^f Excluded studies that only report combined data for singleton and multiple gestation pregnancies.

^g Excluded studies that enroll lactating and non-lactating mothers and only present combined data for lactating and non-lactating mothers.

^h Included study participants who were exclusively or predominantly human milk feeding women (human milk quantity outcome). Included women during lactation (human milk composition outcome).

ⁱ Excluded studies that only enroll multiple gestation pregnancies or present only combined analyses of singleton and multiple gestations (human milk quantity outcome only).

^j At outcomes: developmental milestones including neurocognitive development.

^k Excluded studies that exclusively enroll multiple gestation pregnancies or exclusively present combined analyses of singleton and multiple gestations.

^l Included studies conducted in women up to 6 months before pregnancy (at intervention or exposure). Included studies of women during pregnancy at intervention or exposure and outcomes (micronutrient status, gestational diabetes, hypertensive disorders).

^m At intervention or exposure and outcomes (micronutrient status, milk composition).

ⁿ Included studies conducted in women up to 6 months before pregnancy (at intervention or exposure).

^o Excluded studies conducted exclusively in non-lactating women or in lactating women who are not exclusively or predominantly feeding human milk.

^p Additional criteria for within-family studies of siblings. Included siblings with discordant exposures or outcomes or both who were compared using within-family analyses. Excluded siblings who were not compared using within-family analyses.

^q Excluded hospitalized samples.

^r Included women who were pregnant or capable of becoming pregnant. Excluded hospitalized patients, when hospitalization is not related to pregnancy, birth and immediate postpartum.

^s Included studies conducted primarily in adults 21 years and older and studies that enroll some participants under 21 years of age. Excluded studies that exclusively enroll participants under 21 years old.

^t Included at intervention or exposure and intermediate outcomes only.

^u Included women during pregnancy and the post-partum period.

^v Included women who are post-partum and who are lactating.

^w Included women who pregnant or who are capable of becoming pregnant.

^x The systematic review included males and females, but no age groups were specified.

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Suggested Citation:"Appendix C: Systematic Review Matrix Summary." 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. doi: 10.17226/26406.

×

TABLE C-3 Summary of Included and Excluded Study Participants in the New and Updated Systematic Reviews for the 2020–2025 Dietary Guidelines for Americans, by Health Status

Systematic Review	Include	Exclude
Dietary Patterns
Dietary Patterns and Growth, Size, Body Composition, and/or Risk of Overweight or Obesity	Studies that enroll participants who are healthy and/or at risk for chronic disease Studies that enroll some participants + diagnosed with a disease + classified with severe undernutrition, or as underweight, stunted, or obese	Studies that exclusively enroll participants + diagnosed with a disease, or hospitalized with an illness or injury + classified as obese (i.e., studies that aim to treat participants who have already been classified as obese) or who are post-bariatric surgery Addendum: Interventions designed to induce weight loss or treat overweight and obesity through energy-restriction/hypocaloric diets for the purposes of treating additional or other medical conditions.
Dietary Patterns and Risk of Cardiovascular Disease	Studies that enroll participants who are healthy and/or at risk for chronic disease Studies that enroll some participants + diagnosed with a disease + classified with severe undernutrition, or as underweight, stunted, or obese	Studies that exclusively enroll participants + diagnosed with a disease, or hospitalized with an illness or injury (For this criterion, studies that exclusively enroll subjects with obesity will be included.) + classified as obese diagnosed with endpoint outcomes of cardiovascular disease (i.e., studies that aim to treat participants who have already been classified as obese or who are post-bariatric surgery diagnosed with the endpoint outcomes of interest) Interventions designed to induce weight loss or treat overweight and obesity through energy-restriction/hypocaloric diets for the purposes of treating additional or other medical conditions.

Page 169 Cite

Suggested Citation:"Appendix C: Systematic Review Matrix Summary." 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. doi: 10.17226/26406.

×

Systematic Review	Include	Exclude
Dietary Patterns and Risk of Type 2 Diabetes	Studies that enroll participants who are healthy and/or at risk for chronic disease, including those with obesity Studies that enroll some participants + diagnosed with a disease + with type 2 diabetes	Studies that exclusively enroll participants + diagnosed with a disease, or hospitalized with an illness or injury + type 2 diabetes (i.e., studies that aim to treat participants who have already been diagnosed with the endpoint outcomes of interest) Addendum: Interventions designed to induce weight loss or treat overweight and obesity through energy-restriction/hypocaloric diets for the purposes of treating additional or other medical conditions.
Dietary Patterns and Breast, Colorectal, Lung, and Prostate Cancer	Studies that enroll participants who are healthy and/or at risk for chronic disease, including those with obesity Studies that enroll some participants diagnosed with + a disease + cancer	Studies that exclusively enroll participants diagnosed with + a disease, or hospitalized patients with illness or injury. (For this criterion, studies that exclusively enroll subjects with obesity will be included.) + with cancer (i.e., studies that aim to treat participants who have already been diagnosed with the outcome of interest)
Dietary Patterns and Bone Health	Studies that enroll participants who are healthy and/or at risk for chronic disease, including those with obesity Studies that enroll some participants diagnosed with + a disease + low bone mineral density, low bone mineral content, osteoporosis, osteopenia, rickets, and fracture	Studies that exclusively enroll participants diagnosed with + a disease or hospitalized with an illness or injury. (For this criterion, studies that exclusively enroll subjects with obesity will be included.) + with osteoporosis, osteopenia, rickets, and fracture (i.e., studies that aim to treat participants who have already been diagnosed with the outcome of interest)

Page 170 Cite

Suggested Citation:"Appendix C: Systematic Review Matrix Summary." 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. doi: 10.17226/26406.

×

Systematic Review	Include	Exclude
Dietary Patterns and Neurocognitive Health	Studies that enroll participants who are healthy and/or at risk for chronic disease, including those with obesity Studies that enroll some participants diagnosed with + a disease + mild cognitive impairment, dementia, or Alzheimer’s disease	Studies that exclusively enroll participants diagnosed with + a disease or hospitalized with illness or injury. (For this criterion, studies that exclusively enroll subjects with obesity will be included.) + with mild cognitive impairment, dementia, or Alzheimer’s disease (i.e., studies that aim to treat participants who have already been diagnosed with the outcome of interest)
Dietary Patterns and Sarcopenia	Studies that enroll participants who are healthy and/or at risk for chronic disease, including those with obesity Studies that enroll some participants diagnosed with + a disease + sarcopenia + severe sarcopenia	Studies that exclusively enroll participants diagnosed with + a disease. (For this criterion, studies that exclusively enroll subjects with obesity will be included.) + sarcopenia, or severe sarcopenia (i.e., studies that aim to treat participants who have already been diagnosed with the outcome of interest)
Dietary Patterns and All-Cause Mortality	Studies that enroll participants who are healthy and/or at risk for chronic disease, including those with obesity Studies that enroll some participants diagnosed with a disease	Studies that exclusively enroll participants diagnosed with a disease or hospitalized with illness or injury. (For this criterion, studies that exclusively enroll subjects with obesity will be included.)

Page 171 Cite

Suggested Citation:"Appendix C: Systematic Review Matrix Summary." 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. doi: 10.17226/26406.

×

Systematic Review	Include	Exclude
Pregnancy and Lactation
Dietary Patterns During Pregnancy and Gestational Weight Gain	Studies that enroll mothers who are healthy and/or at risk for chronic disease Studies that enroll some mothers + diagnosed with a disease + who were severely undernourished prior to pregnancy Studies that enroll some or all mothers classified as underweight, or obese prior to pregnancy	Studies that ONLY enroll mothers + who gave birth to preterm (<37 weeks) + diagnosed with a disease, including severe undernutrition or hospitalized with an illness or injury
Dietary Patterns During Lactation and Postpartum Weight Loss	Studies that enroll mothers who are healthy and/or at risk for chronic disease Studies that enroll some mothers + diagnosed with a disease + who were severely undernourished prior to pregnancy Studies that enroll some or all mothers classified as underweight, or obese prior to pregnancy	Studies that exclusively enroll mothers + who gave birth to preterm (<37 weeks and 0/7 days) + diagnosed with a disease, including severe undernutrition or hospitalized with an illness or injury
Dietary Patterns During Lactation and Human Milk Composition and Quantity	Studies that enroll mothers who are healthy and/or at risk for chronic disease Studies that enroll some mothers + diagnosed with a disease + who were severely undernourished prior to pregnancy Studies that enroll some or all mothers classified as underweight, or obese prior to pregnancy	Studies that exclusively enroll mothers + who gave birth to preterm (<37 weeks and 0/7 days) + diagnosed with a disease, including severe undernutrition or hospitalized with an illness or injury

Page 172 Cite

Suggested Citation:"Appendix C: Systematic Review Matrix Summary." 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. doi: 10.17226/26406.

×

Systematic Review	Include	Exclude
Dietary Patterns During Lactation and Developmental Milestones, Including Neurocognitive Development, in the Child	Studies that enroll mothers who are healthy and/or at risk for chronic disease Studies that enroll some mothers + diagnosed with a disease + who were severely undernourished prior to pregnancy Studies that enroll some or all mothers classified as underweight, or obese prior to pregnancy	Studies that exclusively enroll mothers + who gave birth to preterm (<37 weeks and 0/7 days) + diagnosed with a disease, including severe undernutrition or hospitalized with an illness or injury
Folic Acid from Fortified Foods and/or Supplements During Pregnancy and Lactation and Health Outcomes	Studies that enroll participants who are healthy and/or at risk for chronic disease, including those with obesity Studies that enroll some participants diagnosed with a disease or with the health outcome of interest: + Gestational diabetes + Hypertensive disorders of pregnancy + Neurocognitive disorders (ADD, ADHD, anxiety, depression, or ASD) Studies that enroll some participants who are deficient in folate Studies that enroll some mothers with infants who are born preterm (<37 weeks and 0/7 days gestational age) Studies that exclusively enroll or enroll some mothers diagnosed with the outcome of interest that is to be examined in the infant/child (developmental milestones, including neurocognitive development)	Studies that exclusively enroll participants + diagnosed with a chronic disease, or hospitalized with an illness or injury. (For this criterion, studies that exclusively enroll participants with obesity will not be excluded.) + with the outcome of interest (gestational diabetes, hypertensive disorders of pregnancy) (i.e., studies that aim to treat participants who have already been diagnosed with the outcome of interest) Studies that exclusively enroll infants born preterm (gestational age <37 weeks and 0/7 days), infants with low birth weight (<2,500 grams), and/or infants born small for gestational age

Page 173 Cite

Suggested Citation:"Appendix C: Systematic Review Matrix Summary." 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. doi: 10.17226/26406.

×

Systematic Review	Include	Exclude
Omega-3 Fatty Acids from Supplements Consumed Before and During Pregnancy and Lactation and Developmental Milestones, Including Neurocognitive Development, in the Child	Studies that enroll participants who are healthy and/or at risk for chronic disease, including those with obesity Studies that enroll some participants diagnosed with a disease or with the health outcome of interest: + Neurocognitive disorders (ADD, ADHD, anxiety, depression, or ASD) + deficient in omega-3 fatty acids Studies that enroll some mothers with infants who are born preterm (<37 weeks and 0/7 days gestational age) Studies that exclusively enroll or enroll some mothers diagnosed with the outcome of interest that is to be examined in the infant/child (developmental milestones, including neurocognitive development)	Studies that exclusively enroll participants + diagnosed with a disease, or hospitalized with an illness or injury. (For this criterion, studies that exclusively enroll participants with obesity will not be excluded.) + with the outcome of interest (i.e., studies that aim to treat participants who have already been diagnosed with the outcome of interest) Studies that exclusively enroll infants born preterm (gestational age <37 weeks and 0/7 days), infants with low birth weight (<2,500 grams), and/or infants born small for gestational age
Maternal Diet During Pregnancy and Lactation and Risk of Child Food Allergies and Atopic Allergic Diseases	Studies that enroll participants who are healthy and/or at risk for chronic disease, including those with obesity Studies that enroll some children diagnosed with a disease or with the health outcome of interest: Food allergies Atopic dermatitis Allergic rhinitis Asthma	Studies that exclusively enroll mothers + who gave birth to preterm (<37 weeks and 0/7 days) infants + diagnosed with a chronic disease, including severe undernutrition or hospitalized with an illness or injury

Page 174 Cite

Suggested Citation:"Appendix C: Systematic Review Matrix Summary." 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. doi: 10.17226/26406.

×

Systematic Review	Include	Exclude
Birth to 24 Months
The Duration, Frequency, and Volume of Exclusive Human Milk and/or Infant Formula Consumption and Overweight and Obesity	Studies that enroll participants: born full-term (≥37 weeks and 0/7 days gestational age) who are healthy and/or at risk for chronic disease Studies that enroll some participants: born preterm (gestational age <37 weeks and 0/7 days), with low birth weight (<2,500 grams), or small for gestational age with failure to thrive/underweight, stunting, or wasting	Studies that exclusively enroll participants: born preterm (gestational age <37 weeks and 0/7 days), with low birth weight (<2,500 grams), or small for gestational age with failure to thrive/underweight, stunting, or wasting diagnosed with a disease or hospitalized with an illness or injury
The Duration, Frequency, and Volume of Exclusive Human Milk and/or Infant Formula Consumption and Nutrient Status	Studies that enroll participants: born full-term (≥37 weeks and 0/7 days gestational age) who are healthy and/or at risk for chronic disease Studies that enroll some participants: born preterm (gestational age <37 weeks and 0/7 days), with low birth weight (<2,500 grams), or small for gestational age diagnosed with a disease who are deficient in the nutrients of interest or have anemia	Studies that exclusively enroll participants: born preterm (gestational age <37 weeks and 0/7 days), with low birth weight (<2,500 grams), or small for gestational age diagnosed with a disease or hospitalized with an illness or injury who are deficient in the nutrients of interest or have anemia (i.e., studies that aim to treat participants who have already been diagnosed with nutrient deficiencies or anemia)

Page 175 Cite

Suggested Citation:"Appendix C: Systematic Review Matrix Summary." 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. doi: 10.17226/26406.

×

Systematic Review	Include	Exclude
Iron from Supplements Consumed During Infancy and Toddlerhood and Growth, Size, and Body Composition	Studies that enroll participants who are healthy and/or at risk for chronic disease Studies that enroll some participants + diagnosed with a disease + classified as underweight, stunted, wasted, or obese Studies that enroll infants born full-term (≥37 weeks and 0/7 days gestational age)	Studies that exclusively enroll participants + diagnosed with a disease + classified as underweight, stunted, wasted, or obese (i.e., studies that aim to treat participants who have already been diagnosed with the outcome of interest) Studies that exclusively enroll infants born preterm (gestational age <37 weeks and 0/7 days), infants with low birth weight (<2,500 grams), and/or infants born small for gestational age
Vitamin D from Supplements Consumed During Infancy and Toddlerhood and Bone Health	Studies that enroll participants who are healthy and/or at risk for chronic disease, including those with obesity Studies that enroll some participants diagnosed with a disease or with rickets. Studies that enroll infants born full-term (≥37 weeks and 0/7 days gestational age)	Studies that exclusively enroll participants + diagnosed with a disease. (For this criterion, studies that exclusively enroll subjects with obesity were included.) + with rickets (i.e., studies that aim to treat participants who have already been diagnosed with the outcome of interest) Studies that exclusively enroll infants born preterm (gestational age <37 weeks and 0/7 days), infants with low birth weight (<2,500 grams), and/or infants born small for gestational age
Beverages and Added Sugars
Beverage Consumption and Growth, Size, Body Composition, and Risk of Overweight and Obesity	Studies that enroll participants who are healthy and/or at risk for chronic disease Studies that enroll some participants + diagnosed with a disease + classified as underweight, stunted, wasted, or obese	Studies that exclusively enroll participants + diagnosed with a disease, or hospitalized with an illness or injury + classified as obese (i.e., studies that aim to treat participants who have already been classified as obese)

Page 176 Cite

Suggested Citation:"Appendix C: Systematic Review Matrix Summary." 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. doi: 10.17226/26406.

×

Systematic Review	Include	Exclude
Beverage Consumption During Pregnancy and Birth Weight	Studies that enroll participants who are healthy and/or at risk for chronic disease, including those with obesity Studies that enroll some mothers diagnosed with a disease Studies that enroll mothers with infants born full-term (≥37 and 0/7 weeks gestational age) Studies that enroll some mothers with infants who are born preterm (gestational age <37 and 0/7 weeks), with low birth weight (2,500 grams), and/or small for gestational age	Studies that exclusively enroll + preterm infants (gestational age <37 and 0/7 weeks) + mothers diagnosed with a disease, or hospitalized with an illness or injury (For this criterion, studies that exclusively enroll mothers with obesity will not be excluded.)
Alcohol Consumption and All-Cause Mortality	Studies that enroll participants who are healthy and/or at risk for chronic disease, including those with obesity Studies that enroll some participants diagnosed with a disease	Studies that exclusively enroll participants diagnosed with a disease or hospitalized with an illness or injury. (For this criterion, studies that exclusively enroll subjects with obesity will not be excluded.)

Page 177 Cite

Suggested Citation:"Appendix C: Systematic Review Matrix Summary." 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. doi: 10.17226/26406.

×

Systematic Review	Include	Exclude
Added Sugars Consumption and Risk of Cardiovascular Disease	Studies that enroll participants who are healthy and/or at risk for chronic disease, including those with obesity Studies that enroll some participants diagnosed with a disease Studies that exclusively enroll participants with high blood pressure or high cholesterol and are evaluating cardiovascular disease endpoint outcomes (i.e., studies that aim to prevent cardiovascular disease in participants who are at high risk) Studies that enroll some participants with endpoint outcomes of cardiovascular disease Studies that enroll infants born full-term (≥37 weeks and 0/7 days gestational age)	Studies that exclusively enroll participants + diagnosed with a disease, or hospitalized with an illness or injury (For this criterion, studies that exclusively enroll participants with obesity will not be excluded.) + with high blood pressure or high cholesterol and are evaluating blood pressure or cholesterol outcomes (i.e., studies that aim to treat participants who already have high blood pressure or high cholesterol). + with endpoint outcomes of cardiovascular disease (i.e., studies that aim to treat participants who have already been diagnosed with the endpoint outcomes of interest) Studies that exclusively enroll infants born preterm (gestational age <37 weeks and 0/7 days), infants with low birth weight (<2,500 grams), and/or infants born small for gestational age

Page 178 Cite

Suggested Citation:"Appendix C: Systematic Review Matrix Summary." 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. doi: 10.17226/26406.

×

Systematic Review	Include	Exclude
Dietary Fats and Seafood
Types of Dietary Fat and Cardiovascular Disease	Studies that enroll participants who are healthy and/or at risk for chronic disease, including those with obesity Studies that exclusively enroll participants with high blood pressure or high cholesterol and are evaluating cardiovascular disease endpoint outcomes Studies that enroll some participant diagnosed with + cardiovascular disease endpoint outcomes. + a disease or hospitalized with and illness or injury Studies that enroll infants born full-term (≥37 weeks and 0/7 days gestational age) Studies that enroll some infants born preterm (gestational age <37 weeks and 0/7 days), infants with low birth weight (<2,500 grams), and/or infants born small for gestational age	Studies that exclusively enroll participants + diagnosed with a disease (e.g., diabetes, renal disease), or hospitalized with an illness or injury (For this criterion, studies that exclusively enroll participants with obesity will not be excluded) + with cardiovascular disease endpoint outcomes (i.e., studies that aim to treat participants who have already been diagnosed with cardiovascular disease) + with high blood lipids (e.g., TC, LDL cholesterol, HDL cholesterol, or triglycerides) and are evaluating any blood lipid intermediate outcome (i.e., studies that aim to treat participants who already have high cholesterol or blood lipids)

Page 179 Cite

Suggested Citation:"Appendix C: Systematic Review Matrix Summary." 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. doi: 10.17226/26406.

×

Systematic Review	Include	Exclude
Seafood Consumption During Pregnancy and Lactation and Neurocognitive Development in the Child	Studies that enroll participants who are healthy and/or at risk for chronic disease, including those with obesity Studies that enroll some participants diagnosed with a disease or with the neurocognitive development and/or health outcomes of interest Studies that enroll infants born full-term (≥37 weeks and 0/7 days gestational age) Studies that enroll some infants born preterm (gestational age <37 weeks and 0/7 days), infants with low birth weight (<2,500 grams), and/or infants born small for gestational age	Studies that exclusively enroll participants + diagnosed with a disease or hospitalized with an illness or injury. (For this criterion, studies that exclusively enroll participants with obesity will not be excluded.) + with the neurocognitive development and/or health outcomes of interest Studies that exclusively enroll infants born preterm (gestational age <37 weeks and 0/7 days), infants with low birth weight (<2,500 grams), and/or infants born small for gestational age
Seafood Consumption during Childhood and Adolescence and Neurocognitive Development	Studies that enroll participants who are healthy and/or at risk for chronic disease, including those with obesity Studies that enroll some participants diagnosed with a disease or with the neurocognitive development and/or health outcomes of interest Studies that enroll infants born full-term (≥37 weeks and 0/7 days gestational age) Studies that enroll some infants born preterm (gestational age <37 weeks and 0/7 days), infants with low birth weight (<2,500 grams), and/or infants born small for gestational age	Studies that exclusively enroll participants + diagnosed with a disease or hospitalized with an illness or injury. (For this criterion, studies that exclusively enroll participants with obesity will not be excluded.) + with the neurocognitive development and/or health outcomes of interest Studies that exclusively enroll infants born preterm (gestational age <37 weeks and 0/7 days), infants with low birth weight (<2,500 grams), and/or infants born small for gestational age

Page 180 Cite

Suggested Citation:"Appendix C: Systematic Review Matrix Summary." 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. doi: 10.17226/26406.

×

Systematic Review	Include	Exclude
Seafood Consumption During Childhood and Adolescence and Cardiovascular Disease	Studies that enroll participants who are healthy and/or at risk for chronic disease, including those with obesity Studies that exclusively enroll participants with high blood pressure or high cholesterol and are evaluating cardiovascular disease endpoint outcomes Studies that enroll some participants + diagnosed with cardiovascular disease endpoint outcomes. + with a disease or hospitalized with and illness or injury Studies that enroll infants born full-term (≥37 weeks and 0/7 days gestational age) Studies that enroll some infants born preterm (gestational age <37 weeks and 0/7 days), infants with low birth weight (<2,500 grams), and/or infants born small for gestational age	Studies that exclusively enroll participants + diagnosed with a disease (e.g., diabetes, renal disease), or hospitalized with an illness or injury (For this criterion, studies that exclusively enroll participants with obesity will not be excluded.) + with cardiovascular disease endpoint outcomes (i.e., studies that aim to treat participants who have already been diagnosed with cardiovascular disease) + with high blood pressure or high cholesterol and are evaluating blood pressure or cholesterol outcomes (i.e., studies that aim to treat participants who already have high blood pressure or high cholesterol)
Frequency of Eating
Frequency of Eating and Growth, Size, Body Composition, and Risk of Overweight and Obesity	Studies that enroll participants who are healthy and/or at risk for chronic disease Studies that enroll some participants + diagnosed with a disease + classified as underweight, stunted, severely undernourished, or obese	Studies that exclusively enroll participants + diagnosed with a disease, or hospitalized with an illness or injury + classified as obese (i.e., studies that aim to treat participants who have already been classified as obese) Studies that exclusively enroll subjects post bariatric surgery

Page 181 Cite

Suggested Citation:"Appendix C: Systematic Review Matrix Summary." 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. doi: 10.17226/26406.

×

Systematic Review	Include	Exclude
Frequency of Eating and Cardiovascular Disease	Studies that enroll participants who are healthy and/or at risk for chronic disease, including those with obesity Studies that enroll some participants + diagnosed with a disease + with endpoint outcomes of cardiovascular disease Studies that exclusively enroll participants with high blood pressure or high cholesterol and are evaluating cardiovascular disease endpoint outcomes (i.e., studies that aim to prevent cardiovascular disease in participants who are at high risk)	Studies that exclusively enroll participants + diagnosed with a disease, or hospitalized with an illness or injury (For this criterion, studies that exclusively enroll participants with obesity will not be excluded.) + with high blood pressure or high cholesterol and are evaluating blood pressure or cholesterol outcomes (i.e., studies that aim to treat participants who already have high blood pressure or high cholesterol) + with endpoint outcomes of cardiovascular disease (i.e., studies that aim to treat participants who have already been diagnosed with the endpoint outcomes of interest) Studies that exclusively enroll subjects post bariatric surgery
Frequency of Eating and Type 2 Diabetes	Studies that enroll participants who are healthy and/or at risk for chronic disease, including those with obesity Studies that enroll some participants diagnosed with + a disease + type 2 diabetes	Studies that exclusively enroll participants + diagnosed with a disease, or hospitalized with an illness or injury (For this criterion, studies that exclusively enroll participants with obesity will not be excluded.) + with type 2 diabetes (i.e., studies that aim to treat participants who have already been diagnosed with type 2 diabetes) Studies that exclusively enroll subjects post bariatric surgery

Page 182 Cite

Suggested Citation:"Appendix C: Systematic Review Matrix Summary." 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. doi: 10.17226/26406.

×

Systematic Review	Include	Exclude
Frequency of Eating During Lactation and Postpartum Weight Loss	Studies that enroll mothers who are healthy and/or at risk for chronic disease Studies that enroll some mothers + diagnosed with a disease + classified as severely undernourished prior to pregnancy Studies that enroll some or all mothers classified as underweight or obese prior to pregnancy	Studies that exclusively enroll mothers diagnosed with a disease, including severe undernutrition, or hospitalized with an illness or injury (for this criterion, studies that exclusively enroll mothers with obesity will not be excluded) Studies that exclusively enroll subjects post bariatric surgery
Frequency of Eating During Pregnancy and Gestational Weight Gain	Studies that enroll mothers who are healthy and/or at risk for chronic disease Studies that enroll some mothers + diagnosed with a disease + classified as severely undernourished prior to pregnancy Studies that enroll some or all mothers classified as underweight or obese prior to pregnancy	Studies that exclusively enroll mothers diagnosed with a disease, including severe undernutrition, or hospitalized with an illness or injury (for this criterion, studies that exclusively enroll mothers with obesity will not be excluded) Studies that exclusively enroll subjects post bariatric surgery
Frequency of Eating and All-Cause Mortality	Studies that enroll participants who are healthy and/or at risk for chronic disease, including those with obesity Studies that enroll some participants diagnosed with a disease	Studies that exclusively enroll participants + diagnosed with a disease (for this criterion, studies that exclusively enroll subjects with obesity will be included) Studies that exclusively enroll subjects post bariatric surgery

Page 183 Cite

Suggested Citation:"Appendix C: Systematic Review Matrix Summary." 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. doi: 10.17226/26406.

×

TABLE C-4 Summary of Inclusion and Exclusion Criteria Used in the New and Updated Systematic Reviews for the 2020–2025 Dietary Guidelines for Americans Related to Study Design

Inclusion Criteria*	Exclusion Criteria**
Randomized controlled trials Non-randomized controlled trials, including quasi-experimental and controlled before and after studies Prospective cohort studies Retrospective cohort studies Nested case-control studies Mendelian randomization studies^a	Uncontrolled trials Case-control studies Cross-sectional studies^b Uncontrolled before-and-after studies^c Narrative reviews Systematic reviews Meta-analyses Obesity treatment studies^d

* Unless noted otherwise, all systematic reviews included studies that met these criteria.

** Unless noted otherwise, all systematic reviews excluded studies that met these criteria.

^a Mendelian randomization studies were included in only one systematic review: Alcohol Consumption and All-Cause Mortality.

^b Cross-sectional studies were included in two systematic reviews: (1) Folic Acid from Fortified Foods and/or Supplements During Pregnancy and Lactation and Health Outcomes and (2) The Duration, Frequency, and Volume of Exclusive Human Milk and/or Infant Formula Consumption and Overweight and Obesity. In the review on folic acid, cross-sectional studies were included for outcomes of human milk composition. In this same review, cross-sectional studies were excluded for outcomes of micronutrient status, gestational diabetes, hypertensive disorders, developmental milestones, including neurocognitive health. In the review on human milk and/or infant formula consumption, cross-sectional studies were included for within-family studies of siblings.

^c Uncontrolled before-and-after studies were included in one systematic review: Folic Acid from Fortified Foods and/or Supplements during Pregnancy and Lactation and Health Outcomes.

^d Obesity treatment studies were excluded in only one systematic review: Beverage Consumption and Growth, Size, Body Composition, and Risk of Overweight and Obesity.

Page 184 Cite

Suggested Citation:"Appendix C: Systematic Review Matrix Summary." 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. doi: 10.17226/26406.

×

Table C-5 Summary of Approach to Answering Questions in the 2020 DGAC Scientific Report^a

Topic	Question	Approach
Current Intakes of Foods, Beverages, and Nutrients	1-5	Data analysis
Food, Beverage and Nutrient Composition During Pregnancy	1,2,5,6	Existing NESR systematic review^b
Food, Beverage and Nutrient Composition During Pregnancy	3,4,7,8,9,10,11	NESR systematic review^c
Food Beverage and Nutrition Consumption During Lactation	1-8	NESR systematic review^c
Human Milk and/or Infant Formula Feeding	1,3	NESR systematic review^c
Human Milk and/or Infant Formula Feeding	2,4	Existing NESR systematic review^b
Foods and Beverages Consumed During Infancy and Toddlerhood	1-5	Existing NESR systematic review^b
Foods and Beverages Consumed During Infancy and Toddlerhood	6-8	NESR systematic review^c
Nutrients from Dietary Supplements During Infancy and Toddlerhood	1,2	NESR systematic review^c
USDA Food Patterns for Children Younger than Age 24 Months	1	Food Pattern Modeling
Dietary Patterns	1-8	NESR systematic review^c
Dietary Fats and Seafood	1-3	NESR systematic review^c
Beverages	1	Data analysis
Beverages	2	NESR systematic review^c
Alcoholic Beverages	1	Data analysis
Alcoholic Beverages	2	NESR systematic review^c

Page 185 Cite

Suggested Citation:"Appendix C: Systematic Review Matrix Summary." 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. doi: 10.17226/26406.

×

Topic	Question	Approach
Added sugars	1	Data analysis
2	NESR systematic review^c
3	Food Pattern Modeling
Frequency of Eating	1	Data analysis
Frequency of Eating	2-5	NESR systematic review^c
USDA Food Patterns for Individuals Ages 2 Years and Older	1	Food pattern modeling

NESR, Nutrition Evidence Systematic Review

^a Information used for this table was extracted from Part D of the 2020 DGAC Scientific Review.

^b See 2020 DGAC Scientific Report for further details.

^c See 2020 DGAC Scientific Report and nesr.usda.gov for information on these systematic reviews.

Page 186 Cite

Suggested Citation:"Appendix C: Systematic Review Matrix Summary." 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. doi: 10.17226/26406.

×

**FIGURE C-1**¹Publication date ranges for literature searches in the systematic reviews conducted for the *2020-2025 DGA* that updated a previous systematic review.

Page 187 Cite

Suggested Citation:"Appendix C: Systematic Review Matrix Summary." 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. doi: 10.17226/26406.

×

SOURCE: This figure was created based on committee’s interpretation of information on any updates to systematic reviews presented within each individual systematic review.
^a Updated search (January 2014 to October 2019), and additional search to cover macronutrient proportion diets (January 2000 to December 2013).
^b Updated search (January 2014 to January 2020).
^c Updated search (January 2014 to November 2019), additional search to cover diets based on macronutrient distribution (January 2000 to December 2014).
^d Updated search (January 2014 to February 2020).
^e Updated search from January 2011 to September 2019, and additional criteria for date of publication for within-family studies of siblings (January 1980 to January 2011).
^f First search captured January 1980–March 2016, and an updated literature search was done to capture January 2016 to September 2019.
^g January 2000 to June 2019 were listed as the search range. An exception was made for the review for evidence on sugar-sweetened beverage consumption that included studies from January 2012 to June 2019.
^h Updated search from January 2010 to March 2020.
ⁱ Updated search from September 2014 to September 2019.
^j Updated search from September 2014 to September 2019.
¹Figure C-1 has been modified after the release of a prepublication version of the report to the sponsor to clarify that the figure depicts systematic reviews that updated a previous NESR review.

Page 188 Cite

Suggested Citation:"Appendix C: Systematic Review Matrix Summary." 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. doi: 10.17226/26406.

×

**FIGURE C-2**¹Date ranges of literature searches done for new systematic reviews in the *2020-2025 DGA*.

Page 189 Cite

Suggested Citation:"Appendix C: Systematic Review Matrix Summary." 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. doi: 10.17226/26406.

×

^a After the initial electronic database search (January 2000 to June 2019), an updated search was conducted to also capture macronutrient distribution articles (January 2000 to November 2019).
^b This review had three separate searches within the 1980 to 2019 inclusion dates: (Micronutrient status and Human Milk Consumption, Gestational Diabetes and and Hypertensive Disorders of Pregnancy, Developmental Milestones).
SOURCE: This figure was created based on committee’s interpretation of information presented within the individual systematic reviews.
¹Figure C-2 has been modified after the release of a prepublication version of the report to the sponsor to clarify that the figure depicts systematic reviews that were entirely new for the 2020-2025 DGA.

Page 190 Cite

Suggested Citation:"Appendix C: Systematic Review Matrix Summary." 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. doi: 10.17226/26406.

×