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5 Moving Forward
Pages 87-114

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From page 87...
... Finally, Timothy Morck, president and founder, Spectrum Nutrition LLC, and Douglas "Duffy" MacKay, senior vice president, scientific and regulatory affairs, Council for Responsible Nutrition (CRN) , discussed the role of the food industry in supporting healthy aging.
From page 88...
... Whereas the DASH diet recommends high intake of low-fat dairy, for example, the Mediterranean diet recommends low intake of full-fat dairy. Fish is classified differently in the two diets as 1  This section summarizes information presented by Dr.
From page 89...
... For the Mediterranean and DASH diets, he said, observational data have shown significant decreases in several adverse health outcomes, including cardiovascular disease (9 percent reduction) ; cancer (with measured effects varying from 6 to 10 percent overall, based on two separate meta-analyses, to a 14 percent reduction for colorectal, 4 percent for prostate, and 56 percent for pharyngeal/esophageal cancer)
From page 90...
... . He also cited data from other clinical trials showing that the DASH diet lowered blood pressure and cholesterol as well (Siervo et al., 2015)
From page 91...
... . In middle-aged men, he observed, a metaanalysis of clinical trial data indicated that multivitamins have not been shown to decrease cardiovascular disease or mortality, but have been shown to be associated with a small reduction in total cancer risk (Macpherson et al., 2013)
From page 92...
... When asked whether the benefits of the Mediterranean and DASH diets derive from what those diets add or what they reduce, Reuben replied that
From page 93...
... Remembering to take 8, 10, or 12 different medicines every day, for example, can be challenging. MacKay remarked that, while he appreciated looking at supplements through the lens of reducing disease risk, he believes that not underscoring the importance of just meeting targeted nutrient intakes independently of disease prevention is like "throwing the baby out with the bathwater." He added that in his opinion, results of the Physicians Health Study II, which showed a statistically significant 8 percent reduction in total cancer associated with taking a daily multivitamin, had been downplayed.
From page 94...
... 14) : "The goal of the Dietary Guidelines is for individuals throughout all stages of the lifespan to have eating patterns that promote overall health and help prevent chronic disease." Additionally, she noted, the first of the five guidelines is to "follow a healthy eating pattern across the lifespan." A key recommendation of the 2015-2020 DGA, Stoody pointed out, is to follow a healthy eating pattern that accounts for all food and beverages within an appropriate calorie level.
From page 95...
... Based on measures of the Healthy Eating Index (HEI) over the last several cycles of the National Health and Nutrition Examination Survey (NHANES)
From page 96...
... HHS and USDA, 2015. FIGURE 5-2  Average Healthy Eating Index (HEI)
From page 97...
... HHS and USDA, 2015. intakes to achieve healthy eating patterns.
From page 98...
... In her opinion, a much bigger conversation is necessary. As the DGA state, "Everyone has a role in helping to create and support healthy eating patterns in multiple settings nationwide, from home to school to work to communities." Stoody noted that the DGA include a socioecological model that covers multiple areas in which change can be supported not just at the individual level but also among sectors, settings, and different social and cultural values and norms.
From page 99...
... With respect to future research, Stoody reiterated that the current edition of the DGA is focused on dietary patterns, informed by an evidence base of those patterns in relation to various health outcomes, including cardiovascular disease, body weight, type 2 diabetes, certain types of cancer, bone health, depression, and dementia/cognitive impairment/Alzheimer's disease. In general, however, she believes more evidence is needed across the lifespan.
From page 100...
... designs -- for example, longer duration of follow-up, assessment of dietary intake at multiple time points over the course of a study, and cohort studies that start earlier in life and that capture dietary patterns contributing to health outcomes later in life. DISCUSSION WITH THE AUDIENCE In the discussion following Stoody's presentation, her observation that the gap between recommended and actual intakes was smallest for children elicited a comment from Wendy Johnson-Askew about the difference between this finding and that of Gerber's Feeding Infants and Toddlers Study (FITS)
From page 101...
... She observed that incorporating vegetables into these mixed dishes already being consumed may be a strategy for increasing vegetable consumption. Johanna Dwyer commented on the fact that most people over age 75 or 80 have one or two chronic conditions and that the majority of these people take dietary supplements.
From page 102...
... . Yet another entirely different dimension of the food industry and food intake, Morck continued, is out-of-home food consumption, including 5  This section summarizes information presented by Dr.
From page 103...
... That said, he asserted, over the past 5-10 years, the food industry has in fact made significant progress toward supporting healthy eating -- for example, by reducing sugar, fat, and calories and eliminating trans fat from the food supply. He described how the production and promotion of healthier foods is one of several public commitments endorsed by food company members of the Grocery Manufacturers Association (GMA)
From page 104...
... Health claims aside, Morck reiterated that the food industry has in fact made significant progress toward supporting healthy eating by reducing sugar, fat, and calories and eliminating trans fat from the food supply. Additionally, the industry has added dietary fiber, mainly through whole grains in flour and soluble fiber in drinks; increased protein, Omega-3 fatty acids, probiotics, iron, and antioxidant vitamins; developed early-stage formulations to hydrolyze proteins and reduce the allergic potential for infants allergic to cow's milk; and provided medical foods for patients unable to consume normal foods.
From page 105...
... He stressed that testing hypotheses through appropriately designed, randomized, doubleblind, placebo-controlled clinical trials is just as important for industry as it is for the scientific community. Additionally, he noted, the food industry can develop and market products consistent with nutritional recommendations.
From page 106...
... , 71 percent of men and 81 percent of women have calcium intakes below the Estimated Average Requirement (EAR) ; 93 percent of men and 97 percent of women have vitamin D levels below the EAR; 96 percent of men and 87 percent of women have fiber levels below the Adequate Intake (AI)
From page 107...
... 50% 25% 0% Vitamin D Vitamin E Folate Vitamin A Calcium Thiamin Vitamin C Iron Vitamin B6 FIGURE 5-6  Percentage of the U.S. population aged 2 years and older with nutrient intakes below Estimated Average Requirements (EARs)
From page 108...
... MacKay explained that iron is considered a nutrient of public health concern for women capable of becoming pregnant, with consequences for both the pregnancy and offspring. The folic acid recommendation (i.e., that women capable of becoming pregnant should consume 400 mcg of synthetic folic acid daily from fortified foods and/or supplements)
From page 109...
... Industry efforts to promote healthy aging at the population level, MacKay elaborated, include investing in a series of health care cost analyses (i.e., conducting economic analyses to estimate the health care cost savings associated with achieving targeted nutrient intakes for certain disease conditions, such as adequate calcium and vitamin D intakes for bone health) ; advocating for a multivitamin to be included as a choice in food assistance programs (e.g., SNAP, WIC)
From page 110...
... . An audience member asked what types of research the food industry has been effective in supporting and areas in which, looking ahead, the
From page 111...
... MacKay mentioned the Physicians Health Study II again, which showed a reduction in cancer risk associated with multivitamin use, and noted that companies provided multivitamins to 11,000 physicians for 10 years with no expectation regarding outcomes. He described any added effect of a multivitamin in reducing the risk of heart disease, for example, beyond state-ofthe-art medical treatment as a "pretty heavy lift," yet companies provided their products for this study at no cost.
From page 112...
... A member of the audience commented about the need to temper some of the positive findings regarding progress made by the food industry. For example, the audience member noted, a third-party University of North Carolina evaluation found that the Healthy Weight Commitment Foundation's removal of 6.4 trillion calories from the food supply translates to about 90 fewer calories per person per day.
From page 113...
... The questioner noted that she has watched patients undergo chemotherapy with no nutritional guidance, and that some physicians even tell their patients to stay away from multivitamins. In response, Stoody agreed with others who had urged that everyone has a role in promoting healthy eating and also agreed on the importance of the consumer.


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