Redesigning the Process for Establishing the Dietary Guidelines for Americans (2017) / Chapter Skim
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7 Recent Approaches to Assessing Nutritional Adequacy and Exploring Chronic Disease
7 Recent Approaches to Assessing Nutritional Adequacy and Exploring Chronic Disease
Pages 189-210
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From page 189... ...
This chapter explores how the 2005, 2010, and 2015 Dietary Guidelines Advisory Committees have approached assessing nutritional adequacy2 and the role of diet in health and chronic disease, noting similarities and 1 Refer to Chapter 1, Box 1-1, for an explanation of how the term DGA is used throughout this National Academies report. 2 This National Academies committee's Statement of Task used the phrase "nutritional suffi ciency." However, to align with standard nomenclature used by the Dietary Reference Intakes, the phrases "nutritional adequacy" and "nutritional inadequacy" will be used in this report.
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From page 190... ...
Recent DGACs have evaluated current nutrient intake levels to determine the extent to which the U.S. population is meeting recommended intake goals, primarily as intake relates to the Dietary Reference Intakes (DRIs)
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From page 191... ...
: The highest average daily nutrient intake level likely to pose no risk of adverse health effects to almost all individuals in a particu lar life stage and gender group. As intake increases above the UL, the potential risk of adverse health effects increases (IOM, 2003, p.
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From page 192... ...
Questions and Data Sources Used to Determine Nutrient Intake Levels of the U.S. Population In the current process to update the DGA, topics and questions reviewed in the scientific report are developed by the DGAC (see Chapter 5 for additional details)
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From page 193... ...
Terminology Describing Nutrient Intake Levels As presented in Table 7-1, the terminology used to describe nutrient intake levels has varied across the editions of the DGAC Scientific Report. The concept of a "shortfall nutrient" has remained relatively consistent across recent editions of the DGAC Scientific Report, describing a nutrient that is underconsumed across the population or in a specific group of the population, relative to DRI values (i.e., Estimated Average Requirement
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From page 194... ...
194 REDESIGNING THE PROCESS FOR ESTABLISHING THE DGA TABLE 7-1 Terminology Used by the 2005, 2010, and 2015 DGACs to Classify Nutrient Intake Levels Descriptions, as Presented in the DGAC Scientific Report Terminology 2005 DGAC 2010 DGAC 2015 DGAC Shortfall • nutrient with a A • high prevalence A • nutrient that is A nutrient high prevalence of inadequate underconsumed of inadequate dietary intake across the dietary intake among any segment population or in • Intake levels are of the population specific groups low enough to relative to the EAR be of concern or AI levels Nutrients • Shortfall • N/A • N/A that pose nutrient for special which dietary challenges guidance to meet recommended intake levels was challenging to develop Nutrients of • Shortfall • Overconsumed • Includes both concern nutrients nutrients and shortfall nutrients dietary components and overconsumed • Shortfall nutrients nutrientsa with biochemical indices of nutrient or functional status, when available, and/or disease prevalence data indicating substantial public health significance Nutrients of • N/A • Synonymous with • Shortfall or public health underconsumed overconsumed concern nutrients of concern nutrients with • Shortfall nutrients, evidence of clearly linked under- or to indicators of overconsumption nutrient inadequacy through or disease biochemical prevalence and nutritional status require special indicators plus consideration in evidence that developing dietary the nutrient guidance to meet inadequacy or recommended food excess is directly intakesb related to a specific health condition
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From page 195... ...
concern." Also emerging in the 2010 and 2015 DGACs was the additional criterion of biochemical indices and/or direct relationship with health conditions as a requisite for a nutrient being classified as being "of (public health) concern." The differentiation between "nutrients of concern" and "nutrients of public health concern," however, has not been consistent across or within the two most recent editions of the DGAC Scientific Report.
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From page 196... ...
The values do not reflect a threshold that was explicitly stated as an a priori decision or criterion in the editions of the DGAC Scientific Report. AI = Adequate Intake; DGAC = Dietary Guidelines Advisory Committee; EAR = Estimated Average Requirement.
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From page 197... ...
Again, the assessment was descriptive and no quanti ative threshold was explicitly stated for what level of intake t in the population or specific group qualified as excessive. Use of Biochemical and Health-Related Data to Support Classification of Nutrients As reflected in the terminology used by recent DGACs to classify nutrient intake levels, a progressive shift occurred toward integrating data beyond just nutrient intake levels in the decision-making process for nutrient classification.
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From page 198... ...
, the health-oriented justifications were supported by full Nutrition Evidence Library (NEL) evidence-based reviews conducted to answer specific questions posed by the DGAC elsewhere in the scientific report (i.e., "What is the effect of saturated fat intake on increased risk of cardiovascular disease or type 2 diabetes, including effects on intermediate markers such as serum lipid and lipoprotein levels?
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From page 199... ...
a From the Centers for Disease Control and Prevention's (CDC's) Second Nutritional Report on Biochemical Indicators of Diet and Nutrition in the U.S.
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were used to justify the selection of saturated fat as a nutrient of concern. The 2015 DGAC did, however, review existing reports on the relationship between saturated fat and cardiovascular disease in a different chapter of its scientific report (HHS/USDA, 2015b)
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committee's evaluation of the approaches taken to assess and categorize nutrient intake levels of the U.S. population highlights the evolution in the process that has taken place across the three most recent DGACs.
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From page 202... ...
For a detailed assessment of the methodological approaches taken to answer the full range of questions posed by the 2015 DGAC, see Chapter 6. Health Outcomes and Measures of Interest Explicitly Included in Questions The three most recent editions of the DGAC Scientific Report used different types of outcomes and measures in the questions regarding health, which have varied in terms of specificity and scope (see Table C-2)
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From page 203... ...
Evidence that a systematic process was implemented to evaluate the validity of biomarkers prior to inclusion in a research question or the evidence base by recent DGACs was not immediately available. The health outcomes of interest were relatively similar across the three most recent editions of the DGAC Scientific Report, with each having evaluated the science of dietary intake as it related to cardiovascular disease, cancers, type 2 diabetes, body weight, and blood pressure.
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From page 204... ...
. However, no explicit processes or criteria were described for identifying emerging or different health outcomes not included in previous editions of the DGAC Scientific Report.
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From page 205... ...
Frameworks and Conceptual Models Used by the 2010 and 2015 DGAC and Corresponding Editions of the DGA Policy Report The movement to expand evaluations beyond the effect of dietary intake and health highlights the multifactorial and interconnected nature of diet, health, and a host of other nondietary factors. In its assessment of the low adherence with the DGA, the 2010 DGAC pointed to the range of factors that influence food intake and presented a socioecological framework.
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206 REDESIGNING THE PROCESS FOR ESTABLISHING THE DGA 2015 DGAC's scientific review of a range of determinants of diet, physical activity behavior, and health and an array of nutrition, physical activity, and related health outcomes. The 2015 DGAC Scientific Report presented an outline of the factors encompassed by each of the components of the Diet and Physical Activity, Health Promotion and Disease Prevention at Individual and Population Levels Across the Lifespan Influences/ Determinants Individual & Household, Biological Community & Social, & Factors Environmental Cultural Factors Factors Public & Systems & Private Sector Sectors Policies Diet & Physical Activity Patterns & Behaviors Healthy C Health A N Weight RO A Promotion P SS T H E LI F ES Physical Chronic Fitness & Disease Healthy Function Prevention Nutritional Status Health Outcomes FIGURE 7-1 Conceptual map created by the 2015 DGAC.
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From page 207... ...
Frameworks presented across the two most recent editions of the DGAC Scientific Report and DGA Policy Report begin to arrange how the different components and levels interface but remain conceptual in nature. CONCLUSION Opportunities exist to improve the process by which the DGAC approaches topics related to dietary intake and health.
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From page 208... ...
2015b. Scientific report of the 2015 Dietary Guidelines Advisory Committee.
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From page 209... ...
2010b. Report of the Dietary Guidelines Advisory Committee on the Dietary Guide lines for Americans, 2010.
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