Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025 A Midcourse Report (2022) / Chapter Skim
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In conducting its work, the DGAC examines the evidence in systematic reviews, food pattern modeling activities, and analysis of federal data sets; holds public meetings; and receives public comments. The DGAC's work culminates with the submission of a DGAC Scientific Report to the secretaries of USDA and HHS.
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As USDA and HHS develop the next edition of the DGA, they consider the current DGAC Scientific Report together with input from the federal agencies and public comments. The release of the 2015 DGAC Scientific Report elicited a public response about reducing consumption of red and processed meat as well as the environmental sustainability of the U.S.
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This included the Scientific Report of the 2020 Dietary Guidelines Advisory Committee (2020 DGAC Scientific Report) , the 2020–2025 DGA, website links, and documents provided in response to dialogue with the committee in two open sessions.
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• How did the process used to develop the Dietary Guidelines for Americans, 2020–2025 (including scientific methodologies, review protocols, and evaluation processes) compare to the seven recom mendations included in the National Academies report Redesigning the Process for Establishing the Dietary Guidelines for Americans?
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. The committee assessed the quality of the systematic review process used to select the studies included in the systematic reviews conducted for the 2020 DGAC Scientific Report.
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Evaluation of the application of the search strategy to specific systematic review questions examined and published to inform the 2020 DGAC Scientific Report. The decision criteria were then applied across the NESR systematic reviews used in the process to develop the 2020–2025 DGA to determine if and to what extent the committee's compilation of identified practices were consistently implemented.3 The analyses carried out for task 1 and task 2 were used to formulate the committee's findings and conclusions.
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Recommendation 1b The committee found that instead of using TEPs, NESR conducted its systematic reviews directly with the 2020 DGAC. The committee's analysis further revealed that the process used by USDA and HHS5 did not provide "consultation during the evidence evaluation" in the way described in the 2017 National Academies report, which proposed that the TEPs could assist with developing the systematic reviews.
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The committee found that, for added sugars and alcohol, USDA and HHS provided a clear, transparent, and public account that the 2020–2025 DGA recommendations differed from the recommendations in the 2020 DGAC Scientific Report and why. Consistent with federal law, the agencies highlighted the "preponderance of scientific evidence" as their basis for decision making.
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Although each step of the systematic review process is described in the 2020 DGAC Scientific Report, the committee found that the procedure does not provide for "a clear delineation of roles in order to minimize the introduction of bias and allow for an objective, evidence-based review" consistent with the 2017 National Academies recommendations. Recommendation 3b The committee found that each systematic review for the 2020–2025 DGA underwent a type of peer review, in contrast to previous DGA cycles in which no peer review was used.
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Recommendation 4 Findings Recommendation 4 focused on ensuring and enhancing the training of NESR staff, promoting continuous quality improvement, engaging 7 Text in this paragraph, and similar text in the report, was modified after release of a prepublication version of the report to the sponsor to clarify that some systematic reviews -- for example, the P/B-24 systematic reviews -- were initiated before the release of the 2017 National Academies report and to correct a technical inaccuracy and clarify who was involved in the review process for the systematic reviews. 8 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 NESR does not use the Grading of Recommendations Assessment, Development and Evaluation system for grading evidence.
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The committee found only limited evidence of other investments or requests for funding for technological infrastructure. Recommendation 4 Conclusions The committee concluded that the NESR systematic review processes were generally aligned with the committee-identified practices.
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The committee found that food pattern modeling was used to assess the ability to meet nutrient recommendations for each life stage through variations in USDA food patterns. The committee also found that refinements were made to account for variability in intakes and to address a range of possible healthy dietary patterns and that the 2020 DGAC Scientific Report explored the need to add or modify the USDA food patterns based on systematic reviews.
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However, the 2017 National Academies report also suggested starting as soon as possible to integrate systems approaches and methods into the DGA process. Although the DGAC, USDA, and HHS acknowledged the importance of the 2017 National Academies recommendation to integrate systems science into 9 This text, and similar text throughout the report, was modified after release of a pre publication version of the report to the sponsor to clarify that the framework and method described was first documented in the 2020 DGAC Scientific Report and later documented in a peer-reviewed journal article.
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Findings for Committee-Identified Practices The 2017 National Academies report recommended that the procedure for using existing DGAC systematic reviews and updating them should incorporate advances in systematic review methodology using a multi-pronged approach. This includes employing an established method for ongoing surveillance to identify and evaluate the research as it is being published, along with the determination of what types of updates may be needed before including existing systematic reviews.
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The committee found that the current methodology for deciding if an existing systematic review needed a full update appeared to be based only on conclusion statements that had been rated with lower grades of evidence. The system for ongoing surveillance of published research recommended in the 2017 National Academies report, not yet implemented, would provide invaluable input on whether to update existing systematic reviews.
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Similarly, the lack of decision guides for determining the need for and type of updates contributed to inconsistent documentation of how existing systematic reviews were updated. The absence of the ongoing surveillance system for published research recommended in the 2017 National Academies report makes it difficult to determine the need for and type of updates to be done.
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OVERARCHING CONCLUSIONS FOR TASK 2 The committee concluded that the overall search strategy was well described and justified and was generally implemented as proposed in the 2017 National Academies report. The methodology for new systematic reviews was more carefully developed than the methodology for using existing systematic reviews.
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Both these recommendations will require investments in specially qualified personnel and new scientific approaches. Sixth, the committee concluded that the overall search strategy for the systematic reviews was well described and justified and was generally implemented as proposed in the 2017 National Academies report.
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