Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025 Final Report (2023) / Chapter Skim
Currently Skimming:
Appendix D: Open Session Materials
Appendix D: Open Session Materials
Pages 137-182
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 137... ...
, as well as members of the 2020 Dietary Guidelines Advisory Committee and the chair of the 2017 National Academies report Redesigning the Process for Establishing the Dietary Guidelines for Americans (DGA)
|
From page 138... ...
team and food pattern modeling staff are standing entities that support the committee's work and, in the interim, conduct other projects and continuous quality advancement activities. At the beginning of each cycle, the Departments outline a time line.
|
From page 139... ...
bA 34-day federal funding gap (i.e., "government shutdown") delayed the process to establish the 2020 Dietary Guidelines Advisory Committee.
|
From page 140... ...
For example, NESR systematic reviews were underway as part of the Pregnancy and Birth to 24 Months Project and were published as the committee began its work. • Additionally, prior to convening the committee, federal staff explored food pattern modeling activities for individuals who are pregnant or lactating, documented and refined the process for identifying nutrients of public health concern, and met to begin discussing data analysis needs.
|
From page 141... ...
For example, initially, the questions on dietary patterns consumed during childhood and adolescence only addressed the outcomes of growth, size, and body composition and bone health; whereas for adults, questions on dietary patterns addressed the outcomes of risk of cardiovascular disease, type 2 diabetes, and certain types of cancer. Following public and federal agency comment, the dietary patterns questions were revised and expanded to address dietary patterns and all health outcomes at each stage of life.
|
From page 142... ...
How were existing systematic reviews updated? Were there changes in the search strategies from the previous DGA update?
|
From page 143... ...
Response: As nutrition science has evolved, so have the approaches for examining scientific evidence. For example, since the 2005 committee, food pattern modeling analysis was included as a method to review evidence, and since the 2010 committee, DGACs have conducted original systematic reviews with support from USDA's NESR (formerly N utrition Evidence
|
From page 144... ...
For other methodological approaches, such as systems modeling, integration of new methods involves adequate funding, availability of federal data sets, and discussion among staff at USDA and HHS, including input from standing federal committees, such as the Dietary Guidelines Subcommittee of the Interagency Committee on Human Nutrition Research.
|
From page 145... ...
NESR's CQA initiative also includes outreach activities designed to disseminate information about us and our work to a range of audiences. NESR's CQA work also aligns with and is guided by a recommendation from the 2017 National Academies report, which encouraged the secretary of USDA to ensure all NESR reviews align with best practices by: • Enabling ongoing training of the NESR staff, • Enabling engagement with and learning from external groups on the forefront of systematic review methods, • Inviting external systematic review experts to periodically evalu ate the NESR's methods, and • Investing in technological infrastructure.
|
From page 146... ...
2022. Evaluating the process to develop the Dietary Guidelines for Americans, 2020– 2025: A midcourse report.
|
From page 147... ...
Emeritus Professor of Nutrition, Department of Nutri tion and Department of Food Science and Technology, Univer sity of California, Davis Ronald Kleinman, 2020 Dietary Guidelines Advisory Committee Vice Chair. Charles Wilder Professor of Pediatrics, Harvard Medical School 4:00 pm Adjourn Open Session
|
From page 148... ...
Obbagy, Center for Nutrition Policy and Promotion, Food and Nutrition Service, U.S. Department of Agriculture Janet de Jesus, Office of Disease Prevention and Health Promotion, Department of Health and Human Services 4:00 pm Adjourn Open Session
|
From page 149... ...
, Technical Expert Pan els (TEPs) , and Dietary Guidelines Scientific Advisory Committee (DGSAC)
|
From page 150... ...
Final selection of committee members is made by the President or heads of departments or agencies. Prior to accepting an appointment with a federal advisory committee, each prospective member should clarify his/her role, obligations, duties, allowable expenses, compensation limitations, and any ethics requirements with their committee's Designated Federal Officer and/or Committee Management Officer, as appropriate.
|
From page 151... ...
The funding supported contract staffing (including contractors to support systematic reviews, data analysis, and communications activities) , DGAC operations (e.g., travel to public meetings, public meeting facilities, report development)
|
From page 152... ...
The DGA writing team included Federal staff who supported the DGAC. To aid in the writing process, staff extracted the Committee's advice to the Departments from its report and provided it to the writing team to consider along with the previous edition of the DGA and public and federal agency comments as they undertook the writing process.
|
From page 153... ...
: "Each edition of the Dietary Guidelines builds on the preceding edition, with the scientific justification for revisions informed by the Committee's scientific report and consideration of public and Federal agency comments." USDA and HHS aimed to be transparent by (1) posting information at DietaryGuidelines.gov about where the DGA "omit or accept only parts" of the advice from the DGAC and (2)
|
From page 154... ...
Thus, NESR seeks to learn from and collaborate with a broad range of systematic review organizations as it develops and advances its methodology -- taking care to understand the rationale underlying various methodological approaches. Then, when we undertake CQA work to advance or develop our own methods, we seek to align with others, but also tailor our methods to ensure applicability to public health nutrition decision-making in the United States.
|
From page 155... ...
CQA work is accomplished by leveraging the expertise of and collaborating with methodologists from other leading systematic review organizations, tailoring established methods for use in the field of public health nutrition, expanding technological infrastructure, and enhancing NESR team knowledge and skills through ongoing training and professional development. Below is a table that lists the major CQA activities NESR has undertaken since working with the 2015 DGAC (2016-2021)
|
From page 156... ...
However, this is not a complete list of all advancements made by NESR, nor does it reflect advancements that occurred prior to 2017. Resources/ CQA Topic Goal Outcomes Collaborators NESR To review and Ongoing NASEM; others TBD Inclusion- update, as Exclusion needed, NESR's Criteria standard (2022–present)
|
From page 157... ...
/National reviews that Toxicology Program are transparent, (NTP) ; PRISMA; rigorous, and Assessment of Multiple align with Systematic Reviews-2; standards of Subject matter experts other major across government and evidence academia; others TBD synthesis organizations continued
|
From page 158... ...
of Australia; reviews and Nordic Nutrition meta-analyses Recommendations; from other others TBD organizations Using and/ To review and Ongoing AHRQ; Cochrane; or updating update NESR's AICR/WCRF; Preferred NESR methodology Reporting Items for reviews for updating Systematic Reviews and (2021–present) existing NESR Meta-Analyses systematic reviews
|
From page 159... ...
methodology methodology for for conducting conducting NESR rapid reviews rapid reviews, defined as an evidence synthesis project that answers a nutrition question of public health importance using streamlined systematic review methods. This flexibility conserves resources and produces a timelier product when full systematic review methods are not needed or feasible.
|
From page 160... ...
Developed a procedural guide as a resource for NESR staff to use to conduct evidence scans. Dietary To identify, Conducted a literature NIH; National Cancer assessment compile, and/ search and compiled Institute; NASEM; methodology or develop an inventory of National Collaborative (2021)
|
From page 161... ...
for conducting conducting continuous methodology continuous evidence monitoring, (2020–2021) evidence which is defined as monitoring an evidence-gathering process in which established systematic review protocols are used to periodically search for, screen, and prepare evidence for future systematic reviews.
|
From page 162... ...
, establishing ORCIDs for NESR staff (implemented) and place ORCID badges on NESR's publications page (to be completed)
|
From page 163... ...
template NESR reviews that scientific, peer-reviewed to improve is well-structured, journals accessibility and 508-compliant, and transparency, set-up to clearly and ensure and transparently utility for any communicate the type of review rationale for the product review, methods and synthesis of evidence that supports the conclusion statements. continued
|
From page 164... ...
Evaluated NESR communication and outreach efforts to a wide-array of audiences (e.g., provide foundational work on infographics, iconography, poster templates, publishing)
|
From page 165... ...
implemented; used to Active-Screener; conduct 2020 DGAC OpenMeta; Rayyan; SR systematic reviews. Toolbox; Buhos Since then, NESR has tested/adopted DistillerSR as a data extraction platform, evaluated DistillerSR's added artificial intelligence (AI)
|
From page 166... ...
We have recently authored a peer reviewed publication describing our process (Spill MK, English LK, Raghavan R, et al. Perspective: USDA Nutrition Evidence Systematic Review Methodology: Grading the Strength of Evidence in Diet and-health-related Systematic Reviews [published online ahead of print, 2021 Dec 16]
|
From page 167... ...
If so, what were the barriers to implementing these improvements or new technologies? Response: In the 2017 NASEM report, Recommendation 4 specified that the Secretary of USDA should ensure that all NESR systematic reviews align with best practices by: a.
|
From page 168... ...
This analysis was used to determine that DistillerSR software best met NESR's needs, and a contract was implemented for use in the systematic reviews conducted by the 2020 DGAC -- a contract that has been in place and expanded per NESR's licensing needs. NESR uses Distiller to screen the results of literature searches, extract data, and conduct risk of bias assessments.
|
From page 169... ...
Then, when we undertake CQA work to advance or develop our own methods, we seek to align with others, but also may tailor our methods to ensure applicability to public health nutrition decision-making in the United States. That said, we have had numerous opportunities in recent years for external systematic review, nutrition science, and public health experts to evaluate NESR's methods.
|
From page 170... ...
• The relationship between added sugars consumption and achiev ing nutrient and food group recommendations. For the Dietary Guidelines for Americans, 2020–2025 development process, federal staff evaluated the analytic methods and development of data inputs and constraints for food pattern modeling and compared them to methods used in the development of guidance in other countries, as well as other modeling exercises described in scientific publications.
|
From page 171... ...
Project management planning is also underway for the refinement phase, which will include methodological enhancements, expected to be completed prior to establishing the 2025 Dietary Guidelines Advisory Committee. During the evaluation phase, the FPM IG has worked with the Departments to provide draft scientific questions on food pattern modeling for public comment.
|
From page 172... ...
The FPM IG has also begun project planning for possible methodological enhancements, which will first go out for peer review by the ICHNR Sub committee on Dietary Guidelines. After the evaluation phase is complete and peer review incorporated, the FPM IG will test, adopt, and document refinements to the food pattern modeling methodology.
|
From page 173... ...
This Subcommittee aims to identify DRI needs and coordinate government sponsorship of DRI reviews, support ing systematic reviews, and other related activities. The DRIs are a major scientific input to the DGA and are used widely in federal programs and policies, nutrition research, educa
|
From page 174... ...
The working group also recently funded a NASEM Standing Committee for the Review of the Dietary Reference Intakes to address overarching issues related to DRIs. Pending a regular source of funding, the working group will develop a continuous process to update DRIs and supporting systematic reviews.
|
From page 175... ...
. Data are released to the public on the NHANES website and inform nutrition research and federal nutrition programs and policies (NHANES, 2022b; Ahluwalia et al., 2016)
|
From page 176... ...
Office of Disease Prevention and Health Promotion. https:// health.gov/news/blog/2018/07/new-ventures-study-infants-young-children through-national-survey (accessed September 22, 2022)
|
From page 177... ...
• Identify, select, and with input by Federal Addition of NESR well-received; CNPP/ODPHP staff are prioritize topics nutrition SMEs, continuous evidence uniquely positioned to support strategic • Oversee monitoring Interagency Committee monitoring planning (e.g., monitor nutrition science of new evidence on Human Nutrition and international guidance, lead ICHNR Research Subcommittee Addition of stating SC on DG, support implementation of on Dietary Guidance "rationale" for DGA (ICHNR SC on DG) , and prioritized questions public comments Barriers to change: Additional question Formation of additional Federal No monitoring of refinement with advisory committee adds significant evidence; monitoring DGAC costs and resources within existing requires the questions budget ceiling for Federal advisory to be identified and committees at both Departments and selected, and protocols to is difficult to justify when existing be developed approach addresses goals; additionally, 2017 NASEM acknowledged multiple approaches to meet this recommendation 177 continued
|
From page 178... ...
Benefits and Barriers Technical Expert Domain and DGAC subcommittees, Similar to 2020 Benefits of the current approach: Panels (TEPs) methodological with review and input • DGAC's participation in developing experts who: from full committee Expansion of role of protocols and synthesizing the • Help NESR ICHNR SC on DG evidence, developing conclusion develop and refine Based on input from: and Federal SMEs statements, and grading the systematic review • Federal SMEs, as to inform systematic strength of the evidence ensures protocols needed review protocols the review is transparent and the • Help USDA/HHS • Previous DGACs independent work of an external, data team identify and TECs (by using/ USDA/HHS expert Committee, which enhances and analyze data updating their existing food pattern its trustworthiness, and reduces (food pattern NESR reviews)
|
From page 179... ...
(DGSAC) types of evidence to for USDA/HHS to inform advice develop conclusions Barriers to change: for USDA/HHS Refined list of questions, The DGAC is an existing Federal consideration but, per charter, limited advisory committee that is reestablished • Identify new review to questions for each edition; it is not a simple questions and identified by USDA/HHS renaming.
|
From page 180... ...
transparency and public deliberations • The DGAC made all • Ensures the DGAC's review and substantive decisions integration of the evidence, and their throughout the advice to the government, is the process of conducting independent work of an external, its systematic expert committee, which enhances reviews, and NESR its trustworthiness, and reduces supported the DGAC the perception of bias or conflict of by facilitating and interest. documenting the • Leverages trained and qualified work necessary for NESR scientists to execute the timely execution of the DGAC's large scope work and tight systematic reviews in timelines accordance with NESR methodology.
|
From page 181... ...
• Integrated the evidence by looking across all of "The DGSAC would be its conclusions -- from charged with integrating systematic reviews, all data inputs such data analysis, and food as systematic reviews, pattern modeling -- to food pattern modeling, develop overarching and descriptive data advice for USDA analyses to develop its and HHS to consider conclusions regarding as the Departments diet and its relationship developed the next to health." edition of the Dietary Guidelines. (in Part B, 181 Chap 2: Integrating the Evidence)
|
From page 182... ...
CNPP = Center for Nutrition Policy and Promotion; CQA = Continuous Quality Advancement; DGA = Dietary Guidelines for Americans; DGAC = Dietary Guidelines Advisory Committee; HHS = U.S. Department of Health and Human Services; ODPHP = Office of Disease Prevention and Health Promotion; SME = subject-matter expert; TEC = Technical Expert Collaborative; USDA = U.S.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.