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The MyPlate Message Chronicles

Updating the Dietary Guidelines for Americans: Status and Looking Ahead

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HE DIETARY GUIDELINES FOR Americans serves as the cornerstone of all Federal nutrition policy, education, outreach, and food assistance programs, and has been adopted broadly by other stakeholders, including registered dietitian nutritionists (RDNs), industry, and other allied health professionals. The process for revising the Dietary Guidelines is currently under way. As primary nutrition educators, RDNs are uniquely qualified to provide comments that can inform the next edition of the Dietary Guidelines, as well as translate them into actionable, targeted messages and programs that can lead to behaviors that can help individuals improve their health through dietary choices. Through the communications work of the Federal government, communication partners, nutrition and dietetics practitioners, and other message multipliers, millions of Americans have been exposed to the messages of the Dietary Guidelines. For example, the nutrition education tool, MyPlate, embodies the science-based recommendations from the Dietary Guidelines by reminding individuals to choose foods from all five food groups as a way to meet nutrient and calorie needs and to make healthful eating choices.

This article was written by Elizabeth Rahavi, RD, nutritionist; Eve Essery Stoody, PhD, lead nutritionist; and Colette Rihane, MS, RD, director, all at the Office of Nutrition Guidance and Analysis, US Department of Agriculture Center for Nutrition Policy and Promotion, Alexandria, VA; and Kellie O. Casavale, PhD, RD, nutrition advisor, and Richard Olson, MD, director, both at the Division of Prevention Science, Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Rockville, MD. http://dx.doi.org/10.1016/j.jand.2014.11.022

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THE DIETARY GUIDELINES: A HISTORICAL PERSPECTIVE The Dietary Guidelines provide science-based advice for healthy people ages 2 years and older to assist them in their efforts to make food and physical activity choices that promote health and reduce risk of disease. As such, the primary purpose of the Dietary Guidelines is to provide recommendations for the prevention of disease and not the treatment of disease. However, given the prevalence of overweight and obesity and dietrelated chronic disease, it also provides advice for individuals who are at increased risk of chronic disease. All Federal dietary guidance for the public is required to be consistent with the Dietary Guidelines, allowing the government to provide uniform advice about nutrition and health. The Dietary Guidelines are congressionally mandated under the 1990 National Nutrition Monitoring and Related Research Act (Public Law 101-445, Section 301[7 U.S.C. 5341], Title III). The law directs the Secretaries of Health and Human Services (HHS) and Agriculture (US Department of Agriculture; USDA) to issue the policy at least every 5 years. The 2010 Dietary Guidelines for Americans is the current policy document in use by the Federal government, until

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the 2015 edition is released toward the end of this calendar year. The Dietary Guidelines were issued voluntarily by HHS and the USDA in 1980, 1985, and 1990; the 1995 edition was the first statutorily mandated policy, followed by subsequent editions at the appropriate intervals (Figure 1). The first four versions of the Dietary Guidelines were small brochures aimed at consumers. The 2000 edition of the Dietary Guidelines was a longer document, aimed at consumers, nutrition and dietetics practitioners and educators, and policy makers. This reflected an understanding that professionals and policy makers who apply the Dietary Guidelines in their work need to better understand the science behind the consumer material. In 2005, the Dietary Guidelines policy document was aimed solely at nutrition and dietetics practitioners and educators and policy makers, and separate consumer materials were developed to communicate dietary guidance recommendations to consumers. The 2010 Dietary Guidelines is intended for policy makers to design and carry out nutrition-related programs and for nutrition and dietetics practitioners and educators and health professionals who develop nutrition curricula, teaching tools, and advice for consumers. Nutrition education materials, including MyPlate and associated materials at ChooseMyPlate.gov, communicate dietary guidance recommendations to the public.

UPDATING THE DIETARY GUIDELINES The process for developing the Dietary Guidelines for Americans occurs in two steps. The first step in the revision process is to charter a Dietary Guidelines Advisory Committee (DGAC), a group of nationally recognized experts in the field of human nutrition and chronic disease prevention, to provide independent advice on the state of the ª 2015 by the Academy of Nutrition and Dietetics.

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Figure 1. Dietary Guidelines for Americans, 1980-2010.

science to the Federal government. The Committee is charged with reviewing the current policy and determining topics for which new scientific evidence might exist to inform revisions to current guidance or suggest new guidance. The DGAC works within its broad charge but determines which scientific questions it wants to pursue. The 2015 DGAC held seven meetings to discuss its review of the scientific literature and to approve its final Advisory Committee Report. Throughout the DGAC’s deliberative process, public comments were submitted to and reviewed by the Committee to inform its work. This first step of the revision process concluded when the Advisory Committee submitted its final scientific Report to the Secretaries of HHS and USDA earlier this year. The DGAC’s Report is posted at DietaryGuidelines.gov and an open comment period has commenced for the public to provide feedback to the government on this Report. The second step in the revision process is currently under way. In this step, the 2015 Dietary Guidelines for Americans policy document is developed by HHS and USDA. The Dietary Guidelines are based on the DGAC’s Report and a consideration of February 2015 Volume 115 Number 2

comments from the public and Federal agencies. As nutrition educators and practitioners implementing dietary recommendations in various settings, RDNs are encouraged to review the Advisory Committee’s Report and provide comments to the government at DietaryGuidelines.gov for consideration in development of the 2015 Dietary Guidelines for Americans.

THE DIETARY GUIDELINES: GROUNDED IN SCIENCE Each edition of the Dietary Guidelines has reflected the state of the scientific evidence available at the time, but the approach to reviewing the science has evolved throughout time (Figure 2). Beginning with the 2010 edition, the Dietary Guidelines is based on a series of robust systematic reviews supported by USDA’s Nutrition Evidence Library (NEL) (www.NEL.gov). Systematic reviews have become the accepted foundation for establishing policy and guidance. In preparing for the 2010 development process, the NEL worked collaboratively with the Academy of Nutrition and Dietetics’ Evidence Analysis Library to develop a process that would ensure that experts who are involved in developing scientific

conclusions would base their findings on an objective analysis of the preponderance and quality of available research. More recently, the NEL process was updated in collaboration with the Agency for Healthcare Research and Quality and was informed by the US Cochrane Collaboration process. For more information on the NEL Methodology visit NEL.gov. The 2015 DGAC was supported by the NEL to review the scientific evidence that will underpin the upcoming 2015 edition of the Dietary Guidelines. The NEL uses a rigorous predefined sixstep approach designed to minimize bias, in addition to ensuring objectivity, transparency, and reproducibility. While about half of the DGAC’s questions were answered using the NEL systematic review process, there were instances where other tools were more appropriate to review the evidence. For example, data analyses were conducted and used by the DGAC to determine current status and trends in the United States as they related to intake of foods and beverages, eating behaviors, and prevalence of disease; food pattern modeling was used to evaluate how recommendations might affect nutrient adequacy; and existing reports such as the 2008 Physical Activity

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Figure 2. Evidence review methods and intended audience for the Dietary Guidelines for Americans, 1980-2015.

Guidelines, the Dietary Reference Intakes, and other reports from credible sources such as the Institute of Medicine were also used as sources of evidence by the Committee.

LOOKING AHEAD The 2010 Dietary Guidelines for Americans recognized that government, industry, families, RDNs, educators, professionals, communities, and organizations all need to work together to improve the choices that individuals make every day when deciding what and how much to eat and drink. While individual behavior change is important, a multi-sector approach based on the Social Ecological Model is also needed to improve the food environ-

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ment and related resources needed to facilitate healthy choices. Nutrition and dietetics practitioners are key players in nutrition education and are essential in interpreting and communicating dietary guidance to consumers as well as tailoring this guidance to specific target audiences who are at risk of developing chronic disease. RDNs working with students in primary or secondary schools, with adults and children in hospitals and clinics, or with individuals and families in grocery stores and other key settings can all use MyPlate and other Federal nutrition education materials to promote the recommendations of the Dietary Guidelines in their communication and collaborative efforts.

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The 2015 Dietary Guidelines for Americans will be updated to reflect current science about the role of nutrition in disease prevention and health promotion, and we encourage dietetic professionals to use the Guidelines and related communication materials as resources so that Americans across the lifespan are provided consistent nutrition guidance. Whether it’s through collaborative partnerships, implementing settingspecific strategies to improve the food environment, or providing consistent communication messages about nutrition and health, opportunities exist to work together to make a real impact on the health and nutrition status of Americans.

February 2015 Volume 115 Number 2

Updating the dietary guidelines for Americans: status and looking ahead.

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