Regan L Bailey1, Jamy D Ard2, Teresa A Davis3, Tim S Naimi4, Barbara O Schneeman5, Jaime S Stang6, Kathryn G Dewey5, Sharon M Donovan7, Rachel Novotny8, Linda G Snetselaar9, Janet de Jesus10, Kellie O Casavale11, TusaRebecca Pannucci12, Eve E Stoody12. 1. Department of Nutrition Science, Purdue University, West Lafayette, IN, USA. 2. Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, NC, USA. 3. USDA/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA. 4. Section of General Internal Medicine, Boston University Medical Center, Boston, MA, USA. 5. (Emeritus) Department of Nutrition, University of California, Davis, Davis, CA, USA. 6. Division of Epidemiology and Community Health, School of Public Health, University of Minnesota-Twin Cities, Minneapolis, MN, USA. 7. Department of Food Science and Human Nutrition, University of Illinois, Urbana-Champaign, IL, USA. 8. Department of Human Nutrition, Food and Animal Sciences, University of Hawai'i at Mānoa, Honolulu, HI, USA. 9. Department of Preventive Nutrition Education, University of Iowa, Iowa City, IA, USA. 10. Office of Disease Prevention and Health Promotion, NIH, US Department of Health and Human Services, Rockville, MD, USA. 11. Office of Nutrition and Food Labeling, Center for Food Safety and Applied Nutrition, FDA, US Department of Health and Human Services, College Park, MD, USA. 12. Center for Nutrition Policy and Promotion, Food and Nutrition Services, USDA, Alexandria, VA, USA.
Abstract
BACKGROUND: Identification of nutrients of public health concern has been a hallmark of the Dietary Guidelines for Americans (DGA); however, a formal systematic process for identifying them has not been published. OBJECTIVES: We aimed to propose a framework for identifying "nutrients or food components" (NFCs) of public health relevance to inform the DGA. METHODS: The proposed framework consists of 1) defining terminology; 2) establishing quantitative thresholds to identify NFCs; and 3) examining national data. The proposed framework utilizes available data from 3 key data sources or "prongs": 1) dietary intakes; 2) biological endpoints; and 3) clinical health consequences such as prevalence of health conditions, directly or indirectly through validated surrogate markers. RESULTS: In identifying potential NFCs of public health concern, the 2020 DGA Committee developed a decision-tree framework with suggestions for combining the 3 prongs. The identified NFCs of public health concern for Americans ≥1 y old included fiber, calcium (≥2 y old), vitamin D, and potassium for low intakes and sodium, added sugars, and saturated fats (≥2 y old) for high intakes that were associated with adverse health consequences. Iron was identified among infants ages 6-12 mo fed human milk. For reproductive-aged and pregnant females, iron (all trimesters) and folate (first trimester) were identified for low intake, based on dietary and biomarker data (iron) or the severity of the consequence (folic acid and neural tube defects). Among pregnant women, low iodine was of potential public health concern based on biomarker data. Other NFCs that were underconsumed, overconsumed, and pose special challenges were identified across the life course. CONCLUSIONS: The proposed decision-tree framework was intended to streamline and add transparency to the work of this and future Dietary Guidelines Advisory Committees to identify NFCs that need to be encouraged or discouraged in order to help reduce risk of chronic disease and promote health and energy balance in the population. Published by Oxford University Press on behalf of the American Society for Nutrition 2021.
BACKGROUND: Identification of nutrients of public health concern has been a hallmark of the Dietary Guidelines for Americans (DGA); however, a formal systematic process for identifying them has not been published. OBJECTIVES: We aimed to propose a framework for identifying "nutrients or food components" (NFCs) of public health relevance to inform the DGA. METHODS: The proposed framework consists of 1) defining terminology; 2) establishing quantitative thresholds to identify NFCs; and 3) examining national data. The proposed framework utilizes available data from 3 key data sources or "prongs": 1) dietary intakes; 2) biological endpoints; and 3) clinical health consequences such as prevalence of health conditions, directly or indirectly through validated surrogate markers. RESULTS: In identifying potential NFCs of public health concern, the 2020 DGA Committee developed a decision-tree framework with suggestions for combining the 3 prongs. The identified NFCs of public health concern for Americans ≥1 y old included fiber, calcium (≥2 y old), vitamin D, and potassium for low intakes and sodium, added sugars, and saturated fats (≥2 y old) for high intakes that were associated with adverse health consequences. Iron was identified among infants ages 6-12 mo fed human milk. For reproductive-aged and pregnant females, iron (all trimesters) and folate (first trimester) were identified for low intake, based on dietary and biomarker data (iron) or the severity of the consequence (folic acid and neural tube defects). Among pregnant women, low iodine was of potential public health concern based on biomarker data. Other NFCs that were underconsumed, overconsumed, and pose special challenges were identified across the life course. CONCLUSIONS: The proposed decision-tree framework was intended to streamline and add transparency to the work of this and future Dietary Guidelines Advisory Committees to identify NFCs that need to be encouraged or discouraged in order to help reduce risk of chronic disease and promote health and energy balance in the population. Published by Oxford University Press on behalf of the American Society for Nutrition 2021.
Entities:
Keywords:
dietary guidelines; nutrient; nutrition policy; nutrition risk; public health
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