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Title: A proposed framework for identifying nutrients and food components of public health relevance in the Dietary Guidelines for Americans

Author
item BAILEY, REGAN - PURDUE UNIVERSITY
item ARD, JAMY - WAKE FOREST SCHOOL OF MEDICINE
item DAVIS, TERESA - CHILDREN'S NUTRITION RESEARCH CENTER (CNRC)
item NAIMI, TIM - BOSTON UNIVERSITY MEDICAL SCHOOL
item SCHNEEMAN, BARBARA - UNIVERSITY OF CALIFORNIA
item STANG, JAIME - UNIVERSITY OF MINNESOTA
item DEWEY, KATHRYN - UNIVERSITY OF CALIFORNIA
item DONOVAN, SHARON - UNIVERSITY OF ILLINOIS
item NOVOTNY, RACHEL - UNIVERSITY OF HAWAII
item SNETSELAAR, LINDA - UNIVERSITY OF IOWA

Submitted to: Journal of Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 12/31/2020
Publication Date: 3/9/2021
Citation: Bailey, R.L., Ard, J.D., Davis, T.A., Naimi, T.S., Schneeman, B.O., Stang, J.S., Dewey, K.G., Donovan, S.M., Novotny, R., Snetselaar, L.G. 2021. A proposed framework for identifying nutrients and food components of public health relevance in the Dietary Guidelines for Americans. Journal of Nutrition. 151(5):1197-1204. https://doi.org/10.1093/jn/nxaa459.
DOI: https://doi.org/10.1093/jn/nxaa459

Interpretive Summary: The Dietary Guidelines for Americans provides a set of evidence-based nutrition recommendations for policymakers, educators, industry leaders, and the public. Identifying nutrients of public health concern is one of the tasks of the Dietary Guidelines for Americans, but an official, systematic process for doing so has not been published. The 2020-2025 Dietary Guidelines Advisory Committee (DGAC), a group of non-federal scientific experts in health and nutrition, proposed a three-pronged, decision tree approach to identify nutrients and food components of public health relevance for the Dietary Guidelines for Americans. The framework defines terminology, establishes quantitative thresholds to identify NFCs, and examines national data. The three prongs of the framework analyze data from dietary intakes, biological endpoints, and clinical health consequences. Using the approach, the DGAC identified nutrients and food components of public health concern for Americans less than 1-year-old as fiber, calcium (less than 2 years old), vitamin D, and potassium for low intakes and sodium, added sugars, and saturated fats (less than 2 years old) for high intakes. For infants ages 6–12 months fed human milk, iron was identified as an nutrients and food components. For reproductive-aged and pregnant females, iron and folate were identified for low intake. Low iodine was of potential public health concern among pregnant women. Other nutrients and food components that were underconsumed, overconsumed, and pose special challenges were identified across the life span. The creation of the three-prong decision tree approach is proposed to restructure and add transparency to the work of future DGACs when advising the Dietary Guidelines for Americans.

Technical Abstract: 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. We aimed to propose a framework for identifying "nutrients or food components" (NFCs) of public health relevance to inform the DGA. 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. 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. 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.