PMC:7454258 / 97318-104988 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/7454258","sourcedb":"PMC","sourceid":"7454258","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7454258","text":"DGAs\nA key cross-departmental nutrition-related activity is the DGAs, the cornerstone for many federal nutrition programs and policies (Supplemental Table 8) (179). The National Nutrition Monitoring and Related Research Act of 1990 (Public Law 101–445) requires the DGAs be reviewed by the Secretaries of both USDA and HHS. Since 1995, a memorandum of understanding between the 2 departments provides a framework for this joint USDA–HHS endeavor, with each department alternating in leading each 5-y edition (180). Regardless of departmental lead, the USDA CNPP conducts the evidence analysis and develops the corresponding consumer-facing education tools (144, 145). The HHS Office of Disease Prevention and Health Promotion (ODPHP) aims to provide technical expertise and develop DGA-related resources for health professionals.\nBoth agencies’ efforts are constrained by limited funding and staff dedicated to the DGAs (144). In mandating the DGAs, Congress (Public Law 101–445) did not authorize or appropriate any regular funding for the DGA process nor, importantly, for the fundamental research, monitoring, and surveillance processes necessary for developing and translating dietary guidance, among other national needs. For example, there is no consistent funding source to develop the nation's DRIs, which are foundational to the DGAs, nor to ensure sufficient research to develop the necessary evidence base for updates of either the DGAs or DRIs. Successive DGACs from the 1980 edition onwards have documented persistent, major research gaps for setting evidence-based guidelines (181). Consistent funding also does not exist to review the impact of the DGAs on the public's understanding of nutrition, food choices, or health, or on the impact on other stakeholders (181–183).\nIn response to concerns that the DGA process may require updated processes and coordination, in 2016 Congress instructed the National Academies of Sciences, Engineering, and Medicine (NASEM) to review and make recommendations to the process for updating the DGAs (Public Law 114–113). First, in February 2017, NASEM released “Optimizing the Process for Establishing the Dietary Guidelines for Americans: The Selection Process” (184). This report provided recommendations for how the advisory committee process can be improved to provide more transparency, eliminate bias, and include committee members with a range of viewpoints. The second report released in September 2017 was entitled “Redesigning the Process for Establishing the Dietary Guidelines for Americans” (182). This report identified the following specific opportunities for improvement in the DGA process: more consistent interpretation of purpose and target audiences of the DGA, greater transparency of the overall process, and more rigorous methodological approaches to the evaluation of the evidence. The USDA-HHS responded to NASEM recommendations in September 2018 indicating changes they will be making in the development of the 2020–2025 DGAs, such as asking for public comments on the topics and scientific questions to be examined in the review of the evidence supporting the development of the next edition (185).\nIn part to respond to these recommendations, the FY2019 appropriations bill provided a one-time allocation of $12.3 million to CNPP, divided over 3 y, to support the 2020–2025 DGAs (186). These one-time funds are supporting a limited set of systematic reviews of published evidence, but not any new research to address critical knowledge gaps. As previously noted, only ∼1.3% of NIH-supported research focuses on diet for the prevention or treatment of disease in humans, and furthermore, among these, only about half of the projects relate to key research gaps identified by the 2015 DGAC (117–119). In addition, while the 2014 Farm Bill (Public Law 113–79) mandated that the DGAs include, for the first time, food-based nutrition guidance for infants and toddlers aged 0–24 mo and women who are pregnant or lactating (prior DGAs did not include or consider these critical populations), no funding was authorized or appropriated to support this new mandate. Given the first-ever focus of the 2020–2025 DGAs on these important populations, it is expected that the 2020 DGAC will identify even more knowledge gaps for setting national dietary guidance than prior editions (187).\nIn 1990, Congress specified that the DGAs focus on the general public, not on specific nutritional recommendations for individuals suffering from diet-related conditions (Public Law 101–445). However, highlighting the scale and scope of diet-related illness, only 12% of US adults are metabolically healthy (as defined by blood glucose, cholesterol, blood pressure, and waist circumference). Thus, the DGAs’ general focus may exclude the specific dietary needs of the great majority of the US population. Until 2014, the NIH supported the development of evidence reviews and dietary guidance for patients with health issues such as overweight and obesity, high blood pressure, and high blood cholesterol, among others (188, 189). These reviews were used by DGACs with input and endorsement from \u003e25 professional groups. The NIH ceased these reports in 2014, in part because the CDC's mandate deals with disease prevention activities and the mandate of the HHS Agency for Healthcare Research and Quality (AHRQ) includes development of systematic evidence reviews to inform clinical practice guidelines (189–191). Certain nongovernmental professional and clinical organizations provide nutrition guidance for populations with or at risk for various chronic conditions, but these various recommendations are not coordinated (192, 193). The current 2020 DGAC process excludes—for the first time—the use of existing high-quality nongovernmental systematic reviews and meta-analyses conducted by peer-reviewed researchers and major professional organizations. Little work has been done to understand the short- or long-term implications of NIH's shift in 2014 away from dietary guidance for populations with disease conditions, or whether CDC and AHRQ efforts are addressing this gap. Thus, currently no federal entity takes the lead on the development of evidence reviews or dietary guidance for patients with diet-related health conditions. Several organizations, including AND, the National Association for the Advancement of Colored People, and the National Hispanic Medical Association, recently formed the Food4Health Alliance to advocate for additional federal nutrition guidelines tailored to the needs of tens of millions of Americans who have diet-related diseases such as hypertension, obesity, and type 2 diabetes—conditions that also disproportionately affect minorities and underserved communities (194).\nIn addition to the lack of consistent funding and staff for the evidence reviews, fundamental research, monitoring, and surveillance processes needed to develop and translate dietary guidance, concerns have been raised that the process of updating the DGAs every 5 y is not protected from political or external influences (e.g., political appointees, Congress, food and beverage industries, agribusiness interests, advocacy groups) (182, 184, 195). A coordinated federal approach and authority for nutrition research could help strengthen the process for objective and independent development, review, and dissemination of the best science evidence to the American public in the DGAs for both healthy individuals and those with major diet-related illnesses, as well as for the evaluation of corresponding intended and unintended impacts of these guidelines and needed changes to improve these 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