Appendix C

DGAC Topics and Questions

This appendix contains two parts. The first part lists the questions addressed in the 2015 DGAC Scientific Report, arranged by the source of evidence as recorded in that report (HHS/USDA, 2015). Questions that were addressed with more than one source of evidence are listed under the source occurring first in this list and clarified in footnotes. The second part is Table C-1, which lists the dietary and nondietary factors assessed in relation to health status and chronic disease explicitly stated in the questions addressed in the 2005, 2010, and 2015 editions of the DGAC Scientific Report.

QUESTIONS ADDRESSED IN THE 2015 DGAC SCIENTIFIC REPORT

Systematic Reviews (de novo Nutrition Evidence Library [NEL] Systematic Review)

• What is the relationship between dietary patterns and risk of cancer?
• What is the relationship between dietary patterns and risk of congenital anomalies?
• What is the relationship between dietary patterns and risk of neurological and psychological illnesses?
• What is the relationship between dietary patterns and bone health?
• What is the relationship between eating out and/or take away meals and body weight in children and adults?

• What is the relationship between frequency and regularity of family shared meals and measures of dietary intake in U.S. population groups?
• What is the relationship between frequency and regularity of family shared meals and measures of body weight and obesity in U.S. population groups?
• What is the relationship between sedentary behavior and measures of dietary intake and body weight in adults?
• What is the relationship between use of diet and body weight self-monitoring strategies and body weight outcomes in adults and youth?
• What is the relationship between knowledge and use of food and menu labels and measures of dietary intake in U.S. population groups?
• What is the relationship between household food insecurity (HFI) and measures of dietary intake and body weight?
• What is the relationship between acculturation and measures of dietary intake?
• What is the relationship between acculturation and body weight?
• What is the relationship between acculturation and risk of cardiovascular disease (CVD)?
• What is the relationship between acculturation and risk of type 2 diabetes?
• What is the relationship between neighborhood and community access to food retail settings and individuals’ dietary intake and quality?
• What is the relationship between neighborhood and community access to food retail settings and weight status?
• What is the impact of obesity prevention approaches in early care and education programs on the weight status of children ages 2 to 5 years?¹
• What is the relationship between population-level dietary patterns and long-term food sustainability?
• What consumer behaviors prevent food safety problems?²
• What is the relationship between sodium intake and blood pressure in children?³
• What is the relationship between sodium intake and cardiovascular disease outcomes?³

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¹ Existing systematic review used in addition to the NEL systematic review.

² Topic update from the 2010 DGAC report; no new systematic review conducted.

³ Update of the 2010 NEL systematic review.

• What is the relationship between the intake of added sugars and cardiovascular disease, body weight/obesity, type 2 diabetes, and dental caries?⁴

Existing Systematic Reviews and Reports

• What is the relationship between dietary patterns and risk of cardiovascular disease?
• What is the relationship between dietary patterns and measures of body weight or obesity?
• What is the relationship between dietary patterns and risk of type 2 diabetes?
• How effective are behavioral interventions in youth that focus on reducing recreational sedentary screen time and improving physical activity and/or diet?
• What is the impact of school-based approaches on the dietary intake, quality, behaviors, and/or preference of school-aged children?
• What is the impact of school-based policies on the dietary intake, quality, behaviors, and/or preferences of school-aged children?
• What is the impact of school-based approaches on the weight status of school-aged children?
• What is the impact of school-based policies on the weight status of school-aged children?
• What is the impact of worksite-based approaches on the dietary intake, quality, behaviors, and/or preferences of employees?
• What is the impact of worksite policies on the dietary intake, quality, behaviors, and/or preferences of employees?
• What is the impact of worksite-based approaches on the weight status of employees?
• What is the impact of worksite policies on the weight status of employees?
• What are the comparative nutrient profiles of current farm-raised versus wild caught seafood?
• What are the comparative contaminant levels of current farm-raised versus wild caught seafood?⁵
• What is the worldwide capacity to produce farm-raised versus wild-caught seafood that is nutritious and safe for Americans?

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⁴ Cardiovascular disease addressed with an NEL systematic review; body weight/obesity, type 2 diabetes, and dental caries addressed with existing reports.

⁵ Data analysis used in addition to existing systematic reviews.

• What is the relationship between usual coffee/caffeine consumption and health?
• What is the relationship between high-dose caffeine consumption and health?
• What is the relationship between aspartame consumption and health?
• What is the relationship between sodium intake and blood pressure in adults?
• What effect does the interrelationship of sodium and potassium have on blood pressure and cardiovascular disease outcomes?
• What is the relationship between intake of saturated fat and risk of cardiovascular disease?
• What is the relationship between the intake of low-calorie sweeteners and body weight/obesity and type 2 diabetes?
• What is the relationship between physical activity, body weight, and health outcomes in children and adolescents?
• What is the relationship between physical activity and body weight?
• What is the relationship between physical activity and cardiorespiratory health?
• What is the relationship between physical activity and metabolic health and risk of type 2 diabetes?
• What is the relationship between physical activity and musculoskeletal health?
• What is the relationship between physical activity and incidence of breast and colon cancer?
• What is the relationship between physical activity and mental health?
• What is the relationship between physical activity and health outcomes in people with disabilities?
• Does being physically active during pregnancy and the postpartum period provide health benefits?
• What is the relationship between the amount and type of physical activity and the risk of adverse events?
• What dose of physical activity is most likely to provide health benefits in children and adolescents?
• What dose of physical activity is most likely to provide health benefits in adults?
• Are there any special considerations for dose of physical activity for older adults?
• What is the relationship between physical activity participation and interventions in school-based settings?

• What is the relationship between physical activity participation and interventions to change the built environment?
• What is the relationship between physical activity participation and interventions based in home settings?
• What is the relationship between physical activity participation and interventions based in early care and education centers?
• What is the relationship between physical activity participation and interventions based in primary health care settings?

Food Pattern Modeling

• How well do updated U.S. Department of Agriculture (USDA) Food Patterns meet Institute of Medicine (IOM) Dietary Reference Intakes and 2010 Dietary Guidelines recommendations? How do the recommended amounts of food groups compare to current distributions of usual intakes for the U.S. population?
• How well do the USDA Food Patterns meet the nutritional needs of children 2 to 5 years of age, and how do the recommended amounts compare to their current intakes? Given the relatively small empty calorie limit for this age group, how much flexibility is possible in food choices?
• Can vitamin D Estimated Average Requirements and/or Recommended Dietary Allowances be met with careful food choices following recommended amounts from each food group in the USDA Food Patterns? How restricted would food choices be, and how much of the vitamin D would need to come from fortified dairy and other food products?
• Using the food pattern modeling process, can healthy eating patterns for vegetarians and for those who want to follow a Mediterranean-style diet be developed? How do these patterns differ from the USDA Food Patterns previously updated for use by the 2015 DGAC?

Descriptive Data Analyses

• What are current consumption patterns of nutrients from foods and beverages by the U.S. population?
• Of the nutrients that are underconsumed or overconsumed, including over the Tolerable Upper Limit of Intake (UL), which present a substantial public health concern?
• What would be the effect on food choices and overall nutrient adequacy of limiting saturated fatty acids to 6 percent of total calories by substituting mono- and polyunsaturated fatty acids?

• Is there evidence of overconsumption of any micronutrients from consumption of fortified foods and supplements?
• What is the level of caffeine intake derived from foods and beverages on the basis of IOM Dietary Reference Intakes age and sex categories in the U.S. population?
• What are current consumption patterns of USDA Food Pattern food groups by the U.S. population?
• What is the contribution of whole grain foods, fruits and vegetables, and other food groups to (1) total fiber intake and (2) total nutrient intake in the USDA Food Patterns? What is the contribution of fruit and vegetables to current nutrient intake (focus on nutrients of concern, including fiber)?
• What would be the impact on the adequacy of the patterns if (1) no dairy foods were consumed, (2) if calcium was obtained from nondairy sources (including fortified foods), and (3) if the proportions of milk and yogurt to cheese were modified? What is the relationship between changes in types of beverages consumed (milk compared with sugar-sweetened beverages) and diet quality?
• What are the trends in USDA Food Pattern food group consumption by the U.S. population?
• What are the current consumption patterns by food categories (i.e., foods as consumed) by the U.S. population?
• What are the top foods contributing to energy intake by the U.S. population?
• What are the top foods contributing to sodium, saturated fat, and added sugars intake by the U.S. population?
• What is the current contribution of fruit products with added sugars to intake of added sugars?
• What is the current contribution of vegetable products with added sodium to intake of sodium?
• What is the current contribution of refined grains to intake of added sugars, saturated fat, some forms of polyunsaturated fat, and sodium?
• What are the sources of caffeine from foods and beverages on the basis of age and sex subgroups?
• What is the contribution of beverage types to energy intake by the U.S. population?
• What are the current status and trends in the number of daily eating occasions and frequency of meal skipping? How do diet quality and energy content vary based on eating occasion?

• What are the current status and trends in the location of meal and snack consumption and sources of food and beverages consumed at home and away from home? How do diet quality and energy content vary based on the food and beverage source?
• What is the current prevalence of overweight/obesity and distribution of body weight, body mass index (BMI), and abdominal obesity in the U.S. population and in specific age, sex, race/ethnicity and income groups? What are the trends in prevalence?
• What is the relative prevalence of metabolic and cardiovascular risk factors (i.e., blood pressure, blood lipids, and diabetes) by BMI/waist circumference in the U.S. population and specific population groups?
• What are the current rates of nutrition-related health outcomes (i.e., incidence of and mortality from cancer [breast, lung, colorectal, and prostate] and prevalence of cardiovascular disease, high blood pressure, diabetes, bone health, congenital anomalies, and neurological and psychological illness) in the overall U.S. population?
• What is the composition of dietary patterns with evidence of positive health outcomes (e.g., Mediterranean-style patterns, Dietary Approaches to Stop Hypertension [DASH]-style patterns, patterns that closely align with the Healthy Eating Index, and vegetarian patterns) and of patterns commonly consumed in the United States? What are the similarities (and differences) within and among the dietary patterns with evidence of positive health outcomes and the commonly consumed dietary patterns?
• To what extent does the U.S. population consume a dietary pattern that is similar to those observed to have positive health benefits (e.g., Mediterranean-style patterns, Dietary Approaches to Stop Hypertension [DASH]-style patterns, patterns that closely align with the Healthy Eating Index, and vegetarian patterns) overall and by age/sex and race/ethnic groups?

REFERENCES

TABLE C-1 Similarities and Differences of the Dietary and Nondietary Factors Assessed in Relation to Health Status and Chronic Disease Explicitly Included in Questions Addressed in the 2005, 2010, and 2015 Editions of the DGAC Scientific Report

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^g Includes separate questions for the relationship between health and intake of animal protein products, vegetable and/or soy protein, milk and milk products, cooked dry beans and peas, whole grains, and vegetables and whole fruit intake, excluding juice.

^h Effect on breastmilk composition and health outcomes in infants.

ⁱ Includes separate questions about the relationship between body weight and macronutrient proportion, sugar-sweetened beverage intake and energy intake, and non-caloric sweeteners and energy intake.

^j Includes separate questions about the relationship between body weight and eating out and/or take away meals, and the frequency and regularity of family shared meals.

^k Includes separate questions about the relationship between body weight and acculturation and household food insecurity.

^l Includes separate questions about the relationship between body weight and intake of low-calorie sweeteners and intake of added sugars.

^m Includes separate questions about the relationship between body weight and sedentary behaviors, physical activity, and physical activity and health.

ⁿ Includes separate questions about low-calorie sweeteners and added sugars intake.

^o Includes separate questions on the effect of obesity prevention approaches in early care and education programs, school-based approaches, school-based policies, worksite-based approaches, and worksite policies.

^p Includes separate questions on the risk of cardiovascular disease and intake of saturated fat, cholesterol, monounsaturated fatty acids (when substituted for saturated fatty acids), and n-6 polyunsaturated fatty acids.

^q Includes separate questions on the relationship between cardiovascular disease and intake of sodium, added sugars, saturated fat, and the interrelationship of sodium and potassium.

^r Includes separate questions on the relationship between blood pressure and intake of sodium and the interrelationship of sodium and potassium.

^s Includes separate questions about the effects of saturated fat intake, monounsaturated fatty acid intake (when substituted for saturated fatty acids), and n-6 polyunsaturated fatty acid intake on risk of type 2 diabetes.

^t Relationship explored was with breast cancer incidence.

^u Relationship explored was with colon cancer incidence.

^v Includes separate questions about the effects of saturated fat intake, monounsaturated fatty acid intake (when substituted for saturated fatty acids), and n-6 polyunsaturated fatty acid intake on risk of type 2 diabetes. Also, the effect of replacing a high carbohydrate diet with a high monounsaturated fatty acid diet in persons with type 2 diabetes.

^w Includes separate questions about the relationship between type 2 diabetes and intake of low-calorie sweeteners and intake of added sugars.

SOURCES: HHS/USDA, 2005, 2015; USDA/HHS, 2010.