Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report (2022)
Chapter: Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table
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Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
TABLE D-1 Comparison of Selected Excerpts from the Dietary Guidelines Advisory Committee Scientific Report and the Dietary Guidelines for Americans1
| Topic Area | DGAC (2020 Scientific Report) | DGA (2020–2025)c |
|---|---|---|
| Individuals Above 2 Years of Age | ||
| Added Sugars | Evidence suggests that adverse effects of added sugars, particularly from sugar-sweetened beverages (SSBs), may contribute to unhealthy weight gain and obesity-related health outcomes. Reducing the amount of added sugars in the diet, either through changes in consumer behavior or in how food is produced and sold, is an achievable objective that could improve population health. After considering the scientific evidence for the potential health effects of added sugars intake, along with findings from model-based estimations of energy available in the dietary pattern after meeting nutrient requirements, the committee suggests that less than 6% of energy from added sugars is more consistent with a dietary pattern that is nutritionally adequate while avoiding excess energy intake from added sugars than is a pattern with less than 10% energy from added sugars.a The addition of sugars to foods or beverages provides energy, generally without contributing additional nutrient content. Taking into account both the 2015 and 2020 committee evidence reviews, relative to the goal of improving the health of a population in which the |
Less than 10% of energy per day starting at the age of 2 Foods and beverages high in calories from added sugars should be limited to help achieve healthy dietary patterns within calorie limits. When added sugars in foods and beverages exceed 10% of calories, a healthy dietary pattern within calories limits is very difficult to achieve…. Based on the assumptions above, an individual who needs 2,000 calories per day (based on age, sex, and physical activity level) has less than 7% of calories available for added sugars. Individuals who need 2,800 calories per day or less have less than 8% of calories available for added sugars. Individuals who need more than 3,000 calories may have a total of 9 to 10% of calories available for added sugars. In this portion of the population that requires high calorie intake, an upper limit of 10% of calories from added sugars may be consumed while still meeting food group recommendations in nutrient dense forms. The 10% added sugar limit allows for flexibility in food choices over time but also requires careful planning. |
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1 The title of this table was modified after release of a prepublication version of the report to the sponsor to clarify that the committee is presenting selected excerpts from the DGA and DGAC, rather than a comprehensive comparison of text from these sources. Additionally, the heading was modified to accurately portray the topic areas and Scientific Report.
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
| Topic Area | DGAC (2020 Scientific Report) | DGA (2020–2025)c |
|---|---|---|
| Individuals Above 2 Years of Age | ||
| Added Sugars | prevalence of overweight and obesity is high, the addition of sugar to the diet raises concerns about the potential risk of increasing unhealthy weight gain and, in turn, increasing risk of obesity-related health outcomes. Foods and beverages with added sugars are part of the culture and traditions of many families and communities in the United States. Therefore, it would not be reasonable, or even desirable, to recommend no consumption of added sugars. However, reducing the amount of added sugars in the diet, through either changes in consumer behavior or in how food is produced and sold, or through food policy, is an achievable objective that could improve population health. Although intake of added sugars remains high, data reviewed by the 2020 committee suggest the consumption of added sugars decreased slightly over the last decade suggesting a reduction is feasible. With the aim of providing a balanced perspective that retains the pleasure of eating while reducing risk of adverse health outcomes, Table D12.4 (refers to table in DGAC, 2020) provides an update to the information provided in the 2015 committee report on the relevant recommendations from various high-profile national and international organizations on this topic.b | Most adults exceed recommended limits for added sugars as a result of eating foods and drinking beverages higher in added sugars and selecting foods and beverages across food groups that are not in nutrient-dense forms. Added sugars are of particular concern for adults because exceeding limits contributes to excess calorie intake. |
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
| Topic Area | DGAC (2020 Scientific Report) | DGA (2020–2025)c |
|---|---|---|
| Individuals Above 2 Years of Age | ||
| Alcoholic Beverages | The committee concurred with the recommendation of the 2015–2020 DGA that those who do not drink should not begin to drink because they believe alcohol would make them healthier. Although alcohol can be consumed at low levels with relatively low risk, for those who choose to consume alcohol, evidence points to a general rule that drinking less is better for health than drinking more. Therefore, the focus should remain on reducing consumption among those who drink, particularly among those who drink in ways that increase the risk of harms. The committee concluded that no evidence exists to relax current DGA recommendations, and there is evidence to tighten them for men such that recommended limits for both men and women who drink would be one drink per day on days when alcohol is consumed. As with previous editions of the DGA, recommended limits pertain to days on which alcohol is consumed.a Orienting guidelines around increasing levels of risk is the general approach used to develop recommendations for other risk factors such as blood pressure, cholesterol, blood glucose, and body mass. That alcohol is a popular product should not change this approach, at least in the context of guidance |
The DGA does not recommend that individuals who do not drink alcohol start drinking for any reason. There are also some people who should not drink at all, such as if they are pregnant or might be pregnant; under the legal age for drinking; if they have certain medical conditions or are taking certain medications that can interact with alcohol; and if they are recovering from an alcohol use disorder or if they are unable to control the amount they drink. If adults age 21 years and older choose to drink alcoholic beverages, drinking less is better for health than drinking more. Evidence indicates that, among those who drink, higher average alcohol consumption is associated with an increased risk of death from all causes compared with lower average alcohol consumption. Alcohol misuse or consuming alcohol in excess of recommendations increases risk of several conditions such as liver disease, CVD, injuries, and alcohol use disorders. To help Americans move toward a healthy dietary pattern and minimize risks associated with drinking, adults of legal drinking age can choose not to drink or to drink in moderation by limiting intakes to two drinks or less in 1 day for men and |
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
| Topic Area | DGAC (2020 Scientific Report) | DGA (2020–2025)c |
|---|---|---|
| Alcoholic Beverages | to promote health. Given a public health orientation and limitations of current evidence, the fact that most existing evidence indicates increased risk of all-cause mortality among men drinking two drinks per day compared to one drink per day, and the possibility that no protection exists for low volume drinking on cardiovascular disease (CVD), changing recommended limits to one drink daily for men is justified and should be strongly considered. It is important to acknowledge that many men consume alcohol in excess of this recommendation (and the current recommendation, for that matter), and may not find revised recommendations achievable or desirable, at least on a consistent basis. Nonetheless, although guidelines may be aspirational they are important for communicating evidence around health, stimulating thought around behavior change, and prioritizing policies that may lead to changes in consumption. Finally, these guidelines are intended to improve public health and should not be interpreted to mean that consumption above these amounts is necessarily indicative of federal definitions of excessive drinking, which are based on higher consumption amounts with higher levels of risk that have been identified as targets for further screening, | one drink or less in 1 day for women, on days when alcohol is consumed. This is not intended as an average over several days, but rather the amount consumed on any single day. Binge drinking, defined as five or more drinks for the typical adult male or four or more drinks for the typical adult female in about 2 hours, should be avoided. Emerging evidence suggests that even drinking within the recommended limits may increase the overall risk of death from various causes, such as from several types of cancer and some forms of CVD. Alcohol has been found to increase risk for cancer, and for some types of cancer, the risk increases even at low levels of alcohol consumption (less than one drink in 1 day). Caution, therefore, is recommended. |
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
| Topic Area | DGAC (2020 Scientific Report) | DGA (2020–2025)c |
|---|---|---|
| counseling, and possibly treatment in a clinical context. Overall, alcohol is an unhealthy substance, and the United States population is far from achieving alcohol consumption levels that would meaningfully reduce alcohol-related harms. Alcohol can be consumed at low levels with relatively low risk, and is consumed by U.S. adults for a variety of reasons. However in terms of health, among those who consume alcohol, drinking less is better for health than drinking more. Currently, no evidence exists to relax current DGA recommendations, and there is evidence to tighten them, for men in particular, such that recommended limits for both men and women should be one drink per day on days when alcohol is consumed. The committee’s suggestions regarding advice to the general public about drinking in moderation for the next DGA can be summarized as follows:b Do not begin to drink alcohol or purposefully continue to drink because you think it will make you healthier.b If you drink alcohol, at all levels of consumption, drinking less is generally better for health than drinking more.b For those who drink alcohol, recommended limits are up to one drink per day for both women and men.b |
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
| Topic Area | DGAC (2020 Scientific Report) | DGA (2020–2025)c |
|---|---|---|
| Beverages | The committee reviewed available data on the relationships between beverage consumption and achieving nutrient and food group recommendations. It also examined evidence on the relationship between beverage consumption and growth, size, body composition, and risk of overweight and obesity for children and adults. All beverages contribute to hydration needs, and many beverages, such as milk and 100% juice, can help people attain recommended nutrient intake goals. Other beverages, such as SSBs, provide energy but contribute very little toward meeting nutrient and food group recommendations. Sweetened beverages, not including coffee and tea with added sugar, account for approximately one-third of total beverage consumption and contribute approximately 30%, 50%, and 60% of added sugars to the diet of young children, adolescents, and adults, respectively. Among the beverages examined, only SSB intake was associated with adiposity, and this was true for both children and adults. Because of their low nutrient-to-energy content ratio and the high prevalence of overweight and obesity in the population, it is important to continue encouraging only limited intake of SSBs. Limited evidence suggests that low- or no-calorie sweetened beverage consumption is associated with reduced adiposity in | When choosing beverages in a healthy dietary pattern, both the calories and nutrients that they provide are important considerations. Beverages that are calorie-free—especially water—or that contribute beneficial nutrients, such as fat-free and low-fat milk and 100% juice, should be the primary beverages consumed. Coffee, tea, and flavored waters also are options, but the most nutrient-dense options for these beverages include little, if any, sweeteners or cream. SSBs (e.g., soda, sports drinks, energy drinks, fruit drinks) and sweetened coffees and teas (including ready-to-drink varieties) contribute more than 40% of daily intake of added sugars. More than in earlier life stages, adults consume coffees and teas with additions, such as sugar and flavored syrup. Frequent consumption of these and other beverages containing added sugars can contribute to excess calorie intake. Some SSBs, such as coffee and tea with milk, contribute to food group intake (e.g., dairy) and can be made without added sugars. Others, such as fruit drinks, can be replaced with nutrient-dense options such as 100% juice to help meet fruit group recommendations. Most adults’ diets include choices across multiple food groups that are not in nutrient-dense forms and therefore cannot accommodate excess calories |
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
| Topic Area | DGAC (2020 Scientific Report) | DGA (2020–2025)c |
|---|---|---|
| adults. The evidence was insufficient to evaluate the effects of SSBs compared to low- or no-calorie sweetened beverage consumption in children.a SSBs are targeted for moderation because they provide little nutrient value besides energy and simple carbohydrates. SSBs may evoke a weaker energy compensation response compared to solid foods, so are more apt to add to, rather than displace, other energy sources. Other beverages, such as milk and 100% juices, are more nutrient-dense and thus play an added role in health promotion and disease prevention.b |
from sweetened beverages. Intake of SSBs should be limited to small amounts and most often replaced with beverage options that contain no added sugars, such as water. |
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
| Topic Area | DGAC (2020 Scientific Report) | DGA (2020–2025)c |
|---|---|---|
| Sugar-Sweetened Beverages (SSBs) | Among the beverages examined in the Nutrition Evidence Systematic Review (NESR) systematic review, only SSB intake was associated with adiposity and this held in both children and adults. The evidence was viewed as moderate for children and limited for adults. Because of their low nutrient-to-energy content ratio and the high prevalence of overweight and obesity in the population, it is important to continue encouraging only limited intake of this class of beverages. Importantly, the influence of intake of these beverages on food intake was not evaluated so understanding of their effect on total diet quality remains incomplete.b | SSBs (e.g., soda, fruit drinks, sports and energy drinks) are not necessary in the child or adolescent diet nor are they a component of the U.S. Department of Agriculture (USDA) Dietary Patterns. Intake of added sugars increases throughout childhood and adolescence, and SSBs are a top contributor. As a percent of total daily energy intake, average intake of added sugars is 11% among young children and peaks at 15% during adolescence. Coinciding with this increase is the contribution of SSBs to total intake of added sugars. In childhood, SSBs make up about 15 to 25% of total added sugars intake. By adolescence, their contribution is 32% and even higher when considering coffee and tea beverages with added sugars (an additional 7%). Most SSBs (e.g., soda, sports drinks) do not contribute to meeting food group goals and often contain a high number of calories. |
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
| Topic Area | DGAC (2020 Scientific Report) | DGA (2020–2025)c | |
|---|---|---|---|
| Low- and No-Calorie–Sweetened Beverage (LNCSB) | The effects of LNCSB on adiposity outcomes was also assessed. No significant association was observed between consumption of beverages containing these sweeteners and adiposity outcomes in children, but their intake was associated with reduced adiposity in adults. Again, the evidence base used to draw these conclusions was limited, but viewed as sufficient to acknowledge that such beverages may be a useful aid in weight management in adults.b |
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
| Topic Area | DGAC (2020 Scientific Report) | DGA (2020–2025)c |
|---|---|---|
| Dietary Fats and Seafood | The committee’s review found that reducing saturated fat intake by replacing it with unsaturated fats, particularly polyunsaturated fat, lowers the incidence of CVD in adults. Replacing saturated with unsaturated fats in the diet also reduces serum total and low-density lipoprotein cholesterol (LDL-C) in all adults and some children, especially boys. However, the benefits of replacing saturated fat with carbohydrates are less clear. In addition, because dietary cholesterol is found only in animal-source foods that are typically also sources of saturated fat, the independent effects of dietary cholesterol on CVD are difficult to assess. The recommended shift from saturated to unsaturated fats occurs best within the context of a healthy dietary pattern consisting of higher intakes of vegetables, fruits, legumes, whole grains, nuts and seeds, with some vegetable oils, low-fat dairy, lean meat and poultry, and fatty fish and lower intakes of red and processed meats, sugar-sweetened foods and drinks, and refined grains. The committee also conducted a review of relationships between seafood consumption during childhood and adolescence and the risk of CVD and neurocognitive outcomes during the life span. Available evidence was insufficient to make a |
Adolescent females also consume less meat, poultry, and eggs than do adolescent males, and in combination with low consumption of seafood and other protein subgroups, including beans, peas, and lentils, this results in the underconsumption of total protein. In addition, adolescent females have low dietary intakes of iron, folate, vitamin B6, and vitamin B12. Average intakes of fruits, vegetables, and dairy fall below the range of recommended intakes for all adults. Although average total grains intakes meets recommendations, intake of whole grains is well below recommendations, and intakes of refined grains exceeds the upper end of the recommended intake range for adults in both age groups. Intake of protein foods generally meets or exceeds recommended intake levels. Current patterns generally include meats, poultry, eggs, and nuts, seeds, and soy, while average intake of seafood falls well below recommendations. For those 2 years and older, intake of saturated fat should be limited to less than 10% of calories per day by replacing them with unsaturated fats, particularly polyunsaturated fats. Saturated fat—Less than 10% of calories per day starting at age 2. |
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
| Topic Area | DGAC (2020 Scientific Report) | DGA (2020–2025)c |
|---|---|---|
| conclusion about seafood intakes during these life stages and risk of later CVD or neurocognitive outcomes. However, no adverse associations were reported.a Considering the totality of the scientific evidence, including the present systematic review, the committee concluded that lowering intake of saturated fat and replacing it with primarily plant-sourced unsaturated fats, lowers serum total and LDL-C and the incidence of CVD.b The committee recommends that dietary cholesterol and saturated fat intake be as low as possible within a healthy dietary pattern, and that saturated fat intake be limited to less than of 10% of total energy intake, as recommended by the 2015–2020 DGA. This recommendation applies to adults and children ages 2 years and older.b The committee recommends that the seafood-related guidance of the 2010 and 2015 committees remain in place, with slight modifications: Two or more servings of cooked seafood per week are recommended for ages 2 years and older.b Choices of fish and seafood with emphasis on species higher in omega-3 polyunsaturated fatty acids and with low methylmercury |
Age 2–18 ranges 2–8 oz/week depending on age – equivalent to 2 servings per week Adults 8 oz/week Contains reference to the U.S. Environmental Protection (EPA) and the U.S. Food and Drug Administration (FDA) advice on mercury in fish in multiple places. FDA and EPA provide joint advice regarding seafood consumption to limit methylmercury exposure for children. Depending on body weight, some children should choose seafood lowest in methylmercury or eat less seafood than the amounts in the Healthy U.S.-Style Dietary Pattern. More information is available on the FDA and EPA websites at FDA.gov/fishadvice_and EPA.gov/fishadvice. |
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
| Topic Area | DGAC (2020 Scientific Report) | DGA (2020–2025)c |
|---|---|---|
| are advised, following federal and local fish and seafood advisories. For those following dietary patterns that do not include seafood, regular intake of other foods high in omega-3 fatty acids, such as flaxseeds, walnuts, soy oil, algae, and eggs that contain omega-3 fatty acids, is appropriate. The 2020–2025 DGA should contain information on amounts and types of seafood to consume as well as those to avoid based on the methylmercury content.b The committee recognizes that recommendations to increase seafood consumption by the American public can have environmental consequences and such impacts should be evaluated in the development of the DGA.b |
||
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
| Topic Area | DGAC (2020 Scientific Report) | DGA (2020–2025)c |
|---|---|---|
| Dietary Patterns | The committee found consistent evidence that certain dietary pattern components are associated with beneficial outcomes for all-cause mortality, CVD, overweight and obesity, type 2 diabetes, bone health, cancer (breast, colorectal, and lung), and neurocognitive health. Common characteristics of dietary patterns associated with positive health outcomes include higher intake of vegetables, fruits, legumes, whole grains, low- or nonfat dairy, lean meat and poultry, seafood, nuts, and unsaturated vegetable oils and low consumption of red and processed meats, sugar-sweetened foods and drinks, and refined grains. In addition, the committee found that negative (detrimental) health outcomes were associated with dietary patterns characterized by higher intake of red and processed meats, sugar-sweetened foods and beverages, and refined grains. The healthy patterns the committee examined in its review comprised various combinations of foods and were identified with many different names (e.g., DASH, Mediterranean). This suggests that a healthy diet that promotes optimum growth and development while minimizing risk factors for chronic diseases can be created and tailored to suit cost considerations and a wide variety of personal and cultural preferences.a |
Adults are encouraged to follow the recommendations on the types of foods and beverages that make up a healthy dietary pattern. The USDA Dietary Patterns provide a framework of nutrient-dense foods and beverages that can be adapted to accommodate budget, culture, and personal preferences to help adults follow a healthy dietary pattern and meet the DGA and their Key Recommendations. In general, calorie needs are lower for females compared to males. Calorie needs decline throughout adulthood due to changes in metabolism that accompany aging. Level of physical activity, body composition, and the presence of chronic disease are additional factors that affect calorie needs. Children and adolescents are encouraged to follow the recommendations on the types of foods and beverages that make up a healthy dietary pattern. The USDA Dietary Patterns, including the Healthy U.S.Style Dietary Pattern, provide a framework to help children and adolescents follow a healthy dietary pattern and meet the DGA and their Key Recommendations. The USDA Foods Patterns can be customized based on dietary needs, personal preferences, and budgetary constraints. |
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
| Topic Area | DGAC (2020 Scientific Report) | DGA (2020–2025)c |
|---|---|---|
| A consistent dietary pattern associated with beneficial outcomes was present across all seven of the reviewed questions for which grades of variable strength were assignable: higher intake of vegetables, fruits, legumes, whole grains, low- or nonfat dairy, lean meat and poultry, seafood, nuts and unsaturated vegetable oils, and low consumption of red and processed meats, sugar-sweetened foods and drinks, and refined grains. Dietary patterns associated with adverse or detrimental outcomes included higher intake of red and processed meats, sugar-sweetened foods and beverages, and refined grains. A notable new observation was an association of the main components of the aforementioned dietary pattern with lower all-cause mortality, a finding the committee graded as strong.b Collectively, these observations have major implications for recommending dietary patterns to the U.S. population. Although the patterns represent different named “diets” (e.g., DASH, Mediterranean), the committee’s review conveys a public health message reflecting key foods across studies that in common comprise a healthy diet that promotes optimum growth and development while minimizing risk factors underlying the onset of chronic diseases.b |
A variety of nutrient-dense foods and beverages can be selected across the food group and subgroups as part of an overall healthy dietary pattern. For this age group, as for all the others, a figure comparing current intakes to recommendations is presented. See “Current Intakes” for more information. Common characteristics of dietary patterns associated with positive health outcomes include relatively higher intake of vegetables, fruits, legumes, whole grains, low- or non-fat dairy, lean meats and poultry, seafood, nuts, and unsaturated vegetable oils, and relatively lower consumption of red and processed meats, sugar-sweetened foods and beverages, and refined grains. The evidence examined showed broad representation across a number of populations and demographic groups. This suggests a consistent association no matter the region or cultural context in which a healthy dietary pattern is consumed. In addition, dietary patterns characterized by higher intake of red and processed meats, sugar-sweetened foods and beverages, and refined grains are, in and of themselves, associated with detrimental health outcomes. These findings are consistent with—and build on—the evidence base that informed the 2015–2020 Dietary Guidelines. |
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
| Topic Area | DGAC (2020 Scientific Report) | DGA (2020–2025)c |
|---|---|---|
| Frequency of Eating | Although the committee was unable to find adequate evidence to answer the questions on the relationship between eating frequency and health outcomes, its analysis of eating frequency in the United States revealed a wide variety of eating frequency patterns that varied by socioeconomic and demographic factors. Diet quality was higher when self-reported meal intake increased two meals per day to three, whereas late-night eating often contained food components recommended to be consumed in moderation. Despite the importance of this topic, the available evidence for many questions was insufficient to form conclusion statements, highlighting the critical need for additional research.a The NESR review did not yield specific answers to the questions concerning the relationship between frequency of eating and health outcomes of obesity, all-cause mortality, risk of CVD, or risk of type 2 diabetes. This was primarily attributable to the limited availability of high-quality data. The committee cannot therefore make recommendations to the departments on frequency of eating and health.b The committee was able to address the relationship between the frequency of eating and achieving nutrient and food group recommendations. The |
Not discussed |
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
| Topic Area | DGAC (2020 Scientific Report) | DGA (2020–2025)c |
|---|---|---|
| committee determined that, on average, Americans self-report 5.7 eating occasions throughout the day with the majority (64%) consuming three meals per day and 28% consuming two meals per day. More than 90% of Americans also report two to three snacking occasions per day. Reported frequency of eating and types of ingested foods varied widely across age, race, ethnicity, and income groups.b Americans who reported consuming an average of three meals per day had a higher diet quality compared to those consuming two meals per day. This was attributable to relatively larger intakes of vegetables, greens and beans, fruit, whole grains, and dairy, and smaller intakes of foods with added sugars and sodium in the three meal per day pattern.b Nearly one-fourth (22–23%) of energy consumed by Americans is provided by snacks.b The committee affirms that healthy dietary patterns and eating frequencies can be constructed in a variety of ways to suit differing life stages and cultural practices. The committee’s findings also suggest that following a dietary pattern that reduces snacking and emphasizes meals, both primarily composed of foods and beverages that contribute to nutrient and food group recommendations, can help align eating patterns with dietary guideline recommendations.b |
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Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
| Topic Area | DGAC (2020 Scientific Report) | DGA (2020–2025)c |
|---|---|---|
| Pregnancy | ||
| Dietary Patterns | Evidence suggests that consuming foods within healthy dietary patterns before and/or during pregnancy may modestly reduce the risk of gestational diabetes, hypertensive disorders of pregnancy, and preterm birth. The components of these beneficial dietary patterns are the same as the dietary components associated with overall chronic disease risk reduction.a Encourage women before and during pregnancy to choose dietary patterns that are higher in vegetables, fruits, whole grains, nuts, legumes, seafood, and vegetable oils, and lower in added sugars, refined grains, and red and processed meats. These dietary patterns protect against poor maternal–fetal outcomes in pregnancy and are consistent with general healthy dietary advice that is given on a population level to achieve healthy weight and prevent chronic disease risk.b With the use of dietary supplements, some women who are pregnant have high intakes of folic acid and iron. Without the supplements these women would be at risk for inadequacy. With the use of supplements, some women who are lactating are exceeding recommendations for iron and folic acid. Given that these high intakes have not been directly linked with |
Women who are pregnant or lactating are encouraged to follow the recommendations on the types of foods and beverages that make up a healthy dietary pattern. The core elements of a healthy diet for women during these life stages are similar to the recommendations for women who are not pregnant. Following a healthy dietary pattern during these life stages can help women meet the DGA and its Key Recommendations. In short, women should meet their increased calorie and nutrient needs with nutrient-dense foods instead of with foods high in added sugars, saturated fat, and sodium. Most health care providers recommend women who are pregnant or planning to become pregnant take a daily prenatal vitamin and mineral supplement in addition to consuming a healthy dietary pattern. Nutrient needs for women who are lactating differ from those who are pregnant. Continued use of prenatal supplements by women who are lactating may exceed their needs for folic acid and iron. Women who are lactating should not exceed the Tolerable Upper Intake Level (UL) of 1,000 micrograms of folic acid and |
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
| Topic Area | DGAC (2020 Scientific Report) | DGA (2020–2025)c |
|---|---|---|
| clinical outcomes, these are not designated of public health concern but warrant monitoring.b Questions related to dietary supplements and/or fortified food sources of vitamins B12 and D, iron, and iodine remain unstudied by this committee.… Given the importance of these nutrients to achieve optimal pregnancy outcomes, and the fact that they are all nutrients of concern among females of reproductive age, additional attention should be given to these nutrients during development of dietary guidelines by future Dietary Guidelines Advisory Committees (DGACs).b |
45 milligrams of iron. Women should seek guidance from a health care provider on appropriate use of prenatal or other dietary supplements during lactation. |
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
| Topic Area | DGAC (2020 Scientific Report) | DGA (2020–2025)c |
|---|---|---|
| Seafood | The committee’s reviews also suggested that seafood intake before pregnancy as part of a healthy dietary pattern, particularly intake of fish high in omega-3 fatty acids, may be related to reduced risk of gestational diabetes and hypertensive disorders, and that consumption during pregnancy may be related to reduced risk of hypertensive disorders and preterm birth and better cognitive development and language and communication development in children. Therefore, the committee concurred with existing recommendations that women who are pregnant should consume at least 8 and up to 12 ounces of a variety of seafood per week from choices that are lower in methlymercury and higher in omega-3 fatty acids.a Encourage women to consume seafood in accordance with recommendations by the 2015–2020 DGA, FDA, and EPA: at least 8 and up to 12 ounces of a variety of seafood per week, from choices that are lower in methylmercury and higher in omega-3 fatty acids.b |
Seafood intake during pregnancy is recommended, as it is associated with favorable measures of cognitive development in young children. Women who are pregnant or lactating should consume at least 8 and up to 12 ounces of a variety of seafood per week, from choices lower in methylmercury. FDA and EPA provide joint advice regarding seafood consumption to limit methylmercury exposure for women who might become or who are pregnant or lactating. Methylmercury can be harmful to the brain and nervous system if a person is exposed to too much of it over time; this is particularly important during pregnancy because eating too much of it can have negative effects on the developing fetus. Based on FDA and EPA’s advice, depending on body weight, some women should choose seafood lowest in methylmercury or eat less seafood than the amounts in the Healthy U.S.-Style Dietary Pattern. Additionally, certain species of seafood (e.g., shark, swordfish, king mackerel) should be avoided during pregnancy. Women following a vegetarian or vegan dietary pattern should consult with a health care provider to determine whether supplementation of iron, vitamin B12, and/or other nutrients such as choline, zinc, iodine, or EPA/DHA is necessary and if so, the appropriate levels to meet their unique needs. |
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
| Topic Area | DGAC (2020 Scientific Report) | DGA (2020–2025)c |
|---|---|---|
| Weight and Weight Gain | Encourage women to achieve a healthy weight before pregnancy, and to strive for gestational weight gain (GWG) within the 2009 IOM recommendations. Previous committees have made this recommendation, and this committee concurs. The increased energy needs during pregnancy can best be met through the consumption of a varied, nutrient-dense diet.b | Weight management is complex, so women should seek advice from a health care provider on the best way to achieve their goals. Women should be encouraged to achieve and maintain a healthy weight before becoming pregnant, as well as follow the gestational weight gain guidelines developed by the National Academies of Sciences, Engineering, and Medicine during pregnancy. |
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
| Topic Area | DGAC (2020 Scientific Report) | DGA (2020–2025)c |
|---|---|---|
| Shortfall Nutrients | Folic acid supplementation is associated with better maternal folate status during pregnancy. It also may reduce the risk of hypertensive disorders among women at high risk or with a previous history of these disorders. Limited evidence suggests that omega-3 fatty acid supplementation during pregnancy can result in favorable cognitive development in children.a Encourage women to consume foods and beverages that are good sources of iron, folate, calcium, choline, magnesium, protein, fiber, and other potential shortfall nutrients.b |
The U.S. Preventive Services Task Force (USPSTF) recommends that all women who are planning or capable of pregnancy take a daily supplement containing 400 to 800 mcg of folic acid. Women who are pregnant or who are planning to become pregnant are advised to take a supplement containing iron when recommended by an obstetrician or other health care provider. Meeting recommended intakes for the dairy and protein food groups—with eggs, meats, and some seafood being notable sources—as well as the beans, peas, and lentils subgroup can help meet choline needs. Meeting nutrient needs through foods and beverages is preferred, but women who are concerned about meeting recommendations should speak with their health care provider to determine whether choline supplementation is appropriate. |
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
| Topic Area | DGAC (2020 Scientific Report) | DGA (2020–2025)c |
|---|---|---|
| Allergenic Foods | Consumption of common allergenic foods, such as eggs and cow milk, during pregnancy did not appear to be associated with an increased risk of food allergies, asthma, and related atopic disease outcomes in the child, nor is the restriction of these foods associated with a decreased risk of these conditions.a Encourage women to not avoid potential allergenic foods during pregnancy unless it is medically warranted.b |
Women do not need to restrict their choices during pregnancy or lactation to prevent food allergy from developing in their child. However, women who are pregnant should pay attention to some important food safety considerations. |
| Alcohol | Encourage women who are or may be pregnant to follow guidance from the 2015 committee that “Women who are or who may be pregnant should not drink. Drinking during pregnancy, especially in the first few months of pregnancy, may result in negative behavioral or neurological consequences in the children. No safe level of alcohol consumption during pregnancy has been established. The committee was not asked to review evidence regarding alcoholic beverage consumption in pregnancy because the departments noted that they would continue the use of existing guidance specifying that women who are pregnant or might be pregnant should not drink alcohol. The committee supports the continued use of this existing guidance.b | Women who are or who may be pregnant should not drink alcohol. However, consumption of alcohol during pregnancy continues to be of concern in the United States. Among women who are pregnant, about 1 in 10 reported consuming alcohol during the past month, with an average intake of two or more drink equivalents on days alcohol is consumed. It is not safe for women to drink any type or amount of alcohol during pregnancy. Women who drink alcohol and become pregnant should stop drinking immediately and women who are trying to become pregnant should not drink at all. Alcohol can harm the baby at any time during pregnancy, even during the first or second month when a woman may not know she is pregnant. |
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
| Topic Area | DGAC (2020 Scientific Report) | DGA (2020–2025)c |
|---|---|---|
| Food Safety | Encourage women who are pregnant to select foods in accordance with food safety recommendations outlined in previous scientific reports of the DGAC and editions of the DGA, including avoiding unpasteurized milk and soft cheeses, undercooked meats, and limiting processed meats. The committee did not review evidence regarding food safety during pregnancy because the departments noted that they would continue the use of existing guidance developed for pregnant women. The committee supports the continued use of this existing guidance. These recommendations can be provided through one-on-one education and through social marketing campaigns and other population-level communication strategies.b | Women who are pregnant and their unborn children are more susceptible than are the general population to the effects of foodborne illnesses, such as listeriosis. They need to take special care to keep foods safe and to not eat foods that increase the risk of foodborne illness. During pregnancy, women should only eat foods containing seafood, meats, poultry, or eggs that have been cooked to recommended safe minimum internal temperatures. They also should take special precautions not to consume unpasteurized (raw) juice or milk, raw sprouts, or some soft cheeses made from unpasteurized milk. Deli and luncheon meats and hot dogs should be reheated to steaming hot or 165°F to kill Listeria, the bacteria that causes listeriosis. |
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
| Topic Area | DGAC (2020 Scientific Report) | DGA (2020–2025)c |
|---|---|---|
| Lactation | ||
| Dietary Patterns | Because of a lack of evidence, the committee was unable to draw conclusions regarding maternal dietary patterns or frequency of eating during lactation and postpartum weight loss. However, the committee’s review suggested that seafood choices are important components of a healthy dietary pattern for women. Therefore, the committee concurred with existing recommendations that women who are lactating should continue to consume seafood at the same amounts recommended during pregnancy. Because of insufficient evidence, the committee was unable to draw conclusions about relationships between dietary patterns during lactation and infant developmental outcomes, between supplementation with omega-3 fatty acids and infant developmental outcomes, or between dietary patterns or consumption or avoidance of specific foods and food allergy, atopic dermatitis, allergic rhinitis, or asthma.a Encourage women who are lactating to consume a wide variety of foods that are consistent with the dietary patterns.b |
Women who are pregnant or lactating are encouraged to follow the recommendations on the types of foods and beverages that make up a healthy dietary pattern. The core elements of a healthy diet for women during these life stages are similar to the recommendations for women who are not pregnant. Following a healthy dietary pattern during these life stages can help women meet the DGA and its Key Recommendations. |
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
| Topic Area | DGAC (2020 Scientific Report) | DGA (2020–2025)c |
|---|---|---|
| Shortfall Nutrients | Moderate evidence did indicate that in women who are lactating, consuming folic acid supplements resulted in higher serum and red blood cell folate concentrations, but no difference in human milk folate concentrations, compared to nonsupplement users.a Encourage consumption of foods and beverages that are good sources of potentially underconsumed nutrients or that are lower than recommended for women who are lactating in the USDA Food Patterns, including choline, magnesium, protein, fiber, and vitamins A, D, and E.b |
The nutrition considerations for the general U.S. population apply to women who are pregnant or lactating. For example, the nutrients of public health concern—calcium, vitamin D, potassium, and dietary fiber—apply to these life stages as well. In addition, iron is a nutrient of public health concern for women who are pregnant. These life stages also have some special nutrient and dietary considerations regarding folate, iodine, choline, seafood, alcoholic beverages, and caffeinated beverages that are discussed in the following sections of this chapter. |
| Iron Supplementation | Encourage women to discontinue the use of prenatal high iron dose supplements during lactation unless they are medically indicated, as these supplements are usually formulated to meet the high iron requirements of pregnant women, not to meet the nutritional requirements for lactating women and can therefore result in iron intakes above the UL.b | For women who are lactating, before menstruation returns, iron needs fall and then return to prepregnancy levels once menstruation resumes. More than half of women continue to use prenatal supplements during lactation. Most prenatal supplements are designed to meet the higher iron needs of pregnancy. Depending on various factors—such as when menstruation returns—prenatal supplements may exceed the iron needs of women who are lactating. Women should seek guidance from a health care provider regarding the appropriate level of iron supplementation during lactation based on their unique needs. |
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
| Topic Area | DGAC (2020 Scientific Report) | DGA (2020–2025)c |
|---|---|---|
| Allergenic Foods | Encourage women to not avoid potential allergenic foods during lactation, unless it is medically indicated to protect the mother’s health.b | Women do not need to restrict their choices during pregnancy or lactation to prevent food allergy from developing in their child. However, women who are pregnant should pay attention to some important food safety considerations. |
| Alcohol | Encourage women to follow guidance from the 2015 DGAC and the AAP that, “women who are breastfeeding should consult with their health care provider regarding alcohol consumption.” This committee did not review evidence regarding alcoholic beverage consumption by lactating women, but supports this prior guidance.b | Not drinking alcohol also is the safest option for women who are lactating. Generally, moderate consumption of alcoholic beverages by a woman who is lactating (up to one standard drink in 1 day) is not known to be harmful to the infant, especially if the woman waits at least 2 hours after a single drink before nursing or expressing breast milk. |
| Caffeine | Encourage women to follow guidance from the 2015 DGAC that “those who are breastfeeding should consult their health care providers for advice concerning caffeine consumption.” This committee did not review evidence regarding caffeine consumption. Insufficient high-quality data are available to make evidence-based recommendations on safe maternal caffeine consumption. Lactating women who are consuming caffeine in foods or beverages may want to monitor the behavior of their infant for fussiness, jitteriness, or poor sleep patterns and adjust their caffeine intake accordingly. The committee supports this guidance.b | Caffeine passes from the mother to infant in small amounts through breast milk, but usually does not adversely affect the infant when the mother consumes low to moderate amounts (about 300 milligrams or less per day, which is about two to three cups of coffee). |
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
| Topic Area | DGAC (2020 Scientific Report) | DGA (2020–2025)c |
|---|---|---|
| Seafood | However, the committee’s review suggested that seafood choices are important components of a healthy dietary pattern for women. Therefore, the committee concurred with existing recommendations that women who are lactating should continue to consume seafood at the same amounts recommended during pregnancy.a Encourage women who are breastfeeding to consume seafood in accordance with recommendations by the 2015–2020 DGA, FDA, and EPA: at least 8 and up to 12 ounces of a variety of seafood per week, from choices that are lower in methylmercury and higher in omega-3 fatty acids.b |
Women who are pregnant or lactating should consume at least 8 and up to 12 ounces of a variety of seafood per week, from choices lower in methylmercury. FDA and EPA provide joint advice regarding seafood consumption to limit methylmercury exposure for women who might become or who are pregnant or lactating. |
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
| Topic Area | DGAC (2020 Scientific Report) | DGA (2020–2025)c |
|---|---|---|
| Weight | Encourage women to maintain a healthy prepregnancy weight, achieve appropriate weight gain during pregnancy, initiate and maintain breastfeeding throughout their child’s infancy, and return to a healthy weight during the postpartum period. This committee did not review evidence regarding relationships of maternal BMI or GWG to lactation success; however, existing evidence shows that high prepregnancy BMI and excess GWG are risk factors for suboptimal breastfeeding outcomes. The 2010 DGA stated, “The development of standardized approaches to promote healthy prepregnancy weight, appropriate weight gain during pregnancy, the initiation and maintenance of breastfeeding during infancy, and a return to healthy weight status postpartum can help prevent overweight and obesity throughout the life span.” This committee supports these recommendations.b | Weight management is complex, so women should seek advice from a health care provider on the best way to achieve their goals. Women should be encouraged to achieve and maintain a healthy weight before becoming pregnant, as well as follow the gestational weight gain guidelines developed by the National Academies of Sciences, Engineering, and Medicine during pregnancy. It is important to note that about half of women retain 10 pounds or more and nearly one in four women retain 20 pounds or more at 12 months postpartum. Postpartum weight retention results in about one in seven women moving from a healthy weight classification before pregnancy to an overweight classification postpartum. Current estimates show that about half of women of childbearing age have a weight classification of overweight or obese. Women with overweight or obesity frequently exceed gestational weight gain recommendations during pregnancy, which increases the likelihood of excess postpartum weight retention. |
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
| Topic Area | DGAC (2020 Scientific Report) | DGA (2020–2025)c |
|---|---|---|
| Birth to 24 Months | ||
| Exclusive Human Milk and/or Infant Formula | The strongest evidence found was that ever being breastfed may reduce the risk of overweight or obesity, type 1 diabetes, and asthma, compared to never being breastfed. Evidence also suggested that a longer duration of any breastfeeding is associated with lower risk of type 1 diabetes and asthma, although the optimal duration of breastfeeding with respect to these outcomes is not well understood. Exclusivity of breastfeeding also was found to be associated with a lower risk of type 1 diabetes. This evidence supports existing AAP and World Health Organization recommendations for breastfeeding in the United States and globally. The committee also investigated associations between infant milk-feeding practices and nutrient status of the infant, including for iron, zinc, iodine, vitamin B12, vitamin D, and fatty acids. For most of these questions, the evidence was scant or nonexistent, which prevented conclusions from being drawn. However, evidence does suggest that human milk feeding may be related to infant fatty acid status, depending on maternal diet. The committee therefore supports recommendations for women who are lactating to consume food sources of long-chain polyunsaturated fatty acids, such as fish. |
Exclusive human milk feeding is one of the best ways to start an infant off on the path of lifelong healthy nutrition. Exclusive human milk feeding, commonly referred to as exclusive breastfeeding, refers to an infant consuming only human milk, and not in combination with infant formula and/or complementary foods or beverages (including water), except for medications or vitamin and mineral supplementation. Families may have a number of reasons for not having human milk for their infant. For example, a family may choose not to breastfeed, a child may be adopted, or the mother may be unable to produce a full milk supply or may be unable to pump and store milk safely due to family or workplace pressures. If human milk is unavailable, infants should be fed an iron-fortified commercial infant formula (i.e., labeled “with iron”) regulated by FDA, which is based on standards that ensure nutrient content and safety. Infant formulas are designed to meet the nutritional needs of infants and are not needed beyond age 12 months. It is important to take precautions to ensure that expressed human milk and prepared infant formula are handled and stored safely. |
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
| Topic Area | DGAC (2020 Scientific Report) | DGA (2020–2025)c |
|---|---|---|
| Despite the importance of the topics examined for the long-term health of the child, the available evidence for many questions was insufficient to form conclusion statements, highlighting the critical need for additional research.a Specifically, the committee concluded that ever being breastfed may reduce the risk of overweight or obesity, type 1 diabetes, and asthma, compared to never being breastfed. For the second issue, evidence suggested that a longer duration of any breastfeeding is associated with lower risk of type 1 diabetes and asthma, although the optimal duration of breastfeeding with respect to these outcomes is not well understood. For the third issue, exclusivity of breastfeeding was found to be associated with a lower risk of type 1 diabetes. Nonetheless, the evidence summarized above supports existing recommendations for breastfeeding in the United States and globally, including many other high-income countries. Those recommendations generally advise exclusive breastfeeding until about age 6 months and continued breastfeeding thereafter, together with appropriate complementary feeding, until at least 12 months or 24 months of age.b |
If families do not have sufficient human milk for their infant but want to feed their infant human milk, they may look for alternative ways to obtain it. It is important for the family to obtain pasteurized donor human milk from a source, such as an accredited human milk bank, that has screened its donors and taken appropriate safety precautions. |
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
| Topic Area | DGAC (2020 Scientific Report) | DGA (2020–2025)c |
|---|---|---|
Therefore, the committee supports the following recommendations:
|
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
| Topic Area | DGAC (2020 Scientific Report) | DGA (2020–2025)c |
|---|---|---|
| Complementary Foods and Beverages (CFBs) | The committee found that introduction at age 4 to 5 months, as compared to 6 months, does not offer long-term advantages or disadvantages with respect to the outcomes reviewed. The reviews also support guidance to provide foods that are rich in iron and zinc during the second 6 months of life among breastfed infants, and the need to provide CFBs that contain adequate amounts of polyunsaturated fatty acids. The committee’s review indicated that introducing peanut and egg, in an age appropriate form, in the first year of life (after age 4 months) may reduce the risk of food allergy to these foods. The evidence for such protective effects is less clear for other types of foods, but the committee found no evidence that avoiding such foods in the first year of life is beneficial with regard to preventing food allergies or other atopic diseases. Avoiding consumption of SSBs by children younger than age 2 years is important for several reasons. First, the energy contributed by such beverages leaves less “room” for energy from nutritious CFBs, leading to potential nutrient gaps. Second, limited evidence suggests that SSB consumption by infants and young children is related to subsequent risk of child overweight. Lastly, intake of SSB in early life may set the stage for greater intake of SSB later in life, with potentially adverse health consequences.a |
At 6 months of age introduce nutrient-dense complementary foods—some may be ready before 6 months but should not be introduced before 4 months. Introduce potentially allergenic foods in first year. SSBs should not be given to children <2 years. At about age 6 months, infants should be introduced to nutrient-dense, developmentally appropriate foods to complement human milk or infant formula feedings. Some infants may show developmental signs of readiness before age 6 months, but introducing complementary foods before age 4 months is not recommended. Waiting until after age 6 months to introduce foods also is not recommended. Starting around that time, complementary foods are necessary to ensure adequate nutrition and exposure to flavors, textures, and different types of foods. Infants should be given age- and developmentally appropriate foods to help prevent choking. It is important to introduce potentially allergenic foods along with other complementary foods. For infants fed human milk, it is particularly important to include complementary foods that are rich in iron and zinc when starting complementary foods. |
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
| Topic Area | DGAC (2020 Scientific Report) | DGA (2020–2025)c |
|---|---|---|
| The existing evidence suggests that CFBs should not be introduced to infants before 4 months of age, and that introduction at age 4 to 5 months, as compared to 6 months, does not offer long-term advantages or disadvantages with regard to growth, size, body composition, overweight or obesity; iron status; or risk of developing food allergy, atopic dermatitis/eczema, or asthma during childhood. This recommendation is consistent with infant feeding guidelines from authoritative sources in high-income countries. Several of these guidelines indicate that complementary foods should be introduced at “about” or “around” 6 months, although some recommend an age range of 4 to 6 months. It should be noted that the outcomes included in the committee’s reviews were limited to infant growth and body composition, nutrient status, developmental milestones, bone health, and atopic or allergic diseases, and did not include infant infectious diseases (e.g., gastrointestinal, respiratory and ear infections) nor any maternal outcomes that may be related to duration of exclusive breastfeeding (and, hence, age of introduction of complementary foods among breastfed infants). Recommendations regarding feeding of infants and children younger than age 2 years should ideally take into account the benefits and | SSBs (e.g., regular soda, juice drinks [not 100% fruit juice], sports drinks, and flavored water with sugar) should not be given to children younger than age 2. Drinks labeled as fruit drinks or fruit-flavored drinks are not the same as 100% fruit juice and contain added sugars. These beverages displace nutrient-dense beverages and foods in the diet of young children. Infants and toddlers do not have room in their diets for the additional calories from added sugars found in these beverages. In addition, SSB intake in infancy and early childhood may predispose children to consume more of these beverages later in life. Before age 12 months, 100% fruit or vegetable juices should not be given to infants. In the second year of life, fruit juice is not necessary, and most fruit intake should come from eating whole fruit. If 100% fruit juice is provided, up to 4 ounces per day can fit in a healthy dietary pattern. Juices that contain added sugars should be avoided. Potentially allergenic foods (e.g., peanuts, egg, cow milk products, tree nuts, wheat, crustacean shellfish, fish, and soy) should be introduced when other complementary foods are introduced to an infant’s diet. Introducing peanut-containing foods in the first year reduces the risk that an infant will develop a food allergy to peanuts. |
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
| Topic Area | DGAC (2020 Scientific Report) | DGA (2020–2025)c |
|---|---|---|
| risks related to all relevant outcomes. The evidence supports guidance to provide foods that are rich in iron and zinc, either intrinsically (e.g., meats) or because of fortification (e.g., iron-fortified infant cereal), particularly during the second 6 months of life among breastfed infants. After iron stores at birth are depleted, an external source of iron is needed to meet the very high requirements for iron to support growth and development. Results of data analysis and food pattern modeling confirm the challenges of meeting iron needs for breastfed infants at ages 6 to 12 months. Iron requirements are lower in the second year of life than during infancy, but a good source of iron is still needed. The evidence also supports the need to provide CFBs that contain adequate amounts of polyunsaturated fatty acids, given their critical role in brain development and the link between dietary intake and the child’s fatty acid status. Intakes of omega-3 and omega-6 fatty acids from CFBs among human milk-fed infants at ages 6 to 12 months are below the estimated needs. The evidence indicates that introducing peanut and egg in the first year of life (after age 4 months) may reduce the risk of food allergy to peanuts and eggs. For other types of food allergy (to fish, shellfish, cow milk products, tree nuts, seeds, | Cow milk, as a beverage, should be introduced at age 12 months or later. There is no evidence that delaying introduction of allergenic foods, beyond when other complementary foods are introduced, helps to prevent food allergy. |
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
| Topic Area | DGAC (2020 Scientific Report) | DGA (2020–2025)c |
|---|---|---|
| wheat, and soy), the evidence for such protective effects is less clear, but the committee found no evidence that avoiding such foods in the first year of life is beneficial with regard to preventing food allergies or other atopic or allergic diseases. Consensus is widespread among authoritative bodies in high-income countries that SSBs should not be consumed by children younger than 2 years of age. The evidence for avoiding or limiting juice intake by the birth to age 24 months population is less clear. A consensus statement from four organizations recommended that juice not be given in the first year of life, and that no more than 4 ounces per day of 100% fruit juice should be consumed at ages 1 to 3 years. That statement was based on the finding that fruit juice consumption in early life may influence consumption of juice and SSBs later in childhood.b |
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
| Topic Area | DGAC (2020 Scientific Report) | DGA (2020–2025)c |
|---|---|---|
| Dietary Supplements | The committee’s examination of evidence on the relationships of supplemental iron to growth, size, and body composition showed no positive effects, and possibly negative effects, on growth when iron supplements were given to breastfed infants younger than age 9 months, compared with infants not given iron or given a placebo. However, for iron-deficient children, providing sufficient iron (from foods, supplements, or fortified foods) is important for reducing iron-deficiency anemia and its consequences, including impaired neurobehavioral development. The committee’s review of vitamin D and bone health in infancy or early childhood showed little to no statistically significant differences in bone health indicators based on doses of vitamin D supplementation greater than 400 IU. Thus, at this time, the existing body of evidence does not provide a basis for recommending vitamin D supplementation above 400 IU per day during infancy (the current AAP recommendation).a The evidence suggesting slower growth among infants given iron supplements suggests that routine iron supplementation of all breastfed infants may not be advisable. An alternative could be to screen for iron deficiency among higher-risk infants younger than |
All infants who are fed human milk exclusively or who receive both human milk and infant formula (mixed fed) will need a vitamin D supplement of 400 IU per day beginning soon after birth. Infant formula is fortified with vitamin D; thus, when an infant is receiving full feeds of infant formula, vitamin D supplementation is not needed. Families who do not wish to provide a supplement directly to their infant should discuss with a health care provider the risks and benefits of maternal high dose supplementation options. Human milk has sufficient vitamin B12 to meet infant needs unless the mother’s vitamin B12 status is inadequate. This can occur for different reasons, including when the mother eats a strictly vegan diet without any animal source foods. When the mother is at risk of vitamin B12 deficiency, human milk may not provide sufficient vitamin B12. In these cases, the mother and/or infant fed human milk may require a vitamin B12 supplement. When feeding infants and toddlers a lacto-ovo vegetarian diet, parents, caregivers, and guardians should consult with a health care provider to determine whether supplementation of iron, vitamin B12, and/or other nutrients is necessary and if so, appropriate levels to meet their unique needs. |
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
| Topic Area | DGAC (2020 Scientific Report) | DGA (2020–2025)c |
|---|---|---|
| age 6 months and provide iron supplements only to those with biomarkers indicating iron deficiency. However, screening for iron deficiency using appropriate biomarkers, such as serum ferritin, could be challenging because it is not as simple as measuring hemoglobin. Iron supplementation is routinely advised for low birthweight and preterm infants beginning at age 1 month, who are born with low iron stores. Apart from those subgroups, infants at higher risk for iron deficiency before age 6 months are those with birth weight less than 3,000 grams, male infants, and those for whom the umbilical cord was clamped immediately. After age 6 months, other sources of iron can be provided, such as iron-rich or iron-fortified complementary foods, so iron supplementation is generally not needed. Further research is needed to (a) evaluate how to best identify and treat infants who become iron deficient before age 6 months, including populations with racial and ethnic diversity, and (b) investigate the biological mechanisms by which iron supplementation during infancy may affect growth, including potential effects on morbidity, the microbiome, zinc and copper status, and oxidative stress or lipid peroxidation. Existing recommendations regarding vitamin D supplementation | Caregivers of infants exclusively fed human milk should talk with their pediatric care provider about whether there may be a need for infants supplementation with iron before age 6 months. |
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
| Topic Area | DGAC (2020 Scientific Report) | DGA (2020–2025)c |
|---|---|---|
| during infancy are based on a body of evidence compiled largely before 2000, the starting date for this review. The limited evidence available since 2000 suggests that doses higher than 400 IU per day (the current American Academy of Pediatrics [AAP] recommendation for infants do not result in differences in biomarkers of bone metabolism in infancy or early childhood. Thus, at this time, the current body of evidence does not provide a basis for recommending vitamin D supplementation above 400 IU per day during infancy. Further research is needed to investigate how much (if any) vitamin D supplementation is needed for breastfed infants when the mother is taking high doses of vitamin D.b | ||
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
| Topic Area | DGAC (2020 Scientific Report) | DGA (2020–2025)c |
|---|---|---|
| Food Patterns | Using the USDA Food Patterns for individuals ages 2 years and older as a starting point, the committee modeled several scenarios that incorporated the potential contribution from human milk or infant formula and reflected the total energy needs at ages 6 to 12 months and 12 to 24 months. The committee was not able to establish a recommended food pattern for infants ages 6 to 12 months but was able to develop potential combinations of CFBs that come close to meeting all nutrient needs. The committee encourages further work to explore options for meeting all nutrient recommendations during that age range. For toddlers ages 12 to 24 months who are fed neither human milk nor infant formula, the committee was able to establish a recommended Food Pattern. The Pattern allows for a variety of nutrient-rich animal-source foods, including meat, poultry, seafood, eggs, and dairy products, as well as nuts and seeds, fruits, vegetables, and grain products, prepared in ways that are developmentally appropriate for this age. Key aspects to emphasize include choosing potassium-rich fruits and vegetables, prioritizing seafood, making whole grains the predominant type of grains offered, and choosing oils over solid fats. |
An important part of establishing an overall healthy dietary pattern is careful consideration of beverages. Guidance for different beverage categories is provided below. Nutrient dense diverse diet that included a variety of food sources from each group starting at 6 months. To support nutrient adequacy, foster acceptance of healthy foods, and set intakes on a path toward a healthy pattern, it is important to encourage foods from all food groups. Because very young children are being exposed to new textures and flavors for the first time, it may take up to 8 to 10 exposures for an infant to accept a new type of food. Repeated offering of foods such as fruits and vegetables increases the likelihood of an infant accepting them. A nutrient-dense, diverse diet from age 6 through 23 months of life includes a variety of food sources from each food group. Protein foods, including meats, poultry, eggs, seafood, nuts, seeds, and soy products, are important sources of iron, zinc, protein, choline, and long-chain polyunsaturated fatty acids. The long-chain polyunsaturated fatty acids, specifically the essential omega-3 and omega-6 fatty |
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
| Topic Area | DGAC (2020 Scientific Report) | DGA (2020–2025)c |
|---|---|---|
| Because nutrient needs are high relative to energy requirements for children ages 6 to 24 months, and the amounts of CFBs that can be consumed are relatively low, especially at the younger ages, it was challenging to develop these Food Patterns. The modeling exercises revealed the importance of prioritizing nutrient-rich food groups and making careful food choices within food groups. Like the USDA Food Patterns for those ages 2 years and older, a strength of the Patterns for younger children is that they provide examples of amounts of food groups and subgroups that can be consumed, but do not dictate specific types of foods. This gives families substantial flexibility to accommodate cultural preferences and cost considerations, and provides opportunities to introduce children to a wide variety of healthy foods that are important in shaping healthy dietary patterns.a Provide a variety of animal-source foods (meat, poultry, seafood, eggs, and dairy), fruits, and vegetables, nuts and seeds, and whole grain products, beginning at ages 6 to 12 months and continuing thereafter, to provide key nutrients, foster acceptance of a variety of nutritious foods, and build healthy dietary habits.b |
acids supplied through seafood, nuts, seeds, and oils, influence the infant’s fatty acid status and are among the key nutrients needed for the rapid brain development that occurs through the infant’s first 2 years of life. Some types of fish such as salmon and trout are also natural sources of vitamin D. To limit exposure to methylmercury from seafood, FDA and EPA issued joint guidance regarding the types of seafood to choose. Vegetables and fruits, especially those rich in potassium, vitamin A, and vitamin C, should be offered to infants and toddlers age 6 through 23 months. The vegetable subgroup of beans, peas, and lentils also provides a good source of protein and dietary fiber. For dairy, families can introduce yogurt and cheese, including soy-based yogurt, before 12 months. However, infants should not consume cow milk, as a beverage, or fortified soy beverage, before age 12 months as a replacement for human milk or infant formula. In the second year of life, when calcium requirements increase, dairy products, including milk, yogurt, cheese, and fortified soy beverages and soy yogurt provide a good source of calcium. Vitamin D-fortified milk and soy |
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
| Topic Area | DGAC (2020 Scientific Report) | DGA (2020–2025)c |
|---|---|---|
|
beverages also provide a good source of vitamin D. For those younger than the age of 2, offer dairy products without added sugar. Grains, including iron-fortified infant cereal, play an important role in meeting nutrient needs during this life stage. Infant cereals fortified with iron include oat, barley, multigrain, and rice cereals. Rice cereal fortified with iron is a good source of nutrients for infants, but rice cereal should not be the only type of cereal given to infants. Offering young children whole grains more often than refined grains will increase dietary fiber as well as potassium intake during the second year of life and help young children establish healthy dietary practices. In the second year of life, toddlers consume less human milk, and infant formula is not recommended. Calories and nutrients should predominantly be met from a healthy dietary pattern of age-appropriate foods and beverages. The Healthy U.S.-Style Dietary Pattern presented here is intended for toddlers ages 12 through 23 months who no longer consume human milk or infant formula. The pattern represents the types and amounts of foods needed to meet energy and nutrition requirements for this period. |
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
| Topic Area | DGAC (2020 Scientific Report) | DGA (2020–2025)c |
|---|---|---|
|
is likely to displace energy from nutrient-dense foods, increasing the risk of nutrient inadequacies. Moreover, consumption of SSBs is linked with increased risk of overweight or obesity. Because food preferences and patterns are beginning to form during this developmental stage, and taste and flavor preferences appear to be more malleable in this life stage than in older children, it is important that caregivers limit consumption of foods that contain added sugars, while encouraging consumption of nutrient-dense foods.b |
For toddlers who are still consuming human milk (approximately one-third at 12 months and 15% at 18 months), a healthy dietary pattern should include a similar combination of nutrient-dense complementary foods and beverages. |
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
| Topic Area | DGAC (2020 Scientific Report) | DGA (2020–2025)c |
|---|---|---|
| Food Patterns for Individuals >2 Years of Age | The three current USDA Food Patterns are the Healthy U.S.Style Pattern, the Healthy Vegetarian Pattern, and the Healthy Mediterranean-Style Pattern. Based on its review of the evidence, the committee confirmed that these Food Patterns represent healthy dietary patterns in that they provide the majority of energy from plant-based foods, such as vegetables, fruits, legumes, whole grains, nuts, and seeds; provide protein and fats from nutrient-rich food sources; and limit intakes of added sugars, solid fats, and sodium. The committee noted that the types of foods that individuals should eat are remarkably consistent and that these patterns can be applied across life stages, even taking into account specific nutrient needs at particular life stages. Because the risk of chronic disease begins early in life, taking steps to apply the best understanding of healthy dietary intakes in the earliest days of life can support lifelong chronic disease risk reduction and improved quality of life.a The recommended USDA Food Patterns for Americans, which achieve healthy dietary intake and meet nutritional goals and energy balance, include the Healthy U.S.-Style, the Healthy Vegetarian, and the Healthy Mediterranean-Style Patterns. No additional food patterns were developed during the work of this committee, confirming the |
Children and adolescents are encouraged to follow the recommendations on the types of foods and beverages that make up a healthy dietary pattern. The USDA Dietary Patterns, including the Healthy U.S.Style Dietary Pattern, provide a framework to help children and adolescents follow a healthy dietary pattern and meet the DGA and their Key Recommendations. The USDA Food Patterns can be customized based on dietary needs, personal preferences, and budgetary constraints. A variety of nutrient-dense foods and beverages can be selected across the food group and subgroups as part of an overall healthy dietary pattern. Adults are encouraged to follow the recommendations on the types of foods and beverages that make up a healthy dietary pattern. The USDA Dietary Patterns provide a framework of nutrient-dense foods and beverages that can be adapted to accommodate budget, culture, and personal preferences to help adults follow a healthy dietary pattern and meet the DGA and their Key Recommendations. |
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
| Topic Area | DGAC (2020 Scientific Report) | DGA (2020–2025)c |
|---|---|---|
| guidance on Patterns issued from this and previous committees.b Food pattern modeling helps to affirm the recommended dietary patterns by demonstrating their effect on nutrient adequacy. Food pattern modeling highlights the effect that diet composition and quality have on nutrient intakes. Consumption of the optimal balance of energy and nutrients has always been a key concern of the committee because under- and overconsumption of certain nutrients and food components are associated with an increased risk of chronic disease. Indeed, food components of public health concern have been identified by the committee based on inadequate intakes of key nutrients that have biomarkers that indicate increased disease risk.b Strong evidence shows the types of foods individuals should primarily be consuming, and this has been reaffirmed by the work of this committee. Additionally, general consensus exists around what types of foods should be limited, as they contribute high amounts of energy with minimal contribution to the nutrients needed to promote optimal health and avoid chronic disease. Even though some needs have important |
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
| Topic Area | DGAC (2020 Scientific Report) | DGA (2020–2025)c |
|---|---|---|
| variations across life stages, the foods that individuals should eat over the life span are remarkably consistent. If healthy eating patterns can be established early in life and sustained thereafter, the impact on the prevalence of chronic disease could be significant.b To facilitate shifting American dietary intakes toward healthier directions, access to healthy food options is critical. The committee recognizes that several barriers and facilitators affect access and influence consumers’ dietary behaviors beyond nutritional considerations, including food costs and food security status. The committee recommends that USDA and the U.S. Department of Health and Human Services continue to assess how food costs and food security status influence food intake and the resulting nutritional status in the American public.b The Healthy U.S.-Style Pattern described in this chapter will serve as the foundation for updating the USDA Food Plans that calculate market basket costs of a healthy eating pattern at four levels: the Thrifty Food Plan (i.e., minimal cost), Low Cost, Moderate Cost, and Liberal Food Plans. These Food Plans demonstrate that healthy eating does not need to be cost prohibitive. However, |
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
| Topic Area | DGAC (2020 Scientific Report) | DGA (2020–2025)c |
|---|---|---|
| little information exists on how food insecurity, which is the limited or uncertain availability of nutritionally adequate and safe foods or limited or uncertain ability to acquire acceptable foods in socially acceptable ways, affects food purchasing behaviors.b | ||
a DGAC (Dietary Guidelines Advisory Committee). 2020. Scientific Report of the 2020 Dietary Guidelines Advisory Committee: Advisory Report to the Secretary of Agriculture and the Secretary of Health and Human Services. Part A. Washington, DC: Agricultural Research Service, U.S. Department of Agriculture.
b DGAC. 2020. Scientific Report of the 2020 Dietary Guidelines Advisory Committee: Advisory Report to the Secretary of Agriculture and the Secretary of Health and Human Services. Part B-F. Washington, DC: Agricultural Research Service, U.S. Department of Agriculture.
c USDA and HHS (U.S. Department of Agriculture and U.S. Department of Health and Human Services). 2020. Dietary Guidelines for Americans, 2020–2025. Washington, DC: Agricultural Research Service, U.S. Department of Agriculture.
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
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Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
Suggested Citation:
"Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2022. Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report. Washington, DC: The National Academies Press.
doi: 10.17226/26406.
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