Part 1 of 2 response to my 11/18/15 FOIA request re: 2015 US DGAC members Barbara Millen, Alice...

8/17/2019 Part 1 of 2 response to my 11/18/15 FOIA request re: 2015 US DGAC members Barbara Millen, Alice Lichtenstein, …

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1

Casavale, Kellie (OS/OASH)

From: Lichtenstein, Alice

Sent: Friday, September 20, 2013 10:39 AM

To: Nelson, Miriam; Casavale, Kellie (OS/OASH); Goodwin, Stephanie (HHS/OASH); 'Millen,

Barbara E'; 'Perez-Escamilla, Rafael'; 'Rihane, Colette - CNPP'

Subject: RE: Subgroup naming

Ditto about the call. I like the subcommittee names as suggested although would

propose being a bit more general for the first, perhaps;

Foods and Nutrients to Promote

Positive message and gives us enough flexibility to address challenges, a.k.a.,

nutrients of concern, under consumed food groups, and quality within foods groups(refined vs whole grains).

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

Alice H. Lichtenstein, D.Sc.

Gershoff Professor of Nutrition Science and Policy

Director and Senior Scientist, Cardiovascular Nutrition Laboratory

Tufts University

JM USDA Human Nutrition Research Center on Aging

711 Washington

Street

Boston, MA 02111

phone: 617 556 3127

e‐mail: [email protected]

From: Nelson, MiriamSent: Friday, September 20, 2013 10:11 AMTo: Casavale, Kellie (OS/OASH); Goodwin, Stephanie (HHS/OASH); 'Millen, Barbara E'; 'Perez-Escamilla, Rafael';Lichtenstein, Alice; 'Rihane, Colette - CNPP'Cc: Nelson, MiriamSubject: Subgroup naming

Barbara, Alice, and Kellie,

Good call today. Here is what I am thinking for a title for the fifth subcommittee:

1. Food Groups, Nutrients of Concern & Health

2. Dietary Patterns & Health

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2

3. Behavior Change

4. Food & Physical Activity Environment

5. Food Consumption Status, Sustainability & Food Safety

Many thanks! Best, Mim

Miriam E. Nelson, PhD

Professor, Friedman School of Nutrition Science and Policy

Tufts University

150 Harrison Avenue, RM 249

Boston, MA 02111

phone: 617-636-3735

fax: 617-636-3727 www.StrongWomen.org

www.ChildObesity180.org

www.facebook.com/StrongWomenwithMiriamNelson

Twitter: @DrMiriamNelson

From: Casavale, Kellie (OS/OASH) [[email protected]]Sent: Thursday, September 19, 2013 5:36 PMTo: Casavale, Kellie (OS/OASH); Olson, Richard (HHS/OASH); Nelson, Miriam; McPeak, Holly (HHS/OASH); Goodwin,Stephanie (HHS/OASH); Thelusma, Joann; 'Spahn, Joanne - CNPP'; 'Millen, Barbara E'; 'Donna Blum-Kemelor'; 'MollyMcGrane'; Sehlke, Mackenzie M; 'Obbagy, Julie - CNPP'; Trish Britten; 'Adrianna Mironick'; Cole, Susan - CNPP(Contractor); 'Perez-Escamilla, Rafael'; Essery, Eve - CNPP; Bowman, Shanthy; Lichtenstein, Alice; 'Rihane, Colette -CNPP'Cc: Post, Robert - CNPP; Anne RodgersSubject: Agenda and Attachments: Science Review Subcommittee Meeting, Friday, Sept. 20th, 8:30-10:00 am

SRSC (and support staff),

On behalf of Barbara, Please find the agenda for tomorrow mornings SRSC call and attachments. These include a

compilation of your preliminary thoughts on subcommittees, which are the focus for discussion for tomorrow’s call.

Currently SRSC meetings are only scheduled through the October public meeting. Tomorrow, we also need to touch base

quickly to determine if you want to continue with every other Friday 9:30‐10:30 am after the October meeting or some

other time.

Science Review Subcommittee Meeting

Friday, September 20, 2013 8:30 am – 10:00 am EDT

Conference Call:

Passcode:

Agenda

Attachments

September 6th SRSC Meeting Minutes

Starting Proposals for Subcommittee Organization

3 Work Group Topic Tables

(b) (6)

(b) (6)

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3

NEL Methodology, Defining Inclusion/Exclusion Criteria

Inclusion/Exclusion Criteria Template (same as was used for NEL training)

Thanks,

Kellie

Kellie O. Casavale, PhD, RD

Nutrition Advisor, Division of Prevention Science

Co‐Executive Secretary, 2015 Dietary Guidelines Advisory Committee

HHS, Office of Disease Prevention and Health Promotion

-----Original Appointment-----From: Casavale, Kellie (OS/OASH)Sent: Tuesday, June 25, 2013 12:27 PMTo: Olson, Richard (HHS/OASH); 'Nelson, Miriam'; McPeak, Holly (HHS/OASH); Goodwin, Stephanie (HHS/OASH); 'JoannThelusma'; 'Spahn, Joanne - CNPP'; 'Millen, Barbara E'; 'Donna Blum-Kemelor'; 'Molly McGrane'; Sehlke, Mackenzie M;'Obbagy, Julie - CNPP'; Trish Britten; 'Adrianna Mironick'; Cole, Susan - CNPP (Contractor); 'Perez-Escamilla, Rafael';Essery, Eve - CNPP; Bowman, Shanthy; 'Lichtenstein, Alice'; 'Rihane, Colette - CNPP'Cc: Post, Robert - CNPP; Anne RodgersSubject: Science Review Subcommittee MeetingWhen: Friday, September 20, 2013 8:30 AM-10:00 AM (GMT-05:00) Eastern Time (US & Canada).Where:

This is an update to the time for the Sept. 20th SRSC call. It is now earlier and 30 minutes longer. Rafael will not be able to

be on this call as he will be traveling back from Spain.

Thanks,

Kellie

(b) (6)

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From: Millen, Barbara E

Sent: Thursday, October 17, 2013 2:19 PM

To: Casavale, Kellie (OS/OASH)

Cc: Olson, Richard (HHS/OASH)

Subject: RE: Minutes Meeting 1

Kellie and Rick,

Welcome back. I can’t imagine how difficult the shutdown has been for everyone there. We have all been thinking

about you and hoping for the best of outcomes.

We will manage but hope you can stay on as long as you’re

completely comfortable.

According to my schedule, we have a SRSC call on Monday. Do you think that will still happen? I leave for Houston early

tomorrow morning and will be at FNCE until late on Tuesday. While you were out, Alice and I have worked on WG3 as

planned and devised a plan. I circulated our thoughts separately to Mim and Raphael (consistent with our protocol) and

spoke with Raphael yesterday. Alice and I wanted to confirm that he was in agreement on a strategy to streamline the

food group questions and reduce the overall number of ideas from WG3. Basically, we propose that when food groups

are examined in relationship to health outcomes, that they be treated as part of the dietary pattern questions. The idea

here would be to determine whether there are food group ‘drivers’ of the pattern’s relationship to health outcomes

(such as breast cancer risk). This would also allow to control for confounding that often occurs when food group

analyses don’t control for the overall dietary pattern. Raphael suggested that there was a considerable amount of

attention paid to cross‐sectional and prospective studies of food groups and health outcomes in 2010 and that study

design weaknesses (such as confounding by dietary pattern) limited the conclusions that could be made or weakened

the strength of evidence. We thought that literature focusing on food groups and health outcomes [without control for

dietary patterns]

could

be

limited

to

existing

systematic

reviews

rather

than

a review

of

original

research.

That

would

probably work except for relatively new health outcomes of interest (for example, perhaps mental health). We did all

agree that food groups and intermediate markers would still be considered and that controlled feeding trials should

provide this evidence. Mim also has the summary Alice and I did and is still reviewing it.

Would you like me to forward it to you or wait until our next call?

All best,

Barbara

Dr. Barbara E. Millen

[email protected]

From: Casavale, Kellie (OS/OASH) [mailto:[email protected]]Sent: Thursday, October 17, 2013 11:08 AMTo: Millen, Barbara ECc: Olson, Richard (HHS/OASH)Subject: RE: Minutes Meeting 1

(b) (6)

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Thanks, Barbara! We are back to work today.

Just wanted to give you a heads up.

We will be pulling together any edits we have on the meeting minutes and can update them online. Our new web

contractor mentioned it would be a costly step, so we will only want to do it once. So, we may wait until we have any

others we’ve found in the interim as well.

Thanks!

Kellie





From: Millen, Barbara E [mailto:[email protected]]Sent: Wednesday, October 02, 2013 10:47 AMTo: Casavale, Kellie (OS/OASH)

Cc: Olson, Richard (HHS/OASH)Subject: Minutes Meeting 1

Hi Kellie,

I know that you are restricted from answering but I thought I would send along my edits to the minutes from Public

Meeting 1. I thought you did a great job and that they read well. I had only minor comments on the material you

prepared and offer suggestions below. Attached is a summary of my comments. I hope you consider including them

too.

All best,

Barbara

Page 7 para 3, last 2 lines Change “….challenging to grab” to “challenging to attract”.

Page 25 What works for individuals to adhere to healthy dietary patterns (i.e. I would suggest that this be edited to say

“sound evidence‐based methods for promoting behavior change at individual and population levels). This including both

traditional counseling and communications methods as well as new and innovative technologies that can be applied in

various settings.

I think WG 2 is intending that the Subcommittee examines both traditional behavioral methods (what providers,

approaches, settings and modes are known to be effective) as well as the evidence on web/mobile/telephonic

approaches.

Page 27 Dr. Millen noted that important descriptive information on behavioral methods from clinical trials has not been

mined sufficiently. She encouraged paying attention to dietary pattern protocols and methods/modes of intervention

(including provider/team characteristics and settings) used to achieve and sustain improved dietary behavior.

(b) (6)

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6



Sent: Thursday, October 17, 2013 3:07 PM

To: Casavale, Kellie (OS/OASH)

Cc: Olson, Richard (HHS/OASH)

Subject: RE: Minutes Meeting 1

Attachments: AL BEM WG Priority Topics SRSC 10.17.2013.docx

Hi Kellie,

Alice and I began the task of streamlining WG3 by summarizing the top (1) priority areas from each work group and

reviewing them for scope and overlap. As part of this discussion we tried to think carefully about whether the most

important topics would be covered if we were only able to answer questions in this tier. Then we talked about how to

handle WG3 specifically since we had agreed in our last SRSC call that the list of questions had to be streamlined. This

let us to the recommendation to incorporate food groups into WG2 questions to the extent possible.

Attached is the working draft we developed and circulated. Let’s add it to the Monday agenda if you think it’s

reasonable and we can see whether we can reach consensus on a reorganization of the questions and our analytical

strategies.

All best,

Barbara

From: Casavale, Kellie (OS/OASH) [mailto:[email protected]]Sent: Thursday, October 17, 2013 2:27 PMTo: Millen, Barbara ECc: Olson, Richard (HHS/OASH)Subject: RE: Minutes Meeting 1

Perfect timing, Barbara. Rick, Colette, and I just touched base and I am about to send out a message noting that we are

still on for the SRSC call on Monday. A discussion of what you described below would be great. If there is a document for

me to include for the meeting related to WG3 and that discussion, please send it my way and I can include it. We also

have several other items for discussion. I will work on an agenda tomorrow.

Thanks!

Kellie



Co‐Executive

Secretary,

2015

Dietary

Guidelines

Advisory

Committee


From: Millen, Barbara E [mailto:[email protected]]Sent: Thursday, October 17, 2013 2:19 PMTo: Casavale, Kellie (OS/OASH)Cc: Olson, Richard (HHS/OASH)Subject: RE: Minutes Meeting 1

Kellie and Rick,

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7

Welcome back. I can’t imagine how difficult the shutdown has been for everyone there. We have all been thinking

about you and hoping for the best of outcomes.

We will manage but hope you can stay on as long as you’re

completely comfortable.

According to

my

schedule,

we

have

a SRSC

call

on

Monday.

Do

you

think

that

will

still

happen?

I leave

for

Houston

early

tomorrow morning and will be at FNCE until late on Tuesday. While you were out, Alice and I have worked on WG3 as

planned and devised a plan. I circulated our thoughts separately to Mim and Raphael (consistent with our protocol) and

spoke with Raphael yesterday. Alice and I wanted to confirm that he was in agreement on a strategy to streamline the

food group questions and reduce the overall number of ideas from WG3. Basically, we propose that when food groups

are examined in relationship to health outcomes, that they be treated as part of the dietary pattern questions. The idea

here would be to determine whether there are food group ‘drivers’ of the pattern’s relationship to health outcomes

(such as breast cancer risk). This would also allow to control for confounding that often occurs when food group

analyses don’t control for the overall dietary pattern. Raphael suggested that there was a considerable amount of

attention paid to cross‐sectional and prospective studies of food groups and health outcomes in 2010 and that study

design weaknesses (such as confounding by dietary pattern) limited the conclusions that could be made or weakened

the strength of evidence. We thought that literature focusing on food groups and health outcomes [without control for

dietary patterns]

could

be

limited

to

existing

systematic

reviews

rather

than

a review

of

original

research.

That

would

probably work except for relatively new health outcomes of interest (for example, perhaps mental health). We did all

agree that food groups and intermediate markers would still be considered and that controlled feeding trials should

provide this evidence. Mim also has the summary Alice and I did and is still reviewing it.

Would you like me to forward it to you or wait until our next call?

All best,

Barbara


[email protected]

From: Casavale, Kellie (OS/OASH) [mailto:[email protected]]Sent: Thursday, October 17, 2013 11:08 AMTo: Millen, Barbara ECc: Olson, Richard (HHS/OASH)Subject: RE: Minutes Meeting 1

Thanks, Barbara! We are back to work today.

Just wanted to give you a heads up.

We will be pulling together any edits we have on the meeting minutes and can update them online. Our new web contractor mentioned it would be a costly step, so we will only want to do it once. So, we may wait until we have any

others we’ve found in the interim as well.

Thanks!

Kellie



(b) (6)

(b) (6)

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8



From: Millen, Barbara E [mailto:[email protected]]Sent: Wednesday, October 02, 2013 10:47 AMTo: Casavale, Kellie (OS/OASH)Cc: Olson, Richard (HHS/OASH)Subject: Minutes Meeting 1

Hi Kellie,

I know that you are restricted from answering but I thought I would send along my edits to the minutes from Public

Meeting 1. I thought you did a great job and that they read well. I had only minor comments on the material you

prepared and offer suggestions below. Attached is a summary of my comments. I hope you consider including them

too.

All best,

Barbara

Page 7 para

3,

last

2 lines

Change

“….challenging

to

grab”

to

“challenging

to

attract”.

Page 25 What works for individuals to adhere to healthy dietary patterns (i.e. I would suggest that this be edited to say

“sound evidence‐based methods for promoting behavior change at individual and population levels). This including both

traditional counseling and communications methods as well as new and innovative technologies that can be applied in

various settings.

I think WG 2 is intending that the Subcommittee examines both traditional behavioral methods (what providers,

approaches, settings and modes are known to be effective) as well as the evidence on web/mobile/telephonic

approaches.

Page 27 Dr. Millen noted that important descriptive information on behavioral methods from clinical trials has not been

mined

sufficiently.

She

encouraged

paying

attention

to

dietary

pattern

protocols

and

methods/modes

of

intervention

(including provider/team characteristics and settings) used to achieve and sustain improved dietary behavior.

PSC-HHS-000008


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9



Sent: Sunday, March 30, 2014 2:02 PM

To: Essery, Eve - CNPP; Frank Hu; Siega-Riz, Anna Maria; [email protected]

Cc: Casavale, Kellie (OS/OASH); Obbagy, Julie - CNPP

Subject: RE: DGAC SC2: Dietary patterns & CVD, BW, & T2D

Hi Eve,

This is very helpful. I wonder if we might discuss the data abstraction. Work has begun in SC4 with a review of

systematic reviews and meta analyses and the data abstraction might be quite different that with the NEL and what was

done with caffeine. The SC might be interested in having more discussion in an upcoming call if possible. Also, I

wondered if we might consider a few of the excluded studies: 32 might provide information on food ‘drivers’ of the

patterns, 35 is examining inflammatory markers that may be of interest relating to PUFAs. Also, along with our theme of

what works, if the following reviews were of RCTs, we might consider them: 31,36,37,41,45. And, 44 is the only one I

saw addressing the issue of dietary variety which may be of interest or worth a bit of SC discussion.

When abstracting these studies, a careful definition of the patterns is important, particularly ‘Mediterranean’ since it

varies so much and the dietary patterns may not be identifiable from the ‘label’.

All best,

barbara


[email protected]

From: Essery, Eve - CNPP [mailto:[email protected]]Sent: Friday, March 28, 2014 6:07 PMTo: Frank Hu; Siega-Riz, Anna Maria; [email protected]; Millen, Barbara ECc: 'Casavale, Kellie (OS/OASH)'; Obbagy, Julie - CNPPSubject: DGAC SC2: Dietary patterns & CVD, BW, & T2D

Hi Frank, Anna Maria, Cheryl, and Barbara,

I just wanted to give you a quick update on the dietary patterns and CVD, BW, and T2D questions. As requested at thepublic meeting, Yat Ping conducted a search for existing systematic reviews/ meta-analyses published since 2008. Hersearch identified 47 articles. I just finished an abstract review of the articles, and 30 are potentially relevant (with mostarticles addressing CVD, but a handful each for body weight and T2D). The next step will be for staff to review the full textof these articles. It is likely that some of the articles will drop off the list following full text review.

I’ve attached the results of the abstract review in case you are interested. I’ll send an updated list after the full text review.From there, the staff will look at reference overlap between the reviews (and the NEL and AHA/ACC reviews), and youcan discuss how best to include these existing systematic reviews/ meta-analyses in your review of the evidence.

I just wanted to let you know that things are moving… More soon!Eve

Eve Essery Stoody, PhDNutritionist | Center for Nutrition Policy and Promotion | USDA3101 Park Center Drive, Room 1034 | Alexandria, VA [email protected] | Office: 703-305-2563 | Fax: 703-305-3300

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www.DietaryGuidelines.gov | www.ChooseMyPlate.gov | www.NEL.gov

This electronic message contains information generated by the USDA solely for the intended recipients. Any

unauthorized interception of this message or the use or disclosure of the information it contains may violate thelaw and subject the violator to civil or criminal penalties. If you believe you have received this message in error,

please notify the sender and delete the email immediately.

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Sent: Friday, May 02, 2014 4:40 PM

To: Lichtenstein, Alice; Anne Rodgers

Cc: Casavale, Kellie (OS/OASH); Olson, Richard (HHS/OASH); 'Rihane, Colette - CNPP'

Subject: RE: Notes from last night -- notes on integration chapter

Thank you Alice. I do agree; dietary guidelines that are based upon our best understanding of nutritional needs of the

population should be the basis of our guidance and the framework of our programs. However, I would add that an

improved understanding of the determinants of nutritional risk (including food insecurity and other factors) and their

relationship to health outcomes may help us better design programs and interventions to reach vulnerable population

or improve program/service effectiveness. Agreed? Thought I would add these further thoughts.

Barbara


[email protected]

From: Lichtenstein, Alice [mailto:[email protected]]Sent: Friday, May 02, 2014 4:19 PMTo: Anne Rodgers; Millen, Barbara ECc: 'Casavale, Kellie (OS/OASH)'; 'Olson, Richard (HHS/OASH)'; 'Rihane, Colette - CNPP'Subject: RE: Notes from last night -- notes on integration chapter

Very useful call today. I think I figured out what I was trying to suggest at the end ofthe call, in an inarticulate way.

Dietary Guidelines should drive programs aimed at addressing issues of householdfood insecurity, household food insecurity should not drive formulation of dietaryguidelines. The issue of diet quality and food insecurity is not new and is embedded incurrent federal assistance programs. Isn’t that why federal feeding programs are tiedto the DG and food assistance programs are either tied to the DG (e.g., WIC) or SNAPconfigured in a way to maximize their purchasing power (e.g., restrictions onpurchasing prepared foods)?

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐


Gershoff Professor

of

Nutrition

Science

and

Policy


Tufts University


711 Washington Street

Boston, MA 02111

phone: 617 556 3127


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12

From: Anne RodgersSent: Friday, May 02, 2014 2:36 PMTo: 'Millen, Barbara E'; Lichtenstein, AliceCc: 'Casavale, Kellie (OS/OASH)'; 'Olson, Richard (HHS/OASH)'; 'Rihane, Colette - CNPP'Subject: FW: Notes from last night -- notes on integration chapter

Anne

Brown

Rodgers

Science Writer

From: Casavale, Kellie (OS/OASH) [mailto:[email protected]]Sent: Wednesday, March 19, 2014 3:21 PMTo: Anne RodgersSubject: FW: Notes from last night

This is

the

follow

‐up

e‐mail

(below)

with

Mim’s

notes

that

I mentioned

on

the

phone

yesterday.

Several

Committee

members have also asked for the updated version of chapter guidance. What’s the status of that document? Are you

also getting the input you need to move the examples of conclusion statements forward?

Kellie





From: Nelson, Miriam [mailto:[email protected]]Sent: Friday, March 14, 2014 6:14 AMTo: '[email protected]'; [email protected] Cc: Casavale, Kellie (OS/OASH); Lichtenstein, AliceSubject: Notes from last night

Hi Barbara and Mary,Great discussion last night late in the dinner about the "synthesis" chapter.

Because I am apt to forget things, I thought I would send along notes on the ideas. I am including Alice on the emailbecause she prompted the conversation!

Here you go (without word-smithing or considering order):

There is the most evidence for healthy food and nutrition from the following:

1. Activate health care sector in nutrition/food health promotion2. Place matters: improve food environment where you live, work, learn, and play3. Respect culture4. Calories matter5. Eat more: vegetables, fruits, legumes, nuts, and seeds7. Eat Less: Added sugars, refined grains, saturated fat, sodium, meats8. Move more!

(b) (6)

(b) (6)

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(I will work on a sustainability one...)

Just didn't want to forget them.Thanks. Mim

PS: here is the section from 2010 - I know we can do better:

Excerpted verbatim:

Four Main Integrated Findings to be Used in Developing the 2010 Dietary Guidelines for Americans:1. Reduce the incidence and prevalence of overweight and obesity of the US population by reducing overall calorie in takeand increasing physical activity.

2. Shift food intake patterns to a more plant-based diet thatemphasizes vegetables, cooked dry beans and peas, fruits, wholegrains,nuts, and seeds. In addition, increase the intake of seafood andfat-free and low-fat milk and milk products, and consume onlymoderate amounts of lean meats, poultry, and eggs.

3. Significantly reduce intake of foods containing added sugars andsolid fats because these dietary components contribute excesscalories and few, if any,nutrients. In addition, reduce sodium intakeand lower intake of refined grains, especially refined grains that arecoupled with added sugar, solid fat, and sodium.

4. Meet the 2008 Physical Activity Guidelines for Americans.

Miriam E. Nelson, PhD Professor, Friedman School of Nutrition Science and Policy Tufts University

150 Harrison Avenue, RM 249 Boston, MA 02111 phone: 617-636-3735 fax: 617-636-3727

www.StrongWomen.org www.ChildObesity180.org www.facebook.com/StrongWomenwithMiriamNelson Twitter: @DrMiriamNelson

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Sent: Friday, May 02, 2014 4:58 PM

To: Lichtenstein, Alice; Anne Rodgers

Cc: Casavale, Kellie (OS/OASH); Olson, Richard (HHS/OASH); 'Rihane, Colette - CNPP'

Subject: RE: Notes from last night -- notes on integration chapter

I agree that this is not our task to design programs or services since that is part of the policy development

process. However, we are looking at ‘what works’ and are trying to cull out the dietary patterns, food and nutrient

‘drivers’ of the patterns, and features of interventions (self ‐monitoring, comprehensive lifestyle intervention, school‐

based and other community programs, etc.) that have proven effectiveness and efficacy or present as ‘best practices’

which we can summarize. Hope that helps clarify.

Barbara


[email protected]

From: Lichtenstein, Alice [mailto:[email protected]]Sent: Friday, May 02, 2014 4:51 PMTo: Millen, Barbara E; Anne RodgersCc: 'Casavale, Kellie (OS/OASH)'; 'Olson, Richard (HHS/OASH)'; 'Rihane, Colette - CNPP'Subject: RE: Notes from last night -- notes on integration chapter

I agree with your reasoning, however, I do not agree that this committee is tasked to“design programs and interventions to reach vulnerable populations or improveprogram/service effectiveness”. Were that the case we would have individuals with

different types of expertise on the committee. That task sounds like an IOMproject. We have a huge job just with the nutrition science/food intake aspect and as Ikeep saying, probably too many times in on any one day, I am concerned that as wekeep expanding our scope we will scrimp on our main goal.

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐




Tufts University


711 Washington

Street

Boston, MA 02111

phone: 617 556 3127


From: Millen, Barbara E [mailto:[email protected]]Sent: Friday, May 02, 2014 4:40 PMTo: Lichtenstein, Alice; Anne Rodgers

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Cc: 'Casavale, Kellie (OS/OASH)'; 'Olson, Richard (HHS/OASH)'; 'Rihane, Colette - CNPP'Subject: RE: Notes from last night -- notes on integration chapter

Thank you Alice. I do agree; dietary guidelines that are based upon our best understanding of nutritional needs of the

population should be the basis of our guidance and the framework of our programs. However, I would add that an

improved understanding of the determinants of nutritional risk (including food insecurity and other factors) and their

relationship to health outcomes may help us better design programs and interventions to reach vulnerable population

or improve program/service effectiveness. Agreed? Thought I would add these further thoughts.

Barbara


[email protected]

From: Lichtenstein, Alice [mailto:[email protected]]Sent: Friday, May 02, 2014 4:19 PMTo: Anne Rodgers; Millen, Barbara ECc: 'Casavale, Kellie (OS/OASH)'; 'Olson, Richard (HHS/OASH)'; 'Rihane, Colette - CNPP'Subject: RE: Notes from last night -- notes on integration chapter

Very useful call today. I think I figured out what I was trying to suggest at the end ofthe call, in an inarticulate way.

Dietary Guidelines should drive programs aimed at addressing issues of householdfood insecurity, household food insecurity should not drive formulation of dietaryguidelines. The issue of diet quality and food insecurity is not new and is embedded incurrent federal assistance programs. Isn’t that why federal feeding programs are tiedto the DG and food assistance programs are either tied to the DG (e.g., WIC) or SNAPconfigured in a way to maximize their purchasing power (e.g., restrictions on

purchasing prepared foods)?

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐




Tufts University



Boston, MA 02111

phone: 617 556 3127


From: Anne RodgersSent: Friday, May 02, 2014 2:36 PMTo: 'Millen, Barbara E'; Lichtenstein, AliceCc: 'Casavale, Kellie (OS/OASH)'; 'Olson, Richard (HHS/OASH)'; 'Rihane, Colette - CNPP'Subject: FW: Notes from last night -- notes on integration chapter

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Anne Brown Rodgers

Science Writer

From: Casavale, Kellie (OS/OASH) [mailto:[email protected]]Sent: Wednesday, March 19, 2014 3:21 PMTo: Anne RodgersSubject: FW: Notes from last night

This is the follow‐up e‐mail (below) with Mim’s notes that I mentioned on the phone yesterday. Several Committee

members have also asked for the updated version of chapter guidance. What’s the status of that document? Are you

also getting the input you need to move the examples of conclusion statements forward?

Kellie


Nutrition Advisor,

Division

of

Prevention

Science



From: Nelson, Miriam [mailto:[email protected]]Sent: Friday, March 14, 2014 6:14 AMTo: '[email protected]'; [email protected] Cc: Casavale, Kellie (OS/OASH); Lichtenstein, AliceSubject: Notes from last night

Hi Barbara and Mary,Great discussion last night late in the dinner about the "synthesis" chapter.

Because I am apt to forget things, I thought I would send along notes on the ideas. I am including Alice on the emailbecause she prompted the conversation!

Here you go (without word-smithing or considering order):

There is the most evidence for healthy food and nutrition from the following:

1. Activate health care sector in nutrition/food health promotion2. Place matters: improve food environment where you live, work, learn, and play3. Respect culture4. Calories matter

5. Eat more: vegetables, fruits, legumes, nuts, and seeds7. Eat Less: Added sugars, refined grains, saturated fat, sodium, meats8. Move more!

(I will work on a sustainability one...)

Just didn't want to forget them.Thanks. Mim

PS: here is the section from 2010 - I know we can do better:

Excerpted verbatim:

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Four Main Integrated Findings to be Used in Developing the 2010 Dietary Guidelines for Americans:1. Reduce the incidence and prevalence of overweight and obesity of the US population by reducing overall calorie in takeand increasing physical activity.

2. Shift food intake patterns to a more plant-based diet thatemphasizes vegetables, cooked dry beans and peas, fruits, whole

grains,nuts, and seeds. In addition, increase the intake of seafood andfat-free and low-fat milk and milk products, and consume onlymoderate amounts of lean meats, poultry, and eggs.

3. Significantly reduce intake of foods containing added sugars andsolid fats because these dietary components contribute excess

calories and few, if any,nutrients. In addition, reduce sodium intakeand lower intake of refined grains, especially refined grains that arecoupled with added sugar, solid fat, and sodium.

4. Meet the 2008 Physical Activity Guidelines for Americans.

Miriam E. Nelson, PhD Professor, Friedman School of Nutrition Science and Policy Tufts University 150 Harrison Avenue, RM 249 Boston, MA 02111 phone: 617-636-3735 fax: 617-636-3727

www.StrongWomen.org www.ChildObesity180.org www.facebook.com/StrongWomenwithMiriamNelson Twitter: @DrMiriamNelson

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Sent: Saturday, May 03, 2014 7:06 AM

To: Siega-Riz, Anna Maria; Frank Hu; Essery, Eve - CNPP

Cc: Anderson, Cheryl; Casavale, Kellie (OS/OASH); Obbagy, Julie - CNPP; Anne Rodgers

Subject: RE: DGAC SC2: Dietary patterns and CVD, T2D, and BWAttachments: CVD.dietary.patterns.Chapter2.4.30.14 bem edits 5 3 2014.docx

Thank you Anna Maria,

I want to say first that I think the CVD summary, as mentioned in my attached ‘comments’, is elegant, informative and

quite thorough. It is the first and will be the model for the others so I would like to be sure we have been as rigorous as

possible. I like the format I reviewed rather than the others.

You will see that I went back and extracted the definitions of DASH and MED‐style diets from the ACC/AHA publications.

It think we ought to do this for the ‘scores’ as well and be certain that we agree with the component foods and nutrients

that we use in our summary conclusion statements. We ought to be a bit more specific on the exposure definitions in

our summaries statements. I have comments in my review. Please accept these in the most constructive way. This is so

important and we want to get it right. While I would like to be as inclusive of the dietary pattern food and nutrient

components, this needs to be data driven. Right now, I fear it is a bit selective of the views (that we may collectively

hold) but may not be truly supported by the data.

Interested in your thoughts. I added Alice to the review list since I know she has deep expertise and strong views on

these areas.

Barbara


[email protected]

From: Siega-Riz, Anna Maria [mailto:[email protected]]Sent: Friday, May 02, 2014 3:38 PMTo: Frank Hu; Essery, Eve - CNPPCc: Millen, Barbara E; Anderson, Cheryl; Casavale, Kellie (OS/OASH); Obbagy, Julie - CNPP; Anne Rodgers

Subject: RE: DGAC SC2: Dietary patterns and CVD, T2D, and BW

Dear Eve, Frank and Barbara;

I made some edits to the T2D and BW conclusions and evidence. I also had just a few edits on Frank’s. Given the

differences in the amount of details provided in these two drafts and the style of writing, it would be very helpfully to all

committee members if the SRC can provide input as to which is preferred. I am happy to go with either.

Thank you and have a great weekend. AMSR

Anna Maria Siega-Riz, PhD, RD

Professor of Epidemiology and Nutrition

and

Associate Dean for Academic Affairs

Gillings School of Global Public Health

2105‐A McGavran‐Greenberg Hall, CB 7435

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(b) (6)

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Chapel Hill, NC 27599

Phone:919‐962‐8410 (CPC); 919‐966‐5984 (Epi)

Email: am [email protected]

From: Frank Hu [mailto:[email protected]]Sent: Thursday, May 01, 2014 9:24 AM

To: Essery, Eve - CNPPCc: Siega-Riz, Anna Maria; Millen, Barbara E; Anderson, Cheryl; Casavale, Kellie (OS/OASH); Obbagy, Julie - CNPP;Figueroa, Angelica M; [email protected] Subject: Re: DGAC SC2: Dietary patterns and CVD, T2D, and BW

Dear All,

attached is a draft of the section on dietary patterns and CVD by integrating the evidence reviews from the NEL

report, AHA/ACC guidelines, and additional meta-analyses/systematic reviews. In addition to CVD outcomes,

evidence on hypertension and dyslipidemia is also included. The review of evidence section is a bit detailed because there are so much data, but it can be consolidated later on if necessary.

I look forward to your comments.

Frank

On Thu, Mar 6, 2014 at 3:10 PM, Essery, Eve - CNPP wrote:

Hi Anna Maria, Frank, Barbara, and Cheryl,

In preparation for tomorrow’s call, I have pulled together a variety of documents so that you have everything in one place.You have seen all of these materials previously except for the summary table for dietary patterns and T2D. Otherwise,everything is exactly the same as the documents you have received previously. Below is a summary of the attachments:

1. Excel summary tables of existing reports for (1) CVD, (2) BW, and (3) T2D. (All three spreadsheets are included inthis file.)

2. Draft chapter content from Anna Maria

3. Email correspondence from Barbara, Frank, and Anna Maria after receiving Anna Maria’s chapter content

4. The pre-pub draft of the NEL report (zip file)

5. The lifestyle guidelines (zip file)

6. The obesity guidelines (zip file)

Also, I have asked staff from the NEL and NHLBI who were involved in these reviews to join the call in case you have anyquestions about the specific reports.

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Talk to you tomorrow at noon ET (9am PT)!

Call-in number:

Access code:

Webinar:

Thanks,

Eve

Eve Essery Stoody, PhD

Nutritionist | Center for Nutrition Policy and Promotion | USDA

3101 Park Center Drive, Room 1034 | Alexandria, VA 22302

[email protected] | Office: 703-305-2563 | Fax: 703-305-3300



unauthorized interception of this message or the use or disclosure of the information it contains may violate thelaw and subject the violator to civil or criminal penalties. If you believe you have received this message in error,


--

*******************************************************

Frank B. Hu, MD, PhD

Professor of Nutrition and EpidemiologyHarvard School of Public Health

Professor of Medicine

Harvard Medical School

(b) (6)

(b) (6)

(b) (6)

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665 Huntington ave, Boston, MA 02115tel: 617 432 0113 fax: 617 432 2435

http://www.hsph.harvard.edu/faculty/frank-hu/

******************************************************

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Sent: Sunday, May 04, 2014 10:01 PM

To: Siega-Riz, Anna Maria; Frank Hu

Cc: Essery, Eve - CNPP; Anderson, Cheryl; Casavale, Kellie (OS/OASH); Obbagy, Julie -

CNPP; Anne Rodgers

Subject: RE: DGAC SC2: Dietary patternse and CVD, T2D, and BW

Hi,

I also think the chapter introduction ought to set the stage for the major themes and approaches, including method of

exposure and outcome assessment, patterns and pattern scoring. The definition and interpretation of the exposures

probably need some particular explanation since we think of ‘risk’ associated with a category (for example, quartile or

quintile) and the ‘score’ may capture only part of the pattern and may not reflect complete compliance with the pattern

components.

All best,

Barbara


[email protected]

From: Siega-Riz, Anna Maria [mailto:[email protected]]Sent: Sunday, May 04, 2014 8:23 PMTo: Frank Hu; Millen, Barbara ECc: Essery, Eve - CNPP; Anderson, Cheryl; Casavale, Kellie (OS/OASH); Obbagy, Julie - CNPP; Anne Rodgers


Barbara and Frank,

I agree that we need to come to a consensus before revising. It seems as if in the introduction of this chapter we should

define the dietary patterns and then for each outcome we can say whether the studies reviewed fit the standard

definition or explain briefly how they deviated. If this is not done upfront, each of these sections are going to get pretty

long rather quickly.

SC#2 has a call on Thursday‐I believe this is important for all of our subcommittee members to participate in.

Eve, as soon as Steve writes up his section can you send that to us review?

AMSR

From: Frank Hu [mailto:[email protected]]Sent: Saturday, May 03, 2014 11:07 AMTo: Millen, Barbara ECc: Siega-Riz, Anna Maria; Essery, Eve - CNPP; Anderson, Cheryl; Casavale, Kellie (OS/OASH); Obbagy, Julie - CNPP; Anne RodgersSubject: Re: DGAC SC2: Dietary patterns and CVD, T2D, and BW

Hi Barbara,

(b) (6)

(b) (6)

(b) (6)

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Thank VERY MUCH for your detailed and thoughtful comments on the dietary pattern - CVD section. OverallI agree with your rigorous, specific, and integrated approach. Before revising this section, I'd like to clarify with

you and the subcommittee on several issues:

1. How detailed information do we need to provide on methods to define dietary patterns (e.g. data-driven

approaches vs. dietary indices vs. trials). Within each of the method, there is a large amount of heterogeneity

across different studies in defining DASH-style diets, Mediterranean-style diets, vs. vegetarian-type diets. It can

easily take a couple of pages to explain the variability in different methodologies and interpretations. Shall we

need a separate section to describe the methodology because the same issue will apply to other endpoints aswell (obesity, diabetes, cancer, etc.)? Would this conform to the chapter template provided by Ann?

2. We need to integrate the evidence from 3 main sources: NEL report, AHA/ACC report, and a review of

additional meta-analyses/systematic reviews. Of note, the exact patterns and components of the patterns are not

identical because these reports/reviews focus on different types of studies and methodologies. For example,AHA/ACC report reviewed only RCTs on intermediate endpoints through 2009, while NEL report is most

focused on large prospective cohort studies on CVD endpoints. I think it is important to identify "common"

elements of the patterns, but also to be inclusive in defining broad dietary patterns that can be beneficial for a

wide range of endpoints (i.e. intermediate endpoints, CVD outcomes) and in different populations (US,European, vegetarians etc.). In other words, we need to define both "common denominators" and potentially

unique elements (e.g., extra virgin olive oil in the Med-diet used in the PREDIMED) of the patterns.

3. You suggest that we should pay attention to key nutrients in certain dietary patterns. Among various patterns

that have been derived, only DASH has a clear characterization of nutrient intakes and other patterns are mostly

focused on foods/food groups.

In the RCTs, the DASH dietary pattern is low in saturated fat, total fat, and cholesterol. It is rich in potassium,magnesium, and calcium, as well as protein and fiber. But most of these nutrients were not used in calculating

DASH scores in observational studies. The calculation of Med-score and HEI scores are mainly based on

foods/food groups. I'm not sure how much we can say about the role of nutrients based on patternanalyses. Shall we delve into specific nutrients in separate sections? I think saturated/total fats, cholesterol,

protein, fiber, and some minerals deserve separate reviews of evidence.

4. PREDIMED trial is the only primary prevention trial of dietary pattern interventions on CVD endpoints (a

separate paper was published on diabetes in Ann Intern Med). Although the trial is not perfect, it is large (>6000

patients in >10 clinical centers), long-duration, and sufficiently powered, with excellent compliance (using plasma and urinary biomarkers for nuts and extra virgin olive oil) and follow-up rates during 4 years. In

contrast, DASH is a small, short-tern, feeding study on intermediate endpoints. Thus, we need to put these

trials in perspectives in terms of methodologies and outcomes. Fortunately, the results from these trials are

largely consistent, supporting broadly defined healthy dietary patterns that are beneficial in reducing risk of a

wide range of CVD risk factors and endpoints. I think we need to look at the big picture when integrating theevidence from different sources.

Can we set up a call to discuss these issues and your other comments? I think it is important to get a consensus

from the subcommittee before the revision.

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Best regards

Frank

On Sat, May 3, 2014 at 7:06 AM, Millen, Barbara E wrote:

Thank you Anna Maria,

I want to say first that I think the CVD summary, as mentioned in my attached ‘comments’, is elegant, informative and

quite thorough. It is the first and will be the model for the others so I would like to be sure we have been as rigorous as

possible. I like the format I reviewed rather than the others.

You will see that I went back and extracted the definitions of DASH and MED‐style diets from the ACC/AHA publications.

It think we ought to do this for the ‘scores’ as well and be certain that we agree with the component foods and nutrients

that we use in our summary conclusion statements. We ought to be a bit more specific on the exposure definitions in

our summaries statements. I have comments in my review. Please accept these in the most constructive way. This is so

important and we want to get it right. While I would like to be as inclusive of the dietary pattern food and nutrient

components, this needs to be data driven. Right now, I fear it is a bit selective of the views (that we may collectively

hold) but may not be truly supported by the data.

Interested in your thoughts. I added Alice to the review list since I know she has deep expertise and strong views on

these areas.

Barbara


[email protected]

From: Siega-Riz, Anna Maria [mailto:am [email protected]]Sent: Friday, May 02, 2014 3:38 PMTo: Frank Hu; Essery, Eve - CNPPCc: Millen, Barbara E; Anderson, Cheryl; Casavale, Kellie (OS/OASH); Obbagy, Julie - CNPP; Anne Rodgers


(b) (6)

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Dear Eve, Frank and Barbara;

I made some edits to the T2D and BW conclusions and evidence. I also had just a few edits on Frank’s. Given the

differences in the amount of details provided in these two drafts and the style of writing, it would be very helpfully to all

committee members if the SRC can provide input as to which is preferred. I am happy to go with either.

Thank you and have a great weekend.

AMSR

Anna Maria Siega-Riz, PhD, RD

Professor of Epidemiology and Nutrition

and

Associate Dean for Academic Affairs

Gillings School of Global Public Health

2105‐A McGavran‐Greenberg Hall, CB 7435

Chapel Hill, NC 27599

Phone:919‐962‐8410 (CPC); 919‐966‐5984 (Epi)

Email: am [email protected]

From: Frank Hu [mailto:[email protected]]Sent: Thursday, May 01, 2014 9:24 AMTo: Essery, Eve - CNPPCc: Siega-Riz, Anna Maria; Millen, Barbara E; Anderson, Cheryl; Casavale, Kellie (OS/OASH); Obbagy, Julie - CNPP;Figueroa, Angelica M; [email protected]

Subject: Re: DGAC SC2: Dietary patterns and CVD, T2D, and BW

Dear All,

attached is a draft of the section on dietary patterns and CVD by integrating the evidence reviews from the NEL

report, AHA/ACC guidelines, and additional meta-analyses/systematic reviews. In addition to CVD outcomes,

PSC-HHS-000025


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evidence on hypertension and dyslipidemia is also included. The review of evidence section is a bit detailed

because there are so much data, but it can be consolidated later on if necessary.

I look forward to your comments.

Frank

On Thu, Mar 6, 2014 at 3:10 PM, Essery, Eve - CNPP wrote:

Hi Anna Maria, Frank, Barbara, and Cheryl,

In preparation for tomorrow’s call, I have pulled together a variety of documents so that you have everything in one place.You have seen all of these materials previously except for the summary table for dietary patterns and T2D. Otherwise,everything is exactly the same as the documents you have received previously. Below is a summary of the attachments:

1. Excel summary tables of existing reports for (1) CVD, (2) BW, and (3) T2D. (All three spreadsheets are included inthis file.)

2. Draft chapter content from Anna Maria

3. Email correspondence from Barbara, Frank, and Anna Maria after receiving Anna Maria’s chapter content

4. The pre-pub draft of the NEL report (zip file)

5. The lifestyle guidelines (zip file)

6. The obesity guidelines (zip file)

Also, I have asked staff from the NEL and NHLBI who were involved in these reviews to join the call in case you have anyquestions about the specific reports.

Talk to you tomorrow at noon ET (9am PT)!

Call-in number:

Access code:

Webinar:

(b) (6)

(b) (6)

(b) (6)

PSC-HHS-000026


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Thanks,

Eve







unauthorized interception of this message or the use or disclosure of the information it contains may violate the

law and subject the violator to civil or criminal penalties. If you believe you have received this message in error,


--

*******************************************************


Professor of Nutrition and EpidemiologyHarvard School of Public Health


Harvard Medical School665 Huntington ave, Boston, MA 02115

tel: 617 432 0113 fax: 617 432 2435


******************************************************

PSC-HHS-000027


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--

*******************************************************


Professor of Nutrition and Epidemiology

Harvard School of Public HealthProfessor of Medicine


tel: 617 432 0113 fax: 617 432 2435


******************************************************

PSC-HHS-000028


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From: Lichtenstein, Alice

Sent: Wednesday, May 07, 2014 11:58 AM

To: Frank Hu; Essery, Eve - CNPP; [email protected]; Tom Brenna

Cc: Anderson, Cheryl; Anna Maria Siega-Riz, PhD, MS, RD ([email protected]); Casavale

Kellie (OS/OASH); Obbagy, Julie - CNPP; McDowell, Margaret (NIH/NIDDK) [E]; Fisher,

Rachel (NIH/NIDDK) [E]Subject: RE: FW: DGAC SC 2: Pre-read for Thurs call

I agree with Frank. Link to the ‘teach-in’;

http://www.hsph.harvard.edu/news/features/saturated-or-not-does-type-of-fat-matter/

The front part is just set up, move the bar until you see the first speaker.

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐




Tufts University



Boston, MA 02111

phone: 617 556 3127


From: Frank Hu [mailto:[email protected]]Sent: Wednesday, May 07, 2014 10:07 AMTo: Essery, Eve - CNPP; Lichtenstein, Alice; [email protected]; Tom BrennaCc: Anderson, Cheryl; Anna Maria Siega-Riz, PhD, MS, RD ([email protected]); Casavale, Kellie (OS/OASH); Obbagy,Julie - CNPP; McDowell, Margaret (NIH/NIDDK) [E]; [email protected]: Re: FW: DGAC SC 2: Pre-read for Thurs call

thanks, Tom, for your comments on the Annals meta-analysis. Since it is focused on individual macronutrients

rather than dietary patterns, I'm not sure whether it fits in this section on patterns and CVD. I think we probablyneed to do a separate evidence-based review on saturated fat and other macronutrients, although this will take

significant time and efforts.

It is well recognized that the Annals paper contains multiple errors/omissions including data abstraction errors, omission ofPUFA studies, lack of comparator (saturated fat vs. carbs)... Overall I think the data and interpretation of this meta-analysis are seriously flawed. The authors tried to correct some of the errors but the corrections are incomplete. We did ateach-in symposium about this study to clarify some of the confusions; both Alice and I presented our viewpoints andinterpretation of the existing evidence.

Attached please see my slides for your information.

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Regarding the WSJ article, it was written by a reporter who does not seem to understand nutrition or epidemiology. Shehas a book on the same topic coming out next week. The article is not peer-reviewed and makes many nonsenseviewpoints without any references or real data to support them.

I think we should discuss these issues tomorrow to see what's the best way to proceed.

Frank

On Wed, May 7, 2014 at 8:25 AM, Essery, Eve - CNPP wrote:

Hi Frank and Cheryl,

Tom sent the comments below related to the dietary patterns and CVD, T2D, and body weight reviews.

Eve

From: gmail.com [mailto: gmail.com] On Behalf Of Tom BrennaSent: Tuesday, May 06, 2014 9:41 PMTo: Siega-Riz, Anna MariaCc: Essery, Eve - CNPP; [email protected]; Millen, Barbara ESubject: Re: DGAC SC 2: Pre-read for Thurs call

Here are a few comments.

Comments on "CVD.dietary.patterns.Chapter2.4.30.14"

(1) Q1: Japanese DP? 100+ papers on Pubmed.

(2) Definitions. I concur with note B7 about definitions. The added paragraph ("AHA/ACC/...") uses many

relative adjectives ("higher", "moderate", relatively low"). Compared to what? The usual answer is "Western" but what's that? Same comment for DASH. My anecdotal survey of dietitians is that they don't know where

MED begins and ends (apart from wine and olive oil), let along Western.

General comments on CVD.

(b) (6) (b) (6)

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Two issues relevant to the CVD story that are probably better considered in solitude.

1) Do we intend to do anything with the (attached) Chowdhury paper, not DP but still reelvant, which has

numerous data analyses that contradict the AHA conclusions?

a) No harm from sat fat (RCT (Fig 1, Intake) and PCS (Fig 2, Biomarker, which can be linked to intake and are

objectively measured)). RCT has non-sig signal for benefit.

b) Benefit from the odd and branched chain FA 15:0 and 17:0, markers of dairy/beef fat (PCS, Figure 2)

c) Benefit from EPA+DHA = "Total long-chain w-3" (RCT & PCS) and from EPA alone (PCS) and DHA alone

(PCS).

d) No benefit from w6 PUFA (RCT & PCS) and no benefit from linoleic acid (PCS)

e) Benefit from circulating arachidonic acid, a marker of meat (and not veg oil) intake (PCS)

While the embargoed version of this paper released to the press was apparently riddled with errors (copy on

request), I think it should be addressed at least among ourselves now or later.

2) The WSJ article from 6 May 2014 (link below) about an upcoming book rehashes many familiar concernswith the saturated fat story. Whether or not the current DGAC includes or rejects this evidence, it is out there

and to my eyes is increasingly prominent in the public mind. DGAC should make non-political

recommendations but I reckon it helpful to policy makers if we are especially solid on those matters that may be

attacked.

The Questionable Link Between Saturated Fat and Heart Disease

Are butter, cheese and steak really bad for you? The dubious science behind the anti-fat crusade

Comment on "Question T2D&BW_summary_5_2_14"

Comment on the sentence highlighted by SAM2: "An unhealthy dietary pattern...sweets." Is this not a circular

observation? Consumption of meats, high-fat dairy, and refined grains and sweets scores low on HEI, and then

we look at a low score and conclude that it is due to these factors. What other ways might HEI be low?

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I generally concur and have no questions at this time about Q3 conclusions.

Tom

On Tue, May 6, 2014 at 8:49 AM, Siega-Riz, Anna Maria wrote:

Thank you Tom. Weighing in here is important for how we will proceed with writing up our conclusions. Safe travels.

AMSR

From: gmail.com [mailto: gmail.com] On Behalf Of Tom Brenna

Sent: Monday, May 05, 2014 7:38 PMTo: Essery, Eve - CNPP; Siega-Riz, Anna MariaCc: [email protected]; Millen, Barbara ESubject: Re: DGAC SC 2: Pre-read for Thurs call

Anna Maria, Eve,

I am just realizing that I'm scheduled to fly on Thursday and land in LA mid-call. I'll call in if there is a change

in schedule or I can somehow get connected.

I'll have a look at the attachments and comment in writing if I think useful.

Apologies.

Tom

On Mon, May 5, 2014 at 5:26 PM, Essery, Eve - CNPP wrote:

Hi SC2 members,

(b) (6) (b) (6)

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On behalf of the Dietary Patterns and CVD, T2D, and body weight work group (Frank, Anna Maria, Barbara, and Cheryl),attached are the current versions of their draft conclusions and report sections for your review prior to Thursday’s SC2call. Also attached are the summary tables for these questions.

Thursday’s agenda is coming soon…

Best,

Eve







unauthorized interception of this message or the use or disclosure of the information it contains may violate the

law and subject the violator to civil or criminal penalties. If you believe you have received this message in error,


--*******************************************************

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Frank B. Hu, MD, PhDProfessor of Nutrition and Epidemiology

Harvard School of Public Health

Professor of MedicineHarvard Medical School

665 Huntington ave, Boston, MA 02115

tel: 617 432 0113 fax: 617 432 2435


******************************************************

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The "teach-in" is a 3 hour long video; I would prefer the written word.

Tom

On Wed, May 7, 2014 at 10:06 AM, Frank Hu wrote:

thanks, Tom, for your comments on the Annals meta-analysis. Since it is focused on individual macronutrientsrather than dietary patterns, I'm not sure whether it fits in this section on patterns and CVD. I think we probablyneed to do a separate evidence-based review on saturated fat and other macronutrients, although this will take

significant time and efforts.

It is well recognized that the Annals paper contains multiple errors/omissions including data abstraction errors, omission ofPUFA studies, lack of comparator (saturated fat vs. carbs)... Overall I think the data and interpretation of this meta-analysis are seriously flawed. The authors tried to correct some of the errors but the corrections are incomplete. We did ateach-in symposium about this study to clarify some of the confusions; both Alice and I presented our viewpoints andinterpretation of the existing evidence.

Attached please see my slides for your information.

Regarding the WSJ article, it was written by a reporter who does not seem to understand nutrition or epidemiology. Shehas a book on the same topic coming out next week. The article is not peer-reviewed and makes many nonsenseviewpoints without any references or real data to support them.

I think we should discuss these issues tomorrow to see what's the best way to proceed.

Frank

On Wed, May 7, 2014 at 8:25 AM, Essery, Eve - CNPP wrote:

Hi Frank and Cheryl,

Tom sent the comments below related to the dietary patterns and CVD, T2D, and body weight reviews.

Eve

From: gmail.com [mailto: gmail.com] On Behalf Of Tom BrennaSent: Tuesday, May 06, 2014 9:41 PMTo: Siega-Riz, Anna MariaCc: Essery, Eve - CNPP; [email protected]; Millen, Barbara ESubject: Re: DGAC SC 2: Pre-read for Thurs call

Here are a few comments.

(b) (6) (b) (6)

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Comments on "CVD.dietary.patterns.Chapter2.4.30.14"

(1) Q1: Japanese DP? 100+ papers on Pubmed.

(2) Definitions. I concur with note B7 about definitions. The added paragraph ("AHA/ACC/...") uses manyrelative adjectives ("higher", "moderate", relatively low"). Compared to what? The usual answer is "Western" but what's that? Same comment for DASH. My anecdotal survey of dietitians is that they don't know where

MED begins and ends (apart from wine and olive oil), let along Western.

General comments on CVD.

Two issues relevant to the CVD story that are probably better considered in solitude.

1) Do we intend to do anything with the (attached) Chowdhury paper, not DP but still reelvant, which has

numerous data analyses that contradict the AHA conclusions?

a) No harm from sat fat (RCT (Fig 1, Intake) and PCS (Fig 2, Biomarker, which can be linked to intake and are

objectively measured)). RCT has non-sig signal for benefit.

b) Benefit from the odd and branched chain FA 15:0 and 17:0, markers of dairy/beef fat (PCS, Figure 2)

c) Benefit from EPA+DHA = "Total long-chain w-3" (RCT & PCS) and from EPA alone (PCS) and DHA alone

(PCS).

d) No benefit from w6 PUFA (RCT & PCS) and no benefit from linoleic acid (PCS)

e) Benefit from circulating arachidonic acid, a marker of meat (and not veg oil) intake (PCS)

While the embargoed version of this paper released to the press was apparently riddled with errors (copy on

request), I think it should be addressed at least among ourselves now or later.

2) The WSJ article from 6 May 2014 (link below) about an upcoming book rehashes many familiar concerns

with the saturated fat story. Whether or not the current DGAC includes or rejects this evidence, it is out thereand to my eyes is increasingly prominent in the public mind. DGAC should make non-political

recommendations but I reckon it helpful to policy makers if we are especially solid on those matters that may be

attacked.

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The Questionable Link Between Saturated Fat and Heart Disease

Are butter, cheese and steak really bad for you? The dubious science behind the anti-fat crusade

Comment on "Question T2D&BW_summary_5_2_14"

Comment on the sentence highlighted by SAM2: "An unhealthy dietary pattern...sweets." Is this not a circularobservation? Consumption of meats, high-fat dairy, and refined grains and sweets scores low on HEI, and then

we look at a low score and conclude that it is due to these factors. What other ways might HEI be low?

I generally concur and have no questions at this time about Q3 conclusions.

Tom

On Tue, May 6, 2014 at 8:49 AM, Siega-Riz, Anna Maria wrote:

Thank you Tom. Weighing in here is important for how we will proceed with writing up our conclusions. Safe travels.

AMSR

From: gmail.com [mailto: gmail.com] On Behalf Of Tom BrennaSent: Monday, May 05, 2014 7:38 PMTo: Essery, Eve - CNPP; Siega-Riz, Anna MariaCc: [email protected]; Millen, Barbara ESubject: Re: DGAC SC 2: Pre-read for Thurs call

Anna Maria, Eve,

(b) (6) (b) (6)

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I am just realizing that I'm scheduled to fly on Thursday and land in LA mid-call. I'll call in if there is a change

in schedule or I can somehow get connected.

I'll have a look at the attachments and comment in writing if I think useful.

Apologies.

Tom

On Mon, May 5, 2014 at 5:26 PM, Essery, Eve - CNPP wrote:

Hi SC2 members,

On behalf of the Dietary Patterns and CVD, T2D, and body weight work group (Frank, Anna Maria, Barbara, and Cheryl),attached are the current versions of their draft conclusions and report sections for your review prior to Thursday’s SC2call. Also attached are the summary tables for these questions.

Thursday’s agenda is coming soon…

Best,

Eve






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This electronic message contains information generated by the USDA solely for the intended recipients. Anyunauthorized interception of this message or the use or disclosure of the information it contains may violate the

law and subject the violator to civil or criminal penalties. If you believe you have received this message in error, please notify the sender and delete the email immediately.

--

*******************************************************

Frank B. Hu, MD, PhDProfessor of Nutrition and Epidemiology

Harvard School of Public Health



tel: 617 432 0113 fax: 617 432 2435


******************************************************

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Sent: Friday, May 09, 2014 11:36 AM

To: Mosher, Amber (OS/OASH); Nelson, Miriam ([email protected]);

'[email protected]' ([email protected]); Alice Lichtenstein

([email protected]); Liz Rahavi ([email protected]); Casavale,

Kellie (OS/OASH); Psota, Tricia - FNS (Contractor)Subject: RE: MEETING PREP: Materials for PAWG call on 5/9 @ 2:30

Attachments: Copy of DGAC_PA questions evidence_MN edit_5 7 14 bem edits 5 9 2014.xlsx

Thanks for the superb summary table. I went through and added comments and made questions in certain places. In

the overall conclusion and Implications statement, it would seem important to consider specifying subgroups for which

there are consistent data (age and sex) and for the recommended types of interventions, those for which evidence is

strongest. I wasn’t sure from the summaries whether some of the conclusions were supported by data or not. Things

for thought and discussion.

Barbara


[email protected]

From: Mosher, Amber (OS/OASH) [mailto:[email protected]]Sent: Wednesday, May 07, 2014 3:20 PMTo: Nelson, Miriam ([email protected]); '[email protected]' ([email protected]); Alice Lichtenstein([email protected]); Liz Rahavi ([email protected]); Casavale, Kellie (OS/OASH);

Millen, Barbara E; Psota, Tricia - FNS (Contractor)Subject: MEETING PREP: Materials for PAWG call on 5/9 @ 2:30Importance: High

All,

On behalf of Mim, please find meeting materials attached for the next Physical Activity Writing Group (PAWG) call. As a

reminder, this meeting is scheduled for Friday, May 9, 2014 from 2:30 – 3:30 p.m.

You will find the following documents attached:

Meeting agenda (Word)

Updated PA questions and evidence (Excel, dated 5.7.14)

Proposed guidance for developing 2015 DGAC evidence reviews (Word, dated 4.15.14)

When reviewing the Excel workbook prior to the call, note that the purple tab represents the PAWG’s list of questions

and corresponding

evidence

from

the

three

PAG

reports.

This

includes

15

questions

in

three

physical

activity

subtopic

areas (i.e., health outcomes = 11; behavioral interventions = 1; environmental interventions = 3). The focus of Friday’s

discussion will only include the questions and evidence in the purple tab. Also note that Mim has provided initial

examples of conclusion and implication statements for questions #1 and #1a for discussion.

Regarding the Proposed guidance for developing 2015 DGAC evidence reviews, note that the PAWG will use scenario 2

(i.e., using existing reports or systematic reviews/meta‐analyses) to address physical activity questions; see pages 4 – 6

for specific guidance.

(b) (6)

(b) (6)

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Finally, we plan to use webcast capabilities to review the Excel workbook during the call on Friday. Conference line and

webcast information is provided in the meeting agenda and Outlook calendar invite. Please let me know if you have any

questions.

Many thanks, ALM

Amber L. Mosher, MPH, RD | Prevention Science Fellow Office of Disease Pre

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