Scientific Report of the 2020 Dietary Guidelines Advisory ...

1 Scientific Report of the 2020 dietary guidelines Advisory Committee Advisory Report to the Secretary of Agriculture and Secretary of Health and Human Services First Print: July 2020. This is the first print of the Scientific Report of the 2020. Dietary Guidelines Advisory Committee and is being provided to the public online. The Report will be formatted for publication and available in hard copy later this year. Online-only supplementary materials for data analysis, food pattern modeling, and NESR systematic reviews can be found through Suggested citation: 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.

2 Department of Agriculture, Agricultural Research Service, Washington, DC. Department of Agriculture Department of Health and Human Services 1400 Independence Avenue SW 200 Independence Avenue SW. Washington, DC 20250 Washington, DC 20201. This first print of the Scientific Report of the 2020 dietary guidelines Advisory Committee is being published by the USDA. The contents of this document may be used and reprinted without permission. Endorsements by the USDA of derivative products developed from this work may not be stated or implied. In accordance with Federal civil rights law and USDA civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, gender identity (including gender expression), sexual orientation, disability, age, marital status, family/parental status, income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded by USDA (not all bases apply to all programs)

3 Remedies and complaint filing deadlines vary by program or incident. Persons with disabilities who require alternative means of communication for program information ( , Braille, large print, audiotape, American Sign Language, etc.) should contact the responsible Agency or USDA's TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339. To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD- 3027, found online at How to File a Program Discrimination Complaint and at any USDA office or write a letter addressed to USDA and provide in the letter all of the information requested in the form.

4 To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: (1) mail: Department of Agriculture, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, SW, Washington, 20250-9410; (2) fax: (202) 690-7442; or (3). email: USDA is an equal opportunity provider, employer, and lender. Contents Contents Letter to the Secretaries Dietary Guidelines Advisory Committee Membership and Federal Support Staff Part A: Executive Summary Part B: Setting the Stage and Integrating the Evidence Chapter 1: Introduction Chapter 2: Integrating the Evidence Part C: Methodology Part D: Evidence on Diet and Health Current Dietary Intakes through the Life Course Chapter 1: Current Intakes of Foods, Beverages, and Nutrients Diet and Health Relationships: Pregnancy and Lactation Chapter 2: Food, Beverage, and Nutrient Consumption During Pregnancy Chapter 3.

5 Food, Beverage, and Nutrient Consumption During Lactation Diet and Health Relationships: Birth to Age 24 Months Chapter 4: Duration, Frequency, and Volume of Exclusive Human Milk and/or Infant Formula Feeding Chapter 5: Foods and Beverages Consumed During Infancy and Toddlerhood Chapter 6: Nutrients from Dietary Supplements During Infancy and Toddlerhood Chapter 7: USDA Food Patterns for Children Younger Than Age 24 Months Diet and Health Relationships: Individuals Ages 2 Years and Older Chapter 8: Dietary Patterns Chapter 9: Dietary Fats and Seafood Chapter 10: Beverages Chapter 11: Alcoholic Beverages Chapter 12: Added Sugars Chapter 13: Frequency of Eating Chapter 14: USDA Food Patterns for Individuals Ages 2 Years and Older Part E: Future Directions Part F: Appendices Appendix F-1: Glossary of Terms Appendix F-2: Public Comments Appendix F-3: Biographical Sketches of the 2020 dietary guidelines Advisory Committee Appendix F-4: Membership of Dietary Guidelines Advisory Committee Subcommittees and Working Groups Appendix F-5: Dietary Guidelines Advisory Committee Report Acknowledgments Scientific Report of the 2020 dietary guidelines Advisory Committee June 30, 2020.

6 The Honorable Sonny Perdue Secretary of Agriculture 1400 Independence Avenue, SW. Washington DC 20250. The Honorable Alex Azar Secretary of Health and Human Services 200 Independence A venue, SW. Washington DC 20201. Dear Secretaries Perdue and Azar, The 2020 dietary guidelines Advisory Committee, appointed on February 21, 2019, has completed its review of topics and questions requested by the Departments of Agriculture and of Health and Human Services and is submitting the attached Report for use in preparing the 2020- 2025 Dietary Guidelines for Americans. The work of the Committee has been guided by the Federal Advisory Committee Act as well as recent changes in the process to develop the Dietary Guidelines for Americans.

7 In part, improvements in developing the Committee's Report were implemented in response to the 2017 National Academies of Sciences, Engineering, and Medicine (NASEM) Report , Redesigning the Process for Establishing the Dietary Guidelines , to make the process more transparent, inclusive, and science-driven. In addition, the Agricultural Act of 2014 mandates the inclusion of infants and toddlers and women who are pregnant or lactating in the 2020-2025 Dietary Guidelines for Americans. As a result, this edition will cover the full lifespan. The Committee's Report emphasizes 2 major themes that can inform the development of the 2020-2025 Dietary Guidelines for Americans: The importance of considering life stage in the Dietary Guidelines for Americans o These life stages include pregnancy, lactation, birth to age 24 months, childhood, adolescence, and adulthood.

8 O Special nutrition considerations exist at each life stage, and improvements in recommended food patterns at each stage have the potential to influence healthy food choices at the next life stage. Dietary patterns provide a framework for the Dietary Guidelines for Americans within and across life stages o Healthy Dietary patterns are defined by the quality of foods that are included, as well as foods that should be limited. o A high-quality Dietary pattern can promote health, achieve nutrient adequacy and energy balance, and reduce the risk of diet-related chronic diseases. o The evidence on specific Dietary components ( , beverages, seafood, added sugars, Dietary fats, macronutrient profile) consistently supports the importance of foods consumed in healthy Dietary patterns as a framework for the Guidelines .

9 1. The Committee identified these themes to address the major public health challenges in the population of overweight and obesity and their related co-morbidities that are associated with Dietary patterns in which typical food choices result in excess energy intake and inadequate nutritional quality. The Committee's work culminated in the development of this Report , which summarizes the Committee's review of nearly 1,500 primary research articles included in original NESR systematic reviews, 16 existing NESR systematic reviews, more than 50 analyses of Federal data sets, and numerous food pattern modeling analyses that represented, for the first time, the entire lifespan.

10 In addition, the Committee relied on evidence from the 2015. Committee Report and the NASEM Dietary Reference Intake recommendations. To complete its tasks, the Committee worked in subcommittees, and their protocols, conclusions, and recommendations were brought forward for full Committee discussion in public meetings. Work on the questions was prioritized to enable the Committee to provide advice that is most relevant to the charge in the Committee's charter. In addition, the work of the Committee was posted on the Dietary Guidelines website in draft form as it evolved, to facilitate transparency and opportunities for public comment.