(See: National Nutrition Monitoring and Related Research Act, P.L.101-445)
Congress stated that the Guidelines should be for the “general public.” Yet the U.S. Departments of Agriculture and Health and Human Services (USDA-HHS), the agencies overseeing the Guidelines, have interpreted this scope to mean that the current Guidelines are only for “healthy Americans.”
The Guidelines are NOT for the 60% of Americans with diet-related chronic disease diagnoses.
The Dietary Guidelines are only for “healthy” Americans–meaning, those who are free from a diet-related chronic disease diagnosis.
These communities are more reliant on federal nutrition programs and also suffer from higher rates of chronic disease.
The National Academies of Science, Engineering, and Medicine recommended that the guidelines should “broaden” in “scope”…
“such that future editions focus on the general public across the entire life span, including all Americans whose health could benefit by improving diet…”
It is therefore critical that the Guidelines offer a true diversity of dietary options for these communities. The danger of excluding so many of our citizens, including those who are most in need of reliable nutrition, is an urgent issue that needs to be addressed by our nation’s leaders.
As required by law, recommendations are based upon the best evidence available at the time, and in some cases are based on informative, but moderate or relatively weak evidence.
The National Academies of Sciences, Engineering, and Medicine recognized this problem and in a 2017 report mandated by Congress, strongly recommended upgrading the scientific review process for the Guidelines, saying:
“The [Dietary Guidelines for Americans] has to be based on the highest standards of scientific data and analyses to reach the most robust recommendations,” including “more rigorous methodological approaches to evaluation of evidence…”
The Dietary Guidelines Advisory Committee assigns a grade to the quality of the science for each question studied (e.g., what is the relationship between a Mediterranean diet and cardiovascular disease?). There are four grading options:
Strong represents a conclusion statement supported by a “large, high-quality body of evidence that addresses the topic.” Ideally, this should include multiple clinical trials, since this is the type of study that can demonstrate cause-and-effect. The level of certainty should be high, unlikely to change, and generalizable to the population of interest.
Moderate represents a conclusion statement with sufficient evidence, but the level of certainty is restricted by the amount of evidence, inconsistency in the findings, or methodological or generalizability concerns.
Limited represents a conclusion statement that is substantiated by insufficient evidence, and certainty is severely restricted by the amount of evidence, inconsistent findings, or methodological or generalizability concerns.
Grade not assignable means a conclusion statement cannot be drawn due to the lack of evidence, or the evidence that is available has severe methodological concerns.