Professional Documents
Culture Documents
Part 1 of 2 Response To My 11/18/15 FOIA Request Re: 2015 US DGAC Members Barbara Millen, Alice Lichtenstein, Frank Hu
Part 1 of 2 Response To My 11/18/15 FOIA Request Re: 2015 US DGAC Members Barbara Millen, Alice Lichtenstein, Frank Hu
^"'"n^f-
(FOIA) request. In summary, you requested copies of all correspondence to and from Dr. Millcn.
Dr. Lichtenstein and Dr. Hu members of the 2015 Dietary Guidelines Advisory Committee.
A records search was conducted by the Office of the Assistant Secretary for Health (OASH), and
234 pages were located that are responsive to your request. Enclosed you will find 234 pages
released, 179 of which are released in their entirety. I have determined to withhold minor
There will be no charges in this instance because the billable costs are less than our threshold of
$25.
Sincerely yours,
Anthony T. S^IT*
t-, t>,
^*I/\ma ji-vh #
Anthony Clemons
Division of FOIA Services
Enclosure: 234 pages on CD
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
AliceH.Lichtenstein,D.Sc.
GershoffProfessorofNutritionScienceandPolicy
DirectorandSeniorScientist,CardiovascularNutritionLaboratory
TuftsUniversity
JMUSDAHumanNutritionResearchCenteronAging
711WashingtonStreet
Boston,MA02111
phone:6175563127
email:Alice.Lichtenstein@Tufts.edu
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
1
PSC-HHS-000001
3. Behavior Change
4. Food & Physical Activity Environment
5. Food Consumption Status, Sustainability & Food Safety
Many thanks! Best, Mim
www.facebook.com/StrongWomenwithMiriamNelson
Twitter: @DrMiriamNelson
From: Casavale, Kellie (OS/OASH) [Kellie.Casavale@hhs.gov]
Sent: Thursday, September 19, 2013 5:36 PM
To: 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'; '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 Rodgers
Subject: Agenda and Attachments: Science Review Subcommittee Meeting, Friday, Sept. 20th, 8:30-10:00 am
SRSC(andsupportstaff),
OnbehalfofBarbara,PleasefindtheagendafortomorrowmorningsSRSCcallandattachments.Theseincludea
compilationofyourpreliminarythoughtsonsubcommittees,whicharethefocusfordiscussionfortomorrowscall.
CurrentlySRSCmeetingsareonlyscheduledthroughtheOctoberpublicmeeting.Tomorrow,wealsoneedtotouchbase
quicklytodetermineifyouwanttocontinuewitheveryotherFriday9:3010:30amaftertheOctobermeetingorsome
othertime.
ScienceReviewSubcommitteeMeeting
Friday,September20,20138:30am10:00amEDT
ConferenceCall:(b) (6)
Passcode:(b) (6)
Agenda
Attachments
September6thSRSCMeetingMinutes
StartingProposalsforSubcommitteeOrganization
3WorkGroupTopicTables
2
PSC-HHS-000002
NELMethodology,DefiningInclusion/ExclusionCriteria
Inclusion/ExclusionCriteriaTemplate(sameaswasusedforNELtraining)
Thanks,
Kellie
KellieO.Casavale,PhD,RD
NutritionAdvisor,DivisionofPreventionScience
CoExecutiveSecretary,2015DietaryGuidelinesAdvisoryCommittee
HHS,OfficeofDiseasePreventionandHealthPromotion
ThisisanupdatetothetimefortheSept.20thSRSCcall.Itisnowearlierand30minuteslonger.Rafaelwillnotbeableto
beonthiscallashewillbetravelingbackfromSpain.
Thanks,
Kellie
PSC-HHS-000003
KellieandRick,
Welcomeback.Icantimaginehowdifficulttheshutdownhasbeenforeveryonethere.Wehaveallbeenthinking
aboutyouandhopingforthebestofoutcomes.
(b) (6)
Wewillmanagebuthopeyoucanstayonaslongasyoure
completelycomfortable.
Accordingtomyschedule,wehaveaSRSCcallonMonday.Doyouthinkthatwillstillhappen?IleaveforHoustonearly
tomorrowmorningandwillbeatFNCEuntillateonTuesday.Whileyouwereout,AliceandIhaveworkedonWG3as
plannedanddevisedaplan.IcirculatedourthoughtsseparatelytoMimandRaphael(consistentwithourprotocol)and
spokewithRaphaelyesterday.AliceandIwantedtoconfirmthathewasinagreementonastrategytostreamlinethe
foodgroupquestionsandreducetheoverallnumberofideasfromWG3.Basically,weproposethatwhenfoodgroups
areexaminedinrelationshiptohealthoutcomes,thattheybetreatedaspartofthedietarypatternquestions.Theidea
herewouldbetodeterminewhethertherearefoodgroupdriversofthepatternsrelationshiptohealthoutcomes
(suchasbreastcancerrisk).Thiswouldalsoallowtocontrolforconfoundingthatoftenoccurswhenfoodgroup
analysesdontcontrolfortheoveralldietarypattern.Raphaelsuggestedthattherewasaconsiderableamountof
attentionpaidtocrosssectionalandprospectivestudiesoffoodgroupsandhealthoutcomesin2010andthatstudy
designweaknesses(suchasconfoundingbydietarypattern)limitedtheconclusionsthatcouldbemadeorweakened
thestrengthofevidence.Wethoughtthatliteraturefocusingonfoodgroupsandhealthoutcomes[withoutcontrolfor
dietarypatterns]couldbelimitedtoexistingsystematicreviewsratherthanareviewoforiginalresearch.Thatwould
probablyworkexceptforrelativelynewhealthoutcomesofinterest(forexample,perhapsmentalhealth).Wedidall
agreethatfoodgroupsandintermediatemarkerswouldstillbeconsideredandthatcontrolledfeedingtrialsshould
providethisevidence.MimalsohasthesummaryAliceandIdidandisstillreviewingit.
Wouldyoulikemetoforwardittoyouorwaituntilournextcall?
Allbest,
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
PSC-HHS-000004
Thanks,Barbara!Wearebacktoworktoday.(b) (6)
Justwantedtogiveyouaheadsup.
Wewillbepullingtogetheranyeditswehaveonthemeetingminutesandcanupdatethemonline.Ournewweb
contractormentioneditwouldbeacostlystep,sowewillonlywanttodoitonce.So,wemaywaituntilwehaveany
otherswevefoundintheinterimaswell.
Thanks!
Kellie
KellieO.Casavale,PhD,RD
NutritionAdvisor,DivisionofPreventionScience
CoExecutiveSecretary,2015DietaryGuidelinesAdvisoryCommittee
HHS,OfficeofDiseasePreventionandHealthPromotion
HiKellie,
IknowthatyouarerestrictedfromansweringbutIthoughtIwouldsendalongmyeditstotheminutesfromPublic
Meeting1.Ithoughtyoudidagreatjobandthattheyreadwell.Ihadonlyminorcommentsonthematerialyou
preparedandoffersuggestionsbelow.Attachedisasummaryofmycomments.Ihopeyouconsiderincludingthem
too.
Allbest,
Barbara
Page7para3,last2linesChange.challengingtograbtochallengingtoattract.
Page25Whatworksforindividualstoadheretohealthydietarypatterns(i.e.Iwouldsuggestthatthisbeeditedtosay
soundevidencebasedmethodsforpromotingbehaviorchangeatindividualandpopulationlevels).Thisincludingboth
traditionalcounselingandcommunicationsmethodsaswellasnewandinnovativetechnologiesthatcanbeappliedin
varioussettings.
IthinkWG2isintendingthattheSubcommitteeexaminesbothtraditionalbehavioralmethods(whatproviders,
approaches,settingsandmodesareknowntobeeffective)aswellastheevidenceonweb/mobile/telephonic
approaches.
Page27Dr.Millennotedthatimportantdescriptiveinformationonbehavioralmethodsfromclinicaltrialshasnotbeen
minedsufficiently.Sheencouragedpayingattentiontodietarypatternprotocolsandmethods/modesofintervention
(includingprovider/teamcharacteristicsandsettings)usedtoachieveandsustainimproveddietarybehavior.
PSC-HHS-000005
HiKellie,
AliceandIbeganthetaskofstreamliningWG3bysummarizingthetop(1)priorityareasfromeachworkgroupand
reviewingthemforscopeandoverlap.Aspartofthisdiscussionwetriedtothinkcarefullyaboutwhetherthemost
importanttopicswouldbecoveredifwewereonlyabletoanswerquestionsinthistier.Thenwetalkedabouthowto
handleWG3specificallysincewehadagreedinourlastSRSCcallthatthelistofquestionshadtobestreamlined.This
letustotherecommendationtoincorporatefoodgroupsintoWG2questionstotheextentpossible.
Attachedistheworkingdraftwedevelopedandcirculated.LetsaddittotheMondayagendaifyouthinkits
reasonableandwecanseewhetherwecanreachconsensusonareorganizationofthequestionsandouranalytical
strategies.
Allbest,
Barbara
From: Casavale, Kellie (OS/OASH) [mailto:Kellie.Casavale@hhs.gov]
Sent: Thursday, October 17, 2013 2:27 PM
To: Millen, Barbara E
Cc: Olson, Richard (HHS/OASH)
Subject: RE: Minutes Meeting 1
Perfecttiming,Barbara.Rick,Colette,andIjusttouchedbaseandIamabouttosendoutamessagenotingthatweare
stillonfortheSRSCcallonMonday.Adiscussionofwhatyoudescribedbelowwouldbegreat.Ifthereisadocumentfor
metoincludeforthemeetingrelatedtoWG3andthatdiscussion,pleasesenditmywayandIcanincludeit.Wealso
haveseveralotheritemsfordiscussion.Iwillworkonanagendatomorrow.
Thanks!
Kellie
KellieO.Casavale,PhD,RD
NutritionAdvisor,DivisionofPreventionScience
CoExecutiveSecretary,2015DietaryGuidelinesAdvisoryCommittee
HHS,OfficeofDiseasePreventionandHealthPromotion
KellieandRick,
6
PSC-HHS-000006
Welcomeback.Icantimaginehowdifficulttheshutdownhasbeenforeveryonethere.Wehaveallbeenthinking
aboutyouandhopingforthebestofoutcomes.
(b) (6)
Wewillmanagebuthopeyoucanstayonaslongasyoure
completelycomfortable.
Accordingtomyschedule,wehaveaSRSCcallonMonday.Doyouthinkthatwillstillhappen?IleaveforHoustonearly
tomorrowmorningandwillbeatFNCEuntillateonTuesday.Whileyouwereout,AliceandIhaveworkedonWG3as
plannedanddevisedaplan.IcirculatedourthoughtsseparatelytoMimandRaphael(consistentwithourprotocol)and
spokewithRaphaelyesterday.AliceandIwantedtoconfirmthathewasinagreementonastrategytostreamlinethe
foodgroupquestionsandreducetheoverallnumberofideasfromWG3.Basically,weproposethatwhenfoodgroups
areexaminedinrelationshiptohealthoutcomes,thattheybetreatedaspartofthedietarypatternquestions.Theidea
herewouldbetodeterminewhethertherearefoodgroupdriversofthepatternsrelationshiptohealthoutcomes
(suchasbreastcancerrisk).Thiswouldalsoallowtocontrolforconfoundingthatoftenoccurswhenfoodgroup
analysesdontcontrolfortheoveralldietarypattern.Raphaelsuggestedthattherewasaconsiderableamountof
attentionpaidtocrosssectionalandprospectivestudiesoffoodgroupsandhealthoutcomesin2010andthatstudy
designweaknesses(suchasconfoundingbydietarypattern)limitedtheconclusionsthatcouldbemadeorweakened
thestrengthofevidence.Wethoughtthatliteraturefocusingonfoodgroupsandhealthoutcomes[withoutcontrolfor
dietarypatterns]couldbelimitedtoexistingsystematicreviewsratherthanareviewoforiginalresearch.Thatwould
probablyworkexceptforrelativelynewhealthoutcomesofinterest(forexample,perhapsmentalhealth).Wedidall
agreethatfoodgroupsandintermediatemarkerswouldstillbeconsideredandthatcontrolledfeedingtrialsshould
providethisevidence.MimalsohasthesummaryAliceandIdidandisstillreviewingit.
Wouldyoulikemetoforwardittoyouorwaituntilournextcall?
Allbest,
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
Thanks,Barbara!Wearebacktoworktoday.(b) (6)
Justwantedtogiveyouaheadsup.
Wewillbepullingtogetheranyeditswehaveonthemeetingminutesandcanupdatethemonline.Ournewweb
contractormentioneditwouldbeacostlystep,sowewillonlywanttodoitonce.So,wemaywaituntilwehaveany
otherswevefoundintheinterimaswell.
Thanks!
Kellie
KellieO.Casavale,PhD,RD
NutritionAdvisor,DivisionofPreventionScience
7
PSC-HHS-000007
CoExecutiveSecretary,2015DietaryGuidelinesAdvisoryCommittee
HHS,OfficeofDiseasePreventionandHealthPromotion
HiKellie,
IknowthatyouarerestrictedfromansweringbutIthoughtIwouldsendalongmyeditstotheminutesfromPublic
Meeting1.Ithoughtyoudidagreatjobandthattheyreadwell.Ihadonlyminorcommentsonthematerialyou
preparedandoffersuggestionsbelow.Attachedisasummaryofmycomments.Ihopeyouconsiderincludingthem
too.
Allbest,
Barbara
Page7para3,last2linesChange.challengingtograbtochallengingtoattract.
Page25Whatworksforindividualstoadheretohealthydietarypatterns(i.e.Iwouldsuggestthatthisbeeditedtosay
soundevidencebasedmethodsforpromotingbehaviorchangeatindividualandpopulationlevels).Thisincludingboth
traditionalcounselingandcommunicationsmethodsaswellasnewandinnovativetechnologiesthatcanbeappliedin
varioussettings.
IthinkWG2isintendingthattheSubcommitteeexaminesbothtraditionalbehavioralmethods(whatproviders,
approaches,settingsandmodesareknowntobeeffective)aswellastheevidenceonweb/mobile/telephonic
approaches.
Page27Dr.Millennotedthatimportantdescriptiveinformationonbehavioralmethodsfromclinicaltrialshasnotbeen
minedsufficiently.Sheencouragedpayingattentiontodietarypatternprotocolsandmethods/modesofintervention
(includingprovider/teamcharacteristicsandsettings)usedtoachieveandsustainimproveddietarybehavior.
PSC-HHS-000008
HiEve,
Thisisveryhelpful.Iwonderifwemightdiscussthedataabstraction.WorkhasbeguninSC4withareviewof
systematicreviewsandmetaanalysesandthedataabstractionmightbequitedifferentthatwiththeNELandwhatwas
donewithcaffeine.TheSCmightbeinterestedinhavingmorediscussioninanupcomingcallifpossible.Also,I
wonderedifwemightconsiderafewoftheexcludedstudies:32mightprovideinformationonfooddriversofthe
patterns,35isexamininginflammatorymarkersthatmaybeofinterestrelatingtoPUFAs.Also,alongwithourthemeof
whatworks,ifthefollowingreviewswereofRCTs,wemightconsiderthem:31,36,37,41,45.And,44istheonlyoneI
sawaddressingtheissueofdietaryvarietywhichmaybeofinterestorworthabitofSCdiscussion.
Whenabstractingthesestudies,acarefuldefinitionofthepatternsisimportant,particularlyMediterraneansinceit
variessomuchandthedietarypatternsmaynotbeidentifiablefromthelabel.
Allbest,
barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
PSC-HHS-000009
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 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.
10
PSC-HHS-000010
ThankyouAlice.Idoagree;dietaryguidelinesthatarebaseduponourbestunderstandingofnutritionalneedsofthe
populationshouldbethebasisofourguidanceandtheframeworkofourprograms.However,Iwouldaddthatan
improvedunderstandingofthedeterminantsofnutritionalrisk(includingfoodinsecurityandotherfactors)andtheir
relationshiptohealthoutcomesmayhelpusbetterdesignprogramsandinterventionstoreachvulnerablepopulation
orimproveprogram/serviceeffectiveness.Agreed?ThoughtIwouldaddthesefurtherthoughts.
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
Very useful call today. I think I figured out what I was trying to suggest at the end of
the call, in an inarticulate way.
Dietary Guidelines should drive programs aimed at addressing issues of household
food insecurity, household food insecurity should not drive formulation of dietary
guidelines. The issue of diet quality and food insecurity is not new and is embedded in
current federal assistance programs. Isnt that why federal feeding programs are tied
to the DG and food assistance programs are either tied to the DG (e.g., WIC) or SNAP
configured in a way to maximize their purchasing power (e.g., restrictions on
purchasing prepared foods)?
AliceH.Lichtenstein,D.Sc.
GershoffProfessorofNutritionScienceandPolicy
DirectorandSeniorScientist,CardiovascularNutritionLaboratory
TuftsUniversity
JMUSDAHumanNutritionResearchCenteronAging
711WashingtonStreet
Boston,MA02111
phone:6175563127
email:Alice.Lichtenstein@Tufts.edu
11
PSC-HHS-000011
AnneBrownRodgers
ScienceWriter
(b) (6)
Thisisthefollowupemail(below)withMimsnotesthatImentionedonthephoneyesterday.SeveralCommittee
membershavealsoaskedfortheupdatedversionofchapterguidance.Whatsthestatusofthatdocument?Areyou
alsogettingtheinputyouneedtomovetheexamplesofconclusionstatementsforward?
Kellie
KellieO.Casavale,PhD,RD
NutritionAdvisor,DivisionofPreventionScience
CoExecutiveSecretary,2015DietaryGuidelinesAdvisoryCommittee
HHS,OfficeofDiseasePreventionandHealthPromotion
PSC-HHS-000012
www.StrongWomen.org
www.ChildObesity180.org
www.facebook.com/StrongWomenwithMiriamNelson
Twitter: @DrMiriamNelson
13
PSC-HHS-000013
Iagreethatthisisnotourtasktodesignprogramsorservicessincethatispartofthepolicydevelopment
process.However,wearelookingatwhatworksandaretryingtoculloutthedietarypatterns,foodandnutrient
driversofthepatterns,andfeaturesofinterventions(selfmonitoring,comprehensivelifestyleintervention,school
basedandothercommunityprograms,etc.)thathaveproveneffectivenessandefficacyorpresentasbestpractices
whichwecansummarize.Hopethathelpsclarify.
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
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 improve
program/service effectiveness. Were that the case we would have individuals with
different types of expertise on the committee. That task sounds like an IOM
project. We have a huge job just with the nutrition science/food intake aspect and as I
keep saying, probably too many times in on any one day, I am concerned that as we
keep expanding our scope we will scrimp on our main goal.
AliceH.Lichtenstein,D.Sc.
GershoffProfessorofNutritionScienceandPolicy
DirectorandSeniorScientist,CardiovascularNutritionLaboratory
TuftsUniversity
JMUSDAHumanNutritionResearchCenteronAging
711WashingtonStreet
Boston,MA02111
phone:6175563127
email:Alice.Lichtenstein@Tufts.edu
From: Millen, Barbara E [mailto:bmillen@bu.edu]
Sent: Friday, May 02, 2014 4:40 PM
To: Lichtenstein, Alice; Anne Rodgers
14
PSC-HHS-000014
Cc: 'Casavale, Kellie (OS/OASH)'; 'Olson, Richard (HHS/OASH)'; 'Rihane, Colette - CNPP'
Subject: RE: Notes from last night -- notes on integration chapter
ThankyouAlice.Idoagree;dietaryguidelinesthatarebaseduponourbestunderstandingofnutritionalneedsofthe
populationshouldbethebasisofourguidanceandtheframeworkofourprograms.However,Iwouldaddthatan
improvedunderstandingofthedeterminantsofnutritionalrisk(includingfoodinsecurityandotherfactors)andtheir
relationshiptohealthoutcomesmayhelpusbetterdesignprogramsandinterventionstoreachvulnerablepopulation
orimproveprogram/serviceeffectiveness.Agreed?ThoughtIwouldaddthesefurtherthoughts.
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
Very useful call today. I think I figured out what I was trying to suggest at the end of
the call, in an inarticulate way.
Dietary Guidelines should drive programs aimed at addressing issues of household
food insecurity, household food insecurity should not drive formulation of dietary
guidelines. The issue of diet quality and food insecurity is not new and is embedded in
current federal assistance programs. Isnt that why federal feeding programs are tied
to the DG and food assistance programs are either tied to the DG (e.g., WIC) or SNAP
configured in a way to maximize their purchasing power (e.g., restrictions on
purchasing prepared foods)?
AliceH.Lichtenstein,D.Sc.
GershoffProfessorofNutritionScienceandPolicy
DirectorandSeniorScientist,CardiovascularNutritionLaboratory
TuftsUniversity
JMUSDAHumanNutritionResearchCenteronAging
711WashingtonStreet
Boston,MA02111
phone:6175563127
email:Alice.Lichtenstein@Tufts.edu
From: Anne Rodgers (b) (6)
Sent: Friday, May 02, 2014 2:36 PM
To: 'Millen, Barbara E'; Lichtenstein, Alice
Cc: 'Casavale, Kellie (OS/OASH)'; 'Olson, Richard (HHS/OASH)'; 'Rihane, Colette - CNPP'
Subject: FW: Notes from last night -- notes on integration chapter
15
PSC-HHS-000015
AnneBrownRodgers
ScienceWriter
(b) (6)
Thisisthefollowupemail(below)withMimsnotesthatImentionedonthephoneyesterday.SeveralCommittee
membershavealsoaskedfortheupdatedversionofchapterguidance.Whatsthestatusofthatdocument?Areyou
alsogettingtheinputyouneedtomovetheexamplesofconclusionstatementsforward?
Kellie
KellieO.Casavale,PhD,RD
NutritionAdvisor,DivisionofPreventionScience
CoExecutiveSecretary,2015DietaryGuidelinesAdvisoryCommittee
HHS,OfficeofDiseasePreventionandHealthPromotion
PSC-HHS-000016
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 take
and increasing physical activity.
www.StrongWomen.org
www.ChildObesity180.org
www.facebook.com/StrongWomenwithMiriamNelson
Twitter: @DrMiriamNelson
17
PSC-HHS-000017
Subject:
Attachments:
ThankyouAnnaMaria,
IwanttosayfirstthatIthinktheCVDsummary,asmentionedinmyattachedcomments,iselegant,informativeand
quitethorough.ItisthefirstandwillbethemodelfortheotherssoIwouldliketobesurewehavebeenasrigorousas
possible.IliketheformatIreviewedratherthantheothers.
YouwillseethatIwentbackandextractedthedefinitionsofDASHandMEDstyledietsfromtheACC/AHApublications.
Itthinkweoughttodothisforthescoresaswellandbecertainthatweagreewiththecomponentfoodsandnutrients
thatweuseinoursummaryconclusionstatements.Weoughttobeabitmorespecificontheexposuredefinitionsin
oursummariesstatements.Ihavecommentsinmyreview.Pleaseaccepttheseinthemostconstructiveway.Thisisso
importantandwewanttogetitright.WhileIwouldliketobeasinclusiveofthedietarypatternfoodandnutrient
components,thisneedstobedatadriven.Rightnow,Ifearitisabitselectiveoftheviews(thatwemaycollectively
hold)butmaynotbetrulysupportedbythedata.
Interestedinyourthoughts.IaddedAlicetothereviewlistsinceIknowshehasdeepexpertiseandstrongviewson
theseareas.
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
DearEve,FrankandBarbara;
ImadesomeeditstotheT2DandBWconclusionsandevidence.IalsohadjustafeweditsonFranks.Giventhe
differencesintheamountofdetailsprovidedinthesetwodraftsandthestyleofwriting,itwouldbeveryhelpfullytoall
committeemembersiftheSRCcanprovideinputastowhichispreferred.Iamhappytogowitheither.
Thankyouandhaveagreatweekend.
AMSR
18
PSC-HHS-000018
ChapelHill,NC27599
Phone:9199628410(CPC);9199665984(Epi)
Email:am siegariz@unc.edu
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 <Eve.Essery@fns.usda.gov> wrote:
Hi Anna Maria, Frank, Barbara, and Cheryl,
In preparation for tomorrows 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 in
this file.)
2. Draft chapter content from Anna Maria
3. Email correspondence from Barbara, Frank, and Anna Maria after receiving Anna Marias 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 any
questions about the specific reports.
19
PSC-HHS-000019
Thanks,
Eve
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 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, PhD
Professor of Nutrition and Epidemiology
Harvard School of Public Health
Professor of Medicine
Harvard Medical School
20
PSC-HHS-000020
21
PSC-HHS-000021
Hi,
Ialsothinkthechapterintroductionoughttosetthestageforthemajorthemesandapproaches,includingmethodof
exposureandoutcomeassessment,patternsandpatternscoring.Thedefinitionandinterpretationoftheexposures
probablyneedsomeparticularexplanationsincewethinkofriskassociatedwithacategory(forexample,quartileor
quintile)andthescoremaycaptureonlypartofthepatternandmaynotreflectcompletecompliancewiththepattern
components.
Allbest,
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
BarbaraandFrank,
Iagreethatweneedtocometoaconsensusbeforerevising.Itseemsasifintheintroductionofthischapterweshould
definethedietarypatternsandthenforeachoutcomewecansaywhetherthestudiesreviewedfitthestandard
definitionorexplainbrieflyhowtheydeviated.Ifthisisnotdoneupfront,eachofthesesectionsaregoingtogetpretty
longratherquickly.
SC#2hasacallonThursdayIbelievethisisimportantforallofoursubcommitteememberstoparticipatein.
Eve,assoonasStevewritesuphissectioncanyousendthattousreview?
AMSR
Hi Barbara,
22
PSC-HHS-000022
Thank VERY MUCH for your detailed and thoughtful comments on the dietary pattern - CVD section. Overall,
I 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 as
well (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 pattern
analyses. 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 the
evidence 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.
23
PSC-HHS-000023
Best regards
Frank
IwanttosayfirstthatIthinktheCVDsummary,asmentionedinmyattachedcomments,iselegant,informativeand
quitethorough.ItisthefirstandwillbethemodelfortheotherssoIwouldliketobesurewehavebeenasrigorousas
possible.IliketheformatIreviewedratherthantheothers.
YouwillseethatIwentbackandextractedthedefinitionsofDASHandMEDstyledietsfromtheACC/AHApublications.
Itthinkweoughttodothisforthescoresaswellandbecertainthatweagreewiththecomponentfoodsandnutrients
thatweuseinoursummaryconclusionstatements.Weoughttobeabitmorespecificontheexposuredefinitionsin
oursummariesstatements.Ihavecommentsinmyreview.Pleaseaccepttheseinthemostconstructiveway.Thisisso
importantandwewanttogetitright.WhileIwouldliketobeasinclusiveofthedietarypatternfoodandnutrient
components,thisneedstobedatadriven.Rightnow,Ifearitisabitselectiveoftheviews(thatwemaycollectively
hold)butmaynotbetrulysupportedbythedata.
Interestedinyourthoughts.IaddedAlicetothereviewlistsinceIknowshehasdeepexpertiseandstrongviewson
theseareas.
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
24
PSC-HHS-000024
DearEve,FrankandBarbara;
ImadesomeeditstotheT2DandBWconclusionsandevidence.IalsohadjustafeweditsonFranks.Giventhe
differencesintheamountofdetailsprovidedinthesetwodraftsandthestyleofwriting,itwouldbeveryhelpfullytoall
committeemembersiftheSRCcanprovideinputastowhichispreferred.Iamhappytogowitheither.
Thankyouandhaveagreatweekend.
AMSR
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,
25
PSC-HHS-000025
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.
Frank
On Thu, Mar 6, 2014 at 3:10 PM, Essery, Eve - CNPP <Eve.Essery@fns.usda.gov> wrote:
Hi Anna Maria, Frank, Barbara, and Cheryl,
In preparation for tomorrows 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 in
this file.)
2. Draft chapter content from Anna Maria
3. Email correspondence from Barbara, Frank, and Anna Maria after receiving Anna Marias 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 any
questions about the specific reports.
26
PSC-HHS-000026
Thanks,
Eve
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 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, PhD
Professor of Nutrition and Epidemiology
Harvard School of Public Health
Professor of Medicine
Harvard Medical School
665 Huntington ave, Boston, MA 02115
tel: 617 432 0113 fax: 617 432 2435
<http://www.hsph.harvard.edu/faculty/frank-hu/>
http://www.hsph.harvard.edu/faculty/frank-hu/
******************************************************
27
PSC-HHS-000027
-*******************************************************
Frank B. Hu, MD, PhD
Professor of Nutrition and Epidemiology
Harvard School of Public Health
Professor of Medicine
Harvard Medical School
665 Huntington ave, Boston, MA 02115
tel: 617 432 0113 fax: 617 432 2435
<http://www.hsph.harvard.edu/faculty/frank-hu/>
http://www.hsph.harvard.edu/faculty/frank-hu/
******************************************************
28
PSC-HHS-000028
Subject:
AliceH.Lichtenstein,D.Sc.
GershoffProfessorofNutritionScienceandPolicy
DirectorandSeniorScientist,CardiovascularNutritionLaboratory
TuftsUniversity
JMUSDAHumanNutritionResearchCenteronAging
711WashingtonStreet
Boston,MA02111
phone:6175563127
email:Alice.Lichtenstein@Tufts.edu
From: Frank Hu [mailto:nhbfh@channing.harvard.edu]
Sent: Wednesday, May 07, 2014 10:07 AM
To: Essery, Eve - CNPP; Lichtenstein, Alice; bmillen@bu.edu; Tom Brenna
Cc: Anderson, Cheryl; Anna Maria Siega-Riz, PhD, MS, RD (am_siegariz@unc.edu); Casavale, Kellie (OS/OASH); Obbagy,
Julie - CNPP; McDowell, Margaret (NIH/NIDDK) [E]; rachel.fisher@nih.hhs.gov
Subject: 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 probably
need 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 of
PUFA studies, lack of comparator (saturated fat vs. carbs)... Overall I think the data and interpretation of this metaanalysis are seriously flawed. The authors tried to correct some of the errors but the corrections are incomplete. We did a
teach-in symposium about this study to clarify some of the confusions; both Alice and I presented our viewpoints and
interpretation of the existing evidence.
Attached please see my slides for your information.
29
PSC-HHS-000029
Regarding the WSJ article, it was written by a reporter who does not seem to understand nutrition or epidemiology. She
has a book on the same topic coming out next week. The article is not peer-reviewed and makes many nonsense
viewpoints 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 <Eve.Essery@fns.usda.gov> wrote:
Hi Frank and Cheryl,
Tom sent the comments below related to the dietary patterns and CVD, T2D, and body weight reviews.
Eve
Comments on "CVD.dietary.patterns.Chapter2.4.30.14"
(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.
30
PSC-HHS-000030
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 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.
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?
31
PSC-HHS-000031
Tom
On Tue, May 6, 2014 at 8:49 AM, Siega-Riz, Anna Maria <am_siegariz@unc.edu> wrote:
ThankyouTom.Weighinginhereisimportantforhowwewillproceedwithwritingupourconclusions.Safetravels.
AMSR
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 <Eve.Essery@fns.usda.gov> wrote:
Hi SC2 members,
32
PSC-HHS-000032
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 Thursdays SC2
call. Also attached are the summary tables for these questions.
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 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.
-*******************************************************
33
PSC-HHS-000033
34
PSC-HHS-000034
Subject:
AliceH.Lichtenstein,D.Sc.
GershoffProfessorofNutritionScienceandPolicy
DirectorandSeniorScientist,CardiovascularNutritionLaboratory
TuftsUniversity
JMUSDAHumanNutritionResearchCenteronAging
711WashingtonStreet
Boston,MA02111
phone:6175563127
email:Alice.Lichtenstein@Tufts.edu
From: (b) (6)
gmail.com [mailto:(b) (6)
gmail.com] On Behalf Of Tom Brenna
Sent: Wednesday, May 07, 2014 4:42 PM
To: Frank Hu
Cc: Essery, Eve - CNPP; Lichtenstein, Alice; bmillen@bu.edu; Anderson, Cheryl; Anna Maria Siega-Riz, PhD, MS, RD
(am_siegariz@unc.edu); Casavale, Kellie (OS/OASH); Obbagy, Julie - CNPP; McDowell, Margaret (NIH/NIDDK) [E];
rachel.fisher@nih.hhs.gov
Subject: Re: FW: DGAC SC 2: Pre-read for Thurs call
PSC-HHS-000035
The "teach-in" is a 3 hour long video; I would prefer the written word.
Tom
On Wed, May 7, 2014 at 8:25 AM, Essery, Eve - CNPP <Eve.Essery@fns.usda.gov> wrote:
Hi Frank and Cheryl,
Tom sent the comments below related to the dietary patterns and CVD, T2D, and body weight reviews.
Eve
36
PSC-HHS-000036
Comments on "CVD.dietary.patterns.Chapter2.4.30.14"
(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.
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 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.
37
PSC-HHS-000037
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?
Tom
On Tue, May 6, 2014 at 8:49 AM, Siega-Riz, Anna Maria <am_siegariz@unc.edu> wrote:
ThankyouTom.Weighinginhereisimportantforhowwewillproceedwithwritingupourconclusions.Safetravels.
AMSR
38
PSC-HHS-000038
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 <Eve.Essery@fns.usda.gov> 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 Thursdays SC2
call. Also attached are the summary tables for these questions.
39
PSC-HHS-000039
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 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, PhD
Professor of Nutrition and Epidemiology
Harvard School of Public Health
Professor of Medicine
Harvard Medical School
665 Huntington ave, Boston, MA 02115
tel: 617 432 0113 fax: 617 432 2435
<http://www.hsph.harvard.edu/faculty/frank-hu/>
http://www.hsph.harvard.edu/faculty/frank-hu/
******************************************************
40
PSC-HHS-000040
Subject:
Attachments:
Thanksforthesuperbsummarytable.Iwentthroughandaddedcommentsandmadequestionsincertainplaces.In
theoverallconclusionandImplicationsstatement,itwouldseemimportanttoconsiderspecifyingsubgroupsforwhich
thereareconsistentdata(ageandsex)andfortherecommendedtypesofinterventions,thoseforwhichevidenceis
strongest.Iwasntsurefromthesummarieswhethersomeoftheconclusionsweresupportedbydataornot.Things
forthoughtanddiscussion.
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
All,
OnbehalfofMim,pleasefindmeetingmaterialsattachedforthenextPhysicalActivityWritingGroup(PAWG)call.Asa
reminder,thismeetingisscheduledforFriday,May9,2014from2:303:30p.m.
Youwillfindthefollowingdocumentsattached:
Meetingagenda(Word)
UpdatedPAquestionsandevidence(Excel,dated5.7.14)
Proposedguidancefordeveloping2015DGACevidencereviews(Word,dated4.15.14)
WhenreviewingtheExcelworkbookpriortothecall,notethatthepurpletabrepresentsthePAWGslistofquestions
andcorrespondingevidencefromthethreePAGreports.Thisincludes15questionsinthreephysicalactivitysubtopic
areas(i.e.,healthoutcomes=11;behavioralinterventions=1;environmentalinterventions=3).ThefocusofFridays
discussionwillonlyincludethequestionsandevidenceinthepurpletab.AlsonotethatMimhasprovidedinitial
examplesofconclusionandimplicationstatementsforquestions#1and#1afordiscussion.
RegardingtheProposedguidancefordeveloping2015DGACevidencereviews,notethatthePAWGwillusescenario2
(i.e.,usingexistingreportsorsystematicreviews/metaanalyses)toaddressphysicalactivityquestions;seepages46
forspecificguidance.
41
PSC-HHS-000041
Finally,weplantousewebcastcapabilitiestoreviewtheExcelworkbookduringthecallonFriday.Conferencelineand
webcastinformationisprovidedinthemeetingagendaandOutlookcalendarinvite.Pleaseletmeknowifyouhaveany
questions.
Manythanks,ALM
42
PSC-HHS-000042
Probablyshouldkeeptrackofthis.IsentitontoSC2andSC3leads.Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
Thoughtyoubothmightbeinterestedinthisrecentrecommendation.Doesntgosofarastomentionwhoisqualified
toprovidetheintensivebehavioralrecommendationbuttheyareencouragingit.Ithinkwecandoandhavedoneabit
betterinourwording.
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
Helloall
Ithoughtyouwouldbeinterestedtoknowabout,andpossiblycommenton,therecentdraftrecommendationfromthe
USPSTF:
Behavioral Counseling to Promote a Healthy Diet and Physical Activity for Cardiovascular Disease
Prevention in Adults with Known Risk Factors: U.S. Preventive Services Task Force Recommendation
Statement
DRAFT
Summary of Recommendation and Evidence
The U.S. Preventive Services Task Force (USPSTF) recommends offering or referring overweight and obese adults who have
additional cardiovascular disease (CVD) risk factors to intensive behavioral counseling interventions to promote a healthy diet and
physical activity for CVD prevention.
This is a Grade B recommendation.
43
PSC-HHS-000043
Moredetailedinformationontheevidencereportandcommentingcanbeaccessedatthislink:
http://www.uspreventiveservicestaskforce.org/tfcomment.htm
Best,
Kathryn
The only study on the attached list that seems relevant to the Obesity Guidelines is STAMPEDE (50 subjects per group
randomized to sleeve, bypass or medical intervention with glycemic and weight endpoints). Given that it is only 50
subjects with sleeve gastrectomy, I don't think that it rises to the level of changing our CQ 5 recommendation. The other
study that we should at least talk about is LABS II (three year data on surgical outcomes; it's authoritative on the amount
of weight loss that could be expected with the various procedures. Its a good study, but I don' t think it changes our
recommendations and we would not change our evidence statements based on this sort of methodology (a casual one of
remembering studies)..
I don't think we should change the evidence statements; they had rigorous methodology which we wouldn't want to
weaken with this sort of approach.
As for other studies that address CQ 1-5, nothing else comes to mind that would likely change our recommendations for
those 5 CQs.
My vote is that I see nothing to add and nothing to change.
Donna
Donna H. Ryan MD
Professor Emerita,
Pennington Biomedical Research Center
Baton Rouge, LA 70808
225 229 3909
donna.ryan@pbrc.edu
New Orleans address:
(b) (6)
Colorado addresses:
(b) (6)
44
PSC-HHS-000044
URGENT:TimelyResponseRequested
Wewouldappreciateyourimmediateattentiontothisrequest
DearACC/AHAObesityWritingCommitteeMember,
Aspartofourongoingguidelinereviewprocess,weareaskingyoutovoteonlatebreakingclinicaltrials(LBCTs)
presentedatthe2013and2014ACC,AHA,ESC,andTCTmeetingstodeterminewhethertheymightleadtoanupdate
orrevisionoftheACC/AHAObesityGuideline.Thisprocesswillassistinprovidingtimelyupdatesoftheguidelines.
ACTIONS:VotesareduebyFriday,May23rd.
1. Please cast your votes using the attached 2014 LBCT Review document.
a. We have indicated which trials are relevant to which guidelines, so please make your votes accordingly.
2. If you feel that some of the trials not listed as relevant to your guideline are in fact relevant, please feel free to
also vote on those trials.
3. Lastly, your input/suggestions are requested regarding any additional studies/data that are not already included.
a. Your expertise in the clinical area specific to your guideline will add tremendous value and will be a
primary consideration when the Task Force decides which guidelines to update. The end goal is to
identify the most important trials that could potentially lead to a change in existing or new
recommendations.
Eachtriallistedinthe2014LBCTReviewdocumenthasalinktotheCardiosourcesummarysheetorotherlinkas
appropriate.Ifthestudyhasbeenpublished,therewillbealinktothePubMedabstractorfullarticleifavailable.
Unpublishedtrialswillnotbeincorporatedintoguidelinesuntiltheypublishbutwewouldstilllikeyourfeedbackabout
thetrial.Note:ToviewtheCardiosourcesummaries,pleasebesureyouareloggedintowww.cardiosource.orgfirst.If
youneedassistanceaccessingthewebsite,pleasecontacttheACCResourceCenterfortechnicalassistanceat1800
2534636,ext.5603.
NextSteps:
Aftercollectinginputfromwritingcommitteemembers,theratingswillbepresentedtotheACC/AHATaskForceon
PracticeGuidelinesonJune9th,2014,andthememberswilldecidewhichwritingcommitteesshouldconvenea
conferencecalltodecideifanupdateisnecessary.Ifafocusedupdateiscommissioned,wewillreconvenethewriting
committeeoraportionofit,pendingreviewofthecompositionoftherelationshipswithindustryofallmembers.Ifyou
haveanyquestionsabouttheprocess,oraboutyourrole,pleasedonothesitatetocontactACC/AHAstaff.
Thereviewcriteriafollow(notlistedinorderofimportance):
Publicationinapeerreviewedjournal(thiselementassurestimefortheevidencetosimmerintheclinical
community,whichhelpsprotectagainstbeingtooreactionary);
Large,randomized,placebocontrolledtrial(s);
45
PSC-HHS-000045
Nonrandomizeddatadeemedimportantonthebasisofresultsaffectingcurrentsafetyandefficacy
assumptions,includingobservationalstudiesandmetaanalyses;
Strength/weaknessofresearchmethodologyandfindings;
Likelihoodofadditionalstudiesinfluencingcurrentfindings;
Impactoncurrentand/orlikelihoodofneedtodevelopnewperformancemeasure(s);
Request(s)andrequirement(s)forreviewandupdatefromthepracticecommunity,keystakeholders,andother
sourcesfreeofrelationshipswithindustryorotherpotentialbias;
Numberofprevioustrialsshowingconsistentresults;and
Needforconsistencywithanewguidelineorguidelineupdatesorrevisions.
Asalways,thankyouforyourdedicationandtimeallocatedforthisreviewprocess.
BestRegards,
JeffreyL.Anderson,M.D.,F.A.C.C.,F.A.H.A.
Chair,ACCF/AHATaskForceonPracticeGuidelines
Cc:LisaBradfield,MarcoDiBuono
46
PSC-HHS-000046
Subject:
Attachments:
HiFranketal,
Thisrevisionisawonderfulsummary.IthinkitisgettingveryclosebutIamhopingwithmyeditstofinetuneitabit
more.ThisisintendedinthemostconstructivewayandIhopethecommentshelp.Iwonderedwhetherweshould
considerincludingoneothercategoryoffoods(lean/lowerfatproteins)andcertainothermacroandmicronutrients
(saturatedfatinparticularbutalsopossiblytotalfat,cholesterolandfiber,potassium,magnesiumandcalcium)as
reflectedinthesummaryofevidence.Irealizethatitmakesthesummarystatementmorecomplicatedbutitisalso
perhapsmorecomplete.Thiswilldepend,ofcourse,onwhetherwehaveconsensusopiniononthisadditionalfood
groupandtheothernutrients.Iwentaheadandalsoeditedthewordingontheprospectivecohortliteraturetoreflect
thenatureoftheresearch(associationsnoteffects).Iwasntsureifitmakessensetocaptureotherprospectivecohort
literaturerelatingtouseoffactor/clusterapproacheswhereemptycalorieandWesternpatternsareassociatedwith
adverseCVDoutcomesandhearthealthierpatternsarebeneficial.
Hopeyourholidayweekendissafeandrestful.
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
Dear All,
attached is a revised draft of the section on dietary patterns and CVD. To address your comments, the revised
version included more detailed information on methods used to derive the patterns, components of the patterns
47
PSC-HHS-000047
that may drive the associations, and variations in the patterns across different studies and populations. Despite
the heterogeneity in study designs, populations, and methodologies, several heart-healthy patterns were
identified with strong evidence from both observational studies RCTs and these patterns share most
components. The implication is that individuals can adopt these patterns according to their personal needs and
preferences.
We can discuss this further at tomorrow's call.
Frank
On Wed, May 21, 2014 at 5:25 PM, Essery, Eve - CNPP <Eve.Essery@fns.usda.gov> wrote:
Hi SC2 members,
On behalf of Anna Maria, attached are materials for tomorrow's SC2 call at 1pm ET (10am PT). Please let me know if you
will not be able to join the call. (Alice, Steve, Marian, and Rafael I have you as unavailable, but let me know if thats
incorrect.) Thanks!
(6)
(6)
(6)
AGENDA
2. Updates
SC1 and SC2 crossover dietary patterns composition project (attachment) [Cheryl and Eve]
Sodium [Cheryl]
PSC-HHS-000048
Next call: Thursday, June 5 from 1:00 to 2:00 pm ET (10:00 to 11:00 am PT)
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 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, PhD
Professor of Nutrition and Epidemiology
Harvard School of Public Health
49
PSC-HHS-000049
Professor of Medicine
Harvard Medical School
665 Huntington ave, Boston, MA 02115
tel: 617 432 0113 fax: 617 432 2435
<http://www.hsph.harvard.edu/faculty/frank-hu/>
http://www.hsph.harvard.edu/faculty/frank-hu/
******************************************************
50
PSC-HHS-000050
Subject:
ThankyouFrank.Irecommendedconsideringtheadditionalnutrientsbecausepolyunsaturatedfatwasincludedinthe
statement.Ithinkincludingitaswellassodiummakessenseanditwouldsureweniceifwereachedconsensuson
saturatedifnottotalfat.LetsseehowothersmightfeelaboutthatparticularlysaturatedfatsinceIbelievemanyofthe
patternsarerelativelylowinit.Intermsofthefactorandclusterpatterns,IdontrecallwhattheNELreviewconcluded.
Wasitthattherewasntenoughconsensustomakefurtherstatementsaboutnotscoring[methods?
Allbest,
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
PSC-HHS-000051
processed meats are often lumped together and poultry and fish are recommended to replace red and processed
meats in these diets (e.g., Med, DASH, AHEI etc). Therefore, I think the conclusion statements and
implications should stick to foods and food patterns (except for sodium, PUFA in vegetable oils) instead of
using the terms like "low fat" or "low carbo", which are not evidence-based and have continued to cause much
controversy and confusions in the general public and recommendations.
I'm not exactly sure your question regarding "otherprospectivecohortliteraturerelatingtouseoffactor/cluster
approacheswhereemptycalorieandWesternpatternsareassociatedwithadverseCVDoutcomesandheart
healthierpatternsarebeneficial."IthoughttheNELhasalreadydonethis.
Frank
On Sun, May 25, 2014 at 8:58 AM, Millen, Barbara E <bmillen@bu.edu> wrote:
HiFranketal,
Thisrevisionisawonderfulsummary.IthinkitisgettingveryclosebutIamhopingwithmyeditstofinetuneitabit
more.ThisisintendedinthemostconstructivewayandIhopethecommentshelp.Iwonderedwhetherweshould
considerincludingoneothercategoryoffoods(lean/lowerfatproteins)andcertainothermacroandmicronutrients
(saturatedfatinparticularbutalsopossiblytotalfat,cholesterolandfiber,potassium,magnesiumandcalcium)as
reflectedinthesummaryofevidence.Irealizethatitmakesthesummarystatementmorecomplicatedbutitisalso
perhapsmorecomplete.Thiswilldepend,ofcourse,onwhetherwehaveconsensusopiniononthisadditionalfood
groupandtheothernutrients.Iwentaheadandalsoeditedthewordingontheprospectivecohortliteraturetoreflect
thenatureoftheresearch(associationsnoteffects).Iwasntsureifitmakessensetocaptureotherprospectivecohort
literaturerelatingtouseoffactor/clusterapproacheswhereemptycalorieandWesternpatternsareassociatedwith
adverseCVDoutcomesandhearthealthierpatternsarebeneficial.
Hopeyourholidayweekendissafeandrestful.
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
PSC-HHS-000052
Dear All,
attached is a revised draft of the section on dietary patterns and CVD. To address your comments, the revised
version included more detailed information on methods used to derive the patterns, components of the patterns
that may drive the associations, and variations in the patterns across different studies and populations. Despite
the heterogeneity in study designs, populations, and methodologies, several heart-healthy patterns were
identified with strong evidence from both observational studies RCTs and these patterns share most
components. The implication is that individuals can adopt these patterns according to their personal needs and
preferences.
Frank
On Wed, May 21, 2014 at 5:25 PM, Essery, Eve - CNPP <Eve.Essery@fns.usda.gov> wrote:
Hi SC2 members,
On behalf of Anna Maria, attached are materials for tomorrow's SC2 call at 1pm ET (10am PT). Please let me know if you
will not be able to join the call. (Alice, Steve, Marian, and Rafael I have you as unavailable, but let me know if thats
incorrect.) Thanks!
(6)
(6)
53
PSC-HHS-000053
Web conference:
(b) (6)
AGENDA
2. Updates
SC1 and SC2 crossover dietary patterns composition project (attachment) [Cheryl and Eve]
Sodium [Cheryl]
Next call: Thursday, June 5 from 1:00 to 2:00 pm ET (10:00 to 11:00 am PT)
54
PSC-HHS-000054
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 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, PhD
Professor of Nutrition and Epidemiology
Harvard School of Public Health
Professor of Medicine
Harvard Medical School
665 Huntington ave, Boston, MA 02115
tel: 617 432 0113 fax: 617 432 2435
<http://www.hsph.harvard.edu/faculty/frank-hu/>
http://www.hsph.harvard.edu/faculty/frank-hu/
******************************************************
-*******************************************************
Frank B. Hu, MD, PhD
Professor of Nutrition and Epidemiology
Harvard School of Public Health
Professor of Medicine
Harvard Medical School
665 Huntington ave, Boston, MA 02115
tel: 617 432 0113 fax: 617 432 2435
55
PSC-HHS-000055
<http://www.hsph.harvard.edu/faculty/frank-hu/>
http://www.hsph.harvard.edu/faculty/frank-hu/
******************************************************
56
PSC-HHS-000056
Subject:
I would suggest keeping in mind, if SFA intake changes, so does either unsaturated fat
or carbohydrate, and the impact can be different. We need to be careful about
focusing on single energy containing nutrients.
AliceH.Lichtenstein,D.Sc.
GershoffProfessorofNutritionScienceandPolicy
DirectorandSeniorScientist,CardiovascularNutritionLaboratory
TuftsUniversity
JMUSDAHumanNutritionResearchCenteronAging
711WashingtonStreet
Boston,MA02111
phone:6175563127
email:Alice.Lichtenstein@Tufts.edu
From: (b) (6)
gmail.com [mailto:(b) (6)
gmail.com] On Behalf Of Tom Brenna
Sent: Monday, May 26, 2014 11:17 AM
To: Frank Hu
Cc: Millen, Barbara E; Essery, Eve - CNPP; Siega-Riz, Anna Maria; Lichtenstein, Alice; c1anderson@ucsd.edu;
steven.clinton@osumc.edu; frank.hu@channing.harvard.edu; mneuhous@fhcrc.org; rafael.perez-escamilla@yale.edu;
Olson, Richard (HHS/OASH); Rihane, Colette - CNPP; Bowman, Shanthy; Obbagy, Julie - CNPP; Fisher, Rachel
(NIH/NIDDK) [E]; margaret.mcdowell@nih.gov; Wong, Yatping - CNPP; Anne Rodgers; Casavale, Kellie (OS/OASH); Eric E
Calloway; PBROWN@hsph.harvard.edu; Mironick, Adrianna; jconnor@fhcrc.org; Bailey, Lauren A.; Knight, Brianna;
Angelica Figueroa
Subject: Re: DGAC SC2: Call THURS @ 1pm ET (10 am PT)
PSC-HHS-000057
On Mon, May 26, 2014 at 10:13 AM, Millen, Barbara E <bmillen@bu.edu> wrote:
ThankyouFrank.Irecommendedconsideringtheadditionalnutrientsbecausepolyunsaturatedfatwasincludedinthe
statement.Ithinkincludingitaswellassodiummakessenseanditwouldsureweniceifwereachedconsensuson
saturatedifnottotalfat.LetsseehowothersmightfeelaboutthatparticularlysaturatedfatsinceIbelievemanyofthe
patternsarerelativelylowinit.Intermsofthefactorandclusterpatterns,IdontrecallwhattheNELreviewconcluded.
Wasitthattherewasntenoughconsensustomakefurtherstatementsaboutnotscoring[methods?
Allbest,
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
PSC-HHS-000058
Since our evidence-based reviews are focused on overall dietary patterns rather than individual nutrients, I
would be hesitate to add those nutrients (except for sodium) to the conclusion statement. I think a statement on
individual nutrients (such as saturated fat, total fat, calcium, potassium, mg, fiber etc.) would warrant separate
systematic reviews if evidence-based statements were to be made about them (I know we don't have time to do
that). Somewhere in the text, we can describe the nutrient profiles of certain dietary patterns, although we need
to be cognizant that some nutrients (e.g., the amount of total fat and saturated fat) are likely to differ according
to different dietary patterns (e.g., Med, DASH, Omni-Heart higher mono or higher protein, vegetarian, AHEI
etc). Clearly, one size does not fit all, but these patterns do share many food components (e.g., fruits, vegs,
legumes, whole grains, nuts, etc). Of note, none of the patterns reviewed here have clearly distinguished
"lean/lower fat proteins" from "high fat proteins", which are fairly vague terms. Instead, red meats and
processed meats are often lumped together and poultry and fish are recommended to replace red and processed
meats in these diets (e.g., Med, DASH, AHEI etc). Therefore, I think the conclusion statements and
implications should stick to foods and food patterns (except for sodium, PUFA in vegetable oils) instead of
using the terms like "low fat" or "low carbo", which are not evidence-based and have continued to cause much
controversy and confusions in the general public and recommendations.
Frank
On Sun, May 25, 2014 at 8:58 AM, Millen, Barbara E <bmillen@bu.edu> wrote:
HiFranketal,
Thisrevisionisawonderfulsummary.IthinkitisgettingveryclosebutIamhopingwithmyeditstofinetuneitabit
more.ThisisintendedinthemostconstructivewayandIhopethecommentshelp.Iwonderedwhetherweshould
59
PSC-HHS-000059
considerincludingoneothercategoryoffoods(lean/lowerfatproteins)andcertainothermacroandmicronutrients
(saturatedfatinparticularbutalsopossiblytotalfat,cholesterolandfiber,potassium,magnesiumandcalcium)as
reflectedinthesummaryofevidence.Irealizethatitmakesthesummarystatementmorecomplicatedbutitisalso
perhapsmorecomplete.Thiswilldepend,ofcourse,onwhetherwehaveconsensusopiniononthisadditionalfood
groupandtheothernutrients.Iwentaheadandalsoeditedthewordingontheprospectivecohortliteraturetoreflect
thenatureoftheresearch(associationsnoteffects).Iwasntsureifitmakessensetocaptureotherprospectivecohort
literaturerelatingtouseoffactor/clusterapproacheswhereemptycalorieandWesternpatternsareassociatedwith
adverseCVDoutcomesandhearthealthierpatternsarebeneficial.
Hopeyourholidayweekendissafeandrestful.
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
Dear All,
attached is a revised draft of the section on dietary patterns and CVD. To address your comments, the revised
version included more detailed information on methods used to derive the patterns, components of the patterns
that may drive the associations, and variations in the patterns across different studies and populations. Despite
the heterogeneity in study designs, populations, and methodologies, several heart-healthy patterns were
60
PSC-HHS-000060
identified with strong evidence from both observational studies RCTs and these patterns share most
components. The implication is that individuals can adopt these patterns according to their personal needs and
preferences.
Frank
On Wed, May 21, 2014 at 5:25 PM, Essery, Eve - CNPP <Eve.Essery@fns.usda.gov> wrote:
Hi SC2 members,
On behalf of Anna Maria, attached are materials for tomorrow's SC2 call at 1pm ET (10am PT). Please let me know if you
will not be able to join the call. (Alice, Steve, Marian, and Rafael I have you as unavailable, but let me know if thats
incorrect.) Thanks!
(6)
(6)
(6)
AGENDA
2. Updates
SC1 and SC2 crossover dietary patterns composition project (attachment) [Cheryl and Eve]
61
PSC-HHS-000061
Sodium [Cheryl]
Next call: Thursday, June 5 from 1:00 to 2:00 pm ET (10:00 to 11:00 am PT)
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 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.
62
PSC-HHS-000062
-*******************************************************
Frank B. Hu, MD, PhD
Professor of Nutrition and Epidemiology
Harvard School of Public Health
Professor of Medicine
Harvard Medical School
665 Huntington ave, Boston, MA 02115
tel: 617 432 0113 fax: 617 432 2435
<http://www.hsph.harvard.edu/faculty/frank-hu/>
http://www.hsph.harvard.edu/faculty/frank-hu/
******************************************************
-*******************************************************
Frank B. Hu, MD, PhD
Professor of Nutrition and Epidemiology
Harvard School of Public Health
Professor of Medicine
Harvard Medical School
665 Huntington ave, Boston, MA 02115
tel: 617 432 0113 fax: 617 432 2435
<http://www.hsph.harvard.edu/faculty/frank-hu/>
http://www.hsph.harvard.edu/faculty/frank-hu/
******************************************************
-*******************************************************
Frank B. Hu, MD, PhD
Professor of Nutrition and Epidemiology
Harvard School of Public Health
Professor of Medicine
Harvard Medical School
665 Huntington ave, Boston, MA 02115
tel: 617 432 0113 fax: 617 432 2435
<http://www.hsph.harvard.edu/faculty/frank-hu/>
63
PSC-HHS-000063
http://www.hsph.harvard.edu/faculty/frank-hu/
******************************************************
64
PSC-HHS-000064
Youmightaswellkeepthisonfilesincehereferstothe2015AHAguidelinesbuthemeanstheDGACguidelinessince
thereareno2015AHAguidelines.
AliceH.Lichtenstein,D.Sc.
GershoffProfessorofNutritionScienceandPolicyDirectorandSeniorScientist,CardiovascularNutritionLaboratory
TuftsUniversityJMUSDAHumanNutritionResearchCenteronAging
711WashingtonStreet
Boston,MA02111
phone:6175563127
email:Alice.Lichtenstein@Tufts.edu
OriginalMessage
From:JoshuaSchwerstfeger[mailto (b) (6)
@me.com]
Sent:Monday,May26,20142:22PM
To:Lichtenstein,Alice
Subject:Bias
DearAlice,
I'msaddenedtoseesomeoneofyourstaturehavingsuchdeeplyheldbiaseswithregardtosaturatedfats.Youwould
doournationmoregoodbyretiring.Goodluckinpickingandchoosingonlythesciencethatsupportsyourbiasin
chairingthe2015AHAguidelines.Iandmyfamilyhavelearnedthatyourrecommendationsareactuallythesourceof
ourcurrentepidemic.
JoshSchwerdtfeger
(b) (6)
65
PSC-HHS-000065
Subject:
Hieveryone,
WhileIagreewiththecomments,weagreedtoidentifythefoodandnutrientdriversofthepatternstotheextent
possible.Theevidencebasewereviewedattemptstodoso(SeethesummaryExceltable)andthefinetuningofour
summary,conclusionsandimplicationsareaimedthis.AnnaMaria,ImightrecommendthesmallerCVDgrouphavea
callasearlyaspossiblethisweektofinalizetherevisionsandthenpresentthemtotheSC2group.Iwilltrytobeas
availableaspossible.Iwouldalsoliketobemindfulofstaffingresourcesandourtimetable.Wemay/maynotbeable
todoadditionalevidencebasedreviewsandwemightnotdesiretodoanutrientbasedNELatthispoint.
Allthebest,
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
Based on my 2010 DGAC experience I strongly agree with Alice's comment. As we had previously agreed I
think that for CVD we should keep our focus on DP's.
Rafael Perez-Escamilla, PhD
Professor of Epidemiology and Public Health
Director, Office of Public Health Practice
Director, Global Health Concentration
Yale School of Public Health
135 College St. (Suite 200)
New Haven CT
66
PSC-HHS-000066
AliceH.Lichtenstein,D.Sc.
GershoffProfessorofNutritionScienceandPolicy
DirectorandSeniorScientist,CardiovascularNutritionLaboratory
TuftsUniversity
JMUSDAHumanNutritionResearchCenteronAging
711WashingtonStreet
Boston,MA02111
phone:6175563127
email:Alice.Lichtenstein@Tufts.edu
From: (b) (6)
gmail.com [mailto:(b) (6)
gmail.com] On Behalf Of Tom Brenna
Sent: Monday, May 26, 2014 11:17 AM
To: Frank Hu
Cc: Millen, Barbara E; Essery, Eve - CNPP; Siega-Riz, Anna Maria; Lichtenstein, Alice;
c1anderson@ucsd.edu; steven.clinton@osumc.edu; frank.hu@channing.harvard.edu;
mneuhous@fhcrc.org; rafael.perez-escamilla@yale.edu; Olson, Richard (HHS/OASH); Rihane, Colette CNPP; Bowman, Shanthy; Obbagy, Julie - CNPP; Fisher, Rachel (NIH/NIDDK) [E];
margaret.mcdowell@nih.gov; Wong, Yatping - CNPP; Anne Rodgers; Casavale, Kellie (OS/OASH); Eric E
Calloway; PBROWN@hsph.harvard.edu; Mironick, Adrianna; jconnor@fhcrc.org; Bailey, Lauren A.; Knight,
Brianna; Angelica Figueroa
Subject: Re: DGAC SC2: Call THURS @ 1pm ET (10 am PT)
PSC-HHS-000067
Thanks, Barbara, I agree that most of the "healthy" patterns are relatively low in saturated fat and
high in unsaturated fats (from olive oil, nuts, and other plant oils). AHA/ACC reviewed the
evidence on substituting vegetable oils rich in PUFA for saturated fat in lowering total and LDL
cholesterol, but patterns from the NEL review and newly identified meta-analyses are not very
specific about the amount of PUFA. Instead of describing MUFA or PUFA, we can include
plant-based oils as part of the conclusion statement.
After the publication of the Annals of Intern Medicine meta-analyses, saturated fat has become
the center of dietary controversy again. Now many people feel that saturated fat is exonerated,
largely based on faulty meta-analyses/interpretations as well as media headlines. However,
although most of the dietary patterns we reviewed contain relatively low saturated fat (typically
at the expenses of higher unsaturated fats), this does not directly address or resolve the saturated
fat controversy. Perhaps the committee is content with the pattern review that makes inference
about saturated fat. Otherwise we have to delve into the saturated fat issue directly by doing a
review of meta-analyses/systematic reviews on saturated fat. If this were to be done, it has to be
done after the pattern reviews are completed. One possibility is to combine saturated fat and
cholesterol reviews together as they mainly come from the same food sources.
Frank
On Mon, May 26, 2014 at 10:13 AM, Millen, Barbara E <bmillen@bu.edu> wrote:
ThankyouFrank.Irecommendedconsideringtheadditionalnutrientsbecausepolyunsaturatedfatwas
includedinthestatement.Ithinkincludingitaswellassodiummakessenseanditwouldsureweniceif
wereachedconsensusonsaturatedifnottotalfat.Letsseehowothersmightfeelaboutthat
particularlysaturatedfatsinceIbelievemanyofthepatternsarerelativelylowinit.Intermsofthe
factorandclusterpatterns,IdontrecallwhattheNELreviewconcluded.Wasitthattherewasnt
enoughconsensustomakefurtherstatementsaboutnotscoring[methods?
Allbest,
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
PSC-HHS-000068
Since our evidence-based reviews are focused on overall dietary patterns rather than individual
nutrients, I would be hesitate to add those nutrients (except for sodium) to the conclusion
statement. I think a statement on individual nutrients (such as saturated fat, total fat, calcium,
potassium, mg, fiber etc.) would warrant separate systematic reviews if evidence-based
statements were to be made about them (I know we don't have time to do that). Somewhere in
the text, we can describe the nutrient profiles of certain dietary patterns, although we need to be
cognizant that some nutrients (e.g., the amount of total fat and saturated fat) are likely to differ
according to different dietary patterns (e.g., Med, DASH, Omni-Heart higher mono or higher
protein, vegetarian, AHEI etc). Clearly, one size does not fit all, but these patterns do share many
food components (e.g., fruits, vegs, legumes, whole grains, nuts, etc). Of note, none of the
patterns reviewed here have clearly distinguished "lean/lower fat proteins" from "high fat
proteins", which are fairly vague terms. Instead, red meats and processed meats are often lumped
together and poultry and fish are recommended to replace red and processed meats in these diets
(e.g., Med, DASH, AHEI etc). Therefore, I think the conclusion statements and implications
should stick to foods and food patterns (except for sodium, PUFA in vegetable oils) instead of
using the terms like "low fat" or "low carbo", which are not evidence-based and have continued
to cause much controversy and confusions in the general public and recommendations.
Frank
On Sun, May 25, 2014 at 8:58 AM, Millen, Barbara E <bmillen@bu.edu> wrote:
HiFranketal,
69
PSC-HHS-000069
Thisrevisionisawonderfulsummary.IthinkitisgettingveryclosebutIamhopingwithmyeditstofine
tuneitabitmore.ThisisintendedinthemostconstructivewayandIhopethecommentshelp.I
wonderedwhetherweshouldconsiderincludingoneothercategoryoffoods(lean/lowerfatproteins)
andcertainothermacroandmicronutrients(saturatedfatinparticularbutalsopossiblytotalfat,
cholesterolandfiber,potassium,magnesiumandcalcium)asreflectedinthesummaryofevidence.I
realizethatitmakesthesummarystatementmorecomplicatedbutitisalsoperhapsmore
complete.Thiswilldepend,ofcourse,onwhetherwehaveconsensusopiniononthisadditionalfood
groupandtheothernutrients.Iwentaheadandalsoeditedthewordingontheprospectivecohort
literaturetoreflectthenatureoftheresearch(associationsnoteffects).Iwasntsureifitmakessense
tocaptureotherprospectivecohortliteraturerelatingtouseoffactor/clusterapproacheswhereempty
calorieandWesternpatternsareassociatedwithadverseCVDoutcomesandhearthealthierpatterns
arebeneficial.
Hopeyourholidayweekendissafeandrestful.
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
Dear All,
70
PSC-HHS-000070
attached is a revised draft of the section on dietary patterns and CVD. To address your
comments, the revised version included more detailed information on methods used to derive the
patterns, components of the patterns that may drive the associations, and variations in the
patterns across different studies and populations. Despite the heterogeneity in study designs,
populations, and methodologies, several heart-healthy patterns were identified with strong
evidence from both observational studies RCTs and these patterns share most components. The
implication is that individuals can adopt these patterns according to their personal needs and
preferences.
Frank
On Wed, May 21, 2014 at 5:25 PM, Essery, Eve - CNPP <Eve.Essery@fns.usda.gov> wrote:
Hi SC2 members,
On behalf of Anna Maria, attached are materials for tomorrow's SC2 call at 1pm ET (10am PT). Please let
me know if you will not be able to join the call. (Alice, Steve, Marian, and Rafael I have you as
unavailable, but let me know if thats incorrect.) Thanks!
AGENDA
71
PSC-HHS-000071
2. Updates
SC1 and SC2 crossover dietary patterns composition project (attachment) [Cheryl and
Eve]
Sodium [Cheryl]
Next call: Thursday, June 5 from 1:00 to 2:00 pm ET (10:00 to 11:00 am PT)
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
72
PSC-HHS-000072
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, PhD
Professor of Nutrition and Epidemiology
Harvard School of Public Health
Professor of Medicine
Harvard Medical School
665 Huntington ave, Boston, MA 02115
tel: 617 432 0113 fax: 617 432 2435
<http://www.hsph.harvard.edu/faculty/frank-hu/>
http://www.hsph.harvard.edu/faculty/frank-hu/
******************************************************
-*******************************************************
Frank B. Hu, MD, PhD
Professor of Nutrition and Epidemiology
Harvard School of Public Health
Professor of Medicine
Harvard Medical School
665 Huntington ave, Boston, MA 02115
tel: 617 432 0113 fax: 617 432 2435
<http://www.hsph.harvard.edu/faculty/frank-hu/>
http://www.hsph.harvard.edu/faculty/frank-hu/
******************************************************
-*******************************************************
73
PSC-HHS-000073
74
PSC-HHS-000074
Frank, you can take the lead, I am exhausted with the SFA/chol issue. I agree with the
limitations of the ACC/AHA document. Would this be something one of your post-docs
could take on? It would be a major contribution.
AliceH.Lichtenstein,D.Sc.
GershoffProfessorofNutritionScienceandPolicy
DirectorandSeniorScientist,CardiovascularNutritionLaboratory
TuftsUniversity
JMUSDAHumanNutritionResearchCenteronAging
711WashingtonStreet
Boston,MA02111
phone:6175563127
email:Alice.Lichtenstein@Tufts.edu
From: Essery, Eve - CNPP [mailto:Eve.Essery@fns.usda.gov]
Sent: Thursday, June 05, 2014 3:08 PM
To: Frank Hu; Lichtenstein, Alice
Cc: Casavale, Kellie (OS/OASH)
Subject: FW: DGAC SC2: Call THURS @ 1pm ET (10 am PT)
HiFrankandAlice,
Asdiscussedtoday,AnnaMariaaskedthetwoofyoutocomeupwithpotentialstrategiestoaddress(1)saturatedfat
and(2)cholesterolthatcouldbebroughttotheScienceReviewSC.AnnaMariaisnotonthenextSC2callonJune19th.
Arethetwoofyouavailable?WouldyouliketousethattimetoreallyfleshoutthesetopicswiththeSC?Ifso,letme
knowiftheresanythingyoudlikethestafftopulltogethertosupportyourdiscussion.
Thanks!
Eve
Correct,IamnotonthecallJune19th.Iamfinewiththemdiscussingthepotentialstrategieswiththeothersduringthat
call.
AMSR
PSC-HHS-000075
Yes,thatsgreat,thankyou.DoyouwantthetopicstogothroughtheSCbeforegoingtoSRSC?Youarenotonthecallin
twoweeks,correct?PerhapswecouldusethattimeforFrankandAlicetodiscusspotentialstrategies?
IaskedFrankandAlicetocomeupwithacoupleofstrategiesthatwecanthenpresenttoSRC.Thestrategiesmay
involvemoretimeandeffortbystaffsoIthinkitisimportanttofirsthavetheirinput.Isthatokay?
aMSR
Gladyouwereabletogetthatin!Whatapackedcall!!
ImnotsureIfollowedthediscussionaroundsaturatedfatandcholesterol.DidyoutaskFrankandAlice(andTom?)to
provideoptionsforhowtodealwiththosetwotopicsthatwouldbebroughtbacktothefullgroup?Imhappytohelp
facilitatethatrequest.IjustwantedtomakesureIunderstoodthenextsteps.THANKS!
Eve,ifforbysomemiracleweendupwithfreetime,IhaverewrittentheconclusionandimplicationstatementsforT2D
andBWtosharewiththegroup.
Theyareattached.
AMSR
PSC-HHS-000076
AGENDA
1. [10 min] Next round of NEL reviews Brief introduction and action items (Julie) [attachment 2]
Dietary patterns and neuro-psych illnesses (Topic team: Tom, Steve, Alice)
Dietary patterns during preconception and birth defects (Topic team: Anna Maria, Rafael, Tom)
Dietary patterns and cancer (lung, prostate, breast, colorectal) (Topic team: Steve, Marian, Rafael) [attachments 3
and 4]
Microbiom
e presentation
Next call: Thursday, June 19 from 1:00 to 2:00 pm ET (10:00 to 11:00 am PT)
Talk soon!
Eve
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 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.
77
PSC-HHS-000077
I am not suggesting you go at it alone, I want to be involved and I think we are on the
same page. I just cant think to straight about how to approach the topic at the moment
so that the nuances dont confound the ultimate outcome.
Were we successful in completing this task it would be wonderful. I am happy to
brainstorm with you and anyone else you think should be involved go come up with an
approach.
AliceH.Lichtenstein,D.Sc.
GershoffProfessorofNutritionScienceandPolicy
DirectorandSeniorScientist,CardiovascularNutritionLaboratory
TuftsUniversity
JMUSDAHumanNutritionResearchCenteronAging
711WashingtonStreet
Boston,MA02111
phone:6175563127
email:Alice.Lichtenstein@Tufts.edu
From: Frank Hu [mailto:nhbfh@channing.harvard.edu]
Sent: Thursday, June 05, 2014 3:56 PM
To: Lichtenstein, Alice
Cc: Essery, Eve - CNPP; Casavale, Kellie (OS/OASH)
Subject: Re: DGAC SC2: Call THURS @ 1pm ET (10 am PT)
Alice,
I'd be happy to take a lead on this. Of course I will need your and other committee members' input. I will try to
put together some strategies together in the next day or two.
Frank
On Thu, Jun 5, 2014 at 3:47 PM, Lichtenstein, Alice <Alice.Lichtenstein@tufts.edu> wrote:
Frank, you can take the lead, I am exhausted with the SFA/chol issue. I agree with the
limitations of the ACC/AHA document. Would this be something one of your post-docs
could take on? It would be a major contribution.
78
PSC-HHS-000078
AliceH.Lichtenstein,D.Sc.
GershoffProfessorofNutritionScienceandPolicy
DirectorandSeniorScientist,CardiovascularNutritionLaboratory
TuftsUniversity
JMUSDAHumanNutritionResearchCenteronAging
711WashingtonStreet
Boston,MA02111
phone:6175563127
email:Alice.Lichtenstein@Tufts.edu
HiFrankandAlice,
Asdiscussedtoday,AnnaMariaaskedthetwoofyoutocomeupwithpotentialstrategiestoaddress(1)saturatedfat
and(2)cholesterolthatcouldbebroughttotheScienceReviewSC.AnnaMariaisnotonthenextSC2callonJune19th.
Arethetwoofyouavailable?WouldyouliketousethattimetoreallyfleshoutthesetopicswiththeSC?Ifso,letme
knowiftheresanythingyoudlikethestafftopulltogethertosupportyourdiscussion.
Thanks!
Eve
PSC-HHS-000079
Correct,IamnotonthecallJune19th.Iamfinewiththemdiscussingthepotentialstrategieswiththeothersduringthat
call.
AMSR
Yes,thatsgreat,thankyou.DoyouwantthetopicstogothroughtheSCbeforegoingtoSRSC?Youarenotonthecallin
twoweeks,correct?PerhapswecouldusethattimeforFrankandAlicetodiscusspotentialstrategies?
IaskedFrankandAlicetocomeupwithacoupleofstrategiesthatwecanthenpresenttoSRC.Thestrategiesmay
involvemoretimeandeffortbystaffsoIthinkitisimportanttofirsthavetheirinput.Isthatokay?
aMSR
Gladyouwereabletogetthatin!Whatapackedcall!!
ImnotsureIfollowedthediscussionaroundsaturatedfatandcholesterol.DidyoutaskFrankandAlice(andTom?)to
provideoptionsforhowtodealwiththosetwotopicsthatwouldbebroughtbacktothefullgroup?Imhappytohelp
facilitatethatrequest.IjustwantedtomakesureIunderstoodthenextsteps.THANKS!
80
PSC-HHS-000080
Eve,ifforbysomemiracleweendupwithfreetime,IhaverewrittentheconclusionandimplicationstatementsforT2D
andBWtosharewiththegroup.
Theyareattached.
AMSR
Hi SC2 members,
On behalf of Anna Maria, attached are materials for tomorrow's SC2 call at 1pm ET (10am PT). Please let me know if you
will not be able to join the call. (Cheryl and Barbara I have you as unavailable.) Thanks!
AGENDA
1. [10 min] Next round of NEL reviews Brief introduction and action items (Julie) [attachment 2]
Dietary patterns and neuro-psych illnesses (Topic team: Tom, Steve, Alice)
Dietary patterns during preconception and birth defects (Topic team: Anna Maria, Rafael, Tom)
81
PSC-HHS-000081
Dietary patterns and cancer (lung, prostate, breast, colorectal) (Topic team: Steve, Marian, Rafael)
[attachments 3 and 4]
Microbiome presentation
Next call: Thursday, June 19 from 1:00 to 2:00 pm ET (10:00 to 11:00 am PT)
Talk soon!
Eve
82
PSC-HHS-000082
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 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, PhD
Professor of Nutrition and Epidemiology
Harvard School of Public Health
Professor of Medicine
Harvard Medical School
665 Huntington ave, Boston, MA 02115
tel: 617 432 0113 fax: 617 432 2435
<http://www.hsph.harvard.edu/faculty/frank-hu/>
http://www.hsph.harvard.edu/faculty/frank-hu/
******************************************************
83
PSC-HHS-000083
Subject:
HiFrank,
Thisisexcellent.Ihadbutafewcommentswhereclarificationmightbehelpful.Imadeacommentaboutthe
mode/methodofintervention.TheACC/AHA/NHLBIreportsalsodefinetheinterventionistswhocarriedourthese
evidencebasedRCTs.Wewillhavetodecidewheretoputthisinformationonwhatmethodsworktoimplementthe
dietarypatternstrategies.Itmightbearaseparateconclusion/implicationorcouldbeincorporatedperhapsintothe
existingone.
Manythanks.
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
Dear All,
Attached please find the revised section on dietary patterns and CVD based on comments from the group. The
Conclusion statement and Implications have been revised according to the discussions at our conference call. In
particular, the wordings are more consistent with those from the NEL report, but also taking into account the
conclusions from the AHA/ACC report. In addition, the phrases "Mediterranean-style dietary patterns" "DASH
or DASH-style dietary patterns", and "Vegetarian-style dietary patterns" are now used throughout the text to
reflect the fact that these diets are not a single unique diet. They do share most of healthy components.
I think this section is pretty close to be finalized. Of course, your additional comments/suggestions would be
greatly appreciated.
84
PSC-HHS-000084
I'd also like to have Anne Roger's help in polishing and formatting the text.
Eve, as discussed yesterday at the Science Review Subcommittee call, we will move ahead with an updated
review of the literature on saturated fat intake and CVD outcomes (incidence or mortality). Similar to dietary
patterns and CVD, this would entail a literature search of meta-analysis/systematic reviews on saturated fat
intake and CVD outcomes published in the past 5 years. This updated review will be synthesized with the
AHA/ACC report (on LDL cholesterol) to provide the evidence base for saturated fat recommendations (using
DGAC 2010 as the basis). I know Tom has expressed interest on this topic. I wonder if anyone else would be
interested in this.
Thanks
Frank
On Wed, May 21, 2014 at 5:25 PM, Essery, Eve - CNPP <Eve.Essery@fns.usda.gov> wrote:
Hi SC2 members,
On behalf of Anna Maria, attached are materials for tomorrow's SC2 call at 1pm ET (10am PT). Please let me know if you
will not be able to join the call. (Alice, Steve, Marian, and Rafael I have you as unavailable, but let me know if thats
incorrect.) Thanks!
AGENDA
PSC-HHS-000085
2. Updates
SC1 and SC2 crossover dietary patterns composition project (attachment) [Cheryl and Eve]
Sodium [Cheryl]
Next call: Thursday, June 5 from 1:00 to 2:00 pm ET (10:00 to 11:00 am PT)
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 the
86
PSC-HHS-000086
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, PhD
Professor of Nutrition and Epidemiology
Harvard School of Public Health
Professor of Medicine
Harvard Medical School
665 Huntington ave, Boston, MA 02115
tel: 617 432 0113 fax: 617 432 2435
<http://www.hsph.harvard.edu/faculty/frank-hu/>
http://www.hsph.harvard.edu/faculty/frank-hu/
******************************************************
87
PSC-HHS-000087
Subject:
Goodthoughts.Ialsowonderedifitwouldmakesensetonotethatthehealthypatternscontainedrelativelylowto
moderatefatintake(withrangespecified).Irealizethatthismightbesomewhatcontroversialbutitisconsistentwith
ourdietarypatternapproachandthereportedrangesforDASHandtheothers.
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
PSC-HHS-000088
Dear All,
Attached please find the revised section on dietary patterns and CVD based on comments from the group. The
Conclusion statement and Implications have been revised according to the discussions at our conference call. In
particular, the wordings are more consistent with those from the NEL report, but also taking into account the
conclusions from the AHA/ACC report. In addition, the phrases "Mediterranean-style dietary patterns" "DASH
or DASH-style dietary patterns", and "Vegetarian-style dietary patterns" are now used throughout the text to
reflect the fact that these diets are not a single unique diet. They do share most of healthy components.
I think this section is pretty close to be finalized. Of course, your additional comments/suggestions would be
greatly appreciated.
I'd also like to have Anne Roger's help in polishing and formatting the text.
Eve, as discussed yesterday at the Science Review Subcommittee call, we will move ahead with an updated
review of the literature on saturated fat intake and CVD outcomes (incidence or mortality). Similar to dietary
patterns and CVD, this would entail a literature search of meta-analysis/systematic reviews on saturated fat
intake and CVD outcomes published in the past 5 years. This updated review will be synthesized with the
AHA/ACC report (on LDL cholesterol) to provide the evidence base for saturated fat recommendations (using
DGAC 2010 as the basis). I know Tom has expressed interest on this topic. I wonder if anyone else would be
interested in this.
Thanks
Frank
On Wed, May 21, 2014 at 5:25 PM, Essery, Eve - CNPP <Eve.Essery@fns.usda.gov> wrote:
89
PSC-HHS-000089
Hi SC2 members,
On behalf of Anna Maria, attached are materials for tomorrow's SC2 call at 1pm ET (10am PT). Please let me know if you
will not be able to join the call. (Alice, Steve, Marian, and Rafael I have you as unavailable, but let me know if thats
incorrect.) Thanks!
Call-in number: (b) (6)
Access code: (b) (6)
Web conference: (b) (6)
AGENDA
2. Updates
SC1 and SC2 crossover dietary patterns composition project (attachment) [Cheryl and Eve]
Sodium [Cheryl]
Next call: Thursday, June 5 from 1:00 to 2:00 pm ET (10:00 to 11:00 am PT)
PSC-HHS-000090
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 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, PhD
Professor of Nutrition and Epidemiology
Harvard School of Public Health
Professor of Medicine
Harvard Medical School
665 Huntington ave, Boston, MA 02115
tel: 617 432 0113 fax: 617 432 2435
<http://www.hsph.harvard.edu/faculty/frank-hu/>
http://www.hsph.harvard.edu/faculty/frank-hu/
******************************************************
91
PSC-HHS-000091
Subject:
If you can get a copy of this weeks Time magazine it would be worth it. The cover
story is saturated fat.
AliceH.Lichtenstein,D.Sc.
GershoffProfessorofNutritionScienceandPolicy
DirectorandSeniorScientist,CardiovascularNutritionLaboratory
TuftsUniversity
JMUSDAHumanNutritionResearchCenteronAging
711WashingtonStreet
Boston,MA02111
phone:6175563127
email:Alice.Lichtenstein@Tufts.edu
From: (b) (6)
gmail.com [mailto:(b) (6)
gmail.com] On Behalf Of Tom Brenna
Sent: Sunday, June 15, 2014 3:45 PM
To: Millen, Barbara E
Cc: Casavale, Kellie (OS/OASH); Frank Hu, MD, PhD MPH; Bowman, Shanthy; Siega-Riz, Anna Maria; Rihane, Colette CNPP; Perez-Escamilla, Rafael; Angelica Figueroa; c1anderson@ucsd.edu; PBROWN@hsph.harvard.edu; Lichtenstein,
Alice; Essery, Eve - CNPP; Obbagy, Julie - CNPP; Frank Hu; Wong, Yatping - CNPP; Knight, Brianna;
mneuhous@fhcrc.org; Eric E Calloway; steven.clinton@osumc.edu; jconnor@fhcrc.org; Mironick, Adrianna; Anne
Rodgers; Olson, Richard (HHS/OASH); Bailey, Lauren A.; margaret.mcdowell@nih.gov; Fisher, Rachel (NIH/NIDDK) [E]
Subject: RE: DGAC SC2: Call THURS @ 1pm ET (10 am PT)
Just a quick note to confirm Frank's comment that I'm interested in the saturated fat story. I'm a little behind the
eight ball since I've not been in on all these conversations, and I received three NEL reviews in the last two
weeks that I'm plowing through, but I'll hope to find time.
Tom
On Jun 15, 2014 3:38 PM, "Millen, Barbara E" <bmillen@bu.edu> wrote:
92
PSC-HHS-000092
Goodthoughts.Ialsowonderedifitwouldmakesensetonotethatthehealthypatternscontainedrelativelylowto
moderatefatintake(withrangespecified).Irealizethatthismightbesomewhatcontroversialbutitisconsistentwith
ourdietarypatternapproachandthereportedrangesforDASHandtheothers.
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
Given that you indicate at conference call that "healthy" dietary patterns include saturated fat
consumption ranging from <7% to > 10% of calories should we be thinking about recommending a
range as a function of dietary pattern vs. trying once again to identify a single cut
point? This approach would be analogous to the evolution of % calories from fat recommendation
and consistent with the strong emphasis of the 2015 DGAC on dietary patterns driven
recommendations.
Best,
PSC-HHS-000093
email: rafael.perez-escamilla@yale.edu
phone: (203) 737-5882
fax: (203) 737-4591
IOM Food and Nutrition Board member
President, International Society for Research in Human Milk and Lactation (ISRHML)
Dear All,
Attached please find the revised section on dietary patterns and CVD based on comments from the group. The
Conclusion statement and Implications have been revised according to the discussions at our conference call. In
particular, the wordings are more consistent with those from the NEL report, but also taking into account the
conclusions from the AHA/ACC report. In addition, the phrases "Mediterranean-style dietary patterns" "DASH
or DASH-style dietary patterns", and "Vegetarian-style dietary patterns" are now used throughout the text to
reflect the fact that these diets are not a single unique diet. They do share most of healthy components.
I think this section is pretty close to be finalized. Of course, your additional comments/suggestions would be
greatly appreciated.
I'd also like to have Anne Roger's help in polishing and formatting the text.
Eve, as discussed yesterday at the Science Review Subcommittee call, we will move ahead with an updated
review of the literature on saturated fat intake and CVD outcomes (incidence or mortality). Similar to dietary
patterns and CVD, this would entail a literature search of meta-analysis/systematic reviews on saturated fat
intake and CVD outcomes published in the past 5 years. This updated review will be synthesized with the
AHA/ACC report (on LDL cholesterol) to provide the evidence base for saturated fat recommendations (using
DGAC 2010 as the basis). I know Tom has expressed interest on this topic. I wonder if anyone else would be
interested in this.
Thanks
Frank
94
PSC-HHS-000094
On Wed, May 21, 2014 at 5:25 PM, Essery, Eve - CNPP <Eve.Essery@fns.usda.gov> wrote:
Hi SC2 members,
On behalf of Anna Maria, attached are materials for tomorrow's SC2 call at 1pm ET (10am PT). Please let me know if you
will not be able to join the call. (Alice, Steve, Marian, and Rafael I have you as unavailable, but let me know if thats
incorrect.) Thanks!
AGENDA
2. Updates
95
PSC-HHS-000095
SC1 and SC2 crossover dietary patterns composition project (attachment) [Cheryl and Eve]
Sodium [Cheryl]
Next call: Thursday, June 5 from 1:00 to 2:00 pm ET (10:00 to 11:00 am PT)
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 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.
96
PSC-HHS-000096
-*******************************************************
Frank B. Hu, MD, PhD
Professor of Nutrition and Epidemiology
Harvard School of Public Health
Professor of Medicine
Harvard Medical School
665 Huntington ave, Boston, MA 02115
tel: 617 432 0113 fax: 617 432 2435
<http://www.hsph.harvard.edu/faculty/frank-hu/>
http://www.hsph.harvard.edu/faculty/frank-hu/
******************************************************
97
PSC-HHS-000097
Subject:
Attachments:
AliceH.Lichtenstein,D.Sc.
GershoffProfessorofNutritionScienceandPolicy
DirectorandSeniorScientist,CardiovascularNutritionLaboratory
TuftsUniversity
JMUSDAHumanNutritionResearchCenteronAging
711WashingtonStreet
Boston,MA02111
phone:6175563127
email:Alice.Lichtenstein@Tufts.edu
From: Frank Hu [mailto:nhbfh@channing.harvard.edu]
Sent: Saturday, June 14, 2014 4:27 PM
To: Essery, Eve - CNPP
Cc: Siega-Riz, Anna Maria; Lichtenstein, Alice; c1anderson@ucsd.edu; jtb4@cornell.edu; steven.clinton@osumc.edu;
frank.hu@channing.harvard.edu; mneuhous@fhcrc.org; rafael.perez-escamilla@yale.edu; Millen, Barbara E; Olson,
Richard (HHS/OASH); Rihane, Colette - CNPP; Bowman, Shanthy; Obbagy, Julie - CNPP; Fisher, Rachel (NIH/NIDDK) [E];
margaret.mcdowell@nih.gov; Wong, Yatping - CNPP; Anne Rodgers; Casavale, Kellie (OS/OASH); Eric E Calloway;
PBROWN@hsph.harvard.edu; Mironick, Adrianna; jconnor@fhcrc.org; Bailey, Lauren A.; Knight, Brianna; Angelica
Figueroa
Subject: Re: DGAC SC2: Call THURS @ 1pm ET (10 am PT)
Dear All,
Attached please find the revised section on dietary patterns and CVD based on comments from the group. The
Conclusion statement and Implications have been revised according to the discussions at our conference call. In
particular, the wordings are more consistent with those from the NEL report, but also taking into account the
conclusions from the AHA/ACC report. In addition, the phrases "Mediterranean-style dietary patterns" "DASH
or DASH-style dietary patterns", and "Vegetarian-style dietary patterns" are now used throughout the text to
reflect the fact that these diets are not a single unique diet. They do share most of healthy components.
I think this section is pretty close to be finalized. Of course, your additional comments/suggestions would be
greatly appreciated.
98
PSC-HHS-000098
I'd also like to have Anne Roger's help in polishing and formatting the text.
Eve, as discussed yesterday at the Science Review Subcommittee call, we will move ahead with an updated
review of the literature on saturated fat intake and CVD outcomes (incidence or mortality). Similar to dietary
patterns and CVD, this would entail a literature search of meta-analysis/systematic reviews on saturated fat
intake and CVD outcomes published in the past 5 years. This updated review will be synthesized with the
AHA/ACC report (on LDL cholesterol) to provide the evidence base for saturated fat recommendations (using
DGAC 2010 as the basis). I know Tom has expressed interest on this topic. I wonder if anyone else would be
interested in this.
Thanks
Frank
On Wed, May 21, 2014 at 5:25 PM, Essery, Eve - CNPP <Eve.Essery@fns.usda.gov> wrote:
Hi SC2 members,
On behalf of Anna Maria, attached are materials for tomorrow's SC2 call at 1pm ET (10am PT). Please let me know if you
will not be able to join the call. (Alice, Steve, Marian, and Rafael I have you as unavailable, but let me know if thats
incorrect.) Thanks!
AGENDA
PSC-HHS-000099
2. Updates
SC1 and SC2 crossover dietary patterns composition project (attachment) [Cheryl and Eve]
Sodium [Cheryl]
Next call: Thursday, June 5 from 1:00 to 2:00 pm ET (10:00 to 11:00 am PT)
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 the
100
PSC-HHS-000100
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, PhD
Professor of Nutrition and Epidemiology
Harvard School of Public Health
Professor of Medicine
Harvard Medical School
665 Huntington ave, Boston, MA 02115
tel: 617 432 0113 fax: 617 432 2435
<http://www.hsph.harvard.edu/faculty/frank-hu/>
http://www.hsph.harvard.edu/faculty/frank-hu/
******************************************************
101
PSC-HHS-000101
Intervention/Exposure
Saturatedfatintake
Comparator
Replacementmacronutrient(PUFA,MUFA,carb[specifyingtype],
protein)
Regarding the question, What is the relationship between saturated fat intake and risk
of cardiovascular disease? I think the questions needs to be modified with a series of
questions;
What is the relationship between saturated fat intake when replaced by PUFA and risk
of cardiovascular disease?
What is the relationship between saturated fat intake when replaced by MUFA and risk
of cardiovascular disease?
What is the relationship between saturated fat intake when replaced by carbohydrate
(capturing type) and risk of cardiovascular disease?
What is the relationship between saturated fat intake when replaced by protein and risk
of cardiovascular disease? (unlikely to find much if anything here)
If we take this approach then the accompanying document would need to be modified
to put as much emphasis on the change in dietary SFA as the change in the other
dietary component(s).
AliceH.Lichtenstein,D.Sc.
GershoffProfessorofNutritionScienceandPolicy
DirectorandSeniorScientist,CardiovascularNutritionLaboratory
TuftsUniversity
JMUSDAHumanNutritionResearchCenteronAging
711WashingtonStreet
Boston,MA02111
102
PSC-HHS-000102
phone:6175563127
email:Alice.Lichtenstein@Tufts.edu
From: Essery, Eve - CNPP [mailto:Eve.Essery@fns.usda.gov]
Sent: Thursday, June 19, 2014 5:25 PM
To: 'Frank Hu'; Lichtenstein, Alice; 'Millen, Barbara E'; jtb4@cornell.edu
Cc: Casavale, Kellie (OS/OASH); Obbagy, Julie - CNPP
Subject: DGAC SC2: Saturated fat (response requested)
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 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.
103
PSC-HHS-000103
Given there is so much attention these days on the Mediterranean diet pattern/MUFA,
perhaps when the data are available we distinguish between MUFA coming from meat
fat vs canola oil (source). I think canola oil is the second most prevalent vegetable oil
in the US diet, after soybean oil (albeit not a close second).
AliceH.Lichtenstein,D.Sc.
GershoffProfessorofNutritionScienceandPolicy
DirectorandSeniorScientist,CardiovascularNutritionLaboratory
TuftsUniversity
JMUSDAHumanNutritionResearchCenteronAging
711WashingtonStreet
Boston,MA02111
phone:6175563127
email:Alice.Lichtenstein@Tufts.edu
From: Frank Hu [mailto:nhbfh@channing.harvard.edu]
Sent: Friday, June 20, 2014 8:35 AM
To: Tom Brenna
Cc: Lichtenstein, Alice; Essery, Eve - CNPP; Millen, Barbara E; Casavale, Kellie (OS/OASH); Obbagy, Julie - CNPP
Subject: Re: DGAC SC2: Saturated fat (response requested)
It is a good idea to spell out the "comparators", especially in prospective cohort studies. Since 85% of PUFA
are linoleic acid, the results for the comparison of PUFA vs. saturated or LA vs. saturated are typically
similar. As far as I know, no study has specifically compared ALA or EPA/DHA with saturated fat. However,
studies have compared high saturated fat food sources such as red and processed meats with foods high in
omega-3 fatty acids, such as marine fish.
Since most MUFA in Western diets share the same food sources as saturated fat (meats and dairy), the
comparison with saturated fat will be difficult to interpret.
Frank
On Fri, Jun 20, 2014 at 8:05 AM, Tom Brenna <jtb4@cornell.edu> wrote:
Alice and all,
Thanks - this is right about where we were in one of the working groups last summer after considerable
discussion and with which I agreed.
104
PSC-HHS-000104
I would add (as I think I did last summer) that PUFA should not be added together. I would have specific
questions for linoleic acid, alpha-linolenic acid, and long chain omega-3. I'm not sure if this is workable with
our resources or the presentations of the papers; someone decide, I'm on board either way and can comment as
appropriate later, and let's get on with it.
Tom
On Fri, Jun 20, 2014 at 7:36 AM, Lichtenstein, Alice <Alice.Lichtenstein@tufts.edu> wrote:
Regarding the question, What is the relationship between saturated fat intake and risk
of cardiovascular disease? I think the questions needs to be modified with a series of
questions;
What is the relationship between saturated fat intake when replaced by PUFA and risk
of cardiovascular disease?
What is the relationship between saturated fat intake when replaced by MUFA and risk
of cardiovascular disease?
105
PSC-HHS-000105
What is the relationship between saturated fat intake when replaced by carbohydrate
(capturing type) and risk of cardiovascular disease?
What is the relationship between saturated fat intake when replaced by protein and risk
of cardiovascular disease? (unlikely to find much if anything here)
If we take this approach then the accompanying document would need to be modified
to put as much emphasis on the change in dietary SFA as the change in the other
dietary component(s).
106
PSC-HHS-000106
Please review the attached documents related to saturated fat and CVD, and let us know if they accurately reflect your
proposed question and approach for answering the question. If possible, please provide your comments and edits by
Wednesday, June 25th. Once we hear from you, we will work on the next steps as described in the attached.
Thank you,
Eve
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 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, PhD
Professor of Nutrition and Epidemiology
Harvard School of Public Health
Professor of Medicine
Harvard Medical School
665 Huntington ave, Boston, MA 02115
tel: 617 432 0113 fax: 617 432 2435
107
PSC-HHS-000107
<http://www.hsph.harvard.edu/faculty/frank-hu/>
http://www.hsph.harvard.edu/faculty/frank-hu/
******************************************************
108
PSC-HHS-000108
Sorry, I seem to have lost track of the e-mail to which the attached document
arrived. Have some comments. More in line with serving as devils advocate.
Mary, I defer to you on all of my suggested changes and comments. You have been in
the weeds on this.
AliceH.Lichtenstein,D.Sc.
GershoffProfessorofNutritionScienceandPolicy
DirectorandSeniorScientist,CardiovascularNutritionLaboratory
TuftsUniversity
JMUSDAHumanNutritionResearchCenteronAging
711WashingtonStreet
Boston,MA02111
phone:6175563127
email:Alice.Lichtenstein@Tufts.edu
From: Rahavi, Elizabeth - CNPP [mailto:Elizabeth.Rahavi@cnpp.usda.gov]
Sent: Wednesday, July 02, 2014 1:39 PM
To: Lichtenstein, Alice; Barbara Millen; Lucile Adams-Campbell; Mary Story; Nelson, Miriam; Wayne Campbell; Amber
Mosher; Anne Rodgers; Blum, Donna - CNPP; Bowman, Shanthy; Joan Lyon; Kellie Casavale; Nancy Terry; Psota, Tricia FNS (Contractor); Rihane, Colette - CNPP; Stephanie Goodwin
Subject: SC 4 Follow Up - Policy Related Questions
HiAll,
ThisemailistofollowupontheSCconversationthismorningrelatedtoquestionsthatwouldlookattheimpactof
Federalnutritionassistanceprograms.Thefollowingpointswereidentifiedduringthatcallasareasforfurther
consideration:
NeedtodevelopspecificquestionstodetermineifanyissuesexistrelatedtothescopeoftheDGACsworkand
generalapplicabilitytotheDietaryGuidelinesforAmericans.
Needtoconsiderhowthesenewquestionsmightbeprioritizedagainstremainingtopicareas,mainlyfood
marketingandotherfoodaccessquestions.
Needtoensurethatasystematicapproachisutilizedtoidentifytheliteraturebaseandreviewtheevidence
(i.e.,NELsystematicreview,systematicreviews,orexistingreports).
TheSCdecidedthattoworkthroughsomeofthesepointsviaasmallerworkinggroup(MS,BM,AHL),althoughallSC
membersarewelcometoattendthismeeting.Herearesomepotentialmeetingtimes:
109
PSC-HHS-000109
Monday,July7th10:0012:00
Tuesday,July8th9:302:00
Ifyouareinterestedinattendingthiscall,pleaseprovideyouravailabilitytoLizRahaviASAP,andwellgetameeting
scheduled.Inthemeantime,herearesomeresourcesthathavebeenprovidedtoFederalstaffrelatedtothistopicarea:
EffectsofFoodAssistanceandNutritionProgramsonNutritionandHealth(multiplevolumes)developedby
ERS:http://www.ers.usda.gov/publications/fanrrfoodassistancenutritionresearchprogram/fanrr191.aspx
FNSsponsoredWICliteraturereview:EffectsoftheSpecialSupplementalNutritionProgramforWomen,
Infants,andChildren(WIC):AReviewofRecentResearch.http://www.fns.usda.gov/effectsspecial
supplementalnutritionprogramwomeninfantsandchildrenwicreviewrecentresearch.Thisisanupdateof
thesystematicreviewthatwasconductedbyERSin2004(linkprovidedabove).
ThereisanotherreportfromFNSNutrientandMyPyramidAnalysisofUSDAFoodsinFiveofitsFoodand
NutritionPrograms.ThisreportprovidesHEI2005scoresforUSDAFoodsprovidedtoFDPIR,TEFAP,CSFP,NSLP
andCACFP.http://www.fns.usda.gov/nutrientandmypyramidanalysisusdafoodsfiveitsfoodandnutrition
programs0.
SCstaffwillalsoreachouttocolleaguesatFNStoseeifotherresourcescanbeidentified.Ifyouareawareofother
reportsrelatedtothistopic,pleasefeelfreetosharethemwiththegroup.
Thanks,
Liz
ElizabethRahavi,RD
Nutritionist
CenterforNutritionPolicyandPromotion
USDepartmentofAgriculture
3101ParkCenterDrive,Rm1034
Alexandria,VA22302
(703)3052441
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 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.
110
PSC-HHS-000110
Subject:
Attachments:
Hereareafewadditionalthoughtsrelatingprimarilytowordinggiventhenatureofthestudydesigns.Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
PSC-HHS-000111
Adrianna; jconnor@fhcrc.org; Bailey, Lauren A.; Knight, Brianna; Figueroa, Angelica M; Joan Lyon
Subject: RE: DGAC SC2: Call THURS @ 1pm ET (10 am PT)
Please see attached. I took the liberty to draft an initial set of graded conclusions.
I'll be offline until Monday but I'm looking forward to our next round of discussions on these
questions.
Best,
Tom
We have noted the difference and once Rafael has had time to review the studies we will discuss.
Thanks
112
PSC-HHS-000112
AMSR
Sent from my iPhone
On Jul 4, 2014, at 6:29 AM, "Tom Brenna" <jtb4@cornell.edu> wrote:
Dear all,
Slide comment:
Since the last meeting much time was spent on the first set of reviews. Because the reviews on
DP connected to Neuro and to Depression were in the second wave of reviews, little time has
been available to discuss conclusions. In our upcoming meeting, I (Tom) can describe the
studies identified in general terms as a sort of promise for more in the next meeting, which would
leave time for the main material on cancer, etc.
The DP and birth defects appears to be nearly done. Prior, I would like to discuss this with
others focused on this topic because it seems my take away may be a bit different. Folate/onecarbon nutrients were the focus of all five studies and emerged as pivotal in at least one study. I
think this should be mentioned.
I could speak with the DP-birth defects group most any day next week.
Tom
On Wed, Jul 2, 2014 at 5:54 PM, Essery, Eve - CNPP <Eve.Essery@fns.usda.gov> wrote:
Hi SC2 members,
On behalf of Anna Maria, attached are materials for tomorrow's SC2 call at 1pm ET (10am PT). Talk
soon!
113
PSC-HHS-000113
AGENDA
114
PSC-HHS-000114
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 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.
115
PSC-HHS-000115
Subject:
Attachments:
AliceH.Lichtenstein,D.Sc.
GershoffProfessorofNutritionScienceandPolicy
DirectorandSeniorScientist,CardiovascularNutritionLaboratory
TuftsUniversity
JMUSDAHumanNutritionResearchCenteronAging
711WashingtonStreet
Boston,MA02111
phone:6175563127
email:Alice.Lichtenstein@Tufts.edu
From: (b) (6)
gmail.com [mailto:(b) (6)
gmail.com] On Behalf Of Tom Brenna
Sent: Sunday, July 06, 2014 8:58 PM
To: Siega-Riz, Anna Maria
Cc: Perez-Escamilla, Rafael; Essery, Eve - CNPP; Lichtenstein, Alice; c1anderson@ucsd.edu; steven.clinton@osumc.edu;
frank.hu@channing.harvard.edu; mneuhous@fhcrc.org; Millen, Barbara E; Olson, Richard (HHS/OASH); Rihane, Colette CNPP; Bowman, Shanthy; Obbagy, Julie - CNPP; Fisher, Rachel (NIH/NIDDK) [E]; margaret.mcdowell@nih.gov; Wong,
Yatping - CNPP; Anne Rodgers; Casavale, Kellie (OS/OASH); Eric E Calloway; PBROWN@hsph.harvard.edu; Mironick,
Adrianna; jconnor@fhcrc.org; Bailey, Lauren A.; Knight, Brianna; Figueroa, Angelica M; Joan Lyon
Subject: Re: DGAC SC2: Call THURS @ 1pm ET (10 am PT)
116
PSC-HHS-000116
From: Perez-Escamilla, Rafael [mailto:rafael.perez-escamilla@yale.edu]
Sent: Friday, July 04, 2014 11:30 AM
To: Siega-Riz, Anna Maria; Tom Brenna
Cc: Essery, Eve - CNPP; alice.lichtenstein@tufts.edu; c1anderson@ucsd.edu; steven.clinton@osumc.edu;
frank.hu@channing.harvard.edu; mneuhous@fhcrc.org; Millen, Barbara E; Olson, Richard (HHS/OASH); Rihane, Colette CNPP; Bowman, Shanthy; Obbagy, Julie - CNPP; Fisher, Rachel (NIH/NIDDK) [E]; margaret.mcdowell@nih.gov; Wong,
Yatping - CNPP; Anne Rodgers; Casavale, Kellie (OS/OASH); Eric E Calloway; PBROWN@hsph.harvard.edu; Mironick,
Adrianna; jconnor@fhcrc.org; Bailey, Lauren A.; Knight, Brianna; Figueroa, Angelica M; Joan Lyon
Subject: RE: DGAC SC2: Call THURS @ 1pm ET (10 am PT)
Please see attached. I took the liberty to draft an initial set of graded conclusions.
I'll be offline until Monday but I'm looking forward to our next round of discussions on these
questions.
Best,
PSC-HHS-000117
Tom
We have noted the difference and once Rafael has had time to review the studies we will discuss.
Thanks
AMSR
Sent from my iPhone
On Jul 4, 2014, at 6:29 AM, "Tom Brenna" <jtb4@cornell.edu> wrote:
Dear all,
Slide comment:
Since the last meeting much time was spent on the first set of reviews. Because the reviews on
DP connected to Neuro and to Depression were in the second wave of reviews, little time has
been available to discuss conclusions. In our upcoming meeting, I (Tom) can describe the
studies identified in general terms as a sort of promise for more in the next meeting, which would
leave time for the main material on cancer, etc.
The DP and birth defects appears to be nearly done. Prior, I would like to discuss this with
others focused on this topic because it seems my take away may be a bit different. Folate/onecarbon nutrients were the focus of all five studies and emerged as pivotal in at least one study. I
think this should be mentioned.
I could speak with the DP-birth defects group most any day next week.
Tom
118
PSC-HHS-000118
On Wed, Jul 2, 2014 at 5:54 PM, Essery, Eve - CNPP <Eve.Essery@fns.usda.gov> wrote:
Hi SC2 members,
On behalf of Anna Maria, attached are materials for tomorrow's SC2 call at 1pm ET (10am PT). Talk
soon!
AGENDA
PSC-HHS-000119
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 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.
120
PSC-HHS-000120
HiKelly,
Latenightlastnight.Didntmakeitinuntilnearly2a.m.IlookedattheIntroslidesandIthinktheattacheddocumentis
goodtogo.Manythankstoyouandtherestofourcolleagues/staffwhoreviewedthemandprovidedinput.
Iwilltakeabitoftimelatertogettheconceptualmodelslidesfinalized.
Seeyouinabit.
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
Barbara,
Afewstaffhadacoupleofgoodcomments.Theactualeditstothepresentationsareminorthough,andcanbeseenin
redtextontheslideandboldtextinthecommentary(asnotedbelow)forthetwofilesattachtitledSHOWSEDITS.
Thelasttwofilesaretheversionsthatdonothighlightthechanges,titledforBEMediting.Workfromthese.
IneedyourIntroslidesnolaterthantomorrownightat7:30pmsothatIcangetthemtotheprinterfor
Thursday.
YourConceptualModel/NextStepsslidesareneedednolaterthanThursdayat7:30pm.)
Presentation:IntroductiontoSCReports
Slide3(InfileSHOWSEDITSseeredtextonslideandboldtextinthecommentarysection)
1. AddedMeetingnutrientrecommendationsunderthedietarypatternsbullet.TheDGACislookingatdietary
patternsand(1)healthoutcomesand(2)sustainability,butthefoodpatternmodelingisalsoimportantand
getsathowdietarypatternshelpusmeetnutrientrecommendations.Nowreads
Focusondietarypatternsrelatedto:
Meetingnutrientrecommendations
Healthoutcomes
Sustainability
121
PSC-HHS-000121
2. Rewordedthesentencebelowtobeconsistentwiththelanguageusedonslide8.Thisaddressesthesensitivity
wehaveheardthatsomepeopleviewbehaviorchangeasgovernmentalcontrol(assillyasthatsoundsto
us).
From:"Wearealsoidentifyingwhatworkstochangethedietandphysicalactivitybehaviorsofindividuals
andpopulationstobetterinformourhealthcareandpublichealthsystemsandreachindividualsand
populationsofallages."
To:WearealsoidentifyingwhatworkstohelpindividualsandpopulationsintheUSmakebettereatingand
physicalactivitychoicestobetterinformourhealthcareandpublichealthsystemsandreachindividualsand
populationsofallages.
3. Changeddeterminetoinfluenceinthesentencebelow.Itwasthoughtthiswassofter.
"TheCommitteeisalsotakingasystemsapproachtoconsiderthemultiplespheresandsystemsofinfluence
ondietarypatterns,physicalactivityandhealthandthefactorsthatdeterminewhat,where,andhowmuchwe
eatandexercise."
Slides13and14
SlidesadjustedtobeatadmoregeneralandlessNELfocusedbecauseallofthequestionswillactuallyhave
conclusionstatements,grades,etcnotjusttheNELquestions.
1.Onslide13DeletedNELtoreadMaterialspresentedtodaymayinclude(ratherthanNELmaterial)
2. Onslide14Deletedsystematicreviewsothisappliestoalltheapproaches:
Conclusionstatements:Briefoverallsummarystatementwordedasananswertothesystematicreview
question;tightlyassociatedwiththeevidence
3. ThegradingcriteriahavenowbeentweakedsothattheywouldalsoapplytononNELquestions.Thetableon
slide14wasreplacedwiththisonebelow.Andslide14wassplittotwoslides(14and15)becausethistableisa
tadlarger.
Theconclusionstatementissubstantiatedbyalarge,highquality,and/orconsistentbodyofevidence
Strong
thatdirectlyaddressesthequestion.Thereisahighlevelofcertaintythattheconclusionisgeneralizable
tothepopulationofinterest,anditisunlikelytochangeifnewevidenceemerges.
Theconclusionstatementissubstantiatedbysufficientevidence,butthelevelofcertaintyisrestricted
bylimitationsintheevidence,suchastheamountofevidenceavailable,inconsistenciesinfindings,or
Moderate
methodologicalorgeneralizabilityconcerns.Ifnewevidenceemerges,therecouldbemodificationsto
theconclusionstatement.
Theconclusionstatementissubstantiatedbyinsufficientevidence,andthelevelofcertaintyisseriously
restrictedbylimitationsintheevidence,suchastheamountofevidenceavailable,inconsistenciesin
Limited
findings,ormethodologicalorgeneralizabiltyconcerns.Ifnewevidenceemerges,therecouldlikelybe
modificationstotheconclusionstatement.
Gradenot Aconclusionstatementcannotbedrawnduetoalackofevidence,ortheavailabilityofevidencethat
assignable
hasseriousmethodologicalconcerns.
Presentation:ConceptualModelandNextSteps(Note:Youwouldwanttomakechangestotheslidesto
theactualoutlineaswellonitsnextiteration.)
GeneralWouldyouliketogroupthefactorsontheslidessothatthoseaddressedbytheDGACappeartogether
followedbythosenotaddressedbytheDGAC?Thiswouldtakesomereworkingofthecommentaryaswell,butcould
bedoneifyoufeltitwaslessawkwardtoreviewthatway.
122
PSC-HHS-000122
Slide13Dietaryproductandnutrientsupplementsisitalicizedasanoutcome,indicatingthattheDGACisdoing
evidencereviewsonthetopic.(Inthenotes,itsays,Dietaryproductandnutrientsupplementuse,including
nutraceuticals.)
StaffdontthinktheDGAChasanyquestionssupplements/nutraceuticalsasanoutcome.(Andthis
mightopenacanofwormsasworded.)DidyoumeanthattherecommendationsoftheDGACmight
includethoserelatedtorecommendingsupplementsforcertaingroups(likeironorfolicacid
supplementswomen)?
Staffalsoquestionedwhatadietaryproductincludes.Thatmayneedsomeclarification.
EDIT:Inthecurrentdraft,theitalicswereremoved(seeredtextonslide)
Slide16
1. UrinarysodiumwashighlightedasaclinicalindicatortheDGACisconsidering,butstaffdidnotthinkthiswas
thecase.EDIT:Tookoffblueanditalics
2. Periandpostmenopausewerentclearsincetheyareusuallypopulationgroups.Ibelieveyoumeant
relatedoutcomes.Also,thefirstpregnancyshouldalsohavebeenfertilitytomatchtheeditfromAnna
Maria.EDIT:Fertility,periandpostmenopause,pregnancyrelatedoutcomes
3. Addedcanceroutcomesinparentheses(breast,colorectal,prostate,lung)totheDietrelatedcancersbullet
soitmatchestheothersthathavespecificoutcomesinparens.
4. AddeddepressiontotheparensafterNeuropsychconditions
Letmeknowifyouhaveanyquestions,issueswiththeseedits,oranythingelseyouwouldlikemetoworkonwith
them.Iamavailabletomorrowbefore10am,butintransitandthenatthemeetingwithyouafterthat.Iwillalso
sendyouandAlicetheagendasforthebreakoutsessionsassoonasIhavethemsoyoucanplanyourattendance.
Thanks,
Kellie
KellieO.Casavale,PhD,RD
NutritionAdvisor,DivisionofPreventionScience
CoExecutiveSecretary,2015DietaryGuidelinesAdvisoryCommittee
HHS,OfficeofDiseasePreventionandHealthPromotion
1101WoottonPkwy,LL117
Rockville,MD20852
(240)4538252
www.DietaryGuidelines.gov
123
PSC-HHS-000123
Happy to discuss the issue. My concern is the following; if we are reiterating the 2008
PA guidelines so be it and clearly state as such. Reproduce verbatim to avoid
confusion. From what I remember, because PA guidelines is a standalone document
and was slated for updating in the future that is what we decided. As written, I dont
think our approach is clear.
AliceH.Lichtenstein,D.Sc.
GershoffProfessorofNutritionScienceandPolicy
DirectorandSeniorScientist,CardiovascularNutritionLaboratory
TuftsUniversity
JMUSDAHumanNutritionResearchCenteronAging
711WashingtonStreet
Boston,MA02111
phone:6175563127
email:Alice.Lichtenstein@Tufts.edu
From: Nelson, Miriam
Sent: Wednesday, August 13, 2014 8:04 AM
To: Lichtenstein, Alice; Campbell, Wayne W; 'campbellw@purdue.edu' (campbellw@purdue.edu)
Cc: Mosher, Amber (OS/OASH); Liz Rahavi (Elizabeth.rahavi@cnpp.usda.gov); (b) (6)
FNS (Contractor)
Subject: PAWG Chapter - next steps?
Psota, Tricia -
HiAliceandWayne,
Thankyouforyourthoroughreviewofthedraftphysicalactivitychaptercontent.Youaddressseveralareasthatwhen
refinedwillsignificantlyimprovetheoverallchapter,particularlytheuseofmoreconsistentandstandardizedlanguage.
Thatsaid,Iamconcernedwiththevolumeofcommentsrelatedtothephysicalactivityquestionsandconclusion
statements,whichhavebeenreviewedanumberoftimes,revisedasrequested,andpresentedattherecentpublic
meeting.
Asyourecall,thegroupagreedtoaddressthistopicareausingevidenceavailableinthePhysicalActivityGuidelinesfor
Americansreports,whichwasextractedandincorporatedintoconclusionstatementsvirtuallyverbatim,without
significantchangestothelanguageordescriptionsofevidence.WhileIgenerallyagreewiththerationalepresentedin
yourfeedback,Iamworriedthegroupislosingsightofthesettledapproachtothephysicalactivitytopicbyproposing
changesthatwouldinevitablychangethecoursewevetakenthusfar.Iamconcernedthatifwestarteditingthe
languagefromthe2008andMidcoursereports,wewillstarttounravelanditwillbecomeimpossibletocontain.Itis
124
PSC-HHS-000124
alsoimportanttorememberthatthe2018PAguidelinesaremovingforward.Mostcriticalinthisreportisthatwe
stresstheimportanceofcombiningPAandgoodnutritionthattheyworktogether;thatAmericansarenotevenclose
tomeetingthe2008PAguidelinesandthatweneedtotakeaction.
Iwouldliketoscheduleacalltodiscussthegroupsnextsteps.Myhopeisthatwecancontinueasplannedandbegin
thechapterwritingassoonaspossible,includingfinalizingtheoverallimplicationsstatementaswellasdraftingthe
introductionandmethodologysections.However,wemustresolveanyreservationsregardingourapproachto
addressingthistopicbeforemovingforward.Amberwillsendadoodlepolltothegrouptoidentifyadate/timeforthis
call.Pleasefeelfreetocontactmewithanyquestionsandconcerns,andmanythanksforyourtimeandthoughtfulness.
Best,Mim
Tufts University
phone: 617-627-4178
www.StrongWomen.org
www.ChildObesity180.org
www.facebook.com/StrongWomenwithMiriamNelson
Twitter: @DrMiriamNelson
125
PSC-HHS-000125
One good thing, it did not come up on the Tufts PR daily search, which means it did
not get wide attention. I will certainly not alert them about it.
AliceH.Lichtenstein,D.Sc.
GershoffProfessorofNutritionScienceandPolicy
DirectorandSeniorScientist,CardiovascularNutritionLaboratory
TuftsUniversity
JMUSDAHumanNutritionResearchCenteronAging
711WashingtonStreet
Boston,MA02111
phone:6175563127
email:Alice.Lichtenstein@Tufts.edu
From: Casavale, Kellie (OS/OASH) [mailto:Kellie.Casavale@hhs.gov]
Sent: Thursday, August 21, 2014 8:55 AM
To: Lichtenstein, Alice
Cc: Mosher, Amber (OS/OASH)
Subject: FW: Dietary Guidelines Panel to Mull New Sodium Research
Alice,
Itwasgoodtochat.Thearticleisbelow.Tofollowuponyourrequest,Amberwilltouchbasewithyouwithsome
guidanceonhowtoapproachacorrectionifyoudecidetopursuethat.Ithinkthisprovidesagreatexampleofhowan
interviewwiththebestintentionsandcarefuldisclaimerscanresultinsomethingunintendedandunexpected.Weknow
youwell,andknowyoudidnotspeakonbehalfoftheDGACeventhoughthereportedmadeitseemthatway.
Haveagreatday!
Kellie
126
PSC-HHS-000126
MORNING
TAKE
6 a.m.
Aug. 18, 2014
Blog Home
Note to Readers: Due to the August recess, CQ on Agriculture & Food will publish a Morning Take
every Monday until Sept. 8, when our regular publishing schedule will resume.
That new study on sodium is likely to get a long look next month from the Dietary Guidelines
Advisory Committee. The study, which tracked 100,000 people across 17 countries, has focused new
attention on the scientific debate about whats a safe level of sodium intake and how far Americans
should try to lower theirs.
Alice Lichtenstein, a nutritionist at Tufts University and vice chairwoman of the advisory committee,
tells CQ Roll Calls Georgina Gustin that the study is critically important given its scope, but that
other factors, such as disease or lifestyle, might affect the studys findings. She said that the advisory
panel will look at the latest science on the issue but isnt planning to recommend changes to the
current guidance on sodium.
127
PSC-HHS-000127
PSC-HHS-000128
CBO projected that the programs would pay out $3.8 billion on this years crops, $2.1 billion for ARC
and $1.7 billion for PLC. Based on the midpoint of the price forecasts issued by USDA last week, the
programs would pay farmers $3.5 billion to $2.9 billion for ARC and $600 million for PLC.
Most of the ARC payments would go to corn growers, while the PLC subsidies would be dominated by
producers of long grain rice, the variety grown in Arkansas and other Southern states. (The
economists numbers are based on prices being at the midpoint of the ranges estimated by USDA.) If
all of my forecasts were that good, I would be happy, Zulauf says of the CBO score. But as we talk
the forecast is subject to incredible change.
Possible 2014 payments per acre under new farm bill programs. (Source: University of
Illinois)
Forecast Vindicates Rice Growers. According to Zulauf and Schnitkey, Southern rice growers
could receive about $90 an acre in PLC payments, which is roughly what they were receiving annually
in the direct annual payments that were abolished by the farm bill (PL 113-79). The forecast would
appear to be a vindication for the rice lobby, which fought hard not only to enact PLC but to make
sure that the price guarantee, or reference price, was so close to the market price that it was likely to
trigger payments.
A key to the rice growers win was Mississippi Sen. Thad Cochrans successful move to oust Pat
Roberts of Kansas as ranking Republican on the Agriculture Committee.
Considerable Uncertainty Yet on Prices, Payments. The economists based their estimates off
the midpoint of the price range USDA projects for each commodity. The actual cost of the two
programs for this years crop could range from negligible to as much as $9 billion, depending on
where prices actually fall within those ranges. USDA, for example, estimates that the average price
129
PSC-HHS-000129
paid to farmers for corn could be anywhere from $3.55 to $4.25 a bushel. At the low end of the price
ranges, the ARC payment could reach $79 an acre, and the PLC payment for long rice could hit $120
an acre, the economists say.
At CQ on Ag and Food:
Lawmakers Push OMB on Menu Labeling
CQ on Agriculture & Food is a paid-subscription newsletter and website published by CQ Roll Call. Routine or systematic forwarding or
photocopying of this publication or portions thereof is a violation of federal copyright laws. To ensure compliance or to inquire about a
site license, contact CQ Roll Call Sales at 800-432-2250 x 6599 or sales@cqrollcall.com. If you are having technica issues accessing
this publication, contact CQ Roll Call Customer Service at 800-432-2250 x 6621 or customerservice@cqrollcall.com. Request a free trial.
An Economist Group Business. Copyright 2014 CQ Roll Call. All rights reserved.
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 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.
130
PSC-HHS-000130
Thanks for your help. Modified slightly, decided to get it scanned, your advice, rather
than sending a pdf directly. Will copy you when it goes out.
AliceH.Lichtenstein,D.Sc.
GershoffProfessorofNutritionScienceandPolicy
DirectorandSeniorScientist,CardiovascularNutritionLaboratory
TuftsUniversity
JMUSDAHumanNutritionResearchCenteronAging
711WashingtonStreet
Boston,MA02111
phone:6175563127
email:Alice.Lichtenstein@Tufts.edu
From: Mosher, Amber (OS/OASH) [mailto:Amber.Mosher@hhs.gov]
Sent: Thursday, August 21, 2014 10:11 AM
To: Casavale, Kellie (OS/OASH); Lichtenstein, Alice
Subject: RE: Dietary Guidelines Panel to Mull New Sodium Research
Importance: High
Alice,
Afterreviewingthearticleclosely,Ibelieveitisappropriateforyoutosendtheeditoraletterofcorrection.Ivedrafted
apotentialletterforyourreviewandusepleaseseeattached.NoticethatIhighlightedaplaceholderforthedateyou
providedcommentstoCQRollCallsreporter.Ifyoudecidetomoveforwardwiththeletter,Iwouldsuggestprinting
andsigningacopyandemailingascannedPDFoftheoriginaltotheeditorialstaff.Icouldnotlocateindividualemail
addressesontheirwebsite,butassumeyoucanreachMr.Brasherdirectlyatphillipbrasher@cqrollcall.com.Finally,
notethatbecauseCQonAgriculture&Foodisapaidsubscriptionservice,(b) (5)
(b) (5)
Pleaseletmeknowifyouhaveanyquestionsorwouldlikeadditionalguidance.
Hopethishelps!ALM
PSC-HHS-000131
Alice,
Itwasgoodtochat.Thearticleisbelow.Tofollowuponyourrequest,Amberwilltouchbasewithyouwithsome
guidanceonhowtoapproachacorrectionifyoudecidetopursuethat.Ithinkthisprovidesagreatexampleofhowan
interviewwiththebestintentionsandcarefuldisclaimerscanresultinsomethingunintendedandunexpected.Weknow
youwell,andknowyoudidnotspeakonbehalfoftheDGACeventhoughthereportedmadeitseemthatway.
Haveagreatday!
Kellie
MORNING
TAKE
6 a.m.
Aug. 18, 2014
Blog Home
Note to Readers: Due to the August recess, CQ on Agriculture & Food will publish a Morning Take
every Monday until Sept. 8, when our regular publishing schedule will resume.
That new study on sodium is likely to get a long look next month from the Dietary Guidelines
Advisory Committee. The study, which tracked 100,000 people across 17 countries, has focused new
attention on the scientific debate about whats a safe level of sodium intake and how far Americans
should try to lower theirs.
132
PSC-HHS-000132
Alice Lichtenstein, a nutritionist at Tufts University and vice chairwoman of the advisory committee,
tells CQ Roll Calls Georgina Gustin that the study is critically important given its scope, but that
other factors, such as disease or lifestyle, might affect the studys findings. She said that the advisory
panel will look at the latest science on the issue but isnt planning to recommend changes to the
current guidance on sodium.
PSC-HHS-000133
decisions to make.
Economists Carl Zulauf of The Ohio State University and Gary Schnitkey at the University of Illinois
have run numbers based on the price forecast the Department of Agriculture released last week and
found that payments under the new Agricultural Risk Coverage and Price Loss Coverage programs
could actually fall a little below the CBO estimate.
CBO projected that the programs would pay out $3.8 billion on this years crops, $2.1 billion for ARC
and $1.7 billion for PLC. Based on the midpoint of the price forecasts issued by USDA last week, the
programs would pay farmers $3.5 billion to $2.9 billion for ARC and $600 million for PLC.
Most of the ARC payments would go to corn growers, while the PLC subsidies would be dominated by
producers of long grain rice, the variety grown in Arkansas and other Southern states. (The
economists numbers are based on prices being at the midpoint of the ranges estimated by USDA.) If
all of my forecasts were that good, I would be happy, Zulauf says of the CBO score. But as we talk
the forecast is subject to incredible change.
Possible 2014 payments per acre under new farm bill programs. (Source: University of
Illinois)
Forecast Vindicates Rice Growers. According to Zulauf and Schnitkey, Southern rice growers
could receive about $90 an acre in PLC payments, which is roughly what they were receiving annually
in the direct annual payments that were abolished by the farm bill (PL 113-79). The forecast would
appear to be a vindication for the rice lobby, which fought hard not only to enact PLC but to make
sure that the price guarantee, or reference price, was so close to the market price that it was likely to
trigger payments.
134
PSC-HHS-000134
A key to the rice growers win was Mississippi Sen. Thad Cochrans successful move to oust Pat
Roberts of Kansas as ranking Republican on the Agriculture Committee.
Considerable Uncertainty Yet on Prices, Payments. The economists based their estimates off
the midpoint of the price range USDA projects for each commodity. The actual cost of the two
programs for this years crop could range from negligible to as much as $9 billion, depending on
where prices actually fall within those ranges. USDA, for example, estimates that the average price
paid to farmers for corn could be anywhere from $3.55 to $4.25 a bushel. At the low end of the price
ranges, the ARC payment could reach $79 an acre, and the PLC payment for long rice could hit $120
an acre, the economists say.
At CQ on Ag and Food:
Lawmakers Push OMB on Menu Labeling
CQ on Agriculture & Food is a paid-subscription newsletter and website published by CQ Roll Call. Routine or systematic forwarding or
photocopying of this publication or portions thereof is a violation of federal copyright laws. To ensure compliance or to inquire about a
site license, contact CQ Roll Call Sales at 800-432-2250 x 6599 or sales@cqrollcall.com. If you are having technica issues accessing
this publication, contact CQ Roll Call Customer Service at 800-432-2250 x 6621 or customerservice@cqrollcall.com. Request a free trial.
An Economist Group Business. Copyright 2014 CQ Roll Call. All rights reserved.
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 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.
135
PSC-HHS-000135
HiEve,
FrankandIaretalkingnextTuesdayandIwillreviewhislatestCVDsummary(IamalsohappytoreviewAnnaMaria's
OverweightandObesitysummarywhensheisready.).BTW,JoanneandKatrinajustpresentedtoSC3anevidence
summarytablethattheyhavecompiledwhichsummarizesdataoninterventionsforweightmanagement,CVDrisk
reduction,andotherselectedendpoints.IbelieveAnnaMariasheisgoingtoconsideritwhendoinghersummaryof
evidenceonoverweightandobesitysinceitincludesinformationoneffectsizesfrombehavioralinterventionforobesity
management(andotheroutcomes,CVDandDM)asreportedintheAHAACCreport.Katrinaisgoingtosendthetable
toyouandtheyaregoingbacktoextractthegradedrecommendations.Thesummarytheyhavedonealsocaptures
informationonthemodeandmethodofbehavioralintervention.Wearediscussingwherebesttoreportonthat
informationinthereportandSC3willcontinueitsdiscussion.
CanyousendmethelatestversionoftheCVDsummaryandthefulldatatables?AnneRodgerssentmesomebut
notedthatImaynothavethelatestversions.WhenAnnaMariaisdone,pleasesendmehersummaryandthedata
tablestoo.
Wewillhavedeterminewhetherwe'regoingtoaddKatrinaandJoanne'sevidencetabletoourtables(atleastthepart
fromAHAACC)andperhapswheretolocatetherestofit.Hopethat'sclearandmakesense.Letmeknowifyouhave
anyquestions.
Manythanks.
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
OriginalMessage
From:Essery,EveCNPP[mailto:Eve.Essery@fns.usda.gov]
Sent:Thursday,September04,20142:39PM
To:Millen,BarbaraE;SiegaRiz,AnnaMaria
Cc:KellieCasavale(OS/OASH)
Subject:RE:recommendatgions.CallthisFriday
HiBarbara,
AnnaMariaandIhademailedaboutpotentiallyincludingthisasanagendaitemontheSC2callnextThursday.Would
youbewillingtotakeoneofthewriteupsandmakecommentsthroughouttohighlighttheaspectsof"whatworks"you
thinkmightbemissing?Thatway,everyoneisonthesamepage,andgroupsthathavereviewedtheindividual
questionscanspeaktoif/howthatinformationmaybeavailableforeachoutcome.Ashasbeenstated,itmightbethat
CVDandBWarethemainareaswherethisinformationcanbeelucidated,butthiswouldgiveeveryoneconcrete
136
PSC-HHS-000136
examplesoftheinformationthatisbeingrequested.Frank'sassistantjustconfirmedthatFrankwillbeontheSC2call
nextweek.
AnnaMariaApologies,I'vebeenbusygettingsomesaturatedfatandaddedsugarsmaterialsout.I'llreviewyour
sectionASAPlikelyearlynextweek.
Best,
Eve
OriginalMessage
From:Millen,BarbaraE[mailto:bmillen@bu.edu]
Sent:Thursday,September04,201412:44PM
To:SiegaRiz,AnnaMaria
Cc:Essery,EveCNPP;KellieCasavale(OS/OASH)
Subject:RE:recommendatgions.CallthisFriday
Manythanks.
Dr.BarbaraE.Millen
bmillen@bu.edu
OriginalMessage
From:SiegaRiz,AnnaMaria[mailto:am_siegariz@unc.edu]
Sent:Thursday,September04,201412:41PM
To:Millen,BarbaraE
Cc:EveCNPPEssery;KellieCasavale(OS/OASH)
Subject:RE:recommendatgions.CallthisFriday
HiBarbara,
ThankyouforthisnoteandIamhappyforyoutoreviewthesectionswrittentoseeifwehaveorcanfurtherbringout
thepointsthatyouhavementionedbelow.IhavecompletedmyseconddraftoftheT2Dconclusions,implicationsand
keyfindings.Ihopetotackletheobesityonenextovertheweekendifpossiblesincethisdoestakelonghoursof
focusedeffort.IsentEveandKellietheT2Ddraftatthebeginningoftheweek.Notsureiftheyhadanyeditsasofyet(
Iamsuretherewillbe)buthereitisforyoutobegintoreview.
TheconclusionandimplicationstatementsforobesityarethelatestversionwehavefromtheJulymeeting.
Bestregards,
AnnaMaria
OriginalMessage
From:Millen,BarbaraE[mailto:bmillen@bu.edu]
Sent:Thursday,September04,201412:25PM
To:SiegaRiz,AnnaMaria
Cc:EveCNPPEssery;KellieCasavale(OS/OASH)
Subject:RE:recommendatgions.CallthisFriday
DearAnnaMaria,
137
PSC-HHS-000137
IspokewithKelliethismorningtogooveravarietyoftopicsthatseemimportanttodiscussbeforewemoveintothe
reviewoftheSCworkbeyondthesubcommitteelevel.SinceFrankhasnotbeenonthemostrecentSC2callswhenthe
'whatworks'topicwasraised,IwouldliketoproposethatItalkwithFrankdirectlyabouttheCVDsummary.When
you'redonewithyoureditstoObesityandDiabetes,itwouldalsobehelpfultohaveashortconversationafterI'vehad
achancetoreviewit.Myhopeistoworkwiththeexistingsummariesofevidenceandthetablestoassessifwe've
madethestrongestcasepossiblefortherelationshipsbetweenand'impact'ofdietarypatternsonhealthoutcomes
(endpointsandintermediatemarkers,whereappropriate).Ithinkwehavecoveredtheprospectivecohortfindings
verywell.So,I'mmostinterestedinlookingcloselyathowtheRCTinformationisbeingbroughtforward(inthecaseof
theexistingreports)andsummarizedandwhatconclusionswedraw.Thisiswellwithinthescopeoftheexistingpriority
questions.Inexamining'relationships'betweendietarypatternsandhealthoutcomes,wehaveidentifiedandanalyzed
evidenceon'associations'aswellasthe'efficacy'and'effectiveness'ofinterventions.Ifwecandrawreasonablystrong
conclusionsaboutbothrelationshipbetweendietarypatternsandthedevelopmentofdiseaseaswellastheefficacy
andimpactofdietarypatternsandhealthoutcomes,itwillbeextremelyimportanttoourDGACwork.Oursummaries
andconclusionswillalsoinfluenceourimplicationsstatementsandrecommendations,soitisimportantthattheyareas
completeaspossible.
Itisnotmyintenttoaddmajorworkatthispoint.Weareallwellawarethatweneedtobecarefulwithstaffand
committeememberactivities.However,itisatthisjuncturethatwemakethenecessaryeditstoanswerourpriority
questionsascompletelyaspossible.Ifwehavetodrawfurtherfromexistingreportsorthepaperswehavealready
summarized,Ihopeitdoesn'taddmuchburden.Ifthereisanyindicationthatitwill,weshoulddefinitelydiscussitwith
theSCbuthopefullyitwon't.
Ihopeyouagreeandwillworkwithmetoaccomplishthisasquicklyaspossible.
Letmeknowyourwritingtimetableforobesityanddiabetesandwhenyoumighthaveahalfhouratmosttotalkearly
nextweek.IwillreachouttoFrank.IfyouwanttotalkbeforeIdo,letmeknow.
Bestregards,
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
OriginalMessage
From:SiegaRiz,AnnaMaria[mailto:am_siegariz@unc.edu]
Sent:Wednesday,September03,20146:57PM
To:EveCNPPEssery;KellieCasavale(OS/OASH);Millen,BarbaraE
Subject:CallthisFriday
Hi,Ihaveadissertationdefensetoattendfrom1012onFridayandthusunabletomakethecall.
Myplanistocompletethekeyfindingsfordietarypatternsandobesityovertheweekend.
AnnaMaria
SentfrommyiPhone
ThiselectronicmessagecontainsinformationgeneratedbytheUSDAsolelyfortheintendedrecipients.Any
unauthorizedinterceptionofthismessageortheuseordisclosureoftheinformationitcontainsmayviolatethelawand
138
PSC-HHS-000138
subjecttheviolatortocivilorcriminalpenalties.Ifyoubelieveyouhavereceivedthismessageinerror,pleasenotifythe
senderanddeletetheemailimmediately.
139
PSC-HHS-000139
IagreewiththerewordingofthequestionsanditseemsthattheArcherprovidessuitablecontextualinformation.I
wasntsurewhytheGroeneveldwasomitted.WhiletheresultssummarizedonimpactonmostCVDriskfactorsseemed
inconclusive,thesummaryseemstonotethatthateffectsonbodyfatwereobservedforlifestyleinterventions.The
qualityratingseemedreasonabledespitethelimitationsnoted.SinceIwasnotonthecall,Idefertoothersforthe
nuancerelatingtothedecision.
Best,
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
Hiall,
AsafollowupactionitemtotodaysSC4call,pleasereviewtheattachmentsandanswerthefollowingquestionsby
Tues9/9:
1. Doyouapprovetheeditstothe3originalworksitequestionsandtheadditionofanotherquestion?
WWCyes.
2. DoyousupportremovingtheGroeneveldpaperfromtheevidencebase?
WWCyes.Itisimportanttonotethatinsufficientevidenceexiststoassessoftheimpactofdietonlyworksite
programs.TheresultsfromVerweijetal.showthatdiet+exerciseprogramswork,butnotexerciseonly
140
PSC-HHS-000140
programs.Animportantareaforresearchmightbewhethertheapparenteffectivenessofdiet+exercise
programsissynergistic(betweenthetwocomponents),orifthedietcomponentisdrivingtheeffect?
3. ShouldtheArcherpaperbeusedforcontextualpurposesonly?
WWCYes.Theinclusionoffindingsfromexperimentally'weaker'studiesinthisreviewisnotconsistentwiththe
rigorousDGACcriteriaforinclusion.
Attachments:
Questionsfortheworksitetopicarea(Word)
WorksiteDuplicationAssessment(Excel)
6articlesofinterest(PDFs)
NotethattheWorddocumentwiththeoriginalandrevisedquestionsindicateswhicharticleswouldbeusedtoanswer
eachquestion.Also,removaloftheGroeneveldarticleisunderconsiderationduetotheoverlapwiththeVerweijarticle,
whichisasystematicreviewandmetaanalysisincludingmostofthestudiesintheGroeneveldpaperandencompasses
awiderdaterange.
Pleaseletmeknowifyouhaveanyquestions.
Best,
Tricia
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 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.
141
PSC-HHS-000141
I support the change. This report is very large. To give adequate time to the details it
would be helpful to move the date. This is particularly true for anyone on an academic
schedule. Courses are usually over early Dec.
AliceH.Lichtenstein,D.Sc.
GershoffProfessorofNutritionScienceandPolicy
DirectorandSeniorScientist,CardiovascularNutritionLaboratory
TuftsUniversity
JMUSDAHumanNutritionResearchCenteronAging
711WashingtonStreet
Boston,MA02111
phone:6175563127
email:Alice.Lichtenstein@Tufts.edu
From: Casavale, Kellie (OS/OASH) [mailto:Kellie.Casavale@hhs.gov]
Sent: Tuesday, September 09, 2014 4:52 PM
To: Millen, Barbara E; Lichtenstein, Alice
Cc: Olson, Richard (HHS/OASH); Colette Rihane; Shanthy Bowman; Anne Rodgers
Subject: Response Needed: DGAC Meeting 6
Importance: High
BarbaraandAlice,
TheCoexecutiveSecretariesandstaffhavedonesomethinkingaboutthetimelineforcompletingthereport.We
wantedtotouchbasewithyoutogetyourthoughtsonpotentiallymovingthedateofthefinalDGACpublicmeeting
fromNovember57thtoearlyDecember(orearlyJanuaryifDecemberisntpossible),whichwouldgivetheCommittee
anadditionalmonthforwritingandreview.
Therewere8weeksbetweentheJanuaryandMarchandtheJulyandSeptembermeetings.Fromthoseexperiences,
Committeemembersandstaffhaveagoodfeelforwhatworkcangetdoneinthattimeframe.Thereareonly7weeks
betweentheSeptemberandNovembermeetingdates.Thisislikelyenoughtimetogettheremainingevidencereviews
completed.However,itislikelynotenoughtimefortheCommitteetocompletethesciencebasechapterwriting,run
thosepiecesthroughathoroughcrossreviewandediting,soundlydevelopandreviewyoursynthesissections,and
completetheothersectionsandappendicesthatwillrequireattention(e.g.,glossaryofterms,methodology).
Wethinktheadditionaltimewouldgiveyouthetimeyouneedforthoroughcrossreviewandsynthesisandwould
resultinabetterfinalproduct.However,evenifwemovedthemeetingbacktoearlyDecember,thegoalofthe
Committeewouldstillbetocompleteitsreportbytheendofthecalendaryear.Thiswouldmeanretainingthe
aggressivetimelinesanddraftinggoaldatestheSCshaveestablishedandnotaddressinganyadditionalquestions
beyondthosealreadyunderway.
142
PSC-HHS-000142
Ifyouareopentothisidea,weneedtocontactNIHimmediately;theavailabilityofmeetingspaceiscrucial.Then,we
wouldneedtoquerytheDGACschedulesforpotentialdates,anotherchallengingtask.Becausethereportwouldbeina
morecompletestateifitwerepresentedinearlyDecemberthanitwouldbeinNovember,itmaybepossiblethata
Decembermeetingwouldbe12daysratherthan3,whichcouldhelpwithschedulingadate.Therearesomestrategies
wealsocouldemployforvettingtheremainingrecommendations(followingFACA)sothattherearentanysurprisesat
thelastmeeting.Wewelcomeyourthoughts!
Thanks,
Kellie
KellieO.Casavale,PhD,RD
NutritionAdvisor,DivisionofPreventionScience
CoExecutiveSecretary,2015DietaryGuidelinesAdvisoryCommittee
HHS,OfficeofDiseasePreventionandHealthPromotion
1101WoottonPkwy,LL117
Rockville,MD20852
(240)4538252
www.DietaryGuidelines.gov
143
PSC-HHS-000143
See notes after each week. I dont know how many members will have teaching
responsibilities in the spring. For me, I dont.
From: Casavale, Kellie (OS/OASH) [mailto:Kellie.Casavale@hhs.gov]
Sent: Wednesday, September 10, 2014 7:52 AM
To: Lichtenstein, Alice
Subject: RE: Response Needed: DGAC Meeting 6
Thanks,Alice.Sinceyouareveryintunewiththeacademicschedule.Doyouhaveanyfeedbackonwhatdaterangein
earlyDec(andearlyJan)mightworkbestformembers?Theworkweekslooklikethis:
DEC
1stweek:Dec15endofclasses
2ndweek:Dec812readingperiod,finalexamspossibilitygoodformeeting,personallyIdontneedtobeatTufts
3rdweek:Dec1519likelygoodformeeting
(4thweekistheweekofChristmas)
(5thweek/1stofJannotgood)
JAN
1stweek:Jan59Iamoutallweek
2ndweek:Jan1216firstpartofweeklikelygood,sometimesclassesstartinthelaterpartoftheweek,somedont
startuntilfollowingweek
(Wewouldntwanttogoanylater,sothereistimetogetthereportsubmittedbeforethecharterendsFeb19th)
Kellie
KellieO.Casavale,PhD,RD
NutritionAdvisor,DivisionofPreventionScience
CoExecutiveSecretary,2015DietaryGuidelinesAdvisoryCommittee
HHS,OfficeofDiseasePreventionandHealthPromotion
I support the change. This report is very large. To give adequate time to the details it
would be helpful to move the date. This is particularly true for anyone on an academic
schedule. Courses are usually over early Dec.
AliceH.Lichtenstein,D.Sc.
144
PSC-HHS-000144
GershoffProfessorofNutritionScienceandPolicy
DirectorandSeniorScientist,CardiovascularNutritionLaboratory
TuftsUniversity
JMUSDAHumanNutritionResearchCenteronAging
711WashingtonStreet
Boston,MA02111
phone:6175563127
email:Alice.Lichtenstein@Tufts.edu
From: Casavale, Kellie (OS/OASH) [mailto:Kellie.Casavale@hhs.gov]
Sent: Tuesday, September 09, 2014 4:52 PM
To: Millen, Barbara E; Lichtenstein, Alice
Cc: Olson, Richard (HHS/OASH); Colette Rihane; Shanthy Bowman; Anne Rodgers
Subject: Response Needed: DGAC Meeting 6
Importance: High
BarbaraandAlice,
TheCoexecutiveSecretariesandstaffhavedonesomethinkingaboutthetimelineforcompletingthereport.We
wantedtotouchbasewithyoutogetyourthoughtsonpotentiallymovingthedateofthefinalDGACpublicmeeting
fromNovember57thtoearlyDecember(orearlyJanuaryifDecemberisntpossible),whichwouldgivetheCommittee
anadditionalmonthforwritingandreview.
Therewere8weeksbetweentheJanuaryandMarchandtheJulyandSeptembermeetings.Fromthoseexperiences,
Committeemembersandstaffhaveagoodfeelforwhatworkcangetdoneinthattimeframe.Thereareonly7weeks
betweentheSeptemberandNovembermeetingdates.Thisislikelyenoughtimetogettheremainingevidencereviews
completed.However,itislikelynotenoughtimefortheCommitteetocompletethesciencebasechapterwriting,run
thosepiecesthroughathoroughcrossreviewandediting,soundlydevelopandreviewyoursynthesissections,and
completetheothersectionsandappendicesthatwillrequireattention(e.g.,glossaryofterms,methodology).
Wethinktheadditionaltimewouldgiveyouthetimeyouneedforthoroughcrossreviewandsynthesisandwould
resultinabetterfinalproduct.However,evenifwemovedthemeetingbacktoearlyDecember,thegoalofthe
Committeewouldstillbetocompleteitsreportbytheendofthecalendaryear.Thiswouldmeanretainingthe
aggressivetimelinesanddraftinggoaldatestheSCshaveestablishedandnotaddressinganyadditionalquestions
beyondthosealreadyunderway.
Ifyouareopentothisidea,weneedtocontactNIHimmediately;theavailabilityofmeetingspaceiscrucial.Then,we
wouldneedtoquerytheDGACschedulesforpotentialdates,anotherchallengingtask.Becausethereportwouldbeina
morecompletestateifitwerepresentedinearlyDecemberthanitwouldbeinNovember,itmaybepossiblethata
Decembermeetingwouldbe12daysratherthan3,whichcouldhelpwithschedulingadate.Therearesomestrategies
wealsocouldemployforvettingtheremainingrecommendations(followingFACA)sothattherearentanysurprisesat
thelastmeeting.Wewelcomeyourthoughts!
Thanks,
Kellie
KellieO.Casavale,PhD,RD
NutritionAdvisor,DivisionofPreventionScience
CoExecutiveSecretary,2015DietaryGuidelinesAdvisoryCommittee
HHS,OfficeofDiseasePreventionandHealthPromotion
1101WoottonPkwy,LL117
145
PSC-HHS-000145
Rockville,MD20852
(240)4538252
www.DietaryGuidelines.gov
146
PSC-HHS-000146
Helloall,
Thankyoufortheverythoughtfulconsiderationofthetimetable.SorrythatIdidntrespondrightawaybutmy
scheduleisreallytight.
Weallknowhowveryhardeveryoneisworkingandthatwehaveacommoninterestinproducingadeepand
informativereportwithontimesubmission.Ialsofavorpushingournextmeetingout.Asyouknow,Iwillbe
presentingattheRoyalSwedishAcademyofSciencesinStockholmonNovember25,justbeforeThanksgiving.The
holidaywillprobablyaffectmostofus.So,aslongaswecanworkaroundit,earlyDecemberorJanuaryworkfor
me.LetsseehowtheCommitteefeels.OuracademicscheduletypicallywentwellintomidDecemberwiththesisand
doctoraldefensesuntiljustbeforetheDecemberbreak.So,Decembermightgettrickyforsomebutletsmoveahead
andseehowitworksout.
Best,
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
BarbaraandAlice,
TheCoexecutiveSecretariesandstaffhavedonesomethinkingaboutthetimelineforcompletingthereport.We
wantedtotouchbasewithyoutogetyourthoughtsonpotentiallymovingthedateofthefinalDGACpublicmeeting
fromNovember57thtoearlyDecember(orearlyJanuaryifDecemberisntpossible),whichwouldgivetheCommittee
anadditionalmonthforwritingandreview.
Therewere8weeksbetweentheJanuaryandMarchandtheJulyandSeptembermeetings.Fromthoseexperiences,
Committeemembersandstaffhaveagoodfeelforwhatworkcangetdoneinthattimeframe.Thereareonly7weeks
betweentheSeptemberandNovembermeetingdates.Thisislikelyenoughtimetogettheremainingevidencereviews
completed.However,itislikelynotenoughtimefortheCommitteetocompletethesciencebasechapterwriting,run
thosepiecesthroughathoroughcrossreviewandediting,soundlydevelopandreviewyoursynthesissections,and
completetheothersectionsandappendicesthatwillrequireattention(e.g.,glossaryofterms,methodology).
Wethinktheadditionaltimewouldgiveyouthetimeyouneedforthoroughcrossreviewandsynthesisandwould
resultinabetterfinalproduct.However,evenifwemovedthemeetingbacktoearlyDecember,thegoalofthe
147
PSC-HHS-000147
Committeewouldstillbetocompleteitsreportbytheendofthecalendaryear.Thiswouldmeanretainingthe
aggressivetimelinesanddraftinggoaldatestheSCshaveestablishedandnotaddressinganyadditionalquestions
beyondthosealreadyunderway.
Ifyouareopentothisidea,weneedtocontactNIHimmediately;theavailabilityofmeetingspaceiscrucial.Then,we
wouldneedtoquerytheDGACschedulesforpotentialdates,anotherchallengingtask.Becausethereportwouldbeina
morecompletestateifitwerepresentedinearlyDecemberthanitwouldbeinNovember,itmaybepossiblethata
Decembermeetingwouldbe12daysratherthan3,whichcouldhelpwithschedulingadate.Therearesomestrategies
wealsocouldemployforvettingtheremainingrecommendations(followingFACA)sothattherearentanysurprisesat
thelastmeeting.Wewelcomeyourthoughts!
Thanks,
Kellie
KellieO.Casavale,PhD,RD
NutritionAdvisor,DivisionofPreventionScience
CoExecutiveSecretary,2015DietaryGuidelinesAdvisoryCommittee
HHS,OfficeofDiseasePreventionandHealthPromotion
1101WoottonPkwy,LL117
Rockville,MD20852
(240)4538252
www.DietaryGuidelines.gov
148
PSC-HHS-000148
Hereyougo.Verynicesummarywithstrongquantifiableoutcomes.Iwouldadvocateacoupleofthingsasnotedinmy
comments,inparticularsomeclarificationonmethodsandmodesofinterventionthataresuccessfulinachievethese
results,whatlevelofPUFAandSFAarerealistictoachieve(basedonthetrialevidenceandpossiblyPCs)sandwhether
thereareanyaddedbenefitsoftotalfatreductionwithPUFAsubstitutionforSFAand/orweightloss.
ManythanksEveandFrankforthisgreatworksoquickly.
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
Dear All,
attached is a draft key trend document. I'd appreciate your comments and suggestions.
Frank
On Tue, Sep 9, 2014 at 12:43 PM, Essery, Eve - CNPP <Eve.Essery@fns.usda.gov> wrote:
Hi Alice, Frank, Tom, and Barbara,
Attached are the materials we reviewed on Thursdays call for your question on saturated fat and CVD. Per your request,
we have added Jakobsen, which was not identified in the original search because it was not tagged as a meta-analysis.
We also added Skeaff, 2009 per Toms request. Skeaff was also not identified in the original search because it did not
include saturated in the title or abstract (no abstract available).
PSC-HHS-000149
3. Reference overlap
4. PDFs of included articles
5. Key trends document Please provide brief responses to the questions to help inform your synthesis and
development of conclusions.
Does one of you want to take the lead and do a first pass and then do a round robin with the group?
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 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, PhD
Professor of Nutrition and Epidemiology
Harvard School of Public Health
Professor of Medicine
Harvard Medical School
665 Huntington ave, Boston, MA 02115
tel: 617 432 0113 fax: 617 432 2435
150
PSC-HHS-000150
<http://www.hsph.harvard.edu/faculty/frank-hu/>
http://www.hsph.harvard.edu/faculty/frank-hu/
******************************************************
151
PSC-HHS-000151
AliceH.Lichtenstein,D.Sc.
GershoffProfessorofNutritionScienceandPolicy
DirectorandSeniorScientist,CardiovascularNutritionLaboratory
TuftsUniversity
JMUSDAHumanNutritionResearchCenteronAging
711WashingtonStreet
Boston,MA02111
phone:6175563127
email:Alice.Lichtenstein@Tufts.edu
From: Millen, Barbara E [mailto:bmillen@bu.edu]
Sent: Friday, September 12, 2014 5:43 AM
To: Frank Hu; Essery, Eve - CNPP
Cc: Lichtenstein, Alice; jtb4@cornell.edu; Casavale, Kellie (OS/OASH); Obbagy, Julie - CNPP
Subject: RE: DGAC: Sat Fat and CVD
Hereyougo.Verynicesummarywithstrongquantifiableoutcomes.Iwouldadvocateacoupleofthingsasnotedinmy
comments,inparticularsomeclarificationonmethodsandmodesofinterventionthataresuccessfulinachievethese
results,whatlevelofPUFAandSFAarerealistictoachieve(basedonthetrialevidenceandpossiblyPCs)sandwhether
thereareanyaddedbenefitsoftotalfatreductionwithPUFAsubstitutionforSFAand/orweightloss.
ManythanksEveandFrankforthisgreatworksoquickly.
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
Dear All,
attached is a draft key trend document. I'd appreciate your comments and suggestions.
152
PSC-HHS-000152
Frank
On Tue, Sep 9, 2014 at 12:43 PM, Essery, Eve - CNPP <Eve.Essery@fns.usda.gov> wrote:
Hi Alice, Frank, Tom, and Barbara,
Attached are the materials we reviewed on Thursdays call for your question on saturated fat and CVD. Per your request,
we have added Jakobsen, which was not identified in the original search because it was not tagged as a meta-analysis.
We also added Skeaff, 2009 per Toms request. Skeaff was also not identified in the original search because it did not
include saturated in the title or abstract (no abstract available).
Does one of you want to take the lead and do a first pass and then do a round robin with the group?
153
PSC-HHS-000153
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 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, PhD
Professor of Nutrition and Epidemiology
Harvard School of Public Health
Professor of Medicine
Harvard Medical School
665 Huntington ave, Boston, MA 02115
tel: 617 432 0113 fax: 617 432 2435
<http://www.hsph.harvard.edu/faculty/frank-hu/>
http://www.hsph.harvard.edu/faculty/frank-hu/
******************************************************
154
PSC-HHS-000154
ThankyouTom,
Iwouldonlyaddthatwhilewerefocusingonthehealthypopulation,ourevidencecertainlydoesincludehighrisk
individuals.Werenotlookingatrehaborinterventionsinthoseposteventbutcertainlythosewithvaryingdegreesof
risk.Justanadditionalthought.Hopefully,thathelpsclarifythings.
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
To all,
I now see Ramsden BMJ 2013 is on the EXCLUDE list because it focuses on secondary prevention. The
Sydney Diet and Heart Study is secondary, not 100% sure of the meta-analysis; I'm looking and will advise if I
disagree.
The Sat Fat and CVD Approach document says the question is "What is the relationship between saturated fat
intake and risk of cardiovascular disease?" I don't see the words primary or secondary in the
document. Implicitly we're discussing healthy people so I suppose exclusion on those criteria are acceptable.
My opinion on research recommendation is unchanged.
Tom
On Fri, Sep 12, 2014 at 7:36 AM, Tom Brenna <jtb4@cornell.edu> wrote:
Dear all.
I added an important typo fix (a missing "not" in 2a) and two proposed research recommendations.
It may be too late but there is another meta-analysis that we've not covered, buried in the back of the attached
paper. It separates omega-3 and omega-6 and while not significant (95% CL = 0.98 to 1.65) shows only signal
of harm from LA predominant ("selective") interventions (all RCT).
155
PSC-HHS-000155
I presume the decision to include the paper turns on formal inclusion criteria. Whether or not it is included, I
think at least we should make the research recommendation to monitor LA and ALA separately.
Tom
On Fri, Sep 12, 2014 at 5:42 AM, Millen, Barbara E <bmillen@bu.edu> wrote:
Hereyougo.Verynicesummarywithstrongquantifiableoutcomes.Iwouldadvocateacoupleofthingsasnotedinmy
comments,inparticularsomeclarificationonmethodsandmodesofinterventionthataresuccessfulinachievethese
results,whatlevelofPUFAandSFAarerealistictoachieve(basedonthetrialevidenceandpossiblyPCs)sandwhether
thereareanyaddedbenefitsoftotalfatreductionwithPUFAsubstitutionforSFAand/orweightloss.
ManythanksEveandFrankforthisgreatworksoquickly.
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
Dear All,
attached is a draft key trend document. I'd appreciate your comments and suggestions.
Frank
On Tue, Sep 9, 2014 at 12:43 PM, Essery, Eve - CNPP <Eve.Essery@fns.usda.gov> wrote:
Hi Alice, Frank, Tom, and Barbara,
156
PSC-HHS-000156
Attached are the materials we reviewed on Thursdays call for your question on saturated fat and CVD. Per your request,
we have added Jakobsen, which was not identified in the original search because it was not tagged as a meta-analysis.
We also added Skeaff, 2009 per Toms request. Skeaff was also not identified in the original search because it did not
include saturated in the title or abstract (no abstract available).
Does one of you want to take the lead and do a first pass and then do a round robin with the group?
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 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.
157
PSC-HHS-000157
-*******************************************************
Frank B. Hu, MD, PhD
Professor of Nutrition and Epidemiology
Harvard School of Public Health
Professor of Medicine
Harvard Medical School
665 Huntington ave, Boston, MA 02115
tel: 617 432 0113 fax: 617 432 2435
<http://www.hsph.harvard.edu/faculty/frank-hu/>
http://www.hsph.harvard.edu/faculty/frank-hu/
******************************************************
158
PSC-HHS-000158
Goodmorning!Seemynotebelow.B
Dr.BarbaraE.Millen
bmillen@bu.edu
HIthere,
Ireviewedthebonehealthslidesanddidafewtweaks.Ihopethisisconsistentonwherewecameoutonthe
implicationsyesterday.IdidntseeanyintheslidedeckIhadsoIaddedacoupleoflinestoreflectthedietarypattern
evidencesummaryandtonotethatweacknowledgetherolesofvitaminDandcalciuminbonehealthacrossall
ages.Hopethismakessense.Ibelievewewillhavethehardcopyofslidesinourbindertoday.Perhapsthesepages
canbeupdated.
Manythanks.
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
PSC-HHS-000159
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 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.
160
PSC-HHS-000160
Cc:
Subject:
SorryMarian.Mycommentonmethodologicallimitationswasthattherangeoflimitationsinthesemethodsmaybias
towardsthenull.Iagreewithyourverypreciseexplanation.Iwasconcernedthoughthatifwedwellontheir
limitationsintheintroductionwithoutsomestrongerstatementoftheiradvantages,itwouldweakenNOTstrengthen
theinterpretationofourconclusions.MycommentwasntterriblyclearsoIhopethishelps.Hopefullymyeditsseem
reasonable.
Manythanks,
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
RE:someofthecommentsbelowaboutmeasurementerror.Weshouldnotstatethatmeasurementerrorwillbias
towardsthenullandmakeourconclusionsstrongerbecausethisisnottrue.Confoundingtypicallybiasestowardsthe
null,butnotmeasurementerror.Measurementerrordistortsrelationships(socanartificiallyincreaseordecreasethe
observedassociations),particularlywhenitissystematicmeasurementerror.
Marian
PSC-HHS-000161
(NIH/NIDDK) [E]'; 'margaret.mcdowell@nih.gov'; Wong, Yatping - CNPP; 'Anne Rodgers'; 'Casavale, Kellie (OS/OASH)';
'PBROWN@hsph.harvard.edu'; Connor, Jennifer N; 'Bailey, Lauren A.'; 'Knight, Brianna'; 'Angelica Figueroa'; Fu,
Stephenie - CNPP; Psota, Tricia - CNPP; anjuli.bodyk@yale.edu
Subject: RE: DGAC SC2: Call TOMR @ 11am ET (8am PT) - DRAFT chapter for review!
Hiall,
Congratulationsonthechapter!Itiscomingtogetherverywell.Itookquiteabitoftimetoreviewitinsomewhat
greaterdetail.Hopefullythiswillmakethenextlevelofrevieweasier.Afewoverallpoints.Itwillbeimportantto
reviewtheconsistencyacrossSCchaptersinthewordingofandemphasisinthedietarypatternstatements.Forthis
review,IsuggestedwordingthatwediscussedinthelastSC2call.YourwordingisveryclosebutyouwillnotethatIam
recommendingsomeslightediting.Also,thewhatworkscouldcomethroughabitstrongerbasedontheevidence,
particularlyasrelatedtoweightmanagement.IamsuggestingthattheAHA/ACCreviewofRCTsprecedethe
prospectivecohortliteratureinthatsectionofthechapter.Itthinkthismaybetterreflectthehighlevelofconcernover
ingrained,veryhighratesofoverweightandobesityinourpopulationandthemoderatetostrongevidenceonhow
besttomanageit.Also,InoticedthattheLookAheadDiabetestrialwasnotaddressedandthinkwecanusethe
AHA/ACCreportsforthatpurpose.ThoseinthefieldconsideritprettydefinitivesoIthinktheconclusionsandevidence
summaryonDMfromtheexistingreportsneedtobedrawnupontoaddtoourDMsection.Itwasnotuntilthecancer
sectionthattherewasmentionthatthecohortliteratureoftenonlydefinesdietaryexposures(orotherexposures)at
baselineandmaynotconsiderallrelevantpotentialconfounders.Youmaywishtoincludethisinthebriefdiscussionof
limitationsinthedietaryassessmentmethodsinyourintroduction.Ididthoughsoftenthewordinghereabit.Idont
thinkwewanttobesostronginourcritiqueofthesemethodsthatwetakeawayfromourconclusions.Thekeythingis
thatthelimitationswilladdtothebiastowardsthenullandmaytherebymakeourmoderatetostrongconclusions
whereweseethemthatmuchmoreimportant.
Ifyouhaveanyquestions,pleaseletmeknow.
Best,
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
PSC-HHS-000162
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 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.
163
PSC-HHS-000163
AddedtoWaynescomments/additions
AliceH.Lichtenstein,D.Sc.
GershoffProfessorofNutritionScienceandPolicy
DirectorandSeniorScientist,CardiovascularNutritionLaboratory
TuftsUniversity
JMUSDAHumanNutritionResearchCenteronAging
711WashingtonStreet
Boston,MA02111
phone:6175563127
email:Alice.Lichtenstein@Tufts.edu
Good morning,
Here are a few edits and draft grading scores for consideration.
Wayne
From: Obbagy, Julie - CNPP [Julie.Obbagy@cnpp.usda.gov]
Sent: Tuesday, November 04, 2014 1:51 PM
To: 'Clinton, Steven'; Campbell, Wayne W; Anderson, Cheryl; 'Lichtenstein, Alice'; campbellw@purdue. edu
Cc: Essery, Eve - CNPP; Casavale, Kellie (OS/OASH)
Subject: DGAC: Sodium Working Group -- Na-CVD systematic review - input needed!
HiAlice,Cheryl,Steve,andWayne
Ivetakenyourinput(fromthekeytrends,andtheemailsbelow),andsummarized/synthesizeditintheattached
document.PriortoourmeetingsonThursFri,pleasereviewtheattacheddocument,focusingonthesesections:
ConclusionStatement
Grade(pleaseindicatewhichDGACgradeyouwouldassignthisconclusion)
EvidenceSynthesis
ResearchRecommendations
Ifyouhaveproposededitsorcomments,pleasecirculatetothefullworkinggroup,andwecanmakesurethattheyare
discussedonThursday,andthatmaterialsarereadyforpresentationpublicallyonFriday.
164
PSC-HHS-000164
Thanks!
Julie
Agreewithconceptthatweuseverbatimconclusions.Thatistheonlyoptionunlesswedoanadditional
evaluationofdata.
2. InresponsetoWayne,BPisasurrogatemarkerforriskofcardiovascular/strokeeventsandindicatorofongoing
cardiovasculardisease(aprocess).
3. NothingelsetoaddpriortodiscussiononThursday.
1.
ThanksAlice,Cheryl,andWayneforsendingyourinput!
165
PSC-HHS-000165
Yes,theconclusionswereallpulledverbatimfromtheIOMandAHA/ACCreports(forexample,theconclusionAlice
inquiredaboutisfoundonpage4oftheattachedPDF).
Icompiledyourinputintoasingledocument(Attached),andwillworkonwritingitupfortheEvidencePortfolioandfor
yourpresentationlaterthisweek.However,thereissomeinconsistencyaroundwhetherornottocarryforward
Conclusion1oftheIOMreport.TheSodiumWorkingGrouphasabreakoutsessiononThursdayfrom13pmEST,and
thisissuecanbediscussedthen.However,ifyouhavesometimetoreviewpriortothatanddiscussviaemail,wecan
captureyourdecisionsandfinalizebeforeThursday.
Thanks!
Julie
Hi Julie,
I have added my comments to those from Alice and Cheryl.
Wayne
From: Anderson, Cheryl [c1anderson@ucsd.edu]
Sent: Friday, October 31, 2014 2:10 PM
To: Obbagy, Julie - CNPP; 'Lichtenstein, Alice'; 'Clinton, Steven'; Campbell, Wayne W
Cc: Essery, Eve - CNPP
Subject: RE: DGAC: Sodium Working Group -- Na-CVD systematic review - input needed!
Hi Julie. Here is mine and Alice's.
Would you please clarify whether the IOM conclusions are taken verbatim from the report. Alice's comment re conclusion
#1 prompted me to ask this.
Thanks,
Cheryl
From: Obbagy, Julie - CNPP [Julie.Obbagy@cnpp.usda.gov]
Sent: Friday, October 31, 2014 10:46 AM
To: Obbagy, Julie - CNPP; Anderson, Cheryl; 'Lichtenstein, Alice'; 'Clinton, Steven'; 'Campbell, Wayne W'
Cc: Essery, Eve - CNPP
Subject: DGAC: Sodium Working Group -- Na-CVD systematic review - input needed!
HiAll,
JustaremindertosendanyinputyouhaveonthesodiumCVDreviewviatheKeyTrendsdocument.
Haveaniceweekend,
Julie
PSC-HHS-000166
HiSodiumWorkingGroup,
JustareminderthatyourinputonthematerialsdescribedbelowisneededtofinishthequestiononSodiumandCVD
risk.
Attachedarematerialsforyourreviewofevidenceontherelationshipbetweensodiumandcardiovasculardisease.
Belowisasummaryoftheattachedmaterials,withactionstepshighlightedinyellow.Sincethisisanupdateofthe
systematicreviewdonebytheIOMandACC/AHA,theKeyTrendsdocumentshouldbedoneconsideringthe4newly
publishedstudies,alongwiththeconclusionsfromthepreviousreviews.Thegoalistoreviewthenewresearch,and
determinewhatyourConclusionStatementandGradearebasedonthetotalityofevidence.
1. SodiumandCVDSearchPlanandResults:Thisdocumentprovidesadetaileddescriptionofthesearch
strategy(databases,searchterms)andresults(#ofarticlesscreened,listofincludedreferences,tablelistthe
articlesthatwereexcludedwithrationale).Pleasereviewandletusknowwhetheryouthinkwehavemissed
anything(searchterms,keyreferences,etc).
2. SodiumandCVDEvidencePortfolio(forthe2015update)
a. EvidenceGrid:Excelspreadsheetthatincludesalldataextractedfromtheincludedarticles
b. DescriptionofEvidence:Overviewoftheincludedarticles(e.g.,subjectcharacteristics,the
interventions/exposuresandoutcomesexaminedandmethodologyused).Theinformationprovidedis
purelydescriptiveinnature,anddoesnotcompareandcontrastthestudiesortheirresults.
c. PDFsofthearticles
3. SodiumandCVDKeyTrendsDocument:Questionsdesignedtofacilitateevidencesynthesis,and
developmentofaconclusionstatementandgrade,byidentifyingkeytrend/themesamongthestudies,
includingsimilaritiesanddifferencesinresults,andfactorsthatmayimpacttherelationshipsbeing
examined.Pleasereviewthe2015EvidencePortfolio,andIOMandAHA/CCconclusionsandprovideuswith
responsestothisdocumentASAP.
4. PDFofthesummaryoftheIOMReport(summary,letusknowifyouwantthefullreport)
5. PDFoftheAHA/ACCreport(summary,letusknowifyouwantthefullreport)
IfyoubeginreviewingtheevidenceandworkingontheKeyTrendsdocument,andhavequestions,pleaseemail.Well
beintouchsoontosetupameetingtodiscussthis,andyourotherworkrelatedtosodium.
Thankyou,
Julie
JulieE.Obbagy,PhD,RD
CenterforNutritionPolicyandPromotion
U.S.DepartmentofAgriculture
julie.obbagy@cnpp.usda.gov
7033052327
AsAmericaschildrenheadbacktoschoolthisFall,
theyllfindthatTheSchoolDayJustGotHealthier!
Clickbelowtofindouthowandwhy.
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 the
167
PSC-HHS-000167
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.
168
PSC-HHS-000168
ThatswhatIhave.Itdoesnthaveanycommentsforme.Iwillstate:TheSRSChasbeendiscussingtheprocessfor
integratingtheconclusionsandrecommendationsacrossallSubcommitteesandCrossCuttingTopicWorkandWriting
groups.IrecentlyaskedtheSCandWGchairstoreflectwiththeirteamsincludingstafftoidentifythemostsalient
themesthathaveemerged.Lookformajorandcommonthemes.Fromthese,highlevelperspectivesmyCoChair,Alice
LichtensteinandI,willprepareasummaryoftheoverallmajorandcrosscuttingthemestodiscussfurtherwiththe
DGAC.Afterthesedeliberations,wewillfinalizeouroverallconclusionsandrecommendationsinanintegratingchapter
forthefinalreport.
IwillnowcallupontheSCchairsinorderandthenourCrossCuttingWorkgroup/WritingGroupChairstototakeliterally
onlyaminuteortwotodescribethethemesacrosstheResearchQuestionstheyaddressed.
Hopethismakessense.
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
NotheyhaventaslongasyouprintedtheoneswhereIaddedthenamesandpicturesoftheSC/Wgchairsforthe
Integrationpresentation.ThatwasthelastchangeImadetoanyofthemGoingtoloadthemonthecomputernow.
Kellie
KellieO.Casavale,PhD,RD
NutritionAdvisor,DivisionofPreventionScience
CoExecutiveSecretary,2015DietaryGuidelinesAdvisoryCommittee
HHS,OfficeofDiseasePreventionandHealthPromotion
Kellie,Haveminechangedatallfromlastnight?IprintedthosealreadyandwonderifIshoulddosoagain?Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
169
PSC-HHS-000169
DGACMembers,
Thecurrentversionsofyourslidesfortodayareattached.Ifyouhavenotdonesoalready,pleaseprepareyourwork
space:
Phoneline:Dialinginthroughalandlineispreferredoveracellphoneorthroughacomputer.Aheadsetconnectedtoa
phoneprovidesthebestsoundquality.
Computer:YouwillbewatchingthroughtheNIHwebcast(thesameviewasthepublic),butdialinginthroughyour
phone.Testyourcomputerwiththelinksbelow:
Testyourbrowserusingthistestpageathttp://videocast.nih.gov/browsertest/
(Therearenolivewebcastsuntiloursthismorningifyouwereunabletotestwatchaliveeventbeforetoday.)
Jointhemeetingat9:30amET(6:30amPT)forasoundcheckandreviewofprocedures.Thelivewebcastbeginsat10
amET(7amPT).Wewilldoanalphabeticalrollcalltocheckthequalityofyourphonesoundat9:30am.
WebcastLink:videocast.nih.gov
*Turnthesoundoffofyourcomputerspeakers.Yoursoundwillcomefromyourphone.
Callin:(b) (6)
LeaderPasscode:(b) (6)
*Afterenteringthepasscode,arecordingwillpromptyoutopress*0.
Press*0fortheoperatortojoinyoutothecall.
Attachments
Agenda
IntroductiontoSubcommitteeReports(Millen)
SC1
SC2
SC3
SC4
(SC5isnotpresenting;noslides)
IntroductiontotheCrosscuttingTopicsofDietaryGuidanceandPublicHealthImportance(Millen)
SodiumWG
AddedSugarsWG
SaturatedFatWG
IntegrationofFindings(Millen,SC/WGChairs/Leads)
Pleaseletusknowifyouhaveanyquestions.Thanks!
Kellie
170
PSC-HHS-000170
AliceH.Lichtenstein,D.Sc.
GershoffProfessorofNutritionScienceandPolicy
DirectorandSeniorScientist,CardiovascularNutritionLaboratory
TuftsUniversity
JMUSDAHumanNutritionResearchCenteronAging
711WashingtonStreet
Boston,MA02111
phone:6175563127
email:Alice.Lichtenstein@Tufts.edu
From: Lichtenstein, Alice
Sent: Tuesday, November 18, 2014 5:05 PM
To: 'Anne Rodgers'; Nelson, Miriam; Millen, Barbara E (bmillen@bu.edu)
Subject: RE: cross reviews of DGAC chapters and timeline for completing report
Hit at the right time for me to review today. Very exciting to see things come together.
Mim, embedded a few questions for you.
AliceH.Lichtenstein,D.Sc.
GershoffProfessorofNutritionScienceandPolicy
DirectorandSeniorScientist,CardiovascularNutritionLaboratory
TuftsUniversity
JMUSDAHumanNutritionResearchCenteronAging
711WashingtonStreet
Boston,MA02111
phone:6175563127
email:Alice.Lichtenstein@Tufts.edu
From: Anne Rodgers (b) (6)
Sent: Tuesday, November 18, 2014 2:04 PM
To: Lichtenstein, Alice; am siegariz@unc.edu; bmillen@bu.edu; c1anderson@ucsd.edu; frank.hu@channing.harvard.edu;
jtb4@cornell.edu; lla9@georgetown.edu; mneuhous@fhcrc.org; mary.story@duke.edu; Nelson, Miriam; rafael.perezescamilla@yale.edu; sabrams@bcm.edu; steven.clinton@osumc.edu; campbellw@purdue.edu
Cc: amfiguer@email.unc.edu; Bailey, Lauren A.; Brianna.Knight@osumc.edu; jconnor@fhcrc.org; lhimes@bcm.edu;
PBROWN@hsph.harvard.edu; tc268@georgetown.edu; anjuli.bodyk@yale.edu; jgoyett@purdue.edu;
Richard.Olson@hhs.gov; colette.rihane@cnpp.usda.gov; Amber.Mosher@hhs.gov; Patricia.Britten@cnpp.usda.gov;
171
PSC-HHS-000171
DearDGACmembers,
Someweeksago,wedescribedthatalloftheScienceBasechaptersandseveralothersectionsofthereportwouldgo
throughacrossreviewprocess.EachoftheScienceBasechapterswillbereviewedbytwomembers;theothersections
willbereviewedbyallmembers.TheseothersectionsincludetheIntroduction,theIntegrationchapter,theoverall
Methodschapter,theGlossary,andNeedsforFutureResearch(acomplicationofalltheSCsresearch
recommendations).
NowthattheScienceBasechaptersarenearlycompleted,Iwantedtoremindyouaboutthecrossreviewprocessand
explainhowitwillwork.Thisprocesswilltakeplaceoverthenext3weeks.
WhenaScienceBasechapterorothersectionisready,IwillsendittothereviewersandtoBarbaraand
Alice.Whenyoureview,pleasefocusonlyonsubstantiveissues(e.g.,majoromissionsordifferenceswithother
chapters),notoneditorialissues.Theattachedguidanceprovidessomethingsyoumaywanttoconsiderasyou
review.Pleaseusethetrackchangesfunctionandmarginalnotesforyourcomments.
Reviewerswillreturnthesectiontome,andIwillsenditbacktotheSCandstaffforrevisions.
Whenyouhavecompletedyourreview,pleasereturnthedraftwithyourcommentstomeandKellie.Iwill
transmityourcommentstoBarbara,Alice,pertinentmembersandstaff,andtheotherreviewer.
Hereisatablethatsummarizesthereviewersandprojectedtimelineforcrossreviews.
SCIENCEBASECHAPTERS
Reviewers
Subcommittee1
Subcommittee2
Subcommittee3
Subcommittee4
AnnaMaria,Wayne
SteveA,Mim
Mary,Frank
Tom,SteveC
Subcommittee5
PhysicalActivity
CrosscuttingTopics(sodium,
addedsugars,lowcalorie
sweeteners,saturatedfat)
OTHERSECTIONS
Section
Marian,Rafael
Cheryl,Lucile
Rafael,SteveA
ExecutiveSummary
ReportIntroduction
Integrationchapter
ResearchRecommendations
AllDGACmembers
AllDGACmembers
AllDGACmembers
AllDGACmembers
Methods
Marian,AnnaMaria,
Wayne
Reviewers
Projecteddateyouwill
receivedraft
Monday11/24
Friday11/21
Wednesday11/19
Friday11/21(allbut
worksites);Worksites
willbesentMonday
12/1)
Tuesday11/25
Monday11/17
TBD
Draftduebackto
AnneandKellie
Tuesday12/1
Wednesday12/3
Tuesday11/25
Monday12/1(allbut
worksites);Worksites
due12/2
Dateyouwillreceive
draft
TBD
TBD
TBD
TBD(discussedbySRSC
11/21)
Thursday11/21
Draftduebackto
AnneandKellie
Tuesday12/2
Monday11/24
Tuesday12/2
172
PSC-HHS-000172
Allofthereportssections(FrontMatter;Introduction,Integration;Methods,ScienceBasechapters;
Appendices)mustbefinalized(meaningthatreviewerscommentsareincorporatedandfinaleditscompleted)
byFriday,December5.AtthattimethereportwillbecompiledandsenttoyoubyTuesday,December9.This
willallowyouseveraldaystoreviewthereportinpreparationforthefinalDGACmeetingonMonday,
December15.
Werecognizetheverytightdeadlinesandthatyouhavemanyotherdemandsonyourtime.Weverymuchappreciate
allthatyouaredoingtocompletetheDGACreportontime.Ifthereareanydetailsofyouravailabilityorapproaches
mostconvenientforyouforcrossreview,pleasefeelfreetosharethosedetailswithmeandKelliesothatwecantake
themintoconsiderationtomaketheprocessassmoothaspossibleforyou.
Thanks,
Anne
AnneBrownRodgers
ScienceWriter
(b) (6)
173
PSC-HHS-000173
You should have been copied on this and the string of e-mails. Sorry, I am very behind, got slide
lined yesterday afternoon unexpectedly.
Mike should have gone through different channels to submit his comments.
AliceH.Lichtenstein,D.Sc.
GershoffProfessorofNutritionScienceandPolicy
DirectorandSeniorScientist,CardiovascularNutritionLaboratory
TuftsUniversity
JMUSDAHumanNutritionResearchCenteronAging
711WashingtonStreet
Boston,MA02111
phone:6175563127
email:Alice.Lichtenstein@Tufts.edu
From: Mike Jacobson [mailto:mjacobson@cspinet.org]
Sent: Wednesday, November 19, 2014 10:10 PM
To: Frank Hu
Cc: Lichtenstein, Alice; Anna Maria Siega-Riz; Mary Story; Nelson, Miriam
Subject: Re: CSPI Urges Dietary Guidelines Committee to Recommend Pregnant Women Avoid Caffeine, Coffee
Frank,
Thanks for considering our concerns.
I'm glad to learn that you reviewed those studies. I certainly wouldn't argue that the case-control and cohort studies (and
meta-analyses that include them) can provide definitive evidence. They have inherent limitations, especially for identifying
relatively rare events. But I don't know that sensitive, accurate studies will ever be conducted, so what should women do
in the meantime?
In cases such as this where there's moderate evidence that higher dosages (>200 or 300 mg/d) pose a risk and there's no
evidence for a threshold, I think that the committee should adopt a precautionary stance. The committee could do what
toxicologists do all the time and recommend that, in light of the uncertainty, a safety factor should be applied...and
recommend that women who are (or are trying to become) pregnant "should avoid caffeine-containing foods and drugs, if
possible, or consume them only sparingly," as the FDA wrote about 30 years ago. Why risk such serious outcomes as
miscarriages and stillbirths (and possibly childhood leukemia)? Caffeine and the beverages that contain it are totally
unnecessary in a diet and have caffeine-free counterparts.
Best wishes,
Mike
174
PSC-HHS-000174
Frank Hu <nhbfh@channing.harvard.edu>
11/19/2014 06:20 PM
insufficient evidence to support further reductions in the maximum recommended intake of caffeine, but
maintenance of current recommendations is a wise precaution."
Based on the data from this and other meta-analyses, our conclusion is pretty cautious:
"Overall, the evidence provides support for current recommendations to limit caffeine intake during pregnancy
as a precaution. Based on existing evidence, pregnant women, or women planning to become pregnant, should
be cautious and adhere to current recommendations of the American Congress of Obstetricians and
Gynecologists regarding caffeine consumption, and not consume more than 200 mg caffeine per day."
Of note, 200 m/d includes non-coffee sources of caffeine, which is not trivial.
175
PSC-HHS-000175
I'm concerned about the methodology of the acute leukemia meta-analysis because it was based on several small
case-control studies, in which the association could be easily be explained by recall bias. In earlier case-control
studies of coffee and heart disease or some cancers, recall bias and confounding by smoking were major
problems because subsequent cohort studies did not substantiated these associations.
Frank
Meta-analyses included 60 unique publications from 53 cohort and casecontrol studies. An increment of 100 g caffeine
was associated with a 14 % (95 % CI 1019 %) increase in risk of spontaneous abortion, 19 % (535 %) stillbirth, 2 % (-2
to 6 %) preterm delivery, 7 % (112 %) low birth weight, and 10 % (95 % CI 614 %) SGA. There was substantial
heterogeneity in all models, partly explained by adjustment for smoking and previous obstetric history, but not by
prospective assessment of caffeine intake. There was evidence of small-study effects such as publication bias. Greater
caffeine intake is associated with an increase in spontaneous abortion, stillbirth, low birth weight, and SGA, but not
preterm delivery. There is no identifiable threshold below which the associations are not apparent, but the size of the
associations are generally modest within the range of usual intake and are potentially explained by bias in study design or
publication. There is therefore insufficient evidence to support further reductions in the maximum recommended
intake of caffeine, but maintenance of current recommendations is a wise precaution.
On Wed, Nov 19, 2014 at 1:05 PM, Mike Jacobson <mjacobson@cspinet.org> wrote:
Dear Frank, Mary, Mim, Alice, and Anna Maria,
CSPI submitted this additional comment to the DGAC, but I wanted to make sure you saw it. I think
that the subcommittee's review of the possible risks of caffeine in pregnancy misread the scientific
research and deferred excessively to ACOG's opinion.
Thanks for reading this comment.
Best,
Mike
PSC-HHS-000176
a transmission received in error is strictly prohibited. If you have received this transmission in error, please
immediately notify me at (202) 777-8328.
PSC-HHS-000177
The Center for Science in the Public Interest is a nonprofit health advocacy group based in Washington, DC,
that focuses on nutrition and food safety policies. CSPI is supported by the 900,000 U.S. and Canadian
subscribers to its Nutrition Action Healthletter and by foundation grants.
Like us on Facebook at http://www.facebook.com/cspinet
Follow us on Twitter at http://twitter.com/cspi
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
To unsubscribe from CSPI news releases, reply to this
178
PSC-HHS-000178
-*******************************************************
Frank B. Hu, MD, PhD
Professor of Nutrition and Epidemiology
Harvard School of Public Health
Professor of Medicine
Harvard Medical School
665 Huntington ave, Boston, MA 02115
tel: 617 432 0113 fax: 617 432 2435
<http://www.hsph.harvard.edu/faculty/frank-hu/>
http://www.hsph.harvard.edu/faculty/frank-hu/
******************************************************
179
PSC-HHS-000179
more
AliceH.Lichtenstein,D.Sc.
GershoffProfessorofNutritionScienceandPolicy
DirectorandSeniorScientist,CardiovascularNutritionLaboratory
TuftsUniversity
JMUSDAHumanNutritionResearchCenteronAging
711WashingtonStreet
Boston,MA02111
phone:6175563127
email:Alice.Lichtenstein@Tufts.edu
From: Frank Hu [mailto:nhbfh@channing.harvard.edu]
Sent: Thursday, November 20, 2014 7:31 AM
To: Mike Jacobson
Cc: Lichtenstein, Alice; Anna Maria Siega-Riz; Mary Story; Nelson, Miriam
Subject: CSPI Urges Dietary Guidelines Committee to Recommend Pregnant Women Avoid Caffeine, Coffee
Mike,
We will discuss your comments in the next conference call. A few further points:
1. I agree that our recommendations need to be cautious, but they should not be overly restrictive without good
data. Besides coffee, tea and chocolate are important sources of caffeine. There is no evidence to exclude these
items from the diets during pregnancy.
2. When it comes to coffee/caffeine, the study design (case-control vs. prospective cohort) does make a big
difference. Many case-control studies in the 1980's and 1990's showed a strong and significant association
between coffee and MI. It is for sure this association was mainly driven by recall bias and confounding by
smoking as numerous prospective studies have now demonstrated that higher coffee consumption is actually
protective against diabetes, CVD, and other outcomes.
3. The only RCT conducted in Denmark showed no effects of caffeine reduction during pregnancy on birth
weight and length of gestation.
BMJ. 2007 Feb 24;334(7590):409. Epub 2007 Jan 26.
PSC-HHS-000180
On Wed, Nov 19, 2014 at 10:10 PM, Mike Jacobson <mjacobson@cspinet.org> wrote:
Frank,
Thanks for considering our concerns.
I'm glad to learn that you reviewed those studies. I certainly wouldn't argue that the case-control and
cohort studies (and meta-analyses that include them) can provide definitive evidence. They have
inherent limitations, especially for identifying relatively rare events. But I don't know that sensitive,
accurate studies will ever be conducted, so what should women do in the meantime?
In cases such as this where there's moderate evidence that higher dosages (>200 or 300 mg/d) pose
a risk and there's no evidence for a threshold, I think that the committee should adopt a precautionary
stance. The committee could do what toxicologists do all the time and recommend that, in light of the
uncertainty, a safety factor should be applied...and recommend that women who are (or are trying to
become) pregnant "should avoid caffeine-containing foods and drugs, if possible, or consume them
only sparingly," as the FDA wrote about 30 years ago. Why risk such serious outcomes as
miscarriages and stillbirths (and possibly childhood leukemia)? Caffeine and the beverages that
contain it are totally unnecessary in a diet and have caffeine-free counterparts.
Best wishes,
Mike
Michael F. Jacobson, Ph.D.
Executive Director
Center for Science in the Public Interest
1220 L Street, NW, Suite 300
Washington, DC 20005
(o) 202-777-8328
(f) 202-265-4954
CSPI web site: www.cspinet.org
Make your voice heard on important health and nutrition issues! Join CSPI's online action network at
http://my.cspinet.org
CONFIDENTIALITY NOTICE: This message is intended only for the use of the individual or entity to which it
is addressed and may contain confidential information. If the reader of this message is not the intended
recipient, please be aware that any dissemination, distribution, or copying of this communication or other use of
a transmission received in error is strictly prohibited. If you have received this transmission in error, please
immediately notify me at (202) 777-8328.
Frank Hu <nhbfh@channing.harvard.edu>
181
PSC-HHS-000181
11/19/2014 06:20 PM
On Wed, Nov 19, 2014 at 1:05 PM, Mike Jacobson <mjacobson@cspinet.org> wrote:
182
PSC-HHS-000182
183
PSC-HHS-000183
PSC-HHS-000184
substances that have drug-like effects and can cross the placenta, the agency wrote in a 1981
brochure.
CSPIs comments also call on the DGAC to consider the risk of childhood leukemia related to drinking
coffee during pregnancy. A 2014 meta-analysis published in the American Journal of Obstetrics and
Gynecology found a dose-related increased risk of childhood acute leukemia associated with
maternal coffee consumption. In comments to the DGAC, epidemiologist Peter Infante called the
evidence linking maternal coffee consumption during pregnancy and childhood acute leukemia
strong. In the U.S., lifetime probability of childhood acute leukemia in children aged 0 to 14 is
approximately 73 per 100,000. According to a risk analysis submitted to the DGAC by biostatistician
Steven Bayard, 19 of those cases might be attributable to coffee consumption of one to two cups per
day during pregnancy.
The Dietary Guidelines Advisory Committee meets next on December 15.
###
View this release online.
The Center for Science in the Public Interest is a nonprofit health advocacy group based in Washington, DC,
that focuses on nutrition and food safety policies. CSPI is supported by the 900,000 U.S. and Canadian
subscribers to its Nutrition Action Healthletter and by foundation grants.
Like us on Facebook at http://www.facebook.com/cspinet
Follow us on Twitter at http://twitter.com/cspi
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
To unsubscribe from CSPI news releases, reply to this
message with the word 'unsubscribe' in the subject line.
Click here to edit your preferences.
Communications Department
Center for Science in the Public Interest
1220 L St., NW Suite 300
Washington, DC 20005
(202) 332-9110
cspinews@cspinet.org
-*******************************************************
Frank B. Hu, MD, PhD
Professor of Nutrition and Epidemiology
Harvard School of Public Health
Professor of Medicine
Harvard Medical School
665 Huntington ave, Boston, MA 02115
185
PSC-HHS-000185
-*******************************************************
Frank B. Hu, MD, PhD
Professor of Nutrition and Epidemiology
Harvard School of Public Health
Professor of Medicine
Harvard Medical School
665 Huntington ave, Boston, MA 02115
tel: 617 432 0113 fax: 617 432 2435
<http://www.hsph.harvard.edu/faculty/frank-hu/>
http://www.hsph.harvard.edu/faculty/frank-hu/
******************************************************
-*******************************************************
Frank B. Hu, MD, PhD
Professor of Nutrition and Epidemiology
Harvard School of Public Health
Professor of Medicine
Harvard Medical School
665 Huntington ave, Boston, MA 02115
tel: 617 432 0113 fax: 617 432 2435
<http://www.hsph.harvard.edu/faculty/frank-hu/>
http://www.hsph.harvard.edu/faculty/frank-hu/
******************************************************
186
PSC-HHS-000186
Commented extensively. In some cases playing the devils advocate. This is our last time to think
about certain issues.
We need to give some thought to redundancy through the whole document. Perhaps general
recommendations that are repeated in multiple chapters and sections within chapters can be moved
to the integration chapter. Otherwise, there seems to be a considerable amount of repetition that can
dilute the message.
Having said that it is my personal impression, I understand if others dont agree. Including Barbara
on this response because I have invoked the integration word.
AliceH.Lichtenstein,D.Sc.
GershoffProfessorofNutritionScienceandPolicy
DirectorandSeniorScientist,CardiovascularNutritionLaboratory
TuftsUniversity
JMUSDAHumanNutritionResearchCenteronAging
711WashingtonStreet
Boston,MA02111
phone:6175563127
email:Alice.Lichtenstein@Tufts.edu
From: Essery, Eve - CNPP [mailto:Eve.Essery@fns.usda.gov]
Sent: Sunday, November 23, 2014 8:28 AM
To: Lichtenstein, Alice; Campbell, Wayne W; Clinton, Steven
Cc: Casavale, Kellie (OS/OASH); Obbagy, Julie - CNPP
Subject: FW: DGAC: For review - Sodium chapter content
Ijustrenamedtheemailsubjectsothateveryoneseesthisisdraftchaptercontentreadyforreview.Seeemailbelow
andtheattachmentThanks!
HiCherylandSodiumWorkingGroup,
Actually,pleaseusetheversionattachedtomakecomments.Thisversionhasallformattingchangesaccepted,andIve
acceptedtheadditionofthemajorsections(e.g.,IntroductionandReviewofEvidencesections)justsothattheyare
187
PSC-HHS-000187
easiertoread.Ikeptalltrackedchangestotheconclusionsandimplications,sincethesesectionshavebeendiscussed
bythegrouppreviously.
WorkingGroupPleasereviewandprovidecommentsonthisdocumentbyendofdayonMonday,Nov24.Please
reviewthedocumentinfull,sincemuchofthecontentisnew,butplaceparticularemphasisontheconclusionsand
implications.PleasealsoreviewtheNeedsforFutureResearchattheendofthedocument,sincethesehavenotbeen
discussedbythegroup.
Thanks!!!
Eve
Dear SWG: Here is a clean version and a marked up version of the sodium chapter.
Eve: Please let everyone know which one they should mark-up.
All: I have two questions embedded. Both are related to whether we need a conclusion statement about articles
published since Jan 2013? One article is in the blood pressure section, the others are in the CVD section.
Best,
Cheryl
From: Essery, Eve - CNPP [Eve.Essery@fns.usda.gov]
Sent: Tuesday, November 18, 2014 8:32 AM
To: Anderson, Cheryl; 'alice.lichtenstein@tufts.edu'; 'Campbell, Wayne W'; 'steven.clinton@osumc.edu'
Cc: Casavale, Kellie (OS/OASH); Obbagy, Julie - CNPP
Subject: DGAC: Cheryl - Sodium chapter content
Hi Cheryl,
As promised, Julie has provided a summary from your NEL evidence portfolio for the (1) sodium and BP in children and
(2) sodium and CVD questions. I have dropped these pieces into the chapter section attached. (This is the same
document I sent you on Saturday. If you have started working on other sections, Im happy to combine the documents.)
Can you please reply with your estimated date for completion of the draft of this section? It will need to go through
Working Group review before it can be placed into the Cross-Cutting chapter for editing and cross-review. Can you give
me a sense for your timeline so that we can plan accordingly?
Thank you!
Eve
Hi Cheryl,
As lead of the Sodium Working Group, as well as the three questions within this section, attached is the chapter template
for the sodium section of the Cross-Cutting chapter. Ive included the content you presented at the public meeting and
provided comments highlighting areas for you to draft content. Once drafted, the content will go through Working Group
review and then be placed into the larger Cross-Cutting chapter with added sugars and saturated fat. In addition to what
you see here, staff will draft the Methodology section of this chapter describing your approach to answering the individual
188
PSC-HHS-000188
questions. As you know, we are now working on a tight timeline. Can you provide the draft content by Thursday, Nov 20
for Working Group review? If that is not possible, please let me know what is so that I can follow-up with Anne on the
timeline for this section.
Please let me know if you need anything or if you have any questions.
Thank you,
Eve
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 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.
189
PSC-HHS-000189
AliceH.Lichtenstein,D.Sc.
GershoffProfessorofNutritionScienceandPolicy
DirectorandSeniorScientist,CardiovascularNutritionLaboratory
TuftsUniversity
JMUSDAHumanNutritionResearchCenteronAging
711WashingtonStreet
Boston,MA02111
phone:6175563127
email:Alice.Lichtenstein@Tufts.edu
From: Essery, Eve - CNPP [mailto:Eve.Essery@fns.usda.gov]
Sent: Monday, November 24, 2014 2:15 PM
To: Lichtenstein, Alice; Campbell, Wayne W; Clinton, Steven; Anderson, Cheryl
Cc: Casavale, Kellie (OS/OASH); Obbagy, Julie - CNPP; Millen, Barbara E (bmillen@bu.edu)
Subject: DGAC: Alice - Sodium
HiAlice,
WedidnotreceivetheattachmentwithyourcommentstothesodiumsectionthatyouemailedonSunday.Canyou
resendthem?Thankyou!
Eve
Commented extensively. In some cases playing the devils advocate. This is our last time to think
about certain issues.
We need to give some thought to redundancy through the whole document. Perhaps general
recommendations that are repeated in multiple chapters and sections within chapters can be moved
to the integration chapter. Otherwise, there seems to be a considerable amount of repetition that can
dilute the message.
Having said that it is my personal impression, I understand if others dont agree. Including Barbara
on this response because I have invoked the integration word.
190
PSC-HHS-000190
AliceH.Lichtenstein,D.Sc.
GershoffProfessorofNutritionScienceandPolicy
DirectorandSeniorScientist,CardiovascularNutritionLaboratory
TuftsUniversity
JMUSDAHumanNutritionResearchCenteronAging
711WashingtonStreet
Boston,MA02111
phone:6175563127
email:Alice.Lichtenstein@Tufts.edu
From: Essery, Eve - CNPP [mailto:Eve.Essery@fns.usda.gov]
Sent: Sunday, November 23, 2014 8:28 AM
To: Lichtenstein, Alice; Campbell, Wayne W; Clinton, Steven
Cc: Casavale, Kellie (OS/OASH); Obbagy, Julie - CNPP
Subject: FW: DGAC: For review - Sodium chapter content
Ijustrenamedtheemailsubjectsothateveryoneseesthisisdraftchaptercontentreadyforreview.Seeemailbelow
andtheattachmentThanks!
HiCherylandSodiumWorkingGroup,
Actually,pleaseusetheversionattachedtomakecomments.Thisversionhasallformattingchangesaccepted,andIve
acceptedtheadditionofthemajorsections(e.g.,IntroductionandReviewofEvidencesections)justsothattheyare
easiertoread.Ikeptalltrackedchangestotheconclusionsandimplications,sincethesesectionshavebeendiscussed
bythegrouppreviously.
WorkingGroupPleasereviewandprovidecommentsonthisdocumentbyendofdayonMonday,Nov24.Please
reviewthedocumentinfull,sincemuchofthecontentisnew,butplaceparticularemphasisontheconclusionsand
implications.PleasealsoreviewtheNeedsforFutureResearchattheendofthedocument,sincethesehavenotbeen
discussedbythegroup.
Thanks!!!
Eve
Dear SWG: Here is a clean version and a marked up version of the sodium chapter.
Eve: Please let everyone know which one they should mark-up.
191
PSC-HHS-000191
All: I have two questions embedded. Both are related to whether we need a conclusion statement about articles
published since Jan 2013? One article is in the blood pressure section, the others are in the CVD section.
Best,
Cheryl
From: Essery, Eve - CNPP [Eve.Essery@fns.usda.gov]
Sent: Tuesday, November 18, 2014 8:32 AM
To: Anderson, Cheryl; 'alice.lichtenstein@tufts.edu'; 'Campbell, Wayne W'; 'steven.clinton@osumc.edu'
Cc: Casavale, Kellie (OS/OASH); Obbagy, Julie - CNPP
Subject: DGAC: Cheryl - Sodium chapter content
Hi Cheryl,
As promised, Julie has provided a summary from your NEL evidence portfolio for the (1) sodium and BP in children and
(2) sodium and CVD questions. I have dropped these pieces into the chapter section attached. (This is the same
document I sent you on Saturday. If you have started working on other sections, Im happy to combine the documents.)
Can you please reply with your estimated date for completion of the draft of this section? It will need to go through
Working Group review before it can be placed into the Cross-Cutting chapter for editing and cross-review. Can you give
me a sense for your timeline so that we can plan accordingly?
Thank you!
Eve
Hi Cheryl,
As lead of the Sodium Working Group, as well as the three questions within this section, attached is the chapter template
for the sodium section of the Cross-Cutting chapter. Ive included the content you presented at the public meeting and
provided comments highlighting areas for you to draft content. Once drafted, the content will go through Working Group
review and then be placed into the larger Cross-Cutting chapter with added sugars and saturated fat. In addition to what
you see here, staff will draft the Methodology section of this chapter describing your approach to answering the individual
questions. As you know, we are now working on a tight timeline. Can you provide the draft content by Thursday, Nov 20
for Working Group review? If that is not possible, please let me know what is so that I can follow-up with Anne on the
timeline for this section.
Please let me know if you need anything or if you have any questions.
Thank you,
Eve
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 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.
192
PSC-HHS-000192
AliceH.Lichtenstein,D.Sc.
GershoffProfessorofNutritionScienceandPolicy
DirectorandSeniorScientist,CardiovascularNutritionLaboratory
TuftsUniversity
JMUSDAHumanNutritionResearchCenteronAging
711WashingtonStreet
Boston,MA02111
phone:6175563127
email:Alice.Lichtenstein@Tufts.edu
From: Clinton, Steven [mailto:Steven.Clinton@osumc.edu]
Sent: Monday, November 24, 2014 8:11 AM
To: 'Anderson, Cheryl'; Essery, Eve - CNPP
Cc: Lichtenstein, Alice; Wayne W Campbell; Barbara E Millen; Kellie Casavale; Obbagy, Julie - CNPP
Subject: RE: DGAC: For review - Sodium chapter content
Herearemycomments,wanttobeveryspecificandclear,alsoIfavorstrongerstatementabouttheneedfordefinitive
studies.
ConsideringthebillionsspentonDRUGstudies,andevenmoreonHEALTHCARE,weshouldbeabletodoafewgood
studies!
GreattohaveAlice'sinput(evenifplayingdevil'sadvocate).Itwillmakethesectionstrongerthenextdraftwill
hopefullybeeasier.
Cheryl
OnNov23,2014,at8:46AM,"Essery,EveCNPP"<Eve.Essery@fns.usda.gov>wrote:
JustincludingCherylonthisemailstringaswell.(Cheryl,Alice,&WayneSorryIjustsentyouablank
email.Ihit"send"onmyphonebyaccident.)Alicethxforyourquickreview!
193
PSC-HHS-000193
SentfrommyiPhone
Beginforwardedmessage:
From:"Essery,EveCNPP"<Eve.Essery@fns.usda.gov>
Date:November23,2014at10:43:34AMCST
To:"Alice.Lichtenstein@tufts.edu"<Alice.Lichtenstein@tufts.edu>,CherylAnderson
<c1anderson@ucsd.edu>,WayneWCampbell<campbeww@purdue.edu>
Subject:Fwd:DGAC:ForreviewSodiumchaptercontent
SentfrommyiPhone
Beginforwardedmessage:
From:"Lichtenstein,Alice"<Alice.Lichtenstein@tufts.edu>
Date:November23,2014at9:51:24AMCST
To:"Essery,EveCNPP"<Eve.Essery@fns.usda.gov>,"Campbell,Wayne
W"<campbeww@purdue.edu>,"Clinton,Steven"
<Steven.Clinton@osumc.edu>
Cc:"Casavale,Kellie(OS/OASH)"<Kellie.Casavale@hhs.gov>,"Obbagy,
JulieCNPP"<Julie.Obbagy@cnpp.usda.gov>,"Millen,BarbaraE
(bmillen@bu.edu)"<bmillen@bu.edu>
Subject:RE:DGAC:ForreviewSodiumchaptercontent
AliceH.Lichtenstein,D.Sc.
GershoffProfessorofNutritionScienceandPolicy
DirectorandSeniorScientist,CardiovascularNutritionLaboratory
TuftsUniversity
JMUSDAHumanNutritionResearchCenteronAging
711WashingtonStreet
Boston,MA02111
phone:6175563127
email:Alice.Lichtenstein@Tufts.edu
194
PSC-HHS-000194
From: Essery, Eve - CNPP [mailto:Eve.Essery@fns.usda.gov]
Sent: Sunday, November 23, 2014 8:28 AM
To: Lichtenstein, Alice; Campbell, Wayne W; Clinton, Steven
Cc: Casavale, Kellie (OS/OASH); Obbagy, Julie - CNPP
Subject: FW: DGAC: For review - Sodium chapter content
Ijustrenamedtheemailsubjectsothateveryoneseesthisisdraft
chaptercontentreadyforreview.Seeemailbelowandthe
attachmentThanks!
HiCherylandSodiumWorkingGroup,
Actually,pleaseusetheversionattachedtomakecomments.This
versionhasallformattingchangesaccepted,andIveacceptedthe
additionofthemajorsections(e.g.,IntroductionandReviewof
Evidencesections)justsothattheyareeasiertoread.Ikeptalltracked
changestotheconclusionsandimplications,sincethesesectionshave
beendiscussedbythegrouppreviously.
WorkingGroupPleasereviewandprovidecommentsonthis
documentbyendofdayonMonday,Nov24.Pleasereviewthe
documentinfull,sincemuchofthecontentisnew,butplaceparticular
emphasisontheconclusionsandimplications.Pleasealsoreviewthe
NeedsforFutureResearchattheendofthedocument,sincethesehave
notbeendiscussedbythegroup.
Thanks!!!
Eve
PSC-HHS-000195
Best,
Cheryl
From: Essery, Eve - CNPP [Eve.Essery@fns.usda.gov]
Sent: Tuesday, November 18, 2014 8:32 AM
To: Anderson, Cheryl; 'alice.lichtenstein@tufts.edu'; 'Campbell, Wayne
W'; 'steven.clinton@osumc.edu'
Cc: Casavale, Kellie (OS/OASH); Obbagy, Julie - CNPP
Subject: DGAC: Cheryl - Sodium chapter content
Hi Cheryl,
As promised, Julie has provided a summary from your NEL evidence
portfolio for the (1) sodium and BP in children and (2) sodium and CVD
questions. I have dropped these pieces into the chapter section
attached. (This is the same document I sent you on Saturday. If you
have started working on other sections, Im happy to combine the
documents.)
Can you please reply with your estimated date for completion of the draft
of this section? It will need to go through Working Group review before it
can be placed into the Cross-Cutting chapter for editing and crossreview. Can you give me a sense for your timeline so that we can plan
accordingly?
Thank you!
Eve
Hi Cheryl,
As lead of the Sodium Working Group, as well as the three questions
within this section, attached is the chapter template for the sodium
section of the Cross-Cutting chapter. Ive included the content you
presented at the public meeting and provided comments highlighting
areas for you to draft content. Once drafted, the content will go through
Working Group review and then be placed into the larger Cross-Cutting
chapter with added sugars and saturated fat. In addition to what you see
here, staff will draft the Methodology section of this chapter describing
your approach to answering the individual questions. As you know, we
are now working on a tight timeline. Can you provide the draft content by
Thursday, Nov 20 for Working Group review? If that is not possible,
please let me know what is so that I can follow-up with Anne on the
timeline for this section.
Please let me know if you need anything or if you have any questions.
Thank you,
Eve
196
PSC-HHS-000196
197
PSC-HHS-000197
Sorry, do not remember discussing. Clearly, it did not gain traction from the 2010 report. It is
technically impossible. Wouldnt we be better offer recommending changes we know are feasible? I
think it is bad idea to recommend for this report.
AliceH.Lichtenstein,D.Sc.
GershoffProfessorofNutritionScienceandPolicy
DirectorandSeniorScientist,CardiovascularNutritionLaboratory
TuftsUniversity
JMUSDAHumanNutritionResearchCenteronAging
711WashingtonStreet
Boston,MA02111
phone:6175563127
email:Alice.Lichtenstein@Tufts.edu
From: Anderson, Cheryl [mailto:c1anderson@ucsd.edu]
Sent: Wednesday, November 26, 2014 9:10 AM
To: Lichtenstein, Alice
Cc: Essery, Eve - CNPP
Subject: Re: DGAC: Cheryl - Sodium is ready for round 2
Goodmorning.Yes,itis.Itisacarryforwardfromthe2010IOMreport.
OnNov26,2014,at3:58AM,"Lichtenstein,Alice"<Alice.Lichtenstein@tufts.edu>wrote:
AliceH.Lichtenstein,D.Sc.
GershoffProfessorofNutritionScienceandPolicy
DirectorandSeniorScientist,CardiovascularNutritionLaboratory
TuftsUniversity
JMUSDAHumanNutritionResearchCenteronAging
711WashingtonStreet
Boston,MA02111
phone:6175563127
email:Alice.Lichtenstein@Tufts.edu
PSC-HHS-000198
To: Essery, Eve - CNPP; Campbell, Wayne W; Lichtenstein, Alice; Clinton, Steven
Cc: Barbara E Millen; Kellie Casavale; Obbagy, Julie - CNPP
Subject: RE: DGAC: Cheryl - Sodium is ready for round 2
Thanks everyone for your edits. I just took a quick look and it seems that Alice has a significant concern
which would delay our being able to send this forward. I was under the impression that, before the 6th
meeting, the working group agreed with the approach described. Since that is not the case, I will call Eve
to discuss how best to proceed. I have to drive all day tomorrow, but will call Eve on the drive for
advice/instructions, then revise the text tomorrow night (PST).
Best,
Cheryl
From: Essery, Eve - CNPP [Eve.Essery@fns.usda.gov]
Sent: Tuesday, November 25, 2014 10:26 AM
To: Campbell, Wayne W; Lichtenstein, Alice; Clinton, Steven; Anderson, Cheryl
Cc: Barbara E Millen; Kellie Casavale; Obbagy, Julie - CNPP
Subject: DGAC: Cheryl - Sodium is ready for round 2
HiCheryl,
AttachedisthelatestsodiumsectionwithallcommentscombinedfromAlice(bothsetsofher
comments),Steve,andWayne.Whendoyouthinkyoucanhaveanupdatedversionofthesection
ready?
Thanks!
EveandJulie
Here is my 2 cents-worth.
Wayne
From: Lichtenstein, Alice [Alice.Lichtenstein@tufts.edu]
Sent: Tuesday, November 25, 2014 7:33 AM
To: Clinton, Steven; 'Anderson, Cheryl'; Essery, Eve - CNPP
Cc: Campbell, Wayne W; Barbara E Millen; Kellie Casavale; Obbagy, Julie - CNPP
Subject: RE: DGAC: For review - Sodium chapter content
AliceH.Lichtenstein,D.Sc.
GershoffProfessorofNutritionScienceandPolicy
DirectorandSeniorScientist,CardiovascularNutritionLaboratory
TuftsUniversity
JMUSDAHumanNutritionResearchCenteronAging
711WashingtonStreet
Boston,MA02111
phone:6175563127
199
PSC-HHS-000199
email:Alice.Lichtenstein@Tufts.edu
Herearemycomments,wanttobeveryspecificandclear,alsoIfavorstrongerstatementaboutthe
needfordefinitivestudies.
ConsideringthebillionsspentonDRUGstudies,andevenmoreonHEALTHCARE,weshouldbeableto
doafewgoodstudies!
GreattohaveAlice'sinput(evenifplayingdevil'sadvocate).Itwillmakethesectionstrongerthenext
draftwillhopefullybeeasier.
Cheryl
OnNov23,2014,at8:46AM,"Essery,EveCNPP"<Eve.Essery@fns.usda.gov>wrote:
JustincludingCherylonthisemailstringaswell.(Cheryl,Alice,&WayneSorryIjust
sentyouablankemail.Ihit"send"onmyphonebyaccident.)Alicethxforyourquick
review!
SentfrommyiPhone
Beginforwardedmessage:
From:"Essery,EveCNPP"<Eve.Essery@fns.usda.gov>
Date:November23,2014at10:43:34AMCST
To:"Alice.Lichtenstein@tufts.edu"<Alice.Lichtenstein@tufts.edu>,
CherylAnderson<c1anderson@ucsd.edu>,WayneWCampbell
<campbeww@purdue.edu>
Subject:Fwd:DGAC:ForreviewSodiumchaptercontent
SentfrommyiPhone
Beginforwardedmessage:
From:"Lichtenstein,Alice"
<Alice.Lichtenstein@tufts.edu>
Date:November23,2014at9:51:24AMCST
To:"Essery,EveCNPP"<Eve.Essery@fns.usda.gov>,
"Campbell,WayneW"<campbeww@purdue.edu>,
200
PSC-HHS-000200
"Clinton,Steven"<Steven.Clinton@osumc.edu>
Cc:"Casavale,Kellie(OS/OASH)"
<Kellie.Casavale@hhs.gov>,"Obbagy,JulieCNPP"
<Julie.Obbagy@cnpp.usda.gov>,"Millen,BarbaraE
(bmillen@bu.edu)"<bmillen@bu.edu>
Subject:RE:DGAC:ForreviewSodiumchapter
content
AliceH.Lichtenstein,D.Sc.
GershoffProfessorofNutritionScienceandPolicy
DirectorandSeniorScientist,CardiovascularNutrition
Laboratory
TuftsUniversity
JMUSDAHumanNutritionResearchCenteronAging
711WashingtonStreet
Boston,MA02111
phone:6175563127
email:Alice.Lichtenstein@Tufts.edu
Ijustrenamedtheemailsubjectsothateveryonesees
thisisdraftchaptercontentreadyforreview.Seeemail
belowandtheattachmentThanks!
201
PSC-HHS-000201
HiCherylandSodiumWorkingGroup,
Actually,pleaseusetheversionattachedtomake
comments.Thisversionhasallformattingchanges
accepted,andIveacceptedtheadditionofthemajor
sections(e.g.,IntroductionandReviewofEvidence
sections)justsothattheyareeasiertoread.Ikeptall
trackedchangestotheconclusionsandimplications,
sincethesesectionshavebeendiscussedbythegroup
previously.
WorkingGroupPleasereviewandprovidecomments
onthisdocumentbyendofdayonMonday,Nov24.
Pleasereviewthedocumentinfull,sincemuchofthe
contentisnew,butplaceparticularemphasisonthe
conclusionsandimplications.Pleasealsoreviewthe
NeedsforFutureResearchattheendofthedocument,
sincethesehavenotbeendiscussedbythegroup.
Thanks!!!
Eve
PSC-HHS-000202
Hi Cheryl,
As lead of the Sodium Working Group, as well as the
three questions within this section, attached is the
chapter template for the sodium section of the CrossCutting chapter. Ive included the content you presented
at the public meeting and provided comments
highlighting areas for you to draft content. Once drafted,
the content will go through Working Group review and
then be placed into the larger Cross-Cutting chapter with
added sugars and saturated fat. In addition to what you
see here, staff will draft the Methodology section of this
chapter describing your approach to answering the
individual questions. As you know, we are now working
on a tight timeline. Can you provide the draft content by
Thursday, Nov 20 for Working Group review? If that is
not possible, please let me know what is so that I can
follow-up with Anne on the timeline for this section.
Please let me know if you need anything or if you have
any questions.
Thank you,
Eve
PSC-HHS-000203
www.DietaryGuidelines.gov | www.ChooseMyPlate.gov |
www.NEL.gov
204
PSC-HHS-000204
Cc:
Subject:
Welldonesummary.IalsoagreewithFrankthatperhapsweoughttomentioninthediscussionoffutureresearchor
therationale.Perhapswecouldincludesomethinglikethefollowing:
EmergingresearchisexploringalternativedietarypatternapproachestotheLowcarbohydrate,higherprotein/fat
dietarypattern.Insomeapproaches(suchasAtkins),thedietarypatternwhichemphasizesanimalproteinsmay
achieveamacronutrientcompositionthatishigherintotalandsaturatedfat.Othersmayemphasizeplantbased
proteinsandfatsandmayachievealowersaturatedfatcontentandmaybehigherinpolyunsaturedfats.Researchis
neededtodeterminetheimpactofthesealternativeapproaches,andperhapsothers,onCVDriskprofilesandother
healthoutcomes.
Manythanks.
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
Hi SC2 members,
As you all know, there has been a continued, and perhaps growing, interest in low-carbohydrate diets, and we have been
asked on numerous occasions why the Dietary Guidelines do not recommend low-carbohydrate diets as the dietary
pattern of choice to the general public. As a result, we met with Anna Maria and Barbara to ask if it would be possible to
include a more direct statement on low-carbohydrate diets in the Subcommittee 2 chapter. In response, Anna Maria has
drafted the following content, which has been added to the SC2 chapter (1) Methodology and (2) Needs for Future
Research. The sections are excerpted below. To support these statements, Anna Maria reviewed search results from
Julie on low-carb diets and the health outcomes considered by SC2. If youd like more information, please let us know. As
this is just added to the methodology, its not a formal recommendation of the DGAC and supports the statements from
the AHA/ACC/TOS Guidelines that were considered for the dietary patterns and body weight question. Please let us know
if you have any questions, comments, or concerns. Your report is instrumental in informing the 2015 Dietary Guidelines,
but it is also extremely helpful to us in addressing these types of questions now and over the next five years. Happy
Thanksgiving!!
Eve
Excerpt from the SC2 Chapter Methodology
There are a number of studies available in the scientific literature that describe diets based on macronutrient proportion or
only test a specific food group or nutrient in the diet. For example, a low-carbohydrate diet fits this description and has
been of public interest. The 2015 DGAC reviewed the body of evidence related to this type of diet as part of Question 2.
205
PSC-HHS-000205
Additionally, the Committee examined the results of exploratory searches on low-carbohydrate diets (defined as <45% of
calories from carbohydrate) and all of the health outcomes considered by the subcommittee published since 2000.
Overall, it appears that there is limited evidence available to address the relationship between low-carbohydrate diets
(<45% energy from carbohydrate) and health, particularly evidence derived from U.S.-based populations. The most
evidence available focused on low-carbohydrate diets and body weight. The 2010 DGAC examined the relationship
between macronutrient proportion and various body weight outcomes concluding that:
1) There is strong and consistent evidence that when calorie intake is controlled, macronutrient proportion of the diet
is not related to losing weight; 2) A moderate body of evidence provides no data to suggest that any one
macronutrient is more effective than any other for avoiding weight re-gain in weight reduced persons; 3) A moderate
body of evidence demonstrates that diets with less than 45% of calories as carbohydrates are not more successful for
long-term weight loss (12 months). There is also some evidence that they may be less safe. In shorter-term studies,
low-calorie, high-protein diets may result in greater weight loss, but these differences are not sustained over time; and
4) A moderate amount of evidence demonstrates that intake of dietary patterns with less than 45% calories from
carbohydrate or more than 35% calories from protein are not more effective than other diets for weight loss or weight
maintenance, are difficult to maintain over the long term, and may be less safe.
The published literature since that review does not provide sufficient evidence to change these conclusions. Thus in
summary, while these studies that examine macronutrient proportion or only test a specific food group or nutrient are
important, they answer different questions related to diet and health and generally did not meet the DGACs definition of a
dietary pattern study unless a full description of the dietary pattern consumed was provided and appropriate methods
were used to adjust for the confounding of foods and nutrients.
Needs for Future Research
More research is warranted to examine the long-term cardiometabolic effects of the various dietary patterns identified in
the AHA/ACC/TOS Guidelines for the Management of Overweight and Obesity in Adults capable of resulting in short-term
weight loss (see Question 2). Rationale: While the research to date demonstrates that to lose weight, a variety of dietary
pattern approaches can be used if a reduction in caloric intake is achieved, the long-term effects of these diets on
cardiometabolic health are unknown. As mentioned in the review of the literature associated with saturated fat and
cardiovascular disease in Chapter 6: Cross-Cutting Topics of Dietary Guidance and Public Health Importance, there may
be unintended consequences of substituting one macronutrient for another. Careful consideration to the types of foods
that are used in these diets and in particular the type of fat and amount of added sugars should be taken into account.
Eve Essery Stoody, PhD
Nutritionist | Center for Nutrition Policy and Promotion | USDA
3101 Park Center Drive, Room 1034 | Alexandria, VA 22302
Eve.Essery@cnpp.usda.gov | Office: 703-305-2563 | Fax: 703-305-3300
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 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.
206
PSC-HHS-000206
Subject:
Verythoughtfulcomments.Notsureifmyearliercommentwascirculatedintherecentconversation.Iagreedwith
AnnaMariassummaryandthoughtabriefexplanationofthenuancesmightbepresented(Ithoughtperhapsinfuture
researchsincetheresearchontherelativemeritsofalternativetypesofcarbohydrates,holdingotherthingsconstant,is
notdefinitiveatthispoint.Itshouldalsoberecognizedthatfatcompositionmaychangedependinguponthefood
sourceschosentoincreaseplantbasedcarbohydrates.HappyThanksgiving!Barbara
From11.26.20148:41am
Well done summary. I also agree with Frank that perhaps we ought to mention in the discussion of future
research or the rationale. Perhaps we could include something like the following:
Emerging research is exploring alternative dietary pattern approaches to the Low-carbohydrate, higher
protein/fat dietary pattern. In some approaches (such as Atkins), the dietary pattern which emphasizes animal
proteins may achieve a macronutrient composition that is higher in total and saturated fat. Others may
emphasize plant-based proteins and fats and may achieve a lower saturated fat content and may be higher in
polyunsaturated fats. Research is needed to determine the impact of these alternative approaches, and perhaps
others, on CVD risk profiles and other health outcomes.
Many thanks.
B arbara
Dr. Barbara E. Millen
bmillen@bu.edu
Dr.BarbaraE.Millen
bmillen@bu.edu
I like what Anna Maria drafted and agree -- thanks for summarizing it so beautifully.
Frank's point about the effects on weight loss is well taken and, from what I can tell, it depends on the outcome.
I was a co-investigator on a recent, moderately sized isocaloric feeding study of 5 weeks duration, testing type
207
PSC-HHS-000207
and amount of carb (OmniCarb). I know some of you saw the abstract and presentation at AHA last spring.
There was no effect of type or amount on CVD risk factors (weight was held stable). This paper is in press.
Consistent with Marian and Rafael's comments, I would like to address it in the implications.
Happy Thanksgiving,
Cheryl
On Nov 26, 2014, at 4:32 PM, "Perez-Escamilla, Rafael" <rafael.perez-escamilla@yale.edu> wrote:
I agree with Anna Maria's recommendation to carry forward 2010 DGAC's work on low carb
diets (with the qualifications that she indicates) and Marian's recommendations below to stick to
evidence reviewed. For example I'm not aware that there is evidence out there to imply that say a
"low carb Mediterranean like diet" is healthier than a "regular carb" Mediterranean diet. I also
think that there are other sections in report that provide the opportunity to recommend dietary
patterns that include healthy fats, and limit saturated fat and refined sugars. So perhaps the
integrative chapter could help bring all of this together without having to over reach beyond the
evidence reviewed.
Best,
Rafael Perez-Escamilla, PhD
Professor of Epidemiology and Public Health
Director, Office of Public Health Practice
Director, Global Health Concentration
Yale School of Public Health
135 College St. (Suite 200)
New Haven CT
IOM Food and Nutrition Board member
Chair, Global Nutrition Council, American Society for Nutrition
President, International Society for Research in Human Milk and Lactation (ISRHML)
Sent from my iPad
On Nov 26, 2014, at 6:35 PM, Neuhouser, Marian L <mneuhous@fredhutch.org> wrote:
I think that what Anna Maria wrote is good and probably sufficient.
Frank - what you mention below is not a research need, but seems more like an
implication but since we did not review these data, not sure we can make this leap. Also
, as you note , not all CHO are created equal but substituting others fats and protein (vs,
say substituting whole grains) has not been sufficiently tested.
My 2 cents
Marian
From: Frank Hu [nhbfh@channing.harvard.edu]
Sent: Wednesday, November 26, 2014 6:27 AM
To: Essery, Eve - CNPP
Cc: Siega-Riz, Anna Maria; alice.lichtenstein@tufts.edu; c1anderson@ucsd.edu;
208
PSC-HHS-000208
Eve,
I think it is important to acknowledge that not all low carbohydrate diets are
created equal. For example, the original Atkins-type low carb diets are high in
saturated fat, cholesterol, and low in fiber, but plant-based low-carb diets (EcoAtkins as David Jenkins called) are high nuts, seeds, legumes, fiber-rich whole
grains, but very low in refined carbs/sugars. These two types of low carb diets
have very different effects on blood lipids in short-term trials and different
associations with risk of type 2 diabetes and CVD in long-term prospective cohort
studies. A Med-type of low carb diets high in healthy sources of protein and fat
was shown to have benefits on blood glucose, body weight, and blood lipids
within 2 years (Shai et al. NEJM 2008).
I wish that the committee has more time to summarize and update the RCT and
cohort evidence on low-carb DIETS and various health outcomes. In any event,
we should not simply dismiss the role of low-carb diets in weight control and
improving overall health outcomes. Instead, we should say that when individuals
cut back on refined carbs/added sugar, they should use healthy sources of fat and
protein as replacement instead of saturated fat-rich food sources.
Frank
PSC-HHS-000209
Eve
210
PSC-HHS-000210
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 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, PhD
Professor of Nutrition and Epidemiology
Harvard School of Public Health
Professor of Medicine
Harvard Medical School
665 Huntington ave, Boston, MA 02115
tel: 617 432 0113 fax: 617 432 2435
<http://www.hsph.harvard.edu/faculty/frank-hu/>
http://www.hsph.harvard.edu/faculty/frank-hu/
******************************************************
211
PSC-HHS-000211
I have been keeping up with all the back and forth about low-carb diets. I too am concern about
entering into a nonsystematic review at this point and clearly there is no time for a SR. I am also
concerned about carrying forward the 2010 material because so much has been published since
then. Hindsight is always helpful. However, we did not think to include a question on low-carb diets.
I think Anna Maria hit the right balance, notwithstanding a few tweaks as suggested.
AliceH.Lichtenstein,D.Sc.
GershoffProfessorofNutritionScienceandPolicy
DirectorandSeniorScientist,CardiovascularNutritionLaboratory
TuftsUniversity
JMUSDAHumanNutritionResearchCenteronAging
711WashingtonStreet
Boston,MA02111
phone:6175563127
email:Alice.Lichtenstein@Tufts.edu
From: Siega-riz, Anna Maria [mailto:am_siegariz@unc.edu]
Sent: Sunday, November 30, 2014 8:21 AM
To: Neuhouser, Marian L; Frank Hu; Essery, Eve - CNPP
Cc: Millen, Barbara E; Lichtenstein, Alice; c1anderson@ucsd.edu; jtb4@cornell.edu; steven.clinton@osumc.edu;
rafael.perez-escamilla@yale.edu; Obbagy, Julie - CNPP; Casavale, Kellie (OS/OASH)
Subject: Re: DGAC SC2: Chapter follow-up
Folks,
JulieandtheNELdidconductareviewonlowcarbforusthoughwearenotaddingitasaformalquestionforreasonsthatwe
mentioninthemethodologysection.Overall,thetotalityoftheevidencedoesnotsupportussayingverymuchatall.Itis
attachedforyourreviewandwecandiscussfurtheronthecallthisweek.
212
PSC-HHS-000212
From:<Neuhouser>,MarianL<mneuhous@fredhutch.org>
Date:Saturday,November29,2014at3:02PM
To:FrankHu<nhbfh@channing.harvard.edu>,EveEssery<Eve.Essery@fns.usda.gov>
Cc:DrPHBarbaraMillen<bmillen@bu.edu>,AnnaSiegaRiz<am siegariz@unc.edu>,AliceLichtenstein
<Alice.Lichtenstein@tufts.edu>,"c1anderson@ucsd.edu"<c1anderson@ucsd.edu>,"'jtb4@cornell.edu'"
<jtb4@cornell.edu>,StevenClinton<steven.clinton@osumc.edu>,RafaelPerezEscamilla<rafael.perez
escamilla@yale.edu>,JulieObbagy<Julie.Obbagy@cnpp.usda.gov>,KellieCasavale<Kellie.Casavale@hhs.gov>
Subject:RE:DGACSC2:Chapterfollowup
I am a little concerned about the timeline and feeling that we don't have time to add a new question on low CARB diets even a narrative non-systematic review would not be consistent with methods we have done for all the other dietary
patterns.
Marian
From: Frank Hu [nhbfh@channing.harvard.edu]
Sent: Friday, November 28, 2014 6:47 AM
To: Essery, Eve - CNPP
Cc: Millen, Barbara E; Siega-Riz, Anna Maria; alice.lichtenstein@tufts.edu; c1anderson@ucsd.edu; jtb4@cornell.edu;
steven.clinton@osumc.edu; rafael.perez-escamilla@yale.edu; Neuhouser, Marian L; Obbagy, Julie - CNPP; Casavale, Kellie
(OS/OASH)
Subject: Re: DGAC SC2: Chapter follow-up
If we decide to do a separate section on low-carb diets, we can still carry forward the 2010 DGAC conclusions,
but provide more background and contextual information, and also be more specific about the long-term safety
issues of such diets. A narrative non-systematic update of the literature, especially on the emerging evidence on
healthy versions of low-carb diets, can be useful given that NEL review is probably not feasible given the time
constraint. Since low-carb diets are recommended as one of the options for weight loss, i think it is important for
the committee to consider clinical and public health implications of such diet and its healthy variations. As
suggested by several committee members, this should be considered in conjunction with the sections on
saturated fat and added sugars.
Best regards
213
PSC-HHS-000213
Frank
On Wed, Nov 26, 2014 at 10:29 AM, Essery, Eve - CNPP <Eve.Essery@fns.usda.gov> wrote:
There is certainly still time to make revisions to what is included in your report. To help facilitate that, Ive dropped this
content into the attached Word document and added Barbaras suggestion below. Please edit, add, revise the statements
as youd like, and we can drop the final content into the chapter early next week. Thank you!
Well done summary. I also agree with Frank that perhaps we ought to mention in the discussion of future
research or the rationale. Perhaps we could include something like the following:
Emerging research is exploring alternative dietary pattern approaches to the Low-carbohydrate, higher
protein/fat dietary pattern. In some approaches (such as Atkins), the dietary pattern which emphasizes animal
proteins may achieve a macronutrient composition that is higher in total and saturated fat. Others may
emphasize plant-based proteins and fats and may achieve a lower saturated fat content and may be higher in
polyunsatured fats. Research is needed to determine the impact of these alternative approaches, and perhaps
others, on CVD risk profiles and other health outcomes.
Many thanks.
B arbara
Dr. Barbara E. Millen
bmillen@bu.edu
PSC-HHS-000214
Hi SC2 members,
As you all know, there has been a continued, and perhaps growing, interest in low-carbohydrate diets, and we have been
asked on numerous occasions why the Dietary Guidelines do not recommend low-carbohydrate diets as the dietary
pattern of choice to the general public. As a result, we met with Anna Maria and Barbara to ask if it would be possible to
include a more direct statement on low-carbohydrate diets in the Subcommittee 2 chapter. In response, Anna Maria has
drafted the following content, which has been added to the SC2 chapter (1) Methodology and (2) Needs for Future
Research. The sections are excerpted below. To support these statements, Anna Maria reviewed search results from
Julie on low-carb diets and the health outcomes considered by SC2. If youd like more information, please let us know. As
this is just added to the methodology, its not a formal recommendation of the DGAC and supports the statements from
the AHA/ACC/TOS Guidelines that were considered for the dietary patterns and body weight question. Please let us know
if you have any questions, comments, or concerns. Your report is instrumental in informing the 2015 Dietary Guidelines,
but it is also extremely helpful to us in addressing these types of questions now and over the next five years. Happy
Thanksgiving!!
Eve
PSC-HHS-000215
weight loss (see Question 2). Rationale: While the research to date demonstrates that to lose weight, a variety of dietary
pattern approaches can be used if a reduction in caloric intake is achieved, the long-term effects of these diets on
cardiometabolic health are unknown. As mentioned in the review of the literature associated with saturated fat and
cardiovascular disease in Chapter 6: Cross-Cutting Topics of Dietary Guidance and Public Health Importance, there may
be unintended consequences of substituting one macronutrient for another. Careful consideration to the types of foods
that are used in these diets and in particular the type of fat and amount of added sugars should be taken into account.
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 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, PhD
Professor of Nutrition and Epidemiology
Harvard School of Public Health
Professor of Medicine
Harvard Medical School
665 Huntington ave, Boston, MA 02115
tel: 617 432 0113 fax: 617 432 2435
<http://www.hsph.harvard.edu/faculty/frank-hu/>
http://www.hsph.harvard.edu/faculty/frank-hu/
******************************************************
216
PSC-HHS-000216
Mary, tried to follow the e-mail trail but not clear what is the FDAs response. I am okay leaving
things as they are written, however, as indicated previously, given the experience with TFA, expecting
a DV any time soon is unrealistic. The impact of listing TFA on the Nutrient Facts label without a DV
was enormous.
Having said that, you are more knowledgeable about this than I am.
AliceH.Lichtenstein,D.Sc.
GershoffProfessorofNutritionScienceandPolicy
DirectorandSeniorScientist,CardiovascularNutritionLaboratory
TuftsUniversity
JMUSDAHumanNutritionResearchCenteronAging
711WashingtonStreet
Boston,MA02111
phone:6175563127
email:Alice.Lichtenstein@Tufts.edu
From: Mary Story, Ph.D. [mailto:mary.story@duke.edu]
Sent: Thursday, November 27, 2014 10:00 AM
To: Nelson, Miriam; Lichtenstein, Alice
Subject: Re: added sugar implication statement
MimandAlice,
IthinkweshouldleavetheImplicationsstateemntaswehaditandnotmakeanychangesbasedontheFDA
response.Pleaseseetheshortstringofemailsbelow.Canyouletmeknowifyouagree.
AfterIhearyourthoguhtsIcantalkwithMarian.
Mary
From:<Essery>,EveCNPP<Eve.Essery@fns.usda.gov>
Date:Wednesday,November26,201411:09AM
To:MaryStory<mary.story@duke.edu>,"Miriam(Mim)E.Nelson,PhD,MS"<miriam.nelson@tufts.edu>,
"alice.lichtenstein@tufts.edu"<alice.lichtenstein@tufts.edu>
Cc:"Britten,PatriciaCNPP"<Patricia.Britten@cnpp.usda.gov>
Subject:RE:addedsugarimplicationstatement
HiMaryThiswasjustFYIbasedonyourandMariansrequesttotouchbasewithEssie.Youcancertainlyleavethemin,
asis.Youarecorrectthatyoucanprovidesuchadvice.IwillincludeastatementaboutconsumerresearchforFOPthat
youcanreviewandeditwhenIsendthechaptertoyouhopefullysoon!Thankyou.
217
PSC-HHS-000217
ThanksyouEveforsendingustheFDAcomments.IwouldliketoleavetheImplicationsstatementaswehave
writtenandonlymaketherecommendationintheresearchsectionthatweneedmoreconsumerresearchonthe
FoP.TheIOMreportwhichweciteclearlyrecommenedastandardizedFoPlabelandsupportforsuchalable.We
donotmentionFDAatallineitherofthestatements.AlsoitsoundsfromEsse'smessagethatthecommitteecan
providesuchadvice.
SoIwouldliketoleaveeverythingintheImplicationsstatementasisandonlyaddaresearchrecommendation
thatconsumerresearchbedoneforFoP.
AlsoIthinktheprocessisthatthecommitteedecidesandshouldnotbeinfluencedbyagovernmentagency.
AliceandMimpleaseweighin.
Mary
From:<Essery>,EveCNPP<Eve.Essery@fns.usda.gov>
Date:Wednesday,November26,201410:44AM
To:MaryStory<mary.story@duke.edu>,"Britten,PatriciaCNPP"<Patricia.Britten@cnpp.usda.gov>
Cc:"Miriam(Mim)E.Nelson,PhD,MS"<miriam.nelson@tufts.edu>,"alice.lichtenstein@tufts.edu"
<alice.lichtenstein@tufts.edu>
Subject:RE:addedsugarimplicationstatement
HiMaryYes,Iwilladdthisstatementtothefinal.
Also,asrequested,IemailedEssieaboutthebulletspertainingtoFDA.Pleaseseeherresponsesbelow.
DGACimplication:TheNutritionFactsPanel(NFP)shouldincludeaddedsugars(ingramsandteaspoons)and
includeapercentdailyvalue,toassistconsumersinmakinginformeddietarydecisionsbyidentifyingthe
amountofaddedsugarinfoodsandbeverages.
FDA response: While such advice may be provided by the DGAC, there are a number of issues that FDA must
consider as a regulatory agency before forming a decision in the rule making process. We have issued a
proposed rule on the NFL and currently are in the process of reviewing the public comments.
DGACimplication:Consumerswouldbenefitfromastandardized,easilyunderstoodfrontofpackage(FOP)
labelonallfoodandbeverageproductstogiveclearguidanceaboutafoodshealthfulness.Anexampleisthe
FOPlabelrecommendedbytheInstituteofMedicine(ref),whichincludedcalories,and0to3nutritional
pointsforaddedsugar,saturatedfat,andsodium.ThiswouldbeintegratedwiththeNFP,allowingconsumers
toquicklyandeasilyidentifynutrientsofconcernforoverconsumption,inordertomakehealthierchoices
FDA response: Such advice may be provided by the DGAC, but as mentioned above, there are a number of
issues that FDA must consider as a regulatory agency. We are wondering whether this suggestion is based on
a review of consumer research that has shown that Consumer would benefit from a standardized, easily
understood front of package. Currently, there are many questions in regard to establishing an FOP and
FDA is evaluating all of the issues. What would help FDA the most in coming to any determination on FOP
labeling is more consumer research.
218
PSC-HHS-000218
From: Mary Story, Ph.D. [mailto:mary.story@duke.edu]
Sent: Wednesday, November 26, 2014 8:38 AM
To: Britten, Patricia - CNPP
Cc: Essery, Eve - CNPP; Miriam (Mim) E. Nelson, PhD, MS; alice.lichtenstein@tufts.edu
Subject: Re: added sugar implication statement
z %inchildren,adolescentsandyoungadults.
However,lookingatthetable,Itisreallychildren9andolderwhowouldfitintothishigher
intakegroup. Because we also have separate data for males and females, I would suggest using
a range and modifying the groups so that young children are not included.
Two suggestions:
Currently,themeanintakeofaddedsugarsintheU.S.populationis13%,andfrom15%to
17%inchildren9andolder,adolescentsandyoungadults.
OR
Currently,themeanintakeofaddedsugarsintheU.S.populationis13%,and15%to17%in
preadolescents,adolescentsandyoungadults.
Trish
MeanIntake
200710
Meanenergy
intake200710
(fromNCI)
Percentof
caloariesfrom
addedsugars
Males
1 to 3
150
1426
1771
2033
2374
2517
2551
2256
1881
1330
10.5%
14.2%
16.8%
16.6%
14.9%
12.9%
11.7%
11.9%
10.2%
252
4 to 8
341
9 to 13
394
14-18
376
19-30
328
31-50
264
51-70
224
71+
Females
1 to 3
135
219
PSC-HHS-000219
4 to 8
9 to 13
14-18
19-30
31-50
51-70
71+
ALL 1+
229
282
281
267
242
200
174
268
1657
1827
1751
1820
1797
1715
1520
1996
13.8%
15.4%
16.0%
14.7%
13.5%
11.7%
11.4%
13.4%
HiEve,TrishandMim,
IjustsentEvethefinaldraftwhichhasreceivedinputfromtheAddedSugarsworkinggroup.Alice
hadsomegoodeditsthatIincorporatedintothisnearfinaldraft.Trishpleaselookatthedraft.
Alicesuggestedachangetoaddthemeanpercentintakeofaddedsugarsforchildren,adolescents
andyoungadolescents.Canyouaddthatinfointhetext?
Mim,thefirstparagraphhaschangedslightlybecauseofAlice'seditsandsoifyoupleaselookatit.
Ithinkitislookinggood.
Eve,sendingittoyounowforthenextsteps.
Mary
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 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.
220
PSC-HHS-000220
On a call now. Overwhelmed with all the reviewing and calls. I have to get back to my
responsibilities at Tufts. Someone else will have to do this.
AliceH.Lichtenstein,D.Sc.
GershoffProfessorofNutritionScienceandPolicy
DirectorandSeniorScientist,CardiovascularNutritionLaboratory
TuftsUniversity
JMUSDAHumanNutritionResearchCenteronAging
711WashingtonStreet
Boston,MA02111
phone:6175563127
email:Alice.Lichtenstein@Tufts.edu
From: Essery, Eve - CNPP [mailto:Eve.Essery@fns.usda.gov]
Sent: Monday, December 01, 2014 10:12 AM
To: Lichtenstein, Alice
Cc: Casavale, Kellie (OS/OASH)
Subject: DGAC: For Alice
Hi Alice,
I believe that you volunteered (or were volunteered?) to lead the cross-cutting chapter. As I think youve seen, over the
past two weeks, there has been a lot of back and forth on sodium, added sugars, and saturated fat. Theres still more fine
tuning to come (e.g., the sodium section); however, attached is the current draft chapter.
Can you review the chapter Introduction (pg 1) and Summary (pg 24) and let me know if you have any edits, additions,
re-writes? Since each of the topic sections provide their own introductions and the implications almost serve as the topic
summaries, I really just pulled together a basic intro and summary for the chapter. Im attaching the complete draft
chapter, but its really here just to give you the basic framework. A lot of pieces are still under review; so, please dont do a
full review of the chapter just yet!
Thanks!
Eve
221
PSC-HHS-000221
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 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.
222
PSC-HHS-000222
HiKelly,
Herearethedocumentsfortodayscall.Seemynotesandeditsfromtheminutesofourlastcall.Letsputhealthcare
ontotheagendafortodayscall(justanupdateonwhatcameofthefinalreviewsontherecommendationthatwetry
toframeourevidencesoastohelpthoseinHHSandhealthcarerelatedpositiontoconsiderthereportanduseitin
policy/programdevelopment.Thiswouldparticularlyentailtheevidenceonpopulationhealthrisksanddisparities,links
betweendietarypatternsandhealthoutcomes,andevidenceonwhatworksatindividualandpopulationlevelsto
changebehaviorforhealthpromotionanddiseaseprevention).
IhavenothadanyfeedbackontherevisedthemeorindividualrecommendationsthatIcirculatedsinceourcall.Ithink
Aliceisverybusykeepingtrackoftheiterationsonsaturatedfatandthecrosscuttingtopicsandmaynothavehada
chancetoiterate.ImfeelingthatitisprematuretocirculateanythingtothefullDGACandwemaynothaveanything
untilEOBMondayandthen,onlyifAlice,SRSCandotherscanprovidefeedback.TimingisverytightandIthinkwemay
alsoneedtosandwichinanotherSRSCcallmidweektoreviewthemodel,theintegrationchapterandthe
introduction.Yourthoughts?
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
BarbaraIdontseethatIhaveheardbackonthisagendaforSRSCtomorrow.Icansenditinthemorning.Butdohavea
fewquestionsinitforyoubeforeIcangetitoutthedoor.Thanks!
Kellie
KellieO.Casavale,PhD,RD
NutritionAdvisor,DivisionofPreventionScience
CoExecutiveSecretary,2015DietaryGuidelinesAdvisoryCommittee
HHS,OfficeofDiseasePreventionandHealthPromotion
PSC-HHS-000223
BarbaraAdraftagendaisattachedforSRSCFridayforyourreview.Afewquestionsforyouinit.Ihaveanallday
meetingtomorrowsoIwillsendthisafterCOB/5:30pm.Draftnotesareattachedaswell.
Thanks,
Kellie
224
PSC-HHS-000224
HIAlice,
ThebigoutstandingitemsfromthemorningSRSCcallarethecompletionoftheintroductionandintegrationchapters
andtheconceptualmodel.ItwasproposedthatyouandIworkovertheweekendwithKellieandAnnetopreparethe
chaptersindraftandthencirculatethemonMondaytotheDGACwithaveryshortturnarounddeadlinesotheycango
outonTuesdaytotheDGACwiththerestofthereport.Wewanttobesurewehavecoveredtheoverarchingthemes
andrecommendationsandresolvedoutstandingissuesfromthepreviousreviews.IwillworkwithNadineifshes
availabletoreviewthingsthatremainontheconceptualmodel.Notsureifyouhavehadthetimetoreviewthe
revisionsIdidontheintegrationchapterbutyourinputwouldbeverymuchappreciated.
Isthereatimeovertheweekendthatyouhaveuptoanhourtoreviewthecurrentdraftoftheintegrationchapterand
introduction.Bothareattachedforyourreview.TheonlytimeIamdefinitelynotavailableisnoonorabout3
tomorrow.
Nadine,canyouletmeknowyouravailabilitytoo?
Manythanks.
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
AliceH.Lichtenstein,D.Sc.
GershoffProfessorofNutritionScienceandPolicy
DirectorandSeniorScientist,CardiovascularNutritionLaboratory
TuftsUniversity
JMUSDAHumanNutritionResearchCenteronAging
711WashingtonStreet
Boston,MA02111
225
PSC-HHS-000225
phone:6175563127
email:Alice.Lichtenstein@Tufts.edu
From: Anne Rodgers [mailto:abrodgers@verizon.net]
Sent: Thursday, December 04, 2014 3:52 PM
To: 'Perez-Escamilla, Rafael'; 'Abrams, Steven A'; 'Millen, Barbara E'; Lichtenstein, Alice; frank.hu@channing.harvard.edu;
Eve.Essery@cnpp.usda.gov
Cc: 'Casavale, Kellie (OS/OASH)'; Richard.Olson@hhs.gov; colette.rihane@cnpp.usda.gov; 'Bodyk, Anjuli';
lhimes@bcm.edu; Bailey, Lauren A.; PBROWN@hsph.harvard.edu
Subject: REVISED SATURATED FAT IMPLICATION FOR YOUR REVIEW
All,
BasedonveryrecentcommentsfromBarbaraandAlice,Frankhasrevisedthesaturatedfatimplications
statement.PleasereviewthisandsendanycommentstomeandKelliebyFriday,December5.
Thanksverymuch,
Anne
AnneBrownRodgers
ScienceWriter
(b) (6)
226
PSC-HHS-000226
AniterationonAnneseditstotheintroduction.Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
HIAlice,
ThebigoutstandingitemsfromthemorningSRSCcallarethecompletionoftheintroductionandintegrationchapters
andtheconceptualmodel.ItwasproposedthatyouandIworkovertheweekendwithKellieandAnnetopreparethe
chaptersindraftandthencirculatethemonMondaytotheDGACwithaveryshortturnarounddeadlinesotheycango
outonTuesdaytotheDGACwiththerestofthereport.Wewanttobesurewehavecoveredtheoverarchingthemes
andrecommendationsandresolvedoutstandingissuesfromthepreviousreviews.IwillworkwithNadineifshes
availabletoreviewthingsthatremainontheconceptualmodel.Notsureifyouhavehadthetimetoreviewthe
revisionsIdidontheintegrationchapterbutyourinputwouldbeverymuchappreciated.
Isthereatimeovertheweekendthatyouhaveuptoanhourtoreviewthecurrentdraftoftheintegrationchapterand
introduction.Bothareattachedforyourreview.TheonlytimeIamdefinitelynotavailableisnoonorabout3
tomorrow.
Nadine,canyouletmeknowyouravailabilitytoo?
Manythanks.
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
227
PSC-HHS-000227
AliceH.Lichtenstein,D.Sc.
GershoffProfessorofNutritionScienceandPolicy
DirectorandSeniorScientist,CardiovascularNutritionLaboratory
TuftsUniversity
JMUSDAHumanNutritionResearchCenteronAging
711WashingtonStreet
Boston,MA02111
phone:6175563127
email:Alice.Lichtenstein@Tufts.edu
From: Anne Rodgers [mailto:abrodgers@verizon.net]
Sent: Thursday, December 04, 2014 3:52 PM
To: 'Perez-Escamilla, Rafael'; 'Abrams, Steven A'; 'Millen, Barbara E'; Lichtenstein, Alice; frank.hu@channing.harvard.edu;
Eve.Essery@cnpp.usda.gov
Cc: 'Casavale, Kellie (OS/OASH)'; Richard.Olson@hhs.gov; colette.rihane@cnpp.usda.gov; 'Bodyk, Anjuli';
lhimes@bcm.edu; Bailey, Lauren A.; PBROWN@hsph.harvard.edu
Subject: REVISED SATURATED FAT IMPLICATION FOR YOUR REVIEW
All,
BasedonveryrecentcommentsfromBarbaraandAlice,Frankhasrevisedthesaturatedfatimplications
statement.PleasereviewthisandsendanycommentstomeandKelliebyFriday,December5.
Thanksverymuch,
Anne
AnneBrownRodgers
ScienceWriter
(b) (6)
228
PSC-HHS-000228
HiAlice,
AnotheriterationontheIntegrationchapter.Ithinktheformattingismuchbetternowandhopefullythethemesand
recommendationsareclearer,bolderandasspecificaspossible.Iwouldrecommendthatyoureviewitinthefinal
reviewformatsotheeditsarenotsooverwhelming.
Letmeknowwhatyouthinkandifacallwouldbehelpful.
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
About to leave for a flight back to return to Boston. Will review then.
AliceH.Lichtenstein,D.Sc.
GershoffProfessorofNutritionScienceandPolicy
DirectorandSeniorScientist,CardiovascularNutritionLaboratory
TuftsUniversity
JMUSDAHumanNutritionResearchCenteronAging
711WashingtonStreet
Boston,MA02111
phone:6175563127
email:Alice.Lichtenstein@Tufts.edu
From: Millen, Barbara E [mailto:bmillen@bu.edu]
Sent: Friday, December 05, 2014 5:55 PM
To: Lichtenstein, Alice
Cc: 'Casavale, Kellie (OS/OASH)'; Anne Rodgers; Braunstein, Nadine (OS/OASH) (Nadine.Braunstein@hhs.gov)
Subject: introduction and Integration
HIAlice,
229
PSC-HHS-000229
ThebigoutstandingitemsfromthemorningSRSCcallarethecompletionoftheintroductionandintegrationchapters
andtheconceptualmodel.ItwasproposedthatyouandIworkovertheweekendwithKellieandAnnetopreparethe
chaptersindraftandthencirculatethemonMondaytotheDGACwithaveryshortturnarounddeadlinesotheycango
outonTuesdaytotheDGACwiththerestofthereport.Wewanttobesurewehavecoveredtheoverarchingthemes
andrecommendationsandresolvedoutstandingissuesfromthepreviousreviews.IwillworkwithNadineifshes
availabletoreviewthingsthatremainontheconceptualmodel.Notsureifyouhavehadthetimetoreviewthe
revisionsIdidontheintegrationchapterbutyourinputwouldbeverymuchappreciated.
Isthereatimeovertheweekendthatyouhaveuptoanhourtoreviewthecurrentdraftoftheintegrationchapterand
introduction.Bothareattachedforyourreview.TheonlytimeIamdefinitelynotavailableisnoonorabout3
tomorrow.
Nadine,canyouletmeknowyouravailabilitytoo?
Manythanks.
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
AliceH.Lichtenstein,D.Sc.
GershoffProfessorofNutritionScienceandPolicy
DirectorandSeniorScientist,CardiovascularNutritionLaboratory
TuftsUniversity
JMUSDAHumanNutritionResearchCenteronAging
711WashingtonStreet
Boston,MA02111
phone:6175563127
email:Alice.Lichtenstein@Tufts.edu
From: Anne Rodgers (b) (6)
Sent: Thursday, December 04, 2014 3:52 PM
To: 'Perez-Escamilla, Rafael'; 'Abrams, Steven A'; 'Millen, Barbara E'; Lichtenstein, Alice; frank.hu@channing.harvard.edu;
Eve.Essery@cnpp.usda.gov
Cc: 'Casavale, Kellie (OS/OASH)'; Richard.Olson@hhs.gov; colette.rihane@cnpp.usda.gov; 'Bodyk, Anjuli';
lhimes@bcm.edu; Bailey, Lauren A.; PBROWN@hsph.harvard.edu
Subject: REVISED SATURATED FAT IMPLICATION FOR YOUR REVIEW
All,
230
PSC-HHS-000230
BasedonveryrecentcommentsfromBarbaraandAlice,Frankhasrevisedthesaturatedfatimplications
statement.PleasereviewthisandsendanycommentstomeandKelliebyFriday,December5.
Thanksverymuch,
Anne
AnneBrownRodgers
ScienceWriter
(b) (6)
231
PSC-HHS-000231
Incredible job of pulling this together so quickly, particularly given my abandonment of the task.
I apologize for my grumpiness on the call yesterday. I have a critical grant that has a submission
date of Jan 2 and delayed writing it until I finished working on all the DGCA sections. This has really
hurt the people in my group and collaborators who are involved with the grant. I now need to work on
it in overdrive and deal with all the final papers in my Nutritional Biochem course in order to submit
the grades. Having said that I will respond to DGAC issues. Please convey my apology to others.
Regarding comments on the attached file, thy are numerous, as usual from me. Dont panic. Some
are comments/questions. Some highlight concerns about repetition with the section. Instead of
working on my grant and grading I have spent quite a few hours on this document. I absolutely have
to drop out for the rest of the weekend.
There is only one issue of semi-major concern. As stated in the excellent opening section our biggest
challenge in the US is BW and chronic disease. We have identified nutrients of concern, both over
and under consumption. The ones associated with overconsumption are the ones associated most
closely with chronic disease risk. Hence, increases in the nutrient density of diets, as it repeatedly
mentioned, although laudable, is only tangentially related to the major health problem in the US. This
concern about the text is reflected in my comments. I am not downgrading nutrient dense diets but
increasing nutrient density of the diets can mean adding a highly fortified breakfast cereal rich in
sugar and refined carbs. I dont think we would predict this would benefit a large proportion of the US
population.
AliceH.Lichtenstein,D.Sc.
GershoffProfessorofNutritionScienceandPolicy
DirectorandSeniorScientist,CardiovascularNutritionLaboratory
TuftsUniversity
JMUSDAHumanNutritionResearchCenteronAging
711WashingtonStreet
Boston,MA02111
phone:6175563127
email:Alice.Lichtenstein@Tufts.edu
From: Millen, Barbara E [mailto:bmillen@bu.edu]
Sent: Friday, December 05, 2014 5:55 PM
To: Lichtenstein, Alice
Cc: 'Casavale, Kellie (OS/OASH)'; Anne Rodgers; Braunstein, Nadine (OS/OASH) (Nadine.Braunstein@hhs.gov)
Subject: introduction and Integration
232
PSC-HHS-000232
HIAlice,
ThebigoutstandingitemsfromthemorningSRSCcallarethecompletionoftheintroductionandintegrationchapters
andtheconceptualmodel.ItwasproposedthatyouandIworkovertheweekendwithKellieandAnnetopreparethe
chaptersindraftandthencirculatethemonMondaytotheDGACwithaveryshortturnarounddeadlinesotheycango
outonTuesdaytotheDGACwiththerestofthereport.Wewanttobesurewehavecoveredtheoverarchingthemes
andrecommendationsandresolvedoutstandingissuesfromthepreviousreviews.IwillworkwithNadineifshes
availabletoreviewthingsthatremainontheconceptualmodel.Notsureifyouhavehadthetimetoreviewthe
revisionsIdidontheintegrationchapterbutyourinputwouldbeverymuchappreciated.
Isthereatimeovertheweekendthatyouhaveuptoanhourtoreviewthecurrentdraftoftheintegrationchapterand
introduction.Bothareattachedforyourreview.TheonlytimeIamdefinitelynotavailableisnoonorabout3
tomorrow.
Nadine,canyouletmeknowyouravailabilitytoo?
Manythanks.
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
AliceH.Lichtenstein,D.Sc.
GershoffProfessorofNutritionScienceandPolicy
DirectorandSeniorScientist,CardiovascularNutritionLaboratory
TuftsUniversity
JMUSDAHumanNutritionResearchCenteronAging
711WashingtonStreet
Boston,MA02111
phone:6175563127
email:Alice.Lichtenstein@Tufts.edu
From: Anne Rodgers (b) (6)
Sent: Thursday, December 04, 2014 3:52 PM
To: 'Perez-Escamilla, Rafael'; 'Abrams, Steven A'; 'Millen, Barbara E'; Lichtenstein, Alice; frank.hu@channing.harvard.edu;
Eve.Essery@cnpp.usda.gov
Cc: 'Casavale, Kellie (OS/OASH)'; Richard.Olson@hhs.gov; colette.rihane@cnpp.usda.gov; 'Bodyk, Anjuli';
lhimes@bcm.edu; Bailey, Lauren A.; PBROWN@hsph.harvard.edu
Subject: REVISED SATURATED FAT IMPLICATION FOR YOUR REVIEW
233
PSC-HHS-000233
All,
BasedonveryrecentcommentsfromBarbaraandAlice,Frankhasrevisedthesaturatedfatimplications
statement.PleasereviewthisandsendanycommentstomeandKelliebyFriday,December5.
Thanksverymuch,
Anne
AnneBrownRodgers
ScienceWriter
(b) (6)
234
PSC-HHS-000234