Australian Dietary Guidelines Update - Business as Usual?

By Claire McDonnell Liu, Nutritionist

A review of the Australian Dietary Guidelines (ADG), launched in 2020, could be strongly incentivized to endorse the status quo.

Australian Dietary Guidelines

Minister for Health Greg Hunt stated in a press release that the review, undertaken once every 10 years, would ensure that the ADG “remained a trusted resource” [1].

Steps taken by the National Health and Medical Research Council (NHMRC), the government agency directing the review, to promote scientific objectivity include the appointment of two committees to oversee the process. Both the “Expert” and the “Governance” committees are intended to be free from the financial conflicts of interest that have historically been problematic. Transparency about conflicts has also been a challenge.

For instance, a study examining Australian clinical practice guidelines issued from 2012 to 2014 found that 70% had at least one writer with a financial tie to the pharmaceutical industry that had not been disclosed [2]. For the U.S. guidelines process, where public disclosure of conflicts of interest has not been practiced, fully 95% of the expert committee members reviewing the science for the 2020-2025 Dietary Guidelines for Americans were found by one analysis to have at least one relationship with industry, and a majority had 20 such relationships or more [3].

By contrast, members of both Australian committees have declared virtually no conflicts of interest with industry. Instead, the Australian Expert and Governance committee members have declared a different type of potential conflict of interest: strong professional and financial ties [4] to the NHMRC.  

All members of both committees except one have received grants from NHMRC and/or held board or working group positions linked with the agency, according to investigations by nutrition researcher Belinda Fettke (see details below). That the committees are so deeply entwined with the body responsible for the guidelines raises questions, such as: how willing can the committee be to embark upon fresh thinking? And: Are the members able to challenge aspects of the dietary guidelines that might be outdated or the subject of scientific debate?

"Transparency is not about restoring trust in institutions. Transparency is the politics of managing mistrust."- Ivan Krastev, Political Scientist in Bulgaria.   

Diet-Related Health Burden in Australia  

Australian Obesity 2018

The review currently underway is significant. The guidelines are intended to be the country’s key source of information on healthy eating for the public, health professionals, and the food and drink industries. The ADG determines policy, nutrition advice, and education, as well as what’s eaten in child-care centers, schools, hospitals, and age-care facilities throughout the country.

Diet is clearly a key determinant of health. Minister Hunt stated in a press release that “A healthy diet is essential to help lower the risk of high cholesterol, high blood pressure, and obesity as well as chronic diseases such as type 2 diabetes, cardiovascular disease and some types of cancers” [1].

The guidelines are arguably more important now than ever, as they have presided over a period of significant health decline in the Australian population. In the 1980s, when the ADG was first introduced, less than 40% of Australian adults were overweight or obese [5].  By 2018, this number had risen drastically, to around 67% of adults overweight or obese [6].

Overweight and obesity was the second leading risk factor for 30 diseases in Australia, including seventeen different types of cancer, four cardiovascular diseases, type 2 diabetes, dementia, asthma, musculoskeletal conditions, and chronic kidney disease, according to one study [7].

Guidelines Challenged 

The ADG has been accused by some experts of not being based on sufficient scientific evidence and of falling short of meeting the population’s changing health needs and eating patterns. 

Governance Committee Chair Professor Lisa Bero has previously set out failings and steps to improve the relevance and quality of the guidelines. In her 2019 article 'Making nutrition guidelines fit for purpose’, published in The BMJ, Bero and colleagues argue that the current approach to developing dietary guidelines is based on methods that "are unsuitable for food and diet based guidelines” [8].  The article puts the case for nutrition guidelines to answer broader context dietary questions, and to move away from available evidence review methods due to "well documented industry influence on nutrition evidence” [8].  However, Bero’s argument for a move towards greater reliance on observational studies in guideline reviews is potentially problematic, due to the consensus by international review methodologies that consider these studies to be low-quality evidence, prone to bias and confounding.

Investigative medical reporter Dr. Maryanne Demasi, in a 2018 article, highlights conflicts of interest arising from the Dietitian’s Association of Australia’s (DAA) “longstanding relationship with the food industry” [9]. The DAA was previously contracted to undertake the ADG scientific literature review for the 2013 guidelines. Dr. Demasi questioned the DAA’s impartiality, citing commercial relationships going back as far as 2007 with food and pharmaceutical companies, including Unilever, Kelloggs, and Nestle. Dr. Demasi laid out the potential conflicts of interest that “existed before, during, and after the [guidelines] tendering process,” in her 2018 presentation “Who Really Influences Food Policy In Australia?” [10] at the University of Sydney.

Prominent sports physician and Chair of the SugarbyHalf campaign, Dr. Peter Brukner, suggests that the high level of carbohydrates recommended in the ADG, including highly refined and processed cereals and wheat products, is likely contributing to the population’s weight and diabetes type 2 crisis [11].

Dr. James Muecke, Australian Ophthalmologist and 2020 Australian of the Year.

Dr. James Muecke, Australian of the Year 2020 and eye surgeon, also questions the ADG assertion that “saturated fats increase our risk of heart disease” [12]. The concept that high fat intake was bad for your heart is now widely challenged [13]. Dr. Muecke states that there is no evidence linking saturated fats from whole fat dairy, unprocessed red meat, and eggs with heart attack, stroke, or type 2 diabetes [14].

Public Call for Evidence

The ADG was first issued in 1982 and is revised “to reflect the latest body of scientific evidence on nutrition, diet, and health” [1]. Updates were released in 1992 (second edition), 2003 (third edition), and 2013 (fourth edition).  

Members of the public may submit evidence to be considered in the next stage of the review.  The NHMRC will make a public call for supporting evidence, reviewing evidence submissions that align with the finalized scope and topics under review. If you are interested in taking an active role in ensuring that the latest science on metabolic health is included in the guidelines process, please contact claire@nutritioncoalition.com.

Further information on the review and the public call for evidence is available on the NHMRC website, or via the NHMRC Dietary Guidelines team: dietaryguidelines@nhmrc.gov.au

References

  1. Department of Health and Aged Care.  Review of the Australian Dietary Guideline Briefing: Living Well for Longer July 2020. 

  2. Moynihan R, Lai A, Jarvis H, et alUndisclosed financial ties between guideline writers and pharmaceutical companies: a cross-sectional study across 10 disease categories BMW Open 2019;9:e025864. doi: 10.1136/bmjopen-2018-025864

  3. Cambridge University Press.  Conflicts of Interest for Members of the US 2020 Dietary Guidelines Advisory Committee.  Mialon et al 2022

  4. NHMRC, Dietary Guidelines Expert Committee – Declaration of Interests [2020].

    NHMRC, Dietary Guidelines Governance Committee – Declaration of Interests [2020].

  5. Australian Bureau of Statistics. Overweight and Obesity in Adults, Australia, 2004-05.  2018.

  6. AIHW. Overweight and Obesity An Interactive Insight.  Web report.  Updated Nov 2020.

  7. AIHW.  Australian Burden of Disease Study 2015: Interactive data on risk factor burden. Web report.  Updated 2021.

  8. The BMJ.  Professor Lisa A Bero.  Making nutrition guidelines fit for purpose. 2019.

  9. Michael West Media. Dr. Maryanne Demasi. National diet guidelines: health policy and corporate conflicts. Nov 2018.

  10. Dr. Maryanne Demasi.University of Sydney ‘Low Carb Down Under’. “Who Really Influences Nutrition Policy in Australia”. 2018

  11. The Canberra Times.  Anita Beaumont.  Silent Assassin: Dietary guidelines advice 'too carb-heavy to prevent type 2 diabetes.  December 2021.

  12. NHMRC. EAT FOR HEALTH Australian Dietary Guidelines Summary.  2013.

  13. The BMJ.  Re-evaluation of the traditional diet-heart hypothesis: analysis of recovered data from Minnesota Coronary Experiment.  2016.

  14. The Canberra Times.  Aussie of The Year Demands Diet Rule Overhaul. 2020.  

NHMRC ties disclosed by Committee Members

Research and summary by Belinda Fettke
Committee declarations, here.

Expert Committee:

Sarah McNaughton (Chair)
Colin Binns
Sandra Campbell
Penelope Love
Evangeline Mantzioris
Gita Mishra
Odette Pearson
Trevor Webb - No previous NHMRC ties
Sze Lin Yoong

Governance Committee:

Lisa Bero (Chair)
Bernadette Richards
Hilda Bastian
Davina Ghersi
Ian Olver

8 of 9 members of the Expert Review panel and all Governance Committee members have been recipients of NHMRC funding, been involved on previous NHMCR committees and/or been involved in past dietary guideline development and/or reviews.

EXPERT COMMITTEE

Professor Sarah McNaughton
Received past funding from NHMRC
Receives current funding from NHMRC
Previous NHMRC panel/working group member
Chief Investigator on multiple NHMRC grants in the last 15 years

  • NHMRC Tender; Evidence evaluation for iodine; 2021-Current; $124,805

  • NHMRC Tender; Evidence evaluation for sodium; 2021-Current; $148,806

  • NHMRC Career Development Fellow; 2016-2019

  • NHMRC Investigator Grant Panel – Emerging Leadership Level; 2019

  • NHMRC Project Grant ID1008879; Mgmt of heart disease; 2018-2020; $850,666

  • NHMRC Project Grant ID1144331; 2018-2020; $858,549

  • NHMRC Discretionary Foods and Drinks Expert Working Group; 2018-2020; Sitting fees paid

  • Served on NHMRC Discretionary Foods & Drinks Expert Working Group 2018-20

  • Served on NHMRC Early Career Fellowship Panel; 2014, 2015, 2016, 2018

  • Previously funded by NHMRC Career Development Fellowship 2006-2009

  • NHMRC Funding Postdoctoral Fellowship 2005 - 2009

  • NHMRC Public Health Postgraduate Research Scholarship; 1999-2002

Emeritus Professor Colin Binns
Received past funding from NHMRC
Receives current funding from NHMRC
Previous NHMRC panel/working group member
Assessor of Grant applications for NHMRC

Service on 16 committees of the NHMRC:

  • Inaugural Chair, Dietary Guidelines Working Party, 1982

  • Dietary guidelines for older Australians 1999

  • Co-Chair NHMRC Working Party for the 2003 dietary guidelines review

  • Co-chaired NHMRC Working Party for the Dietary Guidelines for Children and Adolescents in Australia 2003

  • NHMRC Deputy chair of the 2013 dietary guidelines review

  • NHMRC representative before parliamentary committees

  • NHMRC assessor of grant applications; 2013-2021

  • NHMRC; Represented College of General Practitioners on the Vitamin K Working Party; Working Party member (In abeyance at present)

  • NHMRC; Maternal and Child Health services for Indigenous families, 2025

  • NHMRC; Indigenous health care equity 2020-2025

  • NHMRC; National Foundation for Science and Technology Development Collaborative Research 2019-2022

  • NHMRC Member, Advisory Panel on Marketing of Infant Formula, 2001-2010

  • NHMRC Public Health Council Member, 2003-2006

  • NHMRC Chair, Folate Fortification & Neural Tube Defects Working Party 1993-94

  • NHMRC Chair, Working Party on Thiamin Fortification, 1989

  • NHMRC Chair, Nutrition Committee, 1984-1994

  • NHMRC Member, Nutrition Committee, 1981-1994

  • NHMRC Former Member, Iodine Working Party

  • NHMRC Former Chair, Dietary Guidelines for Older Australians Working Party

  • NHMRC Former Chair, Dietary Guidelines for Children Working Party

  • NHMRC Former Chair, Infant Formulae Advisory Committee

Associate Professor Sandra Campbell
Received past funding from NHMRC
Receives current funding from NHMRC
Previous NHMRC Committee and Assessor of Grant applications for NHMRC

  • NHMRC Assessor of grant applications; 2013-2021

  • NHMRC Committee member; Vitamin K Working; 2017-2019

  • NHMRC; Maternal and Child Health services for Indigenous families, Redesigning maternal, newborn and child health services for the best start in life for First Nations families (AI); 2020 - 2025

  • NHMRC; Indigenous health care equity, Strengthening systems for Indigenous healthcare equity; 2020 - 2025

  • NHMRC Global Alliance Chronic Disease; Models of health care for diabetes in pregnancy; 2015 – 2020

  • NHMRC and Western Australian Department of Health; Perinatal mental health screening for Indigenous women; 2017 - 2020

  • NHMRC; Aboriginal and Torres Strait Islander maternal health; 2014 - 2017

  • NHMRC; Antenatal and postnatal care and health promotion for Aboriginal and Torres Strait Islander families in Cape York communities; 2015 - 2017

  • NHMRC; Family centred care for early childhood; 2015 - 2016

  • NHMRC; Prevention of chronic health conditions in high-risk populations; 2012-16

  • NHMRC Centre for Research Excellence: Improving Health Services for Aboriginal & Torres Strait Islander Children via Apunipima Cape York Health Council 2015-16

Dr. Penelope Love
Received past funding from NHMRC
Receives current funding from NHMRC

  • NHMRC Partnership Projects Grant; Evaluating real-world implementation of an evidence-based program addressing lifestyle behaviours from the start of life; 2019/20 - 2023/24

  • NHMRC Partnership Project; A multi-component supermarket intervention to promote healthy eating; 2017-2020 (Coles)

  • NHMRC CRE; Reducing salt intake using food policy interventions; 2017-2021

  • NHMRC CRE; Implementation for Community Chronic Disease Prevention; 2018

  • NHMRC Project Grant; The Strong Families Trial; 2018

  • NHMRC Project Grant; Strengthening the evidence foundation for public health guidelines; 2018

  • Funded as a post-doc through the NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood 2016

Dr Evangeline Mantzioris
Received past funding from NHMRC
Receives current funding from NHMRC

  • NHMRC; Health in Pre-conception & Pregnancy; 2022 - 2023

  • NHMRC; Awarded a CRE Women’s Health in Reproductive Life; 2021

  • NHMRC; Impact of omega-3 supplements on adiposity at 7yrs; 2017 

Professor Gita Mishra
Received past funding from NHMRC
Receives current funding from NHMRC

NHMRC Leadership Fellow (L3) (APP209577); Tackling multimorbidity in women across the life course: Building the evidence for improved prevention strategies and care pathways; 2022 - 2026

  • NHMRC Centre for Research Excellence; Women and Non-Communicable Diseases; 2019 - 2024

  • NHMRC Project Grant; Obesity, Pre-diabetes and Future Risk of Diabetes: Maximising the evidence, minimizing the cost. Pooled analysis to investigate the effects of obesity on Pre-diabetes; 2016 - 2019

  • NHMRC Project grant M-PreM study: Reproductive factors, from menarche to pre-menopause, and the risk of cardiometabolic and respiratory conditions before menopause; 2017 - 2020

  • NHMRC Project Grant; Investigate the association of preconception factors in the development of asthma; 2017 - 2020

  • NHMRC Principal Research Fellowship School of Public Health, University of Queensland; 2017 - 2022

  • NHMRC Principal Research Fellowship; Leveraging women’s health data resources to reduce chronic disease risk & extend health span 2017 – 2022

  • NHMRC Project Grant; The Mother’s & Children’s Health (MatCH) study; 2017

  • NHMRC Project Grant; Health & wellbeing of women after surgical menopause; 2017

  • NHMRC Project Grant; International collaboration for a Life course Approach to reproductive health and Chronis disease Events (InterLACE) project; 2017

  • NHMC Partnership Project, supported by funding from NHRMC and Cancer Councils in New South Wales, Victoria, South Australia and Western Australia; Translating research into practice: outcomes from the Healthy Living after Cancer partnership project; 2017

  • Unrestricted grant by PAL Technologies, UK; including a NHMRC equipment grant; Prospective Physical Activity, Sitting, and Sleep (ProPASS) consortium; 2017

  • The Faculty of Health, Aarhus University, Denmark & the NHMRC; ECRHS/RHINE/RHINESSA study, Asthma and selective migration from farming environments in a three-generation cohort study; 2017

  • NHMRC Project Grant, The Atherosclerosis Risk in Communities study has been funded in whole or in part with Federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services. Recruitment was funded by VicHealth and Cancer Council Victoria. 2017

  • NHMRC Project Grant Schemes, NHMRC European collaborative grant scheme as part of ALEC (Ageing Lungs in European Cohorts funded by the European Union ’s Horizon 2020 research and innovation programme (grant no 633212); Early menarche is associated with lower adult lung function: A longitudinal cohort study from the first to sixth decade of life; 2017

  • NHMRC Australian Research Council Centre of Excellence in Population Ageing Research; Exploring Workforce Participation Patterns and Chronic Diseases Among Middle-Aged Australian Men and Women Over the Life Course; 2013

Dr Odette Pearson
Received past funding from NHMRC
Receives current funding from NHMRC
Reviewer on NHMRC grant panels

  • Reviewer on NHMRC grant panels

  • NHMRC; Leaving no-one behind, Aged care; 2020 – 2024

  • NHMRC; Aboriginal Hospital Liaison Workforce; 2018 – 2023

  • NHMRC; Adolescent Health; 2020 - 2023

  • NHMRC; Kidney Health; 2019 - 2022

  • NHMRC; Social determinants of health and social & emotional wellbeing. 2019–2023

  • NHMRC; Methamphetamine use & web based therapeutic tool; 2016 - 2020

  • NHMRC; Primary Health Care Adolescent services; 2018 - 2020

  • NHMRC; Social consequences of child abuse and neglect; 2016 – 2020

  • NHMRC; Prevention, management and treatment of chronic disease; 2013 - 2018

  • NHMRC; Child health and development data linkage study; 2013 – 2017

  • NHMRC Capacity Building Grant 2007

Adjunct Associate Professor Trevor Webb
No apparent NHMRC funding or appointments

Associate Professor Sze Lin Yoong
Received past funding from NHMRC
Receives current funding from NHMRC

  • NHMRC; Increasing the implementation of physical activity policies into childcare centres; 2019 - current

  • NHMRC; Increasing implementation of chronic disease prevention programs in community-based setting; 2018 - current

  • NHMRC; Assessing the impact of a novel childcare based physical activity intervention on child outcomes; 2016 - 2018

  • NHMRC; Assessing the use of systems-based online technology to increase implementation of dietary guidelines into childcare centres; 2016 - 2019

  • NHMRC Centre for Research Excellence grant; Implementation for Community Chronic Disease Prevention; 2018

  • NHMRC, Flexischools provided the web-based canteen ordering infrastructure to primary schools; 2018

  • NHMRC; Healthy food in childcare; 2015 

GOVERNANCE COMMITEE

 Chair - Professor Lisa Bero
Received past funding from NHMRC
NHMRC Group Member

•   Member, NHMRC Synthesis & Translation of Research Evidence Advisory Group

•   NHMRC project grant 2018-2020 (no-cost extension into 2021)

 

Associate Professor Bernadette Richards
Receives current funding from NHMRC
Current member of NHMRC Committees 

•   Current member of 3 NHMRC Principle Committees as listed;

•   Member of the NHMRC’s Australian Health Ethics Committee

•   Embryo Research Licensing Committee

•   Dietary Guidelines Governance Committee

•   Was the Chair of the Mitochondrial Donation Expert Working Committee

•   Chief investigator on three current major grants,

•   NHMRC Partnership Grant, “Strategies for the inclusion of vulnerable populations in developing complex and sensitive public policy: A case study in Advance Care Planning”

•    NHMRC Ideas Grant, 'The algorithm will see you now: ethical, legal and social implications of adopting machine learning systems for diagnosis and screening'

•   ARC Discovery Grant, 'Support or Sales? Medical Device Representatives in Australian Hospitals'.

 

Dr. Hilda Bastian
Previous NHMRC Funding (acknowledged without providing specific details)
Previous NHMRC Committees

Adjunct Professor Davina Ghersi
NHMRC employed: Senior Principal Research Scientist
NHMRC Council Advisor
NHMRC Advisory Group Chair

  • NHMRC Senior Principal Research Scientist from 2011 - Research Translation Group, NHMRC

  • Senior advisor to the NHMRC Chief Executive Officer on evaluation and use of research evidence, including research funded by NHMRC and clinical practice, public health and environmental health guidelines produced by the agency.

  • NHMRC She provides methodological support across the agency on issues relating to the creation and translation of research evidence. Main interests in publication bias, selective reporting, research transparency and accountability, systematic reviews and meta-analysis, use of evidence in health policy.

  • Chair, NHMRC Synthesis and Translation of Research Evidence Advisory Group (current)

Professor Ian Olver
Received past funding from NHMRC
Receives current funding from NHMRC
Previous NHMRC Council and Committee member, and Chair

This article was amended on 2nd September 2022. An earlier version stated that “All members of both committees have received grants from NHMRC and/or held board or working group positions linked with the agency”, this should have stated all members except one.