The National Academies of Sciences, Engineering and Medicine (NASEM)

Recommendations to HHS-USDA for Establishing Dietary Guidelines

Optimizing the Process for Establishing the Dietary Guidelines for Americans

Report, Part 1

1. The Secretaries of USDA and HHS should employ an external third-party to review and narrow the candidate pool to a list of primary and alternate nominees. Criteria against which nominees are screened should be developed by USDA and HHS for use by the third-party.

2. The Secretaries of USDA and HHS should make a list of provisional appointees open for public comment-including short biographies and any known conflicts-for a reasonable period prior to appointment.

3. The Secretaries of USDA and HHS should disclose how provisional nominees' biases and conflicts of interest are identified and managed by:

a) Creating and publicly posting a policy and form to explicitly disclose financial and nonfinancial biases and conflicts;

b) Developing a management plan for addressing biases and conflicts for the panel as a whole and individuals, as needed;

c) Certifying that a federal ethics officer independently reviewed and judged the advisory committee's biases and conflicts of interest; and by

d) Documenting how conflicts of interest were managed in the Dietary Guidelines Advisory Committee report.

4. The Secretaries of USDA and HHS should adopt a system for continuous process improvement to enhance outcomes and performance of the Dietary Guidelines Advisory Committee selection process.

Redesigning the Process for Establishing the Dietary Guidelines for Americans

Report, Part 2

1. The Secretaries of the U.S. Department of Agriculture (USDA) and the U.S. Department of Health and Human Services (HHS) should redesign the Dietary Guidelines for Americans (DGA) process to prioritize topics to be reviewed in each DGA cycle, and redistribute the current functions of the Dietary Guidelines Advisory Committee to three separate groups:

a) Dietary Guidelines Planning and Continuity Group to monitor and curate evidence generation, to identify and prioritize topics for inclusion in the DGA, and to provide strategic planning support across DGA cycles;

b) Technical expert panels to provide content and methodological consultation during evaluation of the evidence; and

c) Dietary Guidelines Scientific Advisory Committee to interpret the scientific evidence and draw conclusions.

2. The Secretaries of USDA and HHS should provide the public with a clear explanation when the DGA omit or accept only parts of conclusions from the scientific report.

3. The Secretary of USDA should clearly separate the roles of USDA Nutrition Evidence Library (NEL) staff and the Dietary Guidelines Scientific Advisory Committee (DGSAC) such that:

a) The NEL staff plan and conduct systematic reviews with input from technical expert panels, perform risk-of-bias assessment of individual studies, and assist the DGSAC as needed.

b) The NEL systematic reviews are externally peer reviewed prior to being made available for use by the DGSAC.

c) The DGSAC synthesizes and interprets the results of systematic reviews and draws conclusions about the entire body of evidence.

4. The secretary of USDA should ensure all Nutrition Evidence Library (NEL) systematic reviews align with best practices by:

a) Enabling ongoing training of the NEL staff,

b) Enabling engagement with and learning from external groups on the forefront of systematic review methods,

c) Inviting external systematic review experts to periodically evaluate the NEL's methods, and

d) Investing in technological infrastructure.

5. The Secretaries of USDA and HHS should enhance food pattern modeling to better reflect the complex interactions involved, variability in intakes, and range of possible healthful diets.

6. The Secretaries of USDA and HHS should standardize the methods and criteria for establishing nutrients of concern.

7. The Secretaries of USDA and HHS should commission research and evaluate strategies to develop and implement systems approaches into the DGA. The selected strategies should then begin to be used to integrate systems mapping and modeling into the DGA process.