Part 1 of 2 Response To My 11/18/15 FOIA Request Re: 2015 US DGAC Members Barbara Millen, Alice Lichtenstein, Frank Hu

K/t
DEPARTMENT OF HEALTH & HUMAN SERVICES
Program Support Center
^"'"n^f-
Division of FOIA Services
5600 Fishers Lane Rm 19-01

Rockville, Maryland 20857
Phone: 301-443-3403
Fax: 301-480-5862
PSCFileNo.: 16-0040-FOIA; 16-0226-FOIA
April 28, 2016

Peter Heimlich
3630 River Hollow Run
Duluth, GA 30096
Dear Mr. Heimlich:
This is our first interim response to your November 18, 2015 Freedom of Information Act
(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
portions of 55 pages under FOIA Exemptions (b)(6).

Exemption (b)(6) protects information the disclosure of which would constitute a clearly
unwarranted invasion of privacy. The information withheld consists of an individual's personal

information.
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 #
C 0J Mil WOO 100 1001 i-WDU'
demons -b ,~*,^, <*~~ *
Anthony Clemons
Division of FOIA Services
Enclosure: 234 pages on CD
Casavale, Kellie (OS/OASH)

From:
Sent:
To:
Subject:
Lichtenstein, Alice <Alice.Lichtenstein@tufts.edu>

Friday, September 20, 2013 10:39 AM
Nelson, Miriam; Casavale, Kellie (OS/OASH); Goodwin, Stephanie (HHS/OASH); 'Millen,
Barbara E'; 'Perez-Escamilla, Rafael'; 'Rihane, Colette - CNPP'
RE: Subgroup naming
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
Positive message and gives us enough flexibility to address challenges, a.k.a.,

nutrients of concern, under consumed food groups, and quality within foods groups
(refined vs whole grains).
AliceH.Lichtenstein,D.Sc.
GershoffProfessorofNutritionScienceandPolicy
DirectorandSeniorScientist,CardiovascularNutritionLaboratory
TuftsUniversity
JMUSDAHumanNutritionResearchCenteronAging
711WashingtonStreet
Boston,MA02111
phone:6175563127
email:Alice.Lichtenstein@Tufts.edu
From: Nelson, Miriam

Sent: Friday, September 20, 2013 10:11 AM
To: Casavale, Kellie (OS/OASH); Goodwin, Stephanie (HHS/OASH); 'Millen, Barbara E'; 'Perez-Escamilla, Rafael';
Lichtenstein, Alice; 'Rihane, Colette - CNPP'
Cc: Nelson, Miriam
Subject: Subgroup naming
Barbara, Alice, and Kellie,
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
Miriam E. Nelson, PhD

Professor, Friedman School of Nutrition Science and Policy
Tufts University
150 Harrison Avenue, RM 249
Boston, MA 02111
phone: 617-636-3735
fax: 617-636-3727
www.StrongWomen.org
www.ChildObesity180.org
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
-----Original Appointment----From: Casavale, Kellie (OS/OASH)

Sent: Tuesday, June 25, 2013 12:27 PM
To: Olson, Richard (HHS/OASH); 'Nelson, Miriam'; McPeak, Holly (HHS/OASH); Goodwin, Stephanie (HHS/OASH); 'Joann
Thelusma'; '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: Science Review Subcommittee Meeting
When: Friday, September 20, 2013 8:30 AM-10:00 AM (GMT-05:00) Eastern Time (US & Canada).
Where: (b) (6)
ThisisanupdatetothetimefortheSept.20thSRSCcall.Itisnowearlierand30minuteslonger.Rafaelwillnotbeableto
beonthiscallashewillbetravelingbackfromSpain.
Thanks,
Kellie
PSC-HHS-000003

From:
Sent:
To:
Cc:
Subject:
Millen, Barbara E <bmillen@bu.edu>

Thursday, October 17, 2013 2:19 PM
Olson, Richard (HHS/OASH)
RE: Minutes Meeting 1
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
From: Casavale, Kellie (OS/OASH) [mailto:Kellie.Casavale@hhs.gov]

Sent: Thursday, October 17, 2013 11:08 AM
To: Millen, Barbara E
Cc: Olson, Richard (HHS/OASH)
Subject: RE: Minutes Meeting 1
PSC-HHS-000004
Thanks,Barbara!Wearebacktoworktoday.(b) (6)
Justwantedtogiveyouaheadsup.
Wewillbepullingtogetheranyeditswehaveonthemeetingminutesandcanupdatethemonline.Ournewweb
contractormentioneditwouldbeacostlystep,sowewillonlywanttodoitonce.So,wemaywaituntilwehaveany
otherswevefoundintheinterimaswell.
Thanks!
Kellie
From: Millen, Barbara E [mailto:bmillen@bu.edu]

Sent: Wednesday, October 02, 2013 10:47 AM
To: Casavale, Kellie (OS/OASH)
Subject: Minutes Meeting 1
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

From:
Sent:
To:
Cc:
Subject:
Attachments:

Thursday, October 17, 2013 3:07 PM
Olson, Richard (HHS/OASH)
RE: Minutes Meeting 1
AL BEM WG Priority Topics SRSC 10.17.2013.docx
HiKellie,
AliceandIbeganthetaskofstreamliningWG3bysummarizingthetop(1)priorityareasfromeachworkgroupand
reviewingthemforscopeandoverlap.Aspartofthisdiscussionwetriedtothinkcarefullyaboutwhetherthemost
importanttopicswouldbecoveredifwewereonlyabletoanswerquestionsinthistier.Thenwetalkedabouthowto
handleWG3specificallysincewehadagreedinourlastSRSCcallthatthelistofquestionshadtobestreamlined.This
letustotherecommendationtoincorporatefoodgroupsintoWG2questionstotheextentpossible.
Attachedistheworkingdraftwedevelopedandcirculated.LetsaddittotheMondayagendaifyouthinkits
reasonableandwecanseewhetherwecanreachconsensusonareorganizationofthequestionsandouranalytical
strategies.
Allbest,
Barbara
Sent: Thursday, October 17, 2013 2:27 PM
Perfecttiming,Barbara.Rick,Colette,andIjusttouchedbaseandIamabouttosendoutamessagenotingthatweare
stillonfortheSRSCcallonMonday.Adiscussionofwhatyoudescribedbelowwouldbegreat.Ifthereisadocumentfor
metoincludeforthemeetingrelatedtoWG3andthatdiscussion,pleasesenditmywayandIcanincludeit.Wealso
haveseveralotheritemsfordiscussion.Iwillworkonanagendatomorrow.
Thanks!
Kellie

Sent: Thursday, October 17, 2013 2:19 PM
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
7
PSC-HHS-000007

Subject: Minutes Meeting 1
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

From:
Sent:
To:
Cc:
Subject:

Sunday, March 30, 2014 2:02 PM
Essery, Eve - CNPP; Frank Hu; Siega-Riz, Anna Maria; c1anderson@ucsd.edu
Casavale, Kellie (OS/OASH); Obbagy, Julie - CNPP
RE: DGAC SC2: Dietary patterns & CVD, BW, & T2D
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
From: Essery, Eve - CNPP [mailto:Eve.Essery@fns.usda.gov]

Sent: Friday, March 28, 2014 6:07 PM
To: Frank Hu; Siega-Riz, Anna Maria; c1anderson@ucsd.edu; Millen, Barbara E
Cc: 'Casavale, Kellie (OS/OASH)'; Obbagy, Julie - CNPP
Subject: DGAC SC2: Dietary patterns & CVD, BW, & T2D
Hi Frank, Anna Maria, Cheryl, and Barbara,

I just wanted to give you a quick update on the dietary patterns and CVD, BW, and T2D questions. As requested at the
public meeting, Yat Ping conducted a search for existing systematic reviews/ meta-analyses published since 2008. Her
search identified 47 articles. I just finished an abstract review of the articles, and 30 are potentially relevant (with most
articles addressing CVD, but a handful each for body weight and T2D). The next step will be for staff to review the full text
of these articles. It is likely that some of the articles will drop off the list following full text review.
Ive attached the results of the abstract review in case you are interested. Ill send an updated list after the full text review.
From there, the staff will look at reference overlap between the reviews (and the NEL and AHA/ACC reviews), and you
can discuss how best to include these existing systematic reviews/ meta-analyses in your review of the evidence.
I just wanted to let you know that things are moving More soon!
Eve
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
9
PSC-HHS-000009
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
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please notify the sender and delete the email immediately.
10
PSC-HHS-000010

From:
Sent:
To:
Cc:
Subject:

Friday, May 02, 2014 4:40 PM
Lichtenstein, Alice; Anne Rodgers
Casavale, Kellie (OS/OASH); Olson, Richard (HHS/OASH); 'Rihane, Colette - CNPP'
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
From: Lichtenstein, Alice [mailto:Alice.Lichtenstein@tufts.edu]

Sent: Friday, May 02, 2014 4:19 PM
To: Anne Rodgers; Millen, Barbara E
Cc: 'Casavale, Kellie (OS/OASH)'; 'Olson, Richard (HHS/OASH)'; 'Rihane, Colette - CNPP'
Subject: RE: Notes from last night -- notes on integration chapter
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)?
TuftsUniversity
711WashingtonStreet
Boston,MA02111
phone:6175563127
11
PSC-HHS-000011
From: Anne Rodgers (b) (6)

To: 'Millen, Barbara E'; Lichtenstein, Alice
Subject: FW: Notes from last night -- notes on integration chapter
AnneBrownRodgers
ScienceWriter
(b) (6)

Sent: Wednesday, March 19, 2014 3:21 PM
To: Anne Rodgers
Subject: FW: Notes from last night
Thisisthefollowupemail(below)withMimsnotesthatImentionedonthephoneyesterday.SeveralCommittee
membershavealsoaskedfortheupdatedversionofchapterguidance.Whatsthestatusofthatdocument?Areyou
alsogettingtheinputyouneedtomovetheexamplesofconclusionstatementsforward?
Kellie
From: Nelson, Miriam [mailto:Miriam.Nelson@tufts.edu]

Sent: Friday, March 14, 2014 6:14 AM
To: 'bmillen@bu.edu'; mary.story@duke.edu
Cc: Casavale, Kellie (OS/OASH); Lichtenstein, Alice
Subject: Notes from last night
Hi Barbara and Mary,
Great discussion last night late in the dinner about the "synthesis" chapter.
Because I am apt to forget things, I thought I would send along notes on the ideas. I am including Alice on the email
because she prompted the conversation!
Here you go (without word-smithing or considering order):
There is the most evidence for healthy food and nutrition from the following:
1.
2.
3.
4.
5.
7.
8.
Activate health care sector in nutrition/food health promotion

Place matters: improve food environment where you live, work, learn, and play
Respect culture
Calories matter
Eat more: vegetables, fruits, legumes, nuts, and seeds
Eat Less: Added sugars, refined grains, saturated fat, sodium, meats
Move more!
12
PSC-HHS-000012
(I will work on a sustainability one...)

Just didn't want to forget them.
Thanks. Mim
PS: here is the section from 2010 - I know we can do better:
Excerpted verbatim:
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.
2. Shift food intake patterns to a more plant-based diet that

emphasizes vegetables, cooked dry beans and peas, fruits, whole
grains,
nuts, and seeds. In addition, increase the intake of seafood and
fat-free and low-fat milk and milk products, and consume only
moderate amounts of lean meats, poultry, and eggs.
3. Significantly reduce intake of foods containing added sugars and
solid fats because these dietary components contribute excess
calories and few, if any,nutrients. In addition, reduce sodium intake
and lower intake of refined grains, especially refined grains that are
coupled with added sugar, solid fat, and sodium.
4. Meet the 2008 Physical Activity Guidelines for Americans.
Tufts University
Boston, MA 02111
phone: 617-636-3735
fax: 617-636-3727
www.StrongWomen.org
13
PSC-HHS-000013

From:
Sent:
To:
Cc:
Subject:

Friday, May 02, 2014 4:58 PM
Lichtenstein, Alice; Anne Rodgers
Casavale, Kellie (OS/OASH); Olson, Richard (HHS/OASH); 'Rihane, Colette - CNPP'
RE: Notes from last night -- notes on integration chapter
Iagreethatthisisnotourtasktodesignprogramsorservicessincethatispartofthepolicydevelopment
process.However,wearelookingatwhatworksandaretryingtoculloutthedietarypatterns,foodandnutrient
driversofthepatterns,andfeaturesofinterventions(selfmonitoring,comprehensivelifestyleintervention,school
basedandothercommunityprograms,etc.)thathaveproveneffectivenessandefficacyorpresentasbestpractices
whichwecansummarize.Hopethathelpsclarify.
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu

To: Millen, Barbara E; Anne Rodgers
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.
TuftsUniversity
711WashingtonStreet
Boston,MA02111
phone:6175563127
To: Lichtenstein, Alice; Anne Rodgers
14
PSC-HHS-000014
ThankyouAlice.Idoagree;dietaryguidelinesthatarebaseduponourbestunderstandingofnutritionalneedsofthe
populationshouldbethebasisofourguidanceandtheframeworkofourprograms.However,Iwouldaddthatan
improvedunderstandingofthedeterminantsofnutritionalrisk(includingfoodinsecurityandotherfactors)andtheir
relationshiptohealthoutcomesmayhelpusbetterdesignprogramsandinterventionstoreachvulnerablepopulation
orimproveprogram/serviceeffectiveness.Agreed?ThoughtIwouldaddthesefurtherthoughts.
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu

To: Anne Rodgers; Millen, Barbara E
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)?
TuftsUniversity
711WashingtonStreet
Boston,MA02111
phone:6175563127
To: 'Millen, Barbara E'; Lichtenstein, Alice
Subject: FW: Notes from last night -- notes on integration chapter
15
PSC-HHS-000015

AnneBrownRodgers
ScienceWriter
(b) (6)

Sent: Wednesday, March 19, 2014 3:21 PM
To: Anne Rodgers
Subject: FW: Notes from last night
Thisisthefollowupemail(below)withMimsnotesthatImentionedonthephoneyesterday.SeveralCommittee
membershavealsoaskedfortheupdatedversionofchapterguidance.Whatsthestatusofthatdocument?Areyou
alsogettingtheinputyouneedtomovetheexamplesofconclusionstatementsforward?
Kellie
From: Nelson, Miriam [mailto:Miriam.Nelson@tufts.edu]

Sent: Friday, March 14, 2014 6:14 AM
To: 'bmillen@bu.edu'; mary.story@duke.edu
Cc: Casavale, Kellie (OS/OASH); Lichtenstein, Alice
Subject: Notes from last night
Hi Barbara and Mary,
Great discussion last night late in the dinner about the "synthesis" chapter.
Because I am apt to forget things, I thought I would send along notes on the ideas. I am including Alice on the email
because she prompted the conversation!
Here you go (without word-smithing or considering order):
There is the most evidence for healthy food and nutrition from the following:
1.
2.
3.
4.
5.
7.
8.
Activate health care sector in nutrition/food health promotion

Place matters: improve food environment where you live, work, learn, and play
Respect culture
Calories matter
Eat more: vegetables, fruits, legumes, nuts, and seeds
Eat Less: Added sugars, refined grains, saturated fat, sodium, meats
Move more!
(I will work on a sustainability one...)

Just didn't want to forget them.
Thanks. Mim
PS: here is the section from 2010 - I know we can do better:
Excerpted verbatim:
16
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.
2. Shift food intake patterns to a more plant-based diet that

emphasizes vegetables, cooked dry beans and peas, fruits, whole
grains,
nuts, and seeds. In addition, increase the intake of seafood and
fat-free and low-fat milk and milk products, and consume only
moderate amounts of lean meats, poultry, and eggs.
3. Significantly reduce intake of foods containing added sugars and
solid fats because these dietary components contribute excess
calories and few, if any,nutrients. In addition, reduce sodium intake
and lower intake of refined grains, especially refined grains that are
coupled with added sugar, solid fat, and sodium.
4. Meet the 2008 Physical Activity Guidelines for Americans.
Tufts University
Boston, MA 02111
phone: 617-636-3735
fax: 617-636-3727
www.StrongWomen.org
17
PSC-HHS-000017

From:
Sent:
To:
Cc:

Saturday, May 03, 2014 7:06 AM
Siega-Riz, Anna Maria; Frank Hu; Essery, Eve - CNPP
Anderson, Cheryl; Casavale, Kellie (OS/OASH); Obbagy, Julie - CNPP; Anne Rodgers
(b) (6)
Subject:
Attachments:
RE: DGAC SC2: Dietary patterns and CVD, T2D, and BW

CVD.dietary.patterns.Chapter2.4.30.14 bem edits 5 3 2014.docx
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
From: Siega-Riz, Anna Maria [mailto:am_siegariz@unc.edu]

To: Frank Hu; Essery, Eve - CNPP
Cc: Millen, Barbara E; Anderson, Cheryl; Casavale, Kellie (OS/OASH); Obbagy, Julie - CNPP; Anne Rodgers
(b) (6)
Subject: RE: DGAC SC2: Dietary patterns and CVD, T2D, and BW
DearEve,FrankandBarbara;
ImadesomeeditstotheT2DandBWconclusionsandevidence.IalsohadjustafeweditsonFranks.Giventhe
differencesintheamountofdetailsprovidedinthesetwodraftsandthestyleofwriting,itwouldbeveryhelpfullytoall
committeemembersiftheSRCcanprovideinputastowhichispreferred.Iamhappytogowitheither.
Thankyouandhaveagreatweekend.
AMSR
Anna Maria Siega-Riz, PhD, RD

ProfessorofEpidemiologyandNutrition
and
AssociateDeanforAcademicAffairs
GillingsSchoolofGlobalPublicHealth
2105AMcGavranGreenbergHall,CB7435
18
PSC-HHS-000018
ChapelHill,NC27599
Phone:9199628410(CPC);9199665984(Epi)
Email:am siegariz@unc.edu
From: Frank Hu [mailto:nhbfh@channing.harvard.edu]

Sent: Thursday, May 01, 2014 9:24 AM
To: Essery, Eve - CNPP
Cc: Siega-Riz, Anna Maria; Millen, Barbara E; Anderson, Cheryl; Casavale, Kellie (OS/OASH); Obbagy, Julie - CNPP;
Figueroa, Angelica M; PBROWN@hsph.harvard.edu
Subject: Re: DGAC SC2: Dietary patterns and CVD, T2D, and BW
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
Talk to you tomorrow at noon ET (9am PT)!
Call-in number: (b) (6)

Access code: (b) (6)
Webinar: (b) (6)
Thanks,
Eve

-*******************************************************
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
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/
******************************************************
21
PSC-HHS-000021

From:
Sent:
To:
Cc:
Subject:

Sunday, May 04, 2014 10:01 PM
Siega-Riz, Anna Maria; Frank Hu
Essery, Eve - CNPP; Anderson, Cheryl; Casavale, Kellie (OS/OASH); Obbagy, Julie CNPP; Anne Rodgers (b) (6)
RE: DGAC SC2: Dietary patternse and CVD, T2D, and BW
Hi,
Ialsothinkthechapterintroductionoughttosetthestageforthemajorthemesandapproaches,includingmethodof
exposureandoutcomeassessment,patternsandpatternscoring.Thedefinitionandinterpretationoftheexposures
probablyneedsomeparticularexplanationsincewethinkofriskassociatedwithacategory(forexample,quartileor
quintile)andthescoremaycaptureonlypartofthepatternandmaynotreflectcompletecompliancewiththepattern
components.
Allbest,
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
From: Siega-Riz, Anna Maria [mailto:am_siegariz@unc.edu]

Sent: Sunday, May 04, 2014 8:23 PM
To: Frank Hu; Millen, Barbara E
Cc: Essery, Eve - CNPP; Anderson, Cheryl; Casavale, Kellie (OS/OASH); Obbagy, Julie - CNPP; Anne Rodgers
(b) (6)
BarbaraandFrank,
Iagreethatweneedtocometoaconsensusbeforerevising.Itseemsasifintheintroductionofthischapterweshould
definethedietarypatternsandthenforeachoutcomewecansaywhetherthestudiesreviewedfitthestandard
definitionorexplainbrieflyhowtheydeviated.Ifthisisnotdoneupfront,eachofthesesectionsaregoingtogetpretty
longratherquickly.
SC#2hasacallonThursdayIbelievethisisimportantforallofoursubcommitteememberstoparticipatein.
Eve,assoonasStevewritesuphissectioncanyousendthattousreview?
AMSR

Sent: Saturday, May 03, 2014 11:07 AM
Cc: Siega-Riz, Anna Maria; Essery, Eve - CNPP; Anderson, Cheryl; Casavale, Kellie (OS/OASH); Obbagy, Julie - CNPP;
Anne Rodgers (b) (6)
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
On Sat, May 3, 2014 at 7:06 AM, Millen, Barbara E <bmillen@bu.edu> wrote:

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
From: Siega-Riz, Anna Maria [mailto:am siegariz@unc.edu]

Cc: Millen, Barbara E; Anderson, Cheryl; Casavale, Kellie (OS/OASH); Obbagy, Julie - CNPP; Anne Rodgers
(b) (6)
24
PSC-HHS-000024
DearEve,FrankandBarbara;
ImadesomeeditstotheT2DandBWconclusionsandevidence.IalsohadjustafeweditsonFranks.Giventhe
differencesintheamountofdetailsprovidedinthesetwodraftsandthestyleofwriting,itwouldbeveryhelpfullytoall
committeemembersiftheSRCcanprovideinputastowhichispreferred.Iamhappytogowitheither.
Thankyouandhaveagreatweekend.
AMSR
Anna Maria Siega-Riz, PhD, RD

and
ChapelHill,NC27599
Phone:9199628410(CPC);9199665984(Epi)

Sent: Thursday, May 01, 2014 9:24 AM
Cc: Siega-Riz, Anna Maria; Millen, Barbara E; Anderson, Cheryl; Casavale, Kellie (OS/OASH); Obbagy, Julie - CNPP;
Figueroa, Angelica M; PBROWN@hsph.harvard.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,
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.
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.
Talk to you tomorrow at noon ET (9am PT)!

Webinar: (b) (6)
26
PSC-HHS-000026
Thanks,
Eve

-*******************************************************
tel: 617 432 0113 fax: 617 432 2435
******************************************************
27
PSC-HHS-000027
-*******************************************************
tel: 617 432 0113 fax: 617 432 2435
******************************************************
28
PSC-HHS-000028

From:
Sent:
To:
Cc:
Subject:

Wednesday, May 07, 2014 11:58 AM
Frank Hu; Essery, Eve - CNPP; bmillen@bu.edu; Tom Brenna
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]; Fisher,
Rachel (NIH/NIDDK) [E]
RE: FW: DGAC SC 2: Pre-read for Thurs call
I agree with Frank. Link to the teach-in;

http://www.hsph.harvard.edu/news/features/saturated-or-not-does-type-of-fat-matter/
The front part is just set up, move the bar until you see the first speaker.
TuftsUniversity
711WashingtonStreet
Boston,MA02111
phone:6175563127
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
From: (b) (6)

gmail.com [mailto:(b) (6)
gmail.com] On Behalf Of Tom Brenna
Sent: Tuesday, May 06, 2014 9:41 PM
To: Siega-Riz, Anna Maria
Cc: Essery, Eve - CNPP; alice.lichtenstein@tufts.edu; Millen, Barbara E
Subject: Re: DGAC SC 2: Pre-read for Thurs call
Here are a few comments.
Comments on "CVD.dietary.patterns.Chapter2.4.30.14"
(1) Q1: Japanese DP? 100+ papers on Pubmed.
(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.
General comments on CVD.
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.
The Questionable Link Between Saturated Fat and Heart Disease

Are butter, cheese and steak really bad for you? The dubious science behind the anti-fat crusade
<http://online.wsj.com/news/articles/SB10001424052702303678404579533760760481486?tesla=y>
Comment on "Question T2D&BW_summary_5_2_14"
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
I generally concur and have no questions at this time about Q3 conclusions.
Tom
On Tue, May 6, 2014 at 8:49 AM, Siega-Riz, Anna Maria <am_siegariz@unc.edu> wrote:
ThankyouTom.Weighinginhereisimportantforhowwewillproceedwithwritingupourconclusions.Safetravels.
AMSR
From: (b) (6)

Sent: Monday, May 05, 2014 7:38 PM
To: Essery, Eve - CNPP; Siega-Riz, Anna Maria
Cc: alice.lichtenstein@tufts.edu; Millen, Barbara E
Anna Maria, Eve,
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.
Thursdays agenda is coming soon

Best,
Eve

-*******************************************************
33
PSC-HHS-000033

tel: 617 432 0113 fax: 617 432 2435
******************************************************
34
PSC-HHS-000034

From:
Sent:
To:
Cc:
Subject:

Wednesday, May 07, 2014 4:55 PM
Tom Brenna; Frank Hu
Essery, Eve - CNPP; 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]; Fisher, Rachel (NIH/NIDDK) [E]
RE: FW: DGAC SC 2: Pre-read for Thurs call
There is another point. I thought we had a cut-off on publication date prior to

Chowdhury. If we extend it for Chowdhury, we would have to extend it for all topics.
TuftsUniversity
711WashingtonStreet
Boston,MA02111
phone:6175563127
From: (b) (6)
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
Thanks Frank. I'm afraid I don't expect to be on the call tomorrow.

Of course the Chowdhury paper is not about DP but I thought I would raise it while we are looking at DP and
arriving at apparently different conclusions.
As I mentioned, I recognize that the Chowdhury paper has many problems as outlined by your ppt, as was
outlined by Walter W on the Annals website the day after release, and was addressed, at least in part, by the
final release of that paper. That said, it appears your ppt is on the embargoed paper and not the final published
(corrected) one that I sent along (e.g. slide 2, "N-3 polyunsat (long chain)" is listed as 0.84-1.02 but in the final
is 0.78-0.97). I don't think they corrected everything.
I was familiar with Jakobsen and will avoid debating its merits here.
More importantly, the issue of omissions and missed references really should be settled by a systematic review
that gets at the actual source of the differences, as you say, and I'm all for that whatever time it takes.
The WSJ article is indeed a review of the book.
35
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 10:06 AM, Frank Hu <nhbfh@channing.harvard.edu> wrote:

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.
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
From: (b) (6)

Cc: Essery, Eve - CNPP; alice.lichtenstein@tufts.edu; Millen, Barbara E
Here are a few comments.
36
PSC-HHS-000036
Comments on "CVD.dietary.patterns.Chapter2.4.30.14"
(1) Q1: Japanese DP? 100+ papers on Pubmed.
(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.
General comments on CVD.
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
The Questionable Link Between Saturated Fat and Heart Disease

Are butter, cheese and steak really bad for you? The dubious science behind the anti-fat crusade
<http://online.wsj.com/news/articles/SB10001424052702303678404579533760760481486?tesla=y>
Comment on "Question T2D&BW_summary_5_2_14"
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?
I generally concur and have no questions at this time about Q3 conclusions.
Tom
On Tue, May 6, 2014 at 8:49 AM, Siega-Riz, Anna Maria <am_siegariz@unc.edu> wrote:
ThankyouTom.Weighinginhereisimportantforhowwewillproceedwithwritingupourconclusions.Safetravels.
AMSR
From: (b) (6)

Sent: Monday, May 05, 2014 7:38 PM
To: Essery, Eve - CNPP; Siega-Riz, Anna Maria
Cc: alice.lichtenstein@tufts.edu; Millen, Barbara E
Anna Maria, Eve,
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.
Thursdays agenda is coming soon

Best,
Eve

39
PSC-HHS-000039
-*******************************************************
tel: 617 432 0113 fax: 617 432 2435
******************************************************
40
PSC-HHS-000040

From:
Sent:
To:
Subject:
Attachments:

Friday, May 09, 2014 11:36 AM
Mosher, Amber (OS/OASH); Nelson, Miriam (Miriam.Nelson@tufts.edu);
'campbellw@purdue.edu' (campbellw@purdue.edu); Alice Lichtenstein
(alice.lichtenstein@tufts.edu); Liz Rahavi (Elizabeth.rahavi@cnpp.usda.gov); Casavale,
Kellie (OS/OASH); (b) (6)
Psota, Tricia - FNS (Contractor)
RE: MEETING PREP: Materials for PAWG call on 5/9 @ 2:30
Copy of DGAC_PA questions evidence_MN edit_5 7 14 bem edits 5 9 2014.xlsx
Thanksforthesuperbsummarytable.Iwentthroughandaddedcommentsandmadequestionsincertainplaces.In
theoverallconclusionandImplicationsstatement,itwouldseemimportanttoconsiderspecifyingsubgroupsforwhich
thereareconsistentdata(ageandsex)andfortherecommendedtypesofinterventions,thoseforwhichevidenceis
strongest.Iwasntsurefromthesummarieswhethersomeoftheconclusionsweresupportedbydataornot.Things
forthoughtanddiscussion.
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
From: Mosher, Amber (OS/OASH) [mailto:Amber.Mosher@hhs.gov]

To: Nelson, Miriam (Miriam.Nelson@tufts.edu); 'campbellw@purdue.edu' (campbellw@purdue.edu); Alice Lichtenstein
(alice.lichtenstein@tufts.edu); Liz Rahavi (Elizabeth.rahavi@cnpp.usda.gov); Casavale, Kellie (OS/OASH);
(b) (6)
Millen, Barbara E; Psota, Tricia - FNS (Contractor)
Subject: MEETING PREP: Materials for PAWG call on 5/9 @ 2:30
Importance: High
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
Amber L. Mosher, MPH, RD | Prevention Science Fellow

Office of Disease Prevention and Health Promotion
U.S. Department of Health and Human Services
1101 Wootton Parkway, LL-100
Rockville, MD 20852
O: 240 - 453 - 8261 | C: 202 - 815 - 3618
Amber.Mosher@hhs.gov
Dietary Guidelines for Americans | Physical Activity Guidelines for Americans
42
PSC-HHS-000042

From:
Sent:
To:
Subject:

Wednesday, May 14, 2014 2:54 PM
FW: Comments open until June 9 on draft USPSTF recommendation on diet/ physical
activity counseling
Probablyshouldkeeptrackofthis.IsentitontoSC2andSC3leads.Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
From: Millen, Barbara E

To: Anna Maria Siega-Riz, PhD, MS, RD (am_siegariz@unc.edu); 'Perez-Escamilla, Rafael' (rafael.perezescamilla@yale.edu)
Subject: FW: Comments open until June 9 on draft USPSTF recommendation on diet/ physical activity counseling
Thoughtyoubothmightbeinterestedinthisrecentrecommendation.Doesntgosofarastomentionwhoisqualified
toprovidetheintensivebehavioralrecommendationbuttheyareencouragingit.Ithinkwecandoandhavedoneabit
betterinourwording.
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
From: McMurry, Kathryn (NIH/NHLBI) [E] [mailto:kathryn.mcmurry@nih.gov]

Sent: Wednesday, May 14, 2014 11:10 AM
To: 'Donna Ryan'; 'Alison Beale'; 'Anthony G. Comuzzie'; Millen, Barbara E; 'Bruce Wolfe'; Apovian, Caroline; Loria,
Catherine (NIH/NHLBI) [E]; 'Cathy Nonas'; 'F. Xavier Pi-Sunyer'; 'Frank Hu'; Hubbard, Van (NIH/NIDDK) [E]; 'John M.
Jakicic'; 'June Stevens'; 'Michael Jensen'; 'Robert Kushner'; Yanovski, Susan (NIH/NIDDK) [E]; 'Thomas A. Wadden';
'Victor J. Stevens'
Cc: De Jesus, Janet M (NIH/NHLBI) [E]; (b) (6)
Subject: Comments open until June 9 on draft USPSTF recommendation on diet/ physical activity counseling
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
Kathryn Y. McMurry, M.S.

NHLBINutritionCoordinator
3015942094(direct)
3014804907(fax)
Kathryn.McMurry@nih.gov
From: Donna Ryan [mailto:Donna.Ryan@pbrc.edu]

To: Alison Beale; Anthony G. Comuzzie; Barbara Millen; Bruce Wolfe; Caroline M. Apovian; Loria, Catherine (NIH/NHLBI)
[E]; Cathy Nonas; F. Xavier Pi-Sunyer; Frank Hu; Hubbard, Van (NIH/NIDDK) [E]; Jamy Ard; John M. Jakicic; June
Stevens; Karen Donato; McMurry, Kathryn (NIH/NHLBI) [E]; Kelley, Melinda (NIH/NIA/ERP) [E]; Michael Jensen; Robert
Kushner; Yanovski, Susan (NIH/NIDDK) [E]; Thomas A. Wadden; Victor J. Stevens
Cc: Lisa Bradfield; Ezaldeen Ramadhan; Halperin, Jonathan; JeffreyL.Anderson@imail.org; Marco Dibuono (AHA); Adbul
Abdullah (AHA)
Subject: RE: RESPONSE REQUESTED: 2014 LBCT Voting; Obesity - Due Friday, May 23rd
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
From: Alison Beale [mailto:abeale@acc.org]

Sent: Tue 5/13/2014 1:36 PM
To: Anthony G. Comuzzie; Barbara Millen; Bruce Wolfe; Caroline M. Apovian; Catherine Loria; Cathy Nonas; Donna Ryan;
F. Xavier Pi-Sunyer; Frank Hu; Hubbard Van; Jamy Ard; John M. Jakicic; June Stevens; Karen Donato; Kathryn McMurry;
Melinda Kelley; Michael Jensen; Robert Kushner; Susan Yanoviski; Thomas A. Wadden; Victor J. Stevens
Cc: Lisa Bradfield; Ezaldeen Ramadhan; Alison Beale; 'Halperin, Jonathan'; JeffreyL.Anderson@imail.org; Marco Dibuono
(AHA); Adbul Abdullah (AHA)
Subject: RESPONSE REQUESTED: 2014 LBCT Voting; Obesity - Due Friday, May 23rd
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

From:
Sent:
To:
Cc:
Subject:
Attachments:

Sunday, May 25, 2014 8:59 AM
Frank Hu; Essery, Eve - CNPP
Siega-Riz, Anna Maria; alice.lichtenstein@tufts.edu; c1anderson@ucsd.edu; jtb4
@cornell.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]; McDowell, Margaret (NIH/NIDDK) [E]; 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
RE: DGAC SC2: Call THURS @ 1pm ET (10 am PT)
CVD dietary patterns Chapter2 5 20 14 bem edits 5 25 2014.docx
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

Cc: Siega-Riz, Anna Maria; alice.lichtenstein@tufts.edu; 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 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!
Call-in number: (b)

Access code: (b)
(6)
(6)
Web conference: (b)
(6)
AGENDA
1. Science Review SC follow-up [Barbara and Eve]
Timeline goal: Complete draft chapter by end of September
Conception framework: SC feedback requested (attachment)
Implications: Examples from 2010 DGAC (attachment)
2. Updates
SC1 and SC2 crossover dietary patterns composition project (attachment) [Cheryl and Eve]
Sodium [Cheryl]
Dietary patterns and CVD [Frank]
Dietary patterns and T2D and BW [Anna Maria]

48
PSC-HHS-000048
Dietary patterns and cancer [Steve, Marian, or Rafael, if available, or Julie]
Upcoming NEL reviews [Julie]
Next call: Thursday, June 5 from 1:00 to 2:00 pm ET (10:00 to 11:00 am PT)

-*******************************************************
49
PSC-HHS-000049
tel: 617 432 0113 fax: 617 432 2435
******************************************************
50
PSC-HHS-000050

From:
Sent:
To:
Cc:
Subject:

Monday, May 26, 2014 10:14 AM
Frank Hu
Essery, Eve - CNPP; Siega-Riz, Anna Maria; alice.lichtenstein@tufts.edu;
c1anderson@ucsd.edu; jtb4@cornell.edu; steven.clinton@osumc.edu;
frank.hu@channing.harvard.edu; mneuhous@fhcrc.org; rafael.perezescamilla@yale.edu; Olson, Richard (HHS/OASH); Rihane, Colette - CNPP; Bowman,
Shanthy; Obbagy, Julie - CNPP; Fisher, Rachel (NIH/NIDDK) [E]; McDowell, Margaret
(NIH/NIDDK) [E]; 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
ThankyouFrank.Irecommendedconsideringtheadditionalnutrientsbecausepolyunsaturatedfatwasincludedinthe
statement.Ithinkincludingitaswellassodiummakessenseanditwouldsureweniceifwereachedconsensuson
saturatedifnottotalfat.LetsseehowothersmightfeelaboutthatparticularlysaturatedfatsinceIbelievemanyofthe
patternsarerelativelylowinit.Intermsofthefactorandclusterpatterns,IdontrecallwhattheNELreviewconcluded.
Wasitthattherewasntenoughconsensustomakefurtherstatementsaboutnotscoring[methods?
Allbest,
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu

Sent: Monday, May 26, 2014 10:03 AM
Cc: Essery, Eve - CNPP; Siega-Riz, Anna Maria; alice.lichtenstein@tufts.edu; c1anderson@ucsd.edu; jtb4@cornell.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
Thanks, Barbara, for your helpful suggestions.

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
51
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,
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu

52
PSC-HHS-000052

steven.clinton@osumc.edu; frank.hu@channing.harvard.edu; mneuhous@fhcrc.org; rafael.perezescamilla@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
Dear All,
preferences.
Frank
Hi SC2 members,
incorrect.) Thanks!
Call-in number: (b)

Access code: (b)
(6)
(6)
53
PSC-HHS-000053
Web conference:
(b) (6)
AGENDA
2. Updates
Sodium [Cheryl]

54
PSC-HHS-000054
-*******************************************************
tel: 617 432 0113 fax: 617 432 2435
******************************************************
-*******************************************************
tel: 617 432 0113 fax: 617 432 2435
55
PSC-HHS-000055
******************************************************
56
PSC-HHS-000056

From:
Sent:
To:
Cc:
Subject:

Monday, May 26, 2014 5:00 PM
Tom Brenna; Frank Hu
Millen, Barbara E; Essery, Eve - CNPP; Siega-Riz, Anna Maria; 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]; McDowell,
Margaret (NIH/NIDDK) [E]; 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
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.
TuftsUniversity
711WashingtonStreet
Boston,MA02111
phone:6175563127
From: (b) (6)
To: Frank Hu
Cc: Millen, Barbara E; Essery, Eve - CNPP; Siega-Riz, Anna Maria; Lichtenstein, Alice; c1anderson@ucsd.edu;
Angelica Figueroa
Comment on this string:

I support a saturated fat NEL review, perhaps in combination with cholesterol. I agree with many of Frank's
comments about evidence insofar as they urge caution in extrapolating DP reviews to food groups or nutrients.
I'm not sure where the sodium committee stands and reserve judgement until I see how that group will take the
totality of evidence into account.
Tom
57
PSC-HHS-000057
On Mon, May 26, 2014 at 10:44 AM, Frank Hu <nhbfh@channing.harvard.edu> wrote:

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 metaanalyses/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.Irecommendedconsideringtheadditionalnutrientsbecausepolyunsaturatedfatwasincludedinthe
statement.Ithinkincludingitaswellassodiummakessenseanditwouldsureweniceifwereachedconsensuson
saturatedifnottotalfat.LetsseehowothersmightfeelaboutthatparticularlysaturatedfatsinceIbelievemanyofthe
patternsarerelativelylowinit.Intermsofthefactorandclusterpatterns,IdontrecallwhattheNELreviewconcluded.
Wasitthattherewasntenoughconsensustomakefurtherstatementsaboutnotscoring[methods?
Allbest,
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu

Cc: Essery, Eve - CNPP; Siega-Riz, Anna Maria; alice.lichtenstein@tufts.edu; c1anderson@ucsd.edu; jtb4@cornell.edu;
58
PSC-HHS-000058

Angelica Figueroa
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.
I'm not exactly sure your question regarding "otherprospectivecohortliteraturerelatingtouseoffactor/cluster

approacheswhereemptycalorieandWesternpatternsareassociatedwithadverseCVDoutcomesandheart
healthierpatternsarebeneficial."IthoughttheNELhasalreadydonethis.
Frank
HiFranketal,
59
PSC-HHS-000059
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu

steven.clinton@osumc.edu; frank.hu@channing.harvard.edu; mneuhous@fhcrc.org; rafael.perezescamilla@yale.edu; Millen, Barbara E; Olson, Richard (HHS/OASH); Rihane, Colette - CNPP; Bowman,
Angelica Figueroa
Dear All,
60
PSC-HHS-000060
preferences.
Frank
Hi SC2 members,
incorrect.) Thanks!
Call-in number: (b)

Access code: (b)
(6)
(6)
Web conference: (b)
(6)
AGENDA
2. Updates
61
PSC-HHS-000061
Sodium [Cheryl]

62
PSC-HHS-000062
-*******************************************************
tel: 617 432 0113 fax: 617 432 2435
******************************************************
-*******************************************************
tel: 617 432 0113 fax: 617 432 2435
******************************************************
-*******************************************************
tel: 617 432 0113 fax: 617 432 2435
63
PSC-HHS-000063
******************************************************
64
PSC-HHS-000064

From:
Sent:
To:
Subject:

Monday, May 26, 2014 5:02 PM
FW: Bias
Youmightaswellkeepthisonfilesincehereferstothe2015AHAguidelinesbuthemeanstheDGACguidelinessince
thereareno2015AHAguidelines.
GershoffProfessorofNutritionScienceandPolicyDirectorandSeniorScientist,CardiovascularNutritionLaboratory
TuftsUniversityJMUSDAHumanNutritionResearchCenteronAging
711WashingtonStreet
Boston,MA02111
phone:6175563127
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

From:
Sent:
To:
Cc:
Subject:

Tuesday, May 27, 2014 7:35 AM
Perez-Escamilla, Rafael; Lichtenstein, Alice
Tom Brenna; Frank Hu; Essery, Eve - CNPP; Siega-Riz, Anna Maria;
c1anderson@ucsd.edu; steven.clinton@osumc.edu; frank.hu@channing.harvard.edu;
mneuhous@fhcrc.org; Olson, Richard (HHS/OASH); Rihane, Colette - CNPP; Bowman,
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
From: Perez-Escamilla, Rafael [mailto:rafael.perez-escamilla@yale.edu]

Sent: Tuesday, May 27, 2014 6:56 AM
To: Lichtenstein, Alice
Cc: Tom Brenna; Frank Hu; Millen, Barbara E; Essery, Eve - CNPP; Siega-Riz, Anna Maria; c1anderson@ucsd.edu;
steven.clinton@osumc.edu; frank.hu@channing.harvard.edu; mneuhous@fhcrc.org; 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
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
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 May 26, 2014, at 5:00 PM, "Lichtenstein, Alice" <Alice.Lichtenstein@tufts.edu> wrote:
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.
TuftsUniversity
711WashingtonStreet
Boston,MA02111
phone:6175563127
From: (b) (6)
To: Frank Hu
Cc: Millen, Barbara E; Essery, Eve - CNPP; Siega-Riz, Anna Maria; Lichtenstein, Alice;
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
Comment on this string:

I support a saturated fat NEL review, perhaps in combination with cholesterol. I agree with
many of Frank's comments about evidence insofar as they urge caution in extrapolating DP
reviews to food groups or nutrients.
I'm not sure where the sodium committee stands and reserve judgement until I see how that
group will take the totality of evidence into account.
Tom
On Mon, May 26, 2014 at 10:44 AM, Frank Hu <nhbfh@channing.harvard.edu> wrote:

67
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

Cc: Essery, Eve - CNPP; Siega-Riz, Anna Maria; alice.lichtenstein@tufts.edu; c1anderson@ucsd.edu;
jtb4@cornell.edu; steven.clinton@osumc.edu; frank.hu@channing.harvard.edu; mneuhous@fhcrc.org;
68
PSC-HHS-000068
rafael.perez-escamilla@yale.edu; Olson, Richard (HHS/OASH); Rihane, Colette - CNPP; Bowman,

Angelica Figueroa
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.
I'm not exactly sure your question regarding "otherprospectivecohortliteraturerelatingtouseof

factor/clusterapproacheswhereemptycalorieandWesternpatternsareassociatedwith
adverseCVDoutcomesandhearthealthierpatternsarebeneficial."IthoughttheNELhasalready
donethis.
Frank
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.
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu

Cc: Siega-Riz, Anna Maria; alice.lichtenstein@tufts.edu; 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
Mironick, Adrianna; jconnor@fhcrc.org; Bailey, Lauren A.; Knight, Brianna; Angelica Figueroa
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
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!

Web conference: (b) (6)
AGENDA
71
PSC-HHS-000071
2. Updates
SC1 and SC2 crossover dietary patterns composition project (attachment) [Cheryl and
Eve]
Sodium [Cheryl]

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.
-*******************************************************
tel: 617 432 0113 fax: 617 432 2435
******************************************************
-*******************************************************
tel: 617 432 0113 fax: 617 432 2435
******************************************************
-*******************************************************
73
PSC-HHS-000073

tel: 617 432 0113 fax: 617 432 2435
******************************************************
74
PSC-HHS-000074

From:
Sent:
To:
Cc:
Subject:

Thursday, June 05, 2014 3:48 PM
Essery, Eve - CNPP; Frank Hu
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.
TuftsUniversity
711WashingtonStreet
Boston,MA02111
phone:6175563127
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

Subject: RE: DGAC SC2: Call THURS @ 1pm ET (10 am PT)
Correct,IamnotonthecallJune19th.Iamfinewiththemdiscussingthepotentialstrategieswiththeothersduringthat
call.
AMSR

75
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

Sent: Wednesday, June 04, 2014 4:54 PM
To: Siega-Riz, Anna Maria; 'alice.lichtenstein@tufts.edu'; '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'
Cc: '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
Subject: DGAC SC2: Call THURS @ 1pm ET (10 am PT)
Hi SC2 members,
will not be able to join the call. (Cheryl and Barbara I have you as unavailable.) Thanks!
76
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)
2. [30 min] Review of draft conclusions
Dietary patterns and cancer (lung, prostate, breast, colorectal) (Topic team: Steve, Marian, Rafael) [attachments 3
and 4]
3. [20 min] Other items
Saturated fat and cholesterol
Conceptual framework [attachment 5]
Microbiom
e presentation
Talk soon!
Eve

77
PSC-HHS-000077

From:
Sent:
To:
Cc:
Subject:

Thursday, June 05, 2014 4:41 PM
Frank Hu
Essery, Eve - CNPP; Casavale, Kellie (OS/OASH)
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.
TuftsUniversity
711WashingtonStreet
Boston,MA02111
phone:6175563127
Cc: Essery, Eve - CNPP; Casavale, Kellie (OS/OASH)
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

TuftsUniversity
711WashingtonStreet
Boston,MA02111
phone:6175563127

To: Frank Hu; Lichtenstein, Alice
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

79
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

Sent: Wednesday, June 04, 2014 4:54 PM
To: Siega-Riz, Anna Maria; 'alice.lichtenstein@tufts.edu'; 'c1anderson@ucsd.edu'; 'jtb4@cornell.edu';
'Millen, Barbara E'
(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
Subject: DGAC SC2: Call THURS @ 1pm ET (10 am PT)
Hi SC2 members,
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
2. [30 min] Review of draft conclusions
Dietary patterns and cancer (lung, prostate, breast, colorectal) (Topic team: Steve, Marian, Rafael)
[attachments 3 and 4]
3. [20 min] Other items
Saturated fat and cholesterol
Conceptual framework [attachment 5]
Microbiome presentation
Talk soon!
Eve

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From:
Sent:
To:
Cc:
Subject:

Sunday, June 15, 2014 8:59 AM
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]; McDowell, Margaret (NIH/NIDDK) [E]; Wong, Yatping - CNPP; Anne
Mironick, Adrianna; jconnor@fhcrc.org; Bailey, Lauren A.; Knight, Brianna; Angelica
Figueroa
HiFrank,
Thisisexcellent.Ihadbutafewcommentswhereclarificationmightbehelpful.Imadeacommentaboutthe
mode/methodofintervention.TheACC/AHA/NHLBIreportsalsodefinetheinterventionistswhocarriedourthese
evidencebasedRCTs.Wewillhavetodecidewheretoputthisinformationonwhatmethodsworktoimplementthe
dietarypatternstrategies.Itmightbearaseparateconclusion/implicationorcouldbeincorporatedperhapsintothe
existingone.
Manythanks.
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu

Sent: Saturday, June 14, 2014 4:27 PM
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
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
Hi SC2 members,
incorrect.) Thanks!

AGENDA

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2. Updates
Sodium [Cheryl]

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From:
Sent:
To:
Cc:
Subject:

Sunday, June 15, 2014 3:37 PM
Perez-Escamilla, Rafael; Frank Hu; Essery, Eve - CNPP
Goodthoughts.Ialsowonderedifitwouldmakesensetonotethatthehealthypatternscontainedrelativelylowto
moderatefatintake(withrangespecified).Irealizethatthismightbesomewhatcontroversialbutitisconsistentwith
ourdietarypatternapproachandthereportedrangesforDASHandtheothers.
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu

Sent: Sunday, June 15, 2014 1:06 PM
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; Angelica
Figueroa
Dear Frank and colleagues,

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,
Professor of Epidemiology & Public Health
Department of Chronic Disease Epidemiology
135 College Street, Suite 200 (room 216)
88
PSC-HHS-000088
New Haven CT 06510

email: rafael.perez-escamilla@yale.edu
phone: (203) 737-5882
fax: (203) 737-4591
From: Frank Hu [nhbfh@channing.harvard.edu]
steven.clinton@osumc.edu; frank.hu@channing.harvard.edu; mneuhous@fhcrc.org; Perez-Escamilla, Rafael; Millen,
Barbara E; Olson, Richard (HHS/OASH); Rihane, Colette - CNPP; Bowman, Shanthy; Obbagy, Julie - CNPP; Fisher, Rachel
Angelica Figueroa
Dear All,
interested in this.
Thanks
Frank
89
PSC-HHS-000089
Hi SC2 members,
incorrect.) Thanks!
AGENDA
2. Updates
Sodium [Cheryl]

90
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tel: 617 432 0113 fax: 617 432 2435
******************************************************
91
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From:
Sent:
To:
Cc:
Subject:

Sunday, June 15, 2014 5:32 PM
Tom Brenna; Millen, Barbara E
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; 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.; McDowell, Margaret
(NIH/NIDDK) [E]; Fisher, Rachel (NIH/NIDDK) [E]
If you can get a copy of this weeks Time magazine it would be worth it. The cover
story is saturated fat.
TuftsUniversity
711WashingtonStreet
Boston,MA02111
phone:6175563127
From: (b) (6)
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]
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

Figueroa
Dear Frank and colleagues,
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,

New Haven CT 06510
93
PSC-HHS-000093
phone: (203) 737-5882
fax: (203) 737-4591

steven.clinton@osumc.edu; frank.hu@channing.harvard.edu; mneuhous@fhcrc.org; Perez-Escamilla, Rafael; Millen,
Barbara E; Olson, Richard (HHS/OASH); Rihane, Colette - CNPP; Bowman, Shanthy; Obbagy, Julie - CNPP; Fisher, Rachel
Angelica Figueroa
Dear All,
interested in this.
Thanks
Frank
94
PSC-HHS-000094
Hi SC2 members,
incorrect.) Thanks!

AGENDA
2. Updates
95
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Sodium [Cheryl]

96
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tel: 617 432 0113 fax: 617 432 2435
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97
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From:
Sent:
To:
Cc:
Subject:
Attachments:

Monday, June 16, 2014 8:07 AM
Siega-Riz, Anna Maria; c1anderson@ucsd.edu; jtb4@cornell.edu;
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]; McDowell, Margaret (NIH/NIDDK) [E]; 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
5 Usual intake distributions for cholesterol NHANES 2007-10 SFA AHL.docx
Thanks Frank. Looks good to me. Made some comments.
TuftsUniversity
711WashingtonStreet
Boston,MA02111
phone:6175563127
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];
Figueroa
Dear All,
98
PSC-HHS-000098
interested in this.
Thanks
Frank
Hi SC2 members,
incorrect.) Thanks!

AGENDA

99
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2. Updates
Sodium [Cheryl]

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From:
Sent:
To:
Cc:
Subject:
Attachments:

Friday, June 20, 2014 7:36 AM
Essery, Eve - CNPP; 'Frank Hu'; 'Millen, Barbara E'; jtb4@cornell.edu
Casavale, Kellie (OS/OASH); Obbagy, Julie - CNPP
RE: DGAC SC2: Saturated fat (response requested)
image001.emz
I would suggest tweaking one component of the framework.
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
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).
TuftsUniversity
711WashingtonStreet
Boston,MA02111
102
PSC-HHS-000102
phone:6175563127
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)
Hi Frank, Alice, Barbara, and Tom,

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

103
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From:
Sent:
To:
Cc:
Subject:

Friday, June 20, 2014 9:02 AM
Frank Hu; Tom Brenna
Essery, Eve - CNPP; Millen, Barbara E; Casavale, Kellie (OS/OASH); Obbagy, Julie - CNPP
RE: DGAC SC2: Saturated fat (response requested)
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).
TuftsUniversity
711WashingtonStreet
Boston,MA02111
phone:6175563127
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:
I would suggest tweaking one component of the framework.
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
What is the relationship between saturated fat intake when replaced by MUFA and risk
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).
------------------------------------------------------------------------------Alice H. Lichtenstein, D.Sc.

Gershoff Professor of Nutrition Science and Policy
Director and Senior Scientist, Cardiovascular Nutrition Laboratory
Tufts University
JM USDA Human Nutrition Research Center on Aging
711 Washington Street
Boston, MA 02111
phone: 617 556 3127

e-mail: Alice.Lichtenstein@Tufts.edu

To: 'Frank Hu'; Lichtenstein, Alice; 'Millen, Barbara E'; jtb4@cornell.edu
Subject: DGAC SC2: Saturated fat (response requested)
106
PSC-HHS-000106
Hi Frank, Alice, Barbara, and Tom,
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

-*******************************************************
tel: 617 432 0113 fax: 617 432 2435
107
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******************************************************
108
PSC-HHS-000108

From:
Sent:
To:
Cc:
Subject:
Attachments:

Wednesday, July 02, 2014 4:17 PM
Rahavi, Elizabeth - CNPP; Mary Story, Ph.D.
RE: SC 4 Follow Up - Policy Related Questions
DRAFT SC4 - ECE Weight - Key Trends Document 07 01 14 + MS AHL.docx
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.
TuftsUniversity
711WashingtonStreet
Boston,MA02111
phone:6175563127
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
110
PSC-HHS-000110

From:
Sent:
To:
Cc:
Subject:
Attachments:

Monday, July 07, 2014 7:20 AM
Tom Brenna; Siega-Riz, Anna Maria
Perez-Escamilla, Rafael; Essery, Eve - CNPP; alice.lichtenstein@tufts.edu;
Bailey, Lauren A.; Knight, Brianna; Figueroa, Angelica M; Joan Lyon
DP and Birth Defects - Evidence Portfolio 7 3 14 (1) RPE_amsr jtb bem 7 7 2014.docx
Hereareafewadditionalthoughtsrelatingprimarilytowordinggiventhenatureofthestudydesigns.Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
From: (b) (6)

Sent: Sunday, July 06, 2014 8:58 PM
Cc: Perez-Escamilla, Rafael; Essery, Eve - CNPP; alice.lichtenstein@tufts.edu; c1anderson@ucsd.edu;
PBROWN@hsph.harvard.edu; Mironick, Adrianna; jconnor@fhcrc.org; Bailey, Lauren A.; Knight, Brianna; Figueroa,
Angelica M; Joan Lyon
I added a couple of points and comments.

Tom
On Sat, Jul 5, 2014 at 11:33 AM, Siega-Riz, Anna Maria <am_siegariz@unc.edu> wrote:
Herearemyedits.ThankyouRafaelfortakingthelead.
AMSR

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,
111
PSC-HHS-000111
Adrianna; jconnor@fhcrc.org; Bailey, Lauren A.; Knight, Brianna; Figueroa, Angelica M; Joan Lyon
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,

New Haven CT 06510
phone: (203) 737-5882
fax: (203) 737-4591
From: Siega-Riz, Anna Maria [am siegariz@unc.edu]

To: Tom Brenna
frank.hu@channing.harvard.edu; mneuhous@fhcrc.org; Perez-Escamilla, Rafael; Millen, Barbara E; Olson, Richard
Tom
We have noted the difference and once Rafael has had time to review the studies we will discuss.
Thanks
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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.
Overall comment. Differences in methodology are mentioned as making studies difficult to

compare. In some ways yes, but diet is the independent variable assessed in whatever way, so
when no conclusion emerges I would see that as an effect smaller than the method can
detect. Planes, trains, or automobiles,the destination is the same.
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
1. [45 min] Review draft slides for public meeting (attached)
1 hr 45 min for presentation on Thursday, July 17 (first SC report)
Identify areas to be completed
2. [15 min] Updates
Saturated fat (Topic team: FH, AMSR, AHL, BM)

o Librarian conducting search for existing systematic reviews/meta-analyses on saturated fat
and CVD outcomes published from 2009 to present
o Focus on (1) quantitative recommendation and (2) macronutrient replacement
Added sugars (Topic team: MS/MNel, FH, AHL, BM, WC)

o Staff pulling together background information related to added sugars in the 2010 DGAC
report, 2010 DGA, food pattern modeling reports, and recent WHO proposed guidelines
Other topic updates
SC2 In-Person Meeting: Wednesday, July 16 from 1:00 to 3:30 pm ET

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email immediately.
115
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From:
Sent:
To:
Cc:
Subject:
Attachments:

Monday, July 07, 2014 7:26 AM
Tom Brenna; Siega-Riz, Anna Maria
Perez-Escamilla, Rafael; Essery, Eve - CNPP; c1anderson@ucsd.edu;
Millen, Barbara E; Olson, Richard (HHS/OASH); Rihane, Colette - CNPP; Bowman,
Bailey, Lauren A.; Knight, Brianna; Figueroa, Angelica M; Joan Lyon
DP and Birth Defects - Evidence Portfolio 7 3 14 (1) RPE_amsr jtb AHL.docx
Looks very good. I made a few suggested changes.
TuftsUniversity
711WashingtonStreet
Boston,MA02111
phone:6175563127
From: (b) (6)
Sent: Sunday, July 06, 2014 8:58 PM
Cc: Perez-Escamilla, Rafael; Essery, Eve - CNPP; Lichtenstein, Alice; c1anderson@ucsd.edu; steven.clinton@osumc.edu;
I added a couple of points and comments.

Tom
On Sat, Jul 5, 2014 at 11:33 AM, Siega-Riz, Anna Maria <am_siegariz@unc.edu> wrote:
Herearemyedits.ThankyouRafaelfortakingthelead.
AMSR
116
PSC-HHS-000116

To: Siega-Riz, Anna Maria; Tom Brenna
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,

New Haven CT 06510
phone: (203) 737-5882
fax: (203) 737-4591
From: Siega-Riz, Anna Maria [am siegariz@unc.edu]

To: Tom Brenna
frank.hu@channing.harvard.edu; mneuhous@fhcrc.org; Perez-Escamilla, Rafael; Millen, Barbara E; Olson, Richard
117
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.
Overall comment. Differences in methodology are mentioned as making studies difficult to

compare. In some ways yes, but diet is the independent variable assessed in whatever way, so
when no conclusion emerges I would see that as an effect smaller than the method can
detect. Planes, trains, or automobiles,the destination is the same.
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
1. [45 min] Review draft slides for public meeting (attached)
1 hr 45 min for presentation on Thursday, July 17 (first SC report)
Identify areas to be completed
2. [15 min] Updates
Saturated fat (Topic team: FH, AMSR, AHL, BM)

o Librarian conducting search for existing systematic reviews/meta-analyses on saturated fat
and CVD outcomes published from 2009 to present
o Focus on (1) quantitative recommendation and (2) macronutrient replacement
Added sugars (Topic team: MS/MNel, FH, AHL, BM, WC)

o Staff pulling together background information related to added sugars in the 2010 DGAC
report, 2010 DGA, food pattern modeling reports, and recent WHO proposed guidelines
Other topic updates
SC2 In-Person Meeting: Wednesday, July 16 from 1:00 to 3:30 pm ET

119
PSC-HHS-000119

email immediately.
120
PSC-HHS-000120

From:
Sent:
To:
Subject:
Attachments:

Wednesday, July 16, 2014 9:27 AM
RE: Updated Slide Decks: Intro to SC Reports and CM/Next Steps
Intro to SCs Millen DRAFT 7.15.14 for BEM editing 7 16 2015.pptx
HiKelly,
Latenightlastnight.Didntmakeitinuntilnearly2a.m.IlookedattheIntroslidesandIthinktheattacheddocumentis
goodtogo.Manythankstoyouandtherestofourcolleagues/staffwhoreviewedthemandprovidedinput.
Iwilltakeabitoftimelatertogettheconceptualmodelslidesfinalized.
Seeyouinabit.
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu

Sent: Tuesday, July 15, 2014 2:22 PM
Subject: Updated Slide Decks: Intro to SC Reports and CM/Next Steps
Importance: High
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
1101WoottonPkwy,LL117
Rockville,MD20852
(240)4538252
www.DietaryGuidelines.gov
123
PSC-HHS-000123

From:
Sent:
To:
Cc:
Subject:

Wednesday, August 13, 2014 8:16 AM
Nelson, Miriam; Campbell, Wayne W; 'campbellw@purdue.edu'
(campbellw@purdue.edu)
Mosher, Amber (OS/OASH); Liz Rahavi (Elizabeth.rahavi@cnpp.usda.gov);
(b) (6)
Psota, Tricia - FNS (Contractor); Casavale, Kellie (OS/OASH)
RE: PAWG Chapter - next steps?
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.
TuftsUniversity
711WashingtonStreet
Boston,MA02111
phone:6175563127
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

Chair, Affiliated Faculty, Tisch College of Citizenship and Public Service
Lincoln Filene Hall
10 Upper Campus Road
Tufts University
phone: 617-627-4178
www.StrongWomen.org
125
PSC-HHS-000125

From:
Sent:
To:
Subject:

Thursday, August 21, 2014 9:14 AM
RE: Dietary Guidelines Panel to Mull New Sodium Research
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.
TuftsUniversity
711WashingtonStreet
Boston,MA02111
phone:6175563127
Sent: Thursday, August 21, 2014 8:55 AM
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
Dietary Guidelines Panel to Mull New Sodium

Research
By Philip Brasher, CQ Roll Call
In todays Morning Take:
Panels Vice Chairwoman Says Salt Research Merits Study
Farm Bill Subsidies in Line with CBO Estimate, for Now
Score One for Rice Growers
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
Study may not change government sodium advice. (Philip Brasher)

The 2010 guidelines generally recommend a limit of 2,300 milligrams a day, but say that individuals
with hypertension, blacks, and middle-aged and older adults should aim for no more than 1,500
milligrams. The new study, published in the New England Journal of Medicine, found that people
who consume less than the 2,300 milligrams have a higher risk of heart attack or stroke. The average
American consumes 3,400 milligrams a day. The study was the largest of its kind taking a look at the
impact of lower sodium consumption.
Its a huge study, because they took all the data from all these disparate places, and in the most
conservative way, combined it, Lichtenstein said. But we know there are a huge number of factors
that bear on cardiovascular health. Well never be able to disentangle those from a l festyle
perspective.
Lichtenstein added, Taking this out of context is probably not something on which we should
develop policy.
Farm Bill Numbers on Target, for Now. So far, the bean counters at the Congressional Budget
Office are looking like geniuses when it comes to estimating the cost of the new farm bill, at least as
far as the main new subsidy programs go. Scoring farm bills is notoriously hard, given it means
estimating commodity prices years in advance and getting into the minds of farmers to forecast what
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.
128
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.
You are subscribed as scott.carter@fns.usda.gov

To stop or change your subscription, please visit My Subscriptions.
Issue-Id: 33011794:execbriefagriculturefood:1297
130
PSC-HHS-000130

From:
Sent:
To:
Subject:

Thursday, August 21, 2014 10:39 AM
Mosher, Amber (OS/OASH); Casavale, Kellie (OS/OASH)
RE: Dietary Guidelines Panel to Mull New Sodium Research
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.
TuftsUniversity
711WashingtonStreet
Boston,MA02111
phone:6175563127
From: Mosher, Amber (OS/OASH) [mailto:Amber.Mosher@hhs.gov]
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
Amber L. Mosher, MPH, RD

O: 240 - 453 8261
C: 202 815 3618
E: Amber.Mosher@hhs.gov
From: Casavale, Kellie (OS/OASH)

131
PSC-HHS-000131
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
MORNING
TAKE
6 a.m.
Aug. 18, 2014
Blog Home
Dietary Guidelines Panel to Mull New Sodium

Research
By Philip Brasher, CQ Roll Call
In todays Morning Take:
Panels Vice Chairwoman Says Salt Research Merits Study
Farm Bill Subsidies in Line with CBO Estimate, for Now
Score One for Rice Growers
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.
Study may not change government sodium advice. (Philip Brasher)

The 2010 guidelines generally recommend a limit of 2,300 milligrams a day, but say that individuals
with hypertension, blacks, and middle-aged and older adults should aim for no more than 1,500
milligrams. The new study, published in the New England Journal of Medicine, found that people
who consume less than the 2,300 milligrams have a higher risk of heart attack or stroke. The average
American consumes 3,400 milligrams a day. The study was the largest of its kind taking a look at the
impact of lower sodium consumption.
Its a huge study, because they took all the data from all these disparate places, and in the most
conservative way, combined it, Lichtenstein said. But we know there are a huge number of factors
that bear on cardiovascular health. Well never be able to disentangle those from a l festyle
perspective.
Lichtenstein added, Taking this out of context is probably not something on which we should
develop policy.
Farm Bill Numbers on Target, for Now. So far, the bean counters at the Congressional Budget
Office are looking like geniuses when it comes to estimating the cost of the new farm bill, at least as
far as the main new subsidy programs go. Scoring farm bills is notoriously hard, given it means
estimating commodity prices years in advance and getting into the minds of farmers to forecast what
133
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.
You are subscribed as scott.carter@fns.usda.gov

To stop or change your subscription, please visit My Subscriptions.
Issue-Id: 33011794:execbriefagriculturefood:1297
135
PSC-HHS-000135

From:
Sent:
To:
Cc:
Subject:

Thursday, September 04, 2014 4:31 PM
Essery, Eve - CNPP; Siega-Riz, Anna Maria
RE: recommendatgions. Call this Friday
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
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PSC-HHS-000136
examplesoftheinformationthatisbeingrequested.Frank'sassistantjustconfirmedthatFrankwillbeontheSC2call
nextweek.
AnnaMariaApologies,I'vebeenbusygettingsomesaturatedfatandaddedsugarsmaterialsout.I'llreviewyour
sectionASAPlikelyearlynextweek.
Best,
Eve
OriginalMessage
From:Millen,BarbaraE[mailto:bmillen@bu.edu]
To:SiegaRiz,AnnaMaria
Cc:Essery,EveCNPP;KellieCasavale(OS/OASH)
Manythanks.
Dr.BarbaraE.Millen
bmillen@bu.edu
OriginalMessage
From:SiegaRiz,AnnaMaria[mailto:am_siegariz@unc.edu]
To:Millen,BarbaraE
Cc:EveCNPPEssery;KellieCasavale(OS/OASH)
HiBarbara,
ThankyouforthisnoteandIamhappyforyoutoreviewthesectionswrittentoseeifwehaveorcanfurtherbringout
thepointsthatyouhavementionedbelow.IhavecompletedmyseconddraftoftheT2Dconclusions,implicationsand
keyfindings.Ihopetotackletheobesityonenextovertheweekendifpossiblesincethisdoestakelonghoursof
focusedeffort.IsentEveandKellietheT2Ddraftatthebeginningoftheweek.Notsureiftheyhadanyeditsasofyet(
Iamsuretherewillbe)buthereitisforyoutobegintoreview.
TheconclusionandimplicationstatementsforobesityarethelatestversionwehavefromtheJulymeeting.
Bestregards,
AnnaMaria
OriginalMessage
From:Millen,BarbaraE[mailto:bmillen@bu.edu]
To:SiegaRiz,AnnaMaria
Cc:EveCNPPEssery;KellieCasavale(OS/OASH)
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

From:
Sent:
To:
Cc:
Subject:

Sunday, September 07, 2014 12:40 PM
Campbell, Wayne W; Psota, Tricia - CNPP; Alice H. Lichtenstein; Lucile Adams-Campbell;
Mary Story; Mim Nelson; Wayne Campbell
Lauren Bailey; Goyette-Blankenship, Jessica S; Mosher, Amber (OS/OASH); Casavale,
Kellie (OS/OASH); Rihane, Colette - CNPP; Rahavi, Elizabeth - CNPP
RE: RESPONSE REQUESTED: DGAC SC4 Worksite Topic Area
IagreewiththerewordingofthequestionsanditseemsthattheArcherprovidessuitablecontextualinformation.I
wasntsurewhytheGroeneveldwasomitted.WhiletheresultssummarizedonimpactonmostCVDriskfactorsseemed
inconclusive,thesummaryseemstonotethatthateffectsonbodyfatwereobservedforlifestyleinterventions.The
qualityratingseemedreasonabledespitethelimitationsnoted.SinceIwasnotonthecall,Idefertoothersforthe
nuancerelatingtothedecision.
Best,
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
From: Campbell, Wayne W [mailto:campbeww@purdue.edu]

Sent: Sunday, September 07, 2014 10:29 AM
To: Psota, Tricia - CNPP; Alice H. Lichtenstein; Millen, Barbara E; Lucile Adams-Campbell; Mary Story; Mim Nelson;
Wayne Campbell
Cc: Lauren Bailey; Goyette-Blankenship, Jessica S; Mosher, Amber (OS/OASH); Casavale, Kellie (OS/OASH); Rihane,
Colette - CNPP; Rahavi, Elizabeth - CNPP
Subject: RE: RESPONSE REQUESTED: DGAC SC4 Worksite Topic Area
My responses to the questions are below.

Wayne
From: Psota, Tricia - CNPP [tricia.psota@cnpp.usda.gov]
Sent: Friday, September 05, 2014 1:32 PM
To: Alice H. Lichtenstein; Barbara Millen; Lucile Adams-Campbell; Mary Story; Mim Nelson; Wayne Campbell
Cc: Lauren Bailey; Goyette-Blankenship, Jessica S; Mosher, Amber (OS/OASH); Casavale, Kellie (OS/OASH); Rihane,
Colette - CNPP; Rahavi, Elizabeth - CNPP
Subject: RESPONSE REQUESTED: DGAC SC4 Worksite Topic Area
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
Tricia L. Psota, PhD, RDN

Nutritionist
USDA Center for Nutrition Policy and Promotion
Web: Dietary Guidelines | Nutrition Evidence Library | MyPlate

Twitter: @MyPlate | @NutriciaPsota
Facebook: MyPlate
Phone: 703.305.2568
As Americas children head back to school this Fall,

theyll find that The School Day Just Got Healthier!
Click below to find out how and why.
141
PSC-HHS-000141

From:
Sent:
To:
Cc:
Subject:

Tuesday, September 09, 2014 5:16 PM
Casavale, Kellie (OS/OASH); Millen, Barbara E
Olson, Richard (HHS/OASH); Colette Rihane; Shanthy Bowman; Anne Rodgers
RE: Response Needed: DGAC Meeting 6
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.
TuftsUniversity
711WashingtonStreet
Boston,MA02111
phone:6175563127
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
Rockville,MD20852
(240)4538252
143
PSC-HHS-000143

From:
Sent:
To:
Subject:

Wednesday, September 10, 2014 8:55 AM
See notes after each week. I dont know how many members will have teaching
responsibilities in the spring. For me, I dont.
Sent: Wednesday, September 10, 2014 7:52 AM
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

To: Casavale, Kellie (OS/OASH); Millen, Barbara E
Subject: RE: Response Needed: DGAC Meeting 6
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.
144
PSC-HHS-000144
TuftsUniversity
711WashingtonStreet
Boston,MA02111
phone:6175563127
Importance: High
BarbaraandAlice,
Thanks,
Kellie
145
PSC-HHS-000145
Rockville,MD20852
(240)4538252
146
PSC-HHS-000146

From:
Sent:
To:
Cc:
Subject:

Wednesday, September 10, 2014 11:59 AM
Casavale, Kellie (OS/OASH); Lichtenstein, Alice
Olson, Richard (HHS/OASH); Colette Rihane; Shanthy Bowman; Anne Rodgers
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

Importance: High
BarbaraandAlice,
147
PSC-HHS-000147
Thanks,
Kellie
Rockville,MD20852
(240)4538252
148
PSC-HHS-000148

From:
Sent:
To:
Cc:
Subject:
Attachments:

alice.lichtenstein@tufts.edu; jtb4@cornell.edu; Casavale, Kellie (OS/OASH); Obbagy,
Julie - CNPP
RE: DGAC: Sat Fat and CVD
5 Sat Fat and CVD - Key Trends - 9 9 14 bem edits 9 11 2014.docx
Hereyougo.Verynicesummarywithstrongquantifiableoutcomes.Iwouldadvocateacoupleofthingsasnotedinmy
comments,inparticularsomeclarificationonmethodsandmodesofinterventionthataresuccessfulinachievethese
results,whatlevelofPUFAandSFAarerealistictoachieve(basedonthetrialevidenceandpossiblyPCs)sandwhether
thereareanyaddedbenefitsoftotalfatreductionwithPUFAsubstitutionforSFAand/orweightloss.
ManythanksEveandFrankforthisgreatworksoquickly.
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu

Cc: alice.lichtenstein@tufts.edu; Millen, Barbara E; jtb4@cornell.edu; Casavale, Kellie (OS/OASH); Obbagy, Julie - CNPP
Subject: Re: DGAC: Sat Fat and CVD
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).
Please see the following attached:

1. Include/exclude list Please review and let us know if you think something was incorrectly excluded or is missing.
2. Evidence table
149
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?
Let me know if you need anything else.

Eve

-*******************************************************
tel: 617 432 0113 fax: 617 432 2435
150
PSC-HHS-000150
******************************************************
151
PSC-HHS-000151

From:
Sent:
To:
Cc:
Subject:
Attachments:

Millen, Barbara E; Frank Hu; Essery, Eve - CNPP
jtb4@cornell.edu; Casavale, Kellie (OS/OASH); Obbagy, Julie - CNPP
5 Sat Fat and CVD - Key Trends - 9 9 14 bem edits 9 11 2014 AHL.docx
Very nice job Frank. I added my comments to Barbaras.
TuftsUniversity
711WashingtonStreet
Boston,MA02111
phone:6175563127
Cc: Lichtenstein, Alice; jtb4@cornell.edu; Casavale, Kellie (OS/OASH); Obbagy, Julie - CNPP
Subject: RE: DGAC: Sat Fat and CVD
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu

Dear All,
152
PSC-HHS-000152
Frank

2. Evidence table

Eve

153
PSC-HHS-000153
-*******************************************************
tel: 617 432 0113 fax: 617 432 2435
******************************************************
154
PSC-HHS-000154

From:
Sent:
To:
Cc:
Subject:

Tom Brenna
Frank Hu; Essery, Eve - CNPP; alice.lichtenstein@tufts.edu; Casavale, Kellie (OS/OASH);
Obbagy, Julie - CNPP
ThankyouTom,
Iwouldonlyaddthatwhilewerefocusingonthehealthypopulation,ourevidencecertainlydoesincludehighrisk
individuals.Werenotlookingatrehaborinterventionsinthoseposteventbutcertainlythosewithvaryingdegreesof
risk.Justanadditionalthought.Hopefully,thathelpsclarifythings.
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
From: (b) (6)

Cc: Frank Hu; Essery, Eve - CNPP; alice.lichtenstein@tufts.edu; Casavale, Kellie (OS/OASH); Obbagy, Julie - CNPP
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:
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu

Dear All,
Frank
156
PSC-HHS-000156

2. Evidence table

Eve

157
PSC-HHS-000157
-*******************************************************
tel: 617 432 0113 fax: 617 432 2435
******************************************************
158
PSC-HHS-000158

From:
Sent:
To:
Subject:
Attachments:

Tuesday, September 16, 2014 5:52 AM
FW: DGAC SC2: Mtg tomr @ 12:30 pm ET
DGAC Meeting 5 SC2 9 12 14 bem edits 9 16 2014.pptx
Goodmorning!Seemynotebelow.B
Dr.BarbaraE.Millen
bmillen@bu.edu

Sent: Tuesday, September 16, 2014 5:51 AM
To: 'Essery, Eve - CNPP'; Anna Maria Siega-Riz, PhD, MS, RD (am_siegariz@unc.edu)
Cc: 'Neuhouser, Marian L'; 'steven.clinton@osumc.edu'
Subject: RE: DGAC SC2: Mtg tomr @ 12:30 pm ET
HIthere,
Ireviewedthebonehealthslidesanddidafewtweaks.Ihopethisisconsistentonwherewecameoutonthe
implicationsyesterday.IdidntseeanyintheslidedeckIhadsoIaddedacoupleoflinestoreflectthedietarypattern
evidencesummaryandtonotethatweacknowledgetherolesofvitaminDandcalciuminbonehealthacrossall
ages.Hopethismakessense.Ibelievewewillhavethehardcopyofslidesinourbindertoday.Perhapsthesepages
canbeupdated.
Manythanks.
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu

Sent: Sunday, September 14, 2014 8:14 PM
To: 'Siega-Riz, Anna Maria'; 'alice.lichtenstein@tufts.edu'; 'c1anderson@ucsd.edu'; 'jtb4@cornell.edu';
Millen, Barbara E
(NIH/NIDDK) [E]'; 'margaret.mcdowell@nih.gov'; Wong, Yatping - CNPP; 'Anne Rodgers'; 'Casavale, Kellie (OS/OASH)';
'PBROWN@hsph.harvard.edu'; 'jconnor@fhcrc.org'; 'Bailey, Lauren A.'; 'Knight, Brianna'; 'Angelica Figueroa'; Psota, Tricia
- CNPP;(b) (6)
@gmail.com; Julie Obbagy
Subject: DGAC SC2: Mtg tomr @ 12:30 pm ET
Hi SC2 members,
Attached are materials for tomorrows SC2 meeting in the Orange Skybox from 12:30 to 4:30 pm ET. Frank and Rafael
please see the webinar and conference line information.
2015 Dietary Guidelines Advisory Committee
Subcommittee 2: Dietary Patterns, Foods and Nutrients, and Health Outcomes
159
PSC-HHS-000159
Monday, September 15 from 12:30 to 4:30 pm ET

Orange Skybox-1G600 of Building 35, Porter Building
AGENDA
1. Review and finalize materials to be presented at public meeting (presentation is Tuesday from 2:45 to 4:30 pm ET)
a) Dietary patterns and neuro-pysch illnesses (attachments 2-3)
b) Dietary patterns and birth defects (attachment 4)
c) Dietary patterns and bone health (attachment 5)
d) Saturated fat and CVD (*new* draft conclusions) (attachments 6-7)
e) Alcohol (approach)
2. Dietary patterns and CVD, T2D, and BW what works (attachments 8-10)
Thanks and see you tomorrow!
Eve

160
PSC-HHS-000160

From:
Sent:
To:
Cc:
Subject:

Thursday, October 30, 2014 11:00 AM
Neuhouser, Marian L; Essery, Eve - CNPP; 'Siega-Riz, Anna Maria';
'alice.lichtenstein@tufts.edu'; 'c1anderson@ucsd.edu'; 'jtb4@cornell.edu';
'steven.clinton@osumc.edu'; 'frank.hu@channing.harvard.edu'; 'rafael.perezescamilla@yale.edu'
Olson, Richard (HHS/OASH); Rihane, Colette - CNPP; Bowman, Shanthy; Obbagy, Julie CNPP; Fisher, Rachel (NIH/NIDDK) [E]; McDowell, Margaret (NIH/NIDDK) [E]; 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
RE: DGAC SC2: Call TOMR @ 11am ET (8am PT) - DRAFT chapter for review!
SorryMarian.Mycommentonmethodologicallimitationswasthattherangeoflimitationsinthesemethodsmaybias
towardsthenull.Iagreewithyourverypreciseexplanation.Iwasconcernedthoughthatifwedwellontheir
limitationsintheintroductionwithoutsomestrongerstatementoftheiradvantages,itwouldweakenNOTstrengthen
theinterpretationofourconclusions.MycommentwasntterriblyclearsoIhopethishelps.Hopefullymyeditsseem
reasonable.
Manythanks,
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
From: Neuhouser, Marian L [mailto:mneuhous@fredhutch.org]

To: Millen, Barbara E; Essery, Eve - CNPP; 'Siega-Riz, Anna Maria'; 'alice.lichtenstein@tufts.edu'; 'c1anderson@ucsd.edu';
'jtb4@cornell.edu'; 'steven.clinton@osumc.edu'; 'frank.hu@channing.harvard.edu'; 'rafael.perez-escamilla@yale.edu'
'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!
RE:someofthecommentsbelowaboutmeasurementerror.Weshouldnotstatethatmeasurementerrorwillbias
towardsthenullandmakeourconclusionsstrongerbecausethisisnottrue.Confoundingtypicallybiasestowardsthe
null,butnotmeasurementerror.Measurementerrordistortsrelationships(socanartificiallyincreaseordecreasethe
observedassociations),particularlywhenitissystematicmeasurementerror.
Marian

To: Essery, Eve - CNPP; 'Siega-Riz, Anna Maria'; 'alice.lichtenstein@tufts.edu'; 'c1anderson@ucsd.edu';
'jtb4@cornell.edu'; 'steven.clinton@osumc.edu'; 'frank.hu@channing.harvard.edu'; Neuhouser, Marian L; 'rafael.perezescamilla@yale.edu'
161
PSC-HHS-000161
'PBROWN@hsph.harvard.edu'; Connor, Jennifer N; 'Bailey, Lauren A.'; 'Knight, Brianna'; 'Angelica Figueroa'; Fu,
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

Sent: Monday, October 27, 2014 5:46 PM
Millen, Barbara E
'PBROWN@hsph.harvard.edu'; 'jconnor@fhcrc.org'; 'Bailey, Lauren A.'; 'Knight, Brianna'; 'Angelica Figueroa'; Fu,
Subject: DGAC SC2: Call TOMR @ 11am ET (8am PT) - DRAFT chapter for review!
Attached is the DRAFT compiled SC2 chapter (congrats!!). Anna Maria has requested that for tomorrows discussion, you
focus your review on the Chapter Introduction, Methodology, and Summary and come prepared to discuss your
comments, particularly related to any potential gaps in those sections. We will also talk about next steps for the chapter
review. Thanks and talk soon!
Eve
2015 Dietary Guidelines Advisory Committee

Subcommittee 2: Dietary Patterns, Foods and Nutrients, and Health Outcomes
162
PSC-HHS-000162
Tuesday, October 28 from 11:00am to 12:00 pm ET (8:00 to 9:00 am PT)


163
PSC-HHS-000163

From:
Sent:
To:
Cc:
Subject:
Attachments:

Wednesday, November 05, 2014 9:48 AM
Campbell, Wayne W; Obbagy, Julie - CNPP; 'Clinton, Steven'; Anderson, Cheryl;
campbellw@purdue. edu
RE: DGAC: Sodium Working Group -- Na-CVD systematic review - input needed!
Sodium and CVD - Evidence Portfolio 11 3 14 WC 11-5-14 AHL.docx
AddedtoWaynescomments/additions
TuftsUniversity
711WashingtonStreet
Boston,MA02111
phone:6175563127

Sent: Wednesday, November 05, 2014 8:42 AM
To: Obbagy, Julie - CNPP; 'Clinton, Steven'; Anderson, Cheryl; Lichtenstein, Alice; campbellw@purdue. edu
Subject: RE: DGAC: Sodium Working Group -- Na-CVD systematic review - input needed!
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
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
From: Clinton, Steven [mailto:Steven.Clinton@osumc.edu]

Sent: Tuesday, November 04, 2014 8:54 AM
To: Campbell, Wayne W; Anderson, Cheryl; Obbagy, Julie - CNPP; 'Lichtenstein, Alice'
Cc: Essery, Eve - CNPP; campbellw@purdue. edu
Agreewithconceptthatweuseverbatimconclusions.Thatistheonlyoptionunlesswedoanadditional
evaluationofdata.
2. InresponsetoWayne,BPisasurrogatemarkerforriskofcardiovascular/strokeeventsandindicatorofongoing
cardiovasculardisease(aprocess).
3. NothingelsetoaddpriortodiscussiononThursday.
1.

Sent: Monday, November 03, 2014 9:49 AM
To: Anderson, Cheryl; Obbagy, Julie - CNPP; 'Lichtenstein, Alice'; Clinton, Steven
Good morning everyone,

While I do not think omitting the second sentence of conclusion 1 markedly diminishes the message contained in the first
sentence, I suggest we bring the entire statement forward as written. As described in the 'implications' section of the IOM
summary, the second sentence seems to be contextually related to the DRI report that includes sodium, not specifically
the IOM report. Thus, the statement about using BP as a surrogate marker of CVD may be based on evidence beyond the
IOM report. Also, I recall a similar discussion regarding carrying forward conclusions from reports used for the physical
activity chapter. If memory serves, we decided conclusions from existing reports needed to be carried forward word-forword, otherwise the DGAC would be obligated to conduct an independent assessment of the topic.
Thanks
Wayne
From: Anderson, Cheryl [c1anderson@ucsd.edu]
To: Obbagy, Julie - CNPP; Campbell, Wayne W; 'Lichtenstein, Alice'; 'Clinton, Steven'
Julie: thanks.
Members: please reconsider whether knowing that the text was pulled verbatim from those reports influences your
thinking on conclusion 1.
Looking forward to our meeting on Thursday.
Cheryl
To: 'Campbell, Wayne W'; Anderson, Cheryl; 'Lichtenstein, Alice'; 'Clinton, Steven'
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

Sent: Saturday, November 01, 2014 9:48 AM
To: Anderson, Cheryl; Obbagy, Julie - CNPP; 'Lichtenstein, Alice'; 'Clinton, Steven'
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
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
Sent: Friday, October 31, 2014 10:46 AM
To: Obbagy, Julie - CNPP; Anderson, Cheryl; 'Lichtenstein, Alice'; 'Clinton, Steven'; 'Campbell, Wayne W'
HiAll,
JustaremindertosendanyinputyouhaveonthesodiumCVDreviewviatheKeyTrendsdocument.
Haveaniceweekend,
Julie
From: Obbagy, Julie - CNPP

To: Obbagy, Julie - CNPP; 'Anderson, Cheryl'; 'Lichtenstein, Alice'; 'Clinton, Steven'; 'Campbell, Wayne W'
166
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.
167
PSC-HHS-000167
168
PSC-HHS-000168

From:
Sent:
To:
Subject:

Friday, November 07, 2014 8:07 AM
RE: Public Meeting Slides and Reminders: DGAC Meeting 6
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

Sent: Friday, November 07, 2014 7:53 AM
Subject: RE: Public Meeting Slides and Reminders: DGAC Meeting 6
NotheyhaventaslongasyouprintedtheoneswhereIaddedthenamesandpicturesoftheSC/Wgchairsforthe
Integrationpresentation.ThatwasthelastchangeImadetoanyofthemGoingtoloadthemonthecomputernow.
Kellie

Subject: RE: Public Meeting Slides and Reminders: DGAC Meeting 6
Kellie,Haveminechangedatallfromlastnight?IprintedthosealreadyandwonderifIshoulddosoagain?Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu
169
PSC-HHS-000169

To: Alice Lichtenstein, DSc, MS; Anna Maria Siega-Riz, PhD, MS, RD; Millen, Barbara E; Cheryl Anderson, PhD, MS, MPH;
Frank Hu, MD, PhD, MPH; J. Thomas Brenna, PhD, MS; Lucile Adams-Campbell, PhD, MS; Marian Neuhouser, PhD, RD;
Mary Story, PhD, MS, RD; Miriam (Mim) E. Nelson, PhD, MS; Rafael Prez-Escamilla, PhD, MS; Steven Abrams, MD;
Steven Clinton, MD, PhD; Wayne Campbell, PhD, MS
Cc: Angelica Figueroa; Bailey, Lauren A.; Brianna.Knight@osumc.edu; Jennifer Connor; Ms. Lejuana Himes; Patrice
Brown ; Tidings Chan ; anjuli.bodyk@yale.edu; jgoyett@purdue.edu; Olson, Richard (HHS/OASH); Colette Rihane;
McPeak, Holly (HHS/OASH); Mosher, Amber (OS/OASH); Britten, Patricia - CNPP; Essery, Eve - CNPP; Piercy, Katrina
(HHS/OASH); Rahavi, Elizabeth - CNPP; De Jesus, Janet M (NIH/NHLBI) [E]
Subject: Public Meeting Slides and Reminders: DGAC Meeting 6
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

From:
Sent:
To:
Subject:
Attachments:

FW: cross reviews of DGAC chapters and timeline for completing report
Part_D_Ch6__PA 11-17-14_FINAL FOR CROSS-REVIEW AHL.docx
Should have copied you on this, sorry about that.
TuftsUniversity
711WashingtonStreet
Boston,MA02111
phone:6175563127
From: Lichtenstein, Alice
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.
TuftsUniversity
711WashingtonStreet
Boston,MA02111
phone:6175563127
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
Eve.Essery@cnpp.usda.gov; Katrina.Piercy@hhs.gov; elizabeth.Rahavi@cnpp.usda.gov; dejesusjm@nhlbi.nih.gov;

kellie.casavale@hhs.gov
Subject: cross reviews of DGAC chapters and timeline for completing report
Importance: High
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
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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

From:
Sent:
To:
Subject:

Thursday, November 20, 2014 5:03 PM
FW: CSPI Urges Dietary Guidelines Committee to Recommend Pregnant Women Avoid
Caffeine, Coffee
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.
TuftsUniversity
711WashingtonStreet
Boston,MA02111
phone:6175563127
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
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>
To Mike Jacobson <mjacobson@cspinet.org>,
11/19/2014 06:20 PM
cc Frank Hu <frank.hu@channing.harvard.edu>, Mary Story <mary.story@duke.edu>,

"Nelson, Miriam" <miriam.nelson@tufts.edu>, Alice Lichtenstein
<Alice.Lichtenstein@tufts.edu>, Anna Maria Siega-Riz <am_siegariz@unc.edu>
Subject Re: CSPI Urges Dietary Guidelines Committee to Recommend Pregnant Women
Avoid Caffeine, Coffee
thanks, Mike, for your comments.

We actually reviewed this meta-analysis and its methodological issues as well as conclusion carefully. The
study did not identify 100 g caffeine as a risk threshold because it analyzed caffeine as a continuous variable.
Based on their data from the dose-response continuous analysis, the linear positive association was mainly
driven by the higher categories of intake (>300 g/day). One problem is that the meta-analysis mixed cohort
studies with case-control studies, which are prone to recall bias. The authors concluded "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."
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

Executive Director
(o) 202-777-8328
(f) 202-265-4954
176
PSC-HHS-000176
----- Forwarded by M ke Jacobson/Program/CSPI on 11/19/2014 01:00 PM ----News from CSPI/Program/CSPI

11/19/2014 10:20 AM
To News from CSPI/Program/CSPI@CSPI,

cc
Subject CSPI Urges Dietary Guidelines Committee to Recommend Pregnant Women Avoid Caffeine, Coffee
For Immediate Release:

Wednesday, November 19, 2014
Contact:
Jeff Cronin, 202-777-8370 or Ariana Stone, 202-777-8355
CSPI Urges Dietary Guidelines Committee to Recommend Pregnant Women Avoid

Caffeine, Coffee
Group Cites Increased Risk of Miscarriage, Childhood Leukemia
WASHINGTONThe federal government may be poised to give women who are or might become
pregnant bad advice on how much caffeine is safe to consume during pregnancy, according to the
Center for Science in the Public Interest. Draft advice from the governments Dietary Guidelines
Advisory Committee indicates that pregnant women should be sure to limit their caffeine consumption
to 200 milligrams per day. But CSPI says following that advice could increase the risk of adverse
pregnancy outcomes, including spontaneous abortion, stillbirth, preterm delivery, and childhood
leukemia.
The nonprofit group says that the Dietary Guidelines Advisory Committee, which every five years
crafts the governments official nutrition advice, should instead advise pregnant women to avoid
caffeine-containing foods and beverages. In comments filed today CSPI pointed to a recent metaanalysis published in the European Journal of Epidemiology which found that a dose as low as 100
mg per day of caffeine was associated with a 14 percent increase in risk of miscarriage, and a 19
percent increase in the risk of stillbirth. Consumption of 100 mg of caffeine per day was also
associated with increased risks of small-for-gestational-age fetuses and low birth weight. Risks
177
PSC-HHS-000177
increase as caffeine dosages increase, according to the study.

To put 100 mg of caffeine into context, a 16-ounce Grande Starbucks coffee has 330 mg of
caffeine. Coffee you brew at home has between 60-150 mg per 5-ounce cup, depending on how it is
brewed. A 20-ounce bottle of Diet Coke has 78 mg.
Pregnant women deserve accurate advice about the risks caffeine poses to their healthy pregnancy
and have been badly misinformed, said CSPI chief regulatory affairs attorney Laura
MacCleery. The Dietary Guidelines for Americans shouldnt compound this problem by conveying
an impression that 200 milligrams per day is some kind of red line below which caffeine is safe and
above which caffeine is dangerous. Instead, the science indicates that even lower levels of caffeine
can increase the risk of serious problems, including for only a cup or two of regular coffee per day.
CSPIs comments indicate flaws in the advice given to pregnant women by the respected American
College of Obstetricians and Gynecologists, which the Dietary Guidelines Advisory Committee cites in
its draft recommendation. ACOGs analysis of the risk of miscarriage posed by caffeine is thin and
outdated, the group says. While the recent meta-analysis considers 25 separate studies, ACOG
considered only two of those, including the lone study that found no link to an increased risk of
miscarriage.
The Food and Drug Administration used to recommend that pregnant women avoid caffeinated drinks
altogether, or consume them only sparingly. As a general rule, pregnant women should avoid
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
178
PSC-HHS-000178
message with the word 'unsubscribe' in the subject line.

Click here to edit your preferences.
Communications Department
1220 L St., NW Suite 300
(202) 332-9110
cspinews@cspinet.org
-*******************************************************
tel: 617 432 0113 fax: 617 432 2435
******************************************************
179
PSC-HHS-000179

From:
Sent:
To:
Subject:

Thursday, November 20, 2014 5:04 PM
FW: CSPI Urges Dietary Guidelines Committee to Recommend Pregnant Women Avoid
Caffeine, Coffee
more
TuftsUniversity
711WashingtonStreet
Boston,MA02111
phone:6175563127
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.
Effect of reducing caffeine intake on birth weight and length of gestation:

randomised controlled trial.
Bech BH1, Obel C, Henriksen TB, Olsen J.
180
PSC-HHS-000180
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
Executive Director
(o) 202-777-8328
(f) 202-265-4954
Frank Hu <nhbfh@channing.harvard.edu>
To Mike Jacobson <mjacobson@cspinet.org>,
181
PSC-HHS-000181
11/19/2014 06:20 PM
cc Frank Hu <frank.hu@channing.harvard.edu>, Mary Story <mary.story@duke.edu>,

"Nelson, Miriam" <miriam.nelson@tufts.edu>, Alice Lichtenstein
<Alice.Lichtenstein@tufts.edu>, Anna Maria Siega-Riz <am siegariz@unc.edu>
Subject Re: CSPI Urges Dietary Guidelines Committee to Recommend Pregnant Women
Avoid Caffeine, Coffee
thanks, Mike, for your comments.

We actually reviewed this meta-analysis and its methodological issues as well as conclusion carefully. The
study did not identify 100 g caffeine as a risk threshold because it analyzed caffeine as a continuous variable.
Based on their data from the dose-response continuous analysis, the linear positive association was mainly
driven by the higher categories of intake (>300 g/day). One problem is that the meta-analysis mixed cohort
studies with case-control studies, which are prone to recall bias. The authors concluded "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."
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.
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.
182
PSC-HHS-000182
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

Executive Director
(o) 202-777-8328
(f) 202-265-4954
----- Forwarded by M ke Jacobson/Program/CSPI on 11/19/2014 01:00 PM ----News from CSPI/Program/CSPI

11/19/2014 10:20 AM
To News from CSPI/Program/CSPI@CSPI,

cc
Subject CSPI Urges Dietary Guidelines Committee to Recommend Pregnant Women Avoid Caffeine, Coffee
183
PSC-HHS-000183
For Immediate Release:

Wednesday, November 19, 2014
Contact:
Jeff Cronin, 202-777-8370 or Ariana Stone, 202-777-8355
CSPI Urges Dietary Guidelines Committee to Recommend Pregnant Women Avoid

Caffeine, Coffee
Group Cites Increased Risk of Miscarriage, Childhood Leukemia
WASHINGTONThe federal government may be poised to give women who are or might become
pregnant bad advice on how much caffeine is safe to consume during pregnancy, according to the
Center for Science in the Public Interest. Draft advice from the governments Dietary Guidelines
Advisory Committee indicates that pregnant women should be sure to limit their caffeine consumption
to 200 milligrams per day. But CSPI says following that advice could increase the risk of adverse
pregnancy outcomes, including spontaneous abortion, stillbirth, preterm delivery, and childhood
leukemia.
The nonprofit group says that the Dietary Guidelines Advisory Committee, which every five years
crafts the governments official nutrition advice, should instead advise pregnant women to avoid
caffeine-containing foods and beverages. In comments filed today CSPI pointed to a recent metaanalysis published in the European Journal of Epidemiology which found that a dose as low as 100
mg per day of caffeine was associated with a 14 percent increase in risk of miscarriage, and a 19
percent increase in the risk of stillbirth. Consumption of 100 mg of caffeine per day was also
associated with increased risks of small-for-gestational-age fetuses and low birth weight. Risks
increase as caffeine dosages increase, according to the study.
To put 100 mg of caffeine into context, a 16-ounce Grande Starbucks coffee has 330 mg of
caffeine. Coffee you brew at home has between 60-150 mg per 5-ounce cup, depending on how it is
brewed. A 20-ounce bottle of Diet Coke has 78 mg.
Pregnant women deserve accurate advice about the risks caffeine poses to their healthy pregnancy
and have been badly misinformed, said CSPI chief regulatory affairs attorney Laura
MacCleery. The Dietary Guidelines for Americans shouldnt compound this problem by conveying
an impression that 200 milligrams per day is some kind of red line below which caffeine is safe and
above which caffeine is dangerous. Instead, the science indicates that even lower levels of caffeine
can increase the risk of serious problems, including for only a cup or two of regular coffee per day.
CSPIs comments indicate flaws in the advice given to pregnant women by the respected American
College of Obstetricians and Gynecologists, which the Dietary Guidelines Advisory Committee cites in
its draft recommendation. ACOGs analysis of the risk of miscarriage posed by caffeine is thin and
outdated, the group says. While the recent meta-analysis considers 25 separate studies, ACOG
considered only two of those, including the lone study that found no link to an increased risk of
miscarriage.
The Food and Drug Administration used to recommend that pregnant women avoid caffeinated drinks
altogether, or consume them only sparingly. As a general rule, pregnant women should avoid
184
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
1220 L St., NW Suite 300
(202) 332-9110
cspinews@cspinet.org
-*******************************************************
185
PSC-HHS-000185
tel: 617 432 0113 fax: 617 432 2435

******************************************************
-*******************************************************
tel: 617 432 0113 fax: 617 432 2435
******************************************************
-*******************************************************
tel: 617 432 0113 fax: 617 432 2435
******************************************************
186
PSC-HHS-000186

From:
Sent:
To:
Cc:
Subject:

Sunday, November 23, 2014 10:51 AM
Essery, Eve - CNPP; Campbell, Wayne W; Clinton, Steven
Casavale, Kellie (OS/OASH); Obbagy, Julie - CNPP; Millen, Barbara E (bmillen@bu.edu)
RE: DGAC: For review - Sodium chapter content
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.
TuftsUniversity
711WashingtonStreet
Boston,MA02111
phone:6175563127
Sent: Sunday, November 23, 2014 8:28 AM
To: Lichtenstein, Alice; Campbell, Wayne W; Clinton, Steven
Subject: FW: DGAC: For review - Sodium chapter content
Ijustrenamedtheemailsubjectsothateveryoneseesthisisdraftchaptercontentreadyforreview.Seeemailbelow
andtheattachmentThanks!
From: Essery, Eve - CNPP

To: 'Anderson, Cheryl'; 'alice.lichtenstein@tufts.edu'; 'Campbell, Wayne W'; 'steven.clinton@osumc.edu'
Subject: RE: DGAC: Cheryl - Sodium chapter content
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
From: Anderson, Cheryl [mailto:c1anderson@ucsd.edu]

To: Essery, Eve - CNPP; 'alice.lichtenstein@tufts.edu'; 'Campbell, Wayne W'; 'steven.clinton@osumc.edu'
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]
To: Anderson, Cheryl; 'alice.lichtenstein@tufts.edu'; 'Campbell, Wayne W'; 'steven.clinton@osumc.edu'
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

Sent: Saturday, November 15, 2014 8:56 PM
To: Anderson, Cheryl
Cc: Lichtenstein, Alice; 'Campbell, Wayne W'; 'steven.clinton@osumc.edu'; Casavale, Kellie (OS/OASH); Obbagy, Julie CNPP
Subject: DGAC: Sodium chapter content
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

189
PSC-HHS-000189

From:
Sent:
To:
Cc:
Subject:
Attachments:

Monday, November 24, 2014 2:34 PM
Essery, Eve - CNPP; Campbell, Wayne W; Clinton, Steven; Anderson, Cheryl
Casavale, Kellie (OS/OASH); Obbagy, Julie - CNPP; Millen, Barbara E (bmillen@bu.edu)
RE: DGAC: Alice - Sodium
DGAC Sodium section 11-18-14-1_ca edits for comments AHL.docx
Now I know why no one was throwing eggs at me.
TuftsUniversity
711WashingtonStreet
Boston,MA02111
phone:6175563127
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

To: Essery, Eve - CNPP; Campbell, Wayne W; Clinton, Steven
Cc: Casavale, Kellie (OS/OASH); Obbagy, Julie - CNPP; Millen, Barbara E (bmillen@bu.edu)
Subject: RE: DGAC: For review - Sodium chapter content
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

TuftsUniversity
711WashingtonStreet
Boston,MA02111
phone:6175563127
Ijustrenamedtheemailsubjectsothateveryoneseesthisisdraftchaptercontentreadyforreview.Seeemailbelow
andtheattachmentThanks!

To: 'Anderson, Cheryl'; 'alice.lichtenstein@tufts.edu'; 'Campbell, Wayne W'; 'steven.clinton@osumc.edu'
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

To: Essery, Eve - CNPP; 'alice.lichtenstein@tufts.edu'; 'Campbell, Wayne W'; 'steven.clinton@osumc.edu'
Dear SWG: Here is a clean version and a marked up version of the sodium chapter.
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
To: Anderson, Cheryl; 'alice.lichtenstein@tufts.edu'; 'Campbell, Wayne W'; 'steven.clinton@osumc.edu'
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

Cc: Lichtenstein, Alice; 'Campbell, Wayne W'; 'steven.clinton@osumc.edu'; Casavale, Kellie (OS/OASH); Obbagy, Julie CNPP
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
Thank you,
Eve

192
PSC-HHS-000192

From:
Sent:
To:
Cc:
Subject:
Attachments:

Tuesday, November 25, 2014 7:33 AM
Clinton, Steven; 'Anderson, Cheryl'; Essery, Eve - CNPP
Wayne W Campbell; Barbara E Millen; Casavale, Kellie (OS/OASH); Obbagy, Julie CNPP
RE: DGAC: For review - Sodium chapter content
CLINTON DGAC Sodium section 11-18-14-1_ca edits for comments AHL.docx
Added a few more comments.
TuftsUniversity
711WashingtonStreet
Boston,MA02111
phone:6175563127
To: 'Anderson, Cheryl'; Essery, Eve - CNPP
Cc: Lichtenstein, Alice; Wayne W Campbell; Barbara E Millen; Kellie Casavale; Obbagy, Julie - CNPP
Herearemycomments,wanttobeveryspecificandclear,alsoIfavorstrongerstatementabouttheneedfordefinitive
studies.
ConsideringthebillionsspentonDRUGstudies,andevenmoreonHEALTHCARE,weshouldbeabletodoafewgood
studies!

Sent: Sunday, November 23, 2014 3:49 PM
Cc: Alice.Lichtenstein@tufts.edu; Wayne W Campbell; Clinton, Steven; Barbara E Millen; Kellie Casavale; Obbagy, Julie CNPP
Subject: Re: DGAC: For review - Sodium chapter content
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
From:"Lichtenstein,Alice"<Alice.Lichtenstein@tufts.edu>
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
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.
TuftsUniversity
711WashingtonStreet
Boston,MA02111
phone:6175563127
194
PSC-HHS-000194

Ijustrenamedtheemailsubjectsothateveryoneseesthisisdraft
chaptercontentreadyforreview.Seeemailbelowandthe
attachmentThanks!

To: 'Anderson, Cheryl'; 'alice.lichtenstein@tufts.edu'; 'Campbell, Wayne
W'; 'steven.clinton@osumc.edu'
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

To: Essery, Eve - CNPP; 'alice.lichtenstein@tufts.edu'; 'Campbell, Wayne
Dear SWG: Here is a clean version and a marked up version of the

sodium chapter.
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.
195
PSC-HHS-000195
Best,
Cheryl
To: Anderson, Cheryl; 'alice.lichtenstein@tufts.edu'; 'Campbell, Wayne
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

Cc: Lichtenstein, Alice; 'Campbell, Wayne W';
'steven.clinton@osumc.edu'; Casavale, Kellie (OS/OASH); Obbagy, Julie CNPP
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
Thank you,
Eve

196
PSC-HHS-000196
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.
197
PSC-HHS-000197

From:
Sent:
To:
Cc:
Subject:

Anderson, Cheryl
RE: DGAC: Cheryl - Sodium is ready for round 2
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.
TuftsUniversity
711WashingtonStreet
Boston,MA02111
phone:6175563127
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:
Does this have to do with the GRAS list issue?
TuftsUniversity
711WashingtonStreet
Boston,MA02111
phone:6175563127

198
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
To: Campbell, Wayne W; Lichtenstein, Alice; Clinton, Steven; Anderson, Cheryl
Subject: DGAC: Cheryl - Sodium is ready for round 2
HiCheryl,
AttachedisthelatestsodiumsectionwithallcommentscombinedfromAlice(bothsetsofher
comments),Steve,andWayne.Whendoyouthinkyoucanhaveanupdatedversionofthesection
ready?
Thanks!
EveandJulie

To: Lichtenstein, Alice; Clinton, Steven; 'Anderson, Cheryl'; Essery, Eve - CNPP
Here is my 2 cents-worth.
Wayne
From: Lichtenstein, Alice [Alice.Lichtenstein@tufts.edu]
To: Clinton, Steven; 'Anderson, Cheryl'; Essery, Eve - CNPP
Cc: Campbell, Wayne W; Barbara E Millen; Kellie Casavale; Obbagy, Julie - CNPP
Added a few more comments.
TuftsUniversity
711WashingtonStreet
Boston,MA02111
phone:6175563127
199
PSC-HHS-000199

To: 'Anderson, Cheryl'; Essery, Eve - CNPP
Cc: Lichtenstein, Alice; Wayne W Campbell; Barbara E Millen; Kellie Casavale; Obbagy, Julie - CNPP
Herearemycomments,wanttobeveryspecificandclear,alsoIfavorstrongerstatementaboutthe
needfordefinitivestudies.
ConsideringthebillionsspentonDRUGstudies,andevenmoreonHEALTHCARE,weshouldbeableto
doafewgoodstudies!

Sent: Sunday, November 23, 2014 3:49 PM
Cc: Alice.Lichtenstein@tufts.edu; Wayne W Campbell; Clinton, Steven; Barbara E Millen; Kellie Casavale;
Obbagy, Julie - CNPP
Subject: Re: DGAC: For review - Sodium chapter content
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
From:"Essery,EveCNPP"<Eve.Essery@fns.usda.gov>
To:"Alice.Lichtenstein@tufts.edu"<Alice.Lichtenstein@tufts.edu>,
CherylAnderson<c1anderson@ucsd.edu>,WayneWCampbell
<campbeww@purdue.edu>
Subject:Fwd:DGAC:ForreviewSodiumchaptercontent
SentfrommyiPhone
From:"Lichtenstein,Alice"
<Alice.Lichtenstein@tufts.edu>
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
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.
DirectorandSeniorScientist,CardiovascularNutrition
Laboratory
TuftsUniversity
711WashingtonStreet
Boston,MA02111
phone:6175563127

[mailto:Eve.Essery@fns.usda.gov]
To: Lichtenstein, Alice; Campbell, Wayne W; Clinton,
Steven
Subject: FW: DGAC: For review - Sodium chapter
content
Ijustrenamedtheemailsubjectsothateveryonesees
thisisdraftchaptercontentreadyforreview.Seeemail
belowandtheattachmentThanks!
201
PSC-HHS-000201

To: 'Anderson, Cheryl'; 'alice.lichtenstein@tufts.edu';
'Campbell, Wayne W'; 'steven.clinton@osumc.edu'
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

To: Essery, Eve - CNPP; 'alice.lichtenstein@tufts.edu';
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
To: Anderson, Cheryl; 'alice.lichtenstein@tufts.edu';
202
PSC-HHS-000202

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

[mailto:Eve.Essery@fns.usda.gov]
Cc: Lichtenstein, Alice; 'Campbell, Wayne W';
'steven.clinton@osumc.edu'; Casavale, Kellie
(OS/OASH); Obbagy, Julie - CNPP
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

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
203
PSC-HHS-000203
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.
204
PSC-HHS-000204

From:
Sent:
To:
Cc:
Subject:

Essery, Eve - CNPP; 'Siega-Riz, Anna Maria'; 'alice.lichtenstein@tufts.edu';
'c1anderson@ucsd.edu'; 'jtb4@cornell.edu'; 'steven.clinton@osumc.edu'; 'rafael.perezescamilla@yale.edu'; 'Frank Hu'; 'Neuhouser, Marian L'
Obbagy, Julie - CNPP; Casavale, Kellie (OS/OASH)
RE: DGAC SC2: Chapter follow-up
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

'steven.clinton@osumc.edu'; 'rafael.perez-escamilla@yale.edu'; Millen, Barbara E; 'Frank Hu'; 'Neuhouser, Marian L'
Cc: Obbagy, Julie - CNPP; Casavale, Kellie (OS/OASH)
Subject: DGAC SC2: Chapter follow-up
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.
206
PSC-HHS-000206

From:
Sent:
To:
Cc:
Subject:

Thursday, November 27, 2014 4:58 AM
Anderson, Cheryl; Perez-Escamilla, Rafael
Neuhouser, Marian L; Frank Hu; Essery, Eve - CNPP; Siega-Riz, Anna Maria;
alice.lichtenstein@tufts.edu; jtb4@cornell.edu; steven.clinton@osumc.edu; Obbagy,
Julie - CNPP; Casavale, Kellie (OS/OASH)
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

To: Perez-Escamilla, Rafael
Cc: Neuhouser, Marian L; Frank Hu; Essery, Eve - CNPP; Siega-Riz, Anna Maria; alice.lichtenstein@tufts.edu;
jtb4@cornell.edu; steven.clinton@osumc.edu; Millen, Barbara E; Obbagy, Julie - CNPP; Casavale, Kellie (OS/OASH)
Subject: Re: DGAC SC2: Chapter follow-up
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,
Professor of Epidemiology and Public Health
135 College St. (Suite 200)
New Haven CT
Chair, Global Nutrition Council, American Society for Nutrition
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
Cc: Siega-Riz, Anna Maria; alice.lichtenstein@tufts.edu; c1anderson@ucsd.edu;
208
PSC-HHS-000208
jtb4@cornell.edu; steven.clinton@osumc.edu; rafael.perez-escamilla@yale.edu; Millen,

Barbara E; Neuhouser, Marian L; Obbagy, Julie - CNPP; Casavale, Kellie (OS/OASH)
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
On Wed, Nov 26, 2014 at 8:50 AM, Essery, Eve - CNPP

<Eve.Essery@fns.usda.gov> wrote:
Hi SC2 members,
As you all know, there has been a continued, and perhaps growing, interest in lowcarbohydrate 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!!
209
PSC-HHS-000209
Eve

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. 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, lowcalorie, 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.

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.
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.
-*******************************************************
tel: 617 432 0113 fax: 617 432 2435
******************************************************
211
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From:
Sent:
To:
Cc:
Subject:

Sunday, November 30, 2014 4:23 PM
Siega-riz, Anna Maria; Neuhouser, Marian L; Frank Hu; Essery, Eve - CNPP
Millen, Barbara E; c1anderson@ucsd.edu; jtb4@cornell.edu; steven.clinton@osumc.edu;
rafael.perez-escamilla@yale.edu; Obbagy, Julie - CNPP; Casavale, Kellie (OS/OASH)
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.
TuftsUniversity
711WashingtonStreet
Boston,MA02111
phone:6175563127
From: Siega-riz, Anna Maria [mailto:am_siegariz@unc.edu]
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)
Folks,
JulieandtheNELdidconductareviewonlowcarbforusthoughwearenotaddingitasaformalquestionforreasonsthatwe
mentioninthemethodologysection.Overall,thetotalityoftheevidencedoesnotsupportussayingverymuchatall.Itis
attachedforyourreviewandwecandiscussfurtheronthecallthisweek.
Anna Maria Siega-Riz, PhD

and
ChapelHill,NC27599
Phone:9199665984(Epi)or9199626120(CPC)newasof6/18/14;
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
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)
Happy Thanksgiving to everyone!

Hi Eve, Anna Maria, Barbara,
Thanks for the summary of low-carb pattern, which looks very good overall. Attached please find some
comments/edits. Given the popularity of such pattern and enormous amount of research that has been generated
in the past several years, I was wondering if we should have a separate section on low-carb diets rather than
burying it in the Methodology section. People who are familiar with the field may complain that we gloss over
recent evidence and dont give low-carb diets (under many different names: Atkins, eco-Atkins, South Beach,
Paleo, Zone et al.) sufficient attention that they deserve.
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.
Thanks for considering this idea.
Best regards
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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!

To: Essery, Eve - CNPP; 'Siega-Riz, Anna Maria'; 'alice.lichtenstein@tufts.edu'; 'c1anderson@ucsd.edu';
'jtb4@cornell.edu'; 'steven.clinton@osumc.edu'; 'rafael.perez-escamilla@yale.edu'; 'Frank Hu'; 'Neuhouser, Marian L'
Subject: RE: DGAC SC2: Chapter follow-up
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

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PSC-HHS-000214

'steven.clinton@osumc.edu'; 'rafael.perez-escamilla@yale.edu'; Millen, Barbara E; 'Frank Hu'; 'Neuhouser, Marian L'
Subject: DGAC SC2: Chapter follow-up
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

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.
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.

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
215
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.

www.DietaryGuidelines.gov|www.ChooseMyPlate.gov| www.NEL.gov
-*******************************************************
tel: 617 432 0113 fax: 617 432 2435
******************************************************
216
PSC-HHS-000216

From:
Sent:
To:
Cc:
Subject:

Sunday, November 30, 2014 4:33 PM
Mary Story, Ph.D.; Nelson, Miriam
RE: added sugar implication statement
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.
TuftsUniversity
711WashingtonStreet
Boston,MA02111
phone:6175563127
From: Mary Story, Ph.D. [mailto:mary.story@duke.edu]
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

To: Essery, Eve - CNPP; Miriam (Mim) E. Nelson, PhD, MS; alice.lichtenstein@tufts.edu
Cc: Britten, Patricia - CNPP
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

To: Britten, Patricia - CNPP
Cc: Essery, Eve - CNPP; Miriam (Mim) E. Nelson, PhD, MS; alice.lichtenstein@tufts.edu
Thanks Trish for doing this.

My preference is the first choice.
Eve, could you make this change please
Sent from my iPhone
On Nov 26, 2014, at 8:15 AM, "Britten, Patricia - CNPP" <Patricia.Britten@cnpp.usda.gov> wrote:
HiMary,
IsentthetablebelowtoEveyesterdayinanticipationofyourrequest.Alicessuggestedaddition
was:Currently,themeanintakeofaddedsugarsintheU.S.populationis13%,andx%,y%,and
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%

To: Essery, Eve - CNPP; Britten, Patricia - CNPP; 'Miriam (Mim) E. Nelson, PhD, MS'
Cc: 'alice.lichtenstein@tufts.edu'
Subject: added sugar implication statement
HiEve,TrishandMim,
IjustsentEvethefinaldraftwhichhasreceivedinputfromtheAddedSugarsworkinggroup.Alice
hadsomegoodeditsthatIincorporatedintothisnearfinaldraft.Trishpleaselookatthedraft.
Alicesuggestedachangetoaddthemeanpercentintakeofaddedsugarsforchildren,adolescents
andyoungadolescents.Canyouaddthatinfointhetext?
Mim,thefirstparagraphhaschangedslightlybecauseofAlice'seditsandsoifyoupleaselookatit.
Ithinkitislookinggood.
Eve,sendingittoyounowforthenextsteps.
Mary
email immediately.
220
PSC-HHS-000220

From:
Sent:
To:
Cc:
Subject:

Wednesday, December 03, 2014 8:54 AM
Essery, Eve - CNPP
RE: DGAC: For Alice
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.
TuftsUniversity
711WashingtonStreet
Boston,MA02111
phone:6175563127
Sent: Monday, December 01, 2014 10:12 AM
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
222
PSC-HHS-000222

From:
Sent:
To:
Subject:
Attachments:

Friday, December 05, 2014 5:14 AM
RE: For review: 12.5.14 SRSC Meeting 59 Agenda.docx
11 21 14 SRSC Meeting 58 draft notes bem edits 12 5 2014.docx; 12 5 14 SRSC
Meeting 59 Agenda bem edits 12 4 2014.docx
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

Sent: Thursday, December 04, 2014 7:59 PM
Subject: FW: For review: 12.5.14 SRSC Meeting 59 Agenda.docx
Importance: High
BarbaraIdontseethatIhaveheardbackonthisagendaforSRSCtomorrow.Icansenditinthemorning.Butdohavea
fewquestionsinitforyoubeforeIcangetitoutthedoor.Thanks!
Kellie
From: Casavale, Kellie (OS/OASH)

Sent: Wednesday, December 03, 2014 5:11 PM
To: bmillen@bu.edu
Subject: For review: 12.5.14 SRSC Meeting 59 Agenda.docx
Importance: High
223
PSC-HHS-000223

BarbaraAdraftagendaisattachedforSRSCFridayforyourreview.Afewquestionsforyouinit.Ihaveanallday
meetingtomorrowsoIwillsendthisafterCOB/5:30pm.Draftnotesareattachedaswell.
Thanks,
Kellie
224
PSC-HHS-000224

From:
Sent:
To:
Cc:
Subject:
Attachments:

Friday, December 05, 2014 5:55 PM
Lichtenstein, Alice
Casavale, Kellie (OS/OASH); Anne Rodgers; Braunstein, Nadine (OS/OASH)
introduction and Integration
Integrated OVERARCHING THEMES and Recommendations with popultion added bem
12 5 2014 (2).docx; Part B Chapter 1_Introduction_v1_12-5-14.doc
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

To: Anne Rodgers; 'Perez-Escamilla, Rafael'; 'Abrams, Steven A'; Millen, Barbara E; 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: RE: REVISED SATURATED FAT IMPLICATION FOR YOUR REVIEW
Looks fine to me, just one word change.
TuftsUniversity
711WashingtonStreet
Boston,MA02111
225
PSC-HHS-000225

phone:6175563127
From: Anne Rodgers [mailto:abrodgers@verizon.net]
To: 'Perez-Escamilla, Rafael'; 'Abrams, Steven A'; 'Millen, Barbara E'; Lichtenstein, Alice; frank.hu@channing.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

From:
Sent:
To:
Cc:
Subject:
Attachments:

Saturday, December 06, 2014 7:39 AM
Lichtenstein, Alice
RE: introduction and Integration
Part B Chapter 1_Introduction_v1_12-5-14 bem edits 12 6 2015.doc
AniterationonAnneseditstotheintroduction.Barbara
Dr.BarbaraE.Millen
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,
tomorrow.
Manythanks.
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu

227
PSC-HHS-000227
TuftsUniversity
711WashingtonStreet
Boston,MA02111
phone:6175563127
From: Anne Rodgers [mailto:abrodgers@verizon.net]
All,
Thanksverymuch,
Anne
AnneBrownRodgers
ScienceWriter
(b) (6)
228
PSC-HHS-000228

From:
Sent:
To:
Cc:
Subject:
Attachments:

Lichtenstein, Alice
12 6 2014 (3).docx
HiAlice,
AnotheriterationontheIntegrationchapter.Ithinktheformattingismuchbetternowandhopefullythethemesand
recommendationsareclearer,bolderandasspecificaspossible.Iwouldrecommendthatyoureviewitinthefinal
reviewformatsotheeditsarenotsooverwhelming.
Letmeknowwhatyouthinkandifacallwouldbehelpful.
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu

Sent: Saturday, December 06, 2014 6:15 AM
Subject: RE: introduction and Integration
About to leave for a flight back to return to Boston. Will review then.
TuftsUniversity
711WashingtonStreet
Boston,MA02111
phone:6175563127
HIAlice,
229
PSC-HHS-000229
tomorrow.
Manythanks.
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu

TuftsUniversity
711WashingtonStreet
Boston,MA02111
phone:6175563127
All,
230
PSC-HHS-000230
Thanksverymuch,
Anne
AnneBrownRodgers
ScienceWriter
(b) (6)
231
PSC-HHS-000231

From:
Sent:
To:
Cc:
Subject:
Attachments:

Millen, Barbara E
12 5 2014 (2) AHL.docx
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.
TuftsUniversity
711WashingtonStreet
Boston,MA02111
phone:6175563127
232
PSC-HHS-000232

HIAlice,
tomorrow.
Manythanks.
Barbara
Dr.BarbaraE.Millen
bmillen@bu.edu

TuftsUniversity
711WashingtonStreet
Boston,MA02111
phone:6175563127
233
PSC-HHS-000233

All,
Thanksverymuch,
Anne
AnneBrownRodgers
ScienceWriter
(b) (6)
234
PSC-HHS-000234

Part 1 of 2 Response To My 11/18/15 FOIA Request Re: 2015 US DGAC Members Barbara Millen, Alice Lichtenstein, Frank Hu

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Part 1 of 2 Response To My 11/18/15 FOIA Request Re: 2015 US DGAC Members Barbara Millen, Alice Lichtenstein, Frank Hu

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DEPARTMENT OF HEALTH & HUMAN SERVICES

Program Support Center

Division of FOIA Services

5600 Fishers Lane Rm 19-01

PSCFileNo.: 16-0040-FOIA; 16-0226-FOIA

April 28, 2016

portions of 55 pages under FOIA Exemptions (b)(6).

unwarranted invasion of privacy. The information withheld consists of an individual's personal

C 0J Mil WOO 100 1001 i-WDU'

demons -b ,~*,^, <*~~ *

Casavale, Kellie (OS/OASH)

Lichtenstein, Alice <Alice.Lichtenstein@tufts.edu>

Positive message and gives us enough flexibility to address challenges, a.k.a.,

From: Nelson, Miriam

Barbara, Alice, and Kellie,

Miriam E. Nelson, PhD

-----Original Appointment----From: Casavale, Kellie (OS/OASH)

Casavale, Kellie (OS/OASH)

Millen, Barbara E <bmillen@bu.edu>

From: Casavale, Kellie (OS/OASH) [mailto:Kellie.Casavale@hhs.gov]

From: Millen, Barbara E [mailto:bmillen@bu.edu]

Casavale, Kellie (OS/OASH)

Millen, Barbara E <bmillen@bu.edu>

From: Millen, Barbara E [mailto:bmillen@bu.edu]

From: Casavale, Kellie (OS/OASH) [mailto:Kellie.Casavale@hhs.gov]

From: Millen, Barbara E [mailto:bmillen@bu.edu]

Casavale, Kellie (OS/OASH)

Millen, Barbara E <bmillen@bu.edu>

From: Essery, Eve - CNPP [mailto:Eve.Essery@fns.usda.gov]

Hi Frank, Anna Maria, Cheryl, and Barbara,

www.DietaryGuidelines.gov | www.ChooseMyPlate.gov | www.NEL.gov

Casavale, Kellie (OS/OASH)

Millen, Barbara E <bmillen@bu.edu>

From: Lichtenstein, Alice [mailto:Alice.Lichtenstein@tufts.edu]

From: Anne Rodgers (b) (6)

From: Casavale, Kellie (OS/OASH) [mailto:Kellie.Casavale@hhs.gov]

From: Nelson, Miriam [mailto:Miriam.Nelson@tufts.edu]

Activate health care sector in nutrition/food health promotion

(I will work on a sustainability one...)

2. Shift food intake patterns to a more plant-based diet that

Casavale, Kellie (OS/OASH)

Millen, Barbara E <bmillen@bu.edu>

From: Lichtenstein, Alice [mailto:Alice.Lichtenstein@tufts.edu]

From: Lichtenstein, Alice [mailto:Alice.Lichtenstein@tufts.edu]

From: Casavale, Kellie (OS/OASH) [mailto:Kellie.Casavale@hhs.gov]

From: Nelson, Miriam [mailto:Miriam.Nelson@tufts.edu]

Activate health care sector in nutrition/food health promotion

(I will work on a sustainability one...)

2. Shift food intake patterns to a more plant-based diet that

Casavale, Kellie (OS/OASH)

Millen, Barbara E <bmillen@bu.edu>

RE: DGAC SC2: Dietary patterns and CVD, T2D, and BW

From: Siega-Riz, Anna Maria [mailto:am_siegariz@unc.edu]

Anna Maria Siega-Riz, PhD, RD

From: Frank Hu [mailto:nhbfh@channing.harvard.edu]

Talk to you tomorrow at noon ET (9am PT)!

Call-in number: (b) (6)

Eve Essery Stoody, PhD

665 Huntington ave, Boston, MA 02115

Casavale, Kellie (OS/OASH)

Millen, Barbara E <bmillen@bu.edu>

From: Siega-Riz, Anna Maria [mailto:am_siegariz@unc.edu]

demons -b ,~,^, <~~ *