Part D. Chapter 2: Dietary Patterns, Foods and Nutrients, and Health Outcomes - Continued
Needs for Future Research
- Conduct additional dietary patterns research for other health outcomes to strengthen the evidence beyond CVD and body weight in populations of various ethnic backgrounds and life course stages in order for future DGACs to draw stronger conclusions.
Rationale: The NEL systematic reviews demonstrated that considerable CVD research related to dietary patterns is available. However, it also is important to note, that unlike CVD, some of the other health outcomes are more heterogeneous and thus may require greater specificity in the examination of diet and disease risk. There is a clear need for all studies examining the relationship between dietary patterns and health outcomes to include the full age spectrum and to take a life course perspective (including pregnancy); insufficient research is being devoted to children and how diseases may evolve over time. An increased emphasis should be placed on understanding how the diets of all those in the U.S. population from various ethnic backgrounds may be associated with health outcomes, thereby broadening knowledge beyond Hispanics and African Americans to include the diversity that exists in the United States today. This may require our national nutrition monitoring programs to over-sample individuals from other national origins to conduct subgroup analysis.
- Improve the understanding of how to more precisely characterize dietary patterns by their food constituents and the implications of the food constituents on nutrient adequacy through the use of Food Pattern Modeling. More precise characterization, particularly of protein foods, is needed.
Rationale: Researchers are characterizing dietary patterns very differently and yet sometimes use similar nomenclatures. This makes it difficult to compare results across studies and as demonstrated in the NEL systematic reviews, can impair the grading of the body of evidence as strong. The reason why researchers are not replicating others findings in different populations may be a function of publication bias. It is important for editors of scientific journals and peer reviewers to appreciate the replication of findings first and then value a research groups methodological nuance that may improve the examination of the association between dietary patterns and health outcomes. Perhaps what should be stressed is a harmonization of research methods across various cohorts or randomized trials, similar to what is being done at the National Cancer Institutes Dietary Patterns Methods Project9 220 led by Drs. Krebs-Smith and Reedy. The use of Food Pattern Modeling as demonstrated in Part D. Chapter 1: Food and Nutrient Intakes, and Health: Current Status and Trends allows questions about the adequacy of the dietary patterns given specific food constituents to be addressed and how modifications of the patterns by altering the foods for specific population groups or to meet specific nutrient targets can be achieved.
- Examine the long-term cardio-metabolic effects of the various dietary patterns identified in the AHA/ACC/TOS Guidelines for the Management of Overweight and Obesity in Adults that are capable of resulting in short-term weight loss (see Question 2, above).
Rationale: Although 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 cardio-metabolic health are not well known. Emerging research is exploring health effects of variations of the low-carbohydrate, higher protein/fat dietary pattern. In some approaches (such as Atkins), the dietary pattern which emphasizes animal products, may achieve a macronutrient composition that is higher in 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 and dietary fiber. Research is needed to determine the impact of these alternative approaches, and perhaps others, on CVD risk profiles as well as other health outcomes. As mentioned in the review of the literature associated with saturated fat and cardiovascular disease in Part D. Chapter 6: Cross-Cutting Topics of Public Health Importance, substituting one macronutrient for another may result in unintended consequences. 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.