DNPAO Seminar Series April 29, 2021
The 2020-2025 Dietary Guidelines for Americans & How It
Impacts Your Work


Hi,

welcome to the DNPAO webinar series

I'm Janelle Gunn. I'm really excited that

you all have joined us this afternoon

as we restart the DNPAO seminar series

uh for those of you those of you who

don't know DNPAO is the Division of
Nutrition, Physical Activity, and Obesity

at CDC. So we're really excited

you're joining us today um we will be

focusing

on the recently released 2020 to 2025

Dietary Guidelines for Americans. You may

hear some of our speakers refer to these

as the DGAs

um I'm Janelle Gunn I lead the Office of

Policy Partnerships and Communications

in DNPAO

and I'm joined today by three

outstanding

speakers who will highlight different

parts

of the Dietary Guidelines.

The seminar today will focus on the 2020

to 2025 Dietary Guidelines and How it

Impacts Your Work um with three

outstanding speakers for you today who

I’ll introduce. So first, we'll have Dr.

Heather Hamner,


a health scientist in DNPAO. She will

focus on newly added recommendations for

children 0 to 2 years old.

She will be followed by Dr. Jennifer

Seymour, a senior scientist and policy

advisor in DNPAO.

She will draw out some of the key

recommendations including

recommendations to limit added sugars.

Lastly, we are pleased to have Chris

Mornick with us.

Chris is a nutrition coordinator for the

Washington Department of Health,

one of our SPAN recipients the State

Physical Activity Nutrition program,

and she will share a field example of an

application of the Dietary Guidelines.

We'll focus on food service guidelines

and creating a nutrition policy.

So to quickly kind of level set before

we jump in

and I hand the virtual microphone over

to our speakers,

I wanted to just set a little bit of

context about the Dietary Guidelines for

Americans.

As a result of the National Nutrition


Monitoring and Related Research Act of

1990,

every five years the Departments of

Health and Human Services and

Agriculture collaborate to develop

the Dietary Guidelines for Americans.

Each new edition

builds on the previous edition and

covers the preponderance of evidence

and results and guidelines for the

Public. These DGAs serve as federal

nutrition policy, so for us at DNPAO that

means the nutrition work of our

recipients

our SPAN, HOP, High Obesity Program, and

REACH,

Racial and Ethnic Approaches to

Community Health. Their work is also

consistent with the Dietary Guidelines

for Americans.

The DGAs have been largely consistent

over time

um with each edition building on the

previous edition.

There is a focus on dietary patterns as

food and beverages act synergistically

to impact health. In the development of

the dietary guidelines there's four key

stages.

So the first is to identify topics and

supporting scientific questions.

The second is to appoint a dietary

guidelines advisory committee to review

the evidence.

The third is to develop the guideline

and the fourth is where we are now,

implementation of the

of the dietary guide. So this edition’s

theme is to make every bite count

and here's how. The first is to follow a

healthy dietary pattern at every stage

of life.

It's never too early or too late to eat

healthfully.

The second is to customize and enjoy

nutrient-dense

food and beverage choices to reflect

personal preference,

cultural traditions, and budgetary

considerations.

The third is to focus on meeting food

group needs with nutrient-dense foods

and beverages

and stay within a calorie limit. An

underlying premise of the dietary

guidelines

is that nutritional needs should be met

primarily through foods and beverages.

The fourth is to limit foods and

beverages higher in added sugars,

saturated fat, and sodium and to limit

alcoholic beverages.

Now let's start with some of our

littlest consumers. I'm pleased to hand

over the zoom spotlight to Dr. Heather

Hamner. Heather.

Thank you so much for having me. um Today,

I'm going to focus on the

recommendations that were included for

infants and toddlers and as Janelle

mentioned

this is the first time that the Dietary

Guidelines for Americans

have included children birth to 24

months of age.

So it's great to see that we have so

many folks who are able to join us today

and as we start this presentation I

thought it might be fun to just see how

many organizations

are focusing their efforts on uh

children birth to 24 months of age, So

take a moment

answer the poll we'll get those results

probably back to you towards the end of

the presentation.

The dietary guidelines provide several

key high-level recommendations for this

particular age group.

Today what I'd like to do is walk

through each of these in just a little

bit more detail

and then I'm going to conclude with some

examples of how CDC is working

to incorporate the guidelines into the

work that we do. 

So, the first recommendation is about

feeding infants

human milk for the first six months.

Human milk is the ideal form of

nutrition

as it provides the necessary nutrients,

the protective factors,

and other immunological benefits.

If human milk is unavailable, infants can be

fed an iron fortified

commercial infant formula. Safe handling

and storage 

both for expressed human milk as well as

infant formula

are important and I'm going to highlight

a couple of resources that CDC has

developed

a little bit later in this presentation.

An important thing to note is that

homemade infant formula

as well as those that are improperly or

illegally imported

without a mandated FDA review, should not

be used.

Lastly when human milk is obtained

directly from

individuals or through the internet the

donor is unlikely to have been screened

for infectious diseases

and it's unknown whether the human milk

has been collected

or stored in a way that could reduce the

safety risk for the baby. 

So vitamin D is an important mineral

that supports healthy bone growth.

Infants who are only fed human milk or

if they receive both human milk and

infant formula,

often this is called mixed feeding, need

a vitamin supplement,

Vitamin D supplement of 400

international units per day

beginning soon after birth. For those

infants who are fed infant formula

a Vitamin D supplement is not needed as

infant formula is fortified with Vitamin

D.

Now after 12 months of age, it can still

be challenging to get adequate amounts

of Vitamin D

from foods and beverages even when

consuming a varied diet.

This suggests that many children may

need to continue taking a Vitamin D

supplement,

so it's best to talk with a healthcare

professional.

The third key recommendation is around

offering infants

a variety of complementary foods and

beverages

that meet their caloric and nutrient

needs while limiting

things like added sugar and sodium.

At about six months of age infants can

be introduced to nutrient-dense

complementary foods, specifically iron

and zinc-rich foods are important during

this time period.

Variety and repeated exposures of foods

is another component

of this recommendation. Children can be

introduced to multiple flavors

textures and different food groups and

it can take up to eight to ten different

times for an infant to

accept a new food. Now in the second half

of infancy,

as an infant's oral skills begin to

develop,

the thickness and the texture of foods

can gradually be varied,

but it's important to make sure that the

foods are prepared in a way that's

developmentally appropriate

to help prevent choking.

Potentially allergenic foods can be

introduced

along with other complementary foods.

There is no evidence that delaying the

introduction of these foods

helps to prevent a food allergy.

Introducing peanut-containing foods in

the first year

can reduce the risk that an infant will

develop an allergy to peanuts.

Cow milk products, like yogurt, can be

introduced with other complementary

foods,

but cow milk as a beverage should be

introduced

at 12 months or later.

So, the next recommendation is about a

variety of food sources.

Children should consume a nutrient dense,

diverse

diet that includes foods for multiple

food groups

Protein, vegetables, and fruits, yogurt,

and cheese, including soy-based yogurt

and grains. These food groups provide

important key nutrients like zinc, iron

Vitamins A, C, D and more. 

For example, iron fortified infant

cereals can play an important role

in meeting the iron needs for young

children. Fortified infant cereals

include rice

oat barley and multigrain.

Rice cereal should not be the only

infant cereal that's provided to young

children.

Young children should be offered whole

grains more than refined grains

to increase their dietary fiber as well

as their potassium intake.

The dietary guidelines also identified

several components for infants and young

children to limit.

There's virtually no room in their diet


for added sugars.

This is because the nutrient requirement

for infants and young children

are high relative to their size, but the

amount of complementary foods that they

consume

is actually quite small. This means that

the complementary foods really do need

to be nutrient

dense and not contain additional

calories

coming from things like added sugar. Low

and no calorie sweeteners are not

recommended for children

younger than two. Foods higher in sodium

should also be avoided for young

children. Taste preferences are being

formed during this time period

so consuming added sugars, sweeteners, or

salty foods

may contribute to a preference for

these flavors

later in life. Lastly infants should not

be fed honey,

either raw or cooked in food and should

avoid

unpasteurized foods and beverages as

these can contain harmful pathogens.

So, an important part of a healthy

dietary pattern is also thinking about

Beverages.

Infants do not need any other beverage

other than human milk

or infant formula in the first six

months.

Small amounts of plain fluoridated water

can be given with the introduction of

complementary foods

but not before. After 12 months of age,

children can be introduced to plain cow

milk or fortified soy beverages.

Additionally, children can have

unsweetened plant-based

milk alternatives. It is important to

understand that these plant-based milk

alternatives

contain less protein than cow milk and

are not always fortified with calcium

and Vitamin D. 100% fruit or vegetable

juice can be provided after 12 months of

age.

If it is provided it needs to be limited

to 4 ounces a day.

There are also beverages that should be

avoided including sugar sweetened

beverages

as well as those with caffeine. For

toddler milk or toddler drinks,

there's no clear need for these drinks

as the

needed nutrients can be obtained from

plain

cow milk, fortified soy beverages, or

nutrient dense

complementary foods. Additionally, these

drinks typically contain

added sugar. One of the last key

recommendations

is about transitioning children to a

healthy dietary pattern.

This table shows the healthy U.S. style

dietary pattern

for children 12 to 23 months of age who

are no

longer consuming human milk or infant

formula.

I'm not going to go through this table

in great detail, but you can look at it

in the dietary guidelines if you're

interested.

I do want to point out a couple of

things. First what you'll note is the

caloric intake levels range from about

700

to 1000 calories per day and this is

about the right amount of calories

for toddlers of this age group. You'll

also notice that it includes a variety

of nutrient-dense fruits,

vegetables, grains, protein food, and oil. 

The pattern does not include infant

formula

because it's not recommended after 12

months of age.

For infants who are still consuming

human milk,

a healthy dietary pattern would include

would include a similar combination

of nutrient dense foods and beverages.

You'll also note that as advice

that as I have said earlier there really

is not a lot of room for additional

calories

coming from coming from things like

added sugar.

So finally, in addition to the what to

feed young children,

the how to feed is also really important.

Responsive feeding describes a feeding

style that emphasizes

responding to a feeding cue of an infant

or a young child.


The chart here shows some common signs

of when a child may be showing that

they're hungry

or when they're full. Responsive feeding

can help children learn how to

self-regulate their intake,

which can contribute to building a

healthy eating pattern.

Parents, guardians, and caregivers all

have an important role to play

in helping to establish these eating

patterns as young children are

completely reliant on them for the foods

and the beverages

that they consume. So I want to turn now

to talk briefly

about how CDC is working to incorporate

the guidelines

and I wanted to highlight a couple of

resources that are available,

First we have our infant and toddler

nutrition website.

This site compiles information and

practical strategies

and tips for parents and caregivers with

clear

consistent and credible information.

We're in the process of updating this

website to make sure that it completely

aligns with the dietary guidelines.

We also have some wonderful resources on

safe handling and storage

both for expressed human milk as well as

powdered infant formula.

All of these are available on our

website for download and the

the websites are listed here. Lastly,

there are also ways for organizations to

syndicate

existing content to their own website.

Syndicated content allows an

organization to add cdc.gov

content to their own website without

having to maintain

or update it. The service is free and it

can help provide that clear

consistent and credible information.

We've syndicated the entire infant

toddler nutrition site

as well as multiple breastfeeding web

pages.

So it's a great opportunity to go ahead

and syndicate now.

You can find information on the content

that is available for syndication

as well as exactly how to do it at this

website below.

So with that, thank you for your

attention and I will pass it to Jenna.

Thank you, Heather. Now that we've had a

broad overview of the guidelines

and a deep dive into birth to 24 months,

I'm going to cover what's left.

There's a lot within the guidelines

where I will only be able to wet your

appetite (that is a pun intended).

um So, in the end I hope that this

presentation gives you a reason to learn

more about them.

Around 85 percent of calories are needed

per day to need

meet food group recommendations when

consuming healthful

nutrient dense foods, leaving about 15

percent of calories for other uses

including added sugars,

saturated fat, or alcoholic beverages. The

truth is however the very few people

eat foods in their most nutrient dense

forms, which means

they really don't even have that many

extra calories

in their diet. Now I want to look at

sources of added sugars,

saturated fats, and sodium in Americans

diets.

Sugar sweetened beverages are the number

one source of added sugars at almost

one quarter of intake, with 16 of the

total specifically from soft drinks.

The number two source of added sugars is

desserts and sweet snacks at almost

one-fifth of intake.

So together they account for about 40

percent

of it intake of added sugars.

For saturated fat the number one source

is sandwiches

and the number two source is desserts

and sweet snacks.

Together they account for 30 percent of

intake.

For sodium the number one source is

sandwiches with the rest of intake

spread much more widely throughout the

diet.

There are three major areas of the

guidelines. They're completely or

almost completely new. The b-24 and

the b-24 that Heather already covered

and the two others that I will cover,

starting with women who are pregnant and

lactating.

Dietary patterns for pregnant and

lactating women should be very similar

to any other healthy dietary pattern,

just with different calorie levels. The

chapter on pregnancy and lactation goes

into detail on issues such as nausea,

vomiting, and food aversions, and cravings.

It also explains that women do not need

to restrict their dietary choices to

prevent allergies in their children.

And there is guidance for vegetarian and

vegan women,

guidance for appropriate weight gain, and

food safety issues specific to this

population.

There are special considerations related

to certain critical

nutrients such as folate, folic acid,

Iron, iodine, and choline as well as

information on consuming seafood

alcohol and caffeine. The last new

chapter provides information for older

adults.

The dietary guidelines defines older

adults as 60 years of age or older.

Older adults are more susceptible to

chronic diseases including osteoporosis

and sarcopenia, the loss of muscle with

age.

Older adults can also have issues with

chewing and swallowing

and food safety is very critical since

there is a decline in the immune system

with age.

The special considerations for older

adults include

protein or lean muscle mass, b12,

because the ability to absorb it

decreases with age,

hydration because thirst decreases with

age, and older adults may react faster to

alcohol

and it can have a greater effect as well.

So, now I want to talk about some of the

implications for our work.

Of the topics that are part of our

funded programs the four listed here are

directly related to the content of the

dietary guidelines.

The Food Service Guidelines in Federal

Facilities that is offered as a model

for states and communities to follow

are based on the dietary guidelines. The

guidance for lactating women can play an

important role in interventions to

support breastfeeding.

Nutrition standards in early care and

education can be written using the

content of the DGA,

as well as nutrition standards and key

institutions listed here.

There are also many resources available

for professionals to use on the dietary

guidelines website and more will be

added over time.

So the link at the bottom of this slide

can be very helpful for you and others

with whom you work.

The specific resource shown here, and I

wasn't expecting you to be able to read

it

during this presentation, shows that the

dietary guidelines can be customized for

many different diets,

cultures, budgets, and more. By giving many

examples of the kinds of foods that

fit into the five food groups within the

dietary patterns presented in the DGA.

The dietary guidelines are written for

professionals

with the intention that they will adapt

it to the populations with which they

work.

They discuss the broader categories of

foods that are part of a healthy diet

such as vegetables,

but those broad categories can be made

up of all types of foods

such as (?) which is used in Korean Cuisine,

taro leaves used in Native Hawaiian

Cuisine, Nepalese

for Mexican Cuisine, the three sisters

corn, beans, and squash in certain

American Indian Cuisines,

or broccoli used in many cuisines

throughout the U.S.

Whatever population you may be working

with related to diet,

the guidelines can be adapted to be as

representative as possible.

Now I'm happy to turn over the

presentation to Chris to give an example

from the field.

So hi everyone and thank you, Jenna. My

name is Chris Mornick and I am really

excited today to be able to share with

you about our work developing and

adopting a Nutrition Guidelines Policy

with Special Olympics Washington. So,

first I'd like to thank our partners.

Della Norton is the Director of Health

Programs at Special Olympics Washington

and Mary Pittaway is the Global Clinical

Advisor for Special Olympics

International.

This work would not have been possible

without these two incredible women

and I am so grateful to have had the

chance to work with them and to keep

working with them.

So individuals with intellectual

disabilities have a higher risk for

chronic diseases and other poor health

outcomes.

Research shows these individuals are

more likely to experience obesity,

to smoke, to have high blood pressure, and

to be inactive.

All of which can lead to heart disease,

diabetes,

cavities, poor bone health, and other

preventable conditions.

And these trends mimic what Special

Olympics Washington found during their

2019 Health Promotion screenings

where 30 percent of adult athletes who

participated in the screening were

categorized as overweight,

and 27 percent as obese, similarly 20

percent of participating children were measured

as overweight, and 45

percent as obese. So, in addition to the promotion

of physical activity that is inherent to

Special Olympics mission,

healthy nutrition is also really

important for this population.

The idea of a Nutrition Guidelines

Policy for Special Olympics really

started with Mary Pittaway.

So, in February of 2018, Mary reached out

to the Washington State Department of

Health and asked for help

increasing access to healthy options at

the 2018 USA Games, which were being held

in Seattle.

Although it was too late at that point

to make any changes to the actual food

and beverages that were being served

at the games, we were able to work with

the University of Washington

and developed informational signage for

dining halls helping to direct athletes

to healthier choices.

But what this experience really

highlighted was the need for a nutrition

policy that would help ensure healthy

options were available at all Special

Olympics events.

Now, because no Special Olympics chapter

had ever done a nutrition policy before

Mary suggested that we start locally and

we work with Special Olympics Washington

to develop and adopt nutrition

guidelines that could serve as a model

for the broader Special Olympics

community.

So, in September of 2018 I began working

with Special Olympics Washington to lay

the groundwork for nutrition guidelines

policy.

Nutrition guidelines tailored for a

statewide sports organization,

like Special Olympics, didn't exist. So

we kind of had to start from scratch. We

use the Dietary Guidelines for Americans,

the Food Service Guidelines for Federal

Facilities, and the National School Lunch

Program as our guides.

The first draft of our guidelines

included tiered categories for healthy,

Healthier, and healthiest options. These

were never meant to be our final set of

Guidelines,

but it gave us something to pilot with

athletes and to determine the

feasibility of implementing nutrition

standards.

At the same time, Special Olympics

Washington sought feedback from athlete

communities to get a feel for whether a

nutrition policy would be supported. And

the response that they got back from the

community was

overwhelmingly positive, with athlete

input councils requesting food and

beverage options that were

most often healthier than even what we

listed in our healthiest category of the

guidelines.

Despite this support, Special Olympics

Washington felt most comfortable

initially adopting the guidelines as an

official statement

but stopped short of a policy. This

actually provided more time for us to

get buy-in and to develop resources

before trying to get them to adopt an

organization-wide policy.

So after the statement was issued it

quickly became clear that additional

tools trainings and resources were going

to be needed

in order to help the guidelines be

implemented. So, we reached out to

athletes,

coaches, families, staff, and volunteers to

learn about their resource needs.

We also worked really closely with the

procurement manager and the event staff

and all of this feedback was

incorporated into a 28-page toolkit.

The toolkit has tip sheets, checklists, a

coaches guide,

and general guidance for vendors,

caterers, staff. and volunteers.

As we were developing the toolkit, we

also needed to update the guidelines.


So, we removed the tiered structure and

created a single set of standards which

align as closely as possible to the Food

Service Guidelines for Federal

Facilities

and the DGAs. These guidelines apply

across

all settings and that includes catering,

vending, concessions,

food ordered for restaurants,

sponsorships, and donations.

And in addition to the nutrition

guidelines, we also included two

guidelines for behavioral standards.

These are encouraging healthier choices

and promoting healthy portion sizes.

Special Olympics Washington chose to

make these a part of their guidelines

because they recognize the importance of

helping to make the healthy choice the

easy choice.

And further guidance on these

recommendations is provided in the

toolkit.

So I'm happy to say that in September of

2020,

over two years after we first started

this project, the Special Olympics

Washington Board of Directors voted

unanimously to adopt the healthy food

and beverage guidelines as policy.

So now through the many events that

Special Olympics Washington hosts,

this policy has the potential to impact

more than 28,000 people in our state

each year.

So on this slide I've listed some

resources including a link to the


Special Olympics Washington Health

Initiatives page

and on that page you can access the

guidelines, the toolkit, and a success

story which details the process we

undertook to develop the guidelines and

get them adopted.

And here's my contact information if

anyone has questions or wants to learn

more.

I want to thank everyone so much for

listening and to CDC and the DNPAO team

for the opportunity to share about our

work.

And now I will turn it back to Janelle.

Thank you and we're so pleased to have

you join us today. We have some time for

some

questions and answers um with our

panelists. So as a reminder for all of

you who have joined us today

um please type your questions into the q&

a setting below. And

many thanks to um the extended team at

DNPAO. I see they've been responding to

some questions

um just in the chat in the Q&A box as

well, so hopefully we can get to

everybody's

needs. So, Heather I’m going to ask you a

question first. So just wanted to update

you on the poll,

about 40 percent of our participants today said

Yes, they're working

with the organization that has some type

of nutrition focus

for children 0 to 24 months old. So my

question to you is do the dietary

guidelines recommend

100 percent fruit juice or vegetable juice for

children birth to 24 months?

That's a great question. um So the

dietary guidelines recommend that

a um after 12 months of age,

if juice is provided 100 fruit or

vegetable juice, it can be provided

but it needs to be limited to four

ounces per day. So it's after 12 months

of age.

Great thank you. um I'm going to turn it

over to Jenna

next. Do the DGAs offer specific healthy

dietary patterns for people who are

vegetarian or vegan? Thanks Janelle.

um So there is a specific dietary


pattern

for uh for vegetarians that goes into a

lot

of detail but not specifically

for for vegans. uh But what there is is

quite a bit of advice throughout the

guidelines that do

talk about people who are on vegan diets

and and give

some kind of advice around it. and I

think it is

fairly easy to take the vegetarian

dietary pattern

and and turn it into a vegan dietary

pattern.

Thank you. Chris question for you.

It seems that in order for nutrition

guidelines to be effective you really

need to have buy-in from the

organization and the community.

Can you tell us a little bit more about

how you work with Special Olympics

Washington to get

um buy-in from the guidelines? Sure,

Yeah,  so um buy-in was key for us

throughout the whole process and that's

part of the reason why we took over two

years to get the nutrition policy

adopted.

um As I mentioned we worked extremely

closely with the procurement manager,

so one component is to work with the

people that are going to be impacted

by the actual policy but then you also

need to work with the people that are

going to be

in charge of implementing the policy. So

we developed the toolkit, we also

developed a procurement tool and excel

tool

um and tried to address the specific

challenges and needs of the people that

We’re going to be responsible for seeing

the guidelines out.

And then we worked with coaches, we had a

coaches conference where we presented

the guidelines and

the toolkit and got feedback, so multiple

multiple points for

feedback from the communities.

Thank you. Heather I'm going to head back

to you.


The DGAs recommend that most dairy

choices should be fat free or low fat, is

there any specific recommendation in

terms of whole milk versus low fat milk

for infants between

one to two years and after two years old?

So for most for infants in 12 to 23

months,

they're actually recommending whole fat.

It's important for um

this age group to get that fat content.

It really does have

important implications for brain

development and and just

development in general. For that younger

age group as children transition

out of two years of age, that's when you

can start looking at lower fat options.

Thank you. um Loving all the questions so

continue to put them in the q&

a box and we'll keep going for um as

long as we still have time.

To Jenna, back over to you. Are there

specific milligrams etcetera for each of the

nutrients

or does the dietary guideline sort of

offer more global

recommendations? So it it sort of depends,

so

for um for sodium for added sugar

uh for saturated fat, what you have for

sodium there are specific

milligram recommendations. For saturated

fat it's less than 10

percent of calories in your diet um and the same

thing

for um for added sugar less than 10

of calories is the recommendation. Now

when it comes to the various

nutrients that that make up a wide array

within the diet

um what is used by the dietary

guidelines are the dietary reference

intakes

and then USDA creates dietary patterns

that meet those nutrient intakes.

So when you're following one of the the

nutrient patterns

you will be meeting the the

recommendations

for certain nutrients within the diet, so

that's

anything from like Vitamin A and C and

Vitamin D. 

But then on top of that there are

the special considerations and and

that's where

there will be some discussion around

a certain nutrient for pregnant women

and

and so yes there are specific um

recommendations all based on the dietary

reference it intakes

for those individual nutrients that are

that are

described specifically within the

dietary guidelines.

Thank You. Chris, can your toolkit be

adopted for home use as a guide for

parents or special needs children?

That's a great question um so the

toolkit

is designed more specifically to help

roll out the guidelines and by that I

mean it's designed mostly for

coaches, staff, volunteers,

and people in charge of procurement. But

that's not to say that parents couldn't

use the information as guidance.

um I think that we've had a lot of

coaches who are also parents

um so the feedback that we got on some

of the sections were from

parents of people who had intellectual

disabilities. So, it's

on the uh Special Olympics Health

Initiatives website

um so anyone can access it.

uh Heather you have a question about

caffeinated beverage

and is there any harm in giving uh

I guess a toddler over 12 months

caffeinated beverage?

So caffeine is not recommended for kids

younger than two,

so no. Quick answer.

uh Jenna you said sandwiches are the

number one source of sodium

and saturated fat in the U.S., does this

include things like burgers

from fast food restaurants in that

category? Yes,

it does um so there are definitions

within the dietary guidelines

of exactly what it's covered but when

they talk about sort of that

that sandwich category it includes just

about everything that you can think

of as having sort of a top and bottom

bread type thing so that would be the

burgers and

just the regular sandwiches but it also

includes like anything that being a

hoagie roll

kind of thing. um So it is a wide variety

and yes, it includes

foods that are that are from restaurants

and

prepared products etc.

Thank you. uh Chris is the Washington

Special Olympics helping other states

adopt nutrition guidelines for their

events?

Yeah, so um we have been working actually

with Special Olympics International

as well as CDC to try to get the word

out to other Special Olympics

uh state chapters that are interested in

the guidelines. We've done a presentation

for Special Olympics North America.

We've also done a presentation for the

Food Service Guidelines Collaborative

and we've had quite a few states reach

out. So

we are doing some engagement with other

states around the nutrition guidelines

and happy to do more.

Excellent, thank you. Heather, do the

dietary guidelines provide a dietary

pattern for children birth to 24 months

who are vegetarian? So dietary patterns

are only

provided for kids 12 to 23 months there

wasn't a dietary pattern that could be

established for kids six to 12 months or

six to 11 months.

um But for 12 to 23 months or 23 24

months,

yes, the the pattern there is one in the

appendix so you can go and look.

It does provide some information on a

vegetarian diet and has

more of the food groups coming from

beans and peas uh soy beverages or soy

products. The thing to keep in mind

though are some nutrients that might be

um lacking. So vitamin b12 coming from

animal sources,

it you need to really think about that

as well as

iron. So talking with a healthcare

professional just making sure that

a child is meeting all of their nutrient

needs even while

still consuming a vegetarian diet.

Jenna, how do the DGAs account for

different

cultural and dietary norms?

So overall, really

the the dietary guidelines talk in these

very

general terms because they are intended

for professional audiences, and

then it is assumed that because

they are avoiding getting really

specific

about like this is exactly what your

diet should look like,

there's much more of this here's this

broad dietary pattern that includes

fruits and vegetables and

grains and and protein. That it's

really possible to adapt it for

any kind of of cultural food ways.

And so that's really where and that,

resource that I showed on my last slide,

if you were to go and and look at the

resource page you'll see that it

shows examples for all of the different

food groups

of and, obviously it can't go into

Everything, but it goes into a lot of

different

ways that that there are so many foods

from so many different

cultural food stuffs that can be a part

of this overall dietary pattern. So in

some ways

the the guidelines themselves that are

for professionals

sort of stay away from any one

particular

uh cultural diet

and instead leave that up to the people

who are

turning the guidelines into resources

for the public.

And and that's where there's this

ability to really adapt it to

all kinds of different ways of eating.

Thank you. Chris, so working

um with uh

community groups and others is key to

get buy-in and understand the challenges

and barriers they face

implementing the guidelines. What are

some of the challenges you found in your

work?

Well, um I think one of the primary

challenges was just that,

although there's wonderful models out

there for food service guidelines,

um they don't always have a one-fifth

size

fits all approach as Jenna was saying. So

we did have to do some

adaptations um and I think being patient

was really important because being able

to stakeholder those guidelines and

being able to work with staff and make

sure that our guidelines were

not only appropriate but that they were

going to be feasible

was was really a big challenge as well.

So um

luckily Special Olympics Washington was

just an incredible organization to work

with and we had so much support

but I think having a champion was really

key

as well. um The CEO of Special Olympics

Washington was excited about this he

wanted to make it his legacy before he

retired

so um I think challenges

are really around finding that champion

and then

a lot of the other challenges around

developing guidelines we addressed

so um adapting those guidelines as a

model for your organization

is going to be work and then getting

buy-in.

Thanks and what a wonderful legacy

especially as if it spreads across to

other states,

a big impact. um

When should allergenic foods be

introduced to young children?

So allergenic foods can be introduced

along with other complementary foods.

So it's the same time, if it's peanuts it

needs to be introduced in the first year.

they found research has found that

introducing peanuts

in that first year can help reduce the

risk of a peanut allergy.

For infants who are higher risk for food

allergy, that includes those who may have

severe eczema or an egg allergy or both

that's when peanut containing foods

would need to be introduced a little bit

earlier,

so four to six months. But it's really

important to talk with a healthcare

professional

and do that with them so that we can

really think through and help monitor

that that particular progress.

Thanks. uh Jenna you have a question here

um what is the daily maximum recommended

for added sugar for adults

and is there anything specific for um

maybe an adult

who has pre-diabetes?

Yes, so um as far as the added sugar

it is um in the guidelines it says

less than 10 percent of calories for

for everyone except of course the the

b24

where it says no added sugar. um

But I think it is important to know that

in the dietary guidelines it makes clear

that this is really a pretty

high number um that if you

are to look at dietary patterns and what

actually can fit

into a person's diet for them to get all

the nutrients that they need,

most adults really cannot get

more than eight percent of calories from

added sugar and

really even lower than that um if you're

if you're having any excess saturated

fat or if you consume any alcohol

Whatsoever.

You know all of those things take away

from the number of calories you have

for for other foods so so it really

is um 10 percent is is really

a very high number in some ways and and

really should be going down much lower.

There isn't

specific discussion of pre-diabetes

um really in general the

the dietary guidelines are intended

for a generally healthy population

although what they will say they just

want to be clear that they're not

clinical

guidance uh but what they will say

is that that doesn't mean you can't

adapt again that same

diet broad dietary pattern being adapted

for any number of of chronic diseases as

well.

And so there certainly is is room to

adapt it but

what I would say really for for us when

we're talking about pre-diabetes

then we're going to point people to

our sister division and really talk

about the DDT,

and the the dietary the Diabetes

Prevention Program.

And I will say I am working with them on

an update to that,

that will reflect new issues

in the dietary guidelines and um and I

am also

going to be doing a presentation with

them on the new dietary guidelines in

the not too distant future.

Great, thank you. I think that'll be

helpful.

We have a question for you. um Do you

have diet recommendations by

sport um and then you cover

like beverages at all and do you have

anything about like

during performance versus in general?

It's a little bit

asking some more specifics about your

Guidelines.

Sure, yeah so we do have guidelines

around. Oh I’m sorry

there's a bit of an echo. We do have um

guidelines around healthy beverages

but Special Olympics already has

guidance for athletes more specifically

around

um like pre and post workout so this

guideline uh document really focused

more on things like

catering for you know Special Olympics

games and events,

bagged lunches, food eaten on the road at

restaurants,

snacks served during events local events,

um so it was really more general

guidance based on the dietary guidelines

for americans and we left some of the

more

specific guidance around um

you know like what to consume pre and

post workout to Special Olympics.

Excellent, thanks. Heather back over to

you.

uh With the current guidelines what

would you stress as um

maybe significant changes for families

to prioritize that have

infants or toddlers? Well

so this is the first time we've had

guidelines so I think that's probably

one of the biggest things is that we

just now have this

much more clear guidance for families

and caregivers for kids.

um But I think there are a lot of things

to think about

um the variety and the repeated

exposures for different foods and food

groups that's

really important making sure they're

getting lots of different

opportunities to try different foods,

food groups and then making sure

that we're transitioning to that healthy

dietary pattern. So,

as soon as children are being introduced

to complementary foods,

really focusing in on building that up

from 6 to 11 months so that once we hit

that 12 month mark

we really can start to transition to a

healthy dietary pattern

and then it sets them on the path to

heat have those good dietary patterns as

they get older

and can continue to follow the dietary

guidelines

once they're going into school and other

age groups.

uh Thank you. Jenna, you have a question

um

does the do the DGAs touch at all

on non-nutritive sweeteners

um zero calorie beverages that type of

thing?

Yes, they do. um There there was a

whole review that looked at both

the the non-nutritive sweeteners as as

well as

the sugar sweetened beverages and

um the

it's, I have to admit it's been a little

while since I looked at exactly

everything that that they say, but

it's a little bit more

just carefully worded in saying that

there is some

evidence that that switching from

sugar-sweetened beverages to those with

non-nutritive sweeteners

can have some impact on on

body weight um but that there's

not there's more of a push for

healthier beverages, water

and that if I remember

correctly it's not recommended

for um for those products, maybe Heather

can come in here but not recommended for

um for the use of non-nutri sweeteners

for

for young children.

That's correct yeah.

And then Heather back over to you I have

a question about

almond milk, but maybe it's a good

opportunity to talk about

um plant-based milks and what that

recommendation was again.

Sure, so um plant-based milks

alternatives can be used. I think the the

thing to note

is that fortified soy beverages are the

only ones that are actually considered

to meet the dairy requirement for kids,

so that's something to keep in mind. Oat

milk

would not be that. It's it's important to

think about the protein content, it is

much

less than cow milk, so it's important for

kids to get enough protein they're

building their muscles they're getting

big

so we want to make sure that they have

all of those building blocks

and then a lot of times those

plant-based milk alternatives aren't

fortified

with things like calcium and Vitamin D.

And again, thinking about the bone growth

and development that's occurring

calcium and Vitamin D are are really

critical so that's

that's an important piece that answer

that question.

Yes, thank you. And I would just add in

for adults,

it's it's really very similar that

um only the the soy beverages are

considered an

alternative for the dairy and the other

types of plant-based milks are put into

sort of another beverage category and

not considered a replacement for for

dairy products.

I have one thing to add. That's great go

Ahead.

It's also that it needs to be

unsweetened and I think that's

that's a biggie um because it would

um it becomes a sugar sweetened beverage

at that point and so having

not plain cow milk, so not flavored cow

milk

unsweetened plant milk plant-based milk

alternatives,

that's really important make sure that

we're avoiding those added sugars.

Thank you. Well on behalf of the Division

of Nutrition Physical Activity and

Obesity

I'd really like to thank the panel for

joining me today for

virtual applause for them. and Especially

for Chris Mornick from

the Washington Department of Health for

joining us

for the seminar. We will be doing an

additional

seminar or two throughout the year

really trying to bring

some of the science and the practice to

you all, so I really appreciate

everyone's time today

for joining us and we look forward to

talking with you all soon. Thank you.