DRAFT Australian Dietary Guidelines - Eat For Health

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As nutrition is a continuously evolving area and research studies are published on a regular basis, the Working Committee also considered results from high quality studies (primarily systematic reviews) published after the literature review, and where deemed warranted, included the findings and references in the relevant evidence sections in each Chapter. However, only the Evidence Statements from systematic review of the literature until 2009 were graded. The results of this literature review, including the questions that were asked, are included in the report of the commissioned literature review: A Review of the Evidence to Address Targeted Questions to Inform the Revision of the Australian Dietary Guidelines (referred to as ‘the Evidence Report’) [14]. The original literature search did not locate a sufficient number of food-based studies - rather than nutrient-based studies - to be able to draft evidence statements regarding food intake and dietary patterns for pregnant and breastfeeding women and health outcomes of infants and/or mothers. Therefore, a team from the University of Adelaide and the Women’s and Children’s Health Research Institute was commissioned through a Request for Quote process from the NHMRC multi-use panel to conduct a more extensive search of the literature to locate and summarise studies meeting specified eligibility criteria. This team, led by Philippa Middleton and comprising Professor Maria Makrides, Dr Carmel Collins, Dr Alice Rumbold, Dr Jo Zhou, Professor Caroline Crowther and Associate Professory Vicki Flenady reviewed the literature for health outcomes for infants and mothers from food-based studies on pregnant and breastfeeding women. Parts of this review were used to inform the ‘practical considerations’ for pregnant and breastfeeding women that have been included in these guidelines. The Working Committee also determined that there was an evolving and increasing body of literature on the environmental impacts of the production and consumption of food and viceversa. Therefore, in addition to the original narrative review, a review of the relevant literature, particularly that pertaining to Australia, was conducted by A/Professor Friel and a team at the Australian National University. Following this work, it became clear that the inter-relationship between diet and the environment is a cross-sectoral matter and should be considered as such. NHMRC will work further with other relevant Australian government agencies to develop this work. A2.3 Modelling system In 2008 to 2010, NHMRC undertook an extensive review of the Core Food Groups (1994) and released A modelling system to inform the revision of the Australian Guide to Healthy Eating (the Modelling System) in 2011 [10, 942]. The modelling system determined a range of combinations of the amounts and types of foods that could be consumed to meet the nutritional needs within the least amount of energy for the smallest and least active people within an age and sex group. These are called Foundation Diets. For those that are more physically active or taller (and older, in the case of infants, children and adolescents) within each age/sex group, the models provide additional DRAFT Australian Dietary Guidelines- December 2011 160
food options to meet additional energy needs. These are called Total Diets. (Note that the Total Diet for the smallest, least active people in each age/sex groups is equivalent to the Foundation Diet.) The number of serves and serve sizes modelled in the Modelling System were considered together with other sources of evidence to determine the recommendations in these guidelines (see Section A2.3 below). The Modelling System is located at www.eatforhealth.gov.au. A2.3 Development of the Australian Dietary Guideline recommendations In translating the evidence to formulate the Dietary Guideline recommendations the Working Committee considered the following sources of evidence. The commissioned literature review: A Review of the Evidence to Address Targeted Questions to Inform the Revision of the Australian Dietary Guidelines (referred to as ‘the Evidence Report’) [14]. The commissioned report: A Modelling System for Australia to Inform the Revision of the Australian Guide to Healthy Eating (referred to as ‘the Food Modelling’ document) [10]. NHMRC and NZ Ministry of Health 2006 Nutrient Reference Values for Australia and New Zealand Including Recommended Dietary Intakes (referred to as ‘the NRV document’) [9]. Key authoritative government reports and documents provided by the Working Committee and the NHMRC, including evidence in material provided by stakeholders during consultation processes and findings of relevant large, quality, peer-reviewed studies published after 2009. The previous Dietary Guidelines for Australians series and their supporting documentation [35-37]. The information in the previous guidelines was used as the basis. New evidence was assessed to determine whether associations between food, dietary patterns and health outcomes had strengthened, weakened, or stayed the same since the last review of the evidence. The final wording of the Dietary Guideline recommendations was developed by a Working Committee consensus approach and focus tested. DRAFT Australian Dietary Guidelines- December 2011 161
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Australian Dietary Guidelines Incor
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Australian Dietary Guidelines Austr
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2.4.4 Practical considerations: Lea
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1. Introduction 1.1 Why the Guideli
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income, education, cultural influen
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The Evidence Report (A review of th
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1.4 How the Guidelines were develop
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Levels of evidence in public health
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the study results were generalisabl
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Table 1.1: Changes in macronutrient
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population. NHMRC intends to work w
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Figure 1.2: Australian Guide to Hea
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Executive Summary Dietary patterns
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Consuming a wide variety of foods m
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varieties within each food group, f
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2.1.4.6 People in lower socioeconom
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vegetable intake and cancer has foc
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Endometrial, Ovarian and pancreatic
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2.2.3.2 Cancer Colorectal cancer: E
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2.2.4.2 Cancer Alimentary tract can
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2.2.5.2 Cancer mechanisms There is
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Table 2.1: Recommended number of se
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increasing appetites. Unless prescr
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2.3.2.1 Cardiovascular disease, typ
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Table 2.3: Recommended number of se
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2.4 Lean meat and poultry, fish, eg
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interpret because of widely varying
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2.4.2.3.1 Fish: Cardiovascular dise
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Smoked, salted and chemically prese
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Depending on age and sex, health be
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2.4.4.6 Vegetarians For several nut
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Evidence Statement Grade Consumptio
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2.5.3 How drinking milk and eating
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2.5.4.1 Pregnant and breastfeeding
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the recent review [14]. Many common
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2.6.2.3 Other conditions Dental car
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Where to next Both the quality and
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Executive summary This Guideline em
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3.1.2 The evidence for ‘limiting
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In the longer term, the review cond
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The P:M:S ratio is a useful tool in
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3.2.2 The evidence for ‘limiting
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3.2.3 How limiting intake of foods
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3.2.4.4 Older people Taste percepti
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No large studies have measured the
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Excess weight: Many foods containin
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etter health outcomes than those wh
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Evidence Statement Grade Consumptio
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Dementia: The evidence suggests an
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Drinking coffee, having a cold show
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In the absence of any research to q
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Executive summary Healthy weight is
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prevalence of obesity alone is high
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Compared to having a BMI between 18
Page 109 and 110: 4.1.3.2 Energy intake and trend dat
Page 111 and 112: 4.1.3.4 Energy intake from specific
Page 113 and 114: 4.1.4.2 Benefits of physical activi
Page 115 and 116: 4.2.1 Primary prevention Diet and p
Page 117 and 118: and consistent evidence that dietar
Page 119 and 120: 4.2.2 Secondary prevention Behaviou
Page 121 and 122: Table 4.4 A stepped model for the m
Page 123 and 124: Taller or larger and more active ad
Page 125 and 126: Table 4.5 2010 Institute of Medicin
Page 127 and 128: For older, taller or more active ch
Page 129 and 130: Most older people will benefit from
Page 131 and 132: 5. Encourage and support breastfeed
Page 133 and 134: 5.1 Setting the scene The World Hea
Page 135 and 136: Evidence Statement Grade Exclusive
Page 137 and 138: Table 5.1 Factors associated with d
Page 139 and 140: 5.2.4 Other benefits Sudden Infant
Page 141 and 142: 5.3.1.3 Mothers in the workplace Ev
Page 143 and 144: 5.3.1.3 Community support The succe
Page 145 and 146: Executive summary More than five mi
Page 147 and 148: [929]. Fresh fruit and vegetables c
Page 149 and 150: contamination (see above) avoided.
Page 151 and 152: 1989 - 1995 Composition of Foods, A
Page 153 and 154: 2001 Eat Well Australia: An Agenda
Page 155 and 156: 2011 A Review of the Evidence to Ad
Page 157 and 158: Professor Dorothy Mackerras Dr Dav
Page 159: Level III-2 - A comparative study w
Page 163 and 164: Appendix 3. Assessing growth and he
Page 165 and 166: Table A3.1 International BMI cut-of
Page 167 and 168: A3.1.6 Z-scores and percentiles: Co
Page 169 and 170: Appendix 4. Physical activity guide
Page 171 and 172: Suggested activities include: mode
Page 173 and 174: Appendix 5. Studies examining the h
Page 175 and 176: that further specific studies are r
Page 177 and 178: Table A6.2 Energy and alcohol conte
Page 179 and 180: The economic, social and cultural f
Page 181 and 182: A diet consistent with the Guidelin
Page 183 and 184: In other more recent studies, highe
Page 185 and 186: A7.4 Aboriginal and Torres Strait I
Page 187 and 188: A7.4.3.2. Aboriginal people living
Page 189 and 190: Mortality rates for people born ove
Page 191 and 192: Appendix 8: Glossary Adequate Intak
Page 193 and 194: Carbohydrates Carbohydrates are pol
Page 195 and 196: Exclusive breastfeeding Means an in
Page 197 and 198: Legume/Beans Refers to all forms of
Page 199 and 200: Older adults For the purposes of th
Page 201 and 202: Reduced fat products For a food to
Page 203 and 204: celery and asparagus), gourd vegeta
Page 205 and 206: Evidence Statement Grade Fruit Cons
Page 207 and 208: Table A9.2: Evidence statements (Gr
Page 209 and 210: References 1. Rayner, M. and P. Sca
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27. Wilkinson, R. and M. Marmot, So
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54. Hawkins, S.S., T.J. Cole, and C
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81. Hesketh, K., M. Wake, and E. Wa
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107. McCullough, M.L., et al., Diet
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135. Brimblecombe, J.K. and K. O’
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162. Kreimer, A.R., et al., Diet an
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189. Ward, H.A., et al., Breast, co
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216. Paolini, M., et al., Beta-caro
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244. Kelly, S.A., et al., Wholegrai
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270. Williams, P.G., et al., Cereal
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297. Garcia-Closas, R., et al., Foo
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324. Maclean, C.H., et al., Effects
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349. Vander Wal, J.S., et al., Egg
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376. Elwood, P.C., et al., The surv
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404. Javaid, M.K., et al., Maternal
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430. Lagiou, P., et al., Intake of
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486. Lopez-Ridaura, R., et al., Mag
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512. Kratz, M., et al., The impact
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537. Daniels, S.R. and F.R. Greer,
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776. Monasta, L., et al., Early-lif
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803. Prentice, A.M. and S.A. Jebb,
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830. Callaway, L.K., et al., The pr
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857. Australian Institute of Health
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885. Demmelmair, H., J. von Rosen,
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911. Duong, D.V., C.W. Binns, and A
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940. Cashel K, L.J., NUTTAB89-Nutri
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1049. Altman, J., Hunter-gatherers
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