Draft Australian Dietary Guidelines (PDF, 3MB) - Eat For Health

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• Professor Dorothy Mackerras• Dr David Roberts (until May 2010)• Dr Rosemary Stanton, OAM• Professor Linda TapsellA2.1.2 NHMRC project team• Ms Cathy Connor• Ms Bronwyn Battisson• Ms Marisa Bialowas• Mrs Marion Carey• Ms Cheryl Cooke• Ms Vesna Cvjeticanin• Ms Emma Milde• Ms Tess WinsladeA2.1.3 Department of Health and Ageing project team• Ms Erica Nixon• Ms Caroline Arthur• Ms Marina Dron• Ms Erica Kneipp• Ms Jacinta McDonald• Ms Bronia Rowe• Ms Leticia WhiteA2.1.4 Contractors• Sky Newton, Adelaide Health Technology• Philippa Middleton, methodologist, University of Adelaide• Dr Katrine Baghurst (Australian Guide to Healthy Eating)• RaggAhmed, technical writers• Simon Grose, editor• Dr Rachel Nowak, consultant in science policy, analysis and communication• Quantum Market Research, health professional and consumer focus group testingA2.2 Literature reviewIn the past, the Dietary Guidelines have provided recommendations based on evidence including thatof nutrients and associations with health outcomes. However, as people eat foods rather thanisolated nutrients, the Working Committee determined that the literature review should primarilyDRAFT Australian Dietary Guidelines- December 2011 157
seek evidence on the relationship between foods, dietary patterns and health outcomes. TheWorking Committee determined that the revised guidelines would be an evolution from theprevious versions and build upon their evidence and science base.In 2009, the Dietitians Association of Australia was commissioned through an open Request forTender process to systematically review the literature.The Working Committee, with the assistance of a NHMRC Guideline Assessment Register PanelConsultant, Ms Skye Newton of Adelaide Health Technology Assessment, developed 27 complexsearch questions for the literature review in areas emerging in the literature and areas included inthe 2003 Dietary Guidelines where the evidence base may have changed. A number of establishedfood, diet and health relationships covered in the 2003 Dietary Guidelines, where the evidencebase was unlikely to have changed substantially, were identified as not needing specific searchquestions to be asked. For example, the relationship between diets high in saturated fat andincreased risk of high cholesterol.The 27 search questions for the literature review were prioritised to 12 complex questions inconsideration of time and financial constraints. These formed the basis of questions for three typesof review: systematic literature review (the systematic review of the primary literature); umbrellareview (the systematic review of systematic reviews); and narrative reviews (the comprehensivereview of the literature to answer more qualitative questions, for example, such as that concerningnature and scope of international food guides and practices promoting food safety).The final questions for systematic and umbrella reviews were transcribed into PICO format.Detailed definitions and search terms were developed for each component of the final complexsearch questions and a number of specific search questions for each variable arising from variouspermutations were formulated for each complex question.Standardised processes were used to review the literature [34, 39-41]. Databases searchedincluded CINAHL, MEDLINE, DARE, Cochrane, ScienceDirect, PsychLit and ERIC. For eachspecific search question, the identified articles were retrieved and reviewed for relevance by ateam of reviewers. Papers published before 2002 were excluded. Duplicates, papers not within thescope of the search questions and papers that were already included in meta-analyses, describedcross-sectional studies or were not research studies (for example, letters and editorials) were alsoexcluded.The evidence was assessed according to NHMRC levels and grades for recommendations fordevelopers of guidelines [41] which allowed each article to be critically appraised and assigned a levelof evidence based on a hierarchy according to the type of research question. As this reviewlooked at causality and intervention research questions the following hierarchy was used:• Level I - A systematic review of level II studies• Level II - A randomised controlled trial• Level III-1 - A pseudorandomised controlled trialDRAFT Australian Dietary Guidelines- December 2011 158
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Australian Dietary GuidelinesAustra
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2.4.4 Practical considerations: Lea
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1. Introduction1.1 Why the Guidelin
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income, education, cultural influen
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The Food Modelling Report - transla
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Potential mechanisms through which
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adolescence predict diet quality an
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Figure 1.2: Australian Guide to Hea
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Executive SummaryDietary patterns w
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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 CancerColorectal cancer: Ev
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2.2.4.2 CancerAlimentary tract canc
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2.2.5.2 Cancer mechanismsThere is n
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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 VegetariansFor several nutr
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Evidence StatementConsumption of mo
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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 conditionsDental cari
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Where to nextBoth the quality and q
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Executive summaryThis Guideline emp
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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 peopleTaste perceptio
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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 StatementConsumption of al
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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 summaryHealthy weight is
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prevalence of obesity alone is high
Page 108 and 109: Compared to having a BMI between 18
Page 110 and 111: Kilojoules4.1.3.2 Energy intake and
Page 112 and 113: 4.1.3.4 Energy intake from specific
Page 114 and 115: 4.1.4.2 Benefits of physical activi
Page 116 and 117: 4.2.1 Primary preventionDiet and ph
Page 118 and 119: and consistent evidence that dietar
Page 120 and 121: 4.2.2 Secondary preventionBehaviour
Page 122 and 123: Table 4.4 A stepped model for the m
Page 124 and 125: Taller or larger and more active ad
Page 126 and 127: Table 4.5 2010 Institute of Medicin
Page 128 and 129: For older, taller or more active ch
Page 130 and 131: Most older people will benefit from
Page 132 and 133: 5. Encourage and support breastfeed
Page 134 and 135: 5.1 Setting the sceneThe World Heal
Page 136 and 137: Evidence StatementExclusive breastf
Page 138 and 139: Table 5.1 Factors associated with d
Page 140 and 141: 5.2.4 Other benefitsSudden Infant D
Page 142 and 143: 5.3.1.3 Mothers in the workplaceEvi
Page 144 and 145: 5.3.1.3 Community supportThe succes
Page 146 and 147: Executive summaryMore than five mil
Page 148 and 149: [929]. Fresh fruit and vegetables c
Page 150 and 151: contamination (see above) avoided.
Page 152 and 153: 1989 - 1995 Composition of Foods, A
Page 154 and 155: 2001 Eat Well Australia: An Agenda
Page 156 and 157: 2011 A Review of the Evidence to Ad
Page 160 and 161: • Level III-2 - A comparative stu
Page 162 and 163: food options to meet additional ene
Page 164 and 165: Appendix 3. Assessing growth andhea
Page 166 and 167: Table A3.1 International BMI cut-of
Page 168 and 169: A3.1.6 Z-scores and percentiles: Co
Page 170 and 171: Appendix 4. Physical activity guide
Page 172 and 173: Suggested activities include:• mo
Page 174 and 175: Appendix 5. Studies examining thehe
Page 176 and 177: that further specific studies are r
Page 178 and 179: Table A6.2 Energy and alcohol conte
Page 180 and 181: The economic, social and cultural f
Page 182 and 183: A diet consistent with the Guidelin
Page 184 and 185: In other more recent studies, highe
Page 186 and 187: A7.4 Aboriginal and Torres Strait I
Page 188 and 189: A7.4.3.2. Aboriginal people living
Page 190 and 191: Mortality rates for people born ove
Page 192 and 193: Appendix 8: GlossaryAdequate Intake
Page 194 and 195: CarbohydratesCarbohydrates are poly
Page 196 and 197: Exclusive breastfeedingMeans an inf
Page 198 and 199: Legume/BeansRefers to all forms of
Page 200 and 201: Older adultsFor the purposes of the
Page 202 and 203: Reduced fat productsFor a food to b
Page 204 and 205: celery and asparagus), gourd vegeta
Page 206 and 207: Evidence StatementGradeFruitConsump
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Table A9.2: Evidence statements (Gr
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References1. Rayner, M. and P. Scar
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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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376. Elwood, P.C., et al., The surv
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