2010 Dietary Guidelines Advisory Committee (DGAC .
2010 Dietary Guidelines Advisory Committee(DGAC) Nutrition Evidence Library MethodologyUSDA’s Nutrition Evidence Library supported the 2010 Dietary Guidelines AdvisoryCommittee as it conducted systematic reviews on diet and health. This document includesarchives from www.NEL.gov describing the systematic review methodology used by the2010 Dietary Guidelines Advisory Committee. The NEL systematic review methodology isalso outlined in Part C: Methodology of the Report of the Dietary Guidelines AdvisoryCommittee on the Dietary Guidelines for Americans, 2010.Archived from www.NEL.gov on March 21, 2017
2010 Dietary Guidelines Advisory Committee (DGAC) Nutrition Evidence Library MethodologyTABLE OF CONTENTSTable of Contents . 2Overview . 3Summary of the NEL systematic review process used to support the 2010 DGAC . 4Research Design and Implementation (RDI) Checklists . 6Research Design and Implementation Checklist: Primary Research . 6Research Design and Implementation Checklist: Review Articles . 9Class of Research . 11Classification of reports . 11Conclusion Grading Chart . 12Grading chart used by the 2010 DGAC to evaluate the strength of the body of evidencesupporting conclusion statements . 13Acknowledgements . 152010 DGAC Members . 152010 DGAC Nutrition Evidence Library Staff - US Department of Agriculture . 15NEL Evidence Abstractors . 16American Dietetic Association (ADA) Contract Support . 162Archived from www.NEL.gov on March 21, 2017
2010 Dietary Guidelines Advisory Committee (DGAC) Nutrition Evidence Library MethodologyOVERVIEWGovernment staff assisted the 2010 Dietary Guidelines Advisory Committee membersin the execution of the systematic review using the methodology outlined in Part C:Methodology of the Report of the Dietary Guidelines Advisory Committee on theDietary Guidelines for Americans, 2010. Below is a summary of the NEL evidencebased systematic review process and the division of duties between government staffand the Dietary Guidelines Advisory Committee.For additional information on 2010 Dietary Guidelines Advisory Committee NELmethodology, see the following published article:Spahn JM, Lyon JM, Altman JM, Blum-Kemelor DM, Essery EV, Fungwe TV, MacneilPC, McGrane MM, Obbagy JE, Wong YP. The systematic review methodology used tosupport the 2010 Dietary Guidelines Advisory Committee. J Am Diet Assoc. 2011Apr;111(4):520-3. doi: 10.1016/j.jada.2011.01.005. PubMed PMID: 21443982.3Archived from www.NEL.gov on March 21, 2017
2010 Dietary Guidelines Advisory Committee (DGAC) Nutrition Evidence Library MethodologySUMMARY OF THE NEL SYSTEMATIC REVIEW PROCESS USED TO SUPPORT THE 2010 DGACNEL ProcessStepsFormulate theQuestionGather/classifyevidenceBrief DescriptionGovernment Staff ResponsibilitiesDGAC ResponsibilitiesSpecify a question. Define thePopulation,Intervention/cause,Comparator and Outcome ofinterest (PICO chartdevelopment); define criteriafor study selection.- Facilitate meetings- Define topic areas- Facilitate PICO chart development- Draft questions to research- Conduct preliminary searches- Develop an analytical framework- Recommend search strategies- Define scope of question (PICO)- Populate sort list tool (e.g., search terms,inclusion & exclusion criteria)- Define inclusion and exclusion criteria forliterature search and sort planConduct and document asystematic search of theliterature to find evidencerelated to the question; listsystematic reviews andprimary studies separately.- Facilitate meetings- Review/approve the sort list e.g., reviewinclusion/ exclusion criteria, databases andsearch terms used, included and excludedstudies- Conduct and document a systematic searchof the literature- List included systematic reviews and primarystudies separately- Describe critical components and tablecolumn headings to guide data extraction- List excluded studies with rationale- Hand search manuscripts for additionalcitationsCritically appraiseeach includedstudyReview studies for relevance- Facilitate meetingsto the question and critique for- Build portal infrastructurescientific validity.- Assign included articles to abstractors to draftAbstract key information to anevidence worksheetsevidence worksheet anddetermine the study quality- Perform quality review and finalize evidencerating (positive, negative, orworksheetsneutral) based upon theResearch Design andImplementation Checklist (seebelow).- Review the evidence summary paragraphfor each study for accuracy and clarity- Review overview tables for completenessand clarity4Archived from www.NEL.gov on March 21, 2017
2010 Dietary Guidelines Advisory Committee (DGAC) Nutrition Evidence Library MethodologySummarize theevidenceWrite a brief paragraph thatsummarizes the key data fromeach included study. Developan overview table thatdisplays key information fromeach study to answer thequestion.- Facilitate meetings- Create an evidence summary whichsynthesizes the available evidence. This- Draft a brief, easy-to-read evidence summarymay include:paragraph for each included study to reportrelevant, scientifically valid data- A brief overall summary statementdescribing number and type of studies- Create an overview table based upon DGACreviewedspecifications- Findings including agreement and- Facilitate review of the evidence summary bydisagreement among studiesall subcommittee members- Comparison factor statements e.g.,- Update text in portal as instructed by DGACdifferences in findings by gender, age,membersdisease stage- Methodological statements- Impact of outcome- Definitions - if needed can be added asglossary terms- Bring to full DGAC for review/approvalDevelop aconclusionstatement andgrade the strengthof evidencesupporting theconclusionDevelop researchrecommendationsDevelop a concise conclusion - Facilitate meetingsstatement to answer the- Update text in portal as instructed by DGACquestion based on a synthesismembersof all relevant studies anddeliberation withsubcommittee members.Grade the strength of theevidence informing theconclusion statement usingthe 2010 DGAC ConclusionGrading Chart (see below).Develop researchrecommendations.- Develop a conclusion statement, basedupon a synthesis of the findings of allrelevant studies- Assign a grade to indicate the overallstrength or weakness of evidence informingthe conclusion statement- Bring to DGAC for review/approval- Facilitate meetings and input researchrecommendations in the computer- Develop research recommendationsbased on the review of literature5Archived from www.NEL.gov on March 21, 2017
2010 Dietary Guidelines Advisory Committee (DGAC) Nutrition Evidence Library MethodologyRESEARCH DESIGN AND IMPLEMENTATION (RDI) CHECKLISTSEach study the 2010 Dietary Guidelines Advisory Committee reviewed received aquality rating of positive, neutral, or negative, based upon a predefined scoring system.The appraisal of study quality is a critical component of the systematic reviewmethodology because in a highly transparent manner, it indicates the Committee’sjudgment regarding the relevance (external validity/generalizability) and validity ofeach study’s results. Ratings were assessed using two versions of the ResearchDesign and Implementation Checklists.The Research Design and Implementation Checklist: Primary Research includes tenvalidity questions based on the Agency for Healthcare Research and Quality (AHRQ)domains for research studies. Sub-questions are listed under each validity questionthat identify important aspects of sound study design and execution relevant to eachdomain. Some sub-questions also identify how the domain applies in specific researchdesigns.RESEARCH DESIGN AND IMPLEMENTATION CHECKLIST: PRIMARY RESEARCHRELEVANCE QUESTIONS1. Would implementing the studied intervention or procedure (if found successful)result in improved outcomes for the patients/clients/population group? (NA for someepidemiological studies)2. Did the authors study an outcome (dependent variable) or topic that thepatients/clients/population group would care about?3. Is the focus of the intervention or procedure (independent variable) or topic ofstudy a common issue of concern to dietetics practice?4.Is the intervention or procedure feasible? (NA for some epidemiological studies)VALIDITY QUESTIONS1.Was the research question clearly stated?1.1Was the specific intervention(s) or procedure (independent variable(s)) identified?1.2Was the outcome(s) (dependent variable(s)) clearly indicated?1.3Were the target population and setting specified?2.Was the selection of study subjects/patients free from bias?2.1 Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression,diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria6Archived from www.NEL.gov on March 21, 2017
2010 Dietary Guidelines Advisory Committee (DGAC) Nutrition Evidence Library Methodologycritical to the study?2.2Were criteria applied equally to all study groups?2.3Were health, demographics, and other characteristics of subjects described?2.4Were the subjects/patients a representative sample of the relevant population?3.Were study groups comparable?3.1 Was the method of assigning subjects/patients to groups described andunbiased? (Method of randomization identified if randomized controlled trial (RCT))3.2 Were distribution of disease status, prognostic factors, and other factors (e.g.,demographics) similar across study groups at baseline?3.3Were concurrent controls used? (Concurrent preferred over historical controls.)3.4 If cohort study or cross-sectional study, were groups comparable on importantconfounding factors and/or were preexisting differences accounted for by usingappropriate adjustments in statistical analysis?3.5 If case control study, were potential confounding factors comparable for casesand controls? (If case series or trial with subjects serving as own control, this criterion isnot applicable. Criterion may not be applicable in some cross-sectional studies.)3.6 If diagnostic test, was there an independent blind comparison with an appropriatereference standard (e.g., “gold standard”)?4.Was method of handling withdrawals described?4.1Were follow up methods described and the same for all groups?4.2 Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up,attrition rate) and/or response rate (cross-sectional studies) described for each group?(Follow up goal for a strong study is 80%.)4.3Were all enrolled subjects/patients (in the original sample) accounted for?4.4Were reasons for withdrawals similar across groups?4.5 If diagnostic test, was decision to perform reference test not dependent on resultsof test under study?5.Was blinding used to prevent introduction of bias?5.1 In intervention study, were subjects, clinicians/practitioners, and investigatorsblinded to treatment group, as appropriate?5.2 Were data collectors blinded for outcomes assessment? (If outcome is measuredusing an objective test, such as a lab value, this criterion is assumed to be met.)5.3 In cohort study or cross-sectional study, were measurements of outcomes andrisk factors blinded?5.4 In case control study, was case definition explicit and case ascertainment notinfluenced by exposure status?7Archived from www.NEL.gov on March 21, 2017
2010 Dietary Guidelines Advisory Committee (DGAC) Nutrition Evidence Library Methodology5.5 In diagnostic study, were test results blinded to patient history and other testresults?6. Were intervention/therapeutic regimens/exposure factor or procedure andany comparison(s) described in detail? Were intervening factors described?6.1 In RCT or other intervention trial, were protocols described for all regimensstudied?6.2 In observational study, were interventions, study settings, and clinicians/providerdescribed?6.3 Was the intensity and duration of the intervention or exposure factor sufficient toproduce a meaningful effect?6.4 Was the amount of exposure and, if relevant, subject/patient compliancemeasured?6.5Were co-interventions (e.g., ancillary treatments, other therapies) described?6.6Were extra or unplanned treatments described?6.7Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups?6.8In diagnostic study, were details of test administration and replication sufficient?7.Were outcomes clearly defined and the measurements valid and reliable?7.1Were primary and secondary endpoints described and relevant to the question?7.2Were nutrition measures appropriate to question and outcomes of concern?7.3Was the period of follow-up long enough for important outcome(s) to occur?7.4 Were the observations and measurements based on standard, valid, and reliabledata collection instruments/tests/procedures?7.5Was the measurement of effect at an appropriate level of precision?7.6Were other factors accounted for (measured) that could affect outcomes?7.7Were the measurements conducted consistently across groups?8. Was the statistical analysis appropriate for the study design and type ofoutcome indicators?8.1Were statistical analyses adequately described the results reported appropriately?8.2Were correct statistical tests used and assumptions of test not violated?8.3Were statistics reported with levels of significance and/or confidence intervals?8.4 Was “intent to treat” analysis of outcomes done (and as appropriate, was there ananalysis of outcomes for those maximally exposed or a dose-response analysis)?8.5 Were adequate adjustments made for effects of confounding factors that mighthave affected the outcomes (e.g., multivariate analyses)?8Archived from www.NEL.gov on March 21, 2017
2010 Dietary Guidelines Advisory Committee (DGAC) Nutrition Evidence Library Methodology8.6Was clinical significance as well as statistical significance reported?8.7If negative findings, was a power calculation reported to address type 2 error?9. Are conclusions supported by results with biases and limitations taken intoconsideration?9.1Is there a discussion of findings?9.2Are biases and study limitations identified and discussed?10. Is bias due to study’s funding or sponsorship unlikely?10.1Were sources of funding and investigators’ affiliations described?10.2Was there no apparent conflict of interest?RESEARCH DESIGN AND IMPLEMENTATION CHECKLIST: REVIEW ARTICLESThe Research Design and Implementation Checklist: Review Articles has ten validityquestions that incorporate the AHRQ domains for systematic reviews. These questionsidentify the systematic process for drawing valid inferences from a body of literature.RELEVANCE QUESTIONS1.Will the answer if true, have a direct bearing on the health of patients?2. Is the outcome or topic something that patients/clients/population groups wouldcare about?3.Is the problem addressed in the review one that is relevant to dietetics practice?4.Will the information, if true, require a change in practice?VALIDITY QUESTIONS1.Was the question for the review clearly focused and appropriate?2. Was the search strategy used to locate relevant studies comprehensive? Were thedatabases searched and the search terms used described?3. Were explicit methods used to select studies to include in the review? Wereinclusion/exclusion criteria specified and appropriate? Were selection methodsunbiased?9Archived from www.NEL.gov on March 21, 2017
2010 Dietary Guidelines Advisory Committee (DGAC) Nutrition Evidence Library Methodology4. Was there an appraisal of the quality and validity of studies included in the review?Were appraisal methods specified, appropriate, and reproducible?5. Were specific treatments/interventions/exposures described? Were treatmentssimilar enough to be combined?6. Was the outcome of interest clearly indicated? Were other potential harms andbenefits considered?7. Were processes for data abstraction, synthesis, and analysis described? Werethey applied consistently across studies and groups? Was there appropriate use ofqualitative and/or quantitative synthesis? Was variation in findings among studiesanalyzed? Were heterogeneity issued considered? If data from studies wereaggregated for meta-analysis, was the procedure described?8. Are the results clearly presented in narrative and/or quantitative terms? If summarystatistics are used, are levels of significance and/or confidence intervals included?9. Are conclusions supported by results with biases and limitations taken intoconsideration? Are limitations of the review identified and discussed?10. Was bias due to the review’s funding or sponsorship unlikely?10Archived from www.NEL.gov on March 21, 2017
2010 Dietary Guidelines Advisory Committee (DGAC) Nutrition Evidence Library MethodologyCLASS OF RESEARCHClassifying studies and reports gives an initial picture of the type of studies and level ofevidence available. It also helps organize the reports for critical appraisal. Once thestudy design is identified and classified, this classification was then recorded on thearticle's worksheet template.CLASSIFICATION OF REPORTSClassificationPrimary ReportsARandomized controlled trial (RCT)BCohort studyCNonrandomized trial with concurrent or historical controlsCase-control studyStudy of sensitivity and specificity of a diagnostic testTime seriesDCross-sectional studyTrend StudyCase seriesCase reportBefore and after studyClassificationMSecondary ReportsMeta-analysis or Systematic reviewDecision analysisCost-benefit analysisCost-effectiveness studyRNarrative review (Review article)Consensus statementConsensus reportXMedical opinionAdapted by the American Dietetic Association from Joint Commission Resources: "A PracticalApproach to Evidence Grading." Joint Commission Journal on Quality Improvement 2000:Volume26(12):70711Archived from www.NEL.gov on March 21, 2017
2010 Dietary Guidelines Advisory Committee (DGAC) Nutrition Evidence Library MethodologyCONCLUSION GRADING CHARTThe 2010 Dietary Guideline Advisory Committee approved the use of the followingpredefined criteria to grade the strength of the evidence supporting each conclusionstatement. These criteria guided members to carefully evaluate the followingcharacteristics of the body of literature supporting each conclusion: quality of studies (both strength of design and execution),quantity of studies and subjects,consistency of findings across studies,the magnitude of effect, andgeneralizability of findings.The chart below was used by the 2010 Dietary Guidelines Advisory Committee anddefines the criteria used to determine each grade.12Archived from www.NEL.gov on March 21, 2017
2010 Dietary Guidelines Advisory Committee (DGAC) Nutrition Evidence Library MethodologyGRADING CHART USED BY THE 2010 DGAC TO EVALUATE THE STRENGTH OF THE BODY OF EVIDENCE SUPPORTINGCONCLUSION STATEMENTSElementsQuality- Scientific rigorand validity- Study designand executionConsistency- Consistency offindings acrossstudiesQuantity- Number ofstudies- Number of studyparticipantsStrongModerateStudies of strongdesignLimitedExpert Opinion OnlyGrade NotAssignableStudies of strong designwith minormethodologicalFree from design flaws,concernsbias, and executionproblemsOR only studies ofweaker study design forquestionStudies of weak designfor answering thequestion ORinconclusivefindings due to designflaws, bias, orexecution problemsNo studies availableFindings generallyconsistent in directionand size of effect ordegree of association,and statisticalsignificance with minorvery exceptionsInconsistency amongresults of studies withstrong design,Unexplainedinconsistency amongresults from differentstudies,Conclusion supportedsolely by statements ofinformed nutrition ormedical commentatorsNAOne large study with adiverse population orseveral good qualitystudiesSeveral studies byindependentinvestigatorsLimited number ofstudiesUnsubstantiated bypublished researchstudiesRelevant studieshave not been doneLarge number ofsubjects studiedOR consistency withminor exceptions across OR single studystudies of weakerunconfirmed by otherdesignstudiesDoubts about adequacyof sample size to avoidType I and Type II errorLow number ofsubjects studied and/orinadequate samplesize within studiesConclusion based onusual practice, expertconsensus, clinicalexperience, opinion, orextrapolation from basicresearchNo evidence thatpertains to questionbeing addressedStudies with negativeresults have sufficientlylarge sample size foradequate statisticalpower13Archived from www.NEL.gov on March 21, 2017
2010 Dietary Guidelines Advisory Committee (DGAC) Nutrition Evidence Library MethodologyImpact- Importance ofstudied outcomes- Magnitude ofeffectStudied outcomerelates directly to thequestionSize of effect isclinically meaningfulSome doubt about theStudied outcome is anstatistical or clinicalintermediate outcomesignificance of the effect or surrogate for thetrue outcome ofinterestSignificant (statistical)difference is largeGeneralizability- Generalizabilityto population ofinterestStudied population,Minor doubts aboutintervention andgeneralizabilityoutcomes are free fromserious doubts aboutgeneralizabilityObjective data unavailable Indicates area forfuture researchOR size of effect issmall or lacks statisticaland/or clinicalsignificanceSerious doubts aboutgeneralizability due toGeneralizability limited toscope of experienceNAnarrow or differentstudy population,intervention oroutcomes studied Criteria adapted from the American Dietetic Association Evidence Analysis Library and based upon: Greer N, Mosser G, Logan G, WagstromHalaas G. A practical approach to evidence grading. The Joint Commission Journal on Quality Improvement. 2000;26:700-712. Explanation ofGrades and Grading Chart14Archived from www.NEL.gov on March 21, 2017
2010 Dietary Guidelines Advisory Committee (DGAC) Nutrition Evidence Library MethodologyACKNOWLEDGEMENTS2010 DGAC MEMBERSChairVice ChairLinda V. Van Horn, PhD, RD, LDNaomi K. Fukagawa, MD, PhDNorthwestern UniversityUniversity of VermontChicago, IllinoisMembersCheryl Achterberg, PhDF. Xavier Pi-Sunyer, MD, MPHThe Ohio State UniversityColumbia UniversityColumbus, OhioNew York, New YorkSharon (Shelly) M. NickolsRichardson, PhD, RDEric B. Rimm, ScDThe Pennsylvania State UniversityBoston, MassachusettsUniversity Park, PennsylvaniaMiriam E. Nelson, PhDRoger A. Clemens, DrPHTufts UniversityUniversity of Southern CaliforniaBoston, MassachusettsLos Angeles, CaliforniaJoanne L. Slavin, PhD, RDThomas A. Pearson, MD, PhD, MPHHarvard UniversityUniversity of MinnesotaUniversity of RochesterSt. Paul, MinnesotaRochester, New YorkChristine L. Williams, MD, MPHLawrence J. Appel, MD, MPHColumbia University (Retired)Johns Hopkins Medical InstitutionsHealthy Directions, Inc.Baltimore, MarylandNew York, New YorkRafael Pérez-Escamilla, PhDYale UniversityNew Haven, Connecticut2010 DGAC NUTRITION EVIDENCE LIBRARY STAFF - US DEPARTMENT OFAGRICULTUREJoanne M. Spahn, MS, RD, FADAEve V. Essery, PhDJoan M. G. Lyon, MS, RDYat Ping Wong, MLS, MPH,Research LibrarianJean M. Altman, MSThomas V. Fungwe, PhD15Archived from www.NEL.gov on March 21, 2017
2010 Dietary Guidelines Advisory Committee (DGAC) Nutrition Evidence Library MethodologyPatricia Carrera MacNeil, MS, LN,CNSMary M. McGrane, PhDJulie E. Obbagy, PhD, RDNEL EVIDENCE ABSTRACTORSJuan Andrade, PhDAlexandra Kazaks, PhD, RDSarah Belisle, MSJennifer Kilkus, MS, RD, LDNLaura Bellows, PhD, MPH, RDJi Li, PhDJennifer Chapman, PhD, MPHMurugi Ndirangu, PhDLiwei Chen, MD, PhD, MHSAlicia Powers, MS, PhDPamela Ching, ScD, MS, RDMuge Qi, MS, PhDAlena Clark, PhD, MPHSusan Raatz, PhD, RDCraig Coleman, PharmDChad Rhoden, PhDLaura Dick, PhD, RDJacinda Roach, PhD, RD, LDNancy Fassinger, PhD, RDMurjuyua Rowser, MS, RDLaurie G. Forlano, DO, MPHJulie Shertzer, PhD, RD, LD, CSSDSarah Forrestal, PhDLuAnn Soliah, PhD, LD, RDSarah L. Francis, PhD, MHS, RDAmy Steffey, DVM, MPHKristie Funk, MS, RDAparna Sundaram, MBA, MPHLinda Gauvry, MSJennifer Teske, PhDDiane Harris, PhDKatie Tharp, PhD, MPH, RDHeather Hopwood, MPHToni Tucker, MS, RDPhil Karl, MS, RD, CSSD, LDNAMERICAN DIETETIC ASSOCIATION (ADA) CONTRACT SUPPORTADA Evidence AbstractorsJennifer Aiyer, MS, RDChandra Carty, MMSc, RD, LDStephanie Allshouse, MS, RDMei Chung, MPH, PhDKimberley Bandelier, MPH, RDKatie Clark, MPH, RD, CDEJeannette Beasley, PhD, MPH,RDMary Cluskey, PhD, LD, RDEllen Bowser, MS, RD, CSPPatricia Davidson, DCN, RD, CDETeri Burgess-Champoux, PhD, RD,LDDebby Demory-Luce, PhD, RD, LDKathleen Burzynski, MS, RD, LD,CDE, CNSAlison Dvorak, MS, RDElizabeth Droke, PhD, RDJamie Erskine, PhD, RD16Archived from www.NEL.gov on March 21, 2017
2010 Dietary Guidelines Advisory Committee (DGAC) Nutrition Evidence Library MethodologyMable Everette, PhD, RD, FADAMark Meskin, PhD, RD, FADAElizabeth Friedrich, MPH, RD, LDNYi-Ling Pan, PhD, RDDeon Gines, PhD, RD, CD, CNSDHope S. Paul, MS, RDErica Gradwell, MS, RDJoan Pleuss, MS, RD, CD, CDECharlene Harkins, EdD, RD, LD,FADAAshley Robinson, MS, RD, LDAlida Herling, MPH, RDJennifer Shoemaker, MS, RD, LDNPenni Hicks, PhD, RD, LDLeeAnn Smith, MPH, RDKathy Hoy, EdD, RDLuAnn Soliah, PhD, LD, RDAnne Marie Hunter, PhD, RD, LD,FADAJennifer Spilotro, MS, RD, LDNVijaya Juturu, PhD, FACNAndrea Hutchins, PhD, RDRima Kleiner, MS, RDLinda Lee, MBA, MS, RDMegan Majernik, MS, RD, LDNNadia Marzella, MS, RD, LDNChristiane Meireles, PhD, RD, LDPatricia Mendoza, MS, RD, LDJulie Shertzer, PhD, RD, LD, CSSDJennifer Stein, MS, RDDebra Waldoks, MPH, RD, CLCDana Wells, MPH, RD, LDNValaree Williams, MS, RD, LDNWinifred Yu, MS, RDJoan Zerzan, MS, RD, CDJane Ziegler, DCN, RD, LDN, CNSDJamie Zoellner, PhD, RDCopyeditorsTami Piemonte, MS, RD, LD/NPamela Francois, BSChristine Spahn (National ServiceVolunteer)Debi SchepersConsultants, Staff, and TrainingDeborah S. Cummins, PhDEsther F. Myers, PhD, RD, FADAPatricia L. Splett, MPH, PhD, RD,FADAAnna Neuendorf, MPH, RDAdministrative SupportAntonia AcostaGreg OttWeb DevelopmentMario Rodrigues, WebAuthor17Archived from www.NEL.gov on March 21, 2017
Government staff assisted the 2010 Dietary Guidelines Advisory Committee members in the execution of the systematic review using the methodology outlined in Part C: Methodology of the Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans,
Dietary Guidelines Advisory Committee. 2010. Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 2010, to the Secretary of Agriculture and the Secretary of Health and Human Services. U.S. Department of Agriculture
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(HHS/USDA) 2005 Dietary Guidelines for Americans Dietary Guidelines for Americans (USDA/HHS) 2010 McGovern Report - Dietary Goals (6) 1977 Surgeon General's Report on Health Promotion 1979 Dietary Guidelines for Americans (USDA/HH
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