Health Equity Working Group provides framework for Dietary Guidelines for Americans protocols

DGAC’s subgroup, Health Equity Working Group, which was newly formed this year, reviews each of the subcommittee’s scientific questions and proposals from a health equity lens to ensure the DGA considers diverse racial, ethnic, socio economic and cultural factors.

Dr. Sarah Booth, Ph.D., chair, DGAC, emphasized during a two-day hearing Sept. 12-13 that while health equity and the DGA process are not new, “there is a renewed sense of urgency…for the importance for this work​.”

The US Census Bureau reported ​the median household income decreased 2.9 percent between 2019 and 2020 from $69,560 to $67,521 -- representing “the first statistically significant decline in median household income since 2011.” Poverty rates within racial groups in the same period increased for non-Hispanic white (8.2% ) and Hispanic groups (17%), and stayed the same, but high for Black households at 19.5%.

Higher poverty levels are linked to malnutrition and disrupted food patterns, underscoring the need for consistent and reliable food programs that are culturally sound and sustainable to scale to meet the needs of a growing, diverse population, including households in rural areas experiencing food deserts​.

DGAC is conducting 'diet simulations' for 'a diverse US population'​

Booth explained that the DGAC is examining variations in dietary patterns by “developing a plan right now to conduct diet simulations to draft dietary patterns that consider the wide variety of nutrient-dense foods and beverages consumed in a diverse US population​.”

One simulation, the committee discussed, was exploring the impact of the grains food group across different populations, cultural groups and communities, and replacing some or all of the grains food group with other staple grains, starchy vegetables, beans and peas, or starchy red and orange vegetables in dietary patterns. Yet, the committee emphasized that rather than eliminating grains, this hypothetical method would customize current patterns to address the variability in dietary intakes within diverse population groups. Their discussion highlighted how nutrient goals can suit cultural food preferences and improve flexibility in school meal programs.

Booth also emphasized the role of health equity in systematic reviews, referring to resources like the Cochrane methods and PRISMA E​ reporting guidelines. In simple terms, the Cochrane method is a comprehensive approach to reviewing research on the effects of healthcare interventions, and PRISMA E, a list that includes the relevant components to report the results of the equity in systematic reviews. 

DGAC's consideration of the social science-focused Campbell Collaboration Guidelines conflicted with the Cochrane method's health science approach, and as a result, the committee chose the latter to measure its research, using gender exclusive language in developing DGAC’s protocols “to the greatest extent possible," ​Booth clarified.

Booth emphasized the importance of generalizability for all subcommittees when reviewing evidence, noting, “The Health Equity Working Group has been giving guidance to our subcommittees regarding confounders. Socioeconomic position, for example, is the preferred, more exclusive terminology that should be used to capture a range of factors such as income, education [and] occupation that may be impacting diet health relationships. When we talk about race and/or ethnicity, the Health Equity Working Group discuss that race [and] ethnicity should not be interpreted as a biological construct when considering the diet health relationships, but rather, it should be considered as a social construct​.”

“[Can] results [be] generalized to the broader population of interests? Are the reported results similar [or] different in different participant populations? Are the interventions or exposures applicable to the US context? And are the outcomes applicable to the US population of interest​?” Booth added.