US Department of Health & Human Services, Final Response To My FOIA Requests 16-0040-FOIA & 16-0226-FOIA (5/12/16) /16

DEPARTMENT OF HEALTH & HUMAN SERVICES Program Support Center
Division of FOIA Services

5600 Fishers Lane Rm 19-01
Rockville, Maryland 20857
Phone: 301-443-3403
Fax: 301-480-5862
PSCFileNo.: 16-0040-FOIA; 16-0226-FOIA
May 12,2016
Peter Heimlich
3630 River Hollow Run
Duluth, GA 30096
Dear Mr. Heimlich:
This is our final response to your November 18, 2015 Freedom of Information Act (FOIA)
request. In summary, you requested copies of all correspondence to and from Dr. Millen, Dr.
Lichtenstein and Dr. Hu members of the 2015 Dietary Guidelines Advisory Committee.
A records search was conducted by the Office of the Assistant Secretary for Health (OASH), and
411 pages were located that are responsive to your request. Enclosed you will find 411 pages
released, 330 of which are released in their entirety. I have determined to withhold minor
portions of 81 pages under FOIA Exemptions (b)(6).
Exemption (b)(6) protects information the disclosure of which would constitute a clearly
unwarranted invasion of privacy. The information withheld consists of an individual's personal
information.
Please note that attachments included within emails are drafts of versions that are now public
documents available in the Scientific Report of the 2015 Dietary Guidelines Advisory
Committee at health.gov/dietaryguidelines/, for your convenience I have provided you the link
below.
http://health.HOv/dietarvguidelines/2015-scientific-report/pdfs/scientific-report-of-the-2015-
dietarv-guidelines-advisorv-cornmittee.pdf
http://health.gov/dietaryguidelines/2015/meetings.asp
http://www.nel.gov/categorv.cfm?cid=50
There will be no charges in this instance because the billable costs are less than our threshold of
$25.
If you have reason to believe that the information withheld should not be exempt from
disclosure, you may appeal. Your appeal should be sent within 30 days from the date you
receive this letter to the Director, News Division, Office of the Assistant Secretary for Public
Affairs, U.S. Department of Health and Human Services, Parklawn Building, Room 19-01, 5600
Fishers Lane, Rockville, MD 20857. Clearly mark both the envelope and your letter "'Freedom of
Information Act Appeal."
Sincerely yours,
Denise F.
Wallace-S|i»
Denise F. Wallace
FOIA Officer
Freedom of Information Act Services
Enclosure: 411 pages on CD

Casavale, Kellie (OS/OASH)
From: Lichtenstein, Alice <Alice.Lichtenstein@tufts.edu>

Sent: Monday, February 23, 2015 7:26 AM
To: Casavale, Kellie (OS/OASH)
Subject: FW: Two slide decks: Chapter 5 and PA
Attachments: image001.png
In case you are interested in the most recent discourse. This is one of many, many e-mails that have
been flying back and forth.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Alice H. Lichtenstein, D.Sc.
Gershoff Professor of Nutrition Science and Policy
Director and Senior Scientist, Cardiovascular Nutrition Laboratory
Tufts University
JM USDA Human Nutrition Research Center on Aging
711 Washington Street
Boston, MA 02111

phone: 617 556 3127
e‐mail: Alice.Lichtenstein@Tufts.edu
From: Siega-riz, Anna Maria [mailto:am_siegariz@unc.edu]

To: Mary Story, Ph.D.; Neuhouser, Marian L; Millen, Barbara E; Frank Hu; Siega-riz, Anna Maria
Cc: Nelson, Miriam; Lichtenstein, Alice; Cheryl Anderson, PhD, MS, MPH; Frank Hu, MD, PhD, MPH; J. Thomas Brenna,
PhD, MS; Lucile Adams-Campbell, PhD, MS; Rafael Pérez-Escamilla, PhD, MS; Steven Abrams, MD; Steven Clinton, MD,
PhD; Wayne Campbell, PhD, MS; Griffin, Timothy; mhamm@anr.msu.edu; Grossman, Andrea
Subject: Re: Two slide decks: Chapter 5 and PA
Ditto and furthermore if you make your presentation all at once there is very little incentive for folks to stay for it all.
Anna Maria Siega-Riz, PhD
Professor of Epidemiology and Nutrition
and
Associate Dean for Academic Affairs
Gillings School of Global Public Health
2105‐A McGavran‐Greenberg Hall, CB 7435
Chapel Hill, NC 27599
Phone: 919‐966‐5984
1
PSC-HHS-000001
Email: am siegariz@unc.edu

From: "<Mary Story>", 'Mary Story <mary.story@duke.edu>
Date: Sunday, February 22, 2015 at 5:39 PM
To: "Neuhouser, Marian L" <mneuhous@fredhutch.org>, DrPH Barbara Millen <bmillen@bu.edu>, Frank Hu
<nhbfh@channing.harvard.edu>, Anna Siega‐Riz <am siegariz@unc.edu>
Cc: "'Miriam (Mim) E. Nelson" <miriam.nelson@tufts.edu>, Alice Lichtenstein <Alice.Lichtenstein@tufts.edu>,
"c1anderson@ucsd.edu" <c1anderson@ucsd.edu>, "frank.hu@channing.harvard.edu"
<frank.hu@channing.harvard.edu>, "'jtb4@cornell. edu'" <jtb4@cornell.edu>, Lucile Adams‐Campbell
<lla9@georgetown.edu>, Rafael Perez‐Escamilla <rafael.perez‐escamilla@yale.edu>, Steven Abrams
<sabrams@bcm.edu>, Steven Clinton <steven.clinton@osumc.edu>, Wayne Campbell <campbellw@purdue.edu>,
"Griffin, Timothy" <Timothy.Griffin@tufts.edu>, "mhamm@anr.msu.edu" <mhamm@anr.msu.edu>, "Grossman,
Andrea" <Andrea.Grossman@tufts.edu>

I just read Marion's note and she makes good points. It will seem disjointed not to have the subcomittee's reports.
Barbara it seems like it would be best just to keep the agenda as was.
Mary

From: <Neuhouser>, Marian L <mneuhous@fredhutch.org>
Date: Sunday, February 22, 2015 4:16 PM
To: "'Barbara Millen, DrPH, MPH, RD'" <bmillen@bu.edu>, Frank Hu <nhbfh@channing.harvard.edu>, "Siega‐riz, Anna
Maria" <am siegariz@unc.edu>
Cc: "Nelson, Miriam" <Miriam.Nelson@tufts.edu>, Mary Story <mary.story@duke.edu>, "Lichtenstein, Alice"
<Alice.Lichtenstein@tufts.edu>, "Cheryl Anderson, PhD, MS, MPH" <c1anderson@ucsd.edu>, "Frank Hu, MD, PhD,
MPH" <frank.hu@channing.harvard.edu>, "J. Thomas Brenna, PhD, MS" <jtb4@cornell.edu>, "Lucile Adams‐Campbell,
PhD, MS" <lla9@georgetown.edu>, "Rafael Pérez‐Escamilla, PhD, MS" <rafael.perez‐escamilla@yale.edu>, "Steven
Abrams, MD" <sabrams@bcm.edu>, "Steven Clinton, MD, PhD" <steven.clinton@osumc.edu>, "Wayne Campbell, PhD,
MS" <campbellw@purdue.edu>, "Griffin, Timothy" <Timothy.Griffin@tufts.edu>, "mhamm@anr.msu.edu"
<mhamm@anr.msu.edu>, "Grossman, Andrea" <Andrea.Grossman@tufts.edu>
Subject: RE: Two slide decks: Chapter 5 and PA

Hi Barbara
Thanks for sending this around. My first take on this master for your section is that it emphasizes some of the major work
from SC1 and perhaps to too light on some of the work of the other subcommittees and groups. Slides 16-21 are some of
the major results slides shown from SC1, then slide 22 is very general about SC2 then it jumps to placeholders for slides
22 and 24 (which come from SC1 work and we actually do already have slides for this as we showed the three patterns
and some nutrient content in the public meetings). Slides 26-28 are all major content from SC1 (slides we presented),
leaving only a few very general slides for the rest of the work (but no content from the other SCs or other groups).
As most, but not all of the group knows, I will be traveling on Wed (planned months ago) and not able to participate
since I will be on an airplane at the time of the event. Thus, Cheryl will present SC1. It will be very important to
coordinate with Cheryl because I imagine some of the slides in this master are the very ones she planned on presenting.
I'm concerned about overlap and also concerned that the rest of the important topics from the rest of the SCs will not get
their full overview up front.
Marian
From: Millen, Barbara E [bmillen@bu.edu]

Sent: Sunday, February 22, 2015 11:36 AM
To: Frank Hu; Siega-riz, Anna Maria
Cc: Nelson, Miriam; Mary Story, Ph.D.; Lichtenstein, Alice; Cheryl Anderson, PhD, MS, MPH; Frank Hu, MD, PhD, MPH; J.
Thomas Brenna, PhD, MS; Lucile Adams-Campbell, PhD, MS; Neuhouser, Marian L; Rafael Pérez-Escamilla, PhD, MS;
2
PSC-HHS-000002
Steven Abrams, MD; Steven Clinton, MD, PhD; Wayne Campbell, PhD, MS; Griffin, Timothy; mhamm@anr.msu.edu;
Grossman, Andrea
Subject: RE: Two slide decks: Chapter 5 and PA
HI Everyone,
Frank’s Communications Office recommended that we revise the agenda for the symposium on Wednesday. The major
change would be to have my comments address up front, our charge and evidence‐based methods and the major
findings and integration. The rationale is that those who can’t be there for the full 2.5 hours would get the ‘message’. I
certainly expect that many will stay the full timeframe but this assures that our primary, positive messages are not
lost. Please take a look and let us know your comments.
My draft slides are attached. I will tweak them a bit as I go through the report and make my final presentation
‘notes’. You will see two place holder slides. I asked Kellie and Trish Britten quite some time ago to work on a couple of
slides that compare the three modeled Healthy Dietary Patterns on food group as well as nutrient profile (Tables D1 32
and 33 from the report). My intent is to defuse some of the comment we have been getting. Trish was away until the
other day but I think she is working on them for use on Wednesday.
By all means, comment on the revised agenda and my slides.
I will try to trim back a bit in the next pass and ask that everyone think about doing as much of that as possible. I do
agree with Anna Maria and Frank though that some slides will hardly take a minute. I did a 20 minute webinar this week
(on the Obesity Guidelines) and used 60 slides; I was 2 minutes under the allotted timeframe and didn’t feel at all
rushed. So I think it’s close as is. Let me know if you would recommend emphasizing anything else.
Looks like we have a reasonably consistent format across slide decks. I followed Tom’s advice on the Master but you can
also accomplish it by taking the master for another DGAC members deck and insert your slides. Presto!
All the best,
Barbara
Dr. Barbara E. Millen
bmillen@bu.edu
From: Frank Hu [mailto:nhbfh@channing.harvard.edu]

Sent: Sunday, February 22, 2015 9:54 AM
To: Siega-riz, Anna Maria
Cc: Nelson, Miriam; Millen, Barbara E; Mary Story, Ph.D.; Lichtenstein, Alice; Cheryl Anderson, PhD, MS, MPH; Frank Hu,
MD, PhD, MPH; J. Thomas Brenna, PhD, MS; Lucile Adams-Campbell, PhD, MS; Marian Neuhouser, PhD, RD; Rafael
Pérez-Escamilla, PhD, MS; Steven Abrams, MD; Steven Clinton, MD, PhD; Wayne Campbell, PhD, MS; Griffin, Timothy;
mhamm@anr.msu.edu; Grossman, Andrea
Anna maria,
The slides Kelly sent are not new ones, but those used in our last public meetings (5-7). For saturated fat, I used
the final slides from last meeting, and added one on methods from meeting 6.
You are right that adherence to time limit is more important than the number of slides. My experience has been
that the actual time I end up talking is typically longer than planned, and this is directly correlated with the
number of slides. Nonetheless, 7-8 slides is a general guide, not a rule. Again, our time is very constrained.
As you may have noticed, there are intense and unprecedented interests on the DGAC report, from all sides.
Hence our symposium is extremely timely and should offer an excellent opportunity for us to describe the
strong science base and present key findings.
3
PSC-HHS-000003
We are fine-tuning the agenda and will send out a slightly revised version tomorrow.
The followings are the website for registration and webcast:

In order to attend this symposium, you must pre‐register on our on‐line form
at https://harvard.az1.qualtrics.com/jfe/form/SV 7WL0pzPIwAnLIl7. The website for this event can be found
at http://www.hsph.harvard.edu/dgac‐symposium/. The webcast can also be found on this site.
Frank
On Sun, Feb 22, 2015 at 9:30 AM, Siega-riz, Anna Maria <am siegariz@unc.edu> wrote:
Maybe I missed something, did Kelly send us new slides? Frank while I know we are limited to 8 minutes some of the slides do
not take a full minute to describe so I would not worry so much about the number but more about making sure we don’t go
over our time allotment.
AMSR
Anna Maria Siega-Riz, PhD
and
Phone: 919‐966‐5984
From: Frank Hu <nhbfh@channing.harvard.edu>
Date: Saturday, February 21, 2015 at 6:06 PM
To: "'Miriam (Mim) E. Nelson" <miriam.nelson@tufts.edu>
Cc: DrPH Barbara Millen <bmillen@bu.edu>, 'Mary Story <mary.story@duke.edu>, Alice Lichtenstein
<Alice.Lichtenstein@tufts.edu>, Anna Siega‐Riz <am siegariz@unc.edu>, "c1anderson@ucsd.edu"
<c1anderson@ucsd.edu>, "frank.hu@channing.harvard.edu" <frank.hu@channing.harvard.edu>, "'jtb4@cornell. edu'"
<jtb4@cornell.edu>, Lucile Adams‐Campbell <lla9@georgetown.edu>, "mneuhous@fhcrc.org" <mneuhous@fhcrc.org>,
Rafael Perez‐Escamilla <rafael.perez‐escamilla@yale.edu>, Steven Abrams <sabrams@bcm.edu>, Steven Clinton
<steven.clinton@osumc.edu>, Wayne Campbell <campbellw@purdue.edu>, "Griffin, Timothy"
<Timothy.Griffin@tufts.edu>, "mhamm@anr.msu.edu" <mhamm@anr.msu.edu>, "Grossman, Andrea"
<Andrea.Grossman@tufts.edu>
Dear all,
attached please find my slides on saturated fat, slightly modified from the slides Kellie sent to us yesterday. Please let me
know if you have any comments.
Given the time constraint, each of us has only 7‐8 minutes to speak and hence the number of my slides is limited to 7. It would
be great if you can limit the number of your slides to no more than 8. I know this is hard, but it is important to keep up with
the schedule and leave adequate time for Q & A.
It would be great if you can send me your final slides by Monday.
thanks
Frank
On Fri, Feb 20, 2015 at 9:20 AM, Nelson, Miriam <Miriam.Nelson@tufts.edu> wrote:
4
PSC-HHS-000004
Hi Frank and Barbara,
I am attaching the two slide decks that I have to present. These are edited versions of what we presented in December. I have
cut back on the number of slides dramatically (and some of the words).
I was not as cleaver as Anna Maria in that I wasn't able to figure out how to take off the December 15th reference in the top
right. Can some one else do that?
Also, I am assuming that our title slides should have the chapter number and name, not subcommittee — correct?
If my fellow subcommittee/consultants colleagues have any additional edits/suggestions for the slides, please let me know.
Best, Mim
‐‐
Miriam E. Nelson, PhD
Associate Dean, Tisch College of Citizenship and Public Service
Professor, Friedman School of Nutrition Science and Policy
Lincoln Filene Hall
10 Upper Campus Road
Tufts University
Medford, MA 02155
Phone: 617-627-4178
Fax: 617-627-3401
www.ActiveCitizen.tufts.edu
www.StrongWomen.org
Twitter: @DrMiriamNelson
From: Frank Hu <nhbfh@channing.harvard.edu>
Date: Monday, February 2, 2015 12:10 PM
To: "Millen, Barbara E" <bmillen@bu.edu>
Cc: "Mary Story, Ph.D." <mary.story@duke.edu>, Alice Lichtenstein <alice.lichtenstein@tufts.edu>, "Anna Maria Siega‐
Riz, PhD, MS, RD" <am siegariz@unc.edu>, "Cheryl Anderson, PhD, MS, MPH" <c1anderson@ucsd.edu>, "Frank Hu, MD,
PhD, MPH" <frank.hu@channing.harvard.edu>, "J. Thomas Brenna, PhD, MS" <jtb4@cornell.edu>, Lucille
<lla9@georgetown.edu>, "Marian Neuhouser, PhD, RD" <mneuhous@fhcrc.org>, Miriam Nelson
<miriam.nelson@tufts.edu>, Perez‐Escamilla Rafael <rafael.perez‐escamilla@yale.edu>, "sabrams@bcm.edu"
<sabrams@bcm.edu>, "Steven Clinton, MD, PhD" <steven.clinton@osumc.edu>, "Wayne Campbell, PhD, MS"
<campbellw@purdue.edu>
Subject: Re: Updates DGAC Symposium
I share Mary's concerns and I'm also concerned about time constraint. The entire symposium is 2.5 hours and the
presentations can easily take 1.5 hours. We should leave at least 30‐45 mins for Q&A.
Frank

On Monday, February 2, 2015, Millen, Barbara E <bmillen@bu.edu> wrote:
Very important thought. We are in agreement that we want to have the tone very positive. If we decide to have
the reactors, we can perhaps have them address the report in ways we think will be enhancing of our
5
PSC-HHS-000005
presentation, implications for various settings, areas where policy development might be most helpful, etc.
What do others feel?
Also, apologies for leaving UNC-Chapel Hill off the site list. Anna-Maria is definitely working on this as I
think wveryone is aware from our call.
Barbara

bmillen@bu.edu
From: Mary Story, Ph.D. [mailto:mary.story@duke.edu]

To: Millen, Barbara E; 'Alice Lichtenstein, DSc, MS'; 'Anna Maria Siega-Riz, PhD, MS, RD'; 'Cheryl Anderson, PhD, MS,
MPH'; 'Frank Hu, MD, PhD, MPH'; 'J. Thomas Brenna, PhD, MS'; 'Lucile Adams-Campbell, PhD, MS'; 'Marian Neuhouser,
PhD, RD'; 'Miriam (Mim) E. Nelson, PhD, MS'; 'Rafael Pérez-Escamilla, PhD, MS'; 'Steven Abrams, MD'; 'Steven Clinton,
MD, PhD'; 'Wayne Campbell, PhD, MS'
Subject: Re: Updates DGAC Symposium
Importance: High
Barbara
I have some questions concerns about the reactor panel. I think it is important to have panel members be supporting the DGAC
report and not criticizing anything from the committee report. Of course anyone is free to make critical comments of our
recommendations but in my view this should not be done at this event. Since we cannot control what individuals may say if they
are panel members, I question even having a reactor panel. Depending on who you invite to be a reactor panel this could
backfire.
As an initial speaker I think Jim Marks or Michael McGinnis would be good.

Mary
From: <Millen>, "'Barbara Millen, DrPH, MPH, RD'" <bmillen@bu.edu>

Date: Monday, February 2, 2015 at 10:28 AM
To: "'Alice Lichtenstein, DSc, MS'" <alice.lichtenstein@tufts.edu>, "'Anna Maria Siega-Riz, PhD, MS, RD'"
<am_siegariz@unc.edu>, "'Cheryl Anderson, PhD, MS, MPH'" <c1anderson@ucsd.edu>, "'Frank Hu, MD,
PhD, MPH'" <frank.hu@channing.harvard.edu>, "'J. Thomas Brenna, PhD, MS'" <jtb4@cornell.edu>, "'Lucile
Adams-Campbell, PhD, MS'" <lla9@georgetown.edu>, "'Marian Neuhouser, PhD, RD'"
<mneuhous@fhcrc.org>, "Mary Story, Ph.D." <mary.story@duke.edu>, "'Miriam (Mim) E. Nelson, PhD, MS'"
<miriam.nelson@tufts.edu>, "Rafael Pérez-Escamilla, PhD, MS" <rafael.perez-escamilla@yale.edu>, "'Steven
Abrams, MD'" <sabrams@bcm.edu>, "'Steven Clinton, MD, PhD'" <steven.clinton@osumc.edu>, "'Wayne
Campbell, PhD, MS'" <campbellw@purdue.edu>
Subject: Updates DGAC Symposium
Hello Everyone,
Greetings from another ‘white-out’ here is Boston! Frank and I have heard from many of you about
participating in the February 25th DGAC symposium. As I mentioned on our call, Howard Koh has confirmed
his role as moderator. We seem in agreement that we would use the format from the last two DGAC meetings
are the ‘outline’ for the symposium (presentations on our charge and evidence-based process, the SCs and WGs,
and Integration). We have to work out the timing of each part of the symposium as plans come together. The
Federal staff will be preparing slides for our use. We have not yet identified any alternative dates; Frank is
checking at HSPH. Things are definitely shaping up in terms of our live satellite sites and ideas for speaker(s)
and panelists.
6
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At this point, the following locations are considering creating a satellite site pending confirmation of technology
and availability on our date: Cornell, HSPH (host), Purdue, Tufts, UC-San Diego, UW and FHCRC. Others are
certainly welcome. Please let me know.
Quite a few names have been recommended either as an initial speaker (Jim Marks from RWJ) or as a reactor
panelists (Jim Marks, Bob Eckel, Larry Appel, Paul Whelton, Connie Weaver, Bill Dietz, Harvey Fineberg,
Adam Drewnowski, Kathleen Merrigan, Mike McGinnis, Larry Soler, and former Senator Tom Harkin. On our
call, there seemed to be enthusiasm and agreement that Jim Marks would be ideal for opening remarks. I have
asked Howard Koh (who also recommended him) to contact Jim on our behalf.
Would anyone like to recommend any other panelists? I will circulate other names if you provide them. Of
those already identified above, could you let me your ‘top three or four’ panelists, assuming that Jim Marks
would be one? If you have particular thought about achieving a ‘balance’ of perspectives on the panel, please
let me know. Let’s see if there is consensus on a short list.
Also, it sounds as though a number of you may be planning some introductory remarks or activities in your
respective locations. That is certainly a possibility if you have scheduled time before or after our televised
symposium. I have seen this work very well in other activities of this type so I encourage you to make plans if
you think it would make your local event that much more interesting.
Frank and I will be working on the IT and logistics and will let you know how we thinks evolve.
All the very best,
Barbara

bmillen@bu.edu
From: Millen, Barbara E

Sent: Tuesday, January 27, 2015 4:13 PM
To: 'Alice Lichtenstein, DSc, MS'; 'Anna Maria Siega-Riz, PhD, MS, RD'; 'Cheryl Anderson, PhD, MS, MPH'; 'Frank Hu, MD,
PhD, MPH'; 'J. Thomas Brenna, PhD, MS'; 'Lucile Adams-Campbell, PhD, MS'; 'Marian Neuhouser, PhD, RD'; 'Mary Story,
PhD, MS, RD'; 'Miriam (Mim) E. Nelson, PhD, MS'; 'Rafael Pérez-Escamilla, PhD, MS'; 'Steven Abrams, MD'; 'Steven
Clinton, MD, PhD'; 'Wayne Campbell, PhD, MS'
Subject: Follow-up: DGAC Symposium
Many thanks everyone for your participation in today’s DGAC call and discussion of the upcoming 2015
DGAC Report Symposium. Here is a summary of the notes from the call and a few things learned in
conversations with DGAC members. Please take a look at the Action Items and get back to Frank and me with
details and any questions you might have.
Date and Time: Wednesday, February 25 3:30-6:00 p.m.

Back up Date (mid-March): TBD
Host Location: Harvard School of Public Health (HSPH)
Other Live Locations: UNC-Chapel Hill and to be confirmed, UC San Diego and Purdue;
others TBD.
Audiences: Invited and registered audience for host and live locations.
Registered webinar audience.
7
PSC-HHS-000007
Format: Televised symposium with live audiences in Host and Satellite
locations. Webinar for registered audience for expanded participation.
Symposium format: Introduction: Comments by leader from satellite sites and/or

invited guest presenters (foundation leaders, dignitaries, others TBD).
Moderator: Howard Koh
Report Summary: Follow the last two Public Meetings. The DGAC
Evidence-based Process (and Integration Chapter) presented by Chair.
SC and Workgroup leads (if available) will summarize their
chapters. Integration Chapter.
It was recommended that these presentations include a brief summary of
key findings, recommendations and implications,
and the evidence base on which the conclusions are based (a combination
of key text summaries and data slides).
Reactor Panel: recommended experts in the field, perhaps from
participating institutions or outside experts
Q and A: Questions sent at registration and by email or webinar.
ACTION ITEMS:
1. Federal staff working on slides and general media materials.
2. Frank Hu will check and circulate back‐up mid‐March symposium date(s) and time(s).
3. Each DGAC member will confirm whether they are available to participate, where they will participate (home institution,
HSPH, or at a satellite site),
and what satellite arrangements might be possible at their institution.
a. Communicate this information to Barbara and Frank
4. DGAC members who are considering hosting a live satellite location should confirm with Barbara and Frank as soon as
possible.
IT details can be discussed with Frank.
5. Once further details are set, we will develop ‘copy’ to promote the event and invite participation.
All the best,
Barbara

bmillen@bu.edu

‐‐
*******************************************************
Frank B. Hu, MD, PhD
Professor of Nutrition and Epidemiology
Harvard T.H. Chan School of Public Health
Professor of Medicine
Harvard Medical School
665 Huntington ave, Boston, MA 02115
tel: 617 432 0113 fax: 617 432 2435

<http://www.hsph.harvard.edu/faculty/frank‐hu/>
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http://www.hsph.harvard.edu/faculty/frank‐hu/
******************************************************

‐‐
*******************************************************
tel: 617 432 0113 fax: 617 432 2435

<http://www.hsph.harvard.edu/faculty/frank‐hu/>
http://www.hsph.harvard.edu/faculty/frank‐hu/
******************************************************
--
*******************************************************
tel: 617 432 0113 fax: 617 432 2435
<http://www.hsph.harvard.edu/faculty/frank-hu/>
http://www.hsph.harvard.edu/faculty/frank-hu/
******************************************************
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From: Millen, Barbara E <bmillen@bu.edu>

Sent: Sunday, February 22, 2015 3:25 PM
Cc: Olson, Richard (HHS/OASH); 'Rihane, Colette - CNPP' (Colette.Rihane@cnpp.usda.gov)
Subject: FW: MIND YOUR OWN BUSINESS
Hi there,

My IT person and one of the staff forwarded this ‘hate’ email. We can’t please anyone. Don’t know what your
experience is with this sort of thing. Any thoughts?

Barbara

bmillen@bu.edu

From: Kevin Grinberg [mailto:kevin@activefrequency.com]
Sent: Friday, February 20, 2015 6:19 PM
To: Millen, Barbara E
Subject: Fwd: MIND YOUR OWN BUSINESS
I assume Dolores forwarded you this gem as well. I don't even know what to say...
This nonsense aside, congrats on all the press coverage!
---------- Forwarded message ----------

From: "'M C' via Help" <help@millenniumprevention.com>
Date: Feb 20, 2015 3:46 PM
Subject: MIND YOUR OWN BUSINESS
To: "help@healthmain.com" <help@healthmain.com>
Cc:
"The recommendations Thursday from the Dietary Guidelines Advisory Committee also call for
Americans to reduce meat consumption and to take sustainability into account when dining."
Here's a tip.
MIND YOUR OWN DAMN BUSINESS. Frigging Nanny State bastards need to get laid and get a life.
WE wil leat, drink, smoke, and do WHATEVER we damn well please. NO ONE cares what you think.
Tax sweets? Are you morons aware that we can make our own donuts? Pies? Cakes? What are you
Liberal morons going to do? Tax flour?
America will be better off when the last damn Liberal dies.
10
PSC-HHS-000010

Sent: Thursday, February 19, 2015 7:35 AM
Subject: FW: Your Healthy News
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127
From: HealthDay News Service [mailto:HealthNews@HealthDay.com]

To: Lichtenstein, Alice
Subject: Your Healthy News
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Dietary Fiber
HealthDay News and Weight
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Eating More Fiber Helped People Lose Weight, Researchers

Report
Trial comparing simple dietary change to more complicated regimen found Making one
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MONDAY, Feb. 16, 2015 A simple high-fiber diet can provide health benefits while change may
being easier to stick with than a diet calling for multiple changes in eating habits, a help you
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new clinical trial concludes. and improve
your health,
People who only ad... » Read the full article study finds.
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Dark
Health Tip: Getting Nutrition on the Go Chocolate
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What to eat before and after exercise
When you're traveling, especially for an athletic competition, you don't have to rely on
fast food to fuel your body.
Beware:
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be milk in
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according to
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Meat-Heavy, High-Acid Diet Poses Risk for Those With » Watch
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Switching to regimen higher in fruits, veggies might help stave off organ Coffee and
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FRIDAY, Feb. 13, 2015 Patients struggling with chronic kidney disease who routinely Cancer Risk
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Mediterranean Diet May Lower Stroke Risk, Study Finds female
reproductive
Researchers say healthy eating plan appears to cut odds of blood clot system,
study finds.
THURSDAY, Feb. 12, 2015 A Mediterranean diet may reduce your risk of one type of » Watch
stroke, new research suggests. now
People who most closely followed the Mediterranean diet were less likely to suffer an
ischemic stroke -- ... » Read the full article HealthDay Living:
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Make
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Low Vitamin D Levels in Stroke Survivors a Bad Sign, Study
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Tied to raised risk of a severe stroke, poor recovery, researchers say Turn
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People still need to limit foods with heart-damaging saturated fats and trans
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THURSDAY, Feb. 12, 2015 People who follow a heart-healthy diet won't see much Make diet
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Sent: Thursday, February 12, 2015 12:10 PM
To: Sagon, Candy
Cc: Casavale, Kellie (OS/OASH)
Subject: RE: new dietary guidelines quote--AARP story
Would like to comment but I can't until the report is released.

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Gershoff Professor of Nutrition Science and Policy Director and Senior Scientist, Cardiovascular Nutrition Laboratory
Tufts University JM USDA Human Nutrition Research Center on Aging
Boston, MA 02111

phone: 617 556 3127

‐‐‐‐‐Original Message‐‐‐‐‐
From: Sagon, Candy [mailto:CSagon@aarp.org]
Subject: new dietary guidelines quote‐‐AARP story

Dr. Lichtenstein ‐‐

I'm sure you've seen the news stories about what could be major shift in national dietary guidelines' recommendation
about cholesterol, and I'm hoping you could comment for a health story I'm doing for the AARP website.

The proposed report states that cholesterol is no longer a nutrient of concern. Do you think this was the right move?

As an expert in the relationship between fats in the diet and health, I'm also hoping you could comment on one part that
was discussed in the lengthy Washington Post story on the guidelines ‐ namely, that they would be less restrictive about
the cholesterol in eggs and seafood, like lobster, but still warn against fatty meat, cream and butter.
Isn't the saturated fat and cholesterol in all these foods the same? Why would it be ok to have an egg a day, but not
butter?

Thank you for your help with this.

‐‐Candy Sagon

Candy Sagon| AARP
Senior Associate Editor, Health
601 E Street NW | Washington, DC 20049 | Office: 202‐434‐6065 | csagon@aarp.org<mailto:eambrose@aarp.org>
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Sent: Wednesday, February 11, 2015 8:55 PM
Subject: RE: Advisory Panel Considers Changing Recommendations On Cholesterol
Kellie, very much appreciated. Very well stated.
I just had a colleague ask whether the DG were coming out soon and if she promised not to say
anything could she please have a copy. If colleagues don’t know the difference between DGAC
report and DG I hate to think what the press is going to do with the stories.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127
From: Casavale, Kellie (OS/OASH) [mailto:Kellie.Casavale@hhs.gov]

;)

Kellie O. Casavale, PhD, RD
Nutrition Advisor, Division of Prevention Science
Co‐Executive Secretary, 2015 Dietary Guidelines Advisory Committee
HHS, Office of Disease Prevention and Health Promotion

From: Lichtenstein, Alice [mailto:Alice.Lichtenstein@tufts.edu]
Interesting. Looked at the Athero paper. They did not appear to correct for age in any
analysis. Were that the case, since age and egg yolk in take were correlated, I don’t see how they
could attribute the effect to one factor or the other. Age is a well-established risk factor.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
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Tufts University
Boston, MA 02111

phone: 617 556 3127

To: 'dspence@robarts.ca'
Cc: 'walter.kernan@yale.edu'; Lichtenstein, Alice; 'Neuhouser, Marian L'
Subject: FW: Advisory Panel Considers Changing Recommendations On Cholesterol
Dr. Spence,

Your correspondence below was forwarded to me. Thank you for your interest in the 2015 Dietary Guidelines Advisory
Committee. Information about the Advisory Committee and the process the federal government uses for updating the
Dietary Guidelines for Americans federal policy can be found at www.DietaryGuidelines.gov. Advisory Committee
members cannot accept public comments. Public comment is an important part of our process. In the coming weeks, a
Federal Register notice will be published announcing the availability of the Committee’s Advisory Report, a public
comment period, and the date of a public meeting for providing oral comments to the Federal government on the
Advisory Report. A public comments database will open for the public to submit comments to the Federal government
on the Advisory Report when the Federal Register notice is published. We encourage you to submit your comments
below at that time. You can continue to check DietaryGuidelines.gov for the most up‐to‐date information.
Please let me know if you have any questions.
Thanks,
Kellie


From: David Spence [mailto:dspence@robarts.ca]
Sent: Wednesday, February 11, 2015 11:42 AM
To: Kernan, Walter
Cc: Marion Neuhauser (mneuhous@fhcrc.org); Lichtenstein, Alice
Dear Walter,

Thank you for alerting me to this. I have copied this message to two of the chairs of the committee involved, in the hope
that I may discuss this with them before this report is finalized. I would be happy to present to their committee if the
schedule permits.
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PSC-HHS-000018

The increasingly prevalent belief that dietary cholesterol is not important is the result of a sustained and well‐funded
campaign of the egg industry, following their conviction for false advertising, upheld in the Supreme Court.

The slides of my presentation to the AHA stroke meeting today are attached, along with some papers.

Dr. Neuhauser and Dr. Lichtenstein, please view the videos to which links are provided on my last slide.

It would be a grave error to withdraw the valid longstanding recommendation to limit cholesterol intake, particularly
among patients at risk of vascular disease. Dietary cholesterol is not about the fasting lipids (where the egg industry
would like to keep the focus); it is about the postprandial state.

Best regards,

David Spence

J. David Spence M.D., FRCPC, FAHA
Professor of Neurology and Clinical Pharmacology
Director, Stroke Prevention & Atherosclerosis Research Centre,
Robarts Research Institute, Western University
1400 Western Road, London, ON Canada N6G 2V2
Phone 1‐519‐931‐5731; Fax 1‐519‐931‐5737
Email dspence@robarts.ca http://www.imaging.robarts.ca/SPARC/

From: Kernan, Walter [mailto:walter.kernan@yale.edu]
Sent: February‐11‐15 10:10 AM
To: David Spence
Check out the first article.

Walter N. Kernan, MD
Professor of Medicine (General Medicine)
Yale School of Medicine
Suite 515
2 Church Street South
New Haven, CT 06519
Phone: 203‐764‐7000
Fax: 203‐764‐7552

From: AMA Morning Rounds [mailto:MorningRounds@ama.custombriefings.com]
To: Kernan, Walter
Subject: Advisory Panel Considers Changing Recommendations On Cholesterol
If you are using a mobile device or are unable to see the message below, click here to view
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Good Morning Dr. Walter Kernan. Here are today's top stories. Wednesday, February 11, 2015
Leading the News
Advisory panel considers changing recommendations on cholesterol.

Scott Pelley reported in the CBS Evening News (2/10, story 5, 1:30, Pelley) that according to the Dietary Guidelines Advisory Committee,
a government advisory panel, “we don’t have to worry so much after all about cholesterol in our diets.” Dr. Jon Lapook noted that while
“the amount of cholesterol in your blood is still important,” the panel found that “the amount of cholesterol in your food doesn’t necessarily
translate to a higher level of cholesterol in your blood.” While the current recommendations “say people should have less than 300
milligrams of cholesterol in their diet a day,” that number is “likely to change when the recommendations come out later this year.” Linsey
Davis noted on ABC World News (2/10, story 7, 1:10, Muir) that while the panel said that “eating some foods that are high in cholesterol
like eggs and seafood may not be so bad after all,” foods like “meats and cheeses, because they contain saturated fats, are still on the
list.”
The Washington Post (2/11, Whoriskey) reported in its “Wonkblog” blog that the this “does not reverse warnings about high levels of
‘bad’ cholesterol in the blood, which have been linked to heart disease,” adding that “some experts warned that people with particular
health problems, such as diabetes, should continue to avoid cholesterol-rich diets.” The blog adds that “a group from the American Heart
Association and the American College of Cardiology who looked at the issue in 2013 said there is simply not enough evidence of danger
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to call for limiting cholesterol in diets.”
USA Today (2/11, Szabo) reports that “the committee will send its final recommendations to the Department of Health and Human
Services and the U.S. Department of Agriculture, which issue the dietary advice.” HHS and the USDA “are expected to issue Dietary
Guidelines for Americans, 2015 later this year.”
The AP (2/11, Jalonick) reports, however, that “it’s unclear if the recommendation will make it into the final guidelines.”
Forbes (2/11) contributor Larry Husten writes that “the proposed change reflects a major shift in the scientific view of cholesterol that
has taken place in recent years.” While “serum cholesterol is still considered an important risk factor, cholesterol consumed in food is now
thought to play a relatively insignificant role in determining blood levels of cholesterol.” Also covering the story are Reuters (2/11) and
HealthDay (2/11).
Practice News: VA program needs physicians to provide veterans’ care

After asking for physicians’ help to enhance care for veterans last November, the U.S. Department of Veterans Affairs
(VA) has released information for physicians interested in delivering care through the Veterans Choice Program. Learn
how you can help improve access to care for veterans. Read more at AMA Wire®.
Technology News: Innovators tap physicians for early insights

How would you design your ideal practice environment? What about your ideal electronic health record? With physician
input at the ground level of emerging technologies, practicing medicine could become more satisfying—that’s the
thinking behind a new collaboration that will give physical space to innovators who want to transform health care. Read
more at AMA Wire.
AMA Store: Get expert 2015 coding help with new data file
Simplify your coding with the CPT/RVU 2015 Data File, which offers a definitive resource for physicians seeking to
import 2015 relative value units (RVU) and CPT® and Healthcare Common Procedure Coding System (HCPCS) codes
and descriptions into existing claims and billing systems. Read more at AMA Wire.
Connect with the AMA online: or visit AMA Wire Online
Government and Medicine
Administration warns of penalty for failing to enroll in health coverage.

The Washington Times (2/11, Howell) reports that with only a few days left before the deadline to sign up for health insurance under the
ACA, the Obama Administration “has begun to spotlight the penalty some Americans could pay for failing” to do so. While the
Administration has previously focused on “the benefits of coverage,” the “latest email blasts to customers with HealthCare.gov accounts
warn users to ‘get covered or risk paying a fee.’”
US News & World Report (2/11, Brecht) adds that the premium subsidy consumers receive is based on projected income and family
size for the year. As such, if “you ended up earning more money than expected or had a change in your family in 2014,” you “could be
responsible for paying back some or all of the subsidies received.”
NYTimes examines state efforts to expand Medicaid.

The New York Times (2/11, A16, Goodnough, Subscription Publication) reports on efforts to expand Medicaid in a number of states,
noting “just how complicated the politics of expanding Medicaid have become — and just how different the results of seeking an
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expansion have been from state to state.” In Pennsylvania, for instance, Gov. Tom Wolf (D) “is scrapping his Republican predecessor’s
conservative approach to expanding Medicaid” and pursuing a traditional expansion under the ACA. In Tennessee and Wyoming,
however, “bills to extend Medicaid to far more low-income residents under the law were quashed by Republican legislators last week,
despite having the support of the states’ Republican governors.” The Times adds that, to date, 28 states have accepted Federal funds to
expand Medicaid eligibility.
Senators back bill to exempt volunteer firefighters from employer mandate.

The Hill (2/11, Ferris) reports that a bipartisan group of senators “is relaunching an effort to exempt volunteer firefighters and emergency
responders from an ObamaCare rule requiring employers to offer insurance to full-time employees.” The legislation, introduced by Sens.
Mark Warner (D-VA) and Pat Toomey (R-PA), now has more than 20 co-sponsors. While the IRS has already said it will not count
volunteer fire departments or ambulances as employers under the ACA’s mandate, the senators warned that the government could “still
reverse course” without a change to the law.
Health Coverage and Access
Los Angeles County to reduce AIDS/HIV spending due to increased enrollment in insurance,
Medicare, and Medicaid.
The Los Angeles Times (2/10, Sewell) reports that Los Angeles County announced yesterday that it intended to cut $4 million from its
provision of “medical care to AIDS and HIV patients,” pointing to increased insurance coverage under the Affordable Care Act. AIDS
Healthcare Foundation board Chairwoman Cynthia Davis objected to the proposed cuts, saying that it is necessary “to ensure that these
hard-to-reach and medically underserved clients” receive the care they need. In response, “Mario Perez, head of the county’s HIV
response programs, said the number of patients enrolled in Medicare, Medicaid and private insurance has increased,” as the ACA has
“worked as intended” in the county leading to reduced need for the county funds.
CMS official says Florida low income pool funding won’t be extended.
The Miami Herald (2/11) reports that Florida lawmakers “were scrambling to find $1.3 billion to plug a sudden budget deficit after the
nation’s Medicaid chief said Tuesday that Florida will lose federal money to help hospitals treat poor and uninsured patients.” Eliot
Fishman, director of the Children and Adults Health Programs Group in the Center for Medicaid and CHIP Services at CMS, told
attendees at an Orlando healthcare conference that Federal officials won’t extend Florida’s Low Income Pool (LIP) program, which
reimburses hospitals that treat large numbers of poor and uninsured patients. The announcement “appears to overturn a main premise by
Gov. Rick Scott that the LIP fund would be available next year, thrusting his budget projections into disarray.” A spokeswoman for the
governor, however, pointed out that state officials are meeting with CMS on Wednesday to discuss the LIP extension.
Study supports affordability of health insurance for students.

The Los Angeles Times (2/11) reports that a new analysis from California State University’s Health Insurance Education Project “found
that half the approximately 445,000 students in the CSU system are able to purchase health insurance for less than they would have to
pay in fines for remaining uncovered.” Officials say the numbers show that “buying health insurance makes financial sense,” challenging
“the idea that the cost of health insurance — often cited as the main reason people don’t sign up — is unaffordable.”
Quality and Safety
Report: Patient-safety initiative preventing hospital-acquired infections in Ohio’s pediatric

hospitals.
The Columbus (OH) Dispatch (2/11, Sutherly) reports that “leaders of Ohio’s pediatric hospitals credit an unprecedented patient-safety
initiative with preventing hospital-acquired infections and other harm in about 230 children they treated between January 2012 and
October 2014.” In a newly released “interim report...officials with the Ohio Solutions for Patient Safety project said their work has saved
patients’ families, insurance companies and taxpayers in Ohio nearly $6 million during that period.”
Report: Novel doses of old medications used to circumvent cost controls on traditional ones.
On the front of its Business Day section, the New York Times (2/11, B1, Meier, Subscription Publication) reports that since 2013, “states
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nationwide have moved to crack down on so-called physician dispensing of prescription drugs, a practice largely limited to doctors who
treat injured workers.” However, physicians and “companies have responded by exploiting loopholes in those rules and adopting new
strategies to stay one step ahead, recent studies suggest.” For example, one workaround “has been to create novel dosages of old drugs
to get around cost controls on traditional ones, according to a report issued in January by the Workers Compensation Research Institute.”
The study found that “along with the 7.5-milligram version of cyclobenzaprine, the muscle relaxant, new dosages of two older painkillers,
tramadol and hydrocodone, that carry far higher prices than the standard versions, have also appeared.”
Google search to add illustrations, information on medical conditions.

USA Today (2/11, Cava) reports that Google search will be adding “everything from elaborate illustrations to an assessment of how
common the condition may be,” to search results for 400 of the most commonly searched medical conditions. The company consulted
with physicians “and artists to provide users a better at-a-glance experience.” The company intends to add to those. Amit Singhal,
Google’s vice president in charge of search, said that the company has had physicians and the Mayo Clinic review the information. He
added that Google is not seeking to replace medical advice, but is “hoping to provide a framework for a more informed conversation with
your doctor.” Google employed artists to make detailed illustrations.
Reuters (2/11, Tharakan) and TIME (2/10, Kedmey) also report the news.
Public Health
IOM panel says chronic fatigue syndrome is real.

In a segment lasting nearly three minutes, NBC Nightly News (2/10, story 9, 2:50, Holt) reported that on Tuesday, a panel from the
Institute of Medicine “declared that” chronic fatigue “syndrome is not only real, but the vast majority of people who suffer from it haven’t
even been diagnosed.” NBC News correspondent Ann Thompson explained that the IOM “issued a new set of symptoms to help doctors
recognize the disease,” such as “a drop-off in normal activity for more than six months with profound exhaustion, sleep that doesn’t
refresh, and symptoms that get worse after physical or mental exertion, plus either cognitive impairment” or symptoms that only improve
when patients are lying down.
The New York Times (2/10, Tuller) “Well” blog reported that chronic fatigue syndrome is also known as myalgic encephalomyelitis,
and “many experts now refer to the condition as ME/CFS.” However, the IOM panel “recommended that the illness be renamed ‘systemic
exertion intolerance disease.’” The blog also points out that the IOM “panel was convened at the request of the Department of Health and
Human Services, the Centers for Disease Control and Prevention, the Food and Drug Administration and other federal agencies.”
The Washington Post (2/10, Bernstein) “To Your Health” blog reported that the IOM panel acknowledged how patients with the
illness “struggle, sometimes for years, before finding a health-care provider who diagnoses a disorder.” The panel wrote, “Seeking and
receiving a diagnosis can be a frustrating process for several reasons, including skepticism of health care providers about the serious
nature of [chronic fatigue syndrome] and the misconception that it is a psychogenic illness or even a figment of the patient’s imagination.”
Currently, “less than a third of medical schools include the condition in their curricula and only 40 percent of medical textbooks contain
information on it, the experts said.”
The AP (2/11, Neergaard) reports that while physicians may not know “how to cure the disorder...there are treatments for individual
symptoms, noted committee member Dr. Lucinda Bateman of the Fatigue Consultation Clinic in Salt Lake City.” Meanwhile, “the IOM said
there’s been ‘a paucity of research’ into the causes, treatments, even the natural history of the disease to figure out who may get better
over time.” The AP adds that “the IOM advised the government to develop a toolkit to help doctors diagnose the disease, and to make
sure the disorder is assigned a specific medical billing code.”
Napping may help undo negative health effects of a sleepless night.

TIME (2/11) reports that “a small study of 11 healthy men published online in the Journal of Clinical Endocrinology & Metabolism”
suggests that “the negative health effects of a sleepless night can actually be reversed by a good nap.” For the study, participants
underwent two laboratory sleep sessions. In the first session, “the men only got two hours of sleep and then had their urine and saliva
measured and analyzed for hormonal changes.” For “the second session, the men once again only got two hours of sleep, but this time
they also took two 30-minute naps the following day.” Again, they provide samples of urine and saliva.
HealthDay (2/11, Preidt) reports that after the first session, participants “had a 2.5-fold increase in levels of norepinephrine, a stress
hormone that increases heart rate, blood pressure and blood sugar.” In addition, the men “had lower levels of a protein called interleukin-
6, which fights viruses.” After napping following the second session, “the men’s norepinephrine and interleukin-6 levels were normal.” The
ABC News (2/11, Francis) “Medical Unit” blog also covers the story.
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Childhood vitamin D deficiency may be tied to hardening of the arteries in middle age.
The New York Times (2/11, Bakalar) “Well” blog reports that a study published online in the Journal of Clinical Endocrinology &
Metabolism reveals that “vitamin D deficiency in childhood may be linked to hardening of the arteries in middle age.” The study of 2,148
youngsters ranging in age from three to 18 and followed since 1980 revealed that kids “in the lowest one-quarter for vitamin D levels,
about 15 nanograms per milliliter, were nearly twice as likely to have thickening of the carotid artery as those in the other three quarters.”
This associated “persisted after adjusting for age, sex and other cardiovascular risk factors.”
HealthDay (2/11, Preidt) reports that additional studies are “needed to learn if low vitamin D levels actually contribute to artery
hardening, but the findings highlight the need to ensure children get adequate levels of vitamin D in their diet, said” the study’s lead
author.
LGBT kids who come out in school may suffer lower rates of depression, anxiety than those
who do not.
The Chicago Tribune (2/11, Stevens) reports that a study published in the February issue of the American Journal of Orthopsychiatry
suggests that “lesbian, gay, bisexual and transgender kids who come out at school suffer lower rates of depression and anxiety and
higher rates of self-esteem, long-term, than those who hide their identity from their peers.” The survey of “245 LGBT adults ages 21 to 25”
who were asked about their high-school years and “how the timing of coming out affected their future life satisfaction,” revealed lower
rates of anxiety and depression “even if they’re bullied as a result of coming out.” Reuters (2/11, Seaman) also covers the study.
Patients with type 2 diabetes who are treated for hypertension may have better outcomes.
Reuters (2/11, Doyle) reports that a review published Feb. 10 in the Journal of the American Medical Association suggests that patients
with type 2 diabetes who are treated for hypertension appear to have longer lives and a decreased risk for heart disease. The review
examined 40 studies encompassing some 100,000 patients with type 2 diabetes.
HealthDay (2/11, Dotinga) reports that “people with type 2 diabetes are less likely to suffer heart attacks, strokes or die early when
they take blood pressure medications – even if they don’t actually have high blood pressure.” The review also found that “each decrease
of 10 mm Hg in the systolic blood pressure reading...lowered the risk of early death by 13 percent, heart attacks and similar problems by
11 percent, coronary heart disease by 12 percent and stroke by 27 percent.” In addition, “the risk of albuminuria...and retinopathy”
declined “by 17 percent and 13 percent, respectively.”
MedPage Today (2/11, Brown) reports that an accompanying editorial observed, “These findings are timely, clear, and important and
lend support to current guideline recommendations to consider offering patients with type 2 diabetes antihypertensive therapy when their
systolic blood pressure is 140 mmHg or greater.”
Surveys: Americans slowly embracing complementary medicine.

TIME (2/11, Sifferlin) reports that people in the US “are slowly but surely embracing complementary medicine – alternative practices to go
with standard treatment – according to new data from the National Center for Health Statistics (NCHS).” Data indicate that “while the
overall use of complementary health approaches has remained relatively stable over the years at 34%, certain types are rapidly gaining
popularity, especially yoga.” The Minneapolis (MN) Star Tribune (2/11, Browning) also covers the story.
Researchers studying genomes of “exceptional responders.”

In an 1,100-word article, Bloomberg News (2/11) reports that “renowned hospitals such as Memorial Sloan-Kettering Cancer Center in
New York and the Dana-Farber Cancer Institute in Boston have begun to process the genomes of some of” cancer patients known as
“exceptional responders.” These patients, “because of some combination of genetic makeup...will react favorably to conventional or
experimental medicines and treatments and beat the odds on cancers that defeat most people.” These hospitals are “hoping to learn
whether they possess gene variations that can help others by leading to new treatments and drugs or even the revival of failed ones.”
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Health officials, senators agree on importance of
vaccinations at hearing.
The Hill (2/10, Sullivan) reports that both Republican and Democratic
Senators “stressed the importance of vaccinations” at a hearing yesterday.
The Senate Health Committee’s chairman, Sen. Lamar Alexander (R-TN),
said, “Too many parents are turning away from sound science. ...Sound
science is this: Vaccines save lives.” Sen. Elizabeth Warren (D-MA), asked
Dr. Anne Schuchat, director of the National Center for Immunization at the
CDC if any scientific evidence exists “that vaccines cause profound mental
disorders,” a controversial phrase Sen. Rand Paul (R-KY) had used.
Schuchat responded, “No,” adding “that some of the diseases themselves
can cause mental disorders.” Additionally, both Sen. Barbara Mikulski (D-
MD) and Sen, Susan Collins (R-ME) “not only urged vaccination but raised
concerns about a $50 million proposed cut in President Obama’s budget to a
CDC vaccination program.”
The Springfield (MA) Republican (2/11) reports on Warren’s questions to the “witnesses appearing before a meeting of the full
committee on ‘The Reemergence of Vaccine-Preventable Diseases: Exploring the Public Health Successes and Challenges.’” Her
questions mostly “focused on the safety of vaccines, and on questions that have been raised in the media by parents challenging what is
in vaccines, when they should be given and alternatives to them.”
Business Journals (2/11, Hoover) notes that the public health officials testifying to Congress yesterday said parents who did not
vaccinate their children “are the main reason for this year’s measles outbreak.” Dr. Schuchat stated, “Outbreaks can occur in the United
States when unvaccinated groups are exposed to imported measles virus.” She said that micro-communities of those who don’t vaccinate
“are making it difficult to control the spread of measles and are making us vulnerable to having the virus re-establish itself in our country
again.” Schuchat added that “they put others at risk who cannot get vaccinated because they are too young or they have specific health
conditions.”
NBC News (2/10) reports that the doctors at the Senate hearing told the Congressmen that “false rumors that frighten parents are
clearly behind the current outbreak of measles linked to Disneyland.” However, “the attention being focused on the outbreak might turn
around a dangerous trend of opting out of vaccines for philosophical reasons,” they said. People are more aware now of the
consequences of their choices.
According to the International Business Times (2/11), “During Tuesday’s Senate health committee panel, members and panelists
agreed that vaccines are a public health priority and that children should be immunized.”
USA Today (2/10, Troyan), the Huffington Post (2/11, Edwards-Levy), and Modern Healthcare (2/11, Subscription Publication) also
all highlight the bipartisan agreement in support of immunization of children against preventable diseases.
Growing number of pediatricians turning away parents who won’t vaccinate kids. The Los Angeles Times (2/10,
Mejia) reported that “amid the current measles outbreak,” an increasing number of “pediatricians nationwide are turning away parents
who refuse to vaccinate their children.” Dr. Charles Goodman, a pediatrician who turned away the mother of a child she refused to have
vaccinated, said, “We decided that the patients who are not vaccinated are presenting a clear and present danger.” He believes it isn’t
“fair for a small number of” willfully unvaccinated patients to put those “many patients, who either couldn’t be vaccinated because they’re
too young or had a weakened immune system, at risk.”
In Slate Magazine (2/10), Melinda Wenner Moyer interviewed infectious disease experts about how to protect unvaccinated babies
from the measles.
West Virginia, Mississippi have toughest school vaccination laws. The AP (2/11, Raby, Pettus) reports that states like
Mississippi and West Virginia, which “have struggled with health crises,” including “rampant diabetes and obesity,” are the “only ones that
refuse to exempt school children from mandatory vaccinations based on their parents’ personal or religious beliefs.” In both states,
“barring a significant medical reason, kids who haven’t been vaccinated can’t attend school – public or private.”
NPR (2/10, Plevin) reported on its “All Things Considered” program and in its “Shots” blog that California law allows “incoming
kindergartners who have received at least one dose of each required vaccine to enroll as what’s known as ‘conditional entrants,’” and
beyond that, “it’s up to the school to notify a family when the child’s next shot is due.” Tonya Ross, a registered nurse and director of
nursing services for the Los Angeles Unified School District, “says...that follow-up doesn’t always happen.” Immunization rates must be
reported in the fall, “but there is no additional reporting requirement” beyond the three percent of kindergartners randomly audited “every
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third spring.”
A second piece from the NPR (2/10, Dembosky) on its “Morning Edition” program and in its “Shots” blog considered the question of
whether or not employers “have any responsibility to check the vaccination status of their staff, even when there’s no imminent outbreak.”
Dr. Arthur Reingold, a professor of epidemiology at the School of Public Health at the University of California-Berkeley, said there are
“there are three types of companies,” including: hospitals, where “it makes complete sense to require employees to be vaccinated”; an
office environment that “doesn’t present risks that would justify mandatory vaccination”; and a “places like Disneyland, where there are
many children and international visitors, but they are healthy.”
Obama to withdraw most US troops sent to Africa to contain Ebola.

The New York Times (2/11, Davis, Subscription Publication) reports that according to Administration officials, the President will announce
on Wednesday that “he is withdrawing almost all the American troops who were sent to West Africa to help contain the spread of the
Ebola virus.” While the expected announcement “reflects vindication for Mr. Obama and the administration, whose slow and at times
bungling initial response to the Ebola outbreak raised questions about the president’s ability to handle fast-moving global crises,” it also
“raises questions about whether Mr. Obama is prematurely claiming success on what he had labeled a national security priority, opening
himself to criticism should Ebola again spiral out of control.” The Hill (2/10, Mali) reports that the President will make the announcement
during a White House event at which he will also “outline further steps the U.S. is taking to prevent Ebola cases at home.”
The Wall Street Journal (2/11, Nissenbaum, Barnes, Subscription Publication) notes there are currently 1,300 American troops
working in West Africa. Rear Adm. John Kirby, the Pentagon press secretary, said Tuesday, “Given the success of the U.S. response to
the crisis, the majority of [Defense Department] personnel in West Africa will now return home.”
Bloomberg News (2/10, Linskey) reports that according to a statement from the White House, “most of the remaining soldiers will
return to the U.S. on April 30,” and about 100 personnel will remain after that date.
The AP (2/10) reports USAID Administrator Rajiv Shah stated, “Just 10 months since the first U.S. government personnel deployed,
we have delivered extraordinary results.” Of the 2,800 troops the US deployed, about 1,500 have already returned home. Those
remaining in West Africa “will work with Liberia’s military, regional partners and U.S. civilians to continue fighting Ebola.”
According to the Washington Times (2/10), the American troops deployed to West Africa “constructed Ebola Treatment Units, trained
local and international healthcare workers on how to treat those infected with the disease and provided support to humanitarian and
public-health workers who provided care throughout West Africa.”
Also reporting the story are Reuters (2/11, Maler), TIME (2/10) and NPR (2/10).
Scientists testing Ebola treatments struggle to find enough Ebola patients. The Washington Post (2/11, Brittain)
reports that scientists racing to find a cure for Ebola by conducting experiments in West Africa “are encountering an unexpected
challenge: finding enough Ebola patients as the outbreak recedes.” In Liberia, for example, researchers had to abandon a clinical trial in
late January because of a lack of Ebola patients. On Monday, a Belgian-led team in Guinea launched an experiment testing whether
blood plasma of Ebola survivors can save lives. Another trial “is expected to begin within weeks to test two vaccines,” but “both
experiments need scores of patients with the virus in order to produce statistically significant results.”
A feature on the Washington Post (2/11) website examines the “two promising Ebola vaccines” that have begun clinical trials in West
Africa. The chimp adenovirus vaccine, from GlaxoSmithKline; and VSV-Zebov, made by NewLink and Merck, have both started testing in
parts of Liberia.
World leaders say Ebola outbreak exposed need for better crisis response. The AP (2/10) reports that a “trio of world
leaders says the devastating Ebola outbreak exposed the ‘weakness’ of international crisis response and is seeking a solution.” German
Chancellor Angela Merkel, Norwegian Prime Minister Erna Solberg and Ghanaian President John Mahama have asked UN Secretary-
General Ban Ki-moon to create a high-level panel and commission a report on how the international community can better respond to
such crises. The letter “calls for better approaches to mobilizing funding and resources, strengthening basic health care systems and the
development of vaccines and treatments for ‘neglected tropical diseases.’”
Meanwhile, Bloomberg News (2/11) reports that Britain’s reaction to the Ebola outbreak “cost ‘lives and money,’ according to a U.K.
parliamentary report that criticized the international response to the contagion as ‘totally inadequate.’” The outbreak could have been
contained had the Department for International Development “recognized the risk of the disease sooner, the House of Commons Public
Accounts Committee said Wednesday.”
Visit the AMA Ebola Resource Center for expert resources for physicians and the public.
Health and Diet
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Health benefits of alcohol consumption may be more limited than previously thought.
The Los Angeles Times (2/11, Healy) reports that a study published Feb. 10 in the journal BMJ Open suggests that “the health benefits of
alcohol consumption are more limited than previously thought.” The study found that for women over age 65, “the health benefits of
alcohol are not enormous, but drinkers were less likely to die during a follow-up period of between six and 10 years.” However, “those
health benefits did not significantly vary with the amount women drank: those who claimed they drank two or fewer drinks per month were
just as protected against death from any cause as those who drank 15 or even 20 ‘units’ of alcohol per week.”
HealthDay (2/11) reports that overall, the “review of nearly 53,000 British people found little to no health benefit linked to alcohol
consumption, once the results were adjusted for a range of personal, social, economic and lifestyle factors.” The study’s lead author said,
“Based on the findings from this study, alcohol consumption appears to confer little to no protection against mortality [death] in most age-
sex groups.”
Pharma & Device Update
Promising malaria vaccine unable to secure funding.

Newsweek (2/11, Conaway) reports on a malaria vaccine developed by a company called Sanaria that announced in 2013 that its
vaccine proved to be “100 perfect effective” in “preventing malaria caused by plasmodium falciparum – by far the most deadly of the five
malaria-causing parasites and responsible for almost all of the estimated 600,000 deaths per year.” Despite the promising results,
Sanaria “can’t get support from other researchers in the field and hasn’t been able to secure as much funding as its rivals have.”
Newsweek adds that Sanaria got its start 11 years ago “in an 800-square-foot facility and with a $550,000 Small Business Innovation
Research grant from the National Institute of Allergy and Infectious Diseases.”
Tuesday's Lead Stories
• Study: HPV vaccine does not lead to risky sexual behaviors in teen girls.
• Pennsylvania governor moves toward traditional Medicaid expansion.
• Quest Diagnostics, Myriad Genetics settle dispute over cancer gene tests.
• HHS: Average ACA monthly premium after tax credits is $105.
• Analysis: Clinical trials with violations often make no mention of issues in final report.
• Measles outbreak grows to 166 cases across 18 states, DC.
• Energy drinks associated with greater hyperactivity, inattention risk in middle-school kids.
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28
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Interesting. Looked at the Athero paper. They did not appear to correct for age in any
analysis. Were that the case, since age and egg yolk in take were correlated, I don’t see how they
could attribute the effect to one factor or the other. Age is a well-established risk factor.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

To: 'dspence@robarts.ca'
Cc: 'walter.kernan@yale.edu'; Lichtenstein, Alice; 'Neuhouser, Marian L'
Dr. Spence,

Your correspondence below was forwarded to me. Thank you for your interest in the 2015 Dietary Guidelines Advisory
Committee. Information about the Advisory Committee and the process the federal government uses for updating the
Dietary Guidelines for Americans federal policy can be found at www.DietaryGuidelines.gov. Advisory Committee
members cannot accept public comments. Public comment is an important part of our process. In the coming weeks, a
Federal Register notice will be published announcing the availability of the Committee’s Advisory Report, a public
comment period, and the date of a public meeting for providing oral comments to the Federal government on the
Advisory Report. A public comments database will open for the public to submit comments to the Federal government
on the Advisory Report when the Federal Register notice is published. We encourage you to submit your comments
below at that time. You can continue to check DietaryGuidelines.gov for the most up‐to‐date information.
Thanks,
Kellie
29
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To: Kernan, Walter
Dear Walter,

schedule permits.





Best regards,

David Spence

Phone 1‐519‐931‐5731; Fax 1‐519‐931‐5737

To: David Spence

30
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Suite 515
New Haven, CT 06519
Phone: 203‐764‐7000
Fax: 203‐764‐7552

To: Kernan, Walter
Leading the News
31
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list.”
HealthDay (2/11).


more at AMA Wire.

32
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33
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Quality and Safety

hospitals.

Public Health

34
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author.
who do not.

35
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conditions.”
from the measles.
36
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third spring.”

parts of Liberia.
37
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Health and Diet
sex groups.”


Subscriber Tools
• Send Feedback
• Unsubscribe
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38
PSC-HHS-000038
39
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Attachments: Spence AHA SC 2015 Effect of Dietary Cholesterol and Egg Consumption
REGARDS.pdf; Atherosclerosis 2012 Egg yolk plaque.pdf; Atherosclerosis 2012 Reply to
letters on egg yolk and plaque.pdf; Can J Cardiol 2010 Cholesterol and egg yolk -
Copy.pdf; Can J Cardiol 2011 reply to letters to the Editor on egg yolk - Copy.pdf; Can J
Cardiol Carrot in snowman with warning - Copy.pdf; IAS Commentary Eggs Athero.org
2013.pdf
FYI, see below.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

To: Kernan, Walter
Dear Walter,

schedule permits.





40
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Best regards,

David Spence

Phone 1‐519‐931‐5731; Fax 1‐519‐931‐5737

To: David Spence

Suite 515
New Haven, CT 06519
Phone: 203‐764‐7000
Fax: 203‐764‐7552

To: Kernan, Walter
41
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Leading the News

list.”
42
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HealthDay (2/11).


more at AMA Wire.


43
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Quality and Safety

hospitals.

44
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Public Health


45
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author.
who do not.


46
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conditions.”
from the measles.
47
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third spring.”

parts of Liberia.
Health and Diet
48
PSC-HHS-000048
sex groups.”

Subscriber Tools
• Send Feedback
• Unsubscribe
• Email Help
• Archives
49
PSC-HHS-000049
50
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Sent: Saturday, January 31, 2015 12:56 PM
To: Britten, Patricia - CNPP
Cc: mneuhous@fhcrc.org; sabrams@bcm.edu; c1anderson@ucsd.edu;
mary.story@duke.edu; alice.lichtenstein@tufts.edu; jconnor@fhcrc.org;
lhimes@bcm.edu; lauren.bailey@tufts.edu; Yamini, Essie (FDA/CFSAN); Kuczynski, Kevin
- CNPP; Essery, Eve - CNPP; Wong, Yatping - CNPP; Bowman, Shanthy; Casavale, Kellie
(OS/OASH); Rihane, Colette - CNPP; Olson, Richard (HHS/OASH); Krebs-Smith, Sue
(NIH/NCI) [E]; Reedy, Jill (NIH/NCI) [E]; (b) (6)
Subject: Re: DGAC followup: Potential journal articles from Subcommittee 1's work
Hi Trish, since there relate to one of my areas of career‐long research I would love to help in any way possible. Barbara

Sent from my iPhone

On Jan 30, 2015, at 12:35 PM, "Britten, Patricia ‐ CNPP" <Patricia.Britten@cnpp.usda.gov> wrote:
Hi All,

Feels good to use my SC1 email list again 

As I mentioned on this week’s DGAC administrative call, I have collected ideas for a few potential articles
that SC1 members and staff indicated they were interested in pursuing. I know from experience that
having publications based on our data analyses and modeling work can be very important and very
rewarding. I also know that each article becomes quite time consuming. So, I want to pursue those
articles that are highest priority first, and then look at additional articles that are also of interest. Here is
a beginning list:

 Quantification of the food group composition of dietary patterns with health benefits
Possible Authors: Nadine Braunstein (she has indicated she would like to take the lead on this),
Miyuki Shimizu, Marian, Cheryl, Trish, others?
 Food group density by point‐of‐purchase compared to HEI food group standards
Possible Authors: Mary, Wenyen Juan, Sue KS, Jill Reedy, Trish, others?
 Food group and energy intake recommendations in comparison to usual intake distributions
Possible Authors: Trish, Marian, Sue and/or Jill, others?
NOTE: In the modeling analysis on adequacy of the USDA Food Patterns, we referenced that, for
the first time, all food group recommendations were compared to usual intake distributions in a
systematic way. We were not able to present all of the details of this analysis in the modeling
report and it would be good to have it documented in the literature. We did do this analysis for
vegetable subgroups in 2010, and in the JAND article on the Food Patterns update, that part of
the manuscript was of highest interest to the reviewers.
There are also possibilities of drafting additional manuscripts to document and expand on the SC’s work,
such as the following:

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 The contribution of food categories to nutrient and food group intakes, overall and by age/sex
group (we have data for nutrients and food groups that were not presented, and data for
age/sex groups that was only summarized)
 The development of the Vegetarian and Med‐style Patterns
 The contributions of each food group to overall nutrient intake in the USDA Food Patterns, in
comparison to their contributions based on current intake levels.
Please let me know your thoughts on each of these ideas, if you have additional ideas for manuscripts, if
you would like to be involved in any of these or other manuscripts, or if you are just enjoying not having
DGAC deadlines hanging over your head at the moment 

Best,
Trish

This electronic message contains information generated by the USDA solely for the intended
recipients. Any unauthorized interception of this message or the use or disclosure of the
information it contains may violate the law and subject the violator to civil or criminal penalties.
If you believe you have received this message in error, please notify the sender and delete the
email immediately.
52
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Sent: Monday, January 26, 2015 2:07 PM
To: Lichtenstein, Alice; Essery, Eve - CNPP; Casavale, Kellie (OS/OASH)
Cc: Olson, Richard (HHS/OASH); Rihane, Colette - CNPP; Bowman, Shanthy; 'Anne Rodgers'
Subject: RE: Final approval of edits: Chapter 6: Cross-Cutting Topics
I approve this revision as well. Barbara

bmillen@bu.edu

To: Essery, Eve - CNPP; Millen, Barbara E; Casavale, Kellie (OS/OASH)

It was my error, I must have been on overload last week. Very sorry about that.
The revised version looks correct to me.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127
From: Essery, Eve - CNPP [mailto:Eve.Essery@fns.usda.gov]

To: Lichtenstein, Alice; Millen, Barbara E; Casavale, Kellie (OS/OASH)

Hi Alice,
The text originally said “better sodium and potassium balance” and you edited it to say “ratio.” Rather than put that into a
“balance/ratio” statement, do you just want to recommend lowering sodium? How’s this?...

The Committee encourages the food industry to continue reformulating and making changes to
certain foods to improve their nutrition profile. Examples of such actions include lowering sodium and
added sugars content, achieving better saturated fat to polyunsaturated fat ratio, and reducing portion
sizes in retail settings (restaurants, food outlets, and public venues, such as professional sports
stadiums and arenas). The Committee also encourages the food industry to market these improved
products to consumers.
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I don’t approve. According to the predominance of evidence the critical issue is to reduce the Na
content of food. The issue of Na/K ratio is still emerging and the implication that just taking a K
supplement on top of a high Na diet will improve outcomes cannot be supported by the science. The
Na/K concept has emerged from certain dietary patterns naturally low in Na and high in K, e.g., those
high in F&V.
I am sorry not to have caught this earlier. Improving the SFA/PUFA ratio is appropriate.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127


Hi Barbara and Alice,
We’ve done some editing of your statement for clarity and readability. Do you approve this version of the statement for
inclusion in the Cross-Cutting Chapter and the Integration Chapter?
Thanks!
Eve

certain foods to improve their nutrition profile. Examples of such actions include achieving better
sodium to potassium ratio and/or saturated fat to polyunsaturated fat ratio, lowering added sugars
content, and reducing portion sizes in retail settings (restaurants, food outlets, and public venues,
such as professional sports stadiums and arenas). The Committee also encourages the food industry
to market these improved products to consumers.

Sent: Friday, January 23, 2015 3:18 PM
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Wow, who would have ever thought that could happen.
The sentence conveys what I was thinking about. Was there a reason to leave out SFA. Could we
treat it as for Na/K? Also, I think it should be sodium to potassium ratio. Just a quick read, you can
decide what is most appropriate.
“The Committee also encourages the food industry to continue to reformulate and make changes to
improve the nutrition profile of certain foods to achieve better sodium to potassium ratio, saturated fat
to polyunsaturated fat ratio, lower added sugars content, reduce portion sizes in retail settings
(restaurants, food outlets, and public venues, such as professional sports stadiums and arenas), and
to market them to consumers.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

To: Millen, Barbara E; Lichtenstein, Alice; Casavale, Kellie (OS/OASH)

Just when you thought the Cross‐Cutting Chapter was done… ;)

Alice – You had asked if a statement could be added to the chapter summary stating that the Committee also supports
expanded availability of reduced SFA, Na and added sugar products. We initially said this wasn’t possible because it
hadn’t been vetted by the Committee. However, Kellie and I were walking through some things in the Report, and she
remembered a somewhat similar statement in the Integration Chapter. Below is the paragraph where Alice made the
comment. Would you like to add the highlighted sentence to this chapter? (This is possible since it was already vetted as
part of the Integration Chapter.) Please let us know.

Achieving reductions in sodium, saturated fat, and added sugars, can all be accomplished and are more attainable by
eating a healthy dietary pattern. For all three of these components of the diet, policies and programs at local, state, and
national levels in both the private and public sector are necessary to support reduction efforts. Similarly, the Committee
supports efforts in labeling and other campaigns to increase consumer awareness and understanding of sodium,
saturated fats, and added sugars in foods and beverages . The Committee also encourages the food industry to
continue to reformulate and make changes to improve the nutrition profile of certain foods to achieve better sodium
and potassium balance, lower added sugars content, reduce portion sizes in retail settings (restaurants, food outlets,
and public venues, such as professional sports stadiums and arenas), and to market them to consumers.

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Thanks!
Eve

From: Millen, Barbara E [mailto:bmillen@bu.edu]
Sent: Wednesday, January 21, 2015 4:16 PM
To: Essery, Eve - CNPP; Lichtenstein, Alice; Casavale, Kellie (OS/OASH)

OK. We stand by our evidence base. It’s an interesting research question (but I’m not suggesting any additions)!

Thank you for the clarification. Barbara

bmillen@bu.edu


Barbara – To answer your question about why sources of healthy proteins was deleted from the sat fat section of the
cross-cutting chapter, on Sun 12/21/14 @ 9:33am, Frank sent an email with edits to this section, including the one
referenced below. (Both of you, as well as Tom, were included on the email string.) To accompany this edit, Frank
included a note that states, “Please note that protein sources are removed from here because none of the trials or
epidemiological studies involved protein as a replacement for saturated fat food sources.” His edit was to align more with
the research considered.
Please let me know if you’d like me to forward his email.
Eve

Sent: Wednesday, January 21, 2015 7:17 AM
To: Millen, Barbara E; Essery, Eve - CNPP; Casavale, Kellie (OS/OASH)

I agree with Barbara. By bringing the reference forward what are we suggesting, cut dairy
consumption or worse yet switch from fat-free and low-fat to full fat dairy products? That would not
be consistent with our other guidance.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127
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But here we’re talking about substitution for carbohydrates and CVD risk and lipids. So does reference here to
sustainability make sense? Also, I would wonder about bringing in literature from modeling research when we’re
reporting on saturated fat and CVD.

Other thoughts?

Barbara

bmillen@bu.edu


My guess is due to sustainability issues according to van Doreen et al. Is that correct?
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127


Sorry, on line 473‐4, what is the rationale for eliminating sources of healthy proteins? Otherwise I am fine with the
edits. Barbara

bmillen@bu.edu

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A brief summary of the changes to the cross‐cutting chapter based on your final review is below, with individual
comments provided in the chapter attached.

Kellie – Unless we hear from Barbara and Alice otherwise, this chapter is ready to move forward for finalization.
Thanks!
Eve

 LCSs changed to low‐calorie sweeteners throughout
 Line 375: Deleted “and simple cooking techniques that maximize flavor” to parallel chapter summary.
 Line 492: Added CHD (discussed in the review of evidence)
 Line 1019: Switched order to be “beverages and foods”
 Line 1086: Edits made so that the sentence reads, “For sodium, emphasis should be placed on expanding
industry efforts to reduce the sodium content of foods and helping consumers understand how to flavor
unsalted foods with spices and herbs.” (This is clearly stated in the sodium section; these are just edits to carry
that forward in the chapter summary.)
 A few responses to comments:
o In the style guide, it is requested that a lower case “n” be used for “n=”
o Abbreviations reviewed and edited, when needed
o Alice has commented that she does not support the statement that added sugars “not be replaced with
low‐calorie sweeteners.” However, this has been presented at public meetings, and it was not decided
that this would be deleted or changed, and thus, this would be a substantive change that cannot be
made at this time.
o Alice asked if a statement could be added to the chapter summary stating that the Committee also
supports expanded availability of reduced SFA, Na and added sugar products. However, since this has
not been discussed with the full Committee, it is a substantive edit that cannot be made at this time.

To: Millen, Barbara E; Casavale, Kellie (OS/OASH)
Cc: Olson, Richard (HHS/OASH); Rihane, Colette - CNPP; Bowman, Shanthy; Essery, Eve - CNPP; 'Anne Rodgers'

I agree with Barbara. All along I thought we were emphasizing the need for the food industry to ramp
down on Na.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
58
PSC-HHS-000058
Boston, MA 02111

phone: 617 556 3127

Sent: Monday, January 19, 2015 11:12 AM
To: Casavale, Kellie (OS/OASH); Lichtenstein, Alice
Cc: Olson, Richard (HHS/OASH); 'Colette Rihane'; 'Shanthy Bowman'; 'Essery, Eve - CNPP'; 'Anne Rodgers'

Hi everyone,

I am approving the recommended edits with one exception to edits in the document. I propose a bit of tweaking on
Lines 1981‐4. As written, the emphasis appears to be on educating consumers (I think but it’s not clear) to flavor
unsalted foods with herbs and spices. I think we also want to emphasize expanding food industry initiatives to lower the
sodium content of foods. Do we want to mention any other ‘environmental changes’? I offer some suggested wording
to be more consistent with the conclusion statements.

As with the other chapters, this was a pleasure to read! Many thanks.

Barbara

bmillen@bu.edu

To: Millen, Barbara E; 'Lichtenstein, Alice'
Subject: Final approval of edits: Chapter 6: Cross-Cutting Topics
Importance: High

Barbara and Alice,

Chapter 6: Cross‐cutting Topics of Public Health Importance and a log of edits are attached. The editorial changes were
accepted. You will see that most tracked changes in the chapter are to update the references to refer to the NHLBI
Report and AHA/ACC Guideline pairs accurately. There are a few other substantive tracked changes that address
previously established issues.

Please respond back as soon as possible noting that
1. You approve these all be made and the chapter considered final
2. Note any edits that need tweaking TO ADDRESS THE ORIGINAL ISSUE
 DO NOT SUGGEST ANY NEW EDITS UNLESS YOU NOTICE A BLATANT ERROR.

If you have questions, please reply to the group, and Eve will answer them for you.

Many thanks,

Kellie

59
PSC-HHS-000059
1101 Wootton Pkwy, LL117
Rockville, MD 20852
(240) 453‐8252
www.DietaryGuidelines.gov

This electronic message contains information generated by the USDA solely for the intended recipients. Any
unauthorized interception of this message or the use or disclosure of the information it contains may violate the
law and subject the violator to civil or criminal penalties. If you believe you have received this message in error,
please notify the sender and delete the email immediately.
60
PSC-HHS-000060

It was my error, I must have been on overload last week. Very sorry about that.
The revised version looks correct to me.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127


Hi Alice,
The text originally said “better sodium and potassium balance” and you edited it to say “ratio.” Rather than put that into a
“balance/ratio” statement, do you just want to recommend lowering sodium? How’s this?...

certain foods to improve their nutrition profile. Examples of such actions include lowering sodium and
added sugars content, achieving better saturated fat to polyunsaturated fat ratio, and reducing portion
sizes in retail settings (restaurants, food outlets, and public venues, such as professional sports
stadiums and arenas). The Committee also encourages the food industry to market these improved
products to consumers.


61
PSC-HHS-000061
high in F&V.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127


Thanks!
Eve



62
PSC-HHS-000062
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127





Thanks!
Eve



63
PSC-HHS-000063

bmillen@bu.edu


Eve


‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127



64
PSC-HHS-000064
Other thoughts?

Barbara

bmillen@bu.edu


‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127


edits. Barbara

bmillen@bu.edu




Thanks!
Eve
65
PSC-HHS-000065

made at this time.


down on Na.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127


66
PSC-HHS-000066
Hi everyone,



Barbara

bmillen@bu.edu

Importance: High

Barbara and Alice,




Many thanks,

Kellie

Rockville, MD 20852
(240) 453‐8252

67
PSC-HHS-000067
68
PSC-HHS-000068

high in F&V.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127


Thanks!
Eve


69
PSC-HHS-000069

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127




70
PSC-HHS-000070

Thanks!
Eve




bmillen@bu.edu


Eve


‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111
71
PSC-HHS-000071

phone: 617 556 3127



Other thoughts?

Barbara

bmillen@bu.edu


‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127


edits. Barbara

bmillen@bu.edu

72
PSC-HHS-000072



Thanks!
Eve

made at this time.


down on Na.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
73
PSC-HHS-000073
Tufts University
Boston, MA 02111

phone: 617 556 3127


Hi everyone,



Barbara

bmillen@bu.edu

Importance: High

Barbara and Alice,




Many thanks,

Kellie
74
PSC-HHS-000074

Rockville, MD 20852
(240) 453‐8252

75
PSC-HHS-000075

To: Britten, Patricia - CNPP; Casavale, Kellie (OS/OASH); 'Barbara E Millen'
Cc: Olson, Richard (HHS/OASH); Rihane, Colette - CNPP; Bowman, Shanthy; Essery, Eve -
CNPP; 'Anne Rodgers'
Subject: RE: Final approval of edits: Glossary (and Report Update)
We are then in 100% agreement. What a pleasure.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127
From: Britten, Patricia - CNPP [mailto:Patricia.Britten@cnpp.usda.gov]

To: Lichtenstein, Alice; Casavale, Kellie (OS/OASH); 'Barbara E Millen'

Alice, I meant this to be a cross reference to both the sugars and added sugars definitions, just forgot to put in added
sugars. Here is what it should be:

Sugar‐sweetened beverages—Liquids that are sweetened with various forms of added sugars (see Added Sugars
and Carbohydrates: Sugars). These beverages include, but are not limited to, soda, fruitades, and sports drinks. Also
called calorically‐sweetened beverages.

Kellie, I think with this one last change we all agree and Barbara and Alice have both approved the glossary.

Trish


Great solutions Trish, I agree with them all. Thank you. A hallo is starting to float above all your
heads.
76
PSC-HHS-000076
I do want to clarify one point. For SSB could we not cross reference to the Add Sugars definition or
can we just cross reference to chapters?
See comments in text agreeing with everything and bringing up that point in situ.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127


Alice,

Thanks for your review and suggestions. Kellie asked me to respond on several of your comments to see if we’ve
reached agreement on final wording. Major changes below and all changes reflected in the attachment:

 Saturated fatty acids—Saturated fatty acids have no double bonds. Major sources include animal products such
as meat and dairy products, and tropical oils such as coconut or palm oils. In general, fats high in saturated fatty
acids are solid at room temperature.
 trans fatty acids—Trans fatty acids are unsaturated fatty acids that contain one or more isolated (i.e.,
nonconjugated) double bonds in a trans configuration. Sources of trans fatty acids include partially‐
hydrogenated vegetable oils that are have been used to make traditional shortening and some commercially
prepared baked goods, snack foods, fried foods, and traditional stick margarine. Trans fatty acids also are
present in foods that come from ruminant animals (e.g., cattle and sheep) and are called “natural” or rTFA. Such
foods include dairy products, beef, and lamb.
 Oils—Fats that are liquid at room temperature. Oils come from many different plants and some fish. Some
common oils include canola, corn, olive, peanut, safflower, soybean, and sunflower oils. A number of foods are
naturally high in oils, such as: nuts, olives, some fish, and avocados. Foods that are mainly made up of oil
include mayonnaise, certain salad dressings, and soft (tub or squeeze) margarine with no trans fats. Oils are high
in monounsaturated or polyunsaturated fats, and low in saturated fats than solid fats. A few plant oils, termed
tropical oils, including coconut oil, palm oil and palm kernel oil, are high in saturated fats and for nutritional
purposes should be considered as solid fats. Partially‐hydrogenated oils that contain trans fats should also be
considered as solid fats for nutritional purposes. (See Fats)
 Solid fats—Fats that are usually not liquid at room temperature. Solid fats are found in animal foods except for
seafood, and can be made from vegetable oils through hydrogenation. Some tropical oil plants, such as coconut
and palm, are considered as solid fats due to their fatty acid composition. Solid fats contain more saturated fats
77
PSC-HHS-000077
and/or trans fats than liquid oils (e.g., soybean , canola, and corn oils), with lower amounts of
monounsaturated or polyunsaturated fatty acids. Common fats considered to be solid fats include: butterfat,
beef fat (tallow, suet), chicken fat, pork fat (lard), traidional stick margarine, traditional shortening, coconut oil,
palm oil and palm kernel oil . Foods high in solid fats include: butter, full‐fat cheeses, creams, whole milk, full
fat ice creams , marbled cuts of meats, regular ground beef, bacon, sausages, poultry skin, and many baked
goods made using these products (such as cookies, crackers, doughnuts, pastries, and croissants).The fat
component of milk and cream (butter) is solid at room temperature. (See Fats)
 Lean meat—Any meat with less than 10% fat by weight, or less than 10 grams of fat per 100 grams, based on
USDA and FDA definitions for food label use. Examples include 95% lean ground beef, cooked; broiled beef
steak, lean only eaten; baked pork chop, lean only eaten; roasted chicken breast or leg, no skin eaten; and
smoked/cured ham, lean only eaten .

NOTE:
Crisco Ingredients from the current website:
SOYBEAN OIL, FULLY HYDROGENATED PALM OIL, PARTIALLY HYDROGENATED PALM AND SOYBEAN OILS, MONO AND DIGLYCERIDES, TBHQ AND
CITRIC ACID (ANTIOXIDANTS).

Please let us know if this is okay with these edits.

Thanks,
Tris

Sent: Friday, January 23, 2015 9:29 AM
To: Casavale, Kellie (OS/OASH); 'Barbara E Millen'
Cc: Olson, Richard (HHS/OASH); Rihane, Colette - CNPP; Bowman, Shanthy; Essery, Eve - CNPP; 'Anne Rodgers'; Britten,
Patricia - CNPP

Generally looks good to me and should be very helpful to the users of the report. See comments
below and in text. Regardless of the decision with regard to these, none are such that the document
should be held up.
Minor comments;
 Should have picked this up sooner but BMI z-score should have been listed as its own
separate entry since it is less familiar than BMI and someone may not read down to the bottom
of the BMI entry, especially since reference to BMI z-score is sandwiched in between the text
and table
 General comment, the term “.Eating out” is misleading in the current food environment since it
included prepared outside the home but consumed in the home. Future DRI committees
should rethink the term.
 Suggesting further modified to saturated fat;
In general, fats high in saturated fatty acids are solid at room temperature, with the notable exception of
tropical oils.
78
PSC-HHS-000078
 Trans fat – Should be modified to read “Sources of trans fatty acids include partially‐hydrogenated
vegetable oils that are used to make traditional shortening and some commercially prepared baked goods, snack
foods, fried foods, and traditional stick margarine.”
Shortenings like Crisco are now trans-free. There has been a well-documented shift in
commercial prepared baked goods to be trans free likely resulting from the FDA mandate that
TFA needs to be listed on the Nutrients Facts label. The definition as written does not reflect
this shift. It is certainly not accurate for most margarines, even stick margarine for which many
are trans free. Dated definition.
Other comments in text.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

To: 'Barbara E Millen'; Lichtenstein, Alice
Cc: Olson, Richard (HHS/OASH); 'Colette Rihane'; 'Shanthy Bowman'; 'Essery, Eve - CNPP'; 'Anne Rodgers'; Britten,
Patricia - CNPP
Subject: Final approval of edits: Glossary (and Report Update)
Importance: High

Barbara and Alice,

I think this will be the last file for you to approve, Appendix E‐5 Glossary. Only a handful of additions and minor tweaks
were needed. Explanations for each are provided.

1. You approve these be accepted and glossary considered final

If you have questions, please reply to the group. I have copied Trish as well; she was involved in almost all of these
resolutions.

As an update‐ we are VERY close to moving all of the files to their final form. We expect being able to send them to be
made 508 compliant MONDAY. Once they go to the contractor NO edits can be made. If an error is found that needs
to be documented, we will post an addendum alongside the report to document and communicate these. Because of
the finality of this step, I wanted to be sure you were aware.

There has also been some guidance given to us from far above regarding the timing of the submission of the Report to
the Secretaries. We will describe that on the Administrative call on Tuesday morning.

79
PSC-HHS-000079
Many thanks,

Kellie

Rockville, MD 20852
(240) 453‐8252

80
PSC-HHS-000080

Cc: Britten, Patricia - CNPP; Casavale, Kellie (OS/OASH); Olson, Richard (HHS/OASH);
Rihane, Colette - CNPP; Bowman, Shanthy; Essery, Eve - CNPP; Anne Rodgers
Subject: Re: Final approval of edits: Glossary (and Report Update)
I too approve and agree that all of you are amazing. Barbara

Sent from my iPhone

On Jan 23, 2015, at 3:35 PM, "Lichtenstein, Alice" <Alice.Lichtenstein@tufts.edu> wrote:
Great solutions Trish, I agree with them all. Thank you. A hallo is starting to float above
all your heads.

I do want to clarify one point. For SSB could we not cross reference to the Add Sugars
definition or can we just cross reference to chapters?


‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

Cc: Olson, Richard (HHS/OASH); Rihane, Colette - CNPP; Bowman, Shanthy; Essery, Eve - CNPP; 'Anne
Rodgers'

Alice,

Thanks for your review and suggestions. Kellie asked me to respond on several of your comments to see
if we’ve reached agreement on final wording. Major changes below and all changes reflected in the
attachment:

81
PSC-HHS-000081
 Saturated fatty acids—Saturated fatty acids have no double bonds. Major sources include
animal products such as meat and dairy products, and tropical oils such as coconut or palm oils.
In general, fats high in saturated fatty acids are solid at room temperature.
 trans fatty acids—Trans fatty acids are unsaturated fatty acids that contain one or more isolated
(i.e., nonconjugated) double bonds in a trans configuration. Sources of trans fatty acids include
partially‐hydrogenated vegetable oils that are have been used to make traditional shortening
and some commercially prepared baked goods, snack foods, fried foods, and traditional stick
margarine. Trans fatty acids also are present in foods that come from ruminant animals (e.g.,
cattle and sheep) and are called “natural” or rTFA. Such foods include dairy products, beef, and
lamb.
 Oils—Fats that are liquid at room temperature. Oils come from many different plants and some
fish. Some common oils include canola, corn, olive, peanut, safflower, soybean, and sunflower
oils. A number of foods are naturally high in oils, such as: nuts, olives, some fish, and avocados.
Foods that are mainly made up of oil include mayonnaise, certain salad dressings, and soft (tub
or squeeze) margarine with no trans fats. Oils are high in monounsaturated or polyunsaturated
fats, and low in saturated fats than solid fats. A few plant oils, termed tropical oils, including
coconut oil, palm oil and palm kernel oil, are high in saturated fats and for nutritional purposes
should be considered as solid fats. Partially‐hydrogenated oils that contain trans fats should
also be considered as solid fats for nutritional purposes. (See Fats)
 Solid fats—Fats that are usually not liquid at room temperature. Solid fats are found in animal
foods except for seafood, and can be made from vegetable oils through hydrogenation. Some
tropical oil plants, such as coconut and palm, are considered as solid fats due to their fatty acid
composition. Solid fats contain more saturated fats and/or trans fats than liquid oils (e.g.,
soybean , canola, and corn oils), with lower amounts of monounsaturated or polyunsaturated
fatty acids. Common fats considered to be solid fats include: butterfat, beef fat (tallow, suet),
chicken fat, pork fat (lard), traidional stick margarine, traditional shortening, coconut oil, palm
oil and palm kernel oil . Foods high in solid fats include: butter, full‐fat cheeses, creams, whole
milk, full fat ice creams , marbled cuts of meats, regular ground beef, bacon, sausages, poultry
skin, and many baked goods made using these products (such as cookies, crackers, doughnuts,
pastries, and croissants).The fat component of milk and cream (butter) is solid at room
temperature. (See Fats)

 Lean meat—Any meat with less than 10% fat by weight, or less than 10 grams of fat per 100
grams, based on USDA and FDA definitions for food label use. Examples include 95% lean
ground beef, cooked; broiled beef steak, lean only eaten; baked pork chop, lean only eaten;
roasted chicken breast or leg, no skin eaten; and smoked/cured ham, lean only eaten .

NOTE:
SOYBEAN OIL, FULLY HYDROGENATED PALM OIL, PARTIALLY HYDROGENATED PALM AND SOYBEAN OILS, MONO AND
DIGLYCERIDES, TBHQ AND CITRIC ACID (ANTIOXIDANTS).


82
PSC-HHS-000082
Thanks,
Tris

Rodgers'; Britten, Patricia - CNPP

Generally looks good to me and should be very helpful to the users of the report. See
comments below and in text. Regardless of the decision with regard to these, none are
such that the document should be held up.

Minor comments;
 Should have picked this up sooner but BMI z-score should have been listed as its
own separate entry since it is less familiar than BMI and someone may not read
down to the bottom of the BMI entry, especially since reference to BMI z-score is
sandwiched in between the text and table
 General comment, the term “.Eating out” is misleading in the current food
environment since it included prepared outside the home but consumed in the
home. Future DRI committees should rethink the term.
In general, fats high in saturated fatty acids are solid at room temperature, with the notable
exception of tropical oils.
 Trans fat – Should be modified to read “Sources of trans fatty acids include partially‐

hydrogenated vegetable oils that are used to make traditional shortening and some
commercially prepared baked goods, snack foods, fried foods, and traditional stick margarine.”
Shortenings like Crisco are now trans-free. There has been a well-documented
shift in commercial prepared baked goods to be trans free likely resulting from
the FDA mandate that TFA needs to be listed on the Nutrients Facts label. The
definition as written does not reflect this shift. It is certainly not accurate for most
margarines, even stick margarine for which many are trans free. Dated
definition.


‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

83
PSC-HHS-000083
Cc: Olson, Richard (HHS/OASH); 'Colette Rihane'; 'Shanthy Bowman'; 'Essery, Eve - CNPP'; 'Anne
Rodgers'; Britten, Patricia - CNPP
Importance: High

Barbara and Alice,

I think this will be the last file for you to approve, Appendix E‐5 Glossary. Only a handful of additions
and minor tweaks were needed. Explanations for each are provided.


If you have questions, please reply to the group. I have copied Trish as well; she was involved in almost
all of these resolutions.

As an update‐ we are VERY close to moving all of the files to their final form. We expect being able to
send them to be made 508 compliant MONDAY. Once they go to the contractor NO edits can be made.
If an error is found that needs to be documented, we will post an addendum alongside the report to
document and communicate these. Because of the finality of this step, I wanted to be sure you were
aware.

There has also been some guidance given to us from far above regarding the timing of the submission
of the Report to the Secretaries. We will describe that on the Administrative call on Tuesday morning.

Many thanks,

Kellie

Rockville, MD 20852
(240) 453‐8252

email immediately.
84
PSC-HHS-000084
<17 Appendix E-5 Glossary_SEMI-FINAL_tracked changes_1-22-15 AHL TB 1-23-15
AHL.docx>
85
PSC-HHS-000085

Attachments: 17 Appendix E-5 Glossary_SEMI-FINAL_tracked changes_1-22-15 AHL TB 1-23-15
AHL.docx
Great solutions Trish, I agree with them all. Thank you. A hallo is starting to float above all your
heads.
I do want to clarify one point. For SSB could we not cross reference to the Add Sugars definition or
can we just cross reference to chapters?
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127


Alice,

Thanks for your review and suggestions. Kellie asked me to respond on several of your comments to see if we’ve
reached agreement on final wording. Major changes below and all changes reflected in the attachment:

 Saturated fatty acids—Saturated fatty acids have no double bonds. Major sources include animal products such
as meat and dairy products, and tropical oils such as coconut or palm oils. In general, fats high in saturated fatty
acids are solid at room temperature.
 trans fatty acids—Trans fatty acids are unsaturated fatty acids that contain one or more isolated (i.e.,
nonconjugated) double bonds in a trans configuration. Sources of trans fatty acids include partially‐
hydrogenated vegetable oils that are have been used to make traditional shortening and some commercially
86
PSC-HHS-000086
prepared baked goods, snack foods, fried foods, and traditional stick margarine. Trans fatty acids also are
present in foods that come from ruminant animals (e.g., cattle and sheep) and are called “natural” or rTFA. Such
foods include dairy products, beef, and lamb.
 Oils—Fats that are liquid at room temperature. Oils come from many different plants and some fish. Some
common oils include canola, corn, olive, peanut, safflower, soybean, and sunflower oils. A number of foods are
naturally high in oils, such as: nuts, olives, some fish, and avocados. Foods that are mainly made up of oil
include mayonnaise, certain salad dressings, and soft (tub or squeeze) margarine with no trans fats. Oils are high
in monounsaturated or polyunsaturated fats, and low in saturated fats than solid fats. A few plant oils, termed
tropical oils, including coconut oil, palm oil and palm kernel oil, are high in saturated fats and for nutritional
purposes should be considered as solid fats. Partially‐hydrogenated oils that contain trans fats should also be
considered as solid fats for nutritional purposes. (See Fats)
 Solid fats—Fats that are usually not liquid at room temperature. Solid fats are found in animal foods except for
seafood, and can be made from vegetable oils through hydrogenation. Some tropical oil plants, such as coconut
and palm, are considered as solid fats due to their fatty acid composition. Solid fats contain more saturated fats
and/or trans fats than liquid oils (e.g., soybean , canola, and corn oils), with lower amounts of monounsaturated
or polyunsaturated fatty acids. Common fats considered to be solid fats include: butterfat, beef fat (tallow,
suet), chicken fat, pork fat (lard), traidional stick margarine, traditional shortening, coconut oil, palm oil and
palm kernel oil . Foods high in solid fats include: butter, full‐fat cheeses, creams, whole milk, full fat ice creams ,
marbled cuts of meats, regular ground beef, bacon, sausages, poultry skin, and many baked goods made using
these products (such as cookies, crackers, doughnuts, pastries, and croissants).The fat component of milk and
cream (butter) is solid at room temperature. (See Fats)
 Lean meat—Any meat with less than 10% fat by weight, or less than 10 grams of fat per 100 grams, based on
USDA and FDA definitions for food label use. Examples include 95% lean ground beef, cooked; broiled beef
steak, lean only eaten; baked pork chop, lean only eaten; roasted chicken breast or leg, no skin eaten; and
smoked/cured ham, lean only eaten .

NOTE:
SOYBEAN OIL, FULLY HYDROGENATED PALM OIL, PARTIALLY HYDROGENATED PALM AND SOYBEAN OILS, MONO AND DIGLYCERIDES, TBHQ AND
CITRIC ACID (ANTIOXIDANTS).


Thanks,
Tris

Patricia - CNPP

87
PSC-HHS-000087
should be held up.
Minor comments;
and table
tropical oils.

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

Patricia - CNPP
Importance: High

Barbara and Alice,


88
PSC-HHS-000088

resolutions.



Many thanks,

Kellie

Rockville, MD 20852
(240) 453‐8252

89
PSC-HHS-000089

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127




90
PSC-HHS-000090
saturated fats, and added sugars in foods and beverages . The Committee also encourages the food industry to continue
to reformulate and make changes to improve the nutrition profile of certain foods to achieve better sodium and
potassium balance, lower added sugars content, reduce portion sizes in retail settings (restaurants, food outlets, and
public venues, such as professional sports stadiums and arenas), and to market them to consumers.

Thanks!
Eve




bmillen@bu.edu


Eve


‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
91
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Tufts University
Boston, MA 02111

phone: 617 556 3127



Other thoughts?

Barbara

bmillen@bu.edu


‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127


edits. Barbara
92
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bmillen@bu.edu




Thanks!
Eve

made at this time.


down on Na.
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‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127


Hi everyone,



Barbara

bmillen@bu.edu

Importance: High

Barbara and Alice,



94
PSC-HHS-000094

Many thanks,

Kellie

Rockville, MD 20852
(240) 453‐8252

95
PSC-HHS-000095

To: Essery, Eve - CNPP
Cc: Lichtenstein, Alice; Casavale, Kellie (OS/OASH); Olson, Richard (HHS/OASH); Rihane,
Colette - CNPP; Bowman, Shanthy; Anne Rodgers
Subject: Re: Final approval of edits: Chapter 6: Cross-Cutting Topics
I like it and approve the addition. Barbara

Sent from my iPhone

On Jan 23, 2015, at 3:01 PM, "Essery, Eve ‐ CNPP" <Eve.Essery@fns.usda.gov> wrote:

Alice – You had asked if a statement could be added to the chapter summary stating that the Committee
also supports expanded availability of reduced SFA, Na and added sugar products. We initially said this
wasn’t possible because it hadn’t been vetted by the Committee. However, Kellie and I were walking
through some things in the Report, and she remembered a somewhat similar statement in the
Integration Chapter. Below is the paragraph where Alice made the comment. Would you like to add the
highlighted sentence to this chapter? (This is possible since it was already vetted as part of the
Integration Chapter.) Please let us know.

Achieving reductions in sodium, saturated fat, and added sugars, can all be accomplished and are more
attainable by eating a healthy dietary pattern. For all three of these components of the diet, policies and
programs at local, state, and national levels in both the private and public sector are necessary to
support reduction efforts. Similarly, the Committee supports efforts in labeling and other campaigns to
increase consumer awareness and understanding of sodium, saturated fats, and added sugars in foods
and beverages . The Committee also encourages the food industry to continue to reformulate and make
changes to improve the nutrition profile of certain foods to achieve better sodium and potassium
balance, lower added sugars content, reduce portion sizes in retail settings (restaurants, food outlets,

Thanks!
Eve


OK. We stand by our evidence base. It’s an interesting research question (but I’m not suggesting any
additions)!


bmillen@bu.edu
96
PSC-HHS-000096


Barbara – To answer your question about why sources of healthy proteins was deleted from the sat fat
section of the cross-cutting chapter, on Sun 12/21/14 @ 9:33am, Frank sent an email with edits to this
section, including the one referenced below. (Both of you, as well as Tom, were included on the email
string.) To accompany this edit, Frank included a note that states, “Please note that protein sources are
removed from here because none of the trials or epidemiological studies involved protein as a
replacement for saturated fat food sources.” His edit was to align more with the research considered.


Eve


I agree with Barbara. By bringing the reference forward what are we suggesting, cut
dairy consumption or worse yet switch from fat-free and low-fat to full fat dairy
products? That would not be consistent with our other guidance.

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127


But here we’re talking about substitution for carbohydrates and CVD risk and lipids. So does reference
here to sustainability make sense? Also, I would wonder about bringing in literature from modeling
research when we’re reporting on saturated fat and CVD.

Other thoughts?

Barbara

97
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bmillen@bu.edu



‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127


Sorry, on line 473‐4, what is the rationale for eliminating sources of healthy proteins? Otherwise I am
fine with the edits. Barbara

bmillen@bu.edu



A brief summary of the changes to the cross‐cutting chapter based on your final review is below, with
individual comments provided in the chapter attached.

Kellie – Unless we hear from Barbara and Alice otherwise, this chapter is ready to move forward for
finalization.
Thanks!
Eve

98
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 Line 375: Deleted “and simple cooking techniques that maximize flavor” to parallel chapter
summary.
 Line 1086: Edits made so that the sentence reads, “For sodium, emphasis should be placed on
expanding industry efforts to reduce the sodium content of foods and helping consumers
understand how to flavor unsalted foods with spices and herbs.” (This is clearly stated in the
sodium section; these are just edits to carry that forward in the chapter summary.)
o Alice has commented that she does not support the statement that added sugars “not
be replaced with low‐calorie sweeteners.” However, this has been presented at public
meetings, and it was not decided that this would be deleted or changed, and thus, this
would be a substantive change that cannot be made at this time.
o Alice asked if a statement could be added to the chapter summary stating that the
Committee also supports expanded availability of reduced SFA, Na and added sugar
products. However, since this has not been discussed with the full Committee, it is a
substantive edit that cannot be made at this time.

Rodgers'

I agree with Barbara. All along I thought we were emphasizing the need for the food
industry to ramp down on Na.

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Tufts University
Boston, MA 02111

phone: 617 556 3127

Rodgers'
99
PSC-HHS-000099

Hi everyone,

I am approving the recommended edits with one exception to edits in the document. I propose a bit of
tweaking on Lines 1981‐4. As written, the emphasis appears to be on educating consumers (I think but
it’s not clear) to flavor unsalted foods with herbs and spices. I think we also want to emphasize
expanding food industry initiatives to lower the sodium content of foods. Do we want to mention any
other ‘environmental changes’? I offer some suggested wording to be more consistent with the
conclusion statements.


Barbara

bmillen@bu.edu

Rodgers'
Importance: High

Barbara and Alice,

Chapter 6: Cross‐cutting Topics of Public Health Importance and a log of edits are attached. The
editorial changes were accepted. You will see that most tracked changes in the chapter are to update
the references to refer to the NHLBI Report and AHA/ACC Guideline pairs accurately. There are a few
other substantive tracked changes that address previously established issues.



Many thanks,

Kellie

Rockville, MD 20852
(240) 453‐8252

100
PSC-HHS-000100
email immediately.
101
PSC-HHS-000101

Trish, you are absolutely correct on the coconut oil. I don’t know why liquid stuck in my head, must
be the most refined form, which is not what is currently available. Now I picture all those jars of
coconut oil on Trader Joe’s shelves (with a shudder).
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127


Hi Alice,

In response to your suggestion for the saturated fat definition—I would hesitate to add an exception for tropical
oils. Coconut oil is quite solid at room temperature, and while I can’t find melting points right away, some web images
of red palm oil and palm kernel oil (in jars for commercial sale) look fairly solid—at least opaque—as well. We do say “in
general” at the beginning of the sentence, so I hope that will be sufficient.

I support your edits to the trans fat definition—there has been a recent dramatic shift. I even suggest saying “…that
have been used to make…” rather than “…that are used to make…”

Thanks for your quick review of the glossary!
Trish

Patricia - CNPP

102
PSC-HHS-000102
should be held up.
Minor comments;
and table
tropical oils.

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

Patricia - CNPP
Importance: High

Barbara and Alice,


103
PSC-HHS-000103

resolutions.



Many thanks,

Kellie

Rockville, MD 20852
(240) 453‐8252

104
PSC-HHS-000104

To: Britten, Patricia - CNPP; Lichtenstein, Alice; Casavale, Kellie (OS/OASH)
I approved the recommended edit that Trish made and support leaving the saturated fat definition as is as Trish
recommends. Barbara

bmillen@bu.edu

To: Lichtenstein, Alice; Casavale, Kellie (OS/OASH); Millen, Barbara E

Hi Alice,

In response to your suggestion for the saturated fat definition—I would hesitate to add an exception for tropical
oils. Coconut oil is quite solid at room temperature, and while I can’t find melting points right away, some web images
of red palm oil and palm kernel oil (in jars for commercial sale) look fairly solid—at least opaque—as well. We do say “in
general” at the beginning of the sentence, so I hope that will be sufficient.

I support your edits to the trans fat definition—there has been a recent dramatic shift. I even suggest saying “…that
have been used to make…” rather than “…that are used to make…”

Thanks for your quick review of the glossary!
Trish

Patricia - CNPP

should be held up.
Minor comments;
and table
105
PSC-HHS-000105
tropical oils.

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

Patricia - CNPP
Importance: High

Barbara and Alice,



resolutions.

106
PSC-HHS-000106


Many thanks,

Kellie

Rockville, MD 20852
(240) 453‐8252

107
PSC-HHS-000107

Cc: Olson, Richard (HHS/OASH); 'Colette Rihane'; 'Shanthy Bowman'; 'Essery, Eve - CNPP';
'Anne Rodgers'; Britten, Patricia - CNPP
Attachments: 17 Appendix E-5 Glossary_SEMI-FINAL_tracked changes_1-22-15 AHL.docx
should be held up.
Minor comments;
and table
tropical oils.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127
108
PSC-HHS-000108
Patricia - CNPP
Importance: High

Barbara and Alice,



resolutions.



Many thanks,

Kellie

Rockville, MD 20852
(240) 453‐8252

109
PSC-HHS-000109

Sent: Thursday, January 22, 2015 7:15 AM
Subject: RE: DGAC SYmposium
Alice,

Thank you for your honesty. I have tried to be very careful about conveying to the DGAC that there were concerns
about an event like this, some of which I have personally, but that with careful planning we can minimize them. I opted
in my email to the DGAC members to state this carefully and without getting into the specific details . ‘It is generally
agreed that the symposium would highlight our findings, our systematic, evidence‐based approach, and our
recommendations. Everyone wishes a very positive approach. I think we can carefully manage it.’ I was trying to send a
careful message that this was an important event but a complex one, and not one without risks that have to be
minimized. I also thought the idea of multi‐site locations would give other institutions the clear opportunity to
participate (if DGAC members preferred not to travel to Boston but to tie in from their academic base), making it a
dynamic and clearly multi‐institutional event. Several DGAC members as you know are already looking into this
possibility.

As I mentioned before, I didn’t interpret your comments as being opposed to the symposium. I truly apologize for
indicating there was more enthusiasm than appears warranted. My tendency is towards the positive and, in this case,
with an attempt to convey that this event needs careful planning and management so our report and its strong evidence
base comes is highlighted in the most positive light. I think we can and hope we will.

I do look forward to other collaborations going forward.

All the best,

Barbara

bmillen@bu.edu


Barbara:
Got your phone message late in the day and am now just going through my e-mails.
I was not personally offended by your actions. As indicated in our phone conversation when you first
told me you had met with Walt and Frank about a symposium I laid out my concerns. Those
concerns has not abated, hence, I had decided not to participate in the symposium. Officially, I have
a conflict.
110
PSC-HHS-000110
During the whole DGAC process I think we brought complementary skills to the process. I see no
reason for that not to continue into the future.
Alice
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127


Alice,

I left you a voicemail message and respect your decision. I hope to have a chance to talk with you briefly when it’s
convenient for you.

Looking forward to signing off on the report together and continue to enjoy the collaboration tremendously.

Many thanks,

Barbara

bmillen@bu.edu


Barbara, given the concerns I raised when we first spoke I have decided not to participate in the
symposium. Not necessary for me to be involved in calls.
Thanks for giving me the opportunity to make the decision.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
111
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Tufts University
Boston, MA 02111

phone: 617 556 3127

Sent: Tuesday, January 20, 2015 9:14 AM
Subject: Re: DGAC SYmposium

Will you participate in the DGAC administrative call about the symposium? Barbara

Sent from my iPhone

On Jan 20, 2015, at 7:39 AM, "Lichtenstein, Alice" <Alice.Lichtenstein@tufts.edu> wrote:
Barbara, as I indicated to you from the start I have moderate, at best, enthusiasm for
the meeting. Please don’t send anything further out suggesting I am involved or
supportive. At this point I will sit on the sidelines.

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

Subject: DGAC SYmposium

Hi Alice,

Howard Koh checked his schedule and with federal staff and emailed me and Frank to indicate that he is
free to moderate the symposium. I think he will be balanced and knows very well from his Washington
experience, what the potential is and how to navigate. He has offered to make calls on our behalf to get
a dignitary(ies) involved and others who we may wish to include in some fashion. I thanked him and
asked that he wait until we engage the DGAC in an administrative call to get their input. He understands
and will defer to us.

Should you and I have a call to talk a bit about your and Marian’s thoughts? I emailed Marian as asked
that she look at her travel schedule and try to participate if possible. Your thoughts?

112
PSC-HHS-000112
Barbara

bmillen@bu.edu

113
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bmillen@bu.edu


Eve


‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127
114
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Other thoughts?

Barbara

bmillen@bu.edu


‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127


edits. Barbara

bmillen@bu.edu

115
PSC-HHS-000115



Thanks!
Eve

made at this time.


down on Na.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
116
PSC-HHS-000116
Boston, MA 02111

phone: 617 556 3127


Hi everyone,



Barbara

bmillen@bu.edu

Importance: High

Barbara and Alice,




Many thanks,

Kellie

117
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Rockville, MD 20852
(240) 453‐8252

118
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Subject: FW: DGACFollow-up Please Hold Wednesday Feb 25
This was the response I got back to the first e-mail I sent you where I took my name out of the text.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

Sent: Sunday, January 18, 2015 5:17 PM
Cc: Neuhouser, Marian L; Casavale, Kellie (OS/OASH)
Subject: Re: DGACFollow-up Please Hold Wednesday Feb 25

Alice,

I did not send it in draft to you. It was a copy of what had already gone to the remainder of our DGAC with copies to the
SRSC and work group leads. I indicated in our call with the federal staff that I would be getting information out to them
and thought I had everyone's go ahead including yours.

I did not see your email until later this afternoon.

Barbara

Sent from my iPhone

Marian, I made the same comment and took my name out of the text. I did not realize
even a draft went out with my name in it.

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
119
PSC-HHS-000119
Boston, MA 02111

phone: 617 556 3127

From: Neuhouser, Marian L [mailto:mneuhous@fredhutch.org]
Cc: Lichtenstein, Alice

Barbara

I think I was pretty clear that I supported an event but I was not at all supportive of the idea you
previously presented. Your email below says all chairs were enthusiastic but that is not the case at least
with me. I am deeply disappointed.

Marian

Sent from my iPhone

On Jan 18, 2015, at 8:46 AM, Millen, Barbara E <bmillen@bu.edu> wrote:
Hi Marian,
Apologies that this is a bit formal and perhaps somewhat repetitive. I want to be sure
everyone has the same information. This is the email content (below) now sent to the
remaining members of the DGAC after confirming dates with the SRSC and Workgroup
leads and a conversation with Kellie, Rick, Colette and Eve. BTW, the late January date
will no longer be possible. The report editing is taking a bit longer than expected so we
were advised that is would be safer to go with the most available later February date. I
hope that it might be possible for you to work with the date. I am traveling too for
meetings on Friday the 27th. Logistics will be a bit complicated but I wanted to work
with the date most on the SRSC and our workgroup leads were free.

I wanted to bring you further up to date on some planning that is underway to publicize
the 2015 DGAC report once it is officially published in the Federal register. As we
approached our final public meeting, several members of the SRSC and DGAC
mentioned an interest in doing some publicizing of our work. The SRSC discussed it in
our final calls and were in agreement to work to develop a plan. After our final meeting,
Alice and I conferred with Kellie, Rick and Colette and there is agreement that is
reasonable to assume the report will be published later in February. I also met with
Howard Koh, who as you recall conducting our swearing in to the DGAC. You may also
recall that it was announced that he returned to the Harvard School of Public Health this
past summer. He was enthusiastic about publicizing the DGAC report and offered to
assist where possible. I also met with Walter Willett, Chair of the Nutrition Department,
and he spontaneously offered to host a televised symposium on the report once
published. He suggested that their technology allows live satellite sites so I thought I
120
PSC-HHS-000120
would raise the possibility that our DGAC members host institutions, where possible,
might host a satellite site with a live audience (and possibly presenter).
I polled the SRSC and chapter leads and the workgroup leaders about the idea and
about dates in late February that might work in their schedules. It looks like
Wednesday February 25th is the date that most are free. I hope this might work in your
schedule as well. Everyone I have spoken to thus on our Committee is enthusiastic
about the idea. It is generally agreed that the symposium would highlight our findings,
our systematic, evidence‐based approach, and our recommendations. Everyone wishes
a very positive approach. I think we can carefully manage it. Alice and I had a follow‐up
call with Rick, Kellie and Colette to get their input. They were supportive, recognize that
this would be rather novel (since other DGAC’s have not done this before) and
suggested we might take audience questions in advance to prepare.
I will be sending a Doodle poll to get an Administrative DGAC call together with all DGAC
members so we can talk further about the format, content and logistics of the
symposium. During our planning process and until we send out invitations, please hold
this planning process reasonably confidential. I understand that you may wish to talk
with your institutional IT about your ability to host a site on location.
If you wish to talk about this idea, please let me know. I can be reached at (b) (6)
(b) (6)
(cell is best in case I’m traveling).

All the very best and Happy New Year! This is a wonderful opportunity.

Barbara
bmillen@bu.edu

121
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I don’t remember this being discussed with me.
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Tufts University
Boston, MA 02111

phone: 617 556 3127

To: Neuhouser, Marian L

Marian,

I am sorry for your reaction and had hoped that you might be able to work around the 25th. When the SRSC and
workgroup leads were polled for the available dates, the 25th was the only date when most everyone was free. The
federal staff advised against the earliest date and I did ask HSPH for earlier alternative date in February but Kellie
suggested they would not be realistic in terms of the timing of the report's publication. I too will be traveling right
afterwards to represent us and the 25th will not be easy. When we spoke to the federal staff I did share your concerns
and also discussed them with Frank (not referencing you) and with Alice. He understands as does Howard and Walter
that we want to be inclusive and positive and not have this lead to controversy. It is important to have presentation of
our report and our very sound process.

No specific aspects of the symposium have been set except a date and timing at this point. The next step as I mentioned
was our administrative call. I hope you will participate on setting this up in a way that we are all as comfortable as
possible.

My apologies if you feel I misrepresented anything or was not as open as possible. I tried very seriously to include our
leadership from the outset and the only after discussing things with federal staff, move to schedule the administrative
call. Since we are technically still in our term as DGAC, I was advised to handle communication with the SRSC and
workgroup leads one on one. After the generally positive responses from our leadership, the federal staff recommended
the DGAC call.

If you would like to char further I would be happy to do so. I am concerned and would like to resolve it if at all possible.

122
PSC-HHS-000122
Sincerely,

Barbara

Sent from my iPhone

On Jan 18, 2015, at 12:56 PM, "Neuhouser, Marian L" <mneuhous@fredhutch.org> wrote:
Barbara

I also do not understand why the email says 'dates were conferred with the SRSC ' when I specifically
said I was not available for the Feb dates since I am representing the DGAC at an event in Wash DC since
both you and Alice were not available . I noted this in my previous reply earlier this month when you
proposed this idea and I pretty strongly did not support it.

I am really quite distressed about both this process and the result

Marian

Sent from my iPhone

On Jan 18, 2015, at 9:11 AM, Neuhouser, Marian L <mneuhous@fredhutch.org> wrote:
Barbara

I think I was pretty clear that I supported an event but I was not at all supportive of the
idea you previously presented. Your email below says all chairs were enthusiastic but
that is not the case at least with me. I am deeply disappointed.

Marian

Sent from my iPhone

Hi Marian,
Apologies that this is a bit formal and perhaps somewhat repetitive. I
want to be sure everyone has the same information. This is the email
content (below) now sent to the remaining members of the DGAC after
confirming dates with the SRSC and Workgroup leads and a
conversation with Kellie, Rick, Colette and Eve. BTW, the late January
date will no longer be possible. The report editing is taking a bit longer
than expected so we were advised that is would be safer to go with the
most available later February date. I hope that it might be possible for
you to work with the date. I am traveling too for meetings on Friday
the 27th. Logistics will be a bit complicated but I wanted to work with
the date most on the SRSC and our workgroup leads were free.

123
PSC-HHS-000123
I wanted to bring you further up to date on some planning that is
underway to publicize the 2015 DGAC report once it is officially
published in the Federal register. As we approached our final public
meeting, several members of the SRSC and DGAC mentioned an interest
in doing some publicizing of our work. The SRSC discussed it in our final
calls and were in agreement to work to develop a plan. After our final
meeting, Alice and I conferred with Kellie, Rick and Colette and there is
agreement that is reasonable to assume the report will be published
later in February. I also met with Howard Koh, who as you recall
conducting our swearing in to the DGAC. You may also recall that it was
announced that he returned to the Harvard School of Public Health this
past summer. He was enthusiastic about publicizing the DGAC report
and offered to assist where possible. I also met with Walter Willett,
Chair of the Nutrition Department, and he spontaneously offered to
host a televised symposium on the report once published. He
suggested that their technology allows live satellite sites so I thought I
would raise the possibility that our DGAC members host institutions,
where possible, might host a satellite site with a live audience (and
possibly presenter).
I polled the SRSC and chapter leads and the workgroup leaders about
the idea and about dates in late February that might work in their
schedules. It looks like Wednesday February 25th is the date that most
are free. I hope this might work in your schedule as well. Everyone I
have spoken to thus on our Committee is enthusiastic about the idea. It
is generally agreed that the symposium would highlight our findings, our
systematic, evidence‐based approach, and our
recommendations. Everyone wishes a very positive approach. I think
we can carefully manage it. Alice and I had a follow‐up call with Rick,
Kellie and Colette to get their input. They were supportive, recognize
that this would be rather novel (since other DGAC’s have not done this
before) and suggested we might take audience questions in advance to
prepare.
I will be sending a Doodle poll to get an Administrative DGAC call
together with all DGAC members so we can talk further about the
format, content and logistics of the symposium. During our planning
process and until we send out invitations, please hold this planning
process reasonably confidential. I understand that you may wish to talk
If you wish to talk about this idea, please let me know. I can be reached
at (b) (6) (cell is best in case I’m traveling).

All the very best and Happy New Year! This is a wonderful
opportunity.

Barbara
bmillen@bu.edu

124
PSC-HHS-000124

When I received this e-mail I asked my name be taken out and modified the text accordingly. She
responded by saying she had already sent it out. The following sentences struck me as egregious
since I was not supportive and certainly not enthusiastic – “Everyone I have spoken to thus on our
Committee is enthusiastic about the idea. It is generally agreed that the symposium would highlight
our findings, our systematic, evidence-based approach, and our recommendations. “
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

Sent: Sunday, January 18, 2015 11:48 AM

Hi Alice,

This is what I am in the process of sending to all remaining DGAC members and also to the SRSC and workgroup leads so
that everyone has the same information. Hope you’re taking a break!

I wanted to bring you further up to date on some planning that is underway to publicize the 2015 DGAC report once it is
officially published in the Federal register. As we approached our final public meeting, several members of the SRSC and
DGAC mentioned an interest in doing some publicizing of our work. The SRSC discussed it in our final calls and were in
agreement to work to develop a plan. After our final meeting, Alice and I conferred with Kellie, Rick and Colette and
there is agreement that is reasonable to assume the report will be published later in February. I also met with Howard
Koh, who as you recall conducting our swearing in to the DGAC. You may also recall that it was announced that he
returned to the Harvard School of Public Health this past summer. He was enthusiastic about publicizing the DGAC
report and offered to assist where possible. I also met with Walter Willett, Chair of the Nutrition Department, and he
spontaneously offered to host a televised symposium on the report once published. He suggested that their technology
allows live satellite sites so I thought I would raise the possibility that our DGAC members host institutions, where
possible, might host a satellite site with a live audience (and possibly presenter).
125
PSC-HHS-000125
I polled the SRSC and chapter leads and the workgroup leaders about the idea and about dates in late February that
might work in their schedules. It looks like Wednesday February 25th is the date that most are free. I hope this might
work in your schedule as well. Everyone I have spoken to thus on our Committee is enthusiastic about the idea. It is
generally agreed that the symposium would highlight our findings, our systematic, evidence‐based approach, and our
recommendations. Everyone wishes a very positive approach. I think we can carefully manage it. Alice and I had a
follow‐up call with Rick, Kellie and Colette to get their input. They were supportive, recognize that this would be rather
novel (since other DGAC’s have not done this before) and suggested we might take audience questions in advance to
prepare.
I will be sending a Doodle poll to get an Administrative DGAC call together with all DGAC members so we can talk further
about the format, content and logistics of the symposium. During our planning process and until we send out
invitations, please hold this planning process reasonably confidential. I understand that you may wish to talk with your
institutional IT about your ability to host a site on location.
If you wish to talk about this idea, please let me know. I can be reached at (b) (6) (cell is best in case I’m

traveling).


Barbara
bmillen@bu.edu

126
PSC-HHS-000126

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127



Other thoughts?

Barbara

bmillen@bu.edu


‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
127
PSC-HHS-000127
Tufts University
Boston, MA 02111

phone: 617 556 3127


edits. Barbara

bmillen@bu.edu




Thanks!
Eve

128
PSC-HHS-000128
made at this time.


down on Na.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127


Hi everyone,



Barbara

bmillen@bu.edu

129
PSC-HHS-000129
Importance: High

Barbara and Alice,




Many thanks,

Kellie

Rockville, MD 20852
(240) 453‐8252

130
PSC-HHS-000130


Other thoughts?

Barbara

bmillen@bu.edu


‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127


edits. Barbara

bmillen@bu.edu

131
PSC-HHS-000131



Thanks!
Eve

made at this time.


down on Na.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
132
PSC-HHS-000132
Tufts University
Boston, MA 02111

phone: 617 556 3127


Hi everyone,



Barbara

bmillen@bu.edu

Importance: High

Barbara and Alice,




Many thanks,

Kellie
133
PSC-HHS-000133

Rockville, MD 20852
(240) 453‐8252

134
PSC-HHS-000134

To: De Jesus, Janet M (NIH/NHLBI) [E]
Cc: 'alice.lichtenstein@tufts.edu' (alice.lichtenstein@tufts.edu); Casavale, Kellie (OS/OASH);
Olson, Richard (HHS/OASH); Colette Rihane; Shanthy Bowman; Essery, Eve - CNPP;
Anne Rodgers; Mcgrane, Mary - CNPP (Mary.Mcgrane@cnpp.usda.gov)
Subject: Re: Final approval of edits: Chapter 5 (SC 5)
Sounds good and we should check perhaps against what spectrums are modeled in the research we are reporting on.
Does that seem reasonable? Barbara

Sent from my iPhone

On Jan 20, 2015, at 8:49 AM, "De Jesus, Janet M (NIH/NHLBI) [E]" <dejesusjm@nhlbi.nih.gov> wrote:
Regarding the modelling: the health vegetarian pattern is 34% total fat and 8% saturated fat‐ similar to
the US and Mediterranean patterns.

<image003.png>

Cc: Lichtenstein, Alice; Casavale, Kellie (OS/OASH); Olson, Richard (HHS/OASH); Colette Rihane;
Shanthy Bowman; Essery, Eve - CNPP; Anne Rodgers; Mcgrane, Mary - CNPP
(Mary.Mcgrane@cnpp.usda.gov)

Thank you. The comparison statement doesn't work across the entire spectrum of vegetarian. I hope we
can find a reasonable solution. Barbara

Sent from my iPhone


Molly reviewed the studies again yesterday in response to Barbara’s original comment.
She suggested removing “low‐fat” because the comparator can vary. She should be able
to respond with more information from the studies. We can also check on the
vegetarian diet that was modelled in SC1.

Thanks,
Janet

To: Millen, Barbara E; De Jesus, Janet M (NIH/NHLBI) [E]; Casavale, Kellie (OS/OASH)
Cc: Olson, Richard (HHS/OASH); 'Colette Rihane'; 'Shanthy Bowman'; 'Essery, Eve -
135
PSC-HHS-000135
CNPP'; 'Anne Rodgers'; Mcgrane, Mary - CNPP (Mary.Mcgrane@cnpp.usda.gov)
Subject: RE: Final approval of edits: Chapter 5 (SC 5)

This is an important point and confounder. We should remember, we are
not recommending a low fat diet of any type, rather a moderate fat diet,
due to the risk of dyslipidemia.

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

To: De Jesus, Janet M (NIH/NHLBI) [E]; Casavale, Kellie (OS/OASH); Lichtenstein, Alice

Many thanks. As you are preparing the edits, can you check something for me on the
comparator issue, line 431. My understanding from SC discussions and my read of the
aspect of the report is that the diet containing some meat (lower RPM) may have
somewhat better environmental impact (and certainly health impact). When compared
to a spectrum of vegetarian diets, it outperforms the high‐fat vegetarian diet on land
use (i.e. it can feed more people). So, we can’t use ‘vegetarian’ diet as the comparator
in the statement on line 431+; the correct comparator would seem to be the ‘high‐fat’
vegetarian diet. It’s tricky because this was a modeling exercise. Technically, not all
vegetarian diets (high fat in particular) outperform diets containing some RPM. The
best result, as I understand it, was achieved when RPM intake was lowered and more
people were modeled as vegetarians. That suggest if we can increase the proportion of
(lower fat) vegetarians in the population and generally get people to follow the lower
RPM diet we are advocating, we are likely to achieve better environmental and health
outcomes. Is the vegetarian diet we’re modeling in the report technically a lower‐fat
version as modeled in these studies. I’m not sure. We might want to check So too, we
have to be sure we are capturing the results correctly in the Chapter section and draw
the correct conclusion here.

Thanks for checking.

Barbara

bmillen@bu.edu

From: De Jesus, Janet M (NIH/NHLBI) [E] [mailto:dejesusjm@nhlbi.nih.gov]
136
PSC-HHS-000136
To: Millen, Barbara E; Casavale, Kellie (OS/OASH); 'Lichtenstein, Alice'


Thanks for the helpful comments. We addressed all of your comments in Chapter 5 and
the resolution is described in red below:

Barbara:
Line 121 Clarify where we define ‘seafood’. The comment here sounds like we’re only
addressing fish (finfish) in the report when we extend to seafood, particularly when we
define nutrient composition but also (in some cases) when we examine diet/dietary
pattern and health or environmental outcomes. We may want to clarify both terms
here or elsewhere in the introduction. Good catch. We changed the “fish” in this line to
“seafood.” Seafood is defined in the glossary as including finfish and shellfish. Chapter 5
only uses the term fish when it is referring to “finfish” and this is defined in a footnote
when it is used the first time.
Line 144 Is ‘novel’ really the intended term for the ‘new’ areas of evaluation? We
deleted “and novel”
Line 431 Check the comparator. There may be an error. I thought the contrast was being
discussed in relationship to a high‐fat vegetarian diet? We deleted “low‐fat.”

Alice:
Line 187: This is a very strong term, not certain we could substantiate. I suspect a
number of groups each have different concepts of state‐of‐the‐art. We deleted “state‐
of‐the‐art”
Line 336: Why just federal? Would we not want it incorporated into all feeding
programs and personal choices? We suggest adding “and local.” Another option is to
delete “federal.”

I will send an updated version of the chapter tomorrow.

Thanks,
Janet

Janet M. de Jesus, M.S., R.D.
Public Health Advisor
Center for Translation Research and Implementation Science (CTRIS)
National Heart, Lung, and Blood Institute
National Institutes of Health
6705 Rockledge Drive
Rockledge 1 Building; Room 6189, MSC 7960
Bethesda, MD 20817
301‐496‐5344
dejesusjm@mail.nih.gov

To: Casavale, Kellie (OS/OASH); 'Lichtenstein, Alice'
CNPP'; 'Anne Rodgers'; De Jesus, Janet M (NIH/NHLBI) [E]
137
PSC-HHS-000137

Hi all,

I approve the log of edits for Section D. Chapter 5. Here are my comments o the
chapter. Like the others, it is really a wonderful new chapter, very well done and highly
informative. I highlighted where I saw the need for some possible minor editorial
changes. Hopefully, these are fine:
Lines 110 and 341 paragraph spacing needed
Line 121 Clarify where we define ‘seafood’. The comment here sounds like we’re only
addressing fish (finfish) in the report when we extend to seafood, particularly when we
define nutrient composition but also (in some cases) when we examine diet/dietary
pattern and health or environmental outcomes. We may want to clarify both terms
here or elsewhere in the introduction.
Line 144 Is ‘novel’ really the intended term for the ‘new’ areas of evaluation?
Line 431 Check the comparator. There may be an error. I thought the contrast was being
discussed in relationship to a high‐fat vegetarian diet?
Line 1245 Typo ‘recognized’.

Many thanks.

Barbara

bmillen@bu.edu

Sent: Thursday, January 15, 2015 4:13 PM
CNPP'; 'Anne Rodgers'; De Jesus, Janet M (NIH/NHLBI) [E]
Subject: Final approval of edits: Chapter 5 (SC 5)
Importance: High

Barbara and Alice,

Chapter 5: Food Sustainability and Safety and a short log of edits are attached. Most of
the edits in the chapter are to change “fish” to “seafood” where appropriate and some
additions to the description of the methodology for the topic of DP and Sustainability.


I will be out of town Friday and Tuesday, but look forward to returning with an inbox full
of approvals! If you have questions, please reply to the group and Eve and Janet will
answer them for you.

Many thanks,

Kellie

138
PSC-HHS-000138
Rockville, MD 20852
(240) 453‐8252

139
PSC-HHS-000139

Cc: Lichtenstein, Alice; Casavale, Kellie (OS/OASH); Olson, Richard (HHS/OASH); Colette
Rihane; Shanthy Bowman; Essery, Eve - CNPP; Anne Rodgers; Mcgrane, Mary - CNPP
(Mary.Mcgrane@cnpp.usda.gov)
Thank you. The comparison statement doesn't work across the entire spectrum of vegetarian. I hope we can find a
reasonable solution. Barbara

Sent from my iPhone


Molly reviewed the studies again yesterday in response to Barbara’s original comment. She suggested
removing “low‐fat” because the comparator can vary. She should be able to respond with more
information from the studies. We can also check on the vegetarian diet that was modelled in SC1.

Thanks,
Janet

Rodgers'; Mcgrane, Mary - CNPP (Mary.Mcgrane@cnpp.usda.gov)

This is an important point and confounder. We should remember, we are not
recommending a low fat diet of any type, rather a moderate fat diet, due to the risk of
dyslipidemia.

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

140
PSC-HHS-000140

Many thanks. As you are preparing the edits, can you check something for me on the comparator issue,
line 431. My understanding from SC discussions and my read of the aspect of the report is that the diet
containing some meat (lower RPM) may have somewhat better environmental impact (and certainly
health impact). When compared to a spectrum of vegetarian diets, it outperforms the high‐fat
vegetarian diet on land use (i.e. it can feed more people). So, we can’t use ‘vegetarian’ diet as the
comparator in the statement on line 431+; the correct comparator would seem to be the ‘high‐fat’
vegetarian diet. It’s tricky because this was a modeling exercise. Technically, not all vegetarian diets
(high fat in particular) outperform diets containing some RPM. The best result, as I understand it, was
achieved when RPM intake was lowered and more people were modeled as vegetarians. That suggest if
we can increase the proportion of (lower fat) vegetarians in the population and generally get people to
follow the lower RPM diet we are advocating, we are likely to achieve better environmental and health
outcomes. Is the vegetarian diet we’re modeling in the report technically a lower‐fat version as modeled
in these studies. I’m not sure. We might want to check So too, we have to be sure we are capturing the
results correctly in the Chapter section and draw the correct conclusion here.


Barbara

bmillen@bu.edu



Thanks for the helpful comments. We addressed all of your comments in Chapter 5 and the resolution is
described in red below:

Barbara:
Line 121 Clarify where we define ‘seafood’. The comment here sounds like we’re only addressing fish
(finfish) in the report when we extend to seafood, particularly when we define nutrient composition but
also (in some cases) when we examine diet/dietary pattern and health or environmental outcomes. We
may want to clarify both terms here or elsewhere in the introduction. Good catch. We changed the
“fish” in this line to “seafood.” Seafood is defined in the glossary as including finfish and shellfish.
Chapter 5 only uses the term fish when it is referring to “finfish” and this is defined in a footnote when it
is used the first time.
Line 144 Is ‘novel’ really the intended term for the ‘new’ areas of evaluation? We deleted “and novel”
Line 431 Check the comparator. There may be an error. I thought the contrast was being discussed in
relationship to a high‐fat vegetarian diet? We deleted “low‐fat.”

141
PSC-HHS-000141
Alice:
Line 187: This is a very strong term, not certain we could substantiate. I suspect a number of groups
each have different concepts of state‐of‐the‐art. We deleted “state‐of‐the‐art”
Line 336: Why just federal? Would we not want it incorporated into all feeding programs and personal
choices? We suggest adding “and local.” Another option is to delete “federal.”


Thanks,
Janet

Bethesda, MD 20817
301‐496‐5344

Rodgers'; De Jesus, Janet M (NIH/NHLBI) [E]

Hi all,

I approve the log of edits for Section D. Chapter 5. Here are my comments o the chapter. Like the
others, it is really a wonderful new chapter, very well done and highly informative. I highlighted where I
saw the need for some possible minor editorial changes. Hopefully, these are fine:
Line 121 Clarify where we define ‘seafood’. The comment here sounds like we’re only addressing fish
(finfish) in the report when we extend to seafood, particularly when we define nutrient composition but
also (in some cases) when we examine diet/dietary pattern and health or environmental outcomes. We
may want to clarify both terms here or elsewhere in the introduction.
Line 431 Check the comparator. There may be an error. I thought the contrast was being discussed in
relationship to a high‐fat vegetarian diet?

Many thanks.

Barbara

bmillen@bu.edu

142
PSC-HHS-000142
Rodgers'; De Jesus, Janet M (NIH/NHLBI) [E]
Importance: High

Barbara and Alice,

Chapter 5: Food Sustainability and Safety and a short log of edits are attached. Most of the edits in the
chapter are to change “fish” to “seafood” where appropriate and some additions to the description of
the methodology for the topic of DP and Sustainability.


I will be out of town Friday and Tuesday, but look forward to returning with an inbox full of approvals! If
you have questions, please reply to the group and Eve and Janet will answer them for you.

Many thanks,

Kellie

Rockville, MD 20852
(240) 453‐8252

143
PSC-HHS-000143

To: De Jesus, Janet M (NIH/NHLBI) [E]; Millen, Barbara E; Casavale, Kellie (OS/OASH)
'Anne Rodgers'; Mcgrane, Mary - CNPP (Mary.Mcgrane@cnpp.usda.gov)
I agree with removing low-fat. I would also suggest the document be searched to determine whether
there are any other places where the term low-fat occurs, just in case we missed something.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

Cc: Olson, Richard (HHS/OASH); 'Colette Rihane'; 'Shanthy Bowman'; 'Essery, Eve - CNPP'; 'Anne Rodgers'; Mcgrane,
Mary - CNPP (Mary.Mcgrane@cnpp.usda.gov)


Molly reviewed the studies again yesterday in response to Barbara’s original comment. She suggested removing “low‐
fat” because the comparator can vary. She should be able to respond with more information from the studies. We can
also check on the vegetarian diet that was modelled in SC1.

Thanks,
Janet


This is an important point and confounder. We should remember, we are not recommending a low fat
diet of any type, rather a moderate fat diet, due to the risk of dyslipidemia.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
144
PSC-HHS-000144
Tufts University
Boston, MA 02111

phone: 617 556 3127


Many thanks. As you are preparing the edits, can you check something for me on the comparator issue, line 431. My
understanding from SC discussions and my read of the aspect of the report is that the diet containing some meat (lower
RPM) may have somewhat better environmental impact (and certainly health impact). When compared to a spectrum
of vegetarian diets, it outperforms the high‐fat vegetarian diet on land use (i.e. it can feed more people). So, we can’t
use ‘vegetarian’ diet as the comparator in the statement on line 431+; the correct comparator would seem to be the
‘high‐fat’ vegetarian diet. It’s tricky because this was a modeling exercise. Technically, not all vegetarian diets (high fat
in particular) outperform diets containing some RPM. The best result, as I understand it, was achieved when RPM intake
was lowered and more people were modeled as vegetarians. That suggest if we can increase the proportion of (lower
fat) vegetarians in the population and generally get people to follow the lower RPM diet we are advocating, we are likely
to achieve better environmental and health outcomes. Is the vegetarian diet we’re modeling in the report technically a
lower‐fat version as modeled in these studies. I’m not sure. We might want to check So too, we have to be sure we are
capturing the results correctly in the Chapter section and draw the correct conclusion here.


Barbara

bmillen@bu.edu



Thanks for the helpful comments. We addressed all of your comments in Chapter 5 and the resolution is described in red
below:

Barbara:
Line 121 Clarify where we define ‘seafood’. The comment here sounds like we’re only addressing fish (finfish) in the
report when we extend to seafood, particularly when we define nutrient composition but also (in some cases) when we
145
PSC-HHS-000145
examine diet/dietary pattern and health or environmental outcomes. We may want to clarify both terms here or
elsewhere in the introduction. Good catch. We changed the “fish” in this line to “seafood.” Seafood is defined in the
glossary as including finfish and shellfish. Chapter 5 only uses the term fish when it is referring to “finfish” and this is
defined in a footnote when it is used the first time.
Line 431 Check the comparator. There may be an error. I thought the contrast was being discussed in relationship to a
high‐fat vegetarian diet? We deleted “low‐fat.”

Alice:
Line 187: This is a very strong term, not certain we could substantiate. I suspect a number of groups each have different
concepts of state‐of‐the‐art. We deleted “state‐of‐the‐art”
Line 336: Why just federal? Would we not want it incorporated into all feeding programs and personal choices? We
suggest adding “and local.” Another option is to delete “federal.”


Thanks,
Janet

Bethesda, MD 20817
301‐496‐5344

Cc: Olson, Richard (HHS/OASH); 'Colette Rihane'; 'Shanthy Bowman'; 'Essery, Eve - CNPP'; 'Anne Rodgers'; De Jesus,
Janet M (NIH/NHLBI) [E]

Hi all,

I approve the log of edits for Section D. Chapter 5. Here are my comments o the chapter. Like the others, it is really a
wonderful new chapter, very well done and highly informative. I highlighted where I saw the need for some possible
minor editorial changes. Hopefully, these are fine:
elsewhere in the introduction.
high‐fat vegetarian diet?

Many thanks.
146
PSC-HHS-000146

Barbara

bmillen@bu.edu

Importance: High

Barbara and Alice,

Chapter 5: Food Sustainability and Safety and a short log of edits are attached. Most of the edits in the chapter are to
change “fish” to “seafood” where appropriate and some additions to the description of the methodology for the topic of
DP and Sustainability.


I will be out of town Friday and Tuesday, but look forward to returning with an inbox full of approvals! If you have
questions, please reply to the group and Eve and Janet will answer them for you.

Many thanks,

Kellie

Rockville, MD 20852
(240) 453‐8252

147
PSC-HHS-000147

This is an important point and confounder. We should remember, we are not recommending a low fat
diet of any type, rather a moderate fat diet, due to the risk of dyslipidemia.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127




Barbara

bmillen@bu.edu
148
PSC-HHS-000148



below:

Barbara:

Alice:


Thanks,
Janet

Bethesda, MD 20817
301‐496‐5344


Hi all,
149
PSC-HHS-000149


Many thanks.

Barbara

bmillen@bu.edu

Importance: High

Barbara and Alice,




Many thanks,

Kellie

150
PSC-HHS-000150
Rockville, MD 20852
(240) 453‐8252

151
PSC-HHS-000151

To: De Jesus, Janet M (NIH/NHLBI) [E]; 'Millen, Barbara E'; Casavale, Kellie (OS/OASH)
Regarding the following, either adding local or deleting federal is fine with me.

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

To: 'Millen, Barbara E'; Casavale, Kellie (OS/OASH); Lichtenstein, Alice


below:

Barbara:
152
PSC-HHS-000152

Alice:


Thanks,
Janet

Bethesda, MD 20817
301‐496‐5344


Hi all,


Many thanks.

Barbara

bmillen@bu.edu

153
PSC-HHS-000153
Importance: High

Barbara and Alice,




Many thanks,

Kellie

Rockville, MD 20852
(240) 453‐8252

154
PSC-HHS-000154

To: De Jesus, Janet M (NIH/NHLBI) [E]; Casavale, Kellie (OS/OASH); 'Lichtenstein, Alice'
Also, in terms of the recommended edits for Alice’s comments, I prefer adding ‘and local’ (line 336) and approve the
deletion of ‘state‐of‐the‐art’ and recommend deleting ‘unique’ on line 188. It seems redundant when we use it on line
191.

Best,

Barbara

bmillen@bu.edu



below:

Barbara:

Alice:

155
PSC-HHS-000155

Thanks,
Janet

Bethesda, MD 20817
301‐496‐5344


Hi all,


Many thanks.

Barbara

bmillen@bu.edu

Importance: High

Barbara and Alice,
156
PSC-HHS-000156




Many thanks,

Kellie

Rockville, MD 20852
(240) 453‐8252

157
PSC-HHS-000157

To: De Jesus, Janet M (NIH/NHLBI) [E]; Casavale, Kellie (OS/OASH); 'Lichtenstein, Alice'


Barbara

bmillen@bu.edu



below:

Barbara:
(b) (5)

Line 144 Is ‘novel’ really the intended term for the ‘new’ areas of evaluation? (b) (5)
high‐fat vegetarian diet? (b) (5)
158
PSC-HHS-000158

Alice:
concepts of state‐of‐the‐art. (b) (5)
Line 336: Why just federal? Would we not want it incorporated into all feeding programs and personal choices? (b) (5)
(b) (5)


Thanks,
Janet

Bethesda, MD 20817
301‐496‐5344


Hi all,


Many thanks.

Barbara

bmillen@bu.edu

159
PSC-HHS-000159
Importance: High

Barbara and Alice,




Many thanks,

Kellie

Rockville, MD 20852
(240) 453‐8252

160
PSC-HHS-000160

'Anne Rodgers'; De Jesus, Janet M (NIH/NHLBI) [E]
Attachments: SC 5_Lof of edits_1 15 15.docx; 10 Part D_Chapter 5 Food Sustainability and
Safety_SEMI-FINAL_changes for BEM AHL approval_1-15-15 bem 1 19 2015.docx; 10.
Part D_Chapter 5 Food Sustainability and Safety_SEMI-FINAL_changes for BEM AHL
approval_1-15-15.docx
Hi all,


Many thanks.

Barbara

bmillen@bu.edu

Importance: High

Barbara and Alice,


161
PSC-HHS-000161


Many thanks,

Kellie

Rockville, MD 20852
(240) 453‐8252

162
PSC-HHS-000162

Alice I did not see your email as I mentioned until a short while ago. Communications had all gone out. At this point
nothing specific is planned. I had understood you were withdrawing your concerns as you indicated in our last call. I
understand the reservations you initially raised and I hope we can make this a rest symposium. I think we need to get
the admin. Call schedule to clarify that i hope the DGAC will set the plan and create a number if sites to make this a
meeting with participation across the country.

If you want to chat, please let me know.

Barbara

Sent from my iPhone

On Jan 18, 2015, at 11:57 AM, "Lichtenstein, Alice" <Alice.Lichtenstein@tufts.edu> wrote:
Reasonable e-mail and very generous to include my name given I have not been
involved with the planning. Please leave my name out, I am still ambivalent and at this
point far from enthusiastic. See modified e-mail, below.

I wanted to bring you further up to date on some planning that is underway to publicize the 2015 DGAC
report once it is officially published in the Federal register. As we approached our final public meeting,
several members of the SRSC and DGAC mentioned an interest in doing some publicizing of our
work. The SRSC discussed it in our final calls and were in agreement to work to develop a plan. After
our final meeting, I conferred with Kellie, Rick and Colette and there is agreement that is reasonable to
assume the report will be published later in February. I also met with Howard Koh, who as you recall
conducting our swearing in to the DGAC. You may also recall that it was announced that he returned to
the Harvard School of Public Health this past summer. He was enthusiastic about publicizing the DGAC
report and offered to assist where possible. I also met with Walter Willett, Chair of the Nutrition
Department, and he spontaneously offered to host a televised symposium on the report once
published. He suggested that their technology allows live satellite sites so I thought I would raise the
possibility that our DGAC members host institutions, where possible, might host a satellite site with a
live audience (and possibly presenter).
I polled the SRSC and chapter leads and the workgroup leaders about the idea and about dates in late
February that might work in their schedules. It looks like Wednesday February 25th is the date that
most are free. I hope this might work in your schedule as well. Everyone I have spoken to thus on our
Committee is enthusiastic about the idea. It is generally agreed that the symposium would highlight our
findings, our systematic, evidence‐based approach, and our recommendations. Everyone wishes a very
positive approach. I think we can carefully manage it. I had a follow‐up call with Rick, Kellie and
Colette to get their input. They were supportive, recognize that this would be rather novel (since other
DGAC’s have not done this before) and suggested we might take audience questions in advance to
prepare.
163
PSC-HHS-000163
I will be sending a Doodle poll to get an Administrative DGAC call together with all DGAC members so we
can talk further about the format, content and logistics of the symposium. During our planning process
and until we send out invitations, please hold this planning process reasonably confidential. I
understand that you may wish to talk with your institutional IT about your ability to host a site on
location.
If you wish to talk about this idea, please let me know. I can be reached at (b) (6) (cell is best in

case I’m traveling).


‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127


Hi Alice,

This is what I am in the process of sending to all remaining DGAC members and also to the SRSC and
workgroup leads so that everyone has the same information. Hope you’re taking a break!

our final meeting, Alice and I conferred with Kellie, Rick and Colette and there is agreement that is
reasonable to assume the report will be published later in February. I also met with Howard Koh, who
as you recall conducting our swearing in to the DGAC. You may also recall that it was announced that he
returned to the Harvard School of Public Health this past summer. He was enthusiastic about publicizing
the DGAC report and offered to assist where possible. I also met with Walter Willett, Chair of the
Nutrition Department, and he spontaneously offered to host a televised symposium on the report once
164
PSC-HHS-000164
positive approach. I think we can carefully manage it. Alice and I had a follow‐up call with Rick, Kellie
and Colette to get their input. They were supportive, recognize that this would be rather novel (since
other DGAC’s have not done this before) and suggested we might take audience questions in advance to
prepare.
location.



Barbara
bmillen@bu.edu

165
PSC-HHS-000165

In light if the email exchange this afternoon I wanted the two of you to be aware that Mary, Wayne and Lucille have also
emailed to say it is "exciting", " terrific" and a "wonderful opportunity". I look forward to the administration call. Please
be aware that other than a date the content if the symposium is not set as we discussed in our call. We did note that
Howard Koh was going to be asked whether he might introduce the symposium and I believe that has been done and he
is checking. Otherwise it is the committee's role to recommend ideas for the plan.

Barbara

Sent from my iPhone


‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127


Barbara


Marian

Sent from my iPhone
166
PSC-HHS-000166

Hi Marian,

167
PSC-HHS-000167


Barbara
bmillen@bu.edu

168
PSC-HHS-000168

Cc: Neuhouser, Marian L; Casavale, Kellie (OS/OASH)
Alice,

I did not send it in draft to you. It was a copy of what had already gone to the remainder of our DGAC with copies to the
SRSC and work group leads. I indicated in our call with the federal staff that I would be getting information out to them
and thought I had everyone's go ahead including yours.

I did not see your email until later this afternoon.

Barbara

Sent from my iPhone


‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127


Barbara


169
PSC-HHS-000169
Marian

Sent from my iPhone

Hi Marian,

170
PSC-HHS-000170


Barbara
bmillen@bu.edu

171
PSC-HHS-000171

To: Neuhouser, Marian L; Millen, Barbara E
Subject: RE: DGACFollow-up Please Hold Wednesday Feb 25
Marian, I made the same comment and took my name out of the text. I did not realize even a draft
went out with my name in it.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127


Barbara

I think I was pretty clear that I supported an event but I was not at all supportive of the idea you previously presented.
Your email below says all chairs were enthusiastic but that is not the case at least with me. I am deeply disappointed.

Marian

Sent from my iPhone

Hi Marian,
Apologies that this is a bit formal and perhaps somewhat repetitive. I want to be sure everyone has the
same information. This is the email content (below) now sent to the remaining members of the DGAC
after confirming dates with the SRSC and Workgroup leads and a conversation with Kellie, Rick, Colette
and Eve. BTW, the late January date will no longer be possible. The report editing is taking a bit longer
than expected so we were advised that is would be safer to go with the most available later February
date. I hope that it might be possible for you to work with the date. I am traveling too for meetings on
Friday the 27th. Logistics will be a bit complicated but I wanted to work with the date most on the SRSC
and our workgroup leads were free.
172
PSC-HHS-000172

our final meeting, Alice and I conferred with Kellie, Rick and Colette and there is agreement that is
reasonable to assume the report will be published later in February. I also met with Howard Koh, who
as you recall conducting our swearing in to the DGAC. You may also recall that it was announced that he
returned to the Harvard School of Public Health this past summer. He was enthusiastic about publicizing
the DGAC report and offered to assist where possible. I also met with Walter Willett, Chair of the
Nutrition Department, and he spontaneously offered to host a televised symposium on the report once
positive approach. I think we can carefully manage it. Alice and I had a follow‐up call with Rick, Kellie
and Colette to get their input. They were supportive, recognize that this would be rather novel (since
other DGAC’s have not done this before) and suggested we might take audience questions in advance to
prepare.
location.



Barbara
bmillen@bu.edu

173
PSC-HHS-000173

Subject: RE: DGACFollow-up Please Hold Wednesday Feb 25
Reasonable e-mail and very generous to include my name given I have not been involved with the
planning. Please leave my name out, I am still ambivalent and at this point far from
enthusiastic. See modified e-mail, below.
agreement to work to develop a plan. After our final meeting, I conferred with Kellie, Rick and Colette and there is
agreement that is reasonable to assume the report will be published later in February. I also met with Howard Koh, who
as you recall conducting our swearing in to the DGAC. You may also recall that it was announced that he returned to the
Harvard School of Public Health this past summer. He was enthusiastic about publicizing the DGAC report and offered to
assist where possible. I also met with Walter Willett, Chair of the Nutrition Department, and he spontaneously offered
to host a televised symposium on the report once published. He suggested that their technology allows live satellite
sites so I thought I would raise the possibility that our DGAC members host institutions, where possible, might host a
satellite site with a live audience (and possibly presenter).
recommendations. Everyone wishes a very positive approach. I think we can carefully manage it. I had a follow‐up call
with Rick, Kellie and Colette to get their input. They were supportive, recognize that this would be rather novel (since
other DGAC’s have not done this before) and suggested we might take audience questions in advance to prepare.

traveling).

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
174
PSC-HHS-000174
Boston, MA 02111

phone: 617 556 3127


Hi Alice,

This is what I am in the process of sending to all remaining DGAC members and also to the SRSC and workgroup leads so
that everyone has the same information. Hope you’re taking a break!

agreement to work to develop a plan. After our final meeting, Alice and I conferred with Kellie, Rick and Colette and
there is agreement that is reasonable to assume the report will be published later in February. I also met with Howard
Koh, who as you recall conducting our swearing in to the DGAC. You may also recall that it was announced that he
returned to the Harvard School of Public Health this past summer. He was enthusiastic about publicizing the DGAC
report and offered to assist where possible. I also met with Walter Willett, Chair of the Nutrition Department, and he
spontaneously offered to host a televised symposium on the report once published. He suggested that their technology
allows live satellite sites so I thought I would raise the possibility that our DGAC members host institutions, where
possible, might host a satellite site with a live audience (and possibly presenter).
recommendations. Everyone wishes a very positive approach. I think we can carefully manage it. Alice and I had a
follow‐up call with Rick, Kellie and Colette to get their input. They were supportive, recognize that this would be rather
novel (since other DGAC’s have not done this before) and suggested we might take audience questions in advance to
prepare.

traveling).


Barbara
175
PSC-HHS-000175
bmillen@bu.edu

176
PSC-HHS-000176

Sent: Saturday, January 17, 2015 6:22 AM
Cc: Olson, Richard (HHS/OASH); Colette Rihane; Shanthy Bowman; 'Essery, Eve - CNPP';
Anne Rodgers
Subject: RE: Final: Part C. Methodology
Many thanks. Barbara

bmillen@bu.edu

Cc: Olson, Richard (HHS/OASH); Colette Rihane; Shanthy Bowman; 'Essery, Eve - CNPP'; Anne Rodgers
Subject: Final: Part C. Methodology

Barbara and Alice,

Here is a super easy one for you! There are only a couple of very minor editorial changes in Part C. Methodology. It is
attached. You do not need to approve these edits since they are not the result of substantive decisions by the DGAC. The
document is attached as an FYI. No response needed.

Thanks,

Kellie

Rockville, MD 20852
(240) 453‐8252

177
PSC-HHS-000177

To: Britten, Patricia - CNPP
Cc: Essery, Eve - CNPP; Lichtenstein, Alice; Casavale, Kellie (OS/OASH); Olson, Richard
(HHS/OASH); Rihane, Colette - CNPP; Bowman, Shanthy; Anne Rodgers
Thank you Trish. I think we have all found the categories very important and useful. I was clarifying in the Exec summary
where I thought inclusion of the terms with the foods being discussed would be helpful. I was not advocating a change.
Hope that's clear. Also I was clarifying that we provide the definitions of the categories in our glossary. I think some of
the recent comments reflect a bit of confusion since others may not be familiar with the distinctions.

Thanks again and happy New Year.

Barbara

Sent from my iPhone

On Jan 16, 2015, at 3:25 PM, "Britten, Patricia ‐ CNPP" <Patricia.Britten@cnpp.usda.gov> wrote:
Hi Barbara,

Happy New Year!
Eve asked me to respond since these terms come from Subcommittee 1’s chapter.

I imagine that the distinction between the term “nutrient” and the other terms is clear. Food groups
and food categories both are USDA defined terms. Food components is a more general term that can
be, and has been, used—with clarifying examples—in several ways.

Food Groups: For purposes of the USDA Food Patterns, in Subcommittee 1’s chapter the food groups
are defined as fruits, vegetables, grains, dairy, and protein foods. Some of these groups (vegetables,
grains, protein foods) are divided into subgroups that are explicitly identified with intake goals or limits
in the Food Patterns.

Food Categories: This term was agreed upon by a joint group of ARS/FSRG and CNPP staff when
planning and executing the WWEIA Food Categories analysis, to distinguish foods as consumed from the
USDA Food Groups. Categories are identified as foods as consumed, and for many foods, these differ
greatly from food groups. For example, as you remember, the DGAC requested that foods consumed as
sandwiches and salads be reanalyzed by FSRG to make their categories fit this definition more
closely. This difference is explicitly noted in Subcommittee 1’s chapter and in the Executive summary.

Food Components: This is a general term that has been used in Subcommittee 1’s chapter to describe a
collection of items, which are then specified through a list or examples. I see this term as useful when
the item(s) being discussed are neither food groups nor nutrients, or are a mix of types of items. It is
intended to be general for flexible use, but specified in each individual use of the term. This means that
in some cases (when specified), food components could include food subgroups or nutrients in addition
to other items that are neither. The term is useful because it is flexible.

178
PSC-HHS-000178
The term is used three times in Subcommittee 1’s chapter, and in each case it is followed by the specific
items that it is intended to include. Twice it is in the sentence we have been editing in this email
string—it was added to this sentence (which appears both in the question 5 implications and in the
chapter summary) to clarify the difference between the “components” of refined grains, solid fats, and
added sugars, and overconsumed nutrients.

The only other use of this term in subcommittee 1’s chapter is in a statement beginning on line 1606:

“On the other hand, several of these subcategories, notably desserts and sweet snacks and
sugar‐sweetened beverages, tend to contribute to energy intake with little contribution to
underconsumed food groups and nutrients, but major contributions to one or more
overconsumed food components (see Question 11: What are the top foods contributing to
sodium, saturated fat, and added sugars intake in the U.S. population?)”

In this case, the reference to question 11 provides the specifics for the term food components.

The term “food components” is also used in the Executive Summary, with a clarifying list, in several
places. I believe you (Barbara) have inserted it here for clarity‐‐red text is what you have added.

 Line 64: Furthermore, population intake is too high for two food components, refined grains
and added sugars .

 Line 71: …and to lower population intake of the nutrients, sodium and saturated fat, and the
food components, refined grains . Improved beverage selections that limit or remove sugar‐
sweetened beverages and place limits on sweets and desserts would help lower intakes of the
food component, added sugars.

 Line 77: The DGAC found that although diet quality varies somewhat by the setting where food
is obtained, overall, no matter where the food is obtained, the diet quality of the U.S.
population does not meet recommendations for vegetables, fruit, dairy, or whole grains, and
exceeds recommendations, leading to overconsumption, for the nutrients sodium and saturated
fat and the food components refined grains, solid fats, and added sugars.

The terms food groups, food categories, and food components are defined when they are used in both
Subcommittee 1’s chapter and in the executive summary, usually through examples. Eve and I have
discussed the instances and think that their current use is therefore clear.

Hope this is helpful,
Trish

Cc: Olson, Richard (HHS/OASH); Rihane, Colette - CNPP; Bowman, Shanthy; Anne Rodgers; Britten,
Patricia - CNPP

Eve,

179
PSC-HHS-000179
Sorry but I am going back now to do final edits on the Exec. Summary, etc. and wonder if you can explain
why we have food groups (of the USDA patterns like fruits and vegetables), food components (ones
we’re targeting for change like refined grains), nutrients and food categories (foods (is ‘as eaten’’
correct?) like burgers). It may be confusing without consistent use/clarification and available
definitions,. The existence of these ‘buckets’ seems to have to do with how we approach the analysis of
population dietary intake. We will have to be clear in our explanation.

Can you let me know.

Barbara

bmillen@bu.edu

Cc: Olson, Richard (HHS/OASH); Rihane, Colette - CNPP; Bowman, Shanthy; Anne Rodgers; Britten,
Patricia - CNPP

Hi Alice,

Thanks for your quick review of chapter 1. Kellie asked Trish and I to respond to your concern about
solid fats and saturated fats in the following paragraph.

Following the recommended food intake pattern increases intakes of whole grains, vegetables, fruits,
and fat‐free/low fat dairy and thus increase the likelihood of meeting recommendations for these food
groups while decreasing intake of food components refined grains, solid fats, and added sugars, and the
nutrients sodium and saturated fat .

This sentence was revised after the December meeting in response to the questions raised by you and
Frank Hu. Trish explained during the meeting that solid fat is considered a food, and saturated fat a
nutrient, and they are not totally synonymous. The saturated fat content of various solid fats ranges
from about 30% of total fat (chicken fat) to about 90% (coconut oil). The USDA Food Patterns treat them
as two separate items—one a food component and one a nutrient.

In the Patterns, solid fats are treated as a food component to limit, and the Patterns indicate specific
maximum amounts of solid fat for each calorie level. Saturated fat is part of the nutrient goals and
limits for the Patterns, and amounts of saturated fat in the Patterns are reported in the nutrient content
tables.

The edit we made in the sentence above was to clarify that there are 3 food components that are
decreased when following the USDA Food Patterns (refined grains, solid fat, and added sugars) and 2
nutrients that are decreased (sodium and saturated fat). We thought that the edit clarified that there
were 2 lists, not one. Marian reviewed this wording after the meeting and noted the revision was fine
with her. If it would be helpful to further clarify that there are two lists, we could make a further edit so
that the lists are in separate sentences. Suggestion:

Following the recommended food intake pattern increases intakes of whole grains, vegetables, fruits,
and fat‐free/low fat dairy and thus increase the likelihood of meeting recommendations for these food
groups while decreasing intake of food components refined grains, solid fats, and added
180
PSC-HHS-000180
sugars. Following the recommended pattern also decreases intake of the nutrients sodium and
saturated fat

Please let us know how you’d like to proceed – keep it as is, edit it as suggested above, or suggest
another edit.

Thanks!
Eve and Trish

To: Casavale, Kellie (OS/OASH); Barbara E Millen
Cc: Olson, Richard (HHS/OASH); Rihane, Colette - CNPP; Bowman, Shanthy; Essery, Eve - CNPP; Anne
Rodgers; Britten, Patricia - CNPP

I went through whole chapter so I could see the changes, in situ. My only problem is
with listing solid fat and saturated fat in the same list. We discussed the issue
extensively and I thought agreed to not do it. However, that was my memory, which
may be biased. I certainly could not defend listing both together. See my note.

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

To: Barbara E Millen; Lichtenstein, Alice
Cc: Olson, Richard (HHS/OASH); Colette Rihane; Shanthy Bowman; 'Essery, Eve - CNPP'; Anne Rodgers;
Britten, Patricia - CNPP
Importance: High

Barbara and Alice,

Chapter 1: Food and Nutrient Intakes, and Health: Current Status and Trends and a log of five
substantive edits are attached. For time efficiency, you may prefer to review the log, since it is only a
little more than a page. (The figures are also attached as a PDF for reference only. There are not edits to
them.)


181
PSC-HHS-000181
I will be out of town Friday and Tuesday, but look forward to returning with an inbox full of approvals! If
you have questions, please reply to the group and Eve and Trish will answer them for you.

Many thanks,

Kellie

Rockville, MD 20852
(240) 453‐8252

email immediately.
182
PSC-HHS-000182

Cc: Olson, Richard (HHS/OASH); Rihane, Colette - CNPP; Bowman, Shanthy; Anne Rodgers;
Eve,

Sorry but I am going back now to do final edits on the Exec. Summary, etc. and wonder if you can explain why we have
food groups (of the USDA patterns like fruits and vegetables), food components (ones we’re targeting for change like
refined grains), nutrients and food categories (foods (is ‘as eaten’’ correct?) like burgers). It may be confusing without
consistent use/clarification and available definitions,. The existence of these ‘buckets’ seems to have to do with how we
approach the analysis of population dietary intake. We will have to be clear in our explanation.

Can you let me know.

Barbara

bmillen@bu.edu

Cc: Olson, Richard (HHS/OASH); Rihane, Colette - CNPP; Bowman, Shanthy; Anne Rodgers; Britten, Patricia - CNPP

Hi Alice,

Thanks for your quick review of chapter 1. Kellie asked Trish and I to respond to your concern about solid fats and
saturated fats in the following paragraph.

Following the recommended food intake pattern increases intakes of whole grains, vegetables, fruits, and fat‐free/low
fat dairy and thus increase the likelihood of meeting recommendations for these food groups while decreasing intake of
food components refined grains, solid fats, and added sugars, and the nutrients sodium and saturated fat .

This sentence was revised after the December meeting in response to the questions raised by you and Frank Hu. Trish
explained during the meeting that solid fat is considered a food, and saturated fat a nutrient, and they are not totally
synonymous. The saturated fat content of various solid fats ranges from about 30% of total fat (chicken fat) to about
90% (coconut oil). The USDA Food Patterns treat them as two separate items—one a food component and one a
nutrient.

In the Patterns, solid fats are treated as a food component to limit, and the Patterns indicate specific maximum amounts
of solid fat for each calorie level. Saturated fat is part of the nutrient goals and limits for the Patterns, and amounts of
saturated fat in the Patterns are reported in the nutrient content tables.

183
PSC-HHS-000183
The edit we made in the sentence above was to clarify that there are 3 food components that are decreased when
following the USDA Food Patterns (refined grains, solid fat, and added sugars) and 2 nutrients that are decreased
(sodium and saturated fat). We thought that the edit clarified that there were 2 lists, not one. Marian reviewed this
wording after the meeting and noted the revision was fine with her. If it would be helpful to further clarify that there
are two lists, we could make a further edit so that the lists are in separate sentences. Suggestion:

food components refined grains, solid fats, and added sugars. Following the recommended pattern also decreases
intake of the nutrients sodium and saturated fat

Please let us know how you’d like to proceed – keep it as is, edit it as suggested above, or suggest another edit.

Thanks!
Eve and Trish

Cc: Olson, Richard (HHS/OASH); Rihane, Colette - CNPP; Bowman, Shanthy; Essery, Eve - CNPP; Anne Rodgers; Britten,
Patricia - CNPP

I went through whole chapter so I could see the changes, in situ. My only problem is with listing solid
fat and saturated fat in the same list. We discussed the issue extensively and I thought agreed to not
do it. However, that was my memory, which may be biased. I certainly could not defend listing both
together. See my note.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

Cc: Olson, Richard (HHS/OASH); Colette Rihane; Shanthy Bowman; 'Essery, Eve - CNPP'; Anne Rodgers; Britten, Patricia
- CNPP
Importance: High

Barbara and Alice,

Chapter 1: Food and Nutrient Intakes, and Health: Current Status and Trends and a log of five substantive edits are
attached. For time efficiency, you may prefer to review the log, since it is only a little more than a page. (The figures are
also attached as a PDF for reference only. There are not edits to them.)
184
PSC-HHS-000184


questions, please reply to the group and Eve and Trish will answer them for you.

Many thanks,

Kellie

Rockville, MD 20852
(240) 453‐8252

185
PSC-HHS-000185

I agree with Alice and like the separate sentences that Eve prepared. Barbara

bmillen@bu.edu

To: Essery, Eve - CNPP; Casavale, Kellie (OS/OASH); Millen, Barbara E

The revised text addresses my concern. I understood the issue of food vs nutrient, however, it took
explanation and did not come through with the original wording.
“Following the recommended food intake pattern increases intakes of whole grains, vegetables, fruits,
and fat-free/low fat dairy and thus increase the likelihood of meeting recommendations for these food
saturated fat.”
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

To: Lichtenstein, Alice; Casavale, Kellie (OS/OASH); Barbara E Millen

Hi Alice,

186
PSC-HHS-000186


nutrient.





Thanks!
Eve and Trish

Patricia - CNPP

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
187
PSC-HHS-000187
Boston, MA 02111

phone: 617 556 3127

- CNPP
Importance: High

Barbara and Alice,




Many thanks,

Kellie

Rockville, MD 20852
(240) 453‐8252

188
PSC-HHS-000188

To: Essery, Eve - CNPP; Casavale, Kellie (OS/OASH); Barbara E Millen
The revised text addresses my concern. I understood the issue of food vs nutrient, however, it took
explanation and did not come through with the original wording.
“Following the recommended food intake pattern increases intakes of whole grains, vegetables, fruits,
and fat-free/low fat dairy and thus increase the likelihood of meeting recommendations for these food
saturated fat.”
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

To: Lichtenstein, Alice; Casavale, Kellie (OS/OASH); Barbara E Millen

Hi Alice,



nutrient.
189
PSC-HHS-000189





Thanks!
Eve and Trish

Patricia - CNPP

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

- CNPP
Importance: High

190
PSC-HHS-000190
Barbara and Alice,




Many thanks,

Kellie

Rockville, MD 20852
(240) 453‐8252

191
PSC-HHS-000191

'Anne Rodgers'; De Jesus, Janet M (NIH/NHLBI) [E]
Attachments: 10 Part D_Chapter 5 Food Sustainability and Safety_SEMI-FINAL_changes for BEM AHL
approval_1-15-15 AHL.docx
I approve all the edits. Inserted comments #1 and 2 just for consideration by the group for potential
modification.
The snow is starting to fly in Boston, big lovely snowflakes.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

Importance: High

Barbara and Alice,




192
PSC-HHS-000192
Many thanks,

Kellie

Rockville, MD 20852
(240) 453‐8252

193
PSC-HHS-000193

Anne Rodgers; Britten, Patricia - CNPP
Attachments: 06 Part D_Chapter 1 Food and Nutrient Intakes SEMI-FINAL_changes for approaval by
BEM AHL_1-15-15 AHL.docx
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

- CNPP
Importance: High

Barbara and Alice,




194
PSC-HHS-000194
Many thanks,

Kellie

Rockville, MD 20852
(240) 453‐8252

195
PSC-HHS-000195

Anne Rodgers
Subject: RE: Final: Part C. Methodology
I approve all edits, the few there are.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

Cc: Olson, Richard (HHS/OASH); Colette Rihane; Shanthy Bowman; 'Essery, Eve - CNPP'; Anne Rodgers
Subject: Final: Part C. Methodology

Barbara and Alice,

Here is a super easy one for you! There are only a couple of very minor editorial changes in Part C. Methodology. It is
attached. You do not need to approve these edits since they are not the result of substantive decisions by the DGAC. The
document is attached as an FYI. No response needed.

Thanks,

Kellie

Rockville, MD 20852
(240) 453‐8252

196
PSC-HHS-000196

Cc: Colette Rihane; Olson, Richard (HHS/OASH); Shanthy Bowman; Essery, Eve - CNPP;
Anne Rodgers
Subject: RE: Final Edits for BEM/AHL Review: Executive Summary
Having thought about dairy a bit more I have additional thoughts. First, as Barbara and Kellie have
indicated, we can’t change what the committee agreed on. Second, I am concerned about singling
out dairy as a major source of Na and SFA because it is not the leading source. Dairy products,
particularly non- and low-fat dairy, are outstanding sources of high quality protein, particularly
important since we recommend limiting red and processed meat; is more affordable than fish or meat;
and except for milk has a relatively long shelf life and needs minimal, if any, preparation. In all cases,
particularly for older adult, these are very important issues. The issue of lactose intolerance is no
longer much of an issue due to the availability of low lactose forms. From what I can remember
concerns about dairy intake are from observational studies. These are important to consider but as
we learned with beta-carotene, folate and vit E, not what we should be basing policy on.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

Cc: Lichtenstein, Alice; Colette Rihane; Olson, Richard (HHS/OASH); Shanthy Bowman; Essery, Eve - CNPP; Anne
Rodgers
Subject: Re: Final Edits for BEM/AHL Review: Executive Summary

Understand. This is a complicated time of year for everyone and edits were more difficult than usual. Hopefully my edits
are reasonable. The remaining niggling issue seems to be wording around dairy...a good source of under consumed and
over consumed nutrients. Wonder how best to handle it so I offered some thoughts. I'm available if a call would be
helpful. Barbara

Sent from my iPad

On Jan 5, 2015, at 7:41 AM, "Casavale, Kellie (OS/OASH)" <Kellie.Casavale@hhs.gov> wrote:
Thank you, Barbara and Alice. We will review your notes and get back in touch on them. The
Committee’s work is at the point currently where only the issues discussed on Dec. 15th lead to changes
197
PSC-HHS-000197
in the report. No other substantive changes can be made. So when we review the edits, some may not
be able to be considered unless they are resolving issues discussed in the public meeting. To my
knowledge all of those issues are resolved, we just need your confirmation of that. I am beginning to be
very concerned about the timing of submitting the report. It took the Committee about a week longer
than expected to resolve the very short list of issues that were identified on Dec. 15th.

Barbara, just for clarification, the Under Secretaries do not review your cover letter. The Co‐Executive
Secretaries are reviewing it. It will go through the Under Secretaries and the Acting ASH on its way to the
Secretary though.

I will be in touch with the next pieces as soon as possible.

Many thanks!

Kellie


To: Lichtenstein, Alice; Casavale, Kellie (OS/OASH)
Cc: Colette Rihane; Olson, Richard (HHS/OASH); Shanthy Bowman; Essery, Eve - CNPP; Anne Rodgers

Hi everyone,

Alice’s and my reviews overlapped and here are my thoughts. Having just completed the draft letter to
Secretaries that the Under Secretaries are reviewing, I have been trying to sharpen the clarity of
messages. I thought some of our key points could be emphasized a bit more. Also, I thought we have
to resolve dairy. Our healthy patterns have low‐fat dairy (and alternatives) and we know that dairy as
currently consumed by Americans not only provides a good source of some of the under‐consumed
nutrients of public health concern but also those that are overconsumed, notably sodium (particularly
cheeses) and saturated fat (full fat and even lower fat types). So, I did some tweaking for
consideration. I’m available if we need to talk at all.

B est,

Barbara

bmillen@bu.edu

To: Casavale, Kellie (OS/OASH); Millen, Barbara E

My grant with the Jan 2 deadline was submitted. On vacation this week with my
family. Will keep up in morning and evenings.
198
PSC-HHS-000198

See comments, in red. When I read text, I always think, can we defend it if challenged?
For the most part, yes.

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

To: Millen, Barbara E; Lichtenstein, Alice
Subject: Final Edits for BEM/AHL Review: Executive Summary
Importance: High

Barbara and Alice,

We are in the last phases of finalizing the report to go to the Secretaries next week. Attached is the
Executive Summary to review and determine if the edits can be accepted. The great news is that despite
how long it took me to review the comments, all edits are resolved! You just need to take a look and
give me the green light to accept the changes and consider this “final.”

I will move through each chapter in a similar way. Once you have approved the edits for all chapters, I
will send clean copies to you in one e‐mail with a form for each of you to sign to give us official approval
to submit it to the Secretaries.

Executive Summary
 I deleted a few comments that were old news. However, I left the comment strings on the lines
listed below that provided follow‐up that confirmed they are resolved if you agree to the
tracked changes provided.
o Lines 11‐15
o Lines 54‐56
o Line 59‐ At the end of Frank’s comment there is follow‐up from Trish that provides the
rationale for not making an edit here. Comment is resolved if you agree.
o Line 66
o Line 76
o Line 81
o Lines 88‐89
o Lines 107‐108
o Lines 114‐116‐ Because SC 2 updated their language and it does not mention lean meat,
Barbara requested a sentence be include to acknowledge that lean meat can be part of
a healthy diet. Eve addressed this need here, suggesting wording to add as a footnote.
o Lines 113‐134‐ Edited to make the description of healthy dietary patterns match the
updates in the SC 2 chapter.
199
PSC-HHS-000199
o Lines 142‐144
o Lines 155‐156
o Line 173‐ See follow‐up comments to Alice from Mary and Rafael.
o Lines 179‐181
o Lines 182‐183
o Line 213‐219
o Line 228
o Lines 236‐237
o Line 250
o Line 272‐273
o Lines 285‐288
o Line 293‐ Alice see follow‐up from Mim.
o Line 294
o Lines 319‐320
o Line 321‐ Alice see follow‐up from Janet on your question.
o Lines 334‐357‐ Barbara noted that there is a sentence about saturated fat and one
about added sugars, but not one about sodium. The CC chapter summary also does not
have a congruent sentence. Eve suggested a sentence Cheryl approved for the SWG
which has been added.
o Line 347
o 355‐357‐ No change if Alice is agreeable with Marian’s response.
o 368
o 392‐396
o 404‐408

The Introduction and the Integration chapters will come next, followed by the Science Base chapters.

Thanks!

Kellie

Rockville, MD 20852
(240) 453‐8252

200
PSC-HHS-000200

Subject: Fwd: contact for Dr. Millen
FYI. Will you please contact the NY Times? Many thanks. Barbara
Sent from my iPhone
Begin forwarded message:
From: Kevin Grinberg <kevin@millenniumprevention.com>

Date: January 5, 2015 at 4:07:45 PM EST
To: "Millen, Barbara E" <bmillen@bu.edu>
Cc: "dwolongevicz@millenniumprevention.com" <dwolongevicz@millenniumprevention.com>
Subject: Fwd: contact for Dr. Millen
Barbara, see below (this came in to help@healthmain.com)
Dolores may have forwarded it already (since she sees help@healthmain messages), but I figured
I'd send it along as well.
---------- Forwarded message ----------

From: Lapidos, Juliet <juliet.lapidos@nytimes.com>
Date: Mon, Jan 5, 2015 at 4:04 PM
Subject: contact for Dr. Millen
To: help@healthmain.com
To whom it may concern:
I'm on the editorial board of The New York Times.
I'd like to speak with Barbara Millen as soon as possible about the Dietary Guidelines Review Committee's
recommendations for the 2015 dietary guidelines. I'd like to discuss, specifically, the apparent move to address
environmental concerns in the guidelines.
Thanks and best,

Juliet Lapidos
212 556 5953
201
PSC-HHS-000201

Cc: Lichtenstein, Alice; Colette Rihane; Olson, Richard (HHS/OASH); Shanthy Bowman;
Essery, Eve - CNPP; Anne Rodgers
Understand. This is a complicated time of year for everyone and edits were more difficult than usual. Hopefully my edits
are reasonable. The remaining niggling issue seems to be wording around dairy...a good source of under consumed and
over consumed nutrients. Wonder how best to handle it so I offered some thoughts. I'm available if a call would be
helpful. Barbara

Sent from my iPad


Secretary though.


Many thanks!

Kellie



Hi everyone,

202
PSC-HHS-000202

B est,

Barbara

bmillen@bu.edu




‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

Importance: High

Barbara and Alice,


203
PSC-HHS-000203

Executive Summary
o Lines 11‐15
o Lines 54‐56
o Line 66
o Line 76
o Line 81
o Lines 88‐89
o Lines 107‐108
o Lines 142‐144
o Lines 155‐156
o Lines 179‐181
o Lines 182‐183
o Line 213‐219
o Line 228
o Lines 236‐237
o Line 250
o Line 272‐273
o Lines 285‐288
o Line 294
o Lines 319‐320
o Line 347
o 368
o 392‐396
o 404‐408


Thanks!

Kellie
204
PSC-HHS-000204

Rockville, MD 20852
(240) 453‐8252

205
PSC-HHS-000205

OK. I don't think the changes were substantive unless the query raised on dairy poses a potential problem. It is a
niggling issue. Barbara

Sent from my iPad


Secretary though.


Many thanks!

Kellie



Hi everyone,

206
PSC-HHS-000206

B est,

Barbara

bmillen@bu.edu




‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

Importance: High

Barbara and Alice,



Executive Summary
207
PSC-HHS-000207
o Lines 11‐15
o Lines 54‐56
o Line 66
o Line 76
o Line 81
o Lines 88‐89
o Lines 107‐108
o Lines 142‐144
o Lines 155‐156
o Lines 179‐181
o Lines 182‐183
o Line 213‐219
o Line 228
o Lines 236‐237
o Line 250
o Line 272‐273
o Lines 285‐288
o Line 294
o Lines 319‐320
o Line 347
o 368
o 392‐396
o 404‐408


Thanks!

Kellie

208
PSC-HHS-000208
Rockville, MD 20852
(240) 453‐8252

209
PSC-HHS-000209

Anne Rodgers
Attachments: 02 Part A_Executive Summary_SEMI-FINAL_for BEM AHL final review_1-3-15 bem
edits.docx
Hi everyone,

Alice’s and my reviews overlapped and here are my thoughts. Having just completed the draft letter to Secretaries that
the Under Secretaries are reviewing, I have been trying to sharpen the clarity of messages. I thought some of our key
points could be emphasized a bit more. Also, I thought we have to resolve dairy. Our healthy patterns have low‐fat
dairy (and alternatives) and we know that dairy as currently consumed by Americans not only provides a good source of
some of the under‐consumed nutrients of public health concern but also those that are overconsumed, notably sodium
(particularly cheeses) and saturated fat (full fat and even lower fat types). So, I did some tweaking for

B est,

Barbara

bmillen@bu.edu


My grant with the Jan 2 deadline was submitted. On vacation this week with my family. Will keep up
in morning and evenings.
See comments, in red. When I read text, I always think, can we defend it if challenged? For the most
part, yes.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127
210
PSC-HHS-000210

Importance: High

Barbara and Alice,

We are in the last phases of finalizing the report to go to the Secretaries next week. Attached is the Executive Summary
to review and determine if the edits can be accepted. The great news is that despite how long it took me to review the
comments, all edits are resolved! You just need to take a look and give me the green light to accept the changes and
consider this “final.”

I will move through each chapter in a similar way. Once you have approved the edits for all chapters, I will send clean
copies to you in one e‐mail with a form for each of you to sign to give us official approval to submit it to the Secretaries.

Executive Summary
 I deleted a few comments that were old news. However, I left the comment strings on the lines listed below that
provided follow‐up that confirmed they are resolved if you agree to the tracked changes provided.
o Lines 11‐15
o Lines 54‐56
o Line 59‐ At the end of Frank’s comment there is follow‐up from Trish that provides the rationale for not
making an edit here. Comment is resolved if you agree.
o Line 66
o Line 76
o Line 81
o Lines 88‐89
o Lines 107‐108
o Lines 114‐116‐ Because SC 2 updated their language and it does not mention lean meat, Barbara
requested a sentence be include to acknowledge that lean meat can be part of a healthy diet. Eve
addressed this need here, suggesting wording to add as a footnote.
o Lines 113‐134‐ Edited to make the description of healthy dietary patterns match the updates in the SC 2
chapter.
o Lines 142‐144
o Lines 155‐156
o Lines 179‐181
o Lines 182‐183
o Line 213‐219
o Line 228
o Lines 236‐237
o Line 250
o Line 272‐273
o Lines 285‐288
o Line 294
o Lines 319‐320
211
PSC-HHS-000211
o Lines 334‐357‐ Barbara noted that there is a sentence about saturated fat and one about added sugars,
but not one about sodium. The CC chapter summary also does not have a congruent sentence. Eve
suggested a sentence Cheryl approved for the SWG which has been added.
o Line 347
o 368
o 392‐396
o 404‐408


Thanks!

Kellie

Rockville, MD 20852
(240) 453‐8252

212
PSC-HHS-000212

Anne Rodgers
Attachments: 02 Part A_Executive Summary_SEMI-FINAL_for BEM AHL final review_1-3-15 AHL.docx
My grant with the Jan 2 deadline was submitted. On vacation this week with my family. Will keep up
in morning and evenings.
See comments, in red. When I read text, I always think, can we defend it if challenged? For the most
part, yes.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

Importance: High

Barbara and Alice,

We are in the last phases of finalizing the report to go to the Secretaries next week. Attached is the Executive Summary
to review and determine if the edits can be accepted. The great news is that despite how long it took me to review the
comments, all edits are resolved! You just need to take a look and give me the green light to accept the changes and
consider this “final.”

I will move through each chapter in a similar way. Once you have approved the edits for all chapters, I will send clean
copies to you in one e‐mail with a form for each of you to sign to give us official approval to submit it to the Secretaries.

Executive Summary
 I deleted a few comments that were old news. However, I left the comment strings on the lines listed below that
provided follow‐up that confirmed they are resolved if you agree to the tracked changes provided.
o Lines 11‐15
o Lines 54‐56
213
PSC-HHS-000213
o Line 59‐ At the end of Frank’s comment there is follow‐up from Trish that provides the rationale for not
making an edit here. Comment is resolved if you agree.
o Line 66
o Line 76
o Line 81
o Lines 88‐89
o Lines 107‐108
o Lines 114‐116‐ Because SC 2 updated their language and it does not mention lean meat, Barbara
requested a sentence be include to acknowledge that lean meat can be part of a healthy diet. Eve
addressed this need here, suggesting wording to add as a footnote.
o Lines 113‐134‐ Edited to make the description of healthy dietary patterns match the updates in the SC 2
chapter.
o Lines 142‐144
o Lines 155‐156
o Lines 179‐181
o Lines 182‐183
o Line 213‐219
o Line 228
o Lines 236‐237
o Line 250
o Line 272‐273
o Lines 285‐288
o Line 294
o Lines 319‐320
o Lines 334‐357‐ Barbara noted that there is a sentence about saturated fat and one about added sugars,
but not one about sodium. The CC chapter summary also does not have a congruent sentence. Eve
suggested a sentence Cheryl approved for the SWG which has been added.
o Line 347
o 368
o 392‐396
o 404‐408


Thanks!

Kellie

Rockville, MD 20852
(240) 453‐8252

214
PSC-HHS-000214

Sent: Thursday, December 25, 2014 8:10 AM
To: Frank Hu
Cc: Tom Brenna; Lichtenstein, Alice; Essery, Eve - CNPP; Anne Rodgers; Casavale, Kellie
(OS/OASH)
Subject: Re: dietary fat adn cholesterol
We didn't review data on cholesterol and CVD risk which makes the second point, while valid, a bit
problematical. Not sure how best to resolve it. Barbara
Sent from my iPhone
On Dec 24, 2014, at 10:01 AM, "Frank Hu" <nhbfh@channing.harvard.edu> wrote:
I'm thinking about several justifications for not carrying forward the 2010 cholesterol
recommendation.
1. The main approach of 2015 DGAC is food-based and pattern-based recommendations. Dietary
cholesterol intake is not considered by the DGAC as a major area of public health concern in
developing recommendations based on healthy dietary patterns.
2. There is little scientific evidence to support the 300 mg/day limit. Dietary cholesterol has only
small effects on serum cholesterol, and in prospective cohort studies, dietary cholesterol intake
was not associated with long-term CVD risk. Consumption of eggs (a major source of dietary
cholesterol) was not associated with CVD risk either. The consumption of red meats/process
meats, another major dietary source of dietary cholesterol, is recommended to be reduced in all
the major healthy dietary patterns reviewed by the DGAC.
3. Current level of cholesterol intake in the US population is xxx, well below 300 mg/day.
Average egg consumption is xxx.
4. Regarding seafood, my impression is that the structure of cholesterol in seafood is somewhat

different from that in meats and eggs. Several RCTs showed that seafood cholesterol did not
increase blood cholesterol. It is probably not a good idea to lump cholesterol from meats/eggs
together with that from seafood.
Frank
On Tue, Dec 23, 2014 at 5:40 PM, Millen, Barbara E <bmillen@bu.edu> wrote:
215
PSC-HHS-000215
What do others feel about clarifying why we are not carrying forward the 2010 cholesterol
recommendation. It might be suitable to comment further on that current mean population intake
achieves the prior cholesterol target (under 300 mg) but also to note that a further emphasis on
cholesterol might make the seafood recommendation confusing since some seafood, such as shellfish
are higher in cholesterol. We do want to promote all seafood including shellfish.
What are others’ thoughts?
Barbara
bmillen@bu.edu

Sent: Tuesday, December 23, 2014 5:28 PM
To: Tom Brenna
Cc: Lichtenstein, Alice; Millen, Barbara E; Essery, Eve - CNPP; Anne Rodgers; Casavale, Kellie (OS/OASH)
Subject: Re: dietary fat
Dear All,
I was alerted that we were silent on trans fat at our public meeting presentation. So I added the
following sentence to the implications of saturated fat-CVD section. Please let me know what
you think. If you agree with the wording, I think it should be also added to the Executive
Summary and Integration Chapter.
Trans fat from partially hydrogenated vegetable oils should be avoided.
Happy Holidays!
Frank
216
PSC-HHS-000216
On Mon, Dec 22, 2014 at 6:41 AM, Tom Brenna <jtb4@cornell.edu> wrote:
It's fine with me.
Tom
On Sun, Dec 21, 2014 at 9:33 AM, Frank Hu <nhbfh@channing.harvard.edu> wrote:
Alice,
attached please see my edits/comments on Chapters 2 and 6, in response to your comments.
For SFA, the Mensink and Katan 2003 MA (60 RCTs) included the DELTA trial, and thus, this
provides the strongest overall evidence on the effects of replacing SFA with other macronutrients
on blood lipids. The lipid effects in DASH were not primary outcomes and the results should be
interpreted in the context of the overall dietary pattern rather than as a low-fat diet. I have
consolidated the section on SFA replacement and blood lipids in the cross-cutting chapter and i
think it is now more coherent and stronger.
Frank
On Sat, Dec 20, 2014 at 5:33 PM, Lichtenstein, Alice <Alice.Lichtenstein@tufts.edu> wrote:
Frank, I can see your point. I was too quick to criticize but don’t really have a good
solution.
I have added comments to the integration chapter as well as chapter 2 (more minor
points). Perhaps expressing the data in terms of a 5%E difference in dietary
217
PSC-HHS-000217
composition will provide a stronger argument. We do need to consider Marian’s
statement that reading the text, the data don’t appear strong.
I am interested in what approach you would suggest taking.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111
phone: 617 556 3127

Sent: Saturday, December 20, 2014 4:08 PM
no. Based on your last email, I thought you were sending us something since you "don't agree". I
was waiting for your revision.
Are you still planning to send out a revised version today?
218
PSC-HHS-000218
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111
phone: 617 556 3127

Sent: Friday, December 19, 2014 12:37 PM
Cc: Essery, Eve - CNPP; Casavale, Kellie (OS/OASH); Anne Rodgers
I would prefer to keep at least some evidence summary on blood lipids in the chapter because
this is part of conclusion statements. As Eve mentioned, we can specify the study populations
(e.g. individuals with high cholesterol) when describing the findings from the AHA/ACC report.
Although many of the studies summarized by Mensink and Katan are old, the general
conclusions regarding the effects of replacing saturated fat with PUFA, MUFA, and carbs are
solid and broadly consistent with more recent studies.
I will try to make some adjustment to this section today or tomorrow.
frank
On Thu, Dec 18, 2014 at 8:11 PM, Lichtenstein, Alice <Alice.Lichtenstein@tufts.edu> wrote:
I can live with almost anything now. However, it will be unfortunate if we retain the text
about the old Katan analyses and DELTA and DASH studies copied directly from the
AHA/ACC report because they were both predicated on low fat diets, something we no
longer recommend and have to fight an uphill battle to remind people we don’t
219
PSC-HHS-000219
recommend them. Retaining the text in the 2015 DGAC report is just undermining our
message, in my opinion.
-------------------------------------------------------------------------------
Tufts University
Boston, MA 02111
phone: 617 556 3127
e-mail: Alice.Lichtenstein@Tufts.edu

Sent: Thursday, December 18, 2014 1:59 PM
To: Frank Hu; Lichtenstein, Alice
Cc: Casavale, Kellie (OS/OASH); 'Anne Rodgers'
Subject: RE: dietary fat
Frank and Alice,
Kellie forwarded me the email string on dietary fat since I am compiling the edits to the cross-cutting
chapter. I’m not sure if I have the full email string… Frank – Can you send me the final decision on the
edits to the saturated fat section?
Alice – To your point about how the AHA/ACC Guidelines are specifically for those who would benefit
from cholesterol-lowering, I just wanted to note that the sodium section has a similar situation (the
AHA/ACC Guidelines are for those who would benefit from blood pressure lowering); however, Cheryl just
made this point in her write-up. Could this be resolved by just stating clearly that the AHA/ACC Guidelines
were limited to those with high cholesterol?
220
PSC-HHS-000220
Just let me know what is decided so that I can get it into the final!
THANKS!!
Eve

Sent: Wednesday, December 17, 2014 2:06 PM
Cc: Anne Brown Rodgers (b) (6) Casavale, Kellie (OS/OASH)
Alice,
After your deletions (AHA/ACC, Mensink and Katan, and Hooper), we don't have any evidence
summary on blood lipids to support the following conclusion statement. Dary's paper did not
specifically summarize the lipid effects. Instead, it used lipid effects (TC to LDL ratio) from
Mensink and Katan to project the magnitude of CHD reduction by replacing saturated fat with
PUFA, carbs, or mono.
Strong and consistent evidence from RCTs shows that replacing SFA with unsaturated
fats, especially PUFA, significantly reduces total and LDL cholesterol. Replacing SFA with
carbohydrates (sources not defined) also reduces total and LDL cholesterol, but
significantly increases triglycerides and reduces HDL cholesterol.

Sent: Wednesday, December 17, 2014 7:24 AM
To: Frank Hu (nhbfh@channing.harvard.edu)
Subject: dietary fat
Not certain whether I actually attached/sent my suggested changes.
-------------------------------------------------------------------------------
221
PSC-HHS-000221
Tufts University
Boston, MA 02111
phone: 617 556 3127
From: Anne Rodgers (b) (6)

To: Lichtenstein, Alice; 'Casavale, Kellie (OS/OASH)'
Subject: RE: integration and exec summary
Yes, you commented on the Executive Summary this morning and on the Integration chapter just
before it went into the semi-final draft.
Anne Brown Rodgers
Science Writer
(b) (6)

222
PSC-HHS-000222
To: Casavale, Kellie (OS/OASH); Anne Brown Rodgers (b) (6)
Subject: integration and exec summary
Final chapters, according to my records I have commented on both. If this is not the
case please let me know. I am aware there is still one outstanding issue other
committee members were queried about.
-------------------------------------------------------------------------------
Tufts University
Boston, MA 02111
phone: 617 556 3127
email immediately.
--
*******************************************************
223
PSC-HHS-000223
Harvard School of Public Health
tel: 617 432 0113 fax: 617 432 2435
******************************************************
--
*******************************************************
tel: 617 432 0113 fax: 617 432 2435
******************************************************
--
*******************************************************
tel: 617 432 0113 fax: 617 432 2435
224
PSC-HHS-000224
******************************************************
--
*******************************************************
tel: 617 432 0113 fax: 617 432 2435
******************************************************
--
*******************************************************
tel: 617 432 0113 fax: 617 432 2435
******************************************************
225
PSC-HHS-000225

Sent: Sunday, December 21, 2014 3:52 PM
To: Frank Hu; bmillen@bu.edu; Essery, Eve - CNPP; Tom Brenna; Anne Rodgers
Attachments: 11 Part D_Chapter 6 Cross-cutting Topics_SEMI-FINAL_12-10-14 AHL v2 FH AHL.docx;
07 Part D_Chapter 2 Dietary Patterns_SEMI-FINAL_12-10-14 AHL v3 FH AHL.docx
Put in a few notes of agreement. No additional comments.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

Sent: Sunday, December 21, 2014 9:33 AM
To: Lichtenstein, Alice; bmillen@bu.edu; Essery, Eve - CNPP; Tom Brenna; Anne Rodgers
Alice,
attached please see my edits/comments on Chapters 2 and 6, in response to your comments.
For SFA, the Mensink and Katan 2003 MA (60 RCTs) included the DELTA trial, and thus, this provides the
strongest overall evidence on the effects of replacing SFA with other macronutrients on blood lipids. The lipid
effects in DASH were not primary outcomes and the results should be interpreted in the context of the overall
dietary pattern rather than as a low-fat diet. I have consolidated the section on SFA replacement and blood
lipids in the cross-cutting chapter and i think it is now more coherent and stronger.
Frank
Frank, I can see your point. I was too quick to criticize but don’t really have a good solution.
226
PSC-HHS-000226
I have added comments to the integration chapter as well as chapter 2 (more minor points). Perhaps
expressing the data in terms of a 5%E difference in dietary composition will provide a stronger
argument. We do need to consider Marian’s statement that reading the text, the data don’t appear
strong.
I am interested in what approach you would suggest taking.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111
phone: 617 556 3127

no. Based on your last email, I thought you were sending us something since you "don't agree". I was waiting
for your revision.
Are you still planning to send out a revised version today?
227
PSC-HHS-000227
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111
phone: 617 556 3127

Cc: Essery, Eve - CNPP; Casavale, Kellie (OS/OASH); Anne Rodgers
I would prefer to keep at least some evidence summary on blood lipids in the chapter because this is part of
conclusion statements. As Eve mentioned, we can specify the study populations (e.g. individuals with high
cholesterol) when describing the findings from the AHA/ACC report. Although many of the studies
summarized by Mensink and Katan are old, the general conclusions regarding the effects of replacing saturated
fat with PUFA, MUFA, and carbs are solid and broadly consistent with more recent studies.
I will try to make some adjustment to this section today or tomorrow.
frank
On Thu, Dec 18, 2014 at 8:11 PM, Lichtenstein, Alice <Alice.Lichtenstein@tufts.edu> wrote:
I can live with almost anything now. However, it will be unfortunate if we retain the text about the old
Katan analyses and DELTA and DASH studies copied directly from the AHA/ACC report because
they were both predicated on low fat diets, something we no longer recommend and have to fight an
228
PSC-HHS-000228
uphill battle to remind people we don’t recommend them. Retaining the text in the 2015 DGAC report
is just undermining our message, in my opinion.
-------------------------------------------------------------------------------
Tufts University
Boston, MA 02111
phone: 617 556 3127

Frank and Alice,
Kellie forwarded me the email string on dietary fat since I am compiling the edits to the cross-cutting chapter. I’m not
sure if I have the full email string… Frank – Can you send me the final decision on the edits to the saturated fat section?
Alice – To your point about how the AHA/ACC Guidelines are specifically for those who would benefit from cholesterol-
lowering, I just wanted to note that the sodium section has a similar situation (the AHA/ACC Guidelines are for those who
would benefit from blood pressure lowering); however, Cheryl just made this point in her write-up. Could this be resolved
by just stating clearly that the AHA/ACC Guidelines were limited to those with high cholesterol?
229
PSC-HHS-000229
THANKS!!
Eve

Alice,
After your deletions (AHA/ACC, Mensink and Katan, and Hooper), we don't have any evidence summary on
blood lipids to support the following conclusion statement. Dary's paper did not specifically summarize the lipid
effects. Instead, it used lipid effects (TC to LDL ratio) from Mensink and Katan to project the magnitude of
CHD reduction by replacing saturated fat with PUFA, carbs, or mono.
Strong and consistent evidence from RCTs shows that replacing SFA with unsaturated fats, especially
PUFA, significantly reduces total and LDL cholesterol. Replacing SFA with carbohydrates (sources not
defined) also reduces total and LDL cholesterol, but significantly increases triglycerides and reduces
HDL cholesterol.

-------------------------------------------------------------------------------
230
PSC-HHS-000230
Tufts University
Boston, MA 02111
phone: 617 556 3127

Yes, you commented on the Executive Summary this morning and on the Integration chapter just before it went
into the semi-final draft.
Anne Brown Rodgers
Science Writer
(b) (6)

231
PSC-HHS-000231
Final chapters, according to my records I have commented on both. If this is not the case please let
me know. I am aware there is still one outstanding issue other committee members were queried
about.
-------------------------------------------------------------------------------
Tufts University
Boston, MA 02111
phone: 617 556 3127
--
*******************************************************
232
PSC-HHS-000232
tel: 617 432 0113 fax: 617 432 2435
******************************************************
--
*******************************************************
tel: 617 432 0113 fax: 617 432 2435
******************************************************
--
*******************************************************
tel: 617 432 0113 fax: 617 432 2435
******************************************************
233
PSC-HHS-000233

To: Essery, Eve - CNPP; Frank Hu
I can live with almost anything now. However, it will be unfortunate if we retain the text about the old
Katan analyses and DELTA and DASH studies copied directly from the AHA/ACC report because
they were both predicated on low fat diets, something we no longer recommend and have to fight an
uphill battle to remind people we don’t recommend them. Retaining the text in the 2015 DGAC report
is just undermining our message, in my opinion.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127


Frank and Alice,
Kellie forwarded me the email string on dietary fat since I am compiling the edits to the cross-cutting chapter. I’m not
sure if I have the full email string… Frank – Can you send me the final decision on the edits to the saturated fat section?
Alice – To your point about how the AHA/ACC Guidelines are specifically for those who would benefit from cholesterol-
lowering, I just wanted to note that the sodium section has a similar situation (the AHA/ACC Guidelines are for those who
would benefit from blood pressure lowering); however, Cheryl just made this point in her write-up. Could this be resolved
by just stating clearly that the AHA/ACC Guidelines were limited to those with high cholesterol?
THANKS!!
Eve

234
PSC-HHS-000234
Alice,

After your deletions (AHA/ACC, Mensink and Katan, and Hooper), we don't have any evidence summary on blood lipids
to support the following conclusion statement. Dary's paper did not specifically summarize the lipid effects. Instead, it
used lipid effects (TC to LDL ratio) from Mensink and Katan to project the magnitude of CHD reduction by replacing
saturated fat with PUFA, carbs, or mono.

Strong and consistent evidence from RCTs shows that replacing SFA with unsaturated fats, especially PUFA,
significantly reduces total and LDL cholesterol. Replacing SFA with carbohydrates (sources not defined) also reduces
total and LDL cholesterol, but significantly increases triglycerides and reduces HDL cholesterol.


‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127


Yes, you commented on the Executive Summary this morning and on the Integration chapter just before it went into the
semi‐final draft.

Anne Brown Rodgers
Science Writer
(b) (6)


235
PSC-HHS-000235
Final chapters, according to my records I have commented on both. If this is not the case please let
me know. I am aware there is still one outstanding issue other committee members were queried
about.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

236
PSC-HHS-000236

Subject: RE: a few more edits: CONFIDENTIAL: Draft Semi-Final 2015 DGAC Report- DGAC
Chairs
Sounds like a good plan to me.
Ignoring e-mails during the day to focus on my grant. However, catching up now.
The Food and Nutrition Board had an outstanding session on public/private partnerships. I think we
will hear more about it in the year to come.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

To: 'Millen, Barbara E'; Nelson, Miriam; 'Perez-Escamilla, Rafael'; 'Neuhouser, Marian L'; 'Siega-riz, Anna Maria'; Mary
Story, Ph.D.; Lichtenstein, Alice
Cc: Olson, Richard (HHS/OASH); 'Colette Rihane'; 'Essery, Eve - CNPP'; Britten, Patricia - CNPP; Piercy, Katrina
(HHS/OASH); Rahavi, Elizabeth - CNPP; De Jesus, Janet M (NIH/NHLBI) [E]; Anne Rodgers
Subject: RE: a few more edits: CONFIDENTIAL: Draft Semi-Final 2015 DGAC Report- DGAC Chairs

Anne and I met this morning, and the issues are resolving as discussed in the public meeting. Thus, I would recommend
that we follow the pre‐established protocol and have Barbara and Alice sign off on final changes. Your DGMT leads have
been involved in every edit that involves your SC and will be in the loop to the very end. So you should feel quite
confident that they are in good hands. We will of course be in touch with any chair (or other members) if we (or Barbara
or Alice) have any questions or feel something was not clearly resolved.

When Anne has merged and addressed the comments to the extent she can, she will send the Executive Summary and
ALL of the other sections of the DGAC Report to me. I will review the edits and prepare a summary for Barbara and Alice.
The tracked changes and the summary will go to Barbara and Alice for final sign‐off on behalf of the DGAC. In this step
they approve that the edits made do in fact reflect the decisions made at the final meeting and that no other changes
have been made that do not reflect the decisions of the full DGAC. I will then move the files into their final form,
complete the remaining administrative work on them, and HHS and USDA will prepare for the dual submission to the
Secretaries.

237
PSC-HHS-000237
Please let me know if you have any questions or if there are any issues that you are concerned about.

Thanks,

Kellie


To: Anne Rodgers; De Jesus, Janet M (NIH/NHLBI) [E]; 'Nelson, Miriam'; 'Perez-Escamilla, Rafael'; 'Neuhouser, Marian L';
Casavale, Kellie (OS/OASH); 'Siega-riz, Anna Maria'; Mary Story, Ph.D.
Cc: 'Lichtenstein, Alice'; Olson, Richard (HHS/OASH); 'Colette Rihane'; 'Essery, Eve - CNPP'

Anne,

When you have merged and addressed the comments to the extent you can, will you be circulating it back to Alice and
me. What about others? Barbara

bmillen@bu.edu

To: Anne Rodgers; 'De Jesus, Janet M (NIH/NHLBI) [E]'; 'Nelson, Miriam'; 'Perez-Escamilla, Rafael'; 'Neuhouser, Marian
L'; 'Casavale, Kellie (OS/OASH)'; 'Siega-riz, Anna Maria'
Cc: Millen, Barbara E; 'Lichtenstein, Alice'; 'Olson, Richard (HHS/OASH)'; 'Colette Rihane'; 'Essery, Eve - CNPP'
Subject: Re: a few more edits: CONFIDENTIAL: Draft Semi-Final 2015 DGAC Report- DGAC Chairs

Hi
I had not completed my comments for the Executive Summary. I made these additional changes on the version that
Rafael had sent this morning. He used the version I had sent yesterday morning.
Mary

Date: Wednesday, December 17, 2014 9:35 AM
To: "'De Jesus, Janet M (NIH/NHLBI) [E]'" <dejesusjm@nhlbi.nih.gov>, "'Nelson, Miriam'" <Miriam.Nelson@tufts.edu>,
"Rafael Pérez‐Escamilla, PhD, MS" <rafael.perez‐escamilla@yale.edu>, Mary Story <mary.story@duke.edu>,
"'Neuhouser, Marian L'" <mneuhous@fredhutch.org>, "'Casavale, Kellie (OS/OASH)'" <Kellie.Casavale@hhs.gov>,
"'Siega‐riz, Anna Maria'" <am siegariz@unc.edu>
Cc: "'Barbara Millen, DrPH, MPH, RD'" <bmillen@bu.edu>, "'Lichtenstein, Alice'" <Alice.Lichtenstein@tufts.edu>,
"'Olson, Richard (HHS/OASH)'" <Richard.Olson@hhs.gov>, 'Colette Rihane' <colette.rihane@cnpp.usda.gov>, "'Essery,
Eve ‐ CNPP'" <Eve.Essery@fns.usda.gov>
Subject: RE: a few more edits: CONFIDENTIAL: Draft Semi‐Final 2015 DGAC Report‐ DGAC Chairs

Thanks Janet.

I’ll incorporate this information.

238
PSC-HHS-000238
Anne

Anne Brown Rodgers
Science Writer
(b) (6)

To: Anne Rodgers; 'Nelson, Miriam'; 'Perez-Escamilla, Rafael'; 'Mary Story, Ph.D.'; 'Neuhouser, Marian L'; Casavale, Kellie
(OS/OASH); 'Siega-riz, Anna Maria'
Cc: 'Millen, Barbara E'; 'Lichtenstein, Alice'; Olson, Richard (HHS/OASH); 'Colette Rihane'; 'Essery, Eve - CNPP'

Hi Anne and Mim,

The following text should clarify the comments for SC 5.

p.8, line 242. The text from the SC 5 chapter that can be incorporated: “However, it should be noted that coffee as it is
normally consumed can contain added calories from cream, milk, and added sugars. Care should be taken to minimize
these caloric additions."

p.8, line 336
High caffeine in the SC 5 chapter is defined as “(>400 mg/day for adults; undetermined for children and adolescents)”

Best,
Janet

Janet M.de Jesus, M.S., R.D.
Bethesda, MD 20817
301-496-5344

To: 'Nelson, Miriam'; 'Perez-Escamilla, Rafael'; 'Mary Story, Ph.D.'; 'Neuhouser, Marian L'; Casavale, Kellie (OS/OASH);
'Siega-riz, Anna Maria'
Cc: 'Millen, Barbara E'; 'Lichtenstein, Alice'; Olson, Richard (HHS/OASH); 'Colette Rihane'; 'Essery, Eve - CNPP'; De Jesus,

Thanks, Mim.

Janet, can you send me the answers to Mim’s questions and I’ll add them to the compiled draft? Thanks.
239
PSC-HHS-000239

Anne

Anne Brown Rodgers
Science Writer
(b) (6)

From: Nelson, Miriam [mailto:Miriam.Nelson@tufts.edu]
To: Perez-Escamilla, Rafael; Mary Story, Ph.D.; Neuhouser, Marian L; Casavale, Kellie (OS/OASH); 'Siega-riz, Anna Maria'
Cc: 'Millen, Barbara E'; Lichtenstein, Alice; Anne Rodgers; Olson, Richard (HHS/OASH); Colette Rihane; 'Essery, Eve -
CNPP'
Subject: a few more edits: CONFIDENTIAL: Draft Semi-Final 2015 DGAC Report- DGAC Chairs

Anne, Kellie and Janet,
Here are my edits on top of everyone else's. Janet, I also have two quick questions in the margins regarding accuracy.
Many thanks! Mim

Lincoln Filene Hall
Tufts University
Medford, MA 02155
Phone: 617‐627‐4178
Fax: 617‐627‐3401
www.StrongWomen.org
www.ChildObesity180.org
From: Perez-Escamilla, Rafael [rafael.perez-escamilla@yale.edu]

To: Mary Story, Ph.D.; Neuhouser, Marian L; Casavale, Kellie (OS/OASH); Nelson, Miriam; 'Siega-riz, Anna Maria'
CNPP'
Subject: RE: CONFIDENTIAL: Draft Semi-Final 2015 DGAC Report- DGAC Chairs
I have added my comments to Mary's version:
lines 80, 112, 148, 166, 174 and 368.
best,
Rafael Perez-Escamilla, PhD

Professor of Epidemiology & Public Health
Department of Chronic Disease Epidemiology
Director, Office of Public Health Practice
Director, Global Health Concentration
Yale School of Public Health
240
PSC-HHS-000240
135 College Street, Suite 200 (room 216)
New Haven CT 06510
email: rafael.perez-escamilla@yale.edu
phone: (203) 737-5882
fax: (203) 737-4591
IOM Food and Nutrition Board member
President, International Society for Research in Human Milk and Lactation (ISRHML)
From: Mary Story, Ph.D. [mary.story@duke.edu]

Sent: Tuesday, December 16, 2014 11:47 AM
To: Neuhouser, Marian L; Casavale, Kellie (OS/OASH); Perez-Escamilla, Rafael; 'Miriam (Mim) E. Nelson, PhD, MS';
Cc: 'Millen, Barbara E'; 'Lichtenstein, Alice'; Anne Rodgers; Olson, Richard (HHS/OASH); Colette Rihane; 'Essery, Eve -
CNPP'
Subject: Re: CONFIDENTIAL: Draft Semi-Final 2015 DGAC Report- DGAC Chairs
A few comments added. Please see comment on page 2 about added sugars.

Date: Tuesday, December 16, 2014 9:51 AM
To: "Casavale, Kellie (OS/OASH)" <Kellie.Casavale@hhs.gov>, "Rafael Pérez‐Escamilla, PhD, MS" <rafael.perez‐
escamilla@yale.edu[mailto]>, "'Miriam (Mim) E. Nelson, PhD, MS'" <miriam.nelson@tufts.edu[mailto]>, "'Siega‐riz, Anna
Maria'" <am siegariz@unc.edu[mailto]>, Mary Story <mary.story@duke.edu[mailto]>
Cc: "'Barbara Millen, DrPH, MPH, RD'" <bmillen@bu.edu[mailto]>, "'Lichtenstein, Alice'"
<Alice.Lichtenstein@tufts.edu[mailto]>, Anne Rodgers <abrodgers@verizon.net>, "Olson, Richard (HHS/OASH)"
<Richard.Olson@hhs.gov>, Colette Rihane <colette.rihane@cnpp.usda.gov>, "'Essery, Eve ‐ CNPP'"
<Eve.Essery@fns.usda.gov>
Subject: RE: CONFIDENTIAL: Draft Semi‐Final 2015 DGAC Report‐ DGAC Chairs

There were a few places where I tried to answer some of Alice's questions and also made a few other minor suggestions.
Marian
From: Casavale, Kellie (OS/OASH) [Kellie.Casavale@hhs.gov]

To: 'Rafael Pérez-Escamilla, PhD, MS'; 'Miriam (Mim) E. Nelson, PhD, MS'; Neuhouser, Marian L; 'Siega-riz, Anna Maria';
'Mary Story, Ph.D.'
CNPP'
Subject: FW: CONFIDENTIAL: Draft Semi-Final 2015 DGAC Report- DGAC Chairs
SC Chairs,

Barbara and Alice asked me to share the attached comments from Alice on the Executive Summary and the e‐mail from
Barbara below. Barbara suggests accepting Alice’s suggestions, but they request your input on the one noted below.
Please reply to all.

Thanks,

Kellie

241
PSC-HHS-000241

I agree with all of Alice’s comments except 16. I believe that the RCTs examined in the literature reviews were testing
protocols that could be standardized in healthcare and public health settings and scaled up. It was important to
standardize and test the counseling and multi‐disciplinary activities against ‘usual care’ (in many case) to determine their
effectiveness. A problem in clinical practice these days is the lack of service availability and, where available, no
consistency in its provision. I advocate keeping the paragraph and perhaps stating something about scaling it. Note to
that many of the protocols used graduate assistants (professionals in training) which would further add to cost
efficiencies in practice if interns and others could be trained to participate.

Looking forward to seeing the revisions of the Introduction, Exec. Summary and Integration chapters as well as the
(hopefully) few tweaks that remain from the cross‐reviews and/or meeting recommendations saturated fat, etc.).

Barbara

PS I slept a little later for me this morning!


From: Lichtenstein, Alice [mailto:Alice.Lichtenstein@tufts.edu[mailto]]
To: Olson, Richard (HHS/OASH); Anna Maria Siega-Riz, PhD, MS, RD (am siegariz@unc.edu[mailto]); Barbara Millen,
DrPH, MPH, RD (bmillen@bu.edu[mailto]); Marian Neuhouser, PhD, RD (mneuhous@fhcrc.org); Mary Story, PhD, MS, RD;
Rafel Perez-Escamilla (b) (6) Nelson, Miriam
Cc: Casavale, Kellie (OS/OASH); Rihane, Colette; Essery, Eve - CNPP (Eve.Essery@fns.usda.gov); Bowman, Shanthy;
'amfiguer@email.unc.edu[mailto]'; Bailey, Lauren A.; 'jconnor@fhcrc.org'; 'anjuli.bodyk@yale.edu[mailto]';
(b) (6)

Comments on exec summary.

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127
e‐mail: Alice.Lichtenstein@Tufts.edu[mailto]

From: Olson, Richard (HHS/OASH) [mailto:Richard.Olson@hhs.gov]
To: Lichtenstein, Alice; Anna Maria Siega-Riz, PhD, MS, RD (am siegariz@unc.edu[mailto]); Barbara Millen, DrPH, MPH,
RD (bmillen@bu.edu[mailto]); Marian Neuhouser, PhD, RD (mneuhous@fhcrc.org); Mary Story, PhD, MS, RD; Rafel
Perez-Escamilla (b) (6) Nelson, Miriam
242
PSC-HHS-000242
(b) (6)
Subject: CONFIDENTIAL: Draft Semi-Final 2015 DGAC Report- DGAC Chairs

DGAC members,

What a journey you have made. I am delighted to be sending you the complete semi‐final draft of the 2015 DGAC
Report. There are a number of important details outlined below.
∙ CONFIDENTIAL‐ These are internal and confidential documents. It is essential to the integrity of your work that
colleagues and the public in general have equal access; thus, please treat these files as highly sensitive and
confidential.
∙ REVIEW‐ The cross‐review of the DGAC report was very successful. Thank you for your thoughtful and timely
input to your colleagues. To that end, you have thoroughly reviewed the chapters for the groups on which you
serve and for the chapter(s) you cross‐reviewed. In the files attached please pay special attention to:
o Part A. Executive Summary ‐ You have not yet reviewed this chapter. It primarily provides content from
your other chapters; however, please pay particular attention to the sections that relate to your
subcommittee(s) or working group(s).
o Part B.1 Introduction – You have not yet reviewed this chapter. It describes the work of each group and
includes the conceptual model and its supplementary table (which you have reviewed).
o Part B.2 Integration‐ This chapter was sent to you preliminarily Monday. Those comments were
addressed, as possible. Please review this chapter and provide comments if needed.
o Part C. Methodology‐ This chapter was cross‐reviewed; however, please provide comments if you have
them.
o Part D. Science Base‐ Please review any chapters you did not co‐author or cross‐review if possible.
o Appendices you may need to review include
 APPENDIX E‐1: Needs for Future Research (a compiled list of all research recommendations from
your Science Base chapters)
 APPENDIX E‐2: Glossary of Terms
o Comments from any additional review you do will be the focus of the discussion on your SRSC call this
Friday, Dec. 12th from 9:45 am – 11 am.
o Please provide comments (to Anne and cc Kellie) before Monday, December 15th or discuss those
changes with your Committee in the public meeting. A copy of this draft report will be provided for
each of you at the meeting. If you would like to write edits directly on pages during the meeting,
initial that page and leave it behind with staff who will give them to Kellie to compile. We will recycle
these reports after the meeting (and are reusing notebooks to temporarily house them).

What’s next?! After the DGAC meeting Monday:
∙ Working with the staff and you as needed, Kellie will incorporate the changes the Committee agreed to as a
group at the public meeting and document them. Barbara and Alice will sign‐off on those final changes on behalf
of the full Committee.
∙ Barbara will draft a “Letter to the Secretaries” as the cover letter for your report.
∙ Staff will complete any final formatting and prepare the final report for submission to the Secretaries.
∙ When the report is submitted to the Secretaries (goal first week of January), we will notify you. At that time the
DGAC disbands. However, please refrain from participating in interviews or presentations on the DGAC Report
until it is posted on DietaryGuidelines.gov for the public (goal end of January, about 3 weeks to format for the
internet).
∙ We will coordinate an “administrative” conference call with you early in the new year to describe the activities
in 2015 and answer any questions you have.

Please let us know if you have any questions. We look forward to seeing you together as a group one last time on
Monday. It will be bittersweet to both see this work come to fruition but be on the verge of the conclusion of working so
243
PSC-HHS-000243
closely with you every day. Thank you again for your commitment to this work, not only in these last days, but over the
last year and a half!

Rick

244
PSC-HHS-000244

To: Anne Rodgers; De Jesus, Janet M (NIH/NHLBI) [E]; 'Nelson, Miriam'; 'Perez-Escamilla,
Rafael'; 'Neuhouser, Marian L'; Casavale, Kellie (OS/OASH); 'Siega-riz, Anna Maria'; Mary
Story, Ph.D.
Cc: 'Lichtenstein, Alice'; Olson, Richard (HHS/OASH); 'Colette Rihane'; 'Essery, Eve - CNPP'
Subject: RE: a few more edits: CONFIDENTIAL: Draft Semi-Final 2015 DGAC Report- DGAC
Chairs
Anne,

When you have merged and addressed the comments to the extent you can, will you be circulating it back to Alice and
me. What about others? Barbara

bmillen@bu.edu

To: Anne Rodgers; 'De Jesus, Janet M (NIH/NHLBI) [E]'; 'Nelson, Miriam'; 'Perez-Escamilla, Rafael'; 'Neuhouser, Marian
L'; 'Casavale, Kellie (OS/OASH)'; 'Siega-riz, Anna Maria'
Cc: Millen, Barbara E; 'Lichtenstein, Alice'; 'Olson, Richard (HHS/OASH)'; 'Colette Rihane'; 'Essery, Eve - CNPP'

Hi
Mary


Thanks Janet.


Anne

Anne Brown Rodgers
Science Writer
245
PSC-HHS-000245
(b) (6)


Hi Anne and Mim,



p.8, line 336

Best,
Janet

Bethesda, MD 20817
301-496-5344


Thanks, Mim.


Anne

Anne Brown Rodgers
246
PSC-HHS-000246
Science Writer
(b) (6)

CNPP'

Many thanks! Mim

Lincoln Filene Hall
Tufts University
Medford, MA 02155
Phone: 617‐627‐4178
Fax: 617‐627‐3401
www.StrongWomen.org

CNPP'
lines 80, 112, 148, 166, 174 and 368.
best,

New Haven CT 06510
phone: (203) 737-5882
247
PSC-HHS-000247
fax: (203) 737-4591

CNPP'

<Alice.Lichtenstein@tufts.edu[mailto]>, Anne Rodgers (b) (6) "Olson, Richard (HHS/OASH)"

Marian

'Mary Story, Ph.D.'
CNPP'
SC Chairs,


Thanks,

Kellie


248
PSC-HHS-000248


Barbara



(b) (6)


‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

(b) (6)

249
PSC-HHS-000249
DGAC members,

confidential.
them.

internet).


Rick

250
PSC-HHS-000250

251
PSC-HHS-000251

To: Nelson, Miriam; Neuhouser, Marian L; Mary Story, Ph.D.; Anne Rodgers; De Jesus, Janet
M (NIH/NHLBI) [E]; 'Perez-Escamilla, Rafael'; Casavale, Kellie (OS/OASH); 'Siega-riz,
Anna Maria'; Tom Brenna
Cc: Lichtenstein, Alice; Olson, Richard (HHS/OASH); 'Colette Rihane'; 'Essery, Eve - CNPP';
Griffin, Timothy; mhamm@anr.msu.edu
Subject: RE: Regarding fish...: Draft Semi-Final 2015 DGAC Report- DGAC Chairs
I concur as well. Barbara

bmillen@bu.edu

To: Neuhouser, Marian L; Mary Story, Ph.D.; Anne Rodgers; 'De Jesus, Janet M (NIH/NHLBI) [E]'; 'Perez-Escamilla,
Rafael'; 'Casavale, Kellie (OS/OASH)'; 'Siega-riz, Anna Maria'; Tom Brenna
Cc: Millen, Barbara E; Lichtenstein, Alice; 'Olson, Richard (HHS/OASH)'; 'Colette Rihane'; 'Essery, Eve - CNPP'; Griffin,
Timothy; mhamm@anr.msu.edu
Subject: Regarding fish...: Draft Semi-Final 2015 DGAC Report- DGAC Chairs

Tom provided a response to Marian's question that I thought others might be interested in (and I concur).
Best, Mim
Response:
Mim, Marian,

It is a correct and important point for sure but I think it is covered, or at least that was our intention.

We do acknowledge that programs are in place to stabilize and make sustainable fisheries, emerging for instance from
the Magnuson Act. At least as relevant is the closing of the South American anchovy fishery early this year, which has
caused a substantial disruption in fish oil supplies but is intended to preserve the fishery. All fisheries change season to
season, a reason why they are monitored and reported upon every year and next year is no different in that regard.

The newspaper article is about a particular fishery off the coast of Alaska. Our comment is a general matter about all
fisheries supported by the plot showed Monday that the global wild catch plateaued in 1990 and has been stable; that
plot implies that fisheries go up and down but on average are stable.

Chapter 5, lines 570-577: "Currently, seafood production is in the midst of rapid expansion to meet growing worldwide
demand, but the collapse of some fisheries due to overfishing in past decades raises concerns about the ability to produce
safe and affordable seafood to supply the U.S. population and meet current dietary intake recommendations of at least 8
ounces per week.20, 56. Capture fisheries (wild caught) production has leveled-off as a proportion of fully exploited
stocks, and this is due in part to national and international efforts to fish sustainably (e.g., the U.S. Magnuson-Stevens
Fishery Conservation and Management Act (2006) mandating annual catch limits, managed by the U.S. National
Oceanographic and Atmospheric Administration)."

I honestly think this covers it, and will be pleased to look at language to be added if thought useful based on this
newspaper article.

Cheers,

252
PSC-HHS-000252
Tom

Lincoln Filene Hall
Tufts University
Medford, MA 02155
Phone: 617-627-4178
Fax: 617-627-3401
www.StrongWomen.org
From: Neuhouser, Marian L [mneuhous@fredhutch.org]

To: Mary Story, Ph.D.; Anne Rodgers; 'De Jesus, Janet M (NIH/NHLBI) [E]'; Nelson, Miriam; 'Perez-Escamilla, Rafael';
'Casavale, Kellie (OS/OASH)'; 'Siega-riz, Anna Maria'
Cc: 'Millen, Barbara E'; Lichtenstein, Alice; 'Olson, Richard (HHS/OASH)'; 'Colette Rihane'; 'Essery, Eve - CNPP'
I noticed some questions about the statement re: the wild caught fisheries being “fully exploited. Here is some new
information that was published today. The information here would not be consistent with a statement that the wild
caught fisheries are exploited or depleted

http://seattletimes.com/html/localnews/2025250190 bristolbayxml.html

Marian L. Neuhouser, PhD, RD
Cancer Prevention Program
Fred Hutchinson Cancer Research Center
1100 Fairview Avenue North, M4B402
Seattle, WA 98109-1024
Tel: 206-667-4797
Fax: 206-667-7850
Email: mneuhous@fredhutch.org

To: Anne Rodgers; 'De Jesus, Janet M (NIH/NHLBI) [E]'; 'Nelson, Miriam'; 'Perez-Escamilla, Rafael'; Neuhouser, Marian L;
'Casavale, Kellie (OS/OASH)'; 'Siega-riz, Anna Maria'
Cc: 'Millen, Barbara E'; 'Lichtenstein, Alice'; 'Olson, Richard (HHS/OASH)'; 'Colette Rihane'; 'Essery, Eve - CNPP'

Hi
Mary

253
PSC-HHS-000253

Thanks Janet.


Anne

Anne Brown Rodgers
Science Writer
(b) (6)


Hi Anne and Mim,



p.8, line 336

Best,
Janet

Bethesda, MD 20817
301-496-5344

254
PSC-HHS-000254


Thanks, Mim.


Anne

Anne Brown Rodgers
Science Writer
(b) (6)

CNPP'

Many thanks! Mim

Lincoln Filene Hall
Tufts University
Medford, MA 02155
Phone: 617‐627‐4178
Fax: 617‐627‐3401
www.StrongWomen.org

CNPP'
255
PSC-HHS-000255
lines 80, 112, 148, 166, 174 and 368.
best,

New Haven CT 06510
phone: (203) 737-5882
fax: (203) 737-4591

CNPP'

<Alice.Lichtenstein@tufts.edu[mailto]>, Anne Rodgers (b) (6) "Olson, Richard (HHS/OASH)"

Marian

'Mary Story, Ph.D.'
CNPP'
SC Chairs,
256
PSC-HHS-000256


Thanks,

Kellie




Barbara



(b) (6)


‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
257
PSC-HHS-000257
Boston, MA 02111

phone: 617 556 3127

(b) (6)

DGAC members,

confidential.
them.

258
PSC-HHS-000258
internet).


Rick

259
PSC-HHS-000259

To: Siega-riz, Anna Maria; Neuhouser, Marian L; Casavale, Kellie (OS/OASH); 'Rafael Pérez-
Escamilla, PhD, MS'; Nelson, Miriam; 'Mary Story, Ph.D.'
Cc: 'Millen, Barbara E'; Anne Rodgers; Olson, Richard (HHS/OASH); Colette Rihane; 'Essery,
Eve - CNPP'
Anna Maria, do they specify white potatoes? If so, we should add the word white, if not, the text
should stay as written.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127
From: Siega-riz, Anna Maria [mailto:am_siegariz@unc.edu]

To: Neuhouser, Marian L; Casavale, Kellie (OS/OASH); 'Rafael Pérez-Escamilla, PhD, MS'; Nelson, Miriam; 'Mary Story,
Ph.D.'
CNPP'

I have read over Alice’s edits and questions along with Miriam’s reposes. The only addition is that in regards to FFQs and
potatoes what I have seen is that the FFQs ask about fried potatoes separately from boiled or mashed potatoes. The
fried are then excluded from the vegetable category.
Anna Maria Siega‐Riz, PhD
and
Phone: 919‐966‐5984 (Epi) or 919‐962‐6120 (CPC) new as of 6/18/14;

Date: Tuesday, December 16, 2014 at 9:51 AM
260
PSC-HHS-000260
To: Kellie Casavale <Kellie.Casavale@hhs.gov>, Rafael Perez‐Escamilla <rafael.perez‐escamilla@yale.edu>, "'Miriam
(Mim) E. Nelson" <miriam.nelson@tufts.edu>, Anna Siega‐Riz <am siegariz@unc.edu>, 'Mary Story
<mary.story@duke.edu>
Cc: DrPH Barbara Millen <bmillen@bu.edu>, Alice Lichtenstein <Alice.Lichtenstein@tufts.edu>, Anne Rodgers
(b) (6) Richard Olson <Richard.Olson@hhs.gov>, Colette Rihane <Colette.Rihane@cnpp.usda.gov>,
Eve Essery <Eve.Essery@fns.usda.gov>

Marian

'Mary Story, Ph.D.'
CNPP'
SC Chairs,


Thanks,

Kellie




Barbara

261
PSC-HHS-000261


To: Olson, Richard (HHS/OASH); Anna Maria Siega-Riz, PhD, MS, RD (am siegariz@unc.edu); Barbara Millen, DrPH, MPH,
RD (bmillen@bu.edu); Marian Neuhouser, PhD, RD (mneuhous@fhcrc.org); Mary Story, PhD, MS, RD; Rafel Perez-
Escamilla (b) (6) Nelson, Miriam
'amfiguer@email.unc.edu'; Bailey, Lauren A.; 'jconnor@fhcrc.org'; 'anjuli.bodyk@yale.edu'; (b) (6)


‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

To: Lichtenstein, Alice; Anna Maria Siega-Riz, PhD, MS, RD (am siegariz@unc.edu); Barbara Millen, DrPH, MPH, RD
(bmillen@bu.edu); Marian Neuhouser, PhD, RD (mneuhous@fhcrc.org); Mary Story, PhD, MS, RD; Rafel Perez-Escamilla
(b) (6) Nelson, Miriam

DGAC members,

confidential.
262
PSC-HHS-000262
them.

internet).


Rick

263
PSC-HHS-000263

To: Neuhouser, Marian L; Casavale, Kellie (OS/OASH); 'Rafael Pérez-Escamilla, PhD, MS';
Nelson, Miriam; 'Siega-riz, Anna Maria'; 'Mary Story, Ph.D.'
Cc: 'Millen, Barbara E'; Anne Rodgers; Olson, Richard (HHS/OASH); Colette Rihane; 'Essery,
Eve - CNPP'
Agree with wording changes and need to clarification regarding potatoes. I should have included a
question mark after white.
Thanks for the quick review Marian.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

To: Casavale, Kellie (OS/OASH); 'Rafael Pérez-Escamilla, PhD, MS'; Nelson, Miriam; 'Siega-riz, Anna Maria'; 'Mary Story,
Ph.D.'
CNPP'

Marian

'Mary Story, Ph.D.'
CNPP'
SC Chairs,

264
PSC-HHS-000264

Thanks,

Kellie




Barbara



To: Olson, Richard (HHS/OASH); Anna Maria Siega-Riz, PhD, MS, RD (am_siegariz@unc.edu); Barbara Millen, DrPH, MPH,
RD (bmillen@bu.edu); Marian Neuhouser, PhD, RD (mneuhous@fhcrc.org); Mary Story, PhD, MS, RD; Rafel Perez-


‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127
265
PSC-HHS-000265


DGAC members,

 CONFIDENTIAL‐ These are internal and confidential documents. It is essential to the integrity of your work that
confidential.
 REVIEW‐ The cross‐review of the DGAC report was very successful. Thank you for your thoughtful and timely
them.

 Working with the staff and you as needed, Kellie will incorporate the changes the Committee agreed to as a
 Barbara will draft a “Letter to the Secretaries” as the cover letter for your report.
 Staff will complete any final formatting and prepare the final report for submission to the Secretaries.
 When the report is submitted to the Secretaries (goal first week of January), we will notify you. At that time the
internet).
266
PSC-HHS-000266
 We will coordinate an “administrative” conference call with you early in the new year to describe the activities


Rick

267
PSC-HHS-000267

To: Millen, Barbara E; Olson, Richard (HHS/OASH); Anna Maria Siega-Riz, PhD, MS, RD
(am_siegariz@unc.edu); Marian Neuhouser, PhD, RD (mneuhous@fhcrc.org); Mary
Story, PhD, MS, RD; Rafel Perez-Escamilla (b) (6)
Nelson, Miriam
Cc: Casavale, Kellie (OS/OASH); Rihane, Colette; Essery, Eve - CNPP
(Eve.Essery@fns.usda.gov); Bowman, Shanthy; 'amfiguer@email.unc.edu'; Bailey, Lauren
A.; 'jconnor@fhcrc.org'; 'anjuli.bodyk@yale.edu'; (b) (6)
Agreed. When the studies were done as noted in the text from the AHA/ACC the emphasis was on
low fat diets. That is not consistent with recommendations since 2000.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

To: Lichtenstein, Alice; Olson, Richard (HHS/OASH); Anna Maria Siega-Riz, PhD, MS, RD (am_siegariz@unc.edu); Marian
Neuhouser, PhD, RD (mneuhous@fhcrc.org); Mary Story, PhD, MS, RD; Rafel Perez-Escamilla

The question is what to replace it with in support of the recommendations to remove emphasis on total fat, emphasize
replaced of SFA with PUFA, and deemphasize carbohydrates. As Marion noted at the meeting, the feeding studies don’t
provide evidence of dramatic differences in the effects of macronutrient replacements on TG and HDL.

Barbara

bmillen@bu.edu

To: Olson, Richard (HHS/OASH); Anna Maria Siega-Riz, PhD, MS, RD (am siegariz@unc.edu); Millen, Barbara E; Marian
268
PSC-HHS-000268

I reviewed the section in chapter 6 that Marian raised at the meeting. The material was taken directly
from the AHA/ACC report which is dated. In addition, the AHA/ACC report made their
recommendations specifically for people with elevated LDL-C and had a SFA recommendation of 5-
6%E. Given the inconsistency with our report and the different population of interest I am suggesting
we delete the material from the AHA/ACC report for dietary SFA as I publically stated at our meeting
yesterday.

Looking forward to hearing other comments on the issue.

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

To: Lichtenstein, Alice; Anna Maria Siega-Riz, PhD, MS, RD (am_siegariz@unc.edu); Barbara Millen, DrPH, MPH, RD

DGAC members,

confidential.
them.
269
PSC-HHS-000269

internet).


Rick

270
PSC-HHS-000270

To: Lichtenstein, Alice; Olson, Richard (HHS/OASH); Anna Maria Siega-Riz, PhD, MS, RD
(am_siegariz@unc.edu); Marian Neuhouser, PhD, RD (mneuhous@fhcrc.org); Mary
Story, PhD, MS, RD; Rafel Perez-Escamilla (b) (6)
Nelson, Miriam
The question is what to replace it with in support of the recommendations to remove emphasis on total fat, emphasize
replaced of SFA with PUFA, and deemphasize carbohydrates. As Marion noted at the meeting, the feeding studies don’t
provide evidence of dramatic differences in the effects of macronutrient replacements on TG and HDL.

Barbara

bmillen@bu.edu

To: Olson, Richard (HHS/OASH); Anna Maria Siega-Riz, PhD, MS, RD (am_siegariz@unc.edu); Millen, Barbara E; Marian

yesterday.


‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127
271
PSC-HHS-000271


DGAC members,

confidential.
them.

internet).
272
PSC-HHS-000272


Rick

273
PSC-HHS-000273

(Eve.Essery@fns.usda.gov); Bowman, Shanthy; (b) (6) Olson, Richard
(HHS/OASH)
Subject: RE: AHL Exec Summary Revisions
This e-mail should be distributed to the other SC leads and we should get additional input. I will go
with the majority sentiment.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

(b) (6) Olson, Richard (HHS/OASH)
Subject: AHL Exec Summary Revisions



Barbara


274
PSC-HHS-000274
bmillen@bu.edu

To: Olson, Richard (HHS/OASH); Anna Maria Siega-Riz, PhD, MS, RD (am siegariz@unc.edu); Millen, Barbara E; Marian


‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127


DGAC members,

confidential.
them.
275
PSC-HHS-000275

internet).


Rick

276
PSC-HHS-000276

To: Olson, Richard (HHS/OASH); Anna Maria Siega-Riz, PhD, MS, RD
(am_siegariz@unc.edu); Barbara Millen, DrPH, MPH, RD (bmillen@bu.edu); Marian
Neuhouser, PhD, RD (mneuhous@fhcrc.org); Mary Story, PhD, MS, RD; Rafel Perez-
Attachments: 11. Part D_Chapter 6 Cross-cutting Topics_SEMI-FINAL_12-10-14 AHL.docx
yesterday.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127


DGAC members,

confidential.
277
PSC-HHS-000277
them.

internet).


Rick

278
PSC-HHS-000278

(Eve.Essery@fns.usda.gov); Bowman, Shanthy; (b) (6) Olson, Richard
(HHS/OASH)
Subject: AHL Exec Summary Revisions


Barbara


bmillen@bu.edu

To: Olson, Richard (HHS/OASH); Anna Maria Siega-Riz, PhD, MS, RD (am_siegariz@unc.edu); Millen, Barbara E; Marian


‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127
279
PSC-HHS-000279


DGAC members,

confidential.
them.

internet).
280
PSC-HHS-000280


Rick

281
PSC-HHS-000281

To: Olson, Richard (HHS/OASH); Anna Maria Siega-Riz, PhD, MS, RD
(am_siegariz@unc.edu); Barbara Millen, DrPH, MPH, RD (bmillen@bu.edu); Marian
Neuhouser, PhD, RD (mneuhous@fhcrc.org); Mary Story, PhD, MS, RD; Rafel Perez-
Attachments: 02. Part A_Executive Summary_SEMI-FINAL_12-10-14 AHL.docx
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127


DGAC members,

confidential.
282
PSC-HHS-000282
them.

internet).


Rick

283
PSC-HHS-000283

Just got n. Will review the integration slides one more time when I'm settled and get them to you. Want to be sure the
points and my comments get as specific as possible. Want to address the concerns Alice has made many times , that we
don't just put platitudes but have actionable recommendations.

Barbara

Sent from my iPhone

On Dec 14, 2014, at 3:20 PM, "Casavale, Kellie (OS/OASH)" <Kellie.Casavale@hhs.gov> wrote:
Alice,

You should be able to edit the files. Perhaps you need to save it with a new name and then add them.
I've added Anne to this email string.

I've provided a few follow‐up notes below in case they are helpful as you put together your comments:

‐Regarding food safety, I agree that food safety in terms of the Dietary Guidelines typically means food
safety for the prevention of foodborne illness. However, SC 5 did address this topic comprehensively.
They pulled forward all of the tables from the 2010 DGAC report and then updated them based on
federal food safety policy advancements of FSIS and CFSAN since 2010.

‐Regarding unintended consequences of added sugars, SC5 only addressed aspartame and primarily
related to safety, but the added sugars working group built on that with a section on low‐calorie
sweeteners. So I think where they are addressed related to unintended consequences is mainly in the
cross cutting chapter and SC5 was thinking mostly about safety.
‐ SC5 also addressed contaminants in seafood (but not contaminants in the food supply broadly).

I'm not sure if I'm interpreting your comment correctly. If you feel the scope of SC5 is not described well
by the title of the chapter or the way it is set up within the report, perhaps you want to comment on
that.

I do want to email the DGMT leads and SC chairs this evening to give them an update on any comments
that have come in. Of course, folks might be planning to bring things up tomorrow that we may not be
aware of in advance. So far your comments and a few thoughts from Barbara are the only others
received (other than those from Wayne and Anna Maria earlier in the week).

Kellie

Sent from my iPhone

On Dec 14, 2014, at 1:46 PM, "Lichtenstein, Alice" <Alice.Lichtenstein@tufts.edu> wrote:
284
PSC-HHS-000284
I just spent a tremendous amount of time reviewing the executive
summary. I now find that although I intentionally saved the file I can’t
seem to have actually saved. I then did a test save and got the same
result. . Is that the intent of what was sent out, that it is not modifiable or
is there something I am doing wrong? There seems to be no way to
recover the file I worked on.

I only had one major concern that came up - .the chapter on sustainability
and food safety. As indicated before, we did not review food safety. We
reviewed caffeine and aspartame. The latter we state we did mainly
because we were concerned about an unintended consequence of
reducing added sugar. In the mind of the public and most of us food safety
refers to food borne illness and contaminants. I think in this case there is
no truth in the label and we are setting up expectations that will not be
met.

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

To: Lichtenstein, Alice; Anna Maria Siega-Riz, PhD, MS, RD (am siegariz@unc.edu);
Barbara Millen, DrPH, MPH, RD (bmillen@bu.edu); Marian Neuhouser, PhD, RD
(mneuhous@fhcrc.org); Mary Story, PhD, MS, RD; Rafel Perez-Escamilla
(Eve.Essery@fns.usda.gov); Bowman, Shanthy; 'amfiguer@email.unc.edu'; Bailey,
Lauren A.; 'jconnor@fhcrc.org'; 'anjuli.bodyk@yale.edu'; (b) (6)

DGAC members,

What a journey you have made. I am delighted to be sending you the complete semi‐
final draft of the 2015 DGAC Report. There are a number of important details outlined
below.
 CONFIDENTIAL‐ These are internal and confidential documents. It is essential to
the integrity of your work that colleagues and the public in general have equal
access; thus, please treat these files as highly sensitive and confidential.
 REVIEW‐ The cross‐review of the DGAC report was very successful. Thank you
for your thoughtful and timely input to your colleagues. To that end, you have
thoroughly reviewed the chapters for the groups on which you serve and for the
chapter(s) you cross‐reviewed. In the files attached please pay special attention
to:
285
PSC-HHS-000285
o Part A. Executive Summary ‐ You have not yet reviewed this chapter. It
primarily provides content from your other chapters; however, please
pay particular attention to the sections that relate to your
o Part B.1 Introduction – You have not yet reviewed this chapter. It
describes the work of each group and includes the conceptual model
and its supplementary table (which you have reviewed).
o Part B.2 Integration‐ This chapter was sent to you preliminarily
Monday. Those comments were addressed, as possible. Please review
this chapter and provide comments if needed.
o Part C. Methodology‐ This chapter was cross‐reviewed; however, please
provide comments if you have them.
o Part D. Science Base‐ Please review any chapters you did not co‐author
or cross‐review if possible.
 APPENDIX E‐1: Needs for Future Research (a compiled list of all
research recommendations from your Science Base chapters)
o Comments from any additional review you do will be the focus of the
discussion on your SRSC call this Friday, Dec. 12th from 9:45 am – 11
am.
o Please provide comments (to Anne and cc Kellie) before Monday,
December 15th or discuss those changes with your Committee in the
public meeting. A copy of this draft report will be provided for each of
you at the meeting. If you would like to write edits directly on pages
during the meeting, initial that page and leave it behind with staff who
will give them to Kellie to compile. We will recycle these reports after
the meeting (and are reusing notebooks to temporarily house them).

 Working with the staff and you as needed, Kellie will incorporate the changes
the Committee agreed to as a group at the public meeting and document them.
Barbara and Alice will sign‐off on those final changes on behalf of the full
Committee.
 Barbara will draft a “Letter to the Secretaries” as the cover letter for your
report.
 Staff will complete any final formatting and prepare the final report for
submission to the Secretaries.
 When the report is submitted to the Secretaries (goal first week of January), we
will notify you. At that time the DGAC disbands. However, please refrain from
participating in interviews or presentations on the DGAC Report until it is posted
on DietaryGuidelines.gov for the public (goal end of January, about 3 weeks to
format for the internet).
 We will coordinate an “administrative” conference call with you early in the
new year to describe the activities in 2015 and answer any questions you have.

Please let us know if you have any questions. We look forward to seeing you together as
a group one last time on Monday. It will be bittersweet to both see this work come to
fruition but be on the verge of the conclusion of working so closely with you every day.
Thank you again for your commitment to this work, not only in these last days, but over
the last year and a half!

286
PSC-HHS-000286
Rick

287
PSC-HHS-000287

Cc: Olson, Richard (HHS/OASH); Millen, Barbara E (bmillen@bu.edu); Anne Brown Rodgers
Thanks for your explanations. I will mention again about my concern that the title of SC5 can be open
to misinterpretation. However, before that I will review the chapter.
I tried saving the summary chapter until a new name, that worked. Unfortunately, lost all my
comments. Will try to recreate on while on the plane.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

Cc: Olson, Richard (HHS/OASH); Millen, Barbara E (bmillen@bu.edu); Anne Brown Rodgers

Alice,

You should be able to edit the files. Perhaps you need to save it with a new name and then add them. I've added Anne
to this email string.

I've provided a few follow‐up notes below in case they are helpful as you put together your comments:

‐Regarding food safety, I agree that food safety in terms of the Dietary Guidelines typically means food safety for the
prevention of foodborne illness. However, SC 5 did address this topic comprehensively. They pulled forward all of the
tables from the 2010 DGAC report and then updated them based on federal food safety policy advancements of FSIS and
CFSAN since 2010.

‐Regarding unintended consequences of added sugars, SC5 only addressed aspartame and primarily related to safety,
but the added sugars working group built on that with a section on low‐calorie sweeteners. So I think where they are
addressed related to unintended consequences is mainly in the cross cutting chapter and SC5 was thinking mostly about
safety.
‐ SC5 also addressed contaminants in seafood (but not contaminants in the food supply broadly).

288
PSC-HHS-000288
I'm not sure if I'm interpreting your comment correctly. If you feel the scope of SC5 is not described well by the title of
the chapter or the way it is set up within the report, perhaps you want to comment on that.

I do want to email the DGMT leads and SC chairs this evening to give them an update on any comments that have come
in. Of course, folks might be planning to bring things up tomorrow that we may not be aware of in advance. So far your
comments and a few thoughts from Barbara are the only others received (other than those from Wayne and Anna Maria
earlier in the week).

Kellie

Sent from my iPhone

On Dec 14, 2014, at 1:46 PM, "Lichtenstein, Alice" <Alice.Lichtenstein@tufts.edu> wrote:
I just spent a tremendous amount of time reviewing the executive summary. I now find
that although I intentionally saved the file I can’t seem to have actually saved. I then did
a test save and got the same result. . Is that the intent of what was sent out, that it is
not modifiable or is there something I am doing wrong? There seems to be no way to
recover the file I worked on.

I only had one major concern that came up - .the chapter on sustainability and food
safety. As indicated before, we did not review food safety. We reviewed caffeine and
aspartame. The latter we state we did mainly because we were concerned about an
unintended consequence of reducing added sugar. In the mind of the public and most of
us food safety refers to food borne illness and contaminants. I think in this case there is
no truth in the label and we are setting up expectations that will not be met.

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

To: Lichtenstein, Alice; Anna Maria Siega-Riz, PhD, MS, RD (am siegariz@unc.edu); Barbara Millen,
DrPH, MPH, RD (bmillen@bu.edu); Marian Neuhouser, PhD, RD (mneuhous@fhcrc.org); Mary Story, PhD,
MS, RD; Rafel Perez-Escamilla (b) (6) Nelson, Miriam
Cc: Casavale, Kellie (OS/OASH); Rihane, Colette; Essery, Eve - CNPP (Eve.Essery@fns.usda.gov);
Bowman, Shanthy; 'amfiguer@email.unc.edu'; Bailey, Lauren A.; 'jconnor@fhcrc.org';
'anjuli.bodyk@yale.edu'; (b) (6)

DGAC members,

289
PSC-HHS-000289
What a journey you have made. I am delighted to be sending you the complete semi‐final draft of the
2015 DGAC Report. There are a number of important details outlined below.
 CONFIDENTIAL‐ These are internal and confidential documents. It is essential to the integrity of
your work that colleagues and the public in general have equal access; thus, please treat these
files as highly sensitive and confidential.
 REVIEW‐ The cross‐review of the DGAC report was very successful. Thank you for your
thoughtful and timely input to your colleagues. To that end, you have thoroughly reviewed the
chapters for the groups on which you serve and for the chapter(s) you cross‐reviewed. In the
files attached please pay special attention to:
o Part A. Executive Summary ‐ You have not yet reviewed this chapter. It primarily
provides content from your other chapters; however, please pay particular attention to
the sections that relate to your subcommittee(s) or working group(s).
o Part B.1 Introduction – You have not yet reviewed this chapter. It describes the work of
each group and includes the conceptual model and its supplementary table (which you
have reviewed).
o Part B.2 Integration‐ This chapter was sent to you preliminarily Monday. Those
comments were addressed, as possible. Please review this chapter and provide
comments if needed.
o Part C. Methodology‐ This chapter was cross‐reviewed; however, please provide
comments if you have them.
o Part D. Science Base‐ Please review any chapters you did not co‐author or cross‐review
if possible.
 APPENDIX E‐1: Needs for Future Research (a compiled list of all research
recommendations from your Science Base chapters)
o Comments from any additional review you do will be the focus of the discussion on
your SRSC call this Friday, Dec. 12th from 9:45 am – 11 am.
o Please provide comments (to Anne and cc Kellie) before Monday, December 15th or
discuss those changes with your Committee in the public meeting. A copy of this draft
report will be provided for each of you at the meeting. If you would like to write edits
directly on pages during the meeting, initial that page and leave it behind with staff
who will give them to Kellie to compile. We will recycle these reports after the
meeting (and are reusing notebooks to temporarily house them).

 Working with the staff and you as needed, Kellie will incorporate the changes the Committee
agreed to as a group at the public meeting and document them. Barbara and Alice will sign‐off
on those final changes on behalf of the full Committee.
 Staff will complete any final formatting and prepare the final report for submission to the
Secretaries.
 When the report is submitted to the Secretaries (goal first week of January), we will notify you.
At that time the DGAC disbands. However, please refrain from participating in interviews or
presentations on the DGAC Report until it is posted on DietaryGuidelines.gov for the public (goal
end of January, about 3 weeks to format for the internet).
 We will coordinate an “administrative” conference call with you early in the new year to
describe the activities in 2015 and answer any questions you have.

Please let us know if you have any questions. We look forward to seeing you together as a group one
last time on Monday. It will be bittersweet to both see this work come to fruition but be on the verge of
290
PSC-HHS-000290
the conclusion of working so closely with you every day. Thank you again for your commitment to this
work, not only in these last days, but over the last year and a half!

Rick

291
PSC-HHS-000291

To: Olson, Richard (HHS/OASH); Casavale, Kellie (OS/OASH); Millen, Barbara E
(bmillen@bu.edu)
I just spent a tremendous amount of time reviewing the executive summary. I now find that although I
intentionally saved the file I can’t seem to have actually saved. I then did a test save and got the
same result. . Is that the intent of what was sent out, that it is not modifiable or is there something I
am doing wrong? There seems to be no way to recover the file I worked on.
I only had one major concern that came up - .the chapter on sustainability and food safety. As
indicated before, we did not review food safety. We reviewed caffeine and aspartame. The latter we
state we did mainly because we were concerned about an unintended consequence of reducing
added sugar. In the mind of the public and most of us food safety refers to food borne illness and
contaminants. I think in this case there is no truth in the label and we are setting up expectations that
will not be met.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127


DGAC members,

confidential.
292
PSC-HHS-000292
them.

internet).


Rick

293
PSC-HHS-000293

Sent: Monday, December 08, 2014 7:37 AM
Cc: Anne Rodgers; Casavale, Kellie (OS/OASH); Rihane, Colette - CNPP
Subject: RE: Barbara: Cross-cutting chapter
Attachments: Part D Ch 6_DRAFT_Edited+ABR+RPE+AHL+SA bem 12 8 2015.docx
Eve,

This is a wonderful, elegant chapter. I made a few editorial comments. One is that Alice has recommended we stay away
from the term nutrient dense. We have done so in the integration chapter. We may wish, as has been discussed, to
retain it in the SC and cross‐cutting chapters but I mention it in my comments. Also I did a slight rewording of the
saturated fat recommendation about substitutions. Since we didn’t look extensively at all forms of replacement, I
thought making it simpler was better. The chapter’s future research needs calls for additional research on determining
whether refined and non‐refined carbohydrates have similar effects on TG and other lipids or not. Finally, I thought the
conclusions were to retain the 2400 mg sodium recommendation but the summary has 2300. I know the literature is not
consistent on this topic but we ought to be consistent in the conclusions, implications and summary. Perhaps Cheryl and
you can take a look. Perhaps I misinterpreted this but it shouldn’t take long to check.

Many thanks again for your patience. BTW< the recommendations for action are wonderful and we may want to use
more of this chapter’s language in the integration chapter. Also, you address dental caries which at the moment is not
mentioned in the integration chapter. Anne may wish to make a place holder for it and also make a note that we ought
to try to strengthen the recommendations for individual and population‐level action with the wording as presented
here. Perhaps the workgroups members will make recomemndations in their reviews of the integration chapter today.

All the best,

Barbara

Barbara E. Millen
bmillen@bu.edu

Cc: Anne Rodgers; 'Kellie Casavale'; Rihane, Colette - CNPP
Subject: FW: Barbara: Cross-cutting chapter

Hi Barbara,
The cross-cutting chapter leads are ready to finalize the chapter once they receive your input. Can you let me know when
you might be able to review the chapter? Please review the attached version because it has everyone else’s comments in
one place.
THANK YOU!!
Eve

From: Essery, Eve - CNPP
294
PSC-HHS-000294
Cc: 'Anne Rodgers'; Casavale, Kellie (OS/OASH); Rihane, Colette - CNPP
Subject: Barbara: Cross-cutting chapter

Hi Barbara,
Attached is the edited version of the cross-cutting chapter with comments from Alice, Rafael, Steve A, and Anne
combined. If you have comments or edits, it would be great to add them to this file! Thanks so much!
Eve
Eve Essery Stoody, PhD

Nutritionist | Center for Nutrition Policy and Promotion | USDA
3101 Park Center Drive, Room 1034 | Alexandria, VA 22302
Eve.Essery@cnpp.usda.gov | Office: 703-305-2563 | Fax: 703-305-3300
www.DietaryGuidelines.gov | www.ChooseMyPlate.gov | www.NEL.gov

295
PSC-HHS-000295

Sent: Monday, December 08, 2014 6:25 AM
To: Anne Rodgers
Cc: Casavale, Kellie (OS/OASH); Braunstein, Nadine (OS/OASH); Eve.Essery@fns.usda.gov;
Nadinebraunstein@aol.com; alice.lichtenstein@tufts.edu
Subject: Revised Integration Chapter
Attachments: Integrated OVERARCHING THEMES and Recommendations with popultion added bem
12 6 2014 (5).docx
Hi everyone,

Attached is the revised integration chapter. I have included Essie’s new information on the chronic disease rates and
have tried to the best of my efforts to address Alice’s most recent comments and those of the DGAC and staff. I hope
the themes and recommendations are as clearly written and direct as possible. I tried to reach a balance between
brevity and enough specificity and to make the themes and recommendations as meaningful as possible and to avoid
rhetoric. I hope the balance meets with your approval.

I think the plan at this point is for Anne and Kellie to review the revisions and to put together as clean a document for
DGAC review as early today as possible. I think it still makes sense to ask for urgent turn around by EOB or late today. I
will be available to review compiled reactions and to help with any revisions before the entire report goes to the
committee tomorrow. When is the report going out tomorrow. Will we have time to compile comments from anyone
that asks for ‘grace’ until early tomorrow?

All the best,

Barbara
bmillen@bu.edu

To: Nadinebraunstein@aol.com; Millen, Barbara E
Cc: Kellie.Casavale@hhs.gov; Nadine.Braunstein@hhs.gov; Eve.Essery@fns.usda.gov
Subject: RE: Revised availability this weekend
Ok, thanks Nadine. I’m taking a break for a while now.

Anne Brown Rodgers
Science Writer
(b) (6)

From: (b) (6)
To: bmillen@bu.edu; (b) (6)
Cc: Kellie.Casavale@hhs.gov; Nadine.Braunstein@hhs.gov; Eve.Essery@fns.usda.gov
Subject: Re: Revised availability this weekend
296
PSC-HHS-000296
Thanks for your time this afternoon.
FYI - I have some additional changes that I planned to include that Barbara asked me to do beyond her version. I already
had the life course/life span change as well as the Healthy instead of optimal.
More later. I will work with Barbara's, Anne's and my updates.
Thanks to everyone!
Nadine
In a message dated 12/7/2014 6:23:40 P.M. Eastern Standard Time, bmillen@bu.edu writes:
Hi all,
Please go ahead and work with Nadine on the introduction I sent in my earlier email and get it out to the DGAC
as soon as possible. Let them know the integration chapter will come in a later email. Both will need to come
back by end of business tomorrow. If you prefer, we can send them both first thing in the morning and we can
take a bit of time in the morning to make final revisions. I have an early meeting at 8:15 and expect to get
things back to you later tonight. However, you may need time in the morning to make final edits and review
mine.
I have to head out now and will take the final revisions to integration chapter when I return later this evening. I
won’t be able to finish my review of the cross‐cutting chapter until then either. I have had so much to review
and work on this weekend, I have to take a break right now and resume when I can.
Sorry that I can’t marathon right thought it but I need to break.
Barbara
bmillen@bu.edu
From: Millen, Barbara E

To: 'Nadine'; Anne Rodgers
Cc: Casavale, Kellie (OS/OASH); Braunstein, Nadine (OS/OASH)
Nadine,
297
PSC-HHS-000297

Here is the copy we worked on. It includes the edits I made in response to Anne’s and Kellie’s revisions. Please
forward it and copy me when you’re done with your final edits.
Many thanks!
Barbara
bmillen@bu.edu
From: Nadine (b) (6)

To: Millen, Barbara E; Anne Rodgers
Hi Barbara!
8 am works for me! I have till about 9 am.
If Kellie and Anne will participate then perhaps Kellie can arrange a conference call line for us.
Thanks!
Nadine
Sent from my Verizon Wireless 4G LTE smartphone
-------- Original message --------

298
PSC-HHS-000298
From: "Millen, Barbara E"
Date:12/06/2014 5:29 PM (GMT-05:00)
To: Anne Rodgers
Cc: "Casavale, Kellie (OS/OASH)" ,Nadine ,"Braunstein, Nadine (OS/OASH)"
Prefer starting reasonably early, does 8 work for conceptual model. and them move on to the intro and
integration. Let me know and thanks mellow for alerting Alice if she's available. Barbara
Sent from my iPhone
On Dec 6, 2014, at 3:21 PM, "Anne Rodgers" (b) (6) wrote:
I’m an early riser as well. The whole day is free for me so I can meet anytime.
Anne Brown Rodgers
Science Writer
(b) (6)

Cc: 'Nadine'; Braunstein, Nadine (OS/OASH); Anne Rodgers
Barbara,
299
PSC-HHS-000299
I’ll be up by 7 am I’m sure as well. Here are some options, just let us know what works for you.(
I think Anne and I are both flexible all day.)
 We could start with the conceptual model first sometime before 8:45 am and then move on to
the others. Or discussion the others some other time Sunday, whenever you’d like. Nadine
doesn’t need to be on for Intro and Integration, although she is certainly welcome.
 We could discuss the Intro and Integration anytime you prefer and then the conceptual model
after 4 pm.
We can let Alice know the time we are meeting in case she wants to take a break from her
grant work.
Kellie

To: Braunstein, Nadine (OS/OASH); Millen, Barbara E
Subject: Revised availability this weekend
Hi again, Barbara!
My weekend plans have changed. I will be available tonight (Sat) after 5 pm. Tomorrow
I will be available after 4.
I know that you are a morning person. I could also do Sunday morning from 7-8:45.
300
PSC-HHS-000300
Thanks,
Nadine
From: "Braunstein, Nadine (OS/OASH)"
Date:12/05/2014 10:21 PM (GMT-05:00)
To: "Millen, Barbara E" ,(b) (6)
Cc: "Casavale, Kellie (OS/OASH)"
Subject: RE: introduction and Integration
Hi Barbara!
Sorry for the late reply. I was out of the office today. I won't be available till Saturday evening.
But Sunday is open most of the day (except around 3-4 pm).
Please let me know if you have any time on Sunday.
Looking forward to completing this part of the DGAC report with you.
If you 'reply all' I will get the info on my cell phone while I'm out on Saturday.
Thanks,
Nadine
301
PSC-HHS-000301
Cc: Casavale, Kellie (OS/OASH); Anne Rodgers; Braunstein, Nadine (OS/OASH)
Subject: introduction and Integration
HI Alice,
The big outstanding items from the morning SRSC call are the completion of the
introduction and integration chapters and the conceptual model. It was proposed that
you and I work over the weekend with Kellie and Anne to prepare the chapters in draft
and then circulate them on Monday to the DGAC with a very short turnaround deadline
so they can go out on Tuesday to the DGAC with the rest of the report. We want to be
sure we have covered the overarching themes and recommendations and resolved
outstanding issues from the previous reviews. I will work with Nadine if she’s available
to review things that remain on the conceptual model. Not sure if you have had the time
to review the revisions I did on the integration chapter but your input would be very
much appreciated.
Is there a time over the weekend that you have up to an hour to review the current draft
of the integration chapter and introduction. Both are attached for your review. The only
time I am definitely not available is noon or about 3 tomorrow.
Nadine, can you let me know your availability too?
Many thanks.
Barbara
bmillen@bu.edu

To: Anne Rodgers; 'Perez-Escamilla, Rafael'; 'Abrams, Steven A'; Millen, Barbara E;
frank.hu@channing.harvard.edu; Eve.Essery@cnpp.usda.gov
Cc: 'Casavale, Kellie (OS/OASH)'; Richard.Olson@hhs.gov; colette.rihane@cnpp.usda.gov;
302
PSC-HHS-000302
'Bodyk, Anjuli'; lhimes@bcm.edu; Bailey, Lauren A.; PBROWN@hsph.harvard.edu
Subject: RE: REVISED SATURATED FAT IMPLICATION FOR YOUR REVIEW
Looks fine to me, just one word change.
-------------------------------------------------------------------------------
Tufts University
Boston, MA 02111
phone: 617 556 3127

To: 'Perez-Escamilla, Rafael'; 'Abrams, Steven A'; 'Millen, Barbara E'; Lichtenstein, Alice;
Cc: 'Casavale, Kellie (OS/OASH)'; Richard.Olson@hhs.gov; colette.rihane@cnpp.usda.gov;
'Bodyk, Anjuli'; lhimes@bcm.edu; Bailey, Lauren A.; PBROWN@hsph.harvard.edu
Subject: REVISED SATURATED FAT IMPLICATION FOR YOUR REVIEW
All,
Based on very recent comments from Barbara and Alice, Frank has revised the saturated
fat implications statement. Please review this and send any comments to me and Kellie
by Friday, December 5.
303
PSC-HHS-000303
Thanks very much,
Anne
Anne Brown Rodgers
Science Writer
(b) (6)
304
PSC-HHS-000304

To: Nadine; Anne Rodgers
Attachments: Part B Chapter 1_Introduction_v3_12-7-14 bem NB edits 12 7 2014.doc
Nadine,

Here is the copy we worked on. It includes the edits I made in response to Anne’s and Kellie’s revisions. Please forward
it and copy me when you’re done with your final edits.

Many thanks!
Barbara
bmillen@bu.edu

Hi Barbara!
Thanks!
Nadine

Date:12/06/2014 5:29 PM (GMT-05:00)
To: Anne Rodgers
305
PSC-HHS-000305
Sent from my iPhone

Anne Brown Rodgers
Science Writer
(b) (6)

Barbara,

I’ll be up by 7 am I’m sure as well. Here are some options, just let us know what works for you.( I think
Anne and I are both flexible all day.)
after 4 pm.

We can let Alice know the time we are meeting in case she wants to take a break from her grant work.

Kellie


Hi again, Barbara!
My weekend plans have changed. I will be available tonight (Sat) after 5 pm. Tomorrow I will be
available after 4.
Thanks,
306
PSC-HHS-000306
Nadine

Date:12/05/2014 10:21 PM (GMT-05:00)
Hi Barbara!
Sorry for the late reply. I was out of the office today. I won't be available till Saturday evening. But
Sunday is open most of the day (except around 3-4 pm).
Thanks,
Nadine

HI Alice,
The big outstanding items from the morning SRSC call are the completion of the introduction
and integration chapters and the conceptual model. It was proposed that you and I work over the
weekend with Kellie and Anne to prepare the chapters in draft and then circulate them on
Monday to the DGAC with a very short turnaround deadline so they can go out on Tuesday to
the DGAC with the rest of the report. We want to be sure we have covered the overarching
themes and recommendations and resolved outstanding issues from the previous reviews. I will
work with Nadine if she’s available to review things that remain on the conceptual model. Not
sure if you have had the time to review the revisions I did on the integration chapter but your
input would be very much appreciated.
Is there a time over the weekend that you have up to an hour to review the current draft of the
integration chapter and introduction. Both are attached for your review. The only time I am
definitely not available is noon or about 3 tomorrow.
307
PSC-HHS-000307
Many thanks.
Barbara
bmillen@bu.edu

Cc: 'Casavale, Kellie (OS/OASH)'; Richard.Olson@hhs.gov; colette.rihane@cnpp.usda.gov; 'Bodyk, Anjuli';
lhimes@bcm.edu; Bailey, Lauren A.; PBROWN@hsph.harvard.edu
-------------------------------------------------------------------------------
Tufts University
Boston, MA 02111
phone: 617 556 3127

308
PSC-HHS-000308

All,
Based on very recent comments from Barbara and Alice, Frank has revised the saturated fat
implications statement. Please review this and send any comments to me and Kellie by Friday,
December 5.
Thanks very much,
Anne
Anne Brown Rodgers
Science Writer
(b) (6)
309
PSC-HHS-000309

To: Anne Rodgers; Casavale, Kellie (OS/OASH); 'Nadine'; 'Millen, Barbara E'
Cc: 'Colette Rihane'; Olson, Richard (HHS/OASH); 'Essery, Eve - CNPP'
Since we did not formally synthesize the evidence for the chapter, I don’t think that should be part of
the title. First part of first title looks appropriate to me.
Regarding second title, I think recommendations is too strong a word given there are so many ways
of interpreting it, particularly since the title of our Committee includes the word.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

To: 'Casavale, Kellie (OS/OASH)'; 'Nadine'; 'Millen, Barbara E'
Cc: 'Colette Rihane'; 'Olson, Richard (HHS/OASH)'; 'Essery, Eve - CNPP'; Lichtenstein, Alice
Good morning all,

When we get to the Integration chapter, can we settle on the title? The current title is: Overarching Themes and
Integrated Recommendations: Synthesizing the Evidence

When she reviewed this section, Mim suggested: Integrated Recommendations: Synthesizing the Evidence.

She was comfortable with keeping all the other chapter titles as is.

Thanks,

Anne Brown Rodgers
Science Writer
(b) (6)

310
PSC-HHS-000310
To: 'Nadine'; Millen, Barbara E; Anne Rodgers
Cc: Braunstein, Nadine (OS/OASH); Colette Rihane; Olson, Richard (HHS/OASH); Essery, Eve - CNPP; 'Lichtenstein, Alice'
Sounds like a plan! I already sent the conference line, but here it is again and I will send it in Outlook as well: (b) (6)

I have copied Alice in case she can break from the grant and papers for any part of this. I’m also copying Colette, Rick,
and Eve in case they are able to join.

Sunday, December 7th
8 am: Conceptual Model (1st), then the Introduction and Integration

We do not have a webinar with this line. Barbara, please send the versions of your drafts that you would like us to have
in front of us.

Thanks,
Kellie


From: Nadine [mailto:(b) (6)
Hi Barbara!
Thanks!
Nadine

Date:12/06/2014 5:29 PM (GMT-05:00)
To: Anne Rodgers
311
PSC-HHS-000311
Sent from my iPhone

Anne Brown Rodgers
Science Writer
(b) (6)

Barbara,

I’ll be up by 7 am I’m sure as well. Here are some options, just let us know what works for you.( I think
Anne and I are both flexible all day.)
after 4 pm.

We can let Alice know the time we are meeting in case she wants to take a break from her grant work.

Kellie


Hi again, Barbara!
My weekend plans have changed. I will be available tonight (Sat) after 5 pm. Tomorrow I will be
available after 4.
312
PSC-HHS-000312
Thanks,
Nadine

Date:12/05/2014 10:21 PM (GMT-05:00)
Hi Barbara!
Sorry for the late reply. I was out of the office today. I won't be available till Saturday evening. But
Sunday is open most of the day (except around 3-4 pm).
Thanks,
Nadine

HI Alice,
The big outstanding items from the morning SRSC call are the completion of the introduction
and integration chapters and the conceptual model. It was proposed that you and I work over the
weekend with Kellie and Anne to prepare the chapters in draft and then circulate them on
Monday to the DGAC with a very short turnaround deadline so they can go out on Tuesday to
the DGAC with the rest of the report. We want to be sure we have covered the overarching
themes and recommendations and resolved outstanding issues from the previous reviews. I will
work with Nadine if she’s available to review things that remain on the conceptual model. Not
sure if you have had the time to review the revisions I did on the integration chapter but your
input would be very much appreciated.
313
PSC-HHS-000313
Is there a time over the weekend that you have up to an hour to review the current draft of the
integration chapter and introduction. Both are attached for your review. The only time I am
definitely not available is noon or about 3 tomorrow.
Many thanks.
Barbara
bmillen@bu.edu

-------------------------------------------------------------------------------
Tufts University

314
PSC-HHS-000314
Boston, MA 02111
phone: 617 556 3127

All,
Based on very recent comments from Barbara and Alice, Frank has revised the saturated fat
implications statement. Please review this and send any comments to me and Kellie by Friday,
December 5.
Thanks very much,
Anne
Anne Brown Rodgers
Science Writer
(b) (6)
315
PSC-HHS-000315

Sent: Friday, December 05, 2014 8:22 AM
Subject: RE: For review: 12.5.14 SRSC Meeting 59 Agenda.docx
Thanks Kellie,

My calendar notes say a JetBlue flight at 4:14 on Sunday the 14th returning I believe on the 8 something light on the
15th. I don’t know if the Boston crew opted for earlier flights but I have tended to book the latest flight back and then try
for an earlier flight once at the airport if we arrive earlier. Barbara

bmillen@bu.edu

Cc: Anne Rodgers

Yes, that sounds like a very good plan. On the call this morning let’s ask for availability. You will get the Introduction
from Anne today; however, Nadine still needs to work with you on the conceptual model. Today would be helpful,
although know you are swamped.

Kellie



I was thinking that Alice needed to give some initial reaction to the first two parts I rewrote. That was the plan. The, we
could talk about the population level changes. We could also consider what more we wanted in the introduction but
only after Anne has had the time to do her draft. When thinking about another call, I was hoping to have it with the
SRSC and to schedule it before the full document went to the DGAC. So that would mean having a revised Integration
chapter to the SRSC by end of Sunday and a call on Monday. Is that feasible? If Alice is free late in the day or
(preferably) tomorrow morning, I can make it I probably won’t be back in Boston until very late in the day if not dinner
time. It will depend upon traffic out of New York. ‐

Barbara
bmillen@bu.edu

316
PSC-HHS-000316

Thank you Barbara, as follow‐up. I think you are right about the work to finalize the other sections leaving little room for
work to have progress on the Integration recommendations and the conceptual model. However, that doesn’t change
that these still need to COMPLETE (not just updated drafts, but complete start to finish) no later than Monday. The
members need to see them. We need a plan to make that happen between today, tomorrow, and Sunday.

 I added the health care considerations into the “action items” for the notes and today’s meeting to review.
 I reordered the DGAC Report agenda items for order of importance and flow.
 I’ve added a review of the cross‐cutting chapter status of recommendations to today’s agenda
 Integration chapter‐ We can schedule another call. When do you want it. This really should be done today,
although you mentioned the weekend is better. Do you want feedback from Alice FIRST or on the call?
 Conceptual Model‐ Nadine is managing those edits and updates. She has been e‐mailing you with consolidated
comments and questions and needs to talk with you. She needs more feedback to be able to resolve the
comments she has gotten. Please follow‐up with her. This needs to get finalized by COB Sunday so that it can go
through cross‐review within the Introduction. It needs to be finally formatted by the CNPP graphics artist (not
yours), and they need all next time to do that.
 Final Meeting Presentations‐ They should tell the story of the FINAL recommendations. There will not be time to
talk about the progression over the past two years.

Let’s devise a plan for completion! I’m here!

Kellie



Hi Kelly,

Here are the documents for today’s call. See my notes and edits from the minutes of our last call. Let’s put healthcare
onto the agenda for today’s call (just an update on what came of the final reviews on the recommendation that we try
to frame our evidence so as to help those in HHS and healthcare‐related position to consider the report and use it in
policy/program development. This would particularly entail the evidence on population health risks and disparities, links
between dietary patterns and health outcomes, and evidence on what works at individual and population levels to
change behavior for health promotion and disease prevention).

I have not had any feedback on the revised theme or individual recommendations that I circulated since our call. I think
Alice is very busy keeping track of the iterations on saturated fat and the cross‐cutting topics and may not have had a
chance to iterate. I’m feeling that it is premature to circulate anything to the full DGAC and we may not have anything
until EOB Monday and then, only if Alice, SRSC and others can provide feedback. Timing is very tight and I think we may
also need to sandwich in another SRSC call mid week to review the model, the integration chapter and the
introduction. Your thoughts?

317
PSC-HHS-000317
Barbara

bmillen@bu.edu

Subject: FW: For review: 12.5.14 SRSC Meeting 59 Agenda.docx
Importance: High

Barbara‐ I don’t see that I have heard back on this agenda for SRSC tomorrow. I can send it in the morning. But do have a
few questions in it for you before I can get it out the door. Thanks!

Kellie


From: Casavale, Kellie (OS/OASH)
To: bmillen@bu.edu
Subject: For review: 12.5.14 SRSC Meeting 59 Agenda.docx
Importance: High

Barbara‐ A draft agenda is attached for SRSC Friday for your review. A few questions for you in it. I have an all‐day
meeting tomorrow‐ so I will send this after COB/5:30 pm. Draft notes are attached as well.

Thanks,

Kellie
318
PSC-HHS-000318

To: Anne Rodgers; 'Perez-Escamilla, Rafael'; 'Abrams, Steven A'; 'Millen, Barbara E';
Cc: Casavale, Kellie (OS/OASH); Olson, Richard (HHS/OASH);
colette.rihane@cnpp.usda.gov; 'Bodyk, Anjuli'; lhimes@bcm.edu; Bailey, Lauren A.;
PBROWN@hsph.harvard.edu
Attachments: SFA and PUFA jtb fh clean AHL-2 HU 12 4 clean AHL.docx
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

To: 'Perez-Escamilla, Rafael'; 'Abrams, Steven A'; 'Millen, Barbara E'; Lichtenstein, Alice; frank.hu@channing.harvard.edu;
Eve.Essery@cnpp.usda.gov

All,

Based on very recent comments from Barbara and Alice, Frank has revised the saturated fat implications
statement. Please review this and send any comments to me and Kellie by Friday, December 5.

Thanks very much,
Anne

Anne Brown Rodgers
Science Writer
(b) (6)
319
PSC-HHS-000319

To: Frank Hu
Cc: Tom Brenna; Anne Rodgers; Essery, Eve - CNPP; Casavale, Kellie (OS/OASH);
bmillen@bu.edu
Subject: RE: DGAC CROSS-CUTTING TOPICS CHAPTER FOR YOUR REVIEW
Let’s get federal guidance on this. It is not something fall on a sword over.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

Cc: Tom Brenna; Anne Rodgers; Essery, Eve - CNPP; Casavale, Kellie (OS/OASH); bmillen@bu.edu
Subject: Re: DGAC CROSS-CUTTING TOPICS CHAPTER FOR YOUR REVIEW
Alice,
These are implications, rather than conclusion statements (which should be evidence-based). My understanding
is that the implication statements can be developed for practical purpose, potential policy initiatives (e.g., added
sugar nutrition labeling), and generic guidance for individuals.
Frank
On Wed, Dec 3, 2014 at 8:20 PM, Lichtenstein, Alice <Alice.Lichtenstein@tufts.edu> wrote:
I stand by my statement. If we don’t have the data from our NEL SR we can’t qualify with the word
refined.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
320
PSC-HHS-000320
Tufts University
Boston, MA 02111
phone: 617 556 3127

To: Tom Brenna
Cc: Anne Rodgers; Essery, Eve - CNPP; Casavale, Kellie (OS/OASH); Lichtenstein, Alice; bmillen@bu.edu
Thanks, Tom, for your thoughtful comments. I have no objection to restore the word "refined" before "tropical
oils".
Frank
On Wed, Dec 3, 2014 at 7:50 PM, Tom Brenna <jtb4@cornell.edu> wrote:
Health conscious American consumers, particularly some wishing to use more non-animal products, are
choosing virgin coconut oil as culinary fats and articles on it appear regularly in the press. To my knowledge,
the existing human studies, insofar as they isolate coconut oil effects at all, do not address VCO. On that basis
there is no evidence to make an unqualified statement capturing all of these oils regardless of production
method. As to evidence, ecological studies of populations that consume most of their fat as coconut (= virgin
coconut oil) have low, not high, CVD. These are concordant with animal data replicated in more than one lab
that show VCO lowers LDL while refined deodorized bleached (RDB) CO raises it in the same study - these are
not hydrogenated oils and they have identical fatty acid profiles showing that it is not the fatty acids. This is
also concordant with widespread understanding that cocoa butter, a saturated tropical oil, is non-atherogenic and
in fact cocoa butter (chocolate) is nearly always prepared as a virgin oil.
321
PSC-HHS-000321
I'll state again that I have no doubt that refined coconut oil and palm kernal oil (always refined) are to be
avoided.
I probably would not support an unqualified statement without seeing direct evidence that I suppose I may have
missed. It is likely to drive consumers away from VCO for no good reason. This sat fat recommendation is
going to generate enough bile without going there. I'd like to see the word "refined" restored.
Tom
On Wed, Dec 3, 2014 at 7:29 PM, Frank Hu <nhbfh@channing.harvard.edu> wrote:
Tom,
In the last version, Alice commented "This implies unrefined tropical oils are recommended. I don’t think we
have the evidence to support that implication."
Do we have evidence to distinguish refined and unrefined tropical oils in terms of nutrient profile or health
effects?
How much of the tropical oils in the market is refined vs. unrefined? If the vast majority is refined, then it may
not be useful to qualify the types of tropical oils.
We could add a research question on refined vs. unrefined oils ??
Frank
FRank,
322
PSC-HHS-000322
The word "refined" disappeared in this version in this sentence.
"In practice, non-hydrogenated vegetable oils that are high in unsaturated fats and relatively low in SFA (e.g.,
soybean, corn, olive, and canola oils) instead of animal fats (e.g., butter, cream, beef tallow, and lard) or tropical
oils (e.g., palm, palm kernel, and coconut oils) should be recommended as the primary source of dietary fat."
I support "In practice, non-hydrogenated vegetable oils that are high in unsaturated fats and relatively low in
SFA (e.g., soybean, corn, olive, and canola oils) instead of animal fats (e.g., butter, cream, beef tallow, and lard)
or refined tropical oils (e.g., palm, palm kernel, and coconut oils) should be recommended as the primary source
of dietary fat."
and thought we settled on that (apologies for missing the recent call). Please advise.
Tom
Hi Anne,
Based on Alice's and Babara's comments today, i have revised the implication section for saturated fat. Can you
replace the current version of the implication (page 11) with the text from the attached file? Would you mind
sending the revised document with the new text on saturated fat to the group again for comments?
Thanks
323
PSC-HHS-000323
Frank
On Wed, Dec 3, 2014 at 6:38 PM, Anne Rodgers (b) (6) wrote:
Rafael and Steve, Barbara and Alice,
On behalf of the Cross-cutting Topics Working Group, attached please find their chapter for your cross-review.
Please return any comments to me and Kellie by Friday, December 5 and I will pass them on to the Working
Group and relevant staff.
A couple of notes to keep in mind as you review:
 When you review, please focus on substantive issues (e.g., major omissions, questions, or differences
with other chapters), not on editorial issues or minor points of content. We hope that this approach will
help you review the chapter within the short time period available.
 If you have any comments or questions about references, please note them in marginal comments, not
directly in the text. The references are in EndNotes and any changes to them may disturb the formatting.
Thanks very much for your review of this chapter, and please let me know if you have any questions.
Anne
Anne Brown Rodgers
Science Writer
(b) (6)
324
PSC-HHS-000324
--
*******************************************************
tel: 617 432 0113 fax: 617 432 2435
******************************************************
--
*******************************************************
tel: 617 432 0113 fax: 617 432 2435
******************************************************
325
PSC-HHS-000325
--
*******************************************************
tel: 617 432 0113 fax: 617 432 2435
******************************************************
--
*******************************************************
tel: 617 432 0113 fax: 617 432 2435
******************************************************
326
PSC-HHS-000326

To: Frank Hu; Tom Brenna
Cc: Anne Rodgers; Essery, Eve - CNPP; Casavale, Kellie (OS/OASH); bmillen@bu.edu
Subject: RE: DGAC CROSS-CUTTING TOPICS CHAPTER FOR YOUR REVIEW
I stand by my statement. If we don’t have the data from our NEL SR we can’t qualify with the word
refined.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

To: Tom Brenna
Cc: Anne Rodgers; Essery, Eve - CNPP; Casavale, Kellie (OS/OASH); Lichtenstein, Alice; bmillen@bu.edu
Thanks, Tom, for your thoughtful comments. I have no objection to restore the word "refined" before "tropical
oils".
Frank

Health conscious American consumers, particularly some wishing to use more non-animal products, are
choosing virgin coconut oil as culinary fats and articles on it appear regularly in the press. To my knowledge,
the existing human studies, insofar as they isolate coconut oil effects at all, do not address VCO. On that basis
there is no evidence to make an unqualified statement capturing all of these oils regardless of production
method. As to evidence, ecological studies of populations that consume most of their fat as coconut (= virgin
coconut oil) have low, not high, CVD. These are concordant with animal data replicated in more than one lab
that show VCO lowers LDL while refined deodorized bleached (RDB) CO raises it in the same study - these are
not hydrogenated oils and they have identical fatty acid profiles showing that it is not the fatty acids. This is
also concordant with widespread understanding that cocoa butter, a saturated tropical oil, is non-atherogenic and
in fact cocoa butter (chocolate) is nearly always prepared as a virgin oil.
I'll state again that I have no doubt that refined coconut oil and palm kernal oil (always refined) are to be
avoided.
327
PSC-HHS-000327
I probably would not support an unqualified statement without seeing direct evidence that I suppose I may have
missed. It is likely to drive consumers away from VCO for no good reason. This sat fat recommendation is
going to generate enough bile without going there. I'd like to see the word "refined" restored.
Tom

Tom,
In the last version, Alice commented "This implies unrefined tropical oils are recommended. I don’t think we
have the evidence to support that implication."
Do we have evidence to distinguish refined and unrefined tropical oils in terms of nutrient profile or health
effects?
How much of the tropical oils in the market is refined vs. unrefined? If the vast majority is refined, then it may
not be useful to qualify the types of tropical oils.
We could add a research question on refined vs. unrefined oils ??
Frank

FRank,
The word "refined" disappeared in this version in this sentence.
"In practice, non-hydrogenated vegetable oils that are high in unsaturated fats and relatively low in SFA (e.g.,
soybean, corn, olive, and canola oils) instead of animal fats (e.g., butter, cream, beef tallow, and lard) or tropical
oils (e.g., palm, palm kernel, and coconut oils) should be recommended as the primary source of dietary fat."
I support "In practice, non-hydrogenated vegetable oils that are high in unsaturated fats and relatively low in
SFA (e.g., soybean, corn, olive, and canola oils) instead of animal fats (e.g., butter, cream, beef tallow, and lard)
or refined tropical oils (e.g., palm, palm kernel, and coconut oils) should be recommended as the primary source
of dietary fat."
and thought we settled on that (apologies for missing the recent call). Please advise.
Tom

Hi Anne,
328
PSC-HHS-000328
Based on Alice's and Babara's comments today, i have revised the implication section for saturated fat. Can you
replace the current version of the implication (page 11) with the text from the attached file? Would you mind
sending the revised document with the new text on saturated fat to the group again for comments?
Thanks
Frank
On Wed, Dec 3, 2014 at 6:38 PM, Anne Rodgers (b) (6) wrote:
Rafael and Steve, Barbara and Alice,
On behalf of the Cross-cutting Topics Working Group, attached please find their chapter for your cross-review.
Please return any comments to me and Kellie by Friday, December 5 and I will pass them on to the Working
Group and relevant staff.
 When you review, please focus on substantive issues (e.g., major omissions, questions, or differences
with other chapters), not on editorial issues or minor points of content. We hope that this approach will
help you review the chapter within the short time period available.
 If you have any comments or questions about references, please note them in marginal comments, not
directly in the text. The references are in EndNotes and any changes to them may disturb the formatting.
Anne
Anne Brown Rodgers
Science Writer
(b) (6)
329
PSC-HHS-000329
(b) (6)
--
*******************************************************
tel: 617 432 0113 fax: 617 432 2435
******************************************************
--
*******************************************************
tel: 617 432 0113 fax: 617 432 2435
******************************************************
--
*******************************************************
330
PSC-HHS-000330
tel: 617 432 0113 fax: 617 432 2435
******************************************************
331
PSC-HHS-000331

To: Frank Hu; Essery, Eve - CNPP
Cc: Millen, Barbara E; (b) (6) frank.hu@channing.harvard.edu;
PBROWN@hsph.harvard.edu; Casavale, Kellie (OS/OASH)
Subject: RE: DGAC: Saturated fat
Attachments: SFA and PUFA jtb fh clean AHL.docx
Attached, with comments. Frank, thanks for turning around so quickly.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

Cc: Millen, Barbara E; Lichtenstein, Alice; (b) (6) frank.hu@channing.harvard.edu;
PBROWN@hsph.harvard.edu; Casavale, Kellie (OS/OASH)
Subject: Re: DGAC: Saturated fat
It was a good call today. Based on our discussions, I tweaked the implication statement for saturated
fat. Attached please find a clean version and a tracked version.
Please free feel to edit.
Thanks
frank
On Tue, Dec 2, 2014 at 10:47 AM, Essery, Eve - CNPP <Eve.Essery@fns.usda.gov> wrote:
When: Tuesday, December 02, 2014 1:10 PM‐2:00 PM (UTC‐05:00) Eastern Time (US & Canada).
Where: (b) (6)

Note: The GMT offset above does not reflect daylight saving time adjustments.

*~*~*~*~*~*~*~*~*~*

I’ll open the line at 1:10pm. I’m not sure if you’ll need until 2, but I put it on your calendar.

(b) (6)

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For discussion… 10% quantitative recommendation on saturated fat.
Please see DRAFT cross-cutting chapter attached. The saturated fat section begins on page 9. Thanks!

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Sent: Sunday, November 30, 2014 7:28 PM
To: Essery, Eve - CNPP; Millen, Barbara E; Frank Hu
Cc: frank.hu@channing.harvard.edu; jtb4@cornell.edu; Casavale, Kellie (OS/OASH)
Subject: RE: DGAC: Saturated Fat and CVD
Attachments: SFA and PUFA.docx
See attached for my suggested comments.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

To: Millen, Barbara E; Lichtenstein, Alice; Frank Hu
Frank and all,
Thank you very much for your responses about the quantitative recommendation for saturated fat. I asked this question
because we know the 10% recommendation is used in a number of Federal food assistance programs, and we’ll be asked
about this directly. Do you think it would be possible to state this in your report, possibly in your implications? I’ve
included two draft options for a statement (highlighted below). Preference, edits, additions, or deletions to this
statement? THANK YOU!!!
Eve

Implications
Recommendations on SFA intake should specify replacement macronutrients and emphasize PUFA and should
be based on food and overall dietary patterns. Individuals should consume a dietary pattern that is low in
saturated fat and emphasizes intake of vegetables, fruits, and whole grains; includes low-fat dairy products,
poultry, fish, legumes, non-tropical vegetable oils and nuts; and limits intake of sweets, sugar-sweetened
beverages and red and processed meats. The Committee recommends that emphasis be taken off the quantitative
recommendation of 10%; however, the 10% upper limit could be used as a general guide. ---OR--- The
Committee recommends that the 10% quantitative recommendation be discontinued; however, the 10% upper
limit could be used as a general guide. Non-hydrogenated vegetable oils that are high in unsaturated fats and
relatively low in SFA (such as soybean, corn, olive, and canola oils) instead of animal fats (such as butter,
cream, lard) or refined tropical oils rich in SFA such as palm and coconut oils should be recommended as the
primary source of culinary fat. Although a healthy dietary pattern is relatively low in SFA, it can include lean
334
PSC-HHS-000334
meats and non- and low-fat dairy products consistent with the USDA Food Patterns. Simply reducing saturated
or total fat in the diet by replacing it with any type of carbohydrates is not effective in reducing risk of CVD,
and thus dietary advice should put more emphasis on types of fat rather than the total amount of fat. The
carbohydrates sources in the dietary pattern should be primarily fiber-rich whole grains, legumes, fruits, and
vegetables and should minimize the amount of refined grains and added sugars. The consumption of “low-fat”
or “nonfat” products with high amounts of refined grains and added sugars should be discouraged.

Sent: Saturday, November 22, 2014 5:08 PM
To: Lichtenstein, Alice; Frank Hu; Essery, Eve - CNPP
I would agree.

bmillen@bu.edu

Cc: frank.hu@channing.harvard.edu; jtb4@cornell.edu; Millen, Barbara E; Casavale, Kellie (OS/OASH)
I agree with dropping 10% SFA and encouraging replacement of SFA with unsaturated fat,
particularly PUFA.
I don’t think the issue of dairy should be bundled in with this issue. It should be explored and
addressed separately.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

Sent: Friday, November 21, 2014 11:28 AM
Cc: frank.hu@channing.harvard.edu; Lichtenstein, Alice; jtb4@cornell.edu; bmillen@bu.edu; Casavale, Kellie (OS/OASH)
Subject: Re: DGAC: Saturated Fat and CVD
Eve,
Please see my response to your questions. I'd love to hear others' comments as well.
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PSC-HHS-000335
On Fri, Nov 21, 2014 at 9:21 AM, Essery, Eve - CNPP <Eve.Essery@fns.usda.gov> wrote:
Hi Frank,
I just to be sure we clearly understand what the DGAC is recommending around saturated fat, particularly since there is
currently a key recommendation for saturated fat in the 2010 DGA. Can you review the statements and questions
below? THANKS!
The 2010 DGA recommendation for saturated fat states, “Consume less than 10 percent of calories from saturated fatty
acids by replacing them with monounsaturated and polyunsaturated fatty acids.”
The Saturated Fat Working Group has acknowledged that high saturated fat intake is still of concern. You have also
recommended consuming a healthy dietary pattern low in saturated fat.
Are you recommending that the 10% quantitative recommendation be discontinued, remain, or that it (or some other
percent or range of intake) be used as a general guide (but not as a key recommendation)?
SINCE WE ARE FOCUSING ON OVERALL DIETARY PATTERNS/DIET QUALITY, I WOULD

RECOMMEND THAT THE 10% QUANTITATIVE RECOMMENDATION BE DISCONTINUED, ALONG
WITH OTHER NUMBERS (SUCH AS 35% TOTAL FAT, OR 3 CUPS OF DAIRY/PER DAY). THESE
NUMBERS, WHICH ARE ARBITRARY, HAVE CAUSED A LOT OF CONFUSION IN THE GENERAL
PUBLIC. NONETHELESS, 10% UPPER LIMIT COULD BE USED A GENERAL GUIDE.
In terms of replacement, would you recommend that the guidance place more emphasis on PUFAs than MUFAs or CHO
from healthier sources (because the evidence is more limited around MUFAs and healthier sources of CHO)?
SATURATED FAT SHOULD BE REPLACED BY UNSATURATED FATS, WITH MORE EMPHASIS ON

PUFAs. IN PRACTICE, SINCE MANY FOOD SOURCES OF UNSATURATED FATS SUCH AS
VEGETABLE OILS AND NUTS INCLUDE A BLEND OF MUFAs and PUFAs, THERE IS NO NEED TO
GIVE THE EXACT PROPORTION OF MUFAs and PUFAs IN THE DIET, ESPECIALLY CONSIDERING
THAT THE MED-STYLE DIET WHICH IS RICH IN OLIVE OIL IS CONSIDERED A HEALTHY
DIETARY PATTERN IN SC2. IF INDIVIDUALS CHOOSE TO REPLACE SOME OF SATS WITH CHOs,
THEY SHOULD CHOOSE HEALTHY SOURCES OF CHO SUCH AS WHOLE GRAINS, LEGUMES,
AND F/V.
ON THE OTHER SIDE OF THE COIN, WHEN WE RECOMMEND PEOPLE TO CUT BACK ON
REFINED CHO/ADDED SUGAR, THEY SHOULD REPLACE THEM WITH HEALTHY SOURCES OF
CHOs AND FATS RATHER THAN SATURATED FAT.
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PSC-HHS-000336

Thank you!
Eve

Sent: Tuesday, November 18, 2014 8:36 AM
Cc: frank.hu@channing.harvard.edu; alice.lichtenstein@tufts.edu; jtb4@cornell.edu; bmillen@bu.edu; Casavale, Kellie
(OS/OASH); Obbagy, Julie - CNPP; Fisher, Rachel (NIH/NIDDK) [E]; McDowell, Margaret (NIH/NIDDK) [E]
Hi Eve,
attached please find a revised version of the saturated fat-CVD section. I have added an
introduction/background on this section and brief rationales for key research questions.
I look forward to everyone's comments/suggestions.
Frank
On Sat, Nov 15, 2014 at 9:39 PM, Essery, Eve - CNPP <Eve.Essery@fns.usda.gov> wrote:
Hi Frank,
Your saturated fat section of the report is almost complete. As indicated in the attached, please:
1. Add an introduction to the saturated fat section.
2. Finalize the research recommendations.
3. Make any needed changes following the DGAC public meeting (brief notes and action items from the meeting are
attached – thanks Rachel!).
Once your changes have been made, I’ll add this section to the Cross-Cutting chapter. As you know, we are now on a
tight timeline. Can you review and edit this by Thurs, Nov 20? If this is not possible, please let me know what will work
with your schedule.
337
PSC-HHS-000337
Thank you!
Eve
law and subject the violator to civil or criminal penalties. If you believe you have received this message in
error, please notify the sender and delete the email immediately.
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To: Anne Rodgers; 'Millen, Barbara E'
Cc: Casavale, Kellie (OS/OASH); Eve.Essery@cnpp.usda.gov
Subject: RE: CHAPTERS FOR YOUR CROSS-REVIEW
Attachments: Part D Ch X_DRAFT_SC3 Chapter_Final for cross-review_11-20 AHL.docx
Not certain I was supposed to review SC3 chapter at this point, however, I started to I did. Please
forward to appropriate individuals, if appropriate.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

To: 'Millen, Barbara E'; Lichtenstein, Alice
Cc: 'Casavale, Kellie (OS/OASH)'; Eve.Essery@cnpp.usda.gov
Subject: RE: CHAPTERS FOR YOUR CROSS-REVIEW


I’m sorry if the process has been confusing for you. Here is a chart that summarizes all the review dates. The chapters
that have already gone out for cross‐review are highlighted in yellow. You have both already reviewed the Physical
Activity chapter, so you do not need to read it again. Please do review the SC 1, 3, and 4 chapters and return them to
me and Kellie with any comments by the due dates indicated. I am attaching those chapters here for your convenience.

A couple of notes:
 SC1: This chapter has two pieces – a file with the text and a PDF with the accompanying figures.
 SC4: This chapter includes all of its sections except for worksites. You have already reviewed the food access
and ECE sections at an earlier stage; schools is the only new section for you. The worksites section is still being
finalized and will go out for cross‐review on Monday 12/1.

The chapters for SC2 and SC5 will go out for cross‐review today. Would you like me to include you on the email to the
cross‐reviewers or would you prefer that I send both chapters to you in a separate email?

SCIENCE BASE CHAPTERS
Reviewers Date sent out Draft due back to
Anne and Kellie
Subcommittee 1 Anna Maria, Wayne Monday 11/24 Tuesday 12/1
340
PSC-HHS-000340
Subcommittee 2 Steve A, Mim Tuesday 11/25 Wednesday 12/3
Subcommittee 3 Mary, Frank Friday 11/21 Monday 12/1
Subcommittee 4 Tom, Steve C Monday 11/24 (all but Monday 12/1 (all but
worksites); Worksites worksites); Worksites
will be sent Monday due 12/2
12/1)
Subcommittee 5 Marian, Rafael Tuesday 11/25 Tuesday 12/2
Physical Activity Cheryl, Lucile Monday 11/17 Monday 11/24
Cross‐cutting Topics Rafael, Steve A TBD
(sodium, added sugars,
low‐calorie sweeteners,
saturated fat)
OTHER SECTIONS
Section Reviewers Date sent Draft due back to
Anne and Kellie
Executive Summary All DGAC members TBD
Report Introduction All DGAC members TBD
Integration chapter All DGAC members Prelim: Monday 11/24 Sat 11/29
Final: Wed 12/3 Friday 12/5
Research All DGAC members TBD (discussed by
Recommendations SRSC 11/21)
Methods Marian, Anna Monday 11/24 Tuesday 12/2
Maria, Wayne

Please let me know how I can make things as easy for you as possible.

Thanks,
Anne

Anne Brown Rodgers
Science Writer
(b) (6)

To: Anne Rodgers
Subject: Re: DGAC SC 1 CHAPTER FOR YOUR CROSS-REVIEW

That wasn't clear. I thought we saw everything.
I'm going to need you to send them to me in one email with dates. I'm in transit through the 30th and will do the best I
can. I think I have overlooked some already. Please resend. Barbara

Sent from my iPhone

On Nov 25, 2014, at 1:40 PM, "Anne Rodgers" (b) (6) wrote:
Hi Barbara,
341
PSC-HHS-000341

Please do your reviews of the chapters now, concurrently with the cross‐reviewers. Most of the reviews
are due next Monday (12/1) or Tuesday (12/2) and the SCs will be spending the rest of the week
incorporating those comments and putting the final touches on their chapters so that all the pieces can
come to me by Friday 12/5. That means there isn’t time for you and Alice to review them after the
cross‐reviews.

I hope your meeting is going well. Thanks,
Anne

Anne Brown Rodgers
Science Writer
(b) (6)

To: Anne Rodgers; alice.lichtenstein@tufts.edu
Cc: 'Kellie Casavale'
Subject: RE: DGAC SC 1 CHAPTER FOR YOUR CROSS-REVIEW

Just to review, we’re looking at it once the cross‐review is done. Correct? Or are we to look at this
point? I thought once the SC chairs handle the cross‐review comments but please let me know.

Many thanks.

Barbara
bmillen@bu.edu

Sent: Monday, November 24, 2014 7:57 PM
To: Millen, Barbara E; alice.lichtenstein@tufts.edu
Cc: 'Kellie Casavale'
Subject: FW: DGAC SC 1 CHAPTER FOR YOUR CROSS-REVIEW


I apologize – I neglected to include you on the SC1 cross‐review email. Here is their chapter.

Anne

Anne Brown Rodgers
Science Writer
(b) (6)

342
PSC-HHS-000342
To: 'am siegariz@unc.edu'; 'campbellw@purdue.edu'
Cc: 'kellie.casavale@hhs.gov'; 'Richard.Olson@hhs.gov'; 'colette.rihane@cnpp.usda.gov'; Neuhouser,
Marian L; 'Patricia.Britten@cnpp.usda.gov'; 'amfiguer@email.unc.edu'; 'jgoyett@purdue.edu'
Subject: DGAC SC 1 CHAPTER FOR YOUR CROSS-REVIEW

Hi Anna Maria and Wayne,

On behalf of Subcommittee 1, attached please find their draft chapter for your cross‐review. Please
return any comments to me and Kellie by Tuesday, December 2 and I will pass them on to Marian and
relevant staff.

I realize that I’ve also just sent you the Methods section for cross‐review. I hope that section will not
take you too long to review as it is very straightforward and familiar to you.


 When you review, please focus on substantive issues (e.g., major omissions, questions, or
differences with other chapters), not on editorial issues or minor points of content. I will be
editing the chapter while you are doing your substantive review. We hope that this approach
will help you review the chapter within the short time period available.

 If you have any comments or questions about references, please note them in marginal
comments, not directly in the text. The references are in EndNotes and any changes to them
may disturb the formatting.


Anne

Anne Brown Rodgers
Science Writer
(b) (6)

343
PSC-HHS-000343

I would agree.

bmillen@bu.edu

Cc: frank.hu@channing.harvard.edu; jtb4@cornell.edu; Millen, Barbara E; Casavale, Kellie (OS/OASH)
particularly PUFA.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

Eve,
Hi Frank,
344
PSC-HHS-000344

below? THANKS!


AND F/V.
Thank you!
345
PSC-HHS-000345

Eve

Hi Eve,
Frank
Hi Frank,
with your schedule.
Thank you!
Eve
346
PSC-HHS-000346
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347
PSC-HHS-000347
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348
PSC-HHS-000348

Cc: frank.hu@channing.harvard.edu; jtb4@cornell.edu; bmillen@bu.edu; Casavale, Kellie
(OS/OASH)
particularly PUFA.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

Eve,
Hi Frank,
below? THANKS!
349
PSC-HHS-000349


AND F/V.
Thank you!
Eve
350
PSC-HHS-000350
Hi Eve,
Frank
Hi Frank,
with your schedule.
Thank you!
Eve
351
PSC-HHS-000351
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352
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353
PSC-HHS-000353

Cc: frank.hu@channing.harvard.edu; alice.lichtenstein@tufts.edu; jtb4@cornell.edu;
While I agree that the cut‐points may be arbitrary, it is also helpful to have guides to make points clear for consumers
and clinicians. It would be also helpful to know how a change might impact the modeling work Trish is doing for SC1.

Barbara
bmillen@bu.edu

Cc: frank.hu@channing.harvard.edu; alice.lichtenstein@tufts.edu; jtb4@cornell.edu; Millen, Barbara E; Casavale, Kellie
(OS/OASH)
Eve,
Hi Frank,
below? THANKS!
354
PSC-HHS-000354


AND F/V.
Thank you!
Eve

Hi Eve,
355
PSC-HHS-000355
Frank
Hi Frank,
with your schedule.
Thank you!
Eve
356
PSC-HHS-000356
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357
PSC-HHS-000357

To: Britten, Patricia - CNPP; Neuhouser, Marian L
Cc: Casavale, Kellie (OS/OASH); Yamini, Essie (FDA/CFSAN)
Subject: RE: nutrients of concern
Very helpful to put in perspective. I am playing the role of the devil’s advocate here, given the topic is
so charged this year and trying to anticipate the critics. Coming through the AHA/ACC process has
been bruising.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

To: Neuhouser, Marian L; Lichtenstein, Alice
Cc: Casavale, Kellie (OS/OASH); Yamini, Essie

Hi Marian and Alice,

In reference to the question Alice raised: While a 1% difference doesn’t sound like much, you need to remember that
the entire range of saturated fat intakes is only from 8% to 15% (5th to 95th percentiles‐‐see attached.). Further, only
29% of the population consumes less than 10% of energy as saturated fat. So to me it seems legitimate to call saturated
fat an over consumed nutrient. With an intake range of 7 percentage points, average intakes are 14% above the
recommended limit (1/7th) and 71% of the population doesn’t meet the rec.

Just my 2 cents…

Trish

Cc: Casavale, Kellie (OS/OASH); Britten, Patricia - CNPP

All of SC1 are available for a call this week so let’s put it on the agenda to discuss

358
PSC-HHS-000358
Cc: Casavale, Kellie (OS/OASH); Britten, Patricia - CNPP (Patricia.Britten@cnpp.usda.gov)

Probably worth a discussion at some point. Traditionally we have linked SFA to %E of whole
diet. However, given we have recommended different total fat intakes over the years I am wondering
whether that is a good approach. We got in a bind with the AHA/ACC guidelines because we only
had low fat studies to base our recommendation on (~25% E) and they fed 5%-6% SFA. That may
be fine for a 25%E fat diet and is possible, as Trish so ability demonstrated, but difficult for a 30%-
35% fat diet.
Currently some people are above and some below the 10%E goal. On average the nation is
impressively close. I don’t want to get criticized for just repeating what other committees have
said. Not certain whether there is a good solution but I figured I would bring it up.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

Cc: Casavale, Kellie (OS/OASH); Britten, Patricia - CNPP (Patricia.Britten@cnpp.usda.gov); Neuhouser, Marian L

Hi Alice

This is an excellent question and we do need your continued input on this important topic. Thank you for bringing this
up

Among the entire population age 2 and over the median intake of SFA is 11.1% of total energy. There are numerous
subgroups, however, for whom only a fraction are below 10%. As with the other NOC – we have taken the approach that
if a reasonable subgroup are below the EAR or only a reasonable fraction were above the AI then it was noted as a
nutrient of underconsumption (shortfall) or a nutrient of overconsumption. Nutrients for which we had biomarker data
and/or nutrients that posed health risks were further classified as nutrients of public health concern (NOC)

If we consistently use this approach then SFA is categorized as an NOC because large fractions of subgroups do not meet
the recommendation (see attached, page 7). For example among men and women > 50 years of age, only 32% and 31%
respectively are less than 10%. When we look at the overall median it does not give a good representation of this. Given
this, I am comfortable classifying SFA as an NOC, but now is the time to discuss if the experts in this area see it
differently.

359
PSC-HHS-000359
Trish – anything to add?

Best,

Marian

Subject: nutrients of concern

I am still cogitating over our virtual meeting on Friday. I remain concerned about SFA being listed as
a nutrient of concern for overconsumption if we end up recommending 10%E since we are now at
11%E, very close. Might look like the assessment was a hold-over from 1980.
Marian, any thoughts?
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

360
PSC-HHS-000360

Subject: RE: Public Meeting Slides and Reminders: DGAC Meeting 6
Attachments: 13. INTEGRATION and NEXT STEPS bem edits 11 7 2014.pptx
OK. Just so you have the final deck. Only the notes on Slide 8 have changed.

Barbara

bmillen@bu.edu


No they haven’t as long as you printed the ones where I added the names and pictures of the SC/Wg chairs for the
Integration presentation. That was the last change I made to any of them  Going to load them on the computer now….

Kellie



Kellie, Have mine changed at all from last night? I printed those already and wonder if I should do so again? Barbara

bmillen@bu.edu

To: Alice Lichtenstein, DSc, MS; Anna Maria Siega-Riz, PhD, MS, RD; Millen, Barbara E; Cheryl Anderson, PhD, MS, MPH;
Frank Hu, MD, PhD, MPH; J. Thomas Brenna, PhD, MS; Lucile Adams-Campbell, PhD, MS; Marian Neuhouser, PhD, RD;
Mary Story, PhD, MS, RD; Miriam (Mim) E. Nelson, PhD, MS; Rafael Pérez-Escamilla, PhD, MS; Steven Abrams, MD;
Steven Clinton, MD, PhD; Wayne Campbell, PhD, MS
Cc: Angelica Figueroa; Bailey, Lauren A.; Brianna.Knight@osumc.edu; Jennifer Connor; Ms. Lejuana Himes; Patrice
Brown ; Tidings Chan ; anjuli.bodyk@yale.edu; jgoyett@purdue.edu; Olson, Richard (HHS/OASH); Colette Rihane;
McPeak, Holly (HHS/OASH); Mosher, Amber (OS/OASH); Britten, Patricia - CNPP; Essery, Eve - CNPP; Piercy, Katrina
(HHS/OASH); Rahavi, Elizabeth - CNPP; De Jesus, Janet M (NIH/NHLBI) [E]
Subject: Public Meeting Slides and Reminders: DGAC Meeting 6

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PSC-HHS-000361
DGAC Members,

The current versions of your slides for today are attached. If you have not done so already, please prepare your work
space:

Phone line: Dialing in through a landline is preferred over a cell phone or through a computer. A headset connected to a
phone provides the best sound quality.
Computer: You will be watching through the NIH webcast (the same view as the public), but dialing in through your
phone. Test your computer with the links below:
 Test your browser using this test page at http://videocast.nih.gov/browsertest/
 (There are no live webcasts until ours this morning if you were unable to test watch a live event before today.)

Join the meeting at 9:30 am ET (6:30 am PT) for a sound check and review of procedures. The live webcast begins at 10
am ET (7 am PT). We will do an alphabetical roll call to check the quality of your phone sound at 9:30 am.

Webcast Link: videocast.nih.gov
*Turn the sound off of your computer speakers. Your sound will come from your phone.
Call in: (b) (6)
Leader Passcode: (b) (6)
*After entering the passcode, a recording will prompt you to press *0.
Press *0 for the operator to join you to the call.

Attachments
Agenda
Introduction to Subcommittee Reports (Millen)
SC 1
SC 2
SC 3
SC 4
(SC 5 is not presenting; no slides)
Introduction to the Cross‐cutting Topics of Dietary Guidance and Public Health Importance (Millen)
Sodium WG
Added Sugars WG
Saturated Fat WG
Integration of Findings (Millen, SC/WG Chairs/Leads)

Please let us know if you have any questions. Thanks!

Kellie
362
PSC-HHS-000362

Sent: Thursday, November 06, 2014 6:56 AM
To: Essery, Eve - CNPP; Casavale, Kellie (OS/OASH)
Subject: RE: DGAC: Sat Fat and CVD
Attachments: Lichtenstein head shot 2014.pptx
In future please use cropped photo, attached. Thanks.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

Sent: Wednesday, November 05, 2014 7:54 PM
To: Lichtenstein, Alice; Frank Hu
Cc: bmillen@bu.edu; jtb4@cornell.edu; Casavale, Kellie (OS/OASH); Obbagy, Julie - CNPP; 'McDowell, Margaret
(NIH/NIDDK) [E]'; 'rachel.fisher@nih.hhs.gov'
Hi Frank,
Attached are draft slides for your presentation on Friday. You will have 15 minutes to briefly discuss saturated fat and
CVD as part of the larger session on Cross-Cutting Topics of Dietary Guidance and Public Health Importance. The Added
Sugars Working Group and Sodium Working Group will also be presenting, and your slides are parallel to their
presentations. You can flip through the first few slides pretty quickly. Since you presented this question at the last public
meeting, I only included very brief introductory information. You can state that a more thorough review of the evidence
was presented at the last public meeting and that you are just re-presenting the draft conclusions and implications for
further discussion.
I know there was additional discussion on your implications statement during the SRSC call. Please update the slides with
how you’d like to address the quantitative recommendation.
Let me know if you have any questions. Thanks for all you work!
Eve

Cc: bmillen@bu.edu; jtb4@cornell.edu; Casavale, Kellie (OS/OASH); Obbagy, Julie - CNPP
Giving the matter more thought I wonder whether we can give a range of recommended SFA
intake. There is no magic/data for the 10% number or 7% number that has been used
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PSC-HHS-000363
previously. The AHA/ACC 5% to 6% range is based on two studies using a lower total fat diet
intakes, 26%-27%, the bottom of what we currently recommend.
I don’t have strong feeling on to actual SFA cut point. Probably would be better to tie to percent of
SFA to total fat. Ten% SFA within the context of a 40% fat diet is very different than 10% SFA within
the context of a 25% fat diet. From an implementation perspective it has profound effects.
Regarding up to 10% PUFA I am aware of no organization that is currently recommending

that. Frank, which are you thinking of? If we are limiting SFA and PUFA to 10% each that is
20%. Are the data strong enough to recommend the balance be MUFA?
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

Sent: Wednesday, November 05, 2014 11:21 AM
Cc: bmillen@bu.edu; Lichtenstein, Alice; jtb4@cornell.edu; Casavale, Kellie (OS/OASH); Obbagy, Julie - CNPP
Subject: Re: DGAC: Sat Fat and CVD
Hi Eve,
attached please find my edits on saturated fat conclusion statements and implications based on Alice's and
Barbara's comments. It would be great we can we discuss these on SC2's call.
Shall we include specific cutpoints for saturated fat (<10% calories)? This is a question asked by a lot of people.
I think it is reasonable to include based on current evidence and population average (11-12%). I think this is a
realistic goal compared to 6-7%.
For PUFA, most organizations recommend up to 10% calories, which is also sensible.
Please let me know your thoughts.
frank
On Wed, Nov 5, 2014 at 10:44 AM, Essery, Eve - CNPP <Eve.Essery@fns.usda.gov> wrote:
Hi Frank,
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I’m pulling together your draft slides on saturated fat and CVD. Alice and Barbara provided comments on your draft
conclusions and implications in the attached. Can you send me your updated conclusions and implications to include in
the slides?
There isn’t a sat fat call before the public meeting. However, if you need a minute to discuss this on SC2’s call, I can ask
Anna Maria if we can include this on the agenda…
THANKS!
Eve

Sent: Friday, October 31, 2014 6:43 AM
Cc: jtb4@cornell.edu; Casavale, Kellie (OS/OASH); Obbagy, Julie - CNPP; Anna Maria Siega-Riz
Very nice summary! I added a few comments and advocated that we clarify the conclusions for consistency with our
dietary pattern language in SC1 and SC2 and also to fine tune the ‘main’ messages. I also added a research
recommendation
Barbara
bmillen@bu.edu

Sent: Wednesday, October 29, 2014 9:23 AM
Cc: Millen, Barbara E; jtb4@cornell.edu; Casavale, Kellie (OS/OASH); Obbagy, Julie - CNPP; Anna Maria Siega-Riz
I added some comments.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
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Tufts University
Boston, MA 02111
phone: 617 556 3127

Sent: Tuesday, October 28, 2014 8:07 AM
Cc: Lichtenstein, Alice; Millen, Barbara E; jtb4@cornell.edu; Casavale, Kellie (OS/OASH); Obbagy, Julie - CNPP; Anna
Maria Siega-Riz
attached file.
On Tue, Oct 28, 2014 at 8:06 AM, Frank Hu <nhbfh@channing.harvard.edu> wrote:
Dear all,
attached please find a draft of the evidence summary on saturated fat and CVD. I would appreciate your
comments.
One question is whether we should say something about major food sources of saturated fat, considering that
the DGAC puts more emphasis on foods/patterns than individual nutrients.
Regards
366
PSC-HHS-000366
Frank
On Sat, Sep 13, 2014 at 10:11 PM, Frank Hu <nhbfh@channing.harvard.edu> wrote:
Eve,
Thanks. Attached are draft conclusion statement and implications for saturated fat and CVD. It would be great
if I can get feedback from Alice, Barbara, Tom, and Ana Maria before Monday's discussion at SC2 meeting.
The conclusion statements are longer than usual due to complexity of the evidence base and practical
implications in multiple dimensions.
I look forward to your comments.
Frank
On Sat, Sep 13, 2014 at 5:13 PM, Essery, Eve - CNPP <Eve.Essery@fns.usda.gov> wrote:
Hi Frank,
Yes, I’ll send you the webinar and call-in information to join the SC2 meeting on Monday. The SC2 slides I sent last night
include a few slides on saturated fat, and the slides can be built out based on your discussion on Monday. I think if you
are ready to draft conclusions and implications, please do so! I plan to send out the draft agenda and attachments to
SC2 mid-day tomr. Unless I hear from you otherwise, I’ll include this document as an attachment.
THANKS and talk soon,
Eve

Sent: Saturday, September 13, 2014 7:23 AM
Cc: Millen, Barbara E; Essery, Eve - CNPP; jtb4@cornell.edu; Casavale, Kellie (OS/OASH); Obbagy, Julie - CNPP; Anna
Maria Siega-Riz

367
PSC-HHS-000367
Alice, Tom, and Barbara,
Thanks for your helpful comments. I have tried to incorporate them in the revised version as much as possible.
Some issues need to be discussed. Unfortunately I will not be at the meeting in person on Monday (will fly
there tuesday morning). I assume I can join the discussion via tel or Skype?
Eve, what's the next step? do we need to develop conclusion statement, implications? Do we plan to present
this section at the public meeting on Tuesday?
Frank
On Fri, Sep 12, 2014 at 8:19 AM, Lichtenstein, Alice <Alice.Lichtenstein@tufts.edu> wrote:
Very nice job Frank. I added my comments to Barbara’s.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111
phone: 617 556 3127
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Sent: Friday, September 12, 2014 5:43 AM
Cc: Lichtenstein, Alice; jtb4@cornell.edu; Casavale, Kellie (OS/OASH); Obbagy, Julie - CNPP
Here you go. Very nice summary with strong quantifiable outcomes. I would advocate a couple of things as noted in
my comments, in particular some clarification on methods and modes of intervention that are successful in achieve
these results, what level of PUFA and SFA are realistic to achieve (based on the trial evidence and possibly PCs) s and
whether there are any added benefits of total fat reduction with PUFA substitution for SFA and/or weight loss.
Many thanks Eve and Frank for this great work so quickly.
Barbara
bmillen@bu.edu

Sent: Thursday, September 11, 2014 11:41 PM
Cc: alice.lichtenstein@tufts.edu; Millen, Barbara E; jtb4@cornell.edu; Casavale, Kellie (OS/OASH); Obbagy, Julie - CNPP
Dear All,
attached is a draft key trend document. I'd appreciate your comments and suggestions.
Frank
On Tue, Sep 9, 2014 at 12:43 PM, Essery, Eve - CNPP <Eve.Essery@fns.usda.gov> wrote:
Hi Alice, Frank, Tom, and Barbara,

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PSC-HHS-000369
Attached are the materials we reviewed on Thursday’s call for your question on saturated fat and CVD. Per your request,
we have added Jakobsen, which was not identified in the original search because it was not tagged as a meta-analysis.
We also added Skeaff, 2009 per Tom’s request. Skeaff was also not identified in the original search because it did not
include “saturated” in the title or abstract (no abstract available).
Please see the following attached:
1. Include/exclude list – Please review and let us know if you think something was incorrectly excluded or is missing.
2. Evidence table
3. Reference overlap
4. PDFs of included articles
5. Key trends document – Please provide brief responses to the questions to help inform your synthesis and
development of conclusions.
Does one of you want to take the lead and do a first pass and then do a round robin with the group?
Let me know if you need anything else.
Eve
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Giving the matter more thought I wonder whether we can give a range of recommended SFA
intake. There is no magic/data for the 10% number or 7% number that has been used
previously. The AHA/ACC 5% to 6% range is based on two studies using a lower total fat diet
intakes, 26%-27%, the bottom of what we currently recommend.

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

Hi Eve,
374
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frank
Hi Frank,
the slides?
THANKS!
Eve

recommendation
Barbara
bmillen@bu.edu

375
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‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111
phone: 617 556 3127

Maria Siega-Riz
attached file.
Dear all,
comments.
376
PSC-HHS-000376
Regards
Frank
Eve,
Frank
Hi Frank,
Eve

377
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Maria Siega-Riz
Frank
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
378
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Boston, MA 02111
phone: 617 556 3127

Barbara
bmillen@bu.edu

Dear All,
379
PSC-HHS-000379
Frank
2. Evidence table
Eve
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‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

Hi Eve,
frank
384
PSC-HHS-000384
Hi Frank,
the slides?
THANKS!
Eve

recommendation
Barbara
bmillen@bu.edu

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
385
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Tufts University
Boston, MA 02111
phone: 617 556 3127

Maria Siega-Riz
attached file.
Dear all,
comments.
Regards
386
PSC-HHS-000386
Frank
Eve,
Frank
Hi Frank,
Eve

Maria Siega-Riz
387
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Frank
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111
388
PSC-HHS-000388
phone: 617 556 3127

Barbara
bmillen@bu.edu

Dear All,
Frank
389
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2. Evidence table
Eve
390
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Subject: RE: Draft Slides- Millen
Attachments: INTEGRATION and NEXT STEPS 11 2 14 bem edits 11 4 2014.pptx; INTRO to Cross-
cutting Topics MILLEN 11 2 14 bem edits 11 4 2014.pptx; INTRO to SC Reports MILLEN
11 2 14b bem edits 11 4 2014.pptx
Here you go. Please take a look at these. I didn’t make many changes to the slides themselves but did in the notes in
some places. Unfortunately note edits do not highlight. In particular, please look at Slides 2, 6, 7 and 8 in the Intro
presentation and then slides 3 4 6 and new slide 11 in the Integration deck. Hopefully, this capture what you were
hoping for. I wanted to leave the group with a bit of inspiration and hope I did in Slide 11. Let me know.

These ideas for integration and final recommendation are beginning to sharpen in my mind. Looking forward to our
discussions and meetings.

Barbara

bmillen@bu.edu

Subject: Draft Slides- Millen
Importance: High

Barbara,

Three slide decks are attached as a starting place for your remarks! I hope it will be very nice to be in the comforts of
your home rather than behind a podium this time  Attached please find:

1. Intro to SC Reports‐ (20 min) This presentation is almost identical to the past couple meetings. You probably
have it memorized by now! I updated the commentary a bit to be timely to where you are currently in the
process. There is a placeholder on the conceptual model so that we can discuss tomorrow what you might like
to include here.
2. Intro to Cross‐cutting Topics‐ In the afternoon, before the Sodium, Added Sugars, and Saturated Fat Working
Groups present, you have 10 minutes to set the stage for why the DGAC created working groups. It’s a short
slide deck, and you can elaborate on the rationale for the importance of these topics as “Cross‐cutting topics of
Dietary Guidance and Public Health Importance.”
3. Integration and Next steps‐ There is 20 minutes for presentation/discussion on “Integrating Findings” and 10
minutes for you to review “Next Steps” before Rick adjourns the meeting. I just included the slides from the
Intro to SC remarks that highlight the overarching themes, cross‐cutting‐issues, and topic scopes for the 5 SCs
and 4 WGs as just a starting place to think about what would be most useful to state for the members to provide
some insight that you might find useful in fleshing out the outline for the integration chapter. We can edit these
to be whatever you would find most useful.
394
PSC-HHS-000394
4. Internal Agenda‐ Last, I attached the updated internal agenda that I will send to the entire DGAC so that you can
see on the last two pages how these presentations occur within the full meeting. I have yet to add the call‐in
info for Friday, but will before I circulate it.

Let me know if you have questions or what I can help you with further. We need your final slides by Thursday night.
Thanks!

Kellie

Rockville, MD 20852
(240) 453‐8252

395
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Cc: jtb4@cornell.edu; Casavale, Kellie (OS/OASH); Obbagy, Julie - CNPP; Anna Maria Siega-
Riz
Attachments: Evidence Summary CVD and Sat Fat 10 28 Frankhu AHL BEM.docx
recommendation

Barbara
bmillen@bu.edu

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Tufts University
Boston, MA 02111

phone: 617 556 3127

Maria Siega-Riz
attached file.

Dear all,
396
PSC-HHS-000396
comments.
Regards
Frank

Eve,
Frank
Hi Frank,
Eve

Maria Siega-Riz
397
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Frank
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Tufts University
Boston, MA 02111
phone: 617 556 3127
398
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Barbara
bmillen@bu.edu

Dear All,
Frank
399
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2. Evidence table
Eve
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Sent: Thursday, October 30, 2014 5:32 AM
To: Essery, Eve - CNPP; 'Siega-Riz, Anna Maria'; 'alice.lichtenstein@tufts.edu';
'c1anderson@ucsd.edu'; 'jtb4@cornell.edu'; 'steven.clinton@osumc.edu';
'frank.hu@channing.harvard.edu'; 'mneuhous@fhcrc.org'; 'rafael.perez-
escamilla@yale.edu'
Cc: Olson, Richard (HHS/OASH); Rihane, Colette - CNPP; Bowman, Shanthy; Obbagy, Julie -
CNPP; Fisher, Rachel (NIH/NIDDK) [E]; McDowell, Margaret (NIH/NIDDK) [E]; Wong,
Yatping - CNPP; 'Anne Rodgers'; Casavale, Kellie (OS/OASH);
'PBROWN@hsph.harvard.edu'; 'jconnor@fhcrc.org'; 'Bailey, Lauren A.'; 'Knight, Brianna';
'Angelica Figueroa'; Fu, Stephenie - CNPP; Psota, Tricia - CNPP; anjuli.bodyk@yale.edu
Subject: RE: DGAC SC2: Call TOMR @ 11am ET (8am PT) - DRAFT chapter for review!
Attachments: DGAC SC2_Compiled Chapter_SC review_10-27-14 bem edits 10 28 2014.docx
Hi all,

Congratulations on the chapter! It is coming together very well. I took quite a bit of time to review it in somewhat
greater detail. Hopefully this will make the next level of review easier. A few overall points….It will be important to
review the consistency across SC chapters in the wording of and emphasis in the dietary pattern statements. For this
review, I suggested wording that we discussed in the last SC2 call. Your wording is very close but you will note that I am
recommending some slight editing. Also, the ‘what works’ could come through a bit stronger based on the evidence,
particularly as related to weight management. I am suggesting that the AHA/ACC review of RCTs precede the
prospective cohort literature in that section of the chapter. It think this may better reflect the high level of concern over
ingrained, very high rates of overweight and obesity in our population and the moderate to strong evidence on how
best to manage it. Also, I noticed that the Look Ahead Diabetes trial was not addressed and think we can use the
AHA/ACC reports for that purpose. Those in the field consider it pretty definitive so I think the conclusions and evidence
summary on DM from the existing reports need to be drawn upon to add to our DM section. It was not until the cancer
section that there was mention that the cohort literature often only defines dietary exposures (or other exposures) at
baseline and may not consider all relevant potential confounders. You may wish to include this in the brief discussion of
limitations in the dietary assessment methods in your introduction. I did though soften the wording here a bit. I don’t
think we want to be so strong in our critique of these methods that we take away from our conclusions. The key thing is
that the limitations will add to the bias towards the ‘null’ and may thereby make our moderate to strong conclusions
where we see them that much more important.

If you have any questions, please let me know.

Best,

Barbara

bmillen@bu.edu

Sent: Monday, October 27, 2014 5:46 PM
To: 'Siega-Riz, Anna Maria'; 'alice.lichtenstein@tufts.edu'; 'c1anderson@ucsd.edu'; 'jtb4@cornell.edu';
'steven.clinton@osumc.edu'; 'frank.hu@channing.harvard.edu'; 'mneuhous@fhcrc.org'; 'rafael.perez-escamilla@yale.edu';
Millen, Barbara E
403
PSC-HHS-000403
Cc: 'Olson, Richard (HHS/OASH)'; Rihane, Colette - CNPP; Bowman, Shanthy; Obbagy, Julie - CNPP; 'Fisher, Rachel
(NIH/NIDDK) [E]'; 'margaret.mcdowell@nih.gov'; Wong, Yatping - CNPP; 'Anne Rodgers'; 'Casavale, Kellie (OS/OASH)';
'PBROWN@hsph.harvard.edu'; 'jconnor@fhcrc.org'; 'Bailey, Lauren A.'; 'Knight, Brianna'; 'Angelica Figueroa'; Fu,
Stephenie - CNPP; Psota, Tricia - CNPP; anjuli.bodyk@yale.edu
Subject: DGAC SC2: Call TOMR @ 11am ET (8am PT) - DRAFT chapter for review!
Attached is the DRAFT compiled SC2 chapter (congrats!!). Anna Maria has requested that for tomorrow’s discussion, you
focus your review on the Chapter Introduction, Methodology, and Summary and come prepared to discuss your
comments, particularly related to any potential gaps in those sections. We will also talk about next steps for the chapter
review. Thanks and talk soon!
Eve
2015 Dietary Guidelines Advisory Committee

Subcommittee 2: Dietary Patterns, Foods and Nutrients, and Health Outcomes
Tuesday, October 28 from 11:00am to 12:00 pm ET (8:00 to 9:00 am PT)
Call-in number: (b) (6)
Access code: (b) (6)
Web conference: (b) (6)


404
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Cc: Millen, Barbara E; jtb4@cornell.edu; Casavale, Kellie (OS/OASH); Obbagy, Julie - CNPP;
Anna Maria Siega-Riz
Attachments: Evidence Summary CVD and Sat Fat 10 28 Frankhu AHL.docx
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Tufts University
Boston, MA 02111

phone: 617 556 3127

Maria Siega-Riz
attached file.

Dear all,
comments.
Regards
Frank

Eve,
405
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Frank
Hi Frank,
Eve

Maria Siega-Riz
Frank
406
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Tufts University
Boston, MA 02111
phone: 617 556 3127

407
PSC-HHS-000407

Barbara
bmillen@bu.edu

Dear All,
Frank
2. Evidence table
408
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Eve
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PSCFileNo.: 16-0040-FOIA; 16-0226-FOIA

Dear Mr. Heimlich:

Enclosure: 411 pages on CD

From: Lichtenstein, Alice <Alice.Lichtenstein@tufts.edu>

From: Siega-riz, Anna Maria [mailto:am_siegariz@unc.edu]

Anna Maria Siega-Riz, PhD

From: Millen, Barbara E [bmillen@bu.edu]

From: Frank Hu [mailto:nhbfh@channing.harvard.edu]

The followings are the website for registration and webcast:

Dr. Barbara E. Millen

From: Mary Story, Ph.D. [mailto:mary.story@duke.edu]

As an initial speaker I think Jim Marks or Michael McGinnis would be good.

From: <Millen>, "'Barbara Millen, DrPH, MPH, RD'" <bmillen@bu.edu>

All the very best,

Dr. Barbara E. Millen

From: Millen, Barbara E

Date and Time: Wednesday, February 25 3:30-6:00 p.m.

Symposium format: Introduction: Comments by leader from satellite sites and/or

All the best,

Dr. Barbara E. Millen

From: Millen, Barbara E <bmillen@bu.edu>

This nonsense aside, congrats on all the press coverage!

---------- Forwarded message ----------

From: Lichtenstein, Alice <Alice.Lichtenstein@tufts.edu>

From: HealthDay News Service [mailto:HealthNews@HealthDay.com]

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From: Lichtenstein, Alice <Alice.Lichtenstein@tufts.edu>

From: Lichtenstein, Alice <Alice.Lichtenstein@tufts.edu>

Kellie, very much appreciated. Very well stated.

From: Casavale, Kellie (OS/OASH) [mailto:Kellie.Casavale@hhs.gov]

From: Casavale, Kellie (OS/OASH) [mailto:Kellie.Casavale@hhs.gov]

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From: Lichtenstein, Alice <Alice.Lichtenstein@tufts.edu>