The current review of the Australian Dietary Guidelines with Dr Rosemary Stanton
Rosemary is a stand-out Australian nutritionist and dietitian whose work has been acknowledged with an Order of Australia award. The Australian Dietary Guidelines (ADGs) are Australia’s leading public health nutrition resource. Every few years (when there is funding) the ADGs are reviewed and updated. Join us as Rosemary weighs in on the current ADG review.
We cover:
Promotion of the DGs
Sustainability
International DGs
Expert Committee & Governance Committee
The “very high priorities” of the current review
The need for the DGs to be practical
Stakeholder engagement
Animal protein vs plant protein
Plus more
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National Health and Medical Research Council (NHMRC) written responses:
What are the Australian Dietary Guidelines (ADGs)? What is their main purpose?
The Australian Dietary Guidelines are Australia’s leading public health nutrition resource. They provide guidance on foods, food groups and dietary patterns that protect against chronic disease, and on the foods required for optimal health and wellbeing.
They make recommendations based on whole foods, such as vegetables and meats, rather than recommendations relating to specific food components or individual nutrients.
The Dietary Guidelines promote the benefits of healthy eating, not only to reduce the risk of diet-related disease but also to improve community health and wellbeing.
How are the current 2013 ADGs actually used? Who uses them?
The dietary guidelines are used by clinicians, public health policy makers, educators and consumers to guide healthy eating that supports good health and prevents chronic disease. This includes in workplaces, schools, childcare, food service, food retail and food industry.
The Dietary Guidelines are for Australians of all ages and backgrounds in the general population, including people with common diet-related risk factors such as being overweight. They don’t apply to people with medical conditions requiring specialised dietary advice, or to frail elderly people who are at risk of malnutrition.
Is there any data on how many Australians’ follow the current dietary guidelines?
The Australian Bureau of Statistics report on how Australians measure against some of the Dietary Guidelines recommendations in their National Health Survey. For example, in 2020–21 only 6.1% of adults and 8.5% of children ate the recommended amount of both fruit and vegetables.
How long have the ADGs been around for?
The first version of the Dietary Guidelines written for the general public was released in 1982.
How often are the ADGs updated?
The Dietary Guidelines were updated 1992 (Dietary Guidelines for Australians), 1999 (Dietary Guidelines for older Australians), 2003 Dietary Guidelines for Australian Adults, Dietary Guidelines for Childrens and Adolescents in Australia and 2013 (Australian Dietary Guidelines). As NHMRC relies on external funding to develop or revise public health guidelines, NHMRC reviews evidence and revises guidelines when requested and funded by the Australian Government and/or the states and territories.
So that your everyday Aussie can get an understanding of what goes into a Dietary Guideline review. Can you please give us an overview of the process of this review?
NHMRC public health guidelines and advice follow a rigorous evidence-based approach. There are many steps involved. Guidelines are developed with the assistance of multidisciplinary expert committees consistent with NHMRC’s guideline development process. More information on this can be found on the NHMRC website (www.nhmrc.gov.au/how-nhmrc-develops-public-health-guidelines.
Diet is a huge topic, with a large volume of evidence underpinning the Guidelines. The Dietary Guidelines Expert Committee identified the highest priority topics based on the public health impact. The likelihood that the evidence-base has changed enough since the release of the 2013 Guidelines to change the recommendations was also considered.
To make the most efficient use of scarce resources, existing high-quality systematic reviews will be used where available to update the 2013 Guidelines.
Scoping and mapping work to identify and map existing systematic reviews that can answer the highest priority research questions is currently taking place. The Expert Committee may also identify critical gaps where new evidence reviews may need to be commissioned.
The Expert Committee will consider suitable existing and new reviews, along with other relevant information such as equity, feasibility, preferences and cost in a transparent way.
Guidelines are informed by the judgement of evidence by experts, and the views of consumers, community groups and other people affected by the guidelines.
NHMRC guidelines include a number of quality assurance steps including quality and risk of bias assessment of studies, independent methodological review, public consultation and independent expert review. The revised Guidelines are anticipated to be released in late 2025.
More information about the Dietary Guidelines revision is available on the NHMRC website: https://www.nhmrc.gov.au/health-advice/nutrition/australian-dietary-guidelines-review/guideline-development
How are the multidisciplinary committees (expert & governance) selected?
As part of NHMRC's commitment to best practice and transparency, the Dietary Guidelines Governance Committee (Governance Committee) has been appointed to consider possible conflicts of interest and potential bias across the revision process. The Governance Committee was established under the NHMRC Act, with members appointed by the NHMRC CEO. Members represent a wide range of expertise such as conflicts of interest management, guideline development and review processes, research methodology, health ethics and stakeholder influence on health research and policy.
The Dietary Guidelines Expert Committee (Expert Committee) advises NHMRC on the evidence to be considered and the final recommendations in the revised dietary guidelines. Members were appointed based on their expertise in areas such as evidence translation, epidemiology, research methodology, food and health relationships and nutrition communication. The Expert Committee includes members with expertise in Aboriginal and/or Torres Strait Islander health and consumer behaviours.
In November 2020, NHMRC issued an Expression of Interest, seeking candidates for appointment to the Expert Committee. Individuals were invited to nominate and submit an expression of interest for appointment to the Expert Committee. Applicants who met the selection criteria were asked to disclose relevant interests. The Governance Committee assessed disclosed interests for actual or perceived conflicts of interest in accordance with the NHMRC Policy on the Disclosure of Interests Requirements for Prospective and Appointed NHMRC Committee Members (2019). Applicants were shortlisted based on expertise and disclosed interests, also balancing geographic location, career stage and gender. The shortlist was presented to the CEO of NHMRC for consideration and appointment.
Further information about our Committees is available on the NHMRC website: https://www.nhmrc.gov.au/health-advice/nutrition/australian-dietary-guidelines-review/committees
The NHMRC allows for stakeholder input. Who are the stakeholders and how is their input considered?
Anyone who uses the Dietary Guidelines is a stakeholder. This includes the general public, health professionals, government and industry.
A stakeholder scoping survey to help inform research priorities was completed in 2021. Almost 3000 anonymous responses to the survey were received with half of respondents reporting that they used the Guidelines for work purposes and half reporting that they had used them for personal reasons.
A targeted consultation survey also collected information on how the Guidelines and companion resources are used among people who work with Aboriginal and Torres Strait Islander peoples to promote health and wellbeing.
The results of both surveys were considered during the prioritisation process.
Currently, stakeholders can submit systematic review citations to an open public call for evidence (closing 11 September 2023). This will help NHMRC identify relevant systematic reviews addressing the highest priority research questions.
All stakeholders will be able to comment on the draft guidelines sometime in 2024 or 2025. All feedback is considered by the Expert Committee and the NHMRC and the draft guidelines are updated in response to the feedback, as required.
More information about stakeholder opportunities are outlined on the NHMRC website at https://www.nhmrc.gov.au/health-advice/nutrition/australian-dietary-guidelines-review/communication
Planned public consultation opportunities will be communicated on the website and to the Dietary Guidelines contact list.
How is the process different in this review compared to the review carried out for the 2013 Dietary Guidelines?
The same processes are followed for any guideline developed by the NHMRC. NHMRC guidelines are based on a review of the available evidence and follow transparent development and decision-making processes.
Since the development of the 2013 Guidelines there have been improvements in NHMRC processes in line with international best practice such as the application of Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methods to assess evidence and an enhanced risk of bias assessment.
Additional measures taken for this review include:
strengthened management of disclosures of interest for committee members and contractors
appointment of a Governance Committee to consider possible conflicts of interest and potential bias across the revision
enhanced transparency measures including publication of Expert Committee meeting outcomes (communiques)
a communication log summarizing external communications that aim to influence the review process.
Information about the review process is available on the NHMRC website (https://www.nhmrc.gov.au/health-advice/nutrition/australian-dietary-guidelines-review/guideline-development)
More specifically, how is the stakeholder input different in this review compared to the previous review?
NHMRC recognises the value of public consultation. Opportunities for stakeholder input are communicated through the dietary guidelines contact list and social media channels. While the public consultation requirements have not changed, the methods of notification are now all digital.
Only systematic reviews from stakeholders will be considered at this stage. What does “at this stage” mean?
We are finalising the scoping and mapping work to identify existing systematic reviews that could be used to update the Dietary Guidelines. Given this, we are only interested in systematic reviews right now. Stakeholders will have further opportunities to provide input later in the process.
More information about the prioritisation process and research question development is available in the Prioritisation Process Report on the website (https://www.nhmrc.gov.au/about-us/publications/prioritisation-process-report).
Are other dietary guidelines across the globe that have recently been updated considered?
Yes. NHMRC considers relevant international dietary guidelines. The most recent was the Nordic Nutrition Recommendations published in June 2023.
What are some of the ways that the Australian context is considered?
The Expert Committee is comprised of Australian members. The evidence to decision process will also consider the Australian context when developing recommendations.
Is there any budget being put towards the communication of the updated ADGs once they are released?
The Department of Health and Aged Care is responsible for implementation of the Guidelines.
What are the highest priority topics and how were they decided on?
In summary the priority topics are:
dietary patterns (combinations and amounts of foods regularly consumed)
nutritional needs across the life course
protein-rich foods (meats and poultry, fish, eggs, tofu, nuts and seeds and legumes/beans)
(ultra) processed foods.
Sustainable diets (accessible, affordable and equitable diets with low environmental impacts) were also identified as a very high priority.
During 2020 and 2021, NHMRC undertook initial scoping activities. These activities were intentionally broad, involving web searches, literature database searches and media platform searches. Direct input was sought from stakeholders through surveys and targeted consultation on various aspects of the 2013 Dietary Guidelines and companion resources.
The initial scoping activities identified a broad list of research topic areas of interest. This list was considered by the Expert Committee who participated in a series of surveys and discussions to agree on a shortlist of topic areas.
Further information about the prioritisation process and prioritised topics is available in the Prioritisation Process Report on the website (https://www.nhmrc.gov.au/about-us/publications/prioritisation-process-report).
What definition of ultra-processed foods will be used?
The definition has intentionally been left broad at the scoping stage to capture relevant systematic reviews. The definition will be considered further by the Expert Committee following the scoping and mapping process.
Are there any areas that have never been looked at before but are being reviewed as part of this ADG update?
Information about the topics considered is available in the Prioritisation Process Report: https://www.nhmrc.gov.au/about-us/publications/prioritisation-process-report
The most frequently mentioned ‘new’ topics stakeholders wanted considered in the revised Dietary Guidelines were:
food processing
plant-based diets
cultural considerations.
While these topics may have been considered as part of the 2013 Dietary Guidelines they were not included in key recommendations.
Sustainability was included in the 2013 Dietary Guidelines as an Appendix and stakeholders were keen for it be considered in the revision.
These topics were identified as high priority for review by the Expert Committee.
It’s outlined that the relationship between dietary patterns and/or food intakes and sustainability outcomes is a very high priority. What is the intended separate process that this will be addressed by?
NHMRC is still considering the best way to progress this complex work.
Will any weighting be given to environmental impacts in the food recommendations?
No decision about recommendations have yet been made.
Is there anything that can be shared with the public now on how these ADGs will be different than the previous ADGs?
Information about the work to date and the process we are following is on the NHMRC website. If people want to stay informed they can subscribe to the dietary guidelines email list or visit the website.
