Human milk is considered the biologic norm for feeding the human infant during the first 6 months of life, and it is a preferred food from 6 to 12 months. It is a complex food and exerts its biologic effects well beyond its known nutritional value; however, human milk composition and the complexity of its composition is not wholly known or understood. Thus, defining the composition of milk, as well as both the individual and combined effects of milk components and the volume consumed on infant growth and development, is central to optimizing infant health. Furthermore, defining human milk composition, volume, and the myriad factors that influence milk components is needed for developing future Dietary Reference Intake (DRI) standards for nutrient intakes during the first 12 months of life. Scanning for New Evidence on the Nutrient Content of Human Milk examines the new and emerging evidence describing the nutrient content of human milk as well as the volume of milk consumed, both of which are needed to understand nutrient consumption by healthy breastfed infants. An evidence scan approach was used to summarize the status of the published literature on the nutrient content of human milk and to identify new evidence on nutrients in human milk that could inform the need for a systematic review as a component of the DRI process. Table of Contents Front Matter Summary 1 Introduction 2 Methodological Approach to Evidence Scanning 3 Results 4 Discussion and Future Directions Appendix A: Acronyms and Abbreviations Appendix B: Open Session Agenda Appendix C: Literature Search Results Appendix D: Revised Search Criteria Appendix E: Data Abstraction Spreadsheet Appendix F: Committee Member Biographies

The National Academies of Sciences, Engineering, and Medicine convened a public workshop in September 2017 to explore the evidence for achieving global harmonization of methodological approaches to establishing nutrient intake recommendations. Participants reviewed current nutrient intake recommendations, discussed the feasibility of harmonizing approaches to setting such recommendations globally, examined the development of principles by which they may be applied in diverse contexts that relate to individuals or populations, or regulatory purposes, and examined perceptions and acceptance of nutrient intake recommendations by different stakeholders. This publication summarizes the presentations and discussions from the workshop. Table of Contents Front Matter 1 Introduction 2 Background for the Workshop 3 Harmonization Frameworks 4 Current Models for Establishing Intake Recommendations 5 Exploring Approaches to Evaluating the Evidence 6 Contextual Factors: Host, Diet/Environment, and Health Status 7 Breakout Discussions: Applications, Facilitating Quality, and Cost-Effectiveness 8 Exploring Advantages, Barriers, and Challenges to Global Harmonization of Methodologies for Nutrient Intake Recommendations 9 Moving the Conversation Forward References Appendix A Workshop Agenda Appendix B Speaker and Facilitator Biographies

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) began 40 years ago as a pilot program and has since grown to serve over 8 million pregnant women, and mothers of and their infants and young children. Today the program serves more than a quarter of the pregnant women and half of the infants in the United States, at an annual cost of about $6.2 billion. Through its contribution to the nutritional needs of pregnant, breastfeeding, and post-partum women; infants; and children under 5 years of age; this federally supported nutrition assistance program is integral to meeting national nutrition policy goals for a significant portion of the U.S. population. To assure the continued success of the WIC, Congress mandated that the Food and Nutrition Service of the U.S. Department of Agriculture (USDA) reevaluate the program's food packages every 10 years. In 2014, the USDA asked the Institute of Medicine to undertake this reevaluation to ensure continued alignment with the goals of the Dietary Guidelines for Americans. This, the second report of this series, provides a summary of the work of phase I of the study, and serves as the analytical underpinning for phase II in which the committee will report its final conclusions and recommendations. Table of Contents Front Matter Summary 1 Introduction and Background 2 The WIC Participant Experience 3 Approach to the Task 4 Nutrient Intakes of WIC-Eligible Populations 5 Food Intake of WIC-Eligible Populations 6 Nutrition-Related Health Risks in the WIC Population 7 Promotion, Motivation, and Support of Breastfeeding with the WIC Food Packages 8 Meeting Diverse Dietary Needs and Preferences: Considerations for the WIC Food Packages 9 Background and Approach to Considering Food Package Options 10 Food Expenditure Analysis 11 Findings and Conclusions Appendix A: Acronyms and Abbreviations Appendix B: Glossary Appendix C: Comparison of Institute of Medicine 2006 Recommendations and Regulatory Implementation Appendix D: Composition of the WIC Food Packages Appendix E: The U.S. Department of Agriculture's Food and Nutrition Service Funded Studies Describing the Effect of the 2009 WIC Food Package Changes Appendix F: Changes in the WIC Food Packages and Program Participation: Methods Appendix G: Literature Findings on Barriers and Incentives to WIC Participation and Redemption Appendix H: Workshop Agendas Appendix I: Evidence Review Strategy Appendix J: Dietary Reference Intake Values and Nutrients and Foods Analyzed Appendix K: Diet Quality Indexes Appendix L: Household Food Expenditure Analysis Appendix M: Regulatory Impact Analysis Approach Appendix N: Committee Perceptions of the WIC Experience Appendix O: Summary Results from the Diet Quality of American Young Children by WIC Participation Status Appendix P: Nutrient Intake of WIC and WIC-Eligible Populations Appendix Q: Food Intake of WIC and WIC-Eligible Populations Appendix R: Summary of National Dataset Characteristics Applied in the Evaluation of Health Risks Appendix S: Breastfeeding Literature Findings Appendix T: Chronology of Statutes Pertaining to the Definition of WIC Supplemental Foods Appendix U: Committee Biosketches

Review of WIC Food Packages: An Evaluation of White Potatoes in the Cash Value Voucher assesses the impact of 2009 regulation to allow the purchase of vegetables and fruits, excluding white potatoes, with a cash value voucher on food and nutrient intakes of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) population and to consider whether white potatoes should be permitted for purchase with the voucher. This report considers the effects on diet quality, the health and cultural needs of the WIC population, and allows for effective and efficient administration nationwide in a cost-effective manner. Review of WIC Food Packages: An Evaluation of White Potatoes in the Cash Value Voucher recommends that the U.S. Department of Agriculture should allow white potatoes as a WIC-eligible vegetable, in forms currently permitted for other vegetables, in the cash value voucher pending changes to starchy vegetable intake recommendations in the 2015 Dietary Guidelines for Americans. Table of Contents Front Matter Summary Letter Report Appendix A: Acronyms and Abbreviations Appendix B: Statement of Task Appendix C: Workshop Agendas Appendix D: Literature Search Strategy Appendix E: Dietary Reference Intakes Appendix F: Description of Sensitivity Analysis Scenarios Appendix G: Food Group and Subgroup Intakes Appendix H: Nutrient Intakes Appendix I: Nutrient Profiles Appendix J: Food Group Distributions Appendix K: Healthy Eating Index 2010 Assessment Appendix L: Background Example Data for Sensitivity Analysis Appendix M: Committee Biosketches

This midcourse report provides an initial assessment of how the process used to develop the Dietary Guidelines for Americans, 2020-2025 (DGA) compares to the recommendations in the 2017 National Academies report on redesigning the process for establishing the DGA. It also assesses the criteria and processes for including the scientific studies used to develop the guidelines. The scope of this study was to address the process and not the content of the guidelines. Table of Contents Front Matter Summary 1 Introduction 2 Methodological Approach to the Task 3 Analysis of the Scientific Methodologies, Review Protocols, and Evaluation Processes of the Dietary Guidelines 4 Analysis of the Scientific Studies Used to Develop the Dietary Guidelines for Americans 5 Concluding Remarks Appendix A: Committee Member Biographies Appendix B: Open Session Agendas and Comments Appendix C: Systematic Review Matrix Summary Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table Appendix E: Summary of Selected Systematic Review Practices Appendix F: Selected Systematic Review Methodologies 2015 Versus 2020 Appendix G: Systematic Review Questions Addressing Diet-Related Metabolic Diseases Appendix H: Updated Systematic Reviews

The Food and Nutrition Board (FNB) of the National Academies of Sciences, Engineering, and Medicine was convened in 1940 in response to a request from the U.S. National Defense Advisory Commission to the National Academy of Sciences for aid in studying problems of nutrition in the United States. Today the FNB is the focal point for activities concerned with food, nutrition, and food safety, and their roles in health maintenance and disease prevention. Now in its 80th year, the FNB has continued its growth and expanded its reach both domestically and internationally, providing visionary leadership across a range of nutrition and food science issues toward the improvement of human health. In honor of its 80 years of service to the nation, the FNB convened a public symposium to review the origin and history, policy influence, and future directions of the FNB. This publication summarizes the presentations of the event. Table of Contents Front Matter 1 Introduction 2 Opening Remarks and Perspectives from Leadership 3 Keynote Address 4 The Food and Nutrition Board's Impact on Nutrition and Science: Domestic and International Perspectives 5 New Challenges in Nutrition, Food Science, and Policy 6 Participant Discussion: Future Directions for the Food and Nutrition Board 7 Perspectives on the Future of the Food and Nutrition Board References Appendix A: Symposium Agenda Appendix B: Acronyms and Abbreviations Appendix C: Biographical Sketches of Symposium Speakers and Moderators

An estimated 90 percent of oncology patients in the United States receive treatment in outpatient cancer centers and clinics. This change from the older model of inpatient care has important implications for overall quality of care for oncology patients and nutritional care in particular. Amidst growing concern about access to oncology nutrition services, combined with growing recognition of the importance of providing nutritional care to optimize oncology treatment outcomes and maximize quality of life among both patients and survivors of cancer, the National Academies of Sciences, Engineering, and Medicine convened a public workshop in March 2016 to explore evolving interactions between nutritional care, cancer, and health outcomes. Participants explored how health outcomes and survival of cancer patients in outpatient cancer centers are affected by current standards for nutritional services, nutritional interventions, and benefits associated with oncology patient access to medical nutrition therapy. They also studied the cost of outpatient nutritional care and assessed cost?benefit relationships between oncology nutrition services and health outcomes and survival. This publication summarizes the presentations and discussions from the workshop. Table of Contents Front Matter 1 Introduction 2 Current Knowledge and Status of Nutrition Practices in Oncology Outpatient Care 3 Models of Care: National and International Perspectives 4 Benefits and Costs of Care 5 Dissemination and Implementation: Reaching the Ideal 6 Evidence on Nutrition Care in Outpatient Oncology: Closing Discussion References Appendix A: Workshop Agenda Appendix B: Biographical Sketches of Speakers and Moderators Appendix C: Additional References Used by the Planning Committee to Develop the Workshop

In response to a request from Congress, the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine conducted a study comparing the process to develop the Dietary Guidelines for Americans, 2020-2025 (DGA 2020-2025) to recommendations included in the previously published National Academies report, Redesigning the Process for Establishing the Dietary Guidelines for Americans. This report describes the findings of the committee and conclusions related to this assessment. Notably, this report does not evaluate the merits of the DGA 2020-2025 but evaluates the process by which they were created relative to the recommendations made in the previously published National Academies report. Table of Contents Front Matter Summary 1 Introduction 2 The Process to Create the Dietary Guidelines for Americans is Both Complicated and Complex: Background and Context for Task 3 3 Methodological Approach to the Task 4 Assessing the Potential Implications of Fully Implementing the 2017 Recommendations to Redesign the Process to Establish the Dietary Guidelines for Americans: Committee Findings and Conclusions 5 Concluding Remarks Appendix A: Committee Member Biographies Appendix B: Elements of the 20202025 Dietary Guidelines for Americans Process Appendix C: Data Sources Used by the 2020 Dietary Guidelines Advisory Committee Appendix D: Open Session Materials

For many Americans who live at or below the poverty threshold, access to healthy foods at a reasonable price is a challenge that often places a strain on already limited resources and may compel them to make food choices that are contrary to current nutritional guidance. To help alleviate this problem, the U.S. Department of Agriculture (USDA) administers a number of nutrition assistance programs designed to improve access to healthy foods for low-income individuals and households. The largest of these programs is the Supplemental Nutrition Assistance Program (SNAP), formerly called the Food Stamp Program, which today serves more than 46 million Americans with a program cost in excess of $75 billion annually. The goals of SNAP include raising the level of nutrition among low-income households and maintaining adequate levels of nutrition by increasing the food purchasing power of low-income families. In response to questions about whether there are different ways to define the adequacy of SNAP allotments consistent with the program goals of improving food security and access to a healthy diet, USDA's Food and Nutrition Service (FNS) asked the Institute of Medicine (IOM) to conduct a study to examine the feasibility of defining the adequacy of SNAP allotments, specifically: the feasibility of establishing an objective, evidence-based, science-driven definition of the adequacy of SNAP allotments consistent with the program goals of improving food security and access to a healthy diet, as well as other relevant dimensions of adequacy; and data and analyses needed to support an evidence-based assessment of the adequacy of SNAP allotments. Supplemental Nutrition Assistance Program: Examining the Evidence to Define Benefit Adequacy reviews the current evidence, including the peer-reviewed published literature and peer-reviewed government reports. Although not given equal weight with peer-reviewed publications, some non-peer-reviewed publications from nongovernmental organizations and stakeholder groups also were considered because they provided additional insight into the behavioral aspects of participation in nutrition assistance programs. In addition to its evidence review, the committee held a data gathering workshop that tapped a range of expertise relevant to its task. Table of Contents Front Matter Summary 1 Introduction and Conceptual Framework 2 History, Background, and Goals of the Supplemental Nutrition Assistance Program 3 Food Security and Access to a Healthy Diet in Low-Income Populations 4 Individual, Household, and Environmental Factors Affecting Food Choices and Access 5 Impact of Program Design on Allotment Adequacy 6 Conclusions and Recommendations Appendix A: Acronyms, Abbreviations, and Terms Appendix B: Open Session with Sponsors Appendix C: Workshop Agenda Appendix D: Approach to Literature Review Appendix E: Questions Related to the Statement of Task Appendix F: Questions on theCore Food Security Module Appendix G: Key Recommendations of the *Dietary Guidelines for Americans* Appendix H: Biographical Sketches of Committee Members

The Dietary Reference Intakes (DRIs) are a set of evidence-based nutrient reference values for intakes that include the full range of age, gender, and life stage groups in the US and Canada. At the request of the U.S. Department of Agriculture, Agricultural Research Service and the U.S. Department of Health and Human Services, Food and Drug Administration, Center for Food Safety and Applied Nutrition, the National Academies of Science, Engineering, and Medicine convened an ad hoc committee to carry out a literature search and evidence scan of the peer-reviewed published literature on indicators of nutritional requirements, toxicity, and chronic disease risk reduction for riboflavin. Scanning for New Evidence on Riboflavin to Support a Dietary Reference Intake Review builds on the methodology for evidence scanning nutrients (which have existing DRIs) to determine whether there is new and relevant knowledge available that may merit a formal reexamination of DRIs for riboflavin. This report offers comments on the methodological approach to the evidence scan and discusses its findings and interpretation of the process to provide the study sponsors with a greater context to support their interpretation and application of the reported results. Table of Contents Front Matter Abstract 1 Introduction 2 Methodological Approach to Evidence Scanning 3 Results 4 Discussion and Future Directions Appendix A: Acronyms and Abbreviations Appendix B: Open Session Agenda Appendix C: Literature Searches Appendix D: Committee Member Biographies Appendix E: Excluded Articles

The integration of biology, genomics, and health has opened the possibility of applying genomics technology to nutrition. In 2001, scientists associated with the Human Genome Project announced the successful mapping of the reference sequence of the human genome. Since then, a body of information has emerged. Genomics and related areas of research have contributed greatly to efforts to understand the cellular and molecular mechanisms underlying diet-disease relationships. Integration and application of genetic and genomics technology into nutrition research is, therefore, needed to develop nutrition research programs that are aimed at the prevention and control of chronic disease through genomics-based nutritional interventions. Of interest is the integration of relevant computational methods into nutritional genomics research; the enhancement of tools applicable to systems biology; and the effective dissemination of genomics-derived information to scientists, policy makers, and the interested public. To address these issues, a workshop was held on June 1 and 2, 2006. The workshop included presentations that were structured around three focus sessions: human genetic variation, epigenetics, and systems biology. A fourth session presented discussions on the implications of nutrigenomics for the future of nutrition science research. Numerous themes emerged from the workshop presentations. First, nutrigenomics is a complex field because it addresses issues related to multigenetic traits that can be modified by a number of nutritional and other environmental factors. Such complexity presents a challenge to the field; and the ensuing research opportunities will require cooperative work among scientific disciplines and across government, academic, and industrial centers, as well as adequate funding, to be realized. Additionally, the ability to stretch the limits of conventional research methodologies afforded by new genetic and genomic applications at the level of the individual opens the door to a wealth of potential benefits to areas such as disease prevention and wellness, bearing in mind the necessity of ethical safeguards. This potential, however, must be wisely exploited to avoid the pitfalls of overpromising research results and prematurely setting unrealistic expectations for beneficial outcomes. Finally, careful and rigorous research must be employed to optimize outcomes and assure acceptance by the scientific community. In summary, nutrition science is uniquely poised to serve as the crossroads for many disciplines and, using genomics tools, can bring this knowledge together to better understand and address diet-related chronic diseases and molecular responses to dietary factors.

Caffeine in Food and Dietary Supplements is the summary of a workshop convened by the Institute of Medicine in August 2013 to review the available science on safe levels of caffeine consumption in foods, beverages, and dietary supplements and to identify data gaps. Scientists with expertise in food safety, nutrition, pharmacology, psychology, toxicology, and related disciplines; medical professionals with pediatric and adult patient experience in cardiology, neurology, and psychiatry; public health professionals; food industry representatives; regulatory experts; and consumer advocates discussed the safety of caffeine in food and dietary supplements, including, but not limited to, caffeinated beverage products, and identified data gaps. Caffeine, a central nervous stimulant, is arguably the most frequently ingested pharmacologically active substance in the world. Occurring naturally in more than 60 plants, including coffee beans, tea leaves, cola nuts and cocoa pods, caffeine has been part of innumerable cultures for centuries. But the caffeine-in-food landscape is changing. There are an array of new caffeine-containing energy products, from waffles to sunflower seeds, jelly beans to syrup, even bottled water, entering the marketplace. Years of scientific research have shown that moderate consumption by healthy adults of products containing naturally-occurring caffeine is not associated with adverse health effects. The changing caffeine landscape raises concerns about safety and whether any of these new products might be targeting populations not normally associated with caffeine consumption, namely children and adolescents, and whether caffeine poses a greater health risk to those populations than it does for healthy adults. This report delineates vulnerable populations who may be at risk from caffeine exposure; describes caffeine exposure and risk of cardiovascular and other health effects on vulnerable populations, including additive effects with other ingredients and effects related to pre-existing conditions; explores safe caffeine exposure levels for general and vulnerable populations; and identifies data gaps on caffeine stimulant effects. Table of Contents Front Matter 1 Introduction 2 Intake and Exposure to Caffeine 3 Safety Signals and Surveillance 4 Exploring Safe Caffeine Exposure Levels for Vulnerable Populations 5 Caffeine Effects on the Cardiovascular System 6 Caffeine Effects on the Central Nervous System and Behavioral Effects Associated with Caffeine Consumption 7 Other Compounds Impacting Caffeine Effects 8 Public Comments 9 Moving Forward: Filling the Data Gaps Appendix A: Workshop Agenda Appendix B: Workshop Attendees Appendix C: Biographical Sketches of Workshop Speakers and Moderators Appendix D: Workshop Statement of Task

Despite efforts over the past several decades to reduce sodium intake in the United States, adults still consume an average of 3,400 mg of sodium every day. A number of scientific bodies and professional health organizations, including the American Heart Association, the American Medical Association, and the American Public Health Association, support reducing dietary sodium intake. These organizations support a common goal to reduce daily sodium intake to less than 2,300 milligrams and further reduce intake to 1,500 mg among persons who are 51 years of age and older and those of any age who are African-American or have hypertension, diabetes, or chronic kidney disease. A substantial body of evidence supports these efforts to reduce sodium intake. This evidence links excessive dietary sodium to high blood pressure, a surrogate marker for cardiovascular disease (CVD), stroke, and cardiac-related mortality. However, concerns have been raised that a low sodium intake may adversely affect certain risk factors, including blood lipids and insulin resistance, and thus potentially increase risk of heart disease and stroke. In fact, several recent reports have challenged sodium reduction in the population as a strategy to reduce this risk. Sodium Intake in Populations recognizes the limitations of the available evidence, and explains that there is no consistent evidence to support an association between sodium intake and either a beneficial or adverse effect on most direct health outcomes other than some CVD outcomes (including stroke and CVD mortality) and all-cause mortality. Some evidence suggested that decreasing sodium intake could possibly reduce the risk of gastric cancer. However, the evidence was too limited to conclude the converse-that higher sodium intake could possibly increase the risk of gastric cancer. Interpreting these findings was particularly challenging because most studies were conducted outside the United States in populations consuming much higher levels of sodium than those consumed in this country. Sodium Intake in Populations is a summary of the findings and conclusions on evidence for associations between sodium intake and risk of CVD-related events and mortality. Table of Contents Front Matter Summary 1 Introduction 2 Approach to Evidence Review 3 Sodium Intake and Intermediate Markers for Health Outcomes 4 Sodium Intake and Health Outcomes 5 Findings and Conclusions Appendix A: Acronyms and Abbreviations Appendix B: Committee Member Biographical Sketches Appendix C: Open Session Agendas Appendix D: Biomarkers Figure Appendix E: Literature Search Strategy Appendix F: Presentation of Results - Evidence Tables

The Child and Adult Care Food Program (CACFP) is a federally-funded program designed to provide healthy meals and snacks to children and adults while receiving day care at participating family day care homes, traditional child care centers, afterschool facilities, adult care facilities, and emergency shelters. CACFP has the broadest scope of any of the U.S. Department of Agriculture (USDA) food program, serving more than 3 million children and 114,000 adults across the nation. To receive reimbursement for the foods served, participating programs must abide by requirements set by the USDA. Child and Adult Care Food Program assesses the nutritional needs of the CACFP population based on Dietary Guidelines for Americans and the Dietary Reference Intakes (DRIs) and makes recommendations for revisions to the CACFP meal requirements. The book outlines meal requirements that include food specifications that could be used for specific meals and across a full day, covering all age groups from infants to older adults and meal patterns designed for use in a variety of settings, including in-home care and in large centers. By implementing these meal requirements, consumption of fruits, vegetables, and whole-grain rich foods will increase while consumption of solid fats, added sugars, and sodium will decrease. Not only will this address the high prevalence of childhood obesity, it will also help to achieve consistency with the standards and regulations of other USDA nutrition assistance programs, particularly the Supplemental Nutrition Program for Women, Infants, and Children (WIC), and the National School Lunch and School Breakfast programs. Child and Adult Care Food Program makes practical recommendations that would bring CACFP meals and snacks into alignment with current dietary guidance. The book will serve as a vital resource for federal and state public health officials, care providers working in child and adult day care facilities, WIC agencies, officials working with the National School Lunch and School Breakfast programs, and other organizations serving at-risk populations. Table of Contents Front Matter Summary 1 Introduction 2 The Child and Adult Care Food Program 3 Methods for Examining Food and Nutrient Intakes 4 Nutritional Considerations for Infants and Children 5 Nutritional Considerations for Adults 6 Process for Developing Recommendations for Meal Requirements 7 Recommendations for Meal Requirements 8 Meal Cost Implications 9 Implementation 10 Consistency of Recommendationsfor Meal Requirements and Implementation Strategies with the Committee's Criteria 11 Evaluation and Research Recommendations Appendix A: Acronyms, Abbreviations, and Glossary Appendix B: Biographical Sketches of Committee Members Appendix C: Workshop Agenda: February 2010 Appendix D: Critical Issues for Consideration by the Committee to Review Child and Adult Care Food Program Meal Requirements, as Submitted by the U.S. Department of Agriculture Appendix E: Current CACFP Meal Patterns Appendix F: Selected Food Program Descriptions and Websites Appendix G: Data Sources and Analytical Methods Appendix H: MyPyramid Food Groups and Subgroups Appendix I: Food Cost Approach and Methods Appendix J: Nutrient Targets by Meal and Age Group and Comparison of MyPyramid Food Group and Nutrient Targets with Recommended Meal Patterns Appendix K: Sample Menus Appendix L: Options for Breastfeeding Incentives Appendix M: Potential Partnerships to Assist with Technical Training for CACFP Index

As women of childbearing age have become heavier, the trade-off between maternal and child health created by variation in gestational weight gain has become more difficult to reconcile. Weight Gain During Pregnancy responds to the need for a reexamination of the 1990 Institute of Medicine guidelines for weight gain during pregnancy. It builds on the conceptual framework that underscored the 1990 weight gain guidelines and addresses the need to update them through a comprehensive review of the literature and independent analyses of existing databases. The book explores relationships between weight gain during pregnancy and a variety of factors (e.g., the mother's weight and height before pregnancy) and places this in the context of the health of the infant and the mother, presenting specific, updated target ranges for weight gain during pregnancy and guidelines for proper measurement. New features of this book include a specific range of recommended gain for obese women. Weight Gain During Pregnancy is intended to assist practitioners who care for women of childbearing age, policy makers, educators, researchers, and the pregnant women themselves to understand the role of gestational weight gain and to provide them with the tools needed to promote optimal pregnancy outcomes. Table of Contents Front Matter Summary 1 Setting the Stage for Revising Pregnancy Weight Guidelines: Conceptual Framework 2 Descriptive Epidemiology and Trends 3 Composition and Components of Gestational Weight Gain: Physiology and Metabolism 4 Determinants of Gestational Weight Gain 5 Consequences of Gestational Weight Gain for the Mother 6 Consequences of Gestational Weight Gain for the Child 7 Determining Optimal Weight Gain 8 Approaches to Achieving Recommended Gestational Weight Gain 9 Open Session and Workshop Agendas 10 Committee Member Biographical Sketches Appendix A: Acronyms and Abbreviations, Glossary, and Supplemental Information Appendix B: Supplementary Information on Nutritional Intake Appendix C: Supplementary Information on Composition and Components of Gestational Weight Gain Appendix D: Summary of Determinants of Gestational Weight Gain Appendix E: Results from the Evidence-Based Report on Outcomes of Maternal Weight Gain Appendix F: Data Tables Appendix G: Consultant Reports Index

Since 1990, when the last guidelines for weight gain during pregnancy were issued, the average body weight of women entering their childbearing years has increased considerably, with a greater percentage of these women now classified as overweight or obese. Women of childbearing age are also more likely to have chronic conditions such as high blood pressure or diabetes and to be at risk for poor maternal and child health outcomes. All of these factors increase the likelihood of poor pregnancy outcomes for women and their infants. As part of the continuing effort of The Institute of Medicine (IOM) and the National Research Council (NRC) to promote the revised pregnancy weight gain guidelines recommended in their 2009 study Weight Gain During Pregnancy: Reexamining the Guidelines, the IOM and NRC convened a workshop in March, 2013, to engage interested stakeholders, organizations, and federal agencies in a discussion of issues related to encouraging behavior change that would reflect the updated guidelines on weight gain during pregnancy. During the workshop, the IOM and NRC presented newly developed information resources to support guidance based on the recommendations of the 2009 report. Leveraging Action to Support Dissemination of the Pregnancy Weight Gain Guidelines summarizes the workshop's keynote address and the various presentations and discussions from the workshop, highlighting issues raised by presenters and attendees. Interested stakeholders, organizations, health professionals, and federal agencies met to discuss issues related to encouraging behavior change that would reflect the updated guidelines on weight gain during pregnancy. This report discusses conceptual products as well as products developed for dissemination, ways to facilitate and support behavior change to achieve healthy weight pre- and postpregnancy, and how to put the weight gain guidelines into action to implement change. Table of Contents Front Matter 1 Introduction 2 Keynote Addresses 3 Session 1: Communicating the Pregnancy Weight Gain Guidelines 4 Session 2: Panel Discussion: What Are We Doing to Support Behavior Change? 5 Session 3: Implementing the Guidelines 6 Presentation on the First Thousand Days Program 7 Session 4: Collaborating for Action 8 Final Thoughts Appendix A: Workshop Agenda Appendix B: Workshop Participants Appendix C: Speaker Biographies Appendix D: Workshop Statement of Task

Calcium and vitamin D are essential nutrients for the human body. Establishing the levels of these nutrients that are needed by the North American population is based on the understanding of the health outcomes that calcium and vitamin D affect. It is also important to establish how much of each nutrient may be "too much." Dietary Reference Intakes for Calcium and Vitamin D provides reference intake values for these two nutrients. The report updates the DRI values defined in Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride, the 1997 study from the Institute of Medicine. This 2011 book provides background information on the biological functions of each nutrient, reviews health outcomes that are associated with the intake of calcium and vitamin D, and specifies Estimated Average Requirements and Recommended Dietary Allowances for both. It also identifies Tolerable Upper Intake Levels, which are levels above wish the risk for harm may increase. The book includes an overview of current dietary intake in the U.S. and Canada, and discusses implications of the study. A final chapter provides research recommendations. The DRIs established in this book incorporate current scientific evidence about the roles of vitamin D and calcium in human health and will serve as a valuable guide for a range of stakeholders including dietitians and other health professionals, those who set national nutrition policy, researchers, the food industry, and private and public health organizations and partnerships. Table of Contents Front Matter Summary 1 Introduction 2 Overview of Calcium 3 Overview of Vitamin D 4 Review of Potential Indicators of Adequacy and Selection of Indicators: Calcium and Vitamin D 5 Dietary Reference Intakes for Adequacy: Calcium and Vitamin D 6 Tolerable Upper Intake Levels: Calcium and Vitamin D 7 Dietary Intake Assessment 8 Implications and Special Concerns 9 Information Gaps and Research Needs Appendix A: Acronyms, Abbreviations, and Glossary Appendix B: Issues and Interests Identified by Study Sponsors Appendix C: Methods and Results from the AHRQ-Ottawa Evidence-Based Report on Effectiveness and Safety of Vitamin D in Relation to Bone Health Appendix D: Methods and Results from the AHRQ-Tufts Evidence-Based Report on Vitamin D and Calcium Appendix E: Literature Search Strategy Appendix F: Evidence Maps Appendix G: Cases Studies of Vitamin D Toxicity Appendix H: Estimated Intakes of Calcium and Vitamin D from National Surveys Appendix I: Proportion of the Population Above and Below 40 nmol/L Serum 25-Hydroxyvitamin D Concentrations and Cumulative Distribution of Serum 25-Hydroxyvitamin D Concentrations: United States and Canada Appendix J: Workshop Agenda and Open Session Agendas Appendix K: Biographical Sketches of Committee Members Index Summary Tables: Dietary Reference Intakes

Food choices and eating habits are learned from many sources. The school environment plays a significant role in teaching and modeling health behaviors. For some children, foods consumed at school can provide a major portion of their daily nutrient intake. Foods and beverages consumed at school can come from two major sources: (1) Federally funded programs that include the National School Lunch Program (NSLP), the School Breakfast Program (SBP), and after-school snacks and (2) competitive sources that include vending machines, "a la carte" sales in the school cafeteria, or school stores and snack bars. Foods and beverages sold at school outside of the federally reimbursable school nutrition programs are referred to as "competitive foods" because they compete with the traditional school lunch as a nutrition source. There are important concerns about the contribution of nutrients and total calories from competitive foods to the daily diets of school-age children and adolescents. Nutrition Standards for Foods in Schools offers both reviews and recommendations about appropriate nutrition standards and guidance for the sale, content, and consumption of foods and beverages at school, with attention given to foods and beverages offered in competition with federally reimbursable meals and snacks. It is sure to be an invaluable resource to parents, federal and state government agencies, educators and schools, health care professionals, food manufacturers, industry trade groups, media, and those involved in consumer advocacy. Table of Contents Front Matter Summary 1 Committee Task and Guiding Principles 2 Nutrition-Related Health Concerns, Dietary Intakes, and Eating Behaviors of Children and Adolescents 3 The School Environment 4 Foods and Beverages Sold Outside the School Meal Program 5 Recommended Standards and Actions for Competitive Foods in Schools 6 Next Steps 7 References Appendix A Acronyms and Glossary Appendix B Energy Requirements Appendix C Nutrition Standards for Competitive Foods Sold in Elementary, Middle, or High School Set by States Appendix D Guidelines for Competitive Foods and Beverages Appendix E Open Sessions Appendix F Committee Member Biographical Sketches Index

The fragmented information that consumers receive about the nutritional value and health risks associated with fish and shellfish can result in confusion or misperceptions about these food sources. Consumers are therefore confronted with a dilemma: they are told that seafood is good for them and should be consumed in large amounts, while at the same time the federal government and most states have issued advisories urging caution in the consumption of certain species or seafood from specific waters. Seafood Choices carefully explores the decision-making process for selecting seafood by assessing the evidence on availability of specific nutrients (compared to other food sources) to obtain the greatest nutritional benefits. The book prioritizes the potential for adverse health effects from both naturally occurring and introduced toxicants in seafood; assesses evidence on the availability of specific nutrients in seafood compared to other food sources; determines the impact of modifying food choices to reduce intake of toxicants on nutrient intake and nutritional status within the U.S. population; develops a decision path for U.S. consumers to weigh their seafood choices to obtain nutritional benefits balanced against exposure risks; and identifies data gaps and recommendations for future research. The information provided in this book will benefit food technologists, food manufacturers, nutritionists, and those involved in health professions making nutritional recommendations. Table of Contents Front Matter Summary 1 Introduction 2 Consumption Patterns and Composition of Seafood 3 Health Benefits Associated with Nutrients in Seafood 4 Health Risks Associated with Seafood Consumption 5 Analysis of the Balancing of Benefits and Risks of Seafood Consumption 6 Understanding Consumer Decision Making as the Basis for the Design of Consumer Guidance 7 Balancing Choices: Supporting Consumer Seafood Consumption Decisions Appendix A Glossary and Supplementary Information Appendix B Data Tables Appendix C Tables and Scenarios Appendix D Open Session and Workshop Agendas Appendix E Committee Member Biographical Sketches Index