Putting the Dietary Guidelines for Americans into Action through the National Strategy on Hunger, Nutrition, and Health

The United States is facing a crisis of widespread food insecurity and exceedingly high rates of diet-related diseases like diabetes, obesity, and hypertension. To address this challenge and set a course for improved nutrition and food access nationwide, the Biden-Harris Administration hosted the first White House Conference on Hunger, Nutrition, and Health in over 50 years on September 28, 2022. In the National Strategy, released in conjunction with the Conference, the Administration identified a set of actions that the federal government will take to help achieve its goal of ending hunger and increasing healthy eating and physical activity by 2030, so that fewer Americans experience diet-related diseases. Underpinning many of these actions is the Dietary Guidelines for Americans ( Dietary Guidelines ), which provides scientific advice on nutrition intake to meet nutrient needs, promote health, and prevent disease and serves as the cornerstone of federal food and nutrition programs. This manuscript details how expanded implementation of the Dietary Guidelines can help advance actions in the National Strategy and achieve the goals of the Administration

Putting the Dietary Guidelines for Americans into Action through the National Strategy on Hunger, Nutrition, and Health

The United States is facing a crisis of widespread food insecurity and exceedingly high rates of diet-related diseases like diabetes, obesity, and hypertension. To address this challenge and set a course for improved nutrition and food access nationwide, the Biden-Harris Administration hosted the first White House Conference on Hunger, Nutrition, and Health in over 50 years on September 28, 2022. In the National Strategy, released in conjunction with the Conference, the Administration identified a set of actions that the federal government will take to help achieve its goal of ending hunger and increasing healthy eating and physical activity by 2030, so that fewer Americans experience diet-related diseases. Underpinning many of these actions is the Dietary Guidelines for Americans ( Dietary Guidelines ), which provides scientific advice on nutrition intake to meet nutrient needs, promote health, and prevent disease and serves as the cornerstone of federal food and nutrition programs. This manuscript details how expanded implementation of the Dietary Guidelines can help advance actions in the National Strategy and achieve the goals of the Administration

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570