Chapter one - Introduction
The World Declaration and Plan of Action for Nutrition, which was adopted by 159 governments at the International Conference on Nutrition in Rome in December 1992, committed the international and national communities to the nutrition goals stated in the preface.
The Declaration and Plan of Action recognized that the attainment of these goals required plans of action at the national level appropriate to the cultural context of each nation. That is, it recognized the need for each nation to identify public health issues related to local dietary patterns and to adopt local strategies for their resolution. The World Declaration and Plan of Action for Nutrition is notable for the absence of numerical targets for food and nutrient intakes, and it marks a move in the thinking of nutritionists away from policies dictated by numbers and towards policies dictated by prevailing public health issues. The Declaration and Plan of Action also call for the dissemination of nutrition information through "sustainable food-based approaches that encourage dietary diversification through the production and consumption of micronutrient-rich foods, including appropriate traditional foods".
The concept of disseminating information through food-based dietary guidelines (FBDG) is inherently sensible since consumers think in terms of foods rather than of nutrients. Equally, the concept of FBDG can take account of considerable epidemiological data linking specific food consumption patterns with low incidence of certain diseases while not requiring a complete understanding of the biological mechanisms responsible for such a protective property. For example, Sir James Lind, the Surgeon-General in charge of health policy for the British Navy in 1700, knew that sailors on long sea voyages did not develop an affliction known as scurvy if sufficient limes were kept aboard the fleet and the sailors were encouraged to eat them regularly. This food-based dietary guideline successfully addressed a specific health issue in the complete absence of any biochemical understanding. In the modern era, we observe a low incidence of certain diseases in specific communities with particular eating habits and, while we rightfully search for an explanation of biochemical mechanisms, dietary recommendations based on these food patterns are warranted. An example is the association of high fruit and vegetable consumption with reduced risk of certain NCD and the emerging awareness that several components of these foods and the diets containing them contribute to lower risk.
There is no doubt that, as our knowledge of mechanisms improves, opportunities in food technology will allow for alterations to be made to nutrient and non-nutrient intake within prevailing food consumption patterns. We already recognize direct associations between single nutrients and single conditions (e.g. iron and anaemia, folic acid and neural tube defects, and certain saturated fatty acids and risk of cardiovascular disease) which make it possible for the nutritional properties of existing food supplies to be enhanced. Advances in food technology permit the production of both nutrient-fortified foods and products with reduced salt and saturated fat content. Progress in biotechnology and genetic engineering will play an increasing role in this area in the future. Nonetheless, FBDG remain a valid strategy for public health nutrition.
The purpose of this document is to establish the scientific basis and recommended process for the development and evaluation of FBDG in various regions of the world. Dietary guidelines differ from dietary goals and from recommended dietary intakes or recommended dietary allowances (see box for explanation).
Recommended nutrient intakes (RNI) are also called recommended dietary allowances (RDA), recommended dietary intakes (RDI), dietary reference values (DRY) or population reference intakes in different countries. They are authoritative, quantitative estimates of human requirements for essential nutrients, usually set out with different amounts (in weight/day) considered to be adequate to meet the known nutrient needs of practically all healthy persons.
Dietary guidelines are sets of advisory statements that give dietary advice for the population to promote overall nutritional wellbeing and relate to all diet-related conditions. They have usually been expressed in technical nutritional terms, but some guidelines have been expressed as food groups. Dietary guidelines differ from RNI in that the advice is more provisional' being based on a variety of information, including indirect evidence about the complex relationship of food components with health and with diseasessome of which have long incubation periods. Dietary guidelines are broad targets for which people can aim while RNI indicate what should be consumed on the average every day.
Dietary goals are intended to emphasize the future-looking character of dietary guidelines. Dietary goals can be used for planning at the national level rather than as advice for individuals and are expressed in terms of national average intakes.
Dietary or nutritional targets are the nutritional expression of a set of feasible national health targets fore country. They should be expressed in terms which make monitoring possible.
Development of dietary goals reflects analysis of the health status of the population and determination of goals that will improve the overall health of the population and reduce the risk of disease. Dietary goals may vary among sub-populations of a region due to the prevalence of over- or undernutrition.
The term "food based dietary guidelines" is used in this report to mean the expression of the principles of nutrition education mostly as foods. They are intended for use by individual members of the general public. Where they cannot be expressed entirely as foods they are written in ordinary language. They avoid as far as possible the technical terms of nutritional science.
In addition to FBDG in any country, a set of dietary guidelines expressed in scientific terms may also exist, with quantitative recommendations of nutrients and food components, available for use and reference by policy-makers and health care professionals.
Adopting RNI and dietary goals for a population may form part of the process for development of dietary guidelines, which are the recommended strategies for the population to achieve nutritional well-being. If guidelines are derived from nutrient targets or dietary goals, they should be translated into "food-based guidelines" in order to be adopted by the population. Dietary guidelines represent the practical way to reach the nutritional goals for a population. They take into account the customary dietary pattern and indicate what aspects should be modified. They consider the ecological setting, socioeconomic and cultural factors, and the biological and physical environment in which the population lives.
FBDG will vary among population groups. Hence it is important for each region or country to recognize that more than one dietary pattern is consistent with health and to develop food-based strategies that are appropriate for the local region. Food and diet are not the only components of a healthy lifestyle. Although this document focuses on diet, bodies responsible for developing dietary guidelines are encouraged to integrate these messages with other policies related to health (e.g. smoking, physical activity, alcohol consumption).
Governments and affiliated organizations should find this document helpful for initiating or improving their process of developing FBDG appropriate to their region. The consultation recommends that this document be reviewed periodically (initially in 5 years' time) in the light of the experience of agencies who use the document.
Some of the key points underlying the thinking behind this document are that:
Public health issues should determine the direction and relevance of dietary guidelines.
FBDG are developed in a specific sociocultural context, and need to reflect relevant social, economic, agricultural and environmental factors affecting food availability and eating patterns.
Dietary guidelines need to reflect food patterns rather than numerical goals.
Dietary guidelines need to be positive and encourage enjoyment of appropriate dietary intakes.
A wide range of dietary patterns can be consistent with good health.