The overall purpose of the consultation was to establish the scientific basis for developing and using food-based dietary guidelines (FBDG) to improve the food consumption patterns and nutritional wellbeing of individuals and populations. Such guidelines are needed in virtually all countries given the role that food consumption and dietary practices play in nutrition-related disorders, whether of deficiency or excess. Formerly, most national dietary guidelines were nutrient-based and their use met with only moderate success. This report demonstrates how national authorities can change the traditional focus from nutrients to locally available foods.
The specific purposes of the consultation were to:
• review the scientific evidence and epidemiology of diet-related health problems, including noncommunicable diseases and other forms of malnutrition;
• consider recommended nutrient intakes, and dietary assessment methodologies relative to the development of food-based dietary guidelines;
• develop recommendations for national dietary guidelines and their application.
Food-based dietary guidelines were among the priority considerations at the International Conference on Nutrition, which was convened by FAO and WHO in Rome in 1992. The World Declaration and Plan of Action for Nutrition adopted at the Conference included goals for the elimination or substantial reduction of famine and famine-related deaths, chronic malnutrition, micronutrient malnutrition, and diet-related communicable and noncommunicable disease. Where this last category is concerned promoting appropriate diets and healthy lifestyles was highlighted as an appropriate strategy.
The Consultation recommended that dietary guidelines be based on, and aim to improve, current dietary practices and prevailing diet-related public health problems, rather than be based on nutrient requirements and recommended intake levels. Selected recommendations for nutrient intakes were also reviewed. It was proposed that desirable nutrient intakes generally be expressed in terms of nutrient density per 1000 kcal in the diet, since all family members tend to consume similar diets and nutrient intakes of individuals are thus proportional to the energy each consumes. A summary of selected reference intakes is provided in Annex 3.
The development and implementation of food-based dietary guidelines should be undertaken by an interdisciplinary and intersectoral working group or technical committee. Culturally appropriate modes of presentation of the main messages should be sought, pre-tested and disseminated. Food-based guidelines should be developed in each country; guidelines suitable for one country cannot be expected to be wholly appropriate for others. Different guidelines may also be required for different geographic or socioeconomic groups within the same country. The main steps in their development might include:
• Forming a working group or committee
• Reviewing food consumption patterns
• Drawing conclusions as to the diet/health linkages and main problem areas
• Identifying relevant key national policies (health, agriculture, education, environment, social welfare, women, population)
• Determining the critical health, food or nutrition issues to be targeted by FBDG
• Defining the content and target groups for FBDG
• Ensuring the socioeconomic feasibility and cultural appropriateness of FBDG
• Defining the purpose, goals and targets of the FBDG
• Translating the FBDG into main messages
• Assessing appropriateness/credibility of FBDG and how they are perceived by a test group
• Monitoring changes in people's diet and nutritional status and any concurrent socioeconomic changes.
The report includes a summary of dietary assessment methodologies— national food supply data, household food consumption data, and individual consumption data—which are appropriate for drawing up, and monitoring the use and impact of dietary guidelines. For the last, five methods are presented: food records, 24-hour dietary recall, food frequency questionnaires, diet histories, and food-habit questionnaires. Methods of analysis and computation of nutrient intakes including computer software are described, as is the method of presentation of data on consumption of particular foods and food groups.
The scientific basis for food-based dietary guidelines and the requirements for energy, nutrients (macronutrients and micronutrients), and related non-nutrient food components are presented in greater detail in technical annexes. Examples of the food groups and dietary guidelines used in different countries, and some comments on their respective advantages and disadvantages, are also given.
The consultation recommended that FAO and WHO should collaborate with governments in developing, implementing and monitoring food-based dietary guidelines; identified areas requiring further research, together with an overall review and updating of existing international documentation on recommended dietary allowances and nutrient intakes; and stressed the need for more adequate information on food consumption patterns.
