COMMITTEE ON AGRICULTURE
Rome, 31 March-4 April 2003
Information Note on a Joint WHO/FAO Expert Consultation on Diet, Nutrition and the Prevention of Chronic Diseases
II. Summary of Findings and Recommendations
III. Implications for FAO’s Work on Agriculture, Fisheries and Food
1. The purpose of this Information Note is to inform COAG of the release of a report of a Joint WHO/FAO Expert Consultation on Diet, Nutrition and the Prevention of Chronic diseases. The recommendations arising from this Consultation are likely to have implications for FAO’s future programme of work1., and will be closely related to the implementation of Strategy C.1: Policy options and institutional measures to improve efficiency and adaptability in production, processing and marketing systems, and meet the changing needs of producers and consumers
2. The Expert Consultation was convened in Geneva from 28 January - 1 February 2002. The draft report of the Experts was circulated widely for comments to both FAO and WHO and to all stakeholders, both industry related and consumer/NGO groups. Subsequently, meetings were held in April 2002 with the groups to obtain feedback on the report. A further period of stakeholder consultation ensued, which led to another meeting of the Experts in August 2002 for redrafting the report. The draft final report was released on the websites of both Organizations on 3 March 20032, and the printed version is expected to be released in April 2003.
3. Nearly all countries are facing an emerging epidemic of chronic, non-communicable diseases (NCDs). NCDs account for an estimated 33 million premature deaths world-wide due to heart disease, stroke, cancer, diabetes and obesity. Mortality trends indicate significant increases in NCDs in developing countries. The Expert Consultation was convened to focus attention on this emerging global epidemic, to examine the factors that determine it and to make recommendations that would contribute to a reduction in the incidence of these diseases. Based on the best scientific information available, the Experts provided updated population nutrient targets for use in the development of food-based dietary guidelines and the formulation of appropriate strategies to reduce the health burden of NCDs.
4. A complex range of factors interact to determine the nature and course of this epidemic, which includes changes in food consumption patterns, habitual diets and life styles. The last, in particular, is characterised by a reduction in physical activity, which increases the risk of obesity and is a causal factor for other NCDs. Developing countries, particularly those in rapid social transition and economic development, simultaneously confront the ‘double burden’ of persistent undernutrition in the midst of a growing epidemic of NCDs, which contributes to the increasing loss of economically productive life years, affects economic growth and places an increasing burden on the healthcare sector. Nutrition is a major modifiable determinant of chronic NCDs, with scientific evidence supporting the view that alterations in diet and activity have effects on health throughout the life-course.
5. The Expert Consultation examined the scientific basis of the relationship between diet, nutrition and NCDs from which recommendations were made that would help prevent premature death and disability and reduce the burden of NCDs. The Consultation concluded that healthy diets and adequate physical activity are the key to longer and healthier lives. The consumption of nutrient-dense foods and the balancing of energy intake with the necessary physical activity to maintain a healthy weight are essential at all stages of life. Unbalanced consumption of foods, which are high in energy and low in essential nutrients, combined with inadequate physical activity, contribute to overweight and obesity. The amount of the energy consumed in relation to energy expenditure through physical activity and the nutritional quality of food are key determinants of NCDs.
6. The Experts state in their report that the scientific complexities of these issues should not obscure the simple messages required to orient and guide consumers for a healthier lifestyle. People should eat less high-calorie foods, especially foods high in fats and sugar, use less salt, consume more fruits, vegetables and legumes, select more foods of plant and marine origin and be physically active.
7. To achieve best results in preventing NCDs, the Experts suggest that government strategies and policies should fully recognize the essential role of both diet and physical activity in determining good nutrition and optimal health. Policies and programmes must address the need for change so that healthier choices are available to consumers and are preferred by them.
8. Evidence reviewed by the Experts indicates that increased consumption of fruits and vegetables significantly reduces the risk of cardiovascular disease and some cancers. They noted that disease risk increased as consumption of fats increased, while frequent consumption of fish was protective against heart disease and stroke. They concluded that the amount and frequency of consumption of free sugars increased the risk of dental disease. The Experts summarised five main issues relevant to the prevention of NCDs: (i) unhealthy diets and low levels of physical activity are confirmed risk behaviours; (ii) biological and behavioural risk factors emerge/act in early life and continue to have a negative impact throughout life; (iii) risk factors are increasing globally; (iv) preventive interventions (even of small magnitude and early in the life) offer lifelong benefits; and, (v) altering diet and physical activity patterns in adults reduce risk of premature death and disability due to NCDs.
9. The Expert Consultation noted that its recommendations to increase the per capita availability and consumption of fruits, vegetables and fish, as well as to moderate the consumption of fats, free sugars and salt, may require action throughout the food supply chain.
10. Strategies and investments are needed to increase food supply to achieve food security for all. Ensuring that people have economic and physical access to adequate and safe food of appropriate nutritional quality, is vital. The recommendations of the Expert Consultation are expected to generate new opportunities, challenges and priorities for FAO and will contribute to stock taking of current food production and consumption patterns and trends at national, regional and global levels.
11. Activities related to an inventory of current food production and consumption patterns and trends in dietary changes will be an important area of work for FAO. Consumer behaviour and the promotion of healthy diets are potential areas of future work for nutrition education and health promotion specialists who have an opportunity to investigate and devise strategies to promote healthy eating practices and nutritious diets. The composition of foods in production, supply and processing systems along the food chain will have to increasingly respond to consumer demand and become more environmentally sound, economically viable and nutritionally balanced - thus, more research on food supply, availability, processing and consumption is also necessary.
12. At present, only a minority of the world’s population consumes the recommended intakes of fruits and vegetables. The promotion of increased production, trade and marketing and consumption of fruits and vegetables, particularly in regions where the consumption is low, will impact on FAO’s work. The implementation of this recommendation must consider a broad range of factors, from increased horticultural production to ensuring a safe supply of food to consumers while reducing the risk of pests, contaminants and residues. Increasing urbanization may distance people from primary production and influences the availability and access that the urban poor have to fruits and vegetables. A central challenge is to increase supplies of fruits and vegetables that are readily available, affordable, fresh and safe to ensure consumer access to a diverse and varied diet. There are numerous opportunities for farmer extension and training, nutrition education and health promotion in these areas addressing both micronutrient malnutrition and the reduction of NCD risk. FAO will have many opportunities for increasing horticultural production, in technologies related to storage, improving shelf life and preservation, transportation/marketing as well as in efforts to ensure increased global consumption.
13. Increasing the consumption of fish and fishery products is another important recommendation of the Experts. Fish proteins, fatty acids, oils and micronutrients play an important nutritional role during human growth and development and in the reduction of NCD risks. This recommendation needs to be balanced against concerns for sustainability of marine stocks and the potential depletion of important marine sources of high quality nutritious food. Growth in inland and marine aquaculture production has increasingly substituted for ocean fish catch. FAO will continue to promote better management of capture fisheries and aquaculture to improve quantity and quality of fish for human consumption.
14. Recommendations related to food and nutrient goals for consumption of other food items such as meat, dairy products, edible oils and sugars may have implications for both normative and technical assistance work of FAO. Meat and dairy products improve the nutrition of the vast majority of the world. Livestock products provide high value protein, a wide range of essential micronutrients and remain a desired but insufficiently consumed food in most developing societies. Although current consumption levels are low, recent trends suggest that excessive consumption of animal products may lead to increased NCD risk. Edible oils are also an important source of energy for large segments of the population in developing countries that have diets which contain a low proportion of fat. The types of edible oils used in developing countries are also changing. There are segments of populations that consume excessive proportions of fat, both of vegetable and animal origin, which may contribute to increasing NCD risk.
15. From FAO’s perspective, the issues raised in the report are relevant for its future programme of work. Information on food consumption has hitherto been obtained from national Food Balance data; it is essential to obtain more reliable information on actual food consumption patterns and changing trends based on representative consumption surveys. There is a need to monitor how the food-based dietary guidelines developed in this Report influence the behaviour of consumers and to what extent societies will change their diets and lifestyles towards more healthy patterns and how this is achieved.
16. The quantitative and qualitative implications for agriculture (in particular livestock and horticulture) and fisheries will have to be assessed and action taken to deal with potential future demands of an increasingly urban population. To meet the specified levels of consumption, new strategies for producers and processors may need to be developed. A number of novel issues may need to be tackled, such as: the quality effects of intensive production systems, including residues and contaminants; better dietary quality (i.e. lean meat) of livestock and poultry production; the effects of longer food chains due to longer storage and transport routes with higher risk of deterioration, the use (and misuse) of conserving agents, and contamination; and the agronomic and environmental effects of changes in varietal composition and diversity of consumption patterns, loss of traditional crop varieties and their declining use in daily diets, etc.
17. Trade has an important role to play in improving food and nutrition security and the prevention of NCDs. The impact that agricultural policy, particularly subsidies, has on the structure of production, processing and marketing systems and, ultimately, on the availability of foods that support healthy food consumption patterns should not be overlooked.
18. FAO supports WHO in developing its Global Strategy on Diet, Physical Activity and Health. FAO will develop a strategy for assisting governments to implement policies and programmes, as part of the proposed comprehensive food chain approach, that would provide policy options and institutional measures to improve adaptability in production, processing and marketing systems and that contribute to improved diets and, thereby, the prevention of NCDs.
1 This Information Note of the Expert Consultation Report also complements COAG/2003/5 – FAO’s Strategy for a Food Chain Approach to Food Safety and Quality: A framework document for the development of future strategic direction.
2 The report is available at ftp://ftp.fao.org/es/esn/nutrition/diet_prevention_disease.pdf and http://www.who.int/hpr/NPH/docs/who_fao_expert_report.pdf