Search

Background: In 2021, the World Health Organization (WHO) set sodium benchmarks for packaged foods to guide countries in setting feasible and effective sodium reformulation programs. We modeled the dietary and health impact of full compliance with the WHO’s sodium benchmarks in Australia and compared it to the potential impact of Australia’s 2020 sodium reformulation targets. Methods: We used nationally representative data on food and sodium intake, sodium levels in packaged foods, and food sales volume to estimate sodium intake pre- and post-implementation of the WHO and Australia’s sodium benchmarks for 24 age-sex groups. Using comparative risk assessment models, we then estimated the potential deaths, incidence, and disability-adjusted life years averted from cardiovascular disease, chronic kidney disease, and stomach cancer based on the reductions in sodium intake. Results: Compliance with the WHO’s sodium benchmarks for packaged foods in Australia could lower mean adult sodium intake by 404 mg/day, corresponding to a 12% reduction. This could prevent about 1770 deaths/year (95% uncertainty interval 1168–2587), corresponding to 3% of all cardiovascular disease, chronic kidney disease, and stomach cancer deaths in Australia, and prevent some 6900 (4603–9513) new cases, and 25 700 (17 655–35 796) disability-adjusted life years/year. Compared with Australian targets, the WHO benchmarks will avert around 3 and a half times more deaths each year (1770 versus 510). Conclusions: Substantially greater health impact could be achieved if the Australian government strengthened its current sodium reformulation program by adopting WHO’s more stringent and comprehensive sodium benchmarks.

Strategies to reduce sodium concentrations in packaged foods are effective and cost-effective approaches to reducing the burden of disease attributable to high sodium intakes. This review aimed to comprehensively describe, and explore characteristics of, national strategies to reduce sodium concentrations in packaged foods, and assess progress toward achieving national goals. A secondary aim was to understand the number, type, and variation of food category sodium targets set by countries compared with WHO global sodium benchmarks. National sodium reduction reformulation strategies were identified from a search of peer-reviewed and gray literature up to December 2019 supplemented by verified information from key contacts and experts up to December 2020. Key characteristics of countries’ strategies were extracted, synthesized, and descriptively analyzed, including details of reformulation strategies and evaluation data. Country targets were mapped to the WHO global sodium benchmarks, and the number and variation of country sodium targets by WHO food categories were determined. Sixty-two countries had reformulation strategies to reduce sodium in packaged foods, and 19 countries had evaluated their reformulation strategies. Forty-three countries had sodium targets, which varied in type of targets (maximum sodium concentration: n = 26; maximum concentration plus relative reduction/average/sales-weighted average: n = 8; relative reduction: n = 7; average: n = 2), number of food category targets (range: n = 1 to 150), and regulatory approach (voluntary: n = 28; mandatory: n = 9; both: n = 6). Eight of 34 countries mapped to the WHO benchmarks had targets for just 1 specified food category (bread products). One-third of all countries were implementing national strategies to reduce sodium concentrations in packaged foods including establishing targets and/or processes for industry engagement. This review determined that there is scope to improve most countries’ strategies. There has been limited progress in implementing and evaluating strategies between 2014 and 2019, and regional and income-level disparities persist. The WHO global sodium benchmarks present an important opportunity to accelerate reformulation action globally.

Background: Healthy diets promote optimal growth and development and prevent malnutrition in all its forms, including undernutrition, obesity, and diet-related noncommunicable diseases (NCDs). Objective: This background paper for the International Expert Consultation on Sustainable Healthy Diets characterizes healthy diets and their implications for food system sustainability. Methods: Three complementary approaches to defining healthy diets are compared: World Health Organization (WHO) guidelines or recommendations developed between 1996 and 2019; 2017 Global Burden of Disease (GBD) risk factor study estimates of diet-related risk–outcome associations; and analyses associating indices of whole dietary patterns with health outcomes in population studies and clinical trials. Results: World Health Organization dietary recommendations are global reference points for preventing undernutrition and reducing NCD risks; they emphasize increasing intakes of fruits, vegetables (excepting starchy root vegetables), legumes, nuts, and whole grains; limiting energy intake from free sugars and total fats; consuming unsaturated rather than saturated or trans fats; and limiting salt intake. Global Burden of Disease findings align well with WHO recommendations but include some additional risk factors such as high consumption of processed meat; this approach quantifies contributions of diet-related risks to the NCD burden. Evidence on whole dietary patterns supports WHO and GBD findings and raises concerns about potential adverse health effects of foods with high levels of industrial processing. Conclusions: Implied shifts toward plant foods and away from animal foods (excepting fish and seafood), and for changes in food production systems have direct relevance to the sustainability agenda.

Removing trans fatty acids (TFAs) from the food supply in the Eurasian Economic Union (EAEU) are one of the most effective public health interventions for reducing the risk of noncommunicable diseases. EAEU Member States have taken important steps to reduce TFA in oil and fat products to

Objective:To briefly review the current understanding of the aetiology and prevention of chronic diseases using a life course approach, demonstrating the life-long influences on the development of disease.Design:A computer search of the relevant literature was done using Medline-‘life cycle’ and ‘nutrition’ and reviewing the articles for relevance in addressing the above objective. Articles from references dated before 1990 were followed up separately. A subsequent search using Clio updated the search and extended it by using ‘life cycle’, ‘nutrition’ and ‘noncommunicable disease’ (NCD), and ‘life course’. Several published and unpublished WHO reports were key in developing the background and arguments.Setting:International and national public health and nutrition policy development in light of the global epidemic in chronic diseases, and the continuing nutrition, demographic and epidemiological transitions happening in an increasingly globalized world.Results of review:There is a global epidemic of increasing obesity, diabetes and other chronic NCDs, especially in developing and transitional economies, and in the less affluent within these, and in the developed countries. At the same time, there has been an increase in communities and households that have coincident under- and over-nutrition.Conclusions:The epidemic will continue to increase and is due to a lifetime of exposures and influences. Genetic predisposition plays an unspecified role, and with programming during fetal life for adult disease contributing to an unknown degree. A global rise in obesity levels is contributing to a particular epidemic of type 2 diabetes as well as other NCDs. Prevention will be the most cost-effective and feasible approach for many countries and should involve three mutually reinforcing strategies throughout life, starting in the antenatal period.

This paper describes the first African experience with the Nutrition-Friendly School Initiative (NFSI) in two large West African cities: Ouagadougou, Burkina Faso and Cotonou, Benin. NFSI was launched by the World Health Organization (WHO) and its partners in 2006, as a means of preventing the double burden of malnutrition: the coexistence of undernutrition and overnutrition among school-children. NFSI pilot-testing is one component of the Partnership Project on the Double Burden of Malnutrition, funded by the Canadian International Development Agency for 6 years (2008–2014). The Project assisted the government in the selection of pilot schools, fostered the installation of health and nutrition committees in selected schools, and helped with the initial school self-assessments. In accordance with the empowering philosophy of health promotion, pilot schools did not follow a pre-defined schedule of interventions, except for the training of teachers in nutrition education and the nutritional (anthropometric) surveillance of schoolchildren. For the latter activities, technical assistance and seminal funds were provided. Yearly planning workshops were held for school committees, with WHO support. In both settings, training was given to street vendors in order to improve the hygiene and nutritional value of food sold to schoolchildren. Other activities included special nutrition events and sanitation measures. In both cities, NFSI showed promising results in terms of school and community mobilization towards improved nutrition and health; however, NFSI must be better understood as an endogenous and self-sustaining approach. Furthermore, household poverty and scarce school resources appear as major barriers to gaining full impact of NFSI in low-income populations.

PURPOSE: The aim of this paper is to review the evidence of the association between energy balance and obesity. METHODS: In December 2015, the International Agency for Research on Cancer (IARC), Lyon, France convened a Working Group of international experts to review the evidence regarding energy balance and obesity, with a focus on Low and Middle Income Countries (LMIC). RESULTS: The global epidemic of obesity and the double burden, in LMICs, of malnutrition (coexistence of undernutrition and overnutrition) are both related to poor quality diet and unbalanced energy intake. Dietary patterns consistent with a traditional Mediterranean diet and other measures of diet quality can contribute to long-term weight control. Limiting consumption of sugar-sweetened beverages has a particularly important role in weight control. Genetic factors alone cannot explain the global epidemic of obesity. However, genetic, epigenetic factors and the microbiota could influence individual responses to diet and physical activity. CONCLUSION: Energy intake that exceeds energy expenditure is the main driver of weight gain. The quality of the diet may exert its effect on energy balance through complex hormonal and neurological pathways that influence satiety and possibly through other mechanisms. The food environment, marketing of unhealthy foods and urbanization, and reduction in sedentary behaviors and physical activity play important roles. Most of the evidence comes from High Income Countries and more research is needed in LMICs.

A World Health Organization (WHO) Expert Consultation on Waist Circumference (WC) and Waist-Hip Ratio (WHR) was convened in Geneva from 8 to 11 December 2008 to consider approaches to developing international guidelines for indices and action levels in order to characterize health risks associated with these measures of body fat distribution-alternative or complementary to the existing WHO guidelines for assessments of generalized obesity on the basis of body mass index. Six background papers prepared for the Consultation are compiled in this issue. These six papers examine a range of health outcomes and issues, including whether there is a basis for choosing WC over WHR and whether different action levels by gender, age, ethnicity, country or region are warranted. Although guidelines involving WC and WHR are potentially useful and clearly required, the challenges in identifying cutoffs for international guidelines should not be underestimated or oversimplified. The final report and outcomes of the Expert Consultation will be published by WHO.

The role of dietary fats and oils in human nutrition is one ofthe most complex and controversial areas of investigationsin nutrition science. The first expert consultation thatfocused on the topic of fats was the Joint FAO/WHO ExpertConsultation on the Role of Dietary Fats and Oils in HumanNutrition held in Rome from 21 to 30 September 1977 (FAO,1978). This consultation synthesized the state of knowledgeof dietary fats and oils in human nutrition, including nutri-tional value and both the positive and negative physiologicaleffects of different types of fats. Then the Joint FAO/WHOExpert Consultation on Fats and Oils in Human Nutritionwas held in Rome from 19 to 26 October 1993 to considerthe latest scientific evidence on many crucial and variedroles dietary fats and oils have in human nutrition andexamine the intakes of different types and levels of dietaryfats and oils and their associated health effects (FAO, 1994).The Joint WHO/FAO Expert Consultation on Diet, Nutri-tion and the Prevention of Chronic Disease held at Genevafrom 28 January to 1 February 2002 (WHO, 2003; Nishidaand Shetty, 2004) recognized that the growing epidemic ofchronic disease afflicting both developed and developingcountries was related to dietary and lifestyle changes. Duringthe past decade, rapid expansion in a number of relevantscientific fields and in the amount of population-basedepidemiological evidence has helped to clarify the role ofdiet in preventing and controlling the morbidity andpremature mortality resulting from various noncommunic-able diseases (NCDs). One of the resulting recommendationsaimed at reducing the risk of cardiovascular diseases and inpromoting cardiovascular health was that diets shouldprovide a very low intake of trans fatty acids (TFA), that is,less than 1% of total energy intake. The outcomes andrecommendations of this Expert Consultation then providedthe scientific basis for the WHO Global Strategy on Diet,Physical Activity and Health (DPAS) endorsed by the 57thWorld Health Assembly in May 2004 (WHO, 2004).

Objective To construct growth curves for school-aged children and adolescents that accord with the WHO Child Growth Standards for preschool children and the body mass index (BMI) cut-offs for adults. Methods Data from the 1977 National Center for Health Statistics (NCHS)/WHO growth reference (1–24 years) were merged with data from the under-fives growth standards’ cross-sectional sample (18–71 months) to smooth the transition between the two samples. State-of-the-art statistical methods used to construct the WHO Child Growth Standards (0–5 years), i.e. the Box-Cox power exponential (BCPE) method with appropriate diagnostic tools for the selection of best models, were applied to this combined sample. Findings The merged data sets resulted in a smooth transition at 5 years for height-for-age, weight-for-age and BMI-for-age. For BMI-for-age across all centiles the magnitude of the difference between the two curves at age 5 years is mostly 0.0 kg/m² to 0.1 kg/m². At 19 years, the new BMI values at +1 standard deviation (SD) are 25.4 kg/m² for boys and 25.0 kg/m² for girls. These values are equivalent to the overweight cut-off for adults (> 25.0 kg/m²). Similarly, the +2 SD value (29.7 kg/m² for both sexes) compares closely with the cut-off for obesity (> 30.0 kg/m²). Conclusion The new curves are closely aligned with the WHO Child Growth Standards at 5 years, and the recommended adult cut-offs for overweight and obesity at 19 years. They fill the gap in growth curves and provide an appropriate reference for the 5 to 19 years age group. Bulletin of the World Health Organization 2007;85:660–667.

Nutrition Planning, Assessment and EvaluationService, Food and Nutrition Division, FAO, Rome, ItalyThe Joint WHO/FAO Expert Consultation on diet,nutrition and the prevention of chronic diseases tookplace in Geneva from 28 January to 1 February 2002. Theoverall objective of the Consultation was to review andupdate current international recommendations on diet,nutrition and the prevention of chronic diseases byevaluating the latest scientific evidence and lessonslearned from implementing national interventionstrategies to reduce the burden of these diseases. Specificobjectives included:1. Reviewing the changes in the dietary and healthpatternsworldwideandexaminingtheirrelationshiptoemergence of chronic diseases, particularly obesity,type 2 diabetes, hypertension and cardiovasculardiseases, cancer, dental disease, and osteoporosis.2. Reviewing the latest scientific evidence on therelationship between diet, nutrition and chronicdiseases.3. Examining diet, nutrition and health issues from a lifecourse perspective.4. Considering gene/nutrient interactions and theirimplications.5. Formulating recommendations concerning diet andnutrition for the prevention of chronic diseases toassist countries in developing and implementingeffective evidence-based multisectoral policies andstrategies.6. Identifying further research needs.The selection of the expert participants followed standardcriteria, including geographic and sex balance, inconsultation with regional offices. Thirty experts wereidentified,halffromdevelopingcountriesandcountriesineconomic transition where diet-related chronic diseasesare an increasing public health problem. Before beingofficially invited to participate, all were requested todeclare possible conflicts of interest to ensure the qualityand neutrality of each expert’s contributions.Four working groups composed of world-renownedexperts prepared background papers on majordiet-related chronic diseases, such as obesity, type-2diabetes,cardiovasculardiseasesandcancer,thatincludedcurrent trends for each disease, a review of the strengthand weakness of the scientific evidence linking diet anddisease, and its policy implications. Other experts wereresponsible for papers on dental diseases and osteoporo-sis while WHO staff prepared a paper on the life courseapproach and FAO staff prepared a review of the globaland regional food consumption patterns and trends.Each background paper was peer-reviewed; papers weresubmitted, together with comments by peer-reviewers(some 20 in all), to the Expert Consultation as a generalframework for discussion.Report preparationFollowinground-tableconsultationswithnongovernmen-tal organizations and industry associations in April 2002to obtain feedback on the Expert Consultation’s initialdraftreport,thedraftreportwasmadeavailableonWHO’swebsite for review and comment by all interested partiesuntil June 2002.In August 2002, the Consultation’s Chairperson, Vice-Chairperson and rapporteurs met in Geneva with theWHO/FAO secretariat members as well as with severalexpertsonphysicalactivitytoreviewmorethan120setsofcomments from governments of FAO/WHO MemberStates, representatives of the scientific community,nongovernmental organizations, commercial enterprisesandinterestedindividuals.Thesecommentswerelikewiseposted in their entirety on WHO’s website for publicscrutiny. In October 2002, several members of the ExpertConsultationmetwiththeChairpersonandtheWHO/FAOSecretariatto finalize severalpending issues. In December2002, the final draft report was sent to the members of theExpert Consultation for review and final approval. Thereport was then finalized and published in the WHOTechnical Report Series (TRS 916)

The globalization of trade, which has contributed to food availability and diversification throughout the world, has also increased the chances that the food produced in one place will affect the health and diet of people living in another. As a result, global food safety and nutrition measures applicable across borders, institutions and disciplines, including the establishment of evidence-based international standards on food safety and nutrition, are more important than ever before. Since its inception in 1963, the Codex Alimentarius Commission has developed hundreds of such standards and provided guidance for improving food safety and nutrition in each of its member states and globally. The Commission, whose 186 members represent 99% of the world’s population, is the principal body of the Joint Food and Agriculture Organization of the United Nations (FAO)/World Health Organization (WHO) Food Standards Programme.1 In addition to international food safety and nutrition standards, it develops guidelines and codes of practice, also intended to protect consumers’ health as well as to ensure fair practices in the food trade. Its standards and related texts cover an impressively wide range of subjects of international relevance having to do with biotechnology, pesticides, pathogens, additives and contaminants, food labelling, reference values for nutrients (particularly those related to the risk of noncommunicable diseases) and many other areas. In 1995, the World Trade Organization Agreement on the Application of Sanitary and Phytosanitary Measures called on members of the World Trade Organization to harmonize their national regulations to Codex standards,2 which have since become international benchmarks for food safety. Over the decades the Commission has benefited from the scientific and technical advice provided by WHO. In collaboration with FAO, WHO has convened international meetings of experts to address emerging or emergency issues and provide independent risk assessments, and the recommendations from these meetings feed directly into the Commission’s standard-setting process. Four expert groups meet regularly: the Joint FAO/WHO Expert Committee on Food Additives has carried out risk assessments related to food additives, contaminants, natural toxins and veterinary drug residues in food since 1956; the Joint FAO/WHO Meeting on Pesticide Residues has assessed since 1963 the potential health effects of pesticide residues and recommends safe maximum residue levels for specific food commodities; the Joint FAO/WHO Expert Meeting on Microbiological Risk Assessment has focused since 2000 on risk assessments for selected pathogen–commodity combinations, and the recently-established Joint FAO/WHO Expert Meetings on Nutrition provide scientific advice on nutritional matters. Although Codex standards are sometimes viewed as “trade standards”, their primary purpose is to protect consumers’ health by ensuring the safety and nutritional quality of food products traded worldwide. The importance of this work is evidenced by the large burden of food- and diet-related disorders and illness. Foodborne and waterborne diarrhoeal diseases kill an estimated 2.2 million people annually, most of them children3 and food containing harmful levels of chemicals can cause serious health problems, including cancer. Excessive intake of calories can lead to obesity and to conditions such as diabetes mellitus, coronary heart disease, cancer, hypertension and stroke.4,5 On the other hand, lack of sufficient food and vitamin and mineral deficiencies also cause enormous numbers of deaths and disability. Stunting, a mark of chronic undernutrition, affects 165 million children younger than 5 years and an estimated 35% of all deaths among children in this age group are associated with undernutrition.6 Foodborne diseases and malnutrition undermine not only human health and productivity, but also countries’ potential for sustainable development. As the Commission celebrates 50 years of successful work, it may be a good time to reflect on its trajectory and how it can serve the public interest even better. Over the years the Commission has become more inclusive. Thanks to the work of the FAO/WHO Project and Trust Fund for Enhanced Participation in Codex, launched in 2003, more countries in development and with economies in transition are actively participating in the Commission. The openness, transparency and precision of its reporting and prioritization procedures have been improved. Nonetheless, today’s rapid changes in trade, travel and commerce call for an international standard-setting system that is able to respond more quickly to new situations. One way to achieve this might be through better use of modern information technology. Stronger support of national Codex contact points is needed as well, but equally necessary are heightened political will and an acknowledgement of the importance of food safety and nutrition in public health. Because trade, nutrition and food safety are so closely connected, closer collaboration between different sectors and strengthened interactions between the Codex and other global players will be essential.