Chizuro Nishida, WHO "WHO's perspective on diet, nutrition and prevention of NCDs"


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Breakout Session 2: Non Communicable Diseases
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Chizuro Nishida, WHO "WHO's perspective on diet, nutrition and prevention of NCDs"

  1. 1. WHO's Perspective on Diet, Nutrition and Prevention of NCDs Chizuru Nishida, Coordinator Nutrition Policy and Scientific Advice Unit Department of Nutrition for Health and Development Breakout Session 2: NCD Science Forum 2013, Bonn, 23 – 25 September 2013
  2. 2. 113 Member States 34 Presidents and Prime-Ministers 3 Vice-Presidents and Deputy Prime-Ministers 51 Ministers of Foreign Affairs and Health 100s of civil society 11 Heads of UN Agencies 100s articles in US Foreign Affairs, Economist, Financial Times, Guardian, Wall Street Journal, Forbes, national media 10s headlines on BBC News, CNN, Fox News, ABC News, CBS News, PBS News hour The UN High-level Meeting on NCDs (New York, 19-20 September 2011)
  3. 3. "This is the 2nd health issue ever to be addressed at a special meeting of the United Nations General Assembly. We should all work to meet targets to reduce NCDs. WHO's best buys serve as excellent guidance" Ban Ki-moon • UN Secretary-General • 19 September 2011
  4. 4. The Political Declaration of the High Level Meeting Article 43
  5. 5. The Political Declaration of the High Level Meeting Article 44 Calls upon the private sector to:
  6. 6. Objective 1 To raise the priority accorded to the prevention and control of NCDs in global, regional and national agendas and internationally agreed development goals, through strengthened international cooperation and advocacy Objective 2 To strengthen national capacity, leadership, governance, multisectoral action and partnerships to accelerate country response for the prevention and control of NCDs Objective 3 To reduce modifiable risk factors for NCDs and underlying social determinants through creation of health- promoting environments Objective 4 To strengthen and orient health systems to address the prevention and control of noncommunicable diseases and the underlying social determinants through people- centred primary health care and universal health coverage Objective 5 To promote and support national capacity for high- quality research and development for the prevention and control of NCDs Objective 6 To monitor the trends and determinants of NCDs and evaluate progress in their prevention and control WHO Global Action Plan for the Prevention and Control of NCDs (2013-2020) (endorsed by WHA 66 in May 2013)
  7. 7. WHO NCD Action Plan 2013-2020 (WHA 66.10) Policy options for Member States: promoting a healthy diet • Developing or strengthening food and nutrition policies and action plans • Strengthening implementation of related global strategies: – Global Strategy on Diet, Physical Activity and Health – Global Strategy for Infant and Young Child Feeding – Comprehensive Implementation Plan on Maternal, Infant and Young Child Nutrition – Recommendations on the marketing of foods and non-alcoholic beverages to children • Protecting dietary guidance and food policy from undue influence of commercial and other vested interests
  8. 8. (a) Appropriate breastfeeding practices (b) Marketing of foods and non-alcoholic beverages to children (c) Food producers and processors, other commercial operators, and consumers, to: – Reduce salt/sodium – Increase fruit and vegetables – Reduce/replace saturated fatty acids – Replace trans-fatty acids – Reduce sugars – Limit excess calorie intake, reduce portion size and energy density of foods. (d) Food retailers/caterers to improve availability, affordability and acceptability of healthier food products (e) Healthy food in all public institutions, i.e. schools, workplaces (f) Economic tools, e.g. taxes and subsidies (g) Healthy agricultural products and foods (h) Evidence-informed public campaigns and social marketing (i) Health- and nutrition-promoting environments (j) Nutrition labelling, e.g. Codex Alimentarius WHO NCD Action Plan 2013-2020 (WHA 66.10) Policy options for Member States: promoting a healthy diet Such policies and programmes should include a monitoring and evaluation plan and would aim to:
  9. 9. Comprehensive Implementation Plan on maternal, infant and young child nutrition (WHA 65.6, May 2012)
  10. 10. Child malnutrition Adolescent malnutrition Fetal & infant malnutrition Elderly malnutrition Adult malnutrition Pregnancy Low weight gain Higher maternal mortality Reduced capacity for care Rapid Reduced intellectual potential & reduced school performance Inappropriate food, health & care growth Inappropriate food, health & careInappropriate food, health & care Reduced intellectual potential & reduced school performance Inadequate catch up growth Impaired mental developmentHigher mortality rate /Inappropriate feeding practices Frequent infections Inappropriate food, health & care ((including untimely/inappropriate complementary feeding) Societal and environmental factors Inadequate fetal nutrition Source: Darnton-Hill, Nishida & James, 2002 (adapted) Low birth weight & compromised body composition Obesity Abdominal obesity Diabetes, CVD Lifecourse: causal links MIYCN: The 1st step in preventing NCDs later in life
  11. 11. Global nutrition targets 2025: To improve maternal, infant and young child nutrition (endorsed by WHA65, May 2012) I
  12. 12. CIP-MIYCN 5 high-priority actions for Member States ACTION 1: To create a supportive environment for the implementation of comprehensive food and nutrition policies ACTION 2: To include all required effective health interventions with an impact on nutrition in plans for scaling up ACTION 3: To stimulate the implementation of non health interventions with an impact on nutrition ACTION 4: To provide adequate human and financial resources for the implementation of health interventions with an impact on nutrition ACTION 5: To monitor and evaluate the implementation of policies and programmes
  13. 13. Continuing to update dietary goals for the prevention of NCDs - Effects of fats and fatty acids on health --- SFA and TFA ↓ Justification for prioritising fats and fatty acids in 2012 – 2013 Increasing attention (i.e. global targets for monitoring NCD prevention) and conflicting views on the roles and effects of different fats and fatty acids on health Need updated WHO recommendations and guidance • 1989 WHO Study Group on Diet, nutrition and the prevention of chronic diseases (TRS797, 1990) • 1993 Joint FAO/WHO Expert Consultation on Fats and Oils in Human Nutrition (1994) • 2002 Joint WHO/FAO Expert Consultation on Diet, Nutrition and the Prevention of Chronic Diseases (TRS916, 2003) • 2008 Joint FAO/WHO Expert Consultation on Fats and Fatty Acids in Human Nutrition (FAO 2010) Nutrition guideline development plan of NUGAG Subgroup on Diet & Health 2012 - 2013
  14. 14. Partially hardened vegetable oils mainly contain trans isomers of oleic acid (C18:1 trans-9 or elaidic acid and C18: 1 trans-10). Partially hydrogenated fish oils mainly contain trans isomers of C20:1, 20:2, 22:1 and 22:2 Partially hydrogenated vegetable oils also contain smaller amounts of C18: 1 trans-8, and C18:1 trans-11 (vaccenic acid) Trans isomers of alpha-linolenic acid may arise during deep-fat frying. The differential effects of specific TFAs based on carbon chain length or trans isomer bond(s) position are less well established. Main categories of trans-fatty acids
  15. 15. Industrial TFA "TFA produced by partial hydrogenation of fats and oils should be considered industrial food additives having no demonstrable health benefits and clear risks to human health… as such, food services, restaurants, and food and cooking fat manufacturers should avoid their use" WHO Scientific Update on TFA, 2009 Industrial vs ruminant TFA “... industrial and ruminant TFAs may have similar effects on serum lipoproteins when ruminant TFA are consumed in sufficient quantities (much higher than seen with usual dietary intakes) …” WHO Scientific Update on TFA, 2009 "Limited evidence is available to support a substantial biological difference in the detrimental effects of industrial trans fatty acids (iTFA) and ruminant trans fatty acids (rTFA) on health when rTFA is consumed at seven to ten times the normal level of consumption" USDA Nutrition Evidence Library, 2010
  16. 16. Fatty acid profiles of different fats and oils
  17. 17. Palm oil complexity • Originated from West Africa • Red palm oil became part of important item in the Atlantic slave trade (19th century) • British Industrial Revolution created a demand for palm oil for candle making and as a lubricant for machinery • Largest producers today - Indonesia, Malaysia • Palm oil is 15% cheaper than other oils in Middle East • Malaysian palm oil Egypt UAE Iran - Largest direct importer of edible Malaysian palm oil Economic cooperation agreement: Malaysia – importing crude petroleum Iran – palm oil • McDonald's primarily uses palm oil as a cooking oil for its operations in: • Africa • Asia-Pacific • Middle East • Latin America But NOT in Europe and North America! Why? •Stronger governmental action and regulation?
  18. 18. Roadmap for SFA reduction
  19. 19. Proposed approaches to reduce intake of SFA and TFA • Reformulation – Replacement of TFA with unsaturated FA , esp. PUFA (legislation) – Reduction of SFA and replacement with unsaturated FA, esp. PUFA – Monitoring product composition • Labelling – Policy action for mandatory labelling – Scientifically based consumer friendly labelling schemes (nutrient profiling) • Pricing policies – Differential taxation of products with reduced TFA and SFA content • Marketing restrictions – Advertisements to children (developing nutrient profiling model - EURO) • Menu changes in public institutions • Public awareness and education campaigns – FBDG – Mass media – School education -- NFSI • Evidence generation – Measurement of intake of SFA and TFA – Country experiences in taking action and its impacts