WHO's Perspective on Diet, Nutrition and Prevention

of NCDs

Chizuru Nishida, CoordinatorNutrition Policy and Scientific Advice Unit

Department of Nutrition forHealth and Development

Breakout Session 2: NCDScience Forum 2013, Bonn, 23 – 25 September 2013

� 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)

"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 201 1

The Political Declaration

of the High Level Meeting

Article 43

The Political Declaration

of the High Level Meeting

Article 44

Calls upon the private sector to:

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)

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

(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:

Comprehensive Implementation Plan on

maternal, infant and young child nutrition

(WHA 65.6, May 2012)

Child malnutrition

Adolescent malnutrition

Fetal & infant malnutrition

Elderly malnutrition

Adultmalnutrition

PregnancyLow 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

Inadequatecatch up growth

Impaired mentaldevelopmentHigher mortality rate

/Inappropriate feeding practices

Frequent infectionsInappropriate food, health & care ((including untimely/inappropriate complementary feeding)

Societal and environmental

factors

Inadequatefetal

nutrition

Source: Darnton-Hill, Nishida & James, 2002 (adapte d)

Low birth weight & compromised body composition

ObesityAbdominal obesity

Diabetes, CVD

Lifecourse: causal links MIYCN: The 1 st step in preventing NCDs later in life

Global nutrition targets 2025: To improve maternal, infant and young child nutrition (endorsed by WHA65, May 2012)

I

CIP-MIYCN5 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

� 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 ofNUGAG Subgroup on Diet & Health

2012 - 2013

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

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

Fatty acid profiles of different fats and oils

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 oilEconomic cooperation agreement:

Malaysia – importing crude petroleumIran – 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 Europeand North America!

Why? •Stronger governmental action and regulation?

Roadmap for SFA reduction

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