Deakin University WHO Collaborating Centre for Obesity Prevention The role of nutrient recommendations in devising FBDG – the Australian experience (processes

Deakin University WHO Collaborating Centre for Obesity Prevention

The role of nutrient recommendations in devising

FBDG – the Australian experience (processes and challenges)

Mark Lawrence

22 June 2011


Background: A brief chronology

NRVs:1954 1961 1970 1991 2006

Food selection guides:1940s - 1990s = Five food groups

1998 = Australian Guide to Healthy Eating

Dietary guidelines:1978 1992 2003


2008 – 11: NHMRC review of the 2003 DGs

• The revised NHMRC Dietary Guidelines aim to promote health and wellbeing, and reduce the risk of chronic disease for Australians.

• The NHMRC Dietary Guidelines for Australian Adults and Dietary Guidelines for Children and Adolescents in Australia are based on the best available scientific evidence and provide information for health professionals and the general population about healthy food choices.

Stage 1: Revision of core food groups

Translates the Nutrient Reference Values for Australia and New Zealand Including Recommended Dietary Intakes (2006) into food consumption patterns that:

- are consistent with the latest evidence re food-, diet-, health relationships- promote health and wellbeing- deliver nutritional requirements for people of all ages, gender, activity levels and life-stages- are culturally acceptable and socially equitable- are environmentally sustainable- reflect current Australian food supply and food consumption patterns - provide flexibility in food choice


Foundation and total diets• ‘Foundation’ diet to meet nutrient needs within minimal kJ• ‘Total’ diet to meet remaining kJ needs• Modelling steps:

– Development of composite food groups and application to design Foundation Diets that met RDIs within minimal energy limits for each age/sex group, taking into account chronic disease, environmental, social and cultural constraints

– Development of 100 simulated 7-day diets using individual foods for each age/sex group and checking against EARs for all nutrients modelled

– Development of 7-day total diets for each age/sex group of various activity levels through the addition of flexible food options to the Foundation Diets



Foundation and total diets– RDIs met for all except:

• Iron in women 19-30 yrs (90% met) and children from 2-8 yrs

• Iron in pregnant women• Iodine in lactation• Magnesium and zinc in men ≥ 50 yrs

– EARs met for all except:• Iron in pregnant women (0% met)• Magnesium in older men (97% met)

– AIs all met except for vitamin D– AMDRs achieved (except % protein exceeded in

some small, least active age/gender groups)– ULs achieved (except for sodium in higher energy

diets)– SDTs met (when foods high in LCn3 fatty acids

selected)

Stage 2: Literature review• Development of a set of targeted questions for systematic, umbrella and narrative review to help answer the ultimate question “What should Australians eat?” • DAA led large consortium contracted for this work

• Draft report > 1000 pages and >55,000 papers • Informed revision of Core Food Groups

• Is informing development of revised Dietary Guidelines


Key components of the systematic reviews• Developed research questions• Developed a protocol stating explicitly what the

inclusion/exclusion criteria are, search strategies• Exhaustive search for the literature• Appraised the literature • Extracted and summarised data from relevant studies• Determined the applicability of resultsÞ systematic review of the national and international literature

from 2002, and a review of key literature between 1997 and 2002, on the food-diet-health-disease inter-relationship;

Þ systematic review of national and international literature on food, dietary patterns, nutrition and sustainability; and

Þ assessed and reported on national and international peer reviewed food guides and national data on nutrient intakes.

[Source: Skye Newton – NHMRC/University of Adelaide]

9


Stage 3: Drafting of publications

• Technical writers• Publications will be in a ‘consumer friendly’ format:

• Food selection guide• Dietary guidelines• Educator’s guide• Modelling System to Inform the Revision

of the Australian Guide to Healthy Eating (2010)

• Review of the Evidence to Targeted Questions to Inform the Revision of the Australian Dietary Guidelines.


Draft revised Dietary Guideline recommendations (as at June 2011)

• Achieve and maintain a healthy weight: be physically active and choose amounts of nutritious foods and drinks to meet your energy need

• Enjoy a wide variety of nutritious foods from the following groups every day: – plenty of vegetables, including different types and colours, and

legumes/beans;– fruit;– grain (cereal) foods, mostly wholegrain;– lean meat and poultry, fish, eggs, nuts and seeds, and legumes/beans;– milk, yogurt, cheese and/or their alternatives, mostly reduced fat– and drink water.

• Limit intake of foods and drinks containing saturated and trans fats; added salt; added sugars; and alcohol

• Encourage and support breastfeeding• Care for your food; prepare and store it safely.


Challenges

• Conceptual• Methodological• Technical• Political


Conceptual challenges

• The scope of the food – health relationship

• Should environmental and social (equity) considerations be integrated into dietary guidelines?

• If so, how?

A global agenda

Environmentally effective food choices Proposal notified to the EU 1 15.05.09

http://www.slv.se/upload/dokument/miljo/environmentally_effective_food_choices_proposal_eu_2009.pdf


Methodological challenges• The food – health evidence base

– “The complexity of relations between nutrition and health and the lack of widely accepted guidance on how to address nutrition issues have impeded the transfer of evidence-based methodologies from medicine to the field of nutrition. Whereas the concepts and methods of evidence-based medicine can be applied to nutrition questions, there are important differences between evaluations of drug therapies and nutrient-related health outcomes” [Chung et al, Reporting of systematic reviews of micronutrients and health: a critical appraisal, Am J Clin Nutr, 2009]

– “Because RCTs are inappropriate for many lifestyle interventions, community-based trials and societal/social change interventions, research on these types of interventions is often omitted from the traditional reviews that generate recommendations, guidelines and standards” [Kumanyika S, Economos C Prevention of obesity. Finding the best evidence. World Nutrition, June 2011]


Technical challenges• Lack of recent national adult diet, food and nutrition data• How deal with fortified and novel foods?

• Inclusion of fortified foods in modelling• Which food group?

• What is the best visual representation?• Plates, pyramids, other• Food photographs vs illustrations

• Should ‘discretionary’ foods be included alongside or separate from ‘foundation’ foods?

• Supporting material for DGs and FSG:• public/ health professionals • booklets/ brochures/ posters• web-based format

Political challengeSEAFOOD INDUSTRY MEDIA RELEASE - 14 MAY 2010‘WHILE NHMRC FIDDLES WITH AUSTRALIANS’ HEALTH, ROME IS COMING TO SAVE US’THE National Health & Medical Research Council (NHMRC) -- the Federal Government’s peak health research advisory body -- has been accused of potentially putting the health of Australians at risk.This follows release of a draft report prepared for the NHMRC recommending Australians eat seafood just once a week -- not twice or more, as widely recommended by Australian and international health experts.

“The saying used to be that Nero fiddled while Rome burned but now it’s a case of NHMRC fiddling with Australians’ health while Rome comes to save us,” Mr Palmer said. “Experts from the FAO headquarters in Rome are heading to Melbourne in November for the 2010 International Seafood & Health Conference and they will be discussing their strong recommendations on eating seafood for health.”


Front page, the Australian (21/7/10)

‘Green diet push angers experts’ – “AUSTRALIA'S top health standards body has been accused of

subverting food science to fit a green agenda” – Australian Food and Grocery Council claimed the NHMRC, "lost the plot". …

“what they have done is strayed into an area that they aren't expert in".

http://www.theaustralian.com.au/news/green-diet-push-angers-experts/story-e6frg6n6-1225894792847

Australian editorial 23/7/10

‘Eat your greens but little else’ • Social engineers want to force-feed us dogma for dinner




SMH, 23 February 2011

19http://www.smh.com.au/opinion/society-and-culture/theres-a-major-beef-over-dietary-guidelines-20110222-1b402.html#comments

http://www.smh.com.au/opinion/society-and-culture/theres-a-major-beef-over-dietary-guidelines-20110222-1b402.html#comments

http://www.smh.com.au/opinion/society-and-culture/theres-a-major-beef-over-dietary-guidelines-20110222-1b402.html#comments


Next steps …

• Currently finalising the DG drafting and FSG visuals and determining mechanisms for their implementation

• Public consultation in the next 1-3 months• Launched in late 2011 (anticipated)

• http://www.nhmrc.gov.au/your_health/healthy/nutrition/review.htm

http://www.nhmrc.gov.au/your_health/healthy/nutrition/review.htm

http://www.nhmrc.gov.au/your_health/healthy/nutrition/review.htm

Documents

Deakin University WHO Collaborating Centre for Obesity Prevention The role of nutrient recommendations in devising FBDG – the Australian experience (processes