COAG/2004/3

Table of Contents

I. INTRODUCTION

II. REVIEW OF THE JOINT WHO/FAO EXPERT CONSULTATION REPORT

A. The Determinants, Dimensions and Trends of Non Communicable Diseases

B. The Experts' Recommendations

C. FAO’s Preliminary Analysis of the Changing Structure in Diet vis-à-vis the Experts’ Recommendations

III. POSSIBLE IMPLICATIONS FOR AGRICULTURE, FOOD PROCESSING AND MARKETING

A. Agricultural Production and Trade

B. Food Processing Technologies and Marketing Systems

IV. PROPOSED FOLLOW-UP TO THE EXPERTS’ REPORT

A. WHO’s Global Strategy on Diet, Physical Activity and Health

B. Specific Areas for Consideration

V. FOR THE CONSIDERATION OF THE COMMITTEE ON AGRICULTURE

I. INTRODUCTION

1. The Joint WHO/FAO Expert Consultation on Diet, Nutrition and the Prevention of Chronic Diseases was convened in Geneva, 28 January – 1 February 2002. Based on this consultation, the Experts put forward a set of population-based recommendations which reflects the current knowledge on diet, nutrition and prevention of cardiovascular disease, cancer, dental disease, osteoporosis, diabetes and obesity (also known as non-communicable diseases or NCDs). The Experts circulated their draft report widely for comments to FAO and WHO and to stakeholders including industry and consumer/NGO groups. They held meetings in April 2002, with all parties, to obtain feedback on the report followed by a further period of stakeholder consultation. This consultative process concluded with another meeting of some of the Experts in August 2002 to redraft the report. The final Report¹ was released on the websites of both Organizations on 3 March 2003 and launched jointly by the Directors-General of WHO and FAO at FAO Headquarters, Rome, in April 2003.

2. The 17^th Session of the Committee on Agriculture (COAG), 31 March – 4 April 2003, was informed of the release of the Report². The Committee agreed that it would meet in a Special Session to review the Report and that discussion of the Report would be put on the agenda of the 124^th Session of Council, 23 - 28 June 2003. The Council noted the concerns expressed by some Members that some of the recommendations of the Report ..., while addressing the important relationship between diet and chronic diseases, could result in changes in demand with adverse impacts on small producers and the agricultural economies of developing countries…. It welcomed ... a special session of COAG ... to review the Report together with FAO’s proposal for follow-up, and looked forward to receiving the COAG report at its subsequent session³.

3. This document has two main purposes. The first is to facilitate, from a food and agricultural perspective, COAG’s review of the Report at its 18^th Special Session⁴. The Report is largely the work of medical and nutritional experts and thus logically assesses the evidence linking diet and nutrition to NCDs and presents population nutrient intake goals. These recommended goals, if widely adopted, may have important implications for agricultural production and trade and food processing and marketing that merit further analysis and exploration.

4. The Report also briefly reviews changing food consumption patterns and draws preliminary conclusions which could have implications for the work of FAO and other organizations and institutions. Considering these implications leads to the document’s second purpose; that is, to obtain COAG’s guidance on shaping FAO’s proposals for its follow-up to the Report’s recommendations.

5. These proposals recognise that NCDs are, in themselves, matters of the medical sciences which go beyond the mandate of FAO⁵. However, there will be some elements of a global response that fall clearly within FAO’s purview. There will also be others where responsibilities are shared between FAO and WHO and with other UN agencies and international institutions, underlining the importance of close collaboration between all parties concerned in addressing the growing diet-related health burden.

II. REVIEW OF THE JOINT WHO/FAO EXPERT CONSULTATION REPORT

6. The following provides a brief overview of the Expert Consultation Report and a preliminary analysis by FAO.

A. The Determinants, Dimensions and Trends of Non Communicable Diseases

7. NCDs have become the leading cause of death worldwide. Current WHO estimates suggest that NCDs are responsible for 33 million premature deaths. Heart disease, stroke, cancer, diabetes and lung diseases account for about 59 percent of all deaths⁶. NCDs are no longer a problem restricted to affluent, industrialized countries. They are the cause of 40 percent of all deaths in developing countries and exist alongside hunger and malnutrition inflicting a “double burden” on government budgets and on societies. The NCD burden in developing countries is likely to rise rapidly, probably much faster than in developed countries. The major determinant of this health burden is the “nutrition transition”, that is, the rapid socio-economic, demographic and technological changes in society inducing a shift in habitual dietary consumption and physical activity patterns. This nutrition transition in combination with persistent hunger and undernutrition in populations typical of developing societies presents a fundamental challenge. A number of recent studies have underlined the relationship between undernutrition and the risk of acquiring NCDs, particularly between maternal nutrition and foetal growth (prenatal programming) and the development of obesity and NCDs in later adult life. The increasing evidence of obesity among poorer socio-economic groups, sometimes alongside undernutrition within the same household, exemplifies the close interaction between undernutrition, poverty and NCDs.

8. The Experts based their dietary recommendations on the fact that morbidity and mortality, due to NCDs, are largely preventable and thus have an enormous potential to reduce the economic and health burden of countries. Adoption of healthy diets and lifestyles is a cost-effective approach to reducing the burden imposed by the emerging epidemic of NCDs in developing countries. The ensuring policy messages are twofold: (i) efforts to fight hunger today and improve in particular the nutritional status of women in the reproductive age have the potential to yield an extra dividend tomorrow, and (ii) the recommended guidance to adopt healthier diets is even more important in developing countries where the interactions of early undernutrition and rapid nutritional transition are likely to lead to an increased susceptibility to NCDs in later life.

B. The Experts' Recommendations

9. Against this background of rapidly changing food consumption patterns, increasing urbanisation accompanied by more sedentary lifestyles and the potential contribution of prenatal programming, the Experts prepared a detailed set of nutritional recommendations. The main elements of these recommendations are:

• Increasing the consumption of fruits and vegetables (5 portions per day or the equivalent of at least 400 g per capita per day) will help to reduce the risk of cardio-vascular diseases (CVDs) and certain forms of cancer.
• Limiting the consumption of fats lowers the risk of CVDs, while promoting the consumption of fish protects against heart disease and stroke.
• Limiting high intakes of free sugars, which provide energy without specific nutrients and increase the risk of unhealthy weight gain, improves the nutritional quality of diets and decreases the risk of dental decay.
• Raising awareness for the need for sufficient physical activity.

10. The main recommendations of the Expert Consultation Report in terms of dietary factors, limited to those relevant to the food supply chain, are summarized in Table 1. Details of what these population nutrient intake goals mean in practice and how they differ from recommendations applied to individuals are provided in the Annex to this document.

Table 1: Ranges of selected population nutrient intake goals

Source: Adapted from Table 6, p.56, “Diet, Nutrition and the Prevention of Chronic Diseases”, Report of the Joint WHO/FAO Expert Consultation, WHO Technical Report Series No. 916, WHO, Geneva, 2003.
 

Notes:

(a) Percentage of total energy available after taking into account that consumed as protein and fat; hence, the wide range.

(b) The term “free sugars” refers to all monosaccharides and disaccharides added to foods by the manufacturer, cook or consumer, plus sugars naturally present in honey, syrups and fruit juices.

(c) The suggested range should be seen in the light of the Joint WHO/FAO/UNU Expert Consultation on Protein and Amino Acid Requirements in Human Nutrition, held in Geneva from 9 to 16 April 2002.

C. FAO’s Preliminary Analysis of the Changing Structure in Diet vis-à-vis the Experts’ Recommendations

11. FAO has undertaken a preliminary, country-specific assessment of nutritional supply relative to the Experts’ recommendations. All countries for which FAO compiles food balance sheets were included in the analysis. The analysis traces how the availability of individual dietary components has changed over the past forty years (1961-2001) relative to the recommended intake levels. The main results are summarized in Table 2 which provides a simple headcount of countries that fall above, below or within the recommended limits of nutrient intakes.

Table 2: How many countries meet the recommendations? A headcount of countries

Notes:

(a) All results are based on total availability rather than actual intake. This can result in a misclassification of countries, particularly where recommendations are defined in absolute terms (e.g. for fruits and vegetables or for cholesterol).

(b) Limited to countries for which FAO produces Supply-Utilization Accounts (SUAs).

(c) The disintegration of the Former Soviet Union and other countries in Eastern Europe increased the number of countries for which FAO provided SUAs in the 1990s to 178.

(d) FA = fatty acids
 

12. Without trying to interpret the results in detail, the figures presented in Table 2 reveal that there are both improvements and deteriorations in nutrient supplies relative to the recommendations. The number of countries that has reached and exceeded the 400 g/person/day limit for the supply of fruits and vegetables, for instance, steadily increased over the last forty years. Likewise, the number of countries below the lower limits of 15 percent for fat and of 6 percent for polyunsaturated fatty acids constantly declined. In tandem, however, the number of countries with national averages beyond the recommended upper limits of 300 mg for cholesterol and of 30 percent for fat increased. The direction of these changes is likely to continue; the pace of change could even accelerate.

13. Preliminary results derived from FAO’s long-term outlook for global agriculture suggests that: (i) a number of developing countries, notably in sub-Saharan Africa and South Asia, will remain below the recommended lower limits for protein and fats; (ii) a growing number of developing countries will reach and then even exceed the recommended upper limits; and (iii) many mid-income developing countries and most of the developed ones will rapidly exceed the recommended upper consumption limits, often by a considerable margin and for a growing number of nutrients. The analysis also suggests that the transition towards higher consumption levels will take place at a faster pace than in the past.

III. POSSIBLE IMPLICATIONS FOR AGRICULTURE, FOOD PROCESSING AND MARKETING

14. The dietary recommendations in the Experts’ Report could have profound implications for agriculture, farming systems and trade as well as food processing, distribution and marketing. For an individual country, the implications would depend on the extent of the deviation from the goal, the possibilities to shift to alternative products, the participation in international trade and desired speed of their adoption. At the same time, the dietary adjustment process will take place in the presence of other changes, notably the ongoing liberalization of international and regional trade, globalization of food production, processing and distribution, demographic changes, rapid urbanisation, technological progress and lifestyle changes associated with all of this.

15. A quick assessment does not permit a full analysis of the interplay between these factors and their possible impacts on agriculture and its downstream sectors. It will, by and large, focus on the direct and first-round impacts of adjustments towards the dietary goals. It should also be noted that the proposed population nutrient intake goals (see Annex) are only recommendations, and not prescriptive. Moreover, the evidence to date indicates that, apart from the experience of food safety scares, dietary recommendations made in the past to reduce intake of sugar and fat, for example, have had only a limited impact on consumption. Any precipitate and significant consumption response to the Report’s recommendations is therefore unlikely in a global sense. The recommendations, however, add to the stock of such messages and in the medium to long-term could modify consumption behaviour, initially, at least, in developed countries but gradually also in developing countries.

A. Agricultural Production and Trade

16. Obviously, changes in demand result in changes in supply. Depending upon a country’s comparative advantage and production systems, the adjustments in any country may be matched by changes in production and/or imports and exports.

1. Edible oils and fats

17. The Experts make two principal sets of recommendations with regard to the consumption of fats and oils. The first relates to total fat intake and the second to the desirable fatty acid composition in the diet to reduce health risk. Maximum levels and/or ideal ranges have been defined for the fatty acids depending on their positive or negative effect on health. Diets in individual countries and population groups within countries include different proportions of these fatty acids depending on the oils and fats consumed. In principle, diets with potentially negative health implications are those where saturated fatty acids and/or trans fatty acids are in excess of the desirable range/level while the healthy oils/fats contain more of the mono or poly-unsaturated fatty acids.

18. Fats in the diet account for about 24 percent of total dietary energy supplies (DES) globally, a level that lies comfortably within the recommended range. As far as the recommended range of total fats (15-30 percent of DES) is concerned, the needs for adjustments in agriculture should therefore be limited. The global average, however, masks considerable differences between developed and developing countries, and even more differences within the two country groups. While the share of total fats has reached a level of about 21 percent in developing countries, it has already exceeded the upper limit of the recommendation in developed countries where fats account for 33 percent of DES. An inspection of consumption and recommendations alone, however, is not sufficient to draw inferences on possible impacts for production. Whether and to what extent a reduction of “excess” consumption leads to an adjustment in production ultimately hinges on the interactions of numerous factors, notably on responsiveness of domestic supply and international demand to price changes for fats and oils as well as possible cross-effects to other commodity markets since the single most important provider of edible oils are vegetable oils accounting for nearly 40 percent of total fat supplies.

19. In order to follow up the likely implications of the Report’s recommendations for this sector, reliable and detailed data on the pattern of domestic consumption of oils/fats (for food purposes as opposed to a multitude of other non-food uses) need to be first compiled and analysed. Currently, such information is not readily available. In the absence of an exact breakdown of fat consumption at the individual country level, the analysis of the likely future implications of changing consumption patterns induced by the health-related recommendations on global production and trade in oil crops can only be superficial. Impacts on agriculture could also result in adjustments towards the recommended more desirable fatty acid patterns. At a general level, demand for and thus production of and trade in “more healthy” oils/fats should benefit. This means, for instance, that demand for and thus production of oils and fats rich in saturated fats (such as butter and hard margarine) may decline, while demand and production of oils with healthier fatty acid profiles (e.g. olive oil) could expand.

20. Recommendations for population nutrient intake goals may have a potentially longer-term impact on national and global markets of both oils/fats and their related products. This has raised widespread concern in a sector sensitive to changing market conditions and the high costs associated with changes in the production chain. Recognizing that consumer preferences may change, the sector is expected to increase efforts to adjust to possible shifts in demand related to health, for example, increasing investment in technologies that allow altering the fatty acid composition of individual vegetable oils via genetic modification of the underlying crop, and the manufacture of vegetable oil blends that combine the nutritional characteristics of individual oils in an optimal manner. Research on the beneficial health properties of nutrients (other than fatty acids) contained in specific vegetable oils is also likely to intensify, focusing particularly on palm and coconut oils. Manufacture of hardened fats, based on hydrogenation of oils, may decline over time or may be reoriented towards raw materials, like palm oil, which do not require hydrogenation. Moreover, in the case of palm oil, the search for additional non-food applications is expected to intensify.

2. Sugar

21. The Experts’ Report defines a population nutrient intake goal for free sugars of 10 percent or less of total energy supply. The Report acknowledges that this goal might be controversial, and it has indeed prompted concerns that its adoption might have an adverse impact on sugar producers and the food industry. In practice, the impact would depend on a number of factors. Where sugar is consumed at levels far beyond the 10 percent mark, the necessary downward adjustment in domestic consumption would reduce domestic prices and revenues for beet or cane growers. Most affected would be countries where natural growing conditions limit the shift towards alternative crops and where exports would have to be placed onto an already depressed world market. These difficulties would be much reduced under conditions of a liberalized sugar market characterized by lower protection of sugar production in OECD countries. For many developing countries, a freer international sugar market could therefore open an important channel for otherwise unprofitable production and exports. In all importing countries, higher world market prices brought about by freer trade could dampen the demand for sugar.

22. The intricacies of the world sugar markets (e.g. complex policy structures, regional trade links and the numerous preferential agreements) do not allow a simple quantification of the impacts. However, the dimensions of possible adjustments can be estimated from an examination of current consumption levels. If all of the 93 developed and developing countries, where sugar consumption presently accounts for more than 10 percent of total energy supply, were to reduce intake to the target level, the implied reduction in world consumption of sugar would be about 15 percent. On the other hand, if all 85 countries, where consumption is below the 10 percent mark, were to increase consumption, the implied increase would more than compensate for the reduction in the “above 10 percent” countries.

3. Cereals

23. Cereals are the main source of carbohydrates in most diets. Although the Experts’ Report does not recommend specific dietary intake levels of cereals per se, it does recommend that total carbohydrate intake (from all sources) should be between 55 to 75 percent of energy in the diet. The Report also states that whole grain cereals, along with fruits and vegetables, are the preferred sources of dietary fibre (non-starch polysaccharides), with known health benefits. It is the extent of processing of cereals, as well as the quantity and type consumed, that are important in the context of health benefits.

4. Fruits and vegetables

24. The Experts’ Report recommends a daily intake of fruits and vegetables of at least 400 g/person/day (or 150 kg/person/year). It emphasises that the principal value of fruits and vegetables lies in their potential contribution to reduce the risk for cardiovascular disorders and various types of cancers.

25. FAO food balance sheet data indicate a global availability of 169 kg/person/year for fruits and vegetables. As for other commodities, this global average masks significant variations between countries and communities within them. Many people in developing countries do not eat enough fruits and vegetables and, while the average availability has reached 142 kg per capita, many countries remain below the average and thus even below the target. Moreover, losses occurring for fruits and vegetables at the retail and household levels are likely to be much higher than those for other food items leading to a gross overestimation of actual consumption. However, the substantial increase in per capita availability over the last 20 years augurs well for achieving this particular goal in the future.

26. Impacts on production, processing and marketing need also to be seen in the context of adjustments for this highly perishable group of food products. As already mentioned, losses at the household level can reach very high levels. These high losses mean that the differences between availability and intake can be substantial. This is particularly so where handling and storage infrastructure (cold chains, just-in-time delivery systems, etc.) is not yet available. An adjustment towards the recommended levels could therefore come from many elements of the supply chain, ranging from the possibility to increase horticultural production to efforts to reduce post-harvest losses, investments in better processing and storage technologies and, eventually, to better storage facilities at the household level.

27. Adjusting supplies to such increases in consumption provides scope for significant production increases for fruits and vegetables. Developing countries in particular may benefit from this opportunity, especially those with production systems where substitution of crops with reduced consumption growth, such as sugar cane, by fruits and vegetables is economically and sustainably feasible.

5. Milk and meat

28. Milk and meat products provide a variety of the nutrients covered by the Report’s recommendations. They are, for instance, an important source of proteins but can also contribute to excess consumption of fats, notably saturated fatty acids. Along with a few other animal products (fish, eggs), they are also a source of cholesterol. Many studies have established the link between dietary cholesterol and saturated fatty acids intakes and coronary heart disease. In most developed countries, where milk and meat consumption has already reached high levels, there is a growing awareness of the need to contain further increases. In most developing countries, however, meat and milk consumption levels are still low, often too low to afford their young and growing populations sufficient access to protein, micronutrients and vitamins.

29. There are very many types of processed meat and milk products; hence, the Experts’ recommendations relate not only to total consumption levels but also to the composition of products. For instance, the consumption of poultry meat, being low in saturated fats and cholesterol, is beneficial relative to the so-called red meats. In fact, over the last 30 years the trend towards higher poultry consumption has brought about a massive increase in production in developed and developing countries alike. Whether this shift has the same health benefits for consumers in both country groups is less apparent depending upon the composition of the product. Price premiums paid in developed countries for meat with a lower fat content, such as boneless-skinless poultry breast, has created a surplus of other chicken products with a higher fat content that are often disposed of in developing country markets at lower prices. Developing countries that import these “cheaper” portions raise the share of saturated fatty acid in their overall diet.

6. Fish and fish products

30. Increased consumption of fish and fish products is another of the Report’s recommendation although it does not set a specific target. Fish proteins, fatty acids, oils and micronutrients play an important nutritional role in human growth and development and in the reduction of NCDs risks. This recommendation needs to be balanced against concerns for sustainability of marine stocks. Currently, two-thirds of the total food fish supply are obtained from marine and inland waters, with the remainder from aquaculture. Since the 1970s, world marine fisheries production has leveled off with the majority of stocks being fully exploited. In contrast, aquaculture production has shown a remarkable growth, substituting for the reduction in the marine catch. Continued promotion of better management of capture fisheries and aquaculture to improve quantity and quality of fish for human consumption, while ensuring sustainability, is essential.

31. Global per capita fish consumption nearly doubled in 40 years from about 9 kg per annum in the early 1960s to 16 kg in 1997. Per capita annual availability has risen from about 20 to 28 kg in industrialized countries. During the same period, availability in low income food deficit countries has increased from one-fifth to nearly one-half of that in the more affluent economies. Despite the relatively low consumption of fish in low income countries, the contribution of fish to total animal protein intake is considerable but is slowly declining due to faster growth in the consumption of other animal products.

B. Food Processing Technologies and Marketing Systems

32. The increasing role played by the food industry in the processing and marketing of the basic foodstuffs is having a growing influence on food consumption patterns and dietary intake particularly in urban areas. The almost universal shift to refined grain flour has a direct impact on the nutrient intakes, particularly where wheat and maize are staple foods. Modern milling techniques result in a loss of important nutrients even though consumers may find the products more palatable. Since the 1950s, leavened wheat and maize bread, the dominant staple of European diets for millennia, has made major inroads in every part of the world. Markets for a large variety of baked goods, based on white flour, are expanding rapidly in developing countries even where cereals are not the traditional staple food. This trend is expected to continue and may even accelerate, driven by the increasing globalisation of food industries, the spread of supermarkets and rapid urbanization now witnessed in many developing countries. Rapidly changing social and economic conditions are also leading to increased use of edible oils along with salt and sugar in many commercial, convenience foods even though they contribute little to a healthy diet.

33. These developments create a number of challenges for the food industry. There will be a growing need to provide for healthier and yet still tasty foods that are lower in total fats, salt and sugar but richer in dietary fibre, minerals, vitamins and a healthy mix of fatty acids. How these changes are to be brought about is less clear. Low fat, salt or sugar products are probably the most visible response to changing needs thus far. The dairy industry in developed countries is probably the best example of how the processing industry has catered for a growing demand of low fat products by developing a range of so-called “light products”. However, this also means that surplus milk fat finds its way into other foods, such as full-fat ice-cream or desserts, or is used in bakery products. Another approach has been to replace fats with carbohydrate-based modified starches, gums and cellulose gels (e.g. sucrose polyester). These additives provide the sensation of fat without its high calorie content but their consumption in large quantities may also have some adverse effects.

34. Challenges for the food processing and distribution industry also arise from growing food safety concerns, particularly for perishable products like fruits and vegetables. Such concerns have, for instance, created a growing recognition of the importance of a “farm-to-table” approach reflected in the increasing attention paid to quality assurance initiatives such as Good Agricultural Practices (GAP), Hazard Analysis Critical Control Point (HACCP) and Good Manufacturing Practice (GMP). The Experts’ recommendations may create an added need for these and other initiatives that help ensure food safety throughout the food chain.

35. Supporting infrastructure (systems for transportation, storage, distribution and retail) that facilitates the movement of fresh and processed products to urban and export consumers will also be critical to tackling the challenges of controlling costs and thus making fresh and processed foods more affordable to all income groups in cities. Developments in the food processing sector will have an impact on upstream elements of the food chain. As the processing sector responds to the needs of consumers, processors will place demands for new or modified crop and livestock products on primary producers with associated expectations on delivery schedules and quality attributes.

IV. PROPOSED FOLLOW-UP TO THE EXPERTS’ REPORT

A. WHO’s Global Strategy on Diet, Physical Activity and Health

36. At its 55^th Session held in May 2002, the World Health Assembly (WHA) urged its members to collaborate with WHO in developing a global strategy on diet, physical activity and health for the prevention and control of non-communicable diseases. A draft strategy will be considered at the WHO 113^th Executive Board in January 2004⁷ and at the 57^th Session of WHA in May 2004. FAO is collaborating with WHO in developing this global undertaking including consultations with UN agencies, civil society organizations, the private sector and the general public.

37. In fact, as part of the above strategy, FAO has already collaborated with WHO in developing an initiative to promote the production and consumption of fruits and vegetables, which was launched in November 2003. This joint initiative builds on earlier FAO work in promoting home and school gardens to reduce micronutrient malnutrition.

B. Specific Areas for Consideration

38. FAO needs to shape its work, in its mandated areas of food and agriculture, to the challenges set out in the Experts’ Report. The proposed elements, discussed below, recognize the coexistence of conditions in many developing countries, which predispose them to the “double burden” of undernutrition and NCDs. They also recognize that FAO has responsibilities for informing and protecting food consumers as well as promoting the welfare of small-scale food producers and farmers. FAO’s programmes have to build upon the complementarities between food and nutrition policies on the one hand, and between agricultural and rural development and trade policies on the other.

1. Taking stock of dietary patterns and their health implications

39. The starting point for the Expert Consultation and its recommendations was global trends in the composition of diets and their impact on the incidence of NCDs. These trends are confirmed by the findings of a limited number of nationally representative food consumption surveys in developing countries. Where data are available, they generally support the changes reported above but with significant differences between rural and urban households as to the extent of the change in consumption patterns. How the changes in dietary consumption patterns are reflected in the changes observed on the health risks of populations needs to be clearly documented and confirmed by reliable scientific evidence. The development of an inventory of current food consumption patterns and trends in dietary patterns at national, regional and global levels, as well as monitoring and analyses of these patterns and trends, should be given priority in the normative work of FAO.

40. There is also a need to obtain more reliable information on patterns and changes in actual food consumption based on representative individual and household consumption surveys in both urban and rural environments. This should include an assessment of actual intakes at the level of the individual consumer versus availability at the retail level, i.e. taking account of all post-retail losses, which include, inter alia, household losses in the form of food given to pets, table scraps and other forms of household wastes. In developed countries, such wastes can account for as much as 30 percent of foods purchased.

41. In collaboration with WHO, it will be important to establish more directly the links between the sometimes radical changes in consumption patterns with changes in health parameters in urban and rural population groups and taking account of gender. These analyses would complement the FAO food balance methodology by examining quantitative changes in nutritional intake and qualitative changes in consumption patterns, with the aim of promoting healthier diets.

2. Interpreting dietary goals in country-specific situations

42. FAO and WHO are already active in improving food consumption patterns and nutritional well-being of individuals and populations through promoting the concept of Food-Based Dietary Guidelines (FBDGs). FBDGs are based on an analysis of dietary consumption patterns and disease prevalence specific to the country or region, taking into account the available evidence that links specific food consumption patterns with the incidence of a disease. FBDGs are an important tool in national food and nutrition policy development. The concept of disseminating information and promoting consumer awareness through FBDGs is more appropriate than using nutrient goals alone since consumers think in terms of the food they eat and not of the nutrients it contains. FBDGs thus form the basis for nutrition education for the general public. However, implementing FBDGs in practice is challenging and much effort is needed to help the public to follow the guidelines and change their consumption patterns. Therefore, it may be useful to review country experiences with FBDGs, document key lessons learned and identify best practices and constraints to improving the use and implementation of FBDGs to promote healthy diets. Surveillance systems to monitor changes in diet, physical activity and related health problems are essential to enable public and private sector stakeholders to track progress towards achieving a country’s dietary goals and to guide the options and timing of measures needed to accelerate their achievement. These measures and the necessary information systems may need to be established and/or strengthened.

3. Supporting innovation in food products

43. The assessment of possible impacts of dietary changes on agricultural systems presented in this document was largely limited to a general, qualitative review. Even at this general level, it is apparent that decisions taken by the food processing sector have significant impact on the diet of a population and on the related agricultural production sector. Food processors and retailers attempt to anticipate and respond to market demands so that their businesses remain viable. A key element of this is the creation of new and improved food products together with retailing approaches that better serve their customers. The nature of the food products placed before consumers represents a powerful tool to change dietary patterns. To effect the introduction of new food products and increase the availability of existing products, such as fresh fruits and vegetables, it is necessary to take into consideration factors such as: (i) the numerous interactions and interdependencies between various agricultural markets; (ii) impacts of non-agricultural factors (urbanization, structural change in the food processing industry, consolidation of food distribution channels and the emergence of supermarkets in developing countries) and their feedbacks on agriculture; and (iii) the effects of other policy reforms that may be implemented in parallel (e.g. those promoting freer trade and investment flows, regional integration, etc.). These factors can augment, as well as offset, the effects of the proposed nutritional recommendations.

44. FAO can play an important role in building the capacity of food processors through the sharing of best practices in innovation in food products and food processing. The overall food innovation process consists of two critical elements: (i) the ability to understand the nutritional characteristics of the foods desired by a population and how they contribute to a desirable diet (or not as the case may be); and (ii) the ability to apply known food transformation processes to modify existing products or create new products that can improve the nutritional nature of the foods. In the case of fresh fruits and vegetables, the Report unequivocally states that consumption needs to increase. FAO has the ability to contribute to increasing production, improving post-harvest handling to maintain quality and safety and building demand within a population. As with processed food, there may need to be innovation in the way fresh fruits and vegetables are presented to the consumer (e.g. packaged salads as opposed to whole lettuces).

4. Examining food and nutrition policies and actions

Demand – raising consumer awareness and promoting healthy diets

45. For consumers to enjoy healthy diets, they have to express a corresponding demand and the foods demanded need to be available in the market. An important step towards achieving desirable changes in demand is that consumers are aware of what constitutes a healthy diet. The overall determinants of consumers’ attitudes towards consumption and lifestyle patterns are complex; in addition to income and food prices, food choices are influenced by many factors including social and cultural traditions, taste preferences and presentation and marketing.

46. Appropriate nutritional education and communication can help to promote healthy eating practices. The emphasis of nutritional education should be on training service providers, providing information to consumers including appropriate food labelling and working with the media. Effective interventions go beyond addressing the needs of an individual but should also aim at policy makers, professional networks and consumers’ associations, and a range of actors that influence healthy diets and lifestyles. For the individual, adopting healthy eating practices coupled with adequate physical activity from a young age will offer lifelong health benefits. FAO will need to initiate and test new strategies to assist member countries in developing comprehensive nutritional education programmes and interventions, and in implementing policies and actions that enable individuals to make healthier food choices.

47. The school environment can play a decisive role in developing positive attitudes in the younger generation towards healthy eating and physical activity. School policies that influence food choices (school cafeterias, school feeding programmes and food dispensing outlets) can enhance and complement nutritional education towards the development of lifelong healthy eating habits and lifestyles. Alliances with stakeholders in the community are mutually beneficial and help to expedite changes in individual behaviour needed for improved dietary patterns and lifestyles both in the short and long term.

Supply - adjusting production and other links in the food chain

48. It is expected that adjustments in supply arising from a shift in demand towards healthier foods will be achieved through market forces, government policies and technological advances that will affect the food system. The required incentive or disincentive for production changes depends on health considerations, demand for food products and therewith their market prices. However, markets are rarely perfect and supply may be unresponsive to price changes. Public support may also be required to avoid unduly high adjustment costs. A review of existing domestic policies, by product sector, may be needed to identify consumer subsidies or trading arrangements advantageous to undesirable foods and supply constraints or import barriers applying to desirable foods. At the same time, policies are likely to be required (i) to assist farmers shift resources from the production of less to more desirable products (fruits and vegetables may offer attractive production and trading opportunities), and (ii) to assist them in modifying their production methods, e.g. producing leaner meat animals for the market.

49. A number of emerging issues may influence the availability of products conducive to healthy diets. Such issues include: the effects of intensive production systems and their environmental consequences; challenges related to better dietary quality (i.e. lean meat) of livestock and poultry production and the likely role biotechnology may play in this; the need to evaluate and adopt good agricultural practices to improve quality and safety of foods; 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 contaminants; and the effects of changes in varietal composition, loss of traditional crop varieties and their declining use in daily diets, etc. All these issues are of relevance to FAO’s work in food and agriculture and will need to be addressed as matters of concern that arise from changes in consumption patterns and trends associated with economic development.

V. FOR THE CONSIDERATION OF THE COMMITTEE ON AGRICULTURE

50. This document has brought together the major recommendations of the Joint WHO/FAO Expert Consultation (and ensuing stakeholder consultations) on Diet, Nutrition and the Prevention of Chronic Diseases. It provides a preliminary analysis of the key elements stemming from those recommendations: (i) taking stock of dietary patterns and their health implications; (ii) interpreting dietary goals in country-specific situations; (iii) supporting innovation in food products; and (iv) examining food and agricultural policy options and actions. These are areas proposed for follow-up work by FAO, under the guidance of COAG.

51. In particular, approval by COAG is sought on three main directions that may be pursued by the Organization in its work at the service of Member Countries:

• continuing to strengthen collaboration with WHO in the areas of nutrition and NCDs;
• providing Members with policy advice and technical assistance in raising awareness and educating their populations on the need to adopt appropriate nutritional and healthy diets to prevent the harmful spread of NCDs; and
• assisting Members, particularly developing member countries, in formulating and implementing policies and programmes for diversification in agricultural production where needed to facilitate changes towards healthier diets.

ANNEX

THE CONCEPT OF POPULATION NUTRIENT INTAKE GOALS

1. Many past expert reports, both national and international, have been somewhat ambiguous about the intended application of the goals or guidelines recommended for maintaining good health or preventing diet-related non-communicable diseases (NCDs). An international comparison of such recommendations issued by national agencies illustrates the lack of major differences between them despite the fact that they refer to different population groups. In spite of divergences between national expert groups in some of their judgements about the relative roles of dietary constituents in causing specific diseases, the dietary recommendations are, in general, very similar. However, although not all expert groups make quantitative recommendations, there seems to be clear consensus about the message, the desired direction of change and even the quantitative goals where they have been specified. Also, they do not seem to differ in the dietary goals developed for industrialized or developing countries.

2. The Report of the Joint WHO/FAO Expert Consultation provides explicit nutrient recommendations. It emphasises that these are population intake goals and not individual dietary guidelines. Unlike most national expert groups, which generally deal with a single population group, the Report recommends, in most instances, upper and lower limits for nutrient intake goals recognising that some populations globally may have intakes below the recommended range (and therefore need to increase them up to at least the minimum) while others have intakes above the maximum range (and therefore need to reduce them).

3. The concept of nutrient intake goals is based on the assumption that the first priority is to ensure an equitable distribution of available food in accordance with individual need. Most nutritional guidelines address the estimated needs of individuals and identify the minimum intake to meet their nutritional needs. However, recognising the detrimental effects that excessively high intakes of certain essential nutrient may have, the concept of a safe range of intakes has evolved. Population nutrient intake goals follow this approach and focus on maintaining low population risk rather than low individual risk. Population nutrient intake goals are thus defined as the population average intake that is judged to be consistent with maintenance of health in a population. Health, in this context, is marked by a low prevalence of diet-related diseases in a population. In other words, it is the entire distribution of intakes, characterized by the average per capita intake, that is of interest and not the intake of individuals per se.

4. This concept is illustrated in Figure 1. The Experts’ Report stresses that, because population nutrient intake goals refer to population averages, the aggregate change would be significantly greater than intended if they were to be applied to the diets of individuals. This point is further illustrated in Figure 2 for a nutrient such as saturated fats or for sugar where the recommendation is for a population nutrient intake goal of 10 percent of total energy in the daily diet. Moreover, the intention is for population nutrient goals to be adapted to diets and populations by taking local circumstances into account. Doing so acknowledges that for any given population distribution, 50 percent of the population has an intake greater than the recommended population nutrient intake goal. The objective is to ensure that the population average moves towards the recommended goal in order to reduce the risk within the population of diet-related diseases. These goals are specifically expressed in numerical terms rather than increases or decreases in intakes of specific nutrients as often done with food-based dietary guidelines, since the desirable upward or downward changes depend on existing intakes of the nutrient in a given population in relation to its risk of disease.

Figure 1. Concept of a population nutrient goal

Usual intake

The frequency distributions of nutrient intakes of three hypothetical populations are indicated by the three bell-shaped curves. The risks associated with inadequacy and excess are shown at the two extremes. Populations with mean population nutrient intakes in the range between the lower and upper limits avoid significant risks of inadequacy and excess.

Figure 2. Distinction between a population goal and an individual goal

Saturated fats or free sugars
(percent of energy)

This figure shows the distribution of intakes of saturated fats or of free sugars for three hypothetical populations corresponding to: 1) an existing population whose intake of free sugars is higher than recommended by the Joint WHO/FAO Expert Consultation (right); 2) a population that has achieved the population goal of the maximum intake of 10 percent of energy as free sugars (centre); and 3) a population in which nearly all individuals have an intake less than 10 percent, a situation that represents the result of misinterpretation of the population goal as an individual goal (left).

________________________________

¹ /. Joint WHO/FAO Expert Consultation on Diet, Nutrition and the Prevention of Chronic Diseases. WHO Technical Report Series, No.916. World Health Organization, Geneva, 2003. The Report is available at: http://www.fao.org/DOCREP/005/AC911E/AC911E00.HTM and http://www.who.int/hpr/NPH/docs/who_fao_expert_report.pdf.

2 /. COAG/2003/Inf.3 - Information Note on a Joint WHO/FAO Expert Consultation on Diet, Nutrition and the Prevention of Chronic Diseases, 17^th Session of COAG, 31 March – 4 April 2003.

³ /. Report of the Council of FAO, 124^th Session, Rome, 23-28 June 2003, paragraph 31.

⁴ / The Joint WHO/FAO Expert Report is available to Members at the 18^th Session of COAG as document COAG 2004 INF/1.

⁵ /. The relevant scientific evidence related to the diet-disease links are contained in the Expert Report under the chapters for each section.

⁶ /. The World Health Report: 2002: Reducing risks, promoting healthy life. World Health Organization, Geneva, 2002

⁷ /. Integrated prevention of noncommunicable diseaes, Draft global strategy on diet, physical activity and health, Provisional agenda item 3.7, available at http://www.who.int/gb/EB_WHA/PDF/EB113/eeb11344a1.pdf.