Diet, Nutrition and the Prevention of Chronic Diseases PDF
Preview Diet, Nutrition and the Prevention of Chronic Diseases
Thisreportcontainsthecollectiveviewsofaninternationalgroupofexpertsanddoesnotnecessarilyrepresentthedecisions orthestatedpolicyoftheWorldHealthOrganizationoroftheFoodandAgricultureOrganizationoftheUnitedNations WHOTechnicalReportSeries 916 DIET, NUTRITION AND THE PREVENTION OF CHRONIC DISEASES Report of a Joint WHO/FAO Expert Consultation WorldHealthOrganization Geneva2003 WHOLibraryCataloguing-in-PublicationData JointWHO/FAOExpertConsultationonDiet,NutritionandthePreventionof ChronicDiseases(2002:Geneva,Switzerland) Diet,nutritionandthepreventionofchronicdiseases:reportofajointWHO/FAOexpert consultation,Geneva,28January--1February2002. (WHOtechnicalreportseries;916) 1.Chronicdisease--epidemiology2.Diet--standards 3.Feedingbehavior4.Energymetabolism5.Motoractivity 6.CostofillnessI.TitleII.Series. ISBN924120916X (NLMclassification:QU145) ISSN0512-3054 qWorldHealthOrganization2003 Allrightsreserved.PublicationsoftheWorldHealthOrganizationcanbeobtainedfromMarketingand Dissemination,WorldHealthOrganization,20avenueAppia,1211Geneva27,Switzerland(tel:+4122 7912476;fax:+41227914857;e-mail:[email protected]).Requestsforpermissiontoreproduceor translateWHOpublications---whetherforsaleorfornoncommercialdistribution---shouldbeaddressed toPublications,attheaboveaddress(fax:+41227914806;e-mail:[email protected]). Thedesignationsemployedandthepresentationofthematerialinthispublicationdonotimplythe expressionofanyopinionwhatsoeveronthepartoftheWorldHealthOrganizationconcerningthelegal statusofanycountry,territory,cityorareaorofitsauthorities,orconcerningthedelimitationofitsfrontiers orboundaries.Dottedlinesonmapsrepresentapproximateborderlinesforwhichtheremaynotyetbe fullagreement. Thementionofspecificcompaniesorofcertainmanufacturers’productsdoesnotimplythattheyare endorsedorrecommendedbytheWorldHealthOrganizationinpreferencetoothersofasimilarnature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguishedbyinitialcapitalletters. TheWorldHealthOrganizationdoesnotwarrantthattheinformationcontainedinthispublicationis completeandcorrectandshallnotbeliableforanydamagesincurredasaresultofitsuse. This publication contains the collective views of an international group of experts and does not necessarilyrepresentthedecisionsorthestatedpolicyoftheWorldHealthOrganizationoroftheFood andAgricultureOrganizationoftheUnitedNations. TypesetandprintedinSwitzerland Contents 1. Introduction 1 Reference 3 2. Background 4 2.1 Theglobalburdenofchronicdiseases 4 2.2 Thedoubleburdenofdiseasesinthedevelopingworld 8 2.3 Anintegratedapproachtodiet-relatedandnutrition-relateddiseases 9 References 10 3. Globalandregionalfoodconsumptionpatternsandtrends 13 3.1 Introduction 13 3.2 Developmentsintheavailabilityofdietaryenergy 14 3.3 Availabilityandchangesinconsumptionofdietaryfat 17 3.4 Availabilityandchangesinconsumptionofanimalproducts 20 3.5 Availabilityandconsumptionoffish 22 3.6 Availabilityandconsumptionoffruitsandvegetables 23 3.7 Futuretrendsindemand,foodavailabilityandconsumption 25 3.8 Conclusions 27 References 29 4. Diet,nutritionandchronicdiseasesincontext 30 4.1 Introduction 30 4.2 Diet,nutritionandthepreventionofchronicdiseases throughthelifecourse 31 4.2.1 Fetaldevelopmentandthematernalenvironment 31 4.2.2 Infancy 32 4.2.3 Childhoodandadolescence 34 4.2.4 Adulthood 38 4.2.5 Ageingandolderpeople 39 4.3 Interactionsbetweenearlyandlaterfactorsthroughoutthelifecourse 40 4.3.1 Clusteringofriskfactors 41 4.3.2 Intergenerationaleffects 41 4.4 Gene--nutrientinteractionsandgeneticsusceptibility 41 4.5 Interveningthroughoutlife 42 References 46 5. Populationnutrientintakegoalsforpreventingdiet-relatedchronicdiseases 54 5.1 Overallgoals 54 5.1.1 Background 54 5.1.2 Strengthofevidence 54 5.1.3 Asummaryofpopulationnutrientintakegoals 55 References 59 iii 5.2 Recommendationsforpreventingexcessweightgainandobesity 61 5.2.1 Background 61 5.2.2 Trends 61 5.2.3 Diet,physicalactivityandexcessweightgainandobesity 61 5.2.4 Strengthofevidence 62 5.2.5 Generalstrategiesforobesityprevention 67 5.2.6 Disease-specificrecommendations 68 References 70 5.3 Recommendationsforpreventingdiabetes 72 5.3.1 Background 72 5.3.2 Trends 72 5.3.3 Diet,physicalactivityanddiabetes 73 5.3.4 Strengthofevidence 73 5.3.5 Disease-specificrecommendations 77 References 78 5.4 Recommendationsforpreventingcardiovasculardiseases 81 5.4.1 Background 81 5.4.2 Trends 81 5.4.3 Diet,physicalactivityandcardiovasculardisease 81 5.4.4 Strengthofevidence 81 5.4.5 Disease-specificrecommendations 87 References 91 5.5 Recommendationsforpreventingcancer 95 5.5.1 Background 95 5.5.2 Trends 95 5.5.3 Diet,physicalactivityandcancer 95 5.5.4 Strengthofevidence 95 5.5.5 Disease-specificrecommendations 101 References 101 5.6 Recommendationsforpreventingdentaldiseases 105 5.6.1 Background 105 5.6.2 Trends 105 5.6.3 Dietanddentaldisease 107 5.6.4 Strengthofevidence 116 5.6.5 Disease-specificrecommendations 119 References 119 5.7 Recommendationsforpreventingosteoporosis 129 5.7.1 Background 129 5.7.2 Trends 129 5.7.3 Diet,physicalactivityandosteoporosis 129 5.7.4 Strengthofevidence 130 5.7.5 Disease-specificrecommendations 131 References 132 6. Strategicdirectionsandrecommendationsforpolicyandresearch 134 6.1 Introduction 134 iv 6.2 Policyprinciplesforthepromotionofhealthydiets andphysicalactivity 135 6.3 Prerequisitesforeffectivestrategies 136 6.3.1 Leadershipforeffectiveaction 136 6.3.2 Effectivecommunication 137 6.3.3 Functioningalliancesandpartnerships 138 6.3.4 Enablingenvironments 138 6.4 Strategicactionsforpromotinghealthydietsandphysicalactivity 142 6.4.1 Surveillanceofpeople’sdiets,physicalactivity andrelateddiseaseburden 142 6.4.2 Enablingpeopletomakeinformedchoices andtakeeffectiveaction 142 6.4.3 Makingthebestuseofstandardsandlegislation 142 6.4.4 Ensuringthat‘‘healthydiet’’componentsareavailabletoall 143 6.4.5 Achievingsuccessthroughintersectoralinitiatives 143 6.4.6 Makingthebestuseofhealthservicesandthe professionalswhoprovidethem 143 6.5 Calltoaction 143 Reference 144 Acknowledgements 144 Annex Summaryofthestrengthofevidenceforobesity,type2diabetes, cardiovasculardisease(CVD),cancer,dentaldiseaseandosteoporosis 148 v Joint WHO/FAO Expert Consultation on Diet, Nutrition and the Prevention of Chronic Diseases Geneva,28January--1February2002 Members Dr E.K. Amine, Dean, High Institute of Public Health, Alexandria University, Alexandria,Egypt DrN.H.Baba,Chairperson,DepartmentofNutritionandFoodSciences,American UniversityofBeirut,Beirut,Lebanon DrM.Belhadj,ProfessorofInternalMedicineandDiabetologia,CentreHospitalier Universitaire,Oran,Algeria Dr M. Deurenberg-Yap, Director, Research and Information Management, Health PromotionBoard,Singapore(Co-Rapporteur) Dr A. Djazayery, Professor of Nutrition, Department of Nutrition and Biochemistry, SchoolofPublicHealth,TehranUniversityofMedicalSciences,Tehran,Islamic RepublicofIran DrT.Forrester,Director,TropicalMedicineResearchInstitute,TheUniversityofthe WestIndies,Kingston,Jamaica Dr D.A. Galuska, Division of Nutrition and Physical Activity, National Center for ChronicDisease,PreventionandHealthPromotion,CentersforDiseaseControl andPrevention,Atlanta,GA,USA Dr S. Herman, Senior Researcher, Nutrition Research and Development Centre, MinistryofHealth,Bogor,Indonesia Professor W.P.T. James, Chairman, International Obesity Task Force, London, England DrJ.R.M’BuyambaKabangu,HypertensionUnit,DepartmentofInternalMedicine, UniversityofKinshasaHospital,Kinshasa,DemocraticRepublicoftheCongo ProfessorM.B.Katan,DivisionofHumanNutritionandEpidemiology,Wageningen University,Wageningen,Netherlands Dr T.J. Key, Cancer Research UK, Epidemiology Unit, University of Oxford, The RadcliffeInfirmary,Oxford,England ProfessorS.Kumanyika,CenterforClinicalEpidemiologyandBiostatistics,Schoolof Medicine,UniversityofPennsylvania,Philadelphia,PA,USA(Vice-Chairperson) Professor J. Mann, Department of Human Nutrition, University of Otago, Dunedin, NewZealand Dr P.J. Moynihan, School of Dental Sciences, University of Newcastle-upon-Tyne, Newcastle-upon-Tyne,England Dr A.O. Musaiger, Director, Environmental and Biological Programme, Bahrain CentreforStudiesandResearch,Manama,Bahrain DrG.W.Olwit,Kampala,Uganda Dr J. Petkeviciene, Institute for Biomedical Research, Kaunas Medical University, Kaunas,Lithuania vi Dr A. Prentice, Director, Human Nutrition Research, Medical Research Council, Cambridge,England Professor K.S. Reddy, Department of Cardiology, Cardiothoracic Centre, All India InstituteofMedicalScience,NewDelhi,India DrA.Schatzkin,NutritionalEpidemiologyBranch,NationalCancerInstitute,National InstituteofHealth,Rockville,MD,USA Professor J.C. Seidell, National Institute of Public Health and the Environment, Bilthoven,Netherlands(Co-Rapporteur) Dr A.P. Simopoulos, President, The Center for Genetics, Nutrition and Health, Washington,DC,USA Professor S. Srianujata, Director, Institute of Nutrition, Mahidol University, Nakhon Pathom,Thailand DrN.Steyn,ChronicDiseasesofLifestyle, MedicalResearchCouncil,Tygerberg, SouthAfrica Professor B. Swinburn, School of Health Sciences, Deakin University, Melbourne, Victoria,Australia DrR.Uauy,InstituteofNutritionandFoodTechnology,UniversityofChile,Santiago, Chile;andDepartmentofEpidemiologyandPopulationHealth,LondonSchoolof HygieneandTropicalMedicine,London,England(Chairperson) Dr M. Wahlqvist, Director, Asia Pacific Health and Nutrition Centre, Monash Asia Institute,MonashUniversity,Melbourne,Victoria,Australia ProfessorWuZhao-Su,InstituteofHeart,LungandBloodVesselDiseases,Beijing, China DrN.Yoshiike,DivisionofHealthandNutritionMonitoring,NationalInstituteofHealth andNutrition,Tokyo,Japan Representativesofotherorganizations* UnitedNationsAdministrativeCommitteeonCoordination/SubcommitteeonNutrition (ACC/SCN), DrS.Rabenek,TechnicalSecretary,ACC/SCN,Geneva,Switzerland Secretariat{ DrK.Bagchi,RegionalAdviser,Nutrition,FoodSecurityandSafety,WHORegional OfficefortheEasternMediterranean,Cairo,Egypt DrT.Cavalli-Sforza,RegionalAdviser,Nutrition,WHORegionalOfficefortheWestern Pacific,Manila,Philippines * Unabletoattend:InternationalAtomicEnergyAgency,Vienna,Austria;SecretariatofthePacific Community,Noumea,NewCaledonia;UnitedNationsChildren’sFund,NewYork,NY,USA;United NationsUniversity,Tokyo,Japan;WorldBank,Washington,DC,USA. { Unabletoattend:DrH.Delgado,Director,InstituteofNutritionofCentralAmericaandPanama, GuatemalaCity,Guatemala;DrF.J.Henry,Director,CaribbeanFoodandNutritionInstitute,The UniversityoftheWestIndies,Kingston,Jamaica. vii Dr G.A. Clugston, Director, Department of Nutrition for Health and Development, SustainableDevelopmentandHealthyEnvironments,WHO,Geneva,Switzerland DrI.Darnton-Hill,DepartmentofNoncommunicableDiseasePreventionandHealth Promotion, Noncommunicable Diseases and Mental Health, WHO, Geneva, Switzerland ProfessorA.Ferro-Luzzi,NationalInstituteforFoodandNutritionResearch,Rome, Italy(TemporaryAdviser) DrJ.Leowski,RegionalAdviser,NoncommunicableDiseases,WHORegionalOffice forSouth-EastAsia,NewDelhi,India Dr C. Nishida, Department of Nutrition for Health and Development, Sustainable DevelopmentandHealthyEnvironments,WHO,Geneva,Switzerland(Secretary) DrD.Nyamwaya,MedicalOfficer,HealthPromotion,WHORegionalOfficeforAfrica, Harare,Zimbabwe DrA.Ouedraogo,RegionalOfficer,Nutrition,WHORegionalOfficeforAfrica,Harare, Zimbabwe Dr P. Pietinen, Department of Noncommunicable Disease Prevention and Health Promotion, Noncommunicable Diseases and Mental Health, WHO, Geneva, Switzerland Dr P. Puska, Director, Department of Noncommunicable Disease Prevention and Health Promotion, Noncommunicable Diseases and Mental Health, WHO, Geneva,Switzerland DrE.Riboli,InternationalAgencyforResearchonCancer,Lyon,France DrA.Robertson,RegionalAdviser,NutritionandFoodSecurityProgramme,WHO RegionalOfficeforEurope,Copenhagen,Denmark DrP.Shetty,Chief,NutritionPlanning,AssessmentandEvaluationService,Foodand NutritionDivision,FAO,Rome,Italy Dr R. Weisell, Nutrition Planning, Assessment and Evaluation Service, Food and NutritionDivision,FAO,Rome,Italy Dr D. Yach, Executive Director, Noncommunicable Diseases and Mental Health, WHO,Geneva,Switzerland viii Abbreviations Thefollowingabbreviationsareusedinthisreport: ACC UnitedNationsAdministrativeCommitteeonCoordination AIDS acquiredimmunodeficiencysyndrome BMI bodymassindex CARMEN CarbohydrateRatioManagementinEuropeanNationaldiets CHD coronaryheartdisease CVD cardiovasculardisease DALY disability-adjustedlifeyear DASH dietaryapproachestostophypertension DEXA dual-energyX-rayabsorptiometry DHA docosahexaenoicacid dmf decayed,missing,filledprimary(teeth) DMF decayed,missing,filledpermanent(teeth) dmft decayed,missing,filledprimaryteeth DMFT decayed,missing,filledpermanentteeth DONALD DortmundNutritionalandAnthropometricLongitudinally DesignedStudy ECC earlychildhoodcaries EPA eicosapentaenoicacid EPIC EuropeanProspectiveInvestigationintoCancerandNutrition ERGOB EuropeanResearchGroupforOralBiology FAOSTAT FoodandAgriculturalOrganizationoftheUnitedNations StatisticalDatabases FER fattoenergyratio GDP grossdomesticproduct GISSI GruppoItalianoporloStudiodellaSopravvivenzanell’Infarto Miocardico GNP grossnationalproduct HBP highbloodpressure HDL high-densitylipoprotein HFI hereditaryfructoseintolerance HIV humanimmunodeficiencyvirus HOPE HeartOutcomesPreventionEvaluation IARC InternationalAgencyforResearchonCancer IDDM insulin-dependentdiabetesmellitus IGT impairedglucosetolerance IHD ischaemicheartdisease ix IUGR intrauterinegrowthretardation LDL low-densitylipoprotein MGRS multicentregrowthreferencestudy(i.e.theWHOMGRSstudy) mRNA messengerribonucleicacid MSG monosodiumglutamate MUFA monounsaturatedfattyacid NCD noncommunicabledisease NGO nongovernmentalorganization NIDDM non-insulin-dependentdiabetesmellitus NSP non-starchpolysaccharides PUFA polyunsaturatedfattyacid RCT randomizedcontrolledtrial SCN ACCSubcommitteeonNutrition1 SFA saturatedfattyacid T1DM type1diabetes T2DM type2diabetes VLDL verylow-densitylipoprotein WCRF WorldCancerResearchFund WHR waist:hipcircumferenceratioorwaist:hipratio 1 InApril2002thenameoftheSubcommitteeonNutritionwaschangedtotheUnitedNationsSystem StandingCommitteeonNutrition. x
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