Developing and implementing food-based dietary guidance for fat in the diets of children

The feasibility of implementing food-based dietary guidelines and food graphics in Ethiopia

This study aimed to test the acceptability, cultural appropriateness, consumers' understanding, and practicality of the Ethiopian food-based dietary guideline's messages, tips, and food graphics. A qualitative study design was applied with focus group discussions and key informant interviews. Four different participant groups were included: 40 consumers, 15 high-level nutrition experts, 30 frontline community health extension workers (HEWs), and 15 agriculture extension workers (AEWs) to incorporate different stakeholder perspectives. Data collection was conducted using 7 focus group discussions (FGDs) and 30 key informant interviews (KIIs). Collected data were coded and analyzed using QSR International NVivo V.11 software. Most of the study participants were highly interested in implementing the dietary guidelines once these guidelines are officially released. Based on the participants' views, most of the messages align with the current nutrition education materials implemented in the country except the messages about physical activity and alcohol intake. However, participants suggested defining technical terms such as ultra-processing, whole grain, safe and balanced diet in simpler terms for a better understanding. Practicality, affordability, availability, and access to the market were the major barriers reported for adherence to the guidelines. To be more inclusive of cultural and religious beliefs, findings show that the guideline should address fasting and traditional cooking methods. In conclusion, the dietary guidelines were well received by most stakeholders. They are thought to be feasible once feedback on wording, affordability, availability, and access is considered in the messages, tips, and graphic designs.

Recommended dietary reference intakes, nutritional goals and dietary guidelines for fat and fatty acids: a systematic review

Dietary fat and its effects on health and disease has attracted interest for research and Public Health. Since the 1980s many bodies and organizations have published recommendations regarding fat intake. In this paper different sets of recommendations are analyzed following a systematic review process to examine dietary reference intakes, nutritional goals and dietary guidelines for fat and fatty acids. A literature search was conducted in relevant literature databases along a search for suitable grey literature reports. Documents were included if they reported information on either recommended intake levels or dietary reference values or nutritional objectives or dietary guidelines regarding fat and/or fatty acids and/or cholesterol intake or if reported background information on the process followed to produce the recommendations. There is no standard approach for deriving nutrient recommendations. Recommendations vary between countries regarding the levels of intake advised, the process followed to set the recommendations. Recommendations on fat intake share similar figures regarding total fat intake, saturated fats andtransfats. Many sets do not include a recommendation about cholesterol intake. Most recent documents provide advice regarding specificn-3 fatty acids. Despite efforts to develop evidence based nutrient recommendations and dietary guidelines that may contribute to enhance health, there are still many gaps in research. It would be desirable that all bodies concerned remain transparent about the development of dietary recommendations. In order to achieve this, the type of evidence selected to base the recommendations should be specified and ranked. Regular updates of such recommendations should be planned.

Atualizações em guias alimentares para crianças e adolescentes: uma revisão

OBJETIVO: apresentar uma revisão dos guias alimentares desenvolvidos para crianças e adolescentes. MÉTODOS: revisão sistemática conduzida nas bases de dados Medline e Lilacs e em sites institucionais. Incluíram-se documentos publicados entre 2000-2010. RESULTADOS: foram identificados 17 guias alimentares publicados no mundo, sendo dez na América Latina, três na América do Norte, dois na Europa e dois na Ásia e Oceania. Os guias se diferenciaram quanto à sua estrutura, podendo ser organizados em diretrizes nutricionais, representações gráficas ou em ambas. O conteúdo das diretrizes nutricionais, bem como o número de grupos alimentares e a representação gráfica utilizada nos manuais também são variáveis conforme cultura alimentar da população. Dezesseis guias enfocaram orientações sobre alimentos em detrimento dos nutrientes, sendo que o guia japonês está organizado em recomendações de consumo de preparações de alimentos, se configurando em um instrumento de mais fácil compreensão. Todos os guias alimentares identificados para crianças menores de dois anos (n=5) foram elaborados na América Latina, além de terem sido detectados três manuais, cujas diretrizes se direcionam aos profissionais de saúde, denotando necessidade de capacitação e atualização dos mesmos. CONCLUSÕES: o estudo apontou para a relevância do emprego dos guias alimentares na abordagem à criança e adolescente, fornecendo bases teóricas para profissionais e órgãos de saúde.

Sources of saturated fat and sucrose in the diets of Swedish children and adolescents in the European Youth Heart Study: strategies for improving intakes

OBJECTIVE

To compare macronutrient intakes of Swedish children and adolescents to population goals; to identify the major sources of energy, fat, saturated fat and sucrose; and to simulate the effect adherence to current food-based dietary guidelines (FBDG) would have on saturated fat and sucrose intakes.

DESIGN

Cross-sectional study. From 24 h recall data, food groups contributing most to energy, fat, saturated fat and sucrose were identified. Based on the prevailing consumption of foods mentioned in the FBDG, we simulated five scenarios: changes in milk and yoghurt; cheese; energy-dense, nutrient-dilute foods; soft drinks; and burger and sausage consumption.

SETTING

Stockholm and Örebro (Sweden) in 1998-1999.

SUBJECTS

Children (n 551, 9·6 years) and adolescents (n 569, 15·5 years) participating in the European Youth Heart Study.

RESULTS

Intakes of saturated fat and sucrose exceeded population goals in all age and gender subgroups. Compliance to the goal for saturated fat was lower in children, particularly boys. Compliance to the sucrose goal was lower among adolescents. The major sources of energy, fat, saturated fat and sucrose in the diet reflect not only the traditional Swedish diet but also the influence of energy-dense, nutrient-dilute foods. The simulations suggest that a combination of FBDG is required to bring both saturated fat and sucrose intakes in line with recommendations.

CONCLUSIONS

Widespread adherence to a combination of FBDG could theoretically bring mean intakes in line with population goals. The effect on overall nutrient intakes as well as consumer acceptance of such changes needs to be considered.

Development of food-based complementary feeding recommendations for 9- to 11-month-old peri-urban Indonesian infants using linear programming

Effective population-specific, food-based complementary feeding recommendations (CFR) are required to combat micronutrient deficiencies. To facilitate their formulation, a modeling approach was recently developed. However, it has not yet been used in practice. This study therefore aimed to use this approach to develop CFR for 9- to 11-mo-old Indonesian infants and to identify nutrients that will likely remain low in their diets. The CFR were developed using a 4-phase approach based on linear and goal programming. Model parameters were defined using dietary data collected in a cross-sectional survey of 9- to 11-mo-old infants (n = 100) living in the Bogor District, West-Java, Indonesia and a market survey of 3 local markets. Results showed theoretical iron requirements could not be achieved using local food sources (highest level achievable, 63% of recommendations) and adequate levels of iron, niacin, zinc, and calcium were difficult to achieve. Fortified foods, meatballs, chicken liver, eggs, tempe-tofu, banana, and spinach were the best local food sources to improve dietary quality. The final CFR were: breast-feed on demand, provide 3 meals/d, of which 1 is a fortified infant cereal; > or = 5 servings/wk of tempe/tofu; > or = 3 servings/wk of animal-source foods, of which 2 servings/wk are chicken liver; vegetables, daily; snacks, 2 times/d, including > or = 2 servings/wk of banana; and > or = 4 servings/wk of fortified-biscuits. Results showed that the approach can be used to objectively formulate population-specific CFR and identify key problem nutrients to strengthen nutrition program planning and policy decisions. Before recommending these CFR, their long-term acceptability, affordability, and effectiveness should be assessed.

Desenvolvimento de guias alimentares em diversos países

Os guias dietéticos baseados nos alimentos têm objetivo de favorecer a educação nutricional, utilizando termos que sejam compreensíveis, simples e claros para a maioria dos consumidores e indicando as modificações necessárias nos padrões alimentares. Este trabalho foi realizado com o objetivo de apresentar uma revisão da literatura sobre o desenvolvimento dos guias alimentares em vários países. Para tanto, foi realizado um levantamento bibliográfico no período de 1991 a 2006 nas bases de dados Medline e Lilacs, utilizando como palavras-chave "guia alimentar", "guia dietético" e "desenvolvimento de guia dietético" com o intuito de aprofundar os seguintes itens: elaboração, avaliação, implantação e problemas metodológicos relacionados ao desenvolvimento dos mesmos. Desde 1996, vêm sendo publicadas orientações pelo Comite de Alimentação e Nutrição/Organização Mundial de Saúde para elaboração dos guias alimentares e vários países os desenvolveram de acordo com essas recomendações, apesar dos diversos problemas metodológicos enfrentados. Após o desenvolvimento dos guias alimentares, os maiores desafios são a implantação e a avaliação. Dentre as estratégias para sua divulgação destaca-se a elaboração de ferramentas de educação nutricional, tais como: representação gráfica, folder, apostila e pôster. Com relação à avaliação dos guias alimentares, poucos países realizaram pesquisas abordando o conhecimento e o entendimento dos consumidores. Conclui-se que o processo de desenvolvimento dos guias alimentares é complexo e é necessário realizar um planejamento para sua implantação e avaliação, esta última devendo se voltar tanto ao entendimento como ao impacto sobre a saúde da população.

Using the concept of Food Based Dietary Guidelines to Develop an Optimized Mixed Diet (OMD) for German children and adolescents

OBJECTIVE

To apply for the first time FAO/WHO standards for Food Based Dietary Guidelines (FBDG) to develop a total diet concept named Optimized Mixed Diet (OMD) for children and adolescents in a European country.

METHODS

Exact 7-day menus were composed for sample age groups of children (4-6 years) and adolescents (13-14 years), taking into account the German meal patterns, common non-fortified foods, and sensory preferences of children (practical criteria). Food amounts and food selection within the menus were optimized so far as to achieve a total of reference intakes for 22 nutrients (scientific criteria). Simple food based messages were deduced.

RESULTS

Compared to the existing high-fat, low plant food diet reported from the DONALD Study (Dortmund Nutritional and Anthropometric Longitudinally Designed Study), the OMD is lower in fat and saturated fatty acids and contains ample amounts of plant foods. Reference nutrient densities for age groups between 1 and 18 years were achieved or exceeded, except folate. Foods from the optimized menus were summarized into 11 food groups based on nutritional and practical considerations. Proportions of food groups by weight are independent of age and can be used to recalculate food amounts for various age groups or energy requirements, respectively. For simplification, "recommended" foods were distinguished from "tolerated" foods by their nutrient densities; based on food amounts, 3 simple rules for food consumption were deduced, i.e. beverages and plant foods: ample; animal foods: moderate; high-fat, high-sugar foods: sparingly.

CONCLUSIONS

Exact menus and food amounts are a prerequisite to ascertain nutrient adequacy of FBDG. The OMD demonstrates that a single diet concept with a core of quantified food groups can be adequate for age groups between 1 and 18 years within a country, such as Germany.

An evidence-based approach to the development of national dietary guidelines

It has become apparent that confusing and conflicted nutritional advice from the media in combination with a quick reversal of policymakers' national nutrition recommendations have the potential to lead to public disbelief and cynicism for both the process and the conclusions. Consequently, poor design of policy can lead to ineffective communications with health professionals and the public. The ultimate result is that the public will ignore the recommendations with potentially adverse outcomes. Formal evidence-based clinical practice guidelines are being used regularly in the medical community. The methodology used to develop these guidelines includes a systematic review of the literature, filtering the literature for relevant articles, assessing the scientific quality of the available evidence, and rating the strength or weakness of the final recommendation. This article suggests that national dietary guidelines may be improved if they are based on a more formal evidence-based approach. Current research that is being conducted to test components of a generic, standardized methodology for developing evidence-based population targeted dietary guidelines is described.

Bioavailability of iron, zinc, and other trace minerals from vegetarian diets

Iron and zinc are currently the trace minerals of greatest concern when considering the nutritional value of vegetarian diets. With elimination of meat and increased intake of phytate-containing legumes and whole grains, the absorption of both iron and zinc is lower with vegetarian than with nonvegetarian, diets. The health consequences of lower iron and zinc bioavailability are not clear, especially in industrialized countries with abundant, varied food supplies, where nutrition and health research has generally supported recommendations to reduce meat and increase legume and whole-grain consumption. Although it is clear that vegetarians have lower iron stores, adverse health effects from lower iron and zinc absorption have not been demonstrated with varied vegetarian diets in developed countries, and moderately lower iron stores have even been hypothesized to reduce the risk of chronic diseases. Premenopausal women cannot easily achieve recommended iron intakes, as modified for vegetarians, with foods alone; however, the benefit of routine iron supplementation has not been demonstrated. It may be prudent to monitor the hemoglobin of vegetarian children and women of childbearing age. Improved assessment methods are required to determine whether vegetarians are at risk of zinc deficiency. In contrast with iron and zinc, elements such as copper appear to be adequately provided by vegetarian diets. Although the iron and zinc deficiencies commonly associated with plant-based diets in impoverished nations are not associated with vegetarian diets in wealthier countries, these nutrients warrant attention as nutritional assessment methods become more sensitive and plant-based diets receive greater emphasis.