Science Forum 2013 (www.scienceforum13.org) Breakout Session 2: Non Communicable Diseases Chizuro Nishida main presentation

1. WHO's Perspective on
Diet, Nutrition and Prevention
of NCDs
Chizuru Nishida, Coordinator
Nutrition Policy and Scientific Advice Unit
Department of Nutrition for
Health and Development
Breakout Session 2: NCD
Science Forum 2013, Bonn, 23 – 25 September 2013

2. 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)

3. "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 2011

4. The Political Declaration
of the High Level Meeting
Article 43

5. The Political Declaration
of the High Level Meeting
Article 44
Calls upon the private sector to:

8. 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)

9. 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

10. (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:

11. Comprehensive Implementation Plan on
maternal, infant and young child nutrition
(WHA 65.6, May 2012)

12. Child
malnutrition
Adolescent
malnutrition
Fetal & infant
malnutrition
Elderly
malnutrition
Adult
malnutrition
Pregnancy
Low 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
Inadequate
catch up
growth
Impaired mental
developmentHigher mortality rate
/Inappropriate feeding
practices
Frequent infections
Inappropriate food, health
& care ((including
untimely/inappropriate
complementary feeding)
Societal and
environmental
factors
Inadequate
fetal
nutrition
Source: Darnton-Hill, Nishida & James, 2002 (adapted)
Low birth weight &
compromised body
composition
Obesity
Abdominal obesity
Diabetes, CVD
Lifecourse: causal links
MIYCN: The 1st step in
preventing NCDs later in life

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

14. CIP-MIYCN
5 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

16. 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 of
NUGAG Subgroup on Diet & Health
2012 - 2013

17. 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

18. 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

19. Fatty acid profiles of different fats and oils

20. 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 oil
Economic cooperation agreement:
Malaysia – importing crude petroleum
Iran – 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 Europe
and North America!
Why?
•Stronger governmental action
and regulation?

21. Roadmap for SFA reduction

22. 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