What is Food-Based Dietary Guidelines?

Food-based dietary guidelines (FBDGs) are an instrument of and expression of food and nutrition policy and should be based directly on diet and disease relationships of particular relevance to the individual country. Their primary purpose is to educate healthcare professionals and consumers about health promotion and disease prevention. In this way priorities in establishing dietary guidelines can address the relevant public health concerns whether they are related to dietary insufficiency or excess. In this context, meeting the nutritional needs of the population takes its place as one of the components of food and nutrition policy goals along with the priorities included in the FBDGs for improved health and nutrition for a given population.

The world nutrition and health situation demonstrates that the major causes of death and disability have been traditionally related to under-nutrition in developing countries and to the imbalance between energy intake and expenditure (which lead to obesity and other chronic diseases – diabetes, cardiovascular disease, hypertension, and stroke) in industrialized countries. The tragedy is that many suffer from too little food while others have diseases resulting from too much food, but both would benefit from a more balanced distribution of food and other resources. Although the nature of the health and nutrition problems in these two contrasting groups is very different, the dietary guidelines required to improve both situations are not. Most countries presently have the combined burden of malnutrition from deficit and increasing prevalence of obesity and other chronic diseases from over consumption. The approaches to address the problems, nevertheless, should be country and population specific.

Although two-thirds of the world’s population depends on cereal or tuber-based diets, the other one-third consumes significant amounts of animal food products. The latter group places an undue demand on land, water, and other resources required for intensive food production, which makes the typical Western diet not only undesirable from the standpoint of health but also environmentally unsustainable. If we balance energy intake with the expenditure required for basal metabolism, physical activity, growth, and repair, we will find that the dietary quality required for health is essentially the same across population groups.

Efforts in nutrition education and health promotion should include a strong encouragement for active lifestyles. Improving energy balance for rural populations in developing countries may mean increasing energy intake to normalise low body mass index (BMI, weight/height2, calculated as kg/m2), ensuring adequate energy stores and energy for appropriate social interactions. In sedentary urban populations, improving energy balance will mean increasing physical activity to decrease energy stores (body fat mass) and thus normalise BMI. Thus, the apparent conflicting goals – eradicating undernutrition while preventing overnutrition – are resolved by promoting sufficient energy for a normal BMI. Moreover, if we accept that FBDGs should be ecologically sustainable, the types and amounts of foods included in a balanced diet are not very different for promoting adequate nutrition in the undernourished and preventing overnutrition in the affluent.

This is well exemplified by the similarities in the FBDGs across countries, whether represented by pyramids, rainbows, dishes, pots, etc. It is obvious that consumption of excess energy will induce an increase in energy stores, which may lead to obesity and related health complications. Populations should consume nutritionally adequate and varied diets, based primarily on foods of plant origin with small amounts of added flesh foods. Households should select predominantly plant-based diets rich in a variety of vegetables and fruits, pulses or legumes, and minimally processed starchy staple foods. The evidence that such diets will prevent or delay a significant proportion of non-communicable chronic diseases is consistent.

A predominantly plant-based diet has a low energy density, which may protect against obesity. This should not exclude small amounts of animal foods, which may make an important nutritional contribution to plant-food-based diets, as illustrated in the examples presented earlier. Inadequate diets occur when food is scarce or when food traditions change rapidly, as is seen in societies undergoing demographic transitions or rapid urbanisation. Traditional diets, when adequate and varied, are likely to be generally healthful and more protective against chronic non-communicable diseases than the typical Western diet, consumed predominantly in industrialized societies.

Reorienting food production, agricultural research, and commercialisation policies needs to take into consideration FBDGs, which increase the demand for a variety of micronutrient-rich foods and thus stimulate production to meet the consumption needs. Prevailing agricultural policies encourage research on and production and importation of foods, which do not necessarily meet the requirements of FBDG implementation. For example, great emphasis is placed on cereals, horticultural crops for export, legumes for

export, non-food cash crops, and large livestock. Necessary policy reorientation is required to ensure increased availability of micronutrient-rich foods within the local food system.

Norway has successfully implemented agricultural and food production policies based on a National Nutrition Plan of Action, providing economic incentives for the producer and consumer in support of healthful diets. The results speak for themselves, as Norway has experienced a sustained improvement in life expectancy and a reduction in deaths from cardiovascular disease and other chronic non-communicable conditions.

Reference:
WHO. 1990. Diet, nutrition, and the prevention of chronic diseases. Report of a WHO Study Group. Geneva, World Health Organization, (WHO Technical Report Series, No. 797).