Diet, nutrition and the prevention of chronic diseases: report of a joint WHO/FAO expert consultation.

Diet and nutrition have a key role in disease prevention activities. Chronic diseases linked to diet include obesity, diabetes, cardio-vascular diseases, cancer, osteoporosis and dental diseases. This document is a report of a joint World Health Organization (WHO) and FAO expert consultation that took place in 2002 to review scientific progress in preventing chronic disease, including the identification of risk factors and effective interventions to reduce risks.

The report describes the current context of diet-related diseases and gives an account of the global and regional patterns and trends in the availability and consumption of different food types. It places diet, nutrition and disease in the context of different stages of life and of the wider social, political and economic environment, before setting out specific goals for nutritional intake to prevent specific diet-related diseases. It then sets out the strategic directions and recommendations for policy and research, and concludes with a call to action.

Significant findings reported include the following:

• Economic development normally brings improvement in a country’s food supply and changes in the quality of food production. Not all such changes are positive: adverse changes include a shift towards a higher energy diet, with greater consumption of fats and sugars and reduced intake of complex carbohydrates, dietary fire, fruit and vegetables;
• There is evidence that chronic disease risks begin in the womb and continue into old age. Adult chronic disease reflects cumulative exposures to damaging physical and social environments over one’s lifetime;
• Small changes in risk factors in large populations can significantly reduce disease levels and healthcare costs.

The report sets out a number of strategic actions for promoting healthy diets and physical activity. Such actions may be more or less appropriate in different local and national contexts. It also outlines the following policy principles for countries to address the epidemic of diet-related disease:

• All sectors of the food chain “from ‘farm to table” must be involved if the food system is to address the challenge of dietary change needed to cope with the epidemic of non-communicable disease;
• National strategies must be comprehensive, addressing all diet and physical activity risks for chronic disease together. They should draw on existing international standards, where the role of the WHO and FAO is crucial;
• Each country must select the optimal mix of actions in accordance with the national context. Governments and health ministries have a crucial steering and coordinating role and must work with the private sector, health professionals, academics and civil society;
• Risk factors must be addressed throughout the life course, starting with maternal and child health and continuing through school and workplace to community-based care for the elderly. Such strategies must focus on the needs of the poorest and be gender sensitive;
• Prerequisites for success include effective leadership and communication, functioning alliances and networks, and an enabling economic and policy environment where healthy lifestyle choices are easier to make.