September 5, 2019

WHO recommends stronger Focus on Nutrition within Health Services Report ‘ESSENTIAL NUTRITION ACTIONS’ published on September 4th

‘Essential health packages in all settings need to contain robust nutrition components but countries will need to decide which interventions best support their national health policies, strategies and plans’. Thus is written in a newly published WHO report on nutritional interventions that are needed throughout the world. This report has been released on September 4th is an update from the report of 2013. The report looks at meaningful nutritional interventions during prenatal care, during infancy, during emergencies, for people at risk of non-communicable diseases and for elderly. Supporting breastfeeding is still one of the most important interventions. For the general population, key factor is providing advice on diet such as limiting the intake of free sugars and salt to reduce the risk of heart disease and stroke.

Universal health coverage is at the forefront of international and national efforts as part of the United Nations 2030 Agenda for Sustainable Development, especially for the goals SDG2 and SDG3. Healthy diets and effectively implemented nutrition-specific and nutrition-sensitive interventions will help countries to achieve these goals. This report provides a compact list of nutrition-related interventions recommended by WHO. WHO recommendations aim to advise professionals (policy-makers, programme implementers and other stakeholders) what they can or should do in specific situations to achieve the best outcomes possible, individually or collectively.

 

Prevalence update

Globally, stunting (low height for age) has been declining; between 1990 and 2018, the prevalence of stunting in children aged under 5 years declined from 39.3% to 21.9%, representing a decrease in the number of children with stunting from 253.4 million to 149.0 million. However, global estimates mask much slower progress in Africa (42.6% to 33.1%) and South-East Asia (49.6% to 31.9%) (14). Wasting (low weight for height) still affects 49.5 million children aged under 5 years (7.3%) worldwide, with more than half of these children residing in South-East Asia. During this same period, overweight has been increasing; the prevalence of children considered overweight rose from 5.0% to 5.9% between 1990 and 2018, an increase of over 9 million children (from 30.9 million in 1990 to 40.1 million in 2018).

Among adults, the most recent data available from 2014, indicate that 462 million are underweight, while 1.9 billion are overweight and 600 million of those (or approximately 13% of the world’s population, a rate that doubled between 1980 and 2014) are obese. Adult overweight, obesity and diabetes are rising in nearly every region and country. This “double burden of malnutrition”, among both children and adults, creates unique challenges for resource-limited countries in terms of its potential negative impact, increasing health-care costs, reducing productivity and slowing economic growth, but also provides opportunities for countries to implement integrated actions in nutrition.

 

Nutrional targets

The WHO global nutrition targets 2025, established and endorsed by the World Health Assembly in 2012, aim to combat all forms of malnutrition, including undernutrition, overweight and obesity, as well as micronutrient deficiencies.

Fig. 1. WHO global nutrition targets 2025 and global, diet-related, noncommunicable

Reaching these targets will contribute to the achievement of the United Nations Sustainable Development Goals. Also, even more recently, the United Nations General Assembly proclaimed 2016–2025 the United Nations Decade of Action on Nutrition, calling on governments to intensify action to reduce hunger and malnutrition.

For all of these contexts / population groups, and especially during prenatal care, during infancy, during emergencies, for people at risk of non-communicable diseases and for elderly, WHO has given recommendations.  Of interest to us are the recommendations for oils and fats. These are only mentioned in the general recommendations, that is for all countries, all settings and all population groups.

 

WHO general recommendations

These recommendations are:

Reduce the intake of free sugars through the life-course. In both adults and children, WHO recommends reducing the intake of free sugars to less than 10% of total energy intake. WHO suggests a further reduction of the intake of free sugars to below 5% of total energy intake.

Increase potassium intake from food to reduce blood pressure and the risk of cardiovascular disease, stroke and coronary heart disease in adults. WHO recommends a potassium intake of at least 90 mmol/ day (3510 mg/day) for adults. WHO suggests an increase in potassium intake from food to control blood pressure in children. The recommended potassium intake of at least 90 mmol/day should be adjusted downward for children, based on the energy requirements of children relative to those of adults.

Reduce sodium intake to reduce blood pressure and the risk of cardiovascular disease, stroke and coronary heart disease in adults. WHO recommends a reduction to below 2 g/day sodium (5 g/day salt) in adults. WHO recommends a reduction in sodium intake to control blood pressure in children. The recommended maximum level of intake of 2 g/day sodium in adults should be adjusted downward for children, based on the energy requirements of children relative to those of adults.

Modify dietary fat intake:

  • total fat intake should be less than 30% of total energy intake
  • saturated fatty acid intake should be less than 10% of total energy intakeª
  • trans-fatty acid intake should be less than 1% of total energy intakeª

ª Saturated fatty acids and trans-fatty acids should be replaced with unsaturated fatty acids, particularly polyunsaturated fatty acids.

Consume at least 400 g, or five portions, of fruit and vegetables per day.

For comparison: The Health Council of the Netherlands advises a total fat intake between 20 – 40% of energy, and saturated fatty acid intake of maximum 10% of energy and a trans fatty acid intake of maximum 1% of energy.

 

Key actions for implementation

Based on these recommendations, WHO advises on key actions for implementation, of which are the general outlines:

  • Promoting a healthy food environment – including food systems that promote a diversified, balanced and healthy diet – requires the involvement of multiple sectors and stakeholders, including government and the public and private sectors.
  • Creating coherence in national policies and investment plans – including trade, food and agricultural policies – to promote a healthy diet and protect public health.
  • Encouraging consumer demand for healthy foods and meals.

 

Click here for the total report

Click here for the press release

 

 

Last modified: September 5, 2019