Expert report on diet, nutrition and prevention of chronic diseases.

On the 23rd of April the UN Food and Agriculture Organization (FAO) and the World Health Organization (WHO) launched an expert report on diet (http://www. who.int/hpr/global.strategy.shtml) which will serve as the basis for developing a global strategy, to be finalized for the WHO Executive Board in January 2004. The FAO/WHO Joint Expert Report was based on the collective judgement of a group of 30 independent experts with a global perspective, who worked with around 30 of their peers to review the best currently available evidence. The Report examines cardiovascular diseases, several forms of cancer, diabetes, obesity, osteoporosis and dental disease. The justification for the review and report was the rapidly increasing burden of chronic diseases; in 2001, they contributed approximately 59 per cent of the 56.5 million total reported deaths in the world and 46 per cent of the global burden of disease. ‘Cardiovascular disease, diabetes, cancers, obesity – these are no longer rich country problems,’ says Dr Gro Harlem Brundtland, Director-General of WHO. ‘The majority of chronic disease cases are occurring in the developing world. Our experience shows us that even modest, but populationwide interventions on diet and physical activity, can produce significant changes in the overall chronic disease burden in a surprisingly short time.’ The report’s specific recommendations on diet include: limiting fat to between 15 and 30% of total daily energy intake; saturated fats to less than 10%; carbohydrates should provide the bulk of energy requirements (between 55 and 75% of daily intake); and free, i.e. added, sugars should remain beneath 10%. The report also recommends that daily intake of salt, which should be iodized, be restricted to less than 5 g, while the intake of fruit and vegetables should be at least 400 g. It also noted that physical activity was a key factor in determining the amount of energy spent each day and was fundamental to energy balance and weight control. One hour per day of moderate intensity activity, such as walking, on most days of the week, is needed to maintain a healthy body weight. This report and the subsequent commitment to a global strategy are extremely important for those of us working in Public Health Nutrition. They provide an important opportunity to promote the benefits of an evidencebased approach to solving major public health problems and raise the profile of nutrition. Achieving these targets will require major collaborative efforts across many different sectors in society, and place particular demands on the needs for people skilled in Public Health Nutrition. We in the profession need to make sure that the people we train and the methods we use can support and sustain the approach. An evidence-based approach to evaluating the impact these guidelines have on chronic diseases, particularly in the developing world, will be both an opportunity and a challenge. I have asked Este Vorster and Tim Lang to start off a discussion about the expert report. I look forward to other comments from readers. In my April Editorial, I asked for readers comments on the terminology used to group countries; John Waterlow replied: “Why don’t we describe countries as ‘rich’ and ‘poor’ based on GNP per head? After all, richness and poverty are realities; why should we try to disguise them by euphemisms like ‘developing’ and ‘developed’”. He finishes by commenting: ‘Of course within each category there are very big differences, e.g. between USA and Sweden in the distribution of wealth.’ The discussion remains open for those who want to contribute.