development of food- based dietary guidelines carmen dardano food and nutrition officer/ nutrition...

Development of Food-Development of Food-Based Dietary GuidelinesBased Dietary Guidelines

Carmen Dardano Carmen Dardano

Food and Nutrition Officer/ Nutrition Food and Nutrition Officer/ Nutrition Education and Consumer protection DivisionEducation and Consumer protection Division

OutlineOutline

• What are Dietary Guidelines?• Process for Developing Food-Based

Dietary Guidelines• The Way Forward

What are Dietary What are Dietary Guidelines?Guidelines?

Assist population in following nutrition and related health recomendation

Guide to daily food choices

Guide for healthy eating

A tool for :nutrition educationBehavior change

Food-Based Dietary Food-Based Dietary GuidelinesGuidelines

• Convert scientific knowledge into practical messages

• A major strategy for:– Promoting healthy behavior and

practices– Promoting nutrition education– Helping public make healthy choices– Guiding Food and Nutrition policies

Dietary RecommendationsDietary Recommendations

RDAs: Nutritional and energy requirements and recommendations– Developed for specific populations based

on scientific knowledge

– Speak to nutrients- Calories, Protein, Fat

Form the basis for Dietary Guidelines

Food-Based Dietary Food-Based Dietary GuidelinesGuidelines

• Developed for the general population

• Directed towards the healthy segment of the population

• Not directed to persons already afflicted with health conditions

Process for Developing Food-Process for Developing Food-Based Dietary GuidelinesBased Dietary Guidelines

Steps for Preparing Dietary Steps for Preparing Dietary GuidelinesGuidelines

PlanningCharacterizingTarget Group

SettingObjectives

Preparing TechnicalGuidelines

Testing theFeasibility of the

Recommendations

Preparing Food-Based Dietary

GuidelinesValidation

Correction andAdjustment

Implementation

Evaluation

• FORMATION MULTI-SECTORAL National Committee on FBDG– Ministry of Health– Minsitry of Education– Ministry of Agriculture– Ministry of Social Development – Ministry of Economy– Private sector: university, consumer

group, food industry

PLANNING

PlanningCharacterizingTarget Group

SettingObjectives

Preparing TechnicalGuidelines

Testing theFeasibility of the

Recommendations

Preparing Food-Based Dietary

GuidelinesValidation

Correction andAdjustment

Implementation

Evaluation

Characterizing the Target Characterizing the Target GroupGroup

• Situation health and nutritional status of the group

• Group’s access to food, eating habits, socio-cultural characteristics

• Based on review of existing surveys, reports, publications

• Problems prioritized in terms of scope, feasibility of solving, and impact

TABLE OF CONTENTS OF THE DIAGNOSIS

DOCUMENT

I. INTRODUCTION

II. RISK FACTORS AND PROBLEMS ASSOCIATED WITH DIET

A. Epidemiological Profile

1. Changes in morbidity rates

2. Nutritional status

B. Education of the population

C. Foods

1. Availability

2. Accessibility

3. Consumption

4. Composition

D. Eating habits

1. Distribution

2. Classification

3. Acquisition

III. CONCLUSIONS

IV. PRINCIPAL PROBLEMS IDENTIFIED

DECISION MATRIXDECISION MATRIXPRIORITIZATION OF FOOD AND NUTRITION PRIORITIZATION OF FOOD AND NUTRITION

PROBLEMSPROBLEMSPROBLEMS M V I S

1.

2.

3.

4.

5.

6.

7.

10.

11.

Note: Qualify the problems on scale of 0=less to10= more

M: Expresses Magnitude of the problem

V: Represents Viability = feasibility to solve the problem, through an educational intervention

I: Represents Importance = impact that if the problem is solved

S: Is the total of the results of the three considered factors

PlanningCharacterizingTarget Group

SettingObjectives

Preparing TechnicalGuidelines

Testing theFeasibility of the

Recommendations

Preparing Food-Based Dietary

GuidelinesValidation

Correction andAdjustment

Implementation

Evaluation

Setting ObjectivesSetting ObjectivesObjectives of the nutritional guidelines

– Preventing and reducing priority risks and problems

– Promoting healthy diets and lifestyles– Promote consumption of an adequate diet

in vitamin A and iron

PlanningCharacterizingTarget Group

SettingObjectives

Preparing TechnicalGuidelines

Testing theFeasibility of the

Recommendations

Preparing Food-Based Dietary

GuidelinesValidation

Correction andAdjustment

Implementation

Evaluation

Preparing Technical GuidelinesPreparing Technical Guidelines• Work of nutritionists and dietitians• Technical document:

– Defines the Nutritional goals, behavior to promote, knowledge to , skill to develop, change in environment.

– Converts nutritional goals into types and quantities of food that the population should eat

– Defines of Nutrient recommendations– Outlines the recommended food groups

FORMULATION OF TECHNICAL FORMULATION OF TECHNICAL RECOMMENDATIONS OF THE NUTRITIONAL RECOMMENDATIONS OF THE NUTRITIONAL

GUIDELINESGUIDELINESProblem of Health and Nutrition

Critical Nutrient

Critical Food Practices/ habits/ beliefs

related to the health/

nutrition problem

Technical recommen

dation

DEFINITION OF TECHNICAL RECOMMENDATIONS OF THE DEFINITION OF TECHNICAL RECOMMENDATIONS OF THE NUTRITIONAL GUIDELINES FOR THE CUBAN NUTRITIONAL GUIDELINES FOR THE CUBAN

POPULATIONPOPULATIONHealth Problem Critical nutrient Critical food Practices/ Habits/

Beliefs relatedTechnical

Recommendation

Cardiovascular and brain diseases

Fat saturated Cho. Refined

Na

Vitamins Ac.

Grs omega 3

Fiber

Lards

Oils

Vegetable and fruits

Salt

Sugar

Fish

Grains and cereals

X's of fried food

Little availability vegetables/fruits

Habit vegetable/fruits

consumption

Habit fish consumption Use of table salt X's use of sugarBad distribution of foods during the day Sedentary lifestyle Alcoholism Smoking

Varied diet. Fried food consumption. Prefer use of oil instead of lard.

Consumption of vegetables/fruits. Grain and cereal consumption. Fish consumption. Salt consumption. Sugar consumption. Alcohol consumption. Maintain healthy weight. Physical activity. Diminish energy intake in the night.

TABLE ANALYSIS OF THE TECHNICAL TABLE ANALYSIS OF THE TECHNICAL RECOMMENDATIONSRECOMMENDATIONS

Technical Recommendation Number of times that repeats

Reduce alcohol consumption.Consume a variety diet.Increase consumption of vegetables and fruits.Reduce fried food consumption.Increase grain and cereal consumption.Equitable distribution of energy intake.Increase physical activity.Maintain weight healthy.Reduce sugar consumption.Increase consumption of fish.Consumption of oil vrs lard.Increase milk product consumption.Reduce salt consumption.Reduce smoked food consumption.Reduce coffee consumption.Combination consumption of sources of iron and vitamin C.Hand washing.Adequate food handling.Improve dental hygiene.

7

6

6

5

5

4

4

4

4

3

2

2

2

1

1

1

1

1

1

RECOMMENDED INTERVALS OF ENERGY INTAKE FOR RECOMMENDED INTERVALS OF ENERGY INTAKE FOR DIFFERENT GROUPS OF AGE AND SEXDIFFERENT GROUPS OF AGE AND SEX

Preschool children 2-5 years

Schoolchildren 6-12 years

Adolescents 13-17 years

Adults 18-65 años

Elderly persons > 65 years

Lactating pregnant woman

1,000 1,500 2,000 2,500 3,000 3,500

Category A 1,300 CAL

Category B 2,200 CAL

Category C 3,000 CAL

CALCULATION OF THE CONTENTS OF CALCULATION OF THE CONTENTS OF NUTRIENTS THAT EACH DIET WILL NUTRIENTS THAT EACH DIET WILL

CONTRIBUTECONTRIBUTE

ENERGY 1,300 CAL 3,200 CAL 3,000 CAL

Protein 39 g 66 g 90 g

Fat 36 g 61 g 83 g

Carbohydrates 205 g 346 g 472 g

Vitamin A 390 ER 650 ER 900 ER

Iron 6-9 mg 11-15 mg 15-21 mg

Vitamin C 32 mg 55 mg 75 mg

PARTS NECESSARY FOR COVERING THE THREE PARTS NECESSARY FOR COVERING THE THREE LEVELS OF ENERGYLEVELS OF ENERGY

GROUPS

1,300 CAL 2,200 CAL 3,000 CAL

1 2 1 2 1 2

Milk and alternatives

1 2 0 1 0 1

Vegetables 1 2 1 3 3 2

Fruits 2 1 3 1 2 3

Sugar 7 7 11 11 17 16

Grains 7 7 14 15 20 19

Meat and alternatives

3 2 5 6 8 8

Fat 4 5 8 8 11 11

PlanningCharacterizingTarget Group

SettingObjectives

Preparing TechnicalGuidelines

Testing theFeasibility of the

Recommendations

Preparing Food-Based Dietary

GuidelinesValidation

Correction andAdjustment

Implementation

Evaluation

Testing the Feasibility of the Testing the Feasibility of the RecommendationsRecommendations

• Behavioral Field Tests• Population’s willingness and ability to

meet recommendations• Identify appropriate language to be

used• Identify graphical representation

PlanningCharacterizingTarget Group

SettingObjectives

Preparing TechnicalGuidelines

Testing theFeasibility of the

Recommendations

Preparing Food-Based Dietary

GuidelinesValidation

Correction andAdjustment

Implementation

Evaluation

Preparing Food-Based Dietary Preparing Food-Based Dietary GuidelinesGuidelines

• Recommendations to population through messages

• Messages must be:– Positive– Clear– Comprehensible– Culturally appropriate– “Doable”

Preparing Food-Based Dietary Preparing Food-Based Dietary GuidelinesGuidelines

• Criteria for selecting guidelines:– Objectives and potential for

implementation by target group– Ideal number of messages is 6-8

– To facilitate dissemination and population memory

Preparing Food-Based Dietary Preparing Food-Based Dietary GuidelinesGuidelines

Use of pictures or diagrams– Attractive– Culturally acceptable– Give idea of variety and proportions

FIGURE PROPOSAL–GUATEMALA FIGURE PROPOSAL–GUATEMALA CRITERIA: CULTURALLY ACCEPTABLE VARIETY, CRITERIA: CULTURALLY ACCEPTABLE VARIETY,

PROPORTIONALITYPROPORTIONALITY

NUTRITIONAL GUIDELINES FOR GUATEMALANUTRITIONAL GUIDELINES FOR GUATEMALA

• Include in all meals grains, cereals, or potatoes, because feed, and are economic and delightful.

• Eat every day tortillas and beans. Per one tortilla eat a tablespoonful of beans so it is more substantial.

• Eat every day herbs or vegetables to benefit your organism.

• Eat every day any kind of fruit, because they are healthy, digestive and nutritious.

• In addition to the beans that eat daily, eat at least twice a week an egg, a piece of cheese or a glass of milk.

• Eat at least once a week a piece of liver or of meat.

• Eat varied of food as it shown in the family pot.

Sugar and fatsMeats

(at least once a week)

Herbs and vegetables (every day)

Milk

(at least twice a week)

Fruits (every day)

Grains, cereals, and potatoes (every day)

To maintain your health, wash your hands, cover food and the water

PlanningCharacterizingTarget Group

SettingObjectives

Preparing TechnicalGuidelines

Testing theFeasibility of the

Recommendations

Preparing Food-Based Dietary

GuidelinesValidation

Correction andAdjustment

Implementation

Evaluation

Testing and Validating the Testing and Validating the FBDGFBDG

• Field-tested on people representative of target population

• Testing should be conducted in three phases:– Messages alone– Graphic alone– Messages and graphic together

3636

Dominica: testing Dominica: testing messages and food guidemessages and food guide

• Start the day with breakfast

• Always try to eat a variety of foods every day. Use the basket to help you make the choices.

• Use less salt, salted foods, seasonings and salty snacks

PlanningCharacterizingTarget Group

SettingObjectives

Preparing TechnicalGuidelines

Testing theFeasibility of the

Recommendations

Preparing Food-Based Dietary

GuidelinesValidation

Correction andAdjustment

Implementation

Evaluation

Correcting and Adjusting the Correcting and Adjusting the FBDGFBDG

• Based on test results

• Additional technical review

PlanningCharacterizingTarget Group

SettingObjectives

Preparing TechnicalGuidelines

Testing theFeasibility of the

Recommendations

Preparing Food-Based Dietary

GuidelinesValidation

Correction andAdjustment

Implementation

Evaluation

Promotion of FBDGPromotion of FBDG

• Reproduce, disseminate and implement

• Use sound communication strategy• May be directed to specific segments

of population• Schools are effective for reaching

children and parents• Schools cost-effective

PlanningCharacterizingTarget Group

SettingObjectives

Preparing TechnicalGuidelines

Testing theFeasibility of the

Recommendations

Preparing Food-Based Dietary

GuidelinesValidation

Correction andAdjustment

Implementation

Evaluation

EvaluationEvaluation

• Periodic evaluation in terms of– Implementation process– Impact on target population

• Evaluation methodology and instrument designs– Systematic, objective, and timely

evaluation

Conclusions

• POLITICAL WILL IS A KEY FACTOR IN THE DEVELOPMENT, IMPLEMENTATION, AND EVALUATION OF NUTRITIONAL GUIDELINES.

• IT IS NECESSARY TO FORM A GROUP TO DIRECT •THE PROCESSTHAT HAS LEADERSHIP CAPACITY AND •THE ABILITY TO BRING GROUPS TOGETHER.

• THE IMPORTANCE OF ESTABLISHING CONSENSUS AND BUILDING PARTNERSHIPS THAT PROMOTE THE IMPLEMENTATION OF THE GUIDELINES.

• THE NEED TO SELECT THE MOST APPROPRIATE •COMMUNICATIONS STRATEGIES FOR DISSEMINATING •THE GUIDELINES.

Food GuideFood Guide

Food GuideFood GuideVisual representations to help consumers apply guidelines in their daily lives

Food GuideFood Guide

PYRAMID OF PHYSICAL ACTIVITY

•TV•JUEGOS DE VIDEO•MUCHO TIEMPO SENTADO

2-3 TIMES/WEEK•JUEGUE BOLICHE•BAILE•PATINE•JUEGUE GOLF

•LEVANTE PESAS•EJERCICIOS DE ESTIRAMIENTO•ABDOMINALES

3-5 TIMES/WEEK•TROTE•MONTE BICICLETA•NADE•HAGA AEROBICOS•HAGA ACUAEROBICOS•SALTE CUERDA• CAMINATA A PASO RAPIDO

• FUTBOL•BALONCESTO•VOLIBOL•TENIS•ARTES MARCIALES•GIMNASIA

EVERY DAY

•ESTACIONE SU CARRO LO MAS LEJOS POSIBLE PARA OBLIGARSE A CAMINAR•USE LAS GRADAS EN VEZ DE ELEVADOR•CAMINE LO MAS QUE PUEDA•HAGA OFICIOS DE LA CASA Y JARDINERIA•CAMINE CON SU MASCOTA

•HAGA VIAJES EXTRA BAJANDO Y SUBIENDO LAS GRADAS•CAMINE A DIFERENTES SITIOS EN VEZ DE MANEJAR•ELIJA ACTIVIDADES QUE REALMENTE DISFRUTE•CONVIERTA LAS ACTIVIDADES EN EVENTOS SOCIALES CON SU FAMILIA

REDUCE

PASATIEMPOSFLEXIBILIDAD Y RESISTENCIA

EJERCICIO AEROBICO

ACTIVIDADES RECREATIVAS

FUENTE: Franklin Community Health Network and the Physical activity Task force of Healthy Community Coalition. Http://www.fchn.org/hcc/hccwinter.htm