Document 2004/03 18th Session of COAG COAG 18th Session – 9-10 Feb 2004 Document 2004/03 18th Session of COAG 9 -10 February 2004

Joint FAO/WHO Expert Consultations COAG 18th Session – 9-10 Feb 2004 Joint FAO/WHO Expert Consultations Fats and Oils in Human Nutrition, 1993 Carbohydrates in Human Nutrition, 1997 Vitamin & Mineral Requirements, 1998 Human Energy Requirements, 2001 Protein and Amino Acid Requirements, 2002 Diet, Nutrition and the Prevention of Chronic Diseases, 2003 FAO is mandated to work with WHO on a whole range of issues related to food and nutrition since the 1950s. This includes joint work on nutritional requirements, nutritional indicators and the assessment of undernourishment, nutrition education, etc. It works jointly with WHO on food safety and Codex and codex related activities including provision of scientific advice to Codex and other bodies. The list here is but a sample of joint activities since the 1990s.

Deaths by regions, 2000 % 75 50 25 COAG 18th Session – 9-10 Feb 2004 Non communicable diseases include premature heart disease, stroke, diabetes, and cancers. Overweight and Obesity are serious underlying problems that increase risk of NCDs. If one looks ate the mortality from diseases it is already evident in the year 2000 that NCDs have overtaken infectious diseases in most regions of the world apart from Africa. High cholesterol accounts for 4 million premature deaths while high blood pressure is responsible for 7 million premature deaths. It has been projected that in 2020: 71% of deaths due to heart disease, 75% due to stroke and 70% due to diabetes, will be in developing countries. Premature death and disability from NCDs are the result of unhealthy diets and lack of physical activity. They are largely preventable by healthy diets and lifestyles. AFRICA Eastern Mediterranean SE-ASIA W.PACIFIC AMERICAS EUROPE Accidents Communicable diseases Non-communicable Diseases Source: WHO, World Health Report 2001

Global burden of disease in developing countries COAG 18th Session – 9-10 Feb 2004 Global burden of disease in developing countries 1990 2020 27% 43% 22% 49% 9% 21% The burden of disease is no only due to premature death but also due to disability associated with the illness. These have both economic and health care costs and are hence a burden to the economy of countries. Of the 672 million affected with NCDs in 2000, nearly 370 million are from developing countries. Diabetes alone accounts 84 million in 1995 in developing countries and this is expected to increase to 228 million in 2020 Overweight and obesity are serious problems. WHO has estimated that in 2000 more than 1 billion adults worldwide were overweight while 300 million were clinically obese. Among these half a million were expected to die in North America and Europe alone from obesity related NCDs. 15% 14% Infectious diseases Non Communicable Diseases Mental Illness Injuries

Developing countries face double burden of under and over nutrition COAG 18th Session – 9-10 Feb 2004 Developing countries face double burden of under and over nutrition Poor maternal nutrition and low birth weight increases risk of obesity and NCDs later in life Poverty, hunger and undernutrition are linked to chronic diseases Almost 24% of infants born in developing countries have Low birth weight (below 2.5Kg). The main cause is poor maternal nutrition. The Barker hypothesis has clearly demonstrated that low birth weight increases risk of NCDs in adult hood and that these individuals are more at risk from the usual risk factors such as diet and physical activity in adulthood which increases their risk of Obesity and NCDs. These will further contribute to the double burden in developing societies.

Main recommendations of Expert Report COAG 18th Session – 9-10 Feb 2004 Main recommendations of Expert Report Dietary factor Goal (% of total energy) Total fat 15 - 30% Saturated fatty acids <10% Total carbohydrate 55 - 75% Free sugars <10% Sodium chloride <5 g per day Fruits and vegetables >400 g per day Physical activity 60 minutes of walking/day These are some of the main recommendations

Recommendations of Expert Report COAG 18th Session – 9-10 Feb 2004 Recommendations of Expert Report Goals are recommendations on population averages Goals are not intended as regulatory targets Recommendations in keeping with recent advice provided by national and international reports

The COAG Document 2004/03 COAG 18th Session – 9-10 Feb 2004 Provides preliminary assessment of possible implications for agriculture, food processing and marketing Edible oils and fats Sugar Cereals Fruits and vegetables Milk and meat Fish and fish products Food processing technologies and marketing Proposes follow-up actions Requests guidance from COAG Reviews the Expert Consultation Report

COAG 18th Session – 9-10 Feb 2004 The COAG Document 2004/03 Follow-up in the context of on-going work ... Incorporate emerging scientific evidence on the double burden of hunger and over-nutrition Inform and protect consumers Promote the livelihoods of farmers and food processors given changing consumption patterns

The COAG Document 2004/03 COAG 18th Session – 9-10 Feb 2004 Follow-up in the context of evolving areas ... Take stock of dietary patterns and their health implications Interpret dietary goals in country-specific situations Supporting innovation in food products Examine food and agricultural policy options and actions

The COAG Document 2004/03 COAG’s approval is sought for FAO to ... COAG 18th Session – 9-10 Feb 2004 COAG’s approval is sought for FAO to ... Strengthen work with WHO in nutrition and promotion of healthy diets Provide Members with advice and assistance in raising awareness of nutrition and healthy diets Assist Members in formulating and implementing policies and programmes for diversification of agricultural production

Briefing for COAG 18th Session Changes in nutrient intake: Outlook to 2030 If business as usual continues ... This slides presents the rapid nutrition transition the world has been experiencing over the last 40 years. It will also give an outlook into the next 30 years On the x-axis you see the so-called DES, i.e. the dietary energy supply in calories per person and day On the y-axis is the daily protein availability in g/day Also note that the time will be changing (it’s in the subtitle over the next 60 seconds or so, starting with the year 1960 going to the year 2030 There are a number of lines in the chart to denote whether a diet is rich in energy and/or protein: A diet that provides more than 3000 kcal and more than 75g protein per day is generally considered a very rich diet and is also a potential contributor to obesity We start in 1961 and first go through the past 40 years: As you see, many countries moves into the center at a growing speed. We witness a rapid nutrition transition owing To the achievements of the Green Revolution Falling real prices for food (60% lower than in the 1960s) Rapid income growth, declining population growth (population growth has rapidly declined in developing countries; over the next 30 years (1.1%), it will only be about half of what it was over the last 30 years (2%) [stop the slide at the end of the 1990s] By the end of the 1990s, many developing countries, particularly in Asia and Latin America have moved out of the lower-left quadrant, i.e. out of the area where energy and protein deficiencies are highly prevalent. Outlook to 2030: speed accelerates and the picture of the 1960s reverses: all countries except for those in SSAF are moving towards the upper right corner. This suggests that the burden on obesity and NCDs coming from the diet may quickly accelerate, The projections of the dietary changing alone may even understate the problem: We also expect that growing urbanization, mechanization, etc will reduce calorie expenditure so that excess consumption may even increase faster than this chart suggest But also note that there will be still hunger in the world. As you know, more than we all want (443 million by 2030). In most cases, hunger will be limited to Sub-Saharan African countries, but also a few countries in the Near East North African region and South Asia will still be affected. As a result, we will see a nutritional dichotomy where hunger and overnutrition exist in tandem, often even in the same country. In other words, the double burden of hunger and obesity is poised to further increase over the next 30 years! The world is therefore sitting on a nutritional time bomb, many developing countries can still avoid the obesity and NCD problems of developed countries, but they need to act soon. We thought that the expert recommendations could provide an overall frame for the right nutritional guidance!

Green Room 9 February 2004 13:30 – 14:30 Briefing for COAG 18th Session COAG Side Event Implications of dietary recommendations for the undernourished and developing countries Chair: Hartwig de Haen Implications of recommendations for developing countries Prof. Ricardo Uauy, INTA, Chile (Chair of Expert Consultation) Implications for the undernourished and links with chronic disease Prof. Alan Jackson, Univ Southampton, UK (Chair of Scientific Committee on Nutrition, UK) Implications for producers in developing countries Dr Don Mitchell, World Bank, Washington Green Room 9 February 2004 13:30 – 14:30