Diet Quality: A Missing Link

Transcription

1 Diet Quality: A Missing Link Jennifer Coates, PhD 1 and Anna Herforth, PhD 2 1 Tu@s Friedman School of NutriFon Science and Policy 2 Independent Consultant Bill and Melinda Gates FoundaFon Grand Challenges MeeFng October 6, 2014

2 Outline 1. Diet quality: What is it and why is it important to both nutrifon and agriculture? 2. A missing link: crifcal indicator and data gaps for understanding and acfng on poor diet quality 3. RecommendaFons 4. The INDDEX Project: seeking to improve dietary data availability, access, and use

3 1. Diet quality: what is it and why is it important to both nutrifon and agriculture?

4 Diet Quality: A MulF- dimensional Construct Variety Propor0onality/Balance Adequacy Modera0on/Avoidance of Excess Sources: Arimond and Ruel, 2004; Arimond 2008; Ruel 2013; Wirt et al 2009; Waijers and Feskens, 2005

5 Why Do We Care about Diet Quality? AGRICULTURE DIET ENVIRONMENTAL SUSTAINABILITY NUTRITION AND HEALTH STATUS

6 Quality is embedded in the food security definifon Food security exists when all people, at all Fmes, have physical and economic access to sufficient, safe, and nutri0ous food to meet their dietary needs and food preferences for a healthy and acfve life - - FAO/UN: World Food Summit, 1996

7 Nutrient inadequacy remains a problem

8 While energy excess is rapidly increasing % Stunting (HAZ <2, age <5 years) Overweight (BMI 25, age 20+) Over 1/3 of high stunfng- burden countries have overweight + obesity rates >30% Slide source: Herforth, A. In: The Fight Against Hunger and Malnutri8on. Oxford University Press Data source: WHO Global Health Observatory Data Repository, UNICEF StaFsFcs by Area (WHO 2013; UNICEF 2014).

9 .Leading to serious consequences Top 10 causes of years of life lost : All developing countries, 2010 Source: Institute for Health Metrics and Evaluation

10 Projected increases in diabetes to 2030 Source: International Diabetes Federation, Diabetes Atlas 5 th Ed. 2011

11 Why should the ag and food sector care about diet quality? Markets: unmet need for healthy, high value foods; removing supply side constraints could enable producers to benefit. Ag sector is an engine for food security and of course diet quality is a goal inherent to the food security definifon.

12 2. A Missing Link: crifcal indicator and data gaps for understanding and acfng on poor diet quality

13 4 Key Issues: 1. Lack of validated indices or dashboard of diet quality indicators with global recognifon and insftufonal backing. 2. Lack of nafonally representafve data on individual- level food and nutrient consumpfon 3. Many countries don t have dietary guidelines; there are no global dietary guidelines 4. ExisFng data (eg. FBS, HCES) that could provide data on quality of availability and access are under- uflized

14 No validated global indices of child or adult diet quality are roufnely collected X FAO Undernourishment Indicator X FAO Suite of Food Security Indicators X Food Insecurity Experience Scale X Household Dietary Diversity Score X Economist Global Food Security Index X Demographic and Health Surveys

15 This is also true when referring to the quality of food availability and food access Availability Access Global & NaFonal Household ConsumpFon Individual Quality of food availability and access are necessary, though not sufficient for the individual consumpfon of quality diets

16 E.g., The Global NutriFon Report Finds Dietary Quality Data Challenges Rejected Indicator Household Dietary Diversity Score Explana0on No roufne data collecfon Not validated as an indicator of access to diet quality Women s Dietary Diversity Processed food consumpfon Prevalence of low fruit and vegetable consumpfon No roufne data collecfon Data only available for a few big countries. More work needs to be done Data are sparse and self- reported by countries from surveys that may not be representafve. Source: hup://globalnutrifonreport.org/files/2014/07/country- Profile- Indicators- Table.pdf

17 We are limited in our ability to: Assess and act on dietary causes of malnutrifon and preventable disease Understand the links between agriculture, nutrifon, and the environment IdenFfy risks and the scale of exposure to food contaminants ( safety ) Plan and evaluate relevant policies and programs to shape the food system toward posifve outcomes.

18 3. RecommendaFons

19 Key RecommendaFons for Improving NutriFon through Agriculture Food and agriculture policies can have a beuer impact on nutrifon if they monitor dietary consump0on and access to safe, diverse, and nutri0ous foods hup://unscn.org/files/agriculture- NutriFon- CoP/Agriculture- NutriFon_Key_recommendaFons.pdf

20 RecommendaFon #1: IdenFfy and agree on diet quality informafon needs, driven Quality of the food supply Local- level food environment Household- level access to quality food Individual- level diet quality: by objec8ve Associated behaviors (Eg. meal pauerns, eafng away from home, snacking, consumpfon of highly processed foods, acfvity levels Sustainability, stability, safety, and acceptability Causes and consequences of dietary choices

21 Key Data Sources: Challenges and Constraints Data Source Appropriate For: Challenges and Constraints Food Balance Sheets Household ConsumpFon and Expenditure Surveys Dietary Assessment Surveys Demographic & Health Surveys InformaFon on the quality of the food supply Understanding food environments Quality of household food access Metrics of individual dietary quality Individual dietary pauerns Household or individual proxy indicators of quality, such as MDD- W - No informafon on distribufon - QuesFonable data quality - Not always designed to enable validate indicator construcfon. - Usually captures apparent consumpfon - Expensive, technically complex, sporadically implemented - AddiFons to DHS are possible but must be negofated and require financial support

22 4 Main Approaches to Assessing Individual- level Diet Quality 1. Dietary diversity scores 2. Data- driven dietary pauerns 3. A priori food or nutrient- based indexes 4. Indicator dashboard

23 While validated diet quality indexes exist, they have typically been context- specific [Healthy EaFng Index]

24 RecommendaFon #2: Validate against agreed upon standards for healthy diets Dietary guidelines themselves have remained remarkably consistent over the last century (Davis and Saltos 1999) Remarkable similarifes in food based guidelines across countries (MoD 2001) PAHO and SPRING project launching an inifafve to develop global dietary guidelines for women Arimond, Coates, Herforth to conduct cross- country review of dietary guideline content. Consider Sustainable dietary guidelines

25 RecommendaFon #3: Scale up validated MDD- W Indicator Proxy indicator for global use in assessing women s diet quality: micronutrient adequacy Expert consensus around a 10 food group index, consensus around a 5 food group threshold Requires a commitment and funding to regularly include it in DHS surveys. Advocate to include in post framework

26 RecommendaFon #4: Improve availability of, and access to, individual- level dietary data Automated dietary data collecfon and analysis pla{orm to decrease cost, improve esfmates. Link updated food composifon tables to data collecfon pla{orm for easier analysis of nutrient data. Create a publically accessible and centralized database of individual food consumpfon data to be housed by FAO/WHO.

27 RecommendaFon #5: Improve design of HCES to produce more accurate and useful informafon on quality of food and nutrient access Determine best pracfces for elements such as: capturing foods consumed outside the home opfmal food list length and composifon opfmal recall periods Work with countries to adopt best pracfces

28 RecommendaFon #6: Increase the use of exisfng food consumpfon and dietary data to guide policy- making

29 4. The InternaFonal Dietary Data Expansion (INDDEX) Project: Seeking to improve dietary data availability, access, and use

30 InternaFonal Dietary Data Expansion (INDDEX) Project 1. Standardize and streamline the collecfon and analysis of individual dietary data 2. Improve the design of household consumpfon and expenditure surveys; 3. Increase the use of food and nutrient data to guide nutrifon and agriculture policy 4. SFmulate global cooperafon and country capacity for improved acquisifon and use of dietary data

31 Thank you!