In response to a call from the 58th World Health Assembly (May 2005), World Health Organization (WHO) established the Guidelines Review Committee (GRC) in 2007 with the purpose of developing and implementing procedures to ensure that WHO guidelines are developed in ways consistent with best practices, emphasizing the appropriate use of evidence. The processes described in the WHO Handbook for guideline development has been adopted as of 1 January 2009. Additionally, as part of implementing the outcomes and recommendations of the WHO Nutrition Programme Review undertaken in 2008, the Department of Nutrition for Health and Development (NHD) has been strengthening its role in providing evidence-informed policy and programme guidance to Member States, in partnership with relevant internal departments and partners and guided by the new WHO guideline development process. This normative mandate was reaffirmed through a request from the 63rd World Health Assembly (May 2010) “to strengthen the evidence base on effective and safe nutrition actions to counteract the public health effects of the double burden of malnutrition, and to describe good practices for successful implementation”
To implement the strengthening of evidence-informed nutrition guidance, the WHO Department of Nutrition for Health and Development (NHD) established in 2010 the WHO Nutrition Guidance Expert Advisory Group (NUGAG) guided by the WHO Steering Committee for Nutrition Guidelines Development, which includes representatives from all Departments in WHO with an interest in the provision of recommendations in nutrition. Membership in NUGAG is for two years and NUGAG includes experts from various WHO Expert Advisory Panels as well as experts from a larger roster including those identified through open calls for experts, taking into consideration a balanced mix of genders, breadth in areas of expertise, and representation from all WHO Regions.
The NUGAG implements a biannual programme of work on these areas and has face-to-face meetings up to twice a year and will provide advice to WHO on the following:
- The scope of the guidelines and priority questions for which systematic reviews of evidence will be undertaken
- The choice of important outcomes for decision-making and developing recommendations
- The interpretation of the evidence with explicit consideration of the overall balance of risks and benefits
- The final formulation of recommendations, taking into account the quality of evidence generated and compiled as well as diverse values and preferences, costs, and feasibility
In 2010 – 2011, the NUGAG consisted of four subgroups: 1) micronutrients; 2) diet and health; 3) nutrition in life course and undernutrition; and 4) monitoring and evaluation. However, due to organizational changes implemented in NHD in January 2012 and in an effort to reduce the administrative burden of managing multiple subgroups, the number of NUGAG subgroups has been reduced to two: 1) diet and health; and 2) nutrition actions which subsequently renamed as the guideline development group (GDG) on nutrition actions.
Updating of the dietary goals for the prevention of obesity and diet-related noncommunicable diseases (NCDs) has been the focus of the work of the NUGAG Subgroup on Diet and Health. After completing the work on updating the guidelines on sodium and potassium intakes (published in 2012) and on sugars intake (published in 2015), the NUGAG Subgroup on Diet and Health had been working on the updates of the WHO guidelines on the intake of total fat, saturated fatty acids (SFA) and trans-fatty acids (TFA). These have now been completed and currently the draft guidelines on total fat, SFA and TFA are being prepared to be issued for public consultation before their finalization and publication. The NUGAG Subgroup on Diet and Health is currently working on developing and updating of the guidelines on carbohydrates (CHO), polyunsaturated fatty acids (PUFA) including EPA and DHA, non-sugar sweeteners and dietary patterns.
Updating of these dietary goals is an important element of WHO’s efforts in implementing the NCD agenda, to which the Organization is giving high priority. This will also contribute to the implementation of the Political Declaration of the UN High-level Meeting on NCDs held in New York in September 2011 and the outcome document of the high-level meeting of the UN General Assembly on NCDs (A/RES/68/300) held in New York in July 2014 as well as the implementation of the NCD Action Plan for 2013 – 2020 which was adopted by the 66th World Health Assembly held in May 2013. Furthermore, it had also provided inputs to the work of the high–level Commission on Ending Childhood Obesity established by the WHO Director-General in May 2014.
In November 2014, WHO organized, jointly with the Food and Agriculture Organization of the United Nations (FAO), the Second International Conference on Nutrition (ICN2). ICN2 adopted the Rome Declaration on Nutrition (http://www.fao.org/3/a-ml542e.pdf) and the Framework for Action (http://www.fao.org/3/a-mm215e.pdf), which recommends a set of policy options and strategies to promote diversified, safe and healthy diets at all stages of life. Subsequently the 136th Session of the WHO Executive Board (EB) held in January 2015 and the Sixty-eighth World Health Assembly held in May 2015 endorsed the Rome Declaration and Framework for Action and called on Member States to implement the commitment of the Rome Declaration across multiple sectors, by expanding WHO’s evidence-informed guidance.
Furthermore, in April 2016, the UN General Assembly (UNGA) declared a UN Decade of Action on Nutrition (2016-2025), recognizing the role of nutrition in achieving the 2030 Agenda on Sustainable Development and the Sustainable Development Goals (SDGs). The Decade calls for eradicating hunger and preventing all forms of malnutrition worldwide, particularly stunting, wasting, and 3 overweight in children under five years of age; and anaemia in women and children among other micronutrient deficiencies; as well as for reversing the rising trends in overweight and obesity and reducing the burden of diet-related NCDs in all age groups. Therefore, the goal of the Decade is to increase action at the national, regional and global levels in order to achieve the commitment of the Rome Declaration adopted at ICN2, through implementing policy options included in the Framework for Action and evidence-informed programme actions.
Updating of the dietary goals which the NUGAG Subgroup on Diet and Health has been undertaking will, therefore, contribute not only to the implementation of the ICN2 commitments but also to the achievement of the goals of the Decade.
The Nutrition Policy and Scientific Advice Unit (NPU) in NHD serves as the Secretariat of the NUGAG Subgroup on Diet and Health and is convening, in collaboration with the Nutrition, Physical Activity and Obesity Programme in the Division of NCDs and Promoting Health through the Life-Course at the WHO Regional Office for Europe (EURO), the next meeting of the NUGAG Subgroup on Diet and Health in Lisbon, Portugal from 15 to 18 November 2016. It will be the 10th meeting of the NUGAG Subgroup on Diet and Health, following the nine previous meetings which took place in Geneva in February 2010 and March 2011; in Seoul, Republic of Korea in November 2011; in Geneva in March 2012; in Hangzhou, China in March 2013; in Copenhagen, Denmark in October 2013; in Geneva in September 2014; in Fukuoka, Japan in June 2015; and in Geneva in March 2016.
The main objectives of the 10th meeting are to:
- Regarding the intake of carbohydrates (CHO), non-sugar sweeteners, and polyunsaturated fatty acids (PUFA) (including EPA and DHA):
- Review and discuss the outcomes of the systematic reviews of the evidence and the GRADE Evidence profiles
- Draft evidence-informed recommendations on the intake of CHO, non-sugar sweeteners, and PUFA
- Determine the strength of these respective recommendations, taking into consideration detailed criteria to be considered when moving from evidence to recommendations (i.e. the balance of evidence on benefits and harms, values and preferences, resource implications, priority of the problems, equity and human rights, acceptability, and feasibility)
- Review and identify implications for future research, taking into account ongoing research and any existing controversies
- Review and discuss challenges to the implementation of the guidelines
- Regarding dietary patterns:
- Review the further scoping undertaken, taking into consideration the definition and characteristics determined by the 9th meeting of the NUGAG Subgroup on Diet and Health
- Determine the priority outcomes and other issues, and finalize key questions in PICO format in order to guide systematic review(s)