Dates
25 November 2021 – first session
29 November 2021 – 2nd session
1 December 2021 – 3rd session
10 December 2021 – 4th session
Scope and purpose
In response to a call from the 58th World Health Assembly (May 2005), the 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 internationally recognized best practices, emphasizing the appropriate use of systematically reviewed available evidence. The robust guideline development process being implemented by WHO is described in detail in the WHO Handbook for guideline development (2014).
In accordance with the Organization-wide transformation in strengthening WHO’s role in developing evidence-informed public health guidance, the Department of Nutrition for Health and Development (NHD) has strengthened its role and leadership in providing evidence-informed policy and programme guidance to Member States for promoting healthy diets and nutrition throughout the life course, 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”. More recently WHO’s commitment to strengthen its normative work was reiterated in the 13th General Programme of Work (2019 – 2023)which was endorsed by the 71st World Health Assembly (May 2018). It states that “Setting norms and standards is a unique function and strength of WHO” and further noted that WHO “will reinforce its science- and evidence-based normative work”.
To implement the strengthening of evidence-informed nutrition guidance, 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 promoting healthy diets and nutrition. Membership in NUGAG is usually for three to four 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 will provide advice to WHO on the following:
- The scope of the guidelines and priority questions (in PICO format) that will guide the undertaking of systematic reviews of evidence;
- The choice and prioritization of important outcomes for decision-making and developing recommendations;
- The examination and interpretation of the evidence with explicit consideration of the overall balance of risks and benefits;
- The formulation of recommendations, taking into consideration the quality of evidence generated and compiled as well as diverse values and preferences, balance of benefits and harms, resource implications, priority of the problem, equity and human rights, acceptability and feasibility; and
- The identification of research gaps.
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 were reduced to two: 1) diet and health; and 2) nutrition actions which were subsequently renamed as the guideline development group (GDG) on nutrition actions. In 2018, the NUGAG Subgroup on Policy Actions was also established.
Updating of the dietary goals being carried out by the NUGAG Subgroup on Diet and Health are important elements of WHO’s efforts in implementing the NCD agenda and achieving the ‘triple billion’ targets set up by the 13th General Programme of Work (2019 – 2023), including one billion more people enjoying better health and well-being. 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 and the Framework for Action, 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 68th 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 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 commitment of the Rome Declaration adopted at ICN2, through implementing policy options included in the Framework for Action and evidence-informed programme actions.
The Safe, Healthy and Sustainable Diet Unit (CC Healthy Diets) of the new Department of Nutrition and Food Safety (NFS) established in the beginning of 2020 as part of the WHO’s transformation process serves as the Secretariat of the NUGAG Subgroup on Diet and Health and also now the NUGAG Subgroup on Policy Actions. The NUGAG Subgroups are generally expected to meet annually, but due to the COVID-19 pandemic, it is very unlikely to hold any physical meetings, including those of the NUGAG. Therefore, it is planned to hold a series of virtual meetings to progress the work of the NUGAG on Diet and Health with a view to finalize pending guidelines. The virtual meeting was held on 25 and 29 November, and 1 and 10 December 2021.
The objectives of the 17th meeting are to:
- Review the systematic review and contextual factors review on the use of low-sodium salt substitutes;
- Review the draft recommendations, rationale and remarks on the use of low-sodium salt substitutes, including drafted rationale and remarks;
- Review and identify implications for future research, taking into account on-going research and any existing controversies; and
- Review and identify challenges for implementation of the guideline.
The expected outcome of the meeting is, therefore, to finalize the recommendations and accompanying rationale and remarks on the use of low-sodium substitutes.