Abstract
Nutrition is a major determinant of health throughout all stages of life and together with smoking is the most important risk factor for morbidity and mortality in the Asia Pacific Region. The workshop participants examined Dietary Guidelines and Food Guides that are in use in our region, together with additional materials from the World Health Organization, UNICEF and the World Cancer Research Foundation. The resulting set of guidelines is meant as a reminder of the main issues to be covered in a general public health education program. It may also be of value in reminding public health practitioners, educators, administrators, and policy makers of current nutrition issues. It may additionally be useful as a checklist of the issues to be considered in public health programs and regulations.
The main areas of nutrition that are included in the Guidelines are eating a variety of foods, including vegetables, fruits, whole grain cereals, and nuts. Choose fish, poultry, and meats grown in a sustainable way. Appropriate growth, including avoiding obesity, and physical activity are important. Breastfeeding is the basis of infant nutrition and nutrition of mothers is an important public health measure. Negative factors in the Asian diet include salt, refined sugar, alcohol and fats. The APACPH Dietary Guidelines will need to be kept under review and modified to meet regional differences in food supply. The Guidelines will be useful as a checklist of the issues to be considered in public health programs, addressing both acute and chronic diseases.
Nutrition is one of the most important risk factors for acute and chronic diseases in people of all ages. Much of the burden of disease, early deaths, and disability in the Asia Pacific region could be reduced with public health efforts to address the major risk factors, including nutrition-related causes and smoking. The United Nations Decade of Action on Nutrition 2016-2025 has recently been launched with the aim of reducing the global burden of inappropriate nutrition. 1 The goals of the decade include increasing rates of exclusive breastfeeding to 6 months, reducing wasting and stunting, and reducing the rates of low birthweight, and this article represents the beginning of Asia Pacific Academic Consortium for Public Health’s (APACPH) contribution to this effort. The Global Burden of Diseases Study estimated that up to one half of the disease burden in the Asia Pacific region can be attributed to inappropriate nutrition. 2 In this context, nutrition includes the ingestion of foods to provide energy, specific nutrients and combinations of nutrients, the amount of processing and physical attributes of food, and ways energy is expended. Risk factors such as body size (obesity, body mass index, poor growth) and physical activity are also included.
The members of the APACPH are academic institutions or service institutes that have an academic function. Its mission is to enhance regional capacity to improve the quality of life and to address major public health challenges through the delivery of education, research, and population health services by member institutions. 3 Pooling the expertise available can assist institutions in guiding the education of their students and in advising government and nongovernment institutions on program implementation.
In September 2016, the 48th Conference of APACPH was held at Teikyo University in conjunction with their 50th Anniversary celebrations. A preconference workshop was held to consider Dietary Guidelines and other aspects of public health nutrition. The objective of the workshop was to extract from existing dietary guidelines and from the broader nutrition evidence base in the region a summary of the main issues in public health nutrition guidance.
At the workshop the Dietary Guidelines and Food Guides that are in use in our region and in addition materials from the World Health Organization, UNICEF, and the World Cancer Research Foundation were reviewed.4-10 Since advice on a healthy diet goes back to Hippocrates and earlier the amount of material that could be potentially considered is enormous and well beyond the capacity of this group, we therefore drew on the expertise of working group members from APACPH institutions for this umbrella review. (Additional reference resources will be available on the APACPH website, www.apacph.org/wp/.)
The resulting set of guidelines is meant as a reminder of the main issues to be covered in a general public health education program. It may also be of value in reminding public health practitioners, educators, administrators, and policy makers of current nutrition issues. It may additionally be useful as a checklist of the issues to be considered in public health programs and regulations.
A general set of Food Based Dietary Guidelines for the APACPH Region were discussed using as a basis previous APACPH discussions on Dietary Guidelines.11,12 It is our hope that the results of this discussion will highlight the importance of nutrition in the region and be useful for teaching public health in our institutions and for guiding discussions with government and nongovernment organizations. The workshop attendees agreed to continue work by email after the conference to refine the document, and the authors of this article have all agreed to the content of the document.
The principles used in the review were the following:
Address significant public health issues including mortality, morbidity, and disability
Be food based to allow for easier translation to practical dietary advice
Allow for an adequate intake of the required nutrients (meet the recommended nutrient intakes)
Maintain a healthy growth (for children) and a healthy body weight (for everyone)
Be relevant to a pattern of lifelong nutrition to optimize whole of life health
Consider the constraints of planetary health, by considering the available world resources and the 2-way (or bidirectional) effects of food production and diets on climate change
The working group considered all of the issues in the background paper and proposes the following Dietary Guidelines for use in APACPH Institutions:
Enjoy a variety of nutritious foods relevant to your own culture.
Eat plenty of vegetables, fruits, whole grain cereals, and nuts. Choose fish, poultry, and meats grown in a sustainable way. Avoid preserved and cured meats.
(Variety means foods of all types—cereals, legumes, roots, tubers, vegetables, fruits, nuts, milk, eggs, meat—and diversity within each type—such as beans, soybeans and lentils, rice and corn, potatoes and cassava, tomatoes and squash, orange and banana, chicken, and fish.)
3. Don’t eat too much fat, salt, or sugar (particularly sugar in drinks). Both adults and older children should prefer reduced fat milk.
4. Avoid eating ultra-processed foods such as soft drinks, sweetened cereals, and instant noodles, which are often nutrient poor, nutritionally unbalanced, and include too much sugar salt and fats.
5. Enjoy physical activity daily and keep a healthy body weight (for adults body mass index 18.5-25). Children need sufficient food to grow at a healthy rate. Weigh (check growth of) children and adolescents regularly.
6. Drink plenty of clean water. Tea and coffee are healthy beverages. Avoid drinks that contain sugar.
7. The healthiest option is not to drink alcohol, but if you choose to drink, do so only in moderation. Pregnant women (or women intending to become pregnant) should never drink alcohol.
8. Breastfeeding is the best for all infants (exclusive for 6 months). No other drinks or foods are needed until 6 months when other healthy foods should be introduced. After 1 year, a child can eat appropriate family foods while breastfeeding continues.
9. Mothers need extra nutrition before and during pregnancy and while breastfeeding. Calcium, iron, folate, and iodine supplements are usually needed during pregnancy and may be continued during breastfeeding.
10. Care for your food and eat before it is spoiled. Don’t waste food. Consume food from sustainable sources.
Dietary Guidelines cannot address all nutrition problems in all communities and there remains a need for other public health nutrition interventions. These may include the addition of specific nutrients to food and water including thiamine, folic acid, iodine fluoride, vitamin A, and others. Some legislative actions are required to provide pure, safe, and hygienic food and water, and to regulate the marketing and sale of unhealthy foods such as alcoholic drinks and infant formula. Applying brief yet comprehensive summary recommendations in the form of the APACPH Dietary Guidelines can remind APACPH universities and public health graduates about the importance of nutrition factors to be considered in public health programs.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Resources for the meeting were made available by Teikyo University and APACPH as a component of the APACPH Annual Conference.