WHO-EM/NUT/282/E Healthy Diet

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WHO-EM/NUT/282/EHealthydiet

WHO-EM/NUT/282/EHealthydiet

WHO Library Cataloguing in Publication DataWorld Health Organization. Regional Office for the Eastern MediterraneanHealthy diet / World Health Organization. Regional Office for the Eastern Mediterraneanp.WHO-EM/NUT/282/E1. Healthy Diet - methods 2. Malnutrition - prevention and control 3. Noncommunicable Diseases- prevention and control 4. Health Promotion 5. Health Behavior I. Title II. Regional Office for the EasternMediterranean(NLM Classification: QT 235) World Health Organization 2019Some rights reserved.This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CCBY-NC-SA 3.0 IGO; igo). Under the terms of this licence, youmay copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited.In any use of this work, there should be no suggestion that WHO endorses any specific organization, productsor services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your workunder the same or equivalent Creative Commons licence. If you create a translation of this work, you should addthe following disclaimer along with the suggested citation: “This translation was not created by the World HealthOrganization (WHO). WHO is not responsible for the content or accuracy of this translation. The original Englishedition shall be the binding and authentic edition”. Any mediation relating to disputes arising under the licence shallbe conducted in accordance with the mediation rules of the World Intellectual Property Organization.Suggested citation. Healthy diet. Cairo: WHO Regional Office for the Eastern Mediterranean; 2019. Licence: CC BYNC-SA 3.0 IGO. Sales, rights and licensing. To purchase WHO publications, see http://apps.who.int/bookorders. Tosubmit requests for commercial use and queries on rights and licensing, see http://www.who.int/about/licensing.Third-party materials. If you wish to reuse material from this work that is attributed to a third party, such astables, figures or images, it is your responsibility to determine whether permission is needed for that reuse andto obtain permission from the copyright holder. The risk of claims resulting from infringement of any third-partyowned component in the work rests solely with the user. General disclaimers. The designations employed and thepresentation of the material in this publication do not imply the expression of any opinion whatsoever on the part ofthe World Health Organization concerning the legal status of any country, territory, city or area or of its authorities,or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate borderlines for which there may not yet be full agreement.The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed orrecommended by the World Health Organization in preference to others of a similar nature that are not mentioned.Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.All reasonable precautions have been taken by the World Health Organization to verify the information containedin this publication. However, the published material is being distributed without warranty of any kind, eitherexpressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In noevent shall the World Health Organization be liable for damages arising from its use.

Table of contentsOverviewKey factsHealthy diet for adultsHealthy diet for infants and young childrenPractical advice on maintaining a healthy dietHow to promote healthy dietWHO responseReferences78101214161819

OverviewConsuming a healthy diet throughout a person’s life helpsprevent malnutrition in all its forms as well as a range ofdiet-related noncommunicable diseases and conditions.But the increased consumption of processed food, rapidurbanization and changing lifestyles have led to a shift indietary patterns. People are now consuming more foodshigh in energy, fats and free sugars or salt/sodium, andmany do not eat enough fibre-rich fruits, vegetables andwhole grains.7

Key factsA healthy diet helps protect against malnutrition anddiet-related noncommunicable diseases such asdiabetes, heart disease, stroke and cancer.Adopt healthy dietary practices: balance calories in with calories out limit fat intake shift from saturated to unsaturated fats eliminate industrially-produced trans fats limit sugars and salt intakeBEAT MALNUTRITION ANDNONCOMMUNICABLE DISEASESA healthy diet helps protect againstmalnutrition in all its forms, as wellas diet-related noncommunicablediseases, including diabetes, heartdisease, stroke and cancer.GLOBAL RISKSUnhealthy diet and lack of physicalactivity are leading global risks tohealth.START EARLY IN LIFEHealthy dietary practices start earlyin life – breastfeeding fosters healthygrowth and improves cognitivedevelopment, and may have longerterm health benefits like reducing therisk of becoming overweight or obeseand developing noncommunicablediseases later in life.8

BALANCE CALORIESEnergy intake (calories) should be inbalance with energy expenditure.LIMIT FAT INTAKEEvidence indicates that total fat shouldnot exceed 30% of total energy intaketo avoid unhealthy weight gain (1,2,3),with a shift in fat consumption awayfrom saturated fats to unsaturatedfats (3), and towards the elimination ofindustrially-produced trans fats (4).LIMIT SUGAR INTAKELimiting intake of free sugars toless than 10% of total energy intake(2,5) is part of a healthy diet. Afurther reduction to less than 5% oftotal energy intake is suggested foradditional health benefits (5).LIMIT SALT INTAKEKeeping salt intake to less than 5 g perday helps prevent hypertension andreduces the risk of heart disease andstroke in the adult population (6).2025 GOALSWHO Member States have agreed toreduce the global population’s intakeof salt by 30% and halt the rise indiabetes and obesity in adults andadolescents as well as in childhoodoverweight by 2025 (7,8,9).9

Healthy dietfor adultsFruits, vegetables, legumes,nuts, whole grains.10

5portionsEat fruits, vegetables, legumes (e.g. lentils,beans), nuts and whole grains (e.g. unprocessedmaize, millet, oats, wheat, brown rice) everyday. The recommended daily intake for an adultincludes: 2 cups of fruit (4 servings), 2.5 cups ofvegetables (5 servings), 180 g of grains, and 160 g ofmeat and beans. Red meat can be eaten 1 2 timesper week, and poultry 2 3 times per week.Eat at least 5 portions of fruit and vegetables aday (at least 400 g) (2). Potatoes, sweet potatoes,cassava and other starchy roots are not classifiedas fruit or vegetables.max12Limit total energy intake from free sugars toaround 12 level teaspoons (which is equivalentto 50 g), but ideally less than 5% of total energyintake for additional health benefits (5). Mostfree sugars are added to foods or drinks by themanufacturer, cook or consumer, and can also befound in sugars naturally present in honey, syrups,fruit juices and fruit juice concentrates.Limit total energy intake from fats to less than30% (1,2,3). Unsaturated fats (e.g. found in fish,avocado, nuts, sunflower, canola and olive oils)are preferable to saturated fats (e.g. found in fattymeat, butter, palm and coconut oil, cream, cheese,ghee and lard) (3). Industrially-produced trans fats(found in processed food, fast food, snack food,fried food, frozen pizza, pies, cookies, margarinesand spreads) are not part of a healthy diet.Limit salt to less than 5 g per day (equivalent toapproximately 1 teaspoon) (6) and use iodizedsalt.11

Healthy dietfor infants andyoung children12

In the first 2 years of a child’s life, optimal nutrition fosters healthy growthand improves cognitive development. It also reduces the risk of becomingoverweight or obese and developing noncommunicable diseases later in life.Advice on a healthy diet for infants and children is similar to that for adults,but the following elements are unique to infants and children.Infants should be breastfedexclusively during the first 6months of life.Infants should be breastfedcontinuously until 2 years of ageand beyond.From 6 months of age, breastmilk should be complementedwith a variety of adequate,safe and nutrient-densecomplementary foods. Salt andsugars should not be added tocomplementary foods.13

Practical adviceon maintaininga healthy dietFruits andvegetablesEating at least 400 g, or 5portions, of fruits and vegetablesper day reduces the risk ofnoncommunicable diseases (2), andhelps ensure an adequate daily intakeof dietary fibre.To improve your fruit and vegetableconsumption you can: always include vegetables in your meals eat fresh fruits and raw vegetables assnacks eat fresh fruits and vegetables in season eat a variety of choices of fruits andvegetables.FatsReducing the amount of total fatintake to less than 30% of totalenergy intake helps preventunhealthy weight gain in theadult population (1,2,3).Also, the risk of developingnoncommunicable diseases islowered by reducing saturated fats toless than 10% of total energy intake, andtotal trans fats to less than 1% of totalenergy intake, and replacing both withunsaturated fats (2,3).14

Fats intake can be reduced by: changing how you cook – remove thefatty part of meat; use vegetable oil(not animal oil); and boil, steam or bakerather than fry avoiding processed foods containingtrans fats limiting the consumption of foodscontaining high amounts of saturatedfats (e.g. cheese, ice cream, fatty meat).Salt, sodium andpotassiumMost peopleconsume too muchsodium through salt(corresponding toan average of 9–12 g ofsalt per day) and not enoughpotassium. High salt consumption andinsufficient potassium intake (less than3.5 g) contribute to high blood pressure,which in turn increases the risk of heartdisease and stroke (6,10).1.7 million deaths could be prevented eachyear if people’s salt consumption werereduced to the recommended level of lessthan 5 g per day (11).People are often unaware of the amountof salt they consume. In many countries,most salt comes from processed foods(e.g. ready meals; processed meats likebacon, ham and salami; cheese and saltysnacks) or from food consumed frequentlyin large amounts (e.g. bread). Salt is alsoadded to food during cooking (e.g. bouillon,stock cubes, soy sauce and fish sauce) orat the table (e.g. table salt).You can reduce salt consumption by:Some food manufacturers arereformulating recipes to reduce the saltcontent of their products, and it is helpfulto check food labels to see how muchsodium is in a product before purchasingor consuming it.Potassium, which can mitigate thenegative effects of elevated sodiumconsumption on blood pressure, can beincreased through consumption of freshfruits and vegetables.SugarsThe intake of free sugars shouldbe reduced throughout thelifecourse (5). Evidence indicatesthat in both adults and children,the intake of free sugars shouldbe reduced to less than 10% oftotal energy intake (2,5), and that areduction to less than 5% of total energyintake provides additional health benefits(5). Free sugars are all sugars added tofoods or drinks by the manufacturer, cookor consumer, as well as sugars naturallypresent in honey, syrups, fruit juices andfruit juice concentrates.Consuming free sugars increases therisk of dental caries (tooth decay). Excesscalories from foods and drinks high infree sugars also contribute to unhealthyweight gain, which can lead to overweightand obesity.Sugar intake can be reduced by: limiting the consumption of foodsand drinks containing high amountsof sugars (e.g. sugar-sweetenedbeverages, sugary snacks and candies) eating fresh fruits and raw vegetablesas snacks instead of sugary snacks. not adding salt, soy sauce or fish sauceduring the preparation of food not having salt on the table limiting the consumption of salty snacks choosing products with lower sodiumcontent.15

How to promotehealthy dietDiet evolves over time, being influenced bymany factors and complex interactions. Income,food prices (which will affect the availabilityand affordability of healthy foods), individualpreferences and beliefs, cultural traditions,as well as geographical, environmental,social and economic factors all interact in acomplex manner to shape individual dietarypatterns. Therefore, promoting a healthy foodenvironment, which promotes a diversified,balanced and healthy diet, requires involvementacross multiple sectors and stakeholders,including government and the private sector,while safeguarding public health against vestedinterests.Governments have a central role in creating ahealthy food environment that enables people toadopt and maintain healthy dietary practices.16

Effective actions by policy-makers to create a healthy food environment include:Creating coherence innational policies andinvestment plans includingtrade, food and agriculturalpolicies to promote a healthy dietand protect public health: increase incentives for producers to growand retailers to use and sell fresh fruitsand vegetables reduce incentives for the food industryto continue or increase productionof processed foods with industriallyproduced trans fats, saturated fats andfree sugars encourage reformulation of food productsto reduce the contents of salt, fats (i.e.saturated fats and trans fats) and freesugars implement WHO's recommendations onthe marketing of foods and non-alcoholicbeverages to children establish standards to foster healthydietary practices through ensuringthe availability of healthy, safeand affordable food in pre-schools,schools, other public institutions, and inthe workplace explore regulatory and voluntaryinstruments, such as marketing and foodlabelling policies, economic incentives ordisincentives (i.e. taxation, subsidies), topromote a healthy diet encourage transnational, national andlocal food services and catering outletsto improve the nutritional quality oftheir food, ensure the availability andaffordability of healthy choices, andreview portion size.Encouraging consumerdemand for healthy foods andmeals: promote consumer awareness of a healthydiet develop school policies, standards andprogrammes that encourage children toadopt and maintain a healthy diet educate children, adolescents and adultsabout nutrition and healthy dietary practices encourage culinary skills, including inschools support point-of-sale information, includingthrough nutrition labelling that ensuresaccurate, standardized and comprehensibleinformation on nutrient contents infood in line with the Codex AlimentariusCommission guidelines provide nutrition and dietary counselling atprimary health care facilities.Promoting appropriate infantand young child feedingpractices: implement the International Code ofMarketing of Breast-milk Substitutes andsubsequent relevant World Health Assemblyresolutions, as well as WHO's guidance onending the inappropriate promotion of foodsfor infants and young children implement policies and practices to promoteprotection of working mothers promote, protect and support breastfeedingin health services and the community,including through the Baby-friendly HospitalInitiative.17

WHO responseThe WHO Global Strategy on Diet, PhysicalActivity and Health (12) was adopted in 2004by the World Health Assembly (WHA). Itcalled on governments, WHO, internationalpartners, the private sector and civil societyto take action at global, regional and locallevels to support healthy diet and physicalactivity.In 2010, the WHA endorsed a set ofrecommendations on the marketing offoods and non-alcoholic beverages tochildren (13). These recommendationsguide countries in designing new policiesand improving existing ones to reducethe impact on children of the marketingof unhealthy food. WHO is also helpingto develop a nutrient profile model thatcountries can use as a tool to implement themarketing recommendations.In 2012, the WHA adopted a ComprehensiveImplementation Plan on Maternal, Infant andYoung Child Nutrition and 6 global nutritiontargets to be achieved by 2025, includingthe reduction of stunting, wasting andoverweight in children, the improvement ofbreastfeeding and the reduction of anaemiaand low birth weight (7).In 2013, the WHA agreed 9 global voluntarytargets for the prevention and control ofnoncommunicable diseases, which include18a halt to the rise in diabetes and obesityand a 30% relative reduction in the intake ofsalt by 2025. The Global Action Plan for thePrevention and Control of NoncommunicableDiseases 2013 2020 (8) provides guidanceand policy options for Member States,WHO and other UN agencies to achieve thetargets.With many countries now seeing a rapid risein obesity among children, in May 2014 WHOset up the Commission on Ending ChildhoodObesity. The Commission has finalized areport specifying which approaches andactions are likely to be most effective indifferent contexts around the world.In November 2014, WHO organized, jointlywith the Food and Agriculture Organizationof the United Nations (FAO), the SecondInternational Conference on Nutrition(ICN2). ICN2 adopted the Rome Declarationon Nutrition (14) and the Framework forAction (15), which recommends a set ofpolicy options and strategies to promotediversified, safe and healthy diet at allstages of life. WHO is helping countriesto implement the commitments made atICN2 and the Decade of Action on Nutrition(2016 2025) which was subsequentlydeclared by the United Nations GeneralAssembly in April 2016.

References1. Hooper L, Abdelhamid A, Moore HJ, Douthwaite W, Skeaff CM, Summerbell CD. Effect of reducingtotal fat intake on body weight: systematic review and meta-analysis of randomised controlledtrials and cohort studies. BMJ. 2012; 345: e7666.2. Diet, nutrition and the prevention of chronic diseases: report of a Joint WHO/FAO ExpertConsultation. WHO Technical Report Series, No. 916. Geneva: World Health Organization; 2003.3. Fats and fatty acids in human nutrition: report of an expert consultation. FAO Food and NutritionPaper 91. Rome: Food and Agriculture Organization of the United Nations; 2010.4. Nishida C, Uauy R. WHO scientific update on health consequences of trans fatty acids:introduction. Eur J Clin Nutr. 2009; 63 Suppl 2:S1–4.5. Guideline: Sugars intake for adults and children. Geneva: World Health Organization; 2015.6. Guideline: Sodium intake for adults and children. Geneva: World Health Organization; 2012.7. Comprehensive implementation plan on maternal, infant and young child nutrition. Geneva: WorldHealth Organization; 2014.8. Global action plan for the prevention and control of NCDs 2013 2020. Geneva: World HealthOrganization; 2013.9. Global status report on noncommunicable diseases 2014. Geneva: World Health Organization;2014.10. Guideline: Potassium intake for adults and children. Geneva: World Health Organization; 2012.11. Mozaffarian D, Fahimi S, Singh GM, Micha R, Khatibzadeh S, Engell RE et al. Global sodiumconsumption and death from cardiovascular causes. N Engl J Med. 2014; 371(7):624–634.12. Global strategy on diet, physical activity and health. Geneva: World Health Organization; 2004.13. Set of recommendations on the marketing of foods and non-alcoholic beverages to children.Geneva: World Health Organization; 2010.14. Rome Declaration on Nutrition. Second International Conference on Nutrition. Rome: FAO/WHO;2014.15. Framework for Action. Second International Conference on Nutrition. Rome: FAO/WHO; 2014.19

Nutrition ProgrammeDr Ayoub Al JawaldehRegional AdviserWHO Regional Officefor the Eastern MediterraneanTelephone information 202 227 65376/65000Fax information 202 227 nt/nutritionMailing addressWHO Regional Officefor the Eastern MediterraneanMonazamat Al SehaAl Alameya StreetExtension of Abdel RazzakAl Sanhoury StreetNasr City (11371)PO Box 7608Cairo, Egypt

Limiting intake of free sugars to less than 10% of total energy intake (2,5) is part of a healthy diet. A further reduction to less than 5% of total energy intake is suggested for additional health benefits (5). LIMIT SALT INTAKE Keeping salt intake to less than 5 g per day helps preve

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