WHO events addressing public health priorities
Food composition data, in the form of food composition tables or food composition databases, is very important for policy-makers to help tackle the burden of malnutrition. Food composition data contribute to improvement in nutrition surveillance systems, which, in turn, help to inform policy. Food composition data in the countries of the Eastern Mediterranean Region (EMR) is often incomplete, outdated or unreliable, and some countries have no food composition data (1,2). As the burden of diet-related non-communicable diseases (NCDs) grows rapidly in the Region (1,2), it is particularly important to have data on the levels of sugar, fats (including saturated and trans fatty acids) and salt in foods.
To address this issue, the WHO Regional Office for the EMR organized a regional meeting on 20–22 September 2016 in Rabat, Morocco, to standardize and update food composition tables in the Region, reflecting sugar, trans fat, saturated fat and salt contents. For the purposes of the meeting, it was agreed to focus on trans fatty acids (TFA), total fat, saturated fatty acids (SFA), salt, free sugars and vitamin D. The meeting objectives were to:
review current regional food composition tables and identify gaps in data and information;
sensitize key regional partners, including academia, on international standards for food composition tables including data and information needed to fill gaps; and
agree on a standard model to be used by concerned institutions and academia, which is needed for assessment of dietary intake of various age groups and to serve food labelling and safety.
Summary of discussions
There is a need for more cooperation and collaboration, and potential exists for Member States to mutually support one another’s work, with strategic help from WHO and external expert advisors. In terms of coding descriptions of food products, Member States should use coding systems, such as LanguaL™ (5), to describe foods, in order to facilitate exchange of data. Islamic Republic of Iran was urged to share valuable data from its analysis of 60 key foods as part of compiling new food composition tables (4).
The Moroccan experience in developing food composition tables was seen an excellent example of how a great deal can be achieved with relatively limited resources. There are potential benefits from future cooperation between Morocco and Tunisia in pooling their efforts in this area. Bilateral discussions have already taken place to harmonize methodology, and ongoing discussions will be important to avoid any duplication and ensure that both countries can benefit from one another’s work (4).
Priorities should be TFA, total fat, SFA, salt, sugars and vitamin D. It is important, therefore, that countries focus on foods that contribute most of these nutrients of concern to the diet. It is important to look at the bigger picture of food supply—examining issues about how food is produced, how much is imported, what is used in processed foods and how foods are eaten by consumers. Work on the related area of improving and standardizing methods for measuring food consumption is important. Nutrition policy needs to be informed and guided by data on both food composition and food consumption.
Regarding the establishment of a national food composition table in Kuwait, existing data on composite dishes remains a good starting point, even though it dates back more than 20 years (6). Information on why or how foods might have changed (for example, changes in standards or changes in composition of ingredients) may be used to highlight priorities for new analyses. In order to estimate sugars, the options are either to do completely separate analyses (as samples were not kept) or to estimate free sugars from recipe/ingredient lists.
Plans to collaborate on development of a regional approach for the Gulf region are welcome. There exists a Gulf Cooperation Council (GCC)-wide agreement on standards for labelling and TFA (7). The plan is to have a harmonized approach to all problem solving and methodological issues to eliminate duplication, and to collaborate to save time and resources. It is important to recognize that there are important differences between countries—for example, ghee is commonly used in some countries but not others. It was suggested that where national food consumption surveys are not available, household budget surveys could be used for data on national food patterns and, for example, rural versus urban purchases.
The work being implemented in Pakistan to revise the food composition database and develop dietary guidelines represents an opportunity to establish a coherent programme. The experts participating in the meeting agreed to provide detailed advice on the proposed analytical programme and the contract with the external laboratory. A useful source of guidance is the European Food Information Resource (EuroFIR) network, which has developed a checklist for drawing up contracts with laboratories (8).
The way forward
A number of steps were identified for the way forward for the Region.
- Highlighting the need to address food composition data through existing multisectoral nutrition mechanisms. It is recommended that nutrition focal points raise the importance of developing and updating food composition tables/databases through the nutrition policy mechanism in their country. This could involve using external experts and/or WHO representatives to advocate for the importance of the issue. Member States should contact WHO if support is needed to raise awareness of the issue. It may also be useful to discuss the issue with representatives of the donor community.
- Establishing an Eastern Mediterranean network. Creation of a regional network is recommended for sharing information between Member States and with relevant experts. WHO will take forward this recommendation by notifying focal points in all Member States and developing, in consultation with experts, an online information exchange network for sharing of information and for provision of advice/information. For such a network to thrive and be effective it will be important for Member States to fully engage and participate in the exchange of information.
- Conducting regional training and capacity-building. In addition to online information exchange and e-learning, it is important to facilitate exchange and capacity-building in other ways. It was suggested that a regional training and capacity-building workshop be organized for this purpose. It is important to differentiate between the training needs of those working in laboratories and the needs of those working on compilation of tables/databases, and to ensure that the right audience is targeted.
- Providing technical support to countries. For more specific support to countries, technical support visits are recommended. These could involve Food and Agriculture Organization (FAO)/WHO visits, involving relevant external experts, to work directly with those responsible for setting up food composition databases in country and/or those working in laboratories. Such visits could also be valuable in advocating for the importance of the work and, through meetings with government and potential donors, mobilizing resources.
- Recommending standard methods. Following the discussions on methodology during the meeting, recommendations for standard methods emerged. These agreed methods are recommended for all countries in the Region.
- Establishing centres of excellence for particular methods. Following specific training, some centres of excellence could be established in the Region for particular analytical methods.
Box 1. Common challenges faced throughout the Region
General lack of data on food consumption and patterns
Shortage of accredited laboratories for analysis and challenges faced in sample collection
Absence of use of a regional network to standardize procedures; for example, the INFOODS Listserve exists (3) but
currently little used regionally
Need for the creation of staff subregional clusters, involving key people in the relevant country
Lack of capacity and need for training (4).
References
- Benziger CP, Roth GA, Moran AE. The Global Burden of Disease study and the preventable burden of NCD. Global Heart. 2016;11:393–397. doi: 10.1016/j.gheart.2016.10.024.
- Noncommunicable diseases. What are NCDs? Cairo: WHO Regional Office for the Eastern Mediterranean; 2016 (http://www.emro.who.int/entity/ncds/index.html, accessed 11 January 2017).
- International Network of Food Data Systems (INFOODS), Food and Agriculture Organization of the United Nations, Rome, Italy (http://www.fao.org/infoods, accessed 11 January 2017).
- Summary report on the regional meeting to standardize and update food composition tables, reflecting sugar, trans fat, saturated fat and salt contents. Cairo: WHO Regional Office for the Eastern Mediterranean; 2016 (http://apps.who.int/iris/bitstream/10665/251837/1/IC_Meet_Rep_2016_EN_19232.pdf, accessed 11 January 2017).
- LanguaL™ – The International Framework for Food Description (http://www.langual.org/, accessed 25 January 2017).
- Eid N, Al-Hooti S, Allam M, Bourisly N. Composition and protein quality of food consumed in Kuwait. Kuwait: Kuwait Institute for Scientific Research; 1982.
- GCC Standardization Organization, Riyadh, Saudi Arabia (https://gso.org.sa/gso-website, accessed 11 January 2017).
- European Food Information Resource network (EuroFIR), Brussels, Belgium (http://www.eurofir.org, accessed 11 January 2017).
