A diet low in energy-dense foods that are high in saturated fats and sugars, and abundant in fruit and vegetables, together with an active lifestyle are among the key measures to combat chronic disease recommended in an independent Expert Report prepared for two UN agencies.

The report, commissioned by the World Health Organization (WHO) and the Food and Agriculture Organization (FAO), from a team of global experts, aims to identify new recommendations for governments on diet and exercise to tackle the ever increasing number of people who die each year from chronic diseases. The burden of chronic diseases – which include cardiovascular diseases, cancers, diabetes and obesity – is rapidly increasing worldwide. In 2001, chronic diseases contributed approximately 59% of the 56.5 million total reported deaths in the world and 46%of the global burden of disease.

“This Expert Report is highly significant because it contains the best currently available scientific evidence on the relationship of diet, nutrition and physical activity to chronic diseases, based on the collective judgement of a group of experts with a global perspective,” said Dr Ricardo Uauy, Head of the University of Chile’s Institute of Nutrition and Food Technology, and Professor of Public Health Nutrition at the London School of Hygiene & Tropical Medicine, who chaired the Expert Group.

The Report includes advice on ways of changing daily nutritional intake and increasing energy expenditure by:

- reducing energy-rich foods high in saturated fat and sugar;
- cutting the amount of salt in the diet;
- increasing the amount of fresh fruit and vegetables in the diet;
- undertaking moderate-intensity physical activity for at least an hour a day.

The Report, based on the analysis of the best available current evidence and the collective judgement of 30 experts, emphasizes that energy consumed each day should match energy expenditure.

Evidence suggests that excessive consumption of energy-rich foods can encourage weight gain, the report says and calls for a limit in the consumption of saturated and trans fats, sugars and salt in the diet, noting they are often found in snacks, processed foods and drinks.

The quality of fats and oils in a diet, as well as the amount of salt consumed, the report says, can also have an influence on cardiovascular diseases such as strokes and heart attacks.

The Expert Report is released as WHO prepares a Global Strategy on Diet, Physical Activity and Health following a May 2002 World Health Assembly resolution from its Member States.

The Expert Report will be formally published in April as a WHO/FAO technical report together with an evaluation by the Organizations and outlines of actions to implement the recommendations. The Report will be a critical science-based contribution to the development of the Global Strategy, aimed at reducing the growing burden of disease related to cardiovascular diseases, several forms of cancer, diabetes, obesity, osteoporosis and dental disease.

FAO supports WHO in developing its Global Strategy. As a follow-up to the Report’s findings, FAO will undertake work on identifying information needs and monitoring diets, and on assessing the implications of the Report’s recommendations for all aspects of the food chain as well as for agricultural and trade policies.

The report will form the basis for national and regional bodies to develop specific guidelines on diet and exercise for their local communities.

“The report provides goals for dietary components and physical activity levels consistent with good health and the prevention of the major nutrition related chronic diseases, coronary heart disease and hypertension, cancer, diabetes, obesity, osteoporotic fractures, and dental diseases,” Uauy said.

Urbanization and the rise of chronic diseases

Many of the deaths attributed to chronic diseases are due to risk factors that could easily be prevented such as:

- high blood pressure;
- high cholesterol levels;
- obesity;
- low levels of physical activity.

More and more people in the developing world are suffering from chronic disease, a seismic shift from a few decades ago when chronic disease was associated with the rich, developed world. Increased urbanization – as rural people abandon their land and move towards the cities - plays a large part in this change, according to the report.

City-dwellers are more likely to consume energy-dense diets – high in saturated fat and in refined carbohydrates. This sudden change in diet, combined with a sedentary lifestyle, is having a drastic effect on the urban poor.

“Not all fats or all carbohydrates are the same; it pays to know the difference,” said Dr Uauy, adding, “People should eat less high-calorie foods, especially foods high in saturated fat and sugar, be physically active, prefer unsaturated for saturated fat and use less salt; enjoy fruits, vegetables and legumes and prefer foods of plant and marine origin..”

A diet rich in fruit and vegetables containing immune-system boosting micronutrients could also help the body’s natural defences against infectious diseases, Uauy said.

The Expert Report’s specific recommendations on diet include limiting fat to between 15 and 30 percent of total daily energy intake and saturated fats to less than 10 percent of this total.

Carbohydrates, the report suggests, should provide the bulk of energy requirements – between 55 and 75 percent of daily intake and free sugars should remain beneath 10 percent. Protein should make up a further 10-15 percent of calorie intake and salt should be restricted to less than 5 grams a day. Intake of fruit and vegetables should be plumped up to reach at least 400 grams a day.

The report underlines the fact that chronic diseases are not only caused by overeating but also by eating an unbalanced diet, citing the influence of high salt consumption on increasing blood pressure and saturated fats contributing to high levels of cholesterol.

Physical activity is a key factor in determining the amount of energy used each day and is therefore fundamental to energy balance and weight control. One hour per day of moderate-intensity activity, such as walking, on most days of the week, is needed to maintain a healthy body weight, especially for those people who spend most of their time sitting down, according to the Expert Report.

WHO and FAO hope the report’s findings will provide member states with solid evidence to prepare national health strategies. The Expert Report urges national governments to aim for dietary guidelines that are simple, realistic and food-based. Finland and Japan, countries that have actively intervened in the diet and nutritional behaviour of their populations, have witnessed dramatic decreases in risk factors and plunging rates of chronic disease, the Report says.

Recognising that chronic diseases are preventable, addressing the issues and creating an environment which supports health, the Report says, is the key to reducing rates of deaths and disability from chronic diseases. The process should establish working relationships between communities and governments, encourage local initiatives affecting schools and the workplace and also involve the food industry, the report says.