| Dietary guidelines for a new millennium
Dietary guidelines are carefully constructed, simply worded statements providing valuable nutrition advice for the general public. As government endorsed statements, they are utilised by a wide spectrum of stakeholders including the food industry, food regulators, health educators and promotors, health providers and, of course, consumers. To be of value, guidelines must be comprehensive and reliable, based on the current consensus of nutritional knowledge.
This issue of the Journal includes a series of papers presented at a conference entitled ‘Dietary Guidelines for a New Millennium’, held in February 2000 at the Smart Foods Centre, University of Wollongong. Motivated by the imminent release of revamped dietary guidelines in the United States and the recent release of Dietary Guidelines for Older Australians (1), the purpose of the conference was to review the content of our guidelines and their rationale, to gain a broad stakeholders’ perspective on their value and to encourage the implementation of strategies to maintain their currency and relevance.
It makes good sense to learn from the process of, and rationale for, the current revision of dietary guidelines in the United States. Dr Suzie Harris, Executive Director of the Human Nutrition Institute, International Life Sciences Institute Research Foundation, in Washington, DC, has described the regular five-yearly review and revision of guidelines (2). Concern over the growing prevalence of obesity in the US has prompted sweeping changes in the latest revision. The guidelines were expanded from seven to ten, allowing separate statements for weight maintenance and physical activity; ‘eat a variety of foods’ was replaced with ‘let the pyramid be your guide’; the focus on fat shifted from quantity to quality, and so on. Encouraged by results of consumer research, a number of changes were made to the wording of guidelines to improve their effectiveness. The most important message is that regular updating of the guidelines to maintain their relevance is a necessary but demanding task that requires extensive consultation.
The accompanying articles address the Australian position on dietary guidelines and recommended dietary intakes (RDIs) and present a range of opinions and attitudes of various stakeholder groups.
Colin Binns and co-authors have summarised elegantly Australia’s position with respect to dietary guidelines and related nutrition policy documents. Introduced in 1982 and updated in 1992, the Dietary Guidelines for Australians (3) provide sound advice to the general population about food choices. The simply worded guidelines are supported by two essential components: detailed background papers for health professionals and education materials for consumers. Subsequent recognition that children and older Australians have specific needs has resulted in the publication of guidelines tailored to these populations (1,4). The experience gained by Binns and colleagues in developing these ancillary guidelines highlights the need to update the 1992 guidelines and further emphasises the extensive consultation and review process necessary to achieve widespread acceptance.
Lynne Cobiac also emphasised the continuing evolution of nutritional science and the consequent need to update dietary recommendations. Dietary guidelines are based on RDIs, the fundamental descriptors of nutritional adequacy, that were last updated in the 1980s. As we enter a new millennium, the emphasis is shifting from nutritional adequacy towards optimisation of health. Cobiac described the introduction of nutrient reference values that Australia and New Zealand will develop jointly, taking into consideration a growing number of new nutrients. She also reminded us of the need to take account of the different nutrient requirements of distinct subpopulations such as aged and ethnic groups.
Janine Lewis described how the Australia New Zealand Food Authority (ANZFA) has drawn on dietary guidelines and RDIs from both Australia and New Zealand in reviewing food regulations and developing a joint food standards code. She described two examples of the use of the guidelines: developing a policy framework for the introduction of health claims; and identifying nutrients of public health significance for the revised nutrition information panel on food packaging. RDIs have even more specific applications in the development of nutrition-related food standards in nutrition labelling, in determining limits for vitamin and mineral additions to foods and in risk assessments. However, reiterating Cobiac’s concern about the need to update RDIs, Lewis acknowledged that ANZFA now has to rely on other sources of information for many important nutrients for which official RDIs are currently lacking.
Sandra Capra, representing the dietetic profession, Susan Anderson, speaking for non-government health promotion organisations, Geoffrey Annison from the Australian Food and Grocery Council, and Matt O’Neill from the Australian Consumer’s Association commented on the usefulness of dietary guidelines to their respective constituencies.
Capra showed how dietitians use guidelines and RDIs as practical assessment tools. However, she described some problems associated with over-simplifying nutrition messages or applying RDIs out of context. She also emphasised some of their practical limitations. For example, none of our three sets of dietary guidelines refers to the majority of adults who suffer some form of chronic disease. Thus guidelines should aim to optimise health and physical function rather than simply outlining nutritional adequacy. In so doing, they should be able to take account of individual genetic susceptibility to disease. They should be up to date, reflecting current nutrition issues and the available food supply. Capra indicated the concern of dietitians that there is no clear process for continual review, although the guidelines need to remain relevant and practical tools. She emphasised that dietitians have much to offer in the review process.
Perhaps the most active promulgators of the dietary guidelines are health promotion organisations such as the Heart Foundation and Cancer Council. Anderson told us that 65% of inquiries to the Heart Foundation’s Heartline are nutrition-related and that 94% of consumers are familiar with their Tick program. Their dietary advice is based on the guidelines. However, if these are outdated, as is the case with our current guideline on fats, interest groups will develop their own recommendations, leading to inconsistent messages and discontentment amongst consumers and health professionals. Anderson offered some important recommendations for the guidelines, based on the Heart Foundation’s consumer research: they should be ‘living documents’ evolving with the science; their messages should be unambiguous, relevant to our social context, more specific and positive!
The food industry also has a major stake in realistic dietary guidelines. It needs to provide nutritious products that are acceptable to a health conscious community and comply with the regulatory authority’s interpretation of the guidelines. However, as Annison, representing the Australian Food and Grocery Council, pointed out, our community continues to suffer high levels of diet-related diseases despite the availability of a wide range of affordable, nutritious foods. He questioned the effectiveness of the guidelines and suggested reasons why they might even impede appropriate diet selection. He argued that food regulations based on the guidelines may restrict the nutrient composition of foods and hinder the creation of new healthier foods. While controversial, his comments recognise the trend toward functional foods with increasing sophistication in product formulation. He viewed dietary guidelines, like health claims, as only one element of a comprehensive public health nutrition policy.
The ultimate target for the dietary guidelines is the consumer, reached via sophisticated education programs, advertising and availability of food choices. Although the dietary guidelines are designed as a stand-alone educational tool for consumers, O’Neill pointed out that their very generalised guidance struggles to be meaningful and motivating. He argued that, while advances in nutritional knowledge will be the trigger for reviewing the guidelines, the challenge will be to increase their meaning for consumers, taking into consideration the current and developing relationships that people have with food. These relationships include concern for other food virtues such as safety and environmental sustainability. Clearly there is a need to ensure that consumers have a more proactive presence in areas of food and health policy development.
So where do these carefully considered statements representing such a wide range of viewpoints lead us? There is little doubt that the dietary guidelines have an important and evolving role in optimising the health of our society, a role that is mediated in distinct ways by educators, health professionals and food producers. However, they are only of value if they are relevant to current needs and customs. At a time when lifestyles and eating behaviour are changing rapidly and consumer interest in functional foods for self-management of health is at an all time high, there is an urgent need for revision of our guidelines.
It will be necessary to consider many new nutrients in the future, such as n-3 (omega-3) fatty acids, anti-oxidants and phytoestrogens to name a few. The process of revision will be demanding. It is high time that we established a regular review of the guidelines, as in the USA, with an agreed program of consultation that would enable all stakeholders to make effective contributions. At the same time, we need to ensure that we optimise the mechanisms for propagating and utilising the guidelines and the information on which they are based.
Peter Howe
Scientific Director
Paul Nestel
Chair of Advisory Board
Smart Foods Centre
University of Wollongong
New South Wales
References
- National Health and Medical Research Council. Dietary guidelines for older Australians. Canberra: NHMRC, 1999.
- Harris SS. Dietary guidelines for Americans. Recommendations for the year 2000. Food Aust 2000;52:212-4.
- National Health and Medical Research Council. Dietary guidelines for Australians. Canberra: Australian Government Publishing Service; 1992.
- National Health and Medical Research Council. Dietary guidelines for children and adolescents. Canberra: Australian Government Publishing Service; 1995.
|
Leading article, Volume 57, Number 3, September 2000