In response to a call from the 58th World Health Assembly (May 2005), World Health Organization (WHO) established the Guidelines Review Committee (GRC) in 2007 with the purpose of developing and implementing procedures to ensure that WHO guidelines are developed in ways consistent with internationally recognized best practices, emphasizing the appropriate use of systematically reviewed available evidence. The robust guideline development process being implemented by WHO is described in detail in the
WHO Handbook for guideline development (2014).
In accordance with the Organization-wide transformation in strengthening WHO’s role in developing evidence-informed public health guidance, the Department of Nutrition for Health and Development (NHD) has strengthened its role and leadership in providing evidenceinformed policy and programme guidance to Member States for promoting healthy diets and nutrition throughout the lifecourse, in partnership with relevant internal departments and partners, and guided by the new WHO guideline development process. This normative mandate was reaffirmed through a request from the 63rd World Health Assembly (May 2010) “to strengthen the evidence base on effective and safe nutrition actions to counteract the public health effects of the double burden of malnutrition, and to describe good practices for successful implementation”. More recently WHO’s commitment to strengthen its normative work was reiterated in the13th General Programme of Work (2019 – 2023) was endorsed by the 71st World Health Assembly (May 2018). It states that “Setting norms and standards is a unique function and strength of WHO” and further noted that WHO “will reinforce its science- and evidence-based normative work”.
To implement the strengthening of evidence-informed nutrition guidance, the WHO Department of Nutrition for Health and Development (NHD) established in 2010 the WHO Nutrition Guidance Expert Advisory Group (NUGAG) guided by the WHO Steering Committee for Nutrition Guidelines Development, which includes representatives from all Departments in WHO with an interest in the provision of recommendations in nutrition. Membership in NUGAG is for two years and NUGAG includes experts from various WHO Expert Advisory Panels as well as experts from a larger roster including those identified through open calls for experts, taking into consideration a balanced mix of genders, breadth in areas of expertise, and representation from all WHO Regions.
The NUGAG is generally expected to meet twice a year and will provide advice to WHO on the following:
- The scope of the guidelines and priority questions (in PICO format) that will guide the undertaking of systematic reviews of evidence;
- The choice and prioritization of important outcomes for decision-making and developing recommendations;
- The examination and interpretation of the evidence with explicit consideration of the overall balance of risks and benefits;
- The formulation of recommendations, taking into consideration the quality of evidence generated and compiled as well as diverse values and preferences, balance of benefits and harms, resource implications, priority of the problem, equity and human rights, acceptability and feasibility; and
- The identification of research gaps.
In 2010 – 2011, the NUGAG consisted of four subgroups: 1) micronutrients; 2) diet and health; 3) nutrition in life course and undernutrition; and 4) monitoring and evaluation. However, due to organizational changes implemented in NHD in January 2012 and in an effort to reduce the administrative burden of managing multiple subgroups, the number of NUGAG subgroups has been reduced to two: 1) diet and health; and 2) nutrition actions which was subsequently renamed as the guideline development group (GDG) on nutrition actions.
Updating of the dietary goals for the prevention of obesity and diet-related noncommunicable diseases (NCDs) has been the focus of the work of the NUGAG Subgroup on Diet and Health. After completing the work on updating the guidelines on sodium and potassium intakes (published in 2012) and on sugars intake (published in 2015), the NUGAG Subgroup on Diet and Health had been working on the updates of the WHO guidelines on the intake of total fat, saturated fatty acids and trans-fatty acids. The draft guidelines on saturated fatty acids and trans-fatty acids were completed, launched for public consultation in May 2018, and are currently being finalized. The guideline on total fat intake is currently being prepared to be issued for public consultation before the end of 2018. The NUGAG Subgroup on Diet and Health has also completed the evidence reviews and deliberation on the guideline on the intake of non-sugar sweeteners and the draft guideline is currently being prepared. Furthermore, the NUGAG Subgroup on Diet and Health is working on developing and updating of the guidelines on carbohydrates, polyunsaturated fatty acids including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and dietary patterns.
Updating of these dietary goals is an important element of WHO’s efforts in implementing the NCD agenda, to which the Organization is giving high priority. This will also contribute to the implementation of the Political Declaration of the UN High-level Meeting on NCDs held in New York in September 2011 and the outcome document of the high-level meeting of the UN General Assembly on NCDs (A/RES/68/300) held in New York in July 2014 as well as the implementation of the NCD Action Plan for 2013 – 2020 which was adopted by the 66th World Health Assembly held in May 2013. Furthermore, it had also provided inputs to the work of the high–level Commission on Ending Childhood Obesity established by the WHO Director-General in May 2014.
In November 2014, WHO organized, jointly with the Food and Agriculture Organization of the United Nations (FAO), the Second International Conference on Nutrition (ICN2). ICN2 adopted the Rome Declaration on Nutrition (http://www.fao.org/3/a-ml542e.pdf) and the Framework for Action (http://www.fao.org/3/a-mm215e.pdf), which recommends a set of policy options and strategies to promote diversified, safe and healthy diets at all stages of life. Subsequently, the 136th Session of the WHO Executive Board (EB) held in January 2015 and the Sixty-eighth World Health Assembly held in May 2015 endorsed the Rome Declaration and Framework for Action and called on Member States to implement the commitment of the Rome Declaration across multiple sectors, by expanding WHO’s evidence-informed guidance.
Furthermore, in April 2016, the UN General Assembly (UNGA) declared a UN Decade of Action on Nutrition (2016-2025), recognizing the role of nutrition in achieving the 2030 Agenda on Sustainable Development and the Sustainable Development Goals (SDGs). The Decade calls for eradicating hunger and preventing all forms of malnutrition worldwide, particularly stunting, wasting, and overweight in children under five years of age; and anaemia in women and children among other micronutrient deficiencies; as well as for reversing the rising trends in overweight and obesity and reducing the burden of diet-related NCDs in all age groups. Therefore, the goal of the Decade is to increase action at the national, regional and global levels in order to achieve commitment of the Rome Declaration adopted at ICN2, through implementing policy options included in the Framework for Action and evidence-informed programme actions.
Updating of the dietary goals being carried out by the NUGAG Subgroup on Diet and Health contributes not only to the implementation of the ICN2 commitments, but also to the achievement of the goals of the Decade. But further prompted by the increasing requests from various Member States for WHO’s guidance on effective policy measures to develop enabling food environment for promoting healthy diets and nutrition, NHD initiated in 2017 the establishment of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Subgroup on Policy Actions, which will work alongside the NUGAG Subgroup on Diet and Health. The first meeting of the NUGAG Subgroup on Policy Actions is planned in October/November 2018, with the reviewing of the existing evidence and impacts of a series of policy actions being proposed for countries to implement, in particular nutrition labelling policies, fiscal policies, and marketing policies.
The Nutrition Policy and Scientific Advice Unit (NPU) serves as the Secretariat of the NUGAG Subgroup on Diet and Health and also now the NUGAG Subgroup on Policy Actions and will be convening the next meeting of the NUGAG Subgroup on Diet and Health in Geneva, Switzerland from 3 to 6 December 2018. It will be the 12th meeting of the NUGAG Subgroup on Diet and Health, following the eleven previous meetings which took place in Geneva in February 2010 and March 2011; in Seoul, Republic of Korea in November 2011; in Geneva in March 2012; in Hangzhou, China in March 2013; in Copenhagen, Denmark in October 2013; in Geneva in September 2014; in Fukuoka, Japan in June 2015; in Geneva in March 2016; in Lisbon, Portugal in November 2016; and in Brijuni, Croatia in July 2017.
The main objectives of the 12th meeting are to:
- Review the final systematic reviews and finalize the recommendations on: 1) the intake of carbohydrates; and 2) the intake of polyunsaturated fatty acids (including EPA and DHA), through
- Determining the strength of respective recommendations;
- Taking into consideration detailed criteria, such as the balance of evidence on benefits and harms, values and preferences, resource implications, priority of the problems, equity and human rights, acceptability and feasibility;
- Reviewing and identifying implications for future research, taking into account on-going research and any existing controversies; and
- Reviewing challenges for implementation of the guidelines.
- Review the progress and interim outcomes of the systematic review on dietary patterns, including:
- Detailed protocol;
- Prioritization of the health outcomes;
- Outcomes of search and screening of literature to date;
- Proposed way forward for coding of dietary patterns according to level of processing and source; and
- Any other pending issues that may help guide the finalization of the systematic review.