Scope and purpose
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 68th 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 United Nations General Assembly (UNGA) declared a UN Decade of Action on Nutrition (2016-2025) (https://covid.comesa.int/news-room/events/detail/2016/04/01/default-calendar/general-assembly-proclaims-the-decade-of-action-on-nutrition), 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 dietrelated noncommunicable diseases (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.
The SDGs and the UN Decade of Action on Nutrition are bringing a renewed momentum for Nutrition with a clear expectation for a leadership role reaffirmed for FAO and WHO in providing evidence-informed guidance on nutrition and healthy diets. Key to achieving these global nutrition goals and commitments is ensuring an adequate, healthy diet in infants and young children so that they can develop into healthy, productive adults. Proper infant and young child feeding is critical for improving child survival and promoting healthy growth and development, with the first two years of a child’s life being particularly important, as optimal nutrition during this period lowers morbidity and mortality, reduces the risk of noncommunicable disease, and fosters overall development. A key component of optimal nutrition during childhood and beyond is the adequate (but not excessive) intake of important micro- and macronutrients.
FAO and WHO established vitamin and mineral requirements for all age groups in 2004. Since this time, new data have emerged suggesting that requirements for some micronutrients may need to be updated, particularly for children. Therefore, and in part to inform the planned updating of WHO guidance on complementary feeding, the FAO Nutrition and Food Systems Division (ESN) and the WHO Department of Nutrition for Health and Development (NHD) are establishing an expert group on nutrient requirements which will update nutrient requirements for children aged 0 – 36 months, following the WHO guideline development process as described in the WHO handbook for Guideline Development, 2nd edition (https://apps.who.int/iris/handle/10665/145714) and in line with Article 6 of the FAO Constitution.
The expert group is generally expected to meet annually and will provide advice to WHO on the following:
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The scope of the requirements work and priority questions (in PICO format) that will guide the undertaking of systematic reviews of evidence;
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The choice and prioritization of important outcomes for decision-making and developing recommended intakes (i.e. requirements);
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The examination and interpretation of the evidence with explicit consideration of the overall balance of risks and benefits;
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The formulation of recommended intakes into consideration the quality of evidence generated and compiled as well as, where appropriate, diverse values and preferences, balance of benefits and harms, resource implications, priority of the problem, equity and human rights, acceptability and feasibility; and
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The identification of research gaps.
Prior to initiating the guideline development process, WHO conducted an initial review of the recent scientific literature on nutrient requirements, and compilation of national dietary guidelines from all regions, containing detailed information about nutrient requirements in the age group of interest. Using the data obtained from this preparatory work, FAO and WHO were able to prioritise the nutrients to be updated. The first nutrients to be updated by the expert group will be calcium, vitamin D, and zinc.
Updating of the nutrient requirements for children aged 0-36 months contributes not only to the implementation of the ICN2 commitments and achievement of the goals of the UN Decade of Action on Nutrition, but are also important elements of WHO’s efforts in achieving the ‘triple billion’ targets set up by the 13th General Programme of Work (2019 – 2023), including one billion more people enjoying better health and well-being. This will also contribute to the implementation of the Comprehensive implementation plan on maternal, infant and young child nutrition which was adopted by the 65th World Health Assembly held in May 2012.
The objectives of this work are to:
Review the evidence generated by scoping reviews for calcium, vitamin D, and zinc, and
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Generate key questions in PICO format
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Prioritize health outcomes
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Determine any additional parameters to be used in (e.g. a priori subgroup analyses, important inclusiion/exclusion criteria)
The expected outcomes of the meeting are, therefore, for each nutrient, comprehensive PICO questions, health outcomes ranked by priority (i.e. critical and important), and additional information to guide the identification or commissioning of systematic reviews and other sources of evidence for each of the three nutrients.