Overview
Consuming a healthy diet throughout the life-course helps to prevent malnutrition in all its forms as well as a range of noncommunicable diseases (NCDs) and conditions. However, increased production of processed foods, rapid urbanization and changing lifestyles have led to a shift in dietary patterns. People are now consuming more foods high in energy, fats, free sugars and salt/sodium, and many people do not eat enough fruit, vegetables and other dietary fibre such as whole grains.
The exact make-up of a diversified, balanced and healthy diet will vary depending on individual characteristics (e.g. age, gender, lifestyle and degree of physical activity), cultural context, locally available foods and dietary customs. However, the basic principles of what constitutes a healthy diet remain the same.
A healthy diet includes the following:
In the first 2 years of a childs life, optimal nutrition fosters healthy growth and improves cognitive development. It also reduces the risk of becoming overweight or obese and developing NCDs later in life.
Advice on a healthy diet for infants and children is similar to that for adults, but the following elements are also important:
Eating at least 400g, or five portions, of fruit and vegetables per day reduces the risk of NCDs (2) and helps to ensure an adequate daily intake of dietary fibre.
Fruit and vegetable intake can be improved by:
Reducing the amount of total fat intake to less than 30% of total energy intake helps to prevent unhealthy weight gain in the adult population (1, 2, 3). Also, the risk of developing NCDs is lowered by:
Fat intake, especially saturated fat and industrially-produced trans-fat intake, can be reduced by:
Most people consume too much sodium through salt (corresponding to consuming an average of 912g of salt per day) and not enough potassium (less than 3.5g). High sodium intake and insufficient potassium intake contribute to high blood pressure, which in turn increases the risk of heart disease and stroke (8, 11).
Reducing salt intake to the recommended level of less than 5 g per day could prevent 1.7million deaths each year (12).
People are often unaware of the amount of salt they consume. In many countries, most salt comes from processed foods (e.g. ready meals; processed meats such as bacon, ham and salami; cheese; and salty snacks) or from foods consumed frequently in large amounts (e.g. bread). Salt is also added to foods during cooking (e.g. bouillon, stock cubes, soy sauce and fish sauce) or at the point of consumption (e.g. table salt).
Salt intake can be reduced by:
Some food manufacturers are reformulating recipes to reduce the sodium content of their products, and people should be encouraged to check nutrition labels to see how much sodium is in a product before purchasing or consuming it.
Potassium can mitigate the negative effects of elevated sodium consumption on blood pressure. Intake of potassium can be increased by consuming fresh fruit and vegetables.
In both adults and children, the intake of free sugars should be reduced to less than 10% of total energy intake (2, 7). A reduction to less than 5% of total energy intake would provide additional health benefits (7).
Consuming free sugars increases the risk of dental caries (tooth decay). Excess calories from foods and drinks high in free sugars also contribute to unhealthy weight gain, which can lead to overweight and obesity. Recent evidence also shows that free sugars influence blood pressure and serum lipids, and suggests that a reduction in free sugars intake reduces risk factors for cardiovascular diseases (13).
Sugars intake can be reduced by:
Diet evolves over time, being influenced by many social and economic factors that interact in a complex manner to shape individual dietary patterns. These factors include income, food prices (which will affect the availability and affordability of healthy foods), individual preferences and beliefs, cultural traditions, and geographical and environmental aspects (including climate change). Therefore, promoting a healthy food environment including food systems that promote a diversified, balanced and healthy diet requires the involvement of multiple sectors and stakeholders, including government, and the public and private sectors.
Governments have a central role in creating a healthy food environment that enables people to adopt and maintain healthy dietary practices. Effective actions by policy-makers to create a healthy food environment include the following:
The WHO Global Strategy on Diet, Physical Activity and Health (14) was adopted in 2004 by the Health Assembly. The strategy called on governments, WHO, international partners, the private sector and civil society to take action at global, regional and local levels to support healthy diets and physical activity.
In 2010, the Health Assembly endorsed a set of recommendations on the marketing of foods and non-alcoholic beverages to children (15). These recommendations guide countries in designing new policies and improving existing ones to reduce the impact on children of the marketing of foods and non-alcoholic beverages to children. WHO has also developed region-specific tools (such as regional nutrient profile models) that countries can use to implement the marketing recommendations.
In 2012, the Health Assembly adopted a Comprehensive Implementation Plan on Maternal, Infant and Young Child Nutrition and six global nutrition targets to be achieved by 2025, including the reduction of stunting, wasting and overweight in children, the improvement of breastfeeding, and the reduction of anaemia and low birthweight (9).
In 2013, the Health Assembly agreed to nine global voluntary targets for the prevention and control of NCDs. These targets include a halt to the rise in diabetes and obesity, and a 30% relative reduction in the intake of salt by 2025. The Global Action Plan for the Prevention and Control of Noncommunicable Diseases 20132020 (10) provides guidance and policy options for Member States, WHO and other United Nations agencies to achieve the targets.
With many countries now seeing a rapid rise in obesity among infants and children, in May 2014 WHO set up the Commission on Ending Childhood Obesity. In 2016, the Commission proposed a set of recommendations to successfully tackle childhood and adolescent obesity in different contexts around the world (16).
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 (17), and the Framework for Action (18) which recommends a set of policy options and strategies to promote diversified, safe and healthy diets at all stages of life. WHO is helping countries to implement the commitments made at ICN2.
In May 2018, the Health Assembly approved the 13th General Programme of Work (GPW13), which will guide the work of WHO in 20192023 (19). Reduction of salt/sodium intake and elimination of industrially-produced trans-fats from the food supply are identified in GPW13 as part of WHOs priority actions to achieve the aims of ensuring healthy lives and promote well-being for all at all ages. To support Member States in taking necessary actions to eliminate industrially-produced trans-fats, WHO has developed a roadmap for countries (the REPLACE action package) to help accelerate actions (6).
References
(1)Hooper L, Abdelhamid A, Bunn D, Brown T, Summerbell CD, Skeaff CM. Effects of total fat intake on body weight. Cochrane Database Syst Rev. 2015; (8):CD011834.
(2)Diet, nutrition and the prevention of chronic diseases: report of a Joint WHO/FAO Expert Consultation. WHO Technical Report Series, No. 916. Geneva: World Health Organization; 2003.
(3)Fats and fatty acids in human nutrition: report of an expert consultation. FAO Food and Nutrition Paper 91. Rome: Food and Agriculture Organization of the United Nations; 2010.
(4)Nishida C, Uauy R. WHO scientific update on health consequences of trans fatty acids: introduction. Eur J Clin Nutr. 2009; 63 Suppl 2:S14.
(5)Guidelines: Saturated fatty acid and trans-fatty acid intake for adults and children. Geneva: World Health Organization; 2018 (Draft issued for public consultation in May 2018).
(6)REPLACE: An action package to eliminate industrially-produced trans-fatty acids. WHO/NMH/NHD/18.4. Geneva: World Health Organization; 2018.
(7)Guideline: Sugars intake for adults and children. Geneva: World Health Organization; 2015.
(8)Guideline: Sodium intake for adults and children. Geneva: World Health Organization; 2012.
(9)Comprehensive implementation plan on maternal, infant and young child nutrition. Geneva: World Health Organization; 2014.
(10)Global action plan for the prevention and control of NCDs 20132020. Geneva: World Health Organization; 2013.
(11)Guideline: Potassium intake for adults and children. Geneva: World Health Organization; 2012.
(12)Mozaffarian D, Fahimi S, Singh GM, Micha R, Khatibzadeh S, Engell RE et al. Global sodium consumption and death from cardiovascular causes. N Engl J Med. 2014; 371(7):62434.
(13)Te Morenga LA, Howatson A, Jones RM, Mann J. Dietary sugars and cardiometabolic risk: systematic review and meta-analyses of randomized controlled trials of the effects on blood pressure and lipids. AJCN. 2014; 100(1): 6579.
(14)Global strategy on diet, physical activity and health. Geneva: World Health Organization; 2004.
(15)Set of recommendations on the marketing of foods and non-alcoholic beverages to children. Geneva: World Health Organization; 2010.
(16)Report of the Commission on Ending Childhood Obesity. Geneva: World Health Organization; 2016.
(17)Rome Declaration on Nutrition. Second International Conference on Nutrition. Rome: Food and Agriculture Organization of the United Nations/World Health Organization; 2014.
(18)Framework for Action. Second International Conference on Nutrition. Rome: Food and Agriculture Organization of the United Nations/World Health Organization; 2014.
(19)Thirteenth general programme of work, 20192023. Geneva: World Health Organization; 2018.
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Healthy diet - World Health Organization
