3. There are no such things as healthy/unhealthy food,
There exists only healthy/unhealthy way of eating
• All things are poisons, for there is nothing without poisonous qualities. It is
only the dose which makes a thing poison (Paracelsus, 1538)
• Toxin can become medicine depending on “dose” (morphine, botulinus)
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“Dose makes the poison”: principal theory in toxicology
Risk = Hazard(unit toxicity) × Exposure(amount of intake)
→ We must always think about quality and quantity
Questions
• How about the case of fat/oil?
• Similarly, how about the case of salt?
… diabetes, heart attack,
fatigue
… hyponatremia
4. What is healthy diet
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What is healthy diet
Definition
Source: Healthy diet (who.int)
A healthy diet is essential for good health and nutrition.
It protects you against many chronic noncommunicable diseases, such as heart disease, diabetes and
cancer. Eating a variety of foods and consuming less salt, sugars and saturated and industrially-produced
trans-fats, are essential for healthy diet.
A healthy diet comprises a combination of different foods. These include:
• Exclusively breastfeed babies for the first 6 months and continue breastfeeding until 2 years and
beyond.
• Energy intake should balance energy expenditure.
• Keep total fat intake to less than 30% of total energy intake, with a shift in fat consumption away from
saturated fats to unsaturated fats, and towards the elimination of industrial trans fats.
• Limit intake of free sugars to less than 10 percent (or even less than 5 percent) of total energy intake.
• Keep salt intake to less than 5 g/day.
• Eat at least 400g of fruits and vegetables a day.
How to assess
quality of diet
a) Diversity : if you consume food from variety of food source
b) Balance : if your consumption from different food group is in adequate proportion
c) Adequacy : if your consumption of food from different source ensure adequate intake of nutrients
d) Moderation : if you do not overconsume specific type of food
5. What is sustainable Healthy Diet
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Source: Sustainable healthy diets – guiding principles, FAO
- Guiding principles
1. Breastfeeding practice
2. Avoid highly processed food
3. Consume variety of wholegrain with
variety of fruits and vegetables
4. Moderate amounts of eggs, dairy,
poultry and fish; and small amount of
red meat
5. Safe and clean drinking water
6. Adequate amount of energy and
nutrients
7. Reduce the risk of NCD
8. Ensure food safety
9. Minimize environmental pollution from
food system
10. Avoid biodiversity loss through food
chain
11. Minimize use of antibiotics and
hormone in food production
12. Minimize plastic in food package
13. Reduce food loss and waste
14. Respect local food & dietary culture
15. Ensure affordability and preference
16. Avoid adverse gender-related impact
including time allocation for household
management
6. Staple: Too much is as bad as too little
Food group Negative impact Positive impact
Recommended
intake
Staple Carbohydrate intake more than 60%
of energy, was associated with
increased total mortality (low-middle
income country)
Key source of energy
Fiber reduce mortality risk
232 g/d grain
50 g/d tuber
(2500 Kcal)
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Source: EAT-LANCET (2020)
Carbohydrates play an important role in the human body. They act as an energy source, help control blood glucose and
insulin metabolism, participate in cholesterol and triglyceride metabolism.
7. Protein source and health impact
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Source: EAT-LANCET (2020)
Important to build body cells, body fluids, antibodies, and other parts of the immune system.
Good food sources are animal source foods such as meat, eggs, seafood, and legumes such as beans, peas, and lentils.
Food group Negative impact Positive impact
Recommended
intake
Total protein 56 g/day
Meat Increased cause of death from any
cause (especially processed meat)
(in EU/USA)
Red meat>poultry, fish> nuts, legume
Processed>unprocessed
Inverse association with all cause
mortality (in Asian countries)
14 g/d red meat
29 g/d poultry
Dairy No significant increase or decrease in risk of overall mortality or
cardiovascular disease with increasing consumption of dairy foods
250 g/day
Fish Important source of omega-3 fatty
acid
28 g/day
Egg Substitution of egg by plant protein
can reduce NCD
Replace calorie from staple improve
diet quality and reduce stunting
13 g/day
(1.5 eggs/week)
Nuts &
legume
Alternative to red meat
Energy dense with no weight gain
50 g/d nuts
75 g/d legume
8. Fat intake and health impact
Food group Negative impact Positive impact
Recommended
intake
Total added
fat
• Evidence from prospective cohort
studies and randomized trials has
not suggested a benefit of
reducing total fat intake
• Efficient body energy source
• Protects organs (visceral fat)
• Supports cell growth (cell
membrane, hormone)
• Help to absorb key nutrients
(vitamin)
52 g/day
Composition
of fat
Substantial reduction of cardiovascular disease risk by replacing saturated
fat with unsaturated vegetable oils, especially those high in polyunsaturated
fats that include omega-3 and omega-6 fatty acids
40 g/day
saturated
11.8 g/day
unsaturated
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Source: EAT-LANCET (2020)
Dietary fats are essential to give human body energy and to support cell function. They also help protect organs and help
keep human body warm. Fats help human body absorb some nutrients and produce important hormones, too.
9. Role of key nutrients commonly deficit in many
countries
Key micronutrients commonly deficit in many countries
Iron
Iron deficiency is a primary cause of anemia and can result in cognitive impairment, decreased
work productivity, and death.
Zinc
Zinc deficiency in children is associated with poor health, increased risk of diarrhea, and impaired
cognitive and motor development.
Vitamin A
Vitamin A deficiency has severe consequences, even with mild deficiency, including night
blindness, increased susceptibility to infections, and death.
Source: GAIN and UNICEF. Comprehensive Nutrient Gap Assessment (CONGA)
11. Agriculture, Dietary Diversity, and Health
• Ruel conducted intensive review of 47 articles to examine impact of various agriculture intervention to
nutrition improvement. Overall, number of studies showed clear impact of NSA to DDIs, while impact
on nutrition outcome was limited (Ruel, 2018)
• Eric conducted peer review from 137 articles to examine relationship between DDIs and health impact,
found that associations between DDIs and health outcomes were largely inconsistent. (Eric et al. 2021)
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DDIs Health impact
NSA
Possible
limitation
limited
evidence
good
correlation
● Diversity
● Balance
● Adequacy
● Moderation
Potential
Improvement
through NFA
image: Flaticon.com
12. Food based dietary guideline
FCT
Dietary Reference Intake
Different type of dietary guidance
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Sex age protein Vit-A iron
Male 6 mon. 10.2 375 9.3
Female 6 mon. 375 9.3 9.4
Item protein Vit-A iron
Carrot 1.0 713.3 0.7
Soybean 35.9 1.0 7.3
Item consume
Staple 150
Vegetable 300
milk 200
Meat 40
Egg 20
image: Flaticon.com
Nutrition
science
Food
science
Diet culture
Dietary Diversity Indicators
Item consume
Staple √
Vegetable
Pulses √
Fruits √
ASF
Oil
18. (300)
(250)
(200)
(150)
(100)
(50)
0
50
100
150
Rice, wheat, corn
and other
Tubers or starch
vegetables
Vegetables Fruits Legumes Nuts All sugars
Dietary
gap
(g/capita/day)
Country dietary gap with planetary health diet -1
Northern America
South America
Asia
Africa
Europe
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Regional average food supply (gram/day/capita) is
compared with Planetary Health Diet
oversupply
deficient
image: Flaticon.com
19. (300)
(250)
(200)
(150)
(100)
(50)
0
50
100
150
Dairy foods Beef, lamb and
pork
Chicken and
other poultry
Eggs Fish Unsaturated oils Saturated oils
dietary
gap
(g/capita/day)
Country dietary gap with planetary health diet -2
Northern America
South America
Asia
Africa
Europe
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Regional average food supply (gram/day/capita)
is compared with Planetary Health Diet
oversupply
deficient
image: Flaticon.com
22. Why dietary diversity is difficult
- case of Mozambique -
consume
situation
health
agriculture
staple 〇 • Essential. Always consumed
legume 〇 • Essential. Always consumed
Fruits & vegetable
△
• Consume only when if it is available(seasonality)
• Do not care if not consumed (awareness)
〇 〇
Meat, fish, egg
×
• Everyone like it, but not consumed frequently due to affordability
(production & distribution cost is high)
• I would like to produce if there are good market demand. But market
size is not big enough yet. (market creation)
△ 〇
Dairy product × • Difficult to access (cold chain) △ 〇
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24. Major cause of not having balanced diet
Typical cause Japanese practice
Because it is
expensive
• Combination of commercial agriculture and kitchen garden
• Make use of unused food
Because it is
not available
• Farming technology (greenhouse, variety development, irrigation)
• Preservation technology, processing technology
• Kitchen garden
I don’t care
about balanced
diet
• Nutrition is not top priority in daily life
• How to change mindset?
25. Behavior change strategy
BCC stage Possible action
Realize the
issue
• Conduct survey and Data Visualization
• Personalize nutrition issue (this is my problem!)
• Healthy life tree (how to improve QOL)
Nurture
thinking
farmer
Identify
challenge and
opportunity
• Resource mapping (time, money, workload, available resource)
Seasonal calendar
Daily routine analysis
SWOT analysis
Start from
simple action
• Identify what you can do today without big investment
• Provide technical support
• Link with expert and key stakeholder
Monitor /
review
• Evaluate the action, discuss result
• Consider next action (small improvement)
29. How dietary guidance is conducted in other countries?
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Current development of
FDBG in Africa
30. 4/21/2024
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Source: Indicators
for assessing infant
and young child
feeding practices
(UNICEF)
How dietary guidance have been conducted in African countries?
食べた食材の
種類
特定食材の摂取
の有無
31. NFA application: quick dietary survey,
followed by crop identification
IFNA handbook &
NFAApp
Health & extension
workers
Adequate knowledge of
nutrition, but no nutritious
foods to practice.
① Assess local nutrition gaps and identify
agricultural interventions based on the NFA
concept.
② Produce
nutritious food.
③ Create synergy between
the health and the
agricultural sectors.
Eat nutritious foods!
Stay healthy and happy!
31
32. Promising area of collaboration
?
Health Sector
- Expertise in guiding
local people for better diet.
Agriculture Sector
- Limited access to
nutritious food due to
failure in food system.
32
Improved knowledge, but
lack of access to nutritious
food makes it difficult to
practice.
Let’s eat a
balanced diet!
Nutrition sensitive
approach has not been
fully integrated.
33. What is NFA (Nutrition Focused Approach)? ①
Recomm
ended
intake
Recommen
ded intake
Which nutrients
are needed and
how much?
By using Dietary Reference Intakes
(DRIs) developed by WHO
By using secondary data at
national level, or Apps at the
local level 33
GAP Usual
Nutrient
Intake
34. What is NFA (Nutrition Focused Approach)? ②
34
Egg Broccoli
Local Food
3
Better access through improved food
system
Nutritional requirements per meal
Protein
Fat
Carbohydrate
Vitamin A
Iron
Iron
Dietary diversity score (DDS)
3 4 5
https://www.youtube.com/watch?v=RZG7zkwpgM8
35. • Thank you very much!
• Any question?
⇒ nakada.shunichi.2@jica.go.jp
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Notas del editor
Now we are going to confirm role of key nutrients commonly deficit in many African countries.
Protein.Protein is an Important to build body cells, body fluids, antibodies, and other parts of the immune system. Good sources of protein includes animal base foods such as meat, eggs, seafood, and plant base foods such as beans, peas, and lentils.
Iron.Iron deficiency is a primary cause of anemia and can result in cognitive impairment, decreased work productivity, and death.
Zinc.Zinc deficiency in children is associated with poor health, increased risk of diarrhea, and impaired cognitive and motor development.
Vitamin A.Vitamin A deficiency has severe consequences, even with mild deficiency, including night blindness, increased susceptibility to infections, and death.
Other than these item, iodine deficiency, vitamin D deficiency are also observed in many countries
I briefly explained role of key nutrients for human in this slide. Then In the next slide, I will explain the role of key food group in human health
There are wide range of dietary recommendation we experience in our daily life.
We will make use of two key recommendation out of them, Dietary Reference Intake, referred as DRI and Food Based Dietary Guideline, referred as FBDG.
So what is DRI and FBDG?
DRI tells us required amount of daily intake of nutrients such as protein, vitamin A, iron. Background of DRI is nutrition science and food science, which tries to link specific nutrient and human health, Typical use case of DRI is by the nutritionist to design healthy meal for certain population, such as school children, hospital inpatient
FDBG tells us required amount of dairy intake of key food groups such as egg, vegetables, dairy products. FDBG is designed to be understandable and usable for ordinary people, setting consumption target of food ingredient or menu instead of unfamiliar nutrient name. FDBG is designed to satisfy DRI requirement by combining different type of food item in a good balance. This combination is designed based on the survey of national and local diet culture.
So far, we have went through the concept of healthy diet, especially two typical tool of food guidance, DRI and FBDG.
Now let’s look at the real situation. What is the gap between those recommendation and our current dietary culture.
This graph is from research paper published by international food policy research institute.
Food supply data from each country is compared with global reference FDBG, which is synthesized by author by reviewing ten representative country’s FDBG.
Horizontal axis, all country are sorted by GDP per capita. Vertical axis stands for oversupply or deficient in each country group.
Each graph has six coloring, each color stands for different food group, as indicated in the legend.
From this graph, we can understand dietary transition in the course of economic development.
By looking at each food group from low-income country status to high income status, we can realize there are four type of commodity group.
First group, oversupply during low income status, gradually decrease supply and become deficient at high income status. Starch food group belongs to this category.
Second group, deficit at low income status, gradually increase as income grow, and oversupply at high income status. Animal source food and oil fats belong to this category.
Third group, regardless income status, always deficit. Vegetable, fruits and pulses belong to this category.
Fourth group, regardless income status, always oversupply. Sugar belongs this category.
We can make use of this findings to consider medium to longer term strategy to ensure balanced diet.
Now I will share with you about similar assessment focusing on each country belongs to EAC
Table in previous slide is converted into graph.
It is clear that only tuber is surplus in EAC countries
Continue from previous slide. Again, we can see all food commodity is deficient
Observation at local level
Up to now, we have observed dietary gap based on national agriculture statistics.
This is simple and easy to analyze. However, this is just an estimate, does not necessary give us real picture of local diet.
In the following slide, I share the result of quick dietary survey conducted in Mozambique
I conducted small survey in Niassa province, Mozambique. I conducted quick 24hour dietary recall survey for around 20 households.
Most of household showed quite similar result in terms of food group consumption. So, this is just extraction of four household.
As you can see, there are two type of food group which all household do not consume. First group is animal source food. Second group is vitamin-a rich fruits and vegetables
Then we asked follow-up question why you don’ t consume specific food group, and what is your ideal diet. Answer is summarized in the following slide.
Observation at local level
Up to now, we have observed dietary gap based on national agriculture statistics.
This is simple and easy to analyze. However, this is just an estimate, does not necessary give us real picture of local diet.
In the following slide, I share the result of quick dietary survey conducted in Mozambique
Observation at local level
Up to now, we have observed dietary gap based on national agriculture statistics.
This is simple and easy to analyze. However, this is just an estimate, does not necessary give us real picture of local diet.
In the following slide, I share the result of quick dietary survey conducted in Mozambique
赤字でのご訂正、ありがとうございます。
文字の色を元の色に変更させていただきました。
Nutrient Focused Approach (NFA) is an approach to identify nutrient deficiency and design the context-specific dietary diversification solutions to tackle the nutrition issues that are identified.
This also can be used as a tool to guide specific roles of the agricultural sector in the nutrition issues.