Food Balance Sheets Research Articles

Phytonutrient intakes in relation to European fruit and vegetable consumption patterns observed in different food surveys.

Fruit and vegetables make an important contribution to health, partly due to the composition of phytonutrients, such as carotenoids and polyphenols. The aim of the present study was to quantify the intake of fruit and vegetables across different European countries using food consumption data of increasing complexity: food balance sheets (FBS); the European Food Safety Authority (EFSA) Comprehensive Database; individual food consumption data from the UK National Diet and Nutrition Survey (NDNS). Across Europe, the average consumption of fruit and vegetables ranged from 192 to 824g/d (FBS data). Based on EFSA data, nine out of fourteen countries consumed <400g/d (recommended by the WHO), although even in the highest-consuming countries such as Spain, 36% did not reach the target intake. In the UK, the average consumption of fruit and vegetables was 310g/d (NDNS data). Generally, phytonutrient intake increased in accordance with fruit and vegetable intake across all European countries with the exception of lycopene (from tomatoes), which appeared to be higher in some countries that consumed less fruit and vegetables. There were little differences in the average intake of flavanols, flavonols and lycopene in those who did or did not meet the 400g/d recommendation in the UK. However, average intakes of carotenoid, flavanone, anthocyanidin and ellagic acid were higher in those who consumed >400g/d of fruit and vegetables compared with those who did not. Overall, intakes of phytonutrients are highly variable, suggesting that while some individuals obtain healthful amounts, there may be others who do not gain all the potential benefits associated with phytonutrients in the diet.

Nutrition and Food Consumption Patterns in the Kingdom of Saudi Arabia

The objective of the present study is to describe and examine nutrition and food consumption patterns in KSA, namely to analyze and assess: the trends of per capita supply of major food groups (g/capita/day) from 1961-2007 and dietary energy supply, distribution by macronutrient and diversity of the food supply. Only secondary data were used. Saudi Arabia annual food balance sheet for the period form 1961-2007 which produced by FAO were used to drive the average per capita micronutrients (Dietary Energy Supply, protein and fats). Descriptive statistics were used as analytical tools. The results revealed that the overall supply of the different food groups in KSA is in continuous rise from 881 g/capita/day in the period of 1961/70 to more than double (1735 g/capita/day) in the period of 1981/90. The supply of vegetables showed a sharp drop from over 400 g/capita/day in the year 1990 down to less than 250 g in the year 2000. Fruits supply was slightly better than vegetable during the same period (1990-2007). On the other hand, meat group showed steady, positive increasing supply pattern during the period from 1990 to 2007. During these two decades, meat supply increased from about 26 g/capita/day in 1990 up to 139 g/capita/day in 2007 with a percent increase of 435%. Macronutrients are essentially of vegetal origin, amounted to 92% for energy, 81% for protein to 67% for lipid during the period of 1961/70. In the subsequent years fats from vegetal origin was more or less stabilized at 67-68% while fats from animal origin was at 33%. The share of protein, in the dietary supply has remained stable from 1961/70 to 2001/07. While the share of lipids showed an increase trend from just 15% in 1961/70 up to 1981/90 and stabilized at 25% up to the 2001/07 period. However, the share of carbohydrates in the dietary supply has decreased from 75% in 1961/70 to 64% in 2001/07. In the last five decades the per capita consumption of Sugar and sweetener, meat, animal fat, offal, egg and milk has increased, contrary the consumption of fruits and vegetable have fluctuating trends, such trends will not be continued if Saudi to adopt more healthy lifestyle.

Dietary mineral supplies in Africa.

Dietary micronutrient deficiencies (MNDs) are widespread, yet their prevalence can be difficult to assess. Here, we estimate MND risks due to inadequate intakes for seven minerals in Africa using food supply and composition data, and consider the potential of food-based and agricultural interventions. Food Balance Sheets (FBSs) for 46 countries were integrated with food composition data to estimate per capita supply of calcium (Ca), copper (Cu), iron (Fe), iodine (I), magnesium (Mg), selenium (Se) and zinc (Zn), and also phytate. Deficiency risks were quantified using an estimated average requirement (EAR) ‘cut-point’ approach. Deficiency risks are highest for Ca (54% of the population), followed by Zn (40%), Se (28%) and I (19%, after accounting for iodized salt consumption). The risk of Cu (1%) and Mg (<1%) deficiency are low. Deficiency risks are generally lower in the north and west of Africa. Multiple MND risks are high in many countries. The population-weighted mean phytate supply is 2770 mg capita−1 day−1. Deficiency risks for Fe are lower than expected (5%). However, ‘cut-point’ approaches for Fe are sensitive to assumptions regarding requirements; e.g. estimates of Fe deficiency risks are 43% under very low bioavailability scenarios consistent with high-phytate, low-animal protein diets. Fertilization and breeding strategies could greatly reduce certain MNDs. For example, meeting harvestplus breeding targets for Zn would reduce dietary Zn deficiency risk by 90% based on supply data. Dietary diversification or direct fortification is likely to be needed to address Ca deficiency risks.

Water Footprint in the Mediterranean Food Chain: Implications of Food Consumption Patterns and Food Wastage

Consumed food type, composition and quantity affects water resources demand (cf. water footprint). Since blue water resources availability is limited in the Mediterranean area diets shifting and food losses and waste reduction are key strategies. The paper aims at analyzing the water footprint of food consumption and implications of food waste in terms of water demand. The paper is based on secondary data mainly from the FAO Food Balance Sheets and the Water Footprint Network. Approximately 91% of the water footprint (WF) in the Mediterranean is due to the consumption of agricultural products. Dietary energy ranges between 2,130 (Palestine) and 3,666 kcal/day/person (Turkey). The share of vegetal-based energy in the diet ranges from 66.5% in France to 88.9% in Palestine. Total WF of food supply in Italy (1848.3) is higher than in Finland (1116.7) but lower than in the USA (2198.7 m3/capita/year). The highest water footprint is the green one, followed by the grey then the blue one. Meat and dairy products represent about a half of the WF of food supply. The contribution of cereals is significant in Southern and Eastern Mediterranean countries. The high Mediterranean consumptive water use is exacerbated by food losses and waste. In Egypt, losses in the rice supply chain are about 25%. Food loss and wastage account for more than one quarter of the total consumptive freshwater use. A 50% decrease in food losses and waste at the global level would save 1,350 km3 a year. Adoption of more sustainable food consumption patterns and production systems and the reduction of food losses and waste can help reducing pressure on the scarce water resources in the Mediterranean. Food waste reduction interventions will have significant impact on freshwater resource availability as other water use efficiency measures in agriculture and food production.

Staple Food Balance Sheet, Coefficient of Variation, and Price Disparity in Indonesia

Staple Food Balance Sheet, Coefficient of Variation, and Price Disparity in Indonesia

Environmental footprints of Mediterranean versus Western dietary patterns: beyond the health benefits of the Mediterranean diet.

BackgroundDietary patterns can substantially vary the resource consumption and environmental impact of a given population. Dietary changes such as the increased consumption of vegetables and reduced consumption of animal products reduce the environmental footprint and thus the use of natural resources. The adherence of a given population to the Mediterranean Dietary Pattern (MDP) through the consumption of the food proportions and composition defined in the new Mediterranean Diet pyramid can thus not only influence human health but also the environment. The aim of the study was to analyze the sustainability of the MDP in the context of the Spanish population in terms of greenhouse gas emissions, agricultural land use, energy consumption and water consumption. Furthermore, we aimed to compare the current Spanish diet with the Mediterranean Diet and in comparison with the western dietary pattern, exemplified by the U.S.A. food pattern, in terms of their corresponding environmental footprints.MethodsThe environmental footprints of the dietary patterns studied were calculated from the dietary make-up of each dietary pattern, and specific environmental footprints of each food group. The dietary compositions were obtained from different sources, including food balance sheets and household consumption surveys. The specific environmental footprints of food groups were obtained from different available life-cycle assessments.ResultsThe adherence of the Spanish population to the MDP has a marked impact on all the environmental footprints studied. Increasing adherence to the MDP pattern in Spain will reduce greenhouse gas emissions (72%), land use (58%) and energy consumption (52%), and to a lower extent water consumption (33%). On the other hand, the adherence to a western dietary pattern implies an increase in all these descriptors of between 12% and 72%.ConclusionsThe MDP is presented as not only a cultural model but also as a healthy and environmentally-friendly model, adherence to which, in Spain would have, a significant contribution to increasing the sustainability of food production and consumption systems in addition to the well-known benefits on public health.

Monitoring and benchmarking population diet quality globally: a step‐wise approach

INFORMAS (International Network for Food and Obesity/non-communicable diseases Research, Monitoring and Action Support) aims to monitor and benchmark the healthiness of food environments globally. In order to assess the impact of food environments on population diets, it is necessary to monitor population diet quality between countries and over time. This paper reviews existing data sources suitable for monitoring population diet quality, and assesses their strengths and limitations. A step-wise framework is then proposed for monitoring population diet quality. Food balance sheets (FBaS), household budget and expenditure surveys (HBES) and food intake surveys are all suitable methods for assessing population diet quality. In the proposed 'minimal' approach, national trends of food and energy availability can be explored using FBaS. In the 'expanded' and 'optimal' approaches, the dietary share of ultra-processed products is measured as an indicator of energy-dense, nutrient-poor diets using HBES and food intake surveys, respectively. In addition, it is proposed that pre-defined diet quality indices are used to score diets, and some of those have been designed for application within all three monitoring approaches. However, in order to enhance the value of global efforts to monitor diet quality, data collection methods and diet quality indicators need further development work.

Can current supply figures support the nutritional recommendation of fish consumption in Iran

consumption twice per week recommendation has been adopted in many countries, including Iran, by Nutrition experts. Data derived from food balance sheets (FBSs) and national household food consumption surveys (NHFCSs) show that fish consumption has been increased in the last 20 years in Iran. The gap between supply and recommendation figures in order to analyze the feasibility of this policy however needs to be determined. In this study, we took current figures of fish supply and consumption in Iran and calculated the amount of fish needed to support the recommendation of fish consumption. Data obtained from FAOSTAT-FBSs in 1980-82, 1990-92 and 2000-02, and NHFCS reports in 1992-95 and 2001-03. Fish supplies needed to fulfill the nutritional policy were calculated based on 120 and 180 gr/caput/wk scenarios. Sharp increase happened in the average fish supply from 1980s to 1990s, but slowed down afterwards. In early 2000, fish availability and intake were 4.73 and 4.43 kg (as raw-whole fish)/capita/year, respectively. The amount of fish required to fulfill the recommendation were however calculated as 10.97 and 16.43 kg/caput/yr based on the two scenarios, respectively. This study reveals that the gap between present fish consumption and the amounts for nutritional goal is still big. Whether bridging this gap in terms of feasibility, ecological, environmental and logistical burdens is attainable, needs more evaluation. Nutrition educators should be aware of the effects of their campaigns on the nationwide food policy as well as on issues such as consumer demand, prices, and environment.

Preventing the global burden of type 2 diabetes by improving the quality of staple foods: The Global Nutrition and Epidemiologic Transition Initiative

Type 2 diabetes has reached epidemic proportions globally, affecting low‐ and high‐income countries. Two main contributors have been the epidemiological transition and concomitant adverse changes in diet. We aimed to depict the current state of diabetes in light of the ongoing epidemiological and nutrition transition, and to posit that a key factor has been a shift in the type and processing of staple foods, using data from 10 countries participating in the Global Nutrition and Epidemiologic Transition Initiative (GNET), a collaborative effort aiming to reduce diabetes by improving the quality of traditional foods through culturally‐appropriate interventions. We depicted the epidemiological transition using median age, life expectancy, overall death rate and cause of death, and the nutrition transition using data from food balance sheets. Main staple foods (rice, roots, tubers, wheat, corn, legumes) differed by country, with most countries undergoing a shift in principal contributors to energy in the past 60 years. A notable example was the opposing trend in percent energy from rice (positive) vs. legumes (inverse). GNET countries with pilot data have documented barriers and motivators to increase intake of high‐quality traditional foods. In summary, global research efforts to identify and promote intake of culturally‐acceptable high‐quality staple foods could play a key role in diabetes prevention.

Reversal of Progress against Malnutrition in Egypt

ObjectiveTo assess trends and determinants of stunting, a monitoring indicator for economic and human development in Egypt, where marked economic and social changes have taken place.MethodsWHO global database, Food and Agriculture Organization Food balance sheet and World Bank indicators were used to describe trends in childhood growth, food availability and economic development.ResultsNeonatal, infant and under five mortality rates decreased between 1995 and 2010. Prematurity and congenital anomalies among children &lt; 5 years of age increased (20% and 30% respectively). Stunting decreased from 35% to 20.3% between 1990 and 2003 and bounced back to 30.7% by 2010. Moreover, the onset of stunting is now earlier (&lt; 6 month of age). Iron deficiency anemia increased from 30 to 60% and from 30 to 46% among preschool girls and boys respectively. Gross domestic product per capita increased and inflation rate decreased between 1990 and 2011. A reverse pattern occurred between 2003 and 2004.Daily calorie availability per capita did not change between 1995 and 2009 while calories from animal sources increased from 6.6% to 8.6%. Per capita protein from milk, eggs, poultry and pulses revealed a marked shortage compared to recommendations for 2–5 year old children.ConclusionStunting reflects the cumulative effects of inadequate food intake, poor health conditions and projects low levels of human development and economic growth.Congenital anomalies and prematurity may explain the early onset of stunting predicated by maternal poor health. Egypt, post Arab Spring, has a window of opportunity to reform its subsidy food and social programs to target improvement of maternal nutrition, strengthen breastfeeding and develop complementary feeding.

Soil-type influences human selenium status and underlies widespread selenium deficiency risks in Malawi

Selenium (Se) is an essential human micronutrient with critical roles in immune functioning and antioxidant defence. Estimates of dietary Se intakes and status are scarce for Africa although crop surveys indicate deficiency is probably widespread in Malawi. Here we show that Se deficiency is likely endemic in Malawi based on the Se status of adults consuming food from contrasting soil types. These data are consistent with food balance sheets and composition tables revealing that >80% of the Malawi population is at risk of dietary Se inadequacy. Risk of dietary Se inadequacy is >60% in seven other countries in Southern Africa, and 22% across Africa as a whole. Given that most Malawi soils cannot supply sufficient Se to crops for adequate human nutrition, the cost and benefits of interventions to alleviate Se deficiency should be determined; for example, Se-enriched nitrogen fertilisers could be adopted as in Finland.

Trends in energy and nutrient supply in Trinidad and Tobago from 1961 to 2007 using FAO food balance sheets.

Trinidad and Tobago has experienced an epidemiological transition over recent decades characterised by reduced rates of communicable diseases but rapidly increasing rates of obesity and non-communicable chronic diseases. The objective of the present study was to investigate the changes in energy and nutrient supply that have taken place in Trinidad and Tobago between 1961 and 2007. Food balance sheets for each year between 1961 and 2007 were downloaded from the FAOSTAT database and daily per capita supply for seventeen food commodity groupings was calculated. After appropriate coding, energy and nutrient supply were determined using dietary analysis software. FAO food balance sheets for Trinidad and Tobago from 1961 to 2007. None. The food supply in 2007 provided an extra 1561 kJ (373 kcal)/capita per d than it did in 1961. Energy from carbohydrate as a percentage of total energy fell from 62% in 1961 to 57% in 2007, whereas energy from fat as a percentage of total energy increased from 26% to over 30% and now lies at the upper end of WHO recommendations. Sugars increased from 20% to over 26% of total energy and are well above WHO recommendations. When expressed on a nutrient density basis, supplies of vitamin A, folate and Ca are lower than WHO recommendations. Nutritional imbalances in the Trinidadian food supply need to be addressed to combat the rise in nutrition-related chronic disease that is projected to cause increased disability and premature death in the country in the coming years.

Ecologic Correlations of Selected Food Groups With Disease Incidence and Mortality in Switzerland

BackgroundThere is little information regarding the impact of diet on disease incidence and mortality in Switzerland. We assessed ecologic correlations between food availability and disease.MethodsIn this ecologic study for the period 1970–2009, food availability was measured using the food balance sheets of the Food and Agriculture Organization of the United Nations. Standardized mortality rates (SMRs) were obtained from the Swiss Federal Office of Statistics. Cancer incidence data were obtained from the World Health Organization Health For All database and the Vaud Cancer Registry. Associations between food availability and mortality/incidence were assessed at lags 0, 5, 10, and 15 years by multivariate regression adjusted for total caloric intake.ResultsAlcoholic beverages and fruit availability were positively associated, and fish availability was inversely associated, with SMRs for cardiovascular diseases. Animal products, meat, and animal fats were positively associated with the SMR for ischemic heart disease only. For cancer, the results of analysis using SMRs and incidence rates were contradictory. Alcoholic beverages and fruits were positively associated with SMRs for all cancer but inversely associated with all-cancer incidence rates. Similar findings were obtained for all other foods except vegetables, which were weakly inversely associated with SMRs and incidence rates. Use of a 15-year lag reversed the associations with animal and vegetal products, weakened the association with alcohol and fruits, and strengthened the association with fish.ConclusionsEcologic associations between food availability and disease vary considerably on the basis of whether mortality or incidence rates are used in the analysis. Great care is thus necessary when interpreting our results.

Dietary Shifts in Nepal and its possible impacts on overweight and obesity

Patterns and trends of Nepalese transitions are unknown. This study aimed to describe the economic, dietary and obesityshifts in Nepal by identifying economic time-series trends from government databases; dietary trends from food balance sheets andobesity shifts from family health and demographic health surveys. Trends werecalculated at veyearly increments from available datafrom 1970 to 2010.The average proportion of energy from fat has signi cantly increased from 13% in 1970 to 17% in 2010 ( p <0.05) ( Figure 1 ). Plantfat and sugar are the main contributors to the increased energy intake trends over the 40 years, followed by meat, sh, milk and eggs.Data shows that overweight and obesity rates have increased from 21% of women to 27% in the urban population.Nepalese dietary patterns have changed over the past forty years, especially with increased energy from plant fat, sugar and animalproducts coinciding with increased levels of obesity and overweight, especially in urban areas.

Trends in dietary patterns, alcohol intake, tobacco smoking, and colorectal cancer in Polish population in 1960-2008.

The study examined the relationships between long-term trends in food consumption, alcohol intake, tobacco smoking, and colorectal cancer (CRC) incidence. Data on CRC incidence rates were derived from the National Cancer Registry, on food consumption from the national food balance sheets; data on alcohol and tobacco smoking reflected official statistics of the Central Statistical Office. It was shown that CRC incidence rates were increasing between 1960 and 1995, which could have been affected by adverse dietary patterns (growing consumption of edible fats, especially animal fats, sugar, red meat, and declining fibre and folate intake), high alcohol consumption, and frequent tobacco smoking noted until the end of the 1980s. Since 1990, the dietary pattern changed favourably (decrease in consumption of red meat, animal fats, and sugar, higher vitamin D intake, increase in vegetables and fruit quantities consumed, and decline in tobacco smoking). These changes could contribute to the stabilisation of CRC incidence among women seen after 1996 and a reduction in the rate of increase among men.

Estimating the Global Prevalence of Zinc Deficiency: Results Based on Zinc Availability in National Food Supplies and the Prevalence of Stunting

BackgroundAdequate zinc nutrition is essential for adequate growth, immunocompetence and neurobehavioral development, but limited information on population zinc status hinders the expansion of interventions to control zinc deficiency. The present analyses were conducted to: (1) estimate the country-specific prevalence of inadequate zinc intake; and (2) investigate relationships between country-specific estimated prevalence of dietary zinc inadequacy and dietary patterns and stunting prevalence.Methodology and Principal FindingsNational food balance sheet data were obtained from the Food and Agriculture Organization of the United Nations. Country-specific estimated prevalence of inadequate zinc intake were calculated based on the estimated absorbable zinc content of the national food supply, International Zinc Nutrition Consultative Group estimated physiological requirements for absorbed zinc, and demographic data obtained from United Nations estimates. Stunting data were obtained from a recent systematic analysis based on World Health Organization growth standards. An estimated 17.3% of the world’s population is at risk of inadequate zinc intake. Country-specific estimated prevalence of inadequate zinc intake was negatively correlated with the total energy and zinc contents of the national food supply and the percent of zinc obtained from animal source foods, and positively correlated with the phytate: zinc molar ratio of the food supply. The estimated prevalence of inadequate zinc intake was correlated with the prevalence of stunting (low height-for-age) in children under five years of age (r = 0.48, P<0.001).Conclusions and SignificanceThese results, which indicate that inadequate dietary zinc intake may be fairly common, particularly in Sub-Saharan Africa and South Asia, allow inter-country comparisons regarding the relative likelihood of zinc deficiency as a public health problem. Data from these analyses should be used to determine the need for direct biochemical and dietary assessments of population zinc status, as part of nationally representative nutritional surveys targeting countries estimated to be at high risk.

Estimating the Global Prevalence of Inadequate Zinc Intake from National Food Balance Sheets: Effects of Methodological Assumptions

BackgroundThe prevalence of inadequate zinc intake in a population can be estimated by comparing the zinc content of the food supply with the population’s theoretical requirement for zinc. However, assumptions regarding the nutrient composition of foods, zinc requirements, and zinc absorption may affect prevalence estimates. These analyses were conducted to: (1) evaluate the effect of varying methodological assumptions on country-specific estimates of the prevalence of dietary zinc inadequacy and (2) generate a model considered to provide the best estimates.Methodology and Principal FindingsNational food balance data were obtained from the Food and Agriculture Organization of the United Nations. Zinc and phytate contents of these foods were estimated from three nutrient composition databases. Zinc absorption was predicted using a mathematical model (Miller equation). Theoretical mean daily per capita physiological and dietary requirements for zinc were calculated using recommendations from the Food and Nutrition Board of the Institute of Medicine and the International Zinc Nutrition Consultative Group. The estimated global prevalence of inadequate zinc intake varied between 12–66%, depending on which methodological assumptions were applied. However, country-specific rank order of the estimated prevalence of inadequate intake was conserved across all models (r = 0.57–0.99, P<0.01). A “best-estimate” model, comprised of zinc and phytate data from a composite nutrient database and IZiNCG physiological requirements for absorbed zinc, estimated the global prevalence of inadequate zinc intake to be 17.3%.Conclusions and SignificanceGiven the multiple sources of uncertainty in this method, caution must be taken in the interpretation of the estimated prevalence figures. However, the results of all models indicate that inadequate zinc intake may be fairly common globally. Inferences regarding the relative likelihood of zinc deficiency as a public health problem in different countries can be drawn based on the country-specific rank order of estimated prevalence of inadequate zinc intake.

Modelling the effect on chronic disease health of changing food prices based on greenhouse gas emissions

BackgroundClimate change has been described as the biggest global health threat of the 21st century. There are potential health co-benefits of climate change mitigation strategies, and several studies have investigated effect on health of so-called carbon-friendly diets. Taxation based on greenhouse gas (GHG) emissions is a potential method of internalising the wider costs of climate change to society; such a tax on food and drinks would substantially reduce UK GHG emissions and raise revenue, but the effect on health is unclear. The aim of this study was to model the health effect, the reduction in GHG emissions, and the revenue raised from a tax based on the GHG emissions of food consumed in the UK. MethodsWe modelled a tax of £27·19 per tonne carbon dioxide equivalents (tCO2e)/kg product applied to all products with emissions greater than 4·10 kg CO2e/kg, the mean value for UK emissions across all food groups. Baseline UK consumption data were from the 2010 DEFRA Family Food survey and associated food-specific GHG emissions were taken from a World Wildlife Fund report. We weighted food GHG emissions by country of origin using data for UK imports and exports from UN Food and Agriculture Organization food balance sheets. Derivation of the tax level was based on the DEFRA marginal abatement cost curve for agriculture, which plots the cost effectiveness of different mitigation strategies; this approach estimates that 16·2% of annual UK agriculture-related emissions could be mitigated against at a cost of £27·19/tCO2e. Cross-price and own-price elasticities calculated from Family Food survey purchasing patterns were applied to food groups from the survey to derive changes in consumption after application of the tax. Health outcomes were modelled by a comparative risk assessment model that used age-specific and sex-specific relative risk estimates from meta-analyses to link the consumption of different food categories to mortality. FindingsThis study showed 6751 (95% CI 6147–7347) deaths averted per year and an annual reduction in GHG emissions of 18 765 ktCO2e (41% of the 2010 DEFRA figure of 46 200 ktCO2e for UK emissions relating to agriculture). Revenue generated from this tax scenario was £3·32 billion per year. In this scenario, the most taxed product was beef at £1·76 per kg, with other meats, fish, and coffee also being taxed. Of the 6751 deaths averted, 73% (4915, 95% CI 4379–5461) were due to cardiovascular disease and 15% (1032, 824–1227) were due to cancer. InterpretationTaxation of foods based on their GHG emissions has the potential to reduce emissions from the UK agriculture sector as well as reduce the number of premature deaths in the UK population and generate substantial tax revenue. This analysis included only health benefits from dietary change and not the wider effect on health of reduced atmospheric pollution and slowed climate change. The health implications of fiscal intervention on food based on GHG emissions has not been previously investigated and offers a further approach to climate change mitigation strategies. FundingBritish Heart Foundation.

A Program Needs-Driven Approach to Selecting Dietary Assessment Methods for Decision-Making in Food Fortification Programs

Dietary assessment data are essential for designing, monitoring, and evaluating food fortification and other food-based nutrition programs. Planners and managers must understand the validity, usefulness, and cost tradeoffs of employing alternative dietary assessment methods, but little guidance exists. To identify and apply criteria to assess the tradeoffs of using alternative dietary methods for meeting fortification programming needs. Twenty-five semistructured expert interviews were conducted and literature was reviewed for information on the validity, usefulness, and cost of using 24-hour recalls, Food Frequency Questionnaires/Fortification Rapid Assessment Tool (FFQ/FRAT), Food Balance Sheets (FBS), and Household Consumption and Expenditures Surveys (HCES) for program stage-specific information needs. Criteria were developed and applied to construct relative rankings of the four methods. Needs assessment: HCES offers the greatest suitability at the lowest cost for estimating the risk of inadequate intakes, but relative to 24-hour recall compromises validity. HCES should be used to identify vehicles and to estimate coverage and likely impact due to its low cost and moderate-to-high validity. Baseline assessment: 24-hour recall should be applied using a representative sample. Monitoring: A simple, low-cost FFQ can be used to monitor coverage. Impact evaluation: 24-hour recall should be used to assess changes in nutrient intakes. FBS have low validity relative to other methods for all programmatic purposes. Each dietary assessment method has strengths and weaknesses that vary by context and purpose. Method selection must be driven by the program's data needs, the suitability of the methods for the purpose, and a clear understanding of the tradeoffs involved.

Still Waiting for Godot? Improving Household Consumption and Expenditures Surveys (HCES) to Enable More Evidence-Based Nutrition Policies

The constrained evidence base of food and nutrition policy-making compromises nutrition programs. Nutrition policy-making must do better than relying exclusively on Food and Agriculture Organization Food Balance Sheets. The strategy of relying on observed-weighed food record or 24-hour recall surveys has not proven practical either; they remain few in number, generally not nationally representative, and of dubious external validity. Although Household Consumption and Expenditures Surveys (HCES) have shortcomings, they are increasingly being used to address this information gap. To promote dialog within the nutrition community, and between it and the greater community of HCES stakeholders, in order to identify their shared agenda and develop a strategy to improve HCES for analyzing food and nutrition issues. The diverse origins and objectives of HCES are described, the evolution of their use in addressing food and nutrition issues is traced, and their shortcomings are identified. The causes, relative importance, some potential solutions, and the strategic implications of three distinct categories of shortcomings are discussed. Elements of a possible approach and process for strengthening the surveys are outlined, including identifying best practices, developing guidelines and more rigorously analyzing the tradeoffs involved in common, key survey design and implementation decisions. To date, the nutrition community's role in most HCES has been as a passive user of secondary data. The nutrition community must become more involved in the design, implementation, and analysis of HCES by identifying criteria for prioritizing countries, establishing assessment criteria, applying the criteria in retrospective assessments, identifying key shortcomings, and recommending alternatives to ameliorate the shortcomings. Several trends suggest that this is a propitious time for improving the relevance and reliability of HCES.