1. Development of Food- Based Dietary Guidelines Carmen Dardano Food and Nutrition Officer/ Nutrition Education and Consumer protection Division

2. Outline Outline What are Dietary Guidelines? Process for Developing Food-Based Dietary Guidelines The Way Forward

3. What are Dietary Guidelines? Assist population in following nutrition and related health recomendation Guide to daily food choices Guide for healthy eating A tool for : nutrition education Behavior change

4. Food-Based Dietary Guidelines Convert scientific knowledge into practical messages A major strategy for: –Promoting healthy behavior and practices –Promoting nutrition education –Helping public make healthy choices –Guiding Food and Nutrition policies

5. Dietary Recommendations RDAs: Nutritional and energy requirements and recommendations –Developed for specific populations based on scientific knowledge –Speak to nutrients- Calories, Protein, Fat Form the basis for Dietary Guidelines

6. Food-Based Dietary Guidelines Developed for the general population Directed towards the healthy segment of the population Not directed to persons already afflicted with health conditions

7. Process for Developing Food- Based Dietary Guidelines

8. Steps for Preparing Dietary Guidelines Planning Characterizing Target Group Setting Objectives Preparing Technical Guidelines Testing the Feasibility of the Recommendations Preparing Food- Based Dietary Guidelines Validation Correction and Adjustment Implementation Evaluation

9. FORMATION MULTI-SECTORAL National Committee on FBDG –Ministry of Health –Minsitry of Education –Ministry of Agriculture –Ministry of Social Development –Ministry of Economy –Private sector: university, consumer group, food industry PLANNING

10. Planning Characterizing Target Group Setting Objectives Preparing Technical Guidelines Testing the Feasibility of the Recommendations Preparing Food- Based Dietary Guidelines Validation Correction and Adjustment Implementation Evaluation

11. Characterizing the Target Group Situation health and nutritional status of the group Groups access to food, eating habits, socio-cultural characteristics Based on review of existing surveys, reports, publications Problems prioritized in terms of scope, feasibility of solving, and impact

12. TABLE OF CONTENTS OF THE DIAGNOSIS DOCUMENT I.INTRODUCTION II.RISK FACTORS AND PROBLEMS ASSOCIATED WITH DIET A.Epidemiological Profile 1.Changes in morbidity rates 2.Nutritional status B.Education of the population C.Foods 1.Availability 2.Accessibility 3.Consumption 4.Composition D.Eating habits 1.Distribution 2.Classification 3.Acquisition III.CONCLUSIONS IV.PRINCIPAL PROBLEMS IDENTIFIED

13. DECISION MATRIX PRIORITIZATION OF FOOD AND NUTRITION PROBLEMS PROBLEMSMVIS 1. 2. 3. 4. 5. 6. 7. 10. 11. Note: Qualify the problems on scale of 0=less to10= more M: Expresses Magnitude of the problem V: Represents Viability = feasibility to solve the problem, through an educational intervention I: Represents Importance = impact that if the problem is solved S: Is the total of the results of the three considered factors

14. Planning Characterizing Target Group Setting Objectives Preparing Technical Guidelines Testing the Feasibility of the Recommendations Preparing Food- Based Dietary Guidelines Validation Correction and Adjustment Implementation Evaluation

15. Setting Objectives Objectives of the nutritional guidelines –Preventing and reducing priority risks and problems –Promoting healthy diets and lifestyles –Promote consumption of an adequate diet in vitamin A and iron

16. Planning Characterizing Target Group Setting Objectives Preparing Technical Guidelines Testing the Feasibility of the Recommendations Preparing Food- Based Dietary Guidelines Validation Correction and Adjustment Implementation Evaluation

17. Preparing Technical Guidelines Work of nutritionists and dietitians Technical document: –Defines the Nutritional goals, behavior to promote, knowledge to, skill to develop, change in environment. –Converts nutritional goals into types and quantities of food that the population should eat –Defines of Nutrient recommendations –Outlines the recommended food groups

18. FORMULATION OF TECHNICAL RECOMMENDATIONS OF THE NUTRITIONAL GUIDELINES Problem of Health and Nutrition Critical Nutrient Critical FoodPractices/ habits/ beliefs related to the health/ nutrition problem Technical recommen dation

19. DEFINITION OF TECHNICAL RECOMMENDATIONS OF THE NUTRITIONAL GUIDELINES FOR THE CUBAN POPULATION Health ProblemCritical nutrientCritical foodPractices/ Habits/ Beliefs related Technical Recommendation Cardiovascular and brain diseases Fat saturated Cho. Refined Na Vitamins Ac. Grs omega 3 Fiber Lards Oils Vegetable and fruits Salt Sugar Fish Grains and cereals X's of fried food Little availability vegetables/fruits Habit vegetable/fruits consumption Habit fish consumption Use of table salt X's use of sugar Bad distribution of foods during the day Sedentary lifestyle Alcoholism Smoking Varied diet. Fried food consumption. Prefer use of oil instead of lard. Consumption of vegetables/fruits. Grain and cereal consumption. Fish consumption. Salt consumption. Sugar consumption. Alcohol consumption. Maintain healthy weight. Physical activity. Diminish energy intake in the night.

20. TABLE ANALYSIS OF THE TECHNICAL RECOMMENDATIONS Technical RecommendationNumber of times that repeats Reduce alcohol consumption. Consume a variety diet. Increase consumption of vegetables and fruits. Reduce fried food consumption. Increase grain and cereal consumption. Equitable distribution of energy intake. Increase physical activity. Maintain weight healthy. Reduce sugar consumption. Increase consumption of fish. Consumption of oil vrs lard. Increase milk product consumption. Reduce salt consumption. Reduce smoked food consumption. Reduce coffee consumption. Combination consumption of sources of iron and vitamin C. Hand washing. Adequate food handling. Improve dental hygiene. 76655444432221111117665544443222111111

21. RECOMMENDED INTERVALS OF ENERGY INTAKE FOR DIFFERENT GROUPS OF AGE AND SEX Preschool children 2-5 years Schoolchildren 6-12 years Adolescents 13-17 years Adults 18-65 años Elderly persons > 65 years Lactating pregnant woman 1,000 1,500 2,0002,5003,0003,500 Category A 1,300 CAL Category B 2,200 CAL Category C 3,000 CAL

22. CALCULATION OF THE CONTENTS OF NUTRIENTS THAT EACH DIET WILL CONTRIBUTE ENERGY1,300 CAL3,200 CAL3,000 CAL Protein39 g66 g90 g Fat36 g61 g83 g Carbohydrates205 g346 g472 g Vitamin A390 ER650 ER900 ER Iron6-9 mg11-15 mg15-21 mg Vitamin C32 mg55 mg75 mg

23. PARTS NECESSARY FOR COVERING THE THREE LEVELS OF ENERGY GROUPS 1,300 CAL2,200 CAL3,000 CAL 121212 Milk and alternatives 120101 Vegetables121332 Fruits213123 Sugar7711 1716 Grains7714152019 Meat and alternatives 325688 Fat458811

24. Planning Characterizing Target Group Setting Objectives Preparing Technical Guidelines Testing the Feasibility of the Recommendations Preparing Food- Based Dietary Guidelines Validation Correction and Adjustment Implementation Evaluation

25. Testing the Feasibility of the Recommendations Behavioral Field Tests Populations willingness and ability to meet recommendations Identify appropriate language to be used Identify graphical representation

26. Planning Characterizing Target Group Setting Objectives Preparing Technical Guidelines Testing the Feasibility of the Recommendations Preparing Food- Based Dietary Guidelines Validation Correction and Adjustment Implementation Evaluation

27. Preparing Food-Based Dietary Guidelines Recommendations to population through messages Messages must be: –Positive –Clear –Comprehensible –Culturally appropriate –Doable

28. Preparing Food-Based Dietary Guidelines Criteria for selecting guidelines: –Objectives and potential for implementation by target group –Ideal number of messages is 6-8 –To facilitate dissemination and population memory

31. Preparing Food-Based Dietary Guidelines Use of pictures or diagrams –Attractive –Culturally acceptable –Give idea of variety and proportions

32. FIGURE PROPOSAL–GUATEMALA CRITERIA: CULTURALLY ACCEPTABLE VARIETY, PROPORTIONALITY

33. NUTRITIONAL GUIDELINES FOR GUATEMALA Include in all meals grains, cereals, or potatoes, because feed, and are economic and delightful. Eat every day tortillas and beans. Per one tortilla eat a tablespoonful of beans so it is more substantial. Eat every day herbs or vegetables to benefit your organism. Eat every day any kind of fruit, because they are healthy, digestive and nutritious. In addition to the beans that eat daily, eat at least twice a week an egg, a piece of cheese or a glass of milk. Eat at least once a week a piece of liver or of meat. Eat varied of food as it shown in the family pot. Sugar and fats Meats (at least once a week) Herbs and vegetables (every day) Milk (at least twice a week) Fruits (every day) Grains, cereals, and potatoes (every day) To maintain your health, wash your hands, cover food and the water

34. Planning Characterizing Target Group Setting Objectives Preparing Technical Guidelines Testing the Feasibility of the Recommendations Preparing Food- Based Dietary Guidelines Validation Correction and Adjustment Implementation Evaluation

35. Testing and Validating the FBDG Field-tested on people representative of target population Testing should be conducted in three phases: –Messages alone –Graphic alone –Messages and graphic together

36. 36 Dominica: testing messages and food guide Start the day with breakfast Always try to eat a variety of foods every day. Use the basket to help you make the choices. Use less salt, salted foods, seasonings and salty snacks

37. Planning Characterizing Target Group Setting Objectives Preparing Technical Guidelines Testing the Feasibility of the Recommendations Preparing Food- Based Dietary Guidelines Validation Correction and Adjustment Implementation Evaluation

38. Correcting and Adjusting the FBDG Based on test results Additional technical review

39. Planning Characterizing Target Group Setting Objectives Preparing Technical Guidelines Testing the Feasibility of the Recommendations Preparing Food- Based Dietary Guidelines Validation Correction and Adjustment Implementation Evaluation

40. Promotion of FBDG Reproduce, disseminate and implement Use sound communication strategy May be directed to specific segments of population Schools are effective for reaching children and parents Schools cost-effective

41. Planning Characterizing Target Group Setting Objectives Preparing Technical Guidelines Testing the Feasibility of the Recommendations Preparing Food- Based Dietary Guidelines Validation Correction and Adjustment Implementation Evaluation

42. Evaluation Periodic evaluation in terms of –Implementation process –Impact on target population Evaluation methodology and instrument designs –Systematic, objective, and timely evaluation

43. Conclusions POLITICAL WILL IS A KEY FACTOR IN THE DEVELOPMENT, IMPLEMENTATION, AND EVALUATION OF NUTRITIONAL GUIDELINES. IT IS NECESSARY TO FORM A GROUP TO DIRECT THE PROCESSTHAT HAS LEADERSHIP CAPACITY AND THE ABILITY TO BRING GROUPS TOGETHER. THE IMPORTANCE OF ESTABLISHING CONSENSUS AND BUILDING PARTNERSHIPS THAT PROMOTE THE IMPLEMENTATION OF THE GUIDELINES. THE NEED TO SELECT THE MOST APPROPRIATE COMMUNICATIONS STRATEGIES FOR DISSEMINATING THE GUIDELINES.

44. Food Guide

45. Visual representations to help consumers apply guidelines in their daily lives

46. Food Guide

49. PYRAMID OF PHYSICAL ACTIVITY TV JUEGOS DE VIDEO MUCHO TIEMPO SENTADO 2-3 TIMES/WEEK JUEGUE BOLICHE BAILE PATINE JUEGUE GOLF LEVANTE PESAS EJERCICIOS DE ESTIRAMIENTO ABDOMINALES 3-5 TIMES/WEEK TROTE MONTE BICICLETA NADE HAGA AEROBICOS HAGA ACUAEROBICOS SALTE CUERDA CAMINATA A PASO RAPIDO FUTBOL BALONCESTO VOLIBOL TENIS ARTES MARCIALES GIMNASIA EVERY DAY ESTACIONE SU CARRO LO MAS LEJOS POSIBLE PARA OBLIGARSE A CAMINAR USE LAS GRADAS EN VEZ DE ELEVADOR CAMINE LO MAS QUE PUEDA HAGA OFICIOS DE LA CASA Y JARDINERIA CAMINE CON SU MASCOTA HAGA VIAJES EXTRA BAJANDO Y SUBIENDO LAS GRADAS CAMINE A DIFERENTES SITIOS EN VEZ DE MANEJAR ELIJA ACTIVIDADES QUE REALMENTE DISFRUTE CONVIERTA LAS ACTIVIDADES EN EVENTOS SOCIALES CON SU FAMILIA REDUCE PASATIEMPOS FLEXIBILIDAD Y RESISTENCIA EJERCICIO AEROBICO ACTIVIDADES RECREATIVAS FUENTE: Franklin Community Health Network and the Physical activity Task force of Healthy Community Coalition. Http://www.fchn.org/hcc/hccwinter.htm