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Food and Health Data World Health Organization Regional Office for Europe CopenhagenVJ Food and health data Their use in nutrition policy -making rf BANANAS 0 Ai WHO Regional Publications, European Series, No. 34 The World Health Organization is a specialized agency of the United Nations with primary responsibility for international health matters and public health. Through this Organization, which was created in 1948, the health professions of some 165 countries exchange their knowledge and experience with the aim of making possible the attainment by all citizens of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life. The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own programme geared to the particular health problems of the countries it serves. The European Region has 31 active Member States,' and is unique in that a large proportion of them are industri- alized countries with highly advanced medical services. The European pro- gramme therefore differs from those of other regions in concentrating on the problems associated with industrial society. In its strategy for attaining the goal of "health for all by the year 2000" the Regional Office is arranging its activities in three main areas: promotion of lifestyles conducive to health; reduction of preventable conditions; and provision of care that is adequate, accessible and acceptable to all. The Region is also characterized by the large number of languages spoken by its peoples and the resulting difficulties in disseminating information to all who may need it. The Regional Office publishes in four languages- English, French, German and Russian - and applications for rights of translation into other languages are most welcome. a Albania, Austria, Belgium, Bulgaria, Czechoslovakia, Denmark, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Israel, Italy, Luxembourg, Malta, Monaco,Netherlands,Norway,Poland,Portugal,Romania,SanMarino, Spain, Sweden, Switzerland, Turkey, USSR, United Kingdom and Yugoslavia. Food and health data Their use in nutrition policy- making WHO Library Cataloguing in Publication Data Food and health data. Their use in nutrition policy -making (WHO regional publications. European series ; no. 34) 1.Nutrition 2.Health policy 3.Information systems 4.Nutrition surveys 5.Europe I.Becker, W. II.Helsing, E. III.Series ISBN 92 890 1125 4 (NLM Classification: QU 145) ISSN 0378 -2255 World Health Organization Regional Office for Europe CopenhagenJr, Food and health data Their use in nutrition policy -making Edited by W. Becker and E. Helsing WHO Regional Publications, European Series, No. 34 ICP/NUT 116/119 . Text editing by: M.S. Burgher ISBN 92 890 1125 4 ISSN 0378 -2255 ©World Health Organization 1991 Publications of the World Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. For rights of reproduction or translation, in part or in toto, of publications issued by the WHO Regional Office for Europe applications should be made to the Regional Office for Europe, Scherfigsvej 8, DK -2100 Copenhagen 0, Denmark. The Regional Office welcomes such applications. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. The names of countries or areas used in this publication are those that obtained at the time the original language edition of the book was prepared. The mention of specific companies or of certain manufacturers' products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are dis- tinguished by initial capital letters. The views expressed in this publication are those of the contributors and do not necessarily represent the decisions or the stated policy of the World Health Organization. PRINTED IN DENMARK CONTENTS Page Foreword ix Contributors xi 1. Use of a nutrition information system- E. Helsing 1 Purpose of this book 2 The use of a food and health information system 3 Conclusion 12 References 12 2.Nutrition information systems and data quality requirements - A. Kelly & W. Becker 15 Considerations in the use of data in nutrition planning 16 Data quality 17 Knowing the sources of dietary data 19 References 24 3. Health impact monitoring- K. Test 25 What is health? 26 What to measure 27 Usefulness for nutrition and health policy 29 Indicators of noncommunicable disease status in a population 29 Conclusions 36 References 37 4. Food balance sheets- A. Kelly, W. Becker & E. Helsing 39 Three considerations 39 FAO food balance sheets 41 Some general caveats 43 Comments on some commodities 45 Utility of food balance sheets 46 Conclusions 47 References 47 5. Household budget surveys- W.A. van Staveren, A. van Beem & E. Helsing 49 Definitions 49 Purposes, possibilities and limitations 49 Techniques used 50 Aspects of survey design and the collection of data 51 Validation and presentation of the data 54 Presentation of results 58 Final remarks 60 References 60 6.Dietary surveys and the use of the results- J. Haraldsdôttir 63 Methods 64 Advantages and disadvantages 65 Limitations 65 Selecting a suitable method for a dietary survey 67 Using survey results in nutrition surveillance 67 References 70 7. Problems and pitfalls of food -to- nutrient conversion L. Kohlmeier 73 Assumptions in food -to- nutrient conversion 74 Use of food composition tables 81 Conclusion 81 References 82 8. Database requirements for calculations from food balance sheet data and household budget surveys- D.A.T. Southgate 85 Food balance sheets 85 Household budget surveys 87 References 89 9. Comparison of dietary data from different sources: some examples -W. Sekula, W. Becker, A. Trichopoulou & G. Zajkas 91 FAO and OECD food balance sheets 91 Comparative analysis of FAO and OECD data 93 Comparison of FAO and national data:some examples 100 Comparison of data from different levels of the food chain 110 Conclusions 112 References 117 10.Use and misuse of dietary recommendations to evaluate food intake - E.F. Wheeler & J. Haraldsd6ttir 119 Definitions 119 How requirements and recommended nutrient intakes are established 120 Evaluation of dietary intake 123 Conclusions 128 References 128 Appendix 130 Annex 1.Analysis of the sugar flow in Norway- K. Lund - Larsen & A.H. Rimestad 135 Sources of data 135 Results 136 Reliability of the data 138 Other explanations 139 Conclusion 140 References 142 Annex 2. Proposed system for food and nutrition surveillance in Norway - A.O. SOrheim, G. Botten, L. Johansson & S. Larsen 145 Purposes 145 Organization 146 The coordinators 148 Overall coordination 150 Costs 150 References 151 Annex 3. Grouping foods:uses of FAO food balance sheet database 153 Food groups 154 Analysis 160 References 162 Annex 4. A review of household budget surveys in 17 countries - W. Sekula 163 Bulgaria 163 Denmark 164 Finland 164 France 164 Federal Republic of Germany 165 Greece 165 Ireland 166 Italy 166 Netherlands 167 Norway 167 Poland 167 Portugal 168 Spain 168 Sweden 169 United Kingdom 169 United States 170 Yugoslavia 171 Foreword Health policy -making is receiving more serious attention in Europe than ever before. At the same time, the concept of health has been widened, first from solely curative health care to include preventive activities for both individuals and populations, and then to embrace the promotion of health.This in turn has broadened the range of sectors concerned with health.Makers of policies on topics as diverse as city planning and agriculture, for example, must now put health on their political agendas. In this situation,itis not surprising that food and nutrition policies should draw the attention of health planners. Six European countries have made parliamentary decisions to have food and nu- trition policies: Norway in 1975, Denmark and the Netherlands in 1984, Finland in 1985, Malta in 1988 and Iceland in 1989. Several countries may be on the verge of adopting such a policy; Hungary, Poland and Sweden have laid much of the groundwork. The establishment of a food and nutrition policy usually requires the formulation of objectives for desirable changes in the diet of the population.This in turn presupposes that clear and accurate pic- tures can be drawn of the population's dietary pattern and diet - related health (or disease) pattern.These are needed to indicate where changes ought to take place. Data on the dietary patterns of populations can be obtained from several sources. Food balance sheets, household budget surveys and individual -level studies, as well as mortality statistics, are widely available, although the quality of the information they give is seldom assessed. The present volume is intended to fill this gap, to provide a critical assessment of data sources, so that food and nutrition policy -makers may use them with greater confidence. A 1988 publication, Healthy nutrition: preventing nutrition - related diseases in Europe (WHO Regional Publications, European ix Series, No. 24), described the importanceofnutrition policy -making. Taking the next step, the present volume is intended to
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