International Agency for Research on Cancer, Lyon, Francia
Introduction/Objectives: The world is currently facing an unprecedented global non-communicable disease burden, largely driven by a worldwide nutrition transition characterized by increased consumption of energy-dense foods, (saturated) fatty acids, sugar and salt. The lack of reliable and standardized dietary assessment methodologies is one of the main limitations for measuring, monitoring and comparing the worldwide nutritional transitions and for investigating their association with diseases. In order to address this gap, the International Agency for Research on Cancer (IARC) together with WHO launched a joint “Global nutritional surveillance initiative” (GloboDiet initiative) to promote and support population-based standardized food consumption data. This initiative will aim to provide further infrastructure structure support and international research-policy marker framework to accurately measure, monitor trends and better understand the current global nutrition transition, its determinants and diet-related diseases, with a particular but not exclusive focus on Low- and Medium-Income Countries (LMIC). Current status and progress on the GloboDiet initiative will be presented. Development: The Dietary Exposure Assessment (DEX) at IARC has a longstanding experience in dietary assessment methodologies and their implementation in large international settings. This experience includes in particular, the development, validation and implementation of a standardized interview-based 24-hour dietary recall methodology (GloboDiet-24-HDR) and its related web-infrastructure support (GloboDiet-Research Infrastructure), currently under development. Over the last 20 years, this methodology has been implemented as a reference instrument for calibration in the half-million European Prospective Investigation into Cancer and Nutrition (EPIC) project and more recently has been adapted for pan-European monitoring surveys together with the European Food Safety Authority (“EU Menu project”), with countries involved on voluntary basis. The collection of comparable dietary information within and between countries would enable policy makers to review and update their food and nutrition policies and to develop prevention tools such as food-based dietary guidelines and nutrient profiling models for food labelling, marketing regulations, pricing and procurement policies. Reliable and comparable dietary information would also allow establishing and monitoring strategies to reduce the consumption of sodium and saturated fats and promote the consumption of fruit and vegetables, as the main specific recommended WHO dietary indicators. Seven European countries (i.e. The Netherlands, Germany, Belgium, France, Switzerland, Austria, Malta) are already using or planning to use the IARC methodologies in their national monitoring surveys, and other are under negotiation or involved as observers. The advanced work in the WHO European Region should serve as “a proof of principle” to develop the main dietary assessment tools, support (web) infrastructures and related guidelines, training and standard operating procedures. In parallel, the GloboDiet initiative is piloting the customization and implementation of DEX/IARC methodologies in National surveillance or cohorts, in two to four pilot countries in other regions worldwide, in particular in LMICs facing rapid nutrition transition. Advanced pilot initiatives in Latin America (Brazil, Mexico) and Asia (Republic of Korea) suggest that the expansion of the methodology beyond Europe is possible. However, situations in LMICs raise specific challenges to the implementation of common dietary methodologies. These include the heterogeneity of the populations, a high proportion of illiteracy and lack of communication means to approach them, as well as lack of trained personnel, and resources and/or infrastructure for long-term sustainability. Relying on the WHO national and regional network of offices, and a multi-disciplinary partnership at international, regional and national levels a stepwise strategy is proposed for the implementation of a global initiative to strengthen dietary monitoring systems. A five-step approach will be followed, including 1) the preparation of the Globo- Diet country-versions; 2) the validation (incl. feasibility piloting) of these versions; 3) their implementation in the national surveillance system of the selected countries; 4) the broader expansion to other regional countries and development of local hubs; and 5) provision and analyses of standardized dietary data for multiple research, surveillance and prevention purposes. Conclusions: Starting from a stepwise worldwide initiative which could rapidly be expanded to other countries, the provision of more comparable and detailed dietary data worldwide available as a comprehensive and fully documented e-database(s) for surveillance, prevention, risk assessment and research and science-based evidences to support policymakers in development implementation and monitoring of cost-effective action plans to decrease the current diet-disease burden, at national, regional and international levels. This will also contribute to knowledge transfer, building capacities and their long-term sustainability, particularly in LMIC. Assuming that at least 3 countries per WHO region will reach the actual implementation phase of their National surveillance system together with those already ongoing in 7 European countries, it is expected that standardised data from 25 worldwide countries (N=50,000 individuals) will be available for these multiple and joint purposes, at the end of the project. Key words: Dietary surveillance, worldwide initiative, GloboDiet, standardization, 24-hour dietary recall.