Italian action plan:an example of a win-win strategy

Directorate General Hygiene, Food Safety and Nutrition

Lorenzo M Donini, Gaetana Ferri

Faculty: Lorenzo M Donini

Relationships with commercial interests: I currently have, or I have had in the past two years, an affiliation or financial interest with business corporation(s):

• Grants/Research Support: Danone/Nutricia (PROVIDE Study), Biophytis (SARA-OBS Study)

• Speakers Bureau/Honoraria an other: Nutricia, AKERN, Cosmed

• Consulting Fees: Vivenda, GioService

Conflict of interest: no conflict of interest to declare

Faculty/Presenter Disclosure

EU & WHO objectives

Preventing and fighting

overweight & obesity

Relative reduction of

premature deathfrom NCCD by 25% by 2025

The scientific background

“...Sustainable diets are those diets with low environmental impacts which contribute to food and nutrition security and to healthy life for present and future generations. Sustainable diets are protective and respectful of biodiversity and ecosystems, culturally acceptable,accessible, economically fair and affordable; nutritionally adequate, safe and healthy; while optimizing natural and human resources.”

Berry EM et al.. Public Health Nutrition 2011; 14: 2274-84.

Every Main Meal

Every Week

CulturalElements

Moderation

Every Day

Inscribed in 2013 on the Representative List of the Intangible Cultural Heritage of Humanity (Cyprus, Croatia, Spain, Greece, Italy, Morocco and Portugal)

The Mediterranean diet involves a set of skills, knowledge, rituals, symbols and traditions concerning crops, harvesting, fishing, animal husbandry, conservation, processing, cooking, and particularly the sharing and consumption of food

Eating together is the foundation of the cultural identity and continuity of communities throughout the Mediterranean basin. It is a moment of social exchange and communication, an affirmation and renewal of family, group or community identity.

The Mediterranean diet

2012

Positive local economicreturns

The MD, as a system that respects local specificities, ensures the conservation and development of traditional activities and crafts, thereby guaranteeing the balance between the territory and the people.

Frugality as an overarching principle of the Mediterranean diet expresses the care in food preparation, moderation in portion size and avoiding waste, and is linked to the high cultural, social and economic value that food has for all Mediterraneanpeoples.

Mechanisms underlying the health benefits of MD against CVD may depends on:

increased intake of dietary fiber, antioxidant vitamins (A, C, and E) and carotenoids (beta-carotene, lycopene, lutein, betacryptoxanthin, zeaxanthin, and astaxanthin) from fruits and vegetables, monounsaturated oleic acid from virgin olive oil, omega-3 fatty acids from fish, and reduced consumption of dietary cholesterol and saturated fatty acids (Riccioni, 2007, 2008, 2009, 2010)

effect on human gene expression of proatherogenic genes (Khymenets, 2009; Konstantinidou , 2010; Llorente-Cortes, 2010), insulin sensitivity-related genes (Konstantinidou, 2009), postprandial adiponectin (Paniagua, 2007), and in the expression of atheriosclerosisrelated genes (Konstantinidou, 2009)

The data reviewed suggest that the health benefits of MD pattern are mainly due to the existence of biologic interactions between different components of it rather than to the effect of a single food group or nutrients.

Recently, dietary pattern analysis has emerged as an alternativeand complementary approach to examining the relationshipbetween diet and the risk of chronic diseases.

Instead of looking at individual nutrients or foods, pattern analysisexamines the effects of overall diet.

Conceptually, dietary patterns represent a broader picture offood and nutrient consumption, and may thus be more predictiveof disease risk than individual foods or nutrients.

Several studies have suggested that dietary patterns derived fromfactor or cluster analysis predict disease risk or mortality.

Italian strategy

Data from the 2016 edition

16

Prevalence of overweight and obesity among children aged 8-9 years

“OKkio alla salute” is an Italian surveillance system whose main objective is to describe the geographical variation and evolution over time of the weight status, dietary habits and levels of physical activity performed by children.

2008-2009 2016Relative

reduction (%)

Overweight 23.2 21.3 8

Obesity 12 9.3 22.5

In 2015 a working group involving the Ministries of Health and Industry and the institute for advertising regulation (IAP - Istituto Autodisciplina Pubblicitaria) was constituted.

Two protocols have been signed between the Ministry of Health and the associations of food industry, advertising and trade sectors to foster eating habits in children, to allow easier choices for the consumer, adapted to their lifestyle, and to try to hinder childhood obesity.

The aim of the first protocol was to improve the nutritional quality of foods trying to …

- reduce the concentration of sugar, saturated fats and salt

- limit the serving size

- increase the amount of fibers

- improve the information provided in nutritional labels

… in particular for cereals and sweets products (breakfast cereals and biscuits, sweet and salted snacks), non-alcoholic beverages (soft drinks, fruit juices-nectar-pulps) and dairy products (ice creams, yogurt, fermented milk).

“Obiettivi condivisi per il miglioramento delle caratteristiche nutrizionale dei prodotti alimentari con particolare attenzione alla popolazione infantile (3-12anni)”

http://www.salute.gov.it/imgs/C_17_pubblicazioni_2426_ulterioriallegati_ulterioreallegato_0_alleg.pdf

MONITORING SYSTEM• partial but significant data were received by the by the associations of food

industry, advertising and trade sectors relating to different product categories(breakfast cereals, biscuits, salted and sweet snacks, dairy products)

• the adopted monitoring system is based on reference nutritional valuescalculated as the arithmetic mean of the best-selling products

• an external company performs the market analysis

Data collection shows a marked improvement in nutritional quality of foods,

exceeding in some cases the pre-established objectives.

SFA Trans FAAdded

sugarFiber Na

Serving

size

Breakfast

cereals

2014

2017

- 80%

- 100%

- 6%

- 14%

+75%

+125%

- 33%

- 56%

Biscuits2014

2017

- 4,5%

- 9%

- 80%

- 100%

- 6%

- 20%

+ 25%

+ 50%

Salted snacks2009/2017

2013/2017

- 35%- 10%

Sweet snacks2014

2017

- 4,5%

- 9%

- 90%

- 100%

- 6%

- 14%

- 10%

- 15%

Soft drinks2012

2016

- 6%

- 18%

Fruit juices 2009-2014 - 7/8%

Yogurt/

ferment milk

2011

2015

2018

- 10 %

- 23 %

- 27 %

Ice creams2014

2017

-4,5%

-9%

- 80%

- 100%

-6%

-20%

- 10%

- 20%

[]

[]

149

[]

[]

170

0

20

40

60

80

100

120

140

160

180

Sugars Saturated fats Kcal/serving size

Ave

rage

co

nte

nt

(g/1

00

g)

SWEET SNACKS

CURRENT average content compared to the reformulation

commitments for 2017

Average content (g/100g) Commitments 2017

[]

[]

[]

[]

0

1

2

3

4

5

6

7

Fibers Sodium

Av

era

ge

co

nte

nt

(g/1

00

g)

CRACKERS

CURRENT average content compared to the reformulation

commitments for 2017

Average content (g/100g) Commitments 2017

FAIR ADVERTISING for FOOD PRODUCTS CONCERNING CHILDREN

The second protocol aimed at monitoring and intervention on communication and advertising messages and methods of dissemination information need to be correct and conveyed with appropriate languages to children and their families.

“Linee di indirizzo per la comunicazione commerciale relativa ai prodotti alimentari e alle bevande, a tutela dei bambini e della loro corretta alimentazione» http://www.salute.gov.it/imgs/C_17_pubblicazioni_2427_ulterioriallegati_ulterioreallegato_0_alleg.pdf

WORK IN PROGRESS

Multidisciplinary, multisectoral and multistakeholder development plan to build"global action strategy" to fight against the triple burden of malnutrition(coexistence of food insecurity, undernutrition, and overweight and obesity).http://www.fao.org/3/a-i6130e.pdf

A working group involving differentMinistries (Health, Foreign Affairs, Agriculture, Education), FAO, scientific-agricultural-health institutions and industrial partners has beenconstituted.

Fontana dei quattro fiumi – Roma Pza Navona Gian Lorenzo Bernini – 1648-1651