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Are dietary guidelines sensible to consumers?

Many countries, even different bodies and organizations within the same country, have developed nutrient recommendations and dietary guidelines using a diversity of approaches. The process, criteria and types of evidence to support the recommendations are not clearly specified in all of the reports. Recommendations are not always aligned and controversies remain with respect to the scientific evidence, i.e. fat quality, protein requirements, dairy products or whether potatoes (excluding crisps, chips, French fries) count as vegetables. Further, while transparency and independency should be basic prerequisites for the process of developing guidelines, lobbying pressure has been a common criticism. Ideally, the process of developing recommendations and guidelines should follow standardized protocols using explicit standards for evidence, with the strengths and limitations of the evidence explained in easyto-understand language. Additionally, responsible bodies and organizations should plan timelines for regularly updating recommendations in light of the emerging evidence. As an example, fat consumption has decreased over the past decades in many countries, in line with recommendations, but this has not brought about the expected health outcomes. In fact, new problems have emerged: the advised decrease in fat intake may have induced unwanted dietary changes that have contributed to the increase in overweight and obesity. An adaptation of evidence ratings has been suggested that considers not only the quality of the evidence, but also the net benefit of an intervention – a perspective that also recognizes the potential for harm. Thus, the evidence assessment includes the possibility that no recommendation be made – a possibility intended to provide the appropriate level of caution in issuing guidelines. This issue of Public Health Nutrition focuses on several studies examining different aspects of dietary recommendations and guidelines, from their development to their application. The example of developing and interpreting guidelines for protein intake, expressed as the ratio of protein to energy requirement (P:Erequirement), is described in detail in a commentary by Professor Joe Millward. The commentary is an excellent study of how protein requirements and the P:E value for a given diet are properly interpreted, and why the P:Erequirement value might sometimes be lower than one would expect. Also with respect to developing guidelines, Brown et al. report on European stakeholders’ views on consumer involvement in dietary guideline development. Participation is a key principle in health promotion, and it has been argued that people have the right to participate in the planning and implementation of their health care. Since the general public is the intended end-user of dietary guidelines, members of the public, from individual lay consumers to consumer groups or consumer advocates, could potentially be involved in the process of developing guidelines. Their participation might involve providing qualitative or quantitative consumer research data, or taking part in consultations and decision-making meetings. Brown et al. find that a major benefit of involving consumers might be to increase trust in the process; but given the limited data on best practice for consumer involvement, transparency regarding their role in the process is essential. Other articles deal with the challenge of communicating the message to consumers and encouraging the adoption and implementation of dietary guidelines. Changing icons, either a pyramid or a plate, have led to growing consumer confusion and claims in the media, including popular bloggers and social media. ‘I hated having to think about every little thing I ate in quantitative terms. People aren’t machines. We’re subjective and pleasure-seeking and messy and crazyy Essentially, the experience made me neurotic and anxious about food (one of my great pleasures!) without making me especially healthy’, wrote Joe Satran, blogger at The Huffington Post, in a recent post. More structured quantitative guidance and tips for everyday life can be helpful. However, such guidance should account for different population groups; should consider cultural relevance and the issues of accessibility, affordability, cooking skills and skills to make healthier choices when eating out; and should be based in common eating habits, familiar foods and prevalent food preferences. The toolkit developed by Leslie et al. is a good example of such guidance, while additionally addressing sustainability and encouraging home food preparation. Mithril et al. offer a different approach by developing a regional prototype diet, the New Nordic Diet (NND), which is based largely on foods originating from the Nordic region and also takes palatability, health, food culture and the environment into consideration. In a third article on implementing dietary guidelines, Probst and Tapsell find that, with careful food selection, meal plans with >4 grain-based servings daily can meet nutrient recommendations using lacto-ovo vegetarian and rice-based cuisines, although different strategies are required for different ages and genders.