The challenges of human nutrition: back into the future Marisa Porrini Dip. Scienze e Tecnologie Alimentari e Microbiolo

10. We are facing a global epidemic of obesity Until recently, obesity was considered a condition associated with high socioeconomic status In more recent decades the most dramatic increase in obesity is in low- and middle-income countries (e.g. Mexico, China, Thailand)

13. Paradoxically, obesity coexists with undernutrition In economically advanced regions of developing countries, prevalence rates may be as high as in industrialized countries Prevalence in children and adolescents is on the rise in both developed and developing regions (22 million children under five are estimated to be overweight worldwide)

14. Obesity is a major contributor to the global burden of chronic disease (non communicable diseases) and disability (type 2 diabetes, hypertension, heart disease, stroke, gallbladder disease, certain forms of cancer) Over the next few decades this burden is projected to rise particularly fast in the developing world

17. Elevated consumption of energy-dense, nutrient poor foods Low consumption of vegetable and fruit Reduced level of physical activity at home, at school, at work and for recreation and transport Use of tobacco (WHO 2004)

18. The shifts in the way of eating and moving and subsequent effects on stature and body composition

19. A big nutrition transition took place in the industrialized world over the past two centuries (e.g. the consumption of fat and refined carbohydrates has increased 5 to 10 fold in England) In the low and middle-income countries the shift in the diet occurs within a few decades

20. Major dietary changes include a large increase in the consumption of fat and refined carbohydrates (considering also added sugar), often a marked increase in animal food products contrasted with the fall in whole grain intake and fibre.

21. In the higher-income countries, increased portion sizes, away-from-home food intake, and snacking are eating pattern that accompany dietary changes. Water is often replaced by calorically sweetened beverages For lower-income countries less documentation exists, and high heterogeneity among regions is reported

22. Urban areas higher rates of obesity Greater range of food choices (at lower prices) Less labor-intensive working activities Women work away from home

23. More people are moving to the city 1900 10% of world population inhabited cities 2009 50% By 2050 80% (ONU estimate)

24. Rural area undergo major changes Increased mechanization of farm activity More food available (not necessarily a better variety) Farming of multiple crops single, high-yielding cash crop

25. Increased importation of foods from the industrialized world The increased availability of foods at lower prices means the poor have access to a richer diet Traditional diets meals high in fat and refined carbohydrates grains, vegetables

26. Although these shifts in diet and physical activity are desirable in many ways, they are associated with many onerous nutritional and health effects. It is this paradox and complexity that makes it difficult to arrest the negative aspects of the nutrition transition As poor countries become more prosperous they acquire some of the benefits along with some of the problems of industrialized nations

27. Although almost all Member States in the European region have government-approved policies on nutrition and food safety, the burden of disease associated with poor nutrition continues to grow in the European Region, particularly as a result of the obesity epidemic, while food borne diseases still represent a challenge for European health systems

28. Acute undernutrition is still documented in areas facing food insecurity Chronic undernutrition due to micronutrient deficiencies extensively affects vulnerable populations (elderly, chronically ill patients and disabled individuals) Obesity has reached epidemic proportions

30. The Second European Action Plan addresses the main public health challenges in the area of nutrition, food safety and food security, dealing with diet-related noncommunicable diseases (particularly obesity), micronutrient deficiencies and foodborne diseases.

31. Proposed actions include: improving nutrition and food safety in early life ensuring a safe, healthy and sustainable food supply providing comprehensive information and education to consumers carrying out integrated actions to address related determinants strengthening nutrition and food safety in the health sector monitoring and evaluating progress and outcomes.

32. Improve the availability and affordability of fruit and vegetables Promote the reformulation of mainstream food products Promote appropriate micronutrient fortification of staple food items and develop complementary foods with adequate micronutrient content Improve the nutritional quality of the food supply and food safety in public institutions Ensure that the commercial provision of food products is aligned with food-based dietary guidelines Explore the use of economic tools (taxes, subsidies) Establish targeted programmes for the protection of vulnerable and low socioeconomic groups Establish intersectoral food safety systems with a “farm-to-fork” approach and in accordance with the Codex Alimentarius risk analysis framework

34. To assure a sufficient level of nutrition worldwide To strongly promote healthy eating from early life, focusing on a food-pattern model that could help in making correct choices in line with modern-life needs

35. Thank you for your attention!