Diet and Physical Activity for the Prevention of Noncommunicable Diseases in Low- and Middle-Income Countries: A Systematic Policy Review
Identifieur interne : 000411 ( Pmc/Curation ); précédent : 000410; suivant : 000412Diet and Physical Activity for the Prevention of Noncommunicable Diseases in Low- and Middle-Income Countries: A Systematic Policy Review
Auteurs : Carl Lachat [Belgique] ; Stephen Otchere [Belgique] ; Dominique Roberfroid [Belgique] ; Abubakari Abdulai [Ghana] ; Florencia Maria Aguirre Seret [Belgique] ; Jelena Milesevic [Serbie] ; Godfrey Xuereb [Suisse] ; Vanessa Candeias [Suisse] ; Patrick Kolsteren [Belgique]Source :
- PLoS Medicine [ 1549-1277 ] ; 2013.
Abstract
Carl Lachat and colleagues evaluate policies in low- and middle-income countries addressing salt and fat consumption, fruit and vegetable intake, and physical activity, key risk factors for non-communicable diseases.
Please see later in the article for the Editors' Summary
Url:
DOI: 10.1371/journal.pmed.1001465
PubMed: 23776415
PubMed Central: 3679005
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xml:lang="fr">Belgique</country><wicri:regionArea>Nutrition and Child Health Unit, Institute of Tropical Medicine, Antwerp</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Department of Food Safety and Food Quality, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium</addr-line></nlm:aff><country xml:lang="fr">Belgique</country><wicri:regionArea>Department of Food Safety and Food Quality, Faculty of Bioscience Engineering, Ghent University, Ghent</wicri:regionArea></affiliation></author></analytic><series><title level="j">PLoS Medicine</title><idno type="ISSN">1549-1277</idno><idno type="eISSN">1549-1676</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Carl Lachat and colleagues evaluate policies in low- and middle-income countries addressing salt and fat consumption, fruit 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<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS Med</journal-id><journal-id journal-id-type="iso-abbrev">PLoS Med</journal-id><journal-id journal-id-type="publisher-id">PLoS</journal-id><journal-id journal-id-type="pmc">plosmed</journal-id><journal-title-group><journal-title>PLoS Medicine</journal-title></journal-title-group><issn pub-type="ppub">1549-1277</issn><issn pub-type="epub">1549-1676</issn><publisher><publisher-name>Public Library of Science</publisher-name><publisher-loc>San Francisco, USA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">23776415</article-id><article-id pub-id-type="pmc">3679005</article-id><article-id pub-id-type="publisher-id">PMEDICINE-D-12-03186</article-id><article-id pub-id-type="doi">10.1371/journal.pmed.1001465</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="Discipline-v2"><subject>Medicine</subject><subj-group><subject>Nutrition</subject><subj-group><subject>Obesity</subject></subj-group></subj-group><subj-group><subject>Public Health</subject></subj-group></subj-group><subj-group subj-group-type="Discipline-v2"><subject>Social and Behavioral Sciences</subject></subj-group></article-categories><title-group><article-title>Diet and Physical Activity for the Prevention of Noncommunicable Diseases in Low- and Middle-Income Countries: A Systematic Policy Review</article-title><alt-title alt-title-type="running-head">National Policies for Noncommunicable Diseases</alt-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Lachat</surname><given-names>Carl</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Otchere</surname><given-names>Stephen</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Roberfroid</surname><given-names>Dominique</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Abdulai</surname><given-names>Abubakari</given-names></name><xref ref-type="aff" rid="aff3"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Seret</surname><given-names>Florencia Maria Aguirre</given-names></name><xref ref-type="aff" rid="aff4"><sup>4</sup></xref></contrib><contrib contrib-type="author"><name><surname>Milesevic</surname><given-names>Jelena</given-names></name><xref ref-type="aff" rid="aff5"><sup>5</sup></xref></contrib><contrib contrib-type="author"><name><surname>Xuereb</surname><given-names>Godfrey</given-names></name><xref ref-type="aff" rid="aff6"><sup>6</sup></xref></contrib><contrib contrib-type="author"><name><surname>Candeias</surname><given-names>Vanessa</given-names></name><xref ref-type="aff" rid="aff6"><sup>6</sup></xref></contrib><contrib contrib-type="author"><name><surname>Kolsteren</surname><given-names>Patrick</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="aff" rid="aff2"><sup>2</sup></xref><xref ref-type="corresp" rid="cor1"><sup>*</sup></xref></contrib></contrib-group><aff id="aff1"><label>1</label><addr-line>Nutrition and Child Health Unit, Institute of Tropical Medicine, Antwerp, Belgium</addr-line></aff><aff id="aff2"><label>2</label><addr-line>Department of Food Safety and Food Quality, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium</addr-line></aff><aff id="aff3"><label>3</label><addr-line>Community Nutrition Department, School of Medicine and Health Sciences, University for Development Studies, Tamale, Ghana</addr-line></aff><aff id="aff4"><label>4</label><addr-line>International Diabetes Federation, Brussels, Belgium</addr-line></aff><aff id="aff5"><label>5</label><addr-line>Centre of Research Excellence in Nutrition and Metabolism, Institute for Medical Research, University of Belgrade, Belgrade, Serbia</addr-line></aff><aff id="aff6"><label>6</label><addr-line>Global Strategy on Diet, Physical Activity and Health, Surveillance and Population-Based Prevention Unit, Department of Chronic Diseases and Health Promotion, World Health Organization, Geneva, Switzerland</addr-line></aff><contrib-group><contrib contrib-type="editor"><name><surname>Cobiac</surname><given-names>Linda J.</given-names></name><role>Academic Editor</role><xref ref-type="aff" rid="edit1"></xref></contrib></contrib-group><aff id="edit1"><addr-line>The University of Queensland, Australia</addr-line></aff><author-notes><corresp id="cor1">* E-mail: <email>pkolsteren@itg.be</email></corresp><fn fn-type="conflict"><p>The authors have declared that no competing interests exist. The authors alone are responsible for the views expressed in this article and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated.</p></fn><fn fn-type="con"><p>Conceived and designed the experiments: CL PK. Analyzed the data: CL SO VC FMAS AA JM. Wrote the first draft of the manuscript: CL. Contributed to the writing of the manuscript: AA CL DR FMAS GX JM PK SO VC. <ext-link ext-link-type="uri" xlink:href="http://www.icmje.org/">ICMJE</ext-link> criteria for authorship read and met: AA CL DR FMAS GX JM PK SO VC. Agree with manuscript results and conclusions: AA CL DR FMAS GX JM PK SO VC.</p></fn></author-notes><pub-date pub-type="collection"><month>6</month><year>2013</year></pub-date><pmc-comment> Fake ppub added to accomodate plos workflow change from 03/2008 and 03/2009 </pmc-comment>
<pub-date pub-type="ppub"><month>6</month><year>2013</year></pub-date><pub-date pub-type="epub"><day>11</day><month>6</month><year>2013</year></pub-date><volume>10</volume><issue>6</issue><elocation-id>e1001465</elocation-id><history><date date-type="received"><day>25</day><month>10</month><year>2012</year></date><date date-type="accepted"><day>2</day><month>5</month><year>2013</year></date></history><permissions><copyright-year>2013</copyright-year><copyright-holder>Lachat et al</copyright-holder><license><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</license-p></license></permissions><related-article id="d35e239" related-article-type="companion" ext-link-type="doi" xlink:href="10.1371/journal.pmed.1001466" vol="" page="e1001466"><article-title>Malignant Neglect: The Failure to Address the Need to Prevent Premature Non-communicable Disease Morbidity and Mortality</article-title></related-article><abstract abstract-type="toc"><p>Carl Lachat and colleagues evaluate policies in low- and middle-income countries addressing salt and fat consumption, fruit and vegetable intake, and physical activity, key risk factors for non-communicable diseases.</p><p>Please see later in the article for the Editors' Summary</p></abstract><abstract><sec><title>Background</title><p>Diet-related noncommunicable diseases (NCDs) are increasing rapidly in low- and middle-income countries (LMICs) and constitute a leading cause of mortality. Although a call for global action has been resonating for years, the progress in national policy development in LMICs has not been assessed. This review of strategies to prevent NCDs in LMICs provides a benchmark against which policy response can be tracked over time.</p></sec><sec><title>Methods and Findings</title><p>We reviewed how government policies in LMICs outline actions that address salt consumption, fat consumption, fruit and vegetable intake, or physical activity. A structured content analysis of national nutrition, NCDs, and health policies published between 1 January 2004 and 1 January 2013 by 140 LMIC members of the World Health Organization (WHO) was carried out. We assessed availability of policies in 83% (116/140) of the countries. NCD strategies were found in 47% (54/116) of LMICs reviewed, but only a minority proposed actions to promote healthier diets and physical activity. The coverage of policies that specifically targeted at least one of the risk factors reviewed was lower in Africa, Europe, the Americas, and the Eastern Mediterranean compared to the other two World Health Organization regions, South-East Asia and Western Pacific. Of the countries reviewed, only 12% (14/116) proposed a policy that addressed all four risk factors, and 25% (29/116) addressed only one of the risk factors reviewed. Strategies targeting the private sector were less frequently encountered than strategies targeting the general public or policy makers.</p></sec><sec><title>Conclusions</title><p>This review indicates the disconnection between the burden of NCDs and national policy responses in LMICs. Policy makers urgently need to develop comprehensive and multi-stakeholder policies to improve dietary quality and physical activity.</p><p>Please see later in the article for the Editors' Summary</p></sec></abstract><abstract abstract-type="editors-summary"><title>Editors' Summary</title><sec><title>Background</title><p>Noncommunicable diseases (NCDs)—chronic medical conditions including cardiovascular diseases (heart disease and stroke), diabetes, cancer, and chronic respiratory diseases (chronic obstructive pulmonary disease and asthma)—are responsible for two-thirds of the world's deaths. Nearly 80% of NCD deaths, close to 30 million per year, occur in low- and middle-income countries (LMICs), where they are also rising most rapidly. Diet and lifestyle (including smoking, lack of exercise, and harmful alcohol consumption) influence a person's risk of developing an NCD and of dying from it. Because they can be modified, these risk factors have been at the center of strategies to combat NCDs. In 2004, the World Health Organization (WHO) adopted the Global Strategy on Diet, Physical Activity and Health. For diet, it recommended that individuals achieve energy balance and a healthy weight; limit energy intake from total fats and shift fat consumption away from saturated fats to unsaturated fats and towards the elimination of trans-fatty acids; increase consumption of fruits, vegetables, legumes, whole grains, and nuts; limit the intake of free sugars; and limit salt consumption from all sources and ensure that salt is iodized. For physical activity, it recommended at least 30 minutes of regular, moderate-intensity physical activity on most days throughout a person's life.</p></sec><sec><title>Why Was This Study Done?</title><p>By signing onto the Global Strategy in 2004, WHO member countries agreed to implement it with high priority. A first step of implementation is usually the development of local policies. Consequently, one of the four objectives of the WHO Global Strategy is “to encourage the development, strengthening and implementation of global, regional, national and community policies and action plans to improve diets and increase physical activity.” Along the same lines, in 2011 the United Nations held a high-level meeting in which the need to accelerate the policy response to the NCD epidemic was emphasized. This study was done to assess the existing national policies on NCD prevention in LMICs. Specifically, the researchers examined how well those policies matched the WHO recommendations for intake of salt, fat, and fruits and vegetables, as well as the recommendations for physical activity.</p></sec><sec><title>What Did the Researchers Do and Find?</title><p>The researchers searched the Internet (including websites of relevant ministries and departments) for all publicly available national policies related to diet, nutrition, NCDs, and health from all 140 WHO member countries classified as LMICs by the World Bank in 2011. For countries for which the search did not turn up policies, the researchers sent e-mail requests to the relevant national authorities, to the regional WHO offices, and to personal contacts. All documents dated from 1 January 2004 to 1 January 2013 that included national objectives and guidelines for action regarding diet, physical exercise, NCD prevention, or a combination of the three, were analyzed in detail.</p><p>Most of the policies obtained were not easy to find and access. For 24 countries, particularly in the Eastern Mediterranean, the researchers eventually gave up, unable to establish whether relevant national policies existed. Of the remaining 116 countries, 29 countries had no relevant policies, and another 30 had policies that failed to mention specifically any of the diet-related risk factors included in the analysis. Fifty-four of the 116 countries had NCD policies that addressed at least one of the risk factors. Thirty-six national policy documents contained strategies to increase fruit and vegetable intake, 20 addressed dietary fat consumption, 23 aimed to limit salt intake, and 35 had specific actions to promote physical activity. Only 14 countries, including Jamaica, the Philippines, Iran, and Mongolia, had policies that addressed all four risk factors. The policies of 27 countries mentioned only one of the four risk factors.</p><p>Policies primarily targeted consumers and government agencies and failed to address the roles of the business community or civil society. Consistent with this, most were missing plans, mechanisms, and incentives to drive collaborations between the different stakeholders.</p></sec><sec><title>What Do These Findings Mean?</title><p>More than eight years after the WHO Global Strategy was agreed upon, only a minority of the LMICs included in this analysis have comprehensive policies in place. Developing policies and making them widely accessible is a likely early step toward specific implementation and actions to prevent NCDs. These results therefore suggest that not enough emphasis is placed on NCD prevention in these countries through actions that have been proven to reduce known risk factors. That said, the more important question is what countries are actually doing to combat NCDs, something not directly addressed by this analysis.</p><p>In richer countries, NCDs have for decades been the leading cause of sickness and death, and the fact that public health strategies need to emphasize NCD prevention is now widely recognized. LMICs not only have more limited resources, they also continue to carry a large burden from infectious diseases. It is therefore not surprising that shifting resources towards NCD prevention is a difficult process, even if the human cost of these diseases is massive and increasing. That only about 3% of global health aid is aimed at NCD prevention does not help the situation.</p><p>The authors argue that one step toward improving the situation is better sharing of best practices and what works and what doesn't in policy development. They suggest that an open-access repository like one that exists for Europe could improve the situation. They offer to organize, host, and curate such a resource under the auspices of WHO, starting with the policies retrieved for this study, and they invite submission of additional policies and updates.</p></sec><sec><title>Additional Information</title><p>Please access these websites via the online version of this summary at <ext-link ext-link-type="uri" xlink:href="http://dx.doi.org/10.1371/journal.pmed.1001465">http://dx.doi.org/10.1371/journal.pmed.1001465</ext-link>.</p><list list-type="bullet"><list-item><p>This study is further discussed in a <italic>PLOS Medicine</italic><ext-link ext-link-type="uri" xlink:href="http://dx.doi.org/10.1371/journal.pmed.1001466">Perspective by Stuckler and Basu</ext-link></p></list-item><list-item><p>The WHO website on <ext-link ext-link-type="uri" xlink:href="http://www.who.int/dietphysicalactivity/en/">diet and physical activity</ext-link> contains links to various documents, including a <ext-link ext-link-type="uri" xlink:href="http://www.who.int/dietphysicalactivity/implementation/toolbox/en/index.html">diet and physical activity implementation toolbox</ext-link> that contains links to the 2004 Global Strategy document and a Framework to Monitor and Evaluate Implementation</p></list-item><list-item><p>There is a 2011 WHO primer on NCDs entitled <ext-link ext-link-type="uri" xlink:href="http://www.wpro.who.int/noncommunicable_diseases/documents/ncd_primer/en/index.html">Prioritizing a Preventable Epidemic</ext-link></p></list-item><list-item><p>A recent <italic>PLOS Medicine</italic> editorial and call for papers addressing the <ext-link ext-link-type="uri" xlink:href="http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001360">global disparities in the burden from NCDs</ext-link></p></list-item><list-item><p>A PLOS Blogs post entitled <ext-link ext-link-type="uri" xlink:href="http://blogs.plos.org/globalhealth/2013/02/gpaton1/">Politics and Global HealthAre We Missing the Obvious?</ext-link> and associated comments discuss the state of the fight against NCDs in early 2013</p></list-item><list-item><p>The <ext-link ext-link-type="uri" xlink:href="http://www.ncdalliance.org/">NCD Alliance</ext-link> was founded by the Union for International Cancer Control, the International Diabetes Federation, the World Heart Federation, and the International Union Against Tuberculosis and Lung Disease; its mission is to combat the NCD epidemic by putting health at the center of all policies</p></list-item><list-item><p>The <ext-link ext-link-type="uri" xlink:href="http://data.euro.who.int/nopa/">WHO European Database on Nutrition, Obesity and Physical Activity (NOPA)</ext-link> contains national and subnational surveillance data, policy documents, actions to implement policy, and examples of good practice in programs and interventions for the WHO European member states</p></list-item></list></sec></abstract><funding-group><funding-statement>There was no funding for this work.</funding-statement></funding-group><counts><page-count count="19"></page-count></counts></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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