Building centres of excellence
In January we argued that 2009 should be the year of solutions, and that more resources and thought should be invested in solution-focused activities(Reference Yngve1). In this issue we publish a letter responding to that call, with a proposal for centres of excellence in nutrition research in low-income countries (termed ‘emerging markets’ in the letter)(Reference Yach and Feldman2). The proposal is reached based on, among other things, the lack of authors from developing countries writing and publishing on topics of local importance. The letter raises important issues, and leaves some important questions unanswered.
Who could disagree with a call for such centres? Indeed, we know of at least one such centre recently established in South Africa (H Vorster, personal communication). A key concern has been finding good researchers to work in such centres and keeping them there – there is a serious need for workforce development. Various leadership programmes have been established around the world to support the development of skills in young scientists, with a view to supporting them to become leaders in the future(3).
But excellence in research alone will not reduce malnutrition in all its forms (this term has been recommended to engender a broader understanding of global nutrition problems(Reference Uauy, Corvalan and Dangour4)) around the world. If we were sitting in an African university we might find the proposal a little patronizing. In any case, who will set the agenda for this research, who will decide what models and approaches are likely to be most productive, who will determine the scope and content of research studies, and who will turn research findings into solutions?
When looking at the research priorities for many international and national research bodies we will find the term ‘innovation’, where the meaning is to further develop all the -omics research in order to find new molecular solutions. Probably most of the effective solutions to the worldwide nutrition problems are not to be categorized as molecular or even innovative. A key message from The Lancet series on undernutrition(Reference Morris, Cogill and Uauy5) was not so much that we need more evidence regarding what to do, but that we need a better system and structure that supports practice that applies evidence that leads to solutions. We need to go beyond knowing, to knowing how and showing how. We need to encourage young scientists to stay in their own countries, and we need to address the social, political and economic reasons why impoverished countries stay poor. This is not a matter of better reductionist science to find the underlying mechanisms of action. This requires people to stand up and challenge our current paradigms. Those of us in the North may not like what people in the South have to say. Are we ready to be told?
Food guides: time for a new approach?
Only some groups of people use dietary guidelines and label information to help them shop. These groups are sometimes described as the worried well – that is, the people who pay greatest attention are probably those who least need to worry. Conversely, those for whom change is critical are less likely to use such information. For this latter group, other approaches to improving diets may be more effective – such as getting food manufacturers and retailers to make their cheapest/own brand products more healthy, or by governments providing healthy school meals or subsidising fruits and vegetables to make them more affordable.
But if we are going to group foods and produce dietary guidelines and visual aids such as food guide pyramids or the eat well plate, they may as well be useful. Surprisingly, very few of these tools designed for informing the consumer have been thoroughly evaluated (or at least we don’t get to see the results).
Also, it is difficult to use food guides, because they don’t really represent foods as we encounter them in supermarkets or most foods when purchasing, apart from fresh foods. Most of us now eat products that are mixtures of the traditional food groups that don’t easily fit into any single category.
The UK Food Standards Agency has adopted a ‘traffic light’ system that tells consumers whether foods as sold are high/medium/low in fat, salt and sugar with a red/orange/green traffic light scheme(6). Research in the UK has shown that consumers understand traffic lights and find them less confusing than labels using Guideline Daily Amounts (GDA). Europe has adopted GDA, where levels of nutrients are expressed as a percentage of the average daily requirement for an adult(7). Professor Alan Maryon-Davis, President of the UK Faculty of Public Health, said(8):
This is a potential disaster for the health of European consumers. The GDA system is too complicated and applies only to adults of average build. But what about everybody else? The EU has yet again bowed down to the food industry. We urgently need the much simpler traffic-light system to help us make healthier choices.
In his invited commentary in this issue, Carlos Monteiro proposes a new way of classifying foods that could reshape and make food guides more useful(Reference Monteiro9). He proposes classifying foods into three groups. Group 1 is lightly processed foods such as fresh meat and milk, fruit and vegetables, legumes and cereals, nuts and root vegetables sold as such. Group 2 consists of substances extracted from foods such as fats and oils, flour, pasta, starches and sugars. Group 3 is ultra-processed foods made from a mix of mainly group 2 foods, such as cakes, biscuits, ice cream, savoury and sweet snacks, and sugared soft drinks. These highly processed foods are branded and heavily marketed internationally and are very profitable.
The commentary’s recommendation is to prefer group 1 foods and avoid group 3 foods, and to support the required change of consumption patterns by fiscal policies along the lines used by tobacco and alcohol to alter consumption. Food for thought.
Conflict of interest declarations
Last year the Council of the International Union of Nutritional Sciences approved new guidelines for publishing ethics(Reference Margetts, Finlay, Monteiro, Oniang’o and Shetty10). Public Health Nutrition has adopted these guidelines, which include declaration of competing interests of editors, reviewers and authors. We have tightened up our systems to ensure that these declarations are always completed for every paper published.
