Suttilak Smitasiri

Beyond recommendations: Implementing food-based dietary guidelines for healthier populations

To reduce the increased burden of diet-related disease and promote human potential through food and nutrition globally, harmonization of efforts is urgently needed. This article examines the concept of food-based dietary guidelines (FBDGs) and discusses the possibilities and challenges of harmonizing the process of developing and implementing dietary guidelines. The authors argue that while the development of FBDGs has contributed to the understanding of the role of nutrients and foods in achieving optimal health, the impact of these guidelines on human health has been limited. Science or evidence must be used in FBDG development; nevertheless, there are limitations in current nutrition science. FBDGs should address the health consequences of dietary insufficiency, excess, or imbalance with a broader perspective, considering the totality of the effects of a given dietary pattern, rather than focusing on single nutrients alone. Moreover, the food selection guideline should be seen as complementary to a strategic, comprehensive, and culturally appropriate dietary and health promoting intervention, and not only as a tool for providing nutrition policy and information. Technically, a single unified global set of FBDGs may be desirable and even achievable. This concept, however, presents novel challenges on how to address cultural diversity and the complex social, economic, and political interactions between humans and the food supply, not to mention the complexity of its communication and implementation. Therefore, global harmonized efforts in support of strategic dietary interventions, together with strong global scientific support and facilitation for the development and communication of FBDGs at national or regional levels, are proposed to implement FBDGs for healthier populations.

Sustaining behavioural change to enhance micronutrient status through community- and women-based interventions in north-east Thailand: Vitamin A.

This project was designed as a follow-up of the Social Marketing of Vitamin A–Rich Food (SM/VAF) Project in north-east Thailand. It began in 1996 to determine whether the positive changes indicated at the end of the prior project were sustained in the intervention district and to develop a process to foster the changes achieved from the earlier effort. After one year of implementation, the results showed cumulative improvement in knowledge, attitudes, and practice with respect to intake of vitamin A and fat. A sustained improvement in the consumption of vitamin A–rich foods and fat towards fulfilment of the recommended dietary allowance was clearly demonstrated among pre-school children. During the current project, serum retinol levels among schoolgirls (10–13 years of age) improved from 22.75 ± 6.96 to 33.69 ± 8.25 μg/dl in the intervention group (p < .001), while no significant change was observed in the control group. the difference between intervention and control areas in the change in serum retinol before and after project implementation was highly significant (10.94 ± 9.09 and 3.24 ± 9.14, p < .0001).

Participatory action for nutrition education: Social marketing vitamin a‐rich foods in Thailand

This paper reflects a major concern of nutrition and health educators in the developing world today, namely, how to formulate and implement participatory nutrition intervention programs with community members and key government officials who may come from a number of different development sectors. Through the description of a project entitled “Social Marketing of Vitamin A‐Rich Foods,” the paper highlights the value of a two‐way concept of nutrition communication and problem‐solving which is put in operation by establishing mechanisms for working with both institutional and community groups. This entails calling upon such conceptual frameworks as behavior analysis, nutritional anthropology, media advocacy and social marketing as means for working with collaborators in a decentralized, nondirective fashion. The paper also illustrates how mass media and printed nutrition education materials can potentially support broad institutional and community development processes as well as providing a guideline of re...

Experience with Programs to Increase Animal Source Food Intake in Thailand

Thailand is a Southeast Asian country in rapid transition. It is considered to be food self-sufficient and an important food exporter in the world market. Quantitative data reveal that overall, the population of Thailand consumed a sufficient amount of most macronutrients and micronutrients, except for calcium. Nevertheless, there exist considerable problems of under- and overnutrition, due to unbalanced development in the past 40 y. Programs to increase animal source food intake in Thailand can be categorized into three main types: 1) programs to increase production; 2) programs to increase accessibility; and 3) programs to increase consumption. Overall production of fish, egg, chicken and pork has been adequate; and only beef and milk products need to be imported. To improve access for the poor, the National Poverty Alleviation Plan has been implemented since 1981. In terms of consumption, the Royal Thai government has promoted overall nutritious diets, but does not have national programs to promote animal source foods specifically, except for milk. Programs to increase milk, fish and micronutrient consumption are highlighted. Also, some lessons learned and suggestions for future programs and research are discussed.

A comment on how the nutritional impact of agricultural innovations can be enhanced.

The potential of agriculture still is not sufficiently appreciated by the nutrition community. The marriage of agriculture and nutrition in developing countries has been rare and often unsuccessful. There have been compelling reasons to find relatively quick ways to reduce malnutrition without treating the underlying causes. Thus, national and international nutrition leaders have focused their attention on medically oriented approaches. To many nutrition workers, improving nutrition through food-based approaches is a good idea in theory, but it is not feasible in terms of implementation. More emphasis should be placed on programmes and policies that involve non-staple plant foods, especially fruits and vegetables. For the poor, the cost of animal and fish products is simply too high. Micronutrient-rich vegetable sources are well within their purchasing power. Education and promotion are essential elements for successful food and nutrition interventions. Agricultural innovations will be transferred more effectively and will have enhanced nutritional impact if researchers in agriculture, food policy, and nutrition can also be change initiators and catalysts for better implementation, along with governmental agencies, non-governmental organizations, and intended beneficiaries. Education and promotion do not always reach the more disadvantaged, who are often not well integrated into community power structures, which makes it difficult for them to participate in community activities. A special intensive programme for the poor is often necessary. It is very important that all involved work towards the same goals and use a common set of indicators in achieving change. A “decision-development-dissemination” framework is proposed for enhancing the nutritional impacts of agricultural innovations.

Engaging Communities in a Sustainable Dietary Approach: A Thai Perspective

Lessons learned from developing countries indicate that various development attempts, including nutrition, are not sustained because of inadequate community participation. Although technologies can be introduced, their sustainability will depend almost entirely on the local population. More than a decade of experience in promoting consumption of vitamin A–rich foods in Thailand points to the understanding of contexts and trends of overall national development, strategic positioning of the change process, effective social mobilization, and importance of policy communication as being essential for engaging communities in sustainable endeavours. Information technology, current diet, and the health movement as well as future development approaches will lead to improved opportunities for a sustainable dietary approach. However, the need to reconsider the current nutrition science paradigm and the new market system remains a challenge.