The importance of using risk assessment in developing foodregulations is growing with the globalization of our food supply. The World Trade Organization has entrenched the principles of science-based risk assessment in the Agreement on Sanitary and Phytosanitary Measures. The relevant international organization for food standards, the Codex Alimentarius Commission, recognises risk analysis, and its component parts risk assessment, risk management and risk communication, as the basis for scientific decision-making. Risk assessment comprises two activities: hazard evaluation; and exposure estimation. A hazard may be chemical, microbiological or nutritional in origin. The practical application of risk assessment in Australia is illustrated in this presentation by four examples involving: (1) food additives, (2) microbiological safety of imported raw milk cheeses, (3) genetically modified foods and (4) imported food inspection.
An effective risk management system covering the whole process offood production from “farm to fork” is required by the food industry in order to assure that the food provided to consumers is safe. Food safety and quality assurance begins with the design and development of food products starting with product conceptualisation and continuing with the selection, purchasing, and evaluation of raw materials and with the specifications for processing, packaging and distribution. Within a larger quality management framework a number of tools have been developed by the food industry, which when used in an integrated fashion facilitate the management of food safety. These include good manufacturing practice (GMP), good hygiene practice (GHP) and HACCP (hazard analysis critical control point) as well as quality systems which allow the verification that all factors affecting the safety of a product are under control. Finally, regulations and systems can only function if they are applied. Everyone, from the farmer, the line operator in the manufacturing plant, to the person handling the food in distribution and sales, needs to be aware of his influence with regards safety. The effectiveness of safety awareness programs specific to each area is key to an industry approach to risk management.
Areas of priority for intensive discovery would be theagbiotechnology and biomedical sectors using gene technology as a platform. The use of genetic manipulation in farming and the use of plants as ‘pharma’ factories to manufacture therapeutics would be on the rise. The human genome will continue to have a powerful impact on research and development of human diseases and healthcare. Discovery of genetics and pharmacogenomics will have great impact on drug development and will allow the prediction of the patient's response to various drugs as well as the onset of individualised or ‘designer drugs’. Human stem cells could have their cellular clocks reset by the cloning process, enhancing opportunities to grow young cells, tissues and organs for an aging population. The cellular clock could also be reset by therapeutic cloning. Bioinformatics would be a technology which would be synonymous with biotechnology. The analyses of biotechnology research would be conducted in silico and would involve the exchange of information among sophisticated computer databases. Applications of biotechnology would be even more evident in environmental technology, food development and food processing. In electronics, the use of the specificity of proteins in biochips is underway. In tandem with the explosions in research, regulatory issues, legislation and intellectual property rights will evolve to enhance the climate of discovery and innovation. Public education will have to be continually enhanced as awareness could negate any fear resulting from novel and innovative improvements from biotechnology.
The epidemiology of foodborne diseases is changing. While in manydeveloping nations the efficient treatment of diarrhoeal diseases through oral rehydration has probably led to the prevention of many food related deaths, the underlying problems have not been solved. In these countries, the disease incidence of food-and waterborne disease is still increasing, and now data from other parts of the world indicate that new foodborne pathogens have emerged as important public health problems. Over the last two decades, bacterial infections caused by Campylobacter and enterohaemorrhagic Escherichia coli have emerged, well-recognized pathogens, such as Salmonella enteritidis, have increased dramatically in disease incidence and important foodborne pathogens have become increasingly resistant to antimicrobial agents. The future strategy for prevention of foodborne disease should be founded in scientifically based evaluations of the whole food production chain ‘from farm to table’, including a description of the most important (risk) factors. Epidemiological studies of outbreaks as well as sporadic cases should be aimed at a better understanding of these factors. In terms of public health importance of the problem, the focus should be on the size of the problem, and the potential for improvement. The indications are that both in developed and developing countries there is significant potential for an improvement of the situation. With this aim in mind, international effort should focus on scientific assessments of the potential for risk reduction under different regional conditions.
In order to understand the magnitude and trends of both under-and over-nutrition problems in Asian countries, we reviewed data available in a number of selected countries. In general, the prevalence of under-nutrition is declining in this region but is still heavy in many countries. The trends varied with complexity of individual countries. In China, the prevalence of underweight, stunting and wasting was 21.6%, 30.5% and 2.6% in children of 0-4 years old (90,662 subjects, 1987). Another large-scale survey in 1992(176,976 subjects) presented a prevalence of 17.1%, 33.5% and 4.5%, respectively. Recent studies showed a remarkable improvement in both underweight and stunting. The National Student Survey in 1995, however, showed that the prevalence of under-nutrition was 26.9% for schoolboys and 38.3% for schoolgirls (7-18 yr). There was an increase of 4.7% and 3.5%, respectively, compared with the results of a similar survey conducted in 1985. The proportion of malnutrition in Chinese adults (BMI＜18.5) was 11.6% in 1982 and 9.0% in 1992 for urban areas, and 12.9% and 8.0% for rural areas, indicating a descending trend over the 10 years. The prevalence of underweight was the highest, over 50% among children below 6 years old, in both Bangladesh and India, between 50% and 20% in Malaysia, the Philippines, Thailand and Vietnam, and below 20% in Mongolia, Kazakhstan and Fiji. It showed a declining trend from the 1970s to the 1990s with an average annual reduction of 0.8 to 1.9 percentage points in these countries. The problem of over-nutrition is emerging quickly in this region, not only in some better-off countries but also in countries in economy transition. In China, the prevalence of overweight and obesity in young adults (BMI＞25) was increased from 9.7% to 14.9% for urban areas and from 6.15% to 8.4% for rural areas in a 10-year period (1982-1992), and the prevalence of overweight jumped from 3.38% and 2.75% in 1985 to 7.18% and 8.65% in 1995 for schoolboys and schoolgirls. In India, the increase of overweight and obesity in female adults was 5.0 percentage points from 1989 to 1994. The prevalence of overweight was 24.5% for male and 21.4% for female in Japan (1995), and 28.7% and 26.0% in Malaysia (1990). These results indicate that over-nutrition is a growing problem in this region. Many Asian countries are facing double challenges. They have to deal with both under-nutrition and over-nutrition problems. Among many possible interventions, the further strengthening mass education on healthy diet practice should be emphasized.
Nutrition and dietary survey data has been useful in defining themagnitude of malnutrition and dietary deficit. Such information has been helpful in gaining attention to support or to do more to improve nutrition-advocacy. However, there are also greater opportunities to use the common data to guide the program action. In summary, we have plenty of good nutrition and dietary information available to us in the planning and operation of nutrition intervention program. If we go beyond the use of data to justify area or subject of engagement, we can also use the same data for more efficient and more effective program without additional cost to us.
South Asia is the most populated region of the world with severalnutritional challenges. Though per capita food energy supply, child survival and life expectancy have improved, and even today large segments of the population are below the poverty line with high infant and maternal mortality rates. It is important to recognize the crucial role of nutrition throughout the life cycle-from conception to old age. It is very necessary now to move from food security to nutrition security and improve the quality of foods both in macro- and micronutrients in order to break the transgenerational effects of malnutrition. The key solutions to the problems should address the issue of social development, population stabilization, environmental degradation and inadequate health and nutritional services. Strategies for empowering women and actuating community participation as sustainable programmes for human development, measures to reduce underweight and stunting in children and prevention of micronutrient malnutrition across the population are required. Enhancing food and nutrition security through innovative diversified agriculture and dietary practices, prevention and control of infection, promotion of food safety and fortification of staples with appropriate attention on emerging chronic disorders are essential. Population control measures to stabilize the fertility rates, biotechnological approaches for genetically modified foods, nutrition surveillance based on assessment, analysis and action to address the logistic, technical and compliance issues with emphasis on promotion of breast feeding and complementary foods with adequate attention on the reproductive needs of adolescent girls, pregnant mothers and lactating women would eliminate low birth weight, stunting, and chronic energy deficiency in vulnerable groups. Focused studies on bioavailability of micronutrients and its enhancement, innovative horticulture interventions, fortifications, social marketing strategies would promote the intake of micronutrient and phytonutrient rich foods. In-depth epidemiological research, an insight into foetal origins of adult disease and nutrition-genes interaction and life style alterations will avert the emerging epidemic of chronic diet related disorders. An investment in preventing foetal malnutrition improves nutrition of women in reproductive age, infant and child nutrition and prevents the onset of chronic disease in adult life. Human resource development, IEC measures, technology transfer, operational and logistic research, building of databases, integrated, intersectoral, multidisciplinary plans and sound management information system and surveillance with net working and experience sharing in the region will help to overcome the common challenges and lay the foundation for a better scenario in these regions in the near future.
Over the last three decades, there has been significant changesin the lifestyles of communities, including food habits, and food purchasing and consumption patterns in the Southeast Asian region. As a result, there is a definite change in the food and nutrition issues in the region. Nutritional deficiencies in many of these countries are slowly being decreased in magnitude. On the other hand, the significant proportions of the population are now faced with the other facet of the malnutrition problem, namely diet-related chronic diseases. However, because of the different stages of socio-economic development, the extent of each of these extremes of the malnutrition problems varies considerably between the different countries in Southeast Asia. Nutrition needs in the new millennium would necessarily differ somewhat among these countries while at the same time, there would be a considerable amount of similarities. This presentation highlights several macro issues that countries in the region may focus on in the near future. Various intervention programmes have been undertaken by authorities to tackle the co-existence of twin faces of malnutrition in many developing countries. It would be desirable to have a blue print of such programmes and activities in the National Plans of Action for Nutrition (NPANs). The NPAN should be more than a framework or a descriptive document. It should be a tool for action, an operational plan that sets out priorities; identifies projects and activities, with details of implementation such as what, how and when; designates responsibilities and accountability for the activities; identifies resource requirements and their source; and sets out the plan for monitoring and evaluation. One of the main obstacles in the formulation and effective implementation of intervention programmes in developing countries is the lack of comprehensive data on the extent of the problems in many cases and the causes of such problems specificy to the communities concerned. It is thus imperative to identify appropriate research priorities and conduct relevant studies. It is also important to have basic baseline data collected at regular intervals such as nutritional status of communities and dietary intake. To conduct all these activities, it is vital to ensure adequate funding, preferably through establishing a dedicated fund for research. There should be closer collaboration between countries in the region in all nutrition activities to enable sharing of resources, experiences and learn from the mistakes of others. One existing mechanism is through the ASEAN structure. The other existing mechanisms are through WHO and FAO. One other mechanism is through the International Life Sciences Institute (ILSI) Southeast Asian Branch. Closely related to this need for networking is the need for continuing harmonization of approaches to nutrition activities in the region. Current efforts in harmonisation include RDA, nutritional status assessment methodologies and dietary guidelines. Other areas of harmonisation in the near future include nutrition labelling and claims.
A workshop on National Plans of Action for Nutrition:Constraints, Key Elements for Success, and Future Plans was convened and organized by the WHO Regional Office for the Western Pacific in collaboration with the Institute for Medical Research Malaysia and co-sponsored with FAO and UNICEF from 25—29 October 1999. It was attended by representatives of 25 countries in the region and resource persons, representatives from WHO and other international agencies. The objectives of the workshop were to review the progress of countries in developing, implementing and monitoring national plans of action for nutrition (NPANs) in the Western Pacific Region and to identify constraints and key elements of success in these efforts. Most of the countries have NPANs, either approved and implemented or awaiting official endorsement. The Plan formulation is usually multisectoral, involving several government ministries, non-governmental organizations, and international agencies. Often official adoption or endorsement of the Plan comes from the head of state and cabinet or the minister of health, one to six years from the start of its formulation. The NPAN has stimulated support for the development and implementation of nutrition projects and activities, with comparatively greater involvement of and more support from government ministries, UN agencies and non-governmental agencies compared to local communities, bilateral and private sectors and research and academic institutions. Monitoring and evaluation are important components of NPANs. They are, however, not given high priority and often not built into the plan. The role of an intersectoral coordinating body is considered crucial to a country's nutrition program. Most countries have an intersectoral structure or coordinating body to ensure the proper implementation, monitoring and evaluation of their NPANs.
In the late 1990s, the international development banks and theInternational Monetary Fund (IMF) convened to outline seven International Development Goals (IDGs) to reduce poverty by 2015. These goals incorporated both the economic and social dimensions of poverty. A two-thirds reduction of child mortality and a three-fourths reduction of maternal mortality from rates in 1990 by 2015 are two of these seven IDGs. There is a need for better combinations of cost-effective strategies to reach these challenging goals by the year 2015. This paper discusses the potential usefulness of micronutrient deficiency control programs for this purpose.
Experience in many parts of the developing world has shown thatfood fortification offers a cost-effective and sustainable solution to the problem of micronutrient malnutrition. Building on the advances in science and technology and backed by studies on the economic benefits of fortification programs, governments and industry are beginning to respond positively to the call of nutrition advocates to adopt fortification as a long-term strategy. On the other hand, formidable challenges still remain in many countries in Asia, constraining the widespread adoption of this strategy. The science and technology community needs to provide adequate scientific and technological information as basis for planning and decision making. The government faces the challenge of providing the enabling environment for all stakeholders to cooperate in the fortification effort. Industry faces the challenge of adapting its production system to the requirements of fortification in order that they can contribute to social objectives while pursuing their economic objectives. The international and bilateral aid agencies need to seek tried and innovative ways to support the multiple players of food fortification, as these players in turn face the challenges that confront them.
The limitations of conventional approaches to eliminatingmicronutrient deficiencies drives the search for a sustainable paradigm. This manuscript argues that the public and private sectors must embark on modernization of the Asian food industry and reorientation of the international agricultural research complex so that nutritionally enriched essential foods will be affordable and accessible to the poor. It is recommended that this partnership take special care of the needs of Asian children. The costs of chronic undernutrition, availability of cost-effective strategies, and benefits of sustained nutrition improvement to individuals, families and nations are reviewed. The roles of food fortification, plant breeding and biotechnology, both actual and imminent, are described. The paper concludes that a recast Green Revolution directed to dietary quality may be the key to enhancing the learning and earning capacity of young Asians of the new millenium.“No other technology offers as large and opportunity to improve lives...at such a low cost and in such a short time.."world Bank
Countries that have made the health transition from acommunicable disease base to a non-communicable disease base find themselves gripped in an epidemic of wealth created diseases mediated by altered macronutrient intakes, energy intakes and reduction in physical activity. Avoiding the negative impact of the nutrition transition while accepting the positive aspects of the wealth transition can best be achieved by focussing on publicising the benefits of a low fat diet in the context of an active lifestyle. How this is achieved should reflect ecologically sound food production appropriate to national needs. Countries that achieve this will be in the best position to capitalize on the reduction in communicable disease rates without causing a rise in non-communicable disease rates.
The prevalence of obesity is increasing in most parts of theworld and becoming one of the major global public health problems. Although the components of energy balance have not been adequately estimated over time, available evidence suggests that the increase in obesity is the result of reduced physical activity. Increases in physical activity have been shown to be strongly associated with improving physical fitness and body composition, with probably a positive effect on resting metabolic rate. The Surgeon General's Report on Physical Activity and Health advocates that 30 min of regular, moderate-intensity physical activity is associated with decreases in the risk of chronic diseases and may contribute to quality of life. However, the small changes that contribute 10 min for 3 times a day for aerobic training, or one set instead of three sets of repetitions on resistance training will provide individuals with health benefits. Indeed, nutrition and physical activity should be considered an integral part of fitness and good health, and should be encouraged in all age groups, particularly early in life. The question is no longer centered around the health benefit of increasing physical activity, but rather creating self awareness and behavior changes in individuals. Hence, effective intervention programs are needed that foster long term changes in physical activity. Among various interventions, the Nutrifit program was recently conducted in Thailand and found to improve health related fitness in children. The development of more effective interventions and approaches is a major challenge in this field today.
The key principle in the development of Codex standards is toensure that the decision-making process is based on sound science. The approval for the use of food additives and other chemicals in foods should be made only when adequate scientific data is available. The same principle applies to the development of maximum tolerable (or residue) levels for contaminants in foods. Using the General Standards for Contaminants and Toxins in Foods as an example, the following criteria are considered, when developing recommendations and standards: Toxicological information; Analytical data; Intake data; Fair trade considerations; Technological considerations; and Risk assessment and risk management considerations. The Codex Alimentarius Commission has repeatedly emphasized the use of risk analysis approach, in particular the use of risk assessment in conducting the safety evaluation of food additives, agricultural and veterinary chemicals and environmental and industrial contaminants in foods. In this respect, the well known efforts of the FAO/WHO Joint Expert Committee on Food Additives (JECFA) and the FAO/WHO Joint Meeting on Pesticide Residues (JMPR) provide the much needed information and recommendations for the risk assessment of specific chemicals. The risk assessment approach is also used in the safety evaluation of foods derived from modern biotechnology as well as in the quantitative assessment of microbiological risks in foods.