Perspective: Achieving Sustainable Healthy Diets Through Formulation and Processing of Foods.

Food processing and food (re)formulation can contribute to achieving sustainable healthy diets. Distinct from product formulation, the main purpose of food processing is to provide a stable and resilient supply of safe, shelf-stable, and affordable foods. Although efforts at reformulating processed foods have focused on removing excess added fat, sugar, and salt, product formulation can also take the form of voluntary fortification with protein, fiber, and micronutrients to improve dietary nutrient density and address population health needs. Advances in food technology have also led to the addition of desirable ingredients, including plant-based proteins and fermentation products, to processed foods. Among continuing challenges to product (re)formulation are the need to ensure product safety, maintain sensory appeal, control product cost, assure consumer acceptance, and manage the environmental footprint across the value chain. Voluntary (re)formulation of processed foods by the food industry can help improve diet quality and food security for all.

Market-Driven Food Fortification to Address Dietary Needs.

The global economic and health-related burden of micronutrient deficiency is very large. Reducing these deficiencies is one of the main objectives of the Global Nutrition Targets 2025 of the WHO. To address this form of malnutrition, the WHO/FAO has defined fortification as one of the possible public health interventions, and voluntary fortification is one of the possible fortification approaches. Voluntary fortification can contribute to meeting nutritional requirements in targeted and untargeted populations as long as specific food vehicles are used and specific consumer demands are addressed. Fortified foods should be consumed regularly and need to be affordable, safe, and meet consumer preferences. Two types of fortified food groups will illustrate this form of fortification, namely targeted fortification with complementary feeding (or fortified infant cereals), and market-driven mass fortification as achieved with fortified condiments.

Integrating nutrition science and consumer behaviour into future food policy.

The session 'Advancing risk assessment science - Nutrition' at EFSA's third Scientific Conference 'Science, Food and Society' aimed to foster the ongoing debate on the extent to which single nutrients, whole foods and overall diets may impact human health in wealthy populations, and to explore how societal and technological developments could affect food choices and diets in the future. The overarching goal of the session was to discuss how dietary guidelines could evolve to account for the switch from single nutrient deficiencies to diseases of malnutrition in all its forms as the predominant public health concern in developed countries. Speakers addressed the contribution of single nutrients to the prevalence of chronic metabolic diseases, discussed the need to move towards diets focusing on whole foods and overall eating patterns, provided insides on food innovation and consumer behaviour and stressed the need for multidisciplinary approaches to face these challenges.

Novel public-private partnerships to address the double burden of malnutrition.

Public-private partnerships are an effective way to address the global double burden of malnutrition. While public-private partnerships operate in multiple forms, their leadership usually falls to governments, public health agencies, or nongovernmental organizations, with the private sector taking a subordinate role. The rapid ascent of social media and mass communications worldwide has provided a disruptive technology for new nutrition intervention programs. A new model, provisionally called private-public engagement, takes advantage of social media, mass media, and integrated social marketing to reach parents, families, and communities directly. These new private-public engagement initiatives need to be managed in ways suggested for public-private partnerships by the World Health Organization, especially if the private sector is in the lead. Once the rationale for engagement is defined, there is a need to mobilize resources, establish in-country partnerships and codes of conduct, and provide a plan for monitoring, evaluation, and accountability. Provided here is an example consistent with the private-public engagement approach, ie, the United for Healthier Kids program, which has been aimed at families with children aged less than 12 years. Materials to inspire behavioral change and promote healthier diets and lifestyle were disseminated in a number of countries through both digital and physical channels, often in partnership with local or regional governments. A description of this program, along with strategies to promote transparency and communication among stakeholders, serves to provide guidance for the development of future effective private-public engagements.

Sustainable clinical research, health economic aspects and medical marketing: drivers of product innovation.

Marketing-driven innovation in the field of pediatric nutrition, in particular in the infant formula segment is not sustainable. New benefits of products must be scientifically proven and safety and efficacy of new formulae established in clinical trials. The scientific innovation process of three infant formulae is described. Improvement in protein quality allowed to reduce the protein concentration in whey-based infant formula. Weight gain and BMI of infants fed those formulae corresponds to breastfed infants and is lower than in infants fed traditional formulae with higher protein concentration. A meta-analysis indicates associations between rapid weight gain in infancy and obesity later in life. If infants cannot be exclusively breastfed until 4-6 months of age, feeding low-protein formulae may contribute to positive long-term health outcome with potentially important health economic effects. A partially hydrolyzed whey based formula for prevention of allergic symptoms in children with hereditary risk for allergic diseases was developed more than 25 years ago. The most recent meta-analysis which included 15 randomized clinical trials indicates that the risk of all allergic diseases and atopic dermatitis/eczema is significantly reduced in infants at risk when the partially hydrolyzed formula is fed. The partially hydrolyzed formula had the same protective effect as casein-based high-degree extensively hydrolyzed formula. Because of substantial price differences between the two formulae, feeding the partially hydrolyzed whey formula is cost saving. Hypoallergenic claims can be made in many countries, and international nutrition committees have positively commented the preventive effect of those formulae. Acidified formulae have been widely used during the last decade in replacement feeding programs for infants whose mothers are HIV positive. The formula was innovated by improving whey protein quality and lowering protein concentration. The bacteriostatic properties of the new formula were proven in in vitro tests. Meta-analysis indicated that feeding the formula to immunocompromised infants resulted in growth similar to breastfeeding. The bacteriostatic effects of the acidified formula need to be communicated to health care professionals, but also the risks if replacement feeding is not acceptable, feasible, affordable, sustainable, and safe for mother and infant.

Supplementation with 200 mg/day docosahexaenoic acid from mid-pregnancy through lactation improves the docosahexaenoic acid status of mothers with a habitually low fish intake and of their infants.

BACKGROUND/AIMS: The supply of docosahexaenoic acid (DHA, 22:6omega-3), important for fetal/infant neurodevelopment, depends on the maternal fatty acid (FA) status, which may be marginal in central Europe. Therefore, we investigated the effect of a daily vitamin/mineral supplement with and without 200 mg DHA from mid-pregnancy through lactation on the DHA concentrations in maternal and infant red blood cell phospholipids (RBC%), and in breast milk FA (%). METHODS: At 21 weeks' gestation, 144 women were enrolled into a randomised, double-blind clinical trial receiving daily: (1) a basic vitamin-mineral supplement (Vit/Min group), (2) Vit/Min plus 4.5 g fructo-oligosaccharide (FOS group), or (3) Vit/Min plus 4.5 g FOS plus 200 mg fish oil-derived DHA (DHA-FOS group). FAs were determined by capillary gas-liquid chromatography. RESULTS: While maternal RBC-DHA% at enrolment was not different, at 37 weeks gestation, and 3 months after delivery RBC-DHA% were significantly higher in the DHA-FOS group. The breast milk DHA% was twice as high in the DHA-FOS group (0.50%) than in the two others (0.25 %) (p < 0.001), and the ratio ARA/DHA in the DHA-FOS group was 1.0 +/- 0.43, in the others 2.1 +/- 0.43 (p < 0.001). The RBC-DHA% of the infants in the DHA-FOS group was also significantly higher, and correlated significantly with maternal RBC-DHA% before and 3 months after delivery. CONCLUSIONS: In central Europe, a dose of 200 mg/day DHA from mid-pregnancy through lactation seems appropriate to improve the DHA status of mothers and infants.