Non-Communicable Diseases (NCDs; e.g. heart disease, cancer, diabetes) collectively account for 71% of all deaths worldwide ^[1]. The World Health Organisation (WHO) holds data linking poor diet to NCDs and estimate that insufficient intake of fruit and vegetables is estimated to cause around 14% of gastrointestinal cancer deaths, about 11% of ischemic heart disease deaths and about 9% of stroke deaths worldwide ^[2].

The WHO Global Strategy on diet ^[3] emphasises the need to limit the consumption of saturated fats, trans fatty acids, salt and sugars, and to increase consumption of fruit and vegetables. It also addresses the role of prevention across sectors such as consumer education and communication including marketing, health claims and nutrition labelling as they affect food choices. It is predicted that future rates of increase in NCDs will be greatest in Africa and the Eastern Mediterranean (EM)^[4].

Researchers from Quadram Institute Bioscience (QIB) are at the cutting edge of research linking food with health; this research is underpinned by data collated, managed and made available by QIB’s ‘Food Databanks National Capability’. Sharing QIB expertise and tools with stakeholders in Africa and EM builds capacity and enables development of targeted dietary guidelines that can support reduction in the regional burden of NCDs.

The project

The aim of this QIB-led programme was to support the World Health Organisation (WHO) Action Plan for prevention and control of NCDs in Africa and EM ^{[5] [6]}. National and regional food composition and dietary intake databases are often missing or incomplete in these regions and in urgent need of standardised updating; accurate and comprehensive databases are essential for development of the dietary guidelines needed to encourage healthy eating and reduce disease risk. There was also a need identified for sharing QIB expertise on conducting human based research, food analysis methods and the microbes of fermented foods as this knowledge will support future nutritional research capacity in Africa and EM.

Workshops, hands-on demonstrations and training events were used to facilitate exchange of knowledge, tools and data, then encourage dialogue with a range of stakeholders.

Events were run in target countries, or at QIB (Norwich, UK) if access to specialist equipment was needed. Activities were achieved collaboratively with Wageningen University, European Food Information Resource (EuroFIR), the SMARTFOOD initiative, the AFROFOODS network (46 African countries represented with the aim to support and harmonise national collection and management of food composition data, part of the International Network of Food Data Systems, INFOODS), the International Livestock Research Institute (ILRI) and the University of Pretoria.

AFROFOODS officially requested in 2015 “That relevant and high-quality food composition data of African foods, including local and biodiverse foods are analysed, generated, compiled and published, also in national and regional food composition tables, with the aim to improve food and nutrition security.”

The outcomes

QIB experts provided advice at the 2016 EM regional WHO planning meeting, held in Morocco. A key recommendation on the roadmap for development that was produced was to conduct regional training for the organisations responsible for producing and publishing food composition data.

“Food composition data platforms are now being used in developing countries to determine dietary adequacy in multi-centre food security studies. This will greatly benefit future research.” Prof Hettie Schönfeldt, University of Pretoria.

Between 2016 and 2019, eleven scientists from QIB were involved in ten events, attended by approximately 200 stakeholders from 30 countries representing the WHO; universities; laboratory analysts; AFROFOODS; SMARTFOODS; Research Institutes and Non Government Organisations (NGOs) such as the National Nutrition Institute, the National Centre of Scientific Research and Technology (CNRST), the Council for Scientific and Industrial Research (CSIR) food research centre, the Institute of Applied Science and Technology Research (IRSAT), the International Crops Research Institute for the Aemi-Arid Tropics (ICRISAT), Amref health Africa and Bioversity International; government representatives from the Food and Drug Administration, Ministry of Health (or public health in some countries) and public health officers.

Workshop participants were asked how they will use their new knowledge: “In updating the Nigerian food composition database.” “In updating the Kenyan food composition database.” ”To continue with composition work across Africa.” ”To explore joint funding opportunities.” “It will assist in drafting policy and enforcement of regulatory mandates.”

The QIB-run events led to increased capacity for standardised nutritional research (for example, 89% of the Pretoria workshop participants and 100% of the Nairobi workshop participants reported improved knowledge that they would be able to immediately utilise within their work; 33% of the Nairobi participants had increased correspondence with other researchers, 67% had developed a collaborative project as a direct result of the training and 100% had trained or mentored colleagues based upon their new knowledge) and know-how that will enable African and EM nations to achieve good clinical practice in human based nutrition studies, utilise new methods in food analysis, establish and manage their own food databanks independently and use the information to develop dietary guidelines that will be instrumental in the management of Non-Communicable Diseases.

Through two-way dialogue with stakeholders the particular NCD-related problems faced by African and EM Nations were clarified, which will enable more informed nutritional research and policy development in these regions in the future.

The programme was also valuable for the facilitators who reported increased engagement with local researchers, improved understanding of how their work can be applied in the region, knowledge of associated research being conducted, new or planned collaborative projects with African based researchers of organisations, consulting opportunities and access to new samples or data.

Through standardisation of online food composition databases, providing access to analytical methods and tools developed by European Networks, and improving the estimates of nutrient intake and biomarkers QIB scientists, with African and EM partners, will inform new food and nutrition policies, regulatory measures, labelling and health advice.

Update July 2020

Dr Winifred Fila, a participant in the “conducting human-based research” workshop held in Nairobi during Feb 2018, has been in touch to let us know how she has used the skills and knowledge acquired at the workshop in a nutrition-based intervention study she led in Nigeria. Over a six-week period Winifred, a research student at the University of Calabar, Nigeria, evaluated the potential for fortifying infant diets using underutilized, locally available, plant and animal food sources; she focused particularly on the nutritional status of 6-23 month-old infants from a low-medium income area of Akpabuyo, Cross River State, Nigeria. Results demonstrated that diet fortification with the small bony fish, Ethmalosa fimbriate, vitamin A-rich plant foods and cereals improved nutrition-based health indicators, which supports WHO guidelines on breastfeeding and complementary food. It also provided comprehensive local data on infant diet and anthropometric indices e.g. weight, stunting, wasting and mid upper arm circumferences; this information will support development of targeted nutritional interventions in local communities in Cross River State.

Based on these results Winifred’s next steps are: 1) An in-depth examination of the shelf-life of particular foods and the value of composite flours for improving the nutritional content and safety of formulated diets and 2) Transferring knowledge and skills to rural women, thereby enabling them to make the most of these foods and improve the nutritional status of their children.

“I was able to utilize knowledge and skills acquired from the training in Nairobi to develop and run a successful nutrition intervention trial” said Dr Winifred Fila, University of Calabar, Nigeria.

Summary

In some countries within the African region the rates of overweight and obesity have reached epidemic proportions, with levels above 30-50% being recorded. Data published ^[7] indicates that the issues of obesity and hypertension are still increasing, making these types of interventions ever more important to support  savings in health care cost burdens and generate health and wellbeing impact in the long term.

QIB researchers have supported the development of food composition data in 21 countries during this project.

Improvements in the production and availability of national food composition data have been made in Africa and EM. This will help policymakers develop and update targeted strategies to reduce the burden of NCDs in these regions. These include food-based dietary guidelines that are effective in encouraging healthy eating.

The WHO are monitoring the progress of reducing the occurrence of Non-Communicable Diseases. In 2017 they reported that “We are on the path to tangible progress” ^[8]. This programme is only a tiny fraction of the worldwide WHO supporting mechanism but without it the food composition data in some countries would be less developed, government policies would be less informed and research in specific areas of relevance would not have been possible.

The programme was funded by the Global Challenges Research Fund (GCRF), a UK government initiative supporting cutting-edge research and innovation to address issues faced by developing countries. The initial activities were further advanced in 2018-19 through a second GCRF grant, which allowed progressional capacity building, specifically supporting the production of national food composition tables in the EM and laboratory training in food composition analysis.

References

¹ World Health Organisation (2018). Key facts data sheet. https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases

² WHO Africa Region Ministerial Consultation on NCDs (2011).  https://www.who.int/nmh/events/2011/africa_ncds_background_paper.pdf

³ The WHO Global strategy on diet (2006). http://apps.who.int/gb/archive/pdf_files/WHA59/A59_23-en.pdf?ua=1

⁴ World Health Organisation (2010). Global status report on noncommunicable diseases. Chapter one. https://www.who.int/nmh/publications/ncd_report_chapter1.pdf

⁵ World Health Organisation (2011) Plan of action for the prevention and control of noncommunicable diseases in the Eastern Mediterranean Region. Published by the. WHO-EM/NCD/067/E. http://applications.emro.who.int/dsaf/dsa1217.pdf?ua=1

⁶ World Health Organisation (2012) Promoting a healthy diet for the WHO Eastern Mediterranean Region: User friendly guide. http://applications.emro.who.int/dsaf/emropub_2011_1274.pdf?ua=

⁷ NCD regional profile – Africa region https://www.spring-nutrition.org/sites/default/files/publications/briefs/spring_ncd_africa_summary_profile_1.pdf

⁸ NCD progress monitor 2017. https://apps.who.int/iris/bitstream/handle/10665/258940/9789241513029-eng.pdf?sequence=1