2.3 Recommendations for healthy diets and physical activity

maternal morbidity (hypertensive pregnancy disorders such as pre-eclampsia and eclampsia, overweight and obesity, and depression) and mortality (30). The financial consequences of living with NCDs may be more profound in women; with less access to resources, women are more likely to forego treatment for NCDs, especially in LMICs (31).

2.3.1 Healthy diets

Nutrition guidelines and recommendations have been developed in response to evidence and data from scientific research. Between 1996 and 2019, WHO developed or updated more than 50 nutrition guidelines or recommendations, including with the UN Food and Agriculture Organization (FAO) (32). In 2019, WHO and FAO guidance noted that there are divergent views on the concepts of sustainable diets and healthy diets, and suggested that “countries should decide on the trade-offs according to health situations and goals” (32). Box 2.1 summarizes WHO recommendations for healthy diets in different publications.

Box 2.1. WHO recommendations for healthy diets

“According to WHO, healthy diets protect against malnutrition in all its forms, including non-communicable diseases (NCDs) such as diabetes, heart disease, stroke and cancer. Healthy diets contain a balanced, diverse and appropriate selection of foods eaten over a period of time. In addition, a healthy diet ensures that a person’s needs for macronutrients (proteins, fats and carbohydrates, including dietary fibre) and essential micronutrients (vitamins and minerals) are met, specific to their gender, age, physical activity level and physiological state… While the exact make-up of a healthy diet varies depending on individual characteristics, as well as cultural context, locally available foods and dietary customs, the basic principles of what constitutes a healthy diet are the same” (33):

• consumption of at least 400 g (i.e. five portions) of fruits and vegetables per day; • limiting the intake of free sugar to less than 10% of total energy intake (10);a • limiting the intake of fat to less than 30% of total energy intake; • a preference for unsaturated rather than saturated fats (34, 35);b • reducing the intake of saturated fats to less than 10% of the total energy intake and trans fats to less than 1% (34); • complete avoidance of industrially produced trans fats (34, 35);c • less than 5 g (equivalent to 1 teaspoon) of salt intake per day for adults (and even less for children) (9); and • breastfeeding for children (exclusively for the first 6 months and continuously until 2 years and beyond), with the introduction of complementary foods after 6 months (36).

a The WHO guidelines define free sugar to include “monosaccharides and disaccharides added to foods and beverages by the manufacturer, cook or consumer, and sugars naturally present in honey, syrups, and fruit juice concentrates”. b Unsaturated fats are those found in fish, avocado, nuts, and sunflower, soybean and canola oils. Saturated fats are found in fatty meat, butter, palm and coconut oil, cream, cheese, ghee and lard. c Trans fats are found in baked and fried foods, and pre-packaged snacks and foods, such as frozen pizza, pies, cookies, biscuits, wafers, and cooking oils and spreads. Ruminant trans fats are found in meat and dairy foods from ruminant animals.