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Tracing Africa's progress towards implementing the Non-Communicable Diseases Global action plan 2013-2020: a synthesis of WHO country profile reports.
BMC Public Health. 2017 Apr 05; 17(1):297.BACKGROUND: Half of the estimated annual 28 million non-communicable diseases (NCDs) deaths in low- and middle-income countries (LMICs) are attributed to weak health systems. Current health policy responses to NCDs are fragmented and vertical particularly in the African region. The World Health Organization (WHO) led NCDs Global action plan 2013-2020 has been recommended for reducing the NCD burden but it is unclear whether Africa is on track in its implementation. This paper synthesizes Africa's progress towards WHO policy recommendations for reducing the NCD burden. METHODS: Data from the WHO 2011, 2014 and 2015 NCD reports were used for this analysis. We synthesized results by targets descriptions in the three reports and included indicators for which we could trace progress in at least two of the three reports. RESULTS: More than half of the African countries did not achieve the set targets for 2015 and slow progress had been made towards the 2016 targets as of December 2013. Some gains were made in implementing national public awareness programmes on diet and/or physical activity, however limited progress was made on guidelines for management of NCD and drug therapy and counselling. While all regions in Africa show waning trends in fully achieving the NCD indicators in general, the Southern African region appears to have made the least progress while the Northern African region appears to be the most progressive. CONCLUSION: Our findings suggest that Africa is off track in achieving the NCDs indicators by the set deadlines. To make sustained public health gains, more effort and commitment is urgently needed from governments, partners and societies to implement these recommendations in a broader strategy. While donors need to suit NCD advocacy with funding, African institutions such as The African Union (AU) and other sub-regional bodies such as West African Health Organization (WAHO) and various country offices could potentially play stronger roles in advocating for more NCD policy efforts in Africa.
New York, United Nations System Standing Committee on Nutrition, 2017 Apr. 32 p.The paper aims to present the centrality of nutrition in the current sustainable development agenda. It provides an overview of the numerous and inter-related nutrition targets that have been agreed upon by intergovernmental bodies, placing these targets in the context of the SDGs and the UN Decade of Action on Nutrition. As such, this paper does not give a full technical analysis of the nutrition landscape but rather connects the dots between the various identified areas for policies and action. It aims to inform nutrition actors, including non-traditional ones, regarding opportunities to be engaged and connected in a meaningful way.
Dietary Inadequacies in HIV-infected and Uninfected School-aged Children in Johannesburg, South Africa.
Journal of Pediatric Gastroenterology and Nutrition. 2017 Mar 22;OBJECTIVES: The World Health Organization (WHO) recommends that HIV-infected children increase energy intake and maintain a balanced macronutrient distribution for optimal growth and nutrition. Few studies have evaluated dietary intake of HIV-infected children in resource-limited settings. METHODS: We conducted a cross-sectional analysis of the dietary intake of 220 perinatally HIV-infected children and 220 HIV-uninfected controls ages 5–9 years in Johannesburg, South Africa. A standardized 24-hour recall questionnaire and software developed specifically for the South African population was used to estimate intake of energy, macronutrients, and micronutrients. Intake was categorized based on recommendations by the WHO and Acceptable Macronutrient Distribution Ranges (AMDRs) established by the Institute of Medicine (IOM). RESULTS: The overall mean age was 6.7 years and 51.8% were boys. Total energy intake was higher in HIV-infected than HIV-uninfected children (1341 vs. 1196 kcal/day, p=0.002), but proportions below the recommended energy requirement were similar in the two groups (82.5 vs. 85.2%, p=0.45). Overall, 51.8% of the macronutrient energy intake was from carbohydrates, 13.2% from protein, and 30.8% from fat. The HIV-infected group had a higher percentage of their energy intake from carbohydrates and lower percentage from protein compared to the HIV-uninfected group. Intakes of folate, vitamin A, vitamin D, calcium, iodine, and selenium were suboptimal for both groups. CONCLUSIONS: Our findings suggest that the typical diet of HIV-infected children as well as uninfected children in Johannesburg, South Africa does not meet energy or micronutrient requirements. There appear to be opportunities for interventions to improve dietary intake for both groups.
From the first hour of life: making the case for improved infant and young child feeding everywhere.
2016 Oct; New York, New York, UNICEF, 2016 Oct. 104 p.Food and feeding practices from birth to age 2 have a profound impact on the rest of a child’s life. Good nutrition helps children exercise their rights to grow, learn, develop, participate and become productive members of their communities. This report provides a global status update on infant and young child feeding practices, and puts forth recommendations for improving them.
Rome, Italy, Food and Agriculture Organization of the United Nations [FAO], 2016. 57 p.This compendium has been designed to support officers responsible for designing nutrition-sensitive food and agriculture investments, in selecting appropriate indicators to monitor if these investments are having an impact on nutrition (positive or negative) and if so, through which pathways. It provides an overview of indicators that can be relevant as part of a nutrition-sensitive approach, together with guidance to inform the selection of indicators. The purpose of this compendium is to provide a current compilation of indicators that may be measured for identified outcomes of nutrition-sensitive investments. This compendium does not provide detailed guidance on how to collect a given indicator but points to relevant guidance materials. This compendium does not represent official FAO recommendations for specific indicators or methodologies. It is intended only to provide information on the indicators, methodologies and constructs that may be relevant to consider in the monitoring and evaluation of nutrition-sensitive agriculture investments. It is not envisaged that a single project should collect data on all the indicators presented here. The selection will be informed by the type of intervention implemented, the anticipated intermediary outcomes and nutritional outcomes, as well as the feasibility of data collection in view of available resources and other constraints. The advice of M&E experts and subject matter specialists, should be sought in making the final choice of indicators and in planning the data collection and analysis, including sampling and design of questionnaires. This compendium deals with programmes, projects and investments. While some indicators may be relevant for routine monitoring at national scale, this document does not cover every indicator that would be needed to monitor nutrition sensitivity of policies. (Excerpt)
[Washington, D.C.], World Bank, 2010 Jun. 4 p. (en breve No. 157)Children in Haiti are born into some of the harshest conditions on the planet, and are left at a disadvantage in terms of growth, development, and potential to thrive. Malnutrition rates in Haiti are among the worst in the LAC region. Nearly one-third of all children under-five suffer from stunted growth and three-quarters of children 6-24 months are anemic. Malnutrition takes a serious and irreversible toll, making children more susceptible to disease and death and compromising their cognitive and physical development, which results in low human capital and diminished lifetime earnings. Yet, scaling up ten key nutrition interventions in Haiti is estimated to cost only $46.5 million per year, which is less than 1% of Haiti’s total GDP. (excerpt)
Selecting desirable micronutrient fortificants for plant-based complementary foods for infants and young children in low-income countries.
Journal of the Science of Food and Agriculture. 2015 Jan; 95(2):221-4.The World Health Organization (WHO) recommends that both breast-fed and non-breast-fed children are fed micronutrient fortified complementary foods designed to meet their high nutrient requirements from aged 6 to 23 months of age. This paper summarises the steps recommended by WHO/FAO to identify the country-specific micronutrient shortfalls in complementary diets and establish desirable levels of bioavailable fortificants for centrally processed plant-based complementary foods for infant and young child feeding. The goal of the WHO/FAO guidelines is to achieve a desirably low prevalence of inadequate micronutrient intakes in the target group whilst simultaneously ensuring minimal risk of excessive intakes. (c) 2014 Society of Chemical Industry.
BMC Public Health. 2013; 13 Suppl 3:S17.BACKGROUND: Current WHO guidelines on the management and treatment of diarrhea in children strongly recommend continued feeding alongside the administration of oral rehydration solution and zinc therapy, but there remains some debate regarding the optimal diet or dietary ingredients for feeding children with diarrhea. METHODS: We conducted a systematic search for all published randomized controlled trials evaluating food-based interventions among children under five years old with diarrhea in low- and middle-income countries. We classified 29 eligible studies into one or more comparisons: reduced versus regular lactose liquid feeds, lactose-free versus lactose-containing liquid feeds, lactose-free liquid feeds versus lactose-containing mixed diets, and commercial/specialized ingredients versus home-available ingredients. We used all available outcome data to conduct random-effects meta-analyses to estimate the average effect of each intervention on diarrhea duration, stool output, weight gain and treatment failure risk for studies on acute and persistent diarrhea separately. RESULTS: Evidence of low-to-moderate quality suggests that among children with acute diarrhea, diluting or fermenting lactose-containing liquid feeds does not affect any outcome when compared with an ordinary lactose-containing liquid feeds. In contrast, moderate quality evidence suggests that lactose-free liquid feeds reduce duration and the risk of treatment failure compared to lactose-containing liquid feeds in acute diarrhea. Only limited evidence of low quality was available to assess either of these two approaches in persistent diarrhea, or to assess lactose-free liquid feeds compared to lactose-containing mixed diets in either acute or persistent diarrhea. For commercially prepared or specialized ingredients compared to home-available ingredients, we found low-to-moderate quality evidence of no effect on any outcome in either acute or persistent diarrhea, though when we restricted these analyses to studies where both intervention and control diets were lactose-free, weight gain in children with acute diarrhea was shown to be greater among those fed with a home-available diet. CONCLUSIONS: Among children in low- and middle-income countries, where the dual burden of diarrhea and malnutrition is greatest and where access to proprietary formulas and specialized ingredients is limited, the use of locally available age-appropriate foods should be promoted for the majority of acute diarrhea cases. Lactose intolerance is an important complication in some cases, but even among those children for whom lactose avoidance may be necessary, nutritionally complete diets comprised of locally available ingredients can be used at least as effectively as commercial preparations or specialized ingredients. These same conclusions may also apply to the dietary management of children with persistent diarrhea, but the evidence remains limited.
Geneva, Switzerland, WHO, 2014.  p. (WHO/NMH/NHD/14.3)In 2012, the World Health Assembly Resolution 65.6 endorsed a Comprehensive implementation plan on maternal, infant and young child nutrition, which specified six global nutrition targets for 2025. This policy brief covers the first target: a 40% reduction in the number of children under-5 who are stunted. The purpose of this policy brief is to increase attention to, investment in, and action for a set of cost-effective interventions and policies that can help Member States and their partners in reducing stunting rates among children aged under 5 years. (Excerpts)
Geneva, Switzerland, WHO, 2014.  p. (WHO/NMH/NHD/14.6)In 2012, the World Health Assembly Resolution 65.6 endorsed a Comprehensive implementation plan for maternal, infant and young child nutrition, which specified six global nutrition targets for 2025. This policy brief covers the fourth target: No increase in childhood overweight. The purpose of this policy brief is to increase attention to, investment in, and action for a set of cost-effective interventions and policies that can help Member States and their partners prevent continued increases in overweight in children and ensure that the target is met. (Excerpts)
World Health Organization infant and young child feeding indicators and their associations with child anthropometry: a synthesis of recent findings.
Maternal and Child Nutrition. 2014 Jan; 10(1):1-17.As the World Health Organization (WHO) infant and young child feeding (IYCF) indicators are increasingly adopted, a comparison of country-specific analyses of the indicators’ associations with child growth is needed to examine the consistency of these relationships across contexts and to assess the strengths and potential limitations of the indicators. This study aims to determine cross-country patterns of associations of each of these indicators with child stunting, wasting, height-for-age z-score (HAZ) and weight-for-height z-score (WHZ). Eight studies using recent Demographic and Health Surveys data from a total of nine countries in sub-Saharan Africa (nine), Asia (three) and the Caribbean (one) were identified. The WHO indicators showed mixed associations with child anthropometric indicators across countries. Breastfeeding indicators demonstrated negative associations with HAZ, while indicators of diet diversity and overall diet quality were positively associated with HAZ in Bangladesh, Ethiopia, India and Zambia (P < 0.05).These same complementary feeding indicators did not show consistent relationships with child stunting. Exclusive breastfeeding under 6 months of age was associated with greater WHZ in Bangladesh and Zambia (P < 0.05), although CF indicators did not show strong associations with WHZ or wasting. The lack of sensitivity and specificity of many of the IYCF indicators may contribute to the inconsistent associations observed.The WHO indicators are clearly valuable tools for broadly assessing the quality of child diets and for monitoring population trends in IYCF practices over time. However, additional measures of dietary quality and quantity may be necessary to understand how specific IYCF behaviours relate to child growth faltering.
Rome, Italy, FAO, 2013.  p.Malnutrition in all its forms imposes unacceptably high costs on society in human and economic terms. Addressing malnutrition requires a multisectoral approach that includes complementary interventions in food systems, public health and education. Within a multisectoral approach, food systems offer many opportunities for interventions leading to improved diets and better nutrition. Agricultural production and productivity growth remain essential for better nutrition, but more can be done. Both traditional and modern supply chains offer risks and opportunities for achieving better nutrition and more sustainable food systems. Consumers ultimately determine what they eat and therefore what the food system produces. Better governance of food systems at all levels, facilitated by high-level political support, is needed to build a common vision, to support evidence-based policies, and to promote effective coordination and collaboration through integrated, multisectoral action. (Excerpts)
Zinc treatment to under-five children: applications to improve child survival and reduce burden of disease.
Journal of Health, Population, and Nutrition. 2008 Sep; 26(3):356-65.Zinc is an essential micronutrient associated with over 300 biological functions. Marginal zinc deficiency states are common among children living in poverty and exposed to diets either low in zinc or high in phytates that compromise zinc uptake. These children are at increased risk of morbidity due to infectious diseases, including diarrhoea and respiratory infection. Children aged less than five years (under-five children) and those exposed to zinc-deficient diets will benefit from either daily supplementation of zinc or a 10 to 14-day course of zinc treatment for an episode of acute diarrhoea. This includes less severe illness and a reduced likelihood of repeat episodes of diarrhoea. Given these findings, the World Health Organization/United Nations Children's Fund now recommend that all children with an acute diarrhoeal illness be treated with zinc, regardless of aetiology. ICDDR.B scientists have led the way in identifying the benefits of zinc. Now, in partnership with the Ministry of Health and Family Welfare, Government of Bangladesh and the private sector, the first national scaling up of zinc treatment has been carried out. Important challenges remain in terms of reaching the poorest families and those living in remote areas of Bangladesh.
Non-communicable diseases and global health governance: Enhancing global processes to improve health development.
Globalization and Health. 2007 May 22; 3(1):2.This paper assesses progress in the development of a global framework for responding to non-communicable diseases, as reflected in the policies and initiatives of the World Health Organization (WHO), World Bank and the UN: the institutions most capable of shaping a coherent global policy. Responding to the global burden of chronic disease requires a strategic assessment of the global processes that are likely to be most effective in generating commitment to policy change at country level, and in influencing industry behaviour. WHO has adopted a legal process with tobacco (the WHO Framework Convention on Tobacco Control), but a non-legal, advocacy-based approach with diet and physical activity (the Global Strategy on Diet, Physical Activity and Health). The paper assesses the merits of the Millennium Development Goals (MDGs) and the FCTC as distinct global processes for advancing health development, before considering what lessons might be learned for enhancing the implementation of the Global Strategy on Diet. While global partnerships, economic incentives, and international legal instruments could each contribute to a more effective global response to chronic diseases, the paper makes a special case for the development of international legal standards in select areas of diet and nutrition, as a strategy for ensuring that the health of future generations does not become dependent on corporate charity and voluntary commitments. A broader frame of reference for lifestyle-related chronic diseases is needed: one that draws together WHO's work in tobacco, nutrition and physical activity, and that envisages selective use of international legal obligations, non-binding recommendations, advocacy and policy advice as tools of choice for promoting different elements of the strategy. (author's)
Feeding of nonbreastfed children from 6 to 24 months of age: Conclusions of an informal meeting on infant young child feeding organized by the World Organization, Geneva, March 8-10, 2004.
Food and Nutrition Bulletin. 2004; 25(4):403-406.According to current United Nations recommendations, infants should be exclusively breastfed for the first six months of life and thereafter should receive appropriate complementary feeding with continued breastfeeding up to two years or beyond. However, there are a number of infants who will not enjoy the benefits of breastfeeding in the early months of life or for whom breastfeeding will stop before the recommended period of two years or beyond. A group that calls for particular attention consists of the infants of mothers who are known to be HIV positive. To reduce the risk of HIV transmission, it is recommended that when it is acceptable, feasible, affordable, sustainable, and safe, these mothers give replacement feeding from birth. Otherwise, they should breastfeed exclusively and stop as soon as alternative feeding options become feasible. Another group includes those infants whose mothers have died, or who for some reason do not breastfeed. (excerpt)
Food and Nutrition Bulletin. 2001; 22(4):352-356.In several Eastern and Southern African countries, between one-third and one-half of the children are vitamin A deficient. Not just one strategy, but a combination of supplementation, fortification, and dietary diversification will provide the solution to the elimination of vitamin A deficiency. Food diversification in general is limited by increasing poverty and household food insecurity. Supplementation coverage rates increased from an average of 22% to 68% during the last four years. This was mainly due to integration of supplementation into national immunization days. Now the challenge is to integrate supplementation into sustainable delivery systems. Several countries have started or are planning maize and/or sugar fortification initiatives, but most of the experience so far has been on a pilot scale, and little is known about the impact of the interventions. There is a need to develop strategies for vitamin A supplementation and fortification of different foods to reach all areas and individuals in a country. (author's)
Annals of Oncology. 2006; 17 Suppl 8: p..The burden of cancer in developing countries is growing and threatens to exact a heavy morbidity, mortality, and economic cost in these countries in the next 20 years. The unfolding global public health dimensions of the cancer pandemic demand a widespread effective international response. The good news is that the majority of cancers in developing countries are preventable, and the efficacy of treatment can be improved with early detection. Currently, the knowledge exists to implement sound, evidence-based practices in cancer prevention, screening/early detection, treatment, and palliation. It is estimated that the information at hand could prevent up to one-third of new cancers and increase survival for another one-third of cancers detected at an early stage. To achieve this, knowledge must be translated into action. To facilitate the call to action in the fight against cancer, the World Health Organization (WHO) has developed a comprehensive approach to cancer control. The WHO has produced many valuable guidelines and resources for the effective implementation of national cancer control programs. Several milestones in the WHO's efforts include the Framework Convention for Tobacco Control, and global strategies for diet and exercise, reproductive health, and cervical cancer. This review examines the strategies and approaches that have successfully resulted into global action to confront the rising global burden of cancer in the developing world. (author's)
Genus. 2005 Jul-Dec; 61(3-4):215-246.Since the Rome Population Conference the perceptions of the relationship between population dynamics and food security have undergone significant changes, ranging from fear of unyielding famines caused by explosive population growth to strong confidence in the capacity of the world to stand up to the challenge of growth. Many novel factors, unpredictable at the time, radically changed the scene throughout the half century. Unprecedented population growth happened during times of growing incomes and soaring agricultural production. Emerging actors such as the international agricultural research system played an important role, while emerging factors such as the AIDS epidemic have changed the parameters of the equation. With a world population that will significantly increase in the twenty first century, and that will, for the first time in history, be more urban than rural, not only will the total demand for food be greater than it has ever been, but the nature of that demand will be different. In many countries, changes have been taking place in dietary habits, as well as in methods of food production, processing and marketing, while international trade in raw commodities and processed foods has also grown substantially. (excerpt)
SAJCN. South African Journal of Clinical Nutrition. 2001 Sep; 14(3): p..The massive global burden of diet-related diseases and the growing perception that nutrient-based dietary guidelines are not effective in promoting appropriate diets and healthy lifestyles have motivated a number of countries and regions to develop food-based dietary guidelines (FBDGs). In this issue of the journal, the South African FBDGs are defined and motivated in technical support papers for nutrition scientists and professionals. A working group representing different stakeholders developed the guidelines over a period of 4 years. The process recommended by a joint FAO/WHO expert consultation was followed. The guidelines can now be used as a consistent communication tool because they represent expert agreement on how diet-related public health problems should be addressed by dietary recommendations to consumers. But they can also be used as basis in the planning, implementation and evaluation of public health nutrition strategies. National adoption and use of these guidelines will show a political will to tackle nutrition-related health problems. (excerpt)
Improvement of oral health in Africa in the 21st century -- the role of the WHO Global Oral Health Programme.
African Journal of Oral Health. 2004; 1(1):2-16.Chronic diseases and injuries are overtaking communicable diseases as the leading health problems in all but a few parts of the world. This rapidly changing global disease pattern is closely linked to changing lifestyles which include diet rich in sugars, widespread use of tobacco and increased consumption of alcohol. These lifestyle factors also significantly impact oral health, and oral diseases qualify as major public health problems owing to their high prevalence and incidence in all regions of the world. Like all diseases, they affect primarily the disadvantaged and socially marginalized populations, causing severe pain and suffering, impairing functionability and impacting quality of life. Traditional treatment of oral diseases is extremely costly even in industrialized countries and is unaffordable in most low and middle-income countries. The WHO Global Strategy for prevention and control of noncommunicable diseases and the "common risk factor approach" offer new ways of managing the prevention and control of oral diseases. This report outlines major characteristics of the current oral health situation in Africa and development trends as well as WHO strategies and approaches for better oral health in the 21st century. (author's)
FAO sees decline in 'undernutrition', but the number of hungry continues to grow - Food and Agriculture Organization.
UN Chronicle. 1986 Apr; 23: p..For the first time in 40 years a decline in the incidence of undernutrition in the developing world has been detected by the Food and Agriculture Organization (FAO). Rapid population growth, however, has pushed the number of hungry people slightly upwards, according to FAO's Fifth World Food Survey, published in December. "There is evidence of a turn in the tide', FAO Director-General Edouard Saouma states in the foreword to the Survey. But he cautions that there are no grounds for complacency. "As we have seen from the current African food crisis, widespread malnutrition can all too quickly turn into actual famine and starvation'. The Survey provides both high and low estimates of the undernourished, which reflect two interpretations of the body's energy requirements. According to lower estimates, at least 335 million people in the developing market economies were undernourished in 1979-1981, some 10 million more than a decade before. However, the proportion of people suffering from hunger dropped from 19 to 15 per cent of the total population. (excerpt)
Public Health Nutrition. 2005 Oct; 8(7A):932-939.This background paper considers the extent to which the development of new recommendations for dietary energy requirements needs to account for the macronutrient (fat, carbohydrate, protein and alcohol) profiles of different diets. The issues are discussed from the dual perspectives of avoiding under-nutrition and obesity. It is shown that, in practice, human metabolic processes can adapt to a wide range of fuel supply by altering fuel selection. It is concluded that, at the metabolic level, only diets with the most extreme macronutrient composition would have any consequences by exceeding the natural ability to modify fuel selection. However, diets of different macronutrient composition and energy density can have profound implications for innate appetite regulation and hence overall energy consumption. (author's)
Nutritional Surveillance Project Bulletin. 2001 Jul; (6):1-4.The transition from being exclusively breast-fed to eating the same food as the family is crucial in the life of a young child. The World Health Organization and UNICEF recommend that infants should be exclusively breast-fed for the first 6 months of life and that breastfeeding should continue well into the second year of life. From 6 months of age infants should be given frequent small complementary meals that are rich in micronutrients, protein and energy. Findings from the Nutritional Surveillance Project indicate that, while breastfeeding is sustained, infants are rarely given foods containing micronutrients and protein, even when these foods are available in the household. This suggests that there is potential to improve infants’ diets by making better use of the foods already available in the household. Breast-milk and a good mixture of well-prepared family food can meet the needs of young children during this vulnerable time. (author's)
Manila, Philippines, World Health Organization [WHO], Regional Office for the Western Pacific, 2003.  p.The objective of this paper is to review documented evidence and examine the relationships between the food supply, dietary patterns and obesity in Pacific countries. Obesity and consumption of imported foods seems to be an urban phenomenon in the Pacific. A suitable definition for a recommended proportion of fat in a national diet has been established. Before European contact, the food behaviour of the people of the Pacific region may have remained the same for millennia. The main staples were root crops. Upon European contact, Pacific people were described as strong, muscular and mostly in good health. The leaders and ruling classes appeared to be obese and high value was placed on fatty foods. Daily food intake consisted of large quantities of starchy roots supplemented with leaves, fish, coconuts and fruits. (excerpt)
Journal of Nutrition. 2004 May; 134(5):1175-1180.The WHO recently conducted, within its Global Burden of Disease 2000 Study, a Comparative Risk Assessment (CRA) to estimate the global health effect of low fruit and vegetable intake. This paper summarizes the methods used to obtain exposure data for the CRA and provides estimates of worldwide fruit and vegetable intakes. Intakes were derived from 26 national population-based surveys, complemented with food supply statistics. Estimates were stratified by 14 subregions, 8 age groups, and gender. Subregions were categorized on the bases of child mortality under age 5 y and 15- to 59-y-old male mortality (A: very low child and adult mortality; B: low child and adult mortality; C: low child, high adult mortality; D: high child and adult mortality; E: high child, very high adult mortality). Mean intakes were highest in Europe A [median = 449 g/(person • d)] and the Western Pacific Region A. They were lowest in America B [median = 192 g/(person • d)], and low in Europe C, the South East Asian Regions B and D, and Africa E. Children and elderly individuals generally had lower intakes than middle-aged adults. SDs varied considerably by region, gender, and age [overall median = 223 g/(person • d)]. Assessing exposure levels for the CRA had major methodological limitations, particularly due to the lack of nationally representative intake data. The results showed mean intakes generally lower than current recommendations, with large variations among subregions. If the burden of disease attributable to dietary factors is to be assessed more accurately, more countries will have to assess the dietary intake of their populations using comparable methods. (author's)