What makes a healthy diet a healthy diet? Challenges and opportunities for defining, measuring, and evaluating the health impact of diet at the population level Ashkan Afshin, MD MPH MSc ScD November 15, 2016 Acting Assistant Professor of Global Health
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What makes a healthy diet a healthy diet?Challenges and opportunities for defining, measuring, and evaluating the health impact of diet at the population level
Ashkan Afshin, MD MPH MSc ScD November 15, 2016Acting Assistant Professor of Global Health
Policy Formulation
PolicyAdoption
Policy Implementation
Policy Evaluation
Agenda Setting1. Defining optimal nutrition
2. Quantifying the burden of disease due to malnutrition
3. Evaluating the effectiveness of policies to improve nutrition
4. Evaluating the cost-effectiveness of nutrition policies
5. Evaluating the political/legal feasibility of nutrition policies
6. Evaluating the intensity of implementation of nutrition policies
7. Evaluating the short/long term effects of nutrition policies
Policy Formulation
PolicyAdoption
Policy Implementation
Policy Evaluation
Agenda Setting1. Defining optimal nutrition
2. Quantifying the burden of disease due to malnutrition
3. Evaluating the effectiveness of policies to improve nutrition
4. Evaluating the cost-effectiveness of nutrition policies
5. Evaluating the political/legal feasibility of nutrition policies
6. Evaluating the intensity of implementation of nutrition policies
7. Evaluating the short/long term effects of nutrition policies
4
Malnutrition
5
GBD 2015
1943 1992 2005 2011
1989 2002 2015
Nutrients Foods Dietary patterns
Biological mechanism No biological knowledge Intercorrelations not a problemStatistical Power No food composition data needed Between-food interactionsSupplementation Use in dietary advice
Diet low in calcium Diet low in seafood omega-3 fatty acidsDiet low in polyunsaturated fatty acidsDiet high in trans fatty acids
Diet low in milkDiet high in red meatsDiet high in red meatsDiet high in processed meatsDiet high in processed meatsDiet high in processed meatsDiet high in sugar sweetened beverages
Diet high in sodiumDiet high in sodium
Epidemiologic evidence supporting causality between dietary risk-outcome pairs
GBD 2015
Policy Formulation
PolicyAdoption
Policy Implementation
Policy Evaluation
Agenda Setting1. Defining optimal nutrition
2. Quantifying the burden of disease due to malnutrition
3. Evaluating the effectiveness of policies to improve nutrition
4. Evaluating the cost-effectiveness of nutrition policies
5. Evaluating the political/legal feasibility of nutrition policies
6. Evaluating the intensity of implementation of nutrition policies
7. Evaluating the short/long term effects of nutrition policies