The current National Health and Nutrition Programme (PNNS) guidelines focus on different food groups (fruits and vegetables, starches, etc.) and on physical activity, broken down for specific populations (the elderly, children, adolescents, pregnant and breastfeeding women). Developments in scientific data over the last ten years have made it possible to revise the guidelines on food consumption and physical activity and, more generally, the scientific foundation on which the associated public health objectives are established. In February of last year, ANSES published an initial opinion on the issue of guidelines relating to physical activity and sedentary lifestyles. Today, ANSES is publishing its opinions on the updating of the food consumption guidelines in the framework of the PNNS.
The Agency's work
The work to formulate the food consumption guidelines needed to cover the nutritional requirements and prevent the risk of chronic diseases associated with the consumption of certain food groups, while limiting exposure to contaminants found in food. It also had to take into account the dietary habits of the French population, in order to facilitate the effective adoption of the guidelines developed.
In the first place, the expert assessment work involved updating the dietary reference values for vitamins and minerals, as well as macronutrients, by considering the balance between fats, carbohydrates and proteins. Moreover, as part of an innovative approach, an integrative optimisation tool was also deployed to identify consumption combinations of 32 food groups meeting the nutritional requirements of the adult population, preventing the risk of chronic diseases and limiting exposure to contaminants, by integrating 41 dietary reference values and around a hundred contaminants from among those found in food..
Major changes with regard to the previous recommendations
The Agency's work has resulted in major changes with regard to the previous recommendations. They mainly concern reinforced and regular consumption of pulses (such as lentils, broad beans or chickpeas), the need to give preference to less refined cereal products (such as wholemeal or semi-wholemeal bread and pasta, and brown rice) and the benefits of favouring the consumption of vegetable oils rich in alpha-linolenic acid (such as rapeseed and nut oils).
Consumption of fruits and vegetables remains crucial and must be reinforced, giving preference to vegetables. ANSES also stresses that consumption of sugar-sweetened beverages (such as sodas or fruit juices) should be limited to less than one glass per day.
Lastly, the Agency insists on the need to considerably reduce the consumption of delicatessen meats (such as ham, dried sausage, sausage, pâté, etc.) so that it does not exceed 25 g per day. As for the consumption of meat excluding poultry (such as beef, pork, lamb, etc.), this should not exceed 500 g per week. The benefits of twice-weekly consumption of fish including an oily fish (such as sardines, mackerel, etc.) is reaffirmed.
Guidelines able to cover the nutritional requirements of virtually the entire population while limiting excesses
With the exception of a few nutrients, the proposed guidelines, which specifically take consumption habits into account, are able to cover the nutritional requirements of virtually the entire population.
The dietary requirement for vitamin D is still the subject of numerous scientific debates, mainly due to the difficulty in estimating the amount of vitamin D synthesised by the body following exposure to the sun. In this regard, the Agency calls for a study to be conducted to assess the vitamin D status of the French population. This study is needed for the implementation of suitable management measures, such as:
- personalised supplementation through the healthcare system directed at the adult population;
- specific recommendations on exposure to the sun, compatible with the prevention of skin cancers;
- fortification of foodstuffs in vitamin D overseen by the public authorities, assuming a detailed analysis of the health issues and the expected benefits and risks.
Certain nutrients, in particular sodium and sugars, still present major public health challenges associated with excessive consumption. For sodium, therefore, the proposed food combinations should make it possible to remain below the average consumption for the French population, while reducing intakes in high consumers. Concerning sugars, the available data cannot be used to distinguish the health effects of sugars naturally present in food from those of added sugars. Nevertheless, evidence is converging towards the harmful effects of high sugar intakes, above a maximum intake limit. In order to reduce total intakes for the most exposed populations, it seems vital to control the consumption of foods that are vectors of added sugars and, in particular, to take action on beverages
Continuing efforts to reduce the level of food contamination
The Agency's work also emphasised the difficulty of identifying food combinations that can cover the nutritional requirements of the population while limiting exposure to contaminants. For a limited number of contaminants, in particular inorganic arsenic, acrylamide and lead, the exposure levels remain a concern. As mentioned in the conclusions of its recent opinions on the total diet studies (TDS2, Infant TDS), efforts to reduce levels of contaminants of concern therefore remain necessary. They will eventually enable the population's food choices to be governed by nutritional constraints and not by the levels of contamination in food.
In this context, ANSES reiterates its recommendation that consumers diversify their diet and sources of supply.
Work to be pursued
The expert appraisal conducted by the Agency made it possible to develop the food consumption guidelines. Their formulation and communication to the consumer by the public authorities requires additional work to identify the most suitable formats of expression.
Moreover, the approach used for ANSES's work will be applied for other population groups defined on the basis of physiological criteria (age, sex, level of physical activity, etc.) or from specific dietary behaviour (avoidance, intolerance, food habits, etc.). ANSES thus plans to supplement its work with an assessment of the health effects of the frequencies or structuring of food intakes in the day, as well as the different consumption contexts.
In the longer term, other issues added to the specific nutritional questions may be taken into account for establishing food benchmarks, in order to include them as part of a comprehensive and sustainable approach. In particular, the Agency may consider issues of an environmental (carbon footprint, etc.) or socio-economic (cost of products, etc.) nature that may ultimately form the basis of the consumption guidelines.