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OPEN DEBATE
SOUTH AFRICAN FOOD-BASED DIETARY GUIDELINES
P Love
Chairperson: FBDGs Work Group, School of Agriculture and Agri-Business, University of Natal, Pietersmaritzburg

Editor's Corner
The South African Food-Based Dietary Guidelines Work Group would like to thank the Editor for the opportunity to provide further input regarding the South African Food-Based Dietary Guidelines (FBDGs).

The editorial by Labadarios and Steyn1 highlights some of the many important and difficult issues faced by the FBDGs Work Group in developing and evaluating the preliminary FBDGs. It is for this reason that a special supplement is being compiled for publication in a future issue of the Journal, which will contain the technical support papers and the scientific basis for the existence of each of the preliminary FBDGs as well as discussion on the potential benefits and potential problems with the FBDGs.

The editorial by Labadarios and Steyn1 on the proposed Food-Based Dietary Guidelines (FBDGs)2 in the February issue of this Journal has elicited considerable discussion, as an editorial is meant to do. Penny Love on behalf of the FBDG Work Group provides some additional information on future developments as well as some insight on the major, important and complicated issues the Group had to address. The Editor welcomes Penny Love's invitation to the readers of the Journal to contribute to the process by sending their comments and ideas to the Work Group via the Journal's correspondence columns, or alternatively to the Secretariat: saspen@gerga.sun.ac.za. We also hope that readers will use this opportunity and contribute to this important and historic development in the South African nutrition field.

The preliminary FBDGs (11 statements as tested by Love et al.)2 were compiled by the SA FBDGs Work Group based on extensive reviews of the nutrition-related health concerns, mortality trends, and food consumption patterns of South Africans. The preliminary FBDGs should not be seen as mere adoptions of guidelines produced by other countries. Where they may mimic statements of other countries, this is because South Africa shares similar nutrition-related health concerns with both 'developed' and 'developing' countries. The purpose of these guidelines is the promotion of health to South Africans older than 5 years of age. The decision to have separate guidelines for young children is based on the facts that South African children have specific nutrition-related public health issues (mainly under-nutrition), and that children per se have specific dietary needs for growth and development.3 Separate sub-committees have been formed to address the adaption of these FBDGs for infants, children and adolescents as well as the elderly, pregnant and lactating women, people with HIV/AIDS, and the chronically ill.

Of the discussion points raised in the Editorial,1 two specific issues are of particular importance and although they will be addressed more fully in the forthcoming technical support papers, the SA FBDGs Work Group would appreciate further input from the readers of the Journal. These two issues pertain firstly to having one or two sets of dietary guidelines (for under- and over-nutrition), and secondly to the use of food groups in addition to the FBDGs.

Can a single set of FBDGs address the needs of the diverse South African population?
The editorial1 suggests that a more practical approach to dealing with the diverse South African population, where under- and over-nutrition coexist, might be to have two sets of dietary guidelines. The SA FBDGs Work Group considered this option very carefully, but decided that, on balance, it would be better to have one set of dietary guidelines. Apart from the potential social or ethnic segregation that can be implied by having different sets of nutrition messages, one also needs to consider the element of confusion that could result should an individual be exposed to both sets of information (as may happen with migration or urbanisation). The proposal for separate FBDGs for the under- and over- nourished also ignores the evidence that many South Africans are faced with the coexistence of under- and over-nutrition within the same household and even in the same person.4 Which set of guidelines would an obese person with anaemia receive, or a household with a stunted child and an overweight mother? The preliminary FBDGs are therefore an attempt to provide consistent nutrition messages in a non-segregating manner. The preliminary FBDGs also describe a target diet that South Africans should be aiming towards, whether under-, over- or adequately nourished.

Is there still a need for food groups in addition to the FBDGs?
By definition, food groups are a translation of dietary guidelines into practical advice on the types, and sometimes quantities, of various foods needed for optimal health. It is therefore recommended that a country develops its dietary guidelines first, and that any food group guide (pictorial illustration) be designed to complement these country-specific dietary guidelines.5 A country using dietary guidelines and/or food group guides from other countries is often ineffective in changing food choices and dietary behaviours.6 This is generally because such 'imported' dietary guidelines and/or food group guides do not reflect the country's specific health issues; the availability, accessibility and price of food within the country; and the acceptability to all populations regarding their lifestyle, cultural eating habits and socio-economic circumstances.7

Since the early 1980s, the use of 'imported' food group guides for 'developing' countries has been berated as obsolete, inappropriate, misleading and a disservice, especially when families have a narrow choice of foods and even the staple food is in short supply. It is in the light of these criticisms that many nutrition educators are moving away from the food group approach towards one that focuses on already established, positive dietary practices as a starting point for nutrition education.8,9 Using food-based as opposed to nutrient-based dietary guidelines is one way of achieving this task, where the focus is on:

• identifying existing and potential nutrition-related problems of the consumer
• acknowledging the foods and meal patterns common to the consumer, and
• encouraging desirable and feasible behaviour changes within the constraints faced by the consumer.

In summary, it is important to emphasise that dietary guidelines are never carved in stone! Although health and nutrition experts have been given the opportunity for full discussion of the preliminary FBDGs, the FBDGs Work Group welcomes continuing discussions. Such discussions will increase the scientific validity and practical relevance of the FBDGs, as well as increase the support of nutrition and health educators for the dietary guidelines.

1. Labadarios D, Steyn N. South African food-based dietary guidelines - guidelines for whom? S Afr J Clin Nutr 2001; 14: 5-6.
2. Love P, Maunder E, Green M, Ross F, Smale-Lovely J, Charlton K. South African food-based dietary guidelines. S Afr J Clin Nutr 2001; 14: 9-19.
3. SA FBDGs Work Group. Preliminary food-based dietary guidelines for South Africans. Unpublished report, 1998.
4. Vorster H, Oosthuizen W, Jerling J, Veldman F, Burger H. The Nutritional Status of South Africans: A Review of the Literature from 1975-1996. Durban: Health Systems Trust, 1997.
5. Welsh S. Nutrient standards, dietary guidelines and food guides. In: Present Knowledge in Nutrition. 7th ed. Washington, DC: ILSI Press, 1996.
6. Gillespie A. Principles and issues in developing and implementing dietary guidelines: US perspective. In: Proceedings of the International 'Dietary Guidelines: Expectations and Realities' Symposium. Vancouver: University of British Columbia, 1990.
7. Gibney M. Dietary guidelines: Back to basics. CHO Carbohydrates 1997; 7(4): 1-3.
8. Alnwick D. Nutrition education and UNICEF. Paper prepared for the UNICEF Global Nutrition Policy and Action Workshop, Naivasha, Kenya, 1987.
9. Ritchie J. The misuse of food group classifications for nutrition education in developing countries. J Human Nutr 1981; April: 81-83.