First Meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG)
Subgroups on Micronutrients, and Diet and Health
22-25 February 2010, Geneva, Switzerland
The World Health Organization (WHO) has recognized the need to use more rigorous processes to ensure that health care recommendations are informed by the best available research evidence. In May of 2005 the 58th World Health Assembly passed a resolution requesting the Director-General"to undertake an assessment of WHO's internal resources, expertise and activities in the area of health research, with a view to developing a position paper on WHO's role and responsibilities in the area of health research, and to report through the Executive Board to the next World Health Assembly". WHO asked its Advisory Committee on Health Research (ACHR) for advice on ways in which WHO can improve the use of research evidence in the development of recommendations, including guidelines and policies. The ACHR established the Subcommittee on the Use of Research Evidence (SURE) to collect background documentation and consult widely among WHO staff, international experts and end users of WHO recommendations to inform its advice to WHO. The Guidelines Review Committee (GRC) was established in 2007 with the purpose of developing and implementing procedures to ensure that WHO guidelines are developed in ways consistent with best practice, emphasizing the appropriate use of evidence.
The process described in the WHO Handbook for Guideline Development has been adopted as of 1 January 2009. Additionally, as part of implementing the outcomes and recommendations of the WHO Nutrition Programme Review undertaken in 2008, the Department of Nutrition for Health and Development (NHD) is strengthening its role in providing evidence-based policy and programme guidance to Member States, in partnership with the Department of Research, Policy and Cooperation (RPC) as well as relevant internal partners and guided by the new WHO guidelines development process.
To implement this process, NHD in partnership with RPC and other internal partners are establishing the WHO Nutrition Guidance Expert Advisory Group (NUGAG) guided by the WHO Steering Committee for Nutrition Guidelines Development, which includes representatives from all Departments in WHO with an interest in the provision of recommendations in nutrition. The membership of NUGAG will be for 2 years and includes experts from various WHO Expert Advisory Panels and those identified through open calls for experts taking into consideration a balanced mix of genders, multiple disciplinary areas of expertise, and representation from all WHO Regions. Currently, the NUGAG consists of 4 subgroups: 1) micronutrients; 2) diet and health; 3) nutrition in the life course and undernutrition; and 4) monitoring and evaluation.
The NUGAG will implement a biannual programme of work on these areas and meet twice a year to provide advice on the following:
- The scope of the guidelines and priority questions for which systematic reviews of evidence will be commissioned
- The choice of important outcomes for decision-making and developing recommendations
- The interpretation of the evidence with explicit consideration of the overall balance of risks and benefits
- The final drafting of formulating recommendations, taking into account existing evidence as well as diverse values and preferences
WHO is convening the first WHO NUGAG Meeting in Geneva from 22 to 25 February 2010 to initiate the process. A second meeting will take place on 15-19 November 2010 to review the evidence GRADE tables (Summary of Findings) and finalize the recommendations.
Objectives of the first NUGAG meeting (Geneva, 22-25 February 2010):
- Formally launch the WHO Nutrition Guidance Expert Advisory Group (NUGAG) for 2010-2011.
- Present the WHO Handbook for Guideline Development and GRADE methodology to be used in WHO nutrition guidance and scientific advice.
- Review and finalize the scope, questions, priority outcomes and methods for the development of nutrition guidelines in identified areas in micronutrients; diet and health; and nutrition in the life course and undernutrition for 2010.
The NUGAG Subgroups on Micronutrients and Diet and Health will meet during this time from 22 to 25 February 2010. The topics that each SubGroup will be addressing are as follows:
- Effectiveness and safety of home (point-of-use) fortification with Multiple Micronutrient Powders (MNPs) for infants and young children
- Effectiveness and safety of home (point-of-use) fortification with MNPs for pregnant women
- Effectiveness and safety of wheat flour fortification with micronutrients as public health intervention
- Effectiveness and safety of corn/maize flour fortification with micronutrients as public health intervention
- Effectiveness and safety of oils fortification with micronutrients as public health intervention
- Effectiveness and safety of sugar fortification with micronutrients as public health intervention
- Effectiveness and safety of condiments fortification with micronutrients as public health intervention
- Iron supplementation for infants, young children and preschool age children
- Supplementation with iron alone or iron+folic acid for women in reproductive age
- Iron interventions for children in malaria-endemic areas
Diet and Health SubGroup
- Effects of the level of total fat intake on obesity and other related NCDs
- Effects of sugars intake on health
A call for public comments on the questions that the guidelines intend to address has been published on the WHO web site http://www.who.int/nutrition/en/index.html.
The sources of financial support for this evidence-based guideline process include the Government of Luxemburg, Government of Japan, the U.S. Centers for Disease Control and Prevention (CDC), US Agency International Development (USAID), and the Micronutrient Initiative, with whom we have ongoing collaborations and established partnerships.