Undernutrition and hunger have always formed the foundation of the Food and Agriculture Organisation's (FAO) mandate. Working in collaboration with the International Dietary Energy Consultative Group (IDECG), FAO began to examine both appropriate cut-off points of the body mass index (BMI) at the lower end of the spectrum and the functional consequences of low BMI (<16.0 = Category III Chronic Energy Deficiency (CED); 16.0 -16.9 = Category II CED; 17.0 -18.4 = Category I CED). Over the past decade FAO has recognized the growing obesity epidemic occurring not only in the developed world but also among all income and socioeconomic groups of the developing world. In response, FAO and the World Health Organization (WHO) have collaborated together in joint initiatives. Following the WHO 1998 Obesity Consultation on Preventing and Managing the Global Epidemic, a number of regions examined their individual situation regarding obesity. In looking at the BMI risk-based cut-off points, there appeared to be need for a tailoring of the cut-off points for Asia. The publication The Asia-Pacific Perspective: Redefining Obesity and its Treatment (2000) proposed areaspecific cut points. While such efforts to individualize reference values to a region or situation are attractive and even commendable, there is always the danger of creating confusion particularly if later these figures are changed. It is very important that before values are promulgated, a thorough review is conducted and full confidence can be placed on them.
The Protein Digestibility Corrected Amino Acid Score (PDCAAS) has been adopted for assessing protein quality in human foods since 1991, and the shortcomings of using the PDCAAS have been recognized since its adoption. The 2011 FAO Expert Consultation recognized that the Digestible Indispensable Amino Acid Score (DIAAS) was superior to the PDCAAS for determining protein quality. However, there were insufficient human data on amino acid digestibility before adopting the DIAAS. More human data were needed before DIAAS could be implemented. In 2014, FAO convened an expert working group to propose and agree on research protocols using both human-based assays and animal models to study ileal amino acid digestibility (metabolic availability) of human foods. The working group identified 5 research protocols for further research and development. A robust database of protein digestibility of foods commonly consumed worldwide, including those consumed in low-income countries, is needed for an informed decision on adopting the DIAAS. A review on the impacts of using the DIAAS on public health policies is necessary. It would be advantageous to have a global coordinating effort to advance research and data collection. Collaboration with international and national agriculture institutes is desirable. Opportunities should be provided for young researchers, particularly those from developing countries, to engage in protein-quality research for sustainable implementation of DIAAS. To conclude, the DIAAS is a conceptually preferable method compared with the PDCAAS for protein and amino acid quality evaluation. However, the complete value of the DIAAS and its impact on public health nutrition cannot be realized until there are sufficient accumulated ileal amino acid digestibility data on human foods that are consumed in different nutritional and environmental conditions, measured by competent authorities. A future meeting may be needed to evaluate the size and quality of the data set and to determine the timeline for full adoption and implementation of the DIAAS.
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