The process of setting micronutrient recommendations: a cross-European comparison of nutrition-related scientific advisory bodies

Abstract

Objective: To examine the workings of the nutrition-related scientific advisory bodies in Europe, paying particular attention to the internal and external contexts within which they operate. Design: Desk research based on two data collection strategies: a questionnaire completed by key informants in the field of micronutrient recommendations and a case study that focused on mandatory folic acid (FA) fortification. Setting: Questionnaire-based data were collected across thirty-five European countries. The FA fortification case study was conducted in the UK, Norway, Denmark, Germany, Spain, Czech Republic and Hungary. Results: Varied bodies are responsible for setting micronutrient recommendations, each with different statutory and legal models of operation. Transparency is highest where there are standing scientific advisory committees (SAC). Where the standing SAC is created, the range of expertise and the terms of reference for the SAC are determined by the government. Where there is no dedicated SAC, the impetus for the development of micronutrient recommendations and the associated policies comes from interested specialists in the area. This is typically linked with an ad hoc selection of a problem area to consider, lack of openness and transparency in the decisions and over-reliance on international recommendations. Conclusions: Even when there is consensus about the science behind micronutrient recommendations, there is a range of other influences that will affect decisions about the policy approaches to nutrition-related public health. This indicates the need to document the evidence that is drawn upon in the decisions about nutrition policy related to micronutrient intake.

The Stakeholders’ Views on Factors Influencing Nutrition Policy: a Qualitative Study Across Ten European Countries

“…Our key informants underlined that the task of problem characterisation (risk assessment) lays within SAB and usually is made by government request. The way in which SAB are appointed, how their work is organised, and how problems are framed and solved, shapes their fi nal conclusions [Timotijevic et al, 2011]. This in turn will infl uence the policy-makers' decisions who may take up the scientifi c advice or give less weight to it compared to other factors [Dhonukshe-Rutten, 2013; Timotijevic et al, 2011].…”

“…The way in which SAB are appointed, how their work is organised, and how problems are framed and solved, shapes their fi nal conclusions [Timotijevic et al, 2011]. This in turn will infl uence the policy-makers' decisions who may take up the scientifi c advice or give less weight to it compared to other factors [Dhonukshe-Rutten, 2013; Timotijevic et al, 2011]. Besides, not only what, but also in what way is submitted to authorities, infl uences the process.…”

Communication of scientific uncertainty: international case studies on the development of folate and vitamin D Dietary Reference Values

“…The lack of agreed best practice and disparity in DRV has led to confusion among inter/national policy decision makers, health professionals, the food industry and consumers (19) . An open and transparent DRV process has the potential to assist with understanding why values differ between countries by clearly detailing what, why and how decisions were made, particularly regarding the degree of uncertainty in the evidence and how this was handled or influenced the strength of the final risk assessment conclusions/resultant reference values (19,20) . This would inform the debate on DRV development best practice.…”

“…The European Commission-supported Network of Excellence EURRECA (EURopean micronutrient RECommendations Aligned, FOOD- CT-20006-36196, 2007CT-20006-36196, -2012 was tasked with reviewing the methodologies used to derive DRV, assessing the reasons for value disparity and the potential for methodological alignment across national and international DRV development. Early EURRECA findings highlighted the importance of the nutrition problem formulation stage to ensure risk assessment activities remained achievable while also fulfilling the requirements of risk managers (20) . Further research suggested DRV disparity was unlikely to be explained by differences in concepts, definitions or defined population groups.…”

Explaining the variability in recommended intakes of folate, vitamin B12, iron and zinc for adults and elderly people

“…This variation may be due to differences between populations, e.g. in bioavailability from national diets, but it may also be due to differences in approaches used for establishing recommendations (ANR 1 2SD v. AI) (23) and eminencebased decisions regarding the selection of relevant health indicators and data underlying recommendations (16,19,23,24) . Harmonisation of the process for establishing micronutrient recommendations will increase transparency, objectivity and reliability of recommendations and contribute to aligned nutrition policy across Europe (19,23) .…”