Brazilian Dietary Guidelines

In 2014, the Brazilian government introduced - to what we know in Scotland - very different dietary guidelines which focused on environmental sustainability and in which food was framed as a cultural and social value. They were developed jointly by Ministry of Health, Pan American Health Organisation Brazil and the Center for Epidemiological Research in Nutrition and Health at the University of São Paulo.

The guidelines categorise foods according to the extent of processing rather than recommending levels of separate nutrients. This approach encourages the consumption of fresh and minimally processed foods and actively discourages consumption of ultra-processed foods and drink products.

Traditional healthy foods are grouped and described, along with ideas for healthy breakfasts, lunches and dinners. The advice is based on real meals eaten in Brazil, taken from the Household Budget Survey.

Nuts

Nuts, as understood in these Guidelines, include cashew, baru and Brazil nuts, as well as walnuts, peanuts and almonds.

Nuts have many culinary uses. They are used as ingredients in salads, sauces and various savoury and sweet dishes and are also added to fruit salads. Since they require little or no preparation, they are excellent choices for small meals.

Nuts contain plenty of dietary fibre, vitamins, minerals and other protective bioactive compounds and are also high in healthy unsaturated fats.

Nuts with added salt or sugar become processed foods. As such, their consumption should be limited.

Milk and Cheese

This group includes minimally processed foods such as cos's milk, cheese curds, plain yoghurt and processed foods such as cheeses.

In Brazil, Cow's milk is often consumed pure, with fruit or with coffee in the first meal of the day. It is also an ingredient of creams, pies, cakes andother sweet and savoury dishes. The consumption of natural yoghurt and other fermented milk foods is increasing in Brazil. Cheeses are mainly consumed as part of dishes based on minimally processed foods, as in pasta wit tomato sauce or polenta made with corn flour.

Milk and plain yoghurt are good sources of proteins and some vitamins and minerals.

The guidelines also list six obstacles to a healthy diet and advise how to overcome them: information, supply, cost, cooking skills, time and advertising.
This approach acknowledges many issues from a sustainable development agenda, including local context, inequalities, global challenges and protecting aspects of Brazilian farming, culture and economy.

The Brazilian guidelines give one Golden Rule: “Always prefer natural or minimally processed foods and freshly made dishes and meals to ultra-processed products.”

They also have ten very common-sense recommendations:

1. Make unprocessed or minimally processed foods the basis of your diet
2. Use processed culinary ingredients in small amounts for seasoning and cooking foods and to create culinary preparations
3. Limit consumption of processed foods
4. Avoid ultra-processed products
5. Eat regularly and carefully in appropriate environments and, whenever possible, in company
6. Shop in places that offer a variety of natural or minimally processed foods
7. Develop, exercise and share cooking skills
8. Plan your time to make food and eating important in your life
9. Out of home, prefer places that serve freshly made meals
10. Be wary of food advertising and marketing

Could we use a similar guide in Scotland?
Would it be more effective at improving national diet, our shopping lists and the contents of our fridges?

“A guideline is just a guideline. How we turn it into policy and transform society is a different issue.
It’s important we don’t stop here but keep pushing to make it come to life.” 
Fabio Gomes, Advisor on Nutrition and Physical Activity, Pan-American Health Organization / World Health Organization

Update since 2014

Since 2014, the Guidelines have been successfully implemented into a few public health policies such as the National School Feeding Programme [1].

Evaluations of the impact of the guidelines have shown a slowdown in the consumption of ultra-processed foods (UPFs) after their publication. The implementation efforts have focused on primary health care, and it has been reported that around 85% of primary healthcare workers use the Guidelines in their practice. 

However, the involvement of other sectors and the current political context pose challenges to the continued progress of the guidelines. Multinational companies and other political parties have been attempting to shift Brazil's traditional food culture towards ultra-processed products by denying the environmental impact of processed foods and advocating for individual freedom of choice.

For instance, in 2020, the Brazilian Dietary Guidelines faced a direct attack when the Ministry of Agriculture issued a technical note to the Ministry of Health, urging a revision. The note specifically questioned the recommendation to avoid UPFs, disregarding the well-established evidence linking them to obesity and chronic diseases. However, due to the strong response from civil society and nutrition-related institutions, the Ministry of Agriculture was compelled to backtrack on its stance [1].

Despite the strong resistance, the Brazilian Dietary Guidelines aim to preserve Brazil's cultural traditions. Hence, the country's original food culture remains largely intact. The Brazilian experience can serve as an example for other countries in implementing their own Whole-Food-Based Dietary Guidelines.

References

[1] Gabe, K., Tramontt, C., & Jaime, P. (2021). Implementation of food-based dietary guidelines: Conceptual framework and analysis of the Brazilian case. Public Health Nutrition, 24(18), 6521-6533. doi:10.1017/S1368980021003475.