2021 Food Based Dietary Guidelines Final

Food-Based
Dietary Guidelines
A Review of National Guidance for Children,
Adolescents, and Women
ACKNOWLEDGEMENTS
Lead authors: Mary Arimond and Verónika Molina
Technical reviewers and contributors: Mawuli Sablah, Roland Kupka, France

Begin (UNICEF) and Fatima Hachem, Ana Islas Ramos, and Melissa Vargas (FAO).
This work builds on and extends previous work by Anna Herforth, Mary Arimond,
Cristina Álvarez-Sánchez, Jennifer Coates, Karin Christianson, and Ellen Muehlhoff
(Adv Nutr 2019;10:590–605). Any errors are the responsibility of the authors.
Design: Nona Reuter (UNICEF)
© United Nations Children’s Fund (UNICEF)
June 2021
All rights to this publication remain with the United Nations Children’s Fund (UNICEF.
Permission is required to reproduce any part of this publication.Permissions will be
freely granted to educational or non-profit organizations.
Published by:UNICEF
Nutrition Section, Programme Division
3 United Nations Plaza
New York, NY 10017, USA
Citation: United Nations Children’s Fund (UNICEF). Review of national Food-Based

Dietary Guidelines and associated guidance for infants, children, adolescents, and
pregnant and lactating women. New York: UNICEF, 2020.
Photograph Credits: Cover: © UNICEF/UN0342228/Keïta; page 4: Adobe Stock/©

David Fajula; page 6: © UNICEF/UNI212826/Zhanibekov; page 11: © UNICEF/
UN068180/Noorani; page 14: © UNICEF/UNI189746/Gilbertson VII Photo; page
18: © UNICEF/UN0343212/Pazos; page 21: © UNICEF/UN038719/Pirozzi; page
25: © UNICEF/UNI71790/Talwar; page 32: © UNICEF/2020/Kelvin Banda; Page 34
© UNICEF/UN0259535/Ndinda; page 47: UNICEF/UNI219505; page 53: UNICEF/
UNI217251/Kokic; page 54: UNICEF/UN0343152/Pazos
CONTENTS
Summary 4
1 / Background and objectives 6

1.1 UNICEF’s agenda 6
1.2 Food-based dietary guidelines 9
1.3 Guidelines and guidance 10
1.4 Objectives 10
1.5 Structure of the report 10
2 / Data sources and approach to analysis 11

2.1 Sources 11
2.2 Scope and limitations 12
2.3 Approach to summary and analysis 12
3 / Availability of FBDGs and integration of environmental sustainability 14
4 / Typology of countries 18
5 / Summary of group-specific key messages in FBDGs 21
6 / Summary of group-specific topics addressed in general FBDGs documents 25

6.1 Sub-Saharan Africa: Kenya, Sierra Leone, South Africa 26
6.2 Middle East and North Africa: Lebanon, Qatar 27
6.3 Europe and Central Asia: Ireland, Malta, Sweden, United Kingdom 28
6.4 South Asia: Bangladesh, India, Sri Lanka 28
6.5 East Asia and Pacific: Australia, New Zealand 29
6.6 Latin America and Caribbean: Antigua and Barbuda, Barbados, Belize, Brazil, Jamaica 30
6.7 North America: Canada, United States 30
7 / Country case studies 32

7.1 Overview 32
7.2 Availability of group-specific guidance in case study countries 33
7.3 Development of FBDGs in case study countries 36
7.4 Summary of topics in group-specific guidance 38
7.5 Comparison of selected topics across countries, by groups 40
8 / Discussion and recommendations 47

8.1 Overview of FBDGs for age and physiological groups 47
8.2 Development of FBDGs for age and physiological groups 47
8.3 General recommendations 48
8.4 Recommendations for FBDGs for specific age and physiological groups 50
8.5 Conclusion 53
Annexes 55
Review of National Food-based Dietary Guidelines and Associated Guidance 3

SUMMARY
Food-based dietary guidelines (FBDGs) educate very few countries have integrated environmental
consumers on healthy diets and provide direction sustainability concerns into FBDGs.
for programs and policies aiming to ensure healthy
diets for all. Children of all ages have unique, age- While dietary guidelines statements themselves
specific nutritional needs, problems, and challenges, (sometimes called ‘key messages’) are meant to be
and healthy child growth and development also concise and few (typically, 8-12 statements), they
require adequate nutrition before conception and are used to anchor more extensive guidance and are
during pregnancy and lactation. Considering these often elaborated during the implementation process
needs and challenges across the life cycle, UNICEF in a range of print and web-based resources designed
is exploring the role of FBDGs specific to various age for a variety of audiences including consumers, health
and physiological groups as part of a broader agenda professionals, and policy-makers.
to put children’s nutrition rights first. Further, UNICEF Among countries with FBDGs, about half have
has identified environmental sustainability of diets as consolidated separate FBDGs or other associated
a core concern, to protect children both now and in guidance for one or more age or physiological
the future. groups. In many countries, group-specific guidance
In this report, we survey the availability and content is available for all the groups noted above, but in
of current national FBDGs and associated guidance other countries separate guidance is available only
for pregnant and lactating women, infants, children for infants and young children under 2 years of age.
and adolescents, and we also assess coverage of This means that many countries have little or no
sustainability issues in current guidelines. Using consolidated guidance that is specific to the needs
the online repository of the Food and Agriculture of infants, children, adolescents, or pregnant or
Organization of the United Nations (FAO), we found lactating women.
that slightly fewer than half of all countries have Among countries that do have consolidated guidance
FBDGs, and that low and lower middle income a very wide range of topics are covered for each age
countries were least likely to have them (13% and and physiological group. Broadly speaking, similar
26% of these countries, respectively); FBDGs are topics are covered across country income levels
particularly scarce in the Africa region. To date, and across regions, but the level of specificity in
4 Review of National Food-based Dietary Guidelines and Associated Guidance

guidance varies greatly. Some countries go much 3. Be clear and specific on how much animal-source
further in elaborating not only what to eat, and how food of different types (dairy, meat/poultry, fish,
much, but also in providing the ‘how to’ – detailed eggs) is ‘enough, but not too much’ for each age
and group-specific strategies for achieving healthy and physiological group, recognizing the specific
dietary patterns in context. This ‘how to’ guidance is nutritional needs and available nutrient sources
more likely to be highly detailed for breastfeeding and for each group and balancing with sustainability
for complementary feeding than it is for other ages concerns.
and stages.
4. Be clear and specific on foods/types of foods and
Based on our survey of current national guidance beverages to be minimized or avoided for various
as well as on the UNICEF agenda, this report age groups and/or for everyone.
provides group-specific recommendations on topics
that could be considered for inclusion in future 5. Go beyond ‘what’ and ‘how much’ to eat to how
FBDGs and associated guidance, and also makes – give practical guidance on how healthy diets and
several recommendations for the development, healthy eating can be achieved for different age
documentation and presentation of FBDGs. Key and physiological groups.
recommendations include: 6. Include attention to developmental and
psychosocial dimensions of feeding and eating for
1. When developing national FBDGs, do include different ages.
specific guidance for age and physiological groups
and consolidate it either in sections of a FBDGs 7. Develop consumer-facing documents and
document for the general population, or in separate webpages targeting older children and adolescents
FBDGs or other associated guidance. as well as women of reproductive age and parents;
consider innovating with new media approaches
2. Accompany technical documents detailing the for consumer-facing guidance.
evidence base and development of FBDGs
messages with guidance for practitioners and for
consumers.

1 / BACKGROUND AND OBJECTIVES
1.1 UNICEF’s agenda
The 2019 State of the World’s Children (SOWC) Organization (WHO) articulated a set of guiding
highlights the unique nutritional needs, problems and principles for sustainable healthy diets (see Box 2).
challenges faced at each stage across childhood and
adolescence (Box 1).1 In addition to these challenges, The first three points in UNICEF’s agenda for action
healthy child growth and development also depend (SOWC, p. 10) are:
on adequate nutrition before conception and during
pregnancy and lactation, which presents different 1. Empower families, children and young people to
challenges. demand nutritious food.
2. Drive food suppliers to do the right thing for
The SOWC report highlights the necessity of food children.
system transformation and the roles of diverse
actors in achieving this. Further, UNICEF identifies 3. Build healthy food environments for all children.’
sustainability as a core concern:
In this context, UNICEF and other organizations
have been advocating for the development of
‘….all food production and consumption must
food-based dietary guidelines (FBDGs) targeted to
become sustainable if we are to protect children’s children as well as pregnant and lactating women,
nutrition today and tomorrow’ (p. 23). as an opportunity to improve nutrition outcomes
This core concern aligns with numerous global for children. FBDGs have have traditionally been
initiatives, including the framework for action from designed to inform and empower consumers. But,
the Second International Conference on Nutrition when fully implemented and integrated in national
(ICN2)2 in 2014. More recently, the Food and food, agriculture, education and health policies and
Agriculture Organization (FAO) and the World Health programs they also have the potential to contribute
to food system transformation.
1 UNICEF (2019). The State of the World’s Children 2019. Children, Food and Nutrition: Growing well in a changing world. UNICEF: New York.
2 FAO/WHO (2014). Second International Conference on Nutrition Rome, 19-21. Conference Outcome Document: Framework for Action. http://
www.fao.org/3/a-mm215e.pdf.

BOX 1
Food and nutrition challenges across childhood

0-5 months – rapid growth and development
• Poor breastfeeding practices (late initiation, lack of exclusive breastfeeding, continued breastfeeding)
• Social norms around breastfeeding
• Lack of support for breastfeeding mothers in the workplace
• Inappropriate marketing of breast milk substitutes
6 months to 2 years – rapid growth and development

• Poor breastfeeding practices (lack of continued breastfeeding)
• Social norms around breastfeeding
• Lack of support for breastfeeding mothers in the workplace
• Inappropriate marketing of breast milk substitutes
• Low dietary diversity – inadequate ‘first foods’ lacking in nutrients
• Low feeding frequency
• Consumption of sweet beverages and poor-quality snacks high in sugar, salt or unhealthy fat
• Lack of responsive care and feeding
3-4 years – continued growth/development, transition toward some eating outside the home (e.g. school)
• Poor quality diets, lacking in nutrients and including excess sugar, salt and fat
• Exposure to marketing of unhealthy, ultra-processed foods
• Lack of responsive care and feeding
• Lack of physical activity
• Emerging overweight and obesity
5-9 years – continued growth/development and transition towards more eating outside the home
• Poor quality diets, lacking in nutrients and including excess sugar, salt and fat
• Specifically, low intake of fruits and vegetables
• Hunger at school due to lack of breakfast
• Exposure to marketing of unhealthy, ultra-processed foods
• Availability of sweet beverages and poor-quality snacks in the school environment
• Lack of physical activity
• Emerging overweight and obesity
Adolescence: 10-19 years – rapid growth and development, increasing peer influence
• All of the issues identified for younger school-aged children still apply
• Nutrient needs are very high and iron deficiency is a risk, especially for girls but also for boys
• With increased autonomy and pocket money, may be more fast food consumption
• Body image concerns, and eating disorders
• Lack of concern with long-term health
• Strong influence of peers
• Pregnancy
a
These challenges are discussed in UNICEF (2019), Chapter 2 Feeding a Child for Life.

BOX 2
Sustainable Healthy Diets: Guiding Principlesa

‘Sustainable healthy diets…
1. … start early in life with early initiation of 8. … contain minimal levels, or none if possible, of
breastfeeding, exclusive breastfeeding pathogens, toxins and other agents that can
until six months of age, and continued cause foodborne disease.
breastfeeding until two years and beyond,
combined with appropriate complementary 9. … maintain greenhouse gas emissions, water
feeding. and land use, nitrogen and phosphorus
application and chemical pollution within set
2. … are based on a great variety of unprocessed targets.
or minimally processed foods, balanced
across food groups, while restricting highly 10. … preserve biodiversity, including that of crops,
processed food and drink products.10 livestock, forest-derived foods and aquatic
genetic resources, and avoid overfishing and
3. … include wholegrains, legumes, nuts and overhunting.
an abundance and variety of fruits and
vegetables.11 11. …minimize the use of antibiotics and hormones
in food production.
4. … can include moderate amounts of eggs, dairy,
poultry and fish; and small amounts of red 12. … minimize the use of plastics and derivatives
meat. in food packaging.
5. … include safe and clean drinking water as the 13. … reduce food loss and waste.
fluid of choice.
14. … are built on and respect local culture,
6. … are adequate (i.e. reaching but not exceeding culinary practices, knowledge and
needs) in energy and nutrients for growth and consumption patterns, and values on the way
development, and to meet the needs for an food is sourced, produced and consumed.
active and healthy life across the lifecycle.
15. … are accessible and desirable.
7. … are consistent with WHO guidelines to
reduce the risk of diet-related NCDs, and
16. … avoid adverse gender-related impacts,
ensure health and wellbeing for the general
especially with regard to time allocation (e.g.
population.12
for buying and preparing food, water and fuel
acquisition).’
10 Food processing can be beneficial for the promotion of high quality diets; it can make food more available as well as safer. However, Some forms
of processing can lead to very high densities of salt, added sugar and saturated fats and these products, when consumed in high amounts, can
undermine diet quality. (Global Panel on Agriculture and Food Systems for Nutrition. 2016. Food systems and diets: Facing the challenges of the
21st century. London, UK. http://ebrary.ifpri.org/utils/getfile/collection/p15738coll5/id/5516/filename/5517.pdf)
11 Potatoes, sweet potatoes, cassava and other starchy roots are not classified as fruits or vegetables.
12 They include up to 30-35 percent of total energy intake from fats, with a shift in fat consumption away from saturated fats to unsaturated fats
and towards the elimination of industrial trans fats; less than 10 percent of total energy intake from free sugars (possibly less than 5 percent)
and not more than 5 g per day of salt (to be iodized). WHO. 2018. Healthy diet. WHO fact sheet No. 394 (updated August 2018). Geneva, World
Health Organization, 2018. https://www.who.int/nutrition/publications/nutrientrequirements/healthydiet_factsheet/en/
a FAO and WHO. 2019. Sustainable healthy diets – Guiding principles. Rome, pages 10-11.

BOX 3
A description of food-based dietary guidelinesa

‘National food-based dietary influences, food composition diseases. Yet, many countries
guidelines (FBDGs) provide data, and accessibility, among are now moving towards
context-specific advice and other factors. more holistic perspectives by
principles on healthy diets and addressing food combinations
Typically, FBDGs propose a set
lifestyles, which are rooted on (meals), eating modalities, food
of recommendations in terms of
sound evidence, and respond safety considerations, lifestyle
foods, food groups and dietary
to a country’s public health and sustainability aspects in
patterns to provide the required
and nutrition priorities, food their FBDGs.’
nutrients to promote overall
production and consumption
health and prevent chronic
patterns, sociocultural
a
Source: http://www.fao.org/nutrition/education/food-dietary-guidelines/background/en/ accessed 24 September 2019.
1.2 Food-based dietary guidelines integration within a range of sectoral policies and
programs to help ensure that sustainable healthy
While dietary recommendations from governments diets are available, accessible, and affordable.5
have a far longer history, a structured process for
developing FBDGs was first provided in 1998 by Historically, dietary guidance was at first solely
WHO and FAO (WHO/FAO 1998).3 This process focused on assuring adequacy in intakes of energy
was more recently and concisely described by the and macro- and micronutrients.6 In the latter part
European Food Safety Authority as follows (EFSA of the 20th century, guidance evolved to include
2010):4 moderation messages reflecting concerns with
growing levels of obesity and noncommunicable
• Identify diet-health relationships diseases, particularly in high income countries. In
• Identify country specific diet-related health the 21st century, rapid nutrition transitions in low
problems and middle income countries mean they face double
• Identify nutrients of public health importance burdens of persistent undernutrition caused by
inadequate intakes, coupled with rising overweight,
• Identify foods relevant for FBDGs
obesity and comorbidities. Dietary guidelines
• Identify food consumption patterns are evolving as a response to these public health
• Test and optimize FBDGs challenges and, more recently, to reflect concerns
• Develop graphical representations of FBDGs with environmental sustainability. Box 3 presents the
FAO’s description of FBDGs.
The development of FBDGs requires synthesis
and analysis of a wide range of evidence and FAO is currently revising the global methodology
contextual information; the process also calls for the for developing FBDGs to ensure that they are
involvement of multiple stakeholders from relevant responsive to modern food-related development
sectors and can be both a technical and political challenges and able to fulfil their potential to support
process. positive changes in food systems for the promotion
of sustainable healthy diets. The ongoing process
Developing and testing FBDGs messages should builds on the Organization’s experience in supporting
be followed by implementation and, later, evaluation countries with developing and implementing their
of effectiveness. Full implementation includes not FBDGs, the challenges identified, and lessons
only development of a variety of targeted consumer learned. It also benefits from the input of a range of
education strategies and materials, but also experts in various relevant fields including nutrition,
3 WHO/FAO. 1998. Preparation and Use of Food Based Dietary Guidelines. Report of a joint FAO/WHO consultation Nicosia, Cyprus. WHO
Technical Report Series 880. WHO: Geneva.
4 European Food Safety Authority Panel on Dietetic Products, Nutrition and Allergies (2010) Scientific opinion on establishing Food-Based Dietary
Guidelines. European Food Safety Authority Journal; 8(3):1460.
5 For more information on implementation of FBDGs, see: http://www.fao.org/nutrition/education/food-dietary-guidelines/background/
implementation/en/, accessed 13 February 2020.
6 For a brief history see: Harper AE. Contributions of women scientists in the U.S. to the development of Recommended Dietary Allowances.
J Nutr. 2003;133(11):3698–3702. doi:10.1093/jn/133.11.3698

agriculture, food policy, food consumption, food 1.4 Objectives
composition, nutrition education and behavioural
science, epidemiology, economics, communication, The objectives of this review are to:
sociology, diet modeling, and environmental science, • Build on the previous global review by identifying
among others. Complementary efforts are also availability of FBDGs and other associated
being made to develop guidance on the processes of guidance for specific age and physiological groups,
implementation, monitoring and evaluation, which are as well as gaps in availability;
incipient in the most countries with FBDGs.
• Summarize and describe national FBDGs
A recent analysis by Herforth et al. (2019) provided 7 and associated guidance for infants, children,
a global review of FBDGs and assessed the adolescents, and pregnant and lactating women;
alignment of these guidelines with key elements of • Identify the extent to which sustainability
a healthy diet for the general (adult) population as concerns are currently reflected in FBDGs; and
articulated by WHO.8 These key elements include
consumption of fruits and vegetables (at least 400 g • Recommend desirable features for new efforts to
or 5 portions/day), legumes, nuts and whole grains, develop FBDGs for these groups.
and moderation in intake of free sugars, fats and salt.
The review did not summarize guidance for special 1.5 Structure of the report
groups such as children or pregnant or lactating
women. The sections of this report are as follows:
2. Data sources and approach to analysis
1.3 Guidelines and guidance 3. Availability of FBDGs and integration of
environmental sustainability
According to WHO/FAO (1998, op cit.) FBDGs are
4. A typology of countries
‘the expression of the principles of nutrition education
mostly as foods’ (p. 3) and are intended for use by 5. Summary of group-specific key messages in
the general public. EFSA (2010, op cit.) accordingly FBDGs
note that FBDGs ‘should be comprehensible, short, 6. Summary of group-specific topics addressed
simple, clear and easily memorable’ (p. 10). However, in general FBDGs documents
most countries accompany simple guidelines 7. Country case studies
statements or messages with more detailed 8. Discussion and recommendations
behavioral guidance on how desired food intakes
and dietary patterns can be achieved. The guidelines By ‘group-specific’, we refer to messages or topics
statements are a concise expression of priorities and that provide guidance for the following age and
anchor the more detailed guidance. Such additional physiological groups: infants; young children/toddlers;
guidance may be provided in FBDGs documents, or preschoolers; school-aged children; adolescents;
in other associated guidance pieces developed for women of reproductive age/pre-conception; pregnant
practitioners and/or consumers. women; and/or lactating women.
7 Herforth A., Arimond M., Alvarez-Sanchez C., Coates J., Christianson K. and Muehlhoff E. 2019. A Global Review of Food-Based Dietary
Guidelines. Open access article published by the American Society for Nutrition 2019. Adv. Nutr. 2019.
8 WHO. 2018. Healthy diet. WHO fact sheet No. 394 (updated August 2018). Geneva, World Health Organization, 2018.

2 / DATA SOURCES AND APPROACH
TO ANALYSIS
2.1 Sources
This review is based primarily on material available Generally, the key messages are equivalent to the
at the FAO’s global online repository for FBDGs,9 main dietary guidelines ‘statements’ and are directed
which currently includes 92 countries. This repository at consumers and are then further elaborated
(website) is continually updated as FBDGs are in various professional- and consumer-facing
developed or revised by countries. Only those FBDGs documents.
that are endorsed by a governmental entity are
published in the repository. The website includes a Some country pages also include links to
page for each country that has contributed materials. downloadable documents, including full FBDGs
Each country page usually includes, in English: documents and any available communication
resources or learning materials provided by the
• The official name of the national FBDGs; countries. Examples of consumer-facing documents
• The publication year for the most recent revision available through links at the FAO website include
(and sometimes for earlier versions); posters, tri-fold pamphlets and other brief pamphlets
and brochures, as well longer documents. Many
• A brief description of the process of development of these longer documents are organized around
and stakeholders involved;
the key messages presented at the FAO website.
• A statement of the intended audience and/or Some countries also provide technical and scientific
target group(s) (e.g. age groups) for guidelines; background documents upon which the guideline
statements are based. See Annex 1 for a description
• A food guide (a graphic representation of dietary
and examples of diverse types of dietary guidelines
advice) and a verbal interpretation of the food
documents.
guide; and
• A set of key messages provided by the All materials on the website have been sourced and
responsible country authorities. verified by the responsible government authority
9 http://www.fao.org/nutrition/education/food-dietary-guidelines/en/, accessed 24 September 2019.

at country level. Finally, some country pages have 3, we provide a brief summary of their findings and
additional links to government ministries or other augment with information on countries with FBDGs
agencies that provide additional dietary guidance to published or revised during 2017-2019.
professionals and/or consumers. Some countries
have extensive web-based resources for For these countries, we examined key messages to
professionals and consumers, while for others, these identify any that explicitly related to sustainability and
links provide only another way to download the same examined available documents if they were published
guideline documents available at the FAO website. in English, French, Spanish or Portuguese.
2.2 Scope and limitations All country pages were examined with particular
attention to the statement of audiences/target
Except for analysis of key messages – which are groups and key messages. Statements on audiences
available in English for all countries at the FAO sometimes identify whether separate guidelines
website – analysis was restricted to countries with documents are available for age or physiological
documents available in English, French, Spanish or groups, or alternatively sometimes indicate whether
Portuguese. and how guidance for special groups is incorporated
into FBDGs documents for the general population.
Except for case study countries, analysis is limited to This is the basis for Section 4, which provides a
documents either downloadable at the FAO website, typology of countries.
or found through direct links at the FAO website. All
documents available as of 24 September 2019 were Section 5 provides a summary of group-specific key
downloaded. messages in FBDGs. Key messages were directly
cut-and-pasted from the country pages at the FAO
For the case study countries, more extensive website, and are presented in Table format, organized
searches were made. Additional documents and by UNICEF region. That is, this section summarizes
web content available through links to government only those messages selected by countries for
ministries or agencies were accessed during October presentation at the FAO website.
2019 and downloaded for analysis. The additional
documents and web content were either referred Section 6 summarizes the most common types
to within FBDGs documents or linked to from web- of group-specific content that may be found
pages associated with the FBDGs. The review did ‘embedded’ in FBDGs documents that cover the
not consider documents that provide guidance general population. Many countries that do not
for planners or staff in institutional settings (meal provide separate guidelines for age or physiological
programs in pre-schools or schools, for example). groups nevertheless note special needs of specific
groups in a scattered fashion throughout FBDGs
This review does not evaluate the quality of the documents covering the general population.
country FBDGs development processes nor the
quality/strength of evidence cited by countries as For this Section, due to time limitations we did not
the rationale for specific guidance. However, when aim to do a comprehensive search of all documents,
information on the development process is available, but searched FBDGs documents available in English
these processes are described for the case study and published after 2010. Depending on what was
countries. This review also does not describe or available for each country, these included consumer-
assess implementation or evaluation plans and facing FBDGs documents and/or more technical
processes. documents targeting health professionals and/or
policy-makers. See Annex 2 for a list of documents
2.3 Approach to summary and analysis searched for this section, and for their intended
audiences or uses.
The approach is descriptive and comparative. We
begin by summarizing the availability of FBDGs by Keywords were: infan*; baby; child*; teen*;
World Bank income classification within UNICEF adolescen*; school*; preg*; lact*; and breast*.
regions (Section 3). FAO recently summarized the In addition, documents in French, Spanish and
extent to which sustainability concerns have been Portuguese were skimmed to check if there were
reflected in FBDGs, globally (FAO 2016).10 In Section additional topics not represented in the English-
10 FAO and Food Climate Research Network (2016). Plates, pyramids, planet - Developments in national healthy and sustainable dietary guidelines:
a state of play assessment. FAO: Rome.

language documents. However, documents in other For each case study country, we extracted
languages were not systematically searched with information on the development process and
multiple keywords. intended audiences for the available documents
and resources. We collated a list of topics covered
The objective of this Section is to provide an for each age and physiological group and extracted
indicative and qualitative summary identifying topics guidance for most topics. Section 7 includes a
for the relevant groups that are frequently noted or narrative and comparative summary of the guidance,
addressed across countries, situated within guidance and detailed comparative tables are provided in an
for the general population. Annex.
Section 7 presents country case studies and We conclude in Section 8 with a brief narrative
compares across countries. Countries were selected synthesis of the ‘state of FBDGs’ for infants, children
for case studies based on the following criteria: and pregnant and lactating women, and with
1. Countries that either: recommendations for future FBDGs for these groups.
a. Present guidance for age and/or physiological

groups in a consolidated way (e.g. in separate
chapters) within their main FBDGs document;
or
b. Have separate FBDGs documents for one or
more age or physiological groups; or
c. Have separate guidance (not formally identified
as ‘dietary guidelines’) for one or more groups
that is directly linked to within dietary guidelines
documents or websites;
2. Countries where guidance is relatively recent.
Guidelines published before 2010 were excluded,
and preference was given to the most recent
guidelines that met other criteria;
3. Countries from diverse geographic regions.
In addition to these criteria, due to time limitations

case studies were restricted to countries with
materials available in English, Spanish, and
Portuguese.
For case study countries, all documents available

directly at the FAO country page or through links
provided at the page were examined. In addition,
any other documents that were mentioned within
the guidelines documents as providing guidance for
special groups were also searched for and examined.
For countries with web-based interfaces for

disseminating FBDGs-related materials, we
examined the relevant pages (i.e. age or physiological
group-specific resources) and also downloaded
any available guidance. We followed cross-links
when they led to other government guidance that
was clearly linked to from the dietary guidelines
webpages but did not otherwise search (e.g. we did
not do a content search starting from a Ministry of
Health main page, or similar).

3 / AVAILABILITY OF FBDGS AND
INTEGRATION OF ENVIRONMENTAL
SUSTAINABILITY
Based on their inclusion in the FAO online repository For some countries, it is possible that there are
as of September 2019, FBDGs are available for 92 FBDGs not reported in response to the FAO survey
countries. As previously reported by Herforth et al. that was the basis for the repository. However, it is
(2019, op cit.), slightly more than half of all countries certain that to date, FBDGs are particularly scarce for
with FBDGs have developed or revised them since the Africa region.
2010. Figure 1 shows the availability of FBDGs at the
FAO repository, globally.
Figure 1: Availability of FBDGs

Table 1: Availability of FBDGs by UNICEF region
UNICEF Region Number of countries
Sub-Saharan Africa
West and Central Africa 3
Eastern and Southern Africa 4
Middle East and North Africa 5
Europe and Central Asia

Eastern Europe and Central Asia 8
Western Europe 24
South Asia 5
East Asia and Pacific 13
Latin America and Caribbean 28
North America 2
Table 2: Availability of FBDGs by income

World Bank income classification* Number of countries
Low income 4 (of 31)
Lower middle income 12 (of 47)
Upper middle income 34 (of 60)
High income 42 (of 80)
*
As of 1 July 2019
Table 1 shows availability of FBDGs by UNICEF For all except Germany, full guidelines documents are
region, and Table 2 shows availability by World Bank available in English; see Box 4 for brief summaries.
income classification. Annex 3 provides a table FAO also noted that environmental sustainability was
listing all countries with FBDGs by income level considered during recent guidelines development
within each UNICEF region. processes in Australia and the United States but that
these concerns ultimately were not incorporated into
Considering availability as a percent of all countries at the guidelines, although they are addressed in an
each income level, FBDGs are available for only 13% Annex to the Australian guidelines.11
of low income countries and 26% of lower middle
income countries, compared to 57% of upper middle
income countries and 53% of high income countries.
Concerning the integration of environmental

sustainability into FBDGs, FAO’s (2016, op cit.) recent
report reviewed FBDGs for 83 countries and reported
that among these, only 4 had incorporated attention
to sustainability: Brazil, Germany, Sweden and Qatar.
11 National Health and Medical Research Council. 2013. Australian Dietary Guidelines. National Health and Medical Research Council: Canberra,
Annex G, pp. 130-134.

BOX 4
Integration of environmental sustainability in FBDGs of Brazil, Sweden, and Qatar
Brazil
Ministry of Health. 2014. Dietary Guidelines for the Brazilian Population. MOH: Brasília.
The Brazilian Dietary Guidelines begin with a set of principles that inform and underlie the
rest of the guidelines; one of these establishes environmental sustainability as a fundamental
concern of the guidelines:
‘Healthy diets derive from socially and environmentally sustainable food systems. Dietary
recommendations need to take into account the impact of the means of production and
distribution of food on social justice and environmental integrity’ (p. 18).
This concern is woven throughout the document and informs guidance on foods within food
groups and guidance around processing levels, among others. Sustainability is referenced in
the detailed guidance for the following three messages:
‘Make natural or minimally processed foods the basis of your diet’
‘Avoid consumption of ultra-processed foods’
‘Shop in places that offer a variety of natural or minimally processed foods’
Sweden
National Food Agency. 2015. Find your way to eat greener, not too much and be active. National
Food Agency: Uppsala.
Environmental concerns are a central focus of the Swedish Dietary Guidelines. The Guidelines
are introduced and framed as benefiting both health and the environment. The Guidelines
identify choices with greater and lesser environmental impacts within each food group and
highlight the energy costs of processed foods and beverages that are high in sugar.
Qatar
Public Health Department. 2015. Qatar Dietary Guidelines. Supreme Council of Health: Doha.
The Qatari Guidelines include a guideline statement with an explicit focus on environmental
sustainability.
• Eat healthy while protecting the environment
Key recommendations for this Guideline (p. 32) are:

• Emphasize a plant-based diet, including vegetables, fruit, whole grain cereals, legumes,
nuts and seeds
• Reduce leftovers and waste
• When available, consume foods produced locally and regionally
• Choose fresh, home-made foods over highly processed foods and fast foods
• Conserve water in food preparation
• Follow the recommendations of the Qatar Dietary Guidelines

The following countries had FBDGs published in The technical document for Ecuador’s FBDGs13
2017–2019: indicates that they defined 4 guiding principles, based
on those of Brazil and Uruguay, including:
2017: Barbados; Belgium (Flemish Food Guide only);
Cambodia (school-aged children only); Estonia; Kenya ‘Healthy eating comes from socially just and
environmentally sustainable food systems’ (p. 71)
2018: Ecuador; Panama (children under two years of
age) They provide tables mapping various technical
2019: Canada recommendations and principles to their guidelines
statements and confirm that the guideline on fresh
In Barbados, Cambodia, and Kenya, there were no and local food derives from this principle.
key messages explicitly related to sustainability,
and no focus on sustainability in the full FBDGs Canada is one of the case study countries and we
documents. In Panama, there were no key messages reviewed all available materials. Environmental
related to sustainability, but in the technical FBDGs sustainability is not a central focus of the new
document the stated benefits of breastfeeding Canadian Dietary Guidelines, but there is some minor
(first key message) include that it contributes to attention to this issue. The Guidelines authors identify
environmental protection, because it does not health as the primary focus of the Guidelines but note
generate waste (e.g. packaging). In Estonia there that adherence to the new Guidelines could also have
were no explicit messages on sustainability, and full environmental benefits, as this would shift Canadians
documents were available only in Estonian. towards diets ‘higher in plant-based foods and lower
in animal-based foods’.14 Further, the Guidelines have
For the other countries there were no explicit a strong focus on food skills and identify better food
messages reflecting sustainability considerations but skills as playing a role in reducing food waste, which
one or more key messages that could be motivated in turn reduces environmental impacts.
by both health and environmental concerns; for
example: In summary, in the vast majority of countries
concerns with environmental sustainability are not
Flemish: Make foods derived from plants the yet integrated into FBDGs. This may be due in part
basis of every meal to the complexities of assessing and measuring the
Ecuador: Choose fresh products from local impacts of food choices, as noted in the Canadian
producers and Australian guidelines documents. However,
this is an area of rapidly evolving knowledge and
Canada: Choose protein foods that come from high global interest, and it is possible that more
plants more often countries will integrate these concerns in the near
future. In the meantime, even with no explicit focus
For the first, documents were available only in
on sustainability, adherence to recent guidelines
Flemish; using Google translate for the main web
in many high income countries could shift diets
page of the Food Guide suggests that sustainability
towards increased sustainability, because many high
was considered in the process:
income country guidelines suggest levels of red meat
consumption lower than current patterns.15
‘We want to provide guidelines that are feasible for
everyone in the long term. And that ensure that
there is also enough healthy food for our children
and grandchildren. The result is a realistic and
sustainable model that takes into account the
current eating habits in Flanders’12
(source: https://www.gezondleven.be/themas/voeding;
accessed 19 November 2019).
12 Source: https://www.gezondleven.be/themas/voeding; accessed 19 November 2019.

13 Ministerio de Salud Pública del Ecuador y Organización de las Naciones Unidas para la Alimentación y la Agricultura (2018). Documento Técnico
de las Guías Alimentarias Basadas en Alimentos (GABA) del Ecuador. GABA-ECU 2018: Quito.
14 Health Canada. 2019. Canada’s Dietary Guidelines for Health Professionals and Policy Makers. Health Canada: Ottawa, p. 15.
15 For impacts of changes in food group consumption, see for example: Clark MA, Springmann M, Hill J, Tilman D. Multiple health and
environmental impacts of foods. Proc Natl Acad Sci U S A. 2019 Nov 12;116(46):23357-23362. doi: 10.1073/pnas.1906908116. Epub 2019
Oct 28.

4 / TYPOLOGY OF COUNTRIES
Based on review of country page statements b. Young children under 2 years of age
about audiences/target groups, and/or on available
c. Preschool children
documents,16 countries were classified into the
following simple typology: d. School-aged children
e. Adolescents
1. Countries with FBDGs that do not mention age or
physiological groups; f. Pregnant women
2. Countries with FBDGs that provide advice on g. Lactating women

portions and portion sizes for age or physiological
groups, but provide no other dietary guidance for Regarding ‘type 5’ countries, it is important to note
these groups; that there are two ‘sub-types’;
3. Countries with FBDGs that include scattered 1. Countries where the guidance for some or all
references to the needs of age and/or age and physiological groups is provided within
physiological groups (found in FBDGs documents separate official FBDGs documents;
covering the general population, or occasionally
found only in key messages); 2. Countries where government guidance is
provided, but was either clearly developed
4. Countries with FBDGs documents that include
through separate processes, or where the link
specific sections or sub-sections focused on the
between the dietary guidelines development
needs of age and/or physiological groups;
process and the ‘other guidance’ is not explicit or
5. Countries with FBDGs, or other separate guidance transparent based on information available from
(documents or web-based guidance) for any or the source document or webpage.
all of:
For example, many countries state that their dietary
a. Infants
guidelines are for healthy individuals aged two
16 For this section, ‘available documents’ include documents in English, Spanish, Portuguese or French and: 1. Available for direct download from
the country page at FAO; or 2. Available through links at the country page; or 3. Identified on the country page, but with broken links, if the
documents were available through searching on the document name or at links provided at the FAO website.

and older yet also disseminate – sometimes from guidelines statements or key messages that cover
the same FBDG website and sometimes through the specific population groups.
linked sites or pages – separate professional and/
or consumer guidance on feeding infants and young Table 3 summarizes the number of countries of each
children under two years of age. type by region and by country income classification.
Separate guidance (type 4 or type 5 countries) is
Some countries where children and adolescents are available in around half of the 92 countries with
identified as being covered by the FBDGs and key FBDGs (47 countries). One third (31 countries) do
messages for the general population also provide not provide such guidance; ‘type’ could not be
separate consumer-facing resources for these age determined for nearly 1 in 5 (14 countries) mainly due
groups with additional targeted guidance. However, to language barriers (11 countries in Europe/Central
this additional age-specific guidance may not clearly Asia and 1 country in East Asia); in several other
indicate a concise set of messages. All of these countries, there were broken links to guidance.
different types of guidance were considered in the
case studies, regardless of whether there were
Table 3 Types of guidance for age and/or physiological groups by region and income classificationa
Number of countries with each type of guidanceb
UNICEF Region Type 1 Type 2 Type 3 Type 4 Type 5 Unknownc Total

Sub-Saharan Africa
West and Central Africa 0 1 0 2 0 0 3
Eastern and Southern Africa 0 0 3 1 0 0 4
Middle East and North Africa 0 0 3 0 1 1 5
Eastern Europe and Central Asia 0 0 2 2 1 3 8
Western Europe 1 0 3 1 11 8 24
South Asia 1 0 0 4 0 0 5
East Asia and Pacific 1 0 0 3 7 2 13
Latin America and Caribbean 13 0 3 3 9 0 28
North America 0 0 0 0 2 0 2
Total 16 1 14 16 31 14 92
Low income 1 1 0 1 0 1 4
Lower-middle income 2 0 1 6 2 1 12
Upper-middle income 8 0 5 7 9 5 34
High income 5 0 7 2 19 9 42
a UNICEF regions, and World Bank income classification as of 1 July 2019.
b Typology: 1. Countries with no guidance for age or physiological groups; 2. Guidance on varying portions and portion sizes only; 3. Scattered
references to needs of groups in FBDGs covering the general population; 4. FBDGs with separate sections for groups; 5. Separate FBDGs and/
or other official guidance for groups.
c Countries in this column either had broken links, or the type could not be determined because the relevant documents and web pages were in
languages other than English, Spanish, Portuguese, or French.

Annex 3 lists all countries and identifies which fall children or adolescents, nor for women. In North
into each of the 5 categories. For type 4 and type 5 America, there is guidance for most (U.S.) or all age
countries, the Table in the Annex further indicates and physiological groups (Canada).
for which age and/or physiological groups guidance
is available, and notes when the type could not be The scope of the guidance also varies widely, with
determined, and why. some countries providing guidance narrowly focused
on foods and food groups (how much to eat daily or
The likelihood of providing entirely separate guidance weekly from the food groups on the national food
(type 5) increases with country income classification. guide) while other countries (e.g. Brazil and Canada)
Low and lower middle income countries are more provide extensive guidance around many behaviors
likely to include age and physiological groups in related to obtaining and cooking food, evaluating
separate focused sections within the main dietary marketing of food, and sharing food and skills with
guidelines document (type 4). family. Similarly, considering both FBDGs and other
guidance for infants and children, some countries
Considering both FBDGs and other types of emphasize what to feed and when or how frequently
guidance, there was wide variety in which age and/ to feed, while other countries emphasize how to
or physiological groups were covered by countries in feed – feeding and parenting behaviors and skills –
Europe, Central Asia, and the East Asia and Pacific and provide more context on developmental and/or
region. In South Asia, most countries provide at least socio-emotional aspects of feeding and eating. See
some minimum guidance for each life stage. In Latin the case studies (Section 7) for examples of different
America, many countries provide guidance for infants types of guidance.
and children under two years of age, but not for older

5 / SUMMARY OF GROUP-SPECIFIC
KEY MESSAGES IN FBDGs
For each country with a page at the FAO repository, and pregnant and lactating women, in addition
the relevant authority provided a set of key to encouraging breastfeeding and appropriate
messages. As noted, these are generally equivalent complementary feeding. There were no other notable
to the main dietary guidelines statements and are regional patterns.
messages for consumers. Many countries organize
their longer guidelines documents and/or web In addition to the group-specific key messages in
resources around these messages. Table 4 note that in separate group-specific guidance,
many countries emphasize that their dietary
When there are separate group-specific sections of guidelines messages for the general population also
guidelines documents, or when there are linkages apply. So, for example, in countries where guidelines
out to other guidance for age or physiological groups are meant to cover all healthy people over two years
there may be additional group-specific key messages; of age, general messages all apply to pre-schoolers,
however, in this Section we summarize only key school-aged children, adolescents, and pregnant and
messages on the FAO country pages. lactating women.
Table 4 provides verbatim group-specific messages In Table 4 below Cambodia provides an example of
as found at the FAO country pages. Thirty of the 92 typical messages for the general population, because
countries included one or more key messages that their entire dietary guidelines document targets
either addressed the needs of a specific group or school-aged children. The messages in Table 4
were messages that implicitly include children (for for Cambodian children are similar to many general
example, encouraging family meals). population messages: a message on dietary diversity;
several food-group-specific messages on dairy,
The most common messages are about protein foods, fruits and vegetables, and starchy
breastfeeding (19 countries) and complementary foods; a moderation message for sugar, salt and fats;
feeding (11 countries). All 5 South Asian countries and a message on body weight.
included multiple messages about life stages,
highlighting the needs of children, adolescents

Table 4 Key messages for age and physiological groups
UNICEF Region Country Key messages
Sub-Saharan Africa
West and Central

[none]
Africa
Eastern and
Seychelles • Breastfeed your child exclusively up to 6 months
Southern Africa
• Take care of your family:
Middle-East & North • Breastfeed your baby exclusively for the first six months of their life, and
Qatar
Africa continue until your child is two years old
• Build and model healthy patterns for your family

• Encourage exclusive breastfeeding for the first 6 months of a baby’s life
Albania
Eastern Europe & • Breastfeeding should be continued up to the first year
Central Asia • Babies should be exclusively breastfed up to the 6th month and then
Georgia
breastfeeding plus complementary feeding up to 2 years of age
• During the first 6 months, only breast milk should be given to a baby and then
Turkey
other complementary foods should be started in adequate type and quantity
Western Europe Italy • Pay attention to specific advice for special people
• Avoid drinking [alcohol] completely if you are pregnant or breastfeeding

Malta
• Avoid soft and sweetened drinks especially in children
• Nutrient supplements are not needed, except for specific groups for which
Netherlands
supplementation applies
• Alcoholic beverages are not recommended for children, adolescents, pregnant
Portugal
and lactating women
South Asia
• Pregnant and lactating women should increase intake of all the food groups
daily, especially foods that are rich in iron
Afghanistan • Give infants only breast milk for the first 6 months of life
• From 6 months onward, feed infants and young children different nutritious
foods in addition to breast milk and continue breastfeeding until 24 months
• Eat additional food during pregnancy and lactation
Bangladesh • Practise exclusive breastfeeding for 6 months and start adequate
complementary foods in time
• Ensure provision of extra food and health care to pregnant and lactating
women
• Promote exclusive breastfeeding for 6 months and encourage breastfeeding
India until 2 years or as long as possible
• Feed home-based semi-solid foods to the infant after 6 months
• Ensure adequate and appropriate diets for children and adolescents, both in
health and sickness
• Eat additional and especially nutritious food during pregnancy and lactation
• Exclusively breastfeed your baby for 6 months and continue up to 2 years
Nepal
• Infants should be getting appropriate complementary feeding at 6 months
• Provide special nutritional care for adolescents
• Eat additional food during pregnancy and lactation
• Exclusively breastfeed for 6 months
Sri Lanka
• Start complementary feeding at the completion of 6 months
• Children and adolescents should take an adequate and nutritious diet

East Asia and Pacific
Australia • Encourage, support and promote breastfeeding
Entire Dietary Guidelines document is for school-aged children; key messages

are:
• Eat foods from all food groups everyday as part of a well-balanced diet
• Consume calcium-rich foods such as whole small fish, milk, and milk products
• Eat protein-rich foods such as fish, meat, eggs or beans at least 2 to 3 times a
Cambodia day
• Eat plenty of fruits and vegetables regularly
• Eat cereals and starchy foods such as rice, noodles, bread and its alternatives in
an adequate amount
• Reduce foods high in salt, sugar and fat
• Measure your body weight and height regularly to track your growth
• Breastfeed your baby exclusively for the first 6 months
Fiji
• Give children healthy meals and snacks
• Practice exclusive breastfeeding from birth until 6 months and continue to
Malaysia
breastfeed until 2 years of age
Not directly, but a key message alludes to groups:
Mongolia • Choose healthy food and beverages and consume the amounts recommended
for your physical features
• Breastfeed infants exclusively from birth up to 6 months, then give appropriate
Philippines complementary foods while continuing breastfeeding for 2 years and beyond
for optimum growth and development
Not directly, but there is a key message about family meals; in longer consumer-
Republic of facing document they note the importance of this for decreased risk of obesity for
Korea children, and for learning manners and sharing, and promoting happiness:
• Have frequent family meals
Not directly, but there is a key message stating:
Thailand
• Drink in appropriate quality and quantity for one’s age
• Initiate breastfeeding right after birth, exclusively breastfeed during the first 6
months, then start proper complementary feeding and continue breastfeeding
Viet Nam until 24 months
• Children over 6 months of age and adults are recommended to consume milk
and dairy products appropriate to their age
Latin America & Caribbean
Antigua /
• Feed your baby breast milk only for the first 6 months of the baby’s life
Barbuda
Argentina • Children, adolescents and pregnant women should not drink alcohol
Bahamas • Breast milk is the best choice for infants to start a healthy life
Brazil has ‘10 Steps to Healthy Eating’ and chose to include the text elaborating
each of these in their messages at the FAO website. In the elaboration of several
messages, role of family or children is mentioned:
• Whenever possible, eat in company, with family, friends, or colleagues..... Share
household activities that precede or succeed the consumption of meals
• If you have cooking skills, develop them and share them, especially with boys
Brazil and girls
• Share with family members the responsibility for all activities related to meals.
Make the preparation and eating of meals privileged times of conviviality and
pleasure
• Be critical and teach children to be critical of all forms of food advertising and
marketing

• To prevent anaemia, schoolchildren, adolescents and young women should eat
Colombia
offal once per week.
• Exclusively breastfeed infants from birth up to 6 months because it is the first
Dominican and the best food for them
Republic • Introduce adequate complementary foods (as shown in the food guide) starting
at 6 months of age
Venezuela
(Bolivarian • Breast milk is the best food for infants under 6 months of age
Republic of)

6 / SUMMARY OF GROUP-SPECIFIC
TOPICS ADDRESSED IN GENERAL FBDGS
DOCUMENTS
This section summarizes group-specific topics that general population, in English, and published after
are found in FBDGs documents covering the general 2010. We searched these documents using key
population. Frequently, references to the needs of words (see Section 2.3) and also did quick scans of
age and/or physiological groups are embedded within documents in Spanish, Portuguese and French, to
general guidelines documents. This can be the case ensure that the list of topics found in the English-
both when no other specific guidance is available, but language documents was comprehensive. Table 5
also when separate guidance is available, but country lists countries with recent and available documents
authorities choose to also integrate and highlight in English and indicates the year of publication.
messages for groups within the general guidelines Annex 2 provides a list of documents consulted for
document. this Section. As noted in the methods section and
detailed in the Annex, the documents consulted for
As noted above, for the purposes of this section we this section were a mix of professional-facing and
identified dietary guidelines documents covering the consumer-facing FBDGs documents.
Table 5 Countries with recent general population guidelines documents in English

UNICEF Region Country Year of publication
Sub-Saharan Africa Kenya 2017
Sierra Leone 2016
South Africa 2012
Middle East and North Africa Lebanon 2013
Qatar 2015
Europe and Central Asia Ireland 2012–2016
Malta 2016
Sweden 2015
United Kingdom 2016

South Asia Bangladesh 2013
India 2011
Sri Lanka 2011
East Asia and Pacific a Australia 2012-2013
New Zealand 2015
Latin America & Caribbean Antigua / Barbuda 2013
Barbados 2017
Belize 2012
Brazil 2014
Jamaica 2015
North America Canada 2019
United States 2016

a In addition to these, dietary guidelines for the Philippines were updated in 2012, but the link at the FAO country page did not lead to the
guidelines, and we could not find them through a search at the linked government website.
6.1 Sub-Saharan Africa: Kenya, Sierra Leone, consolidated in Section 3.

South Africa
In the South Africa dietary guidelines document,
Kenya and Sierra Leone provide recent examples there is a separate section for pediatric guidelines.
from Africa where the main dietary guidelines However, these are described as ‘proposed
documents have a strong focus on the life cycle. In guidelines’, and were not yet tested at the time of
both cases guidance for age and physiological groups publication. The status of these guidelines in relation
is presented separately within the main guidelines to current national uses is therefore not clear, without
document i.e. they are both ‘type 4’ countries in our additional sources of information.
typology. The separate guidance is found in Section
3 of the Kenyan dietary guidelines, and in a series of Table 6 lists topics addressed in the Sierra Leone
Annexes for Sierra Leone. In addition, in Sierra Leone guidelines within the sections of the document
the life cycle focus is woven throughout the main covering the general population. There is additional
sections of the general dietary guidelines documents. detailed group-specific guidance on many topics in
In contrast, in the Kenyan guidelines the guidance the Annexes. See Section 7 (case studies), for more
for age and physiological groups is nearly entirely details on Chapter 3 of the Kenyan guidelines.
Table 6 Topics integrated within general population guidelines: Sierra Leone

Topic Age and/or physiological group(s)
Number of meals and snacks Young children, children, adolescents, pregnant & lactating women
Portions and portion sizes Pregnant and lactating women
Animal-source foods
Young children, pregnant women
As sources of micronutrients, especially iron
Prioritizing vulnerable groups Children under five years of age, pregnant & lactating women
Folate sources Pregnant women
Folic acid supplements Pregnant women
Fish oils Young children
Sugar intake Children
Sweet drinks in bottles Infants, young children
Food taboos Pregnant and lactating women
Water needs Infants, young children, lactating women
Food safety Infants, young children
Handwashing Children; before feeding children
Oral hygiene Infants, children
Physical activity Infants, children, adolescents, pregnant and lactating women
Clean air and ventilation Children, women

6.2 Middle East and North Africa: Lebanon, The Qatar Dietary Guidelines cover ages 2 to 65
Qatar and are also ‘type 3’ guidelines in our typology.
Similarly to Lebanon, the Qatari document highlights
Lebanon is a ‘type 3’ country, and the only guidance the needs of specific groups in the text elaborating
for age and physiological groups are brief mentions in on each guideline. Further, the last guideline ‘Take
a guidelines document that is targeted towards adults care of your family’ has two sub-messages, one on
(full title: The Food-Based Dietary Guideline Manual breastfeeding and one instructing to ‘Build and model
for Promoting Healthy Eating in the Lebanese Adult healthy patterns for your family’; the latter covers
Population). There is no guidance for feeding infants topics such as family meals, with many parenting tips
and young children. The needs of ‘Special Population for feeding children.
Groups’ other than infants and young children are
clearly highlighted in Boxes, as relevant, in sections Table 7 combines topics from these two countries
that elaborate each main dietary guideline message. to show the range of brief advice incorporated into
guidelines for the general population.
Table 7 Topics integrated within general population guidelines: Lebanon, Qatar

Milk and dairy consumption, and alternatives;
Children, adolescents, pregnant women
requirements, sources and tips for children
Vegetables and fruit; tips for feeding Children

Folate sources Women of childbearing age, pregnant women
Folic acid supplements Preconception, and pregnant women
Iron supplements Women of childbearing age, pregnant women
Fish and seafood; targets and cautions Preconception, and pregnant women
Need for higher fat diet Young children under two years
Salt and salty foods Children
Fluid/water needs Pregnant and breastfeeding women
Food safety, including specific foods to be

Infants, children, pregnant women
avoided by vulnerable groups
Pre-pregnancy BMIa and weight gain Preconception, and pregnant women

Physical activity Children, adolescents, pregnant women
Supporting an overweight child - how Children
Breastfeeding ‘tips’ Lactating women
‘Build and model healthy patterns’; parenting

around food
• Set regular times for meals and snacks
• Eat at least one meal daily with family
• Be a role model for healthy eating and physical
activity
• Teach children food skills
Parents/families
• Limit sodas
• Offer healthy treats
• Offer new foods multiple times
• Division of labor in feeding – parent is
responsible for what, children are responsible
for how much
• Suitable portion sizes
a BMI = body mass index

6.3 Europe and Central Asia: Ireland, Malta, The separate guidance for Ireland and Sweden is
Sweden, United Kingdom not included in this section (see a case study for
Ireland in Section 7). However, the general guidelines
Ireland is a ‘type 4/5’ country, both providing documents for Ireland and Sweden were searched
guidance in sections within a general document, for ‘special group’ topics that were integrated with
and also providing separate web-based guidance general population guidance, as above. Table 8
for different groups. Sweden is a ‘type 5’ country, summarizes the group-specific guidance topics
providing separate guidance. Malta and the United embedded in general dietary guidelines documents
Kingdom provide limited and brief guidance for Ireland, Malta, Sweden, and the United Kingdom.
throughout their guidelines for the general population
(i.e. they are ‘type 3’ countries).
Table 8 Topics integrated within general population guidelines: Ireland, Malta, Sweden, the United Kingdom
‘Breast is best’ Lactating women/infants
General diet, move towards adult pattern Children 2 to 5
Fish, omega-3 fatty acids Children, pregnant women
Fish, toxins Children, adolescents, women of reproductive age, pregnant women
Fiber-rich fortified cereals Children, adolescents
Need for good calcium intake Children, adolescents
Iron needs Children, adolescents, women of reproductive age
Liver, kidney – not consuming Infants, pregnant women
Vitamin D supplements Infants and young children under five years of age
Folic acid supplements Preconception, and pregnant women
Need for higher fat diet Children under five years of age
Sugary drinks, or sugar-sweetened beverages Children
Salt and salty foods Children
Water Children, adolescents, pregnant and lactating women
Caffeine Pregnant women
Alcohol Pregnant and lactating women
Physical activity Children
6.4 South Asia: Bangladesh, India, Sri Lanka sections focused on infants, children, adolescents,
and pregnant and lactating women.
Similar to Sierra Leone and Kenya, the FBDGs for
these three South Asian countries have a strong life In the South Asian context, where both undernutrition
cycle focus and they are all ‘type 4’ countries. All (wasting, thinness) and overweight and obesity
three guidelines documents are organized around key are significant public health concerns, guidance
messages, and these include messages focused on on fat and energy density may be challenging.
infancy, childhood, adolescence and pregnancy and Both concerns are reflected in the guidance but
lactation (see Table 4). As in Kenya and Sierra Leone, communicating clearly to support consumers to
this means there are sections of the main dietary understand and consume ‘enough, but not too much’
guidelines document devoted to these concerns. is challenging. In addition to encouraging the use
Table 9 summarizes only topics where the needs of of oils for increasing energy density for the general
age or physiological groups are addressed elsewhere population, the Indian guidelines also encourage
in the document, under other dietary guidelines for adding sugar (or jaggery) to complementary foods;
the general population. See the India case study this is generally not encouraged elsewhere.
(Section 7) for more details on their guidelines

Table 9 Topics integrated within general population guidelines: Bangladesh, India, Sri Lanka
Animal-source foods Children, pregnant and lactating women
Protein foods Infants, children, pregnant women
Fruits and vegetables Infants, children, adolescents
Folate sources Pregnant women
Dairy, needs Infants, children, adolescents, pregnant and lactating women
Dairy, types (% fat) Undertwos, overweight and obese children
Fat needs and energy density Infants, children, adolescents, pregnant and lactating women
Fat, moderation General message, immediately following guidance on needs – enough but not too much
Fat types Infants, young children
Sugary foods Children
Salt Infants, young children
Water or fluid needs Infants, children, adolescents, pregnant and lactating women
Physical activity Children, adolescents, pregnant and lactating women
Managing overweight Children
Portions, portion sizes Infants, children, adolescents, pregnant and lactating women
6.5 East Asia and Pacific: Australia, New New Zealand (type 5) provides separate background
Zealand papers and consumer-facing guidance for the
following groups: pregnant and breastfeeding
In Australia, the FBDGs for the general population women, infants and toddlers (0–2 years), and
include specific information for pregnant women and children and young people (2–18 years). The general
children and are summarized for consumers in: Eat for population guidelines document is the Eating and
Health: Australian Dietary Guidelines Summary. There Activity Guidelines for New Zealand Adults. Table
are separate and detailed infant feeding guidelines 10 summarizes those topics addressing age and
covering breastfeeding and complementary feeding. physiological groups that are covered in Australia
However, in addition, Guideline #4 in the general and New Zealand’s general documents (excluding
guidelines is: ‘Encourage, support and promote Australia’s separate section for Guideline #4). See
breastfeeding’ and a section of the general document Section 7 (case studies) for more details on New
also briefly covers this, so Australia is a ‘type 4/5’ Zealand’s separate guidance for age and physiological
country in our typology. groups.
Table 10 Topics integrated within general population guidelines: Australia, New Zealand
Meat Infants, children, pregnant women
Milk, very little Infants
Dairy, needs Children, adolescents
Dairy, types (% fat) Undertwos, over 2 years of age
Fat needs Infants
Fat types Children, adolescents
Fruit juice Infants
Tea, coffee Young children
Sugar-sweetened beverages Children
Water/fluid needs Infants, young children
Alcohol Adolescents, preconception, pregnant and lactating women
Food safety Infants, pregnant women
Choking Young children under 3 years of age
Physical activity Children, adolescents
‘Serves’ and serve sizes Infants, toddlers, children, adolescents, pregnant and lactating women

6.6 Latin America and Caribbean: Antigua and 6.7 North America: Canada, United States
Barbuda, Barbados, Belize, Brazil, Jamaica
Both the Canadian and the U.S. guidelines provide
The FBDGs for Antigua and Barbuda, Barbados, guidance for the population two years of age and
Belize and Jamaica are all directed at the general older. The Canadian guidelines document provides a
public over 24 months of age, and with no separate link to separate guidance for nutrition during infancy,
guidelines for age or physiological groups. The including breastfeeding. In the U.S, guidance for
guidelines documents are relatively brief and infants and young children under 2 and additional
consumer-facing. In Brazil, the main guidelines guidance for pregnant women is currently under
apply to all Brazilians over 24 months of age and are development for the next revision of the FBDGs
written for professionals engaged in health promotion (2020–2025).
and disease prevention. There is separate dietary
guidance for children under 2 years of age; this However, in both countries there are also extensive
guidance is also addressed to a professional audience, web-based resources, including resources addressing
thus Brazil is a ‘type 5’ country. the needs of all age and physiological groups (making
them ‘type 5’ countries). See Section 7 (case studies)
In Antigua and Barbuda, the only group-specific for more information on extensive additional guidance
message is a guideline on exclusive breastfeeding. available in Canada. For this Section, we searched
Barbados, Belize, and Jamaica have no mention only the two main FBDGs documents for the general
of age or physiological groups in their FBDGs population.
documents (i.e. they are ‘type 1’ countries).
In the Canadian general guidance, as in Brazil, there
The Brazilian FBDGs represent a departure from the were no topics related to infants or to pregnant or
types of messages found in most earlier FBDGs, and breastfeeding women, but a strong focus on the
include a much stronger focus on selecting minimally benefits of family meals and of teaching food skills to
processed foods, gaining and sharing food skills, children and adolescents. In addition, there was brief
and understanding constraints to healthy choices guidance on physical activity for children and ‘youth’.
including marketing, among other topics. Searching
on key words, we found no specific topics related While there was no specific guidance in this
to pregnancy, infants or breastfeeding, but found document for foods or beverages for children or
a number of topics related to children, youth and adolescents, the evidence considered in developing
families: the general guidance included evidence for children
and adolescents, for example in relation to intake
• Encouraging family meals, and eating in company of saturated fat and trans fatty acids, sodium, free
more generally sugars, and sugar-sweetened or sugar-containing
• Teaching children and adolescents food skills, beverages. So the general population guidelines were
including gardening, and shopping for, preparing explicitly informed by evidenced-based concerns for
and cooking food children and adolescents.
• Educating children and adolescents about the
Table 11 summarizes topics addressing age and
purposes of food marketing, and limiting screen
physiological groups that are covered in the general
time for children to reduce their exposure to
marketing U.S. guidelines document.
• Recognizing the needs of children and adolescents

for more than 3 meals a day; other eating
occasions were described as ‘small meals’ rather
than snacks
• Promoting bringing healthy ‘small meals’ from
home to school, to avoid purchasing processed
snacks
Many other advocacy actions were also encouraged,
including around food in schools.

Table 11 Topics integrated within general population guidelines: United States
Dairy needs Children, adolescents
Iron sources Adolescent girls, women
Heme iron Young children, women of reproductive age, pregnant women
Iron supplements Pregnant women
Seafood, needs and cautions Young children, pregnant and lactating women
Folate sources Women of reproductive age, pregnant women
Folic acid fortified foods Women of reproductive age
Folic acid supplements Women of reproductive age, pregnant women
Fruit juice Young children
Sodium intake Children, adolescents
Food borne illness, foods to avoid Infants, young children, pregnant women
Physical activity Children, adolescents
Managing overweight and obesity Children, adolescents
BMI and weight gain Preconception, pregnancy
Servings per food group Children, adolescents
In this Section we have presented results separately creating a comprehensive list of topics that could
by region to allow clarity on which topics were be considered for inclusion in future FBDGs and
included in any particular region, but not in others. In associated guidance targeting age and physiological
Section 7 (case studies), topics as described in this groups.
Section will be grouped and combined with additional
topics addressed in the case study countries,

7 / COUNTRY CASE STUDIES
7.1 Overview concise messages for age and physiological groups.

The case studies for Spain and Latin America and the
Following the criteria listed in Section 2.3, the Caribbean were also relatively straightforward with
following countries were identified as potential case one or two source documents per country, and with
studies: many countries providing concise messages for age
and physiological groups.
Sub-Saharan Africa: Kenya, Sierra Leone
Belgium, France, Ireland, For the other high income countries (Ireland, New
Europe:
Spain, Sweden, Switzerland Zealand and Canada) case studies are more complex
South Asia: India because professional and consumer-facing resources
East Asia and the Pacific: New Zealand are numerous, sometimes overlapping in content, and
Argentina, Bolivia, Brazil, accessible through numerous cross-linkages in web
Latin America: Chile, Colombia, Mexico, applications. In New Zealand, however, there is clear
Panama, Paraguay navigation to a page collating all consumer-facing
North America: Canada, United States resources in one place.
However, due to time limitations we needed to select The breadth of the guidance was not associated with
a subset of countries, bolded in the list above.17 country income level. For example, Kenya and India
Source documents and websites for case study (both lower-middle income countries) have an explicit
countries are listed in Annex 4. life cycle focus in the main FBDGs document and
cover all age and physiological groups. However, the
The case studies for Kenya and India were very depth and level of detail in the guidance was generally
straightforward because there is only one source highest in high income countries.
document, and because they each included clear and
17 Selections were made as follows: For Africa and North America, we selected the most recent guidelines (Kenya, Canada); for Europe, we
excluded countries where some group-specific materials were available only in French, Flemish or German (Belgium, France, Switzerland);
we selected Ireland and Spain over Sweden because they had materials for more of the specific age groups. For Latin America, we prioritized
countries with guidance for school-aged children and adolescents (Bolivia, Chile) and those with the most recent guidance for infants and young
children under two years of age (Colombia, Panama). Mexico also has recent guidance covering the full life cycle but was excluded due to time
constraints, as the volume of materials for Mexico is very large.

7.2 Availability of group-specific guidance in groupings for young children do not align with
case study countries UNICEF’s groupings (see Box 1), with many countries
(particularly in Latin America) providing guidance
In this section, we identify which age groups are for infants and young children under 2 years of
covered in each case study country. Tables 12 and age but not for children in their third year. Ireland
13 show availability of group-specific guidance for provides web-based guidance for ‘toddlers’ but the
the case study countries, by age and physiological age range is not defined. India provides serving
group and indicate age groupings. The countries are sizes for children 1-3 years of age but provides no
organized by region. other guidance specific to this age range. Except
for Kenya’s, the age ranges for teenagers (or
Age groupings were not always clear in all guidance adolescents) also do not align with UNICEF’s.
documents; in some cases, age groupings are only
clearly delineated in guidance on number of portions Table 14 identifies the groups covered by the FBDGs,
per day or week, and other behavioral guidance as stated on each FAO country page. For countries
covered broader age ranges across, for example where other government guidance was identified that
across childhood, or all of childhood and adolescence. covered ages not mentioned at the FAO country page
(Ireland and Canada), we indicate the source and the
Globally, there are inconsistencies in age groupings. relationship to the dietary guidelines.
In a majority of the case study countries age
Table 12 Coverage of specific groups in case studies from Africa, Europe, the Pacific and North America
Kenya Irelanda Spain Indiab New Zealandc Canadad
Groups 2017 2011-2018 2010 2011 2013-2017 2019

Pregnant X X X X X
Lactating X X X X
Infants < 6 mo X X X X X
~6 mo ~6 mo ~6 mo
6-12 mo
6-11 mo 6-8 mo 6-9 mo 6-12 mo 7-8 mo
12-24 mo
9-11 mo 9-12 mo 8-12 mo
12-23 mo X 1-3 y X X
Toddlers
Pre-school 24-59 mo 3-6 y 4-6 y 24-59 mo
Children
School-aged 5-9 y 5-12 y 7-12 y 7-9 y 5-12 y
10-12 y
Adolescents 10-19 y 13-18 y 13-16 y 13-15 y 13-18 y Teenagers
16-18 y
a Much of the consumer-facing guidance in Ireland is web-based. There are web pages with guidance for toddlers, children and teenagers. The
general population food guide covers ages 5 and older and differentiates portions for some food groups for ages 5-12 and 13-18. Web pages are
not dated; documents were published, revised or reviewed from 2011-2018.
b The Indian Dietary Guidelines document has chapters on: 1) breastfeeding; 2) feeding home-based solids starting from 6 months; and 3)
adequate feeding for children and adolescents in health and sickness. Exact age groupings are not clear in the chapters; the age groupings
shown here are from Annex 4 which provides portion sizes and number of portions by age.
c New Zealand has separate technical documents and corresponding consumer-facing documents for various age groups. The most recent
updates were in 2013 for infants and toddlers under 2 years of age and for lactating women and 2017 for pregnant women, older children and
adolescents.
d Similarly to Ireland, Canada provides some web-based consumer-facing guidance that does not clearly delineate age groups. Under ‘life stages’,
there are pages for parents of children of all ages (young children through teenagers) and a page directed at teenagers. Canada’s revised
guidelines are very new, and there is no guide to portions though this may be forthcoming. Most web pages are associated with the new 2019
guidelines for the general population over 2 years of age, but some pages for pregnancy and infancy refer to older publications (see Annex 4 for
details).

Table 13 Coverage of specific groups in case studies from Latin America
Bolivia Chile Colombia Panama
Groups: 2013 2013 2018 2018
14-17 yr
Pregnant X
18-49 yr
Lactating X X
Infants < 6 mo X X X
6-8 mo 6-8 mo
6-11 mo X
9-11 mo 9-11 mo
12-23 mo X X X
Pre-school 2-5 y
6-7 y
School-aged 6-10 y
8-10 y
Adolescents 11-18 y 11-18 y
A community health volunteer in Kenya, gives nutrition

counselling on home visits. © UNICEF/UN0259535/Ndinda

Table 14 Target groups and location of group-specific guidance for case study countries
Country Statement of target groups from Location of group-specific guidance
FAO website
The recommendations are targeted at the
Guidance with separate messages for all life stages is in the
Kenya general population with key messages
main dietary guidelines document.
provided for each stage of the life cycle.
Guidance for infants and children under 5 years of age was
The messages of the guidelines are developed separately but is linked to from the Irish dietary
Ireland intended for adults and children over 5 guidelines website. Guidance for ages 5-12 and 13-18 was
years of age. also found in several documents and webpages linked to
from the main dietary guidelines page.
There are two sets of guidelines – one for Separate document for children and adolescents 3-16 years
Spain children and adolescents 3–16 years old, of age, identified as part of the dietary guidelines at FAO
and a second one for the general public. country page.
The guidelines are directed at the
general public. The document includes Guidance with separate messages for all life stages is in the
India
recommendations for different population main dietary guidelines document.
groups.
There are background papers for five
population groups: adults, pregnant
and breastfeeding women, infants The FAO country page provides a link to the age-specific
and toddlers (0–2 years), children and guidelines at the New Zealand Ministry of health website.
New
young people (2–18 years), and older Currently these are termed ‘food and nutrition guidelines’
Zealand
people. Health education resources are but New Zealand in the process of transitioning to ‘eating
developed for use by the general public and activity guidelines’.
to accompany each guideline background
paper.
Guidance for infants is not at the FAO country page but is
linked to through a hyperlink on page 1 of the main dietary
guidelines document and through various links at the
Canada’s food guide provides dietary
Health Canada website. Canada has developed a mobile-
Canada guidance for members of the Canadian
responsive web application for dissemination of guidance;
population two years of age and older.
guidance for children and adolescents 2-18 years of age is
available as life stage ‘tips’ and ‘resources’ linked to from
the main webpage of Canada’s Food Guide.
The guidelines are aimed at the healthy
general population over 2 years of
Three separate documents for: school-aged children;
age, with a focus on different age and
adolescents; and pregnant and breastfeeding women,
Bolivia physiological status groups: school-aged
identified as part of the dietary guidelines at FAO country
children; adolescents; adults aged 20-
page.
59 years; pregnant and breastfeeding
women; adults aged 60+ years
The guidelines are aimed at the general
public 2 years and older. Based on these
guidelines, the INTAa has developed
Separate document for children and adolescents 0-18 years
educational materials, including meal
Chile of age, identified as part of the dietary guidelines at FAO
plans, for different age groups: adults;
country page.
children under 2 years of age; children 2–5
years of age; children 6–10 years of age;
adolescents and the elderly.
The two sets of guidelines are directed at
Separate document covering pregnant and lactating women
the healthy population over 2 years of age,
Colombia and infants and children under 2 years of age, identified as
and at pregnant and breastfeeding women
part of the dietary guidelines at FAO country page.
and children under 2 years of age.
Panama has two guidelines which are
Separate for infants and children under 2 years of age,
aimed at the healthy population 2 years
Panama identified as part of the dietary guidelines at FAO country
and older, and at healthy children under 2
page.
years of age.
a INTA = Institute of Nutrition and Food Technology (INTA) of the University of Chile.

7.3 Development of FBDGs in case study New Zealand
countries New Zealand publishes separate FBDGs for different
population groups. In addition to those for adults,
Some case study countries (Ireland, New Zealand, New Zealand has separate FBDGs for four other
Canada and Colombia) provide detailed descriptions population groups:
of their FBDGs development processes. Other
countries stated they followed the process in the • Infants and toddlers (0–2 years)
WHO/FAO (1996) document without providing • Children and young people (2–18 years)
further description, or briefly described consultative
• Pregnant and breastfeeding women
processes involving a range of national stakeholders.
One country also identified previously developed • Older people (age 65 and older)
program guidance as a source (e.g. from infant and
young child feeding programs). Guideline development is briefly described in a
technical document that presents the FBDGs for
To illustrate several different approaches, this adults.20 In addition, New Zealand’s web interface
section provides a summary of FBDGs development is exceptionally clear and transparent regarding the
processes for the case study countries where details process of FBDGs development and revision.21 One
were available to us. webpage lists the specific previous reviews and
reports that were considered for each ‘eating and
Ireland activity evidence statement’ (which map directly to
The main guidelines for the general population aged guidelines) and provides hyperlinks to access each
5 and over were developed by the Department of cited report.
Health, working in partnership with other nutrition
experts in Ireland. The guidelines are based on a In addition to this documentation for adults, there is
2011 scientific document published by the Food a separate technical background paper describing the
Safety Authority of Ireland (FSAI).18 Guidance for evidence base for the guidance for each group listed
pre-conception through infancy was developed above.22
through by a separate Expert Working Group and
was reviewed by the Scientific Committee and the Finally, New Zealand goes farther than many other
Nutrition Sub-committee of the FSAI.19 countries in also providing clarity and transparency
on graded evidence statements backing many other
For the main guidelines, after identifying nutrients aspects of behavioral guidance, not only evidence
of concern and setting calorie and nutrient goals by for relationships between foods/dietary patterns and
age group and gender, the previous FBDGs were health outcomes.23 The statements cover support
evaluated by modeling the implied daily dietary for breastfeeding, parental feeding practices and
patterns and comparing to the new goals. New parenting style, adult role modelling, responsive
patterns (servings per food group) were developed eating, mealtimes and food skills and food literacy.
iteratively. Specific issues such as perceptions of
serving sizes and best images for identifying portions These evidence statements are presented in detail
were explored through qualitative research with in Annex 5, because they encompass many of the
consumers. topics that are the subject of newer guidance in other
countries. New Zealand provides a positive model of
transparency for the development of FBDGs.
18 Food Safety Authority of Ireland. 2011. Scientific Recommendations for Healthy Eating in Ireland. FSAI: Dublin, available at: https://www.fsai.
ie/science_and_health/healthy_eating.html
19 Food Safety Authority of Ireland. 2011. Scientific Recommendations for a National Infant Feeding Policy, 2nd Ed. FSAI: Dublin, available at:
https://www.fsai.ie/resources_publications.html
20 Ministry of Health. 2015. Eating and Activity Guidelines for New Zealand Adults. MOH: Wellington. Available at: https://www.health.govt.nz/
system/files/documents/publications/eating-activity-guidelines-for-new-zealand-adults-oct15_0.pdf
21 The overall revision process is graphically described in a flow diagram at this page: Process for developing the eating and activity guidelines:
https://www.health.govt.nz/our-work/eating-and-activity-guidelines/process-developing-eating-and-activity-guidelines. For the 2015
Guidelines for New Zealand Adults, the evidence review process is described at: Evidence for the Eating and Activity Statements: https://www.
health.govt.nz/our-work/eating-and-activity-guidelines/evidence-eating-and-activity-statements
22 See: https://www.health.govt.nz/our-work/eating-and-activity-guidelines/current-food-and-nutrition-guidelines
23 See: Gerritsen S and Wall C. 2017. How We Eat: Reviews of the evidence on food and eating behaviours related to diet and
body size. Wellington: Ministry of Health and: https://www.health.govt.nz/our-work/eating-and-activity-guidelines/
issue-based-documents-eating-and-activity/summary-evidence-statements-food-and-eating-behaviours

Canada Colombia
The Canadian FBDGs messages apply to adults and Colombia provides separate FBDGs covering
children 2 years of age and older.24 The technical pregnant and lactating women and infants and
document also includes a hyperlink to a separate young children under 2 years of age.25 In 2017,
guidance document for infants and young children the Colombian Family Welfare Institute and FAO
under 2 years of age, and also directs readers to established an agreement related to reviewing and
a variety of online resources for specific age and updating dietary guidelines for these groups.
physiological groups.
An interdisciplinary National Technical Committee for
Canada’s Dietary Guidelines are developed by Food Based Food Guidelines (CTNGA) was reformed,
Health Canada through a structured, multi-step and including delegates from different ministries and
well-documented process, with three main sets of government agencies, academia, and the National
considerations: Association of Nutritionists, among others. The
revision process was led by ICBF, with technical
• Scientific basis, including nutrient standards and support from FAO as technical secretariat and
the effects of food and nutrients on health; CTNGA.
• Canadian context, including demographics and
health status; food skills, habits and behaviors; The revision process followed the methodology
attitudes and beliefs about healthy eating; food adapted by FAO for their member countries. The
and nutrient intakes; the food supply; the policy process started with a technical review of the food
environment; and the nutrition information guides published in 2004; then, research topics
environment; and and questions were formulated and prioritized
• Evidence around use of existing dietary guidance, and subsequently resolved through the review of
including awareness and understanding; scientific evidence and consultation of experts.
confidence and acceptance; and integration and
use.
Evidence was graded and diet-health associations

with ‘convincing’ evidence were identified as
relevant for inclusion (while also considering other
factors including stakeholder needs). In compiling
evidence, the Canadian process primarily considered
existing reviews from leading scientific organizations
or federal agencies as well as health claims
assessments from Health Canada.
Guidance for infants and young children was

developed separately by the Infant Feeding Joint
Working Group, which is a collaboration between
Health Canada and national organizations (Canadian
Paediatric Society’s Nutrition and Gastroenterology
Committee; Dietitians of Canada; Breastfeeding
Committee for Canada; Public Health Agency of
Canada). The process was also supported by an
Infant Feeding Expert Advisory Group and was
informed by input from stakeholders in open
consultations.
24 Source: Health Canada. 2019a. Canada’s Dietary Guidelines for Health Professionals and Policy Makers. Health Canada: Ottawa. Available at:
https://food-guide.canada.ca/static/assets/pdf/CDG-EN-2018.pdf.
25 Source: Instituto Colombiano de Bienestar Familiar. 2018. Guias Alimentarias Basadas en Alimentos para mujeres Gestantes, Madres en
Período de Lactancia y Niños y Niñas menores de dos años de Colombia. Documento Técnico. ICBF: Bogotá. Available at: https://www.icbf.
gov.co/sites/default/files/gabasmenor2anos_documentotecnico_2018.pdf

7.4 Summary of topics in group-specific h. Guidance on fish and seafood; portions,
guidance mercury and other toxins, safe preparation
4. Dairy (also an animal-source food, but often
In this section, we summarize all the topics
treated as a separate group)
addressed for age and physiological groups,
a. Extra needs for age and physiological groups
whether embedded within guidelines for the general
b. Milk types – Percent fat at different ages
population (Section 6) or in documents reviewed for
c. Milk in infancy
the case studies. We have organized the many topics
d. Other calcium-rich foods and alternatives for
into broader categories, presented below in outline
vegans, lactose-intolerance, or when dairy is
form. Not all topics are relevant for all population
unavailable or unaffordable
groups, but many are present in guidance for all
e. Maximum amount for toddlers (several
groups.
countries indicate 500 ml/day)
f. Food safety for certain products;
In addition to the topics below, depending on the age
unpasteurized, certain types of cheeses
range for the country’s general guidance, in many
(Listeria risk)
cases the general guidance applies. Some countries
mention this in group-specific consumer-facing 5. Vegetables and fruits
guidance, but do not elaborate (e.g. Irish guidance a. Guidance on portions of each, per group
for pregnancy: ‘follow the basic healthy eating b. Variety within vegetables and fruits
guidelines’) while others incorporate the general c. Folate sources
guidance into the consumer guidance for groups (e.g.
6. Fortified foods and ingredients
the New Zealand booklets consolidating guidance for
a. Folic acid fortified foods
age and physiological groups).
b. Iodized salt
Topics in the group-specific guidance are: 7. Supplements

a. Vitamins: Vitamin B12, folic acid, vitamin D –
1. Meal patterns and frequency of eating/feeding when needed, dosage, duration
a. Number of meals and snacks b. Minerals: Calcium, iron, iodine – when needed,
b. Importance of breakfast dosage, duration
c. Discouraging ‘grazing’; encouraging regularity c. Multiple micronutrients – pills or powders,
for meals and snacks (or ‘mini-meals’) content, indications, duration
2. Portions/servings d. Vitamin A supplements/cod liver oil – limiting
a. Portions sizes for different ages during pregnancy
b. Portions or servings for each food group per e. Vitamin D sources/sun exposure/sun safety
day or week f. Use of antacids during pregnancy
c. Size of plates and cups (e.g. smaller for small 8. Fat
children) a. Fat types and sources
d. Additional portions during pregnancy (from X b. Sources of omega-3 fatty acids
weeks) and while breastfeeding c. Fat needs and energy-density for infants and
3. Animal-source foods and/or protein-rich foods young children under two
a. When scarce: Prioritizing vulnerable groups for d. Moderation for other groups
any available animal-source foods e. Lower fat cooking methods
b. Guidance on portions of various types, and for 9. Sugar (see also beverages)
plant- and animal-sources a. Limit added sugar; don’t add to
c. Guidance on red meat and/or processed meat complementary food
d. Guidance on liver (pregnancy – limit, or
10. Salt
encourage)
a. Limit salt; don’t add to complementary food
e. Guidance on eggs (may be encouraged as
b. Use iodized salt
complementary foods)
f. Guidance on iron sources, heme and 11. Foods high in fat, sugar and salt
non-heme a. Discourage consumption of country-specific
g. Guidance on inhibitors/enhancers (tea, coffee, examples; ‘occasional foods’; define and
vitamin-C sources) describe these (often, foods high in fat, sugar
or salt; certain highly processed foods)

12. Beverages f. ‘Screen time’ – limiting for children,
a. Avoidance of sweet beverages in bottles adolescents
b. Use of cup from early age (in infancy) g. Sleep
c. Sugary drinks/sugar-sweetened beverages/
20. Special topics for pregnant women
sweet drinks – guidance for all ages
a. Dealing with ‘pregnancy symptoms’: nausea,
d. Clear guidance on 100% juice
vomiting, heartburn, constipation
e. Energy drinks, energy shots, other caffeinated
b. Anticipatory guidance on breastfeeding
drinks
including early initiation, skin-to-skin contact
f. Tea and coffee (see also iron above); guidance
c. Counseling against weight loss
for all groups
g. Water and/or fluid needs, including additional 21. Special topics for breastfeeding
needs during lactation a. Recommended practices: early initiation,
h. Alcohol (avoidance or limits) feeding colostrum, feeding on demand,
exclusive breastfeeding, duration of
13. Food taboos
breastfeeding
a. Address as needed for age and physiological
b. ‘How-to’ guidance (e.g. positioning, latching
groups
on, maintaining supply) and where to find
14. Vegetarians/vegans practical help
a. Special care needed with diet and specific c. How to know if baby is getting enough; normal
nutrient needs for ages and physiological number of wet diapers
groups d. What to expect: stools, spitting up
b. Guidance on supplements (e.g. B12 for vegans) e. Dealing with colic
f. Enlisting family support
15. Food safety
g. Don’t ‘cut calories’ during breastfeeding
a. Household hygiene and handwashing
h. How to express breast milk; how to safely
b. Selecting and preparing/processing/cooking/
store and use expressed milk
storing food safely
i. Introducing cups
c. Specific food safety risks during pregnancy
and for infants and young children; foods to 22. Special topics for formula feeding
avoid a. Choice of formula; current advice on use of soy
d. Choking hazards; foods to avoid for infants formulas
and young children; food processing to reduce b. How to safely make up and store infant
hazards; supervision formula
c. How to bottle feed; not forcing infant to finish
16. Allergies and intolerance
the bottle
a. Consuming and introducing potential allergens,
d. Infant formula until 12 months of age, and no
also gluten – updated guidance for pregnancy
need for follow-on formula
and infancy
e. Introducing cups
17. Oral hygiene and dental health
23. Special topics for complementary feeding
a. In pregnancy
a. Detailed guidance at each stage, e.g. on
b. Care of infant teeth and use of pacifiers/
frequency, quantity, texture, variety, adequacy,
dummies
responsive feeding, and/or hygiene
18. Weight, height and BMI b. Several countries provide guidance on feeding
a. Tracking growth practices separately for age sub-groups (or
b. Pre-pregnancy BMI ‘stages’) such as ~6 months, 7-8 months, 9-11
c. Tracking pregnancy weight gain months, 12+ months
d. Managing overweight and obesity c. How to tell when child is ready for each stage
e. Supporting an overweight child d. Introducing new foods one-by-one
19. ‘Lifestyle’/environment e. Anticipatory guidance: young children may
a. Physical activity need to be offered new foods many times
b. Smoking before they will accept
c. Non-prescription drugs and herbs; some are f. Iron sources
dangerous during pregnancy or lactation g. How to make homemade complementary
d. Illegal drugs foods, including (as needed) how to reduce
e. Indoor air quality bulk; introduce whole grains gradually

h. Do not give low-fat diet f. Keep healthy snacks available at home and
i. No added sugar or salt do not keep a regular stock of less healthy
j. Other foods, drinks and ingredients to avoid choices/foods to avoid
(due to safety, sugar/salt content) g. Plan for healthy snacks and drinks away from
k. Responsive feeding practices: recognizing home
hunger and satiety cues, no forcing, allow child
to indicate when full, engaging with child 7.5 Comparison of selected topics across
l. Managing constipation countries, by groups
24. Special topics for feeding young children
Specific guidance for each age and physiological
a. Portion sizes and frequency of meals and
group is detailed and compared across countries in
snacks
tables in Annex 6. Here, we describe similarities and
b. Best beverages – water and milk; beverages to
differences in guidance across countries for each age
limit or to avoid, including specific guidance on
and physiological group.
juice
c. Role of ‘treats’; foods to limit – specific
For the purposes of this section (and Annex 6) we
examples and country-specific foods/food
are focusing on guidance on behaviors related to
categories to avoid
food and beverage consumption, and do not compare
d. Healthy snacks/ ‘mini-meals’
guidance on the following: food safety practices;
e. What to do when children have consistently
growth or weight monitoring and monitoring of
poor appetite
weight gain during pregnancy; physical activity; and a
f. Parenting around feeding; dealing with picky
diverse set of other non-food-related lifestyle issues
eaters, what to do when children refuse
(e.g. smoking, drug use, indoor air quality, sleep).
entire food groups, ‘division of responsibility’
in feeding – caregiver to provide variety of Guidance for pregnant women
healthy choices at meals and snacks but child Seven of the case study countries provide separate
chooses how much to eat guidance for pregnant women (Kenya, Ireland, India,
25. Feeding infants and children during illness New Zealand, Canada, Bolivia and Colombia). All
a. Types of foods countries encourage a varied diet, and all provide
b. Small amounts but frequent guidance on: additional quantities of food during
c. Fluids, breastfeeding and oral rehydration salts pregnancy; food groups to consume; food groups
d. Extra feeding after illness to moderate; folic acid supplementation, and total
abstinence from alcohol.
26. Promoting healthy dietary patterns for
children and adolescents Most countries indicate the number of daily portions
a. See also practices for the whole family per food group. The number of portions per food
b. Parents/caregivers set a good example group varies by country, but this is not a meaningful
c. Teach children and teens food skills, including comparison because standard portion sizes also
(as age appropriate) planning meals, shopping, vary. However, there is more consistency with
cooking, and gardening; make learning fun recommendations for ample dairy consumption and
d. Offer suitable portion sizes for age most countries recommend 3-5 portions (e.g. 3-5
e. Limit treats and other less healthy choices; X 100 ml fluid milk). Most countries also encourage
as for young children identify foods and ample water, but only some give guidance in terms
beverages high in fat, sugar or salt - country- of glasses per day. Most countries advise to limit
specific foods/food categories to avoid caffeinated beverages and most highlight that tea and
27. Practices for the whole family coffee reduce absorption of iron; some advise they
a. Family meals should be consumed between meals and not with
b. Developing and sharing/teaching food skills meals. Finally, most countries provide guidance on
(e.g. growing, shopping for, processing and dietary management of nausea, vomiting, heartburn
cooking food) and constipation.
c. No television or electronic devices during
meals
d. Read nutrition labels
e. Healthier cooking practices (e.g. less frying/
deep frying)

Guidance that varies most by country includes: unnecessarily restrictive diets during pregnancy
(whether due to cultural food taboos, or due to
• Nature of guidance on extra food – extra meals unwarranted concerns about potential allergens)
and snacks vs. extra portions of specific food
groups; the food groups for which extra portions India, Colombia and Bolivia provide multiple
are recommended; total additional kilocalories messages on fats, sugar and salt (India only), with
implied by the guidance; and whether the extra both positive messages to consume sufficiently (or
food is recommended throughout pregnancy, or in not restrict) and also moderation messages to avoid
the second and third trimester
excess.
• Guidance on liver – consumption is encouraged in
some countries and discouraged in others to avoid Guidance for lactating women
overconsumption of vitamin A Except for Canada, the case study countries with
• Guidance on fish – consumption is encouraged separate guidance for pregnant women also provide
in most countries, but some countries do not separate guidance for lactating women (Kenya,
mention it; among those who encourage fish Ireland, India, New Zealand, Bolivia and Colombia).
consumption, some but not all give detailed Canadian guidance for the breastfed infant notes
guidance on types of fish to consume, and the fluid needs of the mother, but there is no dietary
avoiding mercury contamination guidance.
• Extent of guidance on iron, calcium, and folate
sources, and specifically on non-dairy sources of For the 6 countries providing guidance, all encourage
calcium a varied diet and all provide guidance on: additional
quantities of food during lactation; food groups to
• Extent of guidance for vegetarians/vegans during
consume; and food groups to moderate. As for
pregnancy
pregnancy, most countries indicate the number
• Guidance on supplementation varies widely by of daily portions per food group including ample
context, as would be expected dairy consumption of 3-5 portions. Some countries
o Folic acid is the only supplement recommended emphasize increased fluid intake for lactating women.
in all countries, but the recommended dosage
and duration of supplementation varies The areas of difference between countries are
generally similar to those for pregnant women:
o Iron supplements are recommended in most
countries but not in New Zealand, and Ireland • Nature of guidance on extra food – extra meals
advises that the ‘physician may recommend and snacks, vs. extra portions of specific food
iron supplements for some women’; among groups; the food groups for which extra portions
countries recommending, the dosage varies are recommended; total additional kilocalories
o Other supplements recommended in some implied by the guidance; and whether the extra
countries include iodine, vitamin B12, vitamin D, food is recommended (implicitly) throughout
and calcium lactation, or explicitly only in the first 6-12 months
• Some countries encourage consumption of • Extent of guidance on iron, calcium, and folate
fortified salt (singly- or doubly-fortified)26 while a sources, and specifically on non-dairy sources of
few countries encourage consumption of other calcium
fortified foods • Extent of guidance for vegetarians/vegans during
• Some countries provide guidance on sugary lactation
beverages • Guidance on supplementation varies widely by
• While all countries include moderation messages context; there is no consistency across countries
for foods high in sugar, fat, and/or salt, some do • Some countries encourage consumption of
not address all three, and the level of detail in fortified salt (singly- or doubly-fortified) while a
the guidance varies widely with some countries few countries encourage consumption of other
providing long lists of foods to avoid and other fortified foods
strategies to reduce consumption of sugar,
salt and saturated and/or trans- fats; only some • Some countries provide guidance on sugary
countries frame moderation in relation to level of beverages
food processing • Guidance on caffeinated beverages and alcoholic
• Only a few countries address the issue of avoiding beverages varies across countries; some countries
26 Singly fortified salt is fortified with iodine; doubly fortified salt is fortified with iodine and iron.

advise abstaining from alcohol while others allow New Zealand, Canada, Chile) provide guidance on
but provide guidance on expressing breastmilk choice of infant formula and safe use of formula
before drinking alcohol and not breastfeeding for
• The two lower middle income countries (Kenya
2-3 hours after consuming alcohol
and India) provide guidance on exclusive
• Guidance for foods high in fat, sugar and salt is breastfeeding in the first few days of life, through
the same as for pregnant women and there is the specifying what not to give
same wide variation in level of detail
Other topics covered by only one or several countries
• One country cautioned women against
unsupervised elimination diets and recommended include:
seeking medical advice if the mother is concerned
• Recognizing hunger cues (including newborn)
that something she is eating is affecting the baby
• Dealing with breastfeeding problems (infant
Infants 0-6 months of age refusing, tender nipples, engorgement)
All case study countries except for Spain and Bolivia
• Colic
provide separate guidance for infants under 6 months
of age (Kenya, Ireland, India, New Zealand, Canada, • Use of cups
Chile, Colombia, and Panama). • Vitamin D supplementation
• Breastfeeding and HIV+ women
Most or all countries provide guidance on:
• Contraindications to breastfeeding
• Early initiation of breastfeeding; only some
of these mention value of giving colostrum Infants and young children 6-23 months of age
specifically All case study countries except for Spain and Bolivia
• Feeding on demand; fewer countries specifically provide separate guidance for infants under 6-23
mention night feeds months of age (Kenya, Ireland, India, New Zealand,
Canada, Chile, Colombia, and Panama). Age ranges
• Exclusive breastfeeding for 6 months; India states
and sub-groupings varied by country, with India
‘for a minimum of 6 months’
providing guidance for 6-12 months of age and all
• How to tell of the breastfed baby is getting other countries covering 6-23 months, dividing into
enough various sub-groupings or stages (see Table 12 above).
• Expressing breastmilk; while all mention this, More extensive guidance is provided for this age
only a few provide detailed practical guidance on group than for any other.
expressing and safe storage and use of expressed
breastmilk; one covers use of banked milk Most countries provide guidance on the following and
the guidance is reasonably consistent:
All countries provide some mention or guidance
on the following topics, but the guidance is • Continued breastfeeding/duration of breastfeeding
heterogeneous: • First foods – what foods and textures, and how
much to offer in baby’s first meals
• Breastfeeding skills and ‘how to’; examples range
from brief mention of the value of time spent skin- • Detailed guidance on textures for the different age
to-skin to detailed guidance on recognizing hunger sub-groups/stages
cues, positioning, latching on, how to tell if baby is • Menus or recipes, some divided by age sub-
sucking well, breaking suction, alternating breasts, groups/stages
etc.
• Timing of introduction of food groups, with some
• Support for the breastfeeding mother; some inconsistencies (for example, age to introduce fish
countries provide mothers with lists of and eggs)
government and community resources (public
health agencies and community support groups), • Frequency of meals and snacks, although with
whereas others advocate for and detail practical some minor variation in the recommendations
roles for spouses, families and communities • Examples of healthy snacks
Topics where there is a pattern related to country • Descriptions of diverse diets and foods groups,
income level: without specifying portions per day or portion
sizes; only a few counties (India, Panama)
• Four of the five high income countries (Ireland, specifies precise portion sizes and number of
portions for this age group

• Guidance on infant formula – what type, and safe • Guidance on foods high in sugar, salt and fat:
use of formula. Several countries specify that Ireland and several countries in Latin America had
follow-on formula is not needed. India provides detailed lists of foods and ingredients that should
guidance for giving animal milks to non-breastfed not be given to infants; Canada had a positive
infants message on the need for nutritious higher fat
foods for this age group, and other countries did
Some countries provide guidance on: not address
• Guidance on choking hazards; only a few countries Finally, there were a number of topics mentioned in
mention other foods to avoid for safety reasons the guidance of only one or two countries:
(e.g. honey before 12 months, unpasteurized dairy,
bran, liver) • Detailed guidance on signs of developmental
• Role of the parent and role of the child in feeding/ readiness for first foods
eating, and responsive feeding practices • Detailed guidance on the ‘how to’ of giving babies
• Importance of family meals their first foods
• Use of cups • What to do if a child refuses certain foods or food

groups
There were only a few patterns for country income • Issues around appetite
levels:
• As noted above, only a few countries provided
specific portions/portion sizes per food group for
• Both lower-middle income countries (Kenya
this age range
and India) provided guidance on feeding during
illness, while only one high income country did so • Advice to use a separate bowl for the child’s food
(Panama)
• Guidance on dietary management of constipation
• Only Kenya and India included the concept of
adding oil (both countries) and sugar (India) to Young children 2-4 years of age/toddlers/
complementary foods to increase energy. Both preschoolers
also gave examples of energy-dense foods to add Seven of the case study countries provide separate
to complementary foods (e.g. in Kenya, avocado guidance for young children over 2 years of age
and groundnut paste). Chile recommends adding (Kenya, Ireland, Spain, India, New Zealand, Canada,
vegetable oil to porridge but does not connect this
and Chile). As noted, the age ranges vary by country,
to the issue of energy intake or energy density
and in some countries, guidance covers a wider age
• Only the high income countries (Ireland, New range (e.g. all children and adolescents 2-18).
Zealand and Canada) provided guidance around
introducing potential allergens, and this guidance Most of the 7 countries provide guidance on:
varied among the three countries
• Food groups, portions, and portion sizes – though
There were a few topics that most or all countries quantities per food group vary.
included, but where the guidance was highly varied,
• All countries with portion information recommend
including: ample dairy (generally, ~500-750 ml/day); one
country notes that children who drink too much
• Guidance on supplements
milk (more than 500 ml/day) may not eat enough
• Guidance on fortified foods and ingredients food (New Zealand)
• Guidance on beverages, where the five high • Beverages – but the guidance varies, with some
income countries had detailed guidance on countries only providing positive messages
many types of drinks to avoid, as well as positive about milk, or milk and water, (Kenya, India) and
guidance on milk and water. Kenya and India other countries providing moderation messages
focused on milk intake, while Kenya noted to avoid about sweet or sweetened drinks, and on certain
coffee or tea made with sugar beverages to avoid (e.g. coffee, tea, energy
drinks). Advice on 100% juice varies.
• Guidance on sugar, salt and fat: As noted Kenya
and India include positive messages on adding oil • Healthy snacks – and most countries give
to complementary foods; India has recommended examples
portions and portion sizes for sugar and oil; only
about half of the countries commented on not
adding salt to baby’s food

• Parenting around food/feeding and/or responsive guidance on healthy eating, foods and beverages to
feeding: Most countries include this topic, and moderate, and most importantly in guidance on the
several provide very detailed guidance (see Tables role of the parent in feeding this age group.
A6.10 and A6.11 in Annex 6)
• Family meals School-aged children
Eight of the case study countries provide separate
• Moderation in foods high in fat, sugar and salt;
guidance for school-aged children (Kenya, Ireland,
the level of detail in the guidance varies, and in
Spain, India, New Zealand, Canada, Bolivia and Chile).
some countries the moderation message is only
As noted, the age ranges for school-aged children
for sweet foods and beverages, not for high fat or
high sodium/salty foods vary by country, and in some countries, guidance
covers a wider age range (e.g. all children and
Topics where there is more variation in guidance adolescents 2-18). Groupings include: 5-9 years; 5-12
include: years; 6-10 years; and 7-12 years. For this age group,
the general population guidance also applies in a
• Frequency of meals and snacks: some guidance majority of the case study countries; i.e. school-aged
suggests very structured meal patterns, with children are covered by the general dietary guidelines,
specific numbers of meals and snacks, while but the countries have supplemented with age-
other guidance is more flexible ‘If your toddler specific guidance.
can’t manage set ‘meals’, then offer a number
of nutritious snacks throughout the day instead.’ Many of the consistencies and inconsistencies just
(Ireland); a few countries emphasize the described for young children follow a similar pattern
importance of establishing the habit of eating
in guidance for school-aged children.
breakfast. Two countries discourage ‘pecking’ or
‘grazing’ (Spain, New Zealand)
For this age group, all countries provide guidance on
• Similarly, while most countries specify portion moderation in foods high in fat, sugar and salt and/
sizes, some put a stronger emphasis on allowing or highly processed foods; as for younger children
the child to choose the quantity the level of detail in the guidance varies. However
• Guidance on milk fat varies across countries for there tends to be more detail because the general
this age group with several countries advising population guidelines apply, and these often have key
a transition to reduced fat or low-fat milk; most messages (and sections of guidelines documents)
mention that nonfat (skim/skimmed) milk is not detailing this.
appropriate for underfives; some countries do not
specify the type of milk All countries also provide guidance on beverages –
• Sugar and oil – a few countries have as for younger children the guidance varies in terms
recommended portions of these (e.g. India of the number of types of beverages to avoid and
advises 15-20 g of sugar a day for this age group) for which to moderate intake, and some countries
whereas others have moderation messages specify recommended quantities for water intake
while others do not.
Some topics are addressed by only one or a few
countries: Most of the 8 countries provide guidance on:
• Food skills – starting early to involve young • Food groups, portions, and portion sizes – though
children in shopping, cooking, gardening, etc. quantities per food group vary
• Dealing with picky eaters • Several countries emphasize appropriate/smaller
portion sizes for children (Ireland, New Zealand)
• Children with poor appetite
while Kenya emphasizes allowing the child to
• Children in vegetarian families choose his/her own portion size from preferred
• Supplements for this age group foods, ‘provided they are adequate, wholesome
and nutritious’
• Fortified foods and ingredients
• Choking hazards ample dairy for this age group as for younger
• Feeding during illness children (generally, ~500-750 ml/day)
• For countries where the general population
While overweight is not necessarily addressed guidance applies, there is more emphasis on
directly, it is addressed indirectly through the whole grains and fish

• Healthy snacks – and most countries give addition to or instead of consumer-facing guidance for
examples parents.
• Parenting around food/feeding: As for younger
children, most countries include this topic. There All countries provide guidance on moderation in foods
is more of an emphasis on parents (and other high in fat, sugar and salt and/or highly processed
adults) as role models foods and as for school-aged children there is a fair
amount of detail in many countries. All countries also
• Family meals are encouraged, and several
provide guidance on beverages, and there are often
countries also specifically advise to turn off
detailed lists of beverages to prefer and those to
television and other devices during meals
moderate. Several countries advise against alcohol.
• Teaching children food skills is more commonly
mentioned and described for this age group Most of the 8 countries provide guidance on:
Topics where there is more variation in guidance • Food groups, portions, and portion sizes – though
include: quantities per food group vary. Some differentiate
number of portions or portion size by sex and/or
• Frequency of meals and snacks: some guidance activity level
suggests very structured meal patterns, with
specific numbers of meals and snacks, while
ample dairy for this age group as for younger
other guidance is more flexible; a few countries
children (generally, ~500-800 ml/day)
emphasize the importance of establishing
the habit of eating breakfast. Two countries • Number of meals and snacks, and the importance
discourage ‘pecking’ or ‘grazing’ (Spain, New of breakfast
Zealand)
• Healthy snacks; countries with ‘teen-facing’
• Sugar and oil – a few countries have guidance provide many examples and strategies
recommended portions of these (e.g. India for healthy snacking at home and elsewhere
advises 20-30 g of sugar a day for this age group)
• Family meals – and the teen’s own role
whereas others have moderation messages
• Sugar, fat and salt: Most countries provide
Some topics are addressed by only one or a few moderation messages, but some countries also
countries: provide quantitative recommendations for intakes
of oil and sugar
• Children in vegetarian families
Some countries provide guidance on:
• Supplements for this age group
• Fortified foods and ingredients • The role of the parent or other adults. Several
countries emphasize new concerns and roles at
• Feeding during illness
this age, such as being observant for signs of
eating disorders or unhealthy dieting
Adolescents
The same eight case study countries that provided • Half of the countries address body weight, body
separate guidance for school-aged children also image, dietary and/or eating disorders, but the
provide guidance for adolescents (Kenya, Ireland, level of detail in the guidance or messages is
Spain, India, New Zealand, Canada, Bolivia and generally low. Messages are also diverse with
some emphasizing caution about weight gain,
Chile). As for younger children, the age ranges vary
whereas Canada, for example, provides a different
by country, and in some countries, guidance covers
message for adolescents: ‘Working on building
a wider age range (e.g. all children and adolescents healthy eating habits and focusing on your overall
2-18). Groupings include: 10-19 years; 11-18 years; health can be more important than focusing on
13-16 years; and 13-18 years. For this age group, your body weight’
the general population guidance also applies in a
• In countries with ‘adolescent-facing’ guidance,
majority of the case study countries; i.e. adolescents
many roles are suggested for the adolescent
are covered by the general dietary guidelines, but
him/herself as a role model, and in encouraging
the countries have supplemented with age-specific parents and schoolmates to make healthy choices
guidance.
• Half of the countries emphasize teaching (or
For adolescents, several countries provide consumer- learning) a variety of food skills at this age
facing guidance directed to the teen him/herself, in

• Half have nutrient-focused messages (generally, Some topics are addressed by only one or a few
on iron and calcium; rarely, on fiber and vitamin countries:
B12 for vegetarians); other countries without
nutrient-focused messages cover the topic of high • Additional needs for athletes
micronutrient needs in background information
• Meeting micronutrient needs of adolescents who
and through emphasis on iron-rich foods and
are vegetarians
calcium sources
• Meeting needs of pregnant adolescents
• Half of the countries have messages on fortified
foods and ingredients, mostly from the applicable
general population guidelines
• Some countries provide additional messages
about variety and types of fruits and vegetables

8 / DISCUSSION AND RECOMMENDATIONS
8.1 Overview of FBDGs for age and More extensive guidance may include detailed
physiological groups suggestions for how population groups can meet
guidelines. For example, some countries provide
FBDGs are available for slightly fewer than half of very detailed guidance on how to initiate and
all countries, globally, and availability is associated maintain breastfeeding, how to express milk,
with country income level, with FBDGs available how to choose and safely use infant formula, and
for only 13% and 26% of low income and lower how to introduce complementary foods. Some
middle income countries, respectively. Among the country FBDGs have also begun to address a
92 countries with FBDGs at the FAO repository, wider range of behavioral issues around food and
half provide separate guidance for age and/or diets, including responsive feeding, parenting to
physiological groups. In Africa, the Middle East, help children develop healthy habits and a healthy
South Asia, Europe, and North America, when relationship to foods and eating, and addressing
such guidance is provided it is more likely to cover the developmental stage of adolescence. Relatedly,
many or all of the groups in this review (infants, some newer FBDGs also focus on the social
young children, preschoolers, school-aged children, role of meals in the family and the community,
adolescents and pregnant and lactating women). In on transmission of food skills to children and
Latin America, there are a larger number of countries adolescents, and on the role of marketing and the
that provide separate guidance only for infants and need to limit exposure but also to educate children
young children under two years of age. and adolescents on this issue.
There is wide variability in the scope and specificity 8.2 Development of FBDGs for age and
of the guidance. At minimum, the FBDGs provide physiological groups
messages only, or messages accompanied by a brief
rationale (‘why’) and focus on ‘what, how much, Only some of the guidance for specific groups is
and how often’ to eat a variety of foods, along with clearly developed and disseminated as part of the
common moderation messages for foods high in sugar, national FBDGs. In other cases, and particularly in
salt, and/or fat. These may or may not be accompanied high income countries government guidance for
by messages on consuming adequate amounts of specific groups (most commonly, infants, young
water, avoiding or limiting alcohol, encouraging physical children, and pregnant and lactating women) may
activity, and/or practicing food safety. be developed through parallel processes.

There is a structured process for development of and refining messages, and in documenting these
FBDGs that has been followed by many countries, processes.
but there is large variation in the nature and scope of
available evidence (and gaps) at country level, and in Finally, all countries face the challenge of keeping
how countries develop and review evidence, which FBDGs and all associated consumer resources up to
may sometimes be related to available resources. date, especially for topics where evidence has shifted
Some countries commission new systematic reviews in recent years or is highly contextual. Even in high
during the guidelines development process, but income countries with more resources to support
most countries rely on a mix of available reviews websites, documents with conflicting information
(for example from WHO, the International Agency were found, and many consumer-facing documents
for Research on Cancer, the U.S., and certain other did not have version or revision dates. This makes
high income countries). Some countries (e.g. Canada) it difficult to know if they reflect the most recent
also incorporate evidence from government reviews revision of technical documents.
related to health claims. Often, countries also
incorporate expert consensus processes. 8.3 General recommendations
Some countries are explicitly aiming to broaden the Section 7.4 provided an extensive list of topics
range of evidence considered acceptable as a basis that countries could consider for inclusion when
for FBDG. Brazil highlights this in one of the five developing FBDGs for age and physiological groups.
principles that inform and underlie the rest of their Decisions on what to include will depend on national
guidelines: ‘Different sources of knowledge inform public health and food system priorities, but certain
sound dietary advice’.27 They note that in addition ‘core’ topics for each age and physiological group
to experimental, clinical, and population studies, are suggested for consideration in the next section.
qualitative studies are also powerful and traditional Before focusing on each group, we propose a set of
dietary patterns themselves are ‘vital evidence’, general recommendations on: 1. What to include
representing a natural experiment and resulting in at a minimum; 2. Some issues that may be in
well-adapted dietary patterns and enjoyable meals. tension in some guidelines; and 3. Documentation
and presentation of guidelines and of processes
Following Brazil, Ecuador also articulated principles and evidence. These general recommendations are
including that the guidelines should reflect a dialogue followed by group-specific recommendations.
among different types of knowledge. They also
articulate principles related to broader concerns with Include:
well-being (physical, emotional, sociocultural) and 1. Whether in separate documents/webpages (type
with sustainability. They map certain key messages 5) or separately within the main FBDGs document
(guidelines) to these principles, rather than to (type 4), do include specific guidance for age and
systematic evidence reviews.28 physiological groups.
There is also variation in available description and 2. Develop both professional and consumer-
documentation for evidence reviews. In some cases, facing guidance. For professionals, in addition
it is possible to clearly ‘map’ evidence and evidence to technical documents with the evidence base
statements to guidelines relating to intake of foods/ or rationale for the FBDGs, shorter guides to
food groups and food substances (e.g. trans fats) ‘best practice’ are useful; see, for example, best
and dietary patterns, and for evidence related to practice guidance for pre-conception through
physical activity. It is far less common for countries infancy from Ireland.29
to describe and provide the evidence base for many 3. When the general population FBDGs also apply to
other types of behavioral guidance, such as guidance the population sub-group (for example, diversity
encouraging responsive feeding and family meals. across and within food groups, moderation
messages) communicate this clearly in consumer-
In addition to the variation in developing and
facing guidance; that is, consolidate the guidance
documenting the evidence base for guidelines
for that sub-group so it is accessible in one place/
statements, there is variation in the process of testing
27 Ministry of Health. 2014. Dietary Guidelines for the Brazilian Population. MOH: Brasília, p. 20.
28 Ministerio de Salud Pública del Ecuador y Organización de las Naciones Unidas para la Alimentación y la Agricultura (2018). Documento Técnico
de las Guías Alimentarias Basadas en Alimentos (GABA) del Ecuador. GABA-ECU 2018: Quito, pp. 71-74.
29 Food Safety Authority of Ireland (FSAI). 2012. Best Practice for Infant Feeding in Ireland - A Guide for Healthcare Professionals. FSAI: Dublin.

one source; see New Zealand (Annex 4) for an minimize the consumption of processed foods
example. high in salt, sugar and fats.
4. At a minimum, include guidance on ‘what’ foods/ Increasingly, in countries undergoing rapid
beverages and ‘how much’, including for various nutrition transitions, there is a similar tension in
animal-source foods. communicating on ‘enough, but not too much’
for animal-source foods.31 There are no easy
5. Include clarity and as much specificity as possible
solutions, but these issues warrant very careful
on foods/types of foods and beverages to be
communication.
minimized or avoided for various age groups and/
or for everyone.
Documentation and presentation:
6. To the extent that resources allow and evidence
9. Clearly identify the audience for each resource
supports, go beyond ‘what’ and ‘how much’ to
(document or webpage); if possible, develop
‘how’ – how can healthy diets be achieved for
separate (but clearly linked) professional and
different age and physiological groups.
consumer-facing resources; they should be linked
in the sense that when the technical rationale is
Address tensions:
updated, the consumer-facing resource is also
7. Defining quantities vs. emphasizing learning to updated.
recognize satiety
10. Provide sufficient detail so that health
Particularly for infants and young children, there professionals and other technical staff involved in
can be some inherent tension between defining using FBDGs in programmatic or policy contexts
portion sizes and number of portions per age/ can clearly understand how each guideline was
physiological group, vs. a focus on attention developed, including what systematic and/or
to hunger and satiety cues, normal variations narrative reviews were considered, and what parts
in appetite from day-to-day, and parenting that of guidelines are based on expert consensus, etc.
leaves responsibility for ‘how much’ to the child. Transparency could also benefit other countries
If they are included, it can be emphasized that during their guidelines development processes,
portion sizes help guide how much to offer and as many countries rely on previous national
make available to the child but are not to be guidelines from elsewhere in their evidence
‘enforced’. Guidance on ‘what’ and ‘how much’ reviews.
can be accompanied by guidance on responsive
11. When possible, also describe the evidence
feeding and the respective roles of parents and
for broader behavioral guidance, not only, for
children at different stages of development.
example, for relationships between foods/food
8. Communicating on adequacy and excess for patterns and health outcomes. New Zealand
the same foods/food groups/ingredients (Section 7.4 and Annex 5) provides one positive
In countries facing double-burdens, where example of transparency about the evidence base
continued undernutrition co-exists with increasing for broader behavioral guidance.
levels of overweight and obesity, there are 12. Include publication and revision dates on all
inherent tensions when communicating about documents, even those that are consumer-
energy intakes and energy-density. The Indian facing, and where relevant (e.g. professional
guidance (Section 7.5) illustrates this where, for practice resources) clearly identify the associated
example, caregivers are advised to add sugar to documents presenting the technical evidence
complementary foods. base.
More broadly, in the Indian guidance for the 13. Innovate with new media approaches for
general population for Guideline 1 (‘Eat a variety of consumer-facing guidance, particularly when
foods to ensure a balanced diet’) there is a bullet designing for children and adolescents; this may
indicating: ‘Include jaggery or sugar and cooking require new partnerships.
oils to bridge the calorie or energy gap’,30 while
at the same time Guideline 7 advises moderation
in intake of oils, and Guideline 14 advises to
30 National Institute of Nutrition. Dietary Guidelines for India - A manual. NIN: Hyderabad, p. 17.
31 This challenge was articulated in the South African guidelines: Vorster HH, Badham JB, Venter CS. 2013. An introduction to the revised food-
based dietary guidelines for South Africa. S Afr J Clin Nutr 2013;26(3): S1-S164, p. S74.

8.4 Recommendations for FBDGs for specific • Achieving and maintaining a healthy body weight
age and physiological groups • Consuming a diverse diet adequate in
micronutrients, and specifically including adequate
In this section, we propose topics to consider for amounts of folate-rich foods
inclusion in group-specific FBDGs and associated
• Practices that enhance (or do not inhibit)
guidance that reflect the concerns identified in
absorption of iron
UNICEF’s SOWC as well as examples found during
our review of existing guidelines and guidance. For • Depending on context, there may be guidance on
all topics below, brief guidelines statements could be folic acid supplements
accompanied by more detailed guidance on ‘how’ to
achieve, in the national context. Pregnancy
This group is also covered by general population
As noted, there is a difference between concise guidelines in most countries, where general
FBDGs messages and the more detailed guidance population guidance covers healthy diets and other
that countries and other actors within countries behaviors (e.g. water intake; food safety; physical
can provide when elaborating them. However, activity; smoking; etc.). Additional topics to consider
the guideline messages themselves anchor the for pregnant women include:
more detailed guidance and provide a ‘space’ for
elaborating the additional behavioral guidance. This • Appropriate weight gain during pregnancy
can be considered when crafting a set of guidelines • Additional food during pregnancy – recommended
statements. For example, Australia’s broad guideline amounts, types, and timing (throughout
statement ‘Encourage, support and promote pregnancy, 2nd and 3rd trimester, etc.) may vary
breastfeeding’ points toward and can anchor specific by context
guidance on a range of actions in families and • In some contexts: Need for additional dairy and/or
communities, rather than focusing solely on maternal alternate calcium sources
behavior or practices.
• Guidance on organ meats and fish, including
safety concerns in context (mercury, excess of
In the lists below, we indicate more specific types of
vitamin A)
guidance, that would be subsumed under or ‘pointed
to’ by much more concise guidelines statements or • Practices that enhance (or do not inhibit)
messages. absorption of iron
• In some contexts: guidance for vegetarians and
In addition to the group-specific topics below, various vegans
food skills and/or food literacy have been emphasized
• In some contexts: Additional food safety guidance
in some general population guidance, and sometimes
(e.g. to avoid listeriosis)
in age group-specific guidance, for example
encouraging caregivers to teach and help children • Context-specific guidance on micronutrient
gain age-appropriate food skills. Relevant capacities supplements
include any or all of: food production/gardening, • Guidance on caffeinated drinks and alcohol
shopping, reading labels, recognizing the influence
• Dietary management of nausea, vomiting,
of marketing, making best selections when eating heartburn, and constipation
outside the home, meal planning, home processing of
ingredients, cooking, avoiding waste, storing food and • Avoiding unnecessary dietary restrictions
(whether due to cultural food taboos, fear of
using leftovers safely, and composting.
potential allergens, etc.)
Women of reproductive age • Appropriate levels and types of physical activity
This group is covered by general population FBDGs, during pregnancy
but some countries also address women of • Anticipatory guidance for initiating breastfeeding
reproductive age (generally, 15-49 years of age) in
guidance for pregnancy. This is because there are Nutrition for the mother during breastfeeding
additional risks for mothers and infants when women As above, this group is also covered by general
enter pregnancy underweight, overweight or obese, population guidelines. Among countries that provide
or with micronutrient deficiencies. Adequate intake of detailed guidance on breastfeeding practices most
folate/folic acid is required before conception, to lower also cover nutrition for the mother, but some provide
risk of neural tube defects. Topics to consider include: little or no guidance on the mother’s diet. In addition

to general population guidance, additional topics to ‘pointed to’ with one or several concise guidelines on
consider for breastfeeding women include: complementary feeding.
• Weight management/avoiding restrictive weight Topics to consider for this age group include:
loss diets while breastfeeding
• Continued breastfeeding
• Additional food during breastfeeding –
recommended amounts, types, and duration (e.g. • Developmental readiness and age of introduction
first 6 months, longer, etc.) may vary by context of complementary food
• Practices that enhance (or do not inhibit) • For 6-12 months, stages in transitioning to family
absorption of iron food, and for each stage appropriate: foods,
textures, quantities to offer, frequency of feeding,
• In some contexts: guidance for vegetarians and
responsive feeding and roles of the caregiver and
vegans
the child; example menus and/or recipes
• Context-specific guidance on micronutrient
• Timing of introduction of food groups (particularly
supplements
various animal-source foods) and of fluid milk
• Guidance on sufficient extra fluids/water
• Practical ‘how to’ for feeding, including dealing
• Guidance on caffeinated drinks and alcohol with food refusal/‘picky eaters’
• Avoiding unnecessary dietary restrictions • Dealing with poor appetite
(whether due to taboos, fear of potential allergens,
etc.)
• Frequency of meals and snacks in the 2nd year of
• Here and/or in the guidance for breastfeeding
life
infants, include guidance on how other family
and community members can support the • Portions and portion sizes to offer in the 2nd year
breastfeeding mother of life
• Responsive feeding/feeding styles in the 2nd year
Infants 0-5 months of age of life and beyond
Infants and young children are not covered by general
population guidelines in any country. Topics to • Other ‘food parenting’ issues such as providing
a role model, and use of food as reward, and
consider for this age group include:
creating pleasant mealtimes
• Early initiation of breastfeeding/feeding colostrum • Healthy snacks
• Exclusive breastfeeding • Recommended beverages (including guidance on
• Feeding on demand and at night type of milk), and those to avoid
• Practical support for breastfeeding mothers • Guidance on sugar and salt, and on unhealthy
foods high in sugar, salt and/or unhealthy fats
• ‘How-to’ guidance as needed, also including
dealing with common breastfeeding problems • Context specific guidance on micronutrient
supplements and home fortification
• Guidance on expressing breast milk and safely
storing and using it • Use of cups
• Guidance on selection and safe use of infant • Hygiene and safe feeding (including choking
formula hazards)
• Context-specific guidance on micronutrient Toddlers/preschoolers – 24-59 months

supplements Age groupings among young children are not
• Context-specific guidance on breastfeeding for consistent across different countries’ guidance and
HIV+ women often this age group is grouped with older school
children. Countries also vary regarding the age
Complementary feeding period 6-23 months range for the general population guidance, with
of age many indicating the general guidance applies to
This age grouping differs from UNICEF’s (see Box all individuals 2 years of age or older, while others
1) but follows from the age grouping in most of the restrict to 5 years or older or to adults. The topics
available guidance. Guidance for this age group was listed here for consideration for this age group are
generally among the most extensive of any group. in addition to typical general population guidance on
As noted, the long list of topics below could be food groups.

• Responsive feeding and roles of parent/caregiver For example, ‘age appropriate food skills’ will
and of child be different for these older children and limiting
• Family meals exposure to food marketing may require parents
and others to advocate for changes to school
• Teaching age-appropriate food skills environments. As children are now more
• Limiting exposure to food/beverage marketing autonomous, ‘responsive feeding’ might be better
(e.g. limiting screen time) described as age-appropriate parenting around food,
• Recommended number of meals and snacks; for example, allowing children to serve themselves at
establishing a breakfast habit ‘family-style’ meals.
• Age-appropriate portion sizes and portions per day In addition to those listed above for preschoolers,
or week for each food group
topics to consider for school children include:
• Along with general population guidance on food
groups, specific guidance for this age group on all • Providing a healthy breakfast
types of animal-source foods, including guidance • Depending on context, providing healthy snacks
on milk fat (%) and beverages to take along to school
• Healthy snacks • Additional strategies to increase fruit and
• Foods to limit or avoid (e.g. foods high in sugar, vegetable intake for this age group
salt, and/or fat; ultra-processed foods)
Adolescents 10-19 years of age
• Hygiene and safe feeding (including choking
hazards) For this age group, consumer-facing guidance should
be designed targeting the adolescent him/herself.
• Clear and specific guidance on beverages, Again, with few exceptions most of the topics
including on a variety of sweetened beverages
identified for younger children are also relevant for
and 100% juice, and on beverages to avoid (e.g.
adolescents. The specific details for some topics
caffeinated beverages, sports and energy drinks)
again differ for adolescents. For example, age-
• Strategies for dealing with ‘picky eaters’ appropriate food skills could now cover a wide range
• Context-specific guidance on micronutrient (meal planning, budgeting, shopping, cooking, etc).
supplements Additional considerations and guidance topics could
include:
• Age-appropriate physical activities • Importance of a healthy breakfast and options for
quick and healthy breakfasts
• Two other topics that were rarely addressed but
may warrant special attention are: • Recognizing the influence of marketing
• Dealing with poor appetite • Eating outside the home: best choices and
strategies for healthy eating
• Supporting and parenting overweight children
• Carrying water and healthy snacks
School children 5-9 years of age • Specific guidance on meeting high iron and
UNICEF’s SOWC divides children aged 5-9 years calcium needs – food sources, alternatives for
from adolescents aged 10-19 years. As with younger vegetarians/vegans, inhibitors and enhancers
children, age groupings in country guidance may
• Addressing body image concerns
vary from this, particularly in how each end of the
adolescent age range is defined. In most countries, • Dietary and lifestyle guidance for the pregnant
general population guidance on healthy eating/healthy teenager
dietary patterns applies to children in this age group.
Additional topics for this age group are very similar to
those listed above for preschoolers, but the specific
details can vary.

8.5 Conclusion
This review has summarized relevant FBDGs and a

wide range of associated behavioral guidance that
countries currently provide for infants, children,
adolescents, and for pregnant and lactating women.
Based on current concerns as articulated in UNICEF’s
SOWC and on examples from countries, we have
provided recommendations and a set of topics that
could be considered for inclusion in future group-
specific FBDGs and associated guidance.
It is widely recognized that even in high-income

countries with a long history of developing,
communicating, and otherwise implementing
evidence-based FBDGs, dietary patterns are far
from ideal. It is important to acknowledge that while
development and implementation of FBDGs is
necessary – to inform consumers as well as program
and policy design– it is very far from sufficient.
The recommendations provided here should be
viewed in the context of much broader calls for food
system transformation to make diets nutritious, safe,
affordable, and sustainable.

ANNEXES
Annex 1. Types of dietary guidelines documents available at the FAO website 56
Annex 2. Information sources for Section 6 57
Annex 3. Countries with FBDGs at the FAO repository and a typology of guidance
for age and physiological groups 62
Annex 4. References for country case studies 68

Kenya 68
Ireland 68
Spain 69
India 70
New Zealand 70
Canada 71
Bolivia 72
Chile 72
Colombia 72
Panama 72
Annex 5. New Zealand’s summary evidence statements on food and eating behaviours 75
Table A5.1 New Zealand’s summary evidence statements on food and eating behaviours 75
Annex 6. Comparison of group-specific dietary guidance across case study countries 26

Pregnancy 26
Table A6.1: Guidance for nutrition during pregnancy: Kenya, Ireland, India, New Zealand, and Canada 26
Table A6.2: Guidance for nutrition during pregnancy: Bolivia and Colombia 31
Lactation 33
Table A6.3: Guidance for nutrition during lactation: Kenya, Ireland, India, and New Zealand 33
Table A6.4: Guidance for nutrition during lactation: Bolivia and Colombia 37
Infants under 6 months of age 39
Table A6.5: Guidance for infants under 6 months of age: Kenya, Ireland, India, New Zealand, and Canada 39
Table A6.6: Guidance for infants under 6 months of age: Chile, Colombia, and Panama 46
Infants 6-23 months of age 50
Table A6.7: Guidance for 6-23 months of age: Kenya, Ireland, India, New Zealand, and Canada 50
Table A6.8: Guidance for 6-23 months of age: Chile, Colombia, Panama 84
Young children 2-4 years of age/toddlers/preschoolers 93
Table A6.9: Guidance for 2-4 years/toddlers/preschoolers: Kenya, Ireland, Spain, India and New Zealand 93
Table A6.10: Guidance for 2-4 years/toddlers/preschoolers: Canada and Chile 99
School-aged children 103
Table A6.11: Guidance for school-aged children: Kenya, Ireland, Spain, India and New Zealand 103

Annex 1.
Types of dietary guidelines documents available
at the FAO website
Country institutions have developed a wide range of resources and outputs that are part of their FBDGs,
ranging from one-page posters to 100+-page technical documents. Some documents are clearly intended
to be consumer-facing, based on the language used (i.e., document is clearly addressing the reader as a
consumer) and visual design. The longest and most technical documents may be intended for use by health
professionals and technical staff e.g. of government agencies. In some cases, audiences for a document are
explicitly identified, for example in a preface, but in many cases they are not. Some longer and quite technical
documents are nevertheless directed at consumers. Examples from countries illustrate the diversity.
Country Title of document Description
Dominica Food Based Poster with graphic food guide and key messages.
Dominica
Dietary Guidelines
Guide Alimentaire du Bénin Tri-fold brochure with graphic food guide, key messages,
Benin descriptions of food groups and recommended portions by age,
sex and physiological group.
Food Based Dietary 20-page pamphlet presenting 7 dietary guidelines ( = key

Guyana Guidelines for Guyana messages) and providing an explanations of each guideline, and
suggestions for how to implement.
The official dietary 27-page pamphlet presenting the key messages and tips for
Denmark guidelines (Danish: De consumers. Highly visual, with limited text.
officielle kostråd)
Food Based Dietary 40-page document targeted to consumers (stated in preface).

Guideline for Thai Organized around 9 ‘rules’ ( = key messages) and providing
Thailand
detailed explanations of each guideline, and a self-evaluation tool
for consumers.
Food Based Dietary 80-page technical document that includes a situation analysis,
Sierra Guidelines for Healthy description of the process of developing the FBDGs, a section
Leone Eating explaining each guideline, a section on implementation, and
annexes covering needs of special populations.
Dietary Guidelines for 122-page technical document including description of the

United Americans 2015-2020 development of the guidelines, an overview of the new guidelines,
States and detailed supporting information and suggestions for
implementing the guidelines.
Guías alimentarias para 262-page technical document describing the objectives,

la población Argentina: development, testing, and implementation plan for the guidelines.
Argentina
Documento técnico
metodológico

Annex 2.
Information sources for Section 6
UNICEF Region Country Year of publication Title of publication(s) Intended audiences or uses
Kenya 2017 Ministry of Health. National Guidelines for ‘The Guidelines….are intended for use across sectors
Healthy Diets and Physical Activity. Government by professionals including health managers, health care
of Kenya: Nairobi. 100 pages. workers, implementing partners, training institutions,
agriculture extension workers among others in all their
efforts to promote optimal nutrition and health.’ P iii.
Sierra 2016 Sierra Leone Food-based Dietary Guidelines for ‘…the Guidelines are designed to influence not only
Leone Healthy Eating (document does not indicate how individual food choices but also provide coherent policy
to cite). 80 pages. guidance on the production of nutrient-dense foods, social
Sub-Saharan protection programmes, school meals, nutrition standards,
Africa health and agriculture interventions that involve the
commitment of diverse sectors influencing the health and
nutritional well-being of the nation.’ P. i.
Vorster HH, Badham JB, Venter CS. An ‘This special supplement in the current issue of the SAJCN
introduction to the revised food-based dietary publishes the technical support papers which motivate and
South guidelines explain each of the recently revised South African FBDGs
2013
Africa messages.’ P. S3.
for South Africa. S Afr J Clin Nutr 2013;26(3): S1-
S164. 165 pages.
The Faculty of Agricultural and Food Sciences. ‘This manual has been adopted by the Ministry of Public
The Food-Based Dietary Guideline Manual for Health for its dissemination to policy makers, health-care
Lebanon 2013 Promoting Healthy Eating in the Lebanese Adult providers, nutritionists, and dietitians in Lebanon.’ Preface.
Population. The American University of Beirut:
Beirut. 79 pages.
Middle East and
North Africa Public Health Department. Qatar Dietary ‘The Qatar Dietary Guidelines will direct both individual
Guidelines. Supreme Council of Health: Doha. 42 behavior change and the development of health and food
Qatar 2015 pages. policies in Qatar. They also provide consistent information
for the development of new education and social marketing
resources in Qatar.’ P. 5.

Food Safety Authority of Ireland. 2019. Healthy ‘This guide…is designed to help health professionals,
Eating, Food Safety, and Food Legislation – A catering services, and food businesses provide safe food
Europe and
Ireland 2019 Guide Supporting the Healthy Ireland Food and trustworthy information to consumers, so that they can
Central Asia
Pyramid. FSAI: Dublin. 90 pages. make informed decisions about the foods they choose to
eat.’ P. 5.
Malta 2016 Dietary guidelines for Maltese adults: Healthy Audience and uses not stated but based on communication
eating the Mediterranean Way! Government of style and language, consumer-facing.
Malta: Valletta. Ministry for Health. 16 pages.
As stated in title, for professionals. No further description
Dietary Guidelines For Maltese Adults: of uses.
Information for Professionals involved in Nutrition
Education. Government of Malta: Valletta;
Ministry for Health. 32 pages.
Sweden 2015 National Food Agency. Find your way to eat Audience and uses not stated but based on communication
Europe and
greener, not too much and be active. National style and language, consumer-facing.
Central Asia
Food Agency: Uppsala. 26 pages.
United 2018 Public Health England. 2018. A Quick Guide to the ‘This document is aimed at catering providers to support
Kingdom Government’s Healthy Eating Recommendations, healthier catering provision, health professionals (including
12 pages, and dietitians and nutritionists), teachers, university students,
academics, industry and is also a source of information for
The Eatwell Guide. Public Health England:
the general population.’ P. 4.
London. 12 pages.
Audience and uses not stated but based on communication
style and language, consumer-facing.

Bangladesh Institute of Research and ‘The dietary guidelines ….will serve as an educational
Rehabilitation in Diabetes, Endocrine and tool to express nutrition principles in terms of foods and
Metabolic Disorders (BIRDEM). Dietary Guidelines dietary practices…. In addition, they will contribute to
Bangladesh 2013
for Bangladesh. BIRDEM: Dhaka. 53 pages. the improvement of nutrition behavior in the population
and serve as a tool to guide health, agriculture and food
policies.’ P. v-vi.
South Asia National Institute of Nutrition. Dietary Guidelines ‘This updated version of DGI…should serve as a valuable
for India - A manual. NIN: Hyderabad. 139 pages. source of concise, accurate and accessible information,
both for members of the general public and those who
India 2011 are involved in dissemination of nutrition and health
education….This book makes an attempt to inform us on
matters of everyday nutrition in a user friendly manner and
thus, aims to influence our dietary behavior.’ PP i-ii.
Ministry of Health. Food Based Dietary Guidelines ‘These guidelines will be made available to the health
for Sri Lankans. MOH: Colombo. 99 pages. workers and general public in all three languages and
simpler messages will be developed for the use of media
Sri Lanka 2011 targeting the general public. The grass-root level health and
nutrition workers may make use of these tools effectively
in the effort of improving health and wellbeing of all Sri
Lankans.’ P. v.
National Health and Medical Research Council. Audience and uses not stated but based on communication
East Asia and Eat for Health: Australian Dietary Guidelines style and language, consumer-facing.
Australia 2013
Pacifica Summary. Commonwealth of Australia: Canberra.
53 pages.
Ministry of Health. Eating and Activity Guidelines Audience and uses not stated but based on communication
for New Zealand Adults: Summary of Guidelines style and language, consumer-facing.
Statements and Key Related Information. MOH:
New Wellington. 6 pages, and
2015
Zealand This document…is written for health practitioners and
Ministry of Health. Eating and Activity Guidelines
others who provide health advice on nutrition and physical
for New Zealand Adults. MOH: Wellington. 87
activity for New Zealand adults. P. 2.
pages.

Antigua / 2013 Ministry of Health. Food-Based Dietary ‘The Food-Based Dietary Guidelines … is an important
Barbuda Guidelines: Antigua & Barbuda. MOH: St. John’s. educational tool that converts scientific information on
Tri-fold pamphlet. nutritional requirements and food composition into simple,
population language.’
Barbados 2017 Ministry of Health. Food-Based Dietary Guidelines ‘The National Nutrition Centre has produced the Food Based
for Barbados. MOH: St. Michael. 8 pages. Dietary Guidelines for Barbados with the aim of providing
simple dietary information to assist individuals in making
wise food and lifestyle choices.’ P. 2.
Belize 2012 Ministry of Health. Food-Based Dietary Guidelines ‘A National Food Based Dietary Guideline (FBDG) is
for Belize. MOH: Belmopan. 38 pages. an important educational tool that converts scientific
information on nutritional requirements and food
composition into simple, population-based language. The
guidelines provide technical advice about ways to improve
diets and health in a manner that is easy for the public to
Latin America understand … can be used by health care providers, policy
and Caribbean makers, community leaders, educators and the public at
large.’ P. 4.
Brazil Ministry of Health. Dietary Guidelines for the ‘These Guidelines are for all Brazilians. Some of these
Brazilian Population. MOH: Brasília. 80 pages. Brazilians will be workers whose jobs involves health
promotion activities, such as health professionals,
community workers, educators, capacity building trainers,
as well as other professionals….The hope is that these
2014 Guidelines will be used in people’s homes, in health
facilities, in schools, and in all other places concerned with
health and its promotion, such as community centres, social
assistance reference centres, and headquarters of social
movements.’ P. 11.
Jamaica Ministry of Health. Food-Based Dietary Guidelines Audience and uses not stated but based on communication
2015
for Jamaica 2015. MOH: Kingston. 15 pages. style and language, consumer-facing.
Canada 2019 Health Canada. Canada’s Dietary Guidelines for ‘The intended audience is health professionals and policy
Health Professionals and Policy Makers. Health makers. The guidelines are a resource for developing
North America Canada: Ottawa. 62 pages. nutrition policies, programs, and educational resources for
members of the Canadian population two years of age and
older.’ P. 1.

United 2016 U.S. Department of Health and Human Services ‘The main purpose of the Dietary Guidelines is to inform the
States and U.S. Department of Agriculture. 2015–2020 development of Federal food, nutrition, and health policies
Dietary Guidelines for Americans. 8th Edition. and programs. The primary audiences are policymakers,
HHS/USDA: Washington. 144 pages. as well as nutrition and health professionals…. The Dietary
North America Guidelines also may be used to inform the development of
programs, policies, and communication by audiences other
than the document’s principal audiences. These…include
businesses, schools, community groups, media, the food
industry, and State and local governments.’ PP 5-6.

Annex 3.
Countries with FBDGs at the FAO repository and a typology of guidance
for age and physiological groups
World Bank
income For type 4 & type 5 countries, which age/physiological groups are covered; if
UNICEF Region Countriesa classificationb Typologyc not in English, languaged
Sub-Saharan Africa
West and Central Africa Benin Low 2
Sierra Leone Low 4 All age and physiological groups, in Annex of the DGs document
Nigeria Lower middle 4
Eastern and Kenya Lower middle 4 All age and physiological groups in Section 3 of DGs document (lifecycle)
Southern Africa
Namibia Upper middle 3
South Africa Upper middle 3/4 Guidelines for underfives are proposed in the DGs document, but are identified as not
yet tested
Seychelles High 3
Middle East and Iran Upper middle ? Broken link from FAO to documents; website in Persian
North Africa
Lebanon Upper middle 3
Israel High 5 All age and physiological groups, in a range of consumer-facing guides
Oman High 3
Qatar High 3
a
At FAO repository as of 24 September 2019.
b
World Bank classification as of 1 July 2019.
c
Typology: Countries with no guidance for age or physiological groups; Guidance on varying portions and portion sizes only; Scattered references to needs of groups in DGs for general population; DG with separate sections for
groups; Separate DGs and/or other official guidance for groups
d
DGs = dietary guidelines.

World Bank
income For type 4 & type 5 countries, which age/physiological groups are
UNICEF Region Countriesa classificationb Typologyc covered; if not in English, languaged
Eastern Europe and Albania Upper middle 4 All age and physiological groups, in Section 3 of DGs document (lifecycle)
Central Asia
Bosnia Herzegovina Upper middle ? Cannot determine ‘type’; document in Bosnian
Bulgaria Upper middle 3
FYRM Upper middle ? Cannot determine ‘type’; document in Macedonian
Georgia Upper middle 4 Infants, children and adolescents in a life cycle section of the DGs document
Romania Upper middle ? Cannot determine ‘type’; document in Romanian
Turkey Upper middle 3
Croatia High 5 Children 7–10 years and children and adolescents 11–15 years of age; Croatian
Austria High 5 Pregnant and breastfeeding women, undertwos; guidelines for children 1–3 years
are being prepared; German
Belgium High 5 0–3 year-old children, 3–12 year-old children, 12–18 year-old adolescents; French,
Flemish
Cyprus High 5 Children 6-12 years; Greek
Denmark High ? Cannot determine ‘type’; document in Danish
Estonia High ? Cannot determine ‘type’; document in Estonian

Western Europe
Finland High ? Cannot determine ‘type’; document in Finnish
France High 5 Pregnant and lactating women, children 0-3 years, children 3-18 years directed to
parents, and a separate guide directed to teenagers; French
Germany High ? Cannot determine ‘type’; document in German
Greece High 5 All age and physiological groups, in separate guides for women (pregnant,
breastfeeding) and infants, children and adolsecents; documents in Greek
Hungary High ? Cannot determine ‘type’; document in Hungarian

World Bank
income For type 4 & type 5 countries, which age/physiological groups are
UNICEF Region Countriesa classificationb Typologyc covered; if not in English, languaged
Iceland High ? Cannot determine ‘type’; document in Icelandic
Ireland High 5 All age and physiological groups, in a range of consumer-facing guides
Italy High 4 Pregnant and lactating women, children and adolescents; Italian
Latvia High 5 Undertwos, children and adolescents 2-18 years; Latvian
Malta High 3
Netherlands High 1
Norway High ? Cannot determine ‘type’; document in Norwegian

Western Europe (cont.) Poland High 5 School-aged children and adolescents; Polish
Portugal High 3
Slovenia High ? Cannot determine ‘type’; document in Slovenian
Spain High 5 Children and adolescents 3-16 years old; Spanish
Sweden High 5 Pregnant and lactating women, infants < 1 year and 1-2 year olds
Switzerland High 5 All age and physiological groups, in a range of consumer-facing guides; some
documents available in English; others only in French and German
United Kingdom High 3

World Bank
UNICEF Region Countries a
classificationb Typology c
not in English, languaged
Afghanistan Low 4 Guidelines document forthcoming; per FAO website there are specific
recommendations for pregnant and lactating women and infants and young children
Nepal Low 1
South Asia
Bangladesh Lower middle 4 Pregnancy and lactation, 0-6 months and limited attention to 6-23 (timely introduction)
India Lower middle 4 All age and physiological groups, in sections on guidelines per each life cycle stage
Sri Lanka Upper middle 4 All age and physiological groups, in sections on guidelines per each life cycle stage
Cambodia Lower middle 5 6-17 years; document describing development in English; consumer-facing document in
Khmer
Indonesia Lower middle 4 Unknown which groups are covered; government website is ‘under maintenance’; per
FAO country page, guide includes specific advice for groups through the life cycle
Mongolia Lower middle 1
Philippines Lower middle ? Broken link, and could not find guidelines documents online
Viet Nam Lower middle 4 Undertwos (breastfeeding and complementary feeding messages); dairy message for
children and adults; Vietnamese
East Asia and the Pacific China Upper middle 5 Most or all groups; Chinese
Fiji Upper middle 4 0-6 months (exclusive breastfeeding) and children (snacks)
Malaysia Upper middle 5 Separate guidance for children and adolescents; other groups covered in main DGs
document; broken link at Ministry website so documents not obtained
Thailand Upper middle 5 Underfives; could not locate this online
Australia High 5 Undertwos in a separate DGS document; all other age/physiological groups covered in
main DGs and in many consumer-facing resources
Japan High ? Cannot determine ‘type’; documents in Japanese
New Zealand High 5 All age and physiological groups, in separate consumer-facing documents per each life
cycle stage
Broken link at FAO website; search for DGs led to an Asia Pac J Clin Nutr article on
Republic of Korea High 5 revision of DGs indicating there are ‘dietary action guides’ for: Infants and toddlers;
pregnant and lactating women; children; adolescents. Could not locate these online.

World Bank
Bolivia Lower middle 5 6-10 years, 11-18 years, pregnant and breastfeeding women; Spanish
El Salvador Lower middle 3
Honduras Lower middle 1
Argentina Upper middle 4 Pregnant women, infants and young children, in a section on life cycle stages; Spanish
Belize Upper middle 1
Brazil Upper middle 5 Undertwos; Portuguese
Colombia Upper middle 5 Undertwos, pregnant and breastfeeding women; Spanish
Costa Rica Upper middle 1
Cuba Upper middle 5 Undertwos; Spanish
Dominica Upper middle 1
Dominican Republic Upper middle 4 0-6 months (exclusive breastfeeding), and limited attention to complementary feeding
Latin America and
(timely introduction); Spanish
the Caribbean
Ecuador Upper middle 3
Grenada Upper middle 1
Guatemala Upper middle 5 Undertwos; Spanish
Guyana Upper middle 1
Jamaica Upper middle 1
Mexico Upper middle 5 All age and physiological groups, in main DGs and in numerous group-specific
consumer-facing resources; Spanish
Paraguay Upper middle 5 Undertwos; Spanish
St Lucia Upper middle 1
St Vincent/ Grenadines Upper middle 1
Venezuela Upper middle 4 0-6 months (exclusive breastfeeding); Spanish

World Bank
Latin America Antigua / Barbuda High 1
and the
Bahamas High 1
Caribbean (cont.)
Barbados High 1
Chile High 5 Under twos; children 2–5 years of age; children 6–10 years of age; adolescents; Spanish
Panama High 5 Under twos; Spanish
St Kitts and Nevis High 1
Uruguay High 3
North America Canada High 5 All age and physiological groups
United States High 5 All groups except undertwos

Annex 4
References for country case studies
Kenya
• Ministry of Health. 2017. National Guidelines for Healthy Diets and Physical Activity. Government of
Kenya. Nairobi. Available at: http://nak.or.ke/wp-content/uploads/2017/12/NATIONAL-GUIDELINES-FOR-
HEALTHY-DIETS-AND-PHYSICAL-ACTIVITY-2017-NEW-EDIT.pdf
Ireland
The Department of Health leads the ‘Healthy Ireland’ initiative, and the dietary guidance is situated within this
(https://www.gov.ie/en/campaigns/healthy-ireland/). Many consumer-facing web-based resources for the general
population are available through the ‘Eat Well’ section the Healthy Ireland website (https://www.gov.ie/en/
publication/da7f19-eat-well/#healthy-eating-guidelines).
In addition to the DoH, two other authorities were linked to via the Eat Well page and provide a range of
resources. These are the Food Safety Authority of Ireland (FSAI), and ‘safefood’.
Resources from the Food Safety Authority of Ireland (FSAI)

These documents are available for download and are targeted to health professionals and policy-makers.
• Food Safety Authority of Ireland. 2011. Scientific Recommendations for Healthy Eating in Ireland. FSAI:
Dublin. Available at: https://www.fsai.ie/resources_publications.html
• Food Safety Authority of Ireland. 2019. Healthy Eating, Food Safety, and Food Legislation – A Guide
Supporting the Healthy Ireland Food Pyramid. FSAI: Dublin. Available at: https://www.fsai.ie/science_and_
health/healthy_eating.html
• Food Safety Authority of Ireland. 2011. Scientific Recommendations for a National Infant Feeding Policy, 2nd
Ed. FSAI: Dublin, available at: https://www.fsai.ie/resources_publications.html
• Food Safety Authority of Ireland. 2012. Best Practice for Infant Feeding in Ireland – A Guide for Healthcare
Professionals. FSAI: Dublin. Available at: https://www.fsai.ie/resources_publications.html
Consumer-facing resources from the ‘Eat Well’ page of the ‘Healthy Ireland’ initiative
Most resources are available for download, but the first is provided via the web interface only.
• ~One-half page of text on ‘Healthy Eating for Kids’: https://www.gov.ie/en/publication/da7f19-eat-
well/#healthy-eating-guidelines. Within this brief advice there are links to recipes.
• A 7-page consumer-facing food pyramid information leaflet titled ‘Healthy Food for Life’, providing a
‘guide to everyday food choices for adults, teenagers and children aged five and over: https://assets.gov.
ie/7649/3049964a47cb405fa20ea8d96bf50c91.pdf
• A food pyramid poster and an expanded pyramid poster, with examples detailed per food group: https://
www.gov.ie/en/publication/70a2e4-the-food-pyramid/
All three of the above provide details on food groups, serving sizes and servings for different age groups (5
years and older).
• A poster with an example daily meal plan for a 10-year old girl: https://assets.gov.ie/7567/
d52712b9e9fa4f30a471bcae0337dbca.pdf
• A poster with an example daily meal plan for a 30-year old breastfeeding mother: https://assets.gov.
ie/7569/f05dd9cd4c0d4453b476d1e16d77fd5c.pdf
There are also posters with example daily meal plans for men and older women.

There is a series of ‘food guide’ posters for the food groups shown on the Irish food pyramid. These posters
provide information on serving sizes, and tips on how to eat/drink well within the food group; the guidance is
not specific to any age or physiological group:
• Vegetables, salad and fruit: https://assets.gov.ie/7577/78bdb3e0e9f648f1ae3c4d74657f5673.pdf

• Milk, yogurt and cheese: https://assets.gov.ie/7578/aa59fb9287714f1fb91c42f19c998d1c.pdf
• Cereals, bread, potatoes, pasta and rice: https://assets.gov.ie/7576/6cb96c2de5794ad2af0b5d88048d55fa.
pdf
• Meat, poultry, fish, eggs, beans and nuts: https://assets.gov.ie/7579/
b44458be78574701a5e674cdb1d826ff.pdf
• Fats, oils and spreads: https://assets.gov.ie/7574/71bfc2250ab247b3a1db853b05e62a2e.pdf
• Foods and drinks high in fat, sugar and salt: https://assets.gov.
ie/7575/2b30a99b2f2f494a935cb34bdd9c3680.pdf
Consumer-facing resources from the ‘safefood’ website

Some resources are available for download and others are provided via the web interface only.
• Pregnancy: https://www.safefood.eu/Healthy-Eating/Food-Diet/Life-Stages/Pregnancy.aspx and

downloadable at: https://www.safefood.eu/SafeFood/media/SafeFoodLibrary/Documents/Consumer/
Healthy%20Living/Healthy_eating_for_pregnancy.pdf
• Infancy: https://www.safefood.eu/Healthy-Eating/Food-Diet/Life-Stages/Infants.aspx and downloadable at:
https://www.safefood.eu/SafeFood/media/SafeFoodLibrary/Documents/Healthy%20Eating/Feeding-your-
baby-HSE-2018.pdf
• The page for infancy links to additional detailed advice on breastfeeding topics and support, with
different links for the Republic of Ireland and Northern Ireland: (https://www2.hse.ie/babies-and-toddlers/
breastfeeding/ and https://www.breastfedbabies.org/).
• Weaning: https://www.safefood.eu/Healthy-Eating/Food-Diet/Life-Stages/Weaning.aspx and downloadable
at: https://www.safefood.eu/SafeFood/media/SafeFoodLibrary/Documents/Healthy%20Eating/Weaning-
made-easy-0518.pdf
• Toddlers: https://www.safefood.eu/Healthy-Eating/Food-Diet/Life-Stages/Toddlers.aspx
• Children: https://www.safefood.eu/Healthy-Eating/Food-Diet/Life-Stages/School-children.aspx; the section
for children also includes a resource on growing a vegetable patch: https://www.safefood.eu/Healthy-
Eating/Food,-Diet-and-Health/Life-Stages/Children/Growing-your-own-vegetable-patch.aspx
• Teenagers: https://www.safefood.eu/Healthy-Eating/Food-Diet/Life-Stages/Teens.aspx
• For pregnant women, children and teenagers, there are also links to the Eat Well healthy eating guidance
for the general population, for information on food groups and other messages.
• How to get children to eat healthy food: https://www.safefood.eu/Healthy-Eating/Food-Diet/Eating-In/How-
to-get-children-to-eat-healthy-food.aspx
• Food hacks for students: https://www.safefood.eu/Healthy-Eating/Food,-Diet-and-Health/Eating-In/Food-
hacks-for-students.aspx
• Why family meals matter: https://www.safefood.eu/Healthy-Eating/Food,-Diet-and-Health/Eating-In/Why-
family-meals-matter.aspx
Spain
• Madrid 2010. Nutricion Saludable de la Infancia y la Adolescencia. La Alimentacion de tus Niños y Niñas
(Healthy Nutrition of Childhood and Adolescence. The Feed of your Children). Available at FAO website:
http://www.aecosan.msssi.gob.es/AECOSAN/docs/documentos/nutricion/educanaos/alimentacion_ninos.
pdf

India
• National Institute of Nutrition. 2011. Dietary Guidelines for Indians – A Manual. NIN: Hyderabad. Available at:
http://ninindia.org/DietaryGuidelinesforNINwebsite.pdf
New Zealand
Documents
• Ministry of Health. 2015. Eating and Activity Guidelines for New Zealand Adults. MOH: Wellington. Available
at: https://www.health.govt.nz/system/files/documents/publications/eating-activity-guidelines-for-new-
zealand-adults-oct15_0.pdf
• Ministry of Health. 2008. Food and Nutrition Guidelines for Healthy Infants and Toddlers (Aged 0–2): A
background paper (4th Ed) – Partially Revised December 2012. MOH: Wellington. Available at: https://www.
health.govt.nz/publication/food-and-nutrition-guidelines-healthy-infants-and-toddlers-aged-0-2-background-
paper-partially
• Ministry of Health. 2013. Eating for Healthy Babies and Toddlers from Birth to 2 Years Old. MOH:
Wellington. Available at: https://www.healthed.govt.nz/resource/eating-healthy-babies-and-toddlersngā-kai-
tōtika-mō-te-hunga-kōhungahunga
• Ministry of Health. 2012. Food and Nutrition Guidelines for Healthy Children and Young People (Aged 2–18
years): A background paper. Partial revision February 2015. MOH: Wellington. Available at: https://www.
health.govt.nz/publication/food-and-nutrition-guidelines-healthy-children-and-young-people-aged-2-18-
years-background-paper
• Source: Ministry of Health. 2017. Eating for Healthy Children Aged 2 to 12. MOH: Wellington. Available
at: https://www.healthed.govt.nz/resource/eating-healthy-children-aged-2-12ngā-kai-tōtika-mō-te-hunga-
kōhungahunga
• Source: Ministry of Health. 2017. Healthy Eating for Young People. MOH: Wellington. Available at: https://
www.healthed.govt.nz/resource/healthy-eating-young-people
• Ministry of Health. 2006 (revised 2008). Food and Nutrition Guidelines for Healthy Pregnant and
Breastfeeding Women: A background paper. MOH: Wellington. Available at: https://www.health.govt.nz/
system/files/documents/publications/food-and-nutrition-guidelines-preg-and-bfeed.pdf
• Source: Ministry of Health. 2017. Eating for Healthy Pregnant Women. MOH: Wellington. Available at:
https://www.healthed.govt.nz/resource/eating-healthy-pregnant-womenngā-kai-totika-mā-te-wahine-hapū
• Source. Ministry of Health. 2013. Eating for Healthy Breastfeeding Women. MOH: Wellington. Available at:
https://www.healthed.govt.nz/resource/eating-healthy-breastfeeding-womenngā-kai-totika-mā-te-ūkaipō
Main webpages
• Page collating the main consumer-facing documents: https://www.health.govt.nz/our-work/eating-and-

activity-guidelines/resources-eating-and-activity-public
• The Eating and Activity Guidelines for New Zealand Adults: https://www.health.govt.nz/publication/eating-
and-activity-guidelines-new-zealand-adults
• Page with age/physiological group-specific guidance: https://www.health.govt.nz/our-work/eating-and-
activity-guidelines/current-food-and-nutrition-guidelines
• Process for developing the eating and activity guidelines: https://www.health.govt.nz/our-work/eating-and-
activity-guidelines/process-developing-eating-and-activity-guidelines
• Evidence for the Eating and Activity Statements: https://www.health.govt.nz/our-work/eating-and-activity-
guidelines/evidence-eating-and-activity-statements
• How We Eat – Reviews of the evidence on food and eating behaviours related to diet and body size: https://
www.health.govt.nz/publication/how-we-eat-reviews-evidence-food-and-eating-behaviours-related-diet-
and-body-size

• Current Food and Nutrition Guidelines page for age/group-specific guidance: https://www.health.govt.nz/
our-work/eating-and-activity-guidelines/current-food-and-nutrition-guidelines).
Canada
The official webpage for the Canada’s food guide is:
• https://food-guide.canada.ca/en/
The following technical documents are available from the FAO country page:
• Health Canada. 2019. Canada’s Dietary Guidelines for Health Professionals and Policy Makers. Health
Canada. Ottawa. Available at: https://food-guide.canada.ca/static/assets/pdf/CDG-EN-2018.pdf.
• Health Canada. 2016. Evidence review for dietary guidance: Summary of results and implications for
Canada’s Food Guide 2015. Health Canada. Ottawa. Available at: https://www.canada.ca/content/
dam/canada/health-canada/migration/publications/eating-nutrition/dietary-guidance-summary-resume-
recommandations-alimentaires/alt/pub-eng.pdf.
• Health Canada. 2019. Food, Nutrients and Health: Interim Evidence Update 2018 For Health Professionals
and Policy Makers. Health Canada. Ottawa. Available at: https://www.canada.ca/content/dam/hc-sc/
documents/services/canada-food-guide/resources/evidence/food-nutrients-health-interim-evidence-
update-2018/pub1-eng.pdf.
In addition, a longer technical document, not linked to at the FAO website but referenced in the documents
above, is available:
• Health Canada. 2016. Evidence review for dietary guidance: Technical report 2015. Health Canada. Ottawa.
Available at: http://publications.gc.ca/collections/collection_2018/sc-hc/H164-192-2016-eng.pdf.
• One consumer-facing document is available for download from the FAO country page:
• Canada’s Food Guide – a 2-page consumer-facing document with a ‘healthy plate’ and some key messages.
Available at: https://food-guide.canada.ca/static/assets/pdf/CFG-snapshot-EN.pdf.
In addition to downloadable documents, the FAO country page provides a series of links for further
information, as follows:
• Canada’s Food Guide Snapshot: https://food-guide.canada.ca/en/food-guide-snapshot/. This presents the

Food Guide with embedded hyperlinks to further information.
• Canada’s Dietary Guidelines: https://food-guide.canada.ca/en/guidelines/. This is a web version of the
Dietary Guidelines for Health Professional and Policy Makers; available to download by section, and with
hyperlinks to related resources.
• Healthy Eating Recommendations: https://food-guide.canada.ca/en/healthy-eating-recommendations/.
The recommendations are the same as the key messages selected by Health Canada for the country page
at FAO. In the web version, each recommendation and sub-recommendation is hyperlinked to additional
information. Some of the additional information is relevant to or targeted to age or physiological groups,
but at this interface it is not organized by age/physiological group, such advice is scattered and embedded
‘under’ key messages.
• Evidence Behind Canada’s Food Guide: https://www.canada.ca/en/health-canada/services/canada-
food-guide/resources/evidence.html. This links to a page that provides further links and explanations
of the process followed in developing and revising Canada’s guidelines, including the evidence review
and stakeholder engagement processes. There are links to the Guidelines, to the Evidence Review and
Evidence Update listed above.
• History of Canada’s Food Guides from 1942 to 2007: https://www.canada.ca/en/health-canada/services/
canada-food-guide/about/history-food-guide.html.

In addition to the documents and websites above, the guidelines document (2019) refers to and provides a
hyperlink to additional web-based guidance for feeding infants and young children, Nutrition for Healthy Term
Infants at: https://www.canada.ca/en/health-canada/services/canada-food-guide/resources/infant-feeding.
html. This in turn leads to two sets of principles and recommendations with supporting technical rationale for
each recommendation, and to additional consumer-facing guidance. The principles and recommendations are
targeted to health-care providers.
• Nutrition for Healthy Term Infants: Recommendations from Birth to Six Months: https://www.canada.
ca/en/health-canada/services/canada-food-guide/resources/infant-feeding/nutrition-healthy-term-infants-
recommendations-birth-six-months.html.
• Nutrition for Healthy Term Infants: Recommendations from Six to 24 Months: https://www.canada.ca/
en/health-canada/services/canada-food-guide/resources/infant-feeding/nutrition-healthy-term-infants-
recommendations-birth-six-months/6-24-months.html.
• Healthy Canadians - Infant Nutrition Birth to 24 Months: https://www.canada.ca/en/health-canada/services/
infant-care/infant-nutrition.html.
• Safety of Donor Human Milk in Canada: https://www.canada.ca/en/health-canada/services/canada-food-
guide/resources/infant-feeding/safety-donor-human-milk-canada.html.
• Safety of Homemade Infant Formulas in Canada: https://www.canada.ca/en/health-canada/services/
canada-food-guide/resources/infant-feeding/safety-homemade-infant-formulas-canada.html.
Similarly, the guidelines document also refers to additional online resources for several life stages, including
childhood and adolescence. These are accessed via the main page for Canada’s Food Guide: http://www.
canada.ca/foodguide, under a button for ‘Tips’. While not explicitly noted in the guidelines document, there
is also guidance for prenatal nutrition, available from the same main page by branching to ‘Resources’, and
additional guidance for breastfeeding (with overlapping content to those above) under ‘Tips’. Further branching
from these pages leads to both guidance for professionals and consumer-facing guidance.
• Resource: Prenatal Nutrition: https://www.canada.ca/en/health-canada/services/canada-food-guide/

resources/prenatal-nutrition.html
• The page above provides links to a series of topic-specific professional resources and a consumer-facing
resource: The Sensible Guide to a Healthy Pregnancy: https://www.canada.ca/en/public-health/services/
health-promotion/healthy-pregnancy/healthy-pregnancy-guide.html
• Tips: Breastfeeding Your Baby: https://www.canada.ca/en/public-health/services/health-promotion/
childhood-adolescence/stages-childhood/infancy-birth-two-years/breastfeeding-infant-nutrition.html
• Tips: Healthy Eating for Parents and Children: https://food-guide.canada.ca/en/tips-for-healthy-eating/teens/
• Tips: Healthy Eating for Teens: https://food-guide.canada.ca/en/tips-for-healthy-eating/teens/
• Tips: Healthy Eating at School: https://food-guide.canada.ca/en/tips-for-healthy-eating/school/
In addition to all of the above, additional consumer-facing resources are available, but were not reviewed for
this case study. These include resources on food safety available at:
https://www.canada.ca/en/health-canada/services/food-safety-vulnerable-populations.html
There is specific guidance for pregnancy, and for children under five years of age:
• https://www.canada.ca/en/health-canada/services/food-safety-vulnerable-populations/food-safety-
pregnant-women.html
• https://www.canada.ca/en/health-canada/services/food-safety-vulnerable-populations/food-safety-
information-children-ages-5-under.html

For pregnant women, there are also links to resources on listeriosis, and smoking:
• https://www.canada.ca/en/public-health/services/diseases/listeriosis.html
• https://www.canada.ca/en/health-canada/services/health-concerns/tobacco/smoking-your-body/pregnancy.
html
Bolivia
• Bolivia 2013. Guia Alimentaria para la mujer durante el periodo de Embarazo y Lactancia (‘Food guide for
women during the period of pregnancy and lactation’). Available at: https://www.minsalud.gob.bo/images/
Libros/DGPS/PDS/p345_g_dgps_uan_GUIA_ALIMENTARIA_PARA_LA_MUJER_DURANTE_EL_
PERIODO_DE_EMBARAZO_Y_LACTANCIA.pdf and at: https://www.minsalud.gob.bo/38-libros-y-normas/
fichas-bibliograficas/1679-unidad-de-alimentacion-y-nutricion-2
• Bolivia 2013. Guia Alimentaria para el niño y la niña en edad escolar (‘Food Guide for girls and boys of school
age’). Available at: https://www.minsalud.gob.bo/images/Libros/DGPS/PDS/p343_g_dgps_uan_GUIA_
ALIMENTARIA_PARA_LA_NIAS_Y_EL_NIO_EN_EDAD_ESCOLAR.pdf and at: https://www.minsalud.gob.
bo/38-libros-y-normas/fichas-bibliograficas/1676-unidad-de-alimentacion-y-nutricion
• Bolivia 2013. Guia Alimentaria para los y las Adolescentes. (‘Food Guide for Adolescent girls and boys’).
Available at: https://www.minsalud.gob.bo/images/Libros/DGPS/PDS/p344_g_dgps_uan_GUIA_
ALIMENTARIA_PARA_LAS_ADOLESCENTES.pdf and at: https://www.minsalud.gob.bo/38-libros-y-
normas/fichas-bibliograficas/1679-unidad-de-alimentacion-y-nutricion-2
Chile
• Chile 2013. Guia de Alimentación del Niño(a) menor de 2 años/ Guia de alimentación para la Adolescencia.
(Food guide for children under 2 years of age through adolescence). Available at: http://www.fao.org/
nutrition/education/food-dietary-guidelines/regions/countries/chile/en/
Colombia
• Colombia 2018. Guias Alimentarias Basadas en Alimentos para mujeres Gestantes, Madres en Período de
Lactancia y Niños y Niñas menores de dos años de Colombia. Documento Técnico. (Food-Based Dietary
Guidelines for Pregnant Women, Nursing Mothers and Children under two years of age in Colombia.
Technical Document). Available at: https://www.icbf.gov.co/sites/default/files/gabasmenor2anos_
documentotecnico_2018.pdf
• Colombia 2018. Guias Alimentarias Basadas en Alimentos para mujeres Gestantes, Madres en Período
de Lactancia y Niños y Niñas menores de dos años de Colombia. Material Educativo (Food-Based Dietary
Guidelines for Pregnant Women, Nursing Mothers and Children under two years of age in Colombia.
Educational Material). Available at: https://www.icbf.gov.co/sites/default/files/gabasmenor2anos_
infografia_2018.pdf
Panama
Technical document:
• Panama 2018. Guia Alimentaria para menores de 2 años de Panama. (‘Food Guidelines for children under 2
years old from Panama’). Available at: http://www.fao.org/3/CA1014ES/ca1014es.pdf
Educational material:
• Panama 2018. Guia Alimentaria para menores de 2 años de Panama. (‘Food Guidelines for children under 2
years old from Panama’). Available at: http://www.fao.org/3/CA1017ES/ca1017es.pdf

Annex 5
New Zealand’s summary evidence statements on
food and eating behaviours
The source for Table A5.1 is the following web-page of the Ministry of Health, New Zealand: https://www.
health.govt.nz/our-work/eating-and-activity-guidelines/issue-based-documents-eating-and-activity/summary-
evidence-statements-food-and-eating-behaviours
The review methodology and grading criteria are described in detail in the accompanying background paper:
Gerritsen S and Wall C. 2017. How We Eat: Reviews of the evidence on food and eating behaviours related to
diet and body size. Wellington: Ministry of Health.
Table A5.1 New Zealand’s summary evidence statements on food and eating behaviours
Evidence statements Topic and grade
For partners of pregnant/breastfeeding mothers
Be supportive about breastfeeding (with a positive attitude; remembering it is best for Family support for
baby and your partner’s health). Your support makes it more likely that the mother of breastfeeding
your child will intend to breastfeed, start breastfeeding and breastfeed for longer. Your
Grade A
support also helps her feel more confident about her ability to breastfeed.
For breastfeeding mothers
Involve your partner and/or your own mother in breastfeeding education and support Family support for
(both before and after birth). Their support can help you to start breastfeeding and to breastfeeding
breastfeed for longer.
Grade A
Eat a wide variety of foods and flavours (including bitter vegetables such as broccoli Parental feeding
and cauliflower) while you are pregnant and/or breastfeeding. This makes it more likely practices and
that your child will accept vegetables in early childhood. parenting style
Grade B
For parents and caregivers of children and young people
Be a nurturing and supportive parent. This helps your child to keep eating a healthy diet Parental feeding
and to stay a healthy body size. practices and
parenting style
Grade A
Watch out for signs that your baby or toddler is hungry or has eaten enough. With Responsive eating
this awareness, you can help your child make small improvements in their diet, food
Grade B
preferences and eating behaviours. It may also protect them from gaining too much
weight.
Especially in the early years, keep offering children a wide range of foods, no matter Parental feeding
what foods they say they prefer. Allow them to make their own choices from a wide practices and
variety of foods and encourage them to ‘take one bite’ of unfamiliar foods. parenting style
Grade B
When your child tries a new food, give them lots of encouragement. Do not use food Parental feeding
as a reward (eg, ‘If you eat the vegetables you can have dessert’). Your praise and practices and
encouragement is more helpful and avoids your child thinking some foods are ‘special’ parenting style
or ‘good’ and that others are ‘boring’ or ‘bad’. Focus instead on how useful different
Grade B
types of food are for their body, to give them energy and keep them healthy.

Do not restrict how much your child eats (when they appear to eat too much) or Parental feeding
pressure them to eat (when they appear to eat too little). Forcing a particular way of practices and
eating on a child can make them develop unhelpful ways of thinking about food, poor parenting style
dietary habits and may make them put on too much weight.
Grade A
Avoid strict food rules, but at the same time do not give your child the complete Parental feeding
freedom to choose any food. practices and
parenting style
Grade A
Set limits on the amount of takeaways, sweets and sugary drinks that your child (up to Parental feeding
the age of 10 years) has as this helps protect them against a poor diet and putting on practices and
too much weight. The best approach is to set those limits without making your child parenting style
aware of them – just quietly limit their access to, or restrict the portion size of, these
Grade A
foods and drinks.
Eat together as a family. This may help children and young people to eat a healthier diet Mealtimes
and behave in ways that support good nutrition.
Grade B
Avoid watching TV while eating – this applies to both you and your child. Children, Responsive eating
young people and adults all tend to eat more while watching TV. The same effect may
Grade A
also happen with other screens (for example, computers, phones).
Limit the number of sugar-sweetened drinks you have. What you drink influences what Adult role-modelling
your young child prefers to drink. of healthy eating
Grade B
Give your child a healthy breakfast every day. This can help them achieve better results Mealtimes
at school.
Grade A
Eat breakfast yourself. Your role modelling encourages your young person to eat Adult role-modelling
breakfast. of healthy eating
Grade B
Give children and young people regular meals and snacks (three or more times a day). Mealtimes
This may help to keep their weight down.
Grade A
Eat fruit and vegetables yourself. Your role modelling encourages your child to eat Adult role-modelling
more fruit and vegetables. of healthy eating
Grade B
Avoid strict food rules, but at the same time do not give your child the complete Parental feeding
freedom to choose any food. practices and
parenting style
Grade A
Involve your child in preparing food and in cooking. This helps your child gain the Food literacy
knowledge, skills and behaviours they need to make healthy food choices (food
Grade C
literacy). Cooking classes in schools and community kitchens may also help them to
develop these skills and behaviours.
Support gardening at school as part of the wider curriculum. This may increase Food literacy
children and young people’s access to vegetables and fruits, as well as encouraging
Grade C
them to eat and enjoy these foods.
For early childhood teachers

Be an enthusiastic, positive role model of healthy eating during mealtimes. Your good Adult role-modelling
example may influence pre-schoolers’ eating behaviours. of healthy eating
Grade C
For adults
Eat a healthy breakfast every day (at all ages). This appears to improve diet quality Mealtimes
overall and may protect against weight gain, but is not linked with weight loss.
Grade B
If you want to maintain or lose weight, focus on your energy intake over the whole day Mealtimes
rather than on how often you eat. Body size does not appear to be linked to the number
Grade A
of times you eat a day. However, be aware eating more often does give you more
opportunities to increase your energy (kilojoule or calorie) intake.
Be mindful and pay attention to food while you eat, and then stop eating when you feel Responsive eating
full. This helps you to regulate your eating patterns and overcome unhealthy weight
Grade B
control behaviours. More research is needed about whether these techniques help to
maintain or lose weight.
Get involved in preparing food and in cooking. This helps you gain the knowledge, skills Food literacy
and behaviours you need to make healthy food choices (food literacy). Cooking classes
Grade C
in community kitchens may also help you to develop these skills and behaviours.

Annex 6
Comparison of group-specific dietary guidance across case study
countries
The tables in this Annex summarize separately for age and physiological groups. The tables include general population guidance (indicated as ‘GPG’) when relevant.
Source document titles are listed at the top of each table; for full citations see Annex 4.
Pregnancy
Table A6.1: Guidance for nutrition during pregnancy: Kenya, Ireland, India, New Zealand, and Canada
Sources: Kenya: Professional-facing National Guidelines for Healthy Diets and Physical Activity; Ireland: Best Practice for Infant Feeding in Ireland - A Guide for
Healthcare Professionals, and consumer-facing Healthy Eating for Pregnancy; India: Professional- /consumer-facing Dietary Guidelines for Indians – A Manual; New
Zealand: Consumer-facing Eating for Healthy Pregnant Women, Canada: Web-based professional guidance and web-based plus downloadable consumer-facing
guidance: The Sensible Guide to a Healthy Pregnancy.
Topic Kenya Ireland India New Zealand Canadaa
1-2 extra servings of

fruits and vegetables Eat more food. Extra portions
OR dairy OR bread, during pregnancy: ‘Fat/Oil-2, Captured in recommended One extra snack in second
Additional food Extra meal and two snacks
potatoes, and cereal Milk-2, Fruit-1, Green Leafy servings per food group. and third trimester.
group in 2nd and 3rd Vegetables-1/2.’
trimester
GPG: Use the Pyramid

GPG: Eat a variety of foods Eat a variety of healthy GPG: Make it a habit to eat
as a guide for serving GPG: Eat a variety of foods to
Food groups from different food groups foods every day from each a variety of healthy foods
sizes and remember that ensure a balanced diet
every day. of the four main food groups each day
portion size matters
Daily. Choose whole grain.

GPG: 3-5 servings, At least 6 servings; choose
Grains GPG: Eat whole or GPGb: 9 portions Choose products lower in
depending on activity whole grain
unprocessed starchy foods fat, sugar and salt.
level. Whole grain is
Roots and with each meal.
best. -- -- --
tubers

Meat, poultry Eat liver and red meat when Fish: Eat twice a week. GPG: Under Guideline 1 on At least 2 servings a day
Guidance on types to variety: Include animal-source Eat lean meats and meat
Fish available. of lean meat, poultry, fish/
consume, limit and foods ‘such as milk, eggs and alternatives (legumes,
seafood, eggs, legumes,
GPG: Eat lean meat, poultry, avoid (mercury). meat, particularly for pregnant tofu) daily. Eat fish weekly.
nuts and seeds. Guidance on
Eggs fish, insects or eggs at least and lactating women and Detailed guidance on fish to
Avoid liver. iron sources and enhancers.
twice a week children. consume/limit/avoid.
No more than 100 g liver a
GPG: Eat 2 servings a week. Professional guidance
GPGb: 2 portions daily if
Legumes day of meat, poultry, indicates 150 g cooked fish
GPG: Eat at least 4 times a vegetarian; 1 portion if not
fish, eggs, legumes or Detailed guidance on fish to
week weekly.
nuts. consume/limit/avoid.
Nuts --
Conflicting guidance
on number of servings; At least 3 servings a day;
Milk, yogurt or cheese every
3 or 5 servings a day; prefer reduced or low-fat.
day (same as GPG)
avoid unpasteurized and Guidance on alternate Daily – reduced, low-fat, or
GPG: Drink fresh milk, certain types of cheese. 5 portions daily, because GPGb
sources of calcium. Non- non-fat. Drink fortified soy
Dairy fermented milk or yoghurt Identifies alternate food is 3, and 2 extra are indicated
dairy milks should be beverages if not drinking
every day. Use low-fat or sources of calcium. during pregnancy.
calcium fortified, and for milk.
skim with little or no added vegans, also should be B12
GPG: Reduced fat or
sugar fortified.
low-fat dairy; limit
cheese.
GPG: 5 servings a day; 2 portions daily; GPGb is 1 and

Fruits At least 2 servings Daily
variety including green GPG: Eat more fruit and 1 extra indicated.
leafy vegetables, red and vegetables, at least 5 to 4-5 portions daily; GPGb is Daily – at least one dark
Vegetables yellow vegetables, and fruit 7 servings a day 3 and 1/2 extra green leafy At least 4 servings green and one orange
all daily vegetables are indicated. vegetable daily

60 mg iron + 400 μg folic Physician may Conflicting statements: 0.8 mg folic acid daily for a Prenatal multivitamin daily,
acid daily for 270 days recommend iron pregnant women are advised month preconception and with 0.4 mg of folic acid and
during pregnancy supplements for some to take ‘daily supplements of through the 12th week of 16-20 mg of iron.
women; 400 μg folic iron, folic acid, vitamin B12 and pregnancy; higher does if
Professional guidance (but
acid daily preconception calcium’; elsewhere stated: at high risk for neural tube
not consumer-facing) also
and for 1st 12 weeks of ‘Take iron, folate and calcium defects; 150 µg iodine-
indicated the multivitamin
Supplements pregnancy; 5 μg vitamin supplements regularly, after only tablet throughout
should include B12.
D daily; avoid fish 14-16 weeks of pregnancy’. pregnancy; no other
liver oil, supplements Higher dose of folic acid (0.5 supplements but describes
containing vitamin A, mg) pre-conceptually and vitamin D sources and who
and liver throughout pregnancy if may be at risk and if so
there is history of neural tube advice to consult medical
defects. practitioner.
Tea or coffee between -- Avoid tea before, during, or Vitamin C sources to Covered in professional
meals, not with meals; oil, soon after a meal. enhance iron absorption. guidance, but not in
Inhibitors/ nuts or seeds with vitamin consumer-facing guidance.
Eat vitamin C-rich foods to Avoid drinking tea with
enhancers A-rich vegetables
enhance absorption of iron meals.
(examples given)
Use iodized salt, in small -- GPG: use iron fortified iodized Choose breads and cereals Drink fortified soy
amounts; salt (double fortified salt). fortified with folic acid. beverages if not drinking
Non-dairy milks should be milk.
GPG: choose fortified maize GPG: Prefer fortified processed
calcium fortified, and for
Fortified foods and wheat flour foods.
vegans, also should be B12
GPG: use fortified oil fortified.
If using salt, choose iodized

salt.
8-10 glasses of water; Limit caffeine intake; no 8-12 glasses of water a day; 9 cups of fluid daily; water Drink ‘plenty’ of water; limit
no alcohol; tea or coffee alcohol limit caffeinated beverages; no or reduced- or low-fat milk caffeinated beverages.
between meals, not with alcohol. are best; limit caffeinated
GPG: Drink water; replace
meals drinks and do not take with
Avoid tea before, during, or sugary drinks with water.
Beverages meals; limit soft drinks,
soon after a meal.
flavored waters, fruit drinks, No alcohol.
diet drinks. Energy drinks,
energy shots and alcohol not
recommended.

GPG: Dairy with little or no -- GPG: Guideline 1 on variety -- --

added sugar includes: ‘Include jaggery
or sugar and cooking oils

to bridge the calorie or
Sugar
energy gap.’ Guideline 8 on
overweight advises: ‘Cut down
sugar, salt, fatty foods, refined
foods, soft drinks and alcohol’
Use iodized salt, in small -- Guideline 10 is ‘restrict salt If using salt, choose iodized --
amounts, same as GPG intake to a minimum; but in salt.
section on pregnancy states:
GPG: GPG: Use iodized salt
Salt ‘salt intake should not be
but use it sparingly. Gives
restricted’.
a list of ways to reduce
consumption of salt and
foods high in salt.
GPG: Low-fat or skim dairy GPG: Reduced fat or 6 5-g servings, because GPGa Prefer reduced or low-fat GPG: Choose healthy fats
low-fat dairy; limit is 4 servings and 2 extra are dairy. instead of saturated fats.
GPG: Moderation message
cheese. indicated.
with 7 sub-messages
detailing how to reduce GPG: Use fats and oils GPG: Adults should choose
unhealthy fats and increase in very small amounts. low-fat, protein-rich foods
healthy fats. Guidance on selecting such as lean meat, fish,
Fat healthier types of fats,
pulses and low-fat milk
and on lower fat cooking
(Guideline 1)
methods.
GPG: Moderate intake of edible
oils and decrease solid fats
(Guideline 7) Provides positive
and negative messages on
fats.

GPG: Avoid processed GPG: No more GPG: Limit consumption Choose and prepare foods GPG: Limit highly processed
foods with trans fatty acids than once or twice of sugar and unhealthy low in fat, salt, and sugar. foods. Prepare meals and
a week. Provides processed foods (these are Detailed suggestions on snacks using ingredients
GPG: Limit consumption of
detailed examples described). how to achieve this, and that have little to no added
Foods and sweetened food and drinks
and suggestions for detailed list of foods and sodium, sugars or saturated
beverages high GPG: Restrict intake of
substitutions. beverages to consume only fat.
in sugar, salt, preserved and processed
occasionally.
and/or fat foods such as papads, GPG: Replace sugary drinks
with water.
pickles, sauces, ketchup, salted
biscuits, chips, cheese and
salted fish.
Nausea, Advice to seek nutrition Provides guidance for Provides examples of Provides guidance for Provides guidance for
vomiting, counselling, but also coping with all of these. high-fiber foods to avoid coping with all of these coping with all of these.
heartburn, provides dietary strategies constipation.
constipation to address these
-- Potentially allergenic -- Avoiding common food --

foods should not be allergens not recommended
Food allergens avoided unless the
mother herself has an
allergy
a The new Canadian Food Guide web application does not appear to include recommended servings or serving sizes for any age or physiological group; this may be forthcoming as part of the application as it is mentioned as
forthcoming on p. 1 of Health Canada. 2019. Canada’s Dietary Guidelines for Health Professionals and Policy Makers. Heath Canada: Ottawa.
b For India, the general population guidance on portion sizes is for a sedentary adult woman (p. 20 in National Institute of Nutrition. 2011. Dietary Guidelines for India - A manual. NIN: Hyderabad).

Table A6.2: Guidance for nutrition during pregnancy: Bolivia and Colombia
Sources: Bolivia: Professional-facing Guia Alimentaria para la mujer durante el periodo de Embarazo y
Lactancia; Colombia: Two professional-facing documents: Guias Alimentarias Basadas en Alimentos para
mujeres Gestantes, Madres en Período de Lactancia y Niños y Niñas menores de dos años de Colombia.
Documento Técnico; and Guias Alimentarias Basadas en Alimentos para mujeres Gestantes, Madres en
Período de Lactancia y Niños y Niñas menores de dos años de Colombia. Material Educativo.
Topic Bolivia Colombia
Additional food Extra serving/day of dairy, fruit and sugar Extra portions in the 2nd and 3rd trimester
and 2 extra servings/day of vegetables for grains, roots and tubers, plantains,
vegetables, meat, and oil. For 14-17 years,
also an extra portion of fruit, and for adult
women extra dairy.
Food groups GPG: Eat a varied diet daily, which includes For your health and that of your baby,
food from all groups, increasing the eat fresh, varied and natural foods, as
amount of vegetables and fruits. indicated by the ‘Colombian Family’s
Healthy Plate’.
Portions per food group vary by age and

trimester of pregnancy; ranges are shown
below
Grains 6 40-50 g portions/day 3-3.5 portions/day
Roots and tubers 3 100 g portions/day 3-4.5 portions/day (including plantains)
Meat, poultry 2 8-100 g portions/day 2.5-3.5 portions/day
GPG: Consume animal source foods which

are source of iron (meats and offal) at least
3 times per week.
Fish -- --
Eggs -- 1 portion/day
Legumes -- 1 portion/day
Nuts -- 1 portion/day
Dairy 3 100 ml portions/day 3-4 portions/day
Fruits 3 100 g portions/day 3-3.5 portions/day
Vegetables 4 50-100 g portions/day 2-3 portions/day
Iron and folic acid, dosage and duration Iron and folic acid, dosage and duration
Supplements
not indicated not indicated
Inhibitors/ Reduce consumption of coffee and tea

--
enhancers (inhibition of iron absorption)
GPG: Always use iodized salt in foods, with

Fortified foods --
moderation
Beverages No alcohol No alcohol
GPG: Reduce the consumption of tea and Do not consume, soda, sugary drinks,
coffee, replacing them with milk, fruit energy drinks
juices or ‘apis’ (Apis: Traditional drink
made from purple corn, ground yellow
corn, cinnamon, sugar and clove)

Sugar 4 10 g portions/day, but too much sugar 1 portion/day
is not beneficial for the mother, nor for
the baby; simple sugars cause sudden
changes in blood glucose and insulin
levels, a situation that can lead to diabetes
during pregnancy
Salt GPG: Always use iodized salt in foods, with Reduce salt intake
moderation
Fat 3 10 ml portions/day 2.2-2.9 portions/day, of which only 0.2 is

saturated
GPG: Prefer vegetable oils and avoid
animal source fats and reheated oils
Foods and GPG: Avoid the over consumption of sugar, Do not consume fast foods, soda, sugary
beverages high in sweets, sodas and alcoholic drinks drinks, energy drinks and packaged
sugar, salt, and/ products
or fat
Avoid cold meats, sauces, and broths and
soups in sachets/envelopes and buckets
Nausea, vomiting, Provides guidance for coping with nausea --

heartburn, and vomiting
constipation
Food allergens -- --

Lactation
Table A6.3: Guidance for nutrition during lactation: Kenya, Ireland, India, and New Zealand
Sources: Kenya: Professional-facing National Guidelines for Healthy Diets and Physical Activity; Ireland: Best Practice for Infant Feeding in Ireland - A Guide for
Healthcare Professionals, and an additional professional-facing document: Healthy Eating, Food Safety, and Food Legislation – A Guide Supporting the Healthy
Ireland Food Pyramid; India: Professional- and consumer-facing Dietary Guidelines for Indians – A Manual; New Zealand: Consumer-facing Eating for Healthy
Breastfeeding Women
Topic Kenya Ireland India New Zealand
Additional food Two extra meals and two snacks 1-2 extra servings of fruits and Extra portions during lactation: Captured in recommended servings
vegetables OR dairy OR bread, ‘Cereals-1, Pulses-2, Fat/Oil-2, Milk- per food group.
potatoes, and cereal group 2, Fruit-1, Green Leafy
Vegetables-1/2’. Between 6-12

months lactation, diet should
gradually reduce to normal
Food groups GPG: Eat a variety of foods from GPG: Use the Pyramid as a guide GPG: Eat a variety of foods to Eat a variety of healthy foods every
different food groups every day. for serving sizes and remember ensure a balanced diet day from each of the four main food
that portion size matters groups
Grains GPG: Eat whole or unprocessed GPG: 3-5 servings, depending on 10 portions; GPGb is 9 portions and At least 7 servings; choose whole
starchy foods with each meal. activity level. Whole grain is best. 1 extra indicated during lactation grain
Roots and tubers -- --
Meat, poultry Eat a variety of plant- and animal- 1-2 servings a week of oily GPG: Under Guideline 1 on variety: At least 2 servings a day of lean
source proteins. fish; guidance on types to limit Include animal-source foods ‘such meat, poultry, fish/seafood, eggs,
Fish
(mercury) as milk, eggs and meat, particularly legumes, nuts and seeds. Guidance
GPG: Eat lean meat, poultry, fish,
Eggs for pregnant and lactating women on iron sources and enhancers.
insects or eggs at least twice a GPG: Eat 2 servings a day of meat,
and children.
week poultry, fish, eggs, legumes or nuts.
Legumes GPG: Eat at least 4 times a week 4 portions daily if vegetarian; 3

portions if not (i.e. 2 more than
GPGb)
Nuts --

Dairy Emphasizes high calcium needs At least 3 servings of dairy 5 portions daily, because GPGb is At least 3 servings a day; prefer
but does not make a specific products. 3, and 2 extra are indicated during reduced or low-fat. Guidance on
recommendation for dairy during lactation. alternate sources of calcium. Non-
GPG: Reduced fat or low-fat dairy;
lactation. dairy milks should be calcium
limit cheese.
fortified, and for vegans, also
GPG: Drink fresh milk, fermented
should be B12 fortified.
milk or yoghurt every day. Use low-
fat or skim with little or no added
sugar.
Fruits GPG: 5 servings a day; variety GPG: 5-7 servings a day 2 portions daily; GPGb is 1 and 1 At least 2 servings
including green leafy vegetables, extra indicated.
red and yellow vegetables, and fruit
Vegetables 4-5 portions daily; GPGb is 3 and At least 4 servings
all daily
1/2 extra green leafty vegetables
are indicated.
Supplements Only as prescribed by a trained 5 μg vitamin D daily Daily supplements of iron, folic 150 µg iodine-only tablet
health care provider acid, vitamin B12 and calcium.
400μg folic acid daily No other supplements but
describes vitamin D sources
If vegan, lactose intolerant, or do
not consume enough calcium rich
foods,
calcium supplement may be

needed
Inhibitors/ Eat vitamin C-rich foods ‘like fruits -- Avoid tea before, during, or soon Vitamin C sources to enhance iron
enhancers and vegetables’ to enhance iron after a meal. absorption.
absorption.
Eat vitamin C-rich foods to enhance Avoid drinking tea with meals.
Tea or coffee between meals, not absorption of iron (examples given)
with meals. Limit intake of tea and
coffee.
Fortified foods GPG: choose fortified maize and -- GPG: use iron fortified iodized salt Non-dairy milks should be calcium
wheat flour (double fortified salt). fortified, and for vegans, also
should be B12 fortified.
GPG: use fortified oil GPG: Prefer fortified processed
foods. If using salt, choose iodized salt.
GPG: Use iodized salt but use it
sparingly

Beverages Take lots of ‘nutritious fluids At least 8 glasses of fluids daily; Avoid tea before, during, or soon 9 cups of fluid daily; water or
like milk, soup, juice, porridge, milk and water are best choices after a meal. reduced- or low-fat milk are best;
beverages and water’ limit caffeinated drinks and do not
No more than 2-3 cups caffeinated Avoid alcohol.
take with meals; limit soft drinks,
Limit tea and coffee, and take beverages
flavored waters, fruit drinks, diet
separately from meals (iron
Alcohol: Limit alcohol; follow GPG drinks. Energy drinks, energy shots
absorption)
for intake for women (11 units/ and alcohol not recommended.
week). Additional behavioral If consumed, minimize risk by
guidance (e.g. do not drink just waiting 2-3 hours after drinking to
before feeding; expressing) breastfeed the baby; if needed give
provided alcohol-free expressed milk to the
baby.
Sugar GPG: Dairy with little or no added -- GPG: Guideline 1 on variety --

sugar includes: ‘Include jaggery or sugar
and cooking oils to bridge the
calorie or energy gap.’ Guideline 8
on overweight advises: ‘Cut down
sugar, salt, fatty foods, refined
foods, soft drinks and alcohol’
Salt GPG: Use iodized salt but use it -- GPG: Guideline 10 is ‘restrict salt If using salt, choose iodized salt.
sparingly. Gives a list of ways to intake to a minimum’
reduce consumption of salt and
foods high in salt.
Fat GPG: Low-fat or skim dairy GPG: Reduced fat or low-fat dairy; 6 5-g servings, because GPGa is 4 Prefer reduced or low-fat dairy.
limit cheese. servings and 2 extra are indicated.
GPG: Moderation message with Guidance on choosing foods rich in
7 sub-messages detailing how to GPG: Use fats and oils in very small GPG: Adults should choose low- polyunsaturated fat and omega-3s
reduce unhealthy fats and increase amounts. Guidance on selecting fat, protein-rich foods such as lean (examples given).
healthy fats. healthier types of fats, and on lower meat, fish, pulses and low-fat milk
fat cooking methods. (Guideline 1)
GPG: Moderate intake of edible oils

and decrease solid fats (Guideline
7)
Provides positive and negative

messages on fats.

Foods and GPG: Avoid processed foods with GPG: No more than once or twice a GPG: Limit consumption of sugar Choose and prepare foods low
beverages high trans fatty acids week. Provides detailed examples and unhealthy processed foods in fat, salt, and sugar. Detailed
in sugar, salt, and suggestions for substitutions. (these are described). suggestions on how to achieve
GPG: Limit consumption of
and/or fat this, and detailed list of foods
sweetened food and drinks GPG: Restrict intake of preserved
and beverages to consume only
and processed foods such as
occasionally.
papads, pickles, sauces, ketchup,
salted biscuits, chips, cheese and
salted fish.
Food allergens -- -- -- Discuss any concerns with a health

care provider; cutting out foods
may not help a colicky baby
a The new Canadian Food Guide web application does not appear to include recommended servings or serving sizes for any age or physiological group; this may be forthcoming as part of the application as it is mentioned as
forthcoming on p. 1 of Health Canada. 2019. Canada’s Dietary Guidelines for Health Professionals and Policy Makers. Heath Canada: Ottawa. At present
b For India, the general population guidance on portion sizes is for a sedentary adult woman (p. 20 in National Institute of Nutrition. 2011. Dietary Guidelines for India - A manual. NIN: Hyderabad).

Table A6.4: Guidance for nutrition during lactation: Bolivia and Colombia
Sources: Bolivia: Professional-facing Guia Alimentaria para la mujer durante el periodo de Embarazo y
Lactancia; Colombia: Two professional-facing documents: Guias Alimentarias Basadas en Alimentos para
mujeres Gestantes, Madres en Período de Lactancia y Niños y Niñas menores de dos años de Colombia.
Documento Técnico; and Guias Alimentarias Basadas en Alimentos para mujeres Gestantes, Madres en
Período de Lactancia y Niños y Niñas menores de dos años de Colombia. Material Educativo.

Extra serving/day of dairy, grains, Extra servings are indicated for most food
and fruit, and 2 extra servings/day of groups during lactation
Additional food
vegetables; 1.5 extra servings of sugar
and 0.5 extra servings of fats
GPG: Eat a varied diet daily, which GPG: Eat natural and diverse foods, as
includes food from all groups, increasing indicated in the ‘Colombian Family’s
the amount of vegetables and fruits. Healthy Plate’
Food groups
Portions per food group vary by age and
by semester of lactation; ranges are shown
below
Grains 7 40-50 g portions/day 3-3.5 portions/day
Roots and tubers 3 100 g portions/day 4-4.5 portions/day (includes plantains)
2 8-100 g portions/day 3.5 portions/day
Meat, poultry GPG: Consume animal source foods GPG: Consume animal source foods which
which are source of iron (meats and offal) are source of iron (meats and offal) at least
at least 3 times per week. 3 times per week
Fish -- --
Eggs -- 1 portion/day
Legumes -- 0.8-1 portion/day
Nuts -- 0.8-1 portion/day
Dairy 3 100 ml portions/day 3.5-4 portions/day
Fruits 3 100 g portions/day 3 portions/day
Vegetables 4 50-100 g portions/day 2-3 portions/day
Iron, dosage and duration not indicated Iron and folic acid, dosage and duration
Supplements
not indicated
Reduce consumption of coffee and tea --

Inhibitors/enhancers
(inhibition of iron absorption)
GPG: Always use iodized salt in foods, --

Fortified foods
with moderation
No alcohol Increase water consumption
GPG: Reduce the consumption of tea and

Beverages coffee, replacing them with milk, fruit
juices or ‘apis’ (Apis: Traditional drink
made from purple corn, ground yellow
corn, cinnamon, sugar and clove)
Sugar 4.5 10 g portions/day 1 portion/day

GPG: Always use iodized salt in foods, --
Salt
with moderation
3.5 10 ml portions/day 2.9-3.4 portions/day, of which only 0.2 is

Fat saturated
GPG: Prefer vegetable oils and avoid
animal source fats and reheated oils
Foods and beverages GPG: Avoid the over consumption of --

high in sugar, salt, sugar, sweets, sodas and alcoholic drinks
and/or fat
Food allergens -- --

Infants under 6 months of age
Table A6.5: Guidance for infants under 6 months of age: Kenya, Ireland, India, New Zealand, and Canada
Sources: Kenya: Professional-facing National Guidelines for Healthy Diets and Physical Activity; Ireland: Best Practice for Infant Feeding in Ireland - A Guide for Healthcare
Professionals; and web-based consumer-facing guidance at: https://www2.hse.ie/babies-and-toddlers/breastfeeding/; India: Professional- and consumer-facing Dietary
Guidelines for Indians – A Manual; New Zealand: Consumer-facing Eating for Healthy Babies and Toddlers, Canada: Professional-facing guidance: Nutrition for Healthy Term
Infants: Recommendations from Birth to Six Months; web-based consumer-facing guidance at: https://www.canada.ca/en/health-canada/services/infant-care/infant-nutrition.
html and consumer-facing booklet: 10 Valuable Tips for Successful Breastfeeding.
Topic Kenya Irelanda India New Zealand Canada

Start breastfeeding within ‘Holding your baby with ‘Start breast-feeding within -- ‘Breastfeed right after
an hour after delivery their skin next to your skin an hour after delivery and birth. Cuddle your baby
immediately after birth will do not discard colostrum’ on your chest…When you
Skin to skin contact is likely
calm and relax you both. and your baby are skin to
to help with latching on
Skin-to-skin contact with skin… your milk production
Mother should breastfeed your baby in the first hour and baby’s feeding reflexes
immediately after delivery after birth will help get are triggered….Remain
to provide baby with the first feed off to a good skin to skin with your baby
colostrum start.’ until after a successful
Early initiation breastfeed’
and/or giving ‘When you start
colostrum breastfeeding, your breasts
will release an early
milk called colostrum.
It is produced in small
amounts by your body
and is quite thick in
consistency. Colostrum is
full of antibodies that will
help your baby fight off
infection.’
‘Do not give any other -- ‘Feeding honey, glucose, -- --

food or drink (not even water or dilute milk formula
Exclusive
pre-lacteal feeds), before lactation should be
breastfeeding in
except for medicines as avoided’
first few days
recommended by a trained
health care professional’

‘Breastfeed babies on Professional guidance: ‘Breast-feed the infant ‘Young babies need to be Don’t time feeds, look for
demand – any time when ‘Infant-led or demand frequently and on demand fed often and on demand hunger cues.
Feeding on they want to during the day feeding is normal and to establish and maintain (when they are hungry)’
‘Night feeds are important
demand and and night’ ensures a good milk good milk supply’
to establish breastfeeding
feeding at night supply’
and to maintain milk
production’
‘Do not give any other Professional guidance: ‘For ‘Breast-feed exclusively ‘Breast milk is specially ‘Breastfeeding is the only
food or drink… except the first 6 months, infants (not even water) for a made for your baby and is food or drink your baby will
Exclusive for medicines as should be exclusively minimum of six months if all your baby needs until need for the first 6 months’
breastfeeding in recommended by a trained breastfed’ the growth of the infant is they are around 6 months
first 6 months health care professional’ adequate’ old’
‘avoid giving an infant any
other drinks’
‘Express breastmilk that Detailed professional and ‘A working mother can ‘You can express breast Very brief mention of
can be given to the baby, consumer-facing guidance express her breast milk and milk. For babies under storing and warming
from a cup, when it is not on how-to, including for store it hygienically up to 8 3 months, sterilise all expressed breast milk
possible to be with the preparing to express hrs. This can be fed to her equipment and containers.
baby’ breastmilk; how to express infant by the caretaker’ For babies over 3 months,
by hand, with a hand thoroughly wash and
Expressing breast pump or an electric breast rinse all equipment and
milk pump; storing expressed containers.’
breastmilk for use at home;
Provides details on safe
preparing to feed stored
storage/how long to store
expressed breast milk to an
infant; feeding expressed
breastmilk to an infant.

‘If it seems that the baby Extensive web-based -- -- Guidance on caring for
is refusing to breastfeed, consumer-facing guidance tender nipples and on
provide help and support to (as well as a contact link engorgement
the mother so that her baby for breastfeeding expert)
will feed again.’ on a large number of
potential problems or
‘The baby may appear
issues: breastfeeding
Breastfeeding to refuse to breastfeed
with C-section, baby with
problems if he/she is feeling sick,
one side preference, flat/
if sudden changes have
inverted nipples, sore
upset him/her, if he/
nipples, engorgement,
she is distracted or if he/
leaking breasts, mastitis,
she has decided to stop
relactation, tongue-tie, and
breastfeeding at around
others.
one year. Use expressed
milk for feeds’
‘The mother should keep Detailed consumer-facing ‘Frequent sucking by ‘If your baby is hungry after Provides guidance on
her baby close to her, guidance for initiating the baby and complete feeding from one breast, recognizing hunger cues,
with plenty of skin-to- breastfeeding, positioning emptying of breast are then offer the other breast. positioning, latching
skin contact to promote (various positions), and important for sustaining After feeding on both on, how to tell if baby is
breastfeeding’ attachment. adequate breast milk breasts, begin the next sucking well, breaking
output’ feed on the breast used suction
How to know when an
last.
infant wants to breastfeed; ‘The next time you
Breastfeeding breastfeed your baby, start
For professionals: Checklist
skills and ‘how-to’ with the breast on which he
to help mothers know if
finished the last time’
breastfeeding is going well
‘If feeding well, an infant

will suckle deeply; mothers
will hear some swallowing
and the feeding will not be
painful’

-- Description of normal Description of normal ‘Baby’s appetite, weight Principles of ‘supply and
number of wet diapers and number of wet diapers and gain and lots of wet demand’
number and color of bowel number and color of bowel nappies tell you how much
How to tell if the
movements for breastfed movements for breastfed milk your baby needs’
baby is getting
babies babies
enough Description of normal
bowel movements for
breastfed babies
Spouses, family members Educating and supporting ‘Ensure active family Limited – a list of who the ‘Getting help with
and friends should: women who choose support for breast-feeding’ mother can contact for breastfeeding:
to breastfeed – during help with breastfeeding or
Allow time and space for Everybody needs a bit of
antenatal care, in the formula feeding
the mother to breastfeed help sometimes. It can
maternity unit, and in
while at home by providing take time for you and
community care
a comfortable sitting area; your baby to get used to
and assisting with caring Describes legal rights breastfeeding. Don’t give
for and controlling older in the workplace for up. It can sometimes take
children. breastfeeding mothers up to 6 weeks…
Support for the
breastfeeding Provide emotional and Both professional and Health professionals
mother physical support for the consumer-facing guidance have a lot of experience
mother to exclusively address practical ways helping women and their
breastfeed by helping partner and family babies breastfeed. They
with household chores, members can help understand what you’re
assisting the mother in going through.
Groups the mother can
feeding the baby with
contact for help and You can get help, advice,
expressed breast milk
support tips, and support for
when she is away, and
breastfeeding from:
supporting her to eat
(provides a list)’
healthy meals.

-- Breastfeeding mothers -- -- --
should not be advised
to stop. Advise to avoid
drinking too much
tea, coffee, and other
caffeinated drinks
Colic
For formula-fed infants,
parents/carers should seek
advice of a healthcare
professional regarding use
of specialised formula
-- Consumer-facing: Breastfeeding by HIV+ -- Recognizing hunger cues.

Signs that baby is women
hungry; medication
while breastfeeding,
breastfeeding while
pregnant
Professional-facing:
Other Breastfeeding and

breastfeeding contraception;
topics
Situations in which
breastfeeding is not
advisable (medical
contraindications);
Checklist for healthcare

professionals regarding
what mothers should know
about breastfeeding

-- ‘Soya formula should only -- Guidance covers checking Guidance for professionals:
be used if your doctor has ‘use-by’ dates; give a
Recommends cow milk-
recommended them…. cow’s milk formula unless
based, commercial infant
Regular cow’s milk is not a health professional
formula. Soy-based infant
suitable for your baby until advises other; do not give
formula is indicated for
he or she is one year old’ cow’s milk or condensed or
galactosemia or for infants
evaporated milk
who cannot consume
dairy-based products
for cultural or religious
reasons.
Choice of infant ‘Recommend infant
formula formulas for special
medical purposes only
when …infant has the
indicated condition.
Discourage the use of

home-made, evaporated
milk formula. Cow milk,
goat milk, soy beverage,
rice beverage or any other
beverages should not be
given to young infants’

-- There is detailed guidance -- Detailed guidance on Not in the consumer-facing
on safe bottle feeding, both how to prepare infant guides. Guidance for
consumer-facing and in the formula including hygiene professionals covers:
‘best practices’ guide for practices, advice to sterilize
Use of banked human milk
professional. and use boiled water to
as well as:
make up powder for first 3
Guidance for professionals
months; detailed guidance Detailed guidance on
covers:
on making up formula and proper preparation and
Safe use and
Equipment needed; using within 2 hours. safe
storage of infant
washing the equipment;
formula Also: ‘Babies should not Notes to warn caregivers of
sterilising the equipment;
be left lying with a bottle the risk of choking if infants
using the right water
to suck on because of the are left alone while feeding
to make up the feed;
risk of choking and ear and explain the dangers of
preparing the feed; storing
problems. Also, if they ‘propping’ a bottle
and transporting feeds; and
fall asleep with milk in
how to feed according to
their mouths, the milk can
appetite
damage their teeth’
Both breastfed and non- Breastfed: ‘talk to doctor -- ‘Babies who are breastfed
breastfed: 5μg (200 IU) of or nurse about vitamin D should get a vitamin
vitamin D3 daily supplements, especially D supplement of 10
Supplements
for dark-skinned breastfed micrograms (µg) or 400
babies’ international units (IU) each
day’
‘Express breastmilk that Not during 1st 6 months -- -- --

can be given to the baby,
Use of cup from a cup, when it is not
possible to be with the
baby’
a
For Ireland, except for consumer-facing guidance on infant formula, all guidance in this table comes from a ‘best practices’ guide for health professionals.

Table A6.6: Guidance for infants under 6 months of age: Chile, Colombia, and Panama
Sources: Chile: Professional-facing Guia de Alimentación del Niño(a) menor de 2 años / Guia de alimentación para la Adolescencia; Colombia: Colombia: Two
professional-facing documents: Guias Alimentarias Basadas en Alimentos para mujeres Gestantes, Madres en Período de Lactancia y Niños y Niñas menores de
dos años de Colombia. Documento Técnico; and Guias Alimentarias Basadas en Alimentos para mujeres Gestantes, Madres en Período de Lactancia y Niños y Niñas
menores de dos años de Colombia. Material Educativo; Panama: Professional-facing Documento Técnico de las Guías Alimentaria para los menores de 2 años de
Panama and consumer-facing: Guías Alimentaria para los menores de 2 años de Panama.
Topic Chile Colombia Panama

Early and frequent colostrum suction maintains Offer breast milk during the first hour of life and Early attachment is generated once the child
adequate glycemic levels in the newborn, in skin-to-skin contact, to promote breastfeeding receives breast milk in his first hour of birth,
prevents dehydration and exaggerated weight success. where he has the opportunity to receive his
loss, and also helps the infant to properly first milk or colostrum. It is the baby’s first
Feed your baby colostrum, it is the first milk, and
establish coordination between the functions of vaccine as it is richer in fat-soluble proteins
saves lives thanks to its high content of nutrients
suction, breathing and swallowing. and vitamins and some minerals, in addition to
Early initiation and defenses.
containing oligosaccharides, immunoglobulin
and/or giving Colostrum also provides important
A and lactoferrin. Colostrum occurs only within
colostrum immunological protection and facilitates
the first 4 days after birth. Its texture and
the reproduction of lactobacillus bifid in the
appearance is dense, yellowish and sticky and
intestinal lumen, promoting enterobacterial
it is important to guide the mother that this is
colonization by a protective flora.
normal and that she should give it to the baby
for its beneficial effects. It also acts as a laxative
and helps prevent jaundice.
Exclusive -- -- --
breastfeeding in
first few days
To ensure adequate production and flow of The practice of exclusive breastfeeding during --
Feeding on breast milk, it is necessary to breastfeed the the first six months must be on demand, that is,
demand and child both day and night, whenever baby wants, without schedules or restrictions, day and night,
feeding at night ‘on demand’, ‘unrestricted breastfeeding’ or every time the baby asks for it
‘breastfeeding driven by the infant’
In 2002, the World Health Assembly (WHO) To help the children to grow up healthy, --
Exclusive and UNICEF adopted the World Strategy for intelligent, safe and affectionate, support
breastfeeding in Infant and Young Child Feeding. This Strategy mothers to practice exclusive breastfeeding, as
first 6 months recommends exclusive breastfeeding as optimal the only food during the first six months of life.
infant feeding during the first 6 months of life.

In some situations, to continue feeding the infant In cases of temporary separation of the mom There are some situations that force the mother
with exclusive breastfeeding, milk extraction can and baby, you can extract, preserve, transport to have to express the milk. If the mother
be a very useful alternative. There are several and supply breast milk to your baby. decides to express breast milk, she must take
simple milk extraction techniques; the manual into account important aspects such as the
To express breast milk you can do so manually,
extraction technique is described. The duration hygiene of the place where she does it, how she
in a warm, hygienic and quiet environment.
Expressing extracted milk can be kept will depend on the is going to save the extracted milk and how they
breast milk mode of preservation; modes of preservation Collect the breast milk extracted in glass jars are going to give the baby milk. It is preferable
are described. with a plastic screw cap and refrigerate it for up to give the baby milk in cups, teaspoons or cups
to 12 hours or freeze it for up to 3 months and avoid using a bottle.
There is explanation and drawings of the manual

extraction of milk and of extraction with pumps.
-- -- The most frequent breastfeeding problems

are described, along with what to do (cracked
nipples, mastitis and blocked ducts)
Breastfeeding
problems They also describe three conditions for
not breastfeeding: Galactosemia, HIV, and
phenylketonuria
Mother and children must choose the most -- Ideally, the mother should have the baby in her
comfortable position. There are different lap, aligned with her face facing the mother’s
alternatives; it is very useful to use the nursing chest. Drawings show the steps to achieve a
cushion. A significant percentage of the good grip.
Breastfeeding problems related to breastfeeding are due to
The position taken by the mother should be such
skills and ‘how- poor technique, for this reason it is important to
that both the baby and she feel comfortable,
to’ support, educate and evaluate the breastfeeding
and that the baby can breastfeed in the amount
technique early.
he needs. Several positions are described
with text and drawings: Classic sitting, ‘sitting
watermelon’, ‘horse riding sitting’

Normal weight gain -- --
Average 6 diapers a day wet with clear urine.

How to tell if the Average 4 yellow and fluid stools daily; from day
baby is getting 5 of life there may be a gradual decrease in the
enough frequency of bowel movements.
At 1 month of life 1 per day is normal. It is also

normal to be more abundant over time
In the process of breastfeeding, the participation -- Some women have difficulty initiating
of the father is essential in supporting the breastfeeding successfully, especially when they
mother, strengthening attachment, helping lack about certainty its benefits and importance.
in other household chores or caring for other For this reason it is essential that the mother
children, and also caring for the child when baby receives close support and adequate counseling.
Support for the
is not breastfeeding.
breastfeeding During consultations during pregnancy, it is
mother important that the mother receive this type
of counseling in order to ensure exclusive
breastfeeding during the first six months of life
and the continuation of it until two years of age
or older.
Colic -- -- --
Photos with hunger signs divided into early Breastfeeding strengthens the emotional bond Description of the physiology of breastfeeding.
Other signs (Waking up, shaking, looking for the between the mother and her baby. Description of the benefits of BF for the
breastfeeding breast) intermediate signs (stretching, shaking, mother, for the child, for the family and for the
topics sucking hands) Late signs (Crying, intense environment
agitation, redness)
Under 5 months of age: With breastfeeding -- --

(BF): supplement with the starting formula the
Choice of infant minimum number of times needed, and support
formula breastfeeding to be able to abandon the formula
if possible Without BF: start formula according
to the requirements of the baby.

The preparation of the starter formula is -- --
indicated in each product package, although in
Safe use and general the desired contributions and energy
storage of infant density are achieved by diluting it between
formula 13% - 14% using the measure that each package
brings. Formula does not require the addition of
any ingredient or nutrient.
Supplements -- -- --
-- Provide the breast milk extracted using cup or --

Use of cup
glass

Infants 6-23 months of age
Table A6.7: Guidance for 6-23 months of age: Kenya, Ireland, India, New Zealand, and Canada
Sources: Kenya: Professional-facing National Guidelines for Healthy Diets and Physical Activity; Ireland: Consumer-facing Feeding your baby: Introducing Family
Meals, 2018 edition; India: Professional- and consumer-facing Dietary Guidelines for Indians – A Manual; New Zealand: Consumer-facing Eating for Healthy Babies
and Toddlers from Birth to Two Years, 2013; Canada: Web-based consumer-facing guidance: Infant nutrition (covers through 24 months)
Topic Kenya Ireland Indiaa New Zealand Canada

Age range 6-23 months 6-23 months 6-12 mo a
6-23 months 6-24 months,
differentiated as:
Some guidance Some guidance Some guidance
differentiated by: differentiated by: differentiated by: 6-12 months;
6 months; 7-8 months; 9-11 ‘About’ 6 months; 6-9 ‘Around’ 6 months; 7-8 12-24 months
months; 12-23 months months; 9-12 months; 12-23 months; 8-12 months; 12-23
months months
Continued -- Best practice guide for ‘Encourage breastfeeding Not covered; breast milk is ‘Continue to breastfeed
breastfeeding/ professionals: ‘From 6 till two years or more, if identified as a ‘best drink’ for up to two years or
duration of months to 2 years and possible’ from 12-23 months, but so is more, as long as both
breastfeeding beyond, breastfeeding whole cow’s milk; guidance you and your child want
should continue…’ on dairy indicates either to’
Guide for parents/caregivers:
‘Babies who are breastfed

can continue to be breastfed
while they are starting family
foods and up to 2 years of
age and beyond’

How to tell Provides a detailed -- ~ 6 months: Provides a --
when baby is description of developmental detailed description of
ready for foods signals for readiness for developmental signals for
other than first foods – these signals readiness for first foods
breast milk are ‘generally seen between 7-8 months: describes signs
4 and 6 months (17 and 26 baby is ready to move from
weeks) of age’ pureed to mashed foods and
finger foods
8-12 months describes
signs of readiness for more
textures, lumpy food, and
firmer finger food
12 months: signs of
readiness for family foods

Guidance on ‘Start at six months of age Be guided by infant Provides instructions ‘Offer solids when your baby ‘Start with foods that
starting foods with small amounts of food readiness. Some infants may on how to prepare is most relaxed and happy. contain iron and offer
other than and increase the quantity be ready before 6 months, amylase-rich food and Give the milk feed first (until them a few times each
breast milk as the child gets older, but no infant needs solid provides recipes for 4 8–9 months old) and offer day. Iron-rich foods
while maintaining frequent food before 4 months complementary food solids as a ‘top up’. include meats such
The transition
breastfeeding between mixtures as beef, lamb, game,
Provides detailed guidance Hold baby while you feed
Guidance on meals and at night. poultry, and fish. Meat
for introducing first foods, them or sit them in a baby
how to feed alternatives include
Gradually increase food including ‘equipment’, highchair. Use a small
eggs, tofu, and legumes
Guidance consistency and variety choosing the right moment teaspoon and put the food in
such as beans and
on making as the child grows older, (baby is alert, not too the middle of their tongue.
lentils. Iron-fortified
complementary adapting to his/her hungry, caregiver is not Throw out any uneaten food
infant cereal is also a
foods requirements and abilities’ rushed, no distractions, etc.). left on baby’s plate.
common first food.
Provides guidance on Offer breastmilk or formula Try one new food every 2–4
Gradually increase the
additions to enrich before first solids days
number of times a day
complementary foods; see
‘Introduce each food on Remove the skins and seeds that you offer solid
also guidance on textures
its own for 2 days before from fruit and vegetables foods’
introducing another food’ before you cook or purée
Example menus provides
them
‘Use breastmilk, formula for ages 7, 11, and
milk or water to moisten Use expressed breast milk 17 months, and for a
their food to the correct or formula to make the food 17-month vegetarian
consistency’ runny enough for your baby child
to swallow
Offer a wide variety of foods
Provides meal ideas for 8-12
Recipes provided
months and 12-23 months

Adding milk to From 6 months, ‘Infants should be From 6 months, First foods (from 6
complementary food 1st recommended first introduced to different recommended foods months) can include:
mentioned at 7-8 months and foods include: Cereals, vegetables and fruits include: Cereals, meat,
Beef, lamb, game,
fluid milk from 12 months meat, poultry, fish, fruit, gradually. poultry, fish, legumes, fruit,
poultry, fish, eggs, tofu,
vegetables (see below re: vegetables (see below re:
In families which can afford legumes, and iron-
textures) textures)
egg yolk and meat soup can fortified infant cereal
Age of 6-9 months: As above be introduced. At about one 7-8 months, as above plus
If you are making the
introduction of plus eggs, bread, rice, year of age, the child should egg, soft cheese, custard
transition to cow milk as
various foods pasteurized cheese, yogurt, share the family diet’ and plain yogurt
your child’s main milk
and cow’s milk in small
Milk is indicated beginning source, wait until your
amounts to moisten food
at 6-12 months (Annex 4) baby is between 9 and 12
9-12 months: most months old
homemade family foods
From 12 months: whole

cow’s milk as a beverage
Breastfed: Start with pureed foods Feed complementary food ‘Three small meals a day 12-24 months: ‘Establish
offered with one milkfeed, on demand 3-4 times a day and small healthy snacks a schedule of regular
6 months – feed
and progress to 2-3 meals between meals’ meals and snacks for
complementary food 2 times/
and 2-3 snacks/day your child’
day
7-8 months – 3 times
9-11 months – 4 times: 3

meals and one snack
Recommended
number of meals 12-23 months – 5 times: 3
and snacks meals and 2 snacks
Non-breastfed:
At 6-8 months, feed 1 extra

meal, and add one snack
depending on appetite.
From 9 months, provide 1-2

extra meals and 2 snacks
depending on the appetite’

6 months: ‘Start with 2 About 6 months: Start with See below per food group When starting, at around 6 ‘Pay attention to your
TBLSP at each feed and 1 teaspoon and build up to months: baby’s hunger cues.
increase to 3 TBSP in the 3rd 6 tsp at a time. Progress to Trust your child to decide
‘Try ½–2 teaspoons first
to 4th week’ 5-10 teaspoons per meal how much they are going
and gradually increase the
to eat at any meal’
7-8 months: ‘Increase amount 6-9 months: 2-4 tablespoons amount until baby is having
gradually to half (½) a 250 ml per meal about 3–4 teaspoons at a
cup’ meal’
9-12 months: 4-6
Recommended 9-11 months: Give half (½) a tablespoons per meal General guidance:
portion sizes or 250 ml cup dailyb of family
From 12 months: ‘All babies are different.
total quantity food’
Watch for signs of being
‘Give them a portion suitable
12-23 months: Give ¾ to 1 full – some babies turn their
for their age and appetite
cup of 250 ml’ heads away. As your baby
Give smaller portions to becomes more active, you
begin with then let them ask will need to offer small
for more if they are hungry amounts of food often’
Use smaller plates and

cutlery’

6 months: ‘thick enough not About 6 months: ‘Puréed For ‘young infants’ a ‘semi- Around 6 months: Infant Not discussed; example
to run off the spoon’ foods, starts with quite solid consistency’ cereals, baby rice, and menus for different ages
thin (‘runny’) consistency, pureed foods specify textures
7-8 months: ‘Mashed/pureed
gradually getting thicker
family foods, by 8 months 7-8 months: Continue
as your baby gets used to
the baby can begin eating to puree meat and fish;
taking foods from a spoon’
finger foods. Thicken food as can give mashed fruits,
the baby grows older’ 6-9 months: ‘Moves to vegetables, egg and
mashed foods… gradually legumes; finger food: very
9-11 months: ‘finely chopped
becoming lumpier in texture. soft fruit and vegetables,
family foods, finger foods
Guidance on Soft finger foods’ toast fingers, thin slices of
and sliced foods’
texture cheese
9-12 months: ‘Moves to
12-23 months: ‘Cut food into
minced and chopped family 8-12 months: Can add
small, soft pieces so that
foods. More textured finger minced meat and finely
the child can pick, chew and
foods’ chopped soft foods, and
swallow comfortably’
slightly firmer finger foods
‘By the time your baby is
(examples given)
1 year of age they should
be able to eat most meals 12-23 months: Most family
enjoyed by the rest of the foods (see below under
family’ choking risks)
-- Whole cow’s milk ‘Top milk’ Whole cow’s milk from 12-23 No skim or partly
Guidance on
months skimmed milk before 2
milk fat (%)
years
‘Snacks may be ripe banana, Many examples provided -- Examples: Fruits, Many examples in the
mango, boiled potato etc.’ vegetables, crackers with example menus
Healthy snacks
peanut butter, grated
cheese, yogurt
-- -- -- -- Limit to 750 mL of milk/

Poor appetite day to not affect intake
of other foods

-- ‘Your baby may refuse a new -- ‘If they don’t like the food the --
food. If they do, don’t force first time, wait a few days
them, offer another food that and try again with a smaller
they are familiar with and amount. It might take up to
wait 5-7 days before offering 15 tries!’
the refused food again.
If refusing vegetables:
Babies and young children
‘Don’t worry – it’s very
may need to be offered a
common, especially as
food up to 15 times before
toddlers get older. Keep
they will accept it’
trying to introduce a variety
‘Make sure they are not of vegetables over time.
filling up on extra milk, Try offering raw, grated
drinks or snacks too close to vegetables or pieces of soft
mealtimes. fruit as an alternative’
Picky eaters
Keep distractions to a
minimum; turn off the
television and eat family
meals with your child so that
they can learn from you.
If they refuse certain foods,

try again a few days later.
Do not offer sweet foods

such as yogurts instead of
savoury foods asthey will
soon learn that if they refuse
dinner they can still get
dessert.’

‘Interact with the child during ‘Encourage your baby to -- -- ‘Let them discover
meals to respond to his/her touch and play with their different textures and
cues about the amount of food’ experiment with feeding
food he/she wants’ themselves.
‘Baby led weaning is a way
6 months: ‘Do not force the of introducing solid food Give your baby foods
baby to eat’ ‘The baby needs by allowing your baby to they can eat using their
time to get used to new food’ choose what they eat and hands.’
to feed themselves from the
7-8 months: ‘Be patient and ‘Pay attention to your
very start’ while caregiver
actively encourage the baby baby’s hunger cues.
offers a varied and balanced
to eat’ Trust your child to decide
Role of parent/ diet’
how much they are going
caregiver and of 9-23 months: ‘Make
Food pouches do not teach to eat at any meal.’
child; responsive mealtimes a relaxed and
the same eating skills as
feeding happy time for the child Be a role model; try new
eating from a spoon or with
while encouraging and not and nutritious foods
fingers
forcing e.g. clap hands, make yourself.
funny faces and demonstrate ‘Don’t use foods, especially
opening the mouth wide, foods high in fat or sugar, as
saying encouraging words’ a reward or treat’
For 12+ months: ‘Don’t

pressure them to eat all the
food on their plate, allow
them to stop when they say
they are full’
-- ‘Never leave a baby or young -- -- Eat together as a family

child alone during feeding as often as you can
Eating as a family is
Family meals important as babies and
children learn by example.
This can encourage them to
have a wide and varied diet

‘Feed babies a variety of Ireland does not provide -- New Zealand does not By 12 months, your child
Food groups meals from at least four food guidance on number of provide guidance on number needs a variety of foods
groups in each meal’ portions or portion sizes of portions or portion sizes from the food groups in
Grains 6 months: Begin with staple per day or week. Age of 0.5 30 g portion per day or week. Age of Canada’s Food Guide:
foods, like porridge…. introduction of various food introduction of various food vegetables and fruits,
Roots and 0.5 100 g portion
groups is indicated above. groups is indicated above. whole grain foods, and
tubers 7-8 months: Include at least
protein foods
one food from: animal Example menus are provided Example menus are
Meat, poultry ‘1 portion of pulse may be Canada does not provide
source, staple, legumes and and include diverse food provided and include diverse
exchanged w/1 portion of guidance on number of
Fish seeds, vitamin A rich fruits groups. food groups.
meat’ portions or portion sizes
and vegetables (and milk for
non-breastfed) ‘In families which can afford per day or week. Age of
Eggs egg yolk and meat soup can introduction of various
9-11 months: Give a variety be introduced’ food groups is indicated
of foods, include milk, above.
Legumes 0.25 30 g portion
sorghum, millet, pigeon
-- Example menus are
peas, groundnuts, cowpeas
Nuts and seeds provided and include
and green grams, orange-
diverse food groups.
fleshed sweet potatoes (and
If not breastfed on demand, Breastfed: 200 ml milk You may choose to continue If not breastfeeding,
milk for non-breastfed)
a maximum of 1 pint of breastfeeding and/or offer offer 500 ml of whole
Non-breastfed: 400 ml milk
12-23 months: Include at whole cow’s milk a day up to 2 cups (500 ml) of milk/day. Limit to
Dairy least one food from: animal whole milk a day. The more maximum of 750 ml/day
Do not give low-fat or
source, staple, legumes and breast milk your toddler has,
skimmed milk
seeds, vitamin A rich fruit the less whole milk they
and vegetables. Give the need
Fruits child 2-3 cups (250ml) of milk See above for other food 1 100 g portion See above for other food See above for other food
groups groups groups
0.25 100 g portion green
leafy vegetables
0.25 100 g portion other
vegetables
‘Dietary fibre in green leafy
vegetables can… promote
Vegetables the bowel movements
leading to loose motions
in infants. Since GLVs
are rich in dietary fibre,
it is advisable to initially
feed only the juice of the
GLVs after cooking them
properly’ Review of National Food-based Dietary Guidelines and Associated Guidance 109
‘Vitamin A supplementation 5μg (200 IU) of vitamin D3 Non-breastfed infants Doctor may recommend ‘Continue to give your
at six months, and every six daily throughout the first fed animal milk (instead vitamin D supplements breastfed infant a
months thereafter, until the year of life of infant formula) should vitamin D supplement of
age of five’ receive supplements of iron 10 µg (400 IU)’
and vitamin C
Supplements Home fortification: ‘1 sachet
of micronutrient powders
to one meal every third day.
At least 10 sachets/month
and a total of 60 sachets in 6
months’
From 12 months, add small No emphasis; fortified -- Iron-fortified infant cereal Iron-fortified infant
Fortified foods amounts of iodized salt breakfast cereals are as a first food starting from cereal is a common first
and ingredients included in a table of calcium around 6 months food
sources

‘Give clean and safe water 6-12 months: Breastfed: 200 ml milk 6-12 months: Breast milk (or ‘If you are going to make
from a clean cup formula) and water fortified soy beverage
Breast milk on demand or Non-breastfed: 400 ml milk
your child’s main milk
Do not give tea or coffee or infant formula. Cooled boiled 1-2 years: Breast milk, whole
source, wait until they
drinks made with sugar’ water can be offered cow’s milk, and water
are 2 years of age. Rice
Breastfed: Formula: at 6-9 months, 3-4 6-18 months: Boil water from or nut beverages should
feeds about 600mls per day; tanks or bore holes not be used as your
6 months: ‘Give the child
from 9-12 months about child’s main milk source’
small sips of clean drinking Do not offer drinks
400ml per day
water’ containing natural or added If not breastfeeding,
Follow-on-milks are not sugar, such as fruit juice, offer 500 ml of whole
12-23 months: ‘Give the child
recommended cordial, fizzy drinks, or milk/day. Limit to
2-3 cups (250 ml) of milk’
flavoured milks maximum of 750 ml/day
Fruit juices are not
Non-breastfed:
recommended Never give babies and Limit fruit juice and do
At 6 months: 3-4 cups milk toddlers tea, coffee, alcohol, not offer sweetened
Beverages Do not give: Cow’s milk;
smart or energy drinks or beverages
6-8 months: 1-2 cups milk sheep’s milk or rice milk; tea
other adult drinks
or coffee, even decaffeinated If your child seems
From 9 months: 1-2 cups milk
varieties; fruit juice drinks or thirsty, offer water
(nb: this seems inconsistent
fizzy drinks; sports or energy
with advice for breastfed) Do not offer herbal teas,
drinks, or dilutable squashes
sports drinks or other
12-23 months: drinks with caffeine or
artificial sweeteners
Breastmilk on demand, or a
maximum of 1 pint of whole
cow’s milk a day
Infant formula is not

necessary
Do not give low-fat or

skimmed milk
Mentions cups even Introduce from 6 months; -- -- From 6-12 months: ‘Give
for younger infants, for after 12 months bottles your baby an open cup
expressed breastmilk. For should be stopped when offering fluids
Use of cup
infants 6 months and older other than breast milk. At
give water in a cup first, your baby will need
help with the cup’

-- ‘Don’t add salt or sugar to Since infants cannot ‘Don’t add salt, sugar, honey, --
Sugar your baby’s food’ consume bulky sweeteners, soy sauce,
complementary food, cream, butter or margarine
Don’t give honey or sugar
in sufficient quantities, to your baby’s food’
From 7 months, add small -- energy-rich foods like
amounts of oil to food fats and sugars should
be included in such
Fat preparations.
2 5 g portions of sugar/day
4 5 g portions of oil/day
‘Do not give meals that are ‘Don’t add salt or sugar to -- --
too spicy or salty’ your baby’s food. If making
Salt a family meal, remove their
From 12 months, add small
portion before adding salt’
amounts of iodized salt
-- ‘Don’t use stock cubes, -- -- Higher-fat, nutritious

gravy, packets or jars of foods are an important
sauce when making family source of energy for your
foods for your child’ child. Examples: breast
milk, whole cow’s milk
Do not give processed
cheese, avocado, nut
or cured meats (such as
butters, and some fish
sausages, ham, bacon)
such as salmon or trout
Foods high ‘Foods high in fat, sugar or
in sugar, salt, salt, such as biscuits, crisps,
and/or fat chocolate, sweets, ice-cream
or fizzy drinks should not be
a regular part of your child’s
daily diet at any age
‘Don’t use foods, especially

foods high in fat or sugar, as
a reward or treat’

Avoid feeding meals that Unpasteurized cheese -- ‘Babies should be at least 12 ‘Do not offer solid foods
contain bones or hard pieces months old before they eat that are hard, small and
Undercooked eggs
as they might choke the child honey’ round, or smooth and
Bran sticky’
Choking risks: Small hard
Liver foods; small round foods;
foods with skins or leaves
Whole or chopped nuts
that are difficult to chew;
Other foods compressible food that
to avoid can get stuck in children’s
throats; thick pastes; fibrous
or stringy foods (examples
given for each)
Avoid giving whole nuts and

large seeds until children are
at least 5 years old
‘Breastfeed the child more ‘Never starve the child -- --

during illness, in addition to
Feed energy-rich cereals-
meals
pulse diet with milk and
Provide extra food after mashed vegetables
illness – the equivalent of one
Feed small quantities at
extra meal per day’
frequent intervals
Feeding during Continue breast-feeding as

illness long as possible
Give plenty of fluids during

illness
Use oral rehydration

solution to prevent and
correct dehydration during
diarrhea episodes’

See guidance for 0-6 months ‘What should be done See guidance for 0-6 months See guidance for 0-6
for choice of formula and if breast-milk is not for choice of formula and months for choice of
safe use. adequate?’ safe use. In addition: formula and safe use.
‘If breast-feeding fails’: Feed ‘Use breast milk or formula

animal milk or commercial as the main drink until your
infant formula; milk should baby is 12 months old.
be boiled; at first, may be There is no need to change
diluted 1:1 with water; full to a follow-on formula at 6
Infant formula strength milk from 4 weeks months’
of age; 120-180 ml milk +
1 tsp sugar 6-8 times/day.
Follow label instructions
for formula; use sterile
cup, spoon, bottle and
nipple; avoid overfeeding
‘artificially-fed infants to
prevent obesity’
‘Do not give meals that are Advice on dealing with -- ‘Delaying the introduction of Introduce common
too spicy or salty’ constipation (fruits, solid food until your baby is food allergens one at
‘Separate the child’s bowl …
vegetables, fluids) ready for it and continuing a time
to breastfeed while you
to tell how much he/she has ‘You should not avoid certain
introduce solids – may help
eaten’ foods in your baby’s diet
prevent allergic reactions to
in an attempt to prevent
‘Complementary foods some foods’
allergy. There is no benefit to
should meet the basic criteria
Other feeding delaying the introduction of
of frequency, amount,
practices peanut’
texture (thickness), variety,
adequacy, active feeding and ‘There is now no need to
hygiene (FATVAH)’ avoid gluten when you are
introducing foods into your
Provide suggestions to add
baby’s diet’
to enrich complementary
foods (milk, oil, avocado,
peanut paste)
a The Indian Dietary Guidelines document has chapters on: 1) breastfeeding; 2) feeding home-based solids starting from 6 months; and 3) adequate feeding for children and adolescents in health and sickness. Exact age
groupings are not clear in the chapters; the age groupings shown here are from Annex 4 which provides portion sizes and number of portions by age. b For Kenya, advice on quantity for age 9-11 months may be a typo as it
indicates quantity per day but it is in a table column labeled quantity per meal. The quantity seems low for per day.

Table A6.8: Guidance for 6-23 months of age: Chile, Colombia, Panama
Sources: Chile: Professional-facing Guia de Alimentación del Niño(a) menor de 2 años / Guia de alimentación para la Adolescencia; Colombia: Colombia: Two
professional-facing documents: Guias Alimentarias Basadas en Alimentos para mujeres Gestantes, Madres en Período de Lactancia y Niños y Niñas menores de
dos años de Colombia. Documento Técnico; and Guias Alimentarias Basadas en Alimentos para mujeres Gestantes, Madres en Período de Lactancia y Niños y Niñas
menores de dos años de Colombia. Material Educativo; Panama: Professional-facing Documento Técnico de las Guías Alimentaria para los menores de 2 años de
Panama and consumer-facing: Guías Alimentaria para los menores de 2 años de Panama.

Age range 0-6 months 6-8 months 6-8 months
6-11 months 9-11 months 9-11 months
12-23 months 12-24 months 12-24 months
Continued breastfeeding / Breast milk remains the best at this age to Continue breastfeeding as many times as Continued BF is mentioned in each age
duration of breastfeeding supplement solid nutrition the boy or girl wants, after meals group
How to tell when baby is -- -- --

ready for foods other than
breast milk
Guidance on starting foods The incorporation of solid food should When you introduce a new food, offer When you are in this process of introducing
other than breast milk occur around 6 months in order to meet it several times until it is accepted and food…. breastfeeding should continue,
nutritional requirements and stimulate in different preparations to promote its but it does not mean that you first fill the
The transition
neurological and motor development. acceptance. child with milk and then offer food. It would
Guidance on how to feed be the other way around: first the child is
Complementary feeding includes solid or To promote the health and nutrition of
offered food with patience and dedication
Guidance on making semi-solid foods (porridge or purees), and children, offer a variety of fresh, natural
and, once it is over, he is breastfed.
complementary foods also liquid foods (water). foods prepared at home from six months of
age and continue breastfeeding for up to 2 Introduce one new food at a time and not
years or more several at a time, to give the child a chance
to try it calmly and accept or reject it. If he
rejects it, give it again another day until
he accept it. Keep in mind that this is an
adaptation process and to be patient.

Age of introduction of various From 6-12 months 6-8 months 6-8 months
foods
6 Months Offer one new food at a time along with one Cereals, fruits, vegetables, stews, meats, oil
already known. Insert a new one 2 to 4 days or butter (one teaspoon) should be offered
Daily: Green vegetables, colored
later according to the baby’s tolerance. as start-up foods
vegetables, fruits, cereals, tubers, oil
Cereals 9-11 months
3 times/week
Cereal products Add new foods such as macaroni, whole
Meat (Beef, chicken, pork)
egg.
Tubers
7 Months
12-24 months
Fruits
2 times a week
When the child turns one, he must enjoy
Vegetables
Fish, legumes healthy foods with the rest of the family
12-24 months
9-10 Months
Family food
1-2 times a week
Egg
1-2 years
Daily: Cereals, vegetables, fruits, semi-

skimmed milk, water
Twice a week: Meat of all kinds, fish and

seafood, legumes

Recommended number of -- 6-8 months Between 6 and 8 months, the child should
meals and snacks be given two main meals a day if breastfed,
2-3 meals / day, and according to appetite,
and 4 times if not breastfed.
1-2 snacks
At 9 to 11 months, 3 meals if breastfed and
The frequency of meals should be
4 if not breastfed; and after 12 months feed
progressive, until reaching three meals a
4 to 5 times a day.
day at 8 months.
9-11 months
Offer at least 3 meals a day and one or two

snacks according to your baby’s appetite.
12-24 months
3-4 meals / day, and according to appetite,

1-2 snacks
Recommended portion sizes At the beginning of complementary 6-8 months 6-8 months
or total quantity feeding, the porridge or mixed puree must
Start with 2-3 tablespoons per meal and Quantity: 1⁄2 cup or 5 tablespoons for each
be delivered in small quantities, and it can
gradually increase to 1/2 glass or 250 ml cup meal
be increased as feeding progresses and is
accepted, consuming at 8 months about 9-11 months 9-11 months
150 ml of porridge (3/4 cup), plus 100 ml (1/2
The amount of food per meal is half a cup (4 The amount increases to 3⁄4 cup or the
cup) of fruit; and at 9 months 200 ml (1 cup)
ounces) equivalent, 7 tablespoons per mealtime
of porridge and 100 ml (1/2 cup) of fruit at
each meal. These amounts are referential 12-24 months 12-24 months
and may vary on different occasions.
The amount of food per main meal is 1 cup 1 cup or 10 tablespoons for each meal
or plate (8 ounces)

Guidance on texture Porridge or soft puree is recommended, 6-8 months 6-8 months
without lumps, or pieces of fiber that
Offer very thick mashed foods, until As for consistency, it must be in the form of
stimulate the extrusion reflex. When the
chewing ability appears purees, porridge, mashed, shredded
upper incisors have erupted (8-9 months),
the porridge may have the consistency of 9-11 months 9-11 months
thicker mash and then ground with a fork,
Offer finely chopped, crushed foods that Include food in the form of small pieces
with timing related to the eruption of the
the baby can take by hand
first molars (around 12 months) 12-24 months
12-24 months
The consistency of the food should be
Offer the variety of solid foods, with some the same as the rest of the family, while
modified textures: chopped, ground, small preventing choking
pieces
Guidance on milk fat (%) Semi-skimmed milk (3%) Whole milk --
Healthy snacks -- -- Snacks should always be given to the

child in all age groups, offering fruits,
breastfeeding, or some cereal in small
quantities. They should not be given before
the meal, otherwise, the baby will not eat
the main meal
Poor appetite -- -- --
Picky eaters -- The presentation of the dish is important;

use colors that are appealing to the child
When you introduce a new food, offer
and adapted for their utensils. Try to make
it several times until it is accepted and
the food attractive to the eye
in different preparations to promote its
acceptance Practice with combinations of foods that
mask some flavors that you feel the child
doesn’t like
Encourage the child to eat with patience and

dedication without distractions that prevent
him from enjoying the moment

Role of parent/caregiver and It is recommended that children eat in a Pay attention to your baby’s hunger and Feed the child slowly; encourage him to eat
of child; responsive feeding pleasant and quiet environment, using satiety signals without forcing it.
tools that they identify as their own. It
Offer food slowly and patiently and ‘Perceptual feeding’ or responsive refers to
is not recommended that distractions
encourage the baby to eat principles of psychosocial care that should
appear during mealtimes, especially avoid
be used when feeding the child, focused on
television when offering meals. Signs of hunger in the child
active attention and stimulation during the
Respect if the child does not want more 6-8 months moments of infant feeding, which implies
food; observe if this is total rejection or if it a reciprocity between the child and his
Brings his head close to the spoon or tries
is repeated, to determine if the child is ill. caregiver, based in three aspects:
to bring food to his mouth. Points to the
Establishing a flexible eating routine makes food. • The child shows signs of hunger or satiety
it easy for the child to organize their social through motor actions, facial expressions or
9-11 months
interaction patterns without anxiety. vocalizations
Reaches for the food
• The caregiver recognizes the signals and
Expresses desire for specific food with responds quickly to the signal warmly and
words or sounds. Points to the food. appropriately to the stage of the child’s
development
He gets excited when he sees food.
• The child experiences a response given by
12-24 months
the caregiver
Combines phrases with gestures; for
example, says ‘I want that’ and points to
food
Takes parents to the kitchen and points out

the food or drink he wants
Family meals Children must adapt to family customs and -- From one year, children should share the
progressively the child must join the family family table and eat the same foods that
meals the rest of the family consumes, both in the
type of food, the amount, frequency and
consistency required at this stage
Food groups

Grains Include cereals from 6 months of age, Cereals: 6-8 months: ½ cup daily
including those that contain gluten (wheat,
Rice, corn, wheat, barley, oats, rye, 9-11 months: ½ cup daily
oats, rye and barley), even in children with a
prepared at home.
first-degree family history of celiac disease. 12-24 months: ½ cup daily
It is not clear whether the introduction of Cereal products: pasta, bread, toast
gluten in the period between 4 months
and 6 months prevents or delays the onset
of celiac disease in a susceptible general
population or in infants with a family
history.
Roots and tubers -- Potato, yucca, yam, green banana. --
Meat, poultry According to availability, and preferably Include a portion of animal foods such as 6-8 months: 1 oz. chopped 2-4 times/week
low-fat meat, beef or chicken meats, offal, eggs and fresh cheeses daily
9-11 months: 2 oz. chopped 2-4 times/week
at meals
12-24 months: 1 oz. chopped 2-4 times/week
Red and white meats, offal, chicken, pork,
fresh fish and smaller species such as
rabbit, and guinea pig
Fish Fish can be incorporated between 6-7 -- 6-8 months: 1 oz chopped once/week
months. It is recommended to give at least
9-11 months: 2 oz chopped once/week
2 times per week, giving preference for fatty
fish (salmon, sardine) for its high content of 12-24 months: 1 oz. chopped 2-4 times/week
DHA, which helps in the child’s neuromotor
development
Eggs Egg can be introduced between 9-10 6-8 months: 1 unit yolk only, 3 times/week
months; give 1 or 2 times/week in place of
Eggs 9-11 months: 1 unit yolk only, 3 times/week
meat
12-24 months: 1 unit daily
Legumes Introduce legumes stewed with cereals Beans, chickpeas, lentils, dried peas 6-8 months: 1/3 cup 3 times/week
between 7-8 months (ground, until about 12
9-11 months: 1/3 cup 3 times/week
months); a portion of them replaces mashed
vegetables with meat. 12-24 months: 1/3 cup 3 times/week
Consumption is recommended twice a

week.

Nuts and seeds -- -- --
Dairy Semi-skimmed milk (3%) Cow’s milk or other mammals 6-8 months: Breast milk on demand
Curd and fresh cheeses without added salt. 9-11 months: Breast milk on demand
Yogurt and kumis made from whole milk 12-24 months: Breast milk on demand
Fruits All kind of fruits Fresh fruits such as papaya, guava, apple, 6-8 months: 2 portions daily
mango, tangerine, orange, granadilla, etc.
For dessert, fruit puree, raw or cooked, with 9-11 months: 2 portions daily
no added sugar or honey is recommended Offer your children fruits taking advantage
12-24 months: 2 portions daily
of those that are in season
Vegetables Green Vegetables (spinach, broccoli, celery, 6-8 months: ½ cup daily
zucchini, others)
Spinach, broccoli, cauliflower, carrot, etc. 9-11 months: ½ cup daily
Colored vegetables (carrots, mushrooms,
Offer your children vegetables taking 12-24 months: ½ cup daily
eggplant)
advantage of those that are in season
Supplements Supplementation with iron (Fe) 1 mg/kg/day -- Iron supplementation in children under
is justified in exclusively breastfed infants 24 months is suggested as a preventive
from 4 months to one year strategy for anemia
Fortified foods and It is not justified in infants fed fortified -- Consumption of fortified foods such as
ingredients formulas wheat flour fortified with iron

Beverages Since the child receives solid food, water -- Water is the best option to quench your
can be offered (boiled only in the case of child’s thirst. Young children need about
not having potable water), without the 2 cups of to meet their fluid needs. Once
addition of sugar, honey, or any other your baby starts eating solid foods, it is
natural or artificial flavoring or sweetener. recommended to offer a total of 4-8 ounces
per day of drinking water in a cup. This will
20-50 ml can be given 2-3 times a day, in
help the baby become familiar with the
addition to milk.
taste and acquire a taste for simple water.
Powdered beverages, juices or nectars Do not add sugar or honey to the water for
with sugar, soft drinks and in general any the child to accept it.
sugary drinks or artificial sweeteners are
It is not recommended to offer processed
not recommended or necessary. If the child
fruit juices or sugary drinks before the first
refuses to drink water, it is not advisable
year of life, such as sodas, sugary drinks
to modify its flavor by adding any type
from powdered mixtures, flavored drinks,
of flavoring; the right thing is to continue
sports drinks, commercial juices and
offering only water so that child can acquire
nectars.
the habit.
Use of cup -- The baby must have his own spoon, glass Children should have their own utensils
and plate. such as plate, glass and teaspoon from the
beginning of the introduction of food

Sugar It is not recommended to add sugars to Do not add sugar or honey in children´s Excessive consumption of calories from
the preparations. Artificial sweeteners food and preparations. Do not offer candy. free sugars contributes to weight gain and
(saccharin, aspartame, sucralose, stevia presence of cavities and reduces appetite in
or other) should not be used in food for children less than 2 years.
children under 2 years old, directly or in
Intake of free sugars should be reduced
preparations or commercial products (‘light’
throughout life. Children under 2 years
or ‘diet’ or other similar)
of age do not require the consumption of
free sugars to cover their caloric needs,
but it could be added after the first year. It
is not recommended to add more than 3
teaspoons (15 grams) of added sugar, which
represents 60 calories, contributing 8% of
total daily calories, and which can come
from white or brown sugar, honey, or sugar
that was added to some preparation.
Fat At the time of serving it is recommended to Vegetable oil and butter can be used 6-8 months: 1 teaspoon daily
add to the porridge or mixed puree 2.5-3.0
Do not include trans- fats found in packaged 9-11 months: 1 teaspoon daily
ml of raw vegetable oil, preferably canola
products, margarine and cookies
or soy 12-24 months: 2 teaspoons daily
Salt It is not recommended to add salt to food Do not add salt, condiments to food A high consumption of salt and sodium
prepared for the child prepared for the child since childhood increases the risk of
suffering from high blood pressure,
coronary heart disease and stroke in
adulthood. It is estimated that the sodium
requirement of children under 6 months is
0.12 g/day. From 7 to 12 months they require
0.37 g/day and from 1 to 3 years, 1 g/day

Foods high in sugar, salt, and/ It is not advisable to include in the children’s Do not offer processed products such as In several sections of the guides we talk
or fat diet foods that are not beneficial for health, sugary drinks, and sausages, among others about the harmful effect of the consumption
for example, those foods with high energy of salt, sugar and highly processed
Do not offer your child canned milk,
content or calories, salt/sodium, sugars products.
commercial compotes, baby box cereals,
or saturated fats, such as sweets, sugary
packaged products, cold meats, fast foods
breakfast cereals, chocolates, candies, ice
and sugary drinks
cream, cookies, cakes, juices and fancy
drinks, sweet or savory snacks and in
general those foods labeled “HIGH IN”
sodium, sugars, saturated fats or calories.
These foods are inadequate for infants,
they contribute to generating bad habits
from very young ages, they deteriorate
the quality of the diet, they can lead to the
rejection of meals and they contribute to
developing malnutrition due to excess,
lack of micronutrients, development of
noncommunicable diseases, and dental
caries, among others.
Other foods to avoid -- -- --
Feeding during illness -- -- When the child is sick:
Give more liquid and more breast milk for

rehydration.
Give more soft foods than usual. Choose

baby’s favorites. The amount he eats is
likely to decrease, so the frequency should
increase. This way he will have more energy
to recover quickly.
Encourage the child to eat with dedication

and patience. Understand that he feels bad
and wants to eat little.

Infant formula If the child has already started formula, --
you can use formula diluted generally
between 14-15%, using the measures
included with each package, or if you
do not have these formulas, use LPF
diluted to 7.5%, adding 5% cereal without
adding sugar. These recommendations
may require modifications by the health
team, depending on the child’s nutritional
condition.
The use of continuation formulas after 6

months of life is not required according to
scientific evidence. Starting formula can be
used throughout the first year, when you
have to supplement or replace breast milk.
Other feeding practices -- The food of their territories contributes to --

the growth and development of children
and strengthens their cultural identity as
Colombians

Young children 2-4 years of age/toddlers/preschoolers
Table A6.9: Guidance for 2-4 years/toddlers/preschoolers: Kenya, Ireland, Spain, India and New Zealand
Sources: Kenya: Professional-facing National Guidelines for Healthy Diets and Physical Activity; Ireland: Web-based consumer-facing guidance at: https://www.
safefood.eu/Healthy-Eating/Food-Diet/Life-Stages/Toddlers.aspx; Spain: Nutricion Saludable de la Infancia y la Adolescencia. La Alimentacion de tus Niños y Niñas; India:
Professional- and consumer-facing Dietary Guidelines for Indians – A Manual; New Zealand: Consumer-facing Eating for Healthy Children Aged 2 to 12.
Topic Kenya Ireland Spain India New Zealand

Age range 24-59 months Guidance for ‘toddlers’; age 3-6 years Guidance for children and Guidance covers children
range is not defined. Some adolescents is combined. ages 2-12 years. Some
guidance is specifically Some statements are guidance is divided by age
for undertwos, but other specific to ‘young children’ (underfives and 5-12 years
statements refer to older under five years of age. of age)
children up to five years of
age
Recommended 2-4 meals and 1-2 healthy ‘If your toddler can’t ‘Address energy needs’ as ‘Snacks provide a useful 3 meals and 2-3 snacks or
number of snacks; small frequent manage set ‘meals’, then it is a period of growth and contribution’ ‘mini-meals’; do provide
meals and meals offer a number of nutritious development breakfast
snacks snacks throughout the day
Initiate the habit of Don’t encourage
instead.’ Advises to get
breakfast ‘continuous eating or
the toddler in the habit of
grazing’
having breakfast each day. Have breakfast, lunch,
afternoon snack (‘merienda
cena’) and dinner
Avoid ‘pecking’ and abuse

of snacks
Recommended 1½-2 bowls of 250ml of food -- -- ‘Discourage overeating ‘Smaller serving sizes than
portion sizes or per meal as well as indiscriminate an adult’s’; detailed per food
total quantity dieting’; see portion sizes in group
food groups below.
Encourage to stop eating
when they feel full

Guidance on -- Semi-skimmed milk is OK Unless medically -- At 2 years, can gradually
milk fat (%) after 2nd birthday, but not prescribed, there is no need introduce reduced fat and
nonfat (skim) milk to give skim/non-fat milk low-fat dairy
Healthy snacks Give nutritious snacks ‘such Fruit and milk, but don’t let -- -- Numerous suggestions
as ripe banana, mango, children fill up on fruit or provided
boiled egg, sweet potatoes milk between meals as it
or milk’ will affect appetite
Poor appetite -- Only mention is as above -- Only mention is that Advises that children who
under snacks appetite may be low during drink too much milk (more
illness than 500 ml/day) may not
eat enough food
Picky eaters -- Notes it is normal for -- -- Notes it is normal to need to

children to refuse specific offer new foods many times
foods or all foods from time before they are accepted;
to time; gives reasons why
Advises that children who
they may refuse
drink too much milk (more
Parent/caregiver may need than 500 ml/day) may not
to offer a food 8-10 times eat enough food;
before it is accepted
Let the child control how
Advises to reduce much food they eat
distractions (e.g. television)
Make mealtimes fun rather
during meals
than a battle
Avoid giving snacks or
drinks just before meals
Provides specific and

detailed suggestions for
when child refuses meat,
milk, or vegetables

Role of parent/ ‘Encourage but do not force -- Educate to ‘eat everything’ ‘Take extra care’ in feeding Be a positive role model
caregiver and the child to eat’ young children under five
Spend the necessary time ‘Provide a wide variety of
of child
for the child to learn to eat healthy foods for children to
while enjoying choose from’
Food should not be Encourage to try new foods

perceived by them as a prize
Encourage to stop eating
Do not use food to solve when they feel full
problems that have nothing
‘Don’t use rewards or force
to do with it, such as
or push a child to eat’
boredom, tensions, anxiety
crisis, etc.
Be a good role model in

your own practices
Family meals ‘Make meal times a relaxed -- As far as possible, share -- ‘Make mealtimes fun…
and happy time for the child’ meals. Meals should be
Have meals together as
pleasant and convey correct
a family (when possible)
eating habits and manners
and turn off the TV and
cellphones.
Have meals at times that

suit children – this may
mean having meals earlier
than you are used to.’
Food skills -- -- Enjoy shopping and -- ‘Take children food

preparing food together shopping and encourage
with children them to choose healthy
foods’
‘Make preparing food fun

– involve children from an
early age’

Food groups No specific guidance on Ensure a varied diet, with Example serving sizes of
servings or amounts per greatest possible diversity different items provided for
food group. There is a link of foods each group
to the food guide pyramid
Need for animal-source
as illustration of a ‘healthy
foods (meat, fish, eggs,
balanced diet’ but this has
dairy) is proportionally
portions and portion sizes
larger than for adults
for ages 5 years and up, not
for toddlers
Grains Include staple foods; not Daily (bread) 1-3 yrs: 2 30 g portions/day At least 4 servings/day;
clear if for each meal, or include whole grain types
Combine legumes, rice and 4-6 yrs: 4 30 g portions/day
every day
pasta throughout the week
Roots and Moderation, especially of 1-3 yrs: 50 g portion/day --

tubers French fries
4-6 yrs: 100 g portion/day
Meat, poultry Include animal source food; Alternate meat and Pulses ‘may be exchanged’
not clear if for each meal, or processed meat, fatty and with 1 50 g portion of egg/
Fish At least one serving/day
every day lean fish and eggs meat/chicken/fish
Eggs
Encourage consumption of
fish
No more than 4-5 eggs/ Vegetarian children: at least

week 1-2 servings/day of legumes,
nuts or seeds
Legumes Include legumes and seeds; Encourage consumption 1 30 g portion/day
not clear if for each meal, or
Combine legumes, rice and
every day
Increase the nutrient density
Nuts and seeds -- --
of foods by adding oilseeds
(e.g. groundnuts, soybeans)
Dairy 2-3 cups of milk a day Daily – at least 500 ml of ‘Plenty of milk and milk 2-3 servings/day; 250 ml
milk. Can substitute yogurt products’; milk is one serving
or cheese
5 100 g portions/day

Fruits Include vitamin A-rich fruits Fruits, vegetables and salad 1 100 g portion/day At least 2 servings/day
and vegetables; not clear if daily
Vegetables Green leafy vegetables: At least 2 servings/day
for each meal, or every day
‘5 a day’ for fruits and
50 g portion/day
vegetables
Other vegetables:
Supplements Vitamin A supplements -- -- -- --

every 6 months
Fortified foods GPG: Choose fortified maize -- -- GPG: Always use iron If child does not drink cow’s
meal and wheat flour fortified iodized salt (double milk, can give soy milk with
fortified salt) added calcium and vitamin
GPG: Use fortified oil
B12
Dietary Guidelines (p.
18) states guidance is
complementary to separate
guidelines on use of
multiple micronutrient
powders for home
fortification
Beverages ‘Plenty’ of clean water Water and milk are most At least 500 ml milk/day Give plenty of milk – 5 100 Lots of small drinks through
‘tooth-friendly’. ml portions/day the day; they may forget to
2-3 cups of milk a day Water is the best drink.
drink
100% juice is a healthy Meals should always be
‘Give children under five
choice but only give with accompanied by water Water is best
years of age plain, full
meals and dilute it 10:1 with
cream milk whenever Sodas and soft drinks – only Milk is good and can be
water
possible’ occasionally served after meals or with
‘Fizzy drinks, sugary snacks
squashes, tea and coffee are
‘Give less’ juice; dilute juice
not suitable’
with equal amount of water
and give only with meals
Soft drinks only

occasionally (< one a wk)
Do not give: tea, coffee,

energy drinks, energy shots
Sugar Don’t add sugar or honey to Avoid excessive fat, sugar 3-4 5 g portions of sugar. --
foods and salt
Young children below the
age of 5 years should be
given less bulky foods, rich
in energy and protein such
as legumes, pulses, nuts,
edible oil/ghee, sugar, milk
and eggs.
Fat If no fatty foods in the meal, -- Fats are necessary but avoid See above; also: --
put a little fat or oil in the overly high fat intake e.g.
5 5 g portions of fat/oil
meal to add energy and help from fatty cheeses, butter
absorb vitamin A and flavored margarines, or Avoid ‘overindulgence’ in
from fat contained in pates, fats.
spreads, sandwich bread
and various buns
Salt Use iodized salt for family -- Avoid excessive fat, sugar Avoid excessive salt intake --
meals sparingly and salt
Foods high Avoid sugary foods and -- Sweets should be taken in GPG: Guideline 14: Limit fruit juice and dried
in sugar, salt, sweets moderation. Avoid ‘abuse’ ‘Minimize the use of fruit
and/or fat of sweets, ‘goodies’ and processed foods rich in salt,
Provides a long and diverse
soft drinks sugar and fats’; this section
list of foods high in sugar,
has detailed description of
salt and fat – children
foods to limit
should eat these only
occasionally (less than once
a week)
Limit processed meats
Limit ‘takeaways’ to
occasionally
Other foods to -- Raw eggs, whole or -- -- Do not give small hard

avoid chopped nuts (choking foods, such as whole nuts
hazard), certain fish and large seeds (choking)
(mercury content)

Feeding during -- -- -- ‘Never starve the child. --
illness
Feed energy-rich cereals-
pulse diet with milk and
mashed vegetables.
Feed small quantities at

frequent intervals.
Continue breast-feeding as
long as possible.
Give plenty of fluids during

illness.
Use oral rehydration

solution to prevent and
correct dehydration during
diarrhea episodes.’

Table A6.10: Guidance for 2-4 years/toddlers/preschoolers: Canada and Chile
Sources: Canada: Web-based consumer-facing guidance for parents of children at: https://food-guide.canada.
ca/en/tips-for-healthy-eating/parents-and-children/; Chile: Professional-facing: Guia de Alimentación del Niño(a)
menor de 2 años/ Guia de alimentación para la Adolescencia.
Topic Canada Chile

Age range The Canadian Dietary Guidelines cover The Chilean Dietary Guidelines cover ages 2
ages 2 and above. Additional guidance and above. Except for portions, the guidance
summarized here is for parents of children of is the same from 2-18 years. Guidance on
any age – young children through teenagers. portions in this table is for children 2-5 years.
Recommended Offer small meals and snacks at regular 4 or 5 – breakfast, lunch, afternoon snack and
number of times throughout the day dinner, and possibly another light ‘collation’
meals and
snacks
Recommended The new Canadian Food Guide web Portions sizes are indicated per food group
portion sizes or application does not appear to include below
total quantity recommended servings or serving sizes;
may be forthcoming.
Guidance on -- GPG: Eat low-fat dairy products

milk fat (%)
Healthy snacks -- Fruits, vegetables, dairy products. Avoid

foods that have the warning message:
“HIGH IN” CALORIES, SUGARS, SODIUM
AND SATURATED FATS, such as soft drinks,
sugary nectars and juices, sweets, cocktail
foods, sweet and savory pastry and snack
products.
Poor appetite -- Variation in appetite are normal and can have

many causes
Picky eaters ‘Children are more likely to accept a new This is covered in a detailed section on
food the more often they are exposed to it. development of eating habits and behavior.
An unfamiliar food can be offered again later Recommendations include including a
if it is rejected the first time. variety of flavors in meals, introducing new
foods gradually, in small quantities, and with
You can help overcome picky eating by:
patience and persistence, and introduce
- making routines together with familiar foods. Introduce by
showing the child that the mother, father, or
- offering foods more than once
older siblings enjoy the food. They also note
- planning your meals and snacks that flavor exposure begins in utero, and
continues during breastfeeding
- involving your kids in meal preparation’

Topic Canada Chile
Role of parent/ Lead by example: ‘Prepare and eat healthy This is covered in detail the same section
caregiver and of foods…Enjoy a variety of healthy foods’ and there is an Annex on feeding styles.
child
‘Let your children decide how much food Suggestions include:
they want to eat’
Offer praise for good behaviors but do not
highlight or punish bad behaviors
Do not use food as a reward and do not use

food to calm a child who is hurt or upset
Do not force a child to finish food, child

should stop when satiated
Offer portions and textures that are

appropriate for the child’s age
Family meals Encourages family meals as often as Create a positive, pleasant environment and
possible model respectful behavior
Make time so meals are not rushed Eating alone or in front of the television,
computer, or other distraction can lead to
Serve family-style (food is put into larger
overeating
bowls or serving dishes on the table):
children choose which foods to eat and how
much
Put away toys and screens during mealtime

Topic Canada Chile
Food skills ‘Teach your kids about making healthy food --
choices.
Plan out your meals and snacks with your

kids to have the healthy foods they like in the
home.
Get your kids cooking. Support them,

regardless of age, by helping them with
simple food-related tasks.’
Food groups The new Canadian Food Guide web

application does not appear to include
Grains recommended servings or serving sizes; 1 (girls) to 1.5 (boys) units bread daily
may be forthcoming.
1 small plate of cereals, noodles or potatoes
4-5 times per week
Roots and
tubers
Meat, poultry 1 small unit 2 times/week
Fish 1 small unit 2 times/week
GPG: Recommends baked or grilled fish
Eggs 2-3 per week
Legumes 1 small plate 2 times/week
GPG: Don’t mix with cold or cured meats
Nuts and seeds --
Dairy 3 cups/day - dairy without sugar (milk, yogurt

or cheese)
Fruits Fruits – two/day
Vegetables - 2 plates/day
Vegetables GPG: Eat fresh vegetables and fruits of

different colors five times a day
Supplements -- --
Fortified foods -- --

Topic Canada Chile
Beverages ‘Replace sugary drinks with water’ 1.2-1.5 quarts/day, including fluid in milk,
soup and other liquids
GPG: To stay hydrated, drink 6–8 glasses of

water a day
Sugar -- GPG: Avoid eating sugar
Fat -- --
Salt -- GPG: Eat foods with little salt and take the
salt shaker away from the table
Foods high in Limit the amount of highly processed foods GPG: If you want to maintain a healthy
sugar, salt, and/ you offer (many examples provided) weight, avoid eating sugar, sweets, sugar-
or fat sweetened juices and beverages
Prepare meals and snacks with little to no
added sodium, sugars, or saturated fat GPG: Take good care of your heart by
avoiding fried foods, and fatty foods like cold
and cured meats and mayonnaise
GPG: Read and compare food labels and

choose products with less fat, sugar and salt
(sodium)
Other foods to -- --
avoid
Feeding during -- --
illness

School-aged children
Table A6.11: Guidance for school-aged children: Kenya, Ireland, Spain, India and New Zealand
Sources: Kenya: Professional-facing National Guidelines for Healthy Diets and Physical Activity; Ireland: Professional-facing Healthy Eating, Food Safety, and Food
Legislation – A Guide Supporting the Healthy Ireland Food Pyramid, and web-based consumer-facing guidance at: https://www.safefood.eu/Healthy-Eating/Food-Diet/
Life-Stages/School-children.aspx; Spain: Nutricion Saludable de la Infancia y la Adolescencia. La Alimentacion de tus Niños y Niñas; India: Professional- and consumer-
facing Dietary Guidelines for Indians – A Manual; New Zealand: Consumer-facing Eating for Healthy Children Aged 2 to 12.

Age range 5 to 9 years Noted that the 7-12 years Guidance for children and Guidance covers children ages 2-12
messages in the adolescents is combined. Some years. Some guidance is divided by
Noted that at
guidelines are statements are specific to age (underfives and 5-12 years of age)
this age, the key
intended for adults ‘young children’ under five years
messages in the
and children over of age.
general population
5 years of age.
guidelines also
Guidance (e.g.
apply
servings) is provided
for children 5-12
years of age
Recommended Give child a healthy Offer children a ‘Address energy needs’ as ‘Snacks provide a useful 3 meals and 2-3 snacks or ‘mini-
number of breakfast variety of nutritious it is a period of growth and contribution’ meals’; do provide breakfast
meals and snacks throughout development
Don’t encourage ‘continuous eating or
snacks the day
Have breakfast, lunch, grazing’
cena’) and dinner
Avoid ‘pecking’ and abuse of

snacks

Recommended Allow child to Importance of -- ‘Discourage overeating as well ‘Smaller serving sizes than an adult’s’;
portion sizes or choose his/her appropriate portion as indiscriminate dieting’; see detailed per food group
total quantity own portion size sizes – ‘As a rule of portion sizes in food groups
Encourage to stop eating when they
from preferred thumb, a 5-year old below.
feel full
foods, ‘provided should eat about
they are adequate, half the amount
wholesome and that an adult does.
nutritious’ Many adults eat
larger portions than
they need also. Try
giving everyone
smaller portions on
their plates…. Using
smaller plates, for
children and adults,
can help.’
GPG: Portion sizes

for meat, poultry,
fish, and cheese are
related to finger and
palm size.
Healthy snacks GPG: ‘Eat fresh Provides a long list -- -- Numerous suggestions provided
fruits and raw of healthy snack
vegetables as options
snacks instead of
sugary snacks’
Poor appetite -- -- -- Only mention is that appetite Advises that children who drink too
may be low during illness much milk (more than 500 ml/day)
may not eat enough food

Picky eaters -- -- -- -- Notes it is normal to need to offer
new foods many times before they are
accepted;
Advises that children who drink too

much milk (more than 500 ml/day)
may not eat enough food;
Let the child control how much food

they eat
Make mealtimes fun rather than a

battle
Role of parent/ -- ‘Children are better Food should not be -- Be a positive role model
caregiver and at making changes perceived by them as a prize
‘Provide a wide variety of healthy
of child when the whole
Do not use food to solve foods for children to choose from’
family do it together.’
problems that have nothing
Encourage to try new foods
to do with it, such as
boredom, tensions, anxiety Encourage to stop eating when they
crisis, etc. feel full
Be a good role model in your ‘Don’t use rewards or force or push a

own practices child to eat’
Family meals -- -- As far as possible, share -- ‘Make mealtimes fun…

meals. Meals should be
Have meals together as a family
pleasant and convey correct
(when possible) and turn off the TV
eating habits and manners
and cellphones.
Have meals at times that suit children

– this may mean having meals earlier
than you are used to.’
Food skills -- Links to a webpage Enjoy shopping and -- ‘Take children food shopping and
on growing preparing food together with encourage them to choose healthy
vegetables with children foods’
children
‘Make preparing food fun – involve
children from an early age’

Food groups Nutrient-dense Ensure a varied diet, with Number of portions for some Example serving sizes of different
foods from at least greatest possible diversity food groups differs by age and items provided for each group
4 food groups every of foods sex for: 4-6 yrs, 7-9 yrs, 10-12
day year old girls and 10-12 year old
boys
Grains GPG: ‘Include whole Girls: 3-4 servings/ Daily (bread) 4-10 30 g portions, depending on At least 5 servings/day; include whole
or unprocessed day age and sex grain types
starchy foods as
Boys: 3-5 servings/ pasta throughout the week
part of meals’
day
Roots and Moderation, especially of 1 100 g portion --
tubers GPG: Whole grain or French fries
whole meal are best.
Eat with each meal.
Meat, poultry GPG: ‘Eat lean meat, 2 servings Alternate meat and 1-2 30 portions pulses,
fish and seafood, processed meat, fatty and depending on age
Fish GPG: Eat oily fish up At least one serving/day
poultry, insects or lean fish and eggs
to twice a week May be exchanged with egg/
Eggs eggs at least twice a
Encourage consumption of meat/chicken/fish (50 g per
week.’
fish portion)
No more than 4-5 eggs/week Vegetarian children: at least 2

servings/day of legumes, nuts or
seeds
Legumes GPG: At least 4 Encourage consumption
times a week
Dairy GPG: ‘Drink fresh 5-8 yrs: 3 servings/ Daily – at least 500 ml of 5 100 ml portions 2-3 servings/day; 250 ml milk is one
milk, fermented day milk. Can substitute yogurt serving
milk or yoghurt or cheese
9-12 yrs: 5 servings/
every day’
day

Fruits GPG: ‘Eat plenty 5-7 servings/day Fruits, vegetables and salad 1 100 g portion At least 2 servings/day
of green leafy daily
Vegetables GPG: Base your Green leafy vegetables: 0.5 to 1 At least 3 servings/day
vegetables, red and
meals on these and ‘5 a day’ for fruits and 100 g portion, depending on age
yellow vegetables
enjoy a variety of vegetables
and fruits every Other vegetables: 1-2 100 g
colors. More is better
day; and include portions, depending on age
a variety of other
vegetables and
fruits’
Supplements -- -- -- -- --
Fortified foods GPG: Use iodised -- -- GPG: Always use iron fortified If child does not drink cow’s milk, can
salt, but use it iodized salt (double fortified salt) give soy milk with added calcium and
sparingly vitamin B12
GPG: Use fortified

oil
Beverages Child should drink Plenty of fluids At least 500 ml milk/day Give plenty of milk – 5 100 ml Lots of small drinks through the day;
‘plenty of fluids regularly throughout portions/day they may forget to drink
Water is the best drink.
especially water and the day. On average
Meals should always be Water is best
milk’ about 8 glasses a day
accompanied by water
Milk is good and can be served after
Limit intake of Water and milk are
Sodas and soft drinks – only meals or with snacks
sugary drinks such the most ‘tooth-
occasionally
as ‘sweetened/ friendly’ ‘Give less’ juice; dilute juice with equal
coloured water/ amount of water and give only with
Avoid sweetened
juice’ meals
fruit juices and juice
GPG: Drink fresh drinks Soft drinks only occasionally (< one a
milk, fermented wk)
Unsweetened fruit
milk or yoghurt
juice – drink with Do not give: tea, coffee, energy drinks,
every day. Use low-
meals, not between, energy shots
fat or skim milk
and for ‘younger
GPG: Limit the children’ dilute 1:10
consumption of with water
sweetened foods
and drinks.

Sugar GPG: If you use -- Avoid excessive fat, sugar 4-6 5 g portions, depending on --
sugar, use it and salt age
sparingly
Fat GPG: Use oil or GPG: Always cook Fats are necessary but avoid 5-7 5 g portions, depending on --
fat in moderation with as little fat or overly high fat intake e.g. age
in meals; limit the oil as possible – from fatty cheeses, butter
Avoid ‘overindulgence’ in fats.
amount of solid fat. grilling, oven-baking, and flavored margarines, or
Use fortified oil. steaming, boiling or from fat contained in pates,
Many suggestions stir-frying spreads, sandwich bread
for reducing fat and various buns
intake are provided.
Salt GPG: Use iodised -- Avoid excessive fat, sugar Avoid excessive salt intake --
salt, but use it and salt
sparingly
GPG: ‘Use
condiments and
processed foods
sparingly like ready
meals, processed
meats like bacon,
ham and salami,
cheese and salty
snacks. Reduce the
use of seasoning
cubes as they also
contain salt’

Foods high Limit intake of GPG: Limit processed Avoid sweets, soda, fatty GPG: Guideline 14: ‘Minimize the Limit fruit juice and dried fruit
in sugar, salt, sugary and salty salty meats such as cheese and spreads, and use of processed foods rich in
Provides a long and diverse list
and/or fat snacks ‘such as sausages, bacon and very salty foods salt, sugar and fats’; this section
of foods high in sugar, salt and
potato crisps, cakes, ham has detailed description of foods
fat – children should eat these only
biscuits’ to limit
GPG: Foods high in occasionally (less than once a week)
GPG: Limit the fat, sugar and salt:
consumption of not every day, once
sweetened foods or twice a week at Limit ‘takeaways’ to occasionally
and drinks. most. Examples
listed.
Feeding during -- -- -- Same guidance as for younger --

illness children (Table A6.9)

Table A6.12: Guidance for school-aged children: Canada, Bolivia, and Chile
Sources: Canada: Web-based consumer-facing guidance for parents of children at: https://food-guide.canada.
ca/en/tips-for-healthy-eating/parents-and-children/; Bolivia: Professional-facing Guia Alimentaria para el niño y
la niña en edad escolar; Chile: Professional-facing: Guia de Alimentación del Niño(a) menor de 2 años/ Guia
de alimentación para la Adolescencia.
Topic Canada Bolivia Chile

Age range The Canadian Dietary The Bolivian Dietary The Chilean Dietary
Guidelines cover ages 2 and Guidelines cover ages 2 and Guidelines cover ages 2 and
above. Additional guidance above. There is a separate above. Except for portions,
summarized here is for document for school-aged the guidance is the same
parents of children of any children 6-10 year of age. from 2-18 years. Guidance on
age – young children through Guidance on portions is portions in this table is for
teenagers separate for 6-7 and 8-10 children 6-10 years
years
Recommended Offer small meals and snacks Breakfast, lunch, dinner plus 4 or 5 – breakfast, lunch,
number of at regular times throughout a morning snack and an afternoon snack and dinner,
meals and the day afternoon snack and possibly another light
snacks ‘collation’
Recommended The new Canadian Food Portion sizes were indicated Portions sizes are indicated
portion Guide web application per food group but there per food group below
sizes or total does not appear to include were some inconsistencies
quantity recommended servings in the document, so they are
or serving sizes; may be not shown here.
forthcoming.
Healthy snacks -- -- Recommendations for

healthy school snacks:
Prefer natural foods such as:

natural fruits, nuts, among
others, avoiding added salt
and sugar
Consume only one snack

per school day. Eat small
portions, since they should
only be a complement to the
main food
Always accompany the snack

with water
Poor appetite -- -- Variation in appetite are

normal and can have many
causes

Picky eaters ‘Children are more likely to -- This is covered in a detailed
accept a new food the more section on development of
often they are exposed to eating habits and behavior.
it. An unfamiliar food can The nature of the guidance
be offered again later if it is is most relevant for toddlers
rejected the first time. and preschoolers (see tables
above for those age groups)
You can help overcome picky
eating by:
- making routines
- offering foods more than

once
- planning your meals and

snacks
- involving your kids in meal

preparation’
Role of parent/ Lead by example: ‘Prepare -- This is covered in detail the

caregiver and and eat healthy foods…Enjoy same section and there is an
of child a variety of healthy foods’ Annex on feeding styles.
‘Let your children decide how Suggestions include:

much food they want to eat’
Offer praise for good
behaviors but do not
highlight or punish bad
behaviors
Do not use food as a reward

and do not use food to calm
a child who is hurt or upset
Do not force a child to finish

food, child should stop when
satiated
Offer portions that are

appropriate for the child’s
age
Family meals Encourages family meals as -- Create a positive, pleasant

often as possible environment and model
respectful behavior
Make time so meals are not
rushed Eating alone or in front of
the television, computer, or
Serve family-style (food
other distraction can lead to
is put into larger bowls or
overeating
serving dishes on the table):
children choose which foods
to eat and how much
Put away toys and screens

during mealtime

Food skills ‘Teach your kids about -- --
making healthy food choices.
Plan out your meals and

snacks with your kids to have
the healthy foods they like in
the home.
Get your kids cooking.

Support them, regardless of
age, by helping them with
simple food-related tasks.’
Food groups The new Canadian Food GPG: Consume a varied diet
Guide web application daily, including foods from
does not appear to include all groups, and increasing
recommended servings the quantity of vegetables
or serving sizes; may be and fruits
forthcoming.
Grains 3 portions/day 1.5 (girls) to 2 (boys) units
bread daily
Roots and 2 portions/day
tubers 1 small plate of cereals,
noodles or potatoes 4-5
times per week
Meat, poultry 1 portion/day 1 small unit 2 times/week
GPG: Consume animal

source foods which are
source of iron (meats and
offal) at least 3 times per
week
Fish -- 1 small unit 2 times/week
GPG: Recommends baked or

grilled fish
Eggs -- 2-3 per week
Legumes -- 1 small plate 2 times/week
GPG: Don’t mix with cold or

cured meats
Nuts and seeds --
Dairy 2 portions/day 3 cups/day - dairy without

sugar (milk, yogurt or
GPG: Increase the
cheese)
consumption of milk and
dairy products
Fruits 2 portions/day Fruits – 3 units/day
Vegetables 2 portions/day Vegetables - 2 plates/day
GPG: Eat fresh vegetables

and fruits of different colours
five times a day
Fortified foods -- GPG: Always use iodized salt --

in foods, with moderation

Beverages ‘Replace sugary drinks with Avoid coffee and tea because 1.5-2.0 quarts, including
water’ they inhibit iron absorption fluid in milk, soup and other
liquids
GPG: Drink 6-8 glasses of
water daily to complement GPG: Avoid sugar-sweetened
meals juices and beverages
GPG: Reduce the

consumption of tea and
coffee, replacing them with
milk, fruit juices or “apis”
Sugar -- GPG: Avoid the over GPG: Avoid eating sugar

consumption of sugar
Fat -- GPG: Prefer vegetable oils --

and avoid animal source fats
and reheated oils
Salt -- GPG: Always use iodized salt GPG: Eat foods with little salt
in foods, with moderation and take the salt shaker away
from the table
Foods high Limit the amount of highly GPG: Avoid the over GPG: If you want to maintain
in sugar, salt, processed foods you offer consumption of sugar, a healthy weight, avoid
and/or fat (many examples provided) sweets, and sodas eating sugar, sweets, sugar-
sweetened juices and
Prepare meals and snacks
beverages
with little to no added
sodium, sugars, or saturated GPG: Take good care of your
fat heart by avoiding fried foods,
and fatty foods like cold and
cured meats and mayonnaise
GPG: Read and compare

food labels and choose
products with less fat, sugar
and salt (sodium)
Feeding during -- --
illness

Adolescents
Table A6.13 Guidance for adolescents: Kenya, Ireland, Spain, India and New Zealand
Sources: Kenya: Professional-facing National Guidelines for Healthy Diets and Physical Activity; Ireland: Professional-facing Healthy Eating, Food Safety, and Food
Legislation – A Guide Supporting the Healthy Ireland Food Pyramid, and web-based consumer-facing guidance at: https://www.safefood.eu/Healthy-Eating/Food-
Diet/Life-Stages/Teens.aspx; Spain: Nutricion Saludable de la Infancia y la Adolescencia. La Alimentacion de tus Niños y Niñas; India: Professional- and consumer-
facing Dietary Guidelines for Indians – A Manual; New Zealand: Consumer-facing Healthy Eating for Young People.

Age range 10 to 19 years Noted that the messages 13-16 years Guidance for children and 13-18 years
in the general guidelines adolescents is combined.
Noted that at this age, the Consumer-facing guidance
are intended for adults and Guidance in this Table is the
key messages in the general is directed to the adolescent
children over 5 years of age. same as for children (above)
population guidelines also
Guidance (e.g. servings) is except for portions, shown
apply
provided for teenagers 13-18 here for ages 13-18.
years of age. There is also
consumer-facing guidance
directed to teenagers
Recommended Three meals and 2 snacks -- ‘Address energy needs’ as ‘Snacks provide a useful Three meals plus 2-3 snacks
number of it is a period of growth and contribution’ ‘if you are hungry’
‘Help adolescent to have a
meals and development
healthy breakfast’ Always take time to eat a
snacks
Have breakfast, lunch, healthy breakfast
cena’) and dinner
Avoid ‘pecking’ and abuse

of snacks
Recommended Portion sizes are in an GPG: Portion sizes for meat, -- ‘Discourage overeating Guidance on food groups
portion sizes or Annex poultry, fish, and cheese are as well as indiscriminate includes examples of
total quantity related to finger and palm dieting’; see portion sizes in portions sizes for each
size. food groups below. group

Healthy snacks Create ‘family lists’ of Encourages fruits and -- -- Many examples provided
healthy snack ideas vegetables for snacking and
provides examples
Remind adolescent to pack
a healthy snack and water
for after school activities
GPG: ‘Eat fresh fruits and

raw vegetables as snacks
instead of sugary snacks’
Role of parent/ Kenya provides extensive -- For adults: -- For the teen:
caregiver and suggestions for those caring
Be a good role model in Lead by example –
family and the for adolescents (see also
your own practices encourage your family and
adolescent snacks, family meals, food
whānau and friends to make
skills, nutrient-focused Supervise the adolescent’s
healthy food choices.
guidance): diet to ensure they are not
eating usual or ‘absurd’
‘Limit eating in rooms of the
food combinations or very
house other than the kitchen
monotonous diets to lose
and dining room’
weight – this can result in
‘Create ‘family lists’ of deficiencies and anorexia
healthy breakfast, snack and
Encourage adolescent to be
packed lunch ideas’
active
‘Watch for signs of an eating
Avoid letting food issues
disorder’ (many ‘signs’
create conflicts and
described) If concerned seek
interfere with relationship
professional help
with the adolescent
‘There should be a
Teach the adolescent about
positive role model for the
nutrition and its impact on
adolescent’ who…. ‘eats
health, ‘aesthetics’, and
and enjoys a well-balanced
well-being
diet, tries new foods, uses
polite table manners, and
practices healthy eating
habits’

Family meals ‘Have family meals and keep -- As far as possible, share -- As often as you can, eat
mealtimes pleasant; turn off meals. Meals should be meals with your family and
TV, talk to each other, model pleasant and convey correct whānau (extended family)
polite table manners’ eating habits and manners
Food skills ‘Encourage adolescent to -- Enjoy shopping and -- Suggests the teenager can
make his/her own meals and preparing food together help with preparing the
snacks and to plan family with children family meals
meals’
Provides suggestions for
‘Teach adolescents about eating when ‘out and about’,
food production’ including on healthier
choices for takeaways
Nutrient- Eat several servings of ‘Look after your bones’ – Provides examples of good Guideline 5 on diets for --
focused dairy products, green provides teenagers with food sources of all nutrients children and adolescents
guidance leafy vegetables and other information on calcium and and fiber emphasizes calcium
calcium-rich foods and vitamin D, calcium sources needs and provides a set
beverages… (dairy and non-dairy) and of key points related to
strategies for increasing this, including describing
For girls, eat iron rich foods’
dairy consumption. calcium sources
For parent/caregiver: Encourages ‘skimmed and
semi-skimmed’ dairy.
‘Keep plenty of calcium-rich
foods and beverages on ‘Eat plenty of iron’ –
hand’ (dairy and non-dairy describes best iron sources
examples provided) (including fortified foods)
and gives suggestions for
‘Encourage iron-rich foods’
meals and snacks with iron-
(many examples provided)
rich foods. Indicates girls
needs are higher, and gives
information /examples of
enhancers (vitamin C-rich
foods) and inhibitors (tea
and coffee); advises no tea/
coffee within 30 minutes of
meals

Food groups ‘Eat a variety of foods from Number of servings for Ensure a varied diet, with Number of portions for Eat a variety of foods from
at least four food groups. grains/roots/tubers varies greatest possible diversity some food groups differs these groups every day:
by both sex and activity of foods by age and sex for: 13-15 vegetables and fruit; breads
level (‘active’ or ‘inactive’) yrs girls/boys and 16-18 yrs and cereals; milk and milk
girls/boys products; lean meats,
chicken, seafood, eggs,
legumes, nuts and seeds.
Grains GPG: ‘Include whole or Girls: 3-4 servings/day Daily (bread) 11-15 30 g portions, At least 6 servings daily
unprocessed starchy foods depending on age and sex
Boys: 4-7 servings/day Combine legumes, rice and
as part of meals’
GPG: Whole grain or whole
Roots and meal are best. Eat with each Moderation, especially of 1-2 100 g portions, --
tubers meal. French fries depending on age and sex
Meat, poultry GPG: ‘Eat lean meat, fish 2 servings Alternate meat and 2-3 30 g portions pulses, At least 2 servings daily
and seafood, poultry, processed meat, fatty and depending on age of lean meats, chicken,
Fish GPG: Eat oily fish up to
insects or eggs at least lean fish and eggs seafood, eggs, legumes and
twice a week May be exchanged with
Eggs twice a week.’ nuts
Encourage consumption of egg/meat/chicken/fish
fish Vegetarians need at least 3
servings of legumes, nuts
No more than 4-5 eggs/
or seeds
week
Legumes GPG: At least 4 times a week Encourage consumption

Dairy GPG: ‘Drink fresh milk, 5 servings/day Daily – at least 500 ml of 5 100 ml portions At least 3 servings daily
fermented milk or yoghurt milk. Can substitute yogurt
Choose low-fat options
every day’ or cheese

Fruits GPG: ‘Eat plenty of green 5-7 servings/day Fruits, vegetables and salad 1 100 g portion At least 2 servings of fruit
leafy vegetables, red and daily daily
Vegetables GPG: Base your meals on Green leafy vegetables: 1
yellow vegetables and fruits
these and enjoy a variety of ‘5 a day’ for fruits and 100 g portion Dried fruit and fruit juices
every day; and include a
colors. More is better vegetables are not recommended
variety of other vegetables Other vegetables: 2 100 g
and fruits’ portions At least 3 servings of
vegetables daily
Eat a wide variety of fruits

and vegetables
For vegetarians -- Identifies nutrients that may -- No guidance specific Provides guidance on
be lacking, and plant food to adolescents. For all choosing foods to meet
sources of these (except for vegetarians, emphasizes the their iron, calcium and B12
vitamin B12). importance of dairy for B12 requirements
If drinking soymilk, ‘read the

labels and go for a brand
that is fortified with calcium’
Supplements -- -- Only if a doctor advises -- --
Fortified foods GPG: Use iodised salt, but -- -- GPG: Always use iron For vegetarians: If you drink
use it sparingly fortified iodized salt (double soy milk, choose one that
fortified salt) has added calcium and
GPG: Use fortified oil
vitamin B12

Beverages GPG: Drink fresh milk, 6-8 glasses of fluids At least 500 ml milk/day Give plenty of milk – 5 100 6-8 glasses of water a day
fermented milk or yoghurt ml portions/day and more in hot weather or
Water and milk are the best Water is the best drink.
every day. Use low-fat or when very active
choices Meals should always be
skim milk
accompanied by water Water is best
Drink extra before and after
GPG: Limit the consumption
sports Sodas and soft drinks – only Low-fat milk is also a good
of sweetened foods and
occasionally choice
drinks. GPG on drinks:
No alcohol Drink less of: fruit drinks
Limit fruit juices and
and fruit juice; soft drinks
smoothies (no more than 1
should be less than once a
a day)
week
‘Be wary of’ juice drinks
Coffee and tea, no more
Provides information on than 1-2 cups daily, and
‘fizzy drinks’, sports drinks don’t drink with meals
and energy drinks and
Not recommended: energy
implies are not great, but
drinks or energy shots;
does not explicitly state to
alcohol
‘limit’
Sugar GPG: If you use sugar, use it -- Avoid excessive fat, sugar 4-6 5 g portions, depending --
sparingly and salt on age
Fat GPG: Use oil or fat in GPG: Always cook with as Fats are necessary but avoid 7-10 5 g portions fat/oil, --
moderation in meals; limit little fat or oil as possible overly high fat intake e.g. depending on age
the amount of solid fat. – grilling, oven-baking, from fatty cheeses, butter
Avoid ‘overindulgence’ in
Use fortified oil. Many steaming, boiling or stir- and flavored margarines, or
fats
suggestions for reducing fat frying from fat contained in pates,
intake are provided. spreads, sandwich bread
and various buns

Salt GPG: Use iodised salt, but -- Avoid excessive fat, sugar Avoid excessive salt intake --
use it sparingly and salt
GPG: ‘Use condiments and

processed foods sparingly
like ready meals, processed
meats like bacon, ham and
salami, cheese and salty
snacks. Reduce the use of
seasoning cubes as they
also contain salt’
Foods high ‘Avoid sticky, sugar-rich GPG: Limit processed salty Consumption of sweets and GPG: Guideline 14: Dried fruit and fruit juices
in sugar, salt, and salty snacks that are meats such as sausages, snacks should be moderate ‘Minimize the use of are not recommended
and/or fat high in fat’ bacon and ham processed foods rich in salt, because of sugar content
sugar and fats’; this section
GPG: Limit the consumption GPG: Foods high in fat, Otherwise, messages are
has detailed description of
of sweetened foods and sugar and salt: not every positive vs. restrictive,
foods to limit
drinks. day, once or twice a week at i.e. providing guidance on
most. Examples listed. many healthy snack options
and healthier options when
eating outside the home
Feeding during -- -- Same guidance as for --

illness children (Table A6.9)
Advice on Monitor excesses to avoid --

weight overweight and obesity
See also above under role of

caregiver/family

Table A6.13: Guidance for adolescents: Canada, Bolivia, and Chile
Sources: Canada: Web-based consumer-facing guidance for parents of adolescents at: https://food-guide.
canada.ca/en/tips-for-healthy-eating/parents-and-children/, and teen-facing guidance at: https://food-guide.
canada.ca/en/tips-for-healthy-eating/teens/; Bolivia: Professional-facing Guia Alimentaria para el niño y la
niña en edad escolar; Chile: Professional-facing: Guia Alimentaria para los y las Adolescentes.

Age range The Canadian Dietary Guidelines The Bolivian Dietary The Chilean Dietary
cover ages 2 and above. This Guidelines cover ages Guidelines cover ages 2 and
is augmented by web-based 2 and above. There is a above. Except for guidance
consumer-facing guidance directed separate document for on portions, the guidance is
at the teenager ‘Healthy eating for school-aged adolescents the same from 2-18 years.
teens’ – age range not specified 11-18 year of age. Guidance on portions in
Guidance on portions this table is for adolescents
is separate for girls 11-18 years
and boys and for light,
medium and heavy
activity levels
Recommended Emphasizes importance of Eat 4 to 6 times a day 4 or 5 – breakfast, lunch,

number of breakfast: ‘If you often skip (for example, breakfast, afternoon snack and dinner,
meals and breakfast, think of the reasons morning snack, lunch, and possibly another light
snacks why and plan ways to overcome afternoon snack or light ‘collation’
these. Try preparing your breakfast meal, and dinner). The
the night before. Do you have an 6th would be for very
activity early in the morning? Think active adolescents,
about bringing breakfast with you.’ like high-performance
athletes. It is important
not to skip meals or
replace them with
snacks.
Special emphasis is
placed on not skipping
breakfast
Recommended The new Canadian Food Guide Portion sizes are Portions sizes are indicated
portion web application does not appear to indicated per food group per food group below
sizes or total include recommended servings or
quantity serving sizes; may be forthcoming.
Healthy snacks Advises the teenager to plan ahead Examples of healthy Recommendations for
for healthy snacks; bring them snacks are provided healthy school snacks:
along to school and elsewhere
Prefer natural foods such
This can ‘can help you choose as: natural fruits, nuts,
healthier options and save money’ among others, avoiding
added salt and sugar
Suggests fruits and vegetables as
healthy snacks Consume only one snack
per school day. Eat small
portions, since they should
only be a complement to
the main food
Always accompany the

snack with water

Role of parent/ ‘Be a champion -- This is covered in a detailed
caregiver and section on development
Talk to your parents about healthy
family and the of eating habits and
eating. You can encourage them to
adolescent behavior. The nature of the
take sugary drinks and other highly
guidance is most relevant
processed foods off your family’s
for younger children (see
grocery list.
tables above)
…. suggest ideas for healthy meals
your whole family will enjoy
…. You can also talk to your

friends, coaches, teachers
Think about:
How you can make the healthy

choice the easy choice at school
and in your community
How you can use healthy foods

to celebrate at class parties or
sporting events
Joining the student council to

ensure there are healthy choices
available for everyone’
GPG: Be mindful of your eating

habits: Take time to eat; notice
when you are hungry and when
you are full
GPG: Enjoy your food: Culture and

food traditions can be a part of
healthy eating
GPG: Be aware that food marketing

can influence your choices

Family meals ‘Eating meals with others is an -- Create a positive, pleasant
important part of healthy eating. environment and model
respectful behavior
The meals you eat with your family
can give you a chance to connect Eating alone or in front of
with your family. the television, computer, or
other distraction can lead to
This can help you:
overeating
Develop healthy habits
Learn about culture and food

traditions
Build and strengthen family

relationships
Turn off the TV and put away your

phone, lap-top or other screens.
When you are distracted while
you eat, you can lose track of how
much you have eaten
Food skills ‘Learn new skills. Try helping with: -- --
Grocery shopping
Preparing meals and snacks
Being responsible for certain

meals
Meal planning and creating a

grocery list
Nutrient- -- -- --
focused
guidance

Food groups GPG: Make it a habit to eat a GPG: Consume a varied
variety of healthy foods each day diet daily, including
foods from all groups,
GPG: Eat plenty of vegetables
and increasing the
and fruits, whole grain foods and
quantity of vegetables
protein foods. Choose protein
and fruits
foods that come from plants more
often. Portions vary by gender
and activity; the range is
shown
The new Canadian Food Guide
Grains 4-7 40-50 g portions/day 2 (girls) to 2.5 (boys) units
web application does not appear to
bread daily
Roots and include recommended servings or 2-4 100 g portions/day
tubers serving sizes; may be forthcoming. 1 medium plate (girls) to
2 plates (boys) of cereals,
noodles or potatoes 4-5
times per week
Meat, poultry 2-4 80-100 g portions/day 1 medium unit 2 times/

week
GPG: Consume animal
source foods which are
source of iron (meats
and offal) at least 3 times
per week
Fish -- 1 medium unit 2 times/

week
GPG: Recommends baked

or grilled fish
Eggs -- 2-3 per week
Legumes 1 portion/day 1 plate 2 times/week
GPG: Don’t mix with cold or

cured meats
Nuts and -- --
seeds
Dairy 3-4 200 ml portions/day 3 cups/day - dairy without

sugar (milk, yogurt or
GPG: Increase the
cheese)
consumption of milk and
dairy products
Fruits Fruits – 3-4 100 g Fruits – 3 units/day

portions/day
Vegetables Vegetables - 2 plates/day
Vegetables – 4-5 50-100 g
GPG: Eat fresh vegetables
portions/day
and fruits of different
Emphasizes the colours five times a day
importance of fruits and
vegetables as sources of
fiber
For -- -- --
vegetarians

Fortified foods -- GPG: Always use iodized --
salt in foods, with
moderation
Beverages ‘Make water your drink of choice. Avoid alcohol 1.5-2.0 quarts, including
Carry a reusable water bottle so fluid in milk, soup and other
GPG: Drink 6-8 glasses
you always have water with you’ liquids
of water daily to
complement meals GPG: Avoid sugar-
sweetened juices and
GPG: Reduce the
beverages
consumption of tea and
coffee, replacing them
with milk, fruit juices or
“apis”
Sugar -- 3-4 10 g portions GPG: Avoid eating sugar
GPG: Avoid the over

consumption of sugar
Fat GPG: Choose foods with healthy 4-6.5 10 ml portions --

fats instead of saturated fat
GPG: Prefer vegetable
oils and avoid animal
source fats and reheated
oils
Salt -- GPG: Always use iodized GPG: Eat foods with little
salt in foods, with salt and take the salt shaker
moderation away from the table
Foods high ‘Choose foods that have little to no GPG: Avoid the over GPG: If you want to
in sugar, salt, added sodium, sugars or saturated consumption of sugar, maintain a healthy weight,
and/or fat fat. sweets, and sodas avoid eating sugar, sweets,
sugar-sweetened juices and
Compare the nutrition facts table
beverages
on foods to choose products that
are lower in sodium, sugars or GPG: Take good care of
saturated fat.’ your heart by avoiding fried
foods, and fatty foods like
GPG: Limit highly processed
cold and cured meats and
foods. If you choose these foods,
mayonnaise
eat them less often and in small
amounts. GPG: Read and compare
food labels and choose
products with less fat,
sugar and salt (sodium)
Feeding during -- -- --
illness
Advice on ‘Working on building healthy Maintain a healthy 2 of the guidelines for the
weight eating habits and focusing on weight – exercise and general population apply:
your overall health can be more avoid extremes of intake/
To maintain a healthy
important than focusing on your extreme weight-loss
weight, eat healthily and be
body weight’ diets.
physically active every day.
If you want to maintain

a healthy weight, avoid
eating sugar, sweets,
sugar-sweetened juices and
beverages

© United Nations Children’s Fund (UNICEF)
June 2021
Permission is required to reproduce any part of this publication.

Permissions will be freely granted to educational or non-profit
organizations.
Published by:
UNICEF
Nutrition Section, Programme Division
3 United Nations Plaza
New York, NY 10017, USA

2021 Food Based Dietary Guidelines Final

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Food-Based

Technical reviewers and contributors: Mawuli Sablah, Roland Kupka, France

© United Nations Children’s Fund (UNICEF)

Citation: United Nations Children’s Fund (UNICEF). Review of national Food-Based

Photograph Credits: Cover: © UNICEF/UN0342228/Keïta; page 4: Adobe Stock/©

1 / Background and objectives 6

2 / Data sources and approach to analysis 11

3 / Availability of FBDGs and integration of environmental sustainability 14

5 / Summary of group-specific key messages in FBDGs 21

6 / Summary of group-specific topics addressed in general FBDGs documents 25

7 / Country case studies 32

8 / Discussion and recommendations 47

Review of National Food-based Dietary Guidelines and Associated Guidance 3

4 Review of National Food-based Dietary Guidelines and Associated Guidance

Review of National Food-based Dietary Guidelines and Associated Guidance 5

1.1 UNICEF’s agenda

6 Review of National Food-based Dietary Guidelines and Associated Guidance

Food and nutrition challenges across childhood

6 months to 2 years – rapid growth and development

Review of National Food-based Dietary Guidelines and Associated Guidance 7

Sustainable Healthy Diets: Guiding Principlesa

8 Review of National Food-based Dietary Guidelines and Associated Guidance

A description of food-based dietary guidelinesa

Review of National Food-based Dietary Guidelines and Associated Guidance 9

10 Review of National Food-based Dietary Guidelines and Associated Guidance

9 http://www.fao.org/nutrition/education/food-dietary-guidelines/en/, accessed 24 September 2019.

Review of National Food-based Dietary Guidelines and Associated Guidance 11

12 Review of National Food-based Dietary Guidelines and Associated Guidance

a. Present guidance for age and/or physiological

In addition to these criteria, due to time limitations

For case study countries, all documents available

For countries with web-based interfaces for

Review of National Food-based Dietary Guidelines and Associated Guidance 13

Figure 1: Availability of FBDGs

14 Review of National Food-based Dietary Guidelines and Associated Guidance

Europe and Central Asia

Table 2: Availability of FBDGs by income

Concerning the integration of environmental

Review of National Food-based Dietary Guidelines and Associated Guidance 15

Integration of environmental sustainability in FBDGs of Brazil, Sweden, and Qatar

Key recommendations for this Guideline (p. 32) are:

16 Review of National Food-based Dietary Guidelines and Associated Guidance

12 Source: https://www.gezondleven.be/themas/voeding; accessed 19 November 2019.

Review of National Food-based Dietary Guidelines and Associated Guidance 17

2. Countries with FBDGs that provide advice on g. Lactating women

18 Review of National Food-based Dietary Guidelines and Associated Guidance

Number of countries with each type of guidanceb

UNICEF Region Type 1 Type 2 Type 3 Type 4 Type 5 Unknownc Total

a UNICEF regions, and World Bank income classification as of 1 July 2019.

Review of National Food-based Dietary Guidelines and Associated Guidance 19

20 Review of National Food-based Dietary Guidelines and Associated Guidance

Review of National Food-based Dietary Guidelines and Associated Guidance 21

West and Central

Europe and Central Asia

• Avoid drinking [alcohol] completely if you are pregnant or breastfeeding

22 Review of National Food-based Dietary Guidelines and Associated Guidance

Australia • Encourage, support and promote breastfeeding

Entire Dietary Guidelines document is for school-aged children; key messages

Review of National Food-based Dietary Guidelines and Associated Guidance 23

24 Review of National Food-based Dietary Guidelines and Associated Guidance

Table 5 Countries with recent general population guidelines documents in English

Sierra Leone 2016

South Africa 2012