Guías Alimentarias Basadas en Sistemas Alimentarios con Enfoque de Curso de Vida: Manual General

Objectives

The 2023 Food-Based Dietary Guidelines for the Dominican Republic establish a life-course and food-systems framework for improving nutrition, health, food sovereignty and food and nutrition security. They are intended to provide context-specific, evidence-based technical recommendations that support sustainable diets from health, economic, cultural and environmental perspectives, and serve as a reference for national and subnational policies, programmes and nutrition education.[1][2]

• Promote varied, balanced, adequate, sufficient and safe diets, prioritising local foods, inclusion, gender equity, sustainability and reduced food waste.[3][4]
• Address all forms of malnutrition and diet-related non-communicable diseases through healthier dietary patterns, physical activity and action on food environments and food systems.[2][5]
• Apply recommendations across the life course, from preconception, pregnancy and the first 1,000 days through childhood, adolescence, adulthood and older age.[3][6]
• Promote exclusive breastfeeding for the first six months, continued breastfeeding until at least two years, and timely, safe, diverse and responsive complementary feeding from six months.[3][7][8]
• Encourage diets centred on fresh or minimally processed foods, fruit, vegetables, pulses, whole grains and other nutrient-rich foods, while limiting sodium, added sugars, saturated and trans fats and ultra-processed products.[4][9]
• Support food-system sustainability through resilient family farming, equitable land access, sustainable production, water efficiency, reduced food loss and waste, local marketing, and improved affordability and access to healthy foods.[10][11][12]
• Strengthen food environments through front-of-pack nutrition labelling, regulation of advertising directed at children and vulnerable groups, nutrition education, healthy school and household gardens, and fiscal measures affecting non-nutritious products.[13][14][15]
• Align national action with the Global Nutrition Monitoring Framework, the 2025 global nutrition targets, Sustainable Development Goal 2 on Zero Hunger, and Sustainable Development Goal 3.4 on reducing premature mortality from non-communicable diseases.[16][17]

Implementation

The guidelines were developed through an evidence-based, multisectoral and participatory methodology combining life-course nutrition analysis with food-systems assessment. The Ministry of Public Health and Social Assistance leads health-sector coordination, supported by national technical groups, government institutions, academia, professional bodies, civil society and international partners.[2][18][6]

• Use planning, literature review, national data extraction, evidence inclusion and exclusion criteria, problem prioritisation and PICO, meaning population, intervention, comparison and outcome, research questions to establish recommendations.[19][20]
• Analyse food and nutrition conditions by life stage, including dietary patterns, nutritional requirements, barriers and facilitators to healthy eating, breastfeeding and complementary feeding.[21][20][22]
• Assess food systems through supply chains, food environments and consumers, covering production, storage, distribution, processing, retail, marketing, affordability, water access, social protection and food traditions.[23][24]
• Develop recommendations through virtual sessions, weekly technical working-group meetings, stakeholder workshops and face-to-face validation, including workshops held in 2023.[18][6][25]
• Coordinate implementation with the Ministry of Agriculture, National Health Service, National Institute of Student Welfare, National Institute for Early Childhood, National Council for Children and Adolescents, Technical Secretariat for Food and Nutrition Sovereignty and Security, consumer-protection bodies, academic institutions and professionals from multiple disciplines.[2][26]
• Engage education, agriculture, finance, industry and commerce, municipalities, schools, producer organisations, retailers, civil society, food industry actors and international organisations in regulatory, educational, production and food-environment actions.[13][14][15]
• Deliver public-facing guidance through technical documents, educational tools, communications materials, a validated national visual icon, dietary calculations for population groups and practical advice for families and caregivers.[1][27][28]
• Implement breastfeeding support through primary care, public and private institutions, community circles, mother-companion programmes and improved hospital certification for humanised maternal and newborn care.[29][30]
• Strengthen food safety through sanitary and phytosanitary controls, good agricultural and handling practices, and annual surveillance and control programmes for residues and pathogens in primary production.[31][32]
• Use national nutrition, health and food-security evidence to inform prioritisation, including surveillance of low birth weight, congenital anomalies, breastfeeding, child feeding and nutrition outcomes.[33][34][35]
• Monitor progress towards the six global nutrition outcomes, including stunting, anaemia in women of reproductive age, low birth weight, childhood overweight, exclusive breastfeeding and severe acute malnutrition.[16]
• Build the national evidence base through studies on maternal nutrition, infant feeding, older adults, food transport and storage, and contemporary dietary practices, as the source identifies important information gaps.[36]

Monitoring & Evaluation

Monitoring draws primarily on national surveys, nutrition surveillance, administrative notifications and evidence reviews, but the guidelines do not establish one consolidated monitoring and evaluation framework with a common reporting cycle, targets, data-quality procedures or accountability architecture.[1][2][36]

• Use the Global Nutrition Monitoring Framework to follow six outcomes: stunting among children under five, anaemia in women of reproductive age, low birth weight, childhood overweight, exclusive breastfeeding during the first six months, and severe acute malnutrition.[16]
• Assess progress towards Sustainable Development Goal 3.4 through mortality attributed to cardiovascular disease, cancer, diabetes and chronic respiratory disease.[17]
• Operate the National Epidemiological Surveillance System to record live births, stillbirths, major and minor congenital anomalies, and low-birth-weight episodes; health facilities submit low-birth-weight notifications through the Early Warning Module and consolidated reporting is weekly.[33][34]
• Track congenital neural-tube defects through surveillance notifications and disaggregate reported cases by sex, nationality or origin, mortality status and defect type.[33]
• Monitor breastfeeding through Demographic and Health Surveys and the National Multipurpose Household Survey using Multiple Indicator Cluster Surveys methodology. Exclusive breastfeeding among infants aged 0–5 months was reported at 16% in 2019, after falling to 6.7% in 2013.[37][38]
• Measure complementary feeding among children aged 6–23 months using minimum dietary diversity, minimum meal frequency and minimum acceptable diet. In 2019, reported values were 51.1%, 72.8% and 38.5% respectively.[39][40]
• Screen children under five through mid-upper-arm circumference under the 2020–2023 malnutrition reduction plan; among 24,897 children assessed, 0.6% had severe acute malnutrition and 3.1% moderate acute malnutrition.[41]
• Undertake annual food-safety surveillance and control programmes, analysing 2,000 samples each year for residues and pathogens, including Salmonella and Listeria monocytogenes.[31][32]
• Monitor compliance with breastfeeding policies and legislation through the Breastfeeding Commission, regional and local maternal, child-health and nutrition coordinators, and relevant legislators; follow up community breastfeeding-circle interventions.[30][42]
• Strengthen evidence through national studies on maternal nutrition, breastfeeding determinants, complementary feeding, older people’s nutrition, food transport and storage, and contemporary food preferences, reflecting identified information gaps.[36]

Available monitoring evidence identifies important gaps, including the absence of current population-level nutritional-status statistics for pregnant women, no national prevalence estimate for gestational diabetes, limited evidence on facilitators of healthy complementary feeding, and incomplete information on food transport and storage.[43][44][45][46]

Food-system monitoring domains proposed or implied include food access and prices, agricultural and household incomes, women’s productive participation, employment informality, water and soil conditions, deforestation, greenhouse-gas emissions and biodiversity. These domains are not presented as a formal indicator set with assigned reporting responsibilities.[47][46]

Costing & Financing

The guidelines contain limited explicit costing. They identify potential financing mechanisms and affordability constraints, but do not provide an overall implementation budget, costed workplan, confirmed allocation, funding-gap assessment or economic model for the national dietary-guideline programme.[48][49][50]

• Recognise the estimated cost of a healthy diet as 3.88 United States dollars, with 20% of the population reported unable to afford it.[48]
• Record food as 21.1% of household expenditure and alcoholic beverages as 2.4%, based on the cited household expenditure evidence.[48]
• Identify poverty, food waste and affordability as food-security constraints; the cited evidence reports approximately 1.1 million kilograms of food lost weekly and poverty affecting 27.7% of the population in 2022.[48]
• Consider a specific tax on sugar-sweetened beverages, differentiated by added-sugar content and adjusted for inflation and economic growth, as a revenue-mobilisation measure.[51]
• Estimate that a tax scenario raising average sugar-sweetened beverage prices by 20% could generate between 7,200 million and 7,500 million Dominican pesos and reduce consumption by 15% to 18.5%.[51]
• Use a documented elasticity assumption that a 10% beverage price rise is associated with an 8.41% reduction in consumption.[49][51]
• Note that households reportedly spend about 12% of income purchasing water, particularly affecting vulnerable households.[52]
• Establish a priority national-budget line to promote healthy eating, although no monetary allocation is specified.[50]
• Identify investment needs for rural infrastructure, irrigation and water efficiency, cold storage, meteorological monitoring, producer training and institutional capacity, without quantified requirements.[10][11][12]

Technical and financial support is acknowledged from the Food and Agriculture Organization of the United Nations, the Institute of Nutrition of Central America and Panama, and UNICEF for specified development or malnutrition-reduction activities, but no monetary amounts are reported.[2][53]

Mass food fortification is characterised as a cost-effective public-health intervention for micronutrient quality, while the source provides no associated cost estimate.[54]