ACHIEVEMENTS AND CHALLENGES OF NUTRITION AND PHYSICAL ACTIVITY POLICY IN BULGARIA Stefka Petrova National Center of Public...
PRESENTATION OUTLINE <ul><li>Main problems  in nutrition & nutritional status and related diseases of Bulgarian population...
MAIN NUTRITION/NUTRITIONAL STATUS  PROBLEMS AND RELATED DISEASES <ul><li>Exclusive  breastfeeding  low rate; early introdu...
 
Average Sodium Intakes in 52 countries <ul><li>Average levels of excreted Na in urine – most reliable indicator for Na int...
OVERWEIGHT AND OBESITY PREVALENCE AMONG ADULTS IN BULGARIA National nutrition surveys ,  1998 and  2004 M 19-30 F19-30 M 3...
OVERWEIGHT AND OBESITY PREVALENCE AMONG CHILDREN AND ADOLESCENTS OF AGE 7-19 YEARS   National nutrition surveys ,  1998 an...
MORTALITY RATE OF CEREBROVASCULAR DISEASE FOR MEN IN BULGARIA AND EU MEMBER STATES   Source: WHO, 2003
INCIDENCE OF REGISTERED CASES OF COLORECTAL  CANCER    Source: National Center of Health Information, 2004
FOOD AND NUTRITION ACTION PLAN,  2005-2010 <ul><li>GOALS: </li></ul><ul><li>To achieve positive changes in the national di...
Национален план за действие  “ Храни и Хранене” 2005-2010
SUPPORTING A HEALTHY START <ul><li>Promote optimal fetal nutrition :   </li></ul><ul><li>-  Promotion of healthy nutrition...
SUPPORTING A HEALTHY START <ul><li>Protect, promote and support breastfeeding:   </li></ul><ul><li>- Internet  web site , ...
 
SUPPORTING A HEALTHY START <ul><li>Improvement of pre-school and school nutrition:   </li></ul><ul><li>-  Manuals for heal...
 
 
 
ENSURING A HEALTHY SUSTAINABLE FOOD SUPPLY <ul><li>Improve the availability of fruits and vegetables </li></ul><ul><li>- R...
PROVIDING COMPREHENSIVE INFORMATION AND EDUCATION TO CONSUMERS <ul><li>Development and Promotion of  Food Based Dietary Gu...
Bulgarian Food Based Dietary Guidelines for different population groups
 
PROVIDING COMPREHENSIVE INFORMATION AND EDUCATION TO CONSUMERS <ul><li>National week  for counteracting obesity  –  annual...
PARTNERSHIP IN REALIZATION OF THE NATIONAL OBESITY WEEKS <ul><li>Schools, kindergartens </li></ul><ul><li>NGOs </li></ul><...
DISCUSSION FORUMS DURING NATIONAL OBESITY COUNTERACTING WEEK
PROVIDING COMPREHENSIVE INFORMATION AND EDUCATION TO CONSUMERS <ul><li>Participation in EU Network on reducing marketing p...
EUROPEAN DAY OF HEALTHY FOOD AND COOKING
MONITORING AND EVALUATION <ul><li>Established national nutrition monitoring system  – including MH, NCPHP and 28 Regional ...
 
Prevalence of stunting (< -2 SD, length/height-for-age) in children under 5 assessed by  WHO and BG standards National sur...
Prevalence of underweight (<-2SD, weight-for-age) in children under 5 years old assessed by WHO and  BG standards  Nationa...
Anemia in Infants and Young Children National survey, 2007 % Age  Relative rate of children aged 6 months to 5 years with ...
Prevalence of anemia  in women  ( Hb<1 2 ,0 g/dL)  with children of age under 5, differentiated by age of children and eth...
Child Obesity Surveillance , 2008
Prevalence of overweight and obesity among schoolchildren aged 6-19 years National survey, 2010
National behavioral risk factor survey among population aged 25-64 , 2007 Intensive Physical activity:   every day have on...
Mean daily stay in sitting position by gender  (%) National behavioral risk factor survey among population 25-64 , 2007 <u...
IMPACT OF CINDI PROGRAM Relative rate of HYPERTENSION  (≥140/90  mm   Hg )  among Bulgarian population by gender   ( %)   ...
IMPACT OF CINDI PROGRAM Relative rate of subjects with high blood Cholesterol level (>   6 ,2  mmol / l) by gender   (%)  ...
Challenges in Food and Nutrition Policy <ul><li>Develop of adequate to the current problems  FNAP  2011-2016 </li></ul><ul...
Physical Activity Policy <ul><li>National Strategy and National Program for Development of Physical Education and Sports, ...
Promotion of Physical Activity <ul><li>Partnership  with NGOs </li></ul><ul><li>Joint campaigns  of professionals, municip...
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Plenary3 s petrova

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Plenary3 s petrova

  1. 1. ACHIEVEMENTS AND CHALLENGES OF NUTRITION AND PHYSICAL ACTIVITY POLICY IN BULGARIA Stefka Petrova National Center of Public Health Protection
  2. 2. PRESENTATION OUTLINE <ul><li>Main problems in nutrition & nutritional status and related diseases of Bulgarian population as a basis for Food and Nutrition Action Plan </li></ul><ul><li>Achievements of Bulgarian Food and Nutrition Action Plan, 2005-2010 </li></ul><ul><li>Challenges of Food and Nutrition Policy, 2011-2015 </li></ul><ul><li>Policy on Physical Activity </li></ul>
  3. 3. MAIN NUTRITION/NUTRITIONAL STATUS PROBLEMS AND RELATED DISEASES <ul><li>Exclusive breastfeeding low rate; early introduction of complimentary foods; </li></ul><ul><li>Negative characteristics of national nutrition pattern : high fat intake; low fresh fruit& vegetable consumption in winter and spring; high salt intake; low fish consumption; high sugary products & soft drinks intake from children; </li></ul><ul><li>Low intake of a number vitamins and minerals ; </li></ul><ul><li>High prevalence of overweight and obesity , including among children; </li></ul><ul><li>Low physical activity among most of the population; </li></ul><ul><li>High morbidity and mortality rates of diet related chronic diseases: CVD, cancer, diabetes, osteoporosis. </li></ul>
  4. 5. Average Sodium Intakes in 52 countries <ul><li>Average levels of excreted Na in urine – most reliable indicator for Na intakes: “Nutrition and stroke” study in Varna city, 2000 </li></ul>14 g salt / day
  5. 6. OVERWEIGHT AND OBESITY PREVALENCE AMONG ADULTS IN BULGARIA National nutrition surveys , 1998 and 2004 M 19-30 F19-30 M 30-60 F 30-60 Year M 60-75 F 60-75
  6. 7. OVERWEIGHT AND OBESITY PREVALENCE AMONG CHILDREN AND ADOLESCENTS OF AGE 7-19 YEARS National nutrition surveys , 1998 and 2004 M 7-10 M 10-14 M 14-19 F 14-19 Year F 7-10 F 10-14
  7. 8. MORTALITY RATE OF CEREBROVASCULAR DISEASE FOR MEN IN BULGARIA AND EU MEMBER STATES   Source: WHO, 2003
  8. 9. INCIDENCE OF REGISTERED CASES OF COLORECTAL CANCER Source: National Center of Health Information, 2004
  9. 10. FOOD AND NUTRITION ACTION PLAN, 2005-2010 <ul><li>GOALS: </li></ul><ul><li>To achieve positive changes in the national dietary pattern for decreasing the risk of nutrient deficiencies and diet-related chronic diseases; </li></ul><ul><li>To decrease the health risk related to food contaminants and food additives; </li></ul><ul><li>To improve food security through increased availability of health promoting foods and their accessibility for the whole population. </li></ul>
  10. 11. Национален план за действие “ Храни и Хранене” 2005-2010
  11. 12. SUPPORTING A HEALTHY START <ul><li>Promote optimal fetal nutrition : </li></ul><ul><li>- Promotion of healthy nutrition for pregnant women – on national and local level - education materials, consultancies, national/local level campaigns, including media </li></ul><ul><li>- Folic acid supplementation of women in prepregnancy – joint work of nutritionists and specialists in obstetrics & gynecology </li></ul><ul><li>- Education of medical specialists (GP’s, nurses, etc.) – courses, education materials, seminars </li></ul>
  12. 13. SUPPORTING A HEALTHY START <ul><li>Protect, promote and support breastfeeding: </li></ul><ul><li>- Internet web site , information materials </li></ul><ul><li>- Consultative Center on Breastfeeding and Hot Telephone Line in Sofia </li></ul><ul><li>- Accreditation of new Baby Friendly Hospitals </li></ul><ul><li>- Organization, training and support of groups “Mothers support mothers” </li></ul><ul><li>- Annually country-wide promotion of World Breastfeeding Week </li></ul><ul><li>- National Conference on Breastfeeding with pediatricians, Pleven, 2008 </li></ul>
  13. 15. SUPPORTING A HEALTHY START <ul><li>Improvement of pre-school and school nutrition: </li></ul><ul><li>- Manuals for healthy nutrition with recipes for kindergartens and schools developed and mandatory used </li></ul><ul><li>- Training of staff in kindergartens and schools, control on nutrition </li></ul><ul><li>- Nutrition education modules developed, efficiency studied </li></ul><ul><li>- Member of WHO Nutrition Friendly Schools Initiative </li></ul><ul><li>- New regulation for foods & meals in school canteens and cafeteria , banning of sugary products and soft drinks, energy drinks, snacks with high fat and salt content, 2009 </li></ul><ul><li>- New regulation on requirements for healthy nutrition in kindergartens , launched in 2010, under publication </li></ul>
  14. 19. ENSURING A HEALTHY SUSTAINABLE FOOD SUPPLY <ul><li>Improve the availability of fruits and vegetables </li></ul><ul><li>- Regulation for mandatory availability of fruits & vegetables in school cafeteria, 2009 </li></ul><ul><li>- Governmental Program for free breakfast (schoolchildren of 1-4 grade) – mandatory including fruits and vegetables, 2005 </li></ul><ul><li>R eformulation of food products </li></ul><ul><li>- Discussion forums on possibilities to reduce salt, added sugar and fats in foods, setting targets - nutritionists, food producers, food technology experts </li></ul><ul><li>- Participation in WHO/EC Salt Reduction Initiative – setting target foods, working group, agreement with food manufacturers, national information campaign </li></ul>
  15. 20. PROVIDING COMPREHENSIVE INFORMATION AND EDUCATION TO CONSUMERS <ul><li>Development and Promotion of Food Based Dietary Guidelines for different population groups </li></ul><ul><li>Food labeling : harmonization with EU regulation, introduction of GDAs (Guideline Daily Amounts) </li></ul><ul><li>Information of the community : web pages of Ministry of Health and Ministry of Agriculture and Foods, involving of mass-media </li></ul>
  16. 21. Bulgarian Food Based Dietary Guidelines for different population groups
  17. 23. PROVIDING COMPREHENSIVE INFORMATION AND EDUCATION TO CONSUMERS <ul><li>National week for counteracting obesity – annual campaign since 2006: country-wide, variety of activities related to promotion of healthy nutrition and physical activity, organized by Ministry of Health, National Center of Public Health Protection and Regional Inspectorates </li></ul>
  18. 24. PARTNERSHIP IN REALIZATION OF THE NATIONAL OBESITY WEEKS <ul><li>Schools, kindergartens </li></ul><ul><li>NGOs </li></ul><ul><li>Food industry </li></ul><ul><li>Professional organizations </li></ul><ul><li>Municipalities </li></ul><ul><li>Mass-media </li></ul>
  19. 25. DISCUSSION FORUMS DURING NATIONAL OBESITY COUNTERACTING WEEK
  20. 26. PROVIDING COMPREHENSIVE INFORMATION AND EDUCATION TO CONSUMERS <ul><li>Participation in EU Network on reducing marketing pressure on children - establishment of a working group, debatable forum with experts, producers, NGO’s </li></ul><ul><li>World Food Day (16 October) – annually discussion forum, press conference </li></ul><ul><li>European Day of Healthy Food and Cooking (8 November): target group- children, attractive events </li></ul>Избери плодове и зеленчуци вместо нездравословна храна
  21. 27. EUROPEAN DAY OF HEALTHY FOOD AND COOKING
  22. 28. MONITORING AND EVALUATION <ul><li>Established national nutrition monitoring system – including MH, NCPHP and 28 Regional Health Inspectorates </li></ul><ul><li>- 5 national surveys carried out in 1997-2004 </li></ul><ul><li>- 3 national surveys conducted in 2006-2010: infants and children under 5 -2007; adults – 2008; schoolchildren aged 6-19 years - 2010 </li></ul><ul><li>- Participation in WHO/EU Childhood Obesity Surveillance Initiative, 2008 </li></ul><ul><li>- New software for food consumption and nutrient intake assessment, up-dated picture book for determination of food consumption </li></ul>
  23. 30. Prevalence of stunting (< -2 SD, length/height-for-age) in children under 5 assessed by WHO and BG standards National survey, 2007 WHO (2006) Bulgarian standards
  24. 31. Prevalence of underweight (<-2SD, weight-for-age) in children under 5 years old assessed by WHO and BG standards National survey, 2007 WHO (2006) Bulgarian standards
  25. 32. Anemia in Infants and Young Children National survey, 2007 % Age Relative rate of children aged 6 months to 5 years with anemia ( Hb<11,0 g/dL) , differentiated by age and ethnicity
  26. 33. Prevalence of anemia in women ( Hb<1 2 ,0 g/dL) with children of age under 5, differentiated by age of children and ethnicity National survey , 2007 <ul><li>The most risk groups are the women during the first months after delivery and those with Roma ethnicity. </li></ul>% Age of children
  27. 34. Child Obesity Surveillance , 2008
  28. 35. Prevalence of overweight and obesity among schoolchildren aged 6-19 years National survey, 2010
  29. 36. National behavioral risk factor survey among population aged 25-64 , 2007 Intensive Physical activity: every day have only 5.9% of males and 2.8% of females . Moderate Physical Activity: every day have only 8% of males and 6.4% of females . 0 days 1 days 2-3 days 4-5 days above 6 days men women 0 days 1 days 2-3 days 4-5 days above 6 days men women
  30. 37. Mean daily stay in sitting position by gender (%) National behavioral risk factor survey among population 25-64 , 2007 <ul><li>About 50% of women and men spent in sitting position 2-5 hours daily . Above 5 hours daily in sitting position are 36.1% of men and 43.6% of women, at higher rate among office employees and students . </li></ul><ul><li>Among persons who spent 5 hours daily in sitting position, about 1/3 are with elevated blood pressure . </li></ul><ul><li>With increased BMI are 73.02% of men and 52.4% of women , and with increased cholesterol levels are 51.9% of persons, predominantly elderly. </li></ul>0-60 min 61-120 min 121-300 min Above 300 min men women
  31. 38. IMPACT OF CINDI PROGRAM Relative rate of HYPERTENSION (≥140/90 mm Hg ) among Bulgarian population by gender ( %) in Tarnovo city
  32. 39. IMPACT OF CINDI PROGRAM Relative rate of subjects with high blood Cholesterol level (> 6 ,2 mmol / l) by gender (%) in Tarnovo city
  33. 40. Challenges in Food and Nutrition Policy <ul><li>Develop of adequate to the current problems FNAP 2011-2016 </li></ul><ul><li>Multisectoral integrated approach </li></ul><ul><li>Efficient strategies: </li></ul><ul><ul><li>Improve food/nutritional environment </li></ul></ul><ul><ul><li>Create possibilities for informed choice </li></ul></ul><ul><ul><li>Access to healthy nutrition </li></ul></ul><ul><ul><li>Community involement </li></ul></ul><ul><ul><li>Public-private partnership </li></ul></ul><ul><ul><li>Focus on priority groups and settings </li></ul></ul><ul><li>Adequate financing </li></ul>
  34. 41. Physical Activity Policy <ul><li>National Strategy and National Program for Development of Physical Education and Sports, 2005-2008, 2009-2013: </li></ul><ul><ul><li>Urban planning for PA friendly environment </li></ul></ul><ul><ul><li>Promotion of cycling and walking </li></ul></ul><ul><ul><li>Improve and promote sporting facilities </li></ul></ul><ul><ul><li>Improve and promote leisure facilities </li></ul></ul><ul><li>Program “Sports for children in leisure time”, 2005-2010 </li></ul><ul><li>Campaigns on national/local level annually </li></ul>
  35. 42. Promotion of Physical Activity <ul><li>Partnership with NGOs </li></ul><ul><li>Joint campaigns of professionals, municipalities, food producers </li></ul><ul><li>Directed mainly to children but also to all age groups, including elderly people </li></ul>
  36. 43. [email_address]

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