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  • 1. TALKING POINTS NUTRITION MONTH 2009 “Wastong nutrisyon kailangan, lifestyle diseases iwasan” 1. What is Nutrition Month? 2. What is the theme for 2009 NM? 3. What are the objectives of 2009 NM? 4. What are lifestyle diseases? 5. What are the causes and risk factors of non-communicable diseases? 6. How serious is lifestyle-related diseases? 7. What is the role of nutrition in lifestyle-related diseases? 8. What is the state of nutrition in the country in relation to lifestyle-related diseases? 9. What is the dietary pattern of Filipinos and how does this relate with lifestyle diseases? 10. What is an unhealthy diet? 11. What are the recommendations for diet and nutrition in relation to lifestyle-related diseases? 12. What are some pointers to achieve a healthy diet? 13. What are some evidence-based nutrition and related interventions to address lifestyle diseases? 14. What are the current initiatives to promote healthy diets for lifestyle- disease prevention and control? 15. What actions can be done to promote the consumption of healthy diets at various levels? 16. How will the 2009 Nutrition Month be celebrated? References 1
  • 2. Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL TALKING POINTS NUTRITION MONTH 2009 1. What is Nutrition Month? In 1974 by virtue of Presidential Decree No. 491 or the Nutrition Act of the Philippines, the National Nutrition Council (NNC) was tasked to coordinate the nationwide celebration of Nutrition Month (NM) every July of each year. The objective of Nutrition Month is to promote good nutrition. Since then, the NNC together with local government units, nongovernment organizations, the private sector, schools, communities and other stakeholders have come to celebrate Nutrition Month along a chosen theme. 2. What is the theme for 2009 NM? This year’s Nutrition Month celebration will be guided by the theme, “Wastong nutrisyon kailangan, lifestyle diseases iwasan!”. The theme focuses on the role and importance of proper nutrition in the prevention and control of diet-related lifestyle diseases or commonly known as non-communicable diseases (NCDs). 3. What are the objectives of 2009 NM? a. To increase awareness on the role and importance of proper nutrition in the prevention and control of NCDs among the general public. b. To encourage individuals and families to make positive decisions towards proper nutrition particularly along the consumption of healthy diets and the practice of healthy lifestyle behaviors; and c. To encourage communities, national and local governments, nongovernment organizations, private sector, media, the academe, policy-makers and other stakeholders to put in place an enabling environment that promotes proper nutrition and healthy lifestyle behaviors among Filipinos. 4. What are lifestyle diseases? Lifestyle or behavior diseases are also known as non-communicable diseases. These are called such because much of the risk factors 2
  • 3. associated with them are related to how one lives. The four major lifestyle-related non-communicable diseases that currently dominate the list of leading causes of death in the country are cardiovascular diseases (CVD), cancers, diabetes mellitus and chronic obstructive pulmonary diseases (COPD). Because these are caused by a combination of factors, lifestyle- related diseases when acquired become chronic diseases. For now, these can only be alleviated through a combination of behavioral and medical or surgical interventions. 5. What are the causes and risk factors of non-communicable diseases? • Lifestyle-related diseases share many risk factors that are indicative of disease processes and their progression. These risks include tobacco use, unhealthy diet, physical inactivity, increased alcohol consumption, stressful lifestyle and even malnutrition, among others. • Lifestyle-related diseases are a result of the accumulation of exposures to damaging physical and social environments that start not only in mid-adult life but in childhood and as increasing evidence shows, likely begin in fetal life and continue to old age. 6. How serious is lifestyle-related diseases? a. The World Health Organization (WHO) in its 2005 global report "Preventing chronic diseases: a vital investment" stated that, from a projected total of 58 million deaths from all causes in 2005, chronic diseases accounted for an estimated 35 million, which is double the number of deaths from all infectious diseases (including HIV/AIDS, tuberculosis and malaria), maternal and perinatal conditions, and nutritional deficiencies combined. 3
  • 4. b. WHO estimated that 60% of all deaths are due to chronic diseases. Cardiovascular disease, the leading chronic disease, kills five times as many people as HIV/AIDS. About 80% of all chronic disease deaths occur in low and middle income countries. c. Disease burden in the Philippines is gradually shifting from communicable to non-communicable diseases. NCDs are the leading causes of mortality particularly diseases of the heart and vascular system, malignant neoplasms, accidents and diabetes mellitus in 2004 (Table 1). The increasing trend in mortality caused by NCDs has been observed in the last three decades (Figure 1). d. NCDs are leading causes of morbidity particularly diseases of the heart and the vascular system as the two main leading causes. (Table 2). It is estimated that 90 percent of Filipinos have one or more of these risk factors: smoking, obesity, hypertension, high blood sugar and abnormal blood cholesterol levels (DOST-FNRI, NNHES, 2003). Table 1. Ten Leading Causes of Mortality among Filipinos, 2004 Cause Rate per Percent 100,000 of total Population deaths 1. Heart diseases 84.8 17.6 2. Vascular system diseases 61.8 12.8 3. Malignant neoplasm 48.5 10.1 4. Accidents 41.3 8.6 5. Pneumonia 38.4 8.0 6. Tuberculosis, all forms 31.0 6.4 7. Ill-defined and unknown causes of 25.5 5.3 mortality 8. Chronic lower respiratory diseases 22.7 4.7 9. Diabetes Mellitus Figure 1. Mortality trends by cause of death, 1970-2000 19.8 4.1 10. Certain conditions originating in the 15.8 3.6 perinatal period Source: DOH website (www.doh.gov.ph/kp/ statistics/mortality), accessed: 9 March 2009 4
  • 5. Table 2. Ten Leading Causes of Morbidity among Filipinos, 2004 Cause Rate per 100,000 Population 1. Acute lower RTI and pneumonia 929.4 2. Bronchitis/Bronchiolitis 861.6 3. Acute watery diarrhea 690.7 4. Influenza 454.7 5. Hypertension 409.6 6. TB respiratory 123.5 7. Chicken pox 56.0 8. Diseases of the heart 44.4 9. Malaria 23.8 10. Dengue fever 19.0 Source: DOH website (www.doh.gov.ph/kp/statistics/morbidity) accessed: 9 March 2009 7. What is the role of nutrition in lifestyle-related Figure 1. Mortality trends by cause of death, 1970-2000 diseases? a. Among the important risk factors to non- Sources: Philippine Health Statistics, 1970, 1975, 1980, 1985, 1990, 1995, 2000. from Pedro, et al, 2006. 5
  • 6. communicable diseases are high blood pressure, high concentrations of cholesterol in the blood, inadequate intake of fruits and vegetables and other fiber-rich foods, overweight or obesity, physical inactivity and tobacco use (WHO Global Strategy on Diet, Physical Activity and Health, 2004). b. Mortality from non-communicable diseases is preventable. An estimated 80% of premature heart disease, stroke, and Type 2 diabetes, and 40% of cancer, could be avoided through healthy diet, regular physical activity, and avoidance of tobacco use. Proper nutrition plays a major role in the prevention, control and management of lifestyle-related non-communicable diseases across the life course namely: fetal development and maternal environment, infancy and childhood, adolescence, adulthood, and ageing and older people (Figure 2) (Darnton-Hill, et. al, 2003). Figure 2. Life Course: the proposed causal links to chronic diseases Source: Darnton-Hill, Nishida and James, 2003 as adopted from ACC/SCN 2000. a. Fetal development and maternal environment 6
  • 7. 1) There is considerable evidence that intra-uterine growth retardation (IUGR) is associated with an increased risk of coronary heart disease, stroke and diabetes. 2) Large size at birth is associated with an increased risk of diabetes and CVD and breast and other cancers. b. Infancy and childhood 1) Breastfeeding is significantly associated with lower blood pressure levels in childhood. 2) Several chronic diseases of childhood and adolescence (type 1 diabetes, celiac disease, some childhood cancers and inflammatory bowel diseases) have also been associated with artificial infant feeding and short-term breastfeeding. 3) Slow growth in infancy has also been associated with increased risk of coronary heart disease (CHD). Low birth weight followed by subsequent adult obesity is associated with higher risk of CHD and diabetes. 4) Stunting in childhood is associated with an increased risk of CHD and stroke and to some extent, diabetes. Meanwhile, accelerated growth in height in childhood has been linked to the risk of stroke and hypertension in later life but the precise period in accelerated growth is unclear. 5) High caloric intake in childhood may be related to an increased risk of cancer and hypertension in later life. 6) Children tracked in these studies have unhealthy lifestyles including excessive intakes of total and saturated fats, cholesterol and salt, inadequate intakes of potassium, and reduced physical activity and often accompanied with high levels of television viewing. 7) Persistent obesity in childhood increases mortality and morbidity more than if the obesity is developed in adulthood. c. Adolescence 1) High blood pressure in adolescence and young adulthood is strongly related to later risk of stroke or CHD, 7
  • 8. independently of blood pressure in mid-life. The risk of CVD through high blood pressure already starts before middle age. 2) Manifestation of chronic disease early in life tends to continue throughout life. 3) Overweight children have at least one additional risk factor for CVD such as raised blood pressure, hyperlipidemia or hyperinsulinemia. Overweight in children tends to persist in adolescence and once established is more difficult to correct in later life. d. Adulthood 1) The known NCD risk factors during adulthood are tobacco use, obesity, physical inactivity, cholesterol, high blood pressure and alcohol. Evidence shows the strong association between serum cholesterol in early adult life in men and CVD in mid-life as well as total mortality. Another factor that increases the risk of having CVD is genetics. 2) Obesity particularly abdominal obesity in adults is one of the main risk factors of CHD, stroke and diabetes. The adverse effects of adult obesity are influenced by the degree of overweight, location of body fat, central obesity, magnitude of weight gain and sedentary lifestyle. e. Ageing and older people The main burden of NCDs is manifested at this stage in life with more general losses in physiological functions. Older persons are more likely to benefit from risk factor modification such as exercise and stress management. 8. What is the state of nutrition in the country in relation to lifestyle-related diseases? Both undernutrition and overnutrition exists among Filipinos (Table 3). One in 4 pregnant women is nutritionally at-risk which increases the likelihood of intra-uterine growth retardation. Underweight persists from infancy to adolescence and among adults as chronic energy deficiency. Overweight among children is low (and is increasing) but high among adults especially among the 40-59 years age group, which increases the risk of NCDs. Overweight and obesity among adults have also been increasing. This is reflected in prevalence of android obesity, 8
  • 9. a risk factor for CVD using waist circumference and waist-hip ratio. Android obesity is especially high among adult females. Table 3. Nutritional status of Filipinos by age groups/physiological state Age Nutritional status Prevalence Reference group/physiological Year state 0-5 years old Underweight 24.6 2005 Stunting 26.3 2005 Overweight 2.0 2005 6-10 years old Underweight 22.8 2005 Stunting 32.0 2005 Overweight 1.6 2005 Adolescents, 11-19 Underweight 15.5 2005 years Pregnant women At-risk 26.6 2003 Lactating women At-risk 11.7 2003 Age Nutritional status Prevalence Reference group/physiological Year state Adults 20-39 years Chronic energy 10.6 2003 deficiency Overweight 17.0 2003 Obese 3.6 2003 40-59 years Chronic energy 10.4 2003 deficiency Overweight 25.0 2003 Obese 5.8 2003 60 and over Chronic energy 23.6 2003 deficiency Overweight 15.8 2003 Obese 3.3 2003 Adults Waist-hip ratio Male 12.1 Female 17.0 Waist circumference 2.4 Male 17.0 9
  • 10. Female Source: DOST-FNRI, 2003 NNS and 2005 Updating of Nutritional Status of Children. 9. What is the dietary pattern of Filipinos and how does this relate with lifestyle diseases? • Food intake of the average Filipino has been changing over the years in terms of quantity and quality. Filipinos are now eating more fish, meat, poultry and eggs which are good sources of protein. However, Filipinos are eating less of fruits and vegetables and complex carbohydrates, and more of sugars and syrups, fats and oils. Results of the 2003 National Nutrition Survey show that about 8.5 percent of adult Filipinos have high blood cholesterol levels in 2003 compared to only 4 percent in 1998 (NNHeS, 2003). This increase can be attributed to the increased consumption of animal- based foods and decline in fruit and vegetable consumption. 10
  • 11. Table 4. Mean one–day per capita food consumption, in grams, Philippines, 1978 – 2003 Food group and Consumption (gram), raw as purchased subgroup 1978 1982 1987 1993 2003 Cereals and cereal 367 356 345 340 364 products Rice and products 308 304 303 282 303 Maize and products 38 34 24 36 31 Other cereals and 21 18 18 22 30 products Starchy roots and 37 42 22 17 19 tubers Sugars and syrups 19 22 24 19 24 Fats and oils 13 14 14 12 18 Fish, meat and poultry 133 154 157 147 185 Fish and products 102 113 111 99 104 Meat and products 23 32 37 34 61 Poultry 7 10 9 14 20 Eggs 8 9 10 12 13 Milk and milk products 42 44 43 44 49 Whole milk 35 35 Milk products 9 14 Dried beans, nuts and 8 10 10 10 10 seeds Vegetables 145 130 111 106 111 Green, leafy, yellow 34 37 29 30 31 Other vegetables 111 93 82 76 80 Fruits 104 102 107 77 54 Vitamin C-rich 30 18 24 21 12 Other fruits 74 84 83 56 42 Miscellaneous 21 32 26 19 39 Beverages 26 Condiments 13 Total (g/day) 897 915 869 803 886 Source: DOST-FNRI: National Nutrition Surveys: 1978, 1982, 1987, 1993, 2003. 11
  • 12. • A study conducted on the health implications of dietary changes in the Philippines by Pedro, Benavides and Barba (2006) also concluded that the changing dietary patterns among Filipinos can be attributed to several factors including 1) increasing urbanization, 2) globalization giving rise to the adoption of westernized diet, 3) trade liberalization which makes local fruits and vegetables relatively more expensive, 4) frequency of eating outside the home, 5) the use of computer, and the 6) influence of mass media. 10. What is an unhealthy diet? An unhealthy diet is composed of foods which are energy-dense and nutrient-poor foods – high in saturated fat, trans-fat, refined carbohydrates, and salt. An unhealthy diet is also low in consumption of fruits and vegetables or low in fiber. (WHO, 2004.) 11. What are the recommendations for diet and nutrition in relation to lifestyle-related diseases? • In May 2004, the World Health Assembly endorsed the World Health Organization Global Strategy on Diet, Physical Activity and Health to address the two main causes of NCDs which are diet and physical activity. The overall goal of the Global Strategy on Diet, Physical Activity and Health is to promote and protect health by guiding the development of an enabling environment for sustainable actions at individual, community, national and global levels that, when taken together, will lead to reduced disease and death rates related to unhealthy diet and physical inactivity. These actions support the United Nations Millennium Development Goals and have immense potential for public health gains worldwide. • The global strategy recognizes that: a. Maternal health and nutrition before and during pregnancy, and early infancy may be important in the prevention of NCDs in the life course. Exclusive breastfeeding for the first six months and appropriate complementary feeding contribute to optimal physical growth and mental development. Infants who suffer prenatal and possibly postnatal growth restrictions, appear to be at a higher risk for NCDs in adulthood. b. Diet and physical activity both influence health either together and separately. Although the effects of diet and physical activity on health often interact, particularly in relation to obesity, there are additional health benefits to be gained from physical activity that are independent of 12
  • 13. nutrition and diet, and there are significant nutritional risks that are unrelated to obesity. Physical activity is a fundamental means of improving the physical and mental health of individuals. c. Healthy diets and physical activity, together with tobacco control, constitute an effective strategy to prevent and control NCDs. 12. What are some pointers to achieve a healthy diet? a. Achieve energy balance and a healthy weight 1) Maintain a balance between calorie intake and calorie expenditure. 2) Simply burn the calories that you eat through regular exercise. Increase the amount and intensity of physical activity to burn more calories. 3) Fad diets are not the way to go in reducing weights. Fad diets only provide short-term, quick-fix approach and do not deliver long-lasting weight lost. b. Eat a balanced meal consisting of foods from all the food groups with at least 60-70% of total calories coming from carbohydrates; 10-15% for protein and 20-25% for total fats; sodium limited to 2,400 mg and cholesterol at 300 mgs or less per day. c. Limit the intake of saturated fats, trans fat and cholesterol. Saturated fats and transfats have been shown to adversely affect blood cholesterol levels. Saturated fats raise cholesterol levels and cause plaque to build up in arteries. On the other hand, transfats can raise total and LDL (or bad) cholesterol and lower HDL (or good) cholesterol. 1) Remove visible fat from meat. Choose lean meats (loin or round) and skinless poultry. 2) Limit intake of meat, poultry and fish and shellfish to 6 ounces or less a day. 3) Eat more fish and nuts often, which contain healthy unsaturated fats. 4) Choose vegetable oil over animal oils which are high in saturated fat. 13
  • 14. 5) Choose low-fat or nonfat or skim dairy products. 6) Avoid high-fat processed meats such as luncheon meats, sausage, hotdogs and bacon; butter, lard, organ meats 7) Cut way down on trans fats, supplied by hydrogenated vegetable oils used in most processed foods and in many fast foods. 8) Beware of “hidden fat” in the following foods such as fried foods, marbled meat, rich cakes and pastries, creamed dishes and soups, mayonnaise and oil-based dressings 9) Buy margarine made with unsaturated liquid vegetable oil as the first ingredient 10) Shift to boiling, broiling, steaming, stir fry to lessen the use of oil. 11) Limit the intake of egg yolk since these are high in dietary cholesterol. 12) Use low-fat or no fat for salads and dips. 13) When making gravy from drippings, chill first then remove the fat. d. Increase consumption of fruits and vegetables, and legumes, whole grains and nuts. Fruits and vegetables contain phytochemicals which may help lower blood pressure and prevent cardiovascular diseases. 1) Eat especially the deeply colored green, orange, and yellow fruits and vegetables since these contain more nutrients. 2) Eat five or more servings of fruits and vegetables each day. 3) Replace high calorie foods with fruits and vegetables 4) Eat whole fruits and vegetables instead of drinking juices because they contain more fiber. 5) Prepare vegetables without added saturated or trans fats, sugar and salt. 6) Nuts are high in calories so consume only a handful a day. Avoid honey-roasted or heavily-salted nuts. 14
  • 15. c. Limit intake of simple sugars 1) Limit sugar-laden foods with little nutritional value like candies, jam, and softdrinks 2) Take sugar only as needed to sweeten your food and drinks 3) Go slow on beverages and food with added sugars (e.g. pastries, chips, doughnuts, cakes, etc) d. Maintain a low-salt diet and ensure that salt is iodized. Salt causes tissues to retain fluid, elevating the pressure in the arteries. 1) Eat foods with little or no added salt 2) Limit the use of salt or any salty seasoning in cooking 3) Salt goes by many other names. Avoid foods with these word listed as ingredients (e.g. salt, sodium, soy sauce, baking soda, baking powder, MSG, monosodium glutamate, NA (chemical symbol for sodium) and some antacids) 4) When cooking, use herbs and spices to naturally flavor or season food instead of table salt, MSG or highly salty condiments. 5) Read labels to find out the sodium content of packed or preserved foods. In food labels, HIGH is >1.5 g salt per 100 g (or 0.6g sodium) while LOW is <0.3g salt per 100 g (or 0.1g sodium) 6) Limit excessive intake of preserved and processed foods, cheese, canned soups, canned fruits and vegetables, instant noodles and canned meats, salted fish and meats, addition of condiments like soy sauce, bagoong and fish sauce, broth cubes, salted snacks 7) Avoid use of pre-packed bouillon seasonings or flavors e. Pay attention to food labels. Be familiar with the nutritional contents written on labels • Calorie-free = fewer than 5 calories per serving • Fat-free = less than 0.5 grams of fat per serving • Low saturated fat = 1 gram or less per serving • Low fat = 3 grams or less per serving 15
  • 16. • Low cholesterol = 20 milligrams or less and 2 grams or less saturated fat per serving • Low sodium = 140 milligrams or less per serving • Low calorie = 40 calories or less per serving f. Beat the fastfood mania 1) Say no to large size, mega-size or all forms of “up-size” 2) Choose grilled chicken sandwiches 3) Avoid ordering sandwiches with double meat 4) Do not add bacon to sandwich because it is high in fat 5) Choose pickle, onions lettuce, tomatoes, mustards and ketchup to add flavor to your choices 6) Avoid the deep-fried sides. If at all, choose a side salad or a fruit dish 7) Stay away from fried fish sandwiches 8) When available, order for a wheat or wholegrain bun 9) Avoid the mayonnaise and other calorie-rich sauces 10) Drink water or diet soda or fruit juices. Regular sodas are loaded with sugars and calories. h. Avoid drinking alcohol since this can raise the levels of fats in the blood (triglycerides); can lead to high blood pressure, heart failure, and increased calorie intake. 13. What are some evidence-based nutrition and related interventions to address lifestyle diseases? Darnton-Hill et al, pointed to the evidence where interventions have had positive impact on the NCD risk factors as well as recommendations from such studies. Some of these are: a. Lowering the saturated fat of diet of children lowered their cholesterol levels b. Properly targeted primary care-based interventions can help prevent obesity in children from a very young age 16
  • 17. c. Individual counseling aimed at reducing weight, improving diet and increasing physical activity demonstrated reduction in the risk of progression to diabetes by 58% over 4 years d. 80% of cases of CHDs and 90% of type II diabetes could be potentially avoided through changing lifestyle factors and one third of cancers could be avoided by eating healthy, maintaining normal weight and exercising throughout the life span e. Long-term reduction of serum cholesterol concentration by 10% through moderate dietary change can lower the risk of ischemic heart disease by 50% at age 40, falling to 20% at age 70 f. Prevention of impaired fetal growth through improved nutrition of girls and women not only contributes to lower maternal mortality and better child survival and development but may also prevent obesity, diabetes and CVD in developing countries The WHO Global Strategy on Diet, Physical Activity and Health recommends strategies that must be evidence-based, comprehensive, culture-specific, multi-disciplinary and participatory, multi-sectoral, with long-term perspective that involves all members of society. The strategy must also have a life-course perspective that starts with maternal health and prenatal nutrition, pregnancy outcomes, exclusive breastfeeding for six months, and child and adolescent health; reaches children at schools, adults at worksites and other settings, and the elderly; and encourages a healthy diet and regular physical activity from youth into old age. The Global Strategy calls for broader, comprehensive and coordinated public health efforts that address a number of issues. For diet, these include all aspects of nutrition (overnutrition and undernutrition, micronutrient deficiencies), food security, food safety, and support for exclusive breastfeeding. For physical activity, issues include requirements for physical activity in the workplace, home and school life, increasing urbanization and various aspects of city planning, transportation, safety and access to physical activity during leisure. 14. What are the current initiatives to promote healthy diets for lifestyle- disease prevention and control? Below are some programs/strategies that are implemented to promote healthy diets: a. Healthy lifestyle campaign 17
  • 18. The Department of Health spearheads the National Healthy Lifestyle Program. The DOH recognizes that the four most prominent non-communicable diseases are linked by common preventable risk factors related to lifestyle including smoking, stressful and sedentary lifestyle and unhealthy diet. The healthy lifestyle approach includes the promotion of proper diet and nutrition, increased physical activity, smoking prevention and cessation among others. The healthy lifestyle campaign was relaunched and repackaged in February 2009 as “HL to the MAX” to promote seven major and vital healthy practices: a. No smoking (Huwag Manigarilyo) b. Don’t drink alcohol (Iwas Alak) c. No to illegal drugs (Talo Ka sa Droga) d. Eat low-fat, low-salt, high-fiber diet (Wastong Pagkain) e. Prevent hypertension (Bantay Presyon) f. Do physical activity (Katawang Aktibo) g. Manage Stress (Bawas Stress) The healthy lifestyle campaign promotes transformation of various settings into healthy settings such as healthy workplace, healthy-eating place, healthy communities and healthy schools, among others. b. Coalition-building Thirty-nine government and non-government organizations, medical societies and associations have grouped together to form the Philippine Coalition for the Prevention and Control of Non-Communicable Diseases (PCPCPNCD). The coalition undertakes various activities and programs to prevent and control NCDs. Among its accomplishments are advocacy for the declaration of the Decade of Healthy Lifestyle 2005-2010, search for HL Advocacy Award and conduct of conferences on HL, among others. c. Promotion of good nutrition The Nutrition Information and Education Program under the Medium-Term Philippine Plan of Action for Nutrition formulated by the National Nutrition Council as an integral component of the Philippine Development Plan promotes the practice of the Nutritional Guidelines for Filipinos for better health. Likewise, the Accelerated Hunger-Mitigation Program, the banner program of 18
  • 19. Her Excellency, President Gloria-Macapagal Arroyo to address hunger in the country includes the “Promote Good Nutrition” component which aims to promote good nutrition practices among Filipinos, The component includes the conduct of nutrition counseling and nutrition education sessions for improved infant and young child feeding practices anchored on exclusive breastfeeding and appropriate complementary feeding, increased consumption of eggs, vegetables and other nutritious foods. d. Integration of nutrition in the school curriculum, both in the elementary and secondary levels e. Wellness programs undertaken in the workplace both in private and public sectors f. Promotion of healthy eating places that includes advocacy for fast food establishments to serve healthy food choices and acknowledging these establishments though the giving of citations and awards. g. Initiatives are underway to pursue the enactment of a food and nutrition labeling law. 15. What actions can be done to promote the consumption of healthy diets at various levels? Individual/Family a. Eat a variety of foods every day with special attention to fruits and vegetables, legumes and those with complex carbohydrates b. Grow fruits and vegetables at home c. Cook healthy foods for the family, one that is low-fat, low salt and high in carbohydrates d. Choose healthy foods when eating away from home e. Care for pregnant women should include proper nutrition f. Practice appropriate infant and young child feeding practices including exclusive breastfeeding for 6 months and thereafter giving appropriate complementary foods while continuing breastfeeding for two years and beyond g. Monitor and manage the weight of family members h. Have regular medical check-up for early detection of diseases 19
  • 20. i. Learn more about proper nutrition j. Exercise regularly together with the family Community a. Plant and maintain fruits and vegetables gardens in vacant lots b. Mobilize the youth to conduct sports activities that integrate promotion of healthy diets c. Advocate for healthy food options in carinderias and restaurants to serve fruits and vegetables, limit fried foods, avoid serving high- fat foods, limit salt in cooked foods, provide small, medium and large serving portion options d. Organize exercise activities that members of the community can participate in e. Provide safe play area for children and other supportive infrastructure to integrate physical activity into everyday life f. Provide access to community members a means to measure and monitor their weights Schools a. Implement school policies that promote healthy diets and physical activity b. Grow fruits trees and vegetables in schools c. Ensure that school canteens serve nutritious foods that include fruits and vegetables, to limit if not all together ban the sale of high fat, high sugar and high salt foods d. Advocate for sari-sari stores, food retailers, carinderias and other food outlets near the vicinity of the school to sell healthy food options to school children e. Include daily physical activities in school and sports events f. Provide play area for students Local Government a. Formulate local policies to support consumption of healthy diets and promote good nutrition and the HL to the Max campaign 20
  • 21. b. Support communities implement programs promoting healthy diets and good nutrition as suggested above c. Implement wellness programs for community members Work place a. Implement wellness programs for employees b. Serve nutritious foods/snacks in the office cafeteria and during meetings and conferences c. Conduct seminars/lectures on healthy diet and lifestyle Nongovernment organizations/private sector/civil society a. Advocate and conduct public education for healthy diets and healthy lifestyle b. Form networks and groups to promote availability of healthy foods c. Share best practices in promoting healthy diets and healthy lifestyle National Government a. Develop and implement food and agriculture policies that enable adequate production and domestic supply of fruits, vegetables and whole grain cereals that are affordable to all segments of the population b. Review and implement policies to promote positive effects of agriculture and trade policies on nutrition and health c. Employ measures to regulate the use of hydrogenation of oils and fats intended for dietary consumption or manufacture of food products; encourage the reduction of use of salt d. Enact and enforce measures towards mandatory labeling of food products with clear codes to enable consumers to readily identify products with high sodium, fat and sugar and caloric content. e. Develop and implement policies involving urban planning and transport to create facilities for supporting physical activity for all people of all ages f. Review and update dietary and nutritional guidelines 21
  • 22. g. Watch over media to ensure that food and beverage advertising does not encourage unhealthy food practices and false nutrition claims h. Ensure that foods used in food distribution/subsidy programs should be healthy International Organizations a. Facilitate the development of global trade policies that will ensure adequate supply of health promoting foods b. Assist in developing and testing culture-specific interventions for promoting population-wide changes in dietary preferences and practices together with physical activity Food industry a. Make low sodium and low-fat foods available in the market and lower the sodium content of regularly consumed foods like bread and noodles b. Food establishments to offer healthier foods including fruits and vegetables c. Reformulate recipes and menu that are high in fat, iodized salt, and sugar which will produce healthier and less energy-dense products d. Use advertising and marketing strategies to promote and support healthy diet or eating e. Implement nutrition labeling of food products for processed foods or provide information on the nutrient content of foods offered in eating places f. Introduce new products with better nutritional value g. Provide consumers with adequate and understandable product and nutrition information 16. How will the 2009 Nutrition Month be celebrated? The celebration for 2009 NM should be able to highlight the importance of healthy diets across the life cycle. The celebration should not only be done in July but promotion of healthy diets needs to be done year round and sustained. The celebration will be more meaningful if it 22
  • 23. includes activities that will lead to the achievement of its objectives, i.e. not only creating awareness on healthy diets but to facilitate an environment that promotes healthy diets across the life span. Examples of activities to highlight the celebration: a.Massive fruit tree and vegetable planting event b.Monitoring of school and office canteens to check on healthy diets c.Contest among carinderias to offer healthy food options d.Food contest on healthy meals and snacks for pregnant women, children and adults e.Mass weighing and measurement of waist circumference to promote management of weights f.Pack a healthy “baon” day to the office/school g.Campaign against the excessive use of white condiments - sugar, salt and monosodium glutamate h.Conduct HL to the Max exercises thrice a week in schools, workplaces and in communities. For more information on Nutrition Month contact the City/Municipal Nutrition Action Officer and/or the NNC Regional Nutrition Program Coordinator or National Nutrition Council 2332 Nutrition Building, Chino Roces Avenue Extension, Taguig City Telephone: (02) 843-5838 or (02) 843-5832 Fax (02) 843-5818 email address: oed_nnc@yahoo.com 23
  • 24. References: 1. Darnton-Hill I., Nishida C. and James, WPT. “A life course approach to diet, nutrition and the prevention of chronic disease”: Public Health Nutrition 7 (1A), 101-121. http:// www.who.int/nutrition/publications/public_health_nut2.pdf accessed on March 6, 2009. 2. Department of Health. HL to the MAX. http://www.doh.gov.ph. Accessed on 19 February 2009. 3. ---------------. Health Indicators. http://www.doh.gov.ph/kp/statistics 4. Department of Health, University of the Philippines, Manila, College of Nursing and World Health Organization. A Training Manual for Health Workers on Promoting Healthy Lifestyles – Noncommunicable diseases. 2003. 5. Food and Nutrition Research Institute-Department of Science and Technology. Nutritional Guidelines for Filipinos, Revised Edition 2000. 6. ----------------. Philippine Nutrition Facts and Figures 2003. October 2006. 7. ----------------. Updating of Nutritional Status of Children, 2005. October 2006. 8. Gaziano, Thomas A., Galea, Gauden and Reddy, K Srinath. Scaling up interventions for chronic disease prevention: the evidence. The Lancet, Volume 370, Issue 9603, Pages 1939 - 1946, 8 December 2007. http://thelancet.com. Accessed on 19 February 2009. 9. Pedro, M.R.A., Benavides, R.C. and Barba, C.V.C. Dietary changes and their health implications in the Philippines. http://www.fao.org/docrep/009/a0442e/a0442e0p.htm#TopOfPage. Accessed on 3 March 2009. 10. Srinath Reddy K. and Katan, Martin B. “Diet, nutrition and the prevention of hypertension and cardiovascular diseases” Public Health Nutrition 7 (1A) 167-186. http://www.who.int/nutrition/publications/public_health_nut5.pdf accessed March 6, 2009. 11. World Health Organization. Global strategy on diet, physical activity and health. Fifty- Seventh World Health Assembly, Eighth plenary meeting, 22 May 2004 – Committee A, third report. http://www.who.int. Accessed on 19 February 2009. 12. ---------------. WHO/FAO Release Independent Expert Report on Diet and Chronic Disease. 3 March 2003. http://www.wpro.who.int/media_centre/press_releases/pr_20030304.htm. Accesse on 19 February 2009 24