Nutrition for Life

National Nutrition Council

he countrys policy-making and coordinating body on nutrition

NNC Secretariat

FOOD
Nutrients action Nonnutrients interaction balance

NUTRITION
USE BY BODY

ingest digest absorb transport utilize excrete

H E A L T H
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Outline
1. 2. 3. 4. 5. 6. Nutritional status and diets of Filipinos Healthy diet for adults Nutritional needs of adults Food and nutrition concerns Nutrition and stress Meal planning
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Nutritional status of Filipinos

Prevailing nutrition problems

1. 2. 3. 4. 5. Hunger Protein-energy malnutrition Micronutrient deficiencies Overnutrition Diet-related noncommunicable diseases (e.g. diabetes mellitus, cancers and cardiovascular diseases)
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State of Nutrition
Underweight 0-5 years Underweight 6-10 years Underweight 11-19 years At-risk pregnant women Underweight lactating women Chronic energy deficient adults
Source: 7th National Nutrition Survey. DOST-FNRI. 2009
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: 26.2% : 25.6% : 17.0% : 28.4% : 13.1% : 11.6%

State of Nutrition
Anemia, overall
Infants, 6 -11 months Pregnant women Lactating women

: 19.5%
: 55.7% : 42.5% : 31.4%

Vitamin A Deficiency, children Iodine deficiency, children

: 40.1% : 11.0%

Source: Initial results, 7th National Nutrition Survey. 2009 and 6th NNS, 2003, DOST-FNRI.
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State of Nutrition
Overweight 0-5 years Overweight 6-10 years Overweight 11-19 years Overweight adults Obese adults
Source: 7th National Nutrition Survey. DOST-FNRI. 2009
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: 2.0% : 1.6% : 4.6% : 21.4% : 5.2%

State of Nutrition and Health

Hypertension Hyperglycemia Dyslipidemia
High total cholesterol High LDL-cholesterol Low HDL-cholesterol High triglyceride
Source: 7th National Nutrition Survey. DOST-FNRI. 2009.
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: 25.3% : 4.8%
: : : : 10.2% 11.8% 64.4% 14.6%

Leading Causes of Morbidity

Cause 1. Acute lower RTI and pneumonia 2. Acute watery diarrhea 3. Bronchitis/Bronchiolitis 4. Hypertension 5. Influenza 6. TB respiratory 7. Diseases of the heart 8. Acute febrile illness 9. Malaria 10. Dengue fever Rate per 100,000 Population 828.8 707.7 689.9 522.8 435.0 169.9 49.3 32.5 27.6 19.6
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Source: 2006 Morbidity Data from DOH website (www.doh.gov.ph/kp/statistics/morbidity)

Leading Causes of Mortality, 2005

Cause
1. Heart diseases 2. Vascular system diseases 3. Malignant neoplasm 4. Pneumonia 5. Accidents 6. Tuberculosis, all forms 7. Chronic lower respiratory diseases 8. Diabetes Mellitus 9. Certain conditions originating in the perinatal period 10. Nephritis, nephrotic syndrome and nephrosis
Rate per 100,000 Population

90.4 63.8 48.9 42.8 39.1 31.2 24.6 21.6 14.5 3.6
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Source: 2005 Mortality Data from DOH website (www.doh.gov.ph/kp/statistics/mortality) accessed: 23 June 2010

Increasing trend of NCDs as cause of death, 1970-2000

Sources: Philippine Health Statistics, 1970, 1975, 1980, 1985, 1990, 1995, 2000. from Pedro, et al, 2006.

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Mean oneday per capita food consumption, in grams, Philippines, 1978 - 2003
Food group and subgroup Cereals and cereal product Starch roots and tubers Sugars and syrups Fats and oils Fish, meat and poultry Eggs Milk and milk products Dried beans, nuts and seeds Vegetables Green, leafy, yellow Other vegetables Fruits Vitamin C-rich Other fruits Miscellaneous Total Consumption (gram), raw as purchased 1978 367 37 19 13 133 8 42 8 145 34 111 104 30 74 21 897 1982 356 42 22 14 154 9 44 10 130 37 93 102 18 84 32 915 1987 345 22 24 14 157 10 43 10 111 29 82 107 24 83 26 869 1993 340 17 19 12 147 12 44 10 106 30 76 77 21 56 19 803 2003 364 19 24 18 185 13 49 10 111 31 80 54 12 42 39 886 15

Source: National Nutrition Surveys: 1978-2003, FNRI

Diets of Filipinos
Increased consumption of: Fish, meat, poultry and egg Sugars and syrups Fats and oils

Less fruits and vegetables and complex carbohydrates

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Changing Filipino diet

Frequency of eating outside the home Use of computer Influence of mass media Increasing urbanization Globalization e.g. adoption of westernized diet Trade liberalization making local fruits and vegetables more expensive
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Fetal development and maternal environment

Intra-uterine growth retardation (IUGR) Increased risk of coronary heart disease, stroke and diabetes

Large size at birth

Increased risk of diabetes, CVD and cancer

Infancy and childhood

Breastfeeding Lower blood pressures in childhood Chronic diseases in childhood and adolescence Increased risk of CHD

Artificial infant feeding and shortterm breastfeeding Slow growth in infancy

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NCD Risk Factors among Filipinos

90% of Filipinos have the following risk factors
Smoking Obesity Hypertension High blood sugar Abnormal blood cholesterol levels
Source: DOST-FNRI. National Nutrition and Health Survey, 2003.
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Nutrition and NCDs

80% of premature heart diseases, stroke, type II diabetes & 40% of cancer could be avoided through: Healthy diet Regular physical activity Avoidance of tobacco use
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Healthy diet

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An unhealthy diet
Composed of foods that are
energy-dense and nutrient-poor high in saturated fat, trans-fat, refined carbohydrates, and salt low in consumption of fruits and vegetables and low in fiber
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What is a healthy diet?

Emphasizes fruits, vegetables, whole grains, root crops & fat-free or low-fat milk Includes lean meats, poultry, fish, beans, egg and nuts Is low in saturated, trans fats, cholesterol, salt (sodium) & added sugars
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Healthy diet

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Recommendations for healthy diet

1. Eat a balanced meal consisting of foods from all the food groups (Go, Grow, Glow)

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Carbohydrates 55-70%

Fats 20-30%

Protein 10-15%
Eat balanced diet from all food groups and in recommended amounts
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Water
Adults need 2.5 liters per day while older adults need 1.5 liters per day Amount increases with physical activity and sweat up to 3.5 liters Drink water when thirsty

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Recommendations for healthy diet

2. Increase fruits and vegetables and legumes
Eat deeply colored green, orange and yellow F/V Eat five or more servings of F/V a day Eat legumes like mongo, peas, beans

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Recommendations for healthy diet

3. Increase whole grains and nuts
Whole grains include wheat, oats, corn, brown rice, whole wheat flour/bread/pasta, popcorn Eat nuts like cashews and peanuts but avoid those salted and fried

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Recommendations for healthy diet

4. Consume fish, lean meat, poultry or dried beans
Low in saturated fat, if not battered or deep-fried Good sources of fish with polyunsaturated fat
Herring, Mackerel, Sardines, Anchovies, Salmon, Tuna, Crab, Prawns, Scallops

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Recommendations for healthy diet

5. Limit saturated fats
Remove visible fat from meat Discard chicken skin Use vegetable oils instead of animal oils Avoid high-fat processed meats such as sausages, hotdogs, bacon Reduce whole milk and its products like cheese, cream and ice cream

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Recommendations for healthy diet

5. Limit saturated fats
Instead of frying, use low-fat cooking like griddling, hot-smoking, grilling, baking, steaming Use non-stick pans to limit oil Stir fry in stock rather than in oil Remove fat drippings

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Recommendations for healthy diet

6. Limit trans fatty acids (TFA)
Produced when converting liquid vegetable oil to semi-solid fat Behave like saturated fat in the body causing blood cholesterol levels to increase Commonly found in biscuits, cakes, pastries, sausages, crackers

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Recommendations for healthy diet

7. Limit intake of simple sugars
Limit sugar-rich foods with little nutritional value like candies, soft drinks, chips, cakes and pastries Take sugar only as needed to sweeten food

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Recommendations for healthy diet

8. Use iodized salt but limit salt intake to no more than 5 grams per day
Eat foods with little or no added salt Avoid using ingredients with high sodium content such as processed foods Use herbs and spices instead of salt, patis
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Recommendations for healthy diet

7. Limit salt intake to no more than 5 grams per day
Eat fresh foods and those naturally low in salt Read labels Enjoy natural taste of foods

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Healthy or unhealthy?

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A healthier food choice?

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HL to the MAX
No smoking (Huwag manigarilyo) Dont drink (Iwas alak) No to illegal drugs (Talo ka sa droga) Prevent hypertension (Bantay presyon) 5. Do physical activity (Katawang aktibo) 6. Manage stress (Bawas stress) 7. Eat low-fat, low-salt, high-fiber diet (Wastong pagkain) 1. 2. 3. 4.

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Stop smoking
Smoking increases risk of

Cancer of lungs, mouth, throat, esophagus, tongue, cervix, pancreas, stomach, bladder and kidney Respiratory diseases Cardiovascular diseases Complications in pregnancy
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Dont drink alcohol

Alcohol consumption
Can raise level of fats in blood Lead to high blood pressure Can lead to nutritional deficiencies Can lead to weight gain

Do not serve alcohol

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Moderate alcohol consumption

Drink moderately! One drink per day for women Two drinks per day for men

1 oz distilled beverage e.g. gin 12 oz or 1 bottle beer 4 oz of glass wine 1 oz or 1 jigger of 100 proof whiskey
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1 drink

Dangers of alcohol abuse

Loss of appetite Risk of liver damage Damage to the heart muscles Increased risk of

Heart attack High blood pressure Birth defects such as retardation, small head, and poor muscle tone
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Physical activity
Do moderate-intensity physical activity
minutes at a time for minutes a day at least days a week

Source: Philippine Association for the Study of Overweight and Obesity (PASOO)

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Managing stress
Be aware of

What stresses you Your physical and emotional reactions to stressors

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Nutritional Health Checklist

I have an illness or condition that made me change the kind and /or amount of food I eat. I eat fewer than two meals per day. I eat few fruits or vegetables, or milk products. I have three or more drinks of beer, liquor or wine almost every day. I have tooth or mouth problems that make it hard for me to eat. I don't always have enough money to buy the food I need. I eat alone most of the time. I take three or more different prescribed or over-the-counter drugs a day. Without wanting to, I have lost or gained 10 pounds in the last six months. I am not always physically able to shop, cook and/or feed myself.

YES 2 3 2 2 2 4 1 1 2 2

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What your score means

Score 0-2 3-5 Good! Recheck your nutritional score in six months. You are at moderate nutritional risk. See what can be done to improve your eating habits and lifestyle. Recheck your nutritional score in three months. You are at high nutritional risk. Seek the advise of your doctor, dietitian or other qualified health professional.
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6 or more

Requirements for adults

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Recommended Energy Intake

Population Group Male, y 30-49 50-64 65+ Female, y 30-49 50-64 65+ 51 51 51 1700 (33) 1520 (30) 1320 (26) 1810 (35) 1620 (32) 1410 (28) 2050 (40) 1830 (36) 1590 (31)
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Body Weight (kg)

ENERGY kcal/day (kcal/kg/day) Light Moderate Heavy 2290 (39) 2050 (35) 1780 (30) 2420 (41) 2170 (37) 1890 (32) 2730 (46) 2440 (41) 2120 (36)

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Requirements of adults
Food group Rice and alternatives Recommended Amounts 5 - 8 cups, cooked

1 serving of rice or alternatives = 1 cup rice, cooked, or 4 pcs. pandesal, or 4 slices of loaf bread, or 1 cup macaroni, spaghetti, cooked or 1 pack instant noodles, or 1 small size root crop
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Requirements of adults
Food group Meat and alternatives Recommended Amounts 2 - 3 servings

Fish/Meat/Poultry/Dried Beans/Nuts 1 serving of fish = 2 pieces (16 cm long); 1 serving of meat/poultry = 30 g lean meat, cooked, or 1 cups cooked dried beans
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Requirements of adults
Food group Egg Whole Milk Recommended Amounts 1 piece, medium size (3-4x a week) 1 glass

1 glass = 240 ml (1 glass whole milk is equivalent to 4 Tbsp powdered whole milk or cup evaporated milk diluted in 1 glass of water)
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Requirements of adults
Food group
Green and leafy vegetables Other vegetables Vitamin C rich fruits Other fruits

Recommended Amounts cup cooked cup cooked 1 medium size or 1 slice of a big fruit 1 medium size or 1 slice of a big fruit
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Requirements of adults
Food group Fats and Oils Sugar
Water and Beverages

Recommended Amounts
6-8 teaspoons 5-8 teaspoons

6-8 glasses

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Food and nutrition concerns

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Skipping breakfast
With breakfast Better attitude Higher productivity Better ability to handle tasks requiring memory More strength and endurance Better concentration Without breakfast Feel more tired Irritable and restless No energy to sustain activity throughout the day

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Healthy Breakfast
Take time Think nutrient-rich foods
Rice, ulam, fruit, water Whole grain cereal with low-fat milk, dried fruits and nuts Omelettes with veggies

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Snacking
Traditional snacks boiled camote, corn, bananas Sandwich - peanut butter with banana; cheese, tuna with vegetables Popcorn Yoghurt mixed with fruit Nuts (dry roasted, low salt) Fruits
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Coffee
May cause tremors, sleeping problems, discomfort Not associated with increased risk of death Consider avoiding coffee or using decaffeinated if you are pregnant, have difficulty in controlling blood pressure and blood sugar levels
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Egg
A nutrient-dense food Cheapest source of high quality protein Eating an egg a day is acceptable for healthy individuals

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Eating out
Choose main dishes with vegetables Say yes to smaller sizes and foods cooked in less fat (steamed, grilled) Drink water instead of sugary drinks Say no to fried sidings, up-size, high-fat dressings and creamy sauces Dont be a member of the clean your plate club
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Fad diet
Rapid weight loss Allow unlimited quantities of any food Combining certain foods at specific times of day Rigid menus No need for exercise

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Healthy weight loss

Weight loss of 1/2 to 2 pounds a week by:
making healthy food choices eating moderate portions building physical activity into your daily life

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Gaining weight
Eat more but smaller meals (5-6 times) Think quality and quantity of foods Eat starchy vegetables such as potatoes, camote and corn more often

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Gaining weight
Go for dried fruits or fruit juices as healthy higher calorie snacks Add powdered milk to soups and sauces to offer calories and protein. Stick with healthy desserts, such as a bowl of fruits

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Maintain energy balance

Energy balance: Energy from food energy used for physical activity If energy from food > energy used = weight gain If energy from food < energy used = weight loss
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INPUT
Calories from food

OUTPUT
Calories used during PA

The Energy Balance

Body Mass Index

= weight (kilograms) 2 height (meter)

Example: = 50 kilograms 2 1.6 (meter) = 19.5

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Body Mass Index Less than 18.5 18.5 to less than 25 25 to less than 30 30 and above

Classification Underweight Normal Overweight Obese

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Assessment of obesity (android) Waist Circumference (WC)

Male about 40 inches Female about 35 inches Waist-Hip Ratio (WHR) - Divide waist circumference by hip circumference Male greater than or equal to 1 Female greater than or equal to 0.85
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Examples of android obesity

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Examples of android obesity

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Dietary or food supplements

Some may help provide some nutrients lacking in the diet BUT may also cause ill effects Not intended to treat, diagnose, cure, mitigate, prevent diseases Must not replace prescribed medicines and healthy diet Do not self-diagnose
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Before taking dietary supplements

Think safety Be wary of quick fix without evidence Spot false claims (cure all, totally safe, money-back guarantee) More may not be better Natural not always safe Is it worth the money?
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Organic Foods
Foods produced without synthetic materials e.g. insecticides or contain only organic ingredients no good evidence that consumption of organic food is beneficial to health in relation to nutrient content Further studies needed

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Nutrition and Stress

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Stress
Pattern of physiological, behavioral, emotional, and cognitive responses to real or imagined stimuli that are perceived as blocking a goal or endangering or otherwise threatening out well-being Plays factor in motivation, adaptation, and reaction to the environment

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Stress
Stress can help protect you in dangerous situation (stress response) Short term stress can even boost immune system

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Stress
When stress becomes chronic or long term, body systems stop working normally It may increase risk of numerous health problems:
Heart disease Sleep problems Digestive problems Depression Obesity Memory impairment Worsening of skin conditions, such as eczema
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What causes stress?

Common causes of short-term stress: Too much to do and not much time Lots of little problems in the same day (like a traffic jam or running late) Getting lost Having an argument

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What causes stress?

Common causes of longer-term stress: Death of a loved one Chronic (ongoing) illness Caring for someone with a serious illness Problems at work Money problems

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Stress management through nutrition and exercise

Physical activity and relaxation techniques can help reduce stress and anxiety Proper nutrition can help the body to handle stress better by keeping it running optimally

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Exercise
Relieves stress, builds muscle, reduces weight, and may help reduce the risk of heart disease Aerobic exercise for several weeks may lead to a decreased output of fight or flight hormones, and may increase endorphinsnatural relaxation chemicals in the brain
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Nutrition and stress

Stress may influence ones eating behavior or eating patterns One may under- or overeat Chronic life stress greater preference for foods high in fats and sugar Linked to weight gain among men and obesity
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Poor nutrition and stress

Research has shown that some foods actually induce a state of stress Excess amounts of sugar, caffeine, salt, and foods poor in vitamins and minerals weaken the bodys resistance to the stress response

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Nutrition
Healthy diet may help one manage/cope with stress Good nutrition promotes optimal mental and physical health

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Foods that help

Vegetables Fruits Legumes Whole grains Omega-3 essential fatty acids

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Foods to avoid Caffeine, chocolates Sugar (candies/sweets) Alcohol

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Meal planning

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Why do we need to plan our meals?

Every member of the family has their own needs Meals that are planned are:
- Affordable - Delicious or satisfying - Safe - Easy to prepare
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Meal planning
Proper planning of meals: - Go, Grow and Glow foods
Steps: 1. Select a staple such as rice 2. Choose a viand rich in protein (Grow foods) 3. Choose what vegetable to include (Glow foods) 4. Choose a fresh fruit for dessert.
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Meal planning tips

Always plan ahead of time! - use a Menu Cycle for a week - ease of time of thinking what to cook - purchase cheaper food items Rich in protein: - dilis, sapsap, tagonton, alamang - beans, eggs, internal organs

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Meal planning tips

One-dish meal - sample: sinigang na bangus - ginisang munggo na may dahon ng malunggay at tinapa/hipon/baboy - simple and easy to prepare dishes (sinigang/nilaga)

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Meal planning tips

Sugar - brown sugar is cheaper and more nutritious For merienda - serve nilagang kamote/nilagang saging Fruits - buy those in season Vegetables - talbos ng kamote and malunggay are cheaper

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Meal planning tips

Recycling of foods - Fried fishes to tortang isda, lumpia, sarciado For preparing healthy and delicious meals - variety - usage of sauces - serve meals hot
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LETS ALL STAND UP

Breathing exercise
Take a deep breath, hold for 5 seconds Exhale with force by saying Hah! Repeat five times
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For more details:

National Nutrition Council 2332 Chino Roces Ave Extn., Taguig City
http://www.nnc.gov.ph https://www.facebook.com/nncofficial https://www.facebook.com/wastongnutrisyon http:///www.youtube.com/user/NNC1974 oed_nnc@yahoo.com Contact numbers: Telefax 843-5838
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