Dpc - Nutrition And Nutrition Guidlines

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Approximate recommended proportion of nutrients among the Philippine population

Back 1

- Approximate proportions of nutrients:
o Carbohydrates : 50-70%
o Proteins – 10-30%
o Fats – 10-20%
o Vitamins, Minerals, fibers

Front 2

Dietary Reference Intake (DRI) and its indices

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Dietary Reference Intake:
-Reference values that guide adequacy and safety
-Best determines a person's dietary intake

DRI indices:
1. Recommended daily allowance (RDA)
- average daily dietary intake sufficient to meet nutrient requirement of healthy individuals in a group

2. Adequate intake (AI)
- estimate of the RDA based on approximations of nutrient intake of a group of healthy people

3. Tolerable upper intake level (UL)
- highest level of daily nutrient intake likely to pose no risks of adverse health effects to the general population

4. Estimated average requirement (EAR)
- nutrient intake value estimated to meet the requirement of half the healthy individuals in a group

Front 3

Body mass index (BMI)

Back 3

- International Standard in assessing body size in adults
- BMI= Weight (kg) / Height (m2)

Values based on Asia-Pacific Guidlines - PASOO

40+
Morbidly obese (Grade 3 obesity)

30+
Obese (Grade 2 obesity)

25 – 30
Overweight (Grade 1 obesity)

18.5 – 24.5
Normal

< 18.5
Underweight

Front 4

Recommended Daily Nutrition for:
Filipino Children 1 - 6 years

1. Fats and Oils
2. Sugar and Sweets
3. Fish, Shellfish, Meat and Poultry, Dried Beans and Nuts; Eggs; Milk and Milk Products
4. Vegetables; Fruits
5. Rice, Rice Products, Corn, Root Crops, Bread, Noodles
6. Water / Other Beverages

Recommended actions:

Back 4

1. Fats and Oils (6 tsps)
2. Sugar and Sweets (4 to 5 tsps)
3. Fish, Shellfish, Meat and Poultry, Dried Beans and Nuts (1 - 1 1/3 servings); Eggs (1/2 piece); Milk and Milk Products (1 glass)
4. Vegetables (1/3 to 1/2 cup serving); Fruits (1 to 2 medium servings)
5. Rice, Rice Products, Corn, Root Crops, Bread, Noodles (2 to 4 1/2 servings)
6. Water / Other Beverages (4 to 7 glasses)

Recommended Actions:
1. Encourage children to regular exercise to prevent obesity
2. Use growth charts to monitor children's height and weight patterns
3. Eat a variety of foods everyday to ensure that all nutrients are provided in proper amount and balance
4. Use iodized salt and eat other fortified foods to increase the intake of micronutrients

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Recommended Daily Nutrition for:
Filipino Pregnant Women

1. Fats and Oils
2. Sugar and Sweets
3. Fish, Shellfish, Meat and Poultry, Dried Beans and Nuts; Eggs; Milk and Milk Products
4. Vegetables; Fruits
5. Rice, Rice Products, Corn, Root Crops, Bread, Noodles
6. Water / Other Beverages

Recommended actions:

Back 5

1. Fats and Oils (7 tsps)
2. Sugar and Sweets (6 tsps)
3. Fish, Shellfish, Meat and Poultry, Dried Beans and Nuts (4 to 5 servings); Eggs (1 piece); Milk and Milk Products (1 glass)
4. Vegetables (3 to 4 servings); Fruits (2 to 3 servings)
5. Rice, Rice Products, Corn, Root Crops, Bread, Noodles (5 1/2 to 6 servings)
6. Water / Other Beverages (6 to 8 glasses)

Recommended actions:
1. Try light moderate activity such as walking. Be sure to consult the doctor before engaging in light to moderate activity. Other activities include swimming, stretching, and floor exercises.
2. Consume sodium / salt in moderate amounts
3. Stop smoking and avoid alcohol during pregnancy
4. Eat a variety of foods everyday to ensure that all nutrients are provided in proper amount and balance
5. Use iodized salt and eat other fortified foods to increase the intake of micronutrients

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Recommended Daily Nutrition for:
Filipino Adults 20 to 39 years

1. Fats and Oils
2. Sugar and Sweets
3. Fish, Shellfish, Meat and Poultry, Dried Beans and Nuts; Eggs; Milk and Milk Products
4. Vegetables; Fruits
5. Rice, Rice Products, Corn, Root Crops, Bread, Noodles
6. Water / Other Beverages

Recommended actions:

Back 6

1. Fats and Oils (6 to 8 tsps)
2. Sugar and Sweets (5 to 8 tsps)
3. Fish, Shellfish, Meat and Poultry, Dried Beans and Nuts (3 to 4 servings); Eggs (1 piece); Milk and Milk Products (1 glass)
4. Vegetables (3 servings); Fruits (2 to 3 servings)
5. Rice, Rice Products, Corn, Root Crops, Bread, Noodles (5 to 8 servings)
6. Water / Other Beverages (8 glasses)

Recommended actions:
1. Do regular exercise in most days of the week for at least 30 minutes
2. Practice good personal and environmental hygiene
3. Eat a variety of foods everyday to ensure that all nutrients are provided in proper amount and balance
4. Use iodized salt and eat other foods to increase the intake of micronutrients

Front 7

DOH Comprehensive Nutrition Program

-Objectives
-Program strategies

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Objectives:
1.General
-Reduction of avitaminosis and other nutritional deficiency morbidity and mortality rates
2.Specific
a. Reduction of PEM prevalence rates among infants and preschoolers
b. Elimination of vitamin A deficiency among those under 5 years of
c. Elimination of iodine deficiency disorders among school children in endemic areas
d. Reduction of iron deficiency anemia prevalence rates among pregnant women, lactating mothers and infants

Program strategies:

A. Standard Nutrition Intervention Programs
1. Food and Micronutrient Supplementation
a. Using indigenous food and micronutrients for treatment of prophylaxis
b. "Araw ng Sangkap Pinoy"
i. Vitamin A capsules 200,000 IU for 12 to 59 months
ii. Iron tablets (200 mg ferrous sulfate) for pregnant and lactating mothers
iii. Iron syrup and drops - for preschoolers and infants
iv. Iodized oil capsule

B. Food fortification
1. Salt iodization program or FIDEL (Fortification for Iodine Deficiency Elimination)
2. Fortified High Value Rice (FVR) - Iron fortified rice
3. Flour and Sugar Fortification with vitamin A
4. Sangkap Pinoy Seal Program

C. Advocacy

D. Support programs
1. Nutrition Surveillance
2. Training of Personnel
3. Operations Research

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Individual indices of Nutritional Status

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1. Medical history and examination
2. Anthropometry
3. Hematologic Screening
4. Biochemical assessment
5. Immunologic Assessment
6. Dental

Front 9

Individual indices of Nutritional Status: Medical history and examination

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- History is important: it is where you can unravel the type of food that they have partaken

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Individual indices of Nutritional Status: Anthropometry

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- Assesses nutritional status of all population groups by determining the prevalence of underweight, underheight, thinness, overweight/obesity
- Weight standards
- Triceps skinfold thickness and arm circumference
o quick measurements for screening
- Targets (what you should look for): height and weight for age

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Individual indices of Nutritional Status: Hematologic Screening

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- Targets:
o RBCs for hemoglobin and iron
1. WBCs for infections
2. Proteins for malnutrition

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Individual indices of Nutritional Status: Biochemical assessment

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- Assesses prevalence of Vitamin A Deficiency (VAD), Iodine Deficiency Disorder (IDD), Iron Deficiency Anemia (IDA)
- Target: Vitamin levels

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Individual indices of Nutritional Status: Immunologic assessment

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- Target: Immunoglobulin (Ig) titers
o An Ig titer is a laboratory test that measures the level of immunoglobulin (antibodies) in a blood sample.
o The Ig level in the blood tells your doctor whether or not you have been exposed to an antigen or something that the body thinks is foreign.

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Individual indices of Nutritional Status: Dental

Back 14

- Mastication is important in order to get the entire nutrient content of the food

Front 15

Community Indices of Nutritional Status

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Direct indices ("ABCD"):
1. Anthropometric methods
2. Biochemical/laboratory
3. Clinical methods
4. Dietary Evaluation

Indirect indices
1. Geographic Community and Population Descriptors
2. Food and Nutrition Resources
3. Vital Health Statistics

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Direct Community Indices of Nutritional Status: Anthropometric methods

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o Given the anthropometric measures of each individual belonging to the community, we can compute for the prevalence and incidence rates of malnutrition, kwashiorkor, marasmus, etc.

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Direct Community Indices of Nutritional Status: Dietary Evaluation

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o 24-hour food recall
-Subject recalls all food &drink taken in the previous 24 hours
o Diet history
o 7-day diet diaries
-Food intake (type& amount)recorded by the subject at time of consumption
o Food frequency record (FFR)
-Subject is given a list food items to indicate his/her intake per day, per week & per month
o Household survey (food basket)
o Actual food intake
-Usual intake, types, amount, frequency & timing
~Meal is weighed & contents are exactly calculated
~Best method but most unused in clinical practice because of the difficulty

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Indirect Community Indices of Nutritional Status: Geographic Community and Population Descriptors

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o Economic factors (i.e. per capita income, population density, social habits)

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Indirect Community Indices of Nutritional Status: Food and Nutrition Resources

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o Ecological variables (i.e. crop production)

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Indirect Community Indices of Nutritional Status: Vital Health Statistics

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o infant & under 5 mortality and morbidity rates
o fertility index