Comparison of cardiovascular disease risk factors among FiLWHEL (2014-2016), NNS (2013) and KNHANES (2013-2015) women.

OBJECTIVES: This study assessed the CVD risk factors among Filipino women (FW) in Korea and compared them with FW in the Philippines and women in Korea (KW). METHODS: A cohort of 504 women from the Filipino Women's Health and Diet Study (FiLWHEL) aged 20-57 years old were age-matched (1:1 ratio) with women from the 2013 National Nutrition Survey in the Philippines and the 2013-2015 Korean National Health and Nutrition Examination Survey. Anthropometric data, blood pressure (BP), lipid and glucose levels were compared across the four populations by calculating the odds ratio (OR)s and 95% confidence interval (CI)s using conditional logistic regression models. RESULTS: Compared to KW, FW in Korea and FW in the Philippines were more than 2 and 3 times higher odds of having obesity for BMI ≥ 30 kg/m2 and waist circumference ≥ 88 cm, respectively. However, FW in Korea had the highest odds (OR 5.51, 95% CI 3.18-9.56) of having hypertension compared to KW. FW in the Philippines had the highest odds of having dyslipidemia (compared to KW, total cholesterol ≥ 200 mg/dL: OR 8.83, 95% CI 5.30-14.71; LDL-C ≥ 130 mg/dL: OR 3.25, 95% CI 2.13-4.98; and triglyceride ≥ 150 mg/dL: OR 2.59, 95% CI 1.59-4.22), but FW in Korea and KW had similar prevalence of dyslipidemia. CONCLUSIONS: FW in Korea had higher prevalence of obesity and hypertension, with similar prevalence of dyslipidemia compared to KW in this sample. FW in the Philippines had higher prevalence of dyslipidemia compared to FW in Korea. Further prospective studies are warranted to examine the CVD risk factors among continental and native-born Filipino women.

Comparing two simplified questionnaire-based methods with 24-h recalls for estimating fortifiable wheat flour and oil consumption in Mandaluyong City, Philippines.

Information on fortifiable food consumption is essential to design, monitor and evaluate fortification programmes, yet detailed methods like 24-h recalls (24HRs) that provide such data are rarely conducted. Simplified questionnaire-based methods exist but their validity compared with 24HRs has not been shown. We compared two simplified methods (i.e., a household food acquisition and purchase questionnaire [FAPQ] and a 7-day semiquantitative food frequency questionnaire [SQ-FFQ]) against 24HRs for estimating fortifiable food consumption. We assessed the consumption of fortifiable wheat flour and oil using a FAPQ and, for wheat flour only, a 7-day SQ-FFQ and compared the results against 24HRs. The participants included children 12-18 months (n = 123) and their mothers 18-49 years selected for a study assessing child vitamin A intake and status in Mandaluyong City, Philippines. For fortifiable wheat flour, the FAPQ estimated considerably lower mean intakes compared to 24HRs for children and mothers (2.2 vs. 14.1 g/day and 5.1 vs. 42.3 g/day, respectively), while the SQ-FFQ estimated slightly higher mean intakes (15.7 vs. 14.1 g/day and 51.5 vs. 42.3 g/day, respectively). For fortifiable oil, the FAPQ estimated considerably higher mean intakes compared to 24HRs for children and mothers (4.6 vs. 1.8 g/day and 12.5 vs. 6.1 g/day, respectively). The SQ-FFQ, but not the FAPQ, generated useful information on fortifiable food consumption that can inform fortification programme design and monitoring decisions in the absence of more detailed individual-level data. Potential adaptations to improve the FAPQ, such as additional questions on foods prepared away from home and usage patterns, merit further research.

Determination of Vitamin A Total Body Stores in Children from Dried Serum Spots: Application in a Low- and Middle-Income Country Community Setting.

BACKGROUND: The retinol isotope dilution (RID) method has been used to evaluate vitamin A (VA) status in healthy adults and children in low- and middle-income countries (LMIC) and to assess the efficacy of various VA interventions. OBJECTIVE: The study was designed to examine whether dried serum spots (DSS) can be applied to RID when conducting VA total body store (TBS) assessments in community settings. METHODS: Four days after an oral dose of 0.4 mg [13C10]retinyl acetate was administered to Filipino children (12-18 mo), a single blood draw was divided to isolate both serum and plasma. Serum (40 µL) was spotted and dried on Whatman 903 cards and shipped at ambient temperature whereas liquid plasma (LP) was frozen at -80°C and shipped on dry ice. The VA tracer to tracee ratio from DSS and LP was quantified by LC-MS/MS. Comparisons between DSS and LP paired samples (n = 72) were made for [13C10]retinol specific activity (SAp) by Pearson's correlation and for VA TBS by Bland-Altman analysis. RESULTS: The sum of 3 coextracted DSS were required to consistently detect [13C10]retinol above the LC-MS/MS limit of quantitation (LOQ). [13C10]retinol SAp from DSS was highly correlated with SAp from LP (r = 0.945; P < 0.01). A comparison of methods for TBS determination using Bland-Altman analysis indicated agreement with an intraindividual difference of 24.7 µmol (4.6%). Mean total liver reserve (TLR) values from DSS and LP were 1.7 µmol/g (± 0.6 SD) and 1.6 µmol/g (± 0.6 SD), respectively. CONCLUSIONS: VA TBS can be determined from DSS thereby reducing the logistics and cost of maintaining a cold chain by shipping samples at ambient temperature and, thus, making the RID technique more feasible in LMIC community settings. This trial was registered at https://clinicaltrials.gov as NCT03030339.

Assessing school-lunch feeding and nutrition education strategy for healthier kids in selected Philippine public schools.

BACKGROUND: Nutrition interventions during the early years of a child's life are anchored on the need to provide good nutrition and proper health care to optimize their growth potential as adults. In the Philippines, undernutrition is a persistent problem among 0-10 year old Filipino children. In this age group, children consume a diet poor in quantity and quality. AIM: This study aimed to assess the effects of a school-lunch and nutrition education intervention among schoolchildren in terms of attaining good nutrition. METHOD: Using a quasi-experimental design, children aged 7-9 years from public elementary schools in the province of Laguna, Philippines were categorized into three intervention groups and one non-intervention group. Anthropometric measurements; nutrition knowledge, attitude and behavior; and food intake among children and households were collected at baseline and endline periods. SPSS for Windows version 16 and Stata version 15 were utilized for data analysis. RESULTS: Mean scores on knowledge, attitude and behavior of schoolchildren in intervention groups increased significantly at endline (p<0.05). Protein requirement was met by more children and households than the energy requirement. Most children with normal nutritional status after the interventions (25.3%) belonged to the group with the complete intervention of school-lunch and nutrition education. CONCLUSIONS: The provision of both school-lunch feeding and nutrition education is effective in improving the knowledge, attitude and behavior scores and nutritional status of schoolchildren. The adoption and institutionalization of complete intervention with school-lunch and nutrition education in elementary public schools should be pursued.

Food sources, energy and nutrient intakes of adults: 2013 Philippines National Nutrition Survey.

BACKGROUND: Comprehensive assessment of dietary intakes of foods and nutrients in Filipino adults are lacking. This study evaluated energy and nutrient intakes and food sources of key nutrients consumed by Filipino adults. METHODS: The participants were from the 2013 National Nutrition Survey wherein food intake of young adults aged 19-49 years (n = 12,896) and older adults aged 50 years and above (n = 7853) were collected using 24-h recalls. Usual nutrient intakes were estimated using PC-SIDE program. The Philippines Dietary Reference Intakes were used to calculate proportions of inadequate intake using Estimated Average Requirement (EAR) and Acceptable Macronutrient Distribution Ranges (AMDR). Energy adequacy was evaluated using the Institute of Medicine (IOM) equation for Estimated Energy Requirements (EER). RESULTS: The nutrient intakes with the highest prevalence of inadequacy (> 50%) were: iron (97-99%), vitamin C (96-98%), calcium (95-98%), riboflavin (86-91%), folate (89-90%), thiamine (73-89%), energy (67-70%), total fat (55-67%), and vitamin A (54-56%). Refined rice, pork and breads contributed most to daily intakes of energy, protein, carbohydrates, thiamine, riboflavin, and iron. Low intake of vegetables, fruits and dairy was common in both age groups. CONCLUSIONS: This study demonstrated that intakes of many nutrients were markedly inadequate among adults in the Philippines, due to the rice-dominant dietary pattern with few nutrient-dense foods. These results can be used to support the development of specific interventions to improve the shortfalls in nutrient intakes.

Integrated school based nutrition programme improved the knowledge of mother and schoolchildren.

This study evaluates the effects of nutrition education on improving knowledge, attitude, and practice (KAP) of mothers and the improvement of the nutritional status of their children. A cluster randomized controlled design using multistage sampling was employed. The integrated school-based nutrition programme included gardening, nutrition education for parents, and supplementary feeding for children (GarNESup). KAP of mothers was assessed using pretested questionnaires administered by teachers. The randomly selected schools were randomly allocated into two groups: Both schools provided lunch to targeted children with one-dish indigenous vegetable recipe, but School 1 received iron-fortified rice whereas School 2 was provided ordinary rice. Eighty wasted and/or anaemic children in each school were fed for 120 days. Nutrition education for children's parents was done every school card claim day and during parent-teacher meetings using 10 developed modules. Weight, height, and haemoglobin level of children and KAP of mothers were measured at baseline and endpoint using standard techniques. KAP of mothers who had completed more than six modules had significantly increased from baseline to endpoint: Negative consequence of worm infestation (33.3% to 60.6%, P = 0.035), importance of serving breakfast for children (42.4% to 78.8%, P = 0.004), cooking vegetables (63.6% to 93.9%, P = 0.002), and purchasing fortified foods was recorded (51.5% to 93.9%, P = 0.000). Children in School 1 had significantly higher weight gain (1.33 ± 0.72) and haemoglobin level (0.49 ± 0.99) than children in School 2 (0.84 ± 0.59; 0.12 ± 0.70). Nutrition education resulted to significant increase of mother's KAP and the implementation of the integrated school-based nutrition model significantly improved children's nutritional status.

Iron absorption from NaFeEDTA-fortified oat beverages with or without added vitamin C.

BACKGROUND: Food fortification is the best long-term approach for reducing the incidence of iron deficiency. OBJECTIVE: To determine iron absorption from NaFeEDTA-fortified oat beverages without and with vitamin C. MATERIALS AND METHODS: Iron absorption in 19 apparently healthy 6-year-old children was studied. Two oat beverages fortified with iron (labeled with stable isotopes of NaFeEDTA), zinc, and vitamin A, without and with vitamin C was consumed in two consecutive days in random order. Blood samples were taken 14 days later for stable isotope measurements. RESULTS: The mean fractional iron absorption from the fortified oat beverage without vitamin C (5.65 ± 0.54%) was significantly lower than that from the beverage with vitamin C (7.14 ± 0.90%; p < 0.05). CONCLUSION: Fortified oat beverages may offer a convenient and effective mechanism to improve the iron status of children. The addition of vitamin C improved iron absorption by an additional 1.5%.

Establishing desirable fortificant levels for calcium, iron and zinc in foods for infant and young child feeding: examples from three Asian countries.

We used the World Health Organization's recommended procedures to establish desirable fortificant levels for three problem micronutrients in children's diets, based on dietary data collected earlier from Filipino (n = 1374; 6-36 months), Mongolian (n = 179; 12-36 months) and Cambodian (n = 177; 12-36 months) children. Prevalence of inadequate and excessive intakes of calcium and zinc (via cut-point method) and iron (via full-probability approach) was assessed after adjusting usual intake distributions with pc-side using internal or external within-person variances from Filipino (calcium and iron) and US National Health And Nutrition Examination Survey III (zinc) national surveys. Fortificant levels were determined by repositioning usual intake distributions so that the 2.5th percentile of the targeted populations equalled the estimated average requirement (calcium, zinc) or so that full-probability prevalence was no larger than 2.5% (iron). Prevalence of inadequate intakes was ≥70% for calcium and iron, except Filipino infants (30% for Ca) and Cambodian toddlers (41% for Fe); but <1% for zinc for toddlers in Mongolia and 20% in Cambodia. Prevalence of excessive intakes was <1% for zinc, calcium and iron, except for Mongolian toddlers (11% for Zn). Desirable fortificant levels, although apparently negligible for zinc, were 530-783 mg for calcium and 10.8-22.8 mg for iron (per 100 g). Fortificant levels can be estimated from 24-h recalls, preferably by applying internal within-person variances. Fortification with calcium and iron was necessary, but seemingly not for zinc, despite a high prevalence of low serum zinc, suggesting the need for better defined cut-offs for population risk of zinc deficiency based on dietary zinc intake and/or serum zinc.

Socio-demographic Determinants of Filipino Consumers Reading Food Product Labels and Nutrition Facts: Findings from the 2018-2019 ENNS.

Objectives: While food product labelling is deemed important in providing consumer information, little is known about the characteristics of those reading and not reading. This study aimed to determine the socio-demographic characteristics of Filipino adult consumers reading and not reading food product labels and nutrition facts to provide insights on their understanding and usage of food labels that may help in designing better label formats of packaged foods and related health education campaigns. Methods: Cross-sectional design using secondary data from the Expanded National Nutrition Survey (ENNS) 2018-2019 was employed. A survey form on Reading Food Product Labels and Nutrition Facts in the ENNS 2018-2019 were collected through face-to-face interviews. Descriptive statistics, test of proportions, and logistic regression were done using Stata version 16. Results: Always reading product labels were reported only by 19.6% of adult consumers, 18 years old and above, while 45.9% reported not reading food product labels. Among those who read food product labels, only 16.7% reported reading nutrition facts. Higher proportions of adults reading nutrition facts were found among those who attained a higher educational level, were less than 40 years old, living in urban residences, and belonging to higher wealth status. 'Not interested' was the top reason of adults who reported not reading nutrition facts. Conclusion: Reading product labels and nutrition facts is not common among Filipino adults. Being not interested was the top reason for not reading food product labels. Older persons, adults with low educational attainment, and belonging to poor households were more likely to not read food product labels and not influenced by nutrition facts which imply the need for a food label format that would cater to those who cannot or have difficulty reading food labels and nutrition facts. An intensified campaign on the importance of reading food product labels is also needed.

Burden of micronutrient deficiencies by socio-economic strata in children aged 6 months to 5 years in the Philippines.

BACKGROUND: Micronutrient deficiencies (MNDs) are a chronic lack of vitamins and minerals and constitute a huge public health problem. MNDs have severe health consequences and are particularly harmful during early childhood due to their impact on the physical and cognitive development. We estimate the costs of illness due to iron deficiency (IDA), vitamin A deficiency (VAD) and zinc deficiency (ZnD) in 2 age groups (6-23 and 24-59 months) of Filipino children by socio-economic strata in 2008. METHODS: We build a health economic model simulating the consequences of MNDs in childhood over the entire lifetime. The model is based on a health survey and a nutrition survey carried out in 2008. The sample populations are first structured into 10 socio-economic strata (SES) and 2 age groups. Health consequences of MNDs are modelled based on information extracted from literature. Direct medical costs, production losses and intangible costs are computed and long term costs are discounted to present value. RESULTS: Total lifetime costs of IDA, VAD and ZnD amounted to direct medical costs of 30 million dollars, production losses of 618 million dollars and intangible costs of 122,138 disability adjusted life years (DALYs). These costs can be interpreted as the lifetime costs of a 1-year cohort affected by MNDs between the age of 6-59 months. Direct medical costs are dominated by costs due to ZnD (89% of total), production losses by losses in future lifetime (90% of total) and intangible costs by premature death (47% of total DALY losses) and losses in future lifetime (43%). Costs of MNDs differ considerably between SES as costs in the poorest third of the households are 5 times higher than in the wealthiest third. CONCLUSIONS: MNDs lead to substantial costs in 6-59-month-old children in the Philippines. Costs are highly concentrated in the lower SES and in children 6-23 months old. These results may have important implications for the design, evaluation and choice of the most effective and cost-effective policies aimed at the reduction of MNDs.

Do school-based nutrition interventions improve the eating behavior of school-age children?

BACKGROUND/OBJECTIVES: Filipino children aged 6-10 yrs are consuming poor quantities and quality of food based on the 2013 Philippine National Nutrition Survey. During these years healthy eating habits must be formed through family influence. Within this background, a complete package of nutrition intervention-feeding and nutrition classes, was pilot tested in selected schools to determine 1) changes in nutrition attitude and behavior and 2) food intake of schoolchildren after the intervention. SUBJECTS/METHODS: A quasi-experimental design was used in the study. School children aged 7-9 yrs enrolled in selected Philippine public elementary schools and their mothers/caregivers were the study participants. Profile and socio-demographic data were collected from each participant at baseline. The nutrition behavior and food intake of children were determined using the modified Child and Diet Evaluation Tool (CADET) and the 24-h food recall form, respectively. Data were analyzed using Stata version 15. RESULTS: No significant differences in characteristics were found among the 339 child-mother pairs in the 4 study groups. The modified CADET recorded improved mean attitude scores of children ranging from 22 to 24 points at endline in the group receiving both lunch feeding and nutrition education classes (group 3). The perceived better behavior of children was reported by their mothers in terms of increased intake of milk and vegetables and decreased consumption of sugar. These improvements were supported by the actual food intake of children obtained from the 24-h food recall. CONCLUSIONS: Family involvement, particularly of mothers/caregivers, appeared to be an important factor in shaping the children's eating behavior. An intervention package with lunch feeding and nutrition classes resulted in a substantial improvement in children's behavior and actual food intake with increased levels of vegetables and milk while lowering sugar consumption. The adoption of the intervention package in public elementary schools should therefore be pursued.

Filipino Children with High Usual Vitamin A Intakes and Exposure to Multiple Sources of Vitamin A Have Elevated Total Body Stores of Vitamin A But Do Not Show Clear Evidence of Vitamin A Toxicity.

Background: Young children exposed to high-dose vitamin A supplements (VAS) and vitamin A (VA)-fortified foods may be at risk of high VA intake and high VA total body stores (TBS). Objectives: TBS and estimated liver VA concentration were compared among children with adequate or high VA intake and different timing of exposure to VAS, and associations between estimated liver VA concentrations and biomarkers of VA toxicity were examined. Methods: Children 12-18 mo of age (n = 123) were selected for 3 groups: 1) retinol intake >600 µg/d and VAS within the past mo, 2) retinol intake >600 µg/d and VAS in the past 3-6 mo, and 3) VA intake 200-500 µg retinol activity equivalents (RAE)/d and VAS in the past 3-6 mo. Dietary intake data were collected to measure VA intakes from complementary foods, breast milk, and low-dose, over-the-counter supplements. TBS were assessed by retinol isotope dilution, and VA toxicity biomarkers were measured. Main outcomes were compared by group. Results: Mean (95% CI) VA intakes excluding VAS were 1184 (942, 1426), 980 (772, 1187), and 627 (530, 724) µg RAE/d, in groups 1-3, respectively; mean VA intake was higher in groups 1 and 2 compared with group 3 (P < 0.05). Geometric mean (GM) (95% CI) TBS were 589 (525, 661), 493 (435, 559), and 466 (411, 528) µmol, respectively. GM TBS and GM liver VA concentrations were higher in group 1 compared with group 3 (liver VA concentration: 1.62 vs. 1.33 µmol/g; P < 0.05). Plasma retinyl ester and 4-oxo-retinoic acid concentrations and serum markers of bone turnover and liver damage did not indicate VA toxicity. Conclusions: In this sample, most children had retinol intakes above the Tolerable Upper Intake Level (UL) and liver VA concentrations above the proposed cutoff for "hypervitaminosis A" (>1 µmol/g liver). There was no evidence of chronic VA toxicity, suggesting that the liver VA cutoff value should be re-evaluated. This trial was registered at www.clinicaltrials.gov as NCT03030339.

Virgin coconut oil is effective in lowering C-reactive protein levels among suspect and probable cases of COVID-19.

Understanding the complex pathogenesis of COVID-19 continues to evolve. With observation and quarantine as the prevailing standard of care, this study evaluated the effects of virgin coconut oil (VCO) in the biochemical markers of suspect and probable cases of COVID-19. A 28-day randomized, double-blind, controlled intervention was conducted among 63 adults in two isolation facilities in Santa Rosa City, Laguna, Philippines. The participants were randomly assigned to receive either a standardized meal (control) or a standardized meal mixed with a predefined dosage of VCO. Changes in clinical markers were measured at three time points (day 0, 14, and 28), with daily monitoring of COVID-19 symptoms. Participants in the intervention group showed a significant decline in the C-reactive protein level, with the mean CRP level normalized to ≤ 5 mg/dL on the 14th day of the intervention. As an adjunct therapy, meals mixed with VCO is effective fostering faster recovery from COVID-19.

High-calcium milk prevents overweight and obesity among postmenopausal women.

BACKGROUND: The Sixth National Nutrition Survey 2003 revealed that the highest prevalence of overweight and obesity among Filipino female adults (30.8%) was found in the age group from 40 to 59 years. Obesity is associated with a number of chronic diseases, including cardiovascular disease, hypertension, and diabetes. Low calcium intake has been identified as a potential contributing factor to overweight and obesity. OBJECTIVE: To assess the effect of a high-calcium,fortified, low-fat milk drink with added vitamin D versus a low-calcium placebo drink on anthropometric measurements of postmenopausal women. METHODS: Women who were at least 5 years postmenopausal were invited to participate in the study. Potential participants underwent three stages of screening: initial interview, dual-energy x-ray absorptiometry, and blood testing for biochemical screening. Anthropometric indices were measured at baseline and the end of the study. Sixty women were qualified to participate in the study. The women were randomly assigned to two groups, one of which received 400 ml of the high-calcium milk daily for 16 weeks while the other received the placebo drink. RESULTS: No significant increases were observed in the anthropometric indices of the subjects receiving the high-calcium fortified milk at the end of the study. However, there were significant increases in the weight (p = .008), body mass index (p = .007), and waist (p = .018) and hip (p = .003) circumferences of the subjects receiving the placebo drink. CONCLUSIONS: A change in dietary calcium intake may be a useful measure as part of an overall approach to prevent the occurrence of overweight and obesity among postmenopausal women.

The Nutritional Impact of Milk Beverages in Reducing Nutrient Inadequacy among Children Aged One to Five Years in the Philippines: A Dietary Modelling Study.

Around half of Filipino children are not consuming any dairy products on a given day, which has shown to be associated with increased risk of inadequate nutrient intakes. The current study applies dietary modelling to assess the nutritional impact of meeting dairy recommendations in reducing nutrient inadequacy in children aged one to five years in the Philippines. Dietary intake data of Filipino children aged one to five years (n = 3864) were analyzed from the 8th National Nutrition Survey 2013. Children who did not meet national dairy recommendations were identified. Two scenarios were applied, based on two types of commonly consumed milk products by the survey participants. In scenario one, one serving of powdered milk was added to the diet of these children. In scenario two, one serving of a young children milk (YCM) or preschool children milk (PCM) was added to the diet of children aged one to two years and three to five years, respectively. Mean nutrient intakes and percentages of children with inadequate intakes were estimated before and after applying modelling scenarios. Scenario one demonstrated improvement in calcium, phosphorus, sodium, vitamin A and riboflavin intakes, while in scenario two, further improvement of intakes of a wider range of nutrients including iron, selenium, zinc, magnesium, potassium, vitamins C, D, E, thiamin, niacin, vitamins B6, and B12 was observed. In both scenarios, if all children would meet their dairy recommendations, theoretical reductions in population nutrient inadequacy would be observed for all micronutrients, for example, only 20% of children aged one to two years would be inadequate in vitamin A instead of the current 60%, iron inadequacy would see a 5% reduction, and approximately 10% reduction for calcium and 20% reduction for folate. The present study is the first to apply dietary modelling to assess the theoretical impact of meeting dairy recommendations on nutrient inadequacy in children in the Philippines. Dairy consumption should be encouraged as part of the strategy to reduce nutrient inadequacies. Calcium, iron, vitamins D, E, and folate are of concern in the Philippines as the level of inadequacies are extremely high in early years, YCM and PCM can help increase the intake of these nutrients.

Contribution of Milk Beverages to Nutrient Adequacy of Young Children and Preschool Children in the Philippines.

Malnutrition is a major public health concern in the Philippines. Milk and dairy products are important sources of energy, protein, and micronutrients for normal growth and development in children. This study aims to assess the contribution of different types of milk to nutrient intakes and nutrient adequacy among young and preschool children in the Philippines. Filipino children aged one to four years (n = 2992) were analysed while using dietary intake data from the 8th National Nutrition Survey 2013. Children were stratified by age (one to two years and three to four years) and by milk beverage consumption type: young children milk (YCM) and preschool children milk (PCM), other milks (mostly powdered milk with different degrees of fortification of micronutrients), and non-dairy consumers (no milks or dairy products). The mean nutrient intakes and the odds of meeting nutrient adequacy by consumer groups were compared, percentage of children with inadequate intakes were calculated. Half (51%) of Filipino children (all ages) did not consume any dairy on a given day, 15% consumed YCM or PCM, and 34% consumed other milks. Among children one to two years, those who consumed YCM had higher mean intakes of iron, magnesium, potassium, zinc, B vitamins, folate, and vitamins C, D, and E (all p < 0.001) when compared to other milk consumers. Non-dairy consumers had mean intakes of energy, total fat, fibre, calcium, phosphorus, iron, potassium, zinc, folate, and vitamins D and E that were far below the recommendations. Children who consumed YCM or PCM had the highest odds in meeting adequacy of iron, zinc, thiamin, vitamin B6, folate, and vitamins C, D, and E as compared to other milks or non-dairy consumers, after adjusting for covariates. This study supports the hypothesis that dairy consumers had higher intakes of micronutrients and higher nutrient adequacy than children who consumed no milk or dairy products. Secondly, YCM or PCM have demonstrated to be good dairy options to achieve nutrient adequacy in Filipino children.

Complementary feeding patterns of Filipino infants and toddlers lack diversity, especially among children from poor households.

BACKGROUND: Consumption of nutritionally adequate complementary foods is essential for optimal growth and development of infants and toddlers, including those in developing countries. The aim of this study was to describe the food and beverage consumption patterns among 6-23.9 month old Filipino infants and toddlers, by household wealth. METHODS: Data from 1087 infants and toddlers from the 2013 National Nutrition Survey were included. Dietary intake data was assessed using a 24Hr recall and population food intakes were stratified into pre-defined wealth categories. RESULTS: Breast milk, infant formula, powdered milk and rice were the most commonly consumed foods and beverages across the age groups. Several differences in complementary feeding by wealth status were observed. Infants from poor households (69%) reported significantly greater consumption of human milk, than those from rich households (42%) who reported a significantly greater consumption of infant/toddler formula (Poor: 22%, Rich: 56%) (P < 0.05). A higher percentage of toddlers from rich households consumed protein-containing foods, cookies and cakes. There was a significant difference in vegetable consumption in 12-17.9 month old children (Poor: 17%, Rich: 31%; P = 0.021). Human milk and formula were the top contributors to energy in 6-17.9 month old children, while rice was the top energy contributor in 18-23.9 month old children. CONCLUSION: Milk and rice were the main dietary components in all Filipino children, contributing up to 60% of energy in the infants from poorer households. Consumption of protein-containing foods and vegetables were typically lower in poorer households. Interventions are required to enable caregivers of young Filipino children to provide complementary foods of high nutritional quality, particularly among children from the poor households.

Process Evaluation of Nutrition Intervention Strategy in a Local Philippine Setting.

Aims: Undernutrition among 0 to 5 years old children remains a public health problem in the Philippines. This process evaluation study documented and examined the implementation of an intervention strategy for young children. Methods: Complementary feeding of 6-month to 2-year-old children was implemented for 120 days by the municipalities of Plaridel and Pulilan in Bulacan, Philippines utilizing local-based food made of rice and mung bean along with nutrition education classes among mothers/caregivers using the developed nutrition modules. A total of 121 mother-/caregiver-child pairs were the program participants of the intervention. Pre-post design were used in the analysis of quantitative data. Qualitative data were encoded verbatim manually using emerging themes. Key informant interviews among community workers and municipal officials and focus group discussions among mothers/caregivers and community workers were conducted to gather the needed data. Results: The municipalities adhered to the program phases of planning, organizing, implementation, monitoring, and evaluation. At end-line, the weight of children participants increased in both municipalities and the mean nutrition knowledge scores of mothers/caregivers increased significantly (P < .05). Conclusions: This process evaluation confirmed that the proposed nutrition intervention strategy for young children can be implemented at the local level. The strong support and active cooperation of the local program implementers and mothers/caregivers and adherence to program requirements were the key factors in the efficient implementation of the intervention. For sustainability, the passing of local ordinance for the adoption of intervention and budget support for implementation of the intervention is recommended.

Philippines Case Study: Government Policies on Nutrition Education.

Government policies at the national and local levels are central to the promotion, protection, and implementation of sound food and nutrition concepts in the Philippines. According to the 2015 national nutrition survey, persistent malnutrition problems, such as protein-energy malnutrition and micronutrient deficiencies (anemia, vitamin A deficiency, and iodine-deficiency disorders), continue to afflict a major proportion of Filipinos. In the Philippines, nutrition education and promotion date back as early as 1900 with the conduct of educational campaigns directed towards the prevention and control of epidemic diseases and to the care and feeding of young infants. This presentation begins with an overview of the Philippine Government, nutritional status of children, the Philippine Plan of Action for Nutrition, then devotes substantial attention to nutrition program for school children, and examines other potential legislative actions that may have an impact on the community and industry. While various nutrition education initiatives, addressing malnutrition problems among Filipinos, resulted in an improvement in some of the conditions, much is still to be done to achieve zero malnutrition for the Philippines. Eliminating hunger and malnutrition is technically feasible. The challenge lies in generating the requisite political will, developing realistic policies, and taking concerted actions nationally and internationally.

Usual Energy and Nutrient Intakes and Food Sources of Filipino Children Aged 6-12 Years from the 2013 National Nutrition Survey.

Usual energy and nutrient intakes and food sources were evaluated in school-aged children in the Philippines using data from the 2013 National Nutrition Survey. A total of 6,565 children 6-12 years old from all sampled 8,592 households were interviewed for a 24-h dietary recall (first day). A second-day recall was obtained from a random subsample (50% of children). Usual energy and nutrient intakes were estimated using the PC-SIDE program. Energy intake was compared with estimated energy requirements (EER) considering an active activity level. Macronutrients were evaluated using acceptable macronutrient distribution ranges. Micronutrient inadequacies were computed using the estimated average requirement cutoff point method. Mean energy intake was 24.6% below the EER. A high prevalence of nutrient inadequacy was found: protein 16%, thiamine 55%, riboflavin 67%, vitamin C 81%, vitamin A 63%, vitamin B6 30%, vitamin B12 9%, folate 70%, calcium 93%, phosphorous 48%, iron 87%, and zinc 38%. Rice was the major food source of energy (52.7%), carbohydrates (67.4%), and protein (35.2%). Rice also contributed a high proportion of daily phosphorous, calcium, thiamine, riboflavin, and iron. This study demonstrated that intakes of many micronutrients of Filipino school children were markedly inadequate. Refined rice was the major food source of energy and nutrients.