The Role of Micronutrients in Ageing Asia: What Can Be Implemented with the Existing Insights.

Life expectancy as a measure of population health does not reflect years of healthy life. The average life expectancy in the Asia-Pacific region has more than doubled since 1900 and is now above 70 years. In the Asia-Pacific region, the proportion of aged people in the population is expected to double between 2017 and 2050. Increased life expectancy leads to an increase in non-communicable diseases, which consequently affects quality of life. Suboptimal nutritional status is a contributing factor to the prevalence and severity of non-communicable diseases, including cardiovascular, cognitive, musculoskeletal, immune, metabolic and ophthalmological functions. We have reviewed the published literature on nutrition and healthy ageing as it applies to the Asia-Pacific region, focusing on vitamins, minerals/trace elements and omega-3 fatty acids. Optimal nutritional status needs to start before a senior age is reached and before the consequences of the disease process are irreversible. Based on the nutritional status and health issues in the senior age in the region, micronutrients of particular importance are vitamins A, D, E, C, B-12, zinc and omega-3 fatty acids. The present paper substantiates the creation of micronutrient guidelines and proposes actions to support the achievement of optimal nutritional status as contribution to healthy ageing for Asia-Pacific populations.

Overcoming the Trans Fat Problem in Thailand.

BACKGROUND: Owing to the clear impact of trans fatty acids (TFAs) on cardiovascular disease, Thailand urgently needs to evaluate the problem and formulate appropriate policies in order to protect the health of its own people and to benefit exportation. Since 9 January, 2019, Thailand's FDA has not allowed the use of partially hydrogenated oils (PHOs) in foods. OBJECTIVE: The aim of this study was to evaluate the situation and potential health risk from TFAs in foods available in Thailand, changes in fatty acid profiles upon replacement of PHOs, as well as to propose control measures for TFAs in the country. METHODS: A total of 176 food samples representing potential sources of TFAs were analyzed for fatty acid profiles, which were later used to evaluate potential health risk based on Thailand's Food Consumption Survey data and the FAO/WHO Guideline on Diet, Nutrition and the Prevention of Chronic Diseases (FAO/WHO guideline). Criteria for postmarketing monitoring of TFAs in food products were also proposed. RESULTS: TFAs were naturally highest in butter (5%) but lower than the limit in the FAO/WHO guideline regarding consumption pattern. TFAs in refined cooking oils were 0.4-0.8%, which was below the European Union (EU) legislative limit. Bakery products, i.e., puffs, pies, and deep-fried donuts, that used PHOs contained 3-5% TFAs and were the main sources of TFAs in Thailand. The postmarketing monitoring process should be based on the FAO/WHO guideline and EU legislative limit for TFAs. The PHOs in bakery products could be replaced with blended oils, although saturated fatty acids might increase. CONCLUSIONS: Thailand's TFA problem was mainly due to the use of PHOs in bakery products. It is feasible to replace PHOs with blended oils. The international TFA limits should be used for the postmarketing monitoring of TFAs in foods on the market.

Fructans in the first 1000 days of life and beyond, and for pregnancy.

Inulin-based prebiotics are non-digestible polysaccharides that influence the composition of the gut microbiota in infants and children, notably eliciting a bifidogenic effect with high short chain fatty acid levels. Inulin, a generic term that comprises ß-(2,1)-linked linear fructans, is typically isolated from the chicory plant root, and derivatives such as oligofructose and long chain inulin appear to have different physiological properties. The first 1000 days of a child's life are increasingly recognized as a critical timeframe for health also into adulthood, whereby nutrition plays a key role. There is an ever increasing association between nutrition and gut microbiota composition and development, with life health status of an individual. This review summarizes the latest knowledge in the infant gut microbiota from preterms to healthy newborns, as well as in malnourished children in developing countries. The impact of inulin or mixtures thereof on infants, toddlers and young children with respect to intestinal function and immunity in general, is reviewed. Possible benefits of prebiotics to support the gut microbiome of malnourished infants and children, especially those with infections in the developing world, are considered, as well as for the pregnant mothers health. Importantly, novel insights in metabolic programming are covered, which are being increasing recognized for remarkable impact on long term offspring health, and eventual potential beneficial role of prebiotic inulins. Overall increasing findings prompt the potential for gut microbiota-based therapy to support health or prevent the development of certain diseases from conception to adulthood where inulin prebiotics may play a role.

Nutrient Recommendations for Growing-up Milk: A Report of an Expert Panel.

Utilization of expert recommendations in the development of food and beverage nutritional profiles represents an opportunity to merge science and food manufacturing to deliver nutritionally optimized products into the marketplace. This report details expert panel guidelines for the design of a nutritional product for children one to six years of age. This interaction demonstrates the essential synergy between academia and food manufacturers in translating nutrient recommendations to food for their delivery to a population. Important factors for such translation are the identification of applicable nutrient recommendations and selection of an appropriate delivery matrix. This report demonstrates the translation of expert nutritional recommendations to a milk-based product for children--one to six years of age.

Composition of Follow-Up Formula for Young Children Aged 12-36 Months: Recommendations of an International Expert Group Coordinated by the Nutrition Association of Thailand and the Early Nutrition Academy.

BACKGROUND: There are no internationally agreed recommendations on compositional requirements of follow-up formula for young children (FUF-YC) aged 1-3 years. AIM: The aim of the study is to propose international compositional recommendations for FUF-YC. METHODS: Compositional recommendations for FUF-YC were devised by expert consensus based on a detailed literature review of nutrient intakes and unmet needs in children aged 12-36 months. RESULTS AND CONCLUSIONS: Problematic nutrients with often inadequate intakes are the vitamins A, D, B12, C and folate, calcium, iron, iodine and zinc. If used, FUF-YC should be fed along with an age-appropriate mixed diet, usually contributing 1-2 cups (200-400 ml) of FUF-YC daily (approximately 15% of total energy intake). Protein from cow's milk-based formula should provide 1.6-2.7 g/100 kcal. Fat content should be 4.4-6.0 g/100 kcal. Carbohydrate should contribute 9-14 g/100 kcal with >50% from lactose. If other sugars are added, they should not exceed 10% of total carbohydrates. Calcium should provide 200 mg/100 kcal. Other micronutrient contents/100 kcal should reach 15% of the World Health Organization/Food and Agriculture Organization recommended nutrient intake values. A guidance upper level that was 3-5 times of the minimum level was established. Countries may adapt compositional requirements, considering recommended nutrient intakes, habitual diets, nutritional status and existence of micronutrient programs to ensure adequacy while preventing excessive intakes.

Food based dietary guidelines (FBDGs) development and promotion in Thailand.

Dietary guidelines based on 5 food groups was used as a main nutrition education tool until 1996 when food based dietary guidelines (FBDGs) were promoted after 2 years of formulation and development. These FBDGs for the general population were designed to promote desirable and culturally acceptable eating behavior. The nine qualitative guidelines of Thai FBDGs include: 1. eat a variety of foods from each of the five food groups and maintain proper weight, 2. eat adequate rice, or alternate carbohydrate, 3. eat plenty of vegetables and fruits regularly, 4. eat fish, lean meats, eggs, legumes and pulses regularly, 5. drink sufficient amount of milk every day, 6. take moderate amounts of fat, 7. avoid excessive intake of sweet and salty foods, 8. eat clean and uncontaminated foods, and 9. avoid or reduce consumption of alcoholic beverages. In 1998, the quantitative part of Thai FBDGs or food guide model was established as "Nutrition Flag" after rigorous test for understanding and acceptability among consumers. Promotion and dissemination of the Thai FBDGs have been carried out at national and community levels through basic health, agricultural and educational services and training activities, as well as periodic campaigning via multiple communication channels and media. Recently in 2009, the FBDGs for infant and preschool children were introduced to replace the previous infant and young child feeding guidelines. There has been no formal evaluation on the impact of promotion of the Thai FBDGs but some periodic testing of knowledge and practices have shown positive results.

Waist circumference and body fat distribution indexes as screening tools for the overweight and obesity in Thai preschool children.

BACKGROUND: Evidence shows that waist circumference (WC) is one reliable index to predict abdominal obesity in children. This study aims to examine the relationship of WC to other anthropometric indexes and to determine the ability of WC as obesity screening tool. SUBJECTS: 811, 5-6 years old children in Saraburi province, central region of Thailand. METHODS: Anthropometric measurements were performed in children; 406 boys and 405 girls. WC measurement was performed at the umbilicus level. Subcutaneous skinfold was measured on subscapular, suprailiac and abdominal regions. Total body fat was measured with bioelectrical impedance analyzer. Receiver operating characteristic (ROC) analysis was employed to determine WC cut-offs for predicting obesity in children. RESULTS: WC highly correlated with weight-for-height Z-score (WHZ) (r = 0.92-0.94, p = 0.01), body mass index (BMI) (r = 0.95-0.96, p = 0.01), trunk skinfold (r = 0.92-0.93, p = 0.01) and total body fat (r = 0.94-0.95, p = 0.01) for both genders. Based on Thai national reference, the optimal WC cut-offs for predicting obesity were 59.6 cm for boys and 60.5 cm for girls. When IOTF-BMI was employed as reference, WC thresholds were 64.4 cm for boys and 63.1 cm for girls. The latter WC cut-offs provided the slightly underestimated obesity prevalence compared with national reference. CONCLUSION: The strongly positive correlation between WC and weight-height based index and between WC and body fat in Thai preschool children suggests that WC should be the additional index for obesity screening in young children. Further study needs to explore the association between the increased WC and other adverse health outcomes.

Community based approaches to prevent and control malnutrition.

Community based nutrition programmes (CBNP) are increasingly being seen as a key turning point in implementation strategies leading to food and nutrition improvement as a sound basis for socio-economic development. In order to be effective and successful, CBNP require a constellation of methods and services planned from the community along with policy support for effective implementation, reaching the unreachable and empowering those at the grass roots. These also need to be guided and monitored using a set of indicators such as essential minimum needs indicators specific to the community's needs. The community based approach has also been embraced at the global level with the Millennium Development Goals, advocating achieving a set of eight goals ranging from reducing poverty and hunger to improving educational opportunities for all children and forming stronger global partnerships for development. Lessons learned from CBNP in Asia show that in order to be effective, the programmes must be adopted at national level and implemented at community level. National level leadership and commitment to sound nutrition improvement policies and goals, must be combined with basic services, mass mobilization, people empowerment and actions at community level.

Food-based strategies to meet the challenges of micronutrient malnutrition in the developing world.

The purpose of the present paper is to review the evidence in favour of food-based strategies to meet the challenges of micronutrient malnutrition in the developing world. Increasing dietary diversification is the most important factor in providing a wide range of micronutrients, and to achieve this objective in a development context requires an adequate supply, access and consumption of a variety of foods. Diets in developing countries generally lack many nutrients, including energy (inadequate amounts of food), so that strategies need to also emphasize an increase in total food intake, in addition to a greater variety. Agricultural and food policies tend to be oriented to primary agricultural productions, but they could also be formulated to promote and support home gardens and small livestock production for the explicit purpose of increasing the household consumption of micronutrient-rich foods. The adoption of 'desirable' dietary patterns for nutrition improvement, e.g. appropriately formulated to meet micronutrient needs, could be used in the formulation of agricultural policies and programmes. This process could be achieved through support for integrated farming systems oriented to assuring household food security, but also based on a variety of foods that will meet total dietary (including micronutrient) needs. Thus, availability of energy-rich staples, animal and/or fish as major sources of protein, and vitamin-, mineral- and phytonutrient-rich fruit and vegetables could constitute the types of production envisaged. The cultivation of edible indigenous plants as additional sources of micronutrients could also be added. The low bioavailability of some key micronutrients from foods, such as Fe, are substantially enhanced with the right food combinations and with appropriate food processing and preparation techniques. Simple appropriate technology for the preservation of micronutrient-rich foods would need further development and promotion for their year-round availability. Linking community development policies to national programmes for the alleviation of hunger and malnutrition, with an emphasis on increasing the variety of foods consumed, is probably the best strategy for improving micronutrient malnutrition sustainably.

Policy and sustainability issues.

The need for combined and integrated strategies to address iron deficiency is widely recognized, utilizing targeted supplementation, as well as food based strategies including both fortified and nonfortified foods. The challenge is not so much knowing "what" to do as is understanding "how" to implement effective and sustainable interventions. Because the causes of iron and other micronutrient deficiencies are complex, including inadequate food intake, unsanitary conditions and inadequate health services, the solutions may also be complex, requiring multisectoral and interdisciplinary approaches. Top-down strategies are unlikely to be effective and sustainable. Rather, the beneficiaries of the program at the community level must be able to understand malnutrition in simple terms, to envisage potential solutions and to become "demanders" of services. The experience in Thailand provides an example of a country-wide, community-based and participatory approach utilizing facilitators and motivators at the local level to implement and sustain interventions. The experience in Thailand indicates the potential for developing effective and sustainable interventions to address iron deficiency and other micronutrient problems as part of a broad, community-based effort.