DIETARY REFERENCE INTAKES (DRIS) FOR MONGOLIANS

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1 DIETARY REFERENCE INTAKES (DRIS) FOR MONGOLIANS Tuyatsetseg Jambal, Ph.D School of Industrial Technology, Mongolian University of Science & Technology,

2 Outline Background Mongolian DRIs Briefly report of National Nutrition Surveys Conclusion

3 Background 1,564,116 square kilometres Population: 3.1 million

4 Background Recommended Dietary Allowances (RDAs): National Center for Public Health, Ministry of Health (MOH)

5 DRIs Based on evidence: National Nutrition Survey Addressed to the main public health problem for population Recommended and guided the practice to obtain the Balanced Diet in household daily.

6 Comparison of RDAs Standard person: adult, yo, male 1981 Calories: 3000 kcals 1997 Calories: 2600 kcals, protein: 98g, fat: 72g, CHO:390g Calories: 2500 kcals, protein: 94g, fat: 69g, CHO:375g Calories: 2400 kcals, protein: 90g, fat: 67g, CHO:360g CHO: carbohydrate

7 Comparison of RDAs Calories by RDA version Ratio: 100 : 15 : 25 : 60 (cal : pro : fat : CHO) The last version of RDA is comparing and conclusion with National Nutrition Surveys. Cal: calories Pro: protein CHO: carbohydrate

8 Dietary guideline 2000, the first edition of dietary guidelines for Mongolian was established and published Ger (traditional house) guidelines. Nutrition Research Center and MOH

9 Dietary guideline

10

11 Health status

12 Five leading causes of morbidity, , per population Source: Health indicators 2016, Center for Health Development

13 Arterial hypertension accounts for 50.0% of all diseases of the circulatory system, which is per population. By gender, there were for females and for males per population. Diabetes accounted for 48.9% of all diseases of endocrine, nutritional and metabolic disorders and it was 78.6 per population in 2016 which increased by 14.8, compared to the previous year. By gender, there were 75.5 for males and 82.9 for female per population.

14 Five leading causes of mortality, , per population

15 Health status Morbidity, Diseases of the respiratory system 2. Diseases of the digestive system 3. Diseases of the circulatory system 4. Diseases of urinary system 5. Injury, poisoning and certain other consequences of external causes Mortality, Diseases of the circulatory system 2. Neoplasms 3. Injury, poisoning and certain other consequences of external causes 4. Diseases of the digestive system 5. Diseases of respiratory system

16 National Nutrition Surveys To assess the nutrition status of Mongolian population. National Nutrition Survey (NNS) NNS I: 1992 NNS II: 1999 NNS III: 2004 NNS IV: 2010 NNS V: 2017 By MOH with support from international organization. Based on these findings, the government of Mongolia implemented various initiatives to reduce the burden of malnutrition including: breastfeeding promotion, child growth promotion, salt fortification with iodine for reduce iodine deficiency, moreover vitamin A, vitamin D and multi-micronutrient supplementation.

17 Nutrition status: malnutrition in children under 5 yo of age Underweight, wasting, stunting Overweight Prevalence of child obesity is 1.8 times higher in children with high birth weight, as compared to those with normal birth weight.

18 Nutrition status: anemia and iron deficiency in children under 5 yo of age

19 Nutrition status: vitamin A and D deficiency in children under 5 yo of age

20 Nutrition status: prevalence of overweight in woman 5 times higher than NNS IV Higher prevalence in older age

21 Nutrition status: prevalence of obesity in woman

22 Nutrition status: prevalence of anemia in woman Current prevalence of anemia in mothers is 16.2%, compared to 14.4% in the NNS IV. Comparative analysis indicated 1.8 percentage point increase in the prevalence of anemia in mothers 1549 years of age.

23

24 Nutrition status: prevalence of overweight and obesity among men

25 Prevalence of overweight and obesity among men year of age is 48.8%. At regional level, the highest prevalence is found in Western region at 53.3%. Prevalence of anemia among men was 3%. Mean serum ferritin concentration was 141 μg/l, indicating iron overload is less likely. Prevalence of vitamin D inadequacy among men is 82.3%, with vitamin D deficiency standing at 41.9%. Prevalence of vitamin A deficiency is 0.6%, with another 2.6% of men having insufficient amount of vitamin A. Survey results showed about 60% of men had minimally adequate dietary diversity, with percent distribution ranging from 47.9% among rural men to 40.2% in Eastern region.

26 Nutrition status: malnutrition among school children, 6-11 yo Percentage of stunted and wasted children, aged 6-11 years, in Mongolia are 7.3% and 2.8%, respectively. The prevalence of overweight and obesity in school children aged 6-11years sharply increased from 2010 NNS IV level and reached 22.2% and 6.4%, respectively.

27 Consumption of junk (high-calorie, low-nutrient) foods in the past week was nearly universal (99.0%) among children 6-11 years of age. Over half of children (51.4%) consumed junk foods at least once per week and 45.7% consumed junk foods a few times a week. Junk foods were consumed more frequently in urban (49.4%) compared to rural (35.7%) areas and was highest in Ulaanbaatar (53.3%) compared to the other regions (33.0% to 45.3%). Consumption of sugar-sweetened beverages was high with 80.9% of children consuming these at least once in the past week, 20.3% consuming them a few times per week and 4.1% of children consuming a sugar-sweetened beverage at least once per day. Higher consumption of sugar-sweetened beverages was reported in urban (82.6%) compared to rural (76.3%) areas with the highest consumption in Ulaanbaatar (85.8%) compared to other regions (69.6% to 79.5%). Consumption of sweet foods was high with nearly all children having consumed sweet foods in the past week, 45.9% of children 6-11 years having consumed sweet foods a few times per week and 6.1% of children consuming sweet foods at least once per day. In contrast to other junk foods, there was significant difference in consumption of sweet foods between urban and rural areas.

28 Conclusion The prevalence overweight and obesity has been increased among all age groups and do not difference between genders. Double-burden of malnutrition: micronutrient deficiency and obesity. Consumption of junk food and sweetened beverages had been increased quickly. To revise the RDAs for children and teenagers (protein recommendation). Dietary guideline: should be revise

29 RDA: 1997

30 Population group Calorie 2017 Life stage Age Sex (kcal) Infants Early childhood, adolescence Adult Senior, old age Pregnant woman Lactating woman Physically demanding workers Non-Physically demanding workers Calorie 2008 (kcal) Comparison now 0-6 month Male Female month Male Female age Male Female age Male Female age Male Female age Male Female age Male Female age Male Female age Male Female age Male Female First trimester Second trimester Third trimester month month Male Female Male Female

31 Population group Protein (g) Life stage Age Sex Comparison Infants Early childhood, adolescence Adult Senior, old age Pregnant woman Lactating woman Physically demanding workers Non-Physically demanding workers 0-6 month Male 10 - Female month Male 12 - Female age Male Female age Male Female age Male Female age Male Female age Male Female age Male Female age Male Female age Male Female First trimester Second trimester Third trimester month 91-6 month 85 - Male Female 90 - Male 79 - Female 61 -

32 Population group Life stage Age Sex Comparison Infants Early childhood, adolescence Fat (g) 0-6 month Male Female month Male Female age Male Female age Male Female age Male Female age Male Female age Male Female age Male Adult Senior, old age Pregnant woman Lactating woman Physically demanding workers Non-Physically demanding workers Female age Male Female age Male Female First trimester Second trimester Third trimester month 69-6 month 66 - Male 92 - Female 67 - Male 58 - Female 45 -

33 Population group Carbohydrate (g) Life stage Age Sex Comparison Infants Early childhood, adolescence Adult Senior, old age Pregnant woman Lactating woman Physically demanding workers 0-6 month Male 97 - Female month Male Female age Male Female age Male Female age Male Female age Male Female age Male Female age Male Female age Male Female age Male Female First trimester Second trimester Third trimester month month Male Female Non-Physically demanding workers Male Female 244 -

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