Maternal Dietary Intake and Nutritional Status in the Philippines: The 8 th National Nutrition Survey Results

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1 ILSI SEA Region Seminar on Maternal, Infant and Young Child Nutrition, July 24, 217, Bangkok, Thailand Maternal Dietary Intake and Nutritional Status in the Philippines: The 8 th National Nutrition Survey Results MARINA B. VARGAS, Ph.D. Supervising Science Research Specialist, Nutritional Assessment and Monitoring Division (NAMD) Food and Nutrition Research Institute- (FNRI-DOST) Dietary Assessment Survey: Units of Analysis Household Level Individual Level Anthropometric Nutrition Survey Dietary Assessment Survey (Household and Individual Levels) Biochemical Survey Infant and Young Child Feeding Practices and Maternal Nutrition Survey Clinical Nutrition & Health Survey Socioeconomics and Food Security Survey Government Program Participation Survey Philippines Region Wealth quintile Household Size Urban/Rural Location Pre-school children School children Elderly Pregnant women mothers

Thailand 213 Updating Survey SAMPLING DESIGN

Sample Multi-Stage Stratified Sampling Design 17

Sampling Unit One barangay or contiguous

of the NSO Master Sample randomly picked from the

replicate METHODOLOGY HOUSEHOLD: H OUSEHOLD: ONE

METHOD 2nd Stage Enumeration Area Contiguous area

Households INDIVIDUAL FOOD CONSUMPTION Actual

each meal before cooking, that is in raw form

Recall 2 Day Non-Consecutive 24-hr Food Recalls

2 ILSI SEA Region Seminar on Maternal, Infant and Young Child Nutrition, July 24, 217, Bangkok, Thailand 213 Updating Survey SAMPLING DESIGN Philippine Statistical Authority s (PSA) Master Sample Multi-Stage Stratified Sampling Design 17 Regions/ 8 Provinces st Stage Primary Sampling Unit One barangay or contiguous barangays with at least 5 households 4 replicates of the NSO Master Sample randomly picked from the national census Dietary survey covered 1% of 1 replicate METHODOLOGY HOUSEHOLD: H OUSEHOLD: ONE ONE-D DAY AY F FOOD OOD W WEIGHING EIGHING METHOD METHOD 2nd Stage Enumeration Area Contiguous area in a barangay with 15-2 households 3rd Stage Households INDIVIDUAL FOOD CONSUMPTION Actual weighing of food items that will be prepared for each meal before cooking, that is in raw form ANALYSIS OF FOOD INTAKE Method: 24-Hour Food Recall 2 Day Non-Consecutive 24-hr Food Recalls for all members of sample households included in the Household Food Consumption Survey

ILSI SEA Region Seminar on Maternal, Infant and Young Child Nutrition, July 24, 217, Bangkok, Thailand Coverage for Dietary Component by Population Groups: Philippines,213 Total Sample Individuals:

women 18 mothers 395 WOMEN OF REPRODUCTIVE AGE: PHILIPPINES, 213 Age/physiologic group Number of individuals covered Anthropometry Dietary Non-Pregnant/Non- 21,1 3,936, 15-18.

3 ILSI SEA Region Seminar on Maternal, Infant and Young Child Nutrition, July 24, 217, Bangkok, Thailand Coverage for Dietary Component by Population Groups: Philippines,213 Total Sample Individuals: 19,831 Age/population group Number of individuals covered Preschool children, 6m to 5y 2,222 Schoolchildren, 6 to 12y 3,386, 13 to 18 y 2,767, 19 to 59 y 8,786 Elderly, 6 y & older 2,95 Pregnant women 18 mothers 395 WOMEN OF REPRODUCTIVE AGE: PHILIPPINES, 213 Age/physiologic group Number of individuals covered Anthropometry Dietary Non-Pregnant/Non- 21,1 3,936, y 5, , 19 to 49 y 21,943 3,111 Pregnant/ 3,91 575, y , 19 to 49 y 3, TOTAL 31,1 4,511 RESULTS Macronutrient Intake Mean one-day ENERGY intake and proportion meeting recommended energy intake (REI) by age/physiologic group: Philippines, 213 Mean intake (kcal) Proportion meeting REI (%) RECOMMENDED ENERGY INTAKE (kcal): Female : 228 Pregnant: +3 Female : 19 :

ILSI SEA Region Seminar on Maternal, Infant and Young Child Nutrition, July 24, 217, Bangkok, Thailand Proportion of Households Meeting 1% Energy and EAR of Nutrients: Philippines, 213 Nutrient

9 38 311 Proportion of HH Meeting 1% Energy and EAR of Nutrients 2 4 6 8 1 31.7 8.8 15.2 25.1 35.2 21.9 32.9 62.7 *1% RENI 86.

4 ILSI SEA Region Seminar on Maternal, Infant and Young Child Nutrition, July 24, 217, Bangkok, Thailand Proportion of Households Meeting 1% Energy and EAR of Nutrients: Philippines, 213 Nutrient Energy (kcal)* Protein (g) Iron (g) Calcium (g) Vitamin A (mg RE) Thiamin (mg) Riboflavin(mg) Niacin (mg) Ascorbic Acid (mg) Fats (g) Carbohydrates (g) Intake Proportion of HH Meeting 1% Energy and EAR of Nutrients *1% RENI 86.4 Mean one-day PROTEIN intake and proportion meeting estimated average requirement (EAR) by age/physiologic group: Philippines, Mean intake (grams) Proportion meeting EAR (%) ESTIMATED AVERAGE REQUIREMENT (grams): Female : 49 Pregnant: 71 Female : 49 : Mean one-day CARBOHYDRATE and FAT intake by age/physiologic group: Philippines, CARBOHYDRATES (grams) FATS (grams) Nutrient sources of energy intake by age/physiologic group 1% 8% 6% 4% 2% % Energy intake (kilocalories) Non-Pregnant, Non- Pregnant/ Acceptable Macronutrient Distribution Range (AMDR)* Carbohydrates (%) Fat (%) Protein (%) Fats Carbohydrates Protein *The range of intakes for a particular energy source (carbohydrate, protein or fat) that is associated with reduced risk of chronic diseases while providing adequate intakes of essential nutrients, expressed as a percentage of total energy intake)

5 ILSI SEA Region Seminar on Maternal, Infant and Young Child Nutrition, July 24, 217, Bangkok, Thailand Proportion of meeting the Acceptable Macronutrient Distribution Range (AMDR) by age/physiologic group, Philippines, All All Non-Pregnant and Non- Pregnant and Fat Carbohydrates Protein RESULTS Micronutrient Intake (Vitamins) Acceptable Macronutrient Distribution Range (AMDR) Carbohydrates (%) Fat (%) Protein (%) Mean one-day VITAMIN A intake and proportion meeting estimated average requirement (EAR) by age/physiologic group: Philippines, Mean intake (mcg RE) Proportion meeting EAR (%) ESTIMATED AVERAGE REQUIREMENT (mcg RE): Female : 427 Female : Mean one-day VITAMIN C intake and proportion meeting estimated average requirement (EAR) by age/physiologic group: Philippines, Mean intake (milligrams) Proportion meeting EAR (%) ESTIMATED AVERAGE REQUIREMENT (mg): Female : 51 Female :

6 ILSI SEA Region Seminar on Maternal, Infant and Young Child Nutrition, July 24, 217, Bangkok, Thailand Mean one-day THIAMIN intake and proportion meeting estimated average requirement (EAR) by age/physiologic group: Philippines, Mean intake (milligrams) Proportion meeting EAR (%) ESTIMATED AVERAGE REQUIREMENT (mg): Female :.9 Pregnant: 1.2 Female :.9 : Mean one-day RIBOFLAVIN intake and proportion meeting estimated average requirement (EAR) by age/physiologic group: Philippines, Mean intake (milligrams) Proportion meeting EAR (%) ESTIMATED AVERAGE REQUIREMENT (mg): Female :.9 Pregnant: 1.4 Female :.9 : Mean one-day NIACIN intake and proportion meeting estimated average requirement (EAR) by age/physiologic group: Philippines, Mean intake (milligrams) Proportion meeting EAR (%) ESTIMATED AVERAGE REQUIREMENT (mg NE): Female : 11 Pregnant: 14 Female : 11 : RESULTS Micronutrient Intake (Minerals)

7 ILSI SEA Region Seminar on Maternal, Infant and Young Child Nutrition, July 24, 217, Bangkok, Thailand Mean one-day IRON intake and proportion meeting estimated average requirement (EAR) by age/physiologic group: Philippines, Mean intake (milligrams) Proportion meeting EAR (%) ESTIMATED AVERAGE REQUIREMENT (mg): Female : 16.2 Pregnant: 3.3 Female : 26. : Mean one-day CALCIUM intake and proportion meeting estimated average requirement (EAR) by age/physiologic group: Philippines, Mean intake (grams) Proportion meeting EAR (%) ESTIMATED AVERAGE REQUIREMENT (gms): Female :.44 Female : RESULTS INTAKE OF DIETARY SUPPLEMENTS Percentage of women of reproductive age taking vitamin or mineral supplements by age/physiologic group: Philippines, 213 VITAMIN SUPPLEMENTS (n=1,478) (n=6,7) (n=63) (n=994) MINERAL SUPPLEMENTS (n=1,478) (n=6,7) 11.7 (n=63) 6. (n=994)

8 ILSI SEA Region Seminar on Maternal, Infant and Young Child Nutrition, July 24, 217, Bangkok, Thailand Percentage of women of reproductive age taking both vitamin & mineral supplements and food/herbal supplements by age/physiologic group: Philippines, 213 VITAMIN & MINERAL SUPPLEMENTS FOOD/ HERBAL SUPPLEMENTS RESULTS (n=1,478) (n=6,7) (n=63) (n=994) (n=1,478) (n=6,7) (n=63) (n=994) NUTRITIONAL STATUS Cut off points used in classifying nutritional status of nonpregnant/non-lactating adolescents, years old based on the 27 WHO Growth Reference BMI-for-age Nutritional Status Severe thinness Thinness Normal Overweight Obesity Cut-off Points <-3SD <-2SD to -3SD -2SD to +1SD >+1SD (equivalent to BMI 25 kg/m 2 at 19 yrs) >+2SD (equivalent to BMI 3 kg/m 2 at 19 yrs) Cut-off points used in classifying nutritional status of nonpregnant/non-lactating women and lactating mothers, 19 years old and over, based on Body Mass Index (NCHS/WHO, 1978) Classification Cut-off Points Chronic Energy Deficiency (CED) <18.5 Normal 18.5 to Overweight 25. to Obesity 3.

9 ILSI SEA Region Seminar on Maternal, Infant and Young Child Nutrition, July 24, 217, Bangkok, Thailand Cut-off points used in classifying nutritional status of pregnant women based on weight-for-height (Magbitang, 1988) Classification Cut-off Points Nutritionally at-risk <P95 Not Nutritionally at-risk P95 Cut-off points used in classifying nutritional status of lactating mothers, less than19 years old, based on the 27 WHO Growth Reference BMI-for-age Nutritional Status Severe thinness Thinness Normal Overweight Obesity Cut-off Points <-3SD <-2SD to -3SD -2SD to +1SD >+1SD (equivalent to BMI 25 kg/m2) >+2SD (equivalent to BMI 3 kg/m2) Percentage distribution of women of reproductive age by nutritional status and by age/physiologic group : Philippines, 213 Percentage distribution of women of reproductive age by nutritional status and by age/physiologic group : Philippines, Non-Pregnant, Non- Thin Normal Overweight/Obese Pregnant Women Nutritionally at-risk 61.1 Not Nutritionally at-risk 76.4 (n=12) (n=2,67) (n= 5,157) (n=21,943) (n=116) 23.6 (n=1,67) Thin Normal Overweight/Obese Thin Normal Overweight/Obese

10 ILSI SEA Region Seminar on Maternal, Infant and Young Child Nutrition, July 24, 217, Bangkok, Thailand RESULTS MICRONUTRIENT DEFICIENCY Hemoglobin values below which anemia is likely to be present in populations at sea level (WHO, 1972) Age/Sex/Physiological State Normal Hemoglobin Level (g/dl) Children 5 months 6 years old 11 Children years old 12 Adult males 13 Adult females (non-pregnant) 12 Adult females (pregnant) 11 Prevalence of ANEMIA among Filipino women of reproductive age by age and physiologic group: Philippines,213 Age/Physiologic Group n Prevalence (%) Non-Pregnant/ Non- Women, ( y) 1,478, (19-49 y) 6, Pregnant women and mothers, ( y) 63, (19-49 y)

ILSI SEA Region Seminar on Maternal, Infant and Young Child Nutrition, July 24, 217, Bangkok, Thailand Prevalence (%) Trend in anemia prevalence among pregnant and lactating women: Philippines, 1993,

11 ILSI SEA Region Seminar on Maternal, Infant and Young Child Nutrition, July 24, 217, Bangkok, Thailand Prevalence (%) Trend in anemia prevalence among pregnant and lactating women: Philippines, 1993, 1998, 23, 28 and Pregnant Epidemiological criteria for assessment of iodine nutrition in a population based on median or range of urinary iodine concentrations in school-aged children and older ( 6 yrs)* Urinary Iodine Excretion (UIE), µg/l Iodine Intake Iodine Status <2 Insufficient Severe iodine deficiency 2 49 Insufficient Moderate iodine deficiency 5 99 Insufficient Mild iodine deficiency Adequate Optimal More than adequate Risk of induced hyperthyroidism 3 Excessive Risk of adverse health consequences The indicators of iodine deficiency elimination is a median value of 1 µg/l that is, 5% of the sample should be above 1 µg/l, and not more than 2% of the samples should be below 5 µg/l (ICCIDD, 1994) *Applies to adults, but not to pregnant women (WHO, UNICEF and ICCIDD, 21 Prevalence of IODINE DEFICIENCY* among Filipino women of reproductive age by age/physiologic group: Philippines,213 Age/Physiologic Group n Median Prevalence (%) Non-Pregnant/ Non- Women, ( y) 1, , (19-49 y) 5, women, ( y) 13 75, (19-49 y) 1,62 77 Pregnant women, ( y) , (19-49 y) *Iodine deficient (below median values)

12 ILSI SEA Region Seminar on Maternal, Infant and Young Child Nutrition, July 24, 217, Bangkok, Thailand Median and percent distribution of UIE levels by age and physiologic group: Philippines,213 Age/Physiologic Group n UIE µg/dl Median < Non-Pregnant/ Non- Women Percent, ( y) 1, , (19-49 y) 5, women, ( y) , (19-49 y) 1, n Pregnant women Median < , ( y) , (19-49 y) Guidelines used for the interpretation of plasma vitamin A level Classification Level µg/dl Plasma Retinol umol/l Deficient <1 <.35 Low Acceptable High = 5 =1.75 *Iodine deficient (<1 mg/dl) Percentage distribution of women of reproductive age by vitamin A status and by age/physiologic group : Philippines, 213 Percentage (n=1,392) Deficient & Low Acceptable High (n=5,515) Non-Pregnant, Non (n=62) Pregnant/ 13.9 (n=2,99) Prevalence (%) Trend in vitamin A deficiency prevalence among pregnant and lactating women: Philippines, 1993, 1998, 23, 28 and Pregnant

Thailand Mean serum zinc levels and prevalence of

28 Trimester of Pregnancy n Mean serum zinc Cut-off

5 Prevalence of serum folate deficiency and vitamin

Group (in years) n Serum folate deficiency n

13 ILSI SEA Region Seminar on Maternal, Infant and Young Child Nutrition, July 24, 217, Bangkok, Thailand Mean serum zinc levels and prevalence of zinc deficiency among pregnant women: Philippines, 28 Trimester of Pregnancy n Mean serum zinc Cut-off pt* ug/dl Prevalence of deficiency All Prevalence of serum folate deficiency and vitamin B6 deficiency: Metro Manila, Philippines, 28 Age Group (in years) n Serum folate deficiency n Vitamin B6 deficiency st trimester < nd trimester < rd trimester < All *IZiNCG, 24 Am fasting Serun folate normal cut-off level=3. ng/ml Thank You!!!

Mario V. Capanzana, Ph.D. Director IIRR CONFERENCE Silang Cavite

Mario V. Capanzana, Ph.D. Director 2018 IIRR CONFERENCE Silang Cavite Department of Science and Technology Food and Nutrition Research Institute DOST Compound, Gen. Santos Ave., Bicutan, Taguig City, Metro