DIETARY REFERENCE INTAKES (DRIS) FOR MONGOLIANS Tuyatsetseg Jambal, Ph.D School of Industrial Technology, Mongolian University of Science & Technology,
Outline Background Mongolian DRIs Briefly report of National Nutrition Surveys Conclusion
Background 1,564,116 square kilometres Population: 3.1 million
Background Recommended Dietary Allowances (RDAs): 1981 1997 2008 2017 2017 National Center for Public Health, Ministry of Health (MOH)
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.
Comparison of RDAs Standard person: adult, 20-39 yo, male 1981 Calories: 3000 kcals 1997 Calories: 2600 kcals, protein: 98g, fat: 72g, CHO:390g 2008 2017 Calories: 2500 kcals, protein: 94g, fat: 69g, CHO:375g Calories: 2400 kcals, protein: 90g, fat: 67g, CHO:360g CHO: carbohydrate
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
Dietary guideline 2000, the first edition of dietary guidelines for Mongolian was established and published Ger (traditional house) guidelines. Nutrition Research Center and MOH
Dietary guideline
Health status
Five leading causes of morbidity, 2006-2016, per 10 000 population Source: Health indicators 2016, Center for Health Development
Arterial hypertension accounts for 50.0% of all diseases of the circulatory system, which is 503.9 per 10 000 population. By gender, there were 653.1 for females and 357.5 for males per 10 000 population. Diabetes accounted for 48.9% of all diseases of endocrine, nutritional and metabolic disorders and it was 78.6 per 10 000 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 10 000 population.
Five leading causes of mortality, 2006-2016, per 10 000 population
Health status Morbidity, 2006-2016 1. 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, 2006-2016 1. 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
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.
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.
Nutrition status: anemia and iron deficiency in children under 5 yo of age
Nutrition status: vitamin A and D deficiency in children under 5 yo of age
Nutrition status: prevalence of overweight in woman 5 times higher than NNS IV Higher prevalence in older age
Nutrition status: prevalence of obesity in woman
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.
Nutrition status: prevalence of overweight and obesity among men
Prevalence of overweight and obesity among men 15-49 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.
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.
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.
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
RDA: 1997
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 720 - - Female 660 - - 7-12 month Male 820 - - Female 750 - - 1-3 age Male 1060 1260-160 Female 980 1200-220 4-6 age Male 1470 1700-230 Female 1330 1600-270 7-10 age Male 1820 2175-350 Female 1650 1800-150 11-14 age Male 2500 2400-100 Female 2170 1850-320 15-18 age Male 2700 2630 +70 Female 2280 2180 +100 18-29.9 age Male 2400 2590-190 Female 1990 2040-50 30-59.9 age Male 2380 2480-100 Female 1850 1960-110 60 age Male 1920 2030-110 Female 1680 1800-120 First trimester 2080 2040 +40 Second trimester 2280 2340-60 Third trimester 2470 - - 0-6 month 2490 - - 6 month 2390 - - Male 3300 - - Female 2400 - - Male 2100 - - Female 1620 - -
Population group Protein (g) Life stage Age Sex 2017 2008 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 9-7-12 month Male 12 - Female 11-1-3 age Male 15 47-32 Female 14 45-31 4-6 age Male 22 64-42 Female 20 60-40 7-10 age Male 28 81-73 Female 29 67-38 11-14 age Male 45 90-45 Female 46 69-23 15-18 age Male 60 98-38 Female 52 82-30 18-29.9 age Male 90 97-7 Female 72 76-4 30-59.9 age Male 76 97-26 Female 66 73-7 60 age Male 62 76-14 Female 54 67-13 First trimester 73 76-3 Second trimester 81 88-7 Third trimester 97-0-6 month 91-6 month 85 - Male 124 - Female 90 - Male 79 - Female 61 -
Population group Life stage Age Sex 2017 2008 Comparison Infants Early childhood, adolescence Fat (g) 0-6 month Male 32 - - Female 29 - - 7-12 month Male 32 - - Female 29 - - 1-3 age Male 41 35 +6 Female 38 33 +2 4-6 age Male 49 47 +2 Female 44 44 +0 7-10 age Male 61 60 +1 Female 55 50 +5 11-14 age Male 78 67 +11 Female 67 51 +16 15-18 age Male 84 73 +11 Female 71 60 +11 18-29.9 age Male 67 72-5 Adult Senior, old age Pregnant woman Lactating woman Physically demanding workers Non-Physically demanding workers Female 55 57-2 30-59.9 age Male 66 68-2 Female 51 54-3 60 age Male 53 56-3 Female 47 50-3 First trimester 58 57 +1 Second trimester 63 65-2 Third trimester 69-0-6 month 69-6 month 66 - Male 92 - Female 67 - Male 58 - Female 45 -
Population group Carbohydrate (g) Life stage Age Sex 2017 2008 Comparison Infants Early childhood, adolescence Adult Senior, old age Pregnant woman Lactating woman Physically demanding workers 0-6 month Male 97 - Female 90-7-12 month Male 120 - Female 111-1-3 age Male 158 189-31 Female 144 180-36 4-6 age Male 235 255-20 Female 212 240-28 7-10 age Male 290 325-35 Female 260 270-10 11-14 age Male 405 360 +45 Female 344 277 +67 15-18 age Male 426 394 +32 Female 358 327 +31 18-29.9 age Male 360 389-29 Female 302 306-4 30-59.9 age Male 370 372-2 Female 280 294-14 60 age Male 297 304-7 Female 261 270-9 First trimester 317 306 +11 Second trimester 346 351-5 Third trimester 365-0-6 month 376-6 month 364 - Male 495 - Female 360 - Non-Physically demanding workers Male 315 - Female 244 -