46181898 Nutrition Student s Copy

7/30/2019 46181898 Nutrition Student s Copy

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TOOLS IN NUTRITION

A. FNRI and FOOD GUIDE PYRAMIDFNRI (Food and Nutrition Research Institute) - has developed a food pyramid guide, a simple and easy-to-

follow daily eating guide for Filipinos.

Food Pyramid Guide- is a graphic translation of the current Your Guide to Good Nutrition based on the

usual dietary pattern of Filipinos in general.

- was developed to help individuals select a well-balanced diet to promote good health.- It shows the five food groups arranged in a pyramid.

B. 10 NGF (Nutritional Guidelines for Filipinos (NGF) - is a set of ten messages of simple

recommendations that give advice about proper diet and wholesome practices to promote good

health for each individual and family members.

1. Eat a variety of foods everyday. The human body needs more than 40 different nutrients for good health. No single food can provide all

the nutrients in the amounts needed. Eat a variety of foods, to provide all the nutrients required in theproper amount and balance.

2. Breast-feed infants exclusively from birth to 4-6 months and then, give appropriate foods while continuingbreast-feeding.

Infants and children up to 2 years of age are most vulnerable to malnutrition. Breast-feeding is one ofthe most effective strategies to improve child survival. Nutritional requirements of an infant can beobtained solely from breast milk for the first 6 months of life. After that time, breast milk must becomplemented with appropriate foods, but breast-feeding should be continued for up to 2 years of ageor longer.

The decision to breast-feed is made by the mother. Nonetheless, the husband and other familymembers, health workers, neighbors, community organizations, officemates and employers mustencourage her to breast-feed her infant.

3. Maintain children's normal growth through proper diet and monitor their growth regularly. An adequate diet for an active child is one that promotes good health and normal growth. A well-nourished child is healthy, strong, and alert, has good disposition, and grows at a normal rate. A poorly nourished child exhibits sluggish if not permanently delayed physical and mental development.

In addition, he is lethargic and frequently ill because of low resistance to infection.

Over nutrition on the other hand, may lead to obesity that may cause physical and emotional problemsin childhood and later in life.4. Consume fish, lean meat, poultry or dried beans.

To improve the Filipino diet, not only should the total quantity of food be increased but the quality of thediet should also be improved by including animal products of substitutes.

Including fish, lean meat, poultry, or dried beans in the daily meals will not only enhance the proteinquality if the diet but also supply highly absorbable iron, preformed vitamin A and zinc.

Fish, lean meat, poultry without skin, and dried beans, in contrast to fatty meats, are low in saturatedfats, which are linked to heart disease.

5. Eat more vegetables, fruits and root crops. In general, most people do not eat enough vegetables, fruits and root crops. Results of food

consumption surveys conducted by the FNRI show that the average consumption of green leafyvegetables, vitamin C-rich fruits and root crops are low in the Filipino diet.

The consumption of more vegetables, fruits and root crops is encouraged to help correct themicronutrient deficiencies consistently noted in national nutrition surveys. Eating root crops will adddietary energy to the meal.

6. Eat foods cooked in edible/cooking oil daily. In general, Filipinos use very little oil in their cooking. Boiling is the most common method of food

preparation. Hence, the total fat and oil consumption in a Filipino diet is low. Fats and oils are concentrated sources of energy. A low fat and oil consumption results in a diet low in

energy value, contributing to chronic energy deficiency. Fats and oils are also essential for absorptionand utilization of fat-soluble vitamins, such as vitamin A. A low fat intake may be one of the causes ofvitamin A deficiency among Filipinos.

To ensure adequate fat intake, Filipinos should be encouraged to stir-fry foods in vegetable oil or to addfats and oils whenever possible in food preparation. This will guard against chronic energy deficiencyand help to lower the risk of vitamin A deficiency.


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The excessive use of saturated fats and oils, however, may increase the risk of heart disease. Theproper choice of fats and oils therefore is essential.

7. Consume milk, milk products and other calcium-rich foods such as small fish and dark green leafy vegetableseveryday.

Nutrition surveys indicate a consistent failure of Filipinos to meet dietary recommendations for calcium.An adequate amount of calcium in the diet starting from childhood all through adulthood will helpprevent osteoporosis in later life.

Milk and milk products provide highly absorbable calcium besides being good sources of protein,vitamin A and other nutrients.

Milk and other calcium-rich foods are valuable additions to our rice/plant-based diets, which are not onlypoor sources of calcium but also contain calcium-inhibiting substances.8. Use iodized salt, but avoid excessive intake of salty foods.

Goiter and Iodine Deficiency Disorders are rampant in many areas of the Philippines, causing physicaland mental retardation in children. The regular use of iodized salt in the table and in cooking in additionto taking iodine-rich foods, will greatly help in eradicating this preventable disease.

On the other hand, excessive intake of salt and salty foods particularly in susceptible individualsincreases the risk of hypertension and hence of heart disease. Avoiding too much table salt and overlysalty foods may help in the prevention and control of these conditions.

9. Eat clean and safe food. Food and water are essential to life but they may also carry disease-causing organisms like bacteria,

viruses, fungi and parasites, or harmful chemical substances. It is important to buy foods that are safe. Purchase food only from reliable sources. In addition, care

must be taken when preparing and serving meals to prevent food-borne diseases. Sharing in the efforts to improve environmental hygiene and sanitation in the community will greatlycontribute to food safety in the home.

10. For a healthy lifestyle and good nutrition, exercise regularly, do not smoke and avoid drinking alcoholicbeverages.

With the changing lifestyle of Filipinos, chronic degenerative diseases are becoming significant publichealth problems. Healthy diets, regular exercise, abstinence from smoking and moderate alcohol intakeare key components of a healthy lifestyle.

C. RDA/RENI- (sometimes referred to as Recommended Daily Allowance) is defined as "the average

daily dietary intake level that is sufficient to meet the nutrient requirements of nearly all

(approximately 98 percent) healthy individuals".

D. Food Exchange Lists (FELs)

- The word exchange refers to the fact that each item on a particular list in the portion listed may be

interchanged with any other food item on the same list. An exchange can be explained as a substitution,

choice, or serving

- Within each food list, one exchange is approximately equal to another in calories, carbohydrate, protein, and

fat. Each list is a group of measured or weighed foods of approximately the same nutritional value.

- The exchangelists are intended for planning diabetic diets, therefore the foods included are simple and only

those allowed in the diabetic diet are listed. Besides, because of the accuracy and convenience of the

exchange system, the exchange lists are used for weightmanagement as well .


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E. Food Labeling- are the primary means communication between the producer the purchaser or the manufacturer and

the purchaser or consumer.

- Nutritional labelling is a description intended to inform the consumer of nutritional properties.Two Components of Food Labeling

1. Nutrient Decleration2. Nutrition Claim

Purposes of Nutrition LabelingTo ensure that nutritional labeling is effective, the Codex Alementarius guidelines remind the:

1. consumers to make a wise choice by reading the label.2. manufacturer or producer to convey the nutrient content or information on the label.3. manufacturer not to mislead or deceive consumers and that, no nutrition claims are made without

approval by appropriate authorities.


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TERMINOLOGY.The revised edition of the dietary standards is changed from "Recommended Dietary Allowances (RDA)" toRecommended Energy and Nutrient Intakes (RENI)to emphasize that the standards are in terms ofnutrients, and not foods or diets. RENIs are defined as levels of intakes of energy and nutrients which, on thebasis of current scientific knowledge, are considered adequate for the maintenance of health and well being ofnearly all healthy persons in the population. For most nutrients, they are equal to the average physiologicrequirement (AR), corrected for incomplete utilization or dietary nutrient bioavailability, plus two standarddeviations (SD), or twice an assumed coefficient of variation (CV), to cover the needs of almost all individuals inthe population. In the case of nutrient for which data on AR are insufficient, the RNI is an "adequate intake" (AI)which is based on the experimentally observed average intake of healthy individuals. For energy, therecommended intake level is set at the estimated average requirement of individuals in a group (no SD), sinceintakes consistently above the individuals r4equirement lead to overweight or obesity.

POPULATION GROUPINGS.The population groups essentially follow the (FAO/WHO, 2002) groupings. These are similar to those of the1989 Philippine RDA, except for the cut-off for children, which is now 18 years rather than 19 years, consistentwith the International Reference Standards (IRS) for growth.REFERENCE WEIGHTS.The reference weights for adults are the average weights derived from the 1998 National Nutrition Survey(NNS). These weights are higher by 3 kg in the male and 2 kg in the female than the reference weights used inthe 1989 Philippine RDA edition. The reference weights for children are set higher than the average weightsfollowing the International Reference Standards except in late adolescence.RECOMMENDED ENERGY AND NUTRIENT INTAKES.For most nutrients, recommended nutrient intakes (RNIs) for infants, from birth to


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presented in Table 1.

Population

Group

Body

Weight

(kg)

ENERGY

kcal/day (kcal/kg/day)

Light Moderate Heavy

Male, y

19-29 59 2350 (40) 2490 (42) 2800 (47)

30-49 59 2290 (39) 2420 (41) 2730 (46)50-64 59 2050 (35) 2170 (37) 2440 (41)

65+ 59 1780 (30) 1890 (32) 2120 (36)

Female, y

19-29 51 1740 (34) 1860 (36) 2100 (41)

30-49 51 1700 (33) 1810 (35) 2050 (40)

50-64 51 1520 (30) 1620 (32) 1830 (36)

65+ 51 1320 (26) 1410 (28) 1590 (31)

PROTEIN.A safe protein intake level for adults is defined as the lowest level of dietary protein intake that will

balance the losses of nitrogen from the body in persons maintaining energy balance at modest levels ofphysical activity (FAO/WHO/UNU, 1985). The recommended intake levels for children are based on the safelevel of protein intakes estimated by the FAO/WHO/UNU (1985) for a reference protein (egg or milk) adjustedfor the protein quality of Filipino rice-based diets of 70% protein digestibility corrected amino acid score(PDCAAS). These values are very close to estimates obtained from direct studies on Filipinos consuming usual

rice-based diets.VITAMIN A. The recommended intake levels for vitamin A correspond to the safe levels of intake based on theaverage amounts of vitamin A required to maintain a given body-pool size in well-nourished individuals. Foradults, the RNI is equivalent to the estimated average requirement plus 2SDs. When recommendation forchildren are estimated by extrapolation from adult recommendations, the resulting values are lower than thereported intakes of children, 0 to 6 y in populations where evidence of vitamin A deficiency (VAD) is rare. TheCommittee therefore adopts the higher recommendation given by the FAO/WHO (2002).VITAMIN C.The 1989 RDA which was based on the amount that would maintain acceptable serumvitamin C levels in Filipino men and women, is retained. These values are higher than the FAO/WHO RNIwhich is based on intake associated with adequate liver stores and associated with antioxidant protection. Therecommendations for children, 1-9 y, are based on the 2002 FAO/WHO RNIs, while those for older children areextrapolated from adult values.THIAMIN (VITAMIN B1). The Institute of Medicine, Food and Nutrition Board (IOM-FNB) (1998) andFAO/WHO (2002) recommendations, which are both based on the average requirement for normal erythrocytetransketolase (ETK) activity and urinary thiamin excretion and twice an assumed CV of 10% to cover the needsof 97.5% of individuals in the group, are adopted. The IOM-FNB and FAO/WHO-derived estimates, adjusted forPhilippine reference body weighs, are similar to the 1989 RDAs which were then based on a local study donein the '60s on 10 adult Filipinos. The recommended intake level for infants from birth to six months is based on

the reported mean thiamin content of breast milk obtained from mothers without beriberi. It may be necessaryto give supplements as a protective measure against infantile beriberi.RIBOFLAVIN (VITAMIN B2). The RNI is derived from the requirement estimate of the IOM-FNB (1998) whichis based on the amount of riboflavin intake to maintain riboflavin status of satisfactory erythrocyte glutathionereductase activity (EG-AC) level, as criterion of adequacy. These intake levels, which conform with the FAO/WHO (2002) recommendations, are close to the 1989 recommendations which were based on requirementestimates obtained from Filipino adults consuming rice-based diets.NIACIN. The FAO/WHO (2002) and IOM-FNB (1998) estimates, which are based on the amount of niacinintake corresponding to an excretion of N'methyl-nicotinamide that is above the minimal excretion at whichdeficiency symptoms occur, are also adopted for Filipinos. These values are lower than the 1989 RDA becauseno correction is made for bioavailability. The bioavailability of niacin is not considered in setting the RDA


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Table 2. Recommended Energy Nutrient Intakes

Table 3. Recommended Nutrient Intakes for Other Vitamins and Minerals

RNIs for these nutrients are now available as a result of the development of more precise methods ofdetermining human nutritional requirements. In the light of the aggressive marketing of dietary supplements,health care professionals need guidance on reasonable intakes of these nutrients. The 2002 RENI thus provideinformation on recommendations for vitamins D, E, K, B6, and B12, and minerals such as phosphorus,magnesium, fluoride, zinc, selenium, manganese, as well as water and electrolytes.Local data on food composition, deficiency problems, or roles in chronic degenerative diseases, direct studieson requirements, and nutrient-nutrient interrelationship are not available for some of these nutrients.Recommendations of IOM-FNB, 1997-2002 and the FAO/WHO, 2002 are presented as guidelines.The RNIs for other vitamins and minerals are summarized in Table 3.VITAMIN D. The FAO/WHO and IOM-FNB recommendation of 5 g/day for adults is based on the amount ofvitamin D intake necessary to maintain vitamin D status as indicated by a satisfactory level of serum 25-

hydroxy-vitamin D (25-OH-D). The recommended intake levels, according to the IOM-FNB, will cover the needsof adults "regardless of exposure to sunlight".VITAMIN E. The safe level of intake for vitamin E for adults is 12 mg/day. The term "safe" rather then"recommended" is used since the value is derived from data for the US population whose mean PUFA intakecan be presumed to be higher than that of Filipinos since the major source in the Filipino diet is the medium-chain saturated fat-rich coconut oil. High intakes of PUFA are typically accompanied by increased vitamin Eintakes.VITAMIN K. The FAO/WHO (2002) Expert Panel's recommendation set a daily intake of g/kg as basis forsetting RNI. The panel also advised that all breastfed infants should receive vitamin K supplementation at birthaccording to nationally established guidelines.
http://www.fnri.dost.gov.ph/reni/renitable2.htmhttp://www.fnri.dost.gov.ph/reni/renitable2.htmhttp://www.fnri.dost.gov.ph/reni/renitable2.htmhttp://www.fnri.dost.gov.ph/reni/renitable1.htm


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PYRIDOXINE (VITAMIN B6). The RNI for adults of 1.3 mg/day adopted by the FAO/WHO (1998) is based onthe amount required for normalization of the tryptophan load test.COBALAMIN (VITAMIN B12). The IOM-FNB recommendation of 2.4 g/day is based on the amount neededto maintain adequate hematological status. ZINC. The requirement for adults is based on the intake that willmeet the daily absorbed zinc requirements of 0-072 and 0.059 mg/kg for adult males and females, respectively,and adjusted for bioavailability of 30% following the recommendation of FAO/WHO (2002).SELENIUM. The FAO/WHO recommendation of 31 g/day corresponds to the level of intake that providesadequate reserves based on satisfactory levels of plasma selenium, and of glutathione peroxidase activity.

PHOSPHORUS. The RNIs are based on the intake required to maintain serum inorganic phosphate within thenormal range. MAGNESIUM. The FAO/WHO (2002) recommendation is based on a requirement of 4 mg/kgbody weight/ day for adults to achieve a positive magnesium balance.MANGANESE. The IOM-FNB (2002) recommendations is based on the median intake of Americans derivedfrom the US Food and Drug Administration Total Diet Study from 1991-1997.FLUORIDE. IOM-FNB recommendations are based on "adequate intakes" that have been found to preventdental caries.WATER AND ELECTROLYTES. The recommended water intake for adults under average conditions ofenergy expenditure and environmental exposure is 2500 mL based on a recommended intake of 1 mL per kcalof energy expenditure (NRC, 1989) (Table 4). It may be increased to 3735 mL (1.5 mL/kcal) to cover variationsin activity level, sweating, and solute load. Thirst is normally a good indicator of the amount of extra waterneeded to meet the daily requirement, except for older persons whose thirst mechanism may be impaired. For

infants, a recommended intake of 1.5 mL/kcal of energy expenditure, which corresponds to the water-to-energyratio in human milk, has been established as a satisfactory level for the growing infant.The minimum requirements for electrolytes do not include allowance for large, prolonged losses from the skinthrough sweat (Table 5). There is no evidence that higher intakes confer any health benefit. For adults (>18y),desirable intakes of potassium may considerably exceed the minimum recommendations (~3500 mg). Forchildren (


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46181898 Nutrition Student s Copy