NUTRITION PROGRAM

DEPARTMENT OF PUBLIC HEALTH

NON-COMMUNICABLE DISEASE DIVISION

ROYAL GOVERNMENT OF BHUTAN

2015

BHUTAN DIETARY GUIDELINES FOR SCHOOL

CHILDREN

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BHUTAN DIETARY GUIDELINES FOR SCHOOL CHILDREN

Nutrition Program

Department of Public Health

Ministry of Health

2015

For good health and vitality

For proper growth and development

For improved concentration and behavior

For preventing deficiency diseases

For preventing obesity

1. INTRODUCTION

Balanced diet and plenty of physical activity are just what you need for growth and health. But what is a balanced diet? The Bhutan Dietary Guidelines for School Children provides some clear, simple advice about food and nutrition for health for school children.

Why do children need balanced diet?

2. FOUR FOOD GROUPS

The table below gives an overview of the four food groups for Bhutan

Food Group Examples of foods included

Main Nutrients provided

Starchy foods

Rice, Kharang, Kabche, Nabche potatoes, sweet potatoes, starchy root vegetables like yam and tapioca etc.

Carbohydrate, fiber, B vitamins

Fruits and Vegetables Group

Fresh and dried and juiced fruit and vegetables

Carotenes (a form of vitamin A), vitamin C, zinc, iron, and fiber

Meat and alternative Group

Meat, poultry, fish, eggs, meatalternative, pulses, lentils

Protein, iron, zinc, fatty acids, vitamins A and D

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Milk and Dairy Group products

Milk, cheese and yoghurt

Protein, calcium, and vitamin A

3. FOOD REQUIREMENTS

Servings per day

Starchy foods

Fruits and

vegetables

Meat and

alternatives

Milk and

dairy food

product

4-7 years

5-7 4-6 2 2

8-11 years

6-9 5-6 2 2

12-18 years

5-11 5-9 2-3 3

What is a serving?

Serving is a standard amount of food or drink that is generally served. A standard serving size of:

Starchy food: 1/2 cup cooked rice or 1 small potato or 1 slice of bread (40 g)

Fruits and vegetables: 1 medium fruit (± size of tennis ball) or ½ cup fruit or vegetables

Meat and alternatives: 75 -100g cooked chicken or fish or meat (without bone); or 1 egg or one cup of cooked dry beans or lentils

Milk and dairy food products: 1 cup milk or yoghurt; or 40-50 g cheese

GUIDELINE 1: Eat a variety of foods

Foods contain a combination of nutrients and other healthful substances, but no single food can supply all the nutrients in the amounts needed:

Eat a wide variety of foods from the four food groups

Eat the right amounts of food chosen from each of the four food groups

Eat at least three meals per day

GUIDELINE 2: Eat complex starchy foods

What does this food group include?

Starchy foods consist of Rice, potatoes and sweet potatoes, starchy root vegetables, kharang, other grains and breakfast cereals.

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Complex starchy foods also known as wholegrain foods contain much more nutrients and fiber as compared to refined starchy foods. Complex starchy foods include oats, Kharang, brown/red rice and whole meal/whole wheat versions of noodles, bread and breakfast cereals.Why is this food group important?

Starchy foods provide energy, carbohydrate, fiber and vitamin B

Recommendations:

Eat more of complex starchy foods everyday

Eat a portion of starchy foods in each meal every day

4-7 years : 5-7 servings 8-11 years : 6-9 servings 12-18 years : 5-11 servings

GUIDELINE 3: Eat more of fruits and vegetables

What does this food group include?

This group consists of all fruit and vegetables Potatoes are classed as a starchy food and are therefore not included in this food group.Why is this food group important?

Fruit and vegetables are an important source of vitamins including vitamin A and C, minerals such as zinc and iron, and dietary fiber.

Recommendations:

Eat more of fruits and vegetables everyday

Eat a minimum of the following portions of fruits and vegetable everyday

4-7 years : 4-6 servings 8-11 years : 5-6 servings 12-18 years : 5-9 servings

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GUIDELINE 4: Consume fish, poultry, eggs, lean meats, legumes and pulses

What does this food group include?

Meat, poultry, fresh, fish, eggs, meat alternatives, pulses (such as beans, chickpeas and lentils) and nuts.Why is this food group important?

Food from this group provides protein, iron and zinc. It also provides fatty acids, vitamin A and vitamin D

Recommendations:

Eat a minimum of the following portions of meats and alternatives everyday

4-7 years : 2 serving 8-11 years : 2 serving 12-18 years : 2-3 serving

GUIDELINE 5: Consume milk and dairy foods

What does this food group include?

Milk, cheese and yoghurt t. Butter and cream are not included as part of this food group as they are classified as foods high in fat.Why is this food group important?

Foods from this group are a good source of energy, protein, calcium and vitamin A.

Recommendations:

Eat a minimum of the following portions of milk and dairy everyday

4-7 years : 2 serving 8-11 years : 2 serving 12-18 years : 3 servings

GUIDELINE 6: Moderate fat and salt intake

What does this food group include?

Cooking oils (liquid) and solid fats together are referred to as fats. Fats contribute to texture,

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flavour and taste and increase the palatability of the diet. Animal fats contain a high percentage of saturated fatty acids while plant oils contain more unsaturated fats.

Salt is an essential ingredient of food and it enhances taste and flavor.Why is this food group important?

A high intake of fats has been linked to being overweight, high cholesterol levels, cardiovascular heart disease, diabetes and certain cancers.

Salt is a major source of sodium in diet and high intake of sodium has been linked to hypertension and high blood pressure increases the risk of heart disease, stroke and other disease

Recommendations:

Moderate total fats to 15-30% of the total energy intake

Fats that come from plant source should be preferred over fats that come from animal sources. Hydrogenated vegetable oils like vansapati should also be limited.

Consume less than 5 gm or one teaspoon of salt per day

GUIDELINE 7: Limit foods and drinks that contain added sugar

What does this food group include?

Sugars are carbohydrates – examples include fructose, glucose, lactose and sucrose. When sugars occur naturally in foods such as fruits, they are referred to as intrinsic sugars. When the sugars are added to foods and are termed extrinsic sugar. Sucrose is widely used in processed foods and drinks as a sweetener and also plays a role as a flavor enhancer and preservative.

Why is this food group important?

Sugars provide a readily absorbed source of energy, but added sugars can increase the energy content of the diet while diluting its nutrient density.

Sugars are a factor in dental caries and diets high in added sugars are also associated with many adverse health outcomes like obesity heart disease, diabetes etc.

Recommendations:

Limit the intake of sugar sweetened foods and drinks

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GUIDELINE 8: Achieve and maintain healthy body weight

It is very important that healthy body weight is achieved and maintained. Overweight and obesity can lead to Type 2 diabetes, Hypertension, heart disease, stroke and cancers.

Healthy weight can be maintained by eating the correct amounts of a variety of foods and by being physically active.

Body Mass Index (BMI

Body Mass Index (BMI) is a measure of thinness or fatness, and is calculated by dividing one’s weight in kilograms by height squared in meters. However this index can only be used in individuals who are above 19 years of age only.

The formula is:

BMI = weight in kg / (Height in meters) 2

Children below the age of 19 years should use the BMI for age to determine their appropriate weight.

Recommendations

Maintain and achieve a healthy body weight

Maintain weight atleast twice/year by using:

o BMI for those for those above 19 years of age

o Gender specific BMI for age for those below 19 years of age

Get at least 60 minutes (1 hour) of moderate-to-vigorous physical activity everyday to be healthy

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ClassificationUnder weight : below 18.5

Under weight : 18.5 - 24.9

healthy weight : 25 - 30

Obesity: more than 3o

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GUIDELINE 9: Other recommendations

Recommendations for fluids

Drink at least six to eight to eight drinks preferably water (each of 100–150 ml) each day.

Drinks more in hot weather and after extra physical activity

Avoid all soft drinks such as squash, fizzy drinks, energy drinks and flavoured water

Never drink alcohol or alcohol containing drinks

Limit or avoid tea, coffee, cola and other drinks or foods with added caffeine or other stimulants especially for younger children

Recommendations for Junk foods

Junk foods are an informal term given to foods with limited nutritional value. Fast foods, chips, and chocolates and in general those foods that are high in salt, sugar, fat or calories can be included as junk food.

Junk foods should be limited as much as possible as they lead to obesity and many obesity related diseases

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Appendix 2: serving size of foods

Starch group One servingBread 1 slice or 30 gms

Crackers 4-6 pieces

cooked cereals 1/2 cupdry cereals, unsweetened 3/4 cup

dry cereals, sweetened 1/2 cup

dry flour or grain 3 Tbsp

Pasta 1/2 cup

Rice 1/2 cup

Corn 1/2 cup

Popcorn 3 cups

potato (small) 1 (85 g)

potato, mashed 1/2 cup

sweet potato 1/2 cup

Vegetable group One serving

Squash 1 cup

cooked beans, peas, lentils 1/2 cup

raw vegetables 1 cup

cooked vegetables 1/2 cup

tomato or vegetable juice 1/2 cup

Fruit group One serving

fresh fruit 1 small

Water melon (cubes) 360 g (1 cup)canned fruit 1/2 cup

dried fruit 1/4 cup

fruit juice 1/2 cup

Meat, poultry and dairy group One serving

meat, poultry, fish 75 g

Cheese 50 g

cottage cheese 50 g

Egg 1

peanut butter 1.5 Tbsp

cooked beans, peas, lentils 1/2 cup

Milk 1 cup

Yogurt 1 cup

Fats, oil and sweet group One serving

Oil 1 tspMayonnaise 1 tsp

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cream cheese 1 Tbspsalad dressing 1 Tbsp

Peanuts 10

butter or margarine 1 tsp

ice cream 1/2 cup

Cookies 2 smallSyrup 1 Tbspjam or jelly 1 Tbsp

Sugar 2 Tbsp

Pudding 1/4 cup

muffin or cupcake 1/2 small

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