FBDGs of Specific Population Groups – Pregnant & Lactating Women, Elderly & Vegetarians

Gui Shir Ley1 and Mohd Ismail Noor2

1Nutrition Division, Ministry of Health Malaysia 2School of Hospitality, Tourism and Culinary Arts,

Taylor’s University

Food Based Dietary Guidelines (FBDG)

Intended to establish a basis for public food and nutrition, health and agricultural policies and nutrition education programmes to foster healthy eating habits and lifestyles.

To provide standard guide and advice on food, food groups and dietary patterns to promote overall health and prevent chronic diseases.

They involve a substantial amount of research translation, and their implementation has important health consequences.

The importance of FBDG

Dietary guidelines apply to all healthy individuals .

Many countries have also developed guidelines for population groups with special nutritional needs, such as pregnant and lactating women and the elderly.

In addition, some countries also develop dietary recommendations expressed in scientific terms for nutritionists and health care professionals, with quantitative recommendations of nutrients and food components.

The importance of FBDG (cont: )

Dietary guidelines are a tool for nutrition education and behaviour change.

They are meant to provide a basis for national food, nutrition, health and agricultural policies, as well as for the food industry.

Also part of strategy to improve food security, food safety and reduce the risk of prevailing chronic disease.

Development and Process Dietary guidelines are developed by interdisciplinary teams of experts,

comprising representatives of agriculture, health, education, nutrition and food science, consumers, non-governmental organizations, the food industry, communications and anthropology.

Many sources of information are reviewed in this process, such as scientific evidence of the relationship between diet, nutrition and health; and data on food production, food consumption, food composition, cost and accessibility.

Once the draft guidelines (key messages, key recommendations and how to achieve) have been prepared, they will be pilot-tested with consumer groups to ensure they are practical and comprehensible and the messages are well-suited to the local community.

Technical Working Group (TWG) on Nutritional Guidelines

Under the purview of National Coordinating Committee of Food and Nutrition (NCCFN).

A total of 5 TWGs to facilitate the implementation of National Plan for Nutrition of Malaysia (NPANM).

TWG Nutritional Guidelines is one of the 5 established TWGs with the Nutrition Division acting as the Secretariat.

TWG Nutritional Guidelines (Main Committee)

Chairperson : Prof. Emeritus Dr. Mohd Ismail Noor (Taylor’s University)

Secretary : Gui Shir Ley (Nutrition Division, MOH)

Members:

1. Puan Zaiton Hj Daud (Nutrition Division, MOH)

2. Dr. Faridah Abu Bakar (Family Health Division, MOH)

3. Puan Ruffina Dalis ( Health Education Division, MOH)

4. Dr. A’aishah bt Senin (Communicable Diseases Division, MOH)

5. Dr. Siti Nurbaya Shahrir (Non – Communicable Unit, MOH)

6. Pn Jamilah bt Ahmad (Melaka State Health Department, MOH)

7. Pn Norhidayah Othman (FSQD, MOH)

8. Prof Dr. Poh Bee Koon (UKM)

9. Assos Prof Dr Hamid Jan Jan Mohamed (USM)

10.Dr. Tee E Siong (NSM)

11.Dr Zaitun Yassin (NSM)

12.Prof Dr Winnie Chee Siew Swee (IMU)

13.Dr Tan Sue Yee (IMU)

14.Dr Chan Yoke Mun (UPM)

15.Dr Yasmin Ooi Beng Houi (UMS)

16.Dr Mahenderan Appukutty (UiTM)

FBDG in Malaysia

The TWG on Nutritional Guidelines published the first Malaysian Dietary Guidelines in 1999.

10 years later the 2nd version of the Malaysian Dietary Guidelines was published in 2010.

FBDG in Malaysia (for specific age-groups)

In view of the need to address diet-related health issues in various age groups, MDG Children and Adolescents was published in 2013.

FBDGs in Malaysia (for specific population groups)

The TWG on Nutritional Guidelines is currently working on developing 3 dietary guidelines (DGs) for special population groups, namely,

DG for Pregnant and Lactating Women DG for the Elderly DG for Vegetarians

Each set of dietary guidelines contains unique features to address the dietary needs of these population groups.

Malaysian Dietary Guidelines for Elderly

DRAFT

1.Pn. Zaiton Hj. Daud (Nutrition Division, MOH)

2.Cik Teh Wai Siew (Nutrition Division, MOH)

3.Pn. Norlaily Md Nasir (Health Education Division,MOH)

4.Dr. Mohmad Salleh (Family Health Division, MOH)

5.Pn. Roziatun Abdul Wahab (Food Safety Division, MOH)

6.Pn. Nurul Huda Abdul Aziz (Food Safety Division, MOH)

7.En. Mohd Nurul Haryadie Mazuki (Food Safety Division, MOH)

8.Pn. Hariana Haris (Pharmacy Division, MOH)

9.Pn. Siti Rohana Din (Penang State, MOH)

10.Pn. Rohida Salleh Hudin (Kedah State, MOH)

11.Dr. Lee Fatt Soon (HKL, MOH)

12.Dr. Yau Weng Keong (HKL, MOH)

13.En. Mohd Adha Nawawi (Physiotherapist Unit, MOH)

14.Pn. Faridah Omar (Physiotherapist unit, MOH)

15. Dr. Siti Nur’ Asyura Adznam (UPM)

16. En. Hairul Hapizi Samaon (HKL, MOH)

17. Dr. Chan Yoke Mun (UPM)

18. Prof. Dr. Suzana Sahar (UKM)

19. Dr. Yasmin Ooi (UMS)

20. Dr. Arimi Fitri Mat Ludin (UKM)

21. Dr. Tanti Irawati Rosli (UKM)

22. Dr. Sakinah Harith (UMS)

23. Assos Prof Dr. Hamid Jan Jan Mohamed

(USM)

24. Dr. Megan Chong (IMU)

DG Committee for Elderly Chairperson : Dr. Zaitun Yassin (Nutrition Society of Malaysia) Secretary : Gui Shir Ley (Nutrition Division, MOH)

Introduction

Chronological age of elderly population in Malaysia is 60 years and above.

Elderly population in Malaysia is steadily rising from 5.7% in 1990 to 8.35% in 2013.

By the year of 2040, it is expected to be 16.3% of total population (Ministry of Women, Family and Community Development, 2012).

In the 2012 report, elderly population was 8.2% approximately 2.4 million of 29.3 million.

The average life expectancy for males and females is 72.3 and 77.2 years, respectively (Ruhaini, 2013).

Introduction (cont:) Aging may coincide with a declining gustatory function that can affect

dietary intake and ultimately have negative health consequences.

Kaiser et. al 2010 noted there are nine (9) major changes occur in ageing population; body weight, body composition of bone, muscle and fat, immuno compromised, gastrointestinal disturbances, tooth loss, sensory loss, psychological stress, economy and social changes. The changes occurred may influence nutritional status by limiting foods intake and subsequently placed geriatrics in high risk to develop malnutrition (Volkert et al., 2006).

Sakinah et al. (2012) and Hanisah et al. (2012) reported that our local ageing population is susceptible to develop malnutrition influenced by factors such as – impaired dietary intake, physiological changes and economy status.

Key Messages and Recommendations

KM1: Eat a variety of foods within your recommended intake

KM2: Maintain a healthy body weight for optimal health

KM3: Prepare, request or purchase foods and beverages with low fat , salt and sugar

KM4: Drink plenty of water daily

KM5: Be physically active for optimal health

KM6: Practice food safety when purchasing, preparing, cooking and storing food

Key area of Focus

Highlights on the role of family and community members.

Ideas on how to involve the elderly during purchasing and preparation of food.

The importance to keep a healthy dentition.

Use of supplements and drug-dietary supplements interactions.

Contraindications on the use of selected herbal supplements.

Malaysian Dietary Guidelines for Pregnant and Lactating Women

DRAFT

1.Dr. Wan Hamilton Wan Hassan (Hosp Serdang, MOH)

2.Dr Noor Haliza Yussoff (HKL, MOH)

3.Dr Hjh Faridah Abu Bakar (Family Health Division, MOH)

4.Prof Dr Norimah A. Karim (UKM)

5.Dr Maria Safura Mohamad (T&CM, MOH)

6.Dr Jaspal Kaur (T&CM, MOH)

7.Dr Siti Nur Baya Sharir (NCD, MOH)

8.Dr. Zul Azuin Zulkifli (Family Health Division, MOH)

9.Pn. Norzitah Abu Khair (FSQD,MOH)

10.Pn Munira Zakaria (FSQD, MOH)

11.Prof. Madya Datin Dr. Safiah Md Yusof (UiTM)

12.Pn Seri Wirdaningsih Ahmad Wasil (Nutrition Division, MOH)

13.Pn Nur Shafawati Mohd Ghazali (Nutrition Division, MOH)

14.Pn Wirdah Mohamed (NS State Health Dept, MOH)

15.Pn Noor Aini Karimon (Family Health Division, MOH)

16. Pn Haironi Ismail (Physiotherapist HPJ, MOH)

17. Pn Siti Mariam Ali (PLK, MOH)

18. Ms Shahsikala Sivapathy (UCSI)

19. Dr Tan Sue Yee (IMU)

20. Pn. Norlaily Md Nasir (Health Education Division, MOH)

21. Pn. Wong Hui Juan (Selangor State Health Dept, MOH)

22. En Suhaidi Sudin (NS State Health Dept, MOH) 23. Pn Norsyamlina Che Abd Rahim (Selangor State Health

Dept, MOH)

DG Committee for Pregnancy and Lactation Chairperson : Puan Jamilah Ahmad (Melaka State Health Dept, MOH)

Secretary : Gui Shir Ley (Nutrition Division, MOH)

Introduction General healthy eating guidelines, micronutrient sufficiency and macronutrient quantity and quality are important nutrition considerations pre pregnancy, during pregnancy and lactation. Maternal obesity increases the risk of a number of pregnancy complications, including preeclampsia, gestational diabetes mellitus (GDM), and caesarean delivery (Lynch et al, 2008). Excessive weight gain during pregnancy and postpartum retention of pregnancy weight gain are significant risk factors for later obesity in women (Rooney et al, 2002).

Key Messages and Recommendations

KM1: Fulfill energy needs during pregnancy and lactating.

KM2: Eat a variety of food to fulfill energy and nutrients needs during pregnancy and lactation.

KM3: Achieve healthy weight gain

KM4: Be physically active

KM5: Consume safe food

Additional Information 1: Health Problems During Pregnancy

Additional Information 2: Traditional taboos after birth

Key area of Focus

Nutrients need for pregnant and lactating mother.

Special highlights on traditional taboos – Malay, Chinese and Indian.

Physical activity for pregnancy and post partum.

Malaysian Dietary Guidelines for Vegetarians

DRAFT

Chairperson: Dr. Mahenderan Appukutty (UiTM)

Secretary: Gui Shir Ley (Nutrition Division, MOH)

1. Dr. Amutha Ramadas (Sunway University)

2. Dr Barakatun Nisak (UPM)

3. Dr. Cheah Whye Lian (UNIMAS)

4. Dr. Foo Leng Huat (USM)

5. Dr. Geeta Appanah (UPM)

6. Dr. Gan Wan Ying (UPM)

7. Dr Hanis Mastura Yahya (UKM)

8. Puan L. Mageswary Lapchmanan (MOH)

9. Puan Lalitha Palaniveloo (MOH)

10. Prof. Dr. Mirnalini Kandiah (UCSI)

11. Pn. Norlalily Md Nasir (MOH)

12. Pn Nurul Hidayati Nasir (MOH)

13. Dr Norazmir Md Nor (UiTM)

14. En. Ng Chee Kai (MOH)

15. Dr. Roseline Yap Wai Kuan (Taylor’s University)

16. Dr Wong Jyh Eiin (UKM)

17. Cik Shashikala Sivapathy (UCSI)

18. Pn. Siti Sabariah Buhari (UiTM)

19. Cik Teh Wai Siew (MOH)

20. Pn. Viola Micheal (MOH)

21. Dr Yim Hip Seng (UCSI)

22. Dr. Yasmin Ooi (UMS)

DG Committee for Vegetarian

Introduction

Lack of appropriate guidelines and knowledge about vegetarian meal planning may lead to potential imbalances in intake of nutrients.

Special attention is needed to replace meat and other animal products with nutritionally equivalent vegetarian foods, in order to plan nutritionally adequate vegetarian meals.

Although the prevalence of vegetarianism among Malaysians is unknown, increasing concerns over religion, environmental, animal and ethical issues as well as concern about world hunger are turning many towards practicing a vegetarian diet (Lin, 2008; Then and Chan, 2007).

Key Messages and Recommendations KM1: Eat a variety of foods within your recommended intake.

KM2: Eat adequate amount of cereals, cereals-based products (preferably whole grain) and tubers.

KM3: Eat plenty of fruit and vegetables everyday.

KM4: Consume moderate amounts of egg, legumes and nuts.

KM5: Consume adequate amounts of milk and milk products.

KM6: Include appropriate amounts and types of fats in the diets.

KM7: Limit intake of salt and sugar.

KM8: Make effective use of nutrition information on food labels.

Key area of Focus

Four (4) different types of vegetarian – vegan, lacto, ovo, lacto-ovo.

Differences in practices among them.

Introduction to new food list as alternatives e.g. mushroom, seaweed, seeds, nuts and legumes.

Conclusion

Each set of dietary guidelines contains unique features to address the dietary needs of these population groups.

It is hope that with these DGs, public will be well informed with evidence based information, make the right choices and lessen miscommunication between health promoter and the public at large.

DRAFT DRAFT DRAFT

Thank you