NCD – Risk and Malaysian Food Habits
transformation
Emeritus Prof. Dr Mohd Ismail Noor PhD, FASc, FIUNS
School of Hospitality, Tourism and Culinary Arts,
Taylor’s University, Malaysia
International Seminar on “Food, Risks and Sustainability: An Asian Perspective
The Hong Kong Polytechnic University, 6-7 July 2015
2
3
Situation in Malaysia
WHO, 2014
Prevalence of Diabetes (1996-2011)
Feisul Idzwan Mustapha (2013) NCDs: Issues and Challenges. NSPNCD 2013
Burden on Diabetes in Malaysia –
Trends and Projection by 2020
Tahir A& Noor Ani A (2011), NCDs in Malaysia – A Rising Trend. National Health and Morbidity Survey 2011. Conference on
Non-Communicable Diseases (NCDs) 26-27 March 2013
Prevalence of Hypercholesterolaemia
(2006 & 2011)
Total
Known
Undiagnosed
Feisul Idzwan Mustapha (2013) NCDs: Issues and Challenges. NSPNCD 2013
Burden on Hypercholesterolaemia in
Malaysia – Trends and Projection by 2020
Tahir A & Noor Ani A (2011), NCDs in Malaysia – A Rising Trend. National Health and Morbidity Survey 2011. Conference on
Non-Communicable Diseases (NCDs) 26-27 March 2013
Tahir A& Noor Ani A (2011), NCDs in Malaysia – A Rising Trend. National Health and Morbidity Survey 2011. Conference on
Non-Communicable Diseases (NCDs) 26-27 March 2013
Burden on Hypertension in Malaysia – Trends
and Projection by 2020
National Strategic Plan for Non-Communicable Diseases
(NSP-NCD) 2010-2014
• Presented and approved by the Cabinet on
17 December 2010.
• Provides the framework for strengthening
NCD prevention & control program in
Malaysia.
• Adopts the “whole-of-government” and
“whole-of-society approach”.
• Diabetes & obesity are used as the entry
points.
Seven Strategies:1. Prevention and
Promotion
2. Clinical Management
3. Increasing Patient
Compliance
4. Action with NGOs,
Professional Bodies &
Other Stakeholders
5. Monitoring, Research
and Surveillance
6. Capacity Building
7. Policy and Regulatory
interventions
10
Premature Mortality due to NCDs 2000-2012
for Malaysian Males & Females
Feisul Idzwan Mustapha (2014) Increasing Burden of NCD in Malaysia: Challenges in Resource Allocation. NSPNCD 2014
THE MAIN CAUSAL FACTORS: UNHEALTHY DIET
AND SEDENTARY LIFESTYLE
Why focus on Diet?
Diet Related NCDs
Deaths
Non-Diet Related
NCDs Deaths
Non-NCD
Related Deaths
Because >50% deaths are related to diet!
WHO, 2014
Available calories for various food in Malaysia
20
510
60
53
28
245
4
15
731
383
372
45
41
280
8
82
3
103
7
4
1167
324
202
18
0 200 400 600 800 1000 1200 1400
Animal fat
Animal product
Cereal
Fruit
Marine fish
Meat
Oat
Potato
Rice
Sugar &sweetener
Vegetable oil
Vegetable
1969 kcal/d 2009 kcal/d
FAO 2013. Food and Agricultural Organization of the United Nations. Food balance sheets. Available at
http://faostat3.fao.org/home/index.html#DOWNLOAD. Accessed July 2013.
USA
Adapted from Bray & Popkin, AJCN
1998; 68: 1157-1173 with data from FAO
2005, CFNI and recent national surveys
Dietary fat + sugar induce weight gain:
Malaysian fat intakes up 80% and sugar up by 33%
from the early 1960s
Obesity epidemic is inevitable unless
policies to reduce intakes substantially
from fat & sugar with spontaneous
increases in activity are introduced now
Perc
en
tag
e B
MI
>25.0
80
60
50
40
30
20
10
70
Dietary Fat (%) 20 25 30 35 40
Kuwait
Morocco
Mali
China 1982
India Congo
Tunisia
Malaysia Australia
New Caledonia
ItalyBrazilCuba
S. Africa
r = 0.88
Barbados
Guyana
Trinidad & Tobago
Jamaica
+ 20% sugarRussia
Philippines
Kyrgyzstan
Fat and sugar - major increases
Eating out: Meals
Meals only
Breakfast
And or Lunch
And/or Diner
12,5
% on Meals
% on Individuals
64.1 % of the Malaysian individuals eat at least one meal per day outside of the home
12.5 % of individuals eating only at home have at least one meal that comes from outside
Eating out
Eating at home with meals coming from outside
Eating at home
46.12
7.72
10,25
53.88
Prof. JP Poulain – FBS Taylors University 2014
Fast food industries in Malaysia – a selected list (2000)
Brand Year No. of Market Sales
(origin) (Est) Outlets Share (%) (RM million)
KFC (USA) 1973 294/580* 45 578.7
Mc Donald’s (USA) 1982 141/265* 30 349.6
Pizza Hut’s (USA) 1984 85 8 120.0
A & W (USA) 1961 44 4 47.8
Marry Brown (Local) 1981 88 4 NA
Sugar Bun (Local) 1981 45 * 36.1
(1999)
Kenny Roger (USA) 1994 25 * 36.1
Domino’s Pizza (USA) 1997 17 * NA
*Others combined 9%
Source: EDGE publication (2000)
*Figures found in the website for 2013-2014.
No date on other outlets, very likely it has
increased too!
Malaysia is A Food Haven!
Most Malaysian foods are
delicious but unhealthy!
Holistic Approach of Health through Food
2 stages
Stage 1: Transformation of food into healthier
products through the incorporation of functional/
healthy food ingredients and nutraceuticals
Stage 2: Utilize new technology eg. genomics to
allow us to assess the individual’s risk to
diseases
Healthy/ Functional Food Ingredients
Healthier Food Products
Stage 1: Transformation
• Use Healthy Choice oils/ fats
• Reduce caloric level from oils/ fats
• Add high fibre food ingredients
• Use whole grains
• Reduce sugar
• Use ingredients with low glycaemic index
• Improve protein content
• Reduce Sodium
Holistic Approach to Health through
Food
Approach Benefits Ingredients
Increase fibre Reduce prevalence of
colon cancer
Soy Fibre, Soy Flour, Lupin
Fibre, Lupin Flour, Oat,
Wheat Bran, Wholemeal
Wheat Flour, Pea Fibre
Balance Fatty Acid
(1SFA:1MUFA:1PUFA)
Reduce risk of heart disease Balanced Fatty Acid Oil/ Fat
Lower Glycaemic
Index
Reduce risk of diabetes Soy Fibre, Soy Flour, Lupin
Fibre, Lupin Flour, Oat,
Wheat Bran, Wholemeal
Wheat Flour, Pea Flour
Increase the use of
legumes/ lentils
protein
Reduce risk of heart
diseases and cancer
Soy Flour, Lupin Flour, Pea
Flour
Adding of
nutraceuticals
Prevent various diseases LingZhi, Cordyceps,
ginseng, flax seed, fish oil,
garlic etc
Stage 2 - Holistic Approach to
Health through Food
• Changes in eating habits can have big impact on public
health
• However, the problem there is no existing method that
can reliably predict the individual risk to any disease
• New genomics test can measure an individual’s risk to
disease and therefore allow researchers to test
effectiveness of food and nutraceuticals
Food groups Examples
Minimally processed foodsfruits, vegetables, grains, nuts, roots, milk, meat
Processed culinary ingredientsplant oils, butter, sugar, salt
Processed foodscanned foods, breads, cheese
Ultra-processed foodssoft drinks, sweet/savory snacks, fast meals
Moubarac et al Food classification systems based on food processing. Curr Obes Rep 2014 3: 256-273; Monteiro et al Ultra-processing and a new classification of foods. In: Neff R (ed) Introduction to U.S. Food System. San Francisco:Jossey Bass A Wiley Brand; 2015.
NOVA: A food classification based on extent and purpose of industrialprocessing
Ultra-processed foods are designed todisplace fresh foods and freshly prepared meals
7 810
13 14
18 19 20 20
25 27 28
3335 35 36 37
40 41
46 46
5153
55
0
10
20
30
40
50
% 60
FRA
NC
E1
991
ITA
LY 1
996
PO
RTU
GA
L2
00
0
PER
U2
009
GR
EEC
E2
002
CR
OA
TIA
200
4
CO
LOM
BIA
20
06
CY
PR
US
200
3
SPA
IN1
999
BR
AZI
L2
00
8
SLO
VA
KIA
20
03
MA
LTA
200
0
LATV
IA2
004
BEL
GIU
M1
99
9
AU
STR
IA1
999
UR
UG
UA
Y 2
00
6
NO
RW
AY
19
98
MEX
ICO
20
10
FIN
LAN
D 1
99
8
IREL
AN
D1
999
GER
MA
NY
19
98
UK
2008
CH
ILE
200
7
CA
NA
DA
200
1
The share of ultra-processed foods (% of energy) in national food baskets (1991-2010)
* Estimated from national household food expenditure surveys for Brazil (HBS), Canada (FOODEX), Chile (EPF), Colombia(ENIG), Peru (ENAPREF) Mexico (ENIGH), Uruguay (EGIH), and the Data Food Networking (DAFNE) for all Europeancountries, except UK (LCF).
NCD Research in Malaysia: Summary
• We know what needs to be done for the prevention and
control of NCD.
• What we do not know is how best to implement in real
life situations and within the socio-cultural context of
Malaysia.
– Implementation-type research, including
behavioural (qualitative research) can provide
evidence in answering this question.
• Multisectoral approach, not only in
implementation but in research as well.
26
Framework
------------------
Cluster for
Research
Initiative in
Food,
Nutrition
and Public
Health CRI-
FNPH)
Food, Nutrition and
Health Security
Social Sciences & Anthropology
Public Health Nutrition Food Science & Technology
Cluster for Research Initiative in Food, Nutrition
& Public Health
Research Area
- Food processing - Food products
development - Diet Formulation
- Food composition and nutrition profiling
- Functional foods - Organic food - Food safety
- Food economics - Food policy
Research Area
- Food and beverage consumption patterns
- Nutritional status of population
- Disordered eating habits - Diabetes, Obesity and
body composition - Body image
- Energy requirements - Physical activity
- Pharmaceutical diet - Use of supplements - Nutrition education
- Nutrition policy
Research Area
- Epidemiological studies - Health care system - Health promotion
- Disease prevention (e.g NCDs)
- Economic burden of disease
- Public health policy
Research Area
- Social food behaviour (Interactions, conviviality,
commensality) - Eating out & eating
decisions - Food cultures
- Acceptability of food innovation by different
communities - Social representations
and perception of risk - Food anthropology
- Consumer behaviour - Consumer experiences
- Perception on risks - Food marketing plans
Taylors’s University
(May 2015)
We face an
“UPHILL”
Battle
The Lancet Obesity, February 2015
Healthier Choice Logo Program
FEDERATION OF MALAYSIAN MANUFACTURERS
MALAYSIAN FOOD MANUFACTURING GROUP
(FMM MAFMAG)
31
Source of icons: World Heart Federation Champion Advocates Programme
Global NCD
Targets
2014 UN Outcome Document on NCDs(resolution A/RES/68/300)
• Bottom line: Governments committed themselves to intensify their efforts towards a world free of the avoidable burden of NCDs
• Moving forward: Maps out a set of concrete national commitments to be implemented between 2014 and 2018, and provides 3 new global assignments
• Towards the world we want: Next milestone in 2018
Policy Options on Food and Physical Activity to Combat Obesity in Malaysia
Presented by
Mohd Ismail Noor PhD, FASc, FIUNS
On behalf of the
TASK FORCE TO COMBAT OBESITY IN MALAYSIA
to
HE Minister of Health, Malaysia
11 June 2015
Ministry of Health
Malaysia
No Policy Options Task Force Proposal
1. Restrict the number of new food outlets
including 24 hours food outlets within 400
metres radius.
Implement the
proposed policy
options
2. Subsidies for fruits and vegetables.
3. Mandatory to display nutrition information
for all vending machines.
4. Reduce import duty on fruits and
vegetables.
5. Restrict serving size/refilling/value meals in
fast food outlets.
(Intensive discussion with six fast food
industries until December, 2014)
Star, 22 June
2015
STAR 26 June 2015
MALAYSIA BOLEH!!!
(A “Political Will” that MALYSIA can do without and ill-afford!)
Prof Ismail, President MASO
Sunday STAR, 28 June 2015
Obesity is one of the top three global social burden generated by human being
Estimated annual global direct economic impact and investment to mitigate selected global burdens, 20121
0.1
0.3
0.3
0.4
0.4
0.7
0.7
0.9
1.0
1.3
1.4
2.0
2.1
2.1
0.0 0.5 1.0 1.5 2.0 2.5
Poor water and sanitation7
Unsafe sex6
Child and maternal undernutrition
Household air pollution
Workplace risks
Road accidents
Drug use5
Outside air pollution
Climate change
Illiteracy4
Alcoholism
Obesity
Armed violence, war and terrorism3
Smoking
Share of
global
GDP %
Historical
Trend2
2.9
2.8
2.8
2.0
1.7
1.3
1.3
1.0
1.0
0.6
0.5
0.5
0.4
0.1
Source: WHO Global Burden of Disease database - McKinsey Global Institute Analysis (2014)
1. Based on 2010 disability-adjusted life years (DALY) data from Global Burden of Disease database and 2012 economic indicators from the World Bank;
excluding associated revenue or taxes; including lost productivity due to disability and death, direct cost, e.g., for health care, and direct investment to
mitigate; GDP data on purchasing power parity basis.
2. Based on historical development between 1990 and 2010 of total global DALYs lost (Global Burden of Disease).
3. Includes military budget.
4. Includes functional literacy.
5. Includes associated crime & imprisonment.
6. Includes sexually transmitted diseases. Excludes unwanted pregnancies.
7. Excludes lost time to access clean water source.
GDP, $ trillion
The Threat!
Thank You
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