Nutritional Guidelines for Filipinos NUTRITIONAL GUIDELINES FOR FILIPINOS Revised Edition 2012 eS Food and Nutrition Research Institute Department of Science and TechnologyNutritional Guidelines for Filipinos Copyright © 2015 by the Food and Nutrition Research Institute - Department of Science and Technology (FNRI-DOST). ISBN 987-971-8769-34-8 All rights reserved. Reproduction and dissemination of material in this handbook for educational and other non-commercial purpose are authorized without any prior written permission from the FNRI-DOST provided the source is fully acknowledged. Reproduction of material in this handbook for resale or other commercial purposes is prohibited without the permission from FNRI-DOST. Applications for such permission should be addressed to: Dr. Mario V. Capanzana, Director of the Food and Nutrition Research Institute. For correspondence: Food and Nutrition Research Institute DOST Compound, General Santos Avenue Bicutan, Taguig City 1631 Telephone (632) 837 2071 local 2299 Telefax (632) 837 2934 E-mail mvc@fnri.dost gov.ph mar_v_c@yahoo.com Website wwwfnri.dost.gov.ph ‘Suggested Citation: Food and Nutrition Research Institute - Department of Science and Technology. (2015) Nutritional Guidelines for Filipinos Revised 2012. Taguig City: Philippines.Nutritional Guidelines for Filipinos CONTENTS Foreword i Acknowledgement ii Technical Working Group il Project Team iv List of Tables v List of Figures vi List of Appendices vi Introduction 1 The 2012 Nutritional Guidelines for Filipinos 4 Message 1 Eat a variety of foods everyday to get the nutrients needed by the 6 body. Message 2 _Breastfeed infants exclusively from birth up to 6 months then give 37 appropriate complementary foods while continuing breastfeeding for 2 years and beyond for optimum growth and development. Message3 Eat more vegetables and fruits everyday to get the essential 50 vitamins, minerals and fiber for regulation of body processes. Message 4 Consume fish, lean meat, poultry, egg, dried beans or nuts daily for 58 growth and repair of body tissues. Message 5 Consume milk, milk products and other calcium-rich foods, such as 64 small fish and shellfish everyday for healthy bones and teeth. Message 6 Consume safe foods and water to prevent diarthea and other food- 73 and water-borne diseases. Message 7 —_Use iodized salt to prevent lodine Deficiency Disorders. 84 Message 8 Limit intake of salty, fried, fatty and sugar rich foods to prevent 89 cardiovascular diseases. Message 9 Attain normal body weight through proper diet and moderate 102 physical activity to maintain good health and help prevent obesity. Message 10 Be physically active, make healthy food choices, manage stress 119 avoid alcoholic beverages and do not smoke to help prevent lifestyle-related non-communicable diseases. References 134 Mga Gabay sa Wastong Nutrisyon 149 (The Official Filipino translation of the 2012 Nutritional Guidelines for Filipinos)Nutritional Guidelines for Filipinos FOREWORD Nutritional guidelines provide the general public with recommendations about proper diet and wholesome practices to promote good health. The guidelines are aimed at improving current dietary and other lifestyle practices to prevent nutritional problems. In line with current scientific knowledge, it is recommended that these nutritional guidelines should undergo periodic review and revision if necessary in order to be relevant to the current prevailing needs of the population ‘After more than a decade, the Food and Nutrition Research Institute of the Department of Science and Technology (FNRI-DOST) initiated the review and revision of the 2000 Nutritional Guidelines for Filipinos (NGF). This was undertaken by a Technical Working Group (TWG) formed by the FNRI, composed of multi-disciplinary group of experts from the food and nutrition research, public health, academe, nutrition policy, and nutrition education, and supported by a secretariat. The NGF recommendations were derived from the review of current dietary practices, nutritional adequacy, food availability, health status and trends, cultural variations, and socio-economic. conditions prevailing in the Philippines. As in the previous edition, this newly-revised NGF also consists of 10 nutrition messages but with @ corresponding rationale to emphasize the importance of the specific message. Included also in every message are the explanatory texts, important points to consider in teaching the message, frequently asked questions, and action points summarizing the recommendations relating to the message. This handbook will serve as a reference document useful to technical persons and professionals in teaching the public on nutritional guidelines; to policy makers and planners in formulating nutrition policies; to nutrition and health educators, and communicators in developing educational materials about the messages. It is hoped that this reference handbook will contribute to the improvement of the nutritional status, attainment of good nutrition, better productivity and quality of life for all Filipinos. MARIO V. CAPANZANA Ph.D. Director Food and Nutrition Research Institute Department of Science and TechnologyNutritional Guidelines for Filipinos ACKNOWLEDGEMENT The Committee on the Review and Revision of the Nutritional Guidelines for Filipinos (NGF) expresses its sincere gratitude to the participants, facilitators, and rapporteurs during the stakeholders’ consultative meeting where the draft of the NGF Nutrition Messages and Explanatory Texts were presented for their expert advice and valuable suggestions. Grateful acknowledgements are also due to the following: + The FNRI Technical Committee for their constructive suggestions. ‘+ The Philippine Information Agency for their assistance in the pre-testing of the Nutrition Messages in the different regions. ‘+ The participants in the pre-testing of the nutrition messages including the FNRI staff, the Barangay Integrated Development Approach for Nutrition Improvement (BIDANI) of the Rural Poor, University of the Philippines Los Bafios. ‘+ The participants from the professional organizations such the Nutritionist-Dietitians’ Association of the Philippines (NDAP), the Philippine Academy of Family Physicians (PAFP), the Philippine Society of Endocrinology and Metabolism (PSEM) for the survey Conducted on the awareness and usage of the NGF. * The different schools in Metro Manila and selected household members of Malolos, Bulacan in the survey conducted on the awareness and usage of the NGF and for all those who have contributed to the success of this undertaking + Ms. Marilou R. Galang for her valuable inputs in the proofreading of the explanatory texts. * Dr. Teofilo O.L. San Luis, Jr. for sharing his expertise in editing Chapter 7 on the “Use of lodized Salt to prevent lodine Deficiency Disorders”. ‘+ Mr. Brian Patrick C. Lu for his contribution during the initial phase of the development of the NGF icons; Ms. Eleanor Cruz for the initial lay-out of the handbook. + Ms. Angelique Tongco and Ms. Consuelo L. Orense for their assistance in the finalization and editing of the handbook. * Dr. Milflor S. Gonzales for facilitating the printing of the handbook. ‘+ The Nutrition Information and Education Division of the National Nutrition Council - Department of Health for providing the final copy of the 2012 NGF Icons.Nutritional Guidelines for Filipinos 2012 NUTRITIONAL GUIDELINES FOR FILIPINOS TECHNICAL WORKING GROUP* CHAIR Celeste C. Tanchoco, Dr.PH Former Scientist Ill and Chief Nuttition Research and Development Division, Food and Nutrition Research Institute-Department of Science and Technology Former President Nutritionist-Dietitians’ Association of the Philippines MEMBERS Mario V. Capanzana, Ph.D. Director Food and Nutrition Research Institute-Department of Science and Technology Corazon VC Barba, Ph.D. Professor Emeritus University of the Philippines, Los Bafios Rodolfo F. Florentino, M.D., Ph.D. President Nutrition Foundation of the Philippines Maria- Bernardita T. Flores, CESO Il Asst. Secretary of Health and Executive Director IV National Nutrition Council-Department of Health Liberty V. Importa ‘Supervising Health Program Officer National Center for Disease Prevention and Control-Department of Health, Alejandro V. Pineda, M.D. Past National President Philippine Academy of Family Physicians Luz S. See Chief Health Program Officer National Center for Disease Prevention and Control-Department of Health Florentino S. Solon, M.D. President Emeritus Nutrition Center of the Philippines Luz B. Tagunicar ‘Supervising Health Program Officer National Center for Health Promotion-Department of Health “Designation and afilation were as of October 31, 2012 ven the 2012 NGF was approved by the NC Governing Board2012 NUTRITIONAL GUIDELINES FOR FILIPINOS PROJECT TEAM Celeste C. Tanchoco, Dr.PH* Former Scientist Ill and Chief Nutrition Research and Development Division, Food and Nutrition Research Institute-Department of Science and Technology Former President Nuttitionist-Dietitians’ Association of the Philippines Arsonia J. Cruz, RND* Senior Science Research Specialist Food and Nutrition Research Institute Department of Science and Technology Robby Carlo A. Tan, RND Science Research Specialist I Food and Nutrition Research Institute Department of Science and Technology Mina Grace C. Aquino, RND* Science Research Specialist Il Food and Nutrition Research Institute Department of Science and Technology Marilou L. Madrid, RND Senior Science Research Specialist Food and Nutrition Research Institute Department of Science and Technology “Designation and afilation were as of October 31,2012 when the 2012 NGF was approved by the NNC Governing BoardNutritional Guidelines for Filipinos List of Tables Message 1 14 The Macronutrients 8 12 The Fat-Soluble Vitamins 1" 13 ‘The Water-Soluble Vitamins 3 14 Minerals - Macrominerals 7 15 Minerals — Microminerals 19 16 Acceptable Macronutrient Distribution Ranges (AMDR) 23 17 Daily Food Guide for Children 27 18 Daily Food Guide for Adolescents 29 19 Daily Food Guide for Adult 30 4.40 Daily Food Guide for Pregnant and Lactating Women, 3 1 Daily Food Guide for Older Persons 33 Message 2 24 Complementary Feeding Guide 44 Message 5 54 List of common foods high in calcium 69 Message 6 61 Common food and water-borne pathogenic 76 microorganisms. 62 Difference between hot meat from regular meat 82 Message 9 94 ‘Weight-for-age for boys from birth to 5 years 113, 92 Weight-for-age for girls from birth to 5 years 115 93 BMI cut-off points, WHO 105 94 BMI cut-off points, Asia-Pacific Consortium 105 Message 10 10.1 Calories/Hour Expended in Common Physical Activities 125Nutritional Guidelines for Filipinos List of Figures Introduction 1 The 2012 NGF Development Process 2 Message 5 51 Bone density over a lifespan 66 Message 9 O41 BMLfor-age for boys (5 to 19 years), WHO. 117 92 BMLfor-age for girls (5 to 19 years), WHO 118 List of Appendix Message 10 1 ‘The World Health Organization recommended levels. 147 of Physical Activity for HealthNutritional Guidelines for Filipinos INTRODUCTION Proper education on food choices is vital for one’s health because it serves as a basis for daily eating habits. Though many factors hinder to make the right choices, may it be economical, cultural, or social reasons, information dissemination through nutrition education is still best in improving eating habits. Simple and practical nutrition messages that promote moderation, balance, and variety in the diet plus a healthy lifestyle is of optimum importance. These messages are called Nutritional Guidelines which aim to improve the nutritional status of the population. The Nutritional Guidelines were developed in order to provide appropriate diet and health-related practices for the general population. What are Nutritional Guidelines? Nutritional guidelines are primary recommendations that promote good health through proper nutrition. They are simple statements that give advice on the consumption of food and food components for which there are public health concerns. Such concerns may include the Prevalence of malnutrition and specific nutritional deficiencies, nutrient intake imbalance, declining breast-feeding practice, increasing incidence of lifestyle-related chronic degenerative diseases and consumption of unsafe food. ‘What is the purpose of Nutritional Guidelines? Nutritional Guidelines aim to increase knowledge and educate the population on proper health and nutrition. As a result, it will encourage them to consume adequate and balanced diet as well as the promotion of desirable food and nutrition practices in relation to health. The guidelines aim to improve current dietary practices to prevent or alleviate diet-related public health problems in line with current scientific knowledge. Why do we need Nutritional Guidelines? Nutritional Guidelines provide the general public with easy and simple recommendations concerning proper diet and practices that bring about good health for every individual. It also serves as a framework for nutrition educators in giving out information to the public. How were the 2012 Nutritional Guidelines for Filipinos developed? The 2012 Nutritional Guidelines for Filipinos were developed by an inter-agency and multi- disciplinary technical working group chaired by the Food and Nutrition Research Institute, Department of Science and Technology (FNRI-DOST) as shown in Figure 1 and mandated by National Nutrition Council (NNC) Governing Board through Resolution Number 6, Series of 2012 dated 31 October 2012Nutritional Guidelines for Filipinos i v4 3 ks Ed Rome eer Bee Conti) Port Health and fer) eee’ Dem eo rt 5 6 Lari Oe aes see cide various users i 8 pou peso Appropriation and resi) of the NGF Figure 1. The 2012 NGF Process DevelopmentNutritional Guidelines for Filipinos Why is there a need to update the Nutritional Guidelines? The Nutritional Guidelines revision was in response to the changes in the health and nutrition situation of the country and in lieu of new nutrition information and related interventions to address malnutrition, The NGF endeavors in protecting and promoting the nutrition of Filipinos by providing a solid foundation and starting point for nutrition workers in developing nutrition information, education and communication materials, and in conducting nutrition advocacy activities. What are the goals and objectives of the 2012 Nutritional Guidelines for Filipinos? The goal of the NGF is the improvement of the nutritional status, productivity and quality of life of the population through adoption of desirable dietary practices and healthy lifestyle. The objectives of the NGF are (1) promote a healthy well-balanced diet; (2) promote exclusive breastfeeding; (3) give appropriate complementary foods; (4) increase the food and dietary energy of the average Filipino; (5) prevent nutritional deficiency diseases and lifestyle-related diseases; (6) encourage attainment of normal body weight; and (7) promote food safety. What is the difference between the 2000 NGF and 2012 NGF? Resembling the 2000 NGF, the 2012 NGF still has ten messages but now has nutritional and health rationale for each message. The new guidelines aim to improve the nutritional status that enhances productivity and quality of life of the population, by following desirable dietary practices and healthy lifestyle. Who are the target users of the Nutritional Guidelines? The target of the 2012 NGF is the general public. The users of the Nutritional Guidelines could range from policy makers to program planners and managers from the national and local level, Nutrition and other health-related practitioners or volunteers. How are the guidelines to be used? Depending on the scope of work, the NGF can be used in many ways. It can serve as a basis for law makers in creating nutrition policies. Program managers may use it as a framework for the development of nutrition education programs and as reference for evaluation of such programs. Nutrition educators may use the Nutritional Guidelines and this handbook as reference for preparing lectures and creating different nutrition education tools such a brochures, leaflets, and posters, among others.Nutritional Guidelines for Filipinos ‘as approved by National Nutrition Council (NNC) Governing Board through Resolution Number 5, Series of 2012Nutritional Guidelines for FilipinosNutritional Guidelines for Filipinos INTRODUCTION There are more than 40 essential nutrients that the body needs to function well. These nutrients, team up in special ways and depend on each other. Thus, we need all these essential nutrients. No single food can provide all the nutrients the body needs. Eating a variety of foods from all the. different food groups in the proper amount and balance will supply the required nutrients that the body needs. NUTRIENTS IN FOOD Nutrients are chemical substances present in food that regulate body processes; keep the body healthy; supply materials for growth and repair of tissues; and provide energy for work and physical activities. Eating a diet that includes a wide variety of food in the right amounts chosen. from different food groups help individuals to meet the Recommended Energy and Nutrient Intakes (REURNI) of the Philippine Dietary Reference Intakes (PDRI, 2015). For better nutrient intake, choose foods that have been fortified with vitamins and minerals such as vitamin A, iron, and iodine. The major nutrients include: ‘+ the macronutrients namely: proteins, carbohydrates, and fats. ‘+ the micronutrients namely: vitamins such as A, D, E, and K, B complex and C, and minerals such as calcium, iron, iodine, zinc, and fluoride. + water and electrolytes. MACRONUTRIENTS Protein On the average, protein contributes 12.5% of dietary calories in the Filipino diet (FNRI-NNS, 2013). Protein is contributed mainly by cereal and its products due to high consumption of rice as staple food. Fish, meat and poultry share 40.6% of protein in the diet, and the rest comes from eggs, milk and vegetables. The quality of protein from rice, however, is not high. Protein from animal sources is of higher quality than that from plant sources because of its more complete and balanced composition of amino acids (the building blocks of protein). The protein from beans and legumes like monggo and other dried beans including soybeans are of better quality than that of rice and wheat flour products, thus these foods are sometimes referred to as. cheap meat substitutes. In order to achieve proper balance of amino acids, it is recommended to include animal products or dried beans in the diet. This will improve the protein quality of our rice-based diet,Nutritional Guidelines for Filipinos Carbohydrates In the Philippines, dietary carbohydrates account for about of 68.7% of total energy intake (FNRI-NNS, 2013). The three major types of dietary carbohydrates are starch, sugar, and fiber. The sugars include monosaccharides (such as glucose, galactose, and fructose), and disaccharides (such as sucrose or table sugar, maltose and lactose or milk sugar). Complex carbohydrates (polysaccharides) comprise starch and dietary fiber. Starches are polymers of glucose while Sweet tooth Although craving for sweets may somehow satisfy a growing body's need for extra calories, sweets may create an environment favorable for the growth and development of microorganisms that cause tooth decay. Sweets should not be taken close to mealtime. In addition, children should be taught to brush their teeth and wash their mouth after eating sweet foods. Food for adolescents Care should be taken to ensure that adolescents take a variety of foods from different food groups to ensure a balanced diet. Introducing and encouraging them to eat a wide variety of foods can set the pattern of food habits that will be followed throughout life. Because of rapid growth and development, and increased physical activity, adolescents need more food from each of the food groups. This can be met by following the recommended serving sizes in Table 18. Food Groups Recommended Amounts 13 - 15 years 16 - 18 yrs Rice and Rice/Rooterops/Bread/ PastaiNoodies Alternatives 1 serving = 1 cup boiled rice or (cups) 4 pieces pandesal, about 17g. each; 4 slices of loaf bread, 179. each; 1 pack ‘or 60g noodles; 1 cup cooked macaroni 6-8 6%-8% ‘or spaghettl; root crop (2.9. kamote, tube, gabi), 1 medium piece, 160g or 1 to 1412 cup cooked diced Fish and Fish/Meat/Poultry/Egg/Dried Beans/Nuts 1 serving = 1 piece medium size fish, 55-60 g. each, about 16 cm. long; or 1 serving lean meat/poultry = 30g, 4%-5% 44-T% cooked; or % cups cooked dried beans! nuts, 1 % ¢ mongo soup, preferably eaten three times a week Milk Whole mik 1 glass = 240 mi (1 glass (glass/cup) whole milk is equivalent to 4 Tbsp 1 1 powdered whole) Vegetables Leafy green, yellow and other (cups) vegetables = % cup cooked or 45g 1% 1%-2 Fruits Vitamin C rich and others (servings) 1 serving = 1 piece small or 1 slice of a 3 3 big fruit Butter, coconut oil, mayonnaise oll Fats and Oils (com, canola, sesame) = 1 tsp or 5g 6-7 6-8 (tsp) ‘Sugar White, brown, syrup = 1 teaspoon or 59 5%-8 6-8 (tsp) Water and Tolass = 240 mi a-it 70-13 BeveragesNutritional Guidelines for Filipinos ‘Special nutritional concerns during puberty and adolescence Puberty and adolescence are periods of rapid growth and development, thus nutrient requirements are high. Nutritional concerns during adolescence are eating disorders, inappropriate food pattems including skipping meals, the practice of food fads and crash diets and the use of alcohol and drugs. ‘Adolescent girls are also prone to dieting for fear of becoming fat. A well-balanced diet spread over three main meals and small snacks will ensure adequate nutrition. For adolescent girls, menstruation, early pregnancy and subsequent lactation impact on nutritional needs. Pregnancy, childbirth and lactation are much more nutritionally demanding on teenage girls than on adult women. Teenage pregnancy is often the cause of malnutrition not only in the mother but also in the infant, and therefore should be avoided ‘Special nutritional concerns for adults One of the reasons why some people live longer and have good health as they age is good dietary habits. For this reason, special concerns for the nutrition of adults should be considered to prevent chronic diseases and obesity as they grow older (refer to Message No. 9 and 10 for more detailed discussion). Table 1.9 presents the recommended amounts of food for adults. Food Groups Recommended Amounts Rice and Alternatives _Rice/Rootcrops/Bread/ Pasta/Noodles (cups) 1 serving = 1 cup boiled rice or 4 pieces pandesal, about 17 9. eact 4 slices of loaf bread, 179. each; 5-7 1 pack or 60g noodles; 1 cup cooked macaroni or spaghetti, or 1 medium piece or 1 to 1 1/2 cup diced cooked rootcrops (e.g. kamote, ube, gabi) Fish and Alternatives _Fish/Meat/Poultry/Egg/Dried SeansiNuts (servings) 1 serving = 1 piece medium size fish, 55-60 g. each, about 16 om. long; or 1 serving lean meatipoultry = 309, cooked; or 1 pe 4%-5 egg; or % cups cooked dried beansinuts, 1 ¥%c mongo soup, preferably eaten three times a week Mile Whole milk 1 glass = 240 mi (7 glass whole (Glassicup) milk is equivalent to 4 tbsp powdered 1 whole) Vegetables Green, leafy, yellow and others = % cup 2-3 (cups) cooked or 48g Fruits Vitamin Crich and others = 3 (servings) 1 piece small or 1 slice of a big fruitNutritional Guidelines for Filipinos Food Groups Recommended Amounts: Fats and Oils Buiter, coconut oil, mayonnaise oil (com, 5-7 (tsp) canola, sesame) = 1 tsp or 5g Sugar White, brown, syrup = 1 teaspoon or 89 5-6 (tsp) Water and Beverages 1 glass = 240 mi 8. it “19-59 Healthy man or woman Special nutritional concerns for pregnancy and lactating women Pregnancy and lactation are periods of high nutritional needs. A pregnant woman not only has to satisfy her own nutritional requirements but also that of the growing fetus. Her nutritional status before and during pregnancy determines the nutritional status of her infant at birth and in succeeding months and even years. Undernourished mothers tend to give birth to low birth ‘weight babies. Anemic mothers predispose infants to anemia. lodine-deficient mothers may give birth to mentally and physically underdeveloped children. Similarly, lactating women have greatly increased nutritional requirements to satisfy not only their need but also the need for adequate milk production. Women can produce milk with adequate protein, carbohydrate, fat, most minerals, and folate even when they are not eating enough. However, Vitamins B6, B12, A and D in breast milk are likely to deciine in response to prolonged inadequate intake. To satisfy the markedly increased requirements of pregnant and lactating women for energy, protein, vitamin A, iron, calcium and the other important nutrients, increased intake of food from. all food groups is required, ‘The recommended amounts of food for pregnant and lactating women are shown in Table 1.10. Food Groups Recommended Amounts Pregnant Lactating Rice and 1 cup boiled rice = Alternatives (cups) 4 pieces pandesal, about 17 9. each; 4 slices of loaf bread, 17g each; 1 pack or 60g noodles; 1 cup 5%-6% 6-7% cooked macaroni or spaghetti; root crop (e.g. kamote, ube, gabi), cooked! medium 160g or 1 to 1 ¥% cup cooked Fish and Fish/Meat/Poultry/Egg/Dried Alternatives Beans/Nuts 5%-6 6%-7 (servings) 1 serving = 1 piece medium size fish, 55-60 g. each, about 16 cm. long; or 1 servingNutritional Guidelines for Filipinos lean meat/poultry = 30g, cooked: or 1 pc egg: or % cups cooked dried beans/nuts, 1% c mongo soup, preferably eaten three times a week Whole milk 1 glass = 240 mi (1 Milk glass whole milk is equivalent to 4 1 1 (glassicup) Tbsp powdered whole) Vegetables Green, leafy, yellow and others = 3 3 (cups) YA cup cooked or 459 Fruits Vitamin C rich and others 3 3 (servings) 1 serving = 1 pe small size or 1 slice of a big fruit Butter, coconut oil, mayonnaise oil 5-6 7-8 Fats and Oils (com, canola, sesame) = 1 tsp or (tsp) 5g ‘Sugar White, brown, syrup = 1 teaspoon 5-6 5-6 (tsp) or 5g Water and 1 glass = 240 mi 9-10 10-11 Beverages ‘Special Nutritional Needs for Older Persons One of the reasons why some people live longer and have good health as they age is good dietary habits they have practiced throughout life. However, aging is accompanied by physiological changes that impact on food choices. Chewing may become more difficult so texture of the food may need to be adjusted. Absorption of some nutrients is less effective as one advances in years. The immune system gets weaker and so the older individual may need to focus on nutritious foods to fight infections. The sensation of thirst is depressed in older individuals. They are more prone to dehydration and may experience dryness in the mouth if they do not drink enough water. They may also find it hard to move their bowels. Drinking lots of water will flush out waste substances and prevent constipation. Choosing foods with lots of fiber, such as vegetables, fruits, nuts and cereals will also help prevent constipation, The following are the recommended amounts of foods for older persons Table 1.11Nutritional Guidelines for Filipinos Food Groups Recommended Amounts 60-69 years _70 years and over Rice/Rootcrops/Bread/ Pasta/Noodles 1 serving = 1 cup boiled rice or 4 pieces pandesal, about Rice and 17 g. each; 4 slices of loaf 4-512 3K-4% Alternatives (cups) bread, 17g. each; 1 pack or 60g noodles; 1 cup cooked macaroni or spaghetti; or 1 medium piece or 1 to 1 1/2 cup diced cooked rooterops (e.g. kamote, ube, gabi) FishiMeat/Poultry/Egg/Dried Beans/Nuts_ Fish and 1 exchange portion = Alternatives: 1 piece medium size fish, 44-5 4-5 (exchanges) 55-60 g. each, about 16 cm. Jong; or 1 serving lean meat/poultry = 30g, cooked; or % cups cooked dried beans/ nuts or 1% ¢ mongo, preferably eaten three times a week Whole milk 1 glass = 240 mi Milk (1 glass whole milk is 1 1 (glass/cup) equivalent to 4 tbsp powdered whole) Vegetabl Green, leafy, yellow and (cups) others 1% 1% 1 serving = % cup cooked or 459 Fruits Vitamin C rich and others (servings) 1 serving = 4 piece small or 3 3 1 slice of a big fruit Butter, coconut oi, Fats and Oils ‘mayonnaise oil (corn, 3-5 3-5 (tsp) canola, sesame) = 1 tsp or Sugar White, brown, syrup = 4 4-6 4-6 (tsp) teaspoon or 5g Water and 1 glass = 240 mi 7-9 6-8 BeveragNutritional Guidelines for Filipinos FOOD FORTIFICATION To address the problem of micronutrient deficiency, Food Fortification* may serve as an intervention. Food Fortification is defined as the addition of one or more essential nutrients to a food, whether or not it is normally contained in the food, for the purpose of preventing or correcting a demonstrated deficiency of one or more nutrients in the population or specific. population groups (FAO/WHO, 1994). Food fortification is a cost-effective way of increasing the intake of micronutrients generally lacking in the diet without changing food habits. The fortified foods currently available include iodized salt, vitamin A and iron fortified noodles, iron-fortified rice, vitamin A fortified edible oil, vitamin A and iron fortified flour, margarine, sardines, hotdogs, snack foods, and vitamin C fortified juices. The Sangkap Pinoy seal on the label identifies food products which have been officially certified as fortified with vitamins and minerals such as vitamin A, iron, and iodine by the Department of Health (DOH). * The Food Fortification Law (RA 8976) was signed by then President Joseph E. Estrada on November 7, 2000. The law establishes the Philippine Food Fortification Program covering all local and imported processed food products for sale or distribution for human consumption in the Philippines, except for dietary supplements where standards have already been prescribed. In other words, the law applies to all manufacturers, producers, importers, traders, retailers and repackers of foods prescribed to be fortified. It also covers restaurants and food service establishments Whenever they serve foods prescribed to be fortifiedNutritional Guidelines for Filipinos Frequently Asked Questions Can one have a balanced diet with ready-to-eat foods? Yes. A balanced meal can be achieved with convenience foods or cooked foods bought from the restaurant or favorite “carinderia” as long as the foods are chosen well. Individuals who eat out must select food items of better nutritional value. For a balanced meal, they can accompany a pizza, hamburger or hotdog sandwich with a side dish of vegetable and fruit. High fat choices can be balanced with lower fat selections at the next meal How can food labels aid in healthy eating? Food labels tell consumers not only what their foods contain but also how the food relates to an overall healthy diet. Food labels may provide information on recommended size of serving, ingredients list, seal of approval such as the Sangkap Pinoy seal, preparation instruction, serving suggestion, expiry date (best consumed before date), and nutritional information on the back and front of package. The information can be used to make healthier choices. Is it necessary to take nutritional supplements to meet nutrient needs? In general, eating a variety of foods in the right amounts will ensure adequate nutrient intake People who are most likely to have inadequate nutrient intake are pregnant and lactating women, pre-school children, elderly, and individuals who are chronically il, have poor appetites, and those on restricted diets. A physician or a registered nutrtionist-dietitian may prescribe supplements to cover increased nutrient needs, deficiencies in the diet, or to replace nutrient losses due to medication or illness. If there is doubt whether nutrient needs are being met, a Registered Nutritionist-Dietitian can evaluate the person's diet in relation to his/her needs. It should also be emphasized that there can be harmful interactions between drugs and ‘supplements. If the individual is taking medications, it is best to check with the doctor before taking supplements. Excessive use of fiber supplements is associated with greater risk of intestinal problems and decreased absorption of some minerals. The increased nutritional supplements of pregnant women for iron and folic acid cannot be satisfied by ordinary diets. Iron with folic acid supplements should be taken once pregnancy is determined. Pregnant women need to take iodine supplements in any of the following situations: a) IDD prevalence is classified as moderate or severe; b) cretinism and neonatal hypothyroidism are present; c) iodine supplementation may be given in areas where less than 90% of households are using iodized salt and the median urinary iodine is 100ug/ among school children (Micronutrient Supplementation Manual of Operations, DOH).Nutritional Guidelines for Filipinos ACTION POINTS Plan and consume a balanced diet. Eat the recommended amount of food from each of the food groups. Pay particular attention to the increased needs during periods of growth and development (school children and adolescents), pregnancy and lactation. Take care of the increased nutritional needs of adolescents by gi adequate and varied meals to get them ready for adulthood. ing When planning to eat convenience foods, choose those with high nutritional value and observe the principle of variety. Select fortified foods, whenever possible. Read food labels to make healthier food choices. Take nutritional supplements only upon expert advice.¥ ENutritional Guidelines for Filipinos INTRODUCTION Breastfeeding is the normal way of providing young infants with optimum nutrition they need for healthy growth and development. Practically, all mothers can breastfeed, provided they have accurate information, and the support of their family, the community, the health care system, and the society. Breastfeeding should be initiated within the first hour after delivery. The World Health Organization or WHO recommends exclusive breastfeeding for the baby's first 6 months of life, and continued breastfeeding with the addition of appropriate, adequate and safe complementary foods up to two years old and beyond. EXCLUSIVE BREASTFEEDING Exclusive breastfeeding means that the infant receives breastmilk only (including milk expressed from a wet nurse). No other liquids or solids are given, not even water (with the exception of oral rehydration solution (ORS), drops, syrups of vitamins, minerals or medicines). WHO recommends that infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health. From thereon, the infants should receive nutritionally adequate and safe complementary foods, while continuing to breastfeed for up to two years or more. BENEFITS OF EXCLUSIVE BREASTFEEDING The benefits of exclusive breastfeeding on child survival, growth and development are well documented. Exclusive breastfeeding also provides health benefits for mothers. Exclusive breastfeeding is the single most effective intervention for preventing child deaths. Infants under two months old who are not breastfed are six times more likely to die from diarrhea or acute respiratory infections than those who are breastfed. Approximately 1.3 million infant deaths could be prevented each year if exclusive breastfeeding rates increased to 90 percent. Exclusive breastfeeding provides total food security. Breastmilk is a hygienic source of food with the right amount of energy, protein, fat, vitamins, and other nutrients for infants in the first six months. Exclusive breastfeeding optimizes a child's physical and mental growth and development Infants fed with breastmilk show higher developmental scores as toddlers and higher Intelligence Quotient (IQ) as children than those who are not breastfed. Breastmilk supplies key nutrients that are critical for health, growth and development,Nutritional Guidelines for Filipinos ESTABLISHING AND SUSTAINING EXCLUSIVE BREASTFEEDING FOR 6 MONTHS To enable mothers to establish and sustain exclusive breastfeeding for 6 months, it is recommended that the mother should: Breastfeed baby within the first hour of baby's life. Give breastmilk to her baby without any additional food or drink, not even water. Breastfeed baby on demand and as often as baby wants. Refrain from the use of bottles, artificial nipples or pacifiers to prevent nipple confusion. Be informed on potential breastfeeding problems and how these may be addressed. Get involved in a breastfeeding support group of other mothers who are also breastfeeding exclusively. Make it clear at the hospital that she intends to breastfeed her baby exclusively. Continue to breastfeed upon return to work by pumping during the day and breastfeeding at night. IMPORTANCE OF COLOSTRUM Colostrum is the thick yellow fluid that is produced by the mother during the first three days after delivery. It is rich in protein, minerals, vitamins, and antibodies which make infants more resistant to infections and allergy. Colostrum should be given to the baby because of the following benefits: Provides the first immunization against many diseases that an infant encounters after delivery; Protects infants against allergy and infection because it is rich in antibodies; Makes babies resistant to bacterial infections and other diseases hence, an infant is less likely to fall sick; It has a mild purgative effect that clears the tarry first stools called meconium and helps ‘@ newbom rinse his gastrointestinal tract of bilirubin, the waste product accumulated before birth, thereby helps to prevent jaundice,Nutritional Gui lines for Filipinos IMPORTANCE OF BREASTMILK Breastmilk contains almost complete nutrients for 0-6 months old infants and also provides high nutritional value and protection to more than 6 months old until 2 years. Itis easily digested and absorbed by the baby. Is clean and readily available at proper temperature. Protects infants against infection like diarthea and pneumonia. Is readily available for as long as the mother continues to breastfeed (the more frequent the mother nurses her baby, the more breastmilk is produced). IMPORTANCE OF BREASTFEEDING For mother and infant Is economical; Is convenient, breast milk is readily available at room temperature at all times; Promotes emotional bonding as it fosters a close and loving relationship between mother and baby; There is evidence that children who were breastfed perform better in intelligence tests. For the mother Breastfeeding aids in contraction of the uterus to normal size after delivery; If done exclusively and frequently, with no long intervals for the first 6 months and continued for 7 months or longer, provides a natural contraceptive measure for the mother; Reduces risk of breast and ovarian cancer in women; Lowers rates of obesity; Early breastfeeding helps reduce postpartum bleeding and makes the uterus to contract, faster. The longer lactation continues, the greater the protection; ‘Adults who were breastfed as babies often have lower blood pressure and lower cholesterol, as well as lower rates of overweight, obesity and type-2 diabetes.Nutritional Guidelines for Filipinos PREPARING FOR BREASTFEEDING During pregnancy the mother should: ‘+ Be educated on breastfeeding during prenatal visit and home visits (Understand why she should breastfeed); ‘+ Eata balanced diet; ‘+ Prepare emotionally for breastfeeding; ‘+ Know how to breastfeed; and, ‘+ Wear well-ftting brassieres to provide comfort for enlarged breasts. After delivery the mother should: ‘+ Eat a balanced diet and drink enough water and soup; Breastfeed on demand, day and night or as long as the baby wants; ‘+ Get enough rest during the day; ‘+ Allow the baby to empty the breast completely. Do not remove the baby from the breast instead let the baby be the one to detach from the breast when full; + Avoid fear, worry and fatigue especially when nursing the baby; ‘+ Not offer any food or drink to the newborn; and Breastfeed the baby as much as the baby wants. SUCCESSFUL BREASTFEEDING The baby should be initiated to breastfeeding within the first hour after birth. Correct positioning and attachment can prevent nipple soreness and allow the baby to obtain enough milk. The “rooting reflex’ is the baby's natural tendency to turn towards the breast with the mouth open wide; mothers sometimes make use of this by gently stroking the baby’s cheek or lips with their nipple to induce the baby to move into position for a breastfeeding session, then quickly moving the baby onto the breast while its mouth is wide open. To prevent nipple soreness and allow the baby to get enough milk, a large part of the breast covering the areola need to enter the baby's mouthNutritional Guidelines for Filipinos REGULATING BREASTMILK SUBSTITUTES The Milk Code (Executive Order 51), cited as the “National Code of Marketing of Breastmilk Substitutes, Breastmilk Supplements, and Related Products” and its Revised Implementing Rules and Regulations (RIRR) aim to ensure the provision of safe and adequate nutrition for infants and young children by the promotion, protection and support of breastfeeding and by ‘ensuring the proper use of breastmilk substitutes, breastmilk supplements and related products when these are medically indicated and only when necessary, on the basis of adequate information and through appropriate marketing and distribution. Report to DOH the following violations committed against the Milk Code or EO 51 and its Revised Implementing Rules and Regulations or RIRR: Giving directly or indirectly, samples and supplies of products within the scope of the Code or gifts to any sort to any member of the general public, personnel within the health care system. Advertisement, promotion or other marketing materials for products within the scope of the milk code unless such materials are duly authorized and approved by the Inter- agency Committee. Distribution of any gifts or articles to pregnant women and mothers of infants which may promote the use of breastmilk substitutes or bottle feeding to the general public. Use of facility of the health care system for the purpose of promoting infant formula or other products. Giving of financial or material inducements or gifts of any sort to promote products offered or given by milk companies and accepted by health workers. False or misleading information or claims of produets. COMPLEMENTARY FOODS: ‘Complementary food means foods other than milk substitutes, whether manufactured or locally prepared, suitable as a complement to breastmilk to satisfy the nutritional requirements of the infant after 6 months of age. Complementary foods, also called transitional foods, should be introduced as they continue to breastfeed. ‘Complementary foods should be: timely (introduced when the need for energy and nutrients exceed what can be provided through exclusive and frequent breastfeeding); adequate (provide sufficient energy, protein and micronutrients to meet a growing child's nutritional needs); safe (hygienically stored and prepared and fed with clean hands using ‘clean utensils and not bottles and teats); and properly fed (given consistent with a child's, signals of hunger and that meal frequency and feeding methods are suitable for the child's age)Nutritional Guidelines for Filipinos IMPORTANCE OF COMPLEMENTARY FOODS AT 6 MONTHS, Starting other foods in addition to breastmilk at 6 completed months helps a child to grow well. However, giving complementary foods before 6 months may increase risk of illness because of less consumption of the protective factors in breastmilk. It may also take the place of breastmilk, making it difficult to meet the nutritional needs of the child. On the other hand, delaying introduction of complementary food will affect growth and development and may cause malnutrition since the child does not receive the nutrients required to meet his growing needs. WAYS TO INTRODUCE COMPLEMENTARY FOODS Introduce one new food at a time. Continue with the same food for 3 to 4 days. Start with small amounts of any food (teaspoonful or less). Use thin puree consistency when starting solid foods. Gradually shift to a thicker consistency of food with higher nutrient density. Never force an infant to eat. If baby objects to taking some food, mix it with other foods he likes until he becomes accustomed to the flavor. If after several trials, the baby refuses to eat a particular food, omit it for a week or two, and try again. If the dislike persists, omit entirely and substitute with another food of similar nutritional value. Foods may be seasoned slightly. Salt should not be added to the diet of the infant before the age of 1 year, since the baby's maturing kidneys cannot handle sodium efficiently. When baby is able to chew, gradually switch to finely chopped vegetables, fruits, fish and meats. Do not continue soft smooth food for too long. ‘A mother’s dislike for a particular food must not reflect in the choice of foods for the baby.RECOMMENDED COMPLEMENTARY FOODS Nutritional Guidelines for Filipinos A baby's physical ability to handle foods and his nutritional need determine the sequence and timing with which new foods are introduced to a baby's diet. Complementary foods should be added to an infant's diet in the following order (Table 2.1). Table 2.1 Complementary Feeding Guide 6 months Cooked, well Thin rice, gruel, % cup thin strained oatmeal gruel Cooked, mashed 2-3 Cereals (first rootcrops tablespoons semi-solid foods 8 months Cooked Thick gruel, soft % cup thick given to the cooked rice gruel baby) 10 - 12 months. Cooked Soft cooked rice 1 cup Sliced bread, 1 piece biscuits 6 months Mashed Ripe banana, 2% Fruits ripe papaya, ripe tablespoons mango 8 months Cut into small Soff fruit 3 tablespoons pieces 10-12months Cutinto finger Any fruit 4 tablespoons sized pieces Vegetables 7 months Cooked very soft Carrots, sayote, 1 tablespoon squash, abitsuelas, potatoes, kamote tops, kangkong tops, pechay, malunggay leaves 8 months Cooked and finely All vegetables 1 tablespoon. chopped 10-12months Cooked and Allvegetables 1-2 coarsely chopped tablespoons Meat and 7 months Cooked Chicken egg % egg yolk alternatives, Egg _11 months Cooked Chicken egg ‘eggNutritional Guidelines for Filipinos Table 2.1 Complementary Feeding Guide (cont'd) ‘Meatffish/poultry 6-11 months — Deboned, Minced meat, 1-1/3 servings or legumes, dried cooked well, fresh or dried beans mashed or fish or minced 4 serving cooked ground chicken, mashed meat = 30 ‘monggo grams; or fis 1 piece medium, about 35 grams cooked; or % cup cooked dried beans 40-12months —Deboned, Meat, fresh or 1 1/3 servings cooked, flaked or dried fish, chopped well chicken, monggo Milk ‘6 months up Whole milk 2oups Other foods ‘8 months up Steamed, baked Custards, simple 1 teaspoon puddings, plain gulaman or jello Fats andOils* 6-11 months ‘Margarine, 4 teaspoon cooking oil ‘Sugar 6-11 months 3 teaspoon “Fats and olls may be incorporated to the prepared diet by adding to the rice gruel or mashed vegetables or served in cither sautéed or fried dishes for the baby after 6 months of ago. By 12 months, the child can eat the family diet. Soft foods and processed foods fortified with vitamins and minerals are appropriate.Nutritional Guidelines for Filipinos Frequently Asked Questions Can all mothers breastfeed? Yes, all mothers under normal conditions can breastfeed their babies and must be encouraged to breastfeed. Information on the importance of breastfeeding and how and when to breastfeed must be provided before delivery. What can be done i mothers perceive themselves to have “not enough” breastmilk? This is one of the most common reasons that mothers give for wanting to stop breastfeeding, and for wanting to give their baby bottle feeding or cereal porridge too early. Almost all mothers, can produce enough milk. What is needed is to reassure her about this. The health worker must decide if the baby is taking enough milk or not, what the problem is and how she can help the mother. How do you know if the baby is not taking enough breastmilk? The wetness test and the weight check can help one determine if the baby is taking enough milk. ‘+ Wetness test: If the infant is exclusively breastfed and urinates six times a day, then the infant is taking enough breastmilk. If the infant is crying, it must be due to something else. If the mother is giving him water and other drinks, then this test cannot be used. The water will make the infant pass urine even with not enough milk. ‘+ Weight check: Weigh the baby and compare weight-for-age against a growth chart. Weigh the baby every month routinely. A healthy baby should gain about half a Kilogram each month for the first 6 months. A baby who is growing well is getting enough milk. If, the baby's growth curve does not rise fast enough, the baby may be ill or may not be getting enough milk. Reliable signs that a baby is not getting enough milk are: small amount of concentrated urine (less than 6 times per day) and poor weight gain (less than 500 grams per month), Other signs that baby has taken adequate breastmilk ‘+ Is satisfied after 15-20 minutes of feeding; ‘+ Falls asleep promptly after each feeding and sleeps for three to four hours; ‘+ Gains weight satisfactorily from month to month. The baby should double birth weight at five to six months of age and triple weight at one year.Nutritional Guidelines for Filipinos Is re-lactation possible? Yes, re-lactation is possible. If a mother stops breastfeeding because of illness and her milk supply decreases, help the mother to increase milk flow again. When she is well, reassure her that her milk will come back if the baby suckles. If the baby “refuses”, the mother should coax the baby to breastfeed again. Can a working mother continue to breastfeed once she resumes work? Yes, a working mother can continue to breastfeed when she resumes work. While at work, the mother can express breastmilk within the hour that she is supposed to nurse her baby. Expressed milk can be collected in sterile bottles and stored in a refrigerator. These bottles can then be transported home in a thermos flask surrounded by ice and transferred to a refrigerator ‘as soon as the mother reaches home. Breastmik can be kept in the refrigerator for up to 24 hours or in the freezer for 3 months. Why is bottle feeding not advisable? Bottle feeding increases the risk of infections. Improperly prepared infant milk formula can be contaminated with bacteria, especially if the mother does not sterilize the feeding bottle after every feed. Bacteria grow in milk formula very quickly. Milk can be dangerous to a baby long before it smells sour. Besides, there is danger of contamination of milk formula during preparation especially from contaminated water. With the high cost of milk formula, poor mothers may be unable to buy enough milk for their babies. They may give too few feeds, and they may put too little milk or milk powder info each bottle, thereby resulting in over dilution. Nutrient content of cow’s milk may not be appropriate for the baby’s needs in the first year of life. Vitamins and iron are not enough; sodium, calcium and phosphate levels are too much; and the fat and protein quality and content may not be suitable. Babies who are fed on cow's milk early may have more allergy problems, for example, asthma or eczema. Bottle-fed babies are also more prone to diarrhea and respiratory infections. Why not infant formula? Infant formula does not contain the antibodies found in breast milk and is linked to some risks, ‘such as water-borne diseases that arise from mixing powdered formula with unsafe water (many families lack access to clean water). Malnutrition can result from over-diluting formula to “stretch” supplies. Furthermore, frequent feedings maintain the breast milk supply. If formula is used but becomes unavailable, a return to breastfeeding may not be an option due to diminished breast milk production. Follow-on formulas are permissible as part of the ‘complementary feeding plan but not as a substitute for breastmilk. Follow-on formulas should be given ina cup or a glass as a baby who learns to suckle from a bottle may refuse to suckle from the breast.Nutritional Gui lines for Filipinos What are common food-related problems in infancy? Colic is the abdominal discomfort caused by swallowing air. To prevent colic, the baby should be burped after each feed. Hold the baby next to the shoulder or put the baby on his stomach ‘over the lap and pat his back until he burps. Regurgitation is the effortless expulsion of gastric contents caused by gastrointestinal reflux. To minimize regurgitation, position the infant at a 45 to 60-degree angle after a feed Diarthea is the frequent passage of loose, watery and unformed stools. Breastfeeding should be continued during the episode. Plenty of fluids, and if necessary, an oral rehydration solution made with table salt and sugar in water or commercial preparations such as those given by the health center, should be provided. Foods such as banana hasten the development of formed stools and may be included in the diet if the baby is old enough. A physician should be consulted if diarrhea continues for more than a day. Food allergy is a hypersensitive state resulting from the interaction of an allergen with an antibody within the body. It may be manifested in various ways such as diarrhea, skin rashes, eczema, etc. The offending food should be eliminated and acceptable substitutes should be offered. It is best to consult a physician or a health care-provider if food allergy is suspected. Can the mother with HIV breastfeed her baby? Research has shown that exclusive breastfeeding during the first few months of life carries a lower risk of HIV transmission than mixed feeding, For HIV-positive mothers, WHO recommends exclusive breastfeeding for the first six months unless replacement feeding is: + Acceptable (socially welcome); + Feasible (facilities and help are available to prepare formula); + Affordable (formula can be purchased for six months), + Sustainable (feeding can be sustained for six months); and + Safe (formula is prepared with safe water and in hygienic conditions)Nutritional Guidelines for Filipinos ACTION POINTS ‘+ To promote normal growth and development of infants, mothers should: > Practice exclusive breastfeeding for the first six (6) months of life > Continue breastfeeding for up to two (2) years > Provide appropriate, adequate and safe complementary food in addition to breastmilk from 6 months onwards * Feeding should be supported and promoted by all members of the family, the community, the health-care providers and the societyMessage 3 Eat more vegetables and fruits everyday to get the essential vitamins, minerals, and fiber for regulation of body processes eyNutritional Guidelines for Filipinos INTRODUCTION In general, most people do not eat enough green leafy and yellow vegetables, and vitamin C- rich fruits based on the results of the 2013 Food Consumption Survey conducted by the Food and Nutrition Research Institute (FNRI-NNS, 2013). Vegetables and fruits are rich sources of micronutrients such as vitamin A, C, and E as well as calcium, iron, dietary fiber and phytochemicals. Vegetables and fruits play important roles in regulating body processes; they are co-factors in growth and development. Including these foods into the diet may help correct micronutrient deficiencies such vitamin A, iron and iodine; and may help prevent obesity, and non-communicable diseases such as diabetes, heart diseases, and some forms of cancer. Insufficient intake of vegetables and fruits is estimated to cause deaths of around 14% due to gastrointestinal cancer, about 11% due to ischemic heart diseases, and about 9% due to stroke, According to the 2003 World Health Report of the World Health Organization (WHO), about 1.7 million deaths are attributable to low vegetable and fruit consumption. VEGETABLES From the nutrition point of view, vegetables may be defined as those plants or parts of plant Which may be used either as raw or cooked and generally served with an entrée or in salads but not as desserts, Vegetables are classified according to parts of plant used, chemical composition or nutritive value. According to parts of plant used, vegetables may be roots (e.g. sweet potato, cassava, carrot), tubers (e.g. potatoes), bulbs (e.g. garlic, leeks, onions, shallots), seeds (e.g. pulses, legumes), stems and shoots (e.g. celery, bamboo shoots, ubod or coconut pith), leaves (e.g. ‘swamp cabbage, kamote tops) and, fruits (e.g. chayote, squash, tomato), ‘According to chemical composition, vegetables may either be carbohydrate-rich (¢.9. seeds, roots and tubers), protein-rich (e.g. legumes and pulses), fat-rich (e.g. nuts, olives and avocado), and those with high moisture content (e.g. mushrooms, tomatoes, celery, cauliflower, radish, lettuce, and cabbage). ‘According to nutritive value, vegetables are usually depended upon for vitamins, minerals and bulk or indigestible fiber. They are usually classified as regulatory foods or those that contain carotene, vitamin C and vitamin B-complex to protect the eyesight, to keep the skin smooth and clean, to prevent the occurrence of some bleeding gums and easily-bruised skin, and increase body resistance against infection. Vegetables may also be grouped according to their major functions in the body either as body regulating as in the case of green, leafy vegetables or as energy-giving like rootcrops and tubers: * Green, leafy vegetables - such as malunggay, saluyot, kangkong, ampalaya leaves, kamote tops and alugbatiNutritional Guidelines for Filipinos ‘© Other vegetables - non-leafy vegetables such as carrots, squash, eggplant, string beans, chayote, upo, patola, kalabasa, green papaya, unripe jackfruit, and ampalaya. ‘+ Roots and tubers — such as potato, cassava, radish, yam or ubi, gabi, kamote, tugi and singkamas. There are also a number of processed food items available in the market that contain vegetable ingredients which can be referred to as “vegetable derived” products. These products may or may not maintain the nutritional integrity of the vegetable used to produce them. Examples of vegetable-derived products are catsup and tomato sauce NUTRIENTS FOUND IN VEGETABLES Green leafy and yellow vegetables such as malunggay, mustasa, saluyot, kangkong, kamote tops, ampalaya leaves, and alugbati are particularly rich in beta-carotene. Beta-carotene and other carotenoids are converted to vitamin A in the intestinal wall and liver but they require dietary fat for their efficient conversion and utilization. While beta-carotene has only 1/6 the biological activity of preformed vitamin A from animal sources, it is a very important source of vitamin A in our diet because of the wide availability and relatively low cost of vegetables in contrast to animal foods. Moreover, fresh and lightly cooked leafy greens are good sources of vitamin C as well as non-heme iron, calcium, dietary fiber, folic acid, vitamin E, and other phytochemicals. The non-leafy vegetables like eggplant, string beans, sayote, upo, ampalaya, and roots and tubers not only contribute dietary fiber and variety to our meals but also provide additional iron ‘and B-complex vitamins. Non-heme iron found in these plant-based foods are best absorbed when consumed at the same time with foods high in vitamin C. Roots and tubers are often not included in significant proportion in the Filipino diet except as staples in isolated areas. The consumption of starchy roots and tubers such as potatoes, gabi, cassava, and kamote, will add to dietary energy besides improving the pattern of carbohydrate consumption. Root crops also provide dietary fiber and vitamins. Yellow kamote supplies beta- carotene and potato is a good source of vitamin C. IMPORTANCE OF VEGETABLES Vegetables and fruits are rich sources of vitamins and minerals such as vitamins A, C, and E, as well as calcium, folic acid, non-heme iron, potassium, dietary fiber, and other phytochemicals. Dietary fibers can be classified as soluble and insoluble fiber. Soluble fiber found in beans, legumes, such fruits as apples and some grains such as oats, rye and barley, is known to have cholesterol-lowering effects because it increases fecal excretion of bile acids, reduces cholesterol formation in the liver, and increases production of short-chain fatty acids by fermentation in the large intestine. Insoluble fiber found in vegetables, whole wheat grain, and wheat and com bran, increases bulk in the gastrointestinal tract and therefore promotes gastrointestinal motility, hastening the movement of gut contents through the intestinal tract. The rapid passage of the digestive mass through the colon is said to reduce the possibility of potential carcinogens to interact with the mucosal surface. Consuming the recommended amounts of vegetables is beneficial for the prevention of non-Nutritional Guidelines for Filipinos communicable diseases such as heart disease, cancer, diabetes and obesity, as well as for the prevention and alleviation of several micronutrient deficiencies, such vitamin A, iron and iodine. Micronutrient deficiencies prevalent among Filipinos as a result of non-consumption of vegetables Vitamin A Deficiency and Xerophthalmia Vitamin A deficiency is a_major public health nutrition problem in the Philippines especially among children. The 2008 National Nutrition Survey showed that the highest prevalence of Vitamin A Deficiency (VAD) was observed among infants 6 months to 5 years at 15.2%. The deficiency is primarily caused by lack of vitamin A in the diet arising from low intake of animal foods and green leafy and yellow vegetables, compounded by inadequate fat intake. Vitamin A deficiency results in retarded physical growth and development of children and low resistance to infection, resulting in high rates of sickness and death among young children. The deficiency is manifested in early stages by night blindness, and in its severe stages, by lesions in the eye (xerophthalmia) leading to permanent blindness Iron Deficiency Anemia (IDA) For details about IDA, refer to NGF message No. 4. PREPARATION OF VEGETABLES Vegetables are eaten in a variety of ways, as part of main meals and even as snacks. Some vegetables can be consumed raw, some may be eaten cooked, and some must be cooked in order to be edible. Vegetables are most often cooked in savory and salty dishes. However, few vegetables are often used in desserts and other sweet dishes, such as carrot cake. Tips in preparing, cooking or presenting vegetables Boiling is one of the most common ways of cooking vegetables such as in nilaga and sinigang. Preferably, simmer vegetables in a minimum amount of water because soluble nutrients in vegetables such as vitamin C and B complex will be lost in cooking with water. Steaming is the best way to cook vegetables. Not only does it avoid using any type of fats in the cooking process, but it also protects the nutrients in the vegetables because none of the vitamins are lost to the water and drained away. Steaming also preserves the color and nutritional value of vegetables to a very high degree. Vegetables can also be cooked by putting on top of rice in the last stages of cooking, Stir-rying is @ cooking method that can preserve the good flavor and color of vegetables, It is a method of cooking where sliced vegetables and meat are quickly fried in a large pan over very high heat while constantly and briskly stirring them. The cooking technique requires a minimum amount of fat and results in a food that is crisp and tender.Nutritional Guidelines for Filipinos Broiling is a method of cooking by exposing food to direct heat, either on a grill over live coals or a gas burner or electric coil. Broiling differs from roasting and baking, because in broiling, the food is turned during the process so as to cook one side at a time. Vegetables that can be broiled include squash, corn, red and green bell pepper, asparagus and even mushroom. Choose the vegetables that are firm and fresh. Sprinkle both sides with salt, pepper and any desired spice such as ginger or garlic. Microwaving preserves the color and texture of most vegetables better than other conventional cooking. Microwaving requires only little water or no water thus more nutrients are retained. Reasons for not eating vegetables Price and seasonality or availability; time consuming to prepare; Safety issues (fruits and vegetables may contain harmful pesticides); Lack of knowledge on nutrition and health benefits; Fruits and vegetables spoil quickly (taste and texture); Personal preferences for meat, convenience foods, instant foods, or fast foods; and Influence of family members who do not eat vegetables. Ensuring consumption of vegetables Home Gardening Saves money; Provides regular supply; Makes for a varied diet; Helps in food security; Builds family ties; and Provides exercise and joy.Nutritional Guidelines for Filipinos Vegetable Gardening Technologies FAITH (Food Always in the Home) ~ intensified gardening to empower family of 4-6 person produce 50%-80% of their daily nutritional need Urban gardening which uses any type of container. Hydroponics - a method of growing vegetables without soil; uses mineral nutrient solutions. Fence gardening Garden in water-logged areas by making “floating garden’, Magic square garden — is one square meter lot area planted with MACK-P (malunggay, alugbati, camote, kangkong and pechay) or KPMS (kadyos, papaya, malunggay and sigarilyas). Importance of fruits in our diet Fruits should be a regular part of our diet. Some fruits like mango, papaya, guava, and citrus fruits are rich sources of vitamin C which not only prevent scurvy but also are important in increasing resistance to infection and in facilitating the absorption of non-heme iron. Yellow fruits are also rich in beta-carotene. Other common fruits such as banana, melon, and pineapple contribute additional vitamins and minerals. Just like vegetables, fruits also provide fiber that helps regulate bowel movement, thus preventing constipation, a common problem in pregnant women. The vitamins and minerals (micronutrients) such as vitamin A, B, C, E, calcium, potassium, folic acid, iron, and dietary fiber present in vegetables and fruits are essential for the regulation of body processesNutritional Guidelines for Filipinos Frequently Asked Questions What conditions are associated with lack of fiber in the diet? Lack of fiber in the diet could contribute to constipation, Also the development of several chronic diseases such as cardiovascular disease, diabetes, and colon cancer, including large bowel cancer, are believed to be associated with eating too litte fiber. ‘An individual can increase fiber intake by eating a variety of high fiber foods, such as vegetables. and fruits, dried beans and peas, whole grain bread, oatmeal, and other whole grain cereal and pasta Is it true that diabetics should avoid fruit because they are sweet? No. Fruit is not contraindicated for diabetes. However, like any other food, fruits must be included in the right amount. Some physicians and dietitians recommend whole fruits rather than juice for patients with diabetes because juice has a greater glycemic effect (rise in blood sugar after eating the food). Glycemic Index (Gl) is @ measure of how quickly food glucose is, absorbed while Glucose Load (GL) is a measure of the total absorbable glucose in foods. The Gl tells us how slow or fast is the glucose (blood sugar) response from the food we eat, Examples of foods with high glycemic index are whole wheat flour bread, white wheat flour bread, multi-grain loaf, and other bakery products like pandesal and doughnuts. Examples of foods with low GI are fresh fruits like apples, grapes, strawberries, oranges, mango, papaya, guava, avocado, pears, jackfruit; nuts and legumes like peanuts, roasted cashew nuts, red lentils, chickpeas, cowpeas, mung beans, lima beans, green peas, kidney beans, pigeon peas; brown rice and rice products/ noodles like bihon, misua, canton, miki, root crops and tubers like ube, cassava, potato, tugi, kamote, and gabi, skim/whole milk, low-fat yogurt, and natural yogurt. What is vegetarianism? A vegetarian diet is a meal plan that contains mostly plants such as vegetables, fruits, whole grains, legumes, seeds, and nuts with litle or no animal products. There is no single type of vegetarian diet. Instead, vegetarian eating patterns usually fall into the following groups: + Vegan: Diet consists of only plant-based foods. + Lacto-vegetarian: Diet consists of plant foods plus some or all dairy products. + Lacto-ovo vegetarian: Diet consists of plant foods, dairy products, and eggs. ‘* Semi- or partial vegetarian: Diet consists of plant foods and may include chicken or fish, dairy products, and eggs. It does not include red meat.Nutritional Guidelines for Filipinos Are orga foods better than conventional or non-organic foods? Organic means the food is produced without synthetic pesticides, bioengineering or radiation; animals are raised without antibiotics or growth hormones. But the debate about whether ‘organic foods are healthier than the conventional or non-conventional foods continues. In @ recent review of studies published in the Annals of Internal Medicine (Smith-Spangler, 2012), it concluded that there is a limited evidence for the superiority of organic foods. Is it safe to eat raw vegetable salads? Yes. It is safe to eat raw vegetable salad if the vegetables have been washed thoroughly. Choose vegetables, which are crisp and bright in color and show no signs of decay or rotting, They should be washed thoroughly in cold running water before cutting. Soaking time should be reduced to a minimum to obtain maximum retention of water-soluble nutrients. Children in general do not like vegetables. How can children be encouraged to eat vegetables? Vegetables should be prepared and served in such a way that they are attractive to children. For example, mothers may use colorful vegetables such as carrots, baguio beans, and squash and cut them in different shapes. Leafy vegetables can be sliced finely so children can chew them easily. ACTION POINTS To help meet nutrient requirements: ‘+ Consume two to three servings of vegetables each day, one serving of which is a green leafy or yellow vegetable. + Take three servings of fruit daily, one serving of which is a vitamin C-rich fruit. + Encourage vegetable and fruit home gardening.Message 4 Consume fish, lean meat, poultry, egg, dried beans or nuts daily for growth and repair of body tissuesNutritional Guidelines for Filipinos INTRODUCTION Results of the food consumption survey (FNRI-NNS, 2013) among Filipino households showed that only about 63% of the households met the estimated average requirement (EAR) for protein (FNRI-PORI, 2015). Fish, meat, eggs, poultry, nuts, and dried beans are rich sources of protein. Proteins from animal products (meat, fish, poultry, and eggs) contain all the essential amino acids in correct proportion for the synthesis of body tissues are considered of high biological value. Proteins found in plants, legumes, grains, nuts, seeds, and vegetables lack the essential amino acids for the synthesis of body tissues. Protein is important for growth and development of children and the maintenance of body tissues in adults. In addition, animal foods are generally rich in pre- formed vitamin A, B-complex vitamins, heme iron, and zinc. FISH, SEAFOOD, AND SHELLFISH Fish, seafood and shellfish are good sources of high-quality protein, heme iron, vitamin A, and zinc. In addition, fish with edible bones such as anchovies or dilis and other small fishes, together with shellfish are good sources of calcium. Seafood like shrimps, crabs, mussels or tahong and all fishes from salt water, as well as seaweeds, are rich in iodine. Fatty fish like sardines, salmon, mackerel and milkfish or bangus are good sources of long- chain polyunsaturated or omega-3 fatty acids which may help prevent coronary heart disease, stroke and certain forms of cancer. Omega-3 fatty acids found in fish are “incredibly potent” anti- inflammatories, which may explain why they have been linked with lowered rates of diabetes and heart disease. Studies showed that men who ate at least some fish weekly had a lower coronary heart disease (CHD) mortality rate than that of men who ate none. MEAT Meat refers to muscles of animals used as food. This includes beef, pork, carabeef, goat's meat or Kambing, lamb and mutton and poultry. Internal organs of animals as food are also included in this broad definition. Meat is a rich source of protein, iron, and B vitamins. Some may have little vitamin & and zinc. The liver and kidney are richer sources of zinc than muscle meat. Pork liver is richer in zinc than sheep or beef liver. Iron (heme iron) and zine from animal sources, including eggs, are better absorbed than iron and zinc from plant foods. Red meat refers to meat that appears red before cooking. Beef, pork, carabeef, goat's meat, lamb and mutton are all red meats. In fact all meats derived from mammals are red meats. The US Department of Agriculture (USDA) considers all meat from mammals as red meat Myoglobin, a protein that can bind and store oxygen in cells is the pigment that is primarily responsible for the red color of meat.Nutritional Guidelines for Filipinos The amount of myoglobin in meat varies according to species, age of animal, amount of exercise, stress, condition of storage, exposure to oxygen, heat, and processing, Red meat contains protein, thiamin, riboflavin, in addition to vitamins B12 and B6. Nutrients such as zinc, iron, phosphorus appear in much greater abundance in red meat. Moreover, red meat is a great source of muscle-building protein as well as being the best source of the antioxidant called alpha lipoic acid. Still, red meat has been the subject of studies that connect it to health problems beyond cancer, like cardiovascular disease and even arthritis and hypertension. The fat content in red meat is greater than white meat therefore, consuming large quantity of red meat may lead to the possibility of getting fat. White meat refers to any light-colored meat such as fish, seafood, and particularly poultry. Examples of white meat are animal proteins derived from birds (chicken, duck, turkey), fish, amphibians (frog's legs), crustaceans (lobster, shrimps, crabs), or bivalves (oysters, clams and mussels). White meat is best known as meat that is lean, especially in comparison with red meat. The advantage about white meat is that its fat content is less in comparison with red meat. Meats traditionally thought of as white (such as veal and lamb) have been reclassified as red meats. Another advantage to eating white meat over red meat, which is also why health experts recommend it over red meat, is the lower number of calories that it contains, However, the difference in calories between white meat and red meat is not so great that one can choose to eat some red meat once in a while, POULTRY Poultry is a light-colored meat and therefore considered as white meat. Poultry refers to several kinds of domesticated fowl used as food. Wild fowls used as food is generally called Game, The ‘main poultry sources are chicken, duck, goose, turkey, pigeons, and quail EGG Egg is the cheapest source of high quality, bio-available protein with little total fat. Compared to other animal protein sources, eggs contain proportionately less saturated fat (Nike, et al 2010). It supplies all the essential amino acids the body needs. It also provide several vitamins and minerals, including retinol (vitamin A), riboflavin (vitamin B2), folic acid (vitamin B9), vitamin B6, vitamin B12, choline, iron, calcium, phosphorus and potassium. An egg contains only 1 gram of saturated fat but just over 200 milligrams of cholesterol. The yellow part of the egg is the egg yolk. The yolk makes up about a third of the egg’s (30%) weight (Brown, 2005). A large egg yolk contains approximately 60 Calories. It contains all of the fat, slightly less than half of the protein, and most of the other nutrients. All of the egg's vitamins A, D, and E are in the egg yolk. The egg yolk contains more phosphorus, manganese, iron, iodine, copper and calcium than the egg white and it contains all of the zinc. The egg yolk is also one of the few foods to naturally contain vitamin D. It also contains choline, an important nutrient for development of the brain, and is also said to be essential for pregnant and nursing ‘women to ensure healthy fetal brain development,Nutritional Guidelines for Filipinos The egg white or albumen accounts for most of an egg’s weight, about 58% and is made up largely of water and protein (Brown, 2005). It contains more than half the eggs total protei niacin, riboflavin, chlorine, magnesium, potassium, sodium and sulfur. The egg white contains about 15 calories. It also contains some anti-microbial factors such as lysozyme (a germicidal agent), avidin, conalbumin, and lactoferrin. Avidin is of interest nutritionally, because it binds biotin, so eating raw egg is not recommended. However, this is easily denatured when cooked. Conaibumin has the ability to bind divalent and trivalent metallic ions, thus depriving bacteria with such ions (Sun, 2012). For people with a healthy lipid profile, eating one egg a day is not detrimental (Tanchoco et al, 2011). Among eggs, chicken eggs are the most commonly eaten. DRIED BEANS AND NUTS Legumes or dried beans and nuts are botanically the seeds of plants. Nuts are generally larger seeds and enclosed in hard shell and come from different plant families. Most of them are tree nuts. Both legumes and nuts consist of a simple dry fruit carried inside a pod or shell, but upon examining the details, the two groups prove to have significant differences. Botanically speaking, nuts are noted for having only a single seed in the shell, which is not attached, and they can be part of a number of different plant families. Legumes, however, usually have multiple seeds within a casing, which are often attached to its inner wall, and are part of the leguminosae family. Legumes and nuts are good meat substitutes. In general, legumes and nuts are less expensive sources of protein than meat and fish. Legumes contain twice as much protein in a serving portion basis and about half as much protein as lean meat. They are packed with iron (non- heme iron), high in complex carbohydrates, hence, they have low glycemic index. They contain significant amount of fiber, which helps prevent constipation and improve the digestive health. They do not have cholesterol, thus, they prevent heart diseases. They are good sources of several micronutrients and phytochemicals, Legumes are also known as “pulses”. They come from mature seeds of pod-bearing plants and are high in protein (18-25%). The common kinds of legumes are: chickpeas (garbanzos), cow peas (paayap), green peas (gisantes), kidney beans (abitsuelas), lentils, lima beans (patani), mung beans (munggo), and soy beans (utaw or balatong). Peanuts are also legumes because they actually grow underground, as opposed to nuts like walnuts, almonds, etc. that grow on trees (and are referred to as “tree nuts’) Soybeans are unique among the legumes because they are a concentrated source of phytochemicals called isoflavones. Isoflavones are associated with reduced risks of a number of chronic diseases such as cancer, heart disease and osteoporosis. Nuts which usually have only one seed or two at most are always “indehiscent,” meaning it does. not open on its own. The seed of a true nut is never attached to the ovary wall, but instead is loose or fitted into the nut pod. All of these traits can be seen in walnuts, almonds, and other similar nuts.Nutritional Guidelines for Filipinos Nuts like almonds, beechnuts and pistachio nuts contain high protein content. Coconut, pecan, cashew nuts, pili nuts, hazelnuts, macademia nuts, and walnuts have high fat content, while chestnut is high in carbohydrate content. MICRONUTRIENT DEFICIENCIES Iron Deficiency Anemia (IDA) Iron Deficiency Anemia (IDA) is a condition characterized by decreased hemoglobin levels in the blood. Anemia remains a public health concern particularly among children 6 months to one year old, and pregnant and lactating women based on the 2013 National Nutrition Survey (FNRI-NNS, 2013). Anemia in infants and children is associated with retarded physical growth, reduced resistance to infection and slow development of learning abilities. In pregnant women, anemia leads to fetal growth retardation, low infant birth weight, and increased perinatal mortality and labor complications. In adults, it causes fatigue and reduced work capacity. ‘There are two forms of iron in the diet: heme iron (from animal food products) and non-heme iron (from rice, vegetables, and other plant foods). Heme iron is very well absorbed in the gastrointestinal tract. On the other hand, the absorption of non-heme iron is relatively poor. While the absorption of non-heme iron is aided by animal protein and vitamin-C rich foods, it may also be prevented by phytates and phenols. Phytates are natural components of some plant foods like rice whereas phenols are found in coffee and tea. It is for this reason that obtaining enough iron from plant foods alone to satisfy nutritional requirements is very difficult. Hence, the consumption of iron-rich animal products including red meat and glandular organs, (iver and spleen) should be emphasized particularly in weaning infants, children and pregnant and nursing women. Folic Acid Deficiency Folic acid and B12 are essential for body functioning and growth. Folic acid deficiency also known as Folate Deficiency Anemia and Megaloblastic Anemia is caused by lack of folic acid. This usually occurs after 4 to 5 months of deficiency of this nutrient in the diet. Red Blood Cell (RBC) Folate measures the folate stores in the body. Other causes of deficiency are poor absorption due to lack of an intrinsic factor to synthesize Vitamin B12 necessary for absorption of folic acid and iron, increased requirement due to growth or pregnancy, use of medications, alcohol consumption and use of oral contraceptives. ‘Symptoms of folic acid deficiency may include loss of appetite, weight loss, weakness, headaches, palpitations and irritability. Pregnant women with folic acid deficiency are more likely to give birth to premature infants, and babies with low birth weight and neural tube defects. In children, folic acid deficiency can slow growth rate. Food sources of folic acid are red meats such as liver (best source) and beef, chicken, pork and fish.Nutritional Guidelines for Filipinos Frequently Asked Questions Is fish of poorer nutritional value than meat or poultry? No. In general, fish, meat and poultry are all excellent sources of good quality protein, iron and vitamin A. In fact fish is especially recommended for those who are at risk of heart disease. Which is better to choose ~ red meat or white meat? The bottom line is that no matter which meat you eat, you can guard yourself against health problems if you eat in moderation. While white meat is not linked to as many health problems as. fed meat is, it does not feature many of the benefits that you get in red meat, such as the vitamins and minerals. So if you want to get a dose of said nutrients, you should eat more red meat, but do so in a way that is only moderate. Should eggs and other organ meats be restricted in the diet of older persons? Not necessarily. These foods should be restricted only for those who are at risk of heart disease ‘such as individuals who have high blood cholesterol levels, a positive family history of heart disease and hypertension. The restriction on eggs is more of a precaution. An eggyolk contains ‘on an average between 200 milligrams of cholesterol. One egg a day would mean that the other ‘sources of cholesterol would have to be avoided to keep cholesterol intake at the recommended level of 300 mg a day. ACTION POINTS To improve the quality of the diet: ‘+ Consume fish, lean meat, poultry and eggs. ‘+ Include legumes such as dried beans in your diet.64Nutritional Guidelines for Filipinos INTRODUCTION Calcium, together with protein and other nutrients particularly vitamin D, is essential for the formation of strong bones and teeth. Milk, milk products, and small fishes are excellent sources ‘of calcium and should form part of the daily diet starting in childhood to help prevent ‘osteoporosis later in life. National Nutrition Surveys indicate a consistent failure of the Filipinos to meet dietary recommendations for calcium. ‘THE IMPORTANCE OF CALCIUM The skeletal system is made up of 274 bones from the skull to the toes. It supports the entire human body and protects all the major organs and other organ systems. Sufficient and balanced supply of calcium is needed for the bone system to function well and keep the human body healthy. Ninety nine percent of calcium is found in the skeleton and teeth serving as the main building block of the bone structure. Dietary calcium makes the skeleton thick, dense and strong. The remaining one percent of calcium stays in the blood and soft tissues which is used to regulate many body processes, such as regulation of heart beat and muscle contraction. Calcium and phosphorus form the structural element of bone and constitute the major nutritional ‘element for bone health. In addition to protein as the bone matrix, other nutrients such as: magnesium, potassium, and vitamins including A, K, C and D are all essential for proper bone development Calcium, with vitamin D which helps in its absorption, is essential for growth of the skeleton and teeth during infancy and childhood, During childhood, higher intake of calcium is recommended, especially calcium from milk and milk products. This could help attain higher bone mass in adulthood, Puberty and adolescence are periods when the need for calcium is particularly high, Approximately 45 percent of the skeletal mass is formed during puberty. “Peak bone mass” ‘should be achieved during puberty due to the very active daily routine and activity of teenagers. Attaining this at this crucial stage and maintaining it can greatly lessen the chances of having bone problems later in life. During adulthood, especially among women, adequate calcium in the diet enables one to maintain the peak bone mass as long as possible. This prevents osteoporosis after menopause. Risk to osteoporosis among older men may also become less. For pregnant women, adequate calcium is necessary for optimal mineralization of fetal bones and teeth and to maintain the mother's bone calcium. In lactating women, additional dietary ‘calcium is necessary to supply calcium in breast milk. Vitamin D is especially important for the optimum absorption of calcium in the intestines and to keep too much calcium from being lost through the urine. Each day, calcium is lost through the skin, nails, hair, sweat, urine and feces. Our bodies cannot produce calcium. It is therefore important to try to get enough calcium through the foods we eat. When we do not eat enoughNutritional Guidelines for Filipinos food to meet the daily calcium quota, the blood immediately gets calcium directly from the bones. This is called “Calcium Cannibalism” when the blood feeds on calcium in the bones. If left unchecked, the constant withdrawing of calcium from the bones to sustain the body would make the bones brittle and weak. Little by little, the once strong and healthy bones become porous and extremely fragile shells until the bones snap and crunch, osteoporosis has set in. EFFECTS OF CALCIUM AND VITAMIN D DEFICIENCY In children, calcium deficiency due to lack of vitamin D results in rickets where the bones become soft and weak, leading to fracture and bone deformities. If calcium is inadequate during puberty and adolescence, maximum bone mass (peak bone mass) may not be attained, and this may cause bone problems later in life. In adults, calcium deficiency worsens to ‘osteomalacia or softening of the bones caused by lack of vitamin D, resulting to body pains, skeletal deformities, and weak bones. OSTEOPOROSIS AND ITS PREVENTION Bones are the framework for the body. Bones are living tissues that change constantly, with bits of old bones being removed and replaced by new bones. During childhood and adolescence, much more bone is deposited than withdrawn, so the bones grow in both size and density. Bones reach its peak mass by the age of 30 years. At this point, bones have reached their maximum strength and density, known as peak bone mass. Up to 90 percent of peak bone mass is acquired by age 18 in girls and by age 20 in boys, which makes youth the best time to “invest” in one’s bone health. Figure 5.1 shows the bone density of a person over a lifespan. i Figure 5.1 Bone density over a life span