Maria Sofia Amarra

Childhood obesity and diabetes are increasing in the Philippines. The present study aimed to (1) estimate children’s usual intake of minimally processed vs. highly processed foods and (2) identify foods that contribute to the variance in inflammation after controlling for mothers’ education, the sex of the child, and BMI-for-age. Apparently healthy children enrolled in kindergarten and first grade in two public schools in Metro Manila were included (n = 166). Serum C-reactive protein (CRP) was determined using a qualitative CRP test. Dietary intake was assessed using two non-consecutive 24 h recalls obtained from mothers or caretakers and children. Usual food intake was calculated using the multiple source method (MSM). Binary logistic regression was used to determine foods that contributed to the variance in inflammation. Food categories that predicted inflammation were Processed Rice, Cereal, and Starch Products (comprising glutinous rice products and traditional cereal snacks, instant noodles, and extruded chips and crispy snacks) (p = 0.037, 95% CI 1.001, 1.021), Commercial Baked Products (comprising biscuits, cookies, bread, cakes, and pastries) (p = 0.005, 95% CI 1.005, 1.027), and Processed and Preserved Fruit and Vegetables (dried fruits and sweetened soy products) (p = 0.044, 95% CI 1.000, 1.034) after controlling for BMI-for-age, sex, and mothers’ education. Minimally processed foods did not predict inflammation. The consumption of fresh fruits, vegetables, and fresh milk was negligible. Actions are needed to improve the quality of Filipino children’s diets.

The present study examined the association of nutritional status, presence of inflammation, and mothers educational level with Filipino school children’s intellectual ability.

The study examined the association of nutritional status (i.e., anthropometric and micronutrient status) with infection, inflammation, and immune cell quantities in 166 apparently healthy Filipino children aged 5–9 years attending public schools in Manila. Children with low, normal, and high body mass index (BMI)-for-age were compared in terms of micronutrient status (iron, vitamin D, vitamin C, and riboflavin), Epstein–Barr virus (EBV) infection, inflammation, and immune cell quantities. Micronutrients contributing to the variance in inflammation and abnormal immune cell quantities were identified. Inflammation and poorer immune health (characterized by high C-reactive protein (CRP) and low neutrophils, respectively) were more prevalent in children with overweight and obese BMI-for-age than in those with either normal or low BMI. Previous EBV infection was found in 88.7% of children. After controlling for infection, low level of serum vitamin C predicted inflammation, while increased level of iron (hemoglobin) in the presence of vitamin C predicted an abnormal neutrophil level, occurring mostly as neutropenia. Viral infection, overweight, and obesity adversely affect Filipino children’s immune health. Increases in the level of iron (hemoglobin) further impair immune function by providing the iron needed for viral proliferation. The Philippine government requires mandatory iron fortification of staple foods and voluntary iron fortification of processed foods. Given the high prevalence of EBV infection and rising obesity among children, iron fortification policies should be reexamined to ensure that iron is used solely to address iron-deficiency anemia rather than to promote the development of EBV-associated malignancies or other infections. Instead, the policies should focus on increasing vitamin C intake from fresh fruits and vegetables to improve child immunity.

Diabetes is a public health issue in the Philippines, commonly resulting from high sugar intake. This study examined the consumption and sources of total sugar among Filipinos aged 7 months to 18 years old using nationally representative data. Total sugar consumption was estimated using two non-consecutive 24-h recalls and food composition tables. Mean intakes were converted into usual intakes to reduce measurement errors using the Software for intake distribution estimation software. The percentile of usual intakes, energy from sugar consumption, and the amount of sugar in minimally processed and processed foods for different age groups were calculated using STATA. Changes in consumption between 2008 and 2013 were also examined. Children aged 7 – 11 months old consumed 26% of energy from total sugar, higher than that of older age groups. Those in the richest income quintile and living in urban areas had the highest percentage intakes. The median intake of total sugar exceeded 25 g/day, with children aged 1 – 2 years old in the highest income quintile consuming the greatest amount (54.7 g/day). Total sugar comprised 5.3 – 30.9% of energy intake. Processed foods contributed 64 – 75% of total sugar. Food categories that contributed the highest amounts (≥10%) of total sugar to different age groups were as follows: (i) 7 – 11 months old: milk formula, milk products, baked products, sugar, and sweets; (ii) 1 – 2 years old: Sugar, sweets, milk formula, milk products, baked products, and non-alcoholic beverages; and (iii) 3 – 18 years old: Sugar, sweets, baked products, and non-alcoholic beverages. From 2008 to 2013, the consumption of sweetened beverages and baked products increased significantly, while the consumption of fresh and minimally processed fruits and vegetables decreased significantly. Therefore, it is suggested to reduce added sugar in processed foods, provide unsweetened alternatives, reduce the intake of table sugar, baked goods, and confections, and increase the intake of fresh fruits and vegetables.

Low-incomeFilipino mothers’ cultural perceptions of healthy mothers and children do not align with standard nutritional recommendations - JCHM- Print ISSN No: - 2394-272X Online ISSN No:- 2394-2738 Article DOI No:- 10.18231/j.jchm.2022.036, The Journal of Community Health Management-J Community Health Manag

Background: Women’s diet and nutritional status during pregnancy are important in influencing birth outcomes. We conducted a systematic scoping review of the best available evidence regarding dietary intake of Malaysian pregnant women, and the associations of maternal diet, anthropometry, and nutrition-related co-morbidities with the infant’s birth weight (IBW). The study objectives were to examine: (1) the adequacy of micronutrient intake among pregnant women; and (2) the association of maternal factors (anthropometry, diet, plasma glucose and blood pressure) during pregnancy with IBW. Methods: Eleven search engines such as Proquest, EbscoHost, Scopus, Cochrane Library, Science Direct, Wiley Online Library, PubMed, Google Scholar, MyJournal, BookSC and Inter Library Loan with Medical Library Group were extensively searched to identify the primary articles. Three reviewers independently screened the abstracts and full articles based on the inclusion and exclusion criteria. Extracted data included details about the population characteristics, study methods and key findings related to the review objectives. Seventeen studies published from 1972 to 2021 were included, following the PRISMA-ScR guideline. Results: Studies showed that maternal micronutrient intakes including calcium, iron, vitamin D, folic acid, and niacin fell short of the national recommendations. Increased maternal fruit intake was also associated with increased birth weight. Factors associated with fetal macrosomia included high pre-pregnancy body mass index (BMI), excess gestational weight gain (GWG) and high blood glucose levels. Low pre-pregnancy BMI, inadequate GWG, intake of confectioneries and condiments, and high blood pressure were associated with low birth weight. Conclusion: This review identified several factors such as the mother’s food habits, comorbidities, BMI and gestational weight gain as the determinants of low birth weight. This implies that emphasis should be given on maternal health and nutrition for the birth outcome.

Background In response to the global target for reduction in salt intake, several countries have implemented population sodium reduction strategies. These strategies include identification of major sources of sodium in the diet and reformulation of a set number of products available on the market. This study aimed to identify processed foods that can be targeted for reformulation and whose sodium content can be monitored over time in order to reduce sodium intake in the Philippines. The objectives were to: 1) Estimate per capita sodium intake from minimally processed and processed food groups by income quintile and urban/rural location; 2) Identify foods that contribute to the variance in per capita sodium intake that can be used as indicators for monitoring the sodium content of Philippine processed foods. One-day household food weighing data covering 4880 households from the 2008 National Nutrition Survey was used. Per capita sodium consumption from processed and minimally processed food categories and percentiles of sodium intake from these categories by income quintile and urban/rural location were obtained. The percentage contribution of different food categories to mean per capita sodium intake was calculated. Specific foods that contributed to the variance in sodium intake among Filipinos were identified. Results Foods which significantly accounted for 99.4% of the variance in sodium intake were 13 types of processed foods and 2 types of minimally processed foods. The category Processed Soup, Sauces, and Flavor Enhancers contributed the greatest proportion to per capita sodium intake. Specific processed foods that contributed to the variance in per capita sodium intake were instant noodles, traditional fermented condiments and sauces, dried and processed meat, fish, and poultry products, salted eggs, white bread and pan de sal (a traditional Filipino bread), wheat and egg noodles, crispy cereal chips and extruded snacks, butter and margarine, cheese, and chocolate-based beverages. Conclusion Identifying processed foods that significantly contribute to sodium intake, followed by reformulating and monitoring the sodium content of these foods over time should be considered as one strategy to reduce sodium intake in the Philippines.

Background and Objectives: Rising obesity in Southeast Asia, one consequence of economic growth, has been linked to a rising consumption of energy from added sugars. This symposium, organized by ILSI Southeast Asia, explored regional issues related to dietary sugars and health and identified ways in which these issues could be addressed by regional regulatory agencies, food producers, and the consumer. Methods and Study Design: Papers on the following topics were presented: 1) current scientific evidence on the effects of sugars and non-caloric sweeteners on body weight, health, and eating behaviors; 2) innovations by food producers to reduce sugar consumption in the region; 3) regional dietary surveillance of sugar consumption and suggestions for consumer guidance. A panel discussion explored effective approaches to promote healthy eating in the region. Results: Excessive consumption of energy in the form of added sugars can have adverse consequences on diet quality, lipid profiles, and health. There is a need for better surveillance of total and added sugars intakes in selected Southeast Asian countries. Among feasible alternatives to corn sweeteners (high fructose corn syrup) and cane sugar are indigenous sweeteners with low glycemic index (e.g., coconut sap sugar). Their health benefits should be examined and regional sugar consumption tracked in detail. Product reformulation to develop palatable lower calorie alternatives that are accepted by consumers continues to be a challenge for industry and regulatory agencies. Conclusions: Public-private collaborations to develop healthy products and effective communication strategies can facilitate consumer acceptance and adoption of healthier foods.

The current issue of BMC Public Health presents work by the Consortium of Low Income Population Research (CB40R), highlighting a comprehensive aspect of health, i.e., physical health, mental health, health behaviour and health financing; and also nutrition involving all stages of lifespan of the socioeconomic deprived group in Malaysia. Consortium of B40 Research (CB40R) reposited and harmonised shared, non-identifiable data from epidemiological studies involving low income population (B40) in Malaysia. CB40R also performed joint or mega-analyses using combined, harmonised data sets that yield collated results with enhanced statistical power, more variabilities (study population, geographical regions, ethnicities and sociocultural groups) to better understand the needs, characteristics and issues of B40 groups in Malaysia. It also aimed to develope a system/framework of minimum/standard variables to be collected in research involving B40 in future. For this special issues, members of the consortium have been invited to contribute an original article involving analysis of the health aspects, access to health and nutritional issues of the B40 samples. All the papers in this special issue have successfully highlighted the health and nutritional issues (i.e., non-communicable disease (NCD), inflammatory bowel disease (IBD), knowledge towards sexually transmitted disease (STD), low birth weight, Motoric Cognitive Risk (MCR) syndrome, urinary incontinence), mental health, oral health and inequalities among the low-income group in Malaysia, including the rural population and also the urban poor. The low-income population in Malaysia is also at risk of both under- and over nutrition, of which specific cost effective strategies are indeed needed to improve their quality of life. The low income population in Malaysia is facing various health challenges, particularly related to NCD and poor mental health, nutritional and physical function. There is a need for a sustainable intervention model to tackle the issues. It is also important to highlight that reducing SES disparities in health will require policy initiatives addressing the components of socioeconomic status (income, education, and occupation) as well as the pathways by which these affect health.