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Priority nutritional concerns in Asia

Tee ES

Food Nutr Bull, 2002 Dec;23(4):345-8.
PMID: 16619736

The sustained economic growth and increasing economic stability in the Asian region over the last three decades have been accompanied by changing lifestyles leading to significant changes in the food and nutrition issues facing Asian countries. The chronic diseases associated with excessive consumption of nutrients, especially fat, are becoming increasingly apparent. At the same time, Asia has a disproportionate share of the malnutrition problem. Underweight and stunting remain significant problems in many Asian communities, and micronutrient deficiencies of iron, iodine, and vitamin A continue to afflict large population groups. Effective data collection and analysis are essential to formulate and implement intervention programs to address both sides of the changing nutrition scenario in Asia.
Fulltext Food-Based Dietary Guidelines of Southeast Asia: An Analysis of Key Messages

Tee ES

J Nutr Sci Vitaminol (Tokyo), 2015;61 Suppl:S214.
PMID: 26598872 DOI: 10.3177/jnsv.61.S214
Fulltext Nutrition of Malaysians: where are we heading ?

Tee ES

Malays J Nutr, 1999 Dec;5(1):87-109.
PMID: 22692361 MyJurnal

Rapid and marked socioeconomic advancements in Malaysia for the past two decades have brought about significant changes in the lifestyles of communities. These include significant changes in the dietary patterns of Malaysians, eg the increase in consumption of fats and oils and refined carbohydrates and a decreased intake of complex carbohydrates. This resulted in a decline in the proportion of energy from carbohydrates, while an increase in the percentage contribution of fat has been observed. Changes in meal patterns are also evident: more families eat out, busy executives skip meals, the younger generation miss breakfasts and rely too much on fast foods. Many Malaysians have the mistaken belief that the taking of vitamin and mineral supplements can make up for the lack of these nutrients in their daily diets. In addition, communities have become generally more sedentary. All these changes have brought about undesirable effects with significant proportions of the affluent segments of the population being afflicted with various non-communicable diseases associated with overnutrition, namely obesity, hypertension, coronary heart disease and cancers. Nutrition activities and programmes are now being directed to tackle this increasing trend, whilst still attempting to eliminate the undernutrition problems. The ultimate strategy towards achieving a healthy nation is the promotion of a healthy lifestyle, including inculcating a culture of healthy eating. Comprehensive long term programmes, including a series of Healthy Lifestyle (HLS) Programmes have been carried out by the government. Launched in 1991 for six consecutive years, the first phase of the Programme comprised one thematic campaign each year, commencing with coronary heart disease and ending with diabetes mellitus. To further strengthen this long-term strategy, another series of activities to be carried out under the second phase of the HLS programme from 1997 to 2002 was launched within the framework of the National Plan of Action on Nutrition (NPAN) for Malaysia. The implementation of these programmes is, however, a challenge to health and nutrition workers. There is a need to examine the strategies for nutrition education to ensure more effective dissemination of information. The challenge is to determine how best to promote healthy eating within the present scenerio of rapid urbanisation, "western" dietary pattern influence, a whole barrage of convenience and "health" foods and nutrition misinformation. Malaysia continues to march ahead with its development plans to elevate the nation and its people to an even higher level of socio-economic status. The crucial question is: are we able to arrest the increase in these diet-related chronic diseases ? Or are we heading towards further deterioration in dietary pattern and increase in these diseases ? It will be a difficult and challenging journey ahead, requiring the concerted effort of all in the country. It is hoped that through this conference of sharing experiences with other Asian countries, a better understanding and improved strategies could be arrived at.
Fulltext Development and promotion of Malaysian Dietary Guidelines

Tee ES

Asia Pac J Clin Nutr, 2011;20(3):455-61.
PMID: 21859667

Development and promotion of dietary guidelines is one of the key activities outlined in the National Plan of Action for Nutrition of Malaysia for the prevention of nutrition-related disorders. The first official Malaysian Dietary Guidelines (MDG) was published in 1999 and was thoroughly reviewed and launched on 25 March 2010. The new MDG 2010 is a compilation of science-based nutrition and physical activity recommendations. These guidelines form the basis of consistent and scientifically sound nutrition messages for the public. There are 14 key messages and 55 recommendations, covering the whole range of food and nutrition issues, from importance of consuming a variety of foods to guidance on specific food groups, messages to encourage physical activities, consuming safe food and beverages and making effective use of nutrition information on food labels. The MDG also has an updated food pyramid. Various efforts have been made to ensure that the revised MDG is disseminated to all stakeholders. The Ministry of Health has organised a series of workshops for nutritionists and other health care professionals, and the food industry. In collaboration with other professional bodies and the private sector, the Nutrition Society of Malaysia has been promoting the dissemination and usage of the MDG to the public through a variety of formats and channels. These include the publication of a series of leaflets, educational press articles, educational booklets, as well as through educational activities for children. It is imperative to monitor the usage and evaluation of these dietary messages.
Fulltext Dietary intake of adolescents in a rural fishing community in Tuaran District, Sabah

Foo LH, Khor GL, Tee, E. Siong ES, Prabakaran D

Malays J Nutr, 2006;12(1):11-21.
MyJurnal

Dietary intakes and lifestyle habits during adolescence may predict the occurrence of obesity and other diet-related chronic diseases later in life. The purpose of this study was to determine dietary intake of adolescents in a fishing community in Tuaran District, Sabah. A total of 199 apparently healthy adolescents comprising 94 male and 105 female subjects were purposively selected for the study. The mean age of the subjects was 15.2 f 2.2 years with female subjects having a higher mean age of 15.7 f 2.4 years compared to the males (14.6 k1.8 years). The mean BMI of the subjects was 18.4 f 2.9 kg/m2 with females having a significantly higher BMI (18.9 f 2.8 kg/m2) than the males (17.8 f 3.0 kg/m2). Based on the WHO classification (WHO, 1995), 19.6% of the subjects could be classified as thin while 4.5% were at risk of overweight. Overall for both sexes, intake of energy and most nutrients were below the Malaysian recommended nutrient intake (RNI) levels for adolescents, with the exception of vitamin C and niacin. The male subjects showed higher mean intake for vitamin A, thiamine, niacin and vitamin C than the females. Calcium and iron intake ranked among the lowest levels, at 33.4% and 47.2% respectively of the RNI values for both sexes. The main sources of energy were rice, flour products and tubers while fish and seafood were the chief sources of protein. Majority of the subjects (84%) reported taking breakfast daily, which often consisted of fried noodles, fried banana, doughnuts and coffee. Consumption of snacks was popular and commonly consumed snacks were bread, biscuits, and fried banana. The present study revealed that 25.5% and 14.3% of the male and female adolescents respectively were thin, with majority of them consuming inadequate levels of energy and several key nutrients. The results underscore the need for adolescents to be targeted for nutrition and health education as they go through a period of marked physical, physiological and psychological changes.
Fulltext Effectiveness of a nutrition education intervention for primary school children: the healthy kids programme, Malaysia

Chin Yit Siew, Tee E Siong, Zawiah Hashim, Rasyedah Ahmad Raqi, Norimah A Karim

Malaysian Journal of Medicine and Health Sciences, 2020;16(106):1-10.
MyJurnal

Introduction: This paper discussed the effectiveness of “Healthy Kids Programme (HKP)”, specifically in improving the body weight status as well as knowledge, attitude and practice (KAP) of the children. Methods: In this longi- tudinal intervention study, a total of 12 primary schools in Klang Valley were randomly selected and divided into intervention and control groups. There were 386 standard three children participated at baseline. All children in the intervention group participated in the HKP that was conducted by nutritionists. The evaluations included the pre- and post-Immediate Impact survey (IIS) (every topic), and changes in nutrition KAP survey and anthropometric assess- ment of the children at the beginning and end of every year for three years. Results: School children in intervention group reported with an increased in the IIS score for each topic and achieved a significantly higher mean nutrition knowledge score than those in the control group over time. There were no significant differences in mean attitude and practice scores between two groups after the intervention. Children in the intervention group had lower rates of overweight and obesity (pre-test: 27.3%; post-test: 32.5%) than their counterpart (pre-test: 26.6%; post-test: 44.0%). Conclusions: The HKP is effective in improving nutrition knowledge of the children. A lower rate of overweight and obesity was observed in intervention group than control group. This approach will contribute towards inculcating healthy eating and active lifestyle habits among Malaysian children that bring about long-term health benefits.
Fulltext Nutrition knowledge among Malaysian elderly

Norimah A.Karim, Nik Shanita Safii, Safiah Mohd Yusof, Norazliana Mohd Noor, Zawiah Ahmad, Tee, E Siong

Jurnal Sains Kesihatan Malaysia, 2008;6(2):43-54.
MyJurnal

This paper reports the nutrition knowledge of Malaysian elderly, as part of a nationwide study to evaluate the status of nutrition knowledge, attitude and practice (KAP) of food and nutrition among various communities in Malaysia. A total of 906 elderly, age ranging between 60 to 96 years old, with mean age 67.4 ± 6.7 years representing all states in Malaysia participated in the study. An interview administered questionnaire was used to assess the nutrition knowledge and to collect demographic data of the elderly. Subjects were in the 60-65 years (51%) and more than 65 years (49%) age category. There were 46% Malays, 32% Chinese, 6% Indians while the remaining 16% comprised of other minority groups in Malaysia such as Iban, Kadazan, Melanau, Orang Asli and others. More than half of the elderly (54%) had no formal education, 36% completed primary schooling and only 9% finished secondary education. Overall 73% elderly were categorized as having poor nutrition knowledge, 18% moderate and only 9% good. The minority groups had the highest percentage of poor nutrition knowledge (91%) while the Chinese had the highest percentage of good nutrition knowledge (11%). More female (78%) than male (67%) had poor nutrition knowledge, in contrast to more male (10%) than female (8%) with good nutrition knowledge. Chi square test showed that there was a significant correlation between educational status and nutrition knowledge. This was reflected in the results which showed that 81% elderly with no formal education were categorized in the poor nutrition knowledge group. Majority of the elderly did not know about foods to be consumed most (88%), or to be eaten least (87%). Only a quarter to a third of the elderly responded correctly to questions on nutrient function and content. The question on foods with high salt was well responded by the elderly (65%). It is quite discouraging to show that a majority of Malaysian elderly had poor nutrition knowledge. This study indicated that appropriate nutrition education interventions need to be implemented to improve the shortcomings of nutrition knowledge among the Malaysian elderly.
Fulltext Replacing coconut santan with palm oil santan: impact on dietary C12-16 saturated fatty acids, serum total cholesterol and cardiovascular risk

Ng TKW, Tee ES

Malays J Nutr, 1998 Dec;4(1):65-72.
PMID: 22692342

The theoretical impact of the use of coconut cream (santan) powder and palm oil santan powder on the dietary levels of C12-16 saturated fatty acids (SFAs) and linoleic acid (18:2), and on serum total cholesterol (TC), was evaluated holding non-santan dietary variables constant. The prediction was based on a 2,300-kcal hypothetical diet, containing one santan-based dish or snack in each of the 5 daily meals with fat contributing 30% of total calories, while the santan contributed a total of 14% kcal (36g). Replacing coconut santan with palm oil santan reduced the overall dietary C12-16 SFAs from 10.8% kcal to 4.8% kcal (i.e. 6.0% kcal) and the virtual removal of lauric (12:0) + myristic (14:0) acids, while palmitic acid (16:0) rose by 3.3% kcal, and the polyunsaturated linoleic acid (18:2) increased by 1.13% kcal. Applying the Hegsted equation to these dietary fatty acid (FA) changes, predicted a serum TC reduction of 24 -31 mg/dL (0.62- 0.80 mM/L), with the hypocholesterolemic effect being influenced by the low-density lipoprotein receptor (LDLr) set-point of the individual(s) concerned. Thus, the prediction indicated that replacing coconut santan with palm oil santan in santan-based Malaysian dishes or snacks would have a significant beneficial impact on serum TC and hence, cardiovascular risk.
Fulltext Nutrition and the Malaysian Healthy Lifestyle Programme: challenges in implementation

Suleiman AB, Tee ES

Asia Pac J Clin Nutr, 1998 Dec;7(3/4):230-7.
PMID: 24393676

There are significant differences in the food consumption patterns of countries. In the lower income countries, most of the energy intake is derived from cereals and starchy roots. On the other hand, the intake of these carbohydrate foods is much lower in the economically developed countries and more of the energy is derived from added fats, alcohol, meat, dairy products and sweeteners. The contribution of energy from various food groups has changed markedly over the past three decades. With increasing national wealth there is a general tendency for the consumption of cereal foods to decline, whereas the consumption of added fats, alcohol, meat and dairy products has increased over the years. Similar changes have also been observed for Malaysia. These dietary alterations, as well as other lifestyle changes, have brought about a new nutrition scenario in many developing countries. These countries are now faced with the twin problems of malnutrition, that is, undernutrition among some segments of the population and diet-related chronic diseases in other groups; for example, obesity, hypertension, coronary heart disease, diabetes and various cancers. In Malaysia, deaths due to diseases of the circulatory system and neoplasms have been on the rise since the 1960s. The former has been the most important cause of death in the country for more than 15 years, with cancer ranking third for almost 10 years. Epidemiological data collected from different community groups showed increased prevalences of various risk factors amongst Malaysians. In view of the changed nutrition scenario in the country, intervention programmes have been reviewed accordingly. The Healthy Lifestyle (HLS) Programme was launched in 1991 as a comprehensive, long-term approach to combating the emerging diet-related chronic diseases. For six consecutive years one thematic campaign per year was carried out; namely, coronary heart disease (1991), sexually transmitted diseases (1992), food safety (1993), childhood diseases (1994), cancers (1995) and diabetes mellitus (1996). To further strengthen health promotion among the community, another series of activities to be carried out under the second phase of the HLS programme from 1997 to 2002 was launched within the framework of the National Plan of Action on Nutrition (NPAN) for Malaysia. In view of the importance of diet and nutrition in the causation and prevention of chronic diseases, the theme for the first year of this phase was Healthy Eating. It is clear that nutrition education for the community in order to inculcate a culture of healthy eating is the long-term solution. A series of guidelines have been prepared for dissemination to the public via a variety of media and approaches, and with the collaboration of various government and non-governmental organisations. The implementation of the programme is, however, a challenge to health and nutrition workers. There is a need to examine the strategies for nutrition education to ensure more effective dissemination of information. The challenge is to determine how best to promote healthy eating within the present scenerio of rapid urbanisation, 'western' dietary pattern influence, a whole barrage of convenience and 'health' foods, and nutrition misinformation. We would like to share our experiences in the approaches taken and our concerns with other countries in the region given that various opportunities exist for collaboration.
Determinants of iron status in Malaysian adolescents from a rural community

Foo LH, Khor GL, Tee ES, Dhanaraj P

Int J Food Sci Nutr, 2004 Sep;55(6):517-25.
PMID: 15762316

Iron deficiency anaemia is the most common micronutrient deficiency worldwide. The prevalence of anaemia in the developing countries is three to four times higher than that in the developed countries. The iron status was assessed in 199 apparently healthy male and female adolescents aged 12-19 years living in a fishing community in Sabah, Malaysia. Data on socio-economic characteristics, lifestyles, anthropometry measurements, iron status, and dietary intake were gathered. Dietary intake of energy, iron, and most nutrients (with the exception of protein and vitamin C) were below the recommended levels for Malaysian adolescents. Three-quarters of the iron was derived from plant foods. The mean haemoglobin value for the male was 13.9 +/- 1.3 g/dl with 9.5% having less than 12 g/dl, while the respective figures for the female were 12.4 +/- 1.6 g/dl and 28.6%. The mean serum ferritin concentrations for male and female adolescents were 21.5 and 15.4 microg/l, respectively; with 25.7% of the males and 49.5% of the females having deficient levels of ferritin. Dietary intake of total energy and iron, and gender were found to be independent determinants of serum ferritin and haemoglobin levels, accounting for over 40% of the variations for each of these iron indicators. In males, but not in females, the intake of dietary protein and iron, and physical activity were also found to be significant determinants of serum ferritin. The age of subjects and household size were significant determinants of haemoglobin levels for male subjects, but not for female subjects. The findings indicate the importance of adequate intake of energy and dietary iron for improving the iron status of adolescents.
Whole-grain dietary recommendations: the need for a unified global approach

Seal CJ, Nugent AP, Tee ES, Thielecke F

Br J Nutr, 2016 06;115(11):2031-8.
PMID: 27082494 DOI: 10.1017/S0007114516001161

Increased whole-grain (WG) consumption reduces the risk of CVD, type 2 diabetes and some cancers, is related to reduced body weight and weight gain and is related to improved intestinal health. Definitions of 'WG' and 'WG food' are proposed and used in some countries but are not consistent. Many countries promote WG consumption, but the emphasis given and the messages used vary. We surveyed dietary recommendations of fifty-three countries for mentions of WG to assess the extent, rationale and diversity in emphasis and wording of any recommendations. If present, recommendations were classified as either 'primary', where the recommendation was specific for WG, or 'secondary', where recommendations were made in order to achieve another (primary) target, most often dietary fibre intake. In total, 127 organisations were screened, including government, non-governmental organisations, charities and professional bodies, the WHO and European Food Safety Authority, of which forty-nine including WHO provide a WG intake recommendation. Recommendations ranged from 'specific' with specified target amounts (e.g. x g WG/d), 'semi-quantitative' where intake was linked to intake of cereal/carbohydrate foods with proportions of WG suggested (e.g. x servings of cereals of which y servings should be WG) to 'non-specific' based on 'eating more' WG or 'choosing WG where possible'. This lack of a harmonised message may result in confusion for the consumer, lessen the impact of public health messages and pose barriers to trade in the food industry. A science-based consensus or expert opinion on WG recommendations is needed, with a global reach to guide public health decision making and increase WG consumption globally.
Symposium on nutrition and cognition: towards research and application for different life stages

Benton D, Winichagoon P, Ng TP, Tee ES, Isabelle M

Asia Pac J Clin Nutr, 2012;21(1):104-24.
PMID: 22374567

A SYMPOSIUM ON NUTRITION AND COGNITION: Towards research and application for different life stages was held on October 2010 in Malaysia. The influence of diet and nutrition on the cognitive development of the child and on cognitive decline in later life was reviewed. Central to the study of such topics is the assessment of cognitive functioning. Cognitive functioning falls into six main areas: executive functioning, memory, attention, perception, psychomotor and language skills, although each domain can be further subdivided. As it is in the nature of human functioning that the performance on any cognitive test can reflect aspects of many of these domains, ideally a battery of tests should be used to establish the basis of any difference in performance. In intervention studies, frequently there has been a failure to demonstrate a beneficial influence of changes in diet. A possible reason is that studies have failed to acknowledge the time scale and critical ages over which diet has an impact. Diet may have a slow and progressive influence making it difficult for short-term studies to show an improvement. In addition, as many factors influence human behaviour, dietary interventions should only be one part of a coordinated approach; the effect of diet will depend on the social and psychological context in which an individual lives. Placing diet into a broader social and psychological context greatly increases the chance of generating significant findings. This report highlights and reviews presentations and discussions at the symposium.
Fulltext Iron status and dietary iron intake of adolescents from a rural community in Sabah, Malaysia

Foo LH, Khor GL, Tee ES, Prabakaran D

Asia Pac J Clin Nutr, 2004;13(1):48-55.
PMID: 15003914

Iron deficiency anaemia (IDA) is the most prevalent micronutrient deficiency in the world affecting the general health and wellbeing of millions. In Malaysia, moderately high prevalences of anaemia have been reported amongst infants, young children and women of childbearing age. Data is scant for the adolescents. This study was undertaken to assess the iron status and dietary intake of 165 adolescents, comprising 74 male and 91 female subjects, aged 12 to 19 years, from the rural communities in Tuaran District of Sabah, Malaysia. Convenience sampling was used for the selection of study subjects. Multiple iron status indicators namely, serum ferritin (SF), transferrin saturation (TS), mean corpuscular volume (MCV) and haemoglobin (Hb) were determined for the study. The mean age of the subjects was 15.2 +/-2.1 years. While the majority of the subjects (77.6%) had normal body mass index (BMI) values, 17.6% were underweight and 4.8% overweight. About 35% to 40% of the subjects showed deficient values for haematocrit, serum ferritin, serum iron, mean corpuscular haemoglobin (MCH), mean corpuscular volume (MCV) and transferrin saturation (TS), and 20% were anaemic (Hb <12 g/L). Using the multiple criteria of iron status indicators, the prevalence of iron depletion, iron deficiency and IDA in the male and female adolescents were 5.4% vs. 6.6%, 18.9% vs. 26.4% and 5.4% vs. 26.4%, respectively. Iron deficiency anaemia (85.0%) contributed largely to the prevalence of anaemia. The dietary iron intake of the adolescents was unsatisfactory, with approximately 98% of subjects failing to meet the Malaysian RDA level. Almost all the female subjects (91%) had dietary iron intake below two-thirds of the RDA level compared with a much smaller proportion for the male adolescents (68%). The prevalence of IDA in the present study population, especially in the female adolescents, appears to be a significant public health problem. Priority should therefore be given to the eradication of iron deficiency in adolescents from low-income areas by dietary modification and micronutrient supplementation amongst female adolescents.
Regional study of nutritional status of urban primary schoolchildren. 3. Kuala Lumpur, Malaysia

Tee ES, Khor SC, Ooi HE, Young SI, Zakiyah O, Zulkafli H

Food Nutr Bull, 2002 Mar;23(1):41-7.
PMID: 11975368

A total of 5,995 (7.8% of all 7- to 10-year-old primary schoolchildren in Kuala Lumpur), randomly selected from 166 schools (97.6% of all schools), were measured for their weight and height. The analyses of all weight and height data, including the cutoffs used for defining stunting, underweight, and wasting and for thinness and overweight, were carried out as recommended by the World Health Organization (WHO). The prevalances of stunting (height-for-age Z score < -2 SD), underweight (weight-for-age Z score < -2 SD) and wasting (weight-for-height Z score < -2 SD) among all the children studies were 6.7%, 7.1%, and 4.5%, respectively. Undernutrition among boys was more serious than among girls according to all three indicators. Because it was not possible to analyze the weight-for-height data for most of the children above 8.5 years of age, body mass index (BMI)-for-age was used to determine the prevalences of thinness and overweight for all the children. Based on the reference data, the prevalence of overweight (at or above the 95th percentile) was 9.7% and 7.1% for boys and girls, respectively, and 8.4% overall.
The Role of Micronutrients in Ageing Asia: What Can Be Implemented with the Existing Insights

Inui T, Hanley B, Tee ES, Nishihira J, Tontisirin K, Van Dael P, et al.

Nutrients, 2021 Jun 29;13(7).
PMID: 34209491 DOI: 10.3390/nu13072222

Life expectancy as a measure of population health does not reflect years of healthy life. The average life expectancy in the Asia-Pacific region has more than doubled since 1900 and is now above 70 years. In the Asia-Pacific region, the proportion of aged people in the population is expected to double between 2017 and 2050. Increased life expectancy leads to an increase in non-communicable diseases, which consequently affects quality of life. Suboptimal nutritional status is a contributing factor to the prevalence and severity of non-communicable diseases, including cardiovascular, cognitive, musculoskeletal, immune, metabolic and ophthalmological functions. We have reviewed the published literature on nutrition and healthy ageing as it applies to the Asia-Pacific region, focusing on vitamins, minerals/trace elements and omega-3 fatty acids. Optimal nutritional status needs to start before a senior age is reached and before the consequences of the disease process are irreversible. Based on the nutritional status and health issues in the senior age in the region, micronutrients of particular importance are vitamins A, D, E, C, B-12, zinc and omega-3 fatty acids. The present paper substantiates the creation of micronutrient guidelines and proposes actions to support the achievement of optimal nutritional status as contribution to healthy ageing for Asia-Pacific populations.
Fulltext Nutritional anemia in pregnancy: a study at the maternity hospital, Kuala Lumpur

Tee ES, Kandiah M, Ali J, Kandiah V, Zahari MR, Kuladevan R, et al.

Malays J Reprod Health, 1984 Jun;2(1):32-50.
PMID: 12267519

The study presents recent data on the prevalence and pattern of nutritional anemia in the Maternity Hospital, Kuala Lumpur. A total of 309 pregnant women in their third trimester, of Malay, Chinese and Indian origin from the lower socio-economic strata were randomly selected for the study. Hematological indices (including Hb, PCV, MCHC, and TRBC), serum iron, transferrin saturation and ferritin, serum folate as well as protein and albumin were determined. Based on Hb and PCV values, 30-40 percent of the women could be considered anemic; approximately 50 percent of them presented with unsatisfactory serum iron, transferrin saturation and ferritin values; 60.9 percent had low serum folate levels; and about 30 percent may be considered to be of poor protein nutriture. Anemia in the study population was seen to be related mostly to iron and to a lesser extent, folate deficiency. Hematological, iron, folate and protein status was observed to be the poorest amongst the Indian women, better in the Malay group and generally the best amongst the Chinese women. Birth records of 169 of these women revealed that all of them had live births. Nearly all the infants were delivered by normal vaginal delivery (NVD) The mean gestational age was 38.6 weeks. One of the infants had a birth weight of <2.0 kg; incidence of low birth weight, <2.5 kg, was 8.3 percent. Although there was a trend of deteriorating hematological, iron and protein status of women from the 0, 1 -3 and >=4 parity groups, these differences were not statlstlcally significant.
Fulltext School-administered weekly iron-folate supplements improve hemoglobin and ferritin concentrations in Malaysian adolescent girls

Tee ES, Kandiah M, Awin N, Chong SM, Satgunasingam N, Kamarudin L, et al.

Am J Clin Nutr, 1999 Jun;69(6):1249-56.
PMID: 10357747 DOI: 10.1093/ajcn/69.6.1249

BACKGROUND: Iron deficiency and its consequent anemia constitute the commonest micronutrient deficiency in the world.
OBJECTIVE: We investigated whether long-term, weekly iron-folate supplements administered at school would improve hemoglobin and ferritin concentrations in adolescent girls, including those with mild-to-moderate anemia and hemoglobin concentrations indicating borderline anemia.
DESIGN: Subjects were 266 girls with hemoglobin concentrations of 80-119.9 g/L (group A) and 358 girls with hemoglobin concentrations of 120-130 g/L (group B) who were otherwise healthy. Two hundred sixty-six girls in group A and 268 girls in group B were randomly assigned to receive either 60 or 120 mg Fe plus 3.5 mg folic acid weekly for 22 wk. Ninety of the girls in group B were randomly assigned to receive only 5 mg folic acid weekly. Capillary hemoglobin and plasma ferritin were measured at baseline and after 12 and 22 wk of supplementation.
RESULTS: By the end of the study, 2% of the girls had dropped out and > 96% had taken > or = 20 of the 22 tablets; side effects were minimal. Mean plasma ferritin increased significantly in all iron-supplemented groups, independently of initial hemoglobin values and iron doses. Ferritin concentrations decreased in the girls supplemented with folic acid only. As expected, hemoglobin responses to iron were higher in group A than in group B and increases were positively correlated with initial plasma ferritin. Hemoglobin failed to respond to folate supplementation if initial plasma ferritin concentrations were low. Mean hemoglobin increased significantly and consistently in relation to the length of treatment.
CONCLUSION: Long-term, weekly iron-folate supplementation was found to be a practical, safe, effective, and inexpensive method for improving iron nutrition in adolescent schoolgirls.

Comment in: Picciano MF. Iron and folate supplementation: an effective intervention in
adolescent females. Am J Clin Nutr. 1999 Jun;69(6):1069-70. PubMed PMID:
10357724. https://academic.oup.com/ajcn/article/69/6/1069/4714856

Study site: 3 secondary schools, Samarahan district, Sarawak, Malaysia
Fulltext Current status of nutrition labelling and claims in the South-East Asian region: are we in harmony?

Tee ES, Tamin S, Ilyas R, Ramos A, Tan WL, Lai DK, et al.

Asia Pac J Clin Nutr, 2002;11(2):S80-6.
PMID: 12074192

This review includes the situation of nutrition labelling and claims in six countries in South-East Asia: Brunei, Indonesia, Malaysia, Philippines, Singapore and Thailand. With the exception of Malaysia, there is no mandatory nutrition labelling requirements for foods in these countries except for special categories of foods and when nutritional claims are made for fortified or enriched foods. Nevertheless, several food manufacturers, especially multinationals, do voluntarily label the nutritional content of a number of food products. There is, therefore, increasing interest among authorities in countries in the region to start formulating regulations for nutrition labelling for a wider variety of foods. Malaysia has proposed new regulations to make it mandatory to label a number of foodstuffs with the four core nutrients, protein, carbohydrate, fat and energy. Other countries have preferred to start with voluntary labelling by the manufacturers, but have spelt out the requirements for this voluntary labelling. The format and requirements for nutrition labelling differ widely for countries in the region. Some countries, such as Malaysia, closely follow the Codex guidelines on nutrition labelling in terms of format, components to be included and mode of expression. Other countries, such as the Philippines and Thailand, have drafted nutrition labelling regulations very similar to those of the Nutrition Labeling and Education Act (NLEA) of the United States. Nutrition and health claims are also not specifically permitted under food regulations that were enacted before 1998. However, various food products on the market have been carrying a variety of nutrition and health claims. There is concern that without proper regulations, the food industry may not be certain as to what claims can be made. Excessive and misleading claims made by irresponsible manufacturers would only serve to confuse and mislead the consumer. In recent years, there has been efforts in countries in the region to enact regulations on nutrition claims. Recently enacted regulations or amendments to existing regulations of almost all the countries reviewed have included provisions for nutrition claims. Malaysia is in the process of gazetting regulations to clearly stipulate the permitted nutrition claims and the conditions required to make these claims along the guidelines of Codex Alimentarius Commission. Only two countries in the region permit health claims to be made - Indonesia and Philippines. Other countries in the region are following developments in Codex and examining the need for allowing these claims. There are more differences than similarities in the regulations on nutrition labelling and claims among countries in the South-East Asian region as no previous efforts have been made to address these. Hopefully, through this first regional meeting, countries can initiate closer interaction, with a view to working towards greater harmonization of nutrition labelling and health claims in the region.
Fulltext A nutrient profiling system for the (re)formulation of a global food and beverage portfolio

Vlassopoulos A, Masset G, Charles VR, Hoover C, Chesneau-Guillemont C, Leroy F, et al.

Eur J Nutr, 2017 Apr;56(3):1105-1122.
PMID: 26879847 DOI: 10.1007/s00394-016-1161-9

PURPOSE: To describe the Nestlé Nutritional Profiling System (NNPS) developed to guide the reformulation of Nestlé products, and the results of its application in the USA and France.
DESIGN: The NNPS is a category-specific system that calculates nutrient targets per serving as consumed, based on age-adjusted dietary guidelines. Products are aggregated into 32 food categories. The NNPS ensures that excessive amounts of nutrients to limit cannot be compensated for by adding nutrients to encourage. A study was conducted to measure changes in nutrient profiles of the most widely purchased Nestlé products from eight food categories (n = 99) in the USA and France. A comparison was made between the 2009-2010 and 2014-2015 products.
RESULTS: The application of the NNPS between 2009-2010 and 2014-2015 was associated with an overall downwards trend for all nutrients to limit. Sodium and total sugars contents were reduced by up to 22 and 31 %, respectively. Saturated Fatty Acids and total fat reductions were less homogeneous across categories, with children products having larger reductions. Energy per serving was reduced by <10 % in most categories, while serving sizes remained unchanged.
CONCLUSIONS: The NNPS sets feasible and yet challenging targets for public health-oriented reformulation of a varied product portfolio; its application was associated with improved nutrient density in eight major food categories in the USA and France. Confirmatory analyses are needed in other countries and food categories; the impact of such a large-scale reformulation on dietary intake and health remains to be investigated.
Fulltext Sugars and sweeteners: science, innovations, and consumer guidance for Asia

Drewnowski A, Tappy L, Forde CG, McCrickerd K, Tee ES, Chan P, et al.

Asia Pac J Clin Nutr, 2019;28(3):645-663.
PMID: 31464412 DOI: 10.6133/apjcn.201909_28(3).0025

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.

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