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Behavioural Nutrition Newsletter, 2017, Issue 3, February
Nutrition Governance and the Nutrition Transition in Southeast Asia Prepared by:
Professor Geok Lin Khor PhD Emeritus Professor, Universiti Putra Malaysia, Adjunct Professor, International Medical University, Malaysia
March 13 2017
Background
Globally, the burden of under-nutrition, stunting and
micronutrient deficiencies leads to millions of childhood
mortality and morbidity each year (Black et al., 2013). In
parallel, there is an upsurge of obesity amongst children
world-wide (Ng et al., 2014). Rising prevalence of overweight
and obese children is likely to have significant impacts on
obesity, diabetes and other non-communicable diseases in
adults (NCD-Risk Factor Collaboration, 2016). The co-existence of under-nutrition and obesity at the
population and household levels are consequences of the “nutrition transition” (Popkin, 2006; Popkin &
Slining, 2013).
Historically, the nutrition transition is said to be preceded by two processes of population change.
These are the demographic transition - the shift from a pattern of high fertility and high mortality to one of
low fertility and low mortality, and the epidemiologic transition – the shift from a pattern of high prevalence
of infectious diseases to a pattern of chronic non-communicable diseases (NCDs). Diet-related NCDs
escalates in tandem with the nutrition transition, which is associated with major shifts in consumption and
activity patterns leading to adverse health outcomes. According to the nutrition transition stages expounded
In this edition Other items
Introducing the APFNC
Members-Only Discussion Page
https://blogs.deakin.edu.au/apfnc/a
pfnc-members-only-discussion-page/
The APFNC members’ only discussion
page has been launched to help you
connect with fellow members of the
collaboration. Please use
this communication forum to discuss
areas of interest to you and/or the group,
and use it to explore areas of
collaboration and research interest
among APFNC members.
Email [email protected] for the
password.
Thank you very much to our members,
Anna Roesler and Professor Geok Lin
Khor, for their fabulous contributions to
this edition.
Anna Roesler presents a fascinating
article on early eating habits of Northern
Thailand hill tribe Indigenous children,
and contributing factors to early
cessation of exclusive breastfeeding.
Professor Geok Lin Khor presents a
proposal for a compendium on
Nutrition Governance and the Nutrition
Transition in Southeast Asia. She calls for
discussion within members of the APFNC
on the compendium, which will be
externally reviewed and submitted to a
regional journal for publication.
APFNC news
Welcome to
March’s edition
of the APFNC
Behavioural
Nutrition
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by Barry Popkin, countries in the 21st century have mostly moved from the early stages of “hunting and
gathering‟, and the “onset of industrialisation; receding famine‟, to the stage of “rising NCDs”, with few
populations having reached the stage of “healthy behavioural changes”.
Countries in the Southeast Asian (SEA) region are at vastly different economic and technological
levels of development, and are characterised by a wide diversity of socio-cultural lifestyles. These countries
may also be described as currently undergoing different nutrition transition stages. In a way, the region
represents a microcosm of the global situation. Does the region have success stories to share in progressing
from the stage of “rising NCDs” to that of “healthy behavioural changes”? What are the challenges that
seem to leave some countries stagnated at the “rising NCDs” stage?
Proposal
We propose to organise a critical compendium on the experience of the region in coping and
addressing challenges as they move through the nutrition transition stages. We will investigate country data
for the presence of nutrition policies and programs that address the dual burdens of under-nutrition and
overweight/obesity in children and women of reproductive age. We will also examine the associations
between the strength of nutrition governance and the magnitude of under-nutrition and overweight/obesity
in children and women. In this context, we will adopt the scope of nutrition governance as defined in
Sunguya et al (2014)1. In addition to the SEA region, we welcome others from outside SEA, who are
interested to share their insights on public health policy response in addressing the burden of under-
nutrition and overweight/obesity.
The compendium will be externally reviewed and submitted to a regional journal of repute for
publication. We will discuss within the group and the selected journal regarding sponsorship of the
publication. Join the discussion on the APFNC Members-Only Discussion Page:
https://blogs.deakin.edu.au/apfnc/apfnc-members-only-discussion-page/
Scope of each country chapter 1. An in-depth situational analysis of the nutritional status of children and women populations
2. Establishing the associations between the nutrition governance in addressing the burdens of undernutrition and overweight/obesity in children and women.
3. Recommending ameliorating actions that may accelerate countries towards reaching the stage of “Desired Societal/Healthy Behavioural Changes” of the nutrition transition2.
1 Defined by 10 elements in Sunguya et al., (2014): existence of (1) an intersectoral mechanism to address nutrition; (2) a nutrition strategic plan; (3) the strategy is adopted; (4) the strategy is part of the national development plan; (5) a national nutritional policy; (6) the policy is adopted; (7) dietary guidelines; (8) allocation of a budget for implementation of national nutrition policy; (9) regular monitoring and surveillance; (10) a nutrition component in the health budget. 2 Refer to Popkins (2006)
References
Black RE et al The Maternal and Child Health Group
Maternal and child undernutrition and overweight in low-income and middle-income countries.
The Lancet 2013; 382: 427-451
Ng M et al.
Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet 2014; 384: 766- 781.
Popkin BE Global nutrition dynamics: the world is shifting rapidly toward a diet linked with noncommunicable diseases.
Am J Clin Nutr 2006; 84:289 - 298.
Popkin, B and M.M. Slining
New dynamics in global obesity facing low- and middle-income countries. Obesity Reviews 2013; 14 (Suppl. 2):11-20.
Sunguya BF et al
Strong nutrition governance is a key to addressing nutrition transition in low and middle-income countries: review of countries nutrition policies.
Nutrition J 2014; 13: 65.
Local insights into the nutrition of children aged 0-5 years in northern
Thailand
Prepared by:
Anna Roesler PhD Candidate. Public Health. The University of Adelaide. Australia. Professor Vivienne Moore PhD. Public Health. The University of Adelaide. Australia.
Dr. Lisa Smithers PhD. Public Health. The University of Adelaide. Australia.
Undernutrition in early life, from conception and through the first 24 months following birth, can
result in delayed growth and development that is difficult to reverse. One third of Northern Thai hill tribe
indigenous children aged 0-5 years of Karen and Lua ethnicity are stunted, a form of undernutrition.
Previous studies show that hill tribe Thai children have poorer nutritional status compared with other Thai
children. The aims of this research were to gain an in-depth understanding of (1) current infant and young
child feeding (IYCF) beliefs and practices, and (2) factors contributing to poor nutrition, in hill tribe children.
A two-day workshop and 30 in-depth interviews were undertaken in June 2014 in four northern hill
tribe communities. Participants included seven health officers, two nurses, eight village health volunteers
and 26 carers of children aged 0-5 years. Interviews and workshop were conducted in Thai, then transcribed
and translated to English. A detailed thematic analysis was conducted revealing poor adherence to
recommendations for exclusive breastfeeding, introduction of solids and a variety of complementary foods.
Two dominant factors appear to contribute to early cessation of exclusive breastfeeding and early
introduction of solids; the need for mothers to work within one to three months after giving birth, and
grandmothers’ roles as carers while parents work. Carers often reported the perceived need to supplement
breast milk with rice, due to their parents sharing that breast milk was not sufficient. There was a
widespread view that mothers could not make sufficient breast milk, leaving the child hungry and therefore
rice was needed. It was also common for parents to report that they fed their child rice earlier than
recommended in order to reduce reliance on breastfeeding in preparation for mothers return to work.
Villagers generally introduced a variety of foods much later than the WHO recommended time of
around six months. Children are mainly given rice, banana, or occasionally egg, from three to 12 months.
Vegetables and meat are limited and often delayed until after 12 months. While seasonality influenced food
availability, these practices were predominantly related to perceptions of children’s readiness to eat
different foods. Fear of choking and diarrhoea also constrained food choice, underpinned by the distance to
support.
Interventions to improve IYCF need to address remoteness, income and collective parenting. Women
need to be allowed time to care for their infants to meet nutritional recommendations, which would require
changes at family, social and structural levels.
Further Reading: Chotiboriboon, S., Tamachotipong, S., Sirisai, S., Dhanamitta, S., Smitasiri, S., Sappasuwan, C., . . . Eg-Kantrong, P.
(2009). Thailand: food system and nutritional status of indigenous children in a Karen community In FAO & Centre for Indigenous Peoples’ Nutrition and Environment (Eds.), Indigenous Peoples’ Food Systems (pp. 158-183). Rome Food and Agriculture Organization of the United Nations.
UNICEF. (2011). Programming Guide: Infant and Young Child Feeding. New York: UNICEF.
Recent publications by APFNC members
Breanna De Jong, Anthony Worsley, Wei Chun Wang, Rani Sarmugam, Quynh Pham, Judhiastuty Februhartanty and Stacey Ridley
Personal values, marketing attitudes and nutrition trust are associated with patronage of convenience food outlets in the Asia-Pacific region: a cross-sectional study.
Journal of Health, Population & Nutrition, 2017; 36:6 https://jhpn.biomedcentral.com/articles/10.1186/s41043-017-0082-4
DOI: 10.1186/s41043-017-0082-4
Background
An online cross-sectional survey examined the relationships between the demographic characteristics, personal values, trust in sources of nutrition information and the use of convenience food outlets among middle-class household food providers in the Asia-Pacific region. Methods The survey was administered to 3945 household food providers in Melbourne, Singapore, Shanghai, Vietnam and Indonesia in late 2013. Information about demographics, personal values, trust in sources
of nutrition information and use of convenience food outlets was elicited. Exploratory factor analysis, two-step clustering and logistic regression were employed. Result The analyses found that the use of convenience food outlets was positively related to hedonist values and trust in food industry sources of nutrition information. However, lesser use of convenience food outlets and trust in health sources of nutrition information was associated with traditional (community-oriented) values. Conclusions Further replication and extension of these findings would be useful. However, they suggest that improvements in the quality of foods sold in convenience food outlets combined with stronger regulation of food marketing and long-term food education are required.
Deakin University: Institute for Physical Activity and Nutrition Research (I-PAN) recent publications
Lukar Thornton, David Crawford, Karen Lamb and Kylie Ball Where do people purchase food? A novel approach to investigating food purchasing locations
International Journal of Health Geographics, 2017; 16:9 https://ij-healthgeographics.biomedcentral.com/articles/10.1186/s12942-017-0082-z
DOI: 10.1186/s12942-017-0082-z
Background
Studies exploring associations between food environments and food purchasing behaviours have been limited by the absence of data on where food purchases occur. Determining where food purchases occur relative to home and how these locations differ by individual, neighbourhood and trip characteristics is an important step to better understanding the association between food environments and food behaviours.
Methods Conducted in Melbourne, Australia, this study recruited participants within sixteen neighbourhoods that were selected based on their socioeconomic characteristics and proximity to supermarkets. The survey material contained a short questionnaire on individual and household characteristics and a food purchasing diary. Participants were asked to record details related to all food purchases made over a 2-week period including food store address. Fifty-six participants recorded a total of 952 food purchases of which 893 were considered valid for analysis. Households and food purchase locations were geocoded and the network distance between these calculated. Linear mixed models were used to determine associations between individual, neighbourhood, and trip characteristics and distance to each food purchase location from home. Additional analysis was conducted limiting the outcome to: (a) purchase made when home was the prior origin (n. 484); and (b) purchases made within supermarkets (n. 317).
Results Food purchases occurred a median distance of 3.6 km (IQR 1.8, 7.2) from participants’ homes. This distance was similar when home was reported as the origin (median 3.4 km; IQR 1.6, 6.4) whilst it was shorter for purchases made within supermarkets (median 2.8 km; IQR 1.6, 5.6). For all purchases, the reported food purchase location was further from home amongst the youngest age group (compared to the oldest age group), when workplace was the origin of the food purchase trip (compared to home), and on weekends (compared to weekdays). Differences were also observed by neighbourhood characteristics.
Conclusions This study has demonstrated that many food purchases occur outside what is traditionally considered the residential neighbourhood food environment. To better understand the role of food environments on food purchasing behaviours, further work is needed to develop more appropriate food environment exposure measures.
Recent scientific publications
Maternal and infant nutrition
Healthy Eating Research. “Feeding Guidelines for Infants and Young Toddlers: A Responsive Parenting Approach”. http://healthyeatingresearch.org/wp-content/uploads/2017/02/her_feeding_guidelines_report_021416-1.pdf
The specific objective of this project was to develop evidence based infant and toddler feeding guidelines that focus on what and how to feed infants and toddlers, within the context of the growing child and responsive parenting. Although the main focus was the development of guidelines for caregivers on how to prevent excessive weight gain in infants and toddlers, whenever possible the recommendations also took into account outcomes of major public health concern strongly influenced by dietary practices, such as iron deficiency and oral health. In addition, other behaviours influencing hunger and satiety such as physical activity, media use, and sleep, were addressed. The aim of the guidelines presented in this report is to empower caregivers to address the nutritional status and well-being of infants and toddlers by offering them healthier food and beverage options in response to their hunger and satiety cues. Thus the report does not focus on clinical guidelines regarding specific nutrient supplementation needs for infants and toddlers.
Child, teenage and family nutrition
Barnes, Jessica L., and Warren, Cynthia. “Development of Food Group Books for Three- and Four-Year-Old Children”. Family & Consumer Sciences Research Journal. 2017; 45(3): 272-284. DOI 10.1111/fcsr.12200 http://onlinelibrary.wiley.com/doi/10.1111/fcsr.12200/abstract.
Food preferences can be established in young children and these food preferences could extend into adulthood. This article is about MyPlate Food Group Books which are five nonfiction books. Each book covers one food group. The books were developed with input from 4-year-old children, preschool educators, and specialists in nutrition education and child development. The books were tested for acceptance and potential for behaviour change with a small group of 3-year-old children. After the books were read once a day for 2 weeks by teachers, the authors tested the effect of book exposure on food consumption by measuring aggregate plate waste. Although changes in food consumption behaviours were not observed, the teachers indicated changes in the pre-schooler’s attitudes toward trying new foods. Positive attitudes toward new foods could result in increased familiarity and eventually changes in food behaviour
Contact us Stacey Ridley MPH, GradCertHumNutr
APFNC Coordinator
School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, Melbourne, Australia
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the reliability of information provided.
