NSCB - Statistically Speaking... Are Pinoys getting too thin or too fat?

Are Pinoys getting too thin or too fat?²

Every July, the nation celebrates Nutrition Month pursuant to Presidential Decree (PD) No. 491 issued in 1974 – Creating a National Nutrition Council and for other Purposes. The celebration aims to create awareness among Filipinos of the importance of proper nutrition. Through PD 491, the government declares that nutrition is a priority to be implemented by all branches of the government in an integrated fashion. For this year, the Nutrition Month’s theme is "Wastong Nutrisyon ni Mommy, Siguradong Healthy si Baby!" which emphasizes the importance of proper nutrition for healthy moms and babies.

Government efforts to address inadequacies in food intake and at the same time highlight the significance of nutrition are embedded in two major government development plans. The 2004-2010 Medium-Term Philippine Development Plan (MTPDP) outlines, among others, plans and programs to respond to the basic needs of the poor through improved health and nutrition. The plan emphasizes that the provision of essential services like nutrition shall constitute the vital government interventions aimed at raising productivity, generating jobs, reducing poverty, and promoting social justice.³

The 2005-2010 Philippine Plan of Action for Nutrition (PPAN), as the country's blueprint for achieving nutritional adequacy for all Filipinos, envisions a Philippines whose people are well nourished, healthy, intelligent, and socially and economically productive with a high sense of human dignity⁴. The Plan specifically enumerates various objectives on reducing malnutrition, energy deficiency, iron deficiency anemia, Vitamin A deficiency and others.

In addition, the Philippines as a signatory to the Millennium Declaration commits to the eight Millennium Development Goals (MDGs). Target 2 (Halve, between 1990 and 2015, the proportion of people who suffer from hunger), Goal 1 (Eradicate extreme poverty and hunger) of the MDGs has two indicators focusing on nutrition:

Prevalence of underweight children under 5 years of age; and
Proportion of population below minimum level of dietary energy consumption.

As nutrition is multifaceted that involves the food we eat AND don’t eat, the energy and nutrient content of what we eat, its effect on our weight and height and even the circumference of our belly and other anthropometric and biological factors are relevant in assessing our overall nutritional status. These and other nutrition (and health) statistics are necessary to determine whether we have been eating the right amount of right food at the right time to attain the right nutritional status. Right?

As this year’s Nutrition Month’s theme focuses on the importance of proper nutrition among pregnant women, this article attempts to answer questions like: “Does Nanay practice proper nutrition to ensure that Baby Girl or Baby Boy would be healthy?”

Based on the 2003 National Nutrition Survey (NNS)⁵, the usual one-day food consumption of pregnant Filipino women amounts to 810 grams comprised largely of rice and products (29.5%), fish and products (16.0%) and vegetables (12.1%) (Table 1). The rice-fish-vegetable diet which is already 57.6% of a pregnant woman’s mean one-day intake leaves small amount for other food groups which, based on our common knowledge are necessary for a pregnant woman’s proper nutrition: milk and milk products (6.4%) and fruits (8.8%).

In fact, our buntis Nanays have not been eating the right food. Out of the nine essential nutrients (Table 2), pregnant women’s intake of Niacin (mg) was the only one that met the recommended amount (RENI⁶, 2000). In a pregnant women’s diet, energy and protein intake is only 78.4 percent and 84.7 percent adequate, respectively. Iron, which is important for maternal blood volume and iron stores of the baby, is only 28.8 percent adequate while riboflavin intake is even less than half of the requirements at 48.1 percent. Mean intakes of vitamin A, vitamin C, calcium and thiamin are all less than 80 percent indicating poor diet among pregnant women. Could this be the reason why our young Pinoys are no longer performing in school as well as we used to?

The NNS results also show that the prevalence of iron-deficiency anemia (IDA) among pregnant women was still very high at 43.9% in 2003, although lower than the 50.5% prevalence rate in 1998. The prevalence rate of Vitamin A deficiency (VAD) of 17.5% in 2003 is likewise lower compared to the 1998 rate of 22.2% but is still higher than the cut-off point of 15% set by the World Health Organization (WHO). In pregnant women, VAD causes night blindness and may increase the risk of maternal mortality⁷ while anemic mothers predispose infants to anemia⁸.

In general, good nutrition leads to decreases in still births, prematurity, and congenital malformations⁹. But statistics show that Nanay is not getting proper nutrition. And the NNS further shows that a higher proportion (28 in every 100 or 28.4% (<P95)) of pregnant women are nutritionally at-risk in 2005 compared to 2003 (26.6% (P<95%)) (Table 3). If the proportion of nutritionally at-risk pregnant women continues to increase in the coming years, more Pinoy babies will also be at risk.

And how about us typical Pinoys and Pinays? In 2003, a typical one-day food consumption of Filipinos amounted to 886 grams per day, 83 grams more or 10.3% higher compared to 2001 (Table 4). In 2001, an average Filipino’s diet is comprised largely of rice and products (35.1%), vegetables (13.2%) and fish and products (18.3%). In 2003, we ate more rice and products, vegetables and fish but we consumed less corn and products and fruits. We even consumed more beverages (17 grams more) in 2003. Effect of global warming maybe?

In terms of energy and nutrient intake, except for ascorbic acid, Filipinos consumed more energy and other essential nutrients in 2003 than in 2001 with energy and Vitamin A posting significant increases of 221 grams and 63.3 grams, respectively. In addition to meeting the RENI of protein, Vitamin A and Niacin in 2001, the RENI for calcium was also met in 2003 (Table 5).

Rice is of course, our staple food. Based on the latest Food Balance Sheets (FBS) produced by the NSCB, Pinoys consumed an average of 261.8 grams of rice per day in 1990 (Figure 1). For some reason, this increased by around 0.68%¹⁰ annually from 1991 to 2001 when it reached its highest level of 284.1 grams per day¹¹. No wonder, these days, you see too many big-bellied Pinoys! And no wonder gyms and liposuction quack doctors este experts do brisk business.

It is sad to note that pregnant women are not eating enough and not eating the right food when they must. Statistics mentioned earlier reveal that an average Pinoy met more RENI than a pregnant woman. Indeed, the nutritional status of pregnant women in the country is a public health problem. And what is the government doing to address this? The PPAN provides a framework for achieving proper nutrition among Filipinos, including pregnant women. The PPAN, specifically includes a component on Nutrition in Essential Maternal and Child Health Services which addresses the needs of pregnant women.

And speaking of the PPAN, it is imperative to know whether its objectives are being met. Results of the National Nutrition Survey (NNS) reveal the following
good news and bad news (Table 6):

On prevalence of underweight

The prevalence of underweight children aged 0-5 years declined through the years: 32.0% in 1998, 30.6% in 2001, 26.9% in 2003 and 24.6% in 2005.

Starting 2001, there has been a decrease in the prevalence of underweight school-age children from 6-10 years

However, the prevalence of underweight among adolescents (11-19 years) slightly increased from 15.5% in 2003 to 16.0% in 2005

On prevalence of overweight

The proportion of overweight children aged 0-5 years continued to increase from 1998 to 2005

The prevalence of overweight school-age children (6-10 years) continuously increased from 1996 to 2005

The pattern extends to older ages because since 1993, the proportion of overweight adolescents (11-19 years) has increased reaching 4.8% in 2005

On prevalence of Iron Deficiency Anemia (IDA)

The proportion of infants (6 months to less than 1 year) with IDA has been increasing since 1993

However, among children 1-5 years, the prevalence of IDA decreased from 1998 to 2003

Bad news is, IDA prevalence among children 6-12 years increased during the same period

But, good to know that the prevalence of IDA among pregnant and lactating women declined from 1998 to 2003

On prevalence of Vitamin A Deficiency (VAD)

Starting 1993, the prevalence of VAD among infants (6 months to less than 1 year) and children aged 1-12 years has been on an increasing trend

The proportion of VAD among pregnant women decreased from 1998 to 2003

On prevalence of underheight

The proportion of underheight children 0-5 years has been decreasing since 1996

The prevalence of underheight among children aged 6-10 years continued to decrease from 2001. Good news for Barangay Ginebra?

On proportion of households with per capita energy and nutrient intake meeting the RENI

About 9 out of 10 households have per capita intake of Niacin that meets the average requirement which is about 80% of RENI.

Around 7 out of 10 households have per capita intake of protein that meets the average requirement (about 80% of RENI)

Unfortunately, less than 3 out of 10 households meet the average requirements for iron, Vitamin A, calcium and riboflavin.

In general, statistics show that there is an increasing trend in the proportion of underweight adolescents and an increasing trend in the proportion of overweight children, adolescents and adults. I hope this trend does not continue, otherwise magiging lahi tayo ng mga payatots and tabachoys.

Speaking of overweight/obese, the NNS also reveals (Table 6) that the proportion of overweight/obese adults has been increasing from 1993, reaching 24.0% in 2003 with relatively more females being overweight (27.3%) than males (20.9%). Both sexes show increases in the prevalence of overweight/obese with female adults having the highest percentage-point increase of 8.7 from 1993 to 2003. Does this mean that Dabiana, Donya Buding and Kim San Soon are leaving their bellyprints in the sands of time? If we treasure corpulence like men in Mauritania¹² where “obesity has long been the ideal of beauty”, why would we mind?

Aside from the Body Mass Index (BMI)¹³, Waist Circumference (WC) is another measure of the amount of body fat or adipose tissue. In this case, the term “Android Obesity” is used which is an indicator of risks to non-communicable diseases¹⁴. Table 6 shows that the proportion of adults who have WCs greater than the WHO threshold was 2.4% among male adults but 17.0% among female adults in 2003¹⁵. Compared to 1998, the proportion among male adults is lower by 0.3 percentage point while that of female adults is higher by 6.3 percentage points. But with slimming teas and capsules, liposuctions and the increasingly popular Ultrashape and even plastic wraps, who knows? Then we can all say Salamat po doctor.

We are already midway to 2015 which is the year by which signatory countries to the Millennium Declaration must achieve the MDGs. The MDGs is a set of clearly-defined, time-bound and measurable goals and targets geared toward poverty-reduction and ensuring that globalization benefits all the world’s people. It consists of 8 major goals, 18 targets and 48 indicators meant to be achieved in a 25-year timeline (from 1990 to 2015).

With respect to the MDGs on nutrition, the probability that the Philippines will achieve the goal on the prevalence of children under 5 years is medium but very close to high (Table 7). Based on the FNRI’s data, the prevalence of underweight children under 5 years of age decreased from 34.5% in 1990 to 24.6% in 2005.

Among the regions in the country in 2005 , NCR and Region 2 (Cagayan Valley) had the lowest percentage of underweight children 0-5 years both at 14.1% followed by Region 10 (Northern Mindanao) at 14.7%. On the other hand, Region 9 (Zamboanga Peninsula) had the highest proportion of underweight children at 35.2% (Table 8).

Moreover, the probability that the Philippines will achieve its goal of reducing the proportion of households with per capita energy less than 100% adequacy is high. FNRI’s data show that the percentage decreased from 69.4% in 1993 to 56.9% in 2003.

Despite the increasing prices of food and the not-so-good current nutritional status of Filipinos, we have every right to “dream, believe, survive” hoping that one day we can all “go, grow and glow!” But with the impressive government programs on nutrition, it is important to “walk the talk” and “fund the walk”!

In the meantime, let us celebrate Nutrition Month and advocate for "Wastong Nutrisyon ni Mommy, Siguradong Healthy si Baby!"

Reactions and views are welcome thru email to the author at cj.astrologo@nscb.gov.ph

_____________________

¹ Secretary General of the National Statistical Coordination Board (NSCB) and Chairman of the Statistical Research and Training Center (SRTC). He holds a Ph. D. in Statistics from the University of Michigan in Ann Arbor, USA and has taught mathematics and statistics at the University of the Philippines. He is also a past president of the Philippine Statistical Association.

²This article was written by Candido J. Astrologo, Jr. (cj.astrologo@nscb.gov.ph), OIC-Director of the National Statistical Information Center (NSIC) of the NSCB. The author thanks Jessamyn O. Encarnacion, Bernadette B. Balamban, Racquel Dolores V. Sabenano, Eunice N. Tambasen and Noel S. Nepomuceno for their assistance in the preparation of this article.

³2004-2010 Medium-Term Philippine Development Plan, National Economic Development Authority

⁴2005-2010 Philippine Plan of Action for Nutrition, National Nutrition Council

⁵The National Nutrition Survey (NNS) is a designated statistical activity conducted by the Food and Nutrition Research Institute (FNRI) every five (5) years at the national and regional levels. The results are disseminated one (1) year after the reference year. The Update on Nutritional Status of Filipino Children at the Provincial Level is conducted every two years.

⁶RENI or Recommended Energy and Nutrient Intakes. The RENI is the new/revised dietary standard for Filipinos. It is defined as levels of intakes of energy and dietary components, which is considered adequate for the maintenance of health and well-being of nearly all healthy persons in the population. In simple terms, the RENI is used to denote recommendations for energy and 21 nutrients including protein, folate, calcium, and Zinc.

⁷WHO website, http://www.who.int/nutrition/topics/vad/en/

⁸2008 Nutrition Month Talking Points, http://www.nnc.da.gov.ph/08nmtkpt.pdf

⁹ibid

¹⁰Computed using the formula for compound annual growth rate (CAGR), as follows:

¹¹Data on rice consumption from the Supply and Utilization Accounts from the Bureau of Agricultural Statistics show similar trend

¹²Government trying to change desert culture that force-feeds girls (http://www.msnbc.msn.com/id/18141550/)

¹³BMI is used as indicator of thinness and overweight/obesity.

¹⁴Philippine Nutrition Facts and Figures 2003, FNRI

¹⁵The assessment criteria for obesity using waist circumference is based on the World Health Organization’s (WHO) clinical thresholds of greater than or equal to 102 cm (~40 inches) for males and greather than or equal to 88 cm (~35 inches) for females.

Posted 14 July 2008.

Table 1. Mean one-day food consumption of pregnant Filipino women: Philippines, 2003

Food Group/Sub-Group	Mean intake
Food Group/Sub-Group	grams	Percent Distribution
Cereals and Cereal Products	303	37.4
Rice and Products	239	29.5
Corn and Products	30	3.7
Other Cereal Products	34	4.2
Starchy Roots and Tubers	20	2.5
Sugars and Syrups	13	1.6
Fats and Oils	13	1.6
Fish, Meat and Poultry	205	25.3
Fish and Products	130	16.0
Meat and Products	53	6.5
Poultry	22	2.7
Eggs	12	1.5
Milk and Milk Products	52	6.4
Whole Milk	35	4.3
Milk Products	17	2.1
Dried Beans, Nuts and Seeds	6	0.7
Vegetables	98	12.1
Green Leafy and Yellow Vegetables	36	4.4
Other vegetables	62	7.7
Fruits	71	8.8
Vitamin C-Rich fruits	18	2.2
Other fruits	53	6.5
Miscellaneous	17	2.1
Beverages	12	1.5
Condiments and Others	1	0.1
Others	4	0.5
TOTAL	810	100.0

Source: National Nutrition Survey, Food and Nutrition Research Institute

Table 2. Mean one-day and percent adequacy of energy and nutrient intake
of pregnant women: Philippines, 2003

Energy and Nutrients	Unit	Intake Actual	Recommended Intake	% adequacy of RENI
Energy	kcal	1634.00	+300 for 1st trimester; +300 for 2nd trimester	78.4
Protein	g	55.90	66	84.7
Iron	mg	9.70	27 for 1st trimester; 34 for 2nd trimester; and 38 for 3rd trimester	28.8
Calcium	g	0.42	0.80	62.3
Vitamin A (Retinol Equivalent)	mcg	580.70	800	72.6
Thiamin	mg	0.92	1.4	65.9
Riboflavin	mg	0.82	1.7	48.1
Niacin	mg	20.30	18	112.7
Ascorbic Acid	mg	58.80	80	73.6

*100% RENI for Energy and 80% RENI for the other nutrients.
Source: National Nutrition Survey, Food and Nutrition Research Institute

Table 3. Percentage distribution of pregnant women by weight-for-height classification: Philippines, 2001 and 2003

Indicator	1998	2003	2005
Nutritionally at-risk (<P95)	30.7	26.6	28.4
Not nutritionally at-risk (>=P95)	69.3	73.4	71.6

Source: National Nutrition Survey, Food and Nutrition Research Institute

Table 4. Mean one-day per capita food consumption: Philippines, 2001 and 2003

Food Group/Sub-Group	2001		2003
Food Group/Sub-Group	grams	Percent Distribution	grams	Percent Distribution
Cereals and Creal Products	340	42.3	364	41.1
Rice and Products	282	35.1	303	34.2
Corn and Products	36	4.5	31	3.5
Other Cereal Products	22	2.7	30	3.4
Starchy Roots and Tubers	17	2.1	19	2.2
Sugars and Syrups	19	2.4	24	2.7
Fats and Oils	12	1.5	18	2.0
Fish, Meat and Poultry	147	18.3	185	20.9
Fish and Products	99	12.3	104	11.7
Meat and Products	34	4.2	61	6.9
Poultry	14	1.7	20	2.3
Eggs	12	1.5	13	1.5
Milk and Milk Products	44	5.5	49	5.6
Whole Milk	35	4.4	35	4.0
Milk Products	9	1.1	14	1.6
Dried Beans, Nuts and Seeds	10	1.2	10	1.1
Vegetables	106	13.2	111	12.5
Green Leafy and Yellow Vegetables	30	3.7	31	3.5
Other vegetables	76	9.5	80	9.0
Fruits	77	9.6	54	6.1
Vitamin C-Rich fruits	21	2.6	12	1.4
Other fruits	56	7.0	42	4.7
Miscellaneous	19	2.5	39	4.4
Beverages	9	1.1	26	2.9
Condiments and Others	11	1.4	13	1.5
TOTAL	803	100.1	886	100.0

Note: Numbers may not add up to totals due to rounding off.

Source: National Nutrition Survey, Food and Nutrition Research Institute

Figure 1. Rice consumption: 1990-2001 (per capita per gram per day)

Chart

Source: Food Balance Sheets of the Philippines, NSCB

Table 5. Mean one-day per capita percent adequacy of energy and nutrient intake of Filipinos: Philippines 2001 and 2003

Energy and Nutrients*	Unit	2001		2003
Energy and Nutrients*	Unit	Actual Intake	% adequacy of RENI	Actual Intake	% adequacy of RENI
Energy	kcal	1684.0	87.8	1905.0	98.3
Protein	g	49.9	106.2	56.2	99.2
Iron	mg	10.1	64.7	10.1	60.1
Calcium	g	0.4	67.2	0.4	91.4
Vitamin A (Retinol Equivalent)	mcg	391.9	88.1	455.2	57.1
Thiamin	mg	0.7	68.4	0.9	86.3
Riboflavin	mg	0.6	57.1	0.7	68.0
Niacin	mg	16.1	88.0	20.6	156.4
Ascorbic Acid	mg	46.7	73.2	46.5	75.0

*100% RENI for Energy and 80% RENI for the other nutrients.

Source: National Nutrition Survey, Food and Nutrition Research Institute

Table 6. Selected Nutrition Indicators: Philippines, 1993 to 2005

Indicator	1993	1996	1998	2001	2003	2005
Prevalence of Underweight 1
Children 0-5 years	29.9	30.8	32.0	30.6	26.9	24.6
Children 6-10 years	30.5	28.3	30.2	32.9	25.6	22.8
Adolescents 11-19 years	15.8	…	19.8	…	15.5	16.0
Prevalence of Overweight/Obese 1
Children 0-5 years	0.4	0.5	0.4	1.0	1.4	2.0
Children 6-10 years	0.6	0.4	…	0.8	1.3	1.6
Adolescents 11-19 years	2.4	…	2.9	…	3.6	4.8
Adults 20 years and over	16.6	…	20.2	…	24.0	…
Male	14.4	…	17.0	…	20.9	…
Female	18.6	…	23.3	…	27.3	…
Prevalence of Underheight 1
Children 0-5 years	34.3	34.5	34.0	31.4	29.9	26.3
Children 6-10 years	42.2	39.1	40.8	41.1	35.8	32.0
Prevalence of Iron Deficiency Anemia
Infants (6mos. - <1Yr)	49.2	…	56.6	…	66.2	…
Children 1-5 years	25.7	…	29.6	…	29.1	…
Children 6-12 years	42.0	…	35.6	…	37.4	…
Pregnant women	43.6	…	50.7	…	43.9	…
Lactating women	43.0	…	45.7	…	42.2	…
Prevalence of Vitamin A Deficiency
Infants (6mos. - <1Yr)	37.5	…	42.2	…	47.0	…
Children 1-5 years	35.6	…	37.6	…	39.3	…
Children 6-12 years	35.3	…	38.0	…	40.1	…
Pregnant women	16.4	…	22.2	…	17.5	…
Lactating women	16.4	…	16.5	…	20.1	…
Waist Circumference/Prevalence of Android Obesity
Male adults (WC>=102cm)	…	…	2.7	…	2.4	…
Female adults (WC>=88cm)	…	…	10.7	…	17.0	…

¹ Using Body Mass Index (BMI) as indicator of thinness and overweight/obese
… - not available

Source: National Nutrition Survey, Food and Nutrition Research Institute

Table 7. MDG indicators on Nutrition

Indicators	1990	1992	1993	1996	1998	2001	2003	2006	2015 (target)	Average Annual Rate	Required Rate	Pace of Progress
Prevalence of underweight children under 5 years of age	34.5	34.0	29.9	30.8	32.0	30.6	26.9	24.6	17.3	-0.0179	-0.020	.8967
Percent of household with per capita energy less than 100% adequacy	…	…	69.4	…	…	…	56.9	…	34.7	-0.0180	-0.020	.9006

… - not available

Note:

Probability of Achieving the Goal:

Low: Pace of Progress is less than 0.5
Medium: Pace of Progress between 0.5 and 0.9
High: Pace of Progress is greater than 0.9

Source of basic data: National Nutrition Survey, Food and Nutrition Research Institute
Computations by the NSCB MDG Team.

Table 8. Proportion of underweight children among 0-5 year-old, by region: 2005

Region	% underweight
NCR	14.1
CAR	16.2
Region 1 (Ilocos)	26.4
Region 2 (Cagayan)	14.1
Region 3 (Central Luzon)	22.6
Region 4A (CALABARZON)	21.2
Region 4B (MIMAROPA)	30.1
Region 5 (Bicol)	22.0
Region 6 (Western Visayas)	30.0
Region 7 (Central Visayas)	23.7
Region 8 (Eastern Visayas)	32.2
Region 9 (Zamboanga)	35.2
Region 10 (Northern Mindanao)	14.7
Region 11 (Davao)	17.2
Region 12 (Soccskargen)	31.1
Region 13 (Caraga)	20.4
ARMM	23.5

Source: National Nutrition Survey, Food and Nutrition Research Institute

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