NCD – Risk and Malaysian Food Habits

transformation

Emeritus Prof. Dr Mohd Ismail Noor PhD, FASc, FIUNS

School of Hospitality, Tourism and Culinary Arts,

Taylor’s University, Malaysia

International Seminar on “Food, Risks and Sustainability: An Asian Perspective

The Hong Kong Polytechnic University, 6-7 July 2015

2

3

Situation in Malaysia

WHO, 2014

Prevalence of Diabetes (1996-2011)

Feisul Idzwan Mustapha (2013) NCDs: Issues and Challenges. NSPNCD 2013

Burden on Diabetes in Malaysia –

Trends and Projection by 2020

Tahir A& Noor Ani A (2011), NCDs in Malaysia – A Rising Trend. National Health and Morbidity Survey 2011. Conference on

Non-Communicable Diseases (NCDs) 26-27 March 2013

Prevalence of Hypercholesterolaemia

(2006 & 2011)

Total

Known

Undiagnosed

Feisul Idzwan Mustapha (2013) NCDs: Issues and Challenges. NSPNCD 2013

Burden on Hypercholesterolaemia in

Malaysia – Trends and Projection by 2020

Tahir A & Noor Ani A (2011), NCDs in Malaysia – A Rising Trend. National Health and Morbidity Survey 2011. Conference on

Non-Communicable Diseases (NCDs) 26-27 March 2013

Tahir A& Noor Ani A (2011), NCDs in Malaysia – A Rising Trend. National Health and Morbidity Survey 2011. Conference on

Non-Communicable Diseases (NCDs) 26-27 March 2013

Burden on Hypertension in Malaysia – Trends

and Projection by 2020

National Strategic Plan for Non-Communicable Diseases

(NSP-NCD) 2010-2014

• Presented and approved by the Cabinet on

17 December 2010.

• Provides the framework for strengthening

NCD prevention & control program in

Malaysia.

• Adopts the “whole-of-government” and

“whole-of-society approach”.

• Diabetes & obesity are used as the entry

points.

Seven Strategies:1. Prevention and

Promotion

2. Clinical Management

3. Increasing Patient

Compliance

4. Action with NGOs,

Professional Bodies &

Other Stakeholders

5. Monitoring, Research

and Surveillance

6. Capacity Building

7. Policy and Regulatory

interventions

10

Premature Mortality due to NCDs 2000-2012

for Malaysian Males & Females

Feisul Idzwan Mustapha (2014) Increasing Burden of NCD in Malaysia: Challenges in Resource Allocation. NSPNCD 2014

THE MAIN CAUSAL FACTORS: UNHEALTHY DIET

AND SEDENTARY LIFESTYLE

Why focus on Diet?

Diet Related NCDs

Deaths

Non-Diet Related

NCDs Deaths

Non-NCD

Related Deaths

Because >50% deaths are related to diet!

WHO, 2014

Available calories for various food in Malaysia

20

510

60

53

28

245

4

15

731

383

372

45

41

280

8

82

3

103

7

4

1167

324

202

18

0 200 400 600 800 1000 1200 1400

Animal fat

Animal product

Cereal

Fruit

Marine fish

Meat

Oat

Potato

Rice

Sugar &sweetener

Vegetable oil

Vegetable

1969 kcal/d 2009 kcal/d

FAO 2013. Food and Agricultural Organization of the United Nations. Food balance sheets. Available at

http://faostat3.fao.org/home/index.html#DOWNLOAD. Accessed July 2013.

USA

Adapted from Bray & Popkin, AJCN

1998; 68: 1157-1173 with data from FAO

2005, CFNI and recent national surveys

Dietary fat + sugar induce weight gain:

Malaysian fat intakes up 80% and sugar up by 33%

from the early 1960s

Obesity epidemic is inevitable unless

policies to reduce intakes substantially

from fat & sugar with spontaneous

increases in activity are introduced now

Perc

en

tag

e B

MI

>25.0

80

60

50

40

30

20

10

70

Dietary Fat (%) 20 25 30 35 40

Kuwait

Morocco

Mali

China 1982

India Congo

Tunisia

Malaysia Australia

New Caledonia

ItalyBrazilCuba

S. Africa

r = 0.88

Barbados

Guyana

Trinidad & Tobago

Jamaica

+ 20% sugarRussia

Philippines

Kyrgyzstan

Fat and sugar - major increases

Eating out: Meals

Meals only

Breakfast

And or Lunch

And/or Diner

12,5

% on Meals

% on Individuals

64.1 % of the Malaysian individuals eat at least one meal per day outside of the home

12.5 % of individuals eating only at home have at least one meal that comes from outside

Eating out

Eating at home with meals coming from outside

Eating at home

46.12

7.72

10,25

53.88

Prof. JP Poulain – FBS Taylors University 2014

Fast food industries in Malaysia – a selected list (2000)

Brand Year No. of Market Sales

(origin) (Est) Outlets Share (%) (RM million)

KFC (USA) 1973 294/580* 45 578.7

Mc Donald’s (USA) 1982 141/265* 30 349.6

Pizza Hut’s (USA) 1984 85 8 120.0

A & W (USA) 1961 44 4 47.8

Marry Brown (Local) 1981 88 4 NA

Sugar Bun (Local) 1981 45 * 36.1

(1999)

Kenny Roger (USA) 1994 25 * 36.1

Domino’s Pizza (USA) 1997 17 * NA

*Others combined 9%

Source: EDGE publication (2000)

*Figures found in the website for 2013-2014.

No date on other outlets, very likely it has

increased too!

Malaysia is A Food Haven!

Most Malaysian foods are

delicious but unhealthy!

Holistic Approach of Health through Food

2 stages

Stage 1: Transformation of food into healthier

products through the incorporation of functional/

healthy food ingredients and nutraceuticals

Stage 2: Utilize new technology eg. genomics to

allow us to assess the individual’s risk to

diseases

Healthy/ Functional Food Ingredients

Healthier Food Products

Stage 1: Transformation

• Use Healthy Choice oils/ fats

• Reduce caloric level from oils/ fats

• Add high fibre food ingredients

• Use whole grains

• Reduce sugar

• Use ingredients with low glycaemic index

• Improve protein content

• Reduce Sodium

Holistic Approach to Health through

Food

Approach Benefits Ingredients

Increase fibre Reduce prevalence of

colon cancer

Soy Fibre, Soy Flour, Lupin

Fibre, Lupin Flour, Oat,

Wheat Bran, Wholemeal

Wheat Flour, Pea Fibre

Balance Fatty Acid

(1SFA:1MUFA:1PUFA)

Reduce risk of heart disease Balanced Fatty Acid Oil/ Fat

Lower Glycaemic

Index

Reduce risk of diabetes Soy Fibre, Soy Flour, Lupin

Fibre, Lupin Flour, Oat,

Wheat Bran, Wholemeal

Wheat Flour, Pea Flour

Increase the use of

legumes/ lentils

protein

Reduce risk of heart

diseases and cancer

Soy Flour, Lupin Flour, Pea

Flour

Adding of

nutraceuticals

Prevent various diseases LingZhi, Cordyceps,

ginseng, flax seed, fish oil,

garlic etc

Stage 2 - Holistic Approach to

Health through Food

• Changes in eating habits can have big impact on public

health

• However, the problem there is no existing method that

can reliably predict the individual risk to any disease

• New genomics test can measure an individual’s risk to

disease and therefore allow researchers to test

effectiveness of food and nutraceuticals

Food groups Examples

Minimally processed foodsfruits, vegetables, grains, nuts, roots, milk, meat

Processed culinary ingredientsplant oils, butter, sugar, salt

Processed foodscanned foods, breads, cheese

Ultra-processed foodssoft drinks, sweet/savory snacks, fast meals

Moubarac et al Food classification systems based on food processing. Curr Obes Rep 2014 3: 256-273; Monteiro et al Ultra-processing and a new classification of foods. In: Neff R (ed) Introduction to U.S. Food System. San Francisco:Jossey Bass A Wiley Brand; 2015.

NOVA: A food classification based on extent and purpose of industrialprocessing

Ultra-processed foods are designed todisplace fresh foods and freshly prepared meals

7 810

13 14

18 19 20 20

25 27 28

3335 35 36 37

40 41

46 46

5153

55

0

10

20

30

40

50

% 60

FRA

NC

E1

991

ITA

LY 1

996

PO

RTU

GA

L2

00

0

PER

U2

009

GR

EEC

E2

002

CR

OA

TIA

200

4

CO

LOM

BIA

20

06

CY

PR

US

200

3

SPA

IN1

999

BR

AZI

L2

00

8

SLO

VA

KIA

20

03

MA

LTA

200

0

LATV

IA2

004

BEL

GIU

M1

99

9

AU

STR

IA1

999

UR

UG

UA

Y 2

00

6

NO

RW

AY

19

98

MEX

ICO

20

10

FIN

LAN

D 1

99

8

IREL

AN

D1

999

GER

MA

NY

19

98

UK

2008

CH

ILE

200

7

CA

NA

DA

200

1

The share of ultra-processed foods (% of energy) in national food baskets (1991-2010)

* Estimated from national household food expenditure surveys for Brazil (HBS), Canada (FOODEX), Chile (EPF), Colombia(ENIG), Peru (ENAPREF) Mexico (ENIGH), Uruguay (EGIH), and the Data Food Networking (DAFNE) for all Europeancountries, except UK (LCF).

NCD Research in Malaysia: Summary

• We know what needs to be done for the prevention and

control of NCD.

• What we do not know is how best to implement in real

life situations and within the socio-cultural context of

Malaysia.

– Implementation-type research, including

behavioural (qualitative research) can provide

evidence in answering this question.

• Multisectoral approach, not only in

implementation but in research as well.

26

Framework

------------------

Cluster for

Research

Initiative in

Food,

Nutrition

and Public

Health CRI-

FNPH)

Food, Nutrition and

Health Security

Social Sciences & Anthropology

Public Health Nutrition Food Science & Technology

Cluster for Research Initiative in Food, Nutrition

& Public Health

Research Area

- Food processing - Food products

development - Diet Formulation

- Food composition and nutrition profiling

- Functional foods - Organic food - Food safety

- Food economics - Food policy

Research Area

- Food and beverage consumption patterns

- Nutritional status of population

- Disordered eating habits - Diabetes, Obesity and

body composition - Body image

- Energy requirements - Physical activity

- Pharmaceutical diet - Use of supplements - Nutrition education

- Nutrition policy

Research Area

- Epidemiological studies - Health care system - Health promotion

- Disease prevention (e.g NCDs)

- Economic burden of disease

- Public health policy

Research Area

- Social food behaviour (Interactions, conviviality,

commensality) - Eating out & eating

decisions - Food cultures

- Acceptability of food innovation by different

communities - Social representations

and perception of risk - Food anthropology

- Consumer behaviour - Consumer experiences

- Perception on risks - Food marketing plans

Taylors’s University

(May 2015)

We face an

“UPHILL”

Battle

The Lancet Obesity, February 2015

Healthier Choice Logo Program

FEDERATION OF MALAYSIAN MANUFACTURERS

MALAYSIAN FOOD MANUFACTURING GROUP

(FMM MAFMAG)

31

Source of icons: World Heart Federation Champion Advocates Programme

Global NCD

Targets

2014 UN Outcome Document on NCDs(resolution A/RES/68/300)

• Bottom line: Governments committed themselves to intensify their efforts towards a world free of the avoidable burden of NCDs

• Moving forward: Maps out a set of concrete national commitments to be implemented between 2014 and 2018, and provides 3 new global assignments

• Towards the world we want: Next milestone in 2018

Policy Options on Food and Physical Activity to Combat Obesity in Malaysia

Presented by

Mohd Ismail Noor PhD, FASc, FIUNS

On behalf of the

TASK FORCE TO COMBAT OBESITY IN MALAYSIA

to

HE Minister of Health, Malaysia

11 June 2015

Ministry of Health

Malaysia

No Policy Options Task Force Proposal

1. Restrict the number of new food outlets

including 24 hours food outlets within 400

metres radius.

Implement the

proposed policy

options

2. Subsidies for fruits and vegetables.

3. Mandatory to display nutrition information

for all vending machines.

4. Reduce import duty on fruits and

vegetables.

5. Restrict serving size/refilling/value meals in

fast food outlets.

(Intensive discussion with six fast food

industries until December, 2014)

Star, 22 June

2015

STAR 26 June 2015

MALAYSIA BOLEH!!!

(A “Political Will” that MALYSIA can do without and ill-afford!)

Prof Ismail, President MASO

Sunday STAR, 28 June 2015

Obesity is one of the top three global social burden generated by human being

Estimated annual global direct economic impact and investment to mitigate selected global burdens, 20121

0.1

0.3

0.3

0.4

0.4

0.7

0.7

0.9

1.0

1.3

1.4

2.0

2.1

2.1

0.0 0.5 1.0 1.5 2.0 2.5

Poor water and sanitation7

Unsafe sex6

Child and maternal undernutrition

Household air pollution

Workplace risks

Road accidents

Drug use5

Outside air pollution

Climate change

Illiteracy4

Alcoholism

Obesity

Armed violence, war and terrorism3

Smoking

Share of

global

GDP %

Historical

Trend2

2.9

2.8

2.8

2.0

1.7

1.3

1.3

1.0

1.0

0.6

0.5

0.5

0.4

0.1

Source: WHO Global Burden of Disease database - McKinsey Global Institute Analysis (2014)

1. Based on 2010 disability-adjusted life years (DALY) data from Global Burden of Disease database and 2012 economic indicators from the World Bank;

excluding associated revenue or taxes; including lost productivity due to disability and death, direct cost, e.g., for health care, and direct investment to

mitigate; GDP data on purchasing power parity basis.

2. Based on historical development between 1990 and 2010 of total global DALYs lost (Global Burden of Disease).

3. Includes military budget.

4. Includes functional literacy.

5. Includes associated crime & imprisonment.

6. Includes sexually transmitted diseases. Excludes unwanted pregnancies.

7. Excludes lost time to access clean water source.

GDP, $ trillion

The Threat!

Thank You