salad bowl of the pacific – yet the double burden profav workshop nadi, fiji 20-23 october 2014...
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Salad Bowl of the Pacific Salad Bowl of the Pacific – Yet the Double Burden– Yet the Double Burden
PROFAV Workshop
Nadi, Fiji
20-23 October 2014
Ateca Kama
NFNC, MoHMS Fiji
Fiji
Pop 837,27118,333 sq km2 major islands333 islands
Introduction Abundance of fruits and vegetables
MPI estimates Yet beset with serious but preventable nutrition-
related diseasesBurden the economy with excessive medical costsSignificant loss of human development potential and
work productivityMajor cause of preventable NCDs, in particular
childhood obesity and nutrient deficiency diseases – change to poorer quality diet and lifestyle
4
Low birth weight (LBW)(Birth weight <2,500g)
Higher incidence of LBW amongst Indo-Fijian children
7.7
18.8
10.2
0
2
4
6
8
10
12
14
16
18
20
Pe
rc
en
t
Fijians Indo-Fijians ALL
5
UnderweightHigh rate of underweight amongst Indo-fijian children
3.9 3.7
15.9
28.8
7.1
11.5
0
5
10
15
20
25
30
Pe
rc
en
ta
ge
s
Fijians Indo-Fijians All
0-4 years
5-9 years
6
Growth FalteringGrowth faltering amongst Fijian children
75
80
85
90
95
100
105
110
115
120
125
130
135
140
145
Atbirth
0-2m 3-5m 6-8m 9-11m 12-23m 24-59m 5-9y 10-14y 15-17y
Age (months/years)
% o
f th
e N
CH
S M
ed
ian
Fijians NCHS Indo-Fijians
Overweight and Obesity(Overweight: BMI 25-29.9, Obese: BMI ≥30)
56% of the population surveyed was overweight and obese. Underweight
6.1%
Normal37.6%
Overweight32.3%
Obese23.9%
Source: NNS 2004
Anaemia(Under 5 years: Haemoglobin <11g/dl)
High rates of anaemia in children <5 years.
58.8
78.8
6468.3
40.2
51.5
25
40.4
22.1
29.9
0
10
20
30
40
50
60
70
80
Percentages
6-11m 12-23m 24-35m 36-47m 48-59m
Months
19932004
Source: NNS 2004
9
Iron Deficiency in Women(Serum Ferritin = <15µg/L)
11.5
43
23
0
5
10
15
20
25
30
35
40
45
Pe
rc
en
ta
ge
s
Fijians Indo-Fijians All Women
Anaemia in Women and Men
(Haemoglobin = Women <12g/dl, Men <13g/dl)
Higher rates in women especially Indo-Fijian women.
33
51
40
2118
21
0
10
20
30
40
50
60
Pe
rce
nta
ge
s
Women Men
Fijians
Indo-Fijians
All
Source: NNS 2004
11
Vitamin A Deficiency (Serum Retinol = <30µg/dl)
Rates are higher in Indo-Fijian Women
8
21
13
0
5
10
15
20
25
Pe
rc
en
ta
ge
s
Fijians Indo-Fijians All
Changes in Dietary PatternTraditional diets have evolved in the past decade
More prominent amongst iTaukei than Indo-fijiansShifted from traditional dalo to more cheaper cassava
and rice, bread and biscuitsIntake of animal protein has increased substantially
compared to fishFood choice determined mainly by
Value for moneyEase of preparationPersonal preference
ACIAR Report 2002
Nutrition TransitionThe dietary changes observed in the 2004 NNS
typify the “nutrition transition” that included both quantitative and qualitative changes (WHO, 2003)
The adverse changes include:shifts in the diet towards a higher energy density with
more fat and sugary foodsgreater saturated fat (from animal sources)reduced consumption of complex carbohydrates and
dietary fibrereduced fruit and vegetable consumption
The dietary pattern found in the 2004 is consistent with the diet characteristic of nutrition transition
FBS TrendsA total of 3,421 kilocalories/capita/day
54% in excess of the FAO nutrient requirement YET 47% of population is unable to meet minimum Energy requirement
Total nutrient availability showed a steady increase over the years1985 - 2,819 kcals1995 - 2,939 kcals2005 - 3,663 kcals
Calories from imported foods have increased2006 - 51%2007 - 62%2008 - 69%
High importation of sugar, cereals, oil and butter
Import dependent Source: FBS 2009
Other TrendsLow consumption of:
Vegetables and fruits - 25% Green leafy vegetables - 21%
Exclusive Breastfeeding - 40%Major sources of:
Fat - vegetable and meatCholesterol - fish and seafoodSugar - consumed >2 times/day
Anaemia in Women of Child Bearing AgeNNS 2004 - 40%; IS Iron Fortified Flour 2010 - 28%
Anaemia in Children <5 yearsNNS 2004 - 50%; MNS 2008 - 37% Source: NNS 2004
OPIC Study - FruitsConsumption of fruits amongst Fijian
adolescents 59% iTaukei consume 1 or less serve/day68% Indo-fijians consumed 1or less serve/day6% iTaukei consumed > 4 serves/day3% Indo-fijians consumed > 4 serves/day
Frequency of fruit consumption after school higher in males than females.
OPIC Study - VegetablesConsumption of vegetables amongst Fijian
adolescents 42% iTaukei eat 1or less serve per day47% Indo-fijians eat 1or less serve per day39% males eat 1 or less serve per day48% females eat 1 or less serve per day
Fruit availability at home more for Indo-fijians than iTaukei
NCD STEP SurveyFiji has now repeated its second NCD STEPS
survey (in adults), and the findings indicate that the underlying causes and risk factors of these diseases have greatly increased (from 2002 to 2011).Overweight increased from 23.6% to 32.1%Consumption of fruits and vegetables - very low
1.2 % Males and 0.6% Females - consume 5 or more servings of fruits/day
26.4% eat less than 1 serving of vegetables/day 2.9% Males and 2.2% Females - consume 5 or more
servings of fruit and vegetables per day NCD STEP 2002
19
<1 serving per day
1 serving per day
2-4 servings per day
5+ servings per day
Servings of fruits
0 10 20 30 40 50 60 70
Percentage
Value Chain StudyApplicability of VC approaches to address low FV
consumption in FijiIdentify strength, limitations and potential to inform
PH action to increase FV intakeAmaranthus, Papaya and TomatoesPrice and Quality important to food choiceQuality - taste, appearance, perceived health
properties, freshness and convenienceBarriers to consumption - inconsistent availability
and high prices
VC Study Challenges
Access to agricultural input, limited transportation and market infrastructure
Consumers driven by price, so focus on cost-minimization rather than value-addition
Farmers received little information on supply and demand trends
High vulnerability to natural disasters impaired the delivery of consumer-defined value
Findings identified opportunities to enhance FV availability, affordability and acceptability by promoting the qualities of FV that consumers value
Government EffortICN 1 Recommendations
National Plans of Action for NutritionBula 5:30 Campaign
5 servings of fruits and vegetables30 minutes of physical activity
Fiji Food and Nutrition Policy 20089 policy areas
Fiji Plan of Action for Nutrition 2010-2014Programs and Activities
SHC Plan for Fruits and VegetablesGreen Growth Framework
Food Security
Policies, Regulations and SPsPolicies:
Food and Nutrition Policy 2008 Fiji Plan of Action for Nutrition 2010-14 Food and Health Guidelines
National Baby Friendly Hospital Initiative [BFHI] PolicyRegulations:
Marketing Controls - Foods for Infants and Young Children
The Advertising and Promotion of Unhealthy Foods and Non Alcoholic Beverages to Children
Strategic Plans NCD, IYCF, FPAN, MOH, Government, Agencies
FPAN 2010-20141. Advocate nutritional issues and mainstreaming into the
Government decision-making systems
2. Promote and sustain household food security
3. Improve national nutrition status
4. Protect consumers through quality and safety of food and water
5. Improve nutritional status of the socio-economically disadvantaged and the nutritionally vulnerable
6. Nutrition policy for schools
7. Promote healthy diets and lifestyles
8. Establish and promote nutrition surveillance and monitoring system
9. Strengthen collaboration with development partners
Oversight of the FPAN Steering Committee
Evaluation The Fiji Plan of Action for Nutrition 2010-2014 will be
evaluated though the National Nutrition Survey 2014Effect of the nutrition intervention strategies
contained in FPANDetermine whether the strategies have had impact
on the nutritional health of Fiji’s populationFindings will be used to inform future evidence
informed policies, surveillance and nutrition interventionsFiji Food and Nutrition Policy 2015Fiji Plan of Action for Nutrition 2016-2020NCD Strategic Plan 2015-2019
