The Official Publication of Volunteer Youth Leaders for Health - Philippines

Wednesday, July 18, 2012

Good Nutrition and Advocacy towards Disability Prevention

Health Promotion Update No.1 – Series 2012
Ryan John Pascual*




There is a Latin saying, “Omne Trium Perfectum”, which means that everything coming in threes is perfect. True enough, there are three national events that are celebrated every July – two of which are mandated by law, while the third, also the most recent, started only in 2009. During this month, concerned national and local agencies are tasked to spearhead and coordinate the observance of the annual National Nutrition Month and National Disability Prevention and Rehabilitation Week. The third event  is the founding anniversary of a unique youth network for health advocacy and promotion, Volunteer Youth Leaders for Health-Philippines (VYLH-Philippines). Though instituted at different times and supporting different causes, it seems that these three events follow a distinct interrelationship.

The Triumvirate of Events.  First is the National Nutrition Month (1,2) which is mandated by Presidential Decree (P.D.) 491 (signed c. 1974). This decree mandates the dedication of July as Nutrition Month which was previously celebrated in March as Nutrition Week. The celebration aims to create awareness among the Filipinos on the importance of nutrition and a healthy lifestyle.

Second is the National Disability Prevention and Rehabilitation Week (3,4) which is celebrated annually every third week of July. The national event culminates with the commemoration of the birth of the sublime paralytic, Apolinario Mabini (July 17- 23) as provided by Presidential Proclamation 361 (s. 2000). The NDPRW is designed to increase the public’s awareness on the concerns and rights of disabled persons, as well as the prevention and treatments that can alleviate such conditions. 

The third is the Founding Anniversary of the Volunteer Youth Leaders for Health – Philippines. VYLH-Philippines is a network of school- and community-based leaders that is united and equipped with knowledge and skills in mobilizing the youth towards a healthy Philippines. The network was formally instituted on July 18, 2009 as a result of the shared commitment of the pioneer volunteer youth leaders, facilitators, The UPLB Genetics Society, the Institute of Human Genetics, NIH-UP Manila and the Department Health during the First National Youth Camp in Tagaytay City. The concerned agencies for each celebration are presented in Table 1. 




2012 Nutrition Month Theme.  This year’s Nutrition Month theme focuses on vegetables with the theme “Pagkain ng gulay ulagliin, araw-araw itong ihain”. One of the objectives of this campaign is to increase vegetable consumption as part of a healthy diet to address micronutrient deficiencies and non-communicable diseases. Aside from this, according to food consumption surveys, vegetable consumption among Filipinos had decrease in the past three decades. This has been attributed to the fast-paced lifestyle among Filipinos, and the rising preference to quick-serving restaurants and instant meals (2).

Click image to see the vegetable
consumption trend of Filipinos
(Reference: NNC)



Folate in Vegetables. Green, leafy vegetables and legumes contribute to the natural dietary sources of folate. Folate or Vitamin B9 is a water soluble vitamin which means it is not stored in the body, thus it must be replenished daily. Aside from promoting normal body functions such as cell division, folate has an important role in the development of the spine, brain and skull of the fetus which are developed during the first trimester of pregnancy – a period when many women are not aware that they are pregnant. During pregnancy, folate supports the expanding blood volume and rapidly growing fetal tissue within the womb (5). The recommended daily amount of folate is 400 micrograms (0.4 mg). Women with a previous child with neural tube defects are recommended to take 4000 micrograms (4mg).





In a listing of the commonly eaten vegetables among Filipinos by the NNC (2) and comparison of its folate content (5), only malunggay, sitaw and kangkong were found to have folate content greater than 100 micrograms (100μg) per 100 grams of edible portion. The rest ranged from 10-90 micrograms (Table 2).




Other than the 15 vegetables mentioned, there are other vegetables mentioned in the FNRI Dataset (5) that has a high amount of folate (per 100g edible portion). These include Garbanzo beans (Chickpeas), Munggo (Mungbean), Mani (Peanuts), Sunflower seeds, Spinach, Paayap (cowpea), Saluyot (jute), and talbos ng kamote (Sweet potato, young leaves and tops).

The Need for Supplementation. The folate content of vegetables were measured on their raw state. However, most of these vegetables are eaten after they are processed or cooked and food preparation methods (such as cooking) can lessen the folate content in food.

Folate content was also measured in every 100 grams of the edible portion. This means that a high amount of these vegetables is required in order to reach the recommended daily intake values.

Aside from these, maternal diets were also found to meet only one third (33.7%) of the recommended amount for folate (7).

In essence, these are the reasons why the intake or supplementation of folic acid is recommended, aside from dietary folate or the folate present in food. Folic acid is the synthetic counterpart of dietary folate, the natural B-vitamin. Taking the prescribed amount of folic acid through supplements is also the only proven way on preventing neural tube defects. Recent studies have also positively associated folic acid supplementation in the prevention of orofacial clefts (non-syndromic). 

Kalusugan ni Baby, Nagsisimula kay Mommy
(A newborn's health begins in the womb)
Disability Prevention begins in the Womb. Neural tube defects (NTDs) are serious defects of the brain and spine that occur during the first month of conception. These defects can cause serious lifelong complications, including death and paralysis. NTDs include anencephaly or the severe under development of the brain, enencephaly or the protrusion of brain tissue from an abnormal opening of the skin, and spina bifida or the incomplete closure of spinal column.

An important consideration on the occurrence of such defects is that these are PREVENTABLE. Studies have shown that the risks of defects in the formation of the brain and spine can be reduced up to 70% through proper diet and a steady intake of folate-rich foods and folic acid supplements, as early as a month a prior to conception. There are also findings that folic acid is also protective against heart defects, limb deformities, urologic anomalies, omphalocele (umbilical hernia), and orofacial clefts (cleft lip and/or cleft palate)(6).

In a 2003 study among pregnant women in Metro Manila, measurement of the RBC folate and serum folate levels have shown that 12.4% and 43.5% (from a total of 186 subjects) are folate deficient, respectively. In terms of the trimester of pregnancy, folate deficiency was higher among women in the first trimester than those in the second and third (7). This indicates that a significant number of women entered pregnancy with insufficient folate stores within their bodies. Vitamin supplementation might have contributed to the decrease in prevalence among those in the later stages of pregnancy.

Newborn Screening. Another VYLH-Philippines advocacy which is related to disability prevention is the campaign to increase the public’s awareness on newborn screening. Aside from becoming a simple standard newborn care procedure on detecting congenital metabolic disorders, NBS allows the prevention of mental retardation and death. It is important to note that children with these metabolic disorders look normal at birth. One will never know that the baby has the disorder until the onset of ill effects which are already irreversible, otherwise screened and treated. 

Other than this, not all families can fully-support the cost of supporting a child with severe intellectual disabilities due to mental retardation. Even the government has limited opportunities, facilities and support for such condition. Mental retardation may arise as a result of unscreened and untreated congenital hypothyroidism (CH) and phenylketonuria (PKU).

In relation to nutrition, one of the approaches in the management of patients with congenital metabolic disorders is the provision of specialized diets such as calculated protein diet and special milk formula for PKU and MSUD patients. At present, special formulated milk has provided by a pharmaceutical company to the Institute of Human Genetics of the National Institutes of Health-University of the Philippines Manila which manages its distribution to the patient families. 

The Role of Volunteer Youth Leaders. Volunteer Youth Leaders (VYLs) are committed in the promotion of the public’s awareness on the importance of folic acid supplementation in the prevention of neural tube defects, as well as on the value of newborn screening in saving babies from death and mental retardation.

VYLs are also tasked to orient, inform, organize and mobilize the Filipino youth towards these health concerns since these concerns occupy a small portion of the public’s consciousness. Weighing also their impact to the future generation of Filipinos, these health concerns (Folic acid supplementation and Newborn Screening) are pro-active and preventive interventions which outweigh the possibility of detrimental consequences such as infant death, dysmorphology, and disability (paralysis and mental retardation/ intellectual disabilities).

For more details about VYLH-Philippines and its advocacies kindly email vyl_philippines@yahoo.com or visit our online portals: our official blog, vylhphilippines.blogspot.com or our website, sites.google.com/site/vylhphilippines.

References:
(2)    2012 National Nutrition Month Talking Points. National Nutrition Counciln (NNC), Republic of the Philippines. http://www.nnc.gov.ph/information-materials/other-iec-materials/other-iec-materials/doc_download/635-nutrition-month-2012-talking-points
(3)    34th NDPRW. National Council for Disability Affairs, Republic of the Philippines. http://www.ncda.gov.ph/2012/05/34th-national-disability-prevention-and-rehabilitation-ndpr-week-celebration/
(4)    Presidential Proclamation 361. NCDA, Republic of the Philippines. http://www.ncda.gov.ph/disability-laws/proclamations/proclamation-no-361/
(5)    Food and Nutrition Research Institute (FNRI-DOST). 2010. Folate Content of Foods Consumed by Filipinos. 70 pp.
(6)    Philippine Pediatric Society Policy Statements. The Role of Folic Acid in the Prevention of Neural Tube Defects. Series 2004. Vol. 1 No. 3.
(7)    Cheong R, Madriaga J, Desnacido J, Marcos J, Perlas L. Food and Nutrition Research Institute- Department of Science and technology (FNRI-DOST). 2003. Assessment of folate status of some pregnant Filipino women.

___________________
*Ryan John Pascual(ryanjohnpascual@gmail.com)  is an alumnus and the former Folic Acid Campaign Committee Head (VYLH-Philippines Committee) and Education Committee Head of The UPLB Genetics Society. He graduated with a BS Biology (Major in Plant Biology) degree in UP Los Baños. Ryan is currently a graduate student and scholar at the Institute of Biology, University of the Philippines-Diliman. He is also the first National President of VYLH-Philippines which he held during the year 2011-2012.
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