Understanding the status of the Philippine food system is vital in identifying pathways to improve sustainable nutrition security in the country. In the present study, we quantitatively examined the sustainability status of the Philippine food system using the Sustainable Nutrition Security (SNS) metrics. The country’s food system obtained low scores for resilience, food nutrient adequacy, ecosystem stability, and food safety, while better scores were obtained for sociocultural wellbeing, food affordability and availability, and waste and loss reduction. The Philippine food production and supply face important challenges in diversification, coupled with socioeconomic disparities. Potential convergence points among relevant stakeholders were identified to improve the diversity of the food supply chain and to develop the overall resilience of the Philippine food system.

Background. Zinc is now recommended as part of childhood diarrhea case management but there are concerns regarding treatment duration and perceptions of its use when given with ORT.Objectives. This study developed and tested messages on zinc supplementation for childhood diarrhea.Methods. Messages were based on 1) a review of literature and product advertisements, 2) drugstore seller interviews, and 3) focus group discussions (FGDs) among 10 mothers with children six to 59 months old. Subsequent FGDs with 15 mothers consulting at a government hospital helped determine message clarity, comprehension and appeal. A behavioral trial, involving nine mothers whose children had diarrhea, tested recall of and adherence to the messages.Results. The trial tested three messages—Zinc: 1) strengthens resistance; 2) is a vitamin for the gut; 3) increases the appetite of a child with diarrhea. Seven of nine mothers were able to follow instructions on zinc administration, and demonstrated recall and understanding of these messages. Mothers understood that zinc helps the child with diarrhea, improves appetite, reduces symptoms and hastens recovery, but had concerns regarding the side effects (vomiting), co-morbidities (fever, cough) andconsequences of overdose. Standardized counseling cards addressed these concerns. Respondents preferred a simple logo labeled “zinc” with zinc administration instructions on the packaging. Zinc supplementation did not affect ORT use. Conclusion and Recommendations. Messages sufficiently addressed mothers’ concerns on zinc use during childhood diarrhea, with those on zinc improving “resistance” and as a “vitamin for the gut” having the best recall. Results can contribute to zinc’s introduction and promotion in the public sector.

In the Philippines, there is little documentation about the population size of indigenous peoples (IPs) and more so on their health and nutrition status. This study aimed to address the gap in knowledge on the IPs’ nutrition and health status in the Philippines. Analysis of secondary data collected in the 8th National Nutrition Survey (NNS) 2013 and the 2015 Updating Survey of the Nutritional Status of Filipino Children and Other Population Groups conducted by the Department of Science and Technology–Food and Nutrition Research Institute (DOST-FNRI) was done. Face-to-face interviews, anthropometric measurements, blood extraction, urine collection, and blood pressure measurements were utilized as data collection methods. Findings illustrate that majority of the IPs belonged to the poorest and poor quintile, had low educational attainment, and were rural residents. The pervasive problem of undernutrition in the form of stunting and underweight was the most pronounced problem among children and adolescents. Overnutrition was prevalent among adults. Micronutrient deficiencies also exist in the form of anemia and iodine deficiency. There is also evidence of inadequate dietary consumption among the IPs. As evidenced by the results – compared with the non-IP individuals and households – the IP population was poorer, had a significantly higher prevalence of undernutrition and iodine deficiency, and had lower adequacy of energy and other nutrient intakes. On the other hand, the selected risk factors for non-communicable diseases such as hypertension, abdominal obesity, smoking, and alcohol consumption were more pronounced among non-IPs compared to the IPs. IPs remain a marginalized sector of society, making them highly vulnerable to the same persistent nutritional and health problems non-IPs experience. Therefore, culturally sensitive and appropriate interventions should be formulated to improve IPs’ nutrition and health status in the country.

Milled rice is an essential part of the regular diet for approximately half of the world's population. Its remarkable commercial value and consumer acceptance are mostly due to its promising cooking qualities, appealing sensory properties, and longer shelf life. However, the significant loss of the nutrient-rich bran layer during milling makes it less nutritious than the whole grain. Thus, enhancing the nutritive value of milled rice is vital in improving the health and wellbeing of rice consumers, particularly for those residing in the low-economic zones where rice is the primary source of calories and nutrition. This article provides a critical review on multiple frontiers of recent interventions, such as (1) infusing the genetic diversity to enrich amylose and resistant starch to reduce glycaemic index, (2) enhancing the minerals and vitamins through complementary fortification and biofortification as short and long-term interventions, and (3) developing transgenic solutions to improve the nutrient levels of milled rice. Additionally, the review highlights the benefits of functional ingredients of milled rice to human health and the potential of enhancing them in rice to address the triple burden of malnutrition. The potential merit of milled rice concerning food safety is also reviewed in this article.

This study aimed to determine the sociodemographic, socioeconomic, and climate change-related factors associated with meeting recommended energy intake (REI) among Filipino households. This paper utilized data from selected components of the 2013 National Nutrition Survey (NNS) and 2015 Updating Survey of the Department of Science and Technology – Food and Nutrition Research Institute (DOST-FNRI), typhoon/flood occurrence from online reports of the National Disaster Risk Reduction and Management Council (NDRRMC) and drought data for the first quarter (Q1) of 2015 from the Philippine Rice Information System (PRiSM) of the International Rice Research Institute (IRRI). Multiple logistic regression using the backward elimination method was done and post-estimation tests were applied to the final model. Filipino households with more than three members were food insecure and were poor were less likely to meet the REI. On the other hand, households engaged in agricultural work, having a member working abroad, residing in rural areas, and shorter time lag exposure to typhoons/floods were more likely to meet REI. Filipino households in Mindanao, meanwhile, were less likely to meet REI if they had more than three members and were food insecure and more likely to meet REI if they were engaged in agricultural work. The study provides a snapshot of a seemingly minute but significant facet of the health and nutrition situation in the Philippines, which is meeting the REI at the household level in relation to exposure to extreme weather events such as typhoons, floods, and drought brought about by climate change. The results of the study may provide vital inputs to climate change adaptation programs of the government for vulnerable population groups, particularly among farming- and fishing-dependent households who will likely absorb the long-term impact of the extreme weather events to their livelihoods.

Paddy rice cropping systems are largely intensive with widespread use of modern high yielding varieties, fertilizers, and agrochemicals, mostly characterized by rice monocropping, particularly when irrigated. Food provisioning is the most obvious ecosystem service derived from rice farming, but rice farming is also a way of life, particularly in Asia where 90% of rice is produced. Rice farming has been in existence for a long time and is an integral part of cultural traditions globally and is celebrated through different sociocultural festivities and forms part of societal cultural identities. Being semiaquatic, rice fields provide a habitat for a diverse assemblage of fauna and flora. The unique characteristics of paddy soils enable them to sustain intensive rice production and regulate the biogeochemical nutrient cycling. Paddy soils contribute about 11% of the greenhouse gas emissions in agriculture, largely through methane, but also sequester significant amounts of carbon, contributing to mitigation of the emissions. Nonetheless, paddy rice systems offer a range of ecosystem services that vary with growth stages and management practices.

Reliably generating rice varieties with low glycaemic index (GI) is an important nutritional intervention given the high rates of Type II diabetes incidences in Asia where rice is staple diet. We integrated a genome-wide association study (GWAS) with a transcriptome-wide association study (TWAS) to determine the genetic basis of the GI in rice. GWAS utilized 305 re-sequenced diverse indica panel comprising ~2.4 million single nucleotide polymorphisms (SNPs) enriched in genic regions. A novel association signal was detected at a synonymous SNP in exon 2 of LOC_Os05g03600 for intermediate-to-high GI phenotypic variation. Another major hotspot region was predicted for contributing intermediate-to-high GI variation, involves 26 genes on chromosome 6 (GI6.1). These set of genes included GBSSI, two hydrolase genes, genes involved in signalling and chromatin modification. The TWAS and methylome sequencing data revealed cis-acting functionally relevant genetic variants with differential methylation patterns in the hot spot GI6.1 region, narrowing the target to 13 genes. Conversely, the promoter region of GBSSI and its alternative splicing allele (G allele of Wxa ) explained the intermediate-to-high GI variation. A SNP (C˃T) at exon-10 was also highlighted in the preceding analyses to influence final viscosity (FV), which is independent of amylose content/GI. The low GI line with GC haplotype confirmed soft texture, while other two low GI lines with GT haplotype were characterized as hard and cohesive. The low GI lines were further confirmed through clinical in vivo studies. Gene regulatory network analysis highlighted the role of the non-starch polysaccharide pathway in lowering GI.

1Nutritional Assessment and Monitoring Division, Department of Science and Technology Food and Nutrition Research Institute, Taguig City, Metro Manila 1631 Philippines 2International Rice Research Institute (IRRI), University of the Philippines Los Baños, Laguna 4031 Philippines Charmaine A. Duante1*, Jay Lord Q. Canag1, Chona F. Patalen1, Rovea Ernazelle G. Austria1, and Cecilia Cristina S. Acuin2

Iron (Fe) and zinc (Zn) deficiency constitute a major micronutrient deficiency around the globe, affecting rural populations residing in developing countries with minimum purchasing power and/or access to a diverse diet. Biofortification, the enrichment of staple food/crops with bioavailable micronutrients or vitamins in their edible parts, provides a potential sustainable solution towards such issues, in combination with other existing efforts. Utilisation of rice as a platform for the delivery of products biofortified with Fe and Zn could impact greatly the livelihood of people dependent on rice-based agri-food systems globally. The HarvestPlus and its partners have successfully supported the production, deployment and release of conventionally bred Zn-biofortified lines of rice and wheat in several countries; and also support potential innovative approaches such as genetic engineering and genome editing with higher Fe and Zn content in the grain. A large number of reviews on iron biofortification in rice has been published, in this review we summarise the Fe biofortification by transgenic approaches, but the major focus of this review is on the conventional and transgenic breeding efforts to generate Zn-biofortified lines in rice and discuss their potential to contribute in eradicating Zn deficiency, by examining bioavailability aspects, as well as the retention of Zn content in rice grains after cooking. We additionally examine the importance of a clear pathway for the successful delivery and large-scale adoption of high-Zn rice to achieve maximum impact.

The Philippines is one of the major rice-producing and rice-consuming countries of Asia. A large portion of its population depends on rice for their daily caloric intake and nutritional needs. The lack of dietary diversity among poor communities has led to nutritional consequences, particularly micronutrient deficiencies. Iron-deficiency anemia (IDA) and zinc deficiency (ZnD) are two serious nutritional problems that affect the health and economic sector of the country. Since rice dominates the Filipino diet by default, biofortification of rice will help improve the micronutrient status. The Philippine government has proactively initiated various programs and policies to address micronutrient deficiencies, particularly through fortification of basic food commodities. Biofortification, the fortification of rice with micronutrients through breeding, is considered the most sustainable and cost-effective strategy that can benefit large vulnerable populations. However, developing promising genotypes with micronutrient-enriched grains should be coupled with improving micronutrient bioavailability in the soil in order to optimize biofortification. This review documents the prevailing soil Zn-deficiency problems in the major rice production areas in the Philippines that may influence the Zn nutritional status of the population. The article also reports on the biofortification efforts that have resulted in the development of two biofortified varieties approved for commercial release in the Philippines. As nutritional security is increasingly recognized as a priority area, greater efforts are required to develop biofortified rice varieties that suit both farmers' and consumers' preferences, and that can address these critical needs for human health in a sustainable and cost-effective manner.

Among children under the age of five, those aged 6-23 months are at a greater risk to suffer from malnutrition. Introduction of appropriate and safe foods to infants at the age of six months is recommended (WHO 2002) to meet evolving nutritional requirements for optimal growth, development, and good health (Ogbo et al. 2015). This secondary, cross sectional study using data from the 8th National Nutrition Survey in 2013 aimed to identify the determinants of meeting the minimum acceptable diet (MAD) among children 6-23 months and at age groups 6-11 mo, 12-17 mo, and 18-23 mo in the Philippines. Child, maternal, and household characteristics were examined in terms of their association with meeting the MAD using bivariate and multiple logistic regression analyses with a 5% level of significance (α=0.05). The final model showed that among children 6-23 mo, having a mother with more than three children (AOR=1.60) and being in the middle wealth quintile (AOR=1.88) had greater odds of meeting the MAD than those having a mother with at least three children and those in the poorest quintile, respectively. Children having more than five family members had lower odds (AOR=0.64) of meeting the MAD compared with less than five members. Among children 6-11 mo, those with more than five family members were more likely (AOR=5.32) to meet the MAD. Among 12-17 mo, children with non-working mothers (AOR=3.01) and those belonging to the rich wealth quintile (AOR=2.86) were more likely to meet the MAD while those with more than five family members were less likely (AOR=0.49) to meet the MAD. Children with low birth weight among 18-23 mo children had lower odds (AOR=0.47) of meeting the MAD. Working mothers, those from poorer quintiles, and those with more than five household members need to be specifically targeted for interventions that promote and encourage child feeding practices that meet the MAD. Philippine Journal of Science 147 (1): 75-89, March 2018 ISSN 0031 7683 Date Received: 23 Feb 2017

Early initiation of breastfeeding, defined as breastfeeding within 1 h after delivery, ensures that the child will receive its first protection from the immunoglobulins found in colostrum.It also helps establish exclusive breastfeeding which is the optimal feeding practice for infants from birth to 6 months.The study aimed to identify the variables of breastfeeding initiation among Filipino children aged 0-23 months and to associate child's breastfeeding initiation with the child's breastfeeding practice during the first two years of life.The study was a cross-sectional analysis of the 8 th National Nutrition Survey (NNS) collected in 2013 which included a national data of 4,960 mother and child pair.Multiple logistic regression was used to identify the determinants of breastfeeding initiation.The association between breastfeeding initiation and the child's feeding practice at the time of the survey was tested using Chi square test at 5% level of significance.Results showed that mothers who gave birth to a full term infants (Adjusted Odds Ration [AOR] 1.9; 95% Confidence Interval [CI] 1.19, 3.04), who had given birth more than once (AOR 1.2; 95% CI 1.00, 1.53) and those who had given birth in a public health center (AOR 1.5; 95% CI 1.08, 2.22) were associated with increased odds of early initiation of breastfeeding.Significant association was also found between infants' breastfeeding initiation and breastfeeding practices at the time of the survey.Factors affecting early initiation of breastfeeding were gestational age at birth, parity, method of delivery, place of delivery, and household wealth quintile.The study provided evidence that there is a need to improve promotion of timely breastfeeding initiation and for the government to strengthen its campaign on Mother-Baby Friendly Hospital Initiative (MBFHI), setting goals that all health delivery facilities in the country are Mother-Baby Friendly certified.

Decentralized settings like the Philippines present systems challenges in operationalizing interventions to address micronutrient deficiencies. An assessment of the country's nutrition situation using data from National Nutrition Surveys from the 1990s to 2013 shows substantial reductions in the prevalences of selected micronutrient deficiencies based on the following indicators: anemia, urinary iodine concentrations, and serum retinol. The drop in prevalences occurred in all population groups and coincide with the periods of full implementation of the country's food fortification laws: the 1995 Salt Iodization Law and the 2000 Food Fortification Act. The laws mandated fortification of salt for human consumption with iodine, rice with iron, cooking oil with Vitamin A, and flour with iron and Vitamin A. Micronutrient supplementation for iron and Vitamin A (VAS), while on‐going throughout the same period, alone cannot explain the reduction in unsupplemented groups. Even among supplemented children, levels of deficiency returned to baseline 3–4 months after high‐dose VAS. Vitamin A Deficiency (VAD) decline in supplemented groups was noted only after the fortification law was implemented. Diet diversity patterns were characterized by an over‐all decline in the consumption of fruits and vegetables; the increases in meat and poultry consumption occurred mostly in the richer quintiles who are not likely to be micronutrient deficient to begin with. The reduction in iodine deficiency was sustained despite lowering allowable levels of salt iodination in 2007. While iron deficiency is not the sole cause of anemia in the country, it is plausible that iron fortification of flour, together with intensified malaria control and deworming efforts, contributed substantially towards anemia reduction. Implementation of the food fortification laws are characterized by: 1) substantial oversight and resources from national government including policies and guidelines, commodity procurements, monitoring and evaluation processes, and mass media advocacy campaigns, 2) local government counterparts with supportive local policies and ordinances, salt testing in markets and retail outlets, community‐based distribution of fortified products and of iron and Vitamin A supplements, local level monitoring processes and 3) feedback mechanisms through supervisory visits, program implementation reviews, feedback conferences, and surveys.Support or Funding InformationPhilippine Government, World Bank

BackgroundPoor maternal nutrition as indicated by chronic energy deficiency (CED) has been linked to a higher risk of dying due to pregnancy-related complications and is associated with negative birth outcome including intrauterine growth retardation that could lead to the intergenerational cycle of malnutrition.ObjectivesObjective. This study aimed to identify the determinants of maternal under nutrition using data of the “2011 Updating Survey” conducted by FNRI-DOST.MethodsThe 11,531 mothers with children 0–5 years old were included as participants and were classified into pregnant mothers, lactating mothers and non-pregnant/non-lactating mothers (NP/NL). The anthropometric measurements were assessed using the appropriate anthropometric indices for each physiologic group. Bivariate analysis using chi-square and binary logistic regression were applied to identify the potential determinants of maternal undernutrition.ResultThe likelihood of undernutrition as indicated by CED among NPNL mothers increased with lower socioeconomic status (OR: 1.47; CI: 1.18–1.83), urban place of residence (OR: 1.25; CI: 1.04–1.49), younger age at first pregnancy (OR: 2.23; CI: 1.76–2.82), late timing of first prenatal visit (OR: 1.26; CI: 1.06–1.50), non-participation in prenatal services (OR: 1.31; CI: 1.09–1.56) and poor kitchen cleanliness (OR: 2.16; CI: 1.44–2.35). On the other hand, undernutrition among pregnant mothers is directly associated with 2 factors, the wealth status (OR: 2.19; CI: 1.27–3.79) and consumption of variety of fruits (OR: 0.26; CI: 0.08–0.82) while age was borderline odds. (OR: 0.45; CI: 0.18–1.07, p=0.07). Among lactating mothers, the likelihood of undernutrition increased with longer duration of breastfeeding (OR: 1.86; CI: 1.40–2.47) while wealth status (OR: 1.28; CI: 0.99–1.67, p=0.06), non- participation in postnatal services (OR: 1.27; CI: 0.98–1.66, p=0.07), non-consumption of calcium-rich foods (OR: 0.70; CI: 0.48–1.03, p=0.07) and non-usage of food cover (OR: 1.94; CI: 0.99–3.81, p=0.05) showed borderline odds.ConclusionMaternal undernutrition is determined by socio-economic, demographic, reproductive, health and dietary practices. Strategies aimed at improving maternal nutrition should prioritize (1) female adolescents, (2) schools and out-of-school youth programs, (3) gatekeepers in nutrition and health as part of support group team to ensure access to prenatal delivery and post-natal services.

Data from the 1998–2008 Philippine National Nutrition and Health Surveys (NNHeS) were analyzed to establish trends in the prevalence of hypertension and diabetes, and of their risk factors. The NNHeS are nationally representative surveys conducted every 5 years and include anthropometric, biochemical and clinical assessments of adults ≥ 20 years old. Prevalences of hypertension, diabetes, dyslipidemia, obesity, high BMI, high WC, high WHR, smoking and alcohol intake are increasing, as are intake of high energy‐dense foods. Having a high WC increases the odds of having hypertension 3‐fold, and of diabetes 7‐fold among males. For females, a high WHR will increase the odds of hypertension by 1.5 times, and of diabetes by almost 6 times. WC and WHR predict hypertension and hyperglycemia better than BMI with significantly higher areas under the curve particularly for females, and may be useful for screening individuals in resource‐constrained settings. Preventive measures for these chronic disease conditions are urgently needed as they threaten to overwhelm a health system set up to address infectious and maternal and child health conditions.Grant Funding Source: WHO

We examine the question “How well can diet diversity (DD) indicators predict dietary quality for Filipino infants 6 to 11 months old from an urban poor municipality?” Dietary data was collected monthly from 6 to 11 months of age, using a 24 hour recall method, from a sample of 1013 infants in peri‐urban Manila. Dietary diversity (DD) was calculated from the sum of 8 food groups with at least 1 g consumed over a 24 hour period. Mean DD score over the 6 month period was 2.1 for breastfed (BF) and 2.7 for non‐breastfed infants (BBF). Nutrient adequacy was measured as mean micronutrient density adequacy (MMDA). Mean MMDA for BF was 49.8 and 58.6 for NBF. In the combined sample the correlation between DD and MMDA is significant (p<0.01, r=0.523) for the period 6–11 mos. However, fortified food product intake attenuates this relationship between DD and MMDA, and the interaction between fortified product intake & DD significantly affects MMDA. Therefore in populations where fortified foods are common, DD is not a useful indicator of diet quality.Support was provided by WHO.

Although maternal and child mortality are on the decline in southeast Asia, there are still major disparities, and greater equity is key to achieve the Millennium Development Goals. We used comparable cross-national data sources to document mortality trends from 1990 to 2008 and to assess major causes of maternal and child deaths. We present inequalities in intervention coverage by two common measures of wealth quintiles and rural or urban status. Case studies of reduction in mortality in Thailand and Indonesia indicate the varying extents of success and point to some factors that accelerate progress. We developed a Lives Saved Tool analysis for the region and for country subgroups to estimate deaths averted by cause and intervention. We identified three major patterns of maternal and child mortality reduction: early, rapid downward trends (Brunei, Singapore, Malaysia, and Thailand); initially high declines (sustained by Vietnam but faltering in the Philippines and Indonesia); and high initial rates with a downward trend (Laos, Cambodia, and Myanmar). Economic development seems to provide an important context that should be coupled with broader health-system interventions. Increasing coverage and consideration of the health-system context is needed, and regional support from the Association of Southeast Asian Nations can provide increased policy support to achieve maternal, neonatal, and child health goals.

BACKGROUND The Philippines met all the three targets for tuberculosis (TB) incidence, prevalence and mortality based on the Global Tuberculosis Report of 2015, however, the country still remains as one of the high-burden countries identified by the World Health Organization (WHO). Factors that may have contributed to the increasing incidence of TB are knowledge and attitude of Filipinos towards the disease, as gaps and misconceptions create barriers for TB control efforts.

The relationship of growth increment from 6 to 11 mos to dietary intake & feeding behaviors was examined in a sample of 250 infants in poor peri-urban metro-Manila households. Monthly 24-hour food recalls were converted to nutrient values using Philippine Food Composition Tables; anthropometric measures were analyzed using new WHO reference standards. Growth increment was expressed as difference between weight-for-age z scores (WAZ) at 6 & 11 months. Mean WAZ among BF (n=118) infants significantly declined (t=−10.01, p<0.001) but remained essentially unchanged for NBF (n=132; t=−1.25, p=0.212). Caloric intake was significantly associated with growth for both (BF, p<0.01; NBF, p=0.02), but micronutrients & feeding behaviors associated with growth differed. For BF zinc intake, giving rice water & chocolate milk was associated with better growth; higher vit C & adding sugars to other foods marked poor growth. For NBF, better growth was marked by higher folate & giving eggs; poor growth by giving sweets. These differences indicate that complementary feeding patterns were substantially different between BF & NBF. On average, mothers of BF need to add more energy to child diet, while avoiding low nutrient dense foods is a priority for NBF. Results highlight the importance of tailoring counseling advice by breastfeeding status to reduce growth faltering in the 2nd semester of life.