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The 11th Asian Network Symposium on Nutrition

Implementation of Research Evidence in Health and Nutrition for Asia and the Pacific Countries

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Chairpersons: Dr. KIMURA Yumi (Osaka University) and Dr. Juliawati UNTORO (WHO/WPRO)

�P�j��u��Keynote Lecture
�@Transforming implementation research into nutrition actions
�@�@Dr. Juliawati UNTORO (WHO Regional Office for the Western Pacific)
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�Q�j�������|�[�gResearch Reports
�@What is Implementation Research and how to do it?
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�@�@Dr. SHIMAZU Taichi(Division of Behavioral Sciences, Institute for Cancer Control, National Cancer Center)
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�R�j�J���g���[���|�[�gCountry Reports
�@Practice to address the challenge through the result evidence of the Health and Morbidity Survey
�@�@Dr. Ahmad Ali ZAINUDDIN (Centre for Nutrition Epidemiology Research, Malaysia)
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�@Practice to address the challenge through the result evidence of Nutrition Surveys
�@�@Dr. Truong Tuyet MAI (National Institute of Nutrition, Vietnam)
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�@Basic research for the development of a nutrient profile model for Japan leading to behavior change for adequate intake of nutrients and foods
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Questions Answer
About sugars, in Japan, we don�ft have nutrition reference value for sugars so 10 % cap of sugars, could you share the guideline if it is updated since 2015?
Everyone likes sugar, but unfortunately, our evidence shows that excessive sugar consumption is associated with various chronic diseases. Our recommendation remains to limit sugar intake to 10% or lower of total daily energy consumption. This translates to a maximum of 50g per day. A further reduction to below 5 % - which is roughly 25g per - day would provide additional health benefits.
We have really good programs and policies, but we are also "implementation challenged" or we cannot fully implement these interventions. How can we resolve the gap or disconnect?
Thank you so much! This is a very important question. As I mentioned in my presentation, addressing the gap between well-designed nutrition and health programs/policies and their effective implementation is a common challenge. Here are few examples of possible strategies to help resolve this gap:
�ELocal Context: Conduct a thorough analysis of the local context, taking into account socioeconomic factors, existing healthcare infrastructure, and prevalent health behaviors. This information informs the design and adaptation of programs to local realities. Identify and leverage local resources, including community leaders, organizations, and facilities, to support program implementation. This enhances community ownership and sustainability.
�EIntegration into National Policies: Ensure that nutrition and health programs align with existing national policies and strategies. This integration helps secure governmental support and resources for the initiatives.
�EDevelop advocacy and communications strategy.
Do you have any hardship to implementing the research and how to resolve the issue?
In case of small workplaces, resources are limited. Companies don�ft have much money to do healthcare activities. And they also don�ft have doctors and public healthcare nurses. So, we brought new implement strategies and to guide employer and healthcare managers in the small work places.
In your opinion, what seems to be the cause of increasing trends of obesity in adult and adolescence, stunting/wasting despite all the guidelines that were made by the ministry?
Basically, as for the government, we can only provide the guideline and recommendation to the population. But in terms of the implementation, we try to focus on the target group, developing the program among the adult and adolescence obesity and overweight. When they were out of the program, in normal behavior, we found they have a lot of food debt. Changing the population�fs behavior is a big task.We had the survey of intervention of the program. Since we have conducted the program in shorter time, we prevent the increase of the obesity and overweight.
Thank you very much for your wonderful presentation. I am really understanding these contentious surveys are crucial to make nutritional policies. I think many countries would like to conduct this survey to have their own nutritional policies, however, due to the insufficient budget, it makes them difficult to do that. I would like to know how Malaysia government assure this budget.
As Institute for Public Health is under the Ministry of Health in Malaysia, the five-year Malaysia plan was approved by the government. We already have a budget approved by the government to conduct a yearly survey since 2011. (Before 2011,) Every implementation program conducted by Ministry of Health needed to request the budget to the government for each survey.
In your view, do you think that implementing breastfeeding interventions to help preterm infants in successfully breastfeeding could contribute to the reduction of stunting and wasting in children under five years old in Malaysia?
Yes. Implementation of breastfeeding interventions can help the preterm infant reduction of stunting and wasting in Malaysia because a lot of proves given by the WHO and literatures are showing that fully breastfeeding among babies can improve and reduce stunting and wasting. On top of that, after exclusive breastfeeding, we also need to look into the complementary feeding after breastfeeding. If the mother missed it, the probability of children�fs stunting and wasting is higher.
Thanks Dr. Ali for the presentation. Can you elaborate on the implementation strategies of addressing the persistent stunting problem in Malaysia? What is the EBI and strategies?
In Malaysia, Clinics have a program for children in low economic status to give the food basket. Sometimes families eat the food basket together. So, we need to look at it. We also conduct schools to monitor stunting and wasting, and school children can get proper activities.
To Dr. MAI,
Seeing the Vietnam success in reducing the stunting problem among children, can you share some of your programmes/plan of action that you did that contributed to the success?
1. 30 years ago, government had big funding. It was program for the implementing reduction of stunting children.
2. A lot of programs and supports last 20 years.
3. Ministry�fs help. system for nutrition. Central to province and local level. We have excellent plan reduction, communication, agriculture how to intervene.
For example, fortification, anemia preventing program, stunting program in the malnutrition.
To Dr. MAI,
Thank you very much for your wonderful presentation. I would loke to know who give diet guidance to the general people/local people/ pregnant women/school children. As Dr. UNTORO said in her presentation, those evidence-based guidelines need to be implemented. And, as my personal curiosity, how Vietnamese Dietitians contribute to this?
About dietitian in Vietnamese, training and educate as dietitian last 10 years. Before, medical doctor and public health was doing as a dietitian. It was used to Center to province level. How to intervene the dietitian in the hospital. Put in the community, in the health system, consulting, to communicate, to provide micronutrients. Vietnamese has a system.
Based on your experience, in terms of developing profile model in Japan, what are the main key challenges? As you mention, salt consumption is high in Asia. What will be your thinking after consultation, which one you might follow in front pack labeling. Will you also include sugar in front pack labeling?
Main challenge in our research is a nutrition profiling model for dishes besides a nutrition profiling model for processed foods. We use seasoning such as soy source in home cooking. So, we excluded it as nutrition profile model for processed foods. This shows consumers what are good dishes.
We recognize reduction of sugar is very important issue. But we don�ft have criteria for reducing sugars in Japan. Because we don�ft have daily values for sugar intake. This is next challenge for our nutrition profile model.
Thanks Dr. TAKEBAYASHI for the interesting presentation. Would you share with us the main complexity of using a 'continuous / scoring' model?
We continue to research and revise the model to more realistic value.
1. Currently, are there any restrictions in Japan in marketing foods/food products to children?
2. Are there any nutrition policies regarding fast foods or fast foods marketing?
In my knowledge, we don�ft have any policies in Japan. Government communicates with the private companies deeply.
To Panelists,
Hello to all. Thanks to all of your valuable insights. May I ask any of the panelists, what is your view on the validity of a survey or an observational study to inform policy and how reliable they are in evidence based nutrition?
The WHO guidelines development process is a systematic and evidence-based approach to provide recommendations on public health issues, based on best available evidence that has been critically appraised and transparent consideration of other relevant variables. The development of the guidelines included identification of needs, scoping to define their scope and questions, formation of a Guideline Development Group (GDG) that comprising experts who systematically review existing evidence through literature reviews and appraise its quality. Recommendations are then formulated, considering factors like benefits, harms, values, and resource implications. The draft guidelines undergo external peer review before final approval and publication. Implementation strategies are devised, and ongoing monitoring and evaluation ensure the guidelines' impact and relevance. The process prioritizes transparency, rigor, and evidence-based guidance to enhance global health outcomes.
The validity of a survey is important. When we choose the school in the area we want to study, we engage the stakeholder to get what is the program running to do. As an example of food insecurity, we have the international guideline for the FIES. In Malaysia, we also validate questionnaire in Malay language. As to the food habit of the Malaysian, we collect data of diet of Malaysian corporations in 2012, of adolescents in 2017, and of adults in 2014 by using 24-hour diary. With food items of Malaysia corporations, we list down around 60,000 food items. We pick the item which is the most contribute to the Malaysian energy and micronutrient. We validated food habits to be implemented in the future survey, because we know internal diet always keep changing. Now we have vital food that affects the population intake.
I am not specialized in nutrition though, it is important to monitor nutrition status by the survey. This is a good evidence to plan political implementation.
I am not sure about this issue, but I think basic study and feasibility study are important. I want to provide these data.
To Dr. MAI,
What seems to be the reason of decreasing of rice consumption amongst the Vietnamese?
1. The improving the economic-social, so improving the diet.
2. The improving the knowledge and practice on proper nutrition.

The 10th Asian Network Symposium on Nutrition

Sustainable Healthy Diet through Healthy Food Environment for Children in Asia and the Pacific

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Chairpersons: Dr. NISHI Nobuo (NIHN, NIBIOHN) and Dr. Juliawati UNTORO (WHO/WPRO)

�@Protecting children from the harmful impact of food marketing in the Western Pacific
�@�@Dr. Juliawati UNTORO (WHO Regional Office for the Western Pacific)
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�@Food marketing and advertising practices: a case study from Fiji
�@�@Dr. Gade WAQA (College of Medicine Nursing �� Health Sciences, Fiji National University, Fiji)
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�@Trading health-regulating imports of sweetened beverages and other commodities to Pacific Countries to prevent and manage non-communicable diseases
�@�@Prof. Colin BELL (Public Health, School of Medicine, Deakin University, Australia)
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�@The current status of food environmental policies in private and government sectors in Vietnam
�@�@Dr. Tran Khanh VAN (Human Resources and Administration, Department of Micronutrients, National Institute of Nutrition, Vietnam)
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�@School lunches in Japan: their contribution to healthier nutrient intake
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�@�@Dr. ASAKURA Keiko (Department of Environmental and Occupational Health, School of Medicine, Toho University, Japan)
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Questions Answer
To Dr. VAN
When Vietnam develop the circular on food nutrition labelling? Do you think it is good to add trans fat in the label?
Yes, we showed to government the importance of TFA to be added in the level. However, companies in Vietnam are complaining they have difficulties to implement it: 1) their resources for formula change, and 2) few labs in Vietnam can provide service of test TFA so companies have difficulties of time for receiving results of TFA and more expenditure for checking TFA. The NIN and MOH are working to find a solution for this.
In Japan, is school lunch covered by the Government or paid by the parents? Any subsidization for the poor?
Thank you for your question. The fees are covered by both the local government and the parents. For low -income families, the fees are subsidized.
To Dr. VAN
In the case a voluntary term can be good to add, means that TFA should be encouraged to be labelled. The goal of WHO is to eliminate TFA in 2023, and already more than 50 countries have policies on TFA.
We are working on solutions for TFA to be mandated. The solutions include supports for companies to implement the mandated regulation of TFA elimination/limitation.
What happens in our policies? I don't get translated very well in the implementation phase also local research is always underfunded for nutrition. Can WHO invest in this? I believe programmable changes especially eating-related behavioral changes are so important to understand in our countries.
I agree that policy implementation is where we should focus our efforts. We have a GACD funded research project in Fiji focused on exactly that. A key part is building in-country capacity. As you note, however, Pacific countries need ongoing investment/support from development agencies such as WHO, SPC, FAO for policy implementation and evaluation.
According to the presentation introduced Korean advertising policy, advertisement of unhealthy food was banned during kid's TV programme. Is there any opposition from food companies? If so, how negotiated them? Did you offer alternative benefit them?
The private sector opposition was observed at the beginning but with the Government leadership and continuous dialogues, the policy was developed and implemented. After the dissemination of the law, the "healthy food products" sold better than "unhealthy" products and that can be an incentive of private sectors to reformulate their products.
How do you see the outcome of the undergoing policies in terms of children�fs health status?
Policies targeting children are made to safeguard them. So, we can say that a government failed in its duty when such policies are not activated or monitored. The last data gathered shows the increasing trend of overweight and obesity in Fiji which means we need more work to safeguard our children.
Will there be any financial and technical support for member countries to conduct research on salt and beverage reduction?
WHO provides technical supports to conduct national assessment/survey which may include salt and food/beverage assessment, for example, the PEN (Package of Essential Noncommunicable Diseases) survey.


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