Nutrition and Health Promotion in Slovenia – micronutrient deficiencies Mojca Gabrijelčič Blenkuš National Institute of Public Health Slovenia Nutrition Day Conference 2010 Micro-Nutrient Deficiences & Malnutrition:Solutions for Key Public Helth Chalanges Brussels, 9th November 2010 Micronutrient deficiencies and malnutrition in Slovenia In general we don’t have severe micronutrient deficiencies or malnutrition problems in Slovenia BUT - What about subpopulation groups? - What institutionalized measures and projects do we have in place to decrease the perceived problems? - How are we using Health in All Policies approach and how do we deal with inequities in health? Nacional food and nutrition program 2005-10 Goals in nutrition pillar - Pregnant and breastfeeding women - Children and adolescent - Active population - Elderly, patients - Low SE groups - Education of experts - Monitoring and evaluation Nutrition of breastfeeding mothers 1. Energy intake is lower than recommendations (app. 84 % of the recommended intake); 2. Proportions in macronutrients are in line with recommendations; 3. Proportions in fatty acids are (SFA : MUFA : PUFA = 2,5 : 2,2 : 1) are not in line with recommendations, specifically high SFA; 4. vitamins: to low absolute and proportional intake of vitamines in comparison with D-A-CD recommendations: vit A (77 % of recommended intake), vit D (54 %), vit E (90 %), vit B1 (79 %), folic acid (42 %), vit C (76 %); 5. minerals: to low absolute in proporcional intake of minerals in comparison with D-A-CD recommendations: Mg (88 % of recommende intake), iron (66 %). Širca Čampa A., Fidler N., Sedmak M. in drugi. Prehrana doječih mater v Sloveniji. V: Zbornik biotehniške fakultete v Ljubljani, Kmetijstvo. Zootehnika, 2003; V:82:2: 135 - 142. Institutionalized health education program for future parents in primary health care VZGOJA ZA ZDRAVJE Priročnik za izvajanje vzgoje za zdravje nosečnic in njihovih partnerjev School for future parents Program is under renovation, healthy lifestyle (including nutrition) is a part of the program Free-access program for all pregnant women in Slovenia; problems of low response in the population of lower educated and low income women - qualitative research data provided; aim: to increase the response to the program in less attracted groups; Program is in line with other activities for pregnant women and young mothers (local environment, work place) Children and adolescent Overweight and obesity in Slovenia boys girls Overweight Obesity OW + obesity overweight obesity OW + obesity 1989 12,9 % 2,7 % 15,6 % 13,1 % 2,5 % 15,6 % 1997 16,3 % 4,5 % 20,8 % 14,9 % 3,6 % 18,5 % 2007 21,2 % 7,7 % 28,9 % 18,2 % 5,9 % 24,1 % Increase 8,3 % 5,0 % + 13,3 % 5,1 % 3,4 % + 8,5 % 1987 - 2007 Vir: Fakulteta za šport Univerze v Ljubljani Sample: 200.000 children, aged 6 – 19 years http://www.fsp.uni-lj.si/didaktika/raziskujemo/BMI%20and%20obesity%20trends%20of%20Slovenian%20children%20and%20youth%201987.pdf Morbidity and conditions due to deficits in micronutrients, in children 1-6 years, routine statistic data for Slovenia Deficit in vitamin A Deficit in vitamin C 2009 Morbidity rate - diagnosis by specialist 2005 Morbidity rate – diagnosis by specialist Deficit in vitamin D, rickets 2009 Morbidity rate – diagnosis by general practitioner Deficit in Calcium 2005 Morbidity rate – diagnosis by general practitioner Deficit in Selen Deficit in Zinc Anemia, due to deficit in Iron Deficit in vitamin B12 Deficit in folate General undernutrition Tyroid disfunction due to iodine deficienc 0 1 2 3 4 5 6 7 8 9 Število/1000 otrok Source: NIPH Slovenia, 2010 10 Iodine deficiency in Slovenia First half of 20th century: 58 % (up to 80 % in some districts) of children with goitre 1953: universal iodisation of salt (10 mg KI/kg) 1958: 22,4 % of children with goitre; mild IDD Nutrition recommendation for low salt in diet 1998: universal salt iodisation with 20 – 30 mg KI/kg 2006/07: 1 % of children with goitre Future: - With lowering salt in diet iodine should be considered, too - More research and regular monitoring needed School environment National - Nutrition and physical activity are part of a regular curiculla in schools, - National school nutrition programe EU level - ESF used by Mo Education, development of a model “Healthy lifestyle in school environment” - CAP School fruit scheme WHO - Slovene healthy schools network - Nutrition friendly school initiative (as a pilot) Z zdravo in uravnoteženo prehrano in gibanjem za zdravje otrok – učna ura za učitelje gospodinjstva v osnovnih šolah Zelena Malo Oranžna Srednje Rdeča Veliko Maš čoba manj kot 3g/100g od 3 do 20g/100g več kot 20g/100g Slad kor manj kot 5g/100g od 5 do 15g/100g več kot 15g/100g Sol manj kot 0.3g/100g od 0.3 do 1.5g/100g več kot 1.5g/100g Content 1. Recommended energy and nutrient daily intake for different age groups (2 – 18 years), with calculations for different of meals 2. Periodicity of meals 3. Recommended frequency of intake for different food groups, fruit and/or vegetables part of every meal 4. List of food items/groups with limited inclusion in daily meals 5. “Demo” seasonal menues Ban on vending machines in school environment in Slovenia since May 2010. Guidelines for healthy nutrition in kindergartens, primary and secondary schools, 2005 National school nutrition programme 1. All kindergartens in Slovenia offer 4 daily meals; - prepared or cooked in their own kitchens. 2. All primary schools offer at least two meals (midmorning snacks and lunches) every school day. Most of them have their own kitchens financed by the Ministry of Education and Sport. 3. Situation in secondary schools is very good since 2008. - government decision to finance one healthy cooked meal - offered by all schools to all secondary school students on daily basis. Budget for measure: 43 milion Euros Universal subsidie for all children. For app. one third of children and adolescents from families with lower socioeconomic status, meals are free of charge. Low-cost method for evaluation of mid morning snacks in primary schools, HFSS foods one of the main categories in evaluation in cooperation with 9 regional institutes, education in the network of RPHIs (97 % of all children attending the meal) 0,8 0,72 0,7 0,63 0,62 average score 0,6 0,56 0,55 0,45 0,5 0,45 0,4 0,39 0,35 Maribor Nova Gorica 0,3 0,2 0,1 0 Slovenj Gradec Koper Kranj Ljubljana Celje Murska Sobota Novo m esto regions Source: Gregorič M, Gabrijelčič Blenkuš M, Dobrila I et all. Analiza prehranske kakovosti osnovnošolskih malic po posameznih regijah v Sloveniji. Raziskovalno poročilo. IVZ RS, Ljubljana, 2008 DUŠEVNO ZDRAVJE Prepoznati in sprejeti svoja pozitivna in negativna čustva in jih na primeren način izraziti. ALKOHOL IN TOBAK Povečati znanje, oblikovanje odgovornega odnosa do alkohola in tobaka, iskanje alternativ alkoholu in tobaku. GIBANJE PREHRANA Povečanje gibanja v šolskem okolju in zavedanja o pomenu gibanja za zdravje. Povečati znanje o različnih vrstah sadja in zelenjave, njunem pomenu za zdravje ter povečati njuno uživanje. School Fruit Scheme 73 % of all Slovene primary schools involved All kids from 6 – 15 years of age, additional funding from Slovene government 517 tons of fruit and vegetables used in schools (2009/10) Relevant partners Concept developed by MAFF, in cooperation with MoE and MoH Working group for the SFS: Responsible for the SFS: MAFF Ministry of Agriculture, Forestry and Food • drafting the Strategy, • national implementation, • official statements; Agriculture: -MAFF - AAMRD The SFS is implemented by: AAMRD – Agency for Agricultural Markets and Rural Development Chamber of Agri. Health: Source: Report of Slovene MAFF to DG AGRI, Feb 2010 - M. of Health, - IPH Education: - M. of Educ. Malnutrition in Slovenia Main problem: patients in hospitals and elderly in elderly care centres (Slovenia: 17,9 % (2003) up to 40 % (2010) of malnourished patients or elderly) Solutions in policy and recommendations documents: - Resolution on nutrition and nutrition care in hospitals, Ministry of Health (2003) - Recommendations on nutrition treatment and care for patients and elderly, Ministry of Health (2008) Implementation: - Unit for clinical nutrition, Institut of Oncology Ljubljana - Main challange for the future (universal access, education, control …) Evaluation of the Slovene FNAP 2005 - 10 Evaluation report will show what is well done and what is still challenging – recommendations for the next policy Key stakeholders (72) were interviewed in the process of evaluation. Results in debated areas were assessed. Work in the area of children and adolescents and future parents was very productive. In the area of clinical nutrition the implementation is stil challenging. Results will be presented at the HL conference in Brussels, 8th and 9th December 2010. Conclusions Main focus today: overweight and obesity. Micronutrient deficiencies and malnutrition should not be neglected. In specific groups this is the main nutrition problem. Institutionalized measures are crucial for improvement (iodization, education at the schools for future parents, schools at primary level, definition of clinical nutrition as a part of treatment proces in the hospitals)
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