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)