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1

2016 Regional dissemination forum

Emerging Nutrition Concerns

Prevalence of Non-Communicable Disease (NCD) Risk Factors:

Time Trends from 1998 to 2015 National Nutrition Survey (NNS)

and Updating of the Nutritional Status of Filipino Children and Other Population Groups

ARMM Regional Dissemination Forum August 16, 2016 Cotabato City


BURDEN of NCDs in the PHILIPPINES

of total deaths in the

country in 2012 were

caused by NCDs.

More than half

(67%)

Diseases of the heart and vascular

system made up one-third

(33.0%) of all deaths Source: WHO-NCD Country Profiles, 2014

2

World Health Assembly May 2013 adopted the following set of Global NCD Targets


ELEVATED BLOOD

PRESSURE

3


Classification

Systolic Blood

Pressure

(mmHg)

Diastolic Blood

Pressure

(mmHg)

Normal < 140 and < 90

Hypertension ≥ 140 or ≥ 90

Classification and cut-off points of

Blood Pressure based on JNC*

* Joint National Committee on Detection and Treatment of High Blood Pressure


*

Trend in the prevalence of elevated blood pressure^ among

adults, 20.0 years and over: Philippines, 1993-2015

22.0 21.0 22.5

25.3

22.3

23.9

0.0

5.0

10.0

15.0

20.0

25.0

30.0

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Pre

va

len

ce

(%

)

^Based on a single visit BP determination

*

* significant (p

4


24.2

29.1

25.1

27.5

20.8

22.2

19.9 20.8

22.5

25.3

22.3

23.9

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Pre

va

len

ce

(%

)

Male

Female

Both

Trend in the prevalence of elevated blood pressure among

adults, 20.0 years and over, by sex: Philippines, 2003-2015

*

* significant (p

5


Prevalence of elevated blood pressure among adults,

20.0 years and over, by occupation: Philippines, 2015

27.6

28.4

18.6

22.8

18.6

23.2

23.1

26.9

30.1

21.9

20.9

0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0

Special Occupations

Officials of Government

Professional

Technicians and Associate Professionals

Clerks

Service Workers and Shop and Market Sales Workers

Farmers, Forestry Workers and Fishermen

Craft and Related Trades Workers

Plant and Machine Operators and Assemblers

Elementary Occupation

No Occupation

Prevalence of elevated blood pressure among adults, 20.0

years and over with 95% CI, by region: Philippines, 2013-2015

23.6

22.0

21.5

24.2

24.2

25.8

26.7

21.7

22.3

26.2

24.1

24.6

27.4

25.8

22.5

26.5

25.1

23.9

0.0 10.0 20.0 30.0

Bicol Region

MIMAROPA

CALABARZON

Central Luzon

Cagayan Valley

Ilocos Region

CAR

NCR

Philippines

Prevalence (%) 2015

2013REGION 95% CI (LL-UL)

2013 2015

PHILIPPINES* 21.8-22.7 23.5-24.3

NCR* 20.5-23.0 23.8-26.5

CAR 24.1-29.4 24.2-29.0

Ilocos Region 24.0-27.5 20.6-24.4

Cagayan Valley 22.5-25.9 24.0-27.5

Central Luzon* 22.5-25.8 26.0-28.8

CALABARZON* 20.1-22.9 23.4-25.8

MIMAROPA 20.3-23.6 21.9-26.5

Bicol Region 21.9-25.3 24.7-27.8

6

22.7

18.6

21.1

20.4

21.0

19.4

23.3

21.4

20.9

20.1

20.8

21.5

21.1

24.0

25.1

19.1

21.4

23.7

0.0 10.0 20.0 30.0

Caraga

ARMM

SOCCSKSARGEN

Davao Region

Northern Mindanao

Zamboanga Peninsula

Eastern Visayas

Central Visayas

Western Visayas

Prevalence (%) 2015

2013REGION

95% CI (LL-UL)

2013 2015

Western Visayas 19.2-22.5 22.4-25.1

Central Visayas 20.0-22.8 19.7-23.1

Eastern Visayas* 21.6-25.0 17.2-21.1

Zamboanga Peninsula* 17.7-21.1 23.4-26.9

Northern Mindanao 19.2-22.8 22.3-25.8

Davao Region 18.8-22.0 19.6-22.7

SOCCSKSARGEN 19.5-22.6 19.9-23.3

ARMM 16.3-20.9 18.3-23.6

Caraga 21.0-24.4 18.4-22.0

Prevalence of elevated blood pressure among adults, 20.0

years and over with 95% CI, by region: Philippines, 2013-2015

18.2

23.3

18.6

18.9

15.9

18.6

22.3

20.4

21.2

20.7

20.4

28.1

20.8

23.9

0.0 10.0 20.0 30.0

Tawi-Tawi

Sulu

Maguindanao

Lanao delSur

Basilan

ARMM

Philippines

Prevalence (%) 2015

2013REGION / PROVINCE

95% CI (LL-UL)

2013 2015

PHILIPPINES* 21.8-22.7 23.5-24.3

ARMM 16.3-20.9 18.3-23.6

Basilan* 12.4-19.4 21.2-36.1

Lanao del Sur 14.9-23.0 17.9-23.2

Maguindanao 14.5-22.7 17.9-23.7

Sulu 15.2-31.5 13.3-31.8

Tawi-Tawi 11.1-25.4 15.2-26.8

Prevalence of elevated blood pressure among adults,

20.0 years and over: ARMM, 2013-2015

7


HIGH FASTING

BLOOD GLUCOSE


Classification and cut-off points of

Fasting Blood Glucose by Guidelines

Classification WHO

and IDFa

Philippine

CPGb

Normal < 110 mg/dL < 100 mg/dL

Impaired Fasting

Glucose (IFG) 110-125 mg/dL 100-125 mg/dL

Diabetes > 126 mg/dL > 126 mg/dL

a International Diabetes Federation b Clinical Practice Guideline

8


Trend in the prevalence of high fasting blood glucose among


3.9

3.4

4.8 5.6

0.0

1.0

2.0

3.0

4.0

5.0

6.0

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Pre

va

len

ce

(%

)

Year

*

* significant (p

9

Prevalence of high fasting blood glucose among adults, 20.0 years and

over , with 95% CI, by region: Philippines, 2013

4.0

5.6

4.8

5.7

3.5

4.3

5.2

4.9

4.8

4.5

5.7

6.7

6.5

7.2

4.4

5.1

4.3

5.6

0.0 2.0 4.0 6.0 8.0 10.0

REGION LOWER LIMIT UPPER LIMIT

PHILIPPINES 5.2 6.0

Ilocos Region 3.0 5.6

Cagayan Valley 4.0 6.3

CAR 3.2 5.7

Central Luzon 5.4 9.0

NCR 5.3 7.6

CALABARZON 5.5 7.8

MIMAROPA 3.6 7.8

Bicol 2.9 6.1

Western Visayas 3.7 5.9

Central Visayas 3.5 6.3

Eastern Visayas 3.9 6.5

Zamboanga Peninsula 2.6 6.1

Northern Mindanao 2.4 4.6

Davao Region 4.3 7.1

SOCCSKSARGEN 3.4 6.2

Caraga 3.8 7.3

ARMM 1.9 6.2

PREVALENCE


TOTAL CHOLESTEROL

10


Classification and cut-off points

of Total Cholesterol

Classification Adult Treatment Panel III, 2001

(mg/dL)

Desirable < 200

Borderline High 200-239

High > 240


Trend in the prevalence of high total cholesterol among


4.0

8.5 10.2

18.6

0.0

5.0

10.0

15.0

20.0

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Pre

va

len

ce

(%

) *

* significant (p

11


Prevalence of high total cholesterol among adults, 20.0 years

and over, by sex and age group: Philippines, 2008-2013

4.0

6.4

10.0

20.0

15.6

12.4 10.4

14.6

19.4

29.1 29.1

24.0

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

20.0-29.9y 30.0-39.9y 40.0-49.9y 50.0-59.9y 60.0-69.9y ≥70.0 years

Pre

va

len

ce

(%

)

2008 2013

*

7.3

15.2

2008 2013

Pre

vale

nce

(%

)

12.8

21.5

2008 2013

Pre

vale

nce

(%

)

*

* significant (p

12


TRIGLYCERIDE


Classification and cut-off points

of Triglycerides

Classification Adult Treatment Panel III, 2001

(mg/dL)

Desirable < 150

Borderline 150-199

High 200-399

Very High > 400

13


Trend in the prevalence of very high triglycerides among


0.7

1.8

2.8

0.0

0.5

1.0

1.5

2.0

2.5

3.0

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Pre

va

len

ce

(%

)

*

* significant (p

14

Prevalence of very high triglycerides among adults,

20.0 years and over with 95% CI, by region: Philippines, 2013

1.1

3.4

5.7

4.5

1.5

1.6

1.3

2.0

2.4

1.6

0.7

1.7

3.5

2.4

5.7

3.9

4.8

2.8

0.0 2.0 4.0 6.0 8.0 10.0

REGION LOWER LIMIT

UPPER LIMIT

PHILIPPINES 2.5 3.0

Ilocos Region 3.6 5.9

Cagayan Valley 2.6 5.2

CAR 3.2 8.2

Central Luzon 1.7 3.2

NCR 2.4 4.7

CALABARZON 1.0 2.5

MIMAROPA 0.4 1.0

Bicol 1.0 2.2

Western Visayas 1.5 3.3

Central Visayas 1.1 2.8

Eastern Visayas 0.7 2.0

Zamboanga Peninsula 0.9 2.4

Northern Mindanao 0.6 2.5

Davao Region 3.4 5.6

SOCCSKSARGEN 4.1 7.2

Caraga 2.0 4.9

ARMM 0.3 1.9

PREVALENCE


SMOKING

15


WHO Classification of Smoking Status

Those who smoked during the survey either on a “daily” (at least one cigarette a day) or on a regular/occasional basis; those who do not smoke daily but who smoke at least weekly or those who smoke less often than weekly.

Those who have ever smoked in the past year prior to survey whether on a daily basis or an aggregate lifetime consumption of at least 100 cigarettes but not daily, and are no longer smoking at the time of the survey

Those individuals who have never smoked at all

CURRENT SMOKERS

FORMER SMOKERS

NEVER SMOKERS

--- World Health Organization (WHO) STEPS Surveillance Manual, 2008


Smoking status among adults, 20.0 years and over:

Philippines, 1998-2015

54.5 55.0 54.3 59.1

63.7

32.7 34.8 31.0

25.4 23.3

12.8 10.2 14.7 15.5 13.0

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Pro

po

rtio

n (%

)

Never Smoker

Current Smoker

Former Smoker

*

* significant (p

16


Smoking status among adolescents, 10.0-19.9 years old, and


* significant (p

17


Proportion of Filipino current smokers, 10.0 years and over

by age group: Philippines, 2013-2015

0.4

3.6

12.2

20.1

24.9

26.4 26.7 26.2

23.9

18.1

0.8

2.7

9.6

17.1

25.0 23.9

23.4 23.6

21.2

15.8

0.0

5.0

10.0

15.0

20.0

25.0

30.0

10.0-12.9y 13.0-15.9y 16.0-17.9y 18.0-19.9y 20.0-29.9 y 30.0-39.9 y 40.0-49.9 y 50.0-59.9 y 60.0-69.9 y ≥70 yrs

Pro

po

rtio

n (

%)

2013

2015

* significant (p

18


Proportion of current smoking among Filipinos 10.0 years old

and over by wealth quintile: Philippines, 2013-2015

33.0

28.0 26.0

23.4

18.1

29.1 26.6

23.8 21.2

17.9

0.0

10.0

20.0

30.0

Poorest Poor Middle Rich Richest

Pro

po

rtio

n (

%)

Adults 20.0 years and over 2013

2015*

* significant (p

19

28.4

27.4

28.2

23.5

23.6

31.4

22.5

19.4

26.1

22.2

21.2

21.4

23.1

18.9

20.5

21.9

20.7

25.8

0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0

Caraga

ARMM

SOCCSKSARGEN

Northern Mindanao

Davao Region

Zamboanga Peninsula

Eastern Visayas

Central Visayas

Western Visayas

Proportion (%)

2015

2013

REGION 95% CI (LL-UL)

2013 2015



Eastern Visayas 19.0-26.0 18.4-25.3

Zamboanga Peninsula*

26.8-36.1 18.2-22.7


Davao Region 20.4-26.5 19.8-26.5

SOCCSKSARGEN* 24.2-32.2 18.8-24.0

ARMM 22.9-31.8 17.8-24.6

Caraga 24.3-32.5 20.1-24.3

Proportion of current smoking among adults, 20.0 years and

over, with 95% CI, by region: Philippines, 2013-2015

Proportion of current smoking among adolescents, 10.0-19.9

years, with 95% CI, by region: Philippines, 2013-2015

7.5

6.5

7.9

9.9

7.9

6.7

4.7

5.7

6.9

5.8

5.3

4.5

5.0

4.7

3.8

3.8

9.7

5.5

0.0 5.0 10.0 15.0 20.0

Bicol Region

MIMAROPA

CALABARZON

Central Luzon

Cagayan Valley

Ilocos Region

CAR

NCR

Philippines

Proportion (%)

2015

2013


2013 2015

Philippines* 6.2-7.5 4.9-6.1

NCR 3.3-8.2 7.1-12.3

CAR 1.8-7.6 1.3-6.3

Ilocos Region 4.3-9.1 2.2-5.4

Cagayan Valley 4.5-11.3 2.8-6.6

Central Luzon* 7.1-12.7 3.7-6.3

CALABARZON 5.9-10.0 3.0-6.0

MIMAROPA 4.4-8.6 3.3-7.3

Bicol Region 4.6-10.5 3.8-7.9

20

6.6

6.3

5.2

3.9

6.3

6.7

6.8

5.1

7.7

2.3

3.9

3.6

6.4

4.6

3.5

5.5

4.6

7.0

0.0 5.0 10.0 15.0 20.0

Caraga

ARMM

SOCCSKSARGEN

Northern Mindanao

Davao Region

Zamboanga Peninsula

Eastern Visayas

Central Visayas

Western Visayas

Proportion (%)

2015

2013


2013 2015




Zamboanga Peninsula 5.1-8.4 1.5-5.5


Davao Region 1.6-6.2 2.5-10.3

SOCCSKSARGEN 2.1-8.3 1.6-5.7

ARMM 3.9-8.7 1.9-5.9

Caraga* 3.8-9.4 1.1-3.5

Proportion of current smoking among adolescents, 10.0-19.9

years, with 95% CI, by region: Philippines, 2013-2015


Proportion of smoking status among adolescents, 10.0-19.9

years, by occupation: Philippines, 2015

63.6

93.7

79.3

26.6

3.0

13.0

9.8

3.4

7.7

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Wit

h J

ob

/B

us

ines

sS

tud

en

tN

oO

ccu

pa

tio

n

Never Current Former

21


BINGE DRINKING


drinking 5 or more standard drinks in a

row for men* or

drinking of 4 or more standard drinks in

a row for women*

BINGE DRINKING

DEFINITION BINGE DRINKING

* currently drinking alcoholic beverages for the past 30 days

22

73.0

63.8

67.2

60.5

53.0

66.5

56.5

51.8

56.2

69.4

54.2

62.7

54.1

66.3

62.3

65.7

52.6

55.2

0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0

Bicol Region

MIMAROPA

CALABARZON

Central Luzon

Cagayan Valley

Ilocos Region

CAR

NCR

Philippines

Proportion (%) 2015

2013REGION

2013 2015

n 95% CI (LL-UL)

n 95% CI (LL-UL)

Philippines (CV=1.6)

5,364 54.3-58.0 5,708 53.5-56.9

NCR (CV=4.2)

467 46.1-57.4 599 48.2-56.9

CAR (CV=5.9)

222 51.9-61.0 257 58.1-73.4

Ilocos Region (CV=4.2)

358 61.4-71.5 335 57.1-67.4

Cagayan Valley (CV=6.4)

273 46.6-59.3 396 58.0-74.7

Central Luzon (CV=4.4)

483 54.4-66.6 348 49.5-58.8

CALABARZON (CV=2.6)

497 62.7-71.7 722 59.5-65.9

MIMAROPA (CV=7.2)

247 55.7-71.8 146 46.6-61.9

Bicol Region (CV=3.5)

298 66.4-79.6 397 64.6-74.3

Proportion of binge drinking among currently drinking adults,

20.0 years and over, with 95% CI by region: Philippines, 2013-2015

61.4

73.9

57.5

45.8

49.6

43.9

40.2

47.0

51.9

46.2

58.9

47.1

41.2

52.7

48.9

51.3

45.6

48.0

0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0

Caraga

ARMM

SOCCSKSARGEN

Davao Region

Northern Mindanao

Zamboanga Peninsula

Eastern Visayas

Central Visayas

Western Visayas

Proportion (%) 2015

2013

Proportion of binge drinking among currently drinking adults,

20.0 years and over, with 95% CI by region: Philippines, 2013-2015

REGION

2013 2015

n 95% CI (LL-UL)

n 95% CI (LL-UL)

Western Visayas (CV=8.5)

340 46.5-57.4 559 39.9-56.0

Central Visayas (CV=7.5)

360 41.2-52.8 312 38.9-52.3

Eastern Visayas (CV=6.7)

485 32.6-47.8 472 44.5-58.0

Zamboanga Peninsula (CV=6.8)

250 37.6-50.1 158 42.4-55.4

Northern Mindanao (CV=7.1)

320 43.3-55.9 258 45.4-60.0

Davao Region (CV=8.0)

276 39.8-51.8 245 34.7-47.6

SOCCSKSARGEN (CV=11.1)

195 48.5-66.4 193 36.9-57.4

ARMM^ (CV=16.0)

52 60.8-84.4 28 40.4-77.5

Caraga* (CV=7.5)

241 55.1-67.7 283 39.4-53.0

^ In ARMM, only 28 adults were current drinkers of alcoholic beverages in the past 30 days, and 58.9% were engaged in binge drinking.

23


60.8 58.8

2013 2015

Pro

po

rtio

n (

%)

65.9 63.3 59.9 56.2

51.6

36.8

60.4 60.2 60.3 56.3

51.5 46.9

0

20

40

60

80

20.0-29.9y 30.0-39.9y 40.0-49.9y 50.0-59.9y 60.0-69.9y ≥70.0 yrs

2013 2015

38.2 41.9

2013 2015

Pro

po

rtio

n (

%)

53.4

30.2 35.2

28.8 29.5

16.4

40.4 44.9 45.2

37.4 39.8 35.3

0

20

40

60

80

20.0-29.9y 30.0-39.9y 40.0-49.9y 50.0-59.9y 60.0-69.9y ≥70.0 yrs

2013 2015

Males

Females

*

* significant (p

24


DEFINITION PHYSICAL ACTIVITY

A person not meeting any of the following criteria is

considered being physically inactive or insufficiently

physically active and therefore at risk of chronic disease:

- 3 or more days of vigorous-intensity activity

of at least 20 minutes per day; OR

- 5 or more days of moderate-intensity activity or

walking of at least 30 minutes per day

Insufficiently Physically Active

Reference: World Health Organization STEPS Surveillance


Proportion of insufficiently physically active adults,

20.0 years and over, by age group: Philippines, 2015

45.5 42.5

2013 2015

Pro

po

rtio

n (

%)

52.3

41.6 38.4 39.3

49.9

65.9

45.0 40.2

37.3 38.9 45.1

65.4

0

20

40

60

80

20.0-29.9y 30.0-39.9y 40.0-49.9y 50.0-59.9y 60.0-69.9y ≥70.0 yrs

2013 2015

*

25

37.0 30.1

2013 2015

Pro

po

rtio

n (

%) 43.0

32.7 30.6 32.6

43.2

57.5

28.7 26.9 27.0 29.5 35.5

57.2

0

20

40

60

80

20.0-29.9y 30.0-39.9y 40.0-49.9y 50.0-59.9y 60.0-69.9y ≥70.0 yrs

52.9 52.9

2013 2015

Pro

po

rtio

n (

%)

60.7

49.5 45.5 45.5

55.9

71.6

59.5

51.0 46.0 47.0

53.0

70.9

0

20

40

60

80

20.0-29.9y 30.0-39.9y 40.0-49.9y 50.0-59.9y 60.0-69.9y ≥70.0 yrs

Males

Females

Proportion of insufficiently physically active adults, 20.0 years

and over, by sex and age group: Philippines, 2013-2015

*

* significant (p

26

46.2

46.8

24.0

33.6

39.5

33.0

40.2

55.0

48.1

38.3

39.0

48.7

34.9

50.6

38.6

45.3

46.2

25.8

0.0 10.0 20.0 30.0 40.0 50.0 60.0

Caraga

ARMM

SOCCSKSARGEN

Davao Region

Northern Mindanao

Zamboanga Peninsula

Eastern Visayas

Central Visayas

Western Visayas

Proportion (%) 2015

2013REGION 95% CI (LL-UL)

2013 2015

Western Visayas* 41.5-54.6 21.8-30.3



Zamboanga Peninsula 27.9-38.2 30.3-47.7

Northern Mindanao* 34.0-45.0 45.2-55.9

Davao Region 25.9-41.4 30.7-39.5

SOCCSKSARGEN* 18.0-30.0 37.2-60.3

ARMM 37.6-55.9 33.0-45.4

Caraga 39.6-52.9 32.9-44.0

Proportion of insufficiently physically active adults, 20.0 years

and over, with 95% CI, by region: Philippines, 2013-2015


Summary

• Elevated Blood Pressure –Prevalence significantly increased after a decline

in 2013, from 22.3% to 23.9% in 2015 – In ARMM, prevalence of elevated blood

pressure increased in 2015 but it was not statistically significant.

–Prevalence in Basilan shoot up to 28.1% in 2015 from 15.9% in 2013 and was highest among the provinces in ARMM.

27


Summary • High Fasting Blood Glucose

– Prevalence continued to increase since 2003. Still, affecting more males than females (5.8% vs. 5.4%) – Based on the 8th NNS conducted in 2013, ARMM was

second lowest among the regions with 4.0% prevalence.

• High Total Cholesterol – There was an alarming increase in the prevalence of high

total cholesterol, affecting 2 in every 10 adults. – Among the regions, ARMM was third lowest in the

prevalence of high total cholesterol (12.0%).


Summary • Smoking

– Proportion of current smoking significantly decreased for both adolescents and adults in 2015.

– Also, proportion rates decreased in ARMM for both adolescents and adults, though not statistically significant.

• Binge drinking – There was an increase in the proportion of female adults, who

were currently drinking alcoholic beverages, engaged in binge drinking in 2015, while it decreased very slightly among males.

– Proportion of binge drinking in ARMM decreased from 73.9% in 2013 to 58.9% in 2015 (n=28), though was not statistically significant.

28


Summary

• Insufficiently physically active adults – Proportion slightly decreased in 2015. However, more women

were still insufficiently physically active than males.

– In ARMM, the proportion decreased by 7.8 percentage points, but this was not significant (46.8% in 2013 to 39.0% in 2015).

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