The Third National Plan of Action for Nutrition of Malaysia

(NPANM III), 2016-2025

Zalma Abdul Razak Nutrition Division

Ministry of Health Malaysia

NPANM III 2016-2025

31st NSM Conference, 31 May - June 2016, Istana Hotel Kuala Lumpur

Content

•Background of NPANM

•NPANM III, 2016-2025 Framework

•NPANM III Indicators

•NPANM III Strategies & Activities

•Conclusion

International Conference on Nutrition (ICN), Rome 1992

NPANM (1996-2000)

National Nutrition Policy of Malaysia (Endorsed by the Cabinet in 2003)

NPANM II (2006-2015) - 12 Strategies based on the National Nutrition Policy

Mid-term Review of NPANM II

Background of NPANM

International Conference on Nutrition

(ICN2), Rome 2014 NPANM III, 2016-2025

NPANM III

(2016 - 2025)

Plan of Action for Prioritizing Intervention to fight Obesity in

Malaysia

MOH Strategic Plan

2016-2020 & other ministries policy & plan of

action

Nutrition programmes in the

country

Global Nutrition

Target 2025 (WHO)

Action Plan to Reduce Double Burden of Malnutrition in the

Western Pacific Region

(2015-2020)

Global Action Plan for the Prevention & Control of NCD

2013-2020

Western Pacific Region Action Plan

for the Prevention & Control of NCD 2014-

2020

ASEAN Integrated Food Security (AIFS) Framework & Strategic Plan of Action on Food Security in the ASEAN

(SPA-FS) (2015-2020)

International Conference on Nutrition 2014 (ICN2)

-- Rome Declaration

- Framework for Action

11th Malaysia

Plan

NPANM II (2006-2015)

THE NATIONAL SCP BLUEPRINT 2016-2030

Bandar Seri Begawan

Declaration on NCDs in ASEAN

2013

INTERNATIONAL & NATIONAL NUTRITION COMMMITMENTS

5

Global Nutrition

Target 2025

ICN2, Rome Declaration on Nutrition & FFA

NPANM III

2016-2025

40% reduction in the number of children under-5 who are stunted

50% reduction of anaemia in women of reproductive age

No increase in childhood overweight

30% reduction in low birth weight

Increase the rate of exclusive breastfeeding in the first 6 months up to at least 50%

Reduce and maintain childhood wasting to less than 5%

Global NCD Targets 2025 – nutrition-related

NPANM III, 2016-2025 FRAMEWORK

Incorporating nutrition objectives, considerations and components into national

development policies and action plans

Foundation

strategies

Facilitating

Strategies

Promoting maternal, infant and young child nutrition

Promoting healthy eating and active living

Preventing and controlling nutritional deficiencies

Preventing and controlling obesity and other diet related NCD

Sustaining food systems for healthy diets

Supporting efforts to promote food safety and quality

To enhance

nutritional status

To reduce diet-related

non-communicable

diseases

TOWARDS ACHIEVING OPTIMAL NUTRITIONAL

WELL-BEING OF MALAYSIANS Goal

Enabling

Strategies

Strengthening

food and nutrition

research and

development

Ensuring sufficient

numbers of qualified

nutritionist and

dieticians

Strengthening

institutional and

community

capacity for

nutrition

Providing standard

nutrition guidelines for

targeted groups

Continuous

assessment and

monitoring of the

nutrition situation

To strengthen food

and nutrition

security

Objectives

• 45 indicators

• 198 activities

• 59 stakeholders (other ministries & government agencies, industries, academicians, professional bodies)

NPANM III, 2016 – 2025

Anemia (9.3% to <5%)

Total Weight Gain (30% increased from baseline)

GDM (No increase from baseline - 8.7%)

Promoting Optimal Maternal, Infant and Young Child Nutrition

Pregnant women

Neonatal

Low Birth Weight (11.3% to 8%)

Continue….

Infant

Exclusive breastfeeding at 6 months

(Target will be determined based on NHMS 2016)

Exclusive breastfeeding at 6 months of age (29.4% to 70%)

(AMP reten)

Complementary food:

- Timely introduction

- Minimum dietary diversity

- Minimum meal frequency

- Minimum acceptable diet

Target will be

determined

based on

NHMS 2016 findings

Percentage of adults meeting recommended servings :

1) Cereal, cereal products & tubers (41.3 % to 60%)

2) Fruits (14.9% to 25%)

3) Vegetables (7.9% to 15%)

4) Meat, poultry & egg (66.8% to 75%)

5) Fish & fish products (31.3% to 50%)

6) Legumes & nuts (17.1% to 50%)

7) Milk & dairy products (24.4% to 60%)

Promoting Healthy Eating & Active Living

Malaysian Food Pyramid

Other MDG Key Messages

1) Percentage of adults consume sodium less than

2000 mg/ day (52.5 % to 70%)

2) Percentage of adults meeting recommended water

intake (44% to 65%)

3) NIP (Read at least 4 nutrients) (5.7% to 12%)

Percentage of anemia among women in reproductive age

(22.8% to <11%)

Preventing & Controlling Nutritional Deficiency

Non-pregnant Women

Children below 5 years Underweight (12.4% to <10%)

Stunting (392,973 - 17.7% to 250,000 - 11%)

Wasting (8.0% to <5%)

School Children Thinness

5-9 years (9.0% to 6%)

10-14 years (6.9% to 5%)

15-17 years (7.0% to 5%)

Continue….

Reduced household food insecurity

status based on 6 parameters.

1) Food quantity (25% to 15%)

2) Food variety (26% to 15%)

3) Meal size reduction (22% to 13%)

4) Skip meals (15% to 9%)

5) Affordable food (24% to 14%)

6) Could not afford to feed children with

variety food (21% to 12%)

Food & Nutrition Security

Overweight No increase from baseline data (3.4%)

Obesity No increase from baseline data (3.7%)

Preventing & Controlling Obesity & NCD

Childhood Obesity

(Under 5 years)

Overweight 5-9 years - No increase from baseline data (12.1%)

10-14 years – No increase from baseline data (16.0%)

15-17 years – No increase from baseline data (14.4%)

Obesity 5-9 years - No increase from baseline data (14.8%)

10-14 years – No increase from baseline data (14.4%)

15-17 years – No increase from baseline data (9.6%)

School Children Obesity

Overweight No increase from baseline data (29.5%)

Obesity No increase from baseline data (17.9%)

Abdominal Obesity No increase from baseline data (40.0%)

Adult Obesity

(18-59 years old)

Elderly Obesity

(>59 years old)

Continue….

Overweight No increase from baseline data (33.6%)

Obesity No increase from baseline data (15.7%)

Hypercholesterolemia No increase from baseline data - 47.7%

Diabetes Mellitus 17.5% to < 15%

Hypertension 30.3% to 24%

Diet related NCD

Continue….

ENABLING STRATEGIES ES 1: Promoting Maternal, Infant and Young Child Nutrition

ES 2: Promoting Healthy Eating and Active Living

ES 3: Preventing and Controlling Nutritional Deficiencies

ES 4: Preventing and Controlling Obesity and Other Diet Related NCD

ES 5: Sustaining Food Systems for Healthy Diets

ES 6: Supporting Efforts to Promote Food Safety and Quality

ES 1 : PROMOTING MATERNAL, INFANT & YOUNG

CHILD NUTRITION

MATERNAL

• Development and Training Module - Training Module on Therapeutic Diet for pregnant mothers comprising: Gestational Diabetes Mellitus Under and over nutrition Anaemia Hypertension

BREASTFEEDING • Conduct promotional activities on exclusive

breastfeeding. Printed promotional material Dialogue/forum Convention/ Seminar Advertisement through mass and social media

ES 2: HEALTHY EATING & ACTIVE LIVING

CHILD CARE CENTRE

• Promotion - Parental involvement in promoting healthy eating.

• Training – TOT (health care givers) to educate mothers and care givers on infant feeding based on Infant and Young Child Feeding modules.

PRESCHOOL

• Promotion - parental involvement in promoting healthy eating, develop teaching materials (e.g. interactive, educational games and conduct conference/ convention .

• Provision of healthy menu. • Kebun Dapur Project -Integrate nutrition components into

“Kebun Dapur Project” initiated by KEMAS.

Continue….

PRIMARY/ SCHOOL CHILDREN

• Promotion

Enhance nutrition promotion

Development of educational package on healthy eating in

line with MDG key messages for school children.

Review healthy eating component in school curriculum

• Intervention Program – School Meal Program

INSTITUTE HIGHER LEARNING

• Promotion - Carry out nutrition promotion, promote healthy menu at cafeteria, develop educational materials on healthy eating targeted to university students and promote healthy eating component into culinary courses.

• Training – TOT on healthy eating in PROSIS module and related club/ programme.

• Revise/ establish the nutrition component in PROSIS module and related club/ programme and conduct TOTs training.

COMMUNITY

• Promotion - Develop healthy eating education materials

including articles, slots in mass media where feasible based on

Malaysian Dietary Guidelines (including My Healthy Plate),

Empower consumers through digital technology MyNutriDiari,

Strengthening of Nutrition Information Centers and Healthy

Community Kitchen.

Creating a calorie conscious society (i.e.: R&R and hotels)

Increasing fruit & vegetable intake

Reducing salt & sugar

Continue….

Continue….

PHYSICAL ACTIVITY

• Component for active living will be implemented under the National Action Plan for Physical Activity (NASPAL), (2016-2025) monitored by the Health Education Division, Ministry of Health.

ES 3 : PREVENTING & CONTROLLING NUTRITIONAL

DEFICIENCIES

WOMEN IN REPRODUCTIVE

AGE

• Promotion - Nutrition education specifically on the importance of micronutrients for women in reproductive age.

CHILDREN BELOW 5 YEARS

• Training - Train staff in registered Child Care Centre on: WHO Manual of nutrition and growth

monitoring (2006).

ES 4 : PREVENTING & CONTROLLING OBESITY & NCD

COMMUNITY

• Promotion - Promote healthy eating through

social media

• Training

Empowerment of community through Weight

Management Programme in KOSPEN initiative

in combating obesity and other diet related

NCDs.

INTEGRATION NUTRITION COMPONENT IN AGRICULTURE POLICY

• Integrate nutrition component in the food Self Sufficient Level (SSL) determination through agricultural food production.

• Adopt Nutrition Enhancing Agriculture-Food Production Calculator.

FOOD STORAGE & PRESERVATION

• Increase the availability of major food storage and preservation infrastructures.

ES 5 : SUSTAINING FOOD SYSTEMS TO PROMOTE HEALTHY DIETS

NUTRITION REQUIREMENT DURING CRISIS/ EMERGENCY

• Establish a guideline on food supply and distribution according to nutrition requirement during crisis/ emergency.

ADVOCACY & PROMOTION

• Promote the consumption of underutilised crops (i.e.: pulasan, kuini, binjai, cherry Terengganu, asam gelugor, terung asam, bambangan, sagu, sukun).

• Increase accessibility to affordable fruits and vegetables.

ES 6 : SUPPORTING EFFORTS TO PROMOTE FOOD SAFETY

EDUCATION FOR NUTRITION LABELLING • Educate consumers on nutrition labelling

FACILITATING STRATEGIES FS 1: Providing Standard Nutrition Guidelines for Targeted Groups

FS 2 : Continuous Assessment and Monitoring of the Nutrition Situation

FS 3: Strengthening Food and Nutrition Research and Development

FS 4: Ensuring Sufficient Numbers of Qualified Nutritionist and Dieticians

FS 5: Strengthening Institutional and Community Capacity for Nutrition

FS 1 : PROVIDING STANDARD NUTRITION GUIDELINES FOR VARIOUS

TARGET GROUP

• Develop comprehensive nutritional guidelines for : Children with special needs for healthcare

providers. Pregnant & Lactating Women. Elderly. Vegetarians.

• Review all guidelines, recommendations and training modules in the context of sustainable food system at least once every ten years: RNI. MDG.

DEVELOP NEW GUIDELINES REVIEW EXISTING GUIDELINES

FS 2 : CONTINUOUS ASSESSMENT & MONITORING OF NUTRITION SITUATION

• Elderly Establish a database of nutritional status

(anthropometry) of the elderly in old folks home.

CONTINUOUS ASSESSMENT

Update of Malaysian Food Composition Database.

Establish the National Institute of Nutrition.

Establish Nutrition Research Priorities (NRP) for Malaysia for each Malaysia Plan (MP).

NATIONAL INSTITUTE OF NUTRITION (NIN)

MALAYSIAN FOOD COMPOSITION DATABASE (FCD)

NUTRITION RESEARCH PRIORITIES (NRP)

FS 3 : STRENGTHENING FOOD & NUTRITION RESEARCH

Strengthen capacity building in postgraduate nutrition research.

POSTGRADUATE NUTRITION RESEARCH

Establish smart partnership on research with key stakeholders or research institutions.

SMART PARTNERSHIP

Incorporate nutrition components into national surveys/ research by other agencies, i.e: Malaysian Family Life Survey (LPPKN), Household Expenditure Survey (DOS).

INCORPORATION NUTRITION COMPONENTS

Periodic review of nutrition & dietetic curriculum in universities.

Continuing Professional Development (CPD) as a requirement to renew practising certificate.

Provide more opportunities for post graduate, sub-speciality training and cross-disciplinary training for nutritionist and dietitians.

CONTINUING PROFESSIONAL DEVELOPMENT (CPD) CURRICULUM

TRAINING

Registration as nutritionist and dietitian practitioner.

NUTRITIONIST AND DIETITIAN PRACTITIONER

Code of ethics and professional conduct for nutritionists and dietitians.

CODE OF ETHICS

To develop Subject Matter Expert (SME) Guidelines for Nutritionists and Dietitians.

SUBJECT MATTER EXPERT (SME)

FS 4 : ENSURING SUFFICIENT NUMBERS OF QUALIFIED NUTRITIONIST &

DIETICIANS

• Training using on children growth monitoring to: TOTs to health staff Echo training to staff of registered nurseries.

• Review nutrition components in Early Childhood Education Courses (Diploma/ Degree).

INFANT & YOUNG CHILD

FS 5 : STRENGTHENING INSTITUTIONAL & COMMUNITY CAPACITY

FOR NUTRITION

• Healthy eating course to be listed in the MOE Training Portal.

• Develop SOP related to nutritional management for supplementary feeding for all age groups during disasters and emergencies.

SOP – DISASTERS AND EMERGENCIES

TRAINING TO TEACHERS

TRAINING TO HEALTH CARE PROVIDER

• Strengthen nutrition component in the training of other professions;

Medical & Para-medic Nurses Teachers (ERT & physical education) • Carry out training on the effective use of

Medical Nutrition Therapy (MNT) for all healthcare professionals.

Conclusion

• NPANM III is a long term plan consists of strategies and activities aims at achieving optimal nutritional well-being of Malaysians.

• NPANM III uses whole-government and whole-society approaches.

• Success of NPANM III relies on ownership & commitment from all the stakeholders.

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Bahagian Pemakanan, KKM

KEMENTERIAN KESIHATAN MALAYSIA MINISTRY OF HEALTH