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Nutrition guides, recipe book to nudge seniors towards healthier eating

Nutrition Month makes a comeback

The Nutrition Month programme makes a comeback yesterday and was launched by Health Minister Datuk Seri Dr S Subramaniam at Mid Valley Exhibition hall. Pix by Shiraz Ali


KUALA LUMPUR: Nutrition Month Malaysia (NMM), a nutrition education programme, returned for its 12th consecutive year with the theme, “Eat Right, Move More: Fight Obesity”.

Recognising the growing problem of overweight and obesity in the country, NMM National Steering Committee chairman Dr Tee E. Siong said this year’s programme aims to promote greater awareness on the importance of healthy eating and active living to reduce the prevalence of obesity.

“It is disturbing when we think of the future and how the number of obesity continue increasing, not only in adults but in children as well.

Various nutrition-related activities will be carried out as part of NMM’s initiative to reinforce the importance of leading a healthy lifestyle to young adults and families,” Dr Tee said at the launch at Mid Valley Exhibition Centre here yesterday.

Launched by Health Minister Datuk Seri Dr S. Subramaniam, the two-day program strives to improve the nutritional status of Malaysian families in order to prevent non-communicable diseases (especially obesity) that are currently on the rise in Malaysia.

Dr Subra said the National Health and Morbidity Survey from 1996 to 2011 revealed that the obesity rate in Malaysia has increased by almost three and a half times, from 4.4 per cent in 1996 to 15.1 per cent in 2011.

“This puts the number of obese Malaysians at about 2.5 million people. Similarly, the overweight rate has also increased from 16.6 per cent in 1996 to 29.4 per cent in 2011,” he said in his speech yesterday.

He noted that it has reached the stage where about one in two Malaysian adults is either overweight or obese.

He said it was well know that an unhealthy lifestyle such as a poor diet, sedentary living, smoking cigarettes and stress play a major role in the rise of obesity and other related non-communicable diseases.

“Therefore, the Health Ministry is fully cognizant of the need for early steps of prevention, as it will make a difference in nipping the prevalence of obesity and NCDs in the bud,” he added.

The NMM 2014 commenced with the launch of the Nutri-Fun Land exhibition, a part of the Family Carnival Programme, which showcased an interactive, educational, and fun area where families could come over and uncover the truth about obesity and learn ways to prevent it.

Families were also given the chance to discover more about the Food Pyramid and the Physical Activity Pyramid, and to  ascertain ways to choose healthier foods and jump start their fitness regimes.

The carnival also showcased free nutrition screenings (Body mass Index (BMI), blood pressure, blood cholesterol, blood glucose and body fat) and provided free dietary advice by trained professionals as well as many other fun activities and games organised by sponsors.

During the carnival, a new NMM guide book entitled NMM guide book entitled “Eat Right, Move More: Fight Obesity” was distributed to the visitors, contents of which largely focused on identifying obesity and its risk factors.

It also included key messages on the prevention of obesity and many other useful tips on healthy eating and living an active lifestyle.

Also highlighted were a few guidelines on weight loss as well as questions and answers aimed at educating readers, especially those overweight and obese individuals, to start living healthily.

Several other outreach activities were also lined up in conjunction with NMM 2014.

These included the Nutri-Fun primary school roadshows in the Klang Valley, where educational combo kits containing materials such as the Kembara Alam Sam comic book and the educational DIY nutritional props (foldable pyramid) were distributed to students who participated.

The NMM programme has been an annual initiative since 2002, and is the collaborative effort of three professional bodies- Nutrition Society of Malaysia (NSM), Malaysian Dietician’s Association (MDA), and Malaysian Association for the Study of Obesity (MASO).

Read more: Nutrition Month makes a comeback – Latest – New Straits Times

via Nutrition Month makes a comeback – Latest – New Straits Times.

Life in the fasting lane


Beware of overeating while breaking your fast, especially after a trip to the Ramadan bazaar. Overeating can lead to a spike in blood sugar, which can lead to hyperglycaemia. – GARY CHEN / The Star

Many Muslims with medical conditions such as diabetes observe a fasting period during Ramadan despite being religiously exempted from doing so. We break down the health risks, as well as preventive measures, to ensure a safe and healthy fasting season.

MILLIONS of Muslims in Malaysia are now celebrating the holy month of Ramadan, including those with medical conditions like diabetes.

In Islam, Ramadan is considered to be the most blessed and spiritually-beneficial month of the year.

For this reason, many observe a fast from dawn to dusk throughout the month, during which they must abstain from eating, drinking and smoking, amongst other practices.

There are however, no restrictions on the amount of food or drink they can consume at night.

According to religious tenets, fasting is intended to teach a person patience, humility and self-control.

This practice is also thought to be good for health, and provides a yearly routine of spiritual cleansing for Muslims.

Many Muslims with legitimate health concerns also fast despite being religiously exempted from doing so – some even going against their doctor’s advice.

Hence, it is imperative for medical professionals, and even more so for those who are fasting, to be aware of the potential risks associated with fasting, and take steps to fast in a safe and healthy manner.

Rising numbers

Diabetes is a condition that causes a person’s blood sugar level to rise too high.

It occurs when the body does not produce enough insulin to function properly, or when the body’s cells do not react to insulin. This is known as insulin resistance.

Type 2 diabetes is the most common type of diabetes and affects up to 90% of diabetic patients around the world.

It usually affects those over the age of 40, although increasingly younger people are also being affected.

Its growing prevalence is associated with rapid cultural and social changes, and is often attributed to unhealthy lifestyle and behavioural patterns such as a poor diet coupled with physical inactivity.


Professor Dr Nor Azmi Kamaruddin explains that factors such as taking too much insulin or other diabetes medications, skipping a meal, or strenuous exercise can cause a dive in blood sugar in diabetic patients.

Prof Nor Azmi explains that factors such as taking too much insulin or other diabetes medications, skipping a meal, or strenuous exercise, can cause a dive in blood sugar in diabetic patients. –Filepic

In 2010, the National Health and Morbidity Survey revealed that an estimated 3.4 million Malaysians suffer from diabetes.

The survey showed an increase in diabetic cases among Malaysians aged 30 and above, from 8.3% in 1996, to 14.9% in 2006. This marks an 80% increase over a period of just 10 years.

The same survey revealed an even more dramatic increase in diabetic cases among the nation’s youth. Between 1996 and 2006, the number of diabetic cases in Malaysians aged 18 years and above rose from 4.4% to 14%, a 200% increase in just a decade.

More alarmingly, it is believed that an estimated one-third (or 36%) of the diabetic population remains undiagnosed.

Fasting is not meant to create excessive hardship on the individual, but Muslims who are diabetic may face significant challenges in managing their condition, as fasting requires abstinence from all foods, fluids, oral medications, as well as IV fluids, which may be required to keep their blood sugar level in check.

Among the problems to look out for include:

Hypoglycaemia (low blood sugar)

Low blood sugar is a well-known risk associated with daytime fasting, especially for diabetic patients. It occurs when there is too much insulin and not enough sugar (glucose) in your blood.

If left untreated, low blood sugar can lead to serious medical problems, including loss of consciousness, and convulsions or seizures that require emergency treatment.

Professor Dr Nor Azmi Kamaruddin, head of the diabetes and endocrine unit at Universiti Kebangsaan Malaysia (UKM), explains that factors such as taking too much insulin or other diabetes medications, skipping a meal, or exercising harder than usual can cause low blood sugar in diabetics.

Not eating enough during sahur, the meal consumed before dawn, can increase the risk of hypoglycaemia, he explains.

The logic behind this is simple. Most diabetic patients are required to take insulin or other diabetic medications to decrease their blood sugar levels. However, consuming less calories than what your body needs naturally will lower your sugar levels. This, compounded with the use of insulin or diabetic medications, could cause blood sugar to plummet to dangerous levels.

“Most people do not eat enough during sahur, because they are not used to eating at that hour. Hence, appetite tends to be poor,” says Prof Azmi.

“Diabetics, in particular, need to consume the same amount of food they usually consume, to maintain a healthy blood sugar level.”

He stresses that reduction of insulin or medication is not recommended because if you do not have enough insulin to cover the extra sugar in your blood, ketoacidosis can occur.

Ketoacidosis itself is a severe, life-threatening condition that requires immediate treatment. Symptoms include nausea, vomiting, abdominal pain, rapid breathing, and in some cases, unconsciousness.

Hyperglycaemia (high blood sugar)

Conversely, high blood sugar also affects people with diabetes. Contributing factors include excessive food intake, illness, and not taking enough glucose-lowering medication.

High blood sugar can become severe and result in serious complications such as diabetic coma, which requires emergency care. In the long term, persistent hyperglycaemia, even if not severe, can lead to complications affecting the eyes, kidneys, nerves and heart.

During Ramadan, most people usually consume two meals per day – one before sunrise and one after sunset.

“However, some people have the tendency to binge-eat when they break fast. That’s when the problem arises,” says Prof Azmi.

“When you starve yourself for some 14 hours, and then consume a significant amount of food, your blood sugar levels will shoot up if you’re diabetic.”

“This occurs especially when people go to bazaars hungry. They tend to overbuy, and subsequently overeat.”


When you have diabetes, excess glucose builds up in your blood. As a result, your kidneys have to work harder to filter and absorb the excess sugar.

If your kidneys can’t keep up, the excess sugar is excreted through your urine, along with fluids drawn from your tissues. This causes frequent urination, which may leave a diabetic dehydrated and constantly thirsty. As they drink more fluids to quench their thirst, they will urinate even more.

This is where the problem arises. Says Prof Azmi: “During Ramadan, diabetic patients tend to suffer from dehydration because they don’t drink enough water to replenish the fluids that have been lost.

“To make things worse, Malaysia is situated in the tropics. On average, we lose up to half a litre of sweat everyday due to the heat.

“Those who work outdoors could lose over a litre every day.”


Mobile applications such as Ramadan, Diabetes and Me (as shown in the picture) allow diabetic patients to keep track of their blood sugar levels throughout the day. .

Mobile applications such as Ramadan, Diabetes and Me (as shown in the picture) allow diabetic patients to keep track of their blood sugar levels throughout the day.

Fasting tips for diabetics

During Ramadan, your regular day-to-day dietary habits get thrown out the window. Health problems can arise from an insufficient diet or as a consequence of overeating.

To avoid this, it is essential for diabetic patients to maintain a healthy and balanced diet throughout the holy month. The aim should be to maintain a consistent body mass.


At the predawn meal, consuming foods rich in “complex” carbohydrates (slow-digesting foods) is advisable because of the delay in digestion and absorption, which keeps you feeling fuller for longer.

In addition, increase your fluid intake during non-fasting hours to avoid dehydration.

When breaking fast, Prof Azmi advises diabetic Muslims to start off with a glass of water, before moving on to dishes, starting from vegetables, protein, and finally to carbohydrates, to avoid overeating.

Ingesting large amounts of foods rich in carbohydrates and fats should be avoided, he says. “About 70-80% of the Asian diet consists of rice. However, the high glycaemic index (GI) in rice could cause blood sugars to spike.

“Also, try to avoid sweetened or carbonated drinks. You might also want to go for whole fruit options instead of fruit juices.

“Ingestion of fruit juices leads to a rapid absorption of glucose in the bloodstream, resulting in a sudden spike in blood sugar.

“In comparison, eating whole fruits involves processes such as chewing and digestion. This will result in a more gradual and stable increase in blood sugar.”

Frequent monitoring of sugar levels and medication

It is important for diabetic patients to monitor their blood sugar levels multiple times a day.

This is especially critical for type 2 diabetes patients who require insulin.

Mobile applications such as Ramadan, Diabetes and Me allow diabetic patients to keep track of their blood sugar levels throughout the day.

Developed by MSD, the app (which is currently only available on IOS devices) feature a blood sugar tracker that offers an easy and convenient way to monitor your daily blood sugar levels.

Meanwhile, those who are on oral medication may have to adjust the dosage or switch to short-acting medication, which can be taken along with their main meal of the day.

Similarly, patients who are on insulin will need to switch to a twice-a-day regime of short-acting insulin, with the larger dose timed before the main evening meal.


Normal levels of physical activity may be maintained. However, Prof Azmi advises against strenuous exercise, as it may lead to a higher risk of hypoglycaemia.

“If a diabetic patient has already been exercising regularly, he should continue, but stick to mild or moderate-intensity exercises,” he says.

“I would suggest exercising just before the break of fast, rather than in the morning, so they will be able to recover from their workouts by replenishing their bodies with food.”

He also points out that diabetic patients should try to avoid sun exposure to avoid further fluid loss.

Pre-Ramadan medical assessment

Ideally, all diabetic patients who wish to fast during Ramadan should undergo a medical assessment and engage in an education programme to undertake the obligation as safely as possible.

The American Diabetes Association recommends that people with type 2 diabetes undergo a medical assessment at least two months prior to fasting.

South-east Asian guidelines for management of endocrine disorders during Ramadan advise planning for the period at least three months in advance.

During this assessment, individual patients need to understand the potential risks they may face if they decide to fast.

Specific changes in diet or medication regimens should be tailored to a patient’s needs, so they can fast on a stable and effective programme.

Such assessments should also extend to those who do not wish to fast due to the heightened risk of hypo- and hyperglycaemia.

via Life in the fasting lane – Health | The Star Online.

How to get your kids to eat more veggies

A new Stanford University study finds that teaching kids about nutrition boosts their desire to eat more vegetables.

WHAT’S the best way to get your kid to eat more vegetables? Smother the broccoli in sauce, cut cucumbers into fun shapes, or ban dessert until they’ve eaten their spinach?

A new study reveals what could be the best approach – simply teach them about nutrition.

Scientists from Stanford University in the US have found that even very young children can benefit from a conceptual framework that encourages them to understand why eating a variety of foods is healthy, the researchers said. The result: kids eat more vegetables by choice.

“Children have natural curiosity – they want to understand why and how things work,” the researchers explained. “Of course we need to simplify materials for young children, but oversimplification robs children of the opportunity to learn and advance their thinking.”

Researchers Sarah Gripshover and Ellen Markman developed five storybooks aimed at revising what children already know about various nutrition-related themes, such as dietary variety, digestion, food groups, and nutrients.

In a study involving more than 160 children between the ages of four and five, the researchers assigned some preschool classrooms to read nutrition books during snack time for about three months, while other classrooms were assigned to conduct snack time as usual. Later, the children were asked questions about nutrition.

Findings showed that the children who had been read the nutrition books were more likely to understand that food had nutrients, and that different kinds of nutrients were important for various bodily functions (even functions that weren’t mentioned in the books), the researchers said. They were also more knowledgeable about digestive processes, understanding, for example, that the stomach breaks down food and blood carries nutrients.

These children also more than doubled their voluntary intake of vegetables during snack time after the three-month intervention, whereas the amount that the control group ate stayed about the same.

Further research is needed to determine whether the conceptual intervention encourages healthy eating habits outside of snack time and whether it’s effective over the long-term, the researchers said.

The study, announced July 1, appears online in the journal Psychological Science.

A separate 2010 conducted by researchers from Penn State in the US found that increasing the amount of vegetables in the first course of preschool lunch could be a clever way to get children to eat more vegetables. – AFP Relaxnews

via How to get your kids to eat more veggies – Nutrition | The Star Online.

Why We Can’t Trust Cereal Companies to Self-Regulate

Breakfast food marketers insist that children won’t eat cereals that aren’t doused in sugar. They’re wrong. frootloops-615.jpgburritoes/Flickr

Breakfast is good. Children who eat breakfast every day are less likely to be obese, and more likely to be well-nourished than those who miss it. Cereals can be an excellent, fairly low-calorie means of delivering needed nutrients like whole grains and fiber. And, of course, there is the milk that goes along with it. On these matters, we and the cereal companies agree.

Where we disagree is how sweet these cereals must be, and which cereals should be marketed to children. The companies have a range of cereals in their portfolios. Why then, do they not market their better cereals — regular Cheerios, Frosted Mini-Wheats, Quaker Oatmeal Squares — to children? These cereals are high in whole grains and much lower in sodium and added sugars. They are hard for nutritionists to object to. But the companies, led by General Mills and Kellogg, claim that children will not eat cereal unless the cereals are highly sweetened. In a piece in the Journal of the American Dietetic Association, top nutrition officials from these two companies said, “Food does not become nutrition until it is eaten,” implying that cereals without lots of sugar will not leave the box.

We found in a study that when children are served low-sugar versions of cereals (Corn Flakes vs. Frosted Flakes for example), they eat the amount a child should have for breakfast, and add fruit and a small amount of sugar to do the sweetening. Children served high-sugar cereals consume much more cereal and sugar (from the cereal), and add less fruit. It is no wonder companies want to market the high-sugar versions to children — they eat more cereal. The amount of excess sugar in children’s cereals is depicted in a video using Cheerios vs. Honey Nut Cheerios as examples.

How do the companies navigate the tricky ground they stand on? They are feeling pressure about the scourge of childhood obesity, from the White House to leading medical groups, and hence the threat of government regulation looms large. But the basic business model is to maximize profits. Hence selling products that children overconsume.

One solution the industry itself proposes is self-regulation. The industry can argue that it will police itself — that it will act in the best interests of children, and that government regulation will not be necessary. An example is the participation of General Mills, Kellogg, and Post in the Children’s Food and Beverage Advertising Initiative (CFBAI), which is “designed to shift the mix of foods advertised to children under 12 to encourage healthier dietary choices and healthy lifestyles.”

Industry self-regulation is worth a try. If the companies can develop ways of protecting children from poor nutrition influences and not require government involvement, everyone wins. The question is whether industry promises get fulfilled — and whether they are meaningful promises to begin with. In order to answer these questions, it is important to have objective data on industry sales and marketing practices, and to track these over time to see if changes are occurring.

Our team at Yale’s Rudd Center for Food Policy and Obesity is doing just that. Three years ago, we released a comprehensive report on the marketing of breakfast cereals to children. The report documented that cereal companies were speaking to children early, often, and when parents weren’t looking. The least healthy cereals were the ones most aggressively marketed to children. Cereal companies were targeting children not only with television ads but through websites containing “advergames” and other branded activities, and advertising on popular kids’ websites like

The companies have promised to do better, including enhancing the nutritional quality of cereals and expanding CFBAI advertising requirements. Thus, we launched a three-year follow up project using the same methods, to determine whether the children’s cereal landscape has improved. This report, Cereal Facts 2012, is being released today.

Our study examined the nutritional quality of more than 100 brands and nearly 300 individual varieties of cereal marketed to children, families, and adults. There is some good news:

  • General Mills and Kellogg delivered on their promise to improve nutritional quality by reducing sodium. General Mills also reduced the sugar in its child brands, and is halfway toward fulfilling its promise to reduce the sugar per serving to “single digits.”
  • Some brands reduced child-targeted advertising. The most notable change was that General Mills and Post discontinued their and websites.

Sadly, there is more bad news than good:

  • From 2008 to 2011, total media spending to promote child-targeted cereals increased by 34 percent.
  • Companies spend more to advertise child brands than they spend on the healthier adult brands.
  • The discontinuation of popular cereal-company advergame websites and associated banner advertising was partially offset by the introduction of new child-targeted websites and increased banner advertising for individual brands and existing websites. For example, Post replaced with, and General Mills introduced advergame sites for Honey Nut Cheerios and Cinnamon Toast Crunch.
  • Companies are developing yet new ways to target children. Kellogg introduced the first food company advergame for mobile phones and tablets targeted to children for Apple Jacks.
  • Post did not fulfill its nutrition promise to lower the sugar content of Pebbles cereals to 9 grams per serving.
  • Hispanic and black youth exposure to cereal marketing increased from 2008 to 2011.The trend is of particular concern, as these young people face the highest rates of obesity and related diseases.
  • Some new products, such as Kellogg’s Krave cereal, continue the unfortunate tradition of implied health benefits on the package, child-oriented contests, and heavy exposure of children and teens to marketing, despite poor nutrition profiles.

The bottom line? Cereal marketing to children in 2012 looks much the same as it did in 2009. In 2009, it was easy to quantify the degree to which the companies promoted their healthiest cereals to children — there was none. How much is there today? None. Cereal companies continue to push their least nutritious products — Froot Loops, Reese’s Puffs, Fruity Pebbles, Lucky Charms — directly to children. Children also continue to see more advertising for cereals than for any other category of packaged food or beverage.

There is no doubt that children need protection from the masterful and ubiquitous marketing by companies of products known to be unhealthy. Industry’s promises to behave better have an empty ring when they continue the marketing of their least healthy products to children.

The Atlantic

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