Behind the scenes the making of the Palau Dietary Guidelines

Amanda Bennett- Nutritionist

Outline

• Background

• Consultation process

• Key Messages

• Dietary Modelling

• Dietary guidelines

• Feedback

Background

• No consistent guidelines used

Findings

• 90% of food imported • Low motivation to use local foods• Food choices based on convenience, cost and

availability• High dependence on canned and packaged foods- +++

high in saturated fat, sodium and sugar• Social relationships built around food sharing• Obesogenic environments• Confusion around:

– What a local healthy diet should include– How much we should be eating – 3 vs 5 food groups

Consultation process

• 4 formal rounds of consultation from draft to content finalization

• Stakeholders included:– Community groups, leaders, MOH staff, USDA and

WHO

Local stakeholders included:MOH – clinical, public health and nursing, MOE, UAK, Kotel A Deurreng, PCAA, OMUB, Nutrition Working Group, Family Federation for World Peace and Unification, Coalition for a Tobacco Free Palau and Faith-based representation.

Feedback from Consultation

• Locally relevant and practical information

• Easy to read and navigate

• Comprehensive guide to address NCD lifestyle risk factors

– Healthy eating

– Physical Activity

– Alcohol

– Tobacco use

Key Message development

Taro Leaf Development

• Prak leaf background • Focuses on three local food

groups• Ongraol• Odoim

• Combining meat, alternative, including dairy

• Fruits and vegetables

Taro Leaf Messages

Dietary Modelling process and challenges

Getting the balance right:

• guidelines meet estimated calorie and nutrient requirements for healthy adults

– 2000 calories per day

• Appropriate servings of protein (odoim) foods

• Focus on local foods first

• Getting the serving sizes right

– Relevant to local context

Food Pattern for 2000 calories

Based on USDA Food Pattern Data for 2000 calories

Food GroupUSDA (calories per

food group)Palau (calories per

food group)

Fruit 200330

Vegetables 125

Grain/Starchy Vegetables 640 650

Protein foods 290530

Dairy foods 245

Oils 230 230

Solid fats & Added Sugar (an allowance- not

recommendation)260 260

Total Calories 2000 2000

Food Pattern for 2000 calories

Based on USDA Food Pattern Data for 2000 calories

Food GroupUSDA (calories per

food group)Palau (calories per

food group)

Fruit 200330

Vegetables 125

Grain/Starchy Vegetables 640 650

Protein foods 290530

Dairy foods 245

Oils 230 230

Solid fats & Added Sugar (an allowance- not

recommendation)260 260

Total Calories 2000 2000

1510

Determining serving size

• Spent time +++++ weighing all sorts of food

• Photo documenting

A word on serving size

• Serving sizes are different for each food group

• All calories are not equal

• Fat, Protein, Carbohydrates and Alcohol all contain different amounts of calories

Determining serving size

• Determined the avg weight for a variety of commonly eaten foods

• Determined what the avg calorie amount each serving contained for that particular food group

• Determined approximate serving size for different foods.

Bringing it all together- Palau dietary guidelines

Fruits and Vegetables– aim for 5 servings every day!

What is a serving of vegetables?

One Serving Vegetables

= 1/2 cup cooked or 1 cup uncooked

A cupped hand= 1/2 cup

cooked

What is a serving of fruit?

One Serving Fruit=

1 medium fruit, 1 cup diced, 2 small fruits

¼ soursop

Ongraol– energy foods: aim for 5 to 8 servings every day!

What is a serving of ongraol?

One Serving Ongraol= ½ cup cooked or ½ medium taro

A cupped hand= 1/2 cup

cooked

Odoim– body building: aim for 3 to 4 servings every day!

What is a serving of odoim?

One Serving Odoim=

Palm of your hand = 1 serving fish, chicken or meat

Not Odoim

Reduce amount of:• Canned & processed meats- Corned beef,

canned pork, hamburger, sausages, turkey tailWarning: these meats are very high in salt and

bad fat.

Putting it all together

Meal Food eaten Fruits & Veg

Ongraol Odoim

Breakfast 2 slices bread with 2 tablespoon peanut butter1 cup low fat milk

211

Snack 1 medium banana 1

Lunch 1 cup rice 1 med fish fillet1 cup salad 1

21

Snack 1 medium cucumber 1

Dinner 1 medium taro2 chicken pieces1 cup sautéed kangkum and mixed vegies

2

21

Total 5 6 4

Summary

• Based on three food groups

• Healthy adult achieving their calorie goal to maintain weight (2000 calories) and nutrient requirements

• Promotes local healthy diet and compliment lifestyle messages to reduce NCDs and promote good health

• Finalized Mid-December

Questions/Comments/Feedback