3.1 Cambodian Recommended Dietary Allowance (CAM-RDA)

Preface

This book has been written to introduce the newly developed Recommended Dietary Allowance (RDA) and Food-Based Dietary Guidelines (FBDG) for school-aged children in Cambodia.

Recommended Dietary Allowance (RDA) is a set of recommended amount of energy and nutrient intake per day. RDA for school-aged children in Cambodia (CAM-RDA) was first formulated based on the data analysis of a nationwide food consumption survey conducted in 136 schools in 23 provinces and Phnom Penh. This book elaborates how the recommended amount of energy and 19 types of nutrient for 6 to 17 years old were calculated. The establishment of RDA is the first step to develop FBDG, but it is meant to be used for hospital diet, school meal programs, food fortification and other nutrition-related activities as well.

Food-Based Dietary Guidelines (FBDG) for school-aged children in Cambodia consist of seven key messages and its educational materials. They have been developed to bring improvement to nutritional issues identified by the nationwide survey. It is very important that FBDG is disseminated to the public and integrated into the school-based health education to promote healthy eating habits.

We hope that RDA and FBDG will be used as a tool to foster healthy growth of school-aged children in Cambodia through integration into health education curriculum. It is also hoped that this book will be used as a reference for nutrition professionals in Cambodia to develop a set of RDA for other age groups in the future.

Phnom Penh, 2017 MINISTER OF HEALTH

We acknowledge Dr. Prak Pisethriangsey, the former director of the Preventive Medicine Department at the Ministry of Health who first generated the enthusiasm among partners to create the first food-based dietary guidelines for Cambodia. Our sincere gratitude goes toProfessor Nobuo Yoshiike and Professor Kaoru Kusama from Aomori University of Health and Welfare in Japan, the advisors to the Foundation for International Development/Relief (FIDR), for their professional support and guidance during the process of development. We would also like to express our great appreciation to FIDR for their technical support and the financial assistance provided by Japanese donors through FIDR. We would like to thank all of the respondents, principals and teachers of the 136 schools who participated in the survey. We would not have been able to conduct this analysis without their cooperation. We would like to thank nutrition experts from government ministries and institutions, international organizations and NGOs for their valuable input and suggestions. Most importantly, we would like to thank each member of the FBDG development team, as listed below, for their contribution and commitment to this project. 1. Ms. Koeut Pichenda, MD, MPH, PhD, Deputy Director of Preventive Medicine Department /PMD/MoH 2. Dr. Chhun Loun, Chief of Non-communicable Disease/PMD/MoH 3. Dr. Hok Sirany, Vice Chief of Non-communicable Disease/PMD/MoH 4. Dr. Chea Mary, Deputy Director of National Nutrition Program/MoH 5. Dr. So Chhavyroth, Deputy Director of School Health Department/MoEYS 6. Dr. Say Ung, Director Department, Health, Food Security and Nutrition of Council of Agriculture and Rural Development 7. Dr. Leang Supheap, Staff of National Institute of Public Health 8. Mr. Hou Kroeun, Deputy Country Director of Helen Keller International 9. Dr. Khim Sam Ath, Technical Officer for Non-Communicable Diseases and Health Promotion of World Health Organization 10. Ms. Hanneke Vandyke, Technical Officer of World Food Program 11. Ms. Din Seanglay, Nutrition Programme Assistant of World Food Program Finally, we would like to extend our appreciation to the following supervisors for their continuous support and assistance:H.E Sok Silo, Deputy Secretary General, Council for Agriculture and Rural Development (CARD), Dr. Kol Hero, Director of Preventive Medicine Department (MoH), Dr. Chhay Kimsotheavy, Director of School Health Department (MoEYS), and Dr. Prak Sophonneary, Deputy Director of National Maternal and Child Health Center and Program Manager of the National Nutrition Program. ii Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Executive Summary

Cambodia, like many other developing countries, is beginning to face the threat of emerging obesity and diet-related non-communicable diseases among school-aged children while the country is still struggling with malnutrition. Dietary habits are rapidly changing, especially in urban areas, with the increased access to undesirable nutrient-poor foods that are high in saturated fats, salt and sugar. These changes attribute to the phenomenon of obesity. On the other hand, stunting, underweight and wasting for age are still common in rural areas.

To address these problems, the Preventive Medicine Department at the Ministry of Health and the Foundation for International Development/Relief (FIDR) formed a joint initiative to develop Food-Based Dietary Guidelines (FBDG) for school-aged children to promote healthy eating behaviors. Like 17 other countries in Asia and the Pacific who have developed their FBDG, Cambodia should also follow the path to create Food-Based Dietary Guidelines in order to tackle nutritional problems, especially among school-aged children who are the future of the country.

The Food and Agriculture Organization of the United Nations (FAO) defines FBDG as providing advice to the general public on foods, food groups and dietary patterns to promote overall health and prevent chronic diseases. So far, Cambodia has not yet established a set of Recommended Dietary Allowances (RDA), therefore formulating RDA was the preliminary step to move on to develop FBDG.

In 2014, the relevant departments of the Royal Government of Cambodia, international organizations and non-governmental organizations met together to discuss the development of FBDG for Cambodian school-aged children. A nationwide survey on the nutritional status and dietary intakes of school-aged children was conducted between November 2014 and July 2015. More than 2,000 children aged 6 to 17 years old at 136 schools in 23 provinces and in Phnom Penh were surveyed using a dietary assessment method called “24-hour dietary recall”*. The overall aim of the survey was to investigate the nutritional status of Cambodian school-aged children by determining the specific nutrient gaps in their diets that can be linked to nutritional problems. The survey revealed that 33% of the students were stunted, 15% were wasted and 35% were underweight. The prevalence of malnutrition amongst school-aged children is estimated to remain high or is even getting worse compared to children under the age of 5 years. More than 50% of the girls in the age group 10-12 years old were stunted, which leads

*24-hour dietary recall will be described in chapter 2

Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia iii to serious negative effects on their health especially during their reproductive age. Also, an important issue to consider is that children who are stunted are at risk of becoming overweight and obese later in life. Malnourished students were more numerous in rural than in urban areas. In rural schools, the prevalence of malnutrition was 36% for stunting, 16% for wasting and 38% for underweight, while the prevalence of malnutrition in urban schools was 20%, 10% and 22% for stunting, wasting and underweight respectively. Students in rural areas depend more on rice as a source of energy and protein than school-aged children in urban areas.

Anthropometric data was also collected during the survey to set a reference body weight for the development of Recommended Dietary Allowance for school-aged children in Cambodia (CAM-RDA). Energy and nutrient requirements for 19 types of macro- and micronutrients for boys and girls within 5 age groups were calculated mostly based on the reference body weight.

CAM-RDA is the foundation to formulate FBDG. In other words, technical recommendations are transformed into simple messages that are applicable to the target population. FBDG developed in a specific cultural context based on RDA can be useful for nutrition education programs and agriculture planning to bring about positive change in eating habits. The guidelines can also be used as the primary reference for making decisions about nutrition policies.

Food-Based Dietary Guidelines (FBDG) for school-aged children in Cambodia – Cambodian Food for Healthy Growth – has been developed with 7 key messages based on scientific evidence along with a food pyramid a visual display of FBDG. A brochure for primary schools and a booklet for secondary/high schools have been developed to provide further information on what and how much to eat from each food type. The feasibility of the messages and educational materials were tested, revised and finalized in collaboration with the FBDG development team.

Key messages:

1. Eat food from all food types with a well-balanced diet* everyday 2. Consume calcium rich-foods such as whole small fish, milk and milk products 3. Eat protein-rich foods such as fish, meat, eggs or beans at least 2 to 3 times a day 4. Eat plenty of fruits and vegetables regularly 5. Eat cereals and starchy foods such as rice, noodles, bread and its alternatives in an adequate amount

iv Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia 6. Reduce food high in salt, sugar and fat 7. Measure your body weight and height regularly and track your growth

* A well-balanced diet is to eat food from all food types in the proper amount and accompanied by physical activities.

Once the Cambodian FBDG is established, the next step is to disseminate the information to the target audience and to implement activities. It is recommended that FBDG is integrated into school-based health education curricula. Accompanying materials shall be used for nutrition education as part of the school health education. FBDG can be also used for interventions that promote healthy eating habits among the general public including parents and caretakers. FBDG can be introduced at various institutions, including health centers and hospitals where nutrition information shall be shared with health professionals and patients. The educational materials can be used to educate patients on healthy diets while RDA can also be used for managing and providing hospital meals.

The Food-Based Dietary Guidelines shall be monitored and evaluated on a regular basis to identify the relevance and applicability of the messages for the target population. People’s lifestyles, eating patterns, and access to food are changing rapidly in the present times. Therefore, their dietary intakes shall be assessed by a wide range of stakeholders in order to ensure that relevant updates to the FBDG and its messages are made regularly.

Tables Chapter 2 Table 2-1: Respondent to questionnaire Table 2-2: Demographic characteristics of study participants by age group Table 2-3: Household demographic by region categories Table 2-4: Nutritional status of children by gender, age, and province Table 2-5: Frequency of food consumption by students Table 2-6: Common seasoning consumed

Chapter 3 Table 3-1: CAM-RDA for school-aged children Table 3-2: CAM-RDA age group Table 3-3: Reference for BMR calculation Table 3-4: Physical activity level by age Table 3-5: Reference value for EER calculation Table 3-6: Reference value for EAR protein calculation Table 3-7: Reference value for RDA protein calculation Table 3-8: Reference value for calcium calculation Table 3-9: Reference value for iron calculation Table 3-10: Reference value for thiamin (VB1) calculation Table 3-11: Reference value for riboflavin (VB2) calculation Table 3-12: Reference value for niacin (VB3) calculation Table 3-13: Reference value for zinc calculation Table 3-14: Reference value for iodine calculation Table 3-15: Reference value for selenium calculation Table 3-16: Reference value for vitamin A calculation Table 3-17: Reference value for vitamin D calculation Table 3-18: Reference value for vitamin C calculation Table 3-19: Reference value for folate calculation Table 3-20: Reference value for copper calculation Table 3-21: Recommended fat percentage calculated from EER Table 3-22: Reference value for dietary fibre calculation Table 3-23: Reference value for sodium calculation Table 3-24: Reference value for potassium calculation Table 3-25: Reference value for phosphorus calculation

vi Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Chapter 4 Table 4-1: Average of height increase per 10 years (Boys) Table 4-2: Average of height increase per 10 years (Girls) Table 4-3: Average of weight increase per 10 years

Chapter 5 Table 5-1: Definition of 6 food types and standard of serving Table 5-2: Energy-based ideal serving size for girls Table 5-3: Energy-based ideal serving size for boys Table 5-4: Ideal menu with serving size Table 5-5: Ideal menu with nutrients data Table 5-6: Summary of the activities during the 1st pilot study

Chapter 6 Table 6-1: Suggested monitoring and evaluation plan

Figures Chapter 1 Figure 1-1: Roles of RDA and FBDG

Chapter 2 Figure 2-1: GIS map of the survey location Figure 2-2: Nutritional status of children by age group Figure 2-3: Typical meal pattern Figure 2-4: Macronutrient distribution (urban vs rural students) Figure 2-5: Macronutrient distribution (boys vs girls) Figure 2-6: Comparison of calcium intake Figure 2-7: Comparison of iron intake Figure 2-8: Comparison of sodium intake

Chapter 3 Figure 3-1: Line graph of CAM-RDA reference body weight for boys Figure 3-2: Line graph of CAM-RDA reference body weight for girls

Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia vii Chapter 4 Figure 4-1: Distribution of energy intake and EER Figure 4-2: Changes in protein supply in Cambodia, neighboring countries, China, Korea, and Japan (1990-2005) Figure 4-3: Ratio of food groups for protein source Figure 4-3a: Cereals Figure 4-3b: Legumes Figure 4-4: Changes in calcium intake and calcium food group (legumes, fish, meat, eggs, milk and milk products) intakes in Japan Figure 4-5: Changes in milk supply in Cambodia, neighboring countries, China, Korea, and Japan (1990-2005) Figure 4-6: Ratio of food groups for calcium source by age group Figure 4-6a: Condiments Figure 4-6b: Vegetables

viii Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia List of Abbreviations

BMR Basal Metabolic Rate CAM-RDA Cambodian Recommended Dietary Allowance CDHS Cambodia Demographic Health Survey DG Dietary Goal EAR Estimated Average Requirement EER Estimated Energy Requirement FAO Food and Agriculture Organization of the United Nations FBDG Food-Based Dietary Guidelines FFQ Food Frequency Questionnaire FIDR Foundation for International Development/Relief GIS Geographic Information Systems IEC materials Information Education and Communication materials MoH Ministry of Health MoEYS Ministry of Education Youth and Sports NCDs Non-communicable Diseases NPH National Pediatric Hospital PAL Physical Activity Level PMD Preventive Medicine Department RDA Recommended Dietary Allowance SEA-RDA Southeast Asia Recommended Dietary Allowance WHO World Health Organization

Preface ...... i Acknowledgement...... ii Executive Summary...... iii List of tables and figures ...... iv List of Abbreviations...... ix

Chapter 1 Introduction 1.1 Background...... 1 1.2 Definition and purpose of RDA and FBDG...... 2 1.3 Timeline of the process...... 5

Chapter 2 Nutritional Status and Dietary Intakes of School-aged Children in Cambodia (2014-2015) 2.1 Survey subject...... 6 2.1.1 Survey subject and Sample size...... 6 2.1.2 Random selection...... 7 2.1.3 Respondents and Response Rate...... 7 2.2 Data collection ...... 8 2.2.1 Anthropometric measurements...... 9 2.2.2 Household questionnaire...... 9 2.2.3 24-hour dietary recall method...... 9 2.2.4 Statistical analysis...... 9 2.3 Results...... 10 2.3.1 Demographic characteristics...... 10 2.3.2 Characteristics of households...... 11 2.4 Nutritional Status of students...... 12 2.4.1 Prevalence of Stunting...... 13 2.4.2 Prevalence of Wasting and Thinness...... 13 2.4.3 Prevalence of Underweight...... 14 2.4.4 Prevalence of Overweight...... 14 2.5 Food Consumption and Nutrient Intakes...... 16 2.5.1 Food consumption by students...... 16 2.5.2 Nutrient Intakes by Students...... 18 2.6 Survey Findings...... 21

Chapter 3 Cambodian Recommended Dietary Allowance (CAM-RDA) 3.1 Cambodian Recommended Dietary Allowance (CAM-RDA)...... 23

x Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia 3.2 Formula to calculate CAM-RDA...... 25 3.2.1 Energy...... 26 3.2.2 Protein...... 28 3.2.3 Calcium...... 29 3.2.4 Iron...... 30 3.2.5 Thiamin (Vitamin B1), Riboflavin (Vitamin B2) and Niacin (Vitamin B3).. 32 3.2.6 Zinc, Iodine, Selenium, Vitamin A, Vitamin D, Vitamin C, and Folate.33 3.2.7 Copper...... 37 3.2.8 Fat...... 38 3.2.9 Dietary fiber...... 38 3.2.10 Sodium...... 39 3.2.11 Potassium...... 40 3.2.12 Phosphorus...... 41

Chapter 4 Comparison of the survey results and CAM-RDA and recommendations for improvement 4.1 Comparison of dietary intakes and CAM-RDA...... 42 4.2 Recommendations on increasing intakes of some important nutrients...... 44 4.2.1 Ideal intake goals for protein and calcium...... 44 4.2.2 Ideal goals for height and weight...... 48

Chapter 5 The Cambodian Food-Based Dietary Guidelines- Cambodian Food for Healthy Growth 5.1 Seven messages...... 50 5.2 Educational materials for dissemination...... 51 5.2.1 Poster...... 52 5.2.2 Brochure...... 53 5.2.3 Booklet...... 55 5.3 The Pilot Study...... 61 5.3.1 The First Pilot Study...... 61 5.3.2 The Second Pilot Study...... 63

Chapter 6 For the next step 6.1 A handbook for parents and caretakers...... 64 6.2 Training programs and workshops for school teachers...... 64 6.3 Mass media usage...... 64 6.4 Campaigns and promotion activities...... 64 6.5 Application in healthcare institutions...... 65 6.6 Monitoring and evaluation...... 65

Appendix 1: Member list of Food-Based Dietary Guidelines Development Team...... 70 Appendix 2-1: The List of 136 Schools...... 72 Appendix 2-2: Questionnaire-School Children Anthropometry...... 77 Appendix 2-3: Questionnaire Household...... 78 Appendix 2-4: Questionnaire for 24 hour recall...... 83 Appendix 3-1: Dietary intakes and CAM-RDA for Boys …..………………..…….………....85 Appendix 3-2: Dietary intakes and CAM-RDA for Girls …...….……...………………….....85 Appendix 3-3: Energy intakes and CAM-RDA...... 86 Appendix 3-4: Protein intakes and CAM-RDA...... 86 Appendix 3-5: Calcium intakes and CAM-RDA...... 87 Appendix 3-6: Iron intakes and CAM-RDA...... 87 Appendix 3-7: Zinc intakes and CAM-RDA...... 88 Appendix 3-8: Vitamin A intakes and CAM-RDA...... 88 Appendix 3-9: Vitamin C intakes and CAM-RDA...... 89 Appendix 3-10: Thiamin (Vitamin B1) intakes and CAM-RDA...... 89 Appendix 3-11: Riboflavin (Vitamin B2) intakes and CAM-RDA...... 90 Appendix 3-12: Niacin (Vitamin B3) intakes and CAM-RDA...... 90 Appendix 3-13: Copper intakes and CAM-RDA...... 91 Appendix 3-14: Fat intakes and CAM-RDA...... 91 Appendix 3-15: Dietary Fibre intakes and CAM-RDA...... 92 Appendix 3-16: Sodium intakes and CAM-RDA...... 92 Appendix 3-17: Salt (Sodium Chloride) intakes and CAM-RDA...... 93 Appendix 3-18: Potassium intakes and CAM-RDA...... 93 Appendix 3-19: Phosphorus intakes and CAM-RDA...... 94

xii Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Chapter 1 Introduction

1.1 Background

Cambodia has been struggling with the poor nutritional status of children. According to the Cambodia Demographic Health Survey (CDHS) 2014, 32 percent of children under the age of 5 are stunted, 10 percent are wasted, and 24 percent are underweight.1)

Focusing at the goal of the National Nutrition Strategy 2009-20152), the Cambodian Government and development agencies have been increasing its efforts to reduce maternal and child morbidity and mortality by improving the nutritional status of women and children. Most of the efforts in nutrition made by the Government and development agencies have been targeting children under the age of 5. However, there seems to be less nutritional interventions for school-aged (6 to 17 years old) children than needed. There is also only limited data available of those age groups.

The nutritional status during the primary school period has a significant impact on pubertal development. Raising awareness among caretakers and educating young children to consume an adequate and balanced diet during that important phase is crucial for their proper growth. As the progression of puberty is affected by malnutrition, young children can remain more likely malnourished and lack proper cognitive development in their adolescent life, which will have an effect during their reproductive years.

While Cambodia is still struggling with undernutrition, issues of obesity and non-communicable diseases (NCDs), which are partly attributable to improper nutritional intake, are gradually appearing. Other neighboring countries are already facing emerging obesity and NCDs, even among children. Cambodia has achieved rapid economic growth but is also facing changes in people’s dietary patterns with many options of nutrient-poor, unbalanced, processed food and sugary beverages. This affects directly today’s eating habits of school-aged children, and they are more exposed to the threat of obesity and NCDs.

Nutritional interventions to promote healthy eating habits of school-aged children are therefore very important and an urgent task on which the Government and development agencies should work together to protect children from diet-related health problems. These interventions are vital to stop the cycle of passing the negative impact of malnutrition on to the next generation. In that sense, nutritional interventions for school-aged children not only support children’s well-being but are also a meaningful investment to increase the productivity and resilience of the population.

Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia 1 The World Declaration and Plan of Action for Nutrition (1992) calls on that governments, together with other groups, should, on the basis of energy and nutrient recommendations, provide advice to the public by disseminating dietary guidelines relevant for different age groups and lifestyles and appropriate for the country’s population.3) However, as written in a report of the Regional Consultation on Food-Based Dietary Guidelines for countries in the Asia Region 2010 “Cambodia does not have a food consumption survey. They also do not have the technical expertise to develop FBDGs” 4), nutrient standards and food-based dietary guidelines based on scientific evidence have not yet been established in Cambodia.

To respond to such needs, the Preventive Medicine Department of the Ministry of Health and the Foundation for International Development/Relief (FIDR) came together to form an initiative to develop the first Cambodian Recommended Dietary Allowance (CAM-RDA) and to facilitate the development of Food-Based Dietary Guidelines (FBDG) for school-aged children to promote healthy eating behaviors. Like 17 other countries in Asia and the Pacific who have developed their FBDGs, it is time for Cambodia to have its own RDA and FBDG to tackle nutritional issues especially among school-aged children who are the future of the country.

In 2014, the relevant departments of the Royal Government of Cambodia, international organizations and non-governmental organizations met together to discuss the development of FBDG for Cambodian school-aged children (see Appendix 1). A nationwide survey was conducted to analyze the situation and the development process was carried out in accordance with the protocols instructed in the joint report “Preparation and Use of Food-Based Dietary Guidelines “by FAO and WHO.5) Although it was a big challenge for all of the development team members as it was the first attempt in Cambodia to create a set of RDA and FBDG, the RDA and FBDG for school-aged children have been finally developed. The purpose of this book is to publish the outcomes and to record the three-year development process. 1.2 Definition and purpose of RDA and FBDG

What is RDA? Recommended Dietary Allowance (RDA) is the amount of nutrient and energy intake per day considered necessary for maintenance of good health, calculated for males and females of various age.6) Sufficient scientific evidence is required to establish RDA. In other countries, RDA is used to develop hospital diet or school meal menus and it is supposed to be periodically reviewed and revised. Since 2007, the National Pediatric Hospital (NPH) in Phnom Penh has provided inpatients with a hospital diet based on nutritional calculations. The NPH referred to the RDA of Southeast Asia to

2 Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia develop menus as there were no established RDA or nutritional requirements specifically for Cambodians.

What is FBDG? Once RDA is established, it should be disseminated to the entire target population. As WHO states, RDA is the foundation for a country to develop Food-Based Dietary Guidelines (FBDG).7) In other words, FBDG are a means of communicating the message to guide the target population to the recommended nutritional level. FBDG present information that the public can easily understand with a focus on ordinary foods, portion sizes and behaviors.8) It can be used as a key tool for nutritional education and behavior change by health providers, teachers and others working directly with the public (Figure 1-1).

Why food-based? Nutrients should primarily be taken from daily diet, for children as well as other age groups (This does not apply to those under clinical treatments). Supplements and fortified food can only support specific nutrients and they do not ensure the wide range of nutrients necessary for child growth. It is recommended that meals for school-aged children be based on the guidelines demonstrated in this book. Implementers of school meal should also refer to FAO recommendation related to sustainability of such meals. Sustainable diets are protective and respectful of biodiversity and the ecosystem, culturally acceptable, accessible, economically fair and affordable, nutritionally adequate, safe and healthy.9)

Fortified Supplements Food

Other Health

Meal Interventions Program Child well-being with good nutrition

Hospital Diet, Nutrition Education Counseling in Schools Public Health Promotion

Dietitians Doctors Researchers

Food-Based Dietary Guidelines

As an educational tool

Recommended Dietary Allowance Ideal intake of nutrients

4 Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia 1.3 Timeline of the process ϮϬϭϰ Ŷ&'ĞǀĞůŽƉŵĞŶƚdĞĂŵ &'ĞǀĞůŽƉŵĞŶƚdĞĂŵ ĐŽŵƉƌŝƐŝŶŐƌĞƉƌĞƐĞŶƚĂƚŝǀĞƐŽĨ ƚŚĞŐŽǀĞƌŶŵĞŶƚ͕ŝŶƚĞƌŶĂƚŝŽŶĂů ŶWƌĞƉĂƌĂƚŝŽŶŽĨƚŚĞƐŝƚƵĂƚŝŽŶĂŶĂůǇƐŝƐ ŽƌŐĂŶŝǌĂƚŝŽŶƐĂŶĚE'KƐŵĞƚ dŚĞƌĞƐĞĂƌĐŚƉƌŽƚŽĐŽůǁĂƐƌĞǀŝĞǁĞĚ ƚŽŐĞƚŚĞƌ͘ ƐĞǀĞƌĂůƚŝŵĞƐƚŽŐĞƚƚŚĞĂƉƉƌŽǀĂůĨƌŽŵ ƚŚĞEĂƚŝŽŶĂůƚŚŝĐŽŵŵŝƚƚĞĞĨŽƌ ,ĞĂůƚŚZĞƐĞĂƌĐŚ͘ ŶEĂƚŝŽŶͲǁŝĚĞƐƵƌǀĞǇ ^ƵƌǀĞǇŽĨ͞EƵƚƌŝƚŝŽŶ^ƚĂƚƵƐĂŶĚ ŝĞƚĂƌǇ/ŶƚĂŬĞƐŽĨ^ĐŚŽŽůͲĂŐĞĚ ϮϬϭϱ ŚŝůĚƌĞŶŝŶĂŵďŽĚŝĂ͟ǁĂƐĐĂƌƌŝĞĚ ŽƵƚŝŶϮƌŽƵŶĚƐ͘ϭϯϲƐĐŚŽŽůƐŝŶϮϯ ŶĂƚĂĞŶƚƌǇĂŶĚĂŶĂůǇƐŝƐ ƉƌŽǀŝŶĐĞƐĂŶĚŝŶWŚŶŽŵWĞŶŚ /ŶƚŽƚĂů͕ϮϬϰϴƐĂŵƉůĞƐǁĞƌĞĐŽůůĞĐƚĞĚ͘ ǁĞƌĞƐƵƌǀĞǇĞĚ͘ dŚĞĂŵŽƵŶƚŽĨŶƵƚƌŝƚŝŽŶĂůŝŶƚĂŬĞĂŶĚ ĞĂƚŝŶŐƉĂƚƚĞƌŶƐŽĨĐŚŝůĚƌĞŶĂƌĞĂŶĂůǇǌĞĚ͘ ŶĂůĐƵůĂƚŝŶŐDͲZ ĂŵďŽĚŝĂŶZĞĐŽŵŵĞŶĚĞĚŝĞƚĂƌǇ ůůŽǁĂŶĐĞ;DͲZͿǁĂƐĐĂůĐƵůĂƚĞĚ ďĂƐĞĚŽŶƚŚĞĨŝŶĚŝŶŐƐŽĨƚŚĞƐƵƌǀĞǇ͘ ^ŽƵƚŚĞĂƐƚZǁĂƐƵƐĞĚĂƐƌĞĨĞƌĞŶĐĞ͘ Ŷ^ƵŵŵĂƌǇƌĞƉŽƌƚŽĨƚŚĞƐƵƌǀĞǇ ƌĞƐƵůƚƐƚŽƚŚĞEĂƚŝŽŶĂůƚŚŝĐĂů ŶƌĂĨƚŝŶŐ&'ƐůŽŐĂŶƐ ϮϬϭϲ ŽŵŵŝƚƚĞĞ &ŽŽĚͲĂƐĞĚŝĞƚĂƌǇ'ƵŝĚĞůŝŶĞƐ;&'Ϳ ǁĂƐĚƌĂĨƚĞĚďĂƐĞĚŽŶƚŚĞĨŝŶĚŝŶŐƐŽĨ ƚŚĞƐƵƌǀĞǇ͘ ŶƌĂĨƚŝŶŐĞĚƵĐĂƚŝŽŶĂůŵĂƚĞƌŝĂůƐ &ŽŽĚŐƵŝĚĞƉǇƌĂŵŝĚƉŽƐƚĞƌĂŶĚ ŽƚŚĞƌ/ŵĂƚĞƌŝĂůƐĨŽƌƉƌŝŵĂƌǇ͕ ŶĞǀĞůŽƉŝŶŐ&&Y ƐĞĐŽŶĚĂƌǇ͕ĂŶĚŚŝŐŚƐĐŚŽŽů &ŽŽĚ&ƌĞƋƵĞŶĐǇYƵĞƐƚŝŽŶŶĂŝƌĞ;&&YͿ ƐƚƵĚĞŶƚƐ͘ ǁĂƐĚĞǀĞůŽƉĞĚĚƌĂĨƚĞĚďĂƐĞĚŽŶƚŚĞ ĨŝŶĚŝŶŐƐŽĨƚŚĞƐƵƌǀĞǇ͘ ŶWŝůŽƚƐƚƵĚǇͬ&&YǀĂůŝĚĂƚŝŽŶ dŚĞŐƵŝĚĞůŝŶĞƐĂŶĚ/ŵĂƚĞƌŝĂůƐ ǁĞƌĞƚĞƐƚĞĚŝŶϭϮƐĐŚŽŽůƐŝŶϲ ŶZĞǀŝƐŝŶŐŐƵŝĚĞůŝŶĞƐĂŶĚ/ŵĂƚĞƌŝĂůƐ ƉƌŽǀŝŶĐĞƐ͘&&YsĂůŝĚĂƚŝŽŶƐƚƵĚǇ &ĞĞĚďĂĐŬĨƌŽŵŽƚŚĞƌŶƵƚƌŝƚŝŽŶĞǆƉĞƌƚƐ ǁĂƐĐŽŶĚƵĐƚĞĚϮƚŝŵĞƐŝŶϰƐĐŚŽŽůƐ ϮϬϭϳ ǁĞƌĞĐŽŶƐŝĚĞƌĞĚ͘dŚĞǁŽƌŬŝŶŐŐƌŽƵƉ ŝŶWŚŶŽŵWĞŶŚ͘ ƌĞǀŝĞǁĞĚĂŶĚĚŝƐĐƵƐƐĞĚĨŽƌ ŶϮŶĚWŝůŽƚƐƚƵĚǇ ŝŵƉƌŽǀĞŵĞŶƚ͘ dŚĞƌĞǀŝƐĞĚŐƵŝĚĞůŝŶĞƐĂŶĚ/ ŵĂƚĞƌŝĂůƐǁĞƌĞƚĞƐƚĞĚŝŶWŚŶŽŵ WĞŶŚĂŶĚ<ĂŵƉŽŶŐŚŚŶĂŶŐ͘

Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia 5 Chapter 2 Nutritional Status and Dietary Intakes of School-aged Children in Cambodia (2014-2015)

The survey was started in November 2014 and completed on July 2015. The period of the survey was divided into two rounds with an interval to avoid the holiday season. 1) Round1 was conducted from November 2014 to January 2015: 49 Schools in 6 provinces and Phnom Penh. 2) Round2 was conducted from May to July 2015: 87 Schools in 17 provinces.

The objectives of the survey were to: (i) examine the nutritional status of Cambodian school aged children (6-17 years old); and (ii) determine the amount of nutritional intake and eating patterns of such children.

The overall aim of the survey was to investigate the nutritional status of Cambodian school-aged children by determining the specific nutrients gaps in their diets that can be linked to nutrition related problems. Based on the results of this survey, the Food Based Dietary Guidelines (FBDG) have been developed and will be promoted in Cambodia for school-aged children. 2.1 Survey subject dŚĞƐƵďũĞĐƚŽĨƚŚĞƐƵƌǀĞǇŝƐƐĐŚŽŽůĂŐĞĚĐŚŝůĚƌĞŶ͗ďĞƚǁĞĞŶϲƚŽdŚĞƐƵďũĞĐƚŽĨƚŚĞƐƵƌǀĞǇŝƐƐĐŚŽŽůĂŐĞĚĐŚŝůĚƌĞŶ͗ďĞƚǁĞĞŶϲƚŽ2.1.1 Survey subject and Sample size ϭϳǇĞĂƌƐŽůĚ͘EĨŽƌ^DZdϭϳǇĞĂƌƐŽůĚ͘EĨŽƌ^DZd ϮϬϭϭϭϬͿϮϬϭϭǁĂƐƵƐĞĚƚŽĐĂůĐƵůĂƚĞŝƚƐƐĂŵƉůĞƐŝǌĞĂƐŝŶƚŚĞĨŽƌŵƵůĂĚŽǁŶďĞϭϬͿTheǁĂƐƵƐĞĚƚŽĐĂůĐƵůĂƚĞŝƚƐƐĂŵƉůĞƐŝǌĞĂƐŝŶƚŚĞĨŽƌŵƵůĂĚŽǁŶďĞ subject of the survey is school aged children: between 6 to 17ůŽǁ͘ yearsůŽǁ͘ old. ENA for SMART 201110) was used to calculate its sample size as in the formula down below.

ଶ ݌ ൈଶ ሺͳ݌ െ ൈ ݌ሻ ሺͳ െ ݌ሻ ܨܨܧܦ ൨ ൈܨܨܧܦ ൌ൤ݖ݊ൌൈ ൤ݖ ൈ ଶ ൨ଶൈ݊ Sample size was determined based on the݀ following݀ formula: where ‘n’ is the required ^ĂŵƉůĞƐŝǌĞǁĂƐĚĞƚĞƌŵŝŶĞĚďĂƐĞĚŽŶƚŚĞĨŽůůŽǁŝŶŐĨŽƌŵƵůĂ͗ǁŚĞƌ^ĂŵƉůĞƐŝǌĞǁĂƐĚĞƚĞƌŵŝŶĞĚďĂƐĞĚŽŶƚŚĞĨŽůůŽǁŝŶŐĨŽƌŵƵůĂ͗ǁŚĞƌsample size, ‘z’ is linked to 95% confidence interval (1.96Ğ͚Ŷ͛ŝƐƚŚĞƌĞƋƵŝƌĞĚƐĂŵƉůĞ was used),Ğ͚Ŷ͛ŝƐƚŚĞƌĞƋƵŝƌĞĚƐĂŵƉůĞ ‘p’ is the ƐŝǌĞ͕͚ǌ͛ŝƐůŝŶŬĞĚƚŽϵϱйĐŽŶĨŝĚĞŶĐĞŝŶƚĞƌǀĂů;ϭ͘ϵϲǁĂƐƵƐĞĚͿ͕ƐŝǌĞ͕͚ǌ͛ŝƐůŝŶŬĞĚƚŽϵϱйĐŽŶĨŝĚĞŶĐĞŝŶƚĞƌǀĂů;ϭ͘ϵϲǁĂƐƵƐĞĚͿ͕estimated prevalence of the key variable of interest ͚Ɖ͛ŝƐƚŚĞĞƐƚŝŵĂƚĞĚƉƌĞǀĂůĞŶĐĞŽĨ(25% ͚Ɖ͛ŝƐƚŚĞĞƐƚŝŵĂƚĞĚƉƌĞǀĂůĞŶĐĞŽĨwas adopted considering over and undernutrition), ‘d’ is the relative desired precision (counted as ±3% which ƚŚĞŬĞǇǀĂƌŝĂďůĞŽĨŝŶƚĞƌĞƐƚ;ϮϱйǁĂƐĂĚŽƉƚĞĚĐŽŶƐŝĚĞƌŝŶŐŽǀĞƌƚŚĞŬĞǇǀĂƌŝĂďůĞŽĨŝŶƚĞƌĞƐƚ;ϮϱйǁĂƐĂĚŽƉƚĞĚĐŽŶƐŝĚĞƌŝŶŐŽǀĞƌshould be sufficient in the most cases in general). To ĂŶĚƵŶĚĞƌŶƵƚƌŝƚŝŽŶͿ͕͚Ě͛ŝƐƚŚĞmeaningfullyĂŶĚƵŶĚĞƌŶƵƚƌŝƚŝŽŶͿ͕͚Ě͛ŝƐƚŚĞ interpret Global ƌĞůĂƚŝǀĞƌĞůĂƚŝǀĞ ĚĞƐŝƌĞĚAcute ĚĞƐŝƌĞĚ ƉƌĞĐŝƐŝŽŶMalnutrition ƉƌĞĐŝƐŝŽŶ ;ĐŽƵŶƚĞĚ estimate ;ĐŽƵŶƚĞĚ ĂƐin the цϯй ĂƐsurvey, ǁŚŝĐŚ цϯй Design ǁŚŝĐŚ ƐŚŽƵůĚ Effect ƐŚŽƵůĚ ďĞ ‘DEFF’ ƐƵĨĨ ďĞ ŝĐŝĞŶƚwas ƐƵĨĨ set ŝĐŝĞŶƚas ŝŶ 2. ƚŚĞ The ŝŶ ŵŽƐƚcalculated ƚŚĞ ĐĂƐĞƐ ŵŽƐƚ ĐĂƐĞƐŝŶ ŝŶ ŐĞŶĞƌĂůͿ͘dŽŵĞĂŶŝŶŐĨƵůůǇŝŶƚĞƌƉƌĞƚ'ůŽďĂůĐƵƚĞDĂůŶƵƚƌŝƚŝŽŶĞŐĞŶĞƌĂůͿ͘dŽŵĞĂŶŝŶŐĨƵůůǇŝŶƚĞƌƉƌĞƚ'ůŽďĂůĐƵƚĞDĂůŶƵƚƌŝƚŝŽŶĞsample required for the study was 1,743 and taking into accountƐƚŝŵĂƚĞŝŶƚŚĞƐƵƌǀĞǇ ƐƚŝŵĂƚĞŝŶƚŚĞƐƵƌǀĞǇa non-response rateϭϬͿ͕ĞƐŝŐŶ ϭϬͿ͕ĞƐŝŐŶ of 20%, the required final sample size was increased to 2,091. ĨĨĞĐƚ͚&&͛ǁĂƐƐĞƚĂƐϮ͘dŚĞĐĂůĐƵůĂƚĞĚƐĂŵƉůĞƌĞƋƵŝƌĞĚĨŽƌĨĨĞĐƚ͚&&͛ǁĂƐƐĞƚĂƐϮ͘dŚĞĐĂůĐƵůĂƚĞĚƐĂŵƉůĞƌĞƋƵŝƌĞĚĨŽƌƚŚĞƐƚƵĚǇǁĂƐϭ͕ϳϰϯĂŶĚƚĂŬŝŶŐƚŚĞƐƚƵĚǇǁĂƐϭ͕ϳϰϯĂŶĚƚĂŬŝŶŐ ŝŶƚŽĂĐĐŽƵŶƚĂŶŽŶͲƌĞƐƉŽŶƐĞƌĂƚĞŽĨϮϬй͕ƚŚĞƌĞƋƵŝƌĞĚĨŝŶĂůƐĂŵŝŶƚŽĂĐĐŽƵŶƚĂŶŽŶͲƌĞƐƉŽŶƐĞƌĂƚĞŽĨϮϬй͕ƚŚĞƌĞƋƵŝƌĞĚĨŝŶĂůƐĂŵƉůĞƐŝǌĞǁĂƐŝŶĐƌĞĂƐĞĚƚŽϮ͕Ϭϵϭ͘ƉůĞƐŝǌĞǁĂƐŝŶĐƌĞĂƐĞĚƚŽϮ͕Ϭϵϭ͘

6 Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia 2.1.2 Random selection

The subjects were randomly selected though multi-stage sampling.

1) Primary Sampling Unit (PSU)*: The target schools were randomly selected from all public schools in Cambodia using the Probability Proportionate to Size (PPS) method. The school lists (Appendix 2-1) from the 24 provinces/municipality are obtained from the Education Management Information System (EMIS) office, Department of Planning, Ministry of Education, Youth and Sport (MoEYS). One hundred fifty-four (154) schools (including reserve samples of 19) schools in 21 cities-provinces (except Pailin) were selected for the survey.

2) Secondary Sampling Unit (SSU)*: Students between 6-17 years old, within PSUs were randomly selected using the systematic sampling technique. As a result, 20 students from each elementary school and 12 students from each secondary and high school were respectively selected for the survey.

*PSU and SSU are selected by using ENA for SMART 2011.

2.1.3 Respondents and Response Rate

Among students selected by SSU, students over 12 years (n=925) were eligible to answer questionnaires directly to enumerators. For students aged between 6 to 11 years (n=1,095), their caretakers were called to answer the questionnaires for them. Those students who did not meet the criteria of the survey were excluded; the criteria were: 1) Student without physical disability affecting his/her weight or height; 2) Student with normal enrollment age for his/her grade.

Altogether students in 136 schools were surveyed: 134 selected schools and 2 reserve sample schools. Response rate was 96.6%. In total, 2,020 samples were collected.

Table 2-1: Respondents to questionnaire (n=2,020)

ZĞƐƉŽŶĚĞŶƚ Ŷ WĞƌĐĞŶƚ

^ƚƵĚĞŶƚƐĞůĨ ϵϮϱ ϰϱ͘ϴ

DŽƚŚĞƌ ϲϮϮ ϯϬ͘ϴ

&ĂƚŚĞƌ ϭϴϱ ϵ͘Ϯ

ƵŶƚ Ϯϱ ϭ͘Ϯ

'ƌĂŶĚŵŽƚŚĞƌ ϭϲϵ ϴ͘ϰ

KƚŚĞƌƌĞůĂƚŝǀĞ ϵϰ ϰ͘ϳ

2.2 Data collection

Cross sectional data were collected to assess health status, socio-economic background, food consumption and eating pattern via three methods: 1) anthropometric measurements, 2) household questionnaire, 3) 24-hour dietary recall method.

Questionnaires were initially designed in English and translated into Khmer by the survey team and nutrition specialists. The translated questionnaires were tested to assure the appropriateness of the questions ahead of the survey.

A pretest of the entire data collection process was conducted in two schools (not selected nor reserved) with 20 students: one school in Phnom Penh and one in Kampong Chhnang province from October 13 to 16, 2014. The pretest served to ensure that the questionnaire was fully understood by the enumerators. It also served to test the enumerator behavior while in conducting interviews. The Nutrition Specialist evaluated the results and a final consultation was held with the enumerators. Difficulties with

8 Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia the questionnaire that were encountered by the enumerators were discussed and phrasing and/or translation was adjusted accordingly.

2.2.1 Anthropometric measurements

Central weighing and measuring stations were installed in each school selected for the survey. Weight and height of children were measured according to an anthropometric protocol based on the WHO Child Growth Standard Training course11) on child growth assessment.

Children’s weights were taken while wearing light clothing and no shoes. Heights and weights were assessed to the nearest 0.5 cm and 0.1 kg respectively. All measures were taken twice and the mean value was used for analysis. (Appendix 2-2)

Weight was measured using standardized digital flat scales (TANITA HD-662, Capacity: 150 kg). Height was measured with a stadiometer (SECA 213, measuring range: 20-205 cm). A pair of enumerators, each consisting of a measurer and an assistant, took all measurements. The data was collected in the record form. (Appendix 2-3)

2.2.2 Household questionnaire

After providing written consent, caretakers for students aged between 6 and 11 years and students over 12 years old were interviewed in person by enumerators. Depending on the given infrastructure, caretakers were either invited in advance to come to school for interview, or enumerators went to caretakers’ homes. (Appendix 2-4)

If the interviews were conducted centrally in a public place, privacy was assured by keeping an adequate distance between the interviewed respondents such that only enumerators were able to hear the answers.

2.2.3 24-hour dietary recall method

A 24-hour dietary recall method was used to collect meal intake. A quick dietary record form was used to record food and drinks respondents consumed over the course of one day, where possible. Based on this quick dietary record form, enumerators asked and probed the amount consumed by the respondent using FIDR Picture Book12). This book shows nine food-groups with pictures of actual portion sizes of 130 sample foods to estimate intake amount.

2.2.4 Statistical analysis

1) Household data was entered using EPI Data version 3.0 and then exported to the SPSS data editor (IBM SPSS Statistics version 20) and checked for inconsistencies. Flagged values were checked against the paper questionnaires.

Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia 9 If necessary, study participants were approached to verify the result. 2) Anthropometric data was entered in WHO Anthro Plus13) and analyzed. 3) Nutrient analysis was performed using FIDR Nutrition Calculation Database 2013. 4) Statistical analysis was performed using IBM SPSS statistics version 20. 2.3 Results 2.3.1 Demographic characteristics

During the study period 2,020 children in 136 schools in 23 provinces and Phnom Penh of Cambodia were surveyed. The age range of students was 6 years old as minimum to 17 years old as maximum. The mean age of students was 12.1 years old with the median age being 12 years old. In five age groups as defined in ASEAN Food Composition Tables 200014) for school-aged children, the age group 13-15 years old was the largest group (33.2%), and 47.5% of boys and 52.5% of girls were involved in this study. All provinces were divided into four regions as follows:

Plain: Phnom Penh, Kandal, Kampong Cham, Tbmong Khmum, Svay Rieng, Prey Veng, Takeo Tonle Sap: Kampong Thom, Siem Reap, Battambang, Pursat, Kampong Chhnang, Banteay Meanchey, Oddar Meanchey, Pailin Coastal: Sihanoukville, Kampot, Kep, Koh Kong Plateau and Mountain: Kampong Speu, Stung Treng, Ratanak Kiri, Mondul Kiri, Kratie, Preah Vihear

As shown in Table 2-2, 19.9% of students live in urban areas while 80.1% live in rural areas. The largest number of students live in plain areas (45.5%), which includes Phnom Penh, Kandal, Kampong Cham, Svay Rieng, Prey Veng, and Takeo. Second to the plains, 34.1% live in Tonle Sap area.

10 Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Table 2-2: Demographic characteristics of study participants by age groups DƵůƚŝƉůĞĂŶƐǁĞƌ 'ƌŽƵƉϭ 'ƌŽƵƉϮ 'ƌŽƵƉϯ 'ƌŽƵƉϰ 'ƌŽƵƉϱ ůů;йͿ WͲǀĂůƵĞΎ ;ϲǇĞĂƌƐͿ ;ϳͲϵǇĞĂƌƐͿ ;ϭϬͲϭϮǇĞĂƌƐͿ ;ϭϯͲϭϱǇĞĂƌƐͿ ;ϭϲͲϭϳǇĞĂƌƐͿ

Ŷ Ϯ͕ϬϮϬ ϳϮ ϰϮϮ ϱϯϮ ϲϳϬ ϯϮϰ Ͳ WĂƌƚŝĐŝƉĂŶƚƐƉĞƌ ϭϰ͘ϵ Ϭ͘ϱ ϯ͘ϭ ϯ͘ϵ ϰ͘ϵ Ϯ͘ϰ Ͳ ĐůƵƐƚĞƌ

ϭϮ͘ϭ ϲ͘Ϭ ϴ͘Ϭ ϭϭ͘ϭ ϭϰ͘Ϭ ϭϲ͘ϰ ŐĞ Ͳ ;цϯ͘ϭϱͿ ;цϬ͘ϳϴͿ ;цϬ͘ϴϯͿ ;цϬ͘ϴϮͿ ;цϬ͘ϱϬͿ

^Ğǆ

DĂůĞ ϵϱϵ;ϰϳ͘ϱйͿ ϯϮ;ϰϰ͘ϰйͿ ϮϬϬ;ϰϳ͘ϰйͿ Ϯϱϭ;ϰϳ͘ϮйͿ ϯϭϬ;ϰϲ͘ϯйͿ ϭϲϲ;ϱϭ͘ϮйͿ Ϭ͘ϲϰϰ &ĞŵĂůĞ ϭ͕Ϭϲϭ;ϱϮ͘ϱйͿ ϰϬ;ϱϱ͘ϲйͿ ϮϮϮ;ϱϮ͘ϲйͿ Ϯϴϭ;ϱϮ͘ϴйͿ ϯϲϬ;ϱϯ͘ϳйͿ ϭϱϴ;ϰϴ͘ϴйͿ

ZĞŐŝŽŶ

WůĂŝŶ ϵϭϵ;ϰϱ͘ϱйͿ Ϯϳ;ϯϳ͘ϱйͿ ϭϴϰ;ϰϯ͘ϲйͿ Ϯϯϲ;ϰϰ͘ϰйͿ ϯϬϭ;ϰϰ͘ϵйͿ ϭϳϭ;ϱϮ͘ϴйͿ

dŽŶůĞ^ĂƉ>ĂŬĞ ϲϴϵ;ϯϰ͘ϭйͿ ϰϭ;ϱϲ͘ϵйͿ ϭϲϭ;ϯϴ͘ϮйͿ ϭϴϲ;ϯϱ͘ϬйͿ ϮϬϰ;ϯϬ͘ϰйͿ ϵϳ;Ϯϵ͘ϵйͿ

ŽĂƐƚĂů ϭϱϰ;ϳ͘ϲйͿ Ϯ;Ϯ͘ϴйͿ Ϯϳ;ϲ͘ϰйͿ ϰϬ;ϳ͘ϱйͿ ϲϰ;ϵ͘ϲйͿ Ϯϭ;ϲ͘ϱйͿ фϬ͘ϬϬϭ WůĂƚĞĂƵĂŶĚ Ϯϱϴ;ϭϮ͘ϴйͿ Ϯ;Ϯ͘ϴйͿ ϱϬ;ϭϭ͘ϴйͿ ϳϬ;ϭϯ͘ϭйͿ ϭϬϭ;ϭϱ͘ϭйͿ ϯϱ;ϭϬ͘ϴйͿ DŽƵŶƚĂŶĞŽƵƐ

ZƵƌĂůͬhƌďĂŶ

ZƵƌĂů ϭ͕ϲϭϴ;ϴϬ͘ϭйͿ ϲϭ;ϴϰ͘ϳйͿ ϯϮϴ;ϳϳ͘ϳйͿ ϰϯϬ;ϴϬ͘ϴйͿ ϱϱϭ;ϴϮ͘ϮйͿ Ϯϰϴ;ϳϲ͘ϱйͿ фϬ͘ϬϬϭ hƌďĂŶ ϰϬϮ;ϭϵ͘ϵйͿ ϭϭ;ϭϱ͘ϯйͿ ϵϰ;ϮϮ͘ϯйͿ ϭϬϮ;ϭϵ͘ϮйͿ ϭϭϵ;ϭϳ͘ϴйͿ ϳϲ;Ϯϯ͘ϱйͿ

*P-value of <0.001 indicates statistically significant level

2.3.2 Characteristics of households

Summary of household demographic by region categories is shown in table 2-3. While a half of students answered, the rest asked their caretakers to answer the questionnaire. Median age of caretakers was 31, in which difference by regions was observed (p<0.001). Most of the caretakers’ relationship to children was mother (74.9%) followed by grandmother (12.8%). About one fifth of respondents owned the poor ID card (21.4%). With regards to the type of poor ID card, proportions of level 1 and 2 were nearly the same (Table 2-3). It was also found that overall, 16.9% of people experienced food deficit, which is not different regionally. (Not shown in table) However, the proportion of respondents experienced food deficit was significantly higher in rural areas compared to urban areas (Rural; 18.2%, Urban; 11.9%, respectively; p = 0.003).

Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia 11 Table 2-3: Household demographic by region categories DƵůƚŝƉůĞĂŶƐǁĞƌƐ ZĞŐŝŽŶĐĂƚĞŐŽƌǇ sĂƌŝĂďůĞƐ ůů;йͿ dŽŶůĞ^ĂƉ WůĂƚĞĂƵĂŶĚ WůĂŝŶ ŽĂƐƚĂů WͲǀĂůƵĞΎ >ĂŬĞ DŽƵŶƚĂŝŶŽƵƐ EƵŵďĞƌŽĨ Ϯ͕ϬϮϬ ϵϭϵ ϲϴϵ ϭϱϰ Ϯϱϴ ƌĞƐƉŽŶĚĞŶƚƐ Yϭ'ĞŶĚĞƌŽĨ ƌĞƐƉŽŶĚĞŶƚ DĂůĞ ϲϲϴ;ϯϯ͘ϭйͿ ϯϭϬ;ϯϯ͘ϳйͿ Ϯϭϳ;ϯϭ͘ϱйͿ ϲϮ;ϰϬ͘ϯйͿ ϳϵ;ϯϬ͘ϲйͿ Ϭ͘ϭϱϰ &ĞŵĂůĞ ϭ͕ϯϱϮ;ϲϲ͘ϵйͿ ϲϬϵ;ϲϲ͘ϯйͿ ϰϳϮ;ϲϴ͘ϱйͿ ϵϮ;ϱϵ͘ϳйͿ ϭϳϵ;ϲϵ͘ϰйͿ YϮĂƌĞƚĂŬĞƌΖƐĂŐĞ DĞĚŝĂŶ;/YZͿ ϯϭ;ϭϱͲϰϮͿ ϯϯ;ϭϲͲϰϯͿ ϯϬ;ϭϱͲϰϯͿ ϭϳ;ϭϱͲϯϲͿ Ϯϱ;ϭϱͲϯϴͿ фϬ͘ϬϬϭ YϯZĞůĂƚŝŽŶƐŚŝƉƚŽ ĐŚŝůĚƌĞŶ DŽƚŚĞƌ ϲϮϮ;ϯϬ͘ϴйͿ Ϯϵϱ;ϯϮ͘ϭйͿ ϮϬϴ;ϯϬ͘ϮйͿ ϰϭ;Ϯϲ͘ϳйͿ ϳϴ;ϯϬ͘ϮйͿ &ĂƚŚĞƌ ϭϴϱ;ϵ͘ϮйͿ ϴϴ;ϵ͘ϲйͿ ϱϴ;ϴ͘ϰйͿ ϭϭ;ϳ͘ϭйͿ Ϯϴ;ϭϬ͘ϵйͿ ƵŶƚ Ϯϱ;ϭ͘ϮйͿ ϭϬ;ϭ͘ϭйͿ ϵ;ϭ͘ϯйͿ Ϯ;ϭ͘ϯйͿ ϰ;ϭ͘ϲйͿ 'ƌĂŶĚŵŽƚŚĞƌ ϭϲϵ;ϴ͘ϰйͿ ϲϯ;ϲ͘ϵйͿ ϴϯ;ϭϮ͘ϭйͿ ϴ;ϱ͘ϮйͿ ϭϱ;ϱ͘ϴйͿ ZĞůĂƚŝǀĞƐ ϵϰ;ϰ͘ϲйͿ ϰϬ;ϰ͘ϯйͿ ϰϯ;ϲ͘ϮйͿ ϱ;ϯ͘ϮйͿ ϲ;Ϯ͘ϯйͿ ^ĞůĨ ϵϮϱ;ϰϱ͘ϴйͿ ϰϮϯ;ϰϲ͘ϬйͿ Ϯϴϴ;ϰϭ͘ϴйͿ ϴϳ;ϱϲ͘ϱйͿ ϭϮϳ;ϰϵ͘ϮйͿ YϰDĂƌŝƚĂůƐƚĂƚƵƐ ^ŝŶŐůĞ ϵϲϴ;ϰϳ͘ϵйͿ ϰϯϳ;ϰϳ͘ϲйͿ ϯϬϲ;ϰϰ͘ϰйͿ ϴϳ;ϱϲ͘ϱйͿ ϭϯϴ;ϱϯ͘ϱйͿ

ŝǀŽƌĐĞĚͬ^ĞƉĂƌĂƚĞĚ ϯϲ;ϭ͘ϴйͿ Ϯϴ;ϯ͘ϬйͿ ϲ;Ϭ͘ϵйͿ Ϭ;ϬͿ Ϯ;Ϭ͘ϴйͿ

tŝĚŽǁĞĚ ϭϬϮ;ϱ͘ϬйͿ ϰϮ;ϰ͘ϲйͿ ϰϴ;ϳ͘ϬйͿ ϯ;ϭ͘ϵйͿ ϵ;ϯ͘ϱйͿ DĂƌƌŝĞĚ ϵϭϯ;ϰϱ͘ϮйͿ ϰϭϮ;ϰϰ͘ϴйͿ ϯϮϴ;ϰϳ͘ϲйͿ ϲϰ;ϰϭ͘ϲйͿ ϭϬϵ;ϰϮ͘ϮйͿ KƚŚĞƌ ϭ;Ϭ͘ϭйͿ Ϭ;ϬͿ ϭ;Ϭ͘ϭйͿ Ϭ;ϬͿ Ϭ;ϬͿ YϱŝƌĞĐƚĐĂƌĞƚĂŬĞƌ ŽĨĐŚŝůĚ DŽƚŚĞƌ ϭ͕ϱϭϯ;ϳϰ͘ϵйͿ ϳϬϱ;ϳϲ͘ϳйͿ ϰϲϳ;ϲϳ͘ϴйͿ ϭϮϭ;ϳϴ͘ϲйͿ ϮϮϬ;ϴϱ͘ϯйͿ &ĂƚŚĞƌ ϳϬ;ϯ͘ϱйͿ ϯϰ;ϯ͘ϳйͿ Ϯϭ;ϯ͘ϬйͿ ϯ;ϭ͘ϵйͿ ϭϮ;ϰ͘ϳйͿ ƵŶƚ ϰϮ;Ϯ͘ϭйͿ ϭϳ;ϭ͘ϵйͿ ϭϱ;Ϯ͘ϮйͿ ϱ;ϯ͘ϮйͿ ϱ;ϭ͘ϵйͿ 'ƌĂŶĚŵŽƚŚĞƌ Ϯϱϵ;ϭϮ͘ϴйͿ ϭϭϳ;ϭϮ͘ϳйͿ ϭϭϬ;ϭϲ͘ϬйͿ ϭϲ;ϭϬ͘ϰйͿ ϭϲ;ϲ͘ϮйͿ ZĞůĂƚŝǀĞƐ ϵϮ;ϰ͘ϲйͿ ϯϱ;ϯ͘ϴйͿ ϰϰ;ϲ͘ϰйͿ ϴ;ϱ͘ϮйͿ ϱ;ϭ͘ϵйͿ ^ĞůĨ ϰϰ;Ϯ͘ϮйͿ ϭϭ;ϭ͘ϮйͿ ϯϮ;ϰ͘ϲйͿ ϭ;Ϭ͘ϳйͿ Ϭ;ϬͿ Yϵ/ƉŽŽƌĐĂƌĚ EŽ ϭ͕ϱϯϬ;ϳϱ͘ϴйͿ ϳϭϲ;ϳϳ͘ϵйͿ ϱϬϮ;ϳϮ͘ϵйͿ ϭϭϴ;ϳϲ͘ϲйͿ ϭϵϰ;ϳϱ͘ϮйͿ zĞƐ ϰϯϯ;Ϯϭ͘ϰйͿ ϭϳϴ;ϭϵ͘ϰйͿ ϭϲϴ;Ϯϰ͘ϰйͿ ϯϯ;Ϯϭ͘ϰйͿ ϱϰ;ϮϬ͘ϵйͿ Ϭ͘Ϯϳϴ ŽŶΖƚŬŶŽǁ ϱϳ;Ϯ͘ϴйͿ Ϯϱ;Ϯ͘ϳйͿ ϭϵ;Ϯ͘ϳйͿ ϯ;Ϯ͘ϬйͿ ϭϬ;ϯ͘ϵйͿ YϭϬdǇƉĞŽĨ/ ;ŶсϰϯϯͿ ;ŶсϭϳϴͿ ;ŶсϭϲϴͿ ;ŶсϯϯͿ ;ŶсϱϰͿ ƉŽŽƌĐĂƌĚ >ĞǀĞůϭ ϭϱϯ;ϯϱ͘ϯйͿ ϲϬ;ϯϯ͘ϳйͿ ϲϬ;ϯϱ͘ϳйͿ ϭϰ;ϰϮ͘ϰйͿ ϭϵ;ϯϱ͘ϮйͿ >ĞǀĞůϮ ϭϴϲ;ϰϯйͿ ϴϯ;ϰϲ͘ϲйͿ ϳϯ;ϰϯ͘ϱйͿ ϴ;Ϯϰ͘ϯйͿ ϮϮ;ϰϬ͘ϳйͿ Ϭ͘ϯϲϳ ŽŶΖƚŬŶŽǁ ϵϰ;Ϯϭ͘ϳйͿ ϯϱ;ϭϵ͘ϳйͿ ϯϱ;ϮϬ͘ϴйͿ ϭϭ;ϯϯ͘ϯйͿ ϭϯ;Ϯϰ͘ϭйͿ ΎDƵůƚŝƉůĞĂŶƐǁĞƌƐ *P-value of <0.001 indicates statistically significant level 2.4 Nutritional Status of students

The nutritional status of study participants by age, gender, and province is shown in Table 2-4. It shows that the mean (Z-score) of all indicators (height-for-age, weight-for- height, and weight-for-age) resulted negative values, which means the participants’ nutritional status is below the average of the WHO standard15).

12 Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia 2.4.1 Prevalence of Stunting

Students whose height-for-age is below minus two standard deviation (<-2SD) compared to WHO child growth standard are considered “stunted”, and are short for their age. Stunting is the outcome of failure to receive adequate nutrition over an extended time16). Recurrent or chronic illness also may contribute to the effect. Thirty-three percent (33.2%) of students were short for their age. The rate of stunting, which includes severe stunting (<-3SD,) for boys (36.8%) was higher than that of girls (30.0%). By age group in total, age group 10-12 years showed the highest rate of stunting (43.0%) (Table 2-4). By comparison with sex, age group 13-15 for boys showed the highest, while age group 10-12 years showed the highest for girls (Figure 2-1). The prevalence of stunting was higher among rural students (36.4%) than among urban students (20.4%). The highest rate of stunting (53.3%) was found in Kep province (Table2-4).

2.4.2 Prevalence of Wasting and Thinness

Students whose weight-for-height is lower than negative 2 standard deviation (<-2SD) compared to WHO child growth standard are considered wasted or thin. Wasting represents the failure to receive adequate nutrition in the period immediately before the survey, and typically is the result of recent illness, especially diarrhea, or the effect of a rapid deterioration in food supplies17).

The survey found that fifteen percent (15.0%) of students were wasted at the time of the survey. The rate of stunting for boys (16.7%) was higher than girls (13.4%). By age group, age group 13-15 years showed the highest rate of wasting (19.4%) (Figure 2-1). The prevalence of wasting in rural area was 16.1% while 10.4% was in urban area. The highest rate of wasting (23.3%) was found in Kep (Table 2-4). The prevalence of thinness or sever thinness (BMI-for-age) was 15.0% in total, and the highest was among 13-15 years old boys (25.0%) and 10-12 years old girls (21.0%).

Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia 13 ^ƚƵŶƚŝŶŐ tĂƐƚŝŶŐ hŶĚĞƌǁĞŝŐŚƚ ϲǇĞĂƌƐŽůĚ ϮϮ͘Ϯ ϰ͘Ϯ ϮϮ͘Ϯ ϳͲϵǇĞĂƌƐŽůĚ Ϯϱ͘ϰ ϵ͘ϳ ϯϮ͘Ϭ ϭϬͲϭϮǇĞĂƌƐŽ ϰϯ͘Ϭ ϭϴ͘ϴ ϱϱ͘ϰ ϭϯͲϭϱǇĞĂƌƐŽ ϯϲ͘ϵ ϭϵ͘ϰ ϭϲͲϭϳǇĞĂƌƐŽ ϮϮ͘Ϯ ϴ͘ϲ

dŽƌĞƐŝǌĞĐŚĂƌƚĚĂƚĂƌĂŶŐĞ͕ĚƌĂŐůŽǁĞƌƌŝŐŚƚĐŽƌŶĞƌŽĨƌĂŶŐĞ͘

Figure 2-2: Nutritional status of children by age group

й EƵƚƌŝƚŝŽŶĂů^ƚĂƚƵƐŽĨŚŝůĚƌĞŶďǇŐĞ'ƌŽƵƉ ϲϬ͘Ϭ

ϱϬ͘Ϭ

ϰϬ͘Ϭ

ϯϬ͘Ϭ

ϮϬ͘Ϭ

ϭϬ͘Ϭ

Ϭ͘Ϭ ϲǇĞĂƌƐŽůĚ ϳͲϵǇĞĂƌƐŽůĚ ϭϬͲϭϮǇĞĂƌƐŽůĚ ϭϯͲϭϱǇĞĂƌƐŽůĚ ϭϲͲϭϳǇĞĂƌƐŽůĚ ^ƚƵŶƚŝŶŐ tĂƐƚŝŶŐ hŶĚĞƌǁĞŝŐŚƚ

*Underweight (Weight for Age) does not include students over 11 years old.

2.4.3 Prevalence of Underweight

Students whose weight-for-age is lower than 2 standard deviation (<-2SD) compared to WHO child growth standard are considered as underweight. The measurement is reflecting the effects of both acute and chronic under nutrition. However, the score of weight-for-age in WHO Anthro Plus is only available up to 10 years old thus students older than 10 years old were not analyzed in this study.

Around thirty-five percent (35.1%) of children was underweight. The prevalence of underweight among boys and girls was almost the same, 35.3% for boys and 35.1% for girls (Table 2-4).

The prevalence of underweight was higher among rural (22.1%) than urban students (38.1%). The highest rate of underweight (75.0%) is found in Stung Treng province (Table 2-4).

2.4.4 Prevalence of Overweight

Students whose weight-for-height is greater than 2 standard deviations compared to WHO growth standard are considered overweight. Overweight and obese children are more likely to stay obese into adulthood and more likely to develop NCDs at a younger age18).

14 Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia The data showed that 3.2% of students in total were overweight. The prevalence of overweight is higher among urban (2.1%) than rural students (0.1%) and highest among children aged 6 (2.8%). Although, in the majority of provinces students are not overweight, Phnom Penh and Siem Reap stand out with 3.7% and 1.2% prevalence of overweight among students, respectively.

Table 2-4: Nutritional status of children by gender, age, and province EƵƚƌŝƚŝŽŶĂůƐƚĂƚƵƐŽĨĐŚŝůĚƌĞŶďǇĂŐĞŐƌŽƵƉĂŶĚƉƌŽǀŝŶĐĞƐ

,ĞŝŐŚƚͲĨŽƌͲĂŐĞ tĞŝŐŚƚͲĨŽƌͲŚĞŝŐŚƚ tĞŝŐŚƚͲĨŽƌͲĂŐĞΎ

EƵŵďĞƌ WĞƌĐĞŶƚͲ WĞƌĐĞŶƚͲ WĞƌĐĞŶƚͲ WĞƌĐĞŶƚͲ WĞƌĐĞŶƚͲ WĞƌĐĞŶƚͲ WĞƌĐĞŶƚͲ WĞƌĐĞŶƚͲ ŽĨ ĂŐĞ ĂŐĞ DĞĂŶ ĂŐĞ ĂŐĞ ĂŐĞ DĞĂŶ ĂŐĞ ĂŐĞ ĂŐĞ DĞĂŶ ĂĐŬŐƌŽƵŶĚ ŚŝůĚƌĞŶ ďĞůŽǁ ďĞůŽǁ ďĞůŽǁ ďĞůŽǁ ĂďŽǀĞ ďĞůŽǁ ďĞůŽǁ ĂďŽǀĞ ŚĂƌĂĐƚĞƌŝƐƚŝĐ ;EͿ ͲƐĐŽƌĞ ͲƐĐŽƌĞ ͲƐĐŽƌĞ Ͳϯ^ ͲϮ^ΎΎ Ͳϯ^ ͲϮ^ΎΎ нϮ^ Ͳϯ^ ͲϮ^ΎΎ нϮ^ ;^Ϳ ;^Ϳ ;^Ϳ ŐĞŐƌŽƵƉ;ǇĞĂƌƐͿ ϲ ϰ͘Ϯ ϮϮ͘Ϯ Ͳϭ͘Ϯϰ ϭ͘ϰ ϰ͘Ϯ Ϯ͘ϴ ͲϬ͘ϳϱ ϰ͘Ϯ ϮϮ͘Ϯ ϭ͘ϰ Ͳϭ͘ϯϭ ϳϮ ϳʹϵ ϱ͘Ϯ Ϯϱ͘ϰ Ͳϭ͘ϯϲ Ϭ͘ϳ ϵ͘ϳ Ϭ͘ϳ ͲϬ͘ϵϮ ϳ͘ϴ ϯϮ͘Ϭ Ϭ͘ϳ Ͳϭ͘ϱϬ ϰϮϮ ϭϬʹϭϮ ϭϭ͘Ϯ ϰϯ͘Ϭ Ͳϭ͘ϳϲ Ϯ͘ϲ ϭϴ͘ϴ Ϭ͘ϲ Ͳϭ͘ϭϮ ϭϯ͘ϰ ϱϱ͘ϰ Ͳ ͲϮ͘ϬϮ ϱϯϮ ϭϯʹϭϱ ϭϮ͘ϴ ϯϲ͘ϵ Ͳϭ͘ϳϮ ϯ͘ϯ ϭϵ͘ϰ Ϭ͘ϭ Ͳϭ͘Ϭϯ ͲͲͲͲϲϳϬ ϭϲʹϭϳ ϰ͘Ϭ ϮϮ͘Ϯ Ͳϭ͘ϯϰ Ϭ͘ϵ ϴ͘ϲ Ϭ͘ϯ ͲϬ͘ϴϯ ͲͲͲͲϯϮϰ

^Ğǆ ŽǇ ϭϭ͘ϰ ϯϲ͘ϴ Ͳϭ͘ϲϳ Ϯ͘ϴ ϭϲ͘ϳ Ϭ͘ϲ Ͳϭ͘ϭϭ ϴ͘ϲ ϯϱ͘ϯ Ϭ͘ϴ Ͳϭ͘ϱϯ ϵϱϵ 'ŝƌů ϳ͘ϰ ϮϮ͘ϲ Ͳϭ͘ϱϬ ϭ͘ϱ ϭϯ͘ϰ Ϭ͘ϰ ͲϬ͘ϴϴ ϴ͘Ϯ ϯϱ͘ϭ Ϭ͘ϲ Ͳϭ͘ϲϭ ϭ͕Ϭϲϭ

ZĞƐŝĚĞŶĐĞ hƌďĂŶ ϰ͘ϳ ϮϬ͘ϰ Ͳϭ͘ϮϬ ϭ͘Ϭ ϭϬ͘ϰ Ϯ ͲϬ͘ϳϲ Ϯ͘ϳ ϮϮ͘ϭ ϭ͘ϴ Ͳϭ͘Ϭϱ ϰϬϮ ZƵƌĂů ϭϬ͘ϰ ϯϲ͘ϰ Ͳϭ͘ϲϳ Ϯ͘ϰ ϭϲ͘ϭ Ϭ͘ϭ Ͳϭ͘Ϭϱ ϵ͘ϳ ϯϴ͘ϭ Ϭ͘ϰ Ͳϭ͘ϳϬ ϭ͕ϲϭϴ

WƌŽǀŝŶĐĞ ĂŶƚĞĂǇDĞĂŶĐŚĞǇ ϰ͘ϯ Ϯϳ͘ϳ Ͳϭ͘ϰϬ ϭ͘ϭ ϱ͘ϯ Ϭ ͲϬ͘ϳϲ ϵ͘ϲ Ϯϰ͘ϱ Ϭ Ͳϭ͘ϰϯ ϵϰ ĂƚƚĂŵďĂŶŐ ϵ͘ϯ ϯϱ͘ϯ Ͳϭ͘ϱϰ Ϭ ϭϬ͘ϳ Ϭ͘ϳ ͲϬ͘ϴϴ ϵ͘ϭ Ϯϵ͘ϭ Ϭ Ͳϭ͘ϱϲ ϭϱϬ <ĂŵƉŽŶŐŚĂŵ ϭϯ͘ϭ ϯϳ͘Ϯ Ͳϭ͘ϳϬ ϰ͘Ϭ Ϯϭ͘Ϯ Ϭ Ͳϭ͘ϭϳ ϭϯ͘ϵ ϰϰ͘ϰ Ϭ Ͳϭ͘ϴϮ Ϯϳϰ <'ŚŚŶĂŶŐ ϭϬ͘Ϭ ϰϮ͘ϵ Ͳϭ͘ϴϳ Ϭ ϴ͘ϲ Ϭ Ͳϭ͘ϬϬ ϲ͘ϵ ϰϭ͘ϰ Ϭ Ͳϭ͘ϳϮ ϳϬ <ĂŵƉŽŶŐ^ƉĞƵ ϳ͘Ϭ ϯϯ͘ϵ Ͳϭ͘ϳϭ Ϭ͘ϵ ϭϲ͘ϱ Ϭ Ͳϭ͘Ϭϴ ϭϭ͘ϭ ϰϬ͘ϳ Ϭ Ͳϭ͘ϲϳ ϭϭϱ <ĂŵƉŽŶŐdŚŽŵ ϭϮ͘ϭ ϰϱ͘ϴ Ͳϭ͘ϳϰ ϭ͘ϵ ϭϱ͘Ϭ Ϭ Ͳϭ͘Ϭϳ ϭϮ͘ϭ ϯϯ͘ϯ Ϭ Ͳϭ͘ϰϵ ϭϬϳ <ĂŵƉŽƚ ϭϭ͘Ϭ Ϯϲ͘ϴ Ͳϭ͘ϰϰ Ϯ͘ϰ ϭϴ͘ϯ Ϭ Ͳϭ͘ϭϳ ϭϲ͘ϳ ϰϰ͘ϰ ϱ͘ϲ Ͳϭ͘ϴϮ ϴϮ <ĂŶĚĂů ϲ͘ϯ Ϯϱ͘ϳ Ͳϭ͘ϰϰ ϰ ϮϬ͘Ϭ Ϭ͘ϲ Ͳϭ͘Ϭϯ ϭϬ͘ϲ ϰϬ͘ϰ Ϯ͘ϭ Ͳϭ͘ϯϬ ϭϳϱ <ŽŚ<ŽŶŐ Ϭ ϴ͘ϯ ͲϬ͘ϯϵ Ϭ ϴ͘ϯ Ϭ ͲϬ͘ϲϴ Ϭ Ϭ Ϭ Ϭ ϭϮ <ƌĂƚŝĞ ϵ͘ϲ ϯϲ͘ϱ Ͳϭ͘ϴϬ Ϭ ϭϵ͘Ϯ Ϭ Ͳϭ͘ϭϴ ϭϴ͘Ϯ ϰϬ͘ϵ Ϭ Ͳϭ͘ϴϵ ϱϮ DŽŶĚƵůŬŝƌŝ Ϭ ϮϬ͘Ϭ Ͳϭ͘ϯϱ Ϭ ϭϬ͘Ϭ Ϭ Ͳϭ͘Ϭϯ Ϭ Ϭ Ϭ Ϭ ϭϬ WŚŶŽŵWĞŶŚ Ϯ͘Ϯ ϭϳ͘Ϭ Ͳϭ͘ϭϮ ϭ͘ϱ ϳ͘ϰ ϯ͘ϳ ͲϬ͘ϲϳ Ϯ͘ϭ Ϯϭ͘ϯ Ϯ͘ϭ Ͳϭ͘Ϭϭ ϭϯϱ WƌĞĂŚsŝŚĞĂƌ ϲ͘ϳ ϯϯ͘ϯ Ͳϭ͘ϳϰ Ϭ ϭϬ͘Ϭ Ϭ ͲϬ͘ϴϴ Ϭ Ϯϳ͘ϯ Ϭ Ͳϭ͘ϰϯ ϯϬ WƌĞǇsĞŶŐ ϴ͘Ϯ ϯϳ͘ϯ Ͳϭ͘ϲϱ ϭ͘ϱ ϭϳ͘ϴ Ϭ͘ϳ Ͳϭ͘Ϭϲ ϭϮ͘Ϯ ϰϲ͘ϯ Ϯ͘ϰ Ͳϭ͘ϴϭ ϭϯϰ WƵƌƐĂƚ ϭϭ͘Ϭ ϯϴ͘ϰ Ͳϭ͘ϲϵ ϭ͘ϰ ϭϱ͘ϭ Ϭ Ͳϭ͘Ϭϰ ϱ͘Ϭ ϯϱ͘Ϭ Ϭ Ͳϭ͘ϳϭ ϳϯ ZĂƚĂŶĂŬŝƌŝ Ϭ ϮϮ͘Ϯ Ͳϭ͘Ϯϱ Ϭ ϭϬ͘ϱ Ϭ Ͳϭ͘Ϭϱ Ϭ ϮϮ͘Ϯ Ϭ Ͳϭ͘ϱϳ ϭϵ ^ŝĞŵZĞĂƉ ϳ͘ϯ Ϯϵ͘ϵ Ͳϭ͘ϱϮ Ϯ͘ϰ ϭϱ͘Ϯ ϭ͘Ϯ ͲϬ͘ϴϯ ϰ͘ϵ ϭϵ͘ϳ Ϭ Ͳϭ͘ϰϲ ϭϲϰ ^ŝŚĂŶŽƵŬsŝůůĞ ϭϬ͘Ϭ ϯϯ͘ϯ Ͳϭ͘ϰϲ Ϭ ϯ͘ϯ Ϭ ͲϬ͘ϲϱ Ϭ Ϯϳ͘ϯ Ϭ Ͳϭ͘ϯϱ ϯϬ ^ƚƵŶŐdƌĞŶŐ ϭϴ͘ϴ ϰϯ͘ϴ Ͳϭ͘ϵϲ Ϭ ϭϱ͘ϲ Ϭ Ͳϭ͘ϬϬ Ϭ ϳϱ͘Ϭ Ϭ ͲϮ͘ϭϴ ϯϮ ^ǀĂǇZŝĞŶŐ ϭϲ͘ϵ ϰϯ͘ϳ Ͳϭ͘ϴϮ Ϯ͘ϴ ϭϭ͘ϯ Ϭ ͲϬ͘ϴϳ ϭϮ͘ϱ ϯϭ͘ϯ Ϭ Ͳϭ͘ϳϱ ϳϭ dĂŬĞŽ ϳ͘ϳ Ϯϳ͘ϳ Ͳϭ͘ϱϱ ϰ͘ϲ ϭϱ͘ϰ Ϭ Ͳϭ͘Ϭϱ ϳ͘ϱ ϰϱ͘Ϭ Ϭ Ͳϭ͘ϴϯ ϭϯϬ KƚĚĂƌDĞĂŶĐŚĞǇ ϮϮ͘ϲ ϰϭ͘ϵ Ͳϭ͘ϲϯ ϯ͘Ϯ ϭϮ͘ϵ Ϭ ͲϬ͘ϴϳ ϭϬ͘Ϭ Ϭ Ϭ ͲϬ͘ϵϱ ϯϭ <ĞƉ ϮϬ͘Ϭ ϱϯ͘ϯ Ͳϭ͘ϵϰ ϯ͘ϯ Ϯϯ͘ϯ Ϭ Ͳϭ͘ϯϵ Ϭ ϰϬ͘Ϭ Ϭ ͲϮ͘Ϭϭ ϯϬ

dŽƚĂů ϵ͘ϯ ϯϯ͘Ϯ Ͳϭ͘ϱϴ Ϯ͘ϭ ϭϱ͘Ϭ Ϭ͘ϱ ͲϬ͘ϵϵ ϴ͘ϰ ϯϱ͘ϭ Ϭ͘ϳ Ͳϭ͘ϱϳ Ϯ͕ϬϮϬ

ΎtĞŝŐŚƚĨŽƌĂŐĞĐĂƚĞŐŽƌǇĚŽĞƐŶŽƚŝŶĐůƵĚĞƐƚƵĚĞŶƚƐŽǀĞƌϭϭǇĞĂƌŽůĚ͘ ΎΎ/ŶĐůƵĚĞƐƐƚƵĚĞŶƚƐфͲϯ^;ďĞůŽǁŵŝŶƵƐƚŚƌĞĞƐƚĂŶĚĂƌĚĚĞǀŝĂƚŝŽŶƐͿĨƌŽŵƚŚĞt,KŚŝůĚ'ƌŽǁƚŚ^ƚĂŶĚĂƌĚƐƉŽƉƵůĂƚŝŽŶŵĞĚŝĂŶ͘

Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia 15 2.5 Food Consumption and Nutrient Intakes 2.5.1 Food consumption by students

Frequency of consumption of selected food groups by students is summarized in Table 2-5. Fruits: The result showed that 86.7% of students ate fruit at least one day a week. Among those, the most common answer (23.7%) was 2 days per week (Table 2-5).

Vegetables: Almost all students (95.9 %) ate vegetable at least one day a week. Among those, the most common answer (31.1%) was 7 days per week (Table 2-5).

Meat: Animal meat was found to be consumed by 91.3% of students at least one day per week. Among those, the most common answer (22.3%) was 3 days per week (Table 2-5).

Fish/poultry or seafood: Fish/poultry or seafood was found to be consumed by almost all students (99.3%) at least one day per week. As fish is widely available in Cambodia, 30.0% of students consumed 7 days per week (Table 2-5).

Milk/Soy milk: In Cambodia, it is not common to consume fresh milk as it is produced in very few amount domestically and not everyone has access to it due to its availability and price. However, around a half (45.9%) of students did drink milk or soymilk at least one day a week. The most common answer (11.6%) was 2 days in a week (Table 2-5). Further, 6.5% of students answered that they consumed unsweetened whole milk while 7.9% of students consumed sweetened whole milk. (Data not shown here)

Junk food consumption: The majority of students (86.6%) consumed junk food at least one day a week. The most common answer (21.9%) was 7 days per week (Table 2-5).

Soft drink consumption: The majority of students (84.3%) consumed soft drink which contain a lot of sugar at least one day per week. The most common answer (18.4%) was 2 days per week (Table 2-5).

16 Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Table 2-5: Frequency of food consumption by students (n=2,020)

WĞƌ &ŝƐŚͬ &ƌƵŝƚ sĞŐĞƚĂďůĞ DĞĂƚ DŝůŬ :ƵŶŬĨŽŽĚ ^ŽĨƚĚƌŝŶŬ ǁĞĞŬ ƉŽƵůƚƌǇ EŽŶĞ ϭϯ͘ϯй ϰ͘ϭй ϴ͘ϳй Ϭ͘ϳй ϱϰ͘ϭй ϭϯ͘ϰй ϭϱ͘ϳй ϭĚĂǇ ϭϲ͘ϴй Ϯ͘ϰй ϭϬ͘ϵй Ϯ͘Ϯй ϭϭ͘ϭй ϳ͘Ϭй ϭϮ͘ϱй ϮĚĂǇƐ Ϯϯ͘ϳй ϳ͘ϳй ϭϵ͘ϴй ϭϬ͘ϭй ϭϭ͘ϲй ϭϰ͘ϴй ϭϴ͘ϰй ϯĚĂǇƐ ϮϮ͘ϱй ϭϳ͘Ϭй ϮϮ͘ϯй ϭϰ͘ϳй ϵ͘Ϯй ϭϲ͘Ϯй ϭϲ͘ϴй ϰĚĂǇƐ ϴ͘ϯй ϭϱ͘Ϭй ϭϮ͘ϴй ϭϲ͘ϳй ϯ͘ϲй ϴ͘Ϭй ϴ͘ϴй ϱĚĂǇƐ ϳ͘ϲй ϭϲ͘ϳй ϭϮ͘ϯй ϭϳ͘ϭй ϯ͘ϱй ϭϬ͘Ϭй ϵ͘ϰй ϲĚĂǇƐ ϭ͘ϱй ϲ͘Ϭй ϯ͘ϰй ϴ͘ϰй ϭ͘ϱй ϴ͘ϳй ϲ͘ϰй ϳĚĂǇƐ ϲ͘ϯй ϯϭ͘ϭй ϵ͘ϴй ϯϬ͘Ϭй ϱ͘ϰй Ϯϭ͘ϵй ϭϭ͘ϴй

Typical meal composition: The type of meal pattern was questioned to identify the typical meal composition. The most common type of meal seemed to be composed of rice with soup or sweetened stew (41%) followed by rice with soup and deep-fried/grilled dish (32%) (Figure 2-3).

Figure 2-3: Typical meal pattern

dǇƉŝĐĂůDĞĂůWĂƚƚĞƌŶ

͗ZŝĐĞǁŝƚŚƐŽƵƉŽƌ '͗ϱй ƐǁĞĞƚĞŶĞĚƐƚĞǁ &͗ϯй ͗ZŝĐĞǁŝƚŚƐƚŝƌͲĨƌŝĞĚĚŝƐŚ

͗ϰϭй ͗ZŝĐĞǁŝƚŚĚĞĞƉͲ ͗ϯϮй ĨƌŝĞĚͬŐƌŝůůĞĚĚŝƐŚ

͗ZŝĐĞǁŝƚŚƐŽƵƉĂŶĚƐƚŝƌͲ ĨƌŝĞĚĚŝƐŚ

͗ZŝĐĞǁŝƚŚƐŽƵƉĂŶĚ ͗ϰй ͗ϭϭй ĚĞĞƉͲĨƌŝĞĚͬŐƌŝůůĞĚĚŝƐŚ ͗ϰй

Common seasoning: The common seasonings consumed were salt (99.5%), oil/fat (98.6%) and MSG/ Rosdee/Knorr (99.4%) (Table 2-6).

Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia 17 Table 2-6: Common seasoning consumed DƵůƚŝƉůĞĂŶƐǁĞƌƐ sĂƌŝĂďůĞƐ ůů;йͿ ZƵƌĂů hƌďĂŶ EƵŵďĞƌŽĨƌĞƐƉŽŶĚĞŶƚƐ Ϯ͕ϬϮϬ ϭ͕ϲϭϴ ϰϬϮ

ŽŵŵŽŶƐĞĂƐŽŶŝŶŐ ĐŽŶƐƵŵĞĚ WĂůŵƐƵŐĂƌ ϳϭϯ;ϯϱ͘ϯйͿ ϱϰϳ;ϯϯ͘ϴйͿ ϭϲϲ;ϰϭ͘ϯйͿ tŚŝƚĞƐƵŐĂƌ ϭ͕ϴϲϵ;ϵϮ͘ϱйͿ ϭ͕ϰϴϬ;ϵϭ͘ϱйͿ ϯϴϵ;ϵϲ͘ϴйͿ &ŝƐŚƐĂƵĐĞ ϭ͕ϴϮϮ;ϵϬ͘ϮйͿ ϭ͕ϰϱϬ;ϴϵ͘ϲйͿ ϯϳϮ;ϵϮ͘ϱйͿ ^ŽǇƐĂƵĐĞ ϳϵϴ;ϯϵ͘ϱйͿ ϱϲϮ;ϯϰ͘ϳйͿ Ϯϯϲ;ϱϴ͘ϳйͿ KǇƐƚĞƌƐĂƵĐĞ ϱϳϳ;Ϯϴ͘ϲйͿ ϯϳϱ;Ϯϭ͘ϮйͿ ϮϬϮ;ϱϬ͘ϯйͿ ^Ăůƚ Ϯ͕ϬϬϵ;ϵϵ͘ϱйͿ ϭ͕ϲϭϮ;ϵϵ͘ϲйͿ ϯϵϳ;ϵϴ͘ϴйͿ D^'ͬZŽƐĚĞĞͬ<ŶŽƌƌ Ϯ͕ϬϬϳ;ϵϵ͘ϰйͿ ϭ͕ϲϭϭ;ϵϵ͘ϲйͿ ϯϵϲ;ϵϴ͘ϱйͿ ŚŝůůŝƐĂƵĐĞ ϯϲϯ;ϭϴ͘ϬйͿ Ϯϱϳ;ϭϱ͘ϵйͿ ϭϬϲ;Ϯϲ͘ϰйͿ sŝŶĞŐĂƌ Ϯϭϲ;ϭϬ͘ϳйͿ ϭϲϱ;ϭϬ͘ϮйͿ ϱϭ;ϭϮ͘ϳйͿ Kŝůͬ&Ăƚ ϭ͕ϵϵϭ;ϵϴ͘ϲйͿ ϭ͕ϱϵϮ;ϵϴ͘ϰйͿ ϯϵϵ;ϵϵ͘ϯйͿ KƚŚĞƌƐ ϵϭϵ;ϰϱ͘ϱйͿ ϴϭϱ;ϱϬ͘ϰйͿ ϭϬϰ;Ϯϱ͘ϵйͿ

2.5.2 Nutrient Intakes by Students

Energy: In comparison between urban and rural area, the average amount of stdents’ total energy intake per day was higher in urban area (1,636 kcal) than that of rural area (1,591kcal) (Figure 2-4). As the amount of energy intake between urban and rural areas differs, the composition of energy intake was also different. As Figure 2-4 shows, the students in rural area were more dependent on carbohydrate as the source of energy than those in urban. On the other hand, the students in urban area consumed more fat than in rural area.

Protein: In comparison between urban and rural area, the result showed that the students in urban area consumed more protein (48.3g) in average than students in rural area (43.9g). Further, boys consumed 47.7g of protein in average and 42.2g for girls, but in terms of energy contribution, both were not so much different from each other (Figure 2-4, 2-5).

Fat: Like protein, more fat was consumed by urban students (17.7% from total energy) than students in rural (14.4% from total energy) in average. In comparison between genders, fat intake was 14.4% for boys and 15.6% for girls in average, and girls’ fat consumption was contributing more to their total energy intake than that of boys (Figure 2-4, 2-5).

18 Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Carbohydrate: All students consumed well amount of carbohydrate. When its intakes were compared ŶĞƌŐǇŝƐƚƌŝďƵƚŝŽŶĨŽƌhƌďĂŶĂŶĚZƵƌĂů^ƚƵĚĞŶƚƐin the macronutrient distribution chart, only a slight difference was ,K WZK &d observedhƌďĂŶ between boys and girls (Figure 2-5). However, it seemed that students in ;ϭ͕ϲϯϲ ϳϬ͘ϱ ϭϭ͘ϴ ϭϳ͘ϳ rural areaŬĐĂůͿ were relying more on carbohydrate, rice in this case, as the main source of their energyZƵƌĂů (Figure 2-4). ;ϭ͕ϱϵϭ ϳϰ͘ϲ ϭϭ͘Ϭ ϭϰ͘ϰ ŬĐĂůͿFigure 2-4: Macronutrient distribution (urban vs rural students)

ŽŵƉĂƌŝƐŽŶŽĨDĂĐƌŽŶƵƚƌŝĞŶƚƐŝƐƚƌŝďƵƚŝŽŶ;йƚŽƚĂůĞŶĞƌŐǇͿ ďĞƚǁĞĞŶZƵĂůǀƐhƌďĂŶƐƚƵĚĞŶƚƐ

ZƵƌĂů ϳϰ͘ϲ ϭϭ͘Ϭ ϭϰ͘ϰ ;ϭ͕ϱϵϭŬĐĂůͿ

hƌďĂŶ ϳϬ͘ϱ ϭϭ͘ϴ ϭϳ͘ϳ ;ϭ͕ϲϯϲŬĐĂůͿ

Ϭ ϭϬ ϮϬ ϯϬ ϰϬ ϱϬ ϲϬ ϳϬ ϴϬ ϵϬ ϭϬϬ

,K WZK &d ;йͿ

Figure 2-5: Macronutrient distribution (boys vs girls)

ŽŵƉĂƌŝƐŽŶŽĨDĂĐƌŽŶƵƚƌŝĞŶƚƐŝƐƚƌŝďƵƚŝŽŶ;йƚŽƚĂůĞŶĞƌŐǇͿ ĨŽƌŽǇƐĂŶĚ'ŝƌůƐ

'ŝƌůƐ ϳϯ͘Ϯ ϭϭ͘Ϯ ϭϱ͘ϲ ;ϭ͕ϱϬϮŬĐĂůͿ

ŽǇƐ ϳϰ͘ϰ ϭϭ͘Ϯ ϭϰ͘ϰ ;ϭ͕ϳϬϵŬĐĂůͿ

Ϭ ϭϬ ϮϬ ϯϬ ϰϬ ϱϬ ϲϬ ϳϬ ϴϬ ϵϬ ϭϬϬ

,K WZK &d ;йͿ

Calcium: In comparison between the area and gender, Figure 2-6 shows that average amounts of total calcium intake were similar. It was observed that fish-related foods largely contributed to calcium intake for both students in urban and rural areas. The students in urban area were more likely to consume calcium from milk and dairy

Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia 19 products, while the students in rural took more calcium from the food group of condiments and spices, which refers to fish paste in this case.

Figure 2-6: Comparison of calcium intake

ŽŵƉĂƌŝƐŽŶŽĨĂůĐŝƵŵ/ŶƚĂŬĞ

ϰϬϵ ƌƵƌĂů

ƵƌďĂŶ ϰϯϵ

ϯϵϯ ŐŝƌůƐ ϰϬϬ ďŽǇƐ

Ϭ ϱϬ ϭϬϬ ϭϱϬ ϮϬϬ ϮϱϬ ϯϬϬ ϯϱϬ ϰϬϬ ϰϱϬ ϱϬϬ DĞĂŶŽĨĂůĐŝƵŵ/ŶƚĂŬĞ;ŵŐͿ

Iron: In comparison between urban and rural area, the average amount of total Iron intake was different as urban students consumed more than rural students. When compared between gender, boys consumed more iron than girls (Figure 2-7).

Figure 2-7: Comparison of iron intake

ŽŵƉĂƌŝƐŽŶŽĨ/ƌŽŶ/ŶƚĂŬĞ

ϵ ƌƵƌĂů

ƵƌďĂŶ ϭϬ

ϴ͘ϱ ŐŝƌůƐ ϵ͘ϱ ďŽǇƐ

Ϭ Ϯ ϰ ϲ ϴ ϭϬ ϭϮ DĞĂŶŽĨ/ƌŽŶ/ŶƚĂŬĞ;ŵŐͿ

20 Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Sodium: As for sodium intake, there were not much difference between genders. In comparison between urban and rural area, however, it showed a clear difference in the average amount of sodium intake, and urban students consumed more sodium (2,251mg) than rural students (1,840mg) (Figure 2-8).

Figure 2-8: Comparison of sodium intake

ŽŵƉĂƌŝƐŽŶŽĨ^ŽĚŝƵŵ/ŶƚĂŬĞ ϭ͕ϴϰϬ

ƌƵƌĂů Ϯ͕Ϯϱϭ

ƵƌďĂŶ

ϭ͕ϴϵϴ ŐŝƌůƐ

ϭ͕ϵϮϮ ďŽǇƐ

Ϭ ϱϬϬ ϭ͕ϬϬϬ ϭ͕ϱϬϬ Ϯ͕ϬϬϬ Ϯ͕ϱϬϬ

DĞĂŶ^ŽĚŝƵŵ/ŶƚĂŬĞ;ŵŐͿ

2.6 Survey Findings

The survey found that 33.2% of the students were stunted, 15.0% was wasted and 35.1% was underweight. The prevalence of malnutrition among school-aged children (6-17 years old) is estimated to remain still high or is even worsen compared to children under 5 years old. The 2014 Cambodia Demographic and Health Survey19) provides data for the prevalence of malnutrition among children under 5 years old: 32.4% of these children were stunted, 9.6% was wasted and 23.9% was underweight. In the students of age group 10-12 years old, stunted (43.0%) was found the most. Wasted (19.4%) appeared the most in the age group of 13-15 years old and underweight (54.4%) was noticed the most in the age group of 10 years old. In gender comparison, the girls of the age group 10-12 years old should be highlighted. More than 50.0% of the girls in the group were stunted, which leads to serious negative effects on their health especially during reproductive age. Girls with stunting are reported to experience slow secondly growth (puberty) and tend to give birth to an underweight baby. Also, an important issue to consider is that children who are stunted are at risk of becoming overweight and obese later in life. Looking at adult overweight and increasing non-communicable diseases in Cambodia20), the high prevalence of stunting among children is worrisome.

Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia 21 The students were found more malnourished in rural area compared to urban area. In rural schools, a prevalence of malnutrition was 36.4% for stunting, 16.1% for wasting and 38.1% for underweight. While the prevalence of malnutrition in urban school was 20.4%, 10.4% and 22.1% for stunting, wasting and underweight respectively. Poverty and food shortage surely wield influence on malnutrition status of students. The mean scores for stunting (height for age: HAZ) among students from those households that possessed ID poor cards was worse (-1.85) than students from normal households (-1.50). In addition, the mean of HAZ for the students from households that experienced food shortage more than one month in the previous year was worse (-1.92) than students from households not experienced (-1.51). In the survey, some key findings on dietary intake of students should be emphasized. In comparison between urban and rural area, the students in rural area are more dependent on rice as a source of energy than those in urban. On the other hand, the students in urban area consume more foods which contain fat and protein and various kinds of foods than in rural area. The prevalence can be reduced by improving nutrient intakes of school-aged children through increase of awareness regarding their quality of diet. Children and caretakers of these children should be educated about the importance of balanced diet. Consumption of protein and calcium rich food products such as milk, legumes, animal meat and whole small fish etc., should be promoted and increased. Further recommendations and suggestions are made in later chapter.

22 Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Chapter 3 Cambodian Recommended Dietary Allowance (CAM-RDA)

Recommended Dietary Allowance (RDA) refers to the level of intake of energy and dietary components which, on the basis of current scientific knowledge, are considered adequate for the maintenance of health and well-being of nearly all healthy persons in the population. RDA provides the levels of nutrient intake that almost all individuals (97% to 98%) should consume to avoid the risk of deficiency and can reduce the risk for development of non-communicable diseases (NCDs) in a target population21). 3.1 Cambodian Recommended Dietary Allowance (CAM-RDA)

Cambodian Recommended Dietary Allowance (CAM-RDA) for school-aged children was developed for the first time in Cambodia through data collection from a nation-wide survey among school-aged children in 2014 and 2015. Energy and nutrient requirements for 19 types of macro- and micronutrients for boys and girls within 5 age groups were calculated based on the reference body weight of Cambodian school-aged children.

The RDA energy and nutrient requirements are used to formulate food-based dietary guidelines (FBDG) that are applicable to the target populations. FBDG developed in a specific cultural context based on RDA can be useful for nutrition education programs and agriculture planning to bring about positive change in eating habits. It can also be used as the primary reference for making decisions about nutrition policies. Moreover, RDA is used as a basis for food labeling of nutrition facts to indicate nutritional values of a food or food product. It is hoped that this newly developed CAM-RDA is not only the foundation for formulating the FBDG, but that is also to serves as a starting point for the government when developing nutrition policy, planning, and education programs.

&$05'$V ŶĞƌŐǇ WƌŽƚĞŝŶ /ƌŽŶ ZĞĨĞƌĞŶĐĞ ƐƚŝŵĂƚĞĚ ZĞĐŽŵŵĞŶĚĞĚ ŐĞ'ƌŽƵƉΎ ŽĚǇ ǀĞƌĂŐĞ ŝĞƚĂƌǇ ĂůĐŝƵŵ 'ĞŶĚĞƌ >Žǁ DŝĚĚůĞ ,ŝŐŚ Ă͗ŵĞŶƐƚƌƵĂƚŝŽŶ ;zĞĂƌƐͿ tĞŝŐŚƚ ZĞƋƵŝƌĞŵĞŶƚ ůůŽǁĂŶĐĞ ;ZͿΎΎ ;ZͿ ŬŐ ŬĐĂů Ő ŵŐ ŵŐ ;ϰͲͿϲ ϭϵ ϭ͕ϯϬϬ ϭ͕ϱϬϬ ϭ͕ϳϬϬ Ϯϱ ϯϬ ϱϱϬ ϲ͘ϱ ϳͲϵ Ϯϰ ϭ͕ϱϬϬ ϭ͕ϳϬϬ ϭ͕ϵϬϬ ϯϬ ϰϬ ϲϬϬ ϳ͘ϱ ŽǇƐ ϭϬͲϭϮ ϯϬ ϭ͕ϴϬϬ Ϯ͕ϭϬϬ Ϯ͕ϯϬϬ ϰϬ ϱϬ ϳϱϬ ϳ͘Ϭ ϭϯͲϭϱ ϰϮ Ϯ͕ϮϬϬ Ϯ͕ϱϬϬ Ϯ͕ϳϬϬ ϰϱ ϲϬ ϴϱϬ ϭϮ͘Ϭ ϭϲͲϭϳ;ϭϴͿ ϱϯ Ϯ͕ϱϬϬ Ϯ͕ϴϬϬ ϯ͕ϭϬϬ ϰϱ ϲϬ ϳϱϬ ϵ͘Ϭ ;ϰͲͿϲ ϭϴ ϭ͕ϯϬϬ ϭ͕ϱϬϬ ϭ͕ϲϬϬ Ϯϱ ϯϬ ϱϬϬ ϲ͘Ϭ ϳͲϵ Ϯϰ ϭ͕ϱϬϬ ϭ͕ϳϬϬ ϭ͕ϵϬϬ ϯϬ ϰϬ ϲϱϬ ϴ͘Ϭ Ă 'ŝƌůƐ ϭϬͲϭϮ ϯϭ ϭ͕ϳϬϬ Ϯ͕ϬϬϬ Ϯ͕ϮϬϬ ϰϬ ϱϬ ϴϱϬ ϵ͘Ϭ ͬϭϯ͘ϱ ϭϯͲϭϱ ϰϯ Ϯ͕ϬϬϬ Ϯ͕ϮϬϬ Ϯ͕ϱϬϬ ϰϬ ϱϬ ϳϱϬ ϵ͘ϱ ͬϭϯ͘ϱ Ă ϭϲͲϭϳ;ϭϴͿ ϰϴ Ϯ͕ϭϬϬ Ϯ͕ϯϬϬ Ϯ͕ϲϬϬ ϰϬ ϱϬ ϲϱϬ ϲ͘Ϭ ͬϭϬ͘Ϭ Ă

dŚŝĂŵŝŶ ŐĞ'ƌŽƵƉ ŝŶĐ /ŽĚŝŶĞ ^ĞůĞŶŝƵŵ sŝƚĂŵŝŶ sŝƚĂŵŝŶ sŝƚĂŵŝŶ ZŝďŽĨůĂǀŝŶ;sϮͿ 'ĞŶĚĞƌ ;sϭͿ ;zĞĂƌƐͿ ŵŐ ʅŐ ŵŐ ʅŐ ʅŐ ŵŐ ŵŐ ŵŐ ;ϰͲͿϲ ϱ͘ϱ ϵϬ ϮϬ ϰϱϬ ϱ ϯϬ Ϭ͘ϲ Ϭ͘ϲ ϳͲϵ ϱ͘ϱ ϭϭϬ ϮϬ ϰϱϬ ϱ ϯϬ Ϭ͘ϴ Ϭ͘ϴ ŽǇƐ ϭϬͲϭϮ ϲ͘Ϭ ϭϭϬ ϯϬ ϱϱϬ ϱ ϲϬ ϭ͘Ϯ ϭ͘ϯ ϭϯͲϭϱ ϴ͘Ϭ ϭϰϬ ϯϬ ϱϱϬ ϱ ϲϬ ϭ͘ϭ ϭ͘Ϯ ϭϲͲϭϳ;ϭϴͿ ϴ͘ϱ ϭϰϬ ϯϬ ϲϬϬ ϱ ϲϬ ϭ͘ϭ ϭ͘Ϯ ;ϰͲͿϲ ϱ͘ϱ ϴϬ ϮϬ ϰϬϬ ϱ ϯϬ Ϭ͘ϲ Ϭ͘ϲ ϳͲϵ ϱ͘ϱ ϭϭϬ ϮϬ ϰϱϬ ϱ ϯϬ Ϭ͘ϴ Ϭ͘ϴ 'ŝƌůƐ ϭϬͲϭϮ ϱ͘ϱ ϭϭϬ Ϯϱ ϱϱϬ ϱ ϲϬ ϭ͘ϭ ϭ͘Ϭ ϭϯͲϭϱ ϳ͘Ϭ ϭϰϬ Ϯϱ ϱϱϬ ϱ ϲϬ ϭ͘ϭ ϭ͘Ϭ ϭϲͲϭϳ;ϭϴͿ ϳ͘Ϭ ϭϱϬ Ϯϱ ϲϬϬ ϱ ϲϬ ϭ͘ϭ ϭ͘Ϭ

EŝĂĐŝŶ &ĂƚΎΎΎ ^ŽĚŝƵŵ ŐĞ'ƌŽƵƉ &ŽůĂƚĞ ŝĞƚĂƌǇ&ŝďƌĞ WŽƚĂƐƐŝƵŵ WŚŽƐƉŚŽƌƵƐ ŽƉƉĞƌ 'ĞŶĚĞƌ ;sϯͿ ;ŵĞĚŝĂŶͿ ;^ĂůƚΎΎΎΎͿ ;zĞĂƌƐͿ ŵŐ ʅŐ й Ő ŵŐ;ŐͿ ŵŐ ŵŐ ŵŐ ;ϰͲͿϲ ϴ ϮϬϬ ϮϬͲϯϬ;ϮϱͿ ϴ ϭ͕ϲϬϬ;ϰͿ ϭ͕ϯϬϬ ϱϬϬ Ϭ͘ϱ ϳͲϵ ϭϭ ϯϬϬ ϮϬͲϯϬ;ϮϱͿ ϭϬ ϭ͕ϲϬϬ;ϰͿ ϭ͕ϰϬϬ ϲϬϬ Ϭ͘ϱ ŽǇƐ ϭϬͲϭϮ ϭϱ ϰϬϬ ϮϬͲϯϬ;ϮϱͿ ϭϮ ϭ͕ϲϬϬ;ϰͿ ϭ͕ϳϬϬ ϴϱϬ Ϭ͘ϲ ϭϯͲϭϱ ϭϱ ϰϬϬ ϮϬͲϯϬ;ϮϱͿ ϭϱ Ϯ͕ϬϬϬ;ϱͿ Ϯ͕ϬϬϬ ϵϱϬ Ϭ͘ϴ ϭϲͲϭϳ;ϭϴͿ ϭϱ ϰϬϬ ϮϬͲϯϬ;ϮϱͿ ϭϴ Ϯ͕ϬϬϬ;ϱͿ Ϯ͕ϯϬϬ ϵϱϬ ϭ͘Ϭ ;ϰͲͿϲ ϴ ϮϬϬ ϮϬͲϯϬ;ϮϱͿ ϴ ϭ͕ϲϬϬ;ϰͿ ϭ͕ϰϬϬ ϰϱϬ Ϭ͘ϱ ϳͲϵ ϭϭ ϯϬϬ ϮϬͲϯϬ;ϮϱͿ ϭϬ ϭ͕ϲϬϬ;ϰͿ ϭ͕ϳϬϬ ϱϱϬ Ϭ͘ϱ 'ŝƌůƐ ϭϬͲϭϮ ϭϱ ϰϬϬ ϮϬͲϯϬ;ϮϱͿ ϭϮ ϭ͕ϲϬϬ;ϰͿ Ϯ͕ϬϬϬ ϴϱϬ Ϭ͘ϲ ϭϯͲϭϱ ϭϱ ϰϬϬ ϮϬͲϯϬ;ϮϱͿ ϭϱ Ϯ͕ϬϬϬ;ϱͿ Ϯ͕ϮϬϬ ϵϬϬ Ϭ͘ϳ ϭϲͲϭϳ;ϭϴͿ ϭϱ ϰϬϬ ϮϬͲϯϬ;ϮϱͿ ϭϲ Ϯ͕ϬϬϬ;ϱͿ Ϯ͕ϯϬϬ ϵϬϬ Ϭ͘ϳ

* 4, 5 years old and 18 years old were excluded from the data collection. ** EAR (Estimated Average Requirement) is the intake level for a nutrient at which the needs of 50 percent of the population will be met22). *** Fat percentage from total energy ****Sodium chloride Note that the figures are rounded for the final CAM-RDA. The actual quatitative amounts are showed in the colored column in the following pages.

24 Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia 3.2 Formula to calculate CAM-RDA

Table 3-1: CAM-RDA for school-aged children

'ĞŶĚĞƌ ŐĞŐƌŽƵƉ;ǇĞĂƌƐͿ ŽǇƐ ;ϰͲͿϲ ϳͲϵ ϭϬͲϭϮ ϭϯͲϭϱ ϭϲͲϭϳ;ϭϴͿ 'ŝƌůƐ ;ϰͲͿϲ ϳͲϵ ϭϬͲϭϮ ϭϯͲϭϱ ϭϲͲϭϳ;ϭϴͿ

All energy and nutrient requirements were calculated based on each age group. Students’ ages were divided into five groups in accordance with the SEA (Southeast Asian)-RDA table. However, while the school age in Cambodia is 6 to 17 years, other ages like 4 or 18 years remained in the table in parentheses as a reference. The *LUOV classificationDJH of CAM-RDA age groups was set as shown in (Table 3-2). 6($ &$0 &$0 5'$V 'DWD 5'$V Reference body weights used for Cambodian school-aged children were set at the mid-point between the median of the survey data and the SEA-RDA. Figure 3-1: Line graph of CAM-RDA reference body weight of boys

ϲϬ͘Ϭ

ϱϬ͘Ϭ

ϰϬ͘Ϭ

ϯϬ͘Ϭ ŽĚǇǁĞŝŐŚƚ;ŬŐͿ ϮϬ͘Ϭ

ϭϬ͘Ϭ

Ϭ͘Ϭ ;ϰͲͿϲ ϳͲϵ ϭϬͲϭϮ ϭϯͲϭϱ ϭϲͲϭϳ;ϭϴͿ ^ͲZƐ ϮϬ͘Ϭ Ϯϳ͘Ϭ ϯϲ͘Ϭ ϰϱ͘Ϭ ϰϵ͘Ϭ DͲĂƚĂ ϭϲ͘ϱ ϮϬ͘ϲ Ϯϲ͘ϵ ϰϬ͘ϰ ϰϲ͘ϳ DͲZƐ ϭϴ͘ϯ Ϯϯ͘ϴ ϯϭ͘ϰ ϰϮ͘ϳ ϰϳ͘ϵ ŐĞŐƌŽƵƉ;ǇĞĂƌƐͿĨŽƌŐŝƌůƐ

Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia 25 %R\V DJH 6($ &$0 &$05'$ 5'$ 'DWD Figure 3-2: Line graph of CAM-RDA reference body weight of girls

ϲϬ͘Ϭ

ϱϬ͘Ϭ

ϰϬ͘Ϭ

ϯϬ͘Ϭ

ϮϬ͘Ϭ ŽĚǇǁĞŝŐŚƚ;ŬŐͿ ϭϬ͘Ϭ

Ϭ͘Ϭ ;ϰͲͿϲ ϳͲϵ ϭϬͲϭϮ ϭϯͲϭϱ ϭϲͲϭϳ;ϭϴͿ ^ͲZ ϮϬ͘Ϭ Ϯϳ͘Ϭ ϯϰ͘Ϭ ϰϳ͘Ϭ ϱϲ͘Ϭ DͲĂƚĂ ϭϴ͘ϭ ϮϬ͘ϴ Ϯϲ͘ϱ ϯϳ͘ϲ ϱϬ͘ϭ DͲZ ϭϵ͘ϭ Ϯϯ͘ϵ ϯϬ͘ϯ ϰϮ͘ϯ ϱϯ͘ϭ ŐĞŐƌŽƵƉ;ǇĞĂƌƐͿĨŽƌďŽǇƐ

3.2.1 Energy

The estimated energy requirement (EER) is “the amount of food energy needed to balance energy expenditure in order to maintain body size, body composition and a level of necessary and desirable physical activity, consistent with long term good health”23).

EER for each age group and sex was calculated based on the BMR predictive equations24) along with level of physical activity. The data of the real target group of Cambodian children from the survey were also used for the calculation.

EER= BMR x PAL +Energy deposition

In which:

Note: Energy deposition = Weight gain per year x 1000/365 x Energy density

Basal Metabolic Rate (BMR) is defined as the lowest rate of energy exchange in the body that is related to the organization of bodily functions and the production of body heat. Technically, it is defined as the rate of energy expenditure of a fasted and fully-rested individual in a thermoneutral environment. It can also simply be defined as the minimal rate of energy expenditure compatible with life. The following equations

26 Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia were used to estimate BMR by using reference body weigh in Kg25).

Table 3-3: Reference for BMR predictive equations

ŐĞ;zĞĂƌƐͿ ŽǇƐ;<ĐĂůͬĚĂǇͿ 'ŝƌůƐ;<ĐĂůͬĚĂǇͿ ϯͲϭϬ ϮϮ͘ϳǆtнϰϵϱ ϮϮ͘ϱǆtнϰϵϵ ϭϬͲϭϴ ϭϳ͘ϱǆtнϲϱϭ ϭϮ͘Ϯǆtнϳϰϲ

W = Reference body weight PAL (Physical Activity Level) Japanese table of PAL were used to calculated estimated energy requirement26)

Table 3-4: Physical activity level by age (for both boys and girls)

ŐĞ W> ;zĞĂƌƐͿ >Žǁ DŝĚĚůĞ ,ŝŐŚ ϲ ϭ͘ϯϱ ϭ͘ϱϱ ϭ͘ϳϱ ϳ ϭ͘ϯϱ ϭ͘ϱϱ ϭ͘ϳϱ ϴ ϭ͘ϰϬ ϭ͘ϲϬ ϭ͘ϴϬ ϵ ϭ͘ϰϬ ϭ͘ϲϬ ϭ͘ϴϬ ϭϬ ϭ͘ϰϱ ϭ͘ϲϱ ϭ͘ϴϱ ϭϭ ϭ͘ϰϱ ϭ͘ϲϱ ϭ͘ϴϱ ϭϮ ϭ͘ϱϬ ϭ͘ϳϬ ϭ͘ϵϬ ϭϯ ϭ͘ϱϬ ϭ͘ϳϬ ϭ͘ϵϬ ϭϰ ϭ͘ϱϬ ϭ͘ϳϬ ϭ͘ϵϬ ϭϱ ϭ͘ϱϱ ϭ͘ϳϱ ϭ͘ϵϱ ϭϲ ϭ͘ϱϱ ϭ͘ϳϱ ϭ͘ϵϱ ϭϳ ϭ͘ϱϱ ϭ͘ϳϱ ϭ͘ϵϱ

Table 3-5: Reference value for EER calculation dĂďůĞ͗ϯͲϱ sĂůƵĞŽĨĂůĐƵůĂƚĞĚƐƚŝŵĂƚĞĚ W> &ŽƌŐƌŽǁƚŚ ŶĞƌŐǇZĞƋƵŝƌĞŵĞŶƚ;ZͿ tĞŝŐŚƚ ,ĞŝŐŚƚ DZ ŶĞƌŐǇ ŐĞ ;ŬŐͿ ;ĐŵͿ tĞŝŐŚƚŐĂŝŶ ĚĞŶƐŝƚǇ ŶĞƌŐǇĚĞƉŽƐŝƚŝŽŶ >Žǁ DŝĚĚůĞ ,ŝŐŚ 'ƌŽƵƉ >Žǁ DŝĚĚůĞ ,ŝŐŚ ;zĞĂƌƐͿ ;ŬŐͬǇĞĂƌͿ ;ŬĐĂůͬŐŽĨ ;ŬĐĂůͬĚĂǇͿ ŬĐĂůͬĚĂǇ ŬĐĂůͬĚĂǇ ŬĐĂůͬĚĂǇ ďŽĚǇͿ

ď Đ Ě Ğ Ĩ Ő Śс;ĨǆϭϬϬϬͬϯϲϱͿǆŐ ĚǆĞнŚ ĚǆĞнŚ ĚǆĞнŚ ŽǇƐ ;ϰͲͿϲ ϭϵ͘ϭ ϭϭϮ͘ϱ ϵϮϳ͘ϰ ϭ͘ϯϱ ϭ͘ϱϱ ϭ͘ϳϱ ϰ͘ϴϲ Ϯ͘ϭϬ Ϯϳ͘ϵϴ ϭ͕ϮϴϬ ϭ͕ϰϲϲ ϭ͕ϲϱϭ ϳͲϵ Ϯϯ͘ϵ ϭϮϬ͘Ϯ ϭ͕Ϭϯϳ͘ϴ ϭ͘ϯϴ ϭ͘ϱϴ ϭ͘ϳϴ ϲ͘ϯϱ Ϯ͘ϯϳ ϰϭ͘ϭϳ ϭ͕ϰϳϳ ϭ͕ϲϴϰ ϭ͕ϴϵϮ ϭϬͲϭϮ ϯϬ͘ϯ ϭϯϮ͘ϰ ϭ͕ϭϴϬ͘ϲ ϭ͘ϰϳ ϭ͘ϲϳ ϭ͘ϴϳ ϭϮ͘Ϭϰ Ϯ͘ϱϬ ϴϮ͘ϰϱ ϭ͕ϴϭϰ Ϯ͕ϬϱϬ Ϯ͕Ϯϴϲ ϭϯͲϭϱ ϰϮ͘ϯ ϭϰϵ͘ϲ ϭ͕ϯϵϭ͘ϯ ϭ͘ϱϮ ϭ͘ϳϮ ϭ͘ϵϮ ϭϬ͘ϳϱ ϭ͘ϲϯ ϰϴ͘ϭϭ Ϯ͕ϭϱϴ Ϯ͕ϰϯϲ Ϯ͕ϳϭϱ ϭϲͲϭϳ;ϭϴͿ ϱϯ͘ϭ ϭϲϯ͘ϳ ϭ͕ϱϳϵ͘ϰ ϭ͘ϱϱ ϭ͘ϳϱ ϭ͘ϵϱ Ϭ͘ϬϬΎ ϭ͘ϵϬ Ϭ͘ϬϬΎ Ϯ͕ϰϰϴ Ϯ͕ϳϲϰ ϯ͕ϬϴϬ 'ŝƌůƐ ;ϰͲͿϲ ϭϴ͘ϯ ϭϬϴ͘ϳ ϵϬϵ͘ϲ ϭ͘ϯϱ ϭ͘ϱϱ ϭ͘ϳϱ ϱ͘ϱϱ Ϯ͘ϴϬ ϰϮ͘ϱϴ ϭ͕Ϯϳϭ ϭ͕ϰϱϮ ϭ͕ϲϯϰ ϳͲϵ Ϯϯ͘ϴ ϭϭϵ͘ϱ ϭ͕Ϭϯϰ͘ϱ ϭ͘ϯϴ ϭ͘ϱϴ ϭ͘ϳϴ ϳ͘ϲϯ ϯ͘Ϭϳ ϲϰ͘Ϭϲ ϭ͕ϰϵϱ ϭ͕ϳϬϮ ϭ͕ϵϬϵ ϭϬͲϭϮ ϯϭ͘ϰ ϭϯϰ͘ϰ ϭ͕ϭϮϵ͘ϰ ϭ͘ϰϳ ϭ͘ϲϳ ϭ͘ϴϳ ϭϭ͘Ϯϴ Ϯ͘ϳϯ ϴϰ͘ϰϯ ϭ͕ϳϰϭ ϭ͕ϵϲϳ Ϯ͕ϭϵϯ ϭϯͲϭϱ ϰϮ͘ϳ ϭϰϵ͘ϴ ϭ͕Ϯϲϲ͘ϵ ϭ͘ϱϮ ϭ͘ϳϮ ϭ͘ϵϮ ϱ͘ϭϱ ϯ͘ϱϳ ϱϬ͘ϯϮ ϭ͕ϵϳϮ Ϯ͕ϮϮϱ Ϯ͕ϰϳϵ ϭϲͲϭϳ;ϭϴͿ ϰϳ͘ϵ ϭϱϱ͘Ϭ ϭ͕ϯϮϵ͘ϴ ϭ͘ϱϱ ϭ͘ϳϱ ϭ͘ϵϱ Ϭ͘ϬϬΎ ϰ͘ϳϬ Ϭ͘ϬϬΎ Ϯ͕Ϭϲϭ Ϯ͕ϯϮϳ Ϯ͕ϱϵϯ

*dĂďůĞ͗ϯ͘ϰ 0.00 is set for the calculation as there is no data from the survey ŐĞ W> ;zĞĂƌƐͿ >Žǁ DŝĚĚůĞ ,ŝŐŚ ϲ ϭ͘ϯϱ ϭ͘ϱϱ ϭ͘ϳϱ ϳ ϭ͘ϯϱ ϭ͘ϱϱ ϭ͘ϳϱ ϴ ϭ͘ϰϬ ϭ͘ϲϬ ϭ͘ϴϬ Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia ϵDevelopment ϭ͘ϰϬ ϭ͘ϲϬ of Recommended ϭ͘ϴϬ Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia 27 ϭϬ ϭ͘ϰϱ ϭ͘ϲϱ ϭ͘ϴϱ ϭϭ ϭ͘ϰϱ ϭ͘ϲϱ ϭ͘ϴϱ ϭϮ ϭ͘ϱϬ ϭ͘ϳϬ ϭ͘ϵϬ ϭϯ ϭ͘ϱϬ ϭ͘ϳϬ ϭ͘ϵϬ ϭϰ ϭ͘ϱϬ ϭ͘ϳϬ ϭ͘ϵϬ ϭϱ ϭ͘ϱϱ ϭ͘ϳϱ ϭ͘ϵϱ ϭϲ ϭ͘ϱϱ ϭ͘ϳϱ ϭ͘ϵϱ ϭϳ ϭ͘ϱϱ ϭ͘ϳϱ ϭ͘ϵϱ 3.2.2 Protein

The estimated average requirement (EAR) is key to calculating RDA. For protein, EAR was calculated using the formula below:

EAR = (Protein deposition/ Conversion for utilization for growthx100 + Maintenance requirement / Efficiency of conversion from dietary proteinx100)x RBW

In which: Protein deposition = weight gain x 1000/365 x body protein mass/100/RBW Conversion for utilization for growth = 40% Maintenance requirement= 0.67 Efficiency of conversion from dietary protein = 70 - 85% RBW = CAM reference BW (Cambodia reference body weight)

Table 3-6: Reference value for EAR Protein calculation

dĂďůĞϯͲϲ ZĞĨĞƌĞŶĐĞŽĚǇ tĞŝŐŚƚŐĂŝŶ ŽĚǇƉƌŽƚĞŝŶ WƌŽƚĞŝŶĚĞƉŽƐŝƚŝŽŶ ŽŶǀĞƌƐŝŽŶĨŽƌ DĂŝŶƚĞŶĂŶĐĞ ĨĨŝĐŝĞŶĐǇ sĂůƵĞŽĨĂůĐƵĂƚĞĚ tĞŝŐŚƚ ;ŬŐͬǇĞĂƌͿ ŵĂƐƐ ;ŐƌŽǁƚŚ ƵƚŝůŝǌĂƚŝŽŶĨŽƌ ƌĞƋƵŝƌĞŵĞŶƚ ;ĚŝŐĞƐƚŝŽŶͿŽĨ ƐƚŝŵĂƚĞĚǀĞƌĂŐĞ ;ŬŐͿ ;йͿ ƌĞƋƵŝƌĞŵĞŶƚͿ ŐƌŽǁƚŚ ;ŐͬŬŐͬĚĂǇͿ ĐŽŶǀĞƌƐŝŽŶĨƌŽŵ ZĞƋƵŝƌĞŵĞŶƚ;ZͿ ŐĞ'ƌŽƵƉ ;ŐͬŬŐͬĚĂǇͿ ;йͿ ĚŝĞƚĂƌǇƉƌŽƚĞŝŶ ;ŐͬĚĂǇͿ ;zĞĂƌƐͿ ;йͿ ĂďĐĚ Ğ Ĩ Ő ďǆϭϬϬϬͬϯϲϱǆ ;ĚͬĞǆϭϬϬнĨͬŐǆϭϬϬͿǆ ĨƌŽŵŽƵƌĚĂƚĂ ĨƌŽŵŽƵƌĚĂƚĂ ĐͬϭϬϬͬĂ Ă ŽǇƐ ;ϰͲͿϲ ϭϵ͘ϭ ϰ͘ϴϲ ϭϱ͘ϱ Ϭ͘ϭϭ ϰϬ͘Ϭ Ϭ͘ϲϳ ϳϬ͘Ϭ Ϯϯ͘ϰ ϳͲϵ Ϯϯ͘ϵ ϲ͘ϯϱ ϭϰ͘ϴ Ϭ͘ϭϭ ϰϬ͘Ϭ Ϭ͘ϲϳ ϳϬ͘Ϭ Ϯϵ͘ϯ ϭϬͲϭϮ ϯϬ͘ϯ ϭϮ͘Ϭϰ ϭϯ͘ϵ Ϭ͘ϭϱ ϰϬ͘Ϭ Ϭ͘ϲϳ ϳϲ͘ϳ ϯϳ͘ϵ ϭϯͲϭϱ ϰϮ͘ϯ ϭϬ͘ϳϱ ϭϰ͘ϯ Ϭ͘ϭϬ ϰϬ͘Ϭ Ϭ͘ϲϳ ϴϭ͘ϳ ϰϱ͘Ϯ ϭϲͲϭϳ;ϭϴͿ ϱϯ͘ϭ Ϭ͘ϬϬ ϭϱ͘Ϭ Ϭ͘ϬϬ ϰϬ͘Ϭ Ϭ͘ϲϳ ϴϱ͘Ϭ ϰϭ͘ϴ 'ŝƌůƐ ;ϰͲͿϲ ϭϴ͘ϯ ϱ͘ϱϱ ϭϰ͘ϭ Ϭ͘ϭϮ ϰϬ͘Ϭ Ϭ͘ϲϳ ϳϬ͘Ϭ ϮϮ͘ϴ ϳͲϵ Ϯϯ͘ϴ ϳ͘ϲϯ ϭϯ͘ϴ Ϭ͘ϭϮ ϰϬ͘Ϭ Ϭ͘ϲϳ ϳϬ͘Ϭ ϯϬ͘Ϭ ϭϬͲϭϮ ϯϭ͘ϰ ϭϭ͘Ϯϴ ϭϰ͘ϳ Ϭ͘ϭϰ ϰϬ͘Ϭ Ϭ͘ϲϳ ϳϲ͘ϳ ϯϴ͘ϴ ϭϯͲϭϱ ϰϮ͘ϳ ϱ͘ϭϱ ϭϯ͘ϴ Ϭ͘Ϭϱ ϰϬ͘Ϭ Ϭ͘ϲϳ ϴϭ͘ϳ ϯϵ͘ϵ ϭϲͲϭϳ;ϭϴͿ ϰϳ͘ϵ Ϭ͘ϬϬ ϭϭ͘ϵ Ϭ͘ϬϬ ϰϬ͘Ϭ Ϭ͘ϲϳ ϴϱ͘Ϭ ϯϳ͘ϳ

dĂďůĞϯͲϳ ƐƚŝŵĂƚĞĚ sĂůƵĞŽĨ TheŐĞ'ƌŽƵƉ aboveǀĞƌĂŐĞ calculatedŽĞĨĨŝĐŝĞŶƚŽĨ EARĂůĐƵůĂƚĞĚ is used to determine the RDA for protein by using the ;zĞĂƌƐͿ ZĞƋƵŝƌĞŵĞŶƚ sĂƌŝĂƚŝŽŶ Z following equation.;ŐͬĚĂǇͿ TwelveĂůĐŝƵŵ point five percent was assumed to be the inter-individual ŽǇƐ 27) variation;ϰͲͿϲ Ϯϯ͘ϰϬof the requirement ϭ͘Ϯϱ Ϯϵ͘Ϯ . ϳͲϵ Ϯϵ͘ϯϰ ϭ͘Ϯϱ ϯϲ͘ϳ ϭϬͲϭϮ ϯϳ͘ϵϭ ϭ͘Ϯϱ ϰϳ͘ϰ ϭϯͲϭϱ ϰϱ͘Ϯϭ ϭ͘Ϯϱ ϱϲ͘ϱ ϭϲͲϭϳ;ϭϴͿ ϰϭ͘ϴϮ ϭ͘Ϯϱ ϱϮ͘ϯ 'ŝƌůƐ RDA (g) = EAR x Coefficient of variation ;ϰͲͿϲ ϮϮ͘ϴϯ ϭ͘Ϯϱ Ϯϴ͘ϱ ϳͲϵ ϯϬ͘ϬϬ ϭ͘Ϯϱ ϯϳ͘ϱ ϭϬͲϭϮ ϯϴ͘ϳϵ ϭ͘Ϯϱ ϰϴ͘ϱ ϭϯͲϭϱ ϯϵ͘ϵϭ ϭ͘Ϯϱ ϰϵ͘ϵ ϭϲͲϭϳ;ϭϴͿ ϯϳ͘ϳϮ ϭ͘Ϯϱ ϰϳ͘ϭCoefficient of variation = 1.25

28 Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Table3-7: Reference value for RDA Protein calculation

ƐƚŝŵĂƚĞĚ sĂůƵĞŽĨ ŐĞ'ƌŽƵƉ ǀĞƌĂŐĞ ŽĞĨĨŝĐŝĞŶƚŽĨ ĂůĐƵůĂƚĞĚ ;zĞĂƌƐͿ ZĞƋƵŝƌĞŵĞŶƚ sĂƌŝĂƚŝŽŶ Z ;ŐͬĚĂǇͿ ĂůĐŝƵŵ ŽǇƐ ;ϰͲͿϲ Ϯϯ͘ϰϬ ϭ͘Ϯϱ Ϯϵ͘Ϯ ϳͲϵ Ϯϵ͘ϯϰ ϭ͘Ϯϱ ϯϲ͘ϳ ϭϬͲϭϮ ϯϳ͘ϵϭ ϭ͘Ϯϱ ϰϳ͘ϰ ϭϯͲϭϱ ϰϱ͘Ϯϭ ϭ͘Ϯϱ ϱϲ͘ϱ ϭϲͲϭϳ;ϭϴͿ ϰϭ͘ϴϮ ϭ͘Ϯϱ ϱϮ͘ϯ 'ŝƌůƐ ;ϰͲͿϲ ϮϮ͘ϴϯ ϭ͘Ϯϱ Ϯϴ͘ϱ ϳͲϵ ϯϬ͘ϬϬ ϭ͘Ϯϱ ϯϳ͘ϱ ϭϬͲϭϮ ϯϴ͘ϳϵ ϭ͘Ϯϱ ϰϴ͘ϱ ϭϯͲϭϱ ϯϵ͘ϵϭ ϭ͘Ϯϱ ϰϵ͘ϵ ϭϲͲϭϳ;ϭϴͿ ϯϳ͘ϳϮ ϭ͘Ϯϱ ϰϳ͘ϭ

3.2.3 Calcium

Only 1% of calcium is found in blood, extracellular fluid, muscle and other tissue, where it plays an important role in mediating vascular contraction and vasodilatation, muscle contraction, nerve transmission and glandular secretion. The other 99% is found in bone and teeth28). To meet the recommended value of calcium, the estimated average requirement is multiplied by the coefficient of variation.

EAR = (Bone mineral accretion + Urinary Excretion + Loss through skin)/Apparent calcium absorption

The above calculated EAR is used to determine the RDA for calcium by using the following equation. 10% was assumed to be the inter-individual variation of the requirement29).

RDA=EAR x Coefficient of variation

Coefficient of variation = 1.2

ŐĞ'ƌŽƵƉ ZĞĨĞƌĞŶĐĞ ŽŶĞ hƌŝŶĂƌǇ >ŽƐƐĞƐ ƉƉĂƌĞŶƚ ŽĞĨĨŝĐŝĞŶƚ Z ĂůĐƵůĂƚĞĚ ;zĞĂƌƐͿ ŽĚǇ ŵŝŶĞƌĂů ĞǆĐƌĞƚŝŽŶ ƚŚƌŽƵŐŚ ĐĂůĐŝƵŵ ŽĨǀĂƌŝĂƚŝŽŶ ;ŵŐͬĚĂǇͿ ǀĂůƵĞŽĨZ tĞŝŐŚƚ ĂĐĐƌĞƚŝŽŶ ;ŵŐͬĚĂǇͿ ƚŚĞƐŬŝŶ ĂďƐŽƌƉƚŝŽŶ ĐĂůĐƵŝŵ ;<ŐͿ ;ŵŐͬĚĂǇͿ ;ŵŐͬĚĂǇͿ ;йͿ ;ŵŐͬĚĂǇͿ Ă ď Đ Ě Ğ Ĩ Őс ŐǆĨ ;ďнĐнĚͿͬĞ ŽǇƐ ;ϰͲͿϲ ϭϵ͘ϭ ϵϵ ϱϱ ϵ Ϭ͘ϰ ϭ͘Ϯ ϰϲϱ ϱϱϴ ϳͲϵ Ϯϯ͘ϵ ϭϬϮ ϲϱ ϭϭ Ϭ͘ϰ ϭ͘Ϯ ϱϬϳ ϲϬϴ ϭϬͲϭϮ ϯϬ͘ϯ ϭϳϬ ϳϳ ϭϯ Ϭ͘ϰ ϭ͘Ϯ ϲϮϱ ϳϱϬ ϭϯͲϭϱ ϰϮ͘ϯ ϮϭϮ ϭϬϬ ϭϳ Ϭ͘ϱ ϭ͘Ϯ ϳϮϴ ϴϳϰ ϭϲͲϭϳ;ϭϴͿ ϱϯ͘ϭ ϭϱϭ ϭϭϴ ϮϬ Ϭ͘ϱ ϭ͘Ϯ ϲϰϭ ϳϳϬ 'ŝƌůƐ ;ϰͲͿϲ ϭϴ͘ϯ ϴϲ ϱϯ ϵ Ϭ͘ϰ ϭ͘Ϯ ϰϮϮ ϱϬϳ ϳͲϵ Ϯϯ͘ϴ ϭϭϵ ϲϱ ϭϭ Ϭ͘ϰ ϭ͘Ϯ ϱϱϱ ϲϲϱ ϭϬͲϭϮ ϯϭ͘ϰ ϭϳϯ ϴϬ ϭϯ Ϭ͘ϰ ϭ͘Ϯ ϲϵϱ ϴϯϯ ϭϯͲϭϱ ϰϮ͘ϳ ϭϰϴ ϭϬϬ ϭϳ Ϭ͘ϰ ϭ͘Ϯ ϲϭϮ ϳϯϱ ϭϲͲϭϳ;ϭϴͿ ϰϳ͘ϵ ϴϵ ϭϬϵ ϭϴ Ϭ͘ϰ ϭ͘Ϯ ϱϰϭ ϲϰϵ

dϯͲϴ 3.2.4 Iron

Most girls reach puberty at an earlier age than boys and they generally start their first menstrual cycle around the age of 10. The RDA was calculated in two recommendations. One is for non-period days and another is for period days (Table 3-9).

30 Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia *** 6-14yrs= 20%; >15yrs= 10% age group)/365days; 10-17yrs: c x (h+d) g 0.075L 3.39/365 ** 6-9 yrs: (volume of hemoglobin of higher age group -volume of hemoglobin the target age agegroup) of the x higher 3.39mg/(median age group median of the target * Extrapolation: W %R\V *LUOV ϭϲͲϭϳ;ϭϴͿ ϭϯͲϭϱ ϭϬͲϭϮ ϳͲϵ ;ϰͲͿϲ ϭϲͲϭϳ;ϭϴͿ ϭϯͲϭϱ ϭϬͲϭϮ ϳͲϵ ;ϰͲͿϲ \UV YROXPRIKHPRJORELQRIKLJKHUDJHJURXSYROXPHRIK PJGD\ NJ; ([WUDSRODWLRQ: JUX,QWHUPHGLDWH $JH*URXS )RUPXOD UHVRXUFH ,QWHULQGLYLGXDOYDULDWLRQRIWKHUHTXLUHPHQW\UV HU HU JNHUPD / PJGD\ NJ\HDU NJ \HDUV \HDUV D YDOXHRIDJH E &$05'$V &$05'$V ; ; ; &$05'$V &$05'$V 5HIHUHQFH :HLJKW %RG\ F 0 =68.6kg, X =68.6kg, HJWJL%DVDO,URQ :HLJKWJDLQ G /RVVHV : 0 =0.96mg/day H

: 9ROXPHRI H 5I H I[J 5HI 5HI 5HI \UV EORRG HPRJORELQHWKHWDUJHWDJHJURXS I KHPRJORELQ OHYHO HUJ J/\HDU J/ J ,QFUHPHQWRI KHPRJORELQ OHYHO K Table 3-9: Reference value for Iron calculation PJ PHGLDQDJHRIWKHKLJ KHPRJORELQ 9ROXPHRI L ,URQGHSRVLWLRQLQ KHPRJORELQ JG\PD JG\PD P PJGD\ PJGD\ PJGD\ PJGD\ M KHUDJHJURXSዙPHGLDQRIWKHWDU 7LVVXH,URQ QRQ PJNJ LURQVWRUDJH ,QFUHPHQWRI G[ N ,QFUHPHQW H MNP5HI MNP 5HI VWRUDJH RI,URQ P 7RWDO,URQ VWRUDJH Q JHWDJHJURXS GD\V\UV 0HQVWUXDO ORVVHV EORRG LHGD\ OWLPH R 3HULRGF\FOH 0HQVWUXDO 5HI RI S RS[[ 0HQVWUXDOLURQ F KG J / PJGD\ /RVVHV T $EVRUSWLRQ ,URQ V RIYDULDWLRQ &RHIILFLHQW

W HMNP JLUOVRIRYHU\UV HMNP V PJGD\ ($5 X HMNPT V PHQVWUXDWLRQ ($5IRU JG\PD PJGD\ PJGD\ PJGD\ Y &DOFXODWHG 9DOXHRI 5'$ Y[W X[W PHQVWUXDWLRQ &DOFXODWHG 9DOXHRI 5'$IRU

Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia 31 3.2.5 Thiamin (Vitamin B1), Riboflavin (Vitamin B2) and Niacin (Vitamin B3)

Following upon the estimated energy requirement (EER) calculated for Cambodian children, the amount of required Vitamin B1, B2, and B3 were calculated based on the EER of CAM-RDA.

X= X0 x EER of CAM-RDA/ EER0

X = new RDA for the target population

X0 = value existing in the reference (SEA-RDA)

EER0 = EER existing in the reference (SEA-RDA) Thiamine (Vitamin B1) was calculated as below (Table 3-10): Table 3-10: Reference value for Thiamin (VB1) calculation

ŐĞ'ƌŽƵƉ ^ͲZ DͲZ ^Ͳsŝƚϭ sĂůƵĞŽĨ ;zĞĂƌƐͿ ;ŬĐĂůͬĚĂǇͿ ŶĞƌŐǇDŝĚĚůĞ ;ŵŐͬĚĂǇͿ ĂůĐƵůĂƚĞĚDͲ ;ŬĐĂůͬĚĂǇͿ Z sŝƚϭ;ŵŐͬĚĂǇͿ ŽǇƐ ;ϰͲͿϲ ϭ͕ϰϳϬ ϭ͕ϱϬϬ Ϭ͘ϲ Ϭ͘ϲ ϳͲϵ ϭ͕ϴϮϱ ϭ͕ϳϬϬ Ϭ͘ϵ Ϭ͘ϴ ϭϬͲϭϮ Ϯ͕ϭϭϬ Ϯ͕ϭϬϬ ϭ͘Ϯ ϭ͘Ϯ ϭϯͲϭϱ Ϯ͕ϲϱϬ Ϯ͕ϱϬϬ ϭ͘Ϯ ϭ͘ϭ ϭϲͲϭϳ;ϭϴͿ Ϯ͕ϵϴϬ Ϯ͕ϴϬϬ ϭ͘Ϯ ϭ͘ϭ 'ŝƌůƐ ;ϰͲͿϲ ϭ͕ϰϳϬ ϭ͕ϱϬϬ Ϭ͘ϲ Ϭ͘ϲ ϳͲϵ ϭ͕ϴϮϱ ϭ͕ϳϬϬ Ϭ͘ϵ Ϭ͘ϴ ϭϬͲϭϮ Ϯ͕ϬϭϬ Ϯ͕ϬϬϬ ϭ͘ϭ ϭ͘ϭ ϭϯͲϭϱ Ϯ͕ϮϬϱ Ϯ͕ϮϬϬ ϭ͘ϭ ϭ͘ϭ ϭϲͲϭϳ;ϭϴͿ Ϯ͕ϮϰϬ Ϯ͕ϯϬϬ ϭ͘ϭ ϭ͘ϭ Riboflavin (Vitamin B2) was calculated as below (Table 3-11): Table 3-11: Reference value for Riboflavin (VB2) calculation

ŐĞ'ƌŽƵƉ ^ͲZ DͲZ ^ͲsŝƚϮ sĂůƵĞŽĨ ;zĞĂƌƐͿ ;ŬĐĂůͬĚĂǇͿ ŶĞƌŐǇDŝĚĚůĞ ;ŵŐͬĚĂǇͿ ĂůĐƵůĂƚĞĚ ;ŬĐĂůͬĚĂǇͿ DͲZ sŝƚϮ ;ŵŐͬĚĂǇͿ ŽǇƐ ;ϰͲͿϲ ϭ͕ϰϳϬ ϭ͕ϱϬϬ Ϭ͘ϲ Ϭ͘ϲ ϳͲϵ ϭ͕ϴϮϱ ϭ͕ϳϬϬ Ϭ͘ϵ Ϭ͘ϴ ϭϬͲϭϮ Ϯ͕ϭϭϬ Ϯ͕ϭϬϬ ϭ͘ϯ ϭ͘ϯ ϭϯͲϭϱ Ϯ͕ϲϱϬ Ϯ͕ϱϬϬ ϭ͘ϯ ϭ͘Ϯ ϭϲͲϭϳ;ϭϴͿ Ϯ͕ϵϴϬ Ϯ͕ϴϬϬ ϭ͘ϯ ϭ͘Ϯ 'ŝƌůƐ ;ϰͲͿϲ ϭ͕ϰϳϬ ϭ͕ϱϬϬ Ϭ͘ϲ Ϭ͘ϲ ϳͲϵ ϭ͕ϴϮϱ ϭ͕ϳϬϬ Ϭ͘ϵ Ϭ͘ϴ ϭϬͲϭϮ Ϯ͕ϬϭϬ Ϯ͕ϬϬϬ ϭ͘Ϭ ϭ͘Ϭ ϭϯͲϭϱ Ϯ͕ϮϬϱ Ϯ͕ϮϬϬ ϭ͘Ϭ ϭ͘Ϭ ϭϲͲϭϳ;ϭϴͿ Ϯ͕ϮϰϬ Ϯ͕ϯϬϬ ϭ͘Ϭ ϭ͘Ϭ

32 Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Niacin (Vitamin B3) was calculated as below (Table 3-12):

Table 3-12: Reference value for Niacin (VB3) calculation

ŐĞ'ƌŽƵƉ ^ͲZ DͲZ ^Ͳsŝƚϯ sĂůƵĞŽĨ ;zĞĂƌƐͿ ;ŬĐĂůͬĚĂǇͿ ŶĞƌŐǇDŝĚĚůĞ ;ŵŐͬĚĂǇͿ ĂůĐƵůĂƚĞĚ ;ŬĐĂůͬĚĂǇͿ DͲZ sŝƚϯ ;ŵŐͬĚĂǇͿ ŽǇƐ ;ϰͲͿϲ ϭ͕ϰϳϬ ϭ͕ϱϬϬ ϴ ϴ͘Ϯ ϳͲϵ ϭ͕ϴϮϱ ϭ͕ϳϬϬ ϭϮ ϭϭ͘Ϯ ϭϬͲϭϮ Ϯ͕ϭϭϬ Ϯ͕ϭϬϬ ϭϲ ϭϱ͘ϵ ϭϯͲϭϱ Ϯ͕ϲϱϬ Ϯ͕ϱϬϬ ϭϲ ϭϱ͘ϭ ϭϲͲϭϳ;ϭϴͿ Ϯ͕ϵϴϬ Ϯ͕ϴϬϬ ϭϲ ϭϱ͘Ϭ 'ŝƌůƐ ;ϰͲͿϲ ϭ͕ϰϳϬ ϭ͕ϱϬϬ ϴ ϴ͘Ϯ ϳͲϵ ϭ͕ϴϮϱ ϭ͕ϳϬϬ ϭϮ ϭϭ͘Ϯ ϭϬͲϭϮ Ϯ͕ϬϭϬ Ϯ͕ϬϬϬ ϭϲ ϭϱ͘ϵ ϭϯͲϭϱ Ϯ͕ϮϬϱ Ϯ͕ϮϬϬ ϭϲ ϭϲ͘Ϭ ϭϲͲϭϳ;ϭϴͿ Ϯ͕ϮϰϬ Ϯ͕ϯϬϬ ϭϲ ϭϲ͘ϰ

3.2.6 Zinc, Iodine, Selenium, Vitamin A, Vitamin D, Vitamin C, and Folate

Another basic rule to extrapolate RDA values is based on the reference body weight of the target group and the reference value of the existing reference, where an exponent of 0.75 is adopted to estimate the ratio of body surface area proportional to the requirement of the selected nutrients. Nutrient and body weight references from SEA were used to calculated Zinc, Iodine, Selenium, Vitamin A, Vitamin D, Vitamin C and Folate.

0.75 X=X0 × (W/W0)

X = new RDA for the target population

X0 = values in the existing reference (SEA-RDA) W = CAM reference BW

W0 = “reference BW” used in the existing reference (SEA-RDA)

Table 3-13: Reference value for zinc calculation

ŐĞ'ƌŽƵƉ ^Ͳt DͲZt ^ͲŶ sĂůƵĞŽĨ ;zĞĂƌƐͿ ;ŬŐͿ ;ŬŐͿ ;ŵŐͬĚĂǇͿ ĂůĐƵůĂƚĞĚ DͲZ Ŷ ;ŵŐͬĚĂǇͿ ŽǇƐ ;ϰͲͿϲ ϮϬ ϭϵ͘ϭ ϱ͘ϳ ϱ͘ϱ ϳͲϵ Ϯϳ Ϯϯ͘ϵ ϲ͘Ϭ ϱ͘ϱ ϭϬͲϭϮ ϯϰ ϯϬ͘ϯ ϲ͘ϴ ϲ͘Ϯ ϭϯͲϭϱ ϰϳ ϰϮ͘ϯ ϴ͘ϵ ϴ͘Ϯ ϭϲͲϭϳ;ϭϴͿ ϱϲ ϱϯ͘ϭ ϴ͘ϲ ϴ͘ϯ 'ŝƌůƐ ;ϰͲͿϲ ϮϬ ϭϴ͘ϯ ϱ͘ϳ ϱ͘ϯ ϳͲϵ Ϯϳ Ϯϯ͘ϴ ϲ͘Ϭ ϱ͘ϱ ϭϬͲϭϮ ϯϲ ϯϭ͘ϰ ϲ͘ϭ ϱ͘ϱ ϭϯͲϭϱ ϰϱ ϰϮ͘ϳ ϳ͘Ϯ ϲ͘ϵ ϭϲͲϭϳ;ϭϴͿ ϰϵ ϰϳ͘ϵ ϲ͘ϴ ϲ͘ϳ

Iodine was calculated as below (Table 3-14):

Table 3-14: Reference value for iodine calculation

ŐĞ'ƌŽƵƉ ^Ͳt DͲZ ^Ͳ/ŽĚŝŶĞ sĂůƵĞŽĨ ;zĞĂƌƐͿ ;ŬŐͿ t;ŬŐͿ ;ђŐͬĚĂǇͿ ĂůĐƵůĂƚĞĚ DͲZ /ŽĚŝŶĞ ;ђŐͬĚĂǇͿ ŽǇƐ ;ϰͲͿϲ ϮϬ ϭϵ͘ϭ ϵϬ ϴϳ ϳͲϵ Ϯϳ Ϯϯ͘ϵ ϭϮϬ ϭϭϬ ϭϬͲϭϮ ϯϰ ϯϬ͘ϯ ϭϮϬ ϭϭϬ ϭϯͲϭϱ ϰϳ ϰϮ͘ϯ ϭϱϬ ϭϯϵ ϭϲͲϭϳ;ϭϴͿ ϱϲ ϱϯ͘ϭ ϭϱϬ ϭϰϰ 'ŝƌůƐ ;ϰͲͿϲ ϮϬ ϭϴ͘ϯ ϵϬ ϴϰ ϳͲϵ Ϯϳ Ϯϯ͘ϴ ϭϮϬ ϭϬϵ ϭϬͲϭϮ ϯϲ ϯϭ͘ϰ ϭϮϬ ϭϬϴ ϭϯͲϭϱ ϰϱ ϰϮ͘ϳ ϭϱϬ ϭϰϰ ϭϲͲϭϳ;ϭϴͿ ϰϵ ϰϳ͘ϵ ϭϱϬ ϭϰϳ

34 Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Selenium was calculated as below (Table 3-15):

Table 3-15: Reference value for selenium calculation

ŐĞ'ƌŽƵƉ ^Ͳt DͲZ ^Ͳ^ĞůĞŶŝƵŵ sĂůƵĞŽĨĂůĐƵůĂƚĞĚ ;zĞĂƌƐͿ ;ŬŐͿ t;ŬŐͿ ;ŵŐͬĚĂǇͿ DͲZ ^ĞůĞŶŝƵŵ ;ŵŐͬĚĂǇͿ

ŽǇƐ ;ϰͲͿϲ ϮϬ ϭϵ͘ϭ ϮϮ Ϯϭ ϳͲϵ Ϯϳ Ϯϯ͘ϵ Ϯϭ ϭϵ ϭϬͲϭϮ ϯϰ ϯϬ͘ϯ ϯϮ Ϯϵ ϭϯͲϭϱ ϰϳ ϰϮ͘ϯ ϯϮ ϯϬ ϭϲͲϭϳ;ϭϴͿ ϱϲ ϱϯ͘ϭ ϯϮ ϯϭ 'ŝƌůƐ ;ϰͲͿϲ ϮϬ ϭϴ͘ϯ ϮϮ Ϯϭ ϳͲϵ Ϯϳ Ϯϯ͘ϴ Ϯϭ ϭϵ ϭϬͲϭϮ ϯϲ ϯϭ͘ϰ Ϯϲ Ϯϯ ϭϯͲϭϱ ϰϱ ϰϮ͘ϳ Ϯϲ Ϯϱ ϭϲͲϭϳ;ϭϴͿ ϰϵ ϰϳ͘ϵ Ϯϲ Ϯϲ

Vitamin A was calculated as below (Table 3-16):

Table 3-16: Reference value for Vitamin A calculation

ŐĞ'ƌŽƵƉ ^Ͳt DͲZt ^Ͳsŝƚ sĂůƵĞŽĨ ;zĞĂƌƐͿ ;ŬŐͿ ;ŬŐͿ ;ђŐͬĚĂǇͿ ĂůĐƵůĂƚĞĚ DͲZ sŝƚ ;ђŐͬĚĂǇͿ ŽǇƐ ;ϰͲͿϲ ϮϬ ϭϵ͘ϭ ϰϱϬ ϰϯϰ ϳͲϵ Ϯϳ Ϯϯ͘ϵ ϱϬϬ ϰϱϲ ϭϬͲϭϮ ϯϰ ϯϬ͘ϯ ϲϬϬ ϱϱϬ ϭϯͲϭϱ ϰϳ ϰϮ͘ϯ ϲϬϬ ϱϱϰ ϭϲͲϭϳ;ϭϴͿ ϱϲ ϱϯ͘ϭ ϲϬϬ ϱϳϲ 'ŝƌůƐ ;ϰͲͿϲ ϮϬ ϭϴ͘ϯ ϰϱϬ ϰϮϬ ϳͲϵ Ϯϳ Ϯϯ͘ϴ ϱϬϬ ϰϱϱ ϭϬͲϭϮ ϯϲ ϯϭ͘ϰ ϲϬϬ ϱϰϮ ϭϯͲϭϱ ϰϱ ϰϮ͘ϳ ϲϬϬ ϱϳϳ ϭϲͲϭϳ;ϭϴͿ ϰϵ ϰϳ͘ϵ ϲϬϬ ϱϴϵ

Table 3-17: Reference value for Vitamin D calculation

ŐĞ'ƌŽƵƉ ^Ͳt DͲZt ^Ͳsŝƚ sĂůƵĞŽĨ ;zĞĂƌƐͿ ;ŬŐͿ ;ŬŐͿ ;ђŐͬĚĂǇͿ ĂůĐƵůĂƚĞĚ DͲZ sŝƚ ;ђŐͬĚĂǇͿ

ŽǇƐ ;ϰͲͿϲ ϮϬ ϭϵ͘ϭ ϱ ϱ ϳͲϵ Ϯϳ Ϯϯ͘ϵ ϱ ϱ ϭϬͲϭϮ ϯϰ ϯϬ͘ϯ ϱ ϱ ϭϯͲϭϱ ϰϳ ϰϮ͘ϯ ϱ ϱ ϭϲͲϭϳ;ϭϴͿ ϱϲ ϱϯ͘ϭ ϱ ϱ 'ŝƌůƐ ;ϰͲͿϲ ϮϬ ϭϴ͘ϯ ϱ ϱ ϳͲϵ Ϯϳ Ϯϯ͘ϴ ϱ ϱ ϭϬͲϭϮ ϯϲ ϯϭ͘ϰ ϱ ϱ ϭϯͲϭϱ ϰϱ ϰϮ͘ϳ ϱ ϱ ϭϲͲϭϳ;ϭϴͿ ϰϵ ϰϳ͘ϵ ϱ ϱ

Vitamin C was calculated as below (Table 3-18):

Table 3-18: Reference value for Vitamin C calculation

ŐĞ'ƌŽƵƉ ^Ͳt DͲZ ^Ͳsŝƚ sĂůƵĞŽĨ ;zĞĂƌƐͿ ;ŬŐͿ t;ŬŐͿ ;ŵŐͬĚĂǇͿ ĂůĐƵůĂƚĞĚ DͲZ sŝƚ ;ŵŐͬĚĂǇͿ ŽǇƐ ;ϰͲͿϲ ϮϬ ϭϵ͘ϭ ϯϬ Ϯϵ ϳͲϵ Ϯϳ Ϯϯ͘ϵ ϯϱ ϯϮ ϭϬͲϭϮ ϯϰ ϯϬ͘ϯ ϲϱ ϲϬ ϭϯͲϭϱ ϰϳ ϰϮ͘ϯ ϲϱ ϲϬ ϭϲͲϭϳ;ϭϴͿ ϱϲ ϱϯ͘ϭ ϲϱ ϲϮ 'ŝƌůƐ ;ϰͲͿϲ ϮϬ ϭϴ͘ϯ ϯϬ Ϯϴ ϳͲϵ Ϯϳ Ϯϯ͘ϴ ϯϱ ϯϮ ϭϬͲϭϮ ϯϲ ϯϭ͘ϰ ϲϱ ϱϵ ϭϯͲϭϱ ϰϱ ϰϮ͘ϳ ϲϱ ϲϮ ϭϲͲϭϳ;ϭϴͿ ϰϵ ϰϳ͘ϵ ϲϱ ϲϰ

36 Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Folate was calculated as below (Table 3-19):

Table 3-19: Reference value for Folate calculation

ŐĞ'ƌŽƵƉ ^Ͳt DͲZ ^Ͳ&ŽůĂƚĞ sĂůƵĞŽĨ ;zĞĂƌƐͿ ;ŬŐͿ t;ŬŐͿ ;ђŐͬĚĂǇͿ ĂůĐƵůĂƚĞĚ DͲZ &ŽůĂƚĞ ;ђŐͬĚĂǇͿ ŽǇƐ ;ϰͲͿϲ ϮϬ ϭϵ͘ϭ ϮϬϬ ϭϵϯ ϳͲϵ Ϯϳ Ϯϯ͘ϵ ϯϬϬ Ϯϳϰ ϭϬͲϭϮ ϯϰ ϯϬ͘ϯ ϰϬϬ ϯϲϳ ϭϯͲϭϱ ϰϳ ϰϮ͘ϯ ϰϬϬ ϯϳϬ ϭϲͲϭϳ;ϭϴͿ ϱϲ ϱϯ͘ϭ ϰϬϬ ϯϴϰ 'ŝƌůƐ ;ϰͲͿϲ ϮϬ ϭϴ͘ϯ ϮϬϬ ϭϴϳ ϳͲϵ Ϯϳ Ϯϯ͘ϴ ϯϬϬ Ϯϳϯ ϭϬͲϭϮ ϯϲ ϯϭ͘ϰ ϰϬϬ ϯϲϭ ϭϯͲϭϱ ϰϱ ϰϮ͘ϳ ϰϬϬ ϯϴϱ ϭϲͲϭϳ;ϭϴͿ ϰϵ ϰϳ͘ϵ ϰϬϬ ϯϵϯ

3.2.7 Copper

Copper was calculated using the same formula as the other micronutrients, but with a

different reference (Table 3-20). The Japanese reference was used for X0 and W0. Fifteen percent was assumed to be the inter-individual variation of the requirement35).

RDA (g) = EAR x Coefficient of variation

Coefficient of variation= 1.3

Table 3-20: Reference value for copper calculation

ŐĞ'ƌŽƵƉ Z/Ɛ:WEZ DͲZ Z/Ɛ:WE Z ŽĞĨĨŝĐŝĞŶƚŽĨ sĂůƵĞŽĨ ;zĞĂƌƐͿ ;ŵŐͬĚĂǇͿ ;ŬŐͿ ;ŬŐͿ ;ŵŐͬĚĂǇͿ ǀĂƌŝĂƚŝŽŶ ĂůĐƵůĂƚĞĚ DͲZ ŽƉƉĞƌ ;ŵŐͬĚĂǇͿ yϬ tϬ Ϭ͘ϳϱ &ŽƌŵƵůĂ t yϬп᧤tͬtϬ᧥ ZǆŽĞĨĨŝĐŝĞŶƚ ŽĨǀĂƌŝĂƚŝŽŶ

ŽǇƐ ;ϰͲͿϲ Ϭ͘ϰ ϭϵ͘ϭ ϮϮ͘Ϯ Ϭ͘ϯϲ ϭ͘ϯ Ϭ͘ϰϲ ϳͲϵ Ϭ͘ϰ Ϯϯ͘ϵ Ϯϲ͘ϭ Ϭ͘ϯϳ ϭ͘ϯ Ϭ͘ϰϵ ϭϬͲϭϮ Ϭ͘ϲ ϯϬ͘ϯ ϰϬ͘ϭ Ϭ͘ϰϲ ϭ͘ϯ Ϭ͘ϲϬ ϭϯͲϭϱ Ϭ͘ϳ ϰϮ͘ϯ ϱϮ͘ϲ Ϭ͘ϲϮ ϭ͘ϯ Ϭ͘ϴϭ ϭϲͲϭϳ;ϭϴͿ Ϭ͘ϴ ϱϯ͘ϭ ϱϵ͘ϳ Ϭ͘ϳϯ ϭ͘ϯ Ϭ͘ϵϱ 'ŝƌůƐ ;ϰͲͿϲ Ϭ͘ϰ ϭϴ͘ϯ Ϯϭ͘ϵ Ϭ͘ϯϱ ϭ͘ϯ Ϭ͘ϰϱ ϳͲϵ Ϭ͘ϰ Ϯϯ͘ϴ Ϯϱ͘ϲ Ϭ͘ϯϴ ϭ͘ϯ Ϭ͘ϰϵ ϭϬͲϭϮ Ϭ͘ϱ ϯϭ͘ϰ ϰϬ͘Ϭ Ϭ͘ϰϰ ϭ͘ϯ Ϭ͘ϱϴ ϭϯͲϭϱ Ϭ͘ϲ ϰϮ͘ϳ ϰϵ͘Ϭ Ϭ͘ϱϰ ϭ͘ϯ Ϭ͘ϳϬ ϭϲͲϭϳ;ϭϴͿ Ϭ͘ϲ ϰϳ͘ϵ ϱϭ͘ϵ Ϭ͘ϱϲ ϭ͘ϯ Ϭ͘ϳϯ

The Japanese reference was used to determine the percentage of the recommended fat intake. The percentages vary from 20-30% based on the level of activity. To calculate the amount of fat intake, we used the estimated energy requirement of each age group and selected the activity level (Table 3-21). A median of 25% is recommended to avoid both chronic energy deficiency and obesity.

Table 3-21: Recommended Fat percentage calculated from EER

ŐĞ'ƌŽƵƉ &Ăƚ;ŵĞĚŝĂŶͿ ;zĞĂƌƐͿ йŶĞƌŐǇ ŽǇƐ ;ϰͲͿϲ ϮϬͲϯϬ;ϮϱͿ ϳͲϵ ϮϬͲϯϬ;ϮϱͿ ϭϬͲϭϮ ϮϬͲϯϬ;ϮϱͿ ϭϯͲϭϱ ϮϬͲϯϬ;ϮϱͿ ϭϲͲϭϳ;ϭϴͿ ϮϬͲϯϬ;ϮϱͿ 'ŝƌůƐ ;ϰͲͿϲ ϮϬͲϯϬ;ϮϱͿ ϳͲϵ ϮϬͲϯϬ;ϮϱͿ ϭϬͲϭϮ ϮϬͲϯϬ;ϮϱͿ ϭϯͲϭϱ ϮϬͲϯϬ;ϮϱͿ ϭϲͲϭϳ;ϭϴͿ ϮϬͲϯϬ;ϮϱͿ

3.2.9 Dietary Fibre

Dietary Fibre was calculated by using the data from the survey combined with Japanese reference values. The new Dietary Goal (DGx) was derived from the equation below:

DGx= 18.9 x (RBW of our data/57.8) 0.75

The above figure 18.9g is the intermediate value of a and b, which is set as a tentative goal to be achieved by considering very low actual intake levels in the target population.

a: Median of DF intake in Japanese adult (over 18 years) (13.7g/day)36). b: Observed risk decrease in heart attack mortality (24g/day)37). 57.8 = the average body weight of Japanese adult

DGx = Tentative goal aimed to prevent life-style related disease e.g. coronary heart disease, stroke and cancer38).

38 Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Table 3-22: Reference value for Dietary Fibre calculation

ŐĞ'ƌŽƵƉ DͲZt '[ ;zĞĂƌƐͿ ;<ŐͿ ;ŐͿ

&ŽƌŵƵůĂ Ă ϭϴ͘ϵǆ;Ăͬϱϳ͘ϴͿϬ͘ϳϱ ŽǇƐ ;ϰͲͿϲ ϭϵ͘ϭ ϴ͘Ϯ ϳͲϵ Ϯϯ͘ϵ ϵ͘ϳ ϭϬͲϭϮ ϯϬ͘ϯ ϭϭ͘ϲ ϭϯͲϭϱ ϰϮ͘ϯ ϭϱ͘Ϭ ϭϲͲϭϳ;ϭϴͿ ϱϯ͘ϭ ϭϳ͘ϳ 'ŝƌůƐ ;ϰͲͿϲ ϭϴ͘ϯ ϴ͘Ϭ ϳͲϵ Ϯϯ͘ϴ ϵ͘ϳ ϭϬͲϭϮ ϯϭ͘ϰ ϭϮ͘Ϭ ϭϯͲϭϱ ϰϮ͘ϳ ϭϱ͘ϭ ϭϲͲϭϳ;ϭϴͿ ϰϳ͘ϵ ϭϲ͘ϰ

3.2.10 Sodium

A reduction in sodium intake to <2 g/day sodium (5 g/day salt) is recommended by WHO to reduce the risk of high blood pressure, cardiovascular disease, stroke and coronary heart disease in adults. Not only for adults, but WHO also recommends a reduction in sodium intake to control blood pressure in children. The recommended maximum level of intake of 2 g/day sodium in adults should be adjusted for children based on the energy requirements of children39).

DGx = [5.0 x (EERx/ EER0) + Ix] / 2

DGx = tentative dietary goal for preventing life-style related diseases 5.0 = Suggested maximum level of intake for sodium chloride (salt) in gram by WHO for adult EERx = EER for CAM-RDA

EER0 = EER for 18-29 years old for SEA-RDA Ix = Median of sodium chloride (salt) intake in CAM data

In this formula, the intermediate values between the true recommended level (=5g) adjusted for EER and the actual intake levels are calculated as a tentative and achievable goal in the real settings of the target population.

^ŽĚŝƵŵŚůŽƌŝĚĞ;ƐĂůƚͿ ^ŽĚŝƵŵ

ŐĞ'ƌŽƵƉ ZĐ ZϬ ů[;ĐĂŵͿ '[ '[Ζ ;zĞĂƌƐͿ ;ŬĐĂůͿ ;ŬĐĂůͿ ;ŐͬĚĂǇͿ ;ŐͬĚĂǇͿ ;ŵŐͬĚĂǇͿ &ŽƌŵƵůĂΘ Ă ď Đ ;ϱǆ;ĂͬďͿнĐͿͬϮ ƌĞƐŽƵƌĐĞ ŽǇƐ ;ϰͲͿϲ ϭ͕ϱϬϬ Ϯ͕ϲϯϱ ϯ͘ϯ ϯ͘ϭ ϭ͕ϱϳϱ ϳͲϵ ϭ͕ϳϬϬ Ϯ͕ϲϯϱ ϯ͘ϯ ϯ͘ϯ ϭ͕ϱϳϱ ϭϬͲϭϮ Ϯ͕ϭϬϬ Ϯ͕ϲϯϱ ϯ͘ϵ ϯ͘ϵ ϭ͕ϱϳϱ ϭϯͲϭϱ Ϯ͕ϱϬϬ Ϯ͕ϲϯϱ ϰ͘ϯ ϰ͘ϱ ϭ͕ϵϲϵ ϭϲͲϭϳ;ϭϴͿ Ϯ͕ϴϬϬ Ϯ͕ϲϯϱ ϰ͘ϳ ϱ͘Ϭ ϭ͕ϵϲϵ 'ŝƌůƐ ;ϰͲͿϲ ϭ͕ϱϬϬ Ϯ͕ϭϭϱ ϯ͘ϯ ϯ͘ϰ ϭ͕ϱϳϱ ϳͲϵ ϭ͕ϳϬϬ Ϯ͕ϭϭϱ ϯ͘ϯ ϯ͘ϳ ϭ͕ϱϳϱ ϭϬͲϭϮ Ϯ͕ϬϬϬ Ϯ͕ϭϭϱ ϯ͘ϵ ϰ͘ϯ ϭ͕ϱϳϱ ϭϯͲϭϱ Ϯ͕ϮϬϬ Ϯ͕ϭϭϱ ϰ͘ϯ ϰ͘ϴ ϭ͕ϵϲϵ ϭϲͲϭϳ;ϭϴͿ Ϯ͕ϯϬϬ Ϯ͕ϭϭϱ ϰ͘ϳ ϱ͘ϭ ϭ͕ϵϲϵ

3.2.11 Potassium

An increase in potassium intake from dietary sources is suggested by WHO in order to reduce blood pressure, the risk of cardiovascular disease, stroke and coronary heart disease in adults. WHO also suggests an increase in potassium intake from dietary sources to control blood pressure in children. The recommended potassium intake of at least 90 mmol/day (3,510mg/day) should be adjusted downward for children, based on the energy requirements of children relative to those of adults40).

DGx = [3,510 x (EERx/EER0) + Ix] / 2

In which: DGx = tentative dietary goal for preventing life-style related diseases 3,510 = recommended potassium intake in mg by WHO for adults EERx = EER for CAM-RDA

EER0 = EER for 18-29 years old for SEA-RDA Ix = median of potassium intake in CAM data

40 Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Table 3-24: Reference value for potassium calculation

ŐĞ'ƌŽƵƉ Z[ ZϬ /[ '[ ;zĞĂƌƐͿ ;ŬĐĂůͬĚĂǇͿ ;ŬĐĂůͬĚĂǇͿ ;ŵŐͬĚĂǇͿ ;ŵŐͬĚĂǇͿ &ŽƌŵƵůĂΘ Ă ď Đ ;ϯ͕ϱϭϬǆ ƌĞƐŽƵƌĐĞ ;ĂͬďͿнĐͿͬϮ ŽǇƐ ;ϰͲͿϲ ϭ͕ϱϬϬ Ϯ͕ϲϯϱ ϱϴϮ ϭ͕ϮϵϬ ϳͲϵ ϭ͕ϳϬϬ Ϯ͕ϲϯϱ ϱϰϲ ϭ͕ϰϬϱ ϭϬͲϭϮ Ϯ͕ϭϬϬ Ϯ͕ϲϯϱ ϲϲϯ ϭ͕ϳϯϬ ϭϯͲϭϱ Ϯ͕ϱϬϬ Ϯ͕ϲϯϱ ϴϭϴ Ϯ͕Ϭϳϰ ϭϲͲϭϳ;ϭϴͿ Ϯ͕ϴϬϬ Ϯ͕ϲϯϱ ϵϬϲ Ϯ͕ϯϭϴ 'ŝƌůƐ ;ϰͲͿϲ ϭ͕ϱϬϬ Ϯ͕ϭϭϱ ϰϰϯ ϭ͕ϰϲϲ ϳͲϵ ϭ͕ϳϬϬ Ϯ͕ϭϭϱ ϰϵϴ ϭ͕ϲϲϬ ϭϬͲϭϮ Ϯ͕ϬϬϬ Ϯ͕ϭϭϱ ϲϱϱ ϭ͕ϵϴϳ ϭϯͲϭϱ Ϯ͕ϮϬϬ Ϯ͕ϭϭϱ ϳϰϭ Ϯ͕ϭϵϲ ϭϲͲϭϳ;ϭϴͿ Ϯ͕ϯϬϬ Ϯ͕ϭϭϱ ϳϭϲ Ϯ͕Ϯϲϲ

3.2.12 Phosphorus

The adult requirements for phosphorus are based on studies of serum inorganic phosphorus concentration. The EAR, and hence the RDA, for healthy adolescents aged 9 through 18 years is based on a factorial approach and is higher than the adult value. This is because this age range is one of intensive growth, with growth rate, absorption efficiency, and normal values of inorganic phosphorus in the extracellular fluid changing during this time41).

CAM-RDA Phosphorus= (DRI US & Canada + Ix)/2

In which:

DRI US & Canada= the DRI value of -US and the RDA value of Canada Ix = Median of Phosphorus intake in CAM data

Table 3-25: Reference value for phosphorus calculation

ŐĞ'ƌŽƵƉ Z/Ɛh^ΘĂŶĂĚĂ /[ DͲ ;zĞĂƌƐͿ ;ŵŐͬĚĂǇͿ ;DͲĂƚĂͿ WŚŽƐƉŚŽƌƵƐ ;ŵŐͬĚĂǇͿ ;ŵŐͬĚĂǇͿ &ŽƌŵƵůĂ Ă ď ;ĂнďͿͬϮ ŽǇƐ ;ϰͲͿϲ ϱϬϬ ϱϭϳ ϱϬϵ ϳͲϵ ϳϱϬ ϰϱϴ ϲϬϰ ϭϬͲϭϮ ϭ͕ϮϱϬ ϰϴϵ ϴϳϬ ϭϯͲϭϱ ϭ͕ϮϱϬ ϲϭϰ ϵϯϮ ϭϲͲϭϳ;ϭϴͿ ϭ͕ϮϱϬ ϲϴϯ ϵϲϳ 'ŝƌůƐ ;ϰͲͿϲ ϱϬϬ ϯϲϵ ϰϯϱ ϳͲϵ ϳϱϬ ϯϵϳ ϱϳϯ ϭϬͲϭϮ ϭ͕ϮϱϬ ϰϴϵ ϴϲϵ ϭϯͲϭϱ ϭ͕ϮϱϬ ϱϮϰ ϴϴϳ ϭϲͲϭϳ;ϭϴͿ ϭ͕ϮϱϬ ϱϮϴ ϴϴϵ

Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia 41 Chapter 4 Comparison of the survey results and CAM-RDA and Recommendations for improvement

This chapter intends to discern the gap between the actual nutritional status and dietary intakes revealed by the nationwide survey and the nutritional objectives (RDA) as well as to introduce recommendations aiming to improve the nutritional status of school-aged children. The recommendations are derived from the gap analysis with relevant data from other Asian countries. It is hoped that this will serve as useful information for policy-makers when developing a nutrition policy for children and adolescents. 4.1 Comparison of dietary intakes and CAM-RDA

From the survey results introduced in Chapter 2, the mean of students’ intake of energy and fifteen nutrients such as protein, calcium, iron, thiamin (VB1), riboflavin (VB2), niacin (VB3), zinc, vitamin A, vitamin C, copper, fat, dietary fiber, sodium/salt (sodium chloride), potassium, phosphorus along with CAM-RDA are shown by gender and age group (Appendix 3-1 to 3-19).

In summary, the majority of students surveyed were found not meeting the CAM-RDA for most nutrients. The total average of energy intake is 1,600 ± 595 kcal (mean ± SD). When energy intake is compared with EER of CAM-RDA, all groups except 6 year- old boys are not within the appropriate range of EER (Figure 4-1). There is a slight difference between girls (54%) and boys (61%) who are getting enough protein. 6 year-old boys (91%) were getting sufficient protein (Appendix 3-4).

The total intake of calcium was 396 ± 246mg (mean±SD). It is the most needed among 10-12 year-old boys (only 6% meet the EAR of CAM-RDA), followed by 13-15 year-old boys and 10-12 year-old girls (in both age groups only 10% meet the EAR of CAM-RDA). Overall, only 14% of students met the EAR of CAM-RDA for calcium (Appendix 3-5). Iron intake was the lowest among 10-12 year-old girls (31% meet EAR of CAM-RDA) and the highest among 16-17 year-old boys (82% meet EAR of CAM-RDA) (Appendix 3-6). None of the students surveyed met the RDA for zinc (Appendix 3-7).

A majority of children did not meet the CAM-RDA for vitamins A, C, B1 and B2. For vitamin A, only 21% of boys and 18% of girls met the recommended dietary intake and it was lowest among 6 year-old boys (only 6% meet CAM-RDA). For vitamin C, only 41% of boys and 44% of girls met the RDA. Only 14% of boys and 13% of girls consumed the recommended amount of thiamin or vitamin B1. Similarly, 18% of boys and 20% of girls met the RDA for riboflavin or vitamin B2, the lowest consumption was seen among 10-12 year old boys (8%). For niacin or vitamin B3, the lowest percentage of students who consumed adequate amounts is among 10-12 year old boys (7%) and

42 Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia girls (7%) (Appendix 3-8 to 3-12).

The percentage of students who met the dietary goal (DG) for fat is low overall (19%) but is higher among girls (22%) than boys (16%) (Appendix 3-13). While the percentage of students who consumed within the dietary goal for sodium (49%) and sodium chloride (49%) seems relatively high, a closer look reveals that the other 50% consumed either more than enough or not enough sodium (Appendix 3-15, 3-16). For potassium, only 2% of students met the DG of CAM-RDA. 17% met the DG for phosphorus, while 9% met the DG for copper, with only slight differences between girls and boys (Appendix 3-18, 3-19). Considering the importance of the sodium-potassium ratio to prevent hypertension, the current data is worrisome. Far too few children consumed an adequate amount of potassium, but too much sodium.

It would be ideal to grasp habitual intakes measured by survey of multiple days to compare them with values of CAM-RDA for more strict assessment. The demonstrated results from a single-day survey could be different from the habitual intakes, therefore, it should be carefully interpreted.

Figure 4-1: Distribution of energy intake and EER

і,ŝŐŚ ;ZͿ

і>ŝŐŚƚ ;ZͿ

іDĂǆŝŵƵŵ

іϳϱй іDĞĚŝĂŶ іϮϱй

іDŝŶŝŵƵŵ

Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia 43 4.2 Recommendations on increasing intakes of some important nutrients 4.2.1 Ideal intake goals for protein and calcium

Adolescents require more nutrients compared to the needs of younger children as they enter puberty and experience many physical changes including growth spurts, sexual maturity, bone mineralization, and body composition changes. The survey results indicated that both boys and girls for aged 10-12 and 13-15 who met or exceeded the standard (or within the standard range) were low. Proteins and calcium are especially important during puberty and its ideal intake goal values are suggested below.

Protein Figure 4-2 shows that protein supply among Asian countries increased significantly in the past 25 years, with a range from 4-15 g of increase in a decade (except Japan). While more protein is being consumed in these countries than in the past, increasing protein intake by 5-10g (from the current 45g to 50-55g) in next 10 years may be both ideal and feasible (Figure 4-2).

Figure 4-2: Changes in protein supply in Cambodia, neighboring countries, China, Korea and Japan (1990-2005)

ϭϬϬ :ĂƉĂŶ

<ŽƌĞĂ ϵϬ ŚŝŶĂ

ϴϬ

ϳϬ sŝĞƚŶĂŵ DǇĂŶŵĞƌ >ĂŽƐ ϲϬ dŚĂŝůĂŶĚ ϱϰ ĂŵďŽĚŝĂ͕ϲϬ ϱϬ ϰϳ ǀĞƌĂŐĞƉƌŽƚĞŝŶƐƵƉƉůǇ;ŐͬĐĂƉŝƚĂͬĚĂǇͿ ϰϰ ϰϬ ϭϵϵϬͲϭϵϵϮ ϭϵϵϱͲϭϵϵϳ ϮϬϬϬͲϮϬϬϮ ϮϬϬϱͲϮϬϬϳ

Change of average protein supply per 10 years (1990-2005) g/capita/day Japan: -4g Korea: 6g China: 15g Vietnam: 15g Myanmar: 15g Laos: 9g Thailand: 4g

44 Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia As demonstrated by the survey, students’ protein intake mostly relied on cereal 36.8%, (82% of which is from rice, 6% from wheat noodle, and 5% from bread), followed by fish (20.7%), meat (16.6%), eggs (4.9%) and legumes (4.9%, 40% of which is from mung bean and 25% from soybean milk) (Figure 4-3). This indicates that students consumed protein mostly from rice. However, this may need to be shifted to protein-rich foods, such as fish, meat, or eggs.

The food portion equivalent to 6g of protein is about 30g of meat or fish, 1 egg, or 60g of legumes. When expressed in serving size, the average intake for protein-rich food (fish, meat, beans and eggs) is around 3 servings at the time of the survey, but should be increased by 1-2 servings, for a total of 4-5 servings.

Figure 4-3: Ratio of food groups for protein source

ŽŶĨĞĐƚŝŽŶĂƌǇ͕ϯ͘ϲ DŝůŬĂŶĚŵŝůŬƉƌŽĚƵĐƚƐ͕ϭ͘ϵ

&ƌƵŝƚƐ͕ϯ͘Ϭ >ĞŐƵŵĞƐ͕ŶƵƚƐĂŶĚƐĞĞĚƐ͕ϰ͘ϵ

&ŝƐŚĂŶĚƐŚĞůůĨŝƐŚ͕ϮϬ͘ϳ ZŝĐĞƉƌŽĚƵĐƚƐ ZŝĐĞŶŽŽĚůĞ KƚŚĞƌƐ ĞƌĞĂůƐ͕ϯϲ͘ϴ KƚŚĞƌƐ͕ϭ͘ϵ Ϯй Ϯй ϯй DĞĂƚĂŶĚŵĞĂƚƉƌŽĚƵĐƚƐ͕ƌĞĂĚ ϱйϭϲ͘ϲ tŚĞĂƚŶŽŽĚůĞ ϲй ŐŐ͕ϰ͘ϵ

Ϭй ϭϬй ϮϬй ϯϬй ϰϬй ϱϬй ϲϬй ϳϬй ϴϬй ϵϬй ϭϬϬй

sĞŐĞƚĂďůĞƐ͕ϯ͘ϱ

ŽŶĚŝŵĞŶƚƐĂŶĚƐƉŝĐĞ͕Ϯ͘Ϯ ZŝĐĞ [Figure 4-3a: Cereals] [Figure 4-3b: Legumes]ϴϮй

ZŝĐĞƉƌŽĚƵĐƚƐ ZŝĐĞŶŽŽĚůĞ KƚŚĞƌƐ EƵƚƐĂŶĚƐĞĞĚƐ Ϯй Ϯй ϯй ϭϯй ƌĞĂĚ ϱй tŚĞĂƚŶŽŽĚůĞ DƵŶŐďĞĂŶ ϲй ϰϬй

KƚŚĞƌůĞŐƵŵĞƐ ;ŝŶĐůƵĚĞ ƐŽǇďĞĂŶͿ ϮϮй

ZŝĐĞ ϴϮй ^ŽǇďĞĂŶŵŝůŬ Ϯϱй

EƵƚƐĂŶĚƐĞĞĚƐ ϭϯй

DƵŶŐďĞĂŶ Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-BasedϰϬй Dietary Guidelines for School-Aged Children in Cambodia 45

KƚŚĞƌůĞŐƵŵĞƐ ;ŝŶĐůƵĚĞ ƐŽǇďĞĂŶͿ ϮϮй

^ŽǇďĞĂŶŵŝůŬ Ϯϱй

ϭͬϭ࣮࣌ࢪ

ϭͬϭ࣮࣌ࢪ Calcium According to statistics for Japan, calcium intake among the intake among Japanese almost doubled over 30 years (from 300mg in 1949 to 548mg in 1979). This is mostly due to milk and milk products consumption, which increased from 4g to 113g over the same time period (Figure 4-4).

Figure 4-5 shows the milk supply in Cambodia and neighboring countries for the past 20 years. Countries such as Vietnam, Thailand, and Myanmar increased their milk supply by double over the two decades.

In Cambodia, milk supply remains low (Figure 4-5), along with milk and milk product consumption. However, this trend may change in future as these milk products can be an ideal source of calcium. In order to achieve the increases seen elsewhere in the region, intake would need to be increased by 50 to 100mg over the next 10 years (from the average of 396mg of current calcium intake to 450-500mg).

From the survey results, students’ intake of calcium mostly relied on the condiments which accounted for 27.6% of calcium consumption (from this, 84% is coming from fish and shrimp paste, and 12% is from fish sauce), followed by cereals (13.9%), fish (12.7%), and vegetables (9.2%, mainly coming from leafy vegetables of 61%) (Figure 4-6). When converted into serving size, only about 0.3 servings were consumed from the calcium-rich foods. This should be increased to 2-3 servings. The food portion equivalent to 1 serving (100mg) of calcium is 100ml for milk, 40g for whole small fish, 60g of tofu, and 50g for amaranth (leafy green vegetables).

Figure 4-4: Changes in calcium intake and calcium food group (Legumes, fish, meat, eggs, milk and milk products) intakes in Japan

ĂůĐŝƵŵ >ĞŐƵŵĞƐ &ŝƐŚ DĞĂƚ ŐŐ DŝůŬĂŶĚŵŝůŬƉƌŽĚƵĐƚƐ ϲϬϬ ϭϰϬ ϱϯϳ ϱϰϴ ϱϬϬ ϱϰϬ ϭϮϬ ϭϬϬ ϰϬϬ ϯϴϱ ϯϬϬ ϴϬ ϯϬϬ ϲϬ ϮϬϬ ϰϬ ϭϬϬ ϮϬ Ϭ Ϭ

ĂůĐŝƵŵŝŶƚĂŬĞ;ŵŐͬĐĂƉŝƚĂͬĚĂǇͿ ϭϵϰϵ ϭϵϱϵ ϭϵϲϵ ϭϵϳϵ ϭϵϴϵ

zĞĂƌ &ŽŽĚŐƌŽƵƉŝŶƚĂŬĞ;ŐͬĐĂƉŝƚĂͬĚĂǇͿ

Source: Ministry of Health, Labour and Welfare, Japan: National nutrition survey

46 Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Figure 4-5: Changes in milk supply in Cambodia, Neighboring countries, China, Korea and Japan (1990-2005)

ϮϱϬ

ϮϬϬ :ĂƉĂŶ

ϭϱϬ

ŚŝŶĂ ϭϬϬ DǇĂŶŵĞƌ dŚĂŝůĂŶĚ <ŽƌĞĂ ϱϬ sŝĞƚŶĂŵ DŝůŬƐƵƉƉůǇ;ŐͬĐĂƉŝƚĂͬĚĂǇͿ >ĂŽƐ Ϭ ĂŵďŽĚŝĂ ϭϵϵϬ ϭϵϵϱ ϮϬϬϬ ϮϬϬϱ ϮϬϭϬ zĞĂƌ

Source: FAO. FAOSTAT. Food Balance Sheets

Figure 4-6: Ratio of food groups for calcium source by age group

Ϭй ϭϬй ϮϬй ϯϬй ϰϬй ϱϬй ϲϬй ϳϬй ϴϬй ϵϬй ϭϬϬй

6 yearsϲzZ^ old Ϯϲ͘Ϭ ϵ͘ϰ

7-9ϳͲϵzZ^ years old Ϯϵ͘Ϯ ϴ͘ϰ

10-12ϭϬͲϭϮzZ^ years old ϯϬ͘ϭ ϲ͘ϴ

13-15ϭϯͲϭϱzZ^ years old Ϯϳ͘Ϯ ϲ͘ϵ

16-17ϭϲͲϭϳzZ^ year old Ϯϯ͘ϳ ϲ͘ϲ

ŽŶĚŝŵĞŶƚƐĂŶĚƐƉŝĐĞ͕ >> ĞƌĞĂůƐ͕ϭϯ͘ϵ KƚŚĞƌƐ͕ϭϯ͘Ϭ Ϯϳ͘ϲ

&ŝƐŚĂŶĚƐŚĞůůĨŝƐŚ͕ϭϮ͘ϳ &ƌƵŝƚƐ͕ϳ͘ϱ ĞǀĞƌĂŐĞƐ͕ϱ͘ϰ sĞŐĞƚĂďůĞƐ͕ϵ͘Ϯ DŝůŬĂŶĚŵŝůŬ >ĞŐƵŵĞƐ͕ŶƵƚƐĂŶĚ ƉƌŽĚƵĐƚƐ͕ϳ͘Ϯ ƐĞĞĚƐ͕ϯ͘ϱ

宥 ^ĞĂǁĞĞĚ sĞŐĞƚĂďůĞ ϯй ƉŝĐŬůĞƐ ϱй

KƚŚĞƌ ǀĞŐĞƚĂďůĞƐ ϯϭй >ĞĂĨǀĞŐĞƚĂďůĞƐ ϲϭй KƚŚĞƌƐ ZŝĐĞŶŽŽĚůĞ ϱй Ϯй

[Figure 4-6a: Condiments] [Figure 4-6b: Vegetables] 宥 ^ĞĂǁĞĞĚ sĞŐĞƚĂďůĞ ϯй KƚŚĞƌƐ ƉŝĐŬůĞƐ Ϯй ϱй 室 &ŝƐŚƐĂƵĐĞ ϭϰй

KƚŚĞƌ ǀĞŐĞƚĂďůĞƐ ϯϭй >ĞĂĨǀĞŐĞƚĂďůĞƐ &ŝƐŚĂŶĚ ϲϭй ƐŚƌŝŵƉƉĂƐƚĞ ϴϰй

4.2.2 Ideal goals for height and weight

As shown by anthropometric results in earlier chapter,KƚŚĞƌƐ it is important to observe the Ϯй physique of studentsϭͬϭ࣮࣌ࢪ at 6-17 years of age. Reducing the number of students who are 室 &ŝƐŚƐĂƵĐĞ underweight, stunted, and thin can be anϭϰй optimal goal for their overall health and growth. Setting ideal goals for weight and height within the next 10 years is recommended using examples from other Asian countries.

In Asia, the children’s average height and weight increased over the past few decades. For instance, boys’ height increases ranged from 0.9 cm (Thailand) to 4.7 cm (Korea), &ŝƐŚĂŶĚ and their weight increases ranged from 0.8 kg (Japan) to 5.3 kg (Korea)ƐŚƌŝŵƉƉĂƐƚĞ on average ϴϰй over years42)-48) (Table 4-1, 4-2). Likewise, girls’ height increased 0.6 cm (Thailand) to 3.9 cm (Korea), and gained 0.8 kg (Japan) to 3.7 kg (Korea) on average over 10 years47),48). Taking into consideration the above data, weight increase of 1-3 kg and height increase of 1-4 cm from the current mean or median may be an ideal goal over the next 10 years (Table 4-3). ϭͬϭ࣮࣌ࢪ

Table 4-1: Average of height increase per 10 years (Boys) ŽǇƐͲŚĞŝŐŚƚŝŶĐƌĞĂƐĞĂǀĞƌĂŐĞƉĞƌϭϬǇƌƐ ŚŝŶĂ ŚŝŶĂ ŐĞ sŝĞƚŶĂŵϰϮͿ dŚĂŝůĂŶĚϰϯͿ ŚŝŶĂϰϲͿ <ŽƌĞĂϰϳͿ :ĂƉĂŶϰϴͿ ͲZƵƌĂůϰϰͿ ͲhƌďĂŶϰϱͿ ;zĞĂƌƐͿ ;ϭϵϳϲͲϮϬϬϲͿ ;ϭϵϱϬͲϮϬϬϬͿ ;ϭϵϴϱͲϮϬϬϱͿ ;ϭϵϴϱͲϮϬϬϱͿ ;ϭϵϴϱͲϮϬϬϱͿ ;ϭϵϲϱͲϮϬϬϱͿ ;ϭϵϰϵͲϭϵϴϵͿ ϲ Ͳ Ͳ Ͳ Ͳ Ϯ͘ϲ Ϯ͘Ϭ Ϯ͘ϭ;ϭ͘ϵ͕Ϯ͘ϴ͕ϭ͘ϳͿΎΎ ϳ Ͳ Ͳ Ϯ͘ϲ Ϯ͘Ϯ ϯ͘ϭ Ϯ͘ϯ ϴ Ͳ Ͳ Ϯ͘ϴ Ϯ͘ϲ Ͳ ϯ͘ϭ Ϯ͘ϱ ϵ Ͳ Ͳ Ϯ͘ϵ Ϯ͘ϲ Ͳ ϯ͘ϭ Ϯ͘ϳ ϭϬ Ͳ ϯ͘Ϭ Ϯ͘ϴ Ͳ ϯ͘ϯ Ϯ͘ϵ ϭϭ Ͳ Ϭ͘ϵ;Ϭ͘ϳ͕ϭ͘ϭͿΎ ϯ͘ϯ ϯ͘ϭ Ͳ ϯ͘ϳ ϯ͘ϰ ϭϮ Ͳ ϰ͘Ϭ ϯ͘ϴ Ͳ ϰ͘ϰ ϯ͘ϵ ϭϯ Ͳ Ͳ ϯ͘ϲ ϯ͘Ϯ Ͳ ϰ͘ϳ ϰ͘ϱ ϭϰ Ͳ Ͳ ϯ͘ϲ Ϯ͘ϵ Ͳ ϰ͘ϱ ϰ͘ϰ ϭϱ Ͳ Ͳ ϯ͘ϯ Ϯ͘ϯ Ͳ ϯ͘ϲ ϯ͘ϰ ϭϲ Ͳ Ϯ͘Ϯ ϭ͘ϳ Ͳ Ϯ͘ϰ Ϯ͘ϳ Ϯ͘ϳ ϭϳ Ͳ ϭ͘ϴ ϭ͘ϯ Ͳ ϭ͘ϴ Ϯ͘ϯ Ύ;ZƵƌĂů͕hƌďĂŶͿ ΎΎ;hƌďĂŶ͕^ƵďƵƌďĂŶ͕ZƵƌĂůͿ

48 'ŝƌůƐͲŚĞŝŐŚƚŝŶĐƌĞĂƐĞĂǀĞƌĂŐĞƉĞƌϭϬǇƌƐDevelopment of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia ŚŝŶĂ ŚŝŶĂ ŐĞ sŝĞƚŶĂŵϰϮͿ dŚĂŝůĂŶĚϰϯͿ ŚŝŶĂϰϲͿ <ŽƌĞĂϰϳͿ :ĂƉĂŶϰϴͿ ͲZƵƌĂůϰϰͿ ͲhƌďĂŶϰϱͿ ;zĞĂƌƐͿ ;ϭϵϳϲͲϮϬϬϲͿ ;ϭϵϱϬͲϮϬϬϬͿ ;ϭϵϴϱͲϮϬϬϱͿ ;ϭϵϴϱͲϮϬϬϱͿ ;ϭϵϴϱͲϮϬϬϱͿ ;ϭϵϲϱͲϮϬϬϱͿ ;ϭϵϰϵͲϭϵϴϵͿ ϲ Ͳ Ͳ Ͳ Ͳ Ϯ͘ϰ Ϯ͘ϭ Ϯ͘Ϭ;ϭ͘ϵ͕Ϯ͘ϲ͕ϭ͘ϲͿΎΎ ϳ Ͳ Ͳ Ϯ͘ϱ ϭ͘ϵ Ϯ͘ϵ Ϯ͘ϯ ϴͲ Ͳ Ϯ͘ϵ Ϯ͘ϰ Ͳ ϯ͘ϭ Ϯ͘ϱ ϵ Ͳ Ͳ Ϯ͘ϵ Ϯ͘ϱ Ͳ ϯ͘ϰ Ϯ͘ϴ ϭϬ Ͳ ϯ͘Ϯ Ϯ͘ϲ Ͳ ϯ͘ϰ ϯ͘ϯ ϭϭ Ͳ Ϭ͘ϲ;Ϭ͘ϱ͕Ϭ͘ϴͿΎ ϯ͘ϱ Ϯ͘ϴ Ͳ ϯ͘ϴ ϯ͘ϴ ϭϮ Ͳ ϯ͘ϯ Ϯ͘ϱ Ͳ ϯ͘ϵ ϯ͘ϳ ϭϯ Ͳ Ͳ ϭ͘ϴ ϭ͘ϱ Ͳ ϯ͘Ϯ ϯ͘ϯ ϭϰ Ͳ Ͳ ϭ͘ϴ ϭ͘Ϯ Ͳ Ϯ͘ϱ Ϯ͘ϲ ϭϱ Ͳ Ͳ ϭ͘ϱ ϭ͘ϭ Ͳ ϭ͘ϳ ϭ͘ϴ ϭϲ Ͳ ϭ͘ϯ Ϭ͘ϴ Ͳ ϭ͘ϰ ϭ͘ϱ ϭ͘ϰ ϭϳ Ͳ ϭ͘ϭ Ϭ͘ϵ Ͳ ϭ͘Ϯ ϭ͘ϰ Ύ;ZƵƌĂů͕hƌďĂŶͿ ΎΎ;hƌďĂŶ͕^ƵďƵƌďĂŶ͕ZƵƌĂůͿ ŽǇƐͲŚĞŝŐŚƚŝŶĐƌĞĂƐĞĂǀĞƌĂŐĞƉĞƌϭϬǇƌƐ ŚŝŶĂ ŚŝŶĂ ŐĞ sŝĞƚŶĂŵϰϮͿ dŚĂŝůĂŶĚϰϯͿ ŚŝŶĂϰϲͿ <ŽƌĞĂϰϳͿ :ĂƉĂŶϰϴͿ ͲZƵƌĂůϰϰͿ ͲhƌďĂŶϰϱͿ ;zĞĂƌƐͿ ;ϭϵϳϲͲϮϬϬϲͿ ;ϭϵϱϬͲϮϬϬϬͿ ;ϭϵϴϱͲϮϬϬϱͿ ;ϭϵϴϱͲϮϬϬϱͿ ;ϭϵϴϱͲϮϬϬϱͿ ;ϭϵϲϱͲϮϬϬϱͿ ;ϭϵϰϵͲϭϵϴϵͿ ϲ Ͳ Ͳ Ͳ Ͳ Ϯ͘ϲ Ϯ͘Ϭ Ϯ͘ϭ;ϭ͘ϵ͕Ϯ͘ϴ͕ϭ͘ϳͿΎΎ ϳ Ͳ Ͳ Ϯ͘ϲ Ϯ͘Ϯ ϯ͘ϭ Ϯ͘ϯ ϴ Ͳ Ͳ Ϯ͘ϴ Ϯ͘ϲ Ͳ ϯ͘ϭ Ϯ͘ϱ ϵ Ͳ Ͳ Ϯ͘ϵ Ϯ͘ϲ Ͳ ϯ͘ϭ Ϯ͘ϳ ϭϬ Ͳ ϯ͘Ϭ Ϯ͘ϴ Ͳ ϯ͘ϯ Ϯ͘ϵ ϭϭ Ͳ Ϭ͘ϵ;Ϭ͘ϳ͕ϭ͘ϭͿΎ ϯ͘ϯ ϯ͘ϭ Ͳ ϯ͘ϳ ϯ͘ϰ ϭϮ Ͳ ϰ͘Ϭ ϯ͘ϴ Ͳ ϰ͘ϰ ϯ͘ϵ ϭϯ Ͳ Ͳ ϯ͘ϲ ϯ͘Ϯ Ͳ ϰ͘ϳ ϰ͘ϱ ϭϰ Ͳ Ͳ ϯ͘ϲ Ϯ͘ϵ Ͳ ϰ͘ϱ ϰ͘ϰ ϭϱ Ͳ Ͳ ϯ͘ϯ Ϯ͘ϯ Ͳ ϯ͘ϲ ϯ͘ϰ ϭϲ Ͳ Ϯ͘Ϯ ϭ͘ϳ Ͳ Ϯ͘ϰ Ϯ͘ϳ Ϯ͘ϳ ϭϳ Ͳ ϭ͘ϴ ϭ͘ϯ Ͳ ϭ͘ϴ Ϯ͘ϯ Ύ;ZƵƌĂů͕hƌďĂŶͿ ΎΎ;hƌďĂŶ͕^ƵďƵƌďĂŶ͕ZƵƌĂůͿ Table 4-2: Average of height increase per 10 years (Girls) 'ŝƌůƐͲŚĞŝŐŚƚŝŶĐƌĞĂƐĞĂǀĞƌĂŐĞƉĞƌϭϬǇƌƐ ŚŝŶĂ ŚŝŶĂ ŐĞ sŝĞƚŶĂŵϰϮͿ dŚĂŝůĂŶĚϰϯͿ ŚŝŶĂϰϲͿ <ŽƌĞĂϰϳͿ :ĂƉĂŶϰϴͿ ͲZƵƌĂůϰϰͿ ͲhƌďĂŶϰϱͿ ;zĞĂƌƐͿ ;ϭϵϳϲͲϮϬϬϲͿ ;ϭϵϱϬͲϮϬϬϬͿ ;ϭϵϴϱͲϮϬϬϱͿ ;ϭϵϴϱͲϮϬϬϱͿ ;ϭϵϴϱͲϮϬϬϱͿ ;ϭϵϲϱͲϮϬϬϱͿ ;ϭϵϰϵͲϭϵϴϵͿ ϲ Ͳ Ͳ Ͳ Ͳ Ϯ͘ϰ Ϯ͘ϭ Ϯ͘Ϭ;ϭ͘ϵ͕Ϯ͘ϲ͕ϭ͘ϲͿΎΎ ϳ Ͳ Ͳ Ϯ͘ϱ ϭ͘ϵ Ϯ͘ϵ Ϯ͘ϯ ϴͲ Ͳ Ϯ͘ϵ Ϯ͘ϰ Ͳ ϯ͘ϭ Ϯ͘ϱ ŽǇƐͺǁĞŝŐŚƚŝŶĐƌĞĂƐĞĂǀĞƌĂŐĞƉĞƌϭϬǇƌƐ ϵ Ͳ Ͳ Ϯ͘ϵ Ϯ͘ϱ Ͳ ϯ͘ϰ Ϯ͘ϴ ŐĞ <ŽƌĞĂϰϳͿ :ĂƉĂŶϰϴͿ ϭϬ Ͳ ϯ͘Ϯ Ϯ͘ϲ Ͳ ϯ͘ϰ ϯ͘ϯ ;zĞĂƌƐͿ ;ϭϵϲϱͲϮϬϬϱͿ ;ϭϵϰϵͲϭϵϴϵͿ ϭϭ Ͳ Ϭ͘ϲ;Ϭ͘ϱ͕Ϭ͘ϴͿΎ ϯ͘ϱ Ϯ͘ϴ Ͳ ϯ͘ϴ ϯ͘ϴ ϲ ϭ͘ϰ Ϭ͘ϴ ϭϮ Ͳ ϯ͘ϯ Ϯ͘ϱ Ͳ ϯ͘ϵ ϯ͘ϳ ϳ ϭ͘ϵ Ϭ͘ϵ ϭϯ Ͳ Ͳ ϭ͘ϴ ϭ͘ϱ Ͳ ϯ͘Ϯ ϯ͘ϯ ϴ Ϯ͘ϱ ϭ͘Ϯ ϭϰ Ͳ Ͳ ϭ͘ϴ ϭ͘Ϯ Ͳ Ϯ͘ϱ Ϯ͘ϲ ϵ Ϯ͘ϵ ϭ͘ϱ ϭϱ Ͳ Ͳ ϭ͘ϱ ϭ͘ϭ Ͳ ϭ͘ϳ ϭ͘ϴ ϭϬ ϯ͘ϰ ϭ͘ϵ ϭϲ Ͳ ϭ͘ϯ Ϭ͘ϴ Ͳ ϭ͘ϰ ϭ͘ϱ ϭ͘ϰ ϭϭ ϯ͘ϴ Ϯ͘ϰ ϭϳ Ͳ ϭ͘ϭ Ϭ͘ϵ Ͳ ϭ͘Ϯ ϭ͘ϰ Ύ;ZƵƌĂů͕hƌďĂŶͿ ϭϮ ϰ͘ϱ ϯ͘Ϭ ϭϯ ϱ͘ϯ ϯ͘ϱ ΎΎ;hƌďĂŶ͕^ƵďƵƌďĂŶ͕ZƵƌĂůͿ ϭϰ ϱ͘ϯ ϯ͘ϳ ϭϱ ϱ͘Ϭ ϯ͘ϯ Table 4-3: Average of weight increaseϭϲ per ϰ͘ϭ 10 years Ϯ͘ϴ ϭϳ ϯ͘ϲ Ϯ͘ϰ Boys Girls ŽǇƐͺǁĞŝŐŚƚŝŶĐƌĞĂƐĞĂǀĞƌĂŐĞƉĞƌϭϬǇƌƐ 'ŝƌůƐͺǁĞŝŐŚƚŝŶĐƌĞĂƐĞĂǀĞƌĂŐĞƉĞƌϭϬǇƌƐ ŐĞ <ŽƌĞĂϰϳͿ :ĂƉĂŶϰϴͿ ŐĞ <ŽƌĞĂϰϳͿ :ĂƉĂŶϰϴͿ ;zĞĂƌƐͿ ;ϭϵϲϱͲϮϬϬϱͿ ;ϭϵϰϵͲϭϵϴϵͿ ;zĞĂƌƐͿ ;ϭϵϲϱͲϮϬϬϱͿ ;ϭϵϰϵͲϭϵϴϵͿ ϲ ϭ͘ϰ Ϭ͘ϴ ϲ ϭ͘Ϭ Ϭ͘ϴ ϳ ϭ͘ϵ Ϭ͘ϵ ϳ ϭ͘ϲ ϭ͘Ϭ ϴ Ϯ͘ϱ ϭ͘Ϯ ϴ Ϯ͘Ϭ ϭ͘Ϯ ϵ Ϯ͘ϵ ϭ͘ϱ ϵ Ϯ͘ϯ ϭ͘ϲ ϭϬ ϯ͘ϰ ϭ͘ϵ ϭϬ ϯ͘ϭ Ϯ͘Ϭ ϭϭ ϯ͘ϴ Ϯ͘ϰ ϭϭ ϯ͘ϰ Ϯ͘ϱ ϭϮ ϰ͘ϱ ϯ͘Ϭ ϭϮ ϯ͘ϲ Ϯ͘ϵ ϭϯ ϱ͘ϯ ϯ͘ϱ ϭϯ ϯ͘ϳ Ϯ͘ϳ ϭϰ ϱ͘ϯ ϯ͘ϳ ϭϰ ϯ͘ϰ Ϯ͘ϯ ϭϱ ϱ͘Ϭ ϯ͘ϯ ϭϱ Ϯ͘ϳ ϭ͘ϳ ϭϲ ϰ͘ϭ Ϯ͘ϴ ϭϲ Ϯ͘Ϭ ϭ͘Ϯ ϭϳ ϯ͘ϲ Ϯ͘ϰ ϭϳ ϭ͘ϲ Ϭ͘ϵ

'ŝƌůƐͺǁĞŝŐŚƚŝŶĐƌĞĂƐĞĂǀĞƌĂŐĞƉĞƌϭϬǇƌƐ ŐĞ <ŽƌĞĂϰϳͿ :ĂƉĂŶϰϴͿ ;zĞĂƌƐͿ ;ϭϵϲϱͲϮϬϬϱͿ ;ϭϵϰϵͲϭϵϴϵͿ ϲ ϭ͘Ϭ Ϭ͘ϴ ϳ ϭ͘ϲ ϭ͘Ϭ ϴ Ϯ͘Ϭ ϭ͘Ϯ ϵ Ϯ͘ϯ ϭ͘ϲ ϭϬ ϯ͘ϭ Ϯ͘Ϭ ϭϭ ϯ͘ϰ Ϯ͘ϱ ϭϮ ϯ͘ϲ Ϯ͘ϵ ϭϯ ϯ͘ϳ Ϯ͘ϳ ϭϰ ϯ͘ϰ Ϯ͘ϯ ϭϱ Ϯ͘ϳ ϭ͘ϳ ϭϲ Ϯ͘Ϭ ϭ͘Ϯ ϭϳ ϭ͘ϲ Ϭ͘ϵ

Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia 49 Chapter 5 The Cambodian Food-Based Dietary Guidelines -Cambodian Food for Healthy Growth-

As presented in Chapter 3, the CAM-RDA for school-aged children has been calculated based on the dietary intakes and nutritional status found through the nationwide survey conducted in 2014-15. In order to promote nutritional recommendations generated through the CAM-RDA to the public, this information needs to be translated into Food-Based Dietary Guidelines (FBDG) that comprise simple messages on healthy eating along with the food pyramid and other Information Education and Communication (IEC) materials that give guidance on specific foods and amount to be eaten each day from each food type.

These guidelines and accompanying IEC materials can be used as tools for nutrition education in schools as well as for interventions that promote healthy eating habits among the general public including caretakers of children. 5.1 Seven messages

The following 7 key messages were first drafted based on the scientific rationale from the survey. The wording of the messages and its statement were evaluated by the FBDG development team to ensure that they are appropriate for school-aged children. They were revised taking into account feedback from other interested parties and finalized by the FBDG development team after pilot testing.

1. Eat food from all food types with a well-balanced diet* everyday 2. Consume calcium rich-food such as whole small fish, milk and milk products 3. Eat protein-rich foods such as fish, meat, eggs or beans at least 2 to 3 times a day 4. Eat plenty of fruits and vegetables regularly 5. Eat cereal and starchy food such as rice, noodles, bread and its alternatives in an adequate amount 6. Reduce food high in salt, sugar and fat 7. Measure your body weight and height regularly and track your growth * Balanced diet is to eat food from all food types in proper amount and fit with physical activity49)

50 Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia 5.2 Educational materials for dissemination

IEC materials play a very important role in drawing the attention of the target population to the guidelines and communicating its substance effectively. The Camboidan Food-Based Dietary Guidlines have been translated into the following 4 kinds of IEC materials.

dǇƉĞŽĨ/ŵĂƚĞƌŝĂů dĂƌŐĞƚĂƵĚŝĞŶĐĞ ŽŶƚĞŶƚƐ ůůƐĐŚŽŽůͲĂŐĞĚ ĐŚŝůĚƌĞŶ;ϲʹϭϳǇĞĂƌƐ &ŽŽĚƉǇƌĂŵŝĚ WŽƐƚĞƌ ŽůĚͿ͕ƚŚĞŐĞŶĞƌĂů ϳŬĞǇŵĞƐƐĂŐĞƐ ƉƵďůŝĐ &ŽŽĚƉǇƌĂŵŝĚ WƌŝŵĂƌǇƐĐŚŽŽů ϳŬĞǇŵĞƐƐĂŐĞƐ ƌŽĐŚƵƌĞ ƐƚƵĚĞŶƚƐ ^ŚŽƌƚƐƚĂƚĞŵĞŶƚŽĨĞĂĐŚŵĞƐƐĂŐĞ ZĞĨĞƌĞŶĐĞǁĞŝŐŚƚĂŶĚŚĞŝŐŚƚ &ŽŽĚƉǇƌĂŵŝĚ ^ĞƌǀŝŶŐƐŝǌĞŝŶĨŽƌŵĂƚŝŽŶ ϳŬĞǇŵĞƐƐĂŐĞƐ ǆƉůĂŶĂƚŝŽŶŽĨĞĂĐŚŵĞƐƐĂŐĞ ^ĞĐŽŶĚĂƌǇͬ,ŝŐŚ ŽŽŬůĞƚ ĂƐŝĐŶƵƚƌŝĞŶƚƐ ƐĐŚŽŽůƐƚƵĚĞŶƚƐ DĂůŶƵƚƌŝƚŝŽŶ DĞĂůƉůĂŶŶŝŶŐ ,ĞĂůƚŚǇƌĞĐŝƉĞ ĐƚŝǀŝƚǇŚĞĐŬůŝƐƚ &ŽŽĚƉǇƌĂŵŝĚ ^ĞƌǀŝŶŐƐŝǌĞŝŶĨŽƌŵĂƚŝŽŶ ,ĂŶĚďŽŽŬ ĂƌĞƚĂŬĞƌ͕ŚĞĂůƚŚ ϳŬĞǇŵĞƐƐĂŐĞƐ ;ƚŽďĞĚĞǀĞůŽƉĞĚͿ ǁŽƌŬĞƌƐ͕ĐŽŵŵƵŶŝƚǇ EƵƚƌŝƚŝŽŶŝŶĨŽƌŵĂƚŝŽŶĂŶĚŵĞĂů ŚĞĂůƚŚǀŽůƵŶƚĞĞƌƐ͕ ƉůĂŶŶŝŶŐ ΎƐĞĞƚŚĞĐŚĂƉƚĞƌϲ͞&ŽƌƚŚĞŶĞǆƚƐƚĞƉ͟ ƚĞĂĐŚĞƌƐ ŽŽŬŝŶŐƚĞĐŚŶŝƋƵĞĂŶĚŚǇŐŝĞŶĞ ƉƌĂĐƚŝĐĞƐ ,ĞĂůƚŚǇZĞĐŝƉĞƐ dŚĞŵĞĞƚŝŶŐŽĨ&' ĚĞǀĞůŽƉŵĞŶƚƚĞĂŵĂĐƚŝǀĞůǇ ĚŝƐĐƵƐƐŝŶŐƚŚĞĨŽŽĚƉǇƌĂŵŝĚ ĂŶĚƚŚĞŬĞǇŵĞƐƐĂŐĞƐ͘ ;:ƵŶĞϮϬϭϳͿ

Target: All school-aged children and the general public

Content: The food items were selected from the top 50 most commonly consumed items reported by respondents during the nationwide survey in 2014-15. Young Cambodian artists drew all of the food items in the pyramid. The shape of pyramid was inspired by Angkor Wat Temple. The pyramid “Cambodian Food for Healthy Growth“ is designed to show the recommended proportion of food types to be consumed; ie., low consumption at the top and higher consumption at the base of the pyramid. The food types are (1) cereals and starchy foods as main source of carbohydrate, (2) fruits and (3) vegetables as important sources of vitamins and minerals, (4) whole small fish, small dried shrimp, milk and milk products as the main source of calcium and (5) meat, fish, eggs, and beans as main sources of protein and (6) fat and condiments such as oil, animal fat, salt and sugar. Examples of food types in the food pyramid: i. Cereals and starchy foods: rice, yellow noodle, white noodle, bread, corn, and potato. ii. Vegetables: morning glory, cucumber, carrot, tomato, spinach, pumpkin, wax gourd, bean sprout and snake gourd. iii. Fruits: banana, pineapple, water-melon, mango, papaya, orange, sapodilla, jack fruit and guava. iv. Protein-rich foods: fish, chicken, meat, eggs, snail, crab and beans. v. Calcium-rich foods: whole small fish, small dried shrimp, tofu, milk and milk products. vi. Salt, sugar, fat and oil: oil and pork fat, salt and sugar.

7 key messages are introduced on both sides of the pyramid expressing the connection between food types and messages by color.

52 Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia 5.2.2 Brochure

Target: Primary school students

Content: The main information is derived from the food pyramid with additional short statement about the 7 key messages. The short statement is to support each key message in order for children to understand the rationale behind the recommendations.

The short statement: Message 1: Eat food from all food types with a well-balanced* diet everyday: Eating food from different food types every day is to support your health and growth. Message 2: Consume calcium-rich food such as whole small fish, milk and milk products: Calcium is important to maintain healthy teeth and bones. Message 3: Eat protein-rich food such as fish, meat, eggs or beans at least 2 to 3 times a day: Protein-rich foods will help you build a strong body and muscles. Message 4: Eat plenty of fruits and vegetables regularly: Eating vegetables and fruits can help you prevent illness. Message 5: Eat cereals and starchy foods such as rice, noodles, bread and its alternatives in an adequate amount: The body needs to maintain a constant supply of energy. Providing energy is the major function of cereals and starchy foods. Message 6: Reduce food high in salt, sugar and fat: Try to limit sweetened drinks. You can choose to stay healthy through selecting foods that are low in fat, salt and sugar. Message 7: Measure your body weight and height regularly and track your growth: Knowing your body weight and height can help you manage healthy growth.

The ideal body weight and height for each age group are also introduced for boys and girls.

ϳϵ 54 Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia 5.2.3 Booklet

Target: Secondary and high school students (13-17 years old)

Content: The below contents were selected taking into consideration the target age group that will soon be responsible for their own food choices and will soon reach their reproductive years.

1. Food pyramid Food pyramid is introduced with illustration of food item and in which type each belongs to.

2. Serving size information “How much do we need to eat from each food type?” In order for an individual to understand

6WDQGDUGRI6HUYLQJ how much to eat from each food type, ɑȶƎ ƽɽ ɌǕǓɌȲȶɭƒ ʑɌƷƛ ɍ ɽ ( it is important to provide guidance Ǖ(c£ǔ:7¢?m:CZ (Ǟ>ǶǴ>$m ©(>ǘ?÷ m on serving sizes. The information was prepared for both boys and girls from £8c;5£ǖ86³m Ǜ3 Y ǇɋʑȲɮɅƸɅ ɞ ɅɸɆȥɭƃ ȲʒȷƷƛ ɋ 7Y(::$c<Ȯ_ ʑʐǒƚ Ɇƙǉȳɪƚ 13-17 years old or more, based on three (ʑʖʕƙƳɊ) ʑɌƷƛ ɍɽǋɅ (ʑʔʐƙƳɊ) of energy requirement levels from CAM- ɳǉɁɳǒƂ Ɍ ʑɴɇƚ ƳɆɔɮ ɪƙƽɁɭ ʔʐƙƳɊ (ʑʑʐƙƳɊ) RDA. Students will be able to identify

their required energy consumption by ɅɸɆɭȶɄɊʂ ƗǂʑɳȼˊɊ ɅɸɆɭȶʂ ʒɆɅƐɹ their age and their physical activity levels (ʗʐƙƳɊ) ȲɅƚɹ (ʘʐƙƳɊ) indicated alongside the table. However, this may need to be explained by

ɴɇƚɳǿƕ ȸɅʓȼơ ɭɸ school teachers or caretakers for better £8c;58d7 ¤ ɆɴɅƚɵɆɁȶȸɩɅʒơ ɩ (ʓʐƙƳɊ) understanding. In addition, a standard ʑɌƷƛ ɍɽǋɅɆɴɅƚ ǒƚ Ɇƙǉȳɪƚ (ʓʐƙƳɊ) ɃɊƂɅʓʐƙƳɊɽ serving size for each food type needs to be introduced along with the serving size guide50). So far, only selected food items ƙɁɑȲɳǪȲɅɽ ƚɹɴɇƚ ɞ ʔȷɸɅɩɁ (ʓʐƙƳɊ) have been listed in the table, but the food ʖ list can be updated as necessary.

&ŽŽĚƚǇƉĞ ^ƚĂŶĚĂƌĚŽĨ^ĞƌǀŝŶŐ WŽƌƚŝŽŶƐŝǌĞŽĨƐĞƌǀŝŶŐ

ϭƐŵĂůůďŽǁůŽƌϭϬƐƉŽŽŶƐŽĨĐŽŽŬĞĚƌŝĐĞ;ϭϰϬŐͿ

ϮŚĂŶŐǀĂǇ;ƐĞƚͿŽĨ<ŚŵĞƌŶŽŽĚůĞ;ϭϲϱŐͿ ĞƌĞĂůƐĂŶĚ^ƚĂƌĐŚǇ ϭƐĞƌǀŝŶŐŝƐϰϬŐŽĨ ЪŽĨĐŽƌŶ;ϲϱŐͿ ĨŽŽĚƐ ĐĂƌďŽŚǇĚƌĂƚĞ ϭůŽĂĨŽĨďĂŐƵĞƚƚĞ;ϳϬŐͿ

ϮЪƉŝĞĐĞƐŽĨƐĂŶĚǁŝĐŚďƌĞĂĚ;ϴϬŐͿ

ϮƐƉŽŽŶƐŽĨŐƌĞĞŶǀĞŐĞƚĂďůĞ;ϯϬŐͿ ϭƐĞƌǀŝŶŐŝƐϯϬŐŽĨ sĞŐĞƚĂďůĞƐ ϯƉŝĞĐĞƐŽĨƉƵŵƉŬŝŶ;ϯϬŐͿ ǀĞŐĞƚĂďůĞƐ ЪŽƌϰƉŝĞĐĞƐŽĨĐƵĐƵŵďĞƌ;ϯϬŐͿ

ϰƉŝĞĐĞƐŽĨǁĂƚĞƌŵĞůŽŶ;ϭϬϬŐͿ

ϯƉŝĞĐĞƐŽĨŐƵĂǀĂ;ϭϬϬŐͿ

&ƌƵŝƚƐ ϭƐĞƌǀŝŶŐŝƐϭϬϬŐŽĨĨƌƵŝƚƐ ϰƉŝĞĐĞƐŽĨƉĂƉĂǇĂ;ϭϬϬŐͿ

ϭЪŽĨďĂŶĂŶĂ;ϭϬϬŐͿ

ϰƉŝĞĐĞƐŽĨƌŝƉĞŵĂŶŐŽ;ϭϬϬŐͿ

ϮƐƉŽŽŶƐŽĨĐŚŽƉƉĞĚŽƌƐůŝĐĞŵĞĂƚ;ϮϬŐͿ

ϰƉŝĞĐĞƐŽĨĨŝƐŚŵĞĂƚ;ϯϬŐͿ WƌŽƚĞŝŶͲƌŝĐŚĨŽŽĚƐ ϭƐĞƌǀŝŶŐŝƐϲŐŽĨƉƌŽƚĞŝŶ ϭĐŚŝĐŬĞŶĞŐŐ;ϱϬŐͿ

ϯƐƉŽŽŶƐŽĨŵƵŶŐďĞĂŶ;ϲϬŐͿ

ϮƐƉŽŽŶƐŽĨƐŵĂůůĨŝƐŚ;ϰϬŐͿ

ϳƐŵĂůůĚƌŝĞĚĨŝƐŚ;ϭϬŐͿ ϭƐĞƌǀŝŶŐŝƐϭϬϬŵŐŽĨ ĂůĐŝƵŵͲƌŝĐŚĨŽŽĚƐ ϭĐƵƉŽĨǇŽŐŚƵƌƚ;ϭϬϬŐͿ ĐĂůĐŝƵŵ ЪŐůĂƐƐŽĨŵŝůŬ;ϭϬϬŵůͿ

ϱͬϵƉŝĞĐĞƐŽĨƚŽĨƵ;ϲϬŐͿ

ͻϭƚĞĂƐƉŽŽŶŽĨďƵƚƚĞƌ;ϱŐͿ

ϭƚĞĂƐƉŽŽŶŽĨŽŝůͬĨĂƚ;ϱŐͿ Table 5-2: Energy-based ideal serving size for girls &ĂƚĂŶĚŽŝůƐ ͲdƌǇƚŽĐŚŽŽƐĞǀĞŐĞƚĂďůĞŽŝůƌĂƚŚĞƌƚŚĂŶĂŶŝŵĂůĨĂƚ͘

Ͳ&ĂƚŝƐĂůƐŽĐŽŶƚĂŝŶĞĚŝŶŽƚŚĞƌĨŽŽĚƚǇƉĞƐ͘

Ͳ>ŝŵŝƚǇŽƵƌĨĂƚŝŶƚĂŬĞďǇϮͲϯƚĞĂƐƉŽŽŶƐ;ϭϬͲϭϱŐͿƉĞƌĚĂǇŽŶůǇ͘

56 Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia ŶĞƌŐǇĂƐĞĚ^ĞƌǀŝŶŐ^ŝǌĞĨŽƌŐŝƌůƐ ŶĞƌŐǇĂƐĞĚ^ĞƌǀŝŶŐ^ŝǌĞĨŽƌŐŝƌůƐTable 5-3: Energy-based ideal serving size for boys >ĞǀĞůŽĨ ŐĞ ZĞƋƵŝƌĞĚ ϭ͘ĞƌĞĂůƐ Ϯ͘ ϯ͘&ƌƵŝƚƐ ϰ͘WƌŽƚĞŝŶͲ ϱ͘ĂůĐƵŝŵͲ ĐƚŝǀŝƚǇ>ĞǀĞůŽĨ ;ǇĞĂƌƐͿŐĞ ZĞƋƵŝƌĞĚŶĞƌŐǇ ϭ͘ĞƌĞĂůƐĂŶĚ sĞŐĞƚĂďůĞƐϮ͘ ϯ͘&ƌƵŝƚƐ ϰ͘WƌŽƚĞŝŶͲƌŝĐŚĨŽŽĚƐ ϱ͘ĂůĐƵŝŵͲƌŝĐŚĨŽŽĚƐ ĐƚŝǀŝƚǇ ;ǇĞĂƌƐͿ ŶĞƌŐǇ ƐƚĂƌĐŚǇĂŶĚ sĞŐĞƚĂďůĞƐ ƌŝĐŚĨŽŽĚƐ ƌŝĐŚĨŽŽĚƐ ƐƚĂƌĐŚǇĨŽŽĚƐ ĨŽŽĚƐ >ĞƐƐĐƚŝǀĞ ϮϬϬϬ ϱͲϳ Ϯ ϯ ϮͲϯ ϰͲϱƐĞƌǀŝŶŐƐ >ĞƐƐĐƚŝǀĞ ;ŬĐĂůͿϮϬϬϬ ƐĞƌǀŝŶŐƐϱͲϳ ƐĞƌǀŝŶŐƐϮ ƐĞƌǀŝŶŐƐϯ ƐĞƌǀŝŶŐƐϮͲϯ ϭϯͲϭϳ ϰͲϱƐĞƌǀŝŶŐƐ ;ŬĐĂůͿϮϱϬϬ ƐĞƌǀŝŶŐƐϳͲϵ ƐĞƌǀŝŶŐƐϮͲϯ ƐĞƌǀŝŶŐƐϰ ƐĞƌǀŝŶŐƐϮͲϯ ϭϯͲϭϳ ϱͲϲƐĞƌǀŝŶŐƐ DŽƌĞĐƚŝǀĞ ;ŬĐĂůͿϮϱϬϬ ƐĞƌǀŝŶŐƐϳͲϵ ƐĞƌǀŝŶŐƐϮͲϯ ƐĞƌǀŝŶŐƐϰ ƐĞƌǀŝŶŐƐϮͲϯ ϱͲϲƐĞƌǀŝŶŐƐ DŽƌĞĐƚŝǀĞ ;ŬĐĂůͿ ƐĞƌǀŝŶŐƐ ƐĞƌǀŝŶŐƐ ƐĞƌǀŝŶŐƐ ƐĞƌǀŝŶŐƐ ŶĞƌŐǇĂƐĞĚ^ĞƌǀŝŶŐ^ŝǌĞĨŽƌďŽǇƐ ŶĞƌŐǇĂƐĞĚ^ĞƌǀŝŶŐ^ŝǌĞĨŽƌďŽǇƐ >ĞǀĞůŽĨ ŐĞ ZĞƋƵŝƌĞĚ ϭ͘ĞƌĞĂůƐ Ϯ͘ ϯ͘&ƌƵŝƚƐ ϰ͘WƌŽƚĞŝŶͲ ϱ͘ĂůĐƵŝŵͲ ĐƚŝǀŝƚǇ>ĞǀĞůŽĨ ;ǇĞĂƌƐͿŐĞ ZĞƋƵŝƌĞĚŶĞƌŐǇ ϭ͘ĞƌĞĂůƐĂŶĚ sĞŐĞƚĂďůĞƐϮ͘ ϯ͘&ƌƵŝƚƐ ϰ͘WƌŽƚĞŝŶͲƌŝĐŚĨŽŽĚƐ ϱ͘ĂůĐƵŝŵͲƌŝĐŚ ĐƚŝǀŝƚǇ ;ǇĞĂƌƐͿ ŶĞƌŐǇ ƐƚĂƌĐŚǇĂŶĚ sĞŐĞƚĂďůĞƐ ƌŝĐŚĨŽŽĚƐ ĨŽŽĚƐƌŝĐŚ ƐƚĂƌĐŚǇĨŽŽĚƐ ĨŽŽĚƐ >ĞƐƐĐƚŝǀĞ ϮϬϬϬ ϱͲϳ ϰͲϱ Ϯ ϯ ϮͲϯ ϭϯͲϭϱ ĨŽŽĚƐ >ĞƐƐĐƚŝǀĞ ;ŬĐĂůͿϮϬϬϬ ƐĞƌǀŝŶŐƐϱͲϳ ƐĞƌǀŝŶŐƐϰͲϱ ƐĞƌǀŝŶŐƐϮ ƐĞƌǀŝŶŐƐϯ ƐĞƌǀŝŶŐƐϮͲϯ ϭϯͲϭϱ ϮϱϬϬ ϳͲϵ ϱͲϲ ϮͲϯ ϰ ϮͲϯ ϭϲͲϭϳ ;ŬĐĂůͿ ƐĞƌǀŝŶŐƐ ƐĞƌǀŝŶŐƐ ƐĞƌǀŝŶŐƐ ƐĞƌǀŝŶŐƐ ƐĞƌǀŝŶŐƐ ;ŬĐĂůͿϮϱϬϬ ƐĞƌǀŝŶŐƐϳͲϵ ƐĞƌǀŝŶŐƐϱͲϲ ƐĞƌǀŝŶŐƐϮͲϯ ƐĞƌǀŝŶŐƐϰ ƐĞƌǀŝŶŐƐϮͲϯ ϭϲͲϭϳ ϮϱϬϬ ϳͲϵ ϱͲϲ ϮͲϯ ϰ ϮͲϯ ϭϯͲϭϱ ;ŬĐĂůͿ ƐĞƌǀŝŶŐƐ ƐĞƌǀŝŶŐƐ ƐĞƌǀŝŶŐƐ ƐĞƌǀŝŶŐƐ ƐĞƌǀŝŶŐƐ ;ŬĐĂůͿϮϱϬϬ ƐĞƌǀŝŶŐƐϳͲϵ ƐĞƌǀŝŶŐƐϱͲϲ ƐĞƌǀŝŶŐƐϮͲϯ ƐĞƌǀŝŶŐƐϰ ƐĞƌǀŝŶŐƐϮͲϯ ϭϯͲϭϱ ϯϭϬϬ ϵͲϭϭ ϲͲϳ ϮͲϯ ϱ ϮͲϯ ϭϲͲϭϳ ;ŬĐĂůͿ ƐĞƌǀŝŶŐƐ ƐĞƌǀŝŶŐƐ ƐĞƌǀŝŶŐƐ ƐĞƌǀŝŶŐƐ ƐĞƌǀŝŶŐƐ DŽƌĞĐƚŝǀĞ ;ŬĐĂůͿϯϭϬϬ ƐĞƌǀŝŶŐƐϵͲϭϭ ƐĞƌǀŝŶŐƐϲͲϳ ƐĞƌǀŝŶŐƐϮͲϯ ƐĞƌǀŝŶŐƐϱ ƐĞƌǀŝŶŐƐϮͲϯ ϭϲͲϭϳ DŽƌĞĐƚŝǀĞ ;ŬĐĂůͿ ƐĞƌǀŝŶŐƐ ƐĞƌǀŝŶŐƐ ƐĞƌǀŝŶŐƐ ƐĞƌǀŝŶŐƐ ƐĞƌǀŝŶŐƐ 3. Ideal Menus

To better illustrate the phrase “good variety, well-balanced diet”, an ideal menu for a day (breakfast, lunch, dinner, and snack) was created in the next page. Each menu was calculated for energy and nutrients using FIDR Nutrition Calculation Database, created based on ASEAN Food Composition Table 51) and was converted into serving sizes for each food type.

ŽƵŶƚŝŶŐĨŽŽĚŐƌŽƵƉƐĞƌǀŝŶŐƐŝŶƚŚĞŵĞŶƵĨŽƌŽŶĞĚĂǇĂƚϮ͕ϬϬϬĐĂůŽƌŝĞƐ ZĞĐŝƉĞ DĂŝŶĚŝƐŚ ĞƌĞĂůƐĂŶĚ sĞŐĞƚĂďůĞƐ &ƌƵŝƚƐ WƌŽƚĞŝŶͲƌŝĐŚĨŽŽĚƐ ĂůĐƵŝŵͲƌŝĐŚĨŽŽĚƐ ŶĞƌŐǇ ƐƚĂƌĐŚǇĨŽŽĚƐ

ƌĞĂŬĨĂƐƚ

ŽŽŬĞĚƌŝĐĞ Ϯ ϯϲϳ

WŽƌŬ DĂƌŝŶĂƚĞĚĨƌŝĞĚ ϭ ƵĐŬĞŐŐ ƉŽƌŬĂŶĚĞŐŐǁŝƚŚ ĐƵĐƵŵďĞƌ &ƌĞƐŚĐƵĐƵŵďĞƌ ϭ ϭϴϭ &ƌĞƐŚŵŝůŬ Ϯ͘ϱ ϭϱϱ

ĂŶĂŶĂ ϭ ϭϬϱ

>ƵŶĐŚ

ŽŽŬĞĚƌŝĐĞ Ϯ ϯϲϳ

^ŶĂĐŬŚĞĂĚ&ŝƐŚ ϭ͘ϱ

WƵŵƉŬŝŶ ^ĂŵůŽƌ^ĂŵůŽƌŬ ůǀǇŐŽƵƌĚ ϯ

tĂǆ'ŽƵƌĚ ϵϲ ^ŶĂĐŬ

^ǁĞĞƚƉŽƚĂƚŽ͕ďŽŝůĞĚ ^ǁĞĞƚƉŽƚĂƚŽ ϭ ϭϲϬ

ŝŶŶĞƌ

ŽŽŬĞĚƌŝĐĞ Ϯ ϯϲϳ

WŽƌŬďĞůůǇ ϭ &ƌŝĞĚĂŵĂƌĂŶƚŚ ϮϯϬ ǁŝƚŚϯůĂǇĞƌƐƉŽƌŬ ŵĂƌĂŶƚŚ Ϯ ϭ

^ĂƉŽĚŝůůĂ͕ƌŝƉĞ ϭ ϴϱ

Ϯ͕ϬϬϬŬĐĂů dŽƚĂů ϳ ϲ Ϯ ϯ͘ϱ ϯ͘ϱ Ϯ͕ϭϭϯ

Ϯ͕ϱϬϬŬĐĂů dŽƚĂů ϴ ϴ Ϯ͘ϱ ϰ ϰ

ϯ͕ϭϬϬŬĐĂů dŽƚĂů ϭϬ͘ϱ ϵ Ϯ͘ϱ ϱ͘ϱ ϰ

58 Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Table 5-5: Ideal menu with nutrients data

/ĚĞĂůŵĞŶƵĂŶĚĨŽŽĚƚǇƉĞƐĞƌǀŝŶŐƐĂƚϯĐĂůŽƌŝĞůĞǀĞůƐ ĂůŽƌŝĞ>ĞǀĞů Ϯ͕ϬϬϬ Ϯ͕ϱϬϬ ϯ͕ϭϬϬ EƵŵďĞƌŽĨ^ĞƌǀŝŶŐƐ ĞƌĞĂůƐĂŶĚƐƚĂƌĐŚĞƐ ϳ ϴ ϭϬ͘ϱ WƌŽƚĞŝŶͲƌŝĐŚĨŽŽĚƐ ϯ͘ϱ ϰ ϱ͘ϱ ĂůĐŝƵŵͲƌŝĐŚĨŽŽĚƐ ϰ͘ϱ ϰ͘ϱ ϱ sĞŐĞƚĂďůĞƐ ϲ ϴ ϵ &ƌƵŝƚƐ Ϯ Ϯ͘ϱ Ϯ͘ϱ

EƵƚƌŝĞŶƚĂƚĂ ŶĞƌŐǇ;ŬĐĂůͿ Ϯ͕ϭϭϯ Ϯ͕ϰϲϭ ϯ͕ϭϬϭ ĂƌďŽŚǇĚƌĂƚĞƐͬŐ ϯϲϰ͘ϰ ϰϮϬ͘ϭ ϱϯϰ WƌŽƚĞŝŶͬŐ ϱϯ͘ϴ ϲϯ͘ϵ ϴϬ͘ϭ &ĂƚͬŐ ϰϴ͘Ϯ ϱϳ͘ϴ ϳϬ͘ϳ ĂůĐŝƵŵͬŵŐ ϳϯϱ ϴϭϲ ϵϭϴ /ƌŽŶͬŵŐ ϭϬ͘ϰ ϭϮ͘ϵ ϭϲ͘ϭ sŝƚĂŵŝŶͬђŐ ϲϲϯ ϵϮϲ ϭϭϴϯ dŚŝĂŵŝŶĞ;sϭͿͬŵŐ Ϭ͘ϴϮ Ϭ͘ϵϳ ϭ͘ϮϮ ZŝďŽĨůĂǀŝŶ;sϮͿͬŵŐ ϭ͘ϯ ϭ͘ϱϭ ϭ͘ϳϵ EŝĂĐŝŶ;sϯͿͬŵŐ ϭϬ͘ϭ ϭϮ͘Ϯ ϭϱ͘ϭ sŝƚĂŵŝŶͬŵŐ ϭϬϴ ϭϯϴ ϭϰϮ

4. Basic nutrients It is important to provide the basic information of essential nutrients such as carbohydrates, protein, fat, vitamins and minerals. Some of their major functions are introduced so that students are able to learn and reflect on choosing better foods.

5. Malnutrition Students are able to learn more about how under and over nutrition affect their health. Particular information on sugar, salt, vitamin A and calcium as well as information related to non-communicable diseases (NCDs) are provided.

6. FBDG messages and explanations: The 7 key messages are mentioned and followed by explanation in order for the students to understand the reason of such recommendations.

Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia 59 Message1: Eat food from all food types with a well-balanced diet everyday Our body cannot synthesize nutrients on its own -- or not to an adequate amount -- and must be provided by the diet. Eating a variety of food ensures you’ll get all the nutrients you need. Choose food items from all the different food types to get the most nutrients.

Message 2: Consume calcium-rich food such as whole small fish, milk and milk products We need to consume a certain amount of calcium to build and maintain strong bones and teeth. When we don’t get enough calcium for our body’s needs, it is taken from our bones, which can lead to bone loss, low bone density and even broken bones. Calcium also facilitates a healthy communication between the brain and various parts of the body. Calcium can also be found in leafy green vegetables.

Message 3: Eat protein-rich food such as fish, meat, eggs or beans at least 2 to 3 times a day Protein is an essential nutrient found in animal products (meat, fish, and eggs), nuts, and beans. Our cells and organs, our muscles, and even our bones could not hold together without the help of protein.

Message 4: Eat plenty of fruits and vegetables regularly Vegetables and fruits contain important vitamins, minerals and fiber. Scientific research shows that if you regularly eat lots of fruits and vegetables, you can lower risk of developing diseases or health problems.

Message 5: Eat cereals and starchy foods such as rice, noodle, bread and its alternatives in an adequate amount Cereals and starchy foods—rice, noodle, bread, potato, corn, and so on—are rich in carbohydrates. Carbohydrate is the preferred energy source for most of the body’s functions, especially brain. Eating cereals and starchy foods should be in conjunction with daily physical exercise to maintain ideal weight and health.

Message 6: Reduce food high in fat, salt, and sugar Many health problems are linked to poor eating habits. Many people eat too much saturated fat (especially animal fat), added salt (fish sauce and salty condiments) and added sugar (sugary beverages). Reducing these by small amounts can make us healthier by helping us manage our weight and reducing our risk of diseases.

Message 7: Measure your body weight and height regularly and track your growth It is important to know your body weight. Being overweight or underweight can increase your risk for serious diseases and health conditions. Try to measure your weight on a regular basis to control and manage your healthy body.

60 Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia 7. Meal Planning After introducing basic nutrients and issues related to under and over nutrition, students will learn how to plan their own meals with healthy food choices. Examples of recommended daily eating habit and overall patterns for a healthier diet are introduced by providing several options applicable to both urban and rural populations.

8. Recipe A recipe is introduced based on traditional Cambodian dishes. These will encourage students to appreciate the Cambodian food culture that consists of variety of vegetables, meat, fish, tropical fruits and rice as the main staple food for Cambodians. They are rich in nutrient and well-balanced food. Nutrition facts and cooking instructions are also illustrated.

9. Review checklist Students can review their current own eating habits and reflect with what they learned throughout the booklet. 5.3 The Pilot Study The purpose of the pilot study was to assess practicality, comprehensibility and cultural acceptability of the developed FBDG. IEC materials, including a food pyramid poster as well as brochures were also shown to target audiences in order to get feedback for revision.

5.3.1 The First Pilot Study

The first-pilot study was conducted in two rounds in 6 provinces: Takeo, Kep, Kampong. Speu, Kampong. Cham, Siem Reap and Preach Vihear. Eight schools (4 primary and 4 secondary schools) were selected in the four regions: Tonle Sap, Plateau and Mountain, Plain and Costal. The respondents were students, caretakers and teachers, totaling 365 (round 1) and 345 (round FIDR staff explaining the food pyramid to Grade 4 students and their parents 2). Three tools were developed and at Sbov Primary School in Kep tested: (1) questionnaire and (2) quiz for students to assess their knowledge and understanding of nutrition education and (3) feedback from teachers to seek their recommendations on IEC and teaching materials (see Appendix 4 for the list of the schools).

Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia 61 st Table 5-6: Summary of the activities of the 1 pilot study 3LORWVWXG\URXQG 3LORWVWXG\URXQG ϭ͘ ĚŵŝŶŝƐƚĞƌƋƵĞƐƚŝŽŶŶĂŝƌĞƚŽƐƚƵĚĞŶƚƐŝŶ ϭ͘ ĚŵŝŶŝƐƚĞƌƋƵĞƐƚŝŽŶŶĂŝƌĞƚŽƚŚĞƐĂŵĞ ĐůĂƐƐ͘ ƐƚƵĚĞŶƚƐĨƌŽŵWƌĞWŝůŽƚ͘ Ϯ͘ ŽŶĚƵĐƚƌĞĨůĞĐƚŝŽŶƐĞƐƐŝŽŶŽŶƚŚĞ Ϯ͘ ŽŶĚƵĐƚƌĞĨůĞĐƚŝŽŶƐĞƐƐŝŽŶŽŶƚŚĞ ƉŽƐƚĞƌƐ;WǇƌĂŵŝĚƉŽƐƚĞƌĂŶĚŶŐŬŽƌ ƉŽƐƚĞƌĂŶĚďƌŽĐŚƵƌĞ;ƉƌŝŵĂƌǇ tĂƚƉŽƐƚĞƌƐͿ ďƌŽĐŚƵƌĞͿ ϯ͘ ŽŶĚƵĐƚEƵƚƌŝƚŝŽŶĚƵĐĂƚŝŽŶ^ĞƐƐŝŽŶ ϯ͘ фEŽEƵƚƌŝƚŝŽŶĚƵĐĂƚŝŽŶǁĂƐŐŝǀĞŶх ǁŝƚŚĂůůƐƚƵĚĞŶƚƐ ϰ͘ ĚŵŝŶŝƐƚĞƌYƵŝǌƚŽĂůůƐƚƵĚĞŶƚƐ ϰ͘ ĚŵŝŶŝƐƚĞƌYƵŝǌƚŽĂůůƐƚƵĚĞŶƚƐ ϱ͘ ŽŶĚƵĐƚYĂŶĚƐĞƐƐŝŽŶĂŶĚŐĂŵĞƐ ϱ͘ ŽŶĚƵĐƚYĂŶĚƐĞƐƐŝŽŶ ϲ͘ ZĞĐĞŝǀĞĨĞĞĚďĂĐŬĨƌŽŵƚĞĂĐŚĞƌƐ ϲ͘ ZĞĐĞŝǀĞĨĞĞĚďĂĐŬĨƌŽŵƚĞĂĐŚĞƌƐ Result  Students: Primary and secondary school students were willing to learn the nutrition topics. They seemed to understand the importance and the relationship between nutrition and health. However, it is difficult to change their eating habits due to the environment at school and at home.  Caretakers: Most of caretakers said they had not paid much attention to what their children should eat. After the session, they understood the importance of nutrition, especially for their children’s healthy growth and they showed their willingness to prepare meals from a variety of food for their family.

This pilot study was useful for learning the areas that should be revised or modified within the IEC materials. The key messages were mostly accepted by students, teachers and caretakers. Some revisions were made by the FBDG development team based on the feedback from the pilot study.

The FBDG development team member from the School Heath Department of MoEYS joined to evaluate the pilot study at Mrum Khang Tboung Secondary School in Kg. Speu

62 Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia 5.3.2 The Second Pilot Study

The second-pilot study was conducted at 2 schools (primary school and secondary school) in Kampong Chhnang and 2 schools (primary school and high school) in Phnom Penh in July 2017 in order to ensure that the target audience understood the revised IEC materials. The pilot study was conducted in focus-group discussions to collect qualitative information. A total of 37 students and 5 teachers participated in the discussions.

The design and wording were discussed again within the FBDG development team for future adjustment based on the feedback from the students.

Students finding weight and height on the brochure The concept of the serving size is explained to the Svay Chrom Primary School, Kg. Chhnang students Sovannaphumi High School, Phnom Penh

Students checking food items in the food pyramid High school student from Sovannapumi School Sovannaphumi primary shcool, Phnom Penh clarifies the serving of Tofu.

Once the Cambodian FBDG is established, the next step is to disseminate the information/messages and implement activities for the target audience.

To increase awareness of FBDG, it needs to be communicated to the public (and target audience) through a variety of materials and methods. As already discussed in the previous chapter, FBDG will be primarily introduced through print materials (poster, brochure, and booklet) accompanied by a visual aid (food pyramid) and will be distributed to school children as part of their educational materials.

For further outreach, FBDG and the information will be disseminated through: 6.1 A handbook for parents and caretakers

Specific instructional materials are needed for parents, caretakers, and health or social workers among the local communities. These groups are made up of key persons who have direct contact with school-aged children. Information on how to use or read FBDG and related information such as food types, serving sizes, basic nutrients and their functions, as well as how to prepare healthy meals will be introduced in the handbook. This will be accompanied by food preparation techniques and information on the risk of diet-related diseases. 6.2 Training programs and workshops for school teachers

School teachers and educational curriculum are the key channels for implementation and communication of FBDG. Training programs for educators should be developed to improve understanding and knowledge of the FBDG and related information. Also, embedding FBDG into the school curriculum and accompanying text books are recommended for implementing nutrition education in schools.

Other possible implications and considerations are: 6.3 Mass media usage

The Cambodian FBDG can be introduced through the web sites of relevant stakeholders and authorities. In addition, information can be compiled into a visual or audio file to reach larger numbers of people at community or other events.

6.4 Campaigns and promotion activities Face to face communication will be ideal for putting FBDG into practice. However, campaigns or promotion activities alone are inadequate to be adopted and improve

64 Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia recognitionϲ͘ϰĂŵƉĂŝŐŶƐĂŶĚƉƌŽŵŽƚŝŽŶĂĐƚŝǀŝƚŝĞƐ of FBDG. To be effective, provision of further assistance for nutrition education and involvement of multiple sectors may be needed in the future. Additionally,&ĂĐĞ ƚŽ ĨĂĐĞ ĐŽŵŵƵŶŝĐĂƚŝŽŶ bringing more ǁŝůů nutritional ďĞ ŝĚĞĂů ĨŽƌinformation ƉƵƚƚŝŶŐ &' to ŝŶƚŽ theƉƌĂĐƚŝĐĞ͘ public will ,ŽǁĞǀĞƌ͕ be necessary ĐĂŵƉĂŝŐŶƐ to Žƌ ƉƌŽŵŽƚŝŽŶ ĂĐƚŝǀŝƚŝĞƐ ĂůŽŶĞ ĂƌĞ ŝŶĂĚĞƋƵĂƚĞƚŽďĞĂĚŽƉƚĞĚĂŶĚŝŵƉƌŽǀĞ ƌĞĐŽŐŶŝƚŝŽŶ ŽĨ &'͘ dŽ ďĞ make FBDG more practical on daily basis. ĞĨĨĞĐƚŝǀĞ͕ƉƌŽǀŝƐŝŽŶŽĨĨƵƌƚŚĞƌĂƐƐŝƐƚĂŶĐĞĨŽƌŶƵƚƌŝƚŝŽŶĞĚƵĐĂƚŝŽŶĂŶĚŝŶǀŽůǀĞŵĞŶƚŽĨŵƵůƚŝƉůĞƐĞĐƚŽƌƐ 6.5ŵĂǇďĞŶĞĞĚĞĚŝŶƚŚĞĨƵƚƵƌĞ͘ĚĚŝƚŝŽŶĂůůǇ͕ďƌŝŶŐŝŶŐŵŽƌĞŶƵƚƌŝƚ Application in healthcare institutions ŝŽŶĂůŝŶĨŽƌŵĂƚŝŽŶƚŽƚŚĞƉƵďůŝĐǁŝůůďĞ FBDGŶĞĐĞƐƐĂƌǇƚŽŵĂŬĞ&'ŵŽƌĞƉ can be introduced at multipleƌĂĐƚŝĐĂůŽŶĚĂŝůǇďĂƐŝƐ͘ institutions, including health centers and hospitals whereϲ͘ϱƉƉůŝĐĂƚŝŽŶŝŶŚĞĂ nutrition informationůƚŚĐĂƌĞŝŶƐƚŝƚƵƚŝŽŶƐ should be shared with health professionals and patients. IEC materials can be used to educate patients on healthy diets and RDA can also be used&'ĐĂŶďĞŝŶƚƌŽĚƵĐĞĚĂƚŵƵůƚŝƉůĞŝŶƐƚŝƚƵƚŝŽŶƐ͕ŝŶĐůƵĚŝŶŐŚĞĂů when managing and providing hospital meals. ƚŚĐĞŶƚĞƌƐĂŶĚŚŽƐƉŝƚĂůƐǁŚĞƌĞŶƵƚƌŝƚŝŽŶ ŝŶĨŽƌŵĂƚŝŽŶƐŚŽƵůĚďĞƐŚĂƌĞĚǁŝƚŚŚĞĂůƚŚƉƌŽĨĞƐƐŝŽŶĂůƐĂŶĚƉĂƚŝĞŶƚƐ͘ / ŵĂƚĞƌŝĂůƐ ĐĂŶ ďĞ ƵƐĞĚ ƚŽ 6.6ĞĚƵĐĂƚĞƉĂƚŝĞŶƚƐŽŶŚĞĂůƚŚǇĚŝĞƚƐĂŶĚZĐĂŶĂůƐŽďĞƵƐĞĚǁŚĞŶ Monitoring and evaluation ŵĂŶĂŐŝŶŐĂŶĚƉƌŽǀŝĚŝŶŐŚŽƐƉŝƚĂů ŵĞĂůƐ͘ In addition to the strategies above, FBDG should be monitored and evaluated on a regularϲ͘ϲDŽŶŝƚŽƌŝŶŐĂŶĚĞǀĂůƵĂƚŝŽŶ basis to identify whether the messages are applicable and relevant to the target population. People’s lifestyles, eating patterns, and access to food are changing /ŶĂĚĚŝƚŝŽŶƚŽƚŚĞƐƚƌĂƚĞŐŝĞƐĂďŽǀĞ͕&'ƐŚŽƵůĚďĞŵŽŶŝƚŽƌĞĚĂŶĚĞǀĂůƵĂƚĞĚŽŶĂƌĞŐƵůĂƌďĂƐŝƐƚŽ rapidlyŝĚĞŶƚŝĨǇǁŚĞƚŚĞƌƚŚĞŵĞƐƐĂŐĞƐĂƌĞĂƉƉůŝĐĂďůĞĂŶĚƌĞůĞǀĂŶƚƚŽƚŚ at present. Therefore, their dietary intakes mustĞƚĂƌŐĞƚƉŽƉƵůĂƚŝŽŶ͘WĞŽƉůĞ͛ƐůŝĨĞƐƚǇůĞƐ͕ also be assessed by a wide rangeĞĂƚŝŶŐƉĂƚƚĞƌŶƐ͕ĂŶĚĂĐĐĞƐƐƚŽĨŽŽĚĂƌĞĐŚĂŶŐŝŶŐƌĂƉŝĚůǇĂƚƉƌĞ of stakeholders in order to make relevant updates toƐĞŶƚ͘dŚĞƌĞĨŽƌĞ͕ƚŚĞŝƌĚŝĞƚĂƌǇŝŶƚĂŬĞƐ the FBDG and its messages. AnŵƵƐƚĂůƐŽďĞĂƐƐĞƐƐĞĚďǇĂǁŝĚĞƌĂŶŐĞŽĨƐƚĂŬĞŚŽůĚĞƌƐŝŶŽƌĚĞƌ ideal evaluation plan is suggested in Table 6-1. ƚŽŵĂŬĞƌĞůĞǀĂŶƚƵƉĚĂƚĞƐƚŽƚŚĞ&' ĂŶĚŝƚƐŵĞƐƐĂŐĞƐ͘ŶŝĚĞĂůĞǀĂůƵĂƚŝŽŶƉůĂŶŝƐƐƵŐŐĞƐƚĞĚŝŶdĂďůĞϲͲϭ͘ Table 6-1: Suggested monitoring and evaluation plan dĂďůĞϲͲϭ͗^ƵŐŐĞƐƚĞĚŵŽŶŝƚŽƌŝŶŐĂŶĚĞǀĂůƵĂƚŝŽŶƉůĂŶ

KďũĞĐƚŝǀĞƐ ǀĂůƵĂƚŝŽŶĐƌŝƚĞƌŝĂ ĨŽƌƐĐŚŽŽůͲĂŐĞĚĐŚŝůĚƌĞŶ &ƌĞƋƵĞŶĐǇĂŶĚŵĞƚŚŽĚ ;ϲʹϭϳǇĞĂƌƐŽůĚͿ x WĞƌĐĞŶƚĂŐĞŽĨƵŶĚĞƌǁĞŝŐŚƚ͕ ƐŚŽƌƚƐƚĂƚƵĞ͕ƚŚŝŶŶĞƐƐĂŶĚ xKŶĐĞĂǇĞĂƌďǇ /ŵƉƌŽǀĞŵĞŶƚŝŶ ŽǀĞƌǁĞŝŐŚƚǁŝůůĚĞĐƌĞĂƐĞ ĂŶƚƌŽƉŽŵĞƚƌŝĐ ƉŚǇƐŝƋƵĞ x ŽĚǇŚĞŝŐŚƚĂŶĚǁĞŝŐŚƚǁŝůů ŵĞĂƐƵƌĞŵĞŶƚ ŝŶĐƌĞĂƐĞ xǀĞƌǇϱͲϭϬǇĞĂƌƐďǇϮϰͲ /ŵƉƌŽǀĞŵĞŶƚŝŶ x /ŶƚĂŬĞƐŽĨƉƌŽƚĞŝŶǁŝůůŝŶĐƌĞĂƐĞ ŚŽƵƌĚŝĞƚĂƌǇƌĞĐĂůůĨŽƌ ŶƵƚƌŝƚŝŽŶƐƚĂƚƵƐ x /ŶƚĂŬĞƐŽĨĐĂůĐŝƵŵǁŝůůŝŶĐƌĞĂƐĞ ϭͲϮĚĂǇƐ

x /ŶƚĂŬĞƐŽĨĨŽŽĚĨƌŽŵƚŚĞƉƌŽƚĞŝŶͲ xKŶĐĞĂǇĞĂƌŽƌďĞĨŽƌĞ /ŵƉƌŽǀĞŵĞŶƚŝŶ ƌŝĐŚĨŽŽĚǁŝůůŝŶĐƌĞĂƐĞ ĂŶĚĂĨƚĞƌŝŶƚĞƌǀĞŶƚŝŽŶƐ ĨŽŽĚŝŶƚĂŬĞƐ x /ŶƚĂŬĞƐŽĨĨŽŽĚĨƌŽŵƚŚĞĐĂůĐŝƵŵͲ ďǇ&ŽŽĚ&ƌĞƋƵĞŶĐǇ ƌŝĐŚĨŽŽĚǁŝůůŝŶĐƌĞĂƐĞ YƵĞƐƚŝŽŶŶĂŝƌĞ;&&YͿΎ * A FFQ should be developed and verified based on the Cambodian dietary contexts to use as a tool Ύ&&YƐŚŽƵůĚďĞĚĞǀĞůŽƉĞĚĂŶĚǀĞƌŝĨŝĞĚďĂƐĞĚŽŶƚŚĞĂŵďŽĚŝĂŶĚŝĞƚĂƌǇĐŽŶƚĞǆƚƐƚŽƵƐĞĂƐĂƚŽŽůŽĨŵŽŶŝƚŽƌŝŶŐĨŽƌƚŚĞ of&'͘&&YŝƐƐƵŝƚĂďůĞĨŽƌůĂƌŐĞ monitoring for the FBDG.ƐĂŵƉůĞƐŝǌĞƐĂŶĚŝƚƌĞƋƵŝƌĞƐƌĞ FFQ is suitable for large sampleůĂƚŝǀĞůǇůĞƐƐƚŝŵĞĂŶĚůŽǁĞƌĐŽƐƚ sizes and it requires ƐƚŚĂŶϮϰͲŚŽƵƌĚŝĞƚĂƌǇƌĞĐĂůů͘relatively less time and lower costs than 24-hour dietary recall.

Chapter 1

1) National Institute of Statistics, Directorate General for Health, and ICF Macro, ‘Cambodia Demographic and Health Survey 2014’, Phnom Penh, Cambodia and Calverton, Maryland, USA, September 2015.

2) National Nutrition Strategy 2009-2015, Ministry of Health, Cambodia, pp. 13-19.

3) Food and Agriculture Organization of United Nations / World Health Organization, World Declaration and Plan of Action for Nutrition, Rome, 1992, p. 32.

4) Hoksrum A, A report of Regional Consultation on Food-Based Dietary Guidelines for countries in the Asia Region: Food and Agriculture Organization of the United Nations, World Health Organization and Institute of Home Economics, University of Delhi, New Delhi, India, 6-9 December 2010, p. 26.

5) Food and Agriculture Organization of the United Nations / World Health Organization, Preparation and Use of Food-Based Dietary Guidelines, Geneva, 1998, WHO Technical Report Series 880.

6) Institute of Medicine, ‘Dietary Reference Intakes: Applications in Dietary Assessment’, Washington, DC, 2000, pp. 2-3.

7) World Health Organization, Dietary recommendations / Nutritional requirements. Available from: http://www.who.int/nutrition/topics/nutrecomm/en/

8) Food and Agriculture Organization of the United Nations, ‘A manual from the English-Speaking Caribbean: Developing Food-Based Dietary Guidelines’, 2007.

9) Barbara Burlingame, et al., Nutrition and Consumer Protection Division, Food and Agriculture Organization of the United Nations, ‘Sustainable diets and biodiversity’, 2012, p. 7.

Chapter 2 10) Standardized Monitoring & Assessment of Relief & Transitions (SMART), ‘Sampling Methods and Sample Size Calculation for the SMART Methodology’, 2012.

66 Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia 11) World Health Organization, ‘Training course on child growth assessment: interpreting growth indicators’, World Health Organization, 2008. [cited May 9 2017]. Available from: http://www.who.int/childgrowth/training/module_h_directors_ guide.pdf

12) Foundation for International Development/Relief, ‘Picture Book for portion size of ingredients and food item’, 2014.

13) World Health Organization, ‘WHO AnthroPlus for personal computers Manual: Software for assessing growth of the world’s children and adolescents’, WHO, Geneva, 2009. Available from: http://www.who.int/growthref/tools/en

14) Puwastien P, Burlingame B, Raroengwichit M, Sungpuag P., ‘ASEAN Food Composition Tables of Nutrition’, Mahidol University, Thailand, 2000.

15) World Health Organization, ‘The WHO Child Growth Standards’, [cited June 5 2017]. Available from: http://www.who.int/childgrowth/standards/en/

16) De Onis M, Blössner M., ‘WHO global database on child growth and malnutrition’, Geneva: World Health Organization, Geneva, 1997, pp. 49–50. [cited July 2 2017]. Available from: http://apps.who.int/iris/bitstream/10665/63750/1/WHO_NUT_97.4.pdf

17) Ibid.

18) Institute of Medicine, ‘Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation’, Washington, DC, 2012. Available from: https://doi. org/10.17226/13275

19) National Institute of Statistics, Directorate General for Health, and ICF Macro, ‘Cambodia Demographic and Health Survey 2014’, Phnom Penh, Cambodia and Calverton, Maryland, USA, September 2015. 20) World Health Organization, ‘Global report on diabetes’, World Health Organization, Geneva, 2016.

Chapter 3

21) E-Siong T, Rodolfo, F., ‘Recommended Dietary Allowances: Harmonization in Southeast Asia’, International Life Sciences Institute-Southeast Asia Region, 2005. P 16.

22) Institute of Medicine, ‘Dietary Reference Intakes’, 3.

23) E-Siong T, 20-21.

26) Ministry of Health Labour Welfare, Japan., ‘Dietary Reference Intakes for Japanese, 2015’, Tokyo, 2015. [in Japanese]. Available from: http://www.mhlw.go.jp/stf/ shingi/0000041824.html

27) Ibid.

28) E-Siong T, 61.

29) Ministry of Health Labour Welfare, Japan., ‘Dietary Reference Intakes for Japanese, 2015’.

30) Hawkins WW., ‘Iron, copper and cobalt. In: Beaton GH, McHenry EW, eds. Nutrition: a comprehensive treatise’, Academic Press, New York, 1964, pp. 309─72.

31) Beaton GH, Corey PN, Steele C., ‘Conceptual and methodological issues regarding the epidemiology of iron deficiency and their implications for studies of the functional consequences of iron deficiency’, Am J Clin Nutr, vol. 50, 1989, pp. 575─88.

32) Dallman PR., ‘Iron deficiency in the weanling: a nutritional problem on the way to resolution’, Acta Paediatr Scand, vol. 323, 1986, (Suppl) pp. 59─67.

33) Yokoi K., ‘Numerical methods for estimating iron requirements from population data’, Biol Trace Elem Res, vol. 95, 2003, pp. 155─72.

34) Chisako Yano, et al., ‘A general survey on what constitutes a “Normal” menstrual cycle’, Japanese Journal of Maternal Health, vol. 4, 2005, pp. 496-502. [in Japanese]

35) Ministry of Health Labour Welfare, Japan., ‘Dietary Reference Intakes for Japanese, 2015’.

36) Ibid.

37) Pereira MA et al., ‘Dietary fiber and risk of coronary heart disease: pooled analysis of cohort studies’, Arch Intern Med, vol. 164, 2004, pp. 370-6.

38) Ministry of Health Labour Welfare, Japan., ‘Dietary Reference Intakes for Japanese, 2015’.

39) World Health Organization, ‘Guideline: Sodium intake for adults and children’, WHO, Geneva, 2012, pp. 18-9.

40) World Health Organization, ‘Guideline: Potassium intake for adults and children’, WHO, Geneva, 2012, pp. 16-7.

68 Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia 41) Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, Food and Nutrition Board, Institute of Medicine, ‘Dietary reference intakes for calcium, phosphorus, magnesium, vitamin D, and fluoride’, National Academies Press, USA, 1997.

Chapter 4

42) Khan NC, Tue HH, Mai le B, Vinh le G, Khoi HH., ‘Secular trends in growth and nutritional status of Vietnamese adults in rural Red River delta after 30 years (1976-2006)’, Asia Pac J Clin Nutr, vol. 19, no 3, 2010, pp. 412-6.

43) Jordan S, Lim L, Seubsman SA, Bain C, Sleigh A., ‘Thai Cohort Study Team: Secular changes and predictors of adult height for 86 105 male and female members of the Thai Cohort Study born between 1940 and 1990’, J Epidemiol Community Health, vol. 66, no. 1, January 2012, pp. 75-80.

44) Chen TJ, Ji CY., ‘Secular changes of stature in rural children and adolescents in China, 1985-2010’, Biomed Environ Sci, vol. 27, no. 8, August 2014, pp. 573-81.

45) Chen TJ, Ji CY., ‘Secular change in stature of urban Chinese children and adolescents, 1985-2010’, Biomed Environ Sci, vol. 26, no. 1, January 2013, pp. 13-22.

46) Li H, Zong X, Zhang J, Zhu Z., ‘Physical growth of children in urban, suburban and rural mainland China: a study of 20 years change’ Biomed Environ Sci, vol. 24, no. 1, February 2011, pp. 1-11.

47) Kim JY, Oh IH, Lee EY, Choi KS, Choe BK, Yoon TY, Lee CG, Moon JS, Shin SH, Choi JM., ‘Anthropometric changes in children and adolescents from 1965 to 2005 in Korea’, Am J Phys Anthropol, vol. 136, no. 2, June 2008, pp. 230-6.

48) Ministry of Education, Culture, Sports, Science and technology, Japan: Annual Report of School Health Statistics Research. [in Japanese]. Available from: http://www.mext.go.jp/b_menu/toukei/chousa05/hoken/1268826.htm

Chapter 5

49) សៀវ必讶莶រ និងសុខ徶ពសម្រាប់បឋមសិក្រា羶៖侶យកដ្ឋានសុខ徶ពសិក្រា羶ឆ្នាំ២០១៣ 50) Takemi Y, Yoshiike N., ‘Shokuji baransu gaido o katsuyo shita eiyo kyoiku shokuiku jissen manyuaru’, the Japan Dietetic Association, Japan, 2006, pp. 8-16. [in Japanese].

51) Puwastien P, ‘ASEAN Food Composition Tables of Nutrition’.

Appendix 1: Member list of Food-Based Dietary Guidelines Development Team

ɍ.Ɍ ɳƻƗ ɹ ɁɯǆɃɪ ɔȶǊƀ Ɉ No Name Title Institution ʑ ɳǎȲȯɑɪɆɀɩƋ Ɂ ɔɅɭƙɆǅɅ ǆɋȲƽƊ ɅƳɌǉɌɑɭǊɈ ƙȲɑɯȶɑɭƴɉɩǇɍ ɳȲˊɁ ɳɈƙȹȷɩǆƎ Deputy director Preventive Medicine Department Ms. Koeut Pichenda (PMD)/MoH

ʒ ɳǎȲȯɑɪɳɎȹƅ. ȺɭɅ ɍɅɽ ƙɆǅɅ ƳɌǌɍɩ ʂɋƙɆɋɭɃƑɅɫȶȹɸȶɬɊɩɅȸƚȶ Dr. Chhun Loun Chief of NCD ƙȲɑɯȶɑɭƴɉɩǇɍ Non-communicable Disease / PMD/MoH

ʓ ɳǎȲȯɑɪɳɎȹƅ. ɒɭȲ ɑɭɪǍɻɅɪ ɔɅɭƙɆǅɅ ƳɌǌɍɩ ʂɋƙɆɋɭɃƑɅɫȶȹɸȶɬɊɩɅȸƚȶ Dr. Hok Sirany Vice Chief of NCD ƙȲɑɯȶɑɭƴɉɩǇɍ Non-communicable Disease / PMD/MoH

ʔ ɳǎȲȯɑɪɳɎȹƅ. ƺ ǋɻ Ɍ ɪ ɔɅɭƙɆǅɅ ȲɊƗɎɄɩ ɪƺɁɩǕǓɌɆɁɮ ƏɊƖ ƙȲɑɯȶɑɭƴɉɩǇɍ Dr. Chea Mary Deputy Manager National Nutrition Program/MoH

ʕ ɳǎȲȯɑɪɳɎȹƅ. ɑɮ ȸɎɌɁɪ ƒ ɔɅɭƙɆǅɅ ǆɋȲƽƊ ɅɑɭȳǊɈɑɩȲǜ ƙȲɑɯȶɔɆɽɌɸ Dr. So Chhavyroth Deputy director ɋɭɎȹɅ ɅɩȶȲɪǔ School Health Department/MoYES

ʖ ɳǎȲɳɎȹƅ. ɑɋ ɔɭɫȶ ƙɆǅɅ ǆɋȲƽƊ ɅɑɭƴɉɩǇɍ ɑɅɩƎɑɭȳɳɑƓȣȶ Dr. Say Ung Director Department ɅɩȶǕǓɌɆɁɮ ƏɊƖ Department of Health, Food Security and Nutrition, office of the Council of Ministers

ʗ ɳǎȲȯɑɪɳɎȹƅ. ǎȶ ɑɭǊɈ ɆɭȴƀɍɩȲ ɎɃǚǒɩ Ə ɅɑɭȳǊɈǒǅɌɀɺ Dr. Leang Supheap Staff National Institute of Public Health

ʘ ɳǎȲ ɒɼɮ ɳƙȲˊɅ ǆɋȲɌȶƙɆƸɸ ɔȶƀƳɌɳɒɴɓɅɳȳɍʂɌɔɅƎɌƺɁɩ Mr. Hou Koeun ƙɆɳɃɑ Helen Keller International Deputy Country Director

70 Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia ʙ ɳǎȲɳɎȹƅ. ȵɫɊ ɑɸǕɁ ɊȜɅɪƎƙȴɆɽƙȴȶȲɊƗɎɄɩ ɪ ɔȶƀƳɌɑɭȳǊɈɈɩɉɈɳǎȲ Dr. Khim Sam Ath ȹɸȶɬɊɩɅȸƚȶ Ʌɩȶɳɍˊ World health Organization ȲɊƕɑɽɑɭȳǊɈ Technical officer for Non- communicable Diseases and Health Promotion ʑʐ Ms. Hanneke Vandyke ɊȜɅɪƎȲɊƗɎɄɩ ɪ ȲɊƗɎɄɩ ɪɳɑƓȣȶǕǓɌɈɩɉɈɳǎȲ Technical Officer World Food Program

ʑʑ ɳǎȲȯɑɪ ȾɩɅ ǒɼ ȶǔɋ ȹɸɅɯɋƳɌȲɊƗɎɄɩ ɪ ȲɊƗɎɄɩ ɪɳɑƓȣȶǕǓɌɈɩɉɈɳǎȲ Ms. Din Seanglay Program Assistant World Food Program

ʑʒ ɊɮɍɅɩɄɩɑƙǋɆɽƳɌɔɉɩɎȾƌɅɿ ɅɩȶȹɸɅɯɋɑɳȜƷƀ ɹɔɅƎɌƺɁɩ Foundation for International Development/Relief (FIDR)

l ʂ ɋ ʂ ɋ ʂ ɋ ʂ ɋ ʂ ɋ o Ȳǜ ɩ Ȳǜ ɩ Ȳǜ ɩ Ȳǜ ɩ Ȳǜ ɩ Ȳǜ ɩ o ʂ ɋ ʂ ɋ ʂ ɋ ʂ ɋ ʂ ɋ h ɩ ɩ ɩ ɩ ɩ Ƀǚɍ Ƀǚɍ Ƀǚɍ Ƀǚɍ Ƀǚɍ c Ɏ Ɏ Ɏ Ɏ Ɏ ɭ ɭ ɭ ɭ ɭ S ɩ ɩ ɩ ɩ ɩ Ƀǚɍ Ƀǚɍ Ƀǚɍ Ƀǚɍ Ƀǚɍ ɔɅ ɆȽɊɑ PrimarySchool ɆȽɊɑ ɆȽɊɑ ɔɅ ɔɅ ɔɅ ɔɅ PrimarySchool Ɏ ɆȽɊɑ ɪ

ɸ ɪ ȶɜ Ɏ l o ɌǍ ɸ ƳɌɳɍ ɮ ɳɍ ɪ o ɪ h ɽ ɸ ȶ ɆȽɊɑ c ɭ ɉ ƚ ɩ ɍ Ɏ ƕ ɑ Ɨ ɽ Ɏ S Ɍ ɮ ƚ ȶ ɼ ɭ ɅɴɑɅɔ ƛ ɼ ɭ Ʌǆȶȼ ȶɵƙɈ ɪ ɍɑ ɍƶ ɍȳ ɍɂ ȶɔ ɯ ɯ ɯ ɯ ɭ Ƀ Ƀ ȲǙɍɒȶƞ ɆȽɊɑ ǎ ɒ ɳȹ Ɉƙȶ Ƀ Ƀ Lovea ȷ e n ƒ u ȶ ɒ ɼ ɭ ɅɴɑɅȲȶǂ Ɏ m ɪ ɫ ɸ ɭ ʂ ɋ ɳɊǒɵƙȹ Ɏ ɭ ɉ ɋ ɳƳɹ ɩ ɭ m ɽ ɪ ɍ ɔɅ ɽ Ɏ ʂ ɋ ɒ o ƚ ȶ C ɳɍ ɋǄɆ ɒ ɼ ɭ ɅɴɑɅȷ ƛ ƚ ȶɵƙɈ ɪ Ȫ ȷ ƛ ɍɑ ɯ Ƀ ƙɈɹǅɁ ɔɅ ɵƙɈȲȲ Ȳȶȹ ǎ ǎ Anlung Vil Anlung Vil Anlung School High ǉɊɳƳɹǒ ɳȹ ǏɍɎȶ Ɉƙȶ Ȳȶǂɀ ƙȲ ǒ ɌƳɈƙǇ ɳɊɑɌȹ Cheung Prey Cheung Prey Cheung SecondarySchool Pongror Pongror SecondarySchool t c i r t s i ɽ Ʌ ɩ ɽ ɪ ɪ D ɭ Ƀ ɸ ɭ ɽ ƸɊ ž ɸ ɸ ɸ ȶɜ ȶɜ ȶɜ Ɛ ȶƙɁȶ ɫ ȶȵ Ɨ ɮ Ɛ ȶƙɁȶ ɫ ɌǍ ɌǍ ɌǍ ɸ ƳɌɳɍ ɸ Ɉȶ ɸ ƳɌɳɍ ɮ ɮ ɮ O Raing Euv Raing O PreahTheat Khlaing Tuol PrimarySchool ɔ ɔ ɑɴȶ ɔ Ȳȶǋɑ MeasKang TaNeung Kang TaKang Sen Hun School High Kang MeasKang PrekKuy Koh ȷ ChamkarLeu LoveaLeu Hang Kbal PrimarySchool Sangkae ɵƙɈȺɌ O Raing Euv Raing O Sophy Tuol Sophy Tuol SecondarySchool ɑ Ǉǅɋ O Raing Euv Raing O KorngChey Raing O Sen Hun School High Ȳ ɵƙɈȺɌ ɳƳɹɑ Ȳȶǋɑ Steung Trang Steung Sna PeamKoh Leu Dei Neng Hun PrimarySchool ȷ ɁƓ ɑ PreyChhor KrauchKhpuos Tuol SecondarySchool PreyChhor Lovea Batheay KohSotin Kampong Cham Kampong Vong Veal Thmar Tuol SecondarySchool Steung Trang Steung MesarChrey MesarChrey School High ChamkarLeu Teap Svay Sen Hun School High Tbaung Khmum Tbaung RokaPor Pram O Chong PrimarySchool o 31 30 17 32 19 18 20 21 22 23 25 24 27 26 29 28 N e c n i ɸ ɭ v ɽ ƸɊ o r ȶȵ Ɨ ɮ ɸ Ɉȶ P Ȳ Kampong Cham ɁƓ Tbong Khmum l e v e L

l ʂ ɋ ʂ ɋ ʂ ɋ ʂ ɋ ʂ ɋ o o Ȳǜ ɩ Ȳǜ ɩ Ȳǜ ɩ Ȳǜ ɩ Ȳǜ ɩ Ȳǜ ɩ Ȳǜ ɩ Ȳǜ ɩ h ʂ ɋ ʂ ɋ ʂ ɋ c ɩ ɩ ɩ ɩ ɩ Ƀǚɍ Ƀǚɍ Ƀǚɍ Ƀǚɍ Ƀǚɍ Ɏ Ɏ Ɏ Ɏ Ɏ ɭ ɭ S ɭ ɭ ɭ ɩ ɩ ɩ Ƀǚɍ Ƀǚɍ Ƀǚɍ ɔɅ ɔɅ ɆȽɊɑ ɆȽɊɑ PrimarySchool Ɏ Ɏ ɆȽɊɑ ɆȽɊɑ ɆȽɊɑ ɔɅ High School High ɆȽɊɑ SecondarySchool SecondarySchool

ɻ l o o h ǋɌ ɆȽɊɑ ʂ ȲƙȲǏ ɭ ɪ ɽ ɑɪ ɆȽɊɑ Ɍ Appendix 2.1: The List of 136 Schools Appendix 2.1: The List c ɮ ɽ Ȳ ɽ ɽ ƒ Ɏȶƞɪ Ɏ ƀ ɑ ɪ ɸ ǍɊ ɔɅ ɋ S ƛ ɸ Ʌ ȶ ɭ ɸ ɳƙɆ ȷ ƕ ɑ ɍ ɮ ƳɆ ɻ Ǝ ǂɑɁ ɔɅ ƀ ɍɆ

ɵɓ ž ƴ ȶǍ ɫ Ɨ ɴɑɅ Ɂ ɻ Ɍǋ ɭ ɮ Ɇ ƙɈɹɊ ɂ ɳɑȟ Thmar Sen Thmar PrimarySchool Soeu ǋ ɵƙɈɁ Malai ɵƙɈȳ ɔ e n u m ɋ ɑƙɊɑ ɻ ƛ ɽ ɽ ɸ ǍɊ Ǉɋȼ Ȳɪ ɴȸ ɋ ɵƙɈǒ m ɭ Ʌ ȷɆ ƛ ɸ Ǝ ɽ ǒ ɽ Ɍ ȶ ɪ ɳƙƳȲ Ɋȶ ȷ ƕ ɑ ɍ o ɮ ɻ Ɂ ɩ Ǝ ǂɑɁ ȴ ƚ ȶ ɋɳǇ C ƛ ɵɓ ȶǍ ɫ Ɋ ɩ Ɂ ɸ Ɉȶ ɻ Ɍǋ ɭ ɮ ǒ Ɇ ɵƙɈǒ Ʌ ɳɑȟ Nimith ȴ ɞɑƞ ǋ Malai ɔɅ ɵƙɈɁ ɵƙɈȳ ɔ Ǉɋȼ ɴƙɈȲȹ ǂɴɑɅ ǒɊȴ BayDamram BayDamram SecondarySchool PreyKhpuos PreyKhpuos PrimarySchool t c i r ɪ ɪ t ɪ ɪ ʂ ɀ Ȳ s ɻ Ɂ Ɍ Ɍ ɭ i ɮ ɽ ɸ Ɇȶ ɸ Ɇȶ D ɪ ɽ ȼ Ɍ ɩ ɽ ȼ ƀ ɍɆ ɪ ƀ ɍɆ ɋɴɆ ɳǒɉ ɻ Ɍ ɩ ɵɓ ſ ȴ ɸ ɳɌȢȶ Ɍɳƙǫ ɻ Ɨ ɳƵɍ ɸ ɳɌȢȶ ɮ ɭ Ȳ Maung Russey Maung PreySvay PreySvay SecondarySchool Ȳ ɳǋȶɞɑƞ Ɋȶ KamriengRaing Boeung Raing Boeung SecondarySchool ǇɁ Serei Sophoan Serei Svay Kampong SamrosKomar Poipet PrimarySchool BattambangPao Svay PreahMonivong School High ɔ ɳǇ MongkolBorei Soeu ɑ Ɋȶ O Chreuv O Kuttasat Kuttasat ǋ MongkolBorei RusseyKroak MongkolBorei School High Malai ɂ ɳǋȶɞɑƞ Bavel Russey Maung PreyTauch PreyTauch PrimarySchool Ȳ ɆɳɎɍ Thmar Kaul Thmar Run Anlung Kap Chop PrimarySchool RukhakKiri PrekChik ChkerPreus Kham Battambang PrimarySchool Mal Ou Mal O ǇɀɅ Ɍ Kamrieng TaSaen Sakawa Samaki PrimarySchool Banan ǇɁ o 1 4 3 2 5 6 7 9 8 15 14 16 10 12 11 13 N ʂ ɋ e c n i v ɸ Ɇȶ o ɋǋɅȹ ɽ ȼ r Ɛ P Banteay Meanchey ǇɁ Ɇǆ Battambang

72 Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Spue Kampong Ȳ Ȳ Chhnang Kampong ɸ Ɉȶ ɸ Ɉȶ P r o ɑ ɽ ƹ ɽ v ƒ ɬ ƕ ȶ i ɸ n c e N 44 45 42 48 43 47 46 40 33 34 39 35 37 38 36 41 o Samrong Torng Khtum Kraing Pheatarak Primary School Primary Pheatarak Khtum Kraing ȷǙɌɊɅ Samrong Torng Oudong Chbar Morn Svay Kravann Marum Khang Secondary School Secondary Marum Khang Svay Kravann əȼ Morn Chbar əȼ əȼ Barset Chbar Morn Roka Thom Phoum Thmei Primary School Primary Phoum Thmei Oudong Thom Roka Morn Chbar ɑ arn on Skous Ǉɑ Samrong Torng Oudong ɑ apn hnn apn PehBt High School Bat Preah Kampong Kampong Chhnang ȷǙɌɊɅ Teuk Phos Kbal Teuk Kbal Teuk Secondary School Secondary Kbal Teuk Kbal Teuk Ȳ Phos Teuk ɳɊɊɁ ȼ Memot apn rlc uge Lungvek Lungvek Kampong Tralach Ƀ Dambe ɁƓ Kampong Leng Pralay Meas Hun Sen Koh Primary School Primary Svay Hun Sen Koh Samaki Meanchey Meas Pralay ǒɊȴ Kampong Leng Ȳ Tbaung Khmum Tonle Bet Tonle Bet Secondary School Secondary Tonle Bet Ȳ Tonle Bet Tbaung Khmum ɸ Ɉȶ ɴɆ ɸ ɫ Ȳɇ ɸ Ɉȶ ɸ Ɉȶ ǍɃ ȳ ɸ ɳǍȶɃȶ ǍɃ ɑ ɸ ɳǍȶɃȶ ɮ Ɍȵ ɭ ɭ ɭ ȶ ȶ ȶ ɩ Ƀ ɭ Ǝ ƀ Ǝ ƹ ɽ ɑ ɭ Ɂȷɍɴȶ ƙɁǔȷ ɽ ɍ Ɇɋɑɒ ɼ ɭ ɅɴɑɅɳƳɹɞɑƞ ƙɆǔɋǋɑ ɴɍȶ ɽ Ɨ ɸ D ɽ Ƒ ɪ ǋɅȹ ƀ ƒ i ȶ ɸ s t r i c ǒ ɋ ʂ t elPn elPn High School Veal Pong Veal Pong ɋ School Primary ǒ Tumpoung Meanchey ǋɅȹ oAgrn 4KnaHigh ǏɍɈȶ School 24 Kanha ǏɍɈȶ Angkrang Po ɳǉɄ Yuthsamaki Trapaing Lopeak Secondary School Secondary Trapaing Lopeak Yuthsamaki Ȳ ɌƳɄ ƺ Choam Kravean Kbal Sleng Primary School Primary Kbal Sleng Choam Kravean ɳɑƽ ȲǙɍɃ Seda ɃɳɅ Ɛ ɸ ƙƳ ɸ Ɉȶ ɭ ƛ ɭ Ƀ ƀ ɑ

ƛ ɸ C ɋƙȲǏ ȲɎɅȲǙɍɴɑ ƙȲɳɎȢɅ ɋ Ƒ ǒɊȴ ƚ Ɇ o ȶ ƙȶʒʔȲȦ Ȩ ɔƙȶȶ ɸ ƛ Ȳ ɸ ƹ ɽ Ƀ ɋ ʂ ɃɳɅ ɩ Ƀ m ƒ ȲǙɍɃ ɫ Ȳ ƙɈɹǇɃɑ ȶ ɸ m ɻ Ʌ u ɪ ƀ ɽ n e Phnom Cheal Secondary School Secondary Phnom Cheal ƙɊ ƙɁǉ ǊɁɌɺ ɉ ɉ Seda Sen Chey Primary School Primary Seda Sen Chey ɳɑƽɴɑɅȹ Trapaing Thmar Primary School Primary Trapaing Thmar ɍɴȶ ƙɁǉ ɮ ɸ Ɉ Ɋ ƒ ɸ ɳȹȢɍ ȩ ɸ ƴȶɁƓ ɮ ȶ ɩ ɂ ƚ Ɇ ȶǎ ƛ Ȳ ȶɂ ɸ ɸ ɪ Ɨ S ɩ Ƀ c ɫ Ȳ ƈ Ɨ ɆȽɊɑ ƚ ȶ ɔɅ ɮ ȶ h ƕ Ȳ ɭ ǍɊɌ o ɽ o ɆȽɊɑ ɋ ʂ l Ƀ

ɩ Ƒ ɪ ɆȽɊɑ Ɏ ɆȽɊɑ ɆȽɊɑ ɔɅ Secondary School Secondary Ɏ ɔɅ Ɏ ɔɅ ɆȽɊɑ ɔɅ ɔɅ ɆȽɊɑ Ƀǚɍ Ƀǚɍ Ƀǚɍ ɩ ɩ ɩ ɭ ɭ ɭ S ɭ ɭ ɭ Ɏ Ɏ Ɏ Ɏ Ɏ Ɏ Ƀǚɍ Ƀǚɍ Ƀǚɍ Ƀǚɍ Ƀǚɍ Ƀǚɍ ɩ ɩ ɩ ɩ ɩ ɩ c ʂ ɋ ʂ ɋ ʂ ɋ h ɩ Ȳǜ ɩ Ȳǜ ɩ Ȳǜ ɩ Ȳǜ ɩ Ȳǜ ɩ Ȳǜ ɩ Ȳǜ o o ʂ ɋ ʂ ɋ ʂ ɋ ʂ ɋ ʂ ɋ ʂ ɋ l

L e v e l Kandal Ȳǁ Kampot Ȳ Thom Kampong Ȳ P ɸ ɈɁ ɸ Ɉȶ r Ǝ o Ʉ ɽ ɍ v ɸ i n c e N 60 64 63 59 58 62 57 56 61 55 49 50 51 54 53 52 o Chhouk Kean Kean Svay Angkor Chey Champei Ang Chaut Primary School Primary Ang Chaut Champei Chey Angkor Ponhea Leu Tumnup Thom Damnak Pring Primary School Primary Damnak Pring Tumnup Thom Ponhea Leu Chhouk Muk Kampoul Prek Anhchanh Chheu Teal Primary School Primary Chheu Teal Anhchanh Prek Kampoul Muk Banteay Meas Sdech Kong Chrung Sralao Secondary School Secondary Chrung Sralao School Primary Sdech Kong Boeung Touk Boeung Touk Meas Banteay Chhou Teuk Koh Koh Thom Ⱥ ɈƼɠ Ɋ Baray Santouk Ɇǆ Ƀ ɳƳɹɄ Santouk Ⱥ ɔȶ Baray ɳȲȢɅǒ ɑɅ ǇǍɋɀ Kampong Svay San Kor San Kor (B) Secondary School Secondary San (B) Kor Santouk San Kor Kampong Svay Kampong Svay Trapaing Russey Samrong Primary School Primary Samrong Trapaing Russey Kampong Svay Ȳ ɑɅ ǇǍɋ ɑɅ Ȳ ɭ ȳȲ ɫ Ȳ ɸ Ɉȶ ɸ Ɉȶ ɮ Ȳ ɮ Ȳ Ɛ ƀ Ɍȹ ɭ ɭ ɭ ɋǋɑ Ⱥ Ɛ Ȳ Ɛ Ȳ Ɛ Ȳ ɸ Ɉ ǒ ɽ ǒ ɽ ɸ ɋ ʂ ɮ D ɍ ɮ ƛ ƛ ƛ ɋ ɋ ɋ i ɿ s t r i c t Ta Ken Ta Chroy Takeo Deum Po Primary School Primary Deum Po Takeo Chroy Dei Eth a on u e hokHigh School Hun Sen Chhouk Sat Porng ɑɁ Ƀ ɴƙɈȲɔȦ oYugHnSnTig High School Hun Sen Taing So Yaung Ɇ ƙɋɴɎɳȼ ɳƙƺɋǂɴȲɎ an rsigTigKaan High School Taing Krasaing Taing Krasaing ɳɑ ǂɴȲɅ ȷ School Primary Sampeuv Loun Cheung Deung ȼ Boeung Lovea Tbeng Sangkruos Primary School Primary Tbeng Sangkruos Boeung Lovea Boeung Lovea Boeung Lovea Secondary School Secondary Boeung Lovea Boeung Lovea ǂ ƙɁǉ ɳȹ ɑ Ɇ Ɇ ǒɅȴɌ ɸ ɅɆ ɫ ȶɃ ɸ Ɇ ɪ ɗȼ ɫ ȶǎ ɫ ȶǎ ȶƙȲǒ ɪ ȶȼ ǌ ɒ ɮ ɳǌȶ ɸ Ǝ ȷȴȶ C ɭ ɪ ƛ Ɉȶ o ȶɞɑƞ ɮ ɸ ɽ Ʉ Ȳ Ɗ ɮ ȶ ƛ ƛ m ɸ ƴȶɳȹ ɽ m ƃ ɳȺ Ȼ ǂ ȶ ɸ u ɪ n e ƙȹ ɪ ȶ Dei Eth Trapaing Bei Primary School Primary Trapaing Bei ȼ ɒ ɼ ɭ ɅɴɑɅȺ Ɇ ɔȶ ƙɁǉ ȼ ɑ ɑ ɴɁƓȶɑɳȜƷ Ɇ ǒɅȴɌ ǁȲ ɸ ɫ ȶɃ ɪ ɗȼ ɫ ȶǎ ƙɳ ɔɅ ȩ ȶƙɑɳȅ ɪ ɊɳǉɄ ȶƙȲǒ ɸ ɳǺɍ ɸ ɳǍȶ ɼ ɭ ɅɴɑɅǂ ɸ ƀ ȹ ɍɆȽɊɑ Ǆɍ ɪ ȶɆ ɮ ɯ ɸ Ȳ S Ɂ Ɗ ƛ ɳɍ c ( ɽ ƙɈ ɆȽɊɑ ɮ Ʌ h ɪ Ȩ ȳ Ɏ ȶ ɪ o ɸ ɆȽɊɑ ɪ ȶ ƀ ɆȽɊɑ ɹ ) o ɳȲɎ ȶɳƵȲ ɸ Ɏ ɮ Ȳ l

Primary School Primary ɆȽɊɑ ɆȽɊɑ ɆȽɊɑ ɆȽɊɑ ɆȽɊɑ ɆȽɊɑ ɔɅ ɔɅ Ƀǚɍ Ƀǚɍ Ƀǚɍ ɩ ɩ ɩ S ɭ ɭ ɭ Ɏ Ɏ Ɏ c Ƀǚɍ Ƀǚɍ Ƀǚɍ ɩ ɩ ɩ h ʂ ɋ ʂ ɋ ʂ ɋ o ɩ Ȳǜ ɩ Ȳǜ ɩ Ȳǜ ɩ Ȳǜ ɩ Ȳǜ ɩ Ȳǜ ɩ Ȳǜ ɩ Ȳǜ ɩ Ȳǜ ɩ Ȳǜ o ʂ ɋ ʂ ɋ ʂ ɋ l

L e v e l

l ʂ ɋ ʂ ɋ ʂ ɋ ʂ ɋ o Ȳǜ ɩ Ȳǜ ɩ Ȳǜ ɩ Ȳǜ ɩ Ȳǜ ɩ o ʂ ɋ ʂ ɋ ʂ ɋ ʂ ɋ ʂ ɋ ʂ ɋ ʂ ɋ h ɩ ɩ ɩ ɩ Ƀǚɍ Ƀǚɍ Ƀǚɍ Ƀǚɍ c Ɏ Ɏ Ɏ Ɏ ɭ ɭ ɭ ɭ S ɩ ɩ ɩ ɩ ɩ ɩ ɩ Ƀǚɍ Ƀǚɍ Ƀǚɍ Ƀǚɍ Ƀǚɍ Ƀǚɍ Ƀǚɍ ɆȽɊɑ ɔɅ Ɏ Ɏ Ɏ Ɏ Ɏ ɔɅ ɆȽɊɑ ɆȽɊɑ ɆȽɊɑ ɪ Ʌ ƒ

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o Ɍ ɼ ɅǍ ɭ ɭ ɪ ɸ o ɭ ɅɌ Ɨ ɪ ɸ ɳɌ ɽ ơ Ɋ ɔɅ h Ƈ ȹ ȶ Ɏ ɪ ɯ ɽ c ɸ Ɉ ɻ Ǝ ȶ S ɭ Ɋȷ ɪ ɍɂ ɯ ƒ ɸ ɸ ƃ Ɛ ɌɳɃɎ ɴɁƓȶʒɩ ɔɅ ƀ ƙǇȹ ɼ ɭ ɅɴɑɅɆ ɼ ɭ ɅɴɑɅɆ ɍɃ ɌɴɆȲȲ Ɋ ɯ ɮ ɮ ɒ ɵƙɈɳǹ Ǉɉ ɒ ƙɑɋ Ȳȥ ɔȶ ɵƙɈɃ PreyThmei Tuol PrimarySchool e n ʑɪ Ƀ Ȳ ɴƙɈȲȳǜɋ ɆȽɊɑ ƒ ɸ ɴɁƓȶ ɉ ȷɩ ɳƵȲȴȶ u ʓɪ ɔ ɉ ʒɪ ɗɅ m ɽ ɍ ȶɃ ɽ Ƀ ɯ ɽ ( ɽ Ƀ Ɍ ɪ m ɸ Ɉ ƒ ɸ ơ Ȳ ɻ ȶ ƚ o ɸ ƃ Ʌ ɯ ɋǇȲ ƺɑ C ƛ ȶɉ ɪ ɍɃ Ȳǃ ɫ ȶȲȲ ɫ Ȳɍ ɫ Ɨ Ɉ ɯ ɸ ɳȷȲ ɴƙɈȲƙȲɳǸ ɴƙɈȲƙȲɳǸ Ɏ ǒ Ƀ Ɍ ɳƵȲȴȶ ɳȹ Ƀ ƙɑɋ Ɇ ƙɑɹȷȲ Ƀ PrekKrabao PrekKrabao School High Ȳȥ Boeung Kak Boeung 2 IndraktevySchool High ɴɁƓȶɈ Cheung Phnom Cheung BaPhnom School High Kanhchom Kanhchom SecondarySchool ɴƙɈȲȳǜɋ ƙȲɳǸ ɂ SrasChak Bun Sen Hun School High TeukLa-Ak 3 Bek O Ka-Am SecondarySchool PrekKhsay (A) PrekKhsay PrimarySchool Tbeng 2Tbeng 2Tbeng Phoum SecondarySchool TeukThla Borei Sen Hun SrayongSchool High Srayong PrimarySchool t c i r t s i ɭ ȳ D Ǝ ȷ ȣȷ ȣȷ ɪ ƅ ƅ ɴȲɎ ƒ ɸ ɸ ȶ ɸ ƳɌɊɅ ɴɍɅ ɍɳƵȲ ɅɳɈȻ ɍɳƵȲ ɴɍɅ ɸ ƸɋǋɌ ɮ ɯ ɮ ɯ ɮ ɞɑƞ ǉɊȹɌ Tuol Kauk Tuol ȷ ȲɳȜȥ Ǉɉ Tuol Kauk Tuol ɴɑɅɑ ȴ Ƀ ChamkarMorn ȼ 1 Tumpoung Tuol Tumpoung Tuol School High Ƀ PeamChor ƙɈɹɳɑ ǉǍ ȴ Pearaing BaPhnom Ȳ ǉɊɌ ȲɳȜȥ Daun Penh Daun PreahSdech Rumchek PreyPhdao PrimarySchool PeamRor Koulen RusseyKeo Pak Svay Sim Chea School High Sen Sok Sen Koulen KanhchreachPoun Thmar Prachum Ang PrimarySchool Kanhchreach KaukLechKong KaukKong SecondarySchool KamchayMear Krabao o 84 96 82 95 93 86 87 85 83 81 92 94 88 89 91 90 N e c n i v ɩ o ǓɌ r P ƙɈɹɎ PreahVihear ɵƙɈɴɎȶ PreyVeng l e v e L

l ʂ ɋ ʂ ɋ ʂ ɋ ʂ ɋ ʂ ɋ o o Ȳǜ ɩ Ȳǜ ɩ Ȳǜ ɩ Ȳǜ ɩ Ȳǜ ɩ Ȳǜ ɩ Ȳǜ ɩ h ʂ ɋ ʂ ɋ ʂ ɋ ʂ ɋ c ɩ ɩ ɩ ɩ ɩ Ƀǚɍ Ƀǚɍ Ƀǚɍ Ƀǚɍ Ƀǚɍ Ɏ Ɏ Ɏ Ɏ Ɏ ɭ ɭ ɭ S ɭ ɭ ɩ ɩ ɩ ɩ Ƀǚɍ Ƀǚɍ Ƀǚɍ Ƀǚɍ ɔɅ ɆȽɊɑ Ɏ High School High Ɏ ɆȽɊɑ Ɏ ɆȽɊɑ ɆȽɊɑ ɅɎ ɯ

ɽ Ɨ l o ɍǇ ɔɅ ɸ ɳǺɈ ɯ ɸ ǌɊ ɔɅ o ʑɪ ɆȽɊɑ Ƀ ɽ ƽ ɆȽɊɑ Ŧ Ƞ ś

h ɭ ɯ ȶ ɸ ǁȻ Ƚ ÿů c ɻ Ɂ ɮ ɻ Ȳ ɭ S ɸ Ɉȶ ȱ Ƃė ɽ ɍ ɽ ɑ ɸ ɸ ɳǺɃ ʂ ȶǒǎ ɆȽɊɑ ɋɴȼȲ ɔɅ Ʌ Ƒ ɌɊ ƕ Ɏ Ɛ ɮ ɼ ɭ ɅɴɑɅǂɳǥ ɸ Ɉȶ ɸ Ɉȶ Ȼ ș ůȫƹůÿ ɳƳɹɌɹ ǒƳɊ ƙɁǉ ɒ Ȳ ȷƙȶȶ ɴƙɈȲɴƙȲȶ ɔɅ Hun Sen Kampong Kampong Sen Hun Sakamoto Tuol Tuol Sakamoto SecondarySchool ǂ ɽ e n u ɋ ɳȲȶȲ ʑɪ ȷǙɔ Ƒ ʑɪ ɑɅ m ɯ ȶ Ȳ ɸ ǁȻ ɽ Ƀ Ʌ ɒ ɼ ɭ ɅɴɑɅɑ ɯ m ơ Ȳ ƚ ȶ ɒ ɼ ɭ ɅɴɑɅȷ ɽ ɍ Ȳ ɫ ɽ ɑ ɸ ɳǺɃ Ɨ o ɋɴȼȲ Ɇǆ ɽ ȳ Ɛ C ɭ ɄɌ ɪ ɸ ɳǺɈ Ȝ ɸ Ɉȶ ɸ Ɉȶ Ȳɍ ɫ ɳƳɹɌɹ Ȳ ɈȶɃ ɑ Ȳ Ƀ Vathanak PrekKrieng ȷǙɔ SecondarySchool ǂɳǥ PorngTeuk Sala Trapaing PrimarySchool ǇȲ ȷƙȶȶ ɎȾƌɅɺ ɳƙƺɋɆǆ ŷĉ t c i ɻ ʂ ɋ ɳƸɊɳǩ ȹɊ ƛ ɍ ɑ r ǋ ɪ t Ǝ s ɋ Ɇǆ i ƛ ɪ ɸ ʂ ɋ Ɍ D ɭ Ŧ ȑ ė ɽ Ȳǁ Ȩ ɴɑɅȹ Ɨ Ɨ ɍɑ ž Ƌ Ɍ ɮ ɡɊ Ɵƹ ƛ ɸ Ɇ Ŝ ɍɳƵȲ ƙɁɆ ɩ ɯ ǎ ȳǜȷ PoSenchey Chao Chom Voan Chumpou PrimarySchool ɳǉɄ ȼɳƷ Sambo ɈƼɠ ɳƳɹɄ LoveaEm Stung Kandal Reah Koh Bakou Leu Ponhea Reah Koh Luong Kampong Luong Kampong SecondarySchool School High KhsachKandal Sithor Kean SvayKean BanteayDek BanteayDek SecondarySchool Takhmao Kampong Kampong PrimarySchool ɳȲȢɅǒ ǂɳǥ Ƀ Tuol Kauk Tuol TeukLa-Ak 1 Muk Santhor PrimarySchool ǋɅȹ Dangkor ǂɳǥ Koh ThomKoh Poun Sampeuv Sampeuv Sen Hun School High Meanchey1 ChbarAmpeuv 1 ChbarAmpeuv PrimarySchool Ɋɀ Takhmao TakhmaoTakhmao Sen Hun School High ȷ ɑ PrekPrasap ChroyBanteay Borei Chith Kampong Keng PrimarySchool Changkrong Changkrong PrimarySchool Mondul Seima Mondul PakKhlang Cham Sen Hun SecondarySchool ɴƙɈȲƙɆɑɈ ÿř o 71 68 67 80 77 70 69 66 65 79 78 72 73 75 76 74 N e c n i v ȶ ɭ o r P ƒ ɸ ɳɈȻ ɳƳɹȲ Koh KongKoh ƙȲɳȷɹ Kratie ɉ Penh Phnom

74 Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Ɋɀ Rattanakkiri ɌɁɅɺȴ Siem Reap ɳɑȢɊǍɆ Mondul Kiri Pausat ɳǉɄ P r Ƌ ɍȴ Ȩ ǒɁ o v ɪ Ɍ i ɪ n ɪ Ɍ ɽ c ɪ e 112 109 106 105 110 104 102 101 100 107 103 108 N 111 97 99 98 o imepSmorSambour Sambour Siemreap ɳɑȢɊǍɆ Puok ɑ Banteay Srey Run Ta Ek Run Ta Ek Secondary School Secondary Run Ek Ta Run Ek Ta Srey Banteay Ɉ ihrKna rkCagrnPe adkHigh School Sandek Bakan Prek Changkran Prek Sithor Kandal ƙȲȴɌ o hkSeSnkmHnSnKo High School Hun Sen Keo Sre Sangkum Koh Nhek ɑ Siemreap Sala Kamreuk Wat Bo Wat Sala Kamreuk Siemreap Krakor ǇƳɅ ȹ ɔȶ atNkmPopel Saut Nikum School Primary Pnhear Ta School Primary Leu Thlork Kauk Trakeat Kor Chi Kreng Chhouk Char Chum Angkor Pursat Ɇǆ ɳƳɹɴȻȲ ɳǉɄ Pursat ɳǉɄ Bakan ǇƳɅ Ɉ ǇɅɍ Banlung ɳɑȢɊǍɆ Puok ɯ ɯ Ȳ ɪ ɴƙȲȶ Ȳ ɪ ɄɌȲǁ ɭ ɮ ƙɃɅ ƀ Ɍȹ Ɛ ɋƙɑ Ȩ ǒɁ Ȩ ǒɁ D ɭ ɸ ɊɈɳɈɍ ɩ ȴɊ ɭ ȶ i s Ǝ t ɪ ɽ ɽ r ɴƙɈȲȷȜƷ ɍ i c t Snam Preah Snam Preah Secondary School Secondary Snam Preah Snam Preah ɑ Reul ɳɌ Boeung Bot Robang Romeas Primary School Primary Robang Romeas Boeung Bot ɳȺ ha ryPursat Prey Phtas Chheu Tom Kbal Teahean Primary School Primary Kbal Teahean Chheu Tom Ɇ ɳƵȲɄ ƸɌȺ Ɍ ɴƙɑɑȶ Kachanh Borei Kamakar 4 Primary School Primary 4 Kamakar Borei Kachanh ha ryPursat Prey Phtas ɇ ǒ Ɉ ɇ Ƹ Ɇ ƳƸȻ ǒǎȲ Puok ǂȲɌ ɅǂɡȲ ɭ ɍ ɯ ɪ ɫ ȶɆɁ Ɛ ɹɵƙɈ Ȳ Ɛ ɹɵƙɈ ɸ Ɇ ƒ C ƙɹǒ ɊƙɈɹ Ɂ ɮ ɪ Ɍ o ɭ ɸ m ɌɁȴɁɆȽɊɑ ȴɌƙɁɳȴȢɁ ɮ Ȳ ƚ Ȳɳɍ ɽ Ȳǁ ɒ ɼ ɭ ɅɴɑɅɴȲɎɑ ƀ Ɋ ɸ ɳɌ m ž ɎɁ Ȳ ɴƙɈȲɑɴɀ Ʌ ɪ u Ǝ ɪ n ɆɌɑɆȽɊɑ ɌɆȶɌǋɑ ɍ e ɑ Reul ɳɌ ǙǄɅɆȽɊɑ ȲǙɍǄǓɅ Kreal Porng Primary School Primary Porng Kreal ɳǉɄ ǂɳɉ ƙƵɍɈȶ ɳǉɄ Ɉ Puok ɅǂɡȲ ɭ ɍ ɯ ɮ ɪ Ȳ Ɍ ɸ Ɇ ƒ Ȳ Ǝ Ɇ ɪ ɊƙɈɹ ɮ ɭ ɮ Ɍ Ǎ ɆȽɊɑ ǋǍʔ Ɉ Ȩ ǒɁ Ƈ ȣ Ȩ ǒɁ S ɾ c h ɽ ɽ Ǝ o Ɏ Ȳ o l

ɪ ǋ ɻ Secondary School Secondary ɔɅ Primary School Primary Secondary School Secondary ɔɅ High School Ɏ ɆȽɊɑ Secondary School Secondary ɆȽɊɑ ɔɅ ɔɅ ɔɅ ɆȽɊɑ Ɏ ɆȽɊɑ Primary School Primary Ƀǚɍ Ƀǚɍ Ƀǚɍ ɩ ɩ ɩ ɭ ɭ S ɭ ɭ ɭ Ɏ Ɏ Ɏ Ɏ Ɏ Ƀǚɍ Ƀǚɍ Ƀǚɍ Ƀǚɍ Ƀǚɍ ɩ ɩ ɩ ɩ ɩ c h ʂ ɋ ʂ ɋ ʂ ɋ ɩ Ȳǜ ɩ Ȳǜ ɩ Ȳǜ ɩ Ȳǜ ɩ Ȳǜ ɩ Ȳǜ ɩ Ȳǜ ɩ Ȳǜ o o ʂ ɋ ʂ ɋ ʂ ɋ ʂ ɋ ʂ ɋ l

L e v e l ǒ Svay Svay Rieng Steung Treng ɑ Shihanouke Preah Takeo ǂɴȲɎ ƙɈɹɑ P ƛ ɫ ȶɴƙɁȶ Ɛ ɋɳɌȢȶ r o ɪ ɒɅ v i n c ɭ e 128 127 126 120 125 122 124 123 N 113 115 114 117 116 121 118 119 o Kiri Vong Kiri Angkor Borei Prek Phtaul Sok An Prek Primary School Primary Sok An Prek Phtaul Prek Borei Angkor Puok ȴ Tramkak Thala Barivat Preah Rumkel Anlung Svay Ler Primary School Primary Anlung Svay Ler Rumkel Preah Thala Barivat Svay Svay Teap Borei Chulsa Kampong Kampong Primary School Primary Kampong Kampong Chulsa Borei Varin ra iaukSnkt4HnSn High School Hun Sen Sangkat 4 Sihanuok Preah ɔȶ Prey Kabas Prey Lovea Prey Lovea Primary School Primary Lovea Prey Lovea Prey Kabas Prey School Secondary Hun Sen Samaki Samaki Stung Treng Prey Nup Prey ƙǂ oesHkAmpil Hek Romeas Romeas Hek Sambath Chamkar Koh Primary School Primary Koh Chamkar Sambath Hek Romeas Ǐ ɵƙɈɅɆ Romeas Hek Krasaing Prey Bet Meas Secondary School Secondary Meas Bet Prey Krasaing Hek Romeas ǒ Ɉ ɵƙɈȲɆǙɑ Ɇ ǔ Ɍ ǃǔɆ ƙɈɹɑ ɌǋɑɴɒȲ ɌǋɑɴɒȲ ɑ ɌǋɑɴɒȲ ǇɎ Bavet ɻ Ɍ ɯ ɮ ɪ Ɍ Ȳ Ɍ Ʌ Ɏȶ ƛ ȹɍǒ ɫ ȶɴƙɁȶ Ɛ ɩ ɪ ɪ ȲȲ ɋǄɆ Ɂ ɸ ƀ ɌɆ ɩ ɽ ɭ Ɍ ɪ ɒɅ ɽ ɽ D ɪ ǏɁ i ɩ s ɭ ɽ t ɽ r i c t Som Leay Bo Leay Bo Primary School Primary Bo Leay Bo Leay Puok ɳǒɊ ɴƙɈȲɳǈ Sambour Samaki Raingsei Primary School Primary Samaki Raingsei Sambour Svay Sar Svay Sar Secondary School Secondary Svay Sar Svay Sar ǎɋɆ Andaung Thmar Hun Sen Primary School Primary Hun Sen Andaung Thmar ǒ ɔɀ Ɉ ɑ ɵƙɈǎ ha ae h huHigh School Chi Phou Mates Chrak ƙɈɹɌ ɑƷ ɔ ƙȲǒ ɑɊƓɁ Ȳ ǒɊȴ ƙȷȲɳɊ ɯ Ȳ ɸ Ɉȶ ɸ Ɉ ƛ ɸ Ɇ C ɋ ɩ ɍ ɮ ɮ Ǝ Ɍ Ȳ ž ɸ o Ɂ ȶɂ ƙȲǒ ɽ

ƛ ȶ ɸ ɔɅ ɩ ɍ ǒ ɑ m ɒ ɽ ʔ ɪ ƀ ɩ ǋɅȹ Ǝ ȹ Ɛ ɑ ɮ Ɛ ǎɋɆ Ɍ ɑ ɍ m Ɨ u Ȳ ȶ ɸ n ȷ ɋ ʂ e Hun Sen Serei Secondary School Secondary Hun Sen Serei Puok ɒ ɒ adc ha High School Samdech Chea ǒɊȴ Ɉ ɵƙɈǎ ɑɳɊ ɵƙɈɆ ɒ ɯ Ȳ ɸ Ɉȶ ɌƳ ɆȽɊɑ ɸ ƳɌɳƳɹ ɪ ɇ ɼ ɭ ɅɴɑɅɑ ɭ ȳǕɅɴƙɈȲɳǈ ƛ ɼ ɭ ɅɴɑɅɔɀ ɼ ɭ ɅɴɑɅɊ ɼ ɭ ɅɴɑɅǒɊȴ ɋ ɮ ƚ ȶ Ǝ ȷƺɑ ǋ ɔɅ ɩ Ƀǋɑ S ƙȲǒ ɽ ǒ ɽ

ƛ ɔɅ ɑ ɪ Ɍȶƞ ƀ c ɮ ɆȽɊɑ Ɍ ƛ h ɋɳɍ o ɪ ɆȽɊɑ ȶ ɩ Ɂ ɸ o ɩ Ɍ Ɏ ɪ Ɋ ɭ ȶ ɔɅ Ɏȶƞ ɪ ɈɎ Ǝ ǊɈ l ɮ Ǝ

ɪ ȶɂ Ɛ ɪ ƀ ɆȽɊɑ ɍ Ɨ High School ɆȽɊɑ Ɏ ɆȽɊɑ ɆȽɊɑ ɆȽɊɑ ɔɅ Ɏ Ƀǚɍ Ƀǚɍ Ƀǚɍ Ƀǚɍ ɩ ɩ ɩ ɩ S ɭ ɭ ɭ ɭ Ɏ Ɏ Ɏ Ɏ c Ƀǚɍ Ƀǚɍ Ƀǚɍ Ƀǚɍ ɩ ɩ ɩ ɩ h ʂ ɋ ʂ ɋ ʂ ɋ ʂ ɋ o ɩ Ȳǜ ɩ Ȳǜ ɩ Ȳǜ ɩ Ȳǜ ɩ Ȳǜ ɩ Ȳǜ ɩ Ȳǜ ɩ Ȳǜ o ʂ ɋ ʂ ɋ ʂ ɋ ʂ ɋ l

L e v e l

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ƀ l o o h c ɸ ȶ S ȫ ȷ Ɏ ɮ ɼ ɭ ɅɴɑɅɔɳƷ ɌƙȲ ɮ ɑƓ ɒ ƙȲǒ e n u m m ɸ ȶƙǇǒɃ ɔ o ɸ Ɏ ɮ ɍ ƀ C ɑƓ ɭ ɵƙɈɄ Ɇ Bosbov Krasaing PrimarySchool PreyThom Sbov t c i ơ Ɍɪ ɔɳƷ r t s i ɽ ȷɳȶ D ɸ ȶƙǇǒɃ ƙɁǉ ɸ ɳǍȶ ɸ ǁȲ ƙɁǉ ɴȲɆ ȼ ɑ Damnak Chang Oeur Chang Damnak AngkoalAngkoal Sen Hun SecondarySchool Samrong Trapaing Prasat Trapaing Prasat Trapaing Krauch O SecondarySchool Kep o N 136 133 134 135 e c ʂ ɋ n i v o Ɖ ǋɅȹ r P ɴȲɆ Kep əɁ Otdar Meanchey l e v e L

l ʂ ɋ o o ʂ ɋ ʂ ɋ ʂ ɋ h c ɩ Ƀǚɍ Ɏ S ɭ ɩ ɩ ɩ Ƀǚɍ Ƀǚɍ Ƀǚɍ Ɏ ɔɅ High School High SecondarySchool ɼ ɭ ɅɎ

l ƀ ƙɈɹ Ɏ o o h c S Ǝ ȷɳɁɳƺɒ ƚ ȶ ɼ ɭ Ʌɴɑȶɔȶ ɸ ɭ ɑɅ Ɂ ȶɪ ɒ e n u ƴȶɳȹ ɽ m m o ƚ ȶ ƀ ǂɳǒɊ ɑɳɊ C ȶƙǂȻ ɫ ɌƳɳƙǤ Boeung Tranh Tranh Boeung Ang Sen Hun TaSomAng School High Techo Samdech School High ɑɅ Ɇ ɔȶ RokaKrao Tom Sanlong Sanlong t c i r t s i ɽ D ɸ ɸ ȲȲ ȶ ɸ ɳǍȶ ɅɴȲɎ ɮ ȼ ƙǂ Samrong Tramkak Traing ƙǄ ɑ Daunkeo o N 129 131 132 130 e ůƵĞĐŽůŽƌŝƐƌŽƵŶĚϭĂŶĚƉŝŶŬĐŽůŽƌŝƐƌŽƵŶĚϮ dŽƚĂůWƌŝŵĂƌǇ^ĐŚŽŽů͗ϲϭdŽƚĂů^ĞĐŽŶĚĂƌǇ^ĐŚŽŽů͗ϰϬdŽƚĂů,ŝŐŚ^ĐŚŽŽů͗ϯϱ dŽƚĂůƉƌŽǀŝŶĐĞ͗ϮϯdŽƚĂůŝƚǇ͗Ϭϭ dŽƚĂů^ĐŚŽŽů͗ϭϯϲ c n i v o r P EŽƚĞ͗

76 Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Appendix 2.2: Questionnaire-School Children Anthropometry ),'51'03 ^ƵƌǀĞǇYƵĞƐƚŝŽŶŶĂŝƌĞͲŶƚŚƌŽƉŽŵĞƚƌǇ YƵĞƐƚŝŽŶŶĂŝƌĞ/͗ ;ŝŶƐĞƋƵĞŶĐĞŽĨƉƌŽǀŝŶĐĞ͕ĚŝƐƚƌŝĐƚ͕ĐŽŵŵƵŶĞ͕ǀŝůůĂŐĞ͕ƐĐŚŽŽů͕ĂŶĚ^ƵƌǀĞǇ^ƵďũĞĐƚĐŽĚĞͿ ĂƚĞ͗ͺͺͬͺͺͬͺͺͺͺͬ dŝŵĞƐƚĂƌƚĞĚͺͺͺͺͺ͗ͺͺͺͺͺ dŝŵĞĨŝŶŝƐŚĞĚͺͺͺͺͺ͗ͺͺͺͺͺ EĂŵĞŽĨ/ŶƚĞƌǀŝĞǁĞƌϭ͗ͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺŽĚĞ͗ͺͺ EĂŵĞŽĨ/ŶƚĞƌǀŝĞǁĞƌϮ͗ͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺŽĚĞ͗ͺͺ ϭ͘ŚŝůĚƌĞŶŶƚŚƌŽƉŽŵĞƚƌǇ ϭ͘ϭ ŚŝůĚ͛ƐŚĞĂůƚŚ ϬсEŽ ͺͺ ĐŽĚŝƚŝŽŶĂƐƐŽĐŝĂƚĞĚ ǁŝƚŚĚŝƐĂďŝůŝƚǇ ϭсzĞƐ^ƉĞĐŝĨǇ͗ͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺ ϴϴсŽŶ͛ƚŬŶŽǁ ϭ͘Ϯ 'ƌĂĚĞ 'ƌĂĚĞƌĂŶŐĞĨƌŽŵ'ƌĂĚĞϭƚŽ'ƌĂĚĞϭϮ͗ͺͺͺͺ ͺͺ ϭ͘ϯ ŚŝůĚ͛ƐĚĂƚĞŽĨďŝƌƚŚ ͺͺͺͺͺͬͺͺͺͺͺͬͺͺͺͺͺͺͺ ŐĞŝŶǇĞĂƌƐ͗ͺͺͺͺ ͺͺ ϴϴсŽŶ͛ƚŬŶŽǁ ϴϴсŽŶ͛ƚŬŶŽǁ ϭ͘ϰ ŚŝůĚ͛ƐƐĞǆ ϭсŽǇ Ϯс'ŝƌů ͺͺ

ϭ͘ϱ ŚŝůĚ͛ƐƌĞůŝŐŝŽŶ ϭсƵĚĚŚŝƐŵ ͺͺ ϮсŚƌŝƐƚŝĂŶŝƚǇ ϯс/ƐůĂŵ ϴϴсŽŶ͛ƚŬŶŽǁ ϵϵсKƚŚĞƌ;^ƉĞĐŝĨǇ͗ͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͿ ϭ͘ϲ ŚŝůĚ͛ƐǁĞŝŐŚƚ ϭƐƚŵĞĂƐƵƌĞŵĞŶƚ͗ͺͺ͘ͺͺŬŐ ϮŶĚŵĞĂƐƵƌĞŵĞŶƚ͗ͺͺ͘ͺͺŬŐ ͺͺ͘ͺͺ ;ŬŝůŽŐƌĂŵͿ ŬŐ ϭ͘ϳ ŚŝůĚ͛ƐŚĞŝŐŚƚ ϭƐƚŵĞĂƐƵƌĞŵĞŶƚ͗ͺͺͺ͘ͺĐŵ ϮŶĚŵĞĂƐƵƌĞŵĞŶƚ͗ͺͺͺ͘ͺ ͺͺͺ͘ͺ ;ĐĞŶƚŝŵĞƚĞƌͿ Đŵ Đŵ ϭ͘ϴ KĞĚĞŵĂ ϬсEŽ ϭсzĞƐ ͺͺ

4XHVWLRQQDLUHRQ$QWKURSRPHWU\ Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia 77 Appendix 2.3: Questionnaire for 24 hour recall

^ƵƌǀĞǇYƵĞƐƚŝŽŶŶĂŝƌĞ,ŽƵƐĞŚŽůĚ ĂƚĞ͗ͺͺͬͺͺͬͺͺͺͺͬ dŝŵĞƐƚĂƌƚĞĚͺͺͺͺͺ͗ͺͺͺͺͺ dŝŵĞĨŝŶŝƐŚĞĚͺͺͺͺͺ͗ͺͺͺͺͺ EĂŵĞŽĨ/ŶƚĞƌǀŝĞǁĞƌϭ͗ͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺŽĚĞ͗ͺͺ EĂŵĞŽĨ/ŶƚĞƌǀŝĞǁĞƌϮ͗ͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺŽĚĞ͗ͺͺ YƵĞƐƚŝŽŶŶĂŝƌĞ/͗ ;ŝŶƐĞƋƵĞŶĐĞŽĨƉƌŽǀŝŶĐĞ͕ĚŝƐƚƌŝĐƚ͕ĐŽŵŵƵŶĞ͕ǀŝůůĂŐĞ͕ƐĐŚŽŽů͕ĂŶĚ^ƵƌǀĞǇ^ƵďũĞĐƚĐŽĚĞͿ EŽ͘ YƵĞƐƚŝŽŶ ZĞƐƉŽŶƐĞKƉƚŝŽŶƐ ŽĚĞ ϭ͘ ,ŽƵƐĞŚŽůĚĚĞŵŽŐƌĂƉŚŝĐ ϭ͘ϭ ^ĞǆŽĨƌĞƐƉŽŶĚĞŶƚ͗ ϭсDĂůĞ Ϯс&ĞŵĂůĞ ͺͺ ϭ͘Ϯ ĂƚĞŽĨďŝƌƚŚ͗ͺͺͺͬͺͺͺͬͺͺͺͺͺ ŐĞŝŶǇĞĂƌƐ͗ͺͺͺͺ ͺͺ ϭ͘ϯ DĂƌŝƚĂůƐƚĂƚƵƐ ϭс^ŝŶŐůĞ ͺͺ ϮсŝǀŽƌĐĞĚͬ^ĞƉĂƌĂƚĞĚ ϯсtŝĚŽǁĞĚ ϰсDĂƌƌŝĞĚ ϴϴсŽŶ͛ƚŬŶŽǁ ϵϵсKƚŚĞƌ ϭ͘ϰ ZĞůĂƚŝŽŶƐŚŝƉƚŽĐŚŝůĚ ϭсDŽƚŚĞƌ ͺͺ Ϯс&ĂƚŚĞƌ ϯсƵŶƚǇ ϰс'ƌĂŶĚŵŽƚŚĞƌ ϱсZĞůĂƚŝǀĞƐ ϲс^ĞůĨ ϴϴсŽŶ͛ƚŬŶŽǁ ϭ͘ϱ tŚŽŝƐƚŚĞĚŝƌĞĐƚĐĂƌĞƚĂŬĞƌŽĨ ϭсDŽƚŚĞƌ ͺͺ ĐŚŝůĚ͍ Ϯс&ĂƚŚĞƌ ϯсƵŶƚǇ ϰс'ƌĂŶĚŵŽƚŚĞƌ ϱсZĞůĂƚŝǀĞƐ ϴϴсŽŶ͛ƚŬŶŽǁ ϭ͘ϲ ĚƵĐĂƚŝŽŶŽĨƌĞƐƉŽŶĚĞŶƚ 'ƌĂĚĞ;ϭͲϭϮͿ͗ͺͺͺ ͺͺ ϬсEŽĞĚƵĐĂƚŝŽŶ ϭϯсhŶŝǀĞƌƐŝƚǇ ϴϴсŽŶ͛ƚŬŶŽǁ ϵϵсKƚŚĞƌ ϭ͘ϳ KĐĐƵƉĂƚŝŽŶŽĨƌĞƐƉŽŶĚĞŶƚ ϭс&ĂƌŵĞƌ ͺͺ Ϯс&ŝƐŚĞƌŵĂŶ͖ ϯс^ŵĂůůďƵƐŝŶĞƐƐ ϰс'ĂƌŵĞŶƚǁŽƌŬĞƌ ϱс'ŽǀĞƌŶŵĞŶƚŽĨĨŝĐŝĂů ϲсĂƐƵĂůůĂďŽƵƌ ϴϴсŽŶ͛ƚŬŶŽǁ ϵϵсKƚŚĞƌ ϭ͘ϴ ,ŽǁŵĂŶǇĐŚŝůĚƌĞŶĚŽǇŽƵ EƵŵďĞƌŽĨĐŚŝůĚƌĞŶ͗ͺͺͺͺ ͺͺ ŚĂǀĞ͍ ϭ͘ϵ ŽǇŽƵŚĂǀĞ/WŽŽƌƋƵŝƚǇ ϬсEŽÆ^ŬŝƉƚŽYϭ͘ϭϭ ͺͺ ĂƌĚ͍ ϭсzĞƐ

78 Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia ϭ͘ϭϬ /ĨǇĞƐ͕ǁŚŝĐŚŽŶĞ͍ ϭсWŽŽƌ>ĞǀĞůϭ ͺͺ ϮсWŽŽƌ>ĞǀĞůϮ ϯсKƚŚĞƌ ϴϴсŽŶ͛ƚŬŶŽǁ ϭ͘ϭϭ tŚĂƚĂƌĞƚŚĞƌĞůŝŐŝŽŶƐŽĨƚŚŝƐ ϭсƵĚĚŚŝƐŵ ͺͺ ŚŽƵƐĞŚŽůĚ͍ ϮсŚƌŝƐƚŝĂŶŝƚǇ ϯс/ƐůĂŵ ͺͺ ;ŵƵůƚŝƉůĞĂŶƐǁĞƌƐͿ ϴϴсŽŶ͛ƚŬŶŽǁ ϵϵсKƚŚĞƌ ϭ͘ϭϮ ŽǇŽƵŽǁŶůĂŶĚĨŽƌĨĂƌŵŝŶŐ͍ ϬсEŽ Æ^ŬŝƉƚŽYϭ͘ϭϰ ͺͺ ϭсzĞƐ ϭ͘ϭϯ tŚĂƚŝƐƚŚĞƐŝǌĞŽĨůĂŶĚ͍ ϭс͘͘͘͘͘͘͘͘͘͘͘͘͘͘ĐƌĞƐ ͺͺͺ͕ͺ Ϯс͘͘͘͘͘͘͘͘͘͘͘͘͘͘,ĞĐƚĂƌĞƐ ͺͺ͕ͺ ϴϴсŽŶ͛ƚŬŶŽǁ ͺͺ ϵϵсKƚŚĞƌ ϭ͘ϭϰ ŽǇŽƵŐƌŽǁǀĞŐĞƚĂďůĞƐ͍ ϬсEŽ Æ^ŬŝƉƚŽYϭ͘ϭϲ ͺͺ ϭсzĞƐ /ĨzĞƐ͕ǁŚŝĐŚƐĞĂƐŽŶ͍ ͺͺ ϭсZĂŝŶǇƐĞĂƐŽŶ ϮсƌǇƐĞĂƐŽŶ ϯсŽƚŚ ϴϴсŽŶ͛ƚŬŶŽǁ ϭ͘ϭϱ ,ŽǁĂƌĞƚŚĞǀĞŐĞƚĂďůĞƐƵƐĞĚ͍ ϭсĂƚŝŶŐ ͺͺ Ϯс^ŽůĚ ϯсŽƚŚ;ĞĂƚĂŶĚƐĞůůͿ ϴϴсŽŶ͛ƚŬŶŽǁ ϵϵсKƚŚĞƌ ϭ͘ϭϲ ŽǇŽƵƉůĂŶƚĨƌƵŝƚƚƌĞĞƐ͍ ϬсEŽ Æ^ŬŝƉƚŽYϭ͘ϭϴ ͺͺ ϭсzĞƐ ϭ͘ϭϳ ,ŽǁŝƐƚŚĞĨƌƵŝƚƵƐĞĚ͍ ϭсĂƚŝŶŐ ͺͺ Ϯс^ŽůĚ ϯсŽƚŚ;ĞĂƚĂŶĚƐĞůůͿ ϴϴсŽŶ͛ƚŬŶŽǁ ϵϵсKƚŚĞƌ ϭ͘ϭϴ ŽǇŽƵƌĂŝƐĞĐŚŝĐŬĞŶ͕ĚƵĐŬ͕ ϬсEŽ Æ^ŬŝƉƚŽY ϭ͘ϮϬ ͺͺ ďŝƌĚŽƌĂŶǇĂŶŝŵĂůƐ͍ ϭсzĞƐ ϭ͘ϭϵ ,ŽǁĂƌĞƚŚĞƐĞĂŶŝŵĂůƐƵƐĞĚ͍ ϭсĂƚŝŶŐ ͺͺ Ϯс^ŽůĚ ;ŵƵůƚŝƉůĞĂŶƐǁĞƌƐͿ ϯсŽƚŚ;ĞĂƚĂŶĚƐĞůůͿ ϰс&ĂƌŵŝŶŐ ϴϴсŽŶ͛ƚŬŶŽǁ ϵϵсKƚŚĞƌ ϭ͘ϮϬ tŚĂƚŝƐƚŚĞŚŽƵƐĞ͛ƐǁĂůů͍ ϭс'ƌĂƐƐͬƚŚĂƚĐŚͬĂŵďŽŽ ͺͺ ϮсDĞƚĂůͬŝŶĐͬdŝŶƐŚĞĞƚŝŶŐ ϯсĞŵĞŶƚ ϰсWůǇǁŽŽĚ ϱсtŽŽĚͬ>ŽŐƐ ϵϵсKƚŚĞƌ

Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia 79 ϭ͘Ϯϭ tŚĞƌĞĚŽǇŽƵŐĞƚƚŚĞǁĂƚĞƌ ϭсWƵďůŝĐǁĂƚĞƌƚĂƉ ͺͺ ǇŽƵƵƐĞĂƚŚŽŵĞ͍ ϮсWƌŝǀĂƚĞǁĂƚĞƌƚĂƉ ;ŝŶĐůƵĚĞǁĂƚĞƌĨŽƌĂůůƉƵƌƉŽƐĞƐ ϯсtĞůů ʹĚƌŝŶŬŝŶŐ͕ĐŽŽŬŝŶŐ͕ĐůĞĂŶŝŶŐ͕ ϰсZĂŝŶǁĂƚĞƌĐŽůůĞĐƚŝŽŶ ŐĂƌĚĞŶ͕ĞƚĐ͘ZĞĐŽƌĚĂůů ϱсZŝǀĞƌͬ^ƚƌĞĂŵͬWŽŶĚ ĂŶƐǁĞƌƐͿ ϴϴсŽŶ͛ƚŬŶŽǁ ϵϵсKƚŚĞƌ Ϯ͘ /ŶĐŽŵĞŐĞŶĞƌĂƚŝŽŶ Ϯ͘ϭ dĂŬŝŶŐƚŚĞƉĂƐƚǇĞĂƌ͕ĐĂŶǇŽƵ WĞƌǁĞĞŬ͗ͺͺͺͺͺͺͺÆ'ŽƚŽYϯ͘ϭ ƚĞůůŵĞǁŚĂƚƚŚĞĂǀĞƌĂŐĞ ĞĂƌŶŝŶŐƐŽĨƚŚĞŚŽƵƐĞŚŽůĚ KƌƉĞƌŵŽŶƚŚ͗ͺͺͺͺͺͺͺÆ'ŽƚŽYϯ͘ϭ ŚĂǀĞďĞĞŶ͍ KƌƉĞƌǇĞĂƌ͗ͺͺͺͺͺͺͺÆ'ŽƚŽYϯ͘ϭ ;ZĞĐŽƌĚŽŶůǇŽŶĞ͕EŽƚĂůůϯͿ ϴϴсŽŶ͛ƚŬŶŽǁ Ϯ͘Ϯ /ĨǇŽƵĚŽŶ͛ƚŬŶŽǁƚŚĞĂŵŽƵŶƚ͕ ϭсчϯϮϬh^ ͺͺ ĐĂŶǇŽƵŐŝǀĞĂŶĞƐƚŝŵĂƚĞŽĨ ϮсDŽƌĞƚŚĂŶϯϮϭͲϯϵϳh^ ƚŚĞĂŶŶƵĂůŚŽƵƐĞŚŽůĚŝŶĐŽŵĞ ϯсDŽƌĞƚŚĂŶϯϵϴͲϰϱϲh^ ŝĨ/ƌĞĂĚƐŽŵĞŽƉƚŝŽŶƐƚŽǇŽƵ͍ ϰсDŽƌĞƚŚĂŶϰϱϲͲϱϳϵh^ /Ɛŝƚ ϱсDŽƌĞƚŚĂŶϱϴϬh^ ϴϴсŽŶ͛ƚŬŶŽǁ ;ZĞĂĚKƉƚŝŽŶƐͿ ϯ͘ ,ǇŐŝĞŶĞ͕^ĂŶŝƚĂƚŝŽŶĂŶĚ,ĞĂůƚŚ ϯ͘ϭ tŚĞƌĞĚŽǇŽƵŐĞƚǇŽƵƌǁĂƚĞƌ ϭсtĂƚĞƌƚĂƉͬƉƌŽƚĞĐƚǁĞůůͬƌĂŝŶǁĂƚĞƌ ͺͺ ĨŽƌĚƌŝŶŬŝŶŐĂƚŚŽŵĞ͍ ϮсhŶƉƌŽƚĞĐƚĞĚǁĞůůͬƌŝǀĞƌͬƐƚƌĞĂŵͬƉŽŶĚ ϴϴсŽŶ͛ƚŬŶŽǁ ϵϵсKƚŚĞƌ ϯ͘Ϯ ŽǇŽƵŶŽƌŵĂůůǇƚƌĞĂƚǁĂƚĞƌ ϬсEŽ Æ^ŬŝƉƚŽYϯ͘ϰ ͺͺ ďĞĨŽƌĞŚŽƵƐĞŚŽůĚĚƌŝŶŬƐ͍ ϭсzĞƐ ϴϴсŽŶ͛ƚŬŶŽǁ Æ^ŬŝƉƚŽYϯ͘ϰ ϯ͘ϯ /Ĩ͞ǇĞƐ͟ŚŽǁĚŽǇŽƵŶŽƌŵĂůůǇ ϭсŽŝůĞĚ ͺͺ ƚƌĞĂƚǁĂƚĞƌĨŽƌĚƌŝŶŬŝŶŐ͍ ϮсĚĚĞĚĐŚůŽƌŝŶĞ ϯс&ŝůƚĞƌĞĚďǇĐůŽƚŚ ͺͺ ;ŶŽƚĞĂůůƌĞƐƉŽŶƐĞƐŝŶ ϰсtĂƚĞƌĨŝůƚĞƌĞĚƚĂŶŬ ƉƌŝŽƌŝƚŝǌĞͿ ϵϵсKƚŚĞƌ ͺͺ ϯ͘ϰ ,ĂǀĞǇŽƵƌĐŚŝůĚƌĞŶŚĂĚĂŶǇ ϭс&ĞǀĞƌ ͺͺ ĚŝƐĞĂƐĞƐŝŶƚŚĞƉĂƐƚŵŽŶƚŚ͍ ϮсŽůĚ ϯсŝĂƌƌŚŽĞĂ ϰсEŽƚƐŝĐŬ ϴϴсŽŶ͛ƚŬŶŽǁ ϵϵсKƚŚĞƌ ϰ͘ &ŽŽĚ^ĞĐƵƌŝƚǇ ϰ͘ϭ ƌĞƚŚĞƌĞĂŶǇƚŝŵĞŝŶƚŚĞƉĂƐƚ ϬсEŽÆ^ŬŝƉ DŽŶƚŚǁŝƚŚĨŽŽĚƐŚŽƌƚĂŐĞ͗ ϭϮŵŽŶƚŚƐǁŚĞŶĨĂŵŝůǇŚĂƐƚŽ ƚŽYϱ͘ϭ ϭс:ĂŶ͖Ϯс&Ğď͖ϯсDĂƌ͖ϰсƉƌ͖ ůŝŵŝƚŶƵŵďĞƌŽĨŵĞĂůƐŽƌ ϱсDĂǇ͖ϲс:ƵŶ͖ϳс:Ƶů͖ϴсƵŐ͖ ϭсzĞƐ ƋƵĂŶƚŝƚǇŽĨĨŽŽĚďĞĐĂƵƐĞŽĨ ϵс^ĞƉ͖ϭϬсKĐƚ͖ϭϭсEŽǀ͖ϭϮсĞĐ

80 Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia ĨŽŽĚĚĞĨŝĐŝƚ͍ /Ĩ͞zĞƐ͕͟ǁŚŝĐŚŵŽŶƚŚ;ƐͿ͍ ϱ͘ &ŽŽĚĐŽŶƐƵŵƉƚŝŽŶ ϱ͘ϭ /ŶĂƚǇƉŝĐĂůǁĞĞŬ͕ŚŽǁŵĂŶǇ EƵŵďĞƌŽĨĚĂǇ͗ͺͺͺͺ ͺͺ ĚĂǇƐĚŽĞƐǇŽƵƌĐŚŝůĚĞĂƚ ϭсŽŶ͛ƚĞĂƚĨƌƵŝƚ ĨƌƵŝƚƐ͍ ϮсZĂƌĞůǇ ϴϴсŽŶ͛ƚŬŶŽǁͬĐĂŶ͛ƚƐĂǇ ϱ͘Ϯ /ŶĂƚǇƉŝĐĂůǁĞĞŬ͕ŚŽǁŵĂŶǇ EƵŵďĞƌŽĨĚĂǇ͗ͺͺͺͺ ͺͺ ĚĂǇƐĚŽĞƐǇŽƵƌĐŚŝůĚĞĂƚ ϭсŽŶ͛ƚĞĂƚǀĞŐĞƚĂďůĞ ǀĞŐĞƚĂďůĞƐ͍ ϮсZĂƌĞůǇ ϴϴсŽŶ͛ƚŬŶŽǁͬĐĂŶ͛ƚƐĂǇ ϱ͘ϯ /ŶĂƚǇƉŝĐĂůŽĨǁĞĞŬ͕ŚŽǁŵĂŶǇ EƵŵďĞƌŽĨĚĂǇ͗ͺͺͺͺ ͺͺ ĚĂǇƐĚŽĞƐǇŽƵƌĐŚŝůĚĞĂƚƌĞĚ ϭсŽŶ͛ƚĞĂƚƌĞĚŵĞĂƚĂŶĚŽƌŐĂŶ ŵĞĂƚŽƌŽƌŐĂŶ;ůŝǀĞƌ͕ŬŝĚŶĞǇ͕ ϮсZĂƌĞůǇ ŚĞĂƌƚͿ͍ ϴϴсŽŶ͛ƚŬŶŽǁͬĐĂŶ͛ƚƐĂǇ ϱ͘ϰ /ŶĂƚǇƉŝĐĂůŽĨǁĞĞŬ͕ŚŽǁŵĂŶǇ EƵŵďĞƌŽĨĚĂǇ͗ͺͺͺͺ ͺͺ ĚĂǇƐĚŽĞƐǇŽƵƌĐŚŝůĚĐŽŶƐƵŵĞ ϭсŽŶ͛ƚĐŽŶƐƵŵĞŵŝůŬÆ^ŬŝƉƚŽYϱ͘ϲ ŵŝůŬ͍ ϮсZĂƌĞůǇ ϴϴсŽŶ͛ƚŬŶŽǁͬĐĂŶ͛ƚƐĂǇ ϱ͘ϱ tŚĂƚƚǇƉĞŽĨŵŝůŬĚŽĞƐǇŽƵƌ ϭсtŚŽůĞƉůĂŝŶŵŝůŬ ͺͺ ĐŚŝůĚƵƐƵĂůůǇĐŽŶƐƵŵĞ͍ ϮсtŚŽůĞƐǁĞĞƚĞŶŵŝůŬ ϯс>ŽǁͬƌĞĚƵĐĞĚĨĂƚ ϰс^ŬŝŵŵŝůŬ ϱс^ǁĞĞƚĞŶĞĚĐŽŶĚĞŶƐĞĚ ϲс^ŽǇĂŵŝůŬ ϴϴсŽŶ͛ƚŬŶŽǁ ϵϵсKƚŚĞƌ ϱ͘ϲ /ŶĂƚǇƉŝĐĂůǁĞĞŬ͕ŚŽǁŽĨƚĞŶ EƵŵďĞƌŽĨĚĂǇ͗ͺͺͺͺ ĚŽĞƐǇŽƵƌĐŚŝůĚĞĂƚũƵŶŬĨŽŽĚ͍ ϭсŽŶ͛ƚĞĂƚ ϮсZĂƌĞůǇ ϴϴсŽŶ͛ƚŬŶŽǁͬĐĂŶ͛ƚƐĂǇ ϱ͘ϳ /ŶĂƚǇƉŝĐĂůǁĞĞŬ͕ŚŽǁŽĨƚĞŶ EƵŵďĞƌŽĨĚĂǇ͗ͺͺͺͺ ĚŽĞƐǇŽƵƌĐŚŝůĚĚƌŝŶŬƐŽĨƚ ϭсŽŶ͛ƚĚƌŝŶŬ ĚƌŝŶŬ͍ ϮсZĂƌĞůǇ ϴϴсŽŶ͛ƚŬŶŽǁͬĐĂŶ͛ƚƐĂǇ ϲ͘ ĂƚŝŶŐƉĂƚƚĞƌŶ ϲ͘ϭ tŚŽŽĨƚĞŶĐŽŽŬŵĞĂůƐŝŶǇŽƵƌ ϭсZĞƐƉŽŶĚĞŶƚ ͺͺ ĨĂŵŝůǇ͍ Ϯс^ƉŽƵƐĞ ϯсŚŝůĚ ϰс,ĞůƉĞƌ ϱсZĞůĂƚŝǀĞƐ ϴϴсŽŶ͛ƚŬŶŽǁ ϵϵсKƚŚĞƌ ϲ͘Ϯ ,ŽǁŵĂŶǇĨĂŵŝůǇŵĞŵďĞƌƐ EƵŵďĞƌ͗ͺͺͺͺͺͺͺͺͺͺƉĞƌƐŽŶƐ ͺͺ ƵƐƵĂůůǇĞĂƚŵĞĂůƐƚŽŐĞƚŚĞƌ ƵƐŝŶŐƐĂŵĞƉŽƚͬĚŝƐŚĞƐ͍

Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia 81 ϲ͘ϯ tŚĂƚŝƐƚŚĞƚǇƉŝĐĂůŵĞĂů ϭсZŝĐĞǁŝƚŚ^ŽƵƉ ͺͺ ĐŽŵƉŽƐŝƚŝŽŶƵƐƵĂůůǇĐŽŶƐƵŵĞĚ ϮсZŝĐĞǁŝƚŚ^ƚŝƌĨƌŝĞĚĚŝƐŚͬŐƌŝůůĞĚͬĚĞĞƉĨƌŝĞĚ ǁŝƚŚƌŝĐĞďǇǇŽƵƌĨĂŵŝůǇ͍ ϯсZŝĐĞǁŝƚŚ^ŽƵƉĂŶĚƐƚŝƌĨƌŝĞĚĚŝƐŚͬŐƌŝůůĞĚͬĚĞĞƉ ĨƌŝĞĚ ϴϴсŽŶ͛ƚŬŶŽǁ ϵϵсKƚŚĞƌ ϲ͘ϰ tŚĂƚĂƌĞƚŚĞŵŽƐƚƉƌĞƉĂƌĞĚ ƌĞĐŝƉĞƐŝŶǇŽƵƌĨĂŵŝůǇ͍ ϭс͙͙͙͙͙͙͙͙͙͙͙͙ ;ůŝƐƚĂůůŶĂŵĞŽĨƌĞĐŝƉĞƐ Ϯс͙͙͙͙͙͙͙͙͙͙͙͙ ŵĞŶƚŝŽŶŝŶŽƌĚĞƌŝŶŐͿ ϯс͙͙͙͙͙͙͙͙͙͙͙͙ ϲ͘ϱ >ĂƐƚŵŽŶƚŚ͕ǁŚĂƚĂƌĞƚŚĞ WĂůŵƐƵŐĂƌ͗ ϬсEŽ͖ ϭсzĞƐ ƐĞĂƐŽŶŝŶŐŶŽƌŵĂůůǇƵƐĞĚďǇ tŚŝƚĞƐƵŐĂƌ͗ ϬсEŽ͖ ϭсzĞƐ ĨĂŵŝůǇ͍ &ŝƐŚƐĂƵĐĞ͗ ϬсEŽ͖ ϭсzĞƐ ^ŽǇƐĂƵĐĞ͗ ϬсEŽ͖ ϭсzĞƐ KǇƐƚĞƌƐĂƵĐĞ͗ ϬсEŽ͖ ϭсzĞƐ ^Ăůƚ͗ ϬсEŽ͖ ϭсzĞƐ D^'ͬZŽƐĚĞĞͬ<ŶŽƌƌ͗ ϬсEŽ͖ ϭсzĞƐ ŚŝůůŝƐĂƵĐĞ͗ ϬсEŽ͖ ϭсzĞƐ sŝŶĞŐĂƌ͗ ϬсEŽ͖ ϭсzĞƐ Kŝůͬ&Ăƚ͗ ϬсEŽ͖ ϭсzĞƐ ϵϵсKƚŚĞƌ

ϲ͘ϲ ,ŽǁŵĂŶǇŵĞĂůĂŶĚƐŶĂĐŬƐ ƌĞĂŬĨĂƐƚ͗ ϬсEŽ͖ ϭсzĞƐ ĐŽŶƐƵŵĞĚďǇĐŚŝůĚƌĞŶƉĞƌĚĂǇ DŽƌŶŝŶŐƐŶĂĐŬ͗ ϬсEŽ͖ ϭсzĞƐ ;ĚĂǇƐĂŶĚŶŝŐŚƚͿ͍ >ƵŶĐŚ͗ ϬсEŽ͖ ϭсzĞƐ ĨƚĞƌŶŽŽŶƐŶĂĐŬ͗ ϬсEŽ͖ ϭсzĞƐ ŝŶŶĞƌ͗ ϬсEŽ͖ ϭсzĞƐ ĨƚĞƌĚŝŶŶĞƌƐŶĂĐŬ͗ ϬсEŽ͖ ϭсzĞƐ

dŚĂŶŬǇŽƵĨŽƌǇŽƵƌƚŝŵĞ͊͊

82 Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Appendix 2.4: Questionnaire for 24 hour recall

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84 Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia 宬宷宵季宬宵宇宊宪宇宬宨宷室宵宼季安宬宥宵宨孭季守宄宕季宩宲宵季宰宨宱家宷宵宸室宷宬宲宱宓宲宷室家家宬宸宰宕宇宄宰宪宕宇宄安室宷宰宪宑宬室宦宬宱季孫宙宅孶孬宕宬宥宲宩宯室容宬宱季孫宙宅孵孬宙宬宷室宰宬宱宄宖宲宧宬宸宰宕宇宄宰宪宗宫宬室宰宬宱季孫宙宅孴孬宝宬宱宦宆室宯宦宬宸宰守宱宨宵宪宼宆宲害害宨宵宓宫宲家害宫宲宵宸家宇宊宪宖室宯宷季孫宖宲宧宬宸宰季宆宫宯宲宵宬宧宨孬宙宬宷室宰宬宱宆完宵宲宱宓宵宲宷宨宬宱 ƉƉĞŶĚŝǆϯͲϮ͗ŝĞƚĂƌǇŝŶƚĂŬĞƐĂŶĚDͲZĨŽƌŐŝƌůƐ 宑宸宷宵宬宨宱宷家孲季宑宸宰宥宨宵季宲宩季家宸宥宭宨宦宷宆宲害害宨宵宓宫宲家害宫宲宵宸家宓宲宷室家家宬宸宰宖宲宧宬宸宰宕宇宄宇宬宨宷室宵宼季安宬宥宵宨安室宷宰宪宑宬室宦宬宱季孫宙宅孶孬宕宬宥宲宩宯室容宬宱季孫宙宅孵孬宙宬宷室宰宬宱宆宙宬宷室宰宬宱宄宝宬宱宦完宵宲宱室宷孫宲宬宰宆宯宵宧孬宪宇宊宪宖室宯宷季孫宖宲宧宬宸宰季宆宫宯宲宵宬宧宨孬宕宇宄宰宪宗宫宬室宰宬宱季孫宙宅孴孬宆室宯宦宬宸宰宓宵宲宷宨宬宱守宱宨宵宪宼 ƉƉĞŶĚŝǆϯͲϭ͗ŝĞƚĂƌǇŝŶƚĂŬĞƐĂŶĚDͲZĨŽƌďŽǇƐ 宑宸宷宵宬宨宱宷家孲季宑宸宰宥宨宵季宲宩季家宸宥宭宨宦宷宊宬宵宯家宅宲宼家宪宇宊宰宪守宇孳孶學孶孹孷孴孱孳孶孹孴孺孴孴孱孳孶孷孶孹孷孴孱孳孶孴學孱孵孳孰孶孳孴孶孱孺孹孱孷孴孷孱孶孵孳孰孶孳孴學孱孻孺孱孴孴孹孱孴孵孳孰孶孳孴學孱孳孹孱孷孴學孱孶孵孳孰孶孳宇宊孨守宕宇宄宰宦宪宪宇宊宰宪宕宇宄宰宪守宄宕宰宪宪宇宊宰宪宕宇宄宰宪守宄宕宰宪守宄宕宪宦宯守守宕宮宦室宯宪守宄宕宰宪

宪宇宊宰宪宇宊宰宪守宇孳孶孷孹孹孴孴孱孳孶學孼孹孻孴孱孳孶孶孺學孷孴孱孳孶孴孶孱孵孳孰孶孳孴孶孱孹學孱孷孴孶孱孺孵孳孰孶孳孴學孱學孹孱孻孴學孱孼孵孳孰孶孳宇宊孴孵孱孷孹孱孴宰宪孴孷孱孹孵孳孰孶孳宇宊宕宇宄孨守宰宪宕宇宄宰宪宕宇宄宕宇宄宰宦宪守宄宕宰宪宰宪宪守宄宕守宄宕宰宪宪宪守宄宕宰宪宇宊宪宦宯守守宕宮宦室宯

孴孯孶孳孳孰孴孯孹孳孳

孹孳孳孰孴孯孹孳孳

宆宄宐孰宕宇宄

孴孯孶孳孳孰孴孯孺孳孳

孴孯孷孳孳

孴孱學孰孷孹孳孳孰孴孯孹孳孳

孷學孳孷孳孳孷孳孳孳孱孶孳孱孹孳孱孹學孱學

宆宄宐孰宕宇宄孷孱學

孶孳孵學

孺孻

孴孯孶孳孳

孴孱學孰孷

學孳孳孷學孳孷學孳孳孱孷孳孱孹孳孱孹學孱學

孷孱學

孶孳孵學

孻孻孯孺孯孻孴孯孵孺學孴孯孳孻孶孴孯學孺孹孴孯孴孵孻孷孹孼孴孯孵孶孴宨宱宖宐宨宧宬室宱宖宇宐宨室宱孶孵孶孹孼孷孷孶孵孵孹孵學孳孷孶孵學孳孴孴孵孶孴孻孵孴孺孻孴孼孵孹孻孴孼學孶孴孶孷孴孺孱孶孳孱學孺孵孱學學孷孱孴孵孼孱學孴孶孱孴孶孵孱學孱孱孳孱孴孳孱孴孶孱孵孳孱孴孵孱孺學孱孴孷孱孳孼孱孶學孱孻孳孱學孻孱孶孶孱孷孳孱孷孳孱孶孹孱孷孳孱孷孳孱學孳孱孶孳孱學孷孱孼孳孱孶孶孱孴孳孱孷學孱孻孯孼孳孴孯孶孳孶孻孳孹孴孯學孼學孴孯孶孼孻孷孹孵孴孯孷孹孴宨宱宖宐宨宧宬室宱宖宇宐宨室宱孼學學孴孺孴學孻學孻孵孵孺孶孷孼孷學孼孵孴孷孷孴學孶孴孼孹孵孺孳孴孷孶孶孳孵孷孻孹孱孶孻孱孵孹孵孱孷學孷孱孻孷孴孱孺孴孷孱孴孷孳孱孼孹季宼宵家孱孱孳孱孴孳孱孴孳孱孴孶孱孶孵孱孳孹孱孺孷孱孴孷孱孻孺孱孺孺孱孺孳孱學孶孱學孳孱學孳孱孶孻孱孴孳孱孷孳孱學孳孱孹孳孱孷孺孱孵孳孱學孷孱孷孳孱學孺孱孹孹季宼宵家孷孳

孶孵

孴孯學孳孳孰孴孯孼孳孳

孹孳孳孰孴孯孹孳孳

宆宄宐孰宕宇宄

孴孯孷孳孳

孴孯孺孳孳孴孱學孰孷

孴孱學孰孷

孹孳孳孷學孳學孳孳

孳孱孷孳孱孻孳孱孻學孱學

學學孳孷學孳學學孳孳孱孷孳孱孻孳孱孻學孱學學孱學

孴孴孶孳孶孳學孱學

孴孴孶孳孶孳

孻孻孯孷孯孷孴孯孶孴孺孴孯孵孷孶孴孯孹孷孳孴孯孶孹孺學孳孴孴孯孷孳孼宨宱宖宐宨宧宬室宱宖宇宐宨室宱孯學孯孺孴孯孵孻孶孴孯孶孺孴孴孯孹學孻孴孯孵孷孶孷孼孴孴孯孶孴學孼孴孷學孻學孷孹孵孴孻孶孶孳孷孼孻孹孳孹孵孳孴孶孶孵孵孼孷孵孼孹孵孴學孶孷孵孻孳孴孺孻孶孵孱孻孴孳孺孱孻孹孻孱孳孶孺孱孺孴學孱孻孶孼孱孶孱孱孳孱孴孳孱孺孳孱孵孶孱孶孶孱孵孹孱孷孷孱孵孹孱孷孺孱孹孻孱孴孳孱學孶孱孺孳孱孷孳孱孺孻孱孵孳孱孶孳孱孺孳孱學孳孱孷孹孱孼孳孱孹孶孱孻孳孱孹孺孱孺宨宱宖宐宨宧宬室宱宖宇宐宨室宱學孶孶孼孺孷孼孻孵孶孳孶孵孶孷學孷學孹孷孴孺孺孶孳學孵孹學孵孵孵學孺孵孵孼孶孵孵孵孺孺孱孵孼孱孶孺孶孱孶學孵孱孺孶孴孱孼孴孹孱孺孶孹孱孶孱孱孳孱孴孵孱學孳孱孷孶孱孶孶孱學學孱孻孷孱孵學孱孼孹孱學孺孱孵孳孱學孶孱孻孳孱孷孳孱學孺孱學孳孱孷孳孱孹孳孱學孳孱孷孹孱孴孳孱孹孷孱孵孳孱學孹孱孼孺孰孼季宼宵家孺孰孼季宼宵家孵孳孳

孵孵孵

孴孯孻孳孳孰孵孯孶孳孳

孹孳孳孰孴孯孹孳孳

孴孯孺孳孳孰孵孯孵孳孳

宆宄宐孰宕宇宄

孹孳孳孰孴孯孹孳孳

孴孯孺孳孳宆宄宐孰宕宇宄

孴孱學孰孷

孻學孳學學孳孹學孳孳孱學孴孱孶孴孱孵孹孱孳

孵孯孳孳孳

學孱孳

孴孱學孰孷孴孳孴孹孹孳孷孳

孼孱學孭孻學孳學學孳孺孳孳孳孱孷孴孱孳孴孱孴學孱學

孴孳孴孹孹孳孷孳孯學孯孻孴孯學孵孻孴孯孵孻孷孴孯孻學孼孴孯孷孻學學學學孴孯學孻孷宨宱宖宐宨宧宬室宱宖宇宐宨室宱孷孷孷孻孼孹孹孶孵孷孻孷孳孷學孷孵孺孶孶孵學孳孵孻孻孶孴孳孹孵孶孳孶孵孵孹孶孹孴孳孹孻孱孶學孱孼孻學孱孺孹孳孱孹孶孻孱孼孵孴孱孳孷孶孱孺孯孺孯孼孴孯孷孺孴孴孯孶孼學孴孯孺孺孺孴孯孶孻孼學學孹孴孯孷孼孳孱孱孳孱孴孵孱學孶孱孼孳孱孶孶孱孶孺孱孼孷孱孺孹孱孼孻孱孹孳孱孹孼孱孺孶孱孻孳孱學孳孱孹孼孱孵孳孱孷孳孱孺孳孱學孳孱孹孺孱孼孳孱孺孷孱孼孳孱孺孼孱孳宨宱宖宐宨宧宬室宱宖宇宐宨室宱孴孳孰孴孵季宼宵家孵孷孷孻孼孹學學孵孷孴孶孼孳學孵孺孺孴孴孵孷孻孶孹孻孶孶孳孶孹學孵孷孼孷孳孺孹孳孻孱孷孳孱孵孻學孱孹孹孹孱孳孶孺孱學孴孻孱孶孷孴孱孴孱孱孳孱孴孵孱孶孳孱孶孶孱孺孶孱學孺孱學孷孱學孺孱孴孺孱孻孼孱孷孳孱孹孶孱孻孳孱學孳孱學孻孱學孳孱學孳孱孺孳孱孹孳孱學孺孱孺孳孱孹孷孱孴孳孱孺孻孱孷孴孳孰孴孵季宼宵家孵學孴

孵孻孴

孵孯孵孳孳孰孵孯孺孳孳孵孯孳孳孳孰孵孯學孳孳

孹孳孳孰孵孯孳孳孳孹孳孳孰孵孯孳孳孳

宆宄宐孰宕宇宄宆宄宐孰宕宇宄

孵孯孳孳孳

孵孯孵孳孳

孴孱學孰學孴孳孱孳孭孴孱學孰學

孼學孳學學孳孺學孳孳孱孹孴孱孵孴孱孴孻孱孳孼孳孳學學孳孹孳孳

孳孱學孴孱孳孴孱孴孺孱孳

孼孱孳

孴孵孴學孹孳孷學孴孵孴孹孹孳孷孳孯孼孯孳孴孯孺孳孼孴孯孵孳孵孴孯孼孼學孴孯孺孹孼孹孴孵孴孯孻孷學孯孵孯孼孴孯孺孵孻孴孯孶孼孷孵孯孳孵孶孴孯學孶孳學孻孺孴孯學孼學孴孶孰孴學季宼宵家孴孶孺孶孼孱孵孺孱孶孴孳孱孶孴孴孱孶孷孱孶孴孴孱孳孼孱孴孷孱孹孴孳孱孴宨宱宖宐宨宧宬室宱宖宇宐宨室宱孳學孺孳孻孱孷孺孱孳孴孳孱學宨宱宖宐宨宧宬室宱宖宇宐宨室宱孷孹孹孴孷孻孴孻孵孹孷孷孴孶孹孷孼孻孻孳孶孷孺孶學孶孷孵孵孷孺孶孺孼孵孺孷孷孷孺孺學學孵孷孺孷孴孵學孴孷孺孼學孺孵孻孵學孶孵孴孴孯孴孹孶孷孹學孻孻孼孱孷孺孱孻孼學孱孷孺孻孱孻孷孻孱孷孵孳孱學學孵孱孳孴孷孶孹孵孵孷孹孷孴孼孴孵孴孴孴學孷孱孻孴孴孴孱孴孼孴孱孵孷孵孱孵孴孻孱孺孷學孱孴孱孱孳孱孴孴孱孶孷孱孶孳孱孶孶孱孴學孱孴孳孱孺孳孱孹孴孱孳孳孱學孳孱孼孳孱孺孳孱孺孳孱孺孳孱孻孱孱孳孱孴孹孱孵孴孱孴孷孱孷孶孱學學孱孴孼孱孴孳孱孺孷孱孶孳孱孹孳孱學孼孱學孳孱孷孳孱孻孳孱孺孳孱孹孻孱孵孳孱孻孷孱孹孳孱孻孼孱孶孴孶孰孴學季宼宵家孱孶孺孵孰孳孴孱孱孷孳孴孱孱孴孷孱孳孹孱孴孴孷孱孷孴孷孱孳孹孱孷孴孷孱孹孵孳孰孶孳孴孶孱孺孹孱孳孼孱孷孻孵孰孳孴孱孱孺孴孴孱孱孴孷孱孼孹孱孹孴學孱孹孴孺孱孴孹孱孺孴孺孱孷孵孳孰孶孳孴孷孱孻孹孱孷孹孶孹孳

孶孴孳

孵孯孴孳孳孰孵孯孹孳孳

孹孳孳孰孵孯孳孳孳

宆宄宐孰宕宇宄孵孯學孳孳孰孶孯孴孳

孵孯孶孳孳孹孳孳孰孵孯孳孳孳

孴孱學孰學

宆宄宐孰宕宇宄孻孱孳孭孼孳孳孹孳孳學學孳孳孱孹孴孱孳孴孱孴孺孱孳

孴孵孴孹孹孳孷孳

孵孯孶孳孳

孴孱學孰學

孼學孳孹孳孳孹學孳孳孱孺孴孱孵孴孱孴孻孱學

孺孱學

孴孷孴學孹孳孷學孳孯孷孯孳孯學孯孼孯孷孴孯學學孵孴孯孷孷孵孴孯孻孼孻孴孯孻學孻孴孯孺孳孹孵孯孵孷學孴孯孷孴孷學孹學孴孯學孳孵孴孯學孳學學學孼孴孯孹孷孵孯孻孯孵孯孷孯孵孯學孴孯孹孵學孴孯孵學孼孴孯孼孵孵孴孯孻孷孹孴孯孶孵孹孵孯孵孻孵孴孯孹孶孳孹孳孻孴孯孺孳孼孵孯孳孳孻學孻孵孵孯孳學孶孳孷孹孻孻孷孼孷孺孳孺孱學孺孱孳孼孱孷孻孱孷孹孱孻孴孳孱孷孺孱孹孷孱孹孻孱學孻孱孹學孱孵孴孳孱孳宨宱宖宐宨宧宬室宱宖宇宐宨室宱孼學孵孶學孷孻學孹孷孹孵學孳孷孷孴學孶孷孺孶孳學孵孻孺孴孹孵學孼學孴孼學孼孼孻孷孶孵孺孶孺孶孷孶孺孳孶孶孵孶孶孻孵孷孹孶孶孺孶孼孶孷孵孶孶孺孶孵學孶孷孵孻孴孹孰孴孺季宼宵家孹孵孴孻孳學孱孷孶孼孱孷學孱孺孼孺孱孳孺孷孱孶學孴孱孼孴孳孻孱孳孶孻孱孻孻孹孱孵孴孻孱孺孷孵孱孴孷孵孱孻孵孳孱孷孷孻孱孶孶孶孺孼孴孱孳孷孺孶孻孱學孺孱孶孼孱孷孴孳孱孷孷孱孷孴孳孱孼孴孳孱孵孺孱孼孴孵孱孳孴孶孱孶孷孱學孻孱孺孴孵孱孻孷孱孺孼孱學孴孳孱孺孷孱孹孴孴孱學宨宱宖宐宨宧宬室宱宖宇宐宨室宱孱孱孱孱孷孷孷孳孱孴孵孷孱孷孼孳孱孺孷孶孱孼孶孱孺孳孱孴孷孱孻學孱孷孺孱孼孴孱孵孷孱孺孷孱孵孳孱孹孴孷孱孶孻孱孺孳孱學孴孳孱孹孶學孱孺孳孱孺孷孳孱孷孶孻孱孼孳孱孹孵孳孱孺孳孱學孷孷孱孶孳孱孹孴孱孴孳孱孺孶孼孱孺孳孱孺孵孳孱學孴孱孳孳孱孺孳孱孺孳孱孺孳孱孼孳孹孻孼學學孷孷孺孳孷孵學孼孷孳孼學孼孷孺孼孳孹孻孶孼孳孹孵孹孳孶孼孹孺孳孺孼孹孻孵孻孹孶孹孻孶孺學孶孷學孷孳孹孵孷孹孷孼孹孷孳孳學孴孻孷孳孺孵孷孷孷孹孳孷孵孼孱孺孺孺孱孷孹孷孴孱孼孼孷孱孹孺孴孱孼學孺孱孺孼孵孱孶孷孶孱孼孻孷孱孵孵孳孱孶孷孺孱孹學孷孱孻孴孼孱學學孺孱孵孱孱孱孱孼孴孹孳孱孴孵孴孱孹孳孳孱孵孼孷孱孴孶孱孵孳孱孴孷孱孼孴孱學孳孱孶孷孱孺孳孱孹孹孶孱孷孳孱學孹孳孱孼孷學孱孻孳孱孷孵孳孱孻學孳孱孹孹孳孱孼孳孱學孻孳孱孺孳孱孹孻孴孱孷孳孱孺孷孳孱孷孴孱孵孳孱孻孳孱孻孳孱孻孳孱孼孴孹孰孴孺季宼宵家孴學孻孴孹孹宨宱宖宐宨宧宬室宱宖宇宐宨室宱宨宱宖宐宨宧宬室宱宖宇宐宨室宱宊宬宵宯家季室宯宯孴孯孳孹孴宅宲宼家季室宯宯孼學孼

宕室宷宬宲季宑宸宰宥宨宵季守守宕孭宓宨宵宦宨宱宷宬宯宨守宱宨宵宪宼宐宨室宱宖宇宲容宨宵季守守宕季宲宩季家宸宥宭宨宦宷宲宩季宆宄宐孰宕宇宄孴孳孵學學孳孺學孼孳孫孨孬孴學孼學孼孼宅宲宼家孹季宼宵家孶孵孴孯孶孳孳孰孴孯孺孳孳孴孯孷孹孴孷孹孵孻孼孹孴孯孴孶孶孴孯孶孼孻孴孯孹孼孹孵孯孴孹孴孹孶孨孹孷孺孺孹孼孵孯孷孷孳孵孯孼孳孷孺孰孼季宼宵家孵孳孳孴孯學孳孳孰孴孯孼孳孳孴孯孷孳孼學孳孴孻孴孵孴孯孳孺孹孴孯孶孹孺孴孯孹孹孵孵孯孳孶孹孶孼孨學孶孳孹孻孵孵孯孶孹孺孶孯孵孷孻孴孳孰孴孵季宼宵家孵學孴孴孯孻孳孳孰孵孯孶孳孳孴孯學孻孷學學學孼孴孻孴孯孴孼學孴孯孷孻學孴孯孼孳孷孵孯孶孼孹孵孻孨孹孳孴孺孻孶孵孯孹學孳孶孯孵學學孴孶孰孴學季宼宵家孶孴孳孵孯孵孳孳孰孵孯孺孳孳孴孯孻孷學孹孴孵孴孯孴孴孶孴孯孶孼孼孴孯孺孹孼孵孯孵孳孹孵孯孹孵孼孵學孨孺孷孷孼孷孷孶孯孴孵孶孶孯學孳孵孴孹孰孴孺季宼宵家孴孹孹孵孯學孳孳孰孶孯孴孳孳孵孯孳學孶學孻孵孴孯孶孴孳孴孯孹孴孻孵孯孳孳孻孵孯孷孹孷孵孯孻孳孵孵孶孨孻孶孳孴孯孴學孶孶孯孳學孺孶孯學孹孹宄宯宯孼學孼孰孴孯孺孳孼孹孳孻孼孼孼孴孯孵孻孼孴孯孹孶孳孵孯孳孹孶孵孯學孶孳孶孳孨孹孳孷孻孶孴孵孯孻孵孵孶孯孷孵孺宊宬宵宯家孹季宼宵家孷孳孴孯孶孳孳孰孴孯孹孳孳孴孯孵孶孴孷孹孼孻孳孻孻孻孹孴孯孴孵孻孴孯孷孵孻孴孯孼孵孹孶學孨學孳孶孹孷孷孵孯孷孵孼孵孯孹孼孶孺孰孼季宼宵家孵孵孵孴孯學孳孳孰孴孯孼孳孳孴孯孶孴學孷孼孴孺孼孷孼孶孷孴孯孵孷孶孴孯學孹孷孴孯孼孻孵孵孻孨學學孴孺學孷孵孯孵孵學孵孯孻孹孼孴孳孰孴孵季宼宵家孵孻孴孴孯孺孳孳孰孵孯孵孳孳孴孯孷孼孳學學孹孻孻孳孴孯孴孳孼孴孯孶孻孼孴孯孺孼孴孵孯孵孺孷孵孼孨孷孳孻孺孵學孵孯學孼孴孶孯孴孼孷孴孶孰孴學季宼宵家孶孹孳孵孯孳孳孳孰孵孯學孳孳孴孯學孼學學孻孺孼孴孳孴孯孴孹孵孴孯學孶孳孴孯孼孵孹孵孯孶孻孶孵孵孨學學孷孺孷孶孵孯孹孷孹孶孯孷孼孼孴孹孰孴孺季宼宵家孴學孻孵孯孴孳孳孰孵孯孹孳孳孴孯孹孷孵學學孼孴孯孳孶學孴孯孶孳孳孴孯學孳學孴孯孻孻孳孵孯孶孷孹孴學孨孺孻孳孼孹孷孵孯孻孷孳孶孯孻孶孶宄宯宯孴孯孳孹孴孰孴孯學孳孵學孹學孻孺孷孴孯孴孳孼孴孯孷孴孷孴孯孺孻孼孵孯孵孺孵孵學孨學孷學孺孺學孵孯學孺孹孶孯孵孼孼宄宯宯孵孯孳孵孳孰孴孯孹孳孳學孼學孼孳孻孴孯孴孻孶孴孯學孳孺孴孯孼孶孴孵孯孷孴孳孵孺孨學孺孺孺孼孳孵孯孺孵孷孶孯孶孻孴官宱宬宷孽季宮宦室宯孭季宕室宱宪宨季宩宵宲宰季孪宯宬宪宫宷季宯宨容宨宯孪季宷宲季孪宋宬宪宫季宯宨容宨宯孪季宲宩季害宫宼家宬宦室宯季室宦宷宬容宬宷宼

守宄宕季孫宯宬宪宫宷季宯宨容宨宯孬季宬家季宸家宨宧季宷宲季室家家宨家家季宷宫宨季宧宬宨宷家季宲宩季宪宵宲宸害家

宄害害宨宱宧宬宻季孶孰孷孽季宓宵宲宷宨宬宱季宬宱宷室宮宨家季室宱宧季宆宄宐孰宕宇宄

宕室宷宬宲季宑宸宰宥宨宵季宓宨宵宦宨宱宷宬宯宨宓宵宲宷宨宬宱守宄宕宐宨室宱宖宇宲容宨宵季守宄宕季宲宩季家宸宥宭宨宦宷孴孳孵學學孳孺學孼孳孫孨孬孴學孼學孼孼宅宲宼家孹季宼宵家孶孵孵學孷孳孱孼孴孷孱孴孵孴孱孵孶孵孱孺孷孴孱孺孷孺孱孵學孺孱學孼孴孨孴孳孱孴孴孵孱孷孺孳孱孳孻孴孱孳孺孰孼季宼宵家孵孳孳孶孳孶孼孱孶孴學孱孻孵孵孱孹孵孻孱孶孶孺孱孺孷孺孱孳學孼孱學孺孴孨孴孶孱孼孴孻孱孺孺孳孱孼孼孺孱孶孴孳孰孴孵季宼宵家孵學孴孷孳孷孶孱孺孵孴孱孳孵孶孱孺孵孼孱孼孶孻孱孼學孶孱孷孹孼孱孵孷孺孨孴孶孱孶孴孼孱孻孻孵孱孻孴孴孺孱孻孴孶孰孴學季宼宵家孶孴孳孷學學孵孱孳孵孳孱學孵孻孱孼孶孺孱孺孷孻孱孷孹孶孱孳孻孳孱孷學孼孨孴孺孱孼孵孷孱孴孻孺孱孹孴孵孵孱孶孴孹孰孴孺季宼宵家孴孹孹孷學學孺孱孵孴孼孱學孶孴孱孵孷孴孱孹學孷孱孻孺孳孱孷孻孹孱孵孹孼孨孵孶孱孹孵孼孱孵孼孴孱孺孴孳孵孱孺宄宯宯孼學孼孰孷孺孱孺孵孳孱孷孵學孱孺孶孶孱孷孷孶孱孼學孻孱孷孺孷孱學孹孴孨孴學孱孶孵孵孱孶孻孹孱孵孴孴孵孱學宊宬宵宯家孹季宼宵家孷孳孵學孶孵孱學孴孶孱孴孴孻孱孼孵孶孱孷孵孼孱學孷孴孱孵孷孻孱孶孹孻孨孴孶孱孴孴孺孱孷孹孷孱孵孹孺孱孴孺孰孼季宼宵家孵孵孵孶孳孶孹孱孶孴孹孱孺孴孼孱孹孵孷孱孹孶孴孱孼孷孷孱孶學孻孱孼學學孨孴孴孱孻孴孹孱學孹孻孱孻孴孳學孱孺孴孳孰孴孵季宼宵家孵孻孴孷孳孷孴孱孴孴孻孱孶孵孳孱孺孵孻孱孹孶孺孱學學孴孱孶孹孷孱孳孷孶孨孼孱孳孴孻孱孳孺孷孱孴孴孳孻孱孶孴孶孰孴學季宼宵家孶孹孳孷孳孷學孱孴孴孻孱孺孵孶孱孺孶孴孱孶孷孵孱孵學孹孱孴孺孳孱孻學孹孨孴孶孱孵孴孻孱孶孻孴孱孻孼孻孱孴孴孹孰孴孺季宼宵家孴學孻孷孳孷孻孱孶孵孳孱孷孵孺孱學孶學孱孵孷孵孱孻學學孱孴孺孻孱學孹孵孨孴孼孱孺孵孷孱孶孼孹孱學孴孴孻孱孳宄宯宯孴孯孳孹孴孰孷孵孱孵孴孻孱孻孵孵孱孴孵孻孱孺孶孻孱孻學孴孱孻孹孹孱孳學孷孨孴孵孱孳孴孻孱孹孺孻孱孷孴孳孹孱孹宄宯宯孵孯孳孵孳孰孷孷孱孻孴孼孱孺孵孶孱孼孶孳孱孺孷孴孱孵學孷孱孺孺孳孱孺學孺孨孴孶孱學孴孼孱孷孻孶孱孷孴孳孻孱孶官宱宬宷孽季宪

守宄宕季宬家季宸家宨宧季宷宲季室家家宨家家季宷宫宨季宧宬宨宷家季宲宩季宪宵宲宸害家

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宑宸宰宥宨宵季宕室宷宬宲季宓宨宵宦宨宱宷宬宯宨完宵宲宱宲宩季守宄宕宐宨室宱宖宇宲容宨宵季守宄宕季家宸宥宭宨宦宷孴孳孵學學孳孺學孼孳孫孨孬孴學孼學孼孼宅宲宼家孹季宼宵家孶孵孷孱學孺孱孹孷孱孷孶孱孺學孱學孺孱孵孻孱孺孴孳孱孺孻孻孨孵孱孼孶孱孵孴孺孱孴孵孻孱學孺孰孼季宼宵家孵孳孳學孱學孺孱孺孶孱孻孶孱孻學孱孴孹孱孼孼孱孷孴孵孱學孹孻孨孴孱孻孶孱孷孴學孱孶孵孵孱孶孴孳孰孴孵季宼宵家孵學孴學孱孳孼孱孳孷孱孼孷孱孳學孱孻孺孱孼孴孴孱孴孴孷孱孳孻孵孨孵孱孶孶孱孵孴孼孱孳孵孻孱孹孴孶孰孴學季宼宵家孶孴孳孼孱孳孴孳孱孴孷孱孹學孱孶孹孱孼孼孱孴孴孴孱孼孴孹孱學學孴孨孵孱孻孷孱孻孴孼孱孶孵學孱孶孴孹孰孴孺季宼宵家孴孹孹孺孱學孴孴孱學孷孱孹孹孱孴孻孱孴孴孳孱孺孴孶孱學孴孻孱孷孻孵孨孷孱孵學孱孷孵孴孱孼孵學孱孵宄宯宯孼學孼屎孼孱學孷孱孺孷孱孹孹孱孴孻孱孺孴孴孱孹孴學孱孺孹孼孨孵孱孻孶孱孻孴孻孱孻孵學孱孴宊宬宵宯家孹季宼宵家孷孳孷孱學學孱孻孶孱孴孵孱學孶孱孶孷孱孼孺孱孵孴孳孱孼孹學孨孵孱孵孵孱孷孴孶孱孳孴孷孱孼孺孰孼季宼宵家孵孵孵學孱學孹孱孼孷孱孵孶孱孶孷孱學孹孱孴孻孱孹孴孴孱孳學孼孨孴孱孺孵孱孺孴孶孱孶孵孵孱孴孴孳孰孴孵季宼宵家孵孻孴孼孱學孭孻孱孷孷孱孴孷孱孳學孱孷孺孱孺孴孳孱學孴孷孱孹孶孴孨孴孱孼孶孱孶孴孹孱孻孵孵孱孴孴孶孰孴學季宼宵家孶孹孳孴孳孱孳孭孼孱孶孷孱孹孷孱孶孹孱孴孻孱孵孴孴孱孹孴學孱孷孶孷孨孵孱孷孶孱孹孴孻孱孳孵學孱孻孴孹孰孴孺季宼宵家孴學孻孻孱孳孭孴孳孱孳學孱孵學孱孶孹孱孶孻孱孹孴孴孱孺孴孹孱孶學孶孨孶孱學孷孱學孵孴孱孹孶孵孱孷宄宯宯孴孯孳孹孴屎孻孱學孷孱孹孶孱孼學孱孷孺孱孹孴孳孱孹孴孷孱孹孷孶孨孵孱孵孶孱孶孴孺孱孴孵孶孱孵宄宯宯孵孯孳孵孳屎孼孱孳孷孱孺孷孱孵學孱孻孻孱孴孴孴孱孳孴學孱孳學學孨孵孱孶孶孱孷孴孻孱孳孵孷孱孵官宱宬宷孽季宰宪 ΎŵĞŶƐƚƌƵĂƚŝŽŶ ZŝƐƵƐĞĚƚŽĂƐƐĞƐƐƚŚĞĚŝĞƚƐŽĨŐƌŽƵƉƐ

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94 Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia This book is jointly written by: Foundation for International Development/Relief (FIDR) Dr. Khim Sam Ath (World Health Organization) Prof. Kaoru Kusama (Aomori University of Health and Welfare, Japan)

Proofread by: Prof. Nobuo Yoshiike (Aomori University of Health and Welfare, Japan) Dr. Chea Mary (National Nutrition Program, Ministry of Health) Team of Preventive Medicine Department (Ministry of Health)

FBDG and IEC materials developed by: FIDR and FBDG Development Team

Illustrations and design of IEC materials by: Yamada School of Art and FIDR

Special thanks to: Kyoto Morning Rotary Club, Japan Yoko Horiuchi (Department of Human Life Science, Aomori University of Health and Welfare, Japan) Suguru Okami (Graduate School of System Design and Management, Keio University, Japan) Hanneke Vandyke (World Food Program)

Additional information about this book can be obtained from: Preventive Medicine Department, Ministry of Health and Foundation for International Development/Relief (FIDR), Email: [email protected]

Development of Recommended Dietary Allowance and Food-Based Dietary Guidelines for School-Aged Children in Cambodia